Ukusebenza Hartmann: incazelo, izigaba, imishini

Ukusebenza Hartmann kwenziwe indlela ekwelapheni umdlavuza kapopopo. Ezimweni eziningi, impatho kuhlinzwa lesi sifo akuyona kuphela ephumelela kunazo kodwa njengoba amakhemikhali okwelapha umdlavuza, okuyinto iqhubeka kuleli sayithi akukuniki Imiphumela efanele.

Izinkomba ukuhlinzwa

Ukusebenza uhlobo Hartmann sibonisa iziguli kahle kanye nabantu abadala kwathiwa unesifo "nomdlavuza kapopopo sigmoid noma umnyango rectosigmoid." Zikhona nezinye izizathu kungani udokotela wakho anganquma ukuqhuba imisebenzi Hartmann:

• kuyinkimbinkimbi igama isimiso isayithi (ezimweni eziningi, ukudla alinyakazi ngokusebenzisa amathumbu ngokuvamile);
• perforation (ngokusebenzisa-wamathumbu disorder);
• volvulus sigmoid ikholoni esimweni esibhibhayo noma inkinga isimo peritonitis (ikholoni ukunwebeka ukusonteka mesentery yayo).

It wenziwa ngokuvamile izinkomba oluphuthumayo, ezifana isimila noma ukubonakaliswa kwamazinyo wamathumbu isimiso.

Ukusebenza Hartmann izigaba

Iziguli eziningi ukuchitha kuphela isigaba saso sokuqala. Isinyathelo esilandelayo owawubhalwe ngaso yokutakula evumayo wenziwa kuphela ngemuva kwezinyanga eziyisithupha.

Ukusebenza Hartmann, ukudalulwa okwanika Petrov B. A., ihlukaniswe izigaba ezimbili. Isetshenziselwa ukwelapha ukwehla futhi ikholoni transverse emathunjini.

Ngakho, wonke operation siqukethe izinyathelo ezilandelayo:

1. Lesi sinyathelo ziye zachaza Petrovym B. A., okwayinika isihloko "resection obstructive." Isikhathi esining impela, iziguli kwathiwa unesifo "umdlavuza" ukuchitha kuphela le nqubo. Luhilela ukususwa ingxenye ethile ye emathunjini, futhi lapho isimila itholakala. Emva kwalokho uthunge inesikhala ingxenye distal. Sekwenzekile up Friend, futhi igebe kwesokunxele in the ingaphakathi lesisu. Ukuphela proximal we eziqhutshwa udokotela ohlinzayo GUTS ukuboniswa udonga besisu ne phambi ingxenye yalo. Lesi siphetho ibizwa ngokuthi ipayipi lokukhipha indle okuzokwenziwa ebhaliwe kabanzi ngezansi.
2. Isinyathelo sesibili ngokuhamba evumayo kwesikhathi nokuvuselelwa oyotholwa hhayi ezinyangeni eziningi ngaphambili kuka amabili, futhi kwezinye izimo, ngisho nangemva kwezinyanga eziyisithupha. He is ukubuyisela phambili ekupheleni ikholoni anastomosis ukuqeda. ngaleyo ndlela ipayipi lokukhipha indle isusiwe. I okufana anastomosis nangapha, kodwa ezimweni eziningi odokotela ayenqabe.

Ilungiselela isiguli ukuhlinzwa

Esokuqala inqubo kulungiselelwa isiguli ngilifeze. Njengoba ngokuvamile kwenza isiguli ababuthakathaka, isiphelile, kubalulekile ukuqhuba uchungechunge survey, kanye nokwelashwa oluqinisayo jikelele abantu abakwazi ukuthutha ngaphandle ukusebenza sokufa. Isetshenziselwa le ndlela yokuxhumana, ogama isinyathelo kuhloswe ukuthuthukisa umsebenzi inhliziyo, ukulawulwa pheshana emathunjini kungase kudingeke ngimpontshelwe igazi, kanye ukuqokwa kwe-inani elikhulu amavithamini kanye ukudla okukhethekile.

Ukusebenza Hartmann kwemishini

Ngokuba ukusebenza isiguli ibekwe emhlane wakhe. Esiswini wembula aphansi Seredinny cut kusukela pubis 5 cm (ngezinye izikhathi kancane kancane) ngenhla umbilicus. Ngemva kwalokho, isiguli uzizwa eshukumiseleka ukuba Trendelenburga (ikhanda nesiphanga ibhande lesiguli elise ngezansi ukhalo). Ngaphezu kwalokho kwenziwe ukugqugquzela okuthiwa kapopopo sigmoid, le njongo livamise ukusetjenziselwa ithawula. Impande yalo mesentery kanye ngaphansi Douglas ephaketheni peritoneum is Ngokuvamile zibonakala ethile novocaine (250 ml). Manje abuyekezwa nendawo isimila kanye nezinye izici zalo ecacisiwe. ikholoni Sigmoid, okuyinto eyenziwa futhi ukusebenza kuyadingeka ukuletha enxebeni amthathe ngakwesokudla eduze umugca losemkhatsini esifubeni. Mesentery ngenkathi sisalokhu. Ngokulandelayo, in the course sikelo okuyinto Uqhekeza olwelwesini peritoneum. Wawunamafutha endaweni, lapho empandeni mesentery. I asike izidumbu zabantu Kwenziwa lonke ubude loop, okuzokwenza kamuva zisuswe. Ngemva kwalokho esiswini akhishwe kuze kube ingaphandle, kwangaphakathi ungqimba asike izidumbu zabantu kwenzeka peritoneum. I Umthambo lesibili nelesithathu aphambana endaweni etholakala phakathi kwalezi izibopho phambi. Le ndawo elinesimo wokuqhuba aphansi Umthambo mesenteric. Ngaphezu kwalokho, it is ligated nge usilika ngentambo. Udokotela ubona ngokucophelela ukuthi Umthambo kwesokunxele oCwebileyo, uma kungenzeka, udokotela futhi alondoloza Umthambo engenhla futhi proctal.

Mesentery futhi aboshezelwa nhlangothi zombili phakathi amathuluzi aphambana, eseqhubeka kuyoshaya ngaphakathi ziyizitsha iboshelwe.

Uma kukhona ukususwa verhneampulyarnogo umnyango Umthambo rectal, esemgwaqweni phezulu, njalo saziso ligated.

Izibopho zisetshenziswa ezindaweni ezilandelayo:

• phezu ingxenye abathintekayo emathunjini;
• ingxenye verhneampulyarny we ingemuva.

Phakathi kwalezi zimo Ukugunda amathumbu abathintekayo isuswe usebenzisa nommese obukhali. Lokhu kwenzeka phakathi izingxenye enempilo. Ukuphela emathunjini is sutured uvalwe. Isetshenziselwa lokhu catgut nosilika ngentambo.

Isikhathi nasezinkingeni ezilandela ngemva kokuhlinzwa

Izenzo ezilandelayo kwenziwa kule nkathi:

• Ngepayipi kathathu ngosuku wageza amathumbu. Isetshenziselwa lokhu ababuthakathaka ingxube isinqandakuvunda, ukuqashwa kukaNksz lapho udokotela enquma ngesisekelo cwaningo.
• Phakathi nezinsuku ezinhlanu kwamaphilisi kwenzeka input.
• Esimisiwe olukhethekile lokudla ngesikhathi ukugujwa okuyinto kungenzeka ukuthatha ukudla ketshezi kuphela.
• Doctor sinquma ekuphathweni kwezidakamizwa ezinomthelela esihlalweni ukubambezeleka.

Gut lavage amashubhu ziyasuswa ngemuva kwezinsuku ezingu-7-9 ngokushesha ngemva kokuhlinzwa.

Ngemva kwezinyanga 3-6 kwezikhathi zokulotshwa-op, isimo flow yayo evumayo ke ungentiwa emathunjini embili sokubuyiselwa, nokususa ingquza nemvelo.

yezinkinga Okungenzeka emva kokuhlinzwa

I inkinga eyinhloko ukuthi kungaba yingozi empilweni isiguli ukopha. Kungenzeka kokubili ngesikhathi ukusebenza futhi ngemva kwaso.

Ngemva kokuhlinzwa, nizitholele ukushaqeka, nakho esongela ukuphila kwesiguli. Izibalo ungibelesela ngokuthi kaningi Ngahlinzwa ufe kungakapheli elilodwa kuya kwamabili zinsuku emva kokuhlinzwa.

I inkinga obujwayelekile Ukungena ukuthelelana isilonda. Ukuze ugweme lokhu kudinga ukulungiselelwa ngokucophelela kakhulu wamathumbu ukuhlinzwa ukuze akhulule esigulini phakathi kokuthi azikhulula ezinsukwini zakuqala kwesikhathi nasezinkingeni ezilandela ngemva kokuhlinzwa. Nokho, uma lo msebenzi ngenxa ukuvaleka emathunjini ukususa okuqukethwe kwalo akunakwenzeka ngezigaba ezimbili, eyayibonakala kuchazwe engxenyeni zokuqala zalesi sihloko.

Izinqubo wenziwa emva kokuhlinzwa

Phakathi nokuvuselelwa kungabonakala nasemkhakheni nokugcinwa urinary, kanye nezikhalo ezivela iziguli, njengoba umthetho, akezi. Artificial umchamo okukhipha, futhi lokhu kwenzeka amahora kuphela emva 10 ngemuva kokuhlinzwa kuqedile. Inqubo wenziwa okungenani izikhathi ezintathu ngosuku. Ukuhluleka ukwenza njalo kungaholela yokuthi esinyeni omane welulela, ke zaprokinetsya nasemuva, yebo, balahlekelwe ikhono ukwenza inkontileka.

esikhundleni isiphetho

Ukusebenza kahle ukuhlinzwa kuthintwa izici eziningi, ikakhulukazi, ngezimo zesiguli ngaphambi nje kokuba ahlinzwe, izinsuku ukuhlinzwa, ngokukhetha indlela efanele yokuqhuba imisebenzi. Kodwa naphezu kwalokhu, ezimweni eziningi, ukusebenza Hartmann sika phezu ikholoni kungaba indlela kuphela ukwelashwa.