Mhando dzakasiyana dzeGastrectomy Procedures
Kuongorora kwepfungwa ndeye nzira yekuvhiya iyo inobvisa, kana zvishoma, chikamu chemuviri. Kune mhando dzakawanda dzekugadzirisa, izvo zvinopesana nekuwanda kwemuviri uye dumbu dzakapoteredza zvakabviswa panguva yekuitwa.
The Esophagus, Stomach, uye Duodenum
Kuti unzwisise zviri nani maitiro akasiyana ekugadzirisa maitiro, zvakakosha kunzwisisa chirwere chemuviri uye zvakapoteredza mishonga.
Vanhu vazhinji vanonzwisisa dumbu uye kuti rinoshanda sei, asi ivo vashoma vanoziva nhengo dzakapoteredza uye maviri.
Kana munhu achidya zvokudya, chirongwa chekudya chinotanga nekutanga kuruma. Meno acho anobatsira kuruma kana kubvarura zvokudya muzvidimbu zviduku, zvino kutsvaira kunowedzera kuvhara zvokudya kusvika kune mamwe anochengetedza chunks. Salivha ine inyemisi inokonzera kudya inotanga zvakare kumakemikari kuputsa zvokudya, asi mazino anoita huwandu hwebasa iri panguva ino mukugadzirisa. Kucheka, zvichienderana nekureba kwenguva yakaita sei uye zvakanyatsoitwa sei, zvinogona kutora steak yakaoma uye inoita kuti ive nyanzvi yakanaka. Kana chikafu chikachekwa zvakanaka, kumedza kunofambisa zvokudya kubva mumuromo kusvika mumutsipa. Mhope inotungamirira chikafu muhombodo.
Inophagus ibhuti rinobatanidza huroti kusvika mudumbu, uye rinobvumira kutsvaga zvokudya kuti zvishoma nezvishoma zviende mudumbu mushure mokunge imwe mhombwe. Pakati peesophagus uye mudumbu ndeye mutsara we sphincter unogona kuzarura nekuvhara, uchibvumira kuti zvokudya zvifambe mukati mudumbu, asi kuzvidzivirira kubva pakudenga mudumbu.
Dumbu rinowedzera asidi kuzvokudya, uye rinoshungurudza chikafu chacho kuti chirambe chichiita chirongwa chekudya. Mushure mokunge dumbu racho rapedza chikamu chayo chekudya, chirwere cheplincter, musumbu uri pasi pemudumbu, unovhura uye unovhara kuti zvibvumira kudya zvishoma nezvishoma kubva mudumbu uye kusvika muchikamu chekutanga chemukati mudumbu.
Ichi chikamu chemukati mudumbu chinonzi duodenum.
Mhando dzeGastrectomy
Mhando dzakasiyana dzegastrectomy ndeyotevera:
- Nzira yepamusoro: Iyi inzira yekugadzirisa iyo chikamu chepasi chemukati chakabviswa.
- Sleeve gastrectomy: Iyi nzira inoshandura chirwere inobvisa kuruboshwe rwemudumbu.
- Esophagogastrectomy : Mushonga wokuvhiya uko kumusoro kwemukati, chirwere chemwoyo chinonzi sphincter, uye chikamu chesophagus chakabviswa.
- Zvose kugadziriswa: Zvose zvemudumbu zvinobviswa mune chirongwa ichi chokuvhiya. Zvikamu zveeophagus uye duodenum zvinogonawo kubviswa.
Zvikonzero zveGastrectomy
Pane zvikonzero zvakawanda nei chikonzero chekugadzirisa chinogona kuitwa. Chimiro chechinetso chichatora rudzi rwekugadzirisa kwemaitiro, uye kuti zviyero zvakadini zvinofanira kubviswa. Nenzira yakawanda, apo inorapa zvirwere zvekudya, kuedza kunoitwa kuti kuderedze huwandu hwemasukisi akabviswa, kuchengetedza mhando dzakawanda dzakanaka sezvinobvira paunenge uchibvisa mhuka dzakaipa.
Kuwedzera muviri
Munguva yakapfuura, chirwere chegastrectomy chakaitwa kuitira kurapa chirwere kana chirwere chinokonzera mudumbu. Kurasikirwa kwehuremu kwaifungidzirwa sechinhu chinokonzera, kana chikonzero, pashure pokurapwa kwechimwe chirwere.
Mumakore achangopfuura, gastrectomy yakashandiswa sekuvhiyiwa kweBaratric, iyo inorapwa nzira yekurapa kuneta.
Kune vanhu vakaoma, kuderedza ukuru hwemuviri kunogona kutungamirira kukura kunoshamisa kwehuwandu hwehutano hwemuviri. Kusiyana nekuvhiyiwa kuora muviri, sleeve gastrectomy varwere vari pangozi yakaderera yekushaya zvokudya zvinovaka muviri nekuda kwekusava nekunwa kwezvinhu zvinovaka muviri, asi vachikwanisa kukonzera mazana emadhora akawanda.
Kusiyana nedzimwe mhando dzokugadzirisa zvinoda kuchengetedza mishonga ine utano sezvinobvira, apo kugadzirisa kwemaslee kunoshandiswa kuitira chinangwa chokurasikirwa, kune hutano huno hutano hunobviswa kuti huderedze zvakanyanya kukwanisa kwomurwere kwekudya.
Izvi zvinoita kuti murwere achinzwa azere nechingwa zvishoma, uyewo zvinotungamirira kukurasikirwa kweuviri.
Zvironda: Peptic ulcers , kana zvironda zvinoumba mudumbu, esophagus kana duodenum, zvinogona kukonzera kurwadziwa kukuru uye kubuda ropa. Kune vamwe varwere, pane kurasikirwa kuduku asi kusingagumi kunogona kukonzera kuenderera mberi kweanemia. Kune vamwe, kubuda ropa zvose zvakangoerekana zvaitika uye zvinokurumidzira, zvinoda kutarisirwa nokukurumidza. Zvironda zvinowanzotanga kuongororwa apo murwere anotsvaka kuongororwa kwemarwadzo emimba. An esophagogroduodenoscopy (EGD) , inozivikanwawo seUpper GI, inowanzoitwa ichiita kuti chiremba aone mukati memudumbu kuitira kuti kuongororwa kunogona kuitwa.
Kusava nemhosva hakusi kazhinji chisarudzo chekutanga chekurapa kwezvironda. Zvichienderana nerudzi rwechirwere, mishonga inogona kuva yekutanga yekurapa, inoteverwa nedzimwe nzira dzekuregera kubuda ropa rakadai sejekisi ye epinephrine, kana kuti nzira inobatsira iyo inoshandisa kupisa kuvhara ropa. Iko apo apo marudzi aya emishonga anokundikana kuporesa zvipembenene kana kukundikana kumira kubuda ropa kwokuti kugadzirisa kunowanzoonekwa.
Tumor
Zvironda zvinouraya uye zvisingava nekenza zvinogona kuitika mudumbu. Kana zvikaitika, uye nzira shoma dzisingabviri dzokubvisa maronda hazvibudiriri kana kuti hazvibviri kutungamirira kumugumo unoda, gastrectomy inogona kuonekwa. Nhamba, ukuru, uye nzvimbo yemarara (s) inobatsira kuziva kuti chikamu chipi chemuviri, chirwere, uye duodenum chinofanira kubviswa.
Bleeding
Kunyange zvazvo zvipembenene zvipembenene zvinowanzokonzera kubuda ropa mudumbu, kune mamwe marudzi ezvinetso zvinogonawo kutungamirira kubuda ropa. Chimwe chezvinyanya kukosha nderopa iyo mudziyo weropa uri pamusoro pezvisikwa mukati memukati wemagetsi, iyo inonzi angioectasia. Iyo inozivikanwawo seyikuita maitiro asina kunaka, kana AVMs, rudzi urwu rwemajeri eropa rukuru runogona kukonzera kubuda ropa.
Pamberi peGastrectomy
Usati wagadzirisa chirwere ichi, murwere achadikanwa kudya kana kunwa kwemaawa matanhatu kana kupfuura mukugadzirira kuvhiyiwa. Zvakakodzera, zvokudya zvose uye mvura inenge ichida kubuda kubva mudumbu kuitira nzira, saka murwere haazodyi mushure mekudya kwemanheru zuva risati rapera chirwere. Kune varwere vane chirwere chinononoka chekudya, kushandura zvinodhaka zvinogona kuva chinhu chimwe chete chinotorwa nemuromo zuva risati rasvika kuwedzera mukana wekuti dumbu richave risina chinhu zvachose.
Panguva yeGastrectomy
Iko gastrectomy inotanga nehukuru anesthesia , kuti ave nechokwadi chokuti murwere haatauri kurwadziwa uye anoramba asina zivo panguva yekuvhiyiwa. Kana mumwe murwere akangogara, akave akaiswa mukati uye akaiswa pamhepo, chirwere chinogona kutanga.
Nzira yekuita gastrectomy inogona kuitwa mune imwe yenzira mbiri: iyo tsika inowanikwa apo kuvharwa kukuru kunowanikwa pamimba, kana kuti mutsva mutsva inenge isina kuvhiringidzika apo zviduku zviduku zvinosanganisira kuvharwa mumubhomba mudumbu zvinoitwa, uye chiremba anovhiya anoshandisa zviduku kamera inopindirwa mune chimwe chezvakagadzirirwa kutarisa kuvhiyiwa pane chekuona.
Imwe nguva iyo midziyo iri panzvimbo, chikamu chakakosha chemuviri chinodzwa uye chakasimbiswa pamwe chete. Nokuda kwekugadzirisa kwese, uko kwese dumbu rinobviswa, sophagus inosangana ne duodenum. Kana chikamu chemuviri chakabviswa mitsara inogona kuvharwa zvakare pamwe chete kuti iite yose, asi duku, mudumbu.
Kana chiremba wacho achangopedza chirongwa chacho, zvigadzirwa zvinobviswa, kusanganisa (s) kwakavharwa, uye anesthesia inomiswa kuitira kuti murwere arambe achimuka. Kana mumwe murwere atanga kumuka, bhubu rinofema rinogona kubviswa kuitira kuti murwere atange kufema ari oga asina ventilator.
Kuwanazve Pashure peGastrectomy
Nzira yekugadzirisa mushure mekugadzirisa chirwere ichi inowanzotarisa kunonokazve kudyidzana kwekudya mukati mokudya. Zvakanaka, zviyo zvichave zvakanyatsoritswa pamwe nekudengenyeka mudumbu, asi varwere vazhinji vanoda kudzoka zvishoma nezvishoma kudya kwavo kwemazuva ose uye panguva iyo vanogona kuona kuti havagoni kubvumira zvimwe zvezvokudya zvavo zvavanofarira. Vazhinji varwere vacharamba nekutengesa kudya kwakachena uye vanofambira mberi zvakaoma kugadzira zvokudya sezvavanogona. Varwere vane sleeve gastrectomy yokurema kuve nekuita chirongwa chakaoma chekudya chinopiwa nechiremba wavo chiremba kuti vawedzere kushama kwavo.
Kune vamwe varwere, pangangodaro kune bhuti inonzi nasogastric tube inowanikwa panguva yekuvhiyiwa. Iyi tube inowanikwa mumhino, pasi pasi, uye mudumbu. Izvi zvinobvumira vashandi kubvisa chero gastric fluid iyo inogona kuvaka, iyo inogona kubatsira kuderedza kushungurudza uye kudzivisa kurutsa. Iyi tube inowanzobviswa apo murwere ari nani zvakakwana kubvumira zvose zvokudya uye mvura.
Izvo chirwere chekuita chirwere chisina kumira zvakanyanya uye varwere vazhinji vanoda imwe mhando yemishonga inorwadza panguva yekudzorera. Madzimai ekufungisisa anowanzonyorova, uye anogona kugumbuka nemazuva mashoma kusvika zuva zvakadai sekuchera uye kukwezva. Munguva yekudzikinura nguva, kubata kwepamuviri, zvisinei kuti ndeyetsika yakakura yekudzikamisa kana zviduku zvishoma zveparparcopi, inofanira kusungirirwa neruoko kana mutsamiro panguva yekunyorova uye kukwegura kubatsira kudzivirira matambudziko.
Ngozi dzeGastrectomy
Mukuwedzera kune njodzi dzeanesthesia uye njodzi dzakawanda dzekuvhiya , chirongwa chegastrectomy chinowedzera njodzi dzinofanira kuonekwa kana chirwere chinorudzirwa. Izvi njodzi dzinofanira kuyerwa pamusoro pengozi yekusaenderera mberi. Semuenzaniso, murwere akaudzwa kuti vanoda chikamu chisina kukodzera pamusana pekuchenesa maronda anozofanira kuisa njodzi yekuve nemaronda anoramba achiyerera kune zvinetso zviripo paanovhiyiwa kugadzirisa dambudziko racho. Zvimwe zvezvinetso izvi zvinosanganisira:
- Kusvinura: Kufanana nekuvhiya kukuru, kune nguva dzose njodzi yekubuda ropa. Iyi njodzi inowedzera mukurapa kwevarwere vari kuvhiyiwa nekuda kwekubuda ropa mumugwagwa wekudya.
- Utachiona: Zvinogona kuti utachiona huchaitika mushure mekuita izvi, muchikamu chemuviri kana muchikamu chekudya.
- Kusvetuka: Kune mukana wekuti suture line apo dumbu rinenge rakasimbiswa pamwe chete richaita. Izvi zvinogona kuva nharo yakakomba sezvo kusvibiswa kweAidhi uye mudumbu mukati maro hakungoiti kukanganisa utachiona hwehutachiwana, asi kubuda kwezvinhu izvi mumimba kuchava kunotsamwisa zvikuru kumatavi ari pedyo.
- Dehiscence uye Kufungidzira: Ichi chinetso chakakomba zvikuru apo kushandiswa kunoitwa pachena kunogona kuzarura uye kunogona kubvumira nhengo dzemaviri kuti dziedze kubuda mumuviri kuburikidza nezvakaitwa. Iko inogona kudzivirirwa kuburikidza nekuputika zvinonzwisisika pavanenge vachinetseka, zvakadai munguva yekunyunyuta.
- Kupera Kunwa Kwemhepo: Vamwe varwere vane dambudziko rekugadzira simbi nemamwe mishonga kubva pane zvokudya zvavo mushure mekugadzirisa uye zvinoda kubhadhara.
- Kutadza Kwem Iron Anemia: Nemhaka yekuderedza kushandiswa kwesimbi, vamwe varwere vanoparara. Iron ndiyo inokosha yekuvakira ropa, pasina simbi muviri haukwanisi kuvaka masero eropa uye mugumisiro pane nguva inoshaiwa ropa.
- Kushungurudza: Kuvharidzira kweputi nokuda kwechivara chechivara panzvimbo yekuvhiya, izvi zvinogona kuita kuti zvive nyore kumedza kudya pasina "kunamatira" pakati pemutsipa uye mudumbu.
- Nausea uye Kuedza
- Dumping Syndrome: Kurasikirwa kwekodha yekuchera sukari / maitiro ega egahydrates kunogona kutungamirira kune "kudurura" kubva mudumbu kusvika ku duodenum nokukurumidza, zvichiita kuti kudimbuke, kurwara, kurwara, kunzwa kupera, kutonhora kunotonhora, kushungurudza, uye kubvisa.
Shoko Rinobva
Kuita gastrectomy chirongwa chikuru chirwere, asi kazhinji chinonyanya kubudirira pakurapa zvirwere zvakawanda zvakakomba zvekudya. Inofanirwawo kuonekwa sekuvhiyiwa kwakachengeteka. Nzira iyi inogona kuita kuti chipatara chigare kwevhiki kana kupfuura, asi varwere vakawanda vanogona kudzokera kuhupenyu hwavo hwemazuva ose-uye zvekudya zvinodiwa-mushure mekuita.
> Kwakabva:
> Gastrectomy. MedlinePlus. Yakasvika muna Gumiguru, 2017. https://medlineplus.gov/ency/article/002945.htm