Zvishoma nezvishoma mumatope hiatal heniya: Zviratidzo uye kurapwa

Hiatal heniya (Photo zvokurwara anoratidzwa pazasi munyaya) uye reflux esophagitis hurwere zvikuru ngozi. Tikafunga inoti izvi segwapa ndichisveerera zvimwe zvikamu gastrointestinal. Zvikurukuru, kuchinja kuitika mune nemarunda anotsigira dumbu uye yegurokuro, mufananidzo iyo pamberi munyaya. Somugumisiro, makakatanwa ari haachatauri. Kunyanya, yokumusoro chikamu mudumbu anoenda mubhokisi nzvimbo. Somugumisiro vakanetseka kushanda ari sphincter unobva dumbu uye yegurokuro (mufananidzo inoratidza chikamu ichi).

fungidzira njodzi

Kana kushandura pakona pakati muridzo uye kutyora mabasa esophageal (pazasi) ari sphincter kunoitika kukanda pasi asidhi zviri mudumbu kana bile kupinda yegurokuro 12 duodenal urikanwi. The muitiro achabatsirwa kukura kuzvimba mucous rearrangement. Izvi zvinowedzera zvikuru mukana kenza. Of Kunyanya kukosha kukura chirwere ane zvishoma nezvishoma mumatope hiatal heniya. Kuvhiya ndiyo chete nzira inenge iripo kubvisa kukanganisa. Zvisinei, kuvhiya kupindira ine nuances ayo. Uyezve ongorora zvose, chii chinoumba hiatal heniya. Ringangova, marudzi uye anokuzviratidza vanonziwo munyaya.

tsananguro

Heniya ari esophageal yokutanga, kazhinji anova pachiimbwa gastroesophageal chirwere. Tora achiperekedzwa kunzwisisa cardiac, pulmonary uye dyspeptic zvirwere. Ivo vasimuke kazhinji nemhaka heniya uye gastroesophageal reflux. Maererano neAmerican uye European Songaniro pamberi HH munhu kwemakore 5-12 mukana kenza makore mashanu gare gare inokura kusvika 270%, uye 12 - ne 350-490% (zvichienderana nezera).

Kuwanda zvokurwara

HH, maererano nevanyori wandei, zviri kukurukurwa sezvo chirwere anowanzonzi chirwere, zvakadai cholecystitis kana esophageal maronda. Maererano kwayo kwakaita zvirwere izvi ndiyo zvirwere vaitungamirira gastrointestinal. HH sezvo esophageal urikanwi, riri kuonekwa zvakakwana ngozi chirwere rinoda mangwanani chirwere uye nokunyatsocherechedza.

kupatsanura

Pane zvikuru zvitatu Mapato ose HH. Idzi dzinosanganisira:

• Axial hiatal heniya. zvokurwara ichi ane rimwe zita. Vanhuwo zita - zvishoma nezvishoma mumatope hiatal heniya. Izvi rworudzi zvokurwara iri dzakaonekwa mu zvinenge 90% wevarwere. State kunoratidzwa panowanikwa esophageal achalasia pamusoro buri. Panyaya iyi, zvave nomusiyano pakakoromoka wokugumisa chaitika.
• Paraesophageal heniya. chimiro ichi rinowanikwa anenge 5% wevarwere. Nokuti ichi mhando zvokurwara kunoratidzwa kuramba nzvimbo Cardia uye chinokosha curvature mudumbu.
• Short yegurokuro. Sezvo yakazvimirira, zvokurwara iri chirwere chaizvo kashoma. The chirwere chiri abnormality kukura. Kazhinji, chirwere ichi pamwe ne zvishoma nezvishoma mumatope hiatal heniya. Nokuti iniwo hwokuratidza kuzvimba uye scarring kwendangariro.

zvishoma nezvishoma mumatope heniya

Ichi chimiro chirwere inozivikanwa nevamwe dzose. Vakawanda zvishoma nezvishoma mumatope heniya ari protrusion, sezvamakaropafadzwa imwe Rusvingo ubatanidzwewo Coated peritoneum muviri. Inogona mberi munyaya munyaya mugove, dundira, nokuburukira muura, uye zvichingodaro. Panyaya iyi, iyo heniya zai havagoni kuva. Diverticulum, kana akaumbwa ichi muviri nzvimbo asina kufukidzwa peritoneum.

The mashandiro kuti chiitiko

Maererano izvi hazvisati zvave dzoga:

• Vachiberekwa hernias. Panyaya iyi zviremera upi chikonzero chimwe kana mamwe madhipatimendi, kwete akavharika peritoneum zvishoma nezvishoma ndiburukire chikamu kwesuwo romukati ari retroperitoneal mafuta. Vakati vabuda mhango. Izvi zvinogona kutanga kare embryonic nguva. Somugumisiro, madhipatimendi vari zvaizopedza chinoumba protrusion pasina heniya zai.
• Vawana zvirwere. Hernias yakadaro inoumbwa zvokuimba marwadzo ari dundira kana ura zvikamu. Ivo kunyimwa serous pechifukidziro uye yakabatana peritoneum.

Inguinal heniya zvishoma nezvishoma mumatope huru ura, kazhinji yakakura dzakawanda pamwe suwo rakafara. Chirwere, kazhinji vakwegura. Dzakaonekwa kushandisa X-ray nenyanzvi guru ura kuongorora. Zvishoma nezvishoma mumatope heniya of dundira anooneka dysuric zvirwere. Varwere akacherekedza weti kaviri. Pakutanga zvikasabudiswa rinoitwa senguva dzose, zvino, kana kudzvanya pamusoro protrusion, pane mumwe uchida uye murwere weti zvakare. Kana chirwere rinoitwa catheterization uye cystography. Nokufamba maitirwo izvi yakaratidza chimiro uye kukura heniya, kusavapo kana kuvapo dundira namabwe.

Axial hiatal heniya

zvokurwara Ndiyo misha mudumbu kana zvimwe abdominal nhengo mubhokisi mhango. Hosha iri chirwere muna 5% yevanhu vakuru. Zvisinei, inenge hafu varwere hauoni chero zviratidzo. Kwakadaro kuyerera zvokurwara nokuti zvishoma nezvishoma mumatope hiatal heniya yave vakadzima zviratidzo chairwo chimiro nokuti protrusion unongoda mukati mumuviri uye pasi kwomuzvarirwo kuona harigoni kuonekwa. The chirwere chinobata vakadzi kakawanda kupfuura vanhu. Chiremba zvokurwara iri kunyanya chokuziva.

marudzi chirwere

Zvishoma nezvishoma mumatope hiatal heniya rakakamurwa:

• Kardiofundalnuyu.
• Total gastric.
• Cardiac.
• Subtotal dumbu.

Paraesophageal hernias dzinoiswa mu:

• Gastrointestinal.
• Stuffing.
• Intestinal.
• Antral.
• Fundus.

pathological Danho

Zvishoma nezvishoma mumatope hiatal heniya anogona Classified zvinoenderana Vhoriyamu mudumbu rakapinza mubhokisi mhango:

• Danho rokutanga. Panyaya iyi, iyo thoracal mhango yacho diaphragm riri pamusoro abdominal chikamu yegurokuro. The dumbu iri ipapo nenzira yakakwirira. Ndiye yakabatana diaphragm zvakananga. Zvino riri Cardia.
• Danho rechipiri. The thoracal mhango ndiye mugove abdominal pakati yegurokuro, mudumbu anosiiwa zvakananga munzvimbo phrenic buri.
• Danho rechitatu. Pamusoro diaphragm vari Cardia, gastric muviri uye pasi (dzimwe nguva mugove antral) abdominal esophageal vakaparadzana.

zvekuchipatara mufananidzo

Zviratidzo zvirwere zviri zvikuru zvakafanana zviratidzo zvirwere zvomudumbu turakiti chokuita havachanyatsogoni inoshanda. Tikafunga nokuderera mu basa esophageal (akaderera) sphincter akacherekedza catarrhal reflux (harungashandurwi kukanda gastric mukati). Over nguva nokuda hasha pokudzora mukanyiwa panzvimbo dzapasi mugove yegurokuro hwapedyo kushoma. Murwere anotanga chokunyunyuta pamusoro chirungurira pashure zvokudya uye kuwedzera kunetseka mupfungwa kana mune chinjikira chinzvimbo. Kazhinji pane kunzwa bundu iri huro. Mushure kudya, marwadzo kuonekwe. Zvakasiyana zvakasikwa. The soreness anogona kupararira pamapfudzi chipande, kupa mu pamutsipa, seri sternum, vakakomba mwoyo kana rezasi shaya. Zviratidzo izvi akafanana zviratidzo angina, iro rinoitwa differential kuongorora chirwere. Mune zvimwe zviitiko marwadzo anooneka pane imwe nzvimbo mumuviri. Zvimwe kufadza murwere rokumusoro dumbu distension, achiziva kuvapo muviri yokumwe.

migumisiro

More kwazvo zviitiko dzinoratidzwa nhamba yematambudziko. Mumwe wavo ari ropa esophageal midziyo. Kazhinji, zvinotora nzvimbo muupenyu Isimba rakadini rinogona kubudiswa chimiro, hworatidza sezvo mberi kupererwa neropa. Ropa angava chirwere uye chakasimba. Mune zvimwe zviitiko, kunyange padzakacherechedza kukanganisa dzakawanda panguva esophageal achizarura uye esophageal perforation. Vakawanda mugumisiro chirwere reflux esophagitis. Inogona ichachinjwa kuva peptic urikanwi mu yegurokuro. Munguva kuramba kurapwa chinokurwadzai ichi zvikuru kuomesa - cicatricial stenosis (aienda) muviri.

Diagnostics

Zvokurwara kuonekwa ari kuitwa nzira dzakawanda. Zvinonzi kutaurwa pakati makuru: esophagogastroduodenoscopy, maekisirei mudumbu uye yegurokuro, intraesophageal ph-mamita. Yaishandiswa Ultrasound, computed tomography, ezofagometriya.

kurapwa chirwere

Akaita mabasa akasiyana-siyana zvainanga Kuderedza ari kuratidzwa kuti pematanho zvishoma nezvishoma mumatope hiatal heniya: zvokudya, mishonga. Kuchinja nzira chinangwa kubvisa chirwere zviratidzo: kurwadziwa, chirungurira, kuda kurutsa. Muchiitiko chino, vakagadzwa zvinodhaka kuti kuderedza gastric acidity. Achishandisa akadaro Somuenzaniso, zvinosanganisira kugadzirira "Kvamatel". Mumwe mamiriro ezvinhu chinobudirira mishonga wevarwere nechirwere hiatal heniya - zvokudya. Zvokudya ndeyevanyori pamberi mafuta, Spicy zvakakangwa zvokudya, doro, chocolate, kofi, zvigadzirwa kuti vanotsigira kugadzirwa gastric muto. Kudya kunofanira maduku zvokudya kazhinji. Kuti adzivise reflux akarara murwere zano pamwe akamutswa rokumusoro muviri nharaunda, uye kudzivisa rinorema kusimuka.

Surgery: mukuru ruzivo

Zvinofanira akati kuti apa mabasa regai kubvisa chikonzero icho pane zvishoma nezvishoma mumatope hiatal heniya. Operation - chete nzira kudzorera anatomic ukama pakati GI nhengo. In nedanho kupindira pave ane antireflux mashandiro kuti kunotadzisa neizvi dzakazvikanda mudumbu mukati. Panguva mashandiro hernial zvachose kuburikidza suturing wakakurisa aperture kune nomumhu.

Used zvomusejari unyanzvi

Nhasi, nyanzvi kushandisa nzira mbiri kupindira:

• Open kuwana. Muchiitiko chino, zvinogona kuitwa Nissen fundoplication kana mupurasitiki kubudikidza Tope. Muchiitiko chokutanga, yakakwirira pangozi yokuita yematambudziko ari yakatarwa. Nekuti mapurasitiki iri nani nokuda Tope.
• Laparoscopic kusvika. Ndicho muduku dzechimwe nzira kupindira. Pashure pokuvhiyiwa nenzira iyi murwere anonaya nokukurumidza uye nyore.

Zvinofanira akati kuti laparoscopic heniya esophageal buri rinowanzoshandiswa kuitwa pamwe kushanda nedzimwe nhengo dziri abdominal mhango. Somuenzaniso, holetsistomiya akaita apo calculous cholecystitis ari chirwere danho, sarudza proximal vagotomy - urikanwi ari duodenum.