RU2271158C1 - Method for surgical treatment at elongation and prolapse of uterine cervix in women of reproductive age - Google Patents

Abstract

FIELD: medicine, operative gynecology.

SUBSTANCE: one should descend uterine cervix with pincers, isolate the cuff dorsally against uterine cervix, dissect cardinal ligaments, amputate uterine cervix, additionally, one should apply colporrhaphy. Then it is necessary to dissect cervical tissue in position of 3 and 9 o'clock wedge-shapely. Moreover, cuff's mucosa should be dissected in the same projection as a triangle. Then stumps of cardinal ligaments should be tightened up and fixed to uterine cervix stump in position of 3 and 9 o'clock. The innovation enables to improve regeneration in area of operational suture and cosmetic effect, prevent cicatricial deformation uterine cervix in postoperational period and keep uterine cervix-similar stump.

EFFECT: higher efficiency of therapy.

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Description

The present invention relates to medicine, namely to operative gynecology.

There is a method of surgical treatment for elongation and prolapse of the cervix in women of various age groups without regard to the state of reproductive function - amputation of the cervix according to Sturmdorf. The method is based on the following steps: lowering the cervix with forceps, excising the neck, separating the edges of the wound around the entire circumference, suturing and forming the external pharynx. (Rembez I.N. Operational gynecology. Kiev, 1985, p. 117). This method has several disadvantages: in some cases in the postoperative period, a severe deformation of the cervix in the external pharynx occurs due to corrugation of the mucosa when suturing at 3 and 9 hours of the cervix, the recurrence of prolapse is 13.5-43.8% . All this significantly increases oncological alertness, which subsequently requires repeated surgical treatment. Elongation and prolapse of the cervix is combined with cystocele; therefore, several operations have to be combined at the same time, in particular Sturmdorf operation with anterior colporaphia and bladder repair.

EFFECT: improved regeneration in the area of the surgical suture by comparing the edges of the wound, cosmetic effect, prevention of cicatricial deformation of the cervix in the postoperative period, preservation of the stump similar to the cervix.

Figure 1 shows a diagram of the preparation of fragments of the mucosa along the front wall of the vagina in the form of a triangular shape; figure 2 - the allocation of the mucous membrane of the cuff around the neck, immersion of the bladder in a pouch, amputation of the cervix; figure 3 - wedge-shaped resection of the mucous cuff and tissue of the cervix dorsally from the external pharynx at 3 and 9 hours, the allocation of cardinal ligaments, flashing them with vicryl, suturing at 3 and 9 hours to fix the cardinal ligaments ; figure 4 - cardinal ligaments tightened, located in the recesses at 3 and 9 hours and stitched in the area of the external pharynx. Sphenoid resection on the mucosa.

The proposed method for the surgical treatment of elongation and prolapse of the cervix is as follows.

The cervix 1 of the uterus is fixed with bullet forceps and lowered onto itself, along the front wall of the vagina, a flap 2 is cut and triangular in shape, 1 cm away from the external opening 3 of the urethra, section 4 is completed circulatory behind the neck. Cuff 5 is allocated dorsally from the neck. The bladder 6 is separated from the anterior wall of the cervix and immersed in a pouch 7. The cardinal ligaments 8 are fixed with a Kocher clamp and cut off, separated as much as possible from the cervix, stitched and laid aside. The cervix is amputated with a scalpel. The length of the amputated part of the neck depends on the degree of elongation. The tissue of the 9th neck at 3 and 9 hours and the mucous membrane of the 10 cuff are wedge-shaped in the same projection in the form of a triangle. The stumps of the cardinal ligaments 8 are pulled into the formed recesses to the external pharynx and hemmed. Suturing the stump of the cervix with fixation of the cardinal ligaments at 3 and 9 hours allows the uterus to be displaced as much as possible in relation to the planes of the small pelvis. Plastic processing of the remaining cervical stump is performed according to Sturmdorf (ibid., Pp. 117-119).

The proposed method of surgical treatment for elongation and prolapse of the cervix in the postoperative period promotes the formation of a cosmetic stump, similar to the neck, prevents the formation of a deforming scar.

The stages of this method are not technically complicated and do not affect the duration of the operation.

The proposed method of surgical treatment for elongation and prolapse of the cervix was operated on 32 patients of reproductive age.

The method is illustrated by the following examples.

Example 1. Patient Erushonkova N.A., 28 years old, No. 985. Diagnosis: Elongation of the cervix. Sop: Perineal rupture of the 2nd degree.

Local status: The external genitalia are developed correctly, according to the female type. When straining from the genital gap, the cervix elongates with a length of 6 cm of hypertrophyrofan, is not eroded, the external pharynx is closed.

P.V. the vagina is free, the uterus is not enlarged, dense, painless, deflected anteriorly. The area of the appendages without pathological formations. In the area of the posterior commissure there is a deep stellate, crotch-deforming scar. Discharge mucous.

The operation was performed under intravenous anesthesia, cervical amputation according to the proposed method. In the postoperative period, wound healing by primary intention.

After a year, a follow-up examination of the patient. The condition is satisfactory. There are no complaints. Local status: the vagina is narrow, deep, more than 10 cm long, the stump of the neck is 1 cm, conical in shape, the mucous membrane is pale pink, the external pharynx is in the form of an ovoid shape with even contours, resembling a pupil. The postoperative scar along the anterior and posterior wall of the vagina is soft, painless, in the area of the external pharynx - an even, barely noticeable scar.

Example 2. Patient Shmonina T.A., 30 years old., No. 5268 Diagnosis: Cervical prolapse, 2 tbsp.

Local status: The external genitalia are developed according to the female type.

O.Z. the cervix is cylindrical, hypertrophied, when strained, hangs from the genital gap by 2 cm.

P.V. the vagina is free, the uterus is anteriorly, not enlarged, the area of the appendages is without a pathological formation, the mucous discharge.

The operation is performed by the proposed method. The postoperative period was uneventful, healing by primary intention. Control inspection in a year.

There are no complaints.

Local status: narrow vagina, cervix 0.5 cm long, pale pink, external pharynx in the form of a pupil. The postoperative scar along the anterior and posterior wall of the vagina is presented in the form of a whitish formation, smooth, thin, painless, not soldered to the underlying tissues.

Claims (1)

A method of surgical treatment for elongation and prolapse of the cervix, including lowering the cervix with forceps, amputation of the cervix, suturing and the formation of the external pharynx, characterized in that they additionally perform anterior colporaphy, isolate the cuff dorsally from the cervix, cut off the cardinal ligaments, and cervical tissue is excised at 3 and 9 hours, and the mucous membrane of the cuff is excised in this projection in the form of a triangle, the stumps of cardinal ligaments are pulled up and fixed to the cervical stump at 3 and 9 hours.

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