I-Peroral Endoscopic Myotomy (POEM) ye-Achalasia Cardia

INKONDLO, noma i-peroral endoscopic myotomy, ihlasela kancane i-endoscopic inqubo esetshenziselwa ukwelapha isimo esaziwa ngokuthi achalasia cardia. I-Achalasia cardia igama lezokwelapha elibhekisela ekungajwayelekile kommizo lapho kuba nzima khona kumuntu ophethwe yikho ukuthi agwinye noma yiluphi uhlobo lokudla. Inqubo ye-POEM ingasiza futhi ekwelapheni ezinye iziyaluyalu ezihlobene nenqubo yokugwinya.

I-POEM iyinqubo ehlasela kancane ephakamisa ukuthi akukho zimbobo ezenziwa esikhumbeni futhi ngokuvamile ibangela ubuhlungu obuncane, kanye nokunikeza ithuba lokuhlala isikhashana esibhedlela nokululama ngokushesha kunezinye izinqubo zokuhlinzwa ezihlaselayo. INKONDLO iyinqubo yenoveli eye yavela njengendlela ehlukile kancane kwezinye izindlela zokwelapha i-achalasia cardia.

Iyini i-Achalasia Cardia?

I-Achalasia cardia yisifo sokugwinya okwenzeka ngenxa ye-esophagus. Abantu abanalesi simo babhekana nezinkinga zokugwinya (dysphagia) ngenxa yokwehluleka ukuxega kwe-esophagal sphincter engezansi.

I-esophagal sphincter engezansi, etholakala ekugcineni kwe-esophagus lapho kuhlangana khona isisu, ilawula ukudlula kokudla kuya esiswini. Abantu abane-achalasia cardia abakwazi ukugwinya i-bolus; kunalokho, ihlala ngaphakathi komminzo futhi yehla kancane iye esiswini. Lesi simo singase sibangele izimpawu zobuhlungu besifuba kanye nokuhlanza ukudla okungagayekile. Kungase kuholele naku kwesisindo ekugcineni. 

Imithi yokwelapha i-achalasia cardia okuhloswe ngayo ukuhlinzeka impumuzo ekuguleni kungase kusize ukukhulula imisipha ephansi ye-esophagal sphincter ukuze ivumele ukudlula kalula kwe-bolus nokudla okungagayeki kungene esiswini ngaphandle kokuvinjwa okuningi. Phakathi kwezinkulungwane zemithi yokwelapha etholakalayo ye-achalasia cardia, ukunwetshwa kwe-pneumatic kuyinto evelele ehilela ukufakwa kanye nokwenyuka kwamandla emali kwebhaluni elivula indlela yokungena isisu. Kungenjalo, umjovo we-Botox nokuphathwa kwemithi kungase futhi kuvumele ukuxegiswa kwe-esophagal sphincter engezansi, kodwa konke lokhu kunikeza isisombululo sesikhashana kuphela. 

I-Heller myotomy, lapho i-POEM iyindlela ehlukile ye-endoscopic, inikeza imiphumela ehlala isikhathi eside kodwa idinga ukuhlinzwa okuvulekile. 

Yiziphi Izinkomba ZeNKONDLO?

Inqubo ye-POEM ingase isetshenziswe ikakhulukazi ekwelapheni i-achalasia cardia ekugcineni okuphansi komminzo. Ukwengeza, abantu abahlangabezana nobunzima obukhulu ngesikhathi sokugwinya, okuholela ekuwohlokeni kwezinga lempilo yomuntu, kufanele bakhethe INKONDLO.

Ubani Ozongenela INKONZO?

Nakuba inqubo ye-POEM ingase iphakanyiswe ikakhulukazi ekwelapheni i-achalasia cardia, ingasiza futhi ukubhekana nezinye izimo ezihambisanayo ze-dysphagia noma i-muscle spasms ku-esophagus ezigulini zabo bonke ubudala. Izimo ezinjalo zingabandakanya:

• I-Distal Oesophageal spasm (DES)
• I-Jackhammer Oesophagus, eyaziwa nangokuthi i-Hypercontractile Esophagus
• I-Nutcracker Oesophagus, eyaziwa nangokuthi i-Hypertensive Oesophageal Peristalsis
• Ukuvinjwa kokuphuma kwe-Esophagogastric (EG)

Ngaphandle kwalezi zimo, i-POEM ingase iphakanyiswe ezigulini eziye zathola ukwelashwa okuhlukile kwe-achalasia cardia, njengemijovo ye-Botox, i-Heller myotomy, noma i-balloon dilation. 

Nakuba inqubo ye-POEM ibhekwa njengephephile, ingase ingafaneleki ezigulini ezinezimo ezithile zempilo noma izinkinga, kuhlanganise nalezo ezine:

• Isifo sesibindi esibi
• Ukuphazamiseka kokujiya kwegazi
• I-esophagitis enzima
• Isifo esibi kakhulu se-bullous lung

Iziguli ezinezicubu ezilimele emphinjeni ngenxa yokuhlinzwa kwangaphambilini nazo zingase zelulekwe ukuba ziyigweme le nqubo. 

Kwenzekani Ngaphambi Kwenqubo YeNKONDLO?

Isiguli esithathwa njengesifanele inqubo ye-POEM kungase kudingeke ukuthi silandele imiyalelo ethile kadokotela waso owelaphayo. Isiguli esinjalo singadinga ukulandela ukudla okuqinile okuwuketshezi okwesikhathi esinconyiwe, kanye nosuku lokuzila ukudla ngaphambi kwenqubo.

Imithi ethile noma izithasiselo ezithathwa iziguli zingase zibe nomthelela ophikisayo enqubweni. Noma yimuphi umuthi noma isithasiselo esiphuzwa iziguli kufanele zaziswe kudokotela noma kudokotela wezifo zamathumbu, futhi kungase kudingeke ukuthi bawuphuze onomthamo oshintshiwe noma bayeke ukuwusebenzisa isikhathi esingaphambi kwenqubo. 

Ngaphezu kwalokho, iziguli zingase zilindele ukuhlolwa ngokomzimba kanye nokuhlolwa okuphelele kwesimo sabo sempilo yonke ngaphambi kwenqubo ukuze kuqinisekiswe impumelelo ephelele yenqubo. 

Kwenzekani Ngesikhathi Senqubo YeNKONDLO?

Inqubo ye-POEM ingenziwa ngaphansi kwe-anesthesia ejwayelekile ngemva kokuhlolwa okuphelele kwesiguli. Njengoba kuyinqubo engenelela kancane, akukho zimbobo ezenziwa esikhumbeni. Kunalokho, i-endoscope ekhethekile (ishubhu eliguquguqukayo elinekhamera) idlula emlonyeni futhi inwetshwe kuze kube sekupheleni komgudu. I-endoscope ivumela ukubonwa kwezakhiwo zangaphakathi ukuze odokotela abahlinzayo basebenze ngaphandle komthungo. 

Ngosizo lwe-endoscope, udokotela ohlinzayo angadlulisa ummese ukuze ahlinze ongqimbeni lwangaphakathi lomminzo ukuze akhe umhubhe. Ngaphezu kwalokho, izingqimba zemisipha ezixhumene eziseceleni kommizo, kanye nomminzo ongezansi nengxenye engenhla yesisu, zikhishwa ngokuhlinzwa kulandela inqubo ye-myotomy. 

Ngemuva kokususwa kwezingqimba ezidingekayo zemisipha kanye nokwakhiwa komhubhe ongaphansi kwe-submucosal, ukusika okuphezulu kuyanqanyulwa. Le nqubo izovumela ukudlula okuvamile kokudla kwehle ngomminzo kuye esiswini futhi kukhulule ukuqina. 

Kwenzekani Ngemva Kwenqubo YeNKONDLO?

Ngemva kokuba inqubo yenziwe ngempumelelo, iziguli zihlale ziqashwe njalo futhi zihlolwe impilo ukuze zinakekeleke ngemva kokuhlinzwa. Ngesikhathi sokuhlala esibhedlela, ukuhlolwa kwezingozi nokululama esigulini kungenziwa ngokuhlolwa kwezithombe. Ukuhlolwa kwe-X-ray ye-barium kungase kunikeze imininingwane emhubheni womminzo futhi kuqinisekise ukugeleza kokudla okungavinjelwe ukuya esiswini.

Ukuthola kabusha ngemva kweNKONDLO

Ngemva kokukhishwa esibhedlela, iziguli kudingeka ziphuze kunemithi noma amaphilisi njengoba belulekwa. Kungase kudingeke ukuthi bavakashele esibhedlela ukuze bahlolwe ukuze baqinisekise impumelelo yenqubo kanye nokwelapha i-dysphagia. 

Ezinye iziguli zingase zidinge imithi yokubhekana nezimpawu zobuhlungu ngesikhathi sokululama, nakuba ezimweni eziningi, kungase kube khona ubuhlungu ngemva kosuku noma ezimbili. Izinguquko zokudla zingatuswa udokotela. Ekuqaleni, iziguli kungase kudingeke ukuba zilandele ukudla okunokudla okuthambile futhi ziqhubekele ekudleni okuvamile njengoba kuthathwa njengokufaneleka ngemva kokuhlolwa phakathi nokuvakashela udokotela njalo. Kungenzeka ukuzwa ubuhlungu emphinjeni izinsuku ezimbalwa noma amasonto kulandela inqubo. 

Iziguli zingase zikwazi ukubuyela emsebenzini phakathi nosuku olulodwa noma ezimbili ngemva kokukhishwa esibhedlela kodwa zingase zivinjelwe ukuphakamisa izinsimbi. 

Izingozi Nezinkinga Ezihlotshaniswa NeNKONDLO

Nakuba inqubo ye-POEM iyinqubo ehlasela kancane evame ukubhekwa njengephephile, kunezinkinga ezithile ezihlobene nale nqubo. Nakuba izinkinga ezinjalo kanye nezingozi zangemva kokuhlinzwa zingavamile, kusenethuba elincane lokwenzeka. Izinkinga kanye nobungozi obuhambisana nenqubo ye-POEM kungase kuhlanganise okulandelayo:

• Izinyembezi kulwelwesi lwe-mucosal lomphimbo 
• Ukutheleleka 
• Ukopha ngenxa yokulimala komminzo 
• Ukuvuvukala komminzo 
• Iphaphu eligoqekile noma i-pneumothorax 
• I-Pneumomediastinum (isimo lapho umoya ukhona ku-mediastinum, isikhala phakathi kwamaphaphu)

Inkinga eyengeziwe engase iqhamuke nenqubo yangemva kwe-POEM isifo se-reflux yamathumbu noma i-GERD, lapho kunokumelana okuncane kakhulu ne-asidi yesisu egeleza ikhuphuke ngomminzo. Nokho, le nkinga ingase ilawulwe ngempumelelo ngosizo lwemithi eqondiswe ukuvimbela i-GERD. 

Imibuzo Evame Ukubuzwa

1. Ingabe inqubo ye-POEM iphephile?

I-POEM iyinqubo ephephile nephumelelayo enikeza imiphumela engcono yesikhathi eside kunezinye eziningi zokwelapha i-achalasia cardia noma ezinye izimo eziholela ku-dysphagia. Izinkinga zingenzeka kodwa azivamile futhi zingaphathwa nge-endoscopically. 

2. Ingabe inqubo ye-POEM ibuhlungu?

Iziguli cishe azinakuzwa ubuhlungu ngesikhathi senqubo njengoba ingenziwa ngaphansi kwe-anesthesia ejwayelekile. Kungase kube nokungakhululeki noma ubuhlungu ngemva kokuhlinzwa noma ngenkathi ugwinya ezinsukwini ezimbalwa zokuqala, kodwa iziguli eziningi zilulama ngokushesha. 

3. Kuthatha isikhathi esingakanani ukwenza inqubo ye-POEM?

Kungase kuthathe cishe amahora angu-2-3 ukuqedela inqubo ye-POEM, okuhlanganisa ukunikeza izinzwa ezijwayelekile ngaphambi kokuhlinzwa kanye ne-myotomy.