Opaleshoni Hartmann: kufotokoza, masiteji, zida

Opaleshoni Hartmann maphunziro njira zochizira matenda a khansa ya m'matumbo. Nthawi zambiri, chithandizo opaleshoni ya matenda sikuti yabwino kwambiri koma monga chithandizo cha mankhwala khansa, imene ili m'kati pa malo sapereka zotsatira yoyenera.

Zikuonetsa kwa opaleshoni

Opaleshoni mtundu Hartmann amasonyeza odwala mkhutu ndi okalamba ndi matenda a "khansa ya m'matumbo sigmoid kapena dipatimenti rectosigmoid." Pali zifukwa zina dokotala anu angasankhe kuchita ntchito Hartmann:

• zovuta kutsekeka malo dzina (nthawi zambiri, zakudya si adutsa matumbo mu general);
• perforation (kudzera-matumbo matenda);
• volvulus sigmoid m'matumbo zinachitikira chilonda kapena vuto peritonitis boma (m'matumbo elongation mapindikidwe mesentery ake).

Iwo anachita zambiri ndi zizindikiro mwadzidzidzi, monga chotupa kapena chiwonetsero cha kuwola matumbo kutsekeka.

Opaleshoni Hartmann magawo a

odwala ambiri amakhala yekha mbali yake yoyamba. Chotsatira panyengo kuchira yabwino imagwiridwa okha patapita miyezi isanu.

Opaleshoni Hartmann, ndi Kuwulura chimene chinapereka Petrov B. A., lagawidwa magawo awiri. Ntchito zochizira atsikira ndi yopingasa m'matumbo a intestine lapansi.

Choncho, ntchito yonse imakhala njira zotsatirazi:

1. Chinthu ichi chakhala anafotokozedwa ndi Petrovym B. A., amene anamupatsa udindo wa "resection obstructive." Nthawi zambiri, odwala ndi matenda a "khansa" amathera yekha njirayi. Zimatengera kuchotsa gawo ena a intestine, ndi zomwe chotupa cha ili. Kenako pa stitching lumen gawo wapotalikira. Chachitika molimba, ndi kusiyana anachoka mu zonse m'mimba. Mapeto proximal wa opareshoni guts dokotala anasonyeza pa khoma m'mimba ndi gawo kutsogolo kwake. Mfundo imeneyi imatchedwa yaikulu, zomwe zinalembedwa mwatsatanetsatane m'munsimu.
2. Sitepe yachiwiri ku njira yabwino nyengo konzanso adzasungidwe osati miyezi kale kuposa awiri, zina, ngakhale patapita miyezi isanu. Iye ndi kubwezeretsa Landilani mapeto m'matumbo anastomosis kutha. Yaikulu Choncho kuchotsedwa. The zosinthika mbali anastomosis ndi uku, koma nthawi zambiri madokotala a kuzikana.

Kukonzekera wodwalayo kwa opaleshoni

Choyamba ndi ndondomeko yokonza wodwalayo timaigwira. Popeza kawirikawiri kumapangitsa wodwala ofooka, wotopa, m'pofunika kuchita mndandanda wa Kafukufuku, komanso ambiri kulimbitsa chithandizo kwa anthu kuyenda popanda ntchito za imfa. Ntchito sing'anga uyu, amene kanthu umalimbana utithandize ntchito mtima, lamulo pa mundawo m'mimba mwina magazi, komanso poika ambiri mavitamini ndi zakudya zapadera.

Opaleshoni Hartmann makina

Ntchito wodwala aikidwa pa nsana wake. Pamimba anaulula m'munsi Seredinny odulidwa kuchokera pubis ndi masentimita 5 (nthawi zina pang'ono zochepa) pamwamba umbilicus lapansi. Kenako, wodwala anasamukira ku Trendelenburga (wodwalayo mutu ndi mapewa lamba ili pansipa mafupa a chiuno cha). Komanso ikuchitika otchedwa yolimbikitsa ya sigmoid m'matumbo, chifukwa cha ichi ambiri ntchito thaulo. Muzu wa mesentery komanso pansi pa Douglas peritoneum mthumba nthawi anayambitsa kuchuluka kwa novocaine (pafupifupi 250 ml). Tsopano audited ndi mwachindunji malo chotupa ndi makhalidwe ake ena. Sigmoid m'matumbo, yomwe ikuchitika ndi ntchito ndi zomuthandiza pabalapo apite naye kumanja pafupi kuti midline lapansi. Mesentery pamene anatambasula. Kenako, ndithudi ndi lumo amene adzaphatikizana wosanjikiza kunja kwa peritoneum lapansi. Mwambo mu malo, kumene mizu ya mesentery lapansi. kung'ambika The ikuchitika mu kutalika kuzungulira, chomwe chiti kenako kuchotsedwa. Kenako m'matumbo akatulutsidwa kunja, ndi M'kati kung'ambika amapezeka peritoneum. Womwe ndi mtsinje wachiwiri ndi wachitatu intersect pa malo amene unali pakati pa clamps izi kutsogolo. Malowa amakhala ndi kumaliseche kwa mtsempha wamagazi m'munsi mesenteric. Ndiponso, ligated ndi silika ulusi. Dokotala mosamala amaona kuti ndi mtsempha wamagazi kumanzere zinasungidwa, ngati n'kotheka, dokotala komanso lofotokozabe mtsempha wamagazi chapamwamba ndipo proctal.

Mesentery ndi clamped kuchokera ku mbali zonse ndi pakati zida intersect, ndiye zina anakafika mkati ndi ziwiya womangidwa.

Ngati pali kuchotsa verhneampulyarnogo dipatimenti thumbo mtsempha wamagazi, limene lili pamwamba pa maziko kuvomerezedwa ligated.

Clamps chagwiritsidwa mu malo awa:

• pa gawo anakhudzidwa wa intestine ya;
• verhneampulyarny gawo la rectum.

Pakati tatifupi amenewa intestine amachotsedwa ntchito scalpel lakuthwa. Izi zimachitika mwa magawo wathanzi. Mapeto a intestine ndi sutured mwamphamvu. Ntchito catgut ndi silika izi ulusi.

Nthawi postoperative

Zochita zotsatirazi zimagwiridwa pa nthawi iyi:

• Mwa chubu katatu patsiku anatsuka intestine. Ntchito imeneyi ofooka njira ya antiseptic, poika zomwe dokotala mukuganiza pamaziko a nkhani.
• Patangopita masiku asanu a mankhwala kumachitika athandizira.
• Anasankha zakudya zapadera pa mwambo umene n'zotheka kuti azimwa chakudya madzi.
• Doctor n'kukulemberani utsogoleli wa mankhwala zimene zimachititsa mpando yomweyo.

machubu m'matumbo lavage amachotsedwa pambuyo masiku 7-9 yomweyo pambuyo opaleshoni.

Pambuyo 3-6 miyezi pambuyo ntchito nthawi, pa chikhalidwe cha madziwo yabwino kuti angathe kuchitikira matumbo kupitiriza kubwezeretsa, ndi kuchotsa zobwera chotulukira.

zosokonezeka kutheka pambuyo opaleshoni

The Vuto lalikulu kuti zikhoza kukhala zoopsa kwambiri ku thanzi la wodwalayo magazi. Iwo angayambe onse pa ntchito ndi pambuyo.

Pambuyo pa opaleshoni, mukalandire mantha, amene agonjetsa moyo wodwalayo. Ziwerengero amalamula kuti nthawi zambiri opaleshoni amafa pasanathe masiku limodzi kapena awiri pambuyo opaleshoni.

The Vuto ambiri ndi malowedwe a matenda pabalapo. Kuti tipewe zimenezi zimafuna kukonzekera osamala mu matumbo kwa opaleshoni kuthetsa wodwalayo kukhala defecate m'masiku oyambirira a nyengo postoperative. Koma ngati ntchito ndi chifukwa kuchepetsa wa intestine kuchotsa nkhani zake si zotheka mbali ziwiri, amene anafotokoza mu gawo loyamba la nkhani imeneyi.

Njira anachita pambuyo opaleshoni

Pa konzanso zingaoneke posungira mkodzo, ndi madandaulo kwa odwala, monga ulamuliro, sichibwera. Amapanga mkodzo linanena bungwe, ndipo izi zimachitika maola pokhapokha 10 pambuyo opaleshoni chokwanira. Ndondomeko anachita katatu konse tsiku. Kulephera kuchita zimenezi kungachititse chakuti chikhodzodzo limangolembedwa anatambasula, izo zaprokinetsya chagada, ndithudi, kutaya luso mgwirizano.

m'malo mapeto

Mwachangu ya opaleshoni zimakhudza zinthu zambiri, makamaka za mmene wodwalayo asanachite opareshoni, masiku opaleshoni, kusankha njira yoyenera wochita ntchito. Koma ngakhale izi, nthawi zambiri, ntchito Hartmann ndi pa m'matumbo kungakhale njira yokhayo mankhwala.