2. Explore the location, size and quantity of hysteromyoma, and determine the uterine incision.
3. Blocking the uterine blood supply Before myomectomy, make a small incision in the avascular area of the left and right broad ligaments in the isthmus of the uterus, put on a rubber tube tourniquet, and ligate the uterine artery and vein to temporarily block the blood supply. If the operation takes a long time, loosen the tourniquet every 10 ~ 15 minutes. Uterine contractions can also be injected into the myometrium during operation to reduce intraoperative bleeding.
4. The intramural myoma should be removed at the part with less blood vessels on the surface of the myoma, and a longitudinal, spindle or arc incision should be made according to the size of the myoma (), reaching the capsule of the myoma, and then blunting along the capsule surface (). When there are many blood vessels at the base, the tumor can be removed after clamping and the stump can be sutured (). Sew the muscle layer 1 ~ 2 () with absorbable thread "8" or continuously. Pay attention to avoid dead ends when sewing. Suture the seromuscular layer intermittently or continuously with absorbable thread No.0 (). For multiple leiomyomas, multiple leiomyomas should be removed from one incision as much as possible. For fibroids near the uterine horn, the incision should be as far away from the uterine horn as possible to avoid postoperative scar affecting tubal patency.
5. Subserous myomectomy This kind of myoma is often pedicled, and it can be clamped against the uterine wall to take the myoma (). When the tumor pedicle is wide, a spindle incision () can be made at the base to remove the myoma of uterus and the superficial muscle layer at the tumor pedicle.
6. Submucous myomectomy If the myoma obviously protrudes into the uterine cavity, it is necessary to enter the uterine cavity to remove the tumor. When suturing myometrium, submucosa should be avoided to avoid implantation of myometrium into endometrium and artificial endometriosis. Pedicled submucosal myoma can be removed via vagina.
7. Cervical myomectomy should understand the relationship between myoma and bladder, rectum and ureter. For the myoma of the anterior cervical wall, first open the bladder and turn the peritoneum (0), then separate the bladder from the lower and lateral edges of the myoma sharply, cut the tissue of the anterior cervical wall to the tumor surface, and passively separate it to the basal part along the tumor capsule, clamp it, take out the myoma, and sew the stump. Suture the cervical myometrium with absorbable line in the shape of "8" or continuous mattress, and turn the bladder peritoneum.
If it is a myoma of the posterior wall of the cervix, we should first open the cervical-rectal space to fold the peritoneum, push the rectum open, and then take out the myoma.
For huge cervical myoma, the posterior lobe of ligament can be opened to find the ureter, and then the ureter tunnel can be cut to free the ureter if necessary, and then the myoma can be removed.
8. Abdomen, sew the abdominal wall layer by layer.