Ngaphambi, Ngesikhathi, nangemva Kokuhlinza Nge-Adenoma Ye-Pituitary
I-pituitary gland iyigugu elibaluleke kakhulu kodwa elincanyana lesisitholakala engxenyeni yobuchopho. Lezi zicubu zibhekwa njengengubo ngoba ifihla ama-hormone emfudlaneni wegazi ukulawula imisebenzi ebalulekile yomzimba, kubandakanya ukukhiqiza, ukukhula ngesikhathi sokuthuthukiswa kwengane kanye nomsebenzi we-thyroid. I-pituitary gland ngokungangabazeki igwebu ebaluleke kakhulu emzimbeni womuntu ngoba yenza izinto eziningi ngesikhathi esisodwa.
I-pituitary gland ifihla ama-hormone ayisithupha ahlukene:
- I-Thyroid Yokugqugquzela I-Hormone (TSH): Ilawula umsebenzi wegciwane le-thyroid
- I-Adrenocorticotropic Hormone (ACTH): Igqugquzela ama-gland adrenal ukukhulula i-adrenalin
- I-Follicle Ukuvuselela I-Hormone (FSH): Idlala indima ekukhuleni nasekukhiqizeni
- I-Luteinizing Hormone (LH): Isiza ukulawula ukukhiqizwa nokuthuthukiswa kocansi
- Ukukhula kweHormone (GH): Ukulawula ukukhula komzimba ngesikhathi sokukhula nokukhula
- Iprolactin (PRL): Ilawula ukukhiqizwa ubisi lwebele ngemva kokukhulelwa
Iziningi zezinhlayiya zihlanganisa i-hormone eyodwa, ngakho-ke i-pituitary ayingavamile ngenxa yobunzima bomsebenzi wayo nendawo yayo ehlukile ebuchosheni, nje ngemuva kwempumu.
I-pituitary gland ayigcini nje ngokuvikela ama-hormone ayisithupha ahlukene, amanye ala ma-hormone alawula ezinye izilonda-kuhlanganise ne-thyroid-ngakho-ke ukuguqulwa komsebenzi we-pituitary gland kungathinta kakhulu impilo nempilo yomuntu.
Ukungalingani kwe-hormone, kungakhathaliseki ukuthi kuvela emgodini we-pituitary noma kwenye indawo yomzimba, ngokuvamile kuphathwa yi-endocrinology. I-endocrinology yilona olukhethekile lwezokwelapha oluphatha izinkinga ze-hormone, kufaka phakathi izinkinga ze-pituitary nezinye izinkinga ze-hormone ezifana nesifo sikashukela.
I-Pituitary Tumor
Uhlobo oluvame kakhulu lwe-pituitary tumor yi-adenoma ye-pituitary, i-tumor engeyona umdlavuza eyenza i-pituitary gland.
Kunezinye izinhlobo zezinambuzane kunokuba zingahle zenzeke, kodwa i-adenoma ihamba kakhulu kakhulu.
I-adenomas ye-Pituitary ihlelwe ngezindlela eziningi. Ziyingozi (engeyona umdlavuza), i-adenoma ene-invasive, noma i-cancerous. Lesi sifo singase sibe yisisu esiyimfihlo, okusho ukuthi i-tumor ifihla ama-hormone, noma kungenzeka. Zibizwa ngokuthi yi-macroadenoma uma zingamamentimitha noma ngaphezulu ngobukhulu futhi zibhekwa njenge-microadenoma uma zingaphansi kwamamentimitha.
Kunezinye izinhlobo zezinambuzane ezingase zenzeke e-pituitary, kodwa eziningi zingavamile futhi ukuhlinzwa kwenziwa ngendlela efanayo nezinqubo zokuphatha i-adenomas.
Ukuthola i-Pituitary Tumor
Izicubu ze-pituitary zivame ukutholakala ngemva kokuba inkinga ebonakala ingabambisani iholela ekuxilongweni kwalolu hlobo lwesisu sobuchopho. Isibonelo, owesifazane osemusha ongakaze abe nomntwana angase aqale ukukhiqiza ubisi lwebele kanye nemiphumela yelebhu angase akhombe isifo se-pituitary njengoba imbangela yenkinga.
Lokhu kusho ukuthi izicubu eziningi ze-pituitary zibizwa ngokuthi "ama-incidentalomas" uma zingatholakali ngenxa yezibonakaliso noma izinkinga, kepha ngesikhathi somsebenzi uphakamisa okuthile. Kule nkinga, i-tumor epituitary ingatholakala ngesikhathi sokuhlolwa kwe-CT ebuchosheni ngenxa yokuthi isiguli siye ekamelweni eliphuthumayo ukuze kube nesifo sohlangothi.
Kulesi simo, kwakungekho izinkinga noma izimpawu ngenxa ye-adenoma, futhi kungenzeka ukuthi ayitholakalanga uma ukuhlolwa kwe-CT kungakenziwa.
Izimpawu ze-Pituitary Tumor
Lokhu okulandelayo yizimpawu ongase uzibone uma unesifo se-pituitary:
- Izinsizwa ezingenasifo futhi zingase zibe nzima kakhulu ngokuhamba kwesikhathi
- I-Acromegaly , isimo esibangelwa i-hormone yokukhula kakhulu ngemva kokuba abantu abaningi bayeke ukukhula, okuholela ezandleni nasezinyaweni ezinkulu kakhulu, futhi uma kungelashwa, izici zobuso ezibukhali. Lapho i-hormone yokukhula kakhulu ibhiqizwa phakathi neminyaka yokukhula, i-gigantism-ukuphakama okukhulu-kungase kubangele.
- I-hypopituitarism , isimo esibangela ukukhula okunamandla ezinganeni
- I-Cushing's syndrome , isimo esingabangelwa i-ACTH kakhulu kusuka ku-pituitary, ngokuvamile kubangele ubuso obunzima nendawo ephakathi kwamahlombe.
- Isifo sika-Addison, isimo esibangelwa i-ACTH encane kakhulu
- Umbono ushintsho
- Ubisi lwebele ngesifazane ongakazalwa
- Ukujikeleza kokuya esikhathini kungase kube okungavamile noma kungabikho
- I-Mood iyashintsha
- Ukungenzi lutho
- Ukungasebenzi kwe-Erectile
- Izinguquko zesisindo
- Imizwa engapheli yokukhathala
- Amazinga we-hormone ye- thyroid aphezulu kakhulu noma aphansi kakhulu
Lapho Ukuhlinzwa Kwama-Pituitary Kuyadingeka
I-adenomas ye-pituitary iyinto evamile kakhulu, kanti eziningi iziguli eziyisithupha ziphethe i-adenoma encane ekhona e-pituitary gland ngesikhathi esithile empilweni yabo. Ngenhlanhla, i-adenoma ebangela izinkinga zempilo yilapho ihamba phambili, cishe cishe i-adenoma eyodwa ye-pituitary ngamakhilomitha ayizinkulungwane ezidala izimpawu.
Iziguli eziningi ezine-adenoma ye-pituitary noma olunye uhlobo lwesifo sofuba esinamandla ziyakwazi ukugwema ukuhlinzwa. Kuziguli ezine-adenoma ye-pituitary engabangeli izinkinga futhi ayidingi imithi, ukuhlinzwa kuyinkinga engadingekile. Ezinye iziguli ziyakwazi ukugwema ukuhlinzwa ngokuthatha imithi elawula izinguquko ze-hormonal ezibangelwa isisu se-pituitary.
Abantu abavame ukudinga usizo lokuhlinzekwa ngokuhlinzeka ngokuhlinzeka ngokuhlinzeka ngokuhlinzeka ngokuhlinzeka ngokuhlinzeka ngokuhlinzeka ngokuhlinzeka ngokuhlinzeka ngokuhlinzekwa ngokuhlinzekwa ngokuhlinzekwa ngokuhlinzeka ngokuhlinzekwa ngokuhlinzekwa ngeziguli ngokuvamile, yibo abangaphenduli kahle imithi, noma banenkinga ebalulekile ngenxa yesisu Lezi zinkinga zingabandakanya ukuguqulwa noma ukulahlekelwa umbono, ikhanda elibi kakhulu, noma ezinye izindaba zezempilo ezibangelwa ukungalingani kwe-hormone.
Izingozi Zokuhlinza Ngama-Pituitary
Ngaphezu kwezingozi ezivamile ezihlobene nokuhlinzwa kanye nezingozi ze-anesthesia, ukuhlinzwa ukukhipha isisu se-pituitary kunezingozi eziyingqayizivele. Okubi kakhulu kulezi zingozi kungalingani okukhulu kwe-hormone okubangelwa umonakalo emgodini we-pituitary ngesikhathi senqubo. Ukulimala kwendlala kungaphazamisa noma yikuphi ama-hormone ayisithupha eyimfihlo yesikhumba se-pituitary, futhi ingaholela ezindabeni eziyinkimbinkimbi ezingabangela izinkinga zezempilo ezindaweni eziningi zomzimba.
Izinkinga ezengeziwe ezingase zenzeke ngemva kokuhlinzekwa kwe-pituitary zihlanganisa:
- I-diabetes insipidus: Ebangelwa ukungalingani kwe-hormone, lesi simo senza umzimba ukhiqize umthamo omkhulu kakhulu womchamo, okuholela ekudambiseni amanzi, ukoma, futhi ezimweni ezimbi, ukudideka.
- Ukuvuza kwamanzi omgogodla : Kungenzeka ukuthi umgogodla we-spinal uvuza kusukela ekhaleni ngemuva kokuhlinzwa okuphephile. Lokhu kungenxa yokuthi imbobo ifakwe emthanjeni ngemuva kwesigxobo socingo ukuze kuvunyelwe ukuhlinzwa. Uma i-glue oyinyumba esetshenziselwa "ukubamba" umgodi awugcwalisisi ngokuphelele indawo, isiguli siyothola impumu yokubhoboza, kufana nomswakama ocacile okhona ngomkhuhlane.
- Isisu sekhanda: Ikhanda ngemuva kwalolu hlobo lokuhlinzwa luvame kakhulu, futhi livame ukuchazwa njengefana nekhanda le-sinus.
- Ukungqubuzana kwe-nasal: Kulindeleke ukuthi amaphuzu angasese azovuleka emva kwalolu hlelo, futhi lokhu ukuxubana kuvame ukuba khona ngesonto noma amabili ngemuva kwenqubo. Ezimweni eziningi ukuxubana kuzoqhubeka ngcono ngesikhathi sokuphumula, futhi ngokuvamile kubangelwa izinsimbi zokugwinya ezicasula izicubu ezinesifiso ngaphakathi ekhaleni.
- I-Meningitis: Ukutheleleka kobuchopho kungenzeka kwenzeke ngemva kokuhlinzwa kobuchopho, njengoba ukuhlinzeka kwandisa ingozi yebhaktheriya efinyelela ebuchosheni.
Ngaphambi Kokuhlinza Ngama-Pituitary Surgery
Ngaphambi kokuba uhlinzekwe emgodini we-pituitary ungalindela ukuthi ube ne-CT scan, i-MRI, noma kungenzeka kokubili kwenziwe ukuze uhlole ubukhulu nesimo se-gland nesisu. Ukuhlola i-Lab kuzophinde kube yingxenye yokuxilongwa kwenkinga, futhi eziningi zalezi zivivinyo zamalebhu zingabuyekezwa ngaphambi kokuhlinzwa uma isisu sikhombisa ukungalingani kwamangqamuzana. Lezi zelabhu zangaphambi kokuhlinzwa zizothola isisekelo sokuqhathanisa ngemuva kokuhlinzwa sekuphelile, futhi kungasiza ekunqumeni ukuthi ukuhlinzeka kuye kwaholela ekuthuthukiseni.
Ukwelashwa Kwezitho Zokuhlukunyezwa
Ukwelashwa ukukhipha isisu se-pituitary kuvame ukuqhutshwa yi-neurosurgeon, udokotela ohlinzayo onguchwepheshe wokwelashwa kwesimiso sezinzwa eziphakathi, okuhlanganisa ubuchopho nomgogodla. Kwezinye izimo, udokotela ohlinzayo we-ENT (indlebe, impumulo nomphimbo) angase abe udokotela ohlinzayo noma ingxenye yeqembu okwenza lokhu kuhlinzwa. Ukuhlinzwa kwenziwa ngaphansi kwe-anesthesia ejwayelekile , enikezwa i-anesthhesiologist noma umhlengikazi wezifo eziphuthumayo (i-CRNA).
Ngenxa yendawo eyingqayizivele ye-pituitary gland ngaphakathi kwe-skull kodwa ngaphandle kobuchopho, kunezindlela ezimbili inqubo engenziwa.
Indlela yokudlulisa
Indlela ejwayelekile kunazo zonke isisu esishubile sisuswe yindlela yokudlulisa amehlo, lapho udokotela ohlinzayo efaka khona izinsimbi ngokusebenzisa ekhaleni futhi umgodi wenziwa esikhwameni esihlala phakathi kwempumu nobuchopho. Ukubeka umgodi omncane kuleli thambo, okuthiwa i-sphenoid bone, uvumela ukufinyelela okuqondile emgodini we-pituitary.
Ukuze kucace, i-pituitary gland ifakwe ebuchosheni, kepha ihlala ngaphansi kwengqondo. Lokhu kuvumela ukuthi igundane lifinyeleleke ngekhala. Inqubo isebenzisa i-endoscope, ithubhu elincane eliguquguqukayo elinomshini wokukhanya, ikhamera nezincane ngaphakathi. I-endoscope ifakiwe futhi udokotela ohlinzayo uyakwazi ukubuka izithombe kumqapha. Izitsha ezincane ngaphakathi kwendawo isetshenziselwa ukusika izicubu ezingafuneki.
Ezimweni eziningi, ukukhishwa kwekhwalithi ephezulu kuthathwe ngaphambi kokuhlinzwa okuhlangene nemishini ekhethekile esetshenziswe ngenkathi yenqubo kusiza ukuhlinza udokotela ohlinzayo ngendlela eya ngqo emgodini we-pituitary. Uma indlela ivulekile, izinsimbi ezincane ezibizwa ngokuthi ama-curettes zisetshenziselwa ukususa izicubu ezingavumelekile zezicubu.
Uma isidumbu sesisu sisusiwe, ucezu oluncane lwamathumbu omzimba lubekwa endaweni lapho isisu sikhishwa khona, kanti udokotela ohlinzayo uzofaka uphawu emgodini owenziwe ngethambo lokufakelwa, i-glue oyinyumba noma kokubili. Ezimweni eziningi, amaconsi azovuleka ukuze avimbele ukuvuvukala ekuphethweni ngokuphelele emagcekeni omzimba.
I-Craniotomy Indlela
Indlela ehlukile yokuhlinzekwa kwe-pituitary iwukuba i-craniotomy, lapho isigaba se-skull sisuswa ukuze sifinyelele ebuchosheni ngokuqondile. Lo mzila uvame kakhulu, futhi uvame ukusetshenziselwa uma ukuhlinzwa akuyona okokuqala okumele kwenziwe kwenzeni ye-pituitary. Kungase futhi isetshenziswe uma kunenkinga ngokuvuza kwe-cerebral umgogodla we-spinal ngemuva kwenqubo yokuqala kumgogodla we-pituitary.
Ngalolu hlobo lokuhlinzekwa kwe-pituitary, inqubo iqala ngemuva kwendawo lapho ukuhlaselwa kuyobe khona khona ihlutshiwe izinwele kanye nensimbi yensimbi ifakwe eduze kwamathempeli ukugcina ikhanda lihlale likhona. I-incision yenziwa esikhwameni futhi isikhumba sivuliwe ukuveza i-skull lapho izimbobo ezincane ezibizwa ngokuthi izibhogo ze-burr zinyathelwe ezindaweni ezimbili ze-skull. I-saw ibese isetshenziselwa ukuxhuma lezi zimbobo ezimbili, kudala ucezu oluthile lwethambo olusungulwe ngethambo olususwa kahle futhi lubekelwe eceleni ngesikhathi senqubo. Isembozo sobuchopho, okuthiwa i-dura, sivulwa futhi ubuchopho buyakwazi ukubonakala.
Uma ubuchopho buvezwa, idivaysi ekhethekile yokuluthwa isetshenziselwa ukuphakamisa ngobumnene ubuchopho ukuvumela ukufinyeleleka engaphansi kwebuchopho lapho i-pituitary gland ihlala khona. Udokotela ohlinzayo angakwazi ukubona ngeso lengqondo lesi gland futhi angasebenzisa ukusebenzisa izinsimbi ezisezandleni.
Uma inqubo isiphelile, ucezu lwe-skull lungafakwa esikhundleni futhi lugcinwe lapho ngeglue noma lugcinwe efrijini elikhethekile ukuze lishintshwe ngosuku oluthile. Isikhumba se-scalp sivaliwe ngama-apples noma glue.
Ngemuva kokuhlinzwa kwezidakamizwa
Iningi leziguli lizochitha usuku noma ezimbili ekunakekelweni okukhulu kwegazi noma ukuhlinzeka ngokuqapha okusheshayo ngemva kokuhlinzwa. Phakathi naleso sikhathi abasebenzi bazogxila ikakhulukazi ekuhlolweni kwegazi ukuze banqume ukuthi ukuhlinzwa kwenzeka yini ekunciphiseni ukungalingani kwe-hormone, futhi kuzobheka ngokucophelela ukukhipha umchamo ukuze kutholakale ukuthi ukuhlinzwa kuye kwabangela isifo sikashukela insipidus. Uzobuye uhlolwe ngokucophelela ukuze uphumule ngemuva noma ikhala eligijima, okungaba isibonakaliso sokuthi i-patch yokuvala umgodi wesithambo se-sphenoid ayizange iqukethe ngokuphelele uketshezi lwamagciwane okuphambana.
Ngemva kwezinsuku ezimbili kuya kwezingu-2 ku-ICU, isiguli singadluliselwa ekamelweni eliphansi noma eliphansi esibhedlela. Iningi leziguli liyakwazi ukubuyela ekhaya ezinsukwini ezingu-3-5 emva kokuhlinzwa ngeziyalezo eziqinile zokungazwakali izindebe kanye nemiyalelo yokuthi ungayinakekela kanjani isisu esiswini.
Iziguli eziningi zikwazi ukubuyela emisebenzini yazo evamile ngemva kwamasonto amabili emva kokuhlinzwa. Iminye imisebenzi engakhuphula ingcindezi yokungena emzimbeni (ukucindezela ngaphakathi kobuchopho) njengokuphakamisa isisindo, ukuvivinya umzimba, ukuguqa nokuphakamisa kufanele kugwenywe okungenani inyanga emva kokuhlinzwa, kodwa imisebenzi efana nokusebenza edeskini, ukuhamba nokushayela ngokuvamile kungenzeka emasontweni amabili.
Emasontweni okuqala okuthola imithi, kuyinto ejwayelekile yokuthola imithi yokwelashwa okufanele inikezwe ngezinhlungu zokuhlinzwa . Imithi eyengeziwe ivame ukuhlinzekwa ukuvimbela ukuqothulwa , njengoba kunesizotha ukunyakaza kwamathumbu kungabuye kwandise ukucindezeleka okungahambi kahle futhi kufanele kugwenywe. Ungase uthole umuthi ukunciphisa ukucinana komswakama nokuvuvukala.
Phakathi nalesi sikhathi, kuvamile ukuzwa ukukhathala, ukucinana komzimba kanye nezinhlobonhlobo zekhanda le-sinus. Kubalulekile ukubika lokhu okulandelayo kumhlinzeki wakho ohlinzayo: i-postnasal drip noma i-runny ekhaleni elingayeki, umkhuhlane, ukubola, ukoma ngokweqile, ukoma ngokweqile, ikhanda elibi kakhulu, nentamo eqinile evimbela isilwane ekuthinteni isifuba.
Ukuvakashelwa kwakho kokulandela kungase kube nge-neurosurgeon yakho, ENT noma kokubili. Ungalindela ukuhlolwa kwegazi okwenziwe ukuqhubeka nokulandela inqubekelaphambili yakho nokunquma ukuthi yimiphi imithi oyodinga, uma ikhona, uma usuphululile.
> Umthombo:
> Ukuhlinzeka Ngokuhlinzwa Kwe-Transsphenoidal FAQ: Umhlahlandlela Weziguli. I-Neuroendocrine ne-Pituitary Tumor Clinic Centre. https://pituitary.mgh.harvard.edu/TranssphenoidalSurgery.htm