Distlenorenal shunt e hole

Distal splenorenal shunt (DSRS) ke mofuta oa opereishene e etsoang ho fokotsa khatello e eketsehileng mothapong oa portal. Mothapo oa portal o tsamaisa mali ho tsoa maling a hau a silang lijo ho ea sebeteng sa hau.

Nakong ea DSRS, mothapo o tsoang lehloeng la hao o tlosoa methapong ea portal. Mothapo o hokahane le mothapo ho liphio tsa hao tsa leqele. Sena se thusa ho fokotsa phallo ea mali ka methapo ea portal.

Mothapo oa portal o tlisa mali ho tsoa maling, spleen, manyeme, le gallbladder sebeteng. Ha phallo ea mali e koetsoe, khatello ea mothapo ona e ba holimo haholo. Sena se bitsoa "portal hypertension". Hangata e hlaha ka lebaka la tšenyo ea sebete e bakoang ke:

• Tšebeliso ea joala
• Lefu la sebete le sa foleng
• Ho koala mali
• Mathata a itseng a tlhaho
• Pherekano ea mantlha ea biliary cirrhosis (lefu la sebete le bakoang ke methapo ea "bile" e koetsoeng)

Ha mali a sitoa ho phalla ka mokhoa o tloaelehileng ka methapo ea portal, ho nka tsela e 'ngoe. Ka lebaka leo, methapo ea mali e ruruhileng e bitsoang foromo ea varices. Ba ba le mabota a masesaane a ka robehang a ba a tsoa mali.

U kanna oa etsoa opereishene ena haeba liteko tsa ho nka litšoantšo tse kang endoscopy kapa x-ray li bontša hore u na le mali a tsoang mali. Ho buuoa ka DSRS ho fokotsa khatello ea methapo ebile ho thusa ho laola ho tsoa mali.

Likotsi tsa anesthesia le ho buuoa ka kakaretso ke:

• Matšoao a alejiki meriana kapa mathata a ho hema
• Ho tsoa mali, ho koala mali kapa tšoaetso

Likotsi tsa ts'ebetso ena li kenyelletsa:

• Ho aha mokelikeli ka mpeng (ascites)
• Pheta ho tsoa mali ho tsoa li-varices
• Encephalopathy (tahlehelo ea ts'ebetso ea boko hobane sebete ha se khone ho tlosa chefo maling)

Pele o etsoa opereishene, o ka ba le liteko tse itseng:

• Angiogram (ho sheba kahare ho methapo ea mali)
• Liteko tsa mali
• Endoscopy

Fa mofani oa tlhokomelo ea bophelo lethathamo la meriana eohle eo u e nkang ho kenyelletsa lengolo la ngaka le li-over-counter, litlama le litlatsetso. Botsa hore na ke life tseo u li hlokang ho emisa ho li nka pele u etsoa opereishene, le hore na ke life tseo u lokelang ho li nka hoseng ha ho buuoa.

Mofani oa hau o tla u hlalosetsa ts'ebetso mme a u joetse nako ea ho khaotsa ho ja le ho noa pele ho ts'ebetso.

Lebella ho lula matsatsi a 7 ho isa ho a 10 sepetlele kamora ho buuoa ho fola.

Ha u tsoha kamora ho buuoa u tla ba le:

• Phala e kenang methapong ea hau (IV) e tla tsamaisa mokelikeli le moriana maling a hao
• Catheter ka senya ea hau ho tsoa moroto
• Phala ea NG (nasogastric) e kenang ka nko ea hao ka mpeng ho tlosa khase le maro
• Pompo e nang le konopo u ka e tobetsa ha u hloka moriana oa bohloko

Ha u ntse u khona ho ja le ho noa, u tla fuoa maro le lijo.

U kanna oa ba le teko ea litšoantšo ho bona hore na shunt e ea sebetsa.

U kanna ua kopana le setsebi sa phepo e nepahetseng, 'me ua ithuta ho ja lijo tse nang le mafura a fokolang le letsoai le fokolang.

Kamora 'opereishene ea DSRS, ho tsoa mali ho laoloa ho batho ba bangata ba nang le khatello ea kelello ea portal. Kotsi e kholo ka ho fetisisa ea ho tsoa mali hape ke khoeling ea pele ka mor'a ho buuoa.

DSRS; Tsamaiso e fapaneng ea splenorenal shunt; Renal - splenic venous shunt; Warren shunt; Ho thatafala ha methapo - distlenorenal ea distal; Ho hloleha ha sebete - distlenorenal ea distal; Khatello ea methapo ea portal - distal splenorenal shunt

Dudeja V, Fong Y. Sebete. Ka: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Buka ea Sabiston ea Ngaka ea ho Buoa. 20th, ed. Philadelphia, PA: Elsevier; 2017: khaolo ea 53.

Libeke SR, Ottmann SE, Orloff MS. Hypertension ea portal: karolo ea lits'ebetso tsa ho koala. Ka: Cameron JL, Cameron AM, bahlophisi. Phekolo ea Hajoale ea Ts'ebetso. 13th ed. Philadelphia, PA: Elsevier; 2020: 387-389.