Tshem tawm ntawm lub plab hauv oncology yog kev phais mob siv los tshem tawm cov txheej txheem oncological thaum ntxov ntawm nws txoj kev loj hlob. Cov txheej txheem zoo li no hauv 80% ntawm cov neeg mob ua kom cov neeg mob rov zoo thiab kho nws lub cev. Nws tseem yog ib qho tseem ceeb uas yuav tsum tau coj mus rau hauv tus account qhov tseeb tias kev ua haujlwm tsis yog ib txwm ua los ntawm tag nrho kev txiav tawm ntawm lub cev. Muaj ntau ntau hom kev phais tshem tawm ntawm lub cev uas pab tshem tawm oncology. Raws li nrog rau lwm txoj kev kho mob, tom qab kev ua haujlwm kom tshem tawm lub plab, tus neeg mob yuav ntsib qee qhov teeb meem. Tsis tas li ntawd, nws tseem ceeb heev uas yuav tsum nco ntsoov tias cov txiaj ntsig ntawm txoj kev kho mob zoo li no thiab lub neej tom qab nws yuav tsis zoo ib yam rau txhua tus neeg mob.
Qhia rau tus txheej txheem
Kev kuaj mob "mob qog noj ntshav" tsis tuag, yog li tus neeg mob tsis tas yuav ntshai thiab ntxhov siab. Kev kho mob ntawm qee hom oncology yog ua los ntawm kev tshem tawm tag nrho cov kabmob (plab plab). Qhov no yuav xav tau ntau yam kev hloov pauv hauv lub neej niaj hnub thiab kev noj haus.
YGastrectomy yog kev tshem tawm ib feem lossis tag nrho ntawm lub cev. Hauv qhov no, nws yog ib qho tseem ceeb uas yuav tsum tau ua tib zoo saib xyuas yam khoom noj twg yuav raug muab rau tus neeg mob tom qab tshem tawm ntawm lub cev thaum muaj kev puas tsuaj rau cov qog nqaij hlav. Qhov tsis muaj plab ua rau muaj kev cuam tshuam rau kev noj haus thiab yuav tsum tau tshuaj xyuas kom tiav.
Kev tshem tawm ntawm lub cev tsuas yog siv yog tias lwm txoj kev kho mob tsis pab. Kev ua haujlwm tau ua nyob rau hauv cov xwm txheej hauv qab no:
- mob qog nqaij hlav hauv plab;
- cov txheej txheem mob;
- perforation ntawm lub plab phab ntsa;
- mob hnyav lossis mob duodenal mob;
- tsim ntawm polyps lossis kev loj hlob ntawm sab hauv plab;
- mob plab.
Thaum lub plab cuam tshuam los ntawm qhov txhab, tus kws kho mob sim ua kom cov acidity ntawm tus neeg mob rov qab los. Cov kua txiv plab pab txo qis yog tias koj tsis tu ncua haus kua txiv kab ntxwv thiab ua rau qeeb taug kev tom qab noj mov.
Contraindications rau cov txheej txheem
Muaj ntau yam kab mob thaum tus kws kho mob tshwj xeeb tshaj tawm kev tshem tawm lub plab rau tus neeg mob, tab sis qhov pom ntawm oncology yog qhov qhia tau tshaj plaws rau kev phais. Txhawm rau ua tiav cov txiaj ntsig zoo dua thaum lub sijhawm ua haujlwm, cov kws tshaj lij tau sau cov kev kho mob nyuaj: hluav taws xob thiab tshuaj khomob.
Tab sis nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias muaj cov xwm txheej uas nws txwv tsis pub kho mob plab nrog kev phais. Cov kws tshaj lij contraindications tseem ceeb suav nrog:
- Kev muaj cov metastases hauv cov kabmob hauv qab no: daim siab, ntsws,zes qe menyuam thiab lwm yam. Feem ntau, tus mob no tshwm sim nrog ib hom mob hnyav - theem plaub ntawm mob plab.
- Kev loj hlob ntawm cov qog nqaij hlav hauv cov qog nqaij hlav uas nyob ntawm qhov deb ntawm lub cev. Feem ntau lawv pib tsim nyob rau hauv lub cev ntawm theem peb ntawm kev txhim kho mob qog noj ntshav.
- Yog tus neeg mob muaj kab mob hnyav ntawm lub raum lossis cov hlab plawv hauv lub cev.
- YCancerous peritonitis.
- Ua tiav kev qaug zog ntawm tib neeg lub cev, thaum tus neeg mob xav tias tsis muaj zog, kev nyuaj siab, nws muaj teeb meem hauv cov txheej txheem physiological, yuag sai, teeb meem nrog lub paj hlwb (kev ntxhov siab, kev puas siab puas ntsws overload).
- Teeb meem nrog ntshav txhaws.
- Lub plab plab vim qhov ntim ntawm cov kua dej ntau hauv lub plab kab noj hniav.
Kev phais mob plab tuaj yeem ua rau tus neeg mob ntawm txhua lub hnub nyoog - qhov no tsis ua lub luag haujlwm tshwj xeeb hauv kev kho.
Kev npaj
Ua ntej yuav ua haujlwm, tshwj xeeb tshaj yog thaum raug cov qog nqaij hlav cancer, tus kws kho mob yuav tsum ua ib qho kev sim thiab kev tshawb fawb.
Cov kev ntsuam xyuas no yog qhov tseem ceeb rau kev txiav txim siab qhov zoo ntawm kev ua haujlwm ntawm cov kabmob tseem ceeb thiab cov kab ke, qhov chaw ntawm kev kis mob qog noj ntshav, nws theem thiab qib ntawm kev nthuav dav. Kev ntsuas ntsuas suav nrog:
- kuaj ntshav thiab kuaj ntshav biochemical;
- urine study;
- Ymicroscopickawm txog cov quav kom paub cov ntshav tsis huv hauv lawv;
- lub hauv siab X-ray;
- gastroscopy - kev tshuaj xyuas endoscopic ntawm sab hauv ntawm cov kabmob ntawm lub plab zom mov;
- biopsy - txheej txheem cuam tshuam nrog kev txiav tawm me me ntawm cov ntaub so ntswg cuam tshuam;
- Ultrasound ntawm lub plab plab;
- MRI thiab CT.
Tshuaj
Kev npaj kho mob ntawm tus neeg mob yuav suav nrog kev noj cov tshuaj hauv qab no:
- tshuaj txhim kho plab zom mov;
- siv cov tshuaj sedatives uas pab txhim kho kev pw tsaug zog thiab rov qab muaj kev noj qab nyob zoo hauv tus neeg mob;
- hloov cov tshuaj protein thiab ntshav plasma thaum muaj ntshav liab;
- siv cov tshuaj uas pab txhim kho kev ua haujlwm ntawm lub siab, lub raum, lub plawv thiab cov hlab ntsha;
- siv tshuaj tua kab mob;
- siv cov tshuaj hemostatic tshwj xeeb;
- nqa tawm plab lavage.
Dhau li ntawm qhov no, nws tseem ceeb heev los npaj tus neeg mob kev coj ncaj ncees rau kev cuam tshuam kev phais. Tus kws kho mob yuav tsum tau qhia rau tus neeg mob kom ntxaws txog txhua qhov zoo thiab qhov tsis zoo ntawm cov txheej txheem, qhov tseem ceeb ntawm nws qhov kev siv thiab cov cuab yeej siv dav dav.
Feem ntau, kev npaj ua ntej ntawm tus neeg mob suav nrog kev siv tshuaj khomob, uas yuav pab txo qhov mob qog noj ntshav thiab txo cov txheej txheem ntawm nws txoj kev loj hlob. Kev npaj tsim nyog rauKev phais yuav pab tsis tau tsuas yog ua kom tau txais txiaj ntsig zoo los ntawm kev ua haujlwm, tab sis kuj los tiv thaiv cov teeb meem tshwm sim tom qab tshem tawm lub plab.
hom haujlwm tseem ceeb
gastrectomy yog dab tsi? Txhawm rau tshem tawm cov qog nqaij hlav hauv tib neeg lub cev, tus kws kho mob siv ntau txoj hauv kev kho. Thaum xaiv cov tswv yim rau kev cuam tshuam kev phais, cov kws kho mob tsom rau cov hauv qab no:
- qhov chaw uas mob qog noj ntshav kis;
- qib kev loj hlob ntawm oncology thiab nws theem;
- hnub nyoog ntawm tus neeg mob;
- muaj cov metastases hauv cov ntaub so ntswg thiab cov kabmob nyob ze.
Hauv kev kho mob, hom kev ua haujlwm hauv qab no yog qhov txawv:
- resection - tshem tawm ntawm ib feem ntawm lub cev uas qhov mob qog noj ntshav nyob;
- gastrectomy - ua tiav kev tshem tawm ntawm lub cev thiab cov ntaub so ntswg;
- lymph node dissection - tshem tawm cov qog nqaij hlav ua ke nrog cov ntaub so ntswg cuam tshuam uas nyob ib sab ntawm lawv (cov txheej txheem no feem ntau ua ua ke nrog resection thiab hysterectomy);
- kev cuam tshuam palliative yog ib qho kev kho mob uas siv rau kev mob qog noj ntshav, nws pab txhim kho kev noj qab haus huv ntawm tus neeg mob thiab ua kom nws lub neej ntev.
Gastrectomy suav nrog kev tshem tawm tag nrho ntawm lub cev, tab sis nws kuj tseem tuaj yeem txuag tau ib feem ntawm lub plab. Gastrectomy muab faib ua hom hauv qab no:
- distal subtotal - kev txiav tawm ntawm ib feem ntawm lub cev uas nws nkag mus rau hauv txoj hnyuv;
- proximalsubtotal - siv thaum oncology kis mus rau sab sauv peb ntawm lub plab: nyob rau hauv cov ntaub ntawv no, ob omentums, ib feem nrog tsawg curvature thiab lymph nodes raug tshem tawm;
- tag nrho - txheej txheem uas tag nrho lub plab tshem tawm thiab txoj hlab pas txuas nrog cov hnyuv;
- sleeve.
Txoj Kev Ua Haujlwm
Muaj ntau ntau txoj hauv kev los ua qhov gastrectomy:
- phais laparoscopic - ua los ntawm kev siv cov cuab yeej endoscopic uas tau muab tso rau hauv lub plab los ntawm ob qhov kev txiav me me: siv rau kev tshem tawm tag nrho thiab ib nrab ntawm lub cev;
- laparotomy yog ib qho kev phais qhib uas muaj kev phais loj hauv phab ntsa plab plab.
Txawm hais tias xaiv txoj kev ua haujlwm, qhov yuav tsum tau ua ua ntej rau nws qhov kev siv yog tshem tawm cov qog ntshav hauv cheeb tsam.
Muaj teeb meem tom qab txheej txheem
Tus neeg tsis muaj plab feem ntau muaj teeb meem. Feem ntau suav nrog cov hauv qab no:
- ntshav qab zib;
- reflux esophagitis;
- poob ceeb thawj;
- mob qog noj ntshav;
- dumping syndrome;
- diffuse peritonitis;
- ntshav ntshav ntau.
Lub sijhawm rov qab los
Lub neej tom qab gastrectomy nyuaj heev. Tom qab kev ua haujlwm, nws yog ib qho tseem ceeb rau ib tug neeg mus rau lub sij hawm rov qab los, uas yuav yog tus kheej rau txhua tusneeg mob. Cov yam ntxwv ntawm kev kho kom rov zoo yuav ncaj qha nyob ntawm lub hnub nyoog ntawm tus neeg mob, txoj kev ua haujlwm thiab qhov ntim ntawm lub plab tshem tawm. Cov txheej txheem rov qab yuav txuas ntxiv rau 3 lub hlis. Thaum lub sij hawm rov qab los ntawm lub cev, ib tug neeg raug txwv los ntawm:
- to overcool or, conversely, overheat;
- ua haujlwm dhau lub cev;
- noj zaub mov tsis zoo.
Tus neeg mob txwv tsis pub noj cov rog, haus luam yeeb, ntsim, noj zaub mov qab, khoom qab zib, dej qab zib ntau ntau. Cov zaub mov yuav tsum muaj xws li boiled los yog steamed lauj kaub tais diav. Thaum ua noj, nws yog ib qho tseem ceeb kom zom thiab zom zoo. Nws tseem txwv tsis pub noj zaub mov txias lossis kub. Nws yog ib qho tseem ceeb rau tus neeg mob kom tso tus cwj pwm phem. Tus kws kho mob uas tuaj koom yuav nws tus kheej ua kev noj zaub mov nruj heev rau tus neeg mob tom qab ua haujlwm, txiav txim siab cov npe ntawm cov zaub mov tseem ceeb txwv thiab tso cai.
Ntau tus neeg mob nug tias lawv nyob nrog mob qog noj ntshav ntev npaum li cas? Lub neej lub sij hawm nrog xws li ib tug pathology yuav ncaj qha nyob ntawm seb lub theem ntawm kis tau tus mob cancer. Yog tias tus kab mob oncological tau kuaj pom nyob rau theem pib ntawm kev loj hlob, ces tus neeg mob tuaj yeem nyob tau ntau xyoo. Thaum txiav txim siab qhov mob qog noj ntshav nyob rau theem kawg ntawm txoj kev loj hlob thiab ua kev kho mob palliative, tus neeg mob lub neej luv dua, thiab qee zaum tsis pub tshaj tsib xyoos.
Kev hloov pauv noj mov
Cov neeg nyob tom qab gastrectomy li cas? Noj zaub mov rauKev tshem tawm ntawm lub cev no yog lub hom phiaj tseem ceeb ntawm kev kho cov txheej txheem ntawm assimilation thiab kev ua zaub mov, nrog rau normalization ntawm metabolic zog. Khoom noj khoom haus yuav tsum muaj nyob rau hauv xws li ib tug txoj kev uas tib neeg lub cev tau txais los ntawm nws cov nram qab no cov as-ham:
- 55% carbs;
- 30% rog;
- Y15% protein.
Nws yog ib qho tseem ceeb kom ntxiv carbohydrates rau hauv koj daim ntawv teev zaub mov thiab zam cov zaub mov uas tuaj yeem ua rau tsam plab. Cov zaub mov kub yuav tsum tsis kub lossis txias.
Nws kuj tseem ceeb rau koj tus kheej kom ua raws li koj tus kheej noj hauv qee qhov me me, yam tsis poob qis (los ntawm 5 mus rau 6 zaug hauv ib hnub).
Thaum muab cov ntawv qhia zaub mov rau kev kho lub cev, kev saib xyuas tshwj xeeb yuav tsum tau them rau cov zaub nyoos (asparagus, carrots, beets thiab spinach), txiv hmab txiv ntoo siav, cov khoom noj ceev ceev, cov khoom noj siv mis, cov nqaij ntuj. Nws yog qhov yuav tsum tau suav nrog cov carbohydrates hauv cov npe ntawm cov khoom (cov no suav nrog txiv hmab txiv ntoo, zaub thiab kua txiv), ua tib zoo saib xyuas tus nqi ntawm qhov hnyav yog tias nws tau poob qis tom qab ua haujlwm. Qhov ceev thiab qhov zoo ntawm kev rov zoo yuav nyob ntawm kev noj haus zoo heev.
Lub neej tsis muaj plab yog ua tau, thiab kev ua haujlwm tshem tawm tsis yog qhov txaus ntshai thiab txaus ntshai raws li qee tus neeg xav.
ntsuas kev tiv thaiv
Txhawm rau zam cov kab mob txaus ntshai xws li mob qog noj ntshav, nws yog ib qho tseem ceeb ua raws li cov cai no:
- coj txoj hauv kev zoo;
- noj kom raug thiab tsis tu ncua (nws txwv tsis pub noj ntaucov zaub mov kaus poom, haus luam yeeb, qab ntsev thiab cov zaub mov rog; tshwj xeeb yuav tsum tau them rau zaub, tshuaj ntsuab, txiv hmab txiv ntoo, wholemeal cereals, khoom noj siv mis nyuj);
- tso tseg tej cwj pwm phem: haus luam yeeb, haus cawv;
- pib tawm dag zog;
- ua routine check-ups.
Txhawm rau tiv thaiv mob qog noj ntshav, tus neeg yuav tsum tau saib xyuas nws txoj kev noj qab haus huv, tsis tu ncua kuaj mob fibrogastroscopy rau kev tiv thaiv. Tsawg kawg yog ob zaug tus neeg mob yuav tsum mus ntsib kws kho mob yog tias nws muaj kev tsis txaus siab txog lub xeev ntawm lub plab zom mov. Tshwj xeeb, kev kuaj xyuas tsis tu ncua yog qhov tseem ceeb rau cov neeg muaj hnub nyoog tshaj 60 xyoo, nrog rau cov neeg uas muaj tus kab mob predisposed ntawm qib caj ces.
Tom qab hnub nyoog 45 xyoos, kws kho mob gastroenterologists qhia cov neeg kom muaj kev tiv thaiv tsis tu ncua (1-2 zaug hauv ib xyoos). Cov qog nqaij hlav plab tuaj yeem pib kis los ntawm cov kab mob me me, uas yuav khaws cov kab mob pathological hauv nws tus kheej. Nws yog ib qho tseem ceeb rau ib tug neeg kom tsis txhob haus cawv thiab haus luam yeeb kom txo tau txoj kev pheej hmoo ntawm kev mob qog noj ntshav.
Lub neej tsis muaj plab, tau kawg, txuas ntxiv mus, tab sis nws yog ib qho tsim nyog yuav tsum ua qee qhov kev txwv thiab kev hloov pauv, hloov koj cov zaub mov. Kwv yees li 1 lab tus tib neeg hauv ntiaj teb raug cuam tshuam los ntawm tus kab mob no. Nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias qhov zoo ntawm lub neej tsis muaj lub plab yuav ncaj qha nyob ntawm theem ntawm cov qog nqaij hlav tshem tawm. Yog li tsis txhob ncua mus ntsib kws kho mob. Qhov tshwm sim ntawm lub neej ib txwm tsis muaj plab yog ntau dua nrog kev mus ntsib kws kho mob raws sijhawm - thaum ntxovKev loj hlob ntawm oncology.
