Gastrectomy

Cov feem ntau ua hauj lwm nyob rau hauv cov kab mob ntawm lub duodenum thiab lub plab yog gastrectomy.

Lub hauv paus ntawm lub lag luam yog excision ntawm mob ib feem ntawm qhov hloov. Yog li laaj restoration (sam xeeb) hnyuv anastomosis yog ua nruab nrab ntawm cov jejunum thiab lub duodenum los yog plab paus.

Phais pab kho tej zaum yuav ua los ntawm ob tug yooj yim txoj kev.

Thaum uas siv cov thawj txoj kev (Billroth I) Gastrectomy yog ua los ntawm tag nrho cov excision nws pyloric antrum thiab ceg. Nyob rau hauv cov ntaub ntawv no, lub imposition ntawm anastomosis yog ua nruab nrab ntawm cov qis ib feem ntawm lub cev thiab lub hauv paus ntawm lub duodenum rau lub hauv paus ntsiab lus ntawm "xaus mus xaus".

Gastrectomy los ntawm cov qauv no tej zaum yuav raug nyob rau hauv ib tug heev txaus ntshai yam tab kaum, manifested nyob rau hauv tsis muaj kev ceev ceev ntawm lub anastomosis nyob lub hlws ris ntawm peb pob qij txha cheeb tsam. Yuav kom tshem tawm nws, muaj ntau ntau yam sib txawv versions. Feem ntau siv Gaberera kev hloov kho II. Nrog rau qhov no ua lag luam, tom qab excision 2 \ 3 mobilization thiab pais plab khoom luminal narrowing nws los ntawm txoj kev crimping nqaws li hais tias nws cov dav yog sib npaug zos rau cov dav ntawm lub lumen ntawm lub duodenum.

Gastrectomy nrog Billroth II txoj kev yog nqa tawm los ntawm nruj nreem hauv paus suturing lub cev. Yuav kom restore lub laaj ntawm tus mob huam nyob rau hauv cov ntaub ntawv no ua overlay rear los yog pem hauv ntej gastroenteroanastomosis.

Qhov kev xaiv ntawm cov qauv ntawm cov excision yog nqa tawm kev noj mus rau hauv tus account lub hom pathology, nws localization thiab excised plab loj.

Muaj txheeb ze thiab tsis indications phais rau excision.

Tsis xam tau tias yog malignancies, recurrent lub rwj los ntshav, xav tias malignancy degeneration ntawm ulcers thiab pyloric stenosis.

Rau tus txheeb ze indications xws li unhealed rau ib ntev lub sij hawm ulcers nyob rau hauv lub duodenum thiab lub plab, raws li zoo raws li perforated lub rwj rau ib tug tom qab ntawm lub zoo ntawm tus neeg mob, uas yog tau txais tsis pub dhau lub thawj rau cov sij hawm tom qab lub perforation.

Nyob rau hauv lub xub ntiag ntawm malignancy thiab peptic rwj lag luam yog ua siv ib tug tshwj xeeb cov txheej txheem.

Yog li, thaum peptic rwj nws yog advisable rau excise 2/3 los yog 3/4 ntawm lub plab nrog pyloric lub cev. Yog li, nws yog tiv thaiv relapse. Nyob rau hauv cov ntaub ntawv ntawm lub sab saum toj ua hauj lwm ntawm lub tsawg curvature ulcers thov subtotal gastrectomy. Thaum zoo li no yog ua li cas excision 4/5 hloov khoom nruab nrog (yuav luag 80%).

Noj cov zaub mov tom qab pais plab resection yuav cov kev txwv ntawm noj cov zaub mov ib lub sij hawm. Yog li, cov neeg mob uas tau pom zoo tsis ntau tshaj 250 grams ntawm cov kua zaub los yog ib tug haus lub khob. Thaum noj su koj yuav noj tsis tau ntau tshaj ob noj mov. Noj thoob plaws hauv lub hnub yog pom zoo heev (tsawg kawg yog tsib los yog rau lub sij hawm). Ua tus naj npawb ntawm tau txais pom zoo protein (120 g), limiting tus nqi ntawm cov carbohydrates (300 g). Nyob rau hauv tej zaum nws yuav tau kiag li cais khoom muaj suab thaj thiab dej qab zib. Nws yog tau tso cai rau siv zib hloov. Yuav kom nce tus nqi ntawm cov protein pom zoo hau nqaij, ntses, calcined los yog grated cheese, scrambled qe dawb.

Nws yog ib advisable kom muaj xws li nyob rau hauv cov khoom noj thiab kev noj haus cov khoom enriched nrog zaub roj. Nyob rau hauv cov ntaub ntawv ntawm cov neeg pluag tolerability, nyob rau hauv kev nyob rau hauv lub dawb daim ntawv thiab lawv cov nqi no tsuas yog muaj rau 70-80 grams tauj ib hnub. Nyob rau hauv rooj plaub ntawm intolerance rau mis nyuj nyob rau hauv nws cov dawb daim ntawv, nws tsuas muaj nyob rau hauv nyob tus yeees ntawm cov tais diav los yog hloov los ntawm lwm cov khoom.

Cov khoom noj kuj tas muaj xws li npaj muaj hlau thiab multivitamin.

Nyob rau hauv cov ntaub ntawv ntawm yuav txo tau nyob rau hauv lub ceeb thawj ntawm lub neeg mob tau tso cai rau kom lub zog tus nqi ntawm cov khoom noj los ntawm 10-15% piv rau lub physiological cai.