Qida borusu xərcəngi əməliyyatı

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Op. Dr. Kamran Beydullayev, MRCS İngiltərə, Ümumi cərrah, Cərrah Transplantoloq, əlaqə 0504063853

Dr. Kamran Bbeydullayev
Op. Dr. Kamran Beydullayev

Qida borusu xərcəngi Azərbaycan ərazisində çox rast gəlinən şişlərdən hesab edilir. Ona görə də bu xəstəliyin müalicəsi aktual hesab edilir. Əməliyyat qida borusu şişlərində yeganə radikal müalicə hesab edilə bilər. Qida borusunun şiş ilə kəsilib çıxarılması və mədənin döş qəfəsinə qaldırılaraq qida borusu ilə anastomoz qoyulması əməliyyatın əsas prinsipidir.

Qida borusu əməliyyatının həm döş qəfəsində olan, həm də qarında olan kəsiklə icra edilməsini ilk dəfə  1946 cı ildə İngiltərə Kral Cərrahlar Kollecində İvor Levis tərəfindən təklif edilmişdir. O zamanlar bu əməliyyat iki mərhələdə aparılırdı. Birinci qarın boşluğu açılırdı, mədə mobilizasiya edilirdi. İkinci mərhələ isə 15 gün sonra aparılırdı və döş boşluğu açılaraq qida borusu çıxarılırdı və anastomoz qoyulurdu. Sonralar bu əməliyyat bir etapda aparılmağa başlandı və hal hazırda qida borusu şişinə görə icra edilən ən populyar əməliyyatdır.

Qida borusu əməliyyatı
Qida borusu əməliyyatı cərrahiyyənin çətin əməliyyatlarından hesab edilsə də komanda güclü olduqda bu söhbət mövzusu deyil

İvor Leus əməliyyatı adətən qida borusunun aşağı hissəsində və mədə qida borusu birləşməsində yaranan bədxassəli şişlər üçün daha uyğundur. Karina səviyyəsindən yuxarıda yerləşən şişlər üçün isə adətən Mc Keovn əməliyyatı təklif edilir.

Mədənin döş qəfəsinə qaldırılması zamanı mədəni qidalandıracaq sağ qastroepiploik arteriya

İvor Levis əməliyyatının üstünlüyü ondan ibarətdir ki, bu əməliyyat zamanı qida borusunu bütün əməliyyat sahəsi boyu sərbəst görə bilirsən, iki sahədə ( döş qəfəsi və qarın boşluğu) limfadisseksiya etmək mümkündür, anastomoz qaçağı daha az ehtimallıdır və qayıdan qırtlaq siniri zədələnməsi daha az rast gəlinir. Çatışmayan cəhəti döş qəfəsindəki yaranın kəskin ağrılı olması, ağciyər tərəfdən ağırlaşmaların yaranması ehtimalı, anastomoz qaçağı zamanı yüksək toksikliyin olmasıdır.

Qarın boşluğundakı əməliyyat zamanı piloroplastika

İvor Levis əməliyyatının ümumi prinsipləri eyni olsa də bəzi xüsusiyyətləri cərrahdan cərraha dəyişir. Məsələn mədənin 12 barmaq bağırsağa drenajını yüngülləşdirmək üçün aparılan əməliyyatlar piloroplastika, pilorusun miotomiyası, botulin toksininin vurulması ola bilər, və yaxud pilorusun drenajı üçün heç bir əməliyyat aparılmaya bilər. Eləcə də qidalandırıcı yeyunostomiyanın qoyulması bəzi cərrahlar üçün rutin icra edilir, digərləri isə yalnız ehtiyac olduqda icra edirlər. Anastomozun qoyulması da bəzi cərrahlar tərəfindən əl ilə, digərləri tərəfindən isə sirkulyar stapler ilə aparılır. Biz adətən ehtiyac olmadıqca yeyunostomiya qoymuruq və drenaj üçün piloroplastika icra edirik. Anastomoz isə sirkulyar stapler ilə qoyulur.

D2 limfodisseksiya
D2 səviyyədə limfa düyünlərinin disseksiyası

Əməliyyatdan sonra isə bu xəstələrdə diqqət yetiriləsi əsas məqamlar ağciyər ağırlaşmalarının qarşısını almaq, ağrıları kontrol etmək, xəstənin qidalanmasına nəzarət etməkdir.

Bunlar da maraqlı ola bilər.

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