Method for ligating uterine artery at uterine extirpation

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

 

The present invention relates to medicine, in particular for surgical gynecology.

There is a method of ligation of the uterine artery by removing the uterus, in which it is separated from the cellulose, followed by crossing below the level of the internal OS and bandaging (Rambus I.N. “Operative gynecology”, Kiev, Health, 1985 page).

Provided technical errors and bleeding from religiouns vaginal artery it compress and bandage.

The disadvantages of the method are its high invasiveness and technical complexity.

Another known method involves the ligation of the trunk of the uterine artery in the parametrial tissue using a needle desana on the level of differentiation of stem on the ascending and descending branches of the uterine artery (Pervanidou PS “Operative gynecology”. M, Medicine, 1971, str).

In the case of infiltration and sclerosed tissue, and in the absence of much experience in operative techniques in gynecologic operations, it is recommended to not tie trunk uterine artery, and separately its ascending and descending branches.

The disadvantages of this known method are its limitations and technical difficulties.

Closest to the proposed method is a method where on the stage ligation of the barrel uterine artery to avoid injury mochito the nick (the crossing with the barrel of the uterine artery) should be “szeparowka” parametrium order to identify the uterine artery. In the following for better security, the last captured clip in place, dividing it into ascending and descending branches. The second clip is superimposed on the vascular bundle and significantly above the core, close to the cervix. Then the vascular bundles Parirenyatwa, the clamps are replaced kemptville (Mylar) ligatures (I. Braude “Operative gynecology”. M, Medgiz, 1952, s.257).

The disadvantage of this known method is relatively high invasiveness.

The objective of the invention is less traumatic way ligation of the uterine artery by removing the uterus.

The problem is solved by the method lies in the fact that put the clip on the edge of the uterus at the level of the internal OS is perpendicular to the edge of the fabric over the clip netscout until mobilization parametrium and second clamp impose parallel to the cervix at the level of the anterolateral arch, sharp along by the second clamp UserProfile tissue from the cervix up to full mobilization on both clips below the end of the clip under the spout clamp stitch underlying tissue and put the ligature and the node before and after clips.

The following examples illustrate the method according to the invention.

Example No. 1.

Patient O., 42 years, is aimed at the Department of operative gynecology Orel oblast clinical hospitals is s with a diagnosis of uterine fibroids, submucous site. Gynecological examination: the uterus is increased to 7 weeks of pregnancy, dense painless in the study, the area of the appendages without features. The patient underwent hysterectomy without adnexa, operation duration 55 minutes.

Under General anesthesia after treatment of the surgical field by Odonata produced laparotomy for Pfannenstiel. Found: the body of the uterus minutesno deformed due to many interstitielle-subserous myoma nodes from 3 to 6 cm in diameter at the bottom and the rear wall and enlarged as to 7-8 weeks of pregnancy. Appendages on both sides are not changed.

Pushing the uterus to the side at all, its own links to the fallopian tube superimposed Kocher clamps and controlmy, ligaments are dissected. Clamps replaced kemptville ligatures. The same is done with the other hand. The leaves of the broad ligament of the uterus divorced. Opened and dissected l. Vesiko-uterinae in the transverse direction together with the front leaf of the broad ligament of the uterus. Topfarm and scissors bladder tsepelovo the bottom and sides up to the level of the anterior vaginal fornix. The uterus is pulled to fold. Sacro-uterine ligaments legirovanyh and dissected. The peritoneum between the ligaments are dissected and pushed slightly downwards on both sides. Right imposed a Kocher clamp on the edge of the uterus at the level of the internal OS of perpendi warno to the edge, the fabric over the clip neccecery until mobilization parametrium. The second clip is imposed parallel to the cervix at the level of the anterolateral arch, sharp along by the second clamp useprivacy tissue from the cervix up to full mobilization on both clips below the end of the clip under his nose is stitched to the underlying tissue. The same is made from the opposite side.

In the area of the anterior vaginal fornix imposed Kocher clamps, dissected anterior vaginal fornix. The vagina is entered gauze swab with alcohol. Then the walls of the vagina crossed circular edges of the vagina captured by the Kocher clamps. The uterus was removed.

The edges of the vagina treated with Odonata. The vagina is sutured separate kemptville seams tightly. Peritonial of the vaginal stump and the stump of the ligament leaves of the broad ligament of the uterus individual and pouch kemptville seams. The abdominal wall is sutured in layers tightly.

The postoperative period was uneventful. When internal research of the vaginal stump without signs of inflammation and infiltration. Arches free, parametrium not changed. The woman was discharged 9 days after surgery.

Example No. 2.

Patient I.D., 49 years, is aimed at the Department of operative gynecology Orel oblast clinical hospital with a diagnosis of uterine fibroids. Gynecological examination: the uterus is increased to 9-0 weeks of pregnancy, dense, painless, region appendages on both sides without features. Diagnosis: uterine fibroids, scar deformity of the cervix. The patient made a hysterectomy, operative duration 1 hour 10 minutes.

After processing the surgical field produced laparotomy for Pfannenstiel. Found: the body of the uterus minutesno deformed due to many interstitielle-subserous myoma nodes on the front and rear walls of the uterus and enlarged as to 9-10 weeks of pregnancy. Appendages on both sides cystic degenerated.

Pushing the uterus to the side, round, Voronko-pelvic ligament imposed Kocher clamps and controlmy, ligaments are dissected. Clamps replaced kemptville ligatures. The same is done with the other hand. The leaves of the broad ligament of the uterus divorced. Opened and dissected pl. Vesiko-uterinae in the transverse direction together with the front leaf of the broad ligament of the uterus. Topfarm and scissors bladder tsepelovo the bottom and sides up to the level of the anterior vaginal fornix. The uterus is pulled to fold. Sacro-uterine ligaments legirovanyh and dissected. The peritoneum between the ligaments are dissected and pushed slightly downwards on both sides. Right imposed a Kocher clamp on the edge of the uterus at the level of the internal OS is perpendicular to the edge of the fabric over the clip neccecery until mobilization parametrium. In the second clip imposed parallel to the cervix at the level of the anterolateral arch, acute along by the second clamp useprivacy tissue from the cervix up to full mobilization on both clips below the end of the clip under his nose is stitched to the underlying tissue. The same is made from the opposite side.

In the area of the anterior vaginal fornix imposed Kocher clamps, dissected anterior vaginal fornix. The vagina is entered gauze swab with alcohol. Then the walls of the vagina crossed circular edges of the vagina captured by the Kocher clamps. The uterus was removed.

The edges of the vagina treated with Odonata. The vagina is sutured separate kemptville seams tightly. Peritonial of the vaginal stump and the stump of the ligament leaves of the broad ligament of the uterus individual and pouch kemptville seams. The abdominal wall is sutured in layers tightly.

The postoperative period was uneventful. When internal research of the vaginal stump without signs of inflammation and infiltration. Arches free, parametrium not changed. The woman was discharged on the 13th day after the operation.

The method according to the invention eliminates the ligation of the vascular bundles, and imposed ligature captures all blood vessels, including vaginal artery.

According to the method of the injury of the ureter is 0.5%, while the implementation of the proposed method at 409 operated injuries of the ureter is not checked, re-bleeding due to failure is igatory, by a known method was observed in 17% of cases, the proposed method is 2%.

The way ligation of the uterine artery by removing the uterus, characterized in that impose a clip on the edge of the uterus at the level of the internal OS perpendicular to the edge of the fabric over the clip netscout until mobilization parametrium and second clamp impose parallel to the cervix at the level of the anterolateral arch, sharp along by the second clamp usepreview tissue from the cervix up to full mobilization on both clips below the end of the clip under the spout clamp stitch underlying tissue and put the ligature and the node before and after clips.



 

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