Umthambo wegazi omkhulu kunayo yonke emzimbeni wethu yi-aorta, esiyibiza ngokuthi "i-Aorta" ngesiNgisi. Cabanga ngayo njengepayipi lamanzi eliyinhloko emzimbeni wethu. Yilo elisakaza igazi lisuka enhliziyweni liye kuwo wonke umzimba. Ngezinye izikhathi, udonga lwalo mthambo wegazi luba buthakathaka bese luqala ukukhukhumala njengebhaluni. Yilokhu esikubiza ngokuthi "i-Aneurysm" kwezokwelapha. Into eyingozi kakhulu ukuthi lokhu kukhukhumala kuyanda futhi kunethuba lokuthi kuzoqhuma ngokuzumayo. Ngakho-ke namuhla sizokhuluma ngendlela yokwelapha yesimanje engagwema lesi simo esiyingozi ngaphandle kokwenza ukunqunywa okukhulu emzimbeni nangomzamo omncane kakhulu.
Kalula nje, iyini i-EVAR?
Incazelo ephelele ye-EVAR ithi `(Ukulungiswa kwe-Endovascular Aneurysm)`. NgesiSinhala, ukulungiswa okwenziwa ngaphakathi kwemithambo yegazi. Lokhu akuyona ukuhlinzwa okukhulu . Lokho kusho ukuthi esikhundleni sokwenza ukuhlinzwa okukhulu ngokusika isisu, lokhu kwelashwa kwenziwa kusetshenziswa imbobo encane kakhulu.
Cabanga ukuthi ipayipi lamanzi elidala selivuvukele futhi selizoqhuma. Esikhundleni sokusika ipayipi bese ulisusa, okwenzekayo lapha kufana nokulilungisa ngokufaka ipayipi elincane neliqinile ngaphakathi kwalo. Odokotela bafaka ipayipi elenziwe ngokukhethekile (i-Stent Graft) emthanjeni wegazi ovuvukele. Lokhu kufana nolwelwesi olukhethekile olwenziwe ngendwangu ne-mesh yensimbi. Uma lokhu kufakwa, igazi ligeleza ngepayipi elisha. Ngemuva kwalokho, akukho ngcindezi efakwa odongeni olubuthakathaka noluvuvukele. Ngakho-ke, ingozi yokuqhuma kwalo iqedwa ngokuphelele.
Kungani sidinga ukwelashwa kwe-EVAR?
Inhloso eyinhloko newukuphela kwayo yalokhu ukuvimbela i-Abdominal Aortic Aneurysm ukuthi ingaqhekeki . Ngoba uma lokho kwenzeka, kuyisimo esisongela kakhulu impilo futhi esibulalayo.
Uma udonga lomthambo wegazi luba buthakathaka, ukucindezela kwegazi okungena ngokushaya kwenhliziyo ngakunye kubangela ukuthi leyo ndawo ebuthakathaka ivuvuke. Kufana nebhamuza ethayini. Alikwazi ukwanda unomphela. Ngesinye isikhathi, liyaqhuma. Uma lokho kwenzeka, inani elikhulu legazi lingageleza emzimbeni, futhi ukufa kungenzeka ngemizuzu embalwa.
Ngakho-ke lokho okwenziwa ukwelashwa kwe-EVAR ukufaka "(Stent Graft)", kushintsha ukugeleza kwegazi, futhi kunciphise ingcindezi odongeni oluvuvukele. Lokho cishe kuyimisa ngokuphelele ingozi yokuqhekeka.
Kalula nje, lokhu kufana nokucisha ibhomu. Ususa ingozi ngaphambi kokuba iqhume.
Ubani ofanelekela lolu hlobo lokwelashwa lwe-EVAR?
Lokhu kwelashwa akwenziwa ngokushesha kuwo wonke umuntu one-aneurysm yesisu. Udokotela wakho uzobheka izici eziningana ukuze anqume ukuthi lokhu kwelashwa kulungile yini kuwe.
- Uma i-aneurysm yakho inkulu ngokwanele , nomaUma amaskeni ebonisa ukuthi ikhula ngokushesha esikhathini esifushane.
- Uma ungakwazi ukuthwala ingozi yokuhlinzwa okukhulu njengokunqamuka kwesisu ngenxa yezinye izimo zezokwelapha (njengesifo senhliziyo noma isifo samaphaphu).
- Uma imithambo yegazi engaphezulu nangaphansi kwayo ivuvukele futhi iqinile (ngoba kudingeka kube nendawo enhle yokufaka ipayipi elisha).
Kungemva kokucabangela izici ezinjengalezi lapho udokotela enquma khona ukuthi ukwelashwa kwe-EVAR kungcono kakhulu kuwe.
Iyiphi indlela ekhethekile ebizwa ngokuthi i-FEVAR?
Umthambo omkhulu we-iliac esiswini sethu ufana nesiqu somuthi. Uhlumela emithanjeni yegazi emincane ethwala igazi ezithweni ezisesiswini sethu (njengezinso namathumbu). Ngezinye izikhathi i-aneurysm yakheka eduze kakhulu nalapho lawo magatsha ehlumela khona. Kuleso simo, ipayipi eliqondile elisetshenziswa ku-EVAR evamile alikwazi ukufakwa, ngoba ukwenza kanjalo kunganqamula ukugeleza kwegazi kulawo magatsha.
Kulezi zimo eziyinkimbinkimbi kangaka lapho kusetshenziswa khona indlela ekhethekile ebizwa ngokuthi i-FEVAR (Fenestrated Endovascular Aneurysm Repair). Ku-`(Stent Graft)` esetshenziswa lapha, kwenziwa izimbobo ezincane ezifana namafasitela ukuze zilingane namagatsha. Ngemva kokufakwa kwepayipi eliyinhloko, kufakwa i-`(Stent)` encane ehlukile ngalawo mafasitela emithanjeni yegazi efana negatsha ukuqinisekisa ukuhamba kwegazi. Nakuba lokhu kuyinkimbinkimbi kancane, kuyinzuzo enkulu ukukwazi ukwelapha i-`(Aneurysm)` ezindaweni ezinzima kangaka ngaphandle kokuhlinzwa okukhulu.
Uyini umehluko phakathi kwe-EVAR ne-TEVAR?
Lokhu kokubili kuyindlela yokwelapha efanayo. Umehluko usendaweni yokwelashwa.
- I-EVAR: Yenzelwa ama-aneurysms esisu (esiswini) .
- Ukulungiswa kwe-Théracic Endovascular Aneurysm (TEVAR): kwenziwa ngenxa ye-aneurysms esifubeni (esifubeni) .
Yiziphi izinzuzo zokwelashwa nge-EVAR?
Uma kuqhathaniswa nokuhlinzwa okukhulu, ukwelashwa kwe-EVAR kunezinzuzo eziningana ezicacile. Kuyinqubo engadingi ukungenelela okuningi.
| Inzuzo | Kalula nje... |
|---|---|
| Isikhathi esincane esibhedlela | Nakuba ukuhlinzwa okukhulu kuthatha cishe isonto, lokhu kuzothatha izinsuku ezimbili noma ezintathu. |
| Inani lokulahlekelwa yigazi liphansi. | Njengoba kungekho ukusikeka okukhulu, ukuphuma kwegazi okuncane kakhulu. |
| Ubuhlungu obuncane ngesikhathi sokuphulukiswa | Njengoba kungekho ukulimala okukhulu, ubuhlungu buncane kakhulu. Ama-painkiller adingeka isikhathi esifushane kuphela. |
| Ungabuyela empilweni evamile ngokushesha. | Ungabuyela emsebenzini kungakapheli inyanga, ngaphandle kokulinda izinyanga. |
| Izingozi ngesikhathi sokuhlinzwa ziphansi. | Ingozi yokuhlaselwa yinhliziyo noma ukufa ngesikhathi sokuhlinzwa iphansi kunangesikhathi sokuhlinzwa okukhulu. |
| Isikhathi sokuhlinzwa sincane. | Lokhu kwelashwa kungaqedwa ngesikhathi esingaphansi kokuhlinzwa okuvulekile. |
Ingabe zikhona izingozi ngokwelashwa nge-EVAR?
Nakuba i-EVAR iyindlela yokwelapha ephumelela kakhulu futhi ephephile, njenganoma iyiphi inqubo yezokwelapha, kunezingozi ezincane ezingase zenzeke. Kodwa-ke, lezi azivamile.
| Ingozi | Incazelo |
|---|---|
| Ukujiya kwegazi | Kukhona ingozi yokuthi igazi liqhekeke emithanjeni yegazi, ikakhulukazi emithanjeni ejulile yemilenze (Deep Vein Thrombosis - DVT). |
| I-Endoleak | Inani elincane kakhulu legazi liyavuza phakathi kwe-stent graft esanda kufakwa kanye nodonga lomthambo wegazi, okwenza i-aneurysm igcwale igazi futhi. Lena inkinga eyinhloko engenzeka phakathi nalokhu kwelashwa. |
| Ezinye izinkinga | Ukuhlaselwa yinhliziyo, izifo, ukwehluleka kwezinso, kanye nokopha ngokweqile kungenzeka, kodwa lokhu akuvamile kakhulu. |
Kwenziwa kanjani ukuhlinzwa kwe-EVAR? Isinyathelo ngesinyathelo
Kulungile, manje ake sibone ukuthi lokhu kwelashwa kwenziwa kanjani ngempela. Uma usukuqonda kahle lokhu, ngeke kube khona ukwesaba okungadingekile.
1. I-Anesthesia: Okokuqala, uzonikezwa i-anesthesia ukuqinisekisa ukuthi awuzizwa ubuhlungu noma ukungakhululeki. Ungase ulale ngokuphelele, noma ungase ungazi lutho kancane.
2. Ukufinyelela: Udokotela uzosebenzisa imithambo yegazi eyinhloko endaweni yakho yangaphakathi (i-Femoral Arteries). Kuzokwenziwa ukusikwa okuncane esikhumbeni.
3. Ukufakwa kwe-catheter: Okulandelayo, kufakwa ithubhu elincane kakhulu neliguquguqukayo (i-catheter) eliqukethe i-stent graft ngembobo eya emthanjeni wegazi.
4. Isiqondiso: Le catheter idinga ukuqondiswa emthanjeni wegazi, kuze kufike lapho kukhona khona i-aneurysm esiswini. Ukuze akubone kahle lokhu, udokotela usebenzisa ubuchwepheshe obukhethekile bokuthwebula izithombe njenge-X-ray (Real-time imaging). Lokhu kusho ukuthi bakwenza lokhu ngokubuka i-catheter inyakaza ngaphakathi emzimbeni.
5. Ukubekwa kwe-Stent Graft: Uma isisendaweni efanele, udokotela uzonweba i-stent graft ngaphakathi kwe-catheter. Izobe isinwebeka ngaphakathi komthambo wegazi bese izinamathisela ngokuqinile ezindongeni, idale indlela entsha neqinile yokugeleza kwegazi.
6. Ukuqeda: Uma i-`(Stent Graft)` isibekwe kahle, i-catheter isuswa ngokucophelela. Imbobo esesinqeni incane kangangokuthi ayidingi ngisho nokuthungwa . Kungasetshenziswa into encane efana neplasta.
Kuthatha isikhathi esingakanani ukululama ngemva kokuhlinzwa?
Nakuba isikhathi sokuphulukiswa singahluka kumuntu nomuntu, yilokhu okuvame ukwenzeka.
- Kuzodingeka uhlale esibhedlela izinsuku ezimbalwa.
- Ngemva kokuhlinzwa, uzokwazi ukudla nokuphuza ngokushesha ngemva kwalokho.
- Ngosizo lwabahlengikazi, bamtshela ukuthi avuke embhedeni aqale ukuhamba ngokushesha okukhulu.
- Uzozizwa ukhathele kancane ezinsukwini ezimbalwa zokuqala ngemva kokubuyela ekhaya, futhi kuzodingeka uthathe imithi yobuhlungu. Lokho kuvamile.
- Ungashayeli uze uthathe imithi yokubulala izinhlungu .
- Iningi labantu liyakwazi ukubuyela emisebenzini yalo kungakapheli inyanga .
- Kufanele ugweme ukuphakamisa izinsimbi amasonto angu-4-6 .
Uma unalezi zimpawu, xhumana nodokotela ngokushesha!
Ngemva kokubuyela ekhaya, kubalulekile ukunaka umzimba wakho. Uma uhlangabezana nanoma yiziphi izimpawu ezingezansi, shayela udokotela wakho ngokushesha.
- Ukuvuvukala, ubuhlungu, noma isikhumba esipholile emilenzeni, ikakhulukazi emilenzeni engezansi (lokhu kungaba izimpawu ze-DVT).
- Uma uzizwa unesizungu noma uphelelwa amandla .
- Uma uzwa ubuhlungu obukhulu esiswini sakho, esifubeni, noma emhlane .
- Ukushaya kwenhliziyo kwenzeka lapho uzwa inhliziyo yakho ishaya ngokushesha.
- Uma uzwa ukubomvu endaweni yesinqe noma ubuhlungu obungavamile emlenzeni .
Ukwelashwa nge-EVAR kuyindlela engcono kakhulu, engebuhlungu kakhulu kunokuhlinzwa okuvulekile kwendabuko. Ungalulama ngokushesha bese uya ekhaya. Kodwa-ke, awukwazi ukukhohlwa ukuthi ukwelashwa kube yimpumelelo. Njengoba udokotela esho, kubalulekile ukubuya ngesikhathi esihleliwe bese kwenziwa esinye iskeni. Yileyo ndlela ongahlola ngayo ukuthi i-`(Stent Graft)` ebekwe isebenza kahle nokuthi ngabe kukhona yini izinkinga ezifana ne-`(Endoleak)`.
Umlayezo Wokuya Nawe Ekhaya
- I-EVAR iyindlela yokwelapha yesimanje engangenisi kakhulu esetshenziswa ukuvimbela ukuqhekeka kwe-aneurysm emthanjeni wegazi oyinhloko esiswini, i-aorta.
- Lapha, kufakwa i-stent graft emthanjeni wegazi kusetshenziswa ithubhu elincane elibizwa ngokuthi i-catheter, elifakwa nge-groin, ngaphandle kokwenza i-incision enkulu.
- Isikhathi sokuhlala esibhedlela, ubuhlungu, kanye nesikhathi sokululama sincane kakhulu kunesokuhlinzwa okuvulekile.
- Ngisho nangemva kokwelashwa, kubalulekile ukuqhubeka nokuya kokuhlolwa njengoba udokotela emyalile. Lokhu kuzosiza ekutholeni izinkinga ezingaba khona kusenesikhathi.
- Uma uhlangabezana nanoma yiziphi izimpawu ezingavamile (ukuvuvukala emilenzeni, ubuhlungu obukhulu, isiyezi) ngemva kokuhlinzwa, funa iseluleko sezokwelapha ngokushesha.
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