total pelvic excision

Gynecologic advanced cancer invades the pelvic organs such as the bladder, rectum or ureter, but the uterus and rectum are not affected by the pelvic wall, no pelvic metastasis, and the systemic and psychological state is good. Treatment of diseases: endometrial cancer, cervical cancer Indication Gynecologic advanced cancer invades the pelvic organs such as the bladder, rectum or ureter, but the uterus and rectum are not affected by the pelvic wall, no pelvic metastasis, and the systemic and psychological state is good. 1. Start a half-flow diet 2 to 3 days before surgery. 2. Oral antibiotics were taken 5 days before surgery. 3. Oral laxative 24 hours before surgery. 4. Clean the enema before the night before surgery and on the day of surgery. Preoperative preparation 1. Start a half-flow diet 2 to 3 days before surgery. 2. Oral antibiotics were taken 5 days before surgery. 3. Oral laxative 24 hours before surgery. 4. Clean the enema before the night before surgery and on the day of surgery. Surgical procedure 1. Position: The same position as the posterior pelvic organ removal. 2. Incision 3. Separation of the basin organ (1) The sigmoid colon is severed and separated along the sigmoid colon to the back of the rectum. If the colon is used to replace the bladder, the intestines can be selected at the same time (see the method for posterior pelvic removal). (2) open the pelvic peritoneum, high-ligation pelvic funnel ligament, cut the uterine round ligament, free the lower ureter, cut off the ureter, rectal ligament and uterine ligament, main ligament and paravaginal tissue separation before the tunnel into the tunnel Clearance. 4. Separate the pelvic organ from the round ligament to open the bladder bottom peritoneum, and separate the loose tissue in the bladder and urethra along the posterior pubis, until the urethra is near the mouth. 5. Remove pelvic lymph nodes. 6. Artificial bladder: The sigmoid colon or ileum can be used to replace the bladder, but the latter is used in the whole pelvic resection. (1) sigmoid colon bladder: Select the sigmoid colon segment, the length depends on the thickness of the abdominal wall, usually about 12 to 15 cm long, including two arterial branches to facilitate blood supply. The proximal segment of the intestine is sutured (two layers) closed. The free sigmoid colon is moved to the right lower abdomen, and a ureter that is free of sufficient length is anastomosed on the mesothelial side of the colon. A small opening is made in the side of the ureteral port, as shown in Fig. 4, a point, the anastomotic area is enlarged, and then corresponding to the corresponding sites a, b, c on the colonic bladder. The suture layer is sutured with an absorbable suture, and the mucosal layer needs to be well aligned. The ureteral stent should be placed before the anastomosis. For the anastomosis method, see the anterior pelvic organ resection. The distal end of the free sigmoid colon was sutured with the opening of the right lower abdominal wall in the same manner as the colostomy of the posterior debridement. (2) ileal bladder: the ileum segment 10 ~ 15cm away from the ileocecal area, about 15 ~ 20cm long, cut off the ileum, so that the free bowel segment, close to the heart end suture closed, retain blood supply. The original ileum ends are anastomosed to maintain continuity. Close the mesenteric hole to prevent intestinal intrusion. The double ureter was anastomosed to the proximal end of the free ileum, and the distal end was sutured with the abdominal wall weapon (see anterior pelvic resection). 7. Sigmoid colostomy: sigmoid colostomy in the same postoperative debridement. 8. Reconstruction of the pelvic floor: After rinsing the abdominal cavity, a piece of peritoneum is separated from the anterior abdominal wall or the lateral abdominal wall, covering the pelvic floor, and sutured and fixed. The retroperitoneal cavity is blocked with Vaseline yarn and one end is led by the perineum. A porous hose can be added to the bottom of the basin for negative pressure drainage. Layered abdomen. wrap the wound. 9. Perineal surgery: basically the same as the posterior pelvic organ removal. The incision starts from the front of the clitoris and descends along the vagina of the left and right vestibules, merging in front of the anal tailbone. For the method of removing the urethra, vagina and rectum, see the extensive uterus plus vaginal resection and anterior pelvic resection. After separation, the entire specimen can be removed from the perineum. 10. Stitching the pelvic floor tissue: The pelvic floor wound has a large defect. It cooperates with the abdominal surgery group to completely stop bleeding, suture the pelvic floor tissue, and reduce the wound surface. 11. Suture the perineal skin and block the pelvic floor wound: the method is the same as the "post-pelvic organ removal". 12. About vaginal reconstruction: Requires a patient who is stable after surgery. If the perineal wound has enough granules and is very clean, vaginal reconstruction is feasible. 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.