nacionaluri rekomendaciebibavsvtaqirurgiasi.doc

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nacionaluri rekomendaciebi bavSvTa

qirurgiaSi

Tbilisi

2006

1



pilorostenozi

pilorostenozi kuWis piloruli nawilis cirkularuli kunTebis hipertrofaa, rac

ganapirobebs nawilobriv an srul gauvalobas ar!even kompensirebuli,subkompensirebul da dekompensirebul "ormebs daavadebis mani"estacia

iw#eba dabadebidan 2$% kviris Semdeg

daavadebis si&Sire '()000 va*ebSi %$+er u"ro &Siria vidre gogonebSi

Sesaloa daavadebis gadacema memkvidreobiT prognozi keTilsaimedoa

mniSvnelovani roli eniWeba pilorusis nervuli elementebis umwi"robasa damasSi degeneraciuli cvlilebebis ganviTarebas savaraudoa kvebis gavlena

-ase, magaliTad u"ro &Siria uuTi kvebis SemT&vevaSi, rac ai&sneba dedis

an !vilis gastrinis momatebiT, an gastrin$sekretinis Tana"ardobis dar.veviT/

intranataluri "aqtorebidan a.saniSnavia dedis mier gadatanili stresi

● iriTadi simptomebi( Sadrevaniseburi1 .ebineba, na.vlis pigmentebis

Semcvelbis gareSe, wonaSi swra"ad kleba, oliguria, silis saaTis1simptomi, mSieri3 gauvaloba

● daavadebis garTulebebi( dehidratacia, eleqtrolituri disbalansi

-hipokalemia/, hipoqloremia, metaboluri alkalozi

● diagnostikuri kriteriumebi( anamnezuri, klinkuri monacemebi,

paraklinikuri kvlevebi -muclis .rus ultrabgera, kuW$nawlavis traqtis

kontrastuli rentgenografa, ultrasonografa, gastroskopia/● di"erencialuri diagnzis !amonaTvali( pilorospazmi, gastro$ezo"agaluri

re4uqsi -&alazia/, kuWis pirveladi atonia, cns$is dazianeba, kistozuri

gaoreba, pankreasis eqtopia

● anamnezis Sekreba -Sadrevaniseburi1 .ebineba, na.vlis pigmentebis

Semcvelobis gareSe, wonaSi kleba, daavadebis daw#eba 2$% kviris

asakidan/

2



● muclis .rus inspeqcia( silis saaTis1 simptomi, kuWis &iluli peristaltika,

pilorusis gadideba, gamomWrali da danaoWebuli kani

● fbrogastroskopia

● kuW$nawlavis rentgenokontrastuli seriuli gamokvleva

● muclis .rus ultrabgeriTi gamokvleva

winasaoperacio mkurnaloba $ winasaoperacio momzadebis zogadi principebis

protokolis Sesabamisad(

● unda Sew#des enteraluri kveba

● saWiroa nazo$gastraluri zondis !adgma da kuwis SigTavsis evakuacia

● metaboluri dar.vevebis koreqcia

● mime dehidrataciis SemT&vevaSi 5$inai albuminis an plazmis in"uzia)0$20 ml7kg )5$20 wuTis ganmavlobaSi

● sabazo &snaris in"uzia )50ml7kg7d.eSi kaliumis gareSe pirveli Sardis

mi.ebis Semdeg &snars emateba kaliumi sad.e.amiso moT&ovnilebis

Sesabamisad

operacia( piloromiotomia -"rede$ramStetis meTodiT/

operaciis Semdgomi mkurnaloba 8 postoperaciuli marTvis protokolis

Sesabamisad(● sabazo &snaris in"uzia pirveli postoperaciuli d.is ganmavlobaSi )50

ml7kg7d., Semdgom 8 in"uzuri Terapiis protokolis Sesabamisad9

● operaciidan 6 sT$is Semdeg garTulebebis ararsebobis SemT&vevaSi

Sesalebelia nazo$gastraluri zondis amo.eba9

● gaurTulebeli operaciis SemT&vevaSi avadm#ofs kveba iw#eba

operaciidan 6 saaTis Semdeg, pilorusis lorwovanis dazianebis

SemT&vevaSi 8 %: saaTis Semdeg● kveba warmoebs protokoliT gaTvaliswinebuli sqemiT

3



Wiplaris Tiaqari da gastoSizisi

Wiplaris Tiaqari -embrionaluri Tiaqari, om"alocele/ aris Wiplaris "uesTan

arsebuli de"eqtidan Sinagani organoebis dislokacia Tiaqris parkiwarmodgenilia amnionuri garsiT Tiaqris parkSi Sesaloa muclis .rus

nebismieri organos arseboba ganas&vaveben mcire zomis -5 sm$mde

diametris/, saSualo zomis -5$)0 sm diametris/, ganieri -)0 sm$ze meti

diametris/ Tiaqrebs

gastroSizisis dros muclis wina kedlis de"eqti -diametri 2$% sm/ mdebareobs

normaluri Wiplaris mar+vniv, Tiaqris parki ar gaa!nia u&Siresad

eventerirebulia Sua nawlavi an kuWi

daavadebis si&Sire ) ( %000 a&alSobilze paTologia &Sirad ganpirobebulia

qromosomuli anomaliebiT -trisomia )', ): da 2)/ warmoadgens ;<=

-e&omphalos 8 macroglossia $ gigantism/ sindromis erT$erT komponents

om"aloceles ukavSireben amnionis peritoneumis lateraluri mezodermuli

!anacvlebis dar.vevas

Wiplaris Tiqrisa da gastroSizisis diagnostika &deba muclis wina kedlis

inspeqciis sa"uvelze Wiplaris Tiaqris -gaurTulebel/ SemT&vevaSi arsebobs

Tiaqris parki, amnionuri garsi da Tiaqris SigTavsi nawlavis mar#u*ebis sa&iT,

romlebic gamodian Wipis rgolidan gastroSizisis dros Tiaqris parki ar

arsebobs, muclis de"eqti mdebareobs Wipis rgolidan mar+vniv, misgan

moSorebiT

● diagnostikuri kriteriumebi( diagnozis dasma &deba muclis wina kedlis

inspeqciis sa"uvelze

● di"erencialuri diagnozi( om"alocelesa da gastroSizisis di"erencireba

da"unebulia Tiaqris parkis arsebobaze, mis lokalizaciaze Tu Tiaqris

parki arsebobs da is gamodis Wipis rgolidan saqme gvaqvs Wiplaris

TiaqarTan Tu muclis wina kedlis de"eqti mdebareobs Wipis rgolidan

4



mar+vniv, muclis .rus eventerirebuli organoebi ar aris da"aruli Tiaqris

parkiT saqme gvaqvs gastroSizisTan

diagnozis dasma &deba muclis wina kedlis inspeqciis sa"uvelze

winasaoperacio momzadeba(

● avadm#ofs mkurnaloba iw#eba winasaoperacio momzadebis zogadi

principebis protokolis Sesabamisad9

● de"eqti unda dai"aros %0>>! temperaturis fziologiur &snarSi

dasvelebuli steriluri sa"enebiT9

● pacienti unda moTavsdes gverdze, raTa Semcirdes wnevis

zemoqmedeba nawlavebze9● kuW$nawlavis traqtis dekompresiis mizniT &deba kuWSi nazo$gastraluri

zondis !adgma da misi SigTavsis evakuacia9

● saWiroa sa"enebis gamocvla da nawlavTa kedelSi sis&lis mimoqcevis

&Siri vizualuri kontroli9

● um+obesia eventerirebuli nawlavebis an de"eqtis moTavseba sterilur

parkSi9

●

siT&is paTologiuri danakargebis arsebobisas saWiroebis dros misimoculobis Semavseblebis -ringeris &snari, fziologiuri &snari, plazma,

5$iani albumini/ nakaduri Se#vana9

operacia(

● mcire da saSualo zomis Wiplaris Tiaqrisas na!venebia radikaluri

operacia 8 TiaqarkveTa, Sinagani organoebis !abruneba muclis .ruSi

da muclis wina kedlis plastika

●

didi zomis Tiaqris pirobebSi mowodebulia grosis operacia konservatiulimkurnaloba na!venebia Tiaqris parkis infcirebisas -gamu&eba iodis

)$inai &snariT/

operaciis Semdgomi mkurnaloba(

1. avadm#ofs mkurnaloba greldeba postoperaciuli marTvis protokolis

Sesabamisad9

2. siT&is paTologiuri danakargebi ivseba plazmis moculobis

Semavseblebis nakaduri Se#vaniT9

5



3. mizanSewonilia fltvebis ga&angrlivebuli &elovnuri ventilacia,

gansakuTrebiT de"eqtis erTmomentiani qirurgiuli da&urvis dros9

4. avadm#ofs kveba iw#eba peristaltikis mudmivi da m#ari a.dgenis,

ukuperistaltikis Sew#vetis da ganavlovani masebis gamo#ofs Semdeg9

5. kveba iw#eba )() ganzavebuli doziT 2 ml7kg erT mi.ebaze da misiSemdgomi mateba &orcieldeba sakvebis aTvisebis Sesabamisad -i&

enteraluri kvebis protokoli/

6



TiaqrebisaTvis dama&asiaTebelia dauzustebeli lokalizaciis muclis qronikuli

tkivili da .ebineba

daavadebis garTulebebi( nawlavis nekrozi -Semogre&isas/, Soki, se"sisi

● diagnostikuri kriteriumebi( klinikuri niSnebi da kuW$nawlavis traqtisseriuli rentgenokontrastuli gamokvlevebis monacemebi

● di"erencialuri diagnozi( tardeba malrotaciis "ormebsa da nawlavTa

gauvalobis s&vadas&va sa&eebs Soris -atrezia, mekoniuri ileusi da

s&va/

gulmkerdis da muclis .rus mimo&ilviTi rentgenograma or proeqciaSi

a.niSnul rentgenogramaze vlindeba ori buStis1 klasikuri niSanimalrotaciisaTvis agreTve dama&asiaTebelia spiralurad da&veuli,

daufqsirebeli Tormetgo+a nawlavi, romelic mdebareobs muclis Sua &azidan

marc&niv cekumis adgilsam#o"elis dasadgenad tardeba kuW$nawlavis traqtis

kontrastuli seriuli rentgenografa


●

avadm#ofs mkurnaloba iw#eba winasaoperacio momzadebis zogadiprincipebis protokolis Sesabamisad9

● saWiroa kvebisa da siT&eebis mi.ebis Sew#veta9

● unda !aidgas nazo$gastraluri zondi da amoiqa!os kuWis SigTavsi kuW$

nawlavis traqtis dekompresiis mizniT9

● auculebelia peritoneumis .ruSi siT&is paTologiuri danakargis Sevseba

in"uzuri Terapiis protokolis Sesabamisad9

operaciuli mkurnaloba( ledis operacia, romelic gulis&mobs strangulaciiskupirebas, Tormetgo+a nawlavis obstruqciis gamomwvevi peritonealuri

Wimebis gaTiSvas, wvrili nawlavis pozicionirebas muclis .rus mar+vena

na&evarSi da apendeqtomias


● avadm#ofs mkurnaloba greldeba postoperaciuli marTvis protokolis

Sesabamisad9

● saWiroa antacidebisa da B2 blokatorebis daniSvna -mg zantaki

2mg7kg7d./ kvebis daw#ebamde(

8



● siT&is paTologiuri danakargebis arsebobisas unda gan&orcildes plazmis

moculobis Semavseblebis nakaduri Se#vana(

● saWiroa muclis garSemowerilobis gazomva #ovel 2$% sT$Si erT&el(

● enteraluri kvebis daw#eba mizanSewonila m&olod nawlavis "unqciis

sruli a.dgenis Semdeg )() ganzavebuli sakvebiT C doziT 2mlD7kg erTmi.ebaze(

9



sazardulis !aWedili Tiaqari

sazardulis Tiaqari bavSvebSi warmoadgens ganviTarebis manks, romelic

ganpirobebulia peritoneumis budobrivi mor!is Seu&orceblobiT Tiaqrisu&Siresi garTulebaa misi !aWedva, gansakuTrebiT erT wlamde asakSi

Eprognozi keTilsaimedoa

sazardulis !aWedili Tiaqris SemT&vevaTa si&Sire bavSvebSi Seadgens )$5$

s

adreuli asakis bavSvebSi sazardulis ar&i moklea da ganieri, gars akravsarasakmarisad ganviTarebuli elastiuri kunTebi muclis wina kedlis kunTebis

daWimva &angrlivi tirilis, &velis, WinTvis, kuWis aSlilobis dros iwvevs muclis

.rus Sida wnevis momatebas da organoTa !amosvlas sazardulis ar&Si

kunTTa spazmi &els uSlis maT muclis .ruSi dabrunebas

● klinikurad a.iniSneba tirili, mousvenroba, .ebineba, mogvianebiT

nawlavTa gauvalobis suraTi sazardulis ar&Si palpaciiT isin+eba mkvrivisimsivnuri warmonaqmni

● Tiaqris !aWedvis garTulebebia nawlavTa mwvave gauvalobis

!amo#alibeba, !aWedili nawlavis gangrenozuli cvlilebebi

● diagnostikuri kriteriumebi( diagnostika e"uneba anamnezur

monacemebs, Tiaqris !aWedvisaTvis dama&asiaTebel zogad klinikur

niSnebs da lokaluri gasin+viT mi.ebul monacemebs● di"erencialuri diagnozi( tardeba sazardulis ar&is lim"adenitTan, saTesle

bagirakis cistasTan da saTesle +irkvlis Semogre&asTan

● daavadebulis simimis &aris&i damokidebulia Tiaqris !aWedvis

vadebTan, daavadebis dasaw#isSi zogadi mdgomareoba

damakma#oflebelia !aWedvidan )2 saaTis Semdeg mdgomareoba

mkveTrad uaresdeba gamo&atulia zogadi intoqsikacia, eqsikozi,

nawlavTa mwvave gauvalobis suraTi

10



!vilis gamokvlevisas saWiroa misi moTavseba trendelenburgis poziciaSi

tardeba Semdegi .onisiebebi(

● avadm#o"s utardeba sedacia mizanSewonilia qloralhidratis o#nis

gamo#eneba9

● mizanSewonilia Tbili abazana )0$)5 wT$is ganmavlobaSi an sazardulisareSi saTburis dadeba9

● gamwmendi o#na9

● Tu Seulebeli &deba Tiaqaris !asworeba, operacia unda gakeTdes

saswra"o wesiT9

6 Tvemde asakis bavSvebSi Tiaqris qirurgiuli mkurnalobis !venebebia(

● konservatiuli mkurnalobis daw#ebidan erTi saaTis ganmavlobaSi ver&er&deba !aWedili Tiaqris !asworeba9

● Tu !aWedvidan gasulia )2 saaTze meti9

● !aWedvis &angrlivoba ucnobia9

● !aWedili Tiaqris areSi ganviTarda anTebadi cvlilebebi9

● Tu sazardulis !aWedil Tiaqars Tan a&lavs .ebineba da muclis Seberva,

an gamo&atulia peritonitis romelime klinikuri niSani9

mowodebulia sazardulis Tiaqris operaciuli mkurnalobis sami iriTadi meTodi(

Tu Tiaqari SedarebiT mcire zomisaa da !aWedvidan gasulia mcire dro $

Tiaqris prakis gadakvanva da amokveTa de"eqtis anatomiuri da&urviT(

Tu Tiaqris "ormirebidan gasulia didi dro, igi periodulad iWedeboda,

magram &er&deboda !asworeba 8 Tiaqris parkis ma.ali ligireba da sazardulis

ar&is plikacia( umcrosi asakis bavSvebSi didi zomis Tiaqrebis SemT&vevaSi 8

Tiaqris parkis ma.ali ligireba da Tiaqris ar&is plastika

sazardulis !aWedili Tiaqris operaciisSemdgomi mkurnaloba warmoebs

avadm#ofs postoperaciuli marTvis protokolis Sesabamisad

w#lulovan$nekrozuli enterokoliti

11



w#lulovan$nekrozuli enterokoliti warmoadgens a&alSobilebsa da !vilebSi

meoradi peritonitis ganviTarebis u&Sires mizezs igi upiratesad gv&vdeba

d.enaklul a&alSobilebSi, agreTve garTulebuli mSobiarobis, na#ofs &angrlivi

asfqsiisa da cns$is samSobiaro travmis dros

w#lulovan$nekrozuli enterokoliti gv&vdeba #oveli )000 coc&ladSobil

a&alSobilidan )$' SemT&vevaSi

daavadeba polietiologiuria ganviTarebis mniSvnelovani "aqtoria in"eqcia

garkveuli mniSvneloba eniWeba d.enaklulobis "onze enteralur kvebas

daavadeba iw#eba sis&ldeniT kuW$nawlavis traqtidan, muclis SeteviTi tkiviliT, T&ieri ganavlovani masiT ga&Sirebuli nawlavTa moqmedebiT

daavadebis nawlavis per"oraciiT garTulebisas sunTqvisa da gul$sis&lar.vTa

mwvave ukmarisobis "onze viTardeba nawlavTa gauvalobisa da peritonitis

suraTi

● diagnostikuri kriteriumebi( daavadebis diagnostika em#areba klinikur,

rentgenologiur da laboratoriul monacemebs a.iniSneba leikocitozi"ormulis marc&niv gada&riT, hipoqloremia, hipokalemia, metaboluri

acidozi nawlavis per"oraciisas vertikalur poziciaSi gada.ebul muclis

mimo&ilviT rentgenogramaze vlindeba Tavisu"ali haeri dia"ragmis qveS

● di"erencialuri diagnozi( tardeba nawlavis Tanda#olil gauvalobasTan,

nawlavis parezTan

● daavadebis simimis &aris&i damokidebulia per"oraciis, peritonitis

arsebobaze

tardeba gulmkerdisa da muclis rentgenografuli gamokvleva pirdapir da

gverdiT proeqciaSi diagnozis dazustebis mizniT, sis&lis saerTo da bioqimiuri

analizebis gan&orcieleba

per"oraciamdel etapze mkurnaloba konservatiulia igi iw#eba winasaoperacio

momzadebis zogadi principebis protokolis Sesabamisad tardeba Semdegi

.onisiebebi(

12



● nazo$gastraluri zondis !adgma da kuWis SigTavsis amoqa!va kuW$


● w#deba enteraluri kveba da siT&eebis miwodeba9

● in"uzuri Terapia,

● antibiotikoTerapia,● simptomuri Terapia

per"oraciis etapze mkurnaloba operaciulia qirurgiuli !areva &orcieldeba

m&olod avadm#ofs mdgomareobis stabilizaciis Semdeg operaciis masStabi

damokidebulia per"oraciuli &vrelis zomaze Tu de"eqtis diametri ar

a.emateba 0,5 sm$s &deba misi gakerva orsarTuliani nakeriT Tu per"oraciuli

&vreli didi zomisaa da nawlavis kedlebi infltrirebulia, na!venebia nawlavisrezeqcia da edeba enterostoma

operaciisSemdgom periodSi avadm#ofs mkurnaloba greldeba

postoperaciuli marTvis protokolis Sesabamisad(

● sruli parenteraluri kveba greldeba aranakleb ' kviris ganmavlobaSi9

● auculebelia peritoneumis .ruSi siT&is paTologiuri danakargis Sevseba

in"uzuri Terapiis protokolis Sesabamisad9● F vitaminis -ftonadioni/ ineqciebi kunTebSi )$2 mg7d.eSi enteraluri

kvebis daw#ebamde9

● #ovel 2$% sT$Si erT&el izomeba muclis garSemoweriloba9

● enteraluri kvebis daw#eba mizanSewonilia m&olod nawlavis "unqciis

sruli a.dgenis Semdeg, )() ganzavebuli sakvebiT doziT 2 ml7kg

erT+erad mi.ebaze9

mwvave apendiciti

Wianawlavis anTeba, anu apendiciti bavSvebSi #velaze metad gavrcelebuli

qirurgiuli daavadebaa daavadeba u"ro &Siria @$)% wlis asakSi SedarebiT

iSviaTia adreul asakSi prognozi keTilsaimedoa

#ovel )000 bavSvze modis apendicitis saSualod % SemT&veva

13



mwvave apendicitis dros adgili aqvs Wianawlavis kedlis anTebas, romlis

mizezic in"eqciaa misi gamomwvevi specifuri mikrobi ar arsebobs

d.eisaTvis damuSavebulia paTogenezis ori Teoriuli mimarTuleba( in"eqciuri

Teoria apendicits gani&ilavs, rogorc Wiadanamatis sakuTari baqteriuli 4oriTinvaziis Sedegs paTologiuri cvlilebebis a.mocenebis winapirobaa mikrobTa

virulentobis zrda, rac ganpirobebulia apendiqsSi nawlavis SigTavisis

SegubebiT, ganavlovani qvebis mo&vedriT, parazitebis invaziiT da aS

nervul$sis&lar.vovani Teoria gulis&mobs Wiadanamatis infcirebas misi

sis&lis mimoqcevisa da neirtrofkis moSlilobaTa "onze Wianawlavis iSemia

&deba nawlavis SigTavisis 4oridan mikrobebis SeWris da danamatSi

Semdgomi paTologiuri cvlilebebis a.mocenebis winapiroba

' wlis zemoT bavSvebSi apendicitis tipiuri niSnebia( tkivili mar+vena Teos

"osos areSi, iulebiTi mdebareoba, temperaturis aweva subvebrilitetamde,

pulsisa da s&eulis temperatures Tana"ardobis dar.veva, erTeuli pir.ebineba,

muclis wina kedlis kunTebis daWimuloba, leikocitozi -)0000 8 )5000mkl$Si/

"ormulis marc&niv gada&riT ' wlamde asakis bavSvebSi wam#vani klinikuri

niSnebia( avadm#ofs moduneba, Wirveuloba, ilis dar.veva, mraval+eradi.ebineba, c&eleba -':$'AG!$mde/, tkivili Wipis areSi, an lokalizaciis gareSe,

leikocitozi -)5000 8 20000 mkl$Si/

mwvave apendicitis garTulebebia( apendikularuli infltrate, periapendikuluri

abscesi, mwvave apendiciti per"oraciiT da di"uzuri peritoniti

● diagnostikuri kriteriumebi( daavadebis diagnostika &orcieldeba

anamnezis , klinikuri da laboratoriuli monacemebis sa"uvelze

●

di"erencialuri diagnozi( !vil bavSvebSi tardeba otitTan, invaginaciasTan,bavSvTaH in"eqciebTan, pnevmoniasTan mozrdili asakis bavSvebSi 8

kuW$nawlavis traqtis mwvave daavadebebTan, gogonebSi genitalur

paTologiasTan, urologiur daavadebebTan

● daavadebis simime ganpirobebulia garTulebebiT -mwvave

destruqciuli apendiciti per"oraciis gareSe da per"oraciiT/

14



grovdeba anamnezi, tardeba klinikuri, laboratoruli gamokvlevebi( sis&lis

saerTo analizi, hematokriti, +guf da rezusi, Sardis saerTo analizi, Saqris

gansaz.vra, .ebinebisa da diareis SemT&vevaSi eleqtrolitebis gansaz.vra

winasaoperacio momzadeba moicavs(● enteraluri kvebis Sew#vetas,

● nazo$gastraluri zondis !adgmas da kuWis SigTavsis evakuacias kuW$


● intravenurad sabazo sain"uzio &snarebis Se#vanas,

● antibiotikoTerapias in"eqciis marTvis protokolis Sesabamisad

mkurnaloba operaciulia 8 apendeqtomia

operaciisSemdgomi mkurnaloba(

● pacientis Tavsdeba na&evrad m+domare poziciaSi9

● tardeba sasicoc&lo parametrebis monitoringi9

● avadm#o"s ukeTdeba adeqvaturi analgezia da sedacia

● in"uzuri Terapia protokolis Sesabamisad9

●

antibiotikoTerapia &orcieldeba saWiroebis SemT&vevaSi9● avadm#o"s peroralurad siT&e eleva operaciidan )2 sT$is Semdeg

T&ieri sakvebis mi.eba Sesalebelia operaciis meore d.idan

● operaciidan 6 $ @ d.is Semdeg temperaturuli reaqciis ararsebobis

SemT&vevaSi Sesalebelia pacientis gawera saavadm#o"odan

ambulatoriul dakvirvebaze

15



mwvave osteomieliti

mwvave osteomieliti warmoadgens vlis tvinis anTebas, romlis drosac

procesi vrceldeba vlis #vela struqturul elementze 8 vlis tvinze, kompaqturqsovilze, periosteumze da &asiaTdeba osteolizisT da osteoporoziT viTardeba

panostiti, anTebiTi procesi gadadis vlis irgvlivmdebare rbil qsovilebze

klinikuri mimdinareobis mi&edviT ganas&vaveben sam "ormas(

● toqsiuri -adinamiuri/

● septikopiemiuri

● msubuqi -adgilobrivi/

mwvave osteomielitiT u&Siresad avaddebian saskolo asakis bavSvebi

biWebSi gv&vdeba or+er u"ro &Sirad vidre gogonebSi daavadebas a&asiaTebs

garkveuli sezonuroba #velaze &Sirad igi gv&vdeba za"&ulis da gaza"&ulis

periodSi

daavadebis iriTadi gamomwvevia staflokoki, zog+er streptokoki, nawlavis

!&iri paTogenezSi mniSvnelovania in"eqciis ganviTarebis "onze vlis tviniskvebis moSla da nekrozi daavadebis keraSi sis&lis mimoqcevis dar.vevis

mizezi Sesaloa i#os baqteriuli embolia, sis&lar.vTaH re4eqsuri spazmi,

Trombozi, rac iwvevs sis&lis nakadis Senelebas, mikrobis fqsacias da anTebis

ganviTarebas daavadebis &elSemw#obia travma, adgilobrivi gadacieba,

gadatanili in"eqciuri daavadebebi, sensibilizacia da s&va

toqsiuri "ormisaTvis dama&asiaTebelia swraf, elviseburi mimdinareoba,mkveTrad gamo&atuli intoqsikacia, temperatura %0$%)G!$mde, gonebis

dabindva, bodva, halucinaciebi, taqipnoe, taqikardia, pulsi susti, afseburi,

gulis tonebi mo#ruebuli9 sunTqva zerele, kani mkrTali, lokaluri cvlilebebi

umniSvneloa

septikopiemiuri "ormis dros avadm#ofs zogadi mdgomareoba mimea

daavadeba iw#eba zogadi sisustiT, heqtiuri temperaturuli reaqciiT -':$'AG!/

gamo&atulia mwvave intoqsikaciis niSnebi dazianebis keraSi lieri tkivilebai,

Sesieba, lokaluri temperaturis momateba, moraobis Sez.udva, kanis

16



hiperemia, paresTezia, 4uqtuacia a.niSnuli "ormisaTvis dama&asiaTebelia

metastazuri kerebis warmoSoba -u&Siresad fltvebSi/

● diagnostikuri kriteriumebi( daavadebis diagnostika &deba anamnezuri,

klinikuri, laboratoriuli da rentgenologiuri gamokvlevebis monacemebissa"uvelze i#eneben radio$izotopur, eqogenur skanirebas, kompiuterul

tomografas, osteomedulografas, valSida wnevis gazomvas

● di"erencialuri diagnozi( toqsiuri "ormis dros tardeba s&vadas&va

in"eqciur daavadebebTan, rogorebicaa meningiti, muclis tif, gripi da

s&va s&va SemT&vevaSi saWiroa di"erencireba mwvave revmatizmTan,

rbili qsovilebis 4egmonasTan, vlis simsivnesTan, tuberkulozTan,

travmasTan

anamnezur da klinikur monacemebTan erTad moicavs sis&lis saerTo analizs

agreTve(

● aucilebelia dazianebuli ubnisa da gulmkerdis rentgenologiuri

gamokvleva pirdapir da gverdiT proeqciebSi9

● saWiroebisas tardeba diagnostikuri osteopunqcia, osteoper"oracia da

izomeba valSida wneva9● kompiuteruli tomografa

winasaoperacio momzadeba moicavs Semdeg .onisiebebs(

● oqsigenoTerapiis mizanSewoniloba w#deba individualurad paTologiisa

da oqsigenaciis statusis gaTvaliswinebiT9

● gamo&atuli hipovolemiis dros saWiroa moculobis Semavseblebis

nakaduri Se#vana )0$20ml7kg$ze doziT9● antibiotikoTerapia tardeba osteomielitis gamomwvevi mikro4oris

specifkisa da antibiotikis osteotropulobis gaTvaliswinebiT ar!evis

preparatia linkomicini9

● diseminirebuli sis&lar.vSida Sededebis sindromis dros aucilebelia

heparinoTerapia a&ladga#inuli plazmis trans"uziis "onze

● mkurnalobis am etapidan mizanSewonilia eqstrakorporuli detoqsikaciis

meTodebis gamo#eneba -mag plazma"erezi/

17



operaciuli mkurnaloba iTavlis2winebs Semdeg iriTad midgomebs(

lulovani vlebis osteomielitisas(● osteoper"oracias, vlis .rus drenirebas da sanacias antiseptiuri

&snarebis, "agebis, ozonirebuli &snarisa da antibiotikebis gamo#enebiT9

● osteoper"oraciul &vrelebSi unda !aidgas polieTilenis drena*ebi9

● osteoper"oraciis dros gakveTil rbil qsovilebSi unda !aidos rezinis

sawretebi9

brt#eli vlebis osteomielitisas tardeba adgilobrivi qirurgiuli mkurnalobiT

gaTvaliswinebuli #vela .onisieba sakuTriv osteoper"oraciis garda9

operaciisSemdgomi mkurnaloba greldeba postoperaciuli marTvis protokolis

Sesabamisad

● saTanado antibiotikoTerapia9

● heparinoTerapia koagulogramis ma!veneblebis mi&edviT9

● desensibilizaciuri Terapia antihistaminuri preparatebis gamo#enebiT9

● eqstrakorporuli detoqsikaciis seansebi9

● gansakuTrebiT mime SemT&vevebSi Sesalebelia

imunomakoregirebeli Terapiis gamo#eneba9

● aucilebelia vlis .rusa da Wrilobis gamorec&va antiseptikuri &snarebiT9

● saWiroa s&va piemiuri kerebisa da garTulebebis drouli gamovlena da

Sesabamisi mkurnaloba

araper"orirebuli anusi

d.eisaTvis mi.ebulia klasifkacia, romelic iTvaliswinebs a&alSobilTa sqess

mowodebulia "ormebi va*ebSi, gogonebSi da Sereuli anomaliebi va*ebSi

anusis anomaliebia( kanis fstula, analuri stenozi, analuri membrana,

reqtoureTruli fstula, reqtovezikuluri fstula, anoreqtaluri agenezia fstulis

gareSe swori nawlavis atrezia gogonebSi( Sorisis fstula, vestibuluri fstula,

vaginaluri fstula, anoreqtaluri agenezia fstulis gareSe, persistirebuli kloaka

Sereuli anomaliebia( anoreqtaluri mankebi Serw#muli &er&emlis svetis

anomaliebTan

18



anusis atrezia gv&vdeba ) ( %000 a&alSobilze va*ebSi &Siria vidre gogonebSi

va*ebSi #velaze gavrcelebuli "ormaa anusis atrezia reqtoureTruli fstuliT, &olo

gogonebSi 8 reqtovestibuluri fstula

paTologiis ganviTareba dakavSirebulia kloakis gardaqmnis dar.vevebTan isukanaskneli warmoadgens .rus sadac Tavdapirvelad i&sneba ukana

nawlavis, saSarde da sasqeso gzebi mas aqvs brma parkis sa&e da da&urulia

kloakis apkiT embriogenezis meoT&e kviridan kloakis SigniT warmoiqmneba

"rontaluri ti&ari, romliTac igi i#o"a ventralur da dorsalur nawilebad merve

kviris bolos kloakis apkis gar.vevis Sedegad orive nawili i&sneba

Sesabamisad wina 8 Sardsasqeso da ukana 8 swori nawlavis -#iTa/ &vrelebiT

ganviTarebis a.niSnul periodSi na#o"ze raime teratogenuri "aqtoriszemoqmedebam Seileba gamoiwvios s&vadas&va sa&is mankebis

"ormireba

klinikuri simptomebi mraval"erovania, rac ganpirobebulia anomaliis

anatomiuri mraval"erovnebiT sruli atreziebis dros dabadebidan )0$)2 saaTis

Semdeg TandaTan "ormirdeba nawlavTa dabali gauvalobis suraTi avadm#o"s

a.eniSneba Wirveuloba, .ebineba Tavdapirvelad kuWis, Semdeg nawlavisSigTavsiT, muclis Seberva, eqsikozis suraTi

araper"orirebuli anusis drouli diagnostikisaTvis sakmarisia Sorisis inspeqcia

swori nawlavis izolirebuli atreziis SemT&vevaSi anusi normaluradaa

"ormirebuli, rac arTulebs diagnostikas aseT SemT&vevebSi dabadebidan )0$

)2 saaTis Semdeg "ormirdeba nawlavTa gauvalobis klinikuri suraTi atreziis

sima.lis gansaz.vra Sesalebelia ew bigis simptomiT1 a&alSobilistirilisas anusis saproeqcio areSi TiTis daWerisas Seigrnoba mekoniumis

mowola bigis1 sa&iT atreziebis fstuliani "ormebis dros klinika

damokidebulia fstulis lokalizaciaze gogonebSi iriTadi niSnebia dabadebis

pirvelive d.eebidan airebisa da mekoniumis gamo#o"a sasqeso napralidan

saSarde sistemaSi fstulis arsebobisas -iriTadad va*ebSi/ mekoniuemi da

airebi gamoi#o"a Sardsadenis gareTa &vrelidan

● a&alSobilis Sorisis inspeqcia

19



● muclis .rus invertograma

● muclis .rus ultrabgeriTi skanireba

● Sardis saerTo analizi

ma.ali da Sualeduri atreziebisas na!venebia oretapiani qirurgiuli !areva $kolostomia, &olo mogvianebiT radikaluri operacia dabali atreziis dros

mimarTaven anoplastikas kolostomiis gareSe

avadm#ofs mkurnaloba greldeba postoperaciuli marTvis protokolis

Sesabamisad(

● kolostomiis SemT&vevaSi kvebis daw#eba Sesalebelia peristaltikisa

da stomis "unqcionirebis daw#ebis Semdeg, ris gamoc intravenurad

gadasas&meli siT&eebis moculoba !veulebriv ar a.emateba )00ml7kg72% sT$Si9

● dabali atreziis gamo gan&orcielebuli operaciuli !arevis SemT&vevaSi

kvebis daw#eba !veulebriv Sesalebeli &deba meore d.idanve, rac

moiT&ovs intravenurad Se#vanili siT&eebis minimalur moculobas9

● radikaluri !areva ma.ali atreziis dros rekomendirebulia ' Tvidan )

wlamde asakSi9

●

operaciis Semdgom periodSi &Siria swori nawlavis bu*irebis aucileblobada saWiro &deba pacientze meTval#ureobis daweseba bu*ireba

!veulebriv iw#eba 2$' kviris Semdeg9

20



sa#lapavis atrezia

sa#lapavis atrezia ganviTarebis Tanda#olili mankia igi "ormirdeba

embriogenezis meoT&e kviraze gamoi#o"a sa#lapavis atreziis 6 tipi H tipisdros sa#lapavis orive nawili bolovdeba #rud I tpis SemT&vevaSi sa#lapavis

proqsimaluri nawili fstulis saSualebiT uerTdeba traqeas, distaluri #rud

bolovdeba ! tipis atreziis dros sa#lapavis proqsimaluri nawili bolovdeba

#rud, &olo distaluri uerTdeba traqeas an mTavar bronqs J tipis atreziebis

dros sa#lapavis rogorc proqsimaluri, ise distaluri boloebi uerTdebian traqeas

damoukidebeli fstulebiT ; tipis SemT&vevaSi gavqvas traqeoezo"aguli fstula

atreziis gareSe -ew B$is magvari atrezia/ K tipis atrziis dros sa#lapavis orivenawilis uerTdeba erTmaneTs SemaerTebelqsovilovani zonriT, traqeasTan

fstula ar a.iniSneba

sa#lapavis atreziis SemT&vevaTa saerTo raodenobidan ! tipi gv&vdeba

:6,5$Si ; tipi a.iniSneba SemT&vevaTa %,2$Si H da K tipebi vlindeba

',@$Si TiToeuli I tipis sa#lapavis atreziis SemT&vevaTa si&Sire Seadgens

0,:$s #velaze iSviaTia J tipis atrezia 8 0,@

daavadeba polietiologiuria sa#lapavis atreziis a.mocenebas ukavSireben

embriogenezis meoT&e kviraze na#o"ze s&vadas&va teratogenuri "aqorebis

zemoqmedebas

hipersalivacia, &mauriani sunTqva dabadebisas, mogvianebiT 8 mzardi

respiraciuli distresi

anamnezSi #urad.ebas ip#robs dedis mravalw#lianoba klinikuri simptomebis

arsebobisas aucilebelia !aedgas nazo$gastraluri zondi, romlis zoma

damokidebulia a&alSobilis wonaze sa#lapavi milis atreziis arsebobaze eWvi

unda iqnas mitanili, Tu dadebiTia ele"antis cda1 an zondi Se#ovndeba

sa#lapav milSi da brundeba piris .ruSi diagnozis dadasturebisaTvis saWiroa

!atardes rentgenokontrastuli gamokvleva nazo$gastraluri zondiT, ra drosac

zustdeba brmad dabolovebuli sa#lapavi milis sigre

21



di"erncialuri diagnostika tardeba atreziis tipebs Soris

daavadebis simime -vaterstounis mi&edviT/ ganisaz.vreba ' risk$kategoriiT

? kategoria 8 a&alSobilebi sa#lapavis atreziis garTulebisa da Tanm&lebi

daavadebis gareSe ?? kategoria 8 a&alSobilebi mcire masiT, saSualo simimis

pnevmoniiT an s&va Tanda#olili mankiT ??? kategoria 8 dabadebisas mcirewoniT, mime pnevmoniiT da ganviTarebis rTuli Tanda#lili mankiT

anamnezuri da klinikuri monacemebis Segrovebis Semdeg diagnosis

dazustebis mizniT saWiroa(

● nazogastraluri zondis !adgma -zondi #ovndeba sa#lapavSi an

brundeba piris .ruSi/

● ele"antis cda1 $ dadebiTia atrezisas● gulmkerdisa da muclis mimo&ilviTi rentgenografiT Sesalebelia

pnevmoniis dadastureba, &olo kuWSi da nawlavis mar#u*ebSi airis

arseboba miuTiTebs fstulaze sasunTq gzebsa da sa#lapavis distalur

nawils Soris9

● rentgenokontrastuli gamokvleva nazo$gastraluri zondiT, saSualebas

ileva dazustdes brmad dabolovebuli sa#lapavi milis sigre

mkurnaloba iw#eba winasaoperacio momzadebis zogadi principebis

protokolis Sesabamisad aucilebelia piris .rudan da sa#lapavidan lorwos

perioduli aspiracia #ovel )5$20 wuTSi

qirurgiuli mkurnaloba warmoebs Semdegi taqtikiT(

● stabiluri zogadi mdgomareobis pirobebSi, mime paTologiis ar

arsebobis dros tardeba Tanda#olili anomaliis gadaudebeli radikalurikoreqcia9

● Tu sa#lapavis #ru boloebs Soris manili a.emateba 2 santimetrs,

a&alSobilis mime mdgomareobis, mcire wonis -naklebi )000gr$ze/ an

gviani diagnostikis dros -@2 sT$ze meti/, operacia tardeba or etapad(

○ pirveli sa"e&uri C gastrostomia da saWiroebisas qveda fstulis

gadakvanva saSualebas ileva, enteralurad ikvebos avadm#of da

Tavidan iqnas acilebuli kuWis m*ave SigTavsis re4uqsi fstulis gavliTfltvebSi9

22



○ meore sa"e&uri C Torakotomia, mar+vena eqstraprevlaruli midgomiT,

fstulis gadakveTiTa da sa#lapavis boloebis anastonozis dadebiT

#urad.eba unda mieqces meore fstulis arsebobas9

● orive qirurgiuli sa"e&uri unda !atardes erTmaneTisgan

gancalkevebulad, klinikuri gaum+obesebis Sesabamisad9● Tu sa#lapavis #ru boloebs Soris manili a.emateba 2 santimetrs,

tardeba sa#lapavis dilatacia )$' kviris ganmavlobaSi, sanam !atardeba

saboloo operaciuli !areva9

postoperaciul periodSi avadm#ofs mkurnaloba greldeba postoperaciuli

marTvis protokolis Sesabamisad

● saWiroa avadm#ofs sawolis wamoweva Tavis m&ares9● piris .rudan lorwos "rT&ili regularuli amoqa!va9

● sasunTqi gzebis vakuumsanaciisas Tavidan unda iqnas acilebuli saqa!i

milis .rmad !asvla9

● Tavidan unda iqnas acilebuli kisris lieri gaSla9

● Tavidan unda iqnas acilebuli reintubacia da kisris gadawevaL

● Tu anastomozis dadebisas mo&da sa#lapavi milis zedmetad daqa!va,

saWiroa marTviTi sunTqva aranakleb @2 saaTis ganmavlobaSi● Tu zondi gatarebulia wvril nawlavSi, kvebis daw#eba Sesalebelia

pirveli postoperaciuli d.eebidan Tu zondi ar aris !adgmuli wvril

nawlavSi, &snarebis intravenuri in"uzia unda gagreldes me&uTe

d.emde, sanam ar iqneba dadasturebuli sa#lapavi milis mTlianoba

sa#lapavi milis mTlianobis dadasturebisas kveba iw#eba nazo$

gastraluri zondis gamo#enebiT, &olo avadm#ofs damakma#oflebeli

zogadi mdgomareobis pirobebSi kvebis daw#ebidan ori d.is SemdegSesalebelia nazo$gastraluri zondis amo.eba da peroraluri kvebis

sa"e&urebrivi daw#eba -i& enteraluri kvebis protokoli/9

● nazo$gastraluri zondis amo.ebis Semdgom unda gagreldes

mkurnaloba B2 blokatoriT -mg ranitidini 2mg7kg7d./ re4uqs ezo"agitis

proflaqtikis mizniT

● gulmkerdis .rudan drena*is amo.eba Sesalebelia m&olod mas

Semdeg, rac dadasturebuli iqneba sa#lapavi milis mTlianoba -me&uTed.es/

23



● Tu Sem!neuli iqna sa#lapavis Seviwroveba, operaciidan 2 kviris

Semdeg iw#eba sa#lapavis "rT&ili dilatacia -sa#lapavis bu*ireba/9

● gaweris Semdeg aucilebelia pacientze &angrlivi meTval#ureoba,

sa#lapavis Seviwroebis gamosavlenad da drouli dilataciis !asatareblad9

24



dia"ragmis Tiaqari

dia"ragmis kedelSi arsebuli bunebrivi &vrelebis an paTologiuri de"eqtebis gziT

muclis .rus organoebis gulmkerdSi gadanacvlebas ewodeba dia"ragmis Tiaqari ar!even dia"ragmis Tiaqris Tanda#olil da Seenil "ormebs dia"ragmis

Tiaqris sa&eebia( bogdalekis posterior$lateraluri, morganis wina subkostaluri

da sa#lapavis &vrelis Tiaqrebi

#ovel '000 coc&ladSobil a&alSobilze modis dia"ragmis Tanda#olili Tiaqris erTi

SemT&veva &Siria Tanm&lebi anomaliebic -anence"alia, hidroce"alia, gulis

mankebi da s&v/

dia"ragmis embriogenezi iw#eba !anasa&is ganviTarebis mesame kviridan

Tu dia"ragmis garkveul ubanSi gidis kunTebi r!eba ganuviTarebeli, muclis

.rus organoebis zewoliT gaT&elebuli dia"ragmis kedeli gadainacvlebs

gulmkerdis .ruSi aseT Tiaqars ewodeba WeSmariti, vinaidan mas aqvs

Tiaqris parki Tu di"ragmis ganviTarebisas mis kedelSi dar!a de"eqti &vrelis

sa&iT, muclis .rus organoebi uSualod gadaadgildeba gulmkerdis .ruSi daganviTardeba cru Tiaqari parkis gareSe dia"ragmis Seenili Tiaqrebis

gamomwvevi mizezi travmuli dazianeba da dia"ragmis relaqsaciaa

Tanda#olili di"ragmis Tiaqari vlindeba a&alSobilis dabadebisTanave sunTqvisa

da gul$sis&lar.vTa mwvave ukmarisobis niSnebiT dia"ragmis Tiaqris

lokalizaciis m&ares sunTqviTi &mianoba ar tardeba ismis nawlavTa

peristaltika gulis sageri gadanacvlebulia Suasa#ris cdomis gamo

davaadebis diagnozs adasturebs klinikuri laboratoriuli da rentgenologiuri

kvlevebis monacemebi Sesalebelia daavadebis prenataluri diagnostika

ultrabgeriTi kvlevis sa"uvelze

di"erencialuri diagnozi tardeba s&vadas&va "ormis fltvis kistebTan, sunTqvis

mwvave ukmarisobiT mimdinare Tanda#olil paTologiebTan

daavadebis simimisa da sicoc&lisunarianobis mi&edviT a&alSobilebi i#ofan '

iriTad +gu"ad(

25



● klinikuri simptomebi #alibdeba dabadebisTanave an mogvianebiT da

gamo&atulia saSualo simwvaviT -sicic&lisunarianobis ma.ali &aris&i/

● klinikuri simptomebi mkafod vlindeba, magram fltvis hipoplazia da

pulmonuri hipertenzia ar aris mkveTrad gamo&atuli -sicoc&lisunrianoba

SedarebiT dabalia/● mkveTrad vlindeba sunTqvis ukmarisoba, fltvis bilateraluri hipoplazia,

pulmonuri hipertenzia mdgradia -sici&lisunarianoba ukiduresad dabalia,

ma.alia operaciuli riski/

● fltvebis auskultacia -sunTqviTi &mianoba ar tardeba Tiaqris lokalizaciis

m&ares, &Sirad moismineba peristaltikis &ma, Suasa#ris cdomis gamo

gadanacvlebulia gulis sageri/● gulmkerdis rentgenologiuri kvleva -plevris .ruSi vizualizdeba nawlavTa

mar#i*ebi, fltvi kolabirebulia, guli da Suasa#qari gadanacvlebulia

+anmrTel m&ares/


● avadm#ofs mkurnaloba iw#eba winasaoperacio momzadebis zogadi

principebis protokolis Sesabamisad9● respiraciuli Terapiis dros ar gamoi#eneba ambus baliSi

pnevmoToraqsisa da kuWSi haeris dagrovebis Tavidan acilebis mizniT

● fltvebis &elovnuri ventilacia unda gan&orcieldes ma.ali suTqvis

si&Siris, dabali !asunTqvis wnevisa da *angbadis ma.ali koncentraciis

gamo#enebiT

qirurgiuli mkurnaloba(

● ar aris mizanSewonili saswra"o operaciuli !areva, pacientis

mdgomareobis stabilizaciamde

● qirurgiuli !areva Sesalebelia transTorakaluri, transabdominaluri an

Torako$abdominaluri midgomiT


26



● avadm#ofs mkurnaloba greldeba postoperaciuli marTvis protokolis

Sesabamisad9

● gulmkerdis .rus drenireba unda gan&orcieldes m&olod pasiuri re*imiT9

● Semcirdes wneva fltvis arteriebSi es .onisiebebi moicavs Semdegs(

○ pB Senar!uneba @%$is "arglebSi -natriumis bikarbonatiT, !M2$isdaqveiTebiT/

○ mocirkulire siT&is moculobis Senar!uneba -Sardi ) ml7kg7sT$ze meti/

an centraluri venuri wneva :$)0 sm B2M$s "arglebSi

○ damakma#oflebeli oqsigenacia -saturaciis Senar!uneba A6$is

zemoT/

○ !M2$is Semcireba -ma.ali si&Siris ventilacia/

● nazo$gastraluri zondis amo.ebis Semdgom unda gagreldesmkurnaloba B2 blokatoriT -mg ranitidini 2mg7kg7d./ re4uqs ezo"agitis

proflaqtikis mizniT

27



mwvave skrotumi

mwvave skrotumi gulis&mobs paTologiur mdgomareobebs romelTac Sesaloa

qondeT in"eqciuri -epididimiti, parotituri orqiti, tuberkulozuri, brucelozuri//,an arain"eqciuri -saTesle +irkvlis travma, saTesle +irkvlis Semogre&a, hidatidis

nekrozi, saTesle +irkvlis idiopaTiuri nekrozi/ genezi bavSvebSi #velaze &Siria

saTesle +irkvlis arain"eqciuri daavadebebi, kerod sis&lis mimoqcevis moSliT

an mikrotravmiT ganpirobebuli

saTesle +irkvlisa da hidatidis Semogre&a &Siria pre da pubertatul periodSi,

rodesac saTesle +irkvlis zrdasTan erTad mniSvnelovnad matulobs misi masasaTesle +irkvlis idiopaTiuri in"arqti iriTadad gv&vdeba a&alSobilebSi

sazardul-skrotumis midamos travma iwvevs saTesle jirkvlis daJeJvas

an gaskdomas saTesle +irkvlis idiopaTiuri nekrozi ganpirobebulia +irkvlis

Semogre&iT, rasac sdevs sis&lmimoqcevis dar.vevebi saTesle +irkvlis

amgvari Semogre&a Sesaloa mogvianebiT spontanurad gaswordes, magram

masSi r!eba degeneraciuli cvlilebebi mwvave orqitis ganviTreba &debamasSi iseTi gamomwvevis SeWris Sedegad, romelsac gaa!nia tropizmi

testikulur qsovilTan mimarTebaSi bavSvebSi #velaze &Siria parotituli orqiti

mwvave skrotumis niSnebia( tkivili, Sesieba, SewiTleba saTesle +irkvlis

da&urul travmas a&asiaTebs a.niSnuli niSnebis swraf ganviTareba +irkvlis an

misi danamatis Semogre&isas tkivili lokalizebulia saTesle bagirakis

ga#olebaze Semogre&ili +irkvali elevirebulia, lier mtkivneulia SesaloaganviTardes hidrocele saTesle +irkvlis gaskdomisas tkivili ga"antulia, skrotumi

asimetriuli, cianozuri, SeSupebuli hidatidis nekrozs a&asiaTebs lokaluri

palpatoruli tkivili

daavadebis diagnostika &deba klinikuri da anamnezuri monacemebis

sa"uvelze specialuri kvlevis meTodebidan Sesaloa gamo#enebul iqnas(

dia"anoskopia, +irkvlis ultrabgeriTi kvleva da sadiagnostiko punqcia

28



di"erencialuri diagnostika &orcieldeba kvinkes SeSupebasTan, saTesle +irkvlis

simsivnesTan

● fzikaluri Semowmebisas +irkvlebi horizontalur poziciaSia9 mtkivneulobis

done imatebs, +irkvlebis wamowevisas● inspeqciiT SewiTleba da Sesieba skriotumis areSi9

● mizanSewonilia +irkvlis ultrabgeriTi gamokvleva

● tardeba dia"anoskopia

● saWiroebisas mizanSewonilia +irkvlis sadiagnostiko punqcia

mwvave skrotumis diagnoscirebisas saWiroa saswra"o operaciuli !areva

operaciis dros zustdeba diagnozi● +irkvlis ga&eTqvisas .ru amosu"Tavdeba hematomisgan, scildeba

danekrozebuli ubnebi da ikereba +irkvlis m"aravi garsi

● Semogre&isas +irkvali swordeba -detorsio/ da sakuTari garsiT fqsirdeba

saerTo budobriv garsze

● danekrozebuli hidatida "uesTan ikvaneba da ikveTeba

● !irqovani orqiepididimitis dros tardeba +irkvlis sakuTari garsis .rus

drenireba● saTesle +irkvlis amokveTa &deba misi aSkara nekrozis dros

29



kriptorqizmi

kriptorqizmis dros erTi an orive saTesle +irkvali !amosuli ar aris saTesle

parkSi, anu a.iniSneba +irkvlebis arasruli migracia

na#o"Si saTesle +irkvlebi !aisa&eba da mdebareobs muclis .ruSi

retroperitonealurad antenataluri ganviTarebis me$6 Tvidan +irkvali hunteris

iogis SekumSvasTan erTad iw#ebs daSvebas igi gaivlis sazardulis ar&s da

dabadebisas fqsirdeba saTesle parkis irTan am procesis normaluri

mimdinareobisaTvis saWiroa rogorc dedis qorionuli gonadotropinis, ise

na#ofs luTeotropuli hormonis optimaluri done aseve sazardulis midamosa dasaTesle parkis normaluri ganviTareba kriptorqizmis mizezebi Seileba i#os

dedisa da na#ofs hormonaluri dar.vevebi, teratogenuli da anTebiTi

"aqtorebi, SemaerTebeli qsovilis an nervuli sistemis Tanda#olili paTologia

ganas&vaveben kriptorqizmis ingvinalur "ormas, rodesac +irkvali im#o"eba

sazardulis ar&Si da abdominalur "ormas, rodesac +irkvali muclis .ruSia

retenciul saTesle +irkvalSi Sesaloa ganviTardes iseTi garTulebebi,rogorebicaa( Semogre&a, nekrozi, travmuli orqiti, avTvisebiani gadagvareba,

spermatogenesis "unqciis moSla

kriptorqizmis diagnostika em#areba saTesle parkis garegan daTvalierebas da

palpacias ingvinaluri "ormis dros +irkvali isin+eba sazardulis ar&Si, &olo

abdominuris dros misi gasin+va ver &e&deba am ukanasknel SemT&vevaSi

diagnozi Seileba dazustdes ultrabgeriTi kvleviTdi"erencialuri diagnostika &orcieldeba anorqizmTan, monorqizmTan, +irkvlis

hipoplaziasTan

daavadebis gamosavali damokidebulia +irkvlis ganviTarebis !amor!enis

&aris&ze, diagnostikisa da operaciuli mkurnalobis vadebze

● saTesle +irkvlis palapaciisas avadm#ofs gamokvelva warmoebs

horizontalur poziciaSi

● diagnozis dazustebisTvis mimarTaven eqoskopiur kvlevas

30



mkurnaloba Sesaloa i#os konservatiuli an operaciuli(

● konservatiuli mkurnaloba warmoebs qorionuli gonadotropiniT -)

wlamde 250 erT, ) $ 2 wlis asakSi 500 erT 2+er kviraSi 5 kviris

ganmavlobaSi/● Tu meqanikuri dabrkolebaa da +irkvali normaluri zomis aris da amasTan

meoradi niSnebi gamo&atulia 8 hormonoTerapia ar Wirdeba

● ganmeorebiT hormonuli Terapiis kurss atareben pirvelis dasrulebidan :

kviris Semdeg

● operaciuli mkurnaloba na!venebia konservatiuli mkurnalobis

ue"eqtobis SemT&vevaSi 2 wlis Semdgom periodSi operaciis tipi 8 erT

an ormomentiani orqidopeqsia

31



saTesle +irkvlisa da saTesle bagirakis w#almanki

saTesle +irkvlis garsebis w#almanki -hidrocele/ da saTesle bagirakis garsebis

w#almanki -"unikulocele/ bavSvTa asakis &Siri daavadebaa

hidrocelesa da "unikuloceles a.moceneba dakavSirebulia peritoneumis

budobrivi mor!is Seu&orceblobis gamo mis .ruSi serozuli siT&is

dagrovebasTan budobrivi mor!is Seu&orcebloba distalur nawilSi iwvevs

saTesle +irkvlis garsebis w#almanks Tu budobrivi mor!i distalurad

obliterirebulia, &olo proqsimaluri monakveTi .iaa da uerTdeba muclis .rus 8

viTardeba saTesle bagirakis SeerTebuli w#almanki budobrivi mor!is sruliSeu&orceblobis SemT&vevaSi igi mTlainad ukavSirdeba muclis .rus viwro

&vreliT 8 warmoiSveba saTesle +irkvlisa da bagirakis SeerTebuli w#almanki Tu

budobrivi mor!is distaluri da proqsimaluri nawilebi obliterirebulia, &olo siT&e

grovdeba mis Sua nawilSi, viTardeba saTesle bagirakis izolirebuli w#almanki

anu kista u"rosi asakis bavSvebSi hidrocelesa da "unikuloceles ganviTarebis

mizezi aris travma an anTeba

● saTesle parkis Sesabamisi na&evari gadidebulia -orm&rivi hidroceles

dros mTeli saTesle parki/

● hidroceles dros Sesieba mrgvali "ormisaa, qveda polusSi isin+eba

+irkvali

● SeerTebuli w#almankisas isin+eba mogro "ormis elastiuri

warmonaqmni misi zeda kide mdebareobs sazardulis ar&is gareTa

rgolTan, palpaciiT umtkivneuloa● dia"anoskopiiT a.iniSneba dadebiTi sinaTlis "enomeni

● Tu w#almanki sarqvliT ukavSirdeba muclis .rus igi daWimulia

● saTeslle bagirakis kistas aqvs mrgvali, mkafo saz.vrebi

daavadebis Jdiagnozi ismeba inspeqciisa da palpaciis sa"uvelze

gamoi#eneba dia"anoskopia, saWiroebis SemT&vevaSi ultrabgeriTi kvleva

di"erencireba saWiroa sazardulis TiaqarTan

32



● inspeqcia

● palpacia

● dia"anoskopia

● saWiroebisas ultrabgeriTi skanireba

erT wlamde asakis bavSvebSi Sesaloa w#almankis TviTgankurneba

● operacia sasurvelia gan&orcieldes ) wlis asakidan

● saTesle +irkvlis w#almankisas mowodebulia vilkelmanis operacia

● bagirakis w#almankisas unda mo&des kistozuri warmonaqmnis

amokveTa

● SeerTebuli w#almankisas keTdeba rosis operacia

33



hirSprungis daavadeba

a.niSnul daavadebas a&asiaTebs nawlavis garkveuli ubnis aperistaltika, rac

vlindeba avadm#ofs qronikuli #abzobiTa da nawlavTa gauvalobiT

hirSpringis daavadeba gv&vdeba ) ( 5000 coc&ladSobil a&alSobilze si&SiriT

biWebi avaddebian %$5$+er u"ro &Sirad vidre gogonebi prognozi

damokidebulia operaciisSemdgomi garTulebebis a.mocenebasa da maT

"ormaze

daavadebis ganviTareba ganpirobebulia ms&vili nawlavis distalur nawilSiintramuruli nervuli gangliebis -auerba&isa da meisneris wnulebi/

ganuviTareblobasTan, ris gamoc gamo&atulia Sesabamisi ubnis aperistaltika,

dar.veulia nawlavis SigTavsis pasa*i, "ekaluri masa grovdeba agangliuri ubnis

zemoT, viTardeba nawlavis gaganiereba

daavadebis iriTadi simptomebia(

●

damoukidebeli de"ekaciis ararseboba -qronikuli #abzoba/● daavadebis mani"estacia iw#eba dabadebidan

● avadm#o"s a.eniSneba didi zomis ba#a#iseburi muceli1

● muclis wina kedelze mo!ans nawlavis mar#u*ebis peristaltika

● palpaciiT a.iniSneba Ti&is1 simptomi -muclis wina kedelze &elis

daWeriT !ndeba !anaWdevi/

● a.iniSneba ganavlovani intoqsikacia -anemia, hipotrofa, gonebrivi da

fzikuri ganviTarebis !amor!ena/● ms&vil nawlavSi ganavlovani qvis "ormirebisas vlindeba nawlavTa sruli

gauvaloba

ar!even daavadebis sam "ormas(

● kompensirebuls

● subkompensirebuls

● dekompensirebuls

34



diagnozi ismeba anamnezis, klinikuri monacemebis sa"uvelze

gamoi#eneba(

● reqtaluri gasin+va -swori nawlavis sfnqterebis tonusi momatebulia da

ampula #ovelTvis Tavisu"alia ganavlovani masebisagan/

● muclis .rus mimo&ilviT rentgenogramaze vlindeba ms&vili nawlavisgadaberili mar#i*ebi, dia"ragmis ma.ali dogma

● kontrastuli irigografiT ms&vili nawlavis garkveul ubanze a.iniSneba

Seviwrovebuli monakveTis arseboba da amis zemoT mdebare nawlavis

gaganiereba

di"erencialuri diagnostika tardeba daavadebebTan, romelTac a&asiaTebT

dabali gauvalobis niSnebi a&alSobilebSi esenia( mekoniuri ileusi, Teos

nawlavis terminaluri nawilis stenozi, ms&vili nawlavis Tanda#olili gaganierebaan atonia u"osi asakis bavSvebSi( "siqogenuri #abzoba, hiperTireozi,

"ermentopaTia da s&va

● muclis garSemowerilobis gansaz.vra

● muclis inspeqcia da palpacia

● muclis .rus mimo&ilviTi rentgenografa

●

reqtaluri gasin+va● irigografa

● saWiroebisas swori nawlavis kedlis bio"sia

mkurnaloba operaciulia optimalur periodad iTvleba 2$' welis asaki

winasaoperacio momzadebaSi mniSvnelovania ms&vili nawlavis sistematuri

dacla o#nebis gziT, specialuri dietis dacva -peristaltikis galierebis mizniT/,

muclis masa*i da presis kunTebis var+iSiradikaluri qirurgiuli operaciisas &deba agangliuri segmentis rezeqcia

35



Tormetgo+a nawlavis gauvaloba

Tormetgo+a nawlavis gauvaloba, Tanda#olili ma.ali gauvaloba Sesaloa

ganpirobebuli i#os rigi mizezebiT maT Sorisaa( Tormetgo+as atrezia dastenozi, duodenumis membrana, beWdiseburi pankreasi, Tormetgo+as

agenezia

paTologiis si&Sire Seadgens ) ( 2@00 coc&ladSobil a&alSobilze igi erTnairad

gv&vdeba rogorc gogonebSi, ise va*ebSi prognozi damokidebulia daavadebis

"ormis sirTuleze, a&alSobilis zogad mdgomareobasa da Tanm&lebi paTologiis

arsebobaze

daavadebis ganviTareba dakavSirebulia Tormetgo+a nawlavis di"erencirebis

procesTan, ir.veva misi Sua nawilis rekanalizacia -embriogegzis me$'

kviraze/, rac ganapirobebs sanaTuris Tanda#olil obstruqcias

daavadebis iriTadi klinikuri simptomebia( .ebineba, romelic vlindeba

dabadebisTanave obstruqciis "ateris dvrils zemoT arsebobisas na.ebinebimasebi ar Seicaven na.vels da piriqiT .ebinebis si&Sire da amona.ebi

masebis raodenoba damokidebulia gauvalobis "ormaze

● nawlavTa moqmedeba a.iniSneba mekoniuri masebiT, romelic

normaluradaa Se"erili obstruqciis "ateris dvrils zemoT arsebobisas

winaa.mdeg SemT&vevaSi igi webovania da monacris"ro

● gamo&atulia adinamia, eqsikozi, eleqtrolituri disbalansi

●

Sesaloa aspiraciis ganviTareba● s&eulis temperatura momatebulia

● muclis zeda nawili Seberilia

● laboratoriulad vlindeba hemoglobinis, eriTrocitebis, leikocitebis donis

momateba

● muclis .rus mimo&ilviT rentgenogramaze a.iniSneba gaganierebuli

kuWi da Tormetgo+a nawlavi -ori buStis simptomi/

36



ismeba klinikuri, laboratoriuli, rentgenografuli da eqoskopiuri kvlevbis

sa"uvelze

di"erencialuri diagnozi tardeba pilorospazmTan, sazardulis !aWedil TiaqarTan

● gulmkerdisa da muclis .rus mimo&ilviTi rentgenografa● saWiroebisas tardeba kuW$nawlavis traqtis rentgenokontrastuli kvleva

● sis&lis da Sardis saerTo analizi, +guf, rezusi, hematokriti da

eleqtrolitebi

winasaoperacio momzadeba iw#eba momzadebis zogadi principebis

protokolis Sesabamisad

● idgmeba nazo$gastraluri zondi● &orcieldeba in"uzuri Terapia

● aspiraciul pnevmoniasTan brola

operacia 8 duodeno$duodeno anastomozi

operaciisSemdgomi mkurnaloba greldeba avadm#ofs postoperaciuli

marTvis protokolis Sesabamisad da maT Soris moicavs(● analgezia, sedacias,

● srul parenterul kvebas,

● siT&is paTologiuri danakargebis Sevsebas,

● enteraluri kveba iw#eba nawlavis "unqciis sruli a.dgenis Semdeg

37



wvrili nawlavis atrezia

wvrili nawlavis atrezia nawlavTa Tanda#olili gauvalobis u&Siresi mizezia

Sesaloa wvrili nawlavis nebismieri ubnis atrezia -treicis iogidan ileocekalurkuT&emde/ ganas&vaveben atreziis oT& tips ? tipi 8 wvrili nawlavis sanaTurSi

membranis arseboba erTiani kunTovani SriT ?? tipi 8 fbrozuli zonriT SeerTebuli

nawlavTa brmad daboloebuli "ragmentebi ??? tipi 8 atrezia nawlavis brma

daboloebebis sruli gaTiSviT, +or+lis N$s magvari de"eqtiT, an +or+lis didi zomis

de"eqtiT da sis&lar.vze Semo&veuli Teos nawlaviT ?N tipi 8 wvrili nawlavis

mravlobiTi atrezirebuli ubnebi

prognozi damokidebulia anomaliis tipze, Tanm&lebi daavadebebis

simimeze, postoperaciuli garTulebebis &asiaTze

saWmlis momnelebeli milis ganviTarebisas misi rekanalizaciis Se"er&ebis

SemT&vevaSi ir.veva sanaTuris gamavloba da viTardeba atrezia Tu

rekanalizacia dair.va mokle monakveTSi nawlavis sanaTuri i&ureba T&eli

apkiT -membranuli atrezia/ nawlavis sanaTuris u"ro did monakveTzeda&Soba ganapirobebs fbrozuli zonris warmoqmnas klinika vlindeba

dabadebisTanave

klinika vlindeba dabadebisTanave a.iniSneba mraval+eradi .ebineba,

amona.ebi Seicavs na.vlis minarevebs, viTardeba eqsikozi, wonaSi kleba,

intoqsikacia, oliguria, eleqtrolituri disbalansi muceli !avardnilia, Seberilia

epigastriumi

di"erencialuri diagnozi tardeba .ebinebiT mimdinare s&va daavadebebTan(

pilorospazmTan, "sevdookluziur sindromTan, cns$is samSobiaro travmasTan

da s&va

● gulmkerdisa da muclis .rus mimo&ilviTi rentgenografa

● kuW$nawlavis traqtis sakontrasto rentgenografa

● sis&lis Sardis saerTo analizebi, hematokriti, eleqtrolitebi

38



winasaoperacio momzadeba iw#eba momzadebis zogadi principebis

protokolis Sesabamisad

● idgmeba nazo$gastraluri zondi

● &orcieldeba in"uzuri Terapia● tardeba mizanmimarTuli antibiotikoTerapia

● simptomuri Terapia

operaciuli !arevis masStabi damokidebulia atreziis tipze

postoperaciuli mkurnaloba &orcieldeba avadm#ofs operaciisSemdgomi

marTvis zogadi protokolis Sesabamisad

39



nawlavTa Seenili gauvaloba

-invaginacia/

nawlavTa invaginacia warmoadgens nawlavis erTi mar#u*is !anergvas

meoreSi ganas&vaveben wvrili nawlavis wvrilSi !aWedva, ms&vili nawlavis

ms&vilSi !aWedvas, Teos nawlavis brma nawlavSi !aWedvas

invaginacia u&Siresad gv&deba ) wlamde asakis bavSvebSi :()000 si&SiriT

prognozi rogorc wesi keTilsaimedoa, rac damokidebulia daavadebis drouli

diagnostikiT

paTologiis ganviTarebaSi wam#vani adgili ukavia nawlavis peristaltikis riTmis

dar.vevebs, rac Seileba ganpirobebuli i#os nawlavis anTebiTi davadebebiT,

dizinteriiT, nawlavTa polipoziT da s&va

daavadeba iw#eba uecrad, mkveTri, SeteviTi &asiaTis perioduli tkiviliT muclis

areSi a.iniSneba pir.ebineba, sis&liani diarea daavadebis dasaw#isSi

muceli palpaciiT rbilia, &Sirad isin+eba e&viseburi1 warmonaqmni

-invaginati/ reqtaluri gasin+visas ampula carielia

invaginaciis diagnostikis dagvianebisas viTardeba toqsikozis, eqsikozis suraTi,

vlindeba peritonitis niSnebi

ar!even invaginaciis mimdinareobis sam stadias( dasw#isi -daavadebis

pirveli : sT/, klinikuri suraTis !amo#alibeba -:$2% sT/, mime garTulebaTa

mani"estacia -2% sT$ze meti/

muclis .rus mimo&ilviT rentgenogramaze a.iniSneba homogenuri da!rdilva,

siT&is horizontaluri doneebi peri"eriul sis&lSi a.iniSneba leikocitozi "ormulis

marc&niv gada&riT

● sis&lis, Sardis saerTo analizi, hematokriti

● muclis .rus mimo&ilviTi rentgenografa or proeqciaSi

● sakontrasto rentgenografa haeris Se#vaniT

● endoskopia -kolonoskopia/

40



● laparaskopia

winasaoperacio momzadeba warmoebs Sesabamisi protokolis mi&edviT(

● w#deba sakvebisa da siT&eebis miwodeba

● idgmeba nazo$gastraluri zondi● warmoebs in"uzuri Terapia paTologiuri danakargis gaTvaliswinebiT

invaginaciis diagnozis dasazusteblad da mkurnalobis mizniT gamoi#eneba

kolonoskopia

invaginaciis konservatiulad !asworebis warumateblobis SemT&vevaSi

tardeba operacia -dezinvaginacia, rezeqcia/

operaciisSemdgomi mkurnaloba warmoebs avadm#ofs postoperaciuli

marTvis protokolis Sesabamisad

● avadm#of Tavsdeba na&evradm+domare poziciaSi

● dezinvaginaciis SemT&vevaSi enteraluri siT&eebis micema iw#eba

nawlavis aqtiuri peristaltikis a.dgenis Semdeg

● nawlavis rezeqciisa da pirdapiri anastomozis dadebis SemT&vevaSi

avadm#of srul parenterul kvebaze im#o"eba minimum ' d.e● nawlavTa gamo&atuli parezisas, mikrocirkulaciis gaum+obesebis mizniT

na!venebia periduruli anesTeziis gamo#eneba

41



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