Okuqukethwe
Okwesikhashana manje, kusolwa inqubo entsha yokuhlinzwa, ebizwa ingxenye yokuhlinzwa ye-extraperitoneal, wakhuluma ngaye. i UProf. Philippe Deruelle, udokotela wezifo zabesifazane kanye noNobhala Jikelele Wezokubelethisa we-CNGOF, I-National College of French Obstetrician Gynecologists, iphendula imibuzo yethu.
Ngesikhathi esifanayo, uDkt Bénédicte Simon, owenza ingxenye ye-extra-peritoneal cesarean e-Versailles (Yvelines), usinikeza umbono wakhe kanye nolwazi lwakhe.
A indlela yakamuva kangaka
« Uma senza i-cesarean ngendlela yakudala, sizovula isisu ngokusika okuncane, bese sihlukanisa imisipha, bese sifinyelela esibelethweni ngokuvula i-peritoneum, sidlule esiswini. », Kufingqa uSolwazi Deruelle, ekhumbula lokho i-peritoneum ulwelwesi oluncane olumboza futhi luqukethe zonke izitho zomgodi wesisu, kungakhathaliseki ukuthi ziyazala, ziyachama noma ziyagaya ukudla.
Le ndlela efakazelwe kabanzi inezihibe zayo kanye nezinciphisi, njengoba ukuqalisa kabusha kwezokuthutha kungase kuhambe kancane futhi ukusika i-peritoneum ngezinye izikhathi kungabangela ukunamathela ezingeni lezibazi, futhi ngenxa yalokho ubuhlungu obuningi.
Kusukela ekhulwini lama-XNUMX, enye indlela, ebizwa ngokuthi i-extra-peritoneal cesarean section, yazalwa. Iqukethe sebenzisa izindiza ezahlukene ze-anatomical, ohlangothini, ukuze ungavuli i-cavity yesisu, i-peritoneum..
« Ngale ndlela, sizodlula kwenye indawo, phakathi kwesinye kanye nesibeletho, indawo lapho singekho emgodini wesisu, lapho singakwazi khona ukufinyelela esibelethweni ngaphandle kokusika i-peritoneum. », Kuchaza uSolwazi Deruelle.
Ingxenye yokuhlinzwa ye-Extra-peritoneal: izinkinga ezimbalwa zangemva kokuhlinzwa?
« Kwakuyiqiniso eminyakeni engamashumi amathathu noma amane edlule, ulinganisela uSolwazi Deruelle, lapho sasingazi Inqubo kaCohen Stark, noma ingxenye yokuhlinzwa ebizwa ngokuthi iMisgav Ladach (eqanjwe ngesibhedlela lapho yakhiwa khona), okuvumela ukwelashwa okulula kwangemuva kokuhlinzwa. »
I-extra-peritoneal cesarean section ikhiqiza, ngendlela yayo, izinkinga zokuhlinzwa ezimbalwa kanye nokululama ngokushesha uma kuqhathaniswa namasu amadala okuhlinzwa, lapho kwanqunywa khona imisipha yesisu.
Kodwa namuhla, i-caesarean section eyenziwa kakhulu, ebizwa Cohen Stark, " yaguqula ukunakekelwa kwabesifazane abakhulelwe "Futhi" uhhafu wesikhathi sokusebenza kanye nesikhathi sokululama ", Uqinisekisa uProfessor Deruelle, okhombisa ukuthi uneziguli okuthi, ngisho nangemva kokuhlinzwa kwakudala, zingadla kusihlwa olufanayo futhi zivuke ngakusasa.
Umehluko omkhulu phakathi kwenqubo yokuhlinzwa kwe-extraperitoneal cesarean kanye ne-Cohen Stark, okwamanje ekhuthazwa yiKholeji Lodokotela Odokotela Ababelethisayo, ukuvulwa kwe-peritoneum. Uma kwenziwa kahle, i-Cohen Stark Caesarean ayidingi ukusika imisipha yesisu, evele isakazwe ngaphandle, ngakolunye uhlangothi, i-peritoneum inqunywe ngempela.
Buyini ubufakazi besayensi ngezinzuzo zayo?
Impela, i-extra-peritoneal cesarean section, ngoba ayisindi izicubu futhi ayisiki i-peritoneum, kubonakala kuyisigaba esingenabuhlungu nesingenabuhlungu sokuhlinzwa. Qaphela ukuthi uma ukusika kokuqala kwesikhumba kuvundlile, okwesibili ukusika, lokho kwe-aponeurosis, ulwelwesi olumboza imisipha, kume mpo (kanti ivundlile endleleni kaCohen Stark). Umehluko ongashintsha yonke into ezingeni lokuhamba ngemuva kokuhlinzwa ngokusho kodokotela bezifo zabesifazane abakhuthaza le nqubo, kodwa engazange ihlolwe ngokwesayensi, kuphawula uProfesa Deruelle. Akuzange kufakazelwe ukuthi ukuvulwa okuqondile noma okuvundlile kwe-fascia kushintsha noma yini mayelana nokubuyisela.
Kuleli phuzu, udokotela wezifo zabesifazane u-Bénédicte Simon akavumelani ngokuphelele. Lokhu kukhumbula lokhoucwaningo lwesayensi luyaqhubeka kwa-Israel naseFrance, kanye nokuthi amasu ahlukene athuthukiswe nguDokotela Denis Fauck wengxenye yokuhlinzwa kwe-extra-peritoneal ebolekiwe kokunye ukuhlinza, osekufakazelwe. I-extraperitoneal incision ibolekwa ku- ukuhlinzwa kwe-urological, kuyilapho ukusika okuqondile kwe-fascia kuyindlela ebolekwe ku- ukuhlinzeka nge-vascular. " Kulula ukuqonda ukuthi ukushintsha kusuka ekuhlinzweni okujulile (intraperitoneal) kuya ekuhlinzeni okungaphezulu (ngaphandle kwe-peritoneal) akubuhlungu kakhulu ezigulini:Ukushaqeka kokusebenza akujulile, induduzo ingcono kakhulu », Uyaphikisana noDkt Simon, eqinisekisa ukuthi iziguli zakhe zingaba njalo phezulu ngehora kulandela ukuhlinzwa.
« Isigaba sokuhlinzwa siyindlela evamile yokuhlinzwa, futhi okuwukuphela kokungenelela okudinga ukuhamba nokunethezeka kwangemva kokuhlinzwa ukuze unakekele umntwana. Uma owesifazane ehlinzwa nganoma yini, ngokuvamile akadingi ukunakekela izingane zakhe ezivame ukubhekwa umndeni noma ubaba. Miningi imizamo eyenziwayo yokuthuthukisa ukuhlinzwa kweziguli zangaphandle kuzo zonke izindawo, ngaphandle kokuhlinzwa », Uyazisola uDkt Simon.
Naphezu kwakho konke, kwamukelwa yibo bonke ukuthi ingxenye yokuhlinzwa yokuhlinzwa engaphandle kwe-peritoneal iyinkimbinkimbi kakhulu futhi idinga ukuqeqeshwa kwangempela nodokotela bezifo zabesifazane abaqalisiwe.
« Kunokuntuleka kwedatha ekuphindaphindweni kwalolu hlobo lwesigaba sokuhlinzwa, lapho sisondela ezindaweni zomzimba okungelula kakhulu ukufinyelela kuzo. Ngokwazi kwami, azikho izifundo zesayensi eziqhathanise lesi sigaba sokuhlinzwa nezinye izindlela zokuhlinzwa. ", Njengaleyo kaCohen Stark, igcizelela futhi uSolwazi Deruelle, oweluleka ngokuqapha.
Ngokusho kukadokotela wezifo zabesifazane, uNobhala Jikelele Wezokubeletha we-CNGOF, i-extra-peritoneal cesarean “ ayizange ifundwe ngokwanele ukuba ithuthukiswe kabanzi njengento eyisimangaliso. "
Ingabe imfashini yale ndlela yokuhlinza ingabangela ingxenye yokuxhumana okwenziwa kahle kweminye imitholampilo yangasese eyenze ingxenye yokuhlinzwa engaphandle kwe-peritoneal yaba umsebenzi wayo okhethekile?
UDkt Simon uyawuphika lo mbono, ngoba lo ucela kuphela ukuqeqesha abanye odokotela bezifo zabesifazane, ababonakala bemanqikanqika ngoba akubona njalo ukuthakasela kwabesifazane. Ukwesaba kodokotela bokubelethisa abangebona odokotela abahlinzayo? Ukungabi nelukuluku, umkhuba? UDkt. Simon, ophinde aqeqeshe odokotela phesheya - eTunisia, Israel noma iLithuania -, nokho, ucela ukuhlinzeka ngolwazi lwakhe eFrance…
Ngokuqondene nokuhlanya kwamanje, kungcono kube ngenxa yokuthi uDkt. Simon, ukuba umdlandla wabesifazane uqobo, abasakaza izwi futhi bafakaze ngolwazi lwabo oluhle kakhulu kunoma ubani ofuna ukukuzwa.
Umbuzo obucayi wesikhathi sokusebenza
Kungakhathaliseki ukuthi umuntu uthini mayelana ne-Cohen Stark cesarean, ivumela isikhathi esifushane kakhulu sokusebenza, ngoba isibeletho sitholakala kalula uma i-peritoneum ihlukaniswa. Ngokuphambene, ” i-extraperitoneal cesarean section yandisa isikhathi sokusebenza futhi idinga ukuqeqeshwa okukhethekile, lapho indlela ye-Cohen Stark ilula kakhulu futhi ifinyeza isikhathi sokusebenza », Uqinisekisa uSolwazi Deruelle.
Sikuqonda ngokushesha okukukhathazayo: uma i-extra-peritoneal cesarean ingabambi inkinga ngesikhathi sokuhlinzwa okuhleliwe, kuzoba kakhulu obucayi okufanele ukwenze uma kwenzeka ukuhlinzwa kokuhlinzwa okuphuthumayo, lapho yonke iminithi ibala ukusindisa impilo kamama kanye / noma ingane.
Nakuba ezimweni eziphuthumayo ezisongela ukuphila, uDkt. Simon uyabona ukuthi ukuhlinzwa kwe-extraperitoneal akunconywa, ukholelwa ukuthi Ukwelulwa kwesikhathi sokusebenza, imizuzu eyishumi kuphela, kuyinkinga engamanga ngesikhathi sokuhlinzwa okukhethiwe., okwenziwa ngenxa yezizathu zokwelashwa noma ukunethezeka. “ Iyini imizuzu eyishumi yokuhlinzwa ngaphezu kwezinzuzo zesiguli? Uthi.
Isigaba sokuhlinzwa esikuvumela ukuthi ube umlingisi wokubeletha kwakhe
I-craze ye-extraperitoneal cesarean section nayo ingachazwa yiyo yonke into ezungezile futhi eheha noma yimuphi umama wakusasa ngokulangazelaube ngumlingisi ngesikhathi ebeletha ngokuhlinzwa.
Ngoba i-extra-peritoneal cesarean, umqondo wokuthi yikuphi ukusondela eduze ngangokunokwenzeka ekuzalweni kwe-physiological, ngokuvamile ihambisana nephuzu elincane lepulasitiki (elibizwa ngokuthi "i-Guillarme blower" noma "i-winner flow" ®) lapho owesifazane okhulelwe ehamba khona. vuthela ukukhipha ingane ngesisu ngenxa yokufinyela kwe-abs. Ngokushesha ngemva kokukhululwa komntwana, i- isikhumba esikhumbeni inikezwa futhi, ngenxa yazo zonke izimfanelo esizaziyo: isibopho sikamama nengane, ukufudumala kwesikhumba ...
Kodwa kuyiphutha ukucabanga ukuthi lezi zindlela ezingokwemvelo zokubeletha zenziwa kuphela kumongo we-extra-peritoneal cesarean. ” I-blower nozzle kanye nesikhumba esikhumbeni kungahlanganiswa ngokuphelele nesigaba "se-Caesarean" sakudala, ngu-Cohen Stark. », Usiqinisekisa uSolwazi Deruelle. Okuwukuphela kwento ethize ku-extraperitoneal cesarean section yi- i-incision technique. Konke ukusekelwa okuzungezile le nqubo kungakwazi kufanele kwenziwe kwezinye izingxenye zokuhlinzwa.
Ngeshwa, kufanele kuvunywe ukuthi lokhu kusekelwa akuhlinzekwa ngaso sonke isikhathi kwabesifazane ngesikhathi sokuhlinzwa kanye nokubeletha okuvamile, yingakho isasasa labo ngezikhungo zokubelethela kanye namanye amagumbi okubelethela “emvelo”, lapho izinhlelo zabo zokuzalwa zibonakala zigcwaliseka futhi zihlonishwa kakhulu.
Ngamafuphi, ingxenye yokuhlinzwa ye-extraperitoneal ibonakala ihlukanisa izazi ze-obstetrician-gynecologists okwamanje: abambalwa kubo abakwenzayo, abanye bayangabaza, abanye abayiboni isithakazelo sayo ebusweni bendlela yakudala ... Kukumuntu ngamunye ukwenza umbono wakhe futhi akhethe ngokuvumelana nombono wakhe wokubeletha, amathuba akhe okuma kwezwe, isabelomali sakhe, ukukhathazeka kwakhe ...
Khumbula ukuthi okwamanje, le nqubo isalokhu incane kakhulu eyenziwa eFrance, emitholampilo yangasese edume kakhulu futhi embalwa ngenani. Isimo esidabukisayo uDkt. Simon, othi nakuba kunjalo ukulungele ukusabalalisa amasu akhe kunoma ubani ofuna ukukuzwa, futhi ongaqondi ukuntula isithakazelo kodokotela bezifo zabesifazane baseFrance kanye nodokotela bokubelethisa ngale ndlela entsha.
Kodwa-ke, singacabanga ukuthi, uma ucwaningo luzoqinisekisa izinzuzo zalolu hlobo lwesigaba sokuhlinzwa, futhi nokuthi abesifazane benza isidingo esikhulu saso, ukungabaza kodokotela bokubelethisa kuzogcina kuncipha kuze kube yilapho kufika i-extraperitoneal cesarean. hhayi esikhundleni se-Cohen-Stark Caesarean, kodwa qedela izikhali zokuhlinzwa zodokotela bokubelethisa.
Okokugcina, khumbula ukuthi isigaba sokuhlinzwa sihlala siyindlela yokuhlinzwa okufanele yenziwe kuphela uma kunesidingo sezokwelapha, lapho kubhekene nezimo ze-pathological, ngoba ingozi yezinkinga inkulu kunesikhathi sokubeletha kwesitho sangasese sowesifazane. Izinga lokuhlinzwa ngokuhlinzwa e-France lilinganiselwa ku-20% wokubeletha, ukwazi lokho I-World Health Organization (WHO) incoma izinga eliphakathi kuka-10 no-15%.