Perforation ntawm lub plab: cov tsos mob, kev kho mob, mob

Ntawm tag nrho cov kab mob hauv nruab nrog cev nyob rau hauv lub plab kab noj hniav, perforation ntawm lub plab thiab duodenum rwj yog hais txog 2%. Raws li statistics, cov zaus ntawm no mob tus kab mob no yog 7-12% thiab tshwm sim nyob rau hauv cov neeg mob uas nws muaj hnub nyoog yog 25-35 xyoo. Nyob rau hauv cov ntaub ntawv no, nyob rau hauv cov txiv neej nws zoo nkaus li 5 lub sij hawm ntau tshaj cov poj niam.

Ua rau perforation

Perforation ntawm lub plab (perforation) tshwm ntawm sab hwj chim ulcers thiab hauv qab npoo ntawm cov ntaub. Nws tshwm sim nyob rau txawv dysfunctions vascular patency los ntawm cov hlab ntsha. Qhov no piav yog muaj pov thawj los ntawm qhov tseeb hais tias thaum lub sij hawm ib tug perforation nyob rau hauv lub cheeb tsam ntawm yeej 12 duodenal rwj los yog pais plab phab ntsa yog tsis muaj los ntshav. Rwj perforation ntawm lub plab muaj 3 cov ntaub ntawv:

• raug (plab txheem poured mus rau hauv lub plab kab noj hniav, peritonitis muaj);
• atypical (perforation yog veiled zaub mov caj pas, mucosal folds, thiab cov zoo li);
• raws li pentratsii (hauv qab perforation qhib nyob rau hauv lub zos nyob sib ze kabmob).

Feem ntau, xws li ib tug tshwm sim yog preceded los ntawm ib tug muaj zog mob xam qhovkev ulcerative kab mob uas kav rau ib ntev lub sij hawm. Nyob rau hauv cov ntaub ntawv no, cov hniav lwj ntawm nws puag phab ntsa. Perforation ntawm lub plab yuav tshwm sim los ntawm:

• lub siab lub ntsws thiab lub cev kev nyuaj siab;
• siv cawv;
• exacerbation ntawm ulcerative kab mob;
• overeating;
• kev poob plig;
• kev kho mob uas muaj tej yam tshuaj uas ua rau no pathology.

Ib tug yuav tsum xav txog hais tias cov neeg laus nyob rau hauv lub keeb kwm ntawm lub rwj tsis tau yuav, vim hais tias cov neeg mob tsiag ntawv los ntawm ib tug thaum daim duab ntawm tus kab mob.

Yuav ua li cas ua perforation

Raws li txoj cai, mob ulcers nyob rau hauv tsis muaj txoj kev uas txuam nrog H.pylori kab mob. Pom ntawm lub peptic rwj nyob rau hauv 95% ntawm H. pylori qhia nws etiology. Mob rwj yuav suav hais tias raws li ib tug ntev ntawm pais plab rwj. Dhau li H.pylori, perforation ntawm lub plab yuav tau triggered thaum uas:

• Zollinger-Ellison syndrome;
• Drug ulcers thiab lwm yam endocrine kab mob;
• pancreatogenic, thiab lwm yam hom gepatogennymi mob ulceration (e.g., Crohn tus syndrome).

Rau cov tsos ntawm qhov nyob rau hauv lub pais plab phab ntsa yog ntawm kuj zoo kawg tseem ceeb nyob rau hauv tag nrho nws cov kev puas tsuaj khaubncaws sab nraud povtseg hydrochloric acid thiab ib qho kev nce nyob rau hauv siab nyob rau hauv lub plab cheeb tsam. Performative mob rwj yog suav tias yog mus rau theem qhov muaj mob ntawm pais plab rwj. Qhov no pathology yog tsim thaum lub sij hawm lub tsis tuaj kawm ntawv ntawm cov kev tsim nyog rau txoj kev kho.

cov tsos mob

Perforation ntawm lub plab phab ntsa muaj peb lub ntsiab theem:

1. A lub xeev ntawm kev poob siab.
2. Cuav txoj kev vam meej.
3. Peritonitis.

Ncaj qha theem poob siab tshwm sim thaum lub sij hawm perforation thiab ntog ntawm pais plab txheem rau cov ntawv txheeb ntawm peritoneum. Ib tug xav unbearable "riam-zoo li" mob uas zoo nkaus li nyob rau hauv lub qaum khaubncaws sab nraud povtseg ntawm cov mob plab kab noj hniav, uas sai sai kis mus rau tag nrho cheeb tsam ntawm lub plab mog. Feem ntau cov neeg mob nyob rau ntawm no point pib thrash thiab quaj qw. Zuag qhia tag nrho heev ntawm tus mob yog loj hlob sai heev:

• siab decreases;
• mem tes slows cia;
• daim tawv nqaij integument ua ntub dej, txias thiab daj ntseg;
• tus neeg mob yuav siv sij hawm ib tug yuam txoj hauj lwm - rau ib sab, nrog pleev xim rau lub hauv caug mus rau lub plab.

Tom qab ib tug tej lub sij hawm ntawm lub sij hawm (kwv yees li 7 teev) mob yog tsis muaj zog txaus, thiab nyob rau hauv tej rooj plaub, tag disappears. Maj mam tsub kom tsam plab, nws yuav tsis yog li ntawd tense, ploj auscultation nrov nyob rau hauv cov hnyuv. Rua hypotension, arrhythmia pib muaj thiab loj hlob tachycardia. Theem cuav welfare lub sij hawm tej zaum yuav mus txog 12 teev.

tau txim

Nyob rau yav dhau los ob theem ntawm ib tug neeg maj mam tsim peritonitis. Lub degree ntawm lub xeev dua exacerbated los ntawm: tus neeg mob yog muaj zog, tawv qhwv tau ib tug earthy Hawj txawm, ua nplaum nrog hws. Lub pem hauv ntej phab ntsa los ntawm cov peritoneum tense. Ho thiaj li tus nqi ntawm cov zis ua, tej zaum txawm los rau anuria.

Yog hais tias tus neeg mob muaj peptic rwj muaj ib tug atypical daim ntawv no, lub perforation yog muaj nyob rau hauv cov ntaub so ntswg retroperitoneal. Nyob rau hauv tas li ntawd, cov aperture tej zaum yuav disguised zaub mov los yog lwm tus kabmob. Tej zaum qhov delimitation yog tias muaj ntau ntau yam adhesions. Yuav tsum vov lub perforation yog ob peb hom:

• tas mus li;
• ntev;
• luv luv.

Cov perforation tshwm sim, lawv yuav tau yooj yim dua. Paub self-kho neeg mob.

Sib nrug los ntawm peritonitis complicating zaj ntawm pais plab kab mob tau hypovolemia, poob siab thiab sepsis.

kab mob mob "plab rwj"

Perforation ntawm lub plab yuav tsum tau muaj tseeb mob, uas muaj peev xwm yuav ntsia xwb los zoo sau keeb kwm. Yuav kom kuaj tau tus kab mob nws yog tsim nyog los saib ib tug tshwj xeeb. Qhov no zoo ntawm cov teeb meem muab kev koom tes cov kws kho mob gastroenterologists thiab endoscopists.

Ib tug heev ib qho tseem ceeb lub sij hawm yuav tsum tau soj ntsuam yog tias koj xav tias koj muaj ib tug pais plab perforation. Cov tsos mob nyob rau hauv txhua rooj plaub yuav tsis tau ignored, raws li cov advanced theem ntawm tus kab mob tej zaum yuav ua rau kom muaj teeb txim. Tus txheejtxheem lub endoscopist thiab cov gastroenterologist kiag li yuav tsum tau rau txhua tus neeg mob xav tias tus kab mob no, tshwj xeeb tshaj yog nrog cov yuav muaj ib tug kaw perforation. Nyob rau hauv txoj kev tshawb no tsis qhia tag nrho cov ntaub ntawv rau cov mob, tab sis lawv siv yog tsim nyog raws li ib feem ntawm cov kev npaj rau kev phais.

Perforation ntawm lub plab yog txiav txim los ntawm lub hauv qab no txoj kev:

• Tiaj radiography.
• Abdominal ultrasound.
• Upper endoscopy.
• Thaum teeb meem ntawm mob thiab xav tias perforation veiled siv laparoscopy.

Cov kab mob zoo li no cov tsos mob

Perforation ntawm lub plab yuav tsum tau ntaus nqi rau tej tswv yim raws li "mob plab mog", vim hais tias tus kab mob no yuav tsum tau txawv los ntawm:

• pancreatitis;
• cholecystitis thiab hnyuv tws;
• mob lwj;
• raum thiab hepatic Colic;
• mesenteric cov hlab ntsha thrombosis;
• rupture ntawm ib tug aortic aneurysm nyob rau hauv lub plab kab noj hniav;
• lub plawv nres;
• pleurisy.

Raws sij hawm nkag tau mus rau cov kws thiab kev diagnostic ntsuas yuav pab tsim kom muaj ib qho tseeb mob thiab lub sij hawm mus pib kev kho mob ntawm kab mob txaus ntshai.

Yuav ua li cas mus kho tau ib tug perforation?

Nyob rau hauv lub soj ntsuam daim duab, pab nrog pais plab perforation, nws yog nyob rau hauv ob peb txoj kev.

1. Tej kaw ntawm lub rwj. Nws yog tsim los rau cov neeg hluas uas tsis muaj keeb kwm ntawm ulcers nyob rau hauv cov neeg laus cov neeg mob nrog ib tug nce kev pheej hmoo ntawm tshuaj loog thiab ua hauj lwm zoo pab, raws li zoo raws li uas twb muaj lawm diffuse peritonitis.
2. Yog hais tias muaj yog tsis muaj peritonitis, qhov no muaj kev cuam tshuam yuav supplemented los ntawm cov xim proximal vagotomy, uas ua rau nws tau los mus tiv thaiv lub sij hawm ntev tej kev kho mob nyob rau hauv pawg ntseeg ntawm Gastroenterology nyob rau hauv lub neej yav tom ntej.
3. Nyob rau hauv lub xub ntiag ntawm ulcers nyob rau hauv lub pyloric, tob tob ulcers, tseem ceeb los ntshav, stenosis ntawm lub outflow huam, thiab impaired cov neeg uas muaj ib tug tseem ceeb uas yuav muaj kev phais, ua excision ntawm lub defect, pyloroplasty thiab vagotomy kav.
4. Thaum tus neeg mob muaj mixed tsos ntawm ulcerative kab mob los yog ib tug keeb kwm yog ntxiv indications pais plab perforation, qhov no phais yuav supplemented gemigastrektomiey.
5. Tau zoo heev yog muaj nyob rau ntawm lub keeb kwm ntawm laparoscopic thiab endoscopic txoj kev kho. Supplement phais pais plab perforation yuav endoscopic vagotomy thiab endoscopic kev kho mob.

Yog hais tias koj xav tau kom txo tau txoj kev pheej hmoo ntawm kev phais, tau distal gastrectomy los yog laparoscopic omentum tamponade perforation site. Cov manipulations yog zoo tshaj plaws taus los ntawm cov neeg mob uas yuav muab tau rov qab rau hauv ib tug sai npaum li cas lub sij hawm.

Tom qab ua tau zoo rau lub lag luam phais indispensable rau tag nrho cov kev kho ntawm tus neeg mob yog qhov kev tshem tawm uas tsis yog-tshuaj cov neeg ua hauj (thaum lawv lub hom phiaj los mus tiv thaiv cov emergence ntawm pais plab ulcers) los yog mus hloov lawv cyclooxygenase inhibitors, raws li zoo raws li conservative eradication.

Kev tiv thaiv thiab twv ua ntej

Thaum lub sij hawm perforation ntawm lub forecast yog heev hnyav vim hais tias ntawm qhov kev ncua nyob rau hauv mob mob tej zaum yuav ua rau ib tug tuag tau ntawm tus neeg mob. Tuag cov tub ntxhais hluas cov txiv neej yog kwv yees li 2-6% (noj mus rau hauv tus account tus soj ntsuam daim duab, lub sij hawm kev pab thiab lwm yam yam), cov neeg laus cov neeg, qhov no coefficient tsub kom ob peb lub sij hawm.

Kev tiv thaiv ntawm tus kab mob tseem tsis tau yog - yuav tsum raws sij hawm kuaj thiab kho cov kab mob uas yuav coj tus neeg mob mus rau qhov mob.