RU2271763C2 - Method for ovarian fixation after extirpation or supravaginal uterine amputation with tubes - Google Patents

Abstract

FIELD: medicine, operative gynecology.

SUBSTANCE: one should leave ligatures upon the stumps of ovarian own ligaments and parietal peritoneum of ovarian tubular pole, then on should tighten up ovaries by the ligatures kept to fix them towards lateral walls of small pelvis, around each ovary it is necessary to develop a channel out of parietal peritoneum to fix it to the tissues of parietal peritoneum of small pelvis with separate interrupted sutures. The innovation enables to prevent ovarian prolapse in small pelvis cavity after operation and imitate ligamentous apparatus destroyed by ovaries.

EFFECT: higher efficiency of ovarian fixation.

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Description

The invention relates to medicine, namely to oncology, and can be used in gynecology, during surgical interventions in young women with tumors of the genital area, in particular tumors of the cervix, uterus, choriocarcinoma stage I.

It is known that forced and untimely removal of the ovaries has a detrimental effect on the woman's body, disrupting the interaction of the endocrine glands and causing autonomic disorders. Total removal of the internal genitalia is not always justified. Organ-saving operations not only relieve the disease, but also allow you to save the function of the organ.

There is a method of preserving the ovaries when performing a hysterectomy (see atlas "Operational gynecology" K.B. Akunts, Moscow, 1996, pp. 130-142), which consists in the free leaving of the ovaries after removal of the uterus on the vascular pedicle - funnel pelvic ligament.

However, this method of operation leads to an excess of vessels in 8-22% of cases, edema, venous stasis in the ovarian tissue, which disrupts the cyclical production of hormones and leads to organic changes, forms cysts, and in 1.6% of cases, ovarian tumors.

The known "Method of fixation of the uterine stump" (see ed. Certificate No. 984472 from 12.30.82, Bull. No. 48 from 01.01.83) after supravaginal amputation of the uterus with appendages, characterized in that they are sutured to prevent sagging and prolapse of the uterine stump. stumps of round uterine ligaments with each other, the arch formed as a result of suturing is immersed in the bottom of the wedge-shaped excised uterine stump and the posterior wedge-shaped stump, the arch of round ligaments and the front section of the wedge of the uterus are stitched with separate catgut sutures.

Using the method prevents sagging and prolapse of the uterine stump after the operation of the supravaginal amputation of the uterus with appendages, however, the methods of this method may not be acceptable for fixing other organs of the genital area. In particular, due to the anatomical features of women - shortened funnel-pelvic ligaments and round uterine ligaments.

The aim of the invention is to prevent sagging of the ovaries in the pelvic cavity after surgery and imitation of the ligamentous apparatus lost by the ovaries.

This goal is achieved by the fact that after extirpation or supravaginal amputation of the uterus with tubes with shortened funnel-pelvic and round uterine ligaments, the ovaries are fixed to adjacent anatomical structures - ligatures are left on the stumps of the ovarian ligaments and the parietal peritoneum of the ovarian tube, and the ovaries are pulled by the left ligature they are fixed to the side walls of the pelvis, a bed is formed around each ovary, fixing it to the tissues of the parietal peritoneum with separate interrupted sutures.

The invention, "A method for fixing the ovaries after extirpation or supravaginal amputation of the uterus with tubes," is new, since it is unknown from the level of medicine in the surgical treatment of young women with uterine tumors.

The novelty of the invention lies in the fact that after extirpation or supravaginal amputation of the uterus, the ovaries hang freely in the pelvic cavity and due to the anatomical features of the shortened funnel-pelvic and round uterine ligaments, it is impossible to fix the ovaries in a known way of fixing the genitals, imitate the ligament lost by the ovaries during surgery apparatus. The ovaries are fixed to adjacent anatomical structures. On the stumps of their own ligaments of the ovaries and the parietal peritoneum of the tube pole of the ovaries, ligatures are left, the ovaries are pulled by the left ligatures and fixed to the lateral walls of the pelvis, a bed is formed around each ovary, fixing it to the tissues of the parietal peritoneum with separate nodal sutures.

The invention "A method for fixing the ovaries after extirpation or supravaginal amputation of the uterus with tubes" is industrially applicable, as it can be used in healthcare, both in specialized oncology hospitals and in the general medical network, the Research Institute of Oncology during surgical interventions in young women with uterine tumors , benign and background diseases of the genitals.

"A method of fixing the ovaries after extirpation or supravaginal amputation of the uterus with tubes" is as follows.

After performing the main stages of the operation and removing the uterus with tubes, young women surgically imitate the ligamentous apparatus lost by the ovaries and fix the ovaries to adjacent anatomical structures. When performing a surgical procedure, the left ovaries hang freely in the pelvic cavity. If there are short funnel-pelvic and round uterine ligaments on the stumps of their own ligaments of the ovaries and the parietal peritoneum of the tubular pole of the ovaries, ligatures are left, the ovaries are pulled by the left ligatures and fixed to the lateral walls of the pelvis, a bed is formed around each ovary, fixing it to the tissues of the parietal peritoneum small pelvis with separate interrupted sutures.

An example of a specific implementation of the "Method of fixation of the ovaries after extirpation or supravaginal amputation of the uterus with tubes."

Patient S., 34 years old, was admitted to the gynecological department of RNII in May 2001, case history No. 765 / n, with a diagnosis of cervical cancer stage I, clinical group II. From the anamnesis it is known that the patient experienced contact hemoptysis for 6 months. In April, the patient turned to a gynecologist at the place of residence, where, based on a biopsy of the cervix, she was diagnosed with cervical cancer (histological analysis No. 564 - squamous cell carcinoma). At the time of admission to the institute during a gynecological examination, the cervix, represented by an exophytic tumor, which was bleeding in contact, was determined in the mirrors. During vaginal examination revealed: the uterus is slightly larger than normal, appendages without features. Vaults, parametries are free. Vaginal discharge is sacred with separate sections of the tumor mass. The patient was offered an operation - hysterectomy with appendages with fixation of the ovaries by the proposed method, pelvic lymphadenectomy. After performing the main stages of the operation and removing the uterus with tubes, pelvic lymphadenectomy by surgery, the ligament apparatus lost by the ovaries is imitated, the ovaries are fixed to adjacent anatomical structures. When performing a surgical procedure, the left ovaries hang freely in the pelvic cavity. The anatomical feature of this case is the presence of short funnel-pelvic and round uterine ligaments, ligatures are left on the stumps of the ovarian ligaments and the parietal peritoneum of the tube pole of the ovaries, the ovaries are pulled by the left ligatures and fixed to the side walls of the pelvis, forming a bed around each ovary, fixing it to the tissues of the parietal peritoneum of the pelvis with separate interrupted sutures. The operation went without complications. The postoperative period was uneventful. Postoperative histological analysis No. 1453 - squamous cell carcinoma with invasion into the stroma of 2 mm, No. 1454-1460 - there is no cancer metastasis in the lymph nodes. Sutures were removed on the 8th day. Given the microinvasive nature of the tumor process, the absence of the need for radiation therapy, the patient was discharged in a satisfactory condition home under the supervision of an oncologist at the place of residence. Observed in the clinic RNII for 2 years. There were no signs of tumor recurrence, as well as dishormonal disorders.

The technical and economic effectiveness of the “Method for fixation of the ovaries after extirpation or supravaginal amputation of the uterus with tubes” consists in the fact that the surgical method of physiological preservation of the ovaries in young women with oncological pathology - tumors of the cervix, uterus, uterus choriocarcinoma allows to perform gentle and perfect in functional terms, the volume of surgical interventions provides fixation of the ovaries in the pelvic cavity in a position that mimics the natural. The method can be widely used both in specialized oncology hospitals, and in the general medical network.

Claims (1)

A method of fixation of the ovaries after extirpation or supravaginal amputation of the uterus with tubes, including surgical intervention, characterized in that when shortened funnel-pelvic or round uterine ligaments after extirpation or supravaginal amputation of the uterus with tubes on the stumps of their own ligaments of the ovaries and the parietal peritoneum of the tubular pole of the ovaries , pull the ovaries behind the left ligatures and fix them to the side walls of the pelvis, around each ovary form a bed of parietal peritoneum, iruyut it to the tissues of the pelvic peritoneum single interrupted sutures.