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17:05:02　　　www.39.net　　　39</div> <!--time end--> <div class=key>关键è¯ï¼š<a href='/List.aspx?chid=18&Keyword=%e6%89%8b%e6%9c%af&FieldName=tagnamestr' target='_blank'>手术</a></div> <!--key end--> <div class=daodu></div> <!--ad end--> <div class=geyan><label><span>å¥åº·è°šè¯­</span></label></div> <!--geyan end--> <div class=concent fang=08-03-07 17:05:02> <br> <p>è„ç–分为3型，å³è„膨出（婴儿型或胚胎性è„ç–）ã€å°å„¿åž‹å’Œæˆäººåž‹[å›?]ã€?/p><p>è„膨出最少è§ï¼Œå‘生率ä¸?/5000，是一ç§å…ˆå¤©æ€§ç¼ºæŸï¼Œçªå‡ºåˆ°è„带内的腹内è„器仅被覆一层羊膜和腹膜，无皮肤é®ç›–。如暴露在空气中时间较长，会很快干燥并å‘生å死，以致内è„从缺æŸå¤„膨出体外ã€?/p><p>å°å„¿åž‹è„ç–较多è§ï¼Œå‘生率ä¸?%，多å‘生åœ?å²ä»¥å†…，常由于先天è„部腹å£ç¼ºæŸå’Œè…¹å†…压力增高所致。ç–囊外被覆ç€çš®è‚¤å’Œè…¹è†œã€?/p><p>æˆäººåž‹è„ç–较少è§ï¼Œå¤šå‘生在中年以上。å‘病原因一方é¢æ˜¯ç”±äºŽè„部有缺æŸï¼Œå¦ä¸€æ–¹é¢æ˜¯ç”±äºŽè…¹å†…压力增高ã€?/p> <img border="0" src="../../Files/Shoushu/20081271595217177801.jpg"> 1-1 å©´å„¿åž? <img border="0" src="../../Files/Shoushu/20081271595220377802.jpg"> 1-2 å°å„¿åž? <img border="0" src="../../Files/Shoushu/20081271595220377802.jpg"> 1-3 æˆäººåž? å›?　è„ç–类型åŠåˆ‡å? <img border="0" src="../../Files/Shoushu/20081271595223477803.jpg"> 2-1 åˆ‡å¼€ç–囊基部 <img border="0" src="../../Files/Shoushu/20081271595228177804.jpg"> 2-2 æ£€æŸ¥ç–环附近粘è¿? <img border="0" src="../../Files/Shoushu/20081271595231277805.jpg"> 2-3 ç¼åˆè…¹è†œ <img border="0" src="../../Files/Shoushu/20081271595235977806.jpg"> 2-4 é‡å ç¼åˆç­‹è†œå’Œè…¹ç›´è‚ å‰éž˜ <img border="0" src="../../Files/Shoushu/20081271595239077807.jpg"> 2-5 ç­‹è†œç¼åˆå®Œæ¯• <img border="0" src="../../Files/Shoushu/20081271595242177808.jpg"> 2-6 æ¾è§£è„孔皮下粘连 <img border="0" src="../../Files/Shoushu/20081271595246877809.jpg"> 2-7 ç¼åˆå›ºå®šè„孔皮下组织 <img border="0" src="../../Files/Shoushu/200812715952500778010.jpg"> 2-8 å°†æµ…筋膜ç¼åˆå›ºå®šäºŽè…¹ç›´è‚Œéž? å›?　è„ç–ä¿®å¤æœ¯ï¼ˆå°å„¿åž‹ï¼‰ <p>[适应è¯]</p><p>1.è„膨出应在出生åŽç¨äº‹å‡†å¤‡å³è¡Œæ‰‹æœ¯ã€?/p><p>2.å°å„¿åž‹è„ç–，如在2å²ä»¥å†…，直径åœ?cm以下，å¯è¯•ç”¨èƒ¶å¸ƒå†…翻固定，如直径大于2cm，或2å²ä»¥åŽä»ä¸è‡ªæ„ˆï¼Œåº”手术修å¤ã€?/p><p>3.æˆäººåž‹è„ç–，虽嵌顿å‘生率ä¸é«˜ï¼Œä½†å› å…¶ä¸æ˜“自愈，å‡åº”手术治疗ã€?/p><p>4.å„ç§åµŒé¡¿æ€§è„ç–应紧急手术治疗ã€?/p><p>[术å‰å‡†å¤‡]</p><p>1.如有腹内压增高的因素（如咳嗽ã€ä¾¿ç§˜ç­‰ï¼‰ï¼Œåº”在术å‰æ¶ˆé™¤ã€?/p><p>2.其他术å‰å‡†å¤‡åŒä¸€èˆ¬è…¹è‚¡æ²Ÿæ–œç–ä¿®å¤æœ¯ã€?/p><p>[麻醉]</p><p>一般å¯ç”¨å±€éº»ï¼›è¾ƒå¤§çš„è„ç–å¯ä»¥ç”¨è…°éº»æˆ–硬膜外麻醉；å°å„¿è„ç–å¯ä»¥ç”¨éª¶ç®¡éº»é†‰æˆ–用全麻ã€?/p><p>[手术步骤]</p><p>以å°å„¿åž‹è„ç–为例。沿è„ç–下方边缘åšä¸€å¼§å½¢åˆ‡å£ï¼Œåˆ‡å£é•¿åº¦ä»¥èƒ½ä¸Šç¿»çš®ç“£ã€æ˜¾éœ²ç–囊为度[è§å›¾1]。皮肤切开åŽï¼Œç»§ç»­å‘下切开皮下浅筋膜，显露腹直肌å‰éž˜ï¼Œé’性分离出è„ç–ç–囊，在其基部作椭圆形切å£ï¼Œåˆ‡å¼€è…¹ä¸­çº¿ç­‹è†œå’Œéƒ¨åˆ†è…¹ç›´è‚Œå‰éž˜ã€‚分离ç–囊周围的粘连组织并切开ç–囊，切开时需注æ„é¿å…æŸä¼¤ç–内容物[å›?-1]。分离出ç–环四周的腹膜åŽï¼Œç”¨æ­¢è¡€é’³æèµ·ã€å¼ å¼€ï¼Œå†ç”¨å°æŒ‡æŽ¢å…¥ç–环，检查附近有无é‡è¦è„器和粘连[å›?-2]。将ç–囊清ç†å®Œæ¯•åŽï¼Œå‰ªåŽ»å¤šä½™çš„ç–囊腹膜，将腹膜作间断外翻褥å¼ç¼åˆï¼Œé—­åˆè…¹è…”[å›?-3]。é‡å è…¹ä¸­çº¿çš„筋膜切缘和两侧腹直肌å‰éž˜ï¼ˆä¸Šç“£é‡å äºŽä¸‹ç“£ä¹‹ä¸Šçº¦2ï½?cm），ç”?-0æˆ?-0å·ä¸çº¿å°†ä¸‹ç“£é—´æ–­è¤¥å¼ç¼åˆäºŽä¸Šç“£ä¹‹ä¸‹ï¼Œç„¶åŽå°†ä¸Šç“£è¦†äºŽä¸‹ç“£å¤–é¢ä½œé—´æ–­ç¼åˆ[å›?-4ã€?]。ç¼é’ˆä¸å®œè¿‡æ·±ï¼Œä»¥å…æŸä¼¤è…¹è…”内è„器ã€?/p> <p>待筋膜修å¤å®Œæ¯•åŽï¼Œå…ˆç”¨ç¤ºæŒ‡å°†çš®è‚¤åˆ‡å£ä¸Šç“£çš„è„孔撑开，æ¾è§£å‘¨å›´çš„粘连[å›?-6]，å†ç”¨å¦æ‰‹ç¤ºæŒ‡æ•·ä»¥çº±å¸ƒå°†è„孔下压。然åŽï¼Œå°†è„孔部ä½çš„皮下组织ç¼åˆå›ºå®šåœ¨ä¸­çº¿çš„筋膜é¢[å›?-7]，最好将浅筋膜也固定在深é¢çš„筋膜和腹直肌å‰éž˜ä¸Š[å›?-8]。最åŽï¼Œé—´æ–­ç¼åˆçš®ä¸‹ç»„织和皮肤。对较大的分离创é¢ï¼Œåº”于皮下和筋膜上之间放置香烟引æµã€?/p> <p>[术中注æ„事项]</p><p>å°çš„ç–囊无粘连，分离切开常无困难；但大的ç–囊病å²ä¹…，常与内è„有粘连，在分离ã€åˆ‡å¼€ç–囊时，è¦æ³¨æ„é¿å…æŸä¼¤ç–内容物。如果在ç–囊远端切开时，因粘连ä¸èƒ½è¿›å…¥è…¹è…”，å¯å°†ç–囊æ起，分离出腹直肌å‰éž˜å’Œç–囊颈的交界处（该处多无粘连），然åŽåœ¨æ­¤å¤„切开ç–囊，用å°æŒ‡ä¼¸å…¥æŽ¢æŸ¥ï¼ŒæŽ¨å¼€ç²˜è¿žã€‚如为肠管，å¯æŽ¨å›žè…¹è…”；如为大网膜，å¯ä¸Žç–囊一并切除ã€?/p><p>[术åŽå¤„ç†]</p><p>注æ„控制腹胀ã€ä¾¿ç§˜ã€å’³å—½ç­‰å¯ä½¿è…¹å†…压力增高的因素，切å£å¯ç”¨è…¹å¸¦åŒ…扎1周左å³ï¼Œå¾…拆线åŽåŽ»é™¤ã€‚皮下引æµ?8å°æ—¶åŽæ‹”除ã€?/p> </div> <!--concent end--> <div class=next> <p><a href="http://www.whrenai.com/ssdq/ptwk/70357.html">手掌皮肤缺æŸä¿®å¤æœ?/a></p> <p><a href="http://www.whrenai.com/ssdq/ptwk/70359.html">剖腹探查æœ?/a></p> </div> <!--next end--> <div class=fanhui><a href="http://www.whrenai.com"><img 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