Hernia Ya Diaphragm Evela Ngokuzalwa (Cdh)

I-hernia yedayafragmu ezelwe nayo (CDH) yisimo esingavamile esenzeka kumntwana ngaphambi kokuzalwa. Kwenzeka ekuqaleni kokukhulelwa lapho i-diaphragm yomntwana — umsipha ohlukanisa isifuba nesisu — ihluleka ukuvala njengoba kufanele. Lokhu kushiya i-hole e-diaphragm. Le hole ibizwa ngokuthi yi-hernia.

Le hernia emisipha yedayafragmu idala ukuvulwa phakathi kwesisu nesifuba. Amazinyo, isisu, isibindi namanye amalungu esisu angahambela kule hole esifubeni somntwana. Uma amazinyo esifubeni, awenzi ukuxhumana okuvamile okuwabamba endaweni esiswini (ukungabi nalungile). Angazifaka, akwephule ukunikezwa kwegazi (i-volvulus).

Ukuphathwa kwe-CDH kuncike ekutholeni isimo, ubungako balo nokuthi kukhona yini izinkinga zenhliziyo.

I-hernia yedayafragmu ezelwe nayo ihluka ngokukhulu. Ingaba lula futhi ingabi namiphi imiphumela emncane kumntwana, noma ingaba nzima kakhulu futhi ithonye ikhono lokuletha i-oksijini emzimbeni wonke.

Izingane ezelwe ne-CDH zingaba:

• Zinobuhlungu obukhulu bokuqeda ngenxa yamaphaphu amancane angasebenzi kahle (i-pulmonary hypoplasia).
• Izinkinga zokukhula kwenhliziyo.
• Ukonakala kwamathumbu, isisu, isibindi namanye amalungu esisu uma ehamba nge-hernia eya esifubeni.

I-CDH ingatholakala ngesikhathi sokwenza i-ultrasound yengane eselubili. Umhlinzeki wakho wezinsizakalo zezempilo angaxoxa nawe ngezinketho zokwelashwa.

Emasimini amaningi, imbangela ye-congenital diaphragmatic hernia ayaziwa. Kweminye imicimbi, i-CDH ingahlotshaniswa nesifo sokuzalwa noma ukuguquka okungahleliwe kwe-jini okubizwa ngokuthi yi-mutations. Kulezi zimo, ingane ingaba nezinye izinkinga lapho izalwa, njengokungasebenzi kahle kwenhliziyo, amehlo, izingalo nezinyawo, noma isisu namathumbu.

Izinkinga ezingahle zenzeke nge-CDH zihlanganisa:

• Izinkinga zephunga.
• Izinkinga zesisu, amathumbu nempilo yebhefu.
• Isifo senhliziyo.
• Ukutheleleka okuphindaphindayo.
• Ukuba buthuntu.
• Ukushintsha kwesimo sesifuba kanye nomgogodla womhlane.
• Ukubuyela emuva kwesidumbu sesisu — i-asidi yesisu ibuyela emuva etubeni elibizwa ngokuthi yi-esophagus, ehlanganisa umlomo nesisu.
• Izinkinga zokukhula nokukhuluphala.
• Ukulibaziseka ekuthuthukiseni kanye nokukhubazeka kokufunda.
• Ezinye izinkinga ezikhona kusukela ekuzalweni.

Ukukhubazeka kwegciwane lomphimbo kuhlale kutholakala ngesikhathi sokuhlolwa okuvamile kwe-ultrasound yengane eselubili okwenziwa ngaphambi kokuzalwa kwengane yakho. Ukuhlolwa kwe-ultrasound kwangaphambi kokuzalwa kusebenzisa amaza omsindo ukwenza izithombe zesibalo sakho nengane. Ngezinye izikhathi, ukuxilongwa kungase kungenzeki kuze kube ngemva kokuzalwa. Ngokuvamile, i-CDH ingase ingaxilongwa kuze kube ngesikhathi sobuntwana noma kamuva. Lokhu kungaba ngoba ayikho izimpawu noma izimpawu noma ngoba izimpawu nezimpawu ezinjengobunzima bokuqeda umoya nezinhlungu zesisu ziyamila. Umhlinzeki wakho wezempilo usebenzisa i-ultrasound yangaphambi kokuzalwa nezinye izivivinyo ukuqapha ukukhula nokusebenza kwamaphaphu, inhliziyo nezinye izitho zengane yakho ngesikhathi sokukhulelwa kwakho. Ngokuvamile, uba ne-ultrasound yakho yokuqala yengane eselubili ezinyangeni ezimbalwa zokuqala (ikota yokuqala) yokukhulelwa kwakho. Kuqinisekisa ukuthi ukhulelwe futhi kubonisa inani nobukhulu bengane yakho noma izingane. Ngokuvamile, uba ne-ultrasound enye phakathi nezinyanga ezine kuya kweziyisithupha (ikota yesibili) yokukhulelwa kwakho. Umhlinzeki wakho wezempilo uhlola ukukhula nokuthuthuka kwengane yakho. Umhlinzeki wakho ubheka ubukhulu nendawo yamaphaphu, inhliziyo nezinye izitho zengane yakho. Uma ingane yakho ibonisa izimpawu ze-CDH, umhlinzeki wakho angase akufune ukuba uthole ukuhlolwa kwe-ultrasound kaningi. Lokhu kungabonisa ukuthi i-CDH iyingozi kangakanani nokuthi iyanda yini. Kungenziwa ezinye izivivinyo ukuhlola ukusebenza kwezitho zengane yakho. Lezi zingafaka: - Ukuhlolwa kwe-magnetic resonance imaging (MRI) kwengane eselubili. Lena yindlela yokuhlola izithombe zezokwelapha esebenzisa insimu yamagnethi namaza omsakazo akhiqizwe yi-computer ukwenza izithombe ezinemininingwane yezitho namalungu emzimbeni wengane. - I-echocardiogram yengane eselubili. I-echocardiogram isebenzisa amaza omsindo ukukhiqiza izithombe zenhliziyo yengane ibetha futhi iphompa igazi. Izithombe ezivela ku-echocardiogram zingabona izinkinga ngenhliziyo ethuthukayo. - Izivivinyo ze-genetic. Ukuhlolwa kwe-genetic kungabona izifo ze-genetic noma ezinye izinguquko ze-gene ezivame ukuhlotshaniswa ne-CDH. Ukwelulekwa kwe-genetic kungakusiza ukuqonda imiphumela yalezi zivivinyo futhi kukunikeze ulwazi oluthe xaxa ngesimo sengane yakho.

Ukwelashwa kwe-congenital diaphragmatic hernia kuncike ekutholakaleni kwesimo nesimo sabo. Ithimba lakho lokunakekelwa kwezempilo likusizile ukunquma ukuthi yini engcono kuwe nengane yakho.

Ithimba lakho lokunakekelwa kwezempilo likuqapha eduze ngaphambi kokuzalwa kwengane yakho. Ngokuvamile uba ne-ultrasounds nezinye izivivinyo njalo ukuhlola impilo nokuthuthukiswa kwengane yakho.

Ukwelashwa okuvela kwe-CDH eqinile okwamanje kufundwa kubizwa ngokuthi i-fetoscopic endoluminal tracheal occlusion (FETO). Lolu cuku lwenziwa engwaneni yakho ngesikhathi usakhulelwe. Umgomo ukusisiza amaphaphu engane akhule ngangokunokwenzeka ngaphambi kokuzalwa.

FETO yenziwa ngezinqubo ezimbili:

• Inqubo yokuqala. Inqubo yokuqala iyenzeka ekuqaleni kwezinyanga ezimbalwa zokugcina (i-trimester yesithathu) yokukhulelwa kwakho. Udokotela wakho uqeda isiqeshana esincane esiswini nasezitho zokuzala. Udokotela ufake ithyube ekhethekile enekhamera ekupheleni, ebizwa ngokuthi i-fetal endoscope, ngomlomo wengane yakho angene emoyeni (i-trachea). Ibhaluni encane ifakwe emoyeni wengane yakho futhi iphephezelwe.

Umphulukana wemvelo wesizalo ngesikhathi sokukhulelwa, obizwa ngokuthi i-amniotic fluid, ugeleza ungene futhi uphume emaphaphwini engane yakho ngomlomo. Ukuphephezelwa kwibhaluni kugcina i-amniotic fluid emaphaphwini engane yakho. Leli phulukana liwandisa amaphaphu ukubasiza bathuthuke.

• Inqubo yesibili. Ngemuva kwamasonto angu-4 kuya kwangu-6, uba nenqubo yesibili. Ibhaluni isuswa ukuze ingane yakho ikulungele ukufaka umoya emaphaphwini ngemuva kokuzalwa.

Indlela yokulethwa ekhethekile ingase isetshenziswe uma ukubeletha kuqala ngaphambi kokuba ibhaluni isuswe futhi ukususa ibhaluni nge-endoscope akunakwenzeka. Le ndlela ibizwa ngokuthi inqubo ye-ex utero intrapartum treatment (EXIT). Ukulethwa kwenziwa yi-C-section ngokusekelwa kwe-placenta. Lokhu kusho ukuthi ingane yakho iyaqhubeka ithola i-oksijini nge-placenta ngaphambi kokuba i-umbilical cord isiqoshwe. Ukusekelwa kwe-placenta kuyaqhubeka kuze kube yilapho ibhaluni iphumile futhi ithyube yokuphefumula isekhona, ivumela umshini ukuba uthathe ukuphefumula.

Inqubo yokuqala. Inqubo yokuqala iyenzeka ekuqaleni kwezinyanga ezimbalwa zokugcina (i-trimester yesithathu) yokukhulelwa kwakho. Udokotela wakho uqeda isiqeshana esincane esiswini nasezitho zokuzala. Udokotela ufake ithyube ekhethekile enekhamera ekupheleni, ebizwa ngokuthi i-fetal endoscope, ngomlomo wengane yakho angene emoyeni (i-trachea). Ibhaluni encane ifakwe emoyeni wengane yakho futhi iphephezelwe.

Umphulukana wemvelo wesizalo ngesikhathi sokukhulelwa, obizwa ngokuthi i-amniotic fluid, ugeleza ungene futhi uphume emaphaphwini engane yakho ngomlomo. Ukuphephezelwa kwibhaluni kugcina i-amniotic fluid emaphaphwini engane yakho. Leli phulukana liwandisa amaphaphu ukubasiza bathuthuke.

Inqubo yesibili. Ngemuva kwamasonto angu-4 kuya kwangu-6, uba nenqubo yesibili. Ibhaluni isuswa ukuze ingane yakho ikulungele ukufaka umoya emaphaphwini ngemuva kokuzalwa.

Indlela yokulethwa ekhethekile ingase isetshenziswe uma ukubeletha kuqala ngaphambi kokuba ibhaluni isuswe futhi ukususa ibhaluni nge-endoscope akunakwenzeka. Le ndlela ibizwa ngokuthi inqubo ye-ex utero intrapartum treatment (EXIT). Ukulethwa kwenziwa yi-C-section ngokusekelwa kwe-placenta. Lokhu kusho ukuthi ingane yakho iyaqhubeka ithola i-oksijini nge-placenta ngaphambi kokuba i-umbilical cord isiqoshwe. Ukusekelwa kwe-placenta kuyaqhubeka kuze kube yilapho ibhaluni iphumile futhi ithyube yokuphefumula isekhona, ivumela umshini ukuba uthathe ukuphefumula.

FETO ingase ingabi yikhetho elifanele kuwo wonke umuntu. Futhi ayikho iwaranti mayelana nemiphumela yokuhlinzwa. Ithimba lakho lokunakekelwa kwezempilo likuhlola wena nengane yakho ukuze libone ukuthi ningaba yizimbangi zolu cuku. Khuluma nethimba lakho ngezinzuzo nezingozi ezingaba khona kuwe nengane yakho.

Ngokuvamile, ungaletha ingane yakho ngokwemvelo noma nge-C-section. Wena nodokotela wakho niyanquma ukuthi iyiphi indlela engcono kuwe.

Ngemuva kokuzalwa, ithimba lokukhathalela impilo likusizile ukuhlela ukwelashwa okuhlangabezana nezidingo zengane yakho. Ingane yakho cishe izokhathalelwa e-newborn intensive care unit (NICU).

Ingane yakho ingase idinge ithyube yokuphefumula. Ithyube ixhunywe emishinini esiza ingane yakho ukuba iphefumule. Lokhu kunika amaphaphu nenhliziyo isikhathi sokuthuthuka nokukhula.

Amagugu anezingozi ezingathi sína zezinkinga zamaphaphu angase adinge ukwelashwa okuthiwa yi-extracorporeal membrane oxygenation (ECMO). Lokhu kwaziwa nangokuthi yi-extracorporal life support (ECLS). Umshini we-ECMO wenza umsebenzi wenhliziyo namaphaphu engane yakho, uvumela lezi zitho ukuba ziphumule futhi zilulame.

Ubude bengane yakho edinga ukusekelwa ukuphefumula kuncike ekuphenduleni ekwelapheni nakwezinye izinto.

Amagugu amaningi ane-CDH anawo ukuhlinzwa ukuvala umgodi e-diaphragm. Lapho lo mkhuba uqala khona kuncike empilweni yengane yakho nakwezinye izinto. Ukukhathalelwa okulandelayo ukuqinisekisa ukuthi ukulungiswa kuhlala khona ngokuvamile kuhlanganisa i-X-rays yesifuba.

Ngemuva kokushiya isibhedlela, ingane yakho ingase idinge ukusekelwa okwengeziwe. Lokhu kungafaka i-oksijini engeziwe. I-oksijini ihanjiswa ngethyube elincane leplastiki elinamaphiko afaneleka emakhaleni noma ithyube elincane exhunyiwe ku-mask egqokwe phezu kwempumulo nomlomo. Ukusekelwa kokudla kungase kudingeke futhi ukusisiza ekukhuleni nasekuthuthukiseni. Imithi ingase inikezwe izimo ezihlobene ne-CDH, njengokubuyela emuva kwesisu noma i-pulmonary hypertension.

Amakhemisi okuvakasha njalo nodokotela wengane yakho angaxazulula noma yiziphi izinkinga ekuqaleni.

Ukufunda ukuthi ingane yakho ine-congenital diaphragmatic hernia kungaletha uhlangothi lwezinto. Ungase ube nemibuzo eminingi mayelana nelenkaneli yokwelashwa kuwe nengane yakho.

Awekho ukubhekana nalokhu wedwa. Kunezinto eziningi ezikusekela wena nengane yakho. Uma unemibuzo mayelana nesimo sengane yakho nokwelashwa, khuluma nethimba lakho lokukhathalela impilo.