Transvaginal hysterectomy and anterior and posterior vaginal wall repair

Transvaginal hysterectomy and anterior and posterior vaginal wall repair for surgical treatment of uterine prolapse. The external cervix descends below the plane of the ischial spine, which is called uterine prolapse. The cervix descended, but did not reach the vaginal opening, which was lighter than I; the cervix descended to the vaginal opening and was not exported, which was I degree. The cervix is removed from the vaginal opening, and the uterus is still in the vagina, which is lighter to the second degree; the cervix and part of the uterus are removed from the vaginal opening, which is II degree. The cervix and the uterus are all removed from the vaginal opening, which is called III degree uterine prolapse. Often accompanied by varying degrees of vaginal anterior and posterior wall bulging and cervical elongation. Treating diseases: uterine prolapse Indication Transvaginal hysterectomy and anterior and posterior vaginal wall repair are suitable for menopause, menopause, II, III degree uterine prolapse, with cervical hypertrophy, prolongation or precancerous lesions, complicated with functional uterine bleeding, small and medium uterine fibroids. Contraindications 1. Poor general condition, such as severe heart disease, hypertension, nephritis, diabetes, cirrhosis, liver damage, active tuberculosis, pulmonary insufficiency, long-term cough, mental disorders, malignant tumors, bleeding disorders and severe anemia It is not suitable for surgery, and then consider it after improvement. 2. Vulvitis, vaginitis (trichomoniasis, fungi or senile), severe cervical erosion or pelvic inflammatory disease, etc., should be administered after control. 3. Cervical and/or vaginal ulcers are not suitable for surgery when they are not healed; if the ulcer is superficial and located within the resection range, surgery may also be performed. 4. Patients with malignant lesions in the cervix or uterus. It is not suitable for uterine prolapse surgery. Cervical carcinoma in situ or very early uterine body cancer, may be considered for vaginal removal of the uterus, repair the anterior and posterior wall of the vagina. 5. It is not suitable for surgery during menstruation, pregnancy and lactation. After 3 to 7 days of menstruation, the incision will be healed before the next menstrual cramp. If surgery is performed during pregnancy, the possibility of recurrence of uterine prolapse is high. The tissue is weak during lactation, the suture is easy to cut, easy to bleed, and the infection is easy to spread. Preoperative preparation 1. Eat eutrophic, digestible diet, 2d less slag diet before surgery, a small amount of pre-operative dinner, and breakfast on the day of surgery to avoid vomiting during surgery. 2. Start 3 days before surgery, gently scrub the vaginal wall with soapy liquid every day, then rinse with water, then rinse with 1:1000 Xinjieer liquid and dry the vaginal wall. 3. Clean the enema before the operation. 4. Prepare the skin 1 day before the operation. The preparation range includes the pubic symphysis, the genital area, the upper third of the upper thigh and the lower part of the thigh and the anus. It is estimated that the operation is difficult, and the abdominal surgery is required. 5. Due to surgery through the vagina into the abdominal cavity, disinfection should be more stringent. Preparation for blood transfusion should be done. Surgical procedure 1. Transvaginal hysterectomy and vaginal anterior wall repair (1) routine disinfection of the vulva and vagina, cover the disinfection towel. Guide the catheter with a metal catheter. Use the No. 4 silk thread to sew the labia minora on both sides of the labia majora to expose the vestibule. Use the vaginal retractor to open the vagina, expose the cervix, and then clamp the anterior lip of the cervix with double-jaw forceps or tissue forceps and pull it toward the vaginal opening. Note procaine or saline plus an appropriate amount of adrenaline (hypertensive disabled) into the vaginal mucosa, the sides of the bladder and so on. The anterior wall of the vagina is curved under the bladder groove, and the sides should reach the side. (2) Use curved scissors to extend from the incision between the vaginal wall and the bladder wall. The scissors tip should be placed against the vaginal wall. One by one, separate the vaginal wall from the bladder, and carefully approach the urethral opening to the urethral opening about 1 cm. Cut the anterior wall of the vagina after the longitudinal shape. The slit has an inverted T shape. (3) Clamp the vaginal anterior wall of the vagina with a rat tooth forceps and pull it to both sides to expose the bladder under the incision. Bluntly separate, push the pubis cervix fascia to reach the inner edge of the puborectalis muscle. (4) Pulling the cervix down, it can be seen that the bladder is attached to the cervix. A layer of fascia is placed at the junction of the bladder and the cervix, and the fascia is cut and extended to both sides. (5) Wrap the finger with gauze, separate the loose connective tissue between the bladder and the cervix, push up the pleats of the bladder uterus and release the bladder. (6) Pull the bladder upward with a small long hook to expose the uterine peritoneal pleats. Hold the peritoneum with a curved vascular clamp, cut open, and extend the incision to both sides. A 1-needle thread is used as a marker for the peritoneal edge. (7) Push the bladder up, then pull the hook in the peritoneal cavity, retract the incision, and make the bladder to the side, the ureter also moves up with the bladder, which can be protected from injury. (8) Pull the cervix forward and upward to reveal the posterior wall of the cervix and the posterior vaginal fornix. The vaginal posterior wall and the cervical epithelium joint are annularly cut, and the two sides are connected to the anterior wall incision. (9) The cervix is tightened forward and upward, and the vaginal wall is peeled off from the cervix to expose the main ligament along the cervix and the humeral ligament of the posterior side. (10) Incision of the posterior peritoneum of the ankle, with the hand pointing to both sides to enlarge the incision, and into the uterus rectum, to check whether the ligament, attachment and uterus have adhesions. (11) The left uterine ligament was clamped with a curved vascular clamp, and the double suture was cut. (12) The left main ligament was clamped with a curved vascular clamp, and the uterine artery descending branch was cut, and the double suture was ligated. (13) The same method is used to treat the right uterine fibular ligament and main ligament. (14) Pull the uterus from the anterior or posterior iliac crest, and clamp the broad ligament with the 3 long curved vascular clamps next to the left edge of the uterus. Contains fallopian tubes, round ligaments and ovarian ligaments. Cut the forceps between the inner and inner sides 1 to 2, and double suture and ligature with a 10 gauge thread. After the same method is used to treat the right broad ligament and fallopian tube, the uterus is removed. (15) Check the ovary for abnormalities, check the ligaments and fallopian tube stumps for bleeding, and whether the knots are loose. (16) A marker line that is sewn to the edge of the peritoneum before traction to expose the edge of the peritoneal incision and begin to suture the pelvic peritoneum. (17) The needle is threaded from the right anterior peritoneum with a 4th thread, and the traction lines of each stump are lifted one by one. The needles pass through the stump tissue one by one, and finally pass through the posterior peritoneum and are ligated. Each ligament and fallopian tube stump is exposed to the peritoneum. The same method was used to suture the left peritoneum Finally, the peritoneum between the two sides is sutured, that is, the abdominal cavity is closed. (18) The round ligaments, fallopian tubes, ovarian ligaments and uterine fibular ligaments on both sides were sutured with the No. 4 silk thread to strengthen the support force of the pelvic floor. (19) In the bladder between the vaginal transverse groove and the bladder groove, if the bulge is serious, the 1-0 chrome gut can be used to make 1 or 2 purse sutures on the wall; the bulge is lighter and can be on the surface of the bladder. A number of needles on the fascia can be used to reduce the bulging bladder. The fascia on both sides of the bladder and urethra is then sutured to the midline to correct bladder and urethral bulging. (20) Cut off the excess part of the anterior wall of the vagina. The vaginal wall was sutured relatively with a 2-0 chrome gut. The needle passes through the ligament stumps under the wall to prevent the dead space under the vaginal wall. 2. Vaginal posterior wall repair (Posterior Colporrhaphy) The purpose of repairing the posterior wall of the vagina is mainly to reduce the genital hernia of the enlarged prolapse of the factor palace, that is, to suture the levator ani muscles on both sides before suturing the rectum. (1) The rat tooth forceps are respectively sandwiched between the lower and lower sides of the labia minora (about below the opening of the vestibular large gland tube), and the two clamps are brought to the center line, and the two fingers are inserted into the vagina, and the elastic is suitable for degree, and then The rat tooth forceps were pulled out to the sides, and the boundary between the yin skin and the posterior wall of the vagina was cut with a knife. (2) Clamp the upper and lower edges of the transverse incision with two rat tooth clamps as traction. Separate the scissors between the perineal body and the vaginal wall with a pair of scissors, then use a pair of curved scissors along the median line to separate the posterior wall of the vagina and the rectum. The scissors tip is close to the posterior wall of the vagina to avoid damage to the rectum. (3) Wrap the finger with gauze, separate the vaginal posterior wall upward and outward, and expose the levator ani muscle of the rectum and its lateral side. (4) Rectal bulging weight, do one or two purse sutures on the rectal wall to reduce the bulging rectal wall. After the 2-0 chrome gut, the fascia on both sides of the rectum was sutured to the midline of the rectum. (5) Relatively interrupted suture of the inner edge of the levator ani muscle. Before the first suture is ligated, the vaginal cavity should be tested first, and the two fingers can be accommodated. After the suture is finished, the levator ani muscles are shrunk. (6) Cut off the excess vaginal mucosa on both sides along the dotted line. The vaginal wall was sutured intermittently with a 2-0 chrome gut line from the top. The perineal skin is sutured intermittently with a silk thread, or sutured continuously under the skin with a gut. After the operation, the vaginal opening should pass the two fingers. complication 1. Hemorrhage or hematoma. 2. Wound infection. 3. Urinary tract complications.