Ukuqonda inkqubo ye-J-Pouch kunye neengxaki ezinokwenzeka
Inkqubo ye-ileal anal anastamosis (IPAA) inkqubo, eyaziwa ngokuba yinkqubo ye-J-Pouch, yinkqubo ephangaleleyo yokunyangwa kwezilwanyana ezinzima okanye ukulimala okuchaphazela intumbo enkulu (i-colon). Le nkqubo yenzelwe ukususa izicubu ezonakalisiweyo zekholoni kwaye zivumele isigulane ukuba siqhubeke sinohambo "olusisigxina", oko kuthetha ukuba isithambiso sishiya umzimba ngokusebenzisa i-anus.
Ngethuba leenkqubo ze-J-Pouch-okanye iinkqubo ezininzi eziqhelekileyo-i-colon igqithiselwa ngokugqithisileyo kwaye isisu esincinci sakhiwa kwakhona ukuze kuvumele isitulo ukuba siphuma emzimbeni ngokusebenzisa i-anus ngendlela elawulwayo.
I-J-Pouch Ngayiphi na enye Igama
Le nkqubo, okanye iqela leenkqubo, linamagama amaninzi kuxhomekeke kwisigaba sokuhlinzwa kunye nelizwe apho liya kwenziwa khona. Ukongeza kwesikhwama se-elial anastamosis, inkqubo iyaziwa nangokuthi i- J-pouch , isikhwama esingumlenze we-ileo, i-ileo-anal anal (IAR), isikhwama sangaphakathi, i-proctocolectomy yokubuyisela, i-ileal-anal anal -rough, isikhwama seKock, okanye i-eleostomy.
Kutheni i-J-Pouch Surgery isenziwa
Le nqubo iqhutyelwa ngezizathu ezibini: I-colon isifo kwaye / okanye ibonakaliswe kwaye kufuneka isuswe, kwaye isiguli asifuni i-ileostomy. Kwabaninzi, ikholoni igule kangangokuba ubomi babo buwonakaliswa yi-diarrhea rhoqo. Akuqhelekanga ukuva ngezigulane ezinezifo ezinzima zokugulisa izifo ezinama-25 okanye ngaphezulu ukuhamba kwezilwanyana ngosuku.
Ezi gulane kaninzi akakwazi ukuhamba endlwini ngenxa yokwesaba ukufumana ingozi ngenxa yesifo sohudo esingalawulwayo esoloko sihamba kunye nentlungu, kwaye ngamanye amaxesha igazi lisezantsi.
Ileostomy ichazwe
I- ileostomy yindlela yokugonywa kwamathumbu amakhulu ayenziwa ngokuhlukanisa ukuphela kwesisu esincinci ukususela ekuqaleni kwetumbu elikhulu kwaye ibuye isiphephe intumbo encinci ngaphandle kwesisu.
Oku kwenziwa ngokwenza isixhobo esincinci kwisisu kunye nokudala ukuphuma kwesigxina. Esi sikhokelo sihlanganiswa ngeso sixhobo, isikhwama esikhethekileyo kunye nezikhonkwane ezivumela ukuba zihambelane nesikhumba, kwaye isitulo siqokelelwe kwingxowa.
Abantu abaninzi abanomdla wokuba ne-eliostomy ixesha elide. Nangona kuyimfuneko ukugqithisa ikholoni okanye ukususa ikoloni kwezinye iimeko, izigulane zihlala zifuna enye indlela yokugqoka umbane. Izigulane zihlala zikhalaza ukuba i-appliance ingabonakali, inomsindo, iphazamise ukutshatyalaliswa ngokwesondo, iyayicaphukisa isikhumba okanye iyakucasula.
Ngubani Okhethiweyo we-J-Pouch Surgery
Udokotela ogqithisileyo wegolon uya kuba ngumenzi wesigqibo sokugqibela ukuba ngaba isiguli singumgqatswa weNkqubo ye-J-Pouch. Esi sigqibo siya kusekelwe kwiimeko ezininzi, kubandakanywa oku kulandelayo:
- Impilo yonke yomguli
- Uhlobo lweengxaki kumathumbu amakhulu
- Ubunzima beengxaki
- Ingaba okanye ingengenanto ingayigcinwa ngokususwa kwekholoni
- Ingaba okanye ingekho imingcipheko yenkqubo inkulu kunezibonelelo ezinokwenzeka
Imeko yekholoni ayiyi kuba yedwa yinto yokuba isigulane singumviwa wokuhlinzwa. Isigulane esinesifo esilumkileyo esiswini esingaphenduliyo kumachiza, esona sizathu esivakalayo senkqubo, asinokuba ngumviwa wokuhlinzwa ngenxa yokuba sinesimo senhliziyo esenza ukuba i-anesthesia ibe yingozi, okanye isifo sikashukela sikhulu kakhulu lawulwa.
Ngokuqhelekileyo, ukuba ube ngumviwa kwi-J-Pouch inkqubo, isiguli kufuneka sibe nesifo esinzima se-colon okanye umonakalo. I-trauma iya kuba yeso sizathu somonakalo ophathwa kakubi, njengesilonda sobhobho kwisibilini esibangela ukulimala okukhulu kumathumbu amakhulu. Ngokomzimba, i-ulcerative colitis iyona sizathu esiqhelekileyo senkqubo, umdlavuza wekoloni nayo iyesizathu esivakalayo sokuba i-colon isuswe.
I-polyposis ene-familial adenomatous, imeko ephantse ikhokelela kumdlavuza wekolon, nayo iyona sizathu esivakalayo sokuhlinzwa kwe-J-Pouch. Le meko ibangela izigulane ezinama- polyp colps ngelixa zifikelela kwi-middle-thirties yazo kunye nokuvelisa umdlavuza wekoloni kwiminyaka elishumi okanye amabini alandelayo.
Inkqubo ye-J-Pouch yenziwe ngokufanelekileyo ngaphambi kokuxilongwa komhlaza , kunokuba unyango lomhlaza.
Ukunyanga isifo esibizwa ngokuba yiCrohn-esichaphazelekayo kwi-colitis kuba izilonda zesilonda zingabonakala kwiindawo ezingaphandle kwe-colon-ne-J-Pouch ukuhlinzwa. Oku kungenxa yokuba kunokwenzeka ukususa ikoloni kunye nokudala i-J-Pouch kuphela ukufumanisa ukuba i-J-Pouch ivelisa izilonda ezintsha zesilonda, esenokushiya isigulane esibi kunokuba saqala nini unyango.
Izingozi ze-J-Pouch Surgery
Ukongeza kwimingcipheko eqhelekileyo yokuhlinzwa, kuquka ukuphendula kwi-anesthesia kunye neengxaki eziyaziwayo ezifana ne-pneumonia okanye i-clots yegazi, kukho imingcipheko eyongeziweyo ecacileyo kwi-ileostomy kunye neenkqubo ze-J-Pouch. Ezi ngozi ziquka:
- Ukuhlamba okanye ukuhamba: Iingqamaniso zangaphakathi nangaphandle zangaphakathi zikwazi ukuvuza okanye ukuphuma emva kokuhlinzwa.
- I-Ileus: Le yinkxalabo apho ukunyakaza kwe-muscular ye-intestine (peristalsis) yeka emva kwe-anesthesia. Kwiimeko ezininzi ezi zixazulula kwiintsuku ezilandelayo ukuhlinzwa.
- Ukuvalwa: Lona apho ukunciphisa okubangelwa utyando okanye enye ingxaki inqanda ukunyakaza kokutya kunye nesigxina ngokusebenzisa indlela yokugaya.
I-J-Pouch: Yintoni Eyona Njalo?
I-J-Pouch iyinkukhu encinane eyenziwe ukusuka ekupheleni kwesithokazi esincinci sibe yimilo yeJ apho apho isitofu sinokulinda kude kube lixesha lokunyakaza kwebilini. Njenge-rectum, ekhutshwe ngexesha lenkqubo, i-J-Pouch ye-muscular ayikwazi ukugcina isitoli kuphela kude kube yithuba lokunyakaza kwebilini, kodwa isigulane sinalo okanye silawulwa ngokupheleleyo ngexesha lokunyakaza kwebilini. Ngeendlela ezininzi, i-J-Pouch yindlela evulelwe ngophando eyenza ukuphelisa isidingo sokuba i-ileostomy.
I-J-Pouch Steps: 1, 2 kunye noMaha 3
Inkqubo ye-J-Pouch isicwangciso esilungiselelwe ukuba senziwe ngamanyathelo amabini, oku kuthetha ukuba utyando oluthile luya kwenziwa, ngokuphindaphindiweyo kweenyanga ezi-2 ukuya kwezi-3. Ngokuqhelekileyo, inyathelo lokuqala liquka ukususwa kwekoloni, ukwakheka kwe-uleostomy, kunye nokudalwa kwe-J-Pouch. Ngeli nqanaba, intlungu encinci ihlukaniswe emathunjini amakhulu, ngoko isitulo siphumela emzimbeni kwisayithi yeeloostomy.
Kwiinyanga ezimbalwa ezilandelayo i-J-Pouch esanda kuveliswa ivumelekile ukuphilisa nokuqinisa. Emva kokuba i-J-Pouch iphilisiwe kwaye isigulane silungele ukuhlinzwa okongeziweyo, inkqubo enye yenziwa kwaye i-stool iqala ukuhamba emathunjini amancinci, kwi-J-Pouch apho igcinwa khona, ize iphume emzimbeni ngokusebenzisa i-rectum oko kwenziwa ngaphambi kwezi nkqubo.
Le nkqubo yokuhlinzwa iyindlela eqhelekileyo inkqubo ye-J-Pouch eyenziwa. Inkqubo inokuphinda iqhutywe ngenyathelo elinye lokuhlinzwa, oko kuthetha ukuba i-ileostomy ayenziwanga-i-colon kunye ne-rectum isuswe, i-J-Pouch yenziwe kwaye ixhunywe kwisigxina somxube (inxalenye encinci ye-rectum ngaphakathi ngaphakathi kwe-anus ) kwenkqubo efanayo.
Kwezinye iimeko, oogqirha benza utyando kwiinqanaba ezintathu, kodwa oku akuqhelekanga. Zonke iimanyathelo zenkqubo ziqhutywa phantsi kwe-anesthesia jikelele kwaye ziphumela ekuphumeni kwesibhedlele sosuku lwesithathu ukuya kwezi-7, kuxhomekeke kwinani lamagqabantshintshi ayenziweyo kunye nempilo yonke yesigulane.
I-J-Pouch Procedure Video
Ezi nkqubo zinzima kwaye kunzima ukuyiqonda ngokwenene ngaphandle kwezixhobo ezibonakalayo. Ngenxa yoko, i-Crohn's neColitis Foundation yenze le vidiyo ukuba ichaze ngokucacileyo inkqubo ye-J-Pouch.
Yintoni enokuyilindela emva kokuguqulwa kwe-J-Pouch
Emva kokuba utyando lwe-J-Pouch lugqityiwe, lunokuba luninzi lweenyanga ngaphambi kokuba ufikelele "olutsha olusisigxina" ekuhambeni kweembilini. Ngokuqhelekileyo emva kokuhlinzwa kuka-J-Pouch akuthethi ukuba kuqhelekileyo ngokwemigangatho eqhelekileyo yomntu oqhelekileyo oku: ukunyakaza kwimizimba kulawulwa (kungekho ngengozi), ubuncinane enye intsuku nganye iintsuku, zenziwe kodwa zingenzima, kwaye zibuhlungu. Intshukumo "yesiqhelo" emva kokuhlinzwa kuka-J-Pouch ngokuqhelekileyo ukuhambelana kwamapayipi okanye amazambane ahlambulukileyo.
Emva kokuphinda kugqitywe, umonde wesiganeko ufumana iintshukumo ezintlanu okanye ezintandathu ezilawulwayo ezihambayo ngosuku.
Kumntu owayenomdla wokurhoxiswa ngamanzi amaninzi ngamaxesha ngosuku, oku kungabonakala ngathi kukuphuculwa kakuhle, kodwa kumntu owayenentshukumo rhoqo kwaye wayenenkqubo yokuthintela umdlavuza, oku kunokumangalisa kwaye kwenziwe ulungiso olunzima.
Ngokuqhelekileyo, emva kokuphulukana nokugqitywa kwaye isiguli sifunde ukuba kukuphi ukutya kunye namanzi asemzimbeni angakwazi ukwandisa i-J-Pouch kwaye iholele ekuhambeni kwezilwanyana ezilawulwa kakubi, izigulane zibonisa ukwaneliseka ngemiphumo yokuhlinzwa. Phakathi kwama-10 ukuya kuma-20 ekhulwini abanelisekanga ngesiphumo sabo kwaye banyulwe ukuba ne-ileostomy okanye enye inqubo emva kokuba benze inkqubo ye-J-Pouch.
Kwizigulane ezininzi, ukufumana ukutya okulungileyo nokutya nokukhusela kunye nokufunda ukuba yintoni imithi eluncedo ekunciphiseni isifo sohudo kunye nokwandisa ulawulo lokuhamba kwentsholongwane kukhokelela ekuphuculeni jikelele kwiimeko zabo zangaphambili zesifo.
Iziganeko ezinokuthi ziyakwazi emva kwe-J-Pouch
Kukho iingxaki ezininzi ezinokuba nazo emva kokuba inkqubo ye-J-Pouch, ngenhlanhla abaninzi babo baphathwa ngokulula okanye banqandwa. Abasebenzi kwiofisi yakho yokugqirha kunye ne- infernal therapy (abahlengikazi abanomsebenzi wokunyamekela i-ostomy kunye namanye amanxeba) banokubanceda xa bebuya. Unganqikazi ukuxoxa ngazo nayiphi na imiba nalaba baqeqeshi bezobugqirha njengoko sele babone ingxaki ngaphambili.
Gcina ukhumbule ukuba le micimbi iphucula emva kokuhlinzwa, njengoko isiguli sifunde indlela umzimba wawo usebenza ngayo emva kokuhlinzwa kwaye uphinde uhlawule ngokupheleleyo:
- Ukunciphisa Isondlo: I-diarrhea ehlala rhoqo ingakhokelela kumavithamini, amaminerali kunye neekhalori ezithathwa ngumzimba. Ngokuhamba kwexesha, izigulane ezazisweleka phambi kokuhlinzwa zisoloko zondliwa kangcono xa isifo sohudo sinika inkxaso.
- Ukubethelwa: Iiindawo zokugqitywa kwezibhedlele, kubandakanywa intlungu encinci, i-J-Pouch, kunye ne-anus inokuhlangabezana nokunciphisa ngenxa yokukhwela. Oku kuncitshiswa kunokubangela ukukhutshwa komncinci, ukukhathazeka ngokutya okanye isitofu eshukumisa umzila wokutya kunye nobunzima bokuhamba.
- Ukukhulelwa kweThumba: Umsebenzi omnye wekoloni ukufumana i-asidi engaphezulu kwinqanaba lomathumbu. Ngaphandle kwekoloni ukwenza lo msebenzi, ezinye izigulane zifumana ukutshisa kwisayithi se-stoma okanye kwi-anus ebizwa ngokuba "ukutshiswa komlilo". Oku kunokuthintelwa kunye nomnqophiso wokugcoba kwesikhumba.
- I-Pouchitis: Ukuvuvukala kwesikhwama, le meko ingaba bubuhlungu kwaye iphathwa ngokugqithiswa ngamachiza amabini: Flagyl ne Cipro.
- I-Incontinence: Nangona injongo ye-J-Pouch kukunceda isigulane silawulwe xa sisusa izibilini zabo, ezinye izigulane zifumana ukungabikho kwengqondo ngexesha lokubuyisa. Ubuninzi obunzima bokungabikho komsebenzi obudlulileyo kwisigaba sokubuyisela.
- Uhudo: Ukuthetha ngokuchanekileyo, isifo sohudo sinesithandathu okanye ngaphezulu kwezihlalo ezivulekileyo ngosuku, kwaye ezinye iindawo zokuzilahla zihamba ngcono kunezinga labo langaphambili lokulawula. Kwabanye, oku kubi ngaphezu kwexesha elidlulileyo, kodwa kwiiveki ezimbalwa zokuqala zesifo sohudo ziqhelekileyo kwaye zilindeleke. Ngokuqhelekileyo kuphuculwe ngamachiza afana neLomotil okanye i-Immodium kunye neenguqu zokutya. Ukutya okunamandla kunye nesitashi, njengamazambane kunye ne-pasta, kunokukunceda ukuqinisa isihlalo. Ingxelo yokurhobhoza eqhubekayo kumgqirha wakho.
- Ukunyuka kwamanzi: Ukuhamba rhoqo kwimizimba kungakhokelela ekudambiseni amanzi, ngoko kufuneka isifo sohudo kufuneka sibhekiswe kwaye ukunyuka kwamanzi kuyenyuka xa kukho ukungcola kwamanzi. Ukunyanzeliswa kwamanzi kungaphathwa ngokufanelekileyo ekhaya ngombala womchamo. Umchamo omnyama ubonisa isidingo sokwanda kwamanzi, ngelixa umchamo ocacileyo kunye nombala ongabonakaliyo ubonisa ukuhamba ngokufanelekileyo. Ingxelo yokudambisa amanzi kumgulane wakho.
- I-Sodium ephantsi: I-sodium ingalahleka nge-diarrhea, kwaye ifanele ithathe indawo yetsholongwane ene-electrolyte equkethe i-Gatorade okanye iPedialyte. I-sodium esezantsi ihlolwe ngokuhlolwa kwebhuyibhile, ngoko qiniseka ukuba ugqirha wakho uyazi ukuba ufumene ukuba ne-sodium ephantsi.
- Abselvic Abscess: Le ngxowa yentsholongwane eqhubekayo okanye kufuphi ne-J-Pouch site kwaye idinga unyango kunye nokunyanga.
- Ukungasebenzi kwezesondo: I- Erectile i-dysfunction iyingozi yesazi yenkqubo yamadoda. Kubafazi, ukungabikho kokusweleka ngenxa yokutshatyalaliswa kwii-ovari kuyinkxalabo eyaziwayo, njengokuba kubuhlungu ubulili.
- I-Crohn's Emva kwe-J-Pouch: Umahluko phakathi kweCrohn kunye ne-colitis kukuba isifo sikaCrohn sinokuthi senzeke naphina kwindawo yokutya xa i-colitis iphela kumathumbu amakhulu. Ukuba izilonda zika-Crohn zivele kuphela kwi-colon ngaphambi kokuhlinzwa, kungenakuqondakala ukuba zifunyanwe njenge-colitis, kuphela ukuba zifumene ukuba izilonda zifunyanwa kamva kwezinye iindawo emva kokuhlinzwa. Oku kunokukhokelela kwi-J-Pouch enezilonda zesilonda.
- Ukutya okuncinci: Abanye abantu abane-J-Pouches bafumana ukuba banokunyamezela kuphela ukutya okuncinane kangako kunokutya ezintathu ezinkulu ngosuku.
- Iingxaki eziqhelekileyo: Iingxaki eziqhelekileyo ezijongene nabantu abaninzi, ezifana nokuguquka, ziba nzima ngakumbi nge-J-Pouch. Ukutya okuqhelekileyo kubangele igesi ingabangela i-gesi okanye i-gesi ephezulu kuneyona nto yayingayi kuqala phambi kokuhlinzwa. Esi sisiphumo esiqhelekileyo senkqubo, kwaye asinakuyilungisa emva kokuphelisa kwakhona.
- Iimfuneko ze-Ostomy: Kwiimeko ezinzulu apho ukungabikho komsebenzi kuba ngumcimbi oqhubekayo, i-J-Pouch ayinempilo okanye ayisebenziyo, okanye isiguli asinelisekile, i-ileostomy yonyango olukhethiweyo.
- Ukukhulelwa: Uxinzelelo lwe-fetus kwi-pelvis, apho i-J-Pouch ihlala khona, inokubangela ubunzima ngokuhamba kwamathumbu kunye nelizwekazi. Bobabini ugqirha we-colon-rectal kunye nomgqirha oza kudlala indima ekuncedeni umama okhulelweyo ukuba abe nolawulo olungcono ngexesha lokuqala lokuqala, xa le ngxaki ibaluleke kakhulu, kwaye ichonga uhlobo olungcono lokuhambisa.
ILizwi
Le nkqubo yinkqubo enzima kwaye inzima, eyenziwa kuphela kwizigulane ezigula kakhulu okanye zithemba ukukhusela imbali yolondolozo lomhlaza wekoloni. Isigqibo sokuba utyando lwe-J-Pouch alufanele kuthathwe ngokulula kwaye kufuneka kwenziwe kuphela emva kokufumana udokotela ogqirha owenza le nkqubo ngokuqhelekileyo kwaye emva kokuba enengxoxo ejulile malunga nobungozi kunye nemivuzo enokubakho kovavanyo.
> Imithombo:
> Isikhokelo soMonde kunye neNtsapho kwi-Ileal J-Pouch Anal Anastamosis (IPAA). IYunivesithi yasePennsylvania yeCandelo lezeMpilo kwiCandelo leColon kunye noPhando oluPhezulu. http://www.uphs.upenn.edu/surgery/clinical/colon_rectal/ostomy/ileal_j_pouch_surgery.pdf
> Yonke ipoktocolectomy kunye nengxowa yesikhali esilwe. Medline Plus. https://medlineplus.gov/ency/article/007380.htm