Izinqubo Eziningi Ezihlanganisa Eziwusizo
Uma uthola ukuthi une- apnea yokuvimbela ukulala (OSA) , ungase ube nesithakazelo ekufundeni mayelana nezinketho zokuhlinzwa ukuze uphathe lesi simo . Kunezinhlobo zokuhlinza eziningana ezingashintsha ukukhanya kwe-palate elithambile futhi zithuthukise i-apnea yokulala nokuzibamba , okuyinto evame kakhulu ukuba yi-uvulopalatopharyngoplasty (UPPP). Kodwa yiziphi ezinye izindlela zokwelashwa ezitholakalayo?
Funda ngezinqubo ezehlukene ezibizwa ngokuthi i-pharyngoplasty, kanye nezingozi ezihlobene nalezi zinqubo zelungu.
Yiziphi Izinqubo Zobuningi Bokuzenzekelayo?
Ukuhlinzwa kwe-palate kuhlanganisa iqembu lezinqubo ezenziwa ngaphansi kwe-anesthesia jikelele ekamelweni lokusebenza. Izinqubo ezihlukahlukene ezithambile zezinwele zihlanganisa ukuhlinzwa okulandelayo:
- Uvulopalatopharyngoplasty (UPPP) noma i-palatopharyngoplasty
- Ukwandisa i-sphincter pharyngoplasty
- I-lateral pharyngoplasty
- Iphutha le-Uvulopalatal
- Ukuhamba phambili kwe-Palatal pharyngoplasty
- I-Z-palatoplasty
- Ukufuduswa kwesigaba se-pharyngoplasty
Ukuhlinzwa kwe-palate kuhlanganiswe ne- tonsillectomy ezigulini eziningi ezinamathani angakaze asuswe ngaphambilini. Ukuhlinzwa kwe-palate (ngaphandle noma ngaphandle kwe-tonsillectomy) kusetshenziswa ngokuyinhloko ukuphatha i-obnetive obnetive apnea, futhi izinqubo zingenziwa zodwa noma zihlanganiswe nezinqubo ze-hypopharyngeal. Lezi zinqubo zibandakanya ukuhlanganiswa kwezicubu zokususwa kanye nezicubu zokuphindaphinda okuhloswe ukwandisa ubukhulu bomoya ongaphandle ngaphandle kokuthinta imisebenzi evamile njengokuphefumula, ukukhuluma nokugwinya.
Izici ezicacile zenqubo ngayinye zifaka okulandelayo:
I-UPPP yachazwa okokuqala ekwelapheni kwe-apnea yokuvimbela ubuthongo ngo-1982, futhi iminyaka eminingi yenziwa inqubo yodwa. Le nqubo ihlanganisa ukususwa kwe- uvula kanye nengxenye ye-palate esithambile, ngokubeka kabusha ingxenye esele ye-palate elithambile nezinhlangothi zomphimbo okwenziwe ngokuyinhloko ngokuthunga izakhiwo ngokuqondile ngqo. Uma kuqhathaniswa nezinye izinqubo, i-UPPP ihilela ukukhishwa kwesisindo esivela ku-palate esithambile. Uma i-uvula ingasusiwe, le nqubo ibizwa ngokuthi i-palatopharyngoplasty.
- Ukwandisa i-sphincter pharyngoplasty kuhilela cishe akukho ukukhishwa kwezicubu, kepha ukuphindaphinda okuningi kwezicubu. Kule nqubo, imisipha esheshayo ngemuva kwe-tonsil (i-palatopharyngeus muscle) ikhululiwe kusuka ohlangothini lomphimbo futhi ihanjiswe phambili nangemva kwesikhathi. Lokhu kudonsa i-palate elithambile phambili, ngenhloso yokuvula indawo ngemuva kwephunga eliphansi lokuphefumula. Eqenjini elikhethiwe leziguli, le nqubo ibonise imiphumela engcono kune-UPPP esilinganisweni esingenasici esilinganisa lezi ezimbili.
- I-lateral pharyngoplasty ingenziwa kuphela uma iziguli zinamathani. Kuhlanganisa ukukhishwa kwezicubu, kodwa futhi ukuphindaphinda okunamandla kwezicubu ezithambile (uphahla lomlomo) kanye nezicubu zomzimba zangasese (eceleni komphimbo). Le nqubo ihileleke kakhulu kune-UPPP, kodwa iboniswe nemiphumela engcono phakathi kweqembu elikhethiwe leziguli esilinganisweni esilandelayo ngokulinganisa lezi ezimbili.
- Isigqoko se-Uvulopalatal sisetshenziselwa iziguli ezinezintambo ezincane ezithambile. Le nqubo ihilela cishe ukukhipha isisindo se-palate elithambile; Esikhundleni salokho, uhlaka lwamlomo (mucosa) ngaphezu kwengxenye ye-palate elithambile lususwe ukuze kuvunyelwe ukuhlunga kwe-muscle elithambile. Ngokuphumelelayo, kwenza i-palate elithambile ifinyelele ngaphandle kokukhipha imisipha, ngoba ukukhishwa kwamasuli kulindeleke ukuthi kuthinte ukugwinya okujwayelekile.
- Ukuqhubekela phambili kwe-Palatal pharyngoplasty kuthinta ihlombe ngokususa elinye lamathambo ophahleni lomlomo (i-palate elukhuni) endaweni eya emuva, lapho ihlangana khona ne-palate elula. Ngemuva kokususwa kwethambo, i-palate elithambile isuke lihanjiswa phambili futhi likhonjiswe endaweni.
- I-Z-palatoplasty idinga ukuhlukanisa kancane kancane i-palate elithambile phakathi nokudonsa isigamu ngasinye phambili nangemva kwesikhathi. Lokhu kungaphumelela kakhulu ezigulini ezinokuhlukumeza ezinhlangothini zomphimbo, okungenzeka ngemuva kwe-tonsillectomy noma ezinye izinqubo ezithintekayo zokunambitheka. I-Z-palatoplasty ihlotshaniswa nobunzima obuningi ngokugwinya ukulandela okulandelayo kunezinqubo ezithile ze-palate.
- Ukususwa kwesigaba se-pharyngoplasty kuhlanganisa ukukhishwa kwezicubu ezincane kakhulu ngokuthunga ndawonye imisipha ecaleni lomphimbo ngendlela ethile.
Inqubo yokuhlinza ngayinye ekulungele kakhulu kuwe izodinga ukuhlola ngokomzimba ngokucophelela, futhi uxoxe naye, udokotela wakho ohlinzayo.
Izingozi zezinqubo zePalate
Njenganoma iyiphi inqubo yokuhlinzeka, kunezingozi okufanele zicatshangelwe. Ubuhlungu ngokuvamile buyenzeka njengengxenye yokuhlinzwa okulula. Ezinye zezinye izinkinga ezivame kakhulu zihlanganisa okulandelayo:
- Ukuphuza
Yonke inqubo ihlinzeka ingozi yokuphuma, kodwa iningi lalezi zingozi lihlobene ne-tonsillectomy. Ukulinganisa okujwayelekile kokungena kwegazi emva kwe-tonsillectomy ngamaphesenti angu-2 ukuya kwangu-4.
- Ukutheleleka
Ukutheleleka kungenzeka kodwa akunakwenzeka.
- Kunzima ukugwinya
I-palate ibalulekile ekugwineni ngoba igcizelela ukuxhumana phakathi komlomo nasemhlane. Ngemuva kokuhlinzwa kwe-palate, kungenzeka ukuthi ube nokudla, ikakhulukazi uketshezi oluphuzayo, kuvela ngemuva kwempumu noma ngezikhathi ezithile ngekhala. Lokhu kuvame ukwenzeka emavikini amabili okuqala ngemuva kwenqubo, kodwa lokhu kukhonjelwa ngokuvamile akusiyo unomphela noma kubalulekile.
- Izinguquko enkulumweni
I-palate ibalulekile ekukhiqizeni inkulumo. Nakuba izinguquko ezicashile enkulumweni (ezikhonjiswe ngokuhlaziywa kwemininingwane eningiliziwe) zingenzeka, izinguquko ezinkulu zesikhathi eside enkulumweni azivamile.
- Ukunciphisa phezulu komphimbo
Kungenzeka ukuthi ukuphulukiswa okungalungile kungadala ukulimala okunciphisa isikhala ngemuva kwesikhumba esincane.
Uma unesithakazelo ekuxoxweni ngezinketho zokuhlinza ukuphatha i-apnea yokulala, kufanele uqale ngokukhuluma nochwepheshe bakho bokulala . Uma ukuhlinzekwa okunamathelayo kuyinketho ngokusekelwe esimweni sakho, ukuhanjiswa kudokotela ohlinzayo kungase kube isinyathelo sokuqala sokuhlola ukwelashwa okukufanele kakhulu kuwe.
Imithombo:
Cahali MB. "I-Laterry Pharyngoplasty: I-Treatment entsha Yokuvimbela Ukulala I-Apnea-Hypopnea Syndrome." I-Laryngoscope . 2003 Nov; 113 (11): 1961-8.
UFriedman M, Ibrahim HZ, uVidyasagar R, uPomeranz J, noJoseph NJ. "Z-Palatoplasty (ZPP): A Technique for Iziguli ngaphandle Amathani." Otolaryngol Head Neck Surg . 2004 Jul; 131 (1): 89-100.
U-Fujita S, u-Conway W, u-Zorick F, no-Roth T. "Ukulungiswa Kokuhlinzekwa Kokukhubazeka Kwe-Anatomic Okuvimbela Ukulala I-Apnea Syndrome: Uvulopalatopharyngoplasty." Otolaryngol Head Neck Surg . 1981 Nov-Dec; 89 (6): 923-34.
U-Kezirian EJ, uMaselli J, uVittinghoff E, i-Goldberg AN, ne-Auerbach AD. "Ukuvimbela Ukuhlinzwa Kwe-Apnea Yokuvimbela Ukuziphatha Kusetshenziswe Izibonelo E-United States: 2000 kuya ku-2006." Otolaryngol Head Neck Surg . 2010 Sep; 143 (3): 441-7.
U-Kezirian EJ, Weaver EM, Yueh B, Deyo RA, Khuri SF, Daley J, noHenderson W. "Isibangela Sezinkinga Ezimbi Ngemva kwe-Uvulopalatopharyngoplasty." I-Laryngoscope . 2004 Mar; 114 (3): 450-3.
U-Kezirian EJ, Weaver EM, uYueh B, Khuri SF, uDaley J, no-Henderson WG. "Izimbangela Zengozi Ngenxa Yokucindezela Okujulile Ngemva kwe-Uvulopalatopharyngoplasty." I-Arch Otolaryngol Head Neck Surg . 2006 Oct; 132 (10): 1091-8.
Li HY, no-Lee LA. "Ukuthuthwa kwe-Pharyngoplasty yokuvimbela ukulala kwe-Apnea." I-Laryngoscope . 2009 Dec; 119 (12): 2472-7.
I-Pang KP, ne-Woodson BT. "Ukwandisa i-Sphincter Pharyngoplasty: I-Tech Tech entsha yokwelashwa kokuvimbela ukulala kwe-Apnea." I- Otolaryngol Head Neck Surg . 2007 Jul; 137 (1): 110-4.
U-Powell N, uRiley R, uGuilleminault C, noTroell R. "Uvulopalatal Flap yokuguqula nokulala ne-Sleep Apnea Syndrome." Ukulala . 1996; 19: 593-9.
Sher AE, Schechtman KB, noPiccirillo JF. "Ukuhlelwa Kokuhlelwa Kokushintshwa Kwe-Upper Airway Kubantu Abadala Abavimbela Ukulala Apnea Syndrome." Ukulala . 1996 Feb; 19 (2): 156-77.
I-Woodson BT, uRobinson S, noLim HJ. "Imiphumela ye-Transpalatal Advancement Pharyngoplasty Imiphumela Ngokuqhathaniswa ne-Uvulopalatopharyngoplasty." Otolaryngol Head Neck Surg. 2005 Aug; 133 (2): 211-7.
Woodson BT, noToohill RJ. "I-Transpalatal Advancement Pharyngoplasty ye-Obstructive Sleep Apnea." I-Laryngoscope . 1993 Mar; 103 (3): 269-76.