Kulepheretsa UPJ

Ureteropelvic junction (UPJ) kutsekeka ndikutsekeka komwe gawo la impso limalumikiza imodzi mwachubu ku chikhodzodzo (ureters). Izi zimalepheretsa kutuluka kwa mkodzo mu impso.

Kulepheretsa kwa UPJ kumachitika kwambiri mwa ana. Nthawi zambiri zimachitika mwana akamakula m'mimba. Izi zimatchedwa chikhalidwe chobadwa (chobadwa kuyambira kubadwa).

Kutsekeka kumachitika pomwe pali:

• Malo ochepera pakati pa ureter ndi gawo la impso lotchedwa aimpso pelvis
• Mitsempha yamagazi yachilendo yodutsa ureter

Zotsatira zake, mkodzo umakula ndikuwononga impso.

Kwa ana okalamba komanso achikulire, vutoli limatha kukhala chifukwa cha zilonda zam'mimba, matenda, chithandizo cham'mbuyomu chotsekera, kapena miyala ya impso.

Kulepheretsa kwa UPJ ndichomwe chimayambitsa kufooka kwamikodzo mwa ana. Tsopano amapezeka kawirikawiri asanabadwe ndi mayeso a ultrasound. Nthawi zina, vutoli silingachitike mpaka atabadwa. Kuchita opaleshoni kungafunike adakali aang'ono ngati vutoli ndi lalikulu. Nthawi zambiri, opareshoni safunika mpaka mtsogolo. Zovuta zina sizifuna opaleshoni konse.

Sipangakhale zizindikiro zilizonse. Zizindikiro zikachitika, zimatha kuphatikiza:

• Kupweteka kumbuyo kapena m'mbali makamaka mukamwa ma diuretics monga mowa kapena caffeine
• Mkodzo wamagazi (hematuria)
• Mphuno pamimba (pamimba)
• Matenda a impso
• Kukula kosauka kwa ana (kulephera kukula)
• Matenda a mkodzo, nthawi zambiri amakhala ndi malungo
• Kusanza

Ultrasound panthawi yoyembekezera imatha kuwonetsa mavuto a impso mwa mwana wosabadwa.

Mayeso atabadwa atha kukhala:

• BUNI
• Chilolezo cha Creatinine
• Kujambula kwa CT
• Maelekitirodi
• IVP - yosagwiritsidwa ntchito kwambiri
• CT urogram - kusanthula impso ndi ziwombankhanga zonse zosiyana ndi IV
• Kujambula kwa nyukiliya impso
• Kutulutsa cystourethrogram
• Ultrasound

Opaleshoni yokonza kutsekeka imalola mkodzo kuyenda bwinobwino. Nthawi zambiri, opaleshoni yotseguka (yolanda) imachitika mwa makanda. Akuluakulu amatha kuthandizidwa ndi njira zochepa zowononga. Njirazi zimaphatikizapo kudula kocheperako kuposa opaleshoni yotseguka, ndipo imatha kuphatikiza:

• Njira ya Endoscopic (retrograde) sifunikira kudula khungu. M'malo mwake, chida chaching'ono chimayikidwa mu urethra ndi chikhodzodzo komanso mu ureter wokhudzidwayo. Izi zimathandiza dokotalayo kutsegula kutsegula mkati.
• Njira yopangira mavitamini imaphatikizapo kudula kochepa pambali ya thupi pakati pa nthiti ndi mchiuno.
• Pyeloplasty imachotsa khungu m'mabala otsekedwa ndikugwirizananso gawo la impso ndi ureter wathanzi.

Laparoscopy idagwiritsidwanso ntchito kuthana ndi kutsekereza kwa UPJ kwa ana ndi akulu omwe sanachite bwino ndi njira zina.

Chubu chotchedwa stent chitha kuyikidwa kukhetsa mkodzo kuchokera ku impso mpaka opaleshoniyi itachira. Thumba la nephrostomy, lomwe limayikidwa m'mbali mwa thupi kukhetsa mkodzo, lingafunikenso kwakanthawi kochepa pambuyo pochitidwa opaleshoni. Mtundu uwu wa chubu ukhoza kugwiritsidwanso ntchito kuchiza matenda oyipa asanakachite opareshoni.

Kuzindikira ndikuchiza vutoli koyambirira kungathandize kupewa kuwonongeka kwa impso mtsogolo. Kulepheretsa kwa UPJ kupezeka asanabadwe kapena asanabadwe kumatha kusintha pakokha.

Ana ambiri amachita bwino ndipo alibe mavuto okhalitsa. Kuwonongeka kwakukulu kumatha kuchitika kwa anthu omwe amapezeka atakula.

Zotsatira zazitali ndizabwino ndi chithandizo chamakono. Pyeloplasty ili ndi mwayi wopambana kwakanthawi.

Ngati sanalandire, kutsekedwa kwa UPJ kumatha kubweretsa kuwonongeka konse kwa impso (kulephera kwa impso).

Miyala ya impso kapena matenda amatha kupezeka mu impso zomwe zakhudzidwa, ngakhale atalandira chithandizo.

Itanani zaumoyo ngati mwana wanu ali ndi:

• Mkodzo wamagazi
• Malungo
• Chotupa m'mimba
• Zizindikiro zowawa kwakumbuyo kapena kupweteka m'mbali mwake (dera loyang'ana mbali za thupi pakati pa nthiti ndi mafupa a chiuno)

Ureteropelvic mphambano kutsekeka; Kutsekeka kwamipiringidzo ya UP; Kutsekereza mphambano ya ureteropelvic

• Matenda a impso

Mkulu JS. Kutsekedwa kwa thirakiti. Mu: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, olemba. Nelson Textbook of Pediatrics. Wolemba 21. Philadelphia, PA: Elsevier; 2020: chap 555.

Frøkiaer J. Kutsekeka kwa kwamikodzo. Mu: Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu ASL, olemba. Brenner ndi Rector a Impso. 10th ed. Philadelphia, PA: Elsevier; 2016: chap 38.

Meldrum KK. Pathophysiology yokhudzana ndi kwamikodzo. Mu: Wein AJ, Kavoussi LR, Partin AW, Peters CA, olemba. Urology wa Campbell-Walsh. 11th ed. Philadelphia, PA: Elsevier; 2016: chap 48.

Nakada SY, SL Yabwino Kwambiri. Kuwongolera kutsekemera kwapamwamba kwamikodzo. Mu: Wein AJ, Kavoussi LR, Partin AW, Peters CA, olemba. Urology wa Campbell-Walsh. 11th ed. Philadelphia, PA: Elsevier; 2016: chap 49.

Stephany HA, Ost MC. Matenda a Urologic. Mu: Zitelli BJ, McIntire SC, Nowalk AJ, eds. Zitelli ndi Davis ’Atlas of Pediatric Physical Diagnosis. Wachisanu ndi chiwiri. Philadelphia, PA: Elsevier; 2018: mutu 15.