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Abstract: The patient came to our hospital because she felt a mass prolapsed from her vagina, and all the mass prolapsed when she stood, lifted heavy objects and coughed. After the operation, the symptoms of abdominal pain and lumbar pain gradually disappeared, and the patient and her family expressed satisfaction with the treatment.
Basic information】Female, 62 years old
Type of disease】Uterine prolapse
Hospital】Jinan Hospital of Integrative Medicine
Date of consultation】March 2022
Treatment plan】Surgical treatment (laparoscopic hysterectomy with bilateral tubal resection + vaginal stump mesh suspension) + medication (Western medicine: Ornidazole injection, Ceftriaxone sodium for injection, compound amino acid injection, sodium lactate Ringer injection, tranexamic acid injection; Chinese medicine: Bajhen Tang)
【Treatment cycle】7 days of inpatient treatment, 2 months of outpatient review
Treatment effect】Clinical discomfort disappeared, good treatment effect
I. Initial consultation
Patient’s self-report: 2 years ago, she felt a sensation of falling in the vagina, and the symptoms were significantly aggravated after heavy physical work. Six months ago, the patient felt a swelling in her vagina, which could be retracted by itself when she was lying down, but immediately came out when she lifted heavy objects, stood for a long time or coughed. The patient came to our gynecology outpatient clinic for further systematic examination and treatment. The outpatient physician performed gynecological examination and diagnosed pelvic organ prolapse, and told her that she could be treated conservatively or surgically.
(Specialist examination and diagnosis)
II. Treatment history
After admission, routine blood, urine, blood group, coagulation system, complete biochemical and viral tests, electrocardiogram, chest X-ray, ultrasound of liver, biliary, pancreatic, spleen, kidney, heart and lower extremities were performed, and surgical evaluation was performed according to the results. Three days before the operation, Ornidazole injection and Ceftriaxone sodium for injection were given to prevent infection and iodophor vaginal scrub for 3 days. There were no significant abnormalities in the relevant results and no obvious contraindications to surgery, so the operation was performed. Postoperatively, cardiac monitoring, oxygen, continuous catheterization, vaginal scrubbing, acupressure to help venting, and pneumatic therapy to prevent venous thrombosis of both lower extremities were given. The same preoperative antibiotic drugs were administered intravenously to prevent infection, compound amino acid injection and sodium lactate ringer injection to help rehydration, and tranexamic acid injection to prevent postoperative bleeding. Oral herbal medicine was given to replenish Qi and nourish blood, and Bajhen Tang to promote postoperative recovery. After 7 days of hospitalization, the residual urine volume was normalized by ultrasound after stopping catheterization, and the incision was changed with iodophor and discharged.
III. Treatment effect
The whole operation was smooth, with good anesthesia effect, stable respiratory and blood pressure, and little intraoperative bleeding, about 80 ml. After postoperative treatment with anti-inflammatory rehydration and traditional Chinese medicine, the patient’s condition was stable and free of infection. After 7 days of hospitalization, the patient was discharged after being given an abdominal incision change and stitch removal. At the time of discharge, the patient recovered well, general condition was acceptable, vital signs were stable, there was no vaginal bleeding or fluid flow, no abdominal pain or back pain. The patient’s self-report: the number of urination and urine volume were normal after the removal of the urinary catheter, and the patient’s abdominal incision was clean and dry, with good healing, no redness, swelling, hard nodules, no bleeding and exudation, and no distension and pain in both lower limbs.
IV. Notes
The patient’s condition was effectively treated, and as a doctor, I was also happy for her. The patient was instructed to pay attention to the following matters after discharge from the hospital.
1, rest is the main focus, prohibit heavy physical labor, long standing, etc., to ensure sufficient sleep, conducive to physical recovery.
2, diet should be light, nutritious diet, such as eating more food containing more protein, such as eggs, lean meat, milk, soy milk, etc., but also eat more fresh vegetables and fruits to ensure balanced nutrition; avoid eating spicy and stimulating, cold and blood-activating food.
3, due to the postoperative body resistance and immunity decline, although the removal of stitches, but still need healing time, so pay attention to personal hygiene, correct care of abdominal wounds to avoid wound infection, and wash the vulva every night with warm boiled water.
4.Prohibit sexual intercourse for 2 months after surgery, forbid to take a tub bath, take a shower and do not hold urine.
5.If you have vaginal bleeding, pain and other uncomfortable symptoms, go to the gynecological clinic for follow-up in time.
V. Personal insight
Uterine prolapse is a very common disease in gynecology, it is more likely to occur in patients who have more births, often do heavy physical labor, as well as malnutrition and qi deficiency, etc. In this case, the patient failed to treat the symptoms of pelvic organ prolapse in time because the symptoms of pelvic organ prolapse were relatively light, thus causing the prolapse to be more serious at a later stage and some symptoms of abnormal urination and defecation, which affect normal work and life. Therefore, it is necessary to provide timely treatment and follow medical advice for care to promote recovery. The treatment of pelvic organ prolapse is also divided into conservative treatment and surgical treatment. Conservative treatment mainly uses a uterine support, but requires regular care, and poor care is prone to impaction and infection, while surgical treatment is relatively thorough, but for older and frailer patients, it is relatively traumatic. Therefore, which method of treatment to use, but also according to the patient’s body tolerance and other comprehensive judgment.