Ukuqonda Indlela Yokuguqulwa Kwama-J kanye Nezinkinga Ezikhona
Inqubo ye-ileal ye-anal anastamosis (IPAA), eyaziwa ngokuthi inqubo ye-J-Pouch, iyindlela yokwelashwa eyinkimbinkimbi yezifo ezinzima noma ukulimala okuthinta amathumbu amakhulu (colon). Le nqubo yenzelwe ukususa izicubu ezonakalisiwe zekholoni futhi uvumele isiguli ukuba siqhubeke sinohambo "oluvamile" lwesibindi, okusho ukuthi isitolishi sishiya umzimba ngokusebenzisa i-anus.
Ngenkambiso ye-J-Pouch-noma izinqubo eziningi eziphindwe kaningi-ikoloni isuswa ngokuhlinzwa futhi intombazane encane isakhiwe kabusha ukuze kuvumele isitokhi ukuba iphume emzimbeni ngokusebenzisa i-anus ngendlela elawulwayo.
I-J-Pouch Ngayiphi Igama Elinye
Le nqubo, noma iqembu lezinqubo, linamagama amaningi kuye ngokuthi isigaba sokuhlinzwa kanye nezwe elizokwenziwa ngalo. Ngaphandle kwesikhwama se-ileal anal anastamosis, inqubo yaziwa nangokuthi i- J-isikhwama , isikhwama se-ileo-anal, i-ileo-anal anal (IAR), isikhwama sangaphakathi, i-proctocolectomy yokubuyisela kabusha, ukukhishwa kwe-ileal-anal, isikhwama seKock, noma ukuthatha i-ileostomy.
Okwenza ukuhlinzekwa kwe-J-Pouch kwenziwa
Le nqubo yenziwa ngezizathu ezimbili: I-colon igule futhi / noma ibonakale futhi kufanele isuswe, futhi isiguli asifuni i-ileostomy. Kwabaningi, ikoloni isifo kangangokuthi impilo yabo ichithelwa yisifo sohudo esivamile. Kuyinto engavamile ukuzwa ngeziguli ezinezifo ezinzima zokwehla kwesifo sezinyosi ezinama-25 noma ngaphezulu ukunyakaza kwamathumbu ngosuku.
Lezi ziguli ngokuvamile azikwazi ukuhamba endlini ngenxa yokwesaba ukuba nengozi ngenxa yokuhuda okungalawulwayo okuvame ukuhambisana nosizi, kanti ngezinye izikhathi igazi lihlala esitokisini.
I-Ileostomy ichazwe
I- ileostomy yi-bypass yokuhlinzeka emathunjini amakhulu ayenziwa ngokuhlukanisa ukuphela komathumbu amancane kusukela ekuqaleni kwemathumbu amakhulu futhi evuselela ukuphela kwamathumbu amancane ngaphandle kwesisu.
Lokhu kwenziwa ngokwenza umfutho omncane esiswini bese udala ukuphuma kwesitokisi. Lokhu kuhlanganiswa kuhlanganiswe nesebenza, isikhwama esikhethekile esinamathelethi avumele ukuba sibambe esikhumbeni, futhi isitoreji siqoqwe esikhwameni.
Abantu abaningi abanesithakazelo sokuba ne-ileostomy isikhathi eside. Ngesikhathi kudingekile ukudlula i-colon noma ukususa ikholoni kwezinye izimo, iziguli ngokuvamile zifuna enye indlela yokugqoka umshini. Iziguli zivame ukukhononda ngokuthi lo mshini awuhlosile, unomusa, uphazamisa ukusondelana kobulili, kuthukuthelisa isikhumba noma kuvame ukucasula.
Ubani Okhethwa Kokuhlinzwa Kwe-J-Pouch?
Udokotela ohlinzayo wase-kolon uzoba yisinqumo sokugcina sokuthi isiguli singumuntu obhekene nenqubo ye-J-Pouch. Leso sinqumo sizobe sisekelwe ezintweni eziningi, kufaka phakathi okulandelayo:
- Impilo yonke yesiguli
- Uhlobo lwenkinga emathunjini amakhulu
- Ubukhulu benkinga
- Kungakhathaliseki ukuthi inkinga ingasetshenziswa yini ngokususwa kwekhaloni noma cha
- Kungakhathaliseki ukuthi izingozi zenqubo zingaphezu kwezinzuzo ezikhona noma cha
Isimo sekholoni ngeke sibe yinto eyodwa kuphela yokuthi isiguli singumuntu ozokhethwa ngokuhlinzwa. Isiguli esine-colitis esiyingozi kakhulu esingaphenduli emithini yemithi, okuyinto ejwayelekile kunazo zonke yenkambiso, kungenzeka ukuthi ingabi ozobhapathizwa ngenxa yokuthi inesimo senhliziyo esingenza i-anesthesia ibe yingozi, noma isifo sikashukela sayo sibi kakhulu elawulwayo.
Ngokuvamile, ukuba abe ngumfundi we-J-Pouch inqubo, isiguli kumele sibe nesifo esinzima sekhaloni noma umonakalo. I-trauma ingaba isizathu sokulimala okuphathwa ngokuhlinzwa, njengesilonda sokudubula esiswini esisenza ukulimala okukhulu emathunjini amakhulu. Ngokomzimba, isifo sofuba sezilonda yisilwane esiyisizathu esivame kakhulu senqubo, umdlavuza wekolon nayo iyisizathu esivamile sokuba ikholoni isuswe.
I-polyposis ene-adenomatous ejwayelekile, isimo esivame ukuholela emdlalweni we-colon, futhi yisisusa esijwayelekile sokuhlinzwa kwe-J-Pouch. Lesi simo ngokuvamile siholela ezigulini ezinama- colp polyps ngenkathi zifinyelela phakathi kwezintathu futhi zikhula nomdlavuza wekoloni eminyakeni eyishumi noma emibili elandelayo.
Inqubo ye-J-Pouch iyenziwa kahle ngaphambi kokuxilongwa komdlavuza , kunokuba kube ukwelashwa komdlavuza.
Ukwelapha isifo esidumile se-Crohn-esingafani ne-colitis ngoba izilonda ezilonda ulcerative zingabonakala kwezinye izindawo ngaphandle kwe-colon-ne-J-Pouch surgery. Lokhu kungenxa yokuthi kungenzeka ukuthi ususe ikholoni bese udala i-J-Pouch kuphela ukuthola ukuthi i-J-Pouch iqala izilonda ezintsha zezilonda zesilonda, okungenzeka zishiye isiguli esibi nakakhulu kunesikhathi sokuqala ukwelashwa.
Izingozi ze-J-Pouch Surgery
Ngaphandle kwezingozi ezijwayelekile zokuhlinzwa, kubandakanya ukusabela ku-anesthesia nezinkinga eziwaziwayo ezifana ne-pneumonia noma ama-clots wegazi, kunezingozi ezingeziwe ezibhekene ne-ileostomy kanye ne-J-Pouch. Lezi zingozi zihlanganisa:
- Ukweqa noma ukuvuza: Amaphethini wokungena ngaphakathi naphakathi angakwazi ukuvuza noma aphuze ngemuva kokuhlinzwa.
- I-Ileus: Lokhu kuyinkimbinkimbi lapho ukunyakaza kwamathumbu emathumbu (peristalsis) kuyama ngemuva kokubulawa kwe-anesthesia. Ezimweni eziningi lokhu kuxazulula ezinsukwini ezilandelayo ukuhlinzwa.
- Ukuvimbela: Yilapho ukunciphisa okubangelwa ukuhlinzwa noma enye inkinga kuvimbela ukuhamba kokudla nesigqoko ngokusebenzisa umzila wokugaya.
I-J-Pouch: Kanjani Ngokuqondile?
I-J-Pouch iyisikhwama esincane esakhiwe kusukela ekupheleni komathumbu amancane abe yiJ J lapho isitokisi singalinda kuze kube yisikhathi sokunyakaza kwamathumbu. Njenga-rectum, esuswa ngesikhathi senqubo, i-J-Pouch ye-muscular ayikwazi nje ukugcina isitoreji kuze kufike isikhathi sokunyakaza kwamathumba, kodwa isiguli sinokulawula okuthile noma ukulawula isikhathi sokuhamba kwesisu. Ngezindlela eziningi, i-J-Pouch iyi-rectum eyakhiwe ngokuhlinzekwa eqeda isidingo se-ileostomy.
I-J-Pouch Izinyathelo: 1, 2 noMeyi 3
Inqubo ye-J-Pouch ihlelwe ngokujwayelekile ukuba yenziwe ngezinyathelo ezimbili, okusho ukuhlinzwa okuhlukene okuzokwenziwa, ngokuvamile kuphele izinyanga ezimbili kuya kwezingu-3. Ngokuvamile, isinyathelo sokuqala sinokukhishwa kwekoloni, ukwakheka kwe-ileostomy, nokudalwa kwe-J-Pouch. Ngalesi sikhathi, umathumbu omncane uhlukaniswe emathunjini amakhulu, ngakho isitobhi siphume ngomzimba ngesayithi le-eleostomy.
Ezinyangeni eziningana ezilandelayo i-J-Pouch esanda kumiswa ivumelekile ukuphulukisa nokuqinisa. Uma i-J-Pouch iphilisiwe futhi isiguli silungele ukuhlinzekwa okungeziwe, inqubo eyengeziwe yenziwa futhi isitolishi siqala ukuhamba emathunjini amancane, ku-J-Pouch lapho igcinwa khona, bese iphuma emzimbeni ngokusebenzisa i-rectum njenge yenze ngaphambi kwalezi zinqubo.
Le ndlela yokuhlinza kabili iyindlela ejwayelekile kunazo zonke inqubo ye-J-Pouch eyenziwa. Le nqubo ingenziwa futhi njengendlela yokuhlinzwa eyodwa, okusho ukuthi i-ileostomy ayenziwanga-ikoloni kanye ne-rectum zisusiwe, i-J-Pouch yenziwa futhi ixhunywe kwisigxobo se-rectal (ingxenye esele encane ye-rectum ngaphakathi ngaphakathi kwe-anus ) ngendlela efanayo.
Kwezinye izimo, odokotela abahlinzayo bahlinza ngezigaba ezintathu, kodwa lokhu akuvamile. Zonke izinyathelo zenkambiso zenziwa ngaphansi kwe-anesthesia jikelele futhi ziholela ekuhlaleni kwesibhedlela izinsuku ezingu-3 kuya kwezingu-7, kuye ngokuthi inani lezigaba ezenzelwe futhi impilo yonke yesiguli.
I-J-Pouch Procedure Video
Lezi zinqubo ziyinkimbinkimbi futhi kunzima ukuyiqonda ngempela ngaphandle kwezinsiza ezibonakalayo. Ngaleso sizathu, i-Crohn's and Colitis Foundation yenze le vidiyo ukuthi ichaze ngokucacile inqubo ye-J-Pouch.
Yini Ongayilindela Ngemuva Kokuhlinzwa Kwe-J-Pouch
Ngemuva kokuhlinzwa kwe-J-Pouch sekuphelile, kungase kube izinyanga eziningi ngaphambi kokuthi ufinyelele "okujwayelekile" kwakho kokuhamba kwamathumbu. Ngokuvamile emva kokuhlinzwa kwe-J-Pouch akusho ukuthi kuvamile ngamazinga ajwayelekile womuntu ojwayelekile okuyizinto: ukuhamba komzimba kulawulwa (hhayi ngengozi), okungenani eyodwa kwezinsuku ezintathu, okwakhiwa kodwa hhayi kanzima, futhi okungenabuhlungu. Ukunyakaza okuvamile "kokujwayelekile" ngemva kokuhlinzwa kuka-J-Pouch ngokuvamile kuvumelana kwamapayipi noma amazambane ahlambulukile.
Ngemuva kokuphuluka sekuphelile, isiguli esiphezulu sithola ukunyakaza okuhamba ngamathambo amahlanu noma ayisithupha ngosuku.
Kumuntu obhekene nesifo sohudo egazi ngokuphindaphindiwe ngezikhathi, lokhu kungabonakala kungcono kakhulu, kepha kumuntu owayenezimiso zokugaya njalo futhi wenza inqubo yokuvimbela umdlavuza, lokhu kungase kusabe futhi kwenziwe ushintsho olunzima.
Ngokuvamile, ngemva kokuphola sekuphelile futhi isiguli sesifunde ukuthi yini ukudla kanye namanzi okuphuza angakwazi ukukhulisa i-J-Pouch futhi iholele ekuhambeni kwezinyosi ezilawulwa kahle, iziguli ziveza ukwaneliseka ngemiphumela yokuhlinzwa. Phakathi kwamaphesenti angu-10 no-20 abagculisekile ngomphumela wabo bese bakhethwa ukuba babe neeloomy noma enye inqubo ngemuva kokuba inqubo ye-J-Pouch.
Kulezi ziguli eziningi, ukuthola ukudla okufanele ukudla nokugwema kanye nokufunda ukuthi imiphi imithi ewusizo ekunciphiseni isifo sohudo nokwandisa ukuhamba komzimba ukuholela ekuthuthukiseni okuvela esimweni sabo sesifo esidlule.
Izinkinga ezikwaziwayo ezingenzeka ngemuva koku-J-Pouch
Kunezinkinga eziningi ezingase zibe khona ngemuva kokuba nenqubo ye-J-Pouch, ngenhlanhla eziningi zazo ziphathwa kalula noma zivinjelwe. Abasebenzi ehhovisi lakho lokuhlinza kanye nomhlengikazi we- enterostomal therapy (abahlengikazi abasebenza ngokucophelela ekunakekeleni i-ostomy nezinye izilonda) kungaba usizo olukhulu lapho belulame. Unganqikazi ukuxoxa nganoma yiziphi izinkinga zalabachwepheshe bezokwelapha njengoba kungenzeka ukuthi babone inkinga ngaphambili.
Khumbula ukuthi lezi zinkinga ngokuvamile ziyathuthuka ngemva kokuhlinzwa, njengoba isiguli sifunda indlela umzimba wawo osebenza ngayo emva kokuhlinzwa futhi uphinde uvuselele ngokugcwele:
- Ukunciphisa Ukondleka: Ukuhuda kwesisu kungaholela ekutheni amavithamini, amaminerali amancane, namakhalori ambalwa athathwa ngumzimba. Ngokuhamba kwesikhathi, iziguli ezazondla ukudla ngaphambi kokuhlinza ngokuvamile zondla kangcono uma isifo sohudo sidlula.
- Ukuqiniswa: Izindawo zokufakelwa okuhlinzekwa ukuhlinzwa, kufaka phakathi amathumbu amancane, i-J-Pouch, ne-anus ingabhekana nokunciphisa ngenxa yokulimala. Lokhu kunciphisa kungabangela ukuvinjelwa kwamathumba amancane, ubunzima bokudla noma izithambile ezihamba ngendlela yokugaya futhi kunzima ngokunyakaza kwamathumbu.
- Ukwehla kwesithombeni: Umsebenzi owodwa wekoloni ukukhipha i-asidi engaphezu kwamanzi emathunjini. Ngaphandle kwekoloni ukwenza lo msebenzi, ezinye iziguli zithola ukushisa esiteshini se-stoma yazo noma ezungeze i-anus evame ukubizwa ngokuthi "ukushisa komlilo". Lokhu kungavinjelwa ngendoda yokugcoba esikhumbeni.
- I-Pouchitis: Ukuvuvukala kwesikhwama, lesi simo singaba buhlungu futhi ngokuvamile siphathwa ngemithi emibili: i-Flagyl ne-Cipro.
- I-incontinence: Ngenkathi injongo ye-J-Pouch ukusiza isiguli ukuba silawulwe lapho sidlulisa izibilini zabo, ezinye iziguli zizwa ukungathinti isikhathi ngesikhathi sokuphumula. Ubuningi bokuhlangenwe nakho okungahambi kahle okudlulela esigabeni sokutakula.
- Isifo sohudo: Ukukhuluma ngokweqile, isifo sohudo siyisithupha noma ngaphezulu izihlalo ezivulekile ngosuku, kanti ezinye ukuthi izisindo ezivulekile zingcono kunezinga langaphambili lokulawula. Kwabanye, lokhu kubi nakakhulu kunangaphambili, kepha phakathi kwamasonto ambalwa okuqala ahudo lokuphulukisa kuvamile futhi kulindeleke. Kuvame ukuthuthukiswa ngemithi efana neLomotil noma i-Immodium kanye nezinguquko zokudla. Ukudla okunomsoco nesitashi, njengamazambane kanye ne-pasta, kungasiza ukuqinisa isihlalo. Bika uhudo oluqhubekayo ohlinzayo wakho.
- Ukwehla kwamanzi: Ukuhamba njalo kwamathumbu kungaholela ekudambiseni amanzi, ngakho-ke ukuhanjiswa kufanele kuqondiswe futhi ukutholakala kwamanzi kuyenyuka uma kutholakala amanzi emzimbeni. Ukukhipha amanzi emzimbeni kungabhekwa kangcono ekhaya ngombala womchamo. Umchamo omnyama ubonisa isidingo esikhulu soketshezi, kanti umchamo ocacile futhi ongenakubala ungabonakali kahle. Bika ukuphelelwa amandla emzimbeni kwodokotela wakho ohlinzayo.
- I-sodium ephansi: i- sodium ingalahleka nge-soar, futhi kufanele ishintshwe ngamanzi afana ne-electrolyte afana ne-Gatorade noma iPedialyte. I-sodium ephansi ngokuvamile ihlolwe ngokuhlolwa kwelebhu, ngakho qiniseka ukuthi udokotela wakho ohlinzayo uyazi ukuthi uthola ukuthi une-sodium ephansi.
- I-Abscess Abselvic: Lesi yisikhwama sokutheleleka esiqala noma esiseduze ne-J-Pouch site futhi sidinga ukwelashwa nokwelapha okungenzeka ukwelashwa.
- Ukungasebenzi komzimba ngokocansi: Ukungasebenzi kahle kwe-Erectile kuyingozi engaziwayo yenqubo yamadoda. Kulabo besifazane, ukungabi nabantwana ngenxa yokungalahleki ama-ovari kuyisici esingaziwa, njengokuba ubulili bubuhlungu.
- I-Crohn's Ngemuva kwe-J-Pouch: Umehluko phakathi kukaCrohn's ne-colitis ukuthi isifo sikaCrohn singenzeka noma yikuphi emgodleni wokugaya ngenkathi ubulantshi bukhawulelwe emathunjini amakhulu. Uma izilonda zikaCrohn zivele kuphela ekolon ngaphambi kokuhlinzwa, kungase kube nokutholwa ukuthi i-colitis, kuphela ukuthola ukuthi izilonda zitholakala kamuva kwezinye izindawo ngemuva kokuhlinzwa. Lokhu kungaholela ku-J-Pouch enezilonda zesilonda.
- Ukudla okuncane: Abanye abantu abane-J-Pouches bathola ukuthi bangakwazi ukubekezelela ukudla okuncane okuncane kunokudla okungenani ezintathu ngosuku.
- "Izinkinga ezejwayelekile": Izinkinga ezijwayelekile ezibhekene nabantu abaningi, njenge-flatulence, ziba zibi kakhulu nge-J-Pouch. Ukudla okuvame ukubangela igesi kungabangela igesi noma i-gas engaphezu komzimba kunokuba bekungeke kube khona ukuhlinzwa. Lena umphumela ojwayelekile wenqubo, futhi angeke ixazulule ngemva kokuqedwa kokuqedwa.
- Ukudinga i-Ostomy: Ezimweni ezibucayi lapho i-incontinence iba yinkinga eqhubekayo, i-J-Pouch ayilona enempilo noma engeyona ukusebenza, noma isiguli asinelisekile, i-ileostomy yindlela yokwelashwa.
- Ukukhulelwa: Umfutho we-fetus ekhanda, lapho i-J-Pouch ihlala khona, ingabangela ubunzima ngokuhamba kwemathumba kanye ne-continence. Bobabili udokotela ohlinzayo we-colon-rectal kanye nodokotela wezidakamizwa bazoba nendima ekusizeni umama okhulelwe ukuba abe nokulawula okungcono kakhulu phakathi nonyaka wokuqala, lapho le nkinga ibaluleke kakhulu, futhi inquma uhlobo oluhle lokudiliva.
Izwi elivela
Le nqubo iyinkimbinkimbi futhi inselele, eyenziwa kuphela ezigulini ezigula kakhulu noma enethemba lokugwema umlando womndeni oqinile womdlavuza wekoloni. Isinqumo sokuthi ukuhlinzekwa kwe-J-Pouch akufanele kuthathwe kalula futhi kufanele kwenziwe kuphela ngemuva kokuthola udokotela ohlinzayo owenza lezi zinqubo ngesimiso futhi emva kokuba nengxoxo ejulile mayelana nezingozi kanye nemiphumela engaba khona yokuhlinzwa.
> Imithombo:
> Umhlahlandlela womonde kanye nomndeni ku-Ileal J-Pouch Anal Anastamosis (IPAA) Ukuhlinzwa. Uhlelo lwe-University of Pennsylvania lwe-Health Division Division of Colon noRectal Surgery. http://www.uphs.upenn.edu/surgery/clinical/colon_rectal/ostomy/ileal_j_pouch_surgery.pdf
> Ingqikithi ye-proctocolectomy ne-ileal-anal. I-Medline Plus. https://medlineplus.gov/ency/article/007380.htm