total vaginal hysterectomy

a. Vaginal hysterectomy is performed in the vagina without abdominal interference, which can reduce the contamination of the pelvic and abdominal cavity. The patient recovers quickly and the hospital stay is short. b. It can eliminate the worry of patients with good and malignant lesions in the uterus in the future. c. The postoperative morbidity rate is low. d. There is no scar on the abdominal wall. Treatment of diseases: uterine cancer endometrial cancer Indication a. There is no inflammation in the pelvis, adhesions, and no attachments in the attachment. b. For the abdomen without scars or individual abdominal wall obesity. c. The size of the uterus and fibroids is no more than 3 months pregnant uterus size. d. No uterine prolapse can also be used for pelvic floor repair by vaginal resection of the uterus. e. No previous history of pelvic and abdominal surgery, no need to explore or remove the attachment. f. Uterine fibroids with diabetes, coronary heart disease, hypertension, obesity and other medical complications can not tolerate open surgery. Contraindications Pelvic malignant lesions (except early onset carcinoma in situ), endometriosis and pelvic inflammatory disease with extensive pelvic adhesions, larger and lower cervical fibroids, broad ligament fibroids, with larger and cohesive Attachment mass (>6cm diameter), the height of the fundus exceeds the umbilicus, and the extremely narrow vaginal is still recognized as a contraindication for TVH. Preoperative preparation Cervical smear and diagnostic curettage were performed before surgery to exclude cervical and uterine malignant tumors. Surgical procedure a. Position: The bladder lithotomy position, the perineum and vagina are routinely disinfected, and the small labia minora on both sides are fixed on the outer skin of the labia majora with silk thread. b. Catheterization: catheterization with a metal catheter to understand the attachment of the bladder to the cervix. c. Injecting the drug: Fix the labia minora on the vulva skin with silk thread. The cervical forceps clamp the uterus and pull it outwards. Inject sterile saline into the anterior and posterior vaginal mucosa, or add appropriate amount of adrenaline (5 to 6 drops in 100 saline) to reduce bleeding and facilitate separation. No bladder or rectal bulge, no need to inject liquid under the vaginal mucosa. d. Excision of the anterior wall mucosa: a triangular incision in the anterior wall of the vagina, deep into the vaginal mucosa, peeling off the vaginal mucosa from the tip of the triangle, exposing the cervical fascia of the pubic bladder. Those who do not have bladder bulge are exempt from this step. Free bladder, starting from the cervix of the bladder, use scissors to separate the bladder attached to the cervix, and point the bladder upwards until the bladder uterus is reflexed. e. Circumcision and separation of the cervical and posterior wall mucosa: the cervix is pulled forward, cut along both sides of the cervix, extended to the posterior wall, and the entire cervix is circularly cut, and the vaginal and posterior walls are separated by a handle or a finger. Mucosa, exposing the patellofemoral ligament. f. Cutting and suturing the humeral ligament of the uterus: using a vascular clamp to clamp and cut, the No. 7 silk thread is sewn, and the silk thread is reserved for marking. g. Cutting and suturing the main ligament: the cervix is pulled downward and contralaterally. The vascular clamp is used to clamp the cervical clamp, cut and the main ligament is sutured with the 7th thread. If the cervical canal is long, it can be processed in several stages. h. Treatment of uterine blood vessels: The cervix is pulled downward and contralaterally, and the vascular clamp is used to clamp the cervical clamp, cut, and the uterine blood vessels are sutured by the No. 7 silk thread, and the contralateral main ligament and uterine blood vessels are treated in the same way. i. Incision of the bladder uterus reflexed peritoneum: the bladder is reversed and the peritoneum is lifted. After confirming the error, a small opening is cut, and then the incision is enlarged to both sides. At the midpoint of the peritoneum, the wire can be sutured for traction. g. Incision of the uterus rectum reflexive peritoneum: the bladder rectum is reversed and the peritoneum is lifted. After confirming the correctness, a small opening is cut, and then the incision is enlarged. The silk thread can also be used for traction and marking. k. Treatment attachment: the uterus body is pulled out from the uterine rectum incision (if the anterior uterus can also be pulled out from the bladder uterus reflexed peritoneal incision), if the attachment is retained, 2 points are used in the uterine horn. The vascular clamp clamped the isthmus of the fallopian tube, the ligament of the ovary and the round ligament, cut it and sewed it twice with the No. 7 thread, and the proximal line was used as a marker. The opposite side is treated in the same way. If the accessory needs to be removed, the uterus should be pulled out more, the pelvic funnel ligament should be exposed, the pelvic fungus ligament should be clamped, cut, and double-slit. l. suture the pelvic peritoneum: lift the anterior and posterior margin of the peritoneum, check the wound without oozing, start with the 4th silk thread from the side of the anterior peritoneum, through the round ligament and the peritoneum on the inside of the attachment suture, and then pass through the posterior peritoneum. tie. The contralateral angle is treated in the same way, and then the peritoneum is continuously sutured to close the pelvic cavity. This will place the uterine attachment and the ligament ends in the peritoneum. m. Corresponding suture ligaments: The ligaments of each ligament are respectively ligated with the ligaments of the same name on the opposite side, and the ligature is cut off. The O-synthesis line was inserted through the mucosa of the posterior wall of the vagina, and the ligaments of the ligaments around the suture were still pierced from the posterior wall of the vagina, and were ligated to rebuild the pelvic floor support, strengthen the pelvic floor support, and suspend the vaginal stump. If the distance between the two sides is far. Can not be stitched. n. Stitching the vaginal mucosa: The vaginal mucosa is sutured intermittently with the 0-series line from the urethral opening. When it is close to the edge, it is sutured before and after. complication Intraoperative bleeding: Vaginal hysterectomy usually has more bleeding than abdominal hysterectomy. Vaginal incision bleeding or oozing is a more prominent problem than abdominal surgery. The prevention and treatment methods include: cutting the cervical vaginal mucosa with an electric knife, and injecting oxytocin (oxytocin) 10U or 1/24 million epinephrine solution on both sides of the cervix.