Laparoscopy ya kapamba kale idachitika kuti adziwe matenda - kudziwa gawo la oncology ya chiwalo kapena kuchitira opaleshoni yodziwitsa ena khansa yomwe singathe kugwira.
Pazaka khumi zapitazi, kugwiritsa ntchito njirayi kwakula kwambiri. Laparoscopy imapangidwira pancreatic necrosis, kukhetsa kwa ziphuphu "zabodza" zamkati, kuchotsedwa kwa zotupa za kapamba.
Ubwino wazowongolera zamankhwala umaphatikizapo kuchepa kwa kupweteka kwambiri pakukonzanso, kuchepa kwamatumbo paresis. Komanso, nthawi yochepa yokhala m'malo opumira, kuchira wodwalayo mwachangu.
Njira ya laparoscopic imapereka chithunzi chabwino kwambiri cha anatomical, chomwe ndichofunikira kwambiri pakuchita opaleshoni ya pancreatic chifukwa cha kuchuluka kwa mitsempha yayikulu m'magazi olowererapo komanso malo apachirengedwe omwe amapezeka kudera la retroperitoneal.
Zothandiza ndikuwonetsa pancreatic laparoscopy
Laparoscopy ndi njira yatsopano kwambiri yopangira opaleshoni ndi njira zodziwira matenda. Kafukufuku wotereyu amathandiza kusiyanitsa ma pathologies osiyanasiyana, makamaka pokhudzana ndi zovuta zomwe zimachitika chifukwa chophwanya magwiridwe antchito a kapamba.
Ndondomeko imathandizira kwambiri cholangiography pogwiritsa ntchito mitundu yosiyanitsa, radiology, ndi biopsy. Njirayi imakupatsani mwayi wokhazikitsa chomwe chimayambitsa matendawa, omwe amathandiza mwadzidzidzi kuti ayambe kulandira chithandizo.
Ubwino wake umaphatikizapo kusapezeka kwa bala pa khoma lamkati lamkati, kulondola kwambiri pofufuza zamankhwala, kudandaula kopweteka, komanso kuchepa magazi pang'ono. Komanso, yafupikitsanso nyengo yakukonzanso, chiopsezo chochepa cha zovuta za postoperative.
Minofu yam'mimba imatha kusuntha maola 24 atatha kulowererapo. Kugoneka kwa odwala kumachitika kokha kwa masiku anayi, wodwala atathamangitsidwa kunyumba. Laparoscopy ngati njira yopangira opaleshoni itha kuchitidwa zotsatirazi:
- Imfa yamatenda a pancreatic pamsana pa vuto la pancreatitis;
- Kufunika kopenya masinthidwe amkati mwamkati ndi kutupa kwa kapamba;
- Kukhalapo kwa cysts ndi mitundu yosiyanasiyana yopanga chifukwa cha chifuwa chachikulu cha kapamba.
Njira ya laparoscopic imachitika ngati njira yofufuzira. Chizindikirocho ndi jaundice (chimathandiza kukhazikitsa etiology yeniyeni), kukulitsa kwa chiwindi kwa etiology yosadziwika, ascites - ngati sizotheka kuzindikira zomwe zimayambitsa chitukuko ndi njira zina. Ndikofunika kuchita ndi cholecystitis kuti muchepetse kukhalapo kwa maselo a khansa, komanso kudziwa matenda amkodzo.
Laparoscopy ya kapamba amathandiza kudziwa nthawi yomwe matendawa ali, kuchuluka kwa zowonongeka mkati.
Kukonzekera kogwira ntchito
Tisananene kuti kukonzekera ndi chiyani, tidzaimba mawu otsutsa. Sizingatheke kupanga chinyengo pamayendedwe a chotupa neoplasms, ngati zinali zotheka kukhazikitsa mawonekedwe awo oyipa. Chachiwiri chotsutsana ndi kusazindikira kwa dokotala pochita opaleshoni yotsekemera pa kapamba kapena njira zovuta za laparoscopic.
Chitetezo chimachitika motsogozedwa ndi dokotala. Komanso, mabungwewa amaperekedwa ndi mabungwe azachipatala. Mtengo ndi kuphatikiza kwa zinthu zambiri, kuphatikizapo mitengo yamitengo ya chipatala. Mtengo wotsika kwambiri ndi ma ruble 35,000.
Pamaso pa opareshoni, zowunika zasayansi ndi zothandizira zimachitika. Perekani kuyezetsa magazi ambiri, kufufuza zamankhwala osokoneza bongo, kuyerekezera makina, MRI, angiography, biopsy.
Talandira zotsatira za maphunziro awa, dongosolo la opareshoni limapangidwa. Kukonzekera isanachitike:
- Kuwona kwa anatomical kapangidwe ka chakudya.
- Kuyesa kwa magazi a biochemical kupatula kutengera kwa chotupa pa mahomoni.
- Kujambula kwa CT kumathandizira kudziwa malo abwino kwambiri opezeka ndi ziphuphu pakuchita opareshoni.
- Kuunikira zolemba za khansa. Chochitikacho chikuwonetsedwa zamitundu yonse yamatumbo apancreatic.
Nthawi zambiri, laparoscopy imawulula ma neoplasms oyipa omwe amawonedwa kuti ndi opweteka asanachitike opaleshoni. Pankhaniyi, pali zifukwa zina zomwe zimaganiziridwa: Matenda ophatikizika, kukhalapo / kusowa kwa maselo m'mbali mwa resection, komanso kuthekera kwa chithandizo chokwanira.
Funso likuyankhidwanso ngati kuli kofunikira kuchita ntchito ina, koma malinga ndi ndondomeko ya mankhwala a oncological.
Zambiri za laparoscopy
Pofuna kuphunzitsa laparoscopy, mankhwala ochititsa dzanzi amachitidwa. Kuti izi zitheke, kukonzekereratu kumachitika, ndiye kuti wodwalayo amaperekedwa ku chipinda chogwiritsira ntchito pa gurney. Mukayika pa tebulo logwiritsira ntchito, sankhani malo oyenera. Kenako wodwalayo amapatsidwa opaleshoni, chubu chimayikidwa mu trachea, kenako endotracheal anesthesia.
Pofuna kupewa kupanikizika monga thrombophlebitis, zida zapadera zapakanikizana kwapang'onopang'ono zimayikidwa mbali iliyonse yamunsi ya wodwalayo. Khoma lakutsogolo la m'mimba limathandizidwa ndi yankho la antiseptic, malo opangira opaleshoniwo adakutidwa ndi minofu yosalala.
Kapangidwe kakang'ono kamapangidwa kuti aike zida zamankhwala. Pambuyo kuyamwa kwa chotupa neoplasm, minofu necrosis, zida zimachotsedwa mosamala ndipo sutures imagwiritsidwa ntchito pakuwonekera. Pambuyo pake, pamayesedwa trocar - chida chopangira opaleshoni chomwe chimafunikira kubowola pamimba, ngati pakufunika kutulutsa madzi ndi mpweya.
Laparoscopic distal pancreatectomy imachitika pogwiritsa ntchito njira zitatu:
- Ndi chotupa cha ndulu pachimake chimodzi;
- Ndi kusungidwa kwa ndulu ndi mitsempha yamagazi mmenemo;
- Kudutsa zonyamula mungu, komabe, osachotsa ndulu.
Pokonzekera opaleshoni, dokotalayo amayesa kuteteza ndulu, chifukwa mkati mwake mumakhala gawo lapadera polimbana ndi tizilombo tating'onoting'ono tomwe timayambitsa matenda, omwe amathandiza kwambiri kutalika kwa moyo wa munthu. Izi sizotsimikizika mokwanira, chifukwa chake, madokotala ena amatulutsa ndulu, makamaka pamene mabala a laparoscopic ndiosavuta kusunga mitsempha. Njirayi ndiosavuta komanso mwachangu chifukwa simukuyenera kuwononga nthawi yolimbikitsa mitsempha yamagazi.
Atangochita kulowererapo, wodwalayo amapatsidwa mwayi wokhala kumalo osamalira odwala kwambiri, pomwepo ndiye poyambira kukhazikika. Posachedwa, wodwalayo amusamutsira opaleshoni yam'mimba kapena ku dipatimenti yayikulu, komwe amalandila chithandizo ndi zakudya.
Pambuyo pakuwonekera, wodwalayo akulimbikitsidwa kuti azindikire prophylactic, kukaonana ndi katswiri kamodzi pa miyezi isanu ndi umodzi kukayesa mayeso a ultrasound. Onetsetsani kuti mukumwa mankhwala, zakudya zamagulu (kutsatira zakudya za 5 ndi kapamba kwa chaka chimodzi), moyo wathanzi.
Momwe pancreatic laparoscopy imachitikira ikuwonetsedwa mu kanema munkhaniyi.
