I-Sigmoidectomy ukususwa ngokuhlinzwa kwengxenye yokugcina yekholoni, ikholoni ye-sigmoid. Kucatshangelwa kwezinye izimo ze-sigmoid diverticulitis, isimo esivamile kubantu asebekhulile, noma isimila esinomdlavuza esitholakala kukholoni ye-sigmoid.

I-Sigmoidectomy, noma i-sigmoid resection, ukususwa ngokuhlinzwa kwekholoni ye-sigmoid. Lolu uhlobo lwe-colectomy (ukususwa kwengxenye yekholoni). 

Njengesikhumbuzo, ikholoni yakha ne-rectum yamathumbu amakhulu, ingxenye yokugcina yomgudu wokugaya ukudla. Itholakala phakathi kwamathumbu amancane ne-rectum, ilinganiselwa ku-1,5 m futhi yakhiwe izingxenye ezahlukene:

• ikholoni elingakwesokudla, noma ikholoni ekhuphukayo, etholakala ngakwesokudla kwesisu;
• ikholoni eguquguqukayo, ewela ingxenye engenhla yesisu futhi ixhuma ikholoni yesokudla nekholoni yesokunxele;
• ikholoni yesokunxele, noma ikholoni eyehlayo, igijima ohlangothini lwesobunxele lwesisu;
• ikholoni ye-sigmoid ingxenye yokugcina yekholoni. Ixhuma ikholoni yesokunxele ne-rectum.

Ukuhlinzwa kwenzeka ngaphansi kwe-anesthesia ejwayelekile, nge-laparoscopy (laparoscopy) noma i-laparotomy kuye ngokuthi inqubo.

Kufanele sihlukanise izinhlobo ezimbili zesimo: ukungenelela okuphuthumayo kanye nokungenelela okukhethiwe (okungaphuthumi), njengesinyathelo sokuvimbela. Ku-elective sigmoidectomy, ngokuvamile eyenziwa nge-diverticulitis, ukuhlinzwa kwenzeka kude nesiqephu esibucayi ukuze kuvunyelwe ukuvuvukala kuphele. Ngakho-ke ukulungiselela kungenzeka. Ihlanganisa i-colonoscopy yokuqinisekisa ubukhona futhi inqume izinga lesifo se-diverticular, futhi ikhiphe i-tumor pathology. Ukudla okune-fiber ephansi kunconywa izinyanga ezimbili ngemva kokuhlaselwa kwe-diverticulitis.

Kukhona izindlela ezimbili zokusebenza:

• i-anastomosis resection: ingxenye yekholoni ye-sigmoid enesifo iyasuswa futhi i-suture yenziwe (i-colorectal anastomosis) ukubeka izingxenye ezimbili ezisele ekukhulumisaneni futhi ngaleyo ndlela kuqinisekiswe ukuqhubeka kokugaya ukudla;
• I-Hartmann's resection (noma i-terminal colostomy noma ileostomy ene-rectal stump): ingxenye yekholoni ye-sigmoid enesifo iyasuswa, kodwa ukuqhubeka kokugaya akubuyi. I-rectum i-sutured futhi ihlala endaweni. I-colostomy (“i-artificial anus”) ibekwa okwesikhashana ukuze kuqinisekiswe ukukhishwa kwesitulo (“indunu yokufakelwa”). Le nqubo ngokuvamile igcinelwe i-sigmoidectomy ephuthumayo, uma kwenzeka i-peritonitis evamile.

Inkomba eyinhloko ye-sigmoidectomy i-sigmoid diverticulitis. Njengesikhumbuzo, i-diverticula yi-hernias encane odongeni lwekholoni. Sikhuluma nge-diverticulosis lapho ama-diverticula ambalwa ekhona. Ngokuvamile azibonakali, kodwa ngokuhamba kwesikhathi zingagcwala indle eyomile, yome, futhi iholele "kuma-plug" futhi ekugcineni ivuvuke. Sibe sesikhuluma nge-sigmoid diverticulitis lapho lokhu kuvuvukala kuhlala kukholoni ye-sigmoid. Kuvamile kubantu asebekhulile. I-CT scan (i-CT-scan yesisu) iyisivivinyo esikhethwayo sokuhlonza i-diverticulitis.

Kodwa-ke, i-Sigmoidectomy ayiboniswa kuwo wonke ama-diverculitis. Ukwelashwa ngama-antibiotic ngomzila we-venous ngokuvamile kwanele. Ukuhlinzwa kucatshangelwa kuphela uma kwenzeka i-diverticulum eyinkimbinkimbi ene-perforation, ingozi yokutheleleka, futhi kwezinye izimo zokuphindaphinda, njenge-prophylactic. Njengesikhumbuzo, ukuhlukaniswa kwe-Hinchey, okwasungulwa ngo-1978, kuhlukanisa izigaba ezi-4 ngokulandelana kokuqina kokutheleleka:

• isigaba I: phlegmon noma ithumba ngezikhathi ezithile;
• isigaba II: i-pelvic, ithumba lesisu noma i-retroperitoneal (i-peritonitis yendawo);
• isigaba III: i-peritonitis ye-purulent ejwayelekile;
• isigaba IV: i-fecal peritonitis (i-perforated diverticulitis).

I-sigmoidectomy ekhethiwe, okusho ukuthi ukukhetha, kucatshangelwa ezimweni ezithile zokuphindaphinda kwe-diverticulitis elula noma isiqephu esisodwa se-diverticulitis eyinkimbinkimbi. Khona-ke i-prophylactic.

I-sigmoidectomy ephuthumayo, eyenziwa ezimweni ze-purulent noma i-stercoral peritonitis (isigaba III kanye ne-IV).

Enye inkomba ye-sigmoidectomy ukuba khona kwesimila esinomdlavuza esitholakala kukholoni ye-sigmoid. Bese ihlotshaniswa ne-lymph node dissection ukuze kukhishwe wonke amaketanga e-ganglion ekholoni ye-pelvic.

Ngemuva kwe-sigmoidectomy, ingxenye esele yekholoni izothatha ngokwemvelo umsebenzi wekholoni ye-sigmoid. Ukuthutha kungashintshwa isikhashana, kodwa ukubuyela kokujwayelekile kuzokwenziwa kancane kancane.

Uma kwenzeka kungenelele uHartmann, kubekwa indunu yokwenziwa. Ukuhlinzwa kwesibili, uma isiguli singavezi ingozi, kucatshangelwe ukubuyisela ukuqhubeka kokugaya ukudla.

Ukugula kwe-sigmoidectomy yokuvimbela kuphezulu kakhulu, cishe ku-25% wezinga lezinkinga futhi kufaka phakathi izinga lokusebenza kabusha eliholela ekugcwalisekeni kwe-anus yokufakelwa ngezinye izikhathi ecacile yokuhleleka kwe-6% ngonyaka owodwa we-prophylactic colostomy, ukhumbula i-Haute Autorité. de Santé ezincomweni zayo zika-2017. Yingakho ukungenelela kwe-prophylactic manje kwenziwa ngokuqapha okukhulu.