HH - ndichiyani? Zizindikiro ndi mankhwala a HH

Tiyeni tiyambe ndi choona kuti aliyense ali bwino chidule HH. Ndi chiyani icho?

Hiatal chophukacho (HH zili chomwechi lalifupi), kapena chophukacho hiatal, - palibe kuposa matenda yodziwika ndi kusamuka kwa chiwalo (ili mu zonse m'mimba) kudzera kudya dzenje chifundamtima kuti patsekeke thoracic. Thupi ili ndi nthawi m'mimba.

Oesophageal chophukacho akhoza kukhala kobadwa nako kapena kugula chikhalidwe ndi ananenera mawonetseredwe matenda. Kobadwa nako chophukacho ndi zochepa wamba kuposa zinazake. HH angayambe zifukwa zambiri.

M'nkhaniyi tiona zimene HH, zizindikiro, mankhwala ndi maphokoso ntchito nthawi ya matenda.

General maonekedwe a matenda

Kabowo (amene ali kufunika mwachindunji HH) ali ndi mawonekedwe ozungulira kugawa kuti imakhala mitundu iwiri ya nsalu: minofu connective. Ichi ndi kugawa alekanitsa zonse m'mimba ku chifuwa. The tufts mu mnofu zakulera kupanga dzenje yaing'ono imene kum'mero. Ndipo inu mwina kale kumvetsa chifukwa chake amatchedwa kutsegula esophageal.

Tikaonanso hiatal chophukacho (HH). Ndi chiyani icho? Iwo apangidwa chifukwa cha kusamuka kwa thupi kuchokera zonse m'mimba mu chifuwa mwa hiatal kwambiri. Ndipo izo zimachitika chifukwa cha kufooka kwake.

Hiatal chophukacho - matenda wamba kotero kuti kupikisana bwinobwino ndi cholecystitis, kapamba kapena zilonda mmatumbo. Komabe, malinga ndi kuopsa wake, adzapereka iwo kupikisana.

Wachibale zaka wodwala kuti nthawi zambiri matenda akufotokozera anthu achikulire kuposa zaka 60. Pankhani jenda - akazi amavutika kwambiri ku matenda kuposa amuna.

Gawo

oesophageal chophukacho m'magulu malinga ndi makhalidwe awo. Kuonetsetsa mitundu amenewa:

• Akuyandama kapena amodzi chophukacho (chophukacho kwa ofananira ndi paraesophageal okha). Makamaka, paraesophageal chophukacho - izi ndi pamene chifaniziro cha gawo la m'mimba ndi mwachindunji pafupi ndi kum'mero pamwamba pa chifundamtima. Ndipo cardia m'mimba pansipa chifundamtima amalongosola. Ofananira HH - esophageal, mtima, kapena subtotal totalnozheludochnaya. kusiyana A akadali kutsetsereka chophukacho, makamaka pamene aumbike ngati sac hernial alimbane ndi peritoneum lapansi. Kumasiyana ndi mfundo ofananira kuti thumba otsiriza. Ofananira chophukacho angachititse momasuka ndi kayendedwe thupi.
• Paraesophageal chophukacho (fundic kapena antral).
• Kobadwa nako chophukacho, chifukwa yochepa kum'mero ndi anomaly mu chitukuko.
• Hernias la mtundu wina (enteric, zisindikizo ndi zina zotero. P.).

Matenda akhoza m'magulu malinga mlingo:

- Esophageal chophukacho digiri yoyamba. Yodziwika chakuti cardia m'mimba ndi pa mlingo wa chifundamtima, m'mimba pang'ono kukwezeka ndi mwamphamvu adherent kuti chifundamtima. M'mimba kum'mero lili M'mimbamo thoracic pomwepo pamwamba pa chifundamtima.

- Esophageal chophukacho digiri yachiwiri. Chithunzi matenda chiri motere: kum'mero m'mimba mwa thorax, ndi kutsegula esophageal kale gawo la mmimba.

- Esophageal chophukacho digiri lachitatu. Mlingo aakulu, wofanana ndi kupeza ya kum'mero, cardia, ndipo nthawi zina ngakhale thupi ndi fundus za m'mimba pamwamba pa chifundamtima.

Zifukwa chophukacho esophageal

Tanena kale kuti zifukwa ndi hiatal chophukacho kwambiri. Komabe nthawi zambiri ndi zinthu zotsatirazi:

• Kupatulira wa Mitsemphayi connective chifukwa cha kusintha obwera ndi ukalamba kapena anachititsa ndi njira ina.
• Mwadongosolo kapena gawo aakulu kuwonjezeka kuthamanga mu zonse m'mimba yokha. Amachititsa kuwonjezeka kuthamanga angakhale aakulu kudzimbidwa thupi katundu (monga kunyamula zinthu zolemera), yosamveka m'mimba zoopsa ndi zambiri.
• matenda aakulu omwe amagwira zokhudzana ndi dongosolo m'mimba ndipo angasokoneze galimoto ntchito ya ndulu, m'mimba, kapena duodenum.
• Matenda a zopangitsa endocrine (endocrinopathy).
• zizolowezi zoipa (kusuta, kumwa), ndi munthu wachikulire.

HH: Zizindikiro

Malinga ndi mawonetseredwe matenda a matenda otsatirawa mitundu hiatal chophukacho:

- HH asymptomatic;

- HH, chifukwa kudwala imene matendawa amayamba ndi kulephera kwa cardia ya;

- HH, si yodziwika ndi kukhalapo kwa chapamimba matenda cardia insufficiency;

- HH, amene amaoneka ngati vuto la mitundu ina ya matenda m'mimba (kapena kungoti kukhala pa maziko awo);

- paraesophageal HH;

- HH kubadwa, yodziwika ndi yochepa kum'mero.

Ndi zothandiza mtundu uliwonse HH (mtundu uliwonse wa zizindikiro) payokha:

• Asymptomatic hernias. Monga mukudziwa dzina la mawonekedwe matenda, zizindikiro HH mu milandu, palibe. Kwenikweni amatanthauza mtima kapena esophageal chophukacho, mwachitsanzo formations ang'onoang'ono kukula. Pezani mawonekedwe chophukacho kwathunthu mwachisawawa, kawirikawiri - pa Kupenda zonse, ndipo nthawi zina anthu sadziwa n'komwe kuti ali HH - zizindikiro (chithandizo zafotokozedwa pansipa) chifukwa palibe chophukacho.
• HH syndrome cardia kulephera. Zizindikiro ambiri mtima HH - kutentha ndi ululu, postprandial, ndi pa kusintha lakuthwa udindo wa thupi la wodwalayo. Iwo ayenera kukumbukira kuti zizindikiro zambiri zinachitika pa usiku, n'zotheka kufotokoza mbali za kuwonjezeka kamvekedwe ya mitsempha vagus, komanso zosangalatsa za esophageal sphincter m'munsi.

Ponena za mphamvu ya kutentha, mukhoza kunena kuti zingakhale zovuta (mu nkhani iyi, angathe kuchizidwa ndi Mankhwalawa ayenera kumwedwa), ndipo ndithu chowawa (moti ngakhale zimaphwanya ntchito anthu). mwamphamvu ake anatsimikiza ndi zovuta ziti zosiyana, ndipo Choyamba, kuphatikizapo asidi-zilonda, amene ali achilendo kwa madzi muzituluka. Komanso angachite esophageal distension ndi kuponyera zili mmatumbo (makamaka ya ndulu).

Kwambiri diso kugwira mbali ya chophukacho hiatal, ndithudi, ululu. Dziwani kuti zimadalira chifukwa cha kutentha. Kwenikweni zikuoneka zifukwa zofanana. Ululu isanafalikire makamaka m'dera la sternum, ndipo nakweza pamene wodwala zimatenga kunama malo. Kuwonjezera imeneyi komanso ululu torso mmbuyo ndi mtsogolo. Chikhalidwe cha iye angakhale osiyana, nthawi zambiri izo pricking, kudula kapena moto zomverera.

Regurgitation ya nkhani chapamimba - n'kofala kwambiri chizindikiro cha HH. Ndi chiyani icho? Iyi ndiyo njira ya akuponya zili m'mimba m'kamwa. zosasangalatsa kwambiri chodabwitsa, motero zili m'mimba akhoza kulowa trachea kapena bronchi.

Kachiwiri, angapo mawu za ululu. ululu weniweni akuona theka chabe la odwala ndi 25% wa zoterezi psevdokoronarnaya ululu, omwe isanafalikire mu mtima. Kuyambira inu mosavuta tichotse ntchito nitroglycerin. Kuwonjezera kuwawa, odwala amaganiza kusapeza mu interscapular, m'madera hepatopancreatoduodenal, komanso-Chauffard Minkowski, etc.

Komanso, pafupifupi 70% ya odwala ndi chophukacho hiatal (makamaka ngati mtima HH) anakumana ndi chizindikiro monga belching. Nthawi zambiri zimachitika zili m'mimba, ndi kuloŵedwa m'malo ndi kutengeka zosasangalatsa ankaikira chidzalo m'dera epigastric, zimene zikusonyeza aerophagia. Umabweretsa ndi zosasangalatsa kulawa zowawa. Ndipo MANKHWALA OLETSA VUTOLI ndi analgesics mu nkhani iyi, kuchotsa maganizo amenewa sangathe.

Komanso, 40% odwala amavutika kudutsa chakudya pamodzi kholingo, ngakhale pamene mukumwa chakudya madzi. Ngakhale tisaiwale kuti chakudya chotafuna akudutsa mosavuta zokwanira. Anthu akuvutika chizindikiro ichi, nthawi zambiri izo ziri kuwonetseredwa ndi otentha kwambiri kapena mosinthanitsa, chakudya ozizira kwambiri. Choncho, ngati chophukacho ndi akulimbikitsidwa kudya chakudya chokha chimene ali thupi teperatura.

About 4% ya odwala matenda HH hiccups pa maziko a mawonekedwe ofananira wa chophukacho. Only si si hiccups mwachizolowezi. Mbali Aika tinganene kuti ndi nthawi yaikulu (zikhoza masabata kapena miyezi). osati muchisiye izo kwambiri chabe, ndi kuthandiza kukachitika kuti zitha kukhala katswiri oyenerera.

Odwala ena amapeza glossalgia (zilonda lilime) ndi hoarseness, yomwe ndi chotsatira cha amayaka ku zilonda zili chapamimba panamveka pa regurgitation.

Kuwonjezera onse pamwamba, tikhoza kuwonjezera kuti zizindikiro za chophukacho ndi zimadalira kukula kwake.

• HH popanda zizindikiro insufficiency wa cardia lapansi. Zikatero, zizindikiro za matenda osiyanasiyana ndi yapadera kwambiri, osati chophukacho. Zizindikiro za mtundu uwu udzakhala pericardial chophukacho, epigastric kapena ululu retrosternal zikuchitika nthawi yomweyo pambuyo chakudya kapena pambuyo kukweza.

Oterowo zowawa akhoza kwa masiku angapo. Kuti n'chongoletsa iwo mungagwiritse ntchito analgesics sanali chomwa mankhwalawa (kupatula validol chifukwa cha palibe chochitika) kapena nitroglycerin. Komanso, ululu mabasi pamene mukumwa chakudya kapena madzi.

• HH, wosawoneka monga Vuto kapena kungoti kukhala pa maziko a mitundu ina matenda m'mimba. matenda ndi zambiri chapamimba kapena mmatumbo chilonda. Mu mawonekedwe HH zizindikiro zazikulu za matenda, osati chophukacho.
• Paraesophageal HH. mawonekedwe chophukacho amakhala ndi pakalibe zizindikiro zilizonse ndi zizindikiro. Nthawi zambiri matenda a chophukacho paraesophageal limapezeka mosintha pa kafukufuku ambiri. Koma pamene chophukacho Amamchulukitsira, pali esophageal psinjika (mwa kulankhula kwina, kuchepetsa wa kholingo). Nthawi zina, kukhala esophageal kuphipha (a matenda amene anasokonezeka esophageal peristalsis).

Ngati siudzalandilidwa ngathi lamulo paraezafagealnyh hernias pali ululu mu sternum kapena epigastric.

• Kobadwa nako HH yodziwika ndi lalifupi kum'mero. Mu mawonekedwe a chophukacho kum'mero kungakhale yachiwiriyo. Mu oyamba chikhoza kukhala chinthu monga "thoracic m'mimba" omwe amakhala ndi njira zotsatirazi:

- malo a chifuwa;

- kutanthauzira kwa m'mimba intrathoracic.

Zikatero, matenda ndi zovuta, izo zimachitikira pa opaleshoni kapena autopsy.

zosokonezeka zotheka

Hiatal chophukacho kungakhale zosiyanasiyana zosokonezeka. Nthawi zambiri akuwonetseredwa motere:

- gastritis kapena chapamimba chilonda kuti mbali imene chophukacho (limapezeka pafupifupi 8% milandu);

- magazi, magazi m'thupi (pali 20% milandu);

- kumayambiriro ya kum'mero m'munsi mwa sac hernial;

- kufupikitsa ndi kum'mero (zambiri imapezeka ndi kardiaezofagealnymi mitundu);

- prolapse wa mucosa muzituluka mu kholingo (ie retrograde imfa);

- khosi chophukacho (ovuta kwambiri Vuto la zonsezi pamwambapa).

matenda a matenda

Childs, akatswiri kugwira mayesero ambiri pa zifukwa zimene tikhoza kale apezeke "HH." Kodi mtundu wa mayesero:

• Fibrogastroscopy. Mukhoza ntchito kumvetsa mmene kum'mero ndi m'mimba. Zizindikiro Endoscopic wa HH imalongosola yekha dokotala, potengera zomwe zimakhala matenda ndi mankhwala mankhwala.
• X-ray bwinobwino ozikidwa pa barium mosiyana. Kudzera kafukufuku ameneyu, inu mukhoza kutenga chithunzi herniation, ndilo khalidwe lililonse HH madigiri.
• pH-metry. mayeso ino kudziwa mlingo wa acidity m'mimba. M'pofunika molondola perekani mankhwalawa chophukacho.

HH pa Chithandizo kum'mero

Nthawi zambiri, chithandizo hiatal chophukacho umadutsa mankhwala, koma nthawi zina (makamaka pamene mavuto) amafuna alowererepo pa opaleshoni.

Pankhani chithandizo ndi mankhwala, ndi kuchepetsa acidity m'mimba (ntchito Mankhwalawa ayenera kumwedwa), ndi kuchepetsa katulutsidwe muzituluka. Izi - ntchito choyamba. Komanso, ngati mankhwala m'pofunika kuteteza mucosa chapamimba, amenenso amapereka ntchito mankhwala ena.

Pamene mankhwala wapatsidwa zakudya okhwima, zimene ziyenera wonse namtsata. Kwenikweni, zakudya ili pafupi mofanana gastritis: palibe mafuta, palibe zokometsera, wowawasa, mchere. Only chakudya wathanzi, monga masamba, zipatso, dzinthu, soups zakudya ndi broths, Taphunzira nyama.

Choncho, kuthetsa kutentha ndi kuchepetsa katulutsidwe chapamimba akhoza kutenga mankhwala "Maalox". Amene yabwino kwambiri, alipo osati miyala, koma mwa mawonekedwe angakhale angelo, mapiritsi, suspensions. Aliyense mawonekedwe izi zikutanthauza malangizo osiyana ntchito, sipangakhalenso kutchulidwa mankhwala aliwonse a mzinda wanu.

N'zothekanso kutengera njira monga "Rennie" kapena "Gastal". Kuthetsa kutentha kale anaonekera zokwanira kutenga limodzi, ndi kupewa - mapiritsi 4 tsiku (ola limodzi pambuyo chakudya). Komabe, kumbukirani kuti mankhwala amenewa kuchotsa zizindikiro.

Monga opaleshoni, ndi kuchotsa chophukacho mapangidwe.

Zolinga ndi zolondola matenda ndi mankhwala n'kofunika ntchito kwa dokotala (dokotala kapena gastroenterologist).

Chithandizo cha mankhwala wowerengeka

HH Chithandizo wowerengeka azitsamba sudzapereka zotsatira namfunsa, monga nthawi zambiri wodwalayo amafuna mankhwala aakulu kapena ngakhale kuchita opaleshoni.

Ndiko kuti, chophukacho yokha sangathe kuchotsa ndalama za anthu. Chifukwa chokha kugwiritsidwa ntchito - ndi kupweteka.

Ena teas mankhwala akhoza kuthandiza kuchepetsa ululu. Pano pali mankhwala wowerengeka zimene zingakuthandizeni pa nkhondo ndi chophukacho ndi:

- A decoction wa marshmallow mizu. Thirani pafupifupi 20 ga wosweka muzu Althea makapu madzi otentha ndipo mulole izo brew.

- Sakanizani madontho 30 a mowa phula tincture ndi 50 ml ya mkaka. Tengani nthawi 2 tsiku.

- flatulence bwino amathandiza decoction wa mbewu za kaloti. Lembani limodzi gram mbewu makapu 2 madzi otentha ndi kulola osakaniza kwa brew kwa pafupifupi ola limodzi. Muyenera kumwa pamodzi ndi mbewu.

Kumbukirani kuti asanadye kalikonse (makamaka mankhwala wowerengeka) m'pofunika kukaonana ndi dokotala.

Komanso, kugwiritsa ntchito mankhwala wowerengeka, mukhoza tichotse kutentha, hiccups, ndi zizindikiro zina za HH. Koma kumbukirani kuti ichi ndi chifukwa osakhalitsa, ndipo kufunika kuchitira chifukwa cha matenda osati zizindikiro.

oesophageal chophukacho pambuyo opaleshoni

Monga tanena zina, hiatal chophukacho amafuna opaleshoni. HH-opareshoni, ndemanga imene osokoneza, atha kupulumutsa moyo wa milandu patsogolo kwambiri.

Koma zoyenera kuchita pamene opareshoni ndi kale? Kodi kumvera mode pambuyo ntchito? Kodi posachedwa mukhoza kubwerera ku moyo wabwinobwino?

HH pambuyo opaleshoni kwenikweni amafuna chisamaliro komanso chithandizo ndiponso kupewa.

Pa tsiku loyamba pambuyo pa opaleshoni, odwala amafunika ndikuphunzitsidwa kuona ndi electrocardiography. Pa tsiku lachiwiri anali chifuwa X-ray. Lachitatu - okwana zonse magazi ndi maphunziro amuzolengedwa umene kuwerenga akuchipatala sonography.

Kawiri pa tsiku, odwala ayenera kugwira Zochita yosavuta kupuma zokambirana komanso mankhwala thupi.

Koma mankhwala akhoza kunena mfundo zotsatirazi. Amakhala kumayambiriro a saline njira m'nsinga mu buku 1800 ml ya patsiku. odwala onse pambuyo opaleshoni kutenga mankhwala.

Trocar mabala asonyezedwa mowa ndi angamvetsere tsiku.

tsiku limodzi pambuyo opaleshoni wodwalayo kumwa madzi, koma pa tsiku lachiwiri - kutenga chakudya madzi. Nthawi postoperative ndi za 3 miyezi.

Kodi iye HH-opareshoni (ndemanga imene zosiyana malingana ndi kuopsa kwa matenda), takambirana kale pamwambapa. Ndi kuchotsa chophukacho kwambiri.

Pomaliza

Kotero tsopano inu sadzachita mantha, ngati penapake mudzaona chidule HH. Kodi izo ndi momwe izo kumaonekera, inu mukudziwa.

Imangokhala yokha mwachidule, kuti matenda ndi yaikulu kwambiri. Self-mankhwala, makamaka mankhwala azitsamba wowerengeka, ndi ngozi zokwanira ndipo angathe kuyambitsa mavuto aakulu.

Tsoka ku matenda palibe amene sangayesedwe, kuyambira mitundu ina HH asymptomatic. Ndi njira yokhayo yotulukira - mayeso mokwanira chipatala kamodzi pa chaka. Kotero inu mukhoza kupeza matenda zosasangalatsa.