Perforation mudumbu: zviratidzo, kurapwa, matambudziko

Pakati ose chirwere zvirwere nhengo dziri mukati abdominal mhango, perforation mudumbu uye duodenum urikanwi anenge 2%. Maererano nenhamba, kakawanda zviri kuomesa ichi chirwere ndiyo 7-12% uye unowanikwa varwere vane zera iri makore 25-35. Muchiitiko chino, zviri varume zvichiratidzika 5 nguva kakawanda kupfuura vakadzi.

Zvinokonzera perforation

Perforation mudumbu (perforation) rinowanikwa pana yakaderera simba maronda uye pasi micheto chinokosha. It ndepana dysfunctions dzakasiyana vascular patency kuburikidza arteries. tsanangudzo iyi kunoratidzwa yokuti munguva perforation munzvimbo kukundwa 12 duodenal urikanwi kana rusvingo gastric hakuna kubuda ropa. Urikanwi perforation mudumbu ane 3 siyana:

• kwese (dumbu mukati akadurura munzvimbo abdominal mhango, peritonitis hwapedyo);
• atypical (perforation yakafukidzwa chikafu shwanu, mucosal pazvirugu, uye zvakafanana);
• sezvo pentratsii (bottom perforation chavhurwa dzakapoteredza zvomukati).

Kazhinji, kutanga kwakadaro pashure simba kurwadziwa kuri maronda chirwere kunotora kwenguva yakareba. Panyaya iyi, iyo kuora kuti chawo rusvingo. Perforation mudumbu zvinogona kukonzerwa:

• mupfungwa nomumuviri;
• kushandisa doro;
• exacerbation kuti maronda chirwere;
• nokudyisa;
• kunotevera;
• kurapwa nedzimwe zvinodhaka kuti anokonzera zvokurwara ichi.

Munhu anofanira kufunga kuti vanhu vakura vari munhoroondo urikanwi haangavi, achishandisa mufananidzo chirwere yakavanzika nekuti varwere izvi vanoonekwa.

What zvinokonzera perforation

Kazhinji, chenjera nemaronda hakuna nzira chokuita H.pylori hweHIV. Nokusimbisa peptic urikanwi muna 95% kubva H. pylori anoratidza etiology kwayo. Chenjera urikanwi anogona kunzi ave padanho gastric urikanwi. Kunze H.pylori, perforation mudumbu zvinogona kukonzerwa:

• Zollinger-Ellison urwere;
• Drug maronda uye zvimwe zvirwere kwemakemikari anobudiswa;
• pancreatogenic, uye dzimwe mhando gepatogennymi rikwanise ulceration (semuenzaniso, Crohn kuti urwere).

Nokuti zvinoonekwa pakakoromoka gastric rusvingo kwakakosha munyika yose hydrochloric kuparadzwa akaturikidzana ayo asidhi uye kuwedzera nevezera mune abdominal munharaunda. Performative chisingaperi urikanwi ichaongororwa kuti Danho kuchiita gastric urikanwi. zvokurwara ichi chakaumbwa panguva kusavapo anodiwa mishonga.

zviratidzo

Perforation mudumbu rusvingo ane matanho makuru matatu:

1. A mamiriro nehana.
2. kubudirira Nhema.
3. Peritonitis.

Zvakananga Stage kugwinha kunoitika munguva perforation uye akawira pamusoro gastric zviri pamusoro machira ane peritoneum. Kwaunonzwa zvisingatsungiririki marwadzo "banga-se" kuti rinowanikwa yepamusoro akaturikidzana ari abdominal mhango, izvo akakurumidza kupararira munharaunda yose mudumbu. Varwere vakawanda panguva ino dzinotanga achipura uye mhere. Zvinonyatsorehwa kwokuomerwa mamiriro iri kukura nokukurumidza:

• kumanikidzwa kunodzikira;
• kupomba DZEMUNHU DZINODZORA;
• ganda integument kuva dzanyorova, chando uye rakachenuruka;
• murwere anotora kumanikidzwa nechinzvimbo - kurutivi rumwe, pamwe kupendwa pamabvi kuti mudumbu.

Pashure imwe nguva (maawa anenge 7) marwadzo simba, uye mune zvimwe zviitiko, chose nokupera. Zvishoma nezvishoma kunowedzera bloating, zvinova kwete nerongo, Zvibvisike auscultation ruzha iri ura. Kuponeswa hypotension, arrhythmia anotanga kubuda uye kukura tachycardia. Danho zvenhema zvakanaka nguva kungava maawa anosvika 12.

pezvingazoitika

Kwemakore yapfuura maitikiro maviri munhu zvishoma nezvishoma kuva peritonitis. The dhigirii wehurumende zvakare kuwedzera nokuti vabereki: murwere ari lethargic, dehwe yokufukidza wana chinhu ndewevhu Hue, kuva namuka pamwe ziya. Rusvingo pamberi peritoneum nerongo. Sezvineiwo kunoderedza uwandu weti anogadzirwa, dzimwe nguva kunyange anouya anuria.

Kana murwere ane peptic urikanwi ane atypical chimiro, asi perforation inowanika retroperitoneal tishu. Mukuwedzera, aperture anogona yakazonyorwa zvokudya kana akapoteredza nhengo. Zvichida delimitation muitiro kana pane adhesions zhinji. Kufukidza perforation ane mhando dzakawanda:

• zvachose;
• refu;
• pfupi.

Mhando idzi perforation kuitike, avanotarisira kuva nyore. Anozivikanwa nyaya nokuzvidzora achiporesa.

Kunze peritonitis complicating ndima gastric zvirwere zvinogona hypovolemia, kuvhunduka uye sepsis.

chirwere chirwere "dumbu urikanwi"

Perforation mudumbu kunoda kuongororwa zvakarurama, izvo zvinogona kuiswa chete zvakanaka inounganidzwa kare. Rokuongorora chirwere zvakafanira kuona nyanzvi. mhando iyi matambudziko dzinobatanidzwa vanachiremba gastroenterologists uye endoscopists.

A nguva inokosha chaizvo kuti kuongororwa kana uchifungidzira kuti une gastric perforation. Zviratidzo chero zvazvingava hazvigoni kungotariswa, sezvo yepamusoro nzendo chirwere kungaita kuti irreparable nemigumisiro. Kuwanikwa ari endoscopist uye gastroenterologist zvachose zvaidiwa murwere mumwe nomumwe maperembudzi vakafunga, zvikuru zvimwe pamberi namahwindo perforation. Muchidzidzo ichi haaratidzi dzizere mashoko nokuda nechirwere, asi Implementation wavo zvakakodzera sechikamu kugadzirira kuvhiyiwa.

Perforation mudumbu iri pakutsvaga nzira dzinotevera:

• Plain radiography.
• Abdominal Ultrasound.
• Upper endoscopy.
• Kana matambudziko anoitika nechirwere uye vanofungidzirwa perforation akafukidzwa kushandiswa laparoscopy.

Hosha zvakafanana zviratidzo

Perforation mudumbu zvinogona kunzi pfungwa dzakadai se "rikwanise dumbu", nekuti chirwere ichi anofanira kusiyaniswa:

• pfungwa nomuviri zvemwana asati;
• cholecystitis uye appendicitis;
• mota kuora;
• renal uye hepatic colic;
• mesenteric tsinga thrombosis;
• atsamwira ane kutsemuka aneurysm muna abdominal mhango;
• mwoyo kurwisa;
• pleurisy.

Panguva Chaiyo kuwana nyanzvi uye kuitisa matanho chirwere achabatsira chigaro kuongororwa zvakarurama uye nguva kutanga kurapwa zvirwere ngozi.

How kurapa munhu perforation?

Zvichienderana kunotoda mufananidzo, kubatsira gastric perforation, zviri munzira dzakawanda.

1. Normal kuvhara of urikanwi. Wakaitwa vechiduku vasina nhoroondo nemaronda Varwere vakwegura mikana yakawanda yokutindivadza uye rubatsiro operative, uyewo zviripo diffuse peritonitis.
2. Kana pasina peritonitis, kupindira ichi inogona vaisanganisa ne zvokusarudza proximal vagotomy, izvo zvinoita kuti tikwanise kudzivisa kurapwa refu vakanamatira gastroenterology mune ramangwana.
3. In pamberi nemaronda vari pyloric, rakapinza maronda, zvinokosha ropa, stenosis of water drainage turakiti, uye zvakanaka vanhu vane chinokosha pangozi kuvhiyiwa, akaita excision pamusoro kuremara, pyloroplasty uye vagotomy hunde.
4. Kana murwere ane yakavhenganiswa chimiro maronda chirwere kana nhoroondo dziri zvimwe zviratidzo gastric perforation, kuvhiya ichi inogona vaisanganisa gemigastrektomiey.
5. zvabuda Excellent anowanika pamusoro pakanyorwa laparoscopic uye endoscopic kurapa. Chinamatidzwa Kuvhiya gastric perforation kuchaita endoscopic vagotomy uye endoscopic kurapwa.

Kana uchida yekuzvidzivirira kuvhiyiwa, zvinogoneka distal gastrectomy kana laparoscopic omentum tamponade perforation nzvimbo. manipulations aya zvakanaka akashivirira nevarwere kuti inogona kupora munguva zvikuru nokukurumidza.

Apedza zvomusejari oparesheni dzetsika dzemagariro wakazara rakasungwa murwere kubviswa dzisiri steroidal nevamiririri (kana zvavo kudzivisa kwaita gastric nemaronda) kana kuti kuchinja dzavo cyclooxygenase FIs, uyewo kuchinja yokupedza.

Madzivirirwe Kufembera

Panguva perforation of for rakanyatsojeka rinorema nokuda nokunonoka zvokuongorora ezvinhu dzimwe nguva kunoita kuti ngozi mugumisiro murwere. Rufu pakati majaya ndiwo anenge 2-6% (kufungisisa kunotoda mufananidzo, nguva rubatsiro akapa uye navamwe zvinhu), vakwegura vanhu, coefficient ichi inowedzera kanoverengeka.

Kudzivirira chirwere hakukoshi - zvaanoitawo yakakodzera rokuongorora uye kurapa zvirwere vaigona kuunza murwere kuti ichi.