Ukusebenza Wertheim: Yebo yokusebenza, imiphumela, ukuxakeka, ukubuyekezwa

Omunye isici imisebenzi lapho onkopatologii kuyinto kakhulu impela nje, isb hhayi kuphela ukukhishwa kwe-isimila ngokwayo, kodwa futhi isamba esikhulu izicubu onempilo eseduze kwemizi sokugembula. Ngaphezu kwalokho, ne excised unesimila lymph node nkinga lymphatics therein.

ukwelashwa kwe-Radical yomdlavuza wesibeletho endometrial

ukusebenza Wertheim sika ihambisana ngokugcwele izidingo ngenhla. essence yayo itholakala ukususwa kwesibeletho kanye ezihlobene (lesizalo amashubhu futhi ezikhiqiza amaqanda), eyesithathu engenhla sangasese, kwesibeletho nasekusekeleni nemisipha futhi ezizungezile okunamafutha izicubu kusukela zamanzi.

I izinkomba ukuhlinzwa kukhona yomdlavuza wesibeletho lesizalo. Kodwa kwezinye izimo, ukuhlinzwa is hhayi Kunconywa:

• ebukhoneni metastases elikude;
• uma izimila omkhulu, kuhlume semithambo kanye nezinhlaka eduze nodonga ngezinye izikhathi okhalo;
• ezihambisana pathologies ezinzima;
• kakhulu eminyakeni yokuguga.

ukusebenza Wertheim umdlavuza wesibeletho

Uma sikhuluma ekwelapheni lesi sifo, kufanele kuphawulwe ukuthi ukusebenza wathi ingasetshenziswa kokubili ngokuzimela futhi njengengxenye ukwelashwa.

Endabeni umahluko kakhulu squamous umdlavuza cell ukuxilongwa (T1bN0M0 isinyathelo), lokhu kusebenza kakhulu yokuxazulula le nkinga ngaphandle ezihilela izindlela ezifana nokwelashwa ngamakhemikhali futhi ukwelashwa ngemisebe. Nokho, iningi operation Wertheim sika ingxenye ukwelashwa.

Lapho umdlavuza endometrial (ngisho IB esiteji) njalo babelwe amakhambi, ngaphezu ukuhlinzwa.

Ukusebenza Wertheim: hambisa ukusebenza

Ukuhlinzwa sokususwa olukhulu kwesibeletho kanye ezihlobene kuhlanganisa izigaba eziningana. Lezi zihlanganisa:

1. Finyelela.
2. Empambana lesizalo nemisipha.
3. Ukugqugquzela kuzo ngemibhobho fallopian futhi ezikhiqiza amaqanda.
4. Ukugqugquzela lwesinye.
5. Ligation futhi empambana izitsha ukuphakela okukhulu.
6. Ukususwa kwezicubu ebusweni phambi wesibeletho.
7. Empambana emisipheni ukulungisa kwesibeletho emuva (sacral-lesizalo).
8. Empambana nemisipha wesibeletho.
9. resection wesibeletho.
10. Hemostasis isiqu lwesitho sangasese sowesifazane.
11. Peritonization.

ukufinyelela kuhlinzwa

Ukusebenza Wertheim - kokungenela ebanzi idinga ngeso ezinhle ensimini kuhlinzwa kanye nokwenzeka zokukhwabanisa, hhayi ephelezelwa nobunzima noma ukulinganiselwa. Ngakho-ke sigaba kufanele ezanele. Mini efinyelela nokuhlinzwa endoscopic, kulesi simo bengakwamukeli. Ezindabeni yokwelapha abantu abanomdlavuza umphumela yezimonyo ezibalulekile endaweni yokugcina.

Ngokuvamile kwenziwa lesemkhatsini laparotomy longitudinal (asike izidumbu zabantu we anterior udonga besisu umugqa ezimhlophe dlula isisu inkaba) noma ukufinyelela Czerny (laparotomy transverse nge asike izidumbu zabantu we abdominis rectus).

ukugqugquzela kwesibeletho

Kuze kube yimanje, aphambana round umsipha kwesibeletho, kanye suspensory nemisipha esibelethweni yangasese, futhi ukuphela umama ipayipi. Zonke lezi zinkampani kufanele sawela, uma kungenzeka, ezindaweni elingenalo imithambo yegazi. Lokhu kuzonciphisa ukopha. Kwesibeletho kakhulu efanayo esithathwayo phezu izibopho bese kukhishelwa eceleni.

Ngemva kokuwela umsipha suspensory we esibelethweni iba ukususwa kwesibeletho kungenzeka. Okubaluleke kakhulu, nge vivo zabo - ilimaze ureter. Ukuze wenze lokhu, phakathi msebenzi palpation oyisibopho le umsipha ezibanzi. Ngemuva ngokuvamile ishidi kalula ureteral aphindekile. Lokhu zokukhwabanisa ikuvumela ukuba viva kwesibeletho futhi ezihlobene ngaphandle ureteral ukulimala.

Ngemva kokuvula vesico-lesizalo folds esinyeni ukotini swab uyashiywa odongeni phambi wesibeletho. Lokhu kufanele kwenziwe ngaphandle ukuphambuka line isikhungo, ukuze kuncishiswe ingozi yokulimala kuya plexus semithambo.

Uma esinyeni yikho adherent kuya ukuvuvukala kwesibeletho, ngokwahlukana yayo kungaba nzima. Qala keying ecaleni nxazonke nemisipha, futhi niqhubeke izingxenye entanyeni ukuhamba enkulu, bubble uhlukanisa sikelo.

Wertheim ukusebenza Ngaphezu kwalokho kuhilela Ligation imithambo. The main besigaxa semithambo kwesibeletho - Umthambo lesizalo kanye emithanjeni esihambisana naleli bhokisi, behamba onqenqemeni kwesibeletho. Ligation babo ezingeni we os yangaphakathi.

Ukuze ukugqugquzela ezingeziwe lesizalo imbobo wenziwa kanye ukuguquguquka predpuzyrnoy fascia izicubu ngokusebenzisa phambi kobuso blunt wesibeletho phansi. Ngaphezu kwalokho umsipha kwesiphambano, leso ubukade akutholakali zokukhwabanisa: sacro-lesizalo nemisipha wesibeletho. Ngemva kwalokho hysterectomy kuziwa esigabeni sokugcina.

Empeleni hysterectomy, hemostasis futhi peritonization

egumbini kwesitho sangasese ivulekile, wesibeletho esithathwayo ngesikhathi terminals kancane kancane nginqume sangasese. Lokhu kulandelwa hemostasis futhi peritonization. isiqu lwesitho sangasese sowesifazane awukwazi ukuthatha e uvalwe, ingaba amanzi njengoba zemvelo uma kwenzeka noma yimuphi izinqubo sokugembula kule ingaphakathi okhalo kanye ukunqwabelana ubomvu noma igazi lapho.

tube kwesitho sangasese iphathwa ngendlela ekhethekile. Izindonga sangasese ligated vesico-lesizalo futhi rectouterine emphethweni, kanye nemisipha sacro-lesizalo, kanjalo ekufezeni hemostasis futhi peritonization.

Isikhathi nasezinkingeni ezilandela ngemva kokuhlinzwa

Kushiwo ngamuphi umqondo ukuthi isiguli emva kokuhlinzwa Wertheim? ukuhlinzwa okunjalo olukhulu ayikwazi azithalalise ngokuphelele. Ngokungangabazeki, kuthinta impilo yakho kokubili emzimbeni nasengqondweni.

Yini akuhileli operation Wertheim? Imiphumela yalokhu indlela yokwelashwa zingahlukaniswa zibe ekuseni khulu, ngemuva kwesikhathi.

Izinkinga zingaveli ekuqaleni kwenkathi nasezinkingeni ezilandela ngemva kokuhlinzwa

Isikhathi nasezinkingeni ezilandela ngemva kokuhlinzwa ingase ibangele izinkinga:

1. Ukutheleleka amalunga omzimba (hhayi kuphela isikhumba kodwa futhi yangaphakathi).
2. Peritonitis futhi sepsis.
3. Ukopha kusuka endaweni emalungeni, kuhlanganise wezangaphakathi.
4. Hematoma umphetho ndawo.
5. Dysuria.
6. PE (embolism yamaphaphu).

Ngisho lo mkhosi eqinile inzalo akuyona njalo kungenzeka ukuba ligweme izinkinga ezingase zivele ukonakala. Lokhu kungenxa yokuthi ukusebenza wenziwa ngoba iziguli kabani umzimba buthaka futhi emzabalazweni kanye ebulalayo isimila amasosha omzimba sinciphile. Ngakho-ke, ukuvuvukala emalungeni kuzo - isimo kungenzeka. Ngenjongo ekuvimbeleni isimo inikezwe esikhathini postoperative edingekayo antibiotic.

Ukopha kanye nokulimala ebonisa ukuntula hemostasis. Ukuqatjhwa izidakamizwa hemostatic akuzona njalo ngokwanele, futhi ngezinye izikhathi kudingeka uhlinzwe okuphindaphindiwe - isibukezo enxebeni suturing imithambo ukopha.

Dysuria - ukuchama kaningi futhi kabuhlungu. Ukuvela kwalesi uphawu kungenzeka uma elimele lwamafinyila urethral ipayipi futhi okuvela urethritis esibuhlungu.

PE singenzeka njengoba izinkinga zokwenza thrombosis wemikhawulo aphansi. Yingakho esikhathini postoperative kuthiwa anticoagulation babelwe ( "heparin") futhi watusa ukugqoka kokucindezelwa amasokisi noma amabhandeshi nokunwebeka.

Imiphumela inkathi ngasekupheleni

Kukhona nezinkinga ezithile emva kokuhlinzwa Wertheim, ukuthuthukisa esikhathini eside:

1. nezinkinga ezingokomzwelo: ukwesaba izinguquko endleleni umuntu abonakala ngayo kanye nokulahlekelwa ubulili drive (ngoba amaqanda ziyasuswa, okusho ukuthi izinga lama-hormone ocansini washintsha), imizwa mayelana ukungakwazi abakhulelwayo, isibanda ugly phezu anterior udonga besisu.
2. ukuvuvukala besisu.
3. Umvuthwandaba.
4. Ukukhishwa sangasese.
5. Ezemfundo retroperitoneal limfokist.

Okwehlela abesifazane ngemiphumela hysterectomy izinto uqondakala kahle. Ngakho-ke, esikhathini postoperative ukusekela kubaluleke kakhulu futhi ukuqonda umndeni.

Ngikanye namalungu athile yezinkinga (isibanda nasezinkingeni ezilandela ngemva kokuhlinzwa, ukungakwazi unezingane) bamukele kuphela. Ngakolunye ukwesaba kungaba futhi kufanele alwe, njengoba ngokuvamile ubufakazi balokho. Spaying akusho kuhilelani yiziphi izinguquko cardinal ngokubukeka noma imbulunga ngokobulili. Kodwa kungase ibakhathaze ngesikhathi sokuya ocansini uma ngemva gisteretomii kwesokunxele lifushane kakhulu isiqu lwesitho sangasese sowesifazane.

Ukuvuvukala emva kokuhlinzwa Wertheim akhiwa ngendlela efanayo njengoba ngemva kwanoma iyiphi ingaphakathi kuhlinzwa. Lokhu kungenxa traumatization we peritoneum ngesikhathi ukusebenza, okuholela kwetinhlavu zezinzwa izicubu imicu phakathi amashidi wakhe kanye izitho zangaphakathi.

Ukuvuvukala kule komgodi ongaphakathi kwamathumbu kungabangela ubuhlungu besisu, iziyaluyalu ukuchama futhi sokuzikhulula, futhi kwezinye izimo ngisho kuholele isimiso emathunjini. Ngokuba nokuvimbela adhesion kumiswa esikhathini postoperative kukhona ukusebenza kubalulekile ekuqaleni isiguli nokuqhuba izifundo ukuze athole ukwelashwa komzimba ngosuku lokuqala ngemva kokuhlinzwa.

Ukunqamuka kokuya kwenzeka ngemva hysterectomy ngenxa ukususwa ezikhiqiza amaqanda. menopause postoperative baphathe esindayo zemvelo, ngoba kulesi simo, ukushintsha kwama-hormone zenzeka ngokushesha. Ukuze wehlise ukungakhululeki esetshenziswa yokwelapha hormone.

A lwesitho sangasese sowesifazane prolapse ukuhlinzwa Wertheim sezivuma ngenxa umonakalo apharathasi ligamentous (isimo ezidingekile kokwenza hysterectomy) kanye ukufuduka kwezitho okhalo endaweni kuyinto kwesibeletho lingekho. Ngokuba nokuvimbela yezinkinga ezifana isiguli watusa ukwenza ukuzivocavoca ekhethekile, egqoke umkaki, komkhawulo lokuzivivinya izinyanga okungenani 2 ngemva kokuhlinzwa.

Ngokuvamile e isikhala retroperitoneal Kumiswa limfokista Wertheim ngemva kokuhlinzwa. ukuphathwa kwalo kuhlinzwa. Nokho, okuningi ngempumelelo ngaphezulu ukuvimbela okwenziwe ngaleli inkinga namanje at the stage of ukusebenza, esingayenza ngaphandle kokuthi siphathe. Ngenxa yale njongo, izindlela ezahlukene amanzi retroperitoneum.

Okushiwo ngabantu mayelana nokusebenza Wertheim

Ukuze balahle olukhulu umdlavuza wesibeletho noma endometrial osebenza operation Wertheim. Izimpendulo ngakho zihlukile.

Kodokotela kanye neziguli usho izinto ezinhle ngemuva kokuhlinzwa:

1. Ukwanda sokuphila.
2. ukungabi okuqinisekisiwe izifo lesizalo, ezihlanganisa nomdlavuza.
3. Inzalo, ayivumeli ngisho okungenzeka elincane ukukhulelwa okungafunwa.
4. Ukusebenza akusenzi kahle, kungenzeka ukubuyela ekuphileni okuvamile.

Nebubi imisebenzi:

1. Ukungakwazi unezingane.
2. isibanda Ugly phezu anterior udonga besisu.
3. The kungenzeka yezinkinga, kokubili ekuseni khulu, ngemuva kwesikhathi (okuxoxwe ngazo ngenhla).

Kufinyeta

Hysterectomy ngoba Wertheim - ukwelashwa okuphumelelayo olukhulu izimila abulalayo wesibeletho endometrial. Lo msebenzi kuphela bakwazi akhulule ngesineke umdlavuza, kodwa futhi ngandlela-thile ngcono izinga lempilo.

Yiqiniso, njenganoma iyiphi ukuhlinzwa, hysterectomy igcwele ukuthuthukiswa yezinkinga. Nokho, lapho inhlangano afanele isikhathi nasezinkingeni ezilandela ngemva kokuhlinzwa, futhi kuncike izinyathelo ezidingekayo ukukhalima ukuba sizigweme.