Transvaginal uterine submucosal myomectomy

Uterine submucosal fibroids often go out of the cervix as the fibroids gradually grow, and the pedicles even get out of the vaginal opening. May be associated with fibroid surface erosion, bleeding, infection and necrosis. Patients often complain of uterine bleeding or vaginal stinky water. The vaginal examination can be seen in pink or bright red, and the lumps of different sizes protrude from the cervix, often with pedicles. When the fibroids are enlarged and filled with the vagina, the tumor pedicle is not visible and can be touched by fingers. Some fibroids are necrotic, hemorrhagic or inflammatory due to insufficient supply of blood circulation, and the surface of the tumor is mostly grayish white. If there is a small surface vascular rupture, active bleeding can occur. Once diagnosed, surgery should be performed early. Treatment of diseases: uterine fibroids Indication Transvaginal uterine submucosal myomectomy is applied to uterine submucosal fibroids that are visible or accessible to the pedicle. Contraindications 1. The fibroids are larger than the vagina or the pedicle is wide and cannot be exposed. 2. The tumor pedicle is high, the fibroids are embedded in the cervix, and some are exposed in the vagina. The vaginal examination cannot touch the tumor pedicle. Preoperative preparation 1. The size of the fibroids, the height and thickness of the tumor pedicle, the thickness and length should be checked before surgery. 2. Vaginal secretions for bacterial culture and drug susceptibility testing, in order to apply antibiotics after surgery. 3. Scrub the vagina and cervix with a 0.05% chlorhexidine ball, once a day for 3 to 5 days, and if necessary, topical anti-inflammatory drugs. If the condition requires, antibiotics should be applied before surgery to control the infection. Those with anemia should actively correct it. 4. If it is estimated that transvaginal resection may be difficult, preparation for abdominal surgery should be done before surgery. Surgical procedure 1. Disinfect the vulva vagina, spread the disinfection towel, expose the fibroids and the tumor pedicle. The exposed part of the fibroids of the rat tooth clamp was pulled down, and the hemostatic forceps were used to clamp the tumor pedicle up and down. The tumor pedicle is cut between the two clamps. The nodule was sutured with a No. 0 gut thread through the suture. 2. Clamp method If the submucosal fibroids are short and thick, the tumor is too large, the appearance can not see the pedicle, can be used to clamp the tumor pedicle with 2 long curved clamps, remove the tumor, and retain the proximal vascular clamp, after 24 to 48h Remove the vascular clamp. 3. If the curettage is not performed before surgery, pull the suture to one side and perform a full curettage to explore the intrauterine condition. If there is a submucosal or intermuscular fibroid, abdominal surgery is considered according to the condition. complication 1. Bleeding is mainly due to the loosening of the pedicle of the jaws, which causes the blood vessels to retract, causing bleeding. After the discovery, according to the condition, if necessary, abdominal surgery to stop bleeding. 2. Infection can be caused by a preoperative fibroid infection, uncontrolled, and then spread after surgery; 2 myeloma stump necrosis infection. It is characterized by odor of vaginal secretions and elevated body temperature. Antibiotics should be applied in time to control infection. 3. Uterine injuries are less common. Most of the uterus is eversion due to excessive traction of the tumor pedicle, and the uterus is worn through the pedicle of the fibroid. If the perforation is small and there is no infection, the uterine rupture can be sutured by laparotomy; if the injury area is large, hysterectomy should be performed.