Uphawu ukukhwehlela ukushaqeka. Indlela ukuzimisela ukuvuvukala kule besisu

I hernia ventral kuzibonakalisa protrusion lonke isitho yangaphakathi noma ingxenye yayo ngesango ku esifundeni ongama odongeni phambi isiqu noma ephaketheni kwakhiwa. Ngo kwesigamu izinhlaka ngaphakathi komgodi ongaphakathi kwamathumbu elise kanyekanye ne parietal leaf peritoneal ukumboza isikhala ongama ngaphakathi. Ukubonakaliswa ejwayelekile ye hernia kuwuphawu ukukhwehlela ukushaqeka.

Ukuhlonza ubuhlobo ezivukayo wokuphuthuma nalesi sifo, wabeka isandla iminonjana protrusion nokuziphatha yayo uma ukhwehlela. Ngokuvamile, i-push esiyitholayo, okubonisa ukuthi isigijimi kumiswa ezingasadingeki we peritoneum, ukungabi bikho kokukhanya lobo bufakazi bokuthi sibalulekile hernia strangulated. Protrusion kwezitho kwenzeka ngokusebenzisa indandatho hernial. peritoneum parietal nge ingxenye amathumbu, emsipheni, imisipha ezabanjwa phakathi okukhipha limelela sac hernial.

Imisebenzi peritoneum

Ukubeka uzimele izitho ezibalulekile kusiza inqubo homeostasis, exchange uketshezi, isekela ingcindezi besisu:

• It wenza umsebenzi resorptive, okungukuthi ukuncela imikhiqizo ukuhlukaniswa amaprotheni, izicubu necrosis, exudates, amagciwane;
• ikhava serous ezindaweni ezithile izacile futhi duodenum bakwazi ukwaba fibrin futhi uketshezi;
• nomlilahlo, ukukhonza uhlobo isithiyo focus ukuvuvukala ukutheleleka, amasosha omzimba uyabavikela mechanical imvelo amaselula kanye humoral.

Ungenzenjani esiswini kanye nezinkinga zayo

Uma ngokuhamba kokungenela kuhlinzwa kuyinto ngokuhlanganyela ezikweletini, isiguli kungagcinwa ngokugcwele oda likadokotela, kukhona hernia yansukuzonke, esebenza njengesikhali esangweni for endaweni ezondile sesibazi. Hhayi ukusebenza hernia has nezinkinga ezilandelayo:

• uma iziphathimandla equkethwe ngaphakathi komgodlana hernial, kuthiwa ukuthi kuphulwe umthetho ke kancane kancane kuza immobilization zabo, ukuthi ingozi ukuvuvukala, aze asongela ngisho ebulalayo;
• Uma protrusion emathunjini ehilelekile, ke indima ukugudluka ukudla nokuqukethwe nzima;
• kuholela okuvela peritonitis futhi onqenqemeni wenza umcimbi sidewall emathunjini, okuholela necrosis wesabelo wathathwa;
• ithuthukisa inqubo ubovu (ithumba);
• Ungenzenjani umugqa omhlophe kwandisa ukuba usayizi omkhulu, lokhu kuholela icala ngemuva kokukhipha izitho eziqukethwe isikhwama, bengakwamukeli komgodi ongaphakathi kwamathumbu.

Stage peritonitis isikhathi lesi sifo

Ngo izinqubo acute ukuvuvukala kule ndawo besisu ngokushesha ushayele i-ambulense, ukubambezeleka kuyingozi empilweni yomuntu. Peritonitis kuyahlukahluka ephelele noma ezithinta endaweni ethile. Ukuvuvukala kubangelwa nezinhlobo ezihlukahlukene zama-bacterium aerobic kanye anaerobic nilale ngaphakathi komgodi ongaphakathi kwamathumbu. Indlela ukuzimisela theory L. S. Simonyana, kuncike izinguquko sokugembula kanye nesikhathi sifo, peritonitis ihlukanisa isinyathelo:

• ukuphendula isikhathi ihlala phakathi ngosuku lokuqala kanye nezimpawu esiphezulu wabonakaliswa;
• kwathatha isinyathelo anobuthi wenziwa amahora 24 kuya 72, ukubukeka ehlukene izithunywa adakwe ubuthi umzimba;
• ezijulile, ezimweni eziningi, ifomu engelapheki eba emva kwezinsuku ezintathu, isifo nge ukubonakaliswa ngokushesha ukuvuvukala wendawo.

Ukwahlukanisa izifo by the nature of the ukutheleleka

peritonitis Primary iyindlala, lokulandisa mayelana 1% izenzakalo ukuvuvukala. Ukutheleleka kwenzeka ngemva kokungenwa amagciwane peritoneum endleleni kwangaphakathi hematogenous, indlela lymphogenous noma izitho zesifazane okuzala ka amashubhu fallopian.

diaphragm hernia kubangela peritonitis yesibili emva kokuhlinzwa noma ngenxa yezinkinga peritoneal izicubu ukuhlukumezeka. Kulokhu, kukhona ukutheleleka izimbangela ezilandelayo:

• ukutheleleka kusuka ukuvuvukala;
• indlela ezambiwa;
• ingress kwamagciwane ngenxa yokulimala;
• inkinga nasezinkingeni ezilandela ngemva kokuhlinzwa.

Izinhlobonhlobo peritonitis kuye nezinye izinto

Ukwehlukaniswa phakathi esigabeni oyingozi futhi ezingalapheki lisuselwa izimpawu zokwelashwa kanye nesifo. Indlela yokunquma, ngokuvumelana exudate lembula fibrinous, serous, ubovu, fibropurulent, haemorrhagic imvelo ukuvuvukala.

division amafomu Etiological ka peritonitis zibangelwa ezihlukahlukene zezinto eziphilayo of microflora namagciwane, okubangela ukuvuvukala. The main amagciwane abangela izifo namuhla waqaphela njengoba staphylococci, streptococci, anaerobes, Proteus, enterococci, E. coli. Ngokuba impi yase-bacterium zihlanganisa pneumococci, gonococci, hemolytic streptococcus kanye nezinye izinhlobo.

Amaqembu etiological eceleni isehlane izifo nonbacterial icala aseptic, lapho hernia diaphragm nzima ngenxa Ukungena ngaphakathi komgodi peritoneal umchamo, igazi, Bile noma juice esiswini. Lena iphethini eziyingozi, futhi peritonitis emahoreni ambalwa jikisa ezithathelwanayo, njengoba izindonga permeable amagciwane ngokushesha kakhulu lapho kuqala ukushisa.

Ukwephula izinqubo umzimba

Ukuphazamiseka kwamanzi-electrolyte isilinganiso emzimbeni namaprotheni ibhalansi uthathwa njengophawu lokuthi imimese elingaphandle hernia besisu. Isiphetho amaprotheni yanda ngenxa hypermetabolism, nencithakalo yokwakha ebaluleke wenziwa emchamweni, ngifike ngibuyise exudate. Sikuveze gipoproteinomiya futhi kuncishiswe inani amaprotheni ziboniswa ngesikhathi peritonitis elikhulu ethuneni.

Kanye potassium lomzimba ezikhishwe, ke isuka isikhala intercellular, ngenxa yalokhu, iziguli hypokalemia. Ngemva ekuthuthukiseni lesi ukuvuvukala inqubo iphethini kungaba kakhulu ukushintsha, njengoba sehliselwe excretion kwezinso okusamanzi, kukhona ukubhujiswa inombolo ezanele amaseli. Ngenxa yalokho izinguquko ekuthuthukiseni hyperkalemia.

Izingxenye ezimbili kwezintathu iziguli alkalosis igazi eba, ngezinye izikhathi ezicutshini wembula shift maqondana lactic okubangelwa thuthuva kwegazi, ukuphazamiseka izinqubo umzimba futhi hypoxia, le nqubo iphazamisa ukususwa umbhunu.

I isinyathelo we esigungwini period oliguria ekuthuthukiseni hematopoietic uhlelo iqala ukusebenza lapho kuvezwa esidi imikhiqizo umzimba magnesium, i-nitrogen, potassium ne phosphorus. Kukhona shift wegazi nemingcele ku lactic zokuphefumula futhi umzimba. Ukuhlolwa kwe-peritonitis acute ezindala zishintsha ngokushesha, ngakho ukuqapha njalo Kunconywa igazi, umchamo kanye olunye uketshezi lomzimba.

symptomatology peritonitis

Kunezindlela eziningana izici olujwayelekile okuyinto siyazi ukuthi ukunquma umbhunu zivuvukale peritoneum:

• ubuhlungu eqinile babulawa kule peritoneum;
• umkhuhlane;
• isisu siyakhukhumala, kuba nzima;
• umuzwa ubuthaka umzimba wonke;
• retching nesicanucanu;
• kokunikezwa kwe-emathunjini ipheshana, ukuqunjelwa, ukubuyisa.

ukwesekwa Khwehlela syndrome

Kubonakaliswa izifo oyingozi futhi ezingalapheki ka komgodi ongaphakathi kwamathumbu. Sifo i ekhwehlela ahlinzekwa G. G. Karavanovym futhi zichazwe ngokuningiliziwe-IM Siomashem. Imitholampilo eminingi ukuhlinzwa baye bathatha lo uphawu ekutholweni owandulelayo izimpawu ukuvuvukala esiswini.

Izindlela zokusebenzisa

Iminwe kancane ibheke maqondana entendeni futhi knuckles kancane cindezela phezu indawo yokutadishela. Esikhathini esithile ngemva kwalesi senzo akazange athathe ubuhlungu yingcindezi ubohle. Ngemva kwalokho, isiguli lwahlolwa ukuze uphawu ukukhwehlela ukushaqeka. Wanikela ukudlala ukukhwehlela, uma emva inqubo, kukhona ubuhlungu endaweni ingcindezi, kubonisa ukuvuvukala kule peritoneum.

Umgomo we operation

Ukwehla elibukhali ukhwehlela spasm odongeni peritoneal kanye diaphragm okuhambisa push kwamanzi elise ngezansi isibindi eziyishumi nemitshingo. Egcwele futhi equliswa isenzo kwamathumbu, okuyinto okuhambisa ezinyakazayo phansi. Sensation zobuhlungu kwenzeka lapho ezinyakazayo noma ukuthi umzimba ogulayo sihlangana esifundeni yayicindezele esandleni sakhe. Uma ukuvuvukala kuhilela peritoneum, lokujabulela ubuhlungu livezwa shaking ungqimba kwangaphakathi, lapho ingcindezi naphakathi-besisu liphuma khona.

umbhali Isifundo A. Cheremskoy ukukhwehlela syndrome lichaza isenzo maqondana nesifo appendicitis. Uma ukhwehlela nesineke esimweni ukuvuvukala isithasiselo njalo bezwa ubuhlungu e esifundeni iliac. Lokhu umphumela ukuhluka ukukhwehlela futhi umbhunu e peritonitis.

Syndrome ekubhebhetselisa peritonitis oyingozi futhi isigaba ezingamahlalakhona lesi sifo kubangele emizweni ezihlukene uma ukhwehlela. isithasiselo Okungalapheki iyaphendula iphika, sengathi isiguli uzama alibale ubuhlungu. Isigaba acute libhekene ubuhlungu okungabekezeleleki. Uphawu ukukhwehlela ukushaqeka ngezindlela ezahlukene lembula esiteji peritonitis.

Ngaphandle peritonitis, appendicitis futhi umbhunu, lokhu uphawu kuzibonakalisa izifo oyingozi futhi ezingalapheki nezinye izitho besisu. Ubuhlungu kusukela voltage at ukukhwehlela livela uma ukuvuvukala gallbladder, izilonda esiswini kanye isimiso emathunjini. Ngakho, ukukhwehlela ukushaqeka uphawu kuyehluka kuneminye izifundo owembula inqwaba izifo e esigabeni sokuqala.

Ungenzenjani futhi ezahlukeneyo zalo

Ziboya kubantu ingazuzwa futhi azalwa nako. Indlela yesibili izinsana. Lokhu ukuhlukumeza kwenzeka ngenxa peritoneum ayakhiwanga kahle phakathi kwengane esiswini. protrusion Kutholiwe yezitho zangaphakathi avele phakathi nokuphila lesiguli, futhi zihlukaniswe izinhlobo ezintathu:

• ngesikhathi imisipha esibuthaka soMbuso udonga besisu;
• ngenxa yezemidlalo enkulu noma umsebenzi umthwalo;
• posttraumatic ezivukayo ngenxa yokwephulwa ubuqotho peritoneum, uma kukhona ukusebenza kwangaphambilini; laser ine inzuzo phezu zomculo ezivamile kuhlinzwa Kulezo zimo.

hernia Yangaphakathi etholakala ngaphakathi komgodi thoracic noma endaweni besisu. Ngaphandle emizimbeni protrusion elise lezi zindawo ezilandelayo:

• e imbilapho;
• phezu hip ngohlangothi kwangaphakathi noma yangaphandle;
• sacrum lumbar;
• endaweni indawo perineum kanye ukhalo;
• ohlangothini front of the esifubeni (epigastrocele);
• kunoma iyiphi indawo emzimbeni yesibazi kusukela ukuhlinzwa.

Human Ungenzenjani oluthathwa zibe yansukuzonke, kuyinkimbinkimbi noma engeyona inkimbinkimbi (nge ngakwesokudla). Uhlobo lokuqala kufaka protrusion, njalo ivela ngemva kokuhlinzwa.

izimpawu herniation

Kokuqala ukuvuvukala esiteji kwenzeka njengoba umumo isiyingi elinendawo ukungaguquguquki esithambile, kanti isiguli ingakwazi cabaza ngayo ingcindezi ukukhanya. Ngemva ukuncipha kwamanzi peritoneal okwamanje kufanele palpated entry esangweni, projecting ngesimo Slots noma isiyingi besisu odongeni isici.

Osayizi ziyahlukahluka kusuka uphawu yebhangqa amamilimitha angu ezintathu ngamasentimitha ambalwa kweshumi. Uma sac hernial ethumba ingxenye odongeni emathunjini noma umzimba, isici palpation ogobhozayo ezwakalayo umsindo ndima okuqukethwe kwakhe. Izimpawu evilaphayo Kubonakala hernia zihlanganisa ukuqunjelwa, ukucanuzela kwenhliziyo, isilungulela, ukuvuvukala, ukusinda, ukwephulwa kwamalungelo ukuchama.

Ungenzenjani Kunconywa uma kwephulwa we diverticulum, esibonakala by zimpawu ezilandelayo:

• kukhona ngokuvamile okungazelelwe ubuhlungu obuhlabayo ngemva izinsimbi, ukuzivocavoca, sokuzikhulula ukungakhuli kuyaqabukela kwenzeka ngaphandle kwesizathu;
• esikhathini esithile isiguli ngeke bakwazi, njengasekuqaleni, uphawu bushelelezi, kuba nzima futhi kubuhlungu;
• kanye nezimpawu odlule abangu retching, ukukhungatheka ngenxa esihlalweni.

Izimbangela hernia

Zonke izimbangela zihlukaniswe okunemibandela kuyanda bezindawo gijima. Iqembu lokuqala liqukethe izizathu:

• ukukhubazeka azalwa naso noma ukuthuthukiswa okungavamile odongeni kwamathumbu;
• ngasizathu simbe, ukunwetshwa zemvelo ababuthakathaka izindawo esiswini (femoral futhi amasongo inguinal, inkaba);
• ukuncipha kwamandla izicubu eqine ngenxa yezinguquko noma Ukuwohloka umzimba ukuguga;
• khona esiswini posttraumatic izindawo obuthaka noma uma kukhona nephutha kokuhlinzwa, laser khiqiza ephephile kakhulu kulesi sici sebeziqhumbuza.

Iqembu elilandelayo libhekisela sigijima noma nokucupha izici siyimbangela senyusa izinga lomfutho womoya ngaphakathi komgodi ongaphakathi kwamathumbu:

• umsebenzi onzima noma amandla ezemidlalo;
• ukuqunjelwa njalo;
• ukukhwehlela, nemvelo ezingamahlalakhona;
• yangaphakathi ukuvuvukala kwamathumbu ngenxa ukusebenza okungafanele umzimba;
• ukubuyisa.

Indlela ukunquma umbhunu

Udokotela ohlinzayo ascertains ukuthi herniation sekuhloliwe isiguli kanye ukucacisa khona emphilweni isiguli ukucacisa zici ezingenhla kanye yokwanda. Ikhumbula ukulimala yokuphila, ukuhlinzwa nomzimba. Ukuze uthole ukuthi lapho izitho lekhulunywako equkethwe ngaphakathi komgodlana hernial, udokotela cwaningo ngosizo amathuluzi kanye namathuluzi.

Ultrasound esiswini futhi we ziboya Kusinikeza nethuba lokucabangela elingaphakathi okuqukethwe nokuziphatha kwamangqamuzana uphethwe nezinye izifo. -X-ray indlela isetshenziselwa izithombe ezingafani isikhwama kanye hernia esangweni.

izinqubo zokwelapha nokuhlinza

Indlela eyinhloko kwelashwa yokudluliselwa kuhlinzwa. Egqoke umkaki bangisekela inikezwa kulabo iziguli Izimo sina leso siguli, ezifana izinguquko ezihlobene nokukhula noma simpofu igazi ekunqandeni. Ukususa protrusion Kunenkolelo ngokuvumelana uhlelo, uma isiguli ulungiselela ukusebenza, noma ezimweni ezimbi kakhulu, ukuhlinzwa Kwenziwa ngokuphuthuma. Isibonelo umcimbi engahlelelwe esinjalo strangulated hernia nobuhlungu babulawa noma ileus ngokomzimba.

Ukusebenza siqukethe ekuvuleni hernia sac neluhlolo okuqukethwe. Uma izibilini kungukuthi kabana, banciphisa a, esikhwameni kanye nesango sutured kuya ubukhulu esingaweleki. esangweni Plastic kusetshenziswa izicubu kusuka isiguli noma usebenzisa isizukulwane esisha zokwenziwa izinto. Kuyinto ukuhambisana saziso ngemiyalelo post-op udokotela ukuze kuncishiswe ingozi herniation yansukuzonke.

Ekuphetheni, kufanele kusho ukuthi ngezinye izimpawu zokuqala protrusion esifubeni noma besisu odongeni ngokushesha kufanele kudokotela. Ukuhlinzwa ngoba umbhunu akuyona ukusebenza eziyinkimbinkimbi, esinzima nakakhulu ukugwema yezinkinga egijima protrusion futhi izinhlungu ezihambisana nayo.