I-Esophagectomy - ihlasela kancane

I-esophagectomy encane engahlaseli kakhulu ukuhlinzwa ukuze kususwe ingxenye noma wonke umphetho. Lesi yishubhu elihambisa ukudla kusuka emphinjeni kuya esiswini sakho. Ngemuva kokuthi isusiwe, umqala wakhiwa kabusha kusuka engxenyeni yesisu sakho noma ingxenye yamathumbu akho amakhulu.

Isikhathi esiningi, i-esophagectomy yenziwa ukwelapha umdlavuza we-esophagus. Ukuhlinzwa kungenziwa futhi ukwelapha umphimbo uma kungasasebenzi ukuhambisa ukudla esiswini.

Ngesikhathi se-esophagectomy esingahlasela kancane, ukusikeka okuncane kokuhlinzwa kwenziwa (esisikeni) esiswini sakho, esifubeni noma entanyeni. Ububanzi bokubuka (i-laparoscope) namathuluzi wokuhlinza afakwa phakathi kokuqhekeka kokwenza ukuhlinzwa. (Ukususwa kwesimilo kungenziwa futhi ngokusebenzisa indlela evulekile. Ukuhlinzwa kwenziwa ngokusikeka okukhulu.)

Ukuhlinzwa nge-laparoscopic ngokuvamile kwenziwa ngale ndlela elandelayo:

• Uzothola i-anesthesia ejwayelekile ngesikhathi sokuhlinzwa kwakho.Lokhu kuzokugcina ulele futhi ungabi nezinhlungu.
• Udokotela ohlinzayo usika izingcezu ezintathu kuya kwezingu-4 esiswini sakho, esifubeni noma entanyeni engezansi. Lokhu kusika kungamasentimitha ayi-2,5 ubude.
• I-laparoscope ifakwa ngesinye sezisiki esiswini sakho esingenhla. Ububanzi bunokukhanya nekhamera ekugcineni. Ividiyo evela kwikhamera ivela kumonitha egumbini lokusebenza. Lokhu kuvumela udokotela ohlinzayo ukuthi abuke indawo okuhlinzwa kuyo. Amanye amathuluzi okuhlinza afakwa ngokusebenzisa okunye ukusikeka.
• Udokotela ohlinzayo ukhulula umphimbo ezicutshini eziseduze. Ngokuya ngokuthi isisu sakho sinesifo esingakanani, ingxenye noma iningi laso liyasuswa.
• Uma ingxenye yomzimba wakho isusiwe, iziphetho ezisele zihlanganiswa ndawonye kusetshenziswa ukudla okuyisisekelo noma imithungo. Uma ngabe iningi lomzimba wakho lisusiwe, udokotela ohlinzayo usibumba kabusha isisu sakho sibe yipayipi ukuze sakhe umphimbo omusha. Ihlanganiswe nengxenye esele yomhosha.
• Ngesikhathi sokuhlinzwa, ama-lymph node esifubeni nasesiswini kungenzeka asuswe uma umdlavuza usabalele kuwo.
• Ishubhu yokondla ifakwa emathunjini akho amancane ukuze uzondle ngenkathi usalulama ekuhlinzweni.

Ezinye izikhungo zezokwelapha zenza lokhu kuhlinzwa zisebenzisa ukuhlinzeka ngamarobhothi. Kulolu hlobo lokuhlinzwa, kufakwa isikalo esincane nezinye izinsimbi ngokusebenzisa ukusikeka okuncane esikhunjeni. Udokotela ohlinzayo ulawula ubukhulu nezinsimbi ngenkathi ehleli esiteshini sekhompyutha futhi ebuka umhlola.

Ukuhlinzwa kuvame ukuthatha amahora amathathu kuya kwayisithupha.

Isizathu esivame kakhulu sokususa ingxenye, noma konke, kwesifo sakho ukwelapha umdlavuza. Ungase futhi ube nokwelashwa ngemisebe noma i-chemotherapy ngaphambi noma ngemuva kokuhlinzwa.

Ukuhlinzwa ukususa umhosha ongezansi kungenziwa ukwelapha:

• Isimo lapho indandatho yemisipha ku-esophagus ingasebenzi kahle (achalasia)
• Umonakalo omkhulu wolwelwesi lwe-esophagus olungadala umdlavuza (Barrett esophagus)
• Ukuhlukumezeka okukhulu

Lokhu ukuhlinzwa okukhulu futhi kunezingozi eziningi. Abanye babo babucayi. Qiniseka ukuthi uxoxa ngalezi zingozi nodokotela wakho ohlinzayo.

Izingozi zalokhu kuhlinzwa, noma izinkinga ngemuva kokuhlinzwa, zingaphakama kunokujwayelekile uma:

• Abakwazi ukuhamba ngisho nangebanga elifushane (lokhu kwandisa ubungozi bamahlule egazi, izinkinga zamaphaphu, nezilonda zengcindezi)
• Bangaphezu kuka-60 kuya ku-65
• Uyabhema kakhulu
• Bakhuluphele
• Ulahlekelwe isisindo esiningi kusuka kumdlavuza wakho
• Ingabe imithi ye-steroid
• Wayenemithi yomdlavuza ngaphambi kokuhlinzwa

Izingozi ze-anesthesia nokuhlinzwa ngokujwayelekile yilezi:

• Ukungezwani komzimba nemithi
• Izinkinga zokuphefumula
• Ukopha, amahlule egazi, noma ukutheleleka

Izingozi zalokhu kuhlinzwa yilezi:

• I-Acid reflux
• Ukulimala esiswini, emathunjini, emaphashini, noma kwezinye izitho ngesikhathi sokuhlinzwa
• Ukuvuza kokuqukethwe kwesisu sakho noma isisu lapho udokotela ohlinzayo azihlanganisa khona
• Ukunciphisa ukuxhumana phakathi kwesisu sakho nesisu
• Inyumoniya

Uzoba nokuvakashelwa odokotela abaningi kanye nokuhlolwa kwezokwelapha ngaphambi kokuhlinzwa. Ezinye zazo yilezi:

• Ukuhlolwa okuphelele komzimba.
• Ukuhambela nodokotela wakho ukuze uqiniseke ukuthi ezinye izinkinga zezokwelapha ongahle ube nazo, njengesifo sikashukela, umfutho wegazi ophakeme, nezinkinga zenhliziyo noma zamaphaphu ziyalawulwa.
• Ukwelulekwa ngokudla okunempilo.
• Ukuvakashelwa noma isigaba ukufunda okwenzekayo ngesikhathi sokuhlinzwa, okufanele ulindele ngemuva kwalokho, nokuthi yiziphi izingcuphe noma izinkinga ezingase zivele ngemuva kwalokho.
• Uma usanda kwehlisa isisindo, udokotela wakho angakufaka kokudla ngomlomo noma nge-IV amasonto ambalwa ngaphambi kokuhlinzwa.
• Iskena se-CT ukubheka umqala.
• Iskena se-PET ukukhomba umdlavuza nokuthi ususabalele yini.
• I-Endoscopy ukuxilonga nokukhomba ukuthi umdlavuza usuhambe kangakanani.

Uma ubhema, kufanele uyeke amasonto ambalwa ngaphambi kokuhlinzwa. Cela usizo kumhlinzeki wakho wezempilo.

Tshela umhlinzeki wakho:

• Uma ukhulelwe noma kungenzeka ukhulelwe.
• Imiphi imithi, amavithamini, nezinye izithasiselo ozithathayo, ngisho naleyo oyithenge ngaphandle kadokotela.
• Uma uphuze utshwala obuningi, uphuza iziphuzo ezingaphezu kwezingu-1 noma ezi-2 ngosuku.

Phakathi nesonto ngaphambi kokuhlinzwa:

• Ungacelwa ukuthi uyeke ukusebenzisa imishanguzo emincane yegazi. Ezinye zazo i-aspirin, i-ibuprofen (i-Advil, i-Motrin), i-vitamin E, i-warfarin (i-Coumadin), ne-clopidogrel (i-Plavix), noma i-ticlopidine (i-Ticlid).
• Buza udokotela wakho ukuthi yimiphi imithi okufanele usayiphuza ngosuku lokuhlinzwa.
• Lungisa ikhaya lakho ngemuva kokuhlinzwa.

Ngosuku lokuhlinzwa:

• Landela imiyalo yokuthi ungakuyeka nini ukudla nokuphuza ngaphambi kokuhlinzwa.
• Thatha imithi udokotela wakho akutshele ukuthi uyiphuze ngesiphuzo esincane samanzi.
• Fika esibhedlela ngesikhathi.

Iningi labantu lihlala esibhedlela izinsuku ezingu-7 kuya kwezingu-14 ngemuva kokukhishwa kwesisu. Ukuhlala kwakho isikhathi eside kuzoya ngohlobo lokuhlinzwa obukade unalo. Ungachitha usuku olungu-1 kuya kwele-3 egumbini labagula kakhulu (i-ICU) ngemuva kokuhlinzwa.

Ngesikhathi uhlala esibhedlela, uzo:

• Celwa ukuba uhlale eceleni kombhede wakho uhambe ngosuku noma ngosuku olufanayo ngemuva kokuhlinzwa.
• Ukungakwazi ukudla okungenani izinsuku ezimbili kuya kwezingu-7 zokuqala ngemuva kokuhlinzwa. Ngemuva kwalokho, ungakwazi ukuqala ngeziphuzo. Uzokondliwa ngepayipi lokudla elifakwe emathunjini akho ngesikhathi sokuhlinzwa.
• Yiba neshubhu eliphuma eceleni kwesifuba sakho ukukhipha uketshezi olwakhayo.
• Gqoka amasokisi akhethekile ezinyaweni nasemilenzeni ukuvimbela amahlule egazi.
• Thola isibhamu ukuvimbela amahlule egazi.
• Thola umuthi wezinhlungu nge-IV noma uphuze amaphilisi. Ungathola imithi yakho yezinhlungu ngepompo ekhethekile. Ngalepompo, ucindezela inkinobho ukuletha umuthi wezinhlungu lapho uwudinga. Lokhu kukuvumela ukuthi ulawule inani lomuthi wezinhlungu owutholayo.
• Yenza izivivinyo zokuphefumula.

Ngemuva kokuya ekhaya, landela imiyalo yokuthi ungazinakekela kanjani njengoba usalulama. Uzonikezwa imininingwane ngokudla nokudla. Qiniseka ukuthi ulandela leyo miyalo futhi.

Abantu abaningi balulama kahle kulokhu kuhlinzwa futhi bangaba nokudla okujwayelekile. Ngemuva kokululama, kuzodingeka badle izingxenye ezincane futhi badle kaningi.

Uma ngabe uhlinzelwe umdlavuza, khuluma nodokotela wakho ngezinyathelo ezilandelayo zokwelapha umdlavuza.

I-esophagectomy encane engahlaseli; I-robotic esophagectomy; Ukususwa komphimbo - okuhlasela kancane; Achalasia - esophagectomy; I-Barrett esophagus - i-esophagectomy; Umdlavuza we-Esophageal - esophagectomy - laparoscopic; Umdlavuza we-esophagus - esophagectomy - laparoscopic

• Sula ukudla oketshezi
• Ukudla nokudla ngemuva kwe-esophagectomy
• I-Esophagectomy - ukukhipha
• Ishubhu yokudla ye-Gastrostomy - bolus

• Umdlavuza we-Esophageal

UDonahue J, uCarr SR. I-esophagectomy encane engahlaseli. Ku: UCameron JL, uCameron AM, ama-eds. Ukwelashwa Kwamanje. Umhla ka-12. IPhiladelphia, PA: Elsevier; 2017: 1530-1534.

Iwebhusayithi yeNational Cancer Institute. Ukwelashwa komdlavuza we-Esophageal (PDQ) - inguqulo yezempilo. www.cancer.gov/types/esophageal/hp/esophageal- ukwelashwa-pdq. Kubuyekezwe ngoNovemba 12, 2019. Kufinyelelwe ngoNovemba 18, 2019.

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