Kei te rongo koe i te pupuhi i roto i tō korokoro, i tō uma rānei ina kai koe, ina inu rānei? Kei te mataku koe i ētahi wā ki te kai nā te mea e ahua ana kāore tō kai e heke ana? Tērā pea nā tētahi mate onge e kiia nei ko te Achalasia tēnei. Ehara i te mea ngāwari te noho me tēnei mate. He uaua ki te horomi kai, ā, ko te kore kai tika ka arahi pea ki te korenga o ngā kai totika. Nō reira, i tēnei rā ka kōrero tātou mō tētahi pokanga e kiia nei ko te Heller Myotomy, e mahia ana hei rongoā mō tēnei.
He aha te pokanga Heller Myotomy?
Ki te kī māmā noa, he pokanga tapahi iti te Heller Myotomy hei rongoā i te Achalasia . He mate onge te Achalasia e pā ana ki tō tātou korokoro, arā, te paipa kai. Koinei te wā kāore e pai te mahi a te tukanga tuku kai me te wai mai i te korokoro ki te puku.
Ko te tikanga o te kupu "myotomy" he tapahi i te uaua. I roto i te Heller Myotomy, ka tapahia e te taote pokanga ētahi tapahi iti i roto i te mowhiti uaua kei raro o tō korokoro, e kiia nei ko te Lower Esophageal Sphincter (LES) . He uaua matotoru te LES e noho ana i waenganui i te pito o raro o tō korokoro me te pito o runga o tō puku. He rite ki te takirere.
Mena he achalasia tōu, kāore te uaua LES e tuwhera, e kati tika. Ka ārai tēnei i te kai kia kore e rere mai i te korokoro ki roto i te puku. Ka mahi te pokanga Heller Myotomy mā te whakangāwari i te uaua LES me te whakatuwhera.
He maha ngā wā ka mahia tēnei pokanga me tētahi atu tikanga e kiia nei ko te fundoplication . Ko te tikanga o tēnei ko te tango a te taote pokanga i tētahi wāhanga o tō puku ka takai ki tō esophagus. Mā tēnei ka whakaiti i te tūponotanga o te hoki mai o te waikawa o te puku ki roto i tō esophagus (reflux).
Ko te mea nui, ehara te pokanga Heller Myotomy i te rongoā katoa mō te Achalasia. He whakaora roa, heoi anō, me mahi anō pea tēnei pokanga i roto i te wā.
Me pēhea te whakarite i mua i te pokanga?
Hei whakarite kei te pai koe mō te pokanga, ka whakaritea e tō tākuta ētahi whakamātautau i mua i te pokanga. Hei tauira, he whakamātautau toto, he hihi-X o te uma, me te ECG.
I mua i te pokanga, ka kōrero te tohunga whakamoe i a koe ki a koe. Ka pātai atu rātou ki a koe i ngā pātai pēnei i:
- Kua pangia koe e te rongoā whakamoe i mua, ā, he aha te wheako?
- He aha ngā otaota, ngā rongoā, ngā huaora rānei e whakamahia ana e koe?
- Kei te whakamahi koe i te tupeka, i te waipiro, i ētahi atu raau taero rānei?
He iti noa ngā mea hei mahi māu hei whakarite mō te pokanga. Me kōrerohia ēnei, ā, me whakaū hoki ki tō tākuta.
| Me aha? | He aha te hiranga o tēnā? |
|---|---|
| Te whakamutu i te whakamahi nikotīni (ahakoa he aha te momo, tae atu ki ngā hikareti me ngā hikareti hiko) | Ka pā te nikotīni ki tō tohanga toto, ka whakaroa i te whakaora o ngā patunga i muri i te pokanga. |
| Te nohopuku. | Tērā pea ka kī atu tō tākuta kia kaua e kai i tetahi mea mō ngā hāora e ono, neke atu rānei, i mua i te pokanga. Tērā pea ka taea e koe te inu i ngā wai mārama (pēnei i te wai) mō tētahi wā i mua i te pokanga. Engari kia tino pātai atu ki tō tākuta mō tēnei. |
| Te whakamahere i tētahi noho ki te hōhipera. | He pokanga nui tēnei, nō reira me noho koe ki te hōhipera mō te iti rawa i te rā kotahi i muri i te pokanga. Me whakarite hoki kia haria koe e tetahi ki te kāinga, kia noho tahi hoki me koe mō ngā haora 24 tuatahi. |
| Te whakamahere mō te whakaoranga. | I muri i te pokanga, ka tohua pea e te tākuta he rongoā whakamamae mamae. Kāore e taea e koe te taraiwa kia tangohia rā anō e koe, nō reira kimihia he tangata hei āwhina i a koe ki aua mahi. |
Me pēhea te mahi i te pokanga?
Nā, me titiro tātou ki ngā mea e tupu ana i roto i te pokanga. I te nuinga o te wā, ka mahia tēnei mā te laparoscopic . Arā, mā te āwhina o tētahi karu tiro. I konei, ka whakamahia e te taote pokanga tētahi taputapu angiangi me tētahi kāmera e piri ana ki a ia hei tirotiro i roto i tō korokoro me ngā taputapu tino iti hei mahi i te pokanga.
- Tuatahi, ka whakauruhia e te tohunga whakamoe he aho IV (pērā i te ngongo e hoatu ana te tote) ki roto i te uaua i tō ringa, ā, ka hoatu he rongoā hei whakamoe i a koe. Kāore koe e rongo i tetahi mea i te wā o te pokanga.
- Muri iho, ka mahia e te taote pokanga kia rima ngā tapahi iti rawa ki tō puku.
- Kātahi ka whakakīia tō kōhao puku ki te hau waro hauhā. Ka mahia tēnei kia māmā ake ai te neke i ngā taputapu pokanga, kia mārama ai hoki te tirohanga o te korokoro me te taha whakarunga o te puku.
- Kātahi ka whakaurua e te tākuta he kāmera me ngā taputapu pokanga iti mā roto i aua tapahi .
- Mā te whakamahi i ēnei taputapu, ka tapahia te paparanga uaua i te raro o te korokoro kia roa, ā, ka whakatuwheratia te LES.
- Kātahi ka mahia he tikanga e kīia nei ko te fundoplication. Ko te tango i tētahi wāhanga o te taha whakarunga o te puku ka takai ki te esophagus. Mā tēnei ka ārai i te putanga ake o te waikawa o te puku.
- Hei whakamutunga, ka tangohia te kāmera me ngā taputapu, ā, ka tuia aua tapahi iti.
E rua hāora te roa o tēnei pokanga katoa.
He aha ngā mea ka tupu i muri i te pokanga?
Ka rerekē pea te wheako i muri i te pokanga i ia tangata, i ia tangata. Engari i te nuinga o te wā, ka noho koe i te hōhipera mō te pō. I tēnei wā, ka hoatu he wai me he kai māu mā te raina IV. Whai muri i tēnā, ka tīmata te wā whakaora.
Ko te mea nui rawa atu, tera pea ka pupuhi tō korokoro i muri i te pokanga. E rua marama pea te roa ka memeha rawa atu tēnei pupuhi. Nō reira, me whakarerekē haere tō kai.
Mā tō tīma hauora tēnei e whakamārama ki a koe, engari ko te mahere kai e whai ake nei.
| Wā | Kai e wātea ana |
|---|---|
| Te rā tuatahi me te rā tuarua | He wai mārama. Hei tauira: hupa heihei/mīti kau (kua whakaranua), tiēre, putea hukapapa, wai. |
| Mai i te toru o ngā rā ki te whitu o ngā rā | Ngā kai miraka. Hei tauira: te aihikirīmi, te hupa kirīmi kua tātarihia, ngā parāoa pērā i te Kirīmi Wiiti, te Kirīmi Raihi rānei. |
| Mai i te waru o ngā rā tae noa ki te tirotiro wiki e rua | Ngā kai ngāwari. Mā tō tākuta koe e kī atu āhea koe ka taea te tīmata tāpiri i ngā kai mārō. |
He aha ngā painga me ngā mōrearea o tēnei pokanga?
Ngā Painga
He tokomaha te hunga e pāngia ana e te achalasia ka whakamahi i te Heller Myotomy ina kore e angitu ētahi atu maimoatanga kore-pokanga. Ko te painga matua o tēnei tikanga ko te ngaro haere o ngā tohu o te achalasia i muri i te pokanga.
E ai ki tētahi tātaritanga rangahau tata nei, kua ngaro ngā tohumate i waenganui i te 87% me te 92% o te hunga kua whiwhi i tēnei maimoatanga. Heoi, e ai ki tā mātou i kōrero ai i mua, kāore tēnei e whakaora katoa i te achalasia. Tērā pea ka hoki anō ngā tohumate i ētahi wā i muri i te 5-10 tau o te pokanga.
Ngā Tūponotanga
Pērā i ngā pokanga nui katoa, he mōrearea anō hoki kei roto i te Heller Myotomy. Ko ngā mōrearea whānui ko te toto nui me te mate. Hei tāpiri, ko ngā raruraru motuhake ka puta ko:
- Te korokoro o Barrett
- Ngā mate pāwera o te korokoro
- GERD (mate reflux gastroesophageal)
- Pakaru o te korokoro
Āhea te wā e kite ai i te tākuta
Mena ka pā mai ētahi o ngā tohu e whai ake nei i muri i te pokanga, waea atu ki tō tākuta tonu atu, haere rānei ki te Tari Ohotata (ETU) o te hōhipera tata.
- Mena he whero, he pupuhi hoki te wāhi i pokangahia.
- Mena kei te puta mai te pūhā mai i te patunga pokanga.
- Ki te kore e taea e koe te horomi i ngā wai.
- Ki te kore ngā rongoā whakamamae mamae i hoatu e te tākuta e whakaora i te mamae.
Te rerekētanga i waenga i te Heller Myotomy me te pokanga POEM
Kua rongo pea koe i tētahi tikanga e kiia nei ko te POEM. Ko te POEM te whakarāpopototanga mō te Peroral Endoscopic Myotomy . Pērā i a Heller Myotomy, he maimoatanga anō hoki tēnei mō te mate Achalasia.
Ko te rerekētanga i waenganui i ngā mea e rua, i roto i te pokanga POEM, kāore he tapahi i roto i tō puku. Engari, ka whakaurua e tō tākuta he endoscope (he ngongo me te kāmera e piri ana) mā roto i tō waha, ka heke ki raro i tō korokoro. Kātahi ka tapahia te uaua LES mai i roto. I roto i te Heller Myotomy, ka mahia tēnei mai i waho mā roto i ngā tapahi iti i roto i tō puku.
Karere Tangohia ki te Kāinga
- Ko te Heller Myotomy he pokanga e mahia ana hei rongoā i te achalasia, he āhuatanga e uaua ai te horomi.
- I te nuinga o te wā ka mahia tēnei mā te laparoscopy mā roto i ngā tapahi iti i te puku, te wāhi e whakangāwarihia ai te sphincter esophageal o raro.
- Ahakoa ka whakaora roa tēnei pokanga i ngā tohumate, ehara i te mea he rongoā tino pai mō te Achalasia.
- I te wā e ora ana i muri i te pokanga, me whai koe i tētahi kai motuhake mō ētahi wiki.
- He mea tino nui kia whai koe i ngā tohutohu a tō tākuta kia rite ki ngā tohutohu i hoatu i mua atu, me muri mai i te pokanga.
- Rapua tonutia te awhina hauora mēnā ka puta he tohu whakatūpato, pērā i te pupuhi, te pupuhi, te kore rānei e taea te horomi wai i te wāhi i pokangahia.
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