I-nutcracker isophagus yindlela yokuxhamla. Kuluhlu olufanayo lweengxaki ze-motility motility njenge- jackhammer esophagus kunye nokusabalalisa i-spop. E-US malunga naba-1 kwi-100,000 abantu bafumanisa ukuba bane-disophogeal motility disorder ngonyaka, nangona kunjalo, iziganeko zinyani zicatshangelwa ukuba ziphezulu kakhulu kuba zihlala zingabonakali njenge-acid reflux.
I-spops e-Esophageal inokuba yinto eqhelekileyo kubantu baseCaucasia kwaye ivela rhoqo kwiindawokazi kwabasetyhini. Umdala uba yinto enokwenzeka ukuba ufumane ukuphazamiseka kwamagqabi.
Iimpawu zokubonakalisa i-nutcracker isophagus zibandakanya uxinzelelo oluphezulu kunye neengcambu kwiindawo ezisemgangathweni. Izidumbu ze-osophogeal muscle zenza ukuba ukutya kubandakanyeke okanye kufakwe kwi-oopopus. Nangona i-nutcracker isophagus, nangona kunjalo, ngenxa yokuba i-spasms isaqhubeka ngendlela edibeneyo kwaye ilungelelanise kakhulu ukuba ibe nobuhlungu besifuba kunokuba kunzima ukugwinya.
Ayaziwa yintoni ebangela ukuba i-nutcracker isophagus. Ezinye iingcamango kukuba imeko ihambelana ngokusondeza i- reflux disorder (GERD) kwaye ingabangelwa yiyo. Enye ingcamango kukuba kubangelwa ingxaki yentsholongwane, kwaye abanye abantu bakholelwa ukuba kubangelwa impendulo engavumelekanga kwi-acetylcholine ye-substance.
Iimpawu zeNutcracker Esophagus
I-Nutcracker isophagus inokubangela inhlanganisela ethile okanye zonke ezi zilandelayo:
- ubunzima bokugwinya (i-dysphagia) eyenzeka ngokutya okuqinileyo kunye nokusetyenzwa kwaye kungenzeka ngezinye iixesha kuphela
- iintlungu zesifuba
- ukubuyiswa kwakhona kokutya
- ukuhlaziya
Kwakhona kunokwenzeka ukuba i-nutcracker isophagus ibe yi-asymptomatic (ingabangeli iimpawu ezibonakalayo).
Olunye uphando lubonisa ukuba abantu abane-nutcracker esophagus banokuba ne-esophagus e-hypersensitive and stiff.
Iimpawu zezinye iingxaki ze-motility (i-jackhammer esophagus kunye ne-spasm e-disophageal spasm) efana ne-nutcracker esophagus ukuhlola okuthethekileyo kufuneka kwenziwe ukwenzela ukuhlula phakathi kwezi ngxaki.
Ukuchonga i-Nutcracker Esophagus
Ezi zilandelayo zivavanyo zinokukunceda ugqirha wakho ukuba ahlolisise i-nutcracker isophagus:
- I- rumum swallow is a test that involves the swallowing substance that called barium sulfate. I-Barium sulfate ibonisa i-x-ray ukuze kube lula ukujonga indlela ye-barium sulfate ngokusebenzisa inkqubo yokutya. Ukongezelela kwiindawo zokusasazeka, le mvavanyo inokukunceda ukuxilonga iingxaki ezifana nobunzima bokugwinya okanye ukunciphisa isisu. Akufanele ufumane lo vavanyo xa uhlaselwa kwi-barium sulfate kodwa ngokuqhelekileyo uthetha, uvavanyo lunalo irekhodi elifanelekileyo lokukhusela. Nangona kunjalo, i-barium sulfate iyaziwa ukuba ibangele ukutywala ukuze ufune ukusela amanzi amaninzi okanye ukusebenzisa i-soften counter-softol emva kokuvavanywa.
- I- scan ye-CT ingabonisa ukwanda kwodonga lwe-esophageal (olukhulu kunama-3mm) kubantu abane-nutcracker esophagus. Nangona kunjalo, oku kuya kwenzeka kwezinye iimeko kuquka nomhlaza wesifo. Ukuba i-CT yakho yeskrini ibonisa ukugqithiswa kwodonga oluxhomekeke kuyo ugqirha uya kufuna ukuba aqhubeke nokuvavanya ukuqinisekisa ukuba uyaxilongwa.
- I-ultra-frequency ultrasound inokukunceda ekuhlukaniseni phakathi kwe-nutcracker esophagus, i-jackhammer esophagus, kunye ne-spasm.
- I-Manometry ye-Esophageal yinto efanelekileyo kakhulu yokuvavanya ukuphazamiseka kwamagqabhagqabha kunye neengxaki zeentlungu ezingezizo zomzimba. Uvavanyo luquka ukungeniswa kwebhanki elincinci kwimpumlo yakho, phantsi komqala wakho kunye nesisu esiswini sakho. I-tube iyinxinzelelo kwaye iyakwazi ukulinganisa amandla kunye noxinzelelo lwee-muscle contractions xa uginya. Olu vavanyo lunokubangela ukuba abanye bangabonakaliyo okunciphisa nge-spray ebamba ngaphakathi kwempumlo kwaye ngamanye amaxesha phezulu komqala.
- I-Esophagogroduodenoscopy (i-EGD) yinkqubo engenakukwazi ukuxilonga ngokucacileyo isophagus kodwa ingaba luncedo ekulawuleni ezinye izifo ezinjalo ezifana ne-hira hernia okanye i-GERD.
Utyando lwe-Nutcracker Esophagus
Wena kunye nogqirha wakho unokukhetha ukusebenzisa ezinye zonyango ezilandelayo ukukunceda ukulawula iimpawu ze-nutcracker esophagus.
Amachiza amaninzi asetyenziswa ukuphatha le meko kwaye afake i-calcium channel blockers, i-nitrate kunye ne-phosphodiesterase inhibitors. Ukufakelwa kwe-toxin ye-botulin ngaphezu kwe-sphincter engaphantsi kwe-sphincter kunokunqanda iimpawu ngokukhawuleza ukukhutshwa kwe-acetylcholine. Iproton pump inhibitors inokukunceda ukukhulula iimpawu ezinxulumene ne-acid reflux. Enye yemichiza enempumelelo kakhulu yokuphazamiseka kwemizimba ye-motility iquka i-nutcracker isophagus i-tricyclic antidepressants.
I-Balloon dilation ye-esophagus yinkqubo eyenza ububanzi be-esophagus kwaye inokukhupha iimpawu ze-nutcracker esophagus. Inkqubo ivame ukuqhutyelwa kwisigulana kunye nesantya. Uya kufumana umyalelo okhethekileyo malunga nokutya nokusela ixesha elithile ngaphambi kokuba wenze inkqubo yakho. Izingozi zokuxhoma ibhaluni ziquka imiphumo emibi okanye iimpendulo ezithintekayo kwiimpawu ze-anesthesia zonyango ezisetyenzisiweyo okanye ezingafanekiyo ukugqithiswa kwe-esophagus.
Kwiimeko ezigqithiseleyo ezingaphendulanga kakuhle kolunye unyango, inkqubo yokuhlinzwa eyenziwa ngokuthi i-myotomy inokuqinisekiswa. Le nqubo ibizwa nangokuthi i-Heller myotomy okanye i-myotomy ye-esophageal kwaye iqhelekileyo isetyenziselwa ukuphatha i-achalasia kodwa ingasetyenziselwa ukuphatha i-nutcracker isophagus ngokunjalo. It isetyenziswe njengesigqibo sokugqibela kuba kwezinye iimeko kuye kwabangela ukuba izicatshulwa zomsila zidibene ne-nutcracker isophagus ibe yimbi.
Inkqubo inokwenziwa i-laparoscopically okanye njengendlela evulekile kodwa indlela ye-laparoscopic idibene nomngcipheko omncinci kunye nexesha lokubuyisela elifutshane. Isicatshulwa esincinci senziwa nje ngaphezu kweqhosha lomzimba kwaye emva koko iziqalo zomzimba zangaphandle ze-esophagus zinqunywe ukubanceda ukuba bangabaniki. Ukongezelela, ukunciphisa izihlunu kwisiganeko se-gastroesophageal kubangela ukuba i-sphincter phakathi kwesisu kunye nesisu sokuhlala ivulekile.
Ubungozi obubandakanyeka kwi-myotomy ye-esophageal kubandakanya umonakalo kumalungu azungezile kubandakanya ipeni, isibindi, okanye isisu kwakunye nokusuleleka kokusuleleka. Njengoko nayiphi na inkqubo yokucubungula, kukho ingozi yokuphendula okanye ukuchaphazeleka kwemiphumo ye-anesthesia. Njengoko kuthethwe ngaye ngaphambili xa kusetyenziswa ukunyanga i-nutcracker isophagus kukho umngcipheko wokuba iimpawu ziya kuba nzima. Nangona iimpawu zithintela emva kwexesha leminyaka kunokwenzeka ukuba iziphumo ezilungileyo zalo mgaqo ziya kuncipha.
Ukongeza kwiphando lophando olukhankanyiweyo ngasentla luchaza ukuba i-nutcracker isophagus ibonakala ihamba ngcono kwiminyaka embalwa.
> Imithombo:
> Barium Swallow. emedicinealth. Ukuhlaziywa ngoJuni 25, 2015. https://www.emedicinehealth.com/barium_swallow/article_em.htm#what_is_a_barium_swallow
> I-manometry ye-Esophageal. Medline Plus. https://medlineplus.gov/ency/article/003884.htm
> I-Esophageal Spasm. Medscape. https://emedicine.medscape.com/article/174975- ukujonga kwakhona
> Heller Myotomy yeAkayalasia. IYunivesithi yaseWashington University of Medicine eSt. Louis Cardiothoracic Surgery. http://cardiothoracicsurgery.wustl.edu/en/Thoracic/Benign-Esophageal-Disease/Heller-Myotomy-for-Achalasia