Operation Hartmann: tsananguro, nzendo, midziyo

Operation Hartmann ichiitwa sezvo nzira nokuda kurapwa kenza muura. Kazhinji, kuvhiya pakurapa chirwere haisi chete inonyatsobudirira asi chete sezvo mishonga kuti kenza, iyo mberi panzvimbo iyi haapi akakodzera nemigumisiro.

Zvairatidza kunorapwa

Operation mhando Hartmann anoratidza kuti havachanyatsogoni uye vachembera varwere vane chirwere che "kenza yacho sigmoid muura kana rectosigmoid dhipatimendi." Pane zvimwe zvikonzero nei chiremba wako angasarudza kuita akavhiyiwa Hartmann:

• kuoma mhingaidzo nzvimbo zita (kakawanda, zvokudya hachivaiti kuburikidza muura zvavo);
• perforation (kuburikidza-bowel nyonganyonga);
• volvulus sigmoid muura panyaya neronda rinonyenga kana kuomesa ehurumende peritonitis (muura elongation deformation mesentery kwayo).

It rinoitwa kazhinji zvashata zvairatidza, zvakadai bundu kana kuratidzwa kuora bowel mhingaidzo.

Operation Hartmann zvokukura

Varwere vakawanda vanopedza Danho wayo chete wokutanga. Danho panguva yakanaka kupora nguva rinoitwa chete pashure pemwedzi mitanhatu.

Operation Hartmann, iro Kuziviswa yaakapa Petrov B. A., rakakamurwa muzvikamu zviviri. Kushandiswa pakurapa uchiburuka uye transverse muura yacho ura.

Saka, wose oparesheni chinosanganisira zvinotevera matanho:

1. danho iri akarondedzerwa Petrovym B. A., zvakamupa wenyaya "obstructive resection." Kakawanda, varwere chirwere kuti "kenza" vanopedza chete nzira iyi. Kunosanganisira kubviswa mumwe mugove ura, uye umo bundu iri. Zvadaro vari stitching lumen distal chidimbu. Zvaitika kumusoro vakabatisisa, uye pakakoromoka vasara abdominal mhango. The proximal kuguma vakavhiyiwa chiremba ushingi hwakaratidzwa pamusoro abdominal pamadziro nechemberi kwayo. mhedziso iyi zvinonzi colostomy, izvo achanyorwa zvizere pazasi.
2. Danho rechipiri iri zvakanaka nzira rokuchinjwa nguva achaitwa kwete mwedzi yapfuura pane miviri, mune zvimwe zviitiko, kunyange pashure pemwedzi mitanhatu. Ndiye kunotangazve chamazuva ose muura anastomosis rutivi. Saka Colostomy kubviswa. The musiyano wezvinyorwa padivi anastomosis rutivi, asi kakawanda vanovhiya vanozviramba.

Kugadzirira murwere kunorapwa

Chokutanga nzira rokugadzirira murwere kuriita. Sezvo kazhinji chinoita murwere simba, vaneta, zvakakodzera kuitisa dzinotevedzana kuongorora, uyewo vakawanda Kusimbaradza kurapa vanhu kukwanisa kufamba pasina nokushanda rufu. Kushandiswa kwenzira iyi, ane chimwe nechinangwa dzekugonesa cardiac basa, mutemo wenyika nemudumbu angava kuisira ropa, uyewo kugadzwa vakawanda mavhitaminzi uye anokosha zvokudya.

Operation Hartmann michina

Nokuti oparesheni murwere anoiswa pamusoro musana wake. Mudumbu yakaratidza nechepazasi Seredinny chekawo kubva pubis uye 5 masendimita (dzimwe nguva zvishoma zvishoma) pamusoro umbilicus. Zvadaro, murwere yakatamira Trendelenburga (musoro uye fudzi bhandi murwere riri pazasi kuti chiuno). Uyezve akaita vanonzi kuunganidza vanhu sigmoid muura, nokuti chinangwa ichi inowanzoshandiswa tauro. The Mudzi mesentery uyewo pasi Douglas peritoneum muhomwe inowanzopiwa akatanga imwe yakawanda novocaine (anenge 250 ML). Zvinonzi ikozvino audited uye iine nzvimbo bundu wayo zvimwe zvinhu. Sigmoid muura, iro rinoitwa uye nokushanda zvakafanira kuuya ronda uye mutorei kurudyi pedyo midline. Mesentery apo rwakatambanudzwa. Next, ari kosi vari chigero izvo mukanamatira chokunze paiva pakati peritoneum. It akabata panzvimbo, apo pamudzi mesentery. The kwetsinga rinoitwa panyika kureba loop, izvo vakazochinja kubviswa. Zvadaro dumbu asunungurwa kuti kunze, uye yomukati rukoko kwetsinga kunoitika peritoneum. The tsinga chechipiri nechechitatu piringisha pane imwe nzvimbo iyo riri pakati okusungisa izvi mberi. Iyi nzvimbo kunoratidzwa kuerera rezasi mesenteric tsinga. Uyezve, zviri ligated esiriki shinda. Chiremba nokungwarira anoona kuti kuruboshwe tsinga akachengetedzwa, kana zvichibvira, chiremba zvakare anoramba rokumusoro uye proctal tsinga.

Mesentery uye clamped kubva kumativi uye pakati zvokushandisa piringisha, ipapo mberi kuripa mukati mayo mune yakasungirwa midziyo.

Kana pane kubviswa verhneampulyarnogo dhipatimendi rectal tsinga, riri pamusoro, ari madikanwa hwaro ligated.

Okusungisa anechekuita anotevera munzvimbo:

• pamusoro mugove sei pamusoro ura;
• verhneampulyarny chidimbu of mugaranhoko.

Between clip izvi zvakakanganisa ura chinobviswa kushandisa jeko scalpel. Izvi zvinoitika mukati migove utano. Mugumo ura iri sutured zvakasimba. Kushandiswa ichi catgut uye sirika shinda.

The postoperative kumwedzi

Zvinotevera zviito anoteererwa iyi:

• Kuburikidza chubhu katatu pazuva kusuka ura. Kushandiswa ichi simba mhinduro kubva akambozvishandisa kuuraya utachiona, kugadzwa iyo chiremba asarudza pachishandiswa Analyses.
• Mukati memazuva mashanu inorwisa mabhakitiriya kunoitika chiyamuro.
• Vakagadzwa chaiyo kudya paichengetwa izvo zvinoita kutora chete mvura zvokudya.
• Doctor prescribes kwokubatsira mishonga kuti pave kunonoka chair.

Dumbu lavage sepombi vanobviswa pashure pemazuva 7-9 pakarepo pashure kuvhiyiwa.

Pashure 3-6 mwedzi post-kushanda nguva, musi ezvinhu ayo akanaka aibuda chinogona kuitwa intestinal chamazuva kudzorerwa, uye nokubvisa kujairika horo.

Possible yematambudziko pashure pokuvhiyiwa

Huru kuomesa kuti anogona kuva nengozi zvikuru kune hutano murwere ropa. Zvinogona kuitika zvose panguva oparesheni uye pashure pacho.

Mushure vavhiyiwa, mugamuchire kuvhunduka, iyo vanotyisidzira upenyu murwere. Statistics anotirayira kuti kakawanda akavhiyiwa kufa mukati mumwe maviri mazuva pashure kuvhiyiwa.

The inonyanya kuomesa ndiko kupinda chirwere ari ronda. Kuti izvi zvisaitike zvinoda kungwarira chaizvo kugadzirira zviri bowel kunorapwa kuderedza murwere ane defecate mumazuva ari postoperative nguva mangwanani. Zvisinei, kana, kuvhiyiwa kuri nokuda aienda pamusoro ura kubvisa zviri zvayo hazvibviri mumatanho maviri, vakanga chinorondedzerwa chikamu ino yokutanga.

Dzokuvhiyiwa anoitwa avhiyiwa

Panguva vapore inogona kuchengetwa Urinary chengetedzo, uye zvichemo kubva varwere, sezvinoita mutemo, isingadzokizve. Chakagadzirwa weti goho, uye ichi chinoitika maawa chete pashure 10 avhiyiwa zvakakwana. The nzira rinoitwa kanenge katatu pazuva. Kutadza kuita kudaro kungaita kuti chokwadi kuti dundira iri nyore rwakatambanudzwa, izvozvo zaprokinetsya negotsi, Chokwadi, havachakwanisi kubata.

pachinzvimbo mhedziso

The kunyatsoshanda hwokushanda iri sei zvinhu zvizhinji, kunyanya, mamiriro ezvinhu murwere pamberi avhiyiwa, kuvhiya misi, kusarudza nzira yakarurama zvidzidzo kushandiswa. Asi pasinei ichi, kakawanda kacho, Hartmann kuti oparesheni iri muura kunogona kuva nzira chete pakurapwa.