Mukati
Kwenguva yakati zvino, imwe inonzi nzira itsva yecesarean section, inonzi extraperitoneal cesarean chikamu, vakaita kutaura nezvake. the Prof. Philippe Deruelle, gynecologist uye Obstetrics General Secretary we CNGOF, National College yeFrench Obstetrician Gynecologists, inopindura mibvunzo yedu.
Panguva imwecheteyo, Dr Bénédicte Simon, uyo anoita extra-peritoneal cesarean section muVersailles (Yvelines), anotipa maonero ake uye ruzivo rwake.
A kwete saka ichangoburwa tekiniki
« Kana tichiita cesarean nenzira yekare, tichazarura dumbu kuburikidza nekucheka kwakaderera, toparadzanisa misumbu, tobva tapinda muchibereko nekuvhura peritoneum, tichipfuura nemudumbu. », Anopfupisa Purofesa Deruelle, achirangarira izvozvo iyo peritoneum ndiyo membrane yakatetepa inovhara uye ine nhengo dzese dzedumbu remudumbu, ingava yekubereka, weti kana kugaya.
Iyi nzira yakapupurirwa yakawanda ine zvipingamupinyi uye zvinokanganisa, sezvo kutangazve kwekufambisa kunogona kuita zvishoma uye zvishoma. iyo incision ye peritoneum dzimwe nguva inogona kukonzera kunamatira pamwero wemavanga, uye naizvozvo mamwe marwadzo.
Kubva muzana remakore rechimakumi maviri, imwe nzira, inonzi extra-peritoneal cesarean section, yakazvarwa. Zvinosanganisira shandisa ndege dzakasiyana dzeanatomical, padivi, kuti urege kuvhura dumbu remudumbu, iyo peritoneum..
« Nenzira iyi, tichaenda kune imwe nzvimbo, pakati pebundu uye chibereko, nzvimbo yatinenge tisiri mudumbu remimba, kwatinokwanisa kuwana chibereko pasina kuvhara peritoneum. », Anotsanangura Muzvinafundo Deruelle.
Extra-peritoneal cesarean chikamu: mashoma mushure mekuvhiyiwa matambudziko?
« Chaive chokwadi makore makumi matatu kana makumi mana apfuura, anofungidzira Muzvinafundo Deruelle, patakanga tisingazivi Cohen Stark maitiro, kana chikamu cheCesarean chinonzi Misgav Ladach (yakatumidzwa zita rechipatara kwayakagadzirwa), izvo zvinobvumira kurapwa kwakapfava mushure mekuvhiyiwa. »
Iyo yekuwedzera-peritoneal cesarean chikamu inogadzira, nehunyanzvi hwayo, matambudziko mashoma ekuvhiya uye kupora nekukurumidza zvichienzaniswa nemaitiro ekare ekuceya, apa pakadamburwa tsandanyama dzemudumbu.
Asi nhasi, iyo inonyanya kuitwa Kesariya chikamu, inonzi Cohen Stark, " yakachinja kutarisira vakadzi vane pamuviri "Uye" hafu yenguva yekushanda uye nguva yekupora ", Anovimbisa Muzvinafundo Deruelle, anoratidza kuti ane varwere avo, kunyangwe mushure mekuita cesarean yekare, vanogona kudya manheru mamwe chete uye vanomuka zuva rinotevera.
Musiyano mukuru pakati peiyo extraperitoneal cesarean chikamu tekinoroji uye nzira yeCohen Stark, parizvino inosimudzirwa neCollege of Obstetrician Gynecologists, ndeye. kuvhurwa kwe peritoneum. Kana ikaitwa zvakanaka, Cohen Stark Caesarean haidi kucheka mhasuru dzemudumbu, iyo inongopararira yakaparadzana, kune rumwe rutivi, peritoneum inofanirwa kudimburwa.
Ndehupi humbowo hwesainzi hwekubatsira kwayo?
Chokwadi, iyo yekuwedzera-peritoneal cesarean chikamu, nekuti haicheke mhasuru uye haicheke peritoneum, inoita seisinganyanyi kupindira uye isingarwadze cesarean section. Ziva kuti kana kucheka kwekutanga kweganda kwakachinjika, kechipiri kuchekwa, uko kweaponeurosis, membrane inoputira tsandanyama, yakamira (asi yakachinjika muhunyanzvi hweCohen Stark). Kusiyana kwaizoshandura zvinhu zvose pamwero wekufamba kwemashure maererano nevegynecologists vanokurudzira nzira iyi, asi iyo isina kuongororwa nesayenzi, anodaro Purofesa Deruelle. Izvo hazvina kuratidzwa kuti yakamira kana yakatwasuka kuvhurwa kwefascia inoshandura chero chinhu maererano nekupora.
Panyaya iyi, obstetrician-gynecologist Bénédicte Simon haabvumirani zvachose. Izvi zvinorangarira izvozvochidzidzo chesainzi chiri kuitika muIsrael neFrance, uye kuti nzira dzakasiyana dzakagadzirwa naChiremba Denis Fauck dzekuwedzera-peritoneal cesarean chikamu akakwereta kubva kune kumwe kuvhiyiwa, izvo zvakaratidzwa. Iyo extraperitoneal incision saka inokweretwa kubva kune kuvhiyiwa urologic, ukuwo vertical incision yefascia inyanzvi yakakweretwa kubva ku kuvhiyiwa kwepascular. " Zviri nyore kunzwisisa kuti kuchinja kubva pakadzika (intraperitoneal) kuvhiyiwa kuenda kupamusoro (extraperitoneal) kuvhiyiwa kunorwadza kuvarwere:Iko kuvhunduka kwekushanda hakuna kudzika, kunyaradza kuri nani zvakanyanya », Anopokana Dr Simon, achivimbisa kuti varwere vake vanogona kazhinji kuva muawa kutevera chikamu checesarean.
« Cesarean chikamu ndiyo inonyanya kuvhiyiwa kuvhiya, uye kupindira chete kunoda kufamba uye mushure mekushanda kunyaradza kutarisira mwana. Kana mukadzi akavhiyiwa chero chinhu, kazhinji haafanire kuchengeta vana vake avo vanowanzochengetwa nemhuri kana nababa. Kuedza kwakawanda kuri kuitwa kugadzira kuvhiyiwa kwevarwere vari kunze munzvimbo dzese, kunze kwekuvhiya », Regrets Dr Simon.
Pasinei nezvose, zvinogamuchirwa nevose kuti chikamu che-extra-peritoneal cesarean chakanyanya kuoma uye chinoda kudzidzira kwechokwadi nevakatanga gynecologists.
« Iko kushaikwa kwedata pakudzokorora kwerudzi urwu rwechikamu checesarean, kwatinosvika kunzvimbo dzemuviri zvisiri nyore kuwana. Sekuziva kwangu, hapana zvidzidzo zvesainzi zvakafananidza chikamu ichi checesarean kune mamwe maitiro ekuita cesarean. ", Zvakadai saCohen Stark, anoenderera mberi achisimbisa Muzvinafundo Deruelle, uyo anopa kungwarira.
Sekureva kwa gynecologist, Obstetrics General Secretary weCNGOF, the extra-peritoneal cesarean " harina kudzidzwa zvakakwana kuti risimudzirwe zvikuru sechimwe chinhu chinoshamisa. "
Iyo fadhi yehunyanzvi hwekuvhiya iyi ingakonzeresa chikamu kubva mukukurukurirana kwakanyatsoitwa kwemamwe makiriniki akazvimirira ayo akaita kuti extra-peritoneal cesarean section ive yakakosha?
Dr Simon vanoramba pfungwa iyi, nekuti uyu anokumbira chete kudzidzisa vamwe vanachiremba vechikadzi, vanoita sevasingadi nekuti haugare waona kufarirwa kwevakadzi. Kutya kune vezvekuzvara vasiri vanachiremba? Kusada kuziva, tsika? Dr. Simon, uyo anodzidzisawo vanachiremba kunze kwenyika - muTunisia, Israel kana kunyange Lithuania -, zvisinei, anobvunza chete kupa ruzivo rwake muFrance ...
Kana zviri zvekupenga kwazvino, zvingave zvakafanira, kuna Dr. Simon, kuti kushingaira kwevakadzi pachavo, vanoparadzira shoko uye vanopupura nezvechiitiko chavo chakanaka kune ani nani anoda kuvanzwa.
Mubvunzo wakaoma wenguva yekushandisa
Chero chipi zvacho chinotaura nezveCohen Stark cesarean, inobvumira nguva shoma shoma yekushanda, sezvo chibereko chinowanikwa nyore nyore kana peritoneum yakakamurwa. Ukuwo,” extraperitoneal cesarean section inorebesa nguva yekushanda uye inoda kudzidziswa chaiko, uko nzira yeCohen Stark iri nyore uye inopfupisa nguva yekushanda », Anovimbisa Muzvinafundo Deruelle.
Isu tinokurumidza kunzwisisa zvinonetsa: kana iyo yekuwedzera-peritoneal cesarean ikasaunza dambudziko panguva yakarongwa cesarean, zvichave zvakanyanya. yakaoma kuita kana paine emergency cesarean chikamu, uko miniti yega yega yakakosha kuchengetedza hupenyu hwaamai uye / kana mwana.
Nepo kune njodzi dzinotyisa, Dr. Simon anoona kuti extraperitoneal cesarean section haikurudzirwe, anotenda kuti kurebesa kwenguva yekushanda, kwemaminetsi gumi chete, idambudziko remanyepo panguva yesarudzo yecesarean chikamu., inoitirwa zvikonzero zvekurapa kana kuti zviri nyore. “ Chii chiri maminetsi gumi ekuvhiya mukuwedzera kune zvakanakira murwere? Anoti.
Chikamu checesarean chinokutendera kuti uve mutambi wekuzvarwa kwake
Iyo craze ye extraperitoneal cesarean chikamu inogona zvakare kutsanangurwa nezvose zvakaitenderedza uye izvo zvinokwezva chero amai venguva yemberi vanodakuva mutambi panguva yekusununguka kuburikidza nechikamu checesarean.
Nekuti iyo yekuwedzera-peritoneal cesarean, iyo pfungwa yekuti ndeipi kuswedera pedyo sezvinobvira kukuberekwa kwepanyama, inowanzoperekedzwa nechidimbu chepurasitiki (inonzi "Guillarme blower" kana "winner flow" ®) iyo mukadzi ane pamuviri anoenda. vhuvhuta kuti udzinge mwana nemudumbu nekuda kwekubatana kwe abs. Pakarepo mwana asunungurwa, the ganda kuganda inopihwawo, kune zvese zvakanaka zvatinoziva: chisungo chaamai-mwana, kudziya kweganda ...
Asi iko kukanganisa kufunga kuti idzi nzira dzechisikigo dzekuzvara mwana dzinoitwa chete mumamiriro ekunze kwe-peritoneal cesarean. ” Iyo blower nozzle uye ganda reganda rinogona kunyatsobatanidzwa mu "classic" Caesarean chikamu, naCohen Stark. », Anotivimbisa Muzvinafundo Deruelle. Chinhu chega chakanangana neextraperitoneal cesarean chikamu ndicho incision technique. Rutsigiro rwese rwakatenderedza tekiniki iyi runogona kuitwa mune mamwe macesarean section.
Nehurombo, zvinofanirwa kubvumwa kuti tsigiro iyi haiwanzo kupihwa kuvakadzi panguva yekuvhiya uye kuzvara kwakajairika, saka kufarira kwavo nzvimbo dzekuberekera uye mamwe "zvakasikwa" makamuri ekuberekera, uko zvirongwa zvavo zvokuberekwa nazvo zvinoratidzika kuva zvinozadzika zvikuru uye zvinoremekedzwa.
Muchidimbu, extraperitoneal cesarean chikamu chinoratidzika sechinoparadzanisa obstetrician-gynecologists panguva ino: vashoma vavo vanozviita, vamwe vanokahadzika, vamwe havaone kufarira kwayo pamberi peiyo nzira yekare ... Zviri kune mumwe nemumwe kugadzira maonero ake uye kusarudza zvinoenderana nemimba yake yekuzvara, mikana yake yenzvimbo, bhajeti rake, kutya kwake ...
Rangarira kuti pari zvino, nzira iyi inoramba ishoma kwazvo kuitwa muFrance, mumakiriniki akazvimirira ane mukurumbira uye mashoma muhuwandu. Mamiriro ezvinhu akashorwa naDr. Simon, uyo anoti kunyange zvakadaro akagadzirira kuparadzira maitiro ake kune ani zvake anoda kuzvinzwa, uye asinganzwisisi kushayikwa kwekufarira kweFrench gynecologists uye obstetricians nokuda kweiyi nzira itsva.
Zvisinei, tinogona kufunga kuti, kana zvidzidzo zvikasvika pakusimbisa zvakanakira rudzi urwu rwechikamu checesarean, uye kuti vakadzi vanonyanya kuwedzera kudiwa kwaro, kusada kwevanachiremba vezvekudzivirira kunozopedzisira kwaderera kusvika pakuti extraperitoneal cesarean inouya. kwete kutsiva Cohen-Stark Caesarean, asi pedzisa kuvhiya arsenal yevanobereka vana.
Pakupedzisira, yeuka kuti cesarean chikamu chinoramba chiri kupindira kwekuvhiya kunofanira kuitwa chete kana chiitiko chekurapa chinodiwa, mukutarisana nemamiriro ezvinhu ehutano, nokuti njodzi yezvinetso yakakura kudarika panguva yekusununguka kwemukadzi. Muyero wezvikamu zvecaesarean unoitwa muFrance unosvika makumi maviri muzana ekuzvara, tichiziva izvozvo World Health Organisation (WHO) inokurudzira mwero uri pakati pe10 ne15%.