Ukuqonda Indlela Yokuguqulwa Kwama-Pancreas
Ukufakelwa komzimba kuyinkimbinkimbi kakhulu eholela ekuhlinzekeni okuwukuthi ukwelashwa kokugcina kokuhluleka komzimba. Kulokhu, ukufakelwa kungaba ukwelashwa noma ukwelashwa kwe-pancreatic failure noma isifo se-pancreatic.
Kubantu abaningi, ukufakelwa akukaze kube yinto ebalulekile, futhi bayakwazi ukuphatha isifo sabo ngemithi, ukuhlinzwa noma ezinye izindlela zokwelashwa.
Kubantu abangavamile, ukufakelwa kuyadingeka ngoba isifo sabo sinzima kangangokuthi ngaphandle komzimba omusha ngeke baphile isikhathi eside.
Ngokusho nje, ukufakelwa kwenziwa uma isilwane esizalelwe ngesifo sigula noma sigula ukuthi sidinga isitho esiphezulu esivela kumnikezeli.
Imisebenzi yePancreas
I- pancreas ibamba iqhaza elibalulekile emzimbeni womuntu womuntu wokugaya ukudla ngokuphumelelayo nokulondoloza izinga eliqinile legazi lokugcoba egazini. I-pancreas yenza lo msebenzi ngezindima ezimbili ezibalulekile emzimbeni: okwenza amahomoni nokwenza ama-enzyme asetshenziselwa ukugaya ukudla.
Amaphesenti angamashumi ayisishiyagalolunye nesishiyagalolunye ama-pancreas asebenza ukukhiqiza ama-enzyme okugaya asetshenziswa ekuqhekekeni kokudla emanzini. Ama-pancreas akhiqiza ama-enzyme amathathu: i-amylase, i-lipase, ne-protease. U-Amylase uphula ama-carbohydrate, i-lipase iphula amafutha, futhi i-protease iphula amaprotheni atholakala ekudleni.
Uma le ngxenye ye-pancreas isebenza kahle, isimo esibizwa ngokuthi i-exocrine, i-exocrine i-pancreatic insufficient, lezi zinkimbinkimbi zingathathelwa umuthi owenziwe ngomuthi owathathwa ngomlomo. Lolu hlobo lwe-pancreas ukukhishwa aluholeli ukufakelwa kwe-pancreas, njengoba isimo singelashwa ngemithi.
Umsebenzi owaziwa kakhulu we-pancrea ukukhiqizwa kwe-hormone. I-hormone yokuqala ekhiqizwa yi-pancreas yi-glucagon, i-hormone eyandisa ama-blood glucose (ushukela) emazingeni egazini. Ikhishwa uma amazinga e-blood glucose ephansi futhi adinga ukwanda. I-hormone yesibili eyenziwa yi-pancreas i- insulin . I-insulini ikhishwa lapho amazinga e-glucose egazini ephezulu futhi adinga ukwehla. I-hormone yesithathu yi-somatostatin, esebenza ukugcina umsebenzi we-insulini ne-glucagon emazingeni afanelekayo.
I-pancreas isebenza kanzima ukugwema ukuba namazinga e-glucose ephakeme noma ngaphezulu futhi izimpawu nemibandela yezempilo engabangela. Amazinga e-glucose aphansi akuyona inkinga kubantu abaningi, kodwa ukungabi nalutho kwe-insulin kuyinkinga ejwayelekile kakhulu ebhekene nezigidi zabantu baseMelika kodwa eyaziwa ngegama elihlukile: isifo sikashukela .
Lapho umzimba ulwa nomswakama futhi / noma uhluleka ukwenza i-insulin eyanele, isimo sibhekwa ngokuthi uhlobo lwe-diabetes le-type II. Uma ama-pancreas engenzi i-insulin, sibhekisela kulolu hlobo lwesifo sikashukela sohlobo. Ngokujwayelekile, luhlobo lwama-diabetics adinga ukufakelwa kwe-pancreas, njengoba ezinye izinhlobo zesifo sikashukela zikwazi ukuphathwa ngemithi ezikhathini eziningi.
Kungenzeka futhi ukuthi uhlobo lwe-diabetes II luyeke ukwenza noma yikuphi i-insulin ngokuhamba kwesikhathi, okungaholela ekufakweni kabusha.
Ukufakelwa kwe-pancreas kwenziwa lapho ama-pancreas engasakwazi ukusebenza kahle ngokwanele ukulawula amazinga e-glucose egazini, ikhwalithi yokuphila ayimpofu engamukeleki, izinkinga zesifo sikashukela ziyingozi kakhulu noma ziyanda kakhulu, futhi izinzuzo zokuhlinzwa zidlula izingozi ukufakelwa.
Uma Kudingeka
Ukuba uhlobo I isifo sikashukela yedwa asenza ukufakelwa kwe-pancreas kudingekile, njengoba abantu abaningi bekwazi ukuphila ngokugcwele nokucebile ngezinga elilawulwa kahle glucose. Kunzima ukulawula isifo sikashukela, okuvame ukubhekwa ngokuthi "i- brittle " enokulawulwa okuncane kumazinga we-glucose nezimpawu, okuholela ekufakweni.
Lokhu kusho ukuthi uma ubuhlungu besifo sikashukela sekufinyelele endaweni lapho isiguli sigula kakhulu futhi imithi ayikwazi ukuhlinzeka ngokulawulwa kwezifo ezingcono, ukufakelwa kungaba yindlela yokugcina yokwelapha.
Ngokusho kwe-American Diabetes Association (ADA), iziqu zokufakelwa kwe-pancreas kubantu abangenazo izifo ezinzima zezinso zilandelayo:
- Izifo ezinzima kakhulu, ezinzima futhi ezinzima ezifana ne-glucose ephezulu kakhulu, i-glucose ephansi kakhulu noma i-ketoacidosis.
- Ukwandisa izinkinga zomtholampilo / ngokomzwelo nge-insulin therapy
- Ukuhluleka kwe-insulin ukuvimbela ukucindezeleka okunzima
Izingozi
Izingozi ezihambisana nokufakelwa kwe-pancreas zibaluleke ngaphezu kokuhlinza okuningi okuvamile, njengoba isiguli sivame ukugula ngaphambi kokuhlinzwa futhi inqubo iyinkimbinkimbi. Lezi zingozi zihlanganisa izingozi ezijwayelekile iziguli ezibhekana nazo uma zihlinzwa, kanye nezingozi ezihlobene ne-anesthesia ejwayelekile.
Izingozi ezivamile ze-Pancreas Ukuguqulwa kokutshala
- Ukutheleleka
- Ukulawulwa okuncane kwe-glucose
- Ukuphuza
- Izindwangu zegazi
- Ukwenqaba isitho esisha
- Ukuhluleka komzimba
- I-nausea
- Ukuvota
- Uhudo
- Ukusabela ku-anesthesia
- Kunzima ukugcoba kusuka ku-ventilator
Ukuthola udokotela ohlinzayo
Ukubona udokotela wesigqila sokuguqula ngokuvamile kuhilela ukuthola ukuhanjiswa kusuka kudokotela wakho esikhungweni sokufakelwa okuwenza ukufakelwa kwe-pancreas eduze kwekhaya lakho. Ezimweni eziningi, kungase kube khona oyedwa kuphela, kodwa emadolobheni amakhulu, ungaba nezinketho eziningi. Ukudluliselwa kwezinto ngokuvamile kwenziwa ngumuntu wakho we-endocrinologist, udokotela onguchwepheshe wokwelapha izinkinga ze-hormone, noma isifo se-gastroenterologist esiphatha izindaba ngokugaya. Ukudluliselwa kungenziwa futhi ngokunakekelwa okuyisisekelo kanye nezinye izinto ezikhethekile ezithintekayo ekwelapheni kwakho.
Ukuthola Uhlu Lokutshala
Ngemuva kokuhlangana nabasebenzi esikhungweni sokufakelwa, uzohlolwa ukuthi kungenzeka ukufakelwa. Lokhu kuzosho ukubuyekezwa kwamarekhodi akho ezokwelapha, ukuhlolwa kwegazi, izifundo zokucabanga ze-imaging, kanye nezinye izivivinyo ezihloselwe ukucacisa ukuthi ukhona yini kahle ngokwanele ukubekezelela ukuhlinzwa kokufakelwa kodwa ugula ngokwanele ukuthi udinga isitho esisha.
Uma ukuhlolwa kubonisa isidingo sokufakelwa, kanye nokukwazi ukusinda ekuhlinzekeni, nokuvuselela ngomphumela omuhle, futhi uma kutholakala iziqu ezengeziwe njengokukwazi ukukhokhela ukuhlinzwa kanye nokukwazi ukuphatha imithi edingekayo ngemuva ukuhlinzwa, isiguli singabekwa ohlwini lokufakelwa ukulinda isitho ukuze sitholakale.
Inombolo ye-pancreata (ubuningi be-pancreas) etholakalayo yokufakelwa, ngeshwa, incane. Kukhona i-pancrea eyodwa kuphela etholakalayo ngumnikeli ngamunye. Abashukela abayisifo sikashukela abakwazi ukunikela nge-pancreas. Ukwengeza, ama-pancreas aphephile futhi avame ukuphendula kabi ngokugula okubucayi kumnikeli, abantu abaningi abanesifo sikashukela abakakwazi ukunikela nge-pancreas yabo. Lokhu kuholela ekuntulekeni kwezitho ezingathengiswayo kulabo abalindile.
Izinhlobo zokudlulisa
Kunezinhlobo ezimbili zokufakelwa kwe-pancreas okwenziwa manje. Uhlobo oluvame kakhulu yilokho wonke ama-pancreas asuswa kumnikezeli futhi abekwa kumamukeli. Lapho abantu bethi "ukufakelwa kwe-pancreas" lena yindlela abajwayele ngayo ukubhekisela kuyo. Olunye uhlobo lokufakelwa isitshalo se-pancreatic isplantation, lapho amanye amangqamuzana akha ama-pancreas afakwa khona kumamukeli.
Ukufakelwa kwe-Islet Pancreatic
Ngesikhathi sokufakelwa kwesitokisi se-pancreatic islet, ama-pancreas asusiwe kumaseli anikezelayo nesislet ashintshelwe kumamukeli. Ngemuva kokuba isitho sitholakale, ama-pancreas athathwa ebhokisini lokucwaninga lapho amaseli e-islet, akhiqiza i-insulini namanye ama-hormone, ahlukaniswa namanye amaseli we-pancreas. Lezi zingqamuzana zamangqamuzana kuphela zakha amaphesenti angu-5 obuningi be-pancreas, ngakho-ke inani lamathambo esisuswe lisuswe kakhulu kuncane kakhulu kune-pancreas. Yilawa maseli amangqamuzana adluliselwa kumamukeli. Ngokuthakazelisayo, lawa maseli ashintshelwe esibindi ngokufaka ngaphakathi kwesitsha segazi. Amaseli ahlala esibindi futhi aqale ukukhiqiza i-insulin kule ndawo.
E-United States, le nqubo yenziwa kwizibhedlela ezinkulu zaseyunivesithi ezenza ucwaningi kwi-pancreatic islet cell transplantation. Le nqubo yenqubo isacatshangelwa ukuhlolwa futhi iyenziwa kuphela njengengxenye yezifundo eziningi zocwaningo ezindaweni ezihlukene ngalesi sikhathi.
Iziqu ze-islet transplant ngezinye izikhathi zihluke ekuguqulweni komzimba wonke, njengoba kukhona ucwaningo olwenziwe ngendima yesitshalo sokuguqulwa njengokwelashwa kwe- pancreatitis engapheliyo. Isiguli esivamile siyoba nenqubo encane yokufakelwa islet ezintathu noma ngaphezulu ukuzwa inzuzo ephelele yokufakelwa.
Ukufakelwa kwe-Multi-Organ
Kwabanye abantu, izinkinga ze-pancreas zingaholela ezindabeni ezibalulekile nezinye izitho, ikakhulukazi izinso. Kulaba abanye abanesifo sikashukela abanamazinga e-glucose okunzima ukulawula, izinso zonakaliswa kabi, okuvame ukuholela ekuhlulekeni kwezinso kanye nesidingo se-dialysis.
Kulabo bantu ngabanye, ukufakelwa kwe-pancreas yedwa kungenzeki ngokwanele ukubuyisela empilweni enhle, futhi badinga ukufakelwa kwezinso ukuze bangabi nama-dialysis. Okufanelekile, laba bantu bazothola izinso kanye nokufakelwa kwe-pancreas kusuka kumxhasi ofanayo ngesikhathi esifanayo, kodwa ezinye iziguli zithola izitho ezivela kubanikeli abahlukene ngezikhathi ezahlukene.
Indlela Ukutshalwe Ngayo Ngayo
Ukufakelwa kwepancreta kuqala ngokulandela inqubo ehluke ngokuphelele-ukuhlinzwa ukukhipha ama-pancreas avela kumnikeli. Ukufakelwa komzimba wonke kuvamile kakhulu kunomnikelo we-pancreas segment. Izitho zomzimba zonke zivela ekufeni, abaxhasi bokufa ebuchosheni. Izingxenye zama-pancre ngokuvamile zivela kumnikezeli ongumngane noma isihlobo ofuna ukusiza umamukeli.
Uma isitho noma isigaba esinikeziwe sisusiwe, kukhona ifasitela elincane lokufakelwa isitho kumlandi, ngokuvamile amahora angu-8 noma ngaphansi. I-pancreas iyinkimbinkimbi kakhulu, ingaphenduli kahle ukuthi ithinteke futhi ihanjiswe, ngakho-ke odokotela abahlinzayo basebenzela kuphela ukuthinta izicubu eziseduze ngesikhathi sokuhlinzwa. Uma ama-pancreas eqinisekisiwe ukuthi angawuthola umamukeli, noma mhlawumbe ngaphambili, abamukeli bangase baziswe ukuthi isitho sitholakale ukufakelwa. Bese babuzwa ukuthi babike esikhungweni sabo sokufakelwa.
Uma sekutholiwe (igama elithi "ukuvuna" alisasetshenziswa) ama-pancreas athathwa esibhedlela lapho athola khona esikhungweni sokufakelwa lapho kuzofakwa khona i-pancreas kumamukeli.
Ukuhlinzekwa ukubeka isitho kumngenisi kuqala ngogulane obhalwe phansi futhi kufakwe ku- ventilator kanye nokuphathwa kwe- anesthesia jikelele . Uma isiguli sezilele, inqubo ingaqala.
Isikhumba silungele ukunciphisa ingozi yokutheleleka, futhi ukukhishwa kwenziwa ngesisu. I-pancreas ifakwe kwi-duodenum, ingxenye yokuqala yamathumbu amancane ukuze izinyimba zokugaya zingadedelwa ekudleni njengoba ziphuma esiswini. Ukusebenzisa imithwalo yegazi etholakala kumnikeli, ama-pancreas axhunyiwe ekunikezeni igazi ngezidingo zawo siqu futhi akhulule ama-hormone egazini.
Ngokuvamile, ama-pancreas asetshenziselwe ahlala eduze nenkinobho yesisu kunama-pancreas okuqala, atholakala ejulile esiswini. Lokhu kubeka phambi kwesisu kwenza i-biopsy ithathwe kalula esikhathini esizayo, uma kunesidingo.
I-pancreas yesiguli, ebizwa ngokuthi "ama-pancreas bomdabu", ihlala endaweni ngaphandle uma kunesizathu esithile sokususa. Uma ama-pancreas anamathele emathunjini nasemithanjeni yegazi, ukufakwa komzimba kungavalwa futhi isiguli sithathwe ekamelweni lokunakekelwa okujulile (i-ICU) ukuze lihlolwe ngokucophelela ngenkathi kutholakala.
Ukubuyisela
Isiguli esivamile siyochitha izinsuku eziningana ku-ICU ngemuva kwenqubo yokufakelwa. Iningi lizochitha okungenani izinsuku eziyisikhombisa esibhedlela ngaphambi kokuba lihambe ekhaya ukuze liqhubeke nokuphumula. Iningi leziguli libuyela emisebenzini yazo evamile kungakapheli amasonto angu-4-6 okuhlinzwa.
Ukuphila Ngemva Kokutshala
Esinye sezici ezinzima kakhulu zokuphila kanye nempilo emva kokufakelwa ukuvimbela ukwenqatshwa kwesigungu. Ukuvakashelwa njalo esikhungweni sokufakelwa ukutshala kuvamile emva kokuhlinzwa futhi kungavamile uma isikhathi sidlula ngaphandle uma kunezinkinga ngesitho esisha. Kwabaningi, ukubuya ekuphileni okuvamile kungenzeka ngemuva kokuhlinzwa, kodwa abanye bangathola ukuthi bathuthukisiwe, kodwa bengavuli.
Kuzo zonke iziguli zokufakelwa, imithi yokwelapha ukuvimbela ukwenqatshwa kuyoba yiqiniso lokuphila. Ngisho noma isitho singasebenzi kahle, kuzodingeka imithi yokulwa nokulahla, nokuthi imithi ingase iholele ekuguleni okuvamile okufana nezibandayo ezivamile kanye nomkhuhlane njengoba kwenza phansi isimiso somzimba sokuzivikela.
Izingozi Zesikhathi Eside
Izinkinga ezingenzeka ezinyangeni nasezinsukwini ezilandela ukufakelwa kwe-pancreas zibonakala zimbalwa ngenombolo, kodwa zingabi sína. Ukunakekelwa kahle impilo yonke ngokudla kahle, ngokulandela imfundiso yokuhlinza, nokuzivocavoca njalo kubalulekile. Ukunakekelwa kwempilo yakho engokomzwelo emva kokufakelwa kubalulekile, futhi kuvame ukunganaki emzamweni wokuphila kahle.
Okunye okubalulekile ukuthi uqaphele ukubuka lezi zimpawu ezilandelayo:
- Ukulahlwa komzimba
- Ukubhekana nokulahlwa kwemithi
- Ukulawulwa okuncane kwe-glucose
- Umsebenzi wokunciphisa isakhi ngokuhamba kwesikhathi
- Izinkinga ezaziwayo zemithi yokwenqaba
Imithi Yokunqabela Ukulwa
Imithi-ezinye zazo ezifana ne-steroid evame ukushiwo-zisetshenziselwa ukwenza umzimba wamukele isitho esisha, kodwa le mithi ihlangabezana nezinkinga ezingenzeka kanye nezinzuzo zayo ezinkulu.
Imiphumela emibi ejwayelekile yemithi yokulwa nokulahla ihlanganisa:
- I-nausea
- Uhudo
- Ukuvota
- Ubuso obuvuvukile
- Izinsini ezivuvukile
- I-acne
- Ukulahlekelwa izinwele
- Ukungabekezelelani kwelanga
- Ukuphakama kwengcindezi yegazi
- Amazinga e-cholesterol aphakanyisiwe
- Ukulahleka kwe-Bone (i-osteoporosis noma i-osteopenia)
Ukulahlwa kwegciwane
Ukulahlwa kwegciwane kuyinkinga ebalulekile emva kokufakelwa kwanoma yiluphi uhlobo, kanti ezinye iziguli zizobona isiqephu sokwenqatshwa ezinyangeni zokuqala ezilandela ukufakelwa. Isihluthulelo sokusinda isiqephu sokwenqatshwa nesitho esilungisiwe kahle ukukhomba inkinga kuqala futhi uthole ukwelashwa ngokushesha.
Izimpawu ezijwayelekile zokukhishwa kwamanqamu zihlanganisa:
- Fever
- Ubuhlungu noma ngaphezulu kwesitho esisha
- I-glucose yegazi engazinzile
- I-nausea
- Ukuvota
- Ubuhlungu besisu
- Umchamo omnyama
- Ukunciphisa umkhiqizo we-urine
Imiphumela Yesikhathi Eside
Ngokuphelele, imiphumela eyenziwa yiziguli emva kokufakelwa kwe-pancreas kuhle kakhulu. Izinga lokusinda liphakathi kwamaphesenti angama-95 kuya kwangu-98 ngonyaka owodwa, amaphesenti angu-91 kuya kwangu-92 eminyakeni emithathu emva kokufakelwa, namaphesenti angu-78 kuya kwangu-88 eminyakeni emihlanu. Iningi labantu abafayo babangelwa yisifo senhliziyo, kunokuba kube nezinkinga ezivela ekuhlinzekeni, futhi kwenzeka ngaphezu kwezinyanga ezintathu ngemuva kokukhishwa endaweni yokufakelwa.
Okunye okubaluleke kakhulu ukuthi i-pancreata efakwe kanjani emva kokuhlinzwa. Ngonyaka owodwa ngemva kokuhlinzwa, amaphesenti angu-78-88 weziguli ayephethe ama-pancreas asebenzayo namaphesenti angu-27 anama-pancreas asebenzayo eminyakeni eyishumi emva kokuhlinzwa. Ukusebenza kusho ukuthi akukho isidingo sokuba i-insulin, amazinga ajwayelekile we-glucose uma ihlolwe ngemuva kokuzila ukudla, nemiphumela evamile noma ephakeme ye-hemoglobin a1c. Lokhu kusho ukuthi iziguli ezinama-pancreas "angasebenzi" kungenzeka zingasadingeki i-insulin kodwa zibe ne-hemoglobin ephakeme e-a1c, noma ingase ibe yithembele ngokuphelele ye-insulin.
Izwi elivela
Ukufakelwa kwe-pancreas, kungakhathaliseki ukuthi iyilungu lonke noma amangqamuzana e-islet, kuyinkambinkimbi enkulu kakhulu enomthelela wokuphila impilo yonke nokuphila kahle. Kwabaningi, ukufakelwa kuyisisombululo senkinga enkulu kakhulu futhi kuholela ekuthuthukiseni okukhulu izinga lokuphila. Ngokuvamile, inqubo ibangela izinkinga, impilo engafanele, nakwezinye, akukho ukuthuthukiswa kokulawulwa kwe-glucose.
Kubalulekile ukulinganisa umthelela wamanje wezifo ze-pancreatic ngokumelene nemivuzo engaba khona kanye nezinkinga eziza nenqubo yokufakelwa, futhi uqhubeke uqaphele ngemuva kokufunda ngangokunokwenzeka mayelana nenqubo.
> Umthombo:
> I-Pancreatic and islet transplantation e-diabetes mellitus. Kusesikhathini. https://www.uptodate.com/contents/pancreas-and-islet-transplantation-in-diabetes-mellitus