Hysterectomy laparoscopic hom: post-operative lub sij hawm, lub txim xyuas. Kev tshem tawm ntawm uterine fibroids laparoscopically: xyuas

Tam sim no, peb tsim txoj kev yees uas cia rau ib tug ntau yam ntawm gynecological kev cuam tshuam tsawg heev teeb meem thiab ib tug tsawg degree ntawm kev poob plig. Laparoscopic hysterectomy los ntawm - ib tug ntawm lawv.

Laparoscopy li cov txheej txheem tshiab

Laparoscopic phais tau nyob ib ncig ntawm rau ntau tshaj 20 xyoo. Thaum lub sij hawm lub sij hawm no nws tau tsim muaj nws tus kheej raws li ib tug tsawg kawg tus thiab siv tau txoj kev muaj tsawg heev post-operative teeb meem.

Laparoscopic hom kev kawm nyob rau hauv Gynecology tau ntau npaum li cas tej chaw. Yav tas los, xws li ib tug txoj kev ua gynecological phais me me tagnrho. Tab sis nyob rau hauv tsis ntev los no xyoo nyob rau hauv feem ntau cov chaw kuaj mob thiab tsev kho mob, nws tau ua ib yam. Ib tug ntawm cov ua hauj lwm yog los tshem tawm uterine fibroids laparoscopically. Xyuas ntawm cov neeg mob qhia tau tias muaj yog ib tug ceev ceev rov qab los ua hauj lwm muaj peev xwm, txoj kev pheej hmoo ntawm cov teeb meem thiab adhesions ntawm lub me me thiab me ntsis kev puas tsuaj rau ntawm daim tawv nqaij tsis lwj lub tsos ntawm cov poj niam.

Rau cov lag luam yuav tsum tau tsim nyog thiab tej neeg. Intervention yog warranted nyob rau hauv cov ntaub ntawv no, tsawg heev teeb meem. Nyob rau hauv tej rooj plaub, ib tug ua ke ntawm laparoscopic thiab cov pa phais cia li yuav tsum txuag tus neeg mob lub neej. Qhov no tshwj xeeb yuav xaiv qhov tseeb txoj kev los kho lawv cov neeg mob nyob rau hauv txhua rooj plaub zuj zus.

Muaj ntau cov tsev kho mob nqa tawm qhov kev tshem tawm ntawm uterine fibroids laparoscopically. Nyob rau hauv Moscow, yuav luag txhua txhua gynecological department yog txawm peem rau nrog rau cov tsim nyog cov khoom thiab muaj hauj lwm rau nqa tawm no manipulation. Tawm ntawm tag nrho cov gynecological phais 50-60% yog nyob rau ntawm laparoscopy.

Lub ntsiab zoo ntawm tus qauv:

• tsis muaj degree ntawm kev poob plig;

• ceev rov qab muaj nuj nqi ntawm tag nrho cov kabmob;

• Yuav txo tau ntawm post-operative mob;

• tsawg heev adhesions ;

• luv luv lub sij hawm ntawm tsev kho mob;

• nyob hauv chaw zov me nyuam;

• yuav txo tau ntawm cov nqe lus ntawm kev tsis taus;

• ib tug tsawg kawg nkaus ntawm postoperative hernias;

• qhov tsawg kawg nkaus lub sij hawm rau cov kev ncaj ncees;

• txuag tshuaj.

Tsis zoo lub sij hawm laparoscopy

Tag nrho cov zoo yam nyob rau hauv lub chav kawm ntawm kev phais thiab kho cov poj niam npog tag nrho cov tsis zoo uas yog xam qhovkev rau hauv tej laparoscopic phais:

• machinery thiab cov kev kawm uas tsim nyog cov tshwj xeeb yuav tsum tau tseem ceeb kev siv nyiaj txiag;

• kws phais neeg yuav tsum muaj laparoscopic hom kev kawm thiab cov tshuaj phais;

• mob yog nyob rau hauv yuam cai ntawm lub zog ntawm tus kabmob uas txuam nrog rau kev txhaj tshuaj ntawm cov roj mus rau hauv lub plab kab noj hniav, tab sis kev kho thiab kho cov kev tiv thaiv ntawm cov teeb meem yuav zam tau;

• Tsis txhob kav tawm tau ntawm cov neeg kho tshuab kev puas tsuaj mus rau ntau yam kabmob, ntaub so ntswg thiab lug.

Daim ntawv thov nyob rau hauv Gynecology

Nyob rau hauv gynecological laparoscopy xyaum yog thoob plaws. Nyob rau hauv tas li ntawd mus rau lub mob nyob rau hauv meej txog tus neeg mob ntawm mob plab mog, txiav txim qhov ua rau ntawm ntxiv lawm tshob, laparoscopic txoj kev yog siv nyob rau hauv qhov teeb meem xws li:

1. Ectopic cev xeeb tub.

2. Lub kis ntawm lub raj.

3. Phais kom tsis muaj menyuam.

4. Endometriosis.

5. Lub nplaum kab mob.

6. Ntau cov kab mob ntawm zes qe menyuam hlwv, sklerokistoz, ntawm zes qe menyuam apoplexy.

7. benign tsim lub tsev me nyuam (hysterectomy laparoscopic txheej txheem thiaj li kev pheej hmoo ntawm postoperative teeb meem).

8. hyperplastic dab, tsis amenable mus conservative kev kho mob.

Tsis ntev los no gynecologists kheev siv laparoscopic hysterectomy txawm nyob rau hauv phem hlav. Leej twg tsim ntau hom kev kawm rau lub lag luam no, nyob ntawm seb qhov loj ntawm lub tsev me nyuam, nws raws li txoj cai thiab kev koom tes nyob rau hauv tus txheej txheem ntawm nyob sib ze kabmob. Lug siv fibroids lub lag luam no nyob txawv localizations.

uterine fibroids

Uterine fibroids - benign kab mob nyob rau hauv uas nyob rau hauv tus ntawm cov tshuaj hormones tshwm sim loj hlob ntawm fibrous cov ntaub so ntswg nrog lub tsim ntawm cov pob caus ntawd. Nws pom siab loj heev ntawm tus kab mob - txog 25% ntawm tag nrho cov gynecological teeb meem. uterine fibroids muaj ib feem nyob rau hauv tag nrho lub cev ntawm cov poj niam. Myomectomy yog suav hais tias yog "kub txheej txheem" kev kho mob rau tus kab mob no.

Hysterectomy laparoscopically. hom

Thaum xaiv ib tug qauv ntawm cov kev phais kho mob ntawm fibroids yog muab rau tus account ntau yam: qhov chaw nyob thiab loj cov ntshav, functionality, los yog poob ntawm ib sab nruab nrog cev, cov kev mob ntawm tus poj niam. Nyob rau hauv lub uterine txhab appendages ob peb hom ntawm kev phais nyob rau kev ua me nyuam kabmob.

Nyob rau hauv kev xyaum siv:

- tag nrho hysterectomy thaum muab tshem tawm hauv lub cev thiab ncauj tsev me nyuam; subtotal - lub tsev menyuam yog muab tshem tawm hauv lub cev. Yog hais tias nrog rau cov tsev me nyuam amputated yeeb nkab - gistertubektomiya, thiab yog hais tias kav dej thiab Yachnik, xws lag luam yog hu ua gistertubovarioektomiya. Yuav kom radical hauj lwm xws li pangisterektomii - rho tawm tag nrho cov sab hauv genitalia ua ke nrog cov qog ntshav hauv los yog qog lwm tus cov nqaij ntawm qhov chaw mos thiab ib nrab resorted oncological dab.

- Thaum me me ntawm cov chav nyob thiab mus khaws cia nyuam cov poj niam ua ablative phais. Ib tug ntawm cov yog qhov kev tshem tawm subserous uterine fibroids laparoscopically. Nrog me ntsis uterine lesion nqa enucleation ntshav, i.e. husking fibrous cov ntaub so ntswg nrog rau tom ntej saving hloov khoom nruab nrog. Tom qab no ua hauj lwm, ib tug poj niam muaj peev xwm tau txais cev xeeb tub tom qab ib tug tej lub sij hawm thiab muab yug.

Contraindications

Muaj contraindications rau kev phais kom tshem tawm cov menyuam fibroids laparoscopically. Xyuas Gynecologists qhia tias nyob rau hauv feem ntau lub lag luam yuav nqa tawm tag nrho, tsuas yog rau cov poj niam uas raug kev txom nyem los ntawm sab kev mob plawv, ua pa tsis ua hauj lwm, muaj ib tug hernia, teeb meem nrog rau cov ntshav coagulation system los yog marasmus

Tus kwv tij contraindications - ib tug mob nyob rau hauv uas lub lag luam yog ua tau, tab sis nws pib ib co teeb meem. Lawv yog:

• ho hais subcutaneous roj;

• tsis kho kab mob;

• adhesions;

• effusion los yog muaj cov kua nyob rau hauv lub plab kab noj hniav ntawm ntau tshaj 1 liter.

Tab sis niaj hnub gynecologists, muaj laparoscopic txoj kev, tom qab ntxiv kev soj ntsuam ntawm xws kab mob tshuaj cov hoob kawm ntawm kev kho mob, tsau tshuaj rau foci ntawm kab mob thiab nqa tawm phais. Nyob rau tib lub sij hawm luj qhov "pros" thiab "cons" ua ntej koj siv ib tug laparoscopic lag luam.

Kev npaj rau kev phais

Xyuas ntawm cov poj niam uas muaj undergone hysterectomy laparoscopically, nws yog lub npe hu tias tus neeg mob yog tsis txaus siab uas tsuas npaj: Lub lag luam kav 40 feeb, thiab kev npaj - 2 lub lis piam thiab ntau dua.

Nyob rau lub lag luam rau tus poj niam yuav tsum tuaj tom qab cov kev ntsuam xyuas thiab cov kev tshwm sim tau yuav muab:

• kev kuaj ntshav (tag nrho cov, biochemical, ntshav hom thiab v tau, rau kab mob siab, syphilis thiab cov kab mob HIV txhaws, qhov kev txiav txim ntawm zib);

• zis kev ntsuam xyuas - general thiab qhov kev txiav txim ntawm lub qab zib;

• smears;

• electrocardiogram;

• x-rays;

• ultrasound;

• colposcopy;

• soj ntsuam ntawm cov kws tshwj xeeb: ib tug kws kho mob, yog tias tsim nyog, ib tug kws kho plawv thiab lwm tus neeg.

Ua ntej lub lag luam rau cov neeg mob nrog uterine fibroids yuav tsum tau ib daim diagnostic curettage ntawm lub tsev me nyuam thiab kom tau histological tau. Qhov no yog tsim nyog rau qhov chaw nyob rau hauv lub qhov teeb meem ntawm tus nqi ntawm cov kev phais thiab tshem tawm thiab tiv thaiv kom txhob ntxiv kev loj hlob ntawm cancer dab.

Tag nrho cov xeem - ib tug tsim nyog txoj kev, thiab tsuas yog tom qab ib tug tag nrho cov kev tshawb nrhiav ntawm tus kws phais yuav tsum tau nqa tawm kev tshem tawm ntawm lub tsev me nyuam laparoscopically.

Hnub ua ntej qhov phais yog tsis pom zoo kom noj, koj yuav tsum chais plaub lub pubic cov plaub hau.

Ua ntej qhov phais, tus poj niam nyob tawm ib daim ntawv tso cai rau tshuaj loog, thiab nyias rau lub lag luam. Yog hais tias tsim nyog, muab kev kho mob los yog psychoprophylactic kev npaj rau kev phais.

lag luam Technology

Lub lag luam kom tshem tawm cov menyuam laparoscopically ua thaum myomas ntau thiab tsawg mus txog 16 lub lim piam uas cev xeeb tub, uas yog nyuab los ntawm ntshav, yus muaj los ntawm ceev ceev txoj kev loj hlob los yog pheej hmoo ntawm kev phem transformation. Txawm tias ib co tej tub txawg tshem tawm tag nrho cov tsev me nyuam, qhov luaj li cas ntawm cov uas yog hais txog 20 lub lim piam. Tiam sis ntau tshaj feem ntau, muab lub hnub nyoog ntawm tus poj niam, nqa tawm qhov kev tshem tawm ntawm uterine fibroids laparoscopically tawm hauv ib feem me me ntawm lub ncauj tsev menyuam rau poj niam.

Siv peb los yog plaub tej lub plab phab ntsa (ib tug - nyob ze ntawm lub puj ntaws thiab lwm yam ob - nyob rau txhua sab) thiab muab trocars. Qhov no ntaus ntawv yog muab nrog lub koob yees duab rau saib xyuas lub teeb los yog nrog ib tug supercharger installation carbon dioxide los yog cov pa roj nitrous oxide thiab cov cuab yeej.

Tom qab tshem tawm ntawm lub soj ntsuam ua laparoscopically uterine fibroids. Rau no ligament yog excised, ligated hlab ntsha dissected los ntawm lub tsev me nyuam thiab lub qhov chaw mos phab ntsa nws yog muab tshem tawm los ntawm lub qhov chaw mos los ntawm txoj kev incisions nyob rau hauv lub vaults. Qhov no lub lag luam yog hu ua laparoscopically pab paum myomectomy. Siv suturing incisions nyob rau hauv qhov chaw mos. Nyob rau hauv ib lub lag luam tej zaum yuav rho tawm ntau o tsis rov pab.

Tom qab odalyayut cov ntshav los yog cov kua, sau thaum lub sij hawm lub lag luam, kev soj ntsuam xyuas yog nqa tawm dua lub cev thiab cov phab ntsa hauv lub plab kab noj hniav. Ua tib zoo xyuas seb zoo ntaub qhwv thiab ligated hlab ntsha, txawm propotevanie cov ntshav los yog lymphatic kua. Tshem tawm cov roj thiab zaub cov cuab yeej. Ces stitches tshwm sim ntawm daim tawv nqaij thiab subcutaneous cov ntaub so ntswg ntawm qhov chaw ntawm trocar, ntawm daim tawv nqaij yog sutured kom hniav zoo nkauj sutures.

Lub caij ntawm cov lag luam tej zaum yuav tsum yog los ntawm 15 feeb rau 1.5 teev nyob rau hauv lub ntim ntawm siv phais kev cuam tshuam.

Kev ua kom loog nyob rau hauv xws hauj lwm raws li kev tshem tawm ntawm lub tsev me nyuam laparoscopically: xyuas

Yuav ua li cas kom tsaug zog yog ib qho zoo? Lo lus nug no yuav tsum tau solved ua ke nrog tus kws phais ib anesthesiologist, muab cov kev mob ntawm tus neeg mob, cov ntsuas ntawm laboratory kev tshawb fawb, kwv yees li volume ntawm kev ua hauj lwm. Nyob rau hauv Feem ntau, lub neej coj endotracheal tshuaj loog. Xyuas ntawm cov poj niam hais tias nws yog zoo zam lub txim, uas tsis muaj mob taub hau. Poj niam wake tom qab 15-20 feeb tom qab ib lub lag luam xws li kev tshem tawm ntawm lub tsev me nyuam laparoscopically.

Lub postoperative lub sij hawm nrog rau txoj kev tshuaj loog ua rau zoo tau tom qab cov kev pab: tus mob tsis looj koov, muaj tsuas yog me tsis xis nyob, uas kis los ntawm tus 2 hnub. Tej zaum nws yuav ua tau xeev siab, tab sis nws docked "metoclopramide". Thawj hnub koj yuav haus dej haus dej. Nyob rau hauv lub yav tsaus ntuj, koj muaj peev xwm twb tau sawv thiab sawv. On thib ob hnub koj yuav tau noj, uas tsis thab plaub hauv lub plob tsis so tswj, xws li porridge, kua zaub, khoom noj siv mis. Lub extract yog nqa tawm nyob rau hauv lub thib ob hnub tom qab cov kev pab, thiab muaj mob mus so kaw tom qab 30 hnub. Tom qab ntawd tus poj niam yuav xyuam xim mus ua hauj lwm, tab sis, nrog rau cov kev txwv ntawm hnyav lub cev ua hauj lwm rau ib lub hlis. Sutures raug muab tshem tawm nyob rau hauv postoperative hnub 5.

Tom qab muab hlais tawm lawm, cov tau cov teeb meem, uas yog tsawg: qhov raug trocar hauv nruab nrog cev, los ntshav los ntawm nyob rau hauv lub ligated hlab ntsha, subcutaneous mob hawb pob. Tag nrho cov no yuav tiv thaiv tau yog tias nruj me ntsis raws cov khoom lag luam thiab ua tau tshawb ntawm lub plab kab noj hniav kom zoo zoo.

los

Nws yuav tsum tau muab sau tseg tias tom qab ib lub lag luam xws li ib tug laparoscopic hysterectomy txoj kev, cov teebmeem yuav tau txais. Rov qab no tshwm sim tom qab 2 lub lim piam ntawm kev ncaj ncees. 30 hnub tom qab lub lag luam tus poj niam yuav mus txog lawv ua lag ua luam li niaj zaus. Pom zoo tau qoj ib ce. Tab sis ib lub hlis tom qab, nws yog ib undesirable rau thauj cov nqaij mob plab, tsa tes taw hnyav li nyob rau hauv lub hnub.

Nyob rau hauv thaum ntxov hnub tej zaum yuav muaj me nagging pains nyob rau hauv lub plab mog. Qhov no yog dab tsi thiab yuav tsum kis tau rau hauv 1-2 hnub. Cov tsim ntawm adhesions yog ua tau, tab sis raws li statistics qhov no tshwm sim heev tsis tshua muaj thiab tsuas yog nyob rau hauv lub caj predisposition ntawm tus kab mob los yog nyob rau hauv qhia endometriosis.

Me ntsis tawm hauv qhov chaw mos ib ntsuj av. Qhov no yog tsis yog hais tias lub zes qe menyuam yog fwm. Lawv tseem yuav tsim cov tshuaj hormones hais tias ua no cov tshuaj tiv thaiv.

Mob ntawm inflammatory dab tom qab laparoscopic phais yog tsis tshua muaj, vim hais tias cov tshuaj tua kab mob yog tsa tam sim ntawd tom qab cov kev pab thiab ntxiv rau 5 hnub. Nyob rau tib lub sij hawm nws ho dej electrolyte muaj pes tsawg leeg ntawm cov ntshav.

Rov qab fertility neeg mob yuav luag tam sim ntawd, tab sis nyob rau hauv tej rooj plaub muaj ib qho kev nce nyob rau hauv libido. Ib tug poj niam yuav nyob ib kev sib deev lub neej tom qab 1 lub hli tom qab phais. Yog hais tias lub cev yog muab, koj yuav tau txais lub cev xeeb tub tsis pub dhau rau lub hlis tom qab cov kev pab.

Kuv yuav nqa tawm lub lag luam?

Muaj ntau cov tsev kho mob yuav muab hysterectomy laparoscopically. Nyob rau hauv Moscow nroog cov tsev kho mob uas yog nruab nrog cov khoom thiab muaj tshwj xeeb uas paub cov txheej txheem no yuav muab koj cov kev pab no. Lub lw nqi yog pom zoo nrog rau tus kws kho mob.

Lub daim ntawv ntsuam xyuas muaj peev xwm yuav ua tau nyob rau hauv lub chaw ua hauj lwm los yog nyob rau hauv lub pre-lub tsev kho mob qhov chaw nyob. Yuav kom xws hauj lwm tau sau npe quota. Tus nqi ntawm cov laparoscopic hysterectomy yog hais txog 45 mus txog rau 70 txhiab.