He aha ka Percutaneous Nephrolithotomy? Ke Kumu, ke Kaʻina Hana & nā Hōʻike

ʻO ka percutaneous nephrolithotomy kahi hana ʻoki liʻiliʻi i hoʻohana ʻia e wehe i nā pōhaku kīkī nui ʻaʻole hiki ke mālama ʻia me nā ʻano hana ʻē aʻe. E noʻonoʻo e like me ka hana ʻana i kahi ala liʻiliʻi ma kou kua pololei i kou kīkī, e ʻae ana i kāu kauka lapaʻau e wehe palekana i nā pōhaku i nui loa a paʻakikī paha no nā lāʻau lapaʻau liʻiliʻi.

Hāʻawi kēia hana i ka manaʻolana ke hana nei ʻoe me nā pōhaku kīkī e hoʻomau nei i ka ʻeha a i ʻole ke kāohi ʻana i ke kahe mimi. Hoʻohana kāu urologist i nā mea hana kūikawā ma o kahi ʻoki liʻiliʻi e wāwahi a wehe i nā pōhaku, e hāʻawi pinepine ana i ka hoʻomaha koke ʻana mai nā hōʻailona i pili paha i kou ola i kēlā me kēia lā no nā pule a i ʻole nā mahina.

He aha ka percutaneous nephrolithotomy?

ʻO ka percutaneous nephrolithotomy (PCNL) kahi ʻenehana ʻoki kahi e komo ai nā kauka i kou kīkī ma kahi ʻoki liʻiliʻi ma kou kua. ʻO ka huaʻōlelo

He mea pono kēia hana ke ʻaʻole kūpono nā lapaʻau liʻiliʻi e like me ka lithotripsy hawewe haʻalulu a i ʻole ka ureteroscopy no kou kūlana. He nui loa kekahi mau pōhaku, paʻakikī loa, a i ʻole i nā wahi i hiki ʻole i nā ʻenehana ʻē aʻe ke hiki palekana.

Paipai ʻia ka PCNL ke loaʻa iā ʻoe nā pōhaku he nui i hui pū ʻia, nā pōhaku i hoʻokumu i nā maʻi pinepine, a i ʻole i ka wā i kūleʻa ʻole ai nā lapaʻau mua. Hiki i kāu kauka urologist ke ʻōlelo aku i kēia ala inā loaʻa iā ʻoe nā calculi staghorn, he mau pōhaku nui e hoʻopiha ana i nā ʻāpana he nui o ka ʻōnaehana hōʻiliʻili o kou puʻupaʻa.

Eia kekahi, kōkua kēia hana ke hoʻokumu nei nā pōhaku puʻupaʻa i nā hōʻailona koʻikoʻi e like me ka ʻeha nui, ke koko i loko o ka mimi, a i ʻole nā pilikia hana puʻupaʻa. I kekahi manawa, keakea nā pōhaku i ke kahe mimi, e hana ana i kahi kūlana olakino e koi ana i ka hana wikiwiki e pale i ke olakino o kou puʻupaʻa.

He aha ke kaʻina hana no ka nephrolithotomy percutaneous?

ʻO ka hana PCNL maʻamau e lawe i 2-4 mau hola a hana ʻia ma lalo o ka anesthesia maʻamau, ʻo ia hoʻi e hiamoe loa ʻoe a ʻoluʻolu i ka wā o ke ʻoki. E hoʻonoho kāu hui ʻoki iā ʻoe ma kou ʻōpū e hāʻawi i ke komo maikaʻi loa i kou puʻupaʻa.

Hoʻomaka kāu kauka lapaʻau ma ka hoʻohana ʻana i ka ultrasound a i ʻole ke kiʻi X-ray e ʻimi i ke kūlana pololei o kāu mau pōhaku puʻupaʻa. A laila hana lākou i kahi ʻoki liʻiliʻi, ma lalo o hoʻokahi ʻīniha ka lōʻihi, ma kou kua ma luna o ka wahi puʻupaʻa. Hoʻomaopopo kēia kau ʻana i ke ala palekana a me ka maikaʻi loa e hiki ai i kāu mau pōhaku.

A laila, hana kāu kauka lapaʻau i kahi tunnel haiki mai ka ʻili ma nā ʻiʻo o ke kua a i loko o ka puʻupaʻa. Hana ʻia kēia hana, i kapa ʻia ʻo ka dilation tract, me ka hoʻohana ʻana i nā mea hana nui aʻe e hana i kahi ala e lawa ai ka laulā no nā mea hana ʻoki.

Ma hope o ka hoʻokumu ʻia ʻana o ke ala komo, hoʻokomo ʻia kahi nephroscope ma o kēia tunnel. Hāʻawi kēia telescope lahilahi a maʻalahi i kāu kauka lapaʻau e ʻike i loko o kou puʻupaʻa a e ʻimi pololei i nā pōhaku. Loaʻa nō hoʻi i ka nephroscope nā ala no ka hoʻokomo ʻana i nā mea hana like ʻole e pono ai no ka wehe ʻana i nā pōhaku.

Aia ke kaʻina hana wehe pōhaku i ka nui a me ka paʻakikī o kāu mau pōhaku. Hiki ke hopu ʻia nā pōhaku liʻiliʻi a huki ʻia i waho holoʻokoʻa, aʻo nā mea nui e wāwahi ʻia i mau ʻāpana liʻiliʻi me ka hoʻohana ʻana i ka ikehu ultrasonic, pneumatic, a i ʻole laser. Wehe pono kāu kauka lapaʻau i nā ʻāpana pōhaku a pau e pale aku i nā pilikia e hiki mai ana.

Ma hope o ka wehe ʻana i nā pōhaku i ʻike ʻia a pau, hoʻokomo kāu kauka lapaʻau i kahi paipu nephrostomy ma o ke ala komo. Kōkua kēia paipu hoʻokahe liʻiliʻi i ka wehe ʻana i nā ʻāpana pōhaku i koe a hiki i kou puʻupaʻa ke hoʻōla pono. Noho maʻamau ka paipu ma kahi no 1-3 mau lā ma hope o ke ʻoki.

Pehea e hoʻomākaukau ai no kāu nephrolithotomy percutaneous?

Hoʻomaka kāu hoʻomākaukau me kahi loiloi olakino piha e hōʻoia i kou olakino no ke ʻoki. E loiloi kāu kauka i kāu mōʻaukala olakino, nā lāʻau lapaʻau o kēia manawa, a me nā maʻi āu e loaʻa ai. Kōkua kēia loiloi i kāu hui ʻoki e hoʻolālā i ke ala palekana loa no kāu kūlana kikoʻī.

Pono ʻoe i kekahi mau hoʻokolohua ma mua o ke ʻoki e loiloi i ka hana o kou puʻupaʻa a me ke olakino holoʻokoʻa. Hoʻopili maʻamau kēia i nā hoʻokolohua koko e nānā i ka hana o kou puʻupaʻa, ka hiki ke hoʻopaʻa, a me nā hōʻailona maʻi. Hiki nō hoʻi i kāu kauka ke kauoha i nā haʻawina kiʻi e like me nā scans CT e palapala i kahi kikoʻī a me ka nui o kāu mau pōhaku.

Pono pinepine nā hoʻoponopono lāʻau lapaʻau ma mua o ke ʻoki. E hāʻawi kāu kauka i nā ʻōlelo kikoʻī e pili ana i nā lāʻau lapaʻau e hoʻomau a i ʻole e hooki ma mua o ke kaʻina hana. Pono e hooki ʻia nā mea lahilahi koko e like me ka warfarin a i ʻole aspirin i kekahi mau lā ma mua o ke ʻoki e hōʻemi i ka pilikia o ke kahe ʻana.

E loaʻa iā ʻoe nā ʻōlelo aʻoaʻo kikoʻī no ka hoʻokē ʻai ʻana, e koi ana iā ʻoe e pale i ka ʻai ʻana a i ʻole ka inu ʻana i kekahi mea no 8-12 mau hola ma mua o ke ʻoki ʻana. Pale kēia hana i nā pilikia i ka wā o ka anesthesia a hōʻoia i kou palekana i ka wā o ke kaʻina hana.

E kūkākūkā pū kāu hui ʻoki i nā koho hoʻokele ʻeha a me nā mea e manaʻo ai i ka wā e ola ai. E wehewehe lākou i ka paipu nephrostomy, nā mea e manaʻo ai no ka hoʻokahe ʻana, a me nā palena hana. ʻO ka loaʻa ʻana o kēia ʻike ma mua e kōkua i ka hōʻemi ʻana i ka hopohopo a hoʻomākaukau iā ʻoe no kahi hana hoʻōla maʻalahi.

Pehea e heluhelu ai i kāu mau hopena nephrolithotomy percutaneous?

Hoʻoholo ʻia ka holomua o kāu PCNL e ka piha o ka wehe ʻia ʻana o nā pōhaku a me ka maikaʻi o ka hana ʻana o kou puʻupaʻa ma hope. E hana maʻamau kāu kauka ʻoki i nā haʻawina kiʻi ma hope koke o ke kaʻina hana e nānā i nā ʻāpana pōhaku i koe.

ʻO ka hopena kūleʻa, ʻo ia ka wehe ʻia ʻana o nā pōhaku i ʻike ʻia a pau, a ke kahe pono nei kou puʻupaʻa. Loaʻa ka hapa nui o nā maʻi i nā helu hoʻomaʻemaʻe pōhaku piha o 85-95%, ma muli o ka nui a me ka paʻakikī o kā lākou mau pōhaku. E kaʻana like kāu kauka i kēia mau hopena me ʻoe ke pau ke kaʻina hana.

ʻO ke kiʻi post-operative, i hana maʻamau ʻia i loko o 24-48 mau hola, e kōkua i ka ʻike ʻana i nā ʻāpana pōhaku liʻiliʻi e hiki ke noho. I kekahi manawa waiho ʻia nā ʻāpana liʻiliʻi me ka manaʻo inā e hana ʻino lākou ma mua o ka pono. Hele pinepine kēia mau ʻāpana liʻiliʻi ma ke ʻano maoli a i ʻole hiki ke hoʻoponopono ʻia me nā lāʻau lapaʻau liʻiliʻi ma hope.

Hoʻomalu ʻia ka hana o kou puʻupaʻa ma o nā hoʻokolohua koko a me nā ana o ka mimi. Hōʻike nā hopena maʻamau i ka hana puʻupaʻa paʻa a me ka hana mimi maopopo. ʻO nā loli e pili ana i kēia mau hōʻailona e kōkua i kāu hui lapaʻau e hoʻoponopono i kāu hoʻolālā mālama.

E kōkua nā manawa e hele ai ma hope o ka ʻoki ʻana i nā pule 2-4 a me nā mahina 3-6 ma hope o ka ʻoki ʻana i ka nānā ʻana i kou ola lōʻihi. I loko o kēia mau kipa ʻana, e hana kāu kauka i nā hoʻokolohua kiʻi a me nā hoʻokolohua koko e hōʻoia i ka hoʻōla pono ʻana o kou puʻupaʻa a ʻaʻole i hana ʻia nā pōhaku hou.

He aha nā mea pilikia e pono ai ka nephrolithotomy percutaneous?

Hoʻonui kekahi mau maʻi olakino i kou hiki ke hoʻomohala i nā pōhaku puʻupaʻa nui e koi ai i ka PCNL. ʻO ka hoʻomaopopo ʻana i kēia mau mea pilikia e kōkua iā ʻoe e hana me kāu hui mālama ola e pale i ka hana ʻana i nā pōhaku i ka wā e hiki mai ana a pale i ke olakino o kou puʻupaʻa.

ʻO nā maʻi metabolic e pili ana i ke ʻano o ka hana ʻana o kou kino i nā minerala e hana i kahi kaiapuni kahi e hiki ai ke hana i nā pōhaku nui. ʻO kēia mau kūlana ke alakaʻi pinepine i ka hana hou ʻana o nā pōhaku, e pono ai ka PCNL ke lilo nā pōhaku i mea nui no nā lāʻau lapaʻau ʻē aʻe.

• Hyperparathyroidism, e hoʻoulu ana i ka calcium nui i kou koko a me ka mimi
• Cystinuria, kahi maʻi genetic e alakaʻi ai i ka hana ʻana o ka pōhaku cystine
• Hyperoxaluria mua, e hoʻoulu ana i ka hoʻokuʻu ʻana o ka oxalate
• ʻO ka acidosis tubular renal, e pili ana i ka hiki o kou puʻupaʻa ke hoʻohui i ka mimi
• ʻO ka maloʻo mau, e alakaʻi ana i ka mimi i hoʻopaʻa ʻia e paipai i ka ulu ʻana o ka pōhaku

Hiki i nā anomalies anatomical i loko o kāu ʻōnaehana urinary ke hana i nā wahi kahi e paʻa ai nā pōhaku a ulu nui i ka manawa. Pono pinepine kēia mau pilikia structural i ka PCNL no ka mea ʻaʻole hiki i nā pōhaku ke hele maoli ma nā wahi i hoʻopilikia ʻia.

Hāʻawi pū nā mea ola i ka hana ʻana i nā pōhaku nui. Hiki i nā meaʻai kiʻekiʻe i ka sodium, ka protein holoholona, ​​a i ʻole nā ​​meaʻai waiwai oxalate ke paipai i ka ulu ʻana o ka pōhaku. ʻO ka lawe ʻana i ka wai liʻiliʻi, ʻoi aku hoʻi i nā aniau wela a i ʻole i ka wā o ka hana kino, e hoʻopaʻa i kou mimi a paipai i ka hoʻomohala ʻana i ka pōhaku.

ʻO nā hana mua i ka mālama ʻana i nā pōhaku i kū ʻole a i ʻole i pau ʻole paha, hiki ke waiho i nā ʻāpana e ulu aʻe i nā pōhaku nui e koi ana iā PCNL. Ke hōʻike nei kēia kūlana i ke koʻikoʻi o ka wehe ʻana i nā pōhaku a pau a me ka mālama pono ʻana ma hope o kekahi hana i ka mālama ʻana i nā pōhaku kīkī.

He aha nā pilikia e hiki ke loaʻa i ka nephrolithotomy percutaneous?

ʻOiai palekana ʻo PCNL, ʻo ka hoʻomaopopo ʻana i nā pilikia e hiki ke kōkua iā ʻoe e hana i nā hoʻoholo e pili ana i kāu mālama ʻana. He kakaikahi ka hapa nui o nā pilikia a hiki ke mālama pono ʻia ke hiki mai.

ʻO nā pilikia maʻamau ka mea liʻiliʻi a hoʻoponopono koke ʻia me ka mālama kūpono. Hoʻopilikia kēia mau pilikia i ka pākēneka liʻiliʻi o nā maʻi a ʻaʻole pinepine i nā pilikia lōʻihi.

• Ke kahe ʻana o ke koko e koi ana i ka hoʻoili koko (hiki i ka 1-5% o nā hihia)
• Maʻi a i ʻole ke kuni, maʻamau e pane maikaʻi ana i nā lāʻau antibiotic
• Ke kahe ʻana o ka mimi a puni ka pūnaewele nephrostomy tube
• ʻAʻole i pau ka wehe ʻana i nā pōhaku e koi ana i nā hana hou
• Nā loli hana kīkī manawa

He kakaikahi nā pilikia koʻikoʻi akā pono e mālama koke ʻia. Hiki kēia mau hanana i lalo o 1% o nā kaʻina hana, akā ua mākaukau kāu hui ʻoki e mālama iā lākou inā kū mai.

Hiki ke hōʻeha i nā ʻōkana a puni e like me ka colon, spleen, a i ʻole ka māmā inā ʻaʻole i hoʻonoho pono ʻia ke ala komo. ʻOiai ʻaʻole maʻamau, pono paha kēia mau pilikia i nā hana ʻoki hou e hoʻoponopono ai. Hoʻemi nui ka ʻike o kāu kauka a me ke alakaʻi ʻana i nā kiʻi me ka mālama i kēia mau pilikia.

ʻO ka hōʻeha ʻana i nā kīʻaha koko e alakaʻi ana i ke kahe ʻana o ke koko nui he pilikia kakaikahi akā koʻikoʻi. Pono paha kēia kūlana i ka embolization, kahi hana e ālai i ka moku e kahe ana, a i ʻole i nā hihia kakaikahi loa, ka hoʻoponopono ʻana i ke ʻoki. Kōkua nā ʻenehana kiʻi hou i nā kauka e pale i nā kīʻaha koko nui i ka wā o ke kaʻina hana.

Hiki i ka pneumothorax, kahi e komo ai ka ea i loko o ka wahi a puni kou māmā, ke hana inā piʻi loa ke ala komo. Pono paha kēia pilikia i ka waiho ʻana i ka paipu umauma akā e hoʻoponopono maʻamau i loko o kekahi mau lā. E nānā ana kāu hui ʻokiʻoki i kēia hiki a hiki ke mālama koke inā loaʻa.

I ka manawa hea wau e ʻike ai i ke kauka ma hope o ka nephrolithotomy percutaneous?

He mea nui nā manawa e hahai ai no ka nānā ʻana i kou ola a me ka pale ʻana i nā pōhaku kīkī i ka wā e hiki mai ana. E hoʻonohonoho kāu kauka i kēia mau kipa i nā manawa kikoʻī e hōʻoia i ka hoʻōla pono ʻana o kou kīkī a me ka hana maʻamau.

E hoʻokaʻaʻike koke i kāu mea mālama ola inā ʻike ʻoe i nā hōʻailona ʻōlelo aʻo e hōʻike ana i nā pilikia. Pono kēia mau hōʻailona i ka loiloi olakino wikiwiki e pale aku i nā pilikia koʻikoʻi a hōʻoia i kou ola mau.

E ʻimi i ka lāʻau lapaʻau koke inā loaʻa iā ʻoe ke kuni ma luna o 101°F (38.3°C), ʻoiai inā hui pū ʻia me nā haʻalulu a i ʻole nā ​​hōʻailona e like me ka maʻi flu. Hiki i kēia ke hōʻike i kahi maʻi e pono ai ka lāʻau antibiotic. Pēlā nō, pono ka loiloi wikiwiki ʻana i ka ʻeha nui ʻaʻole i mālama ʻia e nā lāʻau lapaʻau i kauoha ʻia a i ʻole ka hoʻomaka koke ʻana o ka ʻeha nui o ka ʻōpū a i ʻole ke kua.

ʻO nā loli i kāu hana mimi a i ʻole ke ʻano e pono ai ka lāʻau lapaʻau. E hoʻokaʻaʻike i kāu kauka inā ʻike ʻoe i ka emi nui ʻana o ka hana mimi, ke koko ʻulaʻula ʻālohilohi i kāu mimi, a i ʻole inā lilo kāu mimi i ke ao a me ka ʻala ʻino. Hiki i kēia mau hōʻailona ke hōʻike i ke kahe ʻana a i ʻole ka maʻi e pono ai ka lāʻau lapaʻau.

ʻO nā pilikia me kāu paipu nephrostomy, e like me ka hāʻule ʻana, ka hoʻōki ʻana i ka hoʻokahe ʻana, a i ʻole ke kumu o ka ʻeha nui, pono i ka mālama olakino koke. Mai ho'āʻo e hoʻololi a wehe paha i ka paipu iā ʻoe iho, no ka mea, hiki i kēia ke hōʻeha a i ʻole nā ​​pilikia.

Eia kekahi, e hoʻonohonoho i nā kipa maʻamau no ka nānā ʻana inā maikaʻi ʻoe. Hāʻawi kēia mau manawa i kāu kauka e nānā i ka hana o kou puʻupaʻa, e nānā i ka hana ʻana o nā pōhaku hou, a e hoʻoponopono i kāu mau hoʻolālā pale. ʻO ka ʻike mua ʻana i nā pilikia e alakaʻi pinepine i ka mālama maʻalahi a me nā hopena maikaʻi.

Nā nīnau i nīnau pinepine ʻia e pili ana i ka nephrolithotomy percutaneous

Q.1 ʻOi aku ka maikaʻi o ka nephrolithotomy percutaneous ma mua o nā lāʻau lapaʻau pōhaku puʻupaʻa ʻē aʻe?

ʻO PCNL ka lāʻau lapaʻau maikaʻi loa no nā pōhaku puʻupaʻa nui, me nā helu kūleʻa o 85-95% no ka wehe ʻana i nā pōhaku piha. Hoʻolālā ʻia ia no nā pōhaku ma mua o 2 mau kenimika a i ʻole nā pōhaku paʻakikī ʻaʻole hiki i nā lāʻau lapaʻau ʻē aʻe ke hoʻoponopono pono.

Ke hoʻohālikelike ʻia me ka lithotripsy hawewe haʻalulu, hāʻawi ʻo PCNL i nā helu kūleʻa kiʻekiʻe loa no nā pōhaku nui akā pono ka manawa hoʻōla lōʻihi. ʻOiai ʻaʻole invasive ka therapy hawewe haʻalulu, ʻaʻole ia e hana pinepine no nā pōhaku ma luna o 2 mau kenimika, e lilo ana ʻo PCNL i koho makemake ʻia no kēia mau pōhaku nui.

Q.2 Hoʻopilikia ka nephrolithotomy percutaneous i ka pōʻino mau i ka puʻupaʻa?

ʻAʻole hana maʻamau ʻo PCNL i ka pōʻino mau i ka puʻupaʻa ke hana ʻia e nā kauka lapaʻau i ʻike ʻia. Mālama ka hapa nui o nā maʻi i ka hana maʻamau o ka puʻupaʻa ma hope o ke kaʻina hana, a nui ka poʻe e ʻike maoli i ka hana puʻupaʻa maikaʻi ʻia i ka wā e hoʻihoʻi ʻia ai ke kahe mimi i ālaina ʻia.

Hoʻōla maoli ke ala liʻiliʻi i hana ʻia i ka wā PCNL i loko o kekahi mau pule, e waiho ana i ka ʻili liʻiliʻi. Hōʻike nā haʻawina e hoʻi maʻamau ka hana puʻupaʻa i nā pae ma mua o ke kaʻina hana a i ʻole ka maikaʻi, ʻoiai inā e hana ana nā pōhaku i ka ālaina a i ʻole ka maʻi ma mua o ka mālama ʻana.

Q.3 Pehea ka lōʻihi o ka hoʻōla ʻana ma hope o ka nephrolithotomy percutaneous?

Noho ka hapa nui o nā maʻi i ka haukapila no 1-3 mau lā ma hope o PCNL, ma muli o kā lākou holomua hoʻōla. Wehe ʻia ka paipu nephrostomy i loko o 24-72 mau hola inā hōʻike nā kiʻi ʻaʻole i koe nā pōhaku a me ka hoʻokahe puʻupaʻa kūpono.

He maʻamau ka hoʻōla piha ʻana i 2-4 pule, i loko o ia manawa e hoʻi mālie ana ʻoe i nā hana maʻamau. Hiki i ka hapa nui o nā kānaka ke hoʻi i ka hana ma ka pākaukau i loko o 1-2 pule, ʻoiai nā hana e koi ana i ka ikaika kino e pono ai 3-4 pule o ka manawa hoʻōla.

Q.4 Hiki anei i nā pōhaku kīkī ke hoʻi mai ma hope o ka nephrolithotomy percutaneous?

ʻOiai e wehe pono ka PCNL i nā pōhaku e kū nei, ʻaʻole ia e pale i ka hana ʻana o nā pōhaku hou. Aia kou pilikia o ka hoʻomohala ʻana i nā pōhaku hou ma nā kumu e waiho nei o kou hana ʻana i nā pōhaku a me ka maikaʻi o kou hahai ʻana i nā hoʻolālā pale.

ʻO ka hana pū ʻana me kāu kauka e ʻike a hoʻoponopono i nā kumu metabolic o kāu mau pōhaku e hōʻemi nui i ka pilikia o ka hana hou ʻana. Hiki i kēia ke komo i nā loli meaʻai, nā lāʻau lapaʻau, a i ʻole ka mālama ʻana i nā maʻi olakino e kōkua ana i ka hana ʻana i nā pōhaku.

Q.5 He ʻeha anei ka nephrolithotomy percutaneous?

ʻO ka hapa nui o nā maʻi e ʻike i ka ʻeha maʻalahi ma hope o ka PCNL, i mālama maikaʻi ʻia me nā lāʻau lapaʻau ʻeha. ʻO ka ʻeha maʻamau ka liʻiliʻi o ka ʻeha ma mua o ka ʻeha mau i ʻike ʻia e nā maʻi he nui mai kā lākou mau pōhaku kīkī nui ma mua o ka mālama ʻana.

E hāʻawi kāu hui lapaʻau i ka mālama ʻeha piha, me nā lāʻau lapaʻau waha a me nā lāʻau lapaʻau e pono ai. ʻIke ka hapa nui o nā maʻi e emi nui ana ko lākou ʻeha i nā lā mua ma hope o ke ʻoki ʻana, a he nui ka poʻe e hōʻike ana i ka maikaʻi loa ke wehe ʻia kā lākou mau pōhaku e ālai ana.