Kumvetsetsa Njira Zowononga J-Pouch ndi Potential
Ndondomeko yotchedwa ileal anastamosis (IPAA) yomwe imatchedwa kuti J-Pouch, ndiyo njira yopangira opaleshoni yovuta ya matenda kapena kuvulala komwe kumakhudza matumbo akuluakulu (colon). Ndondomekoyi imapangidwira kuchotsa minofu yowonongeka ndipo imalola wodwalayo kuti apitirize kukhala ndi "kuyenda" kwa thupi, kutanthauza kuti chitsime chimachoka mu thupi kudzera mu anus.
Pakati pa njira ya J-Pouch-kapena nthawi zambiri njirazi zimatulutsidwa ndipo opaleshoni yaying'ono imamangidwanso kuti zitheke kuti thupi lichoke pamtambo.
A J-Pouch Ndi Dzina Lina Lililonse
Njirayi, kapena gulu la njira, liri ndi mayina angapo malingana ndi siteji ya opaleshoni ndi dziko limene lidzachitike. Kuwonjezera pa chikwama cha leal anal anastamosis, njirayi imadziwika kuti J-pouch , koo-anal chikwama, leo-anal reservoir (IAR), chikwama chamkati, kubwezeretsa proctocolectomy, kutambasula koleal, thumba la Kock, kapena chovala cha ileostomy.
Chifukwa chiyani opaleshoni ya J-Pouch ikuchitika
Ndondomekoyi imachitidwa pa zifukwa ziwiri: Ng'onoting'ono ili ndi matenda / / kuonongeka ndipo iyenera kuchotsedwa, ndipo wodwala sakufuna ileostomy. Kwa ambiri, colon ndi matenda kotero kuti moyo wawo ukuwonongeka ndi kutsekula m'mimba. Zidzakhala zachilendo kumva za odwala omwe ali ndi matenda otupa kwambiri omwe amakhala ndi matenda 25 kapena kuposa tsiku limodzi.
Odwalawa nthawi zambiri satha kuchoka panyumba chifukwa choopa kuti azichita ngozi chifukwa cha kutsegula m'mimba komwe nthawi zambiri kumaphatikizapo ululu, ndipo nthawi zina magazi amapezeka m'mabedi.
Ileostomy ikufotokozedwa
Analoostomy ndi opaleshoni yopitirira matumbo omwe amachititsa kupatula mapeto a matumbo aang'ono kuyambira kumayambiriro kwa matumbo akuluakulu komanso kubwezera matumbo pang'ono kunja kwa mimba.
Izi zimachitidwa mwa kupanga kapangidwe kakang'ono m'mimba ndikupanga kutuluka kwa chitseko. Izi zimagwiritsidwa ntchito ndi chogwiritsira ntchito, thumba lapadera lokhala ndi zikhomo zomwe zimalola kuti zizimamatira khungu, ndipo chophimba chimasonkhanitsidwa m'thumba.
Anthu ambiri safuna kukhala ndi leostomy nthawi yaitali. Pamene kuli kofunikira kudutsa colon kapena kuchotsa colon nthawi zina, odwala nthawi zambiri amafuna njira yoti azivale chovalacho. Odwala nthawi zambiri amadandaula kuti chogwiritsira ntchito ndi chosasamala, chimakhala chokoma, chimayambitsa kugonana, chimakhumudwitsa khungu kapena chimakhala chokhumudwitsa.
Kodi Wotani Wopereka Chithandizo cha J-Pouch?
Dokotala wa opaleshoni wamakono adzakhala wopanga chisankho ngati wodwalayo ali woyenera kuti azitsatira ndondomeko ya J-Pouch. Chisankho chimenecho chidzakhazikitsidwa pazinthu zambiri, kuphatikizapo zotsatirazi:
- Chisamaliro chonse cha wodwalayo
- Mtundu wa vuto m'matumbo akulu
- Kuvuta kwa vutoli
- Kaya kapena ayi vuto lingathe kukhazikitsidwa ndi kuchotsedwa kwa koloni
- Zomwe zingakhale zoopsa za ndondomekoyi ziposa momwe mungapindulire
Mkhalidwe wa coloni sikuti ndiwo wokhawokha ngati wodwalayo ali woyenera kuti apite opaleshoni. Wodwala amene ali ndi zilonda zam'mimba zomwe sizikugwirizana ndi mankhwala, omwe amachititsa kuti awonongeke, sangakhale woyenera kuchita opaleshoni chifukwa ali ndi mtima wa mtima umene ungapangitse anesthesia kukhala woopsa, kapena matenda awo a shuga ndi ovuta kwambiri akulamulidwa.
Kawirikawiri, kukhala wodzitetezera pa njira ya J-Pouch, wodwala ayenera kukhala ndi matenda aakulu a colon kapena kuwonongeka. Kuvutika maganizo kungakhale chifukwa cha kuwonongeka kumene kumachitidwa opaleshoni, monga mfuti ya mfuti ku mimba yomwe imavulaza kwambiri matumbo. Pachilombo, ulcerative colitis ndi chifukwa chodziwika bwino, khansa ya colon ndi chifukwa chodziwikiratu kuti njuchi zichotsedwe.
Odziwika bwino ndi adenomatous polyposis, omwe nthawi zambiri amatengera khansa yamtunduwu, amakhalanso opaleshoni ya J-Pouch. Matendawa amachititsa kuti odwala ali ndi mapulotoni amtunduwu akafika pakati pa zaka makumi atatu ndi makumi asanu ndi atatu ndikuyamba khansa yam'mimba m'zaka khumi kapena ziwiri zotsatira.
Ndondomeko ya J-Pouch imachitidwa musanayambe kudziwa za khansa , m'malo mochiza khansa.
Kuchiza matenda odziwika a Crohn-omwe amasiyana ndi matenda a colitis chifukwa zilonda za zilonda zam'mimba zimawoneka m'madera ena osati a colon-ndi opaleshoni ya J-Pouch. Izi n'zotheka kuchotsa chidebe ndikupanga J-Pouch yekha kuti apeze kuti J-Pouch imayambitsa zilonda zam'mimba zowononga, zomwe zingachititse kuti wodwalayo asapitirire kuchipatala.
Zoopsa za J-Pouch Surgery
Kuphatikiza pa zoopsa zomwe zimachitika pa opaleshoni, kuphatikizapo momwe amachitira ndi anesthesia ndi mavuto omwe amadziwika bwino monga chibayo kapena magazi, palinso zoopsa zina zomwe zimakhala zovuta kwambiri pa njira ya ileostomy ndi J-Pouch. Mavuto awa ndi awa:
- Kupuma kapena kuyendayenda: Mizere yonse ya mkati ndi kunja imatha kutuluka kapena kutuluka magazi atatha opaleshoni.
- Ileus: Izi ndizovuta zomwe zimakhala zowawa m'mimba (peristalsis) pambuyo pa kupweteka kwa anesthesia. Nthawi zambiri izi zimatsimikizira masiku omwe akuchitika opaleshoni.
- Kumangidwanso: Apa ndi pamene kuperewera komwe kumachitika chifukwa cha opaleshoni kapena vuto lina limalepheretsa kayendetsedwe ka chakudya ndi chotupa kudzera m'magawo.
J-Pouch: Kodi Ndi Zeni Zeni Zeni?
J-Pouch ndi thumba laling'ono lomwe linapangidwa kuchokera kumapeto kwa matumbo aang'ono kuti alowe mu J mawonekedwe kumene chophimba chikhoza kuyembekezera mpaka nthawi ya kuyenda. Mofanana ndi rectum, yomwe imachotsedwa panthawiyi, J-Pouch wosungira sungakhoze kusunga kokha pansi mpaka nthawi yakuthamanga, koma wodwala ali ndi zina kapena zowonongeka pa nthawi ya kuyenda. M'njira zambiri, J-Pouch ndilopangidwe lopangidwa ndi opaleshoni yomwe imachotsa kufunika kwa ileostomy.
J-Pouch Steps: 1, 2 ndi Maybe 3
Ndondomeko ya J-Pouch ikukonzekera kuti ichitike mu magawo awiri, kutanthauza kuti opaleshoni ziwiri zidzakwaniritsidwa, nthawi zambiri pamwezi miyezi iwiri kapena itatu. Kawirikawiri, sitepe yoyamba imaphatikizapo kuchotsedwa kwa koloni, mapangidwe a ileostomy, ndi kulengedwa kwa J-Pouch. Panthawiyi, katumbu kakang'ono kamatulukamo m'mimba mwake, choncho chotsitsa chimachoka pamtunda.
Kwa miyezi ingapo yotsatira, J-Pouch watsopanoyo amaloledwa kuchiritsa ndi kulimbikitsa. J-Pouch ikachiritsidwa ndipo wodwalayo ali wokonzeka kuchitidwa opaleshoni yowonjezereka, njira yowonjezera imayendetsedwa ndipo sitima imayamba kuyenda kudzera m'matumbo ang'onoang'ono, mpaka ku J-Pouch komwe imasungidwa, kenako imachoka mthupi kudzera mu chibindiko izo zinachita izi zisanachitike.
Ndondomeko iyi ya opaleshoni ndiyo njira yodziwika kwambiri yomwe njira Y-Pouch imachitikira. Ndondomekoyi ikhonza kuchitidwa opaleshoni imodzi, kutanthauza kuti ileostomy sichichitidwa-colon ndi rectum imachotsedwa, J-Pouch imapangidwira ndikugwirizanitsidwa ndi tsinde laling'ono (gawo laling'ono la rectum mkati mwa anusus ) chimodzimodzi.
Nthaŵi zina, madokotala ochita opaleshoni amachita opaleshoni mu magawo atatu, koma izi sizodziwika bwino. Zotsatira zonsezi zimagwiritsidwa ntchito pansi pa anesthesia ndipo nthawi zambiri amakhala m'chipatala cha masiku atatu mpaka 7, malinga ndi chiwerengero cha magawo omwe akuchitidwa komanso thanzi la wodwalayo.
J-Pouch Procedure Video
Njirazi ndi zovuta komanso zovuta kumvetsetsa popanda zothandiza. Pa chifukwa chimenechi, Crohn's ndi Colitis Foundation yakhazikitsa vidiyoyi kuti ifotokoze bwino njira ya J-Pouch.
Zimene muyenera kuyembekezera Pambuyo pa Kupaleshoni kwa J-Pouch
Pambuyo pa opaleshoni ya J-Pouch yatsirizidwa, ikhoza kukhala miyezi yambiri musanafike pa "zachilendo" zanu zamasamba. Kawirikawiri pambuyo poti opaleshoni ya J-Pouch sikutanthauza zachibadwa ndi miyezo ya munthu wamba omwe ali: Kuthamanga kwa mimba kumayendetsedwa (osati mwangozi), osachepera masiku atatu aliwonse, kupangidwa koma osati kovuta, komanso osapweteka. Chizoloŵezi chokhala ndi "chizolowezi" pambuyo poti opaleshoni ya J-Pouch nthawi zambiri imakhala yogwirizana ndi mbatata kapena mbatata yosenda.
Pambuyo pakutha, wodwala wodwala amakumana ndi kayendedwe ka mawere asanu kapena asanu ndi limodzi pa tsiku.
Kwa munthu yemwe anali ndi matenda otsekula m'magazi maulendo angapo patsiku, izi zingawoneke ngati zowonongeka bwino, koma kwa munthu yemwe anali ndi matumbo nthawi zonse ndipo anali ndi njira yothetsera khansa, izi zikhoza kukhala zochititsa mantha ndikupanga kusintha kovuta.
Kawirikawiri, akachira atatha ndipo wodwala adziŵa zomwe zakudya ndi zamadzimadzi zingachititse kuti J-Pouch iwonongeke, ndipo odwala amasangalala ndi zotsatira za opaleshoni. Pa pakati pa 10 ndi 20 peresenti sakhutira ndi zotsatira zake ndipo amasankhidwa kukhala ndi ileostomy kapena njira ina pambuyo pochita ndondomeko ya J-Pouch.
Kwa odwala ambiri, kupeza zakudya zoyenera kudya ndi kupeŵa komanso kuphunzira mankhwala omwe amathandiza kuchepetsa kutsegula m'mimba komanso kuwonjezera kuwongolera kwa njira yothandizira kuwonetsetsa kuti matendawa asinthe.
Zovuta Zodziŵika Zomwe Zimadziwika Pambuyo pa J-Pouch
Pali mavuto ochulukirapo atatha kupanga njira ya J-Pouch, mwatsoka ambiri a iwo amachiritsidwa mosavuta kapena amaletsedwa. Ogwira ntchito pa ofesi yanu ya opaleshoni ndi mankhwala opatsirana opaleshoni (anamwino omwe amadziwika bwino ndi ostomy ndi mabala ena) angakhale othandizira kwambiri pamene akuchira. Musazengereze kukambirana nkhani iliyonse ndi akatswiri awa azachipatala monga momwe adawonera vutoli kale.
Kumbukirani kuti nkhanizi zimawongolera pambuyo pakuchita opaleshoni, pamene wodwalayo amadziwa momwe thupi lawo limagwirira ntchito pambuyo pa opaleshoni ndikubwezeretsa bwino:
- Kuchepetsa Njala: Kutsegula m'mimba mobwerezabwereza kungayambitse mavitamini, mchere, ndi calories zochepetsedwa ndi thupi. Patapita nthawi, odwala omwe anali osoŵa zakudya asanakwane opaleshoni nthawi zambiri amakhala ndi chakudya chambiri mukatha kutsekula m'mimba.
- Kuwongolera: Malo opangira opaleshoni, kuphatikizapo matumbo aang'ono, J-Pouch, ndi anus amatha kuchepa chifukwa chosowa. Kufooketsa kumeneku kungabweretse vuto laling'ono, zomwe zimakhala zovuta ndi chakudya kapena chotupa chomwe chimadutsa m'magawo ndi zakudya zovuta.
- Kuchepa kwa khungu: Ntchito imodzi ya coloni ndiyokutenga asidi ochuluka m'matumbo. Popanda colon kuti agwire ntchitoyi, odwala ena amawotcha pamalo awo otchedwa stoma kapena pafupi ndi anus yomwe imatchedwa "kutentha". Izi zikhoza kutetezedwa ndi mafuta oletsa khungu.
- Pouchitis: Kutupa kwa thumba, vutoli lingakhale lopweteka ndipo kawirikawiri limachiritsidwa ndi mankhwala awiri: Flagyl ndi Cipro.
- Incontinence: Ngakhale kuti cholinga cha J-Pouch ndicho kuthandiza wodwalayo kuti azilamulira pamene amachotsa matumbo, odwala ena amakumana ndi chizoloŵezi chodziletsa pamene akuchira. Pali zochepa chabe zomwe zimachititsa kuti munthu asamavutike.
- Kutsekula m'mimba: Mwachidziwitso, kutsegula m'mimba ndi sikisi kapena zina zotayika patsiku, ndipo zina zoterezi zimakhala bwino kusiyana ndi momwe analili poyamba. Kwa ena, izi ndi zoipa kuposa kale, koma pamasabata angapo oyamba otsegula m'mimba ndiwowonjezereka. Zimakhala bwino ndi mankhwala monga Lomotil kapena Immodium pamodzi ndi kusintha kwa zakudya. Zakudya zowirira ndi zowonjezera, monga mbatata ndi pasitala, zingathandize kulimbitsa chopondapo. Lembani kutsegula m'mimba kwa dokotala wanu.
- Kutaya madzi m'thupi: Kuthamanga kwafupipafupi kumabweretsa kutaya madzi, kotero kutsekula m'mimba kuyenera kuchitidwa ndipo kuwonjezeka kwa madzi kumawonjezeka ngati kutaya madzi m'thupi. Kutaya madzi m'thupi kumayesedwa bwino kunyumba ndi mtundu wa mkodzo. Msuzi wamdima umasonyeza kuwonjezeka kwa chiwindi, pamene mkodzo wonyezimira komanso wopanda mtundu umasonyeza madzi okwanira. Lembetsani kuti thupi lanu likupita ku dokotala.
- Low Sodium: Sodium ikhoza kutayika kudzera m'mimba yotsekula, ndipo imayenera kusinthidwa ndi madzi otchedwa electrolyte monga Gatorade kapena Pedialyte. Sodium yapamwamba imapezeka kuti ili ndi mayeso, choncho onetsetsani kuti dokotala wanu akudziwa ngati muli ndi sodium yotsika.
- Amadzi amphamvu: Ichi ndi thumba la matenda lomwe limayamba pafupi ndi malo a J-Pouch ndipo limafuna chithandizo chachipatala komanso chotheka.
- Kulephera kugonana: Erectile dysfunction ndi chidziwitso choopsa cha njira ya amuna. Kwa amayi, kusabereka chifukwa chowombera m'mimba mwa mazira ndi chinthu chodziŵika bwino, monga momwe zimapwetekera kugonana.
- Crohn's Pambuyo pa J-Pouch: Kusiyana pakati pa Crohn's ndi colitis ndikuti matenda a Crohn akhoza kuchitika paliponse m'magawo am'mimba pamene kupweteka kumangokhala m'mimba yaikulu. Ngati zilonda za Crohn zimapezeka pokhapokha asanatere opaleshoni, zimatha kuzindikira kuti zilondazo zimapezeka m'malo ena atatha opaleshoni. Izi zikhoza kuyambitsa J-Pouch yomwe imakhala ndi zilonda zam'mimba.
- Zakudya Zing'onozing'ono: Anthu ena omwe ali ndi J-Pouches amaona kuti amatha kulekerera zakudya zing'onozing'ono pokhapokha chakudya chambiri patsiku.
- "Mavuto Ochizolowezi": Mavuto omwe anthu ambiri amakumana nawo, monga kunyalanyaza, amakhala ovuta kwambiri ndi J-Pouch. Chakudya chomwe nthawi zambiri chimayambitsa mpweya chingayambitse mpweya kapena mpweya wambiri umene umakhala wotsika kwambiri kuposa momwe ukanakhalira opaleshoni. Izi ndizochitika zotsatira za ndondomekoyi, ndipo sangathe kuthetsa mutatha kukonzanso.
- Kufunika kwa Ostomy: Nthawi zambiri pamene incontinence imakhala nkhani yosalekeza, J-Pouch sali yathanzi kapena yosagwira ntchito, kapena wodwala alibe kukhutira, ileostomy ndi mankhwala omwe amasankha.
- Mimba: Kupsyinjika kwa mwanayo m'mimba mwa nkhono, komwe J-Pouch amakhala, kungayambitse vuto ndi matumbo ndi chikhalidwe. Onse opaleshoni ya opaleshoni ndi opaleshoni amathandizira amayi omwe ali ndi pakati kuti azikhala ndi mphamvu yabwino pa nthawi yoyamba, pamene vutoli ndilofunika kwambiri, ndikudziwitsa mtundu wabwino kwambiri.
Mawu Ochokera
Ndondomekoyi ndi yovuta komanso yovuta, yomwe imangotengera odwala omwe akudwala kwambiri kapena akufuna kupewa mbiri ya banja la khansara yamtunda. Chisankho chochita opaleshoni ya J-Pouch sichiyenera kuchitidwa mopepuka ndipo chiyenera kuchitika pokhapokha mutapeza dokotala wa opaleshoni amene amachita izi mwachizoloŵezi ndipo atatha kukambirana mozama za kuopsa ndi zopindulitsa za opaleshoni.
> Zotsatira:
> Phunziro lachiyembekezo ndi banja la Ileal J-Pouch Anal Anastamosis (IPAA) Opaleshoni. University of Pennsylvania Health System Chigawo cha Colon ndi Surgery Surgery. http://www.uphs.upenn.edu/surgery/clinical/colon_rectal/ostomy/ileal_j_pouch_surgery.pdf
> Chikwama chonse cha proctocolectomy ndi leal-anal. Medline Plus. https://medlineplus.gov/ency/article/007380.htm