Epispadias futhi kwesinye exstrophy. Ukwelashwa, ukuvuselelwa

Yeka ukuthi kujabulisa kanjani abazali lapho ingane yabo okuzelwe enempilo. Ngeshwa, lokhu akulona lonke. Kunenqwaba kombungu esizalweni, nemizuzu yokuqala zokuvakashela ingane esizalwa engozini ukuphila kwakhe. Enye kunzima kakhulu - esinyeni exstrophy. Ngokwezibalo, kukalutshwana kakhulu futhi ebhaliswe mayelana 1 icala ngoba izinkulungwane 30 ozalwa izingane ziphila. Lokhu value isilinganiso, ngoba kwezinye izindawo inani lezingane nalesi sifo angase ifike 000 noma sehliselwe 1:10 ukuze 1:50 000. Kodwa abazali, ebhekene nenkinga enjalo, Awunandaba izibalo, kubalulekile ukulondoloza ukuphila komntwana njengokuyigugu futhi uyiphakamise isidalwa esingumuntu ephelele. Hlobo luni anomaly nokuthi amathuba ezizalwe nalo?

Kanjani abantu System urinary

Ukuze uqonde kangcono ukuthi yini esinyeni exstrophy, ukusiza ukwazi isakhiwo ngemfanelo kohlelo urinary. Kalula, kubonakala sengathi lokhu: izinso umchamo ikhishwe ngesikhathi igazi filtration, okuyinto ngokuvumelana ureters ku esinyeni. Kuyinto isitho eziyize uyakwazi esisuka, okuvumela uketshezi buthelela kuwo ngezinga elithile bese kukhishelwa ngaphandle we urethra. Endaweni lapho isiteshi kuqala, futhi isinye iphelile, kukhona imisipha ekhethekile ebizwa ngokuthi i sphincter. Inhloso yayo - ukuvimbela ukuvuza umchamo angesabi. Esinyeni itholakala esiswini, endaweni pubic. Kanye kwezitho zangaphakathi nezwe, wayimboza kwezicubu zomzimba, ikakhulukazi phambi odongeni peritoneum. udonga saKhe sakhiwa izingqimba eziningana - le mucosa, submucosa, imisipha kanye nezinye - futhi ebuswa imithambo yegazi aphindaphindiwe ukunquma umbala waso. I ingemuva itholakala eduzane isinye, kodwa odongeni ungqimba kwezicubu kuvimbela kuhlangana umchamo kanye endleni.

izici yangaphandle zokugula

Isinye exstrophy banalesi ngeso lenyama kusukela zikhathi yokuqala yokuphila. Kulesi isifo akukho ingxenye peritoneum, isb esifundeni pubic has umgodi, usayizi okuyinto ziyahlukahluka kusuka 3 kuya 12 cm. Ngenxa yalokho zokugula esinyeni zingaphandle komzimba. phambi nodonga lwawo naye olahlekile, kodwa umsebenzi lo ureters kungabi sengozini. Coming ngehlangothi izinso umchamo uba amathonsi ezikhishwe noma trickles ku nalokho okusala kwesinye, bese ngokusebenzisa imbobo peritoneum uyaphuma. Ngakho akukho ukopha, ngoba isisu odongeni onqenqemeni dissections futhi bubble kwakhiwa futhi kungukuthi kabana igazi emithanjeni yegazi. Nokho, lwamafinyila evulekile njalo kulula kulimaze touch of inabukeni. Okunye iso ebonakalayo ukukhubazeka - isikhundla esiphansi kakhulu we inkaba, noma ukungezwakali kwawo, futhi ayanda yokuma ingquza. Omunye ukukhubazeka ezibonakala ukucasha kuyinto kwehlukana (ithuba) ithambo pubic. Kusukela kuyinsakavukela khona, lesi sibalo kungenzeka ngokuphongoza (umahluko afika kwangu-7 cm), okushintsha eminye kakhulu Gait. Iziguli awunaso isikhathi fixed kuyinto ukuphambuka, ezihambayo, zize zithonye ngapha nangapha (njenge duck). Naphezu yinkimbinkimbi zokugula, usana kuyinto ngempela iphila, esebenzayo futhi uma ethole ukwelashwa okufanele has a sethubeni elihle.

epispadias

Lokhu ozalwe kungaba ezimele, kodwa ngokuvamile kakhulu kuba concomitant izici ezengeziwe labo evelele esinyeni exstrophy. Epispadias - a wokuqhekeka odongeni we urethra. Kuyinto aziphelele (kuphela ithiphu uhlukanise) noma inani (i-urethra is wajinge wanamatsela ngokuphelele emaphethelweni elingaphandle ukuze esinyeni). Ukwelashwa nokuvikelwa ukukhubazeka ukukhiqiza surgically kuphela, futhi uma epispadias isifo ezimele, ukuhlinzwa kwenza ingane kuphela emva kweminyaka eyi-1-3, kodwa ezimweni lapho isici esihambisana esinyeni exstrophy, ezidinga kokungenela ngokushesha, ukuqeda ukusebenza epispadias kungaba kwenziwe ngendlela ngaphezulu ngaphambili.

izizathu

Impendulo ngqo umbuzo wokuthi kungani kukhona esinyeni exstrophy ezinganeni okwamanje. Ososayensi kuphela wakwazi ukuthola ukuthi zokugula kwenzeka uma ngesikhathi kumiswa kwezitho nezicubu (emva amasonto 4-5 ebamba isisu) imibungu ngokuzumayo ehluleka ukwehlukana futhi uhlanganise amaseli. Ngenxa yalokho we ulwelwesi cloacal ayikwazi ukuvalwa, futhi isinye zingaphandle komzimba. Kungani inqubo cell division iphazamisekile? Ochwepheshe bakubiza ngokuthi ezehlela bonke izimbangela kombungu:

• ukubhema, nokusebenzisa utshwala ngesikhathi ekhulelwe;
• i-hyperthyroidism;
• sikashukela;
• isilulu samafayela;
• iziyaluyalu hormone;
• Hyperplasia adrenal;
• imiphumela emibi yemithi;
• chemical ubuthi kanye nezinye.

izindlela Laboratory wathola ukuthi ukubukeka izilwane test extrophy kuthonywa kakhulu umthelela zezidakamizwa cortisone.

Ochwepheshe abaningi musa siqambe ubunjalo zofuzo lesi sifo, ngakho, abazali kanye esinyeni exstrophy futhi emikhayeni izihlobo unaso lesi sifo (omalume, obabekazi, abashana), ematfuba uma ingane ukuphambuka esifanayo 1:70, futhi imindeni lapho kukhona kakade ingane egulayo, 1: 100. Kodwa uma womabili lokhu isici singesabo ezingavamile futhi cishe akasoze uma ayafana yini.

Kungakhathaliseki uphethwe kuyadingeka?

Liyavela ubuso bayo yimuphi udokotela ne imizuzwana yokuqala kokuzalwa kwengane wawembula esinyeni exstrophy. Photo ezibonisa indlela le nkinga Ungabheka, ayikwazi esibizwa ezimnandi, ngakho asazi ukuwashicilela (isithombe ngokwanele kwendikimba). Kubonakala ukuthi sicacise, kodwa uphethwe ukuze kutholakale zonke ukwahluka kungenzeka ezihlobene ukuqhuba kunesidingo. Okokuqala, kubalulekile ukuba sihlole umchamo lokuthola ke uketshezi peritoneal futhi exudate serous.

Kuyadingeka ukwenza cystoscopy, imisindo ephansi, imaging futhi Endoscopy. Njengomthetho, imibukiso kanye izifundo zofuzo ukuqinisekisa noma siqambe-Down syndrome futhi Edwards.

Kombungu kohlelo urinary kwabesilisa

izibalo Relentless uthi abafana esinyeni exstrophy, futhi nalo epispadias waphawula izikhathi 2-5 izikhathi ezingaphezu amantombazane. Ngenxa umehluko nokwakheka kwezitho zobulili uhlelo urinary iziyaluyalu azalwa naso e amantombazane nabafana kuhluke kancane. izifo concomitant kwabesilisa ebuntwaneni kungenzeka cryptorchidism, hypoplasia wamasende, aplasia ka umdlavuza wendlala yabesilisa, futhi kamuva isifo Peyronie sika (ugobile ilungu). Kakade isakhasa kubafana nge estrafiey esinyeni ukunciphisa ngokuphawulekayo abalulekile uma ziqhathaniswa kuyinsakavukela, ubukhulu umthondo, kwezinye izimo kungase kungabi. Lokhu kungenxa yokuthi amathambo pubic, ukuvula njengoba qinisa kuze umzimba cavernous, kwaphazamiseka uxhumano yabo. Uma exstrophy iphutha ngokuhlanganyela epispadias, abafana waphawula asike izidumbu zabantu wenduku glans futhi indawo ingquza eduze the scrotum.

Exstrophy we esinyeni amantombazane

Ngesikhathi ubulili bubuhle lesi sifo ezingavamile kakhulu. isici elikulesi sihloko kungase kube labia ampofu kanye / noma lwesitho sangasese sowesifazane, cleavage clitoral, displacement we ingquza kuze kube sekupheleni emomozini 1.5 cm aphansi indawo wesibeletho (kwezinye izimo, kuyacaca ukuthi ebonakalayo). Ngokuvamile, izingane zabo bobubili ubulili kukhona ukwehla umthamo esinyeni, ukungabi sphincter, indawo engafanele ureters, izinso izinkinga, isibindi, ubende, futhi kungenzeka kwezinso zofuzo.

ukunakekelwa Newborn ne zokugula kohlelo urinary

Kukhona 3 lamadigri esinyeni exstrophy:

1. Umgodi peritoneum-4 cm, ukukhubazeka concomitant bengekho.

2. iphutha phakathi peritoneum bese ithambo pubic kuze kufinyelele 5-6 cm, 1-2 kuyinto isici ahlobene.

3. eziningana ezinzima isici concomitant (epispadias Imininingwane, ecstrophy cloaca nabanye), i-kwehlukana we peritoneum futhi amathambo pubic 8 cm.

Kunoma ikuphi zamagciwane umchamo wengane njalo ethulula lwamafinyila yini ebangela inflammations wabo, kwaze peritonitis futhi pyelonephritis. Lwamafinyila uhlushwa namanabukeni ngokuthinta, abesesula, kanye nezinye izinto enamathela, futhi hypothermia, futhi ukulahlekelwa umswakama lwamafinyila. Ngakho-ke kwesinye exstrophy e izinsana kudinga inzalo esiphezulu futhi ukudala indawo efanelekayo. Ukuze kugwenywe, izingane ukuchitha izifundo extra yokwelapha ngemithi elwa namagciwane, futhi uma kungenzeka, uwafake incubator (amabhokisi amancane).

Ilokhu ethulula umchamo kungaholela dermatitis, kanye avuse papilloma neziqu kwakhiwa kakade 3-4 amasonto zokuphila ingane.

Olunye uphawu ezimbi: ingane ngenxa yokucasuka ekunciphiseni lwamafinyila futhi ezinzima enqaba ukudla, akusho ukulala futhi, ngenxa yalokho, is emuva ekuthuthukisweni.

ukwelashwa

Kuphela surgically kulesigaba yentuthuko imithi ziphathwe esinyeni exstrophy. epispadias obuphelele uma sihambisana ngenhla okuthiwa anomaly, inkimbinkimbi kakhulu nzima kakade futhi iyingozi ngenxa yokuphila ukungenela kid. Operations ngokuvamile ukuchitha eziningi. Okokuqala, ngokuvumelana iningi odokotela emhlabeni ukwenza cishe ngokushesha ngemva kokuzalwa, eminyakeni yobudala yomntwana izinsuku 1-10. Inhloso yayo - izicubu etholakalayo ukudala phambi udonga esinyeni futhi ukuyivala ukwakha sphincter ukunciphisa ithambo engaphelele, uma ukuntuleka isikhumba, sivale igebe elikhona kule peritoneum. Uma imbobo inkulu kakhulu nezicubu ukuvala ingane akwanele, ukusetshenziswa ifilimu yokufakelwa kungase kudingeke lapho sisuswa kamuva. Ngemva lo msebenzi, ingozi yokutheleleka ubalekela izitho urinary, kodwa agcinwayo incontinence.

Ukusebenza wesibili kwenziwa ingane 1 unyaka kodwa iminyaka kungakadluli 2. Kuyinto umthondo plastic. Ngo amantombazane, uma kungekho contraindications, ke kungaba kwenziwe futhi ukungenela kuqala. Eminye imitholampilo at reoperation ureters zidluliselwa ku sigmoid ikholoni futhi udale antireflyuksorny indlela ukugcina ingane kusukela incontinence.

I ukuhlinzwa lwesithathu wenziwa uma ingane eba neminyaka engu-5. Kulesi sigaba, kwakhiwa entanyeni esinyeni is, sphincter enze nezinye izenzo lula nokugcinwa umchamo (uma awuzange ufezwe), kanye nokuthuthukiswa kahle izitho urogenital.

Imisebenzi elandelayo lwenziwa uma kuboniswe. Ikakhulukazi, izinqubo nokuvulwa continence urinary emantombazaneni kwenziwa ngisho iminyaka engu-16, futhi laba bafana - kusukela eminyakeni 17 kuya 18.

Exstrophy we esinyeni omdala

Njengoba ezikhathini eziningi lo zokugula eqondiswa ebuntwaneni, abadala nge esinyeni exstrophy awavamile. Lokhu kwenzeka ezimweni lapho ingane ngenxa yezizathu eziningi zenziwa ukusebenza ngesikhathi esifanele, noma baye kwenziwe ngendlela efanele. Abantu nale isici ukuba babe nezinkinga lithathelwe yezenhlalakahle ithimba ngenxa incontinence urinary. Le nkinga ubhekwa ngelinye lamavesi abaluleke kunawo wonke. Muva nje, kukhona izindlela eziningana wokusebenza ukukulungisa, kodwa noma yisiphi sazo amaphesenti 40-80 kuphela iphathwa ngempumelelo esinyeni exstrophy omdala. Isithombe esingezansi sibonisa esiteji wokulungiselela phambi ukusebenza.

Isici sesibili esibalulekile inkinga - lithathelwe ocansini nabantu abadala, ikakhulukazi amadoda azelwe nge esinyeni exstrophy. Naphezu kwemizamo etusekayo odokotela, akunakwenzeka ukuba kuzuzwe kubuyela egcwele cavernosa corpora we amadoda umthondo. Okokuqala, ngoba cishe njalo zikhubazekile, kanti okwesibili, ngoba ivolumu yabo nje akwanele, ngisho nalapho ukuwagwinya kubo enkothweni pubic. Ngakho-ke, ubude esiphezulu wenduku cishe ungalokothi ezingaphezu kuka 6-7 cm, kuyilapho ukwakhiwa is kuyelelwe bonyana akukafaneli kuphulwe. Iziguli ukwenza ukuhlinzwa plastic phezu urogenital futhi libonisa kwengqondo kanye nemithi.

zokuvimbela

Njengoba sixoxe zokugula izimbangela ngqo awaziwa, odokotela namuhla Awukwazi ukuphendula umbuzo wokuthi kungani kukhona esinyeni exstrophy ngokugcwele. Ukuvimbela bashabalala ekhuleliswa ukubhema, izidakamizwa, utshwala. Futhi, qiniseka ukuthi ukuqhuba ucwaningo ukuze kubhekwe herpes amagciwane, rubella, ugcunsula, toxoplasmosis nezinye izifo embryotoxic. I indima ebalulekile eyadlalwa Ukwelulekwa zofuzo, ikakhulukazi uma umndeni evele isigula nge estrofem epispadias noma esinyeni. Lokhu kubonisa ngokucacile ultrasound ukuphambuka, onikeza ilungelo abesifazane ukuba anqume ukuphuma umntanakhe ogulayo noma cha.

Abantu abazalwe nale zokugula, zonke ekuphileni kufanele libukwe ngesikhathi Urologist. Lokubaluleke kakhulu kubo, futhi yokudla, okuyinto akufaki wonke okunosawoti, okubabayo, enenhlamba, utshwala kanye nokusetshenziswa lemiqulu emikhulu uketshezi.