I-Hernias ye-Diaphragmatic Congenital: I-Diagnosis, Surgery kunye ne-Recovery

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Yintoni I-Diaphragmatic Congenital (i-Bochdalek) yaseHernia?

Ingqungquthela yesifo sokuzalwa, okanye uBhendalek hernia, eyenzeka kwisibeleko kwaye ifunyanwe ngexesha lokukhulelwa okanye kwintsana. Kuyenzeka xa kukho ubuthathaka kwisithintelo, isisipha esahlula isifuba esiswini esiswini. Ukongezelela ukuhlula izitho zesifuba kwizitho zesisu, isithsaba sinceda imiphunga izalise oksijini. (Ukuhamba kwesisu esisibonelayo xa uphefumula kukunyakaza kwesithintelo.)

Isithintelo esinzima esinokuthi sivumele ukuba inxalenye yonke okanye izitho zithintele kwisifuba, ngokusebenzisa umgodi okanye isiphako. Kwiimeko ezininzi, i-hernia ye-diaphragm isiphumo esiphuthumayo, efuna unyango olukhawulezileyo unyango. Oku kungenxa yokuba intliziyo kunye nemiphunga kunzima ukuzalisa nokunika umzimba umzimba nge-oksijini ngenxa yokunyuka kwesifuba. Isana esilutsha olunalo luhlobo lwe-hernia lungaba nomlomo obonakala luhlaza, ngenxa yokungabikho kwe-oksijeni.

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Izizathu kunye neengozi

Iimbangela ze-Hernia ye-Diaphragmatic Congenital

Akukho nto eyaziwayo yeso sidima esicacisayo . Ubuthathaka kwi-muscle bukhona ekuzalweni, okubizwa nangokuthi "i-defenital defect". Ayikho indlela yokuthintela i-hernia ye-diaphragmatic, njengoko ivela kwi-utero, ngaphambi kokuba umntwana azalwe.

Ngubani Osemngciphekweni WaseHernia Eyesibindi Sokuzalwa?

Iindlebe ze-diaphragmatic zenzeke kwi-1 kuzo zonke ii-2,000 ukuya ku-5 000 zokuzalwa. Kukho kubonakala ngathi udibaniso lwezofuzo olubandakanyeka kuloluhlobo lwe-hernia, njengoko umntwana usenokuba yingozi enkulu yokuba nalo hlobo lomnxeba ukuba umntakwabo okanye umzali unesimo. Abafana banomngcipheko ophezulu kunamantombazana.

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Ukuxilongwa

I-hernia ye-diaphragm ayinayo ibonakala phantsi kwesikhumba njengamanzi amaninzi. Kwiimeko ezininzi, akukho zibonakaliso ezibonakalayo ukuba usana olusandul 'uzalwa lunalo hlobo lomnxeba. Kuya kufumaneka ukuba ne-ultrasound ngaphambi kokuba umntwana azalwe, okanye emva kokuzalwa xa isisu sisicinga ukuba "siyinalutho" ngokukhawuleza xa kuhlolwa umzimba. Kwezinye iimeko, i-hernia ingafunyanwa xa oogqirha befuna inkcazo yokuphefumla ubunzima obusana olusandul 'ukuzalwa.

I-hernia ye-diaphragm iyenzeka ngokuqhelekileyo kwicala lasekhohlo lomntwana, okwenza kube yinto evamile ukuba isisu siphumelele ngesiphene. Kwiimeko ezibuhlungu, apho kuphela isisu esabandakanyekayo, umntwana angabonisa kuphela iimpawu zobunzima bokutya nokuhlanza.

Iimvavanyo zingalelwe ukuba zichonge ukuba ziphi iingcipheko ezichaphazelekayo yingxaki. I-echocardiogram inokuyalelwa ukuba ihlolwe umsebenzi wenhliziyo; i-x-ray esifubeni, i- CT scan okanye i- MRI ingasetyenziselwa ukuvavanya izitho ezongezelelweyo. Iimvavanyo zegazi nazo ziyalelwe ukuba ziqikelele ukuba ingakanani i-oksijini iyafikelela egazini ngaphezu komsebenzi webhu lab.

Iimpawu zeHernia yeDiaphragmatic

• Inqanaba lentliziyo elikhawulezayo (intliziyo ezama ngamandla ukufumana i-oksijini emzimbeni)
• Isantya esiphezulu sokuphefumula (imiphunga izama nzima ukufumana i-oksijini emzimbeni)
• I-Cyanosis (imilomo eluhlaza okomileyo kunye nemibhede yomnyobo)
• Iingxaki ezingapheliyo, ezinzima zokuphefumla
• Ukuxilongwa kwe-amniotic ngokweqile ngexesha lokukhulelwa
• Ukuxilongwa kwemiphunga ephothiweyo
• Olunye uhlangothi lwesifuba lubonakala lukhulu kunomnye
• Ingxaki ezinzulu zokutya okanye ukugcina ukutya
• I-X-ray ibhokhwe ibonisa ukungavumeleki esifubeni

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Xa Ubunzima Bokuzalwa Ngamaqabane E-Hernia Ngaba Ixesha Elixakekile?

I-hernia ye-diaphragm ingaba yimeko engxamisekileyo yezizathu ezininzi. Usana lunokuba nobunzima bokuphefumla, njengoko izitho ezongezelelweyo ezifubeni zenza kube nzima ukuba imiphunga ikhulise. Oku kuyinyaniso nentliziyo; kunokuba nzima ukuba intliziyo izalise igazi ngenxa yokugqithisa kwesifuba.

Ukongezelela, kukho umngcipheko wokuqhawulwa kwezitho ezixinzelele kwisifuba, oku kuthetha ukuba izitho eziye zangena kwisifuba zithintela ukuhamba kwegazi. Oku kunokubangela ukufa kwezicubu kunye nezitho ezithwalayo kwi-hernia.

Iintsana ezizalwe nge-hernias ezixinayo zigcinwa ngokunyamekela kwiyunithi yokunyamekela kakhulu ngenxa yeengxaki ezinzima ezihlala zikhona. Nangona ukuba abantwana abazalwa benesifo esicacileyo bayagula kakhulu, ukuhlinzwa kungase kubambezeleke kuze kube yilapho umsebenzi wamaphaphu uzinzileyo, njengoko oku kunokuphucula amathuba okuqhubeka nokuhlinzwa.

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Ukuguqulwa kwe-Hernia ye-Hernia ye-Congenital Diaphragmatic

Utyando oluthile lwe-hernia luqhutshwa ngokusetyenziswa kwe-anesthesia jikelele kwaye luyenziwa kwisifo sengqondo . Ingenziwa ngokukhawuleza, ngokukhawuleza emva kokuzalwa komntwana, okanye ngokukhawuleza xa umntwana ezinzile ngokwaneleyo ukunyamezela ukuhlinzwa. Kwezinye iimeko, kunokukho umfuneko wokuzinzisa ukuphefumula komntwana okanye umsebenzi wenhliziyo ngaphambi kokuhlinzwa. Kwiimeko ezinqabileyo kakhulu, utyando olwenziwa kwi-utero lunokuqwalaselwa, inkqubo apho utyando lwenziwa kwintsana xa umama ukhulelwe. Umntwana uvumelekile ukuba aqhubeke nokuphuhlisa xa kuqhubeka ukukhulelwa, nangona ukukhulelwa kuba ngumngcipheko omkhulu.

Utyando, xa lwenziwa kwintsana, lusetyenziswa ngunyango ogqirha lwabantwana, kodwa lungadinga uncedo lwabanye abagqirha, njengophando lweguldidiracic okanye i- colon-rectal ingcali kwiimeko ezinzima. Ngokuxhomekeke kwiimpawu ezichaphazelekayo, oogqirha abahlukeneyo okanye abongezelelweyo abanezakhono ezihlukeneyo bangathatha inxaxheba ekutyunjweni.

Utyando luvame ukuqhutyelwa ngendlela evulekileyo usebenzisa ukuchithwa okuqhelekileyo ngaphantsi kwembambo yentambo, kunokuba i- laparoscopic indlela engaphantsi. Oku kubangelwa ubunzima beengxaki ezidibaniswe nobukhulu becala besigulane.

Utyando luqala ngokufumana isiphako kwisithintelo kunye nezicubu eziye zanyuka kwindawo yesifuba. Iimpawu kunye nezitho, ukuba zikhona, zibuyiselwa kwisisu. Emva kokuba izicubu zibuyiselwe kwindawo yazo efanele, umgodi kwisalathisi uvaliwe. Oku kwenziwa ukwenzela ukuthintela izicubu zomzimba zokufuduka ukuya kwisigxobo sesifuba. Ukuba isiphene kwisithintelo sinzima kakhulu, i-diaphragm ingadalwa kwizinto zokwenziwa.

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Ukubuyisela kwi-Diaphragmatic Hernia Surgery

Uninzi lwezigulane ze-hernia zigula ngokugqithiseleyo ekupheleni kokuhlinzwa kwaye ziya kuthathwa kwiNyunithi Yokunakekelwa Kwezinyathelo ZikaNonatal (NICU) ukuze ibuyele. Kwizigulane ezingabonakaliyo ezikwazi ukuphefumula ngokwabo emva nje kokuhlinzwa, lindela umntwana ongenakhathazeka kwaye ngamanye amaxesha, kunzima ukuthuthuzela.

Ukuba imiphunga yengane ayinakuphuhliswa okanye ukuba iingxaki zokuphefumula ziyaqhubeka emva kokuhlinzwa, i- ventilator inokuba yimfuneko ngexesha lokubuyiselwa. Kwezinye iimeko ezinzima, i-ventilator ayanele ngokwaneleyo ukuhambisa i-oxygen eyaneleyo emzimbeni. Kule meko i-ECLS / ECMO (i-Extracorporeal Life Support / i-Extracorporeal Membrane Oxygenation) ingasetyenziselwa, umatshini onceda ukukhupha igazi xa imiphunga neentliziyo zingakwazi ukwenza njalo. Olu unyango lusetyenziswa kuphela kwizigulane ezigula kakhulu, abo bayeza kufa ngaphandle kokongezwa kwe-oksijeni emzimbeni.

Ubungakanani bexesha umntwana achitha kwi-ICU ngokuxhomekeka kakhulu kuxhomekeke kwimeko enzima ngayo, ukuba kukho nayiphi na imonakalo yelungu kunye nendlela ephuhlise ngayo iziko.

Ngelishwa, le meko inzima kakhulu kwaye ezinye iintsana aziyikunyamezela ukuhlinzwa. Abanye abantwana bayayenza ngokuhlinzwa, kodwa ukudibaniswa kokuhlinzwa, izitho ezingaphangeliyo okanye umonakalo womzimba kubangelwa ukufa. Kulinganiselwa ukuba i-80% yezigulane zisinda kutyando kunye nokubuyiselwa.

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Iziphumo zexesha elide ze-Diaphragmatic Hernias

I-hernia ye-diaphragm ingabangela iingxaki ngaphambi kokuba umntwana azalwe. Imiphunga kunye nentliziyo yengane ayinakukhula ngokuqhelekileyo, ngenxa yoxinzelelo obangelwa zizicubu ezongezelelweyo esifubeni. Iimpawu okanye izitho ezithe zisa kwisifuba zingabonakaliswa okanye zingaphumeleli ukuphuhlisa ngokufanelekileyo ngenxa yokungahambi kwegazi. Oku kunokubangela iingxaki zokuphefumula eziqhubekayo, iingxaki zeentliziyo kunye nemiba enomsoco.

Ezi zi gulane zihlala zifumana ukulibaziseka okuphuhliswayo, ezinokuthi zinciphise ngokuhamba kwexesha. Kwamanye, ukungaphumeleli kokufumanisa ukuxilongwa kuhamba kunye nexesha elide lokukwazi ukufumana oksijini okwaneleyo emzimbeni.

Ulwazi olungakumbi: Yonke Nge-Hernias

_Imithombo:

_{I-Hernia ye-Diaphragmatic Congenital. Inkqubo yeMpilo yeYunivesithi yaseMichigan. http://surgery.med.umich.edu/pediatric/clinical/physician_content/am/congenital_diaphragmatic.shtml}

_{I-Diaphragmatic Hernias. I-Lucile Packard Children's Hospital eStanford http://www.lpch.org/diseasehealthinfo/healthlibrary/digest/diaphrag.html}