Semi-conservative surgery for pelvic endometriosis

The pelvic endometriosis ectopic semi-conservative surgery is performed for the purpose of removing the lesion and the uterus and retaining the ovarian function. The rest of the procedure is the same as conservative surgery except for the removal of the uterus. Treating diseases: endometriosis Indication 1. Patients with more severe stage III or higher. 2. There are children, no requirement for further birth. 3. The uterus has lesions, such as larger uterine fibroids or adenomyoma and adenomyosis. Contraindications 1. The patient is not very serious, the uterus is normal, and the young patient has not yet given birth. 2. The lesion is very extensive, the pelvic tissue is infiltrated seriously, and the lesion cannot be completely removed. 3. Those who are close to the age of menopause. 4. In stage IV patients, the vital organs are seriously invaded, and the lesions cannot be completely removed. Preoperative preparation 1. Make a comprehensive assessment of the patient's fertility, including related endocrine tests, diagnostic curettage, etc. 2. Do laparoscopic examination as much as possible to determine the stage of the disease, and have a preliminary understanding of the distribution and adhesion of the lesion. 3. If necessary, perform cystoscopy or fiber colonoscopy to rule out the invasion of the lesion. 4. Critically ill patients should be aware that the sigmoid colon and rectum may be involved, and should be prepared for intestinal cleansing before surgery. If there is a suspected ureteral adhesion or compression, a renal map (isotope) examination or pyelography should be performed; a ureteral catheter and a catheter should be placed half an hour before surgery. 5. If the lesion is serious, it is estimated that it is not easy to separate. Before use, high-efficiency progesterone, danazol or GnRH-a can be used for 3 months to soften the lesion, and the adhesion is easy to decompose and reduce bleeding, but it is not suitable for taking too long, resulting in lesions. The boundaries are unclear and easy to miss. Surgical procedure 1. The incision takes the midline incision of the umbilical cord, which is about 12-15 cm long. To fully expose the surgical field, the lower end of the incision should reach the upper edge of the pubic symphysis. 2. Hysterectomy According to different ages, different conditions, choose different surgical methods: 1 subtotal uterine resection: the patient is younger, requires the preservation of the cervix, and the lesion has not invaded to the area below the cervix. 2 total hysterectomy: the lesions are widely distributed, reaching the uterus rectal fossa or posterior vagina. 3. Removal of lesions in the ovary and other parts, including partial resection of the rectum and bladder wall, and abnormalities in the appendix should also be removed. complication 1. Due to the serious adhesion of this disease, the ureter is displaced, and when the adhesion is separated, the ureter is prone to being mistaken, accidentally injured or cut. If it occurs, it should be released immediately, anastomosed or transplanted into the bladder. When separating intestinal tube adhesion, perforation of the intestinal wall is prone to occur, and sometimes tiny holes are easily overlooked, resulting in acute diffuse peritonitis immediately after surgery, with serious consequences. If found in time during surgery, the muscle layer can be sutured with a thin wire and then sutured with a serosal membrane. After the diet is controlled, it can heal naturally. 2. There are many lesions, it is not easy to completely remove them, and the deep lesions are easy to be left behind, leading to postoperative recurrence. Preoperative and postoperative drugs such as danazol and GnRH-a are used for prevention.