transvaginal repair

Applicable to most vaginal vagina, especially those with lower sacral tract. Treatment of diseases: bladder sputum tuberculous bladder spontaneous rupture Indication Applicable to most vaginal vagina, especially those with lower sacral tract. 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 , are not suitable for surgery, to be considered after getting better. 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 Clean the vagina and use intestinal antibiotics 3 days before surgery. Surgical procedure There are two procedures for transvaginal repair. The excision-separation method is suitable for pupils of various sizes and is most commonly used. 1. Position and disinfection: take the lithotomy position, and those who have difficulty in exposure may take the prone position. Routine disinfection of the vulva and vagina. 2. Exposure surgery: Fix the labia minora on the outer skin of the labia majora, expose the pupil with a vaginal hook, use the cervical forceps to pull the cervix, and explore the pupil with a metal catheter to understand its size, location, number and presence or absence. scar. 3. Incision: Under the urethral opening, the anterior wall of the vagina is cut along the midline, and the depth of the incision is not more than the degree of the mucosa (about 0.3 cm). Make an annular incision along the edge of the pupil and extend up and down along the midline of the anterior wall of the vagina. 4. Separation of the vaginal wall: Separation of the vaginal wall from the bladder wall along the incision (Fig. 5), the separation width is about 2 cm, and the vaginal wall is pulled to expose the pupil and the bladder wall. 5. Treatment of the edge of the pupil: Generally, the edge of the hole does not need to be trimmed, and the pupil is enlarged after the trimming, and the suture tension is increased. However, if the organization has surplus and the scar is hard and many, it can be properly trimmed. 6. Stitching the pupil: three layers of suture, namely two layers of the bladder wall and one layer of the vaginal wall. (1) The first layer of suture: a transverse suture-type suture with reduced tension, with a needle pitch of about 0.5 cm. Only the muscles and fascia are sewed without passing through the bladder mucosa to avoid postoperative suture stones. (2) Second layer suture: Intermittent suture stitching is still used, the suture edge is about 0.5 cm from the first layer, and the needle should be staggered from the first layer stitch. (3) Third layer suture: intermittently suture the vaginal wall. The suture direction may be perpendicular or parallel to the direction of the suture of the bladder, and the tension is preferably small. If the vaginal mucosa is too strong, it can be opened without suturing. 7. Leak test: After the second layer of suture is completed, the bladder is injected into the bladder with a dilution of 60-100 ml of methylene blue, so that the pressure is slow to prevent the liquid from leaking out. If there is any leakage, add a needle at the corresponding position. 8. Vaginal built-in gauze: Indwelling catheter, vaginal gauze. If there is more intraoperative bleeding, the bladder should be rinsed with sterile saline at the end of the operation. High vaginal closure is mainly used for high vaginal fistula of the vaginal stump after hysterectomy. 1. Excision of the vaginal mucosa around the pupil: about 1 to 2 cm from the edge of the pupil, circularly cut the vaginal mucosa, and peel off the mucosa around the pupil to the temporal margin. 2. Stitching the anterior and posterior wall of the vagina: suturing the anterior and posterior wall of the vagina, sometimes requiring a layer of reinforcement. complication Hemorrhage or hematoma Intraoperative vascular or stump ligation is not strong, a large amount of bleeding can occur in a short time after surgery, the vaginal wall suture should be disassembled, the bleeding blood vessels should be searched, and the suture should be re-sewn. If only a small amount of bleeding, gauze can be used to fill the vaginal pressure to stop bleeding, and use hemostasis drugs such as Yunnan Baiyao. 2. Wound infection There are many vaginal folds, so it is not easy to completely disinfect. The accumulation of small blood vessels in the surgical field is conducive to bacterial reproduction, and hematoma formation after surgery is more likely to occur. The vaginal purulent secretion in the vagina of the light is accompanied by a vaginal burning sensation; the body temperature fluctuates and rises, the vaginal wall suture is healed or necrotic, there is purulent secretion, antibiotics can be applied, drainage, And keep the vulva clean. 3. Urinary tract complications 1 less urinary (<600ml / d), due to the unwilling to drink water or hot days after surgery, should be supplemented with intravenous saline or 5% glucose solution; 2 urethritis, cystitis, mostly due to repeated catheterization, urinary frequency, urgency, hematuria and other symptoms, given antibiotics, diuretics and other treatment.