Afferent kuzungulira syndrome: matenda ndi mankhwala

Opaleshoni njira pafupifupi nthawi zonse kugwirizana ndi chiopsezo. Kuwonjezera magazi zotheka pa opaleshoni, pali zambiri mavuto yaitali. Izi ndi zowona makamaka ndi mwai yaikulu imene kuchotsa imagwiridwa chiwalo kapena gawo zace. Chitsanzo ndi ntchito Billroth-2. Kwenikweni ake tichipeza mu kuchotsa kwambiri m'mimba, kukonza anastomosis ndi intestine yaing'ono. afferent kuzungulira syndrome zambiri akufotokozera pambuyo opaleshoni imeneyi. mavuto amenewa angabuke mwamsanga pambuyo opaleshoni, ndi miyezi ingapo. Ndi chitukuko cha chikhalidwe ichi ndi achifwamba, kapena m'pofunika kuti opaleshoni ina.

Lingaliro la afferent kuzungulira syndrome

Afferent kuzungulira syndrome pambuyo resection chapamimba amapezeka pafupifupi 13% ya milandu. chiwerengerochi zingasiyane 1 mpaka 50%, malinga ndi madokotala. chizindikiro Aika ndi kusanza ya ndulu, zokhudzana ndi madyedwe chakudya. Afferent kuzungulira syndrome - mkhalidwe mbali ya intestine ndi, monga ngati "mwadzidzidzi" ndi ntchito chimbudzi. Chifukwa, ya ndulu amasonkhana dipatimenti ndi mu kukhalapo kwa zinthu chowawa amatayika kunja. dzina lina Vuto ichi - duodenobilliarny syndrome. boma ndi chizindikiro oopsa, choncho amafuna chithandizo opaleshoni.

Zimayambitsa matendawa

Chinthu chachikulu chomwe syndrome afferent kuzungulira ndi opareshoni Billroth-2. Ndi opaleshoni yaikulu amakhudza thupi lonse. A ntchito zofanana ikuchitika khansa chapamimba, chitukuko cha mavuto a matenda chironda chachikulu, amene sakhoza inathetsedwa njira modekha. Chifukwa cha mpheto uwu wa duodenum ndi yaing'ono intestine ali nawo salinso mwakhama kuchita chimbudzi. Chifukwa cha matenda izi kukula kwa afferent kuzungulira.

Zinthu zimene zimakhudza zosayembekezereka ya vuto ili, ndi kuyan'anila zotsatirazi:

1. Mawotchi chifukwa. Pansipa amatanthauza misa chakudya kulowa lumen "kutali" kumadalira. Komanso, pali anasonkhanitsa ya ndulu, amene akuzengereza ndondomeko chimbudzi.
2. Kuchepa kwa minofu kamvekedwe mu "kutali" gawo. chifukwa kawirikawiri chimayambitsa matenda aakulu a afferent kuzungulira pambuyo resection.
3. Kuphipha wa anastomosis - pamphambano ya tsinde la m'mimba ndi intestine yaing'ono. minofu angathe kuchepetsedwa ndi kuzungulira kubwereketsa.
4. Anam'peza chilema pa anastomosis lapansi. Zimadzetsa kuonongeka kwa kuoneka chifukwa mawotchi afferent kuzungulira syndrome. Iwo akhoza kukhala monga chachikulu (pambuyo opaleshoni), ndipo kachiwiri.
5. Kukweza mawu afferent kuzungulira. Kawirikawiri akufotokozera kachiwiri.

Afferent kuzungulira syndrome: pathogenesis matendawa

Limagwirira wa syndrome afferent kuzungulira tichipeza mayunitsi angapo. Choyamba pali siudzalandilidwa ngathi lamulo kwa thupi mwachizolowezi anatomical ndi zinchito ankachita. Chifukwa cha "yokumba" kukonzanso kwa m'mimba dongosolo ndondomeko chakudya zimasiyanasiyana kuthawa. Food, lili pa nambala mu "kutali" kuzungulira m'mimba, sangathe kupitirirapo pa. Choncho pali kuponyera kumbuyo - Reflux. Komanso, mu pathogenesis wa yotupa ndondomeko pano. Kumachitika chifukwa cha stagnation ya misa ndi m'mimba hypotension KDP. Chifukwa ndi sekondale matumbo dysbiosis. Kenako zimabweretsa kutupa kwa kapepalako m'mimba: cholecystitis, kapamba, esophagitis.

The matenda chithunzi afferent kuzungulira syndrome

Mawonetseredwe chachikulu cha vuto ili ndi ululu komanso kusanza. M'mimba kusapeza kumachitika nthawi yomweyo kapena pambuyo ntchito pa nthawi. Mbali yoyamba pali chachikulu, pachimake afferent kuzungulira syndrome. Iwo amakhala ndi cramping ndi ululu Expander chikhalidwe mu hypochondrium chabwino ndi epigastric. Mu matenda aakulu chifukwa matenda chithunzi kuzungulira chimaoneka osati kwambiri. Ululu kumachitika makamaka kudya, nthawi zambiri - pa phwando zakudya mafuta. Kaya nthawi ya yatsoka matendawo (pachimake kapena aakulu nthawi) zimawonedwa kusanza. Iwo akubwera pambuyo pa kuwuka kwa ululu pamimba, kawirikawiri izi chakudya. Chifukwa kusanza pafupipafupi mwina kuonetsetsa kuti 500 ml pa tsiku ya ndulu. Chifukwa ndi kupata zikutha m'mayiko thupi. Odwala msanga kuonda, kumva kufooka ambiri.

Afferent kuzungulira syndrome: matenda kudwala

Matenda a matenda ikuyamba ndi anamnesis (anasamutsa gastrectomy) ndi mosamala mtima. Choyamba muyenera kudziwa za chikhalidwe cha ululu komanso pafupipafupi kusanza, kugwirizana kwake ndi njira chakudya. Kuzionetsetsa, ayenera kulabadira asymmetry m'mimba: lamanja dipatimenti nkhuni. Chizindikiro chimenechi anabauka pambuyo kusanza, monga nkhani za kuzungulira atatulukamo. Chinthu china ndi matenda a chikasu ndiyo ya sclera ndi khungu.

Kuwonjezera wounikira deta ovutika kwa zasayansi ndi diagnostics malangizo. Kusintha kungakhale KLA (B-12 akusowa magazi m'thupi), magazi chopaka, coprogram (maonekedwe a leukocytes, undigested mafuta). Pamene X-ray umuna anati chizindikiro cha kagawo kakang'ono mu afferent kuzungulira, gipermotornaya dyskinesia. Kusiyana wothandizila chimadzaza kuzungulira chifukwa. Anachita Kupenda endoscopic. Mu aakulu matenda afferent kuzungulira zambiri amalembedwa kusintha yotupa mu ndulu ndipo ducts. Nthawi zina, kapamba akufotokozera. Pamene kutupa ichi poyera ndi kapamba. Pamene kufesa nkhani za matumbo zomera bakiteriya zimawonedwa, chiŵerengero cha chakhungu michere pancreatic. The kukula kwa matenda anatsimikiza mtima zikutha m'mayiko thupi, kukula kwa imfa ya ya ndulu mtima.

Kodi ngozi afferent kuzungulira syndrome: zosokonezeka

Tiyenera kukumbukira kuti matenda afferent kuzungulira ndi vuto lalikulu resection muzituluka. Imfa apitirize ya ndulu kumachitika wakuta choopsa cha thupi. The chakudya tikalowa m'thupi sangathe bwino kudya (chifukwa "kusiya" KDP ndi mbali za m'mimba zing'onozing'ono), ndi zakudya si atamezedwa. Chifukwa cha kukula kwa matumbo dysbiosis ziwalo m'mimba ongoyendayenda njira yotupa. Ndi chitukuko cha Reflux esophagitis kuti zizindikiro zomwe zalembedwa akuwonjezeka ululu pachifuwa, kudzikayikira "mtanda mu mmero." Cholecystitis limodzi ndi kulawa zowawa m'kamwa, nseru. Ngati akulowa kutupa kapamba, ululu akhoza nakweza kuti nsungu khalidwe. Pamene nthawi ya kapamba panopa akhoza kuyamba matenda a shuga. Zovuta za pachimake syndrome afferent kuzungulira monga peritonitis, kutsekeka m'matumbo. matenda amenewa amafuna chisamaliro nthawi yomweyo opaleshoni.

Chithandizo cha matenda a afferent kuzungulira

Kusankha chithandizo kumatengera wodwala, deta zasayansi ndi mayeso malangizo. Nkofunika kudziwa zimene zovuta matendawa ali afferent kuzungulira. Chithandizo kungakhale ndiwofatsa komanso opaleshoni. Wofatsa mankhwala zakudya zapadera, yotupa ndi mankhwala antibacterial (medicaments "Tsefriakson", "Tsiprolet"). Nthawi zina zimafunika mobwerezabwereza chapamimba lavage. Pa lochepa aakulu kufunika chithandizo opaleshoni. Kuyenera umalimbana kuthetsa stagnation chakudya. Nthawi zambiri kubala kukhazikitsanso anastomosis lapansi. Pamene iye anaŵerama chifukwa mu zingwe zopota Ufumuyo udindo lolondola ndi sutured kuti peritoneum lapansi. Kuchuluka ndi mtundu wa mankhwala opaleshoni akhoza kukhala osiyana ndi zimadalira mavuto chifukwa.

Kupewa afferent kuzungulira syndrome

Panopa opaleshoni kuti Billroth-2 muziyesetsa kuiwala njira zina opaleshoni. Izi zachitika pofuna ya Maphunziro Akakhalidwe Kazolengedwa pa mundawo m'mimba. Ngati Billroth-2 opareshoni koma kale, m'pofunika kuchita miyezo njira zotchulidwa dokotala. Kwenikweni izi zikuphatikizapo zakudya. Pambuyo resection sangathe kudya mafuta ndi zakudya zosapatsa thanzi. Tengani chakudya muyenera nthawi 6-7 tsiku chakudya chochepa ndi boma theka-zamadzimadzi (porridges, soups).