Kev phais ntawm cov hnyuv sigmoid yog ua rau kev raug mob thiab cov qog uas ua rau cov hnyuv loj. Feem ntau, xws li kev phais yog ua sai sai. Muaj ntau txoj hauv kev los ua qhov haujlwm no. Feem ntau nws yog ua los ntawm Mikulich lossis Hartmann txoj kev. Kev npaj rau kev phais yog qhov tseem ceeb heev. Tsuas yog tias txhua yam tau ua tiav, qhov tshwm sim tsis zoo tuaj yeem raug cais tawm.
cov ntaub ntawv dav dav
Dab tsi yog qhov kev phais sigmoid colon resection? Lo lus no hais txog qhov kev txiav ntawm ib feem ntawm lub cev. Hauv qee qhov pathologies, ib feem ntawm cov nyuv sigmoid yuav tsum raug tshem tawm.
Kev xaiv ntawm txoj kev tshem tawm yog nyob ntawm hom kab mob. Piv txwv li, laparoscopic resection ntawm sigmoid nyuv yog ua los ntawm cov txheej txheem kho mob tshwj xeeb hu ua laparoscope. Tus kws phais ua rau ntau qhov incisions nyob rau hauv lub dab teg los ntxig cov twj paj nruag. Cov txheej txheem laparoscopic yog suav tias yogKev raug mob tsawg dua thiab maj nrawm dua li qhib kev phais.
Sigmoid nyuv yog dab tsi?
Qhov nruab nrab ntev ntawm txoj hnyuv hauv tib neeg lub cev yog 4 meters. Lub plab hnyuv sigmoid nyob li ntawm 1/8 ntawm qhov. Qhov no ntawm txoj hnyuv yog nyob rau ntawm ciam teb ntawm lub peritoneal kab noj hniav thiab lub pelvis me me - nyob rau hauv sab laug iliac fossa. Tom qab lub plab hnyuv sigmoid yog cov hlab ntsha sab nraud, sab laug piriformis cov leeg, thiab sab laug sacral plexus. Nyob rau hauv pem hauv ntej - lub zais zis nyob rau hauv cov txiv neej thiab lub tsev menyuam nyob rau hauv cov poj niam, raws li zoo raws li loops ntawm cov hnyuv. Vim qhov sib thooj ntawm txoj hnyuv mus rau cov kabmob no, kev ua haujlwm yog suav tias yog qhov nyuaj los ntawm kev pom. Vim nws qhov chaw nyob, cov nyuv sigmoid yog yooj yim palpable.
Diagnosis
Nws yog dab tsi thiab nws qhov peculiarity yog dab tsi? Tus kws kho mob tuaj yeem txiav txim siab ntau yam tsis sib xws: qhov tuab ntawm lub cev, qhov sib xws, qhov sib zog ntawm peristalsis thiab kev ntxhib los mos ntawm qhov chaw. Nyob rau hauv ib txwm lub xeev, ntu no ntawm cov hnyuv yog heev ntom, tsis rumble, nws thickness mus txog 2.5 cm. Nyob rau tib lub sij hawm, nws yuav ua tau heev mobile. Yog tias tus kws kho mob pom ib pob los yog qog ntawm palpation, lwm txoj kev kuaj mob tuaj yeem siv tau. Tus neeg mob tau txais kev kuaj ntshav, kuaj ntshav, sigmoidoscopy thiab irritoscopy. Cov poj niam tseem raug xa mus rau kev kuaj mob mus rau gynecologist, vim muaj ntau tus poj niam cov kab mob zoo ib yam li cov kab mob ntawm cov kab mob sigmoid colon.
Kev qhia
Yuav ua li cas yog qhov kev txiav tawm ntawm txoj hnyuv sigmoid ua? Lub sijhawm ua haujlwm yog teem rautsim cov qog nqaij hlav, nce polyposis, muaj cov kab mob loj heev, uas tuaj yeem ua rau muaj teeb meem. Tsis tas li ntawd ib qho kev qhia rau kev ua haujlwm no yog kev ua txhaum ntawm innervation, ua rau muaj qhov nce hauv qhov ntim ntawm txoj hnyuv, thiab cov kab mob ulcerative ntawm cov mucous membranes. Qhov kev xav tau xwm txheej ceev rau kev phais yuav tshwm sim thaum muaj kev raug mob rau lub plab thiab lub cev sab hauv.
Npaj theem
Cia peb saib kom ze rau qhov no. Ua ntej kev ua haujlwm, tus neeg mob yuav tsum tau ua qee yam kev npaj. Txhawm rau tshem tawm qhov muaj peev xwm kis tau tus kab mob thaum muaj kev cuam tshuam, nws yog qhov yuav tsum tau ntxuav cov hnyuv. Qhov no yuav zam qhov teeb meem ntxiv. Rau kev ntxuav, tshwj xeeb enemas nrog laxatives yog muab tso. Cov tshuaj thiab lawv qhov ntau npaum li cas yog xaiv los ntawm tus kws kho mob tus kheej. Cov theem kev npaj feem ntau kav ib hnub.
Kev noj zaub mov tshwj xeeb yog raug sau tseg ob peb hnub ua ntej kev phais mob rau kev phais ntawm sigmoid nyuv. Kev noj zaub mov feem ntau tsis suav nrog kev siv cov khoom noj nyuaj thiab zom zaub mov. Koj tuaj yeem noj mis nyuj porridge, kua zaub thiab lwm yam kua zaub.
Cov tshuaj tshwj xeeb feem ntau yog sau ua ntej ua haujlwm. Cov no yog cov inhibitors, diuretics thiab tshuaj rau normalize siab. Cov tshuaj no txo qhov kev pheej hmoo ntawm mob plawv. Ob peb lub lis piam ua ntej kev ua haujlwm, nws raug nquahu kom tsis txhob noj cov tshuaj uas muaj cov tshuaj tiv thaiv kab mob - Ibuprofen, Nurofen, Aspirin. Lawv hloov kev ua haujlwm ntawm platelets thiab cuam tshuam rau cov ntshav txhaws. Nws kuj yog qhov zoo dua los sab laj nrog koj tus kws kho mob txog kev noj zaub mov thiab cov vitamins. Ua ntej resection ntawm sigmoid nyuv, nws yog qhov zoo dua kom tsis txhob noj lawv.
Ua ntej ua haujlwm, tus neeg mob yuav tsum tau kuaj los ntawm tus kws tshuaj loog. Nws ntsuam xyuas tus neeg mob tus mob thiab muab tshuaj loog tsim nyog. Thaum npaj cov hnyuv rau resection, nws tsis pom zoo kom noj zaub mov, thiab haus dej ua ntej ua haujlwm.
Methodology
Yuav ua li cas tshem tawm ntawm txoj hnyuv sigmoid? Cov chav kawm ntawm kev ua haujlwm yog nyob ntawm hom pathology. Nyob rau hauv cov ntaub ntawv ntawm plab hnyuv volvulus, uas provoked txoj kev loj hlob ntawm gangrene, ib qho kev ua hauj lwm raws li Hartmann los yog Mikulich yog feem ntau yog sau.
Nws qhov tshwj xeeb yog dab tsi? Resection ntawm sigmoid nyuv raws li Hartmann suav nrog kev tshem tawm ntawm ntu tuag ntawm sigmoid, stitching ntawm qhov kawg ntawm qhov kawg thiab kev tshem tawm ntxiv ntawm lub qhov. Txoj kev no feem ntau yog siv rau cov neeg laus thiab cov neeg mob hnyav.
Kev kho ntawm lub plab sigmoid raws li Mikulich yog ua tiav hauv ob theem. Ua ntej, ib feem ntawm cov nyuv sigmoid raug tshem tawm. Nws qhov xaus yog sutured rau 5 cm. Tom qab ntawd, lawv yog sutured nyob rau hauv daim ntawv ntawm ib rab phom ob rab phom rau hauv phab ntsa ntawm peritoneum. Tom qab 3.5 lub hlis, lub plab hnyuv fistula raug kaw.
Tus txheej txheem ntawm kev ua haujlwm yog txiav txim siab los ntawm qhov xwm txheej ntawm txoj kev loj hlob ntawm pathology. Yog tias pom cov qog nyob hauv nruab nrab peb ntawm lub sigmoid, kev tshem tawm tag nrho ntawm cov hnyuv sigmoid yuav tsum tau.
Post-operative period
Nws yog dab tsi? Yuav tsum ua li casyuav khoom noj khoom haus tom qab resection ntawm sigmoid nyuv? Semi-tiav khoom, kib thiab rog yog contraindicated rau cov neeg mob. Nws yog qhov zoo dua los ua noj zaub mov hauv lub steamer lossis hauv lub cooker qeeb.
Kev noj qab haus huv tom qab kev phais ntawm cov hnyuv sigmoid suav nrog kev siv cov khoom noj ua kua feem ntau: cereals, kua zaub thiab qos yaj ywm mashed. Koj tuaj yeem maj mam qhia cov khoom noj rau hauv koj cov zaub mov. Cov ntawv qhia zaub mov yog tsim los kom lub cev tau txais tag nrho cov vitamins thiab minerals tsim nyog los kho tus neeg mob. Tom qab tshem tawm, cov zaub mov kaus poom, cov khoom noj haus luam yeeb thiab cawv yuav tsum tsis suav nrog. Kwv yees li 10 hnub tom qab kev phais, koj tuaj yeem pib noj cov khoom noj muaj roj tsawg, qe, thiab nqaij. Ib hlis tom qab, koj tuaj yeem suav cov tais diav hauv cov ntawv qhia zaub mov. Qhov xwm txheej tseem ceeb yog cov zaub mov yuav tsum tau txiav kom zoo.
YContraindications
Leej twg yuav tsum tsis txhob ua haujlwm xws li kev tshem tawm ntawm txoj hnyuv sigmoid? Contraindications yog yam uas ua rau muaj teeb meem nyob rau hauv tus txheej txheem ntawm tshem tawm ib feem ntawm lub sigmoid nyuv, raws li zoo raws li ua rau nws nyuaj rau txheeb xyuas cov kab mob thiab cov hlab ntsha nyob ze. Kev tsis lees txais kuj suav nrog cov qog loj thiab rog rog hnyav. Tsis ntev los no cov kev pab cuam phais thiab adhesions kuj ua rau nws ua tsis tau tejyam.
Qhov tshwm sim thiab kev kwv yees
Qhov no yuav tsum tau muab tshwj xeeb. Cov teeb meem dab tsi tshwm sim tom qab ua haujlwm? Resection ntawm sigmoid nyuv yog ib qho kev cuam tshuam uas yog tus cwj pwm los ntawm kev pheej hmoo siab los ntshav los ntawm kev kho mob vascular tsis zoo. Qhov ua rau muaj qhov tshwm sim tsis zoo kuj tuaj yeem ua tsis raugpreoperative npaj, tsis zoo plab hnyuv cleansing thiab tawg suture nruj thaum stump kho. Kev ua haujlwm tsis zoo ntawm lub peritoneum tuaj yeem cuam tshuam qee yam teeb meem. Qee zaum plab hnyuv adhesions tshwm sim tom qab phais, ua rau muaj kev cuam tshuam.
Puas sigmoid colon resection pab? Cov kws kho mob feem ntau muab ib qho kev pom zoo. Qhov tshwm sim ntawm kev tuag nyhav rau xoom. Nrog oncology, relapses feem ntau tsis tshwm sim. Cov xwm txheej tseem ceeb rau kev ua haujlwm tau zoo yog kev ua haujlwm siab ntawm tus kws phais thiab tus kws kho mob tuaj koom.
Txoj haujlwm ntawm kev ua haujlwm
Muaj kev sib raug zoo ntawm plab noj qab haus huv thiab kab mob feem ntau. Kev ua haujlwm tsis zoo ntawm nws cov chaw ua haujlwm tuaj yeem ua rau muaj qhov tsis zoo li qhov mob, tsam plab thiab ua tsis taus pa. Kev phais txoj kev kho mob tsuas yog siv yog tias lwm txoj hauv kev tsis coj cov txiaj ntsig zoo. Thaum ua haujlwm ntau, xws li kev tshem tawm ntawm fistula, tshem tawm ib feem ntawm txoj hnyuv thiab kev kho mob ntawm purulent peritonitis, qhov tshwm sim ntawm kev kis kab mob ntawm qhov chaw phais yuav nce. Qhov no tuaj yeem ua rau mob plab hnyuv thiab tom qab ntawd tshwm sim nws tus kheej hauv daim ntawv ntawm o.
Kev tshem tawm ntawm ib feem ntawm txoj hnyuv yog qhov chaw kawg. Nws raug sau tseg nyob rau hauv cov ntaub ntawv ntawm cov qog nqaij hlav cancer ntawm txoj hnyuv loj lossis sigmoid. Qhov chaw puas ntawm cov hnyuv raug tshem tawm, thiab cov dawb xaus yog sewn ua ke. Yog tias muaj contraindications rau kev ua haujlwm zoo li no,colostomy yog siv. Nrog hom kev phais mob no, siv lub fistula, uas yog coj tawm. Nws tau koom nrog lub hnab colostomy rau kev tso quav tso quav. Qee lub sij hawm tom qab ntawd, qhov teeb meem no tuaj yeem raug tshem tawm los ntawm kev ua haujlwm thib ob kom rov ua haujlwm ntawm plab hnyuv.
Fistula tom qab phais
Yog li koj yuav tsum paub dab tsi txog qhov no? Kev kho Fistula tuaj yeem ua tau ob qho tib si conservatively thiab phais. Thawj qhov kev xaiv suav nrog kev siv tshuaj tua kab mob tshwj xeeb, nrog rau kev noj tshuaj tua kab mob. Feem ntau cov txheej txheem no tsis muab cov txiaj ntsig xav tau.
Kev phais kom zoo dua. Feem ntau, kev ua haujlwm yuav qhib qhov chaw mob thiab tso cov kab noj hniav nrog cov kua paug. Cov ntaub so ntswg nyob ib ncig ntawm lub excised fistula yog rov qab li ntawm ib lub lim tiam. Thawj zaug tom qab ua haujlwm, cov ntshav me tuaj yeem ua tau. Relapses yog qhov tsawg heev, thiab lawv raug kho nrog kev cuam tshuam kev phais. Kev rov qab los sai sai hauv feem ntau.
Late rehab
Vim lub hom phiaj tseem ceeb ntawm cov nyuv sigmoid yog nqus cov dej noo los ntawm cov quav, thaum qhov no ntawm cov hnyuv raug tshem tawm, cov quav tuaj yeem ua kua thiab yuav luag tsis tuaj yeem tswj tau. Qhov no yuav ua rau qee qhov tsis yooj yim. Tom qab ua haujlwm, koj yuav tsum tau kho qhov kev noj haus kom zoo. Lub sijhawm lig ntawm kev kho kom rov zoo yuav tsum muaj qee yam kev txwv. Feem ntau, tus neeg mob tau txais kev noj zaub mov tsawg kawg nkaus ntawm cov co toxins. Yuav tsum tsis muaj dab tsi ntsim ntawm cov ntawv qhia zaub mov,fatty, smoked thiab ntsim. Cov kws kho mob tsis qhia noj legumes, roughage los ntawm cov nroj tsuag fibers, carbonated dej qab zib, tag nrho cov mis nyuj. Qhov no yuav txo cov roj ntau lawm.
Zoo kawg
Hauv qhov kev tshuaj xyuas no, peb tau tshuaj xyuas kom meej tias qhov kev txiav tawm ntawm lub caj pas sigmoid yog dab tsi, qhov twg nws tau ua thiab qhov teeb meem dab tsi tuaj yeem tshwm sim tom qab ua haujlwm no. Cov txheej txheem tuaj yeem ua tiav ob qho tib si npaj thiab thaum muaj xwm txheej ceev thaum raug mob. Muaj ntau txoj hauv kev los ua qhov kev phais no. Qhov tshwj xeeb ntawm kev ua haujlwm yog txiav txim siab los ntawm tus kws kho mob raws li tus yam ntxwv ntawm tus neeg mob lub cev. Nrog rau kev npaj kom raug rau kev phais, tsis muaj teeb meem. Tom qab qhov kev cuam tshuam, xws li kev tshwm sim hauv plab los ntshav, peritonitis (nrog rau kev tsis zoo ntawm lub plab kab noj hniav lossis tsis tiav nruj ntawm cov sutures), nrog rau abscesses thiab cov nplaum nplaum thaum ntxov, tuaj yeem ua tau. Thaum lub sij hawm kho, nws raug nquahu kom txo cov load ntawm lub cev thiab hloov cov khoom noj. Kev noj zaub mov tom qab tshem tawm ntawm cov hnyuv no tsis suav nrog kev siv ntsim, kib, haus luam yeeb, qab ntsev, nrog rau cawv.
Txawm tias muaj teeb meem tom qab kev phais tuaj yeem zam tau, nws yog qhov zoo dua tsis txhob nqa khoom ua ntej ua haujlwm. Tsis txhob ncua sij hawm rau koj tus kheej, thaum thawj cov tsos mob ntawm tus kab mob, tam sim ntawd mus ntsib kws kho mob.
