ImpiloImithi

Enteroplexy: izinhlobo. Izindlela kwakwakhe odongeni emathunjini

Igama elithi "umphetho emathunjini" iqoqo futhi kuhilela ukususwa ukulimala kanye zamehlo emphinjeni, esiswini namathumbu. Ngisho phakathi neMpi YaseCrimea, Pirogov Nikolay Ivanovich esetshenziselwa suturing izitho eziyize ezivuzayo ekhethekile. Basiza ukugcina isitho ethintekile. Kwaphela iminyaka eminingi, sinikeza zonke izinguqulo ezintsha suture emathunjini, waxoxa emihle nemibi ukwahluka ezahlukene ke, okhombisa ukubaluleka kanye ubumbaxambili inkinga. Le ndawo evulekile ucwaningo kanye nokucwaninga. Mhlawumbe esikhathini esizayo esiseduze kuyoba umuntu utawuniketa indlela eyingqayizivele kwezicubu uxhumano. Futhi kuyoba intuthuko kule nqubo ye uthunge.

Izidingo Eziyisisekelo for umphetho emathunjini

Ngo kokuhlinzwa, zikhona izimo eziningana okufanele zifinyelelwe le suture emathunjini ukuze ingasetshenziswa imisebenzi besisu:

  1. Okokuqala, ubuqotho. Lokhu ibangelwa ofanayo olunembile ezishelelayo serous. Zihambisana nomunye futhi ashiselwe uvalwe, ukwakha sesibazi. ukubonakaliswa Negative izakhiwo kukhona ukuvuvukala ezingase kuphazamisa indima okuqukethwe emathunjini tube.
  2. Ikhono nigweme ukusaphaza ngenkathi sigcina imithambo yegazi ukunikezela okwanele lolo umphetho nokwelashwa zalo zokuqala.
  3. I umphetho kufanele bacabangele isakhiwo se-wokugaya ukudla ipheshana udonga.
  4. A amandla abalulekile kulo isilonda.
  5. imiphetho Balimaze inhloso eyinhloko.
  6. Minimal emizimbeni ukuhlukumezeka GI (emathunjini). Lokhu kusho renunciation ka Twining yaseZimbabwe round, ukusetshenziswa izinaliti non-koda, kanye Asebenzisa esebenzisa futhi izibopho, okungase kulimaze odongeni umzimba eziyize.
  7. Isexwayiso izikhumba necrosis.
  8. ukuqhathanisa olunembile izingqimba tube emathunjini.
  9. Ukusetshenziswa impahla okubolayo.

Isakhiwo odongeni emathunjini

Njengomthetho, odongeni emathunjini tube has sakhiwo lesifanako kulo, kunomehlukwana omncane. Isendlalelo kwangaphakathi - izicubu lwamafinyila, esakhiwa ungqimba cubic eyodwa epithelium, okuyinto ezingxenyeni ezithile babe villi for ukumuncwa kangcono. Ukuze mucosa kuyinto friable submucosal ungqimba. Khona-ke kukhona Friend imisipha ungqimba. I ukujiya kanye ilungiselelo le micu incike tube ikhadi emathunjini. Ngo imisipha emphinjeni kukhona circularly, emathunjini amancane - longitudinally, futhi ku obukhulu imisipha Imicu yotshani ahlelwe ngendlela opholile ububanzi. Ukuze ungqimba imisipha kuyinto serosa. Le filimu mncane, ehlanganisa izidumbu nomgodi ukuqinisekisa ukuhamba zawo ezilinganiselwe komunye nomunye. Ukuba khona kwalesi ungqimba kufanele inake lapho ngaphezulu umphetho emathunjini.

Izakhiwo serosa

A impahla ewusizo ukuhlinzwa serosa (m. E. engaphandle) ulwelwesi tube kokudla ukuthi ngemva afanayo emaphethelweni isilonda uvalwe ethe njo amahora ayishumi nambili, amafayibha ngokwanele uvalwe tho nge izinsuku ezimbili. Lokhu kunikeza yobunzima umphetho. Ukuze uthole lo mphumela, kumele usebenzise yaseZimbabwe njalo ngokwanele, okungenani ezine komunye isentimitha.

mncane zokwenziwa lokuluhlaza asetshenziselwa ukunciphisa kwezicubu esicindezelayo isilonda ngesikhathi crosslinking. Ngokuvamile, sutured kuya serosa imisipha zesivikelo sesifuba, anikeza enkulu kuyaqina umthungo, futhi ngaleyo ndlela, ikhono yokwelula ngesikhathi ukudlula bolus. Capture submucosal futhi izingqimba mucosal ukunikeza hemostasis ezinhle futhi amandla ezengeziwe. Kodwa kubalulekile ukukhumbula ukuthi ukutheleleka nge ebusweni engaphakathi tube emathunjini ngu suture kungaba zasakazekela komgodi ongaphakathi kwamathumbu.

Icala zangaphandle engaphakathi umsele alimentary

Ukuze uziqeqeshe udokotela ohlinzayo kubaluleke kakhulu ukwazi futlyarnoy isakhiwo isimiso alimentary umsele odongeni. Ngaphansi lo mbono ikhomba izimo zangaphakathi nezangaphandle. Icala yangaphandle kuhlanganisa serosa futhi imisipha ulwelwesi kanye yangaphakathi - we mucosa kanye submucosa. Ziyakwazi isihlobo ezithathekayo nomunye. Ezingxenyeni ezihlukahlukene tube emathunjini lapho displacement umonakalo ezahlukene. Ngokwesibonelo, incipha kuka kunjalo kwangaphakathi, futhi uma umonakalo isisu ezingeni emphinjeni - ngaphandle. Emathunjini, kokubili emgodleni ukusakaza ngokulinganayo.

Lapho udokotela ohlinzayo sutures odongeni emphinjeni, inaliti is injected obliquely ohlangothini lateral (emaceleni). A perforation is sutured ogangeni esiswini e okuphambene, isiqondiso obliquely-medial. Ithumbu elincane lelikhulu ithungwe ncamashi perpendicular. Ibanga phakathi yaseZimbabwe akufanele kube amamilimitha angu engaphansi kwemine. Izinyathelo eziholela ukwehla ischemia futhi necrosis of emaphethelweni ukulimaza, futhi ukwanda - ukuhluleka ukopha.

Boundary eduze onqenqemeni ezivuzayo nezihlanganiso

umphetho emathunjini kungaba mechanical mathupha. Lesi sakamuva, esikhundleni salokho, zihlukaniswe ku umngcele, eduze onqenqemeni futhi kuhlanganiswe. I pass lokuqala ngokusebenzisa emaphethelweni isilonda, ukubaleka yesibili kusukela onqenqemeni yalo ayiyona isentimitha, futhi kuhlanganiswe sihlanganise kukho ezimbili eyedlule.

ezivuzayo Boundary kukhona odnofutlyarnymi futhi dvuhfutlyarnymi. It kuncike bangaki amagobolondo exhunywe kanyekanye. Bir umphetho nge kungathuthukiswa amagatsha emigwaqo elingaphandle umphetho odongeni Mateshuka (nge ISIZINDA ngaphakathi) ubheke isigaba esisodwa, njengoba nje ibambe muscularis Tunica futhi serosa. Ezintathu ungqimba umphetho emathunjini Pirogov, okuyinto hhayi kuphela ithungwe icala yangaphandle, kodwa futhi ungqimba submucosal ngokusebenzisa umphetho futhi Gely dvuhfutlyarnymi.

Ngakwelinye ihlangothi, kungenzeka ukuxhumana ngokusebenzisa lwenteke njengoba engeyokuqala, futhi umthungo okuqhubekayo. Lokhu temu ukuhlukahluka eziningana:

- Twining round;
- semibhede isekela;
- Reverdy umphetho;
- umphetho Schmid.

Eduze onqenqemeni, futhi, kufanele ngezigaba zabo. Ngakho, isehlane Lambert umphetho elimelela dvustezhkovy suture ihange. It lisetshenziswa yangaphandle (sero-kwemisipha) icala. Nokho kukhona umthamo okuqhubekayo, esikhwameni string, polukisetny, U ezimise-no-Z emise.

ezivuzayo kuhlanganiswe

Njengoba leli gama lisikisela, le sutures kuhlanganiswe ukuhlanganisa tincenye onqenqemeni eduze onqenqemeni. Ukunikezelwa "okuthiwa" sutures kuhlinzwa. Basuke yaqanjwa odokotela owaqala esetshenziswa ukuhlinza ezithweni besisu:

  1. I umphetho kuyinto ekhuthaza Czerny onqenqemeni eduze onqenqemeni sero-kwemisipha ngokuhlanganyela.
  2. umphetho Kirpatovsky - nhlanganisela umphetho onqenqemeni futhi submucosal serous-kwemisipha.
  3. Albert umphetho kuhlanganisa ngokuhlanganyela ezimbili ethize: Lambert futhi Gely.
  4. Tupe umphetho iqala njengenhlangano onqenqemeni ngokusebenzisa umthungo, okuyinto izingxenye nasezinsikeni mafutha anciphisa isikhala esingaphakathi umzimba. Lambert ke suture ibekwe phezulu.

Ukwahlukanisa ngenani lemigqa

Kukhona division of ezivuzayo abalobi nje kuphela kodwa futhi ngenani lemigqa esikhulu eyodwa ngaphezu kwamanye. Udonga emathunjini has nesilinganiso esithile, ngakho amanxeba suturing indlela lwakhiwe ukuze ugweme kuqhuma kwezicubu.

Single irowu ezivuzayo kuyendlulela nzima, kudingeka ube ngokunemba emasu nemacebo kuhlinzwa, ikhono ukusebenza kwe-microscope yokusebenza futhi mncane inaliti atraumatic. Imishini enjalo ayitholakali yonke yokusebenza, hhayi njalo udokotela ohlinzayo ungakwazi ukubhekana naso. Ezisetshenziswa kakhulu kabili emgqeni uthunge. Basuke fixed kahle futhi imiphetho nilimaza kukhona standard igolide ekuhlinzeni besisu.

Multi-irowu sutures asetshenziswa kakhulu kuyaqabukela. Kakhulukazi ngenxa yokuthi i-emathunjini tube umzimba odongeni mncane futhi ethambile, futhi inani elikhulu sesigcilikisha ngabe singangeni ngaphakathi kuyo. Ngokuvamile, Imbondela multirow operation ezivuzayo iphele emathunjini ezinkulu, isb appendectomy. Udokotela ohlinzayo ligature lokuqala ziwumthwalo kumila isithasiselo saleli Bhayibheli. Lesi yisihloko sokuqala, umphetho kwangaphakathi. Khona-ke kukhona suture esikhwameni string ngokusebenzisa ungqimba serous futhi kwemisipha. Yena some avaliwe phezulu Z emise, ukulungisa umdlavuza isiqu nokunikeza hemostasis.

Ukuqhathanisa sutures emathunjini

Ukuze ukwazi ngaphansi kwaziphi izimo kungcono ukusebenzisa elilodwa noma kwenye umthungo, kudingeka wazi namandla nobuthakathaka babo. Ake sihlole kubo ngokuningiliziwe.

1. Ubumpunga serous suture Lambert, ngoba bonke nje ngisahlose waso nezindlela ezihlukahlukene zokusisebenzisa has bokwenza eziningana. Okungukuthi, awusebenzi ukunikeza hemostasis kudingekile; ngempela ethambile; Akukona qhathanisa mucosa kanye submucosa. Ngakho-ke, kufanele usebenzise ngokuhlanganisa nabanye yaseZimbabwe ke.

2. Boundary single- futhi double irowu yaseZimbabwe uqine ngokwanele ukunikeza ukuqhathanisa ezigcwele zonke zamatshe kwezicubu, ukunikeza kwezimo ezifanele wenza kutholakale ukuphulukiswa kwezicubu, ngaphandle ukuvala inesikhala zomzimba, kanye ukuqeda ukubukeka isibazi ezibanzi. Kodwa babe nobubi obuthile. Umphetho permeable kwangaphakathi esiswini microflora. Hygroscopicity kuholela isifo kwezicubu nxazonke.

3. sutures serous-kwemisipha submucosal ifa eside amandla mechanical, ukuhlangabezana nezimiso futlyarnoy wamathumbu odongeni isakhiwo, ukunikeza hemostasis okugcwele ukuvimbela ukuvaleka mafutha anciphisa isikhala esingaphakathi isitho eziyize. umphetho ezinjalo eziphakanyisiwe ngesikhathi esisodwa Pirogov Nikolay Ivanovich. Kodwa kwakungegazi ukushintshashintsha olulodwa-irowu. Lokhu ukuguqulwa has a izimfanelo ezimbi:
- eqinile nakho ngeke kusize izindwangu umugqa uxhumano;
- ukwanda usayizi isibanda ngenxa ukuvuvukala nokuvuvukala.

4. emalungeni Kuhlanganiswe zinokwethenjelwa, kulula ukuba kusebenze, gemostatichny, ukuvuza-ubufakazi futhi iqine. Kodwa ngisho ezifana umthungo ezibonakala ephelele, has nezihibe:
- ukuvuvukala izicubu kanye uxhumano umugqa;
- ukuphulukiswa kancane;
- kumiswa necrosis;
- Amathuba Ephakeme ukuvuvukala;
- ukutheleleka lokuluhlaza e edabula mucosa.

5. Kathathu irowu emalungeni ngokuyinhloko esetshenziselwa Ukuvalwa izici ku ikholoni. Ziyakwazi okuhlala, ukunikeza lithathelwe ezinhle emaphethelweni isilonda. Lokhu kunciphisa ingozi ukuvuvukala necrosis. Phakathi ukushiyeka le ndlela yilezi:
- ukutheleleka ngenxa suturing izindikimba emigodleni emibili kanyekanye;
- ingasheshi ukuvuselelwa kwezicubu kusayithi wamanxeba;
- awokuthi okuvela ukuvuvukala, kanye, ngenxa isimiso;
- ischemia izicubu endaweni le suture.

Singasho ukuthi amasu ngamunye suturing amanxeba kwezitho eziyize kunezinzuzo zako siqu kanye nobubi obuthile. Ukuhlinzwa kuyadingeka ukugxila umphumela umsebenzi wabo - lokho ncamashi efuna ukufeza lo msebenzi. Yiqiniso, imiphumela emihle kufanele njalo BUSA negative, kodwa lona okugcinwe akukwazi ezingeni ngokuphelele.

teething ezivuzayo

Evamile, kungenziwa wonke amalunga omzimba zihlukaniswe amaqembu amathathu: nalezo ziqhuma cishe njalo ziqhuma akuvamile futhi cishe besika. Iqembu lokuqala uthola umphetho Schmid futhi Albert umphetho. Badlula ngokusebenzisa ulwelwesi lwamafinyila, okuyinto abalimala kalula. Ukuze iqembu lesibili basonta ezivuzayo, ibekwe eduze inesikhala umzimba. Lokhu umphetho kanye umphetho Mateshuka Bira. Iqembu lesithathu lihlanganisa ezivuzayo angekho ukuxhumana inesikhala we esiswini. Ngokwesibonelo, Lambert.

Ngokuphelele ukuvala amathuba ukuqhuma we weld akunakwenzeka, ngisho noma isetshenziswa kuphela serosa. Ngaphansi kwezimo alinganayo umphetho okuqhubekayo iyasikwa nge okungenzeka ephakeme kunaleyo engeyokuqala. Lokhu kungenzeka ukwandisa uma intambo Kunenkolelo eduze mafutha anciphisa isikhala esingaphakathi umzimba.

Hlukanisa mechanical kuqhuma ntambo inyumbazane umphetho kanye uquqaba necrotic futhi ukuqhuma ukusabela ngenxa izicubu sicekelwe.

amamaterial resorbable

Kodwana impahla ukhululekile kakhulu ongenza umphetho emathunjini - zokwenziwa Imicu yotshani resorbable. Bavumela ukuthi uxhume emaphethelweni kwesilonda Adalberto isikhathi eside futhi musa ukushiya umzimba impahla yangaphandle nesineke. Ngokukhethekile ikhokhelwa ukuze inqubo ukususwa ntambo kusuka emzimbeni. Imicu yotshani Yemvelo bavezwa izicubu enzyme, kanye nezindwangu zokwenziwa basuke wajinge wanamatsela ngu hydrolysis. Njengoba hydrolysis lingaphansi abulale izicubu zomzimba yomzimba, ke kungcono ukusebenzisa izinto zokwenziwa.

Ngaphezu kwalokho, ukusetshenziswa zokwenziwa izinto kwenza kube nokwenzeka ukuba athole umthungo okuqinile kwangaphakathi. Abanaso zingene Indwangu, ngakho-ke, yonke le nkathazo kulo ukuthi lokhu kungase kuholele ekusebenziseni i phezu, futhi, zikhishiwe. Enye omuhle izinga amapulasitiki ngalolo abazi zimunce amanzi. Lokhu kusho ukuthi umphetho ngeke zikhubazekile futhi izitshalo emathunjini, okungase ngegciwane isilonda, futhi ngeke iwe mafutha anciphisa isikhala esingaphakathi umzimba surface saso.

Ukukhetha umphetho kanye kwento okufanele sutured isilonda, udokotela ohlinzayo kumelwe siqondiswe yiwo nokuhlonipha imithetho yezinto eziphilayo ukuthi ahlinzeke izicubu Fusion. Isifiso hlanganisa inqubo, ukunciphisa inani imigqa noma sebenzisa efakazelwe ngabe imicu akufanele kube umgomo. Okokuqala ukuphepha kubaluleke nesineke, ukusebenziseka yayo, ukuncishiswa post-op isikhathi alulame futhi ubuhlungu.

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