Izinhlobo Ezihlukene Zendlela Yokuziphatha Gastrectomy
I-gastrectomy yindlela yokuhlinza, okungenani, ingxenye yesisu. Kunezinhlobo eziningi ze-gastrectomy, ehluke ekutheni ingakanani yesisu nesisindo esizungezile sisuswa ngesikhathi senqubo.
I-Esophagus, isisu, ne-Duodenum
Ukuze uqonde kangcono izinhlobo ezahlukene zezinqubo zokuhlukunyezwa kwegazi, kubalulekile ukuqonda isisu sezisu nezisondelene.
Iningi labantu liyiqonda isisu nokuthi lisebenza kanjani, kodwa lingalazi kahle izitho nezicubu ezizungezile.
Uma umuntu edla ukudla, inqubo yokugaya iqala ngokuluma kokuqala. Amazinyo asisiza ukuba alume noma aphule ukudla abe yizicucu ezincane, bese ukuhlafuna ngokuqhubekayo kuphuza ukudla kuze kube yizicucu eziphathekayo. I-sali iqukethe ama-enzyme okugaya futhi aqala ukuphulukisa ukudla, kepha amazinyo enza iningi lomsebenzi kuleli phuzu enkambisweni. Ukuhlafuna, kuye ngokuthi kwenzeka isikhathi eside kangakanani nokuthi kungenziwa kanjani, kungathatha isisindo esinzima futhi siwuguqule ube unamathisela omuhle. Uma ukudla kuhloswe kahle, ukugwinya kudlulisa ukudla okuvela emlonyeni kuya emphinjeni. Umphimbo uqondisa ukudla ku-esophagus.
Umswakama uyishubhu ehlanganisa umphimbo emathunjini, futhi ivumela ukudla okufunwa ukuba ihambe kancane kancane isisu ngaphakathi komgogodla ngamunye. Phakathi kwesisu nesisu kuyinto imisipha sphincter engavulwa futhi ivaliwe, ukuvumela ukudla ukuba ahambe esiswini, kodwa ukuvimbela ukuba ashiye phezulu esiswini.
Isisu senezela i-asidi ekudleni, futhi kuphazamise ukudla ukuqhubeka nenqubo yokugaya. Ngemuva kokuba isisu sigcwalise ingxenye yaso yenqubo yokugaya, i-sphincter ye-pyloric, i-muscle ngaphansi kwesisu, ivula futhi ivala ukuze kuvumele ukudla kuphume kancane ngaphakathi esiswini futhi kube yingxenye yokuqala yamathumbu amancane.
Le ngxenye yamathumbu amancane kuthiwa i-duodenum.
Izinhlobo ze-Gastrectomy
Izinhlobo ezahlukene ze-gastrectomy zimi kanje:
- I-gastrectomy ehlukile: Lena inqubo ye-gastrectomy lapho ingxenye engezansi yesisu isusiwe.
- I-gastrectomy ye-Sleeve: Le nqubo isusa ngokusuka ngakwesokunxele kwesisu.
- I-Esophagogastrectomy : Inqubo yokuhlinzwa lapho isisu sesisu, i-sphincter yenhliziyo, kanye nengxenye yesiguli isusiwe.
- I-gastrectomy iyonke: Isisu sisusiwe kule nqubo yokuhlinzwa. Izingxenye ze-esophagus ne-duodenum nazo zingasuswa.
Izizathu ze-Gastrectomy
Kunezizathu eziningi zokuthi kungani i-gastrectomy ingenziwa. Imvelo yenkinga izobe ichaza uhlobo lwe-gastrectomy eyenziwa, nokuthi zingakanani izicubu okumelwe zisuswe. Ngokuvamile, lapho ukwelapha izifo zokugaya, kwenziwa umzamo wokunciphisa inani lezicubu ezisusiwe, ukulondoloza izicubu eziningi ngangokunokwenzeka ngenkathi kususwa izicubu ezimbi.
Ukukhuluphala
Esikhathini esidlule, ukuhlinzeka ngokuhlinzwa kwe-gastrectomy kwenzelwa ukuphatha isifo noma isimo esithinta esiswini. Ukulahlekelwa isisindo kwakubhekwa njengomphumela ohlangothini, noma ngisho nokucindezeleka, ngemuva kokwelashwa kwesinye isifo.
Eminyakeni yamuva, i-gastrectomy isetshenziselwe ukuhlinzeka nge-bariatric, okuyinto inqubo yokuhlinzwa eyenziwe ukuphatha ukukhuluphala ngokweqile.
Kubantu abakhulu kakhulu, ukwehlisa ubukhulu besisu kungaholela ekunciphiseni okuphawulekayo kwesisindo somzimba esiningi. Ngokungafani nokuhlinzwa okuyisisindo, iziguli ze-gastrectomy zamasosha zisezingeni eliphansi lokungondleki ngenxa yokungondleki kahle kwezakhi, kodwa namanje ziyakwazi ukuchitha amakhilogremu amaningi kakhulu.
Ngokungafani nezinye izinhlobo ze-gastrectomy ezifuna ukulondoloza izicubu ezinempilo eningi ngangokunokwenzeka, lapho i-gastrectomy yomunwe eyenziwa ngenhloso yokulahlekelwa isisindo, kunesisindo esibucayi esibonakalayo esususwe ngokunciphisa kakhulu umthamo wesiguli sokudla.
Lokhu kuholela ekubeni isiguli sibe nomuzwa wokudla okuncane kakhulu, futhi okuholela ekulahlekelweni kwesisindo.
Izilonda: Izilonda ze- Peptic , noma izilonda ezitholakala esiswini, isisu noma i-duodenum, zingabangela ubuhlungu obukhulu nokuphuma kwegazi. Kwezinye iziguli, kukhona ukulahlekelwa okuncane kodwa okunamandla kwegazi okungabangela i-anemia eqhubekayo. Kwabanye, ukuphuma kwegazi kokubili kungazelelwe futhi kuphuthumayo, okudinga ukunakwa ngokushesha. Izilonda zivame ukutholwa okokuqala lapho isiguli sifuna ukuxilongwa ngenxa yobuhlungu besisu. I- esophagogroduodenoscopy (EGD) , eyaziwa nangokuthi i-Upper GI, ivame ukwenza ukuthi udokotela abone ngaphakathi kwesisu ukuze kutholakale ukuxilongwa.
I-gastrectomy ayitholakali ukhetho lokuqala lwezilonda. Ngokuya ngohlobo lwesilonda, imithi ingase ibe yindlela yokuqala yokwelashwa, ilandelwa ezinye izindlela zokungena ukuyeka ukuphuma njenge-injection ye-epinephrine, noma inqubo yokuphumula esebenzisa ukushisa ukuyeka ukulahleka kwegazi. Yilapho lezi zinhlobo zokwelashwa zihluleka ukuphulukisa izilonda noma ukuhluleka ukumisa ukuphuma kwamanzi okujwayelekile okubhekwa ngawo.
Izicubu
Izicubu ezinomdlavuza nezingezona umdlavuza zingenzeka esiswini. Uma kwenzeka, futhi izindlela ezincane ezingavamile zokususa izicubu aziphumelelanga noma zingenakwenzeka ukuholela emthonjweni oyifunayo, i-gastrectomy ingacatshangwa. Isamba, ubungako, nendawo ye-tumor (s) kuzosiza ukuthi sinqume ukuthi iyiphi ingxenye yesisu, isisu, ne-duodenum okumelwe isuswe.
Ukuphuza
Nakuba izilonda ze-peptic ziyisizathu esivamile sokugaya esiswini, kunezinye izinhlobo zezinkinga ezingase ziholele nasekuguleni. Enye yezinto ezivame kakhulu kuyinkinga lapho isitsha segazi siphezu kwamathishu ngaphakathi kwezingcuba zesimiso sokugaya, okuthiwa i-angioectasia. Eyaziwa nangokuthi i-malformations e-arteriovenous, noma i-AVM, lolu hlobo lwesitsha esingavamile segazi lungabangela ukuphuma kwegazi.
Ngaphambi kweGastrectomy
Ngaphambi kwenqubo ye-gastrectomy, isiguli siyodinga ukudla noma ukuphuza amahora ayisithupha noma ngaphezulu ukulungiselela ukuhlinzwa. Okufanelekile, konke ukudla kanye nomswakama kuyodingeka ukuthi kuphume isisu ngenqubo, ngakho-ke isiguli ngokuvamile ngeke sidle emva kokudla ngosuku ngaphambi kokuhlinzwa. Kulezi ziguli ezinezinqubo zokugaya kancane, ukucwilisa uketshezi kungase kube yinto eyodwa emlonyeni ngosuku ngaphambi kokuba inqubo yokwandisa amathuba okuthi isisu singabi nalutho ngokuphelele.
Ngesikhathi se-Gastrectomy
Inqubo ye-gastrectomy iqala ngo- anesthesia jikelele, ukuqinisekisa ukuthi isiguli asizwa ubuhlungu futhi sihlala singenasici ngesikhathi sokuhlinzwa. Uma isiguli siphenduliwe, sesifakwe isikhalazo futhi sabekwa ku-ventilator, ukuhlinzwa kungase kuqale.
Inqubo ye-gastrectomy ingenziwa ngeyodwa yezindlela ezimbili: inqubo yendabuko lapho kukhishwa khona isisu esiswini, noma inguqulo entsha emisha encane lapho kufakwa khona ukucubungula okuncane kufaka phakathi ukuchotshozwa kwenkinobho yesisu, kanti udokotela ohlinzayo usebenzisa umncanyana ikhamera ifakwe kwesinye sezimo zokubheka ukuhlinzwa kumqapha.
Lapho izisetshenziswa sezikhona, isigaba esidingekayo sesisu siyakunqunywa futhi sibuyiswe emuva ndawonye. Ukuze i-gastrectomy ephelele, lapho isisu sisusiwe khona, i-oophagus ixhunyiwe ku-duodenum. Uma isigaba sesisu sisusiwe emaphethelweni angagqunywa emuva ndawonye ukuze enze konke, kodwa encane, isisu.
Uma udokotela ohlinzayo eseqedile le nqubo, izitsha zisuswa, ukuchotshozwa (ama) kuvaliwe, futhi i-anesthesia imiswa ngakho isiguli singasuka. Lapho isiguli siqala ukuvuka, ithubhu lokuphefumula lingasuswa ukuze isiguli siqale ukuphefumula sisodwa ngaphandle kweventilator.
Ukubuyisela emva kwe-Gastrectomy
Inqubo yokuphulukisa emva kokuba i-gastrectomy ijwayele ukugxila kokudla kancane kancane kokubuyisela ekudleni. Okungcono, ukudla kuzobe kubekezeleleke kahle ngesisu esisanda kushintshwa, kodwa iziguli eziningi zidinga ukubuyela kancane ekudleni kwazo okujwayelekile futhi ngenkathi inqubo ingathola ukuthi ayikwazi ukubekezelela ezinye zokudla okuthandayo. Iziguli eziningi zizoqala ngokudla okuhlanzekile futhi ziqhubekela phambili kunzima ukugaya ukudla njengoba zikwazi. Iziguli ezine-gastrectomy ye-sleeve yokulahlekelwa isisindo zizoba nesimiso esiqinile sokudla esihlinzekwa udokotela wabo ohlinzayo ukuze kukhuliswe isisindo sabo.
Kwezinye iziguli, kungase kube khona ithubhu ebizwa ngokuthi i-nasogastric tube etholakala ngesikhathi sokuhlinzwa. Le tube itholakala emakhaleni, phansi emphinjeni, nasesisu. Lokhu kuvumela abasebenzi ukuba basuse noma yikuphi uketshezi lwesisu esisengakha, okungasiza ekunciphiseni izinambuzane nokuvimbela ukuhlanza. Le tube iyasuswa lapho isiguli sikwanele ukubekezelela kokubili ukudla kanye namanzi.
I-gastrectomy iyindlela yokuhlinzwa ejulile futhi iziguli eziningi zizodinga uhlobo oluthile lwemithi yokwelapha ngesikhathi senqubo yokutakula. Ukucubungula ngezibeletho kuvamise ukuthambekela kakhulu, futhi kungacasulwa usuku olulula oluvela ezinsukwini ezifana nosuku lokukhwehlela nokukhwehlela. Ngesikhathi sokuphumula, ukucubungula kwesisu, kungakhathaliseki ukuthi ukukhwabanisa okukhulu kwendabuko noma ukucutshungulwa okuncane kwe-laparoscopic, kufanele kubanjwe ngesandla noma ngomcamelo ngenkathi kuhlambalaza nokukhwehlela ukusiza ukuvimbela izinkinga.
Izingozi ze-Gastrectomy
Ngaphezu kwezingozi ze-anesthesia kanye nezingozi ezijwayelekile zokuhlinzwa , inqubo ye-gastrectomy inezingozi ezengeziwe okumelwe zicatshangelwe lapho kuvulwa ukuhlinzwa. Lezi zingozi kumele zilinganiswe ngengozi yokungalaleli. Isibonelo, isiguli esitshelwe ukuthi sidinga i-gastrectomy eyingxenye ngenxa yezilonda eziphaphazayo kufanele ibeke ingozi yokuba nezilonda eziqhubeka ziphuma ezinkingeni ezikhona lapho zenziwa ukuhlinzwa ukulungisa inkinga. Ezinye zalezi zingozi zihlanganisa:
- Ukwehla: Njengokuhlinza okuningi, kuhlale kunengozi yokuphuma. Le ngozi ingaphezulu kwezigameko zomzimba ezibhekene nokuhlinzwa ngenxa yokugaya emgodleni wokugaya.
- Ukwelashwa: Kungenzeka ukuthi ukutheleleka kuzokwenzeka ngemuva kwalokhu kulandelwa, ekuhlosweni kwesisu noma ekuguleni komzimba ngokwawo.
- Ukuhamba: Kukhona ithuba lokuthi umugqa we-suture lapho isisu sithunjiswe emuva ndawonye sizovuza. Lokhu kungaba yinkimbinkimbi enzima njengoba okuqukethwe okwe-acid nesisu akukona nje ukuthi kubangele ukutheleleka okukhulu, kodwa ukuvuza kwezinto kule esiswini kuyodabukisa kakhulu izicubu eziseduze.
- Ukuxoshwa nokucabangela: Lokhu kuyinkimbinkimbi enkulu lapho ukubhekwa kokuhlinzwa kuvula khona futhi kungavumela izitho zangasese ukuba zizame ukuphuma emzimbeni ngokusebenzisa lokho okushiwo. Kungavimbela ukuvimbela ukucabangela lapho becindezeleka, njengesikhathi sokukhipha.
- Ukuncipha Ukwehlisa: Ezinye iziguli zinenkinga yokuncika insimbi nezinye izakhi ekudleni kwazo emva kwenqubo futhi zizodinga ukwesekwa.
- Ukuntuleka Kwe-Iron Anemia: Ngenxa yokunciphisa ukungena kwensimbi, ezinye iziguli ziba ne-anemic. I-iron iyisakhiwo esibalulekile segazi, ngaphandle kwensimbi umzimba awukwazi ukwakha amangqamuzana egazi futhi umphumela ngokuhamba kwesikhathi i-anemia.
- Ukunqunywa: Ukunciphisa isifo ngenxa yesikhumba esibucayi esikhungweni sokuhlinzeka, le nkinga ingenza kube nzima ukugwinya ukudla ngaphandle kokuthi "kunamathele" phakathi komphimbo nesisu.
- I-Nausea ne-Vomiting
- I-Dumping Syndrome: Ukunciphisa ikhono lokugaya ushukela / ama-carbohydrate alula kungaholela ekudleni "kokulahla" kusukela esiswini kuya kwi-duodenum ngokushesha, okuholela ekwehleni, ukuhuda, ukuzwa ukuphelelwa amandla, ukukhukhuma okubandayo, ukucwenga, kanye nokuqhafaza.
Izwi elivela
Inqubo ye-gastrectomy iyinkimbinkimbi enkulu, kodwa ngokuvamile iyimpumelelo kakhulu ekuphatheni izifo eziningi ezinzima zokugaya. Kubuye kubhekwe ukuhlinzwa okuphephile kakhulu. Inqubo ingabangela ukuhlala esibhedlela ngesonto noma ngaphezulu, kodwa iziguli eziningi ekugcineni zikwazi ukubuyela ekuphileni kwazo okujwayelekile-nokudla okuthandayo-emva kwenqubo.
> Umthombo:
> I-Gastrectomy. I-MedlinePlus. Ifinyelele ngo-Okthoba, 2017. https://medlineplus.gov/ency/article/002945.htm