Ake sifunde nge-Esophageal Atresia, isimo esingavamile lapho umphimbo womntwana osanda kuzalwa ungaxhunywanga nesisu.

Ingabe ingane yakho esanda kuzalwa iqala ukukhwehlela nokuquleka ngokushesha nje lapho iphuza ubisi? Ingabe ikhipha igwebu emlonyeni? Noma ingabe isikhumba sayo sibukeka siluhlaza okwesibhakabhaka? Njengomzali, kuyinto evamile ukuzizwa wesaba futhi ukhathazekile uma ubona lezi zinto. Izimpawu ezinjengalezi ngezinye izikhathi zingaba uphawu lwesifo sokuzalwa esingavamile kodwa esibi esibizwa ngokuthi i-Esophageal Atresia (EA) . Ungesabi uma uzwa leli gama. Namuhla, sizoxoxa ngakho konke ngendlela elula kakhulu ongayiqonda.

Kuyini i-Esophageal Atresia (EA)?

Kalula nje, i-Esophageal Atresia iyisici sokuzalwa. Kwenzeka lapho umphimbo womntwana wakho, ipayipi elithwala ukudla kusuka emlonyeni kuya esiswini, lingakhekile ngokuphelele. Igama elithi "atresia" lisho ukuthi indlela emzimbeni ivaliwe noma ivaliwe. Kulesi simo, umphimbo uvaliwe lapho kufanele uxhumeke khona nesisu. Ngenxa yalokho, umntwana akanayo indlela yokudla noma yokuphuza ngendlela evamile.

Cabanga ngalokhu, kufana nepayipi lamanzi eliphuka phakathi bese lihlukana libe izingxenye ezimbili.

Lesi simo singaba nzima kakhulu. Cishe ama-90% ezinsana ezine-EA nazo zinenye inkinga. Ibizwa ngokuthi i-tracheoesophageal fistula (TEF) . Yilapho i-oesophagus engakhekanga kahle ixhumana ne-windpipe, i-windpipe. Lokhu kuyingozi kakhulu ngoba izinto umntwana azigwinyayo, ngisho namathe, zingangena emaphashini esikhundleni sesisu. Uma lokhu kwenzeka, umntwana uzoba nobunzima bokuphefumula, aminyaniswe, futhi angase abe nokutheleleka emaphashini.

Yiziphi izinhlobo eziyinhloko zalesi simo?

I-Esophageal atresia ihlukaniswe ngezinhlobo eziningana eziyinhloko. Lezi zihlukaniswa ngokusekelwe lapho umphimbo uvalekile khona nokuthi uxhumeke khona nomphimbo womoya. Lokhu kungaba nzima kancane, kodwa ukuze kube lula ukukuqonda, bheka ithebula elingezansi.

Odokotela bazokwenza izivivinyo ezahlukene ukuze banqume ukuthi yiluphi uhlobo lwengane yakho olunalo kulezi. Ukwelashwa kuhlelwe ngokufanele.

Yiziphi izimpawu ezibonisa ukuthi umntwana unalesi simo?

Kunezimpawu ezintathu eziyinhloko ezisetshenziswa odokotela nabahlengikazi ukuze basheshe baxilonge lesi simo. Zibizwa nangokuthi "ama-C amathathu."

• Ukukhwehlela
• Ukuminyana (ukunamathela)
• I-Cyanosis (ukushintsha kombala wesikhumba okwesibhakabhaka)

I-Cyanosis yilapho isikhumba, ikakhulukazi izindebe neminwe, siphenduka sibe luhlaza okwesibhakabhaka lapho umzimba ungatholi umoya-mpilo owanele.

Ngaphezu kwalezi zici eziyinhloko, ungabona ezinye izinto:

• Umlomo wengane ugcwele amafinyila amaningi anegwebu.
• Ukuvuza amathe ngaphezu kokuvamile noma ukuhlanza ubisi.
• Uma ngizama ukumnika ubisi, uzizwa enesicanucanu futhi eklinywa.
• Kuba nzima ukuphefumula, futhi kuba nomsindo ongajwayelekile uma uphefumula.

Kungani lokhu kwenzeka ezinganeni? Iyini imbangela eyinhloko?

Lokhu sikubiza ngokuthi ukukhubazeka kokuzalwa. Kubangelwa ushintsho olwenzeka ngesikhathi umntwana ekhula esibelethweni. Ngokuvamile, ezigabeni zokuqala zomntwana osanda kuzalwa, i-esophagus kanye ne-trachea kokubili kuyipayipi elilodwa. Kamuva, lihlukana libe izingxenye ezimbili bese likhula libe amapayipi amabili ahlukene. Isizathu esiyinhloko sokuthuthukiswa kwe-Esophageal Atresia ukuthi isakhiwo esiyipayipi elilodwa siyahlukana futhi siyeke ukukhula ngokuphelele.

Kodwa-ke, ososayensi abakakwazi ukuthola impendulo eqondile yombuzo othi, "Kungani lokho kukhula kumisa phakathi?" Bakholelwa ukuthi izici zofuzo kanye nezici zemvelo kungaba nomthelela kulokhu. Okusho ukuthi, izinguquko ezithile ezenzeka ku-DNA yomntwana kanye namathonya athile endawo umama abhekana nawo ngesikhathi sokukhulelwa kungaba yimbangela.

Ingabe zikhona izinto eziyingozi?

Nakuba kungekho imbangela eqondile eqinisekisiwe yalesi simo, abacwaningi bathole izici eziningana ezivamile zezingane ezizalwa zine-EA. Lezi zingandisa kancane ingozi:

• Umama uneminyaka engaphezu kwengu-35 ubudala kanye/noma ubaba uneminyaka engaphezu kwengu-40 ubudala.
• Ukuthola abantwana ngezindlela zokufakelwa isidoda (njenge-IVF, i-IUI).
• Ukuba namawele noma amawele amathathu.

Ngaphezu kwalokho, i-EA ivame ukubonakala ihlotshaniswa nezinye izinkinga zokuzalwa kanye nezifo zofuzo. Isibonelo:

• I-Trisomy (13, 18 noma 21)
• Inhlangano ye-VACTERL
• I-CHARGE syndrome
• Isifo senhliziyo esizalwa naso
• Ezinye izithiyo zesistimu yokugaya ukudla (i-GI atresias)
• Ukukhubazeka kwezinso kanye nesistimu yokuzala

Odokotela basithola kanjani lesi simo? (Ukuxilongwa)

Esikhathini esiningi, lesi simo sitholakala ngemva kokuzalwa komntwana. Kodwa-ke, ngezinye izikhathi, ukuskena kwangaphambi kokubeletha kunganikeza izinkomba.

• Ngaphambi kokuba umntwana azalwe: Uma ngesikhathi sokuhlolwa kwakho komzimba cishe emavikini angama-20, inani loketshezi lwe-amniotic oluzungeze umntwana liphezulu kakhulu kunokuvamile (lokhu kubizwa ngokuthi i-polyhydramnios ), udokotela angase asole. Lokhu kungenxa yokuthi umntwana uvame ukugwinya leli nani loketshezi. Uma umntwana engakwazi ukugwinya, uketshezi luyanqwabelana. Futhi, uma isisu somntwana sibonakala singenalutho (sinebhamuza elincane noma lingenalo nhlobo) ngesikhathi sokuhlolwa, leso esinye isibonakaliso.
• Ngemva kokuzalwa komntwana: Uma umntwana ebonisa izimpawu esixoxe ngazo ekuqaleni (ukukhwehlela, ukuminyana, ukuba luhlaza okwesibhakabhaka) ngokushesha ngemva kokuzalwa, odokotela basola lokhu ngokushesha. Ukuhlolwa okulula ukuqinisekisa lokhu ukufaka ipayipi elincane (ipayipi le-nasogastric) ngekhala noma emlonyeni womntwana bese uzama ukulidlulisela esiswini. Uma umphimbo uvalekile, ipayipi alikwazi ukungena esiswini. Lima phakathi nendawo.

Ngemuva kwalokho, kwenziwa i-X-ray ukuqinisekisa lokhu nokubona ukuthi hlobo luni lwesici esikhona emgogodleni. I-X-ray ingabona nokuthi uketshezi lungene emaphashini noma umoya ungene esiswini. Ngemva kwalokhu kutholakala, udokotela uzohlola nomntwana ezinye izinkinga zokuzalwa ezihlobene.

Ilashwa kanjani? Ingabe lokhu kungelapheka?

Yebo! Lesi yisimo esingelapheka ngempela. Ukwelashwa kwalokhu kuphela ukuhlinzwa.Esikhathini esiningi, lokhu kuhlinzwa kwenziwa ngokushesha nje ngemva kokuzalwa komntwana.

Ukuphathwa kwangaphambi kokuhlinzwa

Ngaphambi kokwenza ukuhlinzwa, odokotela bathatha izinyathelo eziningana ukuze baqinise isimo somntwana.

• Ukuqinisa ukuphefumula: Ukuze kuvinjelwe ukuthi amafinyila kanye ne-phlegm kungaqongelelani emphinjeni kungafiki emaphashini, kuvame ukususwa ngepayipi (ukumunca). Uma ingane inenkinga yokuphefumula, ixhunywe kumshini wokuphefumula.
• Ukuhlinzeka ngokudla okuphephile: Njengoba ingane ingenakondliwa ngomlomo, ukudla okudingekile kunikezwa ngemithambo ( ukondla kwe-parenteral ) noma ngepayipi elifakwa ngqo esiswini ( ukondla kwe-enteral ).
• Ukuvimbela ukutheleleka: Ama-antibiotic e-IV anikezwa ukuvimbela ukutheleleka kwamaphaphu (i-pneumonia).

Uma ingane ingakafiki isikhathi, inesisindo esingaphansi kwesisindo, noma inezinye izinkinga ezinkulu, njengokukhubazeka kwenhliziyo, ingane kuzodingeka ihlale egunjini lokunakekelwa okujulile kwezingane ezisanda kuzalwa (i-NICU) kuze kube yilapho lezo zimo zizinzile ngaphambi kokuhlinzwa.

Ukuhlinzwa (Ukulungiswa Kokuhlinzwa)

Uma ingane isizimisele ukuthi isilungele ukuhlinzwa, udokotela ohlinzayo uyayihlinza. Ukuhlinzwa kunemigomo emibili eyinhloko:

1. Ukuxhumanisa izingxenye ezimbili ezihlukene zomqala (lokhu kubizwa ngokuthi i-anastomosis ).

2. Ukuvala ukuxhumana okungadingekile (i-fistula) phakathi kwe-pharynx ne-trachea.

Ngobuchwepheshe obuthuthukisiwe banamuhla, lokhu kuhlinzwa kuvame ukwenziwa ngaphandle kokuvula isifuba, kodwa ngokufaka ikhamera namathuluzi ngokusebenzisa izimbobo ezimbalwa ezincane kakhulu (ukuhlinzwa kwe-thoracoscopic). Lokhu kubangela ubuhlungu obuncane enganeni futhi kuphumela ekululameni okusheshayo.

Kwenzekani ngemva kokuhlinzwa?

Ngemva kokuhlinzwa, umntwana ubuyiselwa e-NICU ukuze aqashwe ngokucophelela. Ezinsukwini ezimbalwa kamuva, kwenziwa i-X-ray ekhethekile ebizwa ngokuthi i-esophagram ukuze kuhlolwe ukuthi ngabe ukusikwa kupholile kahle yini nokuthi kukhona yini ukuvuza. Uma konke sekuqinisekisiwe, umntwana kancane kancane wethulwa ohlelweni lokuncelisa ngomlomo. Kuthatha isikhathi ukuthi umntwana ajwayele inqubo yokugwinya.

Yiziphi izinkinga zesikhathi eside ezingase zivele ngemva kokuhlinzwa?

Iningi lezinsana liyalulama ngokuphelele futhi liphile impilo evamile. Kodwa-ke, ezinye izingane zingase zibe nezinkinga ezithile isikhashana ngemva kokuhlinzwa. Kubalulekile ukuzazi lezi.

• Ubunzima bokugwinya: Ezinye izingane zingase zingabi nemisipha emphinjeni yazo esebenza kahle. Lokhu kungabangela ukuba ziminyaniswe lapho ziqala ukudla ukudla okuqinile. Ukudla kufanele kuchotshozwe kahle futhi kunikezwe noketshezi.
• Isifo Sokuphindeka Kwesisu Esingamahlalakhona (i-GERD): Lokhu kwenzeka lapho i-asidi yesisu igeleza ibuyela emuva emgudwini womchamo. Lokhu kungabangela isilungulela kanye nokungagayeki kahle kokudla. Uma kungelashwa, kungalimaza umchamo. Lesi simo senzeka cishe kwengxenye yezingane eziye zahlinzwa i-EA.
• I-Tracheomalacia:Lokhu kuwubuthakathaka be-cartilage emigwaqweni yomoya. Lokhu kungaholela ekuphefumuleni, ukukhwehlela njalo, kanye nokutheleleka kwamaphaphu njalo (i-bronchitis, i-pneumonia).

Uma unezinkinga ezinjalo, ungesabi. Kukhona izindlela zokwelapha zonke lezi. Into ebaluleke kakhulu ukukhuluma nodokotela wakho ngakho njalo bese ulandela imiyalelo yakhe. Kungase kudingeke futhi ufune usizo ku-Speech-Language Pathologist (SLP).