I-Hernias ye-Diaphragmatic Congenital: Ukuxilongwa, Ukuhlinza Nokubuyiswa

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Kuyini Ukuxilongwa Okungavumelani (iBochdalek) Hernia?

I-hernia eyimfucumfucu, noma i-herd Bokedalek, iyenzeka esibelethweni futhi itholakala ngesikhathi sokukhulelwa noma esanda kuzalwa. Kuyenzeka uma kunobuthakathaka esivumelwaneni, imisipha ehlukanisa isikhumba esifubeni esiswini esiswini. Ngaphezu kokuhlukanisa izitho zesifuba ezivela ezingxenyeni zesisu, i-diaphragm nayo isiza amaphaphu agcwalise oksijini. (Ukuhamba kwesisu esiswini osibona lapho uphefumulela ukuhamba kwesifenqema.)

I-hernia enzima kakhulu ingavumela isilwane noma izitho zonke ukuba zishaye esifubeni, ngokusebenzisa umgodi noma isici. Ezimweni eziningi, i-hernia diaphragmatic kuyinto esiphuthumayo, edinga ukwelashwa okusheshayo ngokushesha. Lokhu kungenxa yokuthi inhliziyo namaphaphu kunzima ukugcwalisa nokuhlinzeka umzimba ngomoya oksiphekile ngenxa yokuqhuma kwesifuba esifubeni. Izingane ezisanda kuzalwa nale nhlobo ye-hernia kungenzeka zibe nezindebe ezibonakala ziluhlaza okwesibhakabhaka, ngenxa yokungabi khona kwe-oxygen.

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Izimbangela Nezici Zengozi

Izimbangela ZaseHernia Eyesifo Esiwumkhuhlane

Ayikho imbangela eyaziwayo ye- hernia ephazamisayo . Ubuthakathaka emisipha bukhona ekuzalweni, okubizwa nangokuthi "i-defenital defect." Ayikho indlela yokuvimbela umlando wakhe, njengoba udala utero, ngaphambi kokuba umntwana azalwe.

Ubani Osemngciphekweni WamaHernia Ayingqayizivele?

I-hernias e-diaphragmatic yenzeka ku-1 kuzo zonke izinhlobo zokuzalwa ezi-2,000 kuya ku-5 000. Kuvele kubonakale ukuthi kukhona ukuxhumaniswa kwezakhi zofuzo ezihilelekile kuloluhlobo lwe-hernia, njengoba umntwana engase abe nenengozi eyengeziwe yokuthola lolu hlobo lwe-hernia uma ingane noma umzali enesimo. Abafana banengozini encane kunamantombazane.

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Ukuxilongwa

I-hernia encane ayifuni ukubonakala kwesikhumba ngaphansi kwesikhumba njengamanye ama-hernias amaningi. Ezimweni eziningi, azikho izimpawu ezibonakalayo ukuthi umntwana osanda kuzalwa unalo hlobo lwe-hernia. Kuzotholakala ukuthi une-ultrasound ngaphambi kokuba umntwana azalwe, noma ngemuva kokuzalwa lapho isisu sezwa "ngokungenalutho" ngokusobala lapho kuhlolwa ukuhlolwa komzimba. Kwezinye izimo, i-hernia ingase itholakale lapho odokotela befuna incazelo yenkinga yokuphefumula osanda kuzalwa.

I-hernia eyimfucuza eyenzeka ngokuvame kakhulu ekuhlangothini lwesobunxele kwengane, okwenza kube yinto evamile ukuba isisu siphume ngesiphambeko. Ezimweni ezinzima, lapho kuphela isisu esisithintekayo, umntwana angabonisa kuphela izimpawu zokuhlupheka nokudla nokuhlanza.

Izivivinyo zingalawulwa ukunquma ukuthi yiziphi izitho ezithintekayo yinkinga. I-echocardiogram ingase ilandelwe ukuhlola umsebenzi wenhliziyo; i-x-ray yesifuba, i- CT scan noma i- MRI ingasetshenziselwa ukuhlola izitho ezengeziwe. Izivivinyo zegazi zingabuye zenziwe ukuba zithole ukuthi ingakanani i-oksijini efinyelela egazini ngaphezu komsebenzi we-lab standard.

Izimpawu ze-Hernia ye-Diaphragmatic

• Ukushaya kwenhliziyo okusheshayo (inhliziyo ezama kanzima ukuthola umoya-mpilo emzimbeni)
• Ukuphefumula okusheshayo (amaphaphu azama kanzima ukuthola umoya-mpilo emzimbeni)
• I-Cyanosis (izindebe eziluhlaza okwesibhakabhaka nemibhede yomunwe)
• Izinkinga ezingapheli, ezinzima zokuphefumula
• Ukuxilongwa kwe-amniotic ngokweqile ngesikhathi sokukhulelwa
• Ukuxilongwa kwephaphu eliphelile
• Olunye uhlangothi lwesifuba luphawu oluphawulekayo kunomunye
• Izinkinga ezinzima zokudla noma ukugcina ukudla
• I-X-ray ikhombisa ibhethri engavamile esifubeni

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Ngabe I-Hernia Yokuzibulala Engazalwa Ngesinye Isikhathi Esiphuthumayo?

I-hernia ene-diaphragm kungaba yisimo esiphuthumayo ngezizathu eziningi. Ingane ingase ibe nokuphefumula okunzima kakhulu, njengoba izitho ezengeziwe esifubeni zenza kube nzima emaphashini ukwandisa. Lokhu kuyiqiniso nangenhliziyo; kungaba nzima ukuba inhliziyo igcwaliswe ngegazi ngenxa yokuphefumula kwesifuba.

Ngaphezu kwalokho, kunengozi yokucwiliswa kwezitho ezicindezelayo esifubeni, okusho ukuthi izitho eziye zangena esifubeni zilahlwe ukugeleza kwegazi. Lokhu kungabangela ukufa kwezicubu kanye nezitho ezivuthwa nge-hernia.

Amantombazane azalwe nge-hernias e-diaphragmatic ngokuvamile anakekelwa ekamelweni lokunakekelwa okukhulu ngenxa yezinkinga ezinkulu ezivame ukukhona. Naphezu kokuthi abantwana abazalwa benomkhuhlane we-diaphragmatic abagula kakhulu, ukuhlinzeka kungase kubambezeleke kuze kube yilapho umsebenzi wamaphaphu uqiniswa, ngoba lokhu kungathuthukisa amathuba okuqhubeka nokuhlinzwa.

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Ukuhlinzeka Ngokuhlinzwa Kwe-Hernia Ye-Congenital Diaphragmatic

Ukuhlinzeka ngokuhlinzwa okuyisimiso esibucayi ngokuvamile kwenziwa ngokusebenzisa i- anesthesia jikelele futhi kwenziwa ngesineke . Kungenzeka kwenziwe ngokushesha , ngokushesha ngemuva kokuzalwa kwengane, noma ngokushesha nje lapho ingane izinzile ngokwanele ukubekezelela ukuhlinzwa. Kwezinye izimo, kungase kube nesidingo sokuzinzisa umsebenzi wokuphefumula noma wenhliziyo yengane ngaphambi kokuhlinzwa. Ezimweni ezingavamile kakhulu, ukuhlinzwa ku-utero kungacatshangwa, inqubo lapho ukuhlinzeka khona ku-fetus ngenkathi umama ekhulelwe. I-fetus isivunyelwe ukuqhubeka ithuthuka ngenkathi ukukhulelwa kuqhubeka, nakuba ukukhulelwa kuba yingozi enkulu kakhulu.

Ukuhlinzwa, uma kwenziwa ngesikhathi esanda kuzalwa, kwenziwa ngumhlinzeki ohlinzayo wezingane, kodwa kungadinga usizo lwabanye abahlinzayo, njengodokotela ohlinzayo we- cardiothoracic noma ochwepheshe bekolon-rectal ezimweni ezimbi. Kuye ngezici ezithintekile, abahlinzayo abahlukahlukene noma abengeziwe abanezobuchwepheshe obuhlukile abangaba yingxenye yokuhlinzwa.

Ukuhlinzwa kuvame ukuqhutshwa ngendlela evulekile besebenzisa ukuchotshozwa okujwayelekile ngaphansi kwe-cage cage, kunendlela encane ye- laparoscopic . Lokhu kungenxa yobukhulu bezinkinga ezihlangene nobukhulu obuncane besiguli.

Ukuhlinzwa kuqala ngokuthola i-error in the diaphragm kanye nezicubu eziye zangena endaweni yesifuba. Izicubu kanye nezitho, uma zikhona, zibuyiselwa esiswini. Lapho izicubu zibuyiselwa endaweni yazo efanele, imbobo esivumelwaneni ivaliwe. Lokhu kwenziwa ukuvimbela izicubu zesisu ekuthutheleleni emuva emgodini wesifuba. Uma i-error in the diaphragm ilukhuni kakhulu, i-diaphragm ingadalwa kusuka ezintweni zokwenza izinto.

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Ukuthola okuvela ku-Diaphragmatic Hernia Surgery

Iziguli eziningi ze-hernia zigula kakhulu ekupheleni kokuhlinzwa futhi ziyothathwa ku-Unit Neonatal Intensive Care Unit (NICU) ukuze ibuyiselwe. Kulezi ziguli ezingavamile ezikwazi ukuphefumula ngokwabo ngemva nje kokuhlinzwa, lindela umntwana okhungathekile ongeke akhathazeke futhi ngezinye izikhathi, kunzima ukududuza.

Uma amaphaphu wengane engathuthukisiwe noma uma izinkinga zokuphefumula ziqhubeka nokuhlinzwa, i- ventilator ingadingeka ngesikhathi sokubuyiselwa. Kwezinye izimo ezinzima, i-ventilator akwanele ukuletha oksijini okwanele emzimbeni. Kulezi zimo ECLS / ECMO (Extracorporeal Life Support / Extracorporeal Membrane Oxygenation) ingasetshenziswa, umshini osiza okhiphe igazi lapho amaphaphu nenhliziyo bengakwazi ukwenza kanjalo. Le ukwelashwa isetshenziselwa kuphela iziguli ezigula kakhulu, labo abazofa ngaphandle kokuphefumula okwenziwe okwenziwe emzimbeni.

Ubude besikhathi umntwana abesebenzisa i-ICU buxhomeke kakhulu ekutheni i-hernia yayinamandla kangakanani, uma kukhona ukulimala komzimba nokuthi izitho zithuthukile kangakanani.

Ngeshwa, lesi simo sinzima kakhulu futhi ezinye izingane azibekezeli ukuhlinzwa. Ezinye izingane zenza ngokuhlinzwa, kodwa ukuhlanganiswa kokuhlinzwa, izitho ezingathuthuki noma ukulimala komzimba kuholela ekufeni. Kulinganiselwa ukuthi iziguli ezingu-80% zisinda ekuhlinzekeni nasekutholeni.

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Imiphumela Yesikhathi Eside Ye-Hernias E-Diaphragmatic

I-hernia ephazamisayo ingabangela izinkinga ngaphambi kokuba umntwana azalwe. Amaphaphu nenhliziyo yengane angeke ikhule ngendlela evamile, ngenxa yokucindezelwa okubangelwa izicubu ezengeziwe esifubeni. Izicubu noma izitho ezingena esifubeni zingalimaza noma zihluleke ukuthuthukisa ngendlela efanele ngenxa yokuntuleka kwegazi. Lokhu kungabangela izinkinga zokuphefumula eziqhubekayo, izinkinga zenhliziyo nezinkinga zokudla okunomsoco.

Lezi ziguli zivame ukuthola ukulibaziseka kokuthuthukiswa, okungase kunciphise ngokuhamba kwesikhathi. Kwezinye, ukuhluleka ukucubungula kahle kuhambisana nokungafinyeleli isikhathi eside ukuze uthole umoya okwanele emzimbeni.

Ulwazi Olwengeziwe: Konke Nge-Hernias

_Imithombo:

_{I-Hernia e-Congenital Diaphragmatic. Uhlelo lwezempilo lwe-University of Michigan. http://surgery.med.umich.edu/pediatric/clinical/physician_content/am/congenital_diaphragmatic.shtml}

_{I-Hernias ye-Diaphragmatic. I-Lucile Packard Children's Hospital eStanford http://www.lpch.org/diseasehealthinfo/healthlibrary/digest/diaphrag.html}