RU2132656C1 - Method for treating cysts and ovarian cystoma - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves removing neoplasm with capsule on ovary taken out through minilaparotomy incision. Laparoscopy is carried out first in some particular cases to evacuate the contents of the neoplasm. EFFECT: reduced trauma risk. 2 cl

Description

 The present invention relates to medicine, namely to gynecology, and can be used in the treatment of cysts and some varieties of ovarian cysts in girls, girls and young women.

 The urgency of the problem of diagnosis and treatment of cysts and ovarian cysts in modern gynecology is explained by the frequency of this pathology, as well as the search for new organ-preserving methods of treating this pathology in girls, girls and women of the reproductive period, since the ovaries are an important endocrine and generative organ.

 A known method of treating cysts and ovarian cysts is surgical treatment, which consists in removing the appendages, in removing the pathological formation by husking it or resecting the ovary within healthy tissue (Persianinov L.S. Operational gynecology. - M .: Medicine, 1976, p. 347- 350; Nechaeva ID Ovarian tumors. - Leningrad: Medicine, Leningrad department, 1987, pp. 135-140; Kobozeva N.V., Kuznetsova M.N., Gurkin Yu.A. Gynecology of children and adolescents. - Leningrad : Medicine, Leningrad Branch, 1988, pp. 172-173; Novak F. Operative Gynecologist I - M .: Medicine, 1989, pp 243-245;. Selezneva ND et al Guidelines for Operative Gynecology - M .: Medicine, 1990, 212 - 216, 219).....

 The disadvantages of the above methods are trauma during laparotomy, as well as its consequences: blood loss up to 100 ml or more, severe pain in the early postoperative period, the occurrence of postoperative intestinal paresis, adhesions in the pelvis, prolonged hospital stay after surgery, scar on the anterior abdominal the wall.

 The prototype of our method of treating cysts and ovarian cysts is the laparoscopic method (Adamyan L.V., Beloglazova S.E., Zurabiani Z. R. Laparoscopy in operative gynecology. - Obstetrics and gynecology 1991, N 2, pp. 69-74; Strizhakov AN, Baev OR Modern approaches to the diagnosis and management of patients with tumors and tumor-like formations of the ovaries. - Obstetrics and gynecology 1995, N 4 p. 15-17), consisting in the removal of benign tumors and tumor-like formations of the ovaries, uterine appendages using special e doskopicheskih instruments to perform tissue dissection, puncture formation, aspirate contents medicated hardening cavity wall, hemostasis by coagulation or sutures.

 The disadvantages of this method are the technical complexity of these interventions, the need for special, expensive, mainly imported equipment, relapse and the subsequent need for surgical treatment by laparotomy.

 The purpose of the invention: reducing trauma during operations for cysts and cysts, reducing the length of hospital stay after surgery, the absence of the need for narcotic analgesics after surgery, reducing the number of postoperative complications.

 The essence of the proposal is to remove cystic formations and a cyst outside the abdominal cavity without traditional laparatomy, by removing the affected ovary (after puncture of the formation and aspiration of the contents) from the abdominal cavity under laparoscopic control through a minilaparotomy wound and performing the operation outside the abdominal cavity with traditional surgical techniques with a minimum of surgical tools.

 Our proposed method is as follows: laparoscopy is performed, during which the diagnosis is clarified, the possibility of removal of cystic formations or cystomas by this method is determined (absence of a pronounced adhesion process). Then, one or two trocars are introduced into the abdominal cavity in the iliac regions. Using endoscopic instruments, cysts or cystomas are fixed and the formation is punctured in the avascular zone. The puncture is performed in order to reduce the size by maximizing the aspiration of the contents (the citrate aspirate is subjected to cytological examination). If there are two or three cavities, the puncture and aspiration procedure is repeated. Then, the incision of the anterior abdominal wall in the iliac region, from the side of the formation through which an additional trocar was carried out, is expanded to 3-4 cm by dissection of the skin, subcutaneous fat and aponeurosis. The peritoneum and muscles are stupidly pushed apart with a curved hemostatic clamp. An intestinal pulp or a terminal clamp is inserted through the incision into the abdominal cavity, under visual control, the instrument captures a reduced formation and removes it from the abdominal cavity. Then the ovary is placed on a gauze cloth soaked in warm saline, and an incision is made along the edge of the healthy ovarian tissue with a scalpel so as not to injure the tumor capsule. The edges of the incision are taken onto the clamps of Pean, the hemostatic clamp captures the free part of the capsule, it is husked and removed in a sharp and blunt way. Ovarian integrity is restored by applying catgut sutures in 2 rows. Then the ovary is immersed in the abdominal cavity. The abdominal wall wound is sutured in layers: 1–2 silk sutures for aponeurosis, 1 catgut suture for subcutaneous fat, 1, sometimes 2 silk sutures are sutured to the skin.

 The postoperative period is active: the regimen is free, 4-6 hours after the operation, patients are allowed to get up, drink and eat food on a common table. Anesthetics are used only in the first day (non-narcotic analgesics are prescribed). Sutures are removed on the 5th day, and the next day the patients are discharged home.

 The method was tested in the gynecological department of the 1st city clinical hospital in Krasnodar for 16 patients.

 The results showed that the postoperative period was uneventful and did not require the use of narcotic analgesics, the hospital stay after the operation was reduced to 5-7 days, and there were no postoperative complications.

 Example 1. Patient D., 21 years old. Received planned surgical treatment for cystoma of the right ovary. The patient underwent laparoscopy, during which it was found: antero- and lateral space without pathology. Sacro-uterine ligaments are visible, without pathology. The uterus is visible, normal in size, without pathology.

 Right appendages of the uterus: the ovary is visible, enlarged due to a cystoma 7 x 6 x 5 cm. The fallopian tube is visible along the entire length_11_cm, the shape is not changed, fimbriae are expressed, the color is normal.

 Left uterine appendages: the ovary is visible, measuring 3 x 2.5 x 2 cm, without pathology. The fallopian tube is visible throughout, length_10_cm, the shape is not changed, fimbriae are expressed, the color is normal.

 Laparoscopic diagnosis: Cystoma of the right ovary.

 Produced: cystoma punctured, its contents evacuated (serous fluid - 60 ml, "cito" sent for cytological examination). The incision at the site of the trocar introduced to the right was expanded to 3 cm. Through it, the ovary, which was reduced in size, was captured by the intestinal pulp and brought to the anterior abdominal wall, laid on a gauze cloth soaked in warm saline. With a scalpel, the ovary is dissected over the capsule of the cystoma in the most thinned area, the blunt capsule of the latter is husked. The cystoma bed and ovarian tissue are sutured with separate catgut sutures in 2 rows. Control for hemostasis. The ovary is returned to the abdominal cavity. The wound of the abdominal wall is sutured in layers, one silk suture is applied to the aponeurosis and skin. Control laparoscopy was performed and, as a preventive measure, subsequent washing of the small pelvis with sodium hypochlorite solution. A telescope was removed from the abdominal cavity, and then a trocar, the wound in the umbilical ring was sutured with one silk suture. The wounds in the umbilical ring and in the lower abdomen are treated with an alcohol solution of chlorhexidine and sealed with a sterile sticker.

 The result of a punctate cytological examination: a light yellow liquid, transparent. Microscopy: flat epithelium - 0-0-0-1-1 in the field of view, no red blood cells, no white blood cells, no VK, no atypical cells.

 Histological examination of the capsule: serous papillary adenocystoma.

 The postoperative period was uneventful, on the 5th day the sutures were removed, healing by first intention, the patient was discharged home in satisfactory condition.

 Example 2. Patient O., 20 years old, was admitted to the department with a diagnosis of bilateral ovarian cysts. Prior to admission to the hospital, she received a full course of resolving therapy, without effect. The patient underwent laparoscopy, in which it was found: serous effusion in the abdominal cavity, 10 ml. Anterior and supporting space without pathology. Sacrouterine ligaments are visible, without pathology. The uterus is visible, the shape is correct, dimensions_5_x_4_x_3_cm, without pathology.

 Right appendages of the uterus: the ovary is visible, dimensions 5_x_4_x_3.5_cm with cystic cavities and pronounced vascular pattern. The fallopian tube is visible along its entire length, 10_cm long, the shape is not changed, fimbriae are expressed, the color is normal. Wide uterine ligament, appendix and omentum without pathology. Left uterine appendages: the ovary is enlarged due to a cyst measuring _6_cm in diameter, with a thin smooth capsule and a pronounced vascular pattern. The fallopian tube is visible along its entire length, 10_cm long, the shape is not changed, fimbriae are expressed, the color is normal. Wide uterine ligament and intestines without pathology.

 Laparoscopic diagnosis: Cyst of the left ovary, cystic degeneration of the right ovary.

 Produced: The cyst is punctured on the left, the contents are straw-yellow liquid, 30 ml, “cito” was sent for cytological examination, then the ovary was removed from the abdominal cavity through the 3 cm incision in the left iliac region and laid on a gauze cloth soaked in warm saline, the cyst removed by husking. The ovary is sutured with a 2-row catgut suture, control for hemostasis, and then lowered into the abdominal cavity. Puncture of the right ovary - 5 ml of straw-yellow fluid, the ovary through a 3 cm incision in the right iliac region is removed into the wound, laid on a gauze cloth soaked in warm saline, and then resected within healthy tissue, followed by suturing with a two-row catgut suture, control for hemostasis, after which the ovary is lowered into the abdominal cavity.

 Control examination: there is no bleeding, the pelvis is washed with a solution of sodium hypochlorite as a prophylactic measure. A telescope was removed from the abdominal cavity, and then a trocar, wounds in the umbilical ring and iliac regions were sutured with a silk suture, treated with an alcohol solution of chlorhexidine and sealed with a sterile sticker.

The result of cytological examination of punctate:
of the right ovary - a liquid of light yellow color, transparent. Microscopy: flat epithelium - 0-0-1-1-1 in the field of view, erythrocytes - 1-2 in the field of view, white blood cells - 1-3 in the field of view, VK - no, atypical cells - no.

 of the left ovary - a liquid of light color, transparent. Microscopy: no red blood cells, no white blood cells, no VK, no atypical cells.

Histological examination:
tissue of the right ovary - follicular cyst, hemorrhage in the tissue of the ovary;
capsules of a cyst of the left ovary - follicular cyst.

 The postoperative period was uneventful, on the 5th day the sutures were removed, healing by first intention, the patient was discharged home in satisfactory condition.

 A comparative analysis showed that the use of our proposed method for treating cysts and cysts contributed to a decrease in the morbidity rate, a decrease in the number of postoperative complications, a reduction in the duration of postoperative hospital stay, periods of incapacity for work, and, as a result, a reduction in economic costs compared to traditional methods.

Claims (2)

 1. A method of treating cysts and ovarian cysts, including the removal of a neoplasm with a capsule, characterized in that the neoplasm with a capsule is removed on the ovary removed through a minilaparotomy incision.  2. The method according to claim 1, characterized in that prior to excretion of the ovary with the neoplasm, laparoscopy and evacuation of the contents of the neoplasm are carried out previously.