Myelomeningocele

Myelomeningocele ndi vuto lobadwa nalo lomwe msana ndi ngalande ya msana sizimatseka asanabadwe.

Matendawa ndi mtundu wa msana bifida.

Nthawi zambiri, m'mwezi woyamba wamimba, mbali ziwiri za msana wa mwana (kapena msana) zimalumikizana kuti ziphimbe msana, misana yam'mimba, ndi meninges (minofu yophimba msana). Ubongo womwe ukukula ndi msana panthawiyi umatchedwa neural tube. Spina bifida amatanthauza chilema chilichonse chobadwa komwe neural tube m'dera la msana imalephera kutseka kwathunthu.

Myelomeningocele ndi vuto la neural tube lomwe mafupa a msana samapangika kwathunthu. Izi zimabweretsa ngalande yosakwanira ya msana. Msana ndi meninges zimachokera kumbuyo kwa mwanayo.

Vutoli limatha kukhudza mwana m'modzi mwa makanda 4,000 onse.

Zina zonse za spina bifida nthawi zambiri zimakhala:

• Spina bifida occulta, momwe mafupa a msana samatsekera. Mphepete ndi msana zimakhalabe pomwepo ndipo khungu nthawi zambiri limakwirira cholakwika.
• Meningoceles, vuto lomwe meninja amatha kutuluka kubvuto la msana. Msana wa msana umakhalabe m'malo.

Matenda ena obadwa nawo kapena zofooka zobadwa zitha kukhalanso mwa mwana yemwe ali ndi myelomeningocele. Ana asanu ndi atatu mwa khumi omwe ali ndi vutoli ali ndi hydrocephalus.

Zovuta zina za msana wam'mimba kapena mafupa a mafupa zimawoneka, kuphatikiza:

• Syringomyelia (chotupa chodzaza madzi mkati mwa msana)
• Kusokoneza m'chiuno

Zomwe zimayambitsa myelomeningocele sizikudziwika. Komabe, kuchepa kwa folic acid mthupi la mkazi asanabadwe komanso nthawi yomwe ali ndi pakati kumawoneka ngati kotenga nawo mbali pakubala kwamtunduwu. Folic acid (kapena folate) ndikofunikira pakukula kwaubongo ndi msana.

Mwana akabadwa ndi myelomeningocele, ana amtsogolo m'banjali amakhala pachiwopsezo chachikulu kuposa anthu wamba. Komabe, nthawi zambiri, sipakhala kulumikizana kwa mabanja. Zinthu monga matenda ashuga, kunenepa kwambiri, komanso kugwiritsa ntchito mankhwala oletsa kulanda mwa mayi kumatha kukulitsa chiopsezo cha vutoli.

Mwana wakhanda yemwe ali ndi vutoli amakhala ndi malo otseguka kapena thumba lodzaza madzi pakatikati kuti atsike kumbuyo.

Zizindikiro zimaphatikizapo:

• Kutaya chikhodzodzo kapena matumbo
• Kuperewera pang'ono kapena kwathunthu
• Mbali kapena wathunthu ziwalo za miyendo
• Kufooka kwa m'chiuno, miyendo, kapena mapazi a wakhanda

Zizindikiro zina ndi / kapena zizindikilo zingaphatikizepo:

• Mapazi kapena miyendo yachilendo, monga phazi lamiyendo
• Kupanga kwamadzimadzi mkati mwa chigaza (hydrocephalus)

Kuwunika musanabadwe kumatha kuzindikira izi. Pakati pa trimester yachiwiri, amayi apakati amatha kuyezetsa magazi wotchedwa quadruple screen. Kuyesaku kumawunikira myelomeningocele, Down syndrome, ndi matenda ena obadwa nawo mwa mwana. Amayi ambiri omwe ali ndi mwana wokhala ndi msana wam'mimba amakhala ndi puloteni yochulukirapo yotchedwa maternal alpha fetoprotein (AFP).

Ngati kuyesedwa kwamakanema anayi kuli koyenera, kuyesereranso kumafunikira kuti mutsimikizire matendawa.

Mayesowa angaphatikizepo:

• Mimba ultrasound
• Amniocentesis

Myelomeningocele amatha kuwona mwanayo atabadwa. Kuyezetsa magazi kumatha kuwonetsa kuti mwanayo wataya ntchito zokhudzana ndi mitsempha pansi pa chilema. Mwachitsanzo, kuyang'ana momwe khanda limayankhira ndikamamenyera m'malo osiyanasiyana kumatha kudziwa komwe khanda limamverera.

Kuyesedwa komwe kumachitika mwana akabadwa kungaphatikizepo ma x-ray, ultrasound, CT, kapena MRI ya msana.

Wothandizira zaumoyo atha kupereka upangiri paza majini. Kuchita opaleshoni ya m'mimba kuti atseke chilema (mwanayo asanabadwe) kumachepetsa chiopsezo cha zovuta zina zamtsogolo.

Mwana wanu akabadwa, nthawi zambiri amalankhula za opareshoni kuti akonze vutoli m'masiku ochepa oyamba. Asanamuchite opaleshoni, khanda liyenera kumugwira mosamala kuti muchepetse msana. Izi zingaphatikizepo:

• Chisamaliro chapadera ndi maimidwe
• Zida zodzitetezera
• Zosintha munjira zogwirira ntchito, kudyetsa, ndikusamba

Ana omwe amakhalanso ndi hydrocephalus angafunikire ventriculoperitoneal shunt yoyikidwa. Izi zithandizira kukhetsa madzi owonjezera kuchokera ma ventricles (muubongo) kupita kumalo a peritoneal (m'mimba).

Maantibayotiki amatha kugwiritsidwa ntchito pochiza kapena kupewa matenda monga meningitis kapena matenda amkodzo.

Ana ambiri amafunikira chithandizo chamoyo wonse pamavuto omwe amadza chifukwa cha kuwonongeka kwa msana ndi mitsempha ya msana.

Izi zikuphatikiza:

• Mavuto a chikhodzodzo ndi matumbo - Kupanikizika pang'ono pa chikhodzodzo kumatha kuthandiza kutulutsa chikhodzodzo. Ma machubu amadzimadzi, otchedwa catheters, nawonso angafunike. Mapulogalamu ophunzitsira matumbo komanso zakudya zamafuta ambiri zimathandizira kugwiranso ntchito matumbo.
• Matenda a minofu ndi olumikizana - Mafupa kapena mankhwala atha kufunikira kuti athetse vuto la minofu ndi mafupa. Ma braces angafunike. Anthu ambiri omwe ali ndi myelomeningocele makamaka amagwiritsa ntchito olumala.

Mayeso otsatirawa amapitilirabe pamoyo wamwana. Izi zachitika ku:

• Onani kupita patsogolo
• Onetsetsani mavuto aliwonse anzeru, amitsempha, kapena athupi

Anamwino oyendera, othandizira anthu, magulu othandizira, ndi mabungwe am'deralo atha kupereka chilimbikitso ndikuthandizira posamalira mwana yemwe ali ndi mavuto azovuta zomwe sangathe kuchita.

Kutenga nawo gawo lothandizira msana bifida kungakhale kothandiza.

Myelomeningocele nthawi zambiri amatha kukonzedwa opaleshoni, koma mitsempha yomwe imakhudzidwa mwina imagwirabe ntchito bwinobwino. Kutalika kwa malo olakwika pamsana pa khanda, mitsempha yambiri imakhudzidwa.

Ndi chithandizo choyambirira, kutalika kwa moyo sikukhudzidwa kwambiri. Mavuto a impso chifukwa cha mkodzo wosauka bwino ndi omwe amafa kwambiri.

Ana ambiri adzakhala ndi nzeru zanzeru. Komabe, chifukwa cha chiwopsezo cha hydrocephalus ndi meningitis, ambiri mwa ana awa adzakhala ndi mavuto ophunzirira komanso zovuta zakukomoka.

Mavuto atsopano m'kati mwa msana amatha kukula pambuyo pake, makamaka mwana atayamba kukula msinkhu pakutha msinkhu. Izi zitha kubweretsa kutayika kwantchito komanso mavuto am'mafupa monga scoliosis, kupunduka kwamiyendo kapena akakolo, chiuno chosokonekera, komanso kulimba kwa mgwirizano kapena mgwirizano.

Anthu ambiri omwe ali ndi myelomeningocele makamaka amagwiritsa ntchito olumala.

Zovuta za msana bifida zitha kuphatikiza:

• Kubadwa kwachisoni ndi kubereka kovuta kwa mwana
• Matenda opatsirana pafupipafupi
• Zamadzimadzi zomanga paubongo (hydrocephalus)
• Kutaya matumbo kapena chikhodzodzo
• Matenda a ubongo (meningitis)
• Okhazikika kufooka kapena ziwalo za miyendo

Mndandandawu sungakhale wophatikiza zonse.

Itanani omwe akukuthandizani ngati:

• Thumba kapena malo otseguka amawonekera pa msana wa khanda lobadwa kumene
• Mwana wanu amachedwa kuyenda kapena kukwawa
• Zizindikiro za hydrocephalus zimayamba, kuphatikiza malo ofewa, kukwiya, kugona kwambiri, komanso mavuto akudya
• Zizindikiro za meninjaitisi zimayamba, kuphatikiza malungo, khosi lolimba, kukwiya, komanso kulira kwambiri

Kupatsidwa folic acid kumathandizira kuthana ndi vuto la neural tube zolakwika monga myelomeningocele. Ndibwino kuti mayi aliyense amene akuganiza kuti ali ndi pakati atenge 0,4 mg ya folic acid tsiku lililonse. Amayi oyembekezera omwe ali pachiwopsezo chachikulu amafunika mlingo waukulu.

Ndikofunika kukumbukira kuti kusowa kwa folic acid kuyenera kukonzedwa musanakhale ndi pakati, chifukwa zoperewera zimayamba molawirira kwambiri.

Amayi omwe akukonzekera kutenga pakati amatha kuyezedwa kuti adziwe kuchuluka kwa folic acid m'magazi awo.

Meningomyelocele; Msana bifida; Kusokoneza msana; Neural chubu chilema (NTD); Chilema - myelomeningocele

• Ventriculoperitoneal shunt - kutulutsa

• Msana bifida
• Spina bifida (kukula kwake)

Komiti Yazochita Zoberekera, Society for Maternal-Fetal Medicine. American College of Obstetricians ndi Gynecologists. Maganizo a Komiti ya ACOG ayi. 720: Opaleshoni ya amayi apakati pa myelomeningocele. Gynecol Woletsa. 2017; 130 (3): e164-e167. PMID: 28832491 pubed.ncbi.nlm.nih.gov/28832491/.

Wachibale SL, Johnston MV. Kobadwa nako anomalies chapakati mantha dongosolo. 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 609.

Licci M, Guzman R, Soleman J. Matenda a amayi ndi zovuta pa opaleshoni ya fetus pokonzekera kubereka myelomeningocele kukonzanso: kuwunika mwatsatanetsatane.Maganizo a Neurosurg. 2019; 47 (4): E11. PMID: 31574465 pubed.ncbi.nlm.nih.gov/31574465/.

Wilson P, Stewart J. Meningomyelocele (spina bifida). 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 732.