salpingostomy

For tubal ostomy surgery, there are two methods of open surgery and laparoscopic surgery. Laparoscopic surgery has small wounds, small tissue damage, rapid recovery of patients, short hospital stay, postoperative pain and bloating, and rapid recovery of gastrointestinal function. Open surgery is performed by the operator under direct vision. The degree of fineness is much higher than that of the laparoscopic, and the postoperative pregnancy rate is relatively higher. Treatment of diseases: fallopian tube obstruction tubal obstruction infertility Indication Tubal ostomy is suitable for patients with proximal tubal patency and stagnant water at the distal end. Preoperative preparation The specific blockage and nature of tubal blockage need to be determined by fallopian tube angiography before surgery. Place a catheter and a transvaginal catheter into the uterus. This contrast tube is used during surgery to check whether the fallopian tube is unobstructed during surgery. Surgical procedure Open abdominal tubostomy Cut the layers of the abdominal wall as usual, explore the pelvic cavity, and lift the fallopian tube in the surgical field. Take the distal end of the fallopian tube to make a "ten" or "*" shaped incision. Check whether the fallopian tube is unobstructed by contrast saline and methylene blue. Observe whether the mucosal folds in the lumen of the fallopian tube are rich and whether the tissue is healthy. The mucosal surface of the fallopian tube is turned over, and several short longitudinal cuts are made on the wall of the avascular region to make it a petal shape or a natural umbrella shape. The 4 mm intestinal line was used to carefully suture the mucosal surface of the fallopian tube and the serosal surface, so that there was no bleeding on the incision edge of the fallopian tube, and there was a natural umbrella shape. Laparoscopic tubal ostomy First, the adhesion of the fallopian tubes to other tissues is fully removed. Through the cervix, the fallopian tube is irrigated, so that the distal end of the fallopian tube is covered with a large end, and the fallopian tube is fixed to the uterine fundus with a non-invasive grasping forceps. Use a carbon dioxide laser or micro scissors as a cross cut as far as possible in the original fallopian tube opening. If the original opening is unrecognizable, the ten incision can be made in the avascular zone at the thinnest part of the fallopian tube wall. Place the gripper into the incision repeatedly and open it several times until the incision is satisfactory. The direction of the incision is oriented as far as possible toward the ovary so that it can be picked up later. The intima of the fallopian tube at the new incision was grasped with an atraumatic forceps and turned outward. In order to keep the incision valve in the everted state and prevent the new incision from sticking again, the serosal surface of the newly incision valve can be treated by defocusing laser or low power microbipolar coagulation. The surface tissue is shrunk to achieve the purpose of eversion of the cutting edge. The incision valve can also be directly sutured to the serosal surface of the fallopian tube by using the 4-10 absorbable line. The wound was continuously flushed with heparin-containing Ringer's lactic acid solution (5000 U/L) during the operation. After the operation, the pelvic cavity can be filled with lactated Ringer's solution, or sodium hyaluronate and antibiotics, glucocorticoids and antispasmodic drugs to prevent adhesion. complication Infection after surgery: If the disinfection is not strict or the original reproductive system is chronic inflammation, it may cause postoperative infection. Some patients do not pay attention to personal hygiene after surgery, or do not follow the doctor's advice after surgery, have sex, can also cause bacterial infection, causing pelvic inflammatory disease. Menstrual period does not pay attention to hygiene: endometrial exfoliation during menstruation, uterine sinus opening, and clots, which is a good condition for bacterial growth. If you do not pay attention to hygiene during menstruation, use sanitary napkins or toilet paper with unqualified hygiene standards, or have sex, it will provide bacteria with a chance of retrograde infection, leading to pelvic inflammatory disease. Inflammation spread in adjacent organs: The most common is appendicitis and peritonitis. Because they are adjacent to the female internal reproductive organs, inflammation can spread directly, causing pelvic inflammation in women. Infection of the pelvic cavity causes adhesion around the fallopian tubes, and the fallopian tubes adhere to the pelvis. On the wall.