Extensive total hysterectomy plus total vaginectomy

Extensive hysterectomy and total vaginectomy is a surgical procedure for the treatment of vaginal diseases. The application is: primary vaginal cancer or other gynecological tumors invade the vagina. Partially, but not affected by the rectum, urethra, bladder and side walls of the basin. Treating diseases: endometrial cancer Indication Primary vaginal cancer or other gynecologic tumors invade most of the vagina, but do not affect the rectum, urethra, bladder, and pelvic sidewalls. Contraindications 1, with systemic diseases, can not tolerate surgery. 2, local infection, not suitable for surgery. Preoperative preparation 1. Vaginal rinse for 3 to 5 days, once a day. 2. Oral intestinal antibiotics for 3 to 5 days. Surgical procedure Surgical sequence: extensive whole palace full vaginal resection. Abdominal surgery steps: 1. Incision: median incision in the middle and lower abdomen. 2. Exploration: Understand the relationship between the tumor and the pelvic organs and the anterior and posterior vaginal walls to further determine the scope of surgery. 3. Extensive resection of the uterus: high position cut the pelvic peritoneum on the surface of the pelvic funnel ligament, extending forward to the round ligament, inward and downward along the ureter to reach the uterine ligament. The peritoneal tangential line. The pelvic funnel ligament was ligated at the level of the common iliac artery, and the ligament was cut at the outer 1/3 of the round ligament, and the other side was treated in the same way. Open the bladder peritoneal reflex, sharply separate the bladder cervix and vaginal fistula. Cut the peritoneal reflex of the uterus rectal fossa and separate the rectal vaginal space downward. The patellar ligament was removed 3 cm and the stump was sutured. The ureteral tunnel was separated, the main ligament was cut about 2 to 3 cm, and the stump was sutured. 4. After the upper part of the vagina is completely free of the uterus, continue to separate the vaginal bladder and rectal wall. Cut the paravaginal tissue close to the pelvic wall under direct vision until most of the vagina is free. Perineal surgery steps: 1. Vaginal incision: an incision along the rim of the hymen. 2. Separate the urethral vaginal septum, the vaginal septum with an electric knife to cut the vagina along the virgin margin, and separate the anterior wall of the vagina along the urethra until the lower part of the vagina. If necessary, use a metal catheter to detect the urethra and bladder. 3. Separate the vaginal rectal septum: separate the posterior wall of the vagina from the rectum until the lower part of the vagina. If necessary, the left middle finger enters the rectum for guidance. 4. Closing the vaginal opening 5. Treatment of paravaginal tissue: from the anterior and posterior wall of the vagina to the two side walls, expose the paravaginal genital genital diaphragm, puborectalis muscle, close to the pelvis, until the middle and upper segments. 6. Through the bladder vaginal septum and vaginal rectal septum: the abdominal surgery group with the right index finger or middle finger placed between the bladder vaginal septum (Figure 19) and the vaginal rectal septum, downward and in the direction of the vagina, indicating the separation plane. The vaginal group of surgeons separated in the same plane until they penetrated. 7. Pull out the uterus: Turn the entire uterus out of the bladder. Continue to remove the remaining paravaginal tissue on both sides until the entire uterus, total vaginal resection. 8. Close the pelvic peritoneum and abdominal wall layers: the abdominal group surgery to fully stop bleeding under direct vision, close the peritoneum and abdominal wall layers. 9. Vaginal drainage and occlusion: suture the vaginal cavity as much as possible to stop bleeding and shrink. And in the abdomen group, Vaseline gauze was applied to the rectum and the lower part of the bladder, and two tubes were placed in the drainage. In the middle of the Vaseline gauze, the iodoform yarn is blocked from the pelvic floor to the vaginal opening. The outer end of the drainage hose and the Vaseline gauze iodoform yarn are fixed at the vaginal opening and marked. 10. Vaginal angioplasty: Older patients can naturally grow their granules after the vaginal pull, until the original vaginal cavity is filled and closed. Young patients who need vaginal angioplasty should wait until the wound has a granulation growth after the gauze is pulled. complication 1. Vaginal bleeding: postoperative vaginal drainage, color bright red, may have active bleeding, should use hemostatic drugs, if necessary, re-clogging the vaginal yarn. When conservative treatment is ineffective, it should be stopped in time to stop bleeding. 2. Postoperative infection: This operation has a large wound surface and is easy to be contaminated. Strong antibacterial drugs should be used after surgery. If the body temperature continues to be above 39 °C, vaginal secretions and blood samples should be taken for bacterial culture and drug susceptibility test in time, and the drug should be used under the guidance of drug susceptibility results.