He aha te Percutaneous Nephrolithotomy? Te Whāinga, te Hātepe & ngā Hua

Ko te Percutaneous nephrolithotomy he hātepe pokanga iti e whakamahia ana hei tango i ngā kōhatu whatukuhu nui e kore e taea te rongoā ki ētahi atu tikanga. Whakaarohia me te mea kei te hanga koe i tētahi ara iti mā tō tuara e tika ana ki tō whatukuhu, e āhei ai tō tākuta pokanga ki te tango i ngā kōhatu e nui rawa ana, e mārō ana rānei mō ngā rongoā iti ake te pākaha.

E whai ana tēnei hātepe i te tūmanako i te wā e raru ana koe i ngā kōhatu whatukuhu e pā ana ki te mamae tonu, e aukati ana rānei i te rere o te mimi. Ka whakamahi tō tākuta mimi i ngā taputapu motuhake mā tētahi tapahi iti hei wawahi me te tango i ngā kōhatu, e whai ana i te āwhina tonu i ngā tohumate i pā pea ki tō oranga o ia rā mō ngā wiki, ngā marama rānei.

He aha te percutaneous nephrolithotomy?

Ko te Percutaneous nephrolithotomy (PCNL) he tikanga pokanga e uru ai ngā tākuta ki tō whatukuhu mā tētahi tapahi iti i tō tuara. Ko te kupu "percutaneous" te tikanga "mā te kiri," i te wā e pā ana te "nephrolithotomy" ki te tango i ngā kōhatu mai i te whatukuhu.

I te wā o tēnei hātepe, ka hanga e tō tākuta pokanga tētahi ara whāiti tata ki te whānui o te pene mai i tō kiri tuara e tika ana ki roto i te whatukuhu. E āhei ana tēnei ara ki a rātou te whakauru i tētahi karu ātaahua angiangi e kiia nei ko te nephroscope, e āwhina ana i a rātou ki te kite me te tango i ngā kōhatu whatukuhu e nui ake ana i te 2 henimita.

E whakaarohia ana te hātepe he iti te pākaha nā te mea he iti noa te tapahi e hiahiatia ana i te whakataurite ki te pokanga tuwhera tuku iho. Ko te nuinga o ngā tūroro e pā ana ki te iti ake o te mamae, ngā wā whakaora poto ake, me ngā kiko iti ake i te wā e whakamahi ana rātou i ngā huarahi pokanga tuku iho.

He aha te take e mahia ai te percutaneous nephrolithotomy?

Ka tūtohu tō tākuta i te PCNL i te wā e nui ana ō kōhatu whatukuhu e kore e taea e ētahi atu rongoā te whakatika. Ko ngā kōhatu nui ake i te 2 henimita, ko ērā rānei he āhua uaua, e hiahia ana ki tēnei huarahi tika ake hei whakarite i te tango katoa.

Ka whai mana tēnei tikanga ina kāore e tika ana ngā rongoā iti ake te pākaha pēnei i te rongoā ngaru ohorere, te ureteroscopy rānei mō tō āhuatanga motuhake. Ko ētahi kōhatu he nui rawa noa iho, he mārō rawa, kei ngā wāhi rānei e kore e taea e ētahi atu tikanga te tae atu ki a rātou i runga i te haumaru.

E tūtohutia ana hoki te PCNL ina he maha ngā kōhatu e pātata ana ki a rātou, ngā kōhatu i pā mai ai ngā mate pāwera, i te wā rānei kāore i angitu ngā rongoā o mua. Ka tūtohu pea tō tākuta mimi i tēnei huarahi mēnā he staghorn calculi ō, he kōhatu nui ēnei e whakaki ana i ngā wāhanga maha o tō pūnaha kohikohi whatukuhu.

I tua atu, ka āwhina tēnei tikanga ina he tohu nui te kōhatu whatukuhu pēnei i te mamae nui, te toto i roto i te mimi, i ngā raruraru mahi whatukuhu rānei. I ētahi wā ka aukati katoa ngā kōhatu i te rere o te mimi, ka waihanga i tētahi āhuatanga rongoā e hiahia ana i te wawaotanga tere ki te tiaki i tō hauora whatukuhu.

He aha te tikanga mō te nephrolithotomy percutaneous?

Ko te tikanga PCNL te tikanga e 2-4 haora te roa, ka mahia i raro i te rongoā whānui, ko te tikanga ka moe katoa koe, ka pai hoki i te wā o te pokanga. Ka whakatū tō rōpū pokanga i a koe ki tō puku kia whai wāhi pai ki tō whatukuhu.

Ka tīmata tō tākuta pokanga mā te whakamahi i te whakaahua ultrasound, X-ray rānei ki te kimi i te tūnga tika o ō kōhatu whatukuhu. Ka hanga e rātou tētahi tapahi iti, iti iho i te kotahi inihi te roa, i tō tuara i runga i te wāhi whatukuhu. Ko tēnei tūnga tika e whakarite ana i te ara haumaru me te whai hua ki te tae atu ki ō kōhatu.

I muri mai, ka hanga e tō tākuta pokanga tētahi ara whāiti mai i te kiri mā roto i ngā uaua o te tuara, ki roto i te whatukuhu. Ko tēnei tukanga, e kiia nei ko te whānuitanga o te ara, ka mahia āta mā te whakamahi i ngā taputapu nui haere ki te waihanga i tētahi ara whānui noa iho mō ngā taputapu pokanga.

Ka oti te ara uru, ka whakauruhia he nephroscope mā roto i tēnei ara. Mā tēnei karu roroa angiangi, ngawari hoki e kite ai tō tākuta i roto i tō pūkahukahu, ā, ka kitea ngā kōhatu i te wā tonu. He ara anō tō te nephroscope hei whakauru i ngā momo taputapu e hiahiatia ana mō te tango kōhatu.

E whakawhirinaki ana te tukanga tango kōhatu ki te rahi me te mārō o ō kōhatu. Ka taea te hopu me te toia atu i ngā kōhatu iti, i te mea ka whatiia ngā kōhatu nui ki ngā wāhanga iti mā te whakamahi i te kaha ultrasonic, pneumatic, rānei, laser rānei. Ka ata tango tō tākuta i ngā wāhanga kōhatu katoa hei ārai i ngā raruraru a muri ake nei.

Whai muri i te tango i ngā kōhatu e kitea ana, ka whakanoho tō tākuta i tētahi ngongo nephrostomy mā roto i te ara uru. Mā tēnei ngongo rerenga wai iti e āwhina ana ki te tango i ngā wāhanga kōhatu e toe ana, ā, ka taea e tō pūkahukahu te rongoā tika. Ko te tikanga, ka noho te ngongo ki te wāhi mō te 1-3 rā i muri i te pokanga.

Me pēhea te whakarite mō tō nephrolithotomy percutaneous?

Ka tīmata tō whakarite ki tētahi arotake hauora whānui hei whakarite kia ora koe mō te pokanga. Ka arotake tō tākuta i tō hītori hauora, ngā rongoā e inu ana koe, me ngā mate pāwera kei a koe. Mā tēnei aromatawai e āwhina ana i tō rōpū pokanga ki te whakamahere i te huarahi haumaru mō tō āhuatanga motuhake.

Ka hiahia koe ki ētahi whakamātautau i mua i te pokanga hei arotake i te mahi o tō pūkahukahu me tō hauora whānui. Ko te tikanga, kei roto i tēnei ko ngā whakamātautau toto hei tirotiro i te mahi o tō pūkahukahu, te kaha ki te whakaheke toto, me ngā tohu mate. Ka tono pea tō tākuta i ngā rangahau whakaahua pēnei i te CT scans hei whakaatu i te wāhi me te rahi o ō kōhatu.

He mea tika te whakatikatika i ngā rongoā i mua i te pokanga. Ka hoatu e tō tākuta ngā tohutohu motuhake mō ngā rongoā hei haere tonu, hei whakamutu rānei i mua i te tukanga. Ko ngā whakaheke toto pēnei i te warfarin, te aspirin rānei, me whakamutu i ētahi rā i mua i te pokanga hei whakaiti i te tūponotanga o te whakaheke toto.

Ka whiwhi koe i ngā tohutohu nohopuku taipitopito, e hiahia ana koe kia karo i te kai, i te inu rānei i tētahi mea mō te 8-12 hāora i mua i te pokanga. Mā tēnei whakatūpato e ārai ngā raruraru i te wā o te anahēhia, ā, ka whakarite i tō haumaru puta noa i te tukanga.

Ka kōrero anō tō rōpū pokanga mō ngā kōwhiringa whakahaere mamae me ngā mea e tūmanakohia ana i te wā o te whakaora. Ka whakamāramahia e rātou te ngongo nephrostomy, ngā tūmanako rerenga, me ngā here mahi. Mā te whai i tēnei mōhiohio i mua e āwhina ana ki te whakaiti i te āwangawanga me te whakarite i a koe mō tētahi tukanga whakaora mārie ake.

Me pēhea te pānui i ngā hua o tō nephrolithotomy percutaneous?

Ko te angitu o tō PCNL e inea ana e te katoa o te tango i ngā kōhatu me te pai o te mahi o tō whatukuhu i muri mai. Ko te tikanga ka mahi tō tākuta pokanga i ngā rangahau whakaahua i muri tonu i te tukanga ki te tirotiro mō ngā wāhanga kōhatu e toe ana.

Ko te putanga angitu ko te tango i ngā kōhatu e kitea ana, ā, kei te rerenga tika tō whatukuhu. Ko te nuinga o ngā tūroro ka eke ki ngā reiti whakawātea kōhatu katoa o te 85-95%, i runga i te rahi me te uaua o ā rātou kōhatu. Ka whakawhiti tō tākuta i ēnei hua ki a koe i te otinga o te tukanga.

Ko te whakaahua i muri i te pokanga, e mahia ana i roto i te 24-48 hāora, e āwhina ana ki te tautuhi i ngā wāhanga kōhatu iti pea e toe ana. I ētahi wā ka waiho noa iho ngā wāhanga iti mēnā ka nui ake te kino i te painga o te tango. Ko ēnei wāhanga iti ka paheke noa iho, ka taea rānei te whakatika ki ngā maimoatanga iti ake i muri mai.

Ka aroturukihia te mahi o tō whatukuhu mā ngā whakamātautau toto me ngā ine whakaputa mimi. Ko ngā hua noa e whakaatu ana i te mahi whatukuhu tūmau me te whakaputa mimi mārama. Ko ngā huringa e pā ana ki ēnei tohu ka āwhina i tō rōpū hauora ki te whakatika i tō mahere tiaki.

Ka āwhina ngā tūpono whai muri i te 2-4 wiki me te 3-6 marama i muri i te pokanga ki te aroturuki i tō whakaoranga wā-roa. I ēnei haerenga, ka mahi tō tākuta i ngā rangahau whakaahua me ngā whakamātautau toto kia mōhio ai kei te ora tika tō pūkahukahu, ā, kāore anō he kōhatu hou i hangaia.

He aha ngā āhuatanga mōrearea mō te hiahia ki te nephrolithotomy percutaneous?

Ko ētahi āhuatanga hauora ka whakanui i tō tūponotanga ki te whakawhanake i ngā kōhatu pūkahukahu nui e hiahia ana ki te PCNL. Mā te māramatanga ki ēnei āhuatanga mōrearea ka āwhina i a koe ki te mahi tahi me tō rōpū hauora ki te ārai i te hanganga kōhatu ā muri ake nei me te tiaki i tō hauora pūkahukahu.

Ko ngā mate metabolic e pā ana ki te āhua o te tukatuka o tō tinana i ngā kohuke ka waihanga i tētahi taiao ka taea te hanga kōhatu nui. Ko ēnei āhuatanga ka arahi pinepine ki te hanganga kōhatu hoki mai, ka hiahia te PCNL ina nui rawa ngā kōhatu mō ētahi atu rongoā.

• Hyperparathyroidism, e pā ana ki te nui rawa o te konupūmā i roto i tō toto me te mimi
• Cystinuria, he āhuatanga ira e arahi ana ki te hanganga kōhatu cystine
• Hyperoxaluria tuatahi, e pā ana ki te nui haere o te whakaputanga oxalate
• Renal tubular acidosis, e pā ana ki te kaha o tō pūkahukahu ki te waikawa i te mimi
• Te whakawātea wai tonu, e arahi ana ki te mimi pūmau e whakatairanga ana i te tipu kōhatu

Ko ngā āhuatanga anatomical i roto i tō ara mimi ka waihanga i ngā wāhi ka mau ngā kōhatu ka nui haere i te wā. Ko ēnei take hanganga e hiahia ana ki te PCNL nā te mea kāore e taea e ngā kōhatu te haere māori i ngā wāhi e pā ana.

Ka whai wāhi hoki ngā āhuatanga o te oranga ki te hanganga kōhatu nui. Ko ngā kai nui i te konutai, te pūmua kararehe, te kai rānei i ngā kai whai oxalate ka whakatairanga i te tipu kōhatu. Ko te iti o te inu wai, ina koa i ngā āhuarangi wera, i te wā rānei o te mahi tinana, ka pūmau tō mimi me te whakatairanga i te whanaketanga kōhatu.

Ko ngā rongoā kōhatu o mua kāore i angitu, i te kore rānei i oti, ka waiho pea ngā wāhanga e tipu ana ki ngā kōhatu nui ake e hiahia ana ki te PCNL. Ko tēnei āhuatanga e whakanui ana i te hiranga o te tango i ngā kōhatu katoa me te tiaki tika i muri i ngā rongoā kōhatu tākihi.

He aha ngā raruraru ka puta mai i te nephrolithotomy percutaneous?

Ahakoa te PCNL he haumaru te nuinga, mā te māramatanga ki ngā raruraru ka taea te āwhina i a koe ki te whakatau i ngā whakatau mō tō rongoā. Ko te nuinga o ngā raruraru he mea onge, ā, ka taea te whakahaere pai ina puta mai.

Ko ngā raruraru tino noa he mea iti noa iho, ā, ka tere te whakatau me te tiaki tika. Ko ēnei take e pā ana ki te ōrau iti o ngā tūroro, ā, he uaua te take o ngā raruraru mo te wā roa.

• Te toto e hiahia ana ki te whakawhitinga toto (ka puta i roto i te 1-5% o ngā keehi)
• Te mate, te kirika rānei, te nuinga e pai ana ki ngā paturopi
• Te turuturu mimi huri noa i te pae ngongo nephrostomy
• Te tango kōhatu kāore i oti e hiahia ana ki ngā tikanga atu
• Ngā huringa mahi tākihi mō te wā poto

Ko ngā raruraru nui ake he mea onge engari e hiahia ana kia aro mai te rongoā tonu. Ko ēnei āhuatanga ka puta i roto i te iti iho i te 1% o ngā tikanga, engari kua rite tō rōpū tākuta ki te whakahaere i a rātou mēnā ka puta mai.

Ka taea te whara i ngā okana e tata ana pēnei i te koroni, te kiko, te pūkahukahu rānei mēnā kāore i te tika te tūnga o te ara uru. Ahakoa te mea kāore i te noa, ka hiahia pea ēnei raruraru ki ngā tikanga tākuta atu hei whakatika. Ko te wheako o tō tākuta me te ārahi i te whakaahua tupato e tino whakaiti ana i ēnei tūponotanga.

Ko te whara i te oko toto e arahi ana ki te toto nui he raruraru onge engari he nui. Ka hiahia pea tēnei āhuatanga ki te embolization, he tikanga hei aukati i te oko toto e toto ana, i ngā keehi tino onge, te whakatika tākuta. Ko ngā tikanga whakaahua hou e āwhina ana i ngā tākuta ki te karo i ngā oko toto nui i te wā o te tikanga.

Ka taea te puta te pneumothorax, te wāhi e uru ana te hau ki te wāhi huri noa i tō pūkahukahu, ki te piki rawa te ara uru. Tenei raruraru pea e hiahia ana ki te whakanoho i te ngongo pouaka engari ka ngaro i roto i ngā rā torutoru. Ka aroturukihia tō rōpū tākuta mō tēnei tūponotanga, ā, ka taea te rongoā wawe ki te puta.

Āhea au e kite ai i te tākuta i muri i te percutaneous nephrolithotomy?

He mea nui ngā whakaritenga whai-muri mō te aroturuki i tō whakaora me te ārai i ngā kōhatu tākihi a muri ake nei. Ka whakarite tō tākuta i ēnei haerenga i ngā wā motuhake hei whakarite kia pai te whakaora o tō tākihi me te mahi noa.

Whakapā atu ki tō kaiwhakarato hauora tonu ki te pā mai ngā tohu whakatūpato e tohu ana i ngā raruraru. E hiahia ana ēnei tohu ki te arotake rongoā wawe hei ārai i ngā raruraru nui me te whakarite i tō whakaora tonu.

Rapua te āwhina rongoā tonu ki te whanake koe i te kirika i runga ake i te 101°F (38.3°C), ina koa ki te haere tahi me te wiri, ngā tohu rite te rewharewha rānei. Ka tohu pea tēnei i te mate e hiahia ana ki te rongoā paturopi. Waihoki, ko te mamae nui kāore i te whakahaerehia e ngā rongoā kua whakaritea, te puta ohorere rānei o te mamae nui o te puku, o te tuara rānei, e hiahia ana ki te arotake wawe.

Ko ngā huringa i roto i tō whakaputa mimi, i tōna āhua rānei, e tika ana kia aro mai te rongoā. Whakapā atu ki tō tākuta ki te kite koe i te whakahekenga nui o te whakaputa mimi, te toto whero kanapa i roto i tō mimi, ki te pōkaea, te haunga kino rānei tō mimi. Ka tohu pea ēnei tohu i te toto, i te mate rānei e hiahia ana ki te rongoā.

Ko ngā raruraru ki tō ngongo nephrostomy, pēnei i te taka atu, te aukati i te rerenga, te pā mai rānei o te mamae nui, e hiahia ana ki te manaaki rongoā tonu. Kaua e ngana ki te whakatika anō, ki te tango rānei i te ngongo i a koe anō, nā te mea ka whara, ka raruraru rānei.

Hei tāpiri, whakaritea ngā haerenga whai-muri i te wā e pai ana koe. Mā ēnei whakaritenga e ahei ai tō tākuta ki te aroturuki i te mahi o tō pūkahukahu, te tirotiro mō te hanganga kōhatu hou, me te whakatika i ō rautaki ārai. Ko te kitenga wawe i ngā raruraru ka arahi i te maimoatanga māmā ake me ngā putanga pai ake.

Ngā pātai e pātai pinepine ana mō te nephrolithotomy percutaneous

Q.1 He pai ake te nephrolithotomy percutaneous i ētahi atu maimoatanga kōhatu pūkahukahu?

Ko te PCNL te maimoatanga tino whai hua mō ngā kōhatu pūkahukahu nui, me ngā reiti angitu o te 85-95% mō te tango kōhatu katoa. I hangaia motuhake mō ngā kōhatu nui ake i te 2 henimita, mō ngā kōhatu uaua rānei e kore e taea e ētahi atu maimoatanga te whakatika.

Ki te whakataurite ki te lithotripsy ngaru ohorere, ka nui ake te reiti angitu o te PCNL mō ngā kōhatu nui engari e hiahia ana kia roa ake te wā whakaora. Ahakoa he iti ake te whakaeke o te rongoā ngaru ohorere, he maha ngā wā e kore e whai hua mō ngā kōhatu neke atu i te 2 henimita, nā reira ko te PCNL te kōwhiringa pai mō ēnei kōhatu nui ake.

Q.2 Ka pā te nephrolithotomy percutaneous i te kino tūturu o te pūkahukahu?

Ko te tikanga, kāore te PCNL e pā i te kino tūturu o te pūkahukahu ina mahia e ngā tākuta whai wheako. Ko te nuinga o ngā tūroro e mau tonu ana i te mahi pūkahukahu noa i muri i te tikanga, ā, he maha ngā mea e pai ake ana te mahi pūkahukahu i te wā e whakahokia ana te rere mimi kua aukatia.

Ko te ara iti i hangaia i te wā o te PCNL ka rongoā noa i roto i ngā wiki ruarua, ka waiho i te iti o te kiko. E whakaatu ana ngā rangahau ko te mahi pūkahukahu te tikanga ka hoki ki ngā taumata i mua i te tikanga, pai ake rānei, ina koa i te wā e pā ana ngā kōhatu i te aukati, i te mate rānei i mua i te maimoatanga.

Q.3 Kia pēhea te roa o te whakaora i muri i te nephrolithotomy percutaneous?

Ko te nuinga o ngā tūroro e noho ana i te hōhipera mō te 1-3 rā i muri i te PCNL, i runga i te ahunga whakamua o te whakaora takitahi. Ka tangohia te ngongo nephrostomy i roto i te 24-72 haora mēnā kāore te whakaahua e whakaatu ana i ngā kōhatu e toe ana me te rerenga pūkahukahu tika.

Ko te whakaora katoa e 2-4 wiki te roa, i roto i tenei wa ka hoki haere koe ki nga mahi o ia ra. Ka taea e te nuinga o nga tangata te hoki ki te mahi tari i roto i te 1-2 wiki, engari ko nga mahi e kaha ana te tinana ka hiahia pea kia 3-4 wiki te wa whakaora.

Q.4 Ka hoki mai ano nga kowhatu whatukuhu i muri i te nephrolithotomy percutaneous?

Ahakoa ka tangohia e te PCNL nga kowhatu e noho ana i te wa e whai hua ana, kare e aukati i te hanganga o nga kowhatu hou. Ko to tupono ki te whakawhanake i nga kowhatu hou e whakawhirinaki ana ki nga take i raro iho i te hanganga o ou kowhatu me te pai o to whai i nga rautaki aukati.

Ko te mahi tahi me to taakuta ki te tautuhi me te whakatika i nga take metabolic o ou kowhatu ka tino whakaiti i te tupono o te hokinga mai. Ka uru pea tenei ki nga huringa kai, nga rongoa, te rongoa ranei i nga ahuatanga hauora e whai wāhi ana ki te hanganga kowhatu.

Q.5 He mamae te nephrolithotomy percutaneous?

Ko te nuinga o nga turoro e pa ana ki te mamae ngawari i muri i te PCNL, e pai ana te whakahaere i nga rongoa mamae. He iti ake te mamae i te mamae mau tonu i pa ki te nuinga o nga turoro mai i o ratou kowhatu whatukuhu nui i mua i te maimoatanga.

Ka whakawhiwhia e to roopu hauora te whakahaere mamae whanui, tae atu ki nga rongoa waha me nga rongoa werohanga e tika ana. Ko te nuinga o nga turoro e kite ana ka tino heke te mamae i roto i nga ra tuatahi i muri i te pokanga, a he maha nga tangata e kii ana he pai ake te ahua i te wa i tangohia ai o ratou kowhatu e aukati ana.