Opaleshoni sutures: mitundu ndi njira kukhotera

Mu ntchito zake, madokotala amagwiritsa ntchito sutures, pali mitundu yosiyana iwo, iyi ndi imodzi mwa njira ambiri ntchito kujowina zimakhala kwachilengedwenso: makoma ziwalo mkati, m'mbali bala, ndi ena. Amathandizanso kuti magazi asiye kutuluka, chifukwa ya ndulu, onse zikomo kusankha suture bwino.

M'zaka zaposachedwapa, mfundo yaikulu ya chilengedwe cha mtundu uliwonse wa olowa akuti ndi ulemu m'banja m'mphepete mwa bala, mosasamala kanthu za mtundu wake. msoko ayenera kugwiritsidwa ntchito kuti pali chimodzimodzi chikufanana bala m'mbali, ndipo aliyense wa zigawo wa limba mkati, chimene chimafuna suturing. Mfundo zimenezi lero amaphatikiza mawu akuti "mwatsatanetsatane".

Malinga amene chida ntchito kulenga msoko, komanso luso ntchito, munthu amatha kusiyanitsa mitundu iwiri: Buku ndi makina sutures. Pakuti anakuta china chotulutsa Buku unsembe ntchito ochiritsira ndi zoopsa singano, zopalira singano, tweezers ndi zipangizo zina. Pakuti crosslinking akhoza anasankha kupanga absorbable suture kapena anachokera ku zinthu, zitsulo waya kapena zipangizo zina.

Chisindikizo makina umagwiritsidwa ndi chipangizo wapadera komwe ntchito zakudya zamtundu zitsulo.

Pa stitching mabala ndi mapangidwe anastomoses dokotala mulole stitches mu mzere - mzere ndi zigawo - awiri, kapena ngakhale m'mizere inayi. Pamodzi ndi chakuti matabwa amalowana mukulumikizidwa pamodzi m'mbali chilonda, kotero iwo bwino kwambiri kusiya magazi. Koma kodi mitundu yosiyanasiyana ya zinthu suture lero?

Gulu la sutures opaleshoni

Monga tanena kale, ndi matabwa zimakhala Buku ndi makina, koma pali makalasi angapo magawano awo:

• ali mfundo, komanso njira yothandizira ntchito zawo;
• ngati nawo mawonekedwe - losavuta, nodal, zooneka kapena P Z, chikwama chingwe, 8 zooneka;
• mu magwiridwe ake akhoza kugawidwa mu hemostatic ndipo tili m'mavuto;
• ndi kuchuluka kwa mizere - kuchokera limodzi ndi inayi;
• tsiku lomalizira kupeza mwa nsalu - zochotseka ndi kumizidwa mu vuto loyamba, nthawi zina pambuyo stitches ndi kuchotsedwa, ndipo ngati wachiwiri kukhalabe m'thupi kalekale.

Komanso ofunika ponena ndi kuti sutures opaleshoni, maganizo awo zidzasankhidwa, malinga ndi kugwiritsidwa ntchito: angakhale absorbable ngati ntchito catgut - nyama ndi Vikram Dexon - ndi kupanga. Likulowerera mu lumen thupi - mtundu uwu msoko overlaps ziwalo dzenje. Zonse - izi ndi mitundu ya mfundo zimene si kuchotsedwa, iwo kukhalabe m'thupi kwamuyaya, ndipo anthu ambiri ali ndi connective minofu kapisozi.

zipangizo suturing

Suture zinthu zikuphatikizapo zipangizo zosiyanasiyana ntchito ligation mtima, kutsatira sutures opaleshoni. Mitundu mfundo za suturing minofu ndi khungu zosiyanasiyana chaka chilichonse kwambiri malinga ndi mmene opaleshoni otukuka. Kuti madokotala yekha sanagwiritse ntchito kulumikiza minofu ya ziwalo ndi khungu:

• Nyama tendon;
• khungu nsomba;
• kuwapeza makoswe michira ulusi;
• mitsempha ya nyama;
• Tsitsi anatengedwa kuchokera manes za pa akavalo;
• chingwe umbilical wangobadwa munthu;
• n'kupanga ziwiya;
• hemp kapena kokonati ulusi;
• mphira mtengo.

Koma chifukwa zikuchitika masiku ano, tsopano zatchuka kupanga ulusi. Pali milandu kumene zitsulo Angagwiritsidwenso ntchito.

Pakuti suture aliyense Ufumuyo zina zofunika:

• mkulu mphamvu;
• yosalala pamwamba;
• elasticity;
• zolimbitsa elongation;
• mkulu mlingo wa Pepala la zimakhala ndi.

Koma mmodzi wa i zofunika zimene zimakhudzana ndi nkhani suture n'zogwirizana ndi minofu anthu. zipangizo pakalipano ntchito mfundo, ndi katundu antigenic ndi reactogenic. mitundu mtheradi mwa makhalidwe amenewa kulibe, koma choopsa wa iwo sanamvere.

M'pofunikanso kuti suture anakaniza yolera yotseketsa, ndipo anazisunga izo ngati n'zotheka, pa nthawi yomweyo makhalidwe waukulu ayenera kukhala choyambirira. Suture akhoza zigwirizana ulusi chimodzi kapena zingapo zimene cholukanalukana ndi kupotoza, kuluka kapena kumanga, ndipo pamwamba anali yosalala, iwo TACHIMATA sera, silikoni kapena teflon.

Panopa, opaleshoni ntchito mitundu absorbable ndipo sanali absorbable suture zakuthupi. Gulu la sutures opaleshoni, ambiri a iwo zimaphatikizapo kugwiritsa ntchito filaments absorbable - catgut, womwe wapangidwa kwa tunica muscularis nkhosa intestine yaing'ono, komanso kulenga akhoza ntchito submucosal wosanjikiza. Today pali 13 catgut zamitundu zosiyana pakati pawo awiri.

Mphamvu ya chuma china chotulutsa ndi kuchuluka pamodzi ndi kukula. Mwachitsanzo, mphamvu trehnulevogo mitundu ndi za 1400 ga, koma kukula kwa chimodzi - 11500 a mtundu wa ulusi absorbable akhoza kukhala pakati pa masiku 7 ndi 30.

Wa suture sanali absorbable opaleshoni ntchito yarns za silika, thonje, fulakesi, horsehair.

mitundu ya stitches

Pamene suture dokotala khungu ayenera kuganizira mmene kudula kapena chinang'ambika bala, mmene ake ndi mmene m'mbali ake linathyoka. Komanso amaganizira malo amene anavulala. Opaleshoni wotchuka kwambiri kuti kuonedwa kuti sutures opaleshoni, chithunzi Nkhani isonyeza mmene akuonekera:

• mosalekeza subcutaneous;
• subcutaneous tinatake tozungulira;
• cutaneous nodular;
• mosalekeza Mipikisano mzere, ntchito mkati mwa khungu;
• mosalekeza mu mzere umodzi, ntchito mkati mwa khungu.

Izi zidzathandiza kudziwa ndendende zimene njira sutures opaleshoni amagwiritsidwa kwambiri crosslinking wa chilonda akunja.

Wopitiriza mtundu intradermal

Lake posachedwapa ntchito kaŵirikaŵiri, kupereka bwino zodzikongoletsera chifukwa. mwayi waukulu ndi anatengera kwambiri a m'mbali chilonda, zotsatira zabwino zodzikongoletsera ndi kusokonezeka kochepa wa microcirculation, poyerekeza ndi zina mafupa. Ulusi kwa stitching imachitika mu dermis wosanjikiza ndege kufanana thereto. Komabe, kwa mosavuta kukoka ulusi bwino kutenga monofilament zakuthupi.

Kamodzi ikuchitika chachikulu chithandizo opaleshoni mabala, mitundu ya stitches akhoza anasankha osiyana, koma nthawi zambiri madokotala amakonda sutures absorbable: Biosyns, monokrilu, polysorbate, Dexon ndi ena. Ndipo kuchokera filaments zomwe sizidzipezera kupasuka, abwino monofilament polyamide kapena polypropylene.

linasokonekera ulusi

Izi ndi mmodzi mwa mitundu otchuka a msoko panja. Ndi chilengedwe chake, khungu atabayidwa bwino kudula singano. Ngati inu ntchito, kuboola amaoneka ngati kansalu amene m'munsi imalozera ku bala. mawonekedwe puncture akhoza molondola akugwira suture. The singano ndi anaikapo mu wosanjikiza zaminyewa pafupi m'mphepete chilonda, pakupita 4 mm, kenako ikuchitika padziko oblique mu minofu subcutaneous pamene pang'ono kusuntha kuchokera m'mphepete, monga momwe tingathere.

Kamodzi wakwanitsa msinkhu chomwecho ndi lupanga chilonda, muvi ndi zimayenda kwa midline ndipo ali jekeseni mfundo kuya kwa chilonda. The singano Pankhaniyi chimafikira mu nsalu mosamalitsa symmetrical chilonda Komano, kokha mu nkhani iyi, msoko itagwa nambalayi nsalu.

Cham'mbali ndi ofukula matiresi suture

Mitundu ya stitches opaleshoni ndi mfundo amasankhidwa ndi dokotala malingana ndi kuopsa kwa chilonda, ngati pali vuto pang'ono mu kufanizitsa bala m'mbali, Ndi bwino kugwiritsa ntchito matiresi suture mu mawonekedwe a zilembo P, anakafika horizontally. Ngati ntchito nodal suture chachikulu opaleshoni chilonda kwambiri, mu nkhani iyi, inu mukhoza kusiya yotsalira patsekeke. Iwo akhoza kusonkhanitsa chimene chimatisiyanitsa pabalapo kumabweretsa fester. Zimenezi zikhoza kupewedwa ngati suture mu apansi angapo. Njira imeneyi suturing n'zotheka onse pa likulu ndi mtundu mosalekeza.

Komanso inakwaniritsidwa msoko Donatti (ofukula matiresi suture). Mu kukhazikitsa woyamba ikuchitika kudzera puncture ndi masentimita 2 ochokera m'mbali chilonda. Vykoli ndi mbali ina ndi pa mtunda wofanana. Pamene zikugwira puncture lotsatira ndi mtunda vykoli m'mphepete chilonda ndi kale 0.5 cm. Yarns The kumumanga pokhapokha matabwa onse woyikidwa Choncho n'zotheka kuti magawowa mpheto mu kuya kwa chilonda. Ntchito msoko Donati limachititsa kusoka chilonda ndi diastasis lalikulu.

Kuti mupeze zodzikongoletsera, ngati ntchito iliyonse pamafunika anachita chachikulu chithandizo opaleshoni mabala, mitundu ya stitches amasankhidwa molondola. Ngati osasamala machesi m'mbali chilonda, chifukwa kungachititse kuti amamuyambitsa timabala kwambiri. Ngati ife kugwiritsa ntchito mphamvu kwambiri pamene kumanga ndi mfundo yoyamba, zidzakhala yonyansa yopingasa mipiringidzo, zomwe zili pamodzi kutalika lonse kwa chilonda.

Koma mfundo zingwe, onse ulusi silika kumumanga mfundo ziwiri, ndi kupanga ndiponso catgut - atatu.

Mitundu ya sutures opaleshoni ndi njira ntchito yawo

Pamene ntchito mtundu uliwonse wa msoko, ndi ntchito zambiri mu opareshoni, n'kofunika kuti mosamalitsa kutsatira kuchita njira ya. Kodi molondola ntchito knotted suture?

Ndi singano ija singano koyamba anamulasa m'mphepete chapatali 1 cm, atagwira forceps. Onse vkoly unachitikira moyang'anizana wina ndi mzake. The singano amaloledwa kuchita mwachindunji kupyolera m'mbali zonse, koma nawonso angathe kuchitidwa, ndiye pambuyo wina, ndiye mu lina. Nditamaliza mapeto thonje akugwira forceps ndi singano atachotsedwa, ndipo ulusi amagwirizana, mmene m'mbali mwa chilonda ayenera mwachidule kwa wina ndi mnzake monga momwe akanathera. Choncho kuchita seams zina ndipo malinga ngati bala si kwathunthu sewn mmwamba. Aliyense olowa ayenera kukhala pa mtunda wa 1-2 cm Chrixitu. Nthawi zina, mfundo akhoza umangidwa, pamene matabwa onse tokha.

Kodi zomangira mfundo

Nthawi zambiri, madokotala amagwiritsa ntchito unit yosavuta kumangidwa kwa suture. Ndipo kupanga izo: pambuyo suture ndi yamazinga mu m'mphepete mwa chilonda, malekezero pafupi pamodzi ndi zomangira ziwiri, ndi pamwamba ndi mzake.

mfundo dotolo mukhoza kupanga njira ina: monga ulusi yamazinga pabala, mmodzi chimanjamanja kutenga kumapeto wina ndi zina pambuyo zina ndipo anabweretsa pafupi pamodzi bala m'mbali, kupanga mfundo awiri, ndi kale pa izo mophweka. Malekezero ulusi tadulidwa pa mtunda wa masentimita 1 mu msonkhano.

Kodi kusoka chilonda, ntchito zitsulo bulaketi

Mitundu ya sutures opaleshoni ndi njira ntchito yawo angakhale osiyana, omwe anatsimikiza pa bala malo kutanthauzira. mwina kungakhale mtanda kulumikiza mwa zakudya zamtundu zitsulo.

Zakudya zamtundu ndi zitsulo mbale amene m'lifupi ndi angapo mm, ndi utali - za masentimita, koma mwina. Onse malekezero zake ndi kuperekedwa mu mawonekedwe a mphete, ndipo mkati tsamba, amene likulowerera minofu ndipo alibe Wopanda pa mbedza.

Kutsatira kulimba chilonda motere m'mbali mumpanda tweezers wapadera, awabweretse iwo palimodzi, kulumikiza bwino, kotero kugwira ndi dzanja limodzi, muyenera tweezers wina bulaketi. Pambuyo pake, kuziyika izo pa mzere msoko, kufinya malekezero, khama lawoli. Chifukwa cha mpheto izi bulaketi akufunitsitsa ndi chimakwirira m'mbali mwa chilonda. Kodi zoika mtunda wa 1 cm Chrixitu.

Chotsani zakudya zamtundu, komanso mfundo za mafupa, atapita masiku 7-8 la imposition awo. Chifukwa chaichi mbedza ndi awiri wapadera wa tweezers. Pambuyo kuchotsa bulaketi akhoza limagwirizana, chosawilitsidwa ndi ntchito suturing mabala kachiwiri.

Mitundu ya stitches mu cosmetology

Zodzikongoletsera suture opaleshoni zikhoza kupangidwa ndi aliyense wa sutures alipo: silika, catgut, nsalu ulusi waya woonda, Michel clamps kapena horsehair. Mwa zinthuzi onse okha suture amasungunula, ndi ena onse satero. The sutures ali adalowetsedwa kapena zochotseka.

Ndi moti zinkamveka luso mu cosmetology ntchito yothandizira ndi knotty mafupa, yotsirizira komanso akhoza kugawidwa zambiri mitundu ingapo: nyanja, akazi wamba kapena opaleshoni.

Mu mtundu nodular, pali wina mwayi waukulu pa mosalekeza: izo mwabata nayo bala m'mbali. Koma mosalekeza msoko zikufunika chifukwa ntchito mofulumira ndipo chuma ngati kugwiritsidwa ntchito. Mu cosmetology, mitundu angagwiritsidwe ntchito:

• matiresi;
• mosalekeza msoko Reverdy;
• mosalekeza furrier;
• telala (zamatsenga);
• subcutaneous (American msoko Halsted).

Nthawi imeneyo, ngati wodwalayo ali ndi mavuto amphamvu zimakhala, adokotala akhoza kugwiritsa ntchito mbale kapena matabwa kutsogolera mbale ndi msoko odzigudubuza, imene n'zotheka kutseka zopindika lalikulu ndi adzatsekeredwa kugwira nsalu mu malo amodzi.

Opaleshoni pulasitiki monga dokotala nthawi zina ntchito apodaktilny msoko. Kwenikweni ake kwagona kuti umagwiritsidwa ndi womangidwa yekha ndi chida chapadera: chofukizira singano, forceps, ndi Pean torsion.

Kavalo tsitsi - izi ndi zopambana suture zakuthupi. Mitundu ya sutures opaleshoni ndi mfundo kulili cosmetology, wabwino kulenga ndi izo. Iye kawirikawiri amagwiritsidwa ntchito ntchito ENT, chifukwa pafupifupi palibe kachilombo, si akutivutitsa kwa khungu ndi minofu ndi malo si kukhotera suppuration ndipo amamuyambitsa timabala. Kavalo tsitsi zotanuka, yosiyana silika, izo siziri kusema khungu.

Ntchito sutures mu mano

Mano kugwiritsa ntchito mitundu yosiyanasiyana ya stitches kuti magazi asiye kutuluka kapena kusindikiza m'mphepete mwa bala lalikulu. Mitundu yonse zimfundo mu mano opaleshoni ofanana kwambiri zomwe tafotokoza kale anafotokoza, chinthu chokha chimene pali kusiyana yaing'ono mitundu ya zipangizo. Suture mu M'mimbamo m'kamwa nthawi zambiri ntchito:

• chofukizira singano;
• ophthalmic opaleshoni forceps;
• bidentate mbedza yaing'ono;
• diso lumo.

Kuchita ntchito mu M'mimbamo m'kamwa kungakhale kovuta, ndi akatswiri okha a bizinesi adzakhala wokhoza kuchita ntchito bwino, chifukwa ndi zofunika osati apamwamba chachikulu chithandizo cha zilonda. Mitundu ya stitches mu mano ndi zofunika kusankha bwino, koma koposa zonse - ndi linasokonekera ulusi yosavuta. Ndipo ziletso motere:

1. Kugwirizana chofunika kubaya m'mbali bala pa mtunda okwanira kuchokera kwa wina, thonje kutambasula ngati kuli kotheka, kusiya chabe mapeto - 1-2 cm.
2. Mapeto yaitali ya ulusi ndi singano umachitika mu dzanja lamanzere, ndiye ayenera kukulunga singano chofukizira mobwerera nthawi 2.
3. Mothandizidwa ndi mwini singano kugwila yochepa nsonga ndi kukokera mwa kuzungulira - uyu ndi gawo loyamba la msonkhano, mosamala kumangitsa, pang'onopang'ono kubweretsa pamodzi m'mbali mwa chilonda.
4. Komanso, atagwira kuzungulira, muyenera kuchita mpheto yemweyo, basi Mpukutu kauntala mobwerera kamodzi.
5. Kumangitsa athanzi wagawo, onetsetsani kuti kuyan'ana pachilichonse za mavuto thonje.
6. Kaonedwe wagawo ndi mzere odulidwa, kudula mapeto a chingwe, ndiko onse wokonzeka china chotulutsa.

Ndi bwino kukumbukira kuti molondola stitches tikufunikira kuchokera m'ma bala ndi stitches satero nthawi zambiri kuti kusokoneza magazi aziyenda bwino mu zimakhala ndi. Kwa machiritso anapita likunena, makamaka mabala chifukwa zoopsa, m'pofunika kukhazikitsa masiku angapo ngalande pakati pa matabwa a.

Zosiyanasiyana sutures opaleshoni ndi njira zolepheretsa seams mkati

Osati mfundo muyenera kuti asanene bwino mkati minofu kuyenela sewn mwabata. Internal suture opaleshoni akhoza mitundu ingapo ndipo aliyense lakonzedwa stitching zina. Tiyeni tione aliyense wa mitundu kuti bwino kumvetsa.

msoko aponeurosis

Aponeurosis - malo kumene splice tendinous zimakhala amene mphamvu yapamwamba ndi elasticity. A tingachipeze powerenga malo aponeurosis akuti ndi chiyerekezo cha mzere pamimba - kumene spliced lamanja ndi lamanzere la peritoneum lapansi. Tendon nsalu ndi dongosolo CHIKWANGWANI, nchifukwa chake splicing limodzi ulusi kumawonjezera divergence awo pakati pa madokotala, amenewa amatchedwa zotsatira za anaona.

Chifukwa chakuti zimakhala izi kuchuluka achitetezo kwa mtanda wawo kulumikiza m'pofunika ntchito inayake mafupa. Amaona yodalirika mosalekeza encircling ulusi, umene umatipanga ntchito kupanga absorbable sutures. Kuti zinthu monga "Polisorb", "Biosyns" "Vicryl". Pogwiritsa ntchito sutures absorbable chingalepheretse fistulas ligature. Komanso, polenga chotero olowa Angagwiritsidwenso ntchito sanali absorbable ulusi - "Lavsan". Ndi thandizo lawo, mukhoza kupewa mapangidwe hernias.

The msoko pa minofu adipose ndi peritoneum

M'zaka zaposachedwapa, kawirikawiri sutured machitidwe nsalu, chifukwa iwo kupereka maphatikizidwe kwambiri ndi machiritso mofulumira. Komanso, pakalibe seams si kusokoneza magazi pa malo chilonda mapangidwe. Nthawi imeneyo, ngati palibe msoko sangakhoze kuchita, adokotala akhoza kugwiritsa ntchito pogwiritsa ntchito sutures absorbable - ". Galasi limodzi la"

seams matumbo

Pakuti stapling ziwalo dzenje ntchito mfundo angapo:

• Single mzere sero-akulu-submucosal suture Pirogov, amene msonkhano aikidwa pa thupi kunja chipolopolo.
• Mateshuka msoko, mbali zake n'chakuti malo pa chilengedwe ake amakhalabe m'thupi, mu mucosa ake.
• Single mzere msoko Gumby ntchito pamene dokotala ukugwira m'mimba, amene luso lake ndi ofanana kwambiri kwa msoko Donati.

seams chiwindi

Chifukwa chakuti thupi zokwanira "wofumbutuka" n'kuwadzaza ankawaviika magazi ndi ya ndulu, kuchita padziko msoko wake zovuta ngakhale kwa dokotala akatswiri. Nthawi zambiri, mu nkhani iyi, dokotala amaika msoko mosalekeza popanda kukodwa kapena mosalekeza matiresi suture.

Ndulu ntchito U-zooneka kapena eyiti woboola pakati sutures opaleshoni.

Matabwa pa zotengera

Mitundu ya sutures opaleshoni ntchito traumatology, ndi makhalidwe awo. Ngati mukufuna kuti kusoka ziwiya, mu nkhani iyi komanso zotheka amathandiza mosalekeza msoko popanda kukodwa, amene amaonetsetsa kusindikiza odalirika. Ntchito zambiri kumayambitsa mapangidwe "bunching", koma kupewa amenewa, mungathe, ngati inu ntchito limodzi mzere suture nangula.

Opaleshoni sutures mitundu ntchito mu opareshoni zoopsa ndi ofanana. Aliyense mtundu uli ndi zovuta zake ndi ubwino, koma ngati njira ufulu imposition awo ndi kusankha bwino njira chingwe, olowa aliyense akhoza kugwira ntchito yake ndi kukutetezani bala kapena ulusi thupi. Nthawi kuchotsa suture pa nkhani iliyonse atsimikiziridwa payekha, koma ambiri 8-10 maola kale iwo achotsedwa.