Ngaba ukhe weva ngemithambo yegazi emikhulu neyona ibalulekileyo emzimbeni wakho? Siyibiza ngokuba yi-aorta . Cinga ngayo njengombhobho wamanzi ophambili othwala igazi emzimbeni wakho wonke. Kodwa ngamanye amaxesha, udonga lwale aorta luyabuthathaka luze luqale ukudumba njengebhaluni. Kwizonyango, oku sikubiza ngokuba yi-aneurysm . Kufana nombhobho wamanzi omdala odumbayo. Ukuba le bhaluni iyadumba, inokuba yingozi kakhulu ebomini bakho. Kodwa ungakhathazeki, ngokuhambela phambili kwesayensi yezonyango, ngoku kukho unyango olusebenzayo kakhulu kwiimeko ezinjalo. Namhlanje, sithetha ngendlela ekhethekileyo yonyango eyenziwa ngaphandle kotyando olukhulu.
Yintoni kanye kanye iTEVAR?
Ngamafutshane, i-TEVAR (Thoracic Endovascular Aortic Repair) lunyango lwanamhlanje, olungenabungozi kangako olusetyenziselwa ukulungisa umonakalo kwi-thoracic aorta, ngakumbi ii-aneurysms.
Ngaphambili, le meko yayinyangwa ngotyando olukhulu noluvulekileyo olubandakanya ukuvula isifuba. Inzima kakhulu, ithatha ixesha elide ukuphiliswa, kwaye ineengozi eziphezulu. Kodwa ngoku, kwizigulane ezifanelekileyo, oogqirha baya bekhetha ngakumbi le nkqubo ye-TEVAR. Inexesha elifutshane lokuchacha, umngcipheko omncinci weengxaki ezinkulu, kwaye ikhululekile ngakumbi kwisigulana. Ugqirha wakho uya kugqiba ukuba olu nyango lukulungele na ngokusekelwe kwizinto ezifana nokwakheka kwemithambo yegazi yakho.
I-TEVAR ayilotyando lwentliziyo evulekileyo. Yenziwa ngaphakathi, ngetyhubhu encinci edlula kwimithambo yegazi. Kufana nokulungisa imithambo yegazi ngokufaka ingaphakathi elitsha ngaphakathi.
Ziziphi iimeko ezisetyenziselwa unyango lwe-TEVAR?
Oogqirha basebenzisa kakhulu le ndlela yeTEVAR kwiintlobo ezahlukeneyo zomonakalo kwi-aorta.
| Isigulo | Ingcaciso elula |
|---|---|
| I-Aneurysm ye-Thoracic Aortic | Udonga lwe-aorta, apho ludlula khona esifubeni, luba buthathaka luze luvuthuluke njengebhaluni. Le yeyona meko ixhaphakileyo apho kusetyenziswa i-TEVAR. |
| Ukuqhaqha kwe-Aortic | Igazi liyavuza phakathi kweengqimba zodonga lwangaphakathi lwe-aorta, nto leyo ebangela ukuba udonga lukrazuke ngobude. Le yimeko engxamisekileyo neyingozi kakhulu. |
| Utyando lwe-Aortic | Ukukrazuka okanye ukuqhekeka kwe-aorta ngenxa yokwenzakala okukhulu esifubeni ngenxa yengozi enkulu, njengengozi yemoto. |
Ndingazilungiselela njani ngaphambi kolu tyando?
Ugqirha wakho uza kukuchazela oku ngokweenkcukacha . Ngokuqhelekileyo kufuneka ulungele izinto ezifana nezi:
- Ukusetyenziswa kwamayeza: Ukuba usela amayeza oxinzelelo lwegazi oluphezulu okanye i-cholesterol, kufuneka uwasebenzise kanye njengoko kuyalelwe.
- Kuphephe ukutshaya: Ukuba uyatshaya, kuya kufuneka uyeke ngokupheleleyo ngaphambi kotyando.
- Amanye amayeza: Xelela ugqirha wakho ngamanye amayeza owasebenzisayo ngoku (umz., amayeza okunciphisa igazi). Kusenokufuneka amiswe okwethutyana okanye atshintshwe, ukuba kuyimfuneko, ngokweengcebiso zakhe.
- Uvavanyo lwangaphambi kotyando: Kuya kufuneka kwenziwe uvavanyo oluninzi ngaphambi kotyando.
Uvavanyo lwangaphambi kotyando
Olunye lovavanyo olubaluleke kakhulu yi -CT angiogram . Oku kunokuvelisa umfanekiso ocacileyo, onemilinganiselo emithathu ngobukhulu, indawo, kunye nempilo ye-aorta yakho kunye neminye imithambo yegazi edibana nayo. Ukuze utyando lwe-TEVAR luphumelele, kufuneka kubekho indawo eyaneleyo kwimithambo yegazi yakho ukuvumela ityhubhu encinci (i-catheter) esetyenziselwa unyango ukuba inyuselwe kwi-aorta.
Oogqirha badla ngokufaka le tube nge -femoral artery, ehamba nge-groin yomlenze. Kodwa ukuba loo mthambo wegazi unciphile okanye uvalwe yi-cholesterol deposits (i-plaque), kufuneka bafumane enye indlela. I-CT scan ibalulekile ukuze kucwangciswe konke oku.
Olu vavanyo lukwakunceda ukhethe ubungakanani obufanelekileyo kunye nohlobo lwe -stent graft kwinxalenye eyonakeleyo ye-aorta yakho.
Indlela utyando lwe-TEVAR olwenziwa ngayo
Xa besenza olu nyango, iqela lotyando lilandela la manyathelo:
1. I-Anesthesia: Uza kunikwa i-anesthesia eqhelekileyo okanye i-anesthesia yendawo kunye ne-sedation ukuqinisekisa ukuba awuva ntlungu kwaye ukhululekile kulo lonke utyando.
2. Ukhuseleko lomqolo:Kwezinye iimeko (hayi wonke umntu), umbhobho omncinci (umsele we-lumbar) osusa inani elincinci lolwelo lwe-cerebrospinal kwi-spinal cord unokusetyenziswa ukuthintela umonakalo obangelwa kukuncipha kokuhamba kwegazi ukuya kwi-spinal cord ngexesha lotyando.
3. Ukusikwa okuncinci: Kusikwa okuncinci kakhulu eluswini kwindawo yemiphunga yomlenze, kufutshane nomthambo we-femoral.
4. Ukufakwa kwetyhubhu: Ngale ntambo, intambo encinci (intambo ekhokelayo) idluliselwa emthanjeni wegazi ide idlule kwindawo eyonakeleyo ye-aorta. Emva koko, ityhubhu encinci ebizwa ngokuba yi-catheter ene-stent graft ngaphakathi ifakwa phezu kwale ntambo. Konke oku kwenziwa phantsi kwesikhokelo sendlela ekhethekileyo efana ne-X-ray ( i-fluoroscopy ).
5. Ukubekwa kwe-Stent: I-catheter ikhokelwa kwindawo echanekileyo yomonakalo kwaye i-stent graft engaphakathi iyakhululwa. Ivuleka njengentwasahlobo kwaye inamathele ngokuqinileyo eludongeni lwe-aorta.
6. Umsebenzi: Le stent graft ngoku isebenza njengolwelo olutsha lwe-aorta. Kwimeko ye-aneurysm, igazi lihamba ngolwelo olutsha. Oku kususa uxinzelelo eludongeni olubuthathaka egazini. Oku kuyayithintela ekubeni ikhule kwaye iqhume.
7. Ukugqitywa kotyando: Emva kokuba i-stent ifakiwe, i-catheter iyasuswa, i-incision encinci eyenziwe kwi-groin ivalwe nge-stitches kwaye kufakwa i-bandage.
Ngokwesiqhelo, yonke le nkqubo ithatha malunga neeyure ezimbini.
Zithini iingenelo zonyango lwe-TEVAR?
Ezi zezona zizathu zokuba oogqirha bakhethe indlela yeTEVAR kunotyando oluvulekileyo.
- Ixesha lokuchacha kunye nokuhlala esibhedlele lifutshane kakhulu.
- Ekubeni kungekho sithuba sikhulu sokususa ibele, iintlungu azinciphi.
- Ukopha akunciphi ngexesha lotyando.
- Ineziphumo eziphumelelayo ezifanayo notyando oluvulekileyo.
- Umngcipheko weengxaki ezinkulu okanye ukufa uphantsi (malunga nama-98% okusinda nge-TEVAR, xa kuthelekiswa nama-88%-94% xa kusetyenziswa utyando oluvulekileyo).
- Umonakalo obangelwa kukuncipha kokunikezelwa kwegazi kwamanye amalungu omzimba (ischemia ye-end-organ) mncinci kakhulu.
Ngaba kukho naziphi na iingozi kolu nyango?
Njengakwezinye iintlobo zotyando, kukho iingozi ezithile ezibandakanyekileyo, kodwa azixhaphakanga kakhulu.
- I-Endoleak: Igazi lisavuza lijikeleze i-stent graft lingena kwi-aneurysm.
- Usulelo: Usulelo kwindawo yotyando.
- Ukuhamba kwe-graft: I-stent eyayibekwe ishukuma kancinci ukusuka kwindawo yayo yokuqala.
- I-Paraplegia: Kunqabile kakhulu, ukungasebenzi kakuhle kwemilenze ngenxa yokuncipha kokunikezelwa kwegazi kwi-spinal cord.
- Ukuhlaselwa yintliziyo okanye isifo sohlangothi.
Thetha nogqirha wakho ngale mingcipheko kunye namanyathelo onokuwathatha ukuze uyinciphise.
Ukubuyisela kwimeko yesiqhelo kunye nokulandelela
Emva kotyando, uza kuhlala kwigumbi labagula kakhulu (ICU) usuku olunye okanye ezimbini. Emva koko, uza kudluliselwa kwigumbi eliqhelekileyo kwaye uza kukwazi ukuya ekhaya kungakapheli usuku okanye iveki. Xa ubuyela ekhaya, nyamekela ezi zinto:
- Musa ukuqhuba iveki e-1-2.
- Musa ukungena ebhafini enamanzi de inxeba elingaphakathi liphole (kulungile ukuhlamba).
- Musa ukuphakamisa ubunzima obungaphezulu kwe-5 kg kangangeeveki ezi-1-2.
Eyona nto ibalulekileyo kukulandelela . Le yinto ekufuneka yenziwe ubomi bonke. Njengoko ugqirha esitsho, kufuneka wenze iimvavanyo ezifana ne-CT scan emva kotyando, inyanga enye, iinyanga ezintandathu, unyaka, kwaye qho ngonyaka emva koko, ukuze kubonwe ukuba i-stent isasebenza na kwaye kukho naziphi na ezinye iingxaki.
Ukuba ubonakalisa iimpawu zokuhlaselwa yintliziyo (umz., iintlungu eziqatha esifubeni) okanye isifo sohlangothi (umz., ukugoba kwelinye icala lobuso, ubunzima bokuthetha), yiya kwiSebe lezeMpilo eziNgxamisekileyo (ETU) lesibhedlele esikufutshane ngoko nangoko.
Umyalezo Wokuya Ekhaya
- I-TEVAR yindlela yanamhlanje yokunyanga iimeko eziyingozi ezifana ne-aortic aneurysms, eyenziwa ngokusikwa okuncinci ngaphandle kokuvula isifuba.
- Olu lunyango oluphumelele kakhulu olunemingcipheko embalwa njengotyando oluvulekileyo, ukuchacha ngokukhawuleza, kunye nexesha lokuchacha ngokukhawuleza.
- Ugqirha wakho uya kugqiba ukuba olu nyango lukulungele na emva kovavanyo.
- Kunyanzelekile ukuba kwenziwe uhlolo lokulandelela njengoko ugqirha eyalele ubomi bakhe bonke emva kotyando.
- Ukuba unenkxalabo malunga nonyango lwakho okanye inkqubo yokuchacha, nceda uthethe nogqirha wakho ngaphandle kokuthandabuza.
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