Perforation o te puku: tohumate, maimoatanga, pōauautanga

I roto i te okana mate mau katoa kei roto i te kōhao puku, perforation o te puku, me te whewhe duodenum ko e pā ana ki te 2%. E ai ki ngā tatauranga, te auau o tenei pōauautanga o te mate ko te 7-12%, me te puta i roto i te tūroro nei tau ko 25-35 tau. I roto i tenei take, i roto i nga tangata puta reira 5 wa atu pinepine atu i te wahine.

Take o te perforation

Perforation o te puku (perforation) puta i raro mariao mana me tapa raro o te papanga. puta te reira i dysfunctions rerekē patency iaia i roto i te pera. whakamatauria ana tēnei whakamārama e te meka e i roto i te perforation i te rohe o te hinga 12 whewhe duodenal pakitara pekitīlia ranei he kahore toto. E 3 momo whewhe perforation o te puku:

• angamaheni (ringihia tirotiro puku ki te kōhao puku, whakawhanake peritonitis);
• mohiotia (perforation he repe hipoko kai, puninga mucosal, me te rite);
• rite pentratsii (perforation raro whakatuwheratia i roto i te whekau tata).

Tikanga, mua he tītohunga taua e te mamae kaha mate tūturu ulcerative e pumau mo te wā roa. I roto i tenei take, te pirau o tona taiepa turanga. Ka taea te meinga Perforation o te puku i te:

• aronganui me te ahotea tinana;
• whakamahi o te waipiro;
• exacerbation o mate ulcerative;
• opue;
• whētuki;
• maimoatanga ki etahi taero e meinga tenei māuiuitanga.

Me whai whakaaro e taha e kore e taea e te iwi pakeke i roto i te aamu o te whewhe e, no te mea kei te āhuatanga enei tūroro e te pikitia huna o te mate.

He aha pāngia e perforation

Ka rite ki te tikanga, mariao tāhapa i roto i kore ara e pā ana ki H.pylori mate. Te haamauraa o te whewhe keté i roto i 95% o H. pylori tohu tona etiology. Ka taea te whakaaro whewhe whakapeka rite te wā o te whewhe pekitīlia. Haunga H.pylori, e taea te rongo perforation o te puku i te:

• Zollinger-Ellison syndrome;
• mariao Drug me ētahi atu mate endocrine;
• pancreatogenic, a ētahi atu momo gepatogennymi ulceration whakapeka (hei tauira, syndrome o Crohn).

He o faufaa nui i roto i tona waikawa pūhaumāota paparanga whakangaromanga katoa me te hua i roto i te pēhanga i roto i te rohe puku hoki te ahua o te rua i roto i te taiepa pekitīlia. whakaaro Performative whewhe ma'i te ki wähanga te ahunga whakamua o te whewhe pekitīlia. i hanga tēnei māuiuitanga e i roto i te ngaro o te therapy tika.

tohu

E toru ngā wāhanga matua Perforation o te taiepa puku:

1. He āhua o te ru.
2. te pai teka.
3. Peritonitis.

Tika atamira puta ru i roto i perforation me te hinga o tirotiro pekitīlia i runga i ngā rau o te peritoneum. mana'o Mea fuu mamae "maripi-rite" e puta i roto i te papa o runga o te kōhao puku, e hohoro horapa ki te rohe katoa o te puku. timata te nuinga o tūroro i tenei wāhi ki te kokiri mai, ka karanga. Kei te tipu haere tere te pakeke whānui o te huru:

• heke pēhanga;
• he pini pōturi iho;
• riro mākū, te maeke me te koma integument kiri;
• e te manawanui he tūranga takoha - i tetahi taha, ki te turi peitatanga ki te puku.

I muri i te tetahi wā o te wā kei te ngoikore (āhua 7 haora) mamae, me i roto i ētahi wā, tino riro. Āta whakanuia ana bloating, e kore riro te reira na kukū, ngaro reo auscultation i roto i te piro. hypotension ora, tīmata arrhythmia ki puta me te tupu tachycardia. kia Wāhanga wā toko i te ora teka ki runga ki te 12 haora.

te mau hopearaa taea

Neke atu i te nga wāhanga e rua o te tangata o mua āta whakawhanake peritonitis. Ko lethargic te manawanui, uhi hiako whiwhi he hue mea oneone, hei tāpiapia ki werawera: te tohu o te kāwanatanga kino ake ngaa ano e. Ko te pakitara mua o te kukū peritoneum. Tino whakaheke te nui o mimi hua, ētahi wā noa mai ki anuria.

Ki te he te manawanui whewhe keté he puka mohiotia, he wātea i roto i te kiko retroperitoneal te perforation. I tua atu, kia ke ana ai te piata kai whekau a tawhio noa ranei. Pea te tukanga whakawhāititanga, ki te reira e maha adhesions. Uhi i te perforation ko o te maha ngā momo:

• pūmau;
• roa;
• poto.

Enei momo o perforation puta, ahu ratou ki te kia nui māmā. Kia mohiotia take whaiaro-te whakaora.

I tua atu i peritonitis te fifi irava o mate pekitīlia taea hypovolemia, ru, me te sepsis.

mate tātaritanga "whewhe puku"

titau Perforation o te puku tātaritanga tika, e taea te tāuta anake i te hītori tika kohia. Hei tātari i te mate, ko te mea e tika ana ki te kite i te mātanga. Tenei ahua o raruraru whai wāhi tākuta gastroenterologists me endoscopists.

He wa tino nui kia whakamatautauria ki ki te whakapae a koutou e whai koe i te perforation pekitīlia. e kore e taea te waiho tohu i roto i tetahi take, rite kia arahi i te wāhanga matatau o te mate ki te mau hopearaa tūnguru. Uru ki te endoscopist me te gastroenterologist tino hiahiatia hoki ia manawanui whakapae o te mate, rawa ki te aroaro pea o te perforation kati. I roto i tenei ako e kore e whakaatu raraunga ki tonu mo te tātaritanga, engari he tika to ratou whakatinanatanga hei wāhanga o te faaineineraa no te pokanga.

whakaritea Perforation o te kopu e te ara e whai ake nei:

• Radiography Tōkau.
• ultrasound puku.
• endoscopy runga.
• A, no te huna fifi o te tātaritanga me te perforation whakapae laparoscopy whakamahia.

Diseases ki tohu rite

Ka taea te pēnei Perforation o te puku ki taua ariā rite "puku whakapeka", no te mea me rerekëtanga tenei mate i:

• pancreatitis;
• cholecystitis me te whēkau;
• puku pirau;
• colic tākihi me te ate;
• Thrombosis rua mesenteric;
• whaturama o te aneurysm te pūtahi o roto i te kōhao puku;
• whakaeke ngakau;
• kiripūkahu.

uru wā ki te mātanga me te whakahaere mehua tātaritanga ka āwhina i whakapumautia he tātaritanga tika me te wa ki te timata maimoatanga o mate kino.

Me pēhea te ki te whakaora i te perforation?

Tei runga i te pikitia haumanu, te āwhina ki te perforation pekitīlia, he mea i roto i te maha ngā huarahi.

1. katinga Normal o te whewhe. Kei te hanga te reira mo te iwi taitamariki ki kahore hītori o keha i roto i tūroro paari ki te nui ake mōrea o te rehunga me āwhina whakahaere, me te ngā peritonitis E ruia ana.
2. Ki te kahore he peritonitis, e taea te tāpiri i tēnei wawaotanga i vagotomy proximal whiriwhiri, e hanga ana e ia taea ki te ārai i te maimoatanga wā roa-i roto i te paroita o te gastroenterology i te heke mai.
3. I roto i te aroaro o keha i roto i te pyloric, hohonu tuwhenua, nui toto, stenosis o te wahi matamua, me te iwi waimaero ki te mōrea nui o pokanga, whakamana excision o te koha, pyloroplasty me te kakau vagotomy.
4. A, no te he o te manawanui ahua whakauru o te mate ulcerative ranei he tohu atu te hītori perforation pekitīlia, e taea te tāpiri i tēnei pokanga gemigastrektomiey.
5. E wātea ana i runga i te whakamārama o te therapy laparoscopic me endoscopic hua pai. Ka endoscopic Tāpiritanga pokanga perforation pekitīlia maimoatanga vagotomy me endoscopic.

Ki te hiahia koe ki te whakaiti i te tūponotanga o te pokanga, ka taea distal gastrectomy laparoscopic pae perforation omentum tamponade ranei. Kei te pai ēnei whawhe nohotahi e tūroro e taea whakarato faaoraraa i roto i te wa nui tere.

I muri te raveraa i te mahi hāparapara mahuinga ia mo te ako tonu o te manawanui ko te tango o āpiha kore-steroidal (ka ratou whakaaro ki te ārai i te putanga o keha pekitīlia) ranei ki te taui i to ratou inhibitors cyclooxygenase, me te haepapatanga momo.

Ārai me te Prediction

I roto i te mea tino taimaha perforation o te matapae hoki o te roa i roto i te huru tātaritanga ētahi wā arata'i ki te putanga whakamate o te manawanui. Mate i roto i nga taitama ko āhua 2-6% (tango ki pūkete te pikitia haumanu, āwhina wa whakaratohia me etahi atu āhuatanga), te iwi paari, faarahi tenei whakarea e rave rahi taime.

He Tuarua Prevention o te mate - ka hiahia wā tātari me te hamani i te mate e taea kawea te manawanui ki tenei huru.