Enteroplexy: ano. Nā Papahana i huiia intestinal pa

Kaʻia "intestinal ulana" He He like, a komo ai i ka wehe 'ana o nā palapū a me mā o ka esophagus,'ōpū a me ka naʻau liʻiliʻi. A hiki i ka Crimean War, Pirogov Nikolay Ivanovich hoʻohana no ka suturing puha nā loko kūikawā nakaka. La lakou mamuli o malama i ka hoʻohuli ai i nā hui. No ka nui makahiki, ua kaumaha a pau hou wale nō o intestinal suture, ana no i ka pono a me keakea o keʻano likeʻole o ka mea, i Hōʻike i ka nui a me ka ambiguity o ka pilikia. Kēia wahi mea hamama no ka noiʻi a me ka experimentation. Paha i loko o ka wā e hiki mai ma kahi o ka mea, e ia i kekahi kanaka nana e kaumaha i ka hanana ano o ka pili ana'aʻaʻa. A ka mea, e lilo ia i Hopu i loko o keʻano hana o ka stitching.

XIX. Olelo no intestinal ulana

Iʻoki kino, he mea mau rula e e halawai ma ka intestinal suture ma ka mea i ka mea hiki ke hoʻohana 'ia i loko o abdominal hana:

1. Mua o nā mea a pau, ano hoopono. Kēia Ua loaʻa ma ka pololei'ālike o serous surfaces. Ka mea, hoopili aku i kekahi i kekahi, a i welded paa i, ho okumu i kekahi me ka makaʻu no. Hopena maikaʻi hoike ana mai o na waiwai i adhesions i ke keʻakeʻa i ka hooholo ana o ka intestinal Contents o ka Tube.
2. Ke hiki, e hooki aku i ke kahe ana ke koko, oiai e malama ana lawa koko kokuaia mai e na moku no ka ulana a me kona i kakahiaka nui ho'ōla.
3. Ka ulana E lawe i ka mooolelo o ka 'ole o ka digestive'āpana pa.
4. A nui ka ikaika ma kaʻeha.
5. 'ōwili kihi a iniiaiie manao.
6. Ka palena haʻahaʻa trauma kino GI (gastrointestinal). Kēia hoʻohuʻu renunciation o ka ie milo a stitches, ka hoʻohana 'ana o ka ole-invasive paipu, e like me kaupalena pono o forceps a me clamps, a hiki hanaʻino i ka pa o ka puha kino.
7. Ōlelo Aʻo tehasa necrosis.
8. Pololei e like ana o na papa o ka intestinal Tube.
9. Ka hoʻohana a biodegradable mea.

Ka 'ole o ka intestinal pa

E like me ka rula, o ka intestinal paia o ka Tube mai ka ia 'ole a puni, me ka nīnūnē likeʻole. Ka pahale loko, ahu iho - mucous'aʻaʻa, a he o ka cubic hookahi ahu iho la ka epithelium, a ma kekahi mau wahi i villi no ka maikaʻi omo. No ka mucosa mea friable submucosal, ahu iho. A laila, he mea kekahi i pilipaa Muscle, ahu iho. Ka mānoanoa a me ka hoʻoponoponoʻana o Kamehameha o na olona, hilinaʻi nui ma luna o ka intestinal Tube kāleka. Ma ka esophagus nāʻiʻo i circularly, ma ka liʻiliʻi liʻiliʻi - longitudinally, a ma ke ao Muscle olona, i ka hooponopono ia ma ke ano o ka mea, he akea ka leki. No ka mea Muscle, ahu iho ka serosa. Kēia lahilahi ho film, a uhi iluna o na puha kino, a hōʻoia 'lākou ka hoʻoneʻe pili i kekahi i kekahi. pono lawe ke alo aku o keia ahu iho la i loko o ka wā no superimposed intestinal ulana.

mall serosa

A pono keia mau mea waiwai no kaʻoki kino serosa (m. E. mawaho)ʻili lahilahi o ka digestive Tube mea i ma hope o'ālike o kaʻeha kihi paa i tuko i ia mea no ka he umikumamalua hora, a me na olona, ua lawa ka paa i fused Via mau lā. Ua 'oi aku ka ulana tightness. E kiʻi i kēia kanawai, e pono pili i nā stitches pinepine lawa, ma ka liʻiliʻi loa eha i kekahi kenimika.

lahilahi kemikala nā huakaʻi i hoʻohana e emi i ka traumatic nā'aʻaʻa i loko o ka eha i crosslinking. Nō kāu, ka sutured i ka serosa Muscle olona, a haawi nui elasticity ulana, a me ka pela, me ka hiki, e kau i ka hooholo ana o ka bolus. Hoʻopio aku i submucosal a mucosal papa i maikai hemostasis a me ka hou ikaika. Akā, ia mea nui, e hoomanao i ka maʻiʻaʻai ana me ka pahale ili o ka intestinal Tube ma ka suture ke palahalaha ae ma ka abdominal lua.

Ke waho a me loko hihia o ka alimentary Canal

E hoÿomaÿamaÿa ka surgeon mea loa nui i ka ike e pili ana i futlyarnoy rula ole o ka alimentary Canal pa. Ma lalo o kēia kumumanaʻo e hōʻike ana mawaho a me na hihia. Ka mawaho hihia ka loaʻa o serosa a me ka Muscle membranes a me na - o ka mucosa a me ka submucosa. Ka mea, e hoʻoneʻe pili i kekahi i kekahi. I wahi likeʻole o ka intestinal Tube ka wā o ka pohupani hale o ke pohoʻokoʻa. No ka paha, emi oi ma mua o ka lilo o ka hihia, a ma ka hihia o ka poho o ka'ōpū i ka esophagus kiʻekiʻe - waho. Ma ka liʻiliʻi, nā wahi e halii mai i kōā kaulike.

A hiki i ka surgeon sutures ka esophagus paia, i ke kui kele ma ua injected obliquely i loko o ke kīloi paʻewa kuhikuhi (sideways). A perforation ua sutured i loko o ka gastric pā i loko o ka e ku pono, obliquely-medial ao ao. Small a me ka nui liʻiliʻi ua akeke me kēia nui ÷ haku. Ka mamao ma waena o ka stitches e ole e emi malalo o eha millimeters. Me ke kapuai hookahi e alakai ana i ka emi ma ka ischemia a me necrosis o ka'ōwili kihi, a me ka mea ulu - a hiki i ka holo pono a me ka kahe ana ke koko.

Palena kokoke-kaʻe nakaka, a ami

Intestinal ulana hiki e me mechanical a me ka manuale. Ka hope, i ka huli, ua māheleʻia aʻela ma luna o ka palena, kokoke-kihi a me ka hui. Ka mea mua, e hele ia ma ka lihi o ka eha, i ka lua o ka hee, mai kona maka mea,ʻaʻole he kenimika, a hui pu iho i ka mua koho elua.

Mokuna na nakaka i odnofutlyarnymi a me ka dvuhfutlyarnymi. Ua hilinaʻi nui ma ehia na leho pili ana ka poʻe. Bir ulana me nā aka wahi ma ka pā ulana paia, a Mateshuka (me ka aka wahi i loko o) i kapa i ka hoʻokahi-ke kahua, mai wale loaʻa ka tunica muscularis a me ka serosa. A ekolu-, ahu iho intestinal ulana Pirogov, i ole wale ua; akeke nui mawaho hihia, akā, i ka submucosal, ahu iho ma ka ulana, aʻo Gely dvuhfutlyarnymi.

I huli ai oe, o ka ma pili 'o Randy i ke hoʻokō i ka'āina, a me ke ana ulana. Keia la mahope loaʻa paha kekahi mau likeʻole:

- ie milo a puni;
- Mattress Kākoʻo;
- Reverdy ulana;
- ulana Schmid.

Near-maka, hoi, i kā lākou mau Mea Maluna. Penei, kaʻawale Lambert ulana i ho dvustezhkovy suture heleuma. Ua ua pili i ka pā (sero-muscular) hihia. Akā, he mea kekahi ana ka leo, ka aa kala ole ia -a-, polukisetny, U-hoʻokino a Z-hoʻokino.

hui na nakaka

E like me ka inoa hoʻohuʻu, ka hui sutures hui pu iho oihana mua o ka maka, a kokoke-lihi. Līkaia no "ka inoa"ʻoki lāʻau lapaʻau sutures. Ka mea, i kapaʻia ma hope o nā kumu i hoʻohana mua ia no ka ana ma luna o ka abdominal nā loko:

1. Ke ulana i ka hui Czerny palena, a kokoke-palena sero-muscular ami.
2. Kirpatovsky ulana - he huihui 'ana o ka maka ulana a me ka submucosal serous-muscular.
3. Albert ulana nā mau ilepili hui: Lambert a me Gely.
4. Tupe ulana hoʻomaka me ka lihi ma ka ulana, a eiiiiiaiou e hoopaa ai i ke kino lumen. Lambert laila suture ua kau ma luna.

Mea Maluna ma ka helu o ka lalani

Aia mea no hoi kekahi mahele o ka nakaka kākau ole wale akā, no hoi ma ka helu o ka lalani superimposed kekahi ma luna o ka mea 'ē aʻe. Ke intestinal pā mai i kekahi palena pau, no laila,ʻeha suturingʻano papa hana i ua papahana no laila, e like me ke pale aku pele nā'aʻaʻa.

Single lalani na nakaka ano pilikia, ka mea pono ke hana i ho'ākāka 'miomioʻoki lāʻau lapaʻauʻano hana, ke hiki, e hana me ka pae'ōnaehana microscope a me ka lahilahi atraumatic kui kele. Oia lako a pan mea,ʻaʻole i loaʻa i loko o nā mea a pau pae'ōnaehana, a i na surgeon hiki Makuakane me ia. Ka loa mau hoʻohana papalua-lalani stitching. Ka mea, e pono paa, a wahi iho la penei nō i ke gula hae ma abdominalʻoki kino.

Nunui-lalani sutures i hoʻohana loa kākaʻikahi. ʻano nui manawa i ka mea i ka intestinal şarkı kino pā mea lahilahi, a palupalu, a he nui ka helu o nā filaments makemake penetrating ia. Nui, uhi multirow hana nakaka hope ma ka naʻau liʻiliʻi nui, e laʻa me appendectomy. Ke surgeon mua ligature auhau ia lakou i ma luna o ke kumu o ka i paiiaʻi. 'O kēia ka mua, loko ulana. A laila, he mea aa kala kaula suture ma ka serous a me ka muscular, ahu iho. He puakai a paa hou mai la ka luna Z-hoʻokino, hoʻopunipuni kumu maʻi 'aʻai, a hoolako hemostasis.

Hoʻohālike o intestinal sutures

I mea e ike i loko o ka wahi, i hiki ia mea kupono e pili i kekahi a me kekahi ulana, Pono, e ike i ko lakou ikaika a me ka palupalu. E mākou huli ia i loko o au mamuli.

1. Hinahina-serous suture Lambert, no ka mea a pau kona he lauwili anei a me ka versatility loaʻa paha kekahi mau keakea. O, ka mea, aole e hoʻolako i ka pono hemostasis; muli o kona kulana fragile; Ia, aole ia e hoohalike mucosa a me ka submucosa. Nolaila, e pono e hana ia ma ka hoʻohuiʻia ia me nā stitches.

2. palena single- a me ka papalua lālani stitches i ikaika lawa i piha hoʻohālike no nā papa o nā'aʻaʻa, i pono ai rula no ka hoola ana o nā'aʻaʻa, me ka hou o ka lumen o ke kino, e like me ka pono i hoʻopau i ka helehelena o ka palahalaha me ka makaʻu no. Akā, ka mea i keakea. Ulana permeable pahale gut microflora. Hygroscopicity hiki aku ai i ka maʻiʻaʻai ana i na nā'aʻaʻa a puni ia.

3. serous-muscular-submucosal sutures noho nui ma paʻi ikaika, hālāwai me nā loina futlyarnoy na naau oʻu paia 'ole, i piha hemostasis a me ka pale hou o ka lumen o ka puha hui,. Oia ulana? Aaei i kekahi manawa Pirogov Nikolay Ivanovich. Akā, ka mea, ua he hookahi-lalani oko a. Kēia nā loli i ka hopena maikaʻi ano:
-ʻoʻoleʻa fabrics laina e pili ana;
- he mahuahua ma ka me ka makaʻu no nui no i ka nani a me ka li nui.

4. hui ami i ike loea, oluolu e hoʻokō, gemostatichny, liu-maopopo a me kaʻaʻahu. Akā,ʻo ia ka seemingly hemolele ulana, i kona drawbacks:
- li nui o na nā'aʻaʻa ma ka laina e pili ana;
- kali ho'ōla;
- ho okumu o necrosis;
- High pahiki o nā adhesions;
- maʻiʻaʻai nā huakaʻi i ka hele ma ka mucosa.

5. Triple lalani ami meaʻano nui i hoʻohana no ka panina o mā ma ka AeXIeAaOIePEAaI. Ka mea, e mau nō, i maikai ka hoʻololiʻana o kaʻeha lua penei. Kēia ho'ēmi i kā ka pilikia o ka li nui, a necrosis. I waena o nā hewa o keia hana i:
- maʻiʻaʻai ma muli o ka suturing pae paha mau wahī ka poʻe;
- ka meheu o ia ka wa e noho ana o'aʻaʻa i kaʻeha paena;
- kiʻekiʻe pahiki o ka hanana o adhesions, a, me ka a no o ke iaʻi;
- ischemia'aʻaʻa ma ke kahua o ka suture.

Mākou ke i aku nei au i kēlā me kēiaʻano hana suturing eha o ka puha nā loko i kona mau pono a me keakea. ʻoki kino He pono e kālele ana ma luna o ka hopena hopena o kā lākou hana - mea e like ia i makemake e loaʻa ai i kēia hana. O ka holo ana, e mau lanakila i ka maikaʻi 'ole ma o ka hopena maikaʻi, akā, i ka hope o ka hiki ole e loaʻilikai.

teething na nakaka

Conventionally, na ami a pau hiki ke maheleia i ekolu pūʻulu: ka poe i pele kokoke mau pele kākaʻikahi a aneane e oki ma. Ka mua pūʻulu loaʻa ulana Schmid a me Albert ulana. Ka mea, e hele au ma ka mucousʻili lahilahi, a ua hoopuni poino. A hiki i ka lua o ka pūʻulu e pili ana i na nakaka, hoʻonoho kokoke i ke kino lumen. Kēia ulana a me ka ulana Mateshuka Bira. Ke kolu o ka pūʻulu nā nakaka i mea ole ma ka hui 'ana me ka lumen o ka gut. No ka laʻana, Lambert.

Loa hookaawale ia i ka manawa kūpono o ka pele o ka weld mea,ʻaʻole e hiki, a ina ka mea, ua haawi wale i ka serosa. Ma lalo o like na kumu o ke ana ulana ka mea, uaʻokiʻia me ka pahiki luna ma mua o ka'āina. Ua hoʻoneʻe 'ia paha, e hoomahuahua ina ka pae ua paa kokoke i ke kino lumen.

Hoomaopopo mechanical e pele nā huakaʻi loa ulana pu me necrotic nā paʻi hua a me ka pele o ka naoh like me ka hopena o kūloko poino'aʻaʻa.

Pae holomua Lālā paʻa resorbable mea

Ma kahi loihi ka loa oluolu mea e hiki ke hana intestinal ulana - he resorbable kemikala olona. Ka mea, ae oe, e hoʻohui i nā kihi o ka eha i hala loa o ka lōʻihi manawa, a mai haalele i ke kino o ka hoʻomanawanui haole mea. Mau noonoo ana ua uku ai i keʻano papa hana o ka wehe 'ia' ana o nā huakaʻi, mai ke kino. Natural olona, i hooleiiaʻi mawaho'aʻaʻa nā'ūhū, a ua pipili kemikala olona, ma ka hydrolysis. Mai hydrolysis Ua emi luku mai i nā'aʻaʻa o ke kino, ka mea, e ahoʻia mea i hoʻohana kemikala mea.

Eia hou, i ka hoʻohana 'ana o kemikala meaʻo ia ka mea e hiki ai e loaa i ka puaʻa hiwa paʻa ma loko ulana. Lakou e komo iloko o ka lole, nolaila, i ka pilikia a pau i kēia hiki ke alakai i ka ma, hoi, e hoʻokoe '. Kekahi maikaʻi e like ai lula ea i loko o ia mea, e ole ka hoʻokemu ka wai. Kēia 'o ia hoʻi mea e ole ai ka ulana e ino, a me ka intestinal flora, a hiki iho mailoko o ka eha, a me ka e ole haule mai o ke kino lumen ma luna o kona kino mawaho, ili.

E koho i ka ulana, a me ka mea e e sutured i ka eha, ka surgeon pono e alakai ma ka mahalo no ka liluwelo kānāwai i i'aʻaʻa kuʻi nukeliu. Ka makemake e unify i ke kaʻina hana, emi ka helu o ka lalani a pili ai makemake kaula makalii e ole e i ka pahu hopu. Mua o nā mea a pau nui ahonui maluhia, kona usability, ka ho'ēmiʻana o ka lāʻau kū-operative ke ola manawa a me kaʻeha.