Isifo sofuba sesibindi, ukwelashwa

Isifo sesifo sofuba (IBD) siyiqembu lezifo ezingapheli zomzila wamathumbu, ezibonakaliswa izibonakaliso eziningana zezici, ezihluka ngobunzima. Isifo samathumba esibhubhisayo, ukwelashwa - isihloko sesihloko.

I-IBD evame kakhulu yilezi:

• Ukwelashwa kwe-ulcerative (YAK) - kuthinta intumbu enkulu, evame ukuvela emgqeni;

• Isifo sikaCrohn - singathinta noma yikuphi ingxenye yendlela yokugoma emathunjini: kusukela emlonyeni womlomo kuya kwi-anus. Esikhathini senqubo yokuvuvukala, lonke ubukhulu bodonga lwamathumbu kuvame ukuhileleka.

Izimbangela nokuhlukunyezwa

Naphezu kwenani elikhulu lezifundo zesayensi, izizathu zokuthuthukiswa kwe-VZK azizange zicaciswe ngokugcwele. Ngokomqondo othile, izifo ze-IBD ziyi-virus noma amabhaktheriya angena emathunjini avela emvelweni futhi aqhubhise ukusabela okuhlukumezayo kwamagciwane kusuka ezincane zemvelo zamathumbu. Ukwelashwa kwe-ulcerative kubhalisiwe kuwo wonke amazwe omhlaba, ukusabalalisa kwawo kungama-50-80 amacala abantu abayizinkulungwane eziyikhulu. Lesi sifo sithinta abantu banoma yibuphi ubudala, kodwa iqembu elidala leminyaka engu-15 kuya kwengu-40 lisengozini enkulu kulo. Izinga lomphumela phakathi kwamadoda nabesifazane lifana nhlobo. Ezigulini ezingaba ngu-15%, izihlobo eziseduze (abazali, umfowabo noma udadewabo) nazo zibhekene nalesi sifo. Ngokusho kocwaningo, izingxenye ezimbili kwezintathu zeziguli ezine-Crohn's is smoke. Ukubhema yiyona nto eqinisekisiwe kuphela yendawo yangaphandle echaphazela izigigaba ze-IBD. Emazweni athuthukile, ukusabalalisa kwesifo sikaCrohn kungama-30-4-0 amacala abantu abayizinkulungwane eziyikhulu. Isifo sikaCrohn nesifo sokulonda i-ulcerative colitis siboniswa inkambo ephindaphindiwe (iziqephu zokuqeda lesi sifo kulandelwa izikhathi zokugeleza okungenakwenzeka). Ukucindezeleka kanye nokutheleleka ngegciwane yizifo ezivame ukuphindaphindiwe.

Izimpawu ezivamile ze-ulcerative colitis yizi:

• isifiso esivela njalo sokuchasisa ngesitoreji esiningi;

• ukuxubana kwegazi noma umqubu emanzini;

• ubuhlungu obukhulu besisu, ukwehla emva kokuhlukunyezwa;

• i-malaise ejwayelekile kanye nokukhathala;

• umkhuhlane nokulahlekelwa ukudla.

Izimpawu zesifo sikaCrohn zihlukile ngokuhlukile. Lokhu kuyingxenye ngenxa yokuthi noma yikuphi ingxenye yamathambo emathunjini angathinteka kule sifo. Lapho isifo sikaCrohn singagcinwa:

• isisindo esivulekile esinokuxubana kwegazi;

• ukuchoboza ubuhlungu esiswini;

• ukulahlekelwa kwesisindo;

• Ukuqina kwesisu, ngezinye izikhathi okuholela ekuvimbeleni emathunjini;

• Ukwakhiwa kwe-fistula (amalunga angavamile phakathi kwezitho lapho okuqukethwe kwamathumbu kufaka khona izigqoko eziseduze, isibonelo, esithombeni noma ngesiswini).

Ngaphezu kwalokho, isifo sikaCrohn singathinta i-membrane emangcwabeni yomlomo, amalunga, izitho ezincane. Ezinye iziguli zihlanganisa ukukhushulwa kwesifo ngokusetshenziswa kokudla okuthile, kodwa akukho ukudla okuqondile okuphakanyiswe iziguli ezine-IBD. Ukuxilongwa kwanoma yisiphi isifo seqembu le-IBD ngokuvamile kusekelwe kulwazi lwe-laboratory nokuhlolwa kwesiguli. Ngemuva kokuqoqwa ngokucophelela kokuhlolwa kwe-anamnesis nokuvivinya umzimba jikelele, kufaka phakathi ukuhlolwa komunwe we-rectum, ngokuvamile i-renumeroscopy inikezwa, evumela ukuthi ihlole indawo yangaphakathi ye-rectum nengxenye engezansi yomathumbu amakhulu. Ekufezeni lokhu kuhlola, ithuluzi elikhethekile (sigmoidoscope) lifakwa ngokusebenzisa i-anus, ikuvumela ukuba uhlole umuthi wamathumbu futhi uthathe isampula lesisindo sokuhlolwa okuncane.

Uhlelo lokuhlola

Kungakhathaliseki imiphumela ye-sigmoidoscopy, lezi zifundo ezilandelayo zivame ukuqhutshwa:

• ukuhlolwa kwegazi (kufaka hlangana nokuba khona kwamakhamera wenqubo yokuvuvukala);

• Ama-radiography of the amathumbu asebenzisa i-enum barium. Ebusuku isisu sithwala i-laxative. Ngosuku lokutadisha, isisombululo se-barium senziwa nge-rectum, okuyizinto ezihlukanisa ama-X-ray, okuvumela ukukhomba izindawo zokuvuvukala noma ukunciphisa amathumbu. Uma ecatshangwa ukuthi isifo sikaCrohn, isifo samathumbu esiphezulu sibuye sihlolwe. Kulesi simo, isiguli sithatha ukumiswa kwe-barium ngaphakathi, okwenza kube lula ukubona umathumbu omncane;

• I-Colonoscopy. Kulolu cwaningo, insimbi enkulu yokugcina i-endoscopic enomthombo wokukhanya ithuliswa nge-anus futhi ivumela ukuhlolwa kwe-mucosa emathunjini amakhulu kanye ne-rectum. Ngesizo salo, awukwazi kuphela ukuhlola izindawo zamathumbu ezingenakufinyeleleka nge-sigmoidoscopy, kodwa futhi uma kunesidingo, ukuqhuba i-biopsy yezicubu. Uma usola ukunqotshwa emathunjini angaphezulu, olunye uhlobo lwe-endoscopic yokuhlolwa lubekiwe: i-gastroduodenoscopy. Ekufezeni le nqubo, i-endoscope ekhethekile, ebizwa ngokuthi i-gastroscopy, ifakwa phakathi kwesisu kuya esiswini nase-duodenum. I-gastroscope iyinhlangano ye-fiber optic tube evumela ukuthi uhlole zonke izingxenye zesisu. Isithombe sidluliselwa esikrinini sokuqapha. Le ndlela isetshenziselwa kokubili ukuxilongwa kwe-IBD kanye nezinqubo zokuhlinzwa ezincane ezingenasidingo. Izindlela zokwelashwa kwe-IBD ziyahlukahluka ekuthathweni komlomo ngamalungiselelo e-steroid ekuhlinzekeni okuhlinzekwa, okusetshenziselwa ezimweni ezimbi. Nakuba kungenakwenzeka ukwelashwa okuphelele, iziguli eziningi ziyakwazi ukuphila ngendlela esebenzayo. Ngemuva kokuxilongwa kwe-IBD, isiguli siyabonwa nesifo se-gastroenterologist, ngokuvamile endaweni yokuhlala.

Ukwelapha nge-steroids

Ukuze ususe ukuvuvukala ngokukhuphuka kwe-IBD ukunikeza izidakamizwa ze-steroid ngendlela yamathebhulethi, i-enemas noma i-suppositories. Iziguli zivame ukwesaba ukuqokwa kwe-steroids, zikholelwa ukuthi lezi zingamakhemikhali ezinamandla ezingabangela imiphumela engadingeki, ikakhulukazi ngokufaka isikhathi eside. Imiphumela emibi yalezi zidakamizwa ihlanganisa ukwakheka kobuso obunjengezinyanga, inzuzo yesisindo, ubuthakathaka bemisipha yamagciwane kanye nokwanda kwengcindezi yegazi. Imiphumela emibi yesizukulwane esisha se-steroids ingase ingabi nakancane, noma kunoma yikuphi, akuyona into engathandeki ukuyeka ukuyithatha ngokushesha, njengoba umzimba uthatha isikhathi sokubuyisela isigqi sayo sokukhiqiza ama-hormone e-steroid.

Ukususwa kokuvuvukala

Ngemuva kokuqeda izimpawu zokuqala zesifo, ama-5-aminosalicylic acid acreative preparations (ngesimo se-monotherapy noma ehambisana ne-steroids) enza isisekelo sokwelashwa kwe-IBD. Zihlanganisa i-sulfasalazine, i-mesalazine ne-olsalazine. Ukuphatha kwabo kuvimbela ukuphindaphinda kwesifo, ngaleyo ndlela banikeze ukuxolelwa okuqinile. Lezi zidakamizwa zingasetshenziswa ngendlela yamathebulethi, i-enemas noma amakhandlela futhi ayinayo isenzo esinonya njengama-steroids. Imiphumela emibi yalolu qembu ihlanganisa ukuhlanzeka, ukukhwabanisa, ukuphathwa ikhanda kanye nokuphelelwa yisifo. Ukuze abone ukubekezelelana kwabo ngabanye, isiguli sihlolwe njalo ngegazi. Esinye isidakamizwa esinomthelela onamandla wokuvuvukala yi-azathioprin. Isetshenziselwa ukubekezelelana okuncane kokunciphisa izinga le-steroids, kanye neziguli ezinezinkinga ezilawulwa yi-IBD. Uma uthatha lesi sidakamizwa, udinga ukuqapha okujwayelekile kwezibalo zegazi. Iphesenti elincane leziguli ezine-IBD zidinga ukwelashwa. Uma ukwelashwa okwanele kungakulandelwa, amathuba okuba ukungenelela okuhlinzekwayo ukwanda.

Amafomu anamandla

Ngesifo esingenalutho esilwelwe yisilonda, izibonakaliso zokwelapha ukwelashwa zenzeka ezinganeni ezingaba ngu-30%. Ukwelashwa okudingekayo kuyadingeka lapho kungenakwenzeka ukucima ukukhushulwa okukhulu ngosizo lwamanani aphezulu wemithi, kanye nokunciphisa okukhulu izinga lempilo yesiguli. Ngaphezu kwalokho, ukuhlinzwa kuyadingeka uma kutholakala izimpawu zokuqala zenqubo embi emathunjini.

Izinhlobo zokusebenza

Esigabeni sikaCrohn, ukwelashwa okuhlinzekwa ikakhulukazi kuhloswe ekuqedeni izinkinga ngokususa izindawo ezithintekile zamathumbu. Kulezi ziguli eziningi ezine-ulcerative colitis, ukuzikhethela yiyona-okuthiwa i-protocollectomy yokuvuselela, ehlanganisa ekususeni ingxenye yamathumbu amakhulu bese yenza "iphaketheni" kusukela emathunjini emathumbu emathunjini axhunyiwe yi-anastomosis kuya ku-anus. Ukusebenza kwenziwa ezinyathelweni ezimbili, ngokungafani ne-colectomy, lapho isithukuthelo esikhulu nesisu sisuswa ngesikhathi esifanayo, futhi ukuphuma kwe-stool kwenziwa nge-ileostoma esikhwameni esikhethekile. Ukwelashwa okwanele kwenza kube lula ukulawula inkambo ye-IBD ezigulini eziningi, kodwa lezi zifo aziphilwanga. Kulezi ziguli, ngaphansi kwezimo ezithile, ingozi yokuthuthukisa izicubu ezinonya zamathumbu ziyanda.

Ingozi yokuthola umdlavuza wekoloni noma i-rectum iyanda ngokubandakanya wonke amathumbu (noma ingxenye enkulu yayo) enkambisweni yokuvuvukala, kanye nokwanda kwesikhala. Ingozi yenqubo embi ingancishiswa ngokudlula njalo ikolonoscopy, evumela ukuthi kutholakale izinguquko ezingenakuqhathaniswa ekuqaleni. Kubalulekile ukuphawula ukuthi ezigulini ze-IBD ezincane, liphansi kakhulu. Ngokuvamile, izinguquko ezimbi zivela ngemuva kwesizinda se-Crohn, esiqhubeka ngaphandle kokunqotshwa kwamathumbu amakhulu.

Isibikezelo

Ama-IBD abhekene nenkambo engapheli, futhi ukubonakaliswa kwabo esigulini ngasinye kukhona ngabanye. Esigabeni esisebenzayo, lesi sifo singabangela ukukhathazeka okukhulu, kodwa ngokukhetha kahle kwesifo semithi, ngokucabangela ukujwayelekile kwenkinga yesifo, iziguli eziningi zigcina ikhono lokusebenza ngokugcwele, naphezu kokungenzeki kokwelapha okuphelele. Ngesikhathi sokuxoxwa, isiguli esinesi-IBD singaholela ekuphileni okuvamile. Phakathi kweziguli kukhona umbono wokuthi ukuqhuma kwe-IBD kubonakala "emanzini", okuyinto engalungile ngokuphelele. Eqinisweni, ukuphindaphinda kwesifo kungabangela ukungezwani okukhulu kokukhathazeka ngisho nokucindezeleka, ikakhulu lapho isiguli sinyanzela ukuba sivakashele indlu yangasese. Ngakho-ke, phakathi nenkathi yokukhushulwa, ukuzwelana nokuqonda komunye amalungu omndeni wesiguli kanye nozakwethu kubaluleke kakhulu. Owesifazane ohlela ukukhulelwa, ithuba lokukhulelwa liphakeme ngesikhathi sokukhululwa. Ngesikhathi sokukhulelwa, kungase kube nokucindezeleka kwalesi sifo, kodwa kuvame ukuvela ngendlela engavamile futhi uphendule kahle ekunakekeleni izidakamizwa. Isilinganiso senzuzo kanye nobungozi bokuthatha i-steroids ngesikhathi sokukhulelwa kubalwa njengokuhle, ngoba amathuba okuthuthukisa imiphumela emibi phakathi nalesi sikhathi aphansi ngokwanele.