‘Tsi si dona’ le ememe le dɔwɔwɔ nɛ vɔ megbea? (Anastomotic Leak) Mina míasrɔ̃ nu tso eŋu bɔbɔe!

Èsusui kpɔ be le amekoko gã aɖe megbe la , kuxiwo ate ŋu ado mo ɖa le ŋutilãa me siwo ŋu míebuna gɔ̃ hã oa? Abe alesi ne ètsɔ tsido eve ƒo ƒu, ɣeaɖewoɣi tsi vi aɖe dona tso ƒunukpeƒea ene la, nu ma ke ate ŋu adzɔ ne ʋuka eve siwo le míaƒe ŋutilã me do ƒome to amekoko me. Le atikewɔwɔ me la, míeyɔa esia be anastomotic leak . Esi wònye be esia ate ŋu anye nu vevi aɖe ŋutɔ ta la, ele vevie ŋutɔ be wò kple wò lɔlɔ̃tɔwo mianya nu tso eŋu.

Nuka tututue nye anastomotic leak?

Kpuie ko la, anastomosis nye amekoko si me wotsɔa ŋutilã ƒe mɔ̃ eve ƒe nugbɔwo doa ka kple wo nɔewo. Tsɔe be ele be nàɖe wò dɔgbo ƒe akpa aɖe ɖa. Emegbe ele be nàgatsɔ dɔgbo ƒe akpa eve siwo wotso la aƒo ƒui. Woyɔa kadodo ma be anastomosis.

Fifia, anastomotic leak sia nye ne kadodoa metre nyuie o, eye nusiwo le tube ma me do go. Esia ate ŋu anye afɔku, elabena menyo be nusiwo le míaƒe ŋutilã ƒe mɔ̃wo me nayi teƒe bubuwo o. Le kpɔɖeŋu me, dɔlékuiwo le nusiwo le wò nuɖuɖumeŋusẽ me. Ne esiawo ɖo teƒe bubuwo le wò dɔgbo me la, woate ŋu ahe dɔlékuiwo vɛ.

Nukae dzɔna ne tsi aɖe do le dɔgboa ƒe dɔwɔwɔ vɔ megbe ?

Dɔgbo ɖeɖe nye dɔ si bɔ si me wowɔa anastomosis le, eye anastomotic leak ate ŋu adzɔ. Ne dɔgboa me nuwo sina yia ƒodoa me la, dɔlékuiwo ate ŋu axɔ dɔgboa ƒe akpa si le ƒodoa me (peritoneum) eye wòavuvu. Woyɔa esia be peritonitis . Dɔlékui sia ate ŋu akaka ɖe ŋutinu bubu siwo le ƒodo me kple ʋukawo me. Ne esẽ la, ate ŋu ahe dɔléle aɖe si ate ŋu ade ame ƒe agbe afɔku me si woyɔna be sepsis . Sepsis nye alesi ŋutilãa wɔa nu wògbɔa eme ɖe dɔlékui aɖe ŋu. Esia ate ŋu ana ame natsi dzodzodzoe , ŋutinuwo ƒe dɔmawɔmawɔ nyuie, alo ku gɔ̃ hã.

Bu nusi adzɔ ne nusiwo le míaƒe nuɖaƒe gbeɖuɖɔwo me kɔ ɖe xɔdɔme me ŋu kpɔ. Nu ma ke adzɔ ne nusiwo le míaƒe dɔgbowo me kɔ ɖe míaƒe dɔgbo me. Esia tae esia nye afɔku ale gbegbe ɖo.

Nu bubu si ate ŋu age ɖe ƒodoa me enye wò aɖuɖɔtoe. Le kpɔɖeŋu me, le ayiku dodo na ame alo ayiku ɖeɖeɖa me la, ahiã be woawɔ anastomosis na wò. Ne esia do la, aɖuɖɔ ate ŋu aƒo ƒu ɖe ƒodoa me. Woyɔa esia be aɖuɖɔtoe me dɔléle . Afɔku hã li be woaxɔ dɔlékuiwo kple dɔlékuiwutikewo le ƒodoa godo. Le kpɔɖeŋu me, ne anastomotic leak le wò nuɖuɖutome, si nye wò nuɖuɖu ƒe pɔmpi ƒe akpa aɖe la, ate ŋu ana dɔlékuiwo nadze wò akɔta.

Ɣekaɣie anastomotic leak dzɔna?

Ɣeaɖewoɣi la, tsi sia ate ŋu anɔ anyi le amekokoa wɔɣi. Gake amekolawo léa ŋku ɖe eŋu ɣemaɣi. Zi geɖe la, esia dzɔna le dɔyɔɣia. Nusiwo dona le eme ƒe akpa gãtɔ dzena le kwasiɖa gbãtɔ me le amekokoa megbe , gake woate ŋu ahe ɖewo ɖe megbe. Ðɔktawo alé ŋku ɖe esia ŋu kwasiɖa geɖe le amekokoa megbe. Nu suesuesue siwo le dodom ate ŋu axɔ ɣeyiɣi didi hafi woaɖe woƒe ŋusẽkpɔɖeamedzi afia. Tsi si dona le ŋkeke 30 megbe (`(Delayed Anastomotic Leak)`) mebɔ kura o.

Aleke gbegbee nɔnɔme sia bɔe?

Woka nya ta be anastomotic leaks dzɔna le anastomosis amekoko siwo ade 5% me . Le esiawo dome la, 75% do ƒome kple colectomy amekoko. Afɔku sia lolo ŋutɔ le amekoko siwo wowɔna le dɔgboa ƒe nuwuwu, dɔgbo alo dɔgbo si me ʋuʋudedi le me. Esia le alea elabena teƒea xaxa eye amekoko sesẽ, vevietɔ le ŋutsuwo gome.

Amekae ate ŋu axɔ anastomotic leak wu?

Le nyateƒe me la, amesiame si wowɔ anastomosis na ate ŋu axɔ kuxi sia. Gake afɔku aɖewo li siwo dzia mɔnukpɔkpɔ si li be esia nadzɔ ɖe edzi.

Afɔku siwo ate ŋu adzɔe nye:

• Sigaretnono.
• Nunyuimakpɔɖu alo ʋusɔgbɔdɔ.
• Dɔlélenutsiŋutete ƒe atikewo zazã.
• Dɔdzẽ siwo mebɔ o ƒe amesinɔnɔ.
• Esi wowɔ keklẽŋusẽdɔdamɔnu nɛ ta.
• Nɔnɔme aɖe si woyɔna be ``Sepsis`` alo ``Septic Shock`` si le ŋutilã me xoxo.
• Esi wodo ʋu nɛ le amekoko me ta (`(Intraoperative Blood Transfusion)`).
• Lolo akpa alo suklidɔ (`(Diabetes Mellitus)`) ƒe amesinɔnɔ.
• Amekoko kpata.
• Amekoko xɔa ɣeyiɣi didi akpa.
• Aɖuɖɔtoe me Anastomosis.
• Ŋutsu nyenye le edziɣi (`(Assigned Male Sex)`).

Nukae hea tsi si le dodom sia vɛ?

Zi geɖe la , abi ƒe dɔyɔyɔ ƒe kpododonu gbɔe anastomosis ƒe tsi si le dodom tsona . Esesẽ be woade dzesi nu ɖeka aɖe si gbɔ wòtso, gake nu geɖe ate ŋu awɔe. Le kpɔɖeŋu me:

• Teteɖeanyi si gbɔ eme le amekokoa teƒe: Esia koŋue amekolawo dzea agbagba be yewoaƒo asa na be woaxe mɔ na tsi si le dodom. Kadodo sia ate ŋu ahe alo asẽ ɖe edzi ne wole ʋuʋum. Afɔku sia lolona wu ne amekokoa ƒe teƒea le kpuie alo esesẽ be woage ɖe eme.
• Dɔlékui si woxɔ va yi le ŋutilã ƒe do me: Ne dɔléle aɖe li va yi la, ate ŋu ana lãkusia navuvu eye wòaxɔ abi. Dzoxɔxɔ ɣeyiɣi didi hã ate ŋu ana collagen dzi naɖe akpɔtɔ . Amekolawo atsɔ dɔlékuiwutikewo aklɔ teƒea eye woaŋlɔ dɔlékuiwutikewo na amewo.Ne èdze agbagba be yeatsɔ dɔlékuiwutikewo aɖu dɔlékuia dzi gɔ̃ hã la, lãmekaa ate ŋu agbɔdzɔ kokoko le amekokoa wɔɣi.
• Ʋu ƒe sisi yi ʋuka si do ƒome kplii me dzi ɖe kpɔtɔ (`(Ischemia)`): `(Ischemia)` ate ŋu anye nɔnɔme si nɔ anyi do ŋgɔ alo ate ŋu adzɔ abe amekoko ƒe ŋuɖoɖo ene.
• Dɔlélenutsiŋutete ƒe gbɔdzɔgbɔdzɔ: Lãmesẽ ƒe nɔnɔme aɖewo, atamanono, nunyuimakpɔɖu, alo `(Dɔlélenutsiŋutete ƒe atikewo)` zazã ate ŋu ana dɔlélenutsiŋutete nagbɔdzɔ. Kekelidɔdamɔnu hã gblẽa nu le lãmekawo ŋu eye wògbɔdzɔa dɔlélenutsiŋutete. Esia hã le alea elabena ame geɖe siwo wowɔa dɔ na `(Anastomosis)` nye kansa dɔnɔwo.

Nukae nye anastomotic leak ƒe dzesiwo?

Dzesi gbãtɔ siwo wokpɔna le nɔnɔme sia me kple esiwo bɔ wue nye:

• Ƒodo ƒe Vevesese (`(Ƒodo ƒe Vevesese)`) .
• Dzoxɔxɔ (`(Adzoxɔxɔ)`) .
• Ƒodo ƒe vuvu (ate ŋu atso Peritonitis gbɔ).
• Paralytic ileus (dɔgbo ƒe dɔmawɔmawɔ nyuie) si nɔa anyi ɖaa le amekoko vɔ megbe .

Ne nɔnɔmea gavloe vie la, dzesi siawo tɔgbe ate ŋu ado mo ɖa hã:

• Dzi ƒe tsotso kabakaba (Tachycardia) .
• Delirium (`(Dzidzedzekpɔkpɔ)`) .
• Dɔlékuiwutike `(Sepsis)` .
• Dzidziƒoame .

Aleke tututu nèwɔ de dzesi esia?

Ne èyi wò ɖɔkta gbɔ le amekoko vɔ megbe la, alé ŋku ɖe wò nɔnɔmea ŋu nyuie. Woalé ŋku ɖe wò dzesi veviwo (abe wò dzi ƒe tsotso, gbɔgbɔ ƒe tsotso, dzoxɔxɔ, kple ʋu ƒe sisi), ʋudodokpɔ, kple dɔgbo ƒe dɔwɔwɔ ŋu edziedzi. Ne dɔlékui ƒe dzesi aɖewo le ŋuwò alo wò dɔgbowo mele dɔ wɔm nyuie le dɔgbo ƒe dɔwɔwɔ vɔ megbe o la, wò ɖɔkta ate ŋu asusu be anastomotic leak. Woazã nɔnɔmetata dodokpɔwo (abe scans ene) atsɔ aɖo kpe esia dzi – zi geɖe la , CT scan , si zãa contrast dye .

Aleke wowɔa atike nɛ?

Ne wokpɔe be tsi sia ƒomevi le dodom le ŋuwò la, woatsɔ dɔlékuiwutikewo ada dɔ na wò be woatsɔ aɖu dɔlékuia dzi. Emegbe atikewɔwɔ anɔ te ɖe tsi si le dodom ƒe lolome kple wò nɔnɔmea ƒe sesẽ dzi. Esia ate ŋu alɔ:

• Tsi si dona: Ele be ŋutilãa naɖe tsi kple/alo abi si ƒo ƒu le dɔlélea ta la ɖa. Ne anya wɔ la, ɖɔkta awɔ esia to ŋutigbalẽ me – si fia be to aŋe si me do le si wotsɔ de do sue aɖe si le ŋutigbalẽa me me.
• Dɔgbo ƒe Gbɔɖeme: Ne tsi si le dodom le dɔgboa me la, ahiã be nàdzudzɔ nuɖuɖu alo nunono to nu me le atikewɔwɔ me. Wò ɖɔkta ate ŋu ana tsi si wodona ɖe ʋuka me wò.woanae, eye ne ehiã la, woana nunyiame si wodona ɖe ʋuka me.
• Amekoko Gbugbɔ: Ðewohĩ ahiã be amekolaa nagbugbɔ alé ŋku ɖe anastomosis la ŋu eye wòagawɔ dɔ bubu. Ne anya wɔ la, woazã dɔdamɔnu si me womewɔa dɔ boo aɖeke le o, abe dɔlékuiwo me dzodzro ene . Esia bia be woade fotoɖemɔ̃ to lãɖeɖe sue aɖe me atsɔ alé ŋku ɖe ƒodoa me. Woate ŋu azã dɔwɔnu suewo hã atsɔ aɖe ʋuʋudedi aɖe ɖa alo atsɔ dɔlékuiwutikewo aklɔ doa ɖa. Ne esia mewɔ dɔ o la, ahiã be woagaʋu ƒodoa ƒe doa ake be wòaɖo afisi tsi si le dodom le la gbɔ. Ðewohĩ ahiã be woado ŋusẽ anastomosis la alo ahiã be woawɔ yeye le teƒe bubu si lãmeka siwo le lãmesẽ me le. Ɣeaɖewoɣi la, ehiãna be woana ɣeyiɣi geɖe ŋutilãa be wòada gbe le eŋu hafi woagawɔ anastomosis la ake. Le dɔgboa ƒe dɔwɔwɔ me la, ate ŋu ahiã be amekolaa natrɔ dɔgboa ƒe akpa aɖe hena ɣeyiɣi aɖe ayi ostomy (si nye ʋuʋu yeye si toa anastomosis la ŋu eye wònaa ɣeyiɣi geɖe wu be wòahaya).

Ɣeyiɣi didi kae wòxɔna hafi wòhayana?

Anastomotic leak ate ŋu ana woanɔ kɔdzi kwasiɖa ene alo esi wu nenema.

Ðe womate ŋu axe mɔ ɖe tsi siawo siwo le dodom nu oa?

Nu geɖe li siwo ate ŋu ana anastomotic leak nadzɔ, eye wo dometɔ geɖe mate ŋu atrɔ o. Le kpɔɖeŋu me, dɔnɔa ƒe lãmesẽ, amekokoa sesẽ, kple nu bubu siwo dzɔna le eƒe dɔyɔyɔ me. Gake amekolawo ate ŋu akpɔe ɖa be tsi le dodom le wo me hã le amekokoa me.

Dzodzro

Dodokpɔ siwo wowɔna tsɔ léa ŋku ɖe tsi si le dodom le anastomosis megbe ŋue nye:

• Ya Dodokpɔ: Wotsɔa dzetsi yɔa ŋutilã ƒe doa me eye wotsɔa ya dea ŋutilã ƒe mɔ̃a me. Ne kuɖɔwo dze le tsia me la, tsi aɖe le dodom le kadodoa me. Zi geɖe la, wodzraa tsi siawo ɖo to kadodoa gbugbɔgade alo wo tsɔtsɔ blae me.
• Tsi Dodokpɔ: Wodoa dɔlékuiwutike aɖe ɖe ŋutilã ƒe mɔ̃ me eye wokpɔa egbɔ be tsi le dodom hã.
• Vovototo Dodokpɔ: Le dɔgbo ƒe amekoko gome la, amekola ate ŋu azã CT scan kple vovototodedeameme ƒe amadede atsɔ akpɔe ɖa be tsi aɖe le dodom hã. Wotsɔa amadede si to vovo na wo nɔewo toa aɖuɖɔtoea me yia anastomosis la me be woakpɔe ɖa be tsi aɖe le dodom hã.

Togbɔ be dodokpɔ siawo siwo wowɔna le amekokoa wɔɣi mate ŋu axe mɔ ɖe tsi si le dodom katã nu o hã la, woate ŋu aɖe woƒe xexlẽme dzi akpɔtɔ eye woade dzesi amesiwo le afɔku gã me be tsi nagado ake.

Mɔxexeɖedɔléle ƒe Stoma (`(Mɔxexeɖe Stoma)`)

Le dɔgbo ƒe dɔwɔwɔ me la, amekolawo ate ŋu atrɔ aɖuɖɔ ɖa le dɔgboa me le dɔyɔɣia, si axe mɔ ɖe dɔgbo si le dodom ƒe nugbegblẽ vɔ̃ɖitɔ kekeake nu. Wowɔa esia to ɣeyiɣi kpui aɖe ƒe colostomy alo ileostomy wɔwɔ me.Wowɔa ɖeka, woɖea nusiwo le dɔgboa me le afisi wodoa ka ɖo eye woɖoa wo ɖe akplo me. Togbɔ be esia mexea mɔ na anastomotic leak o hã la, exea mɔ na nusiwo le dɔgboa me be woagage ɖe ƒodoa me ne tsi aɖe do o.

Ostomy naa ʋu yeye aɖe si wowɔ kple asi si me aɖuɖɔ tona, si woyɔna be stoma . Esia wɔnɛ be dɔgboa hayana evɔ aɖuɖɔtoe ƒe vevesese manɔmee. Ɣeaɖewoɣi la, amekolawo wɔa ostomy hena ɣeyiɣi aɖe, si xea mɔ na dɔlélea. Wokafui be woawɔ ostomy hena ɣeyiɣi aɖe be wòanye mɔxexeɖedɔléle nu na amesiwo le afɔku gã me be woaxɔ anastomotic leak.

Nukae nye mɔkpɔkpɔ na amesiwo ŋu anastomotic leak le?

Zi geɖe la, woate ŋu adzra tsi si le dodom siwo wokpɔ la ɖo. Gake dɔlélea didi kaba kple edada le vevie be woatsɔ aɖu dɔlékuiwo dzi eye woaxe mɔ ɖe dɔlékuiwutikewo ƒe dɔléle nu. Le goawo katã me la, amesiwo ŋu anastomotic leak le la ate ŋu axɔ lãmesẽkuxiwo le etsɔme eye woaku. Womenya afisi emetsonu siawo tso anastomotic leak ŋutɔ gbɔ se ɖo o, alo nenye be tsi si le dodom la nye lãmesẽkuxi aɖe ƒe dzesi le amewo katã dome o.

Ɣekaɣie wòle be makpɔ nye ɖɔkta?

Ne èle hayahayam tso anastomosis me la, ke nɔ kadodo kplikplikpli me kple wò ɖɔkta eye nàgblɔ dzesi ɖesiaɖe si mèle mɔ kpɔm na o. Di atikewɔƒe enumake ne dɔlélea ƒe dzesi aɖewo le ŋuwò. Le kpɔɖeŋu me:

• Asrã.
• Dɔgbo ƒe vevesese.
• Dzoxɔxɔ (dzodzo, vuvu).

Nya kawoe wòle be mabia nye ɖɔkta hafi woawɔ dɔ na nye anastomosis?

Ne anastomosis le ŋuwò eye nètsi dzi ɖe anastomotic leak ŋu la, àte ŋu abia wò ɖɔkta tso wò ŋutɔ wò afɔkuwo ŋu, mɔxexeɖedɔléle nu ƒe afɔɖeɖe siwo woate ŋu awɔ, kple afɔɖeɖe siwo wokafu na wò. Le kpɔɖeŋu me:

• Ðe nye amekokoa le afɔku gã aɖe me be anastomotic leak nava?
• Ðe nye ŋutɔ mele afɔku gã aɖe mea?
• Aleke nàwɔ akpɔ `(Anastomotic Leak)` dzi?
• Ðe nèléa ŋku ɖe tsi si le dodom ŋu le amekokoa mea?
• Aleke mawɔ akpɔe ɖa be tsi si le dodom le eme hã le amekoko vɔ megbe?
• Nukae dzɔna ne tsi si le dodom le ŋunye le amekoko vɔ megbe?

Ne ehiã be woawɔ anastomosis na wò la, ke ɖewohĩ enye dɔdamɔnu si axɔ ame ɖe agbe. Le ɣeyiɣi sia tɔgbe me la, esesẽna be woabu kuxi aɖe si ate ŋu ade ame ƒe agbe afɔku me tso amekokoa ŋutɔ me gɔ̃ hã ŋu. Togbɔ be ɖɔktawo vɔ̃nɛ hã la, anastomotic leak ate ŋu adzɔ ɣesiaɣi. Gake le nusianu me la, afɔkua mesɔ gbɔ o. Eye, ne wonya nu tso eŋu eye wowɔ nu kaba la, woate ŋu akpɔ nya geɖe gbɔ.

Nu vevitɔ kekeake siwo dzi wòle be woaɖo ŋkui (Take-Home Message) .

• Anastomotic leak nye nusiwo le dodom tso mɔ̃ eve siwo do ƒome kple wo nɔewo me le amekoko vɔ megbe.
• Esia ate ŋu adzɔ le afisiafi, abe dɔgbo alo aɖuɖɔtoe ene.
• Ne èkpɔ dzesiwo abe asrã, dɔgbo ƒe veve, alo fuɖename ene la, yi ɖɔkta gbɔ enumake.
• Nuwo abe atamanono, suklidɔ, kple nunyuimakpɔɖui ate ŋu ana afɔku sia nadzi ɖe edzi.
• Ne wokpɔ dɔlélea dze sii hedae kaba la, woate ŋu adae zi geɖe. Gake ne womewɔ atike nɛ o la, ate ŋu anye afɔku.
• Ne wole dɔ wɔm na wò la, ƒo nu tso eŋu kple wò ɖɔkta gaglãa. Na wò afɔkuwo, nusi nàwɔ atsɔ axe mɔ ɖe wo nu, kple nusi nàwɔ ne tsi aɖe si le dodom la me nakɔ. Nyanyananae nye ametakpɔnu nyuitɔ kekeake!

` Anastomotic Leak, Amekoko ƒe Kuxiwo, Dɔgbo ƒe Amekoko, Peritonitis, Sepsis, Dɔwɔwɔ vɔ megbe Beléle, Amekoko ƒe Afɔkuwo