Tracheoesophageal fistula a me ka esophageal atresia hoʻoponopono

ʻO ka Tracheoesophageal fistula a me ka esophageal atresia hoʻoponopono kahi ʻoki e hoʻoponopono i ʻelua mau hānau hānau i ka esophagus a me ka trachea. Kū pinepine nā kīnā.

ʻO ka esophagus ka paipu e lawe i ka meaʻai mai ka waha a i ka ʻōpū. ʻO ka trachea (ka makani) ka pahu e lawe i ka ea i loko a i waho o nā akemāmā.

Kū pinepine nā kīnā. Kū paha lākou me nā pilikia ʻē aʻe ma ke ʻano he ʻāpana o kahi maʻi maʻi (ka hui o nā pilikia):

• Hana ʻia ʻo atropia esophageal (EA) ke pili ʻole ka ʻaoʻao luna o ka esophagus me ka esophagus o lalo a me ka ʻōpū.
• ʻO Tracheoesophageal fistula (TEF) kahi pilina maʻamau ma waena o ka ʻaoʻao kiʻekiʻe o ka esophagus a me ka trachea a i ʻole ka makani.

ʻAneʻane pau kēia hana ʻana ma hope o ka hānau ʻana. Hiki ke hoʻoponopono hou i nā hemahema ʻelua i ka manawa like. ʻO ka pōkole, hana ke ʻoki i kēia ala:

• Hāʻawi ʻia ka lāʻau lapaʻau (anesthesia) i mea e hiamoe nui ai ka pēpē a ʻaʻohe ʻeha i ka wā o ke ʻoki.
• Hoʻokiʻoki ka mea lapaʻau i ka ʻaoʻao o ka umauma ma waena o nā iwi ʻaoʻao.
• Pani ʻia ka fistula ma waena o ka esophagus a me ka windpipe.
• Humuhumu pū ʻia nā ʻāpana luna a me lalo o ka esophagus inā hiki.

ʻO ka pinepine o nā ʻāpana ʻelua o ka esophagus kahi mamao loa e humuhumu pū koke. I kēia hihia:

• Hoʻoponopono wale ʻia ka fistula i ka wā o ke ʻoki mua.
• Hoʻokomo ʻia kahi ʻōpū gastrostomy (kahi ʻōmole e hele i loko o ka ʻili i loko o ka ʻōpū) e hāʻawi i kāu keiki i ka meaʻai.
• E ʻoki hou kāu keiki ma hope e hoʻoponopono i ka esophagus.

I kekahi manawa e kali ke kaukōkō i 2 a 4 mau mahina ma mua o ka hana ʻana i ke ʻoki. Hāʻawi ke kali ʻana i kāu pēpē e ulu a i ʻole mālama i nā pilikia ʻē aʻe. Inā hoʻopaneʻe ʻia kāu ʻoki ʻana o kāu keiki:

• E hoʻokomo ʻia kahi Tube gastrostomy (G-Tube) ma o ka paia o ka ʻōpū i loko o ka ʻōpū. E hoʻohana ʻia nā lāʻau numbing (anesthesia kūloko) i ʻole e ʻeha ka pēpē.
• I ka manawa like e hoʻokau ai i ka paipu, hiki i ke kauka ke hoʻonui i ka esophagus o ka pēpē me kahi mea hana kūikawā i kapa ʻia he dilator. E maʻalahi kēia i ke kahakaha o ka wā e hiki mai ana. Pono e hana hou i kēia hana, i kekahi manawa i mau manawa, ma mua o ka hiki ke hoʻoponopono.

ʻO nā Tristoesophageal fistula a me nā atresia esophageal nā pilikia weliweli i ke ola. Pono lākou e mālama koke. Inā ʻaʻole mālama ʻia kēia mau pilikia.

• Hiki paha i kāu keiki ke hanu i ka lihi a me nā wai mai ka ʻōpū i loko o nā akemāmā. Kapa ʻia kēia he ʻiʻini. Hiki iā ia ke kumu i ke kolo a me ka pulemonia (maʻi lele).
• ʻAʻole hiki i kāu keiki ke ale a hoʻowali i nā mea āpau inā ʻaʻole pili ka esophagus i ka ʻōpū.

Nā pilikia o ka anesthesia a me ke kahakaha ʻana ma:

• Nā hopena i nā lāʻau
• Nā pilikia hanu
• Kahe ʻana o ke kahe, ke koko koko, a i ʻole ka maʻi

ʻO nā pōʻino o kēia ʻoki ʻana:

• ʻO ka hāhā naha (pneumothorax)
• ʻO ka liu o ka meaʻai mai ka wahi i hoʻoponopono ʻia
• Low kino mahana (hypothermia)
• Ka hoʻoliʻiliʻi o nā mea i hoʻoponopono ʻia
• Wehe hou ʻia o ka fistula

E ʻae ʻia kāu pēpē i ka neonatal intensive care unit (NICU) ke ʻike koke nā kauka i kekahi o kēia mau pilikia.

E loaʻa i kāu pēpē ka meaʻai ma o ka aa (intravenous, a i ʻole IV) a aia paha ma kahi mīkini hanu (ventilator). Hiki i ka hui mālama ke hoʻohana i ka omo e mālama i nā wai mai ka hele ʻana i loko o nā akemāmā.

ʻO kekahi mau pēpē ma mua, kaumaha haʻahaʻa hānau, a i ʻole nā ​​kīnā hānau ʻē aʻe ma kahi o TEF a me / a i ʻole EA hiki ʻole ke ʻoki ʻia a ulu a nui a i ʻole a mālama ʻia nā pilikia ʻē aʻe a i hele aku paha.

Ma hope o ke kaha ʻana, e mālama ʻia kāu keiki ma ka NICU o ka haukapila.

ʻO nā hōʻailona hou aʻe ma hope o ke kahakaha ʻana:

• Nā Antibiotics e pono ai, e pale aku i ka maʻi
• Mīkini hanu (ventilator)
• ʻO ka pahu pahu (kahi ʻōmole ma o ka ʻili i ka paia o ka pahu) e hoʻokahe i nā wai mai kahi ākea ma waena o waho o ka akemāmā a me ka loko o ka lua o ka pahu
• ʻO nā wai i hoʻopili ʻia (IV), e like me ka meaʻai
• Oxygen
• Nā lāʻau ʻeha inā pono

Inā hoʻomaikaʻi ʻia ʻo TEF a me EA:

• Hoʻokomo ʻia kahi paipu ma o ka ihu i loko o ka ʻōpū (nasogastric tube) i ka wā o ke ʻoki.
• Hoʻomaka pinepine ʻia nā hānai ma o kēia paipu i kekahi mau lā ma hope o ke kaha ʻana.
• Hoʻomaka mālie ka hānai ʻana ma ka waha. Pono paha i ka pēpē ka hānai ʻana i ka lāʻau.

Inā hoʻomaikaʻi wale ʻia ʻo TEF, hoʻohana ʻia kahi paipu G no ka hānai ʻana a hiki i ka hoʻomaʻemaʻe ʻana o ka atresia. Pono paha ka pēpē i ka omo mau a pinepine paha e hoʻomaʻemaʻe i nā huna mai ka esophagus luna.

ʻOiai ʻo kāu pēpē i ka haukapila, e hōʻike ka pūʻulu mālama iā ʻoe pehea e hoʻohana a hoʻololi ai i ka G-tube. E hoʻouna ʻia paha ʻoe i ka home me kahi pahu G keu. E haʻi aku nā limahana o ka haukapila i kahi ʻoihana lako olakino home i kāu pono pono.

Pehea ka lōʻihi o ka noho ʻana o kāu pēpē i ka haukapila e pili ana i ke ʻano kīnā o kāu keiki a inā he mau pilikia ʻē aʻe i ka hoʻohui ʻia o TEF a me EA. Hiki iā ʻoe ke lawe i kāu pēpē i ka home ke lawe lākou i ka hānai ma ka waha a i ʻole ka ʻōpū gastrostomy, ke kaumaha nei, a me ka hanu palekana ʻana iā lākou iho.

Hiki i ke ʻoki kino ke hoʻoponopono hou i kahi TEF a me EA. Ke pau ka hoʻōla ʻana mai ke kaha ʻoki, loaʻa paha i kāu keiki kēia mau pilikia:

• ʻO ka ʻāpana o ka esophagus i hoʻoponopono ʻia e hele a ololi paha. Pono paha kāu keiki e hana i kahi ʻoki hou e mālama ai i kēia.
• He maʻi puʻuwai puʻuwai paha kāu keiki, a i ʻole reflux gastroesophageal (GERD). Kū kēia i ka hele ʻana o ka waikawa mai loko o ka ʻōpū i loko o ka esophagus. Hoʻokumu paha ʻo GERD i nā pilikia hanu.

I ka wā kamaliʻi a me ka wā kamaliʻi, nui nā keiki i nā pilikia me ka hanu ʻana, ka ulu ʻana, a me ka hānai ʻana, a pono e hoʻomau i ka ʻike ʻana i kā lākou kahu mālama mua a me nā loea.

ʻO nā pēpē me TEF a me EA i loaʻa nā kīnā o nā meaola ʻē aʻe, ʻo ka mea maʻamau ka puʻuwai, loaʻa paha nā pilikia olakino lōʻihi.

Hoʻoponopono ʻo TEF; Hoʻoponopono hou ʻo Esophageal atresia

• Ke lawe nei i kāu keiki e kipa i kahi kaikaina maʻi loa
• Mālama ʻeha ʻeha - wehe

• Hoʻoponopono tracheoesophageal fistula - moʻo

ʻO Madanick R, Orlando RC. ʻO Anatomy, histology, embryology, a me nā anomalies ulu o ka esophagus. I: Feldman M, Friedman LS, Brandt LJ, eds. ʻO Sleisenger a me Fordtran's Gastrointestinal a me ka maʻi Liver: Pathophysiology / Diagnosis / Management. 10 o ka lā. Piladelapia, PA: Elsevier Saunders; 2016: chap 42.

ʻO Rothenberg SS. Esophageal atresia a me tracheoesophageal fistula malformations. I: Holcomb GW, Murphy P, St. Peter SD, eds. ʻO Holcomb a me Ashcraft's Pediatric Surgery. ʻEpekema 7 Piladelapia, PA: Elsevier; 2020: chap 27.