Invagination ntawm txoj hnyuv nyob rau hauv tus me nyuam yog ib tug pathology nyob rau hauv uas ib feem ntawm cov hnyuv yog immersed nyob rau hauv lwm yam. Qhov no yog ib qho ntawm feem ntau ua rau mob plab hnyuv, uas yog kuaj pom nyob rau hauv me nyuam mos. Hauv tsab xov xwm no, peb yuav txheeb xyuas cov laj thawj tseem ceeb, cov tsos mob, nrog rau cov kev kuaj mob thiab kho cov hnyuv intussusception hauv tus menyuam.
cov ntaub ntawv dav dav
Cov kab mob no tau pom nyob hauv yuav luag 90% ntawm cov neeg mob hauv cov menyuam mos. Qhov tshwm sim siab tshaj plaws ntawm intussusception hauv tus menyuam muaj hnub nyoog rau lub hlis, thaum cov khoom noj ntxiv pib tshwm sim hauv cov khoom noj. Cov hnyuv tsis yog ib txwm muaj peev xwm rov tsim kho thiab yoog raws cov zaub mov tshiab. Kev txheeb cais qhia tau hais tias muaj txog 4 tus neeg mob plab hnyuv intussusception hauv ib tus menyuam hauv 1000 tus neeg. Nws yuav tsum raug sau tseg tias tus kab mob no muaj ntau dua rau cov tub.
Rau cov hnub nyoog hluas, hauv qhov noTus kab mob no tsis tshua muaj, cov kab mob feem ntau pom nyob rau hauv pawg neeg laus, tshwj xeeb, hauv cov neeg muaj hnub nyoog 45 txog 60 xyoo.
Views
Hom kab mob no uas ua rau mob plab hnyuv hauv cov menyuam yaus suav nrog:
- Primary lossis idiopathic intussusception. Cov laj thawj tseem tsis tau meej.
- Secondary, uas yog qhov tshwm sim ntawm ntau yam kab mob hauv plab.
Raws li cov chaw tshwj xeeb hauv plab hnyuv tau cuam tshuam ib leeg, tus kab mob kuj tau muab faib ua cov hauv qab no: cov hnyuv loj, cov hnyuv me, cov hnyuv me - plab, plab me, plab hnyuv, plab hnyuv loj los ntawm natural fistulous passages los yog stoma.
Yog tias qhov kev taw qhia ntawm cov hnyuv tshwm sim nyob rau hauv cov kev taw qhia ntawm perist altic contractions ntawm phab ntsa, ces nws yog feem ntau hu ua isoperist altic. Nyob rau hauv cov ntaub ntawv uas invagination yog qhia tawm tsam plab hnyuv fibers, ces nws yog tsau li anti-perist altic. Ob ntu ntawm txoj hnyuv, lossis ob peb zaug ib zaug, tuaj yeem koom nrog cov txheej txheem no.
Ntau yam ntawm cov kab mob
Peb mus txuas ntxiv xav txog ntau yam kab mob uas ua rau lub plab zom mov tshwm sim hauv cov menyuam yaus. Raws li hom ntws, intussusception tuaj yeem yog hom hauv qab no:
- recurrent;
- ntsim;
- mob.
Feem ntau hauv kev xyaum yog qhov mob hnyav ntawm tus kab mob, yuav luag 95%rooj plaub. Feem ntau qhov tshwm sim ntawm tus kab mob no yuav yog necrosis ntawm ib feem ntawm txoj hnyuv.
Cov kab mob rov tshwm sim yog kuaj pom hauv cov menyuam mos, tom qab siv cov txheej txheem kev noj qab haus huv tau siv hauv kev kho mob, uas yog txhawm rau txhim kho cov kab mob intussusceptum. Tsis tas li ntawd, daim foos no feem ntau raug kuaj pom nyob rau hauv cov neeg mob plab hnyuv immaturity nyob rau hauv cov me nyuam.
daim ntawv rov tshwm sim ntawm tus kab mob tuaj yeem ntxov. Nyob rau hauv cov ntaub ntawv no, nws tshwm sim nyob rau hauv thawj peb hnub tom qab qhov txo ntawm invaginate. Yog tias ntau tshaj peb hnub dhau los, tom qab ntawd intussusception hu ua lig.
Daim ntawv mob ntev yog ib ntus, me ntsis nkag mus ntawm ib ntu ntawm txoj hnyuv mus rau lwm ntu. Daim ntawv ntawm tus kab mob no tshwm sim nws tus kheej nrog cov tsos mob me me ntawm txoj hnyuv plab.
Yog vim li cas
Dab tsi ua rau mob plab hnyuv? Raws li tau hais ua ntej, feem ntau nws tsis tuaj yeem txheeb xyuas qhov laj thawj ntawm tus kab mob no. Txawm li cas los xij, txhua yam ua tau hauv kev txhim kho cov txheej txheem pathological tau muab faib ua ob pawg: kev siv tshuab, nrog rau kev noj zaub mov, uas yog, cuam tshuam nrog kev siv khoom noj.
Raws li rau cov menyuam yaus hnub nyoog 0 txog 3 xyoos, qhov no, cov khoom noj khoom haus hauv kev loj hlob ntawm intussusception lossis plab hnyuv txhaws yuav yog yam ntxwv. ICD-10 code - K-56. Mechanical yam feem ntau tshwm sim rau cov menyuam yaus.
Nws ntseeg tau tias cov hauv qab no yuav yog lub zog rau kev loj hlob ntawm tus kab mob hauv cov menyuam mos:
- sijhawm pub mis tsis raug.
- Unadjusted modekhoom.
- Pob zaub tuab heev.
- Khoom noj hauv chunks lossis coarse fiber.
Alimentary yam hauv kev loj hlob ntawm tus kab mob kuj yog yam ntxwv ntawm cov neeg laus ib feem ntawm cov neeg mob. Qee zaum cov neeg uas muaj cov tsos mob ntawm tus kab mob no tuaj rau hauv tsev kho mob tom qab lawv tau noj cov zaub mov ib txwm muaj, piv txwv li, dumplings, dumplings, qhob cij dub. Feem ntau, cov neeg mob cuam tshuam nrog kev txhim kho ntawm intussusception nrog cov khoom noj txom ncauj sai thaum lawv nqos cov khoom uas tsis tau noj.
Ntxiv rau, lub luag haujlwm tshwj xeeb hauv kev txhim kho tus kabmob ntawm cov neeg laus yog muab rau cov khoom siv kho tshuab, uas suav nrog cystic formations, polypous kev loj hlob ntawm txoj hnyuv, Meckel's diverticula, uas yog congenital protrusion ntawm phab ntsa ntawm ileum., kab mob pancreatic, qog plab hnyuv, raws li malignant, thiab benign.
Ntxiv rau, muaj ntau yam uas tsis ncaj qha ua rau mob plab, tab sis ua rau muaj kev pheej hmoo ntawm intussusception. Cov no suav nrog kev ua xua hauv plab hnyuv, cystic fibrosis, kev ua haujlwm tsis zoo ntawm lub cev muaj zog, cov xwm txheej tom qab muaj kev phais ntau yam ntawm cov plab hnyuv siab raum, kab mob plab hnyuv, kab mob hauv tsev neeg, keeb kwm ntawm cov txiv neej hnyav dua. Yog tias koj mus rau hauv tsev kho mob, tsis txhob hnov qab tias ICD-10 code rau plab hnyuv txhaws yog K56.
Ntau zaus, intussusception tuaj yeem yog qhov teeb meem ntawm cov kab mob tshwj xeeb thiab cov xwm txheej, uas yuav tsum muaj cov kab mob thiab kab mob ua rau cov hnyuv, mob ntev, mob hnyav ntawm cov kab mob ntev ntawm cov mucous membranes nyob rau hauv ib feem ntawm txoj hnyuv, rau piv txwv,enteritis, gastritis, colitis, lwm yam kab mob ntawm cov hnyuv loj thiab me, peritoneal tuberculosis, tuberculous plob tsis so tswj kab mob, enteroptosis. Nws yog cov kab mob no uas suav tias yog ua rau mob plab hnyuv.
Cov tsos mob ntawm tus menyuam
Yog li, peb tau txiav txim siab seb qhov laj thawj ntawm kev txhim kho tus kab mob tsis zoo no tuaj yeem yog. Txawm li cas los xij, koj yuav tsum paub cov tsos mob ntawm tus kab mob. Nws yuav tsum tau muab sau tseg tias cov cim qhia ntawm, piv txwv li, me me quav intussusception thiab lwm yam yuav luag tib yam. Lawv yog cov hauv qab no:
- mob plab;
- mob plab;
- bloating.
Nyob rau theem pib ntawm kev loj hlob ntawm tus kab mob, qhov mob tshwm sim nws tus kheej raws li kev tawm tsam, lub sijhawm ntev li ntawm 7 feeb. Lub sijhawm sib txawv ntawm kev tawm tsam yog 10 mus rau 30 feeb. Hauv qhov no, kev saib xyuas yuav tsum tau them rau qhov tseeb tias qhov pib ntawm kev tawm tsam yuav mob hnyav. Hais txog kev siv zog, qhov mob muaj zog heev. Thaum qaug dab peg, tus me nyuam tsis xis nyob heev, qw, quaj, rub nws ob txhais ceg rau hauv plab. Cov menyuam mos tib lub sijhawm tsis kam txiv mis lossis ob lub mis. Cov tawv nqaij ua txias rau qhov kov, npog nrog cov hws txias. Qhov kawg ntawm kev tawm tsam yog ntse li nws pib.
Cov tsos mob ntawm tus kab mob hauv tus neeg laus
Thiab cov tsos mob ntawm kev loj hlob ntawm tus kab mob hauv tus neeg mob laus yog dab tsi? Ua ntej tshaj plaws, tus neeg mob tsim mob hnyav hauv plab. Nyob rau hauv parallel nrog qhov no, ntuav tshwm. Feem ntau nws yog nrog tachycardia, pallor ntawm daim tawv nqaij,hws txias thiab lwm yam cim ntawm kev poob siab.
Ob peb teev tom qab pib qhov kev tawm tsam, pom cov ntshav tawm hauv cov quav. Nyob rau hauv cov ntaub ntawv ntawm kev txhim kho ntxiv ntawm tus kab mob thiab necrosis ntawm lub plab hnyuv phab ntsa, cov tsos mob ntawm txoj hnyuv los ntshav kuj yuav pom: qaug zog, ntshav hauv cov quav, kiv taub hau. Lub plab yog mob heev, tsis muaj quav. Ib tug neeg hnov qhov mob hnyav heev, uas nws tuaj yeem tsis nco qab. Cov kev xav tsis zoo ntawm qhov kev siv zog no feem ntau ua rau tsis meej pem thiab delirium. Nyob rau hauv ib qho kev mob siab rau txo qhov mob, ib tug neeg nias nws ob txhais ceg rau nws lub plab thiab assumes ib tug fetal txoj hauj lwm. Lwm cov tsos mob tseem ceeb ntawm intussusception yog ntuav. Nws pib vim qhov tseeb tias intoxication pib hauv cov hnyuv.
Muaj Teeb Meem
Yog tias tsis tau teem sijhawm kho cov txheej txheem kho mob raws sijhawm, kev teeb tsa ntawm lub qhov hluav taws xob roj lossis txawm tias ua haujlwm, ntau yam teeb meem yuav tshwm sim. Feem ntau ntawm cov no yog plab hnyuv, plab hnyuv los ntshav, peritonitis, perforation ntawm lub plab hnyuv phab ntsa vim necrosis, qhov tsos ntawm ib qho hernia sab hauv. Txhawm rau zam txhua qhov no, nws yuav tsum tau nrhiav kev pab tam sim los ntawm tus kws kho mob tshwj xeeb thaum thawj cov tsos mob tshwm sim, thiab tom qab ntawd ua raws li tag nrho cov lus pom zoo rau kev mob plab hnyuv intussusception hauv cov menyuam yaus.
Diagnostics
Kev tsis txaus siab los ntawm tus neeg mob uas muaj tus kab mob no tsis tuaj yeem hu ua tus yam ntxwv nkaus xwb rau tus kab mob no, yog li txhawm rau txhawm rau txheeb xyuas qhov ntsuas, ntsuas, lub cev, thiabsoj ntsuam kuaj. Kev kuaj lub cev muaj xws li kev tshuaj xyuas, tapping, palpation, thiab kuaj nrog endoscope.
Thaum lub sijhawm kuaj, cov cim hauv qab no tau tshwm sim:
- Thaum thawj theem ntawm kev loj hlob ntawm tus kab mob, tus nplaig zoo li qub, tab sis tom qab ntawd cov txheej dawb tshwm rau ntawm nws.
- Lub plab o, cov phab ntsa hauv ntej yog nruj. Daim paib no qhia tau hais tias txoj hnyuv loj tuaj.
txhawm rau paub meej qhov kev kuaj mob, cov cuab yeej siv kuj tseem siv, uas suav nrog fluoroscopy, radiography nrog qhov sib txawv, ultrasound, xam tomography. Tus kws kho mob tshwj xeeb kuj tshuaj xyuas qhov kev tshuaj ntsuam dav dav ntawm cov ntshav thiab quav hauv qab lub tshuab ntsuas.
Txoj kev kho mob
Yog tias qhov kev kuaj mob tau lees paub, ces qhov kev ua haujlwm raug muab rau kev ua haujlwm ntawm plab hnyuv. Txawm li cas los xij, cov menyuam mos, uas nws muaj hnub nyoog li ntawm 3 lub hlis mus rau 3 xyoos, tuaj yeem kho tau tus kab mob no nrog kev pab ntawm kev saib xyuas kev kho mob. Txawm li cas los xij, koj yuav tsum xyuam xim rau qhov tseeb tias kev phais mob xwm txheej ceev tsuas yog zam tau yog tias tsis pub dhau 10 teev dhau los txij li qhov pib muaj tus kab mob, thiab tsis muaj teeb meem tshwm sim.
Txoj kev kho tus kheej muaj kev qhia txog huab cua rau hauv cov hnyuv uas siv lub zais pa tshwj xeeb. Cua yog pumped kom txog thaum lub intussusception clears. Tom qab ntawd, lub qhov hluav taws xob lub raj yog ntsia raws li lub algorithm. Kev ua tau zoo ntawm qhov kev kho mob no yog siab heev. Tom qab cov txheej txheem yog nqa tawmtswj kev kuaj X-ray, thiab tus kws phais mob saib xyuas qhov mob ntawm tus menyuam. Hauv lwm qhov xwm txheej, kev phais mob tau ua.
Yog li, yog menyuam mob plab, yuav ua li cas, peb txheeb nws. Tab sis yuav ua li cas kev phais yuav ua tau? Ua ntej tshaj plaws, kev kho kom zoo ntawm tag nrho cov plab hnyuv siab raum yuav tsum tau ua, vim tias tej zaum yuav muaj ntau yam invaginates. Tom qab ntawd, kev ntsuam xyuas yog ua nyob rau hauv qhov chaw cuam tshuam los txiav txim qhov tseem ceeb ntawm txoj hnyuv. Thaum tsis muaj kev hloov pauv hauv cov phab ntsa ntawm txoj hnyuv, ib ntu yog ua tib zoo tshem tawm ntawm lwm qhov. Yog tias pom tau tias cov kev hloov pauv tau hais, ces qhov chaw hloov kho yuav raug tshem tawm.
Post-operative period
Nws tsis muaj teeb meem dab tsi tshwj xeeb ntawm tus kab mob tau raug tso tawm pneumatically - tom qab kev phais, kev kho mob yuav tsum tau ua tas li. Nws suav nrog kev kho tshuaj tua kab mob, nrog rau kev kho cov kua dej hauv cov hlab ntsha los ntxiv cov ntim ntawm cov ntshav ncig. Qhov no yog qhov tsim nyog nyob rau hauv rooj plaub uas tus neeg mob tau kuaj pom tias los ntshav hauv txoj hnyuv.
Kev Tiv Thaiv
Txhua tus paub tias txhua yam kab mob tiv thaiv yooj yim dua li kho nws tom qab. Tshwj xeeb tshaj yog thaum nws los txog rau xws li ib tug tsis kaj siab kab mob raws li intussusception, uas yuav luag ib txwm yuav tsum tau kev kho mob phais. Raws li kev tiv thaiv kev tiv thaiv, nws yog ib qho tsim nyog los qhia cov khoom noj ntxiv rau cov menyuam yaus raws li lub sijhawm. Qhov no txhais tau hais tias thawj cov khoom tau nkag rau hauv cov khoom noj tsis pub dhau rau lub hlis ntawm lub hnub nyoog ntawm tus menyuam. Qhov tshwm sim hauvcov zaub mov ntawm cov tais diav tshiab yuav tsum tau phased. Maj mam, cov zaub mov noj yuav tsum nce ntxiv. Nws yog qhov zoo tshaj plaws los siv cov tais diav los ntawm ib qho khoom xyaw rau cov khoom noj ntxiv.
Raws li kev tiv thaiv hauv cov neeg laus, lawv yuav tsum ua raws li kev noj haus thiab kev noj haus, tsis suav cov zaub mov ntxhib dhau los ntawm lawv cov zaub mov txhua hnub. Tsis tas li ntawd, thaum noj su lossis noj hmo, koj yuav tsum zom zaub mov kom huv si. Lwm qhov kev tiv thaiv uas yuav tsum tau ua yog kev kuaj mob raws sij hawm thiab kev kho mob ntawm neoplasms hauv plab hnyuv.
kab mob prognosis
Yog tus neeg mob tau mus pw hauv tsev kho mob raws sijhawm, thiab kev kuaj mob thiab kev kho mob ntawm cov kab mob tsis zoo li intussusception tau ua tiav zoo, ces qhov kev kuaj mob yuav zoo heev. Txawm li cas los xij, qee zaum muaj ntau hom kev rov qab los. Qhov kev kwv yees yuav tsis meej meej hauv kev txhim kho qee yam teeb meem ntawm invagination. Lawv kuj tuaj yeem tshwm sim thaum ntxov ntawm kev loj hlob ntawm tus kab mob. Txhua teev yog ib qho tseem ceeb rau lub neej ntawm tus neeg mob, yog li koj yuav tsum tsis txhob yig yog tias koj pom thawj cov tsos mob ntawm plab hnyuv nyob rau hauv koj tus kheej los yog koj tus me nyuam.
