Afferent loop syndrome: nchoputa na ọgwụgwọ

Usoro ịwa ahụ na-fọrọ nke nta mgbe jikọtara ize ndụ. Ke adianade na o kwere omume ọbara ọgbụgba n'oge ịwa ahụ, e nwere ndị ọzọ ogologo oge nsogbu. Nke a bụ eziokwu karịsịa banyere ọtụtụ manipulations nke mwepụ na rụrụ ngwa ma ọ bụ òkè ya. Otu ihe atụ bụ ime Billroth-2. Ya kachasi mkpa mejupụtara na mwepụ nke kasị nke afo na-eke ihe anastomosis na obere eriri afọ. afferent loop ọrịa mgbe amalite mgbe a n'ịwa ahụ. Dị otú ahụ nsogbu nwere ike ibili ozugbo ịwa ahụ, na a ọnwa ole na ole mgbe e mesịrị. Na mmepe nke a ọnọdụ na-enyo enyo, ma ọ bụ ọ dị mkpa na ọzọ ịwa.

Echiche nke afferent loop syndrome

Afferent loop syndrome mgbe gastric resection n'akparamagwa banyere 13% nke ikpe. Nke a na ọnụ ọgụgụ nwere ike ịdị iche iche site 1 50%, dị ka dọkịta. Ya isi mgbaàmà na- vomiting bile, metụtara nri oriri. Afferent loop syndrome - a ọnọdụ nke akụkụ nke eriri afọ bụ, dị ka ọ na-"agbanyụrịrị" si mgbaze usoro. Dị ka a N'ihi ya, ndị bile accumulates na ngalaba na na ọnụnọ nke oghom ihe akwafuo si. Aha ọzọ a sikwuoro - duodenobilliarny syndrome. Steeti a bụ a dị ize ndụ ihe ịrịba ama, ya mere na-achọ ịwa ahụ ọgwụgwọ.

Akpata nke syndrome

Isi kpatara afferent loop syndrome bụ ịwa Billroth-2. Ọ bụ a oke ịwa ahụ na-emetụta ahụ niile. A yiri ọrụ a rụrụ na gastric cancer, mmepe nke nsogbu nke peptic ọnyá afọ ọrịa, nke ike-tutu amama nwayọọ ụzọ. Dị ka a N'ihi nke a mkpachapụ nke duodenum na obere eriri afọ na-aba ifịk ke omume nke mgbaze. N'ihi nke a na-eto eto syndrome nke afferent akaghị.

Ihe na-emetụta omume nke a sikwuoro, bụ ndị na-esonụ imebi:

1. Mechanical akpata. N'okpuru ebe ọ na ọwọrọ nri pụta abanye lumen "anya" na-adabere. Ọzọkwa, e na-akwakọba bile, nke nwekwara igbu oge usoro nke mgbaze.
2. Loss nke Akwara ụda na "anya" ngalaba. Nke a mere na-akpatakarị-adịghị ala ala syndrome nke afferent loop mgbe resection.
3. Spasm nke anastomosis - nkwụsị nke ogwe nke afo na obere eriri afọ. mọzụlụ nwekwara ike belata na akaghị tinyekwa.
4. Ọnyá nkwarụ n'oge anastomosis. Ọ na-eduga ná mpụta nke n'ibu ihe mere afferent loop syndrome. Ọ nwere ike ịzụlite dị ka a bụ isi (mgbe ọrụ), na a ugboro abụọ.
5. Inflection afferent akaghị. Na-emekarị ọ na-amalite ọzọ.

Afferent loop syndrome: pathogenesis nke ọrịa

The usoro nke afferent loop syndrome mejupụtara ọtụtụ nkeji. Mbụ niile e nwere ihe ịda iwu maka ahu na mbụ anatomical na ọtọ interactions. Dị ka a n'ihi "wuru" nhazigharị nke digestive usoro usoro nri dịgasị esi kpọpụ mmadụ nile. Food, họọrọ na "anya" nsia loop, nwere ike agaghị agabiga on. Ya mere e nwere atụfu ya azụ - reflux. Ke adianade do, na pathogenesis nke mkpali usoro ugbu a. Ọ na-adị n'ihi na ọnọdụ na-achọghị nke pụta na digestive hypotension KDP. N'ihi bụ a abụọ nsia dysbiosis. Ọ ekemende na-eduga ná mbufụt nke digestive tract: cholecystitis, pancreatitis, esophagitis.

The adakarị picture na afferent loop syndrome

Isi ngosipụta nke a sikwuoro bụ ihe mgbu na vomiting. Abdominal erughị ala nwere ike ime ozugbo ma ọ bụ mgbe ọrụ karịrị oge. Ke akpa idaha e a bụ isi, nnukwu afferent loop syndrome. Ọ e ji cramping na ihe mgbu Expander uwa ke nri hypochondrium na epigastric. Na-adịghị ala ala syndrome dapụtara adakarị picture loop na-kwupụtara abụghị nke ukwuu. Pain emee ukwuu n'ime mgbe nri, ọzọ mgbe - na n'ikuku nke ọdụdụ oriri. N'agbanyeghị nke oge nke omume nke nsogbu (nnukwu ma ọ bụ ala ala oge) a hụrụ vomiting. Ọ na-abịa mgbe na ịrị elu nke ihe mgbu ke afo, na-emekarị na-esonụ a nri. N'ihi Ugboro vomiting nwere ike igbunye ruo 500 ml kwa ụbọchị nke bile. N'ihi bụ a-aga n'ihu depletion nke ahu. Ọrịa ngwa ngwa hapụ arọ, na-eche general adịghị ike.

Afferent loop syndrome: achọpụta ọrịa daa ọrịa

Diagnosis nke ọrịa na-amalite na anamnesis (bufee gastrectomy) na nnyocha nke onye ọrịa. Mbụ niile mkpa ka ị mara banyere ọdịdị nke ihe mgbu na ugboro nke vomiting, ya njikọ na nri usoro. On ule, kwesịrị ịṅa ntị abdominal asymmetry: nri ngalaba ruo. Nke a mgbaàmà aga efep mgbe vomiting, dị ka ọdịnaya nke loop abịa. Ọzọ mma bụ jaundice nke sclera na akpụkpọ.

Na mgbakwunye na nwale nke na-adakarị data, laabu na instrumental nchọpụta nsogbu. Mgbanwe nwere ike KLA (B-12 erughi anaemia), ọbara iteto, coprogram (ọdịdị leukocytes, undigested abụba). Mgbe X-ray emission hụrụ mgbaàmà nke a niche na afferent loop, gipermotornaya dyskinesia. The iche gị n'ụlọnga jupụtara n'ime dapụtara akaghị. Ọzọkwa rụrụ endoscopic nyochaa. Na-adịghị ala ala afferent loop ọrịa mgbe akara mkpali mgbanwe gallbladder na ducts. Mgbe ụfọdụ, pancreatitis amalite. Mgbe a mbufụt n'anwụ na pancreas. Mgbe agha mkpụrụ ọdịnaya nke nsia nje osisi a hụrụ, ihe ruru nke isi pancreatic enzymes. Ogo nke ọrịa na-ekpebisi ike site na depletion nke ahụ ahụ, size nke ọnwụ nke bile ndidi.

Gịnị bụ ihe ize ndụ nke afferent loop syndrome: nsogbu

Ọ ga-eti na afferent loop syndrome bụ oké sikwuoro nke gastric resection. The na-aga n'ihu ọnwụ nke bile nwere ike ime oké depletion nke ahu. The nri abatakwa ahụ na-apụghị n'ụzọ kwesịrị ekwesị gbara (n'ihi "anya" ndị KDP na akụkụ nke obere eriri afọ), na nri na-adịghị etinye obi gị dum. N'ihi nke mmepe nke nsia dysbiosis eriri afọ akụkụ na-gụrụ mkpali Filiks. Na mmepe nke reflux esophagitis na depụtara mgbaàmà na-atụkwasịkwara obi mgbu, a mmetụta nke "akpụ na akpịrị." Cholecystitis na-esonyere a ilu uto ke inua, ọgbụgbọ. Ọ bụrụ na enyekwara mbufụt nke pancreas, ihe mgbu nwere ike adịkwu nwere herpes agwa. Mgbe oge nke ugbu a pancreatitis nwere ike ịzụlite arịa ọrịa shuga. Nsogbu nke nnukwu afferent loop syndrome gụnyere peritonitis, nsia mgbochi. Ọrịa ndị a na-achọ ozugbo ịwa ahụ na-elekọta.

Ọgwụgwọ nke syndrome nke afferent loop

Oke nke ọgwụgwọ na-adabere na-enwe ndidi, laabu data na instrumental ule. Ọ dị mkpa ka ị mara ihe ogo nke syndrome nwere afferent akaghị. Ọgwụgwọ nwere ike ịbụ na-achọghị mgbanwe na-awa ahụ. Nwayọọ nye iwu a pụrụ iche nri, mkpali na antibacterial ọgwụ ọjọọ (ọgwụgwọ "Tsefriakson", "Tsiprolet"). Mgbe ụfọdụ ịchọ ugboro ugboro gastric lavage. Na-agafeghị oke na oké mkpa ịwa ahụ ọgwụgwọ. Ọ ga-iji na-iwepu ọnọdụ na-achọghị nri. Ọtụtụ mgbe na-emepụta a nwughari nke anastomosis. Mgbe ọ na-ehuda dapụtara loops mmasị ka ziri ezi ọnọdụ na sutured na peritoneum. The ego na ụdị ịwa ahụ ọgwụgwọ nwere ike ịdị iche na-adabere na ihe na-akpata nsogbu.

Prevention of afferent loop syndrome

Ugbu a, ịwa ahụ na Billroth-2 na-agbalị iji dochie ndị ọzọ usoro ịwa ahụ. Nke a na-eme iji chebe physiology nke digestive tract. Ọ bụrụ na Billroth-2 ọrụ ma e mere, ọ dị mkpa iji mezuo ihe niile mgbochi kenyere site dọkịta. N'ụzọ bụ isi a na-agụnye nri. Mgbe resection nwere ike ghara iri mara abụba na nri ratụ ratụ. Were nri gị mkpa 6-7 ugboro n'ụbọchị na obere òkè na ọkara mmiri mmiri ala (porridges, ofe).