SALPINGECTOMY (Greek salpinx a pipe + ekteme excision, removal) — operation of removal of a uterine tube.
It is for the first time made in 1872 by L. Tait. The indication for planned S. is existence of the meshotchaty inflammatory formations of a uterine tube (a hydrosalpinx, a hematosalpinx, a pyosalpinx) which are not giving in to conservative treatment (see. Adnexitis ). As the indication for the emergency S. serves perforation or a rupture of a uterine tube at a pyosalpinx, its torsion at a hydrosalpinx, pipe pregnancy.
Operation is made under anesthetic. At the emergency S. it is reasonable to apply a slit of an abdominal wall, at planned operation — a section across Pfannenshtil (see. Pfannenshtilya section ). At audit of bodies of a small pelvis find the affected uterine tube, and also examine the second uterine tube for identification of possible pipe pregnancy or inflammatory changes. In the presence of commissural process a uterus take aside, opposite to the party of defeat, cut commissures and allocate the affected uterine tube. One Kocher's forceps is imposed on a uterine tube at the corner of a uterus so that it included also the small site of a mesentery of a uterine tube. At the same time it is necessary to watch that own ligament of an ovary did not get to the end of a clip. The second clip is imposed on mezosalpinks parallel to an ampoule of a uterine tube. Mezosalpinks cut until the end of a clip, on the remained its part impose 1 — 2 clip, and delete a pipe (scissors or a scalpel). It is inexpedient to take all mezosalpinks one clip since at deligation its middle part can slip out, and thin — to be cut through that can break hemostasis (see). The site of a mezosalpinks under a clip is stitched catgut (see). Imposing a ligature on a uterine part of a pipe, it is necessary to cut away her stump. The stitch is put from above at an uterine fundus and under the end of a clip. Wedge-shaped excision of a uterine tube from a corner of a uterus should not be applied since at the subsequent pregnancy and childbirth it can lead to a hysterorrhesis. Wedge-shaped excision is admissible only at intersticial or isthmic pregnancy when fetal egg is located at the corner of a uterus and it is impossible to impose clips on a uterine part of a pipe.
Peritonization is carried out by a round ligament of a uterus, to-ruyu taken at the uterine end of a pipe and hemmed over her stump to a uterus. Then a continuous catgut suture the round sheaf is connected to a uterus, own ligament of an ovary and the remains of a mezosalpinks. Peritonization a round sheaf can be made also after linkng of the ligatures imposed on a uterine part of a pipe with a ligature on a mezosalpinksa. Good peritonization is an important point in prevention of possible development of pregnancy in the rest of a uterine tube.
Maintaining the postoperative period depends on the general condition of the patient. At interruption of pipe pregnancy (see. Extrauterine pregnancy ) allow to rise for the 2nd days after operation; in the presence of expressed anemias (see) infusional and antianemic therapy is shown (see. Blood loss ), allow to rise on 3 — the 4th days. At the pyosalpinx complicated by peritonitis carry out antibacterial and disintoxication therapy, allow to rise after removal of drainages on 4 — the 5th days after operation.
See also Uterine tubes .
Bibliography: Braude I. JI. Operational gynecology, M., 1959; Davydov S. N. Tube infertility, M., 1977; Persianinov JI. C. Operational gynecology, M., 1976.
N. V. Strizhova.