Esophagectomy - yotseguka

Open esophagectomy ndi opareshoni yochotsa gawo limodzi kapena lonse. 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 pofuna kuchiza khansa ya kum'mero ​​kapena m'mimba yowonongeka kwambiri.

Mukamatsegula esophagectomy, kudula kamodzi kapena zingapo zazikulu zopangira m'mimba, pachifuwa, kapena m'khosi. (Njira ina yochotsera kum'mero ​​ndi ya laparoscopic. Opaleshoni imachitika kudzera pazing'onoting'ono zingapo, pogwiritsa ntchito mawonekedwe owonera.)

Nkhaniyi ikufotokoza mitundu itatu ya opareshoni yotseguka. Ndi opaleshoni iliyonse, mudzalandira mankhwala (anesthesia) omwe amakupangitsani kugona komanso kumva kupweteka.

Kutsegula m'mimba mwa Transhiatal:

• Dokotalayo amadula kawiri. Dulani limodzi lili m'khosi mwanu ndipo lina lili m'mimba mwanu.
• Kuchokera pakucheka m'mimba, dokotalayo amamasula m'mimba ndi gawo lotsitsa la kumero kumatumba apafupi. Kuchokera pakucheka m'khosi, zotsalazo zonse zimamasulidwa.
• Dokotalayo amachotsa gawo lanu lam'mimba komwe kuli khansa kapena vuto lina.
• Mimba yanu imakonzedwanso mu chubu kuti mupange mimba yatsopano. Ikuphatikizidwa ndi gawo lotsala la mimba yanu ndi zowonjezera kapena zokopa.
• Mukamachita opaleshoni, ma lymph nodes m'khosi mwanu ndi m'mimba mwachidziwikire amachotsedwa ngati khansa yafalikira kwa iwo.
• Thupi lodyetsera limayikidwa m'matumbo anu ang'onoang'ono kuti muzitha kudyetsedwa mukamachira opaleshoni.
• Ma machubu amadzimadzi amatha kutsalira pachifuwa kuti atulutse madzi.

Matenda a Transthoracic esophagectomy: Kuchita opaleshoniyi kumachitika mofananamo ndi njira yakubadwa kwa mwana. Koma kudula kumtunda kumapangidwa m'chifuwa chanu chakumanja, osati m'khosi.

En bloc esophagectomy:

• Dokotalayo amadula kwambiri m'khosi, pachifuwa, ndi m'mimba. Mimba yanu yonse ndi gawo m'mimba mwanu zimachotsedwa.
• Mmimba mwanu monsemo mumapangidwanso mu chubu ndikuyika pachifuwa panu kuti musinthe kholingo. Thupi la m'mimba limalumikizidwa ndi zotsalira zotsalira m'khosi.
• Dokotalayo amachotsanso ma lymph node onse m'chifuwa, m'khosi, ndi m'mimba.

Ambiri mwa opaleshoniyi amatenga maola 3 mpaka 6.

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
• Kuwonongeka kwam'mero
• Mimba yowonongeka kwambiri

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 akulu kuposa zachilendo ngati:

• Simungathe kuyenda, ngakhale mtunda waufupi (izi zimawonjezera chiwopsezo cha kuundana kwamagazi, mavuto am'mapapo, ndi zilonda zamagetsi)
• Ndi achikulire
• Ndimasuta fodya kwambiri
• Ndi onenepa
• Wachepa kwambiri ndi khansa
• Ali pa mankhwala a steroid
• Wakhala ndi matenda akulu kuchokera kum'mimba / m'mimba
• Analandira mankhwala a khansa (chemotherapy) asanachite opareshoni

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
• Zovuta kumeza kapena kuyankhula
• Kutsekeka kwa matumbo

Mudzakhala ndi maulendo ambiri azachipatala komanso mayeso azachipatala musanachite opaleshoni, kuphatikiza:

• Kuyezetsa kwathunthu.
• Kuyendera dokotala wanu kuti mutsimikizire mavuto ena azachipatala omwe mungakhale nawo, monga matenda ashuga, kuthamanga kwa magazi, komanso mavuto amtima kapena mapapo.
• 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 kusuta milungu ingapo musanachite opareshoni. Wothandizira zaumoyo wanu akhoza kukuthandizani.

Uzani wothandizira wanu:

• Ngati muli ndi pakati kapena mutha kukhala ndi pakati
• Ndi mankhwala ati, mavitamini, ndi zina zowonjezera zomwe mukugwiritsa ntchito, ngakhale zomwe mwagula popanda mankhwala
• Ngati mwakhala mukumwa mowa wambiri, kuposa 1 kapena 2 zakumwa 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 chitachitika opaleshoniyi. 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 kwa masiku asanu kapena asanu oyambirira mutachita 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 kuti muteteze matenda am'mapapo.

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

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

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

Trans-hiatal esophagectomy; Trans-thoracic esophagectomy; En bloc esophagectomy; Kuchotsa kum'mero ​​- kutseguka; Kutsekula m'mimba kwa Ivor-Lewis, Esophagectomy yopepuka; Khansa ya Esophageal - esophagectomy - yotseguka; Khansa ya kum'mero ​​- esophagectomy - yotseguka

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

• Khansa ya Esophageal

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 19, 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.