tshem tawm tsis tau tsuas yog cov qog nws tus kheej, tab sis kuj yog ib tug tseem ceeb npaum li cas ntawm noj qab haus huv cov ntaub so ntswg nyob rau hauv ib sab ntawm lub pathological tsom xam. Tsis tas li ntawd, nrog rau cov qog, cov qog nqaij hlav thiab cov hlab ntsha lymphatic uas ntws mus rau hauv lawv tau raug tshem tawm.
Radical kho mob ntawm ncauj tsev menyuam thiab uterine cancer
Wertheim txoj haujlwm ua tau raws li cov kev xav tau saum toj no. Nws cov ntsiab lus yog tshem tawm lub tsev menyuam nrog appendages (cov hlab ntsha thiab zes qe menyuam), sab sauv thib peb ntawm qhov chaw mos, nrog rau cov ligaments txhawb nqa lub tsev menyuam thiab cov nqaij rog nyob ib puag ncig nrog cov qog ntshav.
Qhia rau kev phais yog mob qog noj ntshav ntawm lub ncauj tsev menyuam thiab lub cev ntawm lub tsev menyuam. Tab sis qee zaus, kev phais tsis pom zoo:
- nyob rau hauv lub xub ntiag ntawm metastases nyob deb;
- nyob rau hauv cov qog loj, nrog rau cov hlab ntsha thiab cov kab mob uas nyob ib sab, thiab qee zaum cov phab ntsa ntawm lub plab;
- nrog mob hnyav;
- hnub nyoog laus.
Wertheim kev ua haujlwm rau mob qog noj ntshav
hais lusKev kho mob ntawm cov kab mob no, nws yuav tsum raug sau tseg tias kev ua haujlwm muaj npe tuaj yeem siv ob leeg ntawm nws tus kheej thiab ua ib feem ntawm kev kho ua ke.
Nyob rau hauv cov ntaub ntawv ntawm kev kuaj mob sib txawv heev squamous cell carcinoma (theem T1bN0M0), qhov kev ua haujlwm no tuaj yeem daws qhov teeb meem tsis muaj kev cuam tshuam nrog xws li kev kho tshuaj khomob thiab kev kho hluav taws xob. Txawm li cas los xij, feem ntau cov haujlwm Wertheim yog ib feem ntawm kev kho mob ua ke.
Rau mob qog noj ntshav ntawm lub tsev menyuam (txawm tias nyob rau theem IB), lwm txoj kev kho mob ib txwm raug sau tseg, ntxiv rau kev phais.
Kev Ua Haujlwm Wertheim: kev nce qib ntawm kev ua haujlwm
Kev phais mob rau kev tshem tawm ntawm lub tsev menyuam nrog cov appendages suav nrog ntau theem. Cov no suav nrog:
- Access.
- Hloov lub uterine ligaments.
- Kev sib koom tes ntawm cov hlab ntsha thiab zes qe menyuam.
- Kev mob plab zais zis.
- Ligation thiab transection ntawm lub nkoj xa khoom loj.
- Tshem tawm cov ntaub so ntswg ntawm lub ncauj tsev menyuam.
- Hla cov ligaments uas kho lub tsev menyuam tom qab (sacrouterine).
- Cervical ligament transection.
- Kev kho lub ncauj tsev menyuam.
- Hemostasis ntawm qhov chaw mos pob.
- Peritonization.
Kev nkag mus phais
Wertheim txoj haujlwm yog qhov kev cuam tshuam loj uas yuav tsum muaj kev pom zoo ntawm qhov chaw phais mob thiab muaj peev xwm ntawm kev tswj xyuas uas tsis muaj kev nyuaj lossis kev txwv. Yog li ntawd, qhov txiav yuav tsum txaus. Mini-accesses thiab endoscopicphais hauv qhov no tsis haum. Hauv cov teeb meem ntawm kev kho mob qog noj ntshav, cov txiaj ntsig zoo nkauj yog nyob rau qhov kawg ntawm qhov tseem ceeb.
Feem ntau yog qhov nruab nrab ntev ntev laparotomy (txiav ntawm phab ntsa sab hauv plab raws li linea alba, hla lub plab) los yog Czerny mus kom ze (transverse laparotomy nrog qhov txiav ntawm qhov quav ntawm lub plab plab) feem ntau ua.
Uterine mobilization
Rau lub hom phiaj no, lub voj voog ncig ntawm lub tsev menyuam, cov ligaments tsim nyog thiab suspensory ligaments ntawm zes qe menyuam, nrog rau lub tsev menyuam kawg ntawm lub raj yog sib tshuam. Tag nrho cov kev tsim no yuav tsum tau hla, yog tias ua tau, hauv qhov chaw tsis muaj cov hlab ntsha. Qhov no yuav txo cov ntshav poob. Lub tsev menyuam nws tus kheej yog muab rau ntawm clamps thiab tso tseg.
Tom qab kev hloov pauv ntawm qhov suspensory ligament ntawm zes qe menyuam, nws tuaj yeem tshem tawm cov uterine appendages. Qhov tseem ceeb tshaj plaws thaum lawv txav mus los yog tsis ua rau lub ureter puas. Rau qhov no, thaum lub sijhawm ua haujlwm, palpation ntawm qhov dav ligament ntawm lub tsev menyuam yog xav tau. Ntawm nws daim ntawv rov qab, ureteral quav feem ntau yog yooj yim nyob. Qhov kev tswj hwm no tso cai rau kev txav ntawm lub tsev menyuam thiab adnexa yam tsis muaj kev puas tsuaj rau cov ureters.
Tom qab qhib lub vesicouterine quav, lub zais zis raug cais tawm ntawm phab ntsa ntawm lub ncauj tsev menyuam nrog lub tupfer. Qhov no yuav tsum tau ua yam tsis tau hloov pauv los ntawm txoj kab nruab nrab kom txo tau qhov kev pheej hmoo ntawm kev raug mob rau choroid plexuses.
Yog tias lub zais zis nkag mus rau hauv tsev menyuam los ntawm kev ua kom zoo, nws yuav nyuaj rau cais nws. Nyob rau hauv cov ntaub ntawv no, manipulation pib los ntawm lub puag ncig ligaments thiab mus rau lub caj dab raws cov cheeb tsam nrog lub loj tshaj mus, cais lub zais zis.txiab.
Ntxiv mus, Wertheim txoj haujlwm suav nrog kev sib txuas ntawm cov nkoj. Lub ntsiab vascular pob ntawm lub tsev menyuam yog cov hlab ntsha ntawm lub tsev menyuam thiab nws cov hlab ntsha, uas khiav raws lub uterine tav. Lawv hnav khaub ncaws yog ua nyob rau theem ntawm lub pharynx sab hauv.
Rau qhov kev txav chaw ntawm lub tsev menyuam ntxiv, lub fascia ntawm lub tsev menyuam tau raug muab tshem tawm thiab cov ntaub so ntswg tau bluntly tsiv tawm ntawm lub ncauj tsev menyuam sab hauv. Tom ntej no, ligaments uas yav tas los tsis tuaj yeem siv tau rau kev tswj hwm yog hla: sacro-uterine thiab lub ncauj tsev menyuam ligaments. Tom qab ntawd, hysterectomy nkag mus rau theem kawg.
Hysterectomy kom raug, hemostasis thiab peritonization
Qhov chaw mos fornix qhib, lub ncauj tsev menyuam tau muab los ntawm clamps thiab maj mam txiav tawm ntawm qhov chaw mos. Tom qab ntawd, hemostasis thiab peritonization yog ua. Cov pob txha ntawm qhov chaw mos tsis tuaj yeem nruj nreem kaw, nws tuaj yeem ua rau lub cev ntws tawm thaum muaj cov txheej txheem pathological nyob rau hauv lub plab kab noj hniav thiab tsub zuj zuj ntawm cov kua qaub lossis cov ntshav nyob ntawd.
Lub qhov paum qhov chaw mos raug kho hauv txoj kev tshwj xeeb. Cov phab ntsa ntawm qhov chaw mos yog sutured rau vesicouterine thiab recto-uterine quav, nrog rau cov sacro-uterine ligaments, yog li ua tiav hemostasis thiab peritonization.
Post-operative period
Tus neeg mob xav li cas tom qab ua haujlwm Wertheim? Xws li radical phais kev cuam tshuam tsis tuaj yeem dhau tag nrho yam tsis muaj kab. Tsis muaj qhov tsis ntseeg, nws cuam tshuam rau lub cev thiab lub hlwb.
Wertheim txoj haujlwm ua haujlwm li cas? Cov txiaj ntsig ntawm txoj kev kho mob no raug lees txaismuab faib ua ntxov thiab lig.
Teeb meem tshwm sim hauv lub sijhawm tom qab ntxov
Lub sijhawm Postoperative yuav nyuaj:
- Kab mob ntawm cov sutures (tsis tsuas yog tawv nqaij, tab sis kuj sab hauv).
- Peritonitis thiab sepsis.
- Ntshav los ntawm thaj chaw suture, suav nrog los ntshav sab hauv.
- Hematomas hauv cheeb tsam suture.
- Dysuria.
- PE (pulmonary embolism).
Txawm tias qhov kev coj ua nruj tshaj plaws ntawm kev tsis muaj menyuam tsis tas yuav tso cai kom tsis txhob muaj teeb meem purulent. Qhov no yog vim lub fact tias lub lag luam yog ua nyob rau hauv cov neeg mob uas lub cev twb tsis muaj zog los ntawm kev sib ntaus tawm tsam ib tug malignant qog, kev tiv thaiv yog txo. Yog li ntawd, o ntawm seams nyob rau hauv lawv yog ib qho teeb meem tshwm sim. Txhawm rau tiv thaiv tus mob no nyob rau lub sijhawm tom qab phais tas, yuav tsum tau siv tshuaj tua kab mob.
Ntshav thiab cov tsos ntawm hematomas qhia tias tsis txaus hemostasis. Kev teem sijhawm ntawm cov tshuaj hemostatic tsis yog ib txwm txaus, qee zaum yuav tsum muaj kev phais thib ob - kho lub qhov txhab thiab stitching ntawm cov hlab ntsha los ntshav.
Dysuria yog nquag thiab mob tso zis. Cov tsos mob ntawm tus kab mob no yog ua tau yog hais tias lub urethral mucosa puas los ntawm ib tug catheter thiab traumatic urethritis tshwm sim.
PE tuaj yeem tshwm sim raws li qhov teeb meem ntawm thrombosis ntawm cov leeg ntawm sab qis. Yog vim li cas cov tshuaj anticoagulants ("Heparin") raug sau tseg nyob rau hauv lub sij hawm postoperative thiab hnav compression stockings los yog elastic bandages raug pom zoo.
Qhov tshwm simlub sij hawm lig
Tseem muaj qee yam teeb meem tom qab Wertheim txoj haujlwm uas txhim kho lub sijhawm ntev:
- Cov teeb meem kev xav: ntshai ntawm kev hloov pauv ntawm qhov tsos thiab tsis muaj kev xav ntawm kev sib deev (tom qab tag nrho, lub zes qe menyuam raug tshem tawm, uas txhais tau hais tias qib ntawm cov tshuaj hormones kev sib deev tau hloov), kev txhawj xeeb txog kev xeeb tub tsis tau, dab tuag caws pliav ntawm phab ntsa hauv plab.
- Adhesion txheej txheem ntawm plab kab noj hniav.
- Climax.
- Vaginal prolapse.
- Kev tsim ntawm retroperitoneal lymphocysts.
Cov poj niam txhawj xeeb txog qhov tshwm sim ntawm hysterectomy yog nkag siab. Yog li ntawd, nyob rau lub sijhawm tom qab phais, kev txhawb nqa thiab kev nkag siab ntawm cov neeg hlub yog qhov tseem ceeb heev.
Nrog qee qhov teeb meem (kev caws pliav tom qab phais, tsis muaj peev xwm muaj menyuam) koj tsuas yog yuav tsum tau tso nws. Lwm yam kev ntshai tuaj yeem thiab yuav tsum tau tawm tsam, vim lawv feem ntau tsis muaj peev xwm. Kev tshem tawm ntawm zes qe menyuam tsis ua rau muaj kev hloov pauv hauv qhov tsos lossis kev sib deev. Txawm li cas los xij, tej zaum yuav muaj qhov tsis xis nyob thaum muaj kev sib deev yog tias lub qhov chaw mos luv dhau lawm tom qab hysterectomy.
Adhesions tom qab Wertheim txoj haujlwm tau tsim ib yam li tom qab kev phais plab. Qhov no yog vim traumatization ntawm peritoneum thaum lub sijhawm ua haujlwm, uas ua rau tsim cov ntaub so ntswg sib txuas ntawm nws cov nplooj ntawv thiab cov kabmob sab hauv.
Adhesion nyob rau hauv lub plab kab noj hniav tuaj yeem ua rau mob plab, tso zis thiab tso quav, thiab qee zaus txawm ua rau plab hnyuv.kev cuam tshuam. Txhawm rau tiv thaiv kev tsim cov adhesions hauv lub sijhawm tom qab phais, kev ua kom ntxov ntawm tus neeg mob thiab kho lub cev rau thawj hnub tom qab kev phais yog qhov tseem ceeb.
Climax tom qab hysterectomy tshwm sim vim kev tshem tawm ntawm zes qe menyuam. Postoperative menopause yog ib qho nyuaj rau kev ua siab ntev, vim hais tias nyob rau hauv cov ntaub ntawv no, hormonal hloov tshwm sim sai sai. Kev hloov tshuaj hormone yog siv los txo qhov tsis xis nyob.
Thiab qhov prolapse ntawm qhov chaw mos tom qab Wertheim qhov kev ua haujlwm tuaj yeem ua tau vim kev puas tsuaj rau lub ligamentous apparatus (ib yam mob tsim nyog rau kev ua hysterectomy) thiab hloov chaw ntawm lub plab mog mus rau qhov chaw ntawm lub tsev menyuam uas ploj lawm. Txhawm rau tiv thaiv qhov teeb meem zoo li no, tus neeg mob raug pom zoo kom ua ib qho kev tawm dag zog tshwj xeeb, hnav daim ntaub qhwv, txwv lub cev ua haujlwm tsawg kawg 2 lub hlis tom qab ua haujlwm.
Feem ntau cov lymphocyst tsim nyob rau hauv qhov chaw retroperitoneal tom qab Wertheim txoj haujlwm. Nws txoj kev kho mob yog phais. Txawm li cas los xij, nws muaj txiaj ntsig zoo dua los tiv thaiv qhov tshwm sim ntawm qhov teeb meem no txawm nyob rau theem ntawm kev ua haujlwm dua li kho nws. Rau lub hom phiaj no, ntau txoj hauv kev ntawm cov kua dej ntawm qhov chaw retroperitoneal yog siv.
Lawv hais li cas txog kev ua haujlwm Wertheim
Wertheim txoj haujlwm yog siv los tshem tawm cov qog noj ntshav ntawm lub ncauj tsev menyuam lossis lub cev ntawm lub tsev menyuam. Kev tshuaj xyuas txog nws txawv.
Cov kws kho mob thiab cov neeg mob nco txog lub sijhawm zoo tom qab kev phais:
- Nyob rau hauv lub neej expectancy.
- Guaranteedtsis muaj kab mob uterine, nrog rau mob qog noj ntshav.
- Kev tiv thaiv kab mob tiv thaiv txawm tias me me ntawm kev xeeb tub tsis xav tau.
- Kev ua haujlwm tsis txo qis kev ua haujlwm, nws tuaj yeem rov qab mus rau lub neej tag nrho.
Cons of operation:
- Tsis muaj menyuam.
- Npaj tsis zoo rau ntawm phab ntsa plab anterior.
- Kev muaj teeb meem, ntxov thiab lig (sib tham saum toj no).
Summarize
Wertheim's hysterectomy yog ib qho kev kho mob zoo ntawm cov qog nqaij hlav ntawm lub ncauj tsev menyuam thiab lub cev ntawm lub tsev menyuam. Qhov kev ua haujlwm no tsis yog tuaj yeem cawm tus neeg mob los ntawm kev mob qog noj ntshav, tab sis kuj ua rau qee txoj hauv kev txhim kho lub neej zoo.
Tau kawg, zoo li txhua qhov kev cuam tshuam kev phais, hysterectomy yog fraught nrog teeb meem. Txawm li cas los xij, nrog lub koom haum tsim nyog ntawm lub sijhawm ua haujlwm tom qab thiab ua raws li kev tiv thaiv tsim nyog, lawv tuaj yeem zam tau.
