8/9/2019 RHR and TEA-cartagena

1/34

E` nÿpue` r`gj`e cf e` prktcsjtkt`e gce nkgk

Tr Narjstj`f Guhkftjcr HG, TaG

Trcscft`tjkf js `v`je`iec ̀ t www.gjunajrurmjch`jf.krm

http://www.diuchirurgiemain.org/

8/9/2019 RHR and TEA-cartagena

2/34

Nkhpejn`tjkfs kl WC@

!

7> % `t 3 yc`rs wjta 01 % rc-kpcr`tjkfs! @scptjn ekkscfjfm (0=,9 % kf Q-r`ys &

8/9/2019 RHR and TEA-cartagena

3/34

Nkhpejn`tjkfs kl WC@

! ]kueg tac usc kl ` r`gj`e ac`gprkstacsjs a`vc na`fmcg taccvkeutjkf kl tacsc prkstacscs jf

taksc p`tjcfts ;

8/9/2019 RHR and TEA-cartagena

4/34

]a`t `rc tac r`tjkf`ec lkr r`gj`e ac`g prcscrv`tjkf /rcpe`nchcft / rcscntjkf ;

!

@f`tkhjn`e `fg cxpcrjhcft`ewkrbs a`vc sakwf ta`t tacHNE js tac h`okr st`ijejzcr jftac lrkft`e pe`fc

! HNE `fg nkrkfkjg prkncss jftac s`mjtt`e pe`fc

Wac st`ijejz`tjkf kl tac fkrh`e ceikw okjft rcejcs kf strunturcs ta`ticekfm tk tac « uef` ² `f`tkhy

8/9/2019 RHR and TEA-cartagena

5/34

Akwcvcr

! Jl tac HNE js `iscft /jfsulffnjcft

! Wacf tac f`tjvc r`gj`eac`g icnkhcs `H@OKY st`ijejzcr

! Icn`usc tacrc js `syfcrmy ictwccf ikfcs`fg ejm`hcfts

8/9/2019 RHR and TEA-cartagena

6/34

@ r`gj`e ac`g prkstacsjs js `esk ` st`ijejzcr

! Jl HNE js rcec`scg, tacf r`gj`eac`g rcpe`nchcft `ehkst rc-st`ijejzc tac ceikw

Ocfscf ^E, Kescf I^, Wyrg`e ^, ^koiocrm OK, ^fcppcf K. Ceikw okjft e`xjty `ltcr cxpcrjhcft`e r`gj`e ac`g cxnjsjkf `fg e`tcr`enkee`tcr`e ejm`hcft rupturc? clffn`ny kl prkstactjn rcpe`nchcft ̀ fg ejm`hcft rcp`jr. O ̂ akuegcr Ceikw ̂ urm 94432 07(0)? =1-17.

8/9/2019 RHR and TEA-cartagena

7/34

@ r`gj`e ac`g prkstacsjs js `esk ` st`ijejzcr

! Jf tac s`mjtt`e pe`fc, tac r`gj`e ac`g(wjta ENE) st`ijejzcs tac ceikw (lkrcx`hpec jf tcrrjiec trj`gs)

8/9/2019 RHR and TEA-cartagena

8/34

@fg tac r`gj`e ac`g `esk sust`jfs ek`gs lrkh tac lkrc`rh

! @ikut

8/9/2019 RHR and TEA-cartagena

9/34

Jf Wkt`e ceikw rcpe`nchcft

! Jf hkst p`takekmjcs wcrc ` WC@ js

fccgcg, tac HNE js gcffnjcft! Wacf prcscrv`tjkf/rcpe`nchcft kl

tac r`gj`e ac`g wkueg scch ekmjn`e

8/9/2019 RHR and TEA-cartagena

10/34

Ljrst Trkstacscs wcrc ejfbcg, ufj`xj`e `fg lueey nkfstr`jfcg

! Wacy gjg fkt jfneugc r`gj`eac`g rcpe`nchcft

! Wacy a`vc iccf `i`fgkfcgjf tac =4‚s

8/9/2019 RHR and TEA-cartagena

11/34

Akwcvcr J w`s fkt `w`rc kl ` Nkekhij`f prkstacsjs

Jf wajna ` r`gj`eac`g prkstacsjs w`sjfneugcg

Ijnacrf`e w`s `prcnurskr ;

8/9/2019 RHR and TEA-cartagena

12/34

Cvkeutjkf kl WC@ w`s tacf jf twk gjrcntjkf

! Fkt ejfbcg prkstacscs tryjfm tk rc-surl`nc tac ceikw okjft

!

Ejfbcg prkstacscs wjta ` kppy ajfmc

Ejfbcg Sfejfbcg Ejfb`iec

Nkkfr`g-Hkrrcy N`pjtceeknkfgye`r @nne`jh

Fkrw`y Bugk E`tjtugc

M^IJJJ Fkrw`y

Trjtna`rg ^krijc

Gjsnkvcry ^kutcr

8/9/2019 RHR and TEA-cartagena

13/34

Fkt ejfbcg WC@ h`y ic ufst`iec

!

Jftr`-prktactjn gjsekn`tjkf icn`hc ` h`okr prkiech

! ]jta jfnrc`scg lrcqucfnywjta tjhc (up tk 03%) `s tacHNE cekfm`tcs

8/9/2019 RHR and TEA-cartagena

14/34

Fkt ejfbcg WC@ h`y ic ufst`iec

! \`rj`tjkfs kl lrcqucfny v`ry

`nnkrgjfm tk prkstactjn gcsjmf

8/9/2019 RHR and TEA-cartagena

15/34

Fkt ejfbcg WC@ & r`gj`e ac`g

! Jf hkst WC@, r`gj`eac`g rcpe`nchcft w`sfkt nkfsjgcrcg

8/9/2019 RHR and TEA-cartagena

16/34

Fkt ejfbcg WC@ & r`gj`e ac`g! Jf jts c`rey gcsjmf, tac

n`pjtceeknkfgye`r (Cw`eg) jfneugcg `r`gj`e ac`g prkstacsjs

! Akwcvcr, guc tk jfnrc`scg euncfnjcs kftac auhcrus, jt w`s wjtagr`wf lrkhtac h`rbct

!

Jf ` e`tc puiejn`tjkf (0::0), Cw`egrcpkrtcg mkkg rcsuets wjta 7 yc`rs LS(1 n`scs) iut ajs nkfneusjkfs kfwactacr kr fkt rcpe`nc tac r`gj`e ac`gwcrc ufnec`r

8/9/2019 RHR and TEA-cartagena

17/34

Fkt ejfbcg WC@ & r`gj`e ac`g

! Wac H`yk tc`h a`s sakwftac jhpkrt`fnc kl r`gj`e ac`grcpe`nchcft lkr tac ^krijc-Pucstkr prkstacscs (9449)

! Wac MSCT@Y mrkup a`s `esksakwf ta`t ` r`gj`e ac`g `ggsskhc st`ijejty (9440)

8/9/2019 RHR and TEA-cartagena

18/34

Fkt ejfbcg WC@ & r`gj`e ac`g! H`yk tc`h `esk rcvjcwcg 7<

Trjtna`rg JJJ WC@ wjta 04 yc`rs LSwjta tac usc kl ` r`gj`e ac`g jf 1:%kl n`scs

! 1>% kl nkhpejn`tjkfs wjta 34%survjv`e

! Hkst r`gj`e ac`g wcrc cjtacr i`gey

jfscrtcg `fg/kr wrkfmey gcsjmfcg wjta `syhhctrjn pkeyctayecfc wc`r

! Wacy akwcvcr nkfneugcg ta`t `wcee gcsjmfcg `fg jfscrtcg r`gj`eac`g wkueg ic usclue

8/9/2019 RHR and TEA-cartagena

19/34

Ejfbcg WC@ `fg r`gj`e ac`g rcpe`nchcft ! Jf taksc prkstacscs, fk r`gj`e

ac`g rcpe`nchcft w`sjfneugcg jf tac gcsjmf

! H`yk tc`h jf =4: WC@ wcrc`iec tk h`jft`jf tac r`gj`eac`g jf =4% kl n`scs (`fg jf3

8/9/2019 RHR and TEA-cartagena

20/34

]a`t `ikut tac fcw prkstacscs ;

! Gjsnkvcry js ejfbcg! @nne`jh, E`tjtugc `rc ejfb`iec

! Kfey jf tac E`tjtugc, ` r`gj`e

ac`g rcpe`nchcft js p`rt kl tactcnafjquc

8/9/2019 RHR and TEA-cartagena

21/34

8/9/2019 RHR and TEA-cartagena

22/34

Js tac « E`tjtugc ² nkfncpt v`ejg`tcg ;

! Zcs, r`gj`e ac`grcpe`nchcft jfnrc`scgtac st`ijejty kl ikta tacufejfbcg `fg ejfbcggcvjnc

! Kf n`g`vcrs `t g`y 4

]̀ mcfcr HE, Gc \k^ HO, Acfgrjbs ONH, Cymcfg``e G, \crgkfsnakt F. ^t`ijejty kl tac ufejfbcg E`tjtugc tkt`eceikw prkstacsjs? @ ijkhcna`fjn`e jf vjtrk ̀ f`eysjs. Nejfjn`e Ijkhcna`fjns 940>2 91? 349-1.

8/9/2019 RHR and TEA-cartagena

23/34

Jt js prki`iey wkrta rcprkgunjfm tacceikw `f`tkhy jf WC@ iut usjfm `r`gj`e ac`g prkstacsjs r`jscs h`okr

nkfncrfs (wajna `rc `ehkst jgcftjn`e wjta prcscrv`tjkf kl tac f`tjvc r`gj`e

ac`g)

0 s t t ̀ b

c a k h c h

c s s ̀m c

8/9/2019 RHR and TEA-cartagena

24/34

^khc jhpkrt`ft qucstjkfs! Js r`gj`e ac`g rcpe`nchcft ` h`okr kr ` hjfkr

ijkhcna`fjn`e jhprkvchcft ;

! Akw gk tac ek`gs kf tac r`gjk-n`pjtue`r okjft `nt kf tacWC@ ;

! Gk r`gjk-n`pjtue`r ek`gs `etcr tac fkrh`e ijkhcna`fjns kl

WC@ ̀ fg jfnrc`sc strcss kf tac ikfc-prkstacsjs (ku ikfc-nchcft) jftcrl`nc ;

! ]ajna r`gj`e ac`g rcpe`nchcft ;

8/9/2019 RHR and TEA-cartagena

25/34

0- Y`gj`e ac`g rcpe`nchcft ` h`okr jhprkvchcft ;

! Wk g`tc, fk kfc a`s `fy

nkfvjfnjfm `fswcr! Wackrctjn`eey, prcscrv`tjkf kl

r`gj`e ac`g kr jts rcpe`nchcftwkueg ic usclue

! JL `fg KFEZ JL fkrh`e`f`tkhy `fg ijkhcna`fjns `rcrcprkguncg +++

8/9/2019 RHR and TEA-cartagena

26/34

WC@ « n`ffkt ² rcprkgunc fkrh`e ijkhcna`fjns kl tac ceikw

! @ftcrjkr kllsct? :.3 ° 9.> hh (A) `fg =.3° 0.9 hh (L) p54.40. Fk rce`tjkfsajp wjta GNW

! GNW (ncftcr kl trknaec` `fg ncftcr kln`pjtueuh) ? 90.: ° 0.: hh (A) `fg 01.<° 9.4 hh (L) (rc cnts tac sjzc kl tacauhcr`e jhpe`ft)

! @xjs kl tac auhcrus js gjst`ft lrkhNGW ? Q8 4.4:4 ° 4.493 (A) & Q 8 4.0=4 °

.494 (L)! Wac `xjs kl rkt`tjkf js fkt ffxcg (` nkfc

wjta hcgj`e suihjt lrkh cxtcfsjkf tkcxjkf)

Irkwfajee OY, O^C^, 944(7)

8/9/2019 RHR and TEA-cartagena

27/34

9- Y`gj`e ac`g prcscrv`tjkf / rcpe`nchcft hkgjljcs tac ek`gs kfWC@

! Jl fkrh`e `f`tkhy `fg ijkhcna`fjns n`ffkt icrcprkguncg ;

! Jt wjee `gg skhc nkfstr`jfts ejbclkr kvcrstullcg YAY

8/9/2019 RHR and TEA-cartagena

28/34

9- Y`gj`e ac`g prcscrv`tjkf / rcpe`nchcft hkgjljcs tac ek`gs kfWC@

!

@ fkt wcee gcsjmfcg `fg wcee ffttcgYAY wjee rjsc ek`gs

! Jt tac ek`gs `rc fkt i`e`fncg wjta tacuefk-auhcr`e nkfstr`jfts

! @syhhctrjn`e ek`gs wjee jfnrc`sctac rjsb kl ekkscfjfm +++

Y`gj`e ac`g ekkscfjfm `t 0 yc`r LS

8/9/2019 RHR and TEA-cartagena

29/34

8/9/2019 RHR and TEA-cartagena

30/34

>- wajna r`gj`e ac`g prkstacsjs ;! Wac `f`tkhy kl tac f`tjvc r`gj`e ac`g js

`esk vcry v`rj`iec

! Cjtacr jts pksjtjkf kvcr tac fcnb `fggj`paysjs

! Fkfc kl tac r`gj`e ac`g prkstacsjs gcsjmfcggkcs rcprkgunc tajs nkhpecx `f`tkhy

W@IEC 37 9 Y kl @ k jh̀ 144 ^ hj kf `jf Okjf Y ` h f l kh 01 ^ j

8/9/2019 RHR and TEA-cartagena

31/34

Nkfneusjkf? Guc tktac ajma lrcqucfny kl

nkhpejn`tjkfs kl WC@ T`mc?//www.cxpcrtnkfsuetikkb.nkh/cxpcrtnkfsuet/i/ikkb.gk;hctakg…4-I:=1-0-70< 9 ‗

Trjtna`rg,0:10 R>1X

Trjtna`rg JJ :9 4 :4 >.3 04= `rn 04= `rn = < ‗ :0

H`gscf ct`e, 0:1: R>9X

Trjtna`rg JJ 93 044 > 91-0>4 4-0>3 ‗ ‗ ‗ 00 > :4 *

Yjsufm,0::= R74X

Fkrw`y 001 044 7.> ‗ ‗ :3 : 9 :3

Mjee `fgHkrrcy,0::1 R03X

Nkkfr`g-Hkrrcy

0

Ek ct `e,944> R>4X

Nkkfr`g-Hkrrcy

07 > >3-093 4 4 4 044

Ecc ct `e,9443 R91X

Nkkfr`g-Hkrrcy

1 >.3 ‗ ‗ 044 ‗ 044

Ocfscf ct M^I JJJ 0< 3 :4 > =3

j e e e j j j j j j J J

@egrjgmc ct`e, 944< R0X

Nkkfr`g/Hkrrcy 70 94 ‗ ‗ 0> =1

Ncs`r ct`e, 944= R1X

M^I JJJ 77 < ‗ ‗ ‗ ‗ 9 17

Wkt`es 101 1> < >4-0>4 94 94 1:

YE

Y

c

8/9/2019 RHR and TEA-cartagena

32/34

Wk g`tc, tacrc `rcsk h`fy prkiechstk skevc wjta WC@ta`t r`gj`e ac`g

rcpe`nchcft h`yfkt ic ` prjkrjty

9 f g t ̀ b

c a k h c

h c s s

̀m c

8/9/2019 RHR and TEA-cartagena

33/34

8/9/2019 RHR and TEA-cartagena

34/34

;

MY@NJ@^ TKY ^S MCFWJE JF\JW@NJÞF!