A yanke shawara wanda dole ne a hankali auna
Idan kana da ciwon hanta mai tsanani, irin su cutar hanta ko hepatitis B ko C kuma yana bukatar tiyata ba tare da alaƙa ga hanta ba, abubuwa zasu iya zama da wahala. Ba'a ɗaukar shawarar da za a ci gaba da tiyata a cikin wannan labari. Dole likitanku suyi la'akari da dalilai da dama lokacin da suka yanke shawara game da hadarinku na haɗari da kuma ko za ku fuskanci matsala mai tsanani ko mutuwa saboda tiyata.
Mafi mahimmanci, a cikin wadanda hawan hanta suka rigaya sunyi sulhu ta hanyar mummunan cuta ko rashin lafiya, cututtuka na iya ƙaddamar da ma'auni don tallafin hanta, ko ciwo da cutar hanta, hasara na hanta, da mutuwa. Saboda haka, dole ne a yi la'akari da tiyata idan kana da cutar hanta.
Abubuwan da aka tantance su a cikin 'yan takara masu haɗari tare da cutar hanta sun haɗa da wadannan:
- acuity, haddasa da tsanani na cutar hanta
- irin tiyata
- gaggawa na tiyata
- irin maganin cutar
- intraoperative saukad da cikin karfin jini
Bari mu dubi abubuwa daban-daban da masu asibiti, likitoci, masu ilimin kimiyya (masu ilimin hanta) da sauran sauran mambobin kungiyar kiwon lafiya suka yi la'akari kafin sanin ko mutumin da ke da ciwon hanta shine dan takara don aikin tiyata.
Nazarin jiki
Yaya dan jariri ya dubi, ko gabatarwar asibiti kafin ta tiyata wani ɓangare ne mai muhimmanci wajen tantance cututtuka na waɗanda ke da cutar hanta.
Yawanci, likita zai nemo alamun da alamun da ke nunawa wadanda ke nuna rashin ciwon daji:
- tashin zuciya
- jaundice
- vomiting
- dare sha
- pruritis (itchiness)
- asarar nauyi
A cikin mutane da ke da cirrhosis , yawancin alamomi masu zuwa suna faruwa na biyu zuwa karfin jini kuma suna nuna rashin talauci kuma suna bada shawarar cewa cirrhosis ya karu.
- karuwa a ciki girth (alamar ascites )
- riba mai karɓa (alamar ascites)
- ƙwaƙwalwar ƙwaƙwalwar ajiya (alamar ƙwararrun rashin lafiya )
- Binciken gubar gastrointestinal kwanan nan (alamar nuna zubar da jini)
- canje-canje a yanayin sake barci
- jaundice (yellowing of eyes, fata, da kuma sauran ƙananan membranes)
Mutane da yawa tare da cirrhosis suna fama da sauye-sauye a cikin yanayin barci. Wadannan canje-canjen sun kasance sun danganta da lakaran ƙwayoyin cuta da rashin lafiya da kuma nakasar melatonin metabolism; Duk da haka, har yanzu ba mu ƙaddara ainihin magungunan waɗannan barci ba.
Girman cutar cututtuka
Mutanen da ke fama da ciwon ciwon hauka ko ciwon halayen cirrhosis, da kuma rashin cin zarafin hanta mai haɗari, bai kamata a shawo kan tiyata ba. Wannan yana da mahimmanci saboda ba ka so mai haƙuri ya kasance mai haɗarin hanta yana aiki a lokacin tiyata. Gaba ɗaya, kasancewar cirrhosis yana tasiri sakamakon sakamako mai wuya. Mafi kyawun 'yan takara don aikin tiyata sun hada da mutanen da ke fama da ciwon hauka da ciwon hauka da kuma rashin aikin hanta.
Dangane da aikin tiyata, cirrhosis da kuma ciwon ciwon ciwon ƙwayar cuta yana da dalilai masu ma'ana don kauce wa tiyata. Idan kana da cutar hanta mai tsanani, ya kamata ka guje wa tiyata idan ya yiwu.
Ana amfani da hanyoyi daban-daban na alamar shaidar shaida guda uku don gano ko mutumin da ke da ciwon hanta ya zama dan takarar kirki don aikin tiyata: Sakamakon Child-Pugh, Model for End-Stage Liver Disease (MELD) da ciwon ƙwayar cuta Firayi mai saurin rai (HVPG).
Na bayanin kula, ana amfani da HVPG ne kawai a manyan wuraren kiwon lafiya na ilimi kuma ba a samuwa a ko'ina. Duk da haka, yana da kyakkyawan kyau a tsinkaye hangen nesa ko sakamako na asibiti.
Gudun Blood Hepatic
Wataƙila abu mafi tsanani da zai iya faruwa a lokacin aikin tiyata a waɗanda ke fama da cutar hanta yana rage yawan jinin oxygenated zuwa hanta. Wannan raguwar jini ya haifar da ischemia da necrosis (mutuwar hanta kodoyin), wanda zai haifar da haɗin ƙin hanta ko rashin cin nasara, da kuma sakin masu ƙwararrun ƙwararrun ƙwayoyin cuta waɗanda zasu iya haifar da gazawar ɓangarorin gauraye.
Yawancin lokaci, arteries yana bada jinin oxygenated zuwa gabobin.
Duk da haka, a cikin hanta, samar da jinin oxygenated yana fitowa ne daga magungunan asibiti da kuma tashar tashar ruwa. A gaskiya ma, tashar tabarbare ta hanyar samar da mafi yawan yawan jini a cikin yawancin mutane.
A lokacin aikin tiyata, karfin jini da kuma ƙwayar zuciya na saukewa. Wadannan saukad da rage ƙudurin jinin oxygenated zuwa hanta. Yawanci, ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa ta rushe ko taɗaɗa don ɗaukar slack da kuma ramawa don rage yawan jinin oxygenated zuwa hanta ta hanyar tashar portal. Duk da haka, a cikin mutanen da ke da cirrhosis, canje-canje a cikin hanta, irin su fibrosis da nodularity, rikici tare da iyawar maganin kutsawa don kwantar da hankali da kuma kara yawan jinin oxygenated zuwa hanta. Bugu da ƙari, ƙwararrun magunguna suna tsangwama tare da dilantakar da ke dauke da maganin kutsawa kamar yadda ya haifar da matsala.
A wasu kalmomi, mutanen da ke da cirrhosis suna da matsala don ragewa don saukad da jinin jini a hanta, wanda ya haifar da tiyata da kuma wanzuwa da kuma canza tsarin hanta. Idan ba tare da isasshen jinin oxygenated ya dace a hanta a lokacin aikin tiyata ba, mutum zai iya samun lalacewar hanta da hasara mai tsanani.
Nau'in tiyata
Kafin mutumin da ke da ciwon hanta yana aiki a kan, yana da mahimmanci a yi la'akari da ko wane irin aikin tiyata zai sa mutumin ya kasance mafi haɗari ga rikitarwa.
A lokacin aikin tiyata (tunanin laparotomy), kowane haɗin kai tsaye tare da halayen hanta zai iya haifar da ciwon haɗari da hanta da hanta. Bugu da ƙari, yin tafiya a kusa da wadannan ƙwayoyin jini na iya kara rage yawan jini a hanta lokacin aikin.
Mutanen da ke fama da ciwon hanta mai tsanani, kamar cirrhosis, waɗanda suke buƙatar tayar da gaggawa saboda mummunar cutar, irin su sepsis ko trauma, suna cikin haɗari na mutuwa bayan an yi aiki.
Yin aikin jijiyoyin jini yana kara matsawa ga hanta kuma ya kara matsalolin. Bugu da ƙari, magunguna (magunguna da aka ba don ƙara yawan karfin jini a lokacin lokacin bazara) da kuma zagaye na intanet na iya kara tsananta cutar hanta.
Kamar yadda aka ambata a baya, magunguna zasu iya rage yawan jini da kuma yaduwar jini zuwa hanta kuma kara taimakawa wajen lalata hanta. Bugu da ƙari, a cikin mutanen da ke fama da cutar hanta, ƙwararru za su iya tsayawa da tsayi kuma baza su hadu ba kamar yadda sauƙi ya haifar da tsawon lokaci.
Kammalawa
Na farko, idan hawan enzymes hanta ne kawai aka dauka amma hanta da halayenka yana sarrafawa, za a iya zama dan takarar kirki na tiyata. Na biyu, idan kana da ciwon hawan hepatitis tare da aikin hanta mai kyau, zaka iya zama dan takarar kirki na tiyata. Na uku, idan kuna da hepatitis na giya kuma sun daina shan shan dan lokaci kuma basu da wata cuta, za ku iya zama dan takara mai kyau.
Don Allah a tuna cewa kawai saboda kuna da cirrhosis ba yana nufin ba za ku iya yin tiyata ba. Duk da haka, bayyanar cirrhosis yana shafar sakamako kuma haka baza'a rabu da shi a lokacin tiyata (tunani jaundice, ascites, gastrointestinal, ko variceal, zub da jini da sauransu).
Idan kana da ciwo mai tsanani ko haɗarin cirrhosis, to yana iya zama mummunan ra'ayi. Zai fi kyau muyi tunanin hanta a cikin mutanen da ke fama da cutar hanta mai tsanani irin su hepatitis ko cirrhosis a matsayin mai haɗari mai barci. Bisa ga mahimmanci, likitocin likita suna aiki a kusa da babban mai barci, da kuma ƙuƙwalwa ko kuma hana hanta aiki na biyu zuwa cirrhosis da yawa suka sa wannan mai barci mai barci bai daɗe.
Sakamakon tiyata a cikin wadanda ke da cutar hanta zai iya zama mummunar tsanani. Wasu mutane suna fama da rashin hanta kuma suna mutuwa bayan irin wannan tiyata. Saboda haka, shawarar da kuke yi na yin aikin tiyata a cikin mutanen da ke dauke da ciwon hanta yana kula da su a hankali. Bugu da ƙari kuma, a matsayin mai haƙuri, dole ne ka bayar da izinin sanarwar, ko kuma yarda da hanyar.
Ya kamata a umarce ku don ba da izinin bayanan bayan likitanku da ma'aikatan kiwon lafiyar sun bayyana cikakkun hadarin, wadata, da kuma sakamakon sakamakon. Ka tuna cewa yin aikin tiyata shi ne yanke shawara da kake yi.
Sources
Bacon BR. Cirrhosis da ƙwayoyinsa. A: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Ka'idodin Magungunan Ciki na Harrison, 19th . New York, NY: McGraw-Hill; 2015.
Masu gyara. Ayyukan Medicine. A: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Ka'idodin Magungunan Ciki na Harrison, 19th . New York, NY: McGraw-Hill; 2015.
Montagnese S, De Pitta C, De Rui M, et al. Abun Mawuyacin Wuta a marasa lafiya tare da Cirrhosis. Hepatology . 2014; 59 (2): 705-712.
Qamar AA, Nasara ND. Babi na 53. Amincewa da Takaddama na Ciwon Huta. A cikin: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS. eds. Ka'idoji da Ayyukan Magunguna . New York, NY: McGraw-Hill; 2012.