What are the procedures for 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. Midline incision in the lower abdomen or suprapubic transverse incision.

Cervical septum ligation of uterine blood vessels Figure 2 Uterine surface incision

2. Explore and 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 myoma, make a small incision in the avascular area of ​​the left and right broad ligaments of the isthmus of the uterus, insert a rubber tube tourniquet through it, tie up the uterine artery and vein, and temporarily block its blood supply. If the operation time is long, loosen the tourniquet for 1 minute every 10 to 15 minutes. Inject a contractant into the myometrium to reduce bleeding during the operation.

Separation of fibroids and treatment of fibroid base

4. Intramural myoma: Remove the part with less blood vessels on the surface of the myoma, make longitudinal, fusiform or arc-shaped incisions according to the size of the myoma, go deep into the myoma capsule, and perform blunt separation along the surface of the capsule. When there are more blood vessels at the base, the tumor can be removed after clamping, and the residual end can be sutured. Use absorbable suture "8" word or continuous suture of 1~2 layers of the muscle layer. Pay attention to avoid dead space when suturing. The serous layer is sutured with intermittent or continuous mattress suture with No. 0 absorbable suture. For multiple myomas, try to remove multiple myomas from one incision. For myomas 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.

Basic residual suture suture muscle layer

5. Subserosal myomas are often removed with pedicles. The tumor pedicle can be clamped close to the uterine wall to remove the myoma. When the tumor pedicle is wide, a fusiform incision can be made at the base to remove the uterine tumor pedicle and superficial muscle layer.

Suturing of serosal pedunculated subserosal myoma

6. If the fibroids obviously protrude into the uterine cavity, it is necessary to enter the uterine cavity to remove the tumor. When suturing the myometrium, the mucosal layer should be avoided to prevent the endometrium from implanting into the myometrium and artificially causing endometriosis. Submucosal fibroids 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.