Stage Ia1: total transabdominal hysterectomy is used, and those with normal ovaries should be preserved.
Stage Ia2: Subtotal hysterectomy with normal ovaries should be preserved. If there are tumor thrombi in the lymphatic vessels and blood vessels, the pelvic lymph nodes should be removed.
Stage Ⅰb～Ⅱa: extensive hysterectomy and pelvic lymph node dissection are used, and those with normal ovaries should be preserved.
Our hospital's 2005 version of the routine: principle: early patients below stage IIA take surgical treatment. Patients with large localized lesions in stage ⅠB2 and ⅡA should be treated with intracavitary radiotherapy before surgery, and surgery should be performed after the cancerous lesions have shrunk. Radiotherapy is preferred for patients with stage IIB or above, and chemotherapy is used to increase the sensitivity of high-risk patients. The sensitivity of cervical adenocarcinoma to radiotherapy is a little bit poor, radiotherapy, chemotherapy and surgery should be adopted as the comprehensive treatment method, and the ovaries are not preserved during surgery in principle.
(1) Cervical carcinoma in situ: for young patients with fertility requirements, cervical Leep conization or cold knife conization is feasible; for those without fertility requirements, total hysterectomy outside the fascia is performed.
(2) Stage IA1: sub-extensive total hysterectomy. Ovaries can be preserved in young patients. No need to remove pelvic lymph nodes. For young patients who strongly want to preserve reproductive function, cold knife conization of the cervix is feasible.
(3) Stage ⅠA2: sub-extensive total hysterectomy + pelvic lymph node dissection; young patients who strongly want to preserve reproductive function can choose radical hysterectomy + laparoscopic lymph node dissection.
(4) Stage IB-IIA: extensive total hysterectomy with pelvic lymph node dissection; young patients can have both or one ovary preserved and moved to the lateral abdominal wall at the level of 2 transverse fingers above the umbilicus, so as to avoid the damage of ovarian function caused by the need of pelvic radiotherapy after surgery. Localized cervical cancer foci with a diameter of >4cm can be eliminated before surgery; those who cannot tolerate surgery due to comorbidities or age factors can be treated with a full course of radiotherapy.
Third, the name and scope of various uterine surgery: 1, cervical conization: loop electrosurgical excision procedure (Loop electrosurgical excision procedure, LEEP), cold knife conization 2, total hysterectomy, 3, extrafascial hysterectomy, 4, sub-extensive hysterectomy, 5, extensive hysterectomy, 6, radical curettage of cervical cancer1 Cervical conization: Loop electrosurgical excision procedure (LEEP)
Cold knife conization cervical Loop electrasurgical excision procedure (LEEP) features: ① surgery is simple and easy to operate; ② instrument is small and easy to use; ③ patient painless, less bleeding, no anesthesia, outpatient can be carried out; ④ due to the use of high-frequency electric current, thermal damage to the tissue is small, does not affect the histopathological observation, it is worth the popularization and promotion of the diagnosis and treatment of CIN.
IV. Pre- and post-surgical medical treatment routines for cervical cancer (I) Pre-operative preparation 1. Comprehensive evaluation of indications and contraindications for surgery 2. General pre-operative preparation Dietary and intestinal preparation 3. Preparation of surgical instruments 4. Signature of the patient and the family members (II) Post-operative treatment ① Handling of the urinary catheter: pull out the urinary catheter 5-7 days after the secondary extensive hysterectomy.
Extensive hysterectomy with pelvic lymph node dissection after catheterization: 3 days after the operation continues to open; 3-4 days began to open at regular intervals, every 2-4 hours to open a time, and at the same time began to bladder irrigation, once a day, 1: 10,000 potassium permanganate solution 1000 ml heated to 37-38oC, and after irrigation to retain the discharge of 20-30 minutes; the seventh and ninth days On the 7th-9th day, remove the catheter as appropriate, and exercise self urination. After pulling out the catheter to measure the residual urine, if & gt; 100ml or pull out the catheter can not urinate, continue to keep the ureter regularly open, bladder irrigation, with acupuncture, Chinese medicine and other treatments.
② Drainage: extensive hysterectomy with pelvic lymph node dissection drainage tube treatment: vaginal drainage tube 24 hours after surgery outward 1cm, while the head is elevated in order to drain, 48-72 hours after surgery removed. Abdominal drains can be removed at 48-72 hours after surgery when the drainage fluid is <20ml/24h.
Attachment 1: Radical hysterectomy: Radical hysterectomy is the preservation of the upper part of the cervix and the body of the uterus.
Annex 2: ovarian displacement V. Management of hemorrhage in pelvic surgery: 1. Cause: injury to the iliac vein or pelvic floor venous plexus.
2. Treatment strategy: calm and collected.
(1) gauze compression of the bleeding point, rupture of blood vessels with non-invasive vascular clamps to clamp the breach, non-invasive suture line "8" suture hemostasis; venous plexus hemorrhage can be compressed, invalid in the bleeding point around the ring of several "8" suture, if still ineffective, then continue the gauze compression. If it is still ineffective, then continue gauze compression for 30 - 40 minutes, and continue to bleed on the method of suturing.
(2) If the above method is ineffective, immediately perform double ligation of bilateral internal iliac arteries.
(3) If the above method is ineffective, the abdominal aorta is blocked for 10 - 15 minutes, and the bleeding point is searched for immediately and sutured.
(4) When the above method is ineffective, gauze tamponade compression hemostasis, abdominal closure, and removal of gauze 3 - 5 days after surgery.