RU2197909C1 - Method for surgical treatment in case of uterine descent and partial uterine prolapse in combination with hypertrophy and background diseases of uterine cervix - Google Patents

Abstract

FIELD: medicine, operative gynecology. SUBSTANCE: one should remove mucosal fragment out of anterior vaginal wall. Affected part of uterine cervix is resected with a cone. From the sides of uterine cervix one should cut triangular fragments upon nutritive pedicles. Opened muscular parts should be wedge-likely dissected from both sides. Both right and left triangular fragments should be turned into cervical canal. Anterior colporrhaphy is carried out. Cardinal ligaments are sutured before uterus. Posterior colporrhaphy is carried out along with perineolevatoroplasty. The method enables to restore uterine and vaginal cervix anatomically and functionally in case of uterine descent and partial uterine prolapse along with hypertrophy and background diseases of uterine cervix. EFFECT: higher efficiency of operation. 6 dwg, 1 ex

Description

 The invention relates to medicine, namely to operative gynecology.

 The prototype of the proposed method of surgical treatment is the Manchester operation. The operation is as follows. From the front wall of the vagina 1.5-2 cm below the external opening of the urethra, a triangular flap is turned off, facing down with its base. A circular incision is made around the cervix at the level of the last transverse fold of the vagina only in front to the level of the cardinal ligaments. The bladder and vaginal mucosa are separated upward. A wedge-shaped amputation of the cervix is performed. The cardinal ligaments are stitched together in front of the uterus. Wedge-shaped sections on the front and back lips of the cervix are sutured with single sutures. The side parts of the cuts on both sides are connected by separate seams. Anterior and posterior colporography with perineolevatoroplasty is performed (L.S. Persianinov. Operational gynecology. M: Medicine, 1976, p. 297, 298).

 But the use of this method does not allow the formation of a macroscopically healthy cylindrical cervix in the presence of hypertrophy and the presence of a lesion around the external pharynx of the cervix in the form of background diseases in combination with prolapse and incomplete prolapse of the uterus and causes a significant shortening of the cervix in women of reproductive age. Restoration of the cervix and vagina in order to restore the specific functions of the female body continues to be one of the urgent problems of operative gynecology.

 EFFECT: anatomical and functional restoration of the cervix and vagina with prolapse and incomplete prolapse of the uterus in combination with hypertrophy and background diseases of the cervix.

 In FIG. 1 shows a method for tracing and separating an oval vaginal flap, excising the affected part of the cervix around the external pharynx with a cone, excising and separating triangular flaps from the sides of the cervix, with the base turned outward, leaving feeding legs 3-4 mm wide. In FIG. 2 shows a method of wedge-shaped excision of exposed muscle sections from the sides of the cervix after separation of the mucous membrane. Figure 3 shows a method of applying single-row single sutures to the muscle tissue of excised edges, deploying a triangular mucosal flap around the feeding leg and suturing its base to the upper part of the edge of the cervical mucosa formed after excision of the cone. Figure 4 shows a method of applying a ligature for tucking the upper flap of the mucosa into the cervical canal. In FIG. 5 depicts a method for applying a ligature for tucking the lower flap into the cervical canal and a method for stitching cardinal ligaments in front of the uterus. In FIG. 6 shows the location of the sutures on the mucous membrane of the cervix and the anterior colporography.

 The proposed method of surgical treatment is as follows. 1.5-2 cm below the external opening of the urethra from the anterior wall of the vagina, an oval flap is removed and an oval flap 1 is removed. The affected part around the external pharynx of the cervix is excised with a cone 2. Triangular flap 3 is cut out and separated from the sides of the cervix, with the base turned outward. When separating, the feeding legs 4 of 3-4 mm wide remain, the location of which corresponds to the upper corner of the base of the right (relative to the surgeon) triangle and the lower corner of the base of the left triangle. The muscle sections that are exposed after separation are wedge-shaped on both sides 5. The freshened edges are connected with single catgut sutures 6. The right triangular separated mucosal flap is deployed around the feeding leg and the base of the triangle is sewn to the upper edge of the cervical mucosa formed after excision of the cone with single catgut sutures 7 with minimal grip on the edges. The mucous membrane is tucked into the cervical canal as follows. The seam begins to impose, stepping 3-4 mm from the top of the triangle. Then the end of the ligature 8 is carried out from the cervical canal through the entire thickness of the cervical tissue to the mucosa with a puncture 1.5-2 cm above the edge of the cervix. After that, the other end of the same ligature is inserted into the needle and the ligature is repeated next to the first. The ends of the ligatures are connected. The left flap of the separated mucosa is also deployed around the feeding leg and the base of the triangle is sutured to the lower part of the edge of the cervical mucosa. The left leaf is screwed into the cervical canal in the same way as the right. The cardinal ligaments 9 are sutured together in front of the uterus by a vicryl suture 10. The next step is to perform anterior and posterior colporaphia with perineolevatoroplasty (Figs. 1-6).

 Example 1. Patient R., 35 years old, East. 1387. Was admitted to the hospital with a diagnosis of hypertrophy, cervical leukoplakia, uterine prolapse. Poor pelvic floor muscle failure.

 Complaints of discomfort in the external genital organs, sexual disorders.

 A history of 2 births, 5 medical abortions. During the first birth, perineal rupture of 2 degrees. Secondary healing.

 Objectively, when examined in the mirrors, bimanual and colposcopic examination: the genital gap gapes, the cervix extends beyond the genital gap, the uterus is omitted, the cervix is hypertrophied, normal length, leukoplakia around the external pharynx, and pelvic floor muscle failure.

 The patient underwent a complete clinical and laboratory examination. Plastic surgery is shown as planned.

 Given the totality of clinical data, the woman was operated on by our proposed method. 1.5-2 cm below the external opening of the urethra from the anterior wall of the vagina, an oval flap is removed and removed. The affected part around the external pharynx of the cervix is excised with a cone. From the sides of the cervix, triangular rags are cut and separated, with the base facing outwards. During separation, feeding legs of 3 mm wide were left, the location of which corresponded to the upper corner of the base of the right triangle and the lower corner of the base of the left triangle. The bare muscle sections after separation are wedge-shaped excised on both sides. Refreshed edges are connected by single kettutic sutures. The right triangular separated flap of the mucosa is deployed around the feeding leg and the base of the triangle is sewn to the upper part of the edge of the mucous neck of the uterus, formed after excision of the cone, with single catgut sutures with minimal grip of the edges. The mucous membrane is folded into the cervical canal as follows. The seam began to impose, stepping back 4 mm from the top of the triangle. Then the end of the ligature was carried out from the cervical canal through the entire thickness of the cervical tissue to the mucosa with a puncture 1.5-2 cm above the edge of the cervix. After that, the other end of the same ligature was inserted into the needle and the ligature was repeated next to the first one. The ends of the ligatures are tied together. Thus, the right leaf of the separated mucosa was screwed into the cervical canal. The left flap of the separated mucosa was also deployed around the feeding leg and the base of the triangle was sutured to the lower edge of the cervical mucosa. The left leaf was tucked into the cervical canal in the same way as the right. The cardinal ligaments were sewn together in front of the uterus with a vikril seam. The next step was performed anterior and posterior colporaphia with perineolevatoroplasty.

 The postoperative period without complications. Healing of the perineal skin by primary intention. The condition of the cervix was evaluated after 1.5 months when examined in the mirrors and colposcopically. Macroscopically, the neck is cylindrical in shape, of normal length, the external pharynx is slit-like, and colposcopically — uniform staining with Lugol's solution.

 With a combination of hypertrophy, background diseases of the cervix, prolapse or incomplete prolapse of the uterus, the method of surgical treatment we have proposed is optimal for women of reproductive age, as it helps to restore the specific functions of the female body. At the same time, the neck restored by our method looks macroscopically healthy, maintains a normal length, which cannot be achieved using other methods with this combined pathology. Thanks to the gentle and rational technique for excising the mucous flaps and muscle tissue of the cervix, this operation eliminates the shortening of the cervix, the method of forming the mucous membrane of the cervix excludes narrowing and contraction of the cervical canal.

 This method operated on 6 patients with positive immediate and long-term results.

Claims (1)

 A method for the surgical treatment of prolapse and incomplete prolapse of the uterus in combination with hypertrophy and background diseases of the cervix by performing anterior colpography, suturing the cardinal ligaments in front of the uterus, forming the cervix, posterior colporography with perineoleoplasty, characterized in that an oval flap is separated and an oval flap is removed and removed mucous membrane, the affected part around the external pharynx of the cervix is excised with a cone, triangular flaps are cut out and separated from the sides of the cervix, based face outwards, so that 3-4 mm wide feeding legs remain, the location of which corresponds to the upper corner of the base of the right triangle and the lower corner of the base of the left triangle, the sections of the muscle that are exposed after separation are wedge-shaped from both sides, the freshened edges are connected with sutures, the right triangular the separated flap of the mucous membrane is deployed around the feeding leg and the base of the triangle is sewn to the upper part of the edge of the mucous neck of the uterus, formed after excision of the cone, with single you, to tuck the mucosa into the cervical canal, the suture begins to be applied, stepping 3-4 mm from the top of the triangle, then the end of the ligature is drawn from the cervical canal through the entire thickness of the cervical tissue to the mucosa with a puncture 1.5-2 cm above the edge of the cervix, after of this, the other end of the same ligature is inserted into the needle and the ligature is repeated next to the first, the ligature ends are connected together, the left flap of the separated mucous membrane is deployed around the feeding leg and the base of the triangle is sutured to the lower part of the cervical mucosa edge, the left leaf is screwed into the cervical canal in the same way as the right.

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