RU2336837C1 - Method for female tubal asexualisation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: female tubal asexualisation is made by exsection of tube isthmic part and ligation of the tube stumps on the both sides. The medial tube stump is turned to metra and sewn to lower posterior part of the tube intact part going from the metra angle. The ends of suture used to ligature the lateral tube stump are peritonised by mezosalpings folia and ablated above the knot. Then this stump shifts independently to the side of the peritonised medial stump not less than 5-7 cm. The method allows exclusion of uterine tubes recovery after tubal asexualisation.

EFFECT: exclusion of uterine tubes patency after tubal asexualisation.

1 ex, 3 dwg

Description

The invention relates to medicine, namely to obstetrics and gynecology.

With all modern methods of tubular sterilization, failures (pregnancy) are observed annually after 0.3-1.0% of such operations (N.D.Selezneva, 2006). To prevent sterilization failures, the stumps of the crossed stump should not be allowed to approach (L.S. Persianinov, 1971).

A known method of sterilization by ligation of the fallopian tube near the corner of the uterus (S.K. Rakhimov, 1990. Copyright certificate SU 1600715 A1), however, this technique is not always reliable, because the section of the oviducts is not crossed or excised, sometimes their patency can be restored due to weakening of the ligature or insufficiently strong ligation of the pipe (N.D.Selezneva, 2006).

The Dutzman sterilization method is also known, in which a pipe section is excised after deserting it, followed by immersion of both pipe stumps alternately between the mesosalpinx leaves, however, this technique is painstaking and time-consuming and does not always ensure sufficient separation of the intersected sections of the oviducts.

The aim of the invention is the exclusion of restoration of patency of the fallopian tubes after tubal sterilization.

This goal is achieved by a significant separation and the impossibility of drawing together the stumps of the excised isthmic part of the tube after peritonization of the medial stump with mesosalpinx leaves.

The stages of the proposed method of pipe sterilization are presented in the drawings. Figure 1. - the introduction of a needle with two threads through the mesentery of the pipe in the isthmic section of it.

Figure 2. - displacement of the loop of each thread in opposite directions by 1.5-2 cm from the injection site into the mesosalpinx under the pipe; in this case, the pipe section is freed from the mesentery, then is ligated and excised.

Figure 3. - the medial stump of the tube rotates toward the corner of the uterus and is sutured to the lower posterior part of the intact part of the tube, then it is peritonized with leaves of the mesosalpinx.

The method is as follows.

The fallopian tube in the middle of the isthmic part is grasped by a clamp and, directly under the tube, through the mesosalpinx sheets, a needle with two self-absorbable ligatures (catgut, caproag, etc.) is passed from front to back. Then the ends of each thread are connected separately above the tube and, by shifting the loops of these threads in different directions by 1.5-2 cm (one to the side of the ampoule of the tube, the other to the side of the uterus angle), a section of the tube is stupidly separated from the mesosalpinx and the tube is bandaged with these threads at a distance of 2-3 cm between the nodes. The ligation section of the pipe is excised. Turning the medial stump of the tube toward the uterus, one of the filaments that bind it stitches the stump to the lower back of the intact part of the oviduct, extending from the corner of the uterus. Then, with two or three sutures or a purse-string suture with the same thread, peritonize this stump with mesosalpinx leaves located above and below the tube. The ends of the thread, which was tied to the lateral stump of the pipe, are cut off above the knot, and this stump is further independently displaced to the side from the peritonized medial stump by at least 5-7 cm. The possibility of future contact and connection of both pipe stumps is completely excluded. this ensures the absolute reliability of tube sterilization performed by this method on both pipes alternately. The method is more reliable and simple to execute than the Dutzman method, and is carried out 2 times faster.

This method was used in 15 patients mainly with repeated (including the third and fourth) cesarean section, if there are indications for sterilization and a woman’s written request for its implementation. The duration of follow-up since the resumption of sexual activity without contraception is from 2 to 16 months, the onset of pregnancy is not observed.

Clinical example. Rozhenitsa G., 34 years old, a resident of the district center, pregnancy VIII (previously 6 miscarriages), on 02.08.2005, a repeated cesarean section was performed in maternity hospital No. 2 in Ryazan due to thinning of the uterine scar, myomectomy, tubal sterilization with peritonization medial stump tubes. The postoperative period without complications, the healing of sutures of the abdominal wall by primary intention. Regular sex life was resumed 2 months after surgery - without contraception, pregnancy did not occur within 16 months.

The reliability and high efficiency of the proposed method of tubal sterilization is confirmed by clinical observation and the absence of pregnancy in 12 patients who have regular sex without contraception for 2-14 months from its resumption after sterilization.

Information sources

1. Persianinov L.S. Operative gynecology. M .: Medicine, 1971. - 552 p.

2. Rakhimov S.K. A method of sterilizing women. Copyright certificate for the invention SU 1600715 A1 - 1990. Bull. Number 39.

3. Selezneva N. D. Sterilization // Kulakov V.I., Selezneva N.D., Beloglazova E.E. Guide to operative gynecology. M., 2006 .-- 640 p. S.454-461.

Claims (1)

The method of tube sterilization by excising a section in the isthmic part of the tube with ligation of the stump of the tube, alternately on both sides, characterized in that the medial stump of the tube is turned towards the uterus, is sutured to the lower posterior part of the intact part of the tube extending from the uterus angle and peritonized with mesosalpinx sheets, the ends of the thread with which the lateral stump of the tube was ligated is cut off above the knot, and this stump even further independently moves away from the peritonized medial stump by at least 5-7 cm.

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