I-Esophagectomy - evulekile

I-Open esophagectomy 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 noma isisu esonakaliswe kakhulu.

Ngesikhathi sokuvulwa kwesisu okuvulekile, ukusikeka okukodwa noma ngaphezulu kokuhlinzwa kwenziwa (esisikiwe) esiswini sakho, esifubeni noma entanyeni. (Enye indlela yokususa i-esophagus yi-laparoscopically. Ukuhlinzwa kwenziwa ngezicucu ezimbalwa, kusetshenziswa isilinganiso sokubuka.)

Lo mbhalo ukhuluma ngezinhlobo ezintathu zokuhlinzwa okuvulekile. Nganoma yikuphi ukuhlinzwa, uzothola umuthi (i-anesthesia) ozokugcina ulele futhi ungabi nezinhlungu.

Isophagectomy kaTranshiatal:

• Udokotela ohlinzayo usika kabili okukhulu. Ukusikwa okukodwa kusendaweni yakho yentamo kanti enye isesiswini sakho esingaphezulu.
• Kusukela ekusikeni esiswini, udokotela ohlinzayo ukhulula isisu nengxenye engezansi yomhosha ezicutshini eziseduze. Kusukela ekunqunyeni entanyeni, konke okuseleyo kukhululiwe.
• Udokotela ohlinzayo ube esesusa ingxenye yomzimba wakho lapho umdlavuza noma enye inkinga ikhona.
• Isisu sakho sibuye sishintshwe sibe yipayipi ukuze sakhe umphimbo omusha. Ihlanganiswe engxenyeni esele yesigaxa sakho ngokudla okuyisisekelo noma ngemithungo.
• Ngesikhathi sokuhlinzwa, ama-lymph node entanyeni nasesiswini kungenzeka asuswe uma umdlavuza usabalele kuwo.
• Ishubhu yokondla ifakwa emathunjini akho amancane ukuze uzondle ngenkathi usalulama ekuhlinzweni.
• Amashubhu okuhambisa amanzi angahle ashiywe esifubeni ukukhipha uketshezi.

I-esophagectomy ye-Transthoracic: Lokhu kuhlinzwa kwenziwa ngendlela efanayo nenqubo yokudluliswa komntwana ngaphambi kokuzalwa. Kepha ukusika okuphezulu kwenziwa esifubeni sakho sokunene, hhayi entanyeni.

En bloc esophagectomy:

• Udokotela ohlinzayo usika kakhulu entanyeni, esifubeni nasesiswini. Kususwe wonke umqala wakho nengxenye yesisu sakho.
• Esinye isisu sakho sakhiwe kabusha sibe yipayipi bese sibekwa esifubeni sakho ukuze sithathe indawo yomhosha wakho. Ishubhu lesisu lixhunywe ku-esophagus esele entanyeni.
• Udokotela ohlinzayo ususa nawo wonke ama-lymph node esifubeni sakho, entanyeni nasesiswini.

Iningi lale misebenzi ithatha amahora amathathu kuya kwayisithupha.

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
• Ukuqothulwa kwesisu
• Isisu esonakaliswe kakhulu

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

Izingozi zalokhu kuhlinzwa, noma ngezinkinga ngemuva kokuhlinzwa, zingaba nkulu kunokujwayelekile uma:

• Abakwazi ukuhamba, ngisho nangebanga elifushane (lokhu kwandisa ubungozi bamahlule egazi, izinkinga zamaphaphu, nezilonda zengcindezi)
• Badala
• Uyabhema kakhulu
• Bakhuluphele
• Ulahlekelwe isisindo esiningi kusuka kumdlavuza wakho
• Ingabe imithi ye-steroid
• Ngibe nokutheleleka okunzima okuvela ocansini / esiswini owonakele
• Uthole izidakamizwa zomdlavuza (chemotherapy) 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
• Kunzima ukugwinya noma ukukhuluma
• Ukuvinjelwa kwamathumbu

Uzoba nokuvakashelwa odokotela abaningi nokuhlolwa kwezokwelapha ngaphambi kokuhlinzwa, kufaka phakathi:

• Ukuhlolwa okuphelele komzimba.
• Ukuvakasha 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 ukubhema emasontweni ambalwa ngaphambi kokuhlinzwa. Umhlinzeki wakho wezokunakekelwa kwempilo angakusiza.

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 ukuphuza 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 kwalokhu kuhlinzwa. 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 zokuqala ezi-5 kuye kwezi-7 ngemuva kokuhlinzwa. Ngemuva kwalokho, kungenzeka ukwazi 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 ukuvikela ukutheleleka kwamaphaphu.

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.

Trans-hiatal esophagectomy; Trans-thoracic esophagectomy; En bloc esophagectomy; Ukususwa kwesomlomo - kuvulekile; I-Ivor-Lewis esophagectomy, i-Blunt esophagectomy; Umdlavuza we-Esophageal - esophagectomy - uvulekile; Umdlavuza we-esophagus - esophagectomy - uvulekile

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

• Umdlavuza we-Esophageal

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 19, 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.