Chiratidzo chikosoro kuvhunduka. Nzira Kutsunga kuzvimba ari abdominal

The ventral heniya kunoratidza pacharo protrusion womukati nhengo yose kana mugove waro nepagedhi munzvimbo subcutaneous mudunhu rusvingo pamberi hunde kana akaumba muhomwe. In hafu nhengo dzose abdominal mhango yaiva panguva imwe chete parietal peritoneal rinopeperetswa kufukidza subcutaneous nzvimbo mukati. A chaiwo kuratidzwa mumwe heniya ari chiratidzo chikosoro nehana.

Kuziva ukama yomuka yokukurumidzira pamwe chirwere, isa ruoko kuti protrusion zvisaririra uye ayo maitiro kana vangakosora. Kazhinji, kusunda Runonzwika, zvichiratidza kuti mashoko anomalous paumbwe imwe peritoneum, kusavapo uchapupu strangulated heniya kwakadaro. Protrusion zvomukati kunoitika kuburikidza hernial mhete. Parietal peritoneum pamwe chikamu muura, tsinga, nemarunda vaibatwa muhondo goho rinomiririra hernial zai.

Mashandiro ari peritoneum

Kugadzira muviri nokuti chinokosha zvomukati inobatsira iri nedanho homeostasis, Urume kuchinjanisa, inotsigira abdominal kumanikidzwa:

• It anoita resorptive basa, kureva kupinza yokuparara zvibereko mapuroteni, zvinyama necrosis, exudates, mabhakitiriya;
• serous pabutiro mune dzimwe nzvimbo wakawondereiko kudai mazuva ose uye duodenum kukwanisa govera fibrin uye mvura;
• namafuta, kushumira pamusoro chipingamupinyi mutsa kune anogumbura muupenyu chirwere, kutapata anopa zvokuimba kudzivirirwa cellular uye humoral hunhu.

Heniya dumbu uye ayo yematambudziko

Kana ari weboka kuvhiya kupindira pane sauka vadyi, murwere haasi zvakazara vakateerera chiremba varayirwa, pane idzokororo heniya, iyo inoshanda sezvo pasuo nokuda dzakaonda nzvimbo vanga. Kwete kushandisa heniya ane zvinotevera matambudziko:

• kana zviremera zviri hernial zai, vari kuvhiringidzwa, ipapo zvishoma nezvishoma anouya immobilization yavo, kuti njodzi kuzvimba uye akatyisidzira dzinouraya;
• Kana protrusion pamusoro ura zvinobatanidzwa, ipapo kwemutemo zvavo zvokudya uye vanogutsikana zvakaoma;
• inotungamirira panowanikwa peritonitis uye mupendero jamming sidewall ura, iyo inotungamirira necrosis ari mugove akabatwa;
• anovandudza purulent muitiro (pute);
• Heniya chena mutsetse kunowedzera kuti rakakura kukura, ichi zvinotungamirira nyaya pashure vachibvisa nhengo zviri muhomwe, regai kufanira mune abdominal mhango.

Pavaipfuura peritonitis pamusoro ya chirwere

In chenjera anogumbura pezvakaitwa munzvimbo iri abdominal nzvimbo pakarepo amburenzi, kunonoka ngozi upenyu hwevanhu. Peritonitis dzinosiyana kwakakwana kana kukanganisa vamwe nharaunda. Kuzvimba kunokonzerwa siyana mhando Kurovedza uye anaerobic utachiona, nhema mukati abdominal mhango. Nzira Kutsunga dzidziso L. S. Simonyana, zvichienderana Kumwe kuchinja kunotanga uye nguva yacho chirwere, peritonitis chinosiyanisa danho:

• Zvakaitwa nguva rinovapo muzana rokutanga uye kufadza zviratidzo richiratidzwa;
• yezwi chepfu nhano rinoitwa kwemaawa 24 kusvika 72, pakuonekwa siyana nhume kudhaka uye chepfu muviri;
• yakadzika, kazhinji, imwe kusingarapiki chimiro hwapedyo pashure pemazuva matatu, chirwere pamwe chimbichimbi kuratidzwa omunzvimbo kuzvimba.

Kupatsanura zvirwere kubudikidza hunhu utachiona

Primary peritonitis hariwanikwi, nekurangarira kuti anenge 1% of anogumbura mananara. Chirwere kunoitika pashure nokufumura kubva peritoneum tupukanana yomukati nzira hematogenous, lymphogenous nzira kana kubva hadzi nhengo dzokubereka nadzo kuti fallopian sepombi.

diaphragm heniya kunokonzera peritonitis yechipiri pashure kuvhiyiwa kana nokuda matambudziko anoitika peritoneal tishu mupfungwa. Muchiitiko chino, pane zvinotevera chirwere zvinokonzera:

• chirwere kubva kuzvimba;
• ruptured nzira;
• ingress noutachiona nokuda zvinokuvadza;
• postoperative kuomesa.

Varieties peritonitis zvichienderana zvimwewo

Tumisoro of chakasimba uye chisingaperi Danho rinobva kurapwa zviratidzo uye chirwere. Nzira Pakusarudza, maererano exudate inoratidza fibrinous, serous, purulent, fibropurulent, haemorrhagic anogumbura zvisikwa.

Etiological weboka siyana peritonitis kukonzerwa siyana mhando microflora uye utachiona, zvichiita kuzvimba. Huru pathogenic tupukanana nhasi vakaziva sezvo staphylococci, streptococci, anaerobes, Proteus, enterococci, E. coli. Nokuti hondo mabhakitiriya zvinosanganisira pneumococci, gonococci, hemolytic streptococcus uye zvimwe zvakawanda.

The etiological mapoka yoga yoga nonbacterial zvirwere aseptic nyaya, kana diaphragm heniya rakaoma nokuda kupinda ari peritoneal mhango pakati weti, ropa, bile kana gastric muto. Uyu muenzaniso une ngozi, uye peritonitis mumaawa mashomanana anochinja kuva chirwere, sezvo masvingo vari permeable kune utachiona nokukurumidza pashure kutanga chokutsva.

Kutyora metabolic pezvakaitwa

Nokuvhiringidzirwa mvura-electrolyte reshiyo mumuviri uye mapuroteni mwero anoonekwa sechiratidzo arodzwe dzokunze abdominal heniya. Mhedziso mapuroteni ari nokukurumidza nokuda hypermetabolism, kufirwa chine zvinhu rinokosha rinoitwa munyika weti, mumarutsi, exudate. Ataurwa gipoproteinomiya uye kuderedza uwandu mapuroteni vanoonekwa panguva huru guva peritonitis.

Pamwe chete muviri zvinwiwa kusunungurwa potassium, ruchapinda kubva intercellular nzvimbo nokuda ichi, varwere vane hypokalemia. Pashure kukura kushoma muenzaniso anogona chaizvo kuchinja, sezvo kwakaderedza renal excretion emura, pane kuparadzwa dzinoverengeka masero zvakakwana. Somugumisiro kuchinja kusimukira hyperkalemia.

Zvikamu zviviri muzvitatu wevarwere muropa alkalosis zvikamuka, dzimwe nguva ari munyama yakaratidza iya kune acidosis kwaizokonzerwa kweropa vachivavhiringidza, nokuvhiringidzirwa metabolic urongwa uye hypoxia, izvi anomisa kubviswa imwe heniya.

The danho iri chinouraya nguva pamwe oliguria kusimukira hematopoietic hurongwa rinotanga kushanda pagadzirwe acidic metabolic zvinogadzirwa zvakadai magnesium, senitrogen, potassium uye phosphorus. Pane iya ropa parameters ari kufema uye metabolic acidosis. Miedzo nokuti chenjera peritonitis vari kuchinja nokukurumidza, saka kuramba zvichiongororwa inokurudzirwa ropa, weti nezvimwe muviri zvinwiwa.

symptomatology peritonitis

Pane zvinhu zvinoverengeka mwero zviri nawo tinoziva sei kusarudza munhu heniya uye kuzvimba peritoneum:

• simba zvisingatsungiririki kurwadziwa peritoneum;
• fivhiri;
• dumbu rukazara, zvava nesimba;
• kunzwa simba mumuviri wose;
• retching uye svoto;
• kutyora nemudumbu, kupatira, flatulence.

Chikosoro chirwere rutsigiro

It richiratidzwa chakasimba uye chisingaperi zvirwere ari abdominal mhango. Chirwere nokuti kukosora akapa G. G. Karavanovym uye zvinotsanangurwa zvizere IM Siomashem. Kumakiriniki zhinji Kuvhiya vava chiratidzo ichi nokuda rokutanga kutsunga zviratidzo kuzvimba mudumbu.

Nzira kushandiswa

Minwe hwakakungwa zvishoma akananga emichindwe zvipfundo zvomunwe tumafuta mberi pakudzidza nzvimbo. Vamwe nguva pashure chiito ichi havana kutora kuti marwadzo kubva dzvinyiriro kwakaderera. Pashure paizvozvo, murwere kuongororwa kuti chiratidzo chikosoro kuvhunduka. Akapa kuridza chikosoro, kana pashure nzira, pane marwadzo munzvimbo kufurirwa, inoratidza kuzvimba ari peritoneum.

musimboti oparesheni

The unopinza zvinoderedza vangakosora spasm peritoneal rusvingo uye diaphragm transmits munhu achapesana pemvura yaiva pazasi chiropa uye zvomukati. Vakazadzwa uye pasi zvinoitwa paura, iyo transmits chitsungo pasi. Manzwiro kurwadziwa kunoitika apo inofamba kana kuti muviri vanorwara anosangana imwe nharaunda waitsimbirira rwake. Kana kushoma kunobatanidza peritoneum, iyo kutekenyedzwa kurwadziwa kunoratidzwa nokubatana zvakaturikidzaniswa yomukati, sezvamakaropafadzwa intra-abdominal kumanikidzwa rinobuda.

Study munyori A. Cheremskoy chikosoro chirwere anorondedzera zvinoitwa pamusoro appendicitis chirwere. Kana vangakosora murwere panyaya kuzvimba okuwedzera kunoramba akanzwa kurwadziwa ari iliac nharaunda. Izvi siyanei kubva chikosoro uye heniya mu peritonitis.

Syndrome diffuse chenjera peritonitis uye chisingaperi pavaipfuura chirwere kukonzera nezvekufadza siyana apo vangakosora. Chirwere okuwedzera anoti kupfupika mweya, sezvinonzi murwere ari kuedza kunonoka kurwadziwa. The chenjera Danho kunoratidzwa saregerereka marwadzo. Chiratidzo chikosoro kugwinha munzira dzakasiyana anoratidza padariro peritonitis.

Kunze peritonitis, appendicitis uye heniya, chiratidzo ichi kunooneka pacharo mune chakasimba uye chisingaperi zvirwere nezvimwe abdominal nhengo. Marwadzo kubva voltage panguva chikosoro anooneka kana kuzvimba gallbladder, gastric maronda uye intestinal mhingaidzo. Saka, chikosoro kuvhunduka chiratidzo yakasiyana nedzimwe ongororo kuti chinozivisa vazhinji nezvirwere kutanga kwekupwanyiwa.

Heniya aro dzakasiyana

Miganhu muvanhu vanogona kuwanikwa uye vachiberekwa. Kusarudza wechipiri vana vachangoberekwa. kukanganisa uku kunoitika pamusana malformed peritoneum panguva fetus. Akawana protrusion kuti nhengo dzomukati kuonekwa munguva murwere upenyu, uye vari muzvikamu zvitatu mhando:

• panguva simba tsandanyama ari abdominal rusvingo;
• nokuda huru yemitambo kana basa mutoro;
• posttraumatic anomuka nokuda kutyora kuvimbika peritoneum, kana pane yakapfuura oparesheni; Laser ane paanopfuura kwakajairika pakuvhiya pakadai.

Internal heniya riri thoracal mhango kana abdominal nharaunda. Kunze protrusion miviri iri zvinotevera munzvimbo:

• ari muhudyu;
• pamusoro hudyu pamwe yomukati kana dzokunze parutivi;
• lumbar sacrum;
• munzvimbo nenzvimbo yacho perineum uye chiuno;
• nechemberi kurutivi mutumbi (epigastrocele);
• chero nzvimbo muviri panguva vanga kubva kuvhiyiwa.

Human heniya Classified kupinda idzokororo, kuoma kana kwete kuoma (pamwe kurudyi). Wokutanga mhando rinosanganisira protrusion, nguva dzose kuripo pashure kuvhiyiwa.

zviratidzo herniation

Initial Danho kuzvimba kunoitika somunhu raundi chimiro iro rine nyoro kusachinja-chinja, uye murwere anogona vakazvimiririra deredza pamwe chiedza kuvafurira. Mushure rutapudzo ari peritoneal pamusoro panguva iyi palpated gedhi kupinda, projecting muchimiro cheap car insurance kana dzeraundi abdominal rusvingo kuremara.

Sizes anosiyana kubva Simbiso peya millimeters matatu dzinoverengeka dhazeni masendimita. Kana hernial zai akakunda chikamu intestinal rusvingo kana wake muviri, mamirire palpation anzwike Inotubuka inzwi ndima kugutsikana. Zviratidzo usimbe kuratidza pacharo heniya zvinosanganisira kupatira, kuda kurutsa, chirungurira, bloating, kufundumwara, kutyora weti.

Heniya inokurudzirwa pakuparwa kukanganisa munhu diverticulum, iyo inozivikanwa nokuva anotevera zviratidzo:

• vanowanzoita pakarepo marwadzo pashure uremu vachisimudza, kurovedza muviri, defecation vanotaura kashoma chinoitika pasina chikonzero;
• pane imwe nguva murwere asingagoni, sapakutanga, chisimbiso kumeso, zvinova zvakaoma uye zvinorwadza;
• pamwe yapfuura zviratidzo vakanga retching, kushungurudzwa nechigaro.

Zvinokonzera heniya

Zvose zvinokonzera vari rakakamurwa zvimiso tinazvo simukai uye jog. Boka rokutanga ine kwezvikonzero:

• Vakaremara kana zvemamiriro kukura abdominal rusvingo;
• vamwe chikonzero, kuwedzera zvepanyama simba dumbu nzvimbo (femoral uye inguinal nezvindori, guvhu);
• kuderera kwemitambo zvinyama tensile simba nokuda kuchinja kana kuparadzwa kwemuviri Kukwegura
• Kuvapo mudumbu posttraumatic simba nzvimbo kana paiva kuvhiyiwa, kuti Laser unobereka kupfuura akachengeteka iyi cheka.

The rakatevera boka zvinoreva jog kana triggering zvikonzero chinokonzera kuwedzera kumanikidzwa mukati abdominal mhango:

• nesimba basa kana simba mitambo;
• kakawanda kupatira;
• kukosora, chisingaperi nechisikirwo;
• zvemukati abdominal kuzvimba nokuda inoshanda emunhu nhengo;
• flatulence.

How kuona munhu heniya

The chiremba ascertains kuti herniation pashure pakuongorora murwere uye kuziva kuvapo muupenyu murwere kuona apa zvinhu uye kuwedzera. Kufungisisa upenyu, oparesheni uye muviri kukuvara. Kuti tione izvo dzinogamuchidzanwa nhengo huri hernial zai, chiremba anoitisa kuongorora achibatsirwa zviridzwa nematurusi.

Ultrassom of mudumbu uye miganhu anotibvumira kuti funga yomukati kugutsikana uye mufambiro Kusiyanisa chirwere nevamwe zvirwere. X-ray nzira inoshandiswa nokuda zvakasiyana zvifananidzo bhegi uye gedhi heniya.

Kurapwa uye kuvhiyiwa

The nzira chikuru kurapwa kuvhiya zvivabatsire. Kupfeka rutsigiro chibooreso iri basa varwere vaya zvakakomba contraindications kuti kuvhiyiwa, akadai zera-kufanana kuchinja kana murombo kweropa. Dzichibvisa protrusion akasungwa maererano nepurani, kana murwere ari kugadzirira pokuvhiyiwa, kana mune Muzviitiko zvakaipisisa, kuvhiya rinoitwa nokukurumidza. Muenzaniso chiitiko akadaro kuzvironga iri strangulated heniya pamwe zvisingatsungiririki kurwadziwa kana mumuviri ileus.

The kuvhiyiwa kuri kuzarura heniya zai uye ongororo kugutsikana. Kana zvomukati haana akakuvadzwa, kuderedza, bhegi uye suwo iri sutured kune safambika hukuru. gedhi Plastic anoitwa vachishandisa zvinyama kubva murwere kana kushandisa chizvarwa chitsva chakaita zvokugadzirwa zvinhu. Hazvina fanira zvaidiwa post-kushanda mirayiridzo chiremba kuti yekuzvidzivirira idzokororo herniation.

In mhedziso, zvinofanira kutaurwa kuti nezviratidzo yokutanga protrusion ari mubhokisi kana abdominal rusvingo hwobva kubvunza chiremba. Surgery nokuti heniya haasi kunzwisisa mashandiro, zvikuru zvakaoma kudzivisa matambudziko anoitika achimhanya protrusion uye kurwadziwa chokuita nayo.