Opaleshoni Wertheim: njira ya opaleshoni, zotsatira, zosokonezeka, ndemanga

Mbali imodzi ya ntchito pamene onkopatologii ndi amakani, i.e. osati kuchotsa kwa chotupa wokha, komanso yambiri ya minofu wathanzi pafupi ndi moto pathological. Komanso, ndi excised chotupa ndi lymph mfundo kukhetsa lymphatics m'menemo.

Kwakukulu mankhwala a khansa khomo lachiberekero ndi endometrial

ntchito Wertheim bwino lomwe complies ndi zofunika pamwamba. Kwenikweni umenewu chagona mu kuchotsa chiberekero ndi zokhudzana (machubu uterine ndi thumba losunga mazira), chapamwamba lachitatu la nyini, chiberekero ndi kuthandiza Mitsemphayi ndi ozungulira mafuta minofu kwa mwanabele.

The zikuonetsa kwa opaleshoni ndi khomo lachiberekero ndi uterine khansa. Koma nthawi zina, opaleshoni ali osavomerezeka:

• pamaso pa metastases lakutali;
• ngati zotupa yaikulu, mtima Mphukira ndi ziwalo moyandikana ndi zina m'chiuno pakhoma;
• kugwirizana ndi pathologies chaukali;
• atakalamba.

Wertheim ntchito khansa khomo lachiberekero

Ngati ife kulankhula za mankhwala a matenda, tisaiwale kuti opareshoni anati angagwiritsidwe ntchito onse paokha ndi mbali ya mankhwala osakaniza.

Pankhani ya squamous kwambiri kusiyanitsidwa khansa khungu matenda (T1bN0M0 sitepe), opaleshoni akhoza ukasintha vutolo popanda zokhudza njira monga mankhwala amphamvu ndi mankhwala cheza. Komabe, ambiri a ntchito Wertheim ndi chigawo chimodzi cha mankhwala osakaniza.

Pamene khansa endometrial (ngakhale mu gawo IB) nthawi anatumizidwa mankhwala, kuwonjezera pa opaleshoni.

Opaleshoni Wertheim: kusuntha opareshoni

Opaleshoni Jaji kwakukulu kwa chiberekero ndi zokhudzana zikuphatikizapo magawo angapo. Njirazi ndi monga:

1. Access.
2. The mphambano ya Mitsemphayi uterine.
3. Yolimbikitsa ya Ukalawu ndi thumba losunga mazira.
4. Yolimbikitsa a chikhodzodzo.
5. Ligation ndi mphambano ya zipangizo waukulu chakudya.
6. Kuchotsa minofu kuchokera kutsogolo padziko khomo pachibelekeropo.
7. The mphambano ya Mitsemphayi ndi kukonza chiberekero kumbuyo (sacral-uterine).
8. The mphambano ya Mitsemphayi khomo lachiberekero.
9. khomo lachiberekero resection.
10. Hemostasis ukazi chitsa.
11. Peritonization.

mwayi opaleshoni

Opaleshoni Wertheim - phukusi yaikulu amafuna zowonera wabwino wa kumunda opaleshoni ndi kuthekera kwa mpheto, osati limodzi ndi mavuto kapena mavuto. Choncho gawo ayenera kukhala chokwanira. Mini accesses ndi endoscopic opaleshoni, mu nkhani iyi sizikugwirizana. Mu nkhani ya mankhwala khansa zotsatira zodzikongoletsera chofunika ndi mu malo otsiriza.

Kawirikawiri anachita apakatikati kotenga laparotomy (kung'ambika wa zapambuyo khoma m'mimba mwa mzere woyera wa mimba kulambalala m'michombo) kapena mwayi Czerny (yopingasa laparotomy ndi kung'ambika wa rectus abdominis).

yolimbikitsa ya m'chiberekero

Kuti zimenezi zitheke, intersect wozungulira mitsempha ya m'chiberekero, ndi wapadera suspensory Mitsemphayi n'kuwasanganiza, ndiponso make chitoliro mapeto. Onse mabungwe awa ayenera anawoloka, ngati n'kotheka, mu malo wopanda Mitsempha. Izi kuchepetsa kutaika kwa magazi. Chiberekero chomwecho akutengedwa pa clamps ndi akatulutsidwa pambali.

Ataoloka mitsempha suspensory wa n'kuwasanganiza ndiye kuchotsa chiberekero zotheka. Chofunika kwambiri, ndi yolimbikitsa awo - osati kuwononga ureter. Kuchita izi, pa ntchito ndi lamulo palpation ya mitsempha ikuluikulu. Chapansipansi nthawi zambiri zosavuta pepala ndi ureteral khola. mpheto Zimenezi zimathandiza kuti kusonkhanitsa chiberekero ndi zokhudzana popanda choipa ureteral.

Pambuyo kutsegula vesico-uterine makutu chikhodzodzo thonje swab ndi wosiyana khoma pamaso pa khomo pachibelekeropo. Izi ziyenera kuchitidwa kupatukira mzere pakati, kuchepetsa chiopsezo kuvulazidwa kwa plexus mtima.

Ngati m'chikhodzodzo ndi adherent kwa adhesions chiberekero, kupatukana kwake kungakhale kovuta. Yambani keying zikakhala Mitsemphayi kuzungulira, ndipo pitani pa mbali khosi ndi sayenda kwambiri, kuwira kulekanitsa lumo.

Komanso Wertheim ntchito kumaphatikizapo ligation ziwiya. Waukulu mtima mtolo wa chiberekero - mtsempha wamagazi uterine ndi mitsempha motsatana, kuyenda m'mphepete mwa chiberekero. Ligation a iwo pa mlingo wa Os mkati.

Pakuti yolimbikitsa zina ang'ambe thupilo uterine imagwiridwa ndi kusuntha predpuzyrnoy fascia minofu kupyolera yosamveka kutsogolo padziko chiberekero pansi. Komanso mtanda mitsempha, amene anali kale sakudziwika kwa mpheto: sacro-uterine ndi Mitsemphayi khomo lachiberekero. Pambuyo hysterectomy amene adza kwa chomaliza.

Kwenikweni hysterectomy, hemostasis ndi peritonization

Ukazi m'chipinda chotetezeka tidutse pa khomo pachibelekeropo akutengedwa pa malo ndipo kenako asakhalenso nyini. Pamakhala hemostasis ndi peritonization. ukazi chitsa sitingakhoze kutenga mu mwamphamvu, zingatithandize ngalande mwachibadwa likhoza njira iliyonse pathological mu M'mimbamo m'chiuno ndipo kudzikundikira mafinya kapena magazi kumeneko.

chubu ukazi amaliona m'njira yapadera. Makoma a nyini ligated vesico-uterine ndi rectouterine makutu, komanso sacro-uterine Mitsemphayi, potero kukwaniritsa hemostasis ndi peritonization.

Nthawi postoperative

Kodi wodwalayo pambuyo opaleshoni Wertheim? Chotero opaleshoni kwakukulu sangathe kupitirirapo kwathunthu padera. Mosakayikira, sukhala thanzi la ndiponso nkhawa.

kumatanthauza chiyani ntchito Wertheim? Zotsatira za njira ya mankhwala akhoza kugawidwa mu oyambirira ndi mochedwa.

Zovuta akuwuka kumayambiriro postoperative nthawi

Nthawi postoperative akhoza kusokoneza:

1. Infection zimfundo (osati khungu komanso mkati).
2. Peritonitis ndi sepsis.
3. Magazi kuchokera kudera la mafupa, kuphatikizapo mkati.
4. Hematoma msoko m'deralo.
5. Dysuria.
6. Pe (embolism m'mapapo mwanga).

Ngakhale mwambo lotsatira la sterility Sizotheka kupewa mavuto septic. Ichi ndi chifukwa chakuti opaleshoni imagwiridwa odwala amene thupi ndiponso anafooka kwambiri kulimbana ndi zilonda chotupa chitetezo chokwanira yafupika. Choncho, kutupa kwa m'malo olumikizirana mafupa mu iwo - vuto zotheka. Chifukwa cha kuteteza chikhalidwe kuperekedwa nthawi postoperative chofunika mankhwala.

Magazi ndi kufinya ndikuonetsera kusoweka kwa hemostasis. Kusankidwa mankhwala hemostatic si nthawi yokwanira, ndipo nthawizina opaleshoni mobwerezabwereza - Baibulo la chilonda suturing ziwiya magazi.

Dysuria - pafupipafupi ndi kupweteka pokodza. Maonekedwe a chizindikiro zimenezi ngati kuonongeka mucous urethral catheter ndi zosayembekezereka wa urethritis zoopsa.

Pe angayambe kukhala vuto la thrombosis wa malekezero a m'munsi. N'chifukwa chake mu nthawi postoperative amapatsidwa anticoagulation ( "heparin") ndipo analimbikitsa kuvala psinjika masitonkeni kapena nsalu zotanuka.

Zotsatira za nthawi mochedwa

Pali ena zosokonezeka pambuyo opaleshoni Wertheim, osauka yaitali:

1. Maganizo mavuto: kuopa kusintha zotheka m'maonekedwe ndi imfa ya galimoto kugonana (chifukwa thumba losunga mazira amachotsedwa, kutanthauza kuti mlingo wa mahomoni kugonana anasintha), mmene za sungathe kutenga mimba, wosakongola chilonda pa zapambuyo khoma m'mimba.
2. M'mimba adhesions.
3. Pachimake.
4. Kuchotsa nyini.
5. Education retroperitoneal limfokist.

Zachitikira akazi zotsatira za hysterectomy n'zomveka ndithu. Choncho, mu nthawi postoperative thandizo zofunika kwambiri pomvetsetsa banja.

Ndi ena mavuto (postoperative chilonda, kulephera ndi ana) kuvomereza okha. Pa mantha ena ndipo ayenera kulimbana, monga amachita sizinatheke. Spaying si zikuphatikizapo kusintha kulikonse kadinala maonekedwe kapena dera kugonana. Koma chifukwa angayambitse kusapeza panthawi yogonana ngati pambuyo gisteretomii kumanzere chachifupi kwambiri ukazi chitsa.

Adhesions pambuyo opaleshoni Wertheim anapanga chimodzimodzi monga pambuyo M'mimbamo aliyense opaleshoni. Ichi ndi chifukwa traumatization wa peritoneum pa opaleshoni, imbaenda kuna mapangidwe connective chingwe minofu pakati pa mapepala ake ndi ziwalo.

Adhesions mu zonse m'mimba kumapweteketsa m'mimba, matenda a pokodza ndi defecation, ndi zina kuyambitsa kutsekeka m'matumbo. Pakuti kupewa guluu wolimba mapangidwe mu nthawi postoperative ndi zofunika oyambirira kutsegula kwa wodwalayo komanso kuchititsa mankhwala thupi pa tsiku loyamba pambuyo opaleshoni.

Kusintha zikadzatha hysterectomy chifukwa kuchotsa thumba losunga mazira ndi. Postoperative kusintha kunyamula katundu zachilengedwe, chifukwa mu nkhani iyi, kusintha m'thupi kumachitika mofulumira. Kuchepetsa kusapeza ntchito timadzi m'malo mankhwala.

A ukazi prolapse opaleshoni Wertheim imatheka chifukwa kuwonongeka ligamentous zida (a chikhalidwe zofunika kuchita ndi hysterectomy) ndi kusamutsidwa a ziwalo za m'chiuno mwa malo palibe chiberekero. Pakuti kupewa mavuto amenewa mtima tikulimbikitsidwa kuchita Zochita wapadera, atavala kulimba, malire zolimbitsa thupi kwa miyezi 2 pambuyo opaleshoni.

Nthawi zambiri danga retroperitoneal aumbike limfokista Wertheim pambuyo opaleshoni. mankhwala ake opaleshoni. Sitikudziwa bwino kuteteza zosayembekezereka wa vuto ili akadali pa siteji ya opaleshoni, kuposa kuchiza. Chifukwa chaichi, njira zosiyana ngalande retroperitoneum.

Zimene anthu amanena zokhudza Wertheim opareshoni

Kuti tichotse kwakukulu khansa khomo lachiberekero kapena endometrial likukhudza Wertheim ntchito. Mayankho za izo ndi zosiyana.

Madokotala ndi odwala kunena zinthu zabwino pambuyo opaleshoni:

1. Kuwonjezeka moyo zaka zambiri.
2. Kungakupatseni pakalibe matenda uterine, kuphatikizapo khansa.
3. Kulera, salola ngakhale mwina ka mimba yosakonzekera.
4. opaleshoni sizichepetsa dzuwa, ndi zotheka kuti abwerere ku moyo wabwinobwino.

Kuipa ntchito:

1. Kulephera kubereka ana.
2. Yonyansa chilonda pa zapambuyo khoma m'mimba.
3. Kutheka kwa mavuto, onse oyambirira ndi mochedwa (zomwe zinakambidwa pamwamba).

kuti adzimvera

Hysterectomy kwa Wertheim - ogwira kwakukulu chithandizo cha zilonda zotupa khomo lachiberekero ndi endometrial. Opaleshoni imeneyi ndi wokhoza kuthetsa wodwala matenda a khansa, komanso njira zina bwino khalidwe la moyo.

Kumene, monga opaleshoni iliyonse, hysterectomy ndi zinadzala ndi chitukuko cha matendawo. Komabe, pamene bungwe woyenera wa nthawi postoperative, ndipo akudikila miyeso zofunika njira kupewa iwo.