What is the process of myomectomy? How is myomectomy performed?

[anaesthetization]

1. Continuous epidural block anesthesia.

2. General anesthesia with endotracheal intubation.

[Preoperative preparation]

Preoperative cervical smear, diagnostic curettage, and exclusion of cervical and uterine malignancies.

[Surgical steps and technical points]

1. Incisions: midline incision in the lower abdomen or transverse incision above the pubic symphysis.

Cervical isthmus ligation of uterine blood vessels Figure 2

2. Understand the location, size and number of uterine fibroids to determine the uterine incision.

3. Blocking the blood supply to the uterus Before removing the uterine body fibroids, make a small incision in the avascular area of ​​the left and right broad ligaments of the uterine canyon, pass a rubber tourniquet through it, tie up the uterine movement and veins, and temporarily block the blood supply (Figure 1). If the operation time is long, relax the tourniquet for 1 minute every 10 to 15 minutes. Inject a contractant into the myometrium to reduce bleeding during the operation.

Separate the fibroids and process the fibroid base

4. Removal of intramural fibroids: In the area with fewer blood vessels on the surface of the fibroid, longitudinal, fusiform or arc-shaped incisions are made according to the size of the fibroid (Figure 2), deep into the fibroid capsule, and blunt separation is performed along the surface of the capsule (Figure 3). When there are many basal blood vessels, the tumor can be clamped and removed (Figure 4), and the stump can be sutured (Figure 5). Use absorbable suture "8" words or continuous suture of 1~2 layers of the muscle layer (Figure 6). Be careful to avoid dead space when suturing. Intermittent or continuous mattress suture of the serosa layer (Figure 7). For multiple fibroids, multiple fibroids should be removed from one incision as much as possible. For fibroids close to the uterine horns, the incision should be as far away from the uterine horns as possible to prevent postoperative scars from affecting the patency of the fallopian tubes. Medicine All Online

Suture the muscular layer

5. Resection of subserosal myomas This type of myoma often has a pedicle, and the tumor pedicle can be clamped close to the uterine wall to remove the myoma (Figure 8). When the tumor pedicle is wide, a fusiform incision can be made at the base (Figure 9) to remove the uterine tumor pedicle and superficial muscle layer.

Stitching slurry base

6. Submucosal myoma resection If the myoma obviously protrudes into the uterine cavity, the tumor needs to be removed by entering the uterine cavity. When suturing the myometrium, the mucosal layer should be avoided to prevent the endometrium from implanting into the myometrium and artificially causing endometriosis. Submucosal myoma with pedicles can be removed through the vagina.

In life, we must pay attention to our health, especially some female friends who drink alcohol for a long time and do not pay attention to sleep time, which will cause great harm to their bodies. I introduce hysteromyomectomy and hope it will be of some help to patients and friends.