Esophagectomy - vula

I-esophagectomy evulekileyo kukuhlinzwa ukuze ususe inxenye okanye yonke into. Le yile ityhubhu ehambisa ukutya ukusuka kumqala wakho ukuya esiswini sakho. Emva kokuba isusiwe, umqala uphinde wakheke kwinxalenye yesisu sakho okanye kwinxalenye yamathumbu akho amakhulu.

Uninzi lwexesha, i-esophagectomy yenziwa ukunyanga umhlaza we-esophagus okanye isisu esonakaliswe kakhulu.

Ngethuba le-esophagectomy evulekile, enye okanye ngaphezulu ukusika okukhulu (ukusikwa) kwenziwa esiswini sakho, esifubeni, okanye entanyeni. (Enye indlela yokususa i-esophagus yi-laparoscopically. Utyando lwenziwa ngeendlela ezimbalwa ezincinci, kusetyenziswa ubungakanani bokubukela.)

Eli nqaku lixoxa ngeendlela ezintathu zotyando oluvulekileyo. Ngalo naluphi na utyando, uyakufumana iyeza (i-anesthesia) eliza kukugcina ulele kwaye ungabinazintlungu.

Isophagectomy yaseTranshiatal:

• Ugqirha wenza amanxeba amabini amakhulu. Ukunqunyulwa okukodwa kusentanyeni yakho kwaye enye isisu sakho esisentla.
• Ukusuka esisikweni esiswini, ugqirha ukhulula isisu kunye nendawo esezantsi yomqala kwizicwili ezikufuphi. Ukusuka kunqunyulwe entanyeni, okuseleyo komqala kuyakhululwa.
• Ugqirha osusa ugqirha emva koko ususa inxenye yesifo somhlaza apho umhlaza okanye enye ingxaki ikhoyo.
• Isisu sakho emva koko sifakwa kwityhubhu ukwenza umqala omtsha. Idityaniswe kwinxalenye eseleyo yomqala wakho ngezi staples okanye imithungo.
• Ngexesha lotyando, ii-lymph node entanyeni yakho nasesiswini kunokwenzeka ukuba zisuswe ukuba umhlaza usasazekile kubo.
• Umbhobho wokutya ubekwa emathunjini akho amancinci ukuze ukondliwe ngelixa uchacha kutyando.
• Iityhubhu zokuhambisa amanzi zinokushiyeka esifubeni ukususa ulwelo.

I-esophagectomy yeTransthoracic: Olu tyando lwenziwa ngendlela efanayo nenkqubo yokudlula komzimba. Kodwa ukusikwa okuphezulu kwenziwa kwisifuba sakho sasekunene, hayi entanyeni.

En bloc esophagectomy:

• Ugqirha wenza amanxeba amakhulu entanyeni, esifubeni, nasesiswini. Zonke izisu zakho kunye nenxalenye yesisu sakho ziyasuswa.
• Isisu sakho sonke siphinde safakwa kwityhubhu kwaye sibekwe esifubeni sakho ukubuyisela umqala wakho. Umbhobho wesisu uqhagamshelwe kwindawo eseleyo esophagus entanyeni.
• Ugqirha ususa zonke i-lymph node esifubeni sakho, entanyeni nasesiswini.

Uninzi lwale misebenzi ithatha iiyure ezi-3 ukuya kwezi-6.

Ugqirha lokususa i-esophagus esezantsi linokwenziwa ukunyanga:

• Imeko apho iringi yemisipha engasebenziyo ingasebenzi kakuhle (achalasia)
• Umonakalo omkhulu womda womphetho onokubangela umhlaza (iBarrett esophagus)
• Umonzakalo omkhulu
• Ukutshatyalaliswa kwesifo
• Isisu esonakaliswe kakhulu

Olu luqhaqho olukhulu kwaye lunobungozi obuninzi. Ezinye zazo zinzulu. Qiniseka ukuba uxoxa ngale ngozi kunye nogqirha wakho.

Umngcipheko kolu tyando, okanye ngeengxaki emva kotyando, unokuba mkhulu kunesiqhelo ukuba:

• Abakwazi ukuhamba, nokuba kukude nje (oku kwandisa umngcipheko wamahlwili egazi, iingxaki zemiphunga kunye nezilonda zoxinzelelo)
• Badala
• Ngaba utshaya kakhulu
• Batyebile
• Uphulukene nobunzima obuninzi kumhlaza wakho
• Ngaba amayeza steroid
• Unesifo esibuhlungu esivela kwi-esophagus / isisu esonakalisiweyo
• Wafumana iziyobisi zomhlaza (chemotherapy) ngaphambi kotyando

Umngcipheko we-anesthesia kunye notyando ngokubanzi zezi:

• Ukunyanga kwamayeza kunyango
• Iingxaki zokuphefumla
• Ukopha, amahlwili egazi, okanye usulelo

Iingozi zolu tyando zezi:

• Reflux yeasidi
• Ukwenzakala kwisisu, amathumbu, imiphunga, okanye amanye amalungu ngexesha lotyando
• Ukuvuza kwesiqulatho somqala okanye isisu sakho apho ugqirha wazihlanganisa kunye
• Ukunciphisa unxibelelwano phakathi kwesisu sakho kunye nomqala
• Kunzima ukuginya okanye ukuthetha
• Ukuthintelwa kwamathumbu

Uya kuba notyelelo oluninzi logqirha kunye novavanyo lonyango ngaphambi kotyando, kubandakanya:

• Uvavanyo olupheleleyo lomzimba.
• Ukutyelelwa ngugqirha wakho uqiniseke ukuba ezinye iingxaki zonyango onokuba nazo, ezinjengesifo seswekile, uxinzelelo lwegazi kunye neengxaki zentliziyo okanye zemiphunga ziphantsi kolawulo.
• Iingcebiso ngezondlo.
• Undwendwelo okanye iklasi yokufunda okwenzekayo ngexesha lotyando, into omele uyilindele emva koko, kwaye zeziphi iingozi okanye iingxaki ezinokubakho emva koko.
• Ukuba kutshanje uye waphulukana nobunzima, ugqirha unokukubeka kwisondlo ngomlomo okanye nge-IV kwiiveki ezimbalwa ngaphambi kotyando.
• Iskena se-CT ukujonga umqala.
• Ukuskena i-PET ukufumanisa umhlaza kwaye ukuba sele usasazekile.
• I-Endoscopy ukuxilonga kunye nokuchonga ukuba umhlaza uye kude kangakanani.

Ukuba uyatshaya, kuya kufuneka uyeke ukutshaya iiveki ezininzi ngaphambi kotyando. Umboneleli wakho wezempilo unokunceda.

Xelela umboneleli wakho:

• Ukuba ukhulelwe okanye unokukhulelwa
• Ngawaphi amayeza, iivithamini kunye nezinye izongezo ozithathayo, kwanezo uzithengileyo ngaphandle kommiselo
• Ukuba ubusele utywala obuninzi, ngaphezu kwesiselo esinye okanye ezi-2 ngosuku

Ngexesha leveki ngaphambi kotyando:

• Unokucelwa ukuba uyeke ukuthatha amayeza amancinci egazi. Ezinye zezi aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), kunye ne-clopidogrel (Plavix), okanye i-ticlopidine (Ticlid).
• Buza ugqirha wakho ukuba ngawaphi amayeza ekufuneka uwathathe ngosuku lotyando.
• Lungisa ikhaya lakho emva kotyando.

Ngomhla wotyando:

• Landela imiyalelo yokuba uyeke nini ukutya nokusela ngaphambi kotyando.
• Thatha amayeza ugqirha wakho akuxelele ukuba uwathabathe ngesiphuzo esincinci samanzi.
• Fika esibhedlele ngexesha.

Uninzi lwabantu luhlala esibhedlele kangangeentsuku ezisi-7 ukuya kwezi-14 emva kolu tyando. Unokuchitha i-1 ukuya kwiintsuku ezi-3 kwigumbi lokunyamekela abagulayo (ICU) emva kotyando.

Ngexesha lokuhlala kwakho esibhedlele, uya:

• Celwa ukuba uhlale ecaleni kwebhedi yakho kwaye uhambe ngosuku okanye ngemini enye emva kotyando.
• Ukungakwazi ukutya ubuncinci kwiintsuku zokuqala ezi-5 ukuya kwezi-7 emva kotyando. Emva koko, unokwazi ukuqala ngolwelo. Uya kutyiswa ngombhobho wokutyisa owawubekwe emathunjini akho ngexesha lotyando.
• Yiba nombhobho ophuma ecaleni kwesifuba sakho ukukhupha ulwelo olwakhayo.
• Nxiba isitokhwe esikhethekileyo ezinyaweni nasezinyaweni ukukhusela amahlwili egazi.
• Fumana iifotsholo ukunqanda amahlwili egazi.
• Fumana amayeza entlungu nge-IV okanye uthathe iipilisi. Unokufumana iyeza lakho leentlungu ngempompo ekhethekileyo. Ngale mpompo, ucofa iqhosha ukuhambisa amayeza entlungu xa uwufuna. Oku kukuvumela ukuba ulawule inani lamayeza eentlungu owafumanayo.
• Yenza imithambo yokuphefumla ukuthintela usulelo lwemiphunga.

Emva kokuba ugodukile, landela imiyalelo yendlela yokuzikhathalela njengoko uphilisa. Uya kunikwa ulwazi malunga nokutya kunye nokutya. Qiniseka ukuba uyayilandela loo miyalelo ngokunjalo.

Abantu abaninzi bachacha kakuhle kolu tyando kwaye banokutya okuqhelekileyo. Emva kokuba bachache, kuya kufuneka batye iinxalenye ezincinci kwaye batye rhoqo.

Ukuba uye wahlinzwa umhlaza, thetha nogqirha wakho malunga namanyathelo alandelayo onyango lomhlaza.

Ukutshatyalaliswa kwe-esophagectomy; I-esophagectomy yeTrans-thoracic; Kwi-bloc esophagectomy; Ukususwa komqala - kuvuleke; Ivor-Lewis esophagectomy, Blunt esophagectomy; Isifo somhlaza esophageal - esophagectomy - evulekileyo; Umhlaza we-esophagus-esophagectomy-uvulekile

• Sula ukutya okungamanzi
• Ukutya kunye nokutya emva kwesophagectomy
• Esophagectomy - ukubhobhoza
• Ityhubhu yokondla isisu - i-bolus

• Umhlaza wesisu

Kwiwebhusayithi yeZiko loMhlaza weSizwe. Unyango lwe-Esophageal cancer (PDQ) -uhlobo lobungcali kwezempilo. www.cancer.gov/types/esophageal/hp/esophageal-nyango-pdq. Ukuhlaziywa kweyeNkanga 12, 2019. Ifikeleleke ngoNovemba 19, 2019.

USpicer JD, uDhupar R, uKim JY, uSepesi B, uHofstetter W. Esophagus. Ku: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, ii-eds. Incwadi yeSabiston yoNyango. Umhla we-20. IPhiladelphia, PA: Elsevier; Ngo-2017: isahluko 41.