Yini i-Carotid Endarterectomy? Inhloso, Inqubo & Imiphumela

I-Carotid endarterectomy iyinqubo yokuhlinzwa esusa ukwakheka kwe-plaque emithanjeni yakho ye-carotid. Lezi yimithambo emikhulu yegazi entanyeni yakho ethwala igazi elinothile nge-oxygen ebuchosheni bakho. Lapho i-plaque inciphisa le mithambo, ingakhuphula ingozi yakho yokushaywa unhlangothi, futhi lokhu kuhlinzwa kusiza ukubuyisela ukugeleza kwegazi okufanele ukuvikela ubuchopho bakho.

Yini i-carotid endarterectomy?

I-Carotid endarterectomy ukuhlinzwa okuvikelayo okuhlanza imithambo yakho ye-carotid. Cabanga ngayo njengokuhlanza ipayipi elivaliwe - udokotela ohlinzayo ususa amafutha ne-plaque eziye zakheka ezindongeni zemithambo ngokuhamba kwesikhathi.

Le nqubo iqondiswe ngqo ku-carotid artery stenosis, okusho ukuncipha kwale mithambo yegazi ebalulekile. Ukuhlinzwa kuhilela ukwenza ukusikeka okuncane entanyeni yakho, ukuvula okwesikhashana umthambo, nokuklwebha ngokucophelela ukwakheka kwe-plaque.

Umgomo uwukwandisa umthambo ubuyele osayizini yawo evamile ukuze igazi ligeleze ngokukhululeka ebuchosheni bakho. Lokhu kunciphisa kakhulu ingozi yakho yokuba nokushaywa unhlangothi okubangelwa ukuvinjelwa kokugeleza kwegazi noma izingcezu ze-plaque eziqhekekayo.

Kungani kwenziwa i-carotid endarterectomy?

Udokotela wakho uncoma lokhu kuhlinzwa ikakhulukazi ukuvimbela ukushaywa unhlangothi. Lapho imithambo yakho ye-carotid incipha kakhulu - ngokuvamile ngo-70% noma ngaphezulu - ingozi yokushaywa unhlangothi iyanda kakhulu.

Le nqubo ivame kakhulu ukwenziwa uma unesifo esibi semithambo ye-carotid kodwa ungakabi nokushaywa unhlangothi okukhulu. Iyanconywa futhi uma uke wahlangabezana nokushaywa unhlangothi okuncane (okubizwa ngokuthi ukuhlaselwa kwe-ischemic okwesikhashana noma ama-TIA) noma uma izivivinyo zokucabanga zikhombisa ukwakheka kwe-plaque okuyingozi.

Ngezinye izikhathi odokotela bancoma lokhu kuhlinzwa ngisho noma ungenazo izimpawu, ikakhulukazi uma izivivinyo zembula ukuncipha okuqinile kakhulu. Ukuhlinzwa kusebenza njengesinyathelo sokuvikela, njengokulungisa idamu ngaphambi kokuthi liqhekeke kunokulinda izikhukhula.

Yini inqubo ye-carotid endarterectomy?

Ukuhlinzwa kuvame ukuthatha amahora angu-2-3 futhi kwenziwa ngaphansi kwe-anesthesia ejwayelekile, ngakho-ke uzobe ulele ngokuphelele. Udokotela ohlinzayo wenza ukusikwa okungama-intshi angu-3-4 eceleni kwentamo yakho ukuze afinyelele emthanjeni we-carotid.

Nakhu okwenzekayo ngesikhathi sezinyathelo eziyinhloko zenqubo:

1. Udokotela ohlinzayo uhlukanisa ngokucophelela imisipha nezicubu ukuze afinyelele emthanjeni we-carotid
2. Babeka iziqeshana zesikhashana ngaphezulu nangaphansi kwesigaba esincishisiwe ukuze kumiswe ukugeleza kwegazi
3. I-tube encane (i-shunt) ingafakwa ukuze kugcinwe ukugeleza kwegazi ebuchosheni bakho ngesikhathi senqubo
4. Umthambo uvulwa ngobude, futhi i-plaque isuswa ngokucophelela ngesiqwenga esisodwa uma kungenzeka
5. Umthambo uvalwa ngemithungo emihle, ngezinye izikhathi kusetshenziswa isiqeshana ukuze siwukhulise
6. Ukugeleza kwegazi kubuyiselwa, futhi ukusikwa kuvalwa ngezendlalelo

Ithimba lakho lokuhlinza liqapha ukusebenza kobuchopho bakho kuyo yonke inqubo kusetshenziswa izindlela ezihlukahlukene. Iziguli eziningi zingabuyela ekhaya phakathi nosuku olu-1-2 ngemva kokuhlinzwa.

Ungalungiselela kanjani i-carotid endarterectomy yakho?

Ukulungiselela kwakho kuqala cishe ngesonto ngaphambi kokuhlinzwa ngemiyalelo ethile evela eqenjini lakho lezokwelapha. Kuzodingeka ukuthi uyeke imithi ethile, ikakhulukazi ama-blood thinners, njengoba kuyalelwe udokotela wakho.

Ukulungiselela kwakho ngaphambi kokuhlinzwa kuvame ukuhlanganisa:

• Ukuyeka ukubhema okungenani amasonto ama-2 ngaphambi kokuhlinzwa ukuze kuthuthukiswe ukuphola
• Ukuhlela ukuthi othile akuqhubele ekhaya futhi ahlale nawe amahora angu-24
• Ukugwema ukudla neziphuzo ngemva kwamabili ngaphambi kosuku lwakho lokuhlinzwa
• Ukuphuza noma yimiphi imithi enqunyiwe ngamanzi amancane njengoba kuyalelwe
• Ukuletha uhlu lwazo zonke izidakamizwa zakho zamanje esibhedlela
• Ukugqoka izingubo ezikhululekile, ezixekile ezingadingeki ukuthi zidlule ekhanda lakho

Udktela wakho angase futhi ayalele ezinye izivivinyo ezinjengomsebenzi wegazi noma izifundo zokuthwebula izithombe ukuqinisekisa ukuthi usukulungele ukuhlinzwa. Unganqikazi ukubuza imibuzo nganoma yini ekukhathazayo.

Ungazifunda kanjani imiphumela yakho ye-carotid endarterectomy?

Impumelelo ngemuva kwe-carotid endarterectomy ilinganiswa ngokuqaliswa kokugeleza kwegazi nokuncishiswa kwengozi yokushaywa unhlangothi. Udktela wakho uzosebenzisa izivivinyo ze-ultrasound ukuze ahlole ukuthi umthambo wakho manje uvuleke kakhulu nokuthi igazi ligeleza kahle.

Ngemuva nje kokuhlinzwa, ungalindela ukuvuvukala okuthile nokungakhululeki endaweni yokusika. Intamo yakho ingase izizwe iqine noma ibe ndikindiki amasonto amaningana, okuyinto ejwayelekile ngokuphelele njengoba izicubu ziziphilisa.

Imiphumela yesikhathi eside ngokuvamile ihle kakhulu - izifundo zibonisa ukuthi ukuhlinzwa kunciphisa ingozi yokushaywa unhlangothi ngamaphesenti angaba ngu-50% kubantu abafanelekayo. Abantu abaningi ababi nazimpawu eziqhubekayo futhi bangakwazi ukubuyela emisebenzini yabo ejwayelekile phakathi kwamasonto angu-2-4.

Ithimba lakho lezokwelapha lizohlela ama-aphoyintimenti okulandelayo ukuze liqaphe ukululama kwakho futhi liqinisekise ukuthi umthambo uhlala uvulekile. Lokhu kuhlolwa kubalulekile ekugcineni imiphumela yakho emihle.

Yiziphi izici eziyingozi zokudinga i-carotid endarterectomy?

Izici eziningana zikhuphula amathuba akho okuthuthukisa isifo somthambo we-carotid esingase sidinge lokhu kuhlinzwa. Ubudala buyisici esibaluleke kakhulu, nengozi ekhula kakhulu ngemuva kweminyaka engama-65.

Izici eziyingozi eziyinhloko ezinomthelela ekunciphiseni umthambo we-carotid zihlanganisa:

• Umfutho wegazi ophezulu olimala izindonga zemithambo ngokuhamba kwesikhathi
• Amazinga e-cholesterol aphezulu aholela ekwakhekeni kwe-plaque
• Isifo sikashukela, esisheshisa ukulimala komthambo
• Ukubhema, okuphinda kabili ingozi yakho yesifo somthambo we-carotid
• Umlando womndeni wesifo senhliziyo noma ukushaywa unhlangothi
• Ukuhlaselwa yinhliziyo kwangaphambilini noma isifo somthambo we-peripheral
• Ukukhuluphala nokuphila ngendlela engahleliwe

Ukuba nezinto eziningi eziyingozi kwandisa amathuba akho okuthuthukisa isifo esikhulu semithambo ye-carotid. Izindaba ezinhle ukuthi eziningi zalezi zinto zingalawulwa ngezinguquko zokuphila kanye nemithi.

Ziyini izinkinga ezingaba khona ze-carotid endarterectomy?

Ngenkathi i-carotid endarterectomy ivame ukuba iphephile, njenganoma yikuphi ukuhlinzwa, ithwala ezinye izingozi. Inkinga enkulu kakhulu engaba khona ukushaywa unhlangothi, okwenzeka cishe kuma-1-3% eziguli.

Ezinye izinkinga ezingaba khona, nakuba zingavamile, zihlanganisa:

• Ukuhlaselwa yinhliziyo ngenxa yokucindezeleka kokuhlinzwa
• Ukuphuma igazi noma ukwakheka kwamahlule egazi endaweni yokuhlinzwa
• Ukutheleleka kwesilonda, okuvame ukwelashwa ngama-antibiotics
• Umonakalo wemizwa obangela izinguquko zezwi zesikhashana noma ezingapheli
• Ubunzima besikhashana bokugwinya noma ubuthakathaka bobuso
• Ushintsho lomfutho wegazi oludinga ukulungiswa kwemithi

Izinkinga eziningi zisesikhashana futhi zixazululeka emasontweni kuya ezinyangeni. Ithimba lakho lokuhlinzwa lithatha izinyathelo eziningi zokunciphisa lezi zingozi, futhi izinzuzo ngokuvamile zidlula kakhulu izinkinga ezingaba khona.

Izinkinga ezingavamile zingase zihlanganise ukuquleka noma izinguquko zokuqonda, kodwa lokhu kuthinta ngaphansi kwe-1% weziguli. Udokotela ohlinzayo uzoxoxa ngephrofayili yakho ethile yengozi ngaphambi kwenqubo.

Kufanele ngibone nini udokotela ngemva kwe-carotid endarterectomy?

Kufanele uxhumane nodokotela wakho ngokushesha uma uhlangabezana nanoma yiziphi izimpawu zokushaywa unhlangothi ngemva kokuhlinzwa. Lokhu kuhlanganisa ubuthakathaka obuzumayo, ukuba ndikindiki, ukudideka, ubunzima bokukhuluma, noma ikhanda elibuhlungu elibuhlungu.

Ezinye izimpawu zokuxwayisa ezidinga ukunakekelwa kwezokwelapha okusheshayo zihlanganisa:

• Ukuphuma igazi ngokweqile noma ukuvuvukala endaweni yokuhlinzwa
• Izimpawu zokutheleleka njengomkhuhlane, ubuhlungu obanda, noma i-pus evela esilondeni
• Ushintsho oluzumayo embonweni noma isiyezi
• Ubunzima bokuphefumula noma ubuhlungu besifuba
• Ubuhlungu bentamo obukhulu noma ukuqina
• Ukuba ndikindiki okusha noma ukuluma ebusweni bakho noma emilenzeni

Ukuze kulandelwe njalo, ngokuvamile uzobona udokotela ohlinzayo phakathi kwamasonto angu-1-2 ngemva kokuhlinzwa. Ukuhlolwa okuvamile ngezivivinyo ze-ultrasound kuvame ukuhlelwa ezinyangeni eziyi-6, bese kuba minyaka yonke ukuze kuqashwe umthambo wakho.

Ungakhathazeki ngokuphatheka kabi okuncane, ukulimala, noma ukuvuvukala okuncane - lokhu kuyingxenye ejwayelekile yokuphola. Uma ungabaza, ngaso sonke isikhathi kungcono ukushayela ithimba lakho lezokwelapha ngemibuzo.

Imibuzo evame ukubuzwa mayelana ne-carotid endarterectomy

Q.1 Ingabe i-carotid endarterectomy ilungele ukuvimbela isifo sohlangothi?

Yebo, i-carotid endarterectomy isebenza kahle kakhulu ekuvikeleni isifo sohlangothi kubantu abafanelekayo. Izifundo zibonisa ngokuqhubekayo ukuthi zinciphisa ingozi yesifo sohlangothi ngamaphesenti angaba ngu-50% kubantu abanokuncipha okukhulu komthambo we-carotid.

Ukuhlinzwa kunenzuzo enkulu kubantu abanokuncipha okungama-70% noma ngaphezulu komthambo wabo we-carotid, ikakhulukazi uma beke baba nesifo sohlangothi esincane. Kubantu abanokuncipha okulinganiselwe (50-69%), izinzuzo zincane kodwa zibalulekile ezimweni ezithile.

Q.2 Ingabe ukuncipha komthambo we-carotid ngaso sonke isikhathi kubangela izimpawu?

Cha, ukuncipha komthambo we-carotid kuvame ukuthuthuka buthule ngaphandle kwezimpawu ezisobala. Abantu abaningi banokuvaleka okukhulu okutholakala kuphela ngesikhathi sokuhlolwa okuvamile kwezokwelapha noma izivivinyo zokucabanga ngenxa yezinye izizathu.

Lapho izimpawu zenzeka, ngokuvamile zihlanganisa isifo sohlangothi esincane esinobuthakathaka besikhashana, ukuba ndikindiki, izinguquko zombono, noma ubunzima bokukhuluma. Kodwa-ke, uphawu lokuqala ngezinye izikhathi lungaba isifo sohlangothi esikhulu, yingakho ukuhlolwa kubalulekile kubantu abasengozini enkulu.

Q.3 Kuthatha isikhathi esingakanani ukululama ngemva kwe-carotid endarterectomy?

Abantu abaningi bangakwazi ukubuyela emisebenzini elula phakathi nesonto elilodwa futhi baqale imisebenzi ejwayelekile phakathi kwamasonto angu-2-4. Ukuphola okuphelele kokusika ngokuvamile kuthatha amasonto angu-4-6.

Kuzodingeka ukuthi ugweme ukuphakamisa izinto ezisindayo (ezingaphezu kwamakhilogremu ama-4.5) cishe amasonto ama-2 futhi akufanele ushayele imoto kuze kube yilapho udokotela wakho ekugunyaza, ngokuvamile kungakapheli isonto elilodwa. Abantu abaningi bazizwa bebuyela emazingeni abo amandla avamile kungakapheli inyanga eyodwa ngemva kokuhlinzwa.

Q.4 Ingabe isifo semithambo ye-carotid singabuyela ngemva kokuhlinzwa?

Isifo semithambo ye-carotid singase sibuye, kodwa akuvamile eminyakeni embalwa yokuqala ngemva kokuhlinzwa. Cishe ama-10-20% abantu bangase bathuthukise izinga elithile lokuncipha futhi eminyakeni engama-10-15.

Yingakho izinguquko zokuphila kanye nemithi yokulawula izinto eziyingozi njengomfutho wegazi ophezulu ne-cholesterol kubaluleke kakhulu ngemva kokuhlinzwa. Ukuqapha njalo ngezivivinyo ze-ultrasound kusiza ukubamba noma yiziphi izinkinga zisasekuqaleni.

Q.5 Zikhona ezinye izindlela ezingasetshenziswa esikhundleni se-carotid endarterectomy?

Yebo, ukufakwa kwe-carotid artery stenting kuyinqubo enye lapho kufakwa khona ishubhu elincane le-mesh ngaphakathi komthambo ukuze liwuvule. Lokhu kwenziwa ngembobo encane esinyeni sakho esikhundleni sokuhlinzwa intamo.

Udokotela wakho ukhetha phakathi kokuhlinzwa kanye ne-stenting ngokusekelwe eminyakeni yakho, impilo yonke, i-anatomy, nezinto eziyingozi ezithile. Zombili izinqubo ziyasebenza, kodwa ukuhlinzwa kuvame ukukhethwa kubantu abaningi, ikakhulukazi labo abangaphansi kweminyaka engama-75.