{"id":1686,"date":"2020-07-05T22:08:13","date_gmt":"2020-07-05T19:08:13","guid":{"rendered":"http:\/\/katsanas.com\/?p=1686"},"modified":"2023-10-10T21:48:11","modified_gmt":"2023-10-10T21:48:11","slug":"lembert-suturu","status":"publish","type":"post","link":"https:\/\/www.katsanas.com\/en\/lembert-suturu\/","title":{"rendered":"LEMBERT S\u00dcT\u00dcR\u00dc"},"content":{"rendered":"
\n
\"\"\u015eekil 1 Kesikli Lembert S\u00fct\u00fcr\u00fc<\/div>\n
\"\"\u015eekil 2 Devaml\u0131 Lembert S\u00fct\u00fcr\u00fc<\/div>\n
\"\"\u015eekil 3 Czerny-Lembert S\u00fct\u00fcr\u00fc<\/div>\n<\/div>\n\n\n

LEMBERT S\u00dcT\u00dcR\u00dc<\/h1>\n\n\n\n

1800\u2019l\u00fc y\u0131llar\u0131n ba\u015f\u0131nda Fransa\u2019da operasyonlar\u0131n\u0131 y\u00fcr\u00fcten Antoine Lembert, intestin diki\u015fi s\u0131ras\u0131nda kar\u015f\u0131la\u015ft\u0131\u011f\u0131 baz\u0131 problemlerin \u00fcstesinden gelmek i\u00e7in bir seri deneme ba\u015flat\u0131r. Bu denemeler sonucunda muko-mukozal s\u00fct\u00fcrlerin kalitesinin d\u00fc\u015f\u00fck oldu\u011fu ve sero-sero\u00f6z s\u00fct\u00fcrlerin bu s\u00fct\u00fcr tipinin yerine tercih edilmesi gerekti\u011fini belirtti.<\/p>\n\n\n\n

Daha sonra 1826 y\u0131l\u0131nda, hem anastomotik hem intestin operasyonlar\u0131 i\u00e7in geli\u015ftirdi\u011fi \u00e7ift katmanl\u0131 inversiyon diki\u015f tekni\u011fini iki ilkeye dayand\u0131rd\u0131:<\/p>\n\n\n\n

1) Dikkate de\u011fer kuvveti nedeniyle diki\u015fler submukozaya yerle\u015ftirilmelidir.<\/p>\n\n\n\n

2) Ser\u00f6z membran do\u011fru bir \u015fekilde dairesel olarak yara kenar\u0131na yakla\u015ft\u0131r\u0131lmal\u0131d\u0131r.<\/p>\n\n\n\n

Lembert s\u00fct\u00fcr\u00fcn\u00fcn \u00f6zg\u00fcnl\u00fc\u011f\u00fc, ser\u00f6z y\u00fczeylerin b\u00fck\u00fclmesi ile ayr\u0131 giri\u015flere sahip kesikli veya s\u00fcrekli olarak kas-ser\u00f6z diki\u015fini ger\u00e7ekle\u015ftirilmesi ve yaran\u0131n kenarlar\u0131n\u0131n ba\u011f\u0131rsak l\u00fcmenine \u00e7evrilmesidir.<\/p>\n\n\n\n

Daha sonra Czerny ve Connell taraf\u0131ndan hafif\u00e7e de\u011fi\u015ftirilen bu ilkeler, \u00e7o\u011fu gastrointestinal anastomozun dayand\u0131\u011f\u0131 modern ilkelerin temelini olu\u015fturmaktad\u0131r.<\/p>\n\n\n\n

Lembert s\u00fct\u00fcr\u00fc, i\u00e7 organlar i\u00e7in kullan\u0131labilecek, nispeten h\u0131zl\u0131 bir \u015fekilde ger\u00e7ekle\u015ftirilen, en basit modeldir. Yaran\u0131n dudaklar\u0131n\u0131 i\u00e7e \u00e7evirir ve asla mukozadan ge\u00e7mez, bu nedenle kontaminasyon olas\u0131l\u0131\u011f\u0131 d\u00fc\u015f\u00fckt\u00fcr. 7 temel basamaktan olu\u015fur:<\/p>\n\n\n\n

  1. \u0130\u011fne, yara kenar\u0131ndan yakla\u015f\u0131k 8 mm mesafedeki epidermise dik olarak yerle\u015ftirilir.<\/li>
  2. Hassas bilek hareketleri ile, i\u011fne dermis y\u00fczeyinin alt\u0131ndan d\u00f6nd\u00fcr\u00fcl\u00fcr ve i\u011fne ucu cildin ipsilateral taraf\u0131ndaki yara kenar\u0131ndan 2 mm uzakta \u00e7\u0131kar.<\/li>
  3. \u0130\u011fne, kesiye temas etmeden, kar\u015f\u0131 taraftaki yara kenar\u0131ndan 2 mm uzakta cilde dik olarak penetre eder.<\/li>
  4. \u0130\u011fne dermis y\u00fczeyinin alt\u0131ndan d\u00f6nd\u00fcr\u00fcl\u00fcr ve kesiden 8 mm uzaktan cildi terk eder. B\u00f6ylece di\u011fer taraftaki i\u015flemin tersi tekrar edilmi\u015f olur.<\/li>
  5. S\u00fct\u00fcr kesikli olarak yap\u0131lacaksa (\u015eekil 1) nazik\u00e7e d\u00fc\u011f\u00fcmlenir ve i\u015flem kesi boyunca tekrarlan\u0131r.<\/li>
  6. Devaml\u0131 olarak at\u0131lmas\u0131 planlan\u0131yorsa (\u015eekil 2), ilk giri\u015f noktas\u0131n\u0131n hizas\u0131ndan ba\u015flanacak \u015fekilde i\u015flemler yara sonuna kadar tekrarlan\u0131r ve d\u00fc\u011f\u00fcm at\u0131larak yara kapat\u0131l\u0131r.<\/li>
  7. \u0130ki \u015feklinde de d\u00fc\u011f\u00fcm atma i\u015flemi s\u0131ras\u0131nda epidermis boyunca gerginli\u011fi en aza indirmek ve yara kenarlar\u0131n\u0131n a\u015f\u0131r\u0131 daralmas\u0131n\u0131 \u00f6nlemek i\u00e7in \u00f6zen g\u00f6sterilir.<\/li><\/ol>\n\n\n\n

    Bu teknik, ba\u015f\u0131ndan beri inversiyonun arzu edildi\u011fi ve ger\u00e7ekten gerekli oldu\u011fu ba\u011f\u0131rsak diki\u015f ama\u00e7lar\u0131 i\u00e7in geli\u015ftirilmi\u015ftir. Bu nedenle inversiyon istenmeyen kapatma i\u015flemlerinde kullan\u0131lmas\u0131 tavsiye edilmez. Ba\u011f\u0131rsakta daralma (stenoz) yaratabilir.<\/p>\n\n\n\n

    Herhangi bir transepidermal teknikte oldu\u011fu gibi, bu yakla\u015f\u0131m operasyon sonras\u0131 izlere neden olabilir; s\u00fct\u00fcrlerin zaman\u0131nda \u00e7\u0131kar\u0131lmas\u0131 bu riski azaltmaya yard\u0131mc\u0131 olur ve h\u0131zl\u0131 emilen s\u00fct\u00fcr kullanmak da makul bir se\u00e7enek olabilir.<\/p>\n\n\n\n

    Hi\u00e7bir diki\u015f malzemesi kesinin\/yaran\u0131n i\u00e7inden ge\u00e7mez, b\u00f6ylece yara i\u00e7erisindeki yabanc\u0131 maddenin yara iyile\u015fme etkisini bozma riskini azalt\u0131r.<\/p>\n\n\n\n

    Bu teknik epidermal ucun kavu\u015fmas\u0131na hi\u00e7 katk\u0131da bulunmaz. Bu nedenle daha etkili bir iyile\u015fme i\u00e7in yara kenarlar\u0131n\u0131 etkili bir \u015fekilde hizalayan dermal s\u00fct\u00fcrler yerle\u015ftirildikten sonra kullan\u0131lmas\u0131 idealdir.<\/p>\n\n\n\n

    Lembert tekni\u011findeki bahsi ge\u00e7en eksiklerin fark\u0131nda olan bir\u00e7ok cerrah bu tekni\u011fi geli\u015ftirerek farkl\u0131 uygulamalar i\u00e7in de kullan\u0131lmas\u0131n\u0131n yan\u0131nda, diki\u015f g\u00fcvenli\u011fini art\u0131rmak i\u00e7in yakla\u015f\u0131mlarda da bulunmu\u015flard\u0131r.<\/p>\n\n\n\n

    Czerny-Lembert S\u00fct\u00fcr\u00fc<\/strong><\/h2>\n\n\n\n

    Onkoloji ve Jinekoloji alan\u0131nda uzmanl\u0131\u011f\u0131yla bilinse de \u00e7ok y\u00f6nl\u00fc bir cerrah olan Vincenz Czerny\u2019in t\u0131p ve cerrahi bilimine yapt\u0131\u011f\u0131 bir\u00e7ok katk\u0131 mevcuttur. Alman bilim insan\u0131n\u0131n cerrahi alan\u0131na \u00f6nemli katk\u0131lar aras\u0131nda f\u0131t\u0131k operasyonlar\u0131, abdominal cerrahi ve vajinal histerektomi say\u0131labilir. Ayr\u0131ca plastik g\u00f6\u011f\u00fcs cerrahisinin atas\u0131 olarak kabul edilir. En \u00f6nemlisi, cerrahinin tek ba\u015f\u0131na kanseri kontrol edemeyece\u011fini kabul etmi\u015f ve multimodalite tedavisi i\u00e7in kavramlar geli\u015ftirmi\u015ftir.<\/p>\n\n\n\n

    1900\u2019l\u00fc y\u0131llar\u0131n ba\u015f\u0131nda Heidelberg Cerrahi B\u00f6l\u00fcm\u00fc\u2019nde Profes\u00f6r olarak \u00e7al\u0131\u015ft\u0131\u011f\u0131 s\u0131rada ba\u011f\u0131rsak ve mide anastomozu i\u00e7in yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmalar sonucu geli\u015ftirdi\u011fi Lembert s\u00fct\u00fcr\u00fcn\u00fcn bir modifikasyonu, selefinin mukavemet konusundaki eksi\u011fini gidermek i\u00e7in tasarlanm\u0131\u015ft\u0131r.<\/p>\n\n\n\n

    Czerny-Lembert ba\u011f\u0131rsak s\u00fct\u00fcr\u00fcnde i\u011fne ilk olarak seroza girer, submukoza veya muskulardan ge\u00e7er ve daha sonra kar\u015f\u0131 taraf\u0131n submukoza veya muskularisine girer ve serozadan \u00e7\u0131kar. Bu \u015fekilde s\u00fct\u00fcr\u00fcn ilk s\u0131ras\u0131 olu\u015fturulur ve kesinin \u00fcst k\u0131sm\u0131nda Lembert s\u00fct\u00fcr\u00fc olu\u015fturularak yara kapat\u0131l\u0131r. Kesinin alt ve \u00fcst k\u0131sm\u0131na at\u0131lan toplam iki s\u0131ra Lembert diki\u015fi olarak k\u0131saca \u00f6zetlenebilir (\u015eekil 3).<\/p>\n\n\n\n

    Mert \u00c7eltiko\u011flu
    <\/strong>Kalite G\u00fcvence \u015eefi<\/p>\n","protected":false},"excerpt":{"rendered":"

    1800\u2019l\u00fc y\u0131llar\u0131n ba\u015f\u0131nda Fransa\u2019da operasyonlar\u0131n\u0131 y\u00fcr\u00fcten Antoine Lembert, intestin diki\u015fi…<\/p>\n","protected":false},"author":2,"featured_media":1693,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[50],"tags":[],"class_list":["post-1686","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog-tr"],"_links":{"self":[{"href":"https:\/\/www.katsanas.com\/en\/wp-json\/wp\/v2\/posts\/1686","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.katsanas.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.katsanas.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.katsanas.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.katsanas.com\/en\/wp-json\/wp\/v2\/comments?post=1686"}],"version-history":[{"count":1,"href":"https:\/\/www.katsanas.com\/en\/wp-json\/wp\/v2\/posts\/1686\/revisions"}],"predecessor-version":[{"id":11082,"href":"https:\/\/www.katsanas.com\/en\/wp-json\/wp\/v2\/posts\/1686\/revisions\/11082"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.katsanas.com\/en\/wp-json\/wp\/v2\/media\/1693"}],"wp:attachment":[{"href":"https:\/\/www.katsanas.com\/en\/wp-json\/wp\/v2\/media?parent=1686"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.katsanas.com\/en\/wp-json\/wp\/v2\/categories?post=1686"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.katsanas.com\/en\/wp-json\/wp\/v2\/tags?post=1686"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}