Hysteroscopic surgery for submucosal fibroids

For women, the uterus is one of the most important reproductive organs, because the uterus not only represents women. It is a physiological health characteristic and is also very important for the happiness of the entire family. Therefore, in life we ​​must protect the health of women's uterus. For your current uterine health problems, for example, hysteroscopic surgery has played a great role in the diagnosis and treatment of some diseases of many female friends. So let us now understand what hysteroscopic surgery for submucosal fibroids is all about?

1. Indications

Abnormal uterine bleeding, menorrhagia, oligomenorrhea, irregular menstrual cycle, uterine fibroids, uterine polyps, displacement of IUD, infertility, habitual miscarriage, follow-up examinations after spontaneous or induced abortion, abnormal ultrasound images, long-term lower abdominal pain, artificial conception and preoperative evaluation of in vitro fertilization, etc. are all indications for hysteroscopy.

Hysteroscopic technology can be used to directly examine lesions in the uterine cavity, locate and collect lesion tissue for examination. The diagnosis is accurate, timely, comprehensive and intuitive, and cancer can be detected early. Fallopian tube catheterization can be performed to check the patency of the fallopian tubes and clear blockages in the interstitial part of the fallopian tubes. It is accurate and effective. Hysteroscopic surgery can remove the endometrium, submucosal fibroids, endometrial polyps, uterine septum, intrauterine adhesions and foreign bodies. It has good efficacy, does not require laparotomy, has little trauma, less bleeding, less pain and quick recovery.

The best time for hysteroscopy is from the end of menstruation to before ovulation. There is no need for anesthesia during the examination, so there is no need to fast or be hospitalized. You can go home after the examination. You don’t need to rest or take any supplements the next day. You can just go about your normal daily activities.

2. Operation time

1-10 days after the menstrual period ends, a small amount of spotting can also be checked.

3. Contraindications

There are no clear absolute contraindications, the following are relative contraindications.

1. Vaginal and pelvic infections.

2. Heavy uterine bleeding.

3. Those who want to continue the pregnancy.

4. Current uterine perforation.

5. The uterine cavity is too narrow or the cervix is ​​too hard to dilate.

6. Acute and subacute inflammation of the reproductive tract

7. Severe heart, liver, lung and kidney diseases

8. Invasive cervical cancer

9. Genital tuberculosis without anti-tuberculosis treatment

10. Patients with severe medical diseases who have difficulty tolerating uterine distension operations.

11. Patients with genital tuberculosis who have not received anti-tuberculosis treatment.

12. Those with blood diseases who have no follow-up treatment measures.

4. Preoperative Preparation

1. Perform cardiopulmonary examination, measure blood pressure and pulse, check leucorrhea, and perform cervical scraping.

2. Choice of examination time: Except for special circumstances, it is generally appropriate to do the examination within 5 days after the end of menstruation.

5. Operation steps

1. Anesthesia and analgesia: You can choose any of the following:

(1) Indomethacin suppository: Insert 50-100 mg of indomethacin suppository deep into the anus 20 minutes before the examination.

(2) Paracervical nerve block anesthesia: 5-10 ml of 1% procaine is injected into each side of the cervix.

(3) Surface anesthesia of the cervical mucosa: Use a long cotton swab soaked in 2% lidocaine solution to insert into the cervical canal at the level of the internal cervical os and retain for 1 minute.

(4) Uterine mucosal spray anesthesia: 8 ml of 0.25% bupivacaine is sprayed onto the surface of the endometrium through a special tubular injector and checked after 5 minutes.

2. Inspection method: Take lithotomy position, routinely disinfect the vulva and vagina, clamp the anterior lip of the cervix with a cervical forceps, use a probe to find out the depth and direction of the uterine cavity, and expand it to 6.5-7 according to the outer diameter of the sheath. 5% glucose solution or normal saline is commonly used to distend the uterus. First, the air between the sheath and the optical tube is emptied, and the hysteroscope is slowly inserted. The light source is turned on and the distending fluid is injected. The distending pressure is 13-15kPa (1kPa=7.5mmHg). After the uterine cavity is filled, the field of vision is bright and the scope can be rotated for comprehensive observation in sequence. First check the uterine fundus and the anterior, posterior, left and right walls of the uterine cavity, then check the uterine horns and fallopian tube openings. Pay attention to the morphology of the uterine cavity, whether there are endometrial abnormalities or space-occupying lesions, perform targeted biopsy when necessary, and finally, carefully examine the internal cervical os and cervical canal while slowly pushing out the scope.