Ma `lumot

Laparoskopik jarrohlik: nega gaz yelkamda og'riq keltirdi va u tanamdan qanday chiqib ketdi?

Laparoskopik jarrohlik: nega gaz yelkamda og'riq keltirdi va u tanamdan qanday chiqib ketdi?



We are searching data for your request:

Forums and discussions:
Manuals and reference books:
Data from registers:
Wait the end of the search in all databases.
Upon completion, a link will appear to access the found materials.

Men yaqinda laparoskopik jarrohlik amaliyotini o‘tkazdim va hamshira mening tizimimdan gaz chiqib ketsa, elkamda og‘riq va g‘ijirlashimni aytdi. Men "yelkamdagi og'riq" da'vosi haqida bir oz ma'lumotni qidirdim va bu mening frenik asabimni bezovta qiladigan CO2 gazi bilan bog'liq. Shunday qilib, mening birinchi savolim:

Nima uchun o'ng va chap frenik asab mavjud bo'lsa, og'riq faqat o'ng yelkamda edi? Bemorlarning bir yoki ikkala elkasida og'riqni boshdan kechirishi odatiymi? Agar CO2 og'riq/tirnash xususiyati keltirib chiqarsa, nega boshqa gazga o'tmaysiz?

Mening ikkinchi savolim g'o'ng'irlash va tizimimdan chiqib ketadigan gaz atrofida. Asosan, qanday qilib? Qanday qilib qorin bo'shlig'imdagi gaz og'zimdan chiqib ketadi? Bu qandaydir assimilyatsiya mexanizmi orqalimi?

Rahmat!


CO2 og'riq keltiradimi?

CO2 qo'llash orqali og'riq keltirishi mumkin bosim diafragma ustida; shuningdek cho'zish Diafragmaning tanasining holati tufayli frenik asabni tirnash xususiyati keltirishi mumkin (Hindiston Jarrohlik jurnali).

SHUNINGDEK:

Bir paytlar yelka og'rig'i gazning suv bilan birlashishi natijasida yuzaga kelganiga ishonishgan; yoki u faqat CO2 ni ushlab qolgan. Bu tirnash xususiyati haqiqiy sababi natijasidir hujayra o'limi a ning birikmasidan kelib chiqqan 70oF da gazdan harorat o'zgarishi va gazning quritish effekti .0002% da. Ushbu tirnash xususiyati asosan diafragma mintaqasida joylashgan. CO2 dan boshqa gazlar, ya'ni geliy, azot oksidi va argon bilan o'tkazilgan tajribalar hammasi bir xil yoki shunga o'xshash ta'sir ko'rsatdi (Endometriozni parvarish qilish markazi).

Nima uchun ular CO2 dan foydalanadilar?

Boshlash uchun, Laparoskopiya paytida CO2 (karbonat angidrid) gazi kindik ostidagi maxsus igna orqali yuboriladi. Bu kengaytirilgan qorinni yaratish va saqlash uchun amalga oshiriladi; "pnevmoperitoneum" deb ataladigan holat. Uchun xavfsizlik, narx va qulaylik, CO2 deyarli faqat shu maqsadda ishlatiladi (Endometriozni parvarish qilish markazi).

Nima uchun o'ng elkada og'riq bor?

Laparoskopiya bilan qo'zg'atilgan elka og'rig'i mexanizmi asosan qorin bo'shlig'ida karbonat angidridni ushlab turishdan kelib chiqadi, keyinchalik frenik asabni bezovta qiladi va C4 dermatomasida og'riqni keltirib chiqaradi. Bundan tashqari, karbonat angidrid jigar va jigar o'rtasida to'planadi to'g'ri diafragma, diafragma tirnash xususiyati, shuningdek, yuqori qorin og'rig'iga sabab bo'ladi (JAMA jarrohlik).

LEKIN

Bunday tanaffusdagi operatsiyalarda, shu jumladan LAGBda va bir nechta ginekologik operatsiyalarda og'riq asosan qorin bo'shlig'ida paydo bo'ladi. chap elka. Bu farq operatsiya hududi va bemorning holati og'riq joyiga muhim ta'sir ko'rsatishini ko'rsatadi. Buning sababi shundaki, laparoskopik xoletsistektomiyada jigar teskari Trendelenburg tufayli bemorning o'ng tomoni yuqoriga qarab diafragma ostidan ajratiladi. Bu olib keladi o'ng yarim diafragmaning cho'zilishi va gaz potentsial ravishda o'ng diafragma ostida qolishi mumkin. Hiatal operatsiyalar uchun teskari bo'ladi (Indian Journal of Surgery).

Operatsiyadan keyin CO2 qaerga ketadi?

Gazning ko'p qismi operatsiyadan so'ng darhol jarrohlik yaralari orqali qorin bo'shlig'ini passiv ravishda tark etadi. Qolganlari bilan nima sodir bo'ladi:

Karbonat angidrid suvda oson eriydi va karbonat kislota hosil qiladi. Keyin karbonat kislotasi tomir ichidagi bo'shliqqa so'riladi… (JAMA jarrohlik)

CO2 og'iz orqali chiqarilmaydi va egilishning bevosita sababi emas. Burish natijasida paydo bo'lishi mumkin bosim oshqozon va ichakka qo'llaniladigan gaz.


Bu qanday amalga oshiriladi - Laparoskopiya (kalit teshigi jarrohligi)

Amalga oshirilayotgan laparoskopik muolaja turiga qarab, odatda sizdan 6-12 soat oldin hech narsa yemaslik yoki ichmaslik so‘raladi.

Agar siz aspirin yoki warfarin kabi qonni suyultiruvchi dori (antikoagulyantlar) olayotgan bo'lsangiz, uni bir necha kun oldin qabul qilishni to'xtatish so'ralishi mumkin. Bu operatsiya vaqtida ko'p qon ketishining oldini olish uchun kerak.

Agar siz chekadigan bo'lsangiz, operatsiya oldidan to'xtash tavsiya qilinishi mumkin. Buning sababi shundaki, chekish operatsiyadan keyin davolanishni kechiktirishi va infektsiya kabi asoratlar xavfini oshirishi mumkin.

Ko'pchilik kasalxonani protsedura kuni yoki keyingi kuni tark etishi mumkin. Jarayon oldidan kimdir sizni uyingizga olib borishini tashkillashtirishingiz kerak, chunki sizga kamida 24 soat haydamaslik tavsiya etiladi.


Laparotomiya olib tashlanganidan keyin dermoid kista yana paydo bo'lganmi?

Mening ishim taxminan 9 hafta davom etdi, lekin men buning uchun eng yomon stsenariyman deb o'ylayman.

Yurish kabi past ta'sirli harakatlar eng yaxshi vosita bo'lib tuyuladi. Qorin bo'shlig'ini dumaloq harakatlar bilan ishqalash/massaj qilish ham gazni harakatga keltirganga o'xshaydi. Gaz qorin bo'shlig'ida tiqilib qolgan, shuning uchun men simetikonli dori-darmonlarni ko'p foyda keltirmaydi deb o'ylayman (bu ovqat hazm qilish tizimida qoladi, lekin gaz aslida yo'q).

Jarrohlikning eng yomon ta'siri gaz bo'ldi. Men gaz og'rig'idan ko'ra, kesma va boshqalarni davolashdan og'riqqa toqat qilardim.

Sekin harakatlaning va bu biroz yengillik keltiradi.

Gaz og'rig'i va shishirish ham mening eng yomon ta'sirimdir.

Mening shishgan oshqozon maydoni teginish uchun shunchalik nozikki, uni bosganimda ichimdagi bosimni his qilaman.

Kechasi gaz og'rig'ini ko'proq his qilganimda, men tez-tez siyishga majbur bo'laman. Kimdir buni boshdan kechirganmi yoki yo'qmi, bilmayman.

Yurganimda u yerda tosh ko'tarib ketayotgandek bo'laman. Men ham xafa bo'lyapman, bu hech qachon yo'qolmasligini his qilyapman.

Xo'sh, ginekologim menga gaz/shishishi meni ochganida ichkariga kirgan havo tufayli ekanligini aytdi. U menga 3-4 oygacha davom etishini aytdi, shunda mening oshqozonim yana butunlay tekislanadi. Ammo mening bir yil oldin xuddi shunday operatsiya qilingan bir do'stim bor edi va u menga gazi / shishishi 4 hafta ichida yo'qolganini aytdi. Demak, menimcha, har kim boshqacha?

Operatsiyadan oldin menda ham xuddi shunday shishiradi, bu mening endometrioma kistasining 6 sm bo'lgan adgeziyasi tufayli yuzaga kelgan. Ammo shifokorim operatsiyadan keyin endi endo belgilari bo'lmasligi kerakligini aytdi, chunki adezyon kistasi allaqachon olib tashlangan va u hamma narsani tozalagan.

Voy, bu juda xafa.

Bu mening operatsiyamdan keyingi 8-hafta va men hali ham shishib ketyapman.

Kesig'im ustidagi qorin tugmasigacha bo'lgan joy hali ham shishgan va shishgan. Kechasi shishish shunchalik kuchliki, uni bosganimda, bu joy og'riqli bo'ladi.

Eng yomoni shundaki, shishib ketish bundan buyon yaxshilanmayapti. Men hech qanday yaxshilanishni ko'rmayapman.

Taslim bo'lmang, men nihoyat yaxshilanishni ko'ra boshladim va men hozir deyarli 10 haftadaman. !!

Yolg'iz yurishga harakat qiling. Men yurish paytida juda oz miqdordagi gazni chiqarib yuborganimni ko'rdim. Bundan tashqari, gazni keltirib chiqaradigan ovqatni iste'mol qilmaslik uchun keyingi bir necha hafta davomida nima yeyayotganingizni kuzatishga harakat qiling. Mening oshqozonim ham kechalari yomonlashadi. Shifokor menga bu normal ekanligini aytdi, chunki biz kun bo'yi oshqozonimizni ishlatamiz va u hali ham sezgir, shuning uchun kun oxiriga kelib u yana shishib keta boshlaydi. Bundan tashqari, biz ovqatlanamiz va shuning uchun ba'zida kunning oxiriga kelib u shishiradi. Men ham kun oxirigacha og'riydi, ayniqsa kun bo'yi to'xtamasam. Men hali ham jinsilarimga sig'mayapman, lekin hech bo'lmaganda ba'zi shimlarimga shim kiyishni boshladim. Men tashqariga chiqib, butunlay yangi shkaf sotib olishim kerak deb o'yladim !!

Hali kiyimingizga moslashdingizmi? Men aslida 5 funt qo'ydim va amin bo'ldimki, bularning barchasi gaz va shishgan og'irlik emas, balki haqiqiy yog 'vazn ortishi.


Sigmasimon ichak og'rig'iga hamroh bo'lishi mumkin bo'lgan alomatlar

Sigmasimon ichak og'rig'i belgilari bir kishidan ikkinchisiga farq qilishi mumkin. Yuqorida aytib o'tilganidek, ba'zi odamlar engil bezovta qiluvchi alomatlarga duch kelishadi. Agar quyidagi alomatlar paydo bo'lsa, iloji boricha tezroq tibbiy yordamga murojaat qilish kerak.

  • Qonli diareya
  • Ishtahaning yo'qolishi
  • Og'irlikni yo'qotish
  • Charchoq
  • Isitma va titroq
  • Ichak tutilishi
  • Teri muammolari
  • Qorin bo'shlig'ida sezgirlik

Laparoskopiyadan keyin og'riq

Laparoskopiyadan o'tgan har bir kishi menga qancha vaqt og'riganini aytib bera oladimi, deb o'yladim.

Bir haftadan keyin yurganimda hali ham juda ko'p og'riq his qilyapman va bu normalmi deb o'yladim, chunki hamma joyda odamlar bir necha kundan keyin normal faoliyatni davom ettirishlarini o'qidim.

Men ikki baravar ko'tarilganim yo'q, bu xuddi doimiy tikilgandek, va qadam bosganimda, ayniqsa, qorin bo'shlig'im atrofida qandaydir o'tkir og'riq paydo bo'ladi. Bundan tashqari, ba'zi bir pichoq og'rig'i, hatto o'tirganda ham paydo bo'ladigan ko'rinadi.

Bu odatiymi yoki yo'qligini bilmoqchi edim, men shunday bo'lishini kutdim, lekin shunga o'xshash bo'lganlardan so'rayman, deb o'yladim, ular qorin bo'shlig'i yana qancha vaqtgacha normal bo'lishini aytishlari mumkin.

Assalomu alaykum, men mart oyining o'rtalarida laparoskopiya va tuxumdon va naychani olib tashladim va kindik kesmasi va tuxumdon bo'lgan kesmasi hali ham og'riyapti. Menimcha, davolanish biroz vaqt talab etadi. Siz uchun qisqa vaqt bo'lgani uchun men aytmoqchimanki, tanangiz bilan sabr qiling.

Men o'tgan hafta laparoskopiya qildim, lekin faqat kistani olib tashladim, hech qanday organ yo'q. Bir oz ko'karishlar uchun men normal holatga qaytdim. Vaqti-vaqti bilan men noto'g'ri harakat qilganimda ozgina og'riqni his qilaman - operatsiya qilinganimni eslatadi. Men oddiy kiyimga qaytdim, juda oz shishiradi. Menga omad kulib boqdi.

Men taxminan 2 hafta oldin Lap qildim. Jarrohlikdan keyingi kuni echilmaydigan tikuvlarim chiqib ketayotganini payqadim. Endi 2 hafta o'tgach, pastki qismi hali ham ko'rinib turibdi, lekin qorin bo'shlig'im atrofidagilar emas, ular terining ostida g'oyib bo'lgan va qizarib ketgan, shishgan va qichishgan. Qorin bo'shlig'imda, shuningdek, qorin bo'shlig'i atrofida biroz og'riqni his qilaman va pastki chap tomon ham keladi va ketadi. Bu normalmi?

Men butunlay roziman. Men bugun operatsiyadan 2 hafta o‘tdim va hali ham ko‘p harakatlarni bajara olmayapman. Kecha oqshomgacha o'ng tomonim teshib qo'yguncha ozgina og'riq sezdim (menda beysbol o'lchamidagi kista olib tashlandi, lekin ular tuxumdonni saqlab qolishdi)! Hayz ko'rishim kerak - buning sababi bo'lishi mumkinmi? Jarrohlikdan keyin sizning pD qanday edi?

Men tuxumdonlarimni 1 hafta oldin olib tashladim, chunki menga ko'krak bezi saratoni tashxisi qo'yilgan va mening tanam estrogenga ijobiy gormon retseptorlari. Men hali ham bir oz og'riqni boshdan kechiryapman, xuddi hayz ko'rganimda bo'lgan tuyg'u, ichim og'riyapti va ichak harakati uchun juda jahannam vaqtim bor. Agar kimdir bunga javob bersa, bu normalmi?

Men 2 hafta oldin LAP qildim. Oddiy mashg'ulotlarga qaytishim uchun taxminan 5 kun kerak bo'ldi, lekin bu meni butunlay charchatdi. Lekin men yura boshladim, zinapoyaga chiqdim va hatto emaklashga harakat qildim (bilaman, g'alati) va o'zimni noqulay his qilmadim. Doktorim menga o'zimni to'sqinlik qilmaslikni va oddiy jismoniy faoliyat bilan shug'ullanishni maslahat berdi, lekin bir necha oy davomida oddiy mashg'ulotlarga ham katta rad javobini berdi. Qorin bo'shlig'im atrofidagi joy hali ham tor his qiladi va ba'zida men uzoq vaqt tik turolmayman. Ammo menimcha, u yaxshilanadi va tana o'zini o'zi davolaydi. Iltimos, qorin tugmasi atrofidagi og'riqni jiddiyroq qabul qilishim kerakmi, menga xabar bering

Men endometrioz uchun laparoskopiyadan 6 kun o'tgach. va tik turganimda qovurg'alar ko'krak qafamning markazida birikadigan joyda ko'krak qafasi bosimini olaman. Bundan tashqari, o'ng oyog'imning chanoq, yonbosh va son sohasida og'riq bor.

Kimdadir shunga o'xshash narsa bormi?

Men laparoskopiyam uchun operatsiyadan 6 kun o'tib, juda og'riqliman. Men juma kuni protsedurani o'tkazdim va dushanba kuni ertalab ishga qaytdim, chunki men dam olishga qodir emasman. Men juda qiynalmoqdaman va hamshira bilan gaplashib, ular mening qorin bo'shlig'imda endometriyal jarohatlar va chandiq to'qimalari, kistalar va hokazolarni tozalash uchun juda keng ko'lamli jarrohlik amaliyotini o'tkazishganini bildim. Menda D&C va histeroskopiya ham bor edi. U ishlayotganimdan juda hayron. Menda tanlov bo'lmaganida qiyin. Qanday bo'lmasin, kindigimda bitta kesma joyi bor edi, ikkinchisi esa tos suyagimdan biroz teparoqda kindigimdan pastga tushdi. Men ham o‘t pufagimni laparoskopik usulda olib tashladim va o‘sha operatsiyadan keyin kindik atrofida shunchalik og‘riq borligini eslay olmayman, lekin keyin boshqa og‘riqlar ham kuchliroq edi, shuning uchun men bunga e’tibor bermadim.

Birinchi kechada ko'krak va yelkamda juda ko'p gaz og'rig'i bor edi. Menga aylanib yurish bu bilan yordam berishini aytishdi va oxirgi marta xuddi shunday muammoga duch kelganimdan va bu deyarli ikki hafta davom etganidan so'ng, men shanba kuni biz Pasxa tuxumi ovini o'tkazgan parkda uzoq yurish uchun bordim. Bu men uchun shunday bo'ldi, o'sha kecha va yakshanba kuni gaz deyarli tugadi va bu juda yaxshi edi. Endi mening kindikda doimiy og'riq va chimchilash og'rig'i bor. Menda boshqa og'riqlar bordir, lekin men buni sezmayapman, chunki bu og'riq bu erda oldingi o'rindiqni egallaydi. Umid qilamanki, har kim o'z dardiga yechim topadi. Menga kelsak, men tushdan keyin dam olishga va dam olishga harakat qilaman va bu yordam beradimi, deb o'ylayman.

Operatsiyadan keyin siydik chiqarish va ichak harakatlari bilan bog'liq ko'plab muammolar ham bor edi. Haqiqatan ham, seshanba kuni borish uchun sham ishlatmagunimcha, menda BM yo'q edi. Chorshanba kuni ertalabgacha menda to'liq bo'lmagan. Men sizga aytishim mumkinki, bu operatsiyadan keyin juda normal holat. Agar siz borish zarurligini his qilsangiz va boshqa hech narsa sizga yordam bermasa, glitserinli shamlarni sinab ko'ring, ular yordam beradi.

Men xuddi shu muammolarga duch kelgan har bir kishi uchun hisobimni bermoqchi edim.


Laparoskopik jarrohlikdan keyin nima kutish kerak: Bu atama vaginal devor(lar)ning chiqib ketishiga olib keladigan vaginal tayanchlarning zaifligini anglatadi. Bu qorin bo'shlig'i va tos bo'shlig'i ichidagi bosimni oshiradigan harakatlar paytida, masalan, og'irlikni ko'tarish yoki zo'riqish, yo'talish yoki ichak harakati uchun hojatxonada o'tirish paytida yuzaga keladi. Bu vaginada sezilarli bo'shliq, bo'lak yoki tortishish hissi paydo bo'lishiga olib kelishi mumkin. Bo'lak qinning old, orqa yoki yuqori qismidagi zaiflik yoki uchtasining kombinatsiyasi tufayli bo'lishi mumkin.

Quviq qinning oldida, ichak (to'g'ri ichak) esa qinning orqasida o'tiradi. Bachadon bo'yni va unga biriktirilgan bachadon qinning yuqori qismida yotadi va uning ustida tos bo'shlig'ida ingichka ichak ilmoqlari joylashgan. Vaginadan chiqadigan bo'lakda ushbu organlarning bir yoki bir nechtasi bo'lishi mumkin. Shuning uchun ba'zi odamlar siydik pufagini bo'shatish yoki "tutish" (tez-tez va shoshilinch) yoki ichaklarini ochishda muammolarga duch kelishadi.

Qinning yuqori tayanchlari bo'shashganda, qin paypoq kabi ichkariga aylanishi mumkin. Og'ir holatlarda bu vaginadan tashqariga chiqadigan massa hosil qilishi mumkin. Bu massa bachadon (agar u ilgari olib tashlanmasa), siydik pufagi va / yoki ichakni o'z ichiga olishi mumkin.

Ba'zida prolaps anatomiyani buzishi mumkin, bu esa siydik yo'llarining obstruktsiyasiga olib keladi, bu esa o'g'irlab ketishni maskalashi mumkin (pastga qarang). Prolapsni tuzatish bo'yicha jarrohlik operatsiyadan keyin inkontinansga olib keladigan ushbu obstruktsiyani bartaraf etishi mumkin.

Siydik chiqarishni o'g'irlab ketish: siydikning majburiy yo'qolishi sifatida aniqlanishi mumkin. Uchta asosiy tur mavjud:

  • Stressli inkontinans - faoliyat paytida siydik yo'qoladi (stress) qorin bo'shlig'idagi bosimni oshiradi. Masalan, yo'tal, hapşırma, ko'tarish yoki jismoniy mashqlar. Kofeinni iste'mol qilishni kamaytirish bilan birga tos bo'shlig'idagi mashqlar simptomlarni sezilarli darajada yaxshilashi mumkin. Ushbu choralar yordam bermasa, jarrohlik amaliyoti o'tkazilishi mumkin
  • Urte inkontinans - odatda hojatxonaga borib bo'lmaydigan istak bor (shoshilinch yoki detruzorning beqarorligi) ko'pincha hojatxonaga yetib borishdan oldin siydik oqishi kuzatiladi. Ushbu turdagi inkontinansni davolash uchun dorilar qo'llaniladi
  • Aralash inkontinans - turtki va stressni ushlab turmaslikning kombinatsiyasi

Farzandli ayollarda prolaps va siydik o'g'irlab ketish ko'proq uchraydi. Tug'ilish bilan bog'liq o'zgarishlar yosh bilan yomonlashadi, bu esa asta-sekin prolapsning boshlanishiga olib keladi, deb ishoniladi. Ba'zi ayollar prolapsa rivojlanishiga ayniqsa moyil bo'lib tuyuladi.

Muammoni hal qiladigan ko'plab jarrohlik muolajalar mavjud. Sizning jarrohingiz siz uchun eng yaxshi deb hisoblaydigan narsalarni muhokama qiladi. Sizning ma'lumotingiz uchun ba'zi variantlar quyida keltirilgan.

Vaginal jarrohlik

Chuqur qo'llab-quvvatlovchi mushak, fastsiya va ligamentlarga (to'qimalarga) kirish uchun vaginada kesma qilinadi. Keyin choklar, sun'iy to'r yoki lentalar vaginal tayanchlarni tuzatish va / yoki siydik o'g'irlab ketishni stress qilish uchun ishlatiladi.

  • Old va orqa ta'mirlash - qin ichida qo'llab-quvvatlamaydigan sohada kesmalar amalga oshiriladi. Pastki tuzilmalarni qo'llab-quvvatlash uchun tikuv qatlami qo'llaniladi. Ortiqcha (ortiqcha cho'zilgan) vaginal terini kesish mumkin, so'ngra qin erituvchi choklar bilan yopiladi.
  • Siydik chiqarishni o'g'irlab ketish uchun sub-uretal sling - Bu nisbatan yangi operatsiya stressli siydik o'g'irlab ketishni davolash uchun mo'ljallangan. Kichik kesmalar vaginada va qorinning pastki qismida yoki sonning ichki qismida amalga oshiriladi. Lentaga o'xshash sintetik tasma vaginadan o'tkaziladi va ikkita juda kichik kesma orqali chiqariladi. Keyin tasma zo'riqish paytida siydik pufagi bo'ynini qo'llab-quvvatlash uchun (qorin bo'shlig'i va tos bo'shlig'i ichidagi bosim ko'tariladi) va shu bilan stressni ushlab turolmaslikni tuzatish uchun tarangsiz joylashtiriladi. Bir qator tadqiqotlar ma'lumotlari shuni ko'rsatadiki, bu minimal invaziv usul an'anaviy Burch kolposuspenziyasi operatsiyasiga 5-7 yil davomida 80-90% muvaffaqiyat bilan tengdir.
  • Sakrospinöz fiksatsiya - bu operatsiya vaginaning yuqori qismini ko'tarish va qo'llab-quvvatlash uchun amalga oshiriladi. Vaginal devorda kesma qilinadi va vaginaning yuqori qismiga cho'ziladi. Odatda 2 ta doimiy tikuv sakrospinoz ligament deb nomlanuvchi qattiq tolali tuzilishga joylashtiriladi. Keyin tikuvlar qinning yuqori qismiga terining ostida mahkamlanadi. Ba'zida protsedura har ikki tomondan amalga oshiriladi (ikki tomonlama sakrospinöz fiksatsiya) va yaqinda vaginal to'r deb nomlanuvchi sun'iy tayanch bilan birlashtirilishi mumkin.
  • Vaginal to'r - Ba'zida qin devorining haddan tashqari cho'zilgan to'qimalari prolapsni (bo'rtiq) hosil qiladi, ayniqsa qinni oldingi tuzatish muvaffaqiyatsiz bo'lsa, standart tuzatish uchun mos kelmasligi mumkin. Afsuski, eng ehtiyotkorlik bilan ta'mirlashdan keyin ham ayollarning 20-30 foizida takroriy prolaps paydo bo'lishi mumkin. Agar ayol qorin bo'shlig'ida yuqori bosimni boshdan kechirishda davom etsa (masalan: ich qotishi, og'irlikni ko'tarish yoki zo'riqish, chekuvchining yo'tali yoki sezilarli darajada ortiqcha vazn) bu ehtimoli ko'proq. Bunday hollarda shifokor siydik pufagi ostida yoki to'g'ri ichak ustida yangi qo'llab-quvvatlovchi qatlamni ta'minlash uchun doimiy vaginal to'rdan foydalanishni tavsiya qilishi mumkin. Cho'chqalarning ingichka ichak devoridan olingan sintetik to'r yoki biologik to'rni o'z ichiga olgan turli xil mahsulotlar mavjud - "porcine mesh". Ushbu mahsulotlar ginekologik jarrohlik uchun nisbatan yangi, ammo hozirgacha taxminan 90% muvaffaqiyat darajasi bilan juda istiqbolli ko'rinadi.

Qorin bo'shlig'i jarrohligi

Operatsiya qorin bo'shlig'idagi 15-20 sm kesma orqali amalga oshiriladi. Kesish odatda gorizontal va juda past (Bikini chizig'i).

  • Burch kolposuspenziyasi - Bu siydik o'g'irlab ketishni davolashda an'anaviy yondashuv bo'lib, yaqin vaqtgacha suburetral sling kabi yangi muolajalar solishtiriladigan oltin standart sifatida qabul qilingan. Qorin bo'shlig'idagi kesish (laparotomiya) orqali doimiy choklar qovuq va siydik yo'llarining har ikki tomonidagi vaginaga (siydikni siydik pufagidan tashqariga olib boradigan naycha) qo'yiladi. Ushbu tikuvlar siydik pufagiga ("quviq bo'yni") qo'shiladigan siydik yo'lini qo'llab-quvvatlaydi, bu stressni siydik oqishini davolash uchun.
  • Abdominal sakro kolpopeksiyasi - bu protsedurada qinning yuqori qismidan tos bo'shlig'i ichidagi sakral suyagigacha erimaydigan to'r tikiladi. Bu vaginani ko'taradi va prolapsani tuzatadi. Bugungi kunda ushbu protsedura murakkabroq holatlarda yoki boshqa jarrohlik turlari allaqachon muvaffaqiyatsiz bo'lgan hollarda qo'llaniladi
  • Qorin bo'shlig'i tos bo'shlig'ini ta'mirlash - bu operatsiyalar quyida tavsiflangan laparoskopik muolajalarga o'xshaydi. Bu muolajalar asta-sekin "key teshik" jarrohlik texnikasi bilan almashtiriladi

Laparoskopik jarrohlik

Operatsiya qorin bo'shlig'ida 4-5 ta kichik kesma orqali amalga oshiriladi. "Kalit teshigi jarrohligi" prolaps yoki inkontinansga olib keladigan nuqsonlarni aniqlash va tuzatish uchun ishlatiladi.

  • Laparoskopik Burch kolposuspenziyasi - Bu yuqorida tavsiflangan Burch kolposuspenziyasi bilan bir xil. Faqatgina farq shundaki, qorin bo'shlig'idagi bitta katta kesma o'rniga 4 ta kichik kesma qo'llaniladi. Tadqiqotlar shuni ko'rsatdiki, bu usul an'anaviy ochiq jarrohlik yondashuviga teng uzoq muddatli muvaffaqiyat ko'rsatkichlariga (70-90%) ega.
  • Laparoskopik tos bo'shlig'ini tuzatish - qorin bo'shlig'idan va qinni kesmasdan, doimiy tikuvlar qin va unga tutash bo'lgan qo'llab-quvvatlovchi tuzilmalar o'rtasida joylashtiriladi.

Ushbu operatsiya uzoq davom etadi va vaginal tuzatishga qaraganda biroz yuqoriroq asoratlar darajasiga ega. Vaginal muolajalardan asosiy afzalligi shundaki, laparoskopik yoki qorin tos bo'shlig'i jarrohligi vaginal qo'rqitmasdan yoki toraymasdan prolapsni tuzatishi mumkin.

Ushbu operatsiya yosh bemorlar yoki oldingi operatsiyadan keyin prolapsning qaytalanishi bo'lgan bemorlar uchun ko'proq mos kelishi mumkin. Yaqinda ba'zi ginekologlar yuqorida tavsiflangan to'rli sakro kolpopeksiyasini kalit teshigi asboblari (laparoskopik jarrohlik) bilan bajarishni o'rgandilar, bu operatsiyadan keyingi og'riqni kamaytiradi va tezroq tiklanishni ta'minlaydi.

  • Tos bo'shlig'idagi mashqlar, vazn yo'qotish va kofein, alkogol yoki nikotin miqdorini kamaytirish siydik o'g'irlab ketish holatlarini kamaytiradi.
  • Faqatgina bu konservativ choralar siydik o'g'irlab ketish yoki prolaps belgilarini davolash uchun etarli bo'lishi mumkin
  • Tos bo'shlig'i mashqlari tos bo'shlig'i nuqsonlari bo'yicha ixtisoslashgan fizioterapevt tomonidan o'qitilishi va nazorat qilinishi kerak. Ideal holda, bu tos bo'shlig'ining funktsiyasini maksimal darajada oshirish va takroriy prolaps ehtimolini kamaytirish uchun operatsiyadan oldin boshlanishi kerak.
  • Iltimos, aloqa ma'lumotlari yoki yo'l-yo'riq uchun qabulxonamiz xodimlariga murojaat qiling

Tos bo'shlig'i jarrohligining muvaffaqiyat darajasi

Stressli siydik o'g'irlab ketish uchun jarrohlik - ayollarning taxminan 80-90 foizi operatsiya orqali davolanadi. Afsuski, vaqt o'tishi bilan bir qator ayollar siydik oqishini qaytarib olishadi. Bu operatsiyadan keyin 5-10 yil o'tgach sezilarli bo'ladi.

Prolaps jarrohligining muvaffaqiyat darajasi - prolaps jarrohligining muvaffaqiyat darajasi kamroq o'rganilgan. Umuman olganda, ayollarning 20-30 foizi kelajakda prolapsni davolash uchun ikkinchi operatsiyani talab qiladi, deb ishoniladi. Bu eski prolapsning takrorlanishi yoki yangi turdagi prolapsning rivojlanishi bilan bog'liq bo'lishi mumkin.

Prolaps yoki inkontinans uchun jarrohlikdan keyingi asoratlar

Jarrohlik bilan bog'liq ushbu xavflarni har qanday operatsiya bilan bog'liq bo'lgan umumiy xavflarga va siz olib boradigan operatsiyaga xos xavflarga bo'lish mumkin.

Jarrohlikning umumiy xavfi

  • yara, ko'krak yoki siydik yo'llari infektsiyasi (2-11% xavf)
  • qon quyishni talab qiladigan katta qon ketishi (1-4% xavf)
  • oyoqlarda yoki o'pkada qon pıhtıları (<1% xavf)
  • anestezikaning xavfi, shu jumladan yurak xuruji yoki qon tomirlari. (<1% xavf)
  • anormal chandiq to'qimalarining shakllanishi (keloid)

Prolaps yoki inkontinans operatsiyasiga xos bo'lgan xavflar

Bularga qo'shni organlarning shikastlanish xavfi kiradi, shu jumladan:

  • Ichak yoki siydik chiqarish kanali (<1% xavf)
  • Quviq
    • prolapsni tuzatish (<1% xavf)
    • Inkontinans jarrohligi (3-8% xavf)

    Inkontinans operatsiyasidan keyin siydik pufagi bilan bog'liq muammolar paydo bo'lishi mumkin.

    Siydik chiqarishda vaqtinchalik qiyinchiliklar 15% hollarda yuzaga keladi. Ba'zi bemorlar siydik pufagini uzoq vaqt drenajlashni talab qiladi (kateterizatsiya). Siydik chiqarishning doimiy qobiliyatsizligi juda kam uchraydi.

    Bemorlarning 6% gacha (suburetral sling) dan 15% gacha (Burch kolposuspenziyasi) operatsiyadan keyin shoshilinch alomatlar paydo bo'lishi mumkin. (Yuqoridagi inkontinansga qarang)

    Sintetik to'r vaginal teri ostiga qo'yilgan bo'lsa, u ba'zida taxminan 5-10% hollarda kichik yaraga ("eroziya") olib kelishi mumkin. Agar juda kichik bo'lmasa, eroziyani davolash uchun ko'rinadigan to'rning kichik maydonini olib tashlash uchun kichik protsedura talab qilinishi mumkin.

    Taxminan 1% hollarda vaginal to'r infektsiyalanishi mumkin. Bunday infektsiyalar mashni olib tashlashni talab qilishi mumkin. Kamdan kam hollarda mashni rad etish mumkin.

    Vaginada g'ayritabiiy chandiqlar kamdan-kam hollarda jinsiy aloqani qiyinlashtiradi yoki imkonsiz qiladi.

    Laparoskopik jarrohlik rejalashtirilganda, texnik qiyinchiliklar tufayli operatsiyani yakunlash uchun ochiq (qorin bo'shlig'i) operatsiyasi talab qilinishi mumkin.

    Yuqoridagi ro'yxat to'liq emas va barcha mumkin bo'lgan xavflarni o'z ichiga olmaydi. Agar sizda qo'shimcha tashvishlar bo'lsa, iltimos, mutaxassisingizga murojaat qiling.

    Jarrohlikdan keyin nimani kutish kerak

    • Vaginal yoki laparoskopik tos bo'shlig'ini tiklash operatsiyasi bilan siz odatda operatsiyadan keyin 3 kun ichida uyga qaytasiz.
    • Qorin bo'shlig'i yoki inkontinans operatsiyasi odatda uzoqroq qolishni talab qiladi. (4-5 kun)
    • Vaginal yoki laparoskopik operatsiyadan keyingi bir kun ichida bemorlarning ko'pchiligi faqat og'iz orqali og'riq qoldiruvchi dori-darmonlarni talab qiladi va odatda o'rnidan turib, aylanib yuradi.
    • Qorin bo'shlig'idagi jarrohlik odatda 48 soat davomida og'riq qoldiruvchi in'ektsiyalarni (giyohvand moddalar) talab qiladi va bemorlarning mobilizatsiyasi sekinroq.
    • Jarrohlikdan keyin oz miqdordagi vaginal qon ketish tez-tez uchraydi va u 3-4 hafta davom etishi mumkin. Bu ba'zan noodatiy hid bilan bog'liq bo'lishi mumkin
    • Qo'lingizda juda yupqa gigiena prokladkalari bo'lsin - eng yaxshisi tamponlardan saqlaning
    • Ba'zida siz operatsiyadan 2-4 hafta o'tgach, vaginangizdan oz miqdorda eriydigan tikuv materialini (tikuvlarni) o'tkazib yuborishingiz mumkin.
    • Iltimos, hayz ko'rishdan ko'ra og'irroq bo'lgan har qanday oqindi haqida doktoringizga xabar bering

    Oddiy faoliyatga qayting

    • Operatsiyadan keyingi 4-6 hafta ichida siz og'ir bo'lmagan ishga qaytishingiz mumkin
    • Jarrohlikdan keyin 6 hafta davomida faoliyat cheklanishi kerak (ko'p uy ishlarini o'z ichiga olgan holda)
    • Operatsiyadan keyingi 6-8 hafta davomida hech qanday og'ir ish yoki yuk ko'tarmaslik (5-10 kg dan ortiq) muhim ahamiyatga ega.
    • Haddan tashqari yo'taldan qochishga harakat qiling
    • Umumiy qoida sifatida, agar u og'rigan bo'lsa, buni qilmang!
    • Jinsiy aloqani operatsiyadan olti hafta o'tgach va qon ketish to'xtaganidan bir hafta o'tgach davom ettirmaslik kerak
    • To'liq qulay va o'zini yaxshi his qilmaguncha mashina haydamaslik tavsiya etiladi. Bu 2-6 hafta oralig'ida bo'lishi mumkin. Kasalxonadan chiqqaningizdan keyin kamida bir necha hafta davomida yo'lovchi sifatida uzoq safarni rejalashtirmang
    • Vaqt o'tishi bilan ko'payadigan tez-tez qisqa yurishlar foydalidir (ya'ni 5-10 daqiqadan 20-30 daqiqagacha qurish)
    • Vaginal oqindi to'xtab qolgandan keyin yumshoq suzish yaxshi bo'ladi
    • Qabziyatni oldini olish - Ichakni ochganda zo'riqishlardan saqlaning. Agar bu muammo bo'lsa, tola va suyuqlik miqdorini oshiring (kuniga kamida 1-1½ litr suv iching). Koloksil tabletkalari (kuniga bir yoki ikki marta 1-2 tabletka) ham foydali bo'lishi mumkin
    • Ular operatsiyadan keyin bir yoki ikki hafta ichida qulay tarzda amalga oshirilishi mumkin bo'lganda boshlanishi mumkin. Har qanday harakatda (yo'tal, hapşırma, kulish va h.k.) tos bo'shlig'i mushaklarini bukishni unutmang.
    • Jarrohlikdan keyin qovuqni 24-36 soat davomida to'kib tashlash uchun yumshoq lateks naycha (kateter) talab qilinishi mumkin.
    • Inkontinans operatsiyasidan so'ng, kam sonli ayollar siydik pufagini bo'shatishda doimiy qiyinchiliklarga duch kelishi mumkin va shuning uchun uzoq vaqt davomida kateter kerak bo'ladi.
    • Bunday hollarda siz uyga siydik chiqarish paketi bilan borishingiz va kateterni olib tashlash uchun bir yoki ikki haftadan keyin qaytib kelishingiz mumkin.
    • Shu bilan bir qatorda, siydik pufagi funktsiyasi normal holatga qaytgunga qadar muntazam ravishda siydik pufagini bo'shatish uchun sizga kichik kateter kiritishni o'rgatish mumkin.

    Jarrohlikdan so'ng sizda shunday bo'lishi mumkin

    • Bir daraja ko'ngil aynish
    • Besh kungacha noqulaylik va charchoq odatiy holdir
    • Kesilgan joylarda og'riq
    • 2-3 haftagacha qorin bo'shlig'i shishishi
    • Mushaklarning og'rig'i
    • Yelka uchida va qovurg'a qafasida og'riq. Bu diafragma ostida oz miqdorda gaz qolganligi bilan bog'liq
    • Bundan tashqari, hayz turidagi og'riqlar va bir necha kunlik vaginal qon ketish yoki oqindi bo'lishi mumkin
    • Qabziyat
    • Oddiy paratsetamol va steroid bo'lmagan yallig'lanishga qarshi dorilar (i.enurofen) kabi og'riq qoldiruvchi tabletkalar laparoskopiyadan keyin kamida 5-7 kun, lekin ba'zi hollarda 4 hafta yoki undan ko'proq vaqt talab qilinishi mumkin.
    • Iloji bo'lsa, tarkibida kodein bo'lgan og'riq qoldiruvchi vositalardan saqlaning, chunki ular ich qotishiga olib keladi.
    • Laparoskopiyadan keyin qorinning yuqori qismida karbonat angidrid gazining qoldiqlari diafragma mushaklari yaqinidagi nervlarni tirnash xususiyati tufayli elkada noqulaylik paydo bo'ladi.
    • Bu normal (va xavfli emas) va odatda 1 haftadan kamroq vaqt ichida o'zini tutadi, chunki tanangiz CO2ni qayta singdiradi.
    • Bu mahalliy issiqlik (ta'sirlangan hududga issiqlik yostig'i qo'yish), og'riqni kamaytirish va pozitsion bo'lishi mumkin, shuning uchun turli pozitsiyalarni sinab ko'ring (ya'ni, yoningizda yotish, 2-3 yostiqda yotish va hokazo).
    • Kichkina yaralarni qoplaydigan 2-5 dona kiyinish bo'ladi.
    • Ular rangi o'zgarib ketguncha yoki tozalana boshlaguncha joyida qoldirilishi mumkin.
    • Dushdan keyin ularni sochiq bilan artib yoki sochlarini fen bilan quriting (sovuq sharoitda).
    • Tikuvlaringiz olib tashlanmaguncha va vaginal qon ketish to'xtamaguncha hammom yoki kurortga kirishdan saqlaning.

    Kundalik faoliyatni tiklash:

    • Yuvish, dazmollash, tozalash va bog'dorchilik kabi uy ishlari yo'q
    • Uy atrofida tez-tez qisqa yurish bilan imkon qadar ko'proq dam oling
    • Agar o'zingizni qulay his qilsangiz, haydash, oddiy yumushlar va kuchli bo'lmagan jismoniy mashqlar (masalan, piyoda yurish, velosiped haydash, tay-chi) kabi harakatlar davom ettirilishi mumkin.
    • Haydovchilikni sizning ixtiyoringiz bilan davom ettirish mumkin, lekin odatda 3-7 kundan oldin emas
    • To'lanadigan ishga qaytish
    • Kuchli jismoniy mashqlar (masalan, raqobatbardosh sport) operatsiya hajmiga va o'zingizni qanday his qilayotganingizga qarab 3-4 haftadan so'ng tiklanishi mumkin.
    • Agar biron bir faoliyat sezilarli og'riq yoki noqulaylik tug'dirsa, o'zingizni yaxshi his qilmaguningizcha, bu faoliyatdan qoching
    • Jinsiy aloqa - kichik laparoskopiya uchun 10-14 kun va operativ laparoskopiyadan 3-4 hafta kutish yaxshidir (ya'ni endometriozni olib tashlash, tuxumdon yoki kistani olib tashlash va h.k.), ammo barcha qon ketish yoki vaginal oqindi to'xtaguncha kutmang. Agar shubhangiz bo'lsa, operatsiyadan keyingi tashrifingizda maslahat kuting

    Vaginal qon ketish yoki oqindi

    • Aksariyat ayollarda laparoskopiyadan keyin 7 kundan keyin yoki undan ko'proq vaqt o'tgach, qonga bo'yalgan yoki jigarrang rangga ega bo'lgan vaginal qon ketish yoki oqindi bo'ladi.
    • Bu vaqt ichida tamponlardan foydalanmang.
    • Har bir inson biroz boshqacha tezlikda tiklanadi
    • Agar rivojlanayotgan bo'lsangiz, maslahat uchun Ph 8132 0566 raqamiga murojaat qiling:
      • Og'riqni yo'qotish va dam olishdan keyin o'tmaydigan kuchli qorin og'rig'i
      • Doimiy qusish,
      • Yuqori isitma (>38 daraja)
      • Juda tajovuzkor vaginal oqindi
      • Og'ir vaginal qon ketish

      Laparoskopik jarrohlikdan keyin nima kutish kerak pdf versiyasini yuklab olish uchun shu yerni bosing

      Yuqoridagi hujjatlarni ko'rish va chop etish uchun sizga Adobe Reader kerak bo'ladi.


      Jarrohlikdan keyin og'riqni nazorat qilish

      Jarrohlikdan keyin og'riqni nazorat qilish siz va shifokorlaringiz uchun ustuvor vazifadir. Jarrohlikdan keyin biroz og'riqni kutishingiz kerak bo'lsa-da, shifokoringiz uni xavfsiz tarzda kamaytirish uchun barcha sa'y-harakatlarni amalga oshiradi.

      Og'riqni nazorat qilish sizni qulay his qilishdan tashqari, tiklanishingizni tezlashtirishga yordam beradi va operatsiyadan keyin pnevmoniya va qon pıhtıları kabi ba'zi asoratlarni rivojlanish xavfini kamaytiradi. Agar og'riqlar yaxshi nazorat qilinsa, siz yurish va chuqur nafas olish mashqlari kabi muhim vazifalarni bajarishingiz mumkin bo'ladi.

      Quyidagi ma'lumotlar og'riqni boshqarish variantlarini tushunishingizga yordam beradi. Bu sizning shifokorlaringiz va hamshiralaringizga og'riqni nazorat qilishda qanday yordam berishingiz va og'riqni davolash bo'yicha tanlov qilishda faol rol o'ynashingizga yordam berishingiz mumkinligini tasvirlaydi.

      Agar siz muntazam ravishda uyda og'riq qoldiruvchi vositalarni qabul qilsangiz va ba'zi og'riq qoldiruvchi vositalarga allergiyangiz bo'lsa yoki toqat qila olmasangiz, shifokoringizga xabar bering.

      Operatsiyadan keyin qanday og'riqlarni his qilaman?

      Jarrohlikdan keyin og'riqni his qilgan joyingiz sizni hayratda qoldirishi mumkin. Jarrohlik joyi ko'pincha noqulaylikning yagona maydoni emas. Siz quyidagilarni his qilishingiz yoki sezmasligingiz mumkin:

      • Muscle pain: You may feel muscle pain in the neck, shoulders, back or chest from lying on the operating table.
      • Throat pain: Your throat may feel sore or scratchy.
      • Movement pain: Sitting up, walking, and coughing are all important activities after surgery, but they may cause increased pain at or around the incision site.

      What can I do to help keep my pain under control?

      Important! Your doctors and nurses want and need to know about pain that is not well controlled. If you are having pain, please tell someone! Don't worry about being a "bother."

      You can help the doctors and nurses "measure" your pain. While you are recovering, your doctors and nurses will frequently ask you to rate your pain on a scale of 0 to 10, with “0” being “no pain” and “10” being “the worst pain you can imagine.” Reporting your pain as a number helps the doctors and nurses know how well your treatment is working and whether to make any changes. Keep in mind that your comfort level (your ability to breathe deeply or cough) is more important than absolute numbers (your pain score).

      Who is going to help manage my pain?

      You and your surgeon will decide what type of pain control would be most acceptable for you after surgery. Your surgeon may choose to consult a pain specialist help manage your pain following surgery. Pain specialists are specifically trained in the types of pain control options that follow.

      You are the one who ultimately decides which pain control option is most acceptable. The manager of your post-surgical pain will review your medical and surgical history and check the results from your laboratory tests and physical exam. They can then advise you about which pain management option may be best suited to safely minimize your discomfort.

      After surgery, you will be assessed frequently to ensure that you are comfortable and safe. When necessary, adjustments or changes to your pain management regimen will be made.

      What are the types of pain-control treatments?

      You may receive more than one type of pain treatment, depending on your needs and the type of surgery you are having. All of these treatments are relatively safe, but like any therapy, they are not completely free of risk. Dangerous side effects are rare. Nausea, vomiting, itching, and drowsiness can occur. These side effects can be troubling but are usually easily treated in most cases.

      Intravenous patient-controlled analgesia (PCA)

      Patient-controlled analgesia (PCA) is a computerized pump that safely permits you to push a button and deliver small amounts of pain medicine into your intravenous (IV) line, usually in your arm. No needles are injected into your muscle. PCA provides stable pain relief in most situations. Many patients like the sense of control they have over their pain management.

      The PCA pump is programmed to give a certain amount of medication when you press the button. It will only allow you to have so much medication, no matter how often you press the button, so there is little worry that you will give yourself too much.

      Never allow family members or friends to push your PCA pump button for you. Thhisoblanadi removes the patient control aspect of treatment, which is a major safety feature. You need to be awake enough to know that you need pain medication.

      Patient-controlled epidural analgesia

      Many people are familiar with epidural anesthesia because it is frequently used to control pain during childbirth. Patient-controlled epidural analgesia uses a PCA pump to deliver pain-control medicine into an epidural catheter (a very thin plastic tube) that is placed into your back.

      Placing the epidural catheter (to which the PCA pump is attached) usually causes no more discomfort than having an IV started. A sedating medication, given through your IV, will help you relax. The skin of your back will be cleaned with a sterile solution and numbed with a local anesthetic. Next, a thin needle will be carefully inserted into an area called the "epidural space." A thin catheter will be inserted through this needle into the epidural space, and the needle will then be removed. During and after your surgery, pain medications will be infused through this epidural catheter with the goal of providing you with excellent pain control when you awaken. If additional pain medication is required, you can press the PCA button.

      Epidural analgesia is usually more effective in relieving pain than intravenous medication. Patients who receive epidural analgesia typically have less pain when they take deep breaths, cough, and walk, and they may recover more quickly. For patients with medical problems such as heart or lung disease, epidural analgesia may reduce the risk of serious complications such as heart attack and pneumonia.

      Epidural analgesia is safe, but like any procedure or therapy, it’s not risk free. Sometimes the epidural doesn’t adequately control pain. In this case you’ll be given alternative treatments or be offered replacement of the epidural. Nausea, vomiting, itching and drowsiness can occur. Occasionally you may experience numbness and weakness of the legs which disappears after the medication is reduced or stopped. Headache can occur, but this is rare. Severe complications, such as nerve damage and infection, are extremely rare.

      Nerve blocks

      You may be offered a nerve block to control your pain after surgery. Unlike an epidural, which controls pain over a broad area of your body, a nerve block controls pain isolated to a smaller area of your body, such as an arm or leg. Sometimes a catheter similar to an epidural catheter is placed for prolonged pain control. One advantage of using a nerve block is that it may allow the amount of opioid (narcotic) medication to be significantly reduced. This may result in fewer side effects, such as nausea, vomiting, itching, and drowsiness.

      In some cases, a nerve block can be used as the main anesthetic for your surgery. In this case, you will be given medications during your surgery to keep you sleepy, relaxed, and comfortable. This type of anesthesia provides the added benefit of pain relief both during and after your surgery. It may reduce your risk of nausea and vomiting after surgery. You, your anesthesiologist, and your surgeon will decide before surgery if a nerve block is a suitable pain management or anesthetic option for you.

      Pain medications taken by mouth

      At some point during your recovery from surgery, your doctor will order pain medications to be taken by mouth (oral pain medications). These may be ordered to come at a specified time, or you may need to ask your nurse to bring them to you. Make sure you know if you need to ask for the medication! Most oral pain medications can be taken every 4 hours.

      Important! Do not wait until your pain is severe before you ask for pain medications. Also, if the pain medication has not significantly helped within 30 minutes, notify your nurse. Extra pain medication is available for you to take. You do not have to wait 4 hours to receive more medication.

      What are some of the risks and benefits associated with pain medication?

      Opioids (narcotics) after surgery: medications such as morphine, fentanyl, hydromorphone

      • Foydasi: Strong pain relievers. Many options are available if one is causing significant side effects.
      • Xavflar: May cause nausea, vomiting, itching, drowsiness, and/or constipation. Although these drugs carry a risk of abuse and addiction, the risk is manageable if the medications are used properly, for the right reasons, and for a short period of time.

      Opioids (narcotics) at home (Percocet®, Vicodin® and others)

      • Foydasi: Effective for moderate to severe pain. Many options available.
      • Xavflar: Nausea, vomiting, itching, drowsiness, and/or constipation. Stomach upset can be lessened if the drug is taken with food. You should not drive or operate machinery while taking these medications. Note: These medications often contain acetaminophen (Tylenol®). Make sure that other medications that you are taking do not contain acetaminophen. Too much acetaminophen can damage your liver.

      Non-opioid (non-narcotic) analgesics (Tylenol® and other non-NSAIDS)

      • Foydasi: Effective for mild to moderate pain. They have very few side effects and are safe for most patients. They often decrease the amount of stronger medications you need, which may reduce the risk of side effects.
      • Xavflar: Liver damage may result if more than the recommended daily dose is used. Patients with pre-existing liver disease or those who drink significant quantities of alcohol may be at increased risk.

      Nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil® and Motrin®), naproxen sodium (Aleve®), celecoxib (Celebrex®) and others

      • Foydasi: These drugs reduce swelling and inflammation and relieve mild to moderate pain. Ibuprofen and naproxen sodium are available without a prescription, but ask your doctor about taking them. They may reduce the amount of opioid analgesic you need, possibly reducing side effects such as nausea, vomiting and drowsiness. If taken alone, there are no restrictions on driving or operating machinery.
      • Xavflar: The most common side effects of NSAIDs are stomach upset and dizziness. You should not take these drugs without your doctor's approval if you have kidney problems, a history of stomach ulcers, heart failure or are on "blood thinner" medications such as Coumadin® (warfarin), Lovenox® injections, or Plavix®.

      Be sure to tell your doctor about all medications (prescribed and over-the-counter), vitamins, and herbal supplements you are taking. This may affect which drugs are prescribed for your pain control.

      Are there ways I can relieve pain without medication?

      Yes, there are other ways to relieve pain and it is important to keep an open mind about these techniques. When used along with medication, these techniques can dramatically reduce pain.

      Guided imagery is a proven form of focused relaxation that helps create calm, peaceful images in your mind -- a "mental escape."

      Relaxation media can be purchased at some bookstores or on-line stores, or can be borrowed from your local library. You can bring your relaxation media and listening device to the hospital to play prior to surgery and during your hospital stay.

      For the best results, practice using the relaxation techniques before your surgery, and then use them twice daily during your recovery. Listening to soft music, changing your position in bed, or tuning in to a hospital relaxation channel are additional methods to relieve or lessen pain. Ask your nurse for channel information.

      At home, heat or cold therapy may be an option to help reduce swelling and control your pain. Your surgical team will provide specific instructions if these therapies are appropriate for you.

      If you have an abdominal or chest incision, you will want to splint the area with a pillow when you are coughing or breathing deeply to decrease motion near your incision. You will be given a pillow in the hospital. Continue to use it at home as well.

      Lastly, make sure you are comfortable with your treatment plan. Talk to your doctor and nurses about your concerns and needs. This will help avoid miscommunication, stress, anxiety, and disappointment, which may make pain worse. Keep asking questions until you have satisfactory answers. You are the one who will benefit.

      How can I control pain at home?

      You may be given prescriptions for pain medication to take at home. These may or may not be the same pain medications you took in the hospital. Talk with your doctor about which pain medications will be prescribed at discharge.

      Eslatma: Make sure your doctor knows about pain medications that have caused you problems in the past. This will prevent possible delays in your discharge from the hospital.

      Preparation for your discharge

      Your doctors may have already given you your prescription for pain medication prior to your surgery date. If this is the case, it is best to be prepared and have your medication filled and ready for you when you come home from the hospital. You may want to have your pain pills with you on your ride home if you are traveling a long distance. Check with your insurance company regarding your prescription plan and coverage for your medication. Occasionally, a pain medication prescribed by your doctor is not covered by your insurance company.

      If you don’t receive your prescription for pain medication until after the surgery, make sure a family member takes your prescription and either gets it filled at your hospital’s pharmacy or soon after your discharge from the hospital. It is important that you ARE PREPARED in case you have pain.

      Make sure you wear comfortable clothes, and keep your coughing and deep breathing pillow with you.

      You may want to have your relaxation music available for your travels.

      If you are traveling by plane, make sure you have your pain pills in your carry-on luggage in case the airline misplaces your checked luggage.

      • Remember to take your pain medication before activity and at bedtime. Your doctor may advise you to take your pain medication at regular intervals (such as every four to six hours).
      • Be sure to get enough rest. If you are having trouble sleeping, talk to your doctor.
      • Use pillows to support you when you sleep and when you do your coughing and deep breathing exercises.
      • Try using the alternative methods discussed earlier. Heating pads or cold therapy, guided imagery tapes, listening to soft music, changing your position in bed and massage can help relieve your pain.

      ESLATMA: If you need to have stitches or staples removed and you are still taking pain medications, be sure to have a friend or family member drive you to your appointment. Commonly, you should not drive or operate equipment if you are taking opioid (narcotic)-containing pain medications. Check the label of your prescription for any warnings or ask your doctor, nurse, or pharmacist.

      Frequently asked questions

      I am nervous about getting addicted to pain pills. How do I avoid this?

      With proper use, the risk of becoming addicted to pain medication after surgery is small. The bigger risk is a possible prolonged recovery if you avoid your pain medications, and cannot effectively do your required activities. If you are concerned about addiction, or have a history of substance abuse (alcohol or any drug), talk with your doctors. They will monitor you closely during your recovery. If issues arise following surgery, they will consult the appropriate specialists.

      I’m a small person who is easily affected by medicine. I am nervous that a "normal" dose of pain medication will be too much for me. What should I do?

      During recovery, your healthcare team will observe how you respond to pain medication and make changes as needed. Be sure to communicate with your doctors any concerns you have prior to surgery. The relatively small doses of pain medication given after surgery are highly unlikely to have an exaggerated effect based on your body size.

      I don't have a high tolerance for pain. I am afraid that the pain will be too much for me to handle. What can I do?

      Concern about pain from surgery is very normal. The most important thing you can do is to talk with your surgeon and anesthesiologist about your particular situation. Setting pain control goals with your doctors before surgery will help them better tailor your pain treatment plan. Treating pain early is easier than treating it after it has set in. If you have had prior experiences with surgery and pain control, let your doctor know what worked or what did not work. Remember, there are usually many options available to you for pain control after surgery.

      I normally take Tylenol® if I get a headache. Can I still take Tylenol for a headache if I am on other pain medication?

      As discussed earlier, before taking any other medication, be sure to talk to your doctor. Some of the medications prescribed for use at home contain acetaminophen (Tylenol) and if too much is taken, you may become ill. In order to avoid getting too much of any medication, discuss this issue with your doctor BEFORE you leave the hospital.

      How do I play an active role in my pain control?

      Ask your doctors and nurses about:

      • Pain and pain control treatments and what you can expect from them. You have a right to the best level of pain relief that can be safely provided.
      • Your schedule for pain medicines in the hospital.
      • How you can participate in a pain-control plan.

      Inform your doctors and nurses about:

      • Any surgical pain you have had in the past.
      • How you relieved your pain before you came to the hospital.
      • Pain you have had recently or currently.
      • Pain medications you have taken in the past and cannot tolerate.
      • Pain medications you have been taking prior to surgery
      • Any pain that is not controlled with your current pain medications.
      • Help the doctors and nurses "measure" your pain and expect staff to ask about pain relief often and to respond quickly when you do report pain.
      • Ask for pain medicines as soon as pain begins.
      • Tell us how well your pain is relieved and your pain relief expectations.
      • Use other comfort measures for pain control -- listening to relaxation or soft music, repositioning in bed, etc.

      Your doctors are committed to providing you with the safest and most effective pain management strategy that is most acceptable to you.

      • Pain is different for everyone.
      • Pain may be dull, stabbing, cramping, throbbing, constant, on and off, etc.
      • Treating pain early usually brings quicker and better control.
      • Healing occurs faster when pain is under control.
      • Pain affects blood pressure, heart rate, appetite and general mood.

      Last reviewed by a Cleveland Clinic medical professional on 10/16/2020.

      Ma'lumotnomalar

      • Centers for Disease Control and Prevention. Postsurgical Pain. Accessed 11/2/2020.
      • Garimella V, Cellini C. Postoperative pain control. Clin Colon Rectal Surg. 201326(3):191-196. doi:10.1055/s-0033-1351138.
      • American Society of Anethesiologists. Post Op Pain. Accessed 11/2/2020.
      • American Academy of Orthopaedic Surgeons. Managing Pain with Medications after Orthopaedic Surgery. Accessed 11/2/2020.

      Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

      Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

      Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

      Tegishli institutlar va xizmatlar

      Anesthesiology & Pain Management

      Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

      Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

      Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

      Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

      Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy


      You know that shoulder gas pain that people talk about having after a lap? I’ve had that everyday for seven straight months

      I have not had a lap yet. I was going to get one, and the gyno who was going to do it ordered a pelvic MRI with and without contrast. That night after I got the MRI I drank a bunch of water (like a gallon) because I was told it would flush the contrast out, and I ate 3/4s of a frozen vegan pizza. The following morning I felt nauseous for some reason, and then that night I went for a walk to get things moving. Well, while I was on the walk I nearly shit my pants and had to run home, which has never happened to me before (I am nearly always constipated).

      Immediately after going it felt like some of the diarrhea was still stuck, right in my epigastric area. Almost like something was sloshing around in there. I then had a gnawing pain under my ribs in the front like I had torn something for about a week, followed by the worst pain I have ever felt between my shoulder blades and in my left shoulder. This pain has remained, along with burping and regurgitation, for seven straight months since. I feel bloated in my back/flank area, and it’s extraordinarily difficult for me to pass gas.

      Things that I’ve been told I don’t have:

      Hiatal hernia (had endoscopy, just revealed mild chronic gastritis, which I’ve always had)

      Something wrong with my kidneys (bloodwork is fine)

      Enlarged spleen or other organ (abdominal ultrasound was normal)

      Gallstones/gallbladder disease (again, ultrasound was normal)

      Flank/lumbar hernia (my doctor just looked at me like I was crazy for suggesting this, even though I can feel a bulge in my flank)

      SIBO, but I can’t find the root cause. Also I don’t look pregnant or have a distended abdomen, all the bloating is in my back

      Some degree of gastroparesis or slow gut motility

      They found a nodule and pneumonia on my lung which I just know came from my stomach somehow.

      The pain in my left shoulder and both flanks is so, so bad. And I don’t know why it all started after the MRI. Or maybe the MRI pushed it over the edge? Ugh.


      Why do I fart so much?

      Some flatulence is normal, but excessive farting is often a sign that the body is reacting strongly to certain foods. This can indicate a food intolerance or that a person has a digestive system disorder, such as irritable bowel syndrome.

      Typically, people pass gas 5–15 times per day. Dietary changes, altering eating patterns, and identifying food intolerances can all help prevent excessive flatulence.

      In this article, we look at the possible causes of excessive flatulence and ways to prevent it from happening.

      Share on Pinterest A person may be reacting to certain foods if they are farting excessively.

      Simply eating or drinking is enough to cause gas. As a person eats or drinks, they tend to swallow a bit of air. The body may release this air as a burp, or the air may make its way to the intestines, where it will eventually leave the body as a fart.

      Farting is also an indication of natural activity in the digestive system. The bacteria that live in the gut create different gases as they break down foods, and the body releases these gases as a fart.

      People may notice that they fart more after making changes to their diet. Changes could include becoming vegetarian or vegan, cutting out food groups, or adding new foods to the diet.

      In these cases, any digestive disturbances — which can also include nausea, stomach upsets, and constipation or diarrhea — should settle down as the body adjusts to the new diet. If it does not settle down, this may indicate that the new eating pattern is triggering a food intolerance.

      Some foods cause more digestive gases to build up than others. Foods that cause gas include many carbohydrates, starches, and foods that are high in fiber.

      In contrast, proteins and fats do not typically cause gas, though specific proteins can intensify the odor it gives off.

      The following types of foods may lead to excess flatulence:

      High fiber foods

      Fiber is the tough part of plants or carbohydrates that the human body has trouble breaking down. It does not break down in the small intestine and reaches the colon undigested. Bacteria in the colon break down the fiber in a fermentation process, which produces gas.

      This includes both soluble and insoluble fibers, which only occur in plant foods, such as fruits, vegetables, beans, and greens.

      High fiber foods are good for the gut, but eating too much can cause digestive upset. People can avoid this discomfort by introducing high fiber foods into the diet slowly over several weeks to let their digestive system get used to them.

      Foods that contain raffinose

      Raffinose is a complex sugar that causes gas.

      Beans contain large amounts of raffinose. Other foods that contain smaller amounts include:

      Starchy foods

      Most starchy foods produce gas when the body breaks them down in the large intestine.

      Starchy foods that can cause gas include:

      According to the International Foundation for Gastrointestinal Disorders, rice is the only starch that does not cause gas.

      High sulfur foods

      Sulfur is necessary for a healthy body, but eating too many high sulfur foods may cause excessive gas. Sulfuric foods include alliums, such as onions and garlic, and cruciferous vegetables, such as broccoli and cauliflower.

      Sugar alcohols

      Sugar alcohols, such as xylitol and erythritol, give the sweetness of sugar without the calories. However, they may also cause digestive issues, such as flatulence, as the body has trouble digesting them completely.

      Constipation may also cause more frequent flatulence. As waste sits in the colon, it ferments, releasing extra gas. If the person is constipated, the waste may sit there for much longer than usual, causing excess gas to build up.

      A person with lactose intolerance will notice that they produce more gas when they eat or drink dairy products, such as cheese, butter, or yogurt.

      This occurs when the body cannot break down lactose, a protein found in milk.

      Someone with lactose intolerance may experience other symptoms when they have dairy products, such as:

      When a person has celiac disease, their digestive system cannot break down gluten, which is the protein in wheat. They may experience a wide range of digestive symptoms if they eat gluten, including excessive gas and bloating.

      While gluten and dairy are common intolerances, the body may become intolerant to a wide variety of foods. Eating these foods may cause digestive disturbances, including excessive farting.

      Keeping a food and symptom diary may help a person to identify trigger foods so they can eliminate them from their diet.

      Irritable bowel syndrome (IBS) is a digestive disorder that causes a range of digestive symptoms, including excessive gas, abdominal pain, and regular diarrhea or constipation. The person with IBS may notice symptoms more during periods of high stress or when eating certain foods.

      Several other digestive disorders cause excessive farting. Each condition will have its own cause and symptoms.

      Some possible digestive issues that contribute to excessive farting include:

      • gastroesophageal reflux disease (GERD)
      • inflammatory bowel disease
      • ulcerative colitis
      • gastroparesis
      • autoimmune pancreatitis

      People can often relieve gas by changing their eating habits, identifying and eliminating trigger foods from the diet, or making lifestyle changes.

      Some methods may work better for one person than another, so if one does not work, try another. Methods include:

      Eating slowly

      Much of the gas that farts release comes from eating, as people swallow a bit of air with each bite. Eating in a rush may make matters worse. People who eat in a hurry may not chew their food completely and may swallow bigger chunks of food as well, making the food harder to digest.

      Chewing is an integral part of the digestive process. Thoroughly chewing food makes it easier for the body to break it down. Taking the time to chew food slowly before swallowing may help the body digest this food and reduce the air that enters the intestines.

      Avoiding chewing gum

      Chewing gum may cause a person to swallow air along with their saliva. This may lead to more gas in the intestines and therefore, more flatulence.

      Getting regular exercise

      Getting moderate exercise for at least 30 minutes per day may help prevent gas buildup in the body. It may also stimulate the digestive system, which could help with other issues, such as constipation.

      Reducing trigger foods

      Many foods that cause gas are a vital part of a complete diet. For instance, fiber is essential for digestive health, but eating too much of it may cause flatulence.

      Following a healthful, balanced diet is unlikely to cause long term gas. However, any dietary changes can cause short term gas while the body gets used to the new foods.

      Identifying food intolerances

      People with digestive disorders could keep a food journal to help them identify the possible trigger foods that are causing their reactions, such as lactose or gluten. Once they identify these trigger foods, avoiding them may help prevent excessive farting.

      Avoiding carbonated drinks

      Carbonated drinks add gas to the digestive system. This generally comes back up as a burp but can also continue through the intestines and cause flatulence.

      To avoid this, reduce or eliminate sources of carbonation, such as:

      Taking digestive enzymes

      People who have difficulty digesting certain food groups but want to continue eating them might try taking digestive enzymes specific to those foods.

      For instance, people with lactose intolerance could take the enzyme lactase before eating dairy products to help them digest it.

      There are different digestive enzymes for each food type, so be sure to get the correct enzymes to help with digestion.

      People can buy digestive enzymes in drug stores or choose between brands online.

      Taking probiotics

      Probiotics are supplements containing similar healthful bacteria to the ones in the digestive system. Adding more of these bacteria to the body might make it easier for the body to break down certain foods, which may reduce flatulence in some people.

      Probiotics are available in supermarkets, drug stores, and online.

      In most cases, excessive farting is the result of eating too much of a food that the body does not agree with or eating too quickly. In these cases, there is generally no cause for concern.

      However, people experiencing other digestive symptoms may want to see a doctor, especially if these symptoms get in the way of their everyday life. Other symptoms may include:

      • abdominal pain
      • nausea and vomiting
      • too much pressure in the abdomen
      • regular diarrhea or constipation
      • sudden weight loss

      Doctors will want to check for underlying conditions in the digestive tract.

      Most of the time, farting too much is an indication of eating something the body does not agree with or eating too fast. Some people may have underlying conditions that cause excessive or frequent flatulence, and they will likely experience other symptoms.

      Most people can use simple home remedies and lifestyle changes to relieve gas.

      Anyone experiencing worrying symptoms or additional digestive symptoms may wish to see a doctor for a full diagnosis.


      Potential Complications of Surgery

      In addition to the expected digestive side effects, gallbladder removal carries a small risk of various complications. Bularga quyidagilar kiradi:

      Bile Leakage

      As part of the surgery to remove your gallbladder, clips are used to seal the tube that connected the gallbladder to your main bile duct.

      It’s possible, though, for bile to leak into the abdomen if the clip doesn’t adequately seal the tube.

      When a bile leak occurs, symptoms may include abdominal pain, nausea, fever, and swelling of the abdomen.

      Sometimes a bile leak can be drained without the need for further surgery. In more severe cases, though, an operation is needed to drain the bile and wash out the inside of your abdomen. (3)

      Bile Duct Injury

      In very rare cases, your main bile duct may be injured in the course of removing your gallbladder.

      If your surgeon realizes this right away, it may be possible to fix the problem immediately. But if not, and in certain other cases, you may need an additional operation to fix this. (3)

      Injury to Surrounding Structures

      In extremely rare cases, your surgery may cause damage to nearby blood vessels, your liver, or your intestines.

      These problems can usually be spotted and fixed right away, but if they’re noticed only later, another operation may be needed. (2,3)

      Colicky Pain

      A study published in March 2018 in the journal HPB found that among people who underwent gallbladder removal because of mild gallstone pancreatitis (inflamed pancreas), nearly 15 percent experienced an attack of pain in the area after the surgery.

      Most of these attacks were single events that took place within two months of the surgery. No factors were found to predict who develops this type of pain. (4)

      In some cases, pain may result from gallstones remaining in the bile ducts. Surgically removing these gallstones may resolve the pain. (3)

      Blood Clots

      People with certain risk factors — like prior clots, prolonged immobilization, or cancer — are at higher risk for developing a blood clot after surgery.

      This type of clot, known as deep vein thrombosis, usually develops in your leg but can travel to — and lodge in — other areas of your body, causing problems such as cutting off blood flow to parts of your lungs (known as pulmonary embolism).

      If you have an elevated risk for blood clots, you may need to wear compression stocking after your surgery to prevent clots from forming in your legs. (3)

      Infection

      After your surgery, you may develop either an internal infection or one at the incision site.

      Signs of an infected wound include:

      To treat an infection, your doctor will prescribe antibiotics. In rare cases, it may be necessary to surgically drain fluid or pus from the infected area. (3)

      Bleeding (Hemorrhage)

      While it’s rare, bleeding can occur internally or externally after your operation. If this happens, you may need a further operation to stop the bleeding. (3)

      Anesthesia reactions

      It’s possible — though very rare — to have severe reactions to the anesthesia used for your surgery, including a severe allergic reaction or even sudden death. (3)

      Heart Problems

      Especially if you already have cardiovascular disease, the stress of surgery can cause or worsen heart problems. (2)

      Pneumonia

      During your surgery, you’ll be given a breathing tube, since you won’t be able to breathe on your own under general anesthesia. This ventilated breathing may increase your chance for pneumonia.

      In rare cases, you can develop a lung infection following your surgery as a result of this. Depending on its severity, you may be prescribed oral antibiotics, or you may need to be hospitalized and given intravenous (IV) fluids and antibiotics. (2)

      Scars and Numbness

      It’s possible that you’ll develop scarring and a loss of sensation at or around your incision sites. (5)

      Hernia

      Part of your intestines or some other tissue may bulge through your abdominal wall at an incision site. This bulge may be painful, and if it doesn’t resolve on its own, it may require surgery to correct. (5)


      Videoni tomosha qiling: JINSIY ALOQA PAYTIDA AYOLLARDAGI OGRIQ (Avgust 2022).