Aia kekahi pilina kupanaha ma waena o ka paipu meaʻai a kāu pēpē a me ka paipu makani? E aʻo kākou e pili ana i (Tracheoesophageal Fistula)!

Ke ʻū koke nei kāu keiki liʻiliʻi ma hope o ka inu ʻana i ka waiū a i ʻole ka ʻai ʻana i ka meaʻai? Me he mea lā ua paʻakikī iā ia ke hanu a i ʻole e uliuli? He mea maʻamau iā ʻoe ma ke ʻano he makua ke makaʻu nui a hopohopo. I kekahi manawa, ma hope o kēia mau hōʻailona, ​​​​aia paha kahi maʻi paʻakikī iki, akā hiki ke mālama ʻia a mākou e kamaʻilio ai i kēia lā. ʻO ia ka Tracheoesophageal Fistula , a i ʻole TEF no ka pōkole, a me ke ʻano pili ʻo Esophageal Atresia , a i ʻole EA. Mai hopohopo, e mālama kākou i ka maʻalahi.

He aha ka Tracheoesophageal Fistula (TEF)? E hoʻomaopopo maʻalahi kākou!

ʻAe, e nānā kākou i kēia TEF. I ka ʻōlelo maʻalahi, ʻo ka ʻōmole e lawe ana i ka meaʻai mai ko kākou puʻu a i ko kākou ʻōpū ua kapa ʻia ʻo "esophagus". Pēlā nō, ʻo ka ʻōmole e lawe ana i ka ea i ko kākou mau māmā i ka wā e hanu ai kākou ua kapa ʻia ʻo "trachea". ʻO ka maʻamau, i loko o ke kanaka olakino, aia kēia mau ʻōmole ʻelua, ʻo ka esophagus a me ka trachea, ma kahi kaʻawale, me ka ʻole o ka pilina kekahi i kekahi. Ua like ia me ʻelua alanui, hoʻokahi no ka meaʻai a ʻo kekahi no ka hanu ʻana.

Eia nō naʻe, i loko o ke kanaka me ke ʻano i kapa ʻia ʻo Tracheoesophageal Fistula (TEF) , ʻoiai he pēpē liʻiliʻi, aia kahi pilina kūlohelohe ʻole, a i ʻole lua (fistula) ma waena o ka paipu meaʻai (esophagus) a me ka windpipe (trachea). E noʻonoʻo e like me kahi liki liʻiliʻi ma waena o ʻelua mau paipu wai. He aha ka mea e hana ʻia ma muli o kēia? Ma kahi o ka iho ʻana i ka paipu meaʻai i ka ʻōpū, hoʻomaka ka meaʻai a me nā wai a ka pēpē e ʻai ai a inu ai e hele ma o kēlā pilina kūlohelohe ʻole i loko o ka windpipe a mai laila aku i loko o nā māmā. Kāhea mākou i kēia "aspiration" . He mea weliweli iki kēia, no ka mea, inā komo ka meaʻai i loko o nā māmā, hiki ke loaʻa nā maʻi.

I ka manawa pinepine, ʻike ʻia kēia kūlana TEF me kekahi kūlana ʻē aʻe. ʻO ia hoʻi ʻo Esophageal Atresia (EA) . ʻO ka EA kahi kūlana i hana ʻole ʻia ai ka esophagus (paipu meaʻai), ʻaʻole pili i ka ʻōpū, a kū i ka hapalua. I kekahi manawa ua māhele ʻia ka esophagus i ʻelua ʻāpana, a ua pani ʻia nā wēlau o nā ʻāpana ʻelua (nā ʻeke makapō). E like me ka paipu i haki i waenakonu.

ʻO wai ka mea i hoʻopilikia nui ʻia e kēia kūlana?

ʻO ka tracheoesophageal fistula (TEF) he "kūlana hānau." ʻO ia hoʻi, ua hānau ʻia nā pēpē me ke kūlana. Hoʻokumu ʻia ia e kahi loli liʻiliʻi i ka ulu ʻana o ke keiki i loko o ka ʻōpū. No laila, ʻo ka hapa nui o nā hihia o TEF ua ʻike ʻia a mālama ʻia ma hope o ka hānau ʻana o ke pēpē, i ka wā kamaliʻi.

Eia nō naʻe, ʻoiai he mea kakaikahi loa, hiki i nā pākeke ke loaʻa i kēia kūlana TEF ma hope o ke ola. Ua kapa ʻia ʻo "Acquired Tracheoesophageal Fistula" . Hiki ke hana ʻia kēia e ke kanesa esophageal, ke kanesa māmā, nā maʻi koʻikoʻi e like me ka maʻi puʻupuʻu, a i ʻole kahi ulia i ka wā o ke kaʻina hana lapaʻau.

Pehea ka maʻamau o ka Tracheoesophageal Fistula (TEF)?

Wahi a nā helu helu mai ʻAmelika Hui Pū ʻIa, ua manaʻo ʻia ua hoʻopilikia ka TEF ma kahi o hoʻokahi i loko o kēlā me kēia 3,000 a 5,000 mau pēpē i hānau ʻia. Eia kekahi, ma kahi o 50% o nā pēpē me TEF a i ʻole EA paha he maʻi hānau ʻē aʻe. ʻO ke ʻano kēia, aia paha he mau pilikia ma nā wahi ʻē aʻe, e like me nā puʻupaʻa, ka puʻuwai, a i ʻole ka ʻōnaehana iwi.

ʻAʻole maʻamau ka "Acquired TEF" i loaʻa i ka wā makua. Eia kekahi, he mea kākaʻikahi loa, hiki i kekahi poʻe mākua ke hānau ʻia me TEF a loaʻa nā hōʻailona e ʻike ʻia ma hope o ke ola. ʻO ia hoʻi, loaʻa iā lākou ke ʻano i ka wā hānau, akā ʻike ʻia nā hōʻailona ma hope.

He aha nā ʻano nui o ka Tracheoesophageal Fistula (TEF)?

I kēia manawa, e nānā kākou i nā ʻano nui o kēia maʻi TEF. Hoʻokaʻawale pinepine nā kauka iā ia i ʻelima mau ʻano. He kikoʻī iki kēia, akā e hoʻāʻo kākou e hoʻomaopopo. E noʻonoʻo ʻo ka esophagus (E) he paipu hoʻokahi, a ʻo ka trachea (T) he paipu ʻē aʻe.

• ʻAno A: He TEF kēia, ʻo ia hoʻi, ʻaʻohe pilina maʻamau ʻole. Akā aia ka EA (Esophageal Atresia) . ʻO ke ʻano kēia, ua māhele ʻia ka esophagus i ʻelua ʻāpana, a ua pani ʻia nā wēlau o luna a me lalo o nā ʻāpana ʻelua (nā ʻeke makapō). Ua like ia me ka paipu i haki ma waena a ua pani ʻia nā wēlau ʻelua o nā ʻāpana i haki. Ua kapa ʻia hoʻi kēia ʻo "Pure Esophageal Atresia". Ma kahi o 8% o nā maʻi TEF/EA āpau no kēia ʻano.

• ʻAno B: He mea kākaʻikahi loa kēia, e pili ana i ka 2% wale nō o nā maʻi āpau. Maanei, ua pili ka ʻaoʻao o luna o ka esophagus i ka trachea (aia kahi TEF), akā ʻo ka ʻaoʻao haʻahaʻa o ka esophagus e pau ana i kahi ʻaoʻao pani (ʻeke makapō).

• ʻAno C: ʻO kēia ke ʻano maʻamau. Ma kahi o 85% o nā hihia e hāʻule ana i loko o kēia māhele. ʻO ka mea e hana ʻia ma ʻaneʻi, ʻo ka ʻaoʻao o luna o ka esophagus e pau ana i kahi ʻaoʻao pani (ʻeke makapō), akā ua pili ka ʻaoʻao haʻahaʻa o ka esophagus i ka trachea (TEF). ʻO ke ʻano kēia, ua pili ka ʻāpana o ka esophagus e pono e pili i ka ʻōpū i ka trachea.

• ʻAno D: ʻO kēia ke ʻano kakaikahi loa, e kū ana ma lalo o 1% o nā hihia. Maanei, ua pili ka ʻaoʻao o luna a me lalo o ka esophagus i ka trachea ma ke kaʻawale (ʻelua TEF).

• ʻAno E: Ma kēia ʻano, ua hoʻokumu piha ʻia ka esophagus a pili i ka ʻōpū. ʻO ke ʻano kēia ʻaʻole i loaʻa ka EA. Eia nō naʻe, aia kahi pilina maʻamau ʻole (TEF) ma waena o ka esophagus a me ka trachea. I kekahi manawa ua kapa ʻia kēia he fistula ʻano H, no ka mea hiki ke hoʻohālikelike ʻia ka pilina e like me ka leka "H". Ma kahi o 4% o nā maʻi āpau e hāʻule i kēia ʻano.

ʻOiai paha he mea paʻakikī iki kēia hoʻokaʻawale ʻana, he mea nui loa i nā kauka ke hoʻolālā i ka lāʻau lapaʻau.

He aha nā hōʻailona o ka Tracheoesophageal Fistula (TEF)?

Aia nā hōʻailona o TEF i ka loaʻa ʻana o ka EA (Esophageal Atresia) a me ke ʻano o ka TEF.

ʻAʻole paha e hōʻike nā pēpē me TEF wale nō (no ka laʻana, ʻAno E) me ka ʻole o ka EA i nā hōʻailona i ka wā hānau. Eia nō naʻe, i ka hala ʻana o ka manawa, e ʻike paha lākou i nā mea e like me:

• Loaʻa pinepine nā maʻi māmā ma muli o ka paʻa ʻana o nā ʻāpana meaʻai i loko o nā alaea.
• I ka wā e hānai waiū ai a i ʻole e hānai ana, hanu lākou a manaʻo e like me lākou e ʻū ana.

ʻO nā pēpē me ka Esophageal Atresia (EA) a me ka Tracheoesophageal Fistula (TEF) (e like me ke ʻano maʻamau, ʻo Type C) e hōʻike pinepine i nā hōʻailona i loko o kekahi mau hola o ka hānau ʻana. ʻO nā hōʻailona maʻamau:

• ʻŪ pinepine, ʻoiai i ka wā e hoʻāʻo ai e hānai i ka waiū.
• Ke ʻūʻū nei i ka wā e hoʻāʻo ai e ale.
• Nā pilikia hanu.
• Ka nui o ka hoʻokuʻu ʻana mai ka waha mai.
• ʻO ka pehu ʻana o ka ʻōpū (ʻoi aku hoʻi i ke ʻano C, i ka wā e hele ai ka ea i hanu ʻia ma o ka TEF i loko o ka ʻōpū).
• Lilo ka pēpē i polū (cyanosis) i ka wā e hānai waiū ana.

E noʻonoʻo, aia kahi pēpē hānau hou. I ka manawa e hoʻāʻo ai ka makuahine e hānai i ka waiū, hoʻomaka ka pēpē e ʻū mau, me he mea lā e ʻū ana, a i kekahi manawa e lilo i polū a puni ka waha. Nui ka mucus e puka mai ana mai loko mai o ka waha. Inā ʻike ʻoe i kahi mea e like me kēia, he mea nui loa ia e ʻimi koke i ke kōkua lapaʻau.

He aha ke kumu o ka Tracheoesophageal Fistula (TEF)?

Hana pinepine ʻia kēia i ka wā o ka ulu ʻana o ka fetal, ʻo ia ka manawa e ulu ana ka pēpē i loko o ka ʻōpū. ʻO ka maʻamau, ma waena o ʻehā a me ʻewalu pule ma hope o ka hāpai ʻana, hana ʻia kahi paia ma waena o ka esophagus a me ka windpipe, kahi e hoʻomaka mua ai ma ke ʻano he paipu hoʻokahi. Ke hana pono ʻole ʻia kēia paia, a i ʻole ʻaʻole i piha ka hoʻokaʻawale ʻana, hana ʻia kēia pilina maʻamau i kapa ʻia ʻo Tracheoesophageal Fistula (TEF). ʻAʻole ʻike ʻia ke kumu pololei o kēia ʻano, akā ua manaʻo ʻia ua hana ʻia e nā kumu genetic a me ke kaiapuni.

Pehea e ʻike ai nā kauka i kahi TEF?

He mea kākaʻikahi loa, hiki i ke kauka ke kānalua i kahi TEF ma muli o nā ʻano ʻē i ʻike ʻia ma kahi scan ultrasound ma mua o ka hānau ʻana o ka pēpē. No ka laʻana, inā he nui loa ka wai amniotic a puni ka pēpē (polyhydramnios), a inā ʻaʻole ʻike maopopo ʻia ka ʻōpū o ka pēpē, hiki i ke kauka ke kānalua.

Eia nō naʻe, ʻo ka hapa pinepine, kū mai ka kānalua o TEF i loko o kekahi mau hola o ka hānau ʻana, i ka wā e hoʻomaka ai ka pēpē e hōʻike i nā hōʻailona i ʻōlelo ʻia ma luna (ka nui o ka mucus, ka paʻakikī o ka hanu ʻana, ka hiki ʻole ke ale).

No ka hōʻoia ʻana i kēia kānalua, hiki i ka hui lapaʻau ke hana i nā hoʻokolohua e like me:

• Nā kukuna X-ray o ka umauma a me ka ʻōpū: Hiki i kēia ke nānā i ke kūlana o ka esophagus, nā māmā, a inā he ea i loko o ka ʻōpū. No ka laʻana, hiki i kahi ʻōmole liʻiliʻi (ʻōmole nasogastric) i kau ʻia i loko o ka esophagus o kahi pēpē me ka EA ke kū i ka hapalua o ka X-ray me ka hiki ʻole i ka ʻōpū.
• Endoscopy a i ʻole Bronchoscopy: Ma kēia mau hoʻokolohua, hoʻokomo ʻia kahi ʻōmole lahilahi me kahi kāmela i hoʻopili ʻia ma o ka waha a i ʻole ka ihu a nānā pololei i loko o ka esophagus (endoscopy) a i ʻole ka windpipe (bronchoscopy). Hiki i kēia ke kōkua i ke kuhikuhi ʻana i kahi kikoʻī o ka pilina maʻamau ʻole (fistula).

Ke ʻike ʻia kahi pēpē me TEF a i ʻole EA, e kauoha pinepine ke kauka i nā hoʻokolohua hou aʻe e nānā i nā kīnā hānau ʻē aʻe, e like me ka mea i ʻōlelo ʻia ma mua. No ka laʻana, hiki ke hana ʻia kahi scan puʻuwai (echocardiogram) a me kahi scan puʻupaʻa.

Pehea e mālama ʻia ai ka Tracheoesophageal Fistula (TEF)?

ʻO ke ʻoki kino wale nō ka lāʻau lapaʻau kūpono no TEF. Ma kēia ʻoki kino, wehe ke kauka ʻoki kino i ka pilina maʻamau ʻole ma waena o ka esophagus a me ka trachea o ka pēpē a pani i ka lua. A laila, inā loaʻa pū kekahi EA, hoʻopili ʻia nā ʻāpana ʻelua o ka esophagus i haki ʻia e hiki ai i ka meaʻai ke hele ma waena.

Hiki ke hana ʻia kēia ʻoki kino ma ke ʻano he ʻoki kino hāmama kuʻuna a i ʻole he ʻoki kino minimally invasive (ʻoki kino thoracoscopic) me ka hoʻohana ʻana i kekahi mau ʻoki liʻiliʻi. Aia ke ʻano i hoʻohana ʻia ma nā mea e like me ke kūlana o ka pēpē, ke ʻano o TEF, a me ka ʻike o ke kauka ʻoki kino.

Aia kekahi mau pilikia i kēia ʻoki kino?

E like me nā ʻoki kino āpau, hiki i ke ʻoki kino hoʻoponopono TEF ke loaʻa kekahi mau pilikia. ʻO kēia mau mea:

• Nā leaka anastomotic: Pili kēia i ka leaka ʻana o nā wai mai ka anastomosis (pilina) o ka ʻōmole hānai.
• ʻO nā ʻūmiʻi o ka esophagus: He kūlana kēia kahi e emi ai ka pilina i ka paipu meaʻai i ka hala ʻana o ka manawa. Hiki i kēia ke paʻakikī i ka pēpē ke ale.
• Ka hōʻino ʻana i ke aʻalolo laryngeal: Hiki i kēia ke hoʻopilikia i ka leo o ke pēpē.
• Hoʻi hou ʻana o ka fistula: ʻOiai ma hope o ke ʻoki ʻana, ʻaʻole hiki ke hoʻi hou ka pilina maʻamau. Hana ʻia kēia ma kahi o 3% a 14% o nā hihia.
• Nā maʻi.
• ʻO ka maʻi Reflux Gastroesophageal (GERD): ʻO kēia ka manawa e holo hou ai ka waikawa o ka ʻōpū i loko o ka esophagus. He mea maʻamau kēia ma hope o ke ʻoki ʻana o TEF.

E kamaʻilio pū ke kime lapaʻau me ʻoe e pili ana i kēia mau pilikia. Mai hopohopo, ua mākaukau nā kauka no kēia mau mea a pau.

ʻEhia ka lōʻihi e hoʻōla ai ma hope o ka mālama ʻana iā TEF?

Hiki ke ʻokoʻa ka manawa hoʻōla mai kēlā pēpē a i kēia pēpē. Aia ia i ke koʻikoʻi o ke kūlana o ka pēpē, ke ʻano o ke ʻoki ʻana, a pehea e pane ai ka pēpē i ka lāʻau lapaʻau. I ka hapa nui o nā hihia, hiki ke hala ma kahi o 12 mau pule, a i ʻole ʻekolu mahina, e hoʻōla piha ai. I loko o kēia manawa, hiki ke hānai ʻia ka pēpē ma o kahi ʻōmole hānai kūikawā, a i ʻole e hoʻolauna mālie ʻia i ka hānai waha. E wehewehe nā kauka a me nā limahana hānai i kēia mau mea āpau iā ʻoe.

Hiki ke pale ʻia ka Tracheoesophageal Fistula (TEF)?

ʻAʻohe ala e pale aku ai i ka TEF hānau ʻia i kēia manawa, ʻo ia hoʻi ka TEF i loaʻa i ka wā hānau. ʻO kēia no ka mea e kū mai ana i ka wā o ka fetal. Eia kekahi, ʻoiai ʻo ka loaʻa ʻana o ka TEF, ka mea e kū mai ana i ka wā makua, ua hana pinepine ʻia e ka maʻi kanesa a i ʻole nā ​​maʻi koʻikoʻi, ʻaʻohe ala kikoʻī e pale aku ai. Eia nō naʻe, ʻo ka hahai ʻana i kahi nohona olakino hiki ke kōkua i ka pale ʻana i ka maʻi kanesa a me nā maʻi.

He aha kaʻu e manaʻo ai inā loaʻa ka TEF i kaʻu pēpē?

Inā ua ʻike ʻia kāu pēpē me TEF, e paipai koke ke kime lapaʻau i ke ʻoki kino. Hiki i kēia ke lilo i mea hoʻoweliweli i ke ola, no laila he mea nui e loaʻa koke ka lāʻau lapaʻau. Aia ke ʻano o ke ʻoki kino i ke ʻano o TEF.

Inā loaʻa i ka pēpē kekahi mau pilikia ma hope o ke ʻoki ʻana, e mālama ke kime lapaʻau i ka pēpē i loko o ka haukapila no kekahi mau lā a nānā pono i kona kūlana. ʻO nā pēpē e loaʻa i nā pilikia ma hope koke o ke ʻoki ʻana, ʻoi aku ka nui o ka loaʻa hou ʻana o TEF ma hope. No laila, inā loaʻa kēlā mau pilikia, e hoʻomau ke kauka i ka nānā ʻana i ka pēpē (nā hahai ʻana).

I kahi manawa e like me kēia, ma ke ʻano he mau mākua, hiki iā ʻoe ke manaʻo ua kaumaha kou noʻonoʻo. Hiki iā ʻoe ke makaʻu. He mea maʻamau kēlā. E nīnau i nā kauka a me nā kahu maʻi i kāu mau nīnau a hoʻomaʻemaʻe i kou mau kānalua. E kōkua lākou iā ʻoe.

Hiki ke ho'ōla loa ʻia ka Tracheoesophageal Fistula (TEF)?

ʻAe! Hiki ke ho'ōla piha ʻia ka tracheoesophageal fistula (TEF) me ke ʻoki kino. ʻO ka mea nui loa, ʻo ia ka ʻike mua ʻana a hoʻomaka koke i ka mālama ʻana, no ka mea, he maʻi ia e hoʻoweliweli ai i ke ola. Hiki i ka hana ʻana pēlā ke hoʻoponopono i ka pilina maʻamau ʻole ma waena o ka esophagus a me ka windpipe o ka pēpē, pale i ka meaʻai mai ke komo ʻana i loko o nā māmā (aspiration), a hāʻawi i ka pēpē i ka manawa kūpono e ola ai i ke ola olakino.

ʻO ka mea hope loa, e hoʻomanaʻo i kēia (Leka Lawe-Home)

He mea maʻamau ke kaumaha ke ʻike ʻoe ua loaʻa i kāu keiki liʻiliʻi ka Tracheoesophageal Fistula (TEF). Akā e hoʻomanaʻo, he maʻi hiki ke mālama ʻia kēia.

• ʻO ka ʻike mua ʻana a me ka mālama koke ʻana nā mea nui loa. Inā e uē mau ana kāu pēpē i ka wā e hānai waiū ana a i ʻole e ʻai ana, me he mea lā e paʻakikī ana ka hanu ʻana, a i ʻole e polū, e ʻimi koke i ke kōkua lapaʻau.
• ʻO ke ʻoki kino ke ʻano lapaʻau nui no kēia.E hāʻawi nā kauka i ka lāʻau lapaʻau kūpono loa no kāu pēpē.
• ʻOiai ma hope o ke ʻoki ʻana, he mea nui loa e hahai i nā ʻōlelo aʻo a nā kauka a lawe i ke pēpē no nā hoʻokolohua nānā hou i ka manawa kūpono.
• ʻAʻole ʻoe hoʻokahi. He mea waiwai nui ke kākoʻo o kāu hui lapaʻau, ʻohana, a me nā hoaaloha i kēia manawa. Mai kānalua e kaʻana like i kou mau manaʻo a noi i ke kōkua.

Lana ko mākou manaʻo e kōkua kēia ʻike iā ʻoe e hoʻomaopopo i kēia kūlana paʻakikī. Makemake mākou i kāu pēpē e ho'ōla koke!

ʻO ka fistula tracheoesophageal, esophageal atresia, kūlana hānau, kīnā hānau, olakino pēpē, ʻoki kino pediatric, makemake