Kutsetsereka hiatal chophukacho: zizindikiro ndi mankhwala

Hiatal chophukacho (chithunzi kudwala ndi anapereka m'munsimu m'nkhani) ndi Reflux esophagitis ndi matenda oopsa kwambiri. Against maziko a limati amenewa amalembedwa anatambasula ena zigawo m'mimba. Makamaka, kusintha kumachitika mu Mitsemphayi kuti zithandize m'mimba ndi kum'mero, ndi chithunzi chimene anaperekanso nkhaniyi. Motero, mavuto ali ankatembenukira. Makamaka, kumtunda kwa m'mimba zipita m'dera pachifuwa. Chifukwa kusokonezeka ukugwirira ntchito ya sphincter kulumikiza m'mimba ndi kum'mero (chithunzi chikusonyeza gawo lino).

chiopsezo Nkosatheka

Ngati inu kusintha mbali ya Hiss kulakwila ntchito esophageal (pansi) wa sphincter kumachitika kutaya nkhani asidi wa m'mimba kapena ya ndulu mu mmero 12 mmatumbo chilonda. ndondomeko limodzi ndi chitukuko cha kutupa rearrangement mucous. Zimenezi kwambiri chiopsezo cha khansa. Wa zinthu zofunika kwambiri mu chitukuko cha matenda ndi kutsetsereka hiatal chophukacho. Opaleshoni ndi njira yokhayo zilipo kuthetsa kuphwanya lapansi. Komabe, alowererepo opaleshoni ali zina zabwino zake. Komanso yosanthula mwatsatanetsatane, zimene tingachite chophukacho hiatal. Pati, mitundu ndi mawonetseredwe amatchedwanso nkhaniyi.

mwachidule

Chophukacho yoyambirira esophageal, kawirikawiri akufotokozera molumikizana ndi matenda gastroesophageal. Katengedwe limodzi ndi mtima zovuta, m'mapapo mwanga ndi matenda dyspeptic. Yak makamaka chifukwa cha chophukacho ndi gastroesophageal Reflux. Malinga ndi kugwirizanitsa American ndi European pamaso pa HH munthu kwa zaka 5-12 Mwina khansa zaka zisanu kenako akula 270% ndipo 12 - by 350-490% (malingana ndi msinkhu).

kuwanda kwa kudwala

HH, malinga ndi olemba angapo, amaona ngati matenda ambiri matenda, monga cholecystitis kapena zilonda esophageal. Malinga ndi kuchuluka kwake matenda amenewa ndi kutsogolera matenda m'mimba. HH monga esophageal chilonda, amaona mokwanira oopsa matenda zofuna matenda oyambirira ndi mosamala.

Gawo

Pali mitundu itatu waukulu HH. Njirazi ndi monga:

• Ofananira hiatal chophukacho. kudwala uyu ali dzina lina. Dzina wamba - kutsetsereka hiatal chophukacho. Mtundu wa kudwala ndi wapezeka pafupifupi 90% ya odwala. State amakhala ndi zosayembekezereka wa achalasia esophageal pamwamba una. Pa nkhani imeneyi, wakhala lakuthwa wakuswa kutseka ntchito.
• Paraesophageal chophukacho. mawonekedwe izi zimapezeka mu pafupifupi 5% odwala. Mtundu wa kudwala amakhala ndi udindo zonse cardia ndi kupindika kwambiri m'mimba.
• Short kum'mero. Monga wodziimira kudwala izi amawapeza kawirikawiri. Matendawa chosayenerera chitukuko. Monga ulamuliro, syndrome imeneyi limodzi ndi kutsetsereka hiatal chophukacho. Pakuti yodziwika ndi kutukusira ndipo amamuyambitsa timabala njira.

kutsetsereka chophukacho

Izi mawonekedwe a matenda yodziwika ndi ena peculiarities. Ambiri kutsetsereka chophukacho ndi protrusion, mmene khoma limodzi pang'ono lokutidwa peritoneum thupi. Iwo akhoza zina m'nkhani gawo, chikhodzodzo, akwera natsikira m'matumbo, ndi zina zotero. Mu nkhani iyi, chophukacho sac sangakhale. Diverticulum, mu nkhani zooneka izi m'madera thupi si ataphimbidwa ndi peritoneum lapansi.

Limagwirira wa zosayembekezereka

Malinga ndi Mbali imeneyi n'kopanda:

• Kobadwa nako hernias. Pankhaniyi akuluakulu chifukwa aliyense kapena mabungwe ena, osati chatsekedwa peritoneum pang'onopang'ono kutsikira gawo la kanyumba ka pachipata chamkati cha mafuta retroperitoneal. Pamene iwo abwera kuchokera M'mimbamo lapansi. Zimenezi akhoza kuyamba mwamsanga nthawi embryonic. Chifukwa, m'madipatimenti ali nazo zithandizire pa chigawo protrusion popanda chophukacho sac.
• matenda zinazake. Hernias wa mtundu uwu anapanga ndi chidule makina a chikhodzodzo kapena intestine zigawo. Iwo mosatsata chivundikiro serous ndi pafupi peritoneum lapansi.

Inguinal chophukacho kutsetsereka mu m'mimba, nthawi zambiri zimakhala protrusions lalikulu ndi khomo lotakata. Matenda, nthawi zambiri okalamba. Wapezeka pogwiritsa ntchito njira X-ray wa lalikulu intestine bwino. Kutsetsereka chophukacho wa chikhodzodzo limapezeka matenda dysuric. Odwala amalembedwa awiri pokodza. Poyamba kukhetsa ikuchitika mwachizolowezi, ndipo pamenepo kukanikiza pa protrusion, pali mwaphuma wina ndi mtima urinates kachiwiri. Pamene matenda imagwiridwa catheterization ndi cystography. M'kupita kwa ndondomeko izi anawulula mawonekedwe ndi kukula kwa chophukacho wa, pakalibe kapena kukhalapo miyala ya m'chikhodzodzo.

Ofananira hiatal chophukacho

kudwala Izi ndi kusamutsidwa kwa m'mimba kapena ziwalo zina m'mimba mu chifuwa patsekeke. Matendawa amawapeza 5% ya chiwerengero wamkulu. Komabe, pafupifupi theka la odwala osaganizira zizindikiro zilizonse. Chotero otaya kudwala chifukwa kutsetsereka hiatal chophukacho wafafaniza zizindikiro mawonekedwe lililonse chifukwa protrusion ali oyenerera mwa thupi ndi pansi kuonera yachibadwa iyo siingakhoze wapezeka. matendawa amakhudza akazi zambiri kuposa abambo. Dokotala kudwala ndi makamaka titadziwa.

mitundu ya matenda

Kutsetsereka hiatal chophukacho lagawidwa:

• Kardiofundalnuyu.
• Total muzituluka.
• Mtima.
• Subtotal m'mimba.

hernias Paraesophageal anawagawira mu:

• M'mimba.
• Stuffing.
• Matumbo.
• Antral.
• Fundus.

siteji pathological

Kutsetsereka hiatal chophukacho akhoza wachinsinsi malinga ndi buku la m'mimba ozama mu chifuwa M'mimbamo:

• Gawo loyamba. Pankhaniyi, M'mimbamo thoracic chifundamtima ili pa gawo m'mimba ya kholingo. The m'mimba ndiye mu malo apamwamba. Iye mwachindunji pafupi chifundamtima. Ndipo ili ku cardia lapansi.
• Gawo lachiwiri. M'mimbamo thoracic ndi gawo m'mimba ya kholingo, mmimba ndi wosiyana mwachindunji m'dera la dzenje phrenic.
• Mbali yachitatu. Pamwamba pa chifundamtima ndi cardia, thupi muzituluka ndi pansi (nthawizina antral gawo) m'mimba esophageal kulekanitsidwa.

chithunzi matenda

Zizindikiro za matenda ofanana kwambiri zizindikiro za matenda a thirakiti m'mimba kugwirizana ndi chamoyo mkhutu. Against maziko a kuwonongeka ntchito ya esophageal (m'munsi) sphincter amalembedwa catarrhal Reflux (chigamulocho kuponyera zili chapamimba). Pa nthawi chifukwa kukopa anthu ankhanza wa misa mu gawo m'munsi wa kum'mero akufotokozera yotupa ndondomeko. Wodwala wayamba amadandaula kutentha kudya ndi kukula ndi nkhawa thupi kapena mu malo yopingasa. Nthawi zambiri pali kumverera kwa mtanda mu mmero. Pambuyo chakudya, ululu uonekere. Iwo ali osiyana mu chirengedwe. The soreness akhoza kufalitsa kwa tsamba phewa, kupereka pakhosi, kumbuyo sternum, kuzungulira mtima kapena nsagwada m'munsi. Zizindikiro zimenezi ofanana ndi zizindikiro za angina, yomwe ikuchitika matenda masiyanidwe. Nthawi zina ululu limawonekera pa malo ena a thupi. Zikuoneka kuti akaonekere kwa wodwala chapamwamba pamimba distension, Kukhalapo kwa thupi lina.

zotsatira

Nthawi zambiri aakulu yodziwika ndi chiwerengero cha matendawo. Mmodzi wa iwo magazi kuchokera ziwiya esophageal. Monga ulamuliro, izo zikuchitika mu mawonekedwe zobisika, ndi kuwonetsera monga kupata magazi m'thupi. Magazi mwina aakulu ndi pachimake. Nthawi zina, ngakhale wapezeka siudzalandilidwa ngathi lamulo protrusions pa kutsegula esophageal ndi esophageal perforation. Chotsatira ambiri matenda Reflux esophagitis. Iwo akhoza lidzasinthidwa chironda chachikulu mu kholingo. Pa mankhwala mosalekeza amakwiya chikhalidwe ichi kwambiri Vuto - cicatricial stenosis (kuchepetsa) za thupi.

diagnostics

Kudwala kudziwika ikuchitika ndi njira zingapo. Akutchula mwa akuluakulu: esophagogastroduodenoscopy, X-ray za m'mimba ndi kum'mero, intraesophageal pH mamita. Ntchito ngati ultrasound, yopangidwa tomography, ezofagometriya.

chithandizo matenda

Ikuchitika zosiyanasiyana umalimbana kuchepetsa maonekedwe zimene zigwirizana pamodzi ndi kutsetsereka hiatal chophukacho: zakudya, mankhwala. njira ndiwofatsa Cholinga chake ndi kuthetsa zizindikiro za matenda: mpumulo ululu, kutentha, nseru. Pankhaniyi, woikidwa mankhwala amene amachepetsa acidity muzituluka. Mwa kuchita zimenezi, mwachitsanzo, monga yokonza "Kvamatel". Chimodzi mwa zinthu kwa mankhwala a odwala matenda ndi hiatal chophukacho - zakudya. chakudya okha kukhalapo kwa mafuta, zokometsera, zakudya yokazinga, mowa, chocolate, khofi, mankhwala kulimbikitsa ulimi wa madzi muzituluka. Kudya akhale chakudya yaing'ono zambiri. Pofuna kupewa Reflux kugona wodwala analangiza ndi anamuukitsa dera chapamwamba thupi, ndi kupewa zolemera.

Opaleshoni: onse mudziwe

Kuyenera anati kuti ntchito pamwamba sindikufuna kuthetsa chifukwa muli ndi kutsetsereka hiatal chophukacho. Opaleshoni - njira yokhayo kubwezeretsa ubale anatomic pakati pa mbali GI. Mu ndondomeko za phukusi amalenga limagwirira antireflux zoletsa kuti n'zosiyana waponya zili m'mimba. Pa ntchito hernial kunatha suturing anawonjezera kabowo mwakale.

Ntchito njira opaleshoni

Lero, akatswiri ntchito njira ziwiri za phukusi:

• mwayi Open. Pankhaniyi, izo zikhoza kuchitidwa Nissen fundoplication kapena pulasitiki ndi Tope. Mbali yoyamba, chiopsezo kukhala mavuto a Anatipatsa. Chifukwa pulasitiki Ndi bwino kuti Tope.
• Laparoscopic njira. Izi ndi zochepesetsa zoopsa njira za phukusi. Pambuyo ntchito mu njira iyi wodwalayo akuchira msanga ndiponso mosavuta.

Izo ziyenera anati laparoscopic chophukacho esophageal dzenje kawirikawiri ikuchitika pamodzi ndi ntchito ziwalo zina zonse m'mimba. Mwachitsanzo, holetsistomiya anachita pamene calculous cholecystitis mu gawo aakulu, kusankha proximal vagotomy - chilonda mu duodenum ndi.