Enteroplexy: mhando. Nzira akakura intestinal rusvingo

Shoko rokuti "intestinal musono" ari seboka uye inosanganisira kubviswa akuvara uye zvikanganiso yegurokuro, dumbu uye ura. Kunyange munguva Crimean War, Pirogov Nikolay Ivanovich akashandiswa suturing mhango nhengo dzinokosha vazvo. Vakabatsira kuchengeta zvakakanganisa nenyere. Kwemakore akawanda, isu shanduro zvose idzva intestinal suture kupa, vakakurukura zvakanakira nekuipira kuti akasiyana kusiyana nayo, izvo zvinoratidza kukosha uye unoreva zvakawanda dambudziko. nzvimbo iyi yakazaruka yokutsvakurudza uye kwacho. Zvichida munguva pfupi chichava munhu ichapa rakasiyana nzira maererano tishu. Uye uchava budiriro iri Nzira pamusoro stitching.

Zvinodiwa intestinal musono

In vavhiyiwa, pane mamiriro ezvinhu akawanda kuti akasangana ne intestinal suture kuti rinogona kushandiswa abdominal akavhiyiwa:

1. Chokutanga, kuvimbika. Izvi zvinoitwa enzanirana yakarurama serous hukawanika. Vanoomerera mumwe uye vari welded zvakasimba, pova vanga. Negative nokuratidzwa zvivako zviri adhesions kuti kuvatadzisa ndima yacho intestinal zviri chubhu.
2. Kugona kumisa kubuda kweropa, apo kuramba yakakwana ropa romugove midziyo nokuda musono yayo mangwanani kuporesa.
3. The musono vanofanira kufunga nemamiriro zvomudumbu turakiti rusvingo.
4. A simba chinokosha yose ronda.
5. Vakuvadzei micheto zvepuraimari chinangwa.
6. Minimal kunotevera miviri GI (gastrointestinal). Izvi zvinoreva renunciation kuti twining kumativi stitches, kushandisa dzisiri invasive tsono, uyewo kushandisa kuduku forceps uye okusungisa, izvo zvinogona kukuvadza rusvingo negomba muviri.
7. Yambiro matehwe necrosis.
8. kuenzanisa yakarurama akaturikidzana ari intestinal chubhu.
9. Kushandiswa biodegradable zvinhu.

The nemamiriro intestinal rusvingo

Sezvo kutonga, intestinal rusvingo chubhu ine chivako padzimba, zvidiki zvakasiyana. The rukoko yomukati - mucous zvinyama randinogara chete rukoko cubic pamusoro epithelium, izvo mune zvimwe zvikamu vane villi nokuda nani Absorção de Água. Nokuti mucosa iri friable submucosal rukoko. Zvadaro pane zvakasimba tsandanyama rukoko. Pakukora uye nourongwa fibers kunobva intestinal chubhu kadhi. In yegurokuro tsandanyama vari circularly, ari ura duku - longitudinally, uye mukati merima tsandanyama fibers vari yakarongwa muchimiro yakafara matepi. Nokuti tsandanyama rukoko ndiyo serosa. Ichi nhete firimu, iro rinotaura negomba miviri uye nechokwadi kwavo mufambo hama kune mumwe. Kuvapo rukoko urwu anofanira kufunga kana seari intestinal musono.

Properties serosa

A unoshanda pfuma kunorapwa serosa (m. E. wokunze) Kamudzira pamusoro zvomudumbu chubhu iri kuti pashure chienderane ronda micheto zvakasimba glued kwairi kwemaawa gumi, uye fibers kunge zvakakwana zvakasimba fused Via mazuva maviri. Izvi inopa musono tightness. Kuti izvi chaizvoizvo unofanira kushandisa stitches kazhinji zvakakwana, dzinenge ina kune rimwe sendimita.

dzakaonda chakaita zvokugadzirwa pemavara inoshandiswa kuderedza kunetseka mupfungwa dzomuviri dziri ronda panguva crosslinking. Kazhinji, asi sutured kusvika serosa tsandanyama fibers, iyo kupa mukuru elasticity musono, uye nokudaro, kukwanisa ruoko munguva ndima bolus. Capture submucosal uye mucosal akaturikidzana zvinopa hemostasis zvakanaka uye yokuwedzera simba. Asi zvinokosha kuti tiyeuke kuti chirwere pamwe yomukati penyika intestinal chubhu kubudikidza suture anogona rakapararira abdominal mhango.

The wokunze uye yomukati zvakaitika alimentary Canal

Kudzidzira chiremba kunokosha zvikuru kuziva futlyarnoy musimboti nemamiriro alimentary Canal rusvingo. Pasi dzidziso iyi inotaura kwokunze uye dzimwe nyaya. Rokunze nyaya zvinosanganisira serosa uye tsandanyama membranes uye nechomukati - of mucosa uye submucosa. Ndivo chinjwa hama kune mumwe. Munzvimbo dzakasiyana-siyana dziri intestinal chubhu kana misha kukuvara zvakasiyana. Somuenzaniso, kuderera kupfuura nyaya yomukati, uye kana kukuvara mudumbu kusvikira yegurokuro padanho - kunze. Muna ura, zvose mumuhara vakapararira zvakaenzana.

Kana chiremba sutures yegurokuro rusvingo, tsono iri jekiseni obliquely mune lateral mirayiridzo (padivi). A perforation iri sutured mune gastric Rusvingo zvakashandurwa, obliquely-medial mirayiridzo. Zviduku ura riri vasonanidza chaizvo perpendicular. Kure pakati stitches havafaniri millimeters asingasviki mana. Matanho kutungamirira vasanyanye ischemia uye necrosis of muchikuvadza micheto, uye kuwedzera - kuti kukundikana uye ropa.

Muganhu pedo-kumucheto vazvo uye mapfundo

Intestinal musono inogona zvemaziso uye Chinyorwa. Ekupedzisira, akavapindurawo, vakakamurwa pamuganhu, pedyo-unopinza uye zvabatanidzwa. Chokutanga vanopfuura kuburikidza kumucheto ronda, wechipiri shure kubva pamupendero wayo haasi sendimita, uye zvikabatanidzwa nokubatanidza maviri yapfuura kusarudza.

Muganhu vazvo vane odnofutlyarnymi uye dvuhfutlyarnymi. It zvinoenderana sei anoshongwa zhinji kwakabatana panguva. Bir musono pamwe nodes pamwe rokunze musono parusvingo uye Mateshuka (pamwe nodes mukati) anoreva chimwe-pachikuva, sezvo chete kubata kune tunica muscularis uye serosa. A-rukoko matatu intestinal musono Pirogov, izvo kwete chete ari vasonanidza rokunze nyaya, asi vo submucosal rukoko kuburikidza musono uye vari Gely dvuhfutlyarnymi.

Uyewo kuburikidza kwokubatana anogona chinozoiswa somunhu raiva pedyo nebundu, uye chinoramba musono. Izvi yokupedzisira ane zvakasiyana-siyana dzakawanda:

- twining kumativi;
- metiresi inotsigira;
- Reverdy musono;
- musono Schmid.

Pedyo-kumucheto, zvakare, nokuzvidya kupatsanura kwavo. Saka, ega Lambert musono rinomirira dvustezhkovy suture chikepe. It rinoshandisirwa rokunze (sero-tsandanyama) nyaya. Asi pane chinoramba vhoriyamu, chikwama tambo, polukisetny, U-yakaumba Z-zvakaumbwa.

aibatanidza vazvo

Sezvo zita rinoreva kuti sutures mubatanidzwa sangana zvemamiriro mupendero uye pedyo-mucheto. Govera "anonzi" zvomusejari sutures. Vari zita vanachiremba vakanga kutanga kushandiswa navo akavhiyiwa pamusoro abdominal zvomukati:

1. The musono ndiyo remubatanidzwa Czerny unopinza uye pedyo-mupendero sero-tsandanyama rwakashodoka.
2. Kirpatovsky musono - ibatanidzo mupendero musono uye submucosal serous-tsandanyama.
3. Albert musono zvinosanganisira mbiri chaiyo vagari: Lambert uye Gely.
4. Tupe musono rinotanga sechinhu unopinza kuburikidza musono, izvo zvinoumba vari zvakabatanidzwa muviri lumen. Lambert ipapo suture anoiswa pamusoro.

Kupatsanura nenhamba mitsara

Panewo weboka vazvo kwete chete vanyori asiwo kuwanda mitsara seari rimwe pamusoro mumwe. Rusvingo intestinal ane zvimwe mumucheto, saka maronda suturing mashandiro rakagadzirwa kuti vadzivise kufekuka munyama.

Single mutsara vazvo bindepinde zvakaoma, zvinoda chaizvo nemazvo kuvhiya unyanzvi, kukwanisa kushanda pamwe uchishandisa maikorosikopu uye dzakaonda atraumatic tsono. Zvombo zvakadaro hakusi inowanika anodawo zvose, uye haana chiremba ose anogona kurarama nayo. The anowanzodanwa kushandiswa kaviri-musara stitching. Vari zvakanaka wakaiswa uye muchikuvadza micheto ndiwo mureza yegoridhe abdominal kuvhiyiwa.

Multi-mutsara sutures anoshandiswa chaizvo kashoma. Ainyanya nokuti chokuti intestinal chubhu muviri rusvingo chitete uye munyoro, uye vakawanda filaments kuti rakapinza nayo. Kazhinji, kuifukidza multirow oparesheni vazvo kugumira panguva ura huru, semuenzaniso appendectomy. The chiremba wokutanga ligature zvinoisa mujinga okuwedzera. Uyu ndiye wokutanga, musono rwomukati. Zvadaro pane chikwama tambo suture kuburikidza serous uye tsandanyama rukoko. Iye akasungirirwa akavhara pamusoro Z-zvakaumbwa, kugadzirira kenza chigutsa uye kupa hemostasis.

Kuenzanisa intestinal sutures

Kuti vazive zvinhu ezvinhu zvinokurudzirwa kushandisa imwe kana mumwe musono, vanofanira kuziva kwavo uye zvaasingagoni. Ngationgororei navo zvizere.

1. Gray-serous suture Lambert, nokuti ayo nenyama yose uye pakawanda ane nekuipira dzakawanda. Kureva, haina kupa zvakafanira hemostasis; zvikuru kusimba; Hazvina enzanisa mucosa uye submucosa. Naizvozvo, unofanira kushandisa kuburikidza tichibatanidza pamwe nemamwe stitches.

2. Nepakasiyana-siyana single- uye kaviri mumutsara stitches vane simba zvakakwana zvinopa zvizere kuenzanisa akaturikidzana ose munyama, zvinopa Zvakanyanya Kunaka Panguva Yepamuviri mamiriro kuporeswa munyama, pasina kuderedza lumen muviri, uyewo kubvisa nechitarisiko rakafara vanga. Asi vane payakaipira. Musono permeable rwomumwoyo dumbu microflora. Hygroscopicity inotungamirira hweHIV munyama yakapoteredza.

3. serous-tsandanyama-submucosal sutures nhaka yakawanda zvokuimba simba, kusangana nhungamiro futlyarnoy bowel rusvingo mamiriro, zvinopa zvizere hemostasis uye kudzivirira aienda pamusoro lumen negomba nenyere. musono kwakadaro pfungwa pane imwe nguva Pirogov Nikolay Ivanovich. Asi raiva chete-musara kushanduka. nadzurudzo iyi ane kunaka unhu:
- vanachandagwinyira akamendwa mutsetse kubatana;
- kuwedzera vanga Kukura nokuda kuzvimba uye kuzvimba.

4. Combined majoini yakavimbika, nyore kushandisa, gemostatichny, buri-uchapupu uye yakasimba. Asi kunyange zvakadaro munhu musono anoita akakwana, ane zvainovhiringidzawo ayo:
- kuzvimba munyama achitevedza mutsetse kubatana;
- kunonoka kuporeswa;
- nezvekugadzirwa necrosis;
- High ndingangokuvara adhesions;
- chirwere pemavara mu nomunyika mucosa.

5. Triple mutsara majoini Anonyanyowanika kushandiswa kuvhara urema ari muura. Vane yakasimba, kupa kwadzakabva ronda kumicheto zvakanaka. Izvi zvinoderedza mukana chokutsva uye necrosis. Pakati zvinokanganiswa nzira iyi ndiwo:
- chirwere nokuda suturing shinda sheaths maviri panguva imwe chete;
- kuderera pakuberekwa kutsva kwakaita zvinyama panguva ronda nzvimbo;
- yakakwirira ndingangokuvara panowanikwa adhesions, uye, sezvo migumisiro mhingaidzo;
- ischemia rinenge pa nzvimbo suture.

Tinogona kutaura kuti unyanzvi neimwe suturing maronda mhango nhengo ine mikana ayo uye nekuipira. Kuvhiya zvakakodzera kutarisa tuso basa ravo - chii chaizvo anoda kuti vawane oparesheni ichi. Chokwadi, nguva dzose zvakanaka Migumisiro vanofanira kuikunda zvakaipa, asi vapedzisira haagoni kuva zvachose chechetere.

teething vazvo

Conventionally, vose majoini inogona kupatsanurwa muzvikwata zvitatu: avo kuti kuputika dzinenge nguva dzose kuputika kashoma uye akapotsa kucheka. Boka rokutanga anowana musono Schmid uye Albert musono. Ivo nepakati mucous Kamudzira, iyo nyore kukuvara. Wechipiri boka ndezvaJehovha vazvo, akaiswa pedyo muviri lumen. musono ichi uye musono Mateshuka Bira. Boka rechitatu rinosanganisira vazvo kuti havasi neVadzidzi lumen yacho dumbu. Somuenzaniso, Lambert.

Chose kudzivirira kubata kuputika kune weld hazvibviri, kunyange kana izvozvo rinoshandiswa chete serosa. Under zvakaenzana ezvinhu dzamarudzi musono hunodzurwa ane yepamusoro mukana kupfuura raiva pedyo nebundu. Izvi chinowanzoitika kuwedzera kana shinda iri rakaitirwa pedyo muviri lumen.

Kusiyanisa zvokuimba kuputika yakapfava chokudzingwa musono pamwe necrotic makuru uye kuputika zvakaitwa somugumisiro vemunzvimbo wakakanganiswa tishu.

Advanced resorbable zvinhu

By kure zvikuru kusununguka zvinhu zvinogona kuita intestinal musono - a resorbable chakaita zvokugadzirwa fibers. Vanobvumira here kubatanidza micheto ronda kuti chaizvo kwenguva refu uye regai kusiya muviri murwere wokumwe zvinhu. Pfungwa iri rwakabhadharwa kuna mashandiro rokubvisa nerwodzi kubva mumuviri. Natural fibers pachena zvinyama makemikari, uye chakaita zvokugadzirwa fibers vari wakanamatira ne hydrolysis. Sezvo hydrolysis iri shoma zvinoparadza munyama muviri, zviri nani kushandisa chakaita zvokugadzirwa zvokuvakisa.

Uyezve, kushandisa chakaita zvokugadzirwa zvinhu zvinoita kuti tikwanise kuwana hwakasimba musono yomukati. Havazivi zvinopfuura rejira, saka, zvose dambudziko iri kungaita kuti pamusoro, zvakare, havachafaniri. Chimwe unhu hwakanaka mapurasitiki pakuti havasi yekubata mvura. Izvi zvinoreva kuti musono haringapiwi akaremara uye intestinal kasvisto, izvo zvinogona kukanganisa ronda, uye haangazvidembi kuwira pamuviri lumen pamusoro rayo pamusoro.

Kusarudza musono uye zvinhu kuti sutured vanga, chiremba anofanira kutungamirirwa kuremekedza chaivo mitemo zvinopa tishu Fusion. Chido kubatanidza acho, kuderedza uwandu mitsara kana anoshandisa nekusimba kuti tambo haana kuva nechinangwa. Chekutanga inokosha murwere kuchengeteka, ayo usability, zvinoderedza ose post-kushanda kupora nguva uye kurwadziwa.