Enteroplexy: Iintlobo. udonga Indlela compound emathunjini

Igama elithi "ingenamthungo wamathumbu" yinto ehlangeneyo kwaye kubandakanya ukususwa zokonzakala iintsilelo emphinjeni, isisu kwakunye namathumbu. Nokuba ngexesha iCrimea beMfazwe, Pirogov uNikolay Ivanovich esetyenziselwa suturing amalungu ezibuhlazarha ezivuzayo ezizodwa. Bona bancedisana ukugcina organ achaphazelekayo. Iminyaka emininzi, sinikezela zonke iinguqulelo ezintsha ze suture isisu, waxoxa eluncedo nengeloncedo iindidi ezahlukeneyo kuyo, nto leyo ibonisa ukubaluleka ubumbaxa le ngxaki. Le ndawo sivulelekile ukuba uphando kunye nokuhlola. Mhlawumbi kwixesha elizayo iza kuba ngumntu oza kuqhuba indlela ekhethekileyo lonxibelelwano kwithishyu. Kwaye iya kuba impumelelo ubuchule nemithungo.

iimfuno ezisisiseko ingenamthungo emathunjini

Kutyando, kukho iimeko ezininzi ekufuneka kufikelelwe kuwo suture wamathumbu ukuze ukuba zingasetyenziswa kwimisebenzi esiswini:

1. Okokuqala, ingqibelelo. Oku kuzuzwa ukufanisa echanekileyo imiphezulu serous. Abambelela omnye komnye yaye ofunwa ngokuqinileyo, bakha amabala. kubonakaliswa esibi mihlaba azikhuli ukuba ithintele sicatshulwa ngokuqulethwe wamathumbu tube.
2. Ukukwazi ukunqanda ukopha, lo gama kugcinwe imithambo igazi okulingene umthungo kunye impiliso yayo yokuqala.
3. Le umthungo kufuneka ithathele ingqalelo isakhiwo kodonga lokugaya.
4. A amandla elikhulu kuyo yonke le inxeba.
5. imiphetho nxeba Injongo ephambili.
6. Minimal amabhunga trauma GI (zesisu). Oku kuthetha kukulahlwa kwawo twining yaseZimbabwe ngeenxa zonke, ukusetyenziswa neenaliti non-invasive test, kwakunye Asebenzisa forceps kunye nezibopho, nto leyo ukonakalisa udonga umzimba vuphukuphuku.
7. Isilumkiso khumba necrosis.
8. Uthelekiso oluchanileyo esicwangciswe umphakathi wamathumbu.
9. Ukusetyenziswa nezinto ezinokuboliswa ziintsholongwane.

Ubume bodonga emathunjini

Njengoko umthetho, udonga wamathumbu tube na isakhiwo esifanayo kulo, kunye ezahlukeneyo ezingephi. Umaleko engaphakathi - izihlunu uxakaxa, nto leyo iquka maleko cc esinye epithelium, nto leyo iinxalenye ezithile villi ngenxa ukufunxeka ngcono. Kuba isifo na friable submucosal iyabanda. Ngoko kukho umaleko kwezihlunu tight. Zenza kunye nohlelo imicu ixhomekeke kwikhadi wamathumbu. In kwizihlunu kuvuleke iminxunya ezi circularly, apha emathunjini amancinci - longitudinally, yaye imicu izihlunu shinyi zicwangciswe ngokohlobo amakhasethi ububanzi. Ngokuba umaleko kwezihlunu yi serosa. Oku zibhityile umboniso, nolwenzelwa imizimba nomgongxo nokuqinisekisa ukushukumiseka kuthelekiswa lwabo omnye komnye. Ubukho kwale maleko kufuneka ithathele ingqalelo xa enyanzeliswa phezu komphetho emathunjini.

Iimpahla serosa

A impahla luncedo utyando serosa (m. E. engaphandle) inwebu ye ityhubhu kokudla ukuba emva nasekulinganiseni imiphetho inxeba njo ngokuqinileyo kuyo iiyure ezilishumi, neminye imicu ziye ngokwaneleyo ambathe edidekile nge iintsuku ezimbini. Oku kunika a yobunzima umthungo. Ukuze ufumane Kule meko, kufuneka usebenzise yaseZimbabwe rhoqo ngokwaneleyo, ubuncinane ezine isentimitha omnye.

nemisonto ezingcakacileyo eyenziweyo asetyenziswa ukunciphisa ancedisana lakha inxeba ngexesha crosslinking. Ngokuqhelekileyo, i sutured ukuya serosa kwimicu izihlunu, ezikunika luthambe enkulu ingenamthungo, yaye ngaloo ndlela, ukukwazi ukuba olule ngexesha elingaphesheya bolus. Capture submucosal kwaye izaleko mucosal zinika hemostasis elungileyo namandla olongezelelweyo. Kodwa ke kubalulekile ukukhumbula ukuba ukosuleleka kunye umphezulu engaphakathi wamathumbu ngu suture isasazeke kulo lonke kwisisu.

Ityala nomphandle wocango lomsele alimentary

Ukuze ube ugqirha kubaluleke kakhulu ukwazi malunga nolwakhiwo futlyarnoy umgaqo eludongeni umsele alimentary. Phantsi lo mbono chonga iimeko zangaphandle nangaphakathi. Ityala engaphandle kuquka serosa kunye kwezihlunu imifinya kunye zangaphakathi - le isifo kunye submucosa. Yokuba isihlobo enokususwa omnye komnye. Kwiindawo ezahlukeneyo wamathumbu xa ukubana lomonakalo ezahlukeneyo. Ngokomzekelo, incipha ngaphezu kwimeko engaphakathi, yaye kwimeko umonakalo esiswini ukuya kwinqanaba kuvuleke iminxunya - phandle. Kulo emathunjini, zombini esingxotyeni ngokulinganayo.

Xa ugqirha sutures udonga umphimbo, inaliti leyo lesitofu obliquely kwicala osecaleni (ecaleni). A perforation ke sutured eludongeni esiswini kwenye, ulwalathiso obliquely-medial. emathunjini amancinane emikhulu athungwe ngqo nkqo. Umgama phakathi yaseZimbabwe akufunekanga ibe milimitha ngaphantsi kwe ezine. Amanyathelo kukhokelela ekuncipheni ischemia kunye necrosis ye ekupheleni nxeba, kunye nongeniselo - ukuya ukusilela kunye ukopha.

ezivuzayo kufuphi-edge kumda kunye namalungu

komphetho isisu kunokuba ngoomatshini kunye manual. Nevuthisayo ngexesha ke, yahlulwe kumda, kufutshane-emphethweni nezidibeneyo. Le pass lokuqala ngohlangothi isilonda, kokurhoxa yesibini ukusuka kolunye udini lwalo ayikho isentimitha, nezidibeneyo oludibanisa iinketho emibini edlulileyo.

ezivuzayo zemilambo odnofutlyarnymi kunye dvuhfutlyarnymi. Kukwaxhomekeke nasekubeni zingaphi oonokrwece enxulumene ngaxeshanye. Bir komphetho ne ezalathelwe uphuhliso owayame eludongeni ingenamthungo lwangaphandle kunye Mateshuka (kunye ezalathelwe uphuhliso ngaphakathi) zibhekisela omnye-eqongeni, ekubeni kuphela ibambelele muscularis tunica kunye serosa. A umaleko ezintathu-ingenamthungo wamathumbu Pirogov, nto leyo athungwe kuphela kwimeko engaphandle, kodwa umaleko submucosal ngokusebenzisa umthungo kwaye Gely dvuhfutlyarnymi.

Ngenxa yoko, umzila nge ukuze kusetyenziswa udumbo, kunye umthungo okuqhubekayo. Le yokugqibela has yazo ezininzi:

- twining ngeenxa zonke;
- umatrasi ixhasa;
- Reverdy komphetho;
- komphetho Schmid.

Kufutshane-edge, kakhulu, yiba ukuhlelwa zabo. Ngenxa yoko, bodwa Lambert ingenamthungo emele dvustezhkovy suture ankile. Lisetyenziswa kwi engaphandle (sero-dystrophy) kunjalo. Kodwa kukho umthamo eqhubekayo, esipajini string, polukisetny, U-emile yaye Z-ezimile.

ezivuzayo zihlangene

Nanjengoko igama layo lixela, le sutures emanyeneyo ukudibanisa izinto ngohlangothi kufuphi-buthelezi. Bucala "igama" sutures yotyando. Bona igama emva kokuba oogqirha kuqala wona isebenzela amalungu esiswini:

1. Le umthungo yikhompawundi Czerny emphethweni kunye kufutshane-edge sero-kwimisipha joint.
2. komphetho Kirpatovsky - indibanisela omhlophe emphethweni kunye submucosal serous-dystrophy.
3. Albert komphetho iquka joint ezimbini ezithile: Lambert kunye Gely.
4. Tupe komphetho uqala emphethweni ngokusebenzisa ingenamthungo; leyo macandelo nto zibambene nayo le mithambo umzimba. Lambert ngoko suture ibekwe ngaphezulu.

Classification yi inani lemiqolo

Kukho kwakhona qheke beentanda ababhali nje kuphela kodwa inani lemiqolo enyanzeliswa phezu enye ngezantsi enye ngasentla. Udonga isisu uba kratya elithile, ngoko amanxeba suturing ndlela iyilwe ukwenzela ukunqanda kwizihlunu mlilo.

ezivuzayo kumqolo Single ayangenana kunzima, yona ifuna i ngqo indlela ethile zotyando, ukukwazi ukusebenza neemicroscope zokusebenza kunye inaliti atraumatic. izixhobo olunjalo azifumaneki kuzo zonke yokusebenza, hayi zonke ugqirha unako ukumelana nayo. Le uthunge kabini-mqolo ezisetyenziswa ngokuxhaphakileyo. Bona fixed kakuhle kunye nokuphela kwegqabi nxeba na umgangatho legolide kutyando esiswini.

sutures Multi-mqolo zisetyenziswa kunqabile kakhulu. Ikakhulu kungenxa yokuba eludongeni umzimba wamathumbu ibhityile, soft, kwaye inani elikhulu zixhobo babeza singene kuyo. Ngokubanzi, uzaleke multirow beentanda nokusebenza kuphela xa Amathumbu amakhulu, umz appendectomy. Ugqirha ligature lokuqala azibeka kwisiseko appendix. Lo wokuqala, omhlophe ngaphakathi. Ngoko kukho suture isipaji umtya nge umaleko serous kwemisipha. Yena liqiniswe yaye wavala phezulu Z-ezimilise, ukulungisa umhlaza isiphunzi nokunika hemostasis.

Ukuthelekiswa sutures emathunjini

Ukuze bazi ukuba iimeko kuyacetyiswa ukusebenzisa enye okanye enye umthungo, kufuneka ukwazi amandla kunye nobuthathaka babo. Makhe sihlolisise ngokweenkcukacha.

1. Grey-serous suture Lambert, ngenxa yesandi yawo yonke kunye Ukukwazi neengxaki ezininzi. Oko kukuthi, loo nto ayenzi ukubonelela hemostasis eziyimfuneko; kakhulu ezonakala; Akunamsebenzi thelekisa isifo kunye submucosa. Ngoko ke, kufuneka usebenzise yona ngokuhlanganisa ngayo kunye nezinye yaseZimbabwe.

2. izitishi Boundary kumqolo single- kwaye kabini omelele ngokwaneleyo ukunika uthelekiso ngokupheleleyo zonke inoomaleko izicwili, nokubonelela ngeemeko kangangoko ukuba impiliso izicwili, ngaphandle ukuvala le mithambo umzimba, kwakunye ukuphelisa yimbonakalo amabala esibanzi. Kodwa babe nobubi. Komphetho akubonakali microflora nakwa KwaZulu ngaphakathi. Hygroscopicity kukhokelela ukusulelwa ancedisana ngeenxa zonke.

3. sutures serous-dystrophy-submucosal ilifa amandla enkulu oomatshini, ukuhlangabezana imigaqo futlyarnoy kwamathumbu isakhiwo eludongeni, ukunika hemostasis epheleleyo kunye nokuthintela licuthe le mithambo welungu vuphukuphuku. komphetho Loo kuboniswe ngexesha elinye Pirogov uNikolay Ivanovich. Kodwa kwaba eyaHluke-kumqolo omnye. Le ukuguqulwa has a ezimbi:
- uqhagamshelo line zase eqine;
- ukwanda ubukhulu: kukuqulungana ngenxa ukufukuka kunye nokudumba.

4. amalungu Ludityanisiwe zithembekile, kulula ukuba kusebenze, gemostatichny, avuze-ubungqina kunye ixesha elide. Kodwa loo umthungo elibonakala egqibeleleyo, ibe kuneengxaki zako:
- ukudumba ancedisana ecaleni uqhagamshelo umgca;
- ukuphilisa kade;
- ekumisweni necrosis;
- Amathuba eliphezulu azikhuli;
- usulelo nemisonto xa edlula isifo.

5. amalungu kumqolo Triple zisetyenziswa ikakhulu ngenxa ukuvalwa iziphene ikholoni. Bathi eqinile, ukunika lithathelwe kakuhle emiphethweni inxeba. Oku kunciphisa amathuba okuba nokudumba necrosis. Phakathi iintsilelo yale ndlela zezi:
- usulelo ngenxa suturing imisonto sheaths ezimbini ngaxeshanye;
- kuyehla okutsha yethishyu kwisiza inxeba;
- Amathuba aphezulu isenzeko azikhuli, kwaye, ngenxa yoko kwimiqobo kuye;
- ischemia inyama kwindawo le suture.

Sinokuthi ubuchule ngamnye suturing amanxeba ngokwamalungu ezibuhlazarha zinezibonelelo zayo nezingalunganga. Surgery kuyimfuneko ukuba baqwalasele ekupheleni ngenxa yomsebenzi wabo - yintoni kanye afuna ukufikelela kulo msebenzi. Kakade ke, imiphumo kaGawulayo kufuneka kusoloko busa ezimbi, kodwa ke yokugqibela ayikwazi kuba kumgangatho ngokupheleleyo.

iinkathazo ezingenakunqandwa zamazinyo ezivuzayo

Ngokuqhelekileyo, onke amalungu angohlulwa ngokwamaqela amathathu: ezo adlabhuke phantse lonke qhuma kunqabile kwaye phantse besika. Iqela lokuqala ufumana ingenamthungo Schmid kunye Albert umthungo. Baya kucanda kulo inwebu yangaphakathi, nto leyo onzakele lula. Ukuze iqela lesibini kuba ngumhlaba seams, ibekwe kufuphi mithambo umzimba. Le umthungo kunye nokuhlangana Mateshuka Bira. Iqela lesithathu iquka beentanda ukuba akukho mntu ungathembekanga ukuqhagamshelana mithambo ye ethunjini. Ngokomzekelo, Lambert.

Ngokupheleleyo ukuvala amathuba kuqhambuko le weld akwenzeki, nokuba lisetyenziswa kuphela serosa. Phantsi kweemeko alinganayo ingenamthungo rhoqo uthe wagawulwa kunye namathuba ngaphezu esiludumbo. Oku kungenzeka ukuba konyuke ukuba umsonto ubotshwe kufutshane mithambo umzimba.

Ukwahlula mechanical dubulo vulu exclusion ingenamthungo kunye ezinobunzima necrotic kunye mlilo basabela njani ngenxa yokuvelisa amalungu asekuhlaleni.

izinto Advanced resorbable

Eyona nto kakhulu ukhululekile ukuba unako ukwenza umthungo wamathumbu - a imicu resorbable zokwenziwa. Baya okuvumela ukuba uxhulumane kungqameko enenxeba kakhulu ixesha elide yaye musa ukundishiya umzimba umbandela ogulayo amazwe. ingqalelo ekhethekileyo ihlawulwa indlela sokususwa vulu emzimbeni. imicu Natural abakhuselekanga enzyme zeethishu, neerhali eyenziwayo lwanamathela yi haydrolisis. Ekubeni haydrolisis ingaphantsi ubhubhisa nezihlunu umzimba, oko Kukhethwa ukuba ukusebenzisa izinto zokwenziwa.

Ukongeza, ukusetyenziswa kwezinto zokwenziwa yenza kube lula ukufumana umthungo eqinileyo yangaphakathi. Abayi ukungena laphu, ngoko, wonke umonakalo ukuba oku kukhokelela ngaphezulu, kakhulu, bona ababandakanywa. Enye iplastiki kwizinga HIV ukuba ngaba ukufunxa amanzi. Oku kuthetha ukuba umthungo aziyi gqitha kwaye flora emathunjini, nto leyo ingahlasela isilonda, yaye akuyi kuwa phakathi sayo umzimba kumphezulu sayo.

Ukukhetha le umthungo kunye nezinto ekufuneka sutured inxeba, ugqirha kufuneka bakhokelwe intlonelo imithetho eziphilayo ezibonelela ijwabu nokumanyana. Umnqweno ukubuyisela ubunye inkqubo, ukunciphisa inani lemiqolo okanye ukufaka izicelo nezingqinekayo uya imisonto akufuneki kube yeyona njongo. Okokuqala ukhuseleko ebalulekileyo nomonde, ezimqoka yayo, ukuncitshiswa ixesha ekuphulukwene post-operative kunye neentlungu.