Ingabe lokhu kuyindlela efanele yokwelapha?
I-Angioplasty ne-stenting ziye zashintsha indlela yokwelapha izifo ze-coronary artery , kodwa lezi zindlela zokwelashwa ziye zaletha uhlobo olusha lwenkinga ku-mix. Lena yinkinga yokuphumula - ukuvinjwa okuqhubekayo esakhiweni sokwelapha. Ekuqaleni kweminyaka eyi-2000, ukwelashwa kwe-brachytherapy, noma i-coronary artery therapy, kwaqala ukwelashwa okusha okuthembisayo kokuphumula.
Kodwa ngenkathi i-brachytherapy yayiyi-(futhi ikhona) ephumelelayo kakhulu yokuphumula, manje isetshenzisiwe ngokusetshenziswa kwezidakamizwa-eluting stents .
I-restenosis ngemuva kwe-angioplasty noma i-stenting ibangelwa ukukhula ngokweqile kwezicubu endaweni yokulashwa. Kubangelwa ukusabela okwedlulele ngokweqile, okwenza ukwanda kwamaseli "endothelial" ngokuvamile avamise imithwalo yegazi. Lokhu kukhula kwezicubu kunganciphisa kancane kancane umthambo.
I-brachytherapy ingaphatha ukuphumula ngokubulala amangqamuzana amaningi futhi kuvimbele ukukhula komzimba.
I-Brachytherapy isetshenziswa kanjani?
I-brachytherapy ilawulwa ngesikhathi senqubo ekhethekile yokwelapha inhliziyo. Umshini ngokwawo uhlinzeka ngohlobo olukhethekile lwe-catheter olwenzelwe ukusebenzisa imishanguzo evela emgodini we-coronary. I-catheter idluliselwa emithanjeni ye-coronary kanye nokuvinjelwa okubangelwa ukuphumula. Uma indawo "ekhonjiwe" yendawo ehlosiwe yi-catheter, imishanguzo isetshenziswa.
Izinhlobo ezimbili zemisebe zingasetshenziswa: imisebe ye-gamma nemisebe ye-beta. Zombili izinhlobo zemisebe ziyinkimbinkimbi yokusebenzisa, futhi zidinga ukutholakala kwemishini ekhethekile ebhodini, ukutholwa kwezinqubo ezikhethekile zokuqapha, kanye nabantu abaqeqeshwe ngokukhethekile, ngokuvamile kubandakanya i-oncologist yemisebe.
Izazi ze-cardiologists ezisebenzise i-brachytherapy ziyavuma ukuthi isihluthulelo sempumelelo yimpumelelo yomqhubi. Lezi zinqubo eziyinkimbinkimbi ezidinga okungaphezu kobuchwepheshe obujwayelekile bodokotela wezinhliziyo ezijwayelekile.
Ukuphumelela
Ucwaningo lwezokwelapha lubonise ukuthi i-brachytherapy isebenza kahle ekunciphiseni ukuphumula emithanjeni ye-coronary, nokunciphisa ingozi yokuqhubeka nokuphumula. Ngaphezu kwalokho, ukuhlola kubonakala kubonisa ukuthi iziguli ezinengozi enkulu yokuphumula- (njengabantu abanesifo sikashukela ) -bafuna ukuthola inzuzo enkulu emithini yokwelashwa.
Izinkinga
I-Brachytherapy ayiyona inkinga. Inkinga eyodwa eyingqayizivele ebonwe nge-brachytherapy bekulokhu "umphumela onqenqemeni" - ukubonakala kwezingqimba ezintsha emkhawulweni we-radiation field (indawo ephathwe ngemisebe). Lesi sifo sesiphetho esiphezulu, esithatha isibonakaliso se-barbell noma i- "candy-wrapper" lapho siboniswa nge-angiogram, kuyiphumela elibi elibi eliyinkimbinkimbi yokwelapha. Lezi zilonda zomsindo zingabangelwa ukubekwa kwe-catheter ngokuzibophezela lapho kuhlinzeka i-brachytherapy.
Futhi, iziguli eziphathwa nge-brachytherapy zibonakala zinengozini yokukhula kwe- coronary artery thrombosis (igazi clot).
Ngokuvamile, uma i-thrombosis ilandela i-angioplasty noma i-stenting, ngokuvamile ivele zingakapheli izinsuku ezingu-30 zenqubo. Kodwa i-thrombosis sekwephuzile (eyenzeka ngemva kwezinsuku ezingu-30 zokuqala) ibonakala cishe ezigidini ezingu-10 zeziguli ezithola ubuchopho. Le-thrombosis esedlule ihlotshaniswa ne- infarction ye-myocardial (ukushaya kwenhliziyo ) noma i- angina engaqiniseki . Ukuze usize ukunciphisa lo mngcipheko, ukunciphisa igazi kuyanconywa okungenani ngonyaka ngemuva kwe-brachytherapy.
Kungani I-Brachytherapy Isebenza Ngokuvamile Namuhla?
I-Restenosis yiyona nkinga enkulu engazange ixazulule ezinsukwini zokuqala ze-angioplasty ne-stenting, futhi iminyaka eminingana i-brachytherapy ibonakala njengendlela ethembisayo yokubhekana nokuphumula.
Noma kunjalo, manje isetshenziselwa ukungajwayelekile.
Ukubukeka kwezidakamizwa-e-euting stents kusheshe kwenziwe ukuthi i-brachytherapy isondele cishe. Ucwaningo oluqhathanisa ukuphepha nokusebenza kwe-brachytherapy kuma-stuting-stuting stents ekuphatheni ukuphumula kubonisa kahle ukuthi ama-stents anika imiphumela engcono. Ngaphezu kwalokho, izazi ze-cardiologists zikhululekile ukubeka ama-stents, futhi ama-stents awadingi ukuphazamiseka, izindleko, kanye nobuchwepheshe obukhethekile obudingekayo yi-brachytherapy. Akuzange kuthathe isikhathi eside ukuguqulwa kwe-brachytherapy ngokuyinhloko kwehla kumephu.
Noma kunjalo, i-brachytherapy isebenza kahle futhi iphephile futhi ivunyiwe ukuze isebenziswe yi-Food and Drug Administration. Izikhungo ezimbalwa ezikhethekile zisekela njengendlela yokuphatha ukuphumula.
Namuhla, i-brachytherapy ngokuvamile ibhekwa njengokhetho kuphela kweziguli eziye zazithola zikhona ukuphumula okulandelayo, futhi lapho izidakamizwa eziphuza izidakamizwa ziye zahluleka ukuxazulula inkinga. Ukwamukela ubuchopho buhlungu lezi ziguli kudingeka zidluliselwe kwenye yezikhungo ezimbalwa ezisekela lolu hlobo lwezokwelapha.
Imithombo:
I-Teirstein PS, i-Massullo V, uJani S, et al. Iminyaka emithathu yokulandela imitholampilo kanye ne-angiographic emva kweminye imisebe ye-intracoronary: imiphumela yesilingo somtholampilo esihleliwe. Ukujikeleza kuka-2000; 101: 360.
USapirstein W, uZuckerman B, Dillard J. FDA ukuvunyelwa kwe-coronary-artery brachytherapy. N Engl J Med 2001; 344: 297.
Holmes DR Jr, Teirstein PS, Satler L, et al. Ukulandelwa kweminyaka engu-3 kwe-SISR (i-Sirolimus-Eluting Stents Versus Vascular Brachytherapy ye-In-Stent Restenosis). I-JACC Cardiovasc Interv 2008; 1: 439.