Chibereko laparoscopic nzira: post-kushanda nguva, zvakaipira wongororo. Nokubviswa uterine fibroids laparoscopically: wongororo

Pari, isu akakudziridza itsva ruzivo anobvumira dzakasiyana-siyana gynecological Kupindira shoma yematambudziko uye vakaderera pfungwa. Laparoscopic chibereko ne - mumwe wavo.

Laparoscopy sezvo magadzirirwo itsva

Laparoscopic Kuvhiya kwave kumativi kwemakore anodarika 20. Panguva ino akagadza pacharo ave zvishoma invasive uye inobudirira nzira shoma post-kushanda matambudziko.

Laparoscopic nzira mu Gynecology akawana mukurumbira zvikuru. Kare, kwakadaro nzira akaita gynecological kuvhiya mavhoriyamu diki. Asi mumakore achangopfuura dzakawanda makiriniki nezvipatara, zvava chenhando. Mumwe remapazi izvi ndiko kubvisa uterine fibroids laparoscopically. Reviews wevarwere anoratidza kuti pane nokukurumidza kudzorerwa kushanda okuita, mukana yematambudziko uye adhesions duku uye shoma kuvadza ganda hazvirevi Anotadzira chimiro vakadzi.

Nokuti oparesheni zvinoda vanokwanisa uye ruzivo vashandi. Kupindira kuumbwa mune iyi, usingashandi matambudziko. Mune zvimwe zviitiko, mubatanidzwa laparoscopic uye kwakajairika kuvhiyiwa chete vanoda kuponesa upenyu murwere. nyanzvi Izvi zvichaita kusarudza nzira yakarurama kurapa varwere vavo nechimwe nomumwe.

zvipatara zvakawanda vaite kubviswa uterine fibroids laparoscopically. MuMoscow, anenge ose gynecological dhipatimendi iri vakagadzirira pamwe anodiwa michina uye ane nyanzvi yokuita evanhu ichi. Ose gynecological kuvhiyiwa 50-60% vari dzaidzidziswa laparoscopy.

The chikuru zvakanakira nzira:

• vakaderera kwematambudziko;

• nokukurumidza kupora kushanda zvomukati zvose;

• rutapudzo kuti post-kushanda marwadzo;

• usingashandi adhesions ;

• nguva pfupi muchipatara;

• kugara zuva kutarisirwa;

• rutapudzo yematemu yokuremara;

• kushoma pakati postoperative hernias;

• shoma nguva yokuti vapore;

• kuchengetedza mishonga.

Negative Nguva laparoscopy

All zvinhu izvi zvakanaka mukufamba kuvhiyiwa uye achiporesa vakadzi akafukidza zvose zvazvakaipira kuti vari kuri chero laparoscopic kuvhiyiwa:

• michini nokudzidziswa vanokwanisa vanachiremba inoda zvinokosha havashandisi mari;

• Chiremba anofanira nhaka laparoscopic unyanzvi uye zvetsika kuvhiyiwa;

• Matambudziko vari kutyora mashandiro ari nhengo chokuita jekiseni negasi kupinda abdominal mhango, asi kururamiswa uye gadzirisa kudzivirira yematambudziko izvi zvinogona kudziviswa;

• Regai kutonga kubva mukana zvokuimba kukuvara siyana nhengo, nyama uye nhengo.

Application muna Gynecology

In gynecological laparoscopy kudzidzira kwakapararira. Kuwedzera nechirwere isingavimbiki zviitiko rikwanise dumbu, kuona zvinhu zvinokonzera kushaya mbereko, laparoscopic nzira inoshandiswa ezvinhu akadai:

1. Ectopic pamuviri.

2. pakaputsika chubhu.

3. Nzira mbereko.

4. Endometriosis.

5. The namira chirwere.

6. Various zvirwere ovarian cysts, sklerokistoz, ovarian apoplexy.

7. Benign inotungamirwa dumbu (chibereko laparoscopic unyanzvi kunoderedza ngozi postoperative yematambudziko).

8. hyperplastic urongwa, kwete amenable kuti kuchinja kurapa.

Recently gynecologists yaiwanzoshandiswa laparoscopic chibereko kunyange nyanyisa anomera. Nomunun'una nzira dzakawanda kuti kuvhiyiwa ichi, zvichienderana kukura dumbu, ayo chinzvimbo uye kubatanidzwa mune muitiro pedyo nhengo. Zvinowanzoshandiswa fibroids oparesheni iyi localizations siyana.

uterine fibroids

Uterine fibroids - benign chirwere umo pasi pokudzora mahormone kunoitika yokuwedzera fibrous zvinyama nokuumbwa nokusunungura mapfundo. It vakachengeta refu Kupararira chirwere - vanenge 25% matambudziko ose gynecological. uterine fibroids ane nezvainoita yose muviri wevakadzi. Myomectomy ari vaiona "ndarama mureza" pakurapa chirwere ichi.

Chibereko laparoscopically. mhando

Kana uchisarudza nzira kuvhiya mabatiro fibroids inocherechedzwa nhoroondo dzakawanda zvinhu: nzvimbo uye kukura nodes, functionality, kana kurasikirwa pedyo nadzo, mukuru mamiriro ezvinhu mukadzi. Zvichienderana uterine maronda zvinoshandiswa marudzi anoverengeka kuvhiyiwa pamusoro nhengo dzokubereka nadzo.

In tsika inoshandisa:

- zvachose chibereko kana akabvisa muviri uye cervix; subtotal - muchibereko chemusikana yabviswa muviri. Kana pamwe dumbu kudimburwa mutopota - gistertubektomiya, uye kana nyere uye Yachnik, mashandiro kwakadaro inonzi gistertubovarioektomiya. To okunyanyisa akavhiyiwa akadai pangisterektomii - zvinomuomera kuikanganwa zvose zvemukati nhengo dzokubereka nadzo pamwe chete node nodes kana mumasero akapoteredza nyama pamusoro nepanhengo uye pamwe vava oncological kwendangariro.

- Kana duku yakawanda vezvikwata uye kuchengetedza vana vakadzi vanoita ablative kuvhiyiwa. Chimwe chaizvozvi kwavatapwa subserous uterine fibroids laparoscopically. With zvishomanana uterine lesion akatakurwa enucleation nodes, i.e. husking fibrous zvinyama pamwe nekutambira okuponesa nenyere. Pashure pakuvhiya izvi, mumwe mukadzi anogona pamuviri pashure imwe nguva uye kubereka.

Contraindications

Pane contraindications kunorapwa kubvisa dumbu fibroids laparoscopically. Reviews Gynecologists kunoratidza kuti kakawanda kuvhiyiwa anogona kuitwa zvose, kunze avo vakadzi vanotambura zvikuru zvemwoyo, kufema kukundikana, vane heniya, zvinetso neropa coagulation hurongwa kana marasmus

Hama contraindications - mamiriro umo pokuvhiyiwa zvichiita, asi rinotaura mamwe matambudziko. Ivo:

• yekudyidzana akazivisa subcutaneous mafuta;

• untreated zvirwere;

• adhesions;

• effusion kana pamberi mvura iri abdominal mhango pakati anopfuura 1 fő.

Asi gynecologists ano, tine laparoscopic nzira, pashure tichiongorora zvirwere zvakadai ushandiswe yawapiwa, sanitize foci chirwere uye pakuita kuvhiyiwa. Panguva iyoyowo totarisa "zvayakanakira" uye "nezvayakaipira" usati tipedze laparoscopic oparesheni.

Preparation kunorapwa

Reviews dzemadzimai avo ndavhiyiwa chibereko laparoscopically, zvinozivikanwa kuti varwere vari kusagutsikana chete gadziriro: The oparesheni kunotora maminitsi 40, uye kugadzirira - 2 weeks uye zvakawanda.

On oparesheni mukadzi anofanira kuuya pashure miedzo uye migumisiro vakawana vacharwirwa:

• ropa nemiedzo (zvachose, nemakemikari, ropa mhando uye kusapindirana kweropa chikonzero, nokuti kuzvimba chiropa, njovhera, uye HIV pakugwamba, kutsunga shuga);

• weti miedzo - rwevanhu uye kutsunga shuga;

• smears;

• unonzi, electrocardiograph;

• maekisirei;

• Ultrasound;

• colposcopy;

• Kuongorora kuti vanachiremba: a chiremba, kana zvakafanira, munhu cardiologist uye nevamwe.

Pamberi oparesheni varwere vane uterine fibroids chinoda yoga chirwere curettage pamusoro dumbu uye kuwana histological zvabuda. Izvi zvakakodzera kugadzirisa nyaya uwandu kuvhiyiwa uye kubvisa uye kudzivirira pakuzadzisa kenza kwendangariro.

bvunzo All - rinofanirawo muitiro, uye chete mushure kuongorora zvizere chiremba achagona kuita nokubviswa dumbu laparoscopically.

Zuva kuvhiyiwa haisi varumbidzwa kudya, unofanira kuveura pubic bvudzi.

Asati avhiyiwa, mukadzi anozadza akabudisa mvumo fomu yokutindivadza, uye vachiravana nokuda oparesheni. Kana zvakakodzera, zvinopa zvokurapa kana psychoprophylactic kugadzirira kuvhiyiwa.

mashandiro Technology

The oparesheni kubvisa dumbu vaiita laparoscopically kana myomas Sizes kusvika vhiki 16 pamuviri, izvo kuoma nekudeura ropa, dzinoratidzwa nokukurumidza kana mukana akaipa kushanduka. Kunyange zvazvo dzimwe nyanzvi nebasa zvachose akabvisa dumbu, kukura riri vhiki anenge 20. Asi kazhinji, vakapiwa makore mukadzi, akaita kubviswa uterine fibroids laparoscopically kusiya chikamu chiduku muchibereko chemusikana nokuda yekutevera.

Shandisa zvitatu kana zvina ponji rusvingo abdominal (a - pedyo guvhu uye vamwe vaviri - kurutivi rumwe norumwe) uye chinotarisirwa trocars. mudziyo uyu zvakapa aine kamera kuti vachiongorora chiedza kana ane supercharger chokugadza carbon dioxide inobvisa kana nitrous oxide uye zvokushandisa.

Pashure nokubviswa rokuongorora akaitawo laparoscopically uterine fibroids. Nokuti shwashwa ichi excised, ligated midziyo dissected kubva dumbu uye rusvingo nyinyo riri yabviswa kuburikidza nepanhengo achishandisa cheka vari hwakavigwa mumakamuri. oparesheni iyi anonzi laparoscopically vaibatsira kusangana nekutsi kwemukadzi myomectomy. Kupedza suturing cheka ari nyinyo. Mune imwe oparesheni anogona zvinomuomera kuikanganwa akawanda nodes pasina kuzodzosera kupindira.

Pashure odalyayut ropa kana mvura, vaunganidza panguva oparesheni, rokuongorora rinoitwa zvakare miviri uye madziro abdominal mhango. Nyatsoongorora dziongorore zvakanaka mabhandeji uye ligated nemidziyo, kana propotevanie ropa kana nhengo dzinobudisa mvura. Kubvisa gasi uye kuratidza nematurusi. Zvadaro stitches kunoitika pamusoro ganda uye subcutaneous zvinyama pa nzvimbo trocar, ganda iri sutured zvizorwa sutures.

Ya kushanda zvingava maminitsi 15 kusvika maawa 1,5 zvichienderana bhuku apedza kuvhiya kupindira.

Analgesia pakuvhiya akadai nokubviswa dumbu laparoscopically: wongororo

Chii yokutindivadza iri nani? mubvunzo uyu zvinofanira kugadziriswa pamwe chiremba mutindivadzi, akapa mukuru ezvinhu omurwere, ivo zviratidzo zviri Murabhoritari zvidzidzo, iyo inofungidzirwa vhoriyamu remapazi. Kazhinji, asi kukabatanidzwa endotracheal yokutindivadza. Reviews vakadzi vanoti kuti zvakanaka akashivirira, pasina nomusoro. Female mukai pashure 15-20 maminitsi pashure kuvhiyiwa akadai nokubviswa dumbu laparoscopically.

The postoperative nguva zvakakodzera yokutindivadza kunobatsira pashure kupindira: marwadzo hazvisi kunetsa, pane chete kuduku kusanzwa, iyo inopfuura nomunyika 2 mazuva. Dzimwe nguva zvinogona kuda kurutsa, asi zviri yacho "metoclopramide". zuva rokutanga unogona kunwa mvura chete. Manheru, unogona nechekare simuka kumuka. Nezuva repiri unogona kudya chisingazivi kutsvinyira bowel, akadai Porridge, soups, dheri zvigadzirwa. The mushoma rinoitwa pazuva rechipiri pashure kupindira, uye achirwara anosiya akavharwa pashure pemazuva 30. Pashure paizvozvo mukadzi anogona zvakachengeteka kuenda kubasa, asi kuna akavarambidza inorema mumuviri basa kwemwedzi. Sutures vanobviswa musi postoperative zuva 5.

Pashure pokuvhiyiwa, zvingangove matambudziko, izvo mashoma: ichi kukuvara trocar nhengo dzomukati, ropa kubva pasi ligated midziyo, subcutaneous emphysema. izvi zvose zvinogona kudziviswa kana mukanyatsochengeta vanoomerera michina oparesheni uye aite odhita ari abdominal mhango kunyatsoongorora.

migumisiro

Zvinofanira kucherechedzwa kuti pashure kuvhiyiwa akadai chibereko nzira laparoscopic, zvinokonzerwa zvinoodza kuwana. Recovery kunoitika pashure 2 weeks Zvokusunungurwa. Mazuva 30 avhiyiwa mukadzi anogona kuenda pamusoro basa ravo senguva dzose. Ndakarumbidzwa noitika muviri. Asi gare gare mwedzi, zviri zvisingadiwi vapinze abdominal tsandanyama, simudza Zviidzo zuva.

Mumazuva okutanga vanogona zviduku anokakavara kurwadziwa mudumbu. Izvi zvinoitika uye vanofanira zvakaitika nemazuva 1-2. Paumbwe adhesions kunobvira, asi maererano nenhamba ichi kunoitika kwazvo kashoma uye chete majini kubatwa zviri muviri kana pasi akaratidza endometriosis.

Zvishomanana zvinoerera kubva dzokubereka turakiti. Izvi zvinoitika kana ovaries zvinochengeteka. Vakaramba kubereka mahormone anokonzera iri kuita.

Zviitiko anogumbura pezvakaitwa pashure laparoscopic kuvhiyiwa hadziwanzowaniki, nokuti mushonga anogadzwa pakarepo mushure kupindira uye kuramba kuti 5 mazuva. Panguva iyoyo zvakanga akagadzirisa mvura uye electrolyte Zvinoumba ropa.

Vakadzorerwa kubereka murwere anenge pakarepo, asi dzimwe nguva pane kuwedzera libido. Mukadzi anogona kurarama pabonde upenyu pashure 1 mwedzi pashure kuvhiyiwa. Kana muviri inochengeterwa, unogona kuwana pamuviri mukati memwedzi mitanhatu pashure kupindira.

Apo Ndinogona kuita oparesheni?

zvipatara zvakawanda zvinogona kupa chibereko laparoscopically. In Moscow guta zvipatara kuti vakagadzirira pamwe midziyo uye vane unyanzvi vanoziva unyanzvi ichi ichakupa mabasa aya. The kutengeserana Mutengo abvumirana kupinda chiremba.

The Ongororo kunogona kuitwa muhofisi kana ari pre-chipatara dzokugara. Kuita kwacho zvinoita kunyoresa kota. Mari laparoscopic chibereko anenge 45 kusvika 70 zviuru.