I-tracheoesophageal fistula kunye nokulungiswa kwe-esophageal atresia

I-tracheoesophageal fistula kunye nokulungiswa kwe-esophageal atresia lutyando ukulungisa iziphene ezibini zokuzalwa kwi-esophagus nakwi-trachea. Iziphene zihlala zenzeka kunye.

Umqala ityhubhu ehambisa ukutya ukusuka emlonyeni ukuya esiswini. I-trachea (umbhobho womoya) yityhubhu ethwala umoya uyikhuphe uyikhuphe emiphungeni.

Iziphene zihlala zenzeka kunye. Ziyakwenzeka kunye nezinye iingxaki njengenxalenye yesifo (iqela leengxaki):

• I-Esophageal atresia (EA) yenzeka xa indawo ephezulu yesophagus ingadibani ne-esophagus esezantsi kunye nesisu.
• I-tracheoesophageal fistula (TEF) unxibelelwano olungaqhelekanga phakathi kwenxalenye ephezulu yomqala kunye netrachea okanye umbhobho womoya.

Olu tyando lusoloko lusenziwa kwakamsinya emva kokuzalwa. Zombini iziphene zihlala zilungiswa ngaxeshanye. Ngokufutshane, olu tyando lwenzeka ngale ndlela:

• Iyeza (i-anesthesia) linikwa ukuze umntwana alele ubuthongo obunzulu kwaye angabinazintlungu ngexesha lotyando.
• Ugqirha usika kwicala lesifuba phakathi kweembambo.
• Ifistula phakathi komqala kunye nombhobho womoya uvaliwe.
• Amacandelo aphezulu kunye asezantsi esophagus athungiwe kunye ukuba kunokwenzeka.

Rhoqo la malungu mabini omqala akude kakhulu ukuba angathunga kunye kwangoko. Kule meko:

• Yifistula kuphela elungisiweyo ngexesha lotyando lokuqala.
• Umbhobho we-gastrostomy (ityhubhu ehamba ngesikhumba ungene esiswini) unokubekwa ukuze unike umntwana wakho isondlo.
• Umntwana wakho uya kwenziwa olunye utyando kamva ukulungisa umqala.

Ngamanye amaxesha ugqirha wolinda iinyanga ezi-2 ukuya kwezi-4 ngaphambi kokuba enze utyando. Ukulinda kuvumela umntwana wakho ukuba akhule okanye aphathwe ezinye iingxaki. Ukuba utyando lomntwana wakho lulibazisekile:

• Ityhubhu ye-gastrostomy (G-tube) iya kubekwa eludongeni lwesisu esiswini. Amayeza okubala amanani (i-anesthesia yendawo) aya kusetyenziswa ukuze umntwana angaziva iintlungu.
• Ngexesha elifanayo ityhubhu ibekwe, ugqirha unokukhulisa isophagus yomntwana ngesixhobo esikhethekileyo esibizwa ngokuba sisinciphisi. Oku kuyakwenza ukuba utyando oluzayo lube lula. Le nkqubo inokufuna ukuphindwaphindwa, ngamanye amaxesha amatyeli aliqela, ngaphambi kokuba ukulungiswa kwenziwe.

I-tracheoesophageal fistula kunye ne-esophageal atresia ziingxaki ezisongela ubomi. Kufuneka banyangwe ngoko nangoko. Ukuba ezi ngxaki azinyangwa:

• Umntwana wakho angaphefumla amathe kunye nolwelo olusuka esiswini luye emiphungeni. Oku kubizwa ngokuba ngumnqweno. Ingabangela ukukrwitshwa kunye nenyumoniya (usulelo lwemiphunga).
• Umntwana wakho akakwazi ukugwinya kunye nokugaya konke konke ukuba umqala awuxhumani nesisu.

Umngcipheko we-anesthesia kunye notyando ngokubanzi kubandakanya:

• Impendulo kumayeza
• Iingxaki zokuphefumla
• Ukopha, amahlwili egazi, okanye usulelo

Iingozi zolu tyando zibandakanya:

• Umphunga owileyo (pneumothorax)
• Ukuvuza kokutya kwindawo elungisiweyo
• Ubushushu bomzimba obuphantsi (hypothermia)
• Ukunciphisa amalungu alungisiweyo
• Ukuvulwa kwakhona kwefistula

Umntwana wakho uya kwamkelwa kwicandelo lokhathalelo olunzulu lwe-neonatal (NICU) kwakamsinya nje ukuba oogqirha bafumanisa ukuba zezi ngxaki.

Usana lwakho luya kufumana isondlo nge-vein (intravenous, okanye i-IV) kwaye lusenokuba kumatshini wokuphefumla (i-ventilator). Iqela lokhathalelo linokusebenzisa ukutsala ukugcina ulwelo lungangeni kwimiphunga.

Abanye abantwana abangaphambi kwexesha, abanesisindo sokuzalwa esisezantsi, okanye abanezinye iziphene zokuzalwa ecaleni kwe-TEF kunye / okanye i-EA abanakho ukwenza utyando bade bakhule babe bakhulu okanye de ezinye iingxaki zinyangwe okanye ziphele.

Emva kotyando, umntwana wakho uya kunyanyekelwa esibhedlele i-NICU.

Unyango olongezelelekileyo emva kotyando luhlala lubandakanya:

• Amayeza okubulala iintsholongwane njengoko kufuneka, ukuthintela usulelo
• Umatshini wokuphefumla (umshini wokuphefumla)
• Ityhubhu yesifuba (ityhubhu ngesikhumba esifakwa eludongeni lwesifuba) ukukhupha ulwelo olusuka kwisithuba esiphakathi komphunga nangaphandle kwesifuba
• Amanzi afakwa ngaphakathi (IV), kubandakanya isondlo
• Ioksijini
• Amayeza obuhlungu njengoko kufuneka

Ukuba zombini i-TEF kunye ne-EA zilungisiwe:

• Umbhobho ubekwa ngempumlo ungene esiswini (nasogastric tube) ngexesha lotyando.
• Ukuondla kuhlala kuqala ngale tyhubhu kwiintsuku ezimbalwa emva kotyando.
• Ukutyisa ngomlomo kuqala kancinci. Usana lusenokufuna unyango lokondla.

Ukuba kuphela i-TEF ilungisiwe, ityhubhu ye-G isetyenziselwa ukondla kude kube kulungiswe i-atresia. Usana lusenokufuna ukutsalwa okuqhubekayo okanye rhoqo ukukhupha imfihlo evela kumphambili.

Ngelixa umntwana wakho esesibhedlele, iqela lokhathalelo liya kukubonisa ukuba uyisebenzisa kwaye uyitshintshe njani i-G-tube. Unokuthunyelwa ekhaya kunye ne-G-tube eyongezelelweyo. Abasebenzi basesibhedlele bayakwazisa inkampani ehambisa iinkonzo zekhaya ngezixhobo zakho.

Uhlala ixesha elingakanani usana lwakho esibhedlele luxhomekeke kuhlobo lwesiphene umntwana wakho anaso kunye nokuba kukho ezinye iingxaki ukongeza kwi-TEF ne-EA. Uyakwazi ukuzisa umntwana wakho ekhaya xa sele bethatha ukutya ngomlomo okanye ityhubhu ye-gastrostomy, bafumana ubunzima, kwaye bephefumla ngokukhuselekileyo ngokwabo.

Ugqirha lunokulungisa i-TEF kunye ne-EA. Nje ukuba unyango luphelile, umntwana wakho unokuba nazo ezi ngxaki:

• Inxalenye yesophagus eyayilungisiwe inokuba ncinci. Umntwana wakho unokufuna ukuba enze utyando olungakumbi ukunyanga oku.
• Umntwana wakho unokuba nesifo sentliziyo, okanye i-reflux ye-gastroesophageal (GERD). Oku kwenzeka xa iasidi ephuma esiswini inyukela emqaleni. I-GERD inokubangela iingxaki zokuphefumla.

Ngethuba lokuusana kunye nokufikisa, abantwana abaninzi baya kuba neengxaki ngokuphefumla, ukukhula, kunye nokondla, kwaye kuya kufuneka baqhubeke nokubabona bobabini ababoneleli beenkonzo zokuqala kunye neengcali.

Iintsana ezine-TEF kunye ne-EA nazo ezineziphene kwamanye amalungu, ikakhulu intliziyo, zinokuba neengxaki zexesha elide kwezempilo.

Ukulungiswa kwe-TEF; Ukulungiswa kwe-esophageal atresia

• Ukuzisa umntwana wakho ukuba atyelele umntakwabo ogula kakhulu
• Unonophelo lwenxeba lotyando - luvulekile

• Ukulungiswa kwefistula yetracheoesophageal-uthotho

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IRothenberg SS. I-Esophageal atresia kunye ne-tracheoesophageal fistula malformations. Ku: Holcomb GW, Murphy P, St. Peter SD, ii-eds. Uqhaqho lwabantwana lweHolcomb kunye neAshcraft. Umhla wesi-7. IPhiladelphia, PA: Elsevier; 2020: isahluko 27.