I-stenosis esophageal: izimbangela, izimpawu, ukwelashwa

Ukuqina kwesifo - isimo esihambisana nokunciphisa umzimba kwe-lumen ye-tube esophageal. I-anomaly enjalo ingaba yintshonalanga noma ibonakale eminyakeni yobudala engaphezulu. Izifo zingaholela ezinkingeni eziningi. Ngaphezu kwalokho, izinkinga ngokugwinya nokwedlulisa ukudla esiswini zinomthelela omuhle enhlalakahleni yesiguli kanye nomsebenzi wenyama yonke. Ngakho kungani kuvela ukukhubazeka futhi ingabe ukuthuthukiswa kwayo kungavinjelwa? Yiziphi izimpawu okufanele ngizinake? Ingabe kukhona ukwelashwa okuphumelelayo ngempela?

Ukuqina kwesisu: kuyini?

Njengoba uyazi, i-oophagus iyishubhu engenazimboni ezixhuma i-pharynx nesisu. Ubude bayo obude buyi-25 cm. Ngokuvamile, ububanzi be-tube abufani - i-oophagus inezinto ezintathu ezithinta umzimba, ezitholakala esifundeni se-cartilage ye-cricoid, i-tracheal bifurcation nokuvula ukuvula.

Ku-gastroenterology yanamuhla, ukukhubazeka okuthiwa i-stenosis yesifo ijwayelekile. Kuyini? Lezi zifo, ezihambisana ne-uncharacteristic encane ye-tube esophageal. Njengoba kukhona ubudlelwane obuseduze phakathi kwalesi sigaba somgogodla nezinye izitho (ikakhulukazi, i-trachea, i-aorta, i-pericardium, i-bronchus eyesobunxele, isiqu se- vagus nerve, i- thoracic conduit, ingxenye ye-pleura), khona-ke ukuphazanyiswa kokusebenza kwayo kuhlotshaniswa nobukhulu bezinkinga.

Izimbangela eziyinhloko zokuthuthukiswa kwezifo

Zikhona yini izici eziyingozi ezingabangela isifo esinjalo? Ukuqina kwesifo kungaba nezimbangela ezihlukahlukene. Uma sikhuluma ngezinhlobo zokuzalwa zesifo, zihlobene nokuphulwa kokuthuthukiswa kwe-embryonic, ngenxa yalokho okukhona ukuxoshwa kwendonga yamasipha yomzimba, ukubonakala kwamagceke anezintambo noma ama-cartilaginous.

Ngokuqondene nezibalo ezitholakalayo, izizathu zazo zihluke kakhulu:

• Isibonelo, i-membrane ye-mucous ingonakaliswa ngokuxhumana njalo ne-asidi okuqukethwe kwesisu. Okufanayo kubonakala nge-reflux-esophagitis, izilonda ze-peptic, i-gastritis engapheli, i- hernia ye-diaphragm noma ngisho ne-toxicosis ejulile yabesifazane abakhulelwe, uma ihambisana nokuhlanza njalo.
• Kubalulekile ukukhuluma ngokulimala. I-stenosis eyingozi kunayo yonke ibonakala ngokushisa okushoyo okwemvelo, kanye nangenxa yokulimala odongeni lomzimba wangaphandle. Ungalimala ngesikhathi sezinqubo ezihlukahlukene zokuxilonga, kufaka phakathi ukuzwa kwesisu.
• Ukuvalwa okulula noma okuphelele kwe-lumen kubonakala ngenxa yomdlavuza wesifo noma ukubonakala kwe-neoplasms enobungozi.
• Ukuqina kwesifo kungase kuhlotshaniswe nezifo ezithathelwanayo, kufaka phakathi izifo, imfiva ebomvu, i-syphilis, isifo sofuba, i-diphtheria.
• Kwezinye izimo, ukugxilwa kwe-tube futhi kuhlotshaniswa ne-pathology yezitho ezizungezile. Isibonelo, i-oophagus ingacindezelwa yizikebhe ezingavamile noma izakhi zamakhansela ezikhulisiwe. Ngezizathu ezingenzeka ukuthi zithwale isisu se-mediastinum ne-aneurysm ye-aorta.

Amafomu we-stenosis nezici zawo

Kunezinhlelo eziningi zokuhlukanisa lezi zifo. Isibonelo, isifo se-stenosis singaba sesibhedlela noma sitholakale. Ngendlela, ngamacala angu-90%, kuyindlela yokuzalwa yesifo esenzekayo.

Kuye ngenani lezindawo ezithintekile, ama-stenoses angabodwa ahlukanisiwe (isibonakaliso se-esophagus sincane kuphela endaweni eyodwa) futhi siningi (kunezindlela eziningana zokuguqula izifo). Qaphela ukutholakala kwendawo yesayithi yokunciphisa umzimba, ukuhlukanisa izifo ezitholakala kwisimo somlomo wesibeletho esiphezulu, isigaba esiphakathi (sigaba esincane sitholakala ezingeni le-trachea ne-arch of the aorta), phansi (ukugxila kwe-pathology kusemnyangweni wenhliziyo) futhi kuhlangene.

Kukhona ukwahlukana ngezizathu zesifo. Isibonelo, i-cicatricial stenosis ye-esophagus ibonakala ngokulimala embranini yamangcwaba, futhi ngezinye izikhathi umcibisholo wamasipha we-tube. Esikhathini sendawo isisindo esonakele kancane kancane sibonakala izicubu ezixhumeneyo - yilokho okwenziwa khona ubude. Isizathu, njengomthetho, isifo se-reflux esingapheliyo se-gastroesophageal. Ngezinye izikhathi ukugxila kuhlotshaniswa nokwakheka nokukhula kwezicubu, okungaba kokubili okuhle nokubi. Kunezimo ezibuhlungu zesifo. Kunoma yikuphi, kungenzeka ukucacisa ngokuqondile izici nezici zesifo kuphela emva kokuxilongwa ngokucophelela.

Izinyathelo zokuthuthukiswa kwesifo

Emtholampilo wanamuhla, kuvamile ukuhlukanisa amazinga amane e-stenosis:

• Esigabeni sokuqala, lesi sifo sihambisana nokunciphisa ukukhanya kwe-lumen kuya ku-9-11 mm ububanzi. Ngakho-ke kungenzeka ukuthi kungenzeka ukuthi ufake i-endoscope yobukhulu obujwayelekile.
• Mayelana nesigaba sesibili sikhulume lapho kwenzeka ukuthi ububanzi be-lumen yesigcawu endaweni ye-stenosis yehlelwa ku-6-8 mm. Noma kunjalo, kusengenzeka ukwethula i-fibrobronoscope ngayo.
• Esigabeni sesithathu, i-tube esophageal igxile futhi ububanzi bayo abudluli 3-5 mm. Ngalesi sayithi udokotela angangena kuphela i-fibroscope ekhethekile, elula kakhulu.
• Isigaba sesine sokuthuthukiswa kwalesi sifo sibonakala ngokugxila okuqinile kwe-lumen, ububanzi bayo buyi-1-2 mm. Ezinye iziguli zinokuvinjelwa okuphelele kwesifo, okuyingozi kakhulu.

I-esophagus stenosis: izimpawu

Ekuqaleni lesi sifo sitholwa, ngokushesha isiguli siyothola ukwelashwa okudingekayo. Ngakho-ke yiziphi izimpawu zesimo se-stenosis? Izimpawu zixhomeke kakhulu esimweni nasesiteji sokuthuthukiswa kwesifo.

Uma kungumbuzo wokubeletha kokubeletha, khona-ke "izingcingo eziyingozi" zokuqala zingabonwa ngokushesha. Ngemuva kokudla, ingane ngokuvamile iveza ubisi obungashintshi. Ungabona futhi ukuqina okuqinile kwe-mucus kusuka emaqenjini angasese, kanye nokwehla okukhulu.

Uma kwenzeka ukuthi ingane inesimo esilinganiselwe sokuzalwa kwesisu, izinkinga ziqala ngokusungulwa kokudla kokuqala noma ukudla okuqinile ekudleni.

I-pathology etholakalayo iqala kancane kancane. Njengomthetho, iziguli zinzima ngokugwinya. Isibonelo, kungase kube buhlungu uma udlulisa ukudla ngokusebenzisa isisu, kanye nokubukeka kobuhlungu ngemuva kwe-sternum. Ezimweni zokuqala, i-dysphagia ibonakala ngokusetshenziswa kokudla okuqinile, kodwa njengoba ithini le-esophageal lincane, kuba nzima ukuba umuntu agwinye ngisho nokudla okuketshezi. Ngezinye izikhathi lesi sifo sibe sibi kangangokuthi isiguli asikwazi ukugwinya amanzi noma ngisho namathe.

Uma i-stenosis isesifundeni somlomo wesibeletho, kodwa uketsheziza amanzi noma izingcezu zokudla kungangena emthonjeni, ogcwele ukukhwehlela okuqinile, i-laryngospasm, ukuqubuka komzimba. Ezimweni ezinzima kunazo zonke, i-stenosis iholela ekuthuthukiseni i-aspiration pneumonia.

Ngokuvamile, izingcezu zokudla eziqinile nezikhulu ziqala ukubuthelwa endaweni ye-constriction, okuholela ekusikeni kwesisindo nokuhlanza okuvamile, ukubukeka kwesifo esibi kakhulu. Emiphumeleni engozini ye-stenosis ingabhekwa ukuhlukumeza okuzenzakalelayo kwodonga lwe-esophagus.

Izindlela zesimanje zokuxilonga

Ngisho nangemva kokukhuluma nesiguli, udokotela angakwazi ukuveza izinsolo mayelana nokuba khona kwe-stenosis. Yiqiniso, ucwaningo olwengeziwe luyadingeka. Okokuqala, udinga ukuqhuba i-esophagoscopy, lapho ungathola khona ukukhanya kwe-lumen yesisindo bese ulinganisa ububanzi bayo, futhi uhlole i-membrane. Lapho kukhona izipholaki noma izilonda, i-biopsy endoscopic ingenziwa ngokuba khona kwamaseli abulalayo.

Indlela engabalulekile yokuxilongwa yi-radiography ngokusetshenziswa kwe-medium medium (njengomthetho, isilondolozi se-barium). Le nqubo kusiza ukutadisha ukukhululeka kanye nemikhawulo yesigcawu, kanye nokufunda i-peristalsis yayo.

Yiziphi izindlela zokwelapha umuthi wamanje wanikelwa?

Uhlelo lwezokwelapha luxhomeke ezintweni eziningi, kufaka phakathi uhlobo lwe-pathology, isiteji sokuthuthukiswa kwalo, isimo sesiguli, kanye nezimbangela ze-stenosis. Okokuqala, udinga ukushintsha ukudla - ukudla kufanele kube nokudla okuphakathi kwamanzi kanye noketshezi, okungadlulela ekunciphiseni kwegazi. Uma kungumbuzo obizwa ngokuthi i-dysphagia wesilinganiso sesine, lapho isiguli singakwazi ngisho nokuphuza amanzi, ukudla kulawulwa ngaphakathi.

Kunezindlela eziningana zokuqeda ukunqanda. Ezimweni ezinzima kakhulu, ibhaluni yokuxilonga kwenziwa nge-candle. Kodwa uma i-stenosis ingazibophezeli ezindleleni ezifanayo zokunwetshwa, i-dissection endoscopic yalezi zinsika zenziwa. Uma kwenzeka ukuthi kukhona ukucindezeleka kwesimiso (isibonelo, ukusondeza eduze kwe-tumor ekhulayo), i-stent ekhethekile ingangeniswa ngaphakathi kwe-lumen, ezogcina ubukhulu obudingekayo bendawo.

Ngezinye izikhathi kwenzeka ukuthi lezi zindlela ezingenhla zinganiki umphumela oyifunayo, i-stenosis iyaqhubeka nokuqhubeka. Udokotela anganquma ngesinqumo esinqunyiwe - ukususa ingxenye ethintekile yendawo bese elulama.

Ingabe ukwelashwa kungenzeka ngezindlela zomuntu?

Imithi yendabuko yimboni ehlinzeka ngenani elikhulu lezinye izindlela zokwelashwa. Kungenzeka yini ukuba uziqede isifo esinjengesi-stenosis esophageal? Ukwelashwa ngamakhambi omuntu kuleli cala akumukeleki. Kungenzeka ukuthi udokotela uzakutusa ukulungisa ukudla noma ukunikeza ezinye iziyalezo. Ukwelashwa kwasekhaya kuleli cala kuboniswa ngokungafani.

Zikhona izinyathelo zokuzivikela eziphumelelayo?

Ngeshwa, izindlela zokuvimbela ngempela azikho. Ngokuqondene namafomu okuzalwa, kubalulekile ukuba umama aqaphe isimo sezempilo. Lapho kubhekene nezimo eziyingozi (ukukhulelwa okudluliselwa ngesikhathi sokukhulelwa, njll), ukuhlolwa kufanele kwenziwe ezinsukwini zokuqala emva kokuzalwa kwengane ukuze ukwazi ukulungisa ukudla nokuthatha izinyathelo zokuphepha ngesikhathi.

Lapho esemdala, isiguli siyalulekwa ukuba silandele ukudla, kanye nokwelapha izifo zesigamu sokugaya ukudla ngesikhathi, singavumeli ukuguqulwa kwabo kube yindlela elula noma engapheli.

Ukubikezelwa kweziguli ezine-stenosis esophageal

Uma kungekho ukwelashwa okufika ngesikhathi, i-stenosis ye-esophageal ingabangela izinkinga eziningi. Noma kunjalo, ukungenelela kokuhlinzeka kungaphazamisa ukwephula. Yiqiniso, lapho kunezifo ezithintekayo, ukwelashwa okwengeziwe kuyadingeka. Noma kunjalo, ukuchazwa kwesiguli kunomusa kakhulu. Ukubuyela emuva kungenzeka, kodwa ngokusho kwezibalo, amacala anjalo ahlukile futhi ayabhalwanga kalula.