Enteroplexy: mitundu. Njira pawiri matumbo khoma

Mawu akuti "matumbo msoko" ndi gulu ndipo kumaphatikizapo kuchotsa kuvulala ndi zilema ya kum'mero, m'mimba ndipo matumbo. Ngakhale pamene Crimea nkhondo, Pirogov Nikolay Ivanovich ntchito suturing ziwalo dzenje seams wapadera. Anathandiza kusunga limba akhudzidwa. Kwa zaka zambiri, timapereka Mabaibulo onse atsopano a suture matumbo, anafotokoza ubwino ndi kuipa yofanana osiyanasiyana a izo, zimene zikusonyeza kufunika ndi ambiguity vuto. Kudera limeneli lotseguka kwa kafukufuku amaona. Mwina posachedwapa adzakhala munthu amene adzadzipereka ndi njira yapadera minofu kugwirizana. Ndipo izo zidzakhala yojambula mu njira ya stitching.

zofunikira kwa msoko matumbo

Mu opareshoni, pali zinthu zingapo kuti anakumana ndi suture matumbo kuti zikhoza kugwiritsidwa ntchito mu ntchito m'mimba:

1. Choyamba, kukhulupirika. Izi zimatheka ndi ofananira molondola pamalo serous. Zikugwirizana ndi mzake ndipo welded mwamphamvu, kupanga chipsera. Wachisoni chiwonetsero cha katundu ndi adhesions kuti mwina obstruct Ndime ya nkhani matumbo a chubu.
2. Luso kuti magazi asiye kutuluka, pokhalabe okwanira ziwiya kotunga magazi kwa msoko ndi machiritso ake oyambirira.
3. The msoko ayenera kuganizira Kapangidwe ka m'mimba thirakiti khoma.
4. A mphamvu kwambiri mu chilonda.
5. Namkulunga m'mbali cholinga chachikulu.
6. Kochepa zoopsa matupi GI (m'mimba). Izi zikutanthauza renunciation wa stitches twining yozungulira ntchito masingano si olanda, komanso tingagwire forceps ndi clamps, amene angathe kuwononga mpanda wa thupi dzenje.
7. Chenjezo zikopa necrosis.
8. Zolondola kufanana kwa zigawo za chubu matumbo.
9. Kugwiritsa ntchito zinthu biodegradable.

Kapangidwe ka khoma matumbo

Monga ulamuliro, ndi matumbo khoma la chubu ali dongosolo lomwelo lonse, ndi michira zazing'ono. Lamkati wosanjikiza - mucous minofu, yomwe imakhala ndi kiyubiki wosanjikiza umodzi wa epithelium, amene m'madera ena ndi villi kwa mayamwidwe bwino. Kwa mucosa ndi friable submucosal wosanjikiza. Ndiye pali zolimba minofu wosanjikiza. The makulidwe ndi makonzedwe a ulusi zimadalira khadi matumbo chubu. Mu minofu kum'mero ndi circularly, mu intestine kakang'ono - longitudinally, ndi ulusi minofu wandiweyani imakonzedwa mu mawonekedwe a matepi lonse. Kwa minofu wosanjikiza ndi serosa. Izi woonda filimu, yomwe imaphimba matupi dzenje ndi kuonetsetsa sayenda wachibale awo kwa wina ndi mzake. Pamaso pa wosanjikiza uyu ayenera kuganizira pamene superimposed matumbo msoko.

katundu serosa

A katundu lipindulitsa pa opaleshoni serosa (m. E. wakunja) Kakhungu a chubu m'mimba ndi pambuyo zofanana bala m'mbali mwamphamvu glued kuti kwa maola khumi ndi awiri, ndipo ulusi kuti mokwanira mwamphamvu zinaphatikizidwa kudzera masiku awiri. Izi zimabweretsa msoko zikayamba. Kuti amenewa, muyenera kutsatira stitches zambiri zokwanira, zinayi kwa centimeter wina.

woonda yarns kupanga ntchito kuchepetsa zimakhala maganizo bala pa crosslinking. Childs, sutured kwa serosa ulusi minofu, omwe akutipatsa kwambiri elasticity msoko, chotero, luso kutambasula pa ndime ya bolus lapansi. Jambulani submucosal ndi zigawo mucosal kupereka hemostasis labwino ndi mphamvu zina. Koma m'pofunika kukumbukira kuti matenda ndi pamwamba lamkati la chubu m'mimba mwa suture ingafalire mu zonse m'mimba.

Lakunja wamkati ndiponso nkhani ya ngalande alimentary

Kuchita opaleshoni n'chofunika kwambiri kudziwa mfundo futlyarnoy Kapangidwe ka alimentary ngalande khoma. Mu chiphunzitso chimenechi limatchula milandu kunja ndi mkati. Nkhani akunja zikuphatikizapo serosa ndi minofu nembanemba ndi mkati - kwa mucosa ndi submucosa. Iwo ali makina wachibale wina ndi mzake. M'madera chubu matumbo pamene kusamutsidwa kuwonongeka osiyana. Mwachitsanzo, kuchepekela kuposa vuto lamkati, ndipo vuto la kuwonongeka kwa m'mimba mlingo kum'mero - kunja. Mu intestine, onse m'chimake kufalitsa wogawana.

Pamene dokotala sutures khoma kum'mero, singano jekeseni obliquely motsogozedwa lateral (mmbali). perforation ali sutured mpanda muzituluka mu anyamata, obliquely-medial malangizo. Small ndi lalikulu intestine sewn ndendende perpendicular. Mtunda pakati stitches sayenera millimeters osakwana anayi. Masitepe kukhala ndi kuchepa ischemia ndipo necrosis a m'mbali chilonda, ndi kuwonjezeka - kulephera ndi magazi.

Malire pafupi-m'mphepete seams ndi zimfundo

Matumbo msoko kungakhale makina ndi Buku. Yotsirizira, nayenso agawanika pa malire, pafupi-m'mphepete ndi pamodzi. The ziyambe kudutsa m'mphepete mwa chilonda, ndi mthunzi wachiwiri kuchokera m'mphepete lake si centimeter, ndi ophatikizana kuphatikiza ziwiri zimene mungachite m'mbuyomu.

seams malire ndi odnofutlyarnymi ndi dvuhfutlyarnymi. Zimadalira m'mene zipolopolo ambiri chikugwirizana imodzi. Bir msoko ndi mfundo pamodzi lakunja msoko khoma Mateshuka (ndi mfundo mkati) chikutitsimikizira wina gawo, kuyambira yekha nsinga za tunica muscularis ndi serosa. A atatu wosanjikiza matumbo msoko Pirogov, amene osati sewn nkhani akunja, komanso submucosal wosanjikiza kudzera msoko ndipo ali Gely dvuhfutlyarnymi.

Poyankha, kulumikizana kudzera akhoza akuyendera monga mfundo, ndi msoko mosalekeza. yotsirizira iyi ali yofanana zingapo:

- twining chonse;
- matiresi amathandiza;
- Reverdy msoko;
- msoko Schmid.

Pafupi-m'mphepete, nayenso, ndi gulu lawo. Choncho, olekanitsidwa Lambert msoko chomwe chimayimira dvustezhkovy suture nangula. Amanena kwa akunja (sero-akulu) choncho. Koma pali buku mosalekeza, chikwama chingwe, polukisetny, U-zooneka ndi Z woboola pakati.

ophatikizana seams

Monga dzina lake likunenera, ndi sutures ophatikizana kuphatikiza zinthu za m'mphepete ndi pafupi-m'mphepete. Kuonetsetsa "wotchedwa" sutures opaleshoni. Iwo ali ndi mayina madokotala amene anali oyamba anagwiritsa ntchito ntchito ziwalo m'mimba:

1. The msoko ndi pawiri Czerny m'mphepete ndi pafupi-m'mphepete sero-akulu olowa.
2. Kirpatovsky msoko - osakaniza m'mphepete msoko ndi submucosal serous-akulu.
3. Albert msoko awiri olowa yeniyeni: Lambert ndi Gely.
4. Tupe msoko akuyamba monga m'mphepete mwa msoko, amene zigawo zikuluzikulu ali yomatidwa lumen thupi. Lambert ndiye suture aikidwa pamwamba.

Gulu ndi nambala ya mizere

Palinso Chigawo cha matabwa olemba komanso ndi kuchuluka kwa mizere superimposed pamwamba pa ena. Mpanda matumbo ali mmphepete ena, kotero mabala suturing limagwirira lalembedwa kuti apewe kuphulika zimakhala.

Single mzere seams alipo kovuta, pamafunika yeniyeni mwatsatanetsatane opaleshoni njira, ndi kuchita ndi maso opaleshoni zitani atraumatic singano. Zipangizozo palibe kugwiritsa ntchito zonse, ndipo zonse dokotala angachite ndi izo. The zambiri ntchito awiri mzere stitching. Iwo bwino atathana ndi chilonda m'mbali ndi muyeso wa golide opaleshoni m'mimba.

Mipikisano mzere sutures ntchito kwambiri kawirikawiri. Makamaka chifukwa chakuti matumbo chubu thupi khoma ndiye wochepa thupi ndi yofewa ndipo ambiri filaments kuti ozama izo. Nthawi zambiri, anakuta multirow seams ntchito kutha pa m'mimba, mwachitsanzo appendectomy. Dokotalayo ligature woyamba akusokoneza pa tsinde la kumapeto. Iyi ndi nthawi yoyamba, mkati msoko. Ndiye pali kachikwama chingwe suture kupyolera wosanjikiza serous ndi akulu. Iye omangika ndi kutsekedwa pamwamba Z woboola pakati, kukonza khansa chitsa ndi kupereka hemostasis.

Kuyerekezera sutures matumbo

Pofuna kudziwa zinthu zinali ndi bwino kugwiritsa ntchito limodzi kapena msoko wina, muyenera kudziwa mphamvu ndi zofooka zawo. Tiyeni tione iwo mwatsatanetsatane.

1. Gray-serous suture Lambert, chifukwa lightness zake zonse ndiponso ntchito zake zosiyanasiyana ali kuipa angapo. Ndicho, zilibe kupereka hemostasis zoyenerazi; ndithu osalimba; Iwo sangafanane mucosa ndi submucosa. Choncho, muyenera ntchito ndi kaphatikizidwe ndi stitches ena.

2. malire wosakwatira ndi iwiri mzere stitches ndi mphamvu zokwanira kupereka poyerekezera zonse zigawo zonse zimakhala, kupereka zinthu mulingo woyenera machiritso a zimakhala, popanda kuchepetsa lumen wa thupi, komanso kuthetsa maonekedwe a chilonda chachikulu. Koma iwo kuipa. Msoko permeable mkati m'matumbo microflora. Hygroscopicity kumayambitsa matenda a zimakhala ndi mozungulira icho.

3. serous-akulu-submucosal sutures adzalandira ndithu mawotchi mphamvu, kukumana mfundo futlyarnoy matumbo dongosolo khoma, kupereka hemostasis zonse ndi kuteteza kuchepetsa wa lumen wa limba dzenje. msoko amenewa ankatanthauza nthawi imodzi Pirogov Nikolay Ivanovich. Koma anali wosakwatiwa mzere kusintha. kusinthidwa uyu ali ndi makhalidwe oipa:
- okhwima nsalu mzere kulumikiza;
- ponso pachilonda kukula chifukwa kutupa ndi kutupa.

4. Pamodzi zimfundo ndi odalirika, zosavuta kuzitsatira, gemostatichny, kutayikira-umboni ndi cholimba. Koma ngakhale ngati msoko mwakuwoneka wangwiro, ali ndi zovuta zake:
- kutupa zimakhala pamodzi kugwirizana mzere;
- machiritso pang'onopang'ono;
- mapangidwe necrosis;
- High Mwina adhesions;
- matenda yarns mu kudutsa mucosa lapansi.

5. anapanga mfundo mzere ali makamaka ntchito kutsekedwa ya zopindika m'matumbo. Iwo cholimba, kupereka anatengera wabwino wa m'mphepete bala. Izi amachepetsa chiopsezo kutupa ndi necrosis. Mwa zolakwa za njira imeneyi ndi:
- matenda chifukwa suturing ulusi m'chimake awiri nthawi imodzi;
- liwiro la kusinthika kwa minofu pa bala malo;
- mkulu Mwina wa zosayembekezereka ya adhesions, ndipo, monga chotsatira cha kutsekeka;
- ischemia minofu pa malo suture lapansi.

Tinganenenso kuti aliyense njira suturing mabala a ziwalo dzenje kuli ndi ubwino komanso kuipa. Opaleshoni n'kofunika kuganizira zotsatira za ntchito yawo - chimodzimodzi chimene iye akufuna kukwaniritsa ntchito imeneyi. Inde, Phindu inayenera akanagonjetsa chithunzi, koma chomalizachi sangakhale mlingo kwathunthu.

teething seams

Conventionally, malo onse akhoza kugawidwa m'magulu atatu: anthu amene zimatha kuyambitsa nthawi zimatha kuyambitsa kawirikawiri ndi pafupifupi kudula kupyolera. Gulu loyamba afika msoko Schmid ndi Albert msoko. Amadutsa nembanemba mucous, amene mosavuta anavulala. Kwa gulu lachiwiri a matabwa a, pabwino pafupi lumen thupi. Izi msoko ndi msoko Mateshuka Bira. Gulu lachitatu zikuphatikizapo matabwa kuti si pokhudzana ndi lumen wa m'matumbo. Mwachitsanzo, Lambert.

kukusalani kwathunthu kuthekera kuphulika kwa china chotulutsa si zotheka, ngakhale okhawo serosa lapansi. M'mikhalidwe wofanana msoko mosalekeza ndi kudula ndi Mwina kuposa mfundo za. Izi zizichulukirachulukira ngati ulusi umachitika pafupi lumen thupi.

Kusiyanitsa makina kuphulika thonje kupatulana msoko pamodzi ndi khwimbi necrotic ndi kuphulika kwa anachita chifukwa cha minofu m'dera kuonongeka.

MwaukadauloZida zipangizo resorbable

Kuposa chuma omasuka kwambiri kuti sangathe kuchita matumbo msoko - ndi resorbable ulusi kupanga. Iwo amakulolani kugwirizana m'mbali mwa chilonda kuti ndithu nthawi yayitali ndipo usasiye thupi la chuma mtima yachilendo. chidwi linaperekedwa kwa limagwirira a kuchotsa ulusi ku thupi. ulusi Natural ongoyendayenda michere minofu, ndipo ulusi kupanga ali lamamatira ndi hydrolysis. Popeza hydrolysis ndi zochepa MBAFUDZA zimakhala za thupi, ndi bwino kugwiritsa ntchito angapange.

Komanso, ntchito ya angapange limachititsa kupeza olimba mkati msoko. Iwo mkatikati nsalu Choncho, vuto lonse kuti zingachititse kuti alamule, nayenso, sakuikidwamo. Wina zabwino khalidwe mapulasitiki mu kuti nkhabe kuyamwa madzi. Izi zikutanthauza kuti msoko sati olumala ndi zomera matumbo, amene angathe kupatsira chilonda, ndipo musalekane wa lumen thupi padziko ake akunja.

Kusankha msoko ndi nkhaniyo kuti sutured chilonda, dokotala ayenela kutsogoleledwa ndi kulemekeza malamulo kwachilengedwenso zofunika minofu maphatikizidwe. Chilakolako choti njira, kuchepetsa chiwerengero cha mizere kapena kuwagwiritsa ntchito kutsimikiziridwa kuti chingwe sayenera cholinga. Choyamba zofunika mtima chitetezo magwiritsidwe antchito ake, kuchepetsa pambuyo ntchito kuchira nthawi ndi ululu.