Contents
No kekahi manawa i kēia manawa, ua kapa ʻia kahi ʻenehana hou o ka ʻāpana cesarean ʻāpana cesarean extraperitoneal, ua kamaʻilio e pili ana iā ia. ka ʻO Prof. Philippe Deruelle, ka maʻi maʻi a me ka Obstetrics General Secretary o ka CNGOF, ka National College of French Obstetrician Gynecologists, pane i kā mākou mau nīnau.
Ma ka manawa like, hāʻawi mai ʻo Dr Bénédicte Simon, ka mea e hana ana i ka ʻāpana cesarean extra-peritoneal ma Versailles (Yvelines), i kona manaʻo a me kāna ʻike.
He ʻenehana hou ʻole
« Ke hana mākou i ka cesarean ma ke ʻano maʻamau, e wehe mākou i ka ʻōpū ma kahi ʻoki haʻahaʻa, a laila e hoʻokaʻawale i nā ʻiʻo, a laila e komo i ka ʻōpū ma ka wehe ʻana i ka peritoneum, e hele ana ma ka ʻōpū. », Hōʻuluʻulu ʻo Professor Deruelle, e hoʻomanaʻo ana i kēlā ʻO ka peritoneum ka membrane lahilahi e uhi ana a loaʻa nā ʻāpana āpau o ka ʻōpū o ka ʻōpū, inā he hānau hānau, mimi a ʻai paha.
ʻO kēia ala i hōʻoia nui ʻia he mau hemahema a me nā mea hōʻino, ʻoiai ʻo ka hoʻomaka ʻana o ka transit hiki ke lohi iki a hiki i ka ʻoki ʻana o ka peritoneum i kekahi manawa ke alakaʻi i nā adhesions i ke kiʻekiʻe o nā ʻōpala, a no laila ʻoi aku ka ʻeha.
Mai ka makahiki iwakālua, ua hānau ʻia kekahi ʻano hana, i kapa ʻia ʻo extra-peritoneal cesarean section. Aia i loko o hoʻohana i nā mokulele anatomical like ʻole, ma ka ʻaoʻao, i ʻole e wehe i ka ʻōpū o ka ʻōpū, ka peritoneum..
« Ma kēia ala e hele ai mākou ma kahi ʻē aʻe, ma waena o ka ʻōpū a me ka ʻōpū, kahi ʻaʻole mākou i loko o ka ʻōpū o ka ʻōpū, kahi e hiki ai iā mākou ke komo i ka ʻōpū me ka ʻole o ka ʻoki ʻana i ka peritoneum. », Wehewehe mai o Professor Deruelle.
ʻO ka ʻāpana cesarean extra-peritoneal: liʻiliʻi nā pilikia postoperative?
« He ʻoiaʻiʻo he kanakolu a kanahā paha makahiki i hala. manaʻo ʻo Professor Deruelle, i ko makou ike ole i ka ʻO ka ʻenehana Cohen Stark, a i ʻole ka pauku Cesarean i kapa ʻia ʻo Misgav Ladach (i kapa ʻia ma hope o ka haukapila kahi i kūkulu ʻia ai), hiki ke maʻalahi ka mālama ʻana ma hope o ka hana. »
Hoʻokumu ka ʻāpana cesarean extra-peritoneal, ma kāna ʻenehana, ʻoi aku ka liʻiliʻi o ka hoʻopiʻi ʻana a me ka wikiwiki o ka hoʻihoʻi ʻana i ka hoʻohālikelike ʻana i nā ʻenehana caesarean kahiko, kahi i oki ai na io opu.
Akā i kēia lā, ʻo ka ʻāpana caesarean i hana nui ʻia, i kapa ʻia Cohen Stark, " hoʻololi i ka mālama ʻana i nā wahine hāpai "A" hapa ka manawa hana a me ka manawa ho'ōla ", Ua hōʻoia ʻo Professor Deruelle, nāna i hōʻike he mau maʻi kāna, ʻoiai ma hope o ka cesarean maʻamau, hiki ke ʻai i ke ahiahi hoʻokahi a ala aʻe i ka lā aʻe.
ʻO ka ʻokoʻa nui ma waena o ka ʻenehana ʻāpana cesarean extraperitoneal a me ka ʻenehana Cohen Stark, i hāpai ʻia i kēia manawa e ke Kulanui o Obstetrician Gynecologists, ʻo ia. ka wehe ʻana o ka peritoneum. Inā hoʻokō maikaʻi ʻia, ʻaʻole koi ʻo Cohen Stark Caesarean e ʻoki i nā ʻiʻo o ka ʻōpū, i hoʻolaha wale ʻia, ma ka ʻaoʻao ʻē aʻe, e ʻoki ʻia ka peritoneum.
He aha ka hōʻike ʻepekema no kāna mau pono?
ʻOiaʻiʻo, ʻo ka ʻāpana cesarean extra-peritoneal, no ka mea ʻaʻole ia e ʻoki i nā ʻiʻo a ʻaʻole ia e ʻoki i ka peritoneum, Me he mea lā ʻo ia ka ʻāpana cesarean liʻiliʻi loa a ʻeha ʻole. E hoʻomanaʻo, inā he paepae ka ʻoki mua o ka ʻili, ʻo ka ʻoki ʻelua, ʻo ka aponeurosis, ka membrane e hoʻopuni ana i nā ʻiʻo, he kūpaʻa (aʻo ia ka pae ma ke ʻano o Cohen Stark). ʻO ka ʻokoʻa e hoʻololi i nā mea āpau ma ke kiʻekiʻe o ka mobility postoperative e like me nā gynecologists nāna i hoʻolaha i kēia ʻenehana, akā ʻaʻole i loiloi ʻia ʻepekema, wahi a Professor Deruelle. ʻAʻole i hōʻoia ʻia ʻo ka wehe ʻana a i ʻole ka puka ākea o ka fascia e hoʻololi i kekahi mea e pili ana i ka hoʻihoʻi.
Ma kēia wahi, ʻaʻole ʻae loa ʻo Bénédicte Simon ke kauka obstetrician-gynecologist. Hoʻomanaʻo kēia i kēlāke holo nei kahi noiʻi ʻepekema ma ʻIseraʻela a me Farani, a ʻo nā ʻenehana like ʻole i hoʻomohala ʻia e Kauka Denis Fauck no ka ʻāpana cesarean extra-peritoneal. ʻaiʻē ʻia mai nā ʻokiʻoki ʻē aʻe, i hōʻoia ʻia. No laila ua ʻaiʻē ʻia ka ʻoki extraperitoneal mai ka ʻoki kino urologic, oiai o ka hookiekie ku pololei o ka fascia he hana i aie ia mai ka ke kāpili maʻi. " He mea maʻalahi ka hoʻomaopopo ʻana ʻo ka hoʻololi ʻana mai ke ʻoki hohonu (intraperitoneal) a i ke ʻoki superficial (extraperitoneal) ʻoi aku ka ʻeha no nā maʻi:ʻOi aku ka pāpaʻu o ka haʻalulu hana, ʻoi aku ka maikaʻi o ka hōʻoluʻolu », hoʻopaʻapaʻa ʻo Dr Simon, e hōʻoiaʻiʻo ana e hiki pinepine i kāna mau maʻi i ka hora ma hope o ka pauku cesarean.
« ʻO ka pauku Cesarean ka hana maʻamau maʻamau, a ʻo ka hana wale nō e pono ai ka neʻe ʻana a me ka hōʻoluʻolu post-operative e mālama i ka pēpē. Ke hana ka wahine i kekahi mea, ʻaʻole pono ʻo ia e mālama i kāna mau keiki i mālama mau ʻia e ka ʻohana a i ʻole ka makua kāne. Nui nā hoʻoikaika ʻana e hoʻomohala i ke kaʻina maʻi maʻi ma nā wahi āpau, koe wale nō ka pauku cesarean », Minamina iā Kauka Simona.
ʻOiai ʻo nā mea āpau, ʻae ʻia e nā mea a pau ʻo ka extra-peritoneal cesarean section ʻoi aku ka paʻakikī a koi ʻia i kahi haumāna maoli me nā gynecologists i hoʻomaka.
« Loaʻa ka nele o ka ʻikepili e pili ana i ka hana hou ʻana o kēia ʻano o ka pauku cesarean, kahi e hoʻokokoke ai mākou i nā wahi o ke kino ʻaʻole maʻalahi ke komo. I koʻu ʻike, ʻaʻohe haʻawina ʻepekema i hoʻohālikelike i kēia ʻāpana cesarean me nā ʻano hana cesarean ʻē aʻe. ", E like me kā Cohen Stark, e kuhikuhi hou ana iā Professor Deruelle, nāna e aʻo e akahele.
Wahi a ka gynecologist, Obstetrics General Secretary o ka CNGOF, ka extra-peritoneal cesarean " ʻaʻole lawa i aʻo ʻia e hoʻolaha nui ʻia ma ke ʻano he mea kupanaha. "
Hiki paha i ke ʻano o kēia ʻano hana ʻokiʻoki ke loaʻa i kekahi ʻāpana mai ke kamaʻilio maikaʻi ʻana o kekahi mau keʻena pilikino i hana i ka ʻāpana cesarean extra-peritoneal i kā lākou ʻoihana kūikawā?
Hōʻole ʻo Dr Simon i kēia manaʻo, no ka mea ke noi wale nei kēia e hoʻomaʻamaʻa i nā gynecologists ʻē aʻe, me he mea lā ʻaʻole makemake no ka mea, ʻaʻole ʻike mau i ka hoihoi no nā wahine. ʻO ka hopohopo ma ka ʻaoʻao o nā obstetricians ʻaʻole nā kauka? Ka nele o ka hoihoi, maʻa? ʻO Kauka Simon, ka mea nāna i aʻo i nā kauka ma waho - ma Tunisia, Israel a i ʻole Lithuania - akā naʻe, noi wale ʻo ia e hāʻawi i kāna ʻike ma Farani ...
ʻO ka makemake o kēia manawa, ʻoi aku ka maikaʻi, no Dr. Simon, e ka ohohia o na wahine ponoi, nana i hoolaha aku a hōʻike i ko lākou ʻike maikaʻi loa i ka mea makemake e hoʻolohe iā lākou.
ʻO ka nīnau paʻakikī o ka manawa hana
ʻO kēlā me kēia mea e ʻōlelo ai e pili ana i ka cesarean Cohen Stark, hiki iā ia ke hana pōkole loa, no ka mea hiki ke maʻalahi ka ʻōpū i ka wā i māhele ʻia ai ka peritoneum. ʻO ka mea ʻē aʻe, ” ʻO ka ʻāpana cesarean extraperitoneal e hoʻolōʻihi i ka manawa hana a koi i ka hoʻomaʻamaʻa kikoʻī, kahi maʻalahi loa ka ʻenehana Cohen Stark a hoʻopōkole i ka manawa hana », Ua hōʻoia ʻo Professor Deruelle.
Hoʻomaopopo koke mākou i nā hopohopo: inā ʻaʻole pilikia ka cesarean extra-peritoneal i ka wā o ka cesarean i hoʻonohonoho ʻia, e ʻoi aku ka nui. paʻakikī e hoʻokō inā loaʻa ka ʻāpana cesarean pilikia, kahi e helu ai kēlā me kēia minuke i ke ola o ka makuahine a / a i ʻole ka pēpē.
ʻOiai no nā pilikia ulia pōpilikia, ʻike ʻo Kauka Simon ʻaʻole ʻōlelo ʻia ka pauku cesarean extraperitoneal, manaʻo ʻo ia. ʻO ka lōʻihi o ka manawa hana, he ʻumi mau minuke wale nō, he pilikia wahaheʻe i ka wā o ka pauku cesarean elective, hana ʻia no nā kumu olakino a maʻalahi paha. “ He aha ka ʻumi mau minuke o ka ʻoki ʻana me nā pōmaikaʻi no ka mea maʻi? Ia nei.
ʻO kahi ʻāpana cesarean e hiki ai iā ʻoe ke lilo i mea keaka no kāna hānau ʻana
Hiki ke wehewehe ʻia ka makemake o ka pauku cesarean extraperitoneal e nā mea a pau e hoʻopuni ana iā ia a he mea hoihoi ia i ka makuahine e hiki mai anahe mea hana keaka i ka wā hānau ma ka pauku cesarean.
No ka mea he extra-peritoneal cesarean, ka manaʻo o ia e hoʻokokoke kokoke loa i kahi hānau hānau physiological, ua hui pinepine ia me ka piko plastic liʻiliʻi (i kapa ʻia ʻo "Guillarme blower" a i ʻole "winner flow" ®) kahi e hele ai ka wahine hāpai. puhi e kipaku i ka pēpē ma o ka ʻōpū me ka ʻoki ʻana o ka ʻōpū. Ma hope koke o ka hoʻokuʻu ʻia ʻana o ka pēpē, ka ʻili i ka ʻili Hāʻawi ʻia nō hoʻi, no nā pono āpau a mākou i ʻike ai: ka pilina makuahine-keiki, mehana o ka ʻili ...
Akā, he kuhihewa ka noʻonoʻo ʻana ʻo kēia mau ala kūlohelohe i ka hānau ʻana i hana wale ʻia i loko o ka pōʻaiapili o ka cesarean extra-peritoneal. ” Hiki ke hoʻohui maikaʻi ʻia ka nozzle blower a me ka ʻili i ka ʻili i loko o kahi ʻāpana Caesarean "maʻamau", na Cohen Stark », Hōʻoiaʻiʻo iā mākou ʻo Professor Deruelle. ʻO ka mea wale nō e pili ana i ka pauku cesarean extraperitoneal ʻo ia ka ʻenehana ʻoki. Hiki i nā kākoʻo āpau a puni kēia ʻenehana e hana ʻia ma nā ʻāpana cesarean ʻē aʻe.
ʻO ka mea pōʻino, pono e ʻae ʻia ʻaʻole hāʻawi mau ʻia kēia kākoʻo i nā wahine i ka wā o ka pauku cesarean a me ka hānau ʻana maʻamau. no laila ko lākou hoihoi no nā kikowaena hānau a me nā keʻena hānai "kūlohelohe" ʻē aʻe, kahi i ʻoi aku ka hoʻokō a mahalo ʻia kā lākou hoʻolālā hānau.
I ka pōkole, ʻike ʻia ka māhele cesarean extraperitoneal e hoʻokaʻawale i nā obstetrician-gynecologists no ka manawa: kakaikahi o lākou e hoʻomaʻamaʻa, kānalua kekahi, ʻaʻole ʻike kekahi i kona hoihoi i ke alo o ka ʻenehana maʻamau ... Aia i kēlā me kēia mea e hoʻokumu i kona manaʻo a koho e like me kona manaʻo ʻana i ka hānau ʻana, kona hiki ʻana i ka ʻāina, kāna kālā, kāna hopohopo ...
E hoʻomanaʻo i kēia manawa, ʻaʻole i hoʻomaʻamaʻa ʻia kēia ʻano hana ma Farani, ma nā hale lapaʻau pilikino i kaulana loa a he kakaikahi ka helu. ʻO kahi kūlana i minamina ʻia e Kauka Simona, ka mea i ʻōlelo ua mākaukau ʻo ia e hoʻolaha i kāna ʻenehana i ka poʻe e makemake ana e lohe, a ʻaʻole hoʻi i maopopo i ka nele o ka hoihoi o nā kauka lapaʻau Farani a me nā obstetricians no kēia ala hou.
Eia nō naʻe, hiki iā mākou ke noʻonoʻo, inā hiki mai nā haʻawina e hōʻoia i nā pono o kēia ʻano o ka pauku cesarean, a ʻoi aku ka nui o nā koi a nā wahine no ia mea, e hoʻemi ʻia ka makemake ʻole o nā obstetricians a hiki i ka extraperitoneal cesarean. ʻaʻole e pani i ka Cohen-Stark Caesarean, akā e hoʻopau i ka pūʻali koa o nā kahu hānai.
ʻO ka hope, e hoʻomanaʻo ʻo ka pauku cesarean ka mea e hana wale ʻia inā pono ke olakino, i mua o nā kūlana pathological, no ka mea, ʻoi aku ka nui o ka pilikia o nā pilikia ma mua o ka wā o ka hānau ʻana. ʻO ka helu o nā ʻāpana caesarean i hana ʻia ma Farani ma kahi o 20% o nā hoʻopuka, ʻike ʻoe ka World Health Organization (WHO) paipai i ka helu ma waena o 10 a me 15%.