Mhando dzakasiyana-siyana dzekuvhiya dzinoshandiswa kurapa chirwere chinoputika chirwere (IBD) . Imwe nzira yokuvhiya iyo dzimwe nguva inoshandiswa ndiyo kubviswa kwe rectum (iyo inonzi iprotectomy) uye anus. Kana zvose zvezvivako zvabviswa, imwe nzira ichadikanwa kuti chigaro chibve kubva mumuviri. Kana yose yekoloni yakabviswawo (inonzi colectomy ), kana panguva imwe chete seproctectomy kana kuti, yeoostomy ichadiwa.
Kune vanhu vane Crohn's disease uye ulcerative colitis, chimiro che ileostomy chinonzi yekupedzisira ileostomy ndiyo inowanzoitwa. Iyi ndiyo apo chikamu chemukati mutsva chinounzwa kuburikidza nedumbu, kunze kwemuviri, kugadzira izvo zvinonzi stoma. Chikwata cheputi chinoputika pamusoro pe stoma kuti chiunganidze chigaro uye chinodururwa kakawanda pazuva kana zvichidiwa.
Kuvhiyiwa kweproctectomy kunogonawo kushandiswa kurapa kenza yemakwenzi asi ino ino ichakurukura kuvhiyiwa sezvo inoshanda kune IBD uye pamwe chete nekubvisa anus. Iro rectum, kana kuti yakawanda ye rectum, inobviswawo panguva yekuvhiyiwa kwej-pouch (ileoanal pouch anastomosis, kana IPAA) , iyo inowanzoitwa chete nevarwere vane chironda chekuonda. Kune ava varwere, anus inosara munzvimbo uye chikamu chekupedzisira chemukati mudumbu chakaitwa muurongwa unobata chigaro, sekuita rectum.
Apo iyo anus inobviswawo, iyo nzvimbo yemuviri inobva yavharwa kuvhiyiwa.
Vamwe vanhu vari munharaunda yeBD vanotaura izvi sevari ne "Barbie butt" -kudaidzwa kune vamwe vanhu iyo inovayeuchidza pasi podhori, iyo (pachena) haina chimiro chekurega chigadziko.
A proctectomy chirwere chikuru, uye kwete kwete chete nokuti yakaitwa pasi pesimba rekuita anesthetic uye zvose zvinofamba nayo.
Pashure peproctectomy uye anus kubviswa kweBD, yeostomy isingaperi. Izvozvo zvinogona kuva pfungwa yakaoma kutarisana nezvikonzero zvakawanda.
Zvisinei, zvakakosha kuziva kuti izvi zvinogona kuve kuponesa upenyu kune vamwe vanhu vane IBD uye ichawedzera hukuru hwehupenyu kune vamwe vakawanda. Vanhu vane IBD vane chirwere munzvimbo yavo ye rectum uye anus (iyo perianal area ) vanogona kukunda kurwadziwa uye vane mazano akawanda ezvokurapa uye kugadzwa kwechiremba kuti vatarise zvinetso zvakadai sevarume uye fistula . Pashure pokuvhiyiwa kweproctectomy, vanhu vane IBD vanowanzozvinzwa zviri nani uye vanoona hupenyu hwavo hunovandudzwa.
Chinoita Kuti Mumwe Munhu Ave Aine Zvido Zvavo Rectum naAnus Vakabviswa
Iye zvino kuongororwa kuisa kuwandisa kwevarwere vane Crohn's disease avo vanoda chirwere cheproctectomy sevari pakati pe12 nezana 20 muzana. Vanhu vane chirwere cheCrohn vanogona kuve nekuvhiyiwa uku nokuti chirwere cheCrohn chinokonzera nzvimbo yakakomberedza anus, iyo inonzi perianal.
Chirwere cheCrohn chinogona kukonzera zvinetso zvakadai sefistulas kana abscesses pedyo ne anus. Zvinetso izvi zvinogona kuva zvakaoma kugadzirisa nekuporesa uye zvinogona kukonzera kwete kurwadziwa chete asiwo kuderera kwehupenyu hwehupenyu. Mune zvimwe zviitiko, kushandisa ileostomy kwekanguva chekurega kuva nechigaro munzvimbo iyo kana kuisa mumvura kunogona kubatsira, asi kana zvinhu izvi zvisingashande, proctectomy inogona kukurudzirwa.
Kune varwere vane ulcerative colitis avo vasingadi kupinda chirwere chej-poch kana vasingakwanisi kuvhiyiwa iyo nekuda kwezvinetso mu perianal nzvimbo, proctocolectomy neayoostomy zvachose isarudzo. Kune vashomanana vevanhu vane ulcerative colitis, rectum ichiri ine kuvhuvhuta, uye kuibvisa kwaizopa mukana wakanakisisa wekuvandudza hupenyu hwehupenyu.
Mune vamwe varwere, uye izviwo zvisingashamisi, njodzi yekenza rectal ndeyekuti kubvisa rectum kunonzi ndiyo ndiyo nzira yakanakisisa yekuderedza dambudziko iri.
Proctectomy Surgery
Kuvhiyiwa kweproctectomy ndiko kuvhiyiwa kukuru uye pane maitiro akasiyana-siyana angashandiswa.
Muongorori wechiremba uyo ari kupedza chirwere achasarudza kuti chirwere ichi chichaitwa sei, uye varwere vachada kutaura pamusoro pezvinhu zvakasarudzwa kusarudzo. Boka roga roga rokuvhiya nechipatara richava nenzira yakanakisisa yekupedzisa kuvhiyiwa uye kusarudza nguva yakareba sei varwere vacharamba vari muchipatara mushure mokunge vatungamiri vekuchengeta.
Muzviitiko zvose, kuvhiyiwa uku kunoitwa pasi peaneshesia rose uye zvinoda kugara kwechipatara kwemazuva mashomanana. Kutambura kwepfungwa kuchava chikamu chinokosha chekudzidzira zvose muchipatara uye kumba. Sezvakaitwa nekuvhiya kukuru, kumuka nekubuda pamubhedha nekufamba nokukurumidza apo vashandi vechipatara vanokurudzira zvakakosha pakuporesa.
Mushure mekuvhiyiwa kweproctectomy, varwere vachaenda kumusha nealeostomy itsva, kana imwe isina kuva panzvimbo isati yambovhiyiwa. Imwe nyanzvi yekurapa inopesstomal inobatsira kunzwisisa kuti ungachengetedza sei stoma itsva uye kuti ungashandura sei chigadzirwa cheputi. Ikoko kuchavawo nemakumbo munzvimbo iyo pasi apo anus yakavharwa, uye nzvimbo iyo inogona kutarisirwa zvakanakira nekuchenesa kwekanguva kusvikira yaporeswa zvakakwana. Bhidhiyo yekuvhiya ichapa mirayiridzo pamusoro pezvimwe zvipingamupinyi vasati vasunungurwa kubva kuchipatara.
Kuchinja mune Zvokudya
Varwere vangave vari pamapfupa ekuzorora (kwete kudya zvokudya) kusvikira musikana muduku "uchisimuka" kubva pakuberekwa uye unotanga kuita runyararo uyo unyanzvi hwehutano anokwanisa kunzwa kuburikidza ne stethoscope pamimba. Danho rinotevera rinowanzodya zvinonwiwa zvakajeka zvakadai segelatin uye muto, uye zvishoma nezvishoma kuwedzera mamwe marudzi ezvokudya kusvikira uchidya kudya kwezvokudya zvakare.
Varwere vanowanzoenda kumba pane chirongwa chakashandurwa kwemavhiki mashoma kusvikira muroteral chirwere chinodaro chikafu chinowanzogoneka chinogona kutangazve. Mushure meizvi, pangave pane zvokudya zvishomanana izvo chirwere chechiremba uye gastroenterologist vanokurudzira kuti vadzivirire (zvinhu zvakadai sepopcorn kana nuts) nokuti chero rudzi rwekuvhiya kwepamuviri runoisa dambudziko rekupedzisira rine chigadziro chemuviri . Iyi njodzi yekudzivirira ichasiyana zvikuru nemunhu kune mumwe munhu, saka kudya kunonyatsokurukurwa nechiremba uye navamwe nhengo dzeboka rehutano.
Zvimwe Zvimwe Zvinetso zveProctectomy
Mavanga eperianal: Kuwirirana kwakajairika kweproctectomy chirwere cheCrohn's disease ndechekuva nevanga risina kuvharwa munharaunda ye perianal. Mune zvimwe zviitiko, vanhu vane Crohn's disease vanoda chirwere cheproctectomi vakawana kurwara kwakanaka uye vangangodaro vasina hutano hwakanyanya kupfuura ivo uye vanachiremba vangada kutanga kuvhiyiwa.
Kuva nemafuta kana fistura munharaunda yeperianal kunewo njodzi yekuve nezvinetso munzvimbo iyoyo mushure mekuvhiyiwa. Chirwere chisina kuipa kana mavitamini kukanganisa, kuva kusvuta, uye kuve nekukwirira kunogonawo kuita kuti mavanga aporese mushure mekuvhiyiwa. Muzviitiko zvizhinji, chirwere chisina kuora chinorapwa nenzira inoshandiswa nemaitiro ekuchengeta maronda asi mune zvishoma zvedambudziko, imwe chirwere chinogona kudiwa.
Kuita zvepabonde: Kunetseka nezvebasa rekuita zvepabonde kunowanzoonekwa nehutano hwekuita. Nenzira inofadza, erectile kudzvinyirira mune varume mushure meproctectomy yakaderera, uye inofungidzirwa kuva pakati pemakumi maviri nemana muzana. Kunyangwe zvinyorwa zviri nani ndezvekuti imwe nguva yakareba yekutevera yakaratidza kuti 90 muzana yevanhu vane chirwere cheproctectomy vanogutsikana nehutano hwavo hwepabonde.
Vamwe varwere vanorondedzera kuti basa repabonde rakaipa, uye chiyero chinofungidzirwa kuva pakati pe25 ne30 muzana. Varwere vanoona kuti kuita zvepabonde handizvo zvavanoda kuva iyo vachada kutarisa nyaya iyi nechiremba uye / kana gastroenterologist. Rubatsiro runowanikwa kune nyaya dzakabatana nehutano hwepabonde uye chikamu chakakosha pakuita kuti zvinetso zvinotaridzirwa ndezvizviisa kune hanya neboka rako rehutano.
Mishonga: Vamwe varwere vangave vaine hanya nezvokuti mishonga yavanoita ikozvino inogona kukukanganisa sei. Chimwe chidzidzo chakaratidza kuti vanhu vane Crohn's disease avo vari kugamuchira kurapwa kwechi biologic havakwanisi kuisa njodzi yakakura yekuva nezvinetso nekurapa kupora kupfuura avo vasingatori biologic therapy panguva iyoyo.
Shoko Rinobva
Kuvhiyiwa kweproctectomy ndiyo tariro yakaoma yevanhu vazhinji vane IBD kuti vatarisane. Kuva nekuvhiyiwa uku kunoreva ostomy yekusingaperi, uye kunyange zvazvo varwere vakawanda vachifunga zviri nani uye vanonakidzwa noupenyu mushure mekuvhiyiwa kwehupombwe, zvakasikwa kuva nehanya.
Kutaura nezvekuvhiyiwa nechiremba chiremba uye gastroenterologist zvinowanzobatsira mukuisa mungozi yakawanda maonero. Mashoko akanaka ndeokuti vazhinji vevanhu vane IBD vane chirwere cheproctectomy vanoporesa zvakanaka uye vanoramba vachinzwa zviri nani uye vachifarira upenyu hwavo kupfuura.
> Sources:
> Christensen B. "Zvirwere Zvirwere Zvirwere uye Kusagadzikana Kwepabonde." Gastroenterol Hepatol (NY) . 2014 Jan; 10: 53-55.
> Kamrava A, Mahmoud NN. "Kudzivirira uye kutungamira kwekusakanganiswa kwemaonda." Clin Colon Rectal Surg . 2013 Jun; 26: 106-11.
> Kunitake H, Hodin R, Shellito PC, et al. "Kurapa kweperioperative ne infliximab kune varwere vane Crohn's disease uye ulcerative colitis hazvibatanidzi nehuwandu hwehuwandu hwemagetsi anotevera." J Gastrointest Surg . 2008 Oct; 12 (10): 1730-6; nhaurirano 1736-7.
> Genua JC naVivas DA. "Kutungamirirwa kweZvanga Zvisina Kurapa Perianal Pounds." Clin Colon Rectal Surg . 2007 Nov; 20: 322-328.
> Safar B, Sands D. "Kurwara Kweperianal Crohn." Makliniki muColon uye Rectal Surgery . 2007; 20: 282-293.