Enteroplexy: momo. taiepa intestinal Methods pūhui

Ko te wā "tui intestinal" ko te ngā, me tā te tango o whara me hē o te pū kai, puku me te paru. Ahakoa i roto i te Crimean War, whakamahia Pirogov Nikolay Ivanovich mō te suturing whekau tuwhera kaimono motuhake. Ua tauturu ratou te pupuri i te okana pāngia. No te tau maha, whakahere tatou putanga hou katoa o suture intestinal, kōrero nga painga me ngā kino o te rerekētanga rerekē o reira, e tohu te faufaa me rangirua o te raruraru. he tuwhera mō te rangahau me te tamataraa tenei rohe. Pea i roto i te heke mai tata, ka waiho hei tangata nei e whakahere te tikanga ahurei o te kiko hononga. A ka waiho te reira i te pakaruhanga i roto i te tikanga o te tuitui.

whakaritenga Basic mō te tui intestinal

I roto i te pokanga, i reira e rave rahi tikanga ki te kia tutaki e te suture intestinal i roto i te tikanga e taea te whakamahi i te reira i roto i ngā mahi puku:

1. Tuatahi o te katoa, tapatahi. tutuki ana tēnei te ōrite tika o papa serous e. piri ratou ki tetahi ki tetahi, me te e paiherea piri, hanga he nawe. faaiteraa tōraro o te āhuatanga he adhesions e kia te tāwari i te wahi o nga tirotiro intestinal o te ngongo.
2. Ko te kaha ki te mutu i te toto, i te pupuri i oko supply toto rawaka mō te tui, me tona whakaora wawe.
3. kia tango i te tui o ki pūkete te hanganga o te taiepa wahi kūnatu.
4. He kaha nui, puta noa i te motu.
5. taha maru ia i te whakaaro tuatahi.
6. Iti GI tinana whētuki (gastrointestinal). fakahu'unga tenei liaki o tāwhiwhi tuinga a tawhio, te whakamahi o ngira kore-urutomo, me te iti whakamahi o Kuku me hononga, e taea tūkino te taiepa o te tinana tuwhera.
7. Whakatūpato hiako necrosis.
8. whakarite Accurate o nga paparanga o te ngongo intestinal.
9. Ko te whakamahi o te rauemi pōpopo.

Ko te hanganga o te taiepa intestinal

Ka rite ki te tikanga, kua te hanganga ano, puta noa, ki te rerekētanga iti te taiepa intestinal o te ngongo. Ko te paparanga roto - kiko mucous, e ngā o te paparanga kotahi pūtoru o epithelium, i roto i etahi wahi i Villi mō pai absorption. Hoki mucosa he apa submucosal pōkurukuru. Na i reira ko te apa uaua kikī. Ko te matotoru me te whakaritenga o te muka, tei runga i te kāri ngongo intestinal. I roto i te uaua pū kai e circularly, i roto i te kōpiro iti - ōna, a i roto i te muka uaua matotoru e whakaritea i roto i te puka o rïpene whānui. Hoki te apa uaua ko te serosa. Tenei kiriata angiangi, e hipokina te tinana tuwhera, me te whakarite o ratou whanaunga nekeneke ki tahi i te tahi. Me tango te aroaro o tenei paparanga ki pūkete ka superimposed tui intestinal.

āhuatanga serosa

He taonga whai hua mō te pokanga serosa (m. E. waho) kiriuhi o te ngongo kūnatu ko e i muri i ōrite te taha patunga piri Katahi ki reira mo te tekau ma rua haora, a ka kua feunga piri tauta te muka mā rua ra. E whakarato ana tēnei i te tightness tui. Ki te tiki i tenei pānga, me tono koe i te tuinga maha nui, i te iti rawa e wha ki te kotahi henimita.

E whakamahia ngangana kikokore waihanga ki te whakaiti i te kopa ngaukino i roto i te patunga i roto i crosslinking. Tikanga, te sutured ki te muka uaua serosa, e hoatu nui tui elasticity, a ko te kupu, ki te kaha totoro i roto i te wahi o te bolus. Hopu submucosal me papa mucosal whakarato hemostasis pai, me te atu te kaha. Ko he mea nui ki te mahara i taua mate ki te mata o te ngongo intestinal roto i te suture taea horahia puta noa i te kōhao puku.

Ko te take i waho, me te roto o te arakai

Hei mahi i te taote, ko te tino nui ki te mohio e pā ana ki te hanganga parau tumu futlyarnoy o te taiepa arakai. I raro i tenei ariā tāutu take waho, me te ā. Ko te take i waho ngā serosa me uaua kiriuhi me ā-- o te mucosa me submucosa. Ko ratou whanaunga turanga ki tahi i te tahi. I roto i ngā wāhanga rerekē o te ngongo intestinal ka te displacement o kino rerekē. Hoki tauira, heke atu atu i te take i roto, a i roto i te take o te kino o te puku ki te taumata pū kai - i waho. I roto i te piro, horahia takotoranga e rua te taurite.

A, no te sutures te tākuta te taiepa pū kai, patia te ngira e obliquely i te aronga lateral (tītaha). sutured te perforation te i roto i te pakitara pekitīlia i roto i te ritenga atu, aronga obliquely-medial. tuia whēkau Iti me nui te rite hāngai. Ko te tawhiti i waenganui i nga tuinga kore e waiho iti iho i te wha mitamano. Hipanga arahi ki te hekenga i roto i ischemia me necrosis o nga tapa maru ia, me te hua - ki te kore, me te toto.

Boundary kaimono tata-mata me te hononga

Ka taea e tui intestinal e hangarau me te ā-. Ko te whakamutunga, i roto i te tahuri, e wehea i runga i te rohe, e tata-mata, me te ngā. Ko te haere tuatahi i roto i te mata o te motu, e kore te mea he hēnimeta tuarua te taui i tona mata, a ka ngā whakakotahi i te kōwhiringa o mua e rua.

He odnofutlyarnymi me dvuhfutlyarnymi kaimono Boundary. Tei te reira i runga i te tini o anga hono wā kotahi. Bir he tui ki kōpuku me te taiepa tui waho, me te Mateshuka (ki kōpuku roto) kōrero ki te-wāhanga kotahi, mai i pu anake te muscularis Tunica me serosa. He toru-apa he tui o intestinal Pirogov, e kore anake e tuia take waho, engari ano hoki i te apa submucosal roto i te tui, me te ko Gely dvuhfutlyarnymi.

I roto i te tahuri, kia whakatinana te hononga i roto i rite te kōpuku, me te tui tonu. He maha ngā rerekētanga tenei whakamutunga:

- tāwhiwhi a tawhio;
- E tautoko ana moenga;
- Reverdy tui;
- tui Schmid.

Tata-mata, rawa, i to ratou ake whakarōpū. Ko te kupu, taratahi Lambert tui e tohu punga suture dvustezhkovy. Kei te tono te reira ki te waho take (sero-uaua). i reira ano ko tetahi rōrahi tonu, putea string, polukisetny, U-āhua me Z-āhua.

kaimono ngā

Ka rite ki te ingoa titau, te sutures ngā ngā āhuatanga o te mata, me te tata-mata. Tohatoha "te ingoa" sutures hāparapara. E huaina ratou i muri i te mau taote e whakamahia tuatahi ratou mo ngā mahi i runga i te whekau puku:

1. Ko te tui ko he pūhui Czerny mata, me te tata-mata tahi sero-uaua.
2. tui Kirpatovsky - he huinga o te tui mata me submucosal serous-uaua.
3. Albert tui ngā rua tahi motuhake: Lambert me Gely.
4. haamata Tupe he tui rite te mata i roto i te tui, e kua titia wae ki te lumen tinana. whakanohoia Lambert ka suture te i runga i runga.

Whakarōpū i te maha o ngā rārangi

He he ano hoki te wehenga o kaimono kore anake kaituhi engari ano hoki i te maha o ngā rārangi superimposed tetahi i runga i te tahi atu. Ko te taiepa intestinal he tetahi taha, na kua patunga suturing tikanga kua hangaia kia rite ki te karo i te kopa hūnga.

Inaki uaua kaimono rarangi kotahi, e titau te reira i te pū tikanga hāparapara motuhake, te kaha ki te mahi tahi me te karu whakahaere me te ngira angiangi atraumatic. e kore te mea taua taputapu e wātea ana i roto i te mahi katoa, a taea kore taote katoa akakoromaki i reira. Ko te tuitui haupae-rua tino whakamahia nuitia. E pai te whakaritea ratou, me he taha maru ia te paerewa koura i roto i te pokanga puku.

E whakamahia sutures Maha-rarangi rawa uaua. Te nuinga e tika ana ki te meka i he kikokore, me te ngohengohe te taiepa tinana ngongo intestinal, me te tokomaha nui o kakawaea e ongó reira. Ko te tikanga, mutu kaimono mahi whakakikorua multirow i te kōpiro nui, hei tauira appendectomy. uta te taote motu tuatahi i runga i te turanga o te tāpiritanga. Ko te tuatahi, tui roto tenei. Na i reira ko te suture putea string roto i te paparanga serous me uaua. tightened ia a katia te runga Z-āhua, whakatika pukupuku tumu, me te whakarato hemostasis.

Whakatauritenga o sutures intestinal

I roto i te tikanga ki te mohio i roto i te mea ngā āhuatanga he mea tika ki te tono tetahi tetahi tui ranei, Me ki e mohio ana ratou kaha me ngoikoretanga. Kia titiro tatou ratou i roto i ngā kōrero.

1. Kerei-serous suture Lambert, mo tona otinga katoa me he maha ngā āhuatanga ringa rehe e. Ara, e kore e whakarato reira te hemostasis tika; rawa he pakarukaru; e kore e faaau i te reira mucosa me submucosa. Na reira, me te whakamahi i koe i te reira na roto i te whakakotahi i te reira ki te tahi atu tuinga.

He kaha 2. Boundary tuinga rarangi tahi, me te rua nui whakarato rite tonu o ngā papa katoa o te kopa, te whakarato tikanga tino pai mo te whakaora o te kopa, i waho whāiti te lumen o te tinana, me te whakakore i te ahua o te nawe whanui. Ko to ratou kino. He tui o permeable microflora punuatuna roto. arata'i Hygroscopicity ki te mate o te kopa tawhio reira.

riro 3. sutures serous-uaua-submucosal nui kaha aunoa, te whakatau i te mau parau tumu futlyarnoy hanganga taiepa whēkau, whakarato hemostasis tonu, me te ārai i whāiti o te lumen o te okana tuwhera. fokotu'u taua he tui i te kotahi wā Pirogov Nikolay Ivanovich. Otiia ko reira he rerekētanga kotahi-rarangi. kua he mau huru kino tenei whakarerekētanga:
- mārō hononga raina papanga;
- he hua i roto i te rahi nawe e tika ana ki te ngawhatanga me te mumura.

He pono, ngāwari ki te whakatinana, gemostatichny, turuturu-tohu, me te roa 4. hononga Whakakotahi. Otiia ara taua he tui huru tino, kua ona drawbacks:
- mumura o nga kopa haere te hononga rārangi;
- whakaora puhoi;
- hanganga o necrosis;
- tūponotanga High o adhesions;
- ngangana mate i roto i haere i roto i te mucosa.

Kei te nuinga 5. hononga rarangi Tōtoru whakamahia mō te katinga o hē i roto i te kopirua. He roa ratou, whakarato urutaunga pai o te taha marutanga. te whakaiti i tenei te mōrea o te mumura me te necrosis. I roto i nga tōnounou o tenei tikanga ko:
- mate e tika ana ki te suturing aho e rua sheaths wā kotahi;
- tērā iho te mahi whakaora i o te kikokiko i te pae marutanga;
- tūponotanga nui o takanga o adhesions, a, ka rite ki te putanga o te arai;
- ischemia kikokiko i te pae o te suture.

Ka taea e tatou te mea e ia tikanga suturing patunga o whekau tuwhera he ona ake huapai me ngā huakore. he tika pokanga ki te arotahi ki runga i te hua mutunga o to ratou mahi - he aha rite e hiahia ana ia ki te whakatutuki i tenei mahi. O te akoranga, kia taea te pānga pai tonu i runga i te kino, engari e kore e taea te whakamutunga e tino taumata.

teething kaimono

Conventionally, e taea te wehea nga hononga katoa ki ngā rōpū e toru: te hunga e puia tata puia tonu uaua me tata tapahia i roto i. whiwhi te rōpū tuatahi tui Schmid ko Albert tui. tika ratou i roto i te membrane mucous, kei te ngāwari i whara. Ki te rōpū tuarua no ki te kaimono, tūnga tata te lumen tinana. Tenei tui me te tui Mateshuka Bira. Ko te toru o te rōpū ngā kaimono kore e i roto i te whakapā atu ki te lumen o te punuatuna. Hei tauira, Lambert.

Mutu aukati te taea o te hūnga o te Weld kahore he taea, ara, ki te te tono reira ki te serosa anake. I raro i rite tikanga o tui o tonu kua tapahia te reira ki te tūponotanga runga ake i te kōpuku. Ko te pea ki te whakapiki ake i te mea puritia te miro te tata ki te lumen tinana tenei.

Wehewehe tahi aunoa hū miro aukati he tui ki papatipu necrotic me hūnga o te tauhohenga rite ki te hua o te rohe kikokiko pakaru.

rauemi resorbable Arā

Na roto i te tawhiti te rauemi tino whakamarie e taea te mahi i he tui o intestinal - he muka waihanga resorbable. tukua ratou ki a koutou te hono i te taha o te motu ki rawa he wa roa, me te kore e waiho te tinana o te rauemi ke manawanui. utua ngā aro te ki te huarahi o te tango o miro i te tinana. E whai wāhi ana muka Natural whākōkī kiko, a kua piri muka waihanga i te paparetanga. Mai paparetanga he iti whakangaro te kopa o te tinana, he mea pai ki te whakamahi i ngā rauemi waihanga.

I tua atu, i te whakamahi o ngā rauemi waihanga hanga reira taea ki te whiwhi i te tui roto totoka. e kore e ratou ô i te papanga, reira, te raruraru katoa e tenei i taea e arahi ki te runga, rawa, e araia. Tetahi kirihou kounga pai i roto i taua e kore ratou e mimiti te wai. tikanga o tēnei e kore e kia hauā te tui, me te tipu intestinal, e taea e whakapoke i te motu, a kore e hinga i roto i o te lumen tinana i runga i tona mata waho.

Te kōwhiri i te tui, me te rauemi ki te kia sutured te motu, me te ārahi i te tākuta i te faatura mo nga ture koiora e whakarato kiko hononga. Ko te hiahia ki te whakakotahi i te tukanga, whakaiti i te maha o ngā rārangi tono kï e kore e whenu e te whāinga ranei. Tuatahi o te haumaru katoa nui manawanui, tona whakamahinga, whakaiti o te wā ora pou-operative me te mamae.