Kutali kwa splenorenal shunt

Distal splenorenal shunt (DSRS) ndi mtundu wa opareshoni yochitidwa kuti muchepetse kupanikizika kwina pamitsempha ya pakhomo. Mitsempha yotsegula imanyamula magazi kuchokera m'ziwalo zanu zam'mimba kupita pachiwindi.

Pakati pa DSRS, mitsempha ya ndulu yanu imachotsedwa pamtambo. Mitsemphayo imamangiriridwa kumtsempha ku impso yanu yakumanzere. Izi zimathandiza kuchepetsa kuthamanga kwa magazi kudzera mumitsempha yotsegula.

Mitsempha ya pakhomo imabweretsa magazi kuchokera m'matumbo, ndulu, kapamba, ndi ndulu kupita pachiwindi. Kutuluka kwa magazi kutatsekedwa, kuthamanga mumitsempha iyi kumakhala kwakukulu kwambiri. Izi zimatchedwa portal hypertension. Nthawi zambiri zimachitika chifukwa cha kuwonongeka kwa chiwindi chifukwa cha:

• Kumwa mowa
• Matenda a chiwindi
• Kuundana kwamagazi
• Matenda ena obadwa nawo
• Matenda oyambira a biliary (kufooka kwa chiwindi komwe kumachitika chifukwa chotsekeka ndi ma ducts)

Magazi akakhala kuti sangathe kuyenda bwinobwino kudzera mumitsempha yapanyumba, zimatenga njira ina. Zotsatira zake, zotupa zamagazi zotupa zotchedwa varices form. Amapanga makoma ochepa omwe amatha kuthyoka ndikutuluka magazi.

Mutha kuchitidwa opaleshoniyi ngati mayeso oyerekeza monga ma endoscopy kapena ma x-ray akuwonetsa kuti muli ndi magazi m'magazi. Kuchita ma DSRS kumachepetsa kupanikizika kwa ma varices ndikuthandizira kupewa magazi.

Zowopsa za anesthesia ndi opaleshoni yonse ndi izi:

• Thupi lawo siligwirizana ndi mankhwala kapena mavuto kupuma
• Kukhetsa magazi, magazi kuundana, kapena matenda

Zowopsa za opaleshoniyi ndi izi:

• Kupanga kwamadzimadzi m'mimba (ascites)
• Bwerezani kutuluka magazi kuchokera ku varices
• Encephalopathy (kutayika kwa ubongo chifukwa chiwindi sichitha kuchotsa poizoni m'magazi)

Asanachite opaleshoniyo, mutha kukhala ndi mayeso ena:

• Angiogram (kuwona mkati mwa mitsempha)
• Kuyesa magazi
• Endoscopy

Patsani wothandizira zaumoyo wanu mndandanda wa mankhwala omwe mumamwa kuphatikiza mankhwala akuchipatala, mankhwala azitsamba, ndi zowonjezera. Funsani omwe mukufuna kuti musiye kumwa mankhwala asanachitike opareshoni, ndi omwe muyenera kumwa m'mawa wa opareshoni.

Wothandizira anu adzafotokozera ndondomekoyi ndikukuuzani nthawi yosiya kudya ndi kumwa musanachite opaleshoni.

Yembekezerani kukhala masiku 7 mpaka 10 kuchipatala mutachitidwa opaleshoni kuti mupeze bwino.

Mukadzuka pambuyo pa opaleshoni mudzakhala ndi:

• Chubu mumitsempha mwanu (IV) chomwe chimanyamula madzimadzi ndi mankhwala m'magazi anu
• Catheter mu chikhodzodzo chanu kukhetsa mkodzo
• Thumba la NG (nasogastric) lomwe limadutsa mphuno mwanu m'mimba mwanu kuti muchotse mpweya ndi madzi
• Pampu yokhala ndi batani mutha kusindikiza mukamafuna mankhwala opweteka

Monga momwe mumatha kudya ndi kumwa, mudzapatsidwa zakumwa ndi chakudya.

Mutha kukhala ndi mayeso ojambula kuti muwone ngati shunt ikugwira ntchito.

Mutha kukumana ndi katswiri wazakudya, ndikuphunzira kudya zakudya zonenepa, zopanda mchere.

Pambuyo pa opaleshoni ya DSRS, kutuluka magazi kumayendetsedwa mwa anthu ambiri omwe ali ndi matenda oopsa kwambiri. Chiwopsezo chachikulu chotaya magazi kachiwiri ndi m'mwezi woyamba atachitidwa opaleshoni.

DSRS; Njira zakutali za splenorenal shunt; Aimpso - splenic venous shunt; Warren shunt; Matenda enaake - distal splenorenal; Kulephera kwa chiwindi - distal splenorenal; Kutsekeka kwamitsempha yam'mbali - distal splenorenal shunt

Dudeja V, Fong Y. Chiwindi. Mu: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Buku Lopanga Opaleshoni. Wolemba 20th. Philadelphia, PA: Elsevier; 2017: mutu 53.

Masabata SR, Ottmann SE, Orloff MS. Matenda oopsa kwambiri: gawo la njira zosinthira. Mu: Cameron JL, Cameron AM, olemba, eds. Chithandizo Chamakono Cha Opaleshoni. Wolemba 13. Philadelphia, PA: Elsevier; 2020: 387-389.