wide vulvectomy

The scope of this surgical resection includes subcutaneous fat tissue of the pubic sac, large and small labia, perineum, part of the vaginal wall or part of the lower urinary tract and corresponding parts, and the depth reaches the fascia and sarcolemma. Treatment of diseases: vulvar invasive squamous cell carcinoma Indication Vulvar invasive cancer. Contraindications 1, with systemic diseases, can not tolerate surgery. 2, local infection, not suitable for surgery. Surgical procedure 1. Position: the lithotomy position, or the "human" position - this position is convenient for simultaneous inguinal lymphadenectomy. 2. Marking incision: The external incision is from the pubic pubic symphysis 3cm, along the outer edge of the labia majora on both sides (more than 2cm from the outer edge of the tumor), and the posterior and posterior concomitant unions. The internal incision originates from the upper edge of the vestibular urethral opening and merges downwardly along the vestibular and vaginal sides behind the vaginal opening. However, the boundary of the incision should be determined according to the condition of the tumor. It is generally required to be more than 1 cm from the edge of the tumor, and part of the urethra and vagina should be removed if necessary. Cover the surface of the tumor with gauze before surgery and suture with silk thread. 3. Separation of the flap: starting from the vaginal opening, the entire layer of the skin is cut along the outer incision, the skin of the outer margin is lifted, and the subcutaneous tissue is sneaked outward, and the thickness of the flap is preferably less than 0.5 cm of the subcutaneous fat. The outer edge markers separating the flaps on both sides are 2 to 3 cm on the pubic symphysis, and the pubis nodules and adductor muscles are on both sides. 4. Excision of the upper part of the genital area: After separating the flaps on both sides, the phlegm fat pad and the lymphatic adipose tissue in the upper part of the vulva are removed from the top to the bottom. When cutting to the lower edge of the pubic arch, the clitoris feet are separated and exposed on both sides of the urethra, and clamped, cut, and sewed. The depth of resection is up to the pubic fascia and urogenital fascia. 5. Excision of the middle part of the vulva: along the pubic tuberosity, the lymphatic adipose tissue in front of the labia majora and adductor fascia is removed in one piece to reach the vaginal wall. 6. Excision of the lower part of the vulva: Separate the perineal flap under the outer incision. Note that the lower part of the vulva can not be cut backwards, but should be separated from the anterior and vaginal wall to avoid accidental injury to the rectum. If necessary, the left index finger can be used to extend into the anus. The rectum is instructed. The peeling depth is 1 to 2 cm in the hymen, or depending on the depth of the vaginal invasion. Here, the blood vessels between the tissues are rich and easy to ooze, and attention should be paid to stop bleeding. 7. Internal incision: The vestibular mucosa is cut in an arc from the outer vestibule of the vestibular urethra, and the vaginal mucosa is cut down on both sides of the vagina and merged on the posterior wall of the vagina. If the tumor is located above the urethral opening or invades the urethral opening, the urethra should be exposed under the pubic arch to remove part of the urethra. Urinary incontinence does not occur when the lower urethra is removed by no more than one third of the length of the urethra. Finally, the entire vulvar tissue is removed between the inner and outer incisions. 8. Washing the field: Wash the field with a large amount of warm water, if necessary, dilute with 10 ml of nitrogen mustard (HN2) and wet the wound for 5 min. 9. Stitching and drainage (1) The subcutaneous tissue and the skin of the external urethral opening of the urethra are sutured intermittently from the pubic lice. The outer edges of the left and right skin incisions were sutured intermittently with the vestibular mucosa and vaginal mucosa around the corresponding urethral opening. If the skin defect is large, it can be repaired with a transfer flap. One of the two sides of the wound was placed on the wound surface, and the lower part of the vulva was taken out to stay in the urethra. (2) Partial urethral resection, in order to prevent urethral retraction, a suture is placed about 1 cm above the urethral opening and fixed on the pubic symphysis. The urethra is then released upward by 2 to 3 cm, and then the upper and lower edges of the urethral stump are sutured separately from the sutured skin and the anterior wall of the vagina. 10. Wound dressing: After the operation, the red mercury gauze is blocked in the vagina to suppress hemostasis. Use a bandage or elastic bandage to pressure the entire vulvar wound, so that the flap can be attached to the fascia, which is good for wound healing. complication Postoperative infection.