Ledd Syndrome: Izimpawu, Ukwelashwa

Isimo ubuhlungu kuhlotshaniswa isikhundla okungavamile we duodenum, nezimpumputhe, midgut, ngokuthi syndrome Ledd. Ngokwalokho nenqubo ukucacisa khona emzimbeni yalesi sifo, futhi yiziphi izindlela guided ukwelashwa kwakhe - nalo mbuzo sizohlola kulesi sihloko.

Ledd syndrome

I anomaly ujikeleza emathunjini, kwakhiwa okuyinto phakathi kwengane esiswini (ngokuvamile 10-12 amasonto) futhi kuyinto kokucindezelwa we duodenum kuya volvulus cecum we midgut, unegama ezithile - Ledd syndrome.

ICD-10 - esigabeni ezivamile esephepheni izifo wezokwelapha akhiwa UBANI. Ngaphakathi accordance nga lo International Ukwahlukanisa Izifo wokubuyekeza 10th Ledd syndrome libhekisela izifo, izitho zokugaya (isigaba XI). isimo sokugembula ingekho kaningi ngaphezu kwelinye icala by izinsana 500 nabafana kokutshelwa ngokukhubazeka kwengane kuyizikhathi ezimbili kaningi ngaphezu amantombazane.

Ngokuvamile, uphethwe Kumiswa ngesonto lokuqala isiguli kancane, kancane kancane - ngenyanga yokuqala yokuphila. Ukuze afeze ithole ukuxilongwa okufanele kusuka isazi sezifo zezingane kudinga okuhlangenwe nakho futhi ujwayele olunzulu nge isifo. Kule ndaba, lesi sifo ngaso sonke isikhathi Kutholwe ngendlela esifike ngesikhathi. Isibonakaliso osobala kakhulu isifo ezinsukwini zokuqala zokuphila ukuhlanza Bile.

Ngeshwa, kobukhulu nesineke isimo esinjalo isifo kungenzeka kwayibhebhethekisa azalwa naso ohambisana, njenge:

• izinso hypoplastic noma amaphaphu;
• isifo senhliziyo,
• stenosis yamaphaphu nabanye.

Ledd sifo ngo abadala kuyinto evamile. isimiso emathunjini kungenzeka kube umphumela zomphakathi the cecum, futhi ukuvuvukala kule komgodi ongaphakathi kwamathumbu. Ngezinye izikhathi kumiswa hernia zokugula sokucasuka anterior udonga besisu. Not Okungenani phakathi izici ezithinta kumiswa isimo isifo, ukudlala izimila benign nesibulalayo eminyangweni kahulumeni ehlukahlukene i emathunjini.

Izimpawu zesifo

Ledd sifo ngo izinsana engaveza izimpawu engazinzile. Ngaphezu ukuhlanza futhi regurgitation of Bile ezinsaneni ngezikhathi ezithile kubangela ubuhlungu esiswini. Kwezinye izimo, umuntu uyahluleka uma elwa zenzeka, okuholela acute isimiso emathunjini ne ukuwohloka, kuze isimo collaptoid wengane.

izimpawu Jikelele yalesi sifo:

• ubuhlungu paroxysmal;
• sezinyawo ilibele, ukubuyisa;
• ukuhlanza;
• ukuvuvukala esifundeni epigastric ;
• isihoxiso esiswini aphansi;
• palpation alinikezi ulwazi oluphelele mayelana isimo lesiguli.

Radiography esiswini ubonisa ketshezi ezingeni ezimbili esiswini duodenum, futhi inani elincane igesi emathunjini. Uma phakathi naleyo nqubo esetshenziswa barium yombala sulfate, umphumela ebonisa ekuqongeleleni Ngokuphambene naphakathi esiswini welulela futhi duodenum. Qhathanisa lo mnikelo nalowo izihitshela ngokulinganayo basakaza emathunjini amancane.

Ergography ngokuvamile kwembula nenkanuko edlulele we cecum yi isibindi. Kodwa ukusebenzisa ngekhompyutha tomography kombhala kuyinto midgut kuchazwe emhlabeni Umthambo mesenteric.

emitholampilo isithombe

Ledd syndrome - a zokugula ukuthi edinga ngokushesha kuhlinzwa. Njengoba kushiwo ngaphambili, izimpawu engazinzile futhi kungaba liphindwe ngezikhawu izinsuku eziningana, amasonto noma ngisho iminyaka.

Kwezinye izimo, isimo sifo hhayi okwenza ngokwayo wazizwa iminyaka eminingi futhi asymptomatic. Ngakho izingane ahlupheke ukungakuthandi ukudla, kuthiwa emuva ekuthuthukisweni ngokomzimba.

Ngaphezu sifo classical Ledd, eminye ihlukanise izinhlobo ezimbili:

1. Esimweni sokuqala akukho kombhala we midgut, futhi indawo ezingasadingeki we cecum, okuyinto licindezele duodenum.
2. Esimeni sesibili siye kuphela isehlane midgut volvulus.

Phakathi zokugula (Ledd syndrome) kungenzeka oyingozi futhi subacute (zezifo ezingelapheki). Ngendlela ezingamahlalakhona lapho kungukuthi liphinyiselwe ubuhlungu esiswini, efana colic, ngezinye izikhathi kukhona ukuhlanza, ukungondleki. A ukwephulwa ngezinsimbi zesihlalo. isimo somntwana uchazwa ngokuthi egculisayo. Colon volvulus aliholeli kuwukwephula igazi layo supply. Ngo ngemithambo encane amathumbu igazi stasis kuphela kwenzeka pheshana emathunjini kunezinguquko esisheshayo.

Acute wamathumbu volvulus - usesimweni esibucayi ukuthi uma ukugeleza okungekuhle okuholela necrosis noma esibhibhayo emathunjini.

Ukwelashwa yalesi sifo Ledd

Thuthukisa nesineke jikelele okungamahlala-relapsing Yiqiniso isifo kwenza ukusetshenziswa ejenti antispasmodic. Nokho, lokhu kuphela sinqumo sesikhashana. Inqubo eyinhloko ekwelapheni isimiso emathunjini namanje ukuhlinzwa. ukuphathwa Steel ka pathologies (Ledd syndrome) siqukethe izinyathelo eziningana:

1. Ekuqaleni iqedwe volvulus futhi isimiso.
2. Ngaphezu kwalokho, emathunjini amancane has a isisu eminyangweni efanele, awugqinsi - kwesobunxele.
3. Uma udinga ukulungisa izihibe wamathumbu ngaphakathi peritoneum parietal, enze lokhu zokukhwabanisa. isilinganiso esinjalo siyadingeka uma isiguli normal wamathumbu motility.
4. Okwenziwe i appendectomy.

Eminyakeni yamuva, imithi kabanzi izindlela laparoscopic ukuxilongwa kanye nokwelashwa yalesi sifo. mini-koda okunjalo amasu aphumelela kakhulu. Nokho, ukungenela kuhlinzwa ngendlela efanayo ngendlela kuncike nobunzima ezithile ngenxa ivolumu elincane ngalo ingaphakathi lesisu, kanye ukushuba elincane odongeni kwamathumbu ezinganeni ezinyangeni zokuqala zokuphila. Ngezinye izikhathi ekuseni isikhathi nasezinkingeni ezilandela ngemva kokuhlinzwa, kuphakama izinkinga ezingase zivele:

• sepsis;
• peritonitis;
• ukopha emathunjini;
• ileus.

Amathuba okuphathwa yiyo ukululama ngokugcwele kuzoncika umphumela wokusebenza. Uma agciniwe zonke izindawo pheshana emathunjini, isibikezelo ezingeni lelisetulu izinga lempilo sisihle. Nokho, uma sekube abalulekile resection emathunjini, okuholela lesi sifo of "esiswini iDemo" isiguli izinkinga ngokudla kanye nokungondleki. Lapho le miphumela ukwelashwa kuhlinzwa wenziwa esibhedlela amaningi ngezinhloso zokuthatha umsoco parenteral. Ngezinye izikhathi iziguli ziyeza imisebenzi okuphindaphindiwe. Uma ileus athuthukile sinombono-cystic fibrosis, ukuze siphinde sithole i Izibikezelo okungekuhle.

ukulungiselela preoperative

Uma kutholakala ukuthi uphethwe yini njengoba ezisanda kubelethwa isimiso emathunjini (Ledd syndrome), it is udluliselwe esibhedlela kuhlinzwa, iqondiswa tube nasogastric futhi unikeze okuqukethwe abakhwabanisi isisu njalo. Isikhathi esidingekayo ukuze enze izinyathelo preoperative wokulungiselela incike kobukhulu azalwa naso isimiso emathunjini.

Uma isiguli esolwa encane wamathumbu volvulus, ukwenza izinyathelo ezilandelayo zokuxilonga:

• ukuhlolwa igazi leqembu bese RH isici;
• ukuhlolwa igazi sekusebentisa elithwala umoya-mpilo futhi hematocrit;
• ukuhlaziywa igazi coagulation.

ukwelashwa Steel wenziwa njalo eziphuthumayo, ukulungiselela preoperative kuthatha esiphezulu ihora elilodwa. Ingane eyenziwa yokwelapha ukumnika, hemostatics iqondiswa, analgesics, ngezinye izikhathi umoya omncane. I ipayipi yethulwa emthanjeni emaphakathi.

Endabeni ileus ongaphakeme ukulungiselela preoperative kungathatha amahora angu-24. Ngalesi sikhathi ingane ezelwe okwengeziwe wahlola sinombono ukuhlonza okungenzeka comorbidities. usebenze Ngakho amanzi esiswini, zihlanganisa inani uquqaba labelwe ebekiwe yokwelapha ukumnika, imithi elwa namagciwane kanye ejenti hemostatic. Usana yokudla umthetho.

Izingane eziningi esikhathini postoperative ukuchitha isikhathi eside ukupholisa mechanical, okungase kuhlale kuze kube ngemva kwezinsuku ezinhlanu. Ukwelapha umuntu ngemithi elwa namagciwane isebenzisa izidakamizwa esebenzayo ngokumelene amagciwane anaerobic. Microecological isimo qapha okungenani kabili ngesonto. Amabili nane amahora emva kokuhlinzwa ngemithi ukuthuthukisa motility emathunjini, kanye biologics.