Indlela yokuPhepha yokuNciphisa ingozi yeStyroke
I-carotid endarterectomy yintsebenzo yokuhlinzwa apho i-plaque isuswa kwi-artery carotid. Iiplac ziindawo zokuxhotyiswa kwamanqatha emithanjeni yegazi. Kwi-artery carotid, i-plaque inokunciphisa ukuvula, ukunciphisa ukuhamba kwegazi kwingqondo kunye nokwandisa umngcipheko wee-clots eziqhekeza kwi-plaque kwaye zihamba kwiinqanawa ze-cerebral zenze i-stroke.
Ukunciphisa umkhumbi wegazi kuthiwa yi- stenosis .
UkuBambisana
Oogqirha baye benza i-carotid endarterectomy ixesha elide, kwaye benze njalo ngokufanelekileyo kwiindawo ezinkulu zonyango. I-CEA yokuqala yenziwa ngo-1953 nguDkt DeBakey eHouston, eTexas. Ngeli xesha, i-endarterectomi ye-carotid engaphezu kwe-100 iyenziwa minyaka yonke e-United States.
Inkqubo
Ngethuba le-endarterectomy ye-carotid, ugqirha ovula ugqirha luvula i-carotid artery kwaye uyasusa i-plaque eyenziwe kwinqanaba langaphakathi, elibizwa ngokuba yi-endothelium.
Isinyathelo sokuqala kukuqinisekisa ukuba isigulane senza ukhululekile usebenzisa i-anesthesia jikelele okanye yendawo. Ezinye izigulane zikhetha i-aneshesia yendawo ukuze bakwazi ukuphaphama kwaye baxelele ugqirha ukuba bayayiva nantoni na ayifanele. Le ndlela ibuye ivumele ugqirha ukuba ahlolisise isimo sengqondo sesigulane ngokucela ukuba benze izinto ezifana nokucima isandla. Abanye bangathanda ukulala ngokusebenzisa inkqubo.
Kule meko, ukuqapha kwe-electrophysiologic nge-intraoperative kunye neendlela ezifana ne- electroencephalography (i-EEG) ingasetyenziselwa ukuqinisekisa ukuqhubeka kwengqondo. Akukho bungqina obubonise umahluko phakathi kwesixhobo sokusebenzisa i-aneshesia yendawo okanye i-endarterectomy ye-carotid.
Emva kokuba i-anesthesia ilawulwa, ugqirha ugqirha i-artery ukuba igcine iphuma kwixesha.
Ngoxa i-artery iphoswe, ingqondo iya kuxhomekeka kumzobo we-carotid kwicala eliphambene negazi layo. Isicatshulwa senziwe kwi-artery encinciweyo, kwaye uluhlu lwezicubu ezine-plaque lukhutshwe. Emva kokuba isicatshulwa sisuswe, ugqirha ugqithisa umthamo ndawonye kunye, kunye nesiphango sisuswa.
Abaviwa
Umngcipheko wokuba unxephezelo ngowama-1 ukuya kwe-2 ekhulwini ngonyaka kubantu abane-starotic carotid. ISikhungo sikaZwelonke seMpilo kunye neZiklinikhi eziPhambili zicebise ukuba izigulane ezinomlinganiselo othe ngqo kwi-stenosis ezinokutshatyalaliswa kwintlungu okanye ukuhlaselwa kwe-ischemic engapheliyo kune -endarterectomy kwiiveki ezimbini.
Izilingo ezinkulu zeklinikhi zibonise ukuba ukuba isiguli sinempawu, kulindeleke ukuba siphile iminyaka emihlanu okanye ngaphezulu, kwaye inegqirha onogqirha enezinga elingaphantsi kwe-3 leengxaki, esi sigulane siya kuzuza kwi-endarterectomy.
Iingeniso zimbalwa kubantu abangenazo iimpawu, kodwa kwiimeko ezinzima, i-endarterectomy ye-carotid isenokufaneleka. Kukhona ingxoxo enkulu phakathi kwamagqirha malunga nexesha lokuthatha i-endarterectomy kubantu abangenasiphelo, ngokukodwa njengendlela yokuphathwa kwezonyango zezi gulane ziphucula ngexesha.
Ukungqinelana
I-endarterectomy ye-Carotid akufanele ijonge ukuba i-artery carotid yangaphakathi ivalwe ngokupheleleyo. Nangona kubonakala kungaqondakali, akukho nzuzo eyaziwayo yokuvula umzobo ovalwe ngokupheleleyo, mhlawumbi ngenxa yokuba umda wokuvalela uvaliwe, akukho ndlela yokuba i-clot isuke kwi-plaque uze ufike kwi-brain.
Ukuba sele sele ikhona isifo esikhulu kwicala lobuchopho olunikezwa ngumzobo omncinci, kunenzuzo encinci yokuba nenkqubo eyenziwe. Uninzi lomonakalo owenziweyo lwenziwe kakade, kwaye inkqubo inokunyusa umngcipheko wokuphuma kummandla ochaphazelekayo ngesifo.
Ukuba ugqirha okanye i-anesthesiologist enquma ukuba umntu unengxaki ezininzi zezokwelapha kwaye mhlawumbi uya kuba noxinzelelo kwi-operesheni, ngoko utyando alufanele luqhube phambili.
Uvavanyo lokuqala
Ukucingwa kwemithambo yegazi entanyeni kufuneka kwenziwe ukuba kuqinisekiswe ubunzima kunye nendawo yendawo. Kukho iindlela ezimbalwa ezahlukeneyo zokujonga i-artery carotid yangaphakathi. I-Duplex ultrasound isebenzisa amaza omsindo ukubonisa indlela igazi eligeleza ngayo kwiinqanawa. I-cerebral angiographie yendabuko iquka ukufaka idayi eyahlukileyo kwimithambo yegazi kwaye ujonge indlela esasazeka ngayo kwiinqanawa kwi-x-ray. Nangona le nto ithathwa njengomgangatho wegolide kwi-imaging ye-vascular, inomdla, kwaye imifanekiso emihle kakhulu inokuthi yenziwe nge-CT angiogram (CTA) okanye i-MR angiogram (MRA). Ukuba enye indlela yokujonga iinqanawa ibangela iziphumo ezingenangqondo, ugqirha unokuyalela umyalelo ongaphezulu kwesinye.
Iingxaki ezinokwenzeka
I-CEA inokudibaniswa neengxaki ezinjengobuchopho okanye ukufa ngenxa yenkqubo, nangona kunjalo, umngcipheko uphantsi. Phantse iipesenti ezi-3 zezigulane ezingenazo iimpawu kunye neepesenti ezingama-6 zezigulane ezineempawu ziva ubunzima. Esinye isizathu sokuba kubalulekile ukuba ube nempilo entle ekutyunjweni: Kwingozi yobungozi obuninzi be-1 ekhulwini ngaphandle kokuhlinzwa, kunokuthatha iminyaka embalwa ukuba iinzuzo zentsebenzo ziye zenzele ingozi. Oko kwathiwa, umngcipheko ophezulu wokuba nesifo ngenxa yesiganeko esincinci se-carotid, kungekudala emva kokubethelwa kwangaphambili, kwimeko apho ukuhlinzwa kufuneka kukhuthazwe ngokukhawuleza.
I-Hyperperfusion syndrome enye yempembelelo yecalatid endarterectomy. Xa inxalenye yengqondo iye yahluthwa ukuhamba kwegazi ixesha elide, ikwazi ukulahlekelwa amandla ayo okulawula indlela igazi eliqhelekileyo ligeleza ngayo kuloo mida yegazi. Xa ukuphuma kwegazi ngokukhawuleza kwanda emva kokunciphisa isisombululo, ukungakwazi ukulawula ukujikeleza kwegazi kunokubangela ukuvuvukala kunye nokunciphisa umsebenzi, onokulinganisa ukubetha .
Iingxaki ezincinci zenkqubo ziquka umonakalo kwimbilini ye-hypoglossal , engayilunganga ulwimi, engakhokelela kulwimi olubuthathaka kwelinye icala. Kwaye, njengakuphi na utyando, kukho umngcipheko wokusuleleka kunye nokuphuma kwamanzi.
Imithombo:
IKomiti Elawulayo ye-Asymptomatic Carotid Atherosclerosis Study (ACAS). I-Endarterectomy ye-stroosis ye-carotid. Jama. 1995; 273: 1421-1428.
I-Halliday A, i-Mansfield A, i-Marro J, i-Peto C, i-Peto R, i-Potter J, uTomas D. Ukukhusela ukukhubaza nokubethelwa okubulalayo yi-endarterectomy ephumelelayo kwizigulane ezingenazo iimpawu zengqondo zamva nje. Lancet. 2004; 363: 1491-1502.
U-Sharon Swain, uClaire Turner, uPippa Tyrrell, u-Anthony Rudd egameni leKhokelo loPhuhliso lweZikhokelo, ukuxilonga kunye nokulawulwa kokuqala kwe-stroke esichukumisayo kunye nokuhlaselwa kwe-ischemic esiphezulu: isishwankathelo se-NICE isikhokelo, i-BMJ 2008; 337: a786, i-10.1136 / bmj.a786 (Ipapashwe ngo-24 Julayi 2008)