How many pits of cervical cone have you stepped on?

Engaged in obstetrics and gynecology clinical work for more than 20 years, from the small doctor who was born with calves who are not afraid of tigers, to the old doctors who are now walking on thin ice, in the cervical cold knife cone, whether it is the thunder stepped on by others or the water that they have waded through, they are all frightening and frightened step by step.

Today, I will talk to you about the pit of cervical cone cutting, so as to avoid stepping on the mine again in the future.

Cervical coneectomy (hereinafter referred to as cervical cone) is one of the important ways to diagnose and treat cervical lesions, which can be done by a scalpel, that is, cold knife cone (CKC), or by high-frequency coil ring electroresection (LEEP).

Compared with LEEP, CKC has a longer history of application, although it has the disadvantages of requiring it to be performed under anesthesia in the operating room, the surgical operation is relatively complicated, and the bleeding is relatively large.

However, due to the individualized design according to the patient's cervical morphology and lesions, there is an opportunity to completely remove cervical lesions at one time and send them for pathological examination, and the incision margin is not damaged by electric heat, which does not affect the pathologist's judgment of the incision margin, so it is still widely used in the current clinical work.

Timing of surgery: It is recommended to perform surgery after menstruation is clean.

1 Cervical injury in the direction of 6 to 9 points penetrates the abdominal cavity

The patient is a woman of childbearing age, with a history of caesarean section, no history of vaginal delivery, CIN III, cervical type 3 transformation zone, under intravenous anesthesia under cervical cold knife cone.

The knife is inserted from 12 o'clock, the excision cone is 2.5 cm high, the wound bleeds non-stop after resection, and active bleeding in the direction of 6 to 9 points is still seen after electrocoagulation, and the location is deep.

Immediately review with hysteroscopy and request a bedside ultrasound tip: increased pelvic effusion. Hysteroscopy reveals that the serous layer of the posterior wall of the cervix is communicated with the abdominal cavity, with a rupture of 0.5 cm × 0.5 cm.

Analyze the causes, during the operation, the angle of maintaining the tilt towards the cervical canal was not grasped, and the knife could not be retracted in time, resulting in blood flowing into the abdominal cavity with low tension after penetration, resulting in intra-abdominal bleeding.

Fortunately, it was found in time, and there was no blind hemostasis, and 2/0 of the suction suture was immediately given to close the rupture, and then the cervical molding restored the anatomy and was cured and discharged.

2 Cervical incision is biased and overly widespread

Patients with post-intercourse bleeding, persistent HPV 16 positive presentation, cervical biopsy HSIL, cervical hypertrophy, fragile tissue, almost no normal cervical tissue, suspected invasive carcinoma, diagnostic cones for definitive diagnosis.

At that time, a mental mind removed the lesion cleanly, almost against the edge of the cervix, removing the cervical tissue cone height of 4 cm, the bottom of the cone 3.5 cm.

After resection, the wound bleeds heavily, and the cervical canal tissue is almost invisible, and it is biased to 1 to 3 points, and too much tissue is removed at 6 to 9 points, leaving only the cervical fascia, and the bleeding at nine points is fierce.

After careful examination, the bleeding site is caused by the inferior branch of the uterine artery, and the electrocoagulation is ineffective at all, and it is necessary to suture to stop the bleeding.

Sutures need to be avoided during suturing. The result of postoperative examination is cervical squamous cell carcinoma, and radical cervical cancer resection is performed 10 weeks postoperatively.

During the operation, it was found that the right posterior cervical fascia tissue was thin, the scar healed after local damage, and the surrounding tissues were adhesion, which significantly increased the difficulty of the operation, and the operation also experienced thousands of mountains and rivers, postoperative ups and downs, and finally recovered and discharged from the hospital.

3 Severe adhesions of the cervical canal after surgery

Young women of childbearing age, cervical HSIL, very hypertrophied appearance, type 2 transformation area, large surgical range, cone height beyond the normal range of need to cut, after removal of the cervical canal is not obvious, the entire inverted, suture also failed to form a good cervix.

After the operation, the cervical canal adhesion is serious, and once the menstruation period, the lower abdomen is severely painful, the menstrual blood cannot be discharged, all of which accumulate in the pelvic cavity, and the cervical opening cannot be clearly indicated by gynecological examination.

During the period, the uterine enlargement and cervical canal placement of the urinary catheter were repeatedly administered, and this treatment method was tried for four cycles, but the desired effect could not be achieved.

Finally, hysteroscopic electrosection of the cervical canal was done, and a cervical canal channel was re-incised, which finally solved the problem of patients with periodic abdominal pain.

Prevents cervical adhesions

To take the cervical canal axis as the center, cut up along the cervical canal axis during the operation, always pay attention not to deviate from the direction, and can not cut too much, and timely collection of knives

When suturing, it is necessary to restore the anatomical structure, fully expose the cervical canal, and avoid cervical adhesions.

After 4 weeks of follow-up, a probe can be used to detect whether the cervical canal is adhesions and stenosis, and if so, to perform dilation in time.

How to complete CKC perfectly, you must know it

According to the patient's age, the degree of cervical lesions, the purpose of cone incision (diagnostic, therapeutic), fertility aspirations, cervical morphology (type of transformation zone), and colposcopy, the iodine-stained area is evaluated, the cervical cold knife cone range is designed, and the cervical suture method is designed.

Before the operation, according to the situation, it is necessary to decide whether it is necessary to colposcopize again to evaluate the lesion and design the scope of surgery; find problems during surgery, deal with them in time, do not delay, and cannot be lucky; observe changes in the condition after surgery, pay attention to vital signs, and be predictive.

epilogue

The director often tells us that the operation is no size, any operation must be well-known, not only must be familiar with the surgical steps, but also for the unexpected situations that may occur during the operation, can be calmly handled, such surgical techniques can be pure fire, doctors can climb to a higher level.

The medical road is long, full of thorns, doctors more than anyone hope that their own patients are safe and completely discharged, but the doctor's clinical experience is not through the lessons of blood and tears, whether it is the lessons of others, or their own personal experience, I hope that in these painful lessons, we can improve ourselves more and avoid the same problems again.

Clinically, only by being bold and careful, having a good idea, having the courage to take responsibility, and always maintaining a sense of awe can we go farther, higher and more stable.

Author: Wang Jingli

Curator: Dongdong

Caption: Stand Cool Helo

This article was first published on Lilac Garden's professional platform: Maternity Time