HH - kuyini? Izimpawu kanye nokwelashwa HH

Ake uqale nge yokuthi akubona bonke isifinyezo ajwayelekile HH. Kuyini lokhu?

hernia Hiatal (HH kuyinto elifushane okufanayo), noma umbhunu hiatal, - limane nje isifo libhekene displacement uhlaka (etholakala ngaphakathi komgodi ongaphakathi kwamathumbu) ngokusebenzisa ukudla imbobo diaphragm ngaphakathi komgodi thoracic. Lokhu umzimba cishe njalo esiswini.

hernia Oesophageal ungaba uhlobo azalwa naso noma bathenga futhi ukhiphe ukubonakaliswa emtholampilo. hernia azalwa naso lingaphansi ezivamile kuka kuluthola. HH singenzeka ngenxa yezizathu eziningi.

Kulesi sihloko sizohlola yini HH, izimpawu, ukwelashwa kanye ngemva kwezikhathi zokulotshwa op yalesi sifo.

izici Jikelele lesi sifo

Imbobo (lapho ubaluleke oqondile HH) has simise ukwahlukanisa oluyingungu ukuthi siqukethe izinhlobo ezimbili izindwangu: muscle zezinzwa. Lona ukwahlukanisa ehlukanisa ngaphakathi komgodi ongaphakathi kwamathumbu kusukela esifubeni. I tufts e imisipha diaphragm ukwakha imbobo encane lapho emphinjeni. Futhi cishe kakade uqonde ukuthi kungani libizwa ngokuthi kuvulwa ngomphimbo.

Ukubuyela hernia hiatal (HH). Kuyini lokhu? Kumiswa It is ngenxa displacement we umzimba kusuka ngaphakathi komgodi ongaphakathi kwamathumbu emphongolweni ngokusebenzisa hiatal kakhulu. Futhi kwenzeka ngenxa kuyadamba yayo.

hernia Hiatal - isifo ovamile ukuze ukuncintisana ngempumelelo cholecystitis, pancreatitis noma izilonda duodenal. Nokho, ngokuvumelana ukungathi sína yayo, izophinda abenze ukuncintisana.

yobudala Isihlobo nesineke kungashiwo ukuthi ngokuvamile isifo eba abantu abaneminyaka engama-60. Ngokuphathelene ubulili - abesifazane bavame ukuba yilesi sifo kunabantu.

ngezigaba

hernia oesophageal ihlukaniswa ngokweminyaka izici zabo. Ukwabela izinhlobo ezifana:

• Floating noma hernia esinqunyiwe (hernia ngoba Axial futhi paraesophageal kuphela). Ikakhulukazi, umbhunu paraesophageal - lena lapho umfanekiso ingxenye esiswini eceleni emphinjeni ngenhla diaphragm ngokuqondile. Futhi cardia isisu ngezansi diaphragm igxile. Axial HH - ngomphimbo, inhliziyo, noma totalnozheludochnaya subtotal. Kukhona umehluko namanje beya umbhunu, kwakheka ikakhulukazi lapho ukuthi esakeni enjalo hernial ujenga ne peritoneum. It ihlukile Eqinisweni Axial ukuthi isikhwama zokugcina lapho. Axial hernia Ungahambisa ngokukhululekile ukunyakaza komzimba.
• hernia Paraesophageal (fundic noma antral).
• hernia azalwa naso, okubangwa emphinjeni lemifisha anomaly ekuthuthukiseni.
• Hernias lomunye hlobo (enteric, izimvu zamanzi nokunye. P.).

Lesi sifo kungabuye bahlukaniswa ngokomthombo nangezinga degree:

- hernia ngomphimbo idigri yokuqala. Libhekene e ukuthi cardia isisu ivuliwe ezingeni diaphragm, isisu kancane iyokhushulwa futhi uvalwe adherent ukuze diaphragm. emphinjeni besisu Itholakala ingaphakathi thoracic ngokushesha ngenhla diaphragm.

- hernia ngomphimbo besigaba sesibili. Isithombe sokucindezeleka kanje: emphinjeni besisu ku thorax, futhi kuvulwa ngomphimbo isivele ingxenye esiswini.

- hernia ngomphimbo degree lwesithathu. Izinga olunzima, libhekene nokuthola emphinjeni, cardia, futhi ngezinye izikhathi ngisho emzimbeni futhi fundus isisu ngenhla diaphragm.

Izizathu hernia ngomphimbo

Sishilo kakade ukuthi zizathu hernia hiatal kakhulu. Nokho, ngokuvamile kukhona lezi zinto ezilandelayo:

• Thinning we nemisipha zezinzwa kubangelwa izinguquko ezihlobene nokukhula noma esibangelwa yimuphi omunye izinqubo.
• ukwanda izinhlelo noma eyodwa esigabeni okungalapheki ingcindezi kule komgodi ongaphakathi kwamathumbu uqobo. Ubangela ukwanda ingcindezi kungaba ukuqunjelwa okungamahlalakhona, umsebenzi esindayo (ezifana nokuphakamisa izinto ezisindayo), blunt ukuhlukumezeka besisu nokuningi.
• izifo ukuthi zihlobene ngokuqondile lomgudu wokugaya ukudla bese lokho kungaphazamisa motor umsebenzi nenyongo sesinye, esiswini, noma duodenum.
• Ukungasebenzi kahle we nezindlala endocrine (endocrinopathy).
• Izejwayezi ezimbi (ukubhema, ukuphuza), umuntu osekhulile.

HH: Izimpawu

Kuye ukubonakaliswa emitholampilo ye isifo yilezi ezilandelayo amafomu hernia hiatal:

- HH asymptomatic;

- HH, ngoba zokugula lapho syndrome ibangelwa ukwehluleka cardia;

- HH, akuyona libhekene khona esiswini cardia esingamahlalakhona syndrome;

- HH, okuyinto avele njengoba inkinga nezinye izinhlobo izifo emathunjini (noma nje ukuthuthukisa kungemuva zabo);

- paraesophageal HH;

- HH lokuzalwa, elinesimo emphinjeni iDemo.

It kuyafaneleka ukucabangela uhlobo ngalunye HH (uhlobo izimpawu ngamunye) ngokwehlukile:

• hernias Asymptomatic. Njengoba wazi igama leli fomu lesi sifo, noma yiziphi izimpawu zokutheleleka HH kulezi zimo, akukho. Lokhu ngokuyisisekelo zibhekisele enkulumweni hernia inhliziyo noma ngomphimbo, ie zokwakheka encane ngosayizi. Thola lolu hlobo hernia okungahleliwe ngokuphelele, ngokuvamile - ngesikhathi luhlolo egcwele, futhi ngezinye izikhathi abantu nakuqaphela ukuthi unesikhathi HH - izimpawu (ukwelashwa Kuchazwa kabanzi lapha ngezansi) ngoba akukho umbhunu.
• HH syndrome cardia ukwehluleka. Izimpawu ezivame kakhulu HH inhliziyo - isilungulela ubuhlungu, postprandial, futhi ngesikhathi ushintsho abukhali isikhundla umzimba wesiguli. Kufanele kuphawulwe ukuthi lezi zimpawu ngokuvamile kwenzeka ebusuku, kungenzeka ukuchaza izici okwandisa ithoni we emsipheni vagus, kanye ukuphumula ephansi sphincter ngomphimbo.

Ngokuphathelene ukushuba isilungulela, ungasho ukuthi kungaba lula (kuleli cala, ingelapheka nge antacids), futhi ngempela ubuhlungu (kangangokuthi ngisho phuca ukusebenza komuntu). umfutho wayo kunqunywa isakhiwo yezici ezihlukahlukene, futhi ngokuyinhloko, lokhu kuhlanganisa acid-peptic, okuyinto engavamile ukuba juice esiswini. Futhi, ke kungase kuthonye distension ngomphimbo uyiphonse okuqukethwe duodenal (ngokuyinhloko Bile).

Isici kakhulu amehlo ekubambeni ka hernia hiatal Yiqiniso, ubuhlungu. Kuyaphawuleka ukuthi kuncike imbangela isilungulela. Empeleni kubonakala ngenxa yezizathu ezifanayo. Ubuhlungu itholakala ngokuyinhloko endaweni sternum, futhi iyakhula lapho isiguli kuthatha isikhundla amanga. Ngaphezu lesi simo futhi ubuhlungu esifubeni emuva naphambili. Ubunjalo bakhe zingase zihluke, avame it is ezikuhlabayo, ukusika noma evutha emizweni.

Regurgitation lokuqukethwe esiswini - futhi uphawu ngempela njalo HH. Kuyini lokhu? Lena inqubo ekubunjweni okuqukethwe isisu emlonyeni. mkhuba kubuhlungu ngempela, futhi ngenxa yalokho okuqukethwe isisu ungathola kuqhoqhoqho noma bronchi.

Nalapha futhi, amazwana ambalwa ngobuhlungu. ubuhlungu Real azizwa uhhafu kuphela iziguli futhi 25% izimo psevdokoronarnaya ubuhlungu, okuyinto itholakala inhliziyo. Kusukela ke ungakwazi kalula balahle usebenzisa nitroglycerin. Ngaphezu kwalokhu ubuhlungu, iziguli zingase zibe nomuzwa wokuthi ukungakhululeki ku interscapular, izindawo hepatopancreatoduodenal, kanye-Chauffard Minkowski, njll

Futhi, mayelana 70% kweziguli umbhunu hiatal (ikakhulukazi uma inhliziyo HH) ebhekene uphawu efana nokubhamuka. Ngokuvamile kwenzeka okuqukethwe isisu, futhi esasisandulele iyona umuzwa ongamuhle ejwayelekile ekugcwaleni esifundeni epigastric, okhombisa aerophagia. Iletha i ukunambitheka ababayo edabukisayo. Futhi antispasmodics futhi analgesics kuleli cala, ukususa le mizwa bengayi.

Futhi, 40% eziguli ube nobunzima odlulayo ukudla kanye emphinjeni, ngisho nalapho ukuthatha ukudla okuwuketshezi. Nakuba kunjalo, kufanele kuphawulwe ukuthi ukudla okuqinile sihamba kalula ngokwanele. Abantu abaphethwe lokhu uphawu, avame ke livezwa a nalokho kushisa kakhulu noma okuphambene, ukudla kubanda kakhulu. Ngakho-ke, uma umbhunu Kunconywa ukuba adle ukudla kuphela ukuthi ine teperatura umzimba.

Mayelana 4% leziguli HH hiccups ku isizinda ifomu Axial ka umbhunu. Kuphela akusiwona ngempela hiccups evamile. Sici Its main angabhekwa ubude abalulekile (okungatheni kungase kuhlale amasonto noma izinyanga). hhayi ayibulale kakhulu nje, futhi ukusiza uma kwenzeka ukuthi kungaba uchwepheshe ofanelekayo.

Ezinye iziguli aqothuke glossalgia (ulimi obuhlungu) kanye hoarseness, okuyinto is phetho ukushiswa peptic okuqukethwe esiswini sasikhipha ngesikhathi regurgitation.

Ngaphezu kwakho konke lokhu okungenhla, silayishe ukuthi izimpawu umbhunu incike ngobukhulu bayo.

• HH ngaphandle izimpawu esingamahlalakhona we cardia. Ezimweni ezinjalo, izimpawu zezifo ezingosomathuba evelele kakhulu, umbhunu. Izimpawu leli fomu pericardial umbhunu, epigastric noma ubuhlungu retrosternal okwenzeka ngemva kokudla noma ngemva ephakamisa.

Thatha ezifana izinhlungu ikani kwaphela izinsuku eziningana. Ukuze iwukudambisa kubo ungasebenzisa analgesics non-kwelashwa (ngaphandle validol ngenxa ke akukho nomphumela) noma nitroglycerin. Futhi, ubuhlungu uyama uma uthatha ukudla noma uketshezi.

• HH, okuyinto avele njengoba inkinga noma umane ukuthuthukisa kwi zasemuva zezinye izinhlobo izifo emathunjini. Izifo ezihlala avame esiswini noma isilonda duodenal. Kuleli fomu HH izimpawu eziyinhloko zesifo, hhayi umbhunu.
• Paraesophageal HH. Le ndlela hernia libhekene nokungabi khona kwanoma yiliphi izimpawu nezibonakaliso. Ngokuvamile sitholakele hernia paraesophageal kwenzeka ngezikhathi ngesikhathi inhlolovo jikelele. Kodwa lapho hernia ithuthukisa, lapho kokucindezelwa ngomphimbo (ngamanye amagama, omncane emphinjeni). Ezimweni ezingavamile, ukuthuthukisa spasm ngomphimbo (isifo lapho enyakaziswa peristalsis ngomphimbo).

Uma sokwephulwa kwe paraezafagealnyh hernias kukhona ubuhlungu sternum noma epigastric.

• Azalwa naso HH libhekene emphinjeni iDemo. Kuleli fomu we hernia emphinjeni kungaba ezimbili izinketho. Emfanekisweni wokuqala kubo ingakha into efana "isisu thoracic", okuyinto libhekene amafomu alandelayo:

- indawo esifubeni;

- kwasendaweni esiswini intrathoracic.

Kulo mBhalo, inkinga itholakala nzima kakhulu, ngokuvamile kwenzeka phakathi nokuhlinzwa noma kwesidumbu.

yezinkinga kungenzeka

hernia Hiatal kungaba avuse ezihlukahlukene izinkinga. Ngokuvamile obonakala njengenhlangano elandelayo:

- kolwelwesi noma isilonda esiswini ukuthi ingxenye lapho hernia (elivela cishe 8% of amacala);

- ukopha, anemiya (kukhona u-20% amacala);

- ukwethulwa emphinjeni aphansi ngaphakathi komgodlana hernial;

- kokunciphisa emphinjeni (ngokuvamile atholakala kuphela amafomu kardiaezofagealnymi);

- prolapse we mucosa esiswini e emphinjeni (isb ukulahleka retrograde);

- hernia strangulated (izinkinga ezinzima kunazo zonke kulokhu okungenhla).

sitholakele isifo

Ngokuvamile, ochwepheshe afeze izivivinyo eziningana ngesisekelo okuyinto imiphumela Ungasavele ihlonzwe "HH." Hlobo luni ukuhlolwa:

• Fibrogastroscopy. Ungayisebenzisa ukuqonda isimo emphinjeni nasesiswini. izimpawu endoscopic HH ichaza yena udokotela, okusekelwe kuyo ungenza Ihlahlubo linqume ukwelashwa.
• -X-ray luhlolo, ogxile barium yombala umehluko. Ngalesi inhlolovo, ungathola herniation isithombe, okuyinto sici ngayinye HH-degree.
• pH-metry. Lokhu kuhlola kwenziwa ukuze kutholakale izinga asidi esiswini. Kuyadingeka ukuba kahle nika ekwelapheni umbhunu.

HH Treatment emphinjeni

Ngokuvamile, ukwelashwa hernia hiatal sidlula izidakamizwa, kodwa kwezinye izimo (ikakhulukazi uma yezinkinga) ezidinga ukuthi kungenelelwe kuhlinzwa.

Ngokuphathelene ukwelashwa ngemithi, kuba ukunciphisa asidi we esiswini (usebenzisa antacids), kanye nokunciphisa uketshezi esiswini. Lokhu - umsebenzi kuqala. Futhi, uma ukuphathwa kuyadingeka ukuvikela mucosa esiswini, lapho siphinde sihlinzekele nezinhlelo ezihlanganisa isicelo kwezidakamizwa ezithile.

Lapho ukwelashwa unikezwa Ukudla okuqinile, okumele ngokuphelele balandela. Ngokuyinhloko, lokhu Ukudla cishe kuyafana for kolwelwesi: lakanye amahwahwa enkomo, akukho okubabayo, okumuncu, okunosawoti. ukudla okunempilo kuphela, ezifana imifino, izithelo, okusanhlamvu, amasobho zokudla broths, inyama ebomvu.

Ngakho, ukuze kuqedwe isilungulela ukunciphisa uketshezi esiswini kungathatha lesi sidakamizwa "Maalox". Yikuphi ekahle kakhulu, itholakala amaphilisi nje kuphela, kodwa futhi uhlobo si, amaphilisi, ukumiswa. Ngasinye ngendlela lokhu kusho imiyalelo eyahlukile ukusebenzisa, okuyinto kungenziwa ebalulwe noma yikuphi ekhemisi lomuzi wakho.

Kungenzeka futhi ukuba bamukele izindlela ezifana "Rennie" noma "Gastal". Ukuqeda isilungulela kakade okungabonakala ngokwanele ukuthatha esinye isibhebhe sibonisa, futhi ukuze kuvikelwe - 4 amaphilisi ngosuku (ihora elilodwa emva ukudla). Nokho, khumbula ukuthi le mithi ukususa izimpawu nje kuphela.

Njengoba ukuhlinzwa, kuba ukususa kumiswa umbhunu.

Ukuze uthole esinembile ukuxilongwa kanye nokwelashwa izinjongo kubalulekile ukusebenzisa kudokotela (udokotela ohlinzayo noma gastroenterologist).

Ukwelashwa nokuvikelwa amakhambi abantu

HH Ukwelashwa amakhambi abantu ngeke kube nemiphumela ekahle oyifunayo, njengoba ezimweni eziningi umuntu ogulayo kudinga imithi sina noma ukuhlinzwa.

Okungukuthi, akukho hernia ngokwayo akakwazi ukususa ntu mali. Okuwukuphela isizathu ingasetshenziswa bona - okudambisa ubuhlungu.

Ezinye zezinkambi engamakhambi kungasiza ekunciphiseni izinhlungu. Nazi ezinye amakhambi abantu ukuthi kuzosiza ekulweni ne umbhunu:

- A decoction lwebhece impande. Thela cishe 20 g we nechobozekile impande Althea mug amanzi abilayo wasiqashisa yenza.

- Xuba 30 amaconsi oludakayo propolis tincture kanye 50 ml yobisi. Thatha izikhathi 2 ngosuku.

- ukubuyisa kahle kuyasiza decoction imbewu izaqathe. Gcwalisa eyodwa igremu imbewu 2 izinkomishi amanzi ashisayo bese uvumele ingxube yenza cishe ihora. Udinga baphuze kanye imbewu.

Khumbula ukuthi ngaphambi kokuthatha lutho (ikakhulukazi amakhambi abantu) kubalulekile bonana nodokotela wakho kuqala.

Futhi, usebenzisa amakhambi abantu, ungakwazi balahle isilungulela, hiccups, kanye nezinye izimpawu HH. Kodwa khumbula ukuthi lesi kuphela yalokho zesikhashana, kanye nesidingo welaphe imbangela lesi sifo kunokuba izimpawu.

hernia oesophageal emva kokuhlinzwa

Njengoba kushiwo ngenhla, kwezinye izimo, umbhunu hiatal kudinga ukuhlinzwa. HH-operation, ukubuyekezwa zazo edidayo, empeleni ukuphila ezimweni eziphambili kakhulu.

Kodwa yini okufanele uyenze lapho ukusebenza sekuvele kwenziwe? Ungayilandela kanjani irejista ye-postoperative? Kuthatha isikhathi esingakanani ukubuyela empilweni evamile?

I-GPPOD emva kokuhlinzwa idinga ukunakekelwa kanye nezinyathelo eziphelele zokwelapha nezokuvimbela.

Ngosuku lokuqala emva kokuhlinzwa, iziguli zidinga ukuhlolwa kwe-therapist kanye ne-electrocardiography. Ngosuku lwesibili, kwenziwa i-X-ray yesifuba. Okwesithathu - ukuhlaziywa okujwayelekile okujwayelekile kwegazi, kanye nokucwaninga kwezinto ezinokwemvelo ngokusho ukuthi yikuphi okushiwo yi-sonography.

Kabili ngosuku, iziguli kufanele zenze umzimba olula wokuzivocavoca umzimba nokuzivocavoca umzimba.

Mayelana nokwelapha izidakamizwa, singasho okulandelayo. Iqukethe ukwethulwa kwezixazululo ze-saline ngaphakathi komthamo we-1800 ml ngosuku. Zonke iziguli emva kokuhlinzwa zithatha ama-antibiotics.

Amanxeba aseTrocar aphathwa ngotshwala futhi aphethwe nsuku zonke.

Ngolunye usuku ngemuva kokuhlinzwa, iziguli zingase ziphuze kakade amanzi, futhi kusukela ngosuku lwesibili - zithathe ukudla okuketshezi. Isikhathi se-postoperative sihlala cishe izinyanga ezintathu.

Ukusebenza kwe-GPOD ngokwayo (ukubuyekezwa mayelana nokuthi yikuphi okuhlukile, kuye ngokuthi ubukhulu besifo) sesivele sikhulume ngenhla. Iqukethe ukususwa kwe-hernia ngokwayo.

Isiphetho

Ngakho-ke, manje ngeke usabe uma kukhona lapho uzobona isifinyezo se-GVPD. Kuyini nokuthi kubonakala kanjani, usuyazi kakade.

Kuhlala nje ukufakazela ukuthi lesi sifo sinzima kakhulu. Ukuzivocavoca, ikakhulukazi ukwelashwa ngamakhambi abantu, kuyingozi futhi kungabangela izinkinga ezinkulu.

Kodwa-ke, akekho obhekene nesibambiso ngokumelene nezinkinga, njengoba ezinye izinhlobo ze-GVAP zingenasimo. Indlela kuphela yokuphuma ukuhlolwa ngokugcwele esibhedlela okungenani kanye ngonyaka. Ngakho uzokwazi ukubona lesi sifo esingavamile ngesikhathi.