Ledda chirwere: zviratidzo, kurapwa

Mamiriro ezvinhu anorwadza anowanikwa nechimiro chisina kujairika che duodenum, mapofu uye midgut anonzi Ledd's syndrome. Nezviratidzo zvipi zvinoratidza kuvepo mumuviri wehutano huno uye nzira dzipi dzinotungamirirwa mukurapa kwayo - tichagadzirisa nyaya idzi munyaya yedu.

Ledda Syndrome

Chimwe chinokonzerwa nehutachidzo kutendeuka iyo inoumbwa panguva yekukura kwekuberekwa (kazhinji pavhiki 10-12) uye inopirction ye duodenum ne caecum ine kutenderera kwekati mukati, ine zita rakananga - Ledd's syndrome.

ICD-10 ndiyo inowanzogamuchirwa yakarongwa yekurapa kuongororwa kwekodzero yakagadzirwa ne WHO. Maererano neChirangaridzo Chenyika Yose chezvirwere zvechigumi chekuvandudzwa, Ledd's syndrome inoreva zvirwere zvekugadzirisa chirongwa (kirasi XI). Chirwere chechirwere hachiwaniki kakawanda pane chimwe chezviitiko kune vana vanenge vachangoberekwa mazana mashanu, uye vakomana kaviri vanogona kuonekwa kuti vane chirwere ichi.

Sezvo mutemo, kuongororwa kunosimbiswa muvhiki yekutanga yehupenyu hwechirwere chiduku, zvishoma nezvishoma - mumwedzi wokutanga wehupenyu. Kuti uite chirwere chakakodzera, chiremba wevana anoda ruzivo uye ruzivo rwakakura rwehutachiona. Munyaya iyi, chirwere chacho hachiwanzoonekwa nguva yakakodzera. Chiratidzo chinonyanya kuonekwa chehutachiona mumazuva okutanga ehupenyu kurutsa nekubatanidzwa kwebe.

Zvinosuruvarisa, kuoma kwemamiriro ezvinhu emuurwere ane chirwere chakafanana kunogona kuwedzera kuburikidza nekugadzirisa kuberekwa kwekuzvarwa kusina kunaka, zvakadai se:

• Ipi kana mapapu hypoplasia;
• Chirwere chemwoyo;
• Stenosis yemapurmonary arteri, nezvimwewo.

Ladd's syndrome in adults is rare. Kuvhiringidzika kwepamuviri kunogona kukonzerwa nokufamba kwekecum, pamwe chete nehutachiona hwemuviri mudumbu. Dzimwe nguva kuumbwa kwehutano kunovhiringidzika nehutano hwemuviri wepamuviri mudumbu. Haisi nzvimbo yekupedzisira pakati pezvinhu zvinokonzera kugadzirwa kwemaitiro akaoma, maitiro uye ane marwadzo ematunhu akasiyana-siyana ematumbo anotamba.

Zviratidzo zvechirwere

Ledd's syndrome muzvakazvarwa zvinogona kuratidza zviratidzo zvisingachinji. Mukuwedzera mukurutsa nekudzokazve kwebheka, vana vacheche vanoona kurwadziwa kwepamuviri. Mune zvimwe zviitiko, kudzokerazve kunoitika kunotungamirira kukuvadza kwepachivi mumatumbo nekuwedzerwa, kusvika kuhutano hwemwana.

Zvose zviratidzo zvezvechirwere:

• Paroxysmal kurwadziwa;
• Kugadzirisa kuchengetedza, kuunganidza gasi;
• Kutsiva;
• Kuchengetedza nzvimbo yepigastric ;
• Mucheche pasi pemimba;
• Nhengo haina kupa ruzivo rwakakwana pamusoro pemamiriro emurwere.

Mifananidzo yepamuviri yemimba inobudisa mazinga maviri emvura mumudumbu uye duodenum, pamwe chete nehini shoma mumatumbo. Kana bhaarium sulfate yakashandiswa panguva iyo nzira yacho , chigumisiro chinoratidza kuwedzera kwepakati pakati pemudumbu uye nedodenum. Kusiyana kwakaparadzaniswa zvakafanana pamusoro pezvisungo zvemukati mudumbu.

Irrigography inowanzoratidzira kugadziriswa kwececum pasi pechiropa. Uye pano nerubatsiro rwekombiyuta tomography, kuputika kwemukati mukati mukati meMesenteric arteri inotsanangurwa.

Clinical picture

Ledda chirwere chinorwara chinoda kupindira kushanda nokukurumidza. Sezvambotaurwa kare, zviratidzo zvechirwere zvakashata uye zvinogona kudzokororwa panguva dzemazuva mazhinji, vhiki, kana makore.

Muzviitiko zvakasiyana siyana, chirwere chinorwadza hazvizviiti hachina kuzviita kwemakore akawanda uye hachirevi. Vana panguva imwechete vanotambura nekuderera kwechido, vakachera mushure mekukura mumuviri.

Mukuwedzera kune classic syndrome yeLedd, maviri mafomu mamwe anozivikanwa:

1. Muchiitiko chekutanga, hakuna kutendeuka pakati nepakati, asi nzvimbo isina kukodzera ye caecum inocherechedzwa, iyo inomesa duodenum.
2. Muchiitiko chechipiri, pane kungove chete kwepakati nepakati mukati.

Nzira yezvirwere (Ledda syndrome) inogona kuva yakajeka uye inokonzera (isingaperi). Mune chimiro chisingaperi, hapasati ichitaura mazwi emimba, semukati colic, dzimwe nguva kurutsa, hypotrophy. Ikoko pane bhuni rakaputsika. Mamiriro omwana anoonekwa seanogutsa. Kurwiswa kwemukati hakutungamiri kutyora ropa rayo. Mune mitsemhere yemukati mutsva, kungova neropa chete kunowanikwa uye mumutambo wepamuviri kune jet rinoshanduka.

Kushanduka kwakanyanya kwemukati mumamiriro ezvinhu akaipisisa, ayo, kana asina kunaka, anotungamirira ku necrosis kana chirwere chemukati.

Kurapa kweLedd's syndrome

Kuvandudza huwandu hwehutano hwemurwere nehuwandu hunogara huripo hwechirwere hunobatsirwa nekushandiswa kweantispasmodics. Zvisinei, izvi zvinongova chiyero chenguva pfupi. Nzira huru yekurapa kumeso kwepamuviri isinei nekupindira kwekuvhiya. Kushandisa kurapa kwehutachiona (Ledda syndrome) ine zvikamu zvakasiyana-siyana:

1. Pakutanga, kurutsa nekudzivirira kunobviswa.
2. Ipapo musikana muduku uri mudumbu rakarurama, rakaoma-kuruboshwe.
3. Kana pane chido chekugadziriswa kwemuviri mukati me parietal peritoneum, ita izvi kushandiswa. Chiyero chakafanana chinodiwa kana murwere ane chimiro chisina kuchena chemukati.
4. Appendectomy inoitwa.

Munguva pfupi yapfuura, nzira dzeparuscopic dzokuongorora uye kurapwa kwechirwere dzave dzakapararira mukurapa. Izvozvo-mini-invasive technologies zvinoshanda zvikuru. Zvisinei, kuita chirongwa chinoshandiswa nenzira iyi kunosangana nemamwe matambudziko nekuda kwechidiki chemuviri wemimba, pamwe nehupamhi hutanda hwomukati mudumbu revana vemwedzi yokutanga yehupenyu. Dzimwe nguva munguva yekutanga postoperative pane zvinetso:

• Sepsis;
• Peritonitis;
• Kubuda ropa kumakumbo;
• Kuvhiringidzika kwepamuviri.

Iko mikana yekudzorera zvakakwana ichaenderana nemigumisiro yekushanda. Kana dzose madhipatimendi emutambo wepamuviri akachengeterwa, kufungidzira kwehupamhi hwehuhu hwehupenyu hwakanaka. Kana pakanga paine chizivo chemuviri chinokonzera ku "syndrome" ye "pfupa shoma", murwere ane zvinetso zvine chokuita nekudya uye hypotrophy. Nemigumisiro yakadai yekurapwa kwakapetwa, dzakawanda zvipatara zvinowanikwa kuti zviite chirongwa chepamusoro parenteral. Dzimwe nguva varwere vachafanira kudzokorora mabasa. Kana chirwere chinoputika chichirwisana ne cystic fibrosis, kufungidzira kwekugadzirisa kwakashata.

Preoperative kugadzirira

Kana kamwe mwana achangoberekwa akaonekwa kuti ane chirwere chemuviri (Ledda syndrome), anotamirwa kuchipatara chinopurirwa, akajowa nehutachiona uye anochengetedza kubuda kwemuviri mukati. Nguva iyo inofanirwa kuitisa matanho ekugadzirira kushandiswa, zvakananga zvichienderana nekuoma kwepenital intestinal obstruction.

Kana murwere muduku achifungidzirwa kuchinja marita, zvinotevera zvinongororwa zvinowanikwa:

• Kuongororwa kweropa kweboka uye Rh factor;
• Kuongororwa kweropa kwe hemoglobin uye hematocrit;
• Ropa rekuvhara ropa.

Kushandisa kurapwa kunoitwa nokukurumidza, kugadzirira preoperative kunotora nguva yakareba kweawa rimwe chete. Mwana wacho anopiwa chirwere chinoputika , rinorondedzera hemostatics, mishonga inorwadza, uye dzimwe nguva kuputika kwemhepo. A catheter inowanikwa mukati moutini.

Mumamiriro ekudzivirira kwepachiviri mudumbu, kugadzirira kwekugadzirira kunogona kutora kusvika maawa makumi maviri nemaviri. Munguva ino mwana achangoberekwa anowedzera kuongororwa kuitira chinangwa chekugona kuonekwa nekufambisa chirwere. Panguva imwecheteyo, dhonza mudumbu, funga nezvemazana evanhu vanobviswa, ipai infusion therapy, antibiotics uye haemostatic drugs. Kudyisa mwana achangoberekwa hakubviri.

Vana vazhinji vari munguva inoshandiswa shure vanopera nguva yakareba yokuputika, izvo zvingaguma kusvika mazuva mashanu. Therapy inorwisa mabhakitiriya inoshandisa zvinodhaka zvinopesana nevanaerobic mabhakitiriya. Chimiro chemagetsi chinotariswa kaviri pavhiki. Rimwe zuva mushure mokuvhiyiwa, zvinodhaka zvinorayirwa kuti zvivandudzire zvinetso zvemukati, uyewo zvigadzirwa zvehupenyu.