Is the cervix still there after hysterectomy?

Because of severe damage to the uterus and damage to the uterine cavity, many patients need to undergo self-excision surgery. In addition to retaining the vagina, the ovarian tissue may also be removed after the hysterectomy. Therefore, when performing a hysterectomy, everyone needs to understand the relevant precautions and experience, because only in this way can you have enough confidence to complete the operation. So, will the cervix still be there after the hysterectomy?

Subtotal hysterectomy is easy to operate, has few side effects and complications, preserves the cervix so that the vagina does not shorten, and the secretion of mucus by the cervical canal is beneficial to the maintenance of sexual life after surgery. It is easy for young and middle-aged women to accept and has less psychological impact. Due to early sexual behavior and the increase in multiple sexual partners, the incidence of cervical cancer in my country has gradually increased in recent years, and is clearly tending to be younger. It has been reported abroad that young women under the age of 30 account for 15% to 20% of cervical cancer patients. After the uterus is removed, the anatomical relationship loses its normal state, which increases the difficulty of the stump cervical surgery to varying degrees. Therefore, the indications for subtotal hysterectomy should be strictly mastered and subtotal hysterectomy should be selected with caution.

1. For patients over 40 years old who need to have a hysterectomy, it is recommended to remove the cervix at the same time.

2. When performing subtotal hysterectomy for uterine fibroids, the patient's medical history should be inquired in detail to understand the growth rate of the tumor. For patients with irregular vaginal bleeding, it is best to undergo a segmented diagnostic curettage before surgery to rule out cervical canal cancer and endometrial cancer. For patients with multiple uterine fibroids and adenomyosis, the lesions are likely to involve the cervix and the possibility of recurrence is high, so the choice of subtotal hysterectomy should be cautious.

3. A detailed routine examination of the cervix should be performed before surgery, including vaginal smear, cervical scraping and endocervical smear, endocervical liquid-based cytology examination, and detection and typing of HPV infection. If necessary, colposcopy + cervical biopsy should be performed to exclude the presence of occult cervical cancer.

4. For patients with benign ovarian or uterine diseases who need to undergo hysterectomy, total hysterectomy is generally appropriate, except for young patients with severe pelvic adhesions, difficult surgical operations or poor general conditions, who need to shorten the operation time or certain emergency operations.

5. In order to prevent and promptly detect cervical stump cancer, follow-up should be strengthened after subtotal hysterectomy. If cervical erosion occurs, treatment should be given.

In short, although cervical cancer has a relatively clear cause, HPV infection, and a long precancerous lesion stage, a detailed examination of the cervix before subtotal hysterectomy may reduce the occurrence of occult stump cancer, but the occurrence of true stump cancer is still related to the amount of subtotal hysterectomy. Therefore, it is recommended that people over 45 years old, especially those without follow-up conditions, should undergo total hysterectomy or intrafascial total hysterectomy. However, literature reports that the incidence of cervical stump cancer in people over 60 years old is only 12.5%. For elderly women over 60 years old, taking the method of total hysterectomy to prevent uterine stump cancer is of very limited significance. People over 60 years old may undergo subtotal hysterectomy as appropriate. For patients who retain their cervix, close follow-up after surgery can detect early lesions of the residual cervix.