Ukuphulukisa i-hernia yokuvulwa kwe-esophageal ye-diaphragm: izimpawu kanye nokwelapha

I-Hernia yokuvulwa kwe-esophageal ye-diaphragm (isithombe sokuthi isithombe se-pathology siboniswe ngezansi kulesi sihloko) futhi i-reflux esophagitis yizifo eziyingozi kakhulu. Ngokuphathelene nalezi zimo kukhona ukwelula izingxenye ezithile zomuthi wamathunjini. Ngokuyinhloko, izinguquko zenzeka emigogodleni esekela isisu nesisu, isithombe esinikezwa futhi kulesi sihloko. Ngenxa yokweluleka, ukuhamba endaweni kwenzeka. Ngokuyinhloko, ingxenye yesisu esiswini eliphezulu ivela esifundeni se-thoracic. Ngenxa yalokho, ukusebenza kwe-sphincter okuxhuma isisu nesisu kuphukile (isithombe sibonisa leli sayithi).

Ingozi engenzeka

Ngeshintsho engxenyeni ye-Guiss nokuphulwa komsebenzi we-esophageal (ephansi) sphincter, okuqukethwe kwe-asidi kwesisu noma i-bile kuphonswa ku-duopenus kusukela ku-duodenum. Le nqubo ihambisana nokuthuthukiswa kokuvuvukala, ukuhlelwa kabusha kwe-mucosa. Lokhu kwandisa kakhulu ingozi yomdlavuza. Okubaluleke ngokukhethekile ekuthuthukiseni ukwelashwa yi-hernia ehambayo yokuvulwa kwe-diaphragm. Ukusebenza kuyindlela kuphela etholakalayo yokuqeda lephulwa. Kodwa-ke, ukungenelela okuhlinzekwayo kunezinhlobo zakhe. Okulandelayo, ake sihlole ngokuningiliziwe ukuthi yini eyakhelwe ngayo i-hernia ye-esophageal of the diaphragm. Amadigri, izinhlobo kanye nokubonakaliswa kuzophinde kuchazwe esihlokweni.

Ulwazi jikelele

I-Hernia kuleso sikhumba ngokuvamile ihlanganiswa nesifo se-gastroesophageal. I-GREB ihambisana nenkinga yezifo ze-cardiological, pulmonological kanye ne- dyspeptic. Zivela ngokuyinhloko ngenxa ye-refnia ne-gastroesophageal reflux. Ngokusho kwedatha yezinhlangano zaseMelika naseYurophu, uma umuntu enesifo se-GVLP, amathuba okuba nomdlavuza emva kweminyaka emihlanu kuya kwengu-12 ikhula ngo-270% eminyakeni emihlanu kuya ku-12, futhi ngo-350-490% eminyakeni engu-12 (kuye ngokuthi iminyaka).

Ukukhula kwesifo

I-GAPD, ngokusho kwabalobi abaningana, kubhekwa ukuthi iyisifo esifanayo esivame ukutholakala, njengesibonelo, i-cholecystitis noma isilonda se-esophagus. Ngokusakazeka kwabo, lezi zifo zithatha isikhundla esiphambili phakathi kwezifo ze-GI. I-GVAP, njenge-ulcer ulcer, ibhekwa njengesifo esiyingozi, sidinga ukuxilongwa ngesikhathi esifanele nokuqapha ngokucophelela.

Ukuhlukaniswa

Kunezigaba ezintathu eziyinhloko ze-HVAC. Lokhu kufaka:

• I-herxial herxial yokuvulwa kwe-esophageal ye-diaphragm. Lesi sifo sinamanye amagama. Igama elivamile lingumtholampilo olahlayo wokuvulwa kwe-esophageal we-diaphragm. Loluhlobo lwe-pathology luyatholakala kuma-90% weziguli. Lesi simo sibonakala ngezigameko ze-cardia ngaphezu kokuvulwa kwe-esophageal. Mayelana nalokhu, ukuphulwa okubukhali komsebenzi wokuvala kuphawulwe.
• I-paraesophageal hernia. Leli fomu litholakala kuma-5% weziguli. Ngoba ukukhubazeka kwaloluhlobo luyisici sokungahambi kahle kwesimo se-cardia kanye nokuvinjelwa okukhulu kwesisu.
• Isikhathi esifushane. Njengesizimele, lesi sifo asivamile ukutholakala. Lesi sifo siyinkinga ekuthuthukisweni. Njengomthetho, le syndrome ihambisana ne-hernia ehambayo yokuvulwa kwe-esophageal ye-diaphragm. Ibuye iboniswe nezinqubo zokuvuvukala nezinkomba.

Sliding hernia

Leli fomu lesifo libhekene nezinye izici. Ngokuvamile, i-hernia ehambayo yi-protrusion, lapho enye yezindonga ihlanganiswa ingxenye yelungu le-peritoneal. Kungenzeka ukuthi, ngaphezu kwesayithi elihlolwe kulesi sihloko, isisu, ukukhuphuka nokwehla kwamanzi, njalonjalo. Kulesi sikhwama semithi singase singabi. I-protrusion kuleli cala ikhiwa yizingxenye zelungu elingavali yi-peritoneum.

Indlela yokwenzeka

Ngokuhambisana nalesi sici ukuhlukanisa:

• Umlando wakhe wokuzalwa. Kulesi simo, izitho ngezizathu ezithile noma ezinye izigaba, ezingavaliwe yi-peritoneum, kancane kancane ziya esakhiweni sesango elingaphakathi emathisini e-retroperitoneal. Ngesikhathi esifanayo baphuma emgodini. Le nqubo ingaqala esikhathini sokuqala. Ngenxa yalokho, izingxenye ezifudukayo ziba yingxenye yokufakela ngaphandle kwesigxobo.
• Ukuphulwa okutholakale. Ama-Hernias alolu hlobo awakhiwa ngenxa yokuqhaqhazeka kwamathambo noma izingxenye zesisu. Ayinayo ikhava ye-serous futhi ihambisana ne-peritoneum.

I-inguinal efaka ama-hernias emathunjini amakhulu, njengombuso, iyinhloko yesayizi enkulu ngamasango amakhulu. Kuthathwa, njengomthetho, ekugugeni. Itholakala nge-X-ray izindlela zokuhlola amathumbu amakhulu. Ukwehlisa i-hernia esiqandisini kubonakaliswa yizifo ze-dysuric. Ezigulini, kune-urination double. Ukukhishwa kokuqala kuqhutshwa njengokuvamile, bese kuthi, ngokucindezelwa ku-protrusion, kunesinye isifiso, futhi isiguli sigodla futhi. Uma kutholakala ukuthi, i-catheterization ne-cystography zenziwa. Phakathi nalezi zinqubo, ukuma nobukhulu be-hernia, ukungabikho noma ukutholakala kwamatshe esithombeni kubonakala.

I-herxial herxial yokuvulwa kwe-esophageal ye-diaphragm

Lesi sifo siwukufuduka kwesisu noma ezinye izitho zangasese esifubeni. Lesi sifo sitholakale ku-5% wabantu abadala. Ngesikhathi esifanayo, cishe isigamu seziguli aziboni noma yikuphi ukubonakaliswa. Le nkambo ye-pathology ingenxa yokuthi i- hernia ehambayo yokuvulwa kwe-esophageal ye-diaphragm isulile izimpawu zesimo esivamile, ngoba i-bulging itholakala ngaphakathi komzimba futhi ayitholakali ngesikhathi sokuhlolwa kwesikhashana. Lesi sifo sithinta abesifazane kaningi kunamadoda. Ezinganeni, i-pathology iningi lizalwa ngokwemvelo.

Amafomu wesifo

I-hernia ehambayo yokuvulwa kwe-diaphragm ye-esophageal ihlukaniswe yaba:

• I-cardiofundal.
• Ingqikithi yesisu.
• I-cardiac.
• I-subtotal esiswini.

I-hernia ye-parasophageal ihlukaniswa ibe:

• Amathumbu.
• Ibhokisi lokugxilisa.
• Amathumbu.
• I-Antral.
• Okuyisisekelo.

Izigaba ze-pathology

Ukwehlisa i-hernia yokuvulwa kwe-diaphragm kungachazwa ngokuvumelana nesibalo sesisu esisongela emgodini wesifuba:

• Isigaba sokuqala. Kule nkinga, ingxenye yesisu yesisu isesigodini sesifuba esingaphezu kwesifenqo. Ngesikhathi isisu sisesikhundleni esiphakanyisiwe. Ihlanganiswe ngqo ku-diaphragm. Futhi ezingeni lakhe i-cardia.
• Isigaba sesibili. Esigodini se-thoracic ingxenyeni yesisu yesisu, isisu sitholakala ngokuqondile endaweni yokuvulwa kwe-diaphragmatic.
• Isigaba sesithathu. Ngaphezulu kwe-diaphragm kukhona i-cardia, umzimba wesisu kanye nesezansi (ngezinye izikhathi isifunda se-antral), isisu somzimba.

Isithombe somtholampilo

Izimpawu ze-pathology zifana kakhulu nokubonakaliswa kwezifo zegciwane lokugaya elihlobene nokusebenza okungalungile. Ngokumelene nesimo sokuwohloka komsebenzi we-esophageal (ephansi) sphincter, i-reflux ye-catarrhal iyaphawulwa (okuphindaphindiwe kokukhipha okuqukethwe kwesisu). Ngemva kwesikhashana, ngenxa yethonya elinonya labantu abaningi engxenyeni engezansi ye-esophagus, inqubo yokuvuvukala iqala. Isiguli siqala ukukhononda ngokuphuza emva kokudla futhi sigxiliwe yi-overstrain engokwenyama noma esimweni esingezansi. Ngokuvamile kukhona ukuzwa kwendwangu emqaleni. Ngemva kokudla, ubuhlungu bungase buvele. Unomlingiswa ohlukile. Ubuhlungu bungadlulisela esitepeni, ukunikeza entanyeni, ngemuva kwe-sternum, enhliziyweni noma emhlathini ophansi. Lezi zibonakaliso zifana nezengculazi lapho kutholakala khona ukuhlonza okuhlukile. Kwezinye izimo, ukukhathazeka kubonakala endaweni ethile yomzimba. Izikhalazo ezenzekayo zesiguli ngokuvuvukala kwesisu esiswini, umqondo wokuba khona komzimba wangaphandle.

Imiphumela

Amacala amakhulu kakhulu abhekene nezinkinga eziningi. Omunye wabo uphepha emanzini ase-esophageal. Njengomthetho, uqhubeka ngendlela evulekile futhi uzibonakalise ngesimo se-anemia eqhubekayo. Ukukhipha igazi kungaba okungapheli futhi okunamandla. Kwezinye izimo, ngisho nokuchotshozwa kwe-protrusions ku-oophagus ne-perforation ye-esophagus kubonakala. Umphumela ovame kakhulu we-pathology yi-reflux esophagitis. Ingashintshwa ibe yisilonda se-peptic endaweni. Njengoba ukwelashwa okwesikhathi eside, lesi simo senza kube nzima ukucindezeleka - isicenosis ye-cicatricial (constriction) yelungu.

Izifo

Ukutholakala kwe-pathology kwenziwa ngokusebenzisa izindlela eziningana. Phakathi kwezinto eziyinhloko okufanele sizisho: i-esophagogroduodenoscopy, i- x-ray yesisu nesisu , i-PH-metry ye-intrasophageal. I-Ultrasound, i-tomography ehlanganisiwe, ne-esophagometry nayo isetshenziswa.

Ukwelashwa kwe-pathology

Kunezinyathelo ezihlukahlukene zokunciphisa ukubonakaliswa okuhambisana ne-hernia ehambayo yokuvulwa kwe-esophageal ye-diaphragm: ukudla, imithi. Izindlela zokuzivikela zihloswe ekuqedeni izimpawu ze-pathology: ukususwa kobuhlungu, ukushaya inhliziyo, isisindo sengqondo. Ngesikhathi esifanayo, imithi eyanciphisa i-asidi yesiphuzo esiswini somzimba ishiwo. Izindlela ezinjalo, isibonelo, zifaka izidakamizwa "Kwamatel". Omunye wemibandela yokwelashwa okuphumelelayo kweziguli ezitholwe ne-hernia yokuvulwa kwe-esophageal ye-diaphragm ukudla. Ukudla kuvimbela ukuba khona kwamafutha, okubabayo, ukudla okuthosiwe, utshwala, ushokoledi, ikhofi, imikhiqizo ekhuthaza ukukhiqizwa kwejusi esiswini. Yidla ngezigaba ezincane, ngokuvamile. Ukuvimbela reflux, isiguli sinconywa ukuba silale ngendawo ephakeme ye-trunk endaweni, futhi ugweme ukuphakamisa izinsimbi.

Ukungenelela kokuhlinzwa: ulwazi jikelele

Kumele kuqashelwe ukuthi izinyathelo ezingenhla aziqedi imbangela yesimiso esincane sokuvula ukuphazamiseka kwesimfucumfucu. Ukusebenza yindlela kuphela yokubuyisela ubudlelwane obuhle phakathi kwezingxenye zomuthi wamathumbu. Ngenqubo yokungenelela, kusetshenzwa indlela yokukhipha i-antireflux evimbela ukubuya kokuqukethwe kwesisu. Ngesikhathi sokusebenza, isango lokumiswa liqedwa ngokukhipha ukuphakama okukhulisiwe kuze kube ngosayizi ojwayelekile.

Amasu wokuhlinzwa asetshenzisiwe

Namuhla, ochwepheshe basebenzisa izindlela ezimbili zokungenelela:

• Vula ukufinyelela. Kule nkinga kungenziwa imali yokwenza imali ngokusho kukaNissen noma ipulasitiki ngokusho kweToupe. Esikhathini sokuqala, kunengozi enkulu yezinkinga eziningi. Ngakho-ke, ipulasitiki ithandwa ngaphezu kweToupe.
• Ukufinyelela kwe-laparoscopic. Lena yindlela encane yokungenelela. Ngemuva kokusebenza ngale ndlela, isiguli sisheshe futhi sibuyiselwe kalula.

Kumele kuthiwa i-laparoscopy ne-hernia egazini ivame ukuhambisana ngokusebenza kwezinye izitho emgodini wesisu. Isibonelo, i-cholecystomy yenziwa nge- cholecystitis ebalalayo esigabeni esingapheliyo, i-vagotomy ekhethiwe ekhethiwe - ngesilonda kwi-duodenum.