Operation Hartmann: inkcazelo, izigaba, izixhobo

Operation Hartmann olwenziwe njengendlela yonyango umhlaza wamathumbu. Kwiimeko ezininzi, unyango zoqhaqho esi sifo kuphela ngempumelelo kakhulu kodwa kuphela umhlaza, nto leyo inkqubela kule sayithi ayiniki iziphumo ezifanelekileyo.

Ubungqina obubonakalayo buxela ukuba ukuhlinza

uhlobo Operation Hartmann ibonisa ukuba izigulane nkene abadala unesifo "umhlaza colon sigmoid okanye isebe rectosigmoid." Kukho nezinye izizathu zokuba ugqirha wakho angagqiba ekubeni aqhube imisebenzi Hartmann:

• elukhuni Igama site isithintelo (kwiimeko ezininzi, ukutya na ukuhamba ngapha emathunjini ngokubanzi);
• perforation (nge-kwesisu disorder);
• volvulus sigmoid ikholoni kwimeko njengesilonda okanye ingxaki peritonitis karhulumente (colon zobude deformation mesentery wayo).

It lwenziwa ngokuqhelekileyo izenzo ezibonisa kaxakeka, ezifana ithumba okanye ngokubonakala ukubola namathumbu kokuphazanyiswa.

Operation Hartmann zokukhula

izigulane ezininzi bachitha kuphela inqanaba lalo lokuqala. Inyathelo elilandelayo kwindawo sokubuyisa ixesha ekuphulukenwe entle lwenziwa kuphela emva kweenyanga ezintandathu.

Operation Hartmann, ukuxelwa kwalo wamnika Petrov B. A., yahlulwe ngezigaba ezibini. Ezisetyenziselwa ukunyanga ehla colon ezinqamlezayo yethumbu.

Ngoko ke, yonke ukusebenza iqulathe la manyathelo alandelayo:

1. Eli nyathelo iye yachazwa yi Petrovym B. A., leyo wamnika isihloko "resection obstructive." Amaxesha amaninzi, izigulane unesifo "umhlaza" bachitha le nkqubo kuphela. Oku kubandakanya ukususwa inxalenye ethile emathunjini, kwaye ibekwe nethumba kuyo. Emva koko ke uthunge mithambo ingxenye distal. Oku kwenziwa phezulu gingci, yaye umsantsa oseleyo kwisisu. Isiphelo proximal of the guts ugqirha utyando iboniswe phezu kodonga esiswini kunye nenxalenye ngaphambili. Esi sigqibo kuthiwa indle, oluya kubhalwa iinkcukacha ngezantsi.
2. Inyathelo lesibini ngexesha elilungileyo kweli xesha yesiqhelo uya kubanjwa hayi iinyanga ngaphambi kwe ezimbini, kwezinye iimeko, emva kweenyanga ezintandathu. Nguye ukubuyisela ekuqhubekekeni lesiphelo colon anastomosis ukuba iphele. ngaloo ndlela indle isusiwe. Uhlobo lwe kwicala anastomosis nangapha, kodwa kumaxesha amaninzi oogqirha sikubongoza ngawo.

Ukulungiselela sesigulane utyando

Eyokuqala inkqubo kulungiselelwa isigulane ukuba andinako. Ekubeni ngokuqhelekileyo yenza umguli buthathaka, udiniwe, kuyimfuneko ukuba aqhube uthotho uphando, kwakunye unyango nokomelezwa jikelele abantu abakwazi ukuhamba ngaphandle ukusebenza zokufa. Esetyenziselwa le ndlela, isenzo sakhe ijolise ekuphuculeni umsebenzi kwentliziyo, ulawulo iphecana zesisu babe ukutofelwa igazi, kwakunye nokuqeshwa inani elikhulu iivithamini kunye izidlo ezizodwa.

Operation Hartmann semishini

Kuba ukusebenza isigulane ibekwe emqolo. Esiswini lubonisa Seredinny cut asezantsi ukusuka pubis ne-5 cm (ngamanye amaxesha kancinane ngaphantsi) ngaphezu umbilicus. Emva koko, lo isigulane safudukela Trendelenburga (intloko negxalaba ibhanti yesigulane ibekwe ngezantsi isinqe). Ngaphezu koko kwenziwe ekuthiwa ngokugaya ikholoni sigmoid, ngenxa yale njongo ngokuqhelekileyo kusetyenziswa itawuli. Ingcambu yaloo mesentery ngokunjalo phantsi Douglas epokothweni peritoneum lidla kuqaliswa isixa esithile novocaine (malunga 250 ml). Ngoku eziphicothiweyo abekiweyo indawo thumba kunye nezinye iimpawu zayo. ikholoni Sigmoid, oluqhutywa kunye nokusebenza kuyimfuneko ukuba zazise inxeba amzeke kwicala lasekunene kufutshane osembindini. Mesentery nakuba wayeselula. Okulandelayo, kule khosi ezi isikere leyo anamathele umaleko olungaphandle peritoneum. It Wayibamba endaweni, apho Ingcambu mesentery. Le asike lwenziwa kulo lonke ubude ngokwenzekayo, nto leyo iza kuthi ke nayo zisuswe. Emva koko esiswini akhutshelwe ngaphandle, yaye umaleko asike ngaphakathi kwenzeka peritoneum. Kwemithambo sesibini nesesithathu yendlela yokwenza imigca iwela kwindawo leyo imi phakathi kwezi yamasango ngaphambili. Le ndawo iphawulwa wampompoza ukumpompoza kwemithambo esezantsi mesenteric. Ukongeza, kuba ligated kunye intambo isilika. Ugqirha ebona ngenyameko ukuba kwemithambo ekhohlo yagcinwa, ukuba kunokwenzeka, ugqirha kwakhona igcina kwemithambo eliphezulu kwaye proctal.

Mesentery kunye ska ezivela macala omabini kwaye phakathi izixhobo phambana, ngoko ngakumbi kunabela ngaphakathi sizizitya ibotshelelwe.

Ukuba kukho ukususwa verhneampulyarnogo isebe Umthambo efakwa, apho ingabekwa phezulu, qho mandatory ligated.

Yamasango zisetyenziswe ezi ndawo zilandelayo:

• phezu isabelo achaphazelekileyo emathunjini;
• ingxenye verhneampulyarny ye isikali.

Phakathi kwezi umboniso emathunjini abachaphazelekayo isusiwe usebenzisa kuphungula elibukhali. Oku kwenzeka phakathi iinxalenye esempilweni. Isiphelo emathunjini leyo sutured ngci. Isetyenziswa le zokuthunga neyesilika intambo.

Ithuba postoperative

Ezi ntshukumo zilandelayo lwenziwa kweli thuba:

• Kumbhobho kathathu ngemini wahlamba emathunjini. Isetyenziswa le ezibuthathaka nesisombululo kubola, ukuqeshwa apho ugqirha isigqibo ngokusekelwe wohlalutyo.
• Kwiintsuku ezintlanu ntsholongwane kwenzeka igalelo.
• Abamiselweyo ukutya ngokukodwa ngethuba kugcinwe apho kunokwenzeka khona ukuba ukutya ulwelo kuphela.
• Doctor umisela ulawulo iziyobisi negalelo esitulweni ukulibaziseka.

ngemibhobho kwesisu lavage asuswe emva kweentsuku 7-9 ngoko nangoko emva kotyando.

Emva kweenyanga 3-6 ixesha post-operative, kwi imeko flow yayo entle ngayo kuqhutywa wamathumbu ukuqhubeka nokubuyiselwa, kwaye ukhupha ezimpundu nemvelo.

iingxaki emva kotyando

Oyilwayo eziziintloko kunokuba yingozi kakhulu kwimpilo isigulane owophayo. Oko kunokuthi kwenzeke zombini ngexesha ukusebenza nasemva kokuba.

Emva kotyando, namkele yokothuka, nayo leyo kusongela ubomi yesigulane. Statistics onyanzela rhoqo watyandwa kufa kwisithuba seentsuku omnye ukuya ezimbini emva kotyando.

I ingxaki iqhelekileyo kwii-zokugula inxeba. Ukuze uphephe oku kufuna ukulungiselela ngenyameko kakhulu kwamathumbu ukuba utyando ukuze bawubuyise emikhuhlaneni kokuba azikhulula kwimihla ekuqaleni kweli thuba postoperative. Noko ke, ukuba, lo msebenzi kungenxa licuthe emathunjini ukususa imixholo yawo kunokwenzeka izigaba ezibini, apho kuchazwe inxalenye yokuqala yale nqaku.

Iinkqubo eyenziwa emva kokuba usebenzo

Ngexesha kwimeko yesiqhelo singabonakala ukugcinwa wokuchama, kwaye izikhalazo ezivela izigulane, njengoko umthetho, akayi kuza. Artificial imveliso umchamo, yaye oku kwenzeka iiyure kuphela emva-10 emva kokuba usebenzo lugqityiwe. Lenquba yenzelwa amaxesha ubuncinane kathathu ngemini. Ukungaphumeleli ukwenza njalo kungakhokelela ekubeni esinyini angasolula nje, oko zaprokinetsya umva kwaye, kakade, balahlekelwe ukukwazi ukuncipha.

endaweni yesiphelo

Ukusebenza yokusebenza lichatshazelwe yimiba ezininzi, ingakumbi, imeko yomguli kotyando, imihla utyando phambi, sikhethe indlela efanelekileyo yokuqhuba imisebenzi. Kodwa nangona oku, kwiimeko ezininzi, ukusebenza Hartmann kukuba kwi ikholoni kunokuba indlela kuphela unyango.