Choosing the right time for hysterectomy

The uterus is a characteristic of women and an important organ in the female reproductive system. This surgery is mostly used to remove uterine tumors and certain uterine bleeding and adnexal lesions. Once lesions or irreparable damage occur, the uterus needs to be removed to prevent the spread of the lesions and affect health problems in other parts of the body. Let's take a look at the timing of hysterectomy surgery.

Surgical procedures

(A) Incision: A midline incision is made in the lower abdomen from below the umbilicus to the upper edge of the pubic symphysis.

(ii) After suturing the infundibulopelvic ligament and round ligament, exploration is performed after entering the abdominal cavity to understand the extent of the lesion.

Use toothed hemostatic forceps to clamp the two horns of the uterus to pull and block the ascending branch blood flow of the uterine artery.

The round ligament is sutured 2 to 3 cm away from the uterine horn, and the pelvic infundibulum ligament is double-sutured slightly away from the pelvic wall (to avoid the ureter). The ovarian artery and venous plexus pass through the pelvic infundibulum ligament, which can be seen clearly under light and must be sutured tightly.

(III) Cutting the ligaments and incising the uterine bladder peritoneum

Lift the uterus and suture the sutures, cut the pelvic infundibulum ligament and round ligament. The blood flow to the uterus has been blocked at the uterine cornu, so only a small amount of blood will return when the ligament is cut, and generally no additional clamping is required to stop bleeding. Cut the anterior leaf of the broad ligament between the pelvic infundibulum ligament and the round ligament, free it forward, and cut the uterine bladder peritoneum and fold it to the opposite side.

4. Wandering Ion Palace Body

Use your fingers to gently separate the bladder slightly downward along the plane of loose connective tissue between the uterus and bladder to expose part of the cervix, and then slightly separate the tissues on both sides to expose the uterine artery and vein. The ureter passes below the blood vessels about 2 cm from the cervix. Then cut the posterior leaf tissue of the broad ligament on both sides of the uterine body to above the uterine artery. There is usually no bleeding during cutting, but the cutting should be done slightly away from the uterine body to avoid damaging the ascending branches of the uterine arteries near both sides of the uterine body. At this point, the uterus is completely free, with only a small amount of tissue on both sides connected to the vaginal vault.

5. Wandering cervix

Use your hands to pull the uterus toward the head appropriately, and use your thumbs to push the bladder further below the level of the external cervical opening, while slowly pushing the ureters to both sides. If you pay attention and explore to both sides, you can feel a cord-like object sliding under your fingertips about 2 cm away from the cervix. This is the ureter. As long as the plane is accurate, pushing the bladder down will not be difficult and bleeding will not be excessive. If there are difficulties, it is usually related to the plane of entry being too deep, or it may be caused by inflammatory adhesions. It should be clarified before separation. Sharp dissection can be performed if necessary. It is of positive significance to avoid damaging the ureter by palpating the location of the ureter and then dealing with the tissues on both sides of the cervix.

6. Hysterectomy

Place a gauze pad in the rectouterine pouch to absorb any discharge that may leak from the vagina. Lift the uterus, cut the anterior vaginal fornix, clamp and lift the anterior vaginal wall, and insert a small piece of gauze through the incision to prevent the accumulated fluid in the vagina from flowing out and contaminating the pelvic cavity. Then clamp the anterior lip of the cervix and lift it upwards, cut it open along the vaginal vault, and remove the uterus. When circumcising the vaginal vault, always be sure to lift the cervix to facilitate cutting without contacting the surrounding area to prevent contamination. After each incision, the vaginal stump is clamped to reduce bleeding and provide traction to facilitate suturing after hysterectomy.

Any instrument that has come into contact with the vagina should be placed in a contaminated basin immediately after use.

7. Suturing the vaginal stump and pelvic peritoneum

After the uterus is removed, the vaginal stump is smeared with iodine and alcohol cotton balls, and then No. 1 or No. 2 chromium gut sutures are used to make "8"-shaped interrupted sutures or continuous sutures. Be careful to sew the two corners of the broken end. Finally, carefully check the thickness and peristalsis of the ureters on both sides and whether there is bleeding at the suture points. If there is no abnormality, the pelvic peritoneum is sutured continuously first, and then the abdominal cavity is closed routinely. After the operation, remove the gauze from the vagina.

After reading the above steps of hysterectomy, you will have some understanding of the process of hysterectomy. The choice of operation time still needs to be diagnosed and determined by a professional hospital. It needs to be determined based on the patient's physical condition and the preparation for the operation. So you can read the above carefully first and have an idea of ​​the operation situation in mind.