Perforation esiswini: iimpawu, unyango, iingxaki

Phakathi zonke izifo ezingapheliyo amalungu ibekwe ngaphakathi kwisisu, perforation esiswini kunye isilonda duodenum imalunga-2%. Ngokutsho manani, amaza eli ingxaki yalo sifo 7-12% kwaye kwenzeka xa iziguli yobudala engama-25-35. Kulo mzekelo, emadodeni elivela kuzo izihlandlo 5 kaninzi ngaphezu abafazi.

Izinto ezibangela perforation

Perforation esiswini (perforation) livela kwi nezilonda amandla aphantsi kunye nokuphela kwegqabi kumazantsi eli laphu. Oku kwenzeka dysfunctions ezahlukeneyo patency nemithambo ngenxa yegazi. Le ngcaciso iya kubonakaliswa kukuba ebudeni perforation kummandla bengaphumelelanga 12 isilonda duodenal okanye udonga esiswini akukho ukopha. Isilonda perforation esiswini na iintlobo ezi-3:

• boqobo (imixholo isisu agalelwa kwisisu, peritonitis iphuhlisa);
• Nedlac (perforation yi nobubovu akagqubuthele ukutya, nezibaya mucosal, kwaye ezifana);
• njengoko pentratsii (perforation ezantsi kwavulwa amalungu ezikufutshane).

Ngokuqhelekileyo, into enjalo lwandulelwe intlungu onamandla azalwa isifo sisilonda ukuba ihlala ixesha elide. Kulo mzekelo, i ukubola zeendonga sayo. Perforation esiswini ezinokubangelwa:

• ngokweemvakalelo ntshikilelo ngokomzimba;
• utshwala;
• exacerbation kwezifo okwenziwa sisilonda sikabhobhosi;
• ukudla;
• ukuphatheka;
• yonyango ngamachiza ezithile ezibangela le ngezifo.

Kufuneka ukuba ubani aqwalasele ukuba abantu abadala kwimbali kwethumba ayikwazi ukuba, ngenxa yokuba ezi izigulane luphawulwa umfanekiso efihlakeleyo sifo.

Yintoni ekwenza perforation

Njengomgaqo, izilonda etsolo xa kungekho ndlela elinxulunyaniswa nosulelo H.pylori. Ukungqinwa kwethumba Peptic ngo-95% of H. pylori ibonisa umyalezo wayo. isilonda Acute nga zizakujongwa njengo nqanaba isilonda esiswini. Ngaphandle H.pylori, perforation esiswini nga kuxhokonxwa:

• syndrome Zollinger-Ellison;
• izilonda Drug kunye nezinye izifo ezidalwe;
• pancreatogenic, kunye nezinye iintlobo gepatogennymi zizilonda etsolo (umz, Crohn kaThixo syndrome).

Kuba imbonakalo umngxuma eludongeni esiswini kubaluleke kakhulu kuzo zonke intshabalalo maleko zehydrochloric acid kunye ukwanda koxinzelelo kule ndawo esiswini. isilonda adlalwayo esingapheliyo uthathwa sigaba ukuqhubela phambili isilonda esiswini. Le ngezifo wenziwe ngexesha lokungabikho nothomalaliso eziyimfuneko.

iimpawu

Perforation kodonga isisu na izigaba ezithathu eziphambili:

1. A nematha.
2. nokuchuma mavunwa.
3. Peritonitis.

Ngqo sigaba athuke kwenzeka ngexesha perforation yawa okubhalwe esiswini semaphepheni peritoneum. Omnye uziva olungaphezu intlungu "imela-like" evela kwi zikhabane aphezulu kwisisu, leyo ngokukhawuleza kwalutyhutyha kummandla iphela esiswini. izigulane ezininzi kule ndawo baqale zoke ukhwaze. Nobuzaza iyonke imeko likhula ngokukhawuleza:

• uyancipha;
• ukubetha ehla;
• integument isikhumba sibe kumanzi, ukubanda kunye luthuthu;
• isigulane kuthatha indawo ngenkani - kwelinye icala, kunye amadolo zaveza ukuya isisu.

Emva kwexesha elithile (malunga nama-7 iiyure) iintlungu buthathaka, kwaye kwezinye iimeko, shwaka ngokupheleleyo. Ngcembe kwandisa nokuqunjelwa, kuba akukho langoku kunjalo, unyamalale ingxolo auscultation ethunjini. hypotension Ukusindiswa, arrhythmia uqalisa ukuze akhule tachycardia. Isigaba ixesha ntle bobuxoki inokuba iiyure ukuya ku-12.

engaba khona

Kule izigaba emibini yangaphambili yomntu kancane kancane peritonitis. The degree of karhulumente kwakhona mandundu yi: isigulana ecubhukile, ezigquma yesikhumba kufumana umbala wowomhlaba, abe yokuncamathelisa bazibilise. Udonga phambi kwixesha peritoneum. Ngokuphawulekayo kunciphisa isixa umchamo eveliswe, maxa wambi uza anuria.

Ukuba isigulana umntu isilonda Peptic senziwe ngendlela Nedlac, lo perforation ifumaneka izihlunu retroperitoneal. Ukongeza, emngxunyeni ukuze wazenza ukutya okanye amalungu ezingqongileyo. Mhlawumbi inkqubo kwemida xa kukho azikhuli ezininzi. Layigubungela perforation ke iintlobo:

• ngokusisigxina;
• elide;
• elifutshane.

Ezi ntlobo ze perforation zenzeka, bakholisa ukuba kube lula kakhulu. amatyala self-bephilisa ezaziwayo.

Ngaphandle peritonitis nzima sicatshulwa kwezifo esiswini ungakwazi hypovolemia, ukothuka kunye nokudumba.

uphethwe sisifo "esuswini"

Perforation esiswini ifuna ukuxilongwa, okuyinto ingafakwa kuphela imbali eziqokelelweyo ngokufanelekileyo. Ukufumanisa isifo kuyimfuneko ukubona yincutshe. Olu hlobo iingxaki ababandakanyekayo oogqirha gastroenterologists kunye endoscopists.

ukuba ivavanywe ixesha kubaluleke kakhulu ukuba ukrokrela ukuba unalo perforation esiswini. Iimpawu kuyo nayiphi na imeko azinakho ukutyeshelwa, njengoko sesihambe zesi sifo kunokukhokelela nemiphumo noqhekeko. Ukufikelela le endoscopist kunye gastroenterologist efunekayo ngokupheleleyo ukuze isigulane ngasinye orhanelwa sifo, ingakumbi ukuba kusenokwenzeka ukuba kukho perforation evaliweyo. Kwesi sifundo musani ukubonisa opheleleyo wedatha ngenxa uxilongo, kodwa ukuphunyezwa kuyimfuneko njengenxalenye yamalungiselelo utyando.

Perforation esiswini ixhomekeke ndlela zilandelayo:

• ray Plain.
• ultrasound esiswini.
• endoscopy Upper.
• Xa iingxaki loxilongo kunye perforation okusolwayo zigqutyuthelwe laparoscopy kusetyenziswa.

Izifo ezineempawu ezifanayo

Perforation esiswini ekunokuthiwa iingqiqo ezifana 'isisu etsolo ", ngenxa yokuba esi sifo kufuneka umahluko kusuka:

• pancreatitis;
• cholecystitis kunye appendicitis;
• ithumba ukubola;
• yokulunywa uxabane hepatic;
• thrombosis ndlela mesenteric;
• uqhekeko of an kwemithambo aortic kwi kwisisu;
• ukuhlaselwa yintliziyo;
• unepleurisy.

ukufikelela ngexesha specialist beqhuba amanyathelo lokubhaqa bancede kubekho ukuxilongwa kunye nexesha ukuqalisa unyango lwezifo ezinobungozi.

Indlela ukuba ndiphilise perforation?

Kuxhomekeka umfanekiso lwezonyango, uncedo perforation esiswini, oko ngeendlela ezininzi.

1. ukuvalwa eqhelekileyo kwethumba. Yenziwe kubantu abatsha akukho imbali izilonda kwizigulane abadala kunye nengozi eyonyukileyo zomzimba kunye noncedo zokusebenza, kwakunye peritonitis ehlasela ezikhoyo.
2. Ukuba akukho peritonitis, olu ngenelelo ngoncedo nga kuxhaswa vagotomy ukukhetha proximal, nto leyo eyenza kube lula ukuba ukuthintela kunyango ixesha elide elugcinweni Gastroenterology kwixesha elizayo.
3. Phambi izilonda apha pyloric, izilonda gaze, ukopha ebonakalayo, stenosis ka iphecana lokuphuma, kunye nabantu kakuhle kunye nengozi enkulu zotyando, wenza Ukusikwa unesiphako, pyloroplasty kunye esiqwini vagotomy.
4. Xa isigulane kufuneka inkangeleko olungumxube sisifo okwenziwa sisilonda sikabhobhosi okanye imbali ezibonisa ezongezelelweyo perforation esiswini, le utyando nga kumana gemigastrektomiey.
5. iziphumo ezigqwesileyo ziyafumaneka kwi imvelaphi unyango laparoscopy endoscopic. Songezelelo utyando perforation esiswini uya endoscopic unyango vagotomy kunye endoscopic.

Ukuba ufuna ukunciphisa ingozi kotyando, kunokwenzeka distal gastrectomy okanye isiza perforation omentum tamponade laparoscopy. Ezi zazo ziye ukunyamezeleka kakuhle zizigulane ezinokunika ukuchacha ngexesha ngokukhawuleza kakhulu.

Emva kokwenza lo msebenzi ngotyando neemfanelo ngokupheleleyo ulungiso isigulana ukususwa arhente non-steroidal (xa injongo yazo ukuthintela ukuvela izilonda esiswini) okanye ukutshintsha inhibitors zabo cyclooxygenase, ngokunjalo ngokuphelisa endala.

Prevention and Ipredikshini

Ngexesha perforation ye lentelekelelo kakhulu elinzima ngenxa yokulibaziseka imeko diagnosis ngamanye amaxesha kukhokelela kwisiphumo ezinkulu isigulane. Ukufa phakathi abafana nama-2-6% (kuthathelwa ingqalelo umfanekiso lwezonyango, uncedo ixesha ezinikiweyo kunye nezinye izinto ezithile), abantu abadala, le lomlingani kwandisa izihlandlo eziliqela.

Uthintelo esi sifo zamabanga - lifune ngexesha ukuxilonga nokunyanga izifo ukuba bangazisa isigulana kule meko.