Uyasazi isimo esibizwa ngokuthi 'i-Endoleak' esenzeka ngemva kokwelashwa nge-aneurysm?

Wake wezwa nge-'Aneurysm', isimo lapho udonga lwe-aorta noma umthambo omkhulu wegazi emzimbeni uba buthakathaka futhi uqhume njengebhaluni? Mhlawumbe uke waba nayo, futhi odokotela baye bayiphatha ngokufaka ithubhu elincane elibizwa ngokuthi 'i-Stent Graft', okuyinqubo ebizwa ngokuthi 'i-Endovascular', okusho ukuthi ngaphandle kokwenza i-incision enkulu. Cabanga ngayo njengokuvuza epayipini lamanzi elidala. Ngakho odokotela bafaka elinye ithubhu ngaphakathi kokuvuza ukuze bayiqinise. Kodwa-ke, ngezinye izikhathi ngemva kwalokho kwelashwa, igazi elincane liqala ukuvuza ku-'Stent Graft', liye esikhwameni lapho i-'Aneurysm' yayikhona. Yilokho esikubiza ngokuthi 'i-Endoleak' kwezokwelapha. Namuhla, sizoxoxa ngemininingwane ethe xaxa ngokuthi lokhu kuyini ngempela, kungani kwenzeka, ingabe kuyingozi, ukuthi kutholakala kanjani, nokuthi yiziphi izindlela zokwelapha.

Iyini ngempela i-`Endoleak`?

Kalula nje, i-`Endoleak` isho ukuthi ngemva kokuba i-`Aneurysm` isilashwe futhi yavalwa, igazi liqala ukugeleza futhi ngaphakathi kwesikhwama esidala se-`Aneurysm`. Manje, bheka, ngokuvamile lapho i-`Aneurysm` ilashwa, igazi lakho ligeleza kuphela ngepayipi le-`Stent Graft` elisanda kufakwa. Le 'Stent Graft` ifana nokusekela udonga lwemithambo yegazi olubuthakathaka. Ngakho-ke, igazi aligelezi engxenyeni eyonakele, evuvukele yomthambo wegazi, okungukuthi, i-`Aneurysm Sac`. Khona-ke i-`Aneurysm` iyayeka ukuba nkulu futhi iqhume. Kufanele kube kuhle uma kungekho ukuphuma kwegazi.

Kodwa-ke, uma ngesizathu esithile igazi livuza ngaphandle kwe-'Stent Graft' bese lingena ku-'Aneurysm Sac', lokho kubizwa ngokuthi i-'Endoleak'. Kunezizathu ezahlukahlukene zokuthi kungani le 'Endoleak' yenzeka. Ezinye zazo zibangelwa izinkinga nge-'Graft' uqobo, kanti ezinye zazo zingabangelwa eminye imithambo yegazi emincane eqala ku-'Aneurysm Sac'. Kufana namanzi avuza kwezinye izindawo ngemva kokuvulwa kophahla.

Uma i-`Endoleak` ivele zingakapheli izinsuku ezingu-30 kusukela kulokhu kwelashwa kwe-`Endovascular`, sikubiza ngokuthi ``ama-endoleak okuqala`` . Lawo akhula ngemva kwezinsuku ezingu-30 abizwa ngokuthi ``ama-endoleak esibili`` noma ``ama-endoleak asekupheleni`` .

Ivame kangakanani i-`Endoleak`?

Manje ungase uzibuze ukuthi ngabe le 'Endoleak' yinto eyenzeka kuwo wonke umuntu noma yinto engavamile ukwenzeka. Eqinisweni, lesi simo 'se-Endoleak' singavela cishe kubantu abangu-1 kwabangu-4 ababhekana 'nokulungiswa kwe-Endovascular Aneurysm' (sikubiza ngokuthi 'EVAR' ngamafuphi - lokhu kuyindlela yokwelapha ikakhulukazi 'i-Aneurysm' odongeni lwesisu) noma 'ukulungiswa kwe-Thracic Endovascular Aneurysm' ('TEVAR') ye-'Aneurysm' esifubeni . Ngakho-ke, akuyona into engakaze izwakale. Yingakho kubaluleke kakhulu ukuqaphela lokhu.

Ingabe i-`Endoleak` iyingozi?

Lokhu kungase kukwethuse kancane. "O, ngiyesaba ukuthi kuzophinde kophe igazi, akunjalo?" Ungase ucabange. Kodwa akuwona wonke ama-endoleak ayingozi . Amanye ama-endoleak awabangeli monakalo futhi aziphola ngokwawo. Njengoba nje inxeba elincane liphola ngokwalo. Ezimweni ezinjalo, udokotela wakho angase anqume ukuqapha isimo sakho. Lokhu kusho ukuqhubeka nokwenza izivivinyo bese ebona ukuthi kwenzekani.

Kodwa-ke, ezinye izinhlobo ze-'Endoleak' zimbi kakhulu. Ukuze kuvinjelwe ukuthi i-'Aneurysm' ingaphinde ikhule futhi iqhume, idinga ukwelashwa ngokushesha. Ngoba uma i-'Aneurysm' iqhuma, ingaba yingozi empilweni. Ngakho-ke, ukuthi lokhu kuyingozi noma cha kuncike ohlotsheni lwe-'Endoleak' nendawo ekuyo. Odokotela benza izinqumo ngokusekelwe kuzo zonke lezi zici.

Yiziphi izinhlobo ze-'Endoleak' ezikhona?

Okwamanje kunezinhlobo ezinhlanu ze-'Endoleak' ezitholakele. Uhlobo ngalunye lunembangela ehlukile. Njengoba nje isifo ngasinye sinembangela yaso. Ngokuthuthuka kobuchwepheshe obusha be-'Stent Graft', ezinye izinhlobo ze-'Endoleak' sezinciphile kancane, okuyinto enhle.

Kulezi , i-`Type 2 Endoleak` iyona evame kakhulu . Kodwa-ke , i-`Type 1` kanye ne-`Type 3` endoleaks ziyingozi kakhulu , njengoba zandisa ingozi yokuqhuma kwe-`Aneurysm` (`rupturing`). Ake sibheke lezi zinhlobo ngokuningiliziwe.

`Uhlobo 1 lwe-Endoleak`

Lokhu kwenzeka lapho i-stent graft ingaxhunywanga kahle odongeni lomthambo wegazi, okusho ukuthi ayivalwanga kahle. Cabanga nje, uma kukhona isikhala esincane phakathi kwesembozo nodonga, amanzi azovuza esuka lapho, futhi igazi lizovuza lisuka ekugcineni okuphezulu (okuseduze) noma ekugcineni okungezansi (okukude) kwe-stent graft bese lingena esikhwameni se-aneurysm. I-endoleak yohlobo 1 iyisimo esibi kakhulu, ngakho-ke ngokuvamile sidinga ukwelashwa ngokushesha. Lokhu kungenzeka kakhulu ukuthi kuqhume i-aneurysm kunezinye izinhlobo. Uma odokotela bekubona lokhu, bazothatha isinyathelo ngokushesha.

`Uhlobo 2 lwe-Endoleak`

Lolu uhlobo oluvame kakhulu lwe-endoleak . Luvame kakhulu ngemva kwe-EVAR kune-TEVAR kuma-aneurysms esisu. Lokhu kuvuza kwenzeka lapho igazi liphuma ku-aorta yakho noma emthanjeni one-stent lingena esikhwameni se-aneurysm ngemithambo yegazi emincane (imithambo yamagatsha noma imithambo yegazi ehlanganisiwe). Cabanga ukuthi i-aorta yakho inamagatsha amancane (amagatsha). Manje, noma ngabe sifaka i-stent graft entsha ukuvala imbobo ku-aorta, elinye igazi lisengaphuma kulawo magatsha. Yilokho i-endoleak yohlobo lwesibili eyikho.

Esikhathini esiningi, ama-Endoleak ohlobo lwesibili atholakala zingakapheli izinsuku ezingama-30 kusukela ekwelashweni kwakho kwe-Endovascular. Kodwa-ke, ngezinye izikhathi angavela kamuva, okwaziwa ngokuthi "ama-endoleak asephuzile." Cishe ama-40% ama-Endoleak ohlobo lwesibili atholakala ngemva kwezinsuku ezingama-30. Cishe ama-8% atholakala ngemva konyaka wokwelashwa.

Kodwa iningi lama-'Endoleak' ohlobo lwesibili' alilimazi kangako . Alulama ngokwawo ngemva kwezinyanga eziyisithupha ngaphandle kokwelashwa. Ngoba leyo mithambo yegazi emincane iyazivalela yodwa. Ngisho noma ingalulami, uma i-'Aneurysm Sac' izinzile futhi ingakhuli, udokotela angayiqapha. Kodwa ngezinye izikhathi, ngokuhamba kwesikhathi, le 'Endoleak yohlobo lwesibili' ingabangela izinguquko ku-'Aneurysm Sac' futhi iphenduke i-'Endoleak' eyingozi kakhulu njenge-'Type 1' noma i-'Type 3'. Uma lokho kwenzeka, kudingeka ukwelashwa. Uma i-'Aneurysm' inkulu kunamamilimitha angu-5 (`5mm`), ungadinga ukwelashwa. Uma i-'Aneurysm' ishiywe ingelashwa, kungenzeka ukuthi i-'Aneurysm' izoqhuma.

`Uhlobo 3 lwe-Endoleak`

I-Endoleak yohlobo lwesithathu yenzeka lapho izingxenye ezihambisanayo ze-stent graft yakho zihlukana, noma uma indwangu ye-graft ngokwayo idabuka noma idabuka. Lokhu kufana nepayipi elihlukana ejoyintini, noma kwakheka imbobo epayipini uqobo. Njenge-Endoleak yohlobo lwe-1, kunengozi yokuqhuma kwe-aneurysm ngoba igazi ligeleza ngqo esikhwameni se-aneurysm ngaphansi kwengcindezi. Ngakho-ke, ukwelashwa okusheshayo kubalulekile. Kodwa-ke, ngentuthuko ekwakhiweni kwedivayisi, ama-Endoleak ohlobo lwe-3 awavamile.

`Uhlobo 4 lwe-Endoleak`

Lokhu kwenzeka lapho igazi livuza ngezimbobo ezincane ku-stent graft (i-porisity yezinto ezifakwe ku-graft). Lokhu kuvame ukubonakala ekuqaleni kokwelashwa, kodwa kuvame ukuxazululeka ngokwako. Lokhu kuyinkinga engavamile kakhulu ye-graft, futhi akuvamile kakhulu nge-graft esetshenziswa namuhla.

`Uhlobo 5 lwe-Endoleak`

`Uhlobo 5 lwe-Endoleak` lubizwa nangokuthi ``Endotension``. Lokhu kuyamangaza kancane. Okwenzekayo kulokhu ukuthi, yize kungekho sibonakaliso se-``Endoleak`` ekuhlolweni kwe-``Imifanekiso``, i-``Aneurysm Sac`` iyaqhubeka nokukhula. Nakuba imbangela eqondile yalokhu ingacacile, kucatshangwa ukuthi kungase kube ``ukudluliselwa kwengcindezi`` nge-``Stent Graft```, yize kungekho ukuvuza kwegazi okubonakalayo. Lesi futhi yisimo esidinga ukubhekwa.

Ziyini izimpawu ze-`Endoleak`?

Lena inkinga abantu abaningi abanayo. Ngokuvamile azikho izimpawu obungalindela ukuzibona uma une-endoleak. Ungase ungaboni mehluko. I-endoleak itholakala ngokuhlolwa kwezithombe okwenziwe ngosuku lokwelashwa kwakho kanye nokuhlolwa kokulandelela okwenziwe ngemva kwalokho.Yingakho kubaluleke kakhulu ukuya kulezo zivivinyo zokulandelela. Ukuya kohlolwa ngezinsuku udokotela athi yiyona ndlela kuphela yokuthola into efana nale ngokushesha.

Kodwa-ke, uma i-aneurysm iba nkulu futhi iqhuma (i-aneurysm iqhuma) ngenxa ye-endoleak (ikakhulukazi uhlobo oluyingozi), kuyisimo esiphuthumayo sezokwelapha . Uma lokhu kwenzeka, kungase kube nezimpawu ezilandelayo. Uma lokhu kwenzeka , kufanele ushayele u-911 noma uye esibhedlela esiseduze ngokushesha :

• Umzimba ubanda futhi ujuluka (`Isikhumba esithambile, esijulukayo`).
• Isiyezi, umuzwa wokuzungeza ekhanda.
• Ukuquleka, ukulahlekelwa ukwazi.
• Ukushaya kwenhliziyo kuyashesha ('Ukushaya kwenhliziyo okusheshayo').
• Isicanucanu nokuhlanza.
• Ubunzima bokuphefumula, uzizwa sengathi uyacinana (ukuphelelwa umoya).
• Ubuhlungu obukhulu obungazelelwe esiswini sakho, emhlane ongezansi noma emilenzeni.
• Ubuhlungu obubukhali obungazelelwe obudabukisayo esifubeni noma emhlane.

Uma lezi zimpawu zivela, ungalibali.

Uyithola kanjani i-`Endoleak`?

Njengoba kushiwo ngaphambili, i-endoleak ihlolwa ngokuhlolwa kwezithombe. Lokhu kuhlolwa kwenziwa ngesikhathi nangemva kokulungiswa kwe-endovascular aneurysm yakho. Esikhathini esiningi, ihlolwa ngosuku olufanayo noma zingakapheli izinsuku ezingu-30 zenqubo. Kodwa-ke, ngezinye izikhathi kungenzeka kuze kube yizinyanga ezingu-12 noma ngaphezulu. Yingakho kubaluleke kakhulu ukugcina wonke ama-aphoyintimenti akho okulandelela. Njengokulungisa imoto, lokhu kuyinto edinga ukunakekelwa njalo.

Ukuhlolwa kokuthola i-`Endoleak`

Ukuhlolwa okuyinhloko okusetshenziselwa ukuxilonga i-'Endoleak' ngesikhathi nangemva kokwelashwa yile:

• `I-Computed Tomography (CT) scans`: Lokhu kuthatha izithombe ezihlanganisa ingxenye yomzimba. `I-Stent Graft`, `I-Aneurysm Sac`, kanye nokuvuza kwegazi kungabonakala kahle.
• I-Doppler Ultrasound: Lokhu kusebenzisa amaza omsindo ukubheka ukugeleza kwegazi. Kungabona ukuthi kukhona yini i-endoleak nokuthi igazi ligeleza kanjani.
• I-Angiogram: Kulokhu, kufakwa uketshezi olukhethekile (udayi wokungafani) emithanjeni yegazi bese kuthathwa izithombe ze-X-ray. Ukugeleza kwegazi nokuvuza kungabonakala kahle.

Lezi zivivinyo zingasiza ekunqumeni ukuthi ukwelashwa kwakho kuphumelele yini, ukuthi i-stent graft ikhona yini, nokuthi kukhona yini ukuvuza okuzungeze i-stent.

Kuzodingeka wenze lezi zivivinyo 'zezithombe' izinyanga noma iminyaka ngemuva kokwelashwa. Udokotela wakho uzokutshela ngalezi zivivinyo nokuthi kufanele uzihlole kangaki. Kodwa-ke, lezi zivivinyo zibalulekile ukuze kutholakale noma iyiphi 'i-endoleak' engase ivele kamuva ('i-endoleak yesibili') ngokushesha futhi uyiphathe uma kudingeka.

Yiziphi izindlela zokwelapha i-'Endoleak'?

Ithimba lakho lezokwelapha lizokwelapha i-Endoleak yakho ngokwezidingo zakho. Indlela i-Endoleak ephathwa ngayo ihlukile kumuntu ngamunye. Lokhu kuzoncika ohlotsheni lomzimba wakho (isibonelo, ubude bentamo yakho ye-aneurysm, indawo yemithambo yegazi, njll.), uhlobo lwe-Endoleak, kanye nendawo yayo. Ngokuvamile, kunezinketho ezintathu eziyinhloko zokwelapha i-Endoleak: ukubonwa, ukwelashwa kwe-endovascular, kanye/noma ukuhlinzwa okuvulekile.

Ukuqaphela

Uma une-endoleak engatheni kangako, njenge-endoleak yohlobo lwesibili, udokotela wakho angase ancome indlela "yokulinda ngokuqapha" ukuze abone ukuthi izophola yodwa. Lokhu kungenzeka uma imithambo yegazi exhumanisayo ivala (ivala), imisa ukuhlinzekwa kwegazi esikhwameni se-aneurysm. Kodwa-ke, uma i-endoleak ibangela ukuba isikhwama se-aneurysm sibe sikhulu (okungukuthi, sibe ngaphezu kwama-5 mm), uzodinga ukwelashwa ukuze uvimbele ukuthi singaqhekeki.

Ukwelashwa kwe-Endovascular

Lena yindlela yokwelapha evame kakhulu ye-endovascular aneurysm. Udokotela wakho ohlinzayo angenza ukulungiswa kwe-endovascular aneurysm esebenzisa amasu angangenisi kakhulu. Lokhu kungafaka:

• Ukuvimba imithambo yegazi yegatsha ehambisa igazi ku-aneurysm. Okusho ukuthi, kufakwa into ekhethekile (i-embolizing agent) emithanjeni yegazi emincane ebangela i-Type 2 Endoleak bese ivalwa.
• I-'Stent Graft' inqubo ehilela ukubeka izingcezu ezengeziwe ze-'Stent' ('ama-cuff noma ama-extenders') ngale kokuvuza, yandisa indawo yomthambo wakho omkhulu ('i-Aorta') lapho i-'Stent' yafakwa khona. Lokhu kuvame ukwenziwa nge-'Type 1 Endoleak'.
• Ukuya ngqo esikhwameni se-aneurysm bese uvala isikhwama se-aneurysm usebenzisa izinto ezifana neglue.

Lezi zindlela zivumela ukwelashwa ukuthi kwenziwe ngaphandle kokusikwa okukhulu, ngembobo encane.

Ukuhlinzwa (`Ukuhlinzwa Okuvulekile`)

Uma ukwelashwa nge-endovascular kungenzeki noma kwehluleka, ukuhlinzwa okuvulekile kuvame ukuba yindlela yokugcina. Lokhu kuhilela ukwenza ukusika okukhulu, ukungena ku-aneurysm, kanye nokulungisa i-stent graft noma ukufaka entsha. Lokhu akuvamile kakhulu, njengoba amasu e-endovascular manje esethuthuke kakhulu.

Yini ongayilindela uma une-`endoleak`?

Esikhathini esiningi, i-Endoleak ayidingi ukwelashwa, ikakhulukazi uhlobo 2. Ngisho noma kudingeka ukwelashwa, kunezindlela eziningi ezingangenisi kakhulu ezidinga ukusikwa okuncane. Lokhu kwelashwa kwe-Endovascular kubonise amazinga aphezulu empumelelo. Ngaphezu kwalokho, ubuchwepheshe obusha buyaqhubeka nokuthuthukisa ukusetshenziswa kwe-stent grafts enciphisa ingozi ye-Endoleak.

Uma une-endoleak, ungesabi. Udokotela wakho uzokuchazela izindlela zakho zokwelapha. Into ebaluleke kakhulu ukuthi uzoqhubeka nokuhlolwa okulandelayo ngisho nangemva kokuba i-endoleak isipholile.Kubaluleke kakhulu ukuhlonza nokwelapha noma yiziphi izinkinga zesikhathi esizayo nge-stent graft yakho ngokushesha okukhulu, njengokunakekela imoto.

Kufanele ngimbone nini udokotela wami?

Qiniseka ukuthi ugcina wonke ama-aphoyintimenti okulandelela ngemva kokwelashwa kwakho kwe-EVAR noma i-TEVAR. Udokotela wakho uzokutshela ukuthi udinga kangaki ukuhlolwa kwezithombe. Ngokuvamile, zizosondelana ekuqaleni, kodwa zingase zibe zivamile ngokuhamba kwesikhathi. Landela leyo miyalelo ngqo.

Futhi, uma uhlangabezana nanoma yiziphi izimpawu eziphuthumayo ezihambisana nokuqhuma kwe-aneurysm, njengoba kushiwo ngaphambili, iya esibhedlela ngokushesha ngaphandle kokulinda.

Imibuzo okufanele uyibuze udokotela wakho

Ngemva kwenqubo yakho ye-EVAR noma ye-TEVAR, buza udokotela wakho ngezingozi zezinkinga. Futhi, khuluma ngokuhlolwa okulandelayo kanye nokuthi yiziphi izivivinyo zesithombe ongalindela. Ungabuza imibuzo efana nale:

• Yiziphi izinkinga ezingaba khona ngenxa yalokhu kwelashwa? Iyini ingozi yami yokuthola i-endoleak?
• Kukangaki ngidinga ukuza ukuzolandelelwa? Hlobo luni lokuhlolwa (njenge-CT, i-ultrasound) engizodinga ukukwenza?
• Yiziphi izindlela zokwelapha enginazo uma ngithola i-`endoleak`?
• Yiziphi izinguquko zendlela yokuphila engingayenza ukuze ngisize inhliziyo yami ibe nempilo futhi ngigcine i-stent graft yami isesimweni esihle? (isib., ukuyeka ukubhema, ukuzivocavoca, ukudla okulinganiselayo)

Kubaluleke kakhulu ukubuza imibuzo efana nalena nokuqonda kangcono isimo sakho.

Yimuphi umyalezo esingawuthatha ekhaya kule ndaba?

I-Endoleak iyinkinga elawulekayo engenzeka ngemva kokulungiswa kwe-endovascular aneurysm. Ungase ungadingi ukwelashwa. Kodwa-ke, uma wenza kanjalo, udokotela wakho uzokhuluma nawe ngezinketho zokwelapha ezifanele wena.

Kuvamile ukuthi izinkinga ezinjengalezi zenzeke ngemva kwenqubo esindisa impilo, njengokwelapha i-aneurysm. Kodwa-ke, izinzuzo zenqubo zidlula kakhulu izingozi . Ngakho-ke ungesabi uma uthola ulwazi nge-endoleak.

Into ebaluleke kakhulu ukuya emihlanganweni yokulandelela udokotela akunikeza yona bese uthola izivivinyo azincomayo. Ngaleyo ndlela, noma yiziphi izinkinga zingatholakala futhi zelashwe ngokushesha.

Uma uzizwa ukhathele futhi ukhungathekile, kuyinto evamile. Abantu abaningi badlula entweni efanayo nawe. Khuluma nodokotela wakho nomndeni wakho ngezindlela zokuphatha ukucindezeleka okuza nokululama. Awuwedwa.

I- Endoleak, i-Aneurysm, i-Stent Graft, i-EVAR, i-TEVAR, ukopha, i-Aneurysm, i-Stent Graft, Isifo Senhliziyo