Ukuhlinzwa kwesifo sofuba kuyindlela ejwayelekile yokusetshenziswa njengoba amasu eba ngcono kangcono futhi njengoba imiphumela ithuthukisa .
I-Hemispherectomy ingenye yezindlela zokudala ezindala zokuphefumula . Kuyinkqubo ehilela ukukhipha ingxenye yobuchopho nokunqamula izingxenye zobuchopho ukunciphisa ama-seizures. Phakathi neminyaka edlule, inqubo iguqukile, ngokuphepha okuthuthukisiwe nemiphumela.
Izinkomba
Esikhathini esiningi, i-hemispherectomy isetshenziselwa izingane ezinezinhlobo ezithile zesifo sokuphuza, kepha abanye abantu abadala bangazuza nangenqubo.
I-hemispherectomy ingase ibhekwe ukuthi kungenzeka uma uthola isifo sokuphuza, okusho ukuthi ukugubha okuvame ukwanda, okunzima futhi akukwazi ukulawulwa ngezidakamizwa ezibekezeleleka.
Kubuye kube inketho yezinhlobo ezithile zesithuthwane eyaziwa ukusabela kahle ku-hemispherectomy. Okujwayelekile kakhulu kuhlanganisa:
- I-encephalitis kaRasmussen : Lesi yisifo esingavamile esivame ukuholela ekuphikeleni, kunzima ukulawula ukugubha. I-encephalitis kaRasmussen ingadinga ukwelashwa ngezinqubo zokuhlinza ezifana ne-hemispherectomy noma corpus callosotomy.
- Ukukhwabanisa kwama-cortical: Ngezizathu ezingaqondakali, izingane zingase zizalwe ngokukhubazeka okucashile kobuchopho ezingabangela ukugubha.
- Ukushaywa yi-Perinatal : Ukushaywa yi- Perinatal kwenzeka ngaphambi kokuba umntwana azalwe noma maduzane ngemva kwalokho. Lokhu kungabangela izinkinga ngokusebenza kobuchopho, njengokuhlukunyezwa.
Izinhlobo
Kunezinhlobo zezinhlobo ze-hemispherectomy, futhi ithimba lakho lezokwelapha lizonquma uhlelo oluhle ngokusekelwe kwiphrofayli yesithuthwane nokuhlolwa kwakho kwangaphambi kokuhlinzwa. Izinqubo ezahlukene ze-hemispherectomy zonke zinemininingwane eminingi ejwayelekile, kuhlanganise nokususwa kwezicubu zobuchopho kanye nezindawo zokuhlukanisa ubuchopho.
Inhloso yokukhipha isifunda sobuchopho ukuqeda indawo noma izindawo eziboniswe ukuthi zibangele ukuqhuma kwe-EEG yakho. Inhloso yokuhlukanisa ukuxhumana phakathi kwezindawo zobuchopho ukuvimbela umsebenzi owenziwe ngogesi ebuchosheni ukusakazeka nokubangela ukugubha.
Izinhlobo ezivame kakhulu ze-hemispherectomy yizi:
- I-Anatomic: Le nqubo yilona uhlobo olubanzi kakhulu lwe-hemipherectomy futhi lihilela ukususa izingxenye ze-hemisphere yesobunxele noma kwesokudla ukunciphisa umsebenzi wokuthumba. Nakuba lokhu kubonakala kunzima ngokweqile, abantu abahamba nge-anatomic hemispherectomy bayakwazi ukuphila, futhi basebenze kahle. Kungase kube khona ukulahlekelwa kwamakhono, kodwa ikakhulukazi emakhono ahlobene nokuhlukana kwesokunxele nokubona kwendawo (ikhono lokuqonda ubukhulu obuthathu nokubona izingxenye zomzimba zomuntu siqu).
- Ukusebenza kwendabuko: Lolu hlobo lwe-hemispherectomy luhilela ukususwa kwesigaba esincane semisipha ebuchosheni esivela e-hemisphere okubangela ukugubha, kanye nokuhlukaniswa kwe-corpus callosum.
- I-Peri engavamile: Le nqubo ilinganiselwe ngokususa izicubu zobuchopho kunezinye izinqubo zendabuko. Lokhu kuhilela ukukhishwa kwamanani amancane wezicubu zobuchopho nokuxhumanisa okuphazamisayo phakathi kwezindawo zobuchopho, nokusika konke noma ingxenye ye-corpus callosum.
Njengoba ungalindela, izinqubo eziningi kakhulu zinokuhlangana okuphezulu nezinkinga.
Ukulungiselela
Ngaphambi kokuhlinzwa, kuzodingeka uhlolwe ngaphambi kokuhlinzwa. Lezi zivivinyo ziqaphela ukuthi ukuhlinzwa kwesisu kulindeleke ukukusiza, uhlobo oluthile lohlinzekwa lungcono kuwe, futhi usize ukuqondisa odokotela bakho ekuhleleni inqubo ngokwayo. Izindawo zezindawo okufanele zisuswe zikhethiwe ukuze zigweme ukubangela ukulahlekelwa kobuchopho ukusebenza. Okunye ukuhlolwa okungadingeka ngaphambi kwe-hemispherectomy kufaka:
- I-EEG: I-EEG i-electroencephalogram, okuyinto yokuhlolwa okungenasidingo okulinganisa umsebenzi kagesi wengqondo ngokubeka kalula ama-electrode flat kwi-scalp. Lokhu kuhlola kungasiza ekunqumeni ukuthi yisiphi isifunda sobuchopho esibophezele ukugubha. Esimweni sokuhlela i-hemispherectomy, i-EEG ingakwazi ukubona ukuthi iyiphi indawo okufanele isuswe noma isetshenziswe ngokulawula ukudonsa okukhulu.
- I-EEG yevidiyo: Lokhu kuhlolwa kwe-EGG okuhambisana nokuqapha ividiyo. I-EEG yevidiyo ivumela ithimba lakho lezokwelapha ukuthi liqaphele ukuthi umsebenzi wokutholwa kwe-EEG ubonakala kanjani futhi uma ukucindezeleka kwakho kunenkinga enkulu kuqala ngokuphathelene nokushintsha kwakho kwe-EEG. Ukukhomba lo mhlangano kungasiza ekuhleleni inqubo yakho, ikakhulukazi uma unezinhlobo eziningana zokuqothulwa kanye nezindawo eziningana zomsebenzi ongavamile ophawulwe ku-EEG.
- I-Brain MRI: I-MRI yobuchopho isithombe esicacile sobuchopho. Kungabonisa ukuthi ukuzalwa okuncane (kusukela ekuzalweni) okungavamile kanye nokuthola okungajwayelekile okungase kubangele ukuhlukunyezwa kwakho.
- Ukuhlola kwe-PET: Lokhu kuhlolwa kwesithombe okuhlolisisa imetabolism (umsebenzi odla amandla) ezingxenyeni ezihlukene zobuchopho. Kungase kube usizo ekunqumeni indawo ye-anatomic yokuhlukunyezwa kwakho.
- Ukuhlolwa kwe-WADA: Lokhu kuhlolwa kuhlola indawo yomsebenzi wolimi ebuchosheni bakho. Ukuhlola kwe-WADA akusetshenziswanga ukukhomba umsebenzi wokuthungatha noma indawo kodwa isetshenziselwa ukusiza ngokuhlelekile ukuhlela uhlelo lwakho ukunciphisa ukulahlekelwa komsebenzi ngemuva kokuhlinzwa.
Inqubo
Inqubo yakho ifanelwe wena ngokususelwa ekuhlolweni kwakho kwangaphambi kokuhlinzwa, futhi kungenzeka ukuthi akufani neze nenqubo ye-hemispherectomy yomunye umuntu.
Ukuhlinzwa kwe-Hemispherectomy kuhilela ukudala ukuvulwa kwengxenye ye-skull ukuthola ukufinyelela ebuchosheni, nokususa ngokucophelela isifunda sobuchopho obonakele ukususwa ngaphambi kokuhlinzwa. Phakathi nokuhlinzwa, izindawo odokotela bakho abahlela ukuzinqamula, njenge-corpus callosum, zihlukaniswa ngokucophelela. Futhi noma yimuphi ithambo elikhishwa ngesikhathi sokuhlinzwa libuyiselwa endaweni egumbini lokusebenza.
I-Ventricular Shunt
Iningi labantu abane-hemispherectomy badinga ukuphuma kwe-ventricular , ngokuvamile okwesikhashana. Leli bhubhu eliqoqa uketshezi ukuvimbela ukwedlulela okwedlulele ukwakhiwa kokulimaza ebuchosheni.
Ukuhlinza ubongo ngokwayo kungabangela ukwakhiwa kwesikhashana kwesiketshezi. Ukususwa kwezicubu zobuchopho nakho kubangela ukwakheka kwe-fluid, egijima endaweni esanda kugcwaliswa. Kodwa-ke, ngokuhamba kwesikhathi, ibhalansi ye-fluid kulindeleke ukuba ijwayelekile. Uma kunenkinga engaba khona nge-buildup eqhubekayo ye-fluid, i-shunt ingagcinwa isikhathi eside.
Ukubuyisela
Njengoba usuqala ukuhlinzwa, uzodinga ukuqapha okusheshayo. Uzobe ubopha esikhwameni sakho futhi amathambo akho azophulukisa kancane kancane.
Njengoba usuphuluka, ithimba lakho lezokwelapha lihlola izinga lakho lokuqapha kanye nomsebenzi wakho wezinzwa wokuqapha ukuthuthukiswa futhi ukukhomba noma yikuphi ukucindezeleka, njengokuphuma kwegazi noma ukuvuvukala. I-shunt yakho izobe ihlolwe ngokucophelela ezingeni eliketshezi, igazi, nezimpawu zokutheleleka. Lokhu kungasiza ithimba lakho lezokwelapha libambe futhi livimbele izinkinga ngaphambi kokuba zithuthuke.
Ungase uzizwe udilika noma ulahlekelwe ibhalansi futhi ungadinga usizo ngokudla noma ngeminye yemisebenzi yakho yokuphila kwansuku zonke, njengokuya endlini yokugezela nokugeza, ngezinsuku ezimbalwa noma ngisho namasonto ambalwa. Kufanele ulindele ukuqina, uthuthukise ibhalansi yakho futhi uzimele ngokwengeziwe ezinsukwini nasemasontweni ngemuva kokuhlinzwa.
Njengoba uphila, qiniseka ukuthi utshela ithimba lakho lezokwelapha nganoma yimiphi imizwa engavamile ebonakala ibanjwe ukuthunjwa noma i-aura.
Imiphumela
Ekulandeleni, abantu abaningi abaye bahlangabezana nokuhlangenwe nakho kwe-hemispherectomy okukhulu kwezingcupheni. Abanye abantu bakuthola ukuthuthukiswa okuphelele kwesithuthwane sabo futhi bayakwazi ukumisa imishanguzo yokulwa ne-seizure ngemuva kwenqubo. Iningi labantu abaye banesidingo se-hemispherectomy sokuqhubeka nokuthatha imishanguzo yokulwa ne-seizure yokulawula ukuthunjwa, kepha bayakwazi ukuthatha imithi yokwelapha okungaphezu kokubekezela ngaphambi kokuhlinzwa.
Ngesinye isikhathi, i-hemispherectomy ephindaphinda ingadingeka, kanti imiphumela ebikwe kusuka ku-hemispherectomy ephindaphindiwe kakhulu. Kuyinto engavamile ukuthi ukuhlukunyezwa kube nzima ngemva kwe-hemispherectomy.
Izwi elivela
I-hemispherectomy yindlela yokuhlinza ebalulekile. Uma uke ucabange i-hemispherectomy yokulawula ukuthungatha, kufanele wazi ukuthi inqubo eyenziwa ngabahlinzayo abahlinzekwayo abaye baqeqeshwa ekuhlinzekeni kwesithuthwane futhi baqinisekiswa ekuhlinzekeni kobuchopho. Izinzuzo kanye nokuqeda imithi, izinzwa zokuvuselela izinzwa, kanye nezinqubo zokuhlinzeka ngokungenelela zilinganiselwe ngokucophelela ukuqinisekisa ukuthi izinketho eziphephile futhi eziphumelelayo kakhulu zikhethiwe ngokulawula kwakho okuqondile.
Uma i-hemispherectomy ikhethwe njengendlela engcono kakhulu kuwe, ukuhlolwa kwakho kwangaphambi kokuhlinzwa kunganciphisa noma kuqede ngokuphelele ukulahlekelwa umsebenzi wobuchopho kusukela ekuhlinzekeni. Uma udinga ukuphuza imithi noma ukuhlinzwa ngokuphindaphindiwe, imiphumela ngokulawulwa kokuthungatha kanye nemiphumela emibi iyabonakala kahle, kanti iningi labantu libhekene nokuhlukunyezwa okuncane nangaphansi kwe-hemispherectomy kunokwenza ngaphambi kokuhlinzwa.
> Imithombo:
> Chen S, Guan Y, Liu C, et al. Ukwelashwa kweziguli ezinezifo eziphuthumayo eziphindaphindiwe emva kokuqala kwe-hemispherectomy. Isifo sofuba Res. 2017; 139: 137-142. doi: 10.1016 / j.eplepsyres.2017.11.021.