Ingabe kukhona ukuxhumana okungajwayelekile phakathi kwepayipi lokudla lomntwana wakho kanye nepayipi lomoya? Ake sifunde konke mayelana (ne-Tracheoesophageal Fistula)!

Ingabe ingane yakho encane iyakhwehlela ngokuzumayo ngemva kokuphuza ubisi noma ukudla ukudla? Ingabe ibonakala inobunzima bokuphefumula noma iphenduka ibe luhlaza okwesibhakabhaka? Kuvamile ngawe njengomzali ukuzizwa wesaba kakhulu futhi ukhathazekile. Ngezinye izikhathi, ngemuva kwalezi zimpawu, kungase kube nesimo esiyinkimbinkimbi kancane, kodwa esingelapheka esizokhuluma ngaso namuhla. Leso yi -Tracheoesophageal Fistula , noma i-TEF ngamafuphi, kanye nesimo esihlobene ne -Esophageal Atresia , noma i-EA. Ungakhathazeki, masikwenze kube lula.

Iyini i-Tracheoesophageal Fistula (TEF)? Masiyiqonde kalula!

Kulungile, manje ake sibone ukuthi iyini le TEF. Kalula nje, ithubhu elithwala ukudla kusuka emphinjeni wethu kuya esiswini sethu libizwa ngokuthi "umqala". Ngokufanayo, ithubhu elithwala umoya emaphashini ethu lapho siphefumula libizwa ngokuthi "i-trachea". Ngokuvamile, kumuntu ophilile, la mathubhu amabili, i-esophagus kanye ne-trachea, atholakala ngokwehlukana, ngaphandle kokuxhumana komunye nomunye. Kufana nemigwaqo emibili, eyodwa yokudla kanye nenye yokuphefumula.

Kodwa-ke, kumuntu onesifo esibizwa ngokuthi i-Tracheoesophageal Fistula (TEF) , ikakhulukazi ingane encane, kukhona ukuxhumana okungeyona into engokwemvelo, noma imbobo (i-fistula) phakathi kwepayipi lokudla (umphimbo) kanye nomphimbo womoya (i-trachea). Cabanga ngakho njengokuvuza okuncane phakathi kwamapayipi amabili amanzi. Kwenzekani ngenxa yalokhu? Esikhundleni sokwehla ngepayipi lokudla liye esiswini, ukudla kanye noketshezi umntwana akudlayo futhi akuphuze kuqala ukudlula kulolo xhumano olungeyona engokwemvelo luye epayipini lomoya bese kusuka lapho luye emaphashini. Lokhu sikubiza ngokuthi "isifiso" . Lokhu kuyingozi kancane, ngoba uma ukudla kungena emaphashini, izifo zingavela.

Ngokuvamile, lesi simo se-TEF sibonakala kanye nesinye isimo. Leso yi -Esophageal Atresia (EA) . I-EA yisimo lapho i-esophagus (ipayipi lokudla) ingakheki ngokugcwele, ingaxhumani nesisu, futhi ima phakathi nendawo. Ngezinye izikhathi i-esophagus ihlukaniswa izingxenye ezimbili, futhi iziphetho zezingxenye zombili zivaliwe (amaphakethe angaboni). Njengepayipi eliphukile phakathi.

Ubani othinteka kakhulu yilesi simo?

I-Tracheoesophageal fistula (TEF) ivame ukuba "isimo sokuzalwa." Lokhu kusho ukuthi izingane zizalwa nalesi simo. Sibangelwa ushintsho oluncane ekukhuleni kombungu ngesikhathi usesesibelethweni. Ngakho-ke, izimo eziningi ze-TEF zixilongwa futhi zelashwe isikhathi eside ngemva kokuzalwa komntwana, ngesikhathi sobuntwana.

Kodwa-ke, nakuba kungavamile kakhulu, abantu abadala nabo bangaba nalesi simo se-TEF kamuva ekuphileni. Sibizwa ngokuthi "i-Acquired Tracheoesophageal Fistula" . Lokhu kungabangelwa umdlavuza womphimbo, umdlavuza wamaphaphu, izifo ezinzima njengesifo sofuba, noma ingozi ngesikhathi senqubo yezokwelapha.

Ivame kangakanani i-Tracheoesophageal Fistula (TEF)?

Ngokwezibalo ezivela e-United States, kulinganiselwa ukuthi i-TEF ithinta cishe ingane eyodwa kwezingu-3,000 kuya kwezingu-5,000 ezizalwayo. Ngaphezu kwalokho, cishe u-50% wezingane ezine-TEF noma i-EA zingase zibe nesinye isimo sokuzalwa. Lokhu kusho ukuthi kungase kube nezinkinga kwezinye izindawo, njengezinso, inhliziyo, noma uhlelo lwamathambo.

"I-Acquired TEF" eyenzeka lapho umuntu ekhula ayivamile kakhulu. Futhi, akuvamile kakhulu, abanye abantu abadala bangazalwa bene-TEF futhi babe nezimpawu ezibonakala kamuva ekuphileni. Lokhu kusho ukuthi banalesi simo lapho bezalwa, kodwa izimpawu zibonakala kamuva.

Yiziphi izinhlobo eziyinhloko ze-Tracheoesophageal Fistula (TEF)?

Manje ake sibheke izinhlobo eziyinhloko zalesi simo se-TEF. Odokotela bavame ukusihlukanisa sibe izinhlobo ezinhlanu. Lokhu kuningiliziwe kancane, kodwa ake sizame ukuqonda. Cabanga ukuthi i-esophagus (E) iyipayipi elilodwa, kanti i-trachea (T) ingenye ipayipi.

• Uhlobo A: Lena yi-TEF, okusho ukuthi akukho ukuxhumana okungajwayelekile. Kodwa kukhona i-EA (Esophageal Atresia) . Lokhu kusho ukuthi umphimbo uhlukaniswe izingxenye ezimbili, futhi zombili izingxenye eziphezulu nezingezansi zezingxenye zombili zivaliwe (amaphakethe angaboni). Kufana nepayipi eliphukile phakathi futhi izingxenye ezimbili zezingcezu eziphukile zivaliwe. Lokhu kubizwa nangokuthi "i-Pure Esophageal Atresia". Cishe u-8% wazo zonke iziguli ze-TEF/EA zingalolu hlobo.

• Uhlobo B: Lokhu akuvamile kakhulu, kuthinta u-2% kuphela wabo bonke iziguli. Lapha, ingxenye engenhla yomhubhe ixhunywe ku-trachea (kukhona i-TEF), kodwa ingxenye engezansi yomhubhe iphela ngengxenye evaliwe (isikhwama esingaboni).

• Uhlobo C: Lolu uhlobo oluvame kakhulu. Cishe u-85% wamacala awela kulesi sigaba. Okwenzekayo lapha ukuthi ingxenye engenhla ye-esophagus iphelela esiphethweni esivaliwe (isikhwama esingaboni), kodwa ingxenye engezansi ye-esophagus ixhunywe ku-trachea (TEF). Lokhu kusho ukuthi ingxenye ye-esophagus okufanele ixhunywe esiswini ixhunywe ku-trachea.

• Uhlobo D: Lolu uhlobo olungavamile kakhulu, oluvela ngaphansi kwe-1% yamacala. Lapha, izingxenye eziphezulu nezingezansi zomhubhe zixhunywe ku-trachea ngokwehlukana (kunezinhlobo ezimbili ze-TEF).

• Uhlobo E: Kulolu hlobo, umphimbo wakheke ngokuphelele futhi uxhumene nesisu. Lokhu kusho ukuthi i-EA ayikho. Kodwa-ke, kukhona ukuxhumana okungavamile (TEF) phakathi komphimbo kanye ne-trachea. Lokhu ngezinye izikhathi kubizwa ngokuthi i-H-type fistula, ngoba ukuxhumana kungabunjwa njengohlamvu "H". Cishe u-4% wabo bonke abaguli bawela kulolu hlobo.

Nakuba lokhu kuhlukaniswa kungase kubonakale kuyinkimbinkimbi kancane, kubaluleke kakhulu ukuthi odokotela bahlele ukwelashwa.

Ziyini izimpawu ze-Tracheoesophageal Fistula (TEF)?

Izimpawu ze-TEF zincike ekutheni i-EA (Esophageal Atresia) ikhona yini futhi incike kuhlobo lwe-TEF.

Izingane ezine-TEF kuphela (isibonelo, Uhlobo E) ezingenayo i-EA zingase zingabonisi izimpawu lapho zizalwa. Kodwa-ke, ngokuhamba kwesikhathi, zingase zibone izinto ezifana nalezi:

• Ukutheleleka kwamaphaphu okuvamile kwenzeka ngoba izinhlayiya zokudla zibhajwa emigwaqweni yomoya.
• Lapho bencelisa noma bencelisa, bayaphefumula futhi bazizwe sengathi bayaklinywa.

Izingane ezine-Esophageal Atresia (EA) kanye ne-Tracheoesophageal Fistula (TEF) (njengohlobo oluvame kakhulu, i-Type C) zivame ukukhombisa izimpawu zingakapheli amahora ambalwa zizelwe. Izimpawu ezivame kakhulu yilezi:

• Ukukhwehlela njalo, ikakhulukazi uma uzama ukuncelisa.
• Ukuminyana uma uzama ukugwinya.
• Izinkinga zokuphefumula.
• Ukuphuma kwamafinyila amaningi emlonyeni.
• Ukuvuvukala kwesisu (ikakhulukazi ku-Type C, njengoba umoya ophefumulayo udlula nge-TEF ungene esiswini).
• Ingane iphenduka ibe luhlaza okwesibhakabhaka (i-cyanosis) ngesikhathi incelisa.

Cabanga nje, kukhona umntwana osanda kuzalwa. Lapho nje umama ezama ukuncelisa ubisi, umntwana uqala ukukhwehlela njalo, abonakale sengathi uyaminza, futhi ngezinye izikhathi uphenduka ube luhlaza okwesibhakabhaka emlonyeni. Kuphuma amafinyila amaningi emlonyeni. Uma ubona into efana nale, kubaluleke kakhulu ukufuna iseluleko sezokwelapha ngokushesha.

Yini ebangela i-Tracheoesophageal Fistula (TEF)?

Lokhu kuvame ukwenzeka ngesikhathi sokukhula kombungu, okuyilapho umntwana ekhula esibelethweni. Ngokuvamile, phakathi kwamasonto amane kuya kwayisishiyagalombili ngemva kokukhulelwa, kwakheka udonga phakathi komhubhe kanye nomphimbo, okuqala njengomgudu owodwa. Uma lolu donga lungakheki kahle, noma ukuhlukana kungaphelele, lokhu kuxhumana okungavamile okubizwa ngokuthi i-Tracheoesophageal Fistula (TEF) kwenzeka. Imbangela eqondile yalesi simo ayaziwa okwamanje, kodwa kucatshangwa ukuthi ibangelwa izici zofuzo kanye nezemvelo.

Odokotela bayixilonga kanjani i-TEF?

Akuvamile kakhulu, udokotela angase asole i-TEF ngenxa yeziphambeko ezibonwe ku-ultrasound scan ngaphambi kokuba umntwana azalwe. Isibonelo, uma kukhona uketshezi oluningi kakhulu lwe-amniotic oluzungeze umntwana (i-polyhydramnios), noma uma isisu somntwana singabonakali kahle, udokotela angase abe nokungabaza.

Kodwa-ke, kaningi, ukusola nge-TEF kuvela emahoreni ambalwa ngemva kokuzalwa, lapho umntwana eqala ukukhombisa izimpawu ezibalwe ngenhla (ukuvuvukala ngokweqile, ubunzima bokuphefumula, ukungakwazi ukugwinya).

Ukuqinisekisa lokhu kusola, ithimba lezokwelapha lingenza izivivinyo ezifana nalezi:

• Ama-X-ray esifubeni nakwesisu: Lokhu kungahlola isimo somhubhe, amaphaphu, nokuthi ngabe kukhona umoya esiswini. Isibonelo, ithubhu elincane (ithubhu le-nasogastric) elifakwa emhubheni womntwana one-EA lingase lime phakathi ne-X-ray ngaphandle kokufinyelela esiswini.
• I-Endoscopy noma i-Bronchoscopy: Kulezi zivivinyo, ithubhu elincane elinekhamera enamathiselwe lifakwa ngomlomo noma ekhaleni bese libheka ngqo ngaphakathi kwe-esophagus (endoscopy) noma i-windpipe (bronchoscopy). Lokhu kungasiza ekutholeni indawo yokuxhumana okungavamile (i-fistula).

Uma ingane isitholakale ine-TEF noma i-EA, udokotela uvame uku-oda ukuhlolwa okwengeziwe ukuze ahlole ezinye izinkinga zokuzalwa, njengoba kushiwo ngaphambili. Isibonelo, kungenziwa ukuskena kwenhliziyo (echocardiogram) kanye nokuskena kwezinso.

Iphathwa kanjani i-Tracheoesophageal Fistula (TEF)?

Ukwelashwa okuwukuphela kwendlela ephumelelayo yokwelapha i-TEF ukuhlinzwa. Kulokhu kuhlinzwa, udokotela ohlinzayo ususa ukuxhumana okungavamile phakathi komphimbo womntwana kanye ne-trachea bese evala umgodi. Ngemuva kwalokho, uma i-EA nayo ikhona, izingxenye ezimbili eziphukile zomphimbo ziyaxhunyaniswa ukuze kwenzeke ukuthi ukudla kudlule.

Lokhu kuhlinzwa kungenziwa njengokuhlinzwa okuvulekile kwendabuko noma njengokuhlinzwa okungenasidingo (ukuhlinzwa kwe-thoracoscopic) kusetshenziswa ukusikwa okuncane. Indlela esetshenziswayo incike ezicini ezifana nesimo somntwana, uhlobo lwe-TEF, kanye nolwazi lukadokotela ohlinzayo.

Ingabe zikhona izingozi kulokhu kuhlinzwa?

Njenganoma yikuphi ukuhlinzwa, ukuhlinzwa kokulungisa i-TEF kungaba nezinkinga ezithile. Lokhu kufaka phakathi:

• Ukuvuza kwe-anastomotic: Lokhu kubhekisela ekuvuza koketshezi oluvela ku-anastomosis (uxhumano) lwepayipi lokudla.
• Ukuqina komlomo wesibeletho: Lesi yisimo lapho ukuxhumana nombhobho wokudla kuba mncane ngokuhamba kwesikhathi. Lokhu kungenza kube nzima ngengane ukugwinya.
• Ukulimala kwe-laryngeal nerve: Lokhu kungathinta izwi lomntwana.
• Ukuphinda kwe-fistula: Ngisho nangemva kokuhlinzwa, ukuxhumana okungavamile akuvamile ukuphinda. Lokhu kwenzeka cishe ku-3% kuya ku-14% wamacala.
• Izifo.
• Isifo Sokuphindezela Kwesisu Esiphuma Emlonyeni (GERD): Lokhu kwenzeka lapho i-asidi yesisu ibuyela phezulu emlonyeni. Lokhu kuvamile ngemva kokuhlinzwa kwe-TEF.

Ithimba lezokwelapha lizokhuluma nawe ngalezi zingozi. Ungakhathazeki, odokotela bakulungele konke lokhu.

Kuthatha isikhathi esingakanani ukululama ngemva kokwelashwa kwe-TEF?

Isikhathi sokululama singahluka kuye ngosana. Kuncike ebunzimeni besimo somntwana, uhlobo lokuhlinzwa, kanye nendlela umntwana asabela ngayo ekwelashweni. Ezimweni eziningi, kungathatha cishe amasonto ayi-12, noma cishe izinyanga ezintathu, ukuba alulame ngokugcwele. Phakathi nalesi sikhathi, umntwana anganikwa ukudla ngepayipi elikhethekile lokumunca, noma angase aqaliswe kancane kancane ekumunceni ngomlomo. Odokotela nabasebenzi abahlengikazi bazochaza konke lokhu kuwe.

Ingabe i-Tracheoesophageal Fistula (TEF) ingavinjelwa?

Okwamanje ayikho indlela yokuvimbela i-TEF yokuzalwa, okuyi-TEF ekhona lapho kuzalwa. Lokhu kungenxa yokuthi yenzeka ngesikhathi sokukhulelwa. Futhi, njengoba i-TEF etholwe, eyenzeka lapho umuntu esemdala, ivame ukubangelwa umdlavuza noma izifo ezinzima, ayikho indlela ethile yokuyivimbela. Kodwa-ke, ukulandela indlela yokuphila enempilo kungasiza ekuvikeleni umdlavuza kanye nezifo.

Yini okufanele ngiyilindele uma ingane yami ine-TEF?

Uma ingane yakho itholakale ine-TEF, ithimba lezokwelapha lizoncoma ukuhlinzwa ngokushesha. Lokhu kungaba yisimo esisongela impilo, ngakho-ke kubalulekile ukuthola ukwelashwa ngokushesha. Uhlobo lokuhlinzwa luncike ohlotsheni lwe-TEF.

Uma ingane iba nezinkinga ngemva kokuhlinzwa, ithimba lezokwelapha lizoyigcina esibhedlela izinsuku ezimbalwa futhi liqaphe isimo sayo eduze. Izingane eziba nezinkinga ngaphambi kokuhlinzwa cishe ziyophinde zibuye i-TEF kamuva. Ngakho-ke, uma izinkinga ezinjalo zenzeka, udokotela uzoqhubeka nokuqapha ingane (ukulandelela).

Ngesikhathi esinjengalesi, njengabazali, ningazizwa nikhungathekile ngokwengqondo. Ningase nizizwe nisaba. Lokho kuyinto evamile. Buza odokotela nabahlengikazi imibuzo yakho bese ususa ukungabaza kwakho. Bazokusiza.

Ingabe i-Tracheoesophageal Fistula (TEF) ingelapheka ngokuphelele?

Yebo! I-Tracheoesophageal fistula (TEF) ingelapheka ngokuphelele ngokuhlinzwa. Into ebaluleke kakhulu ukuyibona kusenesikhathi bese uqala ukwelashwa ngokushesha, njengoba kungaba yisimo esisongela impilo. Ukwenza kanjalo kungalungisa ukuxhumana okungavamile phakathi komphimbo womntwana kanye nomphimbo womoya, kuvimbele ukudla ukuthi kungangeni emaphashini (i-aspiration), futhi kunikeze ingane ithuba lokuphila impilo enempilo.

Okokugcina, khumbula lokhu (Umyalezo Wokuya Ekhaya)

Kuvamile ukuzizwa ukhungathekile uma uthola ukuthi ingane yakho ine-Tracheoesophageal Fistula (TEF). Kodwa khumbula, lesi yisimo esingelapheka.

• Ukutholwa kusenesikhathi kanye nokwelashwa okusheshayo yizinto ezibaluleke kakhulu. Uma ingane yakho ikhala njalo ngenkathi incelisa noma idla, ibonakala inobunzima bokuphefumula, noma iphenduka ibe luhlaza okwesibhakabhaka, funa usizo lwezokwelapha ngokushesha.
• Ukuhlinzwa kuyindlela eyinhloko yokwelapha lokhu.Odokotela bazokunikeza ukwelashwa okufanele kakhulu kwengane yakho.
• Ngisho nangemva kokuhlinzwa, kubaluleke kakhulu ukulandela imiyalelo yodokotela nokuyisa umntwana ukuze ayohlolwa ngesikhathi.
• Awuwedwa. Ukusekelwa yithimba lakho lezokwelapha, umndeni, nabangani kubaluleke kakhulu kulesi sikhathi. Unganqikazi ukwabelana ngemizwa yakho nokucela usizo.

Sithemba ukuthi lolu lwazi luzokusiza ukuthi uqonde lesi simo esiyinkimbinkimbi. Sifisela ingane yakho ukululama okusheshayo!

i- tracheoesophageal fistula, i-esophageal atresia, isimo sokuzalwa, ukukhubazeka kokuzalwa, impilo yomntwana, ukuhlinzwa kwezingane, isifiso sokudla