Yini i-Percutaneous Nephrolithotomy? Inhloso, Inqubo & Nemiphumela

I-Percutaneous nephrolithotomy iyinqubo yokuhlinzwa encane esetshenziselwa ukususa amatshe amakhulu ezinso angakwazi ukwelashwa ngezinye izindlela. Cabanga ngayo njengokudala umhubhe omncane ngomhlane wakho ngqo ezinso zakho, okuvumela udokotela ohlinzayo ukuthi akhiphe ngokushesha amatshe amakhulu kakhulu noma anenkani ezingelapheki kalula.

Le nqubo inikeza ithemba uma ubhekene namatshe ezinso abangele ubuhlungu obuqhubekayo noma ukuvimba ukugeleza komchamo. Udokotela wakho we-urologist usebenzisa amathuluzi akhethekile ngokusebenzisa ukusikwa okuncane ukuze aqhekeze futhi asuse amatshe, ngokuvamile enikeza ukukhululeka ngokushesha ezimpawini ezingase zibe nomthelela empilweni yakho yansuku zonke amasonto noma izinyanga.

Yini i-percutaneous nephrolithotomy?

I-Percutaneous nephrolithotomy (PCNL) iyindlela yokuhlinzwa lapho odokotela befinyelela izinso zakho ngokusebenzisa ukusikwa okuncane emhlane wakho. Igama elithi "percutaneous" lisho "ngesikhumba," kuyilapho elithi "nephrolithotomy" libhekisela ekususeni amatshe ezinso.

Ngesikhathi sale nqubo, udokotela ohlinzayo udala indlela emxinwa engaba nobubanzi bepensela esuka esikhumbeni sakho somhlane ngqo ezinso. Lo mhubhe ubavumela ukuthi bafake isibonakude esincanyana esibizwa nge-nephroscope, esibasiza ukuthi babone futhi basuse amatshe ezinso avame ukuba makhulu kunezenti zamamilimitha eziyi-2.

Le nqubo ithathwa njengencane ngoba idinga ukusikwa okuncane uma kuqhathaniswa nokuhlinzwa okuvulekile kwendabuko. Iziguli eziningi ziba nobuhlungu obuncane, izikhathi zokululama ezimfushane, nezibazi ezincane kunezindlela zokuhlinzwa ezivamile.

Kungani kwenziwa i-percutaneous nephrolithotomy?

Udokotela wakho uncoma i-PCNL uma unamatshe amakhulu ezinso ukuthi ezinye izindlela zokwelapha azikwazi ukuwalungisa ngempumelelo. Amatshe amakhulu kunezenti zamamilimitha eziyi-2 noma lawo anesimo esiyinkimbinkimbi ngokuvamile adinga le ndlela eqondile ukuqinisekisa ukususwa okuphelele.

Le nqubo iba yimfuneko xa ukwelashwa okuncinci okufana ne-shock wave lithotripsy okanye i-ureteroscopy kungafaneleki kwimeko yakho ethile. Amanye amatye makhulu kakhulu, anzima kakhulu, okanye abekwe kwiindawo apho ezinye iindlela zingakwazi ukuzifikelela ngokukhuselekileyo.

I-PCNL ikwacetyiswa xa unamatye amaninzi aqokelelwe kunye, amatye abangele usulelo oluphindaphindiweyo, okanye xa unyango lwangaphambili lungaphumelelanga. Ugqirha wakho we-urologist unokucebisa le ndlela ukuba unee-staghorn calculi, amatye amakhulu agcwalisa iindawo ezininzi zenkqubo yokuqokelela izintso zakho.

Ukongeza, le nkqubo iyanceda xa amatye ezintso ebanga iimpawu ezibalulekileyo ezinjengentlungu enkulu, igazi emchameni, okanye iingxaki zokusebenza kwezintso. Ngamanye amaxesha amatye athintela ukuhamba komchamo ngokupheleleyo, edala imeko yezonyango efuna ungenelelo olukhawulezileyo ukukhusela impilo yakho yezintso.

Yintoni inkqubo ye-percutaneous nephrolithotomy?

Inkqubo ye-PCNL ngokuqhelekileyo ithatha iiyure ezi-2-4 kwaye yenziwa phantsi kwe-anesthesia ngokubanzi, okuthetha ukuba uza kulala ngokupheleleyo kwaye ukhululekile ngexesha lotyando. Iqela lakho lotyando liza kukubeka esiswini sakho ukubonelela ngolona lungelo lokufikelela kwizintso zakho.

Ugqirha wakho otyayo uqala ngokusebenzisa i-ultrasound okanye i-X-ray imaging ukufumana indawo echanekileyo yamatye akho ezintso. Emva koko benza ukusikwa okuncinci, ngokuqhelekileyo ngaphantsi kwe-intshi enye ubude, emqolo wakho ngaphezulu kwendawo yezintso. Ukubekwa okuchanekileyo kuqinisekisa indlela ekhuselekileyo nesebenzayo yokufikelela kumatye akho.

Okulandelayo, ugqirha wakho otyayo udala umsele omncinci ukusuka eluswini ngemisipha yangasemva nangaphakathi kwizintso. Le nkqubo, ebizwa ngokuba yi-tract dilation, yenziwa kancinci kancinci kusetyenziswa izixhobo ezinkulu ngokuthe ngcembe ukwenza indlela ebanzi ngokwaneleyo kwizixhobo zotyando.

Uma umzila wokufinyelela usunguliwe, i-nephroscope ifakwa ngalo mhubhe. Le telescope encane, eguquguqukayo ivumela udokotela ohlinzayo ukuthi abone ngaphakathi kwezinso zakho futhi athole amatshe ngqo. I-nephroscope futhi ineziteshi zokufaka amathuluzi ahlukahlukene adingekayo ekuqhumeni kwamatshe.

Inqubo yokukhipha amatshe incike ngosayizi nobulukhuni bamatshe akho. Amatshe amancane angase abanjwe futhi akhiphwe ephelele, kanti amakhulu aphulwa abe yizingcezu ezincane kusetshenziswa amandla e-ultrasonic, pneumatic, noma laser. Udokotela ohlinzayo ukhipha ngokucophelela zonke izingcezu zamatshe ukuvimbela izinkinga zesikhathi esizayo.

Ngemuva kokukhipha wonke amatshe abonakalayo, udokotela ohlinzayo ubeka i-nephrostomy tube ngomzila wokufinyelela. Le tube encane yokukhipha amanzi isiza ukukhipha noma yiziphi izingcezu zamatshe ezisele futhi ivumela izinso zakho ukuthi ziphole kahle. I-tube ngokuvamile ihlala endaweni izinsuku eziyi-1-3 ngemuva kokuhlinzwa.

Ungalungiselela kanjani i-percutaneous nephrolithotomy yakho?

Ukulungiselela kwakho kuqala ngokuhlolwa okubanzi kwezokwelapha ukuqinisekisa ukuthi unempilo eyanele yokuhlinzwa. Udokotela wakho uzobuyekeza umlando wakho wezokwelapha, imithi yamanje, nanoma yikuphi ukungezwani komzimba ongase ube nakho. Lokhu kuhlola kusiza ithimba lakho lokuhlinzwa ukuthi lihlele indlela ephephe kakhulu yesimo sakho esithile.

Uzodinga izivivinyo eziningana zangaphambi kokuhlinzwa ukuze uhlole ukusebenza kwezinso zakho nempilo yonke. Lokhu ngokuvamile kufaka phakathi ukuhlolwa kwegazi ukuhlola ukusebenza kwezinso zakho, ikhono lokujiya, nezimpawu zokutheleleka. Udokotela wakho angase futhi ayale izifundo zokucabanga njenge-CT scans ukukhomba indawo eqondile nosayizi wamatshe akho.

Ukulungiswa kwemithi kuvame ukudingeka ngaphambi kokuhlinzwa. Udokotela wakho uzohlinzeka ngemiyalelo ethile mayelana nokuthi imiphi imithi okufanele iqhubeke noma iyeke ngaphambi kwenqubo. Izinciphisi zegazi ezinjenge-warfarin noma i-aspirin ngokuvamile zidinga ukumiswa ezinsukwini eziningana ngaphambi kokuhlinzwa ukunciphisa ingozi yokopha.

Uzothola imiyalelo ecacile yokuzila ukudla, ngokuvamile ekudinga ukuthi ugweme ukudla noma ukuphuza noma yini amahora angu-8-12 ngaphambi kokuhlinzwa. Lokhu kuqapha kuvimbela izinkinga ngesikhathi sokuhlinzwa futhi kuqinisekisa ukuphepha kwakho ngesikhathi senqubo.

Ithimba lakho lokuhlinzwa lizophinde lixoxe ngezinketho zokuphatha ubuhlungu nokuthi yini ongayilindela ngesikhathi sokululama. Bazochaza nge-nephrostomy tube, okulindelekile kokukhipha amanzi, kanye nemikhawulo yemisebenzi. Ukuba nalo lwazi kusengaphambili kusiza ukunciphisa ukukhathazeka futhi kukulungiselele inqubo yokululama ebushelelezi.

Ungazifunda kanjani imiphumela yakho ye-percutaneous nephrolithotomy?

Impumelelo ye-PCNL yakho ilinganiswa ngokuthi amatshe asuswe ngokuphumelelayo kangakanani nokuthi izinso zakho zisebenza kahle kangakanani ngemva kwalokho. Udokotela ohlinzayo ngokuvamile uzokwenza izifundo zokuthwebula izithombe ngokushesha ngemva kwenqubo ukuze ahlole noma yiziphi izingxenyana zamatshe ezisele.

Umphumela ophumelelayo usho ukuthi wonke amatshe abonakalayo asusiwe, futhi izinso zakho zikhipha amanzi kahle. Iziguli eziningi zifinyelela amazinga okususa amatshe aphelele angama-85-95%, kuye ngosayizi nobunzima bamatshe azo. Udokotela wakho uzokwabelana ngale miphumela nawe uma inqubo isiqediwe.

Ukuthwebula izithombe ngemva kokuhlinzwa, ngokuvamile okwenziwa phakathi kwamahora angu-24-48, kusiza ukuhlonza noma yiziphi izingxenyana zamatshe ezincane ezingase zisele. Ngezinye izikhathi izingcezu ezincane zishiywa ngamabomu uma ukuzisusa kungabangela ingozi enkulu kunenzuzo. Lezi zingxenyana ezincane zivame ukudlula ngokwemvelo noma zingaxazululwa ngemithi engahlaseli kamuva.

Ukusebenza kwezinso zakho kuqashwa ngezivivinyo zegazi kanye nezilinganiso zokukhiqizwa komchamo. Imiphumela evamile ikhombisa ukusebenza kwezinso okuzinzile nokukhiqizwa komchamo ocacile. Noma yiziphi izinguquko ezikhathazayo kulezi zimaki zisiza ithimba lakho lezokwelapha ukuthi lilungise uhlelo lwakho lokunakekela ngokufanele.

Ukuqokwa okulandelayo emavikini ama-2-4 kanye nezinyanga ezi-3-6 ngemva kokuhlinzwa kusiza ukulandela ukululama kwakho kwesikhathi eside. Ngesikhathi salezi zivakashi, udokotela wakho uzoqhuba izifundo zokuthwebula izithombe kanye nokuhlolwa kwegazi ukuqinisekisa ukuthi izinso zakho ziyelapha kahle futhi akukho amatshe amasha akheke.

Ziyini izici eziyingozi zokudinga i-percutaneous nephrolithotomy?

Ezinye izimo zezokwelapha zikhuphula amathuba akho okuthuthukisa amatshe amakhulu ezinso adinga i-PCNL. Ukuqonda lezi zici eziyingozi kukusiza ukuthi usebenze nethimba lakho lezempilo ukuvimbela ukwakheka kwamatshe esikhathi esizayo futhi uvikele impilo yakho yezinso.

Izifo ze-metabolic ezithinta indlela umzimba wakho oqhubula ngayo amaminerali zenza indawo lapho amatshe amakhulu angakheka khona. Lezi zimo zivame ukuholela ekwakhekeni kwamatshe okuphindaphindayo, okwenza i-PCNL idingeke lapho amatshe eseba makhulu kakhulu ukuthi aphathwe ngamanye amakhambi.

• I-Hyperparathyroidism, ebangela i-calcium eyeqile egazini lakho nasemchameni wakho
• I-Cystinuria, isimo se-genetic esiholela ekwakhekeni kwetshe le-cystine
• I-Primary hyperoxaluria, ebangela ukukhishwa kwe-oxalate okwandisiwe
• I-Renal tubular acidosis, ethinta ikhono lezinso zakho lokwenza umchamo ube ne-asidi
• Ukuphelelwa amanzi emzimbeni okungapheli, okuholela emchameni ogxilile okhuthaza ukukhula kwamatshe

Ukuphazamiseka kwe-Anatomical emgudwini wakho womchamo kungakha izindawo lapho amatshe abanjwa khona futhi akhule abe makhulu ngokuhamba kwesikhathi. Lezi zinkinga zesakhiwo zivame ukudinga i-PCNL ngoba amatshe awanakudlula ngokwemvelo ezindaweni ezithintekile.

Izici zokuphila nazo zifaka isandla ekwakhekeni kwamatshe amakhulu. Ukudla okunothe nge-sodium, amaprotheni ezilwane, noma ukudla okunothile nge-oxalate kungakhuthaza ukukhula kwamatshe. Ukuthatha uketshezi olulinganiselwe, ikakhulukazi ezindaweni ezishisayo noma ngesikhathi somsebenzi womzimba, kugxilisa umchamo wakho futhi kukhuthaza ukuthuthukiswa kwamatshe.

Ukwelashwa kwamatshe kwangaphambilini okungaphumelelanga noma okungaphelele kungase kushiye izingcezu ezikhula zibe amatshe amakhulu adinga i-PCNL. Lesi simo sigcizelela ukubaluleka kokususwa kwamatshe okuphelele nokunakekelwa okulungile ngemva kwanoma yikuphi ukwelashwa kwamatshe ezinso.

Ziyini izinkinga ezingase zibe khona ze-percutaneous nephrolithotomy?

Ngenkathi i-PCNL ivikelekile ngokuvamile, ukuqonda izinkinga ezingaba khona kukusiza ukuthi wenze izinqumo ezinolwazi mayelana nokwelashwa kwakho. Izinkinga eziningi azivamile futhi zingalawulwa ngempumelelo uma zenzeka.

Izinkinga ezivame kakhulu ngokuvamile zincane futhi zixazululeka ngokushesha ngokunakekelwa okufanele. Lezi zinkinga ezilawulekayo zithinta iphesenti elincane leziguli futhi akuvamile ukuthi zibange izinkinga zesikhathi eside.

• Ukuphuma kwegazi okudinga ukumpontshwa kwegazi (kwenzeka kuma-1-5% wamacala)
• Ukutheleleka noma umkhuhlane, ngokuvamile kuphendula kahle kuma-antibiotics
• Ukuvuza komchamo endaweni ye-tube ye-nephrostomy
• Ukususwa kwamatshe okungaphelele okudinga izinqubo ezengeziwe
• Ushintsho olwesikhashana ekusebenzeni kwezinso

Izinkinga ezingathi sína zivamile kodwa zidinga ukunakekelwa kwezokwelapha ngokushesha. Lezi zenzakalo zenzeka ngaphansi kwe-1% wezinqubo, kodwa ithimba lakho labahlinzi lilungele ukuzisingatha uma zivela.

Ukwelimala kwezitho ezizungezile njenge-colon, i-spleen, noma amaphaphu kungenzeka uma umzila wokufinyelela ungafakiwe kahle. Ngenkathi kungavamile, lezi zinkinga zingase zidinge izinqubo zokuhlinzwa ezengeziwe ukuzilungisa. Okuhlangenwe nakho kukahlinzi wakho nesiqondiso esiqaphelayo sokucabanga kunciphisa kakhulu lezi zingozi.

Ukwelimala kwemithambo yegazi okuholela ekuphumeni kwegazi okukhulu kungenye inkinga engavamile kodwa engathi sína. Lesi simo singase sidinge i-embolization, inqubo yokuvimba umthambo ophumayo, noma ezimweni ezingavamile kakhulu, ukulungiswa kokuhlinzwa. Izindlela zesimanje zokucabanga zisiza odokotela abahlinzayo ukuthi bagweme imithambo emikhulu yegazi ngesikhathi senqubo.

I-Pneumothorax, lapho umoya ungena esikhaleni esizungeze iphaphu lakho, ingenzeka uma umzila wokufinyelela ukhuphuka kakhulu. Le nkinga ingase idinge ukufakwa kweshubhu lesifuba kodwa ngokuvamile ixazululeka ezinsukwini ezimbalwa. Ithimba lakho labahlinzi liqapha leli thuba futhi lingaliphatha ngokushesha uma kwenzeka.

Kufanele ngibone nini udokotela ngemva kwe-percutaneous nephrolithotomy?

Ukuqokwa okuvamile kokulandela ngemuva kubalulekile ekuqapheni ukululama kwakho nokuvimbela amatshe ezinso esikhathini esizayo. Udokotela wakho uzohlela lezi zivakashi ngezikhathi ezithile ukuze aqinisekise ukuthi izinso zakho ziyelapha kahle futhi zisebenza ngendlela ejwayelekile.

Xhumana nomhlinzeki wakho wezempilo ngokushesha uma uhlangabezana nezimpawu zokuxwayisa ezingase zibonise izinkinga. Lezi zimpawu zidinga ukuhlolwa kwezokwelapha ngokushesha ukuvimbela izinkinga ezingathi sína futhi kuqinisekiswe ukuqhubeka kokululama kwakho.

Funani ukunakekelwa kwezokwelapha ngokushesha uma uthola umkhuhlane ongaphezu kuka-101°F (38.3°C), ikakhulukazi uma ehambisana nokubanda noma izimpawu ezinjengomkhuhlane. Lokhu kungase kubonise ukutheleleka okudinga ukwelashwa ngama-antibiotic. Ngokufanayo, ubuhlungu obukhulu obungalawulwa yimithi echaziwe noma ukuqala okungazelelwe kobuhlungu obukhulu besisu noma emhlane kudinga ukuhlolwa okuphuthumayo.

Ushintsho ekukhipheni umchamo wakho noma ukubukeka nawo kufanele unakekelwe ngudokotela. Xhumana nodokotela wakho uma uqaphela ukwehla okukhulu ekukhiqizweni komchamo, igazi elibomvu ngokugqamile emchamweni wakho, noma uma umchamo wakho uba nefu futhi unuka kabi. Lezi zimpawu zingase zibonise ukopha noma ukutheleleka okudinga ukwelashwa.

Izinkinga ngethubhu lakho le-nephrostomy, njengokuthi liwe, liyeke ukukhipha amanzi, noma libangele ubuhlungu obukhulu, zidinga ukunakekelwa kwezokwelapha ngokushesha. Ungazami ukulishintsha noma ukulisusa wena lelo shubhu, ngoba lokhu kungase kubangele ukulimala noma izinkinga.

Ngaphezu kwalokho, hlela ukuvakashelwa okulandelayo njalo ngisho noma uzizwa kahle. Lokhu kuhlangana kuvumela udokotela wakho ukuthi aqaphe ukusebenza kwezinso zakho, ahlole ukwakheka kwamatshe amasha, futhi alungise amasu akho okuvimbela. Ukutholwa kwangaphambi kwesikhathi kwezinkinga kuvame ukuholela ekwelashweni okulula kanye nemiphumela engcono.

Imibuzo evame ukubuzwa mayelana ne-percutaneous nephrolithotomy

Q.1 Ingabe i-percutaneous nephrolithotomy ingcono kunezinye izindlela zokwelapha amatshe ezinso?

I-PCNL iyindlela yokwelapha ephumelela kakhulu yamatshe amakhulu ezinso, enamazinga empumelelo angama-85-95% wokususa amatshe ngokuphelele. Yenzelwe ngqo amatshe amakhulu kunamasentimitha amabili noma amatshe ayinkimbinkimbi ezingakwazi ukubhekana nawo ngempumelelo ezinye izindlela zokwelapha.

Uma iqhathaniswa ne-shock wave lithotripsy, i-PCNL inikeza amazinga empumelelo aphezulu kakhulu ematsheni amakhulu kodwa idinga isikhathi eside sokululama. Ngenkathi i-shock wave therapy ingahlaseli kangako, ivame ukungasebenzi ematsheni angaphezu kwamasentimitha amabili, okwenza i-PCNL ibe yindlela ekhethwayo yalawo matshe amakhulu.

Q.2 Ingabe i-percutaneous nephrolithotomy ibangela umonakalo unomphela ezinso?

I-PCNL ngokuvamile ayibangeli umonakalo unomphela ezinso uma yenziwa odokotela abahlinzayo abanolwazi. Iningi leziguli ligcina ukusebenza okujwayelekile kwezinso ngemva kwale nqubo, futhi abaningi empeleni bathola ukuthuthuka ekusebenzeni kwezinso njengoba ukugeleza komchamo okuvinjiwe kubuyiselwa.

I-tract encane eyenziwe ngesikhathi se-PCNL iphiliswa ngokwemvelo phakathi kwamasonto ambalwa, ishiya izibazi ezincane. Ucwaningo lubonisa ukuthi ukusebenza kwezinso kuvame ukubuyela emazingeni angaphambi kwenqubo noma ngcono, ikakhulukazi uma amatshe ayebangela ukuvinjelwa noma ukutheleleka ngaphambi kokwelashwa.

Q.3 Kuthatha isikhathi esingakanani ukululama ngemva kwe-percutaneous nephrolithotomy?

Iningi leziguli lihlala esibhedlela izinsuku eziyi-1-3 ngemva kwe-PCNL, kuye ngentuthuko yazo yokululama. I-nephrostomy tube ngokuvamile isuswa phakathi kwamahora angu-24-72 uma ukuthwebula izithombe kungabonisi amatshe asele kanye nokugeleza kwezinso okufanele.

Ukwelulama okuphelele kuvame ukuthatha amasonto angu-2-4, lapho uzobuyela kancane kancane emisebenzini ejwayelekile. Abantu abaningi bangakwazi ukubuyela emsebenzini wedeskini phakathi kwamasonto angu-1-2, kanti imisebenzi edinga amandla amaningi ingase idinge amasonto angu-3-4 esikhathi sokululama.

Q.4 Ingabe amatshe ezinso angabuya ngemva kwe-percutaneous nephrolithotomy?

Ngenkathi i-PCNL isusa amatshe akhona ngempumelelo enkulu, ayivimbeli amatshe amasha ukuthi akheke. Ingozi yakho yokuthuthukisa amatshe amasha incike ezimbangela eziyisisekelo zokwakheka kwamatshe akho nokuthi uzilandela kahle kangakanani izindlela zokuvimbela.

Ukusebenza nodokotela wakho ukuhlonza nokubhekana nezimbangela ze-metabolic zamatshe akho kunciphisa kakhulu ingozi yokuphindeka. Lokhu kungase kuhlanganise izinguquko ekudleni, imithi, noma ukwelapha izimo zezokwelapha eziyisisekelo ezinomthelela ekwakhekeni kwamatshe.

Q.5 Ingabe i-percutaneous nephrolithotomy ibuhlungu?

Iziguli eziningi zizwa ubuhlungu obumaphakathi ngemva kwe-PCNL, obulawulwa kahle ngemithi yokwelapha ubuhlungu. Ubuhlungu buvame ukuba ngaphansi kobukhulu kunobuhlungu obungapheli iziguli eziningi ezibuzwa ngamatshe azo amakhulu ezinso ngaphambi kokwelashwa.

Ithimba lakho lezokwelapha lizohlinzeka ngokuphathwa kobuhlungu okuphelele, okuhlanganisa imithi yomlomo neejekiseni njengoba kudingeka. Iziguli eziningi zithola ukuthi ubuhlungu bazo buyancipha kakhulu ezinsukwini zokuqala ngemva kokuhlinzwa, futhi abaningi babika ukuzizwa ngcono kakhulu uma amatshe abo avimbayo esusiwe.