What is ligation?

Ligation refers to ligating some pipes (such as blood vessels, vas deferens, fallopian tubes, etc.) of human body or organism by certain means (such as catgut). ) or have the same effect. "Ligation" is usually considered as a minor operation. Sometimes "ligation" is used to refer to vasectomy, which was a permanent and irreversible contraceptive operation in the early stage, but now medicine can implement vasectomy and tubal recanalization.

Ligation opportunity

During ligation, women should avoid menstrual period to prevent infection. It is recommended to listen to the doctor.

Suggestion:

The best time for female ligation:

1, non-pregnant, female ligation operation time should be selected within 3-7 days of complete menstruation.

2. Surgery can be performed immediately after early or late induced abortion, but it is not suitable for surgery within 65,438+0 months after spontaneous abortion and expired abortion. For women who wear rings, the rings should be removed first and then sterilized.

3. Puerperal inpatients are generally in good condition and can be operated after 6 hours after delivery; Those who gave birth naturally outside the hospital need to be hospitalized for observation 1-2 days before surgery. Those who have dystocia need to be hospitalized for 4-5 days, and then operated when there are no special circumstances.

4, lactation can be carried out within 3-7 days after menstrual recovery. Women who have not recovered from menstruation can have ligation on any day, but pregnancy must be ruled out.

5. caesarean section. Other gynecologists can also do tubal ligation.

Male ligation

This is a permanent contraceptive method. The principle of contraception is to cut off the vas deferens that transport sperm from testis to penis, so that sperm cannot enter semen and be excreted. This permanent contraceptive method is only suitable for couples who don't want any more children. Male ligation does not produce permanent contraceptive effect immediately, so other reliable contraceptive measures should be taken after operation. Only after two careful examinations, it is proved that there is no sperm at all can contraceptive measures be abandoned. In rare cases, the opened vas deferens will be reopened, thus restoring fertility. Generally speaking, minor complications caused by surgery include swelling and pain of the wound.

Matters needing attention

1, do a good job of preoperative consultation and relieve concerns;

2. There is a small piece of blue around the scrotal incision after operation, so you don't need to see a doctor. If the scrotum is swollen, the skin appears gradually enlarged purple or bleeding. , should be timely diagnosis and treatment;

3. Don't have sexual intercourse within two weeks after operation, pay attention to rest and avoid heavy physical labor and strenuous exercise;

4. Continue contraception for 3 months after operation.

Surgical procedure

1. The subject lies on his back with his lower limbs slightly apart.

2. The doctor fixed the vas deferens on the right side of the subject with his left thumb, forefinger and middle finger, opened the scrotal skin of the subject and pushed aside the spermatic vessels. Ligate one side first, then the other side. In this process, doctors are required to fix their fingers to prevent the vas deferens from slipping.

3. During the operation, the puncture site was selected at the upper part of both sides of the scrotum, and the skin of the scrotum was punctured with a fine needle, and procaine solution was injected.

4. Use vas deferens separation forceps to enlarge the puncture hole.

5. Fixing the vas deferens is to insert the vas deferens fixing forceps from the skin gap, open the clamp ring, and push the vas deferens into the clamp ring with the cooperation of the middle finger of the left hand and fix it.

6. Lift the vas deferens away from the fissure to expose the ivory vas deferens wall. Hang the vas deferens from the adventitia incision with a vas deferens hook.

7. Separate and ligate the vas deferens with a length of 65438±0.5cm, and the tightness is appropriate.

8. Inject spermicidal solution containing phenylmercuric acetate slowly, and then the subject will feel urine.

9. Ligate the distal end of the vas deferens, hold a hemostatic forceps to reverse the proximal (or distal) broken end of the vas deferens, and re-ligate the reversed end with a proximal (or distal) ligature line.

10. No bleeding was found after inspection. Cut the ligature and return the vas deferens to the scrotum. Cover the puncture hole with a small gauze.

Male ligation does not produce permanent contraceptive effect immediately, so other reliable contraceptive measures should be taken after operation. Only after two careful examinations, it is proved that there is no sperm at all can contraceptive measures be abandoned. In rare cases, the opened vas deferens will be reopened, thus restoring fertility.

Female ligation

Female ligation is a method of tubal ligation. Tubal ligation is a kind of tubal sterilization, and sterilization is to make women of childbearing age achieve the purpose of permanent contraception by artificial methods. At present, there are two methods: tubal ligation (surgical sterilization) and drug blocking (drug sterilization). It is a permanent contraceptive method and the main measure to control the population growth rate, which is particularly important in China. In China, tens of millions of women in reproductive period undergo this operation every year, especially in rural areas, and it is still a common sterilization measure until now.

indicate

Tubal ligation has two indications; The first point is that married women have children, and both husband and wife voluntarily request sterilization; Secondly, women who suffer from chronic liver and kidney diseases such as severe heart disease, cardiac insufficiency, liver and kidney dysfunction and some genetic diseases and are not suitable for pregnancy can also do this operation to achieve the effect of infertility.

Its contraindications are: 1. Abdominal skin infection and genital infection cannot be done; Second, the body is too weak to tolerate this operation, such as postpartum hemorrhage, shock, heart failure, etc. Third, if the temperature is above 37.5 degrees twice in 24 hours, it should not be done; Fourth, it is not suitable for pregnancy; Fifth, patients with severe mental illness should suspend surgery.

minimum duration

1, non-pregnancy should be carried out within 3-7 days after menstruation is completely clean.

2. Early or late induced abortion can be operated immediately, but it is not easy to operate within 65,438+0 months after spontaneous abortion and expired abortion. For women who wear rings, the rings should be removed first and then sterilized.

3. Puerperal inpatients are generally in good condition and can be operated after 6 hours after delivery; Natural delivery outside the hospital requires hospitalization observation 1-2 days before operation. For dystocia, you need to stay in hospital for 4-5 days, and then perform surgery when there are no special circumstances.

4, lactation can be carried out within 3-7 days after menstrual recovery. Those who have not recovered from menstruation can choose one-day operation, but pregnancy must be ruled out.

5, cesarean section or other gynecological surgery, tubal ligation at the same time.

influencing factor

Tubal ligation only cuts off the passage where eggs and sperm meet. It is a minor operation, which may cause slight pain, wound infection and other problems, but it will not damage and affect the physiological function of the body, nor will it affect health and sexual life, nor will it hurt "vitality".

As long as the wound is healed after the operation, the sexual life of husband and wife can be restored, and the operation has absolutely no effect on the sexual life of husband and wife. On the contrary, couples' sexual life can be more harmonious and happy because they are no longer afraid of pregnancy.

Because it is the ovary and uterus that affect menstruation and menopause, and ligation only cuts off the fallopian tube, the uterus and ovary are intact. Therefore, ovulation is still the same every month, and menstruation is still the same. It will not stop menstruation and will not affect menstruation. There will be no early menopause. Don't worry about whether the ligation will affect the mood or weight, because the operation will not affect the function of the ovary and can secrete female hormones normally, so it will not affect the mood or weight. However, there may be a few people who are too nervous and affect their mood. As long as you relax and be optimistic, this will not happen in general.

side effect

There are two main reasons for pelvic discomfort after female sterilization; One is caused by pelvic adhesion, and the other is caused by patients' mental factors.

1. The causes of pelvic adhesion are: (1) Rough operation, random clamping of fallopian tubes, extensive damage; (2) Inadequate disinfection is easy to cause infection; (3) Preoperative pelvic inflammatory disease; (4) Pelvic adhesion is also related to the surgical method. Proximal embedding method has little damage to the fallopian tube mesangium, so postoperative adhesion is less. However, there are many adhesions after repeated operations of wave method and wave improvement method to injure the fallopian tube mesangium. (5) Pursuing operation speed and small incision, and sewing omentum and other tissues by mistake; (6) It is related to the timing of ligation.

2. The following measures can be taken to prevent pelvic adhesion: (1) Strictly grasp the indications and carefully check before operation; (2) Operate in strict accordance with the operating procedures, with stable, accurate and light operation and clear hierarchy; (3) It is best to choose the proximal embedding method with little damage; (4) Antibiotics, adrenocortical hormone and other anti-adhesion drugs can be injected into abdominal cavity before abdominal closure.

3. Mental factors: After sterilization, some women have pelvic lesions but usually have no symptoms, and some women have symptoms but no pelvic lesions, indicating that there are mental factors in the symptoms of complications after sterilization. This may be related to the mental stress of patients and some social factors. Therefore, ideological work should be done well before operation, so that they can understand the operation and eliminate tension and resistance, so that even if there are some pelvic lesions after operation, there will be no serious symptoms.

step

1. Longitudinal incision or transverse incision should be selected. The length is about 2 ~ 3 cm. For postpartum ligation, determine the height of the uterine bottom. If the postpartum uterus is too soft, gently massage it to make it hard, and the upper edge of the incision is under the uterus. For those who are ligated after menstruation, the lower edge of the incision is 3 ~ 4 cm away from the two transverse fingers (upper edge) of pubic symphysis.

2. Cut the skin and subcutaneous fat layer by layer, cut off the anterior sheath of rectus abdominis, and passively separate rectus abdominis. Extract the peritoneum, avoid the bladder and blood vessels, and avoid clamping the subperitoneal intestine. Confirmed as peritoneum, cut into abdominal cavity.

3. To find a stable, accurate and portable fallopian tube, the following methods can be used to extract the fallopian tube.

(1) Fingerboard method: If the uterus is in the posterior position, restore to the anterior position first. Touch the uterus with your index finger into the abdominal cavity, slide to the back of the fallopian tube along the uterine horn, then put the fallopian tube in the pressure plate, put the fallopian tube between your finger and the pressure plate, slide to the ampulla of the fallopian tube together, and then gently take it out together.

(2) Hooking method: the hook is pressed down along the front abdominal wall and passes through the bladder uterus, with the hook back clinging to the front uterine wall, sliding to the rear of the bottom of the uterus, and then sliding to one side of the fallopian tube, hooking the ampulla of the fallopian tube, gently lifting it, holding the fallopian tube with toothless pliers under direct vision and gently lifting it. If the hook feels too tight, it may hook the ovarian ligament, and if it is too loose, it may hook the intestinal curvature.

(3) Oval clamp method: If the uterus is in the posterior position, return to the anterior position first. After entering the abdominal cavity, the toothless and buttonless oval forceps slid down to the uterine horn along the anterior abdominal wall through the concave part of the bladder and uterus, then separated the two blades of the oval forceps, slid to the fallopian tube, and rotated inward by 900 degrees, which virtually clamped the ampulla of the fallopian tube and raised the fallopian tube.

4. The proposed fallopian tube must be traced back to the umbrella end to ensure that the fallopian tube is correct. Routine examination of bilateral ovaries.

5. The method of blocking fallopian tube can be based on local experience, but it must be effective, simple and with few complications.

(1) Core-pulling proximal embedding method: lift the isthmus of fallopian tube with two tissue forceps, with the distance between the two forceps being about 2~3.0cm. Select the avascular area of isthmus, inject a small amount of normal saline under the serosa to float the serosa layer, then cut the serosa to make it separate from the fallopian tube, then clamp both ends with two mosquito forceps, and cut it off in the middle.1~/kl

(2) Silver clip method: Place the silver clip on the placing forceps, align the forceps mouth with the raised isthmus of fallopian tube, so that the transverse diameter of the isthmus is completely surrounded by the two arms of the silver clip, slowly press the handle of the forceps, press the upper and lower arms of the forceps, press the silver clip on the fallopian tube for 1 ~ 2 seconds, and then loosen the upper clip to check whether the silver clip is evenly clamped on the fallopian tube.

(3) Fallopian tube folding ligation and cutting method (Platts' modified method): This method is only used when the above method cannot be implemented.

1) Lift the isthmus of fallopian tube with rat dental forceps for folding.

2) Squeeze the fallopian tube with a vascular clamp at a distance of 65438±0.5cm from the tip for 65438 0 minutes.

3) Thread the No.7 silk thread through the mesentery, first ligating the proximal fallopian tube, then ligating the distal fallopian tube, and then ligating the proximal fallopian tube if necessary.

4) A section of fallopian tube about 1cm long was removed above the ligation line.

The contralateral fallopian tubes were ligated in the same way.

6. Check the abdominal cavity and abdominal wall for bleeding, hematoma and tissue damage.

7. Check the gauze and instruments, close the abdominal cavity, and sew the abdominal wall layer by layer with silk thread.

8. Cover the wound with sterile gauze.

history

Tubal ligation has been widely carried out in China for 40 years. At present, the commonly used methods in China include partial excision and ligation of the mesofallopian tube (including embedding suture at the proximal and both ends), double ligation and ligation of fallopian tube, tubal ligation, tubal umbrella resection and so on. Tubal ligation is performed through abdomen, anterior and posterior fornix of vagina and groin. Abdominal surgery is advocated at present. With the proficiency of surgical techniques and the update of surgical instruments, the abdominal incision is obviously reduced, the operation time is obviously shortened, and the irritation of instruments is also reduced. Many areas have developed silver and titanium clips for fallopian tubes, which can also achieve the purpose of blocking the lumen of fallopian tubes.

Drug sterilization is a method of injecting chemical drugs into fallopian tubes through uterus and vagina without surgery to achieve the purpose of sterilization. Because the drugs currently used are corrosive, the application technology requires high requirements, and improper mastery will cause serious reactions. If you want to get pregnant again for some reason, there is almost no chance of re-communication, so it has not been popularized so far. The drugs used also need to be improved. Foreign countries have been exploring tubal sterilization drugs for more than 100 years, but so far they have not achieved satisfactory results. The compound phenol paste developed in China has passed the drug identification, but there are some problems that need further research and improvement.

Transfer from medical equipment maintenance forum

Hope to adopt