Method for surgical correction at closed functioning uterine horn located in the thickness of uterine body

FIELD: medicine, gynecology.

SUBSTANCE: the method includes laparoscopic access. One should perform dissection of closed functioning uterine horn in its bottom area. Under laparoscopic control due to retrograde hysteroresectoscopy one should carry out resection of endometrium of closed functioning uterine horn. Uterine wall should be restored.

EFFECT: decreased traumaticity of operative interference.

1 ex

 

The invention relates to medicine, in particular operative gynecology.

Congenital malformations of the female genital organs make up 4% of all congenital anomalies, and in recent years there has been a tendency to increase.

Diagnosis of malformations of the uterus and vagina is very difficult. The result of diagnostic errors is the unjustified execution of surgical interventions in 24-34% of patients, especially when malformations involving violation of the outflow of menstrual blood. The majority of researchers believe that in the Genesis of malformations of the uterus and vagina are genetic factors, biological inferiority of germ cells and exposure to harmful physical, chemical and biological agents. The emergence of various forms of malformations of the uterus and vagina is due to the fact, at which stage there has been a violation of embryogenesis (had a pathological effect teratogenic factor or were hereditary traits).

In the presence of a uterus with an incremental functioning horn, not communicating with her patients are suffering severe pain that occurs soon after menarche, growing with each menstruation. Gynecological examination revealed one vagina and one cervix. When conducting clinical and instrumental research is of (echography, magnetic resonance imaging, laparoscopy) find two of the uterus with hematometra in one of them. Common tactics with this blemish - removal-functioning closed the horns of the uterus.

The known method of operation, in which laparoscopic access deletes the closed-functioning horn of the uterus: after creating the pneumoperitoneum and conducting diagnostic laparo-hysteroscopy uterine horn capture toothed forceps. Using bipolar coagulator and scissors consistently perform coagulation and the intersection of all uterine ligaments, native ligament of the ovary and fallopian tube end on the side of the uterine horn. Cut front and back pieces of the broad uterine ligament, gallbladder-uterine fold of peritoneum to connection-level vestigial horns with the uterus, the vascular bundle are ligated or coagulated by bipolaron and cross. Using a monopolar coagulator or ultrasonic scalpel cut off the horn from the body of the uterus are then removed from the abdominal cavity by moreletii or through colpotomy hole (Kulakov V.I., L.V. Adamyan Role of endoscopy in the diagnosis and surgical treatment of malformations of the female genital // In the book. "Gynaecological endoscopy", M, "Medicine", 211-226 C.).

The disadvantage of this method is traumatic for the primary cancer, the risk of injury urine is wow bladder and ureter, the possibility of bleeding from atypical located vessels of the uterus, as well as the emergence of later disturbance of the blood supply and innervation of the ovary on the side of the horns of the uterus.

The objective of the invention is a method of surgical correction, allowing to minimize the trauma for the primary cancer, the risk of injury of the bladder and ureter, the possibility of bleeding from atypical located vessels, the occurrence of later disturbance of the blood supply and innervation of the ovary on the side of the horns of the uterus.

This object is achieved by a method of surgical correction, which produce laparoscopy, perform the incision closed-functioning horn of the uterus in the bottom, under the control of the laparoscope by retrograde heteroresistance spend resection of the endometrium closed functioning uterine horns and restore the wall of the uterus.

Example. Patient CHN., 14 years, with complaints sharply painful menstruation. When conducting clinical and instrumental examination including ultrasound scan and magnetic resonance imaging revealed a doubling of uterus, closed-functioning horn of the uterus to the right, hematometra right. Decided to conduct the operation.

The operation is as follows: after imposition of pneumoperitoneum through an incision just below the navel entered laparoscopically additional incisions in the left and right iliac regions for introduction of instruments. Found: the uterus is asymmetrically increased due to the formation of 3,5×3.0 cm to the right in the thick wall of the uterus. Appendages left without features, the right fallopian tube in the form of a rudiment, heatedly in the distal. Produced hysteroscopy: in aseptic conditions in the vagina entered the mirror, naked cervix. In the uterus hysteroscope is introduced. Found the uterus is small, left visualized the mouth of the pipe, the mouth of the right fallopian tube is missing. The cervical canal is not deformed. Laparoscopic access using monopolar coagulator made a longitudinal incision in the bottom of the horns of the uterus before the opening of the cavity, poured out about 50 ml of dark blood, the cavity is rinsed with saline. Under the control of the laparoscope performed retrograde heteroresistance: right through the trocar into the cavity uterine horns entered the tube of a resectoscope, produced by the stretching of the uterus 5% glucose solution. The cavity of the horn has a rounded shape, is not connected with the main uterus, cervical canal and pipe on the left. Performed resection of the mucosa of the closed-functioning horn of the uterus using an electrode-loop mode cutting-coagulation. The endometrium is removed from the abdominal cavity. After extraction of a resectoscope of the wound in the uterus is sutured separate wikilove seams. is idetity distal right rudimentary fallopian tubes removed using a bipolar coagulator and scissors. After inspection of the abdominal cavity, wash it with saline, control of hemostasis laparoscope is removed, the incisions in the skin are sewn separate seams. Operation duration 1 hour 45 minutes estimated Blood loss of less than 50 ml For smooth postoperative period, the patient was discharged on the 6th day.

The proposed method of surgical correction reduces the trauma to the primary of the uterus, allowing you to fully keep its integrity, avoids injuries of the bladder and ureter, the occurrence of disturbance in the blood supply and innervation of the ovary on the side of the horns of the uterus.

A method of surgical correction in closed-functioning uterine horn, located in the thickness of the primary cancer, including laparoscopic access, wherein performing the incision closed-functioning horn of the uterus in the bottom, under the control of the laparoscope by retrograde heteroresistance spend resection of the endometrium closed functioning uterine horns and restore the wall of the uterus.



 

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FIELD: medicine, gynecology.

SUBSTANCE: the method includes laparoscopic access. One should perform dissection of closed functioning uterine horn in its bottom area. Under laparoscopic control due to retrograde hysteroresectoscopy one should carry out resection of endometrium of closed functioning uterine horn. Uterine wall should be restored.

EFFECT: decreased traumaticity of operative interference.

1 ex

FIELD: medicine, surgery, gynecology.

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FIELD: medical engineering.

SUBSTANCE: device has means composed of endovaginal ultrasonic measuring converter introducible into a part of patient vagina with rest against uterine cervix of patient, cervix holder for holding the uterine cervix and connector for coupling the ultrasonic measuring converter and cervix holder. The connector enables the ultrasonic measuring converter subjected to counteraction resistance, to move. The movement under counteraction takes part in the direction away from the uterine cervix.

EFFECT: enhanced effectiveness and accuracy in doing intrauterine, cervical procedures and procedures on fallopian tubes.

54 cl, 7 dwg

FIELD: medicine, gynecology.

SUBSTANCE: through vertical umbilical incision one should introduce an optic trocar supplied with laparoscope, separate peritoneum with gas from pre-peritoneal fiber and through an access developed on should fix anterior vaginal wall to pectineal ligaments from both sides at the level of the middle urethral part and urethrovesical segment by leaving about 1.5-2.5 cm against urethra.

EFFECT: higher efficiency.

1 ex

FIELD: medicine.

SUBSTANCE: method involves shortening and attaching round ligaments to vagina fornix and their suturing under the urethra as sling. Cardial ligaments are shortened and attached to the middle part of the vagina. Triangular flap is cut from posterior vaginal wall, sacrouterine ligaments are sutured. The posterior vaginal wall is separated from the rectum creating in this way duplicature from vaginal walls.

EFFECT: enhanced effectiveness of surgical treatment; eliminated urination disorders.

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FIELD: medicine, operative gynecology.

SUBSTANCE: one should apply a clamp onto uterine edge at the level of internal mouth being perpendicular to the edge, gash tissues above the clamp before the moment of parametral fiber mobilization. Then one should apply the second clamp being parallel to uterine cervix at the level of anterior-lateral arch and separate acutely the tissues against uterine cervix till complete mobilization at both clamps. Then one should suture underlying tissues being below the clamp's end under clamp's tip to apply ligature and the knot both in front and behind the clamps.

EFFECT: decreased traumaticity of the method.

2 ex

FIELD: medicine; medical engineering.

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EFFECT: accelerated and simplified surgical intervention method.

3 cl, 3 dwg

FIELD: medicine.

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EFFECT: enhanced effectiveness of treatment; accelerated treatment and rehabilitation process; reduced risk of traumatic complications; improved cosmetic result.

FIELD: medical engineering.

SUBSTANCE: device has cylindrical uterine dilator. The dilator is manufactured from super-elastic material on the base of titanium nickelide as zigzag wire spiral rolled as cylinder and having end zigzag segments bent to 15-30° outwards. One or several distal zigzag end segments are elongated by 0.5-0.7 times cylinder diameter, closed and twisted and smoothly conjugated when being bent into cylindrical lumen in inclined position relative to its axis.

EFFECT: enhanced effectiveness of cervical canal dilation; simplified method for withdrawing the device.

1 dwg

FIELD: medicine.

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