Operation Wertheim: akoranga o te mahi, mau hopearaa, pōauautanga, arotake

Ko tētahi āhuatanga o ngā mahi, ina ko onkopatologii he tuwhena, i.e. e kore noa te tango o te puku iho, engari ano hoki i te nui o te kiko hauora pātata ki te kanga pathological. I tua atu, ki te puku, me te tīpona kōpuku motuhia riringi lymphatics reira.

maimoatanga tuwhena o te pukupuku i te waha, me te endometrial

tino ū mahi a Wertheim ki te whakaritenga i runga ake. takoto Ko tōna ngako i roto i te tango o te kōpū ki te konga (korere uterine me ovaries), te tuatoru o runga o te tenetene, kōpū, me te tautoko i mea tuhonohono, me te a tawhio noa kiko fatty i taikiri.

Ko te tohu mo te pokanga e waha, me te uterine mate pukupuku. Otiia i roto i ētahi wā, e kore e tūtohu pokanga:

• i roto i te aroaro o metastases mamao;
• i roto i te take o te pukupuku nui, pihi iaia me okana tata, me te taiepa i te tahi taime papatoiake;
• e pā ana ki pathologies nui;
• i roto i te tau tawhito.

mahi Wertheim mō te mate pukupuku waha whare

Ki te kōrero tatou e pā ana ki te maimoatanga o tenei mate, kia tuhia te reira e taea te whakamahi e rua takitahi me hei wāhanga o ngā therapy te mahi mea.

I roto i te take o tino rerekëtanga tātaritanga mate pukupuku pūtau squamous (T1bN0M0 taahiraa), ka taea e tenei mahi radically whakaoti i te raruraru, kahore whai wāhi tikanga pērā i te hahau, me te radiation therapy. Heoi, te nuinga o te mahi a Wertheim ko te wāhanga o te huinga therapy.

A, no te e whakaritea tonu mate pukupuku endometrial (ara i roto i te atamira IB) ki ētahi atu whakaora, i roto i te tua ki te pokanga.

Operation Wertheim: mahi nekehanga

Pokanga mō te tango tuwhena o te kōpū ki te konga ngā maha ngā wāhanga. Ko ētahi o ēnei:

1. Access.
2. Ko te pūtahitanga o tuhonohono uterine.
3. Roopu o nga korere kākano me ovaries.
4. Roopu o te tōngāmimi.
5. Ligation me te pūtahitanga o te oko kai matua.
6. Tangohanga o kikokiko i te mata mua o te whare tangata.
7. Ko te pūtahitanga o te mea tuhonohono whakatika kōpū hoki (sacral-uterine).
8. Ko te pūtahitanga o tuhonohono waha.
9. resection waha.
10. Hemostasis tumu tara.
11. Peritonization.

uru hāparapara

Operation Wertheim - titau wawaotanga whānui mātakitaki pai o te mara hāparapara me te taea o te whawhe, kihai haere tahi e fifi ranei whāititanga. Na reira kia wāhanga rawaka. Mini whai me te pokanga endoscopic, i roto i tenei take e kore e pai. I roto i te take o te maimoatanga mate pukupuku te hua Paku o faufaa kei roto i te wahi whakamutunga.

Ko te tikanga whakamana laparotomy roa waenga (tuakitanga o te taiepa puku mārōrō, o te aho ma o te karo puku te pito) ranei wāhi Czerny (laparotomy hake ki tuakitanga o te abdominis kiri taupoki).

roopu o te kōpū

Ki tenei mutunga, whakawhiti nape a tawhio o te kōpū, me te tūmataiti tuhonohono kura kākano tärewa, a hoki te mutunga whaea okana. kia whiti katoa o enei hinonga, ki te taea, i roto i nga wahi kowaiwai o oko toto. Tenei ka whakaiti i te mate toto. tangohia te rawa taua kōpū te i runga i nga hononga, me te e tukua ki te taha.

I muri whiti te nape tärewa o te kura kākano riro te tango o taea te kōpū. Ko te mea nui, me to ratou roopu - e kore e ki te tūkino i te awa mimi. Ki te mahi i tenei, i roto i te mahi he palpation obligatory o te nape whanui. I roto i te muri, ko te reira te tikanga ngāwari whārangi he taiepa ureteral. Tenei whawhe taea ki a koe te whakaoreore i te kōpū me konga kahore ureteral whara.

I muri te whakatuwhera i te vesico-uterine taiepa wehea te tōngāmimi miro ūkuia i te taiepa mua o te whare tangata. kia meatia tenei, kahore raa'tu i te raina pokapū, ki te whakaiti i te tūpono o te whara ki te plexus iaia.

Ki te he piri ki te adhesions kōpū te tōngāmimi, taea tona wehenga e uaua. A haamata kī i roto i te take o te mea tuhonohono a tawhio noa, ka haere i runga i ki nga wahi kaki ki te nekeneke rahi, mirumiru wehe kutikuti.

mahi anō Wertheim tā ligation o oko. Ko te paihere iaia matua o te kōpū - iatuku uterine me uaua ◊oatu fakataha, e haere ana me te mata o te kōpū. Ligation o ratou i te taumata o te os ā-.

No te roopu atu o uterine kokoti whakamana te me te neke kiko fascia predpuzyrnoy roto i te mata mua puhuki o te cervix ki raro. nape ripeka atu, i nga mua wātea mō te whawhe: sacro-uterine me tuhonohono whare tangata. I muri i taua hysterectomy mai ki te atamira whakamutunga.

Mau hysterectomy, hemostasis me te peritonization

Kua tuwhera kikorangi tara, tangohia te waha kei i te terminals me āta hatepea atu i te tenetene. aru ana tēnei e hemostasis me peritonization. e kore e taea e tumu tara te tango i roto i piri, ka taea e te mahi i te reira manga rite maori i roto i te hui o tetahi tukanga pathological i roto i te kōhao papatoiake me te haaputuputuraa o te pirau toto ranei ki reira.

tukinotia ngongo tara i roto i te ara motuhake. Ko te taiepa o te tenetene ligated vesico-uterine me rectouterine taiepa, me te pai kia rite ki te mea tuhonohono sacro-uterine, ai te whakatutuki hemostasis me peritonization.

Ko te wā postoperative

Kia pehea te ko te manawanui i muri i te pokanga Wertheim? e kore e taea e pokanga tuwhena peheé haere katoa hia. Te kore te feaa, pānga reira te hauora o rua tinana, me te hinengaro.

He aha tura'ii te mahi Wertheim? Ka taea te wehea te mau hopearaa o tenei tikanga o te maimoatanga ki te tīmatanga me te mutunga o.

Pōauautanga puta i roto i te wā postoperative wawe

kia haafifi i te wā postoperative:

1. Belgium o hononga (kore anake te kiri, engari ā-ano hoki).
2. Peritonitis me sepsis.
3. Toto i te rohe o nga hononga, tae atu ki te roto.
4. rohe tui kanokanototo.
5. Dysuria.
6. PE (Embolism pūkahukahu).

e kore e taea tonu Ahakoa te haapa'oraa pakeke o sterility ki te karo i pōauautanga ero. Ko e tika ana ki te meka e te whakamana i te mahi mō ngā tūroro kua ngoikore, me te pera heke te pakanga ki te mate puku mārere te nei tinana tenei. Na reira, mumura o te hononga iho i roto i a ratou - he āhuatanga taea. Hoki te whakaaro o te ārai i te huru i homai i roto i te wā postoperative hiahiatia paturopi.

Toto me te maru tohu te kore o te hemostasis. e kore e Wāhui drugs hemostatic nui tonu, a te tahi mau taime e rapu pokanga toutou - whakahounga o te patunga me te suturing o oko toto.

Dysuria - urination auau, me te mauiui. He taea te ahua o tenei tohu, ki te pakaru pū tōngāmimi urethral mucous me te takanga o te urethritis pāmamae.

Ka taea e PE puta rite te pōauautanga o Thrombosis o nga topito o raro. Ko te aha i roto i te wā postoperative e whakaritea anticoagulation ( "heparin"), ka tūtohu ki te kakahu tokena kōpeketanga tapo'io rapa ranei.

Ko te mau hopearaa o te wā mutunga o

He etahi pōauautanga i muri i te pokanga Wertheim, te whakawhanake i roto i te wā roa:

1. raruraru aronganui: wehi o huringa taea i roto i te ahua me te mate o te puku sex (no te mea e nekehia atu nga ovaries, e te tikanga e puta ke te taumata o hormones sex), ki mana'o e pā ana ki te ngoikore tiki hapu, nawe kino i runga i te taiepa puku he mārōrō.
2. adhesions puku.
3. Tumutumu.
4. Mahuetanga o te tenetene.
5. limfokist retroperitoneal Mātauranga.

Wheako o te wahine e pā ana ki te mau hopearaa o te hysterectomy ko tino mārama. Na reira, i roto i te wā postoperative he tautoko tino nui, me te māramatanga o te whānau.

Ki etahi pōauautanga (nawe postoperative, ki te ngoikore whai tamariki) i ki te whakaae anake. I te tahi atu wehi taea a kia whawhai, kia rite ki te hunga maha ratou he kiko. e kore e Spaying uta e tetahi huringa faufaa rahi i roto i te ahua ao fakasekisualé ranei. Otira kia meinga ai hūhi i roto i takoto ki te i muri i gisteretomii mahue tumu tara poto rawa.

Adhesions i muri i te pokanga Wertheim e hanga e i roto i te ara ano e rite ana i muri i tetahi kōhao hāparapara. he tika ki te traumatization o te peritoneum i roto i te mahi, e arata'i ki te hanganga o ngā whenu kiko tūhonohono i waenganui i ona pepa me whekau tenei.

Adhesions i roto i te kōhao puku taea meinga mamae puku, disorders o urination me defecation, a i roto i ētahi wā noa arahi ki tukuna ai intestinal. Hoki te ārai o te hanganga adhesion i roto i te wā postoperative he nui whakahohenga wawe o te manawanui, me te whakahaere therapy tinana i roto i te ra tuatahi i muri i te pokanga.

puta menopause i muri hysterectomy tika ki te tango o nga ovaries. kawe taimaha tūturu menopause Postoperative, no te mea i roto i tenei take, huringa hormonal puta tere. Hei whakaiti i hūhi whakamahia taiki whakakapinga therapy.

He pokanga prolapse tara riro taea Wertheim tika ki te kino taputapu ligamentous (he tu'unga e tika ana mō te mahi ana i te hysterectomy) me te displacement o te whekau papatoiake i roto i te wahi he kōpū ngaro. Hoki te ārai o taua pōauautanga manakohaia te manawanui kei te raveraa i mahi motuhake, mau he awhi, fakangatangata o mahi tinana hoki i te iti rawa 2 marama i muri i te pokanga.

E mea pinepine i roto i te wāhi retroperitoneal i hanga te limfokista Wertheim i muri i te pokanga. Ko tōna maimoatanga hāparapara. Heoi, nui atu tōtika ārai ko tonu te takanga o tenei pōauautanga i te wā o te mahi, i te ki te hamani. Hoki tenei whakaaro, pana i te wai tikanga rerekē retroperitoneum.

He aha te iwi e mea e pā ana ki te mahi Wertheim

Ki te pehea e o te pukupuku i te waha endometrial ranei tuwhena pā Wertheim mahi. He rerekē ngā urupare e pā ana ki reira.

Doctors me tūroro mea mea pai i muri i te mahi:

1. Ko te hua i roto i te oranga.
2. ngaro whai o uterine mate, tae atu ki te mate pukupuku.
3. Ārai, e kore e tukua noa te tūponotanga iti o te hapūtanga e hiahiatia.
4. E kore e te mahi whakaiti i te pai, he mea ka taea ki te hoki ki te ora noa.

Raruraru ngā mahi:

1. Ngoikore ki te whai tamariki.
2. nawe kino i runga i te taiepa puku he mārōrō.
3. Ko te taea o pōauautanga, e rua wawe, me te mutunga o (kōrero i runga ake).

Hei whakarāpopoto

Hysterectomy mō te Wertheim - whai hua maimoatanga tuwhena o te pukupuku waha, me te endometrial mārere. Tenei mahi, ko te kore e anake e taea ki te atawhai i te manawanui o te mate pukupuku, engari ano hoki i roto i etahi ara whakapiki i te kounga o te ora.

O te akoranga, rite tetahi pokanga, he mahi wehe ki te whanaketanga o pōauautanga hysterectomy. Heoi, ka te whakahaere mātau o te wā postoperative, me raro ki te āraihia tika ki te karo ia ratou.