How Do I Choose between Vasectomy and Tubal Ligation?

Ligation refers to the use of certain means (such as the use of sheep gut) to entangle certain pipes of the human body or organism (such as blood vessels, vas deferens, fallopian tubes, etc.) or play the same effect. "Ligation" is usually considered a minor operation.

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Ligation refers to the use of certain means (such as the use of sheep gut) to connect certain channels of the human body or organism (such as blood vessels, vas deferens,

Ligation surgery time for women should be avoided

This is a permanent method of contraception. The principle of contraception is to transport sperm from the testicles to

Female ligation is a method of tubal ligation. Fallopian tube ligation is a type of fallopian tube sterilization. Artificial sterilization is the use of artificial methods to achieve permanent contraception for women of childbearing age. At present, there are two methods of fallopian tube ligation (surgical sterilization) and drug blocking (drug sterilization). It is a permanent method of contraception. It is the main measure to control the rate of population growth. It is particularly important in China. About tens of millions of women of childbearing age undergo this operation every year, especially in rural areas. Common sterilization measures.

Ligation indications

There are two indications for tubal ligation. The first point is that the married woman has a child, and the couple volunteers to request sterilization. The second point is if there is a serious heart disease, heart failure, chronic Liver and kidney disease with poor liver and kidney function and certain genetic diseases, women who are not suitable for pregnancy can also perform this operation to achieve the effect of infertility.

Its contraindications are as follows: first, abdominal skin infections and genital infections cannot be done; second, the body is very weak and cannot tolerate this operation, such as postpartum hemorrhage, shock, heart failure, etc .; At three o'clock, continuous temperature measurement is not allowed for those who are above 37.5 degrees twice within 24 hours. Fourth, it is not suitable for pregnancy. Fifth, patients with severe mental illness should postpone surgery.

Optimal ligation time

1. Non-pregnant period should be implemented within 3-7 days of complete menstruation.

2. Surgery can be performed immediately after early or late abortion, but it is not easy to operate within 1 month after spontaneous abortion and expired abortion. For women who have been on the ring, they should take the ring before sterilization.

3. Patients who are hospitalized during labor during the puerperium period are generally in good condition, and surgery can be performed 6 hours after delivery; those who undergo labor outside the hospital need to be hospitalized to observe normal conditions for 1-2 days before surgery. For those who have difficulty giving birth, they need to be hospitalized for 4-5 days, and surgery should be performed when there are no special circumstances.

4. Lactation can be performed within 3-7 days after menstrual recovery. Those who have not recovered their menstruation can choose one day of surgery, but pregnancy must be ruled out.

5, cesarean section or other gynecological surgery, can also be used for tubal ligation.

Factors affecting ligation

Ligation of the fallopian tube just cuts off the channel where the eggs and sperm meet. It is a minor operation and may have minor pains and incision infections, but it will not damage and affect the physiological functions of the body, nor will it affect health and sexual life. "vitality".

As long as the wound recovers after the operation, the couple's sexual life can be restored, and the operation has absolutely no effect on the couple's sexual life. On the contrary, because they are no longer worried about pregnancy, they can make the couple's sex life more harmonious and happy.

Because it is the ovaries and uterus that affect menstruation and menopause, the ligation operation only cuts the fallopian tubes, and the uterus and ovaries are intact. Therefore, ovulation is the same every month, and menstruation will continue, which will not stop menstruation or affect menstrual flow. There will be no early menopause. It is not necessary to worry about whether the ligation surgery will affect mood or weight. This is because the surgery does not affect the function of the ovaries and can normally secrete female hormones, so it will not affect mood or weight. But there may be very few people who are emotionally affected by excessive tension. As long as the spirit is relaxed and positive, this usually does not happen.

Ligation side effects

There are two main causes of pelvic discomfort after female sterilization; one is caused by pelvic adhesions, and the other is caused by patients' mental factors.

1. The causes of pelvic adhesions are as follows: (1) rough operation, arbitrary clamping of the fallopian tube, and a large range of damage; (2) inadequate disinfection and easy to cause infection; (3) pelvic inflammation already exists before the operation; ( 4) Pelvic adhesions are also related to the surgical method. Proximal embedding method has less damage to the fallopian mesangium, so there is less adhesion after operation. The wave method and wave modification method often cause more adhesions in the tubal mesentery; (5) pure pursuit of surgical speed and small incisions, large sutures and other tissues by mistake; (6) related to the timing of ligation.

2. We can take the following methods to prevent pelvic adhesions: (1) strictly grasp the indications and carefully conduct preoperative inspection; (2) strictly follow the operating procedures, the operation should be stable, accurate, light, and clear; (3) It is best to use the proximal embedding method with small damage; (4) Intraperitoneal injections such as antibiotics and adrenal corticosteroids can be injected into the abdominal cavity before closing the abdomen.

3. Psychological factors: Some women after sterilization have pelvic lesions but are usually asymptomatic, while some do not have pelvic lesions but are usually symptomatic, which indicates that there are mental factors in the symptoms of complications after sterilization. This may be related to the patient's mental stress and some social factors. Therefore, ideological work should be done well before surgery, so that they can understand the operation, eliminate tension and resistance, so that even if some lesions appear in the pelvic cavity after surgery, no serious symptoms will occur.

Ligation step

1. It is advisable to choose a longitudinal incision or a transverse incision. The length is about 2 ~ 3cm. For postpartum ligation, the height of the uterine fundus is clear. After the uterus is too soft, massage gently to make it hard. The upper edge of the incision is two horizontal fingers below the uterine fundus. After menstrual ligation, the inferior margin of the incision is 3 to 4 cm away from the two transverse fingers of the pubic symphysis (upper margin).

2. Cut the skin and subcutaneous fat layer by layer, cut the anterior sheath of rectus abdominis, and bluntly separate rectus abdominis. Extract the peritoneum, avoid the bladder and blood vessels, and avoid clamping the subperitoneal intestine. It was confirmed as peritoneum, and it was cut into the abdominal cavity.

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

(1) Fingerboard method: If the uterus is posterior, return to the anterior position first. Use your index finger to enter the abdominal cavity to touch the uterus, slide along the uterine horn toward the back of the fallopian tube, then put the pressure plate, place the fallopian tube between your finger and the pressure plate, slide together towards the tubal pot belly, and then gently remove together.

(2) Hook method: The hook is recessed along the front wall of the abdomen through the bladder and uterus, the back of the hook is close to the front wall of the uterus, slide to the back of the bottom of the uterus, and then slide to the side of the fallopian tube to hook the fallopian tube to the abdomen, Lift gently, hold the fallopian tube with toothless forceps under straight view and gently lift. If the hook feels too tight when it is lifted, it may catch the ovarian ligament. If it is too loose, it may catch the bowel curvature.

(3) Oval forceps: If the uterus is posterior, return to the anterior position first. After entering into the abdominal cavity with toothless and buckle-free elbow oval forceps, slide along the anterior abdominal wall through the anterior wall of the uterus through the bladder and uterine depression to the uterine horn, then separate the two leaves of the oval forceps, slide toward the fallopian tube, and rotate 900 , Virtually clamped the ampulla of the fallopian tube and raised the fallopian tube.

4. The proposed fallopian tubes must be traced back to the umbrella end to ensure that the fallopian tubes are correct. Routine examination of both ovaries.

5. The method of blocking the fallopian tubes can be based on local experience, but the methods must be effective, simple, and have fewer complications.

(1) Proximal embedding by core-pulling: Lift the tubal isthmus with two tissue forceps, the distance between the two forceps is about 2 ~ 3.0cm. Select the non-vascular area of the isthmus, first inject a small amount of physiological saline under the serosa to make the serosa layer float, and then cut the serosa in this part to free the fallopian tube. Then clamp the two ends with two mosquito forceps and cut off 1 ~ 1.5cm, ligate the two broken ends with a No. 4 silk thread, and ligate the serous membrane layer at the same time at the distal end.

(2) Silver clamp method: Place the silver clamp on the placing forceps, aiming the forceps mouth at the raised fallopian tube isthmus, so that the transverse diameter of the isthmus enters the two arms of the silver clip, slowly press the handle of the forceps, and press the Upper and lower arms, make the silver clamp press on the fallopian tube, continue pressing for 1 to 2 seconds, then release the upper clamp, and check whether the silver clip is clamped on the fallopian tube flatly.

(3) Fallopian tube ligation and severing method (Mr. Platts modified method): This method is only used when the above methods cannot be performed.

1) Lift the fallopian tube isthmus with a pair of rattooth forceps to fold it.

2) Squeeze the fallopian tube with vascular forceps at a distance of 1.5 cm from the top for 1 minute.

3) Use a 7-gauge silk thread to pass through the mesangium, ligate the proximal fallopian tube first, then surround the distal ligature and, if necessary, the proximal ligature.

4) Cut a section of fallopian tube about 1cm above the ligature.

The contralateral fallopian tube was ligated in the same way.

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

7. Check the gauze and instruments to close the abdominal cavity without error, and suture the abdominal wall layer by layer with silk thread.

8. Cover the wound with sterile gauze.

Ligation history

Tubal ligation has been extensively carried out in China for 40 years. At present, the commonly used methods in China include partial incision and ligation of the mesentery and fallopian tubes (including the proximal and two-end embedding methods), double-fold tubal ligation and resection, and fallopian tube compression. Ligation and salpingectomy, tubal ligation are performed via the abdomen, anterior, posterior fornix, and groin. At present, abdominal surgery is mainly recommended. With the proficiency of surgical techniques and the renewal of surgical instruments, the abdominal incision is significantly reduced, the operation time is significantly shortened, and the irritation of the instrument is also reduced. Many regions have developed fallopian tube silver clips and titanium clips, which can also achieve the purpose of blocking the fallopian tube lumen.

Drug sterilization does not require surgery. It is a method to achieve the goal of sterilization by injecting chemical drugs into the fallopian tube through the vaginal cavity through the uterine cavity. Due to the corrosive nature of the currently used drugs and high requirements for blocking techniques, improper mastery can cause serious reactions. For some reason, there is almost no chance of reintroduction, so it has not yet been promoted. The drugs used 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 drug identification, but there are certain problems that need further research and improvement.