Operation Washington: weboka oparesheni, migumisiro, matambudziko, wongororo

Chimwe chinhu remapazi kana onkopatologii ndiyo yakakura, i.e. kwete chete kubviswa bundu pacharo, asiwo yakawanda utano zvinyama yakabatana pathological wechoto. Uyezve, pamwe excised bundu uye node nodes zvikasabudiswa lymphatics mairi.

Yakakura Mabatirwo remuromo uye endometrial kenza

Washington kuti mashandiro zvakazara sezvarayirwa pamusoro apa zvinodiwa. Chaizvoizvo Its uvete kubviswa dumbu pamwe zvinoshandiswa (uterine sepombi uye ovaries), yokumusoro rechitatu nyinyo, dumbu uye kutsigira nemarunda uye dzakapoteredza nuna rinenge kubva node nodes.

The zvairatidza kunorapwa vari remuromo uye uterine kenza. Asi mune zvimwe zviitiko, kuvhiya hakuna akakurudzira kuti:

• pamberi metastases kure;
• kana anomera hombe, vascular Kutumbuka uye pedyo zvomukati uye rusvingo dzimwe nguva pelvic;
• chokuita kwazvo pathologies;
• pakukwegura.

Washington mashandiro nokuti gomarara

Kana isu kutaura pamusoro kurapwa chirwere ichi, zvinofanira kucherechedzwa kuti akati mashandiro inogona kushandiswa zvese vakazvimiririra uye sechikamu mubatanidzwa mishonga.

Kana kusiyaniswa zvikuru squamous kenza sero diagnosis (T1bN0M0 danho), kuvhiyiwa uku anogona akanyatsosiyana kugadzirisa dambudziko pasina chokuita nzira dzakadai mishonga uye nemwaranzi mishonga. Zvisinei, vazhinji Washington kuti kushanda chinhu chezvinonhuwira mubatanidzwa mishonga.

Kana endometrial kenza (kunyange Danho IB) munogara basa dzimwe kwakajairika, kuwedzera kuvhiyiwa.

Operation Washington: Kutama oparesheni

Kuvhiyiwa yakakura nokubviswa dumbu pamwe zvinoshandiswa kunosanganisira matanho akawanda. Idzi dzinosanganisira:

1. Access.
2. The mharadzano pamusoro uterine nemarunda.
3. Kuunganidza of fallopian sepombi uye ovaries.
4. Kuunganidza of dundira.
5. Ligation uye mharadzano huru inosimbisa midziyo.
6. Nokubviswa zvinyama kubva pamberi pechiso cervix.
7. The mharadzano of nemarunda kugadzira dumbu shure (sacral-uterine).
8. The mharadzano muromo wechibereko urege nemarunda.
9. remuromo resection.
10. Hemostasis kusangana nekutsi kwemukadzi chigutsa.
11. Peritonization.

kuvhiya kuwana

Operation Washington - rakakura kupindira zvinoda Visualization pamusoro kuvhiya munda uye mukana bata zvakanaka, kwete achiperekedzwa matambudziko kana zvausingakwanisi. Naizvozvo chikamu kunge zvakakwana. Mini accesses uye endoscopic kuvhiyiwa, muchiitiko ichi regai kufanira. Munyaya kenza varapwe zvizorwa mugumisiro kukosha iri rokupedzisira nzvimbo.

Raiwanzoitwa evaMedhia longitudinal laparotomy (kwetsinga pamusoro Anterior abdominal rusvingo jena mutsetse mumwe kwomudumbu yokunzvenga guvhu) kana kuwana Czerny (transverse laparotomy pamwe kwetsinga pamusoro rectus abdominis).

kuunganidza of dumbu

Kuti izvi zvidaro, piringisha kumativi shwashwa pamusoro dumbu, uye voga suspensory ovary nemarunda, uye amai mutopota magumo. Vose masangano aya anofanira vayambuka, kana zvichibvira, munzvimbo kuine midziyo ropa. Izvi kuchaderedza ropa kurasikirwa. The chaizvo chete dumbu rakundwa pamusoro okusungisa uye asunungurwa kurutivi.

Pashure pokuyambuka suspensory shwashwa pakati ovary anova nokubviswa dumbu zvinobvira. Chikurukuru, pamwe kuunganidza dzavo - kwete kukuvadza ureter. Kuti aite izvi, panguva yokuvhiyiwa kwairayirwa palpation dzakafara shwashwa. Necheseri kazhinji jira nyore ndiko ureteral muchirugu. bata Izvi zvinobvumira kuti vanounganidzira muchibereko chemusikana uye zvinoshandiswa pasina ureteral kukuvara.

Mushure kuzarura vesico-uterine matanga dundira donje swab anosiiwa parusvingo pamberi cervix. Izvi zvinofanira kuitwa pasina kutsauka kubva pakati mutsetse, kuderedza njodzi yokukuvadzwa kune vascular plexus.

Kana dundira iri adherent kuti dumbu adhesions, ayo kuparadzana kunogona kuva kwakaoma. Tanga keying mune nyaya rwakapoteredza nemarunda, moenda pamutsipa migove pamwe mukuru mufambo, sefuro yaakaparadzanisa chigero.

Uyezve Washington mashandiro kunosanganisira ligation rwengarava. The chikuru vascular chiputu muchibereko chemusikana - uterine tsinga uye munyaya mutsinga, vachifamba pamuuyo dumbu. Ligation wavo pachiyero dzomunyika Os.

Nokuti mamwe kuunganidza pamusoro uterine incision rinoitwa uye kuchinja predpuzyrnoy fascia rinenge kuburikidza kungopotsera pamberi pechiso cervix pasi. Uyezve muchinjikwa shwashwa, dzaiva kare isina kuti zvitinakire: sacro-uterine uye remuromo nemarunda. Pashure paizvozvo chibereko anouya mukunopera.

Chaizvoizvo chibereko, hemostasis uye peritonization

Kusangana nekutsi kwemukadzi rakatenderera inovhurwa, kuti cervix chinobviswa panguva zviteshi uye zvishoma nezvishoma kubviswa kubva nyinyo. Izvi zvinoteverwa hemostasis uye peritonization. kusangana nekutsi kwemukadzi Chigutsa haagoni kutora zvakasimba, unogona kushumira sezvo dzinongoitika abudise ari chiitiko chipi pathological pezvakaitwa ari pelvic mhango uye kuunganidza pus kana ropa ipapo.

Kusangana nekutsi kwemukadzi chubhu ikarapwa munzira chaiyo. Madziro nyinyo ligated vesico-uterine uye rectouterine pazvirugu, uyewo sacro-uterine nemarunda, nokudaro kuwana hemostasis uye peritonization.

The postoperative kumwedzi

Sei murwere mushure kuvhiyiwa Washington? Kuvhiya kukuru haangaupfuuri zvachose kuonekwa. Pasina mubvunzo, zvinokanganisawo utano zvose mumuviri nomupfungwa.

Chii rinobatanidza oparesheni Washington? Migumisiro nzira iyi kunokwanisa kukamurwa kuva mangwanani uye kunonoka.

Matambudziko yomuka pakutanga postoperative nguva

The postoperative nguva anogona omesa:

1. Chirwere mapfundo (kwete chete ganda asiwo zvemukati).
2. Peritonitis uye sepsis.
3. Ropa kubva nzvimbo mapfundo, kusanganisira menyika.
4. Hematoma musono nzvimbo.
5. Dysuria.
6. Pe (pulmonary embolism).

Kunyange nedzidziso kuchengetwa kusabereka haisi nguva zvinogoneka kudzivisa septic matambudziko. Izvi imhaka ndechokuti oparesheni rinoitwa varwere vane muviri simba uye saka hondo pamwe akaipa bundu kutapata ipfupi. Naizvozvo, kuzvimba mapfundo mavari - a zvingaitika. Nechinangwa kudzivirira munhu akapiwa ezvinhu ari postoperative munguva waida inorwisa mabhakitiriya.

Ropa uye kupwanywa kunoratidza kusava hemostasis. Pakugadza hemostatic mishonga havawanzoenda zvakakwana, uye dzimwe nguva zvinoda kudzokororwa kuvhiya - amboshandurirwa ronda uye suturing kuti ropa midziyo.

Dysuria - kakawanda uye anorwadza weti. Nechitarisiko chiratidzo ichi zvinokwanisika kana kukuvaradzwa mucous urethral anobudisa mushonga zvishoma nezvishoma uye panowanikwa wakapona urethritis.

Pe anogona kuitika sezvo pakava pakati thrombosis repasi wamativi. Ndokusaka muna postoperative munguva vanotumirwa anticoagulation ( "heparin") uye varumbidzwa kupfeka compression masokisi kana kwakavharwa nenyama mabhandeji.

Migumisiro vachangobva kumwedzi

Kune vamwe zvakaoma kunzwisisa pashure pokuvhiyiwa Washington, kukura kwenguva:

1. matambudziko Emotional: kutya zvichibvira kuchinja chitarisiko uye nokurasikirwa pabonde ngarurege (nokuti ovaries vanobviswa, izvo zvinoreva kuti padanho dzepabonde mahormone zvakachinja), manzwiro pamusoro nekusagona pamuviri, dzakanga vanga pamusoro Anterior abdominal rusvingo.
2. Abdominal adhesions.
3. Rutarinhari.
4. Kunomutsa Mubvunzo of nyinyo.
5. Education retroperitoneal limfokist.

Zviitiko vakadzi nezvemigumisiro chibereko iwayo zvinonzwisisika. Saka, muna postoperative munguva kutsigira inokosha chaizvo uye kunzwisisa mhuri.

Vamwe matambudziko (postoperative vanga, nekusagona vana) kubvuma chete. Kune dzimwe kutya anogona uye anofanira kurwa, sezvo ivo vari kazhinji kusina pakwakavakirwa. Spaying hazvirevi kunotoreva chero mufundisi kuchinja chitarisiko kana kurara bhora. Asi zvinogona kukonzera kusagadzikana pabonde kana pashure gisteretomii akasiya hupfupi kusangana nekutsi kwemukadzi chigutsa.

Adhesions pashure pokuvhiyiwa Washington vari achiumbwa sezvinoitwa pashure chero kuvhiya mhango. Izvi imhaka traumatization pamusoro peritoneum panguva oparesheni, zvinoita kuti paumbwe connective zvinyama tambo pakati machira ake uye nhengo dzomukati.

Adhesions ari abdominal mhango kunogona kukonzera abdominal marwadzo, kusagadzikana weti uye defecation, uye mune zvimwe zviitiko kunyange kutungamirira intestinal mhingaidzo. Nokuti kudzivirira adhesion inotungamirwa ari postoperative munguva dzinokosha mangwanani activation murwere uye kuitisa mumuviri kurapa rokutanga zuva pashure kuvhiyiwa.

Kubereka kunoitika pashure chibereko nokuda kubviswa ovaries. Postoperative kubereka takura rinorema dzinongoitika, nokuti iyi, kuchinja kwemakemikari omuviri kuitika nokukurumidza. Kuderedza kusagadzikana akashandisa kemikari yokutsiva mishonga.

A kusangana nekutsi kwemukadzi prolapse Kuvhiya Washington anova zvinogoneka nokuda kukuvara ligamentous midziyo (a inodiwa zvimiso kuita chibereko) uye misha yose pelvic nadzo panzvimbo vasipo dumbu. Nokuti kudzivirirwa yematambudziko akadaro murwere inokurudzirwa mabasa chaiwo muviri, akapfeka chibooreso, kukamurwa kurovedza muviri kweinenge 2 months pashure kuvhiyiwa.

Kazhinji iri retroperitoneal nzvimbo achiumbwa limfokista Washington pashure kuvhiyiwa. Its kuvhiya kurapwa. Zvisinei, zvakawanda zvinobudirira kutadzisa panowanikwa kuomesa uyu achiri padariro pokuvhiyiwa, pane kurapa. Nokuti chinangwa ichi, nzira dzakasiyana abudise retroperitoneum.

Chii vanhu vakati pamusoro Washington oparesheni

Kuti kubvisa ari kukuru remuromo kana endometrial kenza zvinoshanda Washington oparesheni. Mhinduro nezvazvo zvakasiyana.

Doctors uye varwere vanoti zvinhu zvakanaka avhiyiwa:

1. Kuwedzera upenyu anotarisirwa.
2. Avimbiswa Kusavapo zvirwere uterine, kusanganisira kenza.
3. Nhumbu, havabvumiri kunyange chiduku ndingangokuvara pamuviri pasingadiwi.
4. The oparesheni hazvideredzi kunyatsoshanda, zvinokwanisika kudzokera dzose upenyu.

Nezvayakaipira akavhiyiwa:

1. Kusakwanisa kuva nevana.
2. Shata vanga pamusoro Anterior abdominal rusvingo.
3. Mukana yematambudziko, zvose mangwanani uye mushakabvu (kukurukurwa pamusoro).

To muchidimbu

Chibereko nokuda Washington - inobudirira zvikuru Mabatirwo nyanyisa remuromo uye endometrial anomera. oparesheni ichi hachisi chete anogona kuderedza murwere kenza, asiwo vamwe nzira anovandudza upenyu.

Chokwadi, kufanana chero avhiyiwa, chibereko hwakazara kukura yematambudziko. Zvisinei, apo hwakakwana kurongwa postoperative kumwedzi, uye pasi zvakakodzera matanho kuzvidzivisa.