A Text-book of Diseases of WomenPenrose, Charles B. (Charles Bingham)
Science
A Text-book of Diseases of Women
Penrose, Charles B. (Charles Bingham)
Women -- Diseases
=Treatment.=--All forms of laceration of the cervix in which there
exist eversion, erosion, cystic degeneration, and sclerosis should
be operated upon. A slight laceration in a young woman in the active
childbearing period does not demand operative treatment if there are no
symptoms referable to the laceration. In women approaching middle life
(forty years of age) all lacerations of the cervix should be closed,
whether or not they produce symptoms.
It should always be remembered that cancer is most likely to originate
in a cervix that has been lacerated, and the woman should be protected
against this danger.
The treatment of laceration of the cervix is operative. A definite
mechanical injury has been inflicted, and the parts must be repaired by
operation.
The operation for the repair of a lacerated cervix is called
trachelorrhaphy. The operation consists in denuding or excising the
tissues on the torn surfaces and bringing the freshened surfaces
together with sutures.
The form of the operation for a bilateral laceration is shown in Fig.
104. The operation should preferably be performed immediately after a
menstrual period.
The instruments necessary for the operation of trachelorrhaphy are two
double tenacula, two single tenacula, tissue-forceps, needle-holder,
shot-compressor, Sims’ speculum, needles, (Fig. 102), knife, and
scissors, sharp-pointed and curved on the flat (Fig. 103). The needles
should be spear-pointed and should be strong and sharp, as the cervical
tissues through which they are passed are often very dense. The
straight or the curved needle may be used.
[Illustration: FIG. 102.--Cervix-needles.]
Silkworm gut, shotted, is an exceedingly good suture-material.
The woman should be placed either in the Sims or the dorso-sacral
position. The vulva, vagina, and cervix should be thoroughly cleansed
and rendered as aseptic as possible. The cervix should be exposed
through the Sims speculum. The anterior and, if desirable, the
posterior lip of the cervix should be seized with a double tenaculum
and held by an assistant; or the lip may be transfixed by a silk
ligature, with which the cervix may be held.
[Illustration: FIG. 103.--Curved scissors for performing
trachelorrhaphy.]
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