Masifunde nge-Esophageal Atresia, imeko engaqhelekanga apho umphimbo wosana olusandul’ ukuzalwa ungadibani nesisu.

Ngaba umntwana wakho osandul’ ukuzalwa uqala ukukhohlela nokuqunjelwa umlomo kwangoko nje ukuba asele ubisi? Ngaba ukhupha igwebu emlonyeni? Okanye ulusu lwakhe lubonakala luluhlaza okwesibhakabhaka? Njengomzali, kuyinto eqhelekileyo ukuziva usoyika kwaye ukhathazekile xa ubona ezi zinto. Iimpawu ezinje ngamanye amaxesha zinokuba luphawu lwesiphene esingaqhelekanga kodwa esinzulu sokuzalwa esibizwa ngokuba yi -Esophageal Atresia (EA) . Musa ukoyika xa usiva eli gama. Namhlanje, siza kuthetha ngayo yonke le nto ngendlela elula kakhulu onokuyiqonda.

Yintoni i-Esophageal Atresia (EA)?

Ngamafutshane, i-Esophageal Atresia sisifo sokuzalwa. Sivela xa umphimbo womntwana wakho, umbhobho othwala ukutya ukusuka emlonyeni ukuya esiswini, ungakhekanga ngokupheleleyo. Igama elithi "atresia" lithetha ukuba indlela emzimbeni ivaliwe okanye ivaliwe. Kule meko, umphimbo uvaliwe apho kufuneka udibane nesisu. Ngenxa yoko, umntwana akanandlela yokutya okanye yokusela ngokuqhelekileyo.

Khawuthelekelele oku, kufana nombhobho wamanzi oqhekekayo phakathi uze wahlukane ube ziinxalenye ezimbini.

Le meko inokuba nzima ngakumbi. Malunga nama-90% eentsana ezine-EA nazo zinenye ingxaki. Ibizwa ngokuba yi-tracheoesophageal fistula (TEF) . Kulapho i-oesophagus engakhekanga kakuhle iqhagamshela kwi-windpipe, i-windpipe. Oku kuyingozi kakhulu kuba izinto umntwana aziginyayo, nokuba ngamathe, zinokungena emaphashini endaweni yesisu. Ukuba oku kuyenzeka, umntwana uya kuba nobunzima bokuphefumla, akrwitshwe, kwaye anokuba nosulelo lwemiphunga.

Ziziphi iintlobo eziphambili zale meko?

I-Esophageal atresia yahlulwe yaba ziintlobo ezininzi eziphambili. Ezi zahlulwe ngokusekwe kwindawo apho umphimbo uvalwe khona kunye nokuba uqhagamshelwe njani na kumbhobho womoya. Oku kunokuba nzima kancinci, kodwa ukuze kube lula ukukuqonda, jonga itheyibhile engasezantsi.

Oogqirha baza kwenza uvavanyo olwahlukeneyo ukuze bafumanise ukuba loluphi uhlobo lomntwana wakho analo. Unyango lucwangcisiwe ngokufanelekileyo.

Ziziphi iimpawu ezibonisa ukuba umntwana unale meko?

Kukho iimpawu ezintathu eziphambili ezisetyenziswa ngoogqirha nabahlengikazi ukuze baxilonge esi sifo ngokukhawuleza. Zikwabizwa ngokuba yi "Three Cs."

• Ukukhohlela
• Ukuminxeka (ukunamathela)
• I-Cyanosis (ukutshintsha kombala oluhlaza okwesibhakabhaka kolusu)

I-Cyanosis iyenzeka xa ulusu, ingakumbi imilebe kunye neminwe, lujika lube luhlaza okwesibhakabhaka xa umzimba ungafumani ioksijini eyaneleyo.

Ukongeza kwezi mpawu ziphambili, ungabona ezinye izinto:

• Umlomo womntwana ugqunywe yi-mucus eninzi enegwebu.
• Ukuvuza amathe ngaphezu kobisi oluqhelekileyo okanye ukugabha.
• Xa ndizama ukumnika ubisi, uziva enesicaphucaphu aze akrwitshwe.
• Kuba nzima ukuphefumla, kwaye kukho isandi esingaqhelekanga xa uphefumla.

Kutheni oku kusenzeka kwiintsana? Yintoni esona sizathu siphambili?

Oku sikubiza ngokuba sisiphene sokuzalwa. Kubangelwa lutshintsho olwenzeka ngelixa umntwana ekhula esibelekweni. Ngokwesiqhelo, kwizigaba zokuqala zomntwana ongekazalwa, i-esophagus kunye ne-trachea zombini ziyityhubhu enye. Kamva, yahlukana yaba ziinxalenye ezimbini kwaye yakhula yaba ziityhubhu ezimbini ezahlukeneyo. Isizathu esiphambili sokuphuhliswa kwe-Esophageal Atresia kukuba isakhiwo esiyityhubhu enye siyahlukana kwaye siyeke ukukhula ngokupheleleyo.

Nangona kunjalo, izazinzulu azikakwazi ukufumana impendulo ecacileyo kumbuzo othi, "Kutheni oko kukhula kumisa phakathi?" Bakholelwa ukuba zombini izinto zemfuza kunye nezinto ezingqongileyo zinokuba nefuthe koku. Oko kukuthi, utshintsho oluthile oluvela kwi-DNA yomntwana kunye neempembelelo ezithile ezingqongileyo umama ajongene nazo ngexesha lokukhulelwa zinokuba yimbangela.

Ngaba kukho naziphi na izinto ezinokubangela umngcipheko?

Nangona kungekho sizathu siqinisekisiweyo sale meko, abaphandi bafumanise iimpawu ezininzi eziqhelekileyo zeentsana ezizalwa zine-EA. Ezi zinokunyusa umngcipheko kancinci:

• Ubudala bomama bungaphezulu kwama-35 kwaye/okanye ubudala bukatata bungaphezulu kwama-40.
• Ukuzala abantwana ngeendlela zokufakelwa amadlozi ngendlela yokwenziwa (njenge-IVF, IUI).
• Ukuba namawele okanye amawele amathathu.

Ukongeza, i-EA idla ngokubonakala inxulumene nezinye iziphene zokuzalwa kunye ne-genetic syndromes. Umzekelo:

• I-Trisomy (13, 18 okanye 21)
• Umbutho we-VACTERL
• Isifo se-CHARGE
• Isifo sentliziyo esizalwa naso
• Ezinye izinto ezithintela inkqubo yokugaya ukutya (i-GI atresias)
• Iziphene zenkqubo yezintso kunye ne-genitourinary

Oogqirha bayixilonga njani le meko? (Ukuxilongwa)

Uninzi lwexesha, le meko ifunyaniswa emva kokuba umntwana ezelwe. Nangona kunjalo, ngamanye amaxesha, iiskeni zokukhulelwa zinokubonelela ngeenkcukacha.

• Ngaphambi kokuba umntwana azalwe: Ukuba ngexesha lokuhlolwa kwe-anatomy yakho malunga neeveki ezingama-20, ubungakanani bolwelo lwe-amniotic olujikeleze umntwana buphezulu kakhulu kunesiqhelo (oku kubizwa ngokuba yi-polyhydramnios ), ugqirha usenokuba nexhala. Oku kungenxa yokuba umntwana udla ngokuginya olu buninzi bolwelo. Ukuba umntwana akakwazi ukuginya, ulwelo luyaqokelelana. Kwakhona, ukuba isisu somntwana sibonakala singenanto (singenamaqamza amancinci okanye singenawo) ngexesha lokuhlolwa, olo lolunye uphawu.
• Emva kokuba umntwana ezelwe: Ukuba umntwana ubonakalisa iimpawu esizixubushile ngaphambili (ukukhwehlela, ukukrwitshwa, ukuluhlaza okwesibhakabhaka) emva nje kokuba ezelwe, oogqirha bakhawuleza bakukrokre oku. Uvavanyo olulula lokuqinisekisa oku kukufaka ityhubhu encinci (ityhubhu ye-nasogastric) ngempumlo okanye emlonyeni womntwana uze uzame ukuyidlulisela esiswini. Ukuba umphimbo uvalekile, ityhubhu ayinakungena esiswini. Iyema phakathi.

Emva koko, kwenziwa i-X-ray ukuqinisekisa oku kunye nokubona ukuba loluphi uhlobo lwesiphene esikuyo. I-X-ray inokubona nokuba ulwelo lungene emiphungeni okanye umoya ungene esiswini. Emva kokuxilonga oku, ugqirha uya kujonga nomntwana ukuba akanazo ezinye iziphene zokuzalwa ezinxulumene noko.

Inyangwa njani? Ngaba le nto inganyangeka?

Ewe! Le yimeko enokunyangeka ngokuqinisekileyo. Unyango olulodwa kuphela lwale meko lutyando.Uninzi lwexesha, olu tyando lwenziwa emva nje kokuba umntwana ezelwe.

Ulawulo lwangaphambi kotyando

Ngaphambi kokuba benze utyando, oogqirha bathatha amanyathelo aliqela ukuze baqinisekise ukuba umntwana uphilile.

• Ukuzinzisa ukuphefumla: Ukuthintela ukuba i-mucus kunye ne-phlegm zingaqokeleleki emqaleni zingafiki emiphungeni, zihlala zisuswa ngetyhubhu (i-suction). Ukuba umntwana unengxaki yokuphefumla, uqhagamshelwa kwi-ventilator.
• Ukubonelela ngesondlo esikhuselekileyo: Ekubeni umntwana engenakondliwa ngomlomo, isondlo esifunekayo sinikezelwa ngemithambo ( isondlo se-parenteral ) okanye ngetyhubhu efakwe ngqo esiswini ( isondlo se-enteral ).
• Ukuthintela izifo: Ii-antibiotics ezine-IV zinikwa ukuthintela izifo zemiphunga (i-pneumonia).

Ukuba umntwana uzelwe ngaphambi kwexesha, utyebile kancinci, okanye unezinye iziphene ezinzulu, ezifana nesiphene sentliziyo, umntwana kuya kufuneka ahlale kwigumbi lokunyamekela abantwana abasandul’ ukuzalwa (i-NICU) de ezo meko zihlale kakuhle ngaphambi kotyando.

Utyando (Ukulungiswa kotyando)

Xa umntwana egqibile ukuba ulungele utyando, ugqirha wenza utyando. Olu tyando luneenjongo ezimbini eziphambili:

1. Ukudibanisa iindawo ezimbini ezahlulwe zomqala (oku kubizwa ngokuba yi -anastomosis ).

2. Ukuvala unxibelelwano olungeyomfuneko (i-fistula) phakathi kwepharynx kunye ne-trachea.

Ngenxa yeteknoloji yanamhlanje ephucukileyo, olu tyando ludla ngokwenziwa ngaphandle kokuvula isifuba, kodwa lufakwa ngokufaka ikhamera kunye nezixhobo ngokusebenzisa imingxunya embalwa emincinci kakhulu (utyando lwe-thoracoscopic). Oku kubangela iintlungu ezincinci kumntwana kwaye kubangela ukuba aphile ngokukhawuleza.

Kwenzeka ntoni emva kotyando?

Emva kotyando, umntwana ubuyiselwa kwi-NICU ukuze ajongwe ngokusondeleyo. Emva kweentsuku ezimbalwa, kwenziwa i-X-ray ekhethekileyo ebizwa ngokuba yi-esophagram ukujonga ukuba inxeba lipholile kakuhle na kwaye kukho ukuvuza. Nje ukuba yonke into iqinisekiswe, umntwana ungeniswa kancinci kancinci kwinkqubo yokutyisa ngomlomo. Kuthatha ixesha ukuba umntwana aqhele inkqubo yokuginya.

Ziziphi iingxaki ezinokwenzeka emva kotyando olude?

Uninzi lweentsana luyachacha ngokupheleleyo kwaye luphila ubomi obuqhelekileyo. Nangona kunjalo, abanye abantwana banokufumana iingxaki okwethutyana emva kotyando. Kubalulekile ukuzazi ezi.

• Ubunzima bokuginya: Abanye abantwana basenokungasebenzi kakuhle kwizihlunu zomqala. Oku kunokubangela ukuba bakrwitshwe xa beqala ukutya ukutya okuqinileyo. Ukutya kufuneka kutyunyuzwe kakuhle kwaye kunikwe ulwelo.
• Isifo seGastroesophageal Reflux (GERD): Oku kulapho i-asidi yesisu ibuyela kwi-esophagus. Oku kunokubangela isitshiso sentliziyo kunye nokungagaywa kakuhle kokutya. Ukuba ayinyangwa, inokonakalisa i-esophagus. Le meko yenzeka malunga nesiqingatha sabantwana abaye benza utyando lwe-EA.
• I-Tracheomalacia:Oku kubuthathaka kwe-cartilage kwiindlela zomoya. Oku kunokukhokelela ekuphefumleni, ukukhohlela rhoqo, kunye nosulelo oluqhelekileyo lwemiphunga (i-bronchitis, i-pneumonia).

Ukuba unayo nayiphi na kwezi ngxaki, ungoyiki. Kukho unyango lwazo zonke ezi zinto. Eyona nto ibalulekileyo kukuthetha nogqirha wakho ngayo rhoqo kwaye ulandele imiyalelo yakhe. Kusenokufuneka ufune uncedo kwiNgcali yePathology yoLwimi lokuThetha (SLP).