Esophagectomy - wowononga pang'ono

Esophagectomy yocheperako kwambiri ndi opareshoni yochotsa gawo lililonse. Ili ndiye chubu chomwe chimasunthira chakudya kuchokera kukhosi kwanu kupita kumimba kwanu. Akachotsedwa, mimbayo imamangidwanso kuchokera mmimba mwanu kapena gawo lina lamatumbo anu.

Nthawi zambiri, esophagectomy imachitika kuti ithetse khansa yam'mero. Kuchita opareshoniyo kumathandizidwanso kuthana ndi kholalo ngati silikugwiranso ntchito kusunthira chakudya m'mimba.

Pakati pa esophagectomy yocheperako, timadulira tating'onoting'ono tating'onoting'ono tomwe timapangidwa m'mimba mwanu, pachifuwa, kapena m'khosi. Mawonekedwe owonera (laparoscope) ndi zida zopangira opaleshoni zimayikidwa kudzera pazomwe zingachititse opaleshoni. (Kuchotsa kum'mero ​​kumatha kuchitidwanso pogwiritsa ntchito njira yotseguka. Opaleshoni imachitika kudzera pakucheka kwakukulu.)

Opaleshoni ya laparoscopic imachitika motere:

• Mudzalandira anesthesia wamba panthawi ya opaleshoni yanu.Izi zidzakupangitsani inu kugona ndi kumva ululu.
• Dokotalayo amadula mabala atatu kapena anayi m'mimba mwanu, pachifuwa, kapena m'khosi. Mabalawa amakhala pafupifupi mainchesi 1,5.
• Laparoscope imalowetsedwa kudzera m'modzi mwa mabala m'mimba mwanu. Kukula kwake kuli ndi kuwala ndi kamera kumapeto. Kanema wochokera pakamera amapezeka pamakina opangira opangira. Izi zimathandiza dokotalayo kuona malo omwe akuchitidwa opaleshoni. Zida zina zopangira opaleshoni zimalowetsedwa kudzera pakadulidwe kena.
• Dokotalayo amamasula kholalo kumatenda apafupi. Kutengera kuchuluka kwa kummero kwanu kudwala, gawo limodzi kapena ambiri amachotsedwa.
• Ngati gawo lina lanu lidzachotsedwa, malekezero otsalawo amalumikizidwa pamodzi pogwiritsa ntchito zowonjezera kapena ulusi. Ngati gawo lanu lalikulu lichotsedwa, dokotalayo amakonzanso m'mimba mwanu kukhala chubu kuti apange khola latsopano. Amalumikizidwa ndi gawo lotsala la pammero.
• Mukamachita opaleshoni, ma lymph nodes m'chifuwa ndi m'mimba mwanu amatha kuchotsedwa ngati khansa yafalikira kwa iwo.
• Thupi lodyetsera limayikidwa m'matumbo anu ang'onoang'ono kuti muzitha kudyetsedwa mukamachira opaleshoni.

Malo ena azachipatala amachita opareshoni iyi pogwiritsa ntchito robotic. Mu mtundu uwu wa opareshoni, mawonekedwe ang'onoang'ono ndi zida zina zimayikidwa kudzera pakucheka pang'ono pakhungu. Dokotalayo amayang'anira kukula kwake ndi zida zake atakhala pamakompyuta ndikuwonera chowunikira.

Opaleshoni nthawi zambiri imatenga maola 3 mpaka 6.

Chifukwa chodziwika kwambiri chochotsera gawo lanu, kapena lonse, ndikumachiza khansa. Muthanso kukhala ndi mankhwala a radiation kapena chemotherapy musanachite opaleshoni kapena pambuyo pake.

Kuchita opaleshoni kuchotsa m'munsi kumathandizanso kuchiza:

• Mkhalidwe womwe minofu yam'mimbamo sigwira ntchito bwino (achalasia)
• Kuwonongeka kwakukulu kwa malo am'mimba omwe angayambitse khansa (Barrett esophagus)
• Kusokonezeka kwakukulu

Uku ndi opaleshoni yayikulu ndipo kuli ndi zoopsa zambiri. Ena mwa iwo ndi okhwima. Onetsetsani kuti mukukambirana za izi ndi dokotala wanu wa opaleshoni.

Zowopsa za opaleshoniyi, kapena mavuto atatha opaleshoni, atha kukhala apamwamba kuposa zachilendo ngati:

• Sitha kuyenda ngakhale mtunda waufupi (izi zimawonjezera chiwopsezo cha kuundana kwamagazi, mavuto am'mapapo, ndi zilonda zamagetsi)
• Ndioposa 60 mpaka 65
• Ndimasuta fodya kwambiri
• Ndi onenepa
• Wachepa kwambiri ndi khansa
• Ali pa mankhwala a steroid
• Anali ndi mankhwala a khansa asanamuchite opaleshoni

Zowopsa za anesthesia ndi opaleshoni yonse ndi izi:

• Thupi lawo siligwirizana ndi mankhwala
• Mavuto opumira
• Kukhetsa magazi, magazi kuundana, kapena matenda

Zowopsa za opaleshoniyi ndi izi:

• Reflux ya acid
• Kuvulala m'mimba, m'matumbo, m'mapapu, kapena ziwalo zina popanga opaleshoni
• Kutulutsa kwa zomwe zili m'mimba mwanu kapena m'mimba momwe dotoloyo adalumikizana nazo
• Kufotokozera za kugwirizana pakati pa mimba ndi mimba
• Chibayo

Mudzakhala ndi maulendo ambiri azachipatala komanso mayeso azachipatala musanachite opareshoni. Zina mwa izi ndi izi:

• Kuyezetsa kwathunthu.
• Kuyendera dokotala wanu kuti mutsimikizire kuti mavuto ena azachipatala omwe mungakhale nawo, monga matenda ashuga, kuthamanga kwa magazi, komanso mavuto amtima kapena am'mapapo, akuwongoleredwa.
• Upangiri wathanzi.
• Ulendo kapena kalasi kuti muphunzire zomwe zimachitika pakuchita opaleshoni, zomwe muyenera kuyembekezera pambuyo pake, komanso zovuta kapena zovuta zomwe zingachitike pambuyo pake.
• Ngati mwangotaya thupi posachedwa, dokotala wanu akhoza kukupatsani zakudya zam'kamwa kapena za IV kwa milungu ingapo musanachite opareshoni.
• CT scan kuti ayang'ane pammero.
• PET kuyesa kuti adziwe khansa ndipo ngati yafalikira.
• Endoscopy kuti muzindikire ndikuzindikira momwe khansa yapita patali.

Ngati mumasuta, muyenera kusiya milungu ingapo musanachite opareshoni. Funsani wothandizira zaumoyo wanu kuti akuthandizeni.

Uzani wothandizira wanu:

• Ngati muli ndi pakati kapena mutha kutenga pakati.
• Ndi mankhwala ati, mavitamini, ndi zina zowonjezera zomwe mukugwiritsa ntchito, ngakhale zomwe mwagula popanda mankhwala.
• Ngati mwakhala mukumwa mowa wambiri, osamwa kamodzi kapena kawiri patsiku.

Sabata isanachitike opaleshoni:

• Mutha kufunsidwa kuti musiye kumwa mankhwala ochepetsa magazi. Zina mwa izi ndi aspirin, ibuprofen (Advil, Motrin), vitamini E, warfarin (Coumadin), ndi clopidogrel (Plavix), kapena ticlopidine (Ticlid).
• Funsani dokotala wanu za mankhwala omwe muyenera kumwa patsiku la opareshoni.
• Konzani nyumba yanu mukatha kuchitidwa opaleshoni.

Patsiku la opareshoni:

• Tsatirani malangizo pa nthawi yomwe muyenera kusiya kudya ndi kumwa musanachite opaleshoni.
• Tengani mankhwala omwe dokotala wanu adakuwuzani kuti mumwe pang'ono pokha madzi.
• Fikani kuchipatala nthawi yake.

Anthu ambiri amakhala mchipatala masiku 7 mpaka 14 atachotsedwa ntchito. Kutalika kwa nthawi yomwe mudzakhale kudzadalira mtundu wa opareshoni yomwe mudakhala nayo. Mutha kukhala masiku 1 mpaka 3 kuchipinda cha odwala mwakayakaya mutangochitidwa opaleshoni.

Mukakhala kuchipatala, mudzachita izi:

• Afunseni kuti mukhale pambali pa kama wanu ndikuyenda tsiku lomwelo kapena tsiku litatha opaleshoni.
• Simungathe kudya osachepera masiku 2 kapena 7 oyamba mutachitidwa opaleshoni. Pambuyo pake, mutha kuyamba ndi zakumwa. Mudzadyetsedwa kudzera mu chubu chodyetsera chomwe chidayikidwa m'matumbo mwanu popanga opaleshoni.
• Mukhale ndi chubu chotuluka m'chifuwa chanu kuti muthe madzi omwe amamanga.
• Valani masitonkeni apadera pamapazi ndi miyendo popewa magazi.
• Landirani akatemera kupewa magazi kuundana.
• Landirani mankhwala opweteka kudzera mu IV kapena kumwa mapiritsi. Mutha kulandira mankhwala anu opweteka kudzera pampu yapadera. Ndi pampu iyi, mumasindikiza batani kuti mupereke mankhwala opweteka mukawafuna. Izi zimakuthandizani kuti muchepetse kuchuluka kwa mankhwala opweteka omwe mumapeza.
• Chitani masewera olimbitsa thupi.

Mukapita kunyumba, tsatirani malangizo amomwe mungadzisamalire mukamachira. Mudzapatsidwa zambiri zokhudza zakudya ndi kudya. Onetsetsani kuti mwatsatiranso malangizowo.

Anthu ambiri amachira kuchipatala ndipo amatha kukhala ndi zakudya zabwino. Akachira, adzafunika kudya pang'ono ndikudya pafupipafupi.

Ngati munachitidwapo opaleshoni ya khansa, kambiranani ndi adokotala za njira zotsatirazi zochizira khansa.

Kuchepetsa kuchepa kwam'mimba; Robotic esophagectomy; Kuchotsa kum'mero ​​- kuwononga pang'ono; Achalasia - matenda am'mimba; Kumimba kwa Barrett - esophagectomy; Khansa Esophageal - esophagectomy - laparoscopic; Khansa ya kum'mero ​​- esophagectomy - laparoscopic

• Chotsani zakudya zamadzi
• Zakudya ndi kudya pambuyo pa esophagectomy
• Esophagectomy - kutulutsa
• Gastrostomy yodyetsa chubu - bolus

• Khansa ya Esophageal

Donahue J, Carr SR. Esophagectomy yochepa kwambiri. Mu: Cameron JL, Cameron AM, olemba, eds. Chithandizo Chamakono Cha Opaleshoni. Wolemba 12. Philadelphia, PA: Elsevier; 2017: 1530-1534.

Tsamba la National Cancer Institute. Chithandizo cha khansa ya Esophageal (PDQ) - mtundu wa akatswiri azaumoyo. www.cancer.gov/types/esophageal/hp/esophageal-kuchiza-pdq. Idasinthidwa Novembala 12, 2019. Idapezeka Novembala 18, 2019.

Spicer JD, Dhupar R, Kim JY, Sepesi B, Hofstetter W. Esophagus. Mu: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Buku Lopanga Opaleshoni. Wolemba 20th. Philadelphia, PA: Elsevier; 2017: mutu 41.