{"id":11881,"date":"2009-12-01T20:00:00","date_gmt":"2009-12-01T20:00:00","guid":{"rendered":""},"modified":"2009-12-01T20:00:00","modified_gmt":"2009-12-01T20:00:00","slug":"chilaiditi-sindromas","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/chilaiditi-sindromas\/11881\/","title":{"rendered":"Chilaiditi sindromas"},"content":{"rendered":"

Karolis SKEBAS<\/p>\n

<\/span><\/p>\n

VU Medicinos fakultetas<\/p>\n

<\/span><\/p>\n

Recenzavo gyd. Arida BUIVYDIEN\u0116<\/p>\n

<\/span><\/p>\n

\u00a0<\/p>\n

<\/span><\/p>\n

\u012eVADAS<\/font><\/span><\/h1>\n

\u00a0<\/p>\n

<\/span><\/i><\/b><\/p>\n

Chilaiditi <\/span><\/i><\/b>(tariama Ky-La-Dity<\/i>) sindromas yra reta klinikin\u0117 b\u016bkl\u0117, kurios da\u017enis, remiantis \u012fvairiais literat\u016bros \u0161altini\u0173 duomenimis, populiacijoje siekia 0,025\u20130,28 proc. Sindromas pasirei\u0161kia skausmu d\u0117l \u017earnos kilpos pad\u0117ties pasikeitimo ir \u012fstrigimo (de\u0161in\u0117s pus\u0117s skersin\u0117s storosios \u017earnos, de\u0161in\u0117s pus\u0117s plonosios \u017earnos) tarp de\u0161iniosios diafragmos pus\u0117s ir kepen\u0173 (1 pav.)<\/i>.<\/span><\/p>\n

\u00a0<\/p>\n

\u00a0<\/p>\n

<\/p>\n

<\/span><\/p>\n

\"Chilaiditi<\/span><\/p>\n

\u00a0<\/p>\n

\u00a0<\/p>\n

Pirm\u0105 kart\u0105 \u0161is sindromas apra\u0161ytas Cantinio <\/i>1865 m., jo pasteb\u0117jimus 1899 m., remdamasiskr\u016btin\u0117s l\u0105stos rentgenogramomis, papild\u0117 Becleras<\/i>. Ta\u010diau i\u0161samiausius tyrimus 1910 m. atliko graik\u0173 radiologas Demetrius Chilaiditis<\/i>, dirb\u0119s Vienoje. Jis i\u0161samiai apra\u0161\u0117 \u0161i\u0105 b\u016bkl\u0119, pavadint\u0105 jo vardu.<\/p>\n

<\/span><\/p>\n

Da\u017eniausiai \u0161is anatominis pakitimas nesukelia joki\u0173 simptom\u0173 ir medicinos literat\u016broje apra\u0161omas Chilaiditi <\/i>simptomas (n\u0117ra joki\u0173 klinikini\u0173 simptom\u0173) diagnozuojamas tik rentgenologiniais metodais. Ta\u010diau tiriant pacient\u0105 rentgenologi\u0161kai, o ypa\u010d sutapus skausminiam sindromui su Chilaiditi <\/i>simptomu, \u0161is anatominis variantas gali b\u016bti palaikytas sunkia liga (\u012ftariamas laisvas oras po diafragma, kurio prie\u017eastis \u2013 \u017earnos perforacija). Neteisingas diagnozavimas gali didinti nereikaling\u0173 operacij\u0173 da\u017en\u012f.<\/p>\n

<\/span><\/p>\n

Pagrindiniai tyrimo metodai, kuriais diagnozuojamas tiek Chilaiditi <\/i>simptomas, tiek sindromas, yra pilvo irkr\u016btin\u0117s rentgenografi ja. Abi Chilaiditi <\/i>i\u0161rai\u0161kos gali b\u016bti arba nuolatin\u0117s, arba laikinos, nes net \u012fstrigusi \u017earna gali gr\u012f\u017eti \u012f pradin\u0119 anatomin\u0119 pad\u0117t\u012f.<\/p>\n

<\/span><\/p>\n

Sindromas b\u016bdingas vyresniems \u017emon\u0117ms, ta\u010diau nustatyta atvej\u0173, kai sindromas pasirei\u0161kia ir vaikams. Sergan\u010di\u0173 vyr\u0173 ir moter\u0173 santykis yra 4:1.<\/p>\n

<\/span><\/p>\n

\u00a0<\/p>\n

<\/span><\/b><\/p>\n

KLINIKINIS ATVEJIS<\/p>\n

<\/span><\/b><\/p>\n

\u00a0<\/p>\n

<\/span><\/p>\n

\u012e hepatologijos ir gastroenterologijos skyri\u0173 paguldyta ligon\u0117 (gimusi 1940 m.), prie\u017eastis \u2013 l\u0117tinio cholecistito pa\u016bm\u0117jimas. Pacient\u0117 skund\u0117si stipriu de\u0161in\u0117s pilvo pus\u0117s skausmu judant (skausmai nesusij\u0119 nei su valgiu, nei su tu\u0161tinimusi). Renkant anamnez\u0119, ligon\u0117 teig\u0117, kad nuolatin\u012f pilvo skausm\u0105 jau\u010dia apie 20 met\u0173. Apie m\u0117nes\u012f skund\u017eiasi stipr\u0117jan\u010diu skausmu. Kasdien skausmui mal\u0161inti vartoja analgetikus. I\u0161 anamnez\u0117s pavyko i\u0161siai\u0161kinti, kad vaikyst\u0117je patyr\u0117 2 pilvo traumas (\u012fspyr\u0117 arklys, u\u017egriuvo medis).<\/p>\n

<\/span><\/p>\n

Objektyvaus i\u0161tyrimo metu nustatytas k\u016bno mas\u0117s indeksas (KMI) buvo 28 kg\/m<\/span>2<\/span>. \u010ciuopiant pilvas mink\u0161tas, labai skausmingas de\u0161in\u0117je pus\u0117je, be pilvapl\u0117v\u0117s dirginimo simptom\u0173.<\/p>\n

<\/span><\/p>\n

Atlikti laboratoriniai kraujo tyrimai \u2013 be pakitim\u0173. Pilvo skausmo prie\u017eas\u010diai patikslinti atlikta pilvo organ\u0173 kompiuterin\u0117 tomografija (KT).<\/p>\n

<\/span><\/p>\n

Tyrimo i\u0161vada: dislokuotos ir rotuotos kepenys. Cholecistitui b\u016bding\u0173 po\u017eymi\u0173 n\u0117ra (2 pav.)<\/i>. Siekiant atmesti galim\u0105 \u017earnyno nepraeinamum\u0105, atliktas \u017earnyno rentgenologinis tyrimas (pasa\u017eas). I\u0161vada: atipin\u0117 plonosios ir storosios \u017earnos pad\u0117tis.<\/p>\n

<\/span><\/p>\n

Konsiliumo metu, dalyvaujant radiologams, abdominalin\u0117s chirurgijos specialistams, gastroenterologams, \u012fvertinus ligon\u0117s nusiskundimus, anamnez\u0117s duomenis, atliktus instrumentinius tyrimus, nustatoma klinikin\u0117 diagnoz\u0117: Chilaiditi <\/i>sindromas (hepatodiafragmin\u0117 \u017earnos interpozicija).<\/p>\n

<\/span><\/p>\n

\u012evertinus, kad skausmas suma\u017e\u0117jo, \u017earn\u0173 nepraeinamumo po\u017eymi\u0173 nefi ksuojama, operacinio gydymo indikacij\u0173 \u0161iuo metu n\u0117ra. Ambulatori\u0161kai rekomenduoti prokinetikai, laktulioz\u0117, spazmolitikai ir analgetikai.<\/p>\n

<\/span><\/p>\n

\u00a0<\/p>\n

<\/span><\/p>\n

LITERAT\u016aROS AP\u017dVALGA<\/font><\/span><\/h1>\n

\u00a0<\/p>\n

<\/span><\/i><\/b><\/p>\n

Chilaiditi simptomo ir sindromo prie\u017eastys<\/span><\/i><\/b><\/p>\n

<\/span><\/p>\n

\u00a0<\/p>\n

<\/span><\/p>\n

Atsi\u017evelgiant \u012f tai, kad klaidingas diagnozavimas didina nereikaling\u0173 chirurgini\u0173 intervencij\u0173 skai\u010di\u0173, o sindromas retas, ta\u010diau pana\u0161us \u012f nema\u017eai itin sud\u0117ting\u0173 ir chirurginio gydymo reikaling\u0173 patologij\u0173, b\u016btina vertinti ir galimai esamus etiologinius veiksnius, sukelian\u010dius Chilaiditi <\/i>simptom\u0105 ar sindrom\u0105:<\/p>\n

<\/span><\/p>\n

1. Ilga ir judri gaubtin\u0117 \u017earna<\/p>\n

<\/span><\/p>\n

2. Storosios \u017earnos ir pjautuvinio rai\u0161\u010di\u0173 silpnumas<\/p>\n

<\/span><\/p>\n

3. L\u0117tinis viduri\u0173 u\u017ekiet\u0117jimas<\/a><\/p>\n

<\/span><\/p>\n

4. Diafragminis nervo pa\u017eeidimas<\/p>\n

<\/span><\/p>\n

5. L\u0117tin\u0117s plau\u010di\u0173 ligos (emfizema, LOPL)<\/p>\n

<\/span><\/p>\n

6. Kepen\u0173 ciroz\u0117<\/a>, ascitas<\/p>\n

<\/span><\/p>\n

7. Aerofagija<\/p>\n

<\/span><\/p>\n

8. Buvusios chirurgin\u0117s manipuliacijos \u017earnyne<\/p>\n

<\/span><\/p>\n

9. Nutukimas<\/a> ir skolioz\u0117<\/a><\/p>\n

<\/span><\/p>\n

10. Kair\u0117s kepen\u0173 skilties vidin\u0117s dalies sunykimas (\u0161iuo atveju da\u017eniausiai pakitusi ir \u0161lapimo p\u016bsl\u0117s pad\u0117tis)<\/p>\n

<\/span><\/p>\n

Ne visada galima tiksliai diagnozuoti \u0161io sindromo prie\u017eastis. Ta\u010diau esant adekva\u010diai klinikai ir rentgenologiniams radiniams, patvirtinama Chilaiditi <\/i>diagnoz\u0117.<\/p>\n

<\/span><\/p>\n

\u00a0<\/p>\n

<\/span><\/i><\/b><\/p>\n

Chilaiditi sindromo klinika<\/p>\n

<\/span><\/i><\/b><\/p>\n

\u00a0<\/p>\n

<\/span><\/i><\/p>\n

Chilaiditi <\/span><\/i>sindromo ar simptomo atsiradimo prie\u017eastis \u2013 de\u0161in\u0117s pus\u0117s \u017earn\u0173 dislokacija tarp diafragmos ir kepen\u0173. Tod\u0117l klinika susijusi su keliais mechanizmais: besivystan\u010diu pa\u010dios \u017earnos suspaudimu ir daline ar visi\u0161ka obstrukcija bei gretim\u0173 organ\u0173 suspaudimo sukeliamais poky\u010diais ir po\u017eymiais. Sindromas da\u017eniausiai klini\u0161kai pasirei\u0161kia \u0161iais simptomais:<\/p>\n

<\/span><\/p>\n

1) Pilvo skausmas<\/p>\n

<\/span><\/p>\n

2) Viduri\u0173 u\u017ekiet\u0117jimas<\/p>\n

<\/a><\/span><\/p>\n

3) Pykinimas, v\u0117mimas<\/p>\n

<\/span><\/p>\n

4) Meteorizmas<\/p>\n

<\/span><\/p>\n

5) Anoreksija<\/p>\n

<\/span><\/p>\n

6) Aritmija<\/a><\/p>\n

<\/span><\/p>\n

7) Kv\u0117pavimo funkcijos sutrikimai<\/p>\n

<\/span><\/p>\n

\u00a0<\/p>\n

<\/span><\/i><\/b><\/p>\n

Chilaiditi sindromo diagnostika<\/p>\n

<\/span><\/i><\/b><\/p>\n

\u00a0<\/p>\n

<\/span><\/p>\n

Sindromas diagnozuojamas atsi\u017evelgiant \u012f klinikinius simptomus ir vertinant rentgenologini\u0173 tyrim\u0173 duomenis. Kr\u016btin\u0117s ir pilvo rentgenogramose po de\u0161iniu diafragmos kupolu matomos oro prisipild\u017eiusios \u017earnos (3\u20134 pav.)<\/i>. Re\u010diau taikomas tyrimas \u0161iems anatominiams pakitimams diagnozuoti \u2013 echoskopija, kurios metu randamos \u017earnos ir oras vir\u0161 de\u0161in\u0117s kepen\u0173 skilties (5\u20136 pav.)<\/i>.<\/span><\/p>\n

\u00a0<\/p>\n

\u00a0<\/p>\n

<\/p>\n

<\/span><\/p>\n

\"Chilaiditi<\/span><\/p>\n

\u00a0<\/p>\n

\"Chilaiditi<\/span><\/p>\n

\u00a0<\/p>\n

\u00a0<\/p>\n

Kitas tikslus, ta\u010diau brangus tyrimas \u2013 kompiuterin\u0117 tomografija, kuri leid\u017eia spr\u0119sti apie kepen\u0173 dislokacij\u0105 ir \u017earn\u0173 pad\u0117t\u012f diafragmos bei kepen\u0173 at\u017evilgiu (7 pav.)<\/i>.<\/span><\/p>\n

\u00a0<\/p>\n

\u00a0<\/p>\n

<\/p>\n

<\/span><\/p>\n

\"Chilaiditi<\/span><\/p>\n

\u00a0<\/p>\n

<\/span><\/i><\/b><\/p>\n

Diferencin\u0117 diagnostika<\/p>\n

<\/span><\/i><\/b><\/p>\n

\u00a0<\/p>\n

<\/span><\/p>\n

Kaip jau min\u0117ta, Chilaiditi <\/i>sindromas savo klinika ir laboratorini\u0173 tyrim\u0173 i\u0161vadomis pana\u0161us \u012f daugel\u012f sud\u0117ting\u0173 lig\u0173 ir komplikacij\u0173, o d\u0117l retumo lieka pamir\u0161tas. D\u0117l \u0161ios prie\u017easties pacientas siun\u010diamas skubiai atlikti chirurgin\u0117s intervencijos. Norint i\u0161vengti \u0161i\u0173 klaid\u0173, b\u016btina, kad kiekvienas gydytojas, tiek bendrosios praktikos, tiek specializuotos srities, \u017einot\u0173<\/p>\n

<\/span><\/p>\n

ne tik apie \u0161\u012f sindrom\u0105, bet ir nuo ko j\u012f vert\u0117t\u0173 skirti:<\/p>\n

<\/span><\/p>\n

\u00a0<\/p>\n

<\/span><\/i><\/b><\/p>\n

I. Vertinant klinik\u0105:<\/p>\n

<\/span><\/i><\/b><\/p>\n

1. Funkciniai skrand\u017eio ir \u017earn\u0173 sutrikimai<\/p>\n

<\/span><\/p>\n

2. Skrand\u017eio ar dvylikapir\u0161t\u0117s ir kit\u0173 plon\u0173j\u0173 \u017earn\u0173 ligos (gastritas<\/a>, opos perforacija, navikas)<\/p>\n

<\/span><\/p>\n

3. Tul\u017eies latak\u0173 ligos (akmenys, u\u017edegimas, navikas)<\/p>\n

<\/span><\/p>\n

4. Kasos ligos (pankreatitas, navikas)<\/p>\n

<\/span><\/p>\n

5. Inkst\u0173 ligos (renalin\u0117 kolika)<\/p>\n

<\/span><\/p>\n

6. Stor\u0173j\u0173 \u017earn\u0173 ligos (u\u017edegimas, navikas, opinis kolitas, Krono liga)<\/p>\n

<\/span><\/p>\n

7. Mechaninis \u017earn\u0173 nepraeinamumas<\/p>\n

<\/span><\/p>\n

8. \u016amus apendicitas<\/a><\/p>\n

<\/span><\/p>\n

9. Peritonitas<\/p>\n

<\/span><\/p>\n

10. Mezenterinis infarktas<\/p>\n

<\/span><\/p>\n

11. Aortos atsisluoksniavimas<\/p>\n

<\/span><\/p>\n

12. Ginekologin\u0117s prie\u017eastys<\/p>\n

<\/span><\/p>\n

13. Stuburo patologija<\/p>\n

<\/span><\/p>\n

\u00a0<\/p>\n

<\/span><\/i><\/b><\/p>\n

II. Vertinantkr\u016btin\u0117s l\u0105stos rentgeno<\/p>\n

<\/span><\/i><\/b><\/p>\n

duomenis:<\/p>\n

<\/span><\/i><\/b><\/p>\n

1. Subdiafragminis abscesas<\/p>\n

<\/span><\/p>\n

2. Pneumoperitoneumas<\/p>\n

<\/span><\/p>\n

3. Retroperitonin\u0117s mas\u0117s<\/p>\n

<\/span><\/p>\n

4. U\u017epakalin\u0117s kepen\u0173 dalies pa\u017eeidimai<\/p>\n

<\/span><\/p>\n

\u00a0<\/p>\n

<\/span><\/i><\/b><\/p>\n

III. Vertinant echoskopijos duomenis:<\/p>\n

<\/span><\/i><\/b><\/p>\n

1. Pneumoperitoneumas<\/p>\n

<\/span><\/p>\n

2. Subdiafragminis abscesas<\/p>\n

<\/span><\/p>\n

3. Diafragmin\u0117 i\u0161var\u017ea<\/p>\n

<\/span><\/p>\n

\u00a0<\/p>\n

<\/span><\/i><\/b><\/p>\n

Gydymas<\/p>\n

<\/span><\/i><\/b><\/p>\n

\u00a0<\/p>\n

<\/span><\/p>\n

Da\u017eniausiai pasirenkama konservatyvaus gydymo ir steb\u0117jimo taktika, nes \u017earn\u0173 dislokacija gali atsikurti, o skausminis sindromas ir kiti po\u017eymiai neb\u016bna intensyv\u016bs. Gydymo taktika labiausiai priklauso nuo sukeliam\u0173 simptom\u0173 ir vyraujan\u010dios j\u0173 prie\u017easties:<\/p>\n

<\/span><\/p>\n

1. Lovos re\u017eimas<\/p>\n

<\/span><\/p>\n

2. Laisvinamieji preparatai<\/p>\n

<\/span><\/p>\n

3. Analgetikai<\/p>\n

<\/span><\/p>\n

4. Nazogastrin\u0117 intubacija<\/p>\n

<\/span><\/p>\n

5. Klizmos ir kt.<\/p>\n

<\/span><\/p>\n

Tik labai retais atvejais skirtinas chirurginis gydymas (esant \u017earn\u0173 u\u017esisukimo\/ nepraeinamumo po\u017eymiams). Gali b\u016bti pasirenkamos \u012fvarios chirurgines intervencijos metodikos: \u012fvairios \u017earn\u0173 peksijos ar net dalin\u0117s rezekcijos.<\/p>\n

<\/span><\/p>\n

\u00a0<\/p>\n

<\/span><\/p>\n

APIBENDRINIMAS<\/font><\/span><\/h1>\n

\u00a0<\/p>\n

<\/span><\/p>\n

Pacientui skund\u017eiantis de\u0161in\u0117s pus\u0117s skausmu, tu\u0161tinimosi sutrikimais, anoreksija ir rentgenologiniu tyrimu ar vir\u0161utinio pilvo auk\u0161to echoskopija nusta\u010dius netipines anatomines strukt\u016bras (oro ir \u017earn\u0173 fragmentus po de\u0161iniuoju kupolu), atmetus galim\u0105 ir da\u017enesn\u0119 patologij\u0105, b\u016btina prisiminti Chilaiditi <\/i>sindrom\u0105, kad b\u016bt\u0173 i\u0161vengta diagnozavimo klaidos ir nereikalingos chirurgin\u0117s intervencijos.<\/p>\n

<\/span><\/p>\n

\u00a0<\/p>\n

<\/span><\/i><\/p>\n

\u017durnalas \u201cInternistas\u201d<\/p>\n

<\/span><\/i><\/p>\n","protected":false},"excerpt":{"rendered":"

Chilaiditi <\/span><\/i><\/b>(tariama Ky-La-Dity<\/i>) sindromas yra reta klinikin\u0117 b\u016bkl\u0117, kurios da\u017enis, remiantis \u012fvairiais literat\u016bros \u0161altini\u0173 duomenimis, populiacijoje siekia 0,025–0,28 proc. Sindromas pasirei\u0161kia skausmu d\u0117l \u017earnos kilpos pad\u0117ties pasikeitimo ir \u012fstrigimo (de\u0161in\u0117s pus\u0117s skersin\u0117s storosios \u017earnos, de\u0161in\u0117s pus\u0117s plonosios \u017earnos) tarp de\u0161iniosios diafragmos pus\u0117s ir kepen\u0173 (1 pav.)<\/i>.<\/o:p><\/span><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[],"tags":[828,2153,689,275,93,516,234,791,445,157,21,2152,2154],"site":[],"post_item_type":[27345],"class_list":["post-11881","post","type-post","status-publish","format-standard","hentry","tag-analgetikai","tag-chirurgines-intervencijos","tag-diagnostika","tag-diagnoze","tag-infarktas","tag-intervencijos","tag-klinika","tag-mases","tag-navikas","tag-nutukimas","tag-sindromas","tag-zarnu-dislokacija","tag-zarnu-ligos"],"acf":{"post_sites":false},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/11881","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/comments?post=11881"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/11881\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=11881"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=11881"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=11881"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=11881"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=11881"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}