I-vulva yakha isethi yezitho zobulili zangaphandle zowesifazane, futhi ifaka / iyaqonda: 

• i-labia majora ne-labia minora;
• ingquza;
• inyama yokuchama eyakha indawo yokuphuma komchamo;
• futhi ekugcineni ukungena kwesitho sangasese nakho kubizwa ngokuthi i-vestibule yesitho sangasese sowesifazane. 

I-Vulvectomy wukuhlinzwa okubandakanya ukukhipha i-vulva ngokwengxenye noma ngokuphelele. Kukhona-ke, kukhona izinhlobo eziningana ze-vulvectomy. 

I-vulvectomy elula ifaka ukususa yonke imomozi, kepha ishiye izicubu eziningi zikhona. Odokotela bavame ukwenza lolu hlobo lokuhlinzwa ukukhipha i-VIN (vulvar intraepithelial neoplasia) ekhona ezindaweni eziningana ku-vulva.

Lezi zingqimba ze-vulvar intraepithelial neoplasms zihlala ziyisifo esibi. Kodwa-ke, imvamisa yabo iyanda, ikakhulukazi ezigulini ezisencane. Lokhu kuxhumene nokukhula kokutheleleka ngokobulili ngenxa ye-HPV (Human papilloma virus). Kufanele wazi futhi ukuthi ezinye izinhlobo ze-VIN zingashintsha zibe umdlavuza ongenayo. Kunezinhlobo ezimbili ze-radical vulvectomy.

I-Radical vulvectomy ekhethekile ifaka phakathi ukukhipha ingxenye yesitho sangasese kanye nezicubu ezisekujuleni kwesimila. Kwesinye isikhathi i-clitoris nayo iyasuswa. Empeleni luhlobo oluvame kakhulu lwe-vulvectomy olwenziwa kumongo wokwelashwa komdlavuza we-vulva.

Ekugcineni, i-radical vulvectomy ephelele ukususwa kwayo yonke imomozi, i-labia majora kanye ne-labia minora, yezicubu ezisekujuleni kwesitho sangasese kanye ne-clitoris.

I-Vulvectomy yenziwa ngenxa yobukhona bezilonda zangaphambi komdlavuza nomdlavuza esithweni sangasese. Lokhu kuhlinzwa kunezinkomba ezimbili eziyinhloko:

• Kuphakathi kokuthi kuvumela ukususa ngokuphelele isimila, kanye neceke lezicubu ezijwayelekile nxazonke;
• Kuphakathi kokuthi ihlose ukudambisa izinhlungu noma ukuqeda izimpawu, kulokhu-ke ukuhlinzwa okunciphisayo.

Ngaphambi kokuhlinzwa, eminye imithi izodinga ukumiswa, njengemithi ethile elwa nokuvuvukala kanye nama-anticoagulants (enza igazi libe uketshezi oluningi). Kunconywa ngokuqinile ukuyeka ukubhema okungenani amasonto ama-4 kuye kwayi-8 ngaphambi kokuhlinzwa. Kuzo zonke izimo, kufanele kunakekelwe ukulandela imiyalo kadokotela. 

Ukuhlinzwa kwenzeka noma:

• ku-anesthesia yesifunda (ethinta umzimba wonke ophansi);
• noma ku-anesthesia ejwayelekile (isiguli silele ngokuphelele). 

Udokotela ohlinzayo ususa i-vulva noma ingxenye yesitho sangasese ngaphambi kokuvala ukusikeka noma ukusikeka nge-suture noma okuyisisekelo. Lo msebenzi uhlala ngokwesilinganiso samahora ayi-1 ukuya kwayi-3. Ezimweni ezingavamile kakhulu, kubalulekile ukufeza ukufakelwa kwesikhumba okwengeziwe, ukuze ukwazi ukuvala isilonda. 

Imvamisa, ukudambisa izinhlungu okunikezwe ngesikhathi sokuhlinzwa kusebenza ngempumelelo ekulawuleni ubuhlungu. Isikhathi sokuhlala esibhedlela imvamisa izinsuku ezi-1 kuye kwezi-5, singahluka ngokuya ngohlobo lokungenelela okwenziwayo. 

Ngemuva kokuhlinzwa, kufanele ulindele ukuba khona kwamadivayisi ahlukahlukene:

• Ngakho-ke, isixazululo sivumela isiguli ukuthi siphuze futhi sizokhishwa ngokushesha nje lapho siphuza ngokwanele futhi siqhubeke nokudla ngokujwayelekile;
• Ukugqoka kungasetshenziswa futhi enxebeni, kususwe ngemuva kwezinsuku ezimbalwa;
• Okuyisisekelo, uma kukhona, kususwa zingakapheli izinsuku eziyi-7-10 zokuhlinzwa;
• Amapayipi we-Inguinal, angamashubhu atholakala emgodini, angafakwa lapho udokotela ohlinzayo esuse i-lymph node eyodwa noma ngaphezulu: la mashubhu avumela ukuphuma kweziphuzo eziqoqwe endaweni ehlinzekwayo futhi azosuswa ezinsukwini ezimbalwa. okulandelayo ukuhlinzwa; 
• Ekugcineni, i-catheter yesinye ifakiwe esinyeni sakho: ivumela ukuqedwa komchamo futhi izosuswa ngemuva kwamahora angama-24 noma angama-48 kulandela i-vulvectomy. Kwezinye izimo, le catheter yesinye ingahlala endaweni ende.

Ukopha ngemuva kokuhlinzwa akuvamile futhi akutholakali kakhulu. Abahlengikazi bahlanza indawo okuhlinzwa kuyo, imomozi, kathathu ngosuku ngesikhathi sokuhlala esibhedlela, okusiza isilonda ukuthi siphole. Ukubuyela ekudleni kwenziwa ngokushesha ezimweni eziningi, futhi ngudokotela noma umhlengikazi ozokwazisa isiguli ukuthi siqale nini ukudla nokuphuza. Kuyadingeka futhi ukuqala ukuhlanganisa futhi, futhi, ngaphezu kwalokho, ukwenza izivivinyo zokuphefumula. Kungenzeka ukuthi lapho ubuyela ekhaya, imijovo ye-anticoagulant eqale esibhedlela izoqhubeka: lokhu kwenza ukuthi kuvinjelwe ukwakheka kwamahlule egazi.

Ukuhlinzwa kweVulvar kuseyindlela yokwelapha ephumelela kunazo zonke kulo mdlavuza. Inemiphumela emihle kakhulu, ikakhulukazi uma ilwa ne-VIN, i-vulvar intraepithelial neoplasia okuthi, njengoba sekushiwo, kaningi ihlale ingeyimbi kakhulu kepha imvamisa yayo iba sengathi iyanda. Kodwa-ke, i-vulvectomy ihlala ishiya i-sequelae, noma ngabe yobuhle, iyasebenza futhi ngokusobala ingokwengqondo.

Ngaphezu kwalokho, lapho kudingeka i-vulvectomy ephelele, ingakhubaza kakhulu i-vulva, kepha futhi idale ukulahleka okukhulu komsebenzi wezocansi.

Ukulandelwa isikhathi eside kweziguli ezisuswe ingxenyana ethile noma okuphelele kubalulekile, ngoba kunezingozi eziphakeme kakhulu zokuphindeka, ikakhulukazi i-vulvar intraepithelial neoplasia. Ukugonywa kwe-HPV kungenzeka kube nomphumela omuhle wokunciphisa izehlakalo zalolu hlobo lomdlavuza we-vulvar, okungenani kumafomu abangelwa yigciwane.

Imiphumela emibi yokwelashwa komdlavuza we-vulvar kungenzeka. Owesifazane ngamunye uzobabona ngokuhlukile. Le miphumela emibi ingenzeka ngesikhathi sokuhlinzwa, kwesinye isikhathi ngemuva nje, noma izinsuku noma amasonto ambalwa kamuva. Kwesinye isikhathi kunemiphumela esephuzile, eyenzeka ezinyangeni ezimbalwa noma ngisho neminyaka ngemuva kokuhlinzwa.

Nayi imiphumela emibi ehlukile engenzeka ngemuva kwe-vulvectomy: 

• ubuhlungu;
• ukuphulukiswa kokulimala kabi;
• ukulimala kwezinzwa okuholela ekubeni ndikindiki noma ukuhayiza;
• izinguquko ekusebenzeni kwesitho sangasese kanye nokubukeka kwaso (ikakhulukazi uma ukuhlinzwa kukhulu, futhi kubonakala ngokwesibonelo ngejethi yomchamo eya ohlangothini olulodwa). 

Ngaphezu kwalokho, ukutheleleka kungenzeka, noma i-lymphedema, okungukuthi ukuvuvukala ngenxa yokuqongelelwa kuketshezi lwe-lymphatic ezicutshini. Ekugcineni, i-vulvectomy ingaba nemiphumela emibi kwezocansi, sekushiwo ngaphambili, futhi ikakhulukazi ukuguqulwa kwesifiso nokuphendula.

Imiphumela emibi eminingi iyazimela noma lapho yelashwa, yize eminye kwesinye isikhathi ingahlala isikhathi eside noma ibe unomphela. Kuzo zonke izimo, kubalulekile ukuxwayisa ithimba lezokunakekelwa kwezempilo elithathe umsebenzi wokuhlinza ngokushesha okukhulu lapho isiguli esihlinzekiwe sihlangabezana nomunye wale miphumela emibi. Ngokushesha lapho inkinga ishiwo, iqembu lezokunakekelwa kwempilo lishesha ukusabela ukukhombisa ukuthi liyisusa kanjani.