Indlela Yokuhlinza Yokunciphisa Ingozi Yokushaya Isisu
I-carotid endarterectomy iyindlela yokuhlinza lapho i-plaque isuswa khona emthini we-carotid. Ama-Plaques yizindawo zokukhiqiza amafutha emithanjeni yegazi. Emthini we-carotid, i-plaque inganciphisa ukuvulwa, ukunciphisa ukugeleza kwegazi kuya ebuchosheni kanye nokwandisa ingozi yezindwangu eziqhekeza i-plaque futhi ihamba ngemikhumbi ye-cerebral ukuze ibangele isifo.
Lokhu kunciphisa kwesitsha segazi kuthiwa yi- stenosis .
Ukuvamile
Odokotela bebelokhu bekwenzela i-carotid endarterectomy isikhathi eside, futhi bawenza njalo njalo ezindaweni ezinkulu zokwelashwa. I-CEA yokuqala yenziwa ngo-1953 nguDkt DeBakey eHouston, eTexas. Ngesikhathi samanje, ukuphela kwe-carotid endarterectomies kwenziwa minyaka yonke e-United States.
Inqubo
Ngesikhathi i-endarterectomy ye-carotid, udokotela ohlinzayo uvula umthambo we-carotid futhi ususe i-plaque eyakhelwe engxenyeni yayo yangaphakathi, eyaziwa ngokuthi i-endothelium.
Isinyathelo sokuqala ukuqinisekisa ukuthi isiguli senza ukhululekile ukusebenzisa i-anesthesia ejwayelekile noma yendawo. Ezinye iziguli zikhetha i-anesthesia yendawo ukuze zihlale ziphapheme futhi zitshele udokotela ohlinzayo uma bezwa noma yini engafanele. Le ndlela ibuye ivumele udokotela ukuba ahlole isimo sesifo sengqondo ngesiguli ngokucela ukuba benze izinto ezifana nokucindezela isandla. Abanye bangathanda ukulala ngokusebenzisa le nqubo.
Kulokhu, ukuqapha kwe-electrophysiologic intraoperative namasu afana ne- electroencephalography (i-EEG) ingasetshenziselwa ukuqinisekisa umsebenzi oqhubekayo wobuchopho. Akukho bufakazi obonise umehluko emphumela phakathi kokusebenzisa i-anesthesia yendawo noma ejwayelekile endarterectomy ye-carotid.
Ngemuva kokuba i-anesthesia ihlinzekwe, udokotela ohlinzayo uvala umcibisholo ukuze awugcine egazini ngesikhathi senqubo.
Ngesikhathi i-artery iphoqa, ubuchopho buyoxhomeka emthini we-carotid ohlangothini oluphambene negazi layo. I-incision yenza umthambo wokugcoba, futhi ungqimba lwamathishu aqukethe i-plaque lusiwe. Uma isikhala sisusiwe, udokotela ohlinzayo ugcizelela umthamo ndawonye, futhi i-clamp isusiwe.
Abafundi
Ingozi yokuba nesifo sokushaya isifo cishe ngamaphesenti angu-1 kuya kwangu-2 ngonyaka kubantu abane-carotid stenosis. I-National Institute for Health kanye ne-Clinical Excellence iye yancoma ukuthi iziguli ezinomthelela ophansi ukuya kwi-stenosis ezinzima ezasanda kuhlaselwa yisifo sokushaya isisu noma ukuhlaselwa kwe-ischemic okudlulayo kune-endarterectomy zingakapheli amasonto amabili.
Izivivinyo ezinkulu zemitholampilo zibonise ukuthi uma isiguli sinamabonakaliso, kulindeleke ukuba siphile iminyaka emihlanu noma ngaphezulu, futhi unomhlinzeki ohlinzayo onekhono elinamaphesenti angaba ngu-3 wezinkinga, leso siguli singazuza ku-endarterectomy.
Izinzuzo zimbalwa kubantu abangenayo izimpawu, kodwa ezimweni ezinzima, i-endarterectomy ye-carotid ingase iqhubeke ifanelekile. Kukhona ukuphikisana okuningi phakathi kwabahlengikazi mayelana nesikhathi sokwenza i-endarterectomy kubantu abangenakulinganiswa, ikakhulukazi njengoba ukuphathwa kwemithi kwalezi ziguli kuthuthukisa isikhathi.
Ukungafani
I-carotid endarterectomy akumele ivivinywe uma umshini wangaphakathi we-carotid uvinjelwe ngokuphelele. Yize kungase kubonakale kungaqondakali, ayikho inzuzo eyaziwayo yokuvula umshini ovalwe ngokuphelele, mhlawumbe ngoba uma umshini uvaliwe, ayikho indlela yokuthi i-clot ivuke emgqeni futhi ihambele ebuchosheni.
Uma sekukhona kakade isifo esibucayi ohlangothini lobuchopho olunikezwe umshini omncane, kunenzuzo encane yokuba inqubo yenziwe. Iningi lomonakalo ongase lenziwe livele lenzekile, futhi inqubo ingayandisa ingozi yokugaya endaweni esithintekile yi-stroke.
Uma udokotela ohlinzayo noma i-anesthhesiologist enquma ukuthi othile unenkinga enkulu kakhulu yezokwelapha futhi kungenzeka ukuthi unenkinga yokuhlinzwa, ke ukuhlinzwa akufanele kuqhubeke.
Ukuhlolwa kokuqala
Ukucabangela imithwalo yegazi entanyeni kufanele kwenziwe ukucacisa ubunzima nendawo ye-plaque. Kunezindlela ezimbalwa ezihlukene zokubuka i-artery carotid yangaphakathi. I-ultrasound ye-Duplex isebenzisa amagagasi omsindo ukukhombisa ukuthi igazi ligeleza kanjani ezitsheni. I-angiography yendabuko ye-cerebral ihilela ukufaka idayisi ehlukile emithanjeni yegazi futhi ubheke ukuthi isakazeka kanjani ezitsheni nge-x ray. Nakuba lokhu kubhekwa njengendinganiso yegolide emibonweni ye-vascular, kuyingozi, futhi izithombe ezinhle kakhulu zingenziwa nge-CT angiogram (CTA) noma i-MR angiogram (MRA). Uma enye indlela yokubheka izitsha iholela emiphumeleni engaqondakali, udokotela angase acele ukuhlolwa okungaphezu kweyodwa.
Izinkinga ezingenzeka
I-CEA ingahle ihlangane nezinkinga ezinzima njenge-stroke noma ukufa ngenxa yenqubo, noma kunjalo, ingozi iphansi kakhulu. Amaphesenti angaba ngu-3 iziguli ezingenazo izimpawu kanti amaphesenti angu-6 weziguli ezinezibonakaliso zihlupheka ngalezi zinkinga. Lesi esinye isizathu sokuthi kungani kubalulekile ukuba sibe nempilo enhle ngokuhlinza: Ngengozini yokuqwashisa komzimba we-1 amaphesenti ngonyaka ngaphandle kokuhlinzwa, kungathatha iminyaka embalwa ukuthi izinzuzo zentsebenzo zibe ngaphezu kwezingozi. Lokho kusho ukuthi ingozi enkulu yokuthola isifo ngenxa yomsindo omncane we-carotid kungekudala ngemuva kokushaya isifo sangaphambilini, lapho kwenzeka ukuhlinzekwa kufanele kunconywe ngokushesha ngangokunokwenzeka.
I-Hyperperfusion syndrome ingenye imiphumela engaba yingozi eyingozi ye-carotid endarterectomy. Uma ingxenye yobuchopho isenqatshelwe ukugeleza kwegazi isikhathi eside, ingase ilahlekelwe amandla ayo okulawula ukuthi igazi lingavame kangakanani ukugeleza kulowo methini yegazi. Lapho ukugeleza kwegazi kungazelelwe ngemuva kokunciphisa ukuxazululwa, ukuhluleka kwengqondo ukulawula ukuthi ukugeleza kwegazi kungabangela umsebenzi wokuvuvukala nokunciphisa, ongase ulingise isifo .
Izinkinga ezinzima kakhulu zenqubo zifaka umonakalo emndenini we- hypoglossal , okungahambi kahle ulimi, okungaholela ekutheni ulimi lubuthakathaka ohlangothini olulodwa. Futhi, njengokunye okuhlinzwa, kunengozi yokutheleleka nokuphuma kwegazi.
Imithombo:
IKomidi eliPhezulu le-Asymptomatic Carotid Atherosclerosis Study (ACAS). I-Endarterectomy ye-carotid artery stenosis. Jama. 1995; 273: 1421-1428.
Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, Thomas D. Ukuvimbela ukukhubaza kanye nokushaya okubulalayo nge-endarterectomy ephumelelayo ye-carotid ezigulini ezingenazo izimpawu zamuva ze-neurological: isilingo esilawulwa ngokungahleliwe. I-Lancet. 2004; 363: 1491-1502.
USharon Swain, uClaire Turner, uPippa Tyrrell, u-Anthony Rudd egameni leNkombandlela yokuThuthukiswa kweQembu, Ukuxilonga kanye nokuphathwa kokuqala kokuhlasela kwesisindo esiphuthumayo nokuhamba kwesikhathi eside: isifingqo se-NICE isiqondiso, BMJ 2008; 337: a786, kufanele: 10.1136 / bmj.a786 (Ishicilelwe ngo-24 Julayi 2008)