Application of silver clip method (collar is one of them) in tubal sterilization

First, a brief history of tubal sterilization and sterilization principle:

Tubal sterilization is an artificial method to prevent eggs and sperm from meeting and cut off their fertility, thus achieving the goal of permanent infertility. It is divided into surgical sterilization and drug sterilization. Surgical sterilization is achieved by cutting off, ligating, electrocoagulation, clamping and inserting fallopian tubes. Drug sterilization is to inject chemical drugs into the fallopian tube to narrow and block the lumen of the fallopian tube and achieve the purpose of sterilization.

Tubal sterilization has a history of 1000 years. As early as 65,438+0,823, tubal sterilization was started by removing the fallopian tubes. In 1970s, small abdominal incision ligation was carried out in China, and now there are Pan Shi's method, Pan Shi's improved method, pericardial embedding method, root clamp method, laparoscopic tubal sterilization, electrocoagulation, spring, silicone ring and blocking sterilization. There are also drug sterilization methods without surgery, especially the "reversible sterilization of fallopian tubes without surgery" invented by Professor Zhao, president of Shanxi Provincial Hospital, which uses silicone polyester to block the fallopian tubes through the vagina.

Second, let's review the clinical operation and requirements of tubal sterilization with you.

(1) indications:

1. Married women who have children and both husband and wife voluntarily request sterilization and have no contraindications.

2, due to some diseases, such as heart disease, kidney disease, serious genetic diseases, etc. , not suitable for pregnancy.

(2) Contraindications:

1, infection, such as abdominal skin infection, postpartum infection, pelvic inflammatory disease, etc.

2, the whole body is weak, can not stand surgery, such as postpartum hemorrhage, anemia, heart failure and other diseases in the acute stage.

3. Measure the body temperature twice every 4 hours within 24 hours, and those higher than 37.5 degrees should be suspended.

4. Severe neurosis.

(3) Operating time:

1, 3-7 days after menstruation is appropriate, and it should be avoided as much as possible during ovulation or after menstruation.

2. Postpartum, second trimester pregnancy, induced abortion and induced labor (silver clip method is not applicable).

3. Spontaneous abortion after normal menstruation and drug abortion after two normal menstruation.

4, exclude breastfeeding after pregnancy.

5. After taking out the IUD.

6, cesarean section, small cesarean section or other open surgery (except for surgery that may be infected).

7. If a pregnant woman or a person with a device requests sterilization, the pregnancy must be terminated or the intrauterine device must be taken out before tubal ligation.

(4) preoperative preparation:

1, do a good job in the ideological work of the subjects, and relieve anxiety and fear.

2, do a good job of preoperative consultation, both husband and wife know, sign the consent form.

3, consult the medical history in detail, pay attention to whether there is a history of abdominal surgery, which side should be clearly indicated if there is surgery, or it is best to mobilize male ligation.

4, do a physical examination, including blood pressure, pulse, temperature, heart and lung auscultation and gynecological examination, if necessary, further examination.

5, check the blood and urine routine and coagulation time, if necessary, symptomatic examination items, preoperative should fill in the medical record.

6, when using procaine anesthesia should do skin test.

7, abdominal skin preparation, including umbilical treatment.

8, preoperative bladder must be emptied, pay attention to the presence of residual urine.

9. If necessary, give sedatives 0.5- 1 hour before operation.

10, after fasting or eating for 4 hours before operation.

(5) homework preparation

1, the operation must be carried out in the operating room.

2. After routine hand brushing, the operator should wear a hat, a mask, a sterile suit and a sterile gloves.

3. The subjects were supine, or their heads were low and their hips were high.

4. Disinfect the skin with 25% iodine and 75% alcohol or 0.5% iodophor, reaching the level below xiphoid process, down to pubic symphysis of pubic mound and below groin, to thigh 1/3, and reaching the armpit midline on both sides.

5. Cover the abdomen with sterile towels to expose the surgical field of vision, and cover it with sterile sheets.

(6) Anesthesia

1, 0.5- 1% procaine is injected into the incision for local infiltration anesthesia, and 0.5% lidocaine can also be selected.

(7) Surgery

1. Take a median straight incision or a transverse incision 3-4cm above the pubic symphysis, about 2-3cm long. For postpartum ligation, determine the height of the uterine bottom. If the postpartum uterus is too soft, gently massage to make it hard, and the upper edge of the incision is at the bottom of the uterus. After menstruation, the upper edge of the incision is located at the two transverse fingers under the uterus, and after menstruation, the lower edge of the incision is 3-4cm away from the two transverse fingers (upper edge) of pubic symphysis.

2, cut the skin layer by layer, subcutaneous fat cut the anterior sheath of rectus abdominis, blunt separation, abdominal straightener. Extract the peritoneum, avoid the bladder and blood vessels, and avoid clamping the subperitoneal intestine. Confirmed as peritoneum, cut into abdominal cavity. Before the peritoneum is cut, it must be alternately clamped and loosened. Then, try to measure with the handle. Only when you see through the shadow of the handle can you cut it. After it is confirmed that it has entered the abdominal cavity, the peritoneal incision will be enlarged, and the peritoneum will be fixed at the upper, lower, left and right points with vascular forceps. It is easy to accidentally injure bladder and intestine when extracting and cutting peritoneum. Special attention should be paid.

3. There are many methods to extract fallopian tubes, and the commonly used ones are as follows: (1) fingerboard tube taking method; (2) Oval forceps tube taking method; (3) Tubal hook tube taking method.

Now, one of the most widely used methods, fingerboard tube taking method, is reviewed. Put the index finger of the left hand into the abdominal cavity, take out the omentum and intestinal tube covering the upper part of the uterus, such as the posterior position of the uterus, then restore the uterus to the anterior position, and then slide along the bottom of the uterus to the rear of the isthmus of the fallopian tube. The right hand grip plate is in a fist-clenching posture, and the large bending part of the fingerboard is close to the palm of the left index finger, and enters the abdominal cavity to reach the front of the fallopian tube. The tip of the fingerboard and the fingertip are disturbed, and the fallopian tube can be sandwiched between the fingerboard and the index finger. At this time, you can take one and lift it upward, and then the index finger and fingerboard move to the umbrella end at the same time and extract it upward. When reaching the abdominal avoidance incision, the assistant gently presses the abdominal wall next to the posterior incision to gradually expose the fallopian tube.

4. Silver clip method: put the silver clip on the placement clip, align the clip mouth with the raised isthmus of fallopian tube, so that the transverse diameter of isthmus all enters the arm of the silver clip, slowly press the clip handle, press the upper and lower arms of the clip, keep the silver clip pressed on the fallopian tube for 1-2 seconds, then loosen the upper clip to check whether the silver clip is evenly clamped on the fallopian tube or whether the omentum is clamped.

5, check the abdominal wall layers for bleeding, hematoma and tissue damage.

6. Seal gauze and instruments in abdominal cavity, and sew abdominal wall layer by layer with silk thread.

7. Cover the wound with sterile gauze.

(eight) intraoperative matters needing attention:

1, strict attention should be paid to aseptic operation to prevent infection, and the bleeding point should be carefully ligated to prevent bleeding or hematoma.

2. During the operation, we should pay high attention to avoid the bad stimulation caused by improper words used during the operation.

3, don't blindly pursue small wounds, open the whole layer.

4, the operation should be stable, accurate, light and thin, to prevent damage to fallopian tube mesothelium, blood vessels, intestines, bladder or other organs.

5, looking for fallopian tubes must be traced back to the umbrella end to avoid accidental clamping.

6. Check the number of instruments and gauze before closing the abdominal cavity to prevent foreign bodies from leaving the abdominal cavity.

7. Ligation and appendectomy should not be performed at the same time.

(9) Postoperative treatment.

1, fill in the operation record.

2. Give antibiotics appropriately to prevent infection.

3, the subjects should be hospitalized observation, if there is any abnormal situation handled in time.

4. The gauze was removed and bandaged seven days after operation.

5. Inform patients of postoperative precautions:

(1) Encourage early field activities.

(2) Keep the surgical site clean and hygienic, and sexual intercourse is not allowed within 2 weeks. Sterilization after abortion and postpartum is not suitable for sexual intercourse 1 month.

(3) It is not advisable to engage in manual labor or strenuous exercise during vacation.

(ten) the time and content of follow-up.

1. Follow-up within 3 months after operation, and follow-up can be combined with gynecological general survey. However, we should pay attention to the abnormal conditions found during the operation, such as adhesion, subcutaneous hemorrhage, muscle hemorrhage, etc., and follow up by telephone at any time.

2. Follow-up contents, postoperative general symptoms, surgical effect, menstrual condition (cycle, menstrual flow, dysmenorrhea), surgical incision, pelvic examination and other organ examination.