I-Ventral Hernia

Ukuqubuka odongeni lwesisu kungase kubonakale kuwukuphazamiseka okuncane, kodwa ezigidini zabantu abaphila ne-ventral hernia, kungaba nomthelela omkhulu ekuphileni kwabo kwansuku zonke. Lesi simo singabangela ubuhlungu, ukungakhululeki ngesikhathi semisebenzi efana nokugoba noma ukuphakamisa, kanye nezinkinga zokugaya ukudla. Lo mhlahlandlela ophelele uhlola konke iziguli okudingeka zazi mayelana ne-ventral hernias, izimpawu, izinhlobo, kanye nemiphumela emibi ye-ventral hernia. 

Iyini i-Ventral Hernia?

I-ventral hernia, eyaziwa nangokuthi i-hernia eqondile, yenzeka lapho izitho zangaphakathi noma izicubu zidlula embotsheni yemisipha yesisu yangaphambili. Igama elithi "ventral" lisho ngokuqondile indawo engaphambili noma yesisu somzimba, okwenza lezi zimila zibonakale ngokucacile odongeni lwesisu.

Izinhlobo ze-Ventral Hernia

Izinhlobo eziyinhloko ze-ventral hernias zihlanganisa:

• I-Hernia ye-Epigastric: Lezi hernia zenzeka engxenyeni engenhla yesisu phakathi kwenkinobho yesisu nethambo lesifuba. Ngokuvamile aqukethe izicubu ezinamafutha futhi ngokuvamile mancane, okwenza kube inselele ukuwaxilonga.
• I-Umbilical Hernias: Akhiwe eduze kwenkinobho yesisu, lezi ziphakathi kwe-ventral hernias ezivame kakhulu. Zivame ukubonakala njengeqhubu elibonakalayo enkabeni futhi zingaba khona kusukela ekuzalweni.
• I-Incisional Hernias: Lokhu kwenzeka endaweni lapho kwakuhlinzekwe khona ngaphambili futhi kuthinta kufika ku-10% weziguli eziye zahlinzwa esiswini.
• I-Parastomal Hernias: Lawa ma-hernia avela endaweni ye-colostomy, ileostomy, noma enye i-stoma lapho amathumbu e-stured esikhumbeni. 
• I-Spigelian Hernias: Lezi zivela ku-quadrants engezansi yesisu, kancane kuya kunoma yiluphi uhlangothi lwe inkaba. Zethula inselele eyingqayizivele njengoba zingangeni njalo kuyo yonke imisipha yodonga lwesisu, okwenza ukuxilongwa kube nzima kakhulu.

Izimpawu ze-Ventral Hernia

Inkomba evame kakhulu iziguli ezibhekana nazo iqhubu elibonakalayo odongeni lwazo lwesisu olungaphambili.

Lesi siqhumane sibonakala kakhulu phakathi nemisebenzi ethile ehlanganisa imisipha yesisu. Iziguli zingase zibone noma zizwe i-hernia ngesikhathi:

• Ehleka noma ekhala
• Ukushaya noma ukuthimula
• Ukusebenzisa indlu yokugezela
• Ukugoba noma ukuphakamisa
• Ukuzivocavoca noma umsebenzi womzimba

Ezinye izimpawu zifaka: 

• Ubuhlungu noma ukungaphatheki kahle okuba kubi kakhulu ngokukhwehlela, ukuphakamisa, noma ukuma isikhathi eside
• I-nausea nokuhlanza
• Ukuvimbela or ukuqunjelwa
• Ububomvu noma ukuvuvukala endaweni ye-hernia

Izimbangela Nezici Zengozi Ye-Ventral Hernia

Ukuthuthukiswa kwe-ventral hernia kungabangelwa izici ezihlukahlukene, kusukela kuzimbangela zemvelo kuya kumathonya okuphila. 

• Izindawo ezibuthakathaka zokuzalwa zikhona kusukela ekuzalweni
• Ukuhlinzwa kwesisu kwangaphambilini, okunengozi efika ku-30% yokuthola i-hernia yokusika
• Izimo zezempilo ezingapheli ezithinta amandla emisipha
• Ukuwohloka kwemisipha yemvelo ngenxa yokuguga
• Ukuhlukumezeka ngokomzimba noma ukulimala esiswini

Izinto ezimbalwa eziyingozi zingaphakamisa amathuba okuthuthukisa i-ventral hernia. Lokhu kubandakanya:

• Ukukhwehlela okungapheli noma ubunzima bokuphefumula
• Ukuqunjelwa okungapheli
• Ukuphakamisa okusindayo okuvamile noma ukusunduza
• Isifo sikashukela kanye nezifo ezithinta izicubu
• Ukukhulelwa nokubeletha
• Ukukhuluphala

Izinkinga ze-Ventral Hernia

Izinkinga ezivame kakhulu ziqhubeka ngezigaba zobunzima:

• Ukuboshwa: Amathumbu avaleleka odongeni lwesisu futhi awakwazi ukuphindiselwa emuva. Lesi simo sibangela ubuhlungu, ukungakhululeki, kanye nokuvinjelwa kwamathumbu okungenzeka.
• Ukukhwabanisa: Ukunikezwa kwegazi ezicutshini eziboshiwe kuyanqamuka, okuholela ekufeni kwezicubu. Lesi simo sidinga ukuhlinzwa okuphuthumayo ngokushesha.
• Ukuvinjwa kwamathumbu: Kungenzeka nge-ventral hernias eboshiwe, okubangela isicanucanu, ukuhlanza, nokuqunjelwa okukhulu.
• Ukufa Kwezicubu: Ngaphandle kokugeleza kwegazi, izicubu ezithintekile ziqala ukufa, okungenzeka zikhiphe ubuthi obubulalayo emzimbeni

Ezimweni lapho i-ventral hernia iqhuma, izinga lokufa likhuphuka kakhulu libe ngu-60-80% ngisho nangemva kokulungiswa kokuhlinzwa. 

Sifo

• Ukuhlola Umzimba: Odokotela bahlola isisu ukuze bathole izimpawu ezibonakalayo ze-herniation. Bangase bacele iziguli ukuthi zenze izenzo ezithile ukuze zenze i-hernia ibonakale kakhudlwana, njengokuma, ukukhwehlela, noma ukushintsha indawo omi kuyo. Lokhu kuhlola okwenziwa ngezandla kuvumela odokotela ukuthi bahlole ukuthi bangakwazi yini ukuyibuyisela ngobumnene i-hernia endaweni, inikeze ulwazi olubalulekile mayelana nobukhulu bayo kanye nokuphuthuma kokwelashwa.
• Umlando Wezokwelapha: Inqubo yokuxilonga ihlanganisa izinyathelo ezimbalwa ezibalulekile:
  • Ingxoxo enemininingwane mayelana nokuqala kwezimpawu nokuqhubeka kwayo
  • Ukuhlolwa kwezimo zezempilo ezingapheli
  • Ukubuyekezwa komsebenzi kanye nemikhuba yokuphila
  • Ukuhlolwa kokudla kanye nezinqubo zokuzivocavoca
• Ukufanekisa: Ezimeni lapho ukuhlolwa komzimba kungaphelele, abahlinzeki bezempilo bangase ba-ode ukuhlolwa kwesithombe okwengeziwe. Lokhu kungase kuhlanganise i-ultrasound yesisu, i-CT scan, noma i-MRI ukuze ubuke i-hernia kangcono. 

Ukwelashwa kwe-Ventral Hernia

Nakuba ukuhlinzwa kokulungisa i-ventral hernia kusewukuphela kwesixazululo esiqinisekile, ezinye iziguli zingase zikhethe izindlela ezingezona zokuhlinzwa.

• Ukwelashwa okungahlinzeki: Ukuphathwa okungahlinzeki ngokuvamile kuhilela ukusebenzisa izinto ezisekelayo ukuze kudambise ukungaphatheki kahle. Odokotela bangase batuse i-truss yesisu, ibhande, noma i-hernia short ukuze kudambise ingcindezi nobuhlungu. 
• Ukuhlinzwa: Izindlela zokuhlinzwa eziyinhloko zihlanganisa:
  • Ukuhlinzwa Okuvuliwe Kwendabuko: Odokotela balungisa i-ventral hernia ngokuthi:
    • I-Herniorrhaphy: I-Herniorrhaphy ihilela ukusika isisu ngaphezu kwe-hernia, ukusunduza amathumbu angaphandle emuva esiswini, nokuvala ukuvuleka.
    • I-Hernioplasty: Le nqubo yokuhlinzwa ihilela ukulungisa nokuqinisa indawo ebuthakathaka nge-mesh.

Odokotela bangasebenzisa izinhlobo ezahlukene ze-mesh yokuhlinza ukuze baqinise ukulungisa ngesikhathi sokuhlinzwa. I-synthetic mesh iyona ehlala isikhathi eside kakhulu, kuyilapho i-biological mesh inikeza ingozi ephansi yokutheleleka. Ukukhethwa kwe-mesh kuncike ezintweni zesiguli ngasinye kanye nokuhlolwa kodokotela ohlinzayo.

• Ukulungisa i-Laparoscopic: Phakathi nale nqubo yokuhlinza ehlasela kancane, udokotela ohlinzayo wenza izimbobo ezimbalwa ezincane ezansi nesisu futhi afake amathuluzi anjengeshubhu, njenge-laparoscope nezinsimbi zokuhlinza, ukuze alungise i-hernia nge-synthetic mesh ne-sutures.
• Izinqubo ezisizwa ngamarobhothi: Ukuhlinza okusizwa ngerobhothi kufana ne-laparoscopy, kodwa udokotela ohlinzayo ulawula izingalo zerobhothi kusuka kukhonsoli futhi enze ukulungisa i-ventral hernia.

Uzoyibona Nini Udokotela

Izimo eziphuthumayo ezidinga ukuhlolwa kwe-ER ngokushesha zifaka:

• Ubuhlungu obukhulu besisu nxazonke i-hernia
• Ukujuluka okukhulu ngokushaya kwenhliziyo okusheshayo
• Ukushisa okuphezulu okuhambisana nesicanucanu nokuhlanza
• Isicanucanu esinamandla esihambisana nokuqunjelwa
• Ububomvu noma ukushintsha kombala endaweni ye-hernia

Lezi zimpawu zingase zibonise i-hernia eklinyiwe, lapho ukunikezwa kwegazi emathunjini e-herniated kuphazamiseka, okungaholela ekufeni kwezicubu.

Prevention

Izinyathelo ezibalulekile zokuvimbela zihlanganisa ukugcina isisindo esinempilo ngokudla okufanele nokuzivocavoca umzimba. Ukukhuluphala ngokweqile kwandisa kakhulu ingozi yokuthuthukisa i-ventral hernias ngokufaka ingcindezi eyengeziwe odongeni lwesisu.

Abantu banganciphisa ubungozi be-ventral hernia ngokulandela lezi zindlela ezibalulekile:

• Ukuzivocavoca njalo ukuze uqinise imisipha eyinhloko ngenkathi ugwema imisebenzi enzima kakhulu
• Ukusebenzisa izindlela ezifanele zokuphakamisa uma uphatha izinto ezinzima
• Ukuphatha izimo ezingamahlalakhona ezifana nesifo sikashukela ngempumelelo
• Ukwelapha ukukhwehlela okungapheli ngokushesha
• Ukugcina ukuma okuhle, ikakhulukazi ngesikhathi somsebenzi wedeski
• Ukuyeka ukubhema, njengoba ababhemayo banamathuba aphindwe kane okuba ne-hernia ephindaphindayo
• Kulabo abavivinya umzimba njalo, kubalulekile ukukhetha imisebenzi efanele. Ukuzivocavoca okunomthelela omncane njengokubhukuda, ukuhamba ngezinyawo, nokuhamba ngebhayisikili ngokuvamile kuyizinketho eziphephile. Kodwa-ke, abantu kufanele bagweme ukuvivinya umzimba okucindezela isisu ngokweqile, njengokuhlala ngokwesiko nokuphakamisa izinsimbi.
• Ukucabangela ukudla kudlala indima ebalulekile ekuvimbeleni. Ukudla okulinganiselayo okucebile nge-fibre kusiza ekuvimbeleni ukuqunjelwa, okungacindezela udonga lwesisu. Ukudla okunothe nge-fiber kuhlanganisa imifino, okusanhlamvu, amantongomane, imbewu, nemifino. 
• Ukwengeza, ukugcina i-hydration efanele nokugwema utshwala kusekela impilo yonke yezicubu.

Isiphetho

I-ventral hernias imelela isimo esibucayi sezokwelapha esidinga ukunakwa nokunakekelwa okufanele. Nakuba zivamile, lezi hernia zingaholela ezinkingeni ezinzima lapho zishiywe zingalashwa, kusukela ebuhlungwini obungapheli kuya ezimweni eziphuthumayo ezisongela ukuphila. Ukungenelela kwezokwelapha kusewukuphela kwendlela yokululama, okwenza ukutholakala kusenesikhathi nokwelashwa kubalulekile ukuze kube nemiphumela engcono.

Iziguli kufanele zihlale ziqaphele izimpawu eziyisixwayiso futhi zifune usizo lwezokwelapha ngokushesha uma zibona izimpawu ezingavamile noma izinguquko ku-hernia yazo. Izinguquko ezilula zendlela yokuphila njengokugcina isisindo esifanele, amasu okuphakamisa afanele, nokuzivocavoca okuvamile kungasiza ekuvimbeleni i-ventral hernias noma kunciphise izinkinga kulabo asebehlonziwe. Ukuhlolwa njalo nodokotela kuqinisekisa ukuqapha okufanele kanye nokungenelela okufika ngesikhathi lapho kudingeka.

Imibuzo Evame Ukubuzwa

1. Uyini umehluko phakathi kwe-ventral kanye ne-umbilical hernia?

I-umbilical hernia empeleni iwuhlobo oluthile lwe-ventral hernia. Ngenkathi i-ventral hernias ingenzeka noma yikuphi odongeni lwesisu olungaphambili, i-umbilical hernias ikhula ngokuqondile endaweni yenkinobho yesisu. Umehluko omkhulu usendaweni yazo - i-ventral hernias ihlanganisa isigaba esibanzi esihlanganisa i-epigastric, incisional, kanye ne-umbilical hernia.

2. Yikuphi ukuhlinzwa okulungele i-ventral hernia?

Indlela yokuhlinzwa elungile incike ezintweni zomuntu ngamunye, kodwa izinketho ezintathu eziyinhloko ziyatholakala. Ukulungiswa kwe-Laparoscopic kuhilela ukusika okuncane, okuvame ukuholela ekuhlaleni isikhashana esibhedlela kanye namazinga aphansi okutheleleka. Ukuhlinzwa okuvulekile kungase kudingeke kuma-hernias amakhulu, kuyilapho ukulungiswa kwerobhothi kunikeza ukulawula okunembile phakathi nenqubo.

3. Ungayinciphisa kanjani i-ventral hernia?

Ukunciphisa i-ventral hernia kudinga amasu aqaphile. Odokotela bangase bazame ukunciphisa mathupha ngokuthi:

• Ukubeka isiguli endaweni yokulala
• Ukufaka ama-compresses abandayo ukunciphisa ukuvuvukala
• Ukusebenzisa ingcindezi emnene ezungeze i-hernia

4. Ingabe ukuhamba kuhle ku-ventral hernia?

Ukuhamba ngokuvamile kubhekwa njengokuphephile futhi kunenzuzo ngemva kokulungiswa kwe-hernia. Iziguli zingakwazi ukuhamba ngokushesha ngemva kokuhlinzwa, nakuba kufanele zigweme imisebenzi ekhandlayo amaviki angu-3-4. Ukuhamba okuvamile kusiza ukugcina ukujikeleza okuhle futhi kukhuthaza ukuphulukiswa ngaphandle kokubeka ubunzima obuningi endaweni yokulungisa.

5. Ibucayi kangakanani i-ventral hernia?

I-ventral hernias ingahluka ukusuka komnene kuya kobunzima. Nakuba ezinye zingase zibangele ukungakhululeki okuncane, ezinye zingaholela ezinkingeni ezinkulu uma zingelashwa. Isimo siba yingozi ikakhulukazi uma i-hernia iklinywa, inqamula ukutholakala kwegazi esicutshini esivalelekile - isimo esidinga ukuhlinzwa okuphuthumayo.

6. Ingabe i-ventral hernia ingabuya?

Yebo, i-ventral hernias ingaphinde ivele. Ucwaningo lubonisa cishe u-85% wokuphindaphinda ngemva kokulungiswa kwe-laparoscopic, futhi u-77% ngemva kokulungiswa okuvulekile kwenzeka phakathi neminyaka emibili yokuhlinzwa. Ingozi yokuphinda incishiswe ngokusebenzisa indlela efanele yokuhlinzwa nokunakekelwa kwangemva kokuhlinzwa, okuhlanganisa nokugcina isisindo esinempilo nokugwema ukuphakamisa okunzima ngesikhathi sokululama.

UDkt. Prashant Bhowate

CARE Medical Team