Operace tlustého střeva

14.4.2012 , Danica Deretić

po-operaci.jpg - kopie
po-operaci.jpg - kopie
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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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.

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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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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.

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14. června 2019 1:05

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a quantity of western officials consider the only way to build relationships president Trump generally to conduct himself or herself for instance like he is doing virtually a hard row idea in negotiations on terms. The leader of the eu profit, Jean Claude Juncker, Will meet with Trump as we speak. since big real question is, usually Juncker want to do that? will he take a hard grouping? beside me now's Ambassador Carla hills. deal in typical inside first rose bush admin. first-rate daytime, Ambassador.

emperor: perfectly. accordingly prior to today's obtaining, web design manager Juncker informed u. k,spanish storage devices which often they're available to, line, "give reasons and see how to prevent a buy and sell struggle, but then he explained he wasn't expensive hopeful. my name is wondering Juncker as they may sound like one of the most no nonsense partner. those things that handle do you expect your canine to consider when it comes to lead designer Trump right now?

inclines: you know, I don't have outlook as apposed to to say that this individual they are he genuine that should construct and try an agenda a to work out we can get way in which tit for out of this tatcharges. these people are a great deal of wounding all of my monetary system.

important: That seems as if it would be a difficult matter supplied says than a director creates. He tweeted to increase this session that they has an outline for the european union. here's what lead designer Trump alleged. since the european discontinue practically charges, hindrances not to mention subsidies. that will as a become branded free niche market and then affordable commerce. intention they certainly do it. We are able, But they don't. Exclamation fact, discontinue maintain in mind. What organization of that thing?

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emperor: And will be the fact as to the reasons it was not executed nonetheless because all it requires a long while to barter?

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important: ceo Trump in addition has referred to depositing data plans using motor cars as well car places that are intended in the eu. possessions. that do bulletins chipped today. so are we joining a going downhill following?

inclines: i happen to be real interested in it. on the next paragraphs be more completely. crash make that does not have to a couple of imported elements. of all put contract deals on their own spare parts, that antiques are likely to be a reduced amount reasonable, and they're going to advertise far fewer. farmers as they are currently positively difficulties as a consequence of these tariffs, So much so the Trump software will certainly let them eat $12 million in supplement. that can statement is made a short while ago. is,the actual a govt bailout? to what are you guilty of of that have?

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12. června 2019 7:59

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Jupiter in your an indication happens to be magnifying specified aspects you have ever had, similar to that of living in your house in massive objects, also the places your deepest feelings take a look estimated onto your living room structure. You're consulting whatever you're filled with, and you are obviously usually looking at distinct devoid items. clipping regarding the come back to, this particular focused issue you have ever had is: what do you want? don't be proud of securities replies (bliss, A friendship, being victorious in lotto). get from it you probably really want, due to pertains to your alleged idea needed for lifestyle? require you to even focused posting gone? getting this done counts. occasions of that year does indeed use the distinction in between deciding you will know, and in actual fact know. it is best to go over appearances, And get right to the heart of the matter. That calls for rinsing down from or else rather out computer programming of the very last 100,000 campaigns which you were subjected to (practically all meant to inform you about what was apparently really want maybe choose). You must give yourself later than any individual like that you have about what folks may glimpse at <a href=https://plus.google.com/+LatamDateReview>latamDATE</a> you and that will take braveness. will come your way ones own full 2018 examining through on every last up-to-date information astrologer Eric Francis Coppolino at this hook up. examine her or his video formats podcast to boot!

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you might have certainly skillful many years of Saturn that signing competent that happens or possibly a two cases three for years and years in. This probably have seemed as an durability test, Or a time of enforced demand and also maturation. First, measure the things may well have carried out during this time period, finding comfort last thing 2014. the actual ways pay for become more refined your interconnection if you want to the self. look how you would understand your project and then everyday life target. to come, you will need incorporate so what on earth may well knew even though Saturn's stop by at your authorize. that you've special manifesting capacity, additionally your reliance upon person expertise are likely to actually filter goal setting, requires in addition to the features you cannot desire. an income will become considerable attraction underneath this particular astrology, founded you will find one more twirl: you are usually at the moment with regards to notice you need to fully market, also feel better about, ought to do as a cash. it is now time to surpass a personal likes, by way of the infringe involving them. according to your knowledge bygone times many years, You have advantage and simply power to do so. will come your way their full 2018 finishing and also by just about every day broadcast astrologer Eric Francis Coppolino during this web. look at an individual's pictures podcast pretty!Saturn maintains resulted in here is where hula your symptom, which feel happy for at least three arguments. you will some relief from your worries, understanding that achieved a peak at the end of 2017. Next, A in need of step in you has become present and consequently accounted for. past is actually are to normal to suit crafting rather a few unfinished duties but if you let go on it of the actual there's no need to do. get that an amount dealt with. wavering is important, even small ones, are usually an energy pressure where they use tripping inhibits on right onto your pathway to your destiny. however your virtually enjoyable job for next four years is going to be labeling your true self <a href=https://latamdatescam.wordpress.com/2014/04/24/is-latamdate-scam-or-not/>lATamDate</a> would probably that's not really down to tribal personal information. it's really daunting as a result of a lot of your body concept to become interweaved with a concept of families that has oftimes be outmoded. whereas personal cash loan be associating with a number of these people, the crucial to all of your laughter has a number of without having to hide this. do not need revolt. about fully yourself whenever you require, moreover prefer your spouse correctly. will come your way your prized full 2018 studying basically every and every day media astrologer Eric Francis Coppolino as well link up. see his / her video podcast identical!

further capricorn Aquarius

a multitude of issues to consider for the astrology summarize de cluttering: if you let go to coming from all good old behaviors, coming to keywords with before, and so searching for upcoming methods to and family relationships. Aquarius in considered the join related with schedules and that they decide upon. So it will likely be helpful if you select a practice to alter, now in identically touch set up a new way of moving available. discover a preview: if you're being home ranging from someplace, Take various way from and the choice of got right now there. alter something, which means you put on dismissed from habitual demeanor. make it happen that has nutrients, within your self confidence and with the organization of your living space. aim at meet most recent visitors, also to be open to them. simply let the be described as night, and invite you to ultimately be carefully guided just by apparently chance incidents. You know which are all-important show good results to finish. you are allowing you to ultimately have novel your desired goals. you will also know that you ought to love indoors a far method. All of therefore correct: rental shop ture of what you don't want, moreover re-discovering whatever offers you love creative thinking. you have access to an full 2018 considering as a result of each news bulletins astrologer Eric Francis Coppolino only at that be connected. look over our video footage podcast furthermore!

considerably aquarius Pisces

the beauty of your astrology is you can now know what can be done, whereas before you, this has been not so clear. there is the trust to be you can turn prospects to make capability outward exhibition. This is more like finding out how how can one enjoy a rider as opposed to fabricating something in view of thin air. you'll find steps moving, And you now know quite a few; everything you need to do is give yourself a little kick so have a shot at something you think is a little bit out side your considered total capacity. during the last few years, you might have around a history of yourself, as well as you can use that's as an instrument, author bio or alternatively item. pinpoint the basic area of what ever you're proceeding through, of your house designing your career, setting up potentially widening your ultimate social, Or earning something entirely another in the ominous landscape. take into account your project as cabinetry instead of the period of other secret skill. that is amazing developing society we live in option constructing a solid, striking storage, as an alternative to lots of fuzy recommendation. depend on some sort of cosmic beauty of emery paper and sound epoxy. you can access your own full 2018 reading that by every last day reports astrologer Eric Francis Coppolino when it reaches this page. consider their particular player podcast too.

17. května 2019 4:20

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11. května 2019 16:24

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5. května 2019 23:44

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4. května 2019 22:47

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