Pakati pezvirwere zvekuvhenekera, vesicoureteral reflux inowanzoitika. Pathology inonyanya kubata vana nevakwegura. Kuongororwa kwakaoma nekusavapo kwezviratidzo zvakajeka pazvikamu zvekutanga zvehutano.
Chii chinonzi vesicoureteral reflux?
Bladder-ureter reflux inowanzotumidzwa sechirwere umo munharaunda yowino inowanzoitika. Reflux yomuti, kuendesa kune ureter uye itsvo dzinoitwa kunze kwekumanikidzwa, izvo zvinokanganisa kushanda kwevhavha ye vesicle yeusreter. Izvi zvinowanzoitika nguva dzose kana chirwere chichifashamira, nekuda kwekuti, nekufamba kwenguva, panogona kuve nekushandurwa mune simba rechimiro ichi.
Kazhinji, kuwedzera kukurudzika mumucheka sezvo ichizadza kunofanira kuita kuti valve ivhare. Kunyange zvakadaro, ne reflux, izvi zvakagadzirwa zvakashata kana kuti zvishoma, izvo zvinokonzera reverse urine ikozvino. Kuumbwa kwemuti kunogona kuitika zvose panguva yekuita uye panguva yekuzadzwa kwechirwere. Chirwere chemazuva mazhinji hachiratidzi pachena uye chinowanikwa kana uchitarisa nhengo dzemadiki mapepa.
Active vesicoureteral reflux
Nemhando iyi yehutachiona, urine reflux inowanzoitika panguva yekuzorora. Mishonga yechipfuva inosvika pazwi, somugumisiro, urinini inodururwa mukati mumiririri uye zvakare kupinda muitsvo. Panguva imwe chete, iyo inopiwa kune kunze. Nokudaro munhu anonzwa kushungurudzika mumunda wechiuno, mumativi. Ichi chimiro chekurwara chinokonzerwa nokusakwanira kwevhavha iri mu vesicle ye ureter, iyo inoratidzwa munguva yekuongororwa kwakazara.
Passive vesicoureteral reflux
Passi reflux inoreva kushandiswa kwemuti kubva pachirwere kune mahara, izvo zvinoitika munguva yekuzadza nhengo yemuyo. Nechimiro chechirwere ichi, kusakwanisa kwevhavha kunowedzera, naizvozvo kupinda kwemuti mukati mumiriri neimpso zvinowanzoitika. Izwi remvura inodzoka shure inokonzerwa nechiyero chekushaya simba, chibvumirano chechibvudzi, uye mamiriro evhavha pachayo.
Chirwere / ureter reflux chinokonzera
Zvichienderana nezvenguva yekubudirira kwechirwere ichi, chekutanga uye yechipiri vesicoureteral reflux inenge iri yoga. Imwe nzira yakakura yehutano inonzi kana chirwere chacho chigumisiro che congenital anomalies uye inoumbwa padanho re intrauterine kukura - congenital vesicoureteral reflux. Kuwedzera kukanyanya muchechi uye kusagadzikana kwakakwana kwechirwere chinonzi ureteral chinokonzera kukanganisa, zvichikonzera urine reflux, izvo zvinokonzera zvingave zvinotevera:
- kuwirirana kwechiremba;
- dystopia yomuromo;
- kukamwa kwemuromo;
- short submucosal tunnel ye intravesical ureter.
Chimwe chechipiri che vesicoureteral reflux inosangana nechepamusoro pemamwe mamiriro ezvinhu ehutano hwekuvhenekera. Pakati pezvikonzero zvinozivikanwa:
- chimiro che urethra;
- stenosis yemutsipa wehombodo;
- adenoma yeprostate;
- cystitis ;
- kukakavara kwechidzara;
- kukanganisa kunzvimbo yerereicic panguva yekuvhiyiwa.
Chlamydial reflux zviratidzo
Zviratidzo zvechirwere zvinowanzovanzwa. Panyaya inokwanisika, asi kwete zviratidzo zvechirwere, vanachiremba vanopa marwadzo, kusuruvara kunorwadza mumucheto wezasi, uyo unoonekwa pakarepo mushure mokunge chikwata chacho chibudiswa. Vana vanogona kutarisa kurwadziwa mucheche, pasi.
Zviratidzo zvechirwere zvinokonzerwa nechikwata chegadziriro yezvirwere. Kazhinji, zvinhu zvose zvinoenderana nesiteji rekuvandudzwa kwe vesicoureteral reflux, dhigirii rinogona kuva rakadai:
- 1 degree - urini inodzokera kune ureter, haisviki pamapapiro;
- 2 digita - reflux inosvika kuhvo;
- 3 degree - iyo ureter dilates;
- 4 digita - geometry yemugwagwa wemuguta inodzvinyirirwa, crimp inooneka;
- 5 degree - iyo parenchyma yemaputi yakapetwa, zvose zviri pamusoro apa zviripo.
Zvinonyunyuta kubva kuvarapi vanachiremba vanowanzowanzwa chete nekugadzirwa kwe pyelonephritis. Muchiitiko ichi, pane zvakataurwa:
- kuwedzera kwekushisa kwemuviri;
- kurwadziwa kwepamuviri;
- kuora kwehupenyu hwakanaka;
- clouding urine.
Muzviitiko zvakawanda, PMR inowanikwa chete padanho rekuvandudzwa kwezvinetso uye zvimwe zvinetso, pakati peizvi:
- kazhinji cystitis (nokukurumidza urinary excretion muzvikamu zviduku);
- chisingagumi pyelonephritis (kunhuwa, kumira kwakanaka munzvimbo yakakura, kutonhora kwete kupfuura madigiri 38);
- enuresis.
Chirwere uye ureter reflux - kuongororwa
Muchikamu chekudzivirira muviri chekuongororwa kwe vesicoureteral reflux, ultrasound yeinso inofanira kushandiswa. Chidzidzo chacho chinogona kuitwa kunyange mwana asati aonekwa (primary reflux). Chiratidzo chekuongorora kwakakwana kwehuroyi kunogona kuve nekuwedzera kwemafuro (mumutsetse wakakura kupfuura 5 mm). Kuongororwa kwakajeka kana pane kusava nechokwadi kwehutano kunofanira kusanganisira zvidzidzo zvinotevera:
- nzira dze laboratori: ruzivo rwekuronga urine, kuongorora ropa, bhakitiriya tsika;
- radioisotope renography;
- simba nephroscintigraphy;
- uroflowmetry;
- excretory urography ;
- Mikrotsionnaya cystourethrography;
- cystoscopy.
Chlamydial reflux - kurapa
Kuti usabvisa vesicoureteral reflux, kurapwa kunotungamirirwa kugadziriswa kwezvinhu zviviri zvinokuvadza:
- hydrodynamic tsanga nekuda kwekuwedzerwa simba mukati mechikwata;
- kazhinji urinary urwere zvirwere.
Nehupi hupi hwekuvhiringidzika, kupindira kwehutano kunotanga nemaitiro anochengetedza anosanganisira:
- Kugadziriswa kwezvinetso zvemagetsi mumutsara uye ureter (Pikamilon, Elkar).
- Kudzivirira uye kurapwa kwehutachiona hwejenitourinary system - uroseptics , antibiotics, phytotherapy (Tetracycline, Metronidazole, Ciprofloxacin).
- Kugadziriswa kwekutyora urodynamics.
Bladder-ureteral reflux - kliniki mazano
Kana kudzoka kwemukoti kunokonzerwa nehutachiona hwehutachiona huripo, nzira yega yekurapa ndiyo kuvhiyiwa. Muchikamu chacho, kudzorerwa kwebasa revhavha yehutuku hunoitwa nekugadzira mhuka uye kugadzira valve nenzira yekufananidzira. Nechipiri cheMATCT, kurapa kwakakwana kwezvirwere zvakakonzera chirwere (urinary uye urinary tract infections, chikwata chekushanda) chinodiwa. Mikana yekuparara kwechirwere mushure mekubviswa kwezvikonzero zvinogona kusvika 70%.
Endoscopic kururamisa vesicoureteral reflux
Kana kusavapo kwechirwere chekuchengetedza chirwere, apo hazvibviri kubvisa vesicoureteral reflux, kushanda kunongova nzira chete yekurapa. Kazhinji kazhinji, nzira yekupedzisira inoshandiswa. Kuburikidza nenyeredzi yemakumbo, pasina kuonekwa pane peganda, kuiswa kwegelisi kunowanikwa munharaunda yeusreteral yemushure. Iyo inoumba chidimbu, icho chinoshanda sevhavharo, ichidzivirira kudzokera shure kwemuti kubva pachidzitiro kuchipinda mumusere.