Hana Wertheim: papa o ka hana, ka hopena, complications, hōʻike manaʻo

Kekahi hiʻona o ka hana ia onkopatologii mea he'ano'ē, a laila ole wale i ka wehe 'ana o kaʻeho ia iho, akā, i ka nui o ke ola'aʻaʻa e pili ana i ka pathological ipu ahi. Eia hou, a me ka excisedʻeho, a lymph aka wahi ninini lymphatics malaila.

'ano'ē lapaau o cervical a me ka maʻi 'aʻai endometrial

Wertheim ka hana loa complies me ka mea ma luna koi. Kona o Mānoa, ke moe i loko o ke ana o ka uterus me appendages (uterine paipu a me ovaries), ka luna kolu o ka vagina, uterus a me kākoʻo ligaments a puni momoma'aʻaʻa mai lymph aka wahi.

ʻO nāʻikepili no kaʻoki kino, ua cervical a me ka uterine Ka maʻi 'aʻai. Akā, ma kekahi hihia,ʻoki kino ua i pono:

• ma ke alo o ka loihi mai metastases;
• ma ka hihia o ka nunui hikoko, vascular omaka ae a me ka moku e nā loko, a kekahi manawa pelvic paia;
• pili me ka loa pathologies;
• i ka wa elemakule.

Wertheim ana no ka cervical Ka maʻi 'aʻai

Inā mākou e kamailio e pili ana i ka iapaau ana o keia maʻi, ka mea e e hoʻomaopopo i ka olelo mai hana hiki ke hoʻohana nā kū kaʻawale, a me kekahi hapa o ka hoʻohui pū Inc.

Ma ka hihia o ka loa differentiated squamous aeea Ka maʻi 'aʻaiʻike, (T1bN0M0 anu u), keia hana hiki radically ke hoʻoponopono i ka pilikia me ke komo pū kāu kiʻina hana e like me chemotherapy a me ka pāhawewe Inc. Naʻe, ka hapanui o ko Wertheim ka hana o ka ke keʻena o ka hoʻohui pū Inc.

I ka endometrial Ka maʻi 'aʻai (a hiki i ke kahua IB) e mau ia i nā therapies, ma ka hou eʻoki kino.

Hana Wertheim: neʻe aku ana

ʻoki kino no ka'ano'ē ana o ka uterus me appendages ka loaʻa o kekahi mau kahua o ka hoʻonaʻauao. Mau nā:

1. Ke kula.
2. Ke kuʻina o ka uterine ligaments.
3. Mobilization o ka fallopian paipu a me ovaries.
4. Mobilization o ka bladder.
5. Ligation a me ke kuʻina o ka moku nui eʻai.
6. Removal o'aʻaʻa, mai ka mua ili o ka cervix.
7. Ke kuʻina o ka ligaments hoʻopunipuni uterus hoʻi (sacral-uterine).
8. Ke kuʻina o cervical ligaments.
9. cervical resection.
10. Hemostasis vaginal kumu.
11. Peritonization.

ʻoki lāʻau lapaʻau ke kōkua o

Hana Wertheim - nui 'uao pono maikai visualization o kaʻoki lāʻau lapaʻau kula, a me ka manawa kūpono o ka manipulation,ʻaʻole pu ma ka pilikia a hoʻokau'. No laila, pono e kūpono pauku. Mini accesses a endoscopicʻoki kino, ma keia hihia, mai pono. I mea o ka maʻi 'aʻai lapaau i ka mea hoʻonani hopena o ka nui o ka hope wahi.

Ana hana Median lonikū laparotomy (dissection o ka anterior abdominal pā o ka laina keʻokeʻo o ka'ōpū holo alaʻokoʻa ka piko) 'ole ke kōkua o Czerny (transverse laparotomy me dissection o ka rectus abdominis).

mobilization o ka uterus

No keia hopena, intersect poepoe ligament o ka uterus, a me ka paulele i ka hoʻomana suspensory ovary ligaments, a me ka makuwahine ohe hopena. A pau o kēia nāʻoihana e e i kela kapa, ina he mea hiki, ma nā wahi devoid o na moku koko. Kēia, e emi i ke koko me keia poho. Ka loa Ia uterus ua ia ma luna o nā clamps, a ua hookuu ia kaʻaoʻao.

Hope e holo i ka suspensory ligament o ka ovary i ka wehe 'ana o ka uterus hiki. Loa importantly, a me kā lākou mobilization - ole e hanaʻino i ka ureter. E hana i kēia, i ka hana i obligatory palpation o ka palahalaha ligament. Ma ke kāʻei kua ia mea nui maʻalahi kuina mea ureteral pa. Kēia manipulation apono 'oe e mobilize i ka uterus a me appendages me ureteral eha.

Ma hope o ka weheʻana i ka vesico-uterine nā pā ua kaawale bladder pulupulu swab, mai ka mua paia o ka cervix. Kēia E e hana me ka deviating, mai ka piko laina, e emi i ka pilikia o ka hewa a hiki i ka vascular plexus.

Inā ka bladder mea adherent i ka uterus adhesions, kona kaawale hiki e pilikia. Hoʻomaka keying i loko o ka hihia o ka puni ligaments, a hele ma i ka ai haʻawina a me ka mea nui loa ka hoʻoneʻe, Oe kaawale'ūpā.

E möakäka hou Wertheim hana kŰia ligation o na moku. I ka papa kuhikuhiE vascular pua o ka uterus - uterine artery, a hele pū ana me aa koko, e hele ana ma ka lihi o ka uterus. Ligation o ia i ka pae ana o ka mea maloko'ōnaehana.

No ka hou mobilization o uterine incision ua hana a me ka aeʻalo predpuzyrnoy fascia'aʻaʻa ma ka kūmūmū mua ili o ka cervix ia. Eia keʻa ligament, i poe mua ou no manipulation: sacro-uterine a me cervical ligaments. Ma hope iho o ia hysterectomy hele mai ai i ke kahua hope.

Maoli hysterectomy, hemostasis a me ka peritonization

Vaginal vault ua wehe, ka cervix ua ia i ka maʻi, a i nā hookiia mai ai mai ka vagina. Keia ua hahai ma hemostasis a me ka peritonization. vaginal kumu hiki ole lawe i paa i, ka mea hiki ke hookauwa like maoli nōkahea i loko o ka hanana o kekahi pathological keʻano o ka hanaʻana i loko o ka pelvic lua a me ka hoʻomāhuahua o ka pus a me ke koko ma laila.

Vaginal Tube ua malamaia lakou nei, i loko o ke kupaianaha alanui. Nā paia o ka vagina ligated vesico-uterine a me ka rectouterine nā pā, e like me ka sacro-uterine ligaments, ma laila loaʻa hemostasis a me ka peritonization.

Ka postoperative manawa

Pehea o ka hoʻomanawanui ma hope oʻoki kino Wertheim? Oia'ano'ēʻoki kino hiki ole hele loa unnoticed. Me ke kanalua, ka mea e loli ai ke ola o nā kino a me ka noʻonoʻo '.

He aha entails hana Wertheim? I ka hopena o keia hana o ka lapaʻau hiki ke maheleia i loko o ka wanaʻao, a lohi.

Complications i kupu mai ma ke kakahiaka nui postoperative wā

Ke postoperative wā e complicate:

1. Maʻiʻaʻai o ami (ole wale o ka ili, aka, i na).
2. Peritonitis a me ka sepsis.
3. Kahe ana ke koko mai o ka wahi o na ami, a me ka Kalaiaina.
4. Hematoma ulana wahi.
5. Dysuria.
6. PE (pulmonary embolism).

ʻO ka mea ikaika ana o ka sterility mea,ʻaʻole manawa i hiki ke pale aku septic complications. O ke kumu ho i ka mea i ka hana ua hana no nā mea maʻi kona kino ua hoʻonāwaliwaliʻia, a no laila, ua hoemi ia i ka paio me ka malignantʻeho e hoʻonele. Nolaila, li nui o na ami i loko o ia - he hiki kulana home 'ole. No ka mea o ka pale o ka haawi ana i loko o ka postoperative wā koi 'ia antibiotics.

Kahe ana ke koko a me ka i pēpē Hōʻike i ka nele o ka hemostasis. Hookohu hemostatic ai 'mea e mau lawa, a me kekahi manawa e noi mai ana ka puanaʻoki kino - hou o kaʻeha a me ka suturing o kahe ana ke koko moku.

Dysuria - pinepine, a ola urination. Keʻano o kēia symptom mea hiki ina poino mucous urethral catheter a me ka hanana o traumatic urethritis.

PE ke'ākoʻakoʻa like me ka complication o thrombosis o ka laloʻaoʻao. I mea no ke aha la i loko o ka postoperative wā e ia anticoagulation ( "heparin") a ua paipaiʻia e komo mīkini'opihia anal a me laholio bandages.

Ka hopena o ka hopena o wā

Aia i kekahi mau complications ma hope oʻoki kino Wertheim, ulu i loko o ka lōʻihi makahiki:

1. Mea naʻau pilikia: makau o hiki loli ma ka nānā aku a me ka lilo ana o ke keka makou a holo (no ka mea, e weheʻia nā ovaries, a 'o ia hoʻi i ka nui o ke keka hormones hoʻololi), manaʻo e pili ana i ka hikiʻole, e kiʻi hapai,ʻinoʻino me ka makaʻu no ma ka anterior abdominal pa.
2. Abdominal adhesions.
3. Climax.
4. Ia kāna o ka vagina.
5. Education retroperitoneal limfokist.

I ka hoao ana o na wahine e pili ana i ka hopena o ka hysterectomy Ua maopopo. No laila, i loko o ka postoperative au ka loa nui kākoʻo a me ka naauao o ka 'ohana.

Me kekahi complications (postoperative me ka makaʻu no, ka mea hikiʻole ia i na keiki) i eʻae wale. Ma ka mea'ē aʻe makaʻu hiki a e kaua, e like me ka mea i pinepine unfounded. Spaying Aʻole i entail kekahi cardinal loli ma ka nānā aku a moe poepoe. Akā, ka mea hiki i discomfort iloko o moe kamaʻilio inā ma hope o gisteretomii haʻalele pōkole loa vaginal kumu.

Adhesions ma hope oʻoki kino Wertheim e hana i loko o ka like me ma hope o kekahiʻoki lāʻau lapaʻau lua. He mea pono i ka traumatization o ka peritoneum i ka hana, e hiki aku ai i ke kahua o ka connective'aʻaʻa kaula makalii ma waena o kona mau a lahilahi, a na nā loko.

Adhesions ma ka abdominal lua hiki i abdominalʻeha, kāna hana o ka urination a me ka defecation, a ma kekahi manawa a hiki alakai i intestinal iaʻi. No ka mea Kāohiʻana o ka mea pīlali ho okumu i loko o ka postoperative wā i nui kakahiaka ho'ā hope o ke ahonui a me ka hoʻokō 'ia' physical Inc i ka lā mua ma hope oʻoki kino.

Menopause ia lŘlŘ ma hope o hysterectomy aie i ka wehe 'ana o na ovaries. Postoperative menopause lawe kaumaha maoli, no ka mea, ma keia hihia, hormonal loli ana hikiwawe loa. I ka ho'ēmi i discomfort hoʻohana hōmona hope Inc.

A vaginal prolapseʻoki kino Wertheim i hiki no i ka poho ligamentous i hoʻomākaukauʻia (i pono ana no ka hoʻokō i ka hysterectomy) a me ka pohupani hale o ka pelvic nā loko ma ka wahi i kahi e uterus. No ka mea Kāohiʻana o ia mau complications ka hoʻomanawanui ua paipai hoʻokō i kūikawā kino, e aahu ana i ke koo aku, i kaupalena 'o physical ha awina no ma ka liʻiliʻi 2 mahina ma hope oʻoki kino.

Pinepine i loko o ka retroperitoneal makahiki ua hana limfokista Wertheim ma hope oʻoki kino. Konaʻoki lāʻau lapaʻau lapaau. Eia naʻe, ua nui aku ka pono ole o ka hanana o kēia complication mea nō ma ke kahua o ka hana, ma mua o ka pono. No keia mea, kekahi mau ano nōkahea retroperitoneum.

He aha kanaka i ka i ana e pili ana i ka Wertheim hana

E kiʻi pohaku uinihepa, o ka'ano'ē cervical paha endometrial Ka maʻi 'aʻai pili Wertheim hana. Pane e pili ana ia meaʻokoʻa.

Kauka a me nā mea maʻi e olelo aku nei maikaʻi mea ma hope o ka hana:

1. Ke mahuahua ma ke ola expectancy.
2. Ua hoʻohiki wa e kaawale aku o uterine maʻi, me Ka maʻi 'aʻai.
3. Contraception, 'aʻole e' ae i ka uuku pahiki o ka hua'ōlelo i makemake hāpai keiki.
4. Ke hana Aʻole e emi i ka ka hoʻokōʻana, he mea hiki, e hoʻi i ka maʻamau ola.

Hooluolu mai ana:

1. Hikiʻole e loaʻa keiki.
2. ʻinoʻino me ka makaʻu no ma ka anterior abdominal pa.
3. I ka manawa kūpono o nā complications, nā kakahiaka nui a me ka hopena o (kūkā mai ma luna).

e hōʻuluʻulu

Hysterectomy no ka Wertheim - ka hoʻokō'ano'ē lapaʻau o malignant cervical a me ka endometrial hikoko. Kēia hana mea ole wale hiki ke höʻike aku i ke ahonui o ka maʻi 'aʻai, akā, kekahi ma kekahiʻaoʻao hoonui ae i na mea e like ai o ke ola.

O ka holo ana, e like kekahiʻoki kino, hysterectomy mea fraught me ka hooulu ana o complications. Naʻe, i ka wa a ka mea kupono hoʻolālā o ka postoperative wā, a me nā kumuhana i ka mea e pono ai kāohi ana, e pale aku ia lakou.