Zamkatimu
Kwa kanthawi tsopano, akuti njira yatsopano yopangira opaleshoni, yotchedwa extraperitoneal cesarean gawo, analankhula za iye. ndi Prof. Philippe Deruelle, katswiri wazachikazi komanso mlembi wamkulu wa Obstetrics wa CNGOF, National College of French Obstetrician Gynecologists, amayankha mafunso athu.
Panthawi imodzimodziyo, Dr Bénédicte Simon, yemwe amapangira opaleshoni yowonjezera peritoneal ku Versailles (Yvelines), amatipatsa malingaliro ake ndi zomwe zinamuchitikira.
A osati posachedwapa njira
« Tikapanga cesarean mwa njira yachikale, tidzatsegula m'mimba kudzera m'mimba mwake, kenaka timalekanitsa minofu, kenaka timapeza chiberekero potsegula peritoneum, kudutsa m'mimba. », Akufotokoza mwachidule Pulofesa Deruelle, pokumbukira zimenezo peritoneum ndi nembanemba yopyapyala yomwe imaphimba ndipo imakhala ndi ziwalo zonse za m'mimba, kaya ndi zoberekera, zamkodzo kapena zogaya chakudya.
Njira yotsimikiziridwa yodziwika bwinoyi ili ndi zovuta zake komanso zosokoneza, chifukwa kuyambiranso kuyenda kumatha kukhala pang'onopang'ono komanso kudulidwa kwa peritoneum nthawi zina kungayambitse kumamatira pa mlingo wa zipsera, choncho ululu kwambiri.
Kuchokera m'zaka za zana la makumi awiri, njira ina, yotchedwa extra-peritoneal cesarean section, inabadwa. Zimapangidwa ndi gwiritsani ntchito ndege zosiyanasiyana za anatomical, kumbali, kuti musatsegule pamimba, peritoneum..
« Mwa njira iyi, tidzadutsa malo ena, pakati pa chikhodzodzo ndi chiberekero, malo omwe sitili m'mimba, momwe tingathere chiberekero popanda kusokoneza peritoneum. », Akufotokoza Pulofesa Deruelle.
Gawo lopangira opaleshoni yowonjezera: zovuta zochepa zapambuyo pa opareshoni?
« Izo zinali zoona zaka makumi atatu kapena makumi anayi zapitazo. akuyerekeza Pulofesa Deruelle, pamene sitinadziwa Njira ya Cohen Stark, kapena gawo la Kaisara lotchedwa Misgav Ladach (wotchedwa pambuyo pa chipatala chomwe chinapangidwira), chomwe chimalola chithandizo chosavuta pambuyo pa opaleshoni. »
Gawo la extraperitoneal cesarean limapanga, ndi njira yake, zovuta zochepa za opaleshoni komanso kuchira msanga poyerekeza ndi njira zakale zoberekera, kumene minofu ya m’mimba inadulidwa.
Koma masiku ano, ambiri amachita opaleshoni gawo, amatchedwa Cohen Stark, ” inasintha kasamalidwe ka amayi apakati "Ndipo" theka la nthawi yogwira ntchito komanso nthawi yochira ", Akutsimikizira Pulofesa Deruelle, yemwe akuwonetsa kuti ali ndi odwala omwe, ngakhale atapanga opaleshoni yachikale, amatha kudya madzulo omwewo ndikudzuka tsiku lotsatira.
Kusiyana kwakukulu pakati pa njira ya extraperitoneal cesarean section ndi njira ya Cohen Stark, yomwe ikulimbikitsidwa ndi College of Obstetrician Gynecologists, ndi. kutsegula kwa peritoneum. Ngati zichitidwa bwino, Cohen Stark Caesarean safuna kudula minofu ya m'mimba, yomwe imangofalikira, komano, peritoneum imadulidwa.
Kodi umboni wa sayansi wa phindu lake ndi wotani?
Zowonadi, gawo la extra-peritoneal cesarean, chifukwa silimadula minofu ndipo silimadula peritoneum, zikuwoneka kuti ndi gawo lopweteka kwambiri komanso lopanda ululu. Zindikirani kuti ngati kudulidwa koyamba kwa khungu kumakhala kopingasa, kung'ambika kwachiwiri, kwa aponeurosis, nembanemba yomwe imakuta minofu, imakhala yoyima (pamene ili yopingasa mu njira ya Cohen Stark). Kusiyanitsa komwe kungasinthe chilichonse pamlingo wakuyenda kwapambuyo pochita opaleshoni malinga ndi akatswiri azachipatala omwe amalimbikitsa njirayi, koma yomwe siinawunikenso mwasayansi, akutero Pulofesa Deruelle. Sizinatsimikizidwe kuti kutseguka kowongoka kapena kopingasa kwa fascia kumasintha chirichonse ponena za kuchira.
Pa mfundo imeneyi, dokotala wodziwa za amayi Bénédicte Simon savomereza kotheratu. Izi zimakumbukirakafukufuku wa sayansi akuchitika ku Israel ndi France, ndi kuti njira zosiyanasiyana zopangidwa ndi Doctor Denis Fauck za gawo la extra-peritoneal cesarean ndi kubwereka ku maopaleshoni ena, omwe atsimikiziridwa. The extraperitoneal incision motero amabwereka kuchokera ku opaleshoni ya urological, pamene kudulidwa koyima kwa fascia ndi njira yobwereka kuchokera ku opaleshoni yapamwamba. " Ndizosavuta kumvetsetsa kuti kusintha kuchokera ku opaleshoni yakuya (intraperitoneal) kupita ku opaleshoni yapamwamba (extraperitoneal) sikupweteka kwambiri kwa odwala:Kugwedezeka kwa opaleshoni ndikocheperako, chitonthozo chimakhala bwino kwambiri », Akutsutsa Dr Simon, kutsimikizira kuti odwala ake nthawi zambiri amakhala mmwamba mu ora kutsatira gawo la cesarean.
« Gawo la Cesarean ndilo opaleshoni yofala kwambiri, ndipo njira yokhayo yomwe imafuna kuyenda ndi chitonthozo pambuyo pa opaleshoni kuti asamalire mwanayo. Mayi akachitidwa opareshoni pa chilichonse, nthawi zambiri safunikira kusamalira ana ake omwe nthawi zambiri amasamalidwa ndi banja kapena abambo. Zoyesayesa zambiri zikupangidwa kuti apange opaleshoni yakunja m'madera onse, kupatula gawo la opaleshoni », Regrets Dr Simon.
Ngakhale zili zonse, zimavomerezedwa ndi onse kuti gawo lopangira opaleshoni la extra-peritoneal mwaukadaulo ndilovuta kwambiri ndipo limafuna kuphunzitsidwa kwenikweni ndi akatswiri azachikazi.
« Pali kusowa kwa deta pa kubwereza kwa mtundu uwu wa gawo la cesarean, kumene timayandikira madera a thupi osati osavuta kupeza. Malinga ndi chidziwitso changa, palibe maphunziro asayansi omwe afananiza gawo la cesarean ndi njira zina zopangira opaleshoni. ", Monga Cohen Stark, akutsindikanso Pulofesa Deruelle, yemwe amalangiza kusamala.
Malinga ndi gynecologist, Obstetrics General Secretary wa CNGOF, extra-peritoneal cesarean " sichinaphunziridwe mokwanira kuti chikwezedwe mokulira monga chinthu chozizwitsa. "
Kodi fashoni ya njira yopangira opaleshoniyi ingapangitse kuti pakhale kulumikizana koyendetsedwa bwino ndi zipatala zina zachinsinsi zomwe zapangitsa kuti gawo lopangira opaleshoni lapadera kukhala lapadera?
Dr Simon akutsutsa lingaliro ili, chifukwa uyu akungopempha kuti aphunzitse madokotala ena achikazi, omwe amawoneka osafuna chifukwa nthawi zonse mumawona chidwi cha akazi. Kuda nkhawa kwa madokotala oyembekezera omwe si maopaleshoni? Kupanda chidwi, chizolowezi? Dr. Simon, yemwe amaphunzitsanso madotolo akunja - ku Tunisia, Israel kapena Lithuania - komabe, amangofunsa kuti apereke chidziwitso chake ku France ...
Ponena za misala yamakono, ingakhale chifukwa, kwa Dr. Simon, kuti changu cha akazi omwe, omwe amafalitsa mawu ndi kuchitira umboni za zochitika zawo zabwino kwambiri kwa aliyense amene akufuna kuwamva.
Funso losavuta la nthawi yogwira ntchito
Chilichonse chimene wina akunena za Cohen Stark cesarean, amalola nthawi yochepa kwambiri yopangira opaleshoni, popeza chiberekero chimapezeka mosavuta pamene peritoneum yagawanika. M'malo mwake, " extraperitoneal cesarean section imatalikitsa nthawi yogwira ntchito ndipo imafuna maphunziro apadera, pomwe njira ya Cohen Stark ndiyosavuta komanso imafupikitsa nthawi yogwira ntchito », Akutsimikizira Pulofesa Deruelle.
Timamvetsetsa mwachangu zodetsa nkhawa: ngati cesarean extra-peritoneal sikhala ndi vuto panthawi ya cesarean yomwe idakonzedwa, ndiye kuti zikhala zochulukirapo. chokhwima kuchita ngati mwadzidzidzi cesarean gawo, pomwe mphindi iliyonse imawerengera kuti ipulumutse moyo wa mayi ndi / kapena mwana.
Ngakhale pazochitika zadzidzidzi, Dr. Simon amazindikira kuti extraperitoneal cesarean section sivomerezedwa, amakhulupirira kuti. kutalikitsa kwa nthawi yopangira, mphindi khumi zokha, ndi vuto labodza panthawi yopangira opaleshoni yosankha., zochitidwa pazifukwa zachipatala kapena kuti zikhale zosavuta. “ Kodi kuwonjezera pa ubwino wa wodwalayo ndi chiyani kwa mphindi khumi? Iye akutero.
Gawo la cesarean lomwe limakupatsani mwayi wokhala wosewera pakubereka kwake
The craze for extraperitoneal cesarean section imathanso kufotokozedwa ndi chilichonse chozungulira ndi zomwe zimakopa mayi wamtsogolo aliyense wofunitsitsakukhala wochita zisudzo panthawi yobereka kudzera mwa opaleshoni.
Chifukwa extra-peritoneal cesarean, lingaliro lomwe liri kuyandikira pafupi kwambiri ndi kubadwa kwa thupi, nthawi zambiri amatsagana ndi nsonga yaing'ono ya pulasitiki (yotchedwa "Guillarme blower" kapena "winner flow" ®) momwe mayi wapakati amapita. kuwomba kutulutsa mwana kudzera m'mimba chifukwa cha kukomoka kwa abs. Mwanayo atangotulutsidwa kumene, a khungu ku khungu imaperekedwanso, chifukwa cha zabwino zonse zomwe timadziwa: mgwirizano wa amayi ndi mwana, kutentha kwa khungu ...
Koma ndi kulakwitsa kuganiza kuti njira zachibadwa zoberekera mwana zimangochitika pokhapokha ngati pali cesarean extraperitoneal. ” Mphuno yopukutira ndi khungu ku khungu zitha kuphatikizidwa bwino mu gawo la "Kaisareya" la Cohen Stark. », Akutitsimikizira Pulofesa Deruelle. Chinthu chokhacho chomwe chili chodziwika bwino cha extraperitoneal cesarean section ndi njira yocheka. Thandizo lonse lozungulira njira iyi lingathe kuchitidwa m'magawo ena opangira opaleshoni.
Tsoka ilo, ziyenera kuvomerezedwa kuti chithandizochi sichimaperekedwa nthawi zonse kwa amayi panthawi ya cesarean komanso pobereka wamba, chifukwa chake chidwi chawo cha malo oberekera ndi zipinda zina "zachilengedwe" zoberekera, kumene mapulani awo obadwa amaoneka kuti akukwaniritsidwa ndi kulemekezedwa.
Mwachidule, gawo lopangira opaleshoni la extraperitoneal likuwoneka kuti likugawaniza akatswiri azachipatala pakalipano: ochepa mwa iwo amachita izi, ena amakayikira, ena samawona chidwi chake pamaso pa njira yachikale ... Zili kwa aliyense kupanga malingaliro ake ndikusankha malinga ndi lingaliro lake la kubadwa, kuthekera kwake komwe amakhala, bajeti yake, nkhawa zake ...
Kumbukirani kuti pakadali pano, njira iyi ikadali yocheperako ku France, muzipatala zapadera zomwe ndizodziwika bwino komanso zochepa. Mkhalidwe wotsutsidwa ndi Dr. Simon, yemwe akunena kuti ali wokonzeka kufalitsa njira yake kwa aliyense amene akufuna kumva, komanso amene samvetsa kusowa chidwi kwa akatswiri achikazi achi French ndi obereketsa chifukwa cha njira yatsopanoyi.
Komabe, titha kuganiza kuti, ngati maphunziro abwera kudzatsimikizira ubwino wa mtundu uwu wa cesarean, komanso kuti amayi amawafuna kwambiri, kukayikira kwa akatswiri oyembekezera kudzachepa kwambiri mpaka kufika kwa extraperitoneal cesarean. osati m'malo mwa Cohen-Stark Caesarean, koma malizitsani zida za opaleshoni ya obereketsa.
Pomaliza, kumbukirani kuti gawo la cesarean limakhalabe njira yopangira opaleshoni yomwe iyenera kuchitidwa pokhapokha ngati pakufunika chithandizo chamankhwala, poyang'anizana ndi zochitika za pathological, chifukwa chiopsezo cha zovuta chimakhala chachikulu kuposa panthawi yobereka. Kuchuluka kwa magawo opangira opaleshoni ku France ndi pafupifupi 20% ya obadwa, podziwa izi World Health Organisation (WHO) imalimbikitsa kuti pakhale pakati pa 10 ndi 15%.