He 'leaka' i loko ma hope o ke ʻoki ʻana? (Anastomotic Leak) E aʻo kākou e pili ana i ia mea me ka maʻalahi!

Ua manaʻo paha ʻoe ma hope o kahi hana nui, hiki ke kū mai nā pilikia i loko o ke kino a mākou e noʻonoʻo ʻole ai? E like me ke kau ʻana i ʻelua paipu wai, i kekahi manawa he wai liʻiliʻi e kahe ana mai ke ami, hiki ke hana like ka mea ke hoʻopili ʻia nā kīʻaha koko ʻelua i loko o ko mākou kino ma o ke ʻoki kino. I ka lāʻau lapaʻau, kapa mākou i kēia he anastomotic leak . ʻOiai hiki ke koʻikoʻi loa kēia, he mea nui loa ia iā ʻoe a me kāu poʻe aloha e ʻike e pili ana i ia mea.

He aha maoli ka leaka anastomotic?

I ka ʻōlelo maʻalahi, ʻo ka anastomosis ke kaʻina hana ʻoki kahi e hoʻopili ʻia ai nā wēlau o nā ʻōmole kino ʻelua. E noʻonoʻo ʻoe ua pono ʻoe e wehe i kahi ʻāpana o kou ʻōpū. A laila pono ʻoe e hoʻopili hou i nā ʻāpana ʻoki ʻelua o ka ʻōpū. Ua kapa ʻia kēlā pilina he anastomosis.

I kēia manawa, ʻo kēia anastomotic leak ka wā e sila pono ʻole ai ka pilina, a kahe nā mea o loko o kēlā paipu. Hiki ke lilo i mea weliweli, no ka mea, ʻaʻole maikaʻi no nā mea o loko o nā paipu o ko mākou kino ke hele i nā wahi ʻē aʻe. No ka laʻana, aia nā bacteria i loko o kāu ʻōnaehana digestive. Inā hiki kēia mau mea i nā wahi ʻē aʻe o kou ʻōpū, hiki iā lākou ke hoʻoulu i nā maʻi.

He aha ka mea e hana ai inā he liki ma hope o ke ʻoki ʻana o ka ʻōpū?

He hana maʻamau ka ʻoki ʻana o ka ʻōpū kahi e hana ʻia ai kahi anastomosis, a hiki ke loaʻa kahi leaka anastomotic. Inā leaka nā mea o loko o ka ʻōpū i loko o ka lua ʻōpū, hiki i ka uhi o ka ʻōpū (peritoneum) ke lilo i maʻi a pehu. Ua kapa ʻia kēia he peritonitis . Hiki i kēia maʻi ke laha i nā ʻōpū ʻē aʻe i loko o ka ʻōpū a i loko o ke kahe koko. Inā lilo ia i mea koʻikoʻi, hiki iā ia ke alakaʻi i kahi maʻi hoʻoweliweli ola i kapa ʻia ʻo sepsis . ʻO Sepsis ka pane nui ʻana o ke kino i kahi maʻi. Hiki i kēia ke alakaʻi i ka haʻalulu , ka hāʻule ʻana o nā ʻōpū, a i ʻole ka make.

E noʻonoʻo i ka mea e hana ʻia inā e ninini ʻia nā mea i loko o kā mākou ʻōpala kīhini i loko o ka lumi hoʻokipa. Pēlā nō hoʻi ka mea e hana ʻia inā e ninini ʻia nā mea i loko o ko mākou ʻōpū i loko o ko mākou ʻōpū. ʻO ia ke kumu he mea weliweli loa kēia.

ʻO kekahi mea e hiki ke kahe i loko o ka lua ʻōpū, ʻo ia kou ala mimi. No ka laʻana, i ka wā o ka hoʻoili ʻana o ka puʻupaʻa a i ʻole ka prostatectomy, pono paha ʻoe e hana i kahi anastomosis. Inā kahe kēia, hiki i ka mimi ke hōʻiliʻili i loko o ka lua ʻōpū. Ua kapa ʻia kēia he urinoma . Aia kekahi pilikia o ka maʻi a me ka sepsis ma waho o ka lua ʻōpū. No ka laʻana, inā he anastomotic leak kou i loko o kou esophagus, ʻo ia kekahi ʻāpana o kāu paipu meaʻai, hiki iā ia ke alakaʻi i ka maʻi i loko o kou lua umauma.

I ka manawa hea e hana ʻia ai kahi leaka anastomotic?

I kekahi manawa hiki ke loaʻa kēia leaka i ka wā o ke ʻoki kino. Akā nānā nā kauka ʻoki kino iā ia i ka manawa. ʻO ka hapa nui, hana ʻia kēia i ka wā o ke kaʻina hana ho'ōla. ʻIke ʻia ka hapa nui o nā leaka i loko o ka pule mua ma hope o ke ʻoki kino , akā hiki ke hoʻopaneʻe ʻia kekahi. E nānā nā kauka i kēia no kekahi mau pule ma hope o ke ʻoki kino. Hiki i nā leaka liʻiliʻi ke lōʻihi ka manawa e hōʻike ai i ko lākou hopena. ʻO nā leaka e kū mai ana ma hope o 30 mau lā (`(Delayed Anastomotic Leak)`) he mea kākaʻikahi loa ia.

Pehea ka maʻamau o kēia ʻano?

Ua hōʻike ʻia nā leaka anastomotic e kū mai ana ma kahi o 5% o nā ʻoki anastomosis. Ma waena o kēia mau mea, 75% e pili ana me nā ʻoki colectomy. He kiʻekiʻe loa kēia pilikia i nā ʻoki i hana ʻia ma ka hopena o ka colon, ka rectum a i ʻole ka sigmoid colon. ʻO kēia no ka mea he haiki ka wahi a he paʻakikī ke ʻoki ʻia, ʻoi aku hoʻi i nā kāne.

ʻO wai ka mea e loaʻa ai kahi leaka anastomotic?

ʻO kaʻoiaʻiʻo, hiki i kekahi mea i hana ʻia i kahi anastomosis ke loaʻa i kēia pilikia. Eia nō naʻe, aia kekahi mau mea pilikia e hoʻonui ai i ka manawa kūpono o kēia.

ʻO nā kumu pilikia:

• Puhi paka.
• ʻAʻole pono ka meaʻai a i ʻole ka anemia.
• Ka hoʻohana ʻana i nā immunosuppressants.
• Loaʻa nā puʻupuʻu haʻahaʻa.
• Ma hope o ka loaʻa ʻana o ka radiation therapy.
• Ke loaʻa nei i ke kino kahi maʻi i kapa ʻia ʻo "Sepsis" a i ʻole "Septic Shock".
• Ma hope o ka loaʻa ʻana o ke koko i ka wā o ke ʻoki kino (`(Intraoperative Blood Transfusion)`).
• Loaʻa i ka momona a i ʻole ka maʻi diabetes (`(Diabetes Mellitus)`).
• ʻOki ulia pōpilikia.
• Lōʻihi loa ke ʻoki ʻana.
• ʻAnastomosis Rectal.
• ʻO ke kāne i ka wā hānau (`(Kāne i hāʻawi ʻia)`).

He aha ke kumu o kēia leaka?

ʻO ka maʻamau, ʻo ka leaka anastomosis ka mea i hana ʻole ʻia e ka hana hoʻōla ʻeha . He mea paʻakikī ke kuhikuhi i hoʻokahi kumu, akā hiki i kekahi mau kumu ke kōkua. Eia kekahi laʻana:

• Ke kaumaha nui ma kahi ʻoki: ʻO kēia ka mea a nā kauka lapaʻau e hoʻāʻo nui ai e pale aku i ka liki ʻana. Hiki ke huki ʻia a paʻa paha kēia pilina i ka wā e neʻe ai. ʻOi aku ka nui o kēia pilikia inā he haiki a paʻakikī paha ke komo ʻana i kahi ʻoki.
• ʻO ka maʻi ma mua i loko o ke kino: Inā he maʻi ma mua, hiki iā ia ke hoʻoulu i ka ʻiʻo e pehu a lilo i mumū. Hiki i ka mumū lōʻihi ke hoʻoulu i ka emi ʻana o ka collagen . E holoi nā kauka ʻoki i ka wahi me nā hopena antiseptic a kuhikuhi i nā antibiotics.ʻOiai inā ʻoe e hoʻāʻo e kaohi i ka maʻi me nā lāʻau antibiotic, hiki ke hoʻonāwaliwali ʻia ke kino i ka wā o ke ʻoki ʻana.
• Ka emi ʻana o ke kahe koko i ke kīʻaha koko hoʻohui (`(Ischemia)`): Hiki i ka `(Ischemia)` ke lilo i maʻi mua a i ʻole hiki ke hana ma ke ʻano he pane i ke ʻoki kino.
• Ka nāwaliwali o ke olakino: ʻO kekahi mau maʻi olakino, ka puhi paka, ka ʻai pono ʻole, a i ʻole ka hoʻohana ʻana i nā `(Immunosuppressants)` hiki ke hoʻonāwaliwali i ka ʻōnaehana pale. Hoʻopōʻino pū ka radiation therapy i nā ʻiʻo a hoʻonāwaliwali i ka ʻōnaehana pale. ʻO kēia kekahi no ka mea he nui ka poʻe e hana ana i ke ʻoki `(Anastomosis)` he poʻe maʻi kanesa.

He aha nā hōʻailona o kahi leaka anastomotic?

ʻO nā hōʻailona mua a me nā hōʻailona pinepine i ʻike ʻia ma kēia ʻano:

• ʻEha ʻōpū (`(ʻEha ʻōpū)`) .
• Kuni (`(Kuni)`) .
• ʻO ka pehu ʻana o ka ʻōpū (hiki paha ma muli o Peritonitis).
• ʻO ka ileus paralytic mau (hana ʻino o ka ʻōpū) ma hope o ke ʻoki kino .

Ke ʻoi aku ka ʻino o ke kūlana, hiki ke ʻike ʻia nā hōʻailona e like me kēia:

• Ka wikiwiki o ka puʻuwai (Tachycardia) .
• Delirium (`(Delirium)`) .
• Sepsis `(Sepsis)` .
• Pūʻiwa .

Pehea ʻoe e ʻike pono ai i kēia?

Ke hele ʻoe e ʻike i kāu kauka ma hope o ke ʻoki ʻana, e nānā pono ʻo ia i kou kūlana. E nānā mau ʻia kāu mau hōʻailona koʻikoʻi (e like me kou pulse, ka nui o ka hanu ʻana, ka mahana, a me ke koko), nā hoʻāʻo koko, a me ka hana ʻōpū. Inā loaʻa iā ʻoe kekahi mau hōʻailona o ka maʻi a i ʻole ʻaʻole hana pono kou mau ʻōpū ma hope o ke ʻoki ʻana i ka colon, hiki i kāu kauka ke kānalua i kahi leak anastomotic. E hoʻohana lākou i nā hoʻāʻo kiʻi (e like me nā scans) e hōʻoia i kēia - ʻo ka maʻamau he CT scan , kahi e hoʻohana ai i kahi dye contrast .

Pehea e mālama ʻia ai?

Inā ua ʻike ʻia ʻoe me kēia ʻano leaka, e mālama ʻia ʻoe me nā lāʻau antibiotic e kāohi i ka maʻi. A laila e hilinaʻi ka lāʻau lapaʻau i ka nui o ka leaka a me ke koʻikoʻi o kou kūlana. Hiki i kēia ke komo pū me:

• Ka Hoʻokahe Wai: Pono ke kino e hoʻokahe i ke wai a/a i ʻole ka pehu i hōʻiliʻili ʻia ma muli o ka maʻi. Inā hiki, e hana ke kauka i kēia ma ke ʻano percutaneous - ʻo ia hoʻi, ma o kahi nila hakahaka i hoʻokomo ʻia ma kahi lua liʻiliʻi ma ka ʻili.
• Hoʻomaha ʻōpū: Inā aia ka leaka i loko o nā ʻōpū, pono ʻoe e hoʻōki i ka ʻai ʻana a i ʻole ka inu ʻana ma ka waha i ka wā o ka mālama ʻana. Hiki i kāu kauka ke hāʻawi iā ʻoe i nā wai intravenous.e hāʻawi ʻia, a inā pono, e hāʻawi ʻia ka meaʻai intravenous.
• Hana Hou ʻana i ke ʻoki kino: Pono paha ke kauka lapaʻau e nānā hou i ka anastomosis a hana i kahi hana ʻē aʻe. Inā hiki, e hoʻohana lākou i kahi kaʻina hana minimally invasive, e like me ka laparoscopy . Pili kēia i ke komo ʻana i kahi kāmela ma o kahi ʻoki liʻiliʻi e nānā i ka lua ʻōpū. Hiki iā lākou ke hoʻohana i nā mea hana liʻiliʻi e hoʻokahe i kahi abscess a holoi paha i ka lua me nā hopena antiseptic. Inā ʻaʻole holo pono kēia, pono paha e wehe hou ʻia ka lua ʻōpū e hiki ai i ka leak. Pono paha e hoʻoikaika ʻia ka anastomosis a i ʻole e hana ʻia kahi mea hou ma kahi ʻokoʻa me nā ʻiʻo olakino. I kekahi manawa, pono e hāʻawi ʻia ke kino i ka manawa hou e ho'ōla ai ma mua o ka hana hou ʻana o ka anastomosis. I ka wā o ke ʻoki ʻana o ka ʻōpū, pono paha ke kauka lapaʻau e hoʻohuli i kahi ʻāpana o ka ʻōpū i loko o kahi ostomy (kahi puka hou e kāpae ana i ka anastomosis a ʻae i ka manawa hou e ho'ōla ai).

ʻEhia ka lōʻihi e ho'ōla ai?

Hiki i kahi leaka anastomotic ke hopena i ka noho haukapila no ʻehā pule a ʻoi aku paha.

ʻAʻole hiki ke pale ʻia kēia mau leaka?

Nui nā kumu e hiki ke kōkua i ka hanana ʻana o ka leaka anastomotic, ʻaʻole hiki ke hoʻololi ʻia ka hapa nui o ia mau mea. No ka laʻana, ke olakino o ka mea maʻi, ka paʻakikī o ke ʻoki ʻana, a me nā kumu ʻē aʻe e kū mai ana i ka wā o ke kaʻina hana ho'ōla. Eia nō naʻe, hiki i nā kauka lapaʻau ke nānā i nā leaka i ka wā o ke ʻoki ʻana.

Nānā ʻana

ʻO nā hoʻokolohua i hana ʻia e nānā i nā leaka ma hope o kahi anastomosis:

• Hoʻāʻo Ea: Hoʻopiha ʻia ka lua o ke kino me ka wai saline a hoʻokomo ʻia ka ea i loko o ka paipu kino. Inā ʻike ʻia nā pehu i loko o ka wai, aia kahi liki ma ka pilina. ʻO ka maʻamau, hoʻoponopono ʻia kēia mau liki ma ka hoʻopili hou ʻana i ka pilina a i ʻole ke humuhumu ʻana.
• Hoʻāʻo Wai: Hoʻokomo ʻia kahi hopena disinfectant i loko o kahi ʻōmole kino a nānā ʻia no nā leaka.
• Hoʻāʻo Hoʻohālikelike: I ke ʻano o ke ʻoki ʻana o ka ʻōpū, hiki i ke kauka lapaʻau ke hoʻohana i kahi CT scan a me kahi dye hoʻohālikelike e ʻike inā he leaka. Hoʻouna ʻia ka dye hoʻohālikelike ma o ka anus i ka anastomosis e ʻike inā he leaka.

ʻOiai ʻaʻole hiki i kēia mau hoʻokolohua i hana ʻia i ka manawa o ke ʻoki ʻana ke pale i nā leaka āpau, hiki iā lākou ke hoʻemi i ko lākou helu a ʻike i ka poʻe i ʻoi aku ka nui o ka pilikia o ka leaka hou ʻana.

Stoma Palekana (`(Stoma Palekana)`)

I ka wā o ke ʻoki ʻana o ka ʻōpū, hiki i nā kauka lapaʻau ke hoʻohuli i ka ʻōpala mai loko mai o nā ʻōpū i ka wā ho'ōla, e pale ana i nā hopena ʻino loa o kahi ʻōpū leaky. Hana lākou i kēia ma ka hana ʻana i kahi colostomy manawa pōkole a i ʻole ileostomy.Hana ʻia kekahi, lawe ʻia nā mea o loko o ka ʻōpū mai ke kiko pili a kuhikuhi ʻia i loko o kahi ʻeke. ʻOiai ʻaʻole kēia e pale i ka leaka anastomotic, pale ia i nā mea o loko o ka ʻōpū mai ke komo ʻana i loko o ka lua ʻōpū inā loaʻa kahi leaka.

Hoʻokumu kahi ostomy i kahi puka hana hou no ka hele ʻana o ka ʻōpala, i kapa ʻia he stoma . ʻAe kēia i nā ʻōpū e ho'ōla me ka ʻole o ka ʻoluʻolu ʻole o ka hele ʻana i ka ʻōpala. I kekahi manawa, hana nā kauka ʻoki i kahi ostomy pale no ka manawa pōkole. Manaʻo ʻia kahi ostomy manawa pōkole ma ke ʻano he hana pale no ka poʻe i loaʻa ka pilikia nui o ka loaʻa ʻana o kahi leaka anastomotic.

He aha ka manaʻolana no ka poʻe i loaʻa kahi leaka anastomotic?

Hiki ke hoʻoponopono ʻia nā leaka i loaʻa. Eia nō naʻe, he mea nui ka ʻike mua a me ka mālama ʻana e kāohi i ka maʻi a pale i ka sepsis. Ma keʻano laulā, ʻoi aku ka nui o ka pilikia o ka poʻe me ka leaka anastomotic i nā pilikia olakino a me ka make i ka wā e hiki mai ana. ʻAʻole maopopo i ka nui o kēia mau hopena ma muli o ka leaka anastomotic ponoʻī, a inā paha he hōʻailona ka leaka o kahi pilikia olakino maʻamau.

Āhea wau e ʻike ai i kaʻu kauka?

Inā ʻoe e hoʻōla ana mai kahi anastomosis, e noho kokoke me kāu kauka a hōʻike i nā hōʻailona i manaʻo ʻole ʻia. E ʻimi koke i ke kōkua lapaʻau inā loaʻa iā ʻoe kekahi mau hōʻailona o ka maʻi. Eia kekahi laʻana:

• Kuni.
• ʻeha ka ʻōpū.
• ʻO ka mumū (ʻulaʻula, ka pehu).

He aha nā nīnau e pono iaʻu e nīnau aku i kaʻu kauka ma mua o ke ʻoki anastomosis?

Inā ʻoe e loaʻa ana i kahi anastomosis a hopohopo e pili ana i kahi anastomotic leak, hiki iā ʻoe ke nīnau i kāu kauka e pili ana i kāu mau kumu pilikia pilikino, nā hana pale e hiki iā lākou ke hana, a me nā hana a lākou e ʻōlelo ai nou. Eia kekahi laʻana:

• Aia anei ka pilikia kiʻekiʻe o ka leaka anastomotic i koʻu ʻoki kino?
• Aia anei au i ka pilikia nui aʻe?
• Pehea ʻoe e kāohi ai i ka `(Anastomotic Leak)`?
• Ke nānā nei ʻoe i nā leaka i ka wā o ke ʻoki kino?
• Pehea e nānā ai i nā leaka ma hope o ke ʻoki ʻana?
• He aha ka mea e hana ai inā he leaka koʻu ma hope o ke ʻoki ʻana?

Inā pono ʻoe e hana i kahi anastomosis, he hana hoʻōla ola paha ia. I ka manawa e like me kēia, he paʻakikī ke noʻonoʻo e pili ana i kahi pilikia e hoʻoweliweli ana i ke ola mai ke ʻoki kino ponoʻī. ʻOiai ka makaʻu o nā kauka, he mea hiki mau ka leaka anastomotic. Akā ma ke ʻano holoʻokoʻa, haʻahaʻa ka pilikia. A, me ka ʻike a me ke komo mua ʻana, hiki ke mālama ʻia nā hihia he nui.

Nā mea nui e hoʻomanaʻo (Leka Lawe-Home)

• ʻO ka leaka anastomotic ka leaka ʻana o nā mea mai loko mai o nā ʻōmole ʻelua i pili ma hope o ke ʻoki ʻana.
• Hiki ke hana i kēia ma nā wahi āpau, e like me nā ʻōpū a i ʻole ke ala urinary.
• Inā ʻike ʻoe i nā hōʻailona e like me ke kuni, ka ʻeha o ka ʻōpū, a i ʻole ka pehu ʻana, e ʻike koke i ke kauka.
• Hiki ke hoʻonui ʻia kēia pilikia e nā mea e like me ka puhipaka, ka maʻi diabetes, a me ka ʻai ʻole.
• Inā ʻike ʻia a mālama ʻia i ka wā mua, hiki ke ho'ōla pinepine ʻia. Eia nō naʻe, inā waiho ʻole ʻia, hiki ke lilo i mea weliweli.
• Inā ʻoe e hana ʻia ana i ke ʻoki kino, e kamaʻilio ākea me kāu kauka e pili ana i ia mea. E akaka e pili ana i kāu mau pilikia, nā mea e hana ai e pale aku ai iā lākou, a me nā mea e hana ai inā puka mai kahi leaka. ʻO ka ʻike ka pale maikaʻi loa!

ʻO ke kahe ʻana o ke koko ma lalo o ka anastomotic, nā pilikia o ke ʻoki kino, ke ʻoki ʻōpū, ka peritonitis, ka sepsis, ka mālama ʻana ma hope o ke ʻoki kino, nā pilikia o ke ʻoki kino