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8.

Khu l thng lot d dy, t trng


v rut non
mc tiu:

1. Trnh by c cc bc k thut khu l thng d dy- t trng do lot.


2. M t c cc bc k thut khu l thng rut non.

1. Thng tn gii phu bnh


- Thng lot non d dy-t trng: b l thng mm mi
- Thng lot x chai: b l thng chc, cng...
- Thng do ung th: b lot thng sn si, l thng thng to, thng trn nn mt
khi u, km theo s hin din ca cc tn thng khc trong bng: Hch, khi u di
cn...
- chn on xc nh l lot lnh tnh hay ung th cn xn mp l thng gi lm
xt nghim gii phu bnh trc khi khu l thng.
- Thng rut non do vt thng cn phi tm nhng vt thng khc, thng thng l
chn. i vi v rut non do chn thng b ch v thng nham nh cn ct lc trc
khi khu. i vi thng rut non bnh l cn xn mp l thng gi gii phu bnh
trc khi khu.
- Tnh trng bng: Tu theo bnh nhn n sm hay mun m bng c: dch tiu
ho v thc n. Dch nh m, thc n v gi mc lm cc tng trong bng ph n, d
tn thng khi kim tra.

2. k thut khu thng d dy t trng do lot


2.1. Chun b
- Bnh nhn nm nga trn bn m, gy m ni kh qun.
- Phu thut vin ng bn phi bnh nhn, ph m ng bn i din dng c vin
ng bn phi phu thut vin.
2.2. K thut
Th 1 - M bng: theo ng trng gia trn rn i vi thng lot d dy-t trng.
i vi thng rut non, m bng theo ng trng gia trn v di rn.
- Dng dao thng rch da v t chc di da. Cm mu t chc di da bng t in
hoc bng cc mi khu ch X (trong trng hp khng c dao in).
- Rch cn theo ng rch da, ti thiu di bng vt rch da.
- t cm mu t chc m ngoi phc mc.
- Lm np phc mc v m phc mc
- Bc mp vt m.
- Banh rng vng m bng banh t ng.
Th 2 - nh gi tn thng:
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- Tnh trng bng: dch tiu ho, dch m, gi mc, v hi x ra...


- Tm lot thng, nh gi tnh trng l thng, lot: v tr, kch thc, mm mi hay
b cng...
Th 3 - X l thng tn:
- Ly dch bng gi lm xt nghim vi khun, ht dch, ra sch bng.
- Xn mp l thng gi gii phu bnh, (nu nghi ngh lot c tnh).
- Khu l thng:
+ i vi l thng nh, trn nn lot non: Ch cn khu mt mi ch X bng ch tiu
chm s3-0.
+ i vi l thng to: Khu l thng bng cc mi ri ton th ch tiu chm s 3-0
theo chiu vung gc vi chiu nhu ng. Ch cn khu mt lp, chc chn hn mt
s tc gi cn buc thm mc ni ln vo ng khu. Khng nn khu hai lp v d
lm rch lp thanh c hoc lm cn tr lu thng t d dy xung t trng trong trng
hp l thng hnh t trng.
+ i vi l thng hnh t trng sau khi khu xong cn kim tra xem c b hp khng
(kim tra c hp khng bng ngn tr v ngn ci nn qua ch khu, hai u ngn tay
c chm vo vo nhau qua thnh rut l khng b hp), nu c cn lm thm th thut
ni v trng.
+ i vi l thng qu to d dy, trong trng hp khng th khu c, khng th
ct on d dy c th lm th thut Newmann: t mt ng thng Malecot vo
trong d dy qua l thng. Khu ti vi chn ng thng. Khu treo d dy vo thnh
bng quanh chn ng thng. ng tc ny thng kh thc hin v t chc xung quanh
l thng trong trng hp ny vim ph n rt nng hoc l t chc khi u rt d b x
rch khi khu buc. Do vy mt s tc gi ch trng khu qun mc ni ln quanh
chn ng thng.
- Lau ra li bng sau khi khu.
- t dn lu di gan a ra di sn phi.
- m gc, kim tra dng c trc khi ng bng.
Th 4 - ng bng: hai lp. Lp cn c-phc mc: khu ch khng tiu hoc tiu chm
s 1 hoc s 2, mi ri. Lp da v t chc di da: khu ch lin mi ri.

3. khu l thng rut non


3.1. Chun b
-Bnh nhn nm nga trn bn m, gy m ni kh qun.
-Phu thut vin ng bn phi hoc bn tri bnh nhn, ph m ng i din. Dng
c vin ng cng bn vi phu thut vin.
3.2. K thut
Th 1 - M bng: theo ng trng trn v di rn. Cc bc tng t nh i vi m
bng khu thng lot d dy-t trng.
Th 2 - nh gi thng tn:
- Tnh trng l thng, s l thng.
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- Cc thng tn phi hp.


- Dch bng...
Th 3 - Khu l thng:
+ i vi l thng rut nh: khu mi ch X ri khu ti vi.
+ Nu l thng to: khu theo chiu ngang mt lp hoc hai lp, vt hoc mi ri ch
khng tiu hoc tiu chm s 4-0.
+ Nu l thng qu ln, nhiu l nh trn mt on rut hoc c tn thng mc treo
tng ng th xt kh nng ct on rut.
+ Kim tra lu thng rut sau khi khu: Dng hai ngn tay ci v tr nh trn hoc bp
on rut pha trn xem dch v hi lu thng qua ch khu.
Th 5 - Lau ra bng v t dn lu:
+Ra bng bng huyt thanh m, ht sch.
+t dn lu Douglas.
Th 6 - ng bng: tng t nh i vi m khu thng lot d dy-t trng.
cu hi lng gi:

1. Trnh by k thut m khu l thng hnh t trng do lot.


2. Trnh by k thut m khu l thng d dy do lot.
3. Trnh by k thut khu l thng rut non do vt thng.
4. Nu ngha ca vic xn mp l thng trc khi khu l thng.

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