A. Whether to do cesarean delivery encountering myoma removal?
1.Modern concept: there is no significant increase in the rate of postpartum bleeding and puerperal disease, and it is safe and feasible.
2.The reasons and advantages of removing myoma at the same time.
(1) At full-term pregnancy, the boundary of myoma is clear and easy to separate.
(2) The uterus is sensitive to oxytocin and there is little increase in bleeding.
(3) High repair capacity of pregnant uterine tissue.
(4) Skilled anesthesia and operating techniques with increased safety assurance.
(5) Avoiding the persistence of myomas after delivery affecting uterine contraction, myoma degeneration and secondary surgery.
II. Characteristics of myoma and type of surgery
1.Digestible myoma: the myoma is estimated to be benign
(1) Single myoma, even if the tumor is large.
(2) Multiple myomas, and it is estimated that the residual myometrium after excision is sufficient for suturing.
2. Myomas with possible hysterectomy, where the original uterine tissue is fragmented after excision, making it difficult to control bleeding:.
(1) The entire uterus is covered with myomas.
(2) interstitial myoma with a tumor >12 cm.
(3) Huge fibroids in the cervical region.
(4) suspected malignant myoma, malignant uterine tumor.
III. Surgical techniques
l. Difficulty: Surgery may be performed in critical condition: pelvic tissue is congested and edematous, anatomical relationship is difficult to identify; long-term compression of surrounding organs by huge fibroids causes adhesions.
2.Key actions for myoma removal
(1) Uterine incision combined with selection of preoperative ultrasound localization.
(2)pike incision of myoma envelope for large myoma.
(3) Continuous mattress or “u” type suture for large tumor cavity.
(4) Appropriate degree of hemostasis: avoid repeated suturing of the wound surface, edema and tearing.
3. Do not pursue speed, resulting in tearing of the peritoneal muscle fibers and blood in the traumatic area.
4, bleeding judgment: is there residual myoma? Excavate too much myoma?
4.Large fibroids in the cervix: obviously will obstruct the birth canal
1.Total hysterectomy one-by-one for larger fibroids in the official neck and complete flattening of the cervical canal for cervical fibroids.
2. subtotal hysterectomy I cervical fibroids at the upper end of the cervical canal.
3.Large cervical fibroids will change the uterine vessels and ureteral alignment, so pay attention to the removal of the tumor within the uterus.
V. Management after myoma removal surgery
1. Pay attention to the amount of vaginal bleeding, intra-abdominal bleeding, uterine rejuvenation, and application of uterine contraction agents.
2. re-evaluate the amount of vaginal bleeding during surgery and postpartum, and pay attention to the decline of hemoglobin
3.Strengthen anti-infection treatment.
4.If the uterine organs are removed, administer deep vein embolization 48-72H postoperatively.