Chii chinonzi Whipple Procedure? Chinangwa, Maitiro & Kupora

Maitiro eWhipple kuvhiyiwa kukuru kunobvisa zvikamu zvepancreas yako, ura hudiki, uye zvimwe zvikamu zviri pedyo zvemuviri. Vanachiremba vanoita kuvhiyiwa uku kwakaoma kunyanya kurapa gomarara repancreas uye mamwe mamiriro akakomba anokanganisa musoro wepancreas yako.

Kuvhiyiwa uku kunowana zita raro kubva kuna Dr. Allen Whipple, uyo akatanga kugadzira nzira iyi muma1930s. Kunyangwe zvichiratidzika sezvinotyisa, maitiro eWhipple akabatsira zviuru zvevanhu kurwisa gomarara repancreas nemamwe mamiriro. Kunzwisisa zvinobatanidzwa mukuvhiyiwa uku kunogona kukubatsira kuti unzwe wakagadzirira uye wakavimba nerwendo rwako rwekurapa.

Chii chinonzi Whipple procedure?

Maitiro eWhipple, anonziwo pancreaticoduodenectomy, anobvisa musoro wepancreas yako pamwe chete nezvikamu zvakabatana zvehurongwa hwako hwekugaya. Chiremba anobvisa musoro wepancreas, chikamu chekutanga cheura hwako hudiki (duodenum), gallbladder yako, uye chikamu chebile duct yako.

Mushure mekubvisa zvikamu izvi, chiremba anobatanidza zvakare nhengo dzakasara kuitira kuti hurongwa hwako hwekugaya huchiri kushanda. Funga nezvazvo sekubvisa chikamu chemapaipi akabatana wobva wanyatso batanidza zvese kuitira kuti sisitimu ishande zvakare. Kuvhiyiwa kunowanzo tora maawa mana kusvika ku8 kuti upedze.

Kune mhando mbiri huru dzemaitiro eWhipple. Iyo classic Whipple inobvisa chikamu chemudumbu wako pamwe chete nenhengo dzimwe. Iyo pylorus-preserving Whipple inochengeta mudumbu wako wese usina kukuvadzwa, izvo zvinogona kubatsira mukugaya mushure mekuvhiyiwa.

Nei maitiro eWhipple achiitwa?

Vanachiremba vanokurudzira maitiro eWhipple kunyanya kurapa gomarara repancreas riri mumusoro wepancreas yako. Iyi inowanzoita mukana wakanakisa wekurapa kana gomarara risati raenda kune dzimwe nhengo dzemuviri wako.

Kuvhiwa kunobatawo mamwe mamiriro akakomba anokanganisa nzvimbo imwechete. Izvi zvinosanganisira tumor mumugero wako webile, ura hudiki, kana nzvimbo iyo pancreas yako inosangana neura hudiki. Dzimwe nguva chronic pancreatitis inokonzera kurwadziwa kwakanyanya uye haipinduri kune dzimwe nzira dzekurapa inogonawo kuda kuvhiwa uku.

Chiremba wako achangokurudzira nzira iyi kana mabhenefiti achipfuura njodzi. Vachanyatsoongorora hutano hwako hwese, saizi nenzvimbo yetumor yako, uye kana cancer yapararira vasati vakurudzira kuvhiwa.

Ndeipi nzira yekuvhiwa kweWhipple?

Nzira yeWhipple inoitika muzvikamu zviviri zvikuru: kubviswa uye kuvakwazve. Chikwata chako chekuvhiya chichashandisa general anesthesia, saka uchavata zvachose panguva yese yekuvhiya.

Panguva yekubvisa, chiremba wako anovhiya anoita incision mudumbu rako repamusoro kuti awane pancreas uye nhengo dzakapoteredza. Vanonyatsoongorora nzvimbo yacho kuti vaone kuti kuvhiwa kuchiri sarudzo chaiyo. Zvadaro vanobvisa musoro wepancreas yako, duodenum, gallbladder, uye chikamu chemugero wako webile.

Chikamu chekuvakazve chinosanganisira kubatanidza nhengo dzako dzakasara. Chiremba wako anovhiya anobatanidza pancreas yasara kuura hwako hudiki, anobatanidza mugero wako webile kuura hwako, uye anobatanidza dumbu rako zvakare. Izvi zvinobvumira bile uye pancreatic juices kuyerera zvakanaka muviri wako wekugaya.

Vamwe vanachiremba vanovhiya vanogona kushandisa nzira diki diki dzine incisions diki uye zviridzwa zvakakosha. Zvisinei, mazhinji eWhipple nzira achiri kuda kuvhiwa kwechinyakare nekuda kwekuoma kunobatanidzwa.

Maitiro ekugadzirira nzira yako yeWhipple?

Kugadzirira kuvhiwa kweWhipple kunosanganisira matanho akati wandei kuti uve nechokwadi chekuti uri mumamiriro akanaka. Chikwata chako chekurapa chichakutungamira kuburikidza nechinhu chimwe nechimwe chinodiwa, asi kugadzirira kunowanzo kutanga 1-2 mavhiki asati avhiwa.

Chiremba wako anogona kukukumbira kuti umise mishonga yakati wandei, kunyanya mishonga inoderedza ropa, svondo rimwe chete vasati vaita kuvhiyiwa. Unozofanirawo kudzivisa kudya kana kunwa chero chinhu mushure mepakati peusiku husati hwaitwa maitiro ako. Vamwe vanhu vanofanira kushambidza nesipo yakakosha yekuuraya mabhakitiriya husiku husati hwaitwa kuvhiyiwa uye mangwanani ekuvhiyiwa.

Heano matanho makuru ekugadzirira ayo timu yako yezvokurapa ingakurudzira:

• Pedzisa bvunzo dzeropa risati raitwa kuvhiyiwa uye scans yekufungidzira
• Sangana nemuongorori weanesthesiologist kuti ukurukure manejimendi erwadziwa
• Gadzirira mumwe munhu kuti akuendesere kumba uye agare newe pakutanga
• Gadzirira imba yako nezvinhu zviri nyore kusvika uye zvigaro zvakanaka
• Tevedza gwara rekudya rakatarwa kana chiremba wako achikurudzira
• Regai kusvuta kana muchisvuta, sezvo izvi zvinogona kukanganisa kupora

Chikwata chako chekuvhiya chichakupa mirairo yakadzama yakatarwa kune mamiriro ako. Usazeza kubvunza mibvunzo pamusoro pechero chinhu chinonzwa chisina kujeka.

Ungaverenga sei mhedzisiro yako yekuvhiya yeWhipple?

Mushure mekuvhiyiwa kwako kweWhipple, chiremba wako achatarisa ese matishu akabviswa pasi pemicroscope. Iri chirevo chepathology rinokuudza ruzivo rwakakosha nezve mamiriro ako uye rinobatsira kuronga matanho ako anotevera.

Chirevo chepathology chicharatidza kana maseru ekenza akawanikwa uye, kana zvakadaro, rudzi uye nhanho yekenza yaunayo. Chiremba wako achatarisawo micheto yetishu yakabviswa kuti aone kana yakachena kubva kumasero ekenza. Migumo yakajeka zvinoreva kuti chiremba anogona kubvisa kenza yese.

Kana wakavhiyiwa kenza, chirevo chako chingasanganisira ruzivo nezve lymph nodes. Chiremba anobvisa lymph nodes dzepedyo panguva yacho kuti aone kana kenza yakapararira ikoko. Ruzivo urwu runobatsira kuona kana uchida imwe kurapwa senge chemotherapy.

Chiremba wako achatsanangura mhedzisiro iyi zvakadzama panguva yekusangana kwako kunotevera. Vachakurukura zvinoreva zvawanikwa pakufanotaurwa kwako uye kana uchida kurapwa kwakawedzerwa.

Nzira yekuzvichengeta iwe pachako mushure mekuvhiyiwa kweWhipple?

Kupora kubva mukuvhiyiwa kweWhipple inzira inononoka inoda moyo murefu uye kutarisisa zvinodiwa nemuviri wako. Vanhu vazhinji vanogara muchipatara kwemazuva 7-10 mushure mekuvhiyiwa, kunyangwe vamwe vachigona kuda nguva yakareba zvichienderana nekuti vanopora sei.

Chikwata chako chekurapa chichakutarisa zvakanyanya kune chero matambudziko panguva yaunenge uri muchipatara. Uchatanga nemvura yakajeka uye zvishoma nezvishoma uchienda kuzvokudya zvakasimba sezvo hurongwa hwako hwekugaya huchigadzirisa. Kurapa kurwadziwa chikamu chakakosha chekupora kwako, uye chikwata chako chichashanda newe kuti ugare wakasununguka.

Paunenge uri kumba, uchada kutevera matungamirirwo chaiwo ekutsigira kupora kwako. Unogona kuda kudya zvidiki, zvikafu zvakawanda nekuti hurongwa hwako hwekugaya hunoshanda zvakasiyana izvozvi. Chiremba wako anogona kunyora zvinowedzera enzyme yepancreatic kubatsira nekugaya.

Kupora zvizere kunowanzo tora mwedzi 2-3, kunyangwe vamwe vanhu vachinzwa zviri nani nekukurumidza uye vamwe vachida imwe nguva. Uchaenda kumisangano yekutevera nguva dzose kuti utarise kupora kwako uye kugadzirisa chero zvinokunetsa.

Ndezvipi zvinhu zvine njodzi zvekuda kuvhiyiwa kweWhipple?

Zvimwe zvinhu zvinogona kuwedzera mukana wako wekuvandudza mamiriro angangoda kuvhiyiwa kweWhipple. Zera rinoita basa rakakosha, sezvo gomarara repancreatic rinowanzoita vanhu vane makore anopfuura 65.

Nhoroondo yemhuri uye zvinhu zvemajini zvinogona zvakare kuwedzera njodzi yako. Kana hama dzepedyo dzakave negomarara repancreatic kana mamwe masindromu emajini, unogona kuve nemukana wakakwira wekuvandudza matambudziko epancreatic. Kusvuta kunowedzera zvakanyanya njodzi yako yegomarara repancreatic, sezvinoita kushandiswa kwakanyanya kwedoro kwemakore mazhinji.

Heano zvinhu zvine njodzi zvikuru zvekuziva nezvazvo:

• Zera rekupfuura makore 65
• Nhoroondo yemhuri yegomarara repancreatic
• Kusvuta kana nhoroondo yekusvuta
• Chronic pancreatitis
• Chirwere cheshuga, kunyanya kana chikaonekwa kamwe kamwe muvanhu vakuru
• Kufutisa
• Mamwe masindromu e genetic

Kuva nezvinhu izvi zvinokonzera njodzi hazvirevi kuti uchada kuvhiyiwa, asi zvakakosha kukurukura nachiremba wako. Kuongororwa nguva dzose kunogona kubatsira kubata matambudziko nekukurumidza apo kurapwa kunonyanya kushanda.

Ndezvipi zvipingamupinyi zvinogona kuitika mushure mekuvhiyiwa kweWhipple?

Kufanana nekumwe kuvhiyiwa kukuru, maitiro eWhipple anotakura njodzi dzimwe uye zvipingamupinyi zvinogona kuitika. Zvisinei, kana zvichiitwa nevavhiyi vane ruzivo pazvipatara zvakakosha, kuvhiyiwa kunowanzova kwakachengeteka uye kunobudirira.

Zvipingamupinyi zvakajairika zvinosanganisira kunonoka kubuda mudumbu, uko dumbu rako rinotora nguva yakareba kupfuura zvakajairika kubuda mushure mekudya. Izvi zvinogona kukonzera kusvotwa uye kurutsa asi zvinowanzoita nani nekufamba kwenguva. Pancreatic fistula, uko muto wepancreatic unobuda kubva pakubatanidzwa kwekuvhiya, ndechimwe chipingamupinyi chinogona kuitika chinowanzoita nani chega.

Heano zvipingamupinyi zvinogona kuitika izvo timu yako yekuvhiya ichatarisa:

• Kunonoka kubuda mudumbu (dumbu rinobuda zvishoma nezvishoma)
• Pancreatic fistula (kubuda kwemuto wepancreatic)
• Kutapukirwa panzvimbo yekuvhiya
• Kubuda ropa kunoda kumwe kurapwa
• Mavhiri eropa mumakumbo ako kana mumapapu
• Chirwere cheshuga kana pancreas yakakwana yabviswa
• Matambudziko ekugaya anoda zvinowedzerwa zve enzyme

Zvizhinji zvezvipingamupinyi zvinogona kutariswa nekuchengetwa kwakakodzera kwekurapa. Chikwata chako chekuvhiya chine ruzivo rwakawanda rwekugadzirisa mamiriro aya uye chichashanda nekukurumidza kugadzirisa chero nyaya dzinooneka.

Ndinofanira kuona chiremba rini nezvekuvhiyiwa kweWhipple?

Unofanira kubata chiremba wako nekukasira kana ukaona zviratidzo zvakasiyana mushure mekuvhiyiwa kweWhipple. Zviratidzo izvi zvinogona kuratidza zvipingamupinyi zvinoda kutariswa nekukurumidza kwekurapa.

Fonera chiremba wako nekukasira kana ukaona fivha inodarika 101°F, kurwadziwa kwakanyanya mudumbu kunowedzera, kusvotwa nekutsvanza zvisingapere, kana zviratidzo zveutachiona munzvimbo yakatemwa. Unofanirawo kutsvaga rubatsiro rwekukasira kana ukaona ganda rako kana maziso achichinja ruvara kuita yero, izvo zvingaratidza dambudziko remugero webile.

Heano zviratidzo zvekuyambira zvinoda kutariswa kwekurapa nekukasira:

• Fivha inodarika 101°F (38.3°C)
• Kurwadziwa kwakanyanya mudumbu kunowedzera
• Kutsvanza kusingapere kunodzivirira kudya kana kunwa
• Zviratidzo zveutachiona (kutsvuka, kupisa, kubuda kubva pakatemwa)
• Kushanduka ruvara kweganda kana maziso kuita yero
• Manyoka akanyanya kana kusakwanisa kuchengeta mvura mumuviri
• Kurwadziwa muchipfuwa kana kuoma kufema

Usazeza kubata timu yako yezvokurapa nechero zvinokunetsa, kunyangwe zvichioneka sezvidiki. Vanoda kunzwa kubva kwauri nezvechinhu chidiki pane kuti unetseke zvisina kufanira kana kupotsa chiratidzo chakakosha.

Mibvunzo inowanzo bvunzwa nezve nzira yeWhipple

M.1 Ko nzira yeWhipple ndiyo kurapwa kwakanaka kwegomarara repancreas here?

Nzira yeWhipple inowanzoita sarudzo yakanaka yekurapa gomarara repancreas riri mumusoro wepancreas, kunyanya kana gomarara risina kupararira kune zvimwe zvikamu zvemuviri. Kuvhiyiwa kunopa mukana wakanaka wekurarama kwenguva refu uye kupora mune izvi zviitiko.

Zvisinei, havasi vese vane gomarara repancreas vanokodzera kuvhiyiwa uku. Chiremba wako achafunga nezvezvinhu zvakaita sehutano hwako hwese, saizi nenzvimbo yetumor, uye kana gomarara rapararira vasati vakurudzira kuvhiyiwa. Dzimwe nguva chemotherapy kana radiation therapy ingave sarudzo dziri nani zvichienderana nemamiriro ako chaiwo.

M.2 Ko kuvhiyiwa kweWhipple kunorapa gomarara repancreas here?

Kuvhiwa kweWhipple kunogona kurapa gomarara repancreatic, asi mhedzisiro inoenderana nezvinhu zvakawanda zvinosanganisira nhanho yegomarara uye kana masero ese egomarara abviswa zvakabudirira. Kana kuvhiwa kuchibvisa gomarara rese rinooneka uye miganhu yakajeka, vanhu vazhinji vanowana remission yenguva refu kana kurapwa.

Chiyero chekupona kwemakore mashanu mushure mekuvhiwa kweWhipple chinosiyana zvichienderana nenhanho yegomarara panguva yekuongororwa. Vanhu vane gomarara rematanho ekutanga vanowanzoita mhedzisiro iri nani pane avo vane chirwere chakanyanya. Chiremba wako achakurukura prognosis yako chaiyo zvichienderana nemamiriro ako ega.

Mubvunzo 3. Zvinotora nguva yakareba sei kupora kubva mukuvhiwa kweWhipple?

Kupora kubva mukuvhiwa kweWhipple kunowanzo tora mwedzi miviri mitatu kune vanhu vazhinji, kunyangwe munhu wese achipora pamwero wavo. Iwe ungangodaro uchipedza mazuva manomwe kusvika gumi muchipatara pakutanga, wobva watora kupora kumba uine mazinga ekuwedzera ekuita.

Mumavhiki mashoma ekutanga, iwe uchada kutora zvinhu zvishoma nezvishoma uye kutarisisa kudya zvidiki, chikafu chinowanzoitika sezvo hurongwa hwako hwekugaya huchigadzirisa. Vanhu vazhinji vanogona kudzokera kuzviitwa zvakareruka mukati memavhiki mana kusvika matanhatu, asi zvinogona kutora mwedzi yakati wandei kuti unzwe zvakajairika zvakakwana.

Mubvunzo 4. Unogona kurarama zvakajairika mushure mekuvhiwa kweWhipple here?

Hongu, vanhu vazhinji vanorarama hupenyu huzere, hwakajairika mushure mekuvhiwa kweWhipple, kunyangwe iwe uchida kuita zvimwe zvigadziriso kune yako yezuva nezuva. Hurongwa hwako hwekugaya huchashanda zvakasiyana, saka iwe ungangoda kudya zvidiki, chikafu chinowanzoitika uye unogona kuda pancreatic enzyme supplements.

Vamwe vanhu vanowana chirwere cheshuga mushure mekuvhiwa kana chikamu chakakosha chepancreas chabviswa, asi izvi zvinogona kutarisirwa nemishonga. Vanhu vazhinji vanokwanisa kudzokera kubasa, kufamba, uye kunakidzwa nezviitiko zvavo zvenguva dzose kana vapora zvizere kubva mukuvhiwa.

Mubvunzo 5. Ndezvipi zvekudya zvandinofanira kudzivisa mushure mekuvhiwa kweWhipple?

Mushure mekuvhiyiwa kweWhipple, unofanirwa kungwarira chikafu chakaoma kugaya kana chine mafuta akawanda, kunyanya mumwedzi mishoma yekutanga yekupora. Basa rako repancreatic rakaderedzwa rinoreva kuti unogona kuva nematambudziko ekugaya chikafu chine mafuta pasina zvinowedzerwa zve enzyme.

Kazhinji, unofanirwa kuderedza chikafu chakakangwa, nyama ine mafuta, uye zvigadzirwa zvemukaka zvine mafuta akawanda kusvikira waziva kuti muviri wako unovashivirira sei. Tarisa pane mapuroteni akatetepa, makabhohaidhireti ari nyore kugaya, uye mvura yakawanda. Chikwata chako chekuchengetedza hutano chichapa gwara rechikafu zvichienderana nekufambira mberi kwako.