Douglas ndi dzina la dokotala waku anatomist waku Scottish James Douglas (1675-1742), yemwe adapereka dzina lake ku mawu osiyanasiyana a Douglas komanso matenda omwe amalumikizidwa nawo: douglassectomy, douglascele, douglassite, Douglas line, ndi zina zambiri .

Cul-de-sac ya Douglas imafotokozedwa ndi akatswiri a anatomists ngati khola la peritoneum yomwe ili pakati pa rectum ndi chiberekero, ndikupanga cul-de-sac.

Cul-de-sac ya Douglas ili patali pansi pa umbilicus wa 4 mpaka 6 cm. Ndilo malo otsika kwambiri a peritoneal cavity, omwe amapangidwa ndi peritoneum, serous membrane yomwe imayang'ana m'mimba.

Kwa amuna

Amuna, cul-de-sac ili pakati pa chikhodzodzo ndi rectum. Ndi kumapeto kwenikweni kwa zibowo zam'mimbamo, pakati pazambuyo pake pa chikhodzodzo ndi panja pa rectum.

Mwa akazi

Kwa amayi, thumba la Douglas limatchedwanso thumba la chiberekero, lomwe lili pakati pa rectum ndi chiberekero. Chifukwa chake chimachepa kumbuyo ndi rectum, kutsogolo kwake ndi chiberekero ndi nyini; ndipo pambuyo pake ndimakutu abulu a recto-uterine.

Udindo wake ndikuthandiza ziwalo ndikuziteteza kumatenda.

Ntchito

Amapangidwa ndi minofu yolumikizana yolimba yomwe imakhala ndi mapuloteni onga collagen, ndi ulusi wotanuka. Kakhungu kameneka kamatchedwanso aponeurosis. 

Njirayi imatha kutulutsa ma serosities, mtundu wa madzi amadzimadzi ofanana ndi gawo lamadzi lotchedwa plasma. 

Ma seramu amapangidwa m'mimbamo ya serous yomwe ndi nembanemba yomwe imayala ming'alu yotseka ya thupi.

Cul-de-sac ya Douglas imapezeka ndi kuyezetsa ukazi mwa amayi, mwa kuwunikanso amuna mwa amuna.

Kuyeza kwa palpation kwa digito nthawi zambiri kumakhala kopweteka.

Kukhudza uku kukamabweretsa ululu, wodwalayo amalira chifukwa kupweteka kumakhala kwamphamvu kwambiri. Kulira uku kumadziwika ndi akatswiri azaumoyo kukhala "kulira kwa a Douglas" popeza zizindikiritsozo ndizachidziwikire.

Palpation imawonetsa kutulutsa kwa intraperitoneal, abscess kapena chotupa cholimba. Pakakhala abscess, palpation imatha kupweteka kwambiri.

Kupweteka kumeneku kumatha kukhala chizindikiro cha matenda ambiri omwe amatha kuchokera ku ectopic pregnancy mwa amayi, chophukacho kapena douglassitis.

Ectopic (kapena ectopic) mimba 

Ectopic (kapena ectopic) mimba imayamba kunja kwa chiberekero:

• mu chubu cha mazira, ndi mimba yamimba;
• m'chiberekero, ndi mimba yamchiberekero;
• mu peritoneal patsekeke, ndi mimba m'mimba.

Pankhani ya ectopic pregnancy, kuyezetsa ukazi kwa mzamba kapena mzamba kumakhala kopweteka kwambiri (kupweteka kwa Douglas) ndipo kumatha kutsagana ndi syncope, pallor, mathamangitsidwe, malungo, kuphulika. Douglas ikhoza kudzazidwa ndi magazi amtundu wofiirira wa sepia.

Kutulutsa kwa chiuno chaching'ono, chifukwa cha nyini iyi, kuseri kwa chiberekero, kumakumana nawo pafupipafupi ngati ectopic pregnancy itaphulika. Kuphulika kumeneku kumayambitsa kuphulika kwa magazi komwe kumasonkhana kuseri kwa izi. Kupindika kwake kumakhala kopweteka kwambiri ndipo ndikofunikira kwambiri pakuzindikira.

Kubadwa kwa chiwalo (kapena kufalikira) kumayambitsidwa ndi chophukacho cha m'matumbo chomwe chatsikira mu Douglas 'cul-de-sac chomwe chimakankhira khoma lakumbuyo kwakumbuyo kudzera kumaliseche.

Douglassitis ndikutupa kwakanthawi kwa peritoneum komwe kuli mu sac ya Douglas-fir. Nthawi zambiri zimayambitsidwa ndi kuphulika kwa intraperitoneal (mu peritoneum, chotupa, kusonkhanitsa magazi kuchokera kutuluka kwa magazi komwe kumayambitsidwa ndi GEU (ectopic pregnancy) kapena abscess kapena abscess.

Dokotala amachita thumbo (la mwamunayo) kapena nyini (kuti mkaziyo) adziwe momwe zinthu ziliri.

Njira zosiyanasiyana

Pakafunika kuchotsedwa, dokotalayo amachita ngalandeyo. Kwa amayi, ndi colpotomy, kulowererapo kudzera pakhoma la nyini ndipo kwa amuna kulowereraku kumatchedwa rectotomy, chifukwa kulowereraku kumachitika kudzera pakhoma lammbali.

Pamene cul-de-sac ya Douglas ikadzaza magazi kapena madzimadzi, ndikofunikira kuchita ngalande, makamaka azimayi kudzera pamakoma azimayi. Izi ndi colpotomy.

Mwa anthu, ngalande nthawi zina zimakhala zofunikira. Poterepa ndikofunikira kuchita izi kudzera kukhoma lakunja kwa rectum, kulowereraku kumatchedwa rectotomy.

Kukhazikika kwa phulusa kumatha kutsimikiziridwa ndi ultrasound ndi puncture yeniyeni ya chikhalidwe chake.

Malangizo

Douglassectomy ndi njira yochitira opaleshoni yomwe imakhudza kuchotsa kwa Douglas 'cul-de-sac. Amachitidwa ndi laparoscopy kapena kudzera m'mitsempha m'mimba yotchedwa laparotomy.