I-Colovesical Fistula

-Delile

• Izimpawu
• Izimbangela nokuxilongwa
• Izinketho zokwelashwa
• Ukuhlinzwa
• Ukubuyiselwa
• Umbono

Ukubuka konke

I-colovesical fistula yisimo. Kuyinto yokuxhumana okuvulekile phakathi kwekholoni (amathumbu amakhulu) nesinye. Lokhu kungavumela udaba lwendle kusuka kukholoni ukuthi lungene esinyeni, lubangele ukutheleleka okubuhlungu nezinye izinkinga.

Ikholoni, esiza ukwakheka kwesitulo ukukhishwa nge-rectum, ihlala ngaphezulu kwesinye. Isinye sigcina umchamo ngaphambi kokuba sikhishwe ngomchamo. Udonga olukhulu lwesicubu ngokujwayelekile luhlukanisa ikoloni nesinye. Ukuhlinzwa noma okunye ukuhlukumezeka kule ngxenye yomzimba kungadala i-fistula.Lapho kuvuleka ukuvuleka, umphumela uba i-colovesical fistula, eyaziwa nangokuthi i-vesicocolic fistula.

Kuyelapheka i-fistula emhlophe. Kodwa-ke, ngoba akujwayelekile, kunenani elilinganiselwe lemininingwane mayelana nokuthi ungasingatha kanjani kangcono lesi simo esibuhlungu.

Izimpawu

Ungahle wazi ukuthi une-fistula e-colovesical uma uhlakulela okunye kokubandakanya:

• Pneumaturia. Lesi ngesinye sezimpawu ezivame kakhulu. Kwenzeka lapho igesi ephuma kukholoni ixubana nomchamo. Ungaqaphela amabhamuza emchameni wakho.
• I-Fecaluria. Lesi sibonakaliso senzeka uma unenhlanganisela yendaba emchameni. Uzobona umbala onsundu noma ubumnyama emchameni wakho.
• I-Dysuria. Lesi sibonakaliso sidala ukuzwa okubuhlungu noma okushisayo lapho uchama, kanye nezifo eziphindaphindayo zomgudu womchamo (UTI). Ingakhula kusuka kunoma yikuphi ukucasuka kwesinye, kepha cishe isigamu samacala e-colovesical fistula akhona nge-dysuria.

• Izimbangela nokuxilongwa

  Amaphesenti angaphezu kwesigamu amacala e-fistula ahlukahlukene angumphumela wesifo se-diverticular.

  
  

  Ezinye izimbangela ze-colovesical fistula zifaka:

  • umdlavuza obomvu
  • isifo sokuvuvukala, ikakhulukazi isifo sikaCrohn
  • ukuhlinzwa okubandakanya ikholoni noma isinye
  • i-radiotherapy (uhlobo lokwelashwa komdlavuza)
  • umdlavuza wezinye izitho ezizungezile

  Ukuhlonza i-fistula e-colovesical kungenziwa nge-cystography, uhlobo lokuhlolwa kwe-imaging. Ngesikhathi senqubo, udokotela wakho ufaka ishubhu elincane, eliguquguqukayo elinekhamera ngasesinqeni sakho. Ikhamera idlulisela izithombe zodonga lwesinye kukhompyutha, ukuze udokotela wakho abone ukuthi kune-fistula yini.

  Enye inqubo yokusiza ngemifanekiso i-barium enema. Lokhu kungasiza ukukhomba izinkinga ngekholoni. Ngesikhathi senqubo, udokotela wakho ufaka inani elincane loketshezi oluqukethe i-barium yensimbi engxenyeni yakho ngokusebenzisa ithubhu elincane. Uketshezi lwe-barium lumboza ingaphakathi le-rectum, luvumela ikhamera ekhethekile ye-X-ray ukuthi ibone izicubu ezithambile kukholoni ngokuningiliziwe kune-X-ray ejwayelekile.

  
  

  Izithombe ze-fistula, kanye nokuhlolwa komzimba, isampuli yomchamo, kanye nokubuyekezwa kwezinye izimpawu, kungasiza udokotela wakho ukuthola i-colovesical fistula.

  Izinketho zokwelashwa

  Ukwelashwa okuncanyelwayo kwe-foloula e-colovesical ukuhlinzwa.

  Ukwelashwa okulondolozayo kungazanywa uma i-fistula incane ngokwanele, hhayi ngenxa yokulimala, futhi isiguli esinezimpawu ezilinganiselwe. Odokotela futhi bangancoma ukwelashwa okulondolozayo lapho isiguli sinezinye izifo ezinzima kakhulu, ukuhlinzwa kungathathwa njengokuphephile, noma lapho umdlavuza usuthuthukile futhi ungasebenzi. Ukwelashwa okulondolozayo kungafaka:

  • ukondliwa ngemithambo yakho ukuze amathumbu akho angasebenzi futhi akwazi ukuphumula
  • ama-antibiotic nemithi ye-steroid
  • kufakwe ipayipi le-catheter esinyeni ukukhipha uketshezi okungenzeka ukuthi kungene kulo kusuka kukholoni

  Inhloso yokwelashwa okulondolozayo ukuthi i-fistula ivale futhi izelaphe yodwa. Kodwa-ke, ukuhlinzeka kusengadingeka ezimweni lapho i-fistula ingazeluli yodwa.

  
  

  Ngoba i-colovesical fistula iyinkinga ye-diverticulitis, qiniseka ukuthi ulandela imiyalo kadokotela wakho ekwelapheni izifo ezi-diverticular. Kwezinye izimo, imithi yanele ukumisa ukuqhubeka kwesimo.

  Ukuhlinzwa

  Lapho ukwelashwa okulondolozayo kungafaneleki noma kungasebenzi, uzodinga ukuhlinzwa. Ukuhlinzwa kungasusa noma kulungise i-fistula futhi kumise ukushintshana koketshezi phakathi kwesinye nekholoni.

  Uhlobo lokuhlinzwa oludingekayo ukwelapha i-colovesical fistula lincike kwi-etiology (imbangela), ukuqina, nendawo ye-fistula. Imvamisa, kulawa macala, odokotela basebenzisa uhlobo lokuhlinzwa olubizwa nge-sigmoid colectomy. Lokhu kuhlinzwa kuhilela ukususwa kwengxenye yekholoni engezansi. Le nqubo ifaka phakathi nokususwa kwe-fistula uqobo, nokukhishwa kwekholoni nesinye.

  Ukuhlinzwa kungenziwa ngokuhlinzwa okuvulekile. Odokotela benza ukusikeka okukhulu esiswini, noma bangena nge-laparoscopically, okubandakanya amathuluzi wokuhlinza akhethekile, amancane kanye nokusikwa okumbalwa okuncane. Ukuhlinzwa nge-laparoscopic kusetshenziswa kaningi kule nqubo ngoba kwenza ukutakula kusheshe futhi kunciphise ubungozi benkinga. Kwesinye isifundo, isikhathi esilinganiselwe sokuhlinzwa kwe-laparoscopic ukulungisa i-fistula ye-colovesical kwakungaphezu nje kwamahora amabili.

  Ukulungiswa kokuhlinzwa nganoma iyiphi indlela kufaka phakathi:

  • elele etafuleni lokuhlinzwa ngezinyawo ezinamaqhuqhuva (aziwa njengendawo ye-lithotomy)
  • i-anesthesia ejwayelekile
  • ukusikwa okuvulekile noma ukusikeka kwama-laparoscopic amaningi
  • Ukwehlukaniswa kwekholoni nesinye, okuhanjiswa kude kude ukuqhubeka nenqubo
  • ukususwa kokuhlinzwa kwe-fistula (inqubo eyaziwa njenge-resection)
  • ukulungiswa kwanoma yikuphi ukukhubazeka noma ukulimala esinyeni kanye / noma kukholoni
  • ukuthuthwa kabusha kwekholoni nesinye ezindaweni zabo ezifanele
  • ukubekwa kwesiqeshana esikhethekile phakathi kwekholoni nesinye ukusiza ukuvimbela ama-fistula wesikhathi esizayo ukuthi angaqali
  • ukuvalwa kwakho konke ukusikeka

  Ukubuyiselwa

  Ucwaningo lwase-Australia lokulungiswa kwe-fistula ye-laparoscopic colovesical fistula luthole ukuthi isilinganiso sokuhlala esibhedlela ngemuva kokuhlinzwa kwakuyizinsuku eziyisithupha. Kungakapheli izinsuku ezimbili, ukusebenza kwamathumbu okujwayelekile kubuyile. Ucwaningo lwamacala endoda eneminyaka engu-58 eyahlinzwa ngokusobala ukuze ilaphe i-colovesical fistula ithole ukuthi ibizizwa iphilile ezinsukwini ezimbili ngemuva kokuhlinzwa. Wadlulisa umchamo ocacile ngemuva kwezinsuku ezimbili, futhi.

  Udokotela wakho uzokunika ama-antibiotic kungakhathalekile uhlobo lokuhlinzwa noma ukuhlinzwa okwenziwayo.

  Kufanele uvuke futhi uhambe ngosuku olulandelayo ngemuva kokuhlinzwa kwakho. Uma kube nezinkinga, noma kunjalo, ungelulekwa ukuthi uhlale embhedeni usuku noma izinsuku ezimbili ezengeziwe. Uma ukuhlinzwa kuphumelele, kufanele ukwazi ukuqala kabusha imisebenzi ejwayelekile, njengokuhamba ngezitebhisi nokushayela, kungakapheli isonto noma amabili. Njenganoma yikuphi ukuhlinzwa endaweni yesisu, kufanele ugweme ukuphakamisa noma yini esindayo amasonto ambalwa. Qiniseka ukuthi ukhuluma nodokotela wakho nganoma yikuphi ukulinganiselwa emisebenzini yakho.

  Cishe uzonikezwa ukudla okucacile oketshezi ngosuku lokuqala noma ngemuva kokuhlinzwa. Ngemuva kwalokho uzokhuphukela ekudleni okuthambile, bese udla ukudla okujwayelekile. Uma unesifo se-diverticular, ungelulekwa ukuthi udle ukudla okunokudla okuphezulu kakhulu. Imininingwane yokudla kwakho izoncika kwezinye izindaba zakho zezempilo. Uma ukhuluphele, uzokwelulekwa ukuthi ulandele uhlelo lokwehlisa isisindo kufaka phakathi izinguquko zokudla nokuzivocavoca umzimba njalo.

  Uma ubona ukuvulwa kokuqhekeka, ukuqunjelwa okukhulu, ukopha ku-rectum yakho, noma umchamo okhanyayo, shayela udokotela wakho. Ubuhlungu abuhlobene nokuphulukiswa kanye nezimpawu zokutheleleka kumasayithi okusika njengokubomvu, imfudumalo, noma amanzi aminyene ngemuva kokuhlinzwa nawo kufanele kubikwe.

  Umbono

  Yize kubuhlungu, i-colovesical fistula ingelashwa ngempumelelo. Kuyafana nezimbangela eziyisisekelo, njengezifo eziguquguqukayo. Noma ungadinga ukushintsha indlela odla ngayo nendlela ophila ngayo, lezi zimo kanye nokwelashwa kwazo akufanele kudale izinkinga zesikhathi eside.