Carotid endarterectomy: izinkomba, ukuxakeka nasezinkingeni ezilandela ngemva kokuhlinzwa, eziqhutshwa ukubuyekezwa, izinzuzo nezingozi

Wonke umuntu uyazi ukuthi isifo sohlangothi kubhekwa yezimbangela ezivame kakhulu sokufa phakathi labantu yonke le mbulunga. Lesi sifo kwenzeka nge imvamisa alinganayo kuwo wonke amazwe emhlabeni. Ngokuvamile kwegazi cerebral kuholela ukukhubazeka kanye paresis, okubangela ukukhubazeka okwesikhashana noma unomphela. Ukuze ugweme ukuthuthukiswa kwalesi sifo, nani nidinga isikhathi ukuze ukuxilonga unhlangothi izici letsintsa futhi ukubhekana nazo. Imbangela enkulu yokufa uhlangothi - atherosclerosis kwemithambo yegazi isiphundu sabo ikhanda. embolism e yobudala emaphakathi futhi ubudala kukhona cishe wonke umuntu. Abantu abaningi eminyakeni engu-60 enikeza yezokwelapha nokuvimbela isifo sokuqina kwemithambo yegazi. Kwezinye izimo, imithi is ngingabazi umphumela oyifunayo. Khona-ke wabonisa ukuhlinzwa - endarterectomy carotid. Le nqubo ihilela ukususwa ingxenye isitsha kabana isifo sokuqina kwemithambo yegazi.

Kungani ukuchitha endarterectomy carotid?

Krovosnabzhnenie ubuchopho incike imithambo carotid. Lezi nezitsha amagatsha le-aorta. Basuke ahlelwe symmetrically nhlangothi zombili entanyeni. Ukungena ngaphakathi komgodi cranial, carotid imithambo zihlukaniswe emagatsheni amancane ingqondo. Ngo iziguli isifo sokuqina kwemithambo yegazi, ingozi eliphezulu amahlule e lezi zitsha. Basuke eyakhiwa cholesterol zingcwecwe nezicubu fibrous. Lapho umfutho wegazi e carotid thrombus naphula ogangeni isitsha bese ufaka ingqondo. Ngenxa yalokho, babangela ischemia - yokuntuleka umoya-mpilo umncane ezicutshini. Okunjalo cerebral ukugeleza kwegazi kuholela ebuhlungu. Ukuvimbela i-stroke, carotid endarterectomy wenziwa. It kusiza ukuvimbela isifo sohlangothi kanye nemiphumela yaso.

inqubo Uhlolojikelele

Carotid endarterectomy - kuyinto ukuhlinzwa, okuyinto kuhlantwa ungqimba kwangaphakathi bomkhumbi nge-plaque atherosclerotic. It wenziwa ezimweni lapho imithi ayinamandla noma ingozi yokushaywa unhlangothi liphezulu kakhulu. Izidakamizwa abakwazi ukunikeza umphumela oyifunayo lapho uqweqwe atherosclerotic ithatha amaphesenti angaphezu kwesigamu ububanzi we Umthambo carotid. Noma uma cholesterol evala inesikhala bomkhumbi okuvela ezinhlangothini eziningana ngesikhathi esisodwa. Ngaphezu kwalokho, ingozi yokushaywa unhlangothi kwandisa kakhulu ebukhoneni nomfutho wegazi ophezulu engalawuliwe. Kulokhu, atheroma noma ngasiphi isikhathi off endothelium, kungakhathaliseki ubukhulu bawo. Umphumela kungenzeka hhayi ukuvaleka iningi Umthambo carotid amagatsha awo ukuthi ukondla ingqondo. Ngenxa yalokho asathuthuka unhlangothi ischemic.

Izimpawu ze-carotid endarterectomy

Ukuhlinzwa (carotid endarterectomy) Kwenziwa alulona olwawo wonke umuntu. Lokho udokotela ekunike imvume ukuhlinzwa, kumele kube ubufakazi sina. Ngokuvamile ukusebenza wenziwa in iziguli umlando kakade idluliselwe kwegazi cerebral palsy. Ngakho, kwezinye izimo walungisiswa carotid endarterectomy? Izinkomba okulandelayo:

1. I ububanzi isikepe ivaliwe qwembe atherosclerotic ngesibalo esingaphezu kwengxenye.
2. unhlangothi okuphindaphindayo emlandweni.
3. Inhlanganisela nomfutho wegazi ophezulu (isinxephezelo isinyathelo) kanye isifo sokuqina kwemithambo yegazi kwemithambo yegazi carotid.

Izimo ukuhlinzwa

Naphezu izinzuzo ukuhlinzwa, futhi kwezinye izimo, abakwazi kwenziwe. Njengoba eminye imisebenzi, it has contraindications carotid endarterectomy. Izibuyekezo iziguli isifo sokuqina kwemithambo yegazi, kwenza kube sobala ukuthi eziningi survey ezihlukene ezenziwa ngaphambi kokuba sihlinzwe. Kuphela emva udokotela leneliseka ngukuthi azikho Izimo, isiguli siqala ukulungiselela lo msebenzi. Carotid endarterectomy kungavunyelwe kulezi zimo ezilandelayo:

1. nemithi engalawuliwe (decompensated) nomfutho wegazi ophezulu.
2. Olubanzi acute unhlangothi ischemic.
3. angina engazinzile noma infarction yamuva esivimba amanzi.
4. Ukwehluleka oyingozi inhliziyo.
5. unhlangothi kwakamuva.
6. Okungalapheki esingamahlalakhona kwegazi 2 no-3 degrees.
7. Alzheimer.
8. Umdlavuza nje futhi sinamandla.

Ukulungiselela carotid endarterectomy

Ngaphambi ekwenzeni carotid endarterectomy kuyadingeka ukwenza lolu cwaningo lokungena ahlukahlukene. Eyokuqala sikhombisa Duplex ultrasound imithambo ye ikhanda nentamo. Nale ndlela udokotela onganquma okufanele ukwenze degree of kuvalwe inesikhala kwemithambo yegazi ka zingcwecwe atherosclerotic. Kwezinye izimo, angiography semithambo. Lolu cwaningo iyisingeniso emgudwini wegazi Ngokuphambene ejenti kulandele ukulawula-X-ray. Indlela esinembile kuyinto CT angiography. It ikuvumela ukuhlola ijamo, ubungako kanye kwasendaweni cholesterol ukunqwabelanisa ku endothelium. Uma udokotela osola ischemia izingxenye ezithile ubuchopho, wenziwa-magnetic resonance imaging. Lapho udokotela yembula izinkomba ukuhlinzwa, kubalulekile ukuba bafinyelele esiphethweni mayelana nesimo jikelele isiguli. Ukuze wenze lokhu phambi endarterectomy carotid ukwenza ECG, Kla, kudlule igazi chemistry coagulation. Uma isiguli ezinye izifo, kubalulekile ukuba uthintane ochwepheshe (endocrinology, wenhliziyo).

Izigaba carotid endarterectomy

Isigaba sokuqala sale ukuhlinzwa kuyinto izinzwa. Kukhethwa izinzwa incike ngokubona udokotela, kanye nokuzimisela isiguli. Kungaba kwenziwe izinzwa wendawo noma ukubulawa kwezinzwa okuvamile. Ngemva kwalokho, udokotela ohlinzayo wangitshela kwenza imbobo kule ndawo lapho imiphumela ultrasound noma angiography kuyinto cholesterol zingcwecwe. Isinyathelo esilandelayo is clamping esitsheni. Ngaphezu kwalokho, Imi senziwe iningi Umthambo carotid. Ngemva udokotela ukuba zibukeke ukuhlola ubukhulu kanye nobungako qwembe atherosclerotic, uphetha ukuthi indlela lapho ukuba aqhubeke nokuqhuba. Kukhona amasu amaningi. Ngokuvamile ziphendukela ukuvula endarterectomy. Ngu lokhu kwakusho imbobo longitudinal bomkhumbi futhi "nokususa" cholesterol ukunqwabelanisa. Ngemva kwalokho, esikhundleni endothelium ezilimele sisetshenziswa "patch." Enye indlela - lokhu endarterectomy eversion. Ngenxa yale njongo isitsha ivuliwe ngaphakathi ngaphandle futhi bahlanza of wt atherosclerotic. Uma lesion we Umthambo carotid likhulu, esikhundleni yayo wenziwa endaweni ethile. Ngenxa yale njongo, izindwangu zokwenziwa. Esigabeni sokugcina carotid endarterectomy wembozwe-uthunge.

kuyinto kwaba ngemva kwezikhathi zokulotshwa op kanjani?

Ngemva carotid endarterectomy kuthatha isikhathi ukubuyisela ukugeleza kwegazi. Kuthatha amasonto ambalwa. Kusukela imbobo e entanyeni usayizi encane, uzwakalise emizweni kancane ubuhlungu. Noma kunjalo, kungenzeka analgesics edingekayo ngosuku lokuqala. Wena ubuye abakwazi phakamisa izinto ezisindayo, futhi babonise emasontweni ambalwa, ngoba njengoba carotid endarterectomy wawenziwa. Inkambo nasezinkingeni ezilandela ngemva kokuhlinzwa kwakukuhle, uma wonke kadokotela likadokotela, hhayi kuphela ngesikhathi isesibhedlela, kodwa futhi uma isiguli iyanqamuka ukushajwa. Sutures ziyasuswa izinsuku 7-10 emva kokuhlinzwa.

Izinkinga of carotid endarterectomy

Kufanele kukhunjulwe ukuthi aphinde ahlinzwe yingozi. Ayikho ngaphandle futhi carotid endarterectomy. Izinkinga ngemva lo msebenzi ezingajwayelekile, mayelana 3% of amacala. Noma kunjalo, ziseZwini, kanti isiguli kumele waxwayisa ngale.

I inkinga yokuqala kakhulu nasezinkingeni ezilandela ngemva kokuhlinzwa ukwehluleka suture. Nge lo msebenzi, kwema- amagciwane esilondeni kuyingozi kakhulu ukuphila lesiguli, njengoba Imi kwenziwe ngqo embhedeni semithambo. Lokhu inkinga kungenzeka ngenxa yokungakhokhi nokulandela imithetho antiseptics.

Esinye isimo esiyingozi elihlobene ne Cea, kuwukwedelela. ingozi Cerebrovascular kungenzeka ngenxa qwembe atherosclerotic isinqamu ngokwahlukana ngesikhathi ukusebenza kanye nenhloko yalo nabo izitsha. Lokhu inkinga iyindlala, ngo 2-3% of amacala.

Ngaphezu kwalokho, ukuhlinzwa ngezinye izikhathi waphawula disorder yesikhashana kwezwi nokugwinya. Lokhu lihlotshaniswa umonakalo eziyimpumelelo ezinzwa elise entanyeni.

yezinkinga Late of carotid endarterectomy restenosis kubhekwa. Lokhu kusho ukusebenzisa kabusha ukuvaleka mafutha anciphisa isikhala esingaphakathi isitsha. Ngokuvamile restenosis kwenzeka ezigulini ungahambisani oda udokotela.

Prevention yezinkinga nasezinkingeni ezilandela ngemva kokuhlinzwa

Izinkinga ezifana sohlangothi umonakalo imizwa entanyeni, musa kuxhomeke nesineke, lapho kuphakama isidingo ngokuhamba ukuhlinzwa. Noma kunjalo, ukuvikela nezinye izimo kungenzeka ngiyabonga kuphela umsebenzi angumfelandawonye Udokotela. Ikakhulukazi kumayelana kabusha okwenziwe zingcwecwe atherosclerotic. Uma ukusebenza iphelile, isiguli kumele njalo waphawula nguchwepheshe. Ngaphezu nenqubo ethile yokuthola isifo, udokotela unika isiguli izincomo ewusizo. Ikakhulukazi le osebenza ku yokuphila: isiguli kumele ayeke ukubhema, nokusebenzisa utshwala, ukudla (udle ukudla ephansi fat). Futhi nokuvinjelwa imithi restenosis ebekiwe. Isiguli kufanele nsuku ukuthatha imithi lipid-ukwehlisa ( "atorvastatin" izidakamizwa), ama-ejenti antiplatelet ( "Cardiomagnyl" ithebhulethi "Clopidogrel").

Operation "carotid endarterectomy": ngobuhle nangobubi bawo

Njengazo zonke izinqubo zokuhlinza, lo msebenzi has kokubili ngebuhle nebubi. Abanye odokotela musa batusa carotid endarterectomy nje isifo sokuqina kwemithambo yegazi zingelashwa conservatively, kanye neziguli akudingeki ukubonakaliswa basemtholampilo isifo. Abanye odokotela bakholelwa ukuthi ukuhlinzwa kuyadingeka nge ukuvaleka abalulekile mafutha anciphisa isikhala esingaphakathi we Umthambo, kungakhathaliseki izimpawu zikhona noma hhayi esigulini. Inzuzo yale nqubo kuyinto wekulihlanta bomkhumbi kusukela cholesterol, ekuthuthukiseni ukugeleza kwegazi. Ukusebenza kungaba kakhulu ukunciphisa ingozi yokushaywa unhlangothi. Noma kunjalo endarterectomy akuqinisekisi ukuthi isitsha ngeke konakale futhi. Futhi, ukuxakeka phakathi nokuhlinzwa ingaqala njengoba ukulimala emsipheni noma ukushaywa unhlangothi. Odokotela abaningi bathi lokhu kubangwa manipulation kuqhathaniswa olungalimazi izinqubo kanye imiphumela abhekwa okunenjongo.

Carotid endarterectomy: Izibuyekezo zabantu eziqhutshwa

imicabango yabantu emihle nemibi ihlangabezane nazo engxoxweni noma iyiphi inqubo yokwelapha kuhlinzwa. Ayikho ngaphandle futhi carotid endarterectomy. Izibuyekezo eziqhutshwa abantu zihlukile. Ezimweni eziningi, abantu benelisekile ukusebenza. Ngenxa wakhe, izimpawu ischemia (kahle ukunakwa, inkumbulo, ukulala), imiphumela yocwaningo kanye isimo jikelele ngcono. Ezinye iziguli waphawula ushintsho izwi, ukugwinya iziyaluyalu ngemva endarterectomy. Ezimweni eziningi, lezi zimpawu wathatha cishe inyanga, bese wanyamalala ngokuphelele.