Myomectomy procedure

Uterine fibroids are a very serious gynecological disease in life. This is a disease that originates from the uterus. For this disease, surgery is the most common treatment. In the early stages, friends can choose to use traditional Chinese medicine for conservative treatment. However, in the later stages, vaginal bleeding and abdominal pain will occur, which means that the condition is serious and autoimmune fibroid removal surgery has to be used. The following article will introduce it to you.

1. Single or multiple uterine fibroids affect fertility.

2. Uterine fibroids cause menstrual disorders and dysmenorrhea.

3. Cervical fibroids require the preservation of reproductive function.

[Anesthesia method]

1. Continuous epidural block anesthesia.

2. General anesthesia with endotracheal intubation.

[Preoperative preparation]

Cervical smear and diagnostic curettage were performed before surgery to rule out malignant tumors of the cervix and uterine body.

[Surgical steps and technical points]

1. Incisions: midline incision in the lower abdomen or transverse incision above the pubic symphysis.

Tie the uterine blood vessels at the cervical isthmus Figure 2 Incisions on the uterine surface

2. Explore and understand the location, size, and number of uterine fibroids to determine the uterine incision.

3. Blocking the blood supply to the uterus Before removing the uterine body myoma, make a small incision in the avascular area of ​​the left and right broad ligaments of the isthmus of the uterus, insert a rubber tourniquet through it, tie up the uterine artery and vein, and temporarily block their blood supply (Figure 1). If the operation time is long, loosen the tourniquet for 1 minute every 10 to 15 minutes. Uterine contractions can also be injected into the myometrium during surgery to reduce bleeding.

Separate the fibroids and treat the base of the fibroids

4. Removal of intramural fibroids: In the area with fewer blood vessels on the surface of the fibroid, a longitudinal, fusiform or arcuate incision is made depending on the size of the fibroid (Figure 2), deep into the fibroid capsule, and blunt separation is performed along the surface of the capsule (Figure 3). When there are more blood vessels at the base, the tumor can be clamped and cut out (Figure 4), and the residual end can be sutured (Figure 5). Use absorbable sutures to make an "8" shape or continuously suture 1 to 2 layers of the muscle layer (Figure 6). Be careful to avoid dead space when suturing. The seromuscular layer is sutured with interrupted or continuous mattress sutures using No. 0 absorbable sutures (Figure 7). For multiple myomas, multiple myomas should be removed from one incision whenever possible. For fibroids close to the uterine cornu, the incision should be made as far away from the uterine cornu as possible to prevent postoperative scars from affecting the patency of the fallopian tubes. Medical All Online www.med126.com

Suture the base stump and suture the muscle layer

5. Resection of subserosal myomas This type of myoma often has a pedicle. The pedicle can be clamped close to the uterine wall and the myoma can be removed (Figure 8). When the tumor pedicle is wide, a fusiform incision can be made at the base (Figure 9) to remove the superficial muscle layer of the fibroid and uterine tumor pedicle.

Suture the serosal base Pedicled subserosal fibroid

6. Submucosal myoma resection: If the myoma obviously protrudes into the uterine cavity, it is necessary to enter the uterine cavity to remove the tumor. When suturing the myometrium, the mucosal layer should be avoided to prevent the endometrium from implanting into the myometrium and artificially causing endometriosis. For pedunculated submucosal fibroids, they can be removed through the vagina.

In life, everyone must pay attention to their physical health, especially some female friends who drink for a long time and do not pay attention to their sleep time, which will cause great harm to their bodies. Yixiaoyi introduced uterine myomectomy to everyone, hoping to be of some help to patients and friends.