Ngokuhambisa Ithemba hiatal: iimpawu kunye nonyango

Ithemba Hiatal (photo ngezifo ithiwe thaca apha ngasezantsi kweli nqaku) kunye reflux esophagitis izifo anobungozi. Ngokuchasene imvelaphi ezi ithi kumakishwa yade of amacandelo athile zesisu. Ngokukodwa, utshintsho kwenzeka nemisipha ezixhasa esiswini kunye kuvuleke iminxunya, ifoto yayo nayo thaca kweli nqaku. Ngenxa yoko, ukungakhululeki ishenxiselwe. Ngokukodwa, inxalenye engentla esiswini iya kwindawo esifubeni. Ngenxa yoko, ukuphazamiseka ekusebenzeni sphincter yokudibanisa esiswini kunye kuvuleke iminxunya (umfanekiso ibonisa eli candelo).

ingozi okwa-

Ukuba utshintsha i engile umsondlo, imisebenzi ukungathobeli esophageal (ezantsi) loMthetho sphincter lwenzeka phosa imixholo asidi esiswini okanye inyongo emphinjeni 12 isilonda duodenal. Le nkqubo kunye nophuhliso ukudumba ngokutsha yangaphakathi. Oku kwandisa kakhulu ingozi yokuba nomhlaza. Eyona nto ibaluleke ngokukodwa kuphuhliso wezifo a ngokokushiyana Ithemba hiatal. Surgery yeyona ndlela kuphela ezikhoyo ukuphelisa umthetho. Nangona kunjalo, ungenelelo utyando uye bokuqonda yayo. Ngaphezu koko uhlaziye iinkcukacha, yintoni eyenza Ithemba hiatal. Ubungakanani, iintlobo kunye obubonakala nayo kweli nqaku.

Overview

Ithemba ekuwuvuleni esophageal, ngokuqhelekileyo ikhula kunye nesifo gastroesophageal. Bokuthatha ephelekwa senhliziyo entsonkothileyo, yemiphunga nezengekho zizigulo dyspeptic. Baya kuvela ikakhulu ngenxa Ithemba kunye reflux gastroesophageal. Ngokutsho izayamaniso American kunye yaseYurophu phambi HH umntu iminyaka 5-12 amathuba umhlaza kwiminyaka emihlanu kamva ikhula ukuya kwi-270%, kunye 12 - nge 350-490% (ngokuxhomekeke ubudala).

ukwanda leengxaki

HH, ngokutsho ababhali eziliqela, loo nto ithathwa njengokuba isifo ngokuqhelekileyo ngoxilongo, ezifana cholecystitis okanye izilonda esophageal. Ngokutsho zikuyo ezi zifo izifo zesisu phambili. HH njengoko isilonda esophageal, loo nto ithathwa ngokwaneleyo izifo eziyingozi efuna isigulo kwangethuba kunye uyiqwalasela kakuhle.

ngezigaba

Kukho iindidi ezintathu ezingundoqo HH. Ezi ziquka:

• Ithemba yezihlunu hiatal. Le ngezifo elinye igama. Igama efanayo - sliding Ithemba hiatal. Olu hlobo leengxaki ibanjiwe phantse 90% yezigulane. State luphawulwa isahlakalo achalasia esophageal ngaphezu umngxuma. Kule nkalo, kuye umsebenzi ukophulwa wokuvala elibukhali.
• Ithemba Paraesophageal. Le imilo ifumaneka nama-5% kwizigulane. Ngokuba lo hlobo leengxaki iphawulwa kwindawo lomgadi cardia kunye ugobile ebalulekileyo isisu.
• emphinjeni mfutshane. Njengoko ezimele, le ngezifo banesifo kunqabile kakhulu. Esi sifo yinto engaqhelekanga kuphuhliso. Ngokuqhelekileyo, le sifo uhamba ngokokushiyana Ithemba hiatal. Kuba kubhaliwe linophawu iinkqubo nokudumba nezibhaxu.

Ithemba sliding

Olu hlobo esi sifo unayo awohluke. Xa Ithemba sliding jikelele yinto Buze, apho eludongeni enye ngokungaphelelanga camera umzimba peritoneum. It xhaxhe lunakho kuqwalaselwa kwinqaku isahlulo, isinyi, zinyuka zisihla colon, njalo-njalo. Kulo mzekelo, ngeke ibe Huy Ithemba. Diverticulum, kulo mzekelo ezimile iindawo zomzimba alubandakanywa peritoneum.

Indlela ingenzeka

Ngokuhambelana kunye nale phawu ayinabantu:

• hernias bekhubazekile. Kulo mzekelo abasemagunyeni ngaso nasiphi na esinye isizathu okanye namanye amasebe, hayi peritoneum evaliweyo ngcembe zehlela kwinxenye kwesango eliphakathi kwamanqatha retroperitoneal. Xa bephuma ibinomthwebeba. Le nkqubo kube kungaqala kwangoko kangangoko kwixesha osandul. Ngenxa yoko, amasebe lisisiqalo component Buze ngaphandle Ithemba sac.
• ukuphazamiseka ezifuniweyo. Hernias yale hlobo akhiwa yindibanisela ngomatshini lwesinye okanye emathunjini komsindo. Bona anqunyulwe inshorensi serous kunye ezikufutshane peritoneum.

Ithemba Inguinal sisihla ngokwemeko emathunjini enkulu, adla lunamaqoqo enkulu kunye nesango ngokubanzi. Sifo, ngokuqhelekileyo abadala. Ukubonakala besebenzisa ubuchule X-ray loviwo Amathumbu amakhulu. Sliding Ithemba lwesinye ivela ukuphazamiseka dysuric. Izigulane ephawulwe echama kabini. Ekuqaleni lomnwe ikhutshwa phandle njengesiqhelo, yaye emva koko, xa ngokucinezela phezu Buze, kukho omnye umnqweno kunye isigulane ochamela kwakhona. Xa uxilongo olwenziwa catheterization kunye cystography. Ekuhambeni yezi nkqubo kutyhilwa imilo kunye nobukhulu Ithemba, ukungabikho okanye ubukho kwamatye kwisinyi.

Ithemba yezihlunu hiatal

Le ngezifo na ukubana esiswini okanye ezinye izigqeba esiswini kuloo ndawo ibinomthwebeba esifubeni. Esi sifo olufunyanwa-5% yabantu abadala. Noko ke, malunga nesiqingatha izigulane isaziso naziphi na iimpawu. Ezo ngezifo flow kuba sliding Ithemba hiatal sele bucinyiwe, imiqondiso imilo ezithile kuba Buze zilahlwa ngaphakathi emzimbeni naphantsi ukubukela eqhelekileyo ayikwazi ukuba andibhaqwa. Esi sifo sichaphazela amabhinqa ngakumbi kunamadoda. ngezifo Pediatric ikakhulu isegazini.

Isifo

Ngokuhambisa Ithemba hiatal wohlulwe:

• Kardiofundalnuyu.
• esiswini Iyonke.
• Inhliziyo.
• esiswini losuku.

hernias Paraesophageal zihlelwe kwi:

• Kwesisu.
• Akunakuba.
• Emathunjini.
• Antral.
• Fundus.

isigaba yezifo

Ngokuhambisa Ithemba hiatal zingahlulwa ngokungqinelana umthamo esiswini zingene lweHo- esifubeni:

• Isigaba sokuqala. Kulo mzekelo, kwisisu thoracic uvalo ibekwe phezu inxalenye esiswini ye emphinjeni. Nesisu ngoko kwindawo ephakamileyo. Yena omelene ngqo uvalo. Yaye imi cardia.
• Isigaba sesibini. Komgodi thoracic uSahlulelo esiswini ke kuvuleke iminxunya, nesisu abazahlulayo ngqo kummandla emngxunyeni phrenic.
• Isigaba sesithathu. Ngaphezu uvalo ke cardia, umzimba esiswini nasezantsi (ngamanye amaxesha isahlulo antral) esophageal esiswini ngokwahlukana.

picture clinical

Iimpawu zezifo efana kakhulu iimpawu izifo wokugaya ezinxulumene kunye nokusebenza kakuhle. Ngokuchasene imvelaphi ngezimvo umsebenzi esophageal sphincter (ngaphantsi) iphawulwe catarrhal reflux (umva ekubunjweni imixholo esiswini). Ekuhambeni kwexesha ngenxa impembelelo ngxwaba ubude kwinxalenye esezantsi kuvuleke iminxunya iphuhlisa inkqubo arhabaxa. Isigulane iqala ukuba ezikhala heartburn emva kokutya kunye nokwandisa noxinezeleko ngokwasemzimbeni okanye ifoto. Kudla kukho yimvakalelo iqhuma emqaleni. Emva kwesidlo, kubonakale intlungu. Zahluke ngokwendalo. Iintlungu ingahlakazeki ukuya igxalaba, ukuze libanike entanyeni, emva kwentamo, ngeenxa intliziyo okanye umhlathi ongezantsi. Ezi mpawu iyafana iimpawu angina, oluqhutywa umehluko kokuxilongwa. Kwezinye iimeko iintlungu kuvela kwindawo ethile apha emzimbeni. Kusenokwenzeka ukuba ndibhenele distension isisu eliphezulu yesigulane, kengoku ubukho umzimba amazwe.

imiphumela

iimeko ezibalaseleyo kakhulu zesi waphawulwa ngezinto eziliqela iingxaki. Omnye wabo owophayo empahleni esophageal. Ngokuqhelekileyo, oko kwenzeka ngendlela afihlakeleyo, kwaye ibonisa kwegazi progressive. Ukopha inokuba ezingapheliyo bukhali. Kwezinye iimeko, nkqu bekubona lunamaqoqo mthetho kwi ukuvulwa esophageal kunye perforation esophageal. Isiphumo iqhelekileyo sifo reflux esophagitis. Oko kuguqulwa ube isilonda Peptic kwi emphinjeni. Ngexesha unyango okuqhubekayo kuphakamisa le meko ingxaki kakhulu ngakumbi - stenosis cicatricial (exineneyo) lomzimba.

ekuxilongweni

Pathology Detection ikhutshwa phandle ngeendlela ezininzi. Oku kukhankanywe phakathi ezinkulu: esophagogastroduodenoscopy, X-reyi esiswini kunye kuvuleke iminxunya, intraesophageal PH-meters. Esetyenziswa ultrasound, Itomography ngekhompyutha, ezofagometriya.

unyango lwezifo

Kwenziwe imisebenzi eyahlukeneyo zijoliswe ekunciphiseni ezibonisa ukuba ihambe sliding Ithemba hiatal: ukutya, amayeza. iindlela Conservative ajolise yokunqanda iimpawu isifo: ntlungu, heartburn, isicaphucaphu. Kulo mzekelo, wamisa iziyobisi zokunciphisa iasidi esiswini. Ngaloo ndlela, umzekelo, iquka ukulungiswa "Kvamatel". Omnye yemiqathango ukuba unyango olusebenzayo zezigulane une Ithemba hiatal - isondlo. Yokudla limited kubukho ezinamanqatha, okuneziqholo, ukutya, nowento ekroqiweyo, utywala, itshokolethi, ikofu, iimveliso ezikhuthaza imveliso incindi esiswini. Ukutya kufuneka kube izidlo ezincinane rhoqo. Ukuthintela reflux isigulane yokulala luyacetyiswa kunye kummandla umzimba wamvusa aphezulu, uphephe onzima.

Surgery: ulwazi ngokubanzi

Kufuneka ke ukuba imisebenzi engaphezulu musa ukuphelisa isizathu apho kukho ngokokushiyana Ithemba hiatal. Operation - indlela kuphela ukubuyisela ubudlelwane zomzimba phakathi kwezahlulo GI. Xa inkqubo yokungenelela kudala yindlela antireflux ethintela ngasemva yimbali imixholo isisu. Ngexesha operation hernial kuphele suturing umngxuma nkulu ubungakanani yesiqhelo.

ubuchule Used kuhlinzwa

Namhlanje, iingcali basebenzisa iindlela ezimbini zokungenelela:

• ukufikelela Vula. Kulo mzekelo, ukuze ithwalelwe Nissen fundoplication okanye iplastiki yi UTope. Kwimeko yokuqala, basengozini enkulu yokuba neengxaki iseti. Ngenxa zeplastiki Kukhethwa ukuba UTope.
• indlela laparoscopy. Le ndlela ubuncinane ebuhlungu ongenelelo. Emva kokuba ukusebenza ngale ndlela isigulane kwakhona ngokukhawuleza kwaye kube lula.

Kufuneka ke ukuba laparoscopy Ithemba esophageal hole udla wenziwe kunye imisebenzi kwezinye ngokwamalungu kwisisu. Umzekelo, holetsistomiya lwenziwa xa cholecystitis calculous kwinqanaba ezingapheliyo, vagotomy uyakhetha proximal - isilonda kwi duodenum.