Ke manaʻo nei ʻoe i kahi puʻupuʻu i loko o kou puʻu a i ʻole ka umauma ke ʻai ʻoe a inu paha? Ke makaʻu nei ʻoe i kekahi manawa e ʻai no ka mea me he mea lā ʻaʻole e iho ana kāu meaʻai? Hiki paha kēia ma muli o kahi maʻi laha ʻole i kapa ʻia ʻo Achalasia. ʻAʻole maʻalahi ka noho ʻana me kēia maʻi. He mea paʻakikī ke ale i ka meaʻai, a ʻo ka ʻai ʻole ʻana i ka meaʻai pono hiki ke alakaʻi i nā hemahema meaʻai. No laila i kēia lā e kamaʻilio mākou e pili ana i kahi ʻoki kino i kapa ʻia ʻo Heller Myotomy, kahi i hana ʻia ma ke ʻano he lāʻau lapaʻau no kēia.
He aha ke ʻano o ke ʻoki ʻana o ka myotomy ʻo Heller?
I ka ʻōlelo maʻalahi, ʻo Heller Myotomy kahi ʻoki liʻiliʻi e mālama ai iā Achalasia . He maʻi laha ʻole ʻo Achalasia e hoʻopilikia i ko kākou esophagus, a i ʻole ka paipu meaʻai. ʻO kēia ka manawa e hana pono ʻole ai ke kaʻina hana o ka hoʻouna ʻana i ka meaʻai a me nā wai mai ka esophagus a i ka ʻōpū.
ʻO ke ʻano o ka huaʻōlelo "myotomy" ʻo ia hoʻi ke ʻoki ʻana i kahi ʻiʻo. I loko o kahi Heller Myotomy, hana ke kauka ʻoki i kekahi mau ʻoki liʻiliʻi i loko o ke apo o nā ʻiʻo ma lalo o kou esophagus, i kapa ʻia ʻo Lower Esophageal Sphincter (LES) . He ʻiʻo mānoanoa ka LES e noho ana ma waena o ka ʻaoʻao haʻahaʻa o kou esophagus a me ka ʻaoʻao luna o kou ʻōpū. Ua like ia me kahi valve.
Inā loaʻa iā ʻoe ka achalasia, ʻaʻole e wehe a pani pono ka ʻiʻo LES. Pale kēia i ka hele ʻana o ka meaʻai mai ka esophagus i loko o ka ʻōpū. Hana ke ʻoki ʻana o Heller Myotomy ma ka hoʻomaha ʻana i ka ʻiʻo LES a wehe iā ia.
Hana pinepine ʻia kēia ʻoki kino me kahi hana ʻē aʻe i kapa ʻia he fundoplication . Pili kēia i ke kauka ʻoki kino e lawe i kahi ʻāpana o kou ʻōpū a kāʻei iā ia a puni kou esophagus. Hoʻemi kēia i ka pilikia o ka waikawa ʻōpū e hoʻi hou mai ana i loko o kou esophagus (reflux).
ʻO ka mea nui, ʻaʻole ʻo ke ʻoki ʻana o Heller Myotomy he lāʻau lapaʻau piha no Achalasia. Hāʻawi ia i ka hōʻoluʻolu lōʻihi, akā naʻe, pono paha e hana hou ʻia kēia ʻoki ʻana i ka hala ʻana o ka manawa.
Pehea ʻoe e hoʻomākaukau ai ma mua o ke ʻoki kino?
I mea e hōʻoia ai ua kūpono ʻoe no ke ʻoki kino, e kauoha kāu kauka i kekahi mau hoʻokolohua ma mua o ke ʻoki kino. Eia kekahi laʻana, nā hoʻokolohua koko, kahi X-ray umauma, a me kahi ECG.
Ma mua o ke ʻoki kino, e kamaʻilio ke kauka anesthesiologist nāna ʻoe e anesthesiologist. E nīnau lākou iā ʻoe i nā nīnau e like me:
- Ua loaʻa anei iā ʻoe ka anesthesia ma mua, a pehea kou manaʻo?
- He aha nā mea kanu, nā lāʻau lapaʻau, a i ʻole nā wikamina āu e hoʻohana ai?
- Ke hoʻohana nei ʻoe i ka paka, ka waiʻona, a i ʻole nā lāʻau lapaʻau ʻē aʻe?
Aia kekahi mau mea e pono ai ʻoe e hana e hoʻomākaukau no ke ʻoki kino. Pono e kūkākūkā ʻia kēia mau mea a hōʻoia ʻia me kāu kauka.
| He aha e hana ai | No ke aha he mea nui kēlā? |
|---|---|
| Ke haʻalele nei i ka hoʻohana ʻana i ka nicotine (ʻo kēlā me kēia ʻano, me nā cigarettes a me nā e-cigarettes) | Hoʻopilikia ka nikotine i kou kahe koko, hiki ke lohi i ka ho'ōla ʻana o nā ʻeha ma hope o ke ʻoki ʻana. |
| Hoʻokē ʻai. | Hiki i kāu kauka ke haʻi aku iā ʻoe ʻaʻole e ʻai i kekahi mea no 6 mau hola a ʻoi aku paha ma mua o ke ʻoki ʻana. Hiki paha iā ʻoe ke inu i nā wai moakaka (e like me ka wai) no kekahi manawa ma mua o ke kaʻina hana. Akā e ʻoluʻolu e nīnau i kāu kauka e pili ana i kēia. |
| Ke hoʻolālā nei i kahi noho ma ka haukapila. | He hana ʻoki kino nui kēia, no laila pono ʻoe e noho ma ka haukapila no hoʻokahi lā ma hope o ke ʻoki kino. Eia kekahi, e hoʻonohonoho i kekahi e hoʻokele iā ʻoe i ka home a noho pū me ʻoe no nā hola 24 mua. |
| Ke hoʻolālā nei no ka ho'ōla hou ʻana. | Ma hope o ke ʻoki ʻana, hiki i ke kauka ke kuhikuhi i nā lāʻau ʻeha. ʻAʻole hiki iā ʻoe ke hoʻokele a hiki i kou lawe ʻana iā lākou, no laila e ʻimi i kekahi e kōkua iā ʻoe me kēlā mau hana. |
Pehea e hana ʻia ai ke ʻoki kino?
I kēia manawa, e nānā kākou i nā mea e hana ʻia ana i loko o ke ʻoki kino. ʻO ka hapa pinepine, hana ʻia kēia ma ke ʻano laparoscopic . ʻO ia hoʻi, me ke kōkua o kahi telescope. Maanei, hoʻohana ke kauka ʻoki kino i kahi mea lahilahi me kahi kāmela i hoʻopili ʻia iā ia e nānā i loko o kou esophagus a me nā mea liʻiliʻi loa e hana i ke ʻoki kino.
- ʻO ka mea mua, e hoʻokomo ke kauka anesthesiologist i kahi laina IV (e like me ka ʻōmole e hāʻawi ana i ka saline) i loko o kahi aa koko ma kou lima a hāʻawi iā ʻoe i ka lāʻau lapaʻau e hoʻomoe iā ʻoe. ʻAʻole ʻoe e manaʻo i kekahi mea i ka wā o ke ʻoki ʻana.
- ʻO ka mea aʻe, e hana ke kauka lapaʻau ma kahi o 5 mau ʻoki liʻiliʻi loa i loko o kou ʻōpū (ʻōpū).
- A laila, ua hoʻopiha ʻia kou lua ʻōpū me ke kinoea kalapona ʻokikene. Hana ʻia kēia i mea e maʻalahi ai ka hoʻoneʻe ʻana i nā mea hana ʻoki a e hāʻawi i kahi ʻike maopopo o ka esophagus a me ka ʻaoʻao o luna o ka ʻōpū.
- I kēia manawa, hoʻokomo ke kauka i kahi kāmela a me nā mea hana ʻoki liʻiliʻi ma o kēlā mau ʻoki .
- Me ka hoʻohana ʻana i kēia mau mea hana, ua ʻoki ʻia ka papa ʻiʻo ma lalo o ka esophagus i ka lōʻihi a ua wehe ʻia ka LES.
- A laila, hana ʻia kahi kaʻina hana i kapa ʻia ʻo fundoplication. Pili kēia i ka lawe ʻana i kahi ʻāpana o ka ʻaoʻao o luna o ka ʻōpū a kāʻei iā ia a puni ka esophagus. Hoʻōki kēia i ka waikawa o ka ʻōpū mai ka piʻi ʻana.
- ʻO ka hope loa, wehe ʻia ke kāmela a me nā lako, a humuhumu ʻia kēlā mau ʻoki liʻiliʻi.
ʻO ka maʻamau, ʻelua hola ka lōʻihi o kēia hana holoʻokoʻa.
He aha ka mea e hana ʻia ma hope o ke ʻoki kino?
Hiki ke ʻokoʻa iki ka ʻike ma hope o ke ʻoki ʻana mai kēlā me kēia kanaka. Akā, ma ke ʻano maʻamau, e noho ʻoe i ka haukapila i ka pō. I loko o kēia manawa, e hāʻawi ʻia ʻoe i nā wai a me nā meaʻai ma o kahi laina IV. Ma hope o kēlā, hoʻomaka ka wā hoʻōla.
ʻO ka mea nui loa, ʻo ia ka pehu ʻana o kou esophagus ma hope o ke ʻoki ʻana. Hiki ke hala ma kahi o ʻelua mahina no ka emi loa ʻana o kēia pehu. No laila, pono ʻoe e hoʻololi mālie i kāu meaʻai.
E wehewehe aku kāu hui lapaʻau i kēia iā ʻoe, akā penei ka papa hana papaʻai maʻamau.
| Manawa | Loaʻa ka meaʻai |
|---|---|
| Lā mua a me ka lua | Nā wai moakaka. Eia kekahi laʻana: ka wai moa/pipi (i hoʻokahe ʻia), ka jelly, nā ʻeke hau, ka wai. |
| Mai ke kolu o ka lā a hiki i ka hiku o ka lā | Nā meaʻai waiū. Eia kekahi laʻana: ʻaikalima, sopa kirīmi i kānana ʻia, nā porridges e like me ka Cream of Wheat a i ʻole ka Cream of Rice. |
| Mai ka lā ʻewalu a hiki i ka nānā ʻana o ʻelua pule | Nā meaʻai palupalu. E haʻi aku kāu kauka iā ʻoe i ka wā hiki iā ʻoe ke hoʻomaka e hoʻohui i nā meaʻai paʻa. |
He aha nā pōmaikaʻi a me nā pilikia o kēia ʻoki kino?
Nā Pōmaikaʻi
Hoʻohana ka nui o ka poʻe me ka achalasia i ka Heller Myotomy ke hāʻule nā lāʻau lapaʻau ʻē aʻe ʻaʻole ʻoki kino. ʻO ka pōmaikaʻi nui o kēia kaʻina hana, ʻo ia ka nalowale ʻana o nā hōʻailona o ka achalasia ma hope o ke ʻoki kino.
Ua hōʻike ʻia kahi loiloi noiʻi hou loa ua nalowale nā hōʻailona ma waena o 87% a me 92% o ka poʻe i loaʻa i kēia lāʻau lapaʻau. Eia naʻe, e like me kā mākou i ʻōlelo ai ma mua, ʻaʻole kēia e ho'ōla loa i ka achalasia. Hiki i nā hōʻailona ke hoʻi hou mai i kekahi manawa 5-10 mau makahiki ma hope o ke ʻoki ʻana.
Nā Pōʻino
E like me nā ʻoki kino nui a pau, he mau pilikia ko Heller Myotomy. ʻO nā pilikia maʻamau e pili ana i ke kahe koko nui a me ka maʻi. Eia kekahi, ʻo nā pilikia kikoʻī e hiki ke hana ʻia:
- ʻO ka ʻōpū o Barrett
- Nā maʻi ʻōpū
- GERD (maʻi reflux gastroesophageal)
- Ka haki ʻana o ka esophagus
I ka manawa hea e ʻike ai i ke kauka
Inā loaʻa iā ʻoe kekahi o kēia mau hōʻailona ma hope o ke ʻoki ʻana, e kāhea koke aku i kāu kauka, a i ʻole e hele i ka Emergency Department (ETU) o ka haukapila kokoke loa.
- Inā ʻulaʻula a pehu kahi i ʻoki ʻia.
- Inā puka mai ka pus mai ka ʻeha ʻoki.
- Inā ʻaʻole hiki iā ʻoe ke ale i nā wai.
- Inā ʻaʻole hiki i nā lāʻau ʻeha i hāʻawi ʻia e ke kauka ke hōʻoluʻolu i ka ʻeha.
ʻO ka ʻokoʻa ma waena o Heller Myotomy a me ke ʻoki kino POEM
Ua lohe paha ʻoe i kahi ʻoki kino i kapa ʻia ʻo POEM. ʻO POEM ka pōkole no Peroral Endoscopic Myotomy . E like me Heller Myotomy, he lāʻau lapaʻau kēia no ke ʻano Achalasia.
ʻO ka ʻokoʻa ma waena o nā mea ʻelua, ʻo ia ka hana ʻoki POEM, ʻaʻohe ʻoki ʻia i loko o kou ʻōpū. Akā, hoʻokomo kāu kauka i kahi endoscope (kahi paipu me kahi kāmela i hoʻopili ʻia) ma kou waha a i lalo i kou esophagus. A laila ʻoki ʻia ka ʻiʻo LES mai loko mai. Ma Heller Myotomy, hana ʻia kēia mai waho ma o nā ʻoki liʻiliʻi i loko o kou ʻōpū.
Leka Lawe-Home
- ʻO Heller Myotomy kahi hana i hana ʻia e mālama i ka achalasia, kahi kūlana e pilikia ai ka ale ʻana.
- Hana pinepine ʻia kēia ma o ka laparoscopically ma o nā ʻoki liʻiliʻi i loko o ka ʻōpū, kahi e hoʻomaha ai ka sphincter esophageal haʻahaʻa.
- ʻOiai ʻo kēia ʻoki kino e hāʻawi i ka hōʻoluʻolu lōʻihi mai nā hōʻailona, ʻaʻole ia he lāʻau piha no Achalasia.
- I ka wā e hoʻōla ai ma hope o ke ʻoki ʻana, pono ʻoe e hahai i kahi papaʻai kūikawā no kekahi mau pule.
- He mea nui loa e hahai pono i nā ʻōlelo a kāu kauka e like me ka mea i hāʻawi ʻia ma mua a ma hope o ke ʻoki ʻana.
- E ʻimi koke i ke kōkua lapaʻau inā ʻike ʻoe i kekahi mau hōʻailona hōʻailona, e like me ka pehu ʻana, ka pus, a i ʻole ka hiki ʻole ke ale i nā wai ma kahi ʻoki.
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