I-tracheal stenosis yincinci ye- trachea yakho, okanye i-windpipe, ngenxa yokwakheka kweethambo okanye i-malformation ye-cartilage kwi-trachea. Ngelixa ukunyanzeliswa kobubele kwi-trachea yakho ayinakuze kubonwe, ukunciphisa amanqaku angaphezulu kwama-50 e-airway yakho kungakhokelela kwiimeko ezinzima. Iingxaki ezi-3 eziqhelekileyo zokudityaniswa kwe-stenosis yilezi zilandelayo:
- Ukubekwa ixesha elide le- tube endotracheal (tube breath) okanye i-tracheostomy
- Isifo sesifo sesisu
- I-Collagen isifo se-vascular (granulomatosis kunye ne-polyangitis, eyaziwayo njenge-Wegener granulomatosis)
Ezinye izizathu ezikhoyo ziquka:
- Ukungalunganga kobudala (ukukhubazeka kokuzalwa)
- I ngxaki
- Inhalation iyatshisa
- Ukunyanga kwamayeza
- Usulelo lwe-trachea
- Izifo ezivuthayo (sarcoidosis okanye i-amyloidosis)
- Cancer
Ngomhlaza kunye nentsholongwane yokuzalwa komntwana, indlela yokuhamba ngomoya iyancatshiswa okanye ivela ngaphandle kwe-trachea, okanye ukusuka ekunciphiseni kwinqwelwe engalunganga. Ezinye izimbangela ze-tracheal stenosis zivame ukuqala ngesilonda kwi-trachea. Isilonda siqala ukuhlambalaza, okuyimpiliso eqhelekileyo, enokuthi yanyanyiswa kwaye ibangele amanxeba amaninzi kunokuba ayimfuneko. Le yongxube yesikhumba esongezelelweyo iyanciphisa indawo kwindawo yakho.
Ingozi yeTracheal Stenosis
Ixesha lokufumana isitoli sokutshatyalaliswa kuxhomekeke kwimbambano yokunciphisa.
Umonakalo wokuthunyelwa kweposi emva kokungena kwimizila engafana nayo ingaqhelekanga, nangona kunjalo umngcipheko wesifo se-stenosis udla ngaphantsi kwama-2 ekhulwini. Ezi zinto zilandelayo ziza kukunyusa amathuba okuba ube ne-post-intubation okanye i-tracheostomy enxulumene ne-stenosis elandelayo:
- Ibhinqa
- Ukugqithisa
- Sikashukela
- U xinzelelo
- Isifo sentliziyo
I-post-intubation okanye i-post-tracheostomy mngcipheko inokunciphisa ukuba oku kulandelayo kwenziwa kwi-ICU:
- Ukuba noxinzelelo lwe-endoctracheal okanye i-tracheostomy ibhalon ibe phakathi kwe-20 ukuya kwe-30 cm yoxinzelelo lwamanzi
- Ukuthintela usulelo ngokunyamekela ngomlomo okwenziwe ngokutshatyalaliswa njengoko kuyimfuneko ukukhusela intsholongwane okanye ukuxhuma i-airways nge-mucus
- Ukuphefumula kwiphepha lokuphefumla indawo ngaphandle komlomo ukunciphisa uxinzelelo
- Ukugcina ubunzulu obufanelekileyo bhubhe yokuphefumula
- Ukuthintela iingxaki kunye neziphefumula zokuphefumla ngethuba lokufakelwa kunye nokuthintela ukususwa ngengozi xa unengxaki yokuhamba.
I-tracheal stenosis ingaba enye yeempawu zokuqala ezibonwe kwi-granulomatosis kunye ne-polyangitis. I-stenosis iyakwenzeka malunga ne-16 ukuya kuma-23 ekhulwini kwexesha. Akukho datha eninzi efumanekayo kwiimeko ezibangelwa kwezinye izimbangela ze-stenosis ye-tracheal.
Iimpawu zeTracheal Stenosis
Kwi-stenosis ye-tracheal stenosis, i-stenosis epholileyo ingasichazwa ngokucacileyo njenge-asthma okanye i-bronchitis ephindaphindiweyo. Nge-stenosis engumnene, ungabonakali iimpawu kude kube yintsana okanye ubutsha xa ubonakala kubonakala kunzima ukuphefumula ngokuzivocavoca. Kwiimeko ezinzima zesifo sokuzalana nesisu sokuzalwa, ungabona ezi zinto zilandelayo:
- Isitrato (ukuphakamisa ukuvakala komsindo)
- I-Cyanotic, eneemilomo eluhlaza okwesibhakabhaka
- Gudla nge-inhalation
- Ukuphefumula okufutshane (dyspnea)
Kwezinye iimeko zokufumana i-tracheal stenosis, iimpawu ezingenako ukuzibonakalisa kwiiveki ezimbalwa emva kokulimala. Ubunzima ngokuphefumla ngumqondiso oqhelekileyo wokuqala. Njengokuzalwa kwe-stenosis yokuzalwa, ungabona isiteyimu, ukuvutha, okanye ukuphefumula okufutshane.
Ukuxilongwa kweTracheal Stenosis
Izindlela ezininzi zokuvavanya zingasetyenziselwa ukunceda ugqirha wakho ukuba aqinisekise ukuba unesifo se-stenosis okanye cha. I-bronchoscopy ithathwa ngokuba yi "Gold Standard" yokufumanisa i-tracheal stenosis kuba ugqirha wakho uya kukwazi ukujonga ngokucacileyo umkhondo wakho.
Nangona kunjalo, kukho iingozi ezinxulumene nale nto ngenxa yokuba ukusetyenziswa kwendawo kuya kuphazamisa indlela ohamba ngayo, ngoko ukugcina amazinga akho oksijini anokuba nzima. Xoxa ngeengxaki zakho ezizimeleyo ezichaphazelekayo ne-bronchoscopy nodokotela wakho.
Ezinye iindlela ogqirha wakho angasebenzisa ziquka i-ray-ray, i-CT scan, i-ultrasound, i-MRI, kunye nokuhlolwa komsebenzi we-pulmonary. Imiqathango ye-x-ray ikulungele ukuchongwa kwesakhiwo, iikholomu zomoya, ukunyamekela, kunye nolunye ulwazi oluphambili. Enye imishini engama-x-ray ingasetyenziswa (i-xeroradiography) ukuqhubela phambili ukuchonga i-stenosis, nangona i-radiation exposure iphezulu kakhulu kunezinye iindlela.
Ukutshekisha kwe-CT kungaba yinkqubo enkulu kumgqirha wakho ekuqaliseni ukuba unayo isifo se stenosis okanye cha. Kodwa kunjalo, kunzima ukuchonga izicathulo ezincinci zokunciphisa umthamo wakho. Amanye amashishini asetyenziswa ngendlela yokudala "i-endoscopy ebonakalayo" ukunciphisa isidingo sokuba ube ne-bronchoscopy. Nangona kunjalo, ukukhangela kwe-CT akuyona indlela efanelekileyo yokuchonga iqondo elincinci le-stenosis.
I-Ultrasound inokukunceda ekuboneni inani lemoya yomoya kwindawo yokuhamba. Oku kuvumela ugqirha wakho ukuba acinge ukuba ngaba uvavanyo olunjalo luyimfuneko, nangona kunjalo, ngenxa yemali ye-cartilage ecaleni kwe-trachea, ukuchaneka kovavanyo kuya kubuzwa ngenxa yeziphumo zethunzi ezibangelwa ukuboniswa kwamagagasi omsindo ophuma kwi-cartilage. Shiya lo vavanyo kuphela kulabo abanezakhono kakhulu ekufumaneni i-tracheal stenosis nge-ultrasound.
Ukukhangela kwe-MRI kwakhona yindlela enye yokunceda ekufumaneni i-tracheal stenosis, kwaye kubantwana kuthathwa njengendlela eqhelekileyo. Impendulo enkulu ye-MRI kukuba ubude bexesha omele uzinikezele ukuba kwenziwe inkqubo kunye nokugqithisa okungenzeka ukuphefumula ngokuqhelekileyo ngexesha loviwo. Amasu aphuculweyo aqhutyelwa phambili ekuphuculeni ukusetyenziswa kwalolu cwangciso ekufumaneni i-tracheal stenosis.
Ukuvavanywa komsebenzi wepulmonary kungenziwa kwiiofisi ezithile zogqirha, okanye ukuba awufumaneki, uya kuthunyelwa kwilebhu yepimonari. Olu vavanyo lunokusetyenziswa ukujonga ukuba zininzi iimpembelelo zokuthi ukuphefumla kwakho kukuvimbela. Oku kuya kunceda kwiingxoxo malunga nokukhethwa kwonyango nodokotela wakho.
Unyango lweStracheal Stenosis
Unokukhetha okukhethiweyo ukuphatha unyango lwe-stenosis kwaye ugqirha wakho uya kuxubusha ukuba zeziphi iindlela ezincinci ezingenayo kwaye unako ukufumana uncedo olungcono lwabantu ngabanye. Uninzi unyango luyimigaqo yokugqibela efuna ukubonakala kakuhle kwendlela yakho. Ukuba indawo ye-stenosis iyinto encinci, ukubeka i-stent, ukuxubusha umzila wakho kunye nebhaluni, okanye ukususa ezinye izicubu ezibomvu nge-laser kuya kunceda ukunciphisa i-stenosis. Ngethuba le nkqubo, ugqirha wakho unokugaya izicubu kwi-trachea yakho kunye ne-steroids ukunceda ukunciphisa naluphi na ukuvuvukala.
Xa ufuna ugqirha obunzima kakhulu, ugqirha wakho unokuncoma ukuthengiswa kwempahla, efuna ukuhlinzwa. Le nkqubo inokugcinwa xa unyango lwe-endoscopic lugqibe, okanye i-stenosis yomtsalane inzima kakhulu kwiinkqubo ze-endoscopic. Ngethuba le nkqubo, ugqirha uya kunqumla inxalenye yendlela echaphazelekayo kwaye ulungise i-trachea yakho ngesikhumba okanye esitini.
Emva kokuhlinzwa, ngokuqhelekileyo uya kuba nefuthe lokuphefumula xa usufumana u-anesthesia. Nangona kunjalo, ukuba kukho ukuvuvukala okukhulu, uncedo oluninzi luya kusetyenziswa. Kule meko, unokulindela ukufakwa kwi-steroids iiyure eziyi-24 ukuya kuma-48 kunye ne-diuretic njengeLasix. Abahlengikazi bakho baya kuqinisekiswa ukuba bagcine intloko yebhedi lakho liphakanyiswe ngama-30 degrees okanye ngaphezulu. Emva kweeyure ezingama-48, uya kubuyela kwigumbi lokusebenza ukuze ukhuphe umbhobho wakho wokuphefumula. Ukuba awukwazi ukuxhasa indlela yakho yokuhamba, i-tracheostomy iya kufakwa ukuze igcine indlela yakho yokuhamba. Ngenxa yobuhlobo obunjalo bonyango, kuthathwa njengesigqibo sokugqibela emva kokuba ezinye iindlela zonyango zihlulekile.
> Imithombo:
> Axtel, AL & Mathisen, DJ. (2017). Ulwaphulo Lwangoku Lonyango: Ulawulo lwe-Tracheal Stenosis. 882-887.
> Hofferberth, SC, Watters, K, Rahbar, R & Fynn-Thompson, F. (2015). Ulawulo lweStenital Tracheal Stenosis. Pediatrics. 136 (3): e660-9.
> Hyzy, RC. (2017) .Iinkcazo zethubhu yokugqibela emva kokubekwa kokuqala: Ukuthintela kunye nokulawulwa kwezigulane zonyango ezikhulayo. http://www.uptodate.com (Ubhaliso olufunekayo)
> Patel, HH, Goldenberg, D & McGinn, JD. (2015). I-Otolaryngology: I-Otolaryngology: Ulawulo loPhando lwe-Upper Airway Stenosis. 68, 982-992.e2
> Waizel-Haiat, S. (2015). I-Tracheal Stenosis Imaging. http://emedicine.medscape.com/article/362175- ukujonga kwakhona
> Won, C, Michaud, G & Kryger, MH. (2015). Izifo kunye neengxaki zePulmonary Pulmonary: Ukhuselo oluphezulu lwabantu abadala. Lwe-5. http://www.accessmedicine.com (Ubhaliso olufunekayo)