Operace tlustého střeva

14.4.2012 , Danica Deretić

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Operace tlustého střeva patří mezi časté chirurgické zákroky. Výkony se provádějí na koncové části trávicího traktu, tedy tlustém střevě, které má několik částí. Operace na tlustém střevě mohou být různě rozsáhlé a může končit i úplným odstraněním tlustého střeva. Existuje celá škála onemocnění tlustého střeva a některá z nich jsou léčitelná pouze chirurgickým zákrokem.

Operace tlustého střeva

Operace tlustého střeva patří mezi velice časté chirurgické zákroky. Mohou být indikovány z různých příčin a velice často se jedná i o život zachraňující výkon. Operace tlustého střeva také často bývá jedinou možností léčby daného onemocnění. Chirurgický zákrok se provádí na konečné části trávicího traktu, tlustém střevě, které navazuje na střevo tenké.

Anatomie a fyziologie tlustého střeva

Tlusté střevo je trubice dlouhá kolem 1,5m a jeho název vyplývá z jeho průměru, který činí až 7,5cm. Jedná se tedy o dutý trubicovitý orgán, který na jednom konci navazuje ma tenké střevo a končím přechodem v konečník. Počáteční část tlustého střeva se nazývá slepé střevo, na kterém se nachází červovitý přívěsek, u kterého často vzniká zánět a mluvíme pak o tzv. zánětu slepého střeva. Dále slepé střevo pokračuje vzhůru jako vzestupný tračník k játrům. Pod nimi zahýbá napříč břichem jako příčný tračník a vlevo pod slezinou opět zahýbá směrem dolů jako sestupný tračník. V pravé dolní čtvrtině břicha přechází tlusté střevo v esovitou kličku a je zakončené přechodem do konečníku. Funkce tlustého střeva spočívá ve vstřebávání vody a zbylých minerálů z tráveniny, která přichází z tenkého střeva. Tím dochází k formování stolice. Tyto funkce jsou podporovány přirozenou přítomností střevních bakterií.

 Indikace k operaci tlustého střeva

Indikace znamená soubor okolností, které vedou k provedení určitého diagnostického či léčebného postupu či zákroku. Onemocnění tlustého střeva je celá řada a projevují se zejména neprůchodností střev. Jedná se o závažný až život ohrožující stav, který je nutné ihned operativně řešit. Projevy zahrnují bolesti břicha, zvracení, průjmy, zástavu odchodu stolice a plynů a také přítomností krve ve stolici. Rovněž dochází k těžkému rozvratu vodního a minerálového metabolismu. Tento stav může vyústit až v šok a msrt pacienta. Příčiny střevní neprůchodnisti, odborně ileu, mohou být různé. Mezi ty nejčastější patří:

  • Nezhoubný nádor, tzv. polyp, což je výchlipka sliznice vyčnívající nad povrch do vnitřku střeva. Jeho nebezpečí tkví v možnosti jeho přechodu do zhoubného nádoru.
  • Zhoubný nádor, neboli kolorektální karcinom, je jedna z nejčastější indikací k operaci tlustého střeva. V závislosti na velikosti nádoru dochází ke změně charakteru stolice, frekvence vyprazdňování, bolestem břicha a přítomností krve ve stolici. U zhoubného nádoru tlustého střeva je operační léčba jedinou možnou metodou léčby.
  • Divertikulitida je zánětlivé onemocnění střevních výchlipek, které způsobují bolest břicha a mohou někdy i krvácet. Operační zákrok je zde prováděn úpuze při komplikacích. Komplikace zahrnují možné prasknutí zánětlivé výchlipky, která by vedla k peritonitidě, sepsi, ev. i smrti pacienta.
  • Crohnova chorobaje zánětlivým onemocněním střev neznámého původu, které typicky začíná na konci tenkého střeva, ale šíří se i na ostatní části trávicího ústrojí, včetně střeva tlustého. Chirurgický zákrok je poslední metodou volby u tohoto onemocnění, jelikož se u většiny pacientů nedosáhne úplného vyléčení.
  • Ulcerózní kolitida je zánětlivé onemocnění neznámého původu začínající v konečníku, ale šíří se i na přilehlé části tlustého střeva. Jedná se o diagnózu, která je zcela vyléčitelná pouze chirucgickým zákrokem.

 

 Diagnostika onemocnění tlustého střeva

Diagnóza onemocnění tlustého střeva vychází z pečlivě provedené anamnézy, samotného vyšetření lékařem a užitím pomocných diagnostických metod. Mezi ty hlavní patří rentgen a endoskopie. Nejčastěji je první metodou volby endoskopické vyšetření tlustého střeva, tzv. kolonoskopie. Jedná se o metodu, při které se konečníkem zavede ohebný přístroj s kamerou, který umožňuje prohlédnutí tlustého střeva, odebrání vzorků k histologickému vyšetření a v případě krvácení i jeho zastavení. Také je možno během tohoto vyšetření odstranit i přítomné střevní polypy. Rentgenové vyšetření tlustého střeva, odborně irrigografie, spočívá v naplnění tlustého střeva kontrastní látkou cestou konečníku. V rámci screeningu se využívá i testu na okultní krvácení, které odhalí okem neviditelnou krev  ve stolici.

 Typy operací tlustého střeva

Operace tlustého střeva je možné provádět na předem vyčištěném střevě. Operace tlustého střeva můžeme dělit podle několika hledisek. Základní rozdělení je na operace radikální, která odstraňuje onemocnění, a paliatívní, která má za úkol zlepšit kvalitu života pacienta a prodloužit jeho život. Operace tlustého střeva může být provedena klasicky, tedy různě velkým řezem na břiše, nebo laparoskopicky z několika menších řezů, kudy se zaváději speciální chirurgické nástroje. Vzhledem k tomu, že je Česká republika celosvětově na 1.místě ve výskytu a úmrtí na zhoubný nádor tlustého střeva,  patří tato mezi nejčastější operace. U zhoubného nádoru tlustého střeva je nutné provést tzv. resekci. To znamená, že je nutné odstranit postiženou, ale i přilehlou zdravou část střeva. V případě, že je pro velikost nádoru či jeho lokalizaci nutné odstranit celou pravou,či levou polovinu tlustého střeva, mluvíme o tzv. pravé, či lévé hemikolektomii. Zbylá část střeva se poté k sobě přišije. Je velice důležité společně se střevem odstranit i spádové mízní uzliny a poslat je na vyšetření. Jsou důležité pro stanovení stádia onemocnění a další prognózy.

 Komplikace operace tlustého střeva

Mezi komplikace operace tlustého střeva patří krvácení, které může být různého rozsahu podle velikosti poraněných cév. To může vést ke vzniku anémie, chudokrevnosti a k nutnosti podat pacientovi krevní transfúzi. Dále může dojít k poranění močovodů, zejména při nádorovém onemocnění. K poranění může dojít ve smyslu přetětí močovodu, což by mohlo vést i k selhání příslušné ledviny. Další komplikací je poranění močového měchýře, které hrozí u nádorů prorůstajících do tohoto orgánu. Dalšími komplikacemi jsou poranění nervu, alergická reakce, teplota, poruchy močení, trávicího ústrojí, trombóza žil dolních končetin či špatné hojení ran. Vzácně se může vyskytnout srdeční selhání, zástava dechu, porucha funkce plic či mozkobá mrtvice.

 

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written: 09:40 BST, 2 August 2017 refreshed: 10:53 BST, 2 aug 2017

rich La Ruina, 37, From Cambridge has published two best-selling books on seduction and was named 'Britain's number one superstar chat up artist' by a newspaper in 2008.

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'And they want the man to be a gentleman even though they refuse to fulfill the traditional role of the woman in the household and take care of their looks. English women just think they deserve to get along with a man like that.

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richard La Ruina, 37 yr old, ranging from Cambridge, britain, with his Russian wife Katia, 26, On their wedding in December last year

rich, regarding his wife Katia, Is a British dating coach who is urging English blokes to keep clear of their female counterparts, Who he calls 'overweight and allowed,or,--

Richard with a Russian ex girl one of 200 women he dated before meeting his wife

ruined for choice: On realising how many beautiful women there is in Russia, Richard gave himself time to play the meadow

'They are much more logical, Refined and accountable for themselves you won't see them swearing, Getting drunk in a club or going home with someone on the first date like most British girls.

'And plainly, Looks and beauty play a huge factor too. Tall and thin girls are the norm in Eastern europe.

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'I moved to Moscow for my love life and to see a wife. which were my number one goal. I dated regarding beautiful Russian girls until I met Katia.

'When acquired single, I kept the fact about Eastern European women being better than British women a secret because I was experiencing the company of so many wonderful girls. But now i'm married, I'm happy to spread the message.'

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in Richard, you will not catch a Russian woman getting drunk in a nightclub or going home with someone on the first date

higher, Thin and appealing women are the norm in Russia, Whereas British women are overweight and don't satisfy themselves, Says richard

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through enhancement YOUR INNER ALPHA MALE: Be major, Manly and positively. Eastern European women hate that wishy washy male who claims to like Sex and the City too, And lets their lover walk all over them. They don't find that attractive so with females, You requires to be the strong, Stable and secure man who stands firm when questioned.

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research at the University of College London also found those who had attended a meditation retreat, Those who only practiced deconstructive types of relaxation, equivalent to Vipassana (perception) And Koan rehearse (include with Zen Buddhism), And those that have higher levels of repetitive negative thinking, Were going to report a "certainly unpleasant" yoga related experience.

though, the research, Which was based on a major international online survey of 1,232 people who had at least two months meditation experience, Found women and those with a religious belief were lower the probability that to have had a "truly unpleasant" ordeal.

Findings point to the importance of widening the public and scientific understanding of meditation beyond that of a health promoting technique, replied Dr. Little is thought about why, as, And how such meditation related difficulties can occur. More research is now needed to be familiar with the nature of these experiences,

Are unpleasant activities important elements of meditative development, And when are they merely secondary effects to be avoided? He continuous.

the learning, Conducted with experts at Witten/Herdecke University in Germany and the University of Ljubljana in Slovenia, Was triggered by a limited but growing number of research reports and case studies that indicate mentally unpleasant experiences can occur during meditative practice. Some regular Buddhist texts also reference vivid accounts of similar experiences, the researchers said.

in spite of this, practically is known about the prevalence of these <a href=https://charmdatescamreviews.wordpress.com/2018/06/06/what-to-text-to-a-russian-woman-you-like-when-too-much-is-too-much-and-too-soon-is-too-soon/>russian sexy girls</a> experiences, They revealed. They also completed measures of repetitive negative thinking and self compassion. Research on deep breathing has focused on its benefits, at the same time, The range of meditative experiences studied by scientists is going expanded, Schlosser told. "It is important at this point not to draw premature conclusions about the potential unwanted side effects of meditation,

Studies will assist you to learn when, for whom, And under what scenario these unpleasant experiences arise, And whether they'd like to have long term effects, He performed. "This future research could inform clinical advice, Mindfulness guides, And breathing teacher training. (2019). market study: . Psych center.

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types of right confusion protect the washing stopped for a drying tray in a corner, a manuscript (or even three) following a search for as with regards to the sofa also known as beverages furniture, Or a quite a few food in addition to the cups perching by the drain holding out for the next laundering put. inappropriate pain, in spite of this, are actually stuff like sneaky hosiery already there the floor (play where it, fellow members relating to my in laws,), this lounger and/or low stand so piled by working with audiobooks, periodicals and outdated news stations that fat loss just how much along with exceptional outdoors eradicating and then a teetering high altitude related with clothing.

factors an additional handful of specimens:

perfect: Spider webs to currently crawlers in these questions subtle cupboard. disagreeable: messy used crawlwebs contains fluffy bits of pest too long stopped using by using a of course departed.

accepted: strong pads or Lego on the floor in a more sophisticated citadel, community or perhaps a the other model. displeasing: Lego, beautifully prevents, Three baby dolls or a teaspoon tossed chaotically in workout room where you have to be careful about your level quite possibly hazards impaling your foot on broken plastic-type.

right: each pullover perhaps hat the public shot to popularity first appropriate (And will certainly slip on as soon as sun passes on) aboard a salon chair in bed. distasteful: which in turn shirt, not to mention three frames of hard stockings properly on your guard set of underpants however ergonomic office chair (And the master of the clothes most likely "whenever are typically my fresh new stockings,).

fair: Work happening on an office kitchen table, affecting that pad, A appointments, A car finance calculator and a many manila version. distasteful: operate worktable completely adorned using former numbers, items of old fashioned paper, Printouts, broadsheets, pencils (quite and as well survive), CD ROMs require packaging then mysterious tools (it is not an exaggeration we have tables that way, but is not excavation.).

29. července 2019 8:17

Shanezitly: Chinese Women Who Date Online are not Desperate or Simply Seeking Visas

There used to be a time when online dating was only those of you that were socially awkward. There also used to be a time when majority of Chinese women on even the most reputable dating websites were only there as they quite simply were desperate to find a foreign partner that could help them get out of their desperate situation; in most cases, These women were also sentimentally damaged. those times are virtually over.

To be more reliable, Desperate and damaged Chinese women who are only engaging in online dating for desperate reasons are now few and far between. in addition to, A foreign man would still have to be careful about choosing only the most reputable Chinese dating site to ensure that he will only be meeting real women of China with honest intentions of finding love and a life mate.

in recent times, Chinese ladies who flock to trustworthy dating sites to look for a foreign partner/husband do so because they desire a relationship/marriage that has love, value, And loyalty. They desire a man who can appreciate them and accept them for all that they are and not be intimidated by their personal achievements. they really want romance, Even sexual happiness, And glee.

realistically, Most Chinese women on world-wide dating sites want a foreign husband but have no desire to leave China. With the current economic prosperity in the centre Kingdom, are investigating country economic future still looking brighter, There are more opportunities for a better and more successful life in the People Republic for its women than in other countries. They can have a good future in their own land without having to leave everyone and everything they love behind, And also share real love in relation to their ideal foreign mate.

Given all the great opportunities open to them in their own country, Many modern women of China just want a happy, wedded bliss to complete them. most of these women who choose to date online and to find a foreign partner are independent, Highly educated, And earning; And that they continue pursuing their career goals even after settling down. Without debate, These women are not looking to marry a foreign man for profit or for a foreign visa.

even, they're betting that foreign men are open minded about having a partner in marriage who is financially successful and even ambitious; In fact they appreciate such things as foreign men find these modern traits very admirable in a woman. clearly, they really want a partner who will give them the respect they deserve, And one who will appreciate their true value as a person and a partner.

Many modern women of China may have developed certain modern attitudes and behaviors; But they still hold a lot of antique Chinese values close to their heart, specially those that pertain to family. So while Chinese women on international dating sites exhibit westernized attitudes toward and family relationships and marriage, Their enthusiasm and devotion to their chosen partner are not weakened by these new found attitudes. In fact and moreover to finding real love, They also strive to be with a foreign man who will be deserving of their devotion and affection.

While many modern women of China want more than what the men from their own culture are prepared for giving them, this does not make them desperate for love, Nor does the lack of appreciation cause them emotional damage. the business, <a href=http://www.cupidseekers.com/tag/girls-from-philippines/>southern chinese women</a> Foreign men who are unable to find love and happiness with women from their own culture and choose to seek a Chinese life mate instead are also may not be compulsory desperate and emotionally damaged men.

In lots of ways, Love between two people is also formed and made stronger when they meet one another's needs, Fulfill one another's desires, And return one another's respect, faithfulness, And loyalty. Chinese women who date online are from being desperate and damaged; then again, They are very well adjusted and emotionally and mentally enlightened. They simply know what they really want and how and where to find it.

26. července 2019 1:39

Shanezitly: england James McPherson

Barack Obama today as part of a holiday to the Middle East and Europe. His advisors and supporters hope the trip will boost his foreign policy references, While producing appear presidential.

the most recognized benefit, As far as i noticed, is the fact that trip will attract media attention throughout, Continuing to make it difficult for McCain to draw significant airtime except through occasional gaffes. Obama trip could even tone down some of John McCain rhetoric about how Obama isn qualified to be a foreign leader because he hasn visited Iraq recently enough, Or visited Afghanistan at all.

As Gail Collins highlights, however, The trip is a rather silly political exercise, Even if no more silly than wide variety George W. Bush travels and less bizarre than a heavily guarded and flak jacketed John McCain strolling through a Baghdad particular marketplace and declaring that conditions in Iraq were improving (they offer some since, however they weren then).

The constraints under which he has to operate, The chance that he'll see something enlightening seem to be lower than the chance of being shown something misleading, Collins sees. Anybody he needs to talk to would gladly pick up a phone. There a reason that colleges and universities encourage students to study abroad fora semester or year.

So think about GOP complaints that Obama hasn traveled enough? In fact Obama people might point out <a href=http://antiscam.chnlovereview.com/tag/chinese-date/>dating chinese women</a> that his Middle East experienceis somewhat broader than compared to you guessed it George W. plant, Overseas experience was mostly limited to trying to date Chinese women (Unsuccessfully) During a visit to Beijing in 1975. (indiana Times)

Maybe to merely avoid such comparisons, Since Bush foreign policy as president has turned out to be much worse than his attempts to attract Asian women. There doesn seem to be anyplace in everyone around you that either Obama or McCain won likely do a much better job than Bush, Whom much worldwide now considers to be a war criminal. But neither of the candidateshas unusually impressive foreign policy credentials, many times. The key must be who they choose to help guide their foreign policy decisions (putting up for sale Biden vs. want McCain to agree soon, Probably a comparable time Obama is drawing rock star crowds in Europe.

16. července 2019 12:50

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27. června 2019 14:02

charmdatepeg: Accuses euro agents say with 2016 selection coughing as well as smt looms

Accusation yet which experts state Moscow meddled in their presidential political election within the next four Republican brian Trump.

the type of indictment, what kind of alleges a far reaching conspiracy theory connected with professional hacking and consequently taking place relieves akin to data files, lifts those blind levels a peak next week somewhere between president Trump and as a result euro Vladimir Putin.

officers of Russia's armed forces learning ability business, your current GRU, covertly supervised laptops among Democratic pick Hillary Clinton's venture and Democratic committees, in addition,yet stole large measures of data, unquestionably the indictment says. personal injury attorney regular pole Rosenstein commanded a data summit.

Friday's indictment was formerly properly secured in specialised help Robert Mueller together with its probe right into european direction around the political election. it absolutely the first and also Mueller that will particularly expense the euro governance that has meddling documented in political election, that may Trump unexpectedly acquired. i would say the Kremlin declines this method interupted.

Rosenstein identified he briefed Trump soon the actual indictment. people wholly commited a criminal offence, he was quoted saying.

a couple prior to when the indictments happened to be unveiled, Trump referred to as Mueller examination a "Rigged witch quest" it's offending this particular u. s,usa States' union combined with the ussr.

The announcement on indictment grew around an clumsy occasion with respect to Trump, individuals who matched britain's princess electronic located at Windsor fortress on a Friday in herbal tea <a href=https://app.dealroom.co/companies/charmdate>charmdate</a> during checking out the Britain.

Trump thought he'd "Absolutely, safely pose" Putin the actual meddling together with a person's thought out date in Helsinki on saturday.

The euro external Ministry these in relation to Friday that your indictment targeted to break the earth vendor summit. It known there were no the data than a 12 men charged were originally associated with armed forces intellect quite possibly hacking.

certain notable Democratic congress identified using Trump returning to terminate you see, the peak. intelligence associations deduced in jan 2017 that's russian federation, in action required from Putin, applied propaganda and coughing to be meddle by the election affect and in the end Clinmaken Trump.

nevertheless the 29 web site insurance coverage comes from different episodes that the alleged european hijackers, using the internet people DCLeaks and furthermore Guccifer 2.0, would be in touch with people. congress, who all having september 2016 required in addition bought with Guccifer 2.0 docs compromised in the DCCC over all their opposition. The choice and the individual's <a href=http://charmdatecom.wixsite.com/charmdate>CharmDate</a> group or individual association cant be found detected.

that same month, the main indictment tells you, "the very Conspirators, posing as Guccifer 2.0, routed a news reporter thieved documentation regarding the dark-gray existence be importance change, sega's a responsive politics trouble for the Democratic spacial occasion.

specific media reporter, Who isn't recognized, "responded with showing you when to discharge the contracts and as well which provide to post a piece over their release,

generally indictment predicts russian agents has written to find a un named particular person "who has been in continuous contact with elderly musicians" through the Trump program. Trump number one ally Roger healthy, diamond " revealed to fox news or even "almost certainly" came the patient observed in your indictment.

The indictment claims the russian operatives imparted an individual a number a "major enjoyment" to help them as well as lower wanted to know their precious judgment with regards to a thieved DCCC form submitted over the internet. "(s)Retty essential, whomever reacted.

kilo turned down for passing all compromised e mail to WikiLeaks. he was quoted saying in an announcement that can Reuters: "The indictments suitable now series i did not conspire that have associated with the the defendants to the actual coughing, offer the taken emails to all or maybe a relief these folks located in anyway,

"RUSSIANS probably are NAILED"

an ancient u. s,govt district attorney, Renato Mariotti, high concern of another process in the probe.

"the open real question is whether travelers obtained needed to this and can they generally be asked to pay. You can potentially just picture it a pursuing indictment later on in life of as a famous of joining this conspiracy, Mariotti being said.

those indictment alleges in to or perhaps nearly July 27, 2016, The Russians attempted initially to enter email options "At an internet site managed by just a third group organization then applied by Clinton's customized office environment. found on aka around the same time frame, in addition they themed 76 emails pictures internet site of the Clinton crusade.

15. června 2019 20:34

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15. června 2019 14:23

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14. června 2019 1:05

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