STRICTURE

From Big Medical Encyclopedia

STRICTURE (strictura; lat. stringere to pull together, squeeze; synonym stenosis) — the organic narrowing of hollow body, a vessel, a channel or channel which is followed by partial or full disturbance of its passability. In relation to a certain body the term «stricture» or «stenosis», napr is traditionally applied, the stricture of an urethra, the general bilious channel and a stenosis of output department of a stomach, an atrioventricular opening, an aorta, etc.

subdivide S. on false (compression), at to-rykh narrowing of a gleam of body is caused by its prelum from the outside, and true, at to-rykh narrowing is caused by changes in walls of body. True S. happen inborn and acquired; the last are more often caused by scarring, tumors, atherosclerotic process in arteries, etc. S. subdivide also on partial (compensated) and full (dekompensirovanny). The page can be single or multiple.

Patomorfol. S.'s characteristic depends on its origin. Concentric is characteristic of cicatricial S., eccentric narrowing of a gleam up to its total disappearance is more rare (see the Atresia), tumoral S. arises due to growth of a tumor in walls of body, atherosclerotic — due to formation of plaques in walls of arteries. Depending on the direction of the movement of contents on a gleam of body S.'s development can be followed by prestenotichesky expansion of its gleam (e.g., in a gullet, the general bilious channel, an ureter, etc.), post-stenotic expansion (e.g., in bronchial tubes), or that and another (e.g., at coarctation of an aorta).

Wedge, S.'s manifestations depend on its localization and extent of disturbance of passability of body. In an initial stage of development of any S. difficulty of passability is compensated for the account of a myopachynsis in the part of body bringing in relation to S., and in arteries and veins — due to development of collaterals. In the subsequent symptoms of impassability — at first function of body, partial, then full with switching off, and the corresponding structural disturbances in it develop.

Treatment

Conservative treatment is possible at the partial S. caused by high-quality process. So, at partial cicatricial S. use corticosteroids, a lidaza, Peloidinum, spasmolytic drugs. Most effectively bougieurage (see), a cut usually carry out at cicatricial S. of a gullet, urethras, a nasal duct, etc. At nek-ry S. make tool expansion of a gleam of body by means of special dilators (see. Cardiospasm ). At S. of the main arteries (coronary, renal, etc.) apply X-ray surgical dilatation by means of special balloon catheters (see. X-ray endovascular surgery ).

Operational treatment of S. is carried out for recovery of passability of body, and at impossibility of it is for creation of artificial fistula — an ostomy (see. Fistulas ). Operations on recovery of passability of body are very various. In particular, treat them: a simple section of cicatricial fabrics in a zone C., napr, a mitral commissurotomy (see the Heart diseases acquired surgical treatment), Geller's operation (see the Cardiospasm), a section of a big nipple of a duodenum (see. Faterov of pacifiers ); S.'s section with opening of a gleam of body and plastic mending of the formed defect, napr, a pyloroplasty (see. Pylorostenosis ); S.'s resection with a neostomy the end in the end, napr, at coarctation of an aorta and a stricture of a trachea, or with prosthetics of the resected department, napr, at limited atherosclerotic occlusions of an aorta; shunting by means of bypass (see. Choledochoduodenostomy ) and other types of an anastomosis at S. bilious ways, a gastroenterostomy (see) at S. of the gatekeeper; shunting by means of a synthetic prosthesis, napr, aortobedrenny shunting at Lerish's syndrome, etc.; shunting with use of other own body, napr, creation of an artificial gullet from a small or large intestine. At nek-ry tumoral S. carry out a resection of body with removal of outside fistula, napr, a belly and perineal extirpation or a rectectomy with colostomy (see), an extirpation of a throat with a tracheostomy (see), etc.

Prevention The page includes timely effective treatment of the diseases causing S., napr, early bougieurage at burns of a gullet, adequate treatment of a peptic ulcer, etc. The main way of prevention of postoperative cicatricial S. consists in atraumatic performance of operation, good knowledge of anatomic options of a structure of bodies, careful imposing of an anastomosis.


S. V. Lokhvitsky.

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