Rupture ntawm cov hlab pas: Ua, Cov tsos mob, kev kho mob

Perforation, los yog es rupture ntawm cov hlab pas - ib tug ua txhaum ntawm lub sam xeeb ntawm cov hlab pas, uas coj qhov chaw tiv thaiv ib tug tom qab ntawm kev poob plig los yog nthawv. Nyob rau hauv xws li ib tug xeev cov kev pab yog ib - tsheb thauj neeg mob, raws li cov kis ntawd ib tug tiag tiag kev hem thawj rau lub neej ntawm tus neeg mob. Txhim kho qhov teeb meem no yuav tsuas yuav ib tug thaum muaj xwm ceev kev phais kev cuam tshuam. Nyob rau hauv huab, yog hais tias tus neeg mob yog nyob rau hauv lub tsev kho mob, thiab qhov khoob yog me me, nws yog ua tau rau conservative kev kho mob.

statistics

Qhov no hom ntawm tus kab mob yog tsis tshua muaj heev, nws yog hais txog 1% ntawm tag nrho cov neeg uas poob rau hauv lub thoracic Department. Perforation tshwm sim peb lub sij hawm ntau rau cov txiv neej cov neeg mob. Tus kab mob yog xav paub ntau ntau nyob rau hauv cov neeg muaj hnub nyoog 50 xyoo thiab laus dua. Boerhaave syndrome los yog syndrome Boerhaven yog hais txog 15% ntawm tag nrho cov neeg nrog perforation.

kev faib ntawm cov kab mob

Pathology yuav tau muab faib raws li lub hauv paus ntsiab lus ntawm tshwm sim:

• ywj siab nosological kab mob xws li Boerhaven syndrome;
• mob lwm yam kab mob, kev poob plig, los yog iatrogenic ua.

Thaum lub qhov chaw ntawm localization:

• tiav rupture ntawm cov hlab pas, i.e. laus perforation thoob plaws lub phab ntsa thickness;
• tsis tiav perforation, uas yog ib ncig mus rau ib los yog ntau tshaj week meem ntawm cov hlab pas;
• nrog los yog kaw kis, localization hauv lub perforation ntawm cov hlab pas;
• Sab nraum zoov qhib perforation nrog localization mus rau lub txheej phab ntsa ntawm cov hlab pas.

Txawm tias cov tsos mob ntawm tus kab mob manifestations zoo tib yam rau ob hom discontinuity.

Mallory-Weiss Syndrome, esophageal los yog keej

esophageal rupture yog xws pathology, raws li zoo raws li tawg lub plab los yog txoj hlab nqos mov. Nrib pleb yuav ua tau ib thiab tej zaum yuav txheej txheem ntawm thoob plaws lub mucosa ntawm cov hlab pas. Rau Mallory-Weiss syndrome yog tsis ntse connective cov ntaub so ntswg kev puas tsuaj. Raws li khoob, tej kab nrib pleb yog cov yam ntxwv ntawm cov neeg mob muaj hnub nyoog 50 xyoo, cov txiv neej nrog txiv neej pw, thiab haus dej haus cawv kev tsim txom.

yog vim li cas

esophageal rupture feem ntau tshwm sim nyob rau hauv lub keeb kwm yav dhau:

• nquag endoscopic xeem ;
• tshuaj kub nyhiab;
• txawv teb chaws lub cev, nyob rau hauv particular mob;
• kev poob plig thiab tob tob raug mob;
• los ntawm careless coj ib tug ntau yam ntawm kev ua hauj lwm, thiab raws li ib tug rau txim ntawm lub esophageal raug mob.

Nyob rau hauv tsawg tus neeg mob, lub kua muag yuav feem ntau ntuav los yog muaj ib tug muaj zog thiab kav ntev hnoos. Labor, los yog es muaj zog me nyuam yuav ua rau tus kab mob. Tiv thaiv lub keeb kwm ntawm ib tug epileptic qaug dab peg kuj tshwm sim kis.

uas yuav muaj pab pawg neeg

Qhov no pab pawg neeg no muaj xws li cov neeg uas muaj raws li nram no pathologies:

• esophagitis;
• esophageal rwj nrog copious ntuav.

Cov neeg uas muaj binge noj syndrome yuav kis tau mob. Los ntawm tus kab mob no yuav ua rau mob lub cev kev nyuaj siab los yog overexertion thaum lub sij hawm defecation. Thaum yuav raug kuj yog cov txiv neej ib nrab ntawm cov tib neeg los ntawm cov 50 lub xyoo.

Cov tsos mob ntawm tus kab mob manifestations

Nyob rau hauv feem ntau tus neeg mob, tus soj ntsuam daim duab yog yus muaj los ntawm ib tug cia li pib ntawm cov tsos mob, thiab yog manifested nyob rau hauv daim ntawv ntawm:

• ntse mob nyob rau hauv lub epigastric cheeb tsam thiab retrosternal;
• xws li loog loog;
• mob hauv siab;
• tawv nqaij dawb ntawm daim tawv nqaij tag nrho cov thoob lub cev;
• hnoos qhuav uas muaj tshwm sim nyob rau hauv "vaj huam sib luag qhov chaw";
• nce salivation;
• tachycardia, txog siav;
• anacatharsis nrog splashes ntawm cov ntshav, thaum lub sij hawm, lub ntuav tej zaum yuav zoo li kas fes thaj av;
• ua tsis taus pa thiab hnyav;
• profuse tawm hws;
• shock rau ib tug tom qab ntawm qhov mob;
• uas qhia tej yam tshwm sim ntawm intoxication;
• ob txhais ceg thiab lub ntsej muag tej zaum yuav tig xiav, thiab npaj cyanosis;
• kis nyob rau hauv lub qab plab yuav yus mediastinitis;
• yog hais tias tus kis ib ncig ntawm lub plab, tej zaum yuav ua rau peritonitis;
• mob hawb pob, sau nrog huab cua, nyob rau hauv lub ntsej muag thiab lub caj dab.

Lub xub ntiag ntawm esophageal rupture cov tsos mob yuav tsum tau tam sim ntawd kev kho mob. Sadly, tab sis nyob rau hauv 50% ntawm cov neeg, perforation ntawm tus neeg mob tuag vim qeeb nyob rau hauv nrhiav kev kho mob.

Qhov teeb meem tseem lus dag nyob rau hauv lub dav hlau uas cov kis cov tsos mob raug rau ib tug xov tooj ntawm lwm yam kab mob thiab yuav ua rau pleuritis los yog infarction. Raws li ib tug tshwm sim, tsis muaj ib tug txaus mob thiab kev kho mob ib tug neeg yuav cia li tuag.

diagnostic ntsuas

Yog hais tias koj xav tias ib tug rupture ntawm cov hlab pas diagnostic kev ua ub no nqa tawm nyob rau thaum muaj xwm ceev hauv paus. Yuav pib, ua lub cev kev xeem, nws puv tawm keeb kwm. Cov ntshav no ces noj rau qhov biochemical thiab tsom xam. Nqa tawm X-ray kev soj ntsuam thiab ultrasound. Nyob rau hauv lub qhov chaw ntawm kev mob, ua siab X-ray. Mob kuj yuav mediastinoscopy thiab pharyngoscope.

X-ray txoj kev tshawb no aimed ntawm kev txheeb xyuas cov kua tshuaj ntsiav thiab cua nyob rau hauv lub pleural thiab mob plab kab noj hniav. Yuav kom txiav txim seb qhov chaw mob nkees yav tas los nkag tau rau hauv cov hlab pas soluble zoo uas migrating, los mus txiav txim qhov chaw nyob thiab qhov ntev ntawm esophageal kev puas tsuaj.

Endoscopy yog tau siv ib tug nruj heev endoscope, tsis txhob inflate cov huab cua txoj hlab nqos mov.

kev kho mob kev kho mob

esophageal rupture kev kho mob yuav phais.

Heev tsis tshua, tab sis tseem siv conservative kev kho mob. Tej yam zoo li yog sai tau yog tias puas mucosa los ntawm tsis muaj ntau tshaj li 1.5 cm Nws yuav ua tau kev puas tsuaj rau cov hlab pas los yog ntses pob txha me koob, lub ntsiab mob -. Mediastinal tsis muaj kev puas tsuaj. Nyob rau hauv tas li ntawd, tus neeg mob yuav tsum tsis txhob yuav nrog cov tsos mob, uas yog ib tug hais rau phais kev cuam tshuam. Nyob rau hauv cov ntaub ntawv no, lub active tshuaj tua kab mob. Khoom noj khoom haus thiab haus dej haus thaum lub sij hawm kev kho mob tsis koom nrog cov kev taw qhia ntawm cov zaub mov los ntawm lub qhov ncauj. Tshuaj tua kab mob muaj los siv rau cov neeg mob ob peb zaug ib hnub twg thiab muab tso rau ua kom tiav txaj so. Yog hais tias cov kev tshwm sim tsis muab ib tug zoo ntxim, nws yog tsim nyog los ua kev cai rau hauv lub lag luam.

Txawm li cas los, feem ntau cov feem ntau "kov yeej" tus kab mob no thiab tiv thaiv kom txhob tuag tsuas yog tau nrog cov koom tes los ntawm cov kws phais neeg. Lub ntsiab hauj lwm ua ub no yog aimed ntawm:

• thaum ntxov kaw ntawm cov kis;
• kua paug, yog tias muaj, los mus tiv thaiv cov kev loj hlob ntawm peritonitis;
• ib ntus cais tawm ntawm cov hlab pas ntawm lub zuag qhia tag nrho digestive system.

Tom qab lub lag luam, yam tsawg kawg 2 hnub tsis noj los ntawm lub qhov ncauj. Fais fab yog muaj los ntawm ib tug gastrostomy. Cov kws kho mob muab tshwj xeeb as tshuaj.

Yog hais tias tus neeg mob tus mob tso cai rau nws, nyob rau hnub 3 pib cov kev taw qhia ntawm cov zaub mov nyob rau hauv lub niaj zaus txoj kev, tab sis muab tso rau ib tug noj haus saum rooj. Yuav kom siv tau cov nram qab no khoom uas tso cai:

• zaub thiab txiv hmab txiv ntoo nyob rau hauv ci daim ntawv;
• cereals;
• kua zaub;
• jelly thiab txiv hmab txiv ntoo dej qab zib;
• nqaij thiab cov ntses, tab sis muaj roj tsawg hom, nco ntsoov ci los yog steamed;
• pudding ntawm cheese thiab nqaij.

Nws yuav ua tau tsis yooj yim sua rau siv hmoov khoom, xws li mov ci. Nws yog txwv tsis pub rau noj kib thiab zaub mov, preservation, acidic cov khoom noj uas yuav thab plaub hauv txheej membrane. Cov khoom uas muaj dyes.

Tag nrho cov khoom uas yuav siv tau tom qab phais, yuav tsum tau muaj lub sib xws ntawm puree los yog yuav peretortom daim ntawv no, ua ntej yuav noj lawv yuav tsum tau coj mus rau ib tug sov so lub xeev, thiab noj me me.

tau teeb meem

Lub txim ntawm kev sib tawg ntawm cov hlab pas yuav ua tau ntsoog loj heev. Advanced ntaub ntawv ntawm tus kab mob yuav ua rau txoj kev loj hlob ntawm kua paug thiab o, uas ua nyob rau hauv kev puas tsuaj rau cov ntaub so ntswg. Early kev kho mob - yuav raug avoidance Guarantee ntawm cov teeb meem los thiab qhov pib ntawm txoj kev tuag.

Twv ua ntej thiab tiv thaiv

Raws li muaj cov esophageal rupture, Mallory-Weiss syndrome, cov raug rau rov qab yog kev lom zem ntau nyob rau ntawm lub sij hawm caij nyoog nruab nrab ntawm qhov pib ntawm cov kev kho mob lub sij hawm thiab esophageal kev puas tsuaj. Ua si ib qho tseem ceeb luag hauj lwm, thiab qhov teeb meem uas nrog tus pathology, qhov chaw ntawm localization thiab luaj li cas ntawm cov kis, cov kev mob ntawm tus neeg mob, mob kab mob.

Kev tiv thaiv nyob rau hauv cov ntaub ntawv no, ua si ib theem luag hauj lwm. Txawm li cas los, cov cais tawm ntawm tej yam yam yuav tiv thaiv tau txoj kev loj hlob ntawm tus kab mob. Kom tsis txhob iatrogenic raug mob, tsis txhob cia koj lub cev rau lub xeev ntawm bulimia, raws sij hawm kev kho mob soj ntsuam.

Nws yog tsim nyog los soj ntsuam qee yam kev cai nyob rau hauv thiaj li yuav txo tau txoj kev pheej hmoo ntawm perforation. Qhia cov me nyuam mus yeej ib txwm noj zaub mov maj mam, zom nws kom huv si. perforation feem ntau tshwm sim tiv thaiv lub keeb kwm ntawm nqos loj daim zaub mov. Tsis txhob hnov qab qhov hais tias "thaum kuv noj, kuv lag ntseg thiab ruam." Nws yog tsim nyog los tsis kam los ntawm muaj zog lub cev puas rau siab, los ntawm hnyav lifting. Noj mov yuav tsum kuas thiab muaj tseeb, tsis txhob ua phem rau haus dej haus cawv.