Kutuluka kwa Portacaval

Portacaval shunting ndi chithandizo cha opaleshoni kuti mupange kulumikizana kwatsopano pakati pamitsempha yamagazi iwiri m'mimba mwanu. Amagwiritsidwa ntchito pochiza anthu omwe ali ndi vuto lalikulu la chiwindi.

Portacaval shunting ndi opaleshoni yayikulu. Zimakhudza kudula kwakukulu pamimba (pamimba). Kenako dokotalayo amalumikizana pakati pa mtsempha wapa zipata (womwe umapereka magazi ambiri a chiwindi) ndi vena cava wotsika (mtsempha womwe umatulutsa magazi kuchokera kumunsi kumunsi kwa thupi.)

Kulumikizana kwatsopano kumasintha magazi kutuluka m'chiwindi. Izi zimachepetsa kuthamanga kwa magazi m'mitsempha yam'mbali ndikuchepetsa chiopsezo chong'ambika (kutuluka) ndi kutuluka magazi m'mitsempha m'mimba ndi m'mimba.

Nthawi zambiri, magazi omwe amatuluka m'mimba, m'mimba, ndi m'matumbo mumayambira pachiwindi. Chiwindi chanu chitawonongeka kwambiri komanso pali zotchinga, magazi samadutsamo mosavuta. Izi zimatchedwa portal hypertension (kukakamizidwa kowonjezereka ndi kusungidwa kwa mtsempha wa portal.) Mitsempha imatha kutseguka (kuphulika), ndikupangitsa magazi kutuluka kwambiri.

Zomwe zimayambitsa matenda oopsa a portal ndi:

• Kumwa mowa kumayambitsa zipsera m'chiwindi (cirrhosis)
• Magazi amatsekemera mumtsinje womwe umachokera pachiwindi kupita pamtima
• Zitsulo zambiri m'chiwindi (hemochromatosis)
• Chiwindi B kapena C

Matenda oopsa a portal amapezeka, mutha kukhala ndi:

• Kutuluka magazi kuchokera m'mitsempha yam'mimba, m'mimba, kapena m'matumbo (magazi opatsirana mwazi)
• Kupanga kwamadzimadzi m'mimba (ascites)
• Kupanga kwamadzimadzi pachifuwa (hydrothorax)

Kutseka kwa Portacaval kumapangitsa gawo lanu lamagazi kutuluka m'chiwindi. Izi zimapangitsa kuti magazi aziyenda bwino m'mimba, m'mimba, ndi m'matumbo.

Kutsekemera kwa Portacaval kumachitika nthawi zambiri ngati transjugular intrahepatic portosystemic shunting (MAFUNSO) sikugwira ntchito. MALANGIZO ndi njira yosavuta komanso yocheperako.

Zowopsa za anesthesia ndi opaleshoni yonse ndi izi:

• Matupi awo sagwirizana ndi mankhwala, mavuto kupuma
• Kukhetsa magazi, magazi kuundana, kapena matenda

Zowopsa za opaleshoniyi ndi izi:

• Kulephera kwa chiwindi
• Kukulitsa kwa matenda encephalopathy (vuto lomwe limakhudza kusunthika, malingaliro, ndi kukumbukira - kumatha kubweretsa kukomoka)

Anthu omwe ali ndi matenda a chiwindi ali pachiwopsezo chachikulu chazovuta pambuyo pa opaleshoni.

Anthu omwe ali ndi matenda owopsa a chiwindi omwe akukulirakulira angafunikire kuganiziridwa pakuyika chiwindi.

Shunt - zenera; Kulephera kwa chiwindi - portacaval shunt; Matenda enaake - portacaval shunt

Henderson JM, Rosemurgy AS, Pinson CW. Njira yodziyimira payokha: portocaval, distal splenorenal, mesocaval. Mu: Jarnagin WR, Mkonzi. Opaleshoni ya Blumgart ya Chiwindi, Biliary Tract, ndi Pancreas. Lachisanu ndi chimodzi. Philadelphia, PA: Elsevier; 2017: mutu 86.

Shah VH, Kamath PS. Matenda oopsa a magazi ndi magazi a variceal. Mu: Feldman M, Friedman LS, Brandt LJ, olemba. Sleisenger ndi Fordtran's Mimba ndi Matenda a Chiwindi: Pathophysiology / Diagnosis / Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016: chap 92.