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إلتصاقات العملية القيصرية

إلتصاقات العملية القيصرية

 

حينما يأتي الموعد المنتظر وتُطل بشائر الولادة تفضل بعض النساء الولادة القيصرية والبعض الآخر الولادة الطبيعية ( المهبلية ), بينما تضطر أخريات إلى الخضوع للجراحة القيصرية بسبب بعض المضاعفات الصحية التي قد يواجهنها أثناء الحمل، ولكن مهما كان سبب خضوع المرأة لعملية قيصرية ، فإنها تكون عرضة  للتعرض لمضاعفات  مثل الإلتصاقات خاصة مع تكرار عدد عمليات الجراحة القيصرية الذي يجعل البطن معرضة بشكل أكبر للإصابة بالإلتصاقات.

ماهي إلتصاقات مابعد العملية القيصرية ؟!

 تتشكل الإلتصاقات كإستجابة طبيعية للصدمة التي تعرض لها جسمك أثناء الجراحة، وهي أحد المضاعفات الشائعة لأي جراحة في حوض البطن بشكلٍ عام وبعد الجراحة القيصرية بشكلٍ خاص، و مع أن الإلتصاقات تبدأ بعملية التشكل فورًا بعد الجراحة القيصرية، إلا أنه قد لايتم إكتشافها إلا بعد أشهر أو حتى سنوات من الولادة، وبعض النساء لا يتعرضن أبداً لهذه المضاعفات.

ماهو شكل الإلتصاقات ؟!

الإلتصاقات هي أشرطة من الأنسجة الندبية الصلبة التي تتشكل داخل البطن أو الحوض وبقية الأعضاء بعد الجراحة، وعندما يشفى جسمك من الجراحة، يربط هذا النسيج الندبي الأعضاء معًا، مما يجعلها تلتصق ببعضها البعض والتي من الصعب منعها من التكون ، وقد تظهر مثل شبكات العنكبوت أو خيوط النايلون التي تحيط بأعضاء جسمك، وتكون هذه الخيوط قوية وقد تسبب إعاقة في تدفق الدم أو تسبب اضطرابًا في وظائف الأعضاء الداخلية المختلفة.

كيف تتكون الإلتصاقات ؟!

يغطي جميع أعضاء البطن غشاء شفاف، يسمى الصفاق. أثناء العملية القيصرية ، يتم قطع الصفاق من أجل كشف الرحم ونتيجة لهذا الشق يلتهب الصفاق بعد الجراحة ، مما يؤدي إلى تلف هذه البطانة الواقية والزلقة أثناء الولادة القيصرية ، حينها يباشر الجهاز المناعي للجسم في شفاء نفسه. هذا يؤدي إلى تشكيل أنسجة ندبة لزجة ، والتي تعرف أيضًا باسم مصفوفة الفيبرين والإلتهاب.

 في معظم الحالات ، يختفي هذا النسيج الندبي بعد فترة وجيزة بمساعدة عملية كيميائية حيوية ، تعرف باسم انحلال الفيبرين ولكن أثناء العملية الجراحية ، قد لا يحدث تحلل الفيبرين بشكلٍ فعال بسبب انخفاض مستويات المواد الكيميائية في الدم المطلوبة لهذه العملية لأنها تقلل أحياناً من تدفق الدم ، هذا يعني أن الأنسجة أو العصابات لا تذوب ولكنها تتطور بدلاً من ذلك إلى إلتصاقات.


كيف يمكن التقليل من حدوث الالتصاقات ؟

  • التعامل الحذر مع الأنسجة وقت العملية لتقليل النزيف، والحرص على تقليل الإحتكاك بين اليد وتجويف البطن أو الحوض والحرص على ممارسة التقنيات الجراحية بشكل دقيق ، وهذا يكون عن طريق الحرص على اختيار مكان دقيق وآمن بتعقيم عالي على أيدي أطباء مختصين .
  •  استخدام العوازل في العملية وهي أنسجة عازلة توضع في الحوض بعد العملية بين الأعضاء تشكل عازل يقلل من شدة التصاق الأعضاء ببعضها (مثل الانترسيد ) – طبعا كل الأمور التي ذكرت أعلاه تقلل ولاتمنع الإلتصاقات.

 

علاج الإلتصاقات :

يتم علاج إلتصاقات الرحم بالمنظار وتعد هذه الطريقة الرئيسية للعلاج، ويُسمى تنظير الرحم الجراحي، وتتم بأن يُدخل الطبيب المنظار للرحم عن طريق المهبل تحت التخدير الكامل أو النصفي.، ثم يقطع الطبيب الأنسجة الندبية المتكوّنة على بطانة جدار الرحم باستخدام مقص طبي صغير أو باستخدام الليزر، وبعدها يضع الطبيب شبكة أو قسطرة خاصة داخل الرحم في بعض الحالات، ويتركها لمدة يحددها الطبيب والتي تكون عادةً من بضعة أيام لعدة أسابيع، بهدف تحفيز شفاء أنسجة بطانة الرحم دون رجوع الإلتصاقات خلال هذه الفترة، يصف الطبيب علاج هرموني لبعض الحالات، ويتضمن العلاج الإستروجين، ومضادات الإلتهاب غير الستيرويدية  (NSAIDs) ، وذلك بهدف السماح لبطانة الرحم بالنمو من جديد بشكل طبيعي، وتقليل فرصة رجوع التصاقات الرحم، ما سيساهم في حل مشكلات الدورة الشهرية وصعوبة الحمل المصاحبه لالتصاقات الرحم. ومن الممكن أن تحدث التصاقات مرة أخرى بعد العلاج، لذا يوصي الأطباء بالانتظار لمدة عام قبل محاولة الحمل.

 

هل تظهر إلتصاقات الحمل بالسونار؟

يعد الكشف عن إلتصاقات الرحم بالسونار أمرًا صعبًا، حيث تظهر الإلتصاقات على شكل مجموعة من أنسجة عضل الرحم تعبر تجويف بطانة الرحم وتجاور جدران الرحم المقابلة، لذا لا يستطيع الطبيب معرفة هل توجد التصاقات أم لا من خلال السونار، لكن يستطيع معرفة وجود الالتصاقات من خلال منظار الرحم.


تذكري دائماً أن الوقاية خير من العلاج لذلك احرصي على الفحص الدوري مع طبيبكِ الخاص للتأكد من سلامة الرحم والحوض والبطن وبقية الأعضاء تجنباً لأي مضاعفات قد تُكتشف في وقت متأخر يُصعب علاجها ..

Dr.Mohamed
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