Opereishene Wertheim: tsela ea ho sebetsa, le liphello, mathata, ulasan pelanggan

E mong tšobotsi ea tshebetso ha onkopatologii ha e le tse khōlō, i.e. e seng feela ho tlosoe hlahala ka boeona e, empa e boetse e le palo e khōlō ea dinama tse nyenyane tse phetseng hantle le haufi le ho tšoana le leifo pathological. Ho phaella moo, le excised hlahala le lisele tsa mmele nodes draining lymphatics ho eona.

Khōlō kalafo ya kankere cervical le endometrial

opereishene Wertheim ka botlalo e ikamahanya le ditlhoko tse ka holimo. mozindo lona larileng ka ka ho tlosa ea popelo le appendages (meqomo uterine le mae a bomme), e ka holimo karolo ea boraro ea ka hara botshehadi, popelo le ho tšehetsa ligaments le pota-potileng mafura dinama tse nyenyane tse ho tloha nodes lisele tsa mmele.

The bontšang bakeng sa ho buuoa ke cervical le uterine kankere. Empa maemong a mang, ho buuoa e sa kgothaletswa:

• ka ho ba teng ha metastases hōle;
• tabeng ea dihlahala ea tonanahali, vascular lehlomela le makala a lebagane le ka linako tse ling pelvic leboteng;
• amanang le pathologies haholo;
• ka botsofali.

Wertheim tshebetso kankere ea cervical

Ha re bua ka ho phekola lefu lena, re lokela ho hlokomela hore ho sebetsa itse ka sebelisoa bobeli nosi le e le karolo ea phekolo motswako.

Tabeng ea squamous haholo farologantswng bolaoa ke kankere ka seleng e fumanoe (T1bN0M0 mohato), tshebetso ena ka radically rarolla bothata boo ntle le e amanang le mekhoa e kang etsoa chemotherapy le phekolo mahlaseli. Leha ho le joalo, boholo ba Wertheim ya tshebetso ha e le karolo ea motsoako phekolo.

Ha kankere endometrial (esita le sethaleng IB) kamehla a abeloa ho liphekolo tse ling, ho phaella ho buuoa.

Opereishene Wertheim: re fallele tshebetsong

Ho buuoa bakeng sa ho tlosa tse khōlō tsa popelo le appendages e kenyeletsa mekhahlelo e 'maloa. Tsena li akarelletsa:

1. Phihlelo.
2. The motsoako oa ligaments uterine.
3. Rotloetsa le ea methapo fallopian le mae a bomme.
4. Rotloetsa le ea senya.
5. Ligation le mateano a litsela tsa methapo ea ka sehloohong fepa ka.
6. Tlosa dinama tse nyenyane tse ho tloha holim 'pel'a molomo oa pōpelo ea.
7. The motsoako oa ligaments ho lokisa popelo morao (sacral-uterine).
8. The motsoako oa ligaments cervical.
9. cervical resection.
10. Hemostasis bosaling kutu.
11. Peritonization.

ho fihlella ho buoa

Opereishene Wertheim - kenella a pharaletseng a hloka lits'oants'o tse ntle tsa naha ho buoa le ka monyetla oa ho mellwane, ha a tsamaea le mathata kapa mefokolo. Ka lebaka leo, karolo e tlameha e be e lekaneng. Mini accesses le endoscopic opereishene, tabeng ena le se ke lumellane. Litabeng tsa kalafo kankere lebaka setlolo ya bohlokwa e sebakeng qetela.

Hangata a etsa bohare longitudinal laparotomy (dissection tsa anterior leboteng ka mpeng ea mola o mosoeu oa mala kgaoleditse ea mokhubung) kapa ho fihlella Czerny (ho parola laparotomy le dissection tsa rectus abdominis).

rotloetsa le ea popelo ea

Ho finyella sena, intersect potoloha ligament ea popelo, 'me ka poraefete suspensory ligaments ovary,' me e boetse e le 'mè oa phala qetellong. Kaofela ha mekhatlo tsena li lokela ho tšela, haeba ho khoneha, libakeng tse bosula le bo sa methapo ea mali. Sena se tla fokotsa ho lahleheloa ke mali. The popelo e tšoanang haholo nkuwa ka lintho tse kopanyang le e lokolloa ho lehlakoreng.

Ka mor'a ho tšela ligament suspensory ea ovary le fetoha khoneha ho tlosa popelo. botlhokwa go feta, ka rotloetsa le bona - a se ke a senya ureter. Ho etsa sena, ka nako ya tshebetso ya e tlamang palpation tsa ligament tse sephara. Ka morao ho ka kakaretso bonolo lakane e ureteral lesaka. Sena mellwane lumella hore u ho koetlisetsa popelo le appendages ntle ureteral kotsi.

Ka mor'a ho bula vesico-uterine lemenong senya k'hothone swab e arohane le leboteng pel'a molomo oa pōpelo ea. Sena se lokela ho etsoa ntle le ho kheloha tseleng ea ho tswa ho mola bohareng, ho fokotsa kotsi ea bobe ho akira theo gun vascular.

Ha senya ke adherent ho adhesions popelo, karohano lona ho ka ba thata. Qala keying ka tabeng ea ligaments ho potoloha, 'me u tsoele pele ho likarolo tse molaleng le tsamaiso khōlō ka ho fetisisa, se ome mathe arola dikere.

Ho ekelletsa moo Wertheim tshebetso akarelletsa ligation likepe. Ka sehloohong vascular sosobaneng ea popelo - mothapo uterine le methapong tsamaeang, ba tsamaea hammoho ka bohale ba popelo le. Ligation tsa bona ka boemo ba ka erorr hare.

Bakeng sa rotloetsa le tlatsetso ea popelo phethile dissection predpuzyrnoy fascia le hlabang koala ke dinama tse nyenyane tse ho tloha holim 'pel'a molomo oa pōpelo fatše. Ho ekelletsa moo le sefapano se ligament, tse neng li neng fumanehe bakeng mellwane: sacro-uterine le ligaments cervical. Mora hysterectomy e tlisoang ke ho ba sethaleng ho qetela.

Ha e le hantle hysterectomy, hemostasis le peritonization

Bosaling Vault e buleha, ho popelo e nkiloeng ka boemelong ba le butle-butle felisoa ka hara botshehadi e. Sena se lateloa ke hemostasis le peritonization. bosaling kutu ke ke a nka ka ka thata-thata, ho ka sebeletsa drainage ka tlhaho ka ketsahalo ea dithulaganyo efe kapa efe pathological ka cavity pelvic le ho bokella boladu kapa mali ho na le.

tube, ka bosaling o tšoaroa ka tsela e khethehileng. Marako a ka hara botshehadi ligated vesico-uterine le rectouterine lemenong, hammoho le ho sacro-uterine ligaments, ka tsela eo ho finyella hemostasis le peritonization.

Nako postoperative

Kamoo ke mamello ka mor'a ho buuoa Wertheim? Joalo ho buoa tse khōlō ka ke ua feta ka ho feletseng bonoe ke motho. Ntle ho pelaelo, e ama bophelo bo botle ba 'meleng le kelellong.

akarelletsa seo tshebetso Wertheim? Liphello tsa ho ena mokhoa oa kalafo ka aroloa hoseng 'me a siuoa ke nako.

Mathata a hlahang mathoasong a postoperative nako

Nako postoperative le ka thatafatsa:

1. Tshwaetso manonyello (e seng feela letlalo empa hape ka hare).
2. Peritonitis le sepsis.
3. Mali ho tswa sebaka sa manonyeletso, ho kopanyelletsa le ba ka hare.
4. Hematoma seam area.
5. Dysuria.
6. PE (embolism methapo).

Esita le ho ketekoa litaelo tse thata tsa nyopa hase kamehla ho ka khona ho qoba mathata maswe. Sena ke ka ntlha ya go ha e le hantle hore ke buuoe e etsoa bakeng sa bakuli bao 'mele e fokola' me ho joalo le ka loana le hlahala maloetseng e fokotsehile. Ka hona, le ho ruruha ea manonyello a ka bona - le boemo bo ka khonehang. Ka morero oa ho thibela boemo bo fanoeng ka nako postoperative hlokahala lithibela-mafu.

Tsoa mali le ho longoa bontša ho hloka hemostasis. Behelanoeng lithethefatsi hemostatic Hase hangata ka ho lekaneng, 'me ka linako tse ling batla hore ho buuoa ka makhetlo-khetlo - hlaoloa tsa leqeba le suturing likepe tsoa mali.

Dysuria - khafetsa le e bohloko ho ntša metsi. Ponahalo ea letšoao sena se ka etsahala ha senyehile mucous urethral catheter le ketsahalo e sa urethritis sithabetsang.

PE ka etsahala ka complication ea thrombosis ea lipheletsong tse tlaase. Ke ka lebaka leo ka nako postoperative ba abeloa anticoagulation ( "heparin") 'me a buella ho apara compression stockings kapa masela a tlamisang rekere.

Liphello tsa nako e morao

Ho na le tse ling mathata a ka mor'a ho buuoa Wertheim, ho ntshetsa pele ka nako e telele:

1. Maikutlo mathata: tšaba khoneha liphetoho le ponahalo e le tahlehelo ka ho kopanela liphate ka koloi (hobane mae a bomme li tlosa, e ho bolela hore boemo ba ho kopanela liphate-hormone chencheloa), maikutlo a ka ho hloleha ho ima, mobe lebali ka anterior mpeng leboteng.
2. Mpeng adhesions.
3. Sehlohlolong.
4. Ho se phethise ketso tsa ka hara botshehadi e.
5. Thuto retroperitoneal limfokist.

Liphihlelo tsa basali ka liphello tsa hysterectomy ntho e utloahalang haholo. Ka hona, ka nako postoperative ke tšehetso ea bohlokoa haholo le ho utloisisa boemo ba lelapa.

Le ba bang ba mathata (postoperative lebali, ho hlōleha ho ba le bana) tlameha ho amohela feela. Ka tšabo le leng ka le lokela ho loana, ha ba ntse ba ba atisa ho se nang motheo. Spaying ha akarelletsa liphetoho leha e le mok'hadinale le ponahalo kapa boemong ba ho kopanela liphate. Empa ho ka 'na etsa hore boemong bo sa thabiseng ka nako kopanela liphate haeba mora gisteretomii setseng khutsufala hoo bosaling kutu.

Adhesions mor'a ho buuoa Wertheim ba thehoa ka tsela e tšoanang le ka mor'a cavity efe kapa efe ho buoa. Sena ke ka ntlha ya go traumatization tsa peritoneum nakong opereishene, e leng e isa hore ho thehoe connective palesa dinama tse nyenyane tse pakeng tsa maqephe a hae le litho tse ka hare.

Adhesions ka cavity ka mpeng ho ka baka bohloko bo ka mpeng, mafu a ea ho ntša metsi le defecation, 'me maemong a mang esita le etsa hore obstruction mala. Bakeng sa thibelo ea mamarello sebopeho ka nako postoperative ke tsa bohlokoa, mathoasong a Tshebediso ya a le mamello le ho khanna phekolo 'meleng ka letsatsi la pele ka mor'a ho buuoa.

Menopause le hlaha ka mor'a hysterectomy ka lebaka la ho ho tloswa ha mae a bomme le. Postoperative menopause tsoele boima tlhaho, hobane tabeng ena, liphetoho hormonal etsahala ka potlako. Ho fokotsa boemong bo sa thabiseng ile a sebelisa li-hormone Phetolo phekolo.

A ka bosaling prolapse opereishene Wertheim fetoha khoneha ka lebaka la ho tshenyo ligamentous sethusathuto (a boemo hlokahalang bakeng sa ho etsa hysterectomy) le displacement tsa litho tsa pelvic sebakeng se le siyo popelo. Bakeng sa thibelo la mathata a joalo e le mamello buelloa phetha tsa boitlhakiso khethehileng, apere e itokisa, moedi wa ho ikoetlisa bakeng sa bonyane likhoeli tse 2 ka mor'a ho buuoa.

Hangata e le ka sebaka sa retroperitoneal Ho thehoa limfokista Wertheim mor'a ho buuoa. kalafo lona ho buoa. Leha ho le joalo, lintho tse ngata ka tsela e atlehang haholoanyane thibela ketsahalo ea complication ena ke ntse ho ba sethaleng sa buuoe, ho feta ho tšoara. Bakeng sa morero ona, mekhoa e fapaneng drainage retroperitoneum.

Seo batho ba se buang mabapi le Wertheim tshebetsong

Ho feliseng ha khōlō cervical kapa endometrial bakeng sa kankere sebdiswa Wertheim tshebetso. Likarabo ka eona e fapane.

Lingaka le bakuli ba bua lintho tse ba positive mor'a opereishene:

1. Keketseho ea ba phela.
2. Guaranteed sieo ha mafu uterine, a akarelletsang kankere.
3. Lithibela, ha a lumelle esita le kgonego nyenyane ea bokhachane e sa le hlokeng.
4. buuoe ha fokotsa bokgoni ba, hoa khoneha hore motho a khutlele ho bophelo bo tloaelehileng.

Tlhoka mesola tshebetso:

1. Hloleha ho ba le bana.
2. Mobe lebali ka anterior leboteng ka mpeng.
3. Ka monyetla oa ho mathata a, ka bobeli pele le morao (tšohloa ka holimo).

ho akaretsa

Hysterectomy bakeng Wertheim - e atlehang khōlō kalafo ea bolaeang lihlahala cervical le endometrial. tshebedisano ena ha se feela khona ho imolla mokuli ke kankere, empa hape ka tsela e itseng e ntlafatsa boleng ba bophelo ba.

Ya e le hantle, ho tšoana le ho buuoa leha e le efe, hysterectomy e tletse lintho tse ngata ho hōla ha mathata. Leha ho le joalo, ha mokhatlo o hlophisitsoeng bokgoni ba nako postoperative, e ikamahantse le le mehato hlokahala e thibelang e ka a qobe.