Izimpawu, Amabangela, kanye Nezokwelapha I-hole ku-Colon
Iyini i-perforation yamathumbu noma umgodi ku-colon yakho futhi yiziphi izimpawu? Ngubani osemngciphekweni? Futhi kanjani ukuphathwa kwe-perforation?
Sibutsetelo
I-colon yakho iqukethe izingqimba ze-muscle ebushelelezi kanye nezinambuzane ezimangcwaba. Ingqimba engaphakathi, ebizwa ngokuthi i-mucosa, ilula futhi ifanelana nezicubu emlonyeni wakho. Ama-perwelation we-bowel ayenzeka uma umgodi wenziwa kule ndawo, ngokuvamile ngenxa yomsebenzi we-colon noma isifo esibi kakhulu.
Umgodi ekoloni uvumela ukuthi okuqukethwe kolononi ukuvuza ngaphakathi kokuqukethwe okuyizinzalo zesisu sakho esiswini.
Izimpawu
Izimpawu ze-poforation yamathumbu zingashintsha futhi zingase zifike kancane kancane noma ngokushesha kuye ngokuthi imbangela ebalulekile. Izimpawu zingafaka:
- Ubuhlungu besisu (ngokuvamile obukhulu futhi buhlakazeka)
- Ukwehluleka okukhulu kwesisu
- Ukuvimbela
- I-nausea nokuhlanza
- Ushintsho emathunjini akho noma imikhuba yakho.
- Ukuphuma kwegazi
- I-Fever (ngokuvamile hhayi ngokushesha)
- Ama-Chills
- Ukukhathala
Izingozi Zezingozi
Ososayensi bathole ukuthi izici eziningana zingandisa ingozi yokuthuthukisa i-perforation yamathumbu. Lokhu kufaka phakathi kokubili izici ezihilelekile ekuhlinzeni noma inqubo (izimbangela ze-iatrogenic) nezifo zezinyosi ezivezwe ukuvuvukala. Izici zengozi zingabandakanya:
- Kamuva noma ngaphambi kwesisu.
- Ukuhlinzwa okusheshayo noma kwangaphambili.
- Ubudala bukhulu kunama-75.
- Umlando wezinkinga eziningi zezokwelapha.
- Ukuthungathwa kwesisu noma isifuba (njengengozi yemoto.)
- Umlando wezifo ze- diverticular .
- Umlando wesifo sofuba sesibindi .
- Umdlavuza weColon
- Ukusetshenziswa kwelilimumab ye-monoclonal antibody immunotherapy.
- Ukunamathela kwama-pelvic (izicubu ezibomvu, ngokuvamile ezihlobene nokuhlinzwa kwangaphambilini.)
- Ubulili besilisa (abesifazane ngokuvamile bane-colon eguquguqukayo, engabangela ukuphazamiseka kwengozi ngesikhathi sokuhlinzwa, kuhlanganise ne-colonoscopy.)
- Izinqubo zokuxilonga nezinqubo ezibandakanya umzila wokugaya, isisu, noma isifuba. Izingozi ze-perforation ngesikhathi se- colonoscopy zihlanganisa nokuba ngowesifazane, ubudala, umlando wezifo ze-diverticular, kanye nokuvimbela izifo.
Izimbangela
Ama-perwelation we-bowel angenzeka ngokuzenzekelayo (ngokungalindelekile) ngenxa yesimo sezokwelapha noma kunalokho kube yinkimbinkimbi yezinqubo ezihlukahlukene zokuxilonga nezinqubo ezenza ngephutha emgodini. I-trauma, ikakhulukazi ukuhlukumezeka okuhlukumezayo esiswini, kuyisisusa esibalulekile sezinyosi.
Izimbangela ezihambisana nezinqubo zihlanganisa:
- I-Enema - I-tube yama-rectal engafanele noma engeniswe ngokuqinile ye-enema ingakwazi ukuvuthwa noma ukuqhuma emgqeni we-colon.
- Ukulungiswa kwe-colonoscopy ye-bowel - Ngokuvamile, ukulungiselela isilwane se-colonoscopy kungabangela ukuguqulwa. Lokhu kuvame kakhulu kubantu abanomlando wokuqothulwa.
- I-Sigmoidoscopy - Nakuba i-endoscope ye-sigmoidoscopy eguquguqukayo iguquguqukayo, i-perforation ihlala isengozini, kodwa ingavamile.
- I-colonoscopy - Iphuzu le-endoscope linamandla okuqhuma ngaphakathi kwendwangu yangaphakathi yekoloni, nakuba lokhu kuyinkimbinkimbi engavamile yenqubo futhi ayibonakali ekolonoscopy ebonakalayo . Ukuguqulwa kwamathumba okuhlobene ne-colonoscopy kuvame kakhulu kulabo abanesifo esibi kakhulu esibelethweni kanye nalabo abasemitholampilo ye-steroid. Izinga le-perforation le-colonoscopy libonakala liphakathi kwabantu abangu-100 abantu abangu-1400 abahlolisise i-colonoscopies kanye no-1 wabantu abangu-1000 abane-colonoscopy yokwelashwa (isibonelo, ukususa i-polyp.)
- Ukuhlinzwa ngamathumbu noma emithanjeni, ikakhulukazi ukuhlinzwa kwekoloni njengomdlavuza wekolon.
Izimbangela ze-poforation yamathumbu (okungahambisani nokuhlinzwa noma izinqubo) zifaka:
- Isifo sesifo sofuba / isifo sofuba njengesifo sikaCrohn nesifo sokulonda. Ingozi yokuphila komzimba nge-Crown's disease iphakathi kwamaphesenti amathathu nantathu, okwenza lokhu kube imbangela evamile kakhulu.
- Ukuvinjelwa kwamathumba amaningi, ikakhulukazi uma ikholoni "ibuthakathaka" yizifo ezihlukahlukene, enye inqubo, noma umdlavuza.
- I-Trauma.
- Isifo se-Ischemic isifo samathumbu (lapho igazi linikezwa ikolon lishintshwa.)
- Umdlavuza weColon.
- Ukufaka umzimba komzimba wangaphandle - Okuvamile ngenxa yokungena kwamathambo enhlanzi, namathanga amathambo, kanye nezinto ezingezona ukudla.
- Ukuthinta okujulile kwamathumbu.
Ukuxilongwa
Uma udokotela wakho esolisa i-perforation yamathumba, angakwazi ukuyala ukuhlolwa ukuze aqinisekise ukusola kwakhe. I-x-ray elula yesisu ingabonisa igesi ngaphandle kwekoloni kodwa ngokuvamile ayixilisi. Iskena se-CT yesisu sakho noma ngaphandle kokuphambene noma i-enam arium noma ukugwinya kungadingeka. Ukubala okuphelele kwegazi kungabonisa ukuphakama kwesibalo sakho segazi elimhlophe uma i-perforation ikhona okwesikhashana, noma ubufakazi be-anemia ngenxa yokuphuma kwegazi. Ngezinye izikhathi ama-perforations amancane athatha izifundo nezikhathi eziningana zokuzicabangela ukuze kutholakale ngokunembile.
Ukwelapha
Ukuguqulwa kwamathumbu kubhekwa njengesimo esiphuthumayo sezokwelapha futhi kudinga ukwelashwa okusheshayo. Uma ungakaphenduliwe, okuqukethwe kwegciwane kungagubha futhi kubangele ukuvuvukala, ukutheleleka ngisho nama-abscesses esiswini sakho. Igama lobuchwepheshe laleli yi-peritonitis, eliyisandulela esibuhlungu ekubhekaneni ne-sepsis-noma ukutheleleka komzimba wonke.
Iningi le-perforations lilungiswa ngokuhlinzwa. Kuye indawo kanye nosayizi wezinyembezi, udokotela angase akwazi ukuyilungisa nge-endoscope, efana neyasetshenziswa ngesikhathi se-colonoscopy-kodwa lokhu akuyona inketho kuwo wonke umuntu. Vula ukuhlinzeka ngamathumbu kungabangela noma kungabangeli isisu ne-colostomy : ukuvulwa kokufakelwa ngaphandle kwesisu sakho lapho isitokisi sidlulela esikhwameni esincane kuze kube yilapho isilonda siphulukiswa.
Izinkinga
Izinkinga ze-perforation ezingaphenduliwe zingabandakanya:
- Ukuphuza
- Ukwelapha (i-peritonitis ne-sepsis)
- Ukufa
Izinkinga zithembele empilweni yomuntu jikelele, kanye nesikhathi esithathile ukuxilonga nokuphatha i-perforation.
Ukubuyisela
Ngesikhathi sokuqala sokuphumula, ngeke ukwazi ukuphuza noma ukudla noma yini ngomlomo. Lokhu kubizwa ngokuthi ukuphumula emathunjini futhi kuvumela isikhathi sokungena ngaphakathi singaphulukisa kahle. Uyothola futhi ithini le-nasogastric endaweni ukuze ukhiphe okuqukethwe kwesisu sakho isikhathi esithile. Ungase uthole ama-antibiotic emithi kanye nomsoco ezinsukwini ezimbalwa uma usesibhedlela. Nakuba ungase ukhathazeke ukubuyela esimisweni sakho esivamile, kubalulekile ukuthi unike isikhathi sakho sekoloni ukuze uphulukise kahle , futhi ulandele imiyalo kadokotela wakho.
Okubalulekile
I-perforation ye-bowel ingenzeka ngokuzenzekelayo, njenge-inflammatory disease, noma ngesikhathi sokuhlinzwa noma ukuhlolwa kwezifo. Izimpawu zingase zivele ngokushesha, noma esikhundleni kancane, futhi kufanele zicatshangelwe kunoma ubani onezizathu eziyingozi zokuphazamiseka okuhlangene nezimo ezingozini zesimo.
Uma uthathwa ekuseni, kunezinketho ezahlukene zokwelashwa ezitholakalayo, kodwa ngisho nokuhlinzwa (okuyinto evame ukudingwa njalo) isilonda singagcinwa futhi silungiswe ngaphandle kwe-colostomy. Ukubuyisela kungathatha isikhathi, kokubili ukuphulukiswa, nokulungisa izinto ezibangelwa ukuphazamiseka.
> Imithombo
- > Holmer, C., Mallmann, C., Musch, M., Kreis, M., noJer Grone. Ukuphathwa kokuhlinzwa kwe-I-orthogenic Perforation ye-Tract Gestrointest Tract: Iminyaka Engu-15 Yezi Experience Esikhathini Esilodwa. I-World Journal of Surgery . 2017 Mashi 21. (Epub ngaphambi kokuphrinta).
- > Kim, J., Lee, H., Ye, B. et al. Isimo Sezingozi Nezikhwama ze-Free Brewel Perforation kwiziguli ezinezifo ze-Crohn's. Izifo ze-Digestive and Sciences . 2017. 62 (6): 1607-1614.
- > Kothari, K., Friedman, B., Grimaldi, G., noJ. Hines. Ukuguqulwa Kwamathumbu Okukhulu Okungaxhunyiwe: I-Spectrum ye-Etiologies kanye ne-CT Findings. I-Radiology yamathumbu . 2017 Meyi 10. (Epub ngaphambi kokuphrinta).
- > Yamauchi, A., Kudo, S., Mori, Y. et al. Ukuhlaziywa okubukeziwe kokuvimbela izikhumba ezinkulu noma ukuqubuzana okubangelwa ukulungiswa komlomo ngeColonoscopy. I-Endoscopy International Open . 2017. 5 (6): E471-E476.