Ese ni iki? Ibimenyetso, Impamvu, n'Ubuvuzi

Uburwayi bwa arteriovenous malformation (AVM) mu bwonko ni ukubogama kw’imitsi y’amaraso mu bwonko aho imitsi itwara amaraso n’imitsi itwara amaraso ashobora guhuza nta mitsi mito ya capillary iri hagati. Tekereza ko ari inzira yoroheje mu nzira y’imitsi y’amaraso mu bwonko ica inzira isanzwe.

Ubu burwayi bugera kuri umwe kuri 2,000 kugeza kuri 5,000, kandi akenshi ni uburwayi wavukanye, nubwo bushobora kutazana ibibazo kugeza mu myaka y’ubukure. Abantu benshi bafite AVM mu bwonko babaho ubuzima busanzwe, kandi benshi ntibigeze bamenya ko bafite ubu burwayi keretse iyo bugaragaye mu bipimo by’ubuvuzi byakozwe kubera impamvu indi.

Ese ni iki?

AVM mu bwonko ibaho iyo imitsi itwara amaraso n’imitsi itwara amaraso mu bwonko bihuza mu buryo butaziguye, aho guca mu mitsi mito ya capillary. Mu bwonko buzima, amaraso ava mu mitsi manini aca mu mitsi mito ya capillary igabanya umuvuduko w’amaraso mbere yuko agera mu mitsi itwara amaraso.

Muri AVM, amaraso afite umuvuduko mwinshi ava mu mitsi manini ajya mu mitsi itwara amaraso itateguwe gufata uwo muvuduko. Ibi bituma habaho ikibazo cy’imitsi y’amaraso idasanzwe yitwa nidus, ijambo ry’ikilatini risobanura “inzitiro”.

Inkuru nziza ni uko AVMs mu bwonko ibaho kuva umuntu avuka kandi ntiyakwirakwira cyangwa ngo ikure mu gihe kinini mu bihe byinshi. Nanone ni uburwayi buke cyane, rero niba uri gusoma ibi kuko wowe cyangwa umuntu ukunda yavuzweho ubu burwayi, nturi wenyine wihangayikishijwe n’ikintu udakunze.

Ibimenyetso bya AVM mu bwonko ni ibihe?

Abantu benshi bafite AVMs mu bwonko ntibagira ibimenyetso na kimwe. Iyo ibimenyetso byabayeho, bishobora gutandukana cyane bitewe n’aho AVM iherereye mu bwonko bwawe n’ubunini bwayo.

Ibimenyetso bisanzwe ushobora kubona birimo:

• Uburwayi bukomeye bw’umutwe butandukanye n’uburwayi busanzwe bw’umutwe
• Imihango, ishobora kuba ikimenyetso cya mbere cya AVM
• Ubusembwa cyangwa ubukonje mu maboko cyangwa amaguru
• Gukoma mu kanwa cyangwa kutabyumva
• Ibibazo by’ububone cyangwa impinduka
• Ibibazo byo kugira umutekano muke cyangwa guhuza
• Ubwenge buke cyangwa kugorana kwibanda

Bamwe bagira ibimenyetso bito byiyongera buhoro buhoro. Ibi bishobora kuba harimo impinduka nto mu bwenge, kugorana kwibuka, cyangwa ibibazo mu mirimo runaka nko gusoma cyangwa kwandika.

Mu bihe bidafite akamaro, AVM ishobora gutera ububabare bukomeye bw’umutwe, akenshi uba ari ububabare bukomeye kurusha ubundi bwose mu buzima bwawe. Ibi bishobora kugaragaza amaraso ava muri AVM, bisaba ubuvuzi bwihuse.

Impamvu za AVM mu bwonko ni izihe?

AVMs mu bwonko ziterwa mu ntangiriro y’iterambere ry’umwana, akenshi mu ndunduro nke z’inda iyo imitsi y’amaraso mu bwonko iba iri gukora. Impamvu nyamukuru y’ibi ntiyumvikana neza, ariko bigaragara ko ari impinduka idasanzwe mu iterambere aho kuba ikintu giterwa n’ibikorwa by’ababyeyi cyangwa imyambarire.

Bitandukanye n’izindi ndwara, AVMs mu bwonko akenshi ntizirakomoka ku babyeyi. Zibaho mu buryo butunguranye, bisobanura ko zibaho ku bw’amahirwe mu iterambere ry’ubwonko. Abahanga mu bya siyansi bemeza ko ari ukubera uburyo imitsi y’amaraso ikora kandi ihuza muri ibyo byumweru by’ingenzi by’iterambere ry’ubwonko.

Nta kintu wowe cyangwa ababyeyi bawe mwakora kugira ngo mwirinde AVM. Ntiterwa n’imibereho, imvune, cyangwa indwara. Uyu mucyo w’iterambere risanzwe bivuze ko AVMs mu bwonko zishobora kuba kuri uwo ari we wese, bitabaye ibyo mu muryango cyangwa ibindi bibazo by’ubuzima.

Ni ryari ukwiye kujya kwa muganga kubera AVM mu bwonko?

Ugomba gushaka ubuvuzi bwihuse niba ufite ububabare bukomeye bw’umutwe butandukanye n’ubundi wari usanzwe ufite, cyane cyane niba buherekejwe n’iseseme, kuruka, cyangwa impinduka mu bwenge. Ibi bishobora kugaragaza amaraso ava muri AVM kandi bisaba ubuvuzi bwihuse.

Tegura gahunda yo kujya kwa muganga niba ubona ibimenyetso bishya cyangwa bikomeye by’ubwonko nko guhura n’imihindo idasobanutse, ububabare buhoraho bw’umutwe butandukanye n’ubusanzwe, cyangwa impinduka buhoro buhoro mu kuganira, ububone, cyangwa guhuza.

Niba umaze kuvurwa AVM mu bwonko, ni ngombwa gukomeza kujya kwa muganga kubona ubuvuzi buhoraho. Bazakurikirana ubuzima bwawe kandi bagufashe kumva impinduka zose mu bimenyetso byawe cyangwa ibisubizo by’ibipimo.

Ibyago bya AVM mu bwonko ni ibihe?

Kubera ko AVMs mu bwonko ibaho kuva umuntu avuka, ibyago bisanzwe ntibikora nk’uko bikora ku zindi ndwara. Ariko kandi, ibintu bimwe bishobora kugira ingaruka ku buryo AVM ishobora gutera ibibazo cyangwa ibimenyetso mu gihe cyawe cy’ubuzima.

Imyaka ishobora kugira uruhare mu mikorere ya AVMs. Abantu benshi bagira ibimenyetso hagati y’imyaka 20 na 40, nubwo ibimenyetso bishobora kugaragara mu myaka yose. Abakiri bato bakunda kugira imihango nk’ikimenyetso cya mbere.

Ubunini n’aho AVM iherereye ni byo bintu by’ingenzi kuruta ibindi byago. AVMs nini cyangwa iherereye mu bice by’ingenzi by’ubwonko bigengwa n’imvugo, imikorere, cyangwa ububone bishobora kuba byoroshye gutera ibimenyetso. Ariko kandi, na AVMs nto zishobora rimwe na rimwe gutera ibibazo bikomeye, mu gihe izikomeye zishobora kutazigera zitera ibimenyetso na kimwe.

Indwara zimwe na zimwe z’impyiko, nka hereditary hemorrhagic telangiectasia, zishobora kongera ibyago byo kugira AVMs nyinshi, ariko izi zigize igipimo gito cyane cy’ibibazo.

Ingaruka zishoboka za AVM mu bwonko ni izihe?

Ingaruka zikomeye za AVM mu bwonko ni ukurasa kw’amaraso, bizwi kandi nko kuva kw’amaraso. Ibi bibaho iyo imitsi y’amaraso idasanzwe ibaye, bituma amaraso asohora mu mubiri w’ubwonko. Nubwo ibi bishobora gutera ubwoba, ni ngombwa kumenya ko AVMs nyinshi ntizigera zirasa amaraso.

Ibyago byo kuva kw’amaraso buri mwaka kuri AVM itarasa amaraso ni bike, hafi 2-3% buri mwaka. Ariko kandi, ibyo byago bishobora gutandukana bitewe n’ibintu byinshi birimo ubunini bwa AVM, aho iherereye, n’imiterere y’imitsi y’amaraso muganga ashobora gusuzuma.

Ibindi bibazo bishoboka birimo:

• Imihango, ibaho kuri 25-30% by’abantu bafite AVMs
• Ibibazo by’ubwonko bikomeza kubera AVM yiba amaraso ava mu mubiri w’ubwonko
• Impinduka mu bwenge cyangwa ibibazo byo kwiga mu bihe bimwe na bimwe
• Ububabare bw’umutwe buhoraho cyangwa bukomeye uko iminsi igenda

Gake cyane, AVMs nini cyane zishobora gutera ibibazo binyuze mu kubura amaraso ava mu mubiri w’ubwonko, bigatuma habaho impinduka buhoro buhoro mu bwonko. Ibi rimwe na rimwe byitwa “steal phenomenon” kuko AVM iba yibye amaraso agomba kugaburira ibice by’ubwonko bizima.

Ni ngombwa kuzirikana ko abantu benshi bafite AVMs mu bwonko babaho ubuzima bwabo bwose batagira ibibazo. Ikipe yawe y’ubuvuzi irashobora kugufasha kumva ibyago byawe bwite hashingiwe ku miterere ya AVM yawe.

AVM mu bwonko imenyekanwa gute?

AVMs mu bwonko isanzwe imenyekanwa hakoreshejwe ibizamini by’amashusho bishobora kwerekana imitsi y’amaraso idasanzwe mu buryo burambuye. Uburyo busanzwe bwo kubona AVM ni uko bugaragaye mu bipimo bya CT scan cyangwa MRI byakozwe kubera impamvu indi, nko gusuzuma ububabare bw’umutwe cyangwa nyuma yo kugira imihango.

Niba muganga akekako ushobora kuba ufite AVM, azakora MRI ifite contrast, itanga amashusho arambuye y’imitsi y’amaraso mu bwonko bwawe. Iki kizamini ntabwo kibabaza kandi nta mbaraga zikoreshejwe, nubwo uzakenera kuryama utuje mu cyumba gito mu gihe cy’iminota 30-60.

Kugira ngo hamenyekane neza imiterere y’imitsi y’amaraso, muganga ashobora kugusaba cerebral angiogram. Ibi bisaba gushyira umuyoboro muto mu mutsi w’amaraso mu kibuno cyangwa ukuboko hanyuma ugashyiramo ibara kugira ngo hamenyekane neza amashusho ya X-ray y’imitsi y’amaraso mu bwonko bwawe. Nubwo ibi bishobora gutera ubwoba, ni uburyo busanzwe butanga amakuru arambuye kuri AVM yawe.

Rimwe na rimwe abaganga bakoresha CT angiography, ihuza CT scan na contrast kugira ngo hamenyekane neza amashusho y’imitsi y’amaraso. Iki kizamini ni cyihuse kurusha angiography isanzwe ariko gitanga amakuru make.

Ubuvuzi bwa AVM mu bwonko ni buhe?

Ubuvuzi bwa AVMs mu bwonko ntibuhora bukenewe, kandi icyemezo gishingira ku bintu byinshi birimo ibimenyetso byawe, ubunini n’aho AVM iherereye, imyaka yawe, n’ubuzima bwawe muri rusange. Abantu benshi bafite AVMs nto, zitagira ibimenyetso, bakurikiranwa gusa hakoreshejwe ibizamini by’amashusho buri gihe.

Iyo ubuvuzi bukenewe, hari uburyo butatu nyamukuru bushobora gukoreshwa bwonyine cyangwa hamwe. Kubaga bisobanura gufungura umutwe hanyuma ukavanaho AVM yose, ibyo bishobora gukiza burundu ariko bisanzwe bikorerwa AVMs nto ziri ahantu hagomba kubagwa.

Stereotactic radiosurgery ikoresha imirasire yibanze kugira ngo ihagarike imitsi y’amaraso idasanzwe mu gihe cy’imyaka 1-3. Ubu buryo budakoresha ubuganga bukora neza kuri AVMs nto kandi ntibukenera kubagwa, nubwo bidatwara igihe kugira ngo hamenyekane neza.

Endovascular embolization isobanura gushyira umuyoboro muto mu mitsi y’amaraso kugera kuri AVM hanyuma ukayikinga hakoreshejwe ikintu cyihariye, imigozi, cyangwa ibikoresho. Ubu buryo bukunze gukoreshwa kuri AVMs nini cyangwa nk’itegurwa ryo kubagwa cyangwa imirasire.

Ikipe yawe y’ubuvuzi izakorana nawe kugira ngo ibone uburyo bwiza hashingiwe ku mimerere yawe. Rimwe na rimwe, uburyo bwiza ni ukukurikirana witonze aho kuba ubuvuzi bwihuse, cyane cyane kuri AVMs zitagira ibimenyetso.

Uko wakwitwara murugo ufite AVM mu bwonko

Kubana na AVM mu bwonko bisobanura gufata ingamba zimwe na zimwe mugihe ukomeza ubuzima busanzwe. Ikintu cy’ingenzi ni ukunywa imiti yose yagenewe nk’uko byategetswe, cyane cyane niba uri kunywa imiti yo kurwanya imihango.

Abantu benshi bibaza ku bijyanye no kugabanya ibikorwa, kandi inkuru nziza ni uko ibikorwa byinshi bisanzwe ari byiza. Ariko kandi, muganga ashobora kugusaba kwirinda ibikorwa bifite ibyago byinshi byo gukomeretsa umutwe, nko gukina imikino ihuza abantu, kugeza igihe AVM yawe ivuwe cyangwa niba ufite ibyago byinshi byo kuva kw’amaraso.

Komeza kwandika ibimenyetso bishya cyangwa bihinduka mu gitabo cyoroshye. Andika ibintu nko guhinduka kw’ububabare bw’umutwe, imihango, cyangwa impinduka mu buryo wumva cyangwa ukora. Aya makuru afasha ikipe yawe y’ubuvuzi gukurikirana ubuzima bwawe no gufata ibyemezo by’ubuvuzi.

Gucunga umunaniro bishobora kuba ingenzi cyane kuko guhangayika kubera uburwayi bwawe ari ibintu bisanzwe. Tekereza ku buryo bwo kwirinda umunaniro, imyitozo ngororamubiri yoroshye nk’uko muganga yawe yabyemeje, no guhuza n’amatsinda y’abantu bafite ibibazo nk’ibyawe.

Menyesha umuryango wawe n’inshuti zawe hafi yawe uburwayi bwawe kandi bumve ibimenyetso bishobora gusaba ubuvuzi bwihuse. Kugira abantu bagufasha bakumva uko ubuzima bwawe bumeze bishobora gutanga ubufasha bw’ibikorwa n’ihumure mu byiyumvo.

Uko wakwitegura kujya kwa muganga

Mbere yo kujya kwa muganga, andika ibimenyetso byawe byose, nubwo bigaragara ko bidafite aho bihuriye na AVM yawe. Vuga igihe byatangiye, uko kenshi bibaho, n’icyo biba byiza cyangwa biba bibi. Aya makuru arambuye afasha muganga wawe kumva uko AVM yawe ishobora kukugiraho ingaruka.

Zana urutonde rwuzuye rw’imiti yose, ibinyobwa, na vitamine unywa, harimo n’umwanya. Nanone, komeza ibizamini byose by’amashusho cyangwa imyanzuro y’ubuvuzi ijyanye na AVM yawe, kuko kubigereranya mu gihe runaka bitanga amakuru y’ingenzi ku mpinduka zose.

Tegura urutonde rw’ibibazo ushaka kubaza. Ushobora kwifuza kumenya ibijyanye no kugabanya ibikorwa, uburyo bwo kuvura, uko ubuzima buzaba bumeze mu gihe kirekire, cyangwa ibimenyetso bikwiye gutuma uhabwa ubuvuzi bwihuse. Kubyandika bizatuma utazasibanganira ibibazo by’ingenzi mu gihe cy’ibizamini.

Tekereza kuzana umuntu wo mu muryango wawe cyangwa inshuti yizewe izagufasha kwibuka amakuru yavuzwe no kugufasha mu byiyumvo. Ibizamini by’ubuvuzi bijyanye n’uburwayi bw’ubwonko bishobora gutera ubwoba, kandi kugira umuntu uri kumwe bishobora kugufasha gutunganya amakuru nyuma.

Niba bishoboka, shakisha ubwoko bwawe bwa AVM mbere kugira ngo ubashe kugirana ikiganiro cyiza na muganga wawe. Ariko kandi, ibuka ko buri AVM ari iyihariye, bityo amakuru ubonye kuri internet ashobora kutakubereye.

Icyo ukwiye kumenya cyane kuri AVM mu bwonko

Ikintu cy’ingenzi cyo kumenya kuri AVMs mu bwonko ni uko ari uburwayi bushobora kuvurwa, kandi abantu benshi babaho ubuzima buzima, busanzwe. Nubwo kuvurwa bishobora gutera ubwoba, ibuka ko ubuvuzi bwarateye imbere cyane, kandi AVMs nyinshi ntizigera ziterwa ibibazo bikomeye.

Ikipe yawe y’ubuvuzi izakorana nawe kugira ngo itegure gahunda ihuza ibyago n’inyungu z’uburyo butandukanye. Ibi bishobora kuba harimo ubuvuzi, cyangwa bishobora kuba harimo gukurikirana witonze hakoreshejwe ibizamini bya buri gihe.

Komeza guhuza n’ikipe yawe y’ubuvuzi, kurikiza amabwiriza yabo, kandi ntutinye kubaza ibibazo igihe ubibonye. Kumva uburwayi bwawe bikugira ububasha bwo gufata ibyemezo byiza kandi bigabanya guhangayika kubera ikintu utazi.

Icy’ingenzi, kuvurwa kwa AVM mu bwonko ntikugutandukanya cyangwa ntikabuza ibyo ushobora kugeraho mu buzima. Hamwe n’ubuvuzi bukwiye no gukurikirana, ushobora gukomeza gukora ibyo wifuza no kubana ubuzima ushaka.

Ibibazo byakunda kubaho kuri AVM mu bwonko

Ese AVMs mu bwonko zishobora gukura mu gihe kinini?

AVMs nyinshi mu bwonko ntizakura cyane nyuma yo kuvuka, nubwo zishobora kugaragara cyane uko imyaka igenda kubera impinduka mu buryo amaraso agenda. Bitandukanye n’ibibyimba, AVMs ni uburwayi buhagaze budakwirakwira cyangwa ngo byiyongere. Ariko kandi, muganga wawe azakurikirana AVM yawe hakoreshejwe ibizamini bya buri gihe kugira ngo akurikirane impinduka zose mu gihe.

Ese ni byiza kubyara niba ufite AVM mu bwonko?

Abagore benshi bafite AVMs mu bwonko babyara neza kandi babyara neza, nubwo ibi bisaba gutegura neza hamwe n’ikipe yawe y’ubuvuzi. Gutwita bishobora kongera gato ibyago byo kuva kw’amaraso kuri AVMs zimwe kubera kongera amaraso n’impinduka z’imisemburo. Abaganga bawe bazasuzumira uko ubuzima bwawe bumeze kandi bashobora kugusaba kuvurwa mbere yo gutwita cyangwa gukurikirana byihariye mu gihe cyo gutwita no kubyara.

Ese nzagomba kwirinda kuguruka cyangwa kujya ahantu hari hejuru?

Abantu benshi bafite AVMs mu bwonko bashobora gukora ingendo no kuguruka bisanzwe nta ngamba zihariye. Impinduka z’umuvuduko mu gihe cyo kuguruka akenshi ntiziba zikomeye ku buryo zishobora kugira ingaruka kuri AVM yawe. Ariko kandi, niba umaze kuvurwa cyangwa ufite ibimenyetso, ni byiza kuganira na muganga wawe ku ngendo kugira ngo umenye neza ko ari byiza kuri wewe.

Ese umunaniro cyangwa imyitozo ngororamubiri bishobora gutera kuva kw’amaraso kuri AVM?

Nubwo imyitozo ikomeye cyangwa umunaniro ukabije bishobora kongera umuvuduko w’amaraso ku buryo bugaragara, ibikorwa bya buri munsi n’imyitozo ngororamubiri iringaniye bisanzwe ari byiza kuri benshi bafite AVMs. Muganga wawe ashobora kugufasha kumenya uko wakora imyitozo hashingiwe ku miterere ya AVM yawe n’ibyago byo kuva kw’amaraso. Ikintu cy’ingenzi ni ukubona umwanya mwiza hagati yo gukora imyitozo no kwirinda ibyago bitari ngombwa.

Ese nzagomba gukora ibizamini by’amashusho kenshi gute?

Uko kenshi ugomba gukora ibizamini by’amashusho biterwa n’imiterere ya AVM yawe, niba umaze kuvurwa, n’ibimenyetso byawe. AVMs zitavuwe zishobora gukurikiranwa buri myaka 1-3, mu gihe izavuwe zishobora gukenera gukurikiranwa vuba kugira ngo hamenyekane neza ko ubuvuzi bukora. Ikipe yawe y’ubuvuzi izategura gahunda yo gukurikirana ihuza ibyo ukeneye kumenya n’ibizamini bitari ngombwa n’imbaraga zikoreshejwe.