Douglas izita remumwe chiremba wechiScotland anatomist chiremba James Douglas (1675-1742), uyo akapa zita rake kune akasiyana cul-de-sac mazwi aDouglas uye kuzvirwere zvakabatana nazvo: douglassectomy, douglascele, douglassite, Douglas mutsara, nezvimwe. .

Iyo Douglas 'cul-de-sac inotsanangurwa nemaatomist sedanga reperitoneum iri pakati perectum nechibereko, ichiumba cul-de-sac.

Douglas 'cul-de-sac iri chinhambwe pazasi pe umbilicus we4 kusvika 6 cm. Iyo ndiyo yakaderera poindi ye peritoneal mhango, iyo pachayo inoumbwa neparitoneum, serous membrane inoisa mudumbu mhango.

Kune varume

Mune varume, iyi cul-de-sac iri pakati pechidzitiro uye rectum. Iwo anongova iwo wezasi magumo eperitoneal mhango, pakati pekunze kwepashure kwedundira uye nechemberi pamusoro peiyo rectum.

Mune vakadzi

Kune vanhukadzi, homwe yeDouglas inonziwo recto-uterine homwe, iri pakati penzou nechibereko. Naizvozvo inoganhurirwa kumashure nekwirikwiti, kumberi nechibereko nemukadzi; uye gare gare nerecto-uterine folds.

Basa rayo ndere kutsigira nhengo nekudzidzivirira kubva kuzvirwere.

mashandiro

Iyo inoumbwa ine gobvu rinobatanidza zvinyama zvine collagen-senge mapuroteni, uye elastic fiber. Iyi membrane yakasimba inonziwo aponeurosis. 

Iyi membrane inokwanisa kuburitsa serosities, rudzi rweiyo lymphatic fluid yakaenzana nechikamu chemvura cheropa chinonzi plasma. 

Serum inoumbika mune iyo serous membranes inova iyo mamina ayo anomiririra akavharwa matanda emuviri.

Douglas 'cul-de-sac inowanikwa nekuongororwa kwemadzimai muvakadzi, nekuongororwa kwese mune varume.

Iyi yedhijitari palpation kuongororwa kazhinji haina kurwadziwa.

Kana kubata uku kuchikonzera kurwadziwa, murwere anochema nekuti kurwadziwa kwacho kune chisimba. Kuchema uku kunozivikanwa nenyanzvi dzezvehutano kuve "kuchema kwaDouglas" sezvo zviratidzo zvakanyatsojeka.

Palpation inoratidza iyo intraperitoneal effusion, abscess kana yakasimba bundu. Mukana wekuputika, kurova kunogona kurwadza kwazvo.

Uku kurwadziwa kunogona kuve chiratidzo chehuzhinji hwehutachiona hunogona kubva pa ectopic nhumbu mumadzimai, hernia kana kunyange douglassitis.

Ectopic (kana ectopic) nhumbu 

Ectopic (kana ectopic) nhumbu inokura kunze kwechibereko chechibereko:

• mune fallopian chubhu, iri tubal nhumbu;
• mune ovary, iri ovarian nhumbu;
• mu peritoneal mhango, ipamuviri wepamuviri.

Panyaya ye ectopic nhumbu, kuongororwa kwemadzimai epamuviri kana nyamukuta kunorwadza zvakanyanya (kurwadziwa kwaDouglas) uye kunogona kuperekedzwa ne syncope, pallor, kumhanyisa kupisa, fivha, kuzvimba. Iyo Douglas inogona kuzadzwa ne sepia shava ropa rakatsvuka.

Kubviswa kwepachiuno chidiki, saka kuseri kweiyi vaginal cul-de-sac, kuseri kwechibereko, kunowanzo sangana muchiitiko chekuputika ectopic nhumbu. Uku kuputika kunokonzera kubuda kweropa uko kunoungana kuseri kweiyi cul-de-sac. Kubata kwaro kunorwadza zvakanyanya uye kwakakosha pakuonekwa.

Iyi nhengo yedzinza (kana kuwanda) inokonzerwa nehernia yematumbo iyo yakadzikira muDouglas 'cul-de-sac uye inosundira iro rekumashure kwemadzimai emadziro kumashure kuburikidza nehuremu.

Douglassitis chirwere chisingaperi che peritoneum iyo iri muDouglas-fir sac. Inowanzo kukonzerwa neiyo intraperitoneal effusion (mu peritoneum, bundu, kuunganidzwa kweropa kubva mukubuda ropa kunokonzerwa neGEU (ectopic nhumbu) kana bundu kana bundu.

Chiremba anoita rectal (yemurume) kana yemukadzi (yemukadzi) kuziva mamiriro eacul-de-sac.

Kupindira kwakasiyana

Kana iyo effusion ichida kubviswa, chiremba anoita drainage. Kune vakadzi, iyo colpotomy, kupindira kuburikidza nemukati memadzimai uye kune varume kupindira uku kunodaidzwa kunzi rectotomy, nekuti kupindira kunoitwa kuburikidza nerekure madziro.

Kana Douglas 'cul-de-sac' izere neropa kana fluid, saka zvakafanira kuita drainage, kunyanya mumadzimai kuburikidza nemadzimai madziro. Ichi chiito ndicho colpotomy.

Muvanhu, kubuda kwemvura dzimwe nguva kunodikanwa zvakare. Muchiitiko ichi zvinodikanwa kuti uzviite kuburikidza nemadziro ekutanga ereceum, kupindira uku kunodaidzwa kunzi rectotomy.

Kugadziriswa kwenzvimbo yekubvisa kunogona kusimbiswa neiyo ultrasound uye ponji inonyatsoita hunhu hwayo.

Douglassectomy

Douglassectomy inzira yekuvhiya iyo inosanganisira kubvisa Douglas 'cul-de-sac. Inoitwa ne laparoscopy kana kuburikidza nekuvhura mudumbu kunonzi laparotomy.