Kunzwisisa nzira yeJ-Pouch uye Zvimwe Zvinetso
Iyo yeal poch anal anastamosis (IPAA), iyo inowanzozivikanwa seJ-Pouch nzira, chirwere chakaoma chokurapa zvirwere zvakakomba kana kukuvadza kunokonzera mumukaka mukuru (colon). Iyi nzira yakagadzirirwa kubvisa tema yakaora yekoloni uye inobvumira murwere kuti arambe achiita "kufamba" kwemafuro, zvichireva chigadziko chinosiya mumuviri kuburikidza ne anus.
Munguva yeJ-Pouch chirongwa-kana kazhinji kazhinji maitiro-iyo koni inobviswa uye chirwere chiduku chinovakwazve kuti chibvumire chibato kuti chibude mumuviri kuburikidza ne anus nenzira yakarongeka.
A J-Pouch NeZimwe Zita Rimwe
Iyi nzira, kana boka remitemo, rine mazita mazhinji zvichienderana nechetatu rekuvhiyiwa uye nyika iyo ichaitwa. Mukuwedzera kune yeal pouch anal anastamosis, iyo nzira inozivikanwawo seJ-pouch , ileo-anal pouch, ileo-anal reservoir (IAR), mukati mehomwe, kudzorera proctocolectomy, ileal-anal pullthrough, Kock chikwama, kana ileostomy takedown.
Chikonzero nei chirwere cheJ-Pouch Chichiitwa
Iyi nzira inoitwa nokuda kwezvikonzero zviviri: Chironi chinorwara uye / kana chakavhiringidzika uye chinofanira kubviswa, uye murwere haadi ialeostomy. Kune vakawanda, mboni inorwara zvokuti hupenyu hwavo huri kuparadzwa nekugara kwehara. Hazvishamisi kunzwa nezvevarwere vane chirwere chakanyanya kuputika chirwere chinenge chiine 25 kana kupfuura mamwe mazamu masikati pazuva.
Varwere ivavo vanowanzokwanisa kubva mumba nekuda kwekushaya njodzi pamusana pekudzivirira kwavo kusingadzorwi kunowanzosangana nemarwadzo, uye dzimwe nguva ropa muhangu.
Ileostomy inotsanangurwa
I- ileostomy inoshandiswa pakuvhima yemukati makuru iyo inoitwa nekuparadzanisa kuguma kwemukati mudumbu kubva pakutanga kwemuviri mudumbu uye kubvumira kuguma kwemukati mudumbu kune kunze kwemuviri.
Izvi zvinoitwa nekuita kudhakwa kwechidiki mudumbu nekugadzira kubuda kwechigaro. Iyi incision inobva yakafukidzwa nemushandisi, bhegi rakagadzirwa nemakateti anobvumira kuti iomerera paganda, uye chigaro chinounganidzwa muhomwe.
Vanhu vazhinji havafariri kuva neostomy kwenguva refu. Nepo zvakakosha kupfuudza colon kana kubvisa colon mune dzimwe nguva, varwere vanowanzoda imwe nzira yekufanira kupfekedza chigadzirwa. Varwere vanowanzonyunyutira kuti chigadzirwa chacho hachina kutarisa, chinonhuwira, chinovhiringidza hukama hwepabonde, chinogumbura ganda kana kazhinji chinogumbura.
Ndiani Akasarudzirwa J-Pouch Surgery
Mumwe chirwere chechiremba chechigoni chichava chigadziro chekupedzisira chekuita kana kana kwete murwere ari mukana weJ-Pouch chirongwa. Chisarudzo ichocho chichave chakavakirwa pane zvinhu zvakawanda, kusanganisira zvinotevera:
- Utano hwakakwana hwemu murwere
- Rudzi rwechinetso mumatumbo makuru
- Kuoma kwedambudziko racho
- Chero kana kwete dambudziko rinogona kugadziriswa nekubviswa kwekoloni
- Zvichida kana kwete zviitiko zvemuitiro zvinopfuura zvingave zvingabatsira
Mamiriro ehuroni haazovi iye oga chikonzero chekuti chirwere chacho chive chikwata chekuvhiyiwa. Murwere ane chironda chakakomba chironda chisina kupindira kumishonga, ndicho chikonzero chinowanzogadziriswa chekugadzirisa, hachifaniri kuva chikwata chekuvhiyiwa nokuti vane mwoyo wemuviri unogona kuita kuti anesthesia iwedzere ngozi, kana chirwere cheshuga hachina kunaka inodzorwa.
Pakati pese, kuti ave mumiririri weJ-Pouch nzira, murwere anofanira kunge ane chirwere chakakomba chepoloni kana kukuvara. Kutambudza kungava chikonzero chekuvadzwa kunoitwa kurapwa, zvakadai sekuputika kweputi kusvika kumimba zvinokonzera kukuvadza kukuru kumutsipa mukuru. Mune mishonga, ulcerative colitis ndiyo chikonzero chinowanzovhiringidza chekugadzirisa, kenza yemukironi ndiyowo chikonzero chinowanzogadziriswa nekoloni.
Familial adenomatous polyposis, mamiriro ezvinhu anowanzotora nguva dzose kune kenza yekoloni, inowanzoita chikonzero chekuvhiya J-Pouch. Izvi zvinowanzokonzera varwere vane colon polyps panguva iyo vanosvika pakati pemakumi matatu nematatu uye vachivandudza kenza yemaroni mumakore gumi kana maviri anotevera.
Nzira yeJ-Pouch inogadziriswa zvakanaka pamberi pekuongororwa kwekenza , kwete sekurapa kwekenza.
Kurapa chirwere che Crohn chinozivikanwa-icho chakasiyana nehutachikiti mune kuti zvipembenene zvehutachiona zvinogona kuonekwa kune dzimwe nzvimbo kunze kwekoloni-ne chirwere che-J-Pouch chinokakavadzana. Izvi zvinokonzerwa nokuti zvinobvira kubvisa colon uye kugadzira J-Pouch chete kuti uwane kuti J-Pouch inoita zvirwere zvitsva zvinouraya, zvingangosiya murwere akaipa kupfuura apo pavakatanga kurapwa.
Ngozi dzeJ-Pouch Surgery
Pamusoro pezviitiko zvakakwana zvekuvhiya, kusanganisira kupindira kune anesthesia uye zvinetso zvinonyatsozivikanwa zvakadai sepneumonia kana ropa, pane zvimwe zvinokonzera izvo zvakananga ku ileostomy uye J-Pouch nzira. Zvengozi izvi zvinosanganisira:
- Kushambadzira kana kubuda: Mitsetse yomukatikati neyekunze inopinza inogona kukonzera kana kubuda mushure mekuvhiyiwa.
- Ileus: Ichi ndicho chinetso apo mushambo kufamba kwemukati (peristalsis) inomira mushure mokunge anesthesia. Muzviitiko zvakawanda izvi zvinogadzirisa mumazuva anotevera kuvhiyiwa.
- Kuvhiringidzika: Apa ndipo apo kuderedza kunokonzerwa nokuvhiyiwa kana imwe dambudziko kunodzivirira kufamba kwezvokudya uye chigaro kuburikidza nehutano hwekudya.
The J-Pouch: Chii Chaicho Chaicho?
I-J-Pouch ihombodo shoma yakaumbwa kubva pamagumo emukumbo muduku kusvika mujimu J apo gumbo rinogona kumirira kusvikira yava nguva yekufamba kwechirwere. Sezvakaita rectum, iyo inobviswa panguva yekufamba, musikana J-Pouch haangogone kuchengeta chigaro kusvikira yava nguva yekufamba kwechirwere, asi murwere ane zvimwe kana kutonga zvachose nguva yekufamba kwechirwere. Munzira dzakawanda, J-Pouch is rectum yakasikwa yakagadzirwa iyo inopedza kukosha kweiyoostomy.
J-Pouch Steps: 1, 2 uye Maybe 3
Nzira yeJ-Pouch inowanzogadzirirwa kuitwa mumatanho maviri, kureva kuti kuvhiyiwa kwakasiyana kunenge kuchiitwa, kazhinji kwemwedzi miviri kusvika ku3. Kazhinji, danho rokutanga rinosanganisira kubviswa kwekoloni, kuumbwa kweleostomy, uye kusikwa kweJ-Pouch. Panguva ino, hutumbu hudiki hwakakonzerwa kubva mumukati mukuru, saka chigaro chinobuda mumuviri kuburikidza nenzvimbo yeoostomy.
Kwemwedzi inoverengeka inotevera J-Pouch ichangobva kuumbwa inobvumirwa kurapa nekusimbisa. Kana imwe J-Pouch ichiporeswa uye murwere akagadzirira chirwere chinowedzera, imwe nzira inoshandiswa uye gumbo rinotanga kufamba nemukomana muduku, kuJ-Pouch iyo inenge yakachengetwa, zvino inobva mumuviri kuburikidza neRectum yakaita zvisati zvaitika izvi.
Iyi nzira mbiri yekuvhiya ndiyo nzira inonyanya kushandisa nzira yeJ-Pouch inoitwa. Nzira yacho inogonawo kuitwa sechimwe chiito chekuvhiya, kureva kuti ileostomy haigoni kuitwa-iyo colon uye rectum inobviswa, J-Pouch inoumbwa uye yakabatanidzwa kune rectal stump (chikamu chiduku chinosara che rectum chiri mukati memusango ) nenzira imwecheteyo.
Mune zvimwe zviitiko, vanachiremba vanovhiya vanoita chirwere muzvikamu zvitatu, asi izvi hazvisi zvishoma. Matanho ose ehurongwa hunoitwa pasi pehuwandu hweanesthesia uye zvinowanzoguma mumazuva matatu kusvika ku7 zvechipatara kugara, zvichienderana nehuwandu hwezvikamu zvakaitwa uye hutano hwehutano.
J-Pouch Procedure Video
Aya maitiro akaoma uye akaoma kunzwisisa zvechokwadi kunze kwekuona zvinobatsira. Nokuda kwechikonzero ichocho, Crohn's naColitis Foundation yakagadzira vhidhiyo ino kuti ijekese zvakajeka nzira yeJ-Pouch.
Zvaunotarisira Pashure peJ-Pouch Surgery
Mushure mokuvhiyiwa kweJ-Pouch kwapera, inogona kuva mwedzi yakawanda usati wawana "itsva" yako yekutenderera. Kazhinji mushure mokuvhiyiwa kwe-J-Pouch hazvireve kuti zvinowanzoitika nemaitiro akaenzana emunhu wepakati pekuti ndeizvi: kufamba kwepamuviri kunotungamirirwa (kwete pangozi), kamwe chete kwemazuva matatu oga oga, akaumbwa asi kwete zvakaoma, uye kwete asingarwadzi. A "chimiro" chechirwere mushure mekuvhiyiwa kwe-J-Pouch inowanzoenderana nekugadzirwa kweparori kana mbatata yakasvibiswa.
Mushure mokunge mushure mwapedza, mutevedzeri murwere anoona kushambadzira kwemashure mashanu kana matanhatu ekudzora masikati pazuva.
Kune mumwe munhu aive neropa rekuda ropa kakawandisa kazhinji pazuva, izvi zvinogona kuratidzika sekuvandudza kunoshamisa, asi kune mumwe munhu aive nekufamba kwemafupa nguva dzose uye ane nzira yekudzivirira kenza, izvi zvingave zvinotyisa uye zvinogadzirisa kuoma kwakaoma.
Muzhinji, mushure mokunge vadzoka zvakare uye mutevedzeri akadzidza kuti zvii uye zvirwere zvinogona kuita kuti J-Pouch iwedzere uye kutungamirira kusanyatsogadziriswa kwemafuro, varwere vanoratidza kugutsikana nemigumisiro yekupayirwa. Pakati pe10 ne20 muzana havagutsikani nemigumisiro yavo uye vanosarudzwa kuti vave neostomy kana imwe nzira shure kwekuitwa kweJ-Pouch.
Kune varwere vazhinji, kuwana zvikafu zvakakodzera zvekudya uye kudzivisa pamwe nekudzidza mishonga ipi inobatsira kuderedza zvirwere uye kuwedzera maronda ekufamba kwekutungamirira kunotungamirira kuhuwandu hunovandudzwa kubva kune hutachiona huripo.
Zvinonyanyozivikanwa Zvimwe Zvinetso Pashure peJ-Pouch
Kune dzakawanda zvinetso zvingangodaro mushure mekuita maitiro e-J-Pouch, zvinonzwisisika kuti vazhinji vavo vanobatwa nyore nyore kana kudziviswa. Vashandi vari muhofisi yechiremba uye chiremba chinonzi enterostomal therapy (vanachiremba vanoita basa rekuchengeta ostomy nemamwe mavanga) vanogona kuva rubatsiro runokosha kana vachiwanazve. Usanonoka kukurukura nyaya ipi neipi nevashandi vezvechiremba sezvavanenge vamboona dambudziko kare.
Ramba uchifunga kuti nyaya idzi dzinowanzovandudza mushure mekuvhiyiwa, sezvo murwere anodzidza nzira iyo muviri wavo unoshanda mushure mekuvhiyiwa uye uchidzorera zvakakwana:
- Kuderedza Kusadya Kwakakwana: Dhairrhea inowanzoitika inogona kutora mavitamini, zvicherwa, uye makoriki mashomanana anowanikwa mumuviri. Nokufamba kwenguva, varwere vakanga vasina kudya zvokudya vasati vambovhiyiwa kazhinji vanowedzera kudya zvakanakisisa kana chirwere chichingobviswa.
- Kugadziriswa: Nzvimbo dzekuvhiya, kusanganisira musana muduku, J-Pouch, uye anus inogona kuve nekuderedza kunokonzerwa nekupora. Uku kuderedza kunogona kukonzera kuvhara kwechingwa, kuoma nechikafu kana chigamba chichifamba mumugwagwa wekudya uye kunetseka nemakumbo.
- Kurapa kweganda: Chimwe chebasa rekoloni ndechokuunganidza zvakanyanya asidi kubva mumatumbo emukati. Pasina colon kuita basa iri, vamwe varwere vanoona kupisa panzvimbo ye stoma yavo kana pedo ne anus iyo inowanzonzi "butt burn". Izvi zvinogona kudzivirirwa nechigodo chezoro paganda.
- Pouchitis: Kuputika kwechikwama, chirwere ichi chinogona kuva chinorwadza uye chinowanzorapwa nemishonga miviri: Flagyl uye Cipro.
- Incontinence: Kunyange zvazvo chinangwa cheJ-Pouch ndechokubatsira murwere kuti ave mutungamiri pavanenge vachifamba mumatumbo avo, vamwe varwere vanoona kusagadzikana pavanenge vadzoka. Uwandu hwechiitiko chinonzi incontinence chinotora kupera chirongwa chekudzorera.
- Dhairrhea: Inyanzvi kutaura, chirwere chemaswere chinokwana matanhatu kana kupfuura zvigaro zvisingabatsiri pazuva, uye kune imwe iyo iyo yezvigadziro zvinosuruvara zviri nani pane yekare yepamusoro yekutonga. Kune vamwe, izvi zvakanyanya kupfuura zvakapfuura, asi mumavhiki mashomanana ekutanga kwekurambana kwemahara zvinowanzodiwa uye zvinotarisirwa. Inowanzovandudzwa nemishonga yakadai seLomotil kana Immodium pamwe nekuchinja kwezvokudya. Zvokudya zvakaoma uye zvakasviba, zvakadai semapatata uye pasta, zvinogona kubatsira kusimbisa chigaro. Bika chirwere chinoramba chichienderera kune chiremba wako.
- Kusagadzikana kwemhepo: Kurwiswa kwemafupa kakawanda kunogona kutungamirira pakupera mvura, saka chirwere chinokonzerwa nehutachiwana chinofanira kutaridzirwa uye kuwedzerwa kwemvura kunowedzera kana kushaya mvura kuchipo. Kuderedza mvura kunogona kutongerwa zvakanakisisa kumba kumba kwemuti. Mumuzi werima unoratidza kuwedzera kwechidikanwi chekunyorova, asi chakanaka uye chinenge chisina muto chisina ruvara chinoratidza hydration yakakwana. Dzokorora kuderera kune chiremba wako.
- Low Sodium: Sodium inogona kurasikirwa nehara, uye inofanira kushandurwa ne electrolyte-ine mvura yakadai seGatorade kana Pedialyte. Sodium sodium inowanzoongororwa nehuro yekuongorora, saka iva nechokwadi kuti chiremba wako anoziva kana iwe unowanikwa une sodium yakaderera.
- Vachivharasi Vashoma: Ichi chikamu chematachiona chinowanikwa mukati kana pedyo neJ-Pouch site uye chinoda kurapwa uye kunogona kurapwa.
- Kuvhiringidza zvepabonde: Erectile dysfunction ingozi inozivikanwa yehutano hwevarume. Kumadzimai, kusununguka nekuda kwekuvhara mazamu omukati chinhu chinozivikanwa chinokonzera kusangana, sekurwadziwa kwepabonde.
- Crohn's Mushure meJ-Pouch: Kusiyana pakati peCrohn's and colitis ndechekuti chirwere cheCrohn chinogona kuitika chero kupi zvayo mumugwagwa wezvokudya apo chirwere chinokwana kumutsipa mukuru. Kana zvipembenene zveCrohn zvinowanikwa mumakoloni vasati vavhiyiwa, zvinogona kuonekwa kuti seviritis, kuti vawane kuti zvipembenene zvinowanikwa mune dzimwe nzvimbo mushure mekuvhiyiwa. Izvi zvinogona kutungamirira kune J-Pouch ine zvipembenene zvekuonda.
- Zvokudya Zviduku: Vamwe vanhu vane J-Pouches vanoona kuti vanogona kungobvumira kudya zviduku zvishoma panzvimbo yezvokudya zvitatu zvemasikati pazuva.
- "Zvinowanzoitika Matambudziko": Matambudziko anowanzosangana nevanhu vakawanda, zvakadai sekunyengera, anotowedzera kuipa neJ-Pouch. Zvokudya izvo zvinowanzokonzera gesi zvinogona kukonzera gasi yakawanda kana gasi zvinotyisa kupfuura zvingadai zvambova kuvhiyiwa. Ichi ndicho chiitiko chechiitiko chemuitiro wacho, uye hachigoni kugadzirisa mushure mokunge kupora kwapera.
- Chido cheOstomy: Muzviitiko zvakakomba apo incontinence inoramba iri nyaya, J-Pouch haisi yeutano kana isiri kushanda, kana murwere asina kugutsikana, neostomy ndiyo kurapa kusarudzwa.
- Kuberekwa: Kuomeswa kwe fetus mumapanga, umo J-Pouch inosara, kunogona kukonzera dambudziko nekufamba kwemuviri uye kubatana. Vose vari chirwere chechiremba uye chiremba anozoita basa mukubatsira amai vane pamuviri kuti vave nesimba rakanakisisa rinogona kuitika mukati mekutanga kwemazana matatu, apo dambudziko iri ndiro rinokosha kwazvo, uye kusarudza nzira yakanakisisa yekuendesa.
Shoko Rinobva
Iyi nzira yakaoma uye yakaoma, iyo inongowanikwa kuvarwere avo vari kurwara zvikuru kana vachitarisira kudzivisa mhuri yakasimba nhoroondo yekenza yekoloni. Chisarudzo chekuti chirwere che-J-Pouch hachifaniri kutorwa zvishoma uye chinofanira kuitwa chete mushure mokuwana chiremba wechiremba anoita maitiro aya pane chiitiko uye mushure mekunge uine hurukuro yakadzika pamusoro pengozi uye mimwe mikomborero yekuvhiyiwa.
> Sources:
> Murwere uye Mhuri Mutungamiri we Ileal J-Pouch Anal Anastamosis (IPAA) Kuvhiya. University of Pennsylvania Health System Chikamu cheColon uye Rectal Surgery. http://www.uphs.upenn.edu/surgery/clinical/colon_rectal/ostomy/ileal_j_pouch_surgery.pdf
> Total proctocolectomy uye ileal-anal pouch. Medline Plus. https://medlineplus.gov/ency/article/007380.htm