Ukuqonda iNkqubo yePancreas Transplantation
Ukutshintshwa komzimba yinkqubo enzima kakhulu ekhokelela ekutyunjweni okwenziwe ngonyango lokugqibela lokuchithwa kwelungu. Kule meko, ukutshintshwa kuya kuba yonyango okanye unyango lwe-failure pancreatic okanye isifo se-pancreatic.
Kubantu abaninzi, ukutshintshwa akuzange kube yinto ebalulekileyo, kwaye banako ukulawula isifo sabo ngamachiza, unyango okanye ezinye iindlela zokwelapha.
Kubantu abangaqhelekanga, ukufakelwa kuyadingeka kuba isifo sabo sinzima kangangokuthi ngaphandle kwelungu elitsha abayi kuphila ixesha elide.
Kucacisiwe nje, ukutshintshwa kwenziwa xa iqumrhu elizalelwa ngalo isiguli ligula kakhulu okanye ligula kangangokuba lifuna ilungu lokutshintshwa kumniki-mali.
Imisebenzi yePancreas
I- pancrea inendima ebalulekileyo ekuziphatheni komzimba womntu ukugaya ukudla ngokufanelekileyo kwaye kugcinwe i-blood glucose level egazini. I-pancreas yenza lo msebenzi ngeendima ezimbini ezibalulekileyo emzimbeni: ukwenza amahomoni kunye nokwenza i-enzymes esetyenziswe ekutyeni ukutya.
Amaphesenti angamashumi anesithoba anesihlanu ama-pancreas asebenza ukuvelisa i-enzyme yokugaya esisetyenziselwa ukuphazamiseka kokutya emanzini. I-pancreas ivelisa ama-enzyme amathathu: amylase, lipase, kunye neprotease. U-Amylase uphula ama-carbohydrate, i-lipase iphula amafutha, kunye neprotease iphula amaprotheni afumaneka ekudleni.
Ukuba le nxalenye ye-pancreas isebenza kakubi, imeko ebizwa ngokuba yi-exocrine institatic insufficiency, ezi zine-enzyme zingathatyathwa yileyeza yeyeza. Olu hlobo lwe-pancreas issue alukho ukufakelwa kwe-pancreas, njengoko le meko inganyangwa ngamayeza.
Umsebenzi owaziwayo kakhulu wepakreas ngumveliso we-hormone. I-hormone yokuqala eveliswa yi-pancreas yi-glucagon, i-hormone eyandisa igazi le-glucose (ishukela) egazini. Ikhutshwa xa amazinga e-blood glucose aphantsi kakhulu kwaye kufuneka ayenyuka. Ihomoni yesibini eveliswa yi-pancreas yi- insulin . I-insulini ikhutshwa xa amazinga e-glucose egazini aphakamileyo kwaye adinga ukunciphisa. I-hormone yesithathu i-somatostatin, eyenza ukugcina umsebenzi we-insulini kunye ne-glucagon kumazinga afanelekileyo.
I-pancreas isebenza nzima ukwenzela ukuba ugweme ukuba nezinga eliphezulu kakhulu okanye lingaphezulu kwama-glucose kunye neempawu kunye nemeko yezempilo engabangela. Amanqanaba e-glucose aphantsi awanalo ingxaki kubantu abaninzi, kodwa ukungabi nalutho kwe-insulin yinto eqhelekileyo ejongene nezigidi zabantu baseMelika kodwa ezaziwa ngegama elihlukile: isifo sikashukela .
Xa umzimba ugxininiswa kwi-insulin kunye / okanye uhluleka ukwenza i-insulin eyaneleyo, le meko ibizwa ngokuba yi-type II yeswekile. Xa i-pancreas engenzi i-insulin, sibhekisela kulo hlobo njengolu hlobo I-diabetes. Ngokuqhelekileyo, luhlobo lwanesifo sikasifo sikashukela esidinga ukufakelwa kwepascreas, njengoko ezinye iintlobo zesifo sikashukela ziyakwazi ukuphathwa ngamachiza amaninzi.
Kwakhona kunokwenzeka ukuba uhlobo lwe-diabetes II luyeke ukwenza nayiphi na insulin ngokuhamba kwesikhathi, nto leyo inokukhokelela ekutshalweni.
Ukufakelwa kwepancreas kwenziwa xa i-pancreas ingasakwazi ukusebenza kakuhle ngokwaneleyo ukulawula amanqanaba e-glucose egazini, umgangatho wobomi awunamkelekanga, ingxaki yesifo sikashukela iyingozi okanye iyancipha, kunye neenzuzo zokuhlinzwa ezigqithiseleyo ingozi ukufakelwa.
Xa Kufuneka
Ukuba ngumhlobo wesifo sikashukela wedwa asenze i-pancreas yokupakisha iyimfuneko, njengabantu abaninzi banokuphila ngokugcwele kunye nobutyebi kunye namazinga e-glucose alawulwa kakuhle. Kunzima-ukulawula isifo sikashukela, esoloko sibhekwa ngokuthi " sinokuthi " sinokulawulwa okuncinci kumazinga e-glucose kunye neempawu, ezikhokelela ekufakweni.
Oku kuthetha ukuba xa ubunzima besifo sikashukela sele sifinyelele kwindawo apho isigulane sigula kakhulu kwaye amayeza angenakubonelela ngokufanelekileyo ukulawula izifo, ukutshintshwa kungaba yindawo yokugqibela yokwenza unyango.
Ngokutsho kwe-American Diabetes Association (ADA), iziqinisekiso zokufakelwa kwe-pancreas kubantu abangenazo izifo zesifo ezintle zilandelayo:
- Ngokuqhelekileyo, iingxaki ezinobunzima kunye nokugqithisa okunzima okunjenge-glucose ephezulu kakhulu, i-glucose ephantsi kakhulu okanye i-ketoacidosis.
- Ukunciphisa iingxaki zeklinikhi / zengxaki ngeyeza le-insulin
- Ukungaphumeleli kwe-insulin ukukhusela iingxaki ezinzima
Mngcipheko
Ubungozi obunxulumene nokutshintshwa kwepakreas zibaluleke ngaphezu kokuhlinzwa okuqhelekileyo, njengoko isigulane sisoloko sigula ngaphambi kokuhlinzwa kwaye inkqubo inzima. Ezi mngcipheko zongezeleleka kwiingozi eziqhelekileyo ezibhekene nezigulane xa zinobuchopho, kunye neengozi ezinxulumene ne-anesthesia jikelele.
Iingozi eziqhelekileyo zePancreas Transplant Surgery
- Sulelo
- Ukulawulwa kakubi kweglucose
- Ukuhlamba
- Iingubo zegazi
- Ukugatya ilungu elitsha
- Ukuhluleka komzimba
- I sizathu
- Ukuvutha
- Uhudo
- Ukuphendula kwi-anesthesia
- Unzima ukugxala kwi-ventilator
Ukufumana i-Surgeon
Ukubona ugqirha ogqithisileyo kubandakanya ukufumana ukudluliselwa kwirejista yakho kwiziko lokutshintshela elenza ukufakelwa kwepancreas kufuphi nekhaya lakho. Kwiimeko ezininzi, kunokuthi kubekho enye kufuphi, kodwa kwiidolophu ezinkulu, unokukhetha ezininzi. Ukuthunyelwa ngokuqhelekileyo kwenziwe ngu-endocrinologist wakho, ugqirha onobuchule bokunyanga kwemicimbi ye-hormone, okanye i-gastroenterologist ejongene nemiba ngokutya. Ukuhanjiswa kungenziwa kwakhona ngononophelo olusisiseko kunye nezinye izakhono ezibandakanyeka kunyango lwakho.
Ukufikelela kwiLuhlu lokuTyhulwa
Emva kokudibana kunye nabasebenzi kwiziko lokutshintshwa, uya kuhlolisiswa ukuba uphumelele. Oku kuya kuthetha ukuhlaziywa kweirekhodi zakho zonyango, iimvavanyo zegazi, ukufundwa kweengcamango ezinokwenzeka, kunye nezinye iimvavanyo ezilungiselelwe ukuchonga ukuba ulungile ngokwaneleyo ukunyamezela utyando lokutshintshwa kodwa ugula ngokwaneleyo ukufuna ilungu elitsha.
Ukuba ukuvavanya kubonisa isidingo sokutshintshwa, kunye nokukwazi ukusinda ekutyunjweni, kunye nokuphulukana nesiphumo esihle, kwaye ukuba iimfundo ezongezelelweyo zidibene nokukwazi ukufumana utyando kunye nokukwazi ukulawula amayeza afunekayo emva utyando, isigulane sinokufakwa kwoluhlu lokutshintshwa ukulinda ilungu ukuba lifumaneke.
Inani le pancreata (ubuninzi beepakreas) ezikhoyo ukutshintshwa, ngelishwa, ncinane. Kukho i-pancreas kuphela efumanekayo ngomniki-mpahla. I-Diabetics ayikwazi ukuba ngumnikeli we-pancreas. Ukongezelela, i-pancreas iyakhawuleza kwaye ihlala isabela ngokungafanelekanga kwisifo esibuhlungu kumniki-mnikelo, baninzi abantu abanesifo sikashukela asikwazi ukunikela nge-pancreas. Oku kukhokelela ekunqongopheni kwamalungu atshintshekayo kulabo abalindileyo.
Iintlobo zoTshintsho
Kukho iintlobo ezimbini zokupakishwa kwepakreas ezenziwa ngoku. Uhlobo oluqhelekileyo lulokuba i-pancreas yonke isuswa kumniki-mali kwaye ibekwa kummkeli. Xa abantu bathi "ukufakelwa kwepencreas" yile nqubo ababhekiselele kuyo. Olunye uhlobo lokufakelwa kwipropati ye-pancreatic islet, apho ezinye iiseli ezenza i-pancreas zifakelwa khona kummkeli.
Isityalo sePancreatic Transplant
Ngethuba lokutshintshwa kweseli ye-pancreatic, i-pancreas isuswe kumniki-mnikelo kunye neeseli ze-islet zitshintshelwe kummkeli. Emva kokuba iqumrhu lifunyenwe, i-pancreas ithathwa kwibhule yophando apho iisel ze-islet, ezivelisa i-insulin nezinye i-hormone, zihluke kwezinye iiseli zepakreta. Ezi zivelisi zeeseli zenza iipesenti ezi-5 kuphela zobunzima bee-pancreas, ngoko ke inani leethambo zesisuswe lisuswe kakhulu kuncinci kune-pancreas. Ziyizi ntsha zeeseli ezifakelwa kummkeli. Kuyathakazelisa ukuba ezi seteli zifakelwa kwisibindi ngokungena kwisitya segazi. Iiseli zihlala kwisibindi kwaye ziqala ukuvelisa i-insulin kuloo ndawo.
E-United States, le nkqubo iqhutyelwa kwizibhedlele ezinkulu zaseyunivesithi ezenza uphando kwi-escreatic islet cell transplantation. Olu hlobo lwenkqubo lugqalwa njengoluvavanyo kwaye lwenziwa kuphela njengenxalenye yezifundo ezininzi zophando kwiindawo ezihlukeneyo ngeli xesha.
Iziqinisekiso zokutshintshwa kwezilwanyana ngamanye amaxesha zihluke kwiintlobo ezihambayo, njengoko kukho uphando oluqhutyelwa kwendima yokutshintshwa kwezilwanyana njengonyango lwe- pancreatitis engapheliyo. Isigulane esiqhelekileyo siya kuba neenkqubela ezimbini kunye nokuphindaphindiweyo ngokuphindaphindiweyo kwenkqubo yokutshintshela islet ukufumana inzuzo epheleleyo yokufakelwa.
Ukutshintshwa kwamanzi amaninzi
Kwabanye abantu, imiba ye-pancreas ingakhokelela kwimibandela ebalulekileyo namanye amalungu, ngakumbi iintso. Abanye abantu abanesifo sikashukela abanesifo esinzima-ukulawula i-glucose, iizintso zonakaliswe kakubi, zihlala zikhokelela ekuphelelweni kwezintso kunye nesidingo sokwenza i-dialysis.
Kwaba bantu, ukutshintshwa kwe-pancreas yodwa kungabi nako ngokwaneleyo ukubuyisela kwimpilo entle, banesidingo sokutshintshwa kweentso ukuze bakwazi ukukhululeka kwe-dialysis. Ngokufanelekileyo, aba bantu baya kufumana iinjongo kunye nokutshintshwa kwepencreas ukusuka kumxhasi omnye ngexesha elinye, kodwa ezinye izigulane zifumana izitho ezivela kubaxhasi abahlukeneyo ngamaxesha ahlukeneyo.
Indlela yokutshintshwa kwayo
Ukufakelwa kwe-Pancreas kuqala ngeenkqubo ezahlukileyo-ukuhlinzwa ukuze kususwe i-pancreas evela kumnikeli. Ukutshintshwa kwesebe eliqhelekileyo kuqhelekileyo kunomnikelo wecandelo le-pancreas. Amalungu onke avela kumntu oshonile, abaxhamli be-brain-dead. Amacandelo ama-pancreas ngokuqhelekileyo avela kumnikeli onomhlobo okanye isihlobo esifuna ukukunceda ummkeli.
Xa iqumrhu elixhaswe okanye inxalenye isuswe, kukho ifowuni emfutshane ukutshintshela ilungu kummkeli, ngokuqhelekileyo iiyure ezisibhozo okanye ngaphantsi. I-pancreas yincinci kakhulu, iphendule kakubi ukuba ichukumiswe kwaye iqhutywe, ngoko oogqirha basebenzela kuphela ukuthinta izicubu ezikufutshane ngexesha lotyando. Xa ama-pancreas eqinisekisiwe asebenzayo kummkeli, okanye mhlawumbi kwangaphambili, abafumanayo abanokuthi baxelelwe ukuba ilungu liye lafumaneka ukuba litshintshwe. Bayibuzwa ngoko ukuba baxele kwiziko labo lokufakelwa.
Emva kokufumana (igama elithi "isivuno" asisetyenziswanga) i-pancreas ithathwa kwisibhedlele apho ifunyenwe kwiziko lokutshintshwa apho i-pancreas iya kufakwa kummkeli.
Utyando lokubeka ilungu kummkeli liqala kunye nesigulane esicatshulwayo kwaye sifakwe kwi- ventilator kunye nokulawulwa kwe- anesthesia jikelele . Xa isiguli silele, le nkqubo ingaqalisa.
Ulusu lukulungele ukunciphisa umngcipheko wokusuleleka, kwaye ukukhangela kwenziwa kwisisu. I-pancreas ifakwe kwi-duodenum, isigaba sokuqala samathumbu amancinci ukwenzela ukuba i-enzyme yokutya ikhutshwe ekudleni njengoko iphuma esiswini. Ukusebenzisa imithwalo yegazi efunyenwe kumnikeli, i-pancreas ifakwe kwigazi ngenxa yeemfuno zayo kunye nokukhulula ama-hormone kwigazi.
Ngokuqhelekileyo, i-pancreas ehlonyelweyo isondele ngakumbi kuncinci yesisu kunamaqanda asekuqaleni, atholakala ngokujulile esiswini. Oku kufakwa phambi kwesisu kuyavumela ukuba i-biopsy ithathwe kalula kwixesha elizayo, ukuba kuyimfuneko.
I-pancreas yesigulane, ebizwa ngokuba yi "pancreas yasekhaya", ihlala kwindawo ngaphandle kokuba kukho isizathu esithile sokukususa. Xa i-pancreas iqhotyoshelwe emathunjini kunye nemithambo yegazi, ukuvakala kungavalwa kwaye isigulane sithathwe kwiyunithi yokunyamekela (ICU) ukuba ihlolwe ngokukhawuleza ngexesha lokubuyiselwa.
Ukubuyisela
Umguli oqhelekileyo uya kuchitha iintsuku eziliqela kwi-ICU emva kwenkqubo yokufakelwa. Uninzi luya kuchitha ubuncinane iintsuku ezisixhenxe esibhedlele ngaphambi kokuya ekhaya ukuqhubela phambili. Uninzi lwezigulana zibuyela kwimisebenzi yazo eqhelekileyo kwiiveki ezi-4-6 zokuhlinzwa.
Ubomi Emva kokutshintshwa
Enye yeengxaki ezinzima zobomi kunye nempilo emva kokutshintshwa kukuthintela ukulahlwa kwelungu. Ukutyelela rhoqo kwiziko lokutshintshwa kuyinto ebonakalayo emva kokuhlinzwa kwaye kuncinci ukuhamba njengoko ixesha lidlula ngaphandle kokuba kukho imiba nelilungu elitsha. Kwabaninzi, ukubuyela kwimpilo eqhelekileyo kunokwenzeka emva kokuhlinzwa, kodwa abanye banokufumana ukuba baphuculwe, kodwa bengasayi kuvuka.
Kuzo zonke izigulane zokufakelwa, imirhumo yeyeza ukukhusela ukukhishwa iya kuba yinto yobomi. Nangona iqumrhu lingasebenzi kakuhle, kuya kufuneka imichiza yokuchaswa, kwaye ukuba amayeza angakhokelela kwizifo eziqhelekileyo ezifana nezibandayo kunye nomkhuhlane njengoko kunciphisa umzimba wokuzivikela.
Ixesha elide
Imiba enokwenzeka kwiinyanga kunye neminyaka emva kokufakelwa kwe-pancreas zibonakala zimbalwa kwinani, kodwa zinokuba nzima. Ukunyamekela impilo yonke ngokutya ngokufanelekileyo, ukulandela umyalelo wokuhlinza, kunye nokusetyenziswa ngokuqhelekileyo kubalulekile. Ukunyamekela impilo yakho yemvakalelo emva kokutshintshwa kubalulekile kwaye kaninzi uyangayinakwa kwizame zokuphila kakuhle.
Kubalulekile ukuba uqaphele ukujonga le miqondiso elandelayo:
- Ukugatywa komzimba
- Ukuphendula ngokunyangwa kwamayeza
- Ukulawulwa kakubi kweglucose
- Umsebenzi owenyukayo ngexesha elithile
- Iingxaki ezaziwayo zokulahla imithi
Iimpawu zokulwa noKhuselo
Imithi-enye yazo efana ne-steroid eqhelekileyo-isetyenziselwa ukwenza umzimba wamukele ilungu elitsha, kodwa la mayeza afikeleleke neengxaki ezinokwenzeka kunye neenzuzo zabo ezinkulu.
Iziphumo eziqhelekileyo zemiphumo yokuchasa ukulahlwa ziquka:
- I sizathu
- Uhudo
- Ukuvutha
- Ubuso obushushu
- Iintlobo zesisu
- Acne
- Ukulahleka kweenwele
- Ukungathobeli kwelanga
- Uxinzelelo lwegazi
- Amazinga e-Cholesterol aphakanyisiwe
- Ukulahleka kwethambo (i-osteoporosis okanye i-osteopenia)
Ukulahlwa komzimba
Ukukhishwa komzimba yinkinga ebalulekileyo emva kokutshintshwa kwanoma yiluphi uhlobo, kwaye ezinye izigulane ziya kuba neqhezu lokugatywa kwiinyanga zokuqala emva kokutshintshwa. Isisitshixo sokusinda kwisiqhelo sokuchaswa kunye nesebe eliphandle ukutshintshwa ngokufanelekileyo kukubona inkcazo kwangaphambili kwaye ufumane unyango ngokukhawuleza.
Iimpawu eziqhelekileyo zokukhishwa kwamanqatha ziquka:
- Fever
- Ubuhlungu okanye ngaphezulu kwelo litsha
- Igazi elingaqinisekanga
- I sizathu
- Ukuvutha
- Intlungu zesisu
- Umchamo omnyama
- Ukwenyuka komchamo
Iziphumo zexesha elide
Ngokubanzi, iziphumo izigulane ezitholakalayo emva kokufakelwa kwepencreas zihle kakhulu. Amazinga okusinda aphakathi kwama-95 ukuya kuma-98 ekhulwini kunyaka, ama-91 ukuya kuma-92 ekhulwini kweminyaka emithathu emva kokutsalwa, kunye ne-78 ukuya kuma-88 ekhulwini kwiminyaka emihlanu. Uninzi lwabafayo lubangelwa zizifo zentliziyo, kunokuba zixakeke kwiinkqubo zokuhlinzwa, kwaye zenzeke ngaphezu kweenyanga ezintathu emva kokuba zikhutshwe kwiziko lokufakelwa.
Kananjalo nokubaluleka kukuba i-pancreata yenziwe njani emva kokuhlinzwa. Ngonyaka owodwa emva kokuhlinzwa, iipesenti ezingama-78-88 zezigulane zineepascreas ezisebenzayo kunye neepesenti ezingama-27 zineepakreji ezisebenza emva kweminyaka elishumi emva kokuhlinzwa. Ukusebenza kuthetha ukuba akukho mfuneko ye-insulin, amazinga e-glucose evamile xa evavanywa emva kokuzila ukutya, kunye neziphumo eziqhelekileyo okanye eziphakamileyo ze-hemoglobin a1c. Oku kuthetha ukuba izigulane ezine-pancreas "ezingasebenzi" zisenokungafuneki i-insulin kodwa zibe ne-hemoglobin ephezulu, okanye i-insulin ngokupheleleyo.
ILizwi
Ukutshintshwa kwepancreas, nokuba iyilungu lonke okanye iisel cell, yinkqubo enzulu kakhulu enempembelelo yokuphila impilo kunye nokuphila. Kwabaninzi, ukutyala kuyisisombululo kwisingxaki esibi kwaye kukhokelela ekuphuculeni okuphezulu kumgangatho wobomi. Ngokuqhelekanga, inkqubo ibangela iingxaki, impilo embi, kunye nezinye, akukho phuculo lokulawula i-glucose.
Kubalulekile ukulinganisa impembelelo yangoku yesifo se-pancreatic ngokubhekiselele kwimbuyekezo enokubakho kunye neengxaki eziza kwinkqubo yokutshintshwa, kwaye uhlale uqaphele emva kokufunda okuninzi malunga nenkqubo.
> Umthombo:
> I-Pancreatic ne-islet transplantation kwi-diabetes mellitus. Isemgangathweno. https://www.uptodate.com/contents/pancreas-and-islet-transplantation-in-diabetes-mellitus