Esophagectomy - wehe

ʻO ka esophagectomy hāmama 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 a i ʻole ka ʻōpū nui i hōʻino ʻia.

I ka wā o ka esophagectomy hāmama, hana ʻia i hoʻokahi a ʻoi paha nā ʻoki lāʻau nui (incision) i loko o kou ʻōpū, umauma, a ʻāʻī. (ʻO kahi ala ʻē aʻe e hemo ai ka esophagus he laparoscopically. Hana ʻia ke kaha ma o nā ʻoki liʻiliʻi, e hoʻohana ana i kahi e ʻike ai.)

Kūkākūkā kēia ʻatikala i ʻekolu mau ʻano o ke kaha ākea. Me nā kahakaha ʻana, e loaʻa iā ʻoe ka lāʻau lapaʻau (anesthesia) e hiamoe ai ʻoe a ʻaʻohe ʻeha.

ʻO ka esophagectomy transhiatal:

• Hana ke kaukoki i ʻoki nui ʻelua. Hoʻokahi ʻoki i loko o kou ʻāʻī wahi a ʻo kekahi i loko o kou ʻōpū o luna.
• Mai kaʻokiʻoki i loko o ka'ōpū, hoʻokuʻu ka mea lapaʻau i ka'ōpū a me ka hapa haʻahaʻa o ka esophagus mai nā mea kokoke. Mai kaʻokiʻoki i ka ʻāʻī, hoʻokuʻu ke koena o ka esophagus.
• Lawe ke kaukōkō i ka ʻāpana o kāu esophagus kahi o ka maʻi ʻaʻai a i ʻole nā ​​pilikia ʻē aʻe.
• Hoʻohou hou ʻia kou ʻōpū i loko o kahi paipu e hana i kahi esophagus hou. Hoʻopili ʻia i ka ʻāpana i koe o kāu esophagus me nā staples a i ʻole nā ​​kuʻi.
• I ka wā o ke kahakaha ʻana, lawe ʻia nā lymph node ma kou ʻāʻī 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.
• Hiki ke waiho ʻia nā paipu hoʻoliʻiliʻi i ka umauma e hemo ai ka wai.

Transthoracic esophagectomy: Hana ʻia kēia ʻoki ma ke ʻano like me ke ʻano o ka transhiatal. Akā ʻo ka ʻoki luna i hana ʻia i kou umauma ʻākau, ʻaʻole ma ka ʻāʻī.

En bloc esophagectomy:

• ʻOki loa ka mea lapaʻau i kou ʻāʻī, umauma, a me kou ʻōpū. Wehe ʻia kāu esophagus āpau a me kahi o kou ʻōpū.
• Hoʻololi hou ʻia ke koena o kou ʻōpū i loko o kahi paipu a waiho ʻia i loko o kou umauma e pani ai i kou esophagus. Pili ka ʻōpū ʻōpū i ka esophagus i koe i ka ʻāʻī.
• Lawe pū ka mea lapaʻau i nā lymph node āpau i kou umauma, ʻāʻī, a me kou ʻōpū.

Lawe ka hapa nui o kēia mau hana i 3 a 6 mau hola.

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
• ʻĀhaʻi luku
• ʻO ka ʻōpū hōʻino loa

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

ʻO nā pilikia o 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, ʻoiai no kahi mamao iki (hoʻonui kēia i ka makaʻu o ke kahe o ke koko, nā pilikia o ka mumū, a me nā ʻeha puʻe)
• He ʻelemakule
• He puhipuhi kaumaha ʻoe
• Ua momona
• Ua lilo ka nui o ke kaupaona mai kou maʻi ʻaʻai
• Aia i nā lāʻau steroid
• Ua loaʻa i ka maʻi maʻi maʻiʻaʻai mai ka poino esophagus / ʻōpū
• Loaʻa i nā lāʻau maʻi ʻaʻai (chemotherapy) ma mua o ke kaha ʻana

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
• Pilikia i ka ale ʻana a i ʻole ka ʻōlelo ʻana
• Pāpale ʻōpū

E loaʻa iā ʻoe nā kipa kauka he nui a me nā hoʻokolohua olakino ma mua o ke kahakaha ʻana, e like me:

• ʻO kahi hoʻokolokolo kino piha.
• ʻO nā kipa me kāu kauka e hōʻoia ai 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 i ʻole nā ​​māmā i kaohi
• 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 haʻalele i ka puhipaka ʻana i mau mau pule ma mua o ke kaha ʻana. Hiki i kāu mea mālama ola 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 ka momona o 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 kēia ʻoki. 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 o ka 5 a 7 mau lā ma hope o ke kaha ʻana. Ma hope o kēlā, hiki 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 e pale ai i ka maʻi maʻi.

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. Ma hope o ke ola ʻana, ʻai paha lākou 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.

Trans-hiatal esophagectomy; Trans-thoracic esophagectomy; En bloc esophagectomy; ʻO ka hemo ʻana o ka esophagus - wehe; ʻO esophagectomy ʻo Ivor-Lewis, ʻaʻoki ʻo Blunt; Maʻi ʻaʻai Esophageal - esophagectomy - wehe; Ka maʻi ʻaʻai o ka esophagus - esophagectomy - wehe

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

• Maʻi ʻaʻai Esophageal

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 19, 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.