I-Nutcracker isophagus iyindlela yokuphazamiseka kwe-esophageal. Kusemkhakheni ofanayo wezinkinga ze-motility ze-esophageal njengoba i- jackhammer esophagus kanye nokusabalalisa ukuphazamiseka kokuphazamiseka kwamandla. E-US abantu abangaba ngu-1 ku-100,000 batholakala ukuthi bane-disorder ye-motility disorder ngonyaka, kodwa-ke, lesi sigameko sangempela sicatshangwa ukuthi siphakeme kakhulu ngoba ngokuvamile singabhekwa njenge-reflux ye-acid.
Ukuphazamiseka kwe-Esophageal kungase kuvame kakhulu kubantu baseCaucasus futhi kwenzeke kaningi kakhulu kwabesifazane kunamadoda. Okhulile uba amathuba okuthola ama-spasms esophageal.
Izici zokuhlukaniswa kwe-nutcracker isophagus zihlanganisa ukucindezelwa okuphezulu kanye nokuphazamiseka okwenziwe endaweni ehlelekile. Ukuphazamiseka kwemisipha ye-esophageal kungabangela ukuba ukudla kungene noma kufakwe endaweni. Njengoba kunesifo se-nutcracker, noma kunjalo, ngenxa yokuthi izikhala ze-spasms zenzeka ngendlela ehlelekile futhi ehleliwe cishe kungenzeka zizwe ubuhlungu besifuba kunenkinga yokugwinya.
Akuyazi kahle ukuthi yini ebangela ukuthi i-nutcracker isophagus. Ezinye izinkolelo ukuthi isimo sisondelene kakhulu ne- reflux disorder (GERD) ye-gastroesophageal (GERD) futhi singabangelwa yiyo. Enye inkolelo yukuthi ibangelwa isifo sezinzwa, kanti abanye abantu bakholelwa ukuthi kubangelwa impendulo engavamile ku-substance acetylcholine.
Izimpawu ze-Nutcracker Esophagus
I-Nutcracker isophagus ingabangela inhlanganisela yezinye noma zonke izimpawu ezilandelayo:
- kunzima ukugwinya (i-dysphagia) eyenzeka kokubili ukudla okuqinile nokuketshezi futhi kungenzeka ngezinye izikhathi kuphela
- ubuhlungu besifuba
- ukuvuselelwa kokudla
- reflux
Kungenzeka futhi ukuba i-nutcracker isingeniso (hhayi ukubangela izimpawu ezibonakalayo).
Olunye ucwaningo lubonisa ukuthi abantu abane-nutcracker esophagus bangase babe ne-esophagus e-hypersensitive and stiff.
Izimpawu zenye ukukhathazeka kwe-motility (i-jackhammer esophagus kanye ne-spasm e-esophageal ebonakalayo) ifana ne-nutcracker esophagus ukuhlolwa okhethekile okumelwe kwenziwe ukuze kwahlukaniswe phakathi kwalezi zifo.
Ukuxilongwa kwe-Nutcracker Esophagus
Izivivinyo ezilandelayo zingasiza udokotela wakho ukuba ahlolisise i-nutcracker esophagus:
- I- barium swallow is a test ehilela ukugwinya into ebizwa nge-barium sulfate. I-Barium sulfate ibonisa ama-x-ray ukuze kwenzeke ukuthi indlela ye-barium sulfate isetshenziswe kanjani. Ngaphandle kokuphazamiseka kwe-esophageal, lokhu kuhlolwa kungasiza ekuxilongeni izinkinga ezinzima njengokugwinya noma ukunciphisa isifo. Akufanele ube nalesi sivivinyo uma uthola umuthi we-barium sulfate kodwa ngokuvamile ukhuluma, ukuhlolwa kunomlando omuhle wokuphepha. Noma kunjalo, i-barium sulfate yaziwa ngokubangela ukuqothulwa ukuze udinga ukuphuza amanzi amaningi noma ukusebenzisa i-softener counter softol emva kokuhlolwa.
- I- scan ye-CT ingabonisa ukuqina kwodonga lwe-esophageal (olukhulu kunama-3mm) kubantu abane-nutcracker esophagus. Noma kunjalo, lokhu kungase kwenzeke nakwezinye izimo kuhlanganise nomdlavuza wesifo. Uma i-CT yakho yeskrini ibonisa ukuqina kwodonga oluxakile udokotela wakho uzodinga ukuthi aqhubeke nokuhlolwa ukuqinisekisa ukuthi uhlolwe.
- I-high-frequency ultrasound ingaba usizo ekuhlukaniseni phakathi kwe-nutcracker esophagus, i-jackhammer esophagus, kanye nokusabalalisa kwe-spasm esophageal.
- I-Manometry Esophageal iyilinga elihle kakhulu lokuthola ukuphazamiseka kokuphazamiseka kwesisu kanye nezimbangela zobuhlungu obungenayo isifo senhliziyo. Ukuhlolwa kuhilela ukufaka ithubhu elincane emakhaleni akho, phansi phansi komphimbo wakho kanye nesisu sakho. I-tube iyinkinga ecindezelekile futhi ingakwazi ukulinganisa amandla nokucindezelwa kwemisipha yezinyosi lapho uginya. Lokhu kuhlolwa kungabangela ukungahambi kahle okunciphisa nge-spray eyenza ngaphakathi ekhaleni futhi ngezinye izikhathi phezulu komphimbo.
- I-Esophagogastroduodenoscopy (EGD) yinkqubo engakwazi ukuhlola ngokuqondile i-nutcracker esophagus kodwa ingasiza ekudaleni ezinye izifo ezifanayo ezifana ne-hernia hiater noma i-GERD.
Ukwelashwa kwe-Nutcracker Esophagus
Wena nodokotela wakho bangakhetha ukusebenzisa ezinye zezokwelapha ezilandelayo ukusiza ukuphatha izimpawu ze-nutcracker esophagus.
Imithi eminingana isetshenziselwa ukwelapha lesi simo futhi ihlanganisa abavimba be-calcium channel, nitrate, ne-phosphodiesterase inhibitors. Ukujova kwe-toxin ye-botulinum ngaphezu kwe-sphincter engaphansi kwe-esophageal kunganciphisa okwesikhashana izimpawu ngokuvimbela ukukhululwa kwe-acetylcholine. I-proton pump inhibitors ingasiza ekunciphiseni izimpawu ezihlobene ne-acid reflux. Omunye wemithi ephumelelayo kakhulu yokukhathazeka kwe-motility okungaxhunyiwe kuhlanganise ne-nutcracker isophagus yi-tricyclic antidepressants.
I-balloon dilation of the esophagus yinkambiso elula ububanzi bendawo futhi inganciphisa izimpawu ze-nutcracker esophagus. Le nqubo ivame ukuqhutshwa ngesifo sangasese futhi ngaphansi kwesilwane. Uzothola imfundo ekhethekile mayelana nokungadli nokuphuza isikhathi esithile ngaphambi kwenqubo yakho. Izingozi ze-balloon dilation zibandakanya imiphumela emibi noma ukusabela okwenziwe izifo emilenzeni yezinhlobo ze-anesthesia esetshenzisiwe noma engavamile ukuphazamiseka kwesifo.
Ezimweni ezimbi kakhulu ezingazange zamukele kahle kwezinye ukwelashwa, inqubo yokuhlinzwa ebizwa ngokuthi i-myotomy ingase iqinisekiswe. Le nqubo ibizwa nangokuthi i-Heller myotomy noma i-myotomy esophageal futhi ijwayele ukusetshenziselwa ukwelapha i-achalasia kepha ingasetshenziselwa ukwelapha i-nutcracker esophagus kanye. It isetshenziswa njengendlela yokugcina yokugcina ngoba kwezinye izimo kuye kwangempela kubangele ukuhlukunyezwa imisipha ehambisana nutcracker isici ukuba kube kubi nakakhulu.
Inqubo ingenziwa i-laparoscopically noma njengendlela evulekile kodwa indlela ye-laparoscopic ihlotshaniswa nengozi encane kanye nesikhathi esifushane sokutakula. Ukuchotshozwa okuncane kwenziwa ngenhla nje kwenkinobho yesisu bese izingxenyeni zangaphandle ze-muscle ziqunyiwe ukusiza ekuvimbeleni ukuba bangene ngemvume. Ukwengeza, ukwehlisa imisipha ekuhlanganyeleni kwe-gastroesophageal kubangela ukuthi i-sphincter phakathi kwesisu nesisu sokuhlala ivulekile.
Izingozi ezihilelekile ku-myotomy esophageal zihlanganisa ukulimala ezithombeni ezizungezile kuhlanganise nesipere, isibindi, noma isisu kanye nokutheleleka kokuthutha. Njenganoma iyiphi inqubo yokuhlinza, kukhona futhi ingozi yokuphendula okweqile noma imiphumela emibi ye-anesthesia. Njengoba kukhulunywe ngaye ngaphambili uma isetshenziselwa ukwelapha isifo se-nutcracker kunengozi yokuthi izimpawu ziyobe zibi kakhulu. Ngisho noma izimpawu ziphazamiseka ngemva kwenkathi yeminyaka kungenzeka ukuthi imiphumela emihle yale nqubo izosondeza.
Ngaphandle kokucwaninga kwezokwelapha okukhulunywe ngenhla kuphakamisa ukuthi i-nutcracker esophagus ibonakala ihamba ngcono yodwa eminyakeni embalwa.
> Imithombo:
> I-Barium Swallow. emedicinehealth. Kubuyekezwe ngoJuni 25, 2015. https://www.emedicinehealth.com/barium_swallow/article_em.htm#what_is_a_barium_swallow
> I-manometry yokulinganisa. I-Medline Plus. https://medlineplus.gov/ency/article/003884.htm
> Spasm Esophageal. I-Medscape. https://emedicine.medscape.com/article/174975- ukubukwa kokubukwa
> Heller Myotomy for Achalasia. I-Washington University School of Medicine eSt. Louis Cardiothoracic Surgery. http://cardiothoracicsurgery.wustl.edu/en/Thoracic/Benign-Esophageal-Disease/Heller-Myotomy-for-Achalasia