Esophagectomy - hoʻohaunaele minimally

ʻO ka esophagectomy hōʻemi minimally invasive kahi ʻoki e wehe i kahi ʻāpana a i ʻole nā ​​esophagus āpau. ʻO kēia paipu e hoʻoneʻe i ka meaʻai mai kou puʻu i kou ʻōpū. Ma hope o ka hemo ʻana, kūkulu hou ʻia ka esophagus mai ka ʻāpana o kou ʻōpū a i ʻole kahi ʻāpana o kou ʻōpū nui.

ʻO ka hapanui o ka manawa, hana ʻia ka esophagectomy e mālama i ka maʻi ʻaʻai o ka esophagus. Hiki ke hana ʻia ke ʻoki e mālama ai i ka esophagus inā ʻaʻole e hana hou e hoʻoneʻe i ka meaʻai i loko o ka ʻōpū.

I ka wā o ka esophagectomy hōʻemi minimally invasive, hana ʻia kahi ʻoki liʻiliʻi (ʻokiʻoki) i kou ʻōpū o luna, ka umauma, a me kou ʻāʻī. Hoʻokomo ʻia kahi pae nānā (laparoscope) a me nā pono hana ma o nā ʻoki e hana i ke ʻoki. (Hiki ke hoʻopau ʻia ka esophagus me ka hoʻohana ʻana i ke ʻano hāmama. Hana ʻia ke kaha ma o nā kaha nui.)

Hana ʻia ka ʻoki laparoscopic ma ke ʻano penei:

• E loaʻa iā ʻoe ka anesthesia laulā i ka manawa o kāu ʻoki.Mālama kēia iā ʻoe i ka hiamoe a me ka ʻole o ka ʻeha.
• Hana ke kauka iā 3 a i ʻehā mau ʻoki liʻiliʻi i kou ʻōpū o luna, ka umauma, a i ʻole ʻāʻī lalo. ʻO kēia mau ʻoki ma kahi o 1-ʻīniha (2.5 cm) ka lōʻihi.
• Hoʻokomo ʻia ka laparoscope ma o kekahi o nā ʻoki i loko o kou ʻōpū o luna. Loaʻa ka laulā i kahi kukui a me ka pahu paʻi kiʻi ma ka hopena. Hōʻike ʻia ke wikiō mai ka pahu paʻi kiʻi ma kahi monitor ma ka lumi lumi. ʻAe kēia i ke kaukipō e ʻike i ka wahi e hana nei. Hoʻokomo ʻia nā mea hana ʻē aʻe i loko o nā ʻoki ʻē aʻe.
• Hoʻokuʻu ka kaukipō i ka esophagus mai nā aʻa kokoke. Kaukaʻi ʻia i ka nui o kāu esophagus i maʻi, ʻāpana a wehe ʻia paha ka hapanui o lākou.
• Inā hoʻoneʻe ʻia kahi ʻāpana o kāu esophagus, hoʻohui ʻia nā koena i koe me ka hoʻohana ʻana i nā staples a i ʻole nā ​​kuʻi. Inā hoʻoneʻe ʻia ka hapa nui o kāu esophagus, hoʻololi ke kaukipō i kou ʻōpū i loko o kahi paipu e hana i kahi esophagus hou. Hoʻopili ʻia i ka ʻāpana i koe o ka esophagus.
• I ka wā o ke ʻoki ʻana, lawe ʻia nā lymph node ma kou umauma a me kou ʻōpū inā ua pālahalaha ka maʻi ʻaʻai iā lākou.
• Hoʻokomo ʻia kahi paipu hānai i kāu ʻōpū liʻiliʻi i hiki ai iā ʻoe ke hānai ʻia ʻoiai ʻoe e hoʻōla nei mai ke ʻoki kino.

Hana kekahi o nā keʻena lapaʻau i kēia hana me ka hoʻohana ʻana i ke kāpoki robotic. I kēia ʻano ʻoki, hoʻokomo ʻia kahi liʻiliʻi a me nā mea hana ʻē aʻe ma o nā ʻoki liʻiliʻi o ka ʻili. Hoʻopili ke kaukōkō i ka laulā a me nā mea kani i ka noho ʻana ma kahi kikowaena kamepiula a me ka nānā ʻana i kahi nānā.

Lawe ka hana ʻoki kino i 3 a 6 mau hola.

ʻO ke kumu maʻamau no ka hemo ʻana i kahi ʻāpana, a i ʻole nā ​​mea āpau o kāu esophagus e mālama i ka maʻi ʻaʻai. Loaʻa paha iā ʻoe kahi radiation radiation a chemotherapy paha ma mua a ma hope paha o ke kaha ʻana.

Hiki ke hana i kahi ʻoki e wehe i ka esophagus lalo e mālama ai:

• ʻO kahi kūlana kahi e holo pono ʻole ai ke apo o ka mākala i ka esophagus (achalasia)
• ʻO ka hōʻino nui o ka uhi ʻana o ka esophagus i hiki ke alakaʻi i ka maʻi ʻaʻai (Barrett esophagus)
• Trauma ʻeha

ʻO kēia ke kaha nui a nui nā pilikia. Kūhewa kekahi o lākou. E noʻonoʻo e kūkākūkā i kēia mau pōpilikia me kāu kauka.

Nā kiʻina no kēia ʻoki ʻana, a no nā pilikia ma hope o ke kaha ʻana, ʻoi aku paha ma mua o ka maʻamau inā ʻoe:

• ʻAʻole hiki ke hele wāwae no kahi mamao loa (hoʻonui kēia i ka makaʻu o ke kahe o ke koko, nā pilikia o ka mumū, a me nā ʻeha puʻe)
• Aia ma mua o 60 a 65
• He puhipuhi kaumaha ʻoe
• Ua momona
• Ua lilo ka nui o ke kaupaona mai kou maʻi ʻaʻai
• Aia i nā lāʻau steroid
• Loaʻa i nā lāʻau ʻaʻai ma mua o ke ʻoki

Nā pilikia no ka anesthesia a me ke kahakaha ʻana ma:

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

ʻO nā pilikia no kēia ʻoki kino penei:

• ʻO ka reflux ʻakika
• ʻO ka hōʻeha i ka ʻōpū, ʻōpū, akemāmā, a i ʻole nā ​​mea ʻē aʻe i ka wā o ke ʻoki
• Kulu o nā ʻike o kāu esophagus a i ʻole ka ʻōpū kahi i hui pū ai ka mea lapaʻau
• Ka liʻiliʻi o ka pilina ma waena o kou ʻōpū a me kou esophagus
• Pulumonia

E loaʻa ana iā ʻoe nā kipa kauka he nui a me nā hoʻokolohua olakino ma mua o kāu ʻoki ʻana. ʻO kekahi o kēia mau mea:

• ʻO kahi hoʻokolokolo kino piha.
• ʻO nā kipa me kāu kauka e hōʻoia i nā pilikia olakino ʻē aʻe āu e loaʻa ai, e like me ka maʻi diabetes, ke koko kiʻekiʻe, a me nā pilikia o ka puʻuwai a me ka hanu.
• ʻLelo aʻoaʻo kino.
• He kipa a papa paha e aʻo ai i ka mea e hana ai i ke kahakaha ʻana, ka mea āu e manaʻo ai ma hope, a he aha nā pilikia a pilikia paha e hiki mai ana ma hope.
• Inā ua lilo kou kaumaha i kēia manawa, hiki i kāu kauka ke kau iā ʻoe i ka meaʻai a waha a i ʻole IV no kekahi mau pule he nui ma mua o ke kahakaha ʻana.
• CT scan e nānā i ka esophagus.
• Nānā ʻo PET e ʻike i ka maʻi ʻaʻai a inā ua pālahalaha ia.
• Endoscopy e kuhi a ʻike i ka mamao o ka maʻi ʻaʻai.

Inā ʻoe he puhipaka, pono ʻoe e hooki i kekahi mau pule ma mua o ke kahakaha ʻana. E noi i kāu mea mālama ola no ke kōkua.

E haʻi i kāu mea hāʻawi:

• Inā hāpai ʻoe a hāpai paha ʻoe.
• He aha nā lāʻau, nā wikamina, a me nā mea hoʻopili ʻē aʻe āu e lawe nei, ʻo nā mea āu i kūʻai ai me ka ʻole o ka lāʻau.
• Inā inu nui ʻoe i ka waiʻona, ʻoi aku ma mua o 1 a 2 paha inu i ka lā.

I loko o ka pule ma mua o ke kahakaha ʻana:

• E noi ʻia paha ʻoe e haʻalele i ka lawe ʻana i nā lāʻau ʻoi aku ke koko. ʻO kekahi o kēia mau aspirin, ibuprofen (Advil, Motrin), wikamina E, warfarin (Coumadin), a me clopidogrel (Plavix), a i ʻole ticlopidine (Ticlid).
• E noi i kāu kauka i nā lāʻau e pono ai ʻoe e lawe i ka lā o ke ʻoki.
• E hoʻomākaukau i kou home no ka pau ʻana o ke kaha.

I ka lā o ke kaha ʻana:

• E hāhai i nā ʻōkuhi i ka wā e hōʻoki ai i ka ʻai a me ka inu ma mua o ke kaha ʻana
• E lawe i nā lāʻau a kāu kauka i haʻi aku ai iā ʻoe e lawe me kahi wahi wai ʻuʻuku.
• E hōʻea i ka haukapila i ka manawa.

Noho ka hapa nui o ka poʻe i ka haukapila no 7 a 14 mau lā ma hope o ka esophagectomy. Pehea kou lōʻihi e hilinaʻi ai i ke ʻano o ke ʻoki āu i loaʻa. Hiki iā ʻoe ke hoʻolilo i 1 a 3 mau lā i ke keʻena mālama maʻi (ICU) ma hope pono o ke kaha ʻana.

I kou noho ma ka haukapila, e:

• Noi ʻia e noho ma ka ʻaoʻao o kou wahi moe a hele wāwae i ka lā a i ʻole ka lā ma hope o ke kaha ʻana.
• ʻAʻole hiki ke ʻai no ka liʻiliʻi ma ka 2 a 7 mau lā ma hope o ke kaha ʻana. Ma hope o kēlā, hiki paha iā ʻoe ke hoʻomaka me nā wai. E hānai ʻia ʻoe ma o kahi paipu hānai i hoʻokomo ʻia i loko o kou ʻōpū i ke kau ʻana.
• E kiʻi i kahi paipu mai ka ʻaoʻao o kou umauma e hoʻokahe i nā wai e kūkulu.
• E komo i nā stocking kūikawā i kou mau wāwae a me kou mau wāwae e pale ai i ke koko koko.
• Loaʻa nā kī ʻana i mea e pale aku ai ke kahe o ke koko.
• Loaʻa i nā lāʻau ʻeha ma o ka IV a i ʻole lawe i nā huaale. Hiki iā ʻoe ke loaʻa i kāu lāʻau ʻeha ma o ka pauma kūikawā. Me kēia pauma, kaomi ʻoe i ke pihi e lawe i nā lāʻau ʻeha ke pono ʻoe. ʻAe kēia iā ʻoe e kaohi i ka nui o nā lāʻau ʻeha e loaʻa iā ʻoe.
• Hana i nā hana hanu.

Ma hope o kou hoʻi ʻana i ka home, e hāhai i nā ʻōkuhi pehea e mālama ai iā ʻoe iho i kou wā e hoʻōla ai. E hāʻawi ʻia ʻoe i ka ʻike e pili ana i ka papaʻai a me ka ʻai ʻana. E mālama pono i kēlā mau ʻōlelo aʻo.

Ola maikaʻi nā poʻe he nui mai kēia ʻoki a hiki ke loaʻa i kahi papaʻai maʻamau maʻamau. Ma hope o ke ola ʻana, pono paha lākou e ʻai i nā ʻāpana liʻiliʻi a ʻai pinepine.

Inā ua ʻoki ʻoe iā ʻoe no ka maʻi ʻaʻai, e kamaʻilio me kāu kauka e pili ana i nā kaʻina hou aʻe e mālama ai i ka maʻi ʻaʻai.

ʻO ka esophagectomy hōʻemi liʻiliʻi; Robotic esophagectomy; ʻO ka hemo ʻana o ka esophagus - hōʻemi minimally invasive; Achalasia - esophagectomy; Barrett esophagus - ʻaihopili; Maʻi ʻaʻai Esophageal - esophagectomy - laparoscopic; Ka maʻi ʻaʻai o ka esophagus - esophagectomy - laparoscopic

• Meaʻai wai maopopo
• ʻO kaʻai a me ka ʻai ʻana ma hope o ka esophagectomy
• Esophagectomy - hoʻokuʻu
• Tube hānai Gastrostomy - bolus

• Maʻi ʻaʻai Esophageal

ʻO Donahue J, Carr SR. ʻO ka esophagectomy hōʻemi liʻiliʻi. I: Cameron JL, Cameron AM, eds. ʻO ke kaʻoki lāʻau lapaʻau o kēia manawa. 12th ed. Piladelapia, PA: Elsevier; 2017: 1530-1534.

Pūnaewele ʻo National Cancer Institute. Hoʻomaʻamaʻa maʻi ʻaʻai Esophageal (PDQ) - mana ʻoihana olakino. www.cancer.gov/types/esophageal/hp/esophageal-treatment-pdq. Hoʻohou Nowemapa 12, 2019. Loaʻa iā Nowemapa 18, 2019.

ʻO Spicer JD, Dhupar R, Kim JY, Sepesi B, Hofstetter W. Esophagus. I: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. ʻO Sabiston Textbook of Surgery. 20 ouk. Piladelapia, PA: Elsevier; 2017: chap 41.