Distal splenorenal shunt

ʻO kahi distal splenorenal shunt (DSRS) kahi ʻano o ke kaha ʻana i hana ʻia e hōʻoluʻolu ai i ke kaomi keu i loko o ka veins portal. Lawe ka puka koko i ke koko mai kāu mau ʻōnaehana digestive i kou ake.

Ma loko o DSRS, wehe ʻia ke aʻa mai kou pūlima mai ka puka koko. Hoʻopili ka uaua i ka aa i kou puʻuwai hema. Kōkua kēia i ka hoʻoliʻiliʻi o ke kahe o ke koko ma o ka veins portal.

Lawe ke kīʻaha awa i ke koko mai ka ʻōpū, nā mānoanoa, ka pancreas, a me ka gallbladder i ke ake. Ke ālai ʻia ke kahe o ke koko, kiʻekiʻe loa ke kaomi o kēia aa. Kapa ʻia kēia ʻo portal hypertension. Kū pinepine ia ma muli o ka hōʻino o ke ake i hoʻokumu ʻia e:

• Hoʻohana rama
• ʻO ka hepatitis viral maʻi
• Huʻi koko
• ʻO kekahi mau maʻi hānau
• ʻO ka cirrhosis biliary mua (nā ʻāpala ate i hoʻokumu ʻia e nā aʻa palalā i ālai ʻia)

Ke hiki ʻole ke kahe o ke koko ma o ka vein portal, lawe ia i kahi ala ʻē aʻe. A ʻo ka hopena, pehu nā kīʻaha koko i kapa ʻia he varises form. Hoʻolālā lākou i nā paia lahilahi hiki ke haki a kahe.

Loaʻa paha iā ʻoe kēia ʻoki inā hōʻike nā hōʻike kiʻi e like me ka endoscopy a i ʻole nā ​​kukuna x he maʻi koko kou. Hoʻoemi ke kahakaha DSRS i ke kaomi ma luna o nā ʻoka a kōkua i ka mālama ʻana i ke kahe ʻana.

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

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

ʻO nā pōʻino o kēia ʻoki ʻana:

• Kūkulu o ka wai i loko o ka ʻōpū (ascites)
• E hana hou i ke kahe ʻana mai nā varises
• Encephalopathy (nalo o ka hana o ka lolo no ka mea ʻaʻole hiki i ke ake ke wehe i nā toxins mai ke koko)

Ma mua o ke kaha ʻana, he mau hoʻokolohua paha kāu:

• Angiogram (e ʻike i loko o nā kīʻaha koko)
• Nā hoʻāʻo koko
• Hoʻopau

E hāʻawi i kāu mea mālama ola i ka papa inoa o nā lāʻau āpau āu e lawe ai e like me ka lāʻau i kuhikuhi ʻia a me ka papa kūʻai, nā mea kanu, a me nā mea hoʻopili. E nīnau i nā mea āu e pono ai e hoʻōki i ka lawe ʻana ma mua o ke kaha ʻana, a ʻo nā mea hea ʻoe e lawe ai i ke kakahiaka o ke ʻoki.

E wehewehe kāu mea lawelawe i ke kaʻina hana a haʻi iā ʻoe i ka manawa e haʻalele ai i ka ʻai ʻana a me ka inu ʻana ma mua o ke kaha.

Makemake e noho 7 a 10 mau lā i ka haukapila ma hope o ke kīpē ʻana e ola hou ai.

Ke ala ʻoe ma hope o ke kahakaha ʻana e loaʻa iā ʻoe:

• ʻO kahi paipu i kou aa (IV) e halihali i ka wai a me ka lāʻau i loko o kou kahe koko
• ʻO kahi catheter i loko o kāu pēke e hoʻokahe i ka mimi
• ʻO kahi Tube NG (nasogastric) e hele i loko o kou ihu i loko o kou ʻōpū e lawe i ke kinoea a me nā wai
• ʻO kahi pauma me kahi pihi hiki iā ʻoe ke kaomi ke pono ʻoe i ka lāʻau ʻeha

Ke hiki iā ʻoe ke ʻai a inu, hāʻawi ʻia ʻoe i nā wai a me nā meaʻai.

Loaʻa paha iā ʻoe kahi hoʻokolohua kiʻi e ʻike inā e holo nei ka shunt.

Hiki paha iā ʻoe ke launa me kahi dietitian, a aʻo pehea e ʻai ai i ka momona momona, paakai haʻahaʻa.

Ma hope o ke kaha ʻana o DSRS, kaohi ʻia ke kahe ʻana i ka hapanui o ka poʻe me ka hypertension portal. ʻO ka makaʻu kiʻekiʻe loa o ke kahe ʻana i ka mahina mua ma hope o ke kaha ʻana.

DSRS; Distal splenorenal shunt kaʻina hana; Renal - splenic venous shunt; Warren shunt; Cirrhosis - distal splenorenal; Hoka kō ʻole - distal splenorenal; Kaomi puʻuwai puka - distal splenorenal shunt

ʻO Dudeja V, ʻo Fong Y. Ke ake. I: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. ʻO Sabiston Textbook of Surgery. 20 ouk. Piladelapia, PA: Elsevier; 2017: chap 53.

Nā Weke SR, Ottmann SE, Orloff MS. ʻO ka piʻi kiʻekiʻe Portal: ke kuleana o nā kaʻina hana shunting. I: Cameron JL, Cameron AM, eds. ʻO ke kaʻoki lāʻau lapaʻau o kēia manawa. 13th ed. Piladelapia, PA: Elsevier; 2020: 387-389.