Transjugular intrahepatic portosystemic shunt (TIPS)

ʻO kahi transjugular intrahepatic portosystemic shunt (TIPS) kahi hana e hana i nā pilina hou ma waena o ʻelua kīʻaha koko i kou ake. Pono ʻoe i kēia kaʻina hana inā loaʻa iā ʻoe nā pilikia koʻikoʻi o ke ake.

ʻAʻole kēia kahi kaʻina hana. Hana ʻia ia e kahi radiologist intervenal e hoʻohana ana i ke alakaʻi x-ray. He kauka radiologist he kauka nāna e hoʻohana i nā kiʻina kiʻi e ʻike pono a mālama i nā maʻi.

E noi ʻia ʻoe e moe i kou kua. E hoʻopili ʻia ʻoe i nā mea nānā e nānā i ka helu o kou puʻuwai a me ke kaomi koko.

E loaʻa paha iā ʻoe kahi anesthesia kūloko a me nā lāʻau e hoʻomaha ai iā ʻoe. ʻO kēia ka mea e hōʻeha ai ʻoe i ka ʻeha a hiamoe. A i ʻole, loaʻa paha iā ʻoe kahi anesthesia āpau (hiamoe a ʻaʻohe ʻeha).

Ma ke kaʻina hana:

• Hoʻokomo ke kauka i kahi catheter (kahi ʻōwili maʻalahi) ma o kou ʻili i kahi aa i kou ʻāʻī. Kapa ʻia kēia aa koko ʻo ka veic jugular. Ma ka wēlau o ka catheter kahi balloon liʻiliʻi a me kahi stent metal tube (Tube).
• Ke hoʻohana nei i kahi mīkini x-ray, alakaʻi ke kauka i ka catheter i kahi aa i loko o kou ake.
• Hoʻokomo ʻia ka kala (ʻāpana ʻokoʻa) i loko o ka aa koko i hiki ai ke ʻike maopopo ʻia.
• Hoʻonui ʻia ka pāluna e kau i ka stent. E ʻeha iki paha ʻoe ke kū kēia.
• Hoʻohana ke kauka i ka stent e hoʻohui i kāu veins portal i kekahi o kāu mau veins hepatic.
• I ka hopena o ke kaʻina hana, ana ʻia kou puʻuwai koko e ʻike pono ua iho i lalo.
• Lawe ʻia ka catheter me ka baluna.
• Ma hope o ke kaʻina hana, kau ʻia kahi kaula liʻiliʻi ma luna o ka ʻāʻī. ʻAʻohe maʻamau o nā humuhumu.
• Lawe ʻia ke kaʻina hana ma kahi o 60 a 90 mau minuke e hoʻopau ai.

E ʻae kēia ala hou e kahe maikaʻi ke koko. E hoʻomāmā ia i ke kaomi o nā ʻōpū o kou ʻōpū, esophagus, ʻōpū, a me ke ake.

ʻO ka maʻamau, ke kahe mai ke koko mai kou esophagus, ʻōpū, a me nā ʻōpū ma loko o ke ake. Ke loaʻa nā ʻino he nui o kou akepa a aia nā ālai, ʻaʻole hiki i ke koko ke kahe ma waena o ia me ka maʻalahi. Kapa ʻia kēia ʻo hypertension portal (hoʻonui i ka kaomi a me ka kākoʻo o ka veins portal). Hiki i nā uaua ke hāmama (haki), a laila kahe nui ke kahe.

ʻO nā kumu maʻamau o ka hypertension portal ka:

• ʻAlekohola e hoʻohana ana i ka scarring o ke ake (cirrhosis)
• Hoʻopili ke koko i kahi aa koko e kahe ana mai ke ake a i ka puʻuwai
• Nui loa ka hao i ke ake (hemochromatosis)
• Hepatitis B a i ʻole hepatitis C

Ke hiki i ka hypertension portal, loaʻa iā ʻoe:

• Kahe ʻana mai nā veins o ka ʻōpū, esophagus, a i ʻole nā ​​ʻōpū (kahe koko)
• Kūkulu o ka wai i loko o ka ʻōpū (ascites)
• Kūkulu o ka wai i ka umauma (hydrothorax)

ʻAe kēia hana i ke kahe e kahe maikaʻi i kou ake, ʻōpū, esophagus, a me nā ʻōpū, a laila hoʻi i kou puʻuwai.

ʻO nā pilikia kūpono me kēia kaʻina hana:

• Poino i nā kīʻaha koko
• Fiva
• Hepatic encephalopathy (kahi maʻi e hoʻopili i ka noʻonoʻo, ka noʻonoʻo, a me ka hoʻomanaʻo, a hiki i ke koma)
• ʻO ka maʻi, bruising, a kahe paha
• Nā hopena i nā lāʻau a i ʻole ke kala
• ʻOʻoleʻa, ʻeha a ʻeha hoʻi i ka ʻāʻī

ʻO nā pilikia nui ʻole:

• Kahe i ka ʻōpū
• Pākuʻi i ka stent
• ʻO keʻoki ʻana i nā kīʻaha koko i ke ake
• Nā pilikia puʻuwai a i ʻole nā ​​mele puʻuwai maikaʻi ʻole
• ʻO ka maʻi o ka stent

E noi paha kāu kauka iā ʻoe e hana i kēia mau hoʻokolohua:

• Nā hoʻokolohua koko (helu piha i ke koko, nā electrolytes, a me nā hoʻāʻo ʻana o nā puʻupaʻa)
• Pākuʻi x-ray a i ʻole ECG

E haʻi i kāu mea mālama ola:

• Inā ʻoe a hāpai paha
• ʻO nā lāʻau āu e lawe nei, ʻo nā lāʻau paha, nā mea hoʻopihapiha, a me nā mea kanu āu i kūʻai ai me ka ʻole o ka lāʻau.

I ka lā o kāu kaʻina hana:

• E hāhai i nā ʻōkuhi i ka wā e hōʻoki ai i ka ʻai a me ka inu ma mua o ke kaʻina hana.
• E noi i kāu kauka i nā lāʻau e pono ai ʻoe e lawe i ka lā o ke kaʻina hana. E lawe i kēia mau lāʻau me kahi wahi wai liʻiliʻi.
• E hāhai i nā ʻōkuhi no ka ʻauʻau ma mua o ke kaʻina hana.
• E hōʻea i ka manawa kūpono i ka haukapila.
• Pono ʻoe e hoʻolālā e noho pō i ka haukapila.

Ma hope o ke kaʻina hana, e ola ʻoe i loko o kou keʻena haukapila. E kiaʻi ʻia ʻoe no ke kahe. E mālama pono ʻoe i kou poʻo.

ʻAʻohe maʻamau ma hope o ke kaʻina hana.

Hiki iā ʻoe ke hoʻi i ka home ke maikaʻi ʻoe. ʻO kēia paha ka lā ma hope o ke kaʻina hana.

Hoʻi ka poʻe he nui i kā lākou hana i kēlā me kēia lā ma 7 a 10 mau lā.

E hana paha kāu kauka i kahi ultrasound ma hope o ke kaʻina hana e hōʻoia i ka hana pono ʻana o ka stent.

E noi ʻia ʻoe e hana i kahi ultrasound hou i loko o kekahi mau pule e ʻike pono ke holo nei ka hana TIPS.

Hiki i kāu radiologist ke haʻi koke iā ʻoe i ka maikaʻi o ke kaʻina hana. Ola ka hapa nui o ka poʻe.

Hana ʻo TIPS ma kahi o 80% a 90% o nā hihia hypertension portal.

ʻOi aku ka palekana o ke kaʻina hana ma mua o ke kahakaha ʻana a ʻaʻole pili i kahi ʻoki a i ʻole nā ​​kuʻi.

ʻPSlelo AINA; Cirrhosis - TIPS; Hoka kō ʻole - TIPS

• Cirrhosis - hoʻokuʻu

• Transjugular intrahepatic portosystemic shunt

ʻO Darcy MD. Transjugular intrahepatic portosystemic shunting: nā hōʻailona a me ke ʻano hana. I: Jarnagin WR, hoʻoponopono. ʻO Blumgart's Surgery of the Liver, Biliary Tract, a me Pancreas. ʻElua huaʻōlelo Piladelapia, PA: Elsevier; 2017: chap 87.

Dariushnia SR, Haskal ZJ, Midia M, et al. ʻO nā kulekele hoʻomaikaʻi maikaʻi no nā transjugular intrahepatic portosystemic shunts. ʻO J Vasc Interv Radiol. 2016; 27 (1): 1-7. PMID: 26614596 www.ncbi.nlm.nih.gov/pubmed/26614596.