Vulva imapanga maliseche akunja a mkazi, ndipo imaphatikizapo / imamvetsetsa: 

• ng'ombe zazikulu ndi labia zazing'ono;
• clitoris;
• nyama ya mkodzo yomwe imapanga malo otulutsira mkodzo;
• ndipo potsiriza polowera kumaliseche amatchedwanso khonde la nyini. 

Vulvectomy ndi opaleshoni yomwe imaphatikizapo kuchotsa maliseche pang'ono kapena kwathunthu. Choncho, pali mitundu ingapo ya vulvectomy. 

Vulvectomy yosavuta imaphatikizapo kuchotsa maliseche onse, koma kusiya minofu yambiri yomwe ili m'malo mwake. Madokotala nthawi zambiri amachita opaleshoni yamtunduwu kuti achotse VIN (vulvar intraepithelial neoplasia) yomwe imapezeka m'malo angapo pavulva.

Ma vulvar intraepithelial neoplasms awa amakhalabe matenda oopsa. Komabe, kuchuluka kwawo kumawonjezeka, makamaka kwa odwala achichepere. Izi zimagwirizana ndi chitukuko cha matenda opatsirana pogonana chifukwa cha HPV (Human papilloma virus). Muyeneranso kudziwa kuti mitundu ina ya VIN imatha kukhala khansa yowononga. Palinso mitundu iwiri ya radical vulvectomy.

Radical partial vulvectomy imaphatikizapo kuchotsa mbali ya vulva komanso minofu yomwe ili pansi pa chotupacho. Nthawi zina clitoris imachotsedwanso. Ndilo mtundu wofala kwambiri wa vulvectomy wochitidwa pochiza khansa ya m'mimba.

Potsirizira pake, vulvectomy yochuluka kwambiri ndiyo kuchotsa maliseche onse, labia yaikulu ndi labia minora, ya minyewa yomwe ili pansi pa maliseche komanso pa clitoris.

Vulvectomy imachitika chifukwa cha kukhalapo kwa zotupa za khansa m'chikazi. Opaleshoniyi ili ndi zisonyezo zazikulu ziwiri:

• Kapena amalola kuchotsa kwathunthu chotupacho, komanso malire a minofu yachibadwa kuzungulira;
• Mwina cholinga chake ndi kuchepetsa ululu kapena kuchepetsa zizindikiro, ndipo pamenepa ndi opaleshoni yochepetsetsa.

Opaleshoni isanayambe, mankhwala ena adzafunika kuyimitsidwa, monga mankhwala oletsa kutupa ndi anticoagulants (omwe amapangitsa magazi kukhala amadzimadzi). Ndikulimbikitsidwanso kusiya kusuta kwa masabata 4 mpaka 8 musanayambe opaleshoni. Nthawi zonse, chisamaliro chiyenera kutengedwa kutsatira malangizo a dokotala. 

Opaleshoniyo imachitika kapena:

• mu anesthesia yachigawo (yomwe imakhudza thupi lonse lapansi);
• kapena mwa anesthesia (wodwalayo akugona kwathunthu). 

Dokotala wa opaleshoni amachotsa maliseche kapena mbali ya vulva asanatseke kudulidwa kapena kudulidwa ndi suture kapena staples. Opaleshoniyi imatha pafupifupi maola 1 mpaka 3. Nthawi zambiri, m'pofunika kuchita zowonjezera khungu grafts, kuti athe kutseka bala. 

Kawirikawiri, zochepetsera ululu zomwe zimaperekedwa panthawi ya postoperative zimathandiza kuthetsa ululu. Kutalika kwa nthawi yokhala m'chipatala nthawi zambiri ndi 1 mpaka masiku a 5, amatha kusiyana malinga ndi mtundu wa chithandizo chomwe chachitika. 

Pambuyo pa opaleshoni, muyenera kuyembekezera kukhalapo kwa zipangizo zosiyanasiyana:

• Choncho, njira yothetsera vutoli imalola wodwalayo kuti adye madzi ndipo adzachotsedwa mwamsanga pamene atha kumwa mokwanira ndikuyambiranso kudya bwino;
• Chovala chingagwiritsidwenso ntchito pabala, ndikuchotsedwa patatha masiku angapo;
• Zotsalira, ngati zilipo, zimachotsedwa mkati mwa masiku 7-10 atachitidwa opaleshoni;
• Mitsempha ya inguinal, yomwe ndi machubu omwe ali mu groin, akhoza kuikidwa pamene dokotalayo wachotsa chimodzi kapena zingapo za lymph nodes: machubuwa amalola kuti madzi atuluke m'dera lomwe akugwiritsidwa ntchito ndipo adzachotsedwa pasanathe masiku angapo. pambuyo opaleshoni; 
• Pomaliza, catheter ya chikhodzodzo imayikidwa mu chikhodzodzo chanu: imalola kuchotsa mkodzo ndipo imachotsedwa pambuyo pa maola 24 kapena 48 kutsatira vulvectomy. Nthawi zina, catheter iyi ya chikhodzodzo imatha kukhala nthawi yayitali.

Kutuluka magazi pambuyo pa opaleshoni sikochitika ndipo sikuchuluka kwambiri. Anamwino amayeretsa malo ogwiritsidwa ntchito, vulva, katatu patsiku panthawi yachipatala, zomwe zimathandiza kuti chilonda chichiritse. Kubwereranso ku chakudya kumachitika nthawi yomweyo nthawi zambiri, ndipo ndi dokotala kapena namwino amene amalangiza wodwalayo kuti ayambenso kudya ndi kumwa. M'pofunikanso kuti ayambe kusonkhanitsa kachiwiri, ndipo, kuwonjezerapo, kuchita masewera olimbitsa thupi kupuma. N'zotheka kuti mukamabwerera kunyumba, majekeseni a anticoagulant omwe anayambika m'chipatala adzapitirizidwa: izi zimapangitsa kuti zikhale zotheka kuteteza mapangidwe a magazi.

Opaleshoni ya vulvar akadali njira yabwino kwambiri yothandizira khansa iyi. Zili ndi zotsatira zabwino kwambiri, makamaka motsutsana ndi VIN, vulvar intraepithelial neoplasia yomwe, monga momwe tafotokozera kale, nthawi zambiri imakhalabe yovuta kwambiri koma yomwe mafupipafupi ake amakhala akuwonjezeka. Komabe, vulvectomy nthawi zonse imasiya sequelae, kaya yokongoletsedwa, yogwira ntchito komanso mwachiwonekere yamalingaliro.

Kuonjezera apo, pamene vulvectomy yochuluka ikafunidwa, imatha kusokoneza kwambiri maliseche, komanso imayambitsa kutaya kwakukulu kwa kugonana.

Kutsata kwanthawi yayitali kwa odwala omwe achotsedwa pang'onopang'ono kapena kuchotsedwa kwathunthu kwa maliseche ndikofunikira, chifukwa pali chiopsezo chachikulu choyambiranso, makamaka kwa vulvar intraepithelial neoplasia. Katemera wa HPV atha kukhala ndi zotsatira zabwino zochepetsera kuchuluka kwa khansa yamtundu uwu, makamaka pamitundu yomwe imayambitsidwa ndi kachilomboka.

Zotsatira za chithandizo cha khansa ya vulvar zikhoza kuchitika. Mkazi aliyense adzawazindikira mosiyana. Zotsatirazi zimatha kuchitika panthawi ya opaleshoni, nthawi zina pambuyo pake, kapena masiku angapo kapena masabata pambuyo pake. Nthawi zina pamakhalanso zotsatira mochedwa, zomwe zimachitika miyezi ingapo kapena zaka pambuyo pa opaleshoni.

Nazi zotsatira zosiyana zomwe zingachitike pambuyo pa vulvectomy: 

• ululu;
• machiritso osauka;
• kuwonongeka kwa mitsempha chifukwa cha dzanzi kapena kumva kulasalasa;
• kusintha kwa ntchito ya maliseche komanso maonekedwe ake (makamaka ngati opaleshoniyo ndi yaikulu, ndipo imawonetseredwa mwachitsanzo ndi jet ya mkodzo yomwe imapita kumbali imodzi). 

Kuonjezera apo, matenda amatha kuchitika, kapena lymphedema, ndiko kuti kutupa chifukwa cha kudzikundikira kwa madzi amadzimadzi m'thupi. Pomaliza, vulvectomy ikhoza kukhala ndi zotsatira zoyipa pakugonana, zanenedwa kale, makamaka kusinthidwa kwa chikhumbo ndi kuyankha.

Zotsatira zoyipa zambiri zimatha zokha kapena zikalandira chithandizo, ngakhale zina zimatha kwa nthawi yayitali kapena kukhala zachikhalire. Nthawi zonse, ndikofunikira kuchenjeza gulu lachipatala lomwe lidatenga opaleshoniyo mwachangu kwambiri wodwalayo akangopeza chimodzi mwazotsatirazi. Vuto likangotchulidwa mwachangu, gulu lachipatala limatha kuchitapo kanthu mwachangu powonetsa momwe lingathetsere vutoli.