Zenker a diverticulum mmene zimaonekera, chithandizo opaleshoni

diverticulum Zenker ndi mtundu chosowa kwambiri wa kudwala pa mundawo m'mimba. Cholowa cha matenda chifukwa cha 3-5% milandu onse. Kunja thumba-protrusion kudwala akuwonetseredwa mucosa wa kum'mero ndi pakhosi mwina ndi mawonekedwe osiyana ndi kukula. Chilema m'mimba thirakiti kumachitika poyambirira pa mpanda wake kumbuyo, ndiyeno nkubwera pambali. Pharyngoesophageal diverticulum ndi onse obadwa nawo ndi kuthi matenda, kupanga njira imene nthawi zambiri pulsionny, ngati pali malo ofooka m'thupi chifukwa kuthamanga mu lumen ake.

Features matendawa

diverticulum Zenker bwino pang'onopang'ono. miyeso yake zosiyanasiyana, kufika nthawi zina phindu la mutu mwana. Diverticulum ndi khosi ndi thupi, yokutidwa ndi epithelium mucous. Mu M'mimbamo ake madzi kungakhale kukweza kwa chimene chingathe kukwaniritsa malita 1.5.

Malowa ali pamtunda kumbuyo mapangidwe kum'mero ndi kumanzere kwa iwo, cha mediastinum chapamwamba. kawirikawiri kukhala mtundu intramural wa kudwala, pamene malowedwe diverticulum akupezeka danga pakati pa makoma a minofu kum'mero.

Akufika zamitundu zikuluzikulu, maphunziro limayamba woyesetsa kukakamiza boma, amene pafupi. Diverticula si zinaphatikizidwa ndipo amayambitsa kutupa mu zimakhala ozungulira bola bbwino peridivertikulit.

The chikuchititsa mavuto a matenda

Mu njira yachibadwa ya kumeza amapezeka kuchepetsa mu pharynx ulusi minofu cricopharyngeal minofu ayamba kumasuka, ndi m'kamwa mwa kum'mero chowululidwa. Ngati kuphwanya ntchito minofu amapezeka diverticulum.

The zifukwa mapangidwe pathologies ndi:

• kutengera za kumtundu;
• esophageal mucosal choipa;
• matenda obadwa nawo a minofu minofu;
• sclerosis ndi calcification wa chichereŵechereŵe;
• kuphwanya chitukuko yoopsa;
• zopindika minofu minofu;
• msana choipa;
• matenda yotupa wa kum'mero komanso pakhosi.

Chipatala kuwonekera kwa matenda

Kodi ndi diverticulum zimenezi? Izo zimatengera kukula kwake. zopindika ang'onoang'ono (2 cm) alibe kuonekera ndipo mwangozi anapeza pamene X-ray kapena Kupenda fluoroscopic.

Ngati panali Zenker diverticula, zizindikiro za matenda zidzasankhidwa malinga ndi magawo a matenda.

Features wa gawo loyamba

Chifukwa gawo loyamba zizindikiro khalidwe nonspecific. Zikuphatikizapo: scratchy pakhosi, profuse salivation, kapena mosinthanitsa, dryness wa mucosa m'kamwa. Odwala titsatire fungo loipa (lawola, tuhlosti, sulfide wa hydrogen). Kungakhale kawirikawiri chifuwa kapena zophinja kumeza. Akamadya pali ponso kamvekedwe, limodzi ndi mavuto minofu khosi, kuchititsa wodwala akumva monga akuti lankhosa ku mmero chotupa. Patapita nthawi, wodwalayo akufotokozera njira ya moyo, chomwe alibe zindikirani chifuwa chosatherapo ndi burp atatha kudya ndi ndikuzolowera gargle.

Features wa gawo lachiwiri ndi lachitatu

Kodi ndi diverticulum mu gawo lachiwiri? Nthawiyi amakhala ndi stagnation wa ntchofu, chakudya, kudzikundikira mpweya, koma thanzi akukhudzidwira si chakhungu. Kuzionetsetsa, dokotala limasonyeza asymmetry wa khosi chifukwa cha protrusion mmodzi ndiye amaganiza. Kuti kukhudza ndi zofewa pa Mwamsanga palpation, ndi pa chakudya kachiwiri kuchuluka kukula. Pa pogogoda pakatikati pa thickening madzimadzi atatha kudya pali chizindikiro cha akukuta, ndi mbali kukanikiza taonera kugunda.

Mu gawo lachitatu la matenda amalembedwa decompensation. Isanayambike zizindikiro kukhala yapadera kwambiri, akukhudzidwira thanzi ndi woipa kwambiri, wodwalayo akuyamba mofulumira kuonda.

Matenda yotupa ndondomeko kunachitika M'mimbamo diverticulum, kumayambitsa mavuto osiyanasiyana: chibayo, asphyxia, abscesses, stasis venous magazi, esophageal perforation makoma, mediastinitis ndi zikamera wa malignancies.

diagnostics

The njira yaikulu matenda diverticulum Zenker a, - X-ray amachitika ndege osiyana. Kukonzekera Special papezeka M'mimbamo mapangidwe, kotero kuti n'zotheka kudziwa osati malo enieni, komanso kukula kwake, mawonekedwe, khosi m'litali, anaŵerama mulitali, chikhalidwe cha ziwalo moyandikana ndi nyumba anatomical. Ngati m'kamwa diverticulum barium slurry akuyamba yaitali, umasonyeza chitukuko cha diverticulitis.

Kuchiza matenda ndi ndiwofatsa

Ngati anapezeka ndi diverticulum Zenker a, mankhwala onse ndiwofatsa komanso opaleshoni njira. Koma ngati opaleshoni mungathe yoyamba kudwala amalimbikira thandizo. Ndi mankhwala ndiwofatsa ndi ankayesetsa pokha pokha pamene pali contraindications kwambiri opaleshoni. Pankhaniyi, wodwala ayenera kutsatira ulamuliro okhwima chakudya, zofewa zakudya, mokwanira kutafuna chakudya. Wodwala ikuchitika pambuyo ingestion ngalande diverticulum, Mwaichi ayenera kukhala mu malo ena. Komanso, mapangidwe amenewa ikuchitika lavage, ndipo wodwalayo ayenera kutenga masamba kapena mafuta paraffin kwa kondomu ya mpanda wake.

chithandizo opaleshoni

Kwambiri zambiri zothandiza pa matenda monga diverticulum Zenker a opaleshoni likhale chomwe chili pa magawo wachiwiri ndi wachitatu wa matenda, limodzi ndi zosokonezeka. maola 48 asanayambe opaleshoni, wodwalayo Kwalamulidwa zakudya madzi, ndi bwino kutsukidwa ndi maphunziro kudzera esophagoscope kapena catheter.

Pamene Zenker a diverticulum view ntchito adzakhala divertikulektomiya gawo, chomwe pochotsa thumba limeneli nsalu mwa mapangidwe kudula. Matendawa kwa wodwala kutumikiridwa ndi kafukufuku wandiweyani mu kum'mero, motero mutsogolo ntchito. Akutali ku zimakhala ozungulira diverticulum intersect pa tsinde ndipo ali sewn kapena knotted mosalekeza suture. Chachotsedwa pathological mapangidwe ntchito stapler, omwe umagwiritsidwa ntchito maziko ake.

Ndiye kafukufuku ikuchitika pa inputted ekstramukoznuyu esophagomyotomy kutalika kwa masentimita angapo. Ngati diverticula kukula yaing'ono, zokwanira mmodzi cricopharyngeal myotomy, kenako iwo ali anaweramuka, ndipo pamodzi ndi Kakhungu mucous pa mundawo m'mimba akupanga lathyathyathya khoma.

Posachedwapa ena zipatala anayamba kuchita opareshoni endoscopic njira, mwachitsanzo. E. Osati kupanga ang'ambe thupilo pa khosi. Kwenikweni ake ndi odulidwa khoma wamba pakati pa kum'mero ndi diverticulum, ndi ntchito stapler endoscopic ikuchitika myotomy. Pambuyo opareshoni zimenezi, wodwalayo akuchira msanga ndi kusiyiratu matendawo.

The postoperative nthawi pambuyo kuchotsa diverticulum Zenker

Features wa nyengo imeneyi kuti wodwalayo maola 48, musadye. Ena madokotala kusiya kwa masiku 3-4 kafukufuku kudyetsa wodwalayo chakudya madzi. Pambuyo kuchotsa kwa masiku 5-6 kale chakudya theka-madzi, pang'onopang'ono kuwonjezera zakudya.

Ngati mulibe kuchiza matenda, kuti madokotala ananena zawo ndi osauka kwambiri. mavuto osiyanasiyana kungachititse kuti imfa 23-33% ya milandu.

Pomaliza

Choncho, Zenker a diverticulum - matenda sioneka kwambiri. Popanda kusonyeza lokha pa chiyambi cha chitukuko, patapita kanthawi izo kwambiri impairs boma thanzi. Kuchitira zikhale kuvomerezedwa, mwachitsanzo. A. A Mwina mkulu imfa zosiyanasiyana zosokonezeka.