Ntawm tag nrho cov kab mob ntev ntawm cov kabmob uas nyob hauv lub plab kab noj hniav, perforation ntawm gastric thiab duodenal rwj yog kwv yees li 2%. Raws li kev txheeb cais, qhov zaus ntawm qhov teeb meem ntawm tus kab mob no yog 7-12% thiab tshwm sim hauv cov neeg mob uas muaj hnub nyoog 25-35 xyoo. Nyob rau tib lub sijhawm, nws tshwm sim 5 zaug hauv cov txiv neej ntau dua li poj niam.
Perforation ntawm lub plab (perforation) tshwm sim nrog txo cov khoom noj khoom haus hauv qab ntawm lub plab thiab cov npoo ntawm cov ntaub so ntswg. Nws tshwm sim nrog ntau yam tsis ua haujlwm ntawm patency ntawm cov hlab ntsha los ntawm cov hlab ntsha. Qhov kev piav qhia no tau ua pov thawj los ntawm qhov tseeb tias thaum lub sij hawm perforation tsis muaj los ntshav ntawm qhov chaw ntawm qhov txhab ntawm duodenum lossis phab ntsa ntawm lub plab. Gastric ulcer perforation muaj 3 daim ntawv:
- raug (cov ntsiab lus ntawm lub plab nchuav rau hauv lub plab kab noj hniav, peritonitis tsim);
- atypical (perforation yog them los ntawm zaub mov, omentum, mucosal quav, thiab lwm yam);
- nyob rau hauv daim ntawv ntawm kev nkag mus (hauv qab ntawm qhov perforation qhib rau cov neeg nyob sib zelub cev).
Raws li txoj cai, qhov tshwm sim no ua ntej los ntawm qhov mob hnyav uas tus yam ntxwv ntawm tus kab mob peptic, uas kav ntev. Nyob rau hauv rooj plaub no, lub cev qhuav dej ntawm phab ntsa ntawm nws lub hauv paus yog ua tau. Gastric perforation tuaj yeem tshwm sim los ntawm:
- kev nyuaj siab thiab lub cev;
- dej;
- exacerbation ntawm peptic ulcer disease;
- overeating;
- mob;
- kho nrog qee yam tshuaj uas ua rau muaj kab mob no.
Nco ntsoov tias cov neeg laus tej zaum yuav tsis muaj keeb kwm ntawm rwj, raws li cov neeg mob no muaj daim duab latent ntawm tus kab mob.
Dab tsi ua rau perforation
Feem ntau, mob rwj mob tsis cuam tshuam nrog H. pylori kab mob hauv txhua txoj kev. Kev lees paub ntawm peptic ulcer hauv 95% qhia tias nws Helicobacter pylori etiology. Tus mob rwj tuaj yeem suav hais tias yog ib theem ntawm gastric ulcer. Ntxiv rau H. pylori, gastric perforation tuaj yeem ua rau:
- YZolinger-Ellison syndrome;
- tshuaj rwj thiab lwm yam kab mob endocrine;
- pancreatogenic, hepatogenic thiab lwm yam mob hnyav (piv txwv li, Crohn's syndrome).
Rau qhov pom ntawm lub qhov hauv phab ntsa plab, nws qhov kev puas tsuaj hauv txhua txheej nrog hydrochloric acid thiab nce siab hauv plab yog qhov tseem ceeb heev. Performative chronic ulcer yog suav hais tias yog ib theem ntawm kev loj hlob ntawm gastric ulcer. Qhov no pathology yog tsim thaum tsis muajkev kho mob uas tsim nyog.
Symptoms of disease
Kev ua ntawm lub plab phab ntsa muaj 3 theem tseem ceeb:
- Tshuaj.
- Kev vam meej cuav.
- Peritonitis.
theem tam sim ntawm kev poob siab tshwm sim thaum lub sij hawm perforation thiab nkag mus rau hauv plab hnyuv mus rau cov nplooj ntawv ntawm lub peritoneum. Ib tug neeg xav tias qhov mob "dagger" tsis tuaj yeem tshwm sim nyob rau hauv cov khaubncaws sab nraud povtseg ntawm lub plab kab noj hniav, uas sai sai kis mus rau tag nrho lub plab kab noj hniav. Cov neeg mob feem ntau ntawm lub sijhawm no pib thrash txog thiab qw. Tag nrho qhov mob hnyav zuj zus tuaj:
- siab txo qis;
- lub plawv dhia qeeb;
- daim tawv nqaij ntub, txias thiab daj;
- tus neeg mob siv txoj haujlwm yuam - ntawm nws sab, nrog nws lub hauv caug nqa mus rau nws lub plab.
Tom qab qee lub sijhawm (kwv yees li 7 teev), qhov mob tsis muaj zog, thiab qee zaum ploj mus. Maj mam, tsam plab nce, nws yuav tsis nruj, suab nrov hauv cov hnyuv ploj thaum lub sij hawm auscultation. Arterial hypotension tshwm sim, arrhythmia pib tshwm thiab tachycardia nce. Lub sijhawm ntawm theem ntawm kev noj qab haus huv tsis zoo tuaj yeem ncav cuag 12 teev.
Muaj feem cuam tshuam
Thaum ob theem dhau los, ib tus neeg maj mam tsim peritonitis. Lub degree ntawm tus mob yog dua aggravated: tus neeg mob yog lethargic, lub integuments ntawm daim tawv nqaij tau ib tug earthy tint, ua nplaum los ntawmhws. Lub anterior phab ntsa ntawm lub peritoneum yog tense. Qhov ntim ntawm cov zis tsim tau txo qis, qee zaum txawm tias ncav cuag anuria.
Yog tias tus neeg mob muaj qhov mob plab atypical, ces perforation yog ua tau nyob rau hauv cov ntaub so ntswg retroperitoneal. Tsis tas li ntawd, lub qhov yuav raug them los ntawm cov zaub mov lossis cov khoom nruab nrog cev. Nws muaj peev xwm delimit tus txheej txheem nyob rau hauv lub xub ntiag ntawm ntau adhesions. Muaj ntau ntau hom perforation npog:
- permanent;
- long;
- short-term.
Cov hom perforation ua tiav, raws li txoj cai, yooj yim dua. Cov xwm txheej ntawm kev kho tus kheej yog paub.
Ntxiv rau peritonitis, hypovolemia, poob siab thiab sepsis tuaj yeem cuam tshuam rau kev kis kab mob plab.
Kev kuaj mob "pas plab ulcer"
Kev mob plab yuav tsum tau kuaj xyuas kom raug, uas tsuas yog tsim los ntawm kev sau anamnesis kom raug. Txhawm rau kuaj tus kab mob, koj yuav tsum hu rau tus kws kho mob tshwj xeeb. Gastroenterologists thiab endoscopists daws cov teeb meem no.
Nws yog ib qho tseem ceeb heev uas yuav tsum tau kuaj xyuas kom raws sijhawm yog tias muaj kev xav tias koj muaj lub plab perforation. Nyob rau hauv tsis muaj cov tsos mob yuav tsum tsis quav ntsej, vim hais tias ib theem siab ntawm tus kab mob tuaj yeem ua rau muaj qhov tshwm sim tsis zoo. Kev thov mus rau endoscopist thiab tus kws kho mob gastroenterologist yog qhov yuav tsum tau muaj rau txhua tus neeg mob uas xav tias muaj tus kab mob no, tshwj xeeb tshaj yog muaj qhov tshwm sim ntawm qhov raug kaw. Txawm li cas los xij, kev tshawb fawb tsis qhia cov ntaub ntawv tiav.rau kev kuaj mob, tab sis lawv xav tau los ua ib feem ntawm kev npaj rau kev phais.
Kev mob plab yog txiav txim siab raws li hauv qab no:
- dav hlau x-ray.
- Ultrasound ntawm plab.
- YEsophagogastroduodenoscopy.
- Thaum qhov kev kuaj mob nyuaj thiab xav tias muaj qhov perforation npog, laparoscopy yog siv.
Kab mob uas muaj cov tsos mob zoo sib xws
Kev plab plab tuaj yeem ua raws li cov ntsiab lus xws li "mob plab", vim tias tus kab mob no yuav tsum sib txawv ntawm:
- pancreatitis;
- cholecystitis thiab mob plab hnyuv;
- tumor decay;
- raum thiab mob siab;
- mesenteric vein thrombosis;
- ruptured plab aortic aneurysm;
- mob plawv;
- pleurisy.
Kev tiv tauj rau tus kws tshaj lij thiab ua cov kev ntsuas tshuaj ntsuam xyuas yuav pab tsim kom muaj kev kuaj mob kom raug thiab pib kho tus kab mob txaus ntshai raws sijhawm.
Yuav ua li cas kho qhov perforation?
Nyob ntawm daim duab kho mob, plab hnyuv tuaj yeem kho tau ntau txoj hauv kev.
- Ib txwm kaw qhov txhab. Nws tau ua hauv cov tub ntxhais hluas uas tsis muaj keeb kwm ntawm qhov txhab, hauv cov neeg laus uas muaj kev pheej hmoo siab ntawm kev siv tshuaj loog thiab kev kho mob, thiab hauv cov neeg mob peritonitis.
- Yog tias tsis muaj kab mob peritonitis, qhov kev cuam tshuam no tuaj yeem ntxiv nrog qhov sib thoojxaiv vagotomy, uas ua rau nws muaj peev xwm tiv thaiv tau kev kho mob mus sij hawm ntev hauv tsev kho mob gastroenterology yav tom ntej.
- Nyob rau hauv lub xub ntiag ntawm lub rwj nyob rau hauv lub cheeb tsam pyloric, rwj nkag mus rau hauv lub rwj, lub qhov txhab los ntshav, stenosis ntawm lub outflow ib ntsuj av, raws li zoo raws li cov neeg tsis muaj zog uas muaj kev pheej hmoo ntawm kev phais, tshem tawm qhov tsis xws luag, pyloroplasty thiab qia vagotomy. ua tau.
- Thaum tus neeg mob muaj ntau hom kab mob peptic los yog muaj keeb kwm ntawm gastric perforation ntxiv, qhov kev phais no yuav ua tiav los ntawm hemigastrectomy.
- Cov txiaj ntsig zoo muaj nyob ntawm keeb kwm ntawm laparoscopic thiab endoscopic kho. Endoscopic vagotomy thiab endoscopic kev kho mob tuaj yeem ua tiav kev phais plab plab.
Yog tias nws tsim nyog los txo qhov kev pheej hmoo ntawm kev phais, kev phais mob ntawm lub plab lossis laparoscopic tamponade perforation ntawm omentum yog ua tau. Cov kev tswj hwm no tau txais txiaj ntsig zoo tshaj plaws los ntawm cov neeg mob, uas tuaj yeem muab kev rov zoo sai dua.
Tom qab ua qhov kev phais mob, qhov xwm txheej tsis tseem ceeb rau kev rov ua tiav ntawm tus neeg mob yog kev tshem tawm cov tshuaj uas tsis yog tshuaj steroidal (thaum lawv cov tshuaj tau tso cai rau cov tsos mob ntawm plab hnyuv) lossis lawv hloov mus rau cyclooxygenase inhibitors, thiab. as conservative eradication.
Tiv thaiv thiab huab cua
Thaum lub sijhawm perforation, qhov kev kuaj mob nyuaj heev, txij li kev kuaj mob lig dhau los qee zaum ua rau tus neeg mob tuag. Kev tuag ntawm cov hluasQhov tshwm sim yog kwv yees li 2-6% (siv rau hauv daim duab kho mob, lub sijhawm muab kev pab thiab qee yam), hauv cov neeg laus qhov piv txwv no nce ntau zaus.
Kev tiv thaiv tus kabmob yog qhov thib ob - yuav tsum tau kuaj xyuas raws sijhawm thiab kho cov kabmob uas tuaj yeem coj tus neeg mob mus rau lub xeev no.
