Pakati pa matenda a urinary system, reflux vesicoureteral imapezeka nthawi zambiri. Matendawa amakhudza kwambiri ana ndi okalamba. Kuzindikira kumakhala kovuta ndi kusakhalapo kwa zizindikilo zoonekeratu pazigawo zoyamba za matenda.
Kodi reflux ya vesicoureteral isani?
Reflux yowononga chikhodzodzo nthawi zambiri amatchulidwa ngati matenda omwe mitsempha ya mkodzo imayambira. Reflux ya mkodzo, kusuntha kwa ureter ndi impso zikuchitika potsutsidwa, zomwe zimasokoneza ntchito ya valve ya vesicle ya ureter. Izi zimachitika nthawi zonse pamene chikhodzodzo chikufalikira, chifukwa chake, patapita nthawi, pangakhale kusintha kwa mphamvu ya chiwalo ichi.
Kawirikawiri, kukakamizidwa kowonjezeka mu chikhodzodzo pamene ikudzaza kuyenera kuyambitsa valavu. Komabe, ndi reflux, mapangidwewa awonongeka kapena akufooka, zomwe zimayambitsa mkodzo wamakono. Kugwiritsidwa kwa mkodzo kungatheke pokhapokha ngati mukukodza komanso pakudza chikhodzodzo. Matendawa kwa nthawi yayitali sadziwonetsa okha ndipo amawoneka pamene akuyang'ana ziwalo za pelvis.
Reflux yogwira ntchito
Ndi mtundu uwu wa matenda, mkodzo reflux umachitika pokhapokha ukakodza. Minofu ya chikhodzodzo imayamba kuuluka, chifukwa chaichi, mkodzo umathiridwa mkati mwa ureters ndikupitirirabe mu impso. Panthawi imodzimodziyo, amapatsidwa kunja. Potero munthuyo amamva zovuta m'munda wa chiuno, kumbali. Matendawa amapezeka chifukwa cholephera kugwiritsira ntchito valavu yomwe ili mkati mwa chidziwitsochi.
Reflux yosautsa ya vesicoureteral
Reflux yamtunduwu imatanthawuza kusamutsidwa kwa mkodzo kuchokera pachikhodzodzo kupita kwa odwala, omwe amapezeka nthawi yodzazidwa ndi mkodzo. Ndi mtundu uwu wa matenda, kuperewera kwa valve kumatchulidwa kwambiri, kotero kulowa kwa mkodzo mu ureters ndi impso zimachitika nthawi zonse. Mkokomo wa mkodzo wobwerera umakhala chifukwa cha kuwonongeka, chikhodzodzo cha chikhodzodzo, ndi chikhalidwe cha valve chomwecho.
Chikhodzodzo chotsekemera / chifuwa chimayambitsa
Malingana ndi nthawi ya chitukuko cha matendawa, chimbudzi choyambirira ndi chachiwiri cha reflux chimakhala chokhaokha. Njira yoyamba yamatenda imatchulidwa pamene matendawa amachokera ku congenital anomalies ndipo amapangidwa pa siteji ya intrauterine chitukuko - congenital vesicoureteral reflux. Kuwonjezeka kwa chikhodzodzo ndi kukwanira kosakwanira kolowera kumene kumatsogolera ku kuphwanya, kumayambitsa mkodzo reflux, zomwe zimayambitsa izi zingakhale motere:
- kawiri kawiri ka ureter;
- dystopia mkamwa;
- kuswa kwa pakamwa;
- Mphindi yochepa kwambiri ya intravesical ureter.
Njira yachiwiri ya reflux ya vesicoureteral imabwera motsutsana ndi mkhalidwe wa zovuta zina zamakono. Zina mwazifukwa zambiri:
- mawonekedwe a urethra;
- stenosis ya khosi la chikhodzodzo;
- adenoma wa prostate;
- cystitis ;
- kukwinya kwa chikhodzodzo;
- kuwonongeka kwa chigawo cha ureteric pa opaleshoni.
Zizindikiro za reflux zowopsa
Chizindikiro cha matendawa nthawi zambiri chimabisika. Zomwe zingatheke, koma osati zovomerezeka za matendawa, madokotala amapereka zowawa, zopweteka m'munsi kumbuyo, zomwe zimawoneka mwamsanga chikhodzodzo chitatha. Ana amatha kuwonetsa ululu m'mimba, m'mimba.
Zizindikiro za matendawa zimayambitsidwa ndi sitepe ya matendawa. Kawirikawiri, chirichonse chimadalira pa siteji ya chitukuko cha reflux vesicoureteral, mlingo umene ungakhale motere:
- Mpaka 1 - mkodzo umabwerera ku ureter, sufikira pamphuno;
- 2 digita - reflux imakafika impso;
- 3 digita - dilates ya dilates;
- 4 digiri - geometry ya tsamba la mkodzo imasokonezeka, crimp ikuwoneka;
- 5 digiri - parenchyma ya mfundo ndi thinned, kusintha konseko kulipo.
Madandaulo ochokera kwa odwala madokotala amamva kawirikawiri kokha ndi chitukuko cha pyelonephritis. Pankhaniyi, palipo:
- kutentha kwa thupi;
- ululu wamimba;
- kuwonongeka kwa moyo wabwino;
- kuzungulira kwa mkodzo.
Kawirikawiri, PMR imapezeka pokhapokha pakukula kwa mavuto ndi zovuta zina, pakati pawo:
- cystitis yowonongeka (yofulumira mitsempha yotsekemera m'magulu ang'onoang'ono);
- pyelonephritis (kupweteka, khalidwe losaoneka bwino m'deralo, kutentha sikuposa madigiri 38);
- enuresis.
Chikhodzodzo ndi chiwerewere reflux - matenda
Mu njira yodzidzimitsira kuti azindikire za reflux ya vesicoureteral, ayenera kugwiritsidwa ntchito kwa ultrasound impso. Phunziroli likhoza kuchitidwa ngakhale asanakwane mwanayo (primary reflux). Chizindikiro cha kukambirana kwathunthu kwa urolo kungakhale kutambasula kwa pelvis (mozungulira kwambiri kuposa 5 mm). Kufufuza kwakukulu ngati pali kukayikira kwa matenda ayenera kuphatikizapo maphunziro awa:
- Njira za ma laboratory: kafukufuku wamakono, kuyesa magazi, chikhalidwe cha bakiteriya;
- chithunzi;
- nephroscintigraphy yogwira;
- uroflowmetry;
- chisamaliro ;
- Mikrotsionnaya cystourethrography;
- cystoscopy.
Chlamydial reflux - mankhwala
Kuchotsa reflux ya vesicoureteral, chithandizo chamankhwala chikuwongolera kuthetsa zinthu ziwiri zowononga:
- mpweya wa hydrodynamic chifukwa cha kuwonjezeka kwa chikhodzodzo;
- zochitika zamakono zamakono.
Ndikusokonezeka kulikonse, njira zochizira zimayambira ndi njira zowonongeka zomwe zikuphatikizapo:
- Kukonzekera kwa zovuta zamagetsi mu chikhodzodzo ndi ureter (Pikamilon, Elkar).
- Kupewa ndi kuchiza matenda opatsirana pogonana - uroseptics , antibiotics, phytotherapy (Tetracycline, Metronidazole, Ciprofloxacin).
- Kuthetsa zolakwa za urodynamics.
Zosangalatsa za chikhodzodzo - zotsimikizika zamakono
Ngati kubwereka kwa mkodzo kumachokera ku matenda a chiberekero, njira yokhayo yochizira ndiyo opaleshoni. Panthawiyi, kubwezeretsa ntchito ya valve ya ureter kumaphatikizapo pakuika minofu ndikupanga valavu mwa njira yopangira. Ndi njira yachiwiri ya MTCT, chithandizo choyenera cha matenda omwe amachititsa matendawa (matenda a urinary ndi urinary, matenda a chikhodzodzo) amafunika. Kukhoza kwa kutha kwa matendawa kuthetsa zowonongeka kungathe kufika 70%.
Endoscopic kukonza reflux vesicoureteral
Ngati palibe mankhwala othandizira odwala, pamene sikutheka kuthetsa reflux yowopsya, opaleshoniyo imakhala njira yokhayo yothandizira. Kawirikawiri, njira yotsirizira imagwiritsidwa ntchito. Kupyolera mu lumen ya ureters, popanda kuwonetsa pakhungu, kuika gelisi kumalowetsedwa m'dera lopanda chilema. Zimapanga chifuwa, chomwe chimakhala ngati valve, kuteteza kubwerera kumbuyo kwa mkodzo kuchokera mu chikhodzodzo kupita mu ureter.