Lag luam Wertheim: chav kawm ntawm lub lag luam, txim, teeb meem, xyuas

Ib tug feature ntawm kev ua hauj lwm thaum onkopatologii yog ib tug tshaj dhau, i.e. tsis tau tsuas yog qhov kev tshem tawm ntawm lub qog nws tus kheej, tab sis kuj yog ib tug txiav txim siab npaum li cas ntawm cov ntaub so ntswg noj qab nyob zoo uas nyob ib sab mus rau lub pathological hearth. Nyob rau hauv tas li ntawd, nrog rau cov excised mob thiab cov qog ntshav txhuav lymphatics therein.

Radical kev kho mob ntawm ncauj tsev menyuam thiab endometrial cancer

Wertheim lub lag luam tag nrho raws li cov saum toj no yuav tsum. Nws essence lies nyob rau hauv lub tshem tawm ntawm lub tsev me nyuam nrog appendages (uterine hlab thiab zes qe menyuam), lub sab sauv feem peb ntawm lub paum, tus menyuam thiab txhawb ligaments thiab lwm fatty cov ntaub so ntswg los ntawm cov qog ntshav hauv.

Lub indications phais yog lub tsev me nyuam thiab uterine cancer. Tab sis nyob rau hauv tej rooj plaub, kev phais yog tsis pom zoo:

• nyob rau hauv lub xub ntiag ntawm nyob deb metastases;
• nyob rau hauv cov ntaub ntawv ntawm loj loj hlav, vascular ntoo thiab nyob ib sab nruab nrog cev thiab tej zaum kuj hu ua pelvic phab ntsa;
• txuam nrog kev mob loj pathologies;
• nyob rau hauv cov laus hnub nyoog.

Wertheim lag luam rau lub tsev me nyuam mob cancer

Yog hais tias peb tham txog cov kev kho mob ntawm tus kab mob no, nws yuav tsum tau muab sau tseg tias hais tias lag luam yuav siv tau ob qho tib si ntawm nws tus kheej thiab raws li ib feem ntawm kev ua ke nrog txoj kev kho.

Nyob rau hauv cov ntaub ntawv ntawm mas differentiated squamous cell mob cancer (T1bN0M0 kauj ruam), lub lag luam no yuav radically daws tau qhov teeb meem tsis muaj feem xyuam nrog txoj kev xws li cov kws khomob thiab tawg txoj kev kho. Txawm li cas los, feem ntau ntawm Wertheim lub lag luam yog ib feem ntawm ua ke txoj kev kho.

Thaum endometrial cancer (txawm nyob rau hauv theem IB) yog ib txwm muab mus rau lwm cov kev kho mob, nyob rau hauv tas li ntawd mus hlais.

Lag luam Wertheim: txav lag luam

Phais rau radical tshem tawm ntawm lub tsev me nyuam nrog appendages muaj xws li ob peb theem. Cov muaj xws li:

1. Access.
2. Cov kev tshuam ntawm uterine ligaments.
3. Mobilization ntawm txoj hlab qe menyuam thiab zes qe menyuam.
4. Mobilization ntawm lub zais zis.
5. Nyuam thiab cov kev tshuam ntawm lub ntsiab pub cov hlab ntsha.
6. Kev tshem tawm ntawm cov ntaub so ntswg los ntawm pem hauv ntej saum npoo ntawm lub ncauj tsev menyuam.
7. Cov kev tshuam ntawm lub ligaments kho lub tsev me nyuam rov qab (sacral-uterine).
8. Cov kev tshuam ntawm lub tsev me nyuam ligaments.
9. lub tsev me nyuam resection.
10. Hemostasis paum hauv paus.
11. Peritonization.

phais nkag

Lag luam Wertheim - uas nws kim heev kev pab yuav tsum tau zoo visualization ntawm lub phais teb thiab tau manipulation, tsis nrog kev nyuaj siab los yog cov kev txwv. Yog li ntawd seem yuav tsum yog tsim nyog. Mini accesses thiab endoscopic phais, nyob rau hauv cov ntaub ntawv no tsis haum. Nyob rau hauv cov teeb meem ntawm kev kho mob cancer rau hauv lub kom hniav zoo nkauj tshwm sim ntawm tseem ceeb yog nyob rau hauv qhov chaw kawg.

Feem ntau ua median longitudinal laparotomy (phais ntawm lub anterior mob plab phab ntsa ntawm ib tug dawb kab ntawm ib plab bypass lub puj ntaws) los yog nkag Czerny (transverse laparotomy nrog phais ntawm lub rectus abdominis).

mobilization ntawm lub tsev me nyuam

Yuav kom qhov no kawg, tshuam round ligament ntawm lub tsev me nyuam, thiab ib tug private suspensory zes qe menyuam ligaments, thiab kuj yog lub niam yeeb nkab kawg. Tag nrho cov chaw yuav tsum tau hla, yog tias ua tau, nyob rau hauv qhov chaw devoid ntawm cov hlab ntsha. Qhov no yuav txo cov ntshav poob. Tus heev tib lub tsev me nyuam yog coj rau lub clamps thiab yog tawm mus rau sab.

Tom qab hla tus suspensory ligament ntawm lub zes qe menyuam yuav qhov kev tshem tawm ntawm lub tsev me nyuam tau. Qhov loj tshaj plaws nyob rau hauv lawv cov mobilization - tsis txhob puas ureter. Ua li no, thaum lub sij hawm lub lag luam yog obligatory palpation ntawm lub sab ligament. Nyob rau hauv lub keeb kwm yav dhau nws yog feem ntau yooj yim rau daim ntawv yog ureteral fold. Qhov no manipulation tso cai rau koj yuav sawv kev lub tsev me nyuam thiab appendages tsis ureteral raug mob.

Tom qab qhib lub vesico-uterine folds zais zis paj rwb kua ntswg seb puas sib cais los ntawm lub hauv pem hauv ntej phab ntsa ntawm lub ncauj tsev menyuam. Qhov no yuav tsum tau ua tsis muaj deviating los ntawm qhov chaw kab, los txo cov kev pheej hmoo ntawm kev raug mob mus rau lub vascular plexus.

Yog hais tias lub zais zis yog adherent mus rau lub tsev me nyuam adhesions, nws sib cais yuav tsis yooj yim. Pib keying nyob rau hauv ib rooj plaub ntawm lub round ligaments, thiab mus rau lub caj dab feem nrog qhov loj tshaj muaj, npuas nkauj nraug txiab.

Ntxiv Wertheim lag luam yuav nyuam ntawm cov hlab ntsha. Lub ntsiab vascular lub nras uas lub tsev me nyuam - uterine leeg thiab nrog leeg, mus taug kev raws tus ntug ntawm lub tsev menyuam. Nyuam ntawm lawv nyob rau theem ntawm cov internal os.

Ntxiv mobilization ntawm uterine incision yog ua thiab hloov predpuzyrnoy fascia cov ntaub so ntswg los ntawm ib tug blunt pem hauv ntej saum npoo ntawm lub ncauj tsev menyuam cia. Ntxiv ntoo khaub lig ligament, uas yav tas los tsis txaus ntseeg rau manipulation: sacro-uterine thiab lub tsev me nyuam ligaments. Tom qab ntawd hysterectomy yoojyim lub theem kawg.

Ua tau hysterectomy, hemostasis thiab peritonization

Paum vault yog qhib, lub ncauj tsev menyuam yog coj nyob rau terminals thiab maj txiav tawm los ntawm qhov chaw mos. Qhov no yog ua raws li los ntawm hemostasis thiab peritonization. paum hauv paus yuav tsis tau nyob rau hauv nruj nreem, nws yuav pab raws li tej yam ntuj tso kua nyob rau hauv cov kev tshwm sim ntawm tej pathological dab nyob rau hauv lub pelvic kab noj hniav thiab tsub zuj zuj ntawm kua paug los sis cov ntshav muaj.

Paum raj yog kho nyob rau hauv ib tug tshwj xeeb txoj kev. Cov phab ntsa hauv qhov chaw mos los ligated vesico-uterine thiab rectouterine folds, raws li zoo raws li lub sacro-uterine ligaments, li no tsis tau raws li hemostasis thiab peritonization.

Lub postoperative lub sij hawm

Yuav ua li cas yog tus neeg mob tom qab phais Wertheim? Tej radical phais yuav kis tsis tau nkaus unnoticed. Yog tsis muaj ib tug tsis ntseeg, nws muaj feem xyuam rau cov kev kho mob ntawm ob lub cev thiab kev puas hlwb.

Yuav ua li cas yuav txais lub lag luam Wertheim? Lub txim ntawm no txoj kev ntawm kev kho mob yuav tsum tau muab faib mus rau hauv thaum ntxov thiab lig.

Teeb meem tshwm sim nyob rau hauv thaum ntxov postoperative lub sij hawm

Lub postoperative lub sij hawm tej zaum yuav complicate:

1. Kab mob ntawm cov pob qij txha (tsis tsuas daim tawv nqaij, tiam sis kuj nrog).
2. Peritonitis thiab sepsis.
3. Ntshav los ntawm lub cheeb tsam ntawm cov pob qij txha, xws li rau sab hauv.
4. Hematoma leeg cheeb tsam.
5. Dysuria.
6. PE (pulmonary embolism).

Txawm lub strictest observance ntawm sterility yog tsis ib txwm tau kom tsis txhob taub dej khawb rau cov teeb meem. Qhov no yog vim lub fact tias lub lag luam yog ua rau cov neeg mob uas nws lub cev tsis muaj zog txaus thiab thiaj li cov tawm tsam nrog kab mob qog hlav kev tiv thaiv yog txo. Yog li ntawd, o ntawm lub pob qij txha nyob rau hauv lawv - ib tug ua tau qhov teeb meem no. Rau cov hom phiaj ntawm kev tiv thaiv ib tug muab kev mob nyob rau hauv lub postoperative lub sij hawm yuav tsum tau tshuaj tua kab mob.

Ntshav thiab nqaij doog qhia ib tug tsis muaj hemostasis. Teem caij hemostatic tshuaj tsis yog ib txwm txaus, thiab tej zaum kuj yuav tsum tau rov muab hlais tawm lawm - kho nqi lus ntawm lub qhov txhab thiab suturing ntawm los ntshav hlab ntsha.

Dysuria - heev thiab mob tso zis. Cov tsos ntawm no cov tsos mob yog sai tau yog tias puas txheej urethral catheter thiab qhov tshwm sim ntawm kev puas urethritis.

PE yuav tshwm sim raws li ib tug mob thrombosis ntawm lub qis extremities. Uas yog vim li cas nyob rau hauv lub postoperative lub sij hawm raug anticoagulation ( "heparin") thiab pom zoo kom hnav compression vuam txwv ntev los yog elastic bandages.

Lub txim ntawm lig lub sij hawm

Muaj ntau yam teeb meem tom qab phais Wertheim, tsim nyob rau hauv lub sij hawm ntev:

1. Emotional cov teeb meem: kev ntshai ntawm tau hloov nyob rau hauv tsos thiab tsis pw ua niam txiv tsav (vim hais tias lub zes qe menyuam raug muab tshem tawm, uas txhais tau tias cov theem ntawm kev sib deev cov tshuaj hormones hloov), kev xav txog lub cev tsis tau cev xeeb tub, cov dab tuag caws pliav nyob rau hauv lub anterior mob plab phab ntsa.
2. Abdominal adhesions.
3. Qhov kawg nkaus.
4. Omission ntawm qhov chaw mos.
5. Kev Kawm Ntawv retroperitoneal limfokist.

Yaam puab paub ntawm cov poj niam txog lub txim ntawm kev hysterectomy yog heev nkag siab. Yog li ntawd, nyob rau hauv lub postoperative lub sij hawm yog tseem ceeb heev kev pab txhawb thiab kev nkag siab ntawm tsev neeg.

Muaj ib co teeb meem (postoperative caws pliav, lub cev tsis muaj cov me nyuam) yuav tau txais xwb. Nyob rau hauv lwm yam kev ntshai muaj peev xwm thiab yuav tsum sib ntaus sib tua, raws li lawv yog feem ntau unfounded. Spaying tsis entail tej cardinal hloov nyob rau hauv tsos los yog kev sib deev ib cheeb. Tab sis tej zaum nws yuav ua rau tsis xis nyob thaum sib deev com hais tias tom qab gisteretomii tshuav ib yam nkaus thiab luv luv paum hauv paus.

Adhesions tom qab phais Wertheim yog tsim nyob rau hauv tib txoj kev raws li tom qab phais kab noj hniav. Qhov no yog vim traumatization ntawm lub peritoneum thaum lub sij hawm lub lag luam, uas ua rau yus mus rau tsim ntawm connective cov ntaub so ntswg strands ntawm nws cov ntawv txheeb thiab hauv nruab nrog cev.

Adhesions nyob rau hauv lub plab kab noj hniav yuav ua rau mob plab, mob tso zis thiab defecation, thiab nyob rau hauv tej rooj plaub txawm ua rau plab hnyuv dab tsi thaiv. Rau kev tiv thaiv ntawm adhesion tsim nyob rau hauv lub postoperative lub sij hawm yog ib qho tseem ceeb thaum ntxov kom tus neeg mob thiab kev kho lub cev nyob rau hauv thawj hnub tom qab phais.

Lawm no tshwm sim tom qab hysterectomy vim qhov kev tshem tawm ntawm lub zes qe menyuam. Postoperative lawm nqa hnyav tej yam ntuj tso, vim hais tias nyob rau hauv cov ntaub ntawv no, hormonal hloov tshwm sim sai heev. Yuav kom txo tau tsis xis nyob siv hormone hloov txoj kev kho.

Ib tug pojniam prolapse phais Wertheim ua tau vim kev puas tsuaj ligamentous apparatus (ib tug tsim nyog mob rau kev ua tau zoo ib tug hysterectomy) thiab lub xaav ntawm lub pelvic kabmob nyob rau hauv qhov chaw no yog tsis tuaj kawm ntawv lub tsev me nyuam. Rau kev tiv thaiv ntawm tej teeb meem rau tus neeg mob yog pom zoo ua tshwj xeeb ce, hnav ib brace, kev txwv ntawm lub cev kev ua rau tsawg kawg 2 lub hlis tom qab phais.

Feem ntau nyob rau hauv lub retroperitoneal qhov chaw yog tsim limfokista Wertheim tom qab phais. Nws yog phais mob. Txawm li cas los, ntau npaum li cas zoo tiv thaiv kom txhob muaj tshwm sim ntawm no yam tab kaum yog tseem nyob rau theem ntawm lub lag luam, tshaj los kho. Rau lub hom phiaj no, txawv txoj kev kua retroperitoneum.

Yuav ua li cas cov neeg no hais txog lub Wertheim lag luam

Yog xav tau tshem ntawm cov radical lub tsev me nyuam los yog endometrial cancer siv Wertheim lag luam. Teb txog nws yog cov sib txawv.

Cov kws kho mob thiab cov neeg mob hais tej uas zoo tom qab lub lag luam:

1. Qhov nce nyob rau hauv lub neej expectancy.
2. Guaranteed tsis tuaj kawm ntawv ntawm uterine kab mob, xws li mob cancer.
3. Pov, tsis pub txawm tias ib tug me me yuav tshwm ntawm ib tug pliaj cev xeeb tub.
4. Lub lag luam tsis txo cov efficiency, nws yog tau rov qab mus rau lub neej zoo.

Cons hauj lwm:

1. Cev tsis muaj cov me nyuam.
2. Dab tuag caws pliav nyob rau hauv lub anterior mob plab phab ntsa.
3. Tseem muaj teeb meem, ob leeg thaum ntxov thiab lig (sib tham saum toj no).

Yuav kom saib lub ntsab lug

Hysterectomy rau Wertheim - zoo radical kev kho mob ntawm phem lub tsev me nyuam thiab endometrial hlav. Qhov no lub lag luam yog tsis tsuas muaj pab tus neeg mob mob cancer, tab sis kuj nyob rau hauv ib txoj kev pab txoj kev zoo ntawm lub neej.

Ntawm cov hoob kawm, zoo li kev phais, hysterectomy yog fraught nrog txoj kev loj hlob ntawm cov teeb meem. Txawm li cas los, thaum lub peev xwm koom haum ntawm lub postoperative lub sij hawm, thiab raug mus rau qhov tsim nyog tiv thaiv kev ntsuas kom tsis txhob rau lawv.