Ni iki cyitwa kubaga kugabanya ingano y'ibihaha? Intego, uburyo & Ibivamo

Kubaga kugabanya ingano y'ibihaha (LVRS) ni uburyo bwo gukuraho ibice byangiritse by'ibihaha byawe kugira ngo bifashe igice gisigaye cy'umubiri gukora neza. Bitekereze nk'aho ukora icyumba kugira ngo igice cyiza cy'ibihaha byawe cyaguke kandi gikore neza ukuraho ibice bitagufasha guhumeka.

Uku kubaga cyane cyane bigenewe abantu bafite emphysema ikomeye, uburwayi aho imifuka y'umwuka mu bihaha byawe yangirika kandi igafata umwuka. Iyo abaganga bakuraho utwo duce twangiritse, urugingo rwawe rushobora kwimuka neza, kandi igice gisigaye cy'ibihaha byawe gishobora gukora akazi kacyo neza.

Ni iki cyitwa kubaga kugabanya ingano y'ibihaha?

Kubaga kugabanya ingano y'ibihaha bikubiyemo gukuraho 20-30% by'igice cy'ibihaha byawe cyangiritse cyane kurusha ibindi mu bihaha byombi. Intego ni ukongera ubushobozi bwawe bwo guhumeka n'imibereho myiza yawe ubyemerera igice cyiza cy'ibihaha byawe kwaguka neza.

Mugihe cyo kubaga, abaganga bamenya ahantu h'ibihaha byawe hangiritse cyane na emphysema. Ibi bice akenshi bisa nk'amabalon yagabanutse atashobora guhanahana neza umwuka wa oxygene na dioxyde ya carbone. Mu gukuraho utwo duce tudakora, kubaga bifasha imitsi yo mu gituza cyawe na diaphragm gukora neza.

Ubu buryo bushobora gukorwa hakoreshejwe uburyo butandukanye, harimo kubaga gakondo cyangwa uburyo butagira ingaruka nyinshi. Umuganga wawe azahitamo uburyo bwiza bushingiye ku ngaruka z'ibihaha byawe n'ubuzima bwawe muri rusange.

Kuki kubaga kugabanya ingano y'ibihaha bikorwa?

Uku kubaga bigirwa abantu bafite emphysema ikomeye bakomeza guhura n'ingorane zo guhumeka nubwo bafashwa neza n'imiti. Intego nyamukuru ni ukongera imibereho myiza yawe n'ubushobozi bwo guhumeka iyo izindi nshuti zitatanze ubufasha buhagije.

Ushobora kuba ukwiriye kubagwa LVRS niba ufite emphysema yo mu gice cyo hejuru cy'ibihaha, aho kwangirika kwibanda mu duce tw'ibihaha byawe tw'inyuma. Ubu bwoko bwo kwangirika bukunda gusubiza neza mu kubagwa kurusha ubundi bwoko bwa emphysema.

Kubagwa birashobora kugufasha kugabanya guhumeka bigoranye, kongera ubushobozi bwo gukora imyitozo, kandi bishobora kongera imyaka yo kubaho. Abarwayi benshi basanga bashobora gusubira mu bikorwa batashoboraga gukora mbere, nk'urugero rwo kugenda intera ndende cyangwa kuzamuka amategeko.

Ni iki gikorerwa kubagwa kugabanya umubare w'ibihaha?

Kubagwa mubisanzwe bifata amasaha 3-4 kandi bikorwa hakoreshejwe anesthesia rusange. Itsinda ryawe ry'abaganga bazakoresha uburyo bumwe mu buryo butandukanye bitewe n'uburwayi bwawe bwihariye n'icyo umuganga akunda.

Ibi nibyo bikunda kuba mu gihe cyo kubagwa:

1. Uzakira anesthesia rusange kugirango ugume wumva neza kandi utazi
2. Umuganga akora ibikomere kugirango agere ku bihaha byawe (haba binyuze mu bikomere bito cyangwa igikomere kinini cy'igituza)
3. Hakoreshejwe ibikoresho byihariye, bamenya igice cyangiritse cyane cy'ibihaha
4. Ibyangiritse bikurwaho neza hakoreshejwe ibikoresho byo gufunga
5. Igice gisigaye cy'ibihaha gifite ubuzima buzima kigenzurwa niba hari umwuka uvamo
6. Imigozi yo mu gituza ishyirwaho kugirango ifashe kuvana amazi n'umwuka
7. Ibikomere bifungwa hamwe n'imitsi cyangwa ibikoresho byo gufunga

Uburyo bwihariye bukoreshwa bushobora gutandukana. Abaganga bamwe bakoresha kubagwa bifashishije amashusho (VATS), bikoresha ibikomere bito na kamera ntoya. Abandi bashobora gukoresha median sternotomy, ikubiyemo gufungura igituza binyuze mu gatuza.

Ni gute witegura kubagwa kugabanya umubare w'ibihaha?

Kwitegura LVRS bikubiyemo ibyumweru byinshi byo gusuzuma no gukora imyitozo kugirango wemeze ko ufite ubuzima bwiza bushoboka mbere yo kubagwa. Itsinda ryawe ry'abaganga rizakorana nawe bya hafi kugirango utunganye ubuzima bwawe mbere y'igikorwa.

Imyiteguro yawe ishobora kurimo izi ntambwe z'ingenzi:

1. Porogaramu yo kuvugurura ibihaha kugirango ukomeze imitsi ifasha mu guhumeka
2. Ibizami byimbitse byo gupima imikorere y'ibihaha n'ibizamini byerekana ishusho
3. Isuzuma ry'umutima kugirango wemeze ko umutima wawe ushobora kwihanganira kubagwa
4. Isesengura ry'imirire no kunoza uburemere bwawe
5. Ibizamini byose by'amaraso n'ibindi bizamini by'ubuvuzi
6. Kureka itabi niba ukirinywa (by'ingenzi rwose)
7. Guhindura imiti nkuko byasabwe na muganga wawe

Uzagomba kandi guhagarika imiti imwe mbere yo kubagwa no gutegura ubufasha murugo mugihe cyo koroherwa. Abantu benshi bamara ibyumweru 6-8 muri porogaramu yo kuvugurura ibihaha mbere yo kubagwa kugirango bongere imbaraga zabo n'ubushobozi bwo guhumeka.

Ni gute usoma ibisubizo byo kubagwa kugirango ugabanye umubare w'ibihaha?

Intsinzi nyuma ya LVRS ipimwa no kunoza ubushobozi bwawe bwo guhumeka, kwihanganira imyitozo, n'ubuzima muri rusange aho gusa imibare kuri test. Abaganga bawe bazakurikiza ibipimo byingenzi kugirango bamenye neza uko kubagwa byagukoreye.

Ubu ni bumwe mu buryo nyamukuru ikipe yawe y'ubuvuzi izasuzuma ibisubizo byawe:

• Umuvuduko wo guhumeka (FEV1) - upima umwuka ushobora guhumeka mumasegonda
• Igeragezwa ryo kugenda iminota itandatu - rikoresha intera ushobora kugenda mumiminota itandatu
• Ibibazo byubuzima bwo kubaho kubijyanye nibikorwa bya buri munsi
• Urugero rwa ogisijeni mugihe cyo kuruhuka no gukora
• Imirasire ya X na CT kugirango urebe kwaguka kwibihaha
• Ibizamini by'amaraso ya arteri kugirango urebe urugero rwa ogisijeni na karubone diyokiside

Abantu benshi babona impinduka muminsi 3-6 nyuma yo kubagwa. Urashobora kubona ko ushobora kugenda kure utagira umwuka muke, kuzamuka amategeko byoroshye, cyangwa kwitabira ibikorwa utashoboraga gukora mbere yo kubagwa.

Ni iki gisubizo cyiza cyo kubagwa kugirango ugabanye umubare wibihaha?

Ibyiza byinshi biboneka ku barwayi bafite emphysema yo mu gice cyo hejuru cy'urugingo rw'umubiri rwo mu gituza kandi bafite ubushobozi buke bwo gukora imyitozo mbere yo kubagwa. Abo bantu akenshi bahura n'iterambere rikomeye mu guhumeka, kwihanganira imyitozo, n'imibereho myiza.

Abantu bakwiriye guhabwa ubuvuzi akenshi babona iterambere riri hagati ya 15-20% mu bizami byabo by'imikorere y'ibihaha kandi bashobora kugenda metero 15-30 mu bizami byo kugenda iminota itandatu. Abantu benshi baravuga kandi ko batagihumeka cyane mu bikorwa bya buri munsi nk'ukoza, guteka, cyangwa imirimo yo mu rugo yoroheje.

Ibyiza birashobora kumara imyaka myinshi, nubwo emphysema ari indwara ikomeza. Abantu bamwe bagumana imikorere yabo imaze imyaka 5-10 cyangwa irenga, mu gihe abandi bashobora kubona kugabanuka gake gake uko imyaka y'ibihaha bisigaye bigenda.

Ni ibihe bintu byongera ibyago byo kutagira umusaruro mwiza wo kubagwa kugabanya ingano y'ibihaha?

Ibintu bimwe na bimwe bishobora kongera ibyago byawe byo kugira ingorane cyangwa kutagira umusaruro mwiza wo kubagwa LVRS. Kumva ibyo bintu byongera ibyago bifasha itsinda ryawe ry'abaganga kumenya niba uri umuntu ukwiriye guhabwa ubuvuzi.

Indwara nyinshi zirashobora gutuma kubagwa bigira ibyago byinshi kuri wowe:

• Imikorere y'ibihaha idahagije (FEV1 itarenze 20% y'ibisanzwe)
• Indwara ikomeye y'umutima cyangwa umuvuduko ukabije w'amaraso mu bihaha
• Gukomeza kunywa itabi cyangwa amateka yo kunywa itabi vuba aha
• Imirire mibi ikomeye cyangwa kuba ufite uburemere buke cyane
• Kubagwa mu gituza mbere cyangwa gukomeretsa cyane mu gituza
• Indwara zikomeye cyangwa indwara yo mu myanya y'ubuhumekero vuba aha
• Ubukure bwinshi (imyaka irenga 75-80)
• Emphysema ihuriweho (kwangirika kwakwirakwiriye mu bihaha byose)

Itsinda ryawe ry'abaganga rizagenzura neza ibyo bintu mugihe cyo kugenzura mbere yo kubagwa. Rimwe na rimwe, gukemura ibintu bimwe byongera ibyago nk'imirire cyangwa imyitozo birashobora kunoza ubushobozi bwawe bwo guhabwa ubuvuzi.

Ese ni byiza kubagwa kugabanya ingano y'ibihaha cyangwa gukoresha imiti?

Umutuzo hagati yo kubagwa no gukomeza kuvurwa n'imiti biterwa n'ubwoko bw'indwara ya emphysema ufite, ibimenyetso ufite ubu, n'ubuzima bwawe muri rusange. Ku bantu babikwiriye, LVRS ishobora gutanga inyungu zikomeye imiti yonyine itashobora kugeraho.

Kubagwa bikunze kugira akamaro cyane niba ufite emphysema yo mu gice cyo hejuru cy'ibihaha hamwe n'ahantu hangiritse cyane bivanzemo ibice bifite ubuzima bwiza. Muri ibyo bihe, gukuraho ahantu habi cyane bishobora kunoza cyane uko igice cy'ibihaha gisigaye gikora.

Gukoresha imiti birashobora kuba byiza niba ufite emphysema ihuriye (ibice byangiritse bikwirakwira kimwe mu bihaha byawe) cyangwa niba ubushobozi bwawe bwo gukora imyitozo bugihagije. Umuganga wawe w'ibihaha azagufasha gupima inyungu zishoboka n'ibibazo byo kubagwa bitewe n'uko ubuzima bwawe bumeze.

Ni izihe ngaruka zishobora kubaho zo kubagwa kugabanya umubare w'ibihaha?

Kimwe n'ubundi bwoko bwose bwo kubagwa bukomeye, LVRS ifite ibibazo bisanzwe n'ibitavugwaho rumwe, ikipe yawe y'abaganga izabiganiraho nawe mu buryo burambuye. Kumva ibyo bibazo bishobora kubaho bifasha gufata icyemezo gifitiye akamaro niba kubagwa ari byiza kuri wewe.

Dore ibibazo bisanzwe ugomba kumenya:

• Kuvamo umwuka muremure kuva ku gice cy'ibihaha (bibaho kuri 30-50% by'abarwayi)
• Umuriro cyangwa izindi ndwara zo mu myanya y'ubuhumekero
• Kuva amaraso bisaba guterwa amaraso
• Umutima utagenda neza mu gihe cyo gukira
• Urujijo rw'agateganyo cyangwa delirium nyuma yo gukoresha anesthesia
• Ibibazo byo gukira ibikomere cyangwa kwandura ahantu hakorewe incision
• Amabuye y'amaraso mu maguru cyangwa mu bihaha

Ibibazo bikomeye ariko bitavugwaho rumwe bishobora kuba birimo kunanirwa guhumeka bisaba guhumeka mu buryo bwa mekaniki, guturika k'umutima, stroke, cyangwa mu bihe bidasanzwe, urupfu. Igipimo cy'urupfu muri rusange kuri LVRS ni hafi 2-5% bitewe n'ikigo cy'ubuvuzi n'itoranya ry'abarwayi.

Nzagomba kubona umuganga ryari nyuma yo kubagwa kugabanya umubare w'ibihaha?

Ugomba guhita uvugana n’ikipe yawe y’ubuvuzi niba ubonye ibimenyetso bibangamiye mu gihe urimo gukira. Kumenya no kuvura hakiri kare ibibazo bishobora gukumira ibindi bibazo bikomeye.

Hamagara muganga wawe ako kanya niba ubonye ibi bimenyetso byo kwitondera:

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• Kugira umwuka mubi cyane cyangwa kuribwa mu gituza
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• Urubanza rurenze 100.4°F (38°C) cyangwa ibimenyetso by’ubwandu
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• Gukorora amaraso cyangwa ibimeze nk'umuhondo n'icyatsi
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• Umutuku, kubyimba, cyangwa kuvusha ku bikomere byawe
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• Kuvusha kw'imiyoboro yo mu gituza byiyongera cyangwa bihindura ibara
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• Uburibwe bukomeye butagenzurwa n'imiti wahawe
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• Kubyimba amaguru yawe cyangwa kugorwa no guhumeka iyo uryamye hasi
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Uzajya ugira gahunda yo gusuzumwa buri gihe kugira ngo ukurikirane imikoreshereze yawe no gukurikirana iterambere ryawe. Uku gusura ni ngombwa kugira ngo umenye ibibazo hakiri kare no guhindura gahunda yawe yo gukira uko bikwiye.

Ibibazo bikunze kubazwa ku bijyanye no kubagwa kugabanya umubare w'ibihaha

Q.1 Ese kubagwa kugabanya umubare w'ibihaha ni byiza ku bwoko bwose bwa emphysema?

Oya, LVRS ikora neza ku bwoko bwihariye bwa emphysema, cyane cyane emphysema yo mu gice cyo hejuru aho kwangirika kwibanda mu bice byo hejuru by'ibihaha byawe. Ubu bwoko bw'imikoreshereze yangiza butuma abaganga bashobora gukuraho ahantu habi cyane mu gihe barinda ibice bifite ubuzima bwiza bishobora kwaguka no gukora neza.

Niba ufite emphysema ihuriweho, aho kwangirika bikwirakwira kimwe mu bihaha byawe byose, kubagwa muri rusange ntibisabwa. Muri ibi bihe, nta turere twihariye

Bitekereze nk'uko guha ibihaha byawe "intangiriro nshya" ukuraho ibice bitagikora neza. Ibi bishobora gutanga imyaka yo guhumeka neza no kugira ubuzima bwiza, ariko uzakomeza gufata imiti yawe ya emphysema no gukurikiranwa.

Q.3 Bifata igihe kingana iki kugira ngo umuntu akire nyuma yo kubagwa kugabanya ingano y'ibihaha?

Gukira bya mbere mubisanzwe bifata ibyumweru 6-8, ariko gukira neza bishobora gufata amezi 3-6 cyangwa arenga. Birashoboka ko uzamara iminsi 7-14 mu bitaro, iminsi ya mbere ukaba uri mu bitaro byita ku barwayi barembye kugira ngo bakurikirane hafi.

Mu byumweru bya mbere uri mu rugo, buhoro buhoro uzongera urwego rwawe rw'ibikorwa ukurikiranwa n'abaganga. Abantu benshi barwaye batangira kubona inyungu zo guhumeka mu mezi 1-3, kandi imikorere myiza ikunze kugaragara nyuma y'amezi 6 nyuma yo kubagwa.

Q.4 Nshobora kubagwa kugabanya ingano y'ibihaha niba nkoresha umwuka wa oxygene?

Gukoresha oxygene ntibigutera guhita utemerewe kubagwa LVRS, ariko bisaba isuzuma ryitondewe. Abantu benshi batsinze bafata oxygene yunganira mbere yo kubagwa, cyane cyane mugihe bakora imyitozo cyangwa basinziriye.

Itsinda ryawe ry'abaganga rizasuzuma niba ibyo ukeneye bya oxygene biterwa n'ibibazo bya mekaniki kubagwa gushobora gukemura (nk'umwuka wazitiwe) cyangwa ibindi bibazo kubagwa ritazafasha. Abantu bamwe barwaye bashobora kugabanya cyangwa gukuraho ibyo bakeneye bya oxygene nyuma yo kubagwa neza.

Q.5 Ni irihe tandukaniro riri hagati yo kubagwa kugabanya ingano y'ibihaha no guhindura ibihaha?

LVRS ikora n'ibihaha byawe bisanzwe ikuraho ibice byangiritse, mugihe guhindura ibihaha bisimbuza ibihaha byawe byose n'ibihaha byatanzwe. LVRS ikunze gutekerezwa kubantu barwaye indwara idakabije cyane batarakeneye guhindurwa.

Gukira muri LVRS muri rusange biragufi kandi ntibigoye cyane kurusha gukira nyuma yo guhindurwa. Ariko, guhindurwa bishobora gutanga impinduka zikomeye kubantu barwaye indwara y'ibihaha igeze ku iherezo. Itsinda ryawe ry'abaganga rizafasha kumenya uburyo bukwiye cyane kubibazo byawe byihariye.