SALPINGECTOMY

From Big Medical Encyclopedia

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.

At the pyosalpinx complicated pelviperitonitis (see) or diffuse peritonitis (see), carry out drainage of an abdominal cavity (see. Drainage ).

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.

Physical therapy appoint on 4 — the 5th days, at a pyosalpinx — after stopping of the peritoneal phenomena. Further recommend to all patients balneoterapiya (see) and mud cure (see).

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.

Яндекс.Метрика