Tracheoesophageal fistula ndi esophageal atresia kukonza

Matenda a Tracheoesophageal fistula ndi esophageal atresia kukonza ndi opareshoni yokonza zolakwika ziwiri zobadwa m'mimba ndi trachea. Zolakwikazo zimachitika limodzi.

Kum'mero ​​ndi chubu chomwe chimanyamula chakudya kuchokera mkamwa kupita m'mimba. Trachea (mphepo yamkuntho) ndi chubu chomwe chimatulutsa mpweya ndikutuluka m'mapapu.

Zolakwikazo zimachitika limodzi. Zitha kuchitika limodzi ndi mavuto ena ngati gawo la matenda (gulu lamavuto):

• Esophageal atresia (EA) imachitika pomwe gawo lakumtunda silimalumikizana ndi m'mimba ndi m'mimba.
• Tracheoesophageal fistula (TEF) ndikulumikizana kwachilendo pakati pa kumtunda kwa kholingo ndi trachea kapena windpipe.

Kuchita opaleshoniyi kumachitika nthawi zambiri akabadwa. Zowonongeka zonsezo zimatha kukonzedwa nthawi yomweyo. Mwachidule, opaleshoniyi imachitika motere:

• Mankhwala (anesthesia) amaperekedwa kuti mwanayo agone tulo tofa nato komanso asamve kuwawa panthawi ya opaleshoni.
• Dokotalayo amadula m'chifuwa pakati pa nthiti.
• Fistula pakati pa kholingo ndi mphepo yatsekedwa.
• Mbali zakumtunda ndi zapansi za khosilo zimasokedwa pamodzi ngati zingatheke.

Nthawi zambiri mbali ziwirizi zimakhala patali kwambiri kuti zisasokonekere nthawi yomweyo. Pamenepa:

• Fistula yokha ndi yomwe imakonzedwa pa opaleshoni yoyamba.
• Chubu cha gastrostomy (chubu chomwe chimadutsa pakhungu mpaka m'mimba) chitha kuyikidwa kuti mupatse mwana wanu chakudya.
• Mwana wanu adzachitidwanso opaleshoni ina kuti akonzetse kholalo.

Nthawi zina dokotalayo amadikirira miyezi iwiri kapena inayi asanachite opaleshoni. Kuyembekezera kumalola mwana wanu kukula kapena kukhala ndi mavuto ena. Ngati opaleshoni ya mwana wanu yachedwa:

• Thumba la gastrostomy (G-chubu) lidzaikidwa kudzera m'mimba m'mimba. Mankhwala ogwiritsira ntchito mankhondo (anesthesia am'deralo) adzagwiritsidwa ntchito kuti mwana asamve kupweteka.
• Pa nthawi yomweyi chubu chimayikidwa, adokotala atha kukulitsa kum'mero ​​kwa khanda ndi chida chapadera chotchedwa dilator. Izi zipangitsa kuti opaleshoni yamtsogolo ikhale yosavuta. Izi zitha kuyenera kubwerezedwa, nthawi zina kangapo, isanakonzeke.

Matenda a Tracheoesophageal fistula ndi esophageal atresia ndi mavuto owopseza moyo. Ayenera kuthandizidwa nthawi yomweyo. Ngati mavutowa sakuchiritsidwa:

• Mwana wanu amatha kupuma malovu ndi madzi kuchokera m'mimba kupita m'mapapu. Izi zimatchedwa kukhumba. Zitha kuyambitsa kutsamwa ndi chibayo (matenda am'mapapo).
• Mwana wanu sangathe kumeza ndi kupukusa konse ngati kholalo silimalumikizana ndi m'mimba.

Zowopsa za anesthesia ndi maopareshoni ambiri ndi monga:

• Zomwe zimachitika ndi mankhwala
• Mavuto opumira
• Kukhetsa magazi, magazi kuundana, kapena matenda

Zowopsa za opaleshoniyi ndi izi:

• Mapapu otayika (pneumothorax)
• Kutayikira kwa chakudya kuchokera kudera lomwe lakonzedwa
• Kutentha kwa thupi (hypothermia)
• Kupondereza ziwalo zokonzedwa
• Kutsegulanso kwa fistula

Mwana wanu adzalandiridwa kuchipatala cha neonatal (NICU) akangodwala madotolo.

Mwana wanu alandila zakudya kudzera m'mitsempha (intravenous, kapena IV) ndipo amathanso kukhala pamakina opumira (mpweya wabwino). Gulu losamalira likhoza kugwiritsa ntchito kuyamwa kuti madzi asalowe m'mapapu.

Ana ena omwe sanabadwe msanga, amabadwa ochepa, kapena ali ndi zovuta zina zobadwa pambali pa TEF ndi / kapena EA sangathe kuchitidwa opaleshoni mpaka atakula kapena mpaka mavuto ena atathandizidwa kapena atatha.

Pambuyo pa opaleshoni, mwana wanu adzasamaliridwa ku NICU ya chipatala.

Mankhwala owonjezera pambuyo pa opaleshoni nthawi zambiri amaphatikizapo:

• Maantibayotiki ngati akufunikira, kupewa matenda
• Kupuma makina (mpweya)
• Thumba la chifuwa (chubu kudzera pakhungu kulowa m'chifuwa) kutulutsa madzi kuchokera pakatikati pa mapapo ndi mkatikati mwa chifuwa
• Madzi amkati (IV), kuphatikiza zakudya
• Mpweya
• Mankhwala opweteka pakufunika

Ngati onse TEF ndi EA akonzedwa:

• Chubu chimayikidwa kudzera pamphuno m'mimba (nasogastric chubu) panthawi yochita opareshoni.
• Zakudya zimayambitsidwa kudzera mu chubu masiku angapo pambuyo pa opaleshoni.
• Kudyetsa pakamwa kumayambika pang'onopang'ono. Mwana angafunikire kumwa mankhwala.

Ngati TEF yokha itakonzedwa, G-chubu imagwiritsidwa ntchito kudyetsa mpaka atresia itatha kukonzedwa. Mwanayo angafunikenso kuyamwa mosalekeza kapena pafupipafupi kuti atulutse zitseko kumtunda.

Mwana wanu akadali mchipatala, gulu losamalira lidzakuwonetsani momwe mungagwiritsire ntchito G-chubu m'malo mwake. Mwinanso mutha kutumizidwa kunyumba ndi G-chubu yowonjezera. Ogwira ntchito pachipatalachi adzauza kampani yopereka chithandizo chamankhwala kunyumba zosowa zanu.

Kutalika kwa nthawi yomwe mwana wanu amakhala mchipatala kumadalira mtundu wa chilema chomwe mwana wanu ali nacho komanso ngati pali zovuta zina kuwonjezera pa TEF ndi EA. Mutha kubweretsa mwana wanu kunyumba akamamwa chakudya pakamwa kapena gastrostomy chubu, akulemera, komanso akupuma payekha.

Opaleshoni imatha kukonza TEF ndi EA. Mukachira kuchokera pa opaleshoniyi, mwana wanu akhoza kukhala ndi mavuto awa:

• Gawo lam'mero ​​lomwe lakonzedwa limatha kuchepa. Mwana wanu angafunikire kuchitidwa opaleshoni yambiri kuti athe kuchiza izi.
• Mwana wanu amatha kupweteka pamtima, kapena gastroesophageal reflux (GERD). Izi zimachitika pamene asidi wochokera m'mimba amapita kummero. GERD itha kubweretsa zovuta kupuma.

Kuyambira ali wakhanda komanso akadali aang'ono, ana ambiri amakhala ndi mavuto pakupuma, kukula, ndi kudyetsa, ndipo amafunika kupitiliza kuwona omwe amawasamalira komanso akatswiri.

Ana omwe ali ndi TEF ndi EA omwe amakhalanso ndi ziwalo zina, makamaka mtima, amatha kukhala ndi mavuto azaumoyo kwanthawi yayitali.

Kukonza TEF; Esophageal atresia kukonza

• Kubweretsa mwana wanu kuti adzachezere m'bale wanu wodwala kwambiri
• Chisamaliro cha bala la opaleshoni - chotseguka

• Kukonzekera kwa fistula ya Tracheoesophageal - mndandanda

Madanick R, Orlando RC. Anatomy, histology, embryology, ndi zolakwika pakukula kwa kholingo. Mu: Feldman M, Friedman LS, Brandt LJ, olemba. Sleisenger ndi Fordtran's Mimba ndi Matenda a Chiwindi: Pathophysiology / Diagnosis / Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016: chap 42.

Rothenberg SS. Esophageal atresia ndi zolakwika za tracheoesophageal fistula. Mu: Holcomb GW, Murphy P, St. Peter SD, eds. Opaleshoni ya Ana ya Holcomb ndi Ashcraft. Wachisanu ndi chiwiri. Philadelphia, PA: Elsevier; 2020: chap 27.