Endokoagulyatsiya endometrioid heterotopias - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Gynecology

Endokoagulyatsiya - method of thermal destruction of endometriosis is used as an independent method of treatment of external genital endometriosis, or as a stage in combination with hormonal therapy: combined estrogen-progestin preparations, progestin, antigonadotropnym drugs.

most safe and gentle method of thermal destruction of endometrioid heterotopias is endokoagulyatsiya method Zemm carried out at a temperature of 90-100 ° C.

By endokoagulyatsii endometriosis should be initiated after careful examination of all the available surface of the pelvic organs and parietal peritoneum, identifying and fixing all visible endometriosis and all suspicious areas, determining the extent of endometriza.

optimal menstrual cycle days for the endoscopic diagnosis of external genital endometriosis is late luteal phase and the first days after the end of menstruation.

During the laparoscopy in the other days of the menstrual cycle, when endometriosis is not so clearly visible, as well as in cases of doubt, it is

recommended to carry out the so-called "thermo-color test."Heat to 100 ° C working end endokoagulyatora slowly carried on suspicious sites.At the same time a healthy peritoneum becomes due burn white and endometrial heterotopias by hemosiderin content of hemoglobin and other products decay become brown or black.Fresh hemorrhage remains red, but the color intensity changes.Before starting endokoagulyatsii procedure necessary to clarify the depth of defeat, as pockets of endometrial growths located in the parietal peritoneum and peritoneum covering the bottom of the bladder and other organs, are soldered to the underlying tissues, especially in the areas of the projection of large vessels and ureters.For this biopsy forceps Zemm or atraumatic forceps grasp the fold of peritoneum near the affected area, and lifting her shift in different directions.Upon germination underlying tissues affected areas almost do not move relative to subperitoneal fiber and lifted with it.

During germination of endometriosis of the ureter wall, endokoagulyatsiyu should not be made of these sites.

from coagulation of endometriosis lesions located on the wall of the intestine and should be avoided, as the endometrial growths of this localization is usually very early sprouting in the muscular layer of the bowel wall.

must be remembered that a biopsy of endometriosis for the purpose of histological confirmation of the diagnosis should be made only in cases of doubt, since found that visual endoscopic picture is sufficient for diagnosis of external genital endometriosis.

biopsy foci of external genital endometriosis produce with the help of two instruments as follows:

atraumatic forceps or biopsy forceps Zemm capture the peritoneum in the vicinity of the lesion and lift it so as to form a fold of peritoneum.At the top of the fold with the scar will be located with the endometrial growths.Introduction through the second operating trocar biopsy forceps Frankengeyma grab the top fold of peritoneum containing endometriosis so as to capture all the layers of endometrioid education, and bite.The edges of the peritoneal defect formed for the purpose of destruction of the remaining endometrial tissue carefully coagulated point coagulator at a temperature of 100-120 ° C.

In order to destroy all visible endometriotic lesions endokoagulyatsiyu endometriosis produce consistently in all areas of the peritoneum, moving from one area of ​​a small basinto another, since perednematochnogo space clockwise.It is best to destruction by a point endokoagulyatora.Coagulation is carried out firmly touching the lesions when the coalescer.Slowly stroking working part endokoagulyatora, coagulated skin surface over the entire area and retreating heterotopia 2-3 mm beyond.It should be remembered that at a temperature of 100-120 ° C for 10 seconds coagulate tissue to a depth of about 1 mm.Endometrial lesions uterosacral ligaments often penetrate the tissue to a considerable depth.Given this, it is necessary to make endokoagulyatsiyu growths at full depth.If unable to penetrate the end point endokoagulyatora deep into the focus of the surface layer can be cut with scissors.

excision is recommended for those entities controlled by vaginal laparoscope, which virtually eliminates trauma rectal When paracervical or endometrioid heterotopias retrotservikalnogo location with a lot of deep-seated tumor formations.

Spaying technically produced endometrial cysts as well as the removal of cysts and other retention, see "Enucleation of ovarian cysts."

Surgical treatment of endometriosis lesions or thin wall of the large intestine, the appendix shall be by laparotomy in the presence of the indications for surgical treatment.