Operation Wertheim: indlela yokusebenza, iziphumo, iingxaki, ncomo

Enye inkalo imisebenzi xa onkopatologii nto ezinkulu, ngamanye kuphela ukususwa nethumba ngokwayo, kodwa kwakhona isixa elininzi ephilile ezikufutshane ezonka yezifo. Ukongeza, kunye excised ithumba kunye nkovu ezalathelwe ekufunxeni lymphatics kulo.

unyango olukhulu komhlaza womlomo wesibeleko kunye endometrial

operation Wertheim xa sithobela ngokupheleleyo nezi mfuno zilapha ngasentla. kubume bayo siyifumana ekususweni wesibeleko kunye ezihlobene (wesizalo kunye amaqanda), lo wesithathu ongentla kwinxenye yelungu lobufazi, isibeleko kunye nokuxhasa nemisipha ezingqongileyo okunamafutha inyama evela ezalathelwe nkovu.

Kubonakala kutyando umhlaza womlomo wesibeleko kunye zesibeleko. Kodwa kwezinye iimeko, utyando ayikhuthazwa:

• phambi metastases ezikude;
• xa yamathumba enkulu, amatsha okuhluma nemithambo kunye namalungu ezikufutshane kunye nodonga maxa wambi zangasese;
• ezinxulumene ezimbi kakhulu;
• ebudaleni.

Wertheim operation umhlaza womlomo wesibeleko

Ukuba sithethe malunga unyango lwesi sifo, kufanele kuqatshelwe ukuba umsebenzi uthe ingasetyenziswa zombini ngokuzimeleyo njengenxenye yonyango udibaniso.

Kwimeko ngokwahlukeneyo kakhulu carcinomas umhlaza iseli diagnosis (T1bN0M0 inqwanqwa), lo msebenzi ngokupheleleyo ukusombulula ingxaki ngaphandle ezibandakanya iindlela ezifana ichemotherapy kunye nonyango radiation. Noko ke, uninzi operation Wertheim yeyona licandelo unyango udibaniso.

Xa umhlaza endometrial (nokuba kukwinqanam IB) zisoloko ababelwe kwezinye nonyango, ukongeza uqhaqho.

Operation Wertheim: operation move

Utyando ukususa olukhulu wesibeleko kunye ezihlobene iquka izigaba ezininzi. Ezi ziquka:

1. Access.
2. Kuhlangana nemisipha zesibeleko.
3. Ukufunwa kwimibhobho Imibhobho kunye zamaqanda.
4. Ukufunwa lwesinye.
5. Tubal kunye ekudibaneni kwe neempahla ukuphakela.
6. Ukususwa yethishyu ukusuka kumphezulu phambi wesibeleko.
7. Ekudibaneni kwe-nemisipha ukulungisa isibeleko umva (sacral-zesibeleko).
8. Kuhlangana imisipha wesibeleko.
9. resection wesibeleko.
10. Hemostasis isiphunzi lobufazi.
11. Peritonization.

ukufikelela kuhlinzwa

Operation Wertheim - ungenelelo olunzulu kufuna nokuthelekelela elungileyo yentsimi zoqhaqho kunye namathuba yokuntlokothiswa, ezingahambi iingxaki okanye umda. Ngoko ke icandelo kufuneka kwanele. Mini zokungena kunye notyando endoscopic, kulo mzekelo musa ukungena. Xa izinto unyango lomhlaza isiphumo izithambiso ngokubaluleka na indawo yokugqibela.

Yenziwa laparotomy longitudinal median (asike kodonga akudala esiswini ye omhlophe umgca a esa isisu inkaba) okanye ukufikelela Czerny (laparotomy ezinqamlezayo kunye asike le abdominis rectus).

ukuhlanganisa isibeleko

Ukuza kuthi ga ngoku, phambana lungu esibusazinge wesibeleko, kunye nemisipha zabucala suspensory maqanda, kwaye isiphelo kumbhobho unina. Zonke ezi zidalwa mayihlatywe kuze, xa kunokwenzeka, kwiindawo lube imithambo yegazi. Oku kuya kunciphisa ilahleko igazi. Isibeleko efanayo kakhulu ithathwa kwi okubamba alahlwa ukuya ecaleni.

Emva ewela lungu suspensory ye isizalo uba ukususwa isibeleko kunokwenzeka. Okona kubalulekileyo, kunye kugaya babo - kungabikho monakalo ureter. Ukuze wenze oku, ngexesha usebenzo Ngokucofa imbopheleleko yenu elo lungu ebanzi. Ngasemva oko ngokubanzi iphepha kulula na ureteral esibayeni. Le buqhinga ikuvumela ukuba ukuhlanganisa wesibeleko kunye ezihlobene ngaphandle ureteral kukwenzakala.

Emva kokuvula i-vesico-zesibeleko nezibaya isinyi yomqhaphu swab siyahlukana udonga phambi wesibeleko. Oku kufuneka kwenziwe ngaphandle Ngokuphambuka ukusuka kumgca osembindini, ukunciphisa ingozi yokwenzakala ukuya plexus nemithambo.

Ukuba esinyini lo unamathele ukuya azikhuli isibeleko, ngokwahlukana kwayo kunokuba nzima. Qala keying kwimeko le nemisipha ngeenxa zonke, nihambe kwiziqephu entanyeni kunye ukuhamba mkhulu, aphuphume yahlukanisa izikere.

Wertheim operation Further ibandakanya tubal iimpahla. Esiqhumeni semithambo iphambili isibeleko - kwemithambo zesibeleko ngemithambo ehamba, ehamba ngohlangothi wesibeleko. Tubal kubo kwinqanaba le os lwangaphakathi.

Kuba kugaya olongezelelweyo zesibeleko liqatywe isebenza kwaye uqala predpuzyrnoy ifascia inyama kwiindawo luhlaza phambi wesibeleko phantsi. lungu Further emnqamlezweni, ezibe ngaphambili ayifumaneki ukuze zisetyenziswe: sacro-zesibeleko kunye nemisipha wesibeleko. Emva koko hysterectomy oza Inqanaba lokugqibela.

Eneneni hysterectomy, hemostasis kunye peritonization

isiqulathi kusisi wavula, wesibeleko kuthathwa iiclamps yaye ngokuthe ngcembe bonqanyulwa bangabikho lobufazi. Oku kulandelwa hemostasis kunye peritonization. isiphunzi kusisi akakwazi ungenisa ngokuqinileyo, oko unako ukukhonza yokukhupha amanzi zendalo xa kuthe kwakho naziphi na iinkqubo zophendlo lwezifo em- zangasese kunye nokwanda kwe ubofu okanye igazi apho.

tube kusisi iphathwa ngendlela ekhethekileyo. Iindonga kwinxenye yelungu lobufazi ligated vesico-zesibeleko kunye rectouterine nezibaya, kwakunye nemisipha sacro-zesibeleko, ngaloo ndlela ekufezekiseni hemostasis kunye peritonization.

Ithuba postoperative

Njani na isigulane emva kotyando Wertheim? utyando olunjalo olukhulu akakwazi abonwe ngokupheleleyo. Ngaphandle kwamathandabuzo, oku kuchaphazela impilo emzimbeni nasengqondweni.

Yintoni ibandakanya operation Wertheim? Imiphumo yale ndlela zonyango lungohlulwa lube phambi kwexesha nasemva kwexesha.

Iingxaki evela kwixesha lokuqala postoperative

Ithuba postoperative kunokuzenza nzima:

1. Usulelo amalunga (hayi kuphela isikhumba kodwa lwangaphakathi).
2. Peritonitis kunye nokudumba.
3. Ukopha ukusuka kwindawo namalungu, kuquka ingaphakathi.
4. komphetho indawo Hematoma.
5. Dysuria.
6. PE (Embolism pulmonary).

Nditsho kugcinwe lingqongqo inzalo akusoloko kusenzeka ukuba siphephe iingxaki nokulimala. Oku kungenxa yokuba i-tyando lwenziwa izigulane isidumbu sakhe ukuba buthathaka kwaye ngokunjalo nomzabalazo ngamathumba ithumba sifo lifinyele. Ngoko ke, ukudumba amalungu kuzo - imeko kunokwenzeka. Ngenjongo yokuthintela i imeko enikwe ixesha postoperative efunekayo antibiotics.

Ukopha kunye nokulimala kubonisa ukunqongophala hemostasis. Izikhundla amachiza hemostatic azisoloko ngokwaneleyo, yaye ngamanye amaxesha ifuna utyando ngokuphindaphindiweyo - uhlaziyo enxebeni suturing kweenqanawa ukopha.

Dysuria - Ukuchama rhoqo buhlungu. Inkangeleko yalo uphawu kunokwenzeka ukuba ezonakeleyo urethral catheter imazi ibonakalisa kunye kukuvela urethritis esibuhlungu.

PE kunokwenzeka njenge kwingxaki ye thrombosis kweqondo asezantsi. Kungenxa yoko le nto kwithuba postoperative ababelwe anticoagulation ( "lweeHedfowuni") kwaye kucetyiswa ukuba ukunxiba iikawusi ucinezelo okanye amabhandeji elastic.

Imiphumo xesha emva

Kukho iingxaki ezithile emva kotyando Wertheim, ukuphuhlisa kwixesha elide:

1. iingxaki Ukuchukumiseka: uloyiko utshintsho kunokwenzeka imbonakalo kunye nelahleko drive sex (kuba zamaqanda zisusiwe, oko kuthetha ukuba inqanaba ka emzimbeni ngesondo awuyitshintshanga), iimvakalelo malunga nokungakwazi ukukhulelwa, siva elibi phezu kodonga sobuKristu esiswini.
2. azikhuli esiswini.
3. Kuvuthondaba.
4. Ukungafakwa kwinxenye yelungu lobufazi.
5. Imfundo retroperitoneal limfokist.

Amava kwabasetyhini malunga neziphumo hysterectomy kakhulu iyaqondakala. Ngenxa yoko, kwisithuba postoperative inkxaso ebaluleke kakhulu nokuqonda nosapho.

Ezinye iingxaki (kukuqulungana postoperative, ukungakwazi ukuba abantwana) ukuba wamkele kuphela. Kwelinye izinto unako yaye kufuneka silwe, njengoko ngokufuthi sizathu. Spaying iBhayibhile ithetha naluphi na utshintsho iyintsika ngenkangeleko okanye kwinqanaba ngokwesondo. Kodwa inokubangela kabi ngexesha lokwabelana ngesondo ukuba emva gisteretomii washiya isiphunzi mfutshane kakhulu lobufazi.

Azikhuli emva kotyando Wertheim akhiwa ngendlela efanayo emva nayiphi kwisisu yotyando. Oku kungenxa traumatization le peritoneum ngethuba kusebenza, nto leyo ekhokelela ukuba ukuyilwa imisonto zeethishu nokuqina phakathi amaxwebhu ayo kunye nezibilini.

Azikhuli kwi kwisisu kungabangela intlungu esiswini, ukuphazamiseka of ukuchama kunye defecation, kwaye kwezinye iimeko nobusenokukhokelela emathunjini. Kuthintelo adhesion uluhlu kwixesha postoperative kukho ukusebenza ebalulekileyo okuqala isigulane kunye nokuqhuba ukwandiswa kwendawo yokuhlala ngosuku lokuqala emva kotyando.

Kwabadala kwenzeka emva hysterectomy ngenxa ukususwa zamaqanda. kwabadala Postoperative lithwale zendalo, kuba kulo mzekelo, utshintsho hormone zenzeke ngokukhawuleza. Ukunciphisa kuyaphela kusetyenziswa unyango hormone.

A utyando prolapse kusisi Wertheim kwenzeka ngenxa yomonakalo isixhobo ligamentous (a imeko ayimfuneko kokwenza hysterectomy) kunye ukubana amalungu zangasese kwi ndawo esibelekweni ndingekho. Kuba ekuthinteleni ingxaki enjalo isigulane abuyise ukwenza imithambo ezizodwa, enxibe isibiyeli, umda umzimba isithuba seenyanga ezi-2 emva kotyando.

Amaninzi kule kwisithuba retroperitoneal amiliswe limfokista Wertheim emva kotyando. ngonyango yotyando. Nangona kunjalo, kakhulu ngempumelelo ngakumbi ukuthintela ukwenzeka kwale ingxaki namanje nenqanaba ngokusebenza, kunokuba ukunyanga. Ukulungiselela le njongo, iindlela ezahlukeneyo amanzi retroperitoneum.

Yintoni abantu bathi malunga nokusebenza Wertheim

Ukuze kukuphelisa umhlaza olukhulu wesibeleko okanye endometrial isicelo operation Wertheim. Iimpendulo ngayo zahlukile.

Koogqirha kunye nezigulane bathi izinto ezakhayo emva kotyando:

1. Ukwanda kweminyaka yokuphila.
2. ukungabikho kuqinisekisa zizifo zesibeleko, kuqukwa umhlaza.
3. Kukhulelwa, akavumi nkqu amathuba encinane ukukhulelwa okungafunekiyo.
4. Olu tyando akuthethi ukunciphisa ukusebenza, kuyenzeka ukuba babuyele ubomi obuqhelekileyo.

Bendlela imisebenzi:

1. Ukungakwazi ukuba nabantwana.
2. siva elibi phezu kodonga sobuKristu esiswini.
3. Ukuba nokwenzeka iingxaki, ethabathela phambi kwexesha nasemva kwexesha (kuxoxwe ngasentla).

Ngamafuphi

Hysterectomy for Wertheim - unyango olusebenzayo olukhulu yamathumba amabi wesibeleko kunye endometrial. Olu tyando kuphela nako bawubuyise isigulana somhlaza, kodwa ngandlel 'ithile kuphucula umgangatho wobomi.

Kakade ke, njengaye nawuphi utyando, hysterectomy igcwele kuphuhliso iingxaki. Noko ke, xa umbutho bolu kwexesha postoperative, yaye ngokuxhomekeke amanyathelo ayimfuneko azizithintelo niphambuke kubo.