Ngaphambi, Ngexesha, nangemva Kwenyango Ku-Adenoma ye-Pituitary
I-pituitary gland yinto ebaluleke kakhulu kodwa incinci yeesisisi esisezantsi kwengqondo. Lezi zicubu zibizwa ngokuba yi-gland kuba ifihla i-hormone kumlambo wegazi ukulawula imisebenzi ebalulekileyo yomzimba, kuquka ukuzaliswa, ukukhula ngexesha lokuphuhlisa umntwana kunye nomsebenzi we-thyroid. I-pituitary gland ngokuqinisekileyo iyona nto ibaluleke kakhulu emzimbeni womntu kuba yenza izinto ezininzi ngelo xesha.
I-pituitary gland ifihla ama-hormone ahlukeneyo ayisithandathu:
- I-Hormone Yokukhuthaza IHormone (TSH): Ulawula umsebenzi we-thyroid gland
- I-Adrenocorticotropic Hormone (ACTH): Ikhuthaza iimpawu ze-adrenal ukukhupha i-adrenalin
- I-Follicle Ukukhuthaza iHormone (FSH): Idlala indima ekukhuleni nasekuzaleni
- I-Luteinizing Hormone (LH): Unceda ukulawula ukuzaliswa kunye nophuhliso lwezesondo
- Ukukhula kweHormone (GH): Ukulawula ukukhula komzimba ebuntwaneni kunye nentsha
- Iprolactin (PRL): Ilawula umveliso wobisi lwebele emva kokukhulelwa
Uninzi lweengqungquthela zenza i-hormone enye, ngoko i-pituitary ingavamile ngenxa yobunzima bomsebenzi wayo kunye nendawo yayo ehlukile kwingqondo, nje emva kwempumlo.
I-pituitary gland ayiyiyo kuphela i-hormone ehlukeneyo ezintandathu, ezinye zee-hormone zilawula ezinye iingqungquthela-kuquka i-thyroid-ngoko utshintsho kwimisebenzi ye-pituitary gland inokuchaphazela kakhulu impilo nempilo yomntu.
Ukungalingani kweHormone, nokuba ivela kwi-pituitary gland okanye kwenye indawo yomzimba, ngokuqhelekileyo iphathwa yi-endocrinology. I-Endocrinology yinto ekhethekileyo yezokwelapha ezithatha imiba ye-hormone, kubandakanywa iingxaki ze-pituitary kunye neminye imiba ye-hormone efana nesifo sikashukela.
Umzimba wokuhlambalaza
Uhlobo oluqhelekileyo lwesifo se-pituitary i-adituoma ye-pituitary, isifo esingumdlavuza esenza i-pituitary gland.
Kukho ezinye iintlobo zamathumbu kunokuba zikwazi ukwenza ifom, kodwa i-adenoma yinto eqhelekileyo kakhulu.
I-adenomas ye-Pituitary ihlelwe ngeendlela ezininzi. Ziyingozi (engekho umdlavuza), i-adenoma engenayo okanye isifo somhlaza. I-tumor ingaba isifo se-secretary, esithetha ukuba i-tumor ifihla i-hormone, okanye ingenakho. Ziyakuthiwa njenge-macroadenoma ukuba ziyi-cmenti okanye ngaphezulu ngaphezulu kwaye zibhekwa njenge-microadenoma ukuba zincinci kuneyentimitha.
Kukho ezinye iintlobo zeemathumba ezinokuthi zenzeke kwi-pituitary, kodwa ezininzi zinqabile kwaye utyando lwenziwa ngendlela efanayo kwiinkqubo zokuphatha i-adenomas.
Ukuchonga i-Pituitary Tumor
Iingcambu zesifo zivame ukuxilongwa emva kokuba inkinga ebonakala ingenakunxulumene ibangela ukuxilongwa kwalo hlobo lwesifo seengqondo. Ngokomzekelo, umfazi omncinci ongakaze abe nomntwana angase aqale ukuvelisa ubisi lwebele kunye nemiphumo yebhabhi angabhekisela kwisifo se-tumor njengesizathu sengxaki.
Oko kwathiwa, amaninzi amathumba adluliselwa kuthiwa "ama-incidentalomas" xa afunyanwanga ngenxa yeempawu okanye iingxaki, kodwa ngexesha lomsebenzi. Kule meko, i-tumor ye-pituitary inokufumaneka ngexesha lovavanyo lwe-CT lokwenziwa kwengqondo kuba isigulane siye ekamelweni lezongxamiseko ngenxa yesifo esithile.
Kule meko, kwakungabikho imiba okanye iimpawu ngenxa ye-adenoma, kwaye akukaze kufunyanwe ukuba i-CT scan ayenzanga.
Iimpawu zoBugcisa
Ezi zilandelayo ziyimpawu onokuzifumana xa unesifo se-pituitary:
- Intloko ezingapheliyo kwaye zingadluka ngexesha
- I-Acromegaly , imeko ebangelwa yi-hormone yokukhula kakhulu emva kokuba abantu abaninzi bayeke ukukhula, bekhokelela kwizandla ezinkulu kunye neenyawo, kwaye ukuba bengaphathwa, kubonakala buso buso obubi. Xa i-hormone yokukhula kakhulu ikhiqizwa ngexesha leminyaka eliselula, i-gigantism-ukuphakama okude-kunokuphumela.
- I-Hypopituitarism , imeko ebangela ukukhula okunamandla kubantwana
- I-Cushing's syndrome , imeko engabangelwa yi-ACTH kakhulu esuka kwi-pituitary, ngokuqhelekileyo ibangele ubuso obunzima kunye nomxube phakathi kwamahlombe.
- Isifo sika-Addison, imeko ebangelwa i-ACTH encinane
- Umbono utshintsha
- Ubisi lwesisu kwibhinqa elingakhange libele
- Umjikelezo wokuya kwimizuzu ungabonakali okanye awukho
- Ukuhamba kweemvakalelo
- Ukungenzi lutho
- Ukungasebenzi kwe-Erectile
- Ukunyusa utshintsho
- Imizwa engapheliyo yokukhathala
- Amanqanaba e- thyroid aphezulu okanye aphantsi kakhulu
Xa kutyhutyha i-Pituitary Surgery
I-adenomas i-pituitary ixhaphake kakhulu, kwaye ininzi yezigulane ezithandathu zifumana i-adenoma encinci ekhoyo kwi-pituitary gland ngexesha elithile ebomini babo. Ngenhlanhla, i-adenoma ebangela ukuba iingxaki zempilo zixakeke kakhulu, kunye ne-pituitary adenoma nganye kwiwaka elenza iimpawu.
Izigulane ezininzi ezine-adenoma ye-pituitary okanye olunye uhlobo lwesifo esiqhekezayo sinokukwazi ukuphepha ukuhlinzwa. Kwizigulane ezine-adenoma ye-pituitary engabangela iingxaki kwaye ayifuni iyeza zonyango, utyando luyonyango olungadingekile. Ezinye izigulane ziyakwazi ukuphepha utyando ngokuthatha amachiza olawula iinguqu ze-hormone ezibangelwa yisisu se-pituitary.
Abantu abathi banokudinga ukungenelela ngophaphalo ngokuqhelekileyo abo bangayiphenduli kakuhle kumachiza, okanye baneengxaki ezibalulekileyo ngenxa yesisu. Ezi ngxaki zingabandakanya ukutshintsha okanye ukulahleka kombono, iintloko ezinzima okanye ezinye zezempilo ezibangelwa ukungalingani kwe-hormone.
Iingozi zoPhengululo lweePituitary
Ukongeza kwiingozi eziqhelekileyo ezihlobene nokuhlinzwa kunye neengozi ze-anesthesia, utyando lokususa isisu se-pituitary sinomngcipheko owodwa. Unobungozi obukhulu bezo mngcipheko kukungalingani okukhulu kwehommone kubangelwa umonakalo kwi-pituitary gland ngexesha le nkqubo. Ukulimala kwintsimbi kungaphazamisa nayiphi nayiphi na i-hormones ayisithupha eyimfihlo yesikhumba, kwaye ingakhokelela kwimibandela enzima engabangela imiba yempilo kwiindawo ezininzi zomzimba.
Imiba eyongeziweyo enokuthi ivele emva kokuhlinzwa ngophethiyo kubandakanya:
- Isifo sikashukela se-insipidus: Ebangelwa ukungalingani kwe-hormone, le meko ibangela ukuba umzimba uvelise umthamo omkhulu wamanzi, okukhokelela ekudambiseni amanzi, kunxanxileyo, kwaye kwiimeko ezinzima, ukudideka.
- Ukuvuza kwamanzi omgudu: Kungenzeka ukuba umlambo wamagqabi ukuvuza empumleni emva kokuhlinzwa okwenziwe ngokugqithisileyo. Oku kungenxa yokuba umgodi udibene kwisitfu emva kwesigxina soxolo ukuze kuvunywe ukuhlinzwa. Ukuba iglue oyinyumba esetyenziselwa "ukupakisha" umgobo awuyizalise ngokupheleleyo indawo, isiguli siya kuba neempumlo zokuphosa, kufana ne-mucus ecacileyo ekhoyo ebandayo.
- Inwele yentloko: Inwele emva kwalolu hlobo lotyando luqhelekileyo, kwaye lidla ngokuchazwa njengento efana nentloko yesono.
- Ukuxinana kokusasaza: Kulindelwe ukuba iipasenti zomnxeba ziza kuhluthwa emva kwalolu hlobo, kwaye le ngqungquthela ibakho rhoqo ngeveki okanye ezimbini emva kwenkqubo. Kwimeko ezininzi ukudibanisa kuya kuphucula ngokukhawuleza ngexesha lokuphucula, kwaye ngokuqhelekileyo kuba ngumphumo wezixhobo zokugqabhuka ezicaphukisa izicubu ezincinci ngaphakathi kwempumlo.
- I-Meningitis: Usulelo lwengqondo luya kwenzeka emva kokuhlinzwa kwengqondo, njengoko utyando lwandisa ingozi yeebhaktheriya ezifikelela kwingqondo.
Ngaphambi kokuba kutyunjiswe
Ngaphambi kokuba utyando kwi-pituitary gland ungalindela ukuba ube ne-CT scan, i-MRI, okanye mhlawumbi zombini eyenziwe ukuvavanya ubungakanani kunye nesimo se-gland kunye ne-tumor. Ukuvavanywa kwebhanki kuya kuba yinxalenye yokuxilongwa kombandela, kwaye ezininzi zeemvavanyo zalebhu zingaphindwa ngaphambi kokuhlinzwa xa i-tumor ibangela ukungalingani kwamangqamu. Ezi zelabhu zangaphambi kokuhlinzwa ziya kuseka isiseko sokuqhathaniswa emva kokuba utyando lugqityiwe, kwaye lunokunceda ukuba ukuba utyando luye lwaphumela ekuphuculeni.
Ukuguqulwa kwezifo
Ugqirha ukususa isisu se-pituitary ngokuqhelekileyo kwenziwa nge-neurosurgeon, ugqirha ogqirha onobuchwephesha kwinkqubo ye-nervous system, ebandakanya ubuchopho nomgudu. Kwezinye iimeko, ugqirha we-ENT (indlebe, impumlo, nomphimbo) unokuthi ugqirha okanye inxalenye yeqela elenza utyando. Utyando lwenziwa phantsi kwe-anesthesia jikelele , enikwa ngumntu onesi-anesthesiologist okanye umongikazi onesi-anesthetist (CRNA).
Ngenxa yendawo ekhethekileyo ye-pituitary gland ngaphakathi kwekrele kodwa ngaphandle kwengqondo, kukho iindlela ezimbini eziya kwenziwa.
Indlela yoTshintsho
Indlela eqhelekileyo isifo sokukhupha sisuswe yindlela ehamba ngayo, apho ugqirha efaka izixhobo ngeempumlo kunye nomngxuma owenziwe kwisinus ehlala phakathi kwempumlo kunye nengqondo. Ukubeka imbobo encinane kule thambo, ebizwa ngokuthi ithambo le-sphenoid, livumela ukufikelela ngqo kwi-pituitary gland.
Ukuze kucace, i-pituitary gland ifakwe kwingqondo, kodwa ihlala phantsi kwengqondo. Oku kuvumela ukuba i-gland ifumaneke ngepumlo. Inkqubo isebenzisa i-endoscope, ityhubhu ebuncitshisiweyo ene-flexible, ikhamera kunye nezixhobo ezincinci ngaphakathi. I-endoscope ifakiwe kwaye ugqirha uyakwazi ukubukela imifanekiso kwi-esweni. Izixhobo ezincinci ngaphakathi kweso sithuba zisetyenziselwa ukunqumla izicubu ezingafunekiyo.
Kwiimeko ezininzi, ukukhishwa kwekhwalithi ephezulu kuthathelwe ngaphambi kokuhlinzwa okuhlanganisiweyo nezixhobo ezizodwa ezisetyenzisiweyo ngexesha lwenkqubo kunceda ukunceda ugqirha kwiyona ndlela ehambileyo eya kwi-pituitary gland. Emva kokuba indlela ivuliwe, izixhobo ezincinci ezibizwa ngokuba yi-curettes zisetyenziselwa ukususa izicubu ezinokungafuneki.
Emva kokuba isisu sisisuswe, inxalenye encinci yamathambo esiswini isetyenziswe kwindawo apho i-tumor isuswe khona, kwaye ugqirha uya kutywina umgodi owenziwe kwithambo kunye ne-bone graft, iglue grift or both. Kwiimeko ezininzi, amaqanda aya kuvuleka ukuze avimbele ukuvuvukala ekuvaleni ngokupheleleyo kwiimpawu zomntu.
Indlela yeCraniotomy
Enye indlela yokuhlinzwa ngophiyoyiti yenziwa yi-craniotomy, apho icandelo lekhaneki lisuswe khona ukufikelela kwingqondo ngokuthe ngqo. Le ndlela ayifani kakhulu, kwaye isetyenziswa ngokuqhelekileyo ukuba utyando aluyena oqala ukuqhutyelwa kwi-pituitary gland. Ingasetyenziselwa ukuba kukho umba wokukhupha i-cerebral spinal fluid emva kwenkqubo yokuqala kwi-pituitary gland.
Ngethuba lolu hlobo lotyando olusesikweni, inkqubo iya kuqala emva kommandla apho ukufakwa komzimba kuya kuhlanjululwa kweenwele kunye nesicatshulwa setsimbi kufakwe kufuphi neetempileni ukugcina intloko igcwele. Isicatshulwa senziwa esikhwameni kwaye isikhumba sivulekile ukuba siveze isikhalazo apho izimbobo ezincinci ezibizwa ngokuba yimibhobho ye-burr zidibene kwimimandla emibini yengqayi. I-saw isetyenziselwa ukudibanisa le mibhobho emibini, ukudala i-melon wedge edibanyiweyo yetshe ekhutshwe ngenyameko ize ibekwe eceleni ngexesha le nkqubo. Isigubungelelo sengqondo, esibizwa ngokuba yimali, sivuliwe kwaye ingqondo iyakwazi ukubonwa.
Xa ubuchopho buvezekile, isisombululo esikhethekileyo sisisetyenziselwa ukuphakamisa ngenyameko ingqondo evumela ukufikelela kwi-underside yengqondo apho i-pituitary gland ihlala khona. Ugqirha unakho ukujonga ngokucacileyo i-gland kwaye ungasebenzisa ukusebenzisa izixhobo ezisezandleni.
Emva kokuba le nkqubo izalisekile, isiqwenga skull singasuswa endaweni kwaye sigcinwe khona ngeglue okanye igcinwe kwihrifri ekhethekileyo ukuze ingatshintshwa ngomhla. Ikhumba le-scalp livaliwe nge-staples okanye iglue.
Emva kokuPhenywa koPhulo
Uninzi lwezigulane ziza kuchitha intsuku okanye ezimbini kwiinkqubo zonyango okanye ezikhuselekileyo zokujonga iliso emva kokuhlinzwa. Ngaloo xesha abasebenzi baya kuqwalaselwa ngokukodwa kwiimvavanyo zegazi ukuqinisekisa ukuba utyando lwaphumelela ekunciphiseni ukungalingani kwe-hormone, kwaye luyakujonga ngokugqithiseleyo ukuvelisa umchamo ukuze kuchongwe ukuba utyando lubangele i-diabetes insipidus. Uza kujongwa ngokukhawuleza malunga ne-postnasal drip okanye impumlo ye-runny, engayimpawu yokuba iqhosha lokuvala umgobo kwisithambo se-sphenoid alinalo ngokupheleleyo i-cerebral spinal fluid.
Emva kweentsuku ezimbini ukuya kwi-ICU, isigulane sinokutshintshwa kwiyunithi ephantsi okanye phantsi komgangatho esibhedlele. Uninzi lwezigulane ziyakwazi ukubuyela ekhaya iintsuku ezingama-3-5 emva kokuhlinzwa kunye nemiyalelo eqinileyo yokungaqhubeki impumlo kunye nemiyalelo malunga nokunyamekela ukukhangela kwisisu.
Uninzi lwezigulane ziyakwazi ukubuyela kwininzi kwimisebenzi yazo eqhelekileyo kwiiveki ezimbini emva kokuhlinzwa. Ezinye izinto ezinokunyusa uxinzelelo lwe-intracranial (uxinzelelo ngaphakathi kwengqondo) ezifana nokuphakamisa isisindo, ukuvuthwa ngokunyanisekileyo, ukuguqa nokuphakamisa kufuneka kukhunjiswe ubuncinane inyanga emva kokuhlinzwa, kodwa imisebenzi efana nokusebenza kwideski, ukuhamba kunye nokuqhuba kunokwenzeka kwiiveki ezimbini.
Kwiiveki zokuqala zokubuyisela oko kuqhelekileyo ukuba unyango lonyango luya kunikwa intlungu . Amachiza ancedayo atholakala ukuba anqande ukutyunjwa , njengoko kuthwala ukunyuka kwenyameko kunokwandisa uxinzelelo lwangaphakathi kwaye kufuneka kugwenywe. Unokufumana iyeza ukwenzela ukunciphisa ukudibanisa kwamanzi kunye nokuvuvukala.
Ngeli xesha, kuqhelekile ukuba uhlale uphelelwe amandla, ukudibanisa kwendoda kunye neenhloko zeentlobo zesinus. Kubalulekile ukubika oku kulandelayo kwi-surgeon yakho: i-postnasal drip okanye i-pitny ekhampini engayiyeki, imfiva, i-chills, ukucola ngokugqithiseleyo, ukoma okweqile, inwele embi, kunye nentamo eqinile ekhusela i-chin ukuba ingathinti isifuba.
Ukuhanjelwa kwakho okulandelelanayo kungenziwa nge-neurosurgeon yakho, ENT okanye zombini. Unokulindela ukuba uvavanyo lwegazi lwenziwe ukwenzela uqhubeke nokulandela inkqubela yakho kwaye ufumane ukuba yiyiphi imithi oyakuyidinga, ukuba kukho, xa usuphilile.
> Umthombo:
> Uphando lwe-Transsphenoidal FAQ: Isikhokelo soMonde. I-Neuroendocrine ne-Pituitary Tumor Clinic Centre. https://pituitary.mgh.harvard.edu/TranssphenoidalSurgery.htm