Perforation m'mimba: zizindikiro, chithandizo, zosokonezeka

Mwa matenda aakulu ziwalo zonse ili mkati zonse m'mimba, perforation cha m'mimba ndi chilonda duodenum ndi 2%. Malinga ndi kafukufuku, pafupipafupi vuto ili la matenda ndi 7-12% ndipo amapezeka odwala amene m'badwo zaka 25-35. Pankhaniyi, amuna zikuoneka nthawi 5 zambiri kuposa akazi.

Zimayambitsa perforation

Perforation ya m'mimba (perforation) limawonekera pa zilonda m'munsi mphamvu ndi m'mbali pansi pa nsalu. Zimachitika pa dysfunctions osiyana mtima patency mwa mitsempha ya. zimenezi chimaoneka ndi chakuti pa perforation m'dera la kugonjetsedwa 12 mmatumbo chilonda kapena chapamimba khoma palibe magazi. Chilonda perforation m'mimba ali mitundu 3:

• lililonse (zili m'mimba anazitsanulira mwa zonse m'mimba, peritonitis akufotokozera);
• atypical (perforation uphimbika chakudya England, mucosal makutu, ndi zina zotero);
• monga pentratsii (pansi perforation anatsegula ziwalo oyandikana).

Childs, chodabwitsa otere yoyamba wamphamvu ululu wa chibadidwe anam'peza matenda kumatenga nthawi yaitali. Pankhaniyi, oipa mpanda wake m'munsi. Perforation m'mimba bwino zimayamba ndi:

• maganizo ndi nkhawa thupi;
• ntchito mowa;
• exacerbation la matenda anam'peza;
• kudya;
• zoopsa;
• ndi mankhwala ena amene amayambitsa kudwala izi.

Mmodzi ayenera kuganizira kuti anthu okalamba mu mbiri ya chilonda sizingatheke, chifukwa odwalawo yodziwika ndi chithunzi zobisika za matenda.

Kodi akapsa perforation

Monga ulamuliro, zilonda pachimake mu zosatheka kugwirizana ndi H.pylori matenda. Umboni wa chironda chachikulu mu 95% ya H. pylori limasonyeza etiology ake. Pachimake chilonda tinganene kuti ngati siteji ya chapamimba chilonda. Kuwonjezera H.pylori, perforation m'mimba akhoza zidzayambike ndi:

• Zollinger-Ellison syndrome;
• zilonda mankhwala ndi matenda ena endocrine;
• pancreatogenic ndi mitundu ina gepatogennymi pachimake ulceration (mwachitsanzo, matenda amatupitsa).

Pakuti maonekedwe a dzenje la mpanda muzituluka ndi zofunika kwambiri mu chidulo ake onse zigawo chiwonongeko hydrochloric ndi kuwonjezeka mu kuthamanga m'dera m'mimba. Performative aakulu chilonda amati GAWO kupitirira wa chapamimba chilonda. kudwala Izi aumbike pa pakalibe mankhwala kutero.

zizindikiro

Perforation a linga m'mimba ali masiteji zazikulu zitatu:

1. A boma kakasi.
2. Onyenga chitukuko.
3. Peritonitis.

Mwachindunji GAWO mantha zidzachitika perforation ndi kugwa kwa nkhani chapamimba pa mapepala peritoneum. Amamva mumamva "mpeni ngati" zowawa amene amapezeka zigawo chapamwamba zonse m'mimba, amene mwamsanga kufalitsa dera lonse la pamimba. odwala kwambiri panthawi ino anayamba woimba ndi kumafuula. Choopsa chachikulu chikhalidwe ikukula mofulumira:

• kuthamanga amachepetsa;
• Kugunda kubweza pansi;
• khungu integument kukhala yonyowa, ozizira ndi wotumbululuka;
• wodwalayo amatenga udindo amakakamizidwa - mbali imodzi, ndi maondo utoto kwa m'mimba.

Patapita nthawi zina za nthawi (pafupifupi 7 maola) ululu ali wofooka, ndi zina, kwathunthu kusiyiratu. Pang'onopang'ono kumawonjezera bloating, kumakhaladi si choncho pano, kutha auscultation phokoso mu intestine lapansi. Opulumutsidwa hypotension, arrhythmia amayamba kutuluka ndi kukula tachycardia. Gawo moyo abodza akhale maola 12.

zotsatira zotheka

Pa yapita magawo awiri a munthu pang'onong'ono peritonitis. Mlingo wa mkhalidwe kachiwiri kulimbikitsa ndi: wodwalayo lethargic zikopa chophimba tikhale ndi hue wanthakayo, kukhala mamina ndi thukuta. Mpanda kutsogolo kwa peritoneum mantha. N'zochititsa chidwi kuchepetsa chiwerengero cha mkodzo umatulutsa, nthawi zina amabwera kwa anuria.

Ngati wodwalayo chironda chachikulu ali fomu atypical, ndi perforation akupezeka minofu retroperitoneal. Komanso, kabowo akhoza ananamizira chakudya kapena ziwalo ozungulira. Mwina ndondomeko delimitation ngati pali adhesions ambiri. Amadzazira perforation ndi a mitundu yosiyanasiyana:

• okhazikika;
• nthawi;
• lalifupi.

Izi mitundu ya perforation zidzachitika, iwo amakhala chophweka kwambiri. Mumadziwika kudziletsa kuchiritsa milandu.

Kupatula peritonitis complicating Ndime ya matenda chapamimba mungathe hypovolemia, mantha ndi sepsis.

matenda matenda "m'mimba chilonda"

Perforation m'mimba amafuna matenda molondola, amene angathe kuikidwa okha mbiri bwino anasonkhana. Matenda a m'pofunika kuona katswiri. Mtundu uwu wa mavuto nawo madokotala gastroenterologists ndi endoscopists.

A nthawi zofunika kwambiri ayesedwe ngati mukuganiza kuti muli ndi perforation muzituluka. Zizindikiro Mulimonsemo sitingakane, monga magawo zapamwamba za matenda kungakhale ndi zotsatirapo mpaka kalekale. Kupeza ndi endoscopist ndi gastroenterologist mwamtheradi wofunikila wodwala aliyense amaganiziridwa matenda, makamaka ndi kukhalapo mwina kwa perforation chatsekedwa. Mu phunziro limeneli satchula deta zonse kwa matenda, koma awo kukhazikitsa m'pofunika kukhala mbali ya pokonzekera opaleshoni.

Perforation m'mimba anatsimikiza mwa njira zotsatirazi:

• Plain radiography.
• M'mimba ultrasound.
• Upper endoscopy.
• Pamene mavuto a matenda ndi amaganiziridwa perforation ophimbidwa ntchito laparoscopy.

Matenda ndi zizindikiro zofanana

Perforation m'mimba akhoza zimachitika mfundo monga "pamimba pachimake", chifukwa matenda ayenera kusiyanitsidwa ndi:

• kapamba;
• cholecystitis ndi appendicitis;
• chotupa kuwola;
• aimpso ndi kwa chiwindi colic;
• mesenteric mtsempha thrombosis;
• chotupa cha aneurysm kung'ambika mu zonse m'mimba;
• mtima;
• pleurisy.

kupeza nthawi yake kwa katswiri ndi kuchititsa miyeso matenda chingatithandize kukhazikitsa matenda zolondola ndi nthawi kuyamba zochizira matenda oopsa.

Kodi achiritse perforation?

Malinga ndi chithunzi matenda, kuthandiza ndi perforation chapamimba, m'njira zingapo.

1. Normal kutsekedwa kwa chilonda cha. Linapangidwa achinyamata ndi mbiriyakale zilonda odwala okalamba ndi chiopsezo cha mankhwala ochititsa dzanzi ndi thandizo ntchito, komanso zilipo akakufunsani peritonitis.
2. Ngati palibe peritonitis, phukusi akhoza wodzilemekeza ndi kusankha proximal vagotomy, zomwe zimathandiza kuti kuteteza yaitali chithandizo kuchipatala cha gastroenterology m'tsogolo.
3. Pamaso pa zilonda mu pyloric ndi, zilonda zopweteka mmakutu, kwambiri magazi, stenosis pa mundawo outflow, ndipo anthu mkhutu ndi chiopsezo kwambiri opaleshoni, anachita excision wa chilema, pyloroplasty ndi vagotomy tsinde.
4. Pamene wodwalayo maonekedwe wosanganiza matenda anam'peza kapena mbiri zikuoneka zina chapamimba perforation opaleshoni izi zikhoza wodzilemekeza gemigastrektomiey.
5. zotsatira zabwino zilipo pa maziko a mankhwala laparoscopic ndi endoscopic. Zowonjezerazo opaleshoni chapamimba perforation adzakhala endoscopic vagotomy ndi endoscopic chithandizo.

Ngati mukufuna kuchepetsa chiopsezo opaleshoni, nkotheka wapotalikira gastrectomy kapena laparoscopic omentum tamponade perforation malo. mwai izi bwino analekerera ndi odwala amene angapereke kuchira mu nthawi zambiri mofulumira.

Atam'chiritsa ntchito opaleshoni singasiyanitsidwe kuti tikonzedwe chonse wodwalayo kuchotsa wothandizila si steroidal (pamene cholinga chawo kuteteza zikamera zilonda chapamimba) kapena kusintha zoletsa awo cyclooxygenase, komanso ndiwofatsa inayamba.

Kupewa ndi kuneneratu

Pa perforation wa Mapa n'kwakukulu kwambiri chifukwa cha akuchedwa mu chikhalidwe matenda nthaŵi zina kumapangitsa kuti ziyende woopsa wa wodwalayo. Imfa pakati anyamata pafupifupi 2-6% (amaganizira chithunzi matenda, nthawi thandizo anapereka ndi zina zinthu zina), anthu okalamba, koyefishienti ichi kumawonjezera kangapo.

Kupewa matenda ndi sekondale - zimafunika yake oterewa ndi kuchiza matenda amene angakubwezereninso wodwalayo chikhalidwe ichi.