Tracheoesophageal fistula uye esophageal atresia kugadzirisa

Tracheoesophageal fistula uye esophageal atresia kugadzirisa ndiko kuvhiyiwa kugadzirisa hurema huviri hwekuzvara mudumbu uye trachea. Kukanganisa kunowanzoitika pamwe chete.

Ziso ndiro chubhu inotakura chikafu kubva pamuromo kuenda mudumbu. Iyo trachea (windpipe) ndiyo chubhu inotakura mweya kupinda nekubuda mumapapu.

Izvo zvinokanganisa zvinowanzoitika pamwe chete. Zvinogona kuitika pamwe nemamwe matambudziko sechikamu cheshuga (boka rematambudziko):

• Esophageal atresia (EA) inoitika kana chikamu chepamusoro chegurusa chisina kubatana nezasi yegurokuro nedumbu.
• Tracheoesophageal fistula (TEF) inobatana zvisina kujairika pakati pechikamu chepamusoro cheyophagus uye trachea kana windpipe.

Uku kuvhiya kunowanzoitwa nguva pfupi mushure mekuberekwa. Ose mahurema anogona kugadziriswa panguva imwe chete. Muchidimbu, kuvhiya kunoitika nenzira iyi:

• Mushonga (anesthesia) unopihwa zvekuti mwana ari muhope huru uye asingarwadziwe panguva yekuvhiyiwa.
• Chiremba anovhiya anocheka parutivi rwechifuva pakati pembabvu.
• Iyo fistula iri pakati peyophagus uye windpipe yakavharwa.
• Zvikamu zvekumusoro nezvepasi zvegurokuno zvakasonerwa pamwechete kana zvichibvira.

Kazhinji zvikamu zviviri zvegurokuta zviri kure zvakanyanya kuti zvisasonane pamwechete ipapo. Mune ino kesi:

• Fistula chete ndiyo inogadziriswa panguva yekutanga kuvhiyiwa.
• Gastrostomy tube (chubhu inoenda kuburikidza neganda kupinda mudumbu) inogona kuiswa kuti ipe mwana wako chikafu.
• Mwana wako achave nekumwe kuvhiyiwa gare gare kuti agadzire esophagus.

Dzimwe nguva chiremba anovhiya anomirira mwedzi miviri kusvika mina asati avhiya. Kumirira kunoita kuti mwana wako akure kana kuve nemamwe matambudziko akarapwa. Kana kuvhiyiwa kwemwana wako kuchinonoka:

• Gastrostomy tube (G-chubhu) ichaiswa kuburikidza nemudumbu mudumbu kupinda mudumbu. Mishonga yekubvisa chiveve (local anesthesia) ichashandiswa kuitira kuti mwana asanzwe kurwadziwa.
• Panguva imwechete iyo chubhu inoiswa, chiremba anogona kuwedzera ziso remwana nechinhu chakakosha chinonzi dilator. Izvi zvichaita kuti ramangwana rekuvhiya rive nyore. Maitiro aya angangoda kudzokororwa, dzimwe nguva kakati wandei, usati wagadziriswa.

Tracheoesophageal fistula uye esophageal atresia matambudziko anotyisidzira hupenyu. Vanoda kurapwa pakarepo. Kana aya matambudziko asina kurapwa:

• Mwana wako anogona kufema mate uye zvinwiwa kubva mudumbu kuenda mumapapu. Izvi zvinonzi kuda. Inogona kukonzera kudzipwa uye mabayo (hutachiona hutachiona).
• Mwana wako haakwanise kumedza nekuzeya zvachose kana iyo esophagus ikasabatana nemudumbu.

Ngozi dzeanesthesia uye kuvhiyiwa kazhinji zvinosanganisira:

• Zviitiko kumishonga
• Matambudziko ekufema
• Kubuda ropa, kugwamba kweropa, kana hutachiona

Ngozi dzekuvhiya uku dzinosanganisira:

• Yakapunzika mapapu (pneumothorax)
• Chikafu chinodonha kubva munzvimbo inogadziriswa
• Tembiricha yemuviri yakaderera (hypothermia)
• Kudimbudzira kwenhengo dzakagadziriswa
• Kuvhurazve fistula

Mwana wako anozogamuchirwa kuchipatara chekubereka (NICU) nekukurumidza kana vanachiremba vaona chero eaya matambudziko.

Mwana wako anowana chikafu nemutsinga (intravenous, kana IV) uye anogona kunge ari pamushini wekufema (ventilator). Chikwata chekutarisira chingashandisa kukweva kuchengetedza mvura kubva pakupinda mumapapu.

Vamwe vacheche vasati vasvika, vane huremu hwekuzvarwa, kana vane zvimwe zviremara zvekuberekwa padivi peTF uye / kana EA vanogona kutadza kuvhiyiwa kudzamara vakura kana kusvika mamwe matambudziko arapwa kana kuti aenda.

Mushure mekuvhiyiwa, mwana wako anozochengetwa muNICU yechipatara.

Mamwe marapirwo mushure mekuvhiyiwa anowanzo sanganisira:

• Mishonga inorwisa mabhakitiriya sezvinodiwa, kudzivirira hutachiona
• Muchina wekufema (ventilator)
• Chest tube (chubhu kuburikidza neganda mukati memadziro echifuva) kubvisa mvura kubva munzvimbo iri pakati pekunze kwepapu uye mukati mechipfuva mhango
• Intravenous (IV) mvura, kusanganisira chikafu
• Okisijeni
• Mishonga yemarwadzo sekudikanwa

Kana zvese zviri zviviri TEF neEE zvagadziriswa.

• Chubhu inoiswa kuburikidza nemhino mudumbu (nasogastric tube) panguva yekuvhiya.
• Kudyisa kunowanzo kutanga kuburikidza neiyi chubhu mazuva mashoma mushure mekuvhiyiwa.
• Kudya nemuromo kunotanga zvishoma nezvishoma. Mwana angangoda kurapwa kurapa.

Kana chete iyo TEF yakagadziriswa, G-chubhu inoshandiswa pakudyisa kusvikira iyo atresia yagadziriswa. Mwana angangoda zvakare kuenderera kana kukwezva kakawanda kubvisa zvinyoro kubva kumusoro kwepamusoro.

Apo mwana wako ari muchipatara, boka rekutarisira richakuratidza maitiro ekushandisa uye kutsiva iyo G-tube. Iwe unogona zvakare kutumirwa kumusha uine imwe G-chubhu. Vashandi vepachipatara vachazivisa kambani yekupa hutano kumba nezvezvaunoda zvemidziyo.

Inguva yakareba sei mwana wako anogara muchipatara zvinoenderana nerudzi rwekuremara mwana wako uye kana paine mamwe matambudziko mukuwedzera kune TEF neEE. Iwe unozokwanisa kuunza mwana wako kumba kana ivo vari kutora feedings nemuromo kana gastrostomy chubhu, iri kuwedzera uremu, uye zvakachengeteka kufema vega.

Kuvhiya kunogona kazhinji kugadzirisa iyo TEF uye EA. Kamwe kupora kubva pakuvhiya kwapera, mwana wako anogona kunge aine matambudziko aya:

• Chikamu cheyesophagus iyo yakagadziriswa inogona kudzikira. Mwana wako angangoda kuvhiyiwa kwakawanda kuti arape izvi.
• Mwana wako anogona kunge aine chirungurira, kana gastroesophageal reflux (GERD). Izvi zvinoitika apo asidhi kubva mudumbu inokwira kupinda mudumbu. GERD inogona kukonzera matambudziko ekufema.

Munguva yehucheche uye hushoma hudiki, vana vazhinji vanozove nematambudziko nekufema, kukura, uye kudya, uye vachazoda kuramba vachiona vese avo vekutanga vanopa rubatsiro uye nyanzvi.

Vacheche vane TEF neEE vane zvakare hurema hwedzimwe nhengo, kazhinji moyo, vanogona kuve nematambudziko ehutano kwenguva refu.

TEF kugadzirisa; Esophageal atresia kugadzirisa

• Kuunza mwana wako kuti ashanyire hama inorwara zvakanyanya
• Kuchengeta ronda rekuvhiya - rakavhurika

• Tracheoesophageal fistula kugadzirisa - akateedzana

Madanick R, Orlando RC. Anatomy, histology, embryology, uye kusimudzira kusagadzikana kwesopu. Muna: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger uye Fordtran's Gastrointestinal uye Chirwere Chirwere: Pathophysiology / Diagnosis / Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016: chitsuwa 42.

Rothenberg SS. Esophageal atresia uye tracheoesophageal fistula malformations. Mune: Holcomb GW, Murphy P, St. Peter SD, eds. Holcomb uye Ashcraft's Pediatric Kuvhiya. 7th ed. Philadelphia, PA: Elsevier; 2020: chitsiko 27.