Where does uterine myoma operation operate?

summary

Many of our patients with uterine fibroids have heard of myomectomy, and many of them have even experienced it, but we still don't know the steps of myomectomy. Let's understand: where is the operation for uterine fibroids? Look at the details below.

Where does uterine myoma operation operate?

1. Incision, median incision of lower abdomen or transverse incision of pubic symphysis. 2. Explore to know the location, size and number of uterine fibroids, so as to determine the uterine incision. 3. Block the blood supply of the uterus. Before the myomectomy of the uterine body, make a small opening in the avascular area of the broad ligament on the left and right sides of the isthmus of the uterus, put a rubber tube tourniquet through it, tie up the uterine artery and vein, and temporarily block the blood supply. If the operation time is long, the tourniquet should be relaxed for 1 minute every 10-15 minutes. Uterine contraction agent can also be injected into the myometrium to reduce bleeding.

For intramural myomectomy, a longitudinal, fusiform or arc-shaped incision should be made at the site with less blood vessels on the surface of the uterine fibroids, depending on the size of the uterine fibroids. The incision should go deep to the capsule of the uterine fibroids, and be separated bluntly along the surface of the capsule. When there are more blood vessels at the base, the uterine tumor can be cut out after clamping, and the stump can be sutured. The absorbable suture was used for "8" or continuous suture of 1-2 layers of muscle layer. Pay attention to avoid dead space during suture. For myoma near the uterine horn, the incision should be as far away from the uterine horn as possible, so as not to affect the tubal patency due to postoperative scar.

Subserosal hysteromyoma resection, this kind of hysteromyoma often with pedicle, can close to the uterine wall clamp tumor pedicle, resection of hysteromyoma. When the pedicle is wide, a fusiform incision can be made at the base to remove the myoma and the superficial muscle layer of the pedicle. Submucosal myomectomy: if the myomectomy obviously protrudes into the uterine cavity, it is necessary to enter the uterine cavity to excise the uterine tumor. When suturing the myometrium, it is necessary to avoid the mucosal layer, so as to avoid the implantation of the myometrium into the endometrium and artificially cause endometriosis. Submucous myoma with pedicle can be resected through vagina.

matters needing attention

The relationship between hysteromyoma and bladder, rectum and ureter should be understood in cervical myomectomy. For uterine leiomyoma of anterior cervical wall, first open the bladder retroflexed peritoneum, sharply separate the bladder to the lower and lateral edge of uterine leiomyoma, cut the tissue of anterior cervical wall to the surface of uterine tumor, passively separate it to the base along the tumor capsule, clamp and remove the leiomyoma, and suture the stump. The myometrium of cervix was sutured with absorbable thread in "8" shape or continuous mattress type for 1-2 layers, and the bladder peritoneum was sutured. If it is uterine fibroids in the posterior wall of the cervix, it is necessary to open the space between the cervix and rectum, fold the peritoneum, push open the rectum, and then remove the uterine fibroids. For huge uterine fibroids of the cervix, the posterior lobe of the broad ligament can be opened first to find the ureter. If necessary, the ureteral tunnel can be cut to free the ureter, and then myomectomy can be performed.