prakticheskoe zanyatie №5. priobretennaya kishechnaya neproxodimost u detey. diagnostika i dif. diagnostika. klinika, lecheniya

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prakticheskoe zanyatie №5. priobretennaya kishechnaya neproxodimost u detey. diagnostika i dif. diagnostika. klinika, lecheniya u detey, kak i u vzroslix, priobretennuyu kishechnuyu neproxodimost razdelyayut na dva osnovnix vida - mexanicheskuyu i dinamicheskuyu. v detskom vozraste v gruppe mexanicheskoy neproxodimosti videlyayut obturatsionnuyu, strangulyatsionnuyu i invaginatsiyu kishechnika. v svoyu ochered prichinoy obturatsionnoy neproxodimosti neredko yavlyaetsya koprostaz pri vrojdennom stenoze pryamoy kishki, bolezni girshprunga, megakolone ili svishevoy forme atrezii pryamoy kishki. strangulyatsionnaya neproxodimost inogda vizivaetsya narusheniem obratnogo razvitiya jeltochnogo protoka ili sledstviem drugix porokov razvitiya. tem ne menee v praktike detskoy xirurgii chashe vsego prixoditsya stalkivatsya so spaechnoy kishechnoy neproxodimostyu, invaginatsiey kishechnika, dinamicheskoy neproxodimostyu. ostraya spaechnaya kishechnaya neproxodimost u detey - odno iz naibolee tyajelix i rasprostranennix zabolevaniy v abdominalnoy xirurgii. v poslednee vremya otmechaetsya vozrastanie udelnogo vesa spaechnoy neproxodimosti sredi prochix vidov ileusa u detey. vajno vsegda pomnit: esli u rebenka voznikla bol v jivote, a v anamneze imelo mesto lyuboe operativnoe …

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te klinicheskix proyavleniy v znachitelnoy stepeni opredelyaet diagnosticheskuyu i lechebnuyu taktiku. pokazaniya k operativnomu vmeshatelstvu opredelyayutsya ne stolko stadiey zabolevaniya (rannyaya, pozdnyaya), skolko ego ostrotoy. klinika i diagnostika. sverxostraya forma spaechnoy kishechnoy neproxodimosti proyavlyaetsya klinicheskoy kartinoy, podobnoy shokovomu sostoyaniyu. v rannie sroki otmechayutsya toksikoz, bistroe narastanie yavleniy eksikoza, voznikaet rezkaya, sxvatkoobraznaya bol v jivote, vo vremya kotoroy bolnoy vremenami ne naxodit sebe mesta, poyavlyayutsya neukrotimaya rvota, virajennoe usilenie peristaltiki. pri pozdnem postuplenii rezko virajena intoksikatsiya, otmechayutsya obilnaya, zastoynogo xaraktera rvota (kalovaya rvota),"peritonealniy" jivot; peristaltika kishechnika rezko oslablena ili otsutstvuet. takaya kartina naibolee xarakterna dlya strangulyatsionnoy neproxodimosti. rentgenologicheski opredelyayutsya chetkie gorizontalnie urovni (chashi kloybera), "arki" v rezko rastyanutix petlyax tonkoy kishki. pri ostroy i podostroy formax simptomi zabolevaniya menee virajeni, no deti takje jaluyutsya na pristupoobraznuyu bol v jivote; voznikaet rvota, usilivaetsya peristaltika kishechnika. klinicheskie proyavleniya zavisyat ot dlitelnosti zabolevaniya. v pozdnie sroki klinicheskaya kartina xarakterizuetsya yavleniyami eksikoza, mnogokratnoy rvotoy zastoynogo …

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spektivnim i visokoinformativnim metodom diagnostiki yavlyaetsya laparoskopiya. lechenie. bolnix so sverxostroy formoy zabolevaniya operiruyut v ekstrennom poryadke posle kratkovremennoy dooperatsionnoy podgotovki. pri podostroy ili ostroy formax lechenie neobxodimo nachinat s kompleksa konservativnix meropriyatiy, vklyuchayushix: 1) oporojnenie jeludka (postoyanniy zond) s periodicheskim ego promivaniem cherez 2 - 3 ch; 2) ganglionarnuyu blokadu; 3) vnutrivennuyu stimulyatsiyu kishechnika: a) 10% rastvor xlorida natriya po 2 ml na 1 god jizni; b) 0,05% rastvor prozerina po 0,1 ml na 1 god jizni; 4) sifonnuyu klizmu cherez 30 - 40 min posle stimulyatsii. odnovremenno rentgenologicheski kontroliruyut passaj vzvesi sulfata bariya po kishechniku. eti meropriyatiya provodyat na fone korrektsii narusheniy gomeostaza, stabilizatsii gemodinamiki, vosstanovleniya mikrotsirkulyatsii. primenenie ukazannoy taktiki v podostroy i ostroy formax pozvolyaet kupirovat spaechnuyu kishechnuyu neproxodimost konservativnimi meropriyatiyami bolee chem u 50% bolnix. xirurgicheskoe lechenie pri bezuspeshnosti konservativnix meropriyatiy zaklyuchaetsya v ustranenii prepyatstviya (rassechenie spaek). pri etom prinimayut vo vnimanie takie faktori, kak rasprostranennost …

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ozvolyaet v maksimalno sjatie sroki s visokoy tochnostyu podtverdit ili isklyuchit diagnoz ostroy spaechnoy neproxodimosti. vipolnenie laparoskopicheskix operatsiy s ispolzovaniem endovideosistemi daet vozmojnost kupirovat kishechnuyu obstruktsiyu i izbegat laparotomii bolee chem u 90% bolnix s ostroy spaechnoy kishechnoy neproxodimostyu, chto svidetelstvuet o visokix lechebnix vozmojnostyax metoda. invaginatsiya - vnedrenie odnogo otdela kishechnika v prosvet drugogo - naibolee chastiy vid priobretennoy kishechnoy neproxodimosti. etot svoeobrazniy variant kishechnoy neproxodimosti vstrechaetsya preimushestvenno u detey grudnogo vozrasta (85 - 90%), osobenno chasto v period s 4 do 9 mes. malchiki zabolevayut pochti v 2 raza chashe devochek. u detey starshe 1 goda invaginatsiya nablyudaetsya redko i v bolshinstve sluchaev bivaet svyazana s organicheskoy prirodoy (divertikul podvzdoshnoy kishki, giperplaziya limfoidnoy tkani, polip, zlokachestvennoe novoobrazovanie i dr.). invaginatsiya otnositsya k smeshannomu, ili kombinirovannomu, vidu mexanicheskoy neproxodimosti, poskolku v ney sochetayutsya elementi strangulyatsii (ushemlenie brijeyki vnedrennoy kishki) i obturatsii (zakritie prosveta kishki invaginatom). v zavisimosti ot lokalizatsii …

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y slojnosti otmechaetsya ne bolee chem u 2 - 3 % vsex bolnix s invaginatsiey kishechnika. pri invaginatsii razlichayut narujnuyu trubku (vlagalishe) i vnutrennyuyu (invaginat). nachalniy otdel vnedrivsheysya kishki nosit nazvanie golovki invaginata. uchitivaya, chto bolshinstvo invaginatsiy nablyudaetsya v ileotsekalnom otdele kishechnoy trubki, prichinu ee vozniknoveniya svyazivayut s funktsionalnimi i anatomicheskimi osobennostyami stroeniya etoy oblasti u detey rannego vozrasta (nedostatochnost ileotsekalnogo klapana, visokaya podvijnost tolstoy kishki i dr.). imeet znachenie i rasstroystvo pravilnogo ritma peristaltiki, zaklyuchayusheesya v narushenii koordinatsii sokrasheniya prodolnix i krugovix mishts s preobladaniem sokratitelnoy sposobnosti poslednix. k nekoordinirovannomu sokrasheniyu mishechnix sloev mogut privesti izmeneniya rejima pitaniya, vvedenie prikorma, vospalitelnie zabolevaniya kishechnika, v tom chisle enterovirusnaya infektsiya. klinika i diagnostika. klinicheskie proyavleniya invaginatsii zavisyat ot ee vida i dlitelnosti. tipichnimi simptomami yavlyayutsya pristupoobraznaya bol v jivote, dvigatelnoe bespokoystvo, odno- ili dvukratnaya rvota, zaderjka stula, krovyanistie videleniya iz pryamoy kishki, palpiruemaya "opuxol" v jivote. v bolshinstve sluchaev zabolevanie nachinaetsya …

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prakticheskoe zanyatie №5. priobretennaya kishechnaya neproxodimost u detey. diagnostika i dif. diagnostika. klinika, lecheniya u detey, kak i u vzroslix, priobretennuyu kishechnuyu neproxodimost razdelyayut na dva osnovnix vida - mexanicheskuyu i dinamicheskuyu. v detskom vozraste v gruppe mexanicheskoy neproxodimosti videlyayut obturatsionnuyu, strangulyatsionnuyu i invaginatsiyu kishechnika. v svoyu ochered prichinoy obturatsionnoy neproxodimosti neredko yavlyaetsya koprostaz pri vrojdennom stenoze pryamoy kishki, bolezni girshprunga, megakolone ili svishevoy forme atrezii pryamoy kishki. strangulyatsionnaya neproxodimost inogda vizivaetsya narusheniem obratnogo razvitiya jeltochnogo protoka ili sledstviem drugix porokov razvitiya. tem ne menee v praktike detskoy xirurgii chashe vsego p...

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