Ese wigeze wumva umutsi w'amaraso munini kandi w'ingenzi mu mubiri wawe? Tuwita aorta . Tekereza nk'umuyoboro w'amazi munini utwara amaraso mu mubiri wawe. Ariko rimwe na rimwe, urukuta rw'uyu muyoboro w'amaraso ruracika intege maze rugatangira kubyimba nk'umupira w'amapine. Mu buvuzi, tuwita aneurysm . Ni nk'umuyoboro w'amazi ushaje ubyimba. Iyo uyu mupira uturitse, ushobora guteza akaga ku buzima bwawe. Ariko ntugahangayike, bitewe n'iterambere ry'ubumenyi bw'ubuvuzi, ubu hari uburyo bwiza cyane bwo kuvura bene ibyo bibazo. Uyu munsi, turimo kuvuga ku buryo bwihariye bwo kuvura bukorwa hatabayeho kubagwa cyane.
TEVAR ni iki mu by'ukuri?
Muri make, TEVAR (Thoracic Endovascular Aortic Repair) ni uburyo bugezweho, bukoreshwa mu gusana ibyangiritse ku muyoboro w'amaraso wo mu gituza, cyane cyane imitsi y'amaraso.
Mu bihe byashize, iyi ndwara yavurwaga hakoreshejwe uburyo bunini kandi bufunguye busaba gufungura igituza. Biragoye cyane, bifata igihe kirekire kugira ngo bikire, kandi bifite ibyago byinshi. Ariko ubu, ku barwayi bujuje ibisabwa, abaganga barimo guhitamo ubu buryo bwa TEVAR. Bugira igihe gito cyo gukira, ingaruka nke zo kugira ibibazo bikomeye, kandi burushaho kuryoherwa n'umurwayi. Muganga wawe azagena niba ubu buryo bugukwiriye ashingiye ku bintu nk'imiterere y'imitsi y'amaraso yawe.
TEVAR si ukubaga umutima ufunguye. Bikorerwa imbere, binyuze mu muyoboro muto unyuze mu miyoboro y'amaraso. Ni nko gusana umuyoboro w'amaraso ushyiramo agace gashya imbere.
Ni ibihe bibazo ubuvuzi bwa TEVAR bukoreshwa?
Abaganga babaga bakoresha cyane cyane ubu buryo bwa TEVAR ku bwoko butandukanye bw'ibyangiritse ku muyoboro w'amaraso.
| Indwara | Ibisobanuro byoroshye |
|---|---|
| Aneurysm y'imitsi yo mu gituza | Urukuta rw'umuyoboro w'amaraso, aho unyura mu gituza, rucika intege kandi rukabyimba nk'umupira w'amapine. Iki ni cyo gikunze gukoreshwa cyane aho TEVAR. |
| Gucamo ibice by'imitsi yo mu bwonko (Aortic Dissection) | Amaraso asohoka hagati y’urukuta rw’imbere rw’umuyoboro w’amaraso, bigatuma urukuta rucikamo ibice birebire. Iki ni ikibazo cyihutirwa cyane kandi giteje akaga. |
| Gufata umuyoboro w'amaraso mu bwonko (Aortic Transection) | Gucika cyangwa gucika kw'umuyoboro w'amaraso bitewe n'ibyago bikomeye byatewe n'impanuka ikomeye, nk'impanuka y'imodoka. |
Ni gute nakwitegura mbere y'uku kubagwa?
Muganga wawe azagusobanurira ibi mu buryo burambuye . Ubusanzwe ugomba kuba witeguye ibintu nk'ibi:
- Imiti ikoreshwa: Niba ufata imiti ivura umuvuduko ukabije w'amaraso cyangwa cholesterol, ugomba kuyikoresha neza nk'uko byavuzwe.
- Irinde kunywa itabi: Niba unywa itabi, ugomba kubireka burundu mbere yo kubagwa.
- Indi miti: Bwira muganga wawe indi miti yose urimo gufata (urugero: imiti igabanya amaraso). Ishobora gukenera guhagarikwa by'agateganyo cyangwa guhindurwa, bibaye ngombwa, nk'uko abyifuza.
- Ibizamini mbere yo kubagwa: Hazakenerwa gukorwa ibizamini byinshi mbere yo kubagwa.
Ibizamini mbere yo kubagwa
Kimwe mu bizamini by'ingenzi ni CT angiogram . Ibi bishobora gutanga ishusho isobanutse neza kandi y'ibice bitatu y'ingano, aho iherereye, n'ubuzima bw'imitsi yawe n'indi mitsi ihuzwa nayo. Kugira ngo ubuvuzi bwa TEVAR bugire icyo bugeraho, hagomba kuba hari umwanya uhagije mu mitsi yawe y'amaraso kugira ngo umuyoboro muto (catheter) ukoreshwa mu kuvura ugere muri aorta.
Abaganga bakunze gushyira uyu muyoboro mu muyoboro w’amaraso unyura mu mutsi w’amaraso wo mu kibuno, unyura mu kibuno cy’ukuguru. Ariko iyo uwo mutsi w’amaraso wagabanutse cyangwa ufunze kubera ko cholesterol yashyizwe mu mubiri (plaque), bagomba gushaka indi nzira. Gupima CT scan ni ngombwa kugira ngo ibi byose bigerweho.
Ibi bizamini bigufasha kandi guhitamo ingano ikwiye n'ubwoko bw'icyuma gifata stent ku gice cyangiritse cy'umutima wawe.
Uburyo ubuvuzi bwa TEVAR bukorwa
Mu gihe cyo gukora ubu buvuzi, itsinda rishinzwe kubaga rikurikiza izi ntambwe:
1. Anesthesia: Uzahabwa anesthesia rusange cyangwa anesthesia yo mu gace hamwe n'umuti ugabanya ububabare kugira ngo umenye neza ko utababara kandi ko umerewe neza mu gihe cyose cyo kubagwa.
2. Uburinzi ku mugongo:Mu bihe bimwe na bimwe (si buri wese), umuyoboro muto (umuyoboro wo mu bwonko) ukuramo amazi make yo mu bwonko mu ruti rw'umugongo ushobora gukoreshwa mu gukumira kwangirika kw'amaraso anyura mu ruti rw'umugongo mu gihe cyo kubagwa.
3. Gukata gato: Gukata gato cyane bikorwa ku ruhu mu gice cyo mu nda cy'ukuguru, hafi y'imitsi yo mu gitsina.
4. Gushyiramo umuyoboro: Binyuze muri uku gukata, umuyoboro muto (umuyoboro w’ubuyobozi) unyura mu miyoboro y’amaraso kugeza igihe unyuze mu gice cyangiritse cya aorta. Hanyuma, umuyoboro muto witwa catheter ufite stent graft imbere ushyirwa hejuru y’uyu muyoboro. Ibi byose bikorwa hifashishijwe uburyo bwihariye bwa X-ray ( fluoroscopy ).
5. Gushyiramo stent: Catheter iyoborwa aho byangiritse neza hanyuma stent graft imbere ikarekurwa. Irafunguka nk'isoko ifata neza ku nkuta za aorta.
6. Imikorere: Iyi stent graft ubu ikora nk'urusobe rushya rw'imiyoboro y'amaraso (aorta). Mu gihe cy'indwara y'amaraso (aneurysm), amaraso atembera muri uru rusobe rushya. Ibi bigabanya umuvuduko ku rukuta rw'amaraso rwacitse intege. Ibi birubuza gukura no guturika.
7. Kurangiza kubagwa: Nyuma yo gushyiramo stent, catheter irakurwaho, agace gato gakozwe mu kibuno gafungwa hakoreshejwe imidomo hanyuma hagashyirwamo igitambaro.
Ubusanzwe, iki gikorwa cyose kimara amasaha abiri.
Ni izihe nyungu zo kuvura TEVAR?
Izi nizo mpamvu abaganga bakunda uburyo bwa TEVAR kuruta kubagwa ku mugaragaro.
- Igihe cyo gukira no kumara mu bitaro ni gito cyane.
- Kubera ko nta gukata gukomeye gukorerwa kugira ngo ibere rikureho, ububabare buragabanuka.
- Kuva amaraso mu gihe cyo kubagwa biragabanuka.
- Bifite ingaruka nziza nk'izo kubagwa ku mugaragaro.
- Ingaruka zo kugira ibibazo bikomeye cyangwa urupfu ni nke (hafi 98% by'abarokotse TEVAR, ugereranije na 88%-94% mu gihe cyo kubagwa ku mugaragaro).
- Kwangirika guturuka ku kugabanuka kw'amaraso ajya ku zindi ngingo (ischemia y'ingingo z'umubiri) ni bike cyane.
Ese hari ingaruka zishobora guterwa n'ubu buvuzi?
Nkuko bigenda mu kubagwa kose, hari ingaruka zimwe na zimwe zibaho, ariko ni gake cyane.
- Endoleak: Amaraso aracyava hirya no hino ku gice cy'umuyoboro w'amaraso (stent graft) yinjira mu gice cy'amaraso (aneurysm).
- Kwandura: Kwandura aho bakorewe ubuvuzi.
- Guhindura imiterere y'umuyoboro: Istent yashyizwemo igenda buhoro uvuye aho yari iri mbere.
- Paraplegiya: Ni gake cyane, amaguru ntakore neza bitewe no kugabanuka kw'amaraso ajya mu ruti rw'umugongo.
- Indwara y'umutima cyangwa indwara yo gucika kw'imitsi.
Vugana na muganga wawe ku byerekeye izi ngaruka n'ingamba ushobora gufata kugira ngo uzigabanye.
Gukira no gukurikirana
Nyuma yo kubagwa, uzaguma mu cyumba cy’indembe (ICU) umunsi umwe cyangwa ibiri. Nyuma y’ibyo, uzajya wimurirwa mu cyumba gisanzwe kandi uzabashe gutaha mu munsi umwe cyangwa icyumweru. Nutaha, kora ibi bikurikira:
- Ntugatware imodoka mu gihe cy'icyumweru kimwe cyangwa bibiri.
- Ntukajye mu mwobo w'amazi kugeza igihe agace k'ikibuno kamaze gukira (nta kibazo cyo kwiyuhagira).
- Ntugaterure ibiro birenga 5 mu gihe cy'icyumweru 1-2.
Ikintu cy'ingenzi ni ugukurikirana . Iki ni ikintu kigomba gukorwa ubuzima bwose. Nk'uko muganga abivuga, ugomba gupimwa nka CT scan nyuma yo kubagwa, ukwezi kumwe, amezi atandatu, umwaka, na buri mwaka nyuma y'ibyo, kugira ngo urebe niba stent ikiri mu mwanya wayo kandi niba hari ibindi bibazo.
Niba ugaragaje ibimenyetso by'indwara y'umutima (urugero: kubabara cyane mu gituza) cyangwa gucika intege mu bwonko (urugero: kunama k'uruhande rumwe rw'isura, kugorwa no kuvuga), jya ku bitaro bikuru byita ku butabazi bw'ibanze (ETU) by'ibitaro biri hafi yawe vuba.
Ubutumwa bwo kujyana mu rugo
- TEVAR ni uburyo bugezweho bwo kuvura indwara zikomeye nka aortic aneurysms, bukorwa hakoreshejwe akato gato nta gufungura igituza.
- Ubu ni uburyo bwiza cyane bwo kuvura bufite ingaruka nke ugereranyije no kubagwa ku mugaragaro, gukira vuba, no gukira vuba.
- Muganga wawe ni we uzasuzuma niba ubu buryo bw'ubuvuzi bukubereye nyuma yo gupimwa.
- Ni itegeko gukurikirana ibizamini nk'uko muganga yabigutegetse ubuzima bwawe bwose nyuma yo kubagwa.
- Niba ufite impungenge ku bijyanye n'ubuvuzi bwawe cyangwa inzira yo gukira, nyamuneka vugana na muganga wawe nta gushidikanya.
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