Ukubheka i-aorta esifubeni? Ake sifunde ngokwelashwa kwe-TEVAR (Ukulungiswa kwe-Thoracic Endovascular Aortic)

Uke wezwa ngomthambo wegazi omkhulu nobaluleke kakhulu emzimbeni wakho? Siwubiza ngokuthi i-aorta . Cabanga ngawo njengepayipi lamanzi eliyinhloko elithwala igazi emzimbeni wakho wonke. Kodwa ngezinye izikhathi, udonga lwale aorta luyabuthaka bese luqala ukukhukhumala njengebhaluni. Kwezokwelapha, lokhu sikubiza ngokuthi i-aneurysm . Kufana nepayipi lamanzi elidala elikhukhumalayo. Uma leli bhaluni liqhuma, kungaba yingozi kakhulu empilweni yakho. Kodwa ungakhathazeki, ngokuthuthuka kwesayensi yezokwelapha, manje sekukhona ukwelashwa okuphumelelayo kakhulu kwezimo ezinjalo. Namuhla, sikhuluma ngendlela yokwelapha ekhethekile eyenziwa ngaphandle kokuhlinzwa okukhulu.

Iyini ngempela i-TEVAR?

Kalula nje, i-TEVAR (Thoracic Endovascular Aortic Repair) iyindlela yokwelapha yesimanje, engangenisi kakhulu esetshenziselwa ukulungisa umonakalo ku-aorta yesifuba, ikakhulukazi ama-aneurysms.

Esikhathini esidlule, lesi simo sasiphathwa ngokuhlinzwa okukhulu, okuvulekile okuhilela ukuvula isifuba. Kuyinkimbinkimbi kakhulu, kuthatha isikhathi eside ukuphulukiswa, futhi kunezingozi ezinkulu. Kodwa manje, ezigulini ezifanelekayo, odokotela bakhetha kakhulu le nqubo ye-TEVAR. Inesikhathi esifushane sokululama, ingozi ephansi yezinkinga ezinkulu, futhi ikhululekile kakhulu esigulini. Udokotela wakho uzonquma ukuthi lokhu kwelashwa kulungile yini kuwe ngokusekelwe ezicini ezifana nokwakheka kwemithambo yegazi yakho.

Yiziphi izimo ezisetshenziswa ukwelashwa kwe-TEVAR?

Odokotela abahlinzayo basebenzisa kakhulu le ndlela ye-TEVAR ezinhlotsheni eziningana zomonakalo ku-aorta.

Ngingalungiselela kanjani ngaphambi kwalokhu kuhlinzwa?

Udokotela wakho uzokuchazela lokhu ngokuningiliziwe . Ngokuvamile kufanele ulungele izinto ezifana nalezi:

• Ukusetshenziswa kwemithi: Uma uthatha imithi yomfutho wegazi ophakeme noma i-cholesterol, kufanele uyisebenzise njengoba nje kuqondiswe.
• Gwema ukubhema: Uma ubhema, kuzodingeka uyeke ngokuphelele ngaphambi kokuhlinzwa.
• Eminye imithi: Tshela udokotela wakho nganoma yimiphi eminye imithi oyithathayo njengamanje (isib. imithi yokunciphisa igazi). Kungadingeka ukuthi iyekwe okwesikhashana noma ishintshwe, uma kudingeka, ngokweseluleko sakhe.
• Ukuhlolwa kwangaphambi kokuhlinzwa: Kuzodingeka kwenziwe ukuhlolwa okuningana ngaphambi kokuhlinzwa.

Ukuhlolwa kwangaphambi kokuhlinzwa

Esinye sezivivinyo ezibaluleke kakhulu i-CT angiogram . Lokhu kungaveza isithombe esicacile, esinobukhulu obuthathu sobukhulu, indawo, kanye nempilo ye-aorta yakho kanye neminye imithambo yegazi exhuma kuyo. Ukuze ukuhlinzwa kwe-TEVAR kuphumelele, kumele kube nendawo eyanele emithanjeni yakho yegazi ukuvumela ithubhu elincane (i-catheter) elisetshenziselwa ukwelashwa ukuthi lidluliselwe ku-aorta.

Odokotela bavame ukufaka leli payipi ngemithambo ye-femoral, edlula embotsheni yomlenze. Kodwa uma lowo mthambo wegazi uncishisiwe noma uvalwe yi-cholesterol deposits (i-plaque), kufanele bathole enye indlela. I-CT scan ibalulekile ukuhlela konke lokhu.

Lezi zivivinyo zikusiza futhi ukuthi ukhethe usayizi ofanele kanye nohlobo lwe -stent graft yengxenye eyonakele ye-aorta yakho.

Indlela yokuhlinzwa kwe-TEVAR eyenziwa ngayo

Lapho benza lokhu kwelashwa, ithimba lokuhlinzwa lilandela lezi zinyathelo:

1. I-Anesthesia: Uzonikezwa i-anesthesia ejwayelekile noma i-anesthesia yendawo ene-sedation ukuqinisekisa ukuthi awuzizwa ubuhlungu futhi ukhululekile phakathi nokuhlinzwa.

2. Ukuvikelwa komgogodla:Kwezinye izimo (hhayi wonke umuntu), ipayipi elincane (i-lumbar drain) elisusa inani elincane loketshezi lwe-cerebrospinal emgogodleni lingasetshenziswa ukuvimbela umonakalo obangelwa ukwehla kokugeleza kwegazi emgogodleni ngesikhathi sokuhlinzwa.

3. Ukusikwa okuncane: Ukusikwa okuncane kakhulu kwenziwa esikhumbeni endaweni ye-groin yomlenze, eduze komthambo we-femoral.

4. Ukufakwa kwepayipi: Ngalesi simbozo, intambo encane (intambo yokuqondisa) idluliselwa emthanjeni wegazi ize idlule engxenyeni eyonakele ye-aorta. Ngemuva kwalokho, ipayipi elincane elibizwa ngokuthi i-catheter ene-stent graft ngaphakathi lifakwa phezu kwale ntambo. Konke lokhu kwenziwa ngaphansi kwesiqondiso sendlela ekhethekile efana ne-X-ray ( i-fluoroscopy ).

5. Ukubekwa kwe-stent: I-catheter iqondiswa endaweni eqondile yomonakalo bese i-stent graft engaphakathi iyakhululwa. Ivuleka njengesiphethu bese inamathela ngokuqinile ezindongeni ze-aorta.

6. Umsebenzi: Lo mthambo we-stent manje usebenza njengolwelwesi olusha lwe-aorta. Uma kwenzeka i-aneurysm, igazi ligeleza ngaleli lwelwesi elisha. Lokhu kususa ingcindezi odongeni olubuthakathaka egazini. Lokhu kuyalivimba ukuthi likhule futhi liqhume.

7. Ukuqedwa kokuhlinzwa: Ngemva kokufakwa kwe-stent, i-catheter iyasuswa, ukusikwa okuncane okwenziwe embotsheni kuyavalwa ngokuthunga bese kufakwa ibhandishi.

Ngokuvamile, yonke le nqubo ithatha cishe amahora amabili.

Yiziphi izinzuzo zokwelashwa kwe-TEVAR?

Lezi yizizathu ezenza odokotela bakhethe indlela ye-TEVAR kunokuhlinzwa okuvulekile.

• Isikhathi sokululama kanye nokuhlala esibhedlela kufushane kakhulu.
• Njengoba kungekho ukusikwa okukhulu kokususa ibele, ubuhlungu buyancipha.
• Ukopha okuncane ngesikhathi sokuhlinzwa.
• Inemiphumela ephumelelayo efanayo nokuhlinzwa okuvulekile.
• Ingozi yezinkinga ezinkulu noma ukufa iphansi (cishe izinga lokusinda elingu-98% nge-TEVAR, uma kuqhathaniswa no-88%-94% ngokuhlinzwa okuvulekile).
• Umonakalo ovela ekuncipheni kokunikezwa kwegazi kwezinye izitho (ischemia yesitho sokuphela) mncane kakhulu.

Ingabe zikhona izingozi ngalokhu kwelashwa?

Njenganoma yikuphi ukuhlinzwa, kunezingozi ezithile ezihilelekile, kodwa azivamile kakhulu.

• I-Endoleak: Igazi lisavuza eduze kwe-stent graft lingena ku-aneurysm.
• Ukutheleleka: Ukutheleleka endaweni yokuhlinzwa.
• Ukunyakaza kwe-graft: I-stent ebekwe isuka kancane endaweni yayo yokuqala.
• Ukukhubazeka: Akuvamile kakhulu, ukulahleka kokusebenza emilenzeni ngenxa yokuncipha kokunikezwa kwegazi emgogodleni.
• Ukuhlaselwa yinhliziyo noma isifo sohlangothi.

Khuluma nodokotela wakho ngalezi zingozi kanye nezinyathelo ongazithatha ukuze uzinciphise.

Ukululama nokulandelela

Ngemva kokuhlinzwa, uzohlala egunjini labagula kakhulu (ICU) usuku olulodwa noma ezimbili. Ngemva kwalokho, uzodluliselwa egunjini elivamile futhi uzokwazi ukuya ekhaya phakathi nosuku noma isonto. Uma ubuyela ekhaya, nakekela lezi zinto:

• Ungashayeli isonto elilodwa noma amabili.
• Ungangeni ebhavini lamanzi kuze kube yilapho imbobo yesisu isipholile (kulungile ukugeza).
• Ungaphakamisi ngaphezu kwama-5 kg ​​amasonto angu-1-2.

Uma uba nezimpawu zokuhlaselwa yinhliziyo (isib. ubuhlungu obukhulu besifuba) noma isifo sohlangothi (isib., ukugoba kolunye uhlangothi lobuso, ubunzima bokukhuluma), hamba ngokushesha eMnyangweni Wezimo Eziphuthumayo (ETU) wesibhedlela esiseduze.