Qhov loj tshaj nyuaj ntawm gastric thiab duodenal ulcers yog ib perforated plab ulcer los yog perforation. Yog tias koj tsis tau sai sai muab kev pabcuam thaum muaj xwm ceev, ib tus neeg ntsib peritonitis thiab tuag taus. Feem ntau, tus kab mob ntawm cov txiv neej, vim hais tias cov poj niam muaj kev tiv thaiv los ntawm lub cev cov tshuaj no, tiv thaiv cov mucous.
Ua rau ntawm perforation ntawm ulcer
Yeej tsis muaj peev xwm ua kom tau ib lub plab ntawm lub plab rau ntawm qhov chaw sib npaug zos, muaj ib txwm preconditions rau qhov no. Nws qhov yuav muaj siab nyob rau hauv cov neeg uas raug kev txom nyem los ntawm kab mob peptic rau ntau tshaj peb lub xyoos, nyob rau hauv cov neeg mob nrog gastritis uas tsis tshua tham nrog ib tus kws kho mob. Hu rau perforation tau:
- muaj zog, ntse load;
- nquag overeating;
- high acidity ntawm pais plab kua txiv;
- siv cov txuj lom;
- tsis ua raws li kev pw tsaug zog thiab kev vam meej, hmo hloov mus ua haujlwm, tsis pw;
- ob leeg siv ntev thiab siv cov tshuaj siv qee yam tshuaj;
- tsis ua raws li kev noj haus, tsis kam noj kua zaub mov, kev tsim txom ntawm cov khoom kib thiab cov khoom noj haus;
- niaj hnub siv cawv thiab haus luam yeeb:
- qub txeeg qub teg.
Perforated ulcer ntawm lub plab - cov tsos mob
Cov mob muaj zog hauv cheeb tsam epigastric yuav ua rau lub tswv yim ntawm perforation ntawm lub plab ulcer, cov tsos mob ntawm cov yam ntxwv thiab eloquent. Perforated ulcer los yog perforation ntawm lub plab yog cais tawm los ntawm:
- etiology;
- qhov chaw (thaj chaw);
- qhov chaw ntawm outflow;
- ncua sij hawm (saib mob theem).
Thawj cov cim qhia ntawm ib lub plhaw perforated
Thaum pib ntawm tus kab mob, nyob rau thawj zaug, thaum lub perforation ntawm lub rwj tsis tau raug kuaj tau pom, cov tsos mob yog yam ntxwv thiab meej. Paub txog lawv, tseem muaj kev tsis nkag siab qhov ua rau cov neeg mob tsis zoo. Muaj peb theem:
- Tshuaj peritonitis, uas kav 3-6 teev. Nyob rau lub sij hawm no muaj mob hnyav nyob rau hauv nruab nrab thiab sab xis ntawm lub plab. Nyob ntawm qhov chaw, lub plab ntawm lub plab ua rau lub plab ua rau mob atypical nyob rau sab laug ntawm sab caj npab. Maj mam, qhov mob ua rau qhov mob plab thiab hnov thoob hauv plab, qhov siab yog qis dua. Cov tawv nqaij ua daj ntseg thiab nplaum, thiab lub plab swells vim yog qhov txuam nrog roj. Nov yog qhov zoo tshaj plaws thaum tus neeg mob yuav tsum tau coj mus rau ib lub tsev kho mob.
- Cov kab mob bacterial peritonitis tsis tshwm sim sai sai, tab sis tom qab 6 teev txij thaum thawj zaug ntawm cov kab mob ntawm lub plab plab raug pom. Maj mam, tus kab mob qog ua qaug tshuaj thiab tus neeg mob tus mob tsis zoo, tab sis nws tsis paub qhov teeb meem ntawm qhov xwm txheej. Qhov no yog lub sij hawm ntawm kev zoo siab, thaum cov cim ntawm kev ntxhuav ntawm qhov mob ua rau qaug zog, qhov mob rov qab thiab tus neeg zoo zoo. Los ntawm lub sijhawm no, lub siab nce siab, zoo li lub cev kub, lub peristalsis tawg, tus nplaig yog them nrog ib tug grey lo.
- Kev qaug rau qaug zog tshwm sim tom qab 12 teev los ntawm qhov pib ntawm tus kab mob. Qhov kub poob, qhov tawv nqaij yuav qhuav, ntuav thiab lub cev qhuav dej pib. Gassing nyob rau hauv lub plab ua rau lub fact tias lub plab ua nyuaj thiab o tuaj vim roj thiab cov khoom siv zom zawm khoom daig nyob rau hauv cov peritoneum. Muaj ib tus neeg mob qhov kev tsis txaus siab rau qhov teeb meem, kev rhuav tshem, tso zis tso zis. Nyob rau theem no lub plab ntawm lub plab yuav pib ua kom tuag thiab nws tseem tsis tuaj yeem txuag tus neeg mob.
Perforated ulcer - X-ray
Kev pom ntawm thawj cov cim qhia ntawm lub plab ua rau lub plab, ib tug neeg yuav tsum xa rau tsev kho mob sai sai. Nrog rau tus kabmob no, txhua yam qeeb yog qhov txaus ntshai heev. Kev kuaj mob yog ua tiav ntawm ntau txoj kev:
- ua ib qho anamnesis ntawm tus neeg mob;
- X-ray thiab kuaj kev sim;
- endoscopic kev xeem.
Nyob rau hauv 80% ntawm cov neeg mob, xoo hluav taws xob ntawm lub perforation ntawm lub plab muab kev zoo. Nws tus cwj pwm qhia txog roj nyob hauv plab kab noj hniav, uas ntog thaum lub sij hawm kev puas tsuaj ntawm lub plab phab ntsa. Yog hais tias nws muaj nuj nqis tsawg me ntsis thiab qhov kev kuaj ntawd tsis paub tseeb, qhov xoo hluav taws xob rov qab ua dua, tom qab tus neeg mob tau ua kua dej tsawg. Tom qab ntawd, cov pa ywj pheej yoojyim tawm ntawm lub qhov ncauj thiab pib tshwm hauv X-rays.
Perforation ntawm ib tug rwj - teeb meem
Zoo li lwm cov kab mob nyuab, kev pleev ntawm lub plab ulcer muaj nws cov teeb meem:
- fistulas sab hauv (hnyuv thiab gallbladder);
- tus abscess;
- pneumothorax nrog ruptured abscess;
- peritonitis .
Yuav ua li cas kho ib tug perforated plab ulcer?
Thaum ib tus neeg mob plab chiv hauv tus neeg mob qhov ncauj, kev kho yuav yog qhov kom sai. Qhov no yog qhov zoo tshaj los ntawm qhov teeb meem thaum nws muaj peev xwm ua kom dauv ib lub qhov, thiab qee qhov, kom tau tawm lub plab resection. Tsuas yog nyob rau ntawm cov neeg mob tshwj xeeb tuaj yeem kho tau yog tias tus neeg mob tsis kam phais mob. Tom qab ntawd, siv cov kua tawm ntawm lub qhov ntswg nrog ib qho kev soj ntsuam siv, nyob rau hauv ib txoj hauv kev li ob peb hnub tus neeg mob tau pw, cov tshuaj rau kev kho mob tiv thaiv.
Perforated plab ulcer - kev pab thaum muaj xwm ceev
Yuav kom txo tau txoj kev pheej hmoo ntawm qhov ua kom muaj tsawg kawg nkaus, kev kho mob sai yuav tsum tau ua nyob rau hauv qhov tob hauv plab cov hauv pliav thaum thawj lub sij hawm ntawm tus kab mob, uas yuav tsum tau muab los ntawm cov kws kho mob. Txhob noj tshuaj rau tus kheej. Nws yog ua tiav hauv cov lus hauv qab no:
- Tus neeg mob tau pw nrog me ntsis taub hau me ntsis thiab qis me ntsis hauv siab.
- Nqus tus txheem ntawm lub plab los ntawm kev sojntsuam.
- Tshem tawm cov kev poob siab (yog tias muaj), ua kom lub plawv nres;
- Ib Txoj kev lis ntshav ntawm saline thiab qabzib yog ua tiav theem ua ntej ua haujlwm.
Perforated ulcer ntawm plab - ua haujlwm
Nyob rau hauv 99% ntawm cov neeg mob, ib tug perforated ulcer ntawm lub plab yog sutured. Nyob ntawm qhov chaw ntawm lub rwj thiab qhov hnyav ntawm tus neeg mob qhov kev mob, xws li kev pab cuam phais yog tsim nyog:
- suturing;
- excision thiab kua;
- resection ntawm lub plab ;
- kev ywj pheej resection thiab vagotomy (tawm ntawm lub paj hlwb lub luag hauj lwm rau qhov tsim tawm ntawm hydrochloric acid kom tsis txhob rov hla);
- kua thiab vagotomy.
Perforated plab ulcer - postoperative lub sij hawm
Kev tuag ntawm lub rwj txhais tau hais tias kev daws teeb meem mus rau qhov teeb meem. Lub sij hawm rov qab los tsis yooj yim thiab ntev. Los ntawm tus cwj pwm tseeb ntawm lub sijhawm no nyob ntawm kev noj qab nyob zoo ntawm kev ua haujlwm. Nthuav tau ntau dua rau kev noj haus thiab kev tsav tsheb. Tom qab phais mus rau 3-4 hnub tus neeg mob tseem nyob hauv txaj, tom qab uas nws tau tso cai rau tau sawv. Ua li no nrog tus pab cuam thiab qeeb heev, vim lub cev tsis muaj zog tom qab phais tas. Kev dag tsis tau txav yog tseem tsis pom zoo vim tias qhov siab yuav ua rau cov txheej txheem nplaum.
Noj cov zaub mov tom qab lub plab ua qhov ncauj plab
Yuav kom tsis txhob muaj teeb meem los ntawm kev phais mus rau xoom, koj yuav tsum noj cov zaub mov nruj tom qab lub plab kev ntxhiab hauv lub plab. Thawj 3-4 hnub tus neeg mob tsis pub, yog li ntawd lub plab yog siv rau lub xeev tshiab. Cov khoom noj tau muab los ntawm ib tug neeg siv, uas siv cov kua qabzib. On thib tsib hnub tus neeg mob yuav pib haus ib me ntsis ntawm jelly thiab ib tug decoction ntawm dogrose , tab sis lub kua hauv ntau loj yog txwv, xws li ntsev. Txog rau thaum xaus ntawm lub lim tiam hauv kev noj haus tau ua ke tsis tau muab cov hmoov nplej / nqaij npuas / nqaij npuas thiab muag muag muag. Kev sib tw rau yav pem suab tom qab kev phais suav:
- hau qaub;
- chav cutlets thiab boiled nqaij ntawm qaib cov txwv, luav, nqaij qaib;
- lean hiav txwv ntses boiled los yog steamed;
- zaub purees;
- Berry jelly;
- mov, oatmeal, buckwheat;
- bananas, pears;
- tsawg-rog tsev cheese, mis, acidophilus kefir;
- crackers ntawm lawv cov mov ci nag hmo.
Hmoov tsis, daim ntawv teev cov khoom tso cai yog heev me me, nyob rau hauv sib piv rau daim ntawv teev cov kev txwv. Lawv yuav tsum ua raws li tag nrho lub neej los yog ua rau tsis tshua muaj kev zam, 2-3 xyoo tom qab ua haujlwm:
- cov khoom haus luam yeeb;
- sausages;
- carbonated dej;
- cucumbers, txiv lws suav, zaub qhwv, nceb noj;
- dos, qej;
- taum;
- dej qab zib, dej cawv, kas fes, kvass;
- qhob noom xim kasfes, khoom qab zib, ice cream, buns.