I-tracheal stenosis yinkimbinkimbi ye- trachea yakho, noma i-windpipe, ngenxa yokwakheka kwezicubu ezibomvu noma ukuchithwa kwe-cartilage e-trachea. Ngenkathi ukunciphisa okuncane ku-trachea yakho kungase kungabonakali, ukunciphisa okukhulu kwamaphesenti angaphezu kwamaphesenti angu-50 ohambo lwakho kungabangela izinkinga ezinkulu. Izimbangela ezintathu ezivame ukwanda kwe-tracheal stenosis yizo:
- Ukubekwa isikhathi eside kwe- tube endotracheal (tube yokuphefumula) noma i-tracheostomy
- Isifo sofuba esiswini
- I-Collagen isifo se-vascular (granulomatosis ne-polyangitis, eyaziwa nangokuthi i-Wegener granulomatosis)
Ezinye izimbangela eziziwa zihlanganisa:
- Ukukhubazeka kwama-Congenital (ukukhubazeka kokuzalwa)
- I-Trauma
- I-inhalation iyashisa
- Ukwelashwa kwamafutha
- Izifo ze-trachea
- Izifo ezivuthayo (sarcoidosis noma amyloidosis)
- I-Cancer
Emdlavuza nasezintweni ezingasebenzi, umoya womoya uyancintiswa noma ungaphandle kwe-trachea, noma kusukela ekungenikeni kwe-cartilage engasebenzi kahle. Ezinye izimbangela ze-tracheal stenosis zivame ukuqala ngesilonda esiswini. I-ulceration iqala ukuqhuma kwesibindi , okuyinto inqubo yokuphulukisa evamile, engagxiliwe futhi ibangele izicubu ezinzima kunalokho okuvame ukudingeka. Lezi zicubu zomzimba ezengeziwe zinciphisa indawo e-trachea yakho.
Isimo se-Tracheal Stenosis
Ukuvama kokuthola i-tracheal stenosis kuncike ekubambeni kwe-tracheal narrowing.
Ukulimala kokuthunyelwa kwesikhumulo sezindiza kungavamile, noma kunjalo ingozi yokuqina kwesifo ngokuvamile ingaphansi kwamaphesenti amabili. Lezi zinto ezilandelayo eziyingozi ziyokwandisa amathuba akho okuba nesimo sokuthunyelwa ngemuva kokufaka isikhalazo noma i-tracheostomy ehlobene ne-tracheal stenosis:
- Owesifazane
- Ukuqapha kakhulu
- Isifo sikashukela
- I-hypertension
- Isifo senhliziyo
Ukuthunyelwa kokuthunyelwe noma ukuthunyelwa kwe-post-tracheostomy kunganciphisa uma lokhu okulandelayo kwenziwa ku-ICU:
- Ukuba nomfutho we-balloon noma endlectracheomy ibhaluni ukucindezela kwamanzi okuphakathi kuka-20 kuya ku-30 cm wezingcindezi zamanzi
- Ukuvimbela ukutheleleka ngokunakekelwa kahle ngomlomo okwenziwe ngokuthandela njengoba kudingekile ukuvimbela ukutheleleka noma ukuvula imimoya nge-mucus
- Ukushintshanisa ithubhu yokuphefumula indawo ngaphandle komlomo ukuze unciphise ingcindezi
- Ukulondoloza ukujula okwanele kwe-tube yokuphefumula
- Ukuvimbela izinkinga ngamatayipi wokuphefumula ngenkathi ufaka nokuvimbela ukususwa ngengozi uma unenkinga yokuhamba emoyeni.
I-tracheal stenosis ingaba yinye yezibonakaliso zokuqala ezibonwe ku-granulomatosis nge-polyangitis. Ukuqina kwesifo kungenzeka cishe ngamaphesenti angama-16 kuya kwangu-23 esikhathi. Ayikho idatha eminingi etholakalayo ekusakazeni kwezinye izimbangela ze-tracheal stenosis.
Izimpawu Ze-Tracheal Stenosis
E-stenosis ye-tracheal stenosis, i-stenosis elula ingase iqondwe ngokuthi i-asthma noma i-bronchitis ephindaphindiwe. Nge-Stenosis ye-tracheal, ungase ungabonakali izimpawu kuze kube yilapho usencane noma ubusha lapho ubonakala sengathi izimpawu ziphefumula ngokuzivocavoca. Ezimweni ezimbi kakhulu ze-stenosis yokuzalwa yangasese, ungabona lezi zimpawu ezilandelayo:
- Umzila (umsindo ophefumulayo ophezulu)
- I-Cyanotic, enezindebe eziluhlaza okwesibhakabhaka
- Gubha nge-inhalation
- Ukuphefumula okuvelayo (dyspnea)
Kwezinye izimo ze-tracheal stenosis, izimpawu zingase zingabonakali amasonto ambalwa ngemva kokulimala. Inzima ngokuphefumula yilona uphawu oluvamile lokuqala. Njenga-stenosis ye-congenital tracheal, ungase ubone isiteji, ukushaywa umoya noma ukuphefumula okuphefumulelwe.
Ukuxilongwa kwe-Tracheal Stenosis
Izindlela eziningana zokuhlola zingasetshenziswa ukusiza udokotela wakho ukuba anqume ukuthi une-tracheal stenosis noma cha. I-bronchoscopy ibhekwa ngokuthi "i-Gold Standard" yokuthola ukuxilongwa kwe-tracheal stenosis ngoba udokotela wakho uzokwazi ukubona ngeso lengqondo umkhondo wakho.
Kodwa-ke, kunezingozi ezithile ezihambisana nalokhu ngoba ukusebenzisa indawo kuzokwenza ukuthi uvinjelwe umoya wakho, ngakho-ke ukugcina amazinga akho okuphefumula kungase kube nzima nakakhulu. Xoxa ngezici zakho eziyingozi ezihambisana ne-bronchoscopy nodokotela wakho.
Ezinye izindlela udokotela wakho angasebenzisa zihlanganisa i-ray ray, i-CT scan, i-ultrasound, i-MRI, kanye nokuhlolwa komsebenzi we-pulmonary. Ama-x-ray ajwayelekile afanele ukuhlonza isakhiwo, amakholomu emoyeni, ukuhlukumezeka, kanye neminye imininingwane yokuqala. Iminye imishini yama-x-ray eyinkimbinkimbi ingahle isetshenziswe (ukulandelana kwemibhalo) ukuze kuqhutshekwe ukuhlonza i-stenosis, kodwa ukuvezwa kwemisebe kuphakeme kakhulu kunezinye izindlela.
I-CT ukuskena kungaba yindlela enhle kumdokotela wakho ekunqumeni ukuthi une-tracheal stenosis noma cha. Kodwa-ke, kunenkinga yokukhomba izicubu ezithambile zezimbangela zokunciphisa umthamo wakho. Amanye amasu asetshenziswa ngendlela yokudala "i-endoscopy ebonakalayo" ukuze unciphise isidingo sokuba ube ne-bronchoscopy. Kodwa-ke, ukuskena kwe-CT akuyona indlela enhle yokuthola izinga eliphansi kakhulu lokuqina kwe-stenosis.
I-Ultrasound ingasiza ekuboneni inani lendawo yomoya emoyeni. Lokhu kuvumela udokotela wakho ukuba anqume ukuthi ngabe ukuhlolwa okungadingekile noma okungadingeki yini, noma kunjalo, ngenxa yemali ye-cartilage eseduze ne-trachea, ukunemba kwesivivinyo kungenziwa kubuzwe ngenxa yemiphumela yokuthunjwa ebangelwa ukucubungula kwamagagasi omsindo ovela ku-cartilage. Shiya lokhu kuhlolwa kuphela kulabo abanekhono kakhulu ekuboneni i-tracheal stenosis nge-ultrasound.
Ukuskena kwe-MRI kuyindlela engcono kakhulu yokusiza ekutholeni ukuqubuka kwe-tracheal stenosis, futhi ezinganeni kuthathwa njengendlela ejwayelekile. Ukwehluleka okukhulu kwe-MRI ubude besikhathi obudinga ukuzibophezela ukuba kwenziwe inqubo futhi ukufiphaza okungavela ekuphefumuleni okuvamile phakathi nokuhlolwa. Amasu athuthukisiwe aqhubeka ethuthukiswa ukuze athuthukise ukusetshenziswa kwale nqubo ekutholeni ukutholakala kwesifo se-tracheal stenosis.
Ukuhlolwa kokusebenza kwamapulmonary kungenziwa kwezinye amahhovisi odokotela, noma uma kungatholakali, uzothunyelwa ebhokisini lepayipi. Lokhu kuhlolwa kungasetshenziselwa ukunquma ukuthi umthelela omkhulu kangakanani ekuvimbeleni ukuphefumula kwakho. Lokhu kuzosiza ezinkulumweni mayelana nokukhethwa kokwelashwa nodokotela wakho.
Ukwelashwa kwe-Tracheal Stenosis
Kunezinketho eziningana zokwelapha i-stenosis ye-tracheal futhi udokotela wakho uzoxoxa ukuthi yikuphi okukhethwa kukho okungabonakali futhi okungenzeka kube nomphumela omuhle wokunakekelwa kwakho ngabanye. Iziningi zokwelashwa yizinqubo zokugcina ezidinga ukubonakala kahle kwe-trachea yakho. Uma indawo ye-stenosis iyingcosana, ukubeka i-stent, ukuhlanza i-trachea yakho ibhaluni, noma ukususa ezinye izicubu ezibomvu nge-laser kuzosiza ukunciphisa i-stenosis. Phakathi nalezi zinqubo, udokotela wakho angaphinde ajobe izicubu ematheni wakho nge-steroids ukusiza ukunciphisa noma yikuphi ukuvuvukala.
Ukuze uthole i-stenosis eyingozi kakhulu, udokotela wakho angase ancoma ukuthengiswa kwe-tracheal, okudinga ukuhlinzwa. Le nqubo igcinwe lapho ukwelashwa kwe-endoscopic kwehlulekile, noma ukuqubuzana nesimo somzimba kunzima kakhulu kunqubo yokugcina. Phakathi nale nqubo, udokotela wakho uzokhipha ingxenye ye-trachea ethintekile futhi ulungise umthamo wakho ngesikhumba noma izicubu zesikhumba.
Ukuhlinzwa okulandelayo, ngokuvamile uzokwazi ukuthatha ithubhu lokuphefumula ngesikhathi sokutakula kusuka ku-anesthesia. Kodwa-ke, uma kukhona ukuvuvukala okukhulu, ukungenelela eziningana kuzosetshenziswa. Kulesi simo, ungalindela ukuthi ubekwe kuma-steroids amahora angu-24 kuya kwangu-48 kanye nesifo sezinyathelo ezifana ne-Lasix. Abahlengikazi bakho nabo bayoqiniseka ukuthi ukugcina ikhanda lombhede wakho kuphakanyiswe ama-degrees angu-30 noma ngaphezulu. Ngemuva kwamahora angu-48, uzobuyela ekamelweni lokusebenza ukuze ithubhu yakho yokuphefumula isuswe. Uma usengakwazi ukusekela umoya wakho womoya, i-tracheostomy izongeniswa ukuze igcine umoya wakho. Ngenxa yemvelo engavamile yalokhu ukwelashwa, kubhekwa njengendlela yokugcina ngemva kokunye okunye okwelashwa kwehlulekile.
> Imithombo:
> Axtel, AL & Mathisen, DJ. (2017). Ukwelapha Okuhlinzeka Ngamanje: Ukuphathwa Kwe-Tracheal Stenosis. 882-887.
> Hofferberth, SC, Watters, K, Rahbar, R & Fynn-Thompson, F. (2015). Ukulawulwa Kwama-Stenosis Okubambisana Ngamaqhawe. Izingane zokwelapha. 136 (3): e660-9.
> Hyzy, RC. (2017) .Izixazululo zethubhu yokugcina emva kokubekwa kokuqala: Ukuvimbela kanye nokuphathwa kumagciwane asebekhulile asezingeni eliphezulu. http://www.uptodate.com (Okubhaliselwe Kudingeka)
> Patel, HH, Goldenberg, D & McGinn, JD. (2015). I-Cummings I-Otolaryngology: Ukuphathwa Okuhlinzekwayo Kwe-Stenosis Ephezulu. 68, 982-992.e2
> Waizel-Haiat, S. (2015). Ukucubungula kwe-Tracheal Stenosis. http://emedicine.medscape.com/article/362175- ukubukwa kabusha
> Won, C, Michaud, G & Kryger, MH. (2015). Izifo Nezifo Eziphazamisayo Ze-Fishman: Ukuvinjelwa Kwe-Upper Airway Kwabantu Abadala. Umagazini we-5. http://www.accessmedicine.com (Okubhaliselwe Kudingeka)