{"id":12172,"date":"2023-08-23T14:45:44","date_gmt":"2023-08-23T14:45:44","guid":{"rendered":"https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/?p=12172"},"modified":"2025-06-13T09:39:27","modified_gmt":"2025-06-13T09:39:27","slug":"llr-arp-2-policy-for-management-of-abdominal-hernias-in-adults","status":"publish","type":"post","link":"https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/pl\/llr-arp-2-policy-for-management-of-abdominal-hernias-in-adults\/","title":{"rendered":"Polityka LLR dotycz\u0105ca leczenia przepuklin brzusznych u doros\u0142ych"},"content":{"rendered":"

Kategoria<\/strong><\/p>\n\n\n\n

Kryteria progowe<\/p>\n\n\n\n

Przepuklina pojawia si\u0119, gdy wewn\u0119trzna cz\u0119\u015b\u0107 cia\u0142a przepycha si\u0119 przez os\u0142abienie mi\u0119\u015bnia lub otaczaj\u0105cej \u015bciany tkanki.<\/p>\n\n\n\n

Niniejsza polityka obejmuje leczenie przepuklin brzusznych, w tym przepuklin pachwinowych, udowych, p\u0119pkowych i pooperacyjnych, wraz z kryteriami skierowa\u0144\/leczenia. Termin \u201eprzepuklina brzuszna\u201d jest terminem niespecyficznym i mo\u017ce obejmowa\u0107 przepuklin\u0119 p\u0119pkow\u0105, nadbrzusza lub naci\u0119cia, dlatego nale\u017cy zastosowa\u0107 bardziej szczeg\u00f3\u0142owy termin.<\/p>\n\n\n\n

Uprawnienia<\/strong><\/p>\n\n\n\n

LLR ICB sfinansuje leczenie przepuklin brzusznych w nast\u0119puj\u0105cych przypadkach<\/strong>
-\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Przepukliny u kobiet<\/strong>
Wszystkie osoby, u kt\u00f3rych podejrzewa si\u0119 przepuklin\u0119 pachwinow\u0105, nale\u017cy kierowa\u0107 do lekarza ze wzgl\u0119du na zwi\u0119kszone ryzyko uwi\u0119zienia\/uduszenia.
-\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Przepukliny pachwinowe:<\/strong>
Leczenie chirurgiczne bezobjawowych lub \u0142agodnych przepuklin pachwinowych u doros\u0142ych
NIERUTYNOWNIE FINANSOWANE<\/strong>

Gdy objawy s\u0105 \u0142agodne, ryzyko powik\u0142a\u0144 jest niskie. Istniej\u0105 dowody na to, \u017ce bezobjawowe przepukliny pachwinowe mo\u017cna bezpiecznie leczy\u0107 nieoperacyjnie \u2013 poprzez uwa\u017cne czekanie. Odzie\u017c taka jak spodnie przepuklinowe mo\u017ce zapewni\u0107 wsparcie pacjentom z przepuklin\u0105
Pacjenci powinni by\u0107 kierowani, je\u015bli spe\u0142niaj\u0105 poni\u017csze kryteria
o Wyst\u0119puje przepuklina pachwinowo-mosznowa
o Zwi\u0119ksza si\u0119 z miesi\u0105ca na miesi\u0105c
o B\u00f3l lub dyskomfort znacz\u0105co utrudnia codzienne funkcjonowanie
o Historia przebywania w wi\u0119zieniu lub rzeczywiste trudno\u015bci w usuni\u0119ciu przepukliny
\u00a0<\/strong>
-\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Przepukliny udowe:<\/strong>
Wszystkie osoby, u kt\u00f3rych podejrzewa si\u0119 przepuklin\u0119 udow\u0105, nale\u017cy skierowa\u0107 do specjalistycznej opieki ze wzgl\u0119du na zwi\u0119kszone ryzyko uwi\u0119zienia\/uduszenia
-\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 P\u0119pkowe, oko\u0142op\u0119pkowe:<\/strong>
Przepukliny p\u0119pkowe pojawiaj\u0105 si\u0119 jako bezbolesny guzek w p\u0119pku lub w jego pobli\u017cu. Wi\u0119kszo\u015b\u0107 rozwi\u0105\u017ce si\u0119 sama. Przepuklin\u0119 p\u0119pkow\u0105 u dzieci do 2. roku \u017cycia operowa\u0107 si\u0119 b\u0119dzie dopiero po trzecim roku \u017cycia.
Wskazaniem do naprawy operacyjnej jest m.in
B\u00f3l
o Uwi\u0119zienie
o Uduszenie
o Wada wi\u0119ksza ni\u017c 1 cm
o Owrzodzenie sk\u00f3ry
o P\u0119kni\u0119cie przepukliny
\u00a0
-\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Przepukliny nadbrzusza<\/strong>
Przepuklin\u0119 nadbrzusza nale\u017cy wyra\u017anie odr\u00f3\u017cni\u0107 od rozwidlenia mi\u0119\u015bnia prostego, czyli poszerzenia kresy bia\u0142ej bez ubytku powi\u0119zi.
Pacjenci powinni by\u0107 kierowani, je\u015bli spe\u0142niaj\u0105 poni\u017csze kryteria
o Przepuklina powi\u0119kszaj\u0105ca si\u0119
o B\u00f3l brzucha
o Nudno\u015bci i wymioty
\u00a0
-\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0Przepuklina rozetna<\/strong>
Bezobjawowe przepukliny pooperacyjne nie wymagaj\u0105 leczenia operacyjnego.

. Rozej\u015bcie mi\u0119\u015bni prostych brzucha<\/strong>
\u00a0<\/strong>
Zabiegi chirurgiczne NIE s\u0105 zlecane. Naprawa nie wi\u0105\u017ce si\u0119 z dobrymi d\u0142ugoterminowymi wynikami, a zwi\u0119kszone ryzyko przepukliny pooperacyjnej. Rozwa\u017c fizjoterapi\u0119.
<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Przewodnictwo<\/strong><\/p>\n\n\n\n

https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK395550\/<\/a><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
ARP 2. Data przegl\u0105du: 2027<\/td><\/tr><\/tbody><\/table><\/figure>","protected":false},"excerpt":{"rendered":"

Category Threshold Criteria A hernia occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. 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