Ni iki Percutaneous Nephrolithotomy? Intego, Uburyo & Ibivamo

Percutaneous nephrolithotomy ni uburyo bwo kubaga butagira ingaruka nyinshi bukoreshwa mu gukuraho amabuye manini yo mu mpyiko adashobora kuvurwa n'ubundi buryo. Tekereza nk'aho ukora umuyoboro muto unyura mu mugongo wawe ugakora mu mpyiko yawe, bigatuma umuganga ubaga akuramo amabuye manini cyangwa akomeye cyane ku buryo budakoresha uburyo bwinshi bwo kuvura.

Ubu buryo butanga icyizere iyo ufite amabuye yo mu mpyiko yateje ububabare buhoraho cyangwa buhagarika urujya n'uruza rw'inkari. Umuganga wawe w'inzobere mu by'impyiko akoresha ibikoresho byihariye binyuze mu gace gato kugira ngo amenagure akureho amabuye, akenshi bitanga ihumure ryihuse ku bimenyetso bishobora kuba byaragize ingaruka ku buzima bwawe bwa buri munsi mu byumweru cyangwa amezi.

Ni iki percutaneous nephrolithotomy ari cyo?

Percutaneous nephrolithotomy (PCNL) ni uburyo bwo kubaga aho abaganga bagerera mu mpyiko yawe banyuze mu gace gato mu mugongo wawe. Ijambo

Iyi nzira iba ngombwa iyo imiti idakoresha ibikoresho byinshi nka shock wave lithotripsy cyangwa ureteroscopy zitabereye imiterere yawe. Amabuye amwe aba manini cyane, akomeye cyane, cyangwa akaba ahantu izindi nzira zitashobora kugera neza.

PCNL kandi irasabwa iyo ufite amabuye menshi yegeranye, amabuye yateje indwara zikunze kugaruka, cyangwa iyo imiti yabanje itagize icyo igeraho. Umuganga wawe w’inzego z’imyororokere ashobora gutanga iyi nzira niba ufite staghorn calculi, ayo akaba ari amabuye manini yuzura ibice byinshi by’inzego zikora imyanda mu mpyiko zawe.

Byongeye kandi, iyi nzira ifasha iyo amabuye yo mu mpyiko ateza ibimenyetso bikomeye nk’ububabare bukomeye, amaraso mu nkari, cyangwa ibibazo by’imikorere y’impyiko. Rimwe na rimwe amabuye afunga urujya n’uruza rw’inkari rwose, bigateza ikibazo cy’ubuvuzi gisaba ubufasha bwihuse kugira ngo urinde ubuzima bw’impyiko zawe.

Ni iki gikorerwa percutaneous nephrolithotomy?

Inzira ya PCNL isanzwe ifata amasaha 2-4 kandi ikorwa hakoreshejwe anesthesia rusange, bivuze ko uzaba uryamye rwose kandi umeze neza mu gihe cyose cyo kubagwa. Itsinda ry’abaganga bazagushyira ku nda kugira ngo babone uburyo bwiza bwo kugera ku mpyiko zawe.

Umuganga wawe abanza gukoresha ultrasound cyangwa X-ray kugira ngo amenye neza aho amabuye yo mu mpyiko yawe aherereye. Hanyuma bakora agace gato, akenshi katarenga santimetero ebyiri, mu mugongo wawe hejuru y’agace k’impyiko. Uku gushyirwa neza neza bituma haboneka inzira nziza kandi ifite akamaro kugira ngo ubashe kugera ku mabuye yawe.

Nyuma, umuganga wawe akora umuyoboro muto uva ku ruhu unyuze mu misitsi yo mu mugongo ukagera mu mpyiko. Iyi nzira, yitwa tract dilation, ikorwa buhoro buhoro hakoreshejwe ibikoresho bigenda byiyongera kugira ngo hakorwe inzira ifite ubugari buhagije ku bikoresho byo kubaga.

Iyo inzira yo kugera ku gice cy'umubiri cyakozwemo umurimo imaze gushyirwaho, nephroscope ishyirwa muri uwo muyoboro. Iyi telescope ntoya, yoroshye, ifasha umuganga wawe kubona imbere mu mpyiko zawe no gushaka amabuye ako kanya. Nephroscope kandi ifite imiyoboro yo gushyiramo ibikoresho bitandukanye bikenewe mu gukuraho amabuye.

Uburyo bwo gukuraho amabuye buterwa n'ubunini n'ubukana bw'amabuye yawe. Amabuye mato ashobora gufatwa agakururwa yose, mu gihe manini avunagurwa mo ibice bito hakoreshejwe imbaraga za ultrasonic, pneumatic, cyangwa laser. Umuganga wawe akuraho witonze ibice byose by'amabuye kugira ngo birinde ibibazo by'ahazaza.

Nyuma yo gukuraho amabuye yose agaragara, umuganga wawe ashyira uruhurirane rwa nephrostomy mu nzira yo kugera ku gice cy'umubiri cyakozwemo umurimo. Uru ruhurirane ruto rufasha gukuraho ibice by'amabuye bisigaye kandi rutuma impyiko zawe zikira neza. Uru ruhurirane rukunze kumara iminsi 1-3 nyuma yo kubagwa.

Ni gute witegura kubagwa kwa nephrolithotomy?

Kwitegura kwawe bitangirana no gusuzuma ubuzima bwawe muri rusange kugira ngo wemeze ko ufite ubuzima bwiza buhagije bwo kubagwa. Muganga wawe azasuzuma amateka yawe y'ubuvuzi, imiti ukoresha ubu, n'uburwayi bwose ushobora kuba ufite. Iri suzuma rifasha ikipe yawe y'abaganga gutegura uburyo bwiza bwo kuvura ikibazo cyawe.

Uzakeneye ibizamini byinshi mbere yo kubagwa kugira ngo usuzume imikorere y'impyiko zawe n'ubuzima bwawe muri rusange. Ibi bikubiyemo ibizamini by'amaraso byo kureba imikorere y'impyiko zawe, ubushobozi bwo gupfuka amaraso, n'ibimenyetso by'indwara. Muganga wawe ashobora kandi gutumiza ibizamini byo gushushanya nka CT scans kugira ngo bamenye neza aho amabuye aherereye n'ubunini bwayo.

Guhindura imiti akenshi birakenewe mbere yo kubagwa. Muganga wawe azatanga amabwiriza yihariye yerekeye imiti yo gukomeza cyangwa guhagarika mbere yo gukora uwo murimo. Imiti ituma amaraso ataguma mu mubiri nka warfarin cyangwa aspirine akenshi igomba guhagarikwa iminsi myinshi mbere yo kubagwa kugira ngo igabanye ibyago byo kuva amaraso.

Uzagenerwa amabwiriza arambuye yo kwiyiriza, akenshi akagusaba kwirinda kurya cyangwa kunywa ikintu icyo aricyo cyose mu masaha 8-12 mbere yo kubagwa. Iki gikorwa cyirinda ingorane zishobora kuvuka mugihe cyo gukoresha imiti yo gutera urujijo, kandi kigashimangira umutekano wawe mugihe cyose cyo kubagwa.

Itsinda ryawe ry’abaganga bazanaganira kandi ku buryo bwo kugabanya ububabare n'ibyo witegura mugihe cyo gukira. Bazagusobanurira kuri nephrostomy tube, ibyo witegura kubona mu miyoboro y'inkari, n'inzitizi z'ibikorwa. Kugira aya makuru mbere bituma ugabanya impungenge kandi bikagutegurira gukira neza.

Ni gute usoma ibisubizo byawe bya percutaneous nephrolithotomy?

Intsinzi yawe ya PCNL ipimwa n'uburyo amabuye yakurwemo yuzuye kandi n'uburyo impyiko yawe ikora neza nyuma yaho. Umuganga ubaga akenshi azakora ibizamini byerekana ishusho y'imbere nyuma y'ako kanya kugirango arebe niba hari ibice by'amabuye bisigaye.

Igisubizo cyiza gisobanura ko amabuye yose agaragara yakurwemo, kandi impyiko yawe ikora neza. Abantu benshi bageraho urugero rwo gukuraho amabuye rwuzuye rwa 85-95%, bitewe n'ubunini n'uburyo amabuye yabo ateye. Muganga wawe azagusangiza ibi bisubizo mugihe igikorwa kirangiye.

Isuzuma ry'ishusho ry'imbere nyuma yo kubagwa, akenshi rikorerwa mu masaha 24-48, rifasha kumenya ibice bito by'amabuye bishobora gusigara. Rimwe na rimwe ibice bito bisigazwa nkana niba kubikuraho byatuma habaho ingaruka mbi kurusha inyungu. Ibi bice bito akenshi binyura mu buryo busanzwe cyangwa bikavurwa hakoreshejwe uburyo butavuna cyane nyuma.

Imikorere y'impyiko yawe ikurikiranwa hakoreshejwe ibizamini by'amaraso n'ingano y'inkari zisohoka. Ibisubizo bisanzwe byerekana imikorere ihamye y'impyiko n'imikorere isobanutse y'inkari. Impinduka zose ziteye impungenge muri ibi bimenyetso bifasha itsinda ryawe ry'abaganga guhindura gahunda yawe yo kwita ku buzima.

Ibyo guhura na muganga nyuma y'iminsi 2-4 na amezi 3-6 nyuma yo kubagwa bifasha gukurikirana uko urwaye urimo gukira mu gihe kirekire. Muri izo nshuro, muganga wawe azakora isuzuma rishingiye ku mashusho n'ibizamini by'amaraso kugira ngo yemeze ko impyiko yawe ikira neza kandi nta mabuye mashya yagaragaye.

Ni ibihe bintu byongera ibyago byo gukenera kubagwa kwa percutaneous nephrolithotomy?

Indwara zimwe na zimwe zongera amahirwe yo kugira amabuye manini mu mpyiko asaba PCNL. Kumva ibyo bintu byongera ibyago bifasha gukorana n'ikipe yawe y'ubuzima kugira ngo wirinde gukora amabuye mu gihe kizaza kandi urengere ubuzima bw'impyiko zawe.

Indwara za metabolike zigira ingaruka ku buryo umubiri wawe utunganya imyunyu ngugu zirema ahantu amabuye manini ashobora gukorerwa. Izo ndwara akenshi zikurura gukora amabuye kenshi, bigatuma PCNL iba ngombwa iyo amabuye aba manini cyane ku buryo atavurwa mu bundi buryo.

• Hyperparathyroidism, itera kalisiyumu nyinshi mu maraso yawe no mu nkari
• Cystinuria, indwara ya genetike itera gukora amabuye ya cystine
• Hyperoxaluria yambere, itera kwisuka kwa oxalate kwiyongera
• Renal tubular acidosis, igira ingaruka ku bushobozi bw'impyiko zawe bwo gushyira aside mu nkari
• Ubwuma buhoraho, butera inkari zishyirwa hamwe zikongera gukura kw'amabuye

Ibibazo by'imyubakire mu nzira yawe y'inkari bishobora kurema ahantu amabuye afatirwa akagenda akura uko igihe kigenda. Ibyo bibazo by'imyubakire akenshi bisaba PCNL kuko amabuye adashobora kunyura mu buryo busanzwe mu duce twagizweho ingaruka.

Ibintu by'imibereho na byo bituma amabuye manini akorwa. Imirire irimo sodium nyinshi, poroteyine y'inyamaswa, cyangwa ibiryo birimo oxalate nyinshi bishobora gutuma amabuye akura. Kunywa amazi make, cyane cyane mu turere dushyushye cyangwa mu gihe cy'imyitozo ngororamubiri, bishyira hamwe inkari zawe kandi bigashishikariza gukora amabuye.

Ubuvuzi bwabanje bw'amabuye butaragenze neza cyangwa butuzuye bushobora gusiga ibisigazwa bikura bakavamo amabuye manini asaba PCNL. Ibi bishimangira akamaro ko gukuraho amabuye yose no gukurikiranwa neza nyuma yo kuvura amabuye yo mu mpyiko.

Ni izihe ngaruka zishobora kuvuka ziterwa na nephrolithotomy ikorerwa mu ruhu?

Nubwo PCNL muri rusange itagira ingaruka zikomeye, gusobanukirwa n'ingaruka zishobora kuvuka bifasha gufata ibyemezo bifitiye akamaro ku buvuzi bwawe. Ingaruka nyinshi ntizikunda kubaho kandi zishobora kuvurwa neza iyo zibayeho.

Ingaruka zisanzwe zikunda kuba nto kandi zikemuka vuba iyo zivuwe neza. Ibi bibazo bishobora kuvurwa bigira ingaruka ku gice gito cy'abarwayi kandi ntibitera ibibazo by'igihe kirekire.

• Gusohoka amaraso bisaba guterwa amaraso (bibaho ku kigereranyo cya 1-5% by'abarwayi)
• Udukoko cyangwa umuriro, akenshi byitabira neza imiti yica udukoko
• Uruzi rw'inkari ruzenguruka ahantu hashyizweho umuyoboro wa nephrostomy
• Gukuraho amabuye bituzuye bisaba izindi nzira zo kuvura
• Impinduka z'agateganyo mu mikorere y'impyiko

Ingaruka zikomeye ntizikunda kubaho ariko zisaba ubuvuzi bwihuse. Ibi bibaho ku kigereranyo kiri munsi ya 1% by'inzira zo kuvura, ariko ikipe yawe y'abaganga iteguye kubikemura nibiramuka bibayeho.

Ukwangirika kw'izindi ngingo zikikije nk'urura runini, urwagashya, cyangwa igihaha bishobora kubaho niba inzira yo kugera ku mpinduka itashyizwe neza. Nubwo bitajyenda bibaho, izi ngaruka zishobora gusaba izindi nzira zo kubaga kugirango zikosorwe. Uburambe bw'umuganga ubaga n'ubuyobozi bwitondewe bw'amashusho bigabanya cyane izi ngaruka.

Ukwangirika kw'imitsi y'amaraso biganisha ku gusohoka amaraso menshi ni indi ngaruka idakunze kubaho ariko ikomeye. Ibi bishobora gusaba embolization, inzira yo guhagarika imitsi isohora amaraso, cyangwa mu bihe bidasanzwe, gukosora mu kubaga. Uburyo bwa none bwo gukoresha amashusho bufasha abaganga kubaga kwirinda imitsi minini y'amaraso mugihe cyo kubaga.

Pneumothorax, aho umwuka winjira mu mwanya uzengurutse uruhara rwawe, bishobora kubaho niba inzira yo kwinjiramo igeze hejuru cyane. Iki kibazo gishobora gusaba gushyiraho umuyoboro mu gituza ariko akenshi gikemuka mu minsi mike. Itsinda ry'abaganga bakora ibijyanye no kubaga baragenzura niba bishoboka kandi barabivura vuba niba bibaye.

Ni ryari nkwiriye kubona umuganga nyuma yo kubagwa nephrolithotomy?

Ibiganiro bisanzwe byo gukurikirana ni ngombwa kugira ngo ugenzure imikorere yawe no gukumira amabuye mu mpyiko mu gihe kizaza. Muganga wawe azategura ibi biganiro mu gihe runaka kugira ngo yemeze ko impyiko yawe ikira neza kandi ikora neza.

Vugana n'umuganga wawe ako kanya niba ubonye ibimenyetso byo kwitondera bishobora kugaragaza ibibazo. Ibi bimenyetso bisaba isuzuma ryihuse ry'ubuvuzi kugira ngo wirinde ibibazo bikomeye kandi wemeze ko ukomeza gukira.

Shaka ubufasha bw'ubuvuzi ako kanya niba ubonye umuriro uri hejuru ya 101°F (38.3°C), cyane cyane niba uherekejwe n'ubukonje cyangwa ibimenyetso bisa n'ibicurane. Ibi bishobora kugaragaza indwara ikeneye kuvurwa n'imiti yica mikorobe. Mu buryo nk'ubwo, ububabare bukomeye butagenzurwa n'imiti yategetswe cyangwa gutangira vuba kw'ububabare bukomeye mu nda cyangwa mu mugongo bisaba isuzuma ryihutirwa.

Impinduka mu musaruro wawe w'inkari cyangwa isura na byo bikwiriye kwitabwaho n'abaganga. Vugana na muganga wawe niba ubonye igabanuka rikomeye ry'umusaruro w'inkari, amaraso atukura cyane mu nkari zawe, cyangwa niba inkari zawe zihinduka ibicu kandi zifite impumuro mbi. Ibi bimenyetso bishobora kugaragaza kuva amaraso cyangwa indwara ikeneye kuvurwa.

Ibibazo by'umuyoboro wawe wa nephrostomy, nk'uko ugwa, guhagarika imigezi, cyangwa gutera ububabare bukomeye, bisaba ubuvuzi bwihutirwa. Ntukagerageze kwimura cyangwa gukuraho umuyoboro wenyine, kuko ibi bishobora gutera imvune cyangwa ibibazo.

Muri rusange, shyiraho gahunda yo gusubira kwa muganga buri gihe nubwo wumva umeze neza. Izo gahunda zifasha muganga wawe gukurikirana imikorere y'impyiko zawe, kugenzura niba hari amabuye mashya yongeye kuboneka, no guhindura ingamba zawe zo kuyarinda. Kumenya ibibazo hakiri kare akenshi bituma kuvurwa byoroha kandi bigatanga umusaruro mwiza.

Ibibazo bikunze kwibazwa ku bijyanye na nephrolithotomy ikorerwa mu mpande z'umubiri

Q.1 Ese nephrolithotomy ikorerwa mu mpande z'umubiri iruta izindi nzira zo kuvura amabuye yo mu mpyiko?

PCNL ni uburyo bwiza bwo kuvura amabuye manini yo mu mpyiko, aho abantu bavurwa bagakira ku kigero cya 85-95% kugira ngo amabuye yose akurwe. Igenewe by'umwihariko amabuye arenze santimetero 2 cyangwa amabuye agoye kuvura, uburyo bindi butabasha kuvura neza.

Ugereranyije na lithotripsy ikoresha imirasire, PCNL itanga umusaruro mwinshi ku mabuye manini ariko bisaba igihe kirekire cyo gukira. N'ubwo lithotripsy ikoresha imirasire itagira ingaruka nyinshi, akenshi ntigira umumaro ku mabuye arenze santimetero 2, bituma PCNL iba uburyo bwiza bwo kuvura ayo mabuye manini.

Q.2 Ese nephrolithotomy ikorerwa mu mpande z'umubiri itera kwangirika kw'impyiko ku buryo buhoraho?

PCNL akenshi ntigatera kwangirika kw'impyiko ku buryo buhoraho iyo ikozwe n'abaganga bafite ubunararibonye. Abantu benshi bakomeza imikorere isanzwe y'impyiko nyuma y'ubwo buryo, kandi benshi mu by'ukuri bagira imikorere y'impyiko irushaho kuba myiza kuko urujya n'uruza rw'inkari rwasubijweho.

Umuhanda muto ukorwa muri PCNL ukira mu buryo busanzwe mu byumweru bike, ugahora hariho ibimenyetso bito. Ubushakashatsi bwerekana ko imikorere y'impyiko isubira ku rwego rwo mbere y'uburyo cyangwa ikaba myiza, cyane cyane iyo amabuye yari ateye imbogamizi cyangwa indwara mbere yo kuvurwa.

Q.3 Bifata igihe kingana iki kugira ngo umuntu akire nyuma ya nephrolithotomy ikorerwa mu mpande z'umubiri?

Abantu benshi bamara mu bitaro iminsi 1-3 nyuma ya PCNL, bitewe n'imikorere yabo yo gukira. Agatubuzo ka nephrostomy akenshi gakurwaho mu masaha 24-72 niba ishusho yerekana ko nta mabuye asigaye kandi impyiko zikora neza.

Gusubirana neza mubisanzwe bifata ibyumweru 2-4, muri icyo gihe uzagenda usubira mu bikorwa bisanzwe. Abantu benshi bashobora gusubira mu kazi ko ku meza mu byumweru 1-2, naho imirimo ikomeye mu mubiri ishobora gusaba ibyumweru 3-4 byo gusubirana.

Q.4 Ese amabuye yo mu mpyiko ashobora kugaruka nyuma yo kubaga nephrolithotomy ya percutaneous?

Mugihe PCNL ikuraho amabuye ahari neza, ntibibuza ko amabuye mashya akorwa. Ibyago byawe byo guteza amabuye mashya biterwa n'impamvu ziri inyuma yo gukorwa kw'amabuye yawe n'uburyo ukurikiza neza ingamba zo kuyakumira.

Gukorana na muganga wawe kugirango umenye kandi uvure impamvu za metabolike z'amabuye yawe bigabanya cyane ibyago byo kugaruka. Ibi bishobora kuba harimo impinduka mu mirire, imiti, cyangwa kuvura indwara zishingiye ku buvuzi zituma amabuye akorwa.

Q.5 Ese nephrolithotomy ya percutaneous irababaza?

Abantu benshi bahura n'ububabare buciriritse nyuma ya PCNL, akenshi bugenzurwa neza n'imiti igabanya ububabare. Ubu bubabare akenshi ntibukabije nk'ububabare burambye abantu benshi bahuye nabwo kuva ku mabuye yabo manini yo mu mpyiko mbere yo kuvurwa.

Itsinda ryawe ry'ubuvuzi rizatanga imicungire yuzuye y'ububabare, harimo imiti yo kunywa no guterwa inshinge uko bikwiye. Abantu benshi basanga ububabare bwabo bugabanuka cyane muminsi mike ya mbere nyuma yo kubagwa, kandi benshi bavuga ko bumva bameze neza cyane mugihe amabuye yabo abuza akurwaho.