Afferent iluphu syndrome: ukuxilongwa kanye nokwelashwa

Izinqubo zokuhlinza Cishe njalo elihlobene ne ingozi. Ngaphezu ukopha kungenzeka phakathi nokuhlinzwa, zikhona izinkinga ezingase zivele ngaphezulu eside. Lokhu kuyiqiniso ikakhulukazi ngokuphathelene manipulations ebanzi lapho ukususwa wenziwa isitho noma ingxenye yayo. Isibonelo ukusebenza Billroth-2. essence yayo siqukethe ekususweni iningi isisu udale i-anastomosis nge emathunjini amancane. afferent iluphu syndrome ngokuvamile eba ngemva kwalokhu ukuhlinzwa. yezinkinga okunjalo ezingavela ngokushesha ngemva kokuhlinzwa, futhi ngemva kwezinyanga ezimbalwa. With ukuthuthukiswa kulesi simo okusolwa, noma-ke kuyadingeka ukuba omunye ukuhlinzwa.

Umqondo afferent iluphu syndrome

Afferent iluphu syndrome ngemva resection esiswini kwenzeka cishe ngo-13% amacala. Lesi sibalo zingahluka kusuka 1 kuya ku-50%, ngokusho kodokotela. uphawu wayo oyinhloko ukuhlanza Bile, ezihlobene ukudla. Afferent iluphu syndrome - isimo lapho ingxenye emathunjini, njengoba kusenjalo namanje abangu "kuvaliwe" enchubeni ukugaya. Ngenxa yalokho, le Bile aqoqana umnyango futhi khona izici ezingezinhle lichitheke. Enye igama laleli inkinga - duodenobilliarny syndrome. Lesi simo kuwuphawu eziyingozi, futhi ngakho-ke zidinga ukwelashwa kuhlinzwa.

Izimbangela yalesi sifo

Isizathu esikhulu afferent iluphu syndrome eyohlinzwa Billroth-2. Kuyinto ukuhlinzwa okukhulu futhi sithinta wonke umzimba. A ukusebenza efanayo wenziwa umdlavuza esiswini, ukuthuthukiswa yezinkinga peptic isilonda isifo, okuyinto kungenakususwa ngendlela emnene ngaphezulu. Ngenxa yalokhu manipulation emathunjini duodenum nabancane Akasekho bahileleke nesenzo ukugaya. Ngenxa yalokhu syndrome elikhulayo afferent iluphu.

Izinto ukuthonya okwenziwe ngaleli inkinga, kukhona ukwephulwa lokhu okulandelayo:

1. imbangela Mechanical. Ngezansi kwakusho uquqaba ukudla ngokufaka inesikhala "off" kokuhlanganisayo. Futhi, lapho zanqwabelana Bile, nakho kubambezela inqubo ukugaya.
2. Ukulahlekelwa imisipha ithoni ku "off" sigaba. Lokhu isizathu ngokuvamile kubangela syndrome njalo afferent iluphu ngemva resection.
3. Spasm ka anastomosis - kwalapho kuhlangana khona isiphunzi salesi isisu emathunjini amancane. imisipha kungabuye encishisiwe futhi esidayisa iluphu.
4. isici esidalwa yizilonda emathunjini sibe phakathi anastomosis. It kuholela ukubukeka isizathu mechanical afferent iluphu syndrome. Kungase uthuthuke njengomuntu oyinhloko (ngemuva kokuhlinzwa), futhi okwesibili.
5. Ukuphakama kwephimbo iluphu afferent. Ngokuvamile sibangelwa futhi.

Afferent iluphu syndrome: pathogenesis lesi sifo

Lo mshini afferent iluphu syndrome siqukethe amayunithi eziningana. Okokuqala kukhona ukwephula ingeyomzimba ekuxhumaneni evamile yokwakheka futhi zisebenza kahle. Ngenxa "wokufakelwa" kabusha wokugaya ukudla enqubweni yesistimu ukudla kuyahlukahluka basishiye. Ukudla, zibalwa ku "off" loop emathunjini, awakwazi ukudlulela phambili. Ngakho-ke kukhona uyiphonse emuva - Reflux. Ngaphezu kwalokho, e-pathogenesis we ukuvuvukala inqubo samanje. Kwenzeka ngenxa yokujama tsi abantu futhi wokugaya ukudla hypotension KDP. Imiphumela iba yinhlanganisela yokukhandleka dysbiosis yesibili emathunjini. Kamuva kuholela ukuvuvukala ipheshana wokugaya ukudla: cholecystitis, pancreatitis, esophagitis.

Lwasemtholampilo isithombe afferent iluphu syndrome

I ukubonakaliswa esemqoka yalolu yinkinga lokhu ubuhlungu nokuhlanza. ukungakhululeki besisu kungenzeka ngokushesha noma ngemva kokuhlinzwa ngokuhamba kwesikhathi. Esimweni sokuqala kukhona eyinhloko, afferent acute iluphu syndrome. It libhekene cramping nobuhlungu Expander nesimo sakhe hypochondrium kwesokudla futhi epigastric. Ngo syndrome ezingamahlalakhona okuholela emitholampilo isithombe iluphu sivezwe okungaka. Ubuhlungu kwenzeka ikakhulukazi ngemva kokudla, kaningi - at yokwamukela ukudla okunamafutha. Kungakhathaliseki isikhathi nesenzakalo yezinkinga (inkathi oyingozi noma ezingamahlalakhona) siyenzeka ukuhlanza. Ngaphambi kokuba kufike ukuphela ukuvelela ubuhlungu esiswini, ngokuvamile ilandela uhlu ukudla. Ngenxa ukuhlanza njalo kungase ukwaba ofika ku-500 nge-ml usuku Bile. Imiphumela iba yinhlanganisela yokukhandleka okuqhubekayo Ukuwohloka emzimbeni. Iziguli ngokushesha ulahlekelwe isisindo somzimba, uzizwe ubuthakathaka jikelele.

Afferent iluphu syndrome: zokugula zokuxilonga

Ukuxilongwa sifo iqala anamnesis (gastrectomy idluliselwe) nokuhlola isiguli. Okokuqala odinga ukukwazi mayelana nohlobo ubuhlungu futhi ukuvama ukuhlanza, uxhumano wakhe nge amasu ukudla. On luhlolo, kufanele sinake asymmetry besisu: ilungelo izinti umnyango. Lokhu uphawu amuke emva ukuhlanza, njengoba okuqukethwe iluphu uyaphuma. Esinye isici iyona jaundice we sclera nesikhumba.

Ngaphezu kokuhlaziywa kwamathenda idatha emitholampilo, elabhorethri nokuhlola wezinsimbi. Izinguquko kungenzeka Kla (B-12 ukuntula anaemia), igazi smear, coprogram (ukubukeka leukocyte, amafutha undigested). Lapho-X-ray ekushayweni waphawula uphawu nasembonini iluphu afferent, dyskinesia gipermotornaya. I-ejenti Ngokuphambene igcwalisa loop okuholela. Futhi wenziwa luhlolo endoscopic. Ngo ezingamahlalakhona afferent iluphu syndrome ngokuvamile imakwe izinguquko ukuvuvukala kule gallbladder futhi mapayipi. Kwezinye izimo, pancreatitis eba. Uma lokhu ukuvuvukala echayeke kanye amanyikwe. Lapho ayihlwanyelayo okuqukethwe emathunjini flora webhaktheriya siyenzeka, isilinganiso kahle enzyme pancreatic. Kobukhulu isifo kunqunywa Ukuwohloka umzimba, ubukhulu ukulahlekelwa Bile nesineke.

Iyini ingozi ka afferent iluphu syndrome: yezinkinga

Kufanele kukhunjulwe ukuthi lesi sifo afferent iluphu kuyinto isimo esibucayi of resection esiswini. Ukulahlekelwa esiqhubekayo Bile kungenzeka Ukuwohloka kabi umzimba. Ukudla ingena emzimbeni ayikwazi inhlabamkhosi (ngenxa "off" le KDP futhi ingxenye emathunjini amancane), kanye nezakhi kungukuthi ugxile. Ngenxa yalokho ukuthuthukiswa dysbiosis emathunjini izitho emathunjini bavezwa izinqubo ukuvuvukala. With ukuthuthukiswa Reflux esophagitis ukuze izimpawu ezibalwe engezwa ubuhlungu besifuba, umuzwa "yinhlama emphinjeni." Cholecystitis kuhambisana ukunambitheka ababayo emlonyeni, isicanucanu. Uma ijoyina ukuvuvukala kwamanyikwe, kuba buhlungu kube kukhulu ukuba herpes uhlamvu. Lapho isikhathi pancreatitis bamanje bangaba ukuthuthukisa sikashukela. Izinkinga of acute afferent iluphu syndrome zihlanganisa peritonitis, isimiso emathunjini. Lezi zifo zidinga ukunakekelwa ngokushesha kuhlinzwa.

Ukwelashwa yalesi sifo ka afferent iluphu

Kukhethwa ukwelashwa incike nesineke, idatha laboratory neluhlolo wezinsimbi. Kubalulekile ukwazi ukuthi kobukhulu syndrome has afferent iluphu. Ukwelashwa kungaba ngoludala futhi kuhlinzwa. ezibekiwe Ezintsha olukhethekile lokudla, ukuvuvukala nezidakamizwa elwa namagciwane (ukuthaka imithi "Tsefriakson", "Tsiprolet"). Kwezinye izimo zidinga okuphindaphindiwe lavage esiswini. Ngezinye isidingo ukwelashwa nokulinganisela ezinzima kuhlinzwa. Kumele okuhloswe ngalo ukuqeda le engalulami ukudla. Ngokuvamile ukukhiqiza ukuvuselelwa anastomosis. Lapho yena egoba okuholela izihibe enamathiselwe isikhundla lesifanele kanye sutured kuya peritoneum. Inani uhlobo ukwelashwa kuhlinzwa kungaba ezahlukene futhi kuncike yezinkinga imbangela.

Ukuvimbela afferent iluphu syndrome

Okwamanje, ukuhlinzwa ukuze Billroth-2 zama ukuyikhipha ucabange ezinye izinqubo zokuhlinza. Lokhu kwenziwa ukuze alondoloze physiology ipheshana wokugaya ukudla. Uma Billroth-2 ukusebenza okwamanje enziwe, kubalulekile ukuba afeze konke izinyathelo zokuvimbela ebekwe udokotela. Ngokuyinhloko lokhu kuhlanganisa ukudla. Ngemva resection akakwazi ukudla okunamafutha kanye nokudla okungenamsoco. Thatha ukudla udinga izikhathi 6-7 ngosuku in izingxenye ezincane kanye nesimo-semi okusamanzi (iphalishi, amasobho).