Yini Inqubo ye-Whipple? Inhloso, Inqubo & Ukululama

Inqubo ye-Whipple iyinhlobo enkulu yokuhlinzwa esusa izingxenye ze-pancreas yakho, amathumbu amancane, nezinye izitho eziseduze. Odokotela benza lokhu kuhlinzwa okuyinkimbinkimbi ikakhulukazi ukwelapha umdlavuza we-pancreatic nezinye izimo ezingathi sína ezithinta ikhanda le-pancreas yakho.

Lokhu kuhlinzwa kuthola igama lalo kuDkt. Allen Whipple, owokuqala ukuthuthukisa le ndlela ngeminyaka yama-1930. Noma kuzwakala kusabisa, inqubo ye-Whipple isize izinkulungwane zabantu ukulwa nomdlavuza we-pancreatic nezinye izimo. Ukuqonda ukuthi lokhu kuhlinzwa kuhilelani kungakusiza ukuthi uzizwe ulungiseleleke futhi uqiniseka ngohambo lwakho lokwelashwa.

Yini inqubo ye-Whipple?

Inqubo ye-Whipple, ebizwa nangokuthi i-pancreaticoduodenectomy, isusa ikhanda le-pancreas yakho kanye nezingxenye ezixhunywe zesistimu yakho yokugaya ukudla. Udokotela ohlinzayo ukhipha ikhanda le-pancreas, ingxenye yokuqala yamathumbu akho amancane (duodenum), i-gallbladder yakho, nengxenye ye-bile duct yakho.

Ngemuva kokususa lezi zingxenye, udokotela ohlinzayo uxhuma kabusha izitho ezisele ukuze uhlelo lwakho lokugaya ukudla lukwazi ukusebenza. Cabanga ngakho njengokususa isigaba samapayipi axhunyiwe bese uxhuma kabusha konke ngokucophelela ukuze uhlelo lusebenze futhi. Ukuhlinzwa kuvame ukuthatha amahora angu-4 kuya kwangu-8 ukuqeda.

Kunezinhlobo ezimbili eziyinhloko zenqubo ye-Whipple. I-Whipple yakudala isusa ingxenye yesisu sakho kanye nezinye izitho. I-pylorus-preserving Whipple igcina isisu sakho sonke singathintekile, okungasiza ekugayeni ukudla ngemuva kokuhlinzwa.

Kungani kwenziwa inqubo ye-Whipple?

Odokotela batusa inqubo ye-Whipple ikakhulukazi ukwelapha umdlavuza we-pancreatic otholakala ekhanda le-pancreas yakho. Lokhu kuvame ukuba yithuba elingcono kakhulu lokwelashwa lapho umdlavuza ungakaze usabalale kwezinye izingxenye zomzimba wakho.

Ukuhlinzwa futhi kuphatha ezinye izimo ezingathi sína ezithinta indawo efanayo. Lokhu kufaka phakathi izimila emgodini wakho we-bile, emathunjini amancane, noma endaweni lapho i-pancreas yakho ihlangana khona emathunjini akho amancane. Ngezinye izikhathi i-pancreatitis engapheli ebanga ubuhlungu obukhulu futhi engaphenduli kwezinye izindlela zokwelapha ingase idinge lokhu kuhlinzwa.

Udokotela wakho uzokuncoma kuphela le nqubo uma izinzuzo zidlula izingozi. Bazohlola ngokucophelela impilo yakho yonke, usayizi nendawo yetumor yakho, nokuthi umdlavuza usabalale yini ngaphambi kokuncoma ukuhlinzwa.

Iyini inqubo yokuhlinzwa kwe-Whipple?

Inqubo ye-Whipple yenzeka ezigabeni ezimbili eziyinhloko: ukususwa nokwakhiwa kabusha. Ithimba lakho lokuhlinza lizosebenzisa i-anesthesia ejwayelekile, ngakho-ke uzobe ulele ngokuphelele ngesikhathi sonke sokuhlinzwa.

Ngesikhathi sokususwa, udokotela ohlinzayo wenza ukusikeka esiswini sakho esiphezulu ukuze afinyelele ku-pancreas kanye nezitho eziqhamukayo. Bahlola ngokucophelela le ndawo ukuze baqiniseke ukuthi ukuhlinzwa kusengukukhetha okulungile. Bese besusa ikhanda le-pancreas yakho, i-duodenum, i-gallbladder, kanye nengxenye yomgudu wakho we-bile.

Isigaba sokwakhiwa kabusha sihlanganisa ukuxhuma kabusha izitho zakho ezisele. Udokotela ohlinzayo unamathisela i-pancreas esele emathunjini akho amancane, exhuma umgudu wakho we-bile emathunjini akho, futhi axhume kabusha isisu sakho. Lokhu kuvumela i-bile kanye nejusi ye-pancreatic ukuthi igeleze kahle ohlelweni lwakho lokugaya ukudla.

Abanye odokotela abahlinzayo bangasebenzisa izindlela ezingahlaseli kakhulu ezinokusikeka okuncane kanye namathuluzi akhethekile. Kodwa-ke, izinqubo eziningi ze-Whipple zidinga ukuhlinzwa okuvulekile kwendabuko ngenxa yobunzima obuhilelekile.

Ungalungela kanjani inqubo yakho ye-Whipple?

Ukulungiselela ukuhlinzwa kwe-Whipple kuhilela izinyathelo eziningana zokuqinisekisa ukuthi usesimweni esingcono kakhulu. Ithimba lakho lezokwelapha lizokuqondisa kuzo zonke izidingo, kodwa ukulungiselela kuvame ukuqala amasonto angu-1-2 ngaphambi kokuhlinzwa.

Udktela wakho cishe uzokucela ukuthi uyeke imithi ethile, ikakhulukazi imithi yokunciphisa igazi, cishe ngesonto elilodwa ngaphambi kokuhlinzwa. Uzodinga futhi ukugwema ukudla noma ukuphuza noma yini ngemuva kwamabili ngobusuku obandulela inqubo yakho. Abanye abantu badinga ukushawa ngensipho ekhethekile elwa namagciwane ngobusuku obandulela ukuhlinzwa nangosuku lokuhlinzwa.

Nawa amasu abalulekile okulungiselela ithimba lakho lezokwelapha elingase lincomise:

• Qedela ukuhlolwa kwegazi kanye nokuskena okuthwebulayo ngaphambi kokuhlinzwa
• Hlangana nodokotela we-anesthesiologist ukuze nixoxe ngokuphathwa kobuhlungu
• Lungiselela othile ukuthi akuqhubele ekhaya futhi ahlale nawe ekuqaleni
• Lungisa ikhaya lakho ngezinto ezifinyeleleka kalula nezihlalo ezinethezekile
• Landela imihlahlandlela ethile yokudla uma udokotela wakho eyincoma
• Yeka ukubhema uma ubhema, ngoba lokhu kungaphazamisa ukuphola

Ithimba lakho lokuhlinza lizokunikeza imiyalelo enemininingwane ethile ngesimo sakho. Unganqikazi ukubuza imibuzo nganoma yini engacacile.

Ungawafunda kanjani imiphumela yakho yokuhlinzwa kwe-Whipple?

Ngemuva kwenqubo yakho ye-Whipple, udokotela wakho ohlinzayo uzohlola zonke izicubu ezisusiwe ngaphansi kwemicroscope. Lo mbiko we-pathology ukutshela imininingwane ebalulekile ngesimo sakho futhi usiza ukuhlela izinyathelo zakho ezilandelayo.

Umbiko we-pathology uzokhombisa ukuthi ngabe amaseli omdlavuza atholakele yini, futhi uma kunjalo, hlobo luni nesigaba somdlavuza onaso. Udokotela wakho uzobheka nemiphetho yezicubu ezisusiwe ukuze abone ukuthi ayinamaseli omdlavuza yini. Imiphetho ecacile isho ukuthi udokotela ohlinzayo cishe ususe wonke umdlavuza.

Uma uhlinzwe ngenxa yomdlavuza, umbiko wakho ungase ufake imininingwane ngama-lymph nodes. Udokotela ohlinzayo ususa ama-lymph nodes aseduze ngesikhathi senqubo ukuze ahlolisise ukuthi umdlavuza usabalale yini lapho. Lolu lwazi lusiza ukunquma ukuthi ngabe udinga ukwelashwa okwengeziwe njenge-chemotherapy.

Udktela wakho ohlinzayo uzochaza lezi ziphumo ngemininingwane eminingi ngesikhathi sokuqokwa kwakho okulandelayo. Bazoxoxa ngalokho okushiwo yizitholakalo ngokuqagela kwakho nokuthi ngabe udinga ukwelashwa okwengeziwe.

Ungazinakekela kanjani ngemuva kokuhlinzwa kwe-Whipple?

Ukwelulama ngemuva kokuhlinzwa kwe-Whipple kuyinqubo kancane kancane edinga ukubekezela nokunaka ngokucophelela izidingo zomzimba wakho. Abantu abaningi bahlala esibhedlela izinsuku eziyi-7-10 ngemuva kokuhlinzwa, yize abanye bengadinga isikhathi eside ngokuya ngokuthi bapholisa kanjani.

Ithimba lakho lezokwelapha lizokuqapha ngokucophelela nganoma yiziphi izinkinga ngesikhathi sokuhlala kwakho esibhedlela. Uzoqala ngamanzi acacile futhi uqhubeke kancane kancane nokudla okuqinile njengoba uhlelo lwakho lokugaya ukudla luzivumela. Ukuphathwa kobuhlungu kuyingxenye ebalulekile yokululama kwakho, futhi ithimba lakho lizosebenza nawe ukukugcina ukhululekile.

Uma usendlini, uzodinga ukulandela imihlahlandlela ethile ukuxhasa ukuphola kwakho. Cishe uzodinga ukudla ukudla okuncane, okuvame ukudliwa njengoba uhlelo lwakho lokugaya ukudla manje lusebenza ngendlela ehlukile. Udokotela wakho angase akwelule ukuthi uthathe izithasiselo ze-enzyme ye-pancreatic ukusiza ekugayeni ukudla.

Ukwelulama okuphelele kuvame ukuthatha izinyanga ezi-2-3, yize abanye abantu bezizwa ngcono ngokushesha kanti abanye badinga isikhathi esiningi. Uzoqokwa njalo ukuze uqaphe ukuphola kwakho futhi ubhekane nanoma yikuphi ukukhathazeka.

Yiziphi izici eziyingozi zokudinga ukuhlinzwa kwe-Whipple?

Izici eziningana zingakhuphula amathuba akho okuthuthukisa izimo ezingadinga ukuhlinzwa kwe-Whipple. Ubudala budlala indima ebalulekile, njengoba umdlavuza we-pancreatic uvame ukuthinta abantu abaneminyaka engaphezu kwengama-65.

Umlando womndeni nezici zofuzo nazo zingakhuphula ingozi yakho. Uma izihlobo eziseduze zibe nomdlavuza we-pancreatic noma izifo ezithile zofuzo, ungase ube nethuba eliphezulu lokuthuthukisa izinkinga ze-pancreatic. Ukubhema kukhulisa kakhulu ingozi yakho yomdlavuza we-pancreatic, njengoba kwenza nokusetshenziswa kotshwala obuningi iminyaka eminingi.

Nazi izici eziyingozi okufanele uziqaphele:

• Ubudala obudlula iminyaka engama-65
• Umlando womndeni womdlavuza wamanyikwe
• Ukubhema noma umlando wokubhema
• I-pancreatitis engamahlalakhona
• Isifo sikashukela, ikakhulukazi uma sithuthuka kungazelelwe kubantu abadala
• Ukukhuluphala ngokweqile
• Izifo ezithile zofuzo

Ukuba nalezi zinto eziyingozi akusho ukuthi ngokuqinisekile uzodinga ukuhlinzwa, kodwa kufanelekile ukuxoxa nodokotela wakho ngazo. Ukuhlolwa njalo kungasiza ekutholeni izinkinga zisasekuqaleni lapho ukwelashwa kuphumelela kakhulu.

Ziyini izinkinga ezingase zibe khona zokuhlinzwa kwe-Whipple?

Njenganoma yikuphi ukuhlinzwa okukhulu, inqubo ye-Whipple inezingozi ezithile kanye nezinkinga ezingase zibe khona. Kodwa-ke, uma kwenziwa odokotela abanolwazi ezikhungweni ezikhethekile, ukuhlinzwa kuvamile ukuthi kuphephe futhi kuphumelele.

Izinkinga ezivame kakhulu zihlanganisa ukuhamba kwesisu okubambezelekile, lapho isisu sakho sithatha isikhathi eside kunokujwayelekile ukuba sikhululeke ngemva kokudla. Lokhu kungabangela isicanucanu nokuhlanza kodwa kuvamile ukuthi kuthuthuke ngokuhamba kwesikhathi. I-pancreatic fistula, lapho ijusi yamanyikwe ivuza ekuqhumeni kokuhlinzwa, enye inkinga engase ibe khona evame ukuphola yodwa.

Nazi izinkinga ezingase zibe khona iqembu lakho lokuhlinzwa elizozigada:

• Ukuhamba kwesisu okubambezelekile (isisu sikhululeka kancane)
• I-pancreatic fistula (ukuvuza kwejusi yamanyikwe)
• Ukutheleleka endaweni yokuhlinzwa
• Ukuphuma kwegazi okudinga ukwelashwa okwengeziwe
• Amaqhubu egazi emilenzeni yakho noma emaphapheni
• Isifo sikashukela uma amanyikwe anele esusiwe
• Izinkinga zokugaya ezidinga izithasiselo ze-enzyme

Izinkinga eziningi ziyalawuleka ngokunakekelwa okufanele kwezokwelapha. Ithimba lakho lokuhlinzwa linolwazi oluningi lokuphatha lezi zimo futhi lizosebenza ngokushesha ukubhekana nanoma yiziphi izinkinga ezingase zivele.

Kufanele ngibone nini udokotela mayelana nokuhlinzwa kwe-Whipple?

Kufanele uthinte udokotela wakho ngokushesha uma uhlangabezana nezimpawu ezithile zokuxwayisa ngemva kokuhlinzwa kwe-Whipple. Lezi zimpawu zingabonisa izinkinga ezidinga ukunakekelwa kwezokwelapha okusheshayo.

Xhumana nodokotela wakho ngokushesha uma uqala umkhuhlane ongaphezu kuka-101°F, ubuhlungu obukhulu besisu obuqhubeka buqina, isicanucanu esiqhubekayo nokuhlanza, noma izimpawu zokutheleleka ngasekuqhumeni kwakho. Kufanele futhi ufune ukunakekelwa ngokushesha uma uqaphela ukuphuzi kwesikhumba sakho noma amehlo, okungase kubonise inkinga ye-bile duct.

Nazi izimpawu zokuxwayisa ezidinga ukunakekelwa kwezokwelapha ngokushesha:

• Umkhuhlane ongaphezu kuka-101°F (38.3°C)
• Ubuhlungu obukhulu besisu obuqhubeka buqina
• Ukwanda kokuhlanza okuvimbela ukudla noma ukuphuza
• Izimpawu zokutheleleka (ububomvu, ukufudumala, ukuphuma ngasekuqhumeni)
• Ukuphuzi kwesikhumba noma amehlo
• Ukuqunjelwa okukhulu noma ukungakwazi ukugcina uketshezi phansi
• Ubuhlungu besifuba noma ubunzima bokuphefumula

Unganqikazi ukuxhumana nethimba lakho lezokwelapha nganoma yiziphi izinkathazo, ngisho noma zibonakala zincane. Bangathanda ukuzwa kuwe ngento encane kunokuthi ukhathazeke ngokungadingekile noma uphuthelwe isimpawu esibalulekile.

Imibuzo evame ukubuzwa mayelana nenqubo ye-Whipple

Q.1 Ingabe inqubo ye-Whipple iyona engcono kakhulu yokwelapha umdlavuza wamanyikwe?

Inqubo ye-Whipple ivame ukuba yindlela engcono kakhulu yokwelapha umdlavuza wamanyikwe otholakala ekhanda lamanyikwe, ikakhulukazi lapho umdlavuza ungakaze usabalale kwamanye amalungu omzimba. Ukuhlinzwa kunikeza ithuba elingcono kakhulu lokusinda isikhathi eside kanye nokwelashwa okungenzeka ezimweni ezinjalo.

Nokho, akuwona wonke umuntu onomdlavuza wamanyikwe ongumuntu okhethekile kulokhu kuhlinzwa. Udokotela wakho uzocabangela izinto ezinjengempilo yakho yonke, usayizi nendawo yethumba, nokuthi umdlavuza usabalale ngaphambi kokuncoma ukuhlinzwa. Ngezinye izikhathi i-chemotherapy noma i-radiation therapy ingase ibe izinketho ezingcono kuye ngesimo sakho esithile.

Q.2 Ingabe ukuhlinzwa kwe-Whipple kuyawelapha umdlavuza wamanyikwe?

Ukuhlinzwa kwe-Whipple kungelapha umdlavuza wamanyikwe, kodwa umphumela uncike ezintweni eziningana ezihlanganisa isigaba somdlavuza nokuthi ngabe zonke izimila zomdlavuza zisusiwe ngempumelelo yini. Uma ukuhlinzwa kususa wonke umdlavuza obonakalayo futhi imingcele icacile, abantu abaningi bafinyelela ekutheni umdlavuza ungabuyi isikhathi eside noma ukwelashwa.

Izinga lokusinda eminyakeni emihlanu ngemuva kokuhlinzwa kwe-Whipple liyahluka ngokuya ngesigaba somdlavuza ngesikhathi sokuxilongwa. Abantu abanomdlavuza wesigaba sokuqala ngokuvamile baba nemiphumela engcono kunalabo abanesifo esithuthuke kakhulu. Udokotela wakho uzoxoxa ngokuqagela kwakho okuthile ngokuya ngesimo sakho.

Q.3 Kuthatha isikhathi esingakanani ukululama ngemuva kokuhlinzwa kwe-Whipple?

Ukwelulama ngemuva kokuhlinzwa kwe-Whipple kuvame ukuthatha izinyanga ezi-2-3 kubantu abaningi, yize wonke umuntu ephola ngejubane lakhe. Cishe uzohlala izinsuku eziyi-7-10 esibhedlela ekuqaleni, bese uqhubeka nokululama ekhaya ngamazinga omsebenzi anda kancane kancane.

Ngemuva kwamasonto ambalwa okuqala, uzodinga ukuthatha izinto kancane futhi ugxile ekudleni ukudla okuncane, okuvame ukudliwa njengoba uhlelo lwakho lokugaya ukudla luzivumela. Abantu abaningi bangabuyela emisebenzini elula phakathi kwamasonto ama-4-6, kepha kungathatha izinyanga eziningana ukuzizwa ubuyele ngokuphelele esimweni esijwayelekile.

Q.4 Ungaphila ngokujwayelekile ngemuva kokuhlinzwa kwe-Whipple?

Yebo, abantu abaningi baphila impilo egcwele, ejwayelekile ngemuva kokuhlinzwa kwe-Whipple, yize kungadingeka ukuthi wenze izinguquko ezithile emsebenzini wakho wansuku zonke. Uhlelo lwakho lokugaya ukudla luzosebenza ngendlela ehlukile, ngakho-ke cishe uzodinga ukudla ukudla okuncane, okuvame ukudliwa futhi kungadingeka izithasiselo ze-enzyme ze-pancreatic.

Abanye abantu bathuthukisa isifo sikashukela ngemuva kokuhlinzwa uma ingxenye enkulu ye-pancreas isusiwe, kepha lokhu kungalawulwa ngemithi. Abantu abaningi bayakwazi ukubuyela emsebenzini, ukuhamba, nokujabulela imisebenzi yabo ejwayelekile uma selulame ngokugcwele ekuhlinzweni.

Q.5 Yikuphi ukudla okufanele ngikugweme ngemuva kokuhlinzwa kwe-Whipple?

Ngemva kokuhlinzwa kwe-Whipple, kuzodingeka ukuthi uqaphele ukudla okunzima ukukugaya noma okunamafutha amaningi, ikakhulukazi ezinyangeni zokuqala zokululama. Ukuncipha komsebenzi wakho we-pancreatic kusho ukuthi ungase ube nenkinga yokugaya ukudla okunamafutha ngaphandle kwezithasiselo ze-enzyme.

Ngokuvamile, kufanele ukhawulele ukudla okuthosiwe, inyama enamafutha, kanye nemikhiqizo yobisi enamafutha amaningi uze wazi ukuthi umzimba wakho uzibekezelela kangakanani. Gxila kumaprotheni anciphile, ama-carbohydrate alula ukugayeka, kanye namanzi amaningi. Ithimba lakho lokunakekelwa kwezempilo lizohlinzeka ngemihlahlandlela yokudla ethile ngokusekelwe ekuqhubekeni kokululama kwakho.