UA15125U - Technique for peritonization of small pelvis after hysterectomy - Google Patents

Abstract

The technique for peritonization of the small pelvis after the hysterectomy comprises applying the sutures between the layers of the dissected peritoneum of small pelvis. The edge of the dissected peritoneum of small pelvis covering the urinary bladder is sewed by the interrupted sutures to the wall of the anterior semicircle of the stump of vagina below the suture line of the stump of vagina. The edge of the dissected peritoneum of small pelvis covering the posterior semicircle of the stump of vagina is sutured to the peritoneum of small pelvis covering the urinary bladder.

Description

Description of the invention

The useful model belongs to medicine, namely to oncology and can be used in 2 surgical treatment of cancer of the female genital organs.

In the surgical treatment of cancer of the female genital organs, one of the most common types of surgical interventions is extirpation of the uterus. Unfortunately, in a number of cases, after the extirpation of the uterus, patients develop urothelial-vaginal fistulas. Inflammatory processes in the area of the sutured stump of the vagina, which spread to the back wall of the bladder, lead to the formation of urothelial fistulas. The development of the 70 inflammatory process in the area of the vaginal stump is facilitated by radiation therapy in the pre- or postoperative periods | (Bardchev M.S., Katsalap S.M., Kurpesheva A.K. et al. Diagnosis and treatment of local radiation damage // Med. radiology - 1992. - Vol. 37, Mo. 11. - P. 12-14), trophic disturbance of the back wall of the urinary bladder due to mobilization of the anterior semicircle of the vagina, reaction to the suture material used to suture the stump of the vagina. 12 A well-known method of peritonization of the small pelvis after extirpation of the uterus, chosen as a prototype, in which "the vagina is closed with catgut sutures, hemostasis is checked and peritonization of all stumps is performed.

To reduce free spaces, the peritonization suture is connected in one or two places with the suture on the stump of the vagina"

IDaviidov S.N., Khromov B.M., Sheyko V.3. Atlas of gynecological operations. - L., Medicine, 1973. - P.1621.

The disadvantage of the prototype method is that after the peritonization of the pelvis, the back wall of the urinary bladder is partially denervated and partially devascularized as a result of mobilization of the anterior semicircle of the vagina, directly adjacent to the line of sutures with which the vaginal stump is sewn. Adherence of the muscular membrane of the back wall of the urinary bladder to the sutured stump of the vagina determines the spread of the inflammatory process directly from the vaginal wound to the bladder. In cases of a pronounced inflammatory process, this can lead to the development of uro-vaginal fistulas. 29 A useful model solves the problem of preventing the development of urothelial-vaginal fistulas after the extirpation of the uterus in patients with malignant neoplasms of the female genital organs, including those subjected to combined treatment.

The task is solved by the fact that the edge of the dissected peritoneum of the small pelvis, which covers the urinary bladder, is sewn with knotted sutures to the wall of the anterior semicircle of the vaginal stump below the seam line of the vaginal stump, and at 30 the edge of the dissected peritoneum of the small pelvis, which covers the back semicircle of the vagina, is sewn to the peritoneum, which covers the bladder, at the level of 2-2.2 cm from its edge.

What is new in the claimed method is that the peritoneum that covers the urinary bladder is sewn to the wall - the front semicircle of the vaginal stump below the line of the vaginal stump seam, and the edge of the dissected peritoneum of the small pelvis that covers the back semicircle of the vagina is sewn to the peritoneum that covers the urinary bladder, at the level of 2-2.2cm from its 3rd edge.This ensures the isolation of the muscular membrane of the back wall of the urinary bladder from the line of sutures, which the vagina was sewn with, that is, from the area of inflammation.

The essence of the method is explained in figures 1-3.

Fig. 1 shows the imposition of nodal sutures between the peritoneum of the small pelvis, which covers the urinary bladder, and the anterior semicircle of the vagina: Z 50 1 - the edge of the dissected peritoneum of the small pelvis, which covers the posterior semicircle of the vagina; c 2 - stump of the vagina;

Iz» Z - the wall of the front semicircle of the stump of the vagina; 4 - the edge of the peritoneum of the small pelvis, which covers the bladder; - muscular shell of the back wall of the urinary bladder; 45 6 - knotted sutures, with which the edge of the dissected peritoneum of the small pelvis, which covers the urinary bladder, is sewn to - the wall of the front semicircle of the vaginal stump. 4! Figure 2 shows the imposition of nodal sutures between the edge of the dissected peritoneum of the small pelvis, which covers the posterior semicircle of the vagina, and the peritoneum, which covers the bladder: - 1 - the edge of the dissected peritoneum of the small pelvis, which covers the posterior semicircle of the vagina; ka 20 4 - the edge of the peritoneum of the small pelvis, which covers the bladder; 7 - knotted sutures, with which the edge of the dissected peritoneum of the small pelvis, which covers the posterior semicircle of the vagina, is sewn to the peritoneum, which covers the bladder at the level of 2 cm from its edge.

Figure 3 shows the general appearance of peritonization of the pelvis after tying the ligatures of all sutures: 1 - the edge of the dissected peritoneum of the pelvis, which covers the posterior semicircle of the vagina; 4 - the edge of the peritoneum of the small pelvis, which covers the bladder; c The method is carried out as follows. Extirpation of the uterus with appendages is performed, the stump of the vagina is sutured. The ligatures of the tied sutures used to sew the vagina are not cut. By pulling these ligatures, the vaginal stump is brought out as much as possible into the wound. Nodal sutures 6 are applied between the edge of the dissected peritoneum of the small pelvis 4, which covers the urinary bladder 5 and the front semicircle of the vaginal stump 2, below the line of the vaginal stump suture. The sutures are tied, as a result of which the peritoneum 60, which covers the bladder, completely isolates its muscular shell from the vaginal stump. The threads of the tied sutures are cut, with which the peritoneum of the urinary bladder is fixed to the front semicircle of the stump of the vagina. The ligatures of the seams, which were used to sew the vagina, are cut. The edge of the dissected peritoneum of the small pelvis, which covers the back semicircle of the vagina 1, is sewn with knotted sutures 7 to the peritoneum, which covers the bladder 4, at a level of 2 cm from its edge. The ligatures of the sutures are tied and the threads are cut. because As a result, the muscular shell of the back wall of the urinary bladder is reliably isolated from the stump of the vagina, which makes it possible to exclude the spread of the inflammatory process to it. Applying the second row of sutures, which fix the edge of the dissected peritoneum of the small pelvis, which covers the posterior semicircle of the vagina, to the peritoneum of the urinary bladder, allows isolating the stump of the vagina from the abdominal cavity. This prevents the spread of the inflammatory process from the stump of the vagina to the abdominal cavity.

An example of a specific implementation of the method.

Patient 3., born in 1961, medical history Mo48834, ХО5-cervical cancer Irst T1MO MO.

The patient underwent a radical hysterectomy. PGD Mo39867-74: Squamous non-keratinized cancer in the cervix with deep invasion. Tumor elements were not detected in the iliac lymph nodes. 70 In order to prevent the formation of a bladder-vaginal fistula, peritonization of the small pelvis was performed according to the stated method.

In the postoperative period, the patient received a course of combined radiation therapy (intracavity radiation therapy SOD 20 Gy, remote radiation therapy - 40 Gy).

After the combined treatment using the claimed method, there were no complications on the side of the urinary /5 Bladder. Currently, the patient is under observation. The state of urination is not disturbed, there are no pathologies on the side of the urinary system.

According to the stated method, 8 patients were operated on. Inflammatory complications in the pelvis, bladder-vaginal fistulas in the postoperative period and 12 months after the operation were not observed.

Claims (1)

The formula of the invention is the method of peritonization of the pelvis after the extirpation of the uterus, which includes suturing between the sheets of the dissected peritoneum of the pelvis, which differs in that the edge of the dissected peritoneum of the pelvis, which covers the bladder, is sewn with knotted stitches to the wall of the front semicircle of the stump of the vagina below the suture line stumps of the vagina, and the edge of the dissected peritoneum of the small pelvis, which covers the back semicircle of the vagina, is sewn to the peritoneum, which covers the bladder, at the level of 2-2.2 cm from its edge. IF) s «- IF) yo - and? - 1 - name) sl 60 b5