Colovesical Fistula
Anter
Hōʻike Overview
ʻO kahi colovesical fistula kahi kūlana. He pilina wehe i waena o ke kolona (ʻōpū nui) a me ka pūpū. Hiki i kēia ke ʻae i ka mea fecal mai ke kolone e komo i loko o ka puhā, a lilo i nā maʻi ʻeha a me nā pilikia ʻē aʻe.
ʻO ke kolona, ka mea e kōkua ai i ka hoʻolahalaha e hoʻokuʻu ʻia ma o ka rectum, e noho ma luna o ka pākeke. Mālama ka ʻōmole i ka mimi ma mua o ka hoʻokuʻu ʻia ma o ka urethra. Hoʻokaʻawale ka paia mānoanoa o nā iʻa i ke kolona a me ka ʻai. Hiki i ke ʻoki kino a i ʻole ʻeha ʻē aʻe i kēia ʻāpana o ke kino ke hana i kahi fistula. Ke hoʻomohala kahi wehe, ʻo ka hopena he colovesical fistula, i ʻike ʻia ʻo vesicocolic fistula.
Hiki ke mālama ʻia kahi fistula colovesical. Eia nō naʻe, no ka mea maʻamau ʻole ia, aia ka palena o ka ʻike e pili ana i ka maikaʻi e mālama ai i kēia ʻano ʻeha.
Nā ʻōuli
E ʻike paha ʻoe he fistula colovesical kāu inā hoʻomohala ʻoe i kekahi o ia me:
- Pneumaturia. ʻO kēia kahi o nā hōʻailona maʻamau. Hana ʻia ia a hui ka gas mai ke kolona me ka mimi. ʻIke paha ʻoe i nā huʻa i loko o kāu mimi.
- Fecaluria. Hana ʻia kēia ʻōuli ke loaʻa iā ʻoe ka hui o ka fecal mea i ka mimi. E ʻike ʻoe i kahi kala ʻeleʻele a i ʻole ao i kāu mimi.
- Dysuria. ʻO kēia ʻōuli ke kumu o ka ʻeha a i ʻole ke ahi ke ʻimi ʻoe, a me nā maʻi urinary tract (UTI) hou. Hiki iā ia ke hoʻomohala mai nā huhū o ka pūpū, akā kokoke i ka hapalua o nā hihia fistula colovesical i loaʻa me ka disuria.
Nā kumu a me nā hōʻailona
ʻOi aku ma mua o ka hapalua o nā hihia colovesical fistula ka hopena o ka maʻi diverticular.
ʻO nā kumu colovesical fistula e komo pū:
- maʻi ʻaʻai kala
- maʻi maʻi ʻōpū, ʻo ia hoʻi ka maʻi ʻo Crohn
- ʻoki kino e pili ana i ke kolona a i ʻole ka ʻai
- radiotherapy (kahi ʻano o ka mālama ʻana i ka maʻi ʻaʻai)
- maʻi ʻaʻai o nā meaola e pili ana
Kuhi ʻia kahi colovesical fistula e hana ʻia me kahi cystography, kahi ʻano o ka hoʻokolohua kiʻi. I ka wā o ke kaʻina hana, hoʻokomo kāu kauka i kahi paipu lahilahi a maʻalahi me kahi kāmela i hoʻokahi wēlau i kāu bladder. Hāʻawi ke kāmela i nā kiʻi o ka paia bladder i kahi kamepiula, i hiki i kāu kauka ke ʻike inā aia he fistula.
ʻO kahi hana kiʻi ʻē aʻe i kōkua ʻia he barium enema. Hiki i kēia ke kōkua i ka ʻike ʻana i nā pilikia me ke kolona. I ka wā o ke kaʻina hana, hoʻokomo kāu kauka i kahi wai liʻiliʻi i loko o ka metala barium i loko o kāu poloka ma o kahi ʻōpala liʻiliʻi. E uhi ka wai barium i ka loko o ka poloka, e ʻae nei i kahi kāmela X-ray kūikawā e ʻike i ka mea palupalu i ke kolona ma ke kikoʻī ʻoi aku ma mua o ka X-ray maʻamau.
ʻO nā kiʻi o ka fistula, a me kahi hoʻokolohua kino, hōʻailona o ka mimi, a me kahi loiloi o nā ʻōuli ʻē aʻe, hiki ke kōkua i kāu kauka e hōʻoia i kahi colovesical fistula.
Nā koho lapaʻau
ʻO ka lāʻau i makemake ʻia no ka colovesical fistula ka ʻoki kino.
Hiki ke hoʻāʻo ʻia ka mālama Conservative inā liʻiliʻi ka fistula, ʻaʻole no ka malignancy, a aia i ka mea maʻi me nā ʻōuli palena. Hiki paha i nā kauka ke koi aku i ka mālama conservative ke loaʻa ka maʻi i nā maʻi ʻē aʻe nui loa, ʻaʻole manaʻo ʻia ke kīpē he palekana, a i ka wā e holo mua ai ka maʻi ʻaʻai. Pākuʻi ʻia paha i ka mālama Conservative:
- hānai ʻia i loko o kāu mau uaua i ʻole e holo pono kāu ʻōpū a hiki ke hoʻomaha
- nā lāʻau antibiotic a me nā lāʻau steroid
- ke hoʻokomo ʻia nei o kahi catheter i loko o ka pahu wai e hoʻokahe i ka wai i komo mai i loko o ka kolone
ʻO ka pahuhopu o ka mālama conservative no ka fistula e pani a hoʻōla iā ia iho. Eia nō naʻe, pono paha ke kahakaha ʻana ma nā hihia kahi e hoʻōla ʻole ai ka fistula iā ia iho.
Ma muli o ka hoʻopiʻi ʻana o ka colovesical fistula i ka diverticulitis, e mālama pono i nā kauoha a kāu kauka i ka mālama ʻana i ka maʻi diverticular. I kekahi mau hihia, lawa nā lāʻau e hōʻoki i ka holomua o ke ʻano.
ʻOki kino
Ke kūpono ʻole a maikaʻi ʻole paha ka conservative therapy, pono ʻoe i ke ʻoki kino. Hiki i kahi hana ke wehe a hoʻoponopono hou paha i ka fistula a kāpae i ka hoʻololi o nā wai ma waena o ka hakahaka a me ke kolona.
ʻO ke ʻano o ke kaha ʻana e pono ai e mālama i kahi colovesical fistula e pili ana i ka etiology (kumu), ke koʻikoʻi, a me kahi o ka fistula. ʻO ka maʻamau, no kēia mau hihia, hoʻohana nā kauka i kahi ʻano o ke ʻoki i kapa ʻia he colectomy sigmoid. Hoʻopili kēia ʻoki ʻana i ka lawe ʻana i kahi ʻāpana o ke kolona lalo.Hoʻopili pū ke kaʻina hana i ka hemo ʻana o ka fistula ponoʻī, a me ka pā ʻana i luna o ke kolona a me ka ʻai.
Hana ʻia paha ka hana me ke kaha hāmama. Hana nā kauka i kahi ʻoki nui i loko o ka ʻōpū, a i ʻole hele i ka laparoscopically, e pili ana i nā pono hana ʻokiʻoki lahilahi a me kekahi mau ʻoki liʻiliʻi. Hoʻohana pinepine ʻia ka ʻoki laparoscopic no kēia kaʻina hana no ka mea hana ia no ka wikiwiki hou ʻana a hoʻemi i ka makaʻu pilikia. I hoʻokahi noiʻi, ʻo ka manawa maʻamau o ka ʻoki laparoscopic e hoʻomaikaʻi ai i kahi colovesical fistula ma kahi o ʻelua mau hola.
Hoʻoponopono ke kīʻaha me kēlā me kēia ʻano:
- e moe ana ma luna o kahi pākaukau me nā wāwae i nā mea hoʻowali (ʻike ʻia ke kūlana lithotomy)
- anesthesia laulā
- kahi ʻoki ākea ākea a i ʻole nā ʻoki laparoscopic he nui
- ka hoʻokaʻawale ʻana o ke kolona a me ka ʻai, kahi e neʻe aku ai i kahi kaʻawale e hoʻomau i ke kaʻina hana
- wehe ʻoki o ka fistula (kahi hana i ʻike ʻia ma ke ʻano he resection)
- hoʻoponopono i nā kīnā a i ʻole ʻeha i ka pūpū a me / a i ʻole kolona
- ka hoʻoneʻe ʻana o ke kolona a me ka huki i ko lākou mau kūlana kūpono
- ke kau ʻana i kahi patch kūikawā ma waena o ke kolona a me ka ʻai e kōkua ai i ka pale ʻana i nā fistula o ka wā e hiki mai ana
- pani o nā ʻoki āpau
Hoʻoiho
Ua ʻike ʻia kahi noiʻi Ausetalia no ka hana ʻana o ka laparoscopic colovesical fistula i ka noho maʻamau ʻana o ka haukapila ma hope o ke kaha ʻana he ʻeono lā. I loko o ʻelua mau lā, hoʻi ka ʻōpū maʻamau. ʻO kahi hihia hihia o kahi kāne 58 makahiki i hana i kahi ʻoki ākea e mālama i kahi colovesical fistula i loaʻa ua maikaʻi ʻo ia i ʻelua mau lā ma hope o ka hana. Ua hala ʻo ia i ka mimi maʻemaʻe i ʻelua mau lā ma hope pū kekahi.
E kauoha aku kāu kauka i nā lāʻau antibiotic me ka nānā ʻole i ke ʻano o ke ʻoki a me nā ʻoki ʻana āu e hana ai.
Pono ʻoe e ala aʻe a hele wāwae i ka lā ma hope o kou ʻoki ʻana. Inā he pilikia, eia naʻe, ʻōlelo ʻia paha ʻoe e noho i kahi moena no hoʻokahi lā a ʻelua paha. Inā kūleʻa ke kaha ʻana, pono ʻoe e hoʻomaka hou i nā hana maʻamau, e like me ka piʻi ʻana i ke alapiʻi a me ka hoʻokele, i loko o hoʻokahi pule a ʻelua paha. E like me kēlā me kēia ʻoki ʻana i ka wahi o ka ʻōpū, pono ʻoe e hōʻalo i ka hāpai ʻana i kekahi mea kaumaha no ʻelua mau pule. E kamaʻilio pono me kāu kauka e pili ana i nā palena i kāu mau hana.
E hāʻawi ʻia ʻoe i ka papaʻai wai-mōakāka i ka lā mua a ma hope paha o ke kaha ʻana. A laila e neʻe ʻoe i luna i nā meaʻai palupalu, a laila i kahi papaʻai maʻamau. Inā loaʻa ʻoe i ka maʻi diverticular, ʻōlelo ʻia paha ʻoe e ʻai i ka papaʻai kiʻekiʻe-fiber. E pili ana nā kikoʻī o kāu papaʻai i kāu pilikia olakino ʻē aʻe. Inā nui ʻoe i ka momona, e aʻo ʻia ʻoe e hāhai i kahi hoʻolālā hōʻemi kaumaha me ka hoʻololi o ka papaʻai a me ka hoʻoikaika mau.
Inā ʻike ʻoe i ka wehe ʻana o nā ʻokiʻoki, ka nui o ka paʻa paʻa ʻana, ke kahe ʻana o ke kahe mai kou pā, a i ʻole ka mimi discolored, e kāhea i kāu kauka. ʻAʻole pili ka ʻeha i ka hoʻōla a me nā hōʻailona o ka maʻi i nā wahi hoʻopaʻa e like me ka ʻulaʻula, ka mehana, a i ʻole ka hoʻokahe mānoanoa ma hope o ke kaha ʻana.
Outlook
ʻOiai ʻeha, hiki ke mālama maikaʻi ʻia kahi colovesical fistula. Pēlā nō ia no nā kumu kumu, e like me ka maʻi diverticular. ʻOiai pono paha ʻoe e hoʻololi i kāu papaʻai a me kou nohona, ʻaʻole pono kēia mau ʻano a me kā lākou mālama ʻana i nā pilikia lōʻihi.
NāʻAtikala Hou
Burn Evaluation
