Masifunde ngotyando lokususa amahlwili egazi emiphungeni (i-Pulmonary Thromboendarterectomy - PTE)

Usenokuba ubunengxaki yokuphefumla ixesha elide, okanye uzive uphelelwa ngumphefumlo xa uhamba. Ugqirha wakho usenokuba ukuxelele ukuba une-pulmonary hypertension, ebangelwa kukuqhekeka kwegazi emiphungeni yakho. Xa le meko ingenakulawulwa ngamayeza, sithetha ngotyando olukhethekileyo olunokusindisa ubomi bakho.

Ngamafutshane, yintoni olu tyando lwe-PTE?

Musa ukoyikiswa ligama elide elithi Pulmonary Thromboendarterectomy. Siza kuyibiza ngokuba yiPTE ngamafutshane. I-PTE yinkqubo enzima kakhulu eyenziwa ngoogqirha abaziingcali. Ibandakanya ukususa amahlwili egazi amadala kunye nezicubu ezinamathele eludongeni lwemithambo yegazi ephambili ethwala igazi ukuya emiphungeni yakho (i-Pulmonary Arteries).

Khawucinge ukuba umbhobho wamanzi ekhayeni lakho uvalekile ngumhlaba kwaye amanzi awaphumi. Utyando lwe-PTE lufana nokucoca ingaphakathi lombhobho nokwenza amanzi aphume kakuhle kwakhona. Le yeyona ndlela ilungileyo yokususa la mahlwili egazi amadala naqinileyo angenakunyibilikiswa ngamayeza. Ngamanye amaxesha, olu tyando lunokuphelisa imeko ngokupheleleyo.

Ziziphi iimeko ezinyangwa ngotyando lwe-PTE?

Olu tyando lwenziwa ikakhulu kubantu abanemeko ebizwa ngokuba yiChronic Thromboembolic Pulmonary Hypertension (CTEPH) . Eli ligama elintsonkothileyo, ngoko masiliqonde.

• I-Chronic: ithetha "ukuhlala ixesha elide."
• I-Thromboembolic: ithetha "okubangelwa kukuphuma kwegazi."
• Uxinzelelo lwegazi oluphezulu lwemiphunga: Oku kuthetha "uxinzelelo lwegazi oluphezulu emiphungeni."

Ngamafutshane, i-CTEPH iyenzeka xa ihlwili legazi (i-Pulmonary Embolism - PE) elakhe lenzeka ngaphambili emiphungeni linganyibiliki kakuhle, kodwa endaweni yoko linamathela eludongeni lwemithambo yegazi emiphungeni, lenze izicubu ezibomvu ngokuhamba kwexesha, lithintele ukuhamba kwegazi, nto leyo ebangela ukuba uxinzelelo lunyuke emiphungeni.

Ngokwesiqhelo, xa umntu enegazi eliqhekekileyo (PE) emiphungeni, oogqirha bamnika amayeza okunciphisa igazi. Uninzi lwexesha, la mayeza ayayinyibilikisa i-blood clots. Kodwa kubantu abambalwa kakhulu, malunga ne-2% - 4%, la ma-blood clots awanyibiliki ngokupheleleyo. Ayaguga, anamathele eludongeni lwemithambo yegazi, aze avale indlela yokuhamba kwegazi. Oku kubeka uxinzelelo olukhulu kwicala lasekunene lentliziyo, elimpompa igazi liye emiphungeni. Ekuhambeni kwexesha, oku kunokukhokelela ekusileleni kwentliziyo , ekonakaleni kwemiphunga, kwanakwiingxaki ezisongela ubomi.

Ngubani ofuna olu tyando? Ngaba wonke umntu angalufumana?

Ukuba une-CTEPH, kuza kuqwalaselwa izinto ezininzi ukuze kuqinisekiswe ukuba ungenza olu tyando.

• Ubukhali beempawu zakho.
• Apho akhona amahlwili egazi, ukuba asasazeke kangakanani, kwaye avale kangakanani imithambo yegazi.
• Ubudala bakho, impilo yakho iyonke, kunye nendlela intliziyo yakho kunye nemiphunga esebenza ngayo.

Ngokutsho koogqirha botyando, ukuba la mahlwili egazi anokususwa ngokukhuselekileyo, unyango olukhethwayo kwi-CTEPH lutyando lwe-PTE.

Nangona kunjalo, ayinguye wonke umntu one-CTEPH onokulutyanda olu tyando. Malunga nama-40%, okanye abantu abane kwabalishumi, abafanelekanga kolu tyando. Isizathu esiphambili soku kukuba lutyando oluntsonkothileyo kakhulu.

Kutheni olu tyando lunzima kangaka?

Ngexesha lotyando, iqela lezonyango lidlulisela okwethutyana umsebenzi wentliziyo yakho nemiphunga yakho kumatshini we-cardiopulmonary bypass . Oku kuthetha ukuba lo matshini unika umzimba wakho ioksijini kwaye upompa igazi ngexesha lotyando.

Okubaluleke ngakumbi, ngexesha lotyando, ugqirha kufuneka abone ngokucacileyo imithambo yegazi ethambileyo emiphungeni. Ukuze kwenziwe oku, kusetyenziswa indlela ekhethekileyo yokunciphisa ubushushu bomzimba wakho ukuya kwi-18 degrees Celsius (65 Fahrenheit), umise ngokupheleleyo ukujikeleza kwegazi okwethutyana (Deep Hypothermic Circulatory Arrest). Umzimba upholiswa ngale ndlela ukuthintela umonakalo engqondweni. Le ndlela ivumela ugqirha ukuba asuse ngononophelo amahlwili egazi kunye nezicubu ezibomvu kwindawo ecacileyo, engenagazi.

Ukuba utyando alunakwenzeka, zeziphi ezinye iindlela ezikhoyo?

Ukuba oogqirha bagqiba kwelokuba awufanelekanga utyando lwe-PTE nangasiphi na isizathu, baya kucebisa ezinye iindlela zonyango.

• Amayeza Omlomo: Kukho amayeza akhethekileyo anokulawula uxinzelelo lwegazi emiphungeni.
• I-Balloon Pulmonary Angioplasty (BPA): Oku kuquka ukusebenzisa ityhubhu encinci efakwe ngomthambo osemlenzeni ukuze kufikelelwe kwimithambo yegazi evalekileyo emiphungeni, kwaye uyivuthele ngesixhobo esifana nebhaluni ukuvula ukuhamba kwegazi.

Uzilungiselela njani ngaphambi kotyando?

Ugqirha wakho uza kukunika imiyalelo ecacileyo malunga nendlela yokulungiselela utyando. Kubaluleke kakhulu ukulandela loo miyalelo ngokuchanekileyo.

Kwenzeka ntoni ngexesha lotyando?

Olu tyando ludla ngokuqala kusasa kwaye luthatha malunga neeyure ezi-6. Uza kufakwa i-anesthesia ngokupheleleyo ukuze ungaziva nto.

1. Uncedo ngokuphefumla: Okokuqala, kufakwa ityhubhu encinci (Endotracheal Tube - ETT) ngomlomo okanye empumlweni, iye kwi-windpipe yakho, ize iqhagamshelwe kumatshini we-oxygen (ventilator). Lo matshini uza kukunceda uphefumle kulo lonke utyando.

2. Ukuvula isifuba: Emva koko, ugqirha uza kusinqumla isifuba sakho (sternum) ukuze afikelele entliziyweni nasemiphungeni.

3. Uqhagamshelo kumatshini we-bypass: Emva koko uza kuqhagamshelwa kumatshini we-Cardiopulmonary Bypass. Lo matshini uza kwenza umsebenzi wentliziyo nemiphunga ngexesha lotyando.

4. Ukupholisa umzimba: Okulandelayo, ubushushu bomzimba wakho buyehla kancinci kancinci bufikelele kwi-18 degrees Celsius.

5. Ukususa amahlwili egazi: Emva kokupholisa umzimba nokuyeka ukujikeleza kwegazi okwethutyana, ugqirha wotyando ususa ngononophelo amahlwili egazi kunye nezicubu ezibomvu ngaphakathi kwemithambo yegazi yemiphunga esebenzisa izixhobo ezikhethekileyo.

6. Ukuvuselela: Emva kokuba amahlwili egazi esusiwe, ubushushu bomzimba wakho bubuyela kwisiqhelo kwaye ukhutshwe kumatshini we-bypass. Kodwa uhlala uqhagamshelwe kwi-ventilator.

7. Ukuvalwa kwesifuba:Ekugqibeleni, ugqirha uza kuvala isifuba sakho aze afake imibhobho emininzi emincinci ukuze akhuphe naluphi na ulwelo olugqithisileyo olunokuthi luqokeleleke emzimbeni wakho.

Kwenzeka ntoni emva kotyando?

Emva kotyando, uza kungeniswa kwigumbi lokunyamekela abagula kakhulu (ICU) . Uza kuhlala e-ICU ngobo busuku. Ngentsasa elandelayo, iqela lezonyango liza kujonga ukuphefumla kwakho. Ukuba uyakwazi ukuphefumla wedwa, i-ventilator iza kususwa.

Ngokwesiqhelo kuya kufuneka uhlale esibhedlele iintsuku ezisi-7 ukuya kwezili-10. Uza kuqala ube kwi-ICU, uze emva koko udluliselwe kwigumbi eliqhelekileyo njengoko imeko yakho iphucuka.

Inkqubo yokuchacha ifana nokuchacha emva kotyando lwentliziyo oluvulekileyo. Uya kukwazi ukuhamba kwiintsuku ezimbalwa kwaye kancinci kancinci ukwazi ukwenza umsebenzi othile. Ngaphambi kokuba ugoduke, uya kuvavanywa ukuze kubonwe ukuba uyayidinga na ioksijini.

Ziziphi iingenelo kunye neengozi zotyando lwe-PTE?

Iingenelo

• Le yindlela kuphela yokunyanga ngokupheleleyo i-CTEPH.
• Kwabaninzi abantu, utyando luphumelele, kwaye ukusebenza kokuphefumla kunye nemiphunga kuyaphucuka kakhulu.
• Abantu abaninzi ababexhomekeke kwioksijini ngaphambi kotyando abasayi kuyidinga ioksijini emva kotyando.
• Umonakalo obangelwe sisifo kwicala lasekunene lentliziyo udla ngokuguqulwa.
• Amathuba okusinda ixesha elide emva kotyando aphezulu kakhulu.

Iingozi kunye neengxaki

Ekubeni olu lutyando olukhulu, kukho iingozi ezithile. Nangona kunjalo, ngenxa yokuqhubela phambili kwetekhnoloji kwiminyaka embalwa edlulileyo, ezi ngozi ziye zancitshiswa kakhulu.

• Umngcipheko wokufa ngexesha lotyando ngoku uphantsi njenge-1%.
• Umngcipheko we-stroke umalunga ne-1% - 2%.
• Abanye abantu basenokuba nezinga elithile loxinzelelo lwegazi oluphezulu emaphaphu emva kotyando. Kuya kufuneka baqhubeke nokusebenzisa amayeza.
• Ngamanye amaxesha, ulwelo luqokelelana ngeenxa zonke zentliziyo (i-pericardial effusion) lunokwenzeka.

Ukuba ufumana ezi mpawu zilandelayo, fowunela u-1990 ngoko nangoko okanye uye kwiSebe lezeMpilo eziNgxamisekileyo (ETU) elikufutshane:

• Intlungu ebuhlungu esifubeni
• Ukuquleka
• Ukuphefumla okukhawulezileyo okubuhlungu

Kuthatha ixesha elingakanani ukuphiliswa?

Ekuhambeni kwexesha, ungabuyela kubomi obuqhelekileyo. Kodwa, kufuneka ube nomonde kancinci.

• Iiveki zokuqala ezi-6: Awukwazi ukuqhuba, ukuya emsebenzini, okanye ukuphakamisa ubunzima obungaphezulu kweekhilogram ezili-10 (malunga ne-4.5 kg).
• Iiveki 7 ukuya kwi-12: Ingaphakamisa ubunzima obufikelela kwiikhilogram ezingama-25 (malunga ne-11 kg).
• Emva kweeveki ezili-12: Imiqathango yokuphakamisa iintsimbi idla ngokususwa.

Uninzi lwabantu lunokubuyela kwimisebenzi yalo yesiqhelo kwisithuba seenyanga ezi-3. Ukuphefumla kwakho kunye nokukwazi kwakho ukuzilolonga kuya kuphucuka kancinci kancinci, kwaye ungabona uphuculo ukuya kuthi ga kwiminyaka emi-4.

Injani imeko yokujonga ugqirha emva kotyando?

Emva kotyando, kuya kufuneka uqhubeke ubona ugqirha.

• Uza kuvavanywa imiphunga yakho kwiiveki ezi-6 emva kotyando, uze uphinde uvavanye phakathi kweenyanga ezi-3-6 kamva.
• Eyona nto ibalulekileyo kukuba kuya kufuneka uthathe amayeza okunciphisa igazi/anciphisa igazi ubomi bakho bonke ukuze uthintele ukwakheka kwamahlwili egazi amatsha.

Ukuba unale mpawu, thetha nogqirha wakho.

• Ukuba intlungu ayinyamezeleki, okanye ukuba intlungu iyancipha ize inyuke kwakhona.
• Ukuba ukubetha kwentliziyo kuyakhawuleza okanye akuhambelani kakuhle.
• Ukuba inxeba lotyando libomvu, lidumbile, likhupha ubovu, okanye linomkhuhlane (ezi ziimpawu zosulelo).

I-PTE lutyando oluxabisekileyo kakhulu olunokunika ubomi besibini kumntu onesifo se-CTEPH. Nangona lutyando oluntsonkothileyo kwaye luthatha ixesha elide ukuba luphile, isiphumo salo, elilithuba lokuphila ngokukhululekileyo ngaphandle kokufuthaniseka kwakhona, asinakuthelekiswa nanto.