Ingaba le yipilisi efanelekileyo yokuphumula?
I-Angioplasty kunye ne-stenting ziye zatshintsha indlela yokunyanga isifo se-coronary disease , kodwa ezi zonyango ziye zazisa uhlobo olutsha lweengxaki kumxube. Le ngxaki yokuphumla - ukukhutshwa okuqhubekayo kwisayithi yonyango. Kwiminyaka yokuqala ye-2000, i-brachytherapy, okanye i-coronary artery yonyango, yaba yintsholongwane elitsha elithembisayo yokubuyiswa kwe-restenosis.
Kodwa ngelixa i-brachytherapy (kwaye ikhona) iphumelele kakhulu ekuphumeni kwe-restenosis, ngoku sele ixhaswa ngokusetyenziswa kwe- drug-eluting stents .
I-Restenosis emva kokuba i-angioplasty okanye i-stenting ibangelwa ukukhula ngokweqile kwezicubu kwindawo yonyango. Yibangelwa ukusabela okuphambene nokuphilisa, ukuvelisa ukwanda kweeseli "endothelial" eziqhelekileyo zigalele imithwalo yegazi. Ukukhula kwezicubu kunganciphisa kwakhona umthamo.
I-Brachytherapy inokuphatha ukuphulukana ngokubulala ama-cell eseleyo kunye nokukhusela ukukhula kweethambo.
I-Brachytherapy isetyenziswa njani?
I-Brachytherapy ilawulwa ngeprojekithi ekhethekileyo yokucwangcisa intliziyo. I-radiation ngokwayo ihanjiswa ngoluhlobo olukhethekileyo lwencatheta eyenzelwe ukusebenzisa i-radiation esuka ngaphakathi kwintsimbi ye-coronary. I-catheter idluliselwa kwimibhobho ye-coronary kunye nokuvalwa kokubanjelwa ekuphumeni. Xa indawo "ekhonjiweyo" yendawo ejoliswe kuyo yi-catheter, i-radiation isetyenziswa.
Iindidi ezimbini zeemitha zangasetyenziswa: i-gamma radiation kunye ne-beta imisebe. Ezi zombini iintlobo zemililo ziyanzima, kwaye zifuna ukusetyenziswa kwezixhobo ezizodwa ebhodini, ukufumana iindlela zokulondoloza ezikhethekileyo, kunye nabantu abaqeqeshwe ngokukhethekileyo, ngokuqhelekileyo kubandakanywa i-oncologist ye-radiation.
I-Cardiologists eziye zasebenzisa i-brachytherapy ziyavuma ukuba isitshixo sokuphumelela ngamava omsebenzisi. Le nkqubo iinkqubo eziyinkimbinkimbi ezifuna ngaphezu kobuchule obuqhelekileyo bokungena kwi-cardiologist.
Impumelelo
Ucwaningo lwezonyango luye lwabonisa ukuba i-brachytherapy isebenza kakuhle ekunciphiseni ukuphumla kwiimitha ze-coronary, kunye nokunciphisa umngcipheko wokuhlala kwakhona. Ukongezelela, uphando lubonakala lubonisa ukuba izigulane ezinobungozi obukhulu bokuphumula- (ezifana nabantu abaneesifo sikashukela ) -ukufuna ukufumana inzuzo enkulu kwiyeza.
Iingxaki
I-brachytherapy ayinayo ingxaki. Ingxaki enye eyahlukileyo ibonwe ne-brachytherapy ibe "yimpembelelo enqamlekileyo" -kubonakala kwimiqobo emitsha kwinqanaba le-radiation (indawo ephathwayo nge-radiation). Le ntsholongwane yempembelelo, ebangela ukubonakala kwebhanki okanye "i-candy-wrapper" xa iboniswe nge-angiogram, yiphumo elibi elibi kakhulu elinzima ukuyiphatha. Ezi zilonda zempembelelo zomsindo zibangelwa kukubekwa kwecatheter xa kulawulwa i-brachytherapy.
Kwakhona, izigulane eziphathwe nge-brachytherapy zibonakala zinobungozi obuncipheko bokuthi i- coronary artery thrombosis (i-clot blood).
Ngokuqhelekileyo, ukuba i-thrombosis ivela emva kwe-angioplasty okanye i-stenting, itholakala kwiintsuku ezingama-30 kule nkqubo. Kodwa i-thrombosis yexesha elide (eqhubeka emva kweentsuku ezingama-30 zokuqala) ibonakala kwi-10% yezigulane ezithola i-brachytherapy. Le ntsholongwane ehamba phambili ixhomekeke kwi- infyoction (myocardial infarction ) okanye i- angina engaqinisekanga . Ukuncedisa ukunciphisa lo mngcipheko, abacebisi begazi banconywa ubuncinane kunyaka emva kokugqithisa.
Kutheni i-Brachytherapy isetyenziswa kakhulu namhlanje?
I-Restenosis yinkinga enkulu engaphendulwanga kwiintsuku zokuqala ze-angioplasty kunye ne-stenting, kwaye iminyaka emininzi i-brachytherapy ibonakala yindlela ethembisayo yokujongana nokuphumula.
Nangona kunjalo, ngoku isetyenziswe kuphela.
Ukubonakala kwezidakamizwa ezilitshizayo izidakamizwa ngokukhawuleza kwenza ukuba i-brachytherapy isondele. Izifundo ngokuthelekiswa ngokuthe ngqo nokukhusela nokusebenza kwe-brachytherapy kwi-drug-eluting stents ekunakekeleni ukuphumula kubonisa ngokucacileyo ukuba izicathulo zinika iziphumo ezingcono. Ukongeza koko, izazi ze-cardiologists zikhululekile ukubeka i-stents, kwaye i-stents ayifuni ukuphazamiseka, indleko kunye nobuchule obukhethekileyo obufunekayo yi-brachytherapy. Akuzange kuthathe ixesha elide ukuba i-brachytherapy ikhulule kakhulu kwimephu.
Sekunjalo, i-brachytherapy iyasebenza kwaye ikhuselekile ngokufanelekileyo kwaye ivunyiwe ukuba isebenziswe nguLawulo lwezoKutya nokuLawulwa kweziMilo. Amancinci amaziko akhethekileyo aqhubeka anikela njengendlela yokunyanga ukuphucula.
Namhlanje, i-brachytherapy ngokuqhelekileyo ithathwa njengento ekhethekileyo kuphela kwizigulana eziye zahlala zihlala zihlala zithe gqwa, kwaye kuye kuthiwa izilwanyana eziphuza izidakamizwa ziye zahluleka ukunqanda ingxaki. Ukufumana i-brachytherapy ezi zigulane kufuneka zihanjiswe kwelinye lamaziko ambalwa aqhubeka enika olu hlobo lonyango.
Imithombo:
I-Teirstein PS, i-Massullo V, uJani S, et al. Ukulandelwa kweminyaka emithathu kliniki kunye ne-angiographic emva kwe-radiation intracononary: iziphumo zoluvavanyo lwekliniki olungenamsebenzi. Ukujikeleza 2000; 101: 360.
Sapirstein W, uZuckerman B, u-Dillard J. FDA ukuvunyelwa kwe-coronary-artery brachytherapy. N Engl J Med 2001; 344: 297.
Holmes DR Jr, Teirstein PS, Satler L, et al. Ukulandelwa kweminyaka emithathu ye-SISR (iSirolimus-Eluting Stents Versus Brachytherapy ye-In-Stent Restenosis). JACC Cardiovasc Phakathi kuka-2008; 1: 439.