Njengoba iziningi ze-hernias ezibelethwayo zingabangeli izimpawu, zivame ukutholakala ngesikhathi se-X-ray esifubeni sesimo somzimba esingaxhunyiwe. Ngezinye izikhathi, inhlamba yokubeletha ingase isolwe kubantu abane-acidix ene-acidix ehlulekayo ukuhluleka ukuphendula ama-antacids noma ezinye izifo. Ezimweni ezinjalo, kunezinombolo eziningi zokuhlolwa odokotela abangasebenzisa ukuqinisekisa ukuxilongwa, kuhlanganise ne-X-rays, i-endoscopy, ne-manometry yokulinganisa.
Ukucabanga
I- hernias encane yokubeletha ngokuvamile ilukhuni ukuyibuka e- X-ray evamile futhi ingabonakala nje njengesakhiwo esigcwele igesi esifundeni sesifuba. Ukuze unikeze incazelo engcono, ukuhlolwa kwezithombe ezifana nesifundo se-GI ye-barium esiphezulu noma ukuskena kwe-tomography (CT) kungabuye kulandwe.
Isifundo se-Barium
Indlela ekhethwayo yokuxilongwa kwe-hernia yokubeletha iyisifundo se-barium esiphezulu sezinyosi zesisu (GI). Ngokuvamile okubizwa ngokuthi i- barium ukugwinya , ukuhlolwa kudinga ukuba uphuze izinkomishi ezingamatshumi amabili nengxenye yetshezi egcwele i-barium sulfate futhi, cishe imizuzu engaba ngu-30 kamuva, ilandelwa uchungechunge lwe-X ray. I-metallic ingubo yembatho isisu nesisu, kusiza ukubahlukanisa emiphumeleni yemifanekiso.
Uma uthola lo mvivinyo, lindela ukuba ukhonjiswe etafuleni njengoba uthola ama-X-ray. Phakathi nenkathi yocwaningo, itafula likhonjiswa njengoba uphuza ibhonum eyengeziwe.
Ngenkathi le nqubo ibhekwa njengephephile, ingabangela ukuqothulwa futhi, ezimweni ezingavamile, ukuthinteka kwamafecal .
Uma ungenakukwazi ukuhamba ngezinyanga ezimbili kuya kwezintathu emva kwenqubo, shayela udokotela wakho.
I-CT Scan
Ucwaningo lwe-barium luvame ukwanele ukwenza ukuxilongwa okucacile. Uma singakwazi ukwenza kanjalo, ukuskena kwe- computed tomography (CT) kungalawulwa. Lokhu kungadingeka kubantu abakhuluphele noma abaye bahlinzwa ngokuhlinzwa kwangasese.
I-CT scan ingasiza kakhulu esimweni esiphuthumayo, njenge- volvulus ye-gastric (isimo esibi lapho isisu sithinta ama-degrees angaphezu kuka-180) noma ukucwenga (lapho ukucindezela noma ukuphikisana kwe-herniation kusika ngokuphelele igazi).
Izinqubo Nezivivinyo
Udokotela wakho angase afune ukuhlolisisa ukuze enze ukuxilongwa, noma ufise imiphumela eyengeziwe ukuze usize ukuqinisekisa eyodwa noma ukunquma ubunzima besimo sakho. Kulezo zimo, lezi zikhetho zingacatshangwa:
I-Endoscopy ephezulu ye-GI
I-hernia yokuzalwa ingatholakala futhi ngenqubo eyaziwa nge- GI endoscopy engenhla . Lena indlela yokubuka eqondile lapho indawo eguquguqukayo, ebizwa ngokuthi i-endoscope, ifakwa emphinjeni wakho ukuze uthole izithombe eziphilayo ze-esophagus, isisu, ne-duodenum (ingxenye yokuqala yamathumbu amancane).
Le nqubo izodinga ukuba uyeke ukudla noma uphuze amahora amane kuya kwangu-8 ngaphambi kokuhlola. Ngaphambi kwenkambiso, unikezwa ukukhushulwa okudambisa ukusiza ukuphumula. I-numbing spray emqaleni wakho ingasetshenziswa futhi. Inqubo ngokuvamile ithatha imizuzu engama-10 kuya kwangu-20, nehora elingeziwe elidingekayo ukuze lilulame kusukela ku-sedation.
I-Endoscopy ngezinye izikhathi ingabangela ukubhoboza, igesi, ukuchoboza, nokuphuza komphimbo. Shayela udokotela wakho uma uhlakulela umkhuhlane, ukubola, ubuhlungu besisu, noma ukuphuma ekhanda.
I-Manometry Esophageal
I-manometry yokulinganisa ubuchwepheshe obusha obuhlola ukuthi imisipha ye-esophagus and esophageal sphincter (i-valve) isebenza. Kungasiza udokotela wakho abone ukuthi izidakamizwa zihamba kanjani, njenge- dysphagia (ubunzima bokugwinya), nokuthi i-hernia yakho ingaba negalelo kubo.
Le nqubo yenziwa ngokukhipha i-anesthetizing yokuqala nge-nostril ngamafutha angenayo. I-tube encane, enezinzwa, isondliwa ngesikhukhula sakho futhi iphinde ibe yindawo yakho. Ukuqapha kwedijithali kuvumela uchwepheshe ukuba abuke futhi abhale izinguquko ekucindezelekeni komzimba njengoba ugwinya.
Umphumela we-manometry ungasiza udokotela wakho anqume inkambo efanele yokwelashwa.
Umphimbo obuhlungu kanye nokucasuka kwekhasi yimiphumela emibi kakhulu.
Ukuqapha kwe-pH Esophageal
Ukuqapha kwe-pH esophageal kuyinto yokuhlolwa okusetshenziselwa ukurekhoda izinguquko ku-asidi yesifo sakho esikhathini esithile (njengoba kulinganiswa ne- pH ). Iphinde ifaka ukufakwa kwenzwa efana nethubhu ekhanda elixhunywe kumqapha owagqoka ebhande lakho. Phakathi namahora angu-24 alandelayo, umqapha ubhalisa njalo lapho uzwa i-acid reflux futhi urekhoda izinguquko ezihlukahlukene emazingeni e-pH.
Ukuhlukaniswa
Uma isifo sakhe sokubeletha sitholwa ukuthi sihlukaniswa ngohlobo, okungasiza ukuphathwa ngokuqondile kanye / noma ukusetshenziswa ukuhlola noma yikuphi ushintsho esimweni sakho. Lezi zinhlobo zihlukaniswa usayizi nezici ze-hernia:
- Uhlobo lwe-1 luyaziwa njenge-hernia ehambayo; isisu sisekuhlelweni lwayo olujwayelekile kanti isabelo se-herniated sisangena futhi siphuma kwi-hiatus (umgodi osesithombeni lapho i-oophagus idlula khona).
- Uhlobo lwesibili luyisimiso se-paresophageal, esingasigxilile ngaphakathi nangaphandle kwe-hiatus kodwa sihlala silinganiselwe eceleni kwesigcawu.
- Uhlobo lwe-3 lwenzeka lapho ukuhlangana kwe-gastroesophageal (ukuhlangana phakathi kwesisu nesisu) kuqala ukugqama ngokusebenzisa i-hiatus.
- Uhlobo lwe-4 lwenzeka uma i-herniation ivumela isisu nezinye izitho, ezifana ne-colon noma isibindi, ukungena ngaphakathi kwesifuba esifubeni.
Ukuhlonza okuhlukile
Izimpawu ze-reflux ze-acidx azivamile kubantu abane-hernia yokuzalwa. Ama-hernias amakhulu angabangela ezinye izimpawu ezinzulu ezifana nobuhlungu obukhulu besifuba, ukuhlanza, ukubuyisela, nokufisa i-pneumonia (okubangelwa ukukhwehlela ukudla emaphashini).
Ngisho noma i-hernia yokubeletha iqinisekiswa, kungase kudingeke ukuthi kutholakale ukuhlukunyezwa okuhlukile uma kuqhathaniswa nezinye izimbangela, ikakhulukazi uma i-hernia encane futhi ingavumelani nokuqina kwempawu. Ezinye zezinye izimbangela ezibandakanya zihlanganisa:
- U-Angina , ongahlukaniswa phakathi nokuhlolwa kokucindezeleka komzimba
- I-pneumonia , izimbangela zazo ezingahlukaniswa yi-X-ray nesifo segazi esifubeni
- Isifo se-reflux se-gastroesophageal (GERD) , esingakwazi ukuhlukaniswa isimo esingapheli sezibonakaliso, kanye nezibonakaliso zokuguguleka kwezinyosi noma izinyosi
- Ukuvinjelwa kwe-gastric outlet, okungahlukaniswa nokukhubazeka kwi-pylorus (ukuvula kusuka esiswini kuya kwe-duodenum) kunokuba i-hiatus
> Imithombo:
> Roman, S. "Ukuxilongwa nokuphathwa kwe-hiatus hernia." BMJ. 2014; 349: g6154. I-DOI: 10.1136 / bmj.g6154.
> Society of American Gastrointestinal and Endoscopic Doctors (SAGES). "Imihlahlandlela yokuphathwa kweHernia yamaHiatal." Los Angeles, California; ukukhipha ngo-Ephreli 2013.