Mune Zvose, J-Pouch Surgery Inowanzoshandiswa Kubata Ulcerative Colitis
Ileoanal pouch anal anastomosis (IPAA) -nokuti sezvo inowanzozivikanwa, j-pouch chirurgical -has inoshandiswa rudzi rwekuvhiyiwa kwevanhu vakawanda vane ulcerative colitis uye vanoda kuvhiyiwa. Iyi nzira yekuvhiya inogona kuitirwawo mhuri yemadenomatous polyposis (FAP) kana zvimwe zviitiko zvekurwisa kenza . Zvisinei, kune vanhu vanoonekwa vane imwe nzira yezvokuvhiringidza zvirwere (IBD) , Crohn's disease, j-poch haigoni kufungidzirwa sarudzo yakakodzera.
Chii Chinonzi J-Pouch?
Kuvhiya kweJ-pouch kunowanzoitirwa vanhu vane chirwere chekuonda chirwere chepfungwa kana apo kurapwa kwechiremba kunokundikana uye zviratidzo zvisingagoneki, kana apo kune hutano husati hwava nekenza mumakoloni (mumatumbo makuru) . Mune imwe nhamba yevanhu vane ulcerative colitis, mishonga inowanikwa mukurapa IBD inogona kusabatsiri pakuvhura kuregererwa kana nekudzivirira zviratidzo, uye hupenyu hwehupenyu hungave husina hurombo zvokuti upiyona hunoonekwa. Vanhu vane chirwere chepachirwere chepachirwere vari pangozi yakawanda yekuva nekenza yekoloni, uye kubviswa kwekoloni kunowanzokurudzirwa kana zviitiko zvebiopsy zvichibva kuratidzwa kwekoloni musati wave nekenza kana kenza.
Mukuvhiya kwe-j-pouch, koni yacho inobviswa, pamwechete nechikamu kana yese rectum . Chikamu chekupedzisira chemukati madiki chinoshandiswa kuita chikwama-kazhinji chiri muchimiro che "J," asi "S" uye "W" maitiro zvinowanzoitwawo. Ihomwe iyo inogadzirwa kubva mumucheche muduku zvino inosangana ne anus (kana rectum, kana pane imwe yakasara), iyo inoita kuti kubviswa kwechigaro kuwedzere "zvakajairika." Kuvhiyiwa kunowanzoitwa mumatanho maviri, asi kunogona kuitwawo mune imwe nhanhatu kana zvitatu.
Nei Hachiri Kuvhiya Uku Kunowanzoitwa Nezvirwere zveCrohn?
Ne ulcerative colitis, chirwere chacho, uye kurwisana kunobatanidzwa, iri mukati mumukumbo mukuru. Kubvisa hutumbu hukuru, asi isiri mushonga weBD, inobvisa chirwere chinonyanya kubata nehosha. NeCrohn's disease, chero chikamu chekudya chekudya chingakanganisa nekuputika uye kunyange kana hutumbu hukuru hubviswa, chirwere cheCrohn chinogona kudzokazve.
Ichokwadi, nzvimbo dzakanyanya kufanana nekuputika kune vanhu vane Crohn's disease ndiyo yeukisi uye mumatumbo makuru. The ileum ndiyo chikamu chekupedzisira chemukati mudumbu, uye chikamu chinoshandiswa kuita chikwama muUpayA. Chirevo chepakutanga ndechokuti, kana chirwere cheCrohn chinokanganisa chikwama, chikwama chinogona "kutadza" uye pakupedzisira chinofanira kubviswa. Kunewo varwere vakamboonekwa kuti vane ulcerative colitis, vane chirwere chej-pouch, uye gare gare vane chirwere chinoshandurwa kuCrohn's disease (kunyange izvi zvisingawanzoitiki).
Zvisinei, zvidzidzo pamusoro pej-chikwata muvanhu vane chirwere cheCrohn vakave nemigumisiro yakavhenganiswa. Zvimwe zvidzidzo zvinoratidza kuti vakawanda sehafu yevarwere vane chirwere cheCrohn uye j-pouch vane ruzivo rwakakundikana uye vanoda kuve nekuvhiyiwa kwakawanda kuti vabvise iyo uye kugadzira ileostomy nokusingaperi . Asi zvimwe zvidzidzo zvinoratidza kuti vamwe varwere vakasarudzwa vakasarudzwa nemhando dzakasiyana dzeCrohn's disease vanogona kukwanisa kushivirira chirwere chej-pouch. Nekuuya kwehupenyu hwehupenyu hweBD (dzakadaro Remicade , Humira , Cimzia , Tysabri, uye Entyvio), vanhu vane chirwere cheCrohn vane zvirongwa zvakawanda zvokurapa kupfuura kare.
Saka, IPAA HAIYE YAKAMBIRWA MUMWE MHURI YOKUTAURA KWAVANHU?
Sezvo nehuzhinji zvinhu maererano neBD, pane zvakasiyana.
Parizvino kune nharo pakati pevatungamiri vemaonero makuru kana kana kwete vamwe varwere vane chirwere cheCrohn vanogona kugamuchira j-poch uye vanoita zvakanaka nazvo. Kune dzimwe mamiriro evanhu vanoongororwa vane Crohn's colitis kana indeterminate colitis avo vakawana chirwere chej-pouch. Zvisinei, kune ngozi yakakura yezvinetso uye zvinokonzera kukanganisa kwechikwama muboka iri revarwere. Pakave pasina kuongororwa kusina kuongororwa pamusoro pej-pouch muvarwere veCrohn's disease vanogona kupa uchapupu hwakakwana hwekupedza gakava neimwe nzira kana imwe.
Sezvimwe nezvimwe nyaya dzakawanda dzakakavhiringidzika muBD, hapana zano rakaratidzwa kuva rakakwirira.
Chero chisarudzo chekugadzira j-pouch yevarwere vane chirwere cheCrohn chinofanira kungoshandiswa nemakwikwi ezvidzidzo kumatunhu ekudzidzira kwepamusoro ane ruzivo rwakanyanya uye ruzivo mukurapa IBD.
Sources:
Braveman JM, Schoetz DJ Jr, Marcello PW, Roberts PL, Coller JA, Murray JJ, Rusin LC. "Kuitika kwechikwata cheleal muvarwere vari kuwedzera chirwere cheCrohn." Dis Colon Rectum . 2004 Oct; 47 (10): 1613-1619.
Brown CJ, Maclean AR, Cohen Z, Macrae HM, O'Connor BI, McLeod RS. "Chirwere cheCrohn uye indeterminate colitis uye chikwata che-ileal-anal anastomosis: mitsva uye maitiro ekukundikana." Dis Colon Rectum . 2005 Aug; 48 (8): 1542-1549.
Joyce MR, Fazio VW. "Ko leal poch anal anastomosis ingashandiswa muCrohn's disease here?" Adv Surg . 2009; 43: 111-137.