Xem mẫu

VIEM PHUC MAC PHAN XU 1.0AI CL/ONG Viem phuc mac phan xu dtfdc mo ta lan dau tien bdi Morgani vao nam 1761. Tdi nam 1943, benh nhan dtfdc mo ctiu song bdi Agerty. Viem phuc mac phan xu la tinh trang viem phuc mac do thung ruot va phan xu vao o bung. Thung ruot co the xay ra trong thdi ky bao thai ho&c quanh de nen co cac thtfdng ton giai phau benh va cac the lam sang khac nhau. Day la mot loai cap ctiu ngoai nhi co ty le ttf vong cao. 2. SINH LY BENH Trong thdi ky bao thai, thai nhi nuo`t ntfdc oi. Ntfdc oi ket hdp vdi dich cua dtfdng tieu hoa va cac te bao dtfdc bong ra tti niem mac ruot de tao th&nh phan xu. Phan xu nhu dong ruot day dan xuong dai ttfc trang. Do nguyen nhan tfic nghen cua ruot hoac do ton thtfdng mach mau tdi ruot ma ma ruot bi thung vi phan xu vao o bung. Phan xu trong thdi ky bao thai khdng cd vi khu&i nhtfng c6 cac men tieu hoa nen din tdi phan ting cua phuc mac d cac mtic do khac nhau roi tao to chtic xd gay dinh cac tang xung quanh de khu tru phan xu lai. Ntiu thung ruot xay ra ngay trtfdc de hoac d thdi diem de thi phan xu tran vao o bung co thi cd hdi trong o bung, dinh ruot it hdn nhtfng bung trtfdng hdn. Stf hinh thanh vdi hoa trong o bung xay ra sau khi phan xu vao o bung it nM`t 10 ngay. Voi hoa xay ra tai cho ruot bi thung nhtfng cung co the d cac vung trong o bung tham chi xuong ca biu. 3. CAC THE GIAI PHAU LAM SANG Tuy theo mtic do dinh ruot, mtic do t&c ruot, stf khu tru cua phan xu trong o bung ma chia thanh cac the benh khac nhau: viem phuc mach ket boc, viem phuc mac hinh thanh nang gia va viem phuc mac dinh xay ra trong thdi ky bao thai con viem phuc mac phan xu xay ra quanh de. 3.1. Viem phuc mac ket boc Day la the benh nang nhat va cd ty le tti vong cao nhat. Phan xu tran vao tat ca cac vung bung, ruot bi dinh lai thanh mot khoi va bi day don ve phia giiia bung, trtfdc cot song. Ruot thtfdng bi t&c hoan toan. 3.2. Viem phuc mac hinh thanh nang gia Phan xu vao o bung dtfdc khu tru lai bdi ruot non va mac noi ldn. Vi tri khoi phan xu thtfdng d mat dtfdi gan. Ruot thtfdng bi dinh nhi€u nhiing vln co thi con 134 ltfu thong. Dich ruot va phan xu chay vao nang gia nhtfng co the ra hau mon. Hdi qua lo thung ruot vao nang gia. 3.3. Viem phuc mac phan xu Phan xu vao ttf do trong o bung, ruot thtfdng dinh it va thtfdng co hep hoac t&c ruot ben dtfdi cho ruot bi thung. Cac quai ruot tren cho t&c, thung thtfdng bi gian, con doan ruot ben dtfdi thtfdng xep. 3.4. Viem phuc mac dinh Thung ruot trong thdi ky bao thai nhtfng dtfdc bit lai. Phan xu vao trong o bung gay dinh ruot. Dinh ruot bi d cac mtfc do khac nhau, co the gay t&c ruot hoan toan, co hoac khong gay tic ruot. Do vay trieu chtfng tic ruot co the xay ra d tudi sd sinh nhtfng co the d tudi bu me hoac tre nho. 4. TRIEU CHITNG LAM SANG VA CAN LAM SANG 4.1. Lam sang: la bieu hien tile ruot sd sinh. - Non: xu&`t hien sdm sau de. Chat non la dich da day, dich mat va muon hdn la dich ruot. - Non nhieu lam tre mat ntfdc va dien giai, cd the chat non trao ngtfdc vao dtfdng hd hap gay viem phoi. - TrUdng bung: cung xuat hien sdm. Bung thtfdng trtfdng deu da c&ng bdng, ndi cac tlnh mach nong d dtfdi da. - Dai tien: thtfdng khdng dai tien phan xu. Tham trtfc tr&ng va thut thao dai - trtfc trang thtfdng khdng ra phan xu, cd the ra ft chat nh&y v&kit the m&u tr&ng due hoac xanh nhat. - Kham biu: cd the th&y biu to cang ca hai ben va nhin cd anh mau xanh. N&n v&bop nhe v&o tui biu thi the tich biu nho lai. Neu choc cd the hut ra ph&n xu. 4.2. X quang Chup bung th&ng khdng chuan bi thtfdng chan do&n dtfdc the benh viem phuc mac. - Viem phuc mac ket boc: th&y md cac vting bung, cac bong hdi trong ruot non thtfdng nho va khu tru d vi tri gitfa byng, trtfdc cot song. - Viem phuc mac hinh th&nh nang gia: thtfdng md d o bung dtfdi, cac bong hdi trong ruot non, cd mot hinh mtic ntfdc hdi r&`t to thtfdng d dtfdi gan ben phai. - Viem phiic m?c ph&n xu: o bung md, cd quai ruot gian c&ng hdi, c6 liem hdi dtfdi cd ho&nh. - Cac v£t can quang l&n d6m cd thi d vi tri b&t ky trong o bung, d sat dtfdng vien phiic m*c th^m chi d biu. 135 Hinh 11.1. Viem phuc mac dinh ruot, calci hoa, chup van co luu thong tieu hoa Hinh 11.2. Viem phuc mac ket boc Hinh 11.3. Viem phuc mac hinhthanh nang gia 136 Hinh 11.4. Viem phuc mac do thung ruot quanh de 4.3. Sieu am Nhting nam gan day, sieu am trtfdc de da chan doan diidc nhieu di tat trtfdc de trong do co viem phuc mac thai nhi. Sieu am co the theo doi tien trien cua viem phuc mac. 5. CHAN DOAN Dtfa tren cac dau hieu lam sang la tfic ruot sd sinh va phim chup bung khong chuan bi hoac co the chup ltfu thong dtfdng tieu hoa. 6. DIEU TR| Day la mot cap ctiu phai phiu thuat. Muc dich phiu thuat la lay bo het phan xu trong o bung, lap lai stf ltfu thong dtfdng tieu hoa. Tuy nhien do mtic do thtfdng ton nang nhe khac nhau ma nen ltfa chon ky thuat md phu hdp. Ngay sau de, nen dat ong thong vao da day de lam xep b6t da day - ruot, lay dtfdng truyen tlnh mach de truyen dich nuoi dtfdng dtfdng tlnh mach va can boi phu ntfdc dien giai, vitamin K va khang sinh. Chu £ giG than nhiSt on dinh, can kham ky de phat hien het cac di tat phoi hdp. 6.1. Ltfa chon ky thuat mo 6.1.1. Mdgiai quyetnguyen nhin Md bvng, sach o bving, gd dinh, tim cho rudt thung ho&c cho gay tic de giai quyet nhtf khau lo thung ho&c c&t noi ruot t&n t&n ho&c t&n cheo. Ltfu y phai 137 lam ltfu thong hoan toan ttf mieng noi ho&c cho khau ruot tdi tan lo hau mon. Dtfdng mo thich hdp thtfdng la dtfdng gitfa tren ron. Trtfdc day, ky thuat nay thtfdng dtfdc ap dung chd tat ca cac the viem phuc mac thai nhi nhtfng ty le ttf vong rat cao d hai the viem phuc mac ket boc va viem phuc mac hinh thanh nang gia. (!) hai the benh nay, khi gd dinh ruot, thtfdng bj rach thanh - cd thanh ruot gay mat mau nhieu va gay dinh ruot sau mo. Neu cat ruot thi benh nhan co hoi chtfng ruot ng&n. Mieng noi ruot thtfdng khong lien tot, d§ bi buc, ro hoac t&c. Do vay ky thuat nay nen chi dinh cho the viem phuc mac phan xu. Vdi the benh nay, ket qua mo thtfdng tot. 6.1.2. Dan luu tdi thieu 6 bung hoac nang gia Lam sdm sau de de thoat dich, phan xu ra ngo&i, ket hdp thut thao lam ltfu thong dai trang, nuoi dtfdng tinh mach. Neu sau v&i ng&y ma phan xu vln ra qua din ltfu, khong co phan ra qua h&u mon thi md tim cho ruot thung hofic tic de dtfa ra ngoai o bung. Mo thi ba de noi lai ruot. 6.3. Dieu tri sau mo Chu y tinh trang than nhiet, nuoi dtfdng dtfdng tlnh mach. Tdi khi co ltfu thong tieu hoa, ong thong da day ra dich trong khong m&t thi cho &n theo dtfdng mieng. 7. TIEN LUONG Tu£ thuoc vao the benh, can n&ng benh nhan, cac di t&t phoi hdp vk cd viem phoi khong. The benh viem phuc mac ket boc va hinh thanh nang gia c6 ty le tit vong cao. TAI LIEU THAM KHAO 1. Canty TG, Leopold GR, Wolf DA. Maternal ultrasonography for the antenatal diagnosis of surgically significant neonatal anomalies. Anna. Surg, 1981, 194: 353-365. 2. Gruner M, Belas M, Levi J.F, Herve J.M. Il6us mSoniales. P6ritonites meconiales. Chirurgie digestive de l’enfant. Doin aditeurs, 1990, p 397-402. 3. Martin.L. Ravich MM, Welch KJ, Benson CD et aL Meconium peritonitis. Pediatric surgery. Chicago: Year Book Medical Publishers, 1979:952*955. 138 ... - tailieumienphi.vn
nguon tai.lieu . vn