2. Another name for cervical conization: cervical conization; Cervical conization; Cervical conization; Conization of cervix
3. Classification of Obstetrics and Gynecology/Gynecological Surgery/* * and * * * Surgery/Cervical Benign Disease Surgery.
4 ICD coding 67.3905
5. Summarize the application of cervical conization in surgical treatment of cervical benign diseases. The types of cervical conization are shown in the following figure (figure11.1.3.6.41).
The indications of cervical conization are as follows:
1. Cervical biopsy is cancer in situ, in order to determine the lesion scope and whether there is infiltration.
2. Severe atypical hyperplasia of cervix.
3. Cervical smear was positive for many times, but biopsy failed to find lesions.
Contraindications: acute reproductive tract inflammation, sexually transmitted diseases, cervical invasive cancer, reproductive tract malformation, blood system diseases and severe bleeding tendency.
8 preoperative preparation 1. 3 ~ 7 days after menstruation, avoid premenstrual surgery.
2. Check leucorrhea, cervical curettage, cervical biopsy if necessary, and blood routine including platelet, bleeding and clotting time.
3. Lavage or scrub the cervix with 0.05% chlorhexidine solution 3 days before operation, 1 time/day.
9 anesthesia and * * * sacral anesthesia or spinal anesthesia. Take the lithotomy position of bladder.
10 operation steps 1. Vulva, * * and cervix are routinely disinfected, and disinfection towels are laid.
2.*** Pull the hook to expose the cervix, and apply the compound iodine solution to the whole cervix to define the scope of the lesion. Clamp the iodine in the cervix with rat teeth pliers and gently pull it down. Insert a metal catheter into the bladder to determine the boundary of the lower edge of the bladder.
3. At the position 0.3 ~ 0.5 cm outside the cervical lesion, make an annular incision with a scalpel in the vertical direction (Figure1.1.3.6.42), and tilt inward by 30 ~ 40 (Figure11.). Note that the cone tip should face the cervical internal orifice, and the direction should not deviate, so that the cervical canal tissue can be completely cut into a cone (Figure11.3.6.44,11.3.6.45 Generally speaking, the bottom of the cone is 2 ~ 3 cm wide and 2.5 cm high, but it cannot exceed the internal opening of the cervix. If there is a bleeding point on the cervical wound, it can be tied with 30 catgut or electrocautery to stop bleeding, and the local area is filled with gauze and taken out after 24 hours.
4. Cervical plastic suture? See cervical resection, but not necessarily.
Precautions in operation 1 1. The top of the neck wound should be in the same direction as the internal opening. If it is cut obliquely or excessively, it may accidentally injure the surrounding tissues or cause massive bleeding.
2. The scope of excision should include the cervical lesion area and most of the cervical canal tissue to avoid the failure of comprehensive examination of the lesion due to too few and too shallow incisions.
3. Take out the cervical specimen, and use the silk thread to thread at 12 as a sign to determine the lesion site.
12 postoperative treatment The following treatment was performed after cervical conization:
1. Use antibiotics and hemostatic drugs to prevent infection and bleeding.
2. There may be a little bloody secretion on the wound surface after operation, which need not be treated. If there is much bleeding, gelatin sponge, hemostatic powder or gauze can be used to stop bleeding, and suture can be used if necessary.
3. Generally, the wound is covered by mucosa 5 ~ 6 weeks after operation, and the cervical canal can be explored with uterine probe at this time. If cervical canal stenosis is found, it can be expanded with a small dilator to facilitate menstrual flow.
13 complications