Cov txheej txheem kho lub ntsws muaj xws li kev tu lub ntsws kom sai los ntawm cov txheej txheem fibrinous, uas tiv thaiv kev kho ntawm nws cov duab. Thaum lub sij hawm kev phais, cov kev hloov ntawm cicatricial sclerotic nyob rau hauv lub visceral pleura raug tshem tawm, uas impede tag nrho cov hauj lwm ntawm lub cev. Txij li kev kho kom zoo nkauj ntawm lub ntsws yog thawj zaug los ntawm Fab Kis tus kws phais Delorme, qhov kev cuam tshuam no tau hu ua Delorme operation.
Indications rau kev phais
Lub ntsws decortication yog qhia rau cov npe me me ntawm cov kab mob thiab raws li txoj hauv kev tseem ceeb ntawm kev kho mob yog siv hauv cov xwm txheej hauv qab no:
- pneumopleuritis tsis tuaj yeem ua raws li kev kho mob ib txwm;
- fibrinothoraxes;
- empyema (thaum tsis muaj ntau tshaj ib lub ntsws ntawm lub ntsws raug cuam tshuam, txog rau lub hlis dhau los);
- txhav pneumothorax, tshwj tsis yog rau qhov dav davswb;
- bronchial fistulas, thiab lwm yam.
Nco ntsoov tias kev ua haujlwm Delorme (raws li kev cuam tshuam kev phais ywj pheej) yog siv tsis tu ncua. Feem ntau, decortication ntawm lub ntsws yog ua tiav nrog pleurectomy, resection los yog thoracoplasty.
Ib daim ntawv nquag ntawm cov txheej txheem tuberculosis, amyloidosis ntawm cov kabmob hauv nruab nrog cev, purulent intoxications, cov txheej txheem cavernous dav thiab kev txwv hnub nyoog tuaj yeem dhau los ua qhov tsis txaus ntseeg rau kev phais. Raws li nyob rau hauv cov ntaub ntawv ntawm resection, kev cuam tshuam yog pom zoo rau cov neeg mob hnub nyoog qis dua 50 xyoo.
Techniques nrog rau kev ua haujlwm Delorme
Pleurectomy nrog decortication ntawm lub ntsws yog siv rau hauv cov neeg mob siab heev. Nrog cov kev cuam tshuam zoo li no, ntxiv rau kev kho kom zoo nkauj, tus kws phais tshem tawm cov parietal pleura, uas ua rau sab nrauv ntawm cov kab noj hniav purulent. Qhov no ua tiav cov khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob
Yog tias tsim nyog (hauv qhov xwm txheej siab), kev ua haujlwm tau ua ua ke ntawm ob lub ntsws. Feem ntau, kev kho kom zoo nkauj ntawm lub ntsws sab xis yog ua ke nrog cov kev cuam tshuam ntawm sab laug thiab rov ua dua, vim tias qhov mob tsawg ntawm ib lub cev tsis cuam tshuam nrog kev phais thiab kev rov zoo ntxiv. Txawm hais tias nrog kev phais ntawm lub ntsws ua haujlwm, kev kho kom zoo nkauj tuaj yeem ua tiav ntawm qhov seem. Lub ntsws decortication no hu ua ib nrab decortication.
TechnicalCov yam ntxwv ntawm kev ua haujlwm Delorme
Cov kws phais niaj hnub no qhia meej qhov txawv ntawm ob hom kev ua haujlwm pleural. Cov kev cuam tshuam los ntawm kev tshem tawm cov txheej thaiv txheej yog hu ua "decortication ntawm lub ntsws". Nyob rau hauv rooj plaub ntawm kev tshem tawm tag nrho cheeb tsam pleural, lo lus "pleurectomy" yog qhov tau txais ntau dua.
Tab Nthuav, cov kev cuam tshuam no tau ua tiav raws li kev siv tshuaj loog, zoo li feem ntau lwm cov haujlwm intrathoracic. Txawm li cas los xij, cov xwm txheej zoo dua yog muab los ntawm kev siv tshuaj loog hauv zos, uas tus kws phais mob muaj sijhawm ntau los cais cov adhesions ntawm cov ntaub so ntswg pleural los ntawm cov ntaub so ntswg ntawm lub hauv siab phab ntsa, cov adhesions feem ntau muaj zog heev. Nws muaj peev xwm siv diathermy thiab dynamically inflate lub ntsws los ntawm lub ntsej muag nruj nruj los yog nrog lub hnab oxygen.
Txoj kev nkag hauv online, raws li txoj cai, tsis txawv ntawm cov txheej txheem uas tau siv thaum lub sijhawm rov txiav txim. Qhov tshwj xeeb yog cov neeg mob uas muaj qhov ntev ntawm lub hauv siab (li ib nrab ntawm ib lub 'meter' los ntawm diaphragm mus rau thaj tsam domed pleural). Nyob rau hauv cov ntaub ntawv no, ib tug intercostal incision yog siv nyob rau hauv peb los yog plaub tav tav siv cov ntsia hlau retractors uas muab txaus nkag (kwv yees li 30 centimeters).
Kho lub ntsws yog kev ua haujlwm, lub hom phiaj yog txhawm rau txhim kho lub ntsws deformed, rov ua haujlwm ntawm lub cev thiab tshem tawm tag nrho cov kab noj hniav. Kev ua haujlwm yog ua los ntawm tus kws phais mob thoracic, feem ntau raws li tau npaj tseg.
Muaj teeb meem tom qab phais
Cov teeb meem tom qab kev phais feem ntau yog ib qho ntawm cov kev cuam tshuam intrathoracic. Cov txheej txheem phais yog qhov nyuaj thiab mob hnyav, yog li qee zaum cov xwm txheej tsis tau npaj tau tshwm sim: los ntshav, ua rau lub ntsws puas tsuaj, pneumothorax.
Txo qhov kev pheej hmoo ntawm cov teeb meem tuaj yeem tso cai rau ntau cov txheej txheem ua ntej ua ntej. Multiaxial fluoroscopy thiab xam tomography tso cai rau txiav txim siab meej ciam teb ntawm qhov txhab, qib ntawm kev ywj pheej ntawm lub diaphragm thiab intercostal mobility, muaj kua nyob rau hauv lub pleural kab noj hniav thiab lub degree ntawm vau ntawm lub cev. Txhawm rau ntxuav cov ntsiab lus ntawm cov kab noj hniav, punctures ntawm pleura yog ua, ua raws li cov tshuaj tua kab mob nrog tshuaj tua kab mob thiab tshuaj tua kab mob.
Zoo kawg
Hauv kev xaus, peb nco ntsoov tias nrog kev kuaj xyuas ua ntej thiab kev npaj kom raug, hauv cov neeg mob feem ntau, kev cuam tshuam kev phais mus raws li txoj kev npaj, thiab cov txiaj ntsig zoo yog pom tau sai tom qab ua haujlwm.
