I-tracheoesophageal fistula nokulungiswa kwe-esophageal atresia

Ukulungiswa kwe-tracheoesophageal fistula kanye ne-esophageal atresia ukulungisa ukuhlinzwa ukulungisa ukukhubazeka okubili kokuzalwa ku-esophagus naku-trachea. Ukukhubazeka kuvame ukuvela ndawonye.

I-esophagus yishubhu elithwala ukudla lisuke emlonyeni liye esiswini. I-trachea (i-windpipe) yishubhu elingenisa futhi lingene namaphaphu emoyeni.

Ukukhubazeka kuvame ukuvela ndawonye. Kungenzeka kanye nezinye izinkinga njengengxenye yesifo (iqembu lezinkinga):

• I-Esophageal atresia (EA) yenzeka lapho ingxenye engenhla yomcibisholo ingaxhumi ne-esophagus engezansi nesisu.
• I-Tracheoesophageal fistula (TEF) ukuxhumana okungavamile phakathi kwengxenye engenhla yesimungulu kanye ne-trachea noma i-windpipe.

Lokhu kuhlinzwa kwenziwa njalo ngemuva nje kokuzalwa. Kokubili ukukhubazeka kungalungiswa ngasikhathi sinye. Kafushane, ukuhlinzwa kwenzeka ngale ndlela:

• Imithi (i-anesthesia) inikezwa ukuze ingane ilele ubuthongo obukhulu futhi ingabi nezinhlungu ngesikhathi sokuhlinzwa.
• Udokotela ohlinzayo usika ohlangothini lwesifuba phakathi kwezimbambo.
• I-fistula phakathi komqala ne-windpipe ivaliwe.
• Izingxenye ezingenhla nezingezansi zomhosha zithungwa ndawonye uma kungenzeka.

Imvamisa izingxenye ezimbili zomhosha ziqhelelene kakhulu ukuthunga ndawonye zisuka. Esimweni esinjalo:

• I-fistula kuphela elungiswa ngesikhathi sokuhlinzwa kokuqala.
• Ishubhu le-gastrostomy (ithubhu elingena esikhunjeni lingene esiswini) lingabekwa ukunikeza ingane yakho umsoco.
• Ingane yakho izophinde ihlinzwe kamuva ukulungisa i-esophagus.

Kwesinye isikhathi udokotela ohlinzayo ulinda izinyanga ezi-2 kuya kwezi-4 ngaphambi kokwenza ukuhlinzwa. Ukulinda kuvumela ingane yakho ukuba ikhule noma yelashwe ezinye izinkinga. Uma ukuhlinzwa kwengane yakho kubambezelekile:

• Ishubhu le-gastrostomy (G-tube) lizofakwa odongeni lwesisu esiswini. Imithi yokugulisa (i-anesthesia yendawo) izosetshenziswa ukuze ingane ingabuzwa ubuhlungu.
• Ngesikhathi esifanayo ithubhu ibekwa, udokotela anganweba isophi somntwana ngensimbi ekhethekile ebizwa nge-dilator. Lokhu kuzokwenza ukuhlinzwa kwesikhathi esizayo kube lula. Le nqubo ingadinga ukuphindwa, kwesinye isikhathi kaningi, ngaphambi kokulungiswa.

I-tracheoesophageal fistula kanye ne-esophageal atresia yizinkinga ezisongela impilo. Badinga ukwelashwa ngokushesha. Uma lezi zinkinga zingelashwa:

• Ingane yakho ingaphefumula amathe namanzi kusuka esiswini kuya emaphashini. Lokhu kubizwa ngokuthi ukufisa. Kungadala ukuminyana kanye nenyumoniya (ukutheleleka kwamaphaphu).
• Ingane yakho ayikwazi ukugwinya nokugayeka nhlobo uma umphimbo ungaxhumi esiswini.

Izingozi ze-anesthesia nokuhlinzwa ngokujwayelekile zifaka:

• Ukusabela emithini
• Izinkinga zokuphefumula
• Ukopha, amahlule egazi, noma ukutheleleka

Izingozi zalokhu kuhlinzwa zifaka:

• Iphaphu eliwile (pneumothorax)
• Ukuvuza kokudla endaweni elungisiwe
• Ukushisa komzimba okuphansi (hypothermia)
• Ukuncipha kwezitho ezilungisiwe
• Ukuvulwa kabusha kwe-fistula

Ingane yakho izokwamukelwa egunjini labagula kakhulu (i-NICU) ngokushesha lapho odokotela bethola enye yalezi zinkinga.

Ingane yakho izothola umsoco ngomthambo (nge-intravenous, noma i-IV) futhi ingahle ibe semshinini wokuphefumula (i-ventilator). Ithimba lokunakekela lingasebenzisa ukuncela ukugcina uketshezi lungangeni emaphashini.

Ezinye izinsana ezingakashayi isikhathi, ezinesisindo esiphansi sokuzalwa, noma ezinokukhubazeka okuthile kokuzalwa ngaphandle kwe-TEF kanye / noma i-EA kungenzeka zingakwazi ukuhlinzwa zize zikhule zibe zikhulu noma kuze kube yilapho ezinye izinkinga sezelashiwe noma sezihambile.

Ngemuva kokuhlinzwa, ingane yakho izonakekelwa ku-NICU yesibhedlela.

Ukwelashwa okwengeziwe ngemuva kokuhlinzwa kuvame ukufaka:

• Ama-antibiotic njengoba kudingeka, ukuvikela ukutheleleka
• Umshini wokuphefumula (umshini wokuphefumula)
• Ishubhu lesifuba (ishubhu ngesikhumba singene odongeni lwesifuba) ukukhipha uketshezi kusuka esikhaleni esiphakathi kwangaphandle kwamaphaphu nangaphakathi kwesikhala sesifuba
• Iziphuzo ezifakwa ngaphakathi (IV), kufaka phakathi umsoco
• Oxygen
• Imithi yezinhlungu njengoba kudingeka

Uma zombili i-TEF ne-EA zilungiswa:

• Ishubhu lifakwa ngamakhala lingene esiswini (nasogastric tube) ngesikhathi sokuhlinzwa.
• Ukuphakelwa kuvame ukuqala ngale tube ngemuva kwezinsuku ezimbalwa ngemuva kokuhlinzwa.
• Ukuphakelwa ngomlomo kuqalwa kancane. Ingane ingadinga ukwelashwa ngokondla.

Uma kulungiswa i-TEF kuphela, i-G-tube isetshenziselwa ukondla kuze kulungiswe i-atresia. Ingane nayo ingadinga ukuncela okuqhubekayo noma okuvamile ukukhipha uketshezi oluvela phezulu.

Ngenkathi ingane yakho isesibhedlela, iqembu lokunakekela lizokukhombisa ukuthi uyisebenzisa kanjani futhi uyishintshe i-G-tube. Ungathunyelwa ekhaya ne-G-tube eyengeziwe. Abasebenzi basesibhedlela bazokwazisa inkampani ehlinzeka ngempilo emakhaya ngezidingo zakho zemishini.

Ukuthi ingane yakho ihlala isikhathi esingakanani esibhedlela kuya ngohlobo lokukhubazeka ingane yakho enakho nokuthi ngabe zikhona yini ezinye izinkinga ngaphezu kwe-TEF ne-EA. Uzokwazi ukuletha ingane yakho ekhaya lapho sebethatha ukondliwa ngomlomo noma ngethambo le-gastrostomy, isisindo, futhi baziphefumulela ngokwabo ngokuphepha.

Ukuhlinzwa kuvame ukulungisa i-TEF ne-EA. Lapho ukuphulukiswa kokuhlinzwa sekuqedile, ingane yakho ingaba nalezi zinkinga:

• Ingxenye yesifo esilungisiwe ingancipha. Ingane yakho ingadinga ukuthi ihlinzwe kakhulu ukwelapha lokhu.
• Ingane yakho ingahle ibe nesilungulela, noma i-reflux ye-gastroesophageal (GERD). Lokhu kwenzeka lapho i-asidi ephuma esiswini ikhuphukela emmangweni. I-GERD ingadala izinkinga zokuphefumula.

Ngesikhathi sobuntwana nasebusaneni, izingane eziningi zizoba nezinkinga ngokuphefumula, ukukhula, nokondla, futhi kuzodingeka ukuthi ziqhubeke nokubona bobabili umhlinzeki wazo wokunakekela oyinhloko kanye nochwepheshe.

Izingane ezine-TEF ne-EA nazo ezinokukhubazeka kwezinye izitho, imvamisa inhliziyo, zingaba nezinkinga zezempilo zesikhathi eside.

Ukulungiswa kwe-TEF; Ukulungiswa kwe-esophageal atresia

• Ukuletha ingane yakho ukuthi ivakashele ingane yakini egula kakhulu
• Ukunakekelwa kwesilonda sokuhlinzwa - kuvulekile

• Ukulungiswa kwe-fistula ye-Tracheoesophageal - uchungechunge

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IRothenberg SS. I-Esophageal atresia kanye ne-tracheoesophageal fistula malformations. Ku: Holcomb GW, Murphy P, St. Peter SD, eds. Ukuhlinzwa Kwezingane zeHolcomb ne-Ashcraft. Umhla wesi-7. IPhiladelphia, PA: Elsevier; 2020: isahluko 27.