Ukulungiswa kwe-hernia okuzalwa ngokwe-diaphragmatic

Ukulungiswa kwe-henia (CDH) ye-Congenital diaphragmatic ukuhlinzwa ukulungisa imbobo noma isikhala ku-diaphragm yengane. Lokhu kuvulwa kubizwa ngokuthi yi-hernia. Luhlobo olungavamile lokukhubazeka kokuzalwa. I-Congenital isho ukuthi inkinga ikhona ngesikhathi sokuzalwa.

Ngaphambi kokuba kwenziwe ukuhlinzwa, cishe zonke izinsana zidinga okokuphefumula ukuze zithuthukise amazinga azo oksijini.

Ukuhlinzwa kwenziwa ngenkathi ingane yakho ingaphansi kwe-anesthesia ejwayelekile (ilele futhi ayikwazi ukuzwa ubuhlungu). Udokotela ohlinzayo uvame ukusika isisu esiswini ngaphansi kwezimbambo ezingenhla. Lokhu kuvumela ukuthi kutholakale izitho ezisendaweni. Udokotela ohlinzayo udonsa lezi zitho ngobumnene azibeke endaweni yazo ngembobo esikuyi-diaphragm nangaphakathi kwesisu.

Ezimweni ezingaphansi kakhulu, ukuhlinzwa kungenziwa ngokusebenzisa ukuqhuma okuncane esifubeni. Ikhamera encane yevidiyo ebizwa nge-thoracoscope ifakwa kwesinye sezinto ezisikiwe. Lokhu kuvumela udokotela ohlinzayo ukuthi abuke ngaphakathi kwesifuba. Izinsimbi zokulungisa imbobo ku-diaphragm zibekwa kokunye ukusikwa.

Kunoma yiluphi uhlobo lokuhlinza, udokotela ohlinzayo ulungisa imbobo ku-diaphragm. Uma umgodi mncane, ungalungiswa ngemithungo. Noma, ucezu lwesiqeshana sepulasitiki lusetshenziselwa ukumboza umgodi.

I-diaphragm iyisicubu. Kubalulekile ekuphefumuleni. Ihlukanisa umgodi wesifuba (lapho inhliziyo namaphaphu akhona) endaweni yesisu.

Enganeni ene-CDH, isicubu se-diaphragm asakheki ngokuphelele. Ukuvulwa kwe-CDH kuvumela izitho ezisuka esiswini (esiswini, ubende, isibindi namathumbu) ukuthi zikhuphuke ziye esifubeni lapho kukhona amaphaphu. Amaphaphu awakhuli ngokujwayelekile futhi ahlala emancane kakhulu ukuba izingane zikwazi ukuziphefumulela lapho zizalwa. Imithambo yegazi emaphashini nayo ikhula ngokungajwayelekile. Lokhu kuholela ekutheni i-oxygen enganele ingene emzimbeni wengane.

I-hernia e-diaphragmatic ingaba yingozi empilweni kanti izingane eziningi ezine-CDH zigula kakhulu. Ukuhlinzwa ukuze kulungiswe i-CDH kufanele kwenziwe ngokushesha okukhulu ngemuva kokuzalwa kwengane.

Izingozi zalokhu kuhlinzwa zifaka:

• Izinkinga zokuphefumula, ezingaba nzima
• Ukopha
• Iphaphu eliwile
• Izinkinga zamaphaphu ezingapheli
• Ukutheleleka
• Ukusabela emithini

Izingane ezizalwa zine-CDH ziyangeniswa egunjini labagula kakhulu elisanda kuzalwa (NICU). Kungaba izinsuku noma amasonto ngaphambi kokuba ingane izinzile ngokwanele ukuba ihlinzwe. Ngenxa yokuthi lesi simo sisongela impilo futhi ukuhambisa usana olusanda kuzalwa kuyingozi, izingane ezaziwa ukuthi zine-CDH kufanele zilethwe esikhungweni esinabahlinzayo bezingane kanye nezazi ze-neonatologists.

• Ku-NICU, ingane yakho izodinga umshini wokuphefumula (umshini wokuphefumula umshini) ngaphambi kokuhlinzwa. Lokhu kusiza ingane ukuthi iphefumule.
• Uma ingane yakho igula kakhulu, umshini we-heart-lung bypass (extracorporeal membrane oxygenator, noma i-ECMO) ungadingeka ukwenza umsebenzi wenhliziyo namaphaphu.
• Ngaphambi kokuhlinzwa, ingane yakho izoba nama-x-ray nokuhlolwa kwegazi njalo ukubona ukuthi amaphaphu asebenza kanjani. Inzwa yokukhanya (ebizwa nge-pulse oximeter) ithephelwa esikhunjeni somntwana ukuqapha izinga le-oxygen egazini.
• Ingane yakho inganikezwa imithi yokulawula umfutho wegazi nokuhlala unethezekile.

Ingane yakho izoba namashubhu abekiwe:

• Kusukela emlonyeni noma ekhaleni kuya esiswini ukugcina umoya ungangeni esiswini
• Emthanjeni ukuqapha umfutho wegazi
• Emthanjeni ukuletha izakhamzimba kanye nemithi

Ingane yakho izoba semshinini wokuphefumula ngemuva kokuhlinzwa futhi izohlala esibhedlela amasonto ambalwa. Uma usususiwe emshinini wokuphefumula, ingane yakho kungenzeka isadinga umoya-mpilo nemithi isikhashana.

Ukuphakelwa kuzoqala ngemuva kokuthi amathumbu engane yakho aqale ukusebenza. Ukuphakelwa kuvame ukunikezwa ngethumbu elincane, elithambile lokudla kusuka emlonyeni noma ekhaleni kuya esiswini noma emathunjini amancane kuze kube yilapho ingane yakho ingathatha ubisi ngomlomo.

Cishe zonke izinsana ezine-CDH zine-reflux lapho zidla. Lokhu kusho ukuthi ukudla noma i-asidi esiswini sabo ikhuphukela phezulu emphinjeni wabo, ithubhu eliholela ukusuka emphinjeni kuye esiswini. Lokhu kungaba ukungakhululeki. Futhi kuholela ekukhafuleni njalo nokuhlanza, okwenza ukuphakelwa kube nzima kakhulu uma ingane yakho ithatha ukudla ngomlomo. I-Reflux yandisa ubungozi be-pneumonia uma izingane zihogela ubisi emaphashini azo. Kungenza futhi ukuthi kube yinselele ezinganeni ukuthi zithathe amakhalori anele ukuze zikhule.

Abahlengikazi kanye nochwepheshe bokudla bazokufundisa izindlela zokubamba nokondla ingane yakho ukuvimbela i-reflux. Ezinye izingane zidinga ukuba sethubeni lokudla isikhathi eside ukuzisiza zithole amakhalori anele ukuze zikhule.

Umphumela walokhu kuhlinzwa uncike ekutheni amaphaphu engane yakho athuthuke kanjani. Ezinye izingane zinezinye izinkinga zezokwelapha, ikakhulukazi ngenhliziyo, ubuchopho, imisipha namalunga, okuvame ukuthinta ukuthi ingane isebenza kahle kangakanani.

Imvamisa umbono ulungile ezinganeni ezinezicubu zamaphaphu ezithuthukile futhi azikho ezinye izinkinga. Yize kunjalo, iningi lezingane ezizalwa zinenkinga yediyaphragmatic zigula kakhulu futhi zizohlala esibhedlela isikhathi eside. Ngokuthuthuka kwezokwelapha, umbono walezi zingane uyathuthuka.

Zonke izingane ezilungiswe i-CDH kuzodingeka zigadwe ngeso lokhozi ukuze kuqinisekiswe ukuthi imbobo ku-diaphragm yazo ayiphinde ivuleke njengoba ikhula.

Izingane ezinokuvula noma ukukhubazeka okukhulu ku-diaphragm, noma ezazinezinkinga eziningi ngamaphaphu azo ngemuva kokuzalwa, zingaba nesifo samaphaphu ngemuva kokuphuma esibhedlela. Bangadinga umoya-mpilo, imithi, kanye neshubhu lokudla izinyanga noma iminyaka.

Ezinye izingane zizoba nezinkinga zokukhasa, ukuhamba, ukukhuluma nokudla. Bazodinga ukubona abelaphi bomzimba noma bomsebenzi ukubasiza ukuba bathuthukise imisipha namandla.

I-hernia e-diaphragmatic - ukuhlinzwa

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

• Ukulungisa i-hernia ye-diaphragmatic - uchungechunge

ICarlo WA, Ambalavanan N. Ukuphazamiseka kwendlela yokuphefumula. Ku: Kliegman RM, Stanton BF, St Geme JW, Schor NF, ama-eds. Incwadi kaNelson Yezingane. Umhla ka-20. IPhiladelphia, PA: Elsevier; 2016: isahluko 101.

IHollinger LE, iHarting MT, uLally KP. Ukulandelwa kwesikhathi eside kwe-hernia ye-diaphragmatic yokuzalwa. I-Semin Pediatr Surg. 2017; 26 (3): 178-184. I-PMID: 28641757 www.ncbi.nlm.nih.gov/pubmed/28641757.

UKeller BA, Hirose S, Umlimi DL. Izinkinga zokuhlinzwa zesifuba nezomoya. Ku: Gleason CA, Juul SE, ama-eds. Izifo zika-Avery Zomntwana osanda kuzalwa. Umhlaka 10. IPhiladelphia, PA: Elsevier; 2018: isahluko 49.

I-Tsao KJ, uLally KP. I-hernia ye-diaphragmatic yokuzalwa nokuzalwa. Ku: Holcomb GW, Murphy JP, Ostlie DJ, abahleli. Ukuhlinzwa Kwezingane ze-Ashcraft. Umhlaka 6. IPhiladelphia, PA: Elsevier Saunders; 2014: isahluko 24.