I-Carotid atherossteosis yisifo esinzima, esihlala isikhathi eside lapho amachaphaza e-atherosulinotic afakwa khona ezindongeni zemithambo ye-carotid.
Isizathu esiyinhloko salesi sifo yizinga lokukhula kwe-cholesterol, ehlotshaniswa kakhulu nama-lipoprotein aphansi.
Kungani kuvela i-arteriosulinosis yamathambo e-carotid futhi kuyingozi ini?
I-Atherossteosis yisifo se-polyetiological. Kunezizathu eziningi ezingenza ukubukeka kokugula emzimbeni womuntu. Kuwo wonke umthamo wezimbangela zesifo, kunezindlela eziningi ezivame kakhulu.
Izimbangela ezivame kakhulu zalesi sifo yilezi:
- Iminyaka engaphezu kwengu-40.
- Amadoda ahlushwa ukufakwa kwe-cholesterol plaques kaningi kunabesifazane.
- Ukubhema kuholele ekulimaleni okukhulu kwemithambo ngenxa yezinguquko esakhiweni sezindonga zazo.
- Ukhuluphele.
- Isifo sikashukela mellitus, ikakhulukazi sohlobo lwesibili.
- Ukuphazamiseka kwe-Hormonal, kufaka phakathi ukungalingani kuma-hormone egilo kanye nokuqala kokuya esikhathini kubantu besifazane.
- Ukusebenzisa kabi utshwala.
- Indima ebalulekile idlalwa yifa.
- Ukuphazamiseka okujwayelekile kwe-lipid metabolism emzimbeni.
- Ukushoda kwama-lipoprotein aphezulu kwabantu ("good" cholesterol).
- Indlela yokuphila yokwehlisa ukuthula.
- I-Metabolic syndrome yisimo esikhethekile esifaka ukubonakaliswa kwe-hypertension (umfutho wegazi ophakeme), isisindo ngokweqile ikakhulukazi esiswini, ama-triglycerides ngokweqile, kanye nokungabekezeleli kwe-glucose.
- Ukucindezelwa kaningi, ukungazinzi ngokomzwelo.
Ukulimala emithanjeni ye-carotid kuyingozi ekuphazamisekeni kwegazi ebuchosheni, ngoba liphethe igazi elinothile oksijini emangqamuzaneni nasezithanjeni zalo. Ekuqaleni, kungavela izimpawu ezincane, njengokukhubazeka kwenkumbulo, ukuguquguquka kwemizwelo ejwayelekile, ikhanda, ukuncipha kwengqondo, nokuqina kwengqondo. Esikhathini esizayo, kungenzeka ukuthi okubizwa ngokuthi yi-transient ischemic ukuhlaselwa (TIAs) - lokhu kungukuphazamiseka kwesikhashana (ngezikhathi ezithile) kwezifo ezingena esikhathini esingaphansi kosuku. Baboniswa ukuphazamiseka okuhlukahlukene kokuzwela emilenzeni, ukulimala okubukwayo, ngisho nokukhubazeka kungenzeka.
Uma izimpawu zokuhlaselwa kwesikhashana kwe-ischemic zingashabalali emahoreni angama-24, khona-ke okunye ukuxilongwa kwenziwa - isifo sohlangothi.
Ukushaywa yi-necrosis yezicubu zobuchopho. Ingenzeka ngenxa ye-hypoxia (ukuntuleka komoya-mpilo) wobuchopho noma ngenxa yokuqina kwesibindi okukuyo.
I-tishu hypoxia ingenzeka ngenxa yokuqina komfutho wegazi (imithambo yegazi inciphile kakhulu, futhi igazi aligobhozi kahle) noma i-atherosulinosis (ama-atherosulinotic plaque angakwazi ukuphuma kakhulu ku-lumen yomkhumbi futhi anciphise ukuhamba kwegazi okujwayelekile). Kulesi simo, unhlangothi lubizwa ngokuthi yi-ischemic (ischemia - ukuntuleka kwegazi elinothiswe umoya-mpilo).
Uma i-hemorrhage yenzeka ezicutshini zobuchopho, khona-ke imbangela yayo evame kakhulu yi-aneurysm yemithambo - yokuncipha kanye nokwandiswa kodonga lomkhumbi, ngenxa yalokho ilahlekelwa yi-elasticity yayo futhi ingaqhuma kalula nganoma yisiphi isikhathi ngenxa yomthwalo noma ukucindezela okukhulu. I-Aneurysm nayo ingakhula lapho kukhona i-atherosclerosis. Ukuqubuka kwengqondo ebuchosheni kusikisela ukuthi ukushaya kwe-hemorrhagic (hemorrhage - ukopha).
Njengoba uzibonela, i-atherossteosis yamathambo e-carotid kungaholela emiphumeleni edabukisayo. Futhi okubi kakhulu, akekho ongabikezela ukuthi unhlangothi lizoziveza kanjani. Uma unganikezeli ukunakekelwa kwezokwelashwa okufanele ngesikhathi esifanele, umuntu angahlala ekhubazekile unomphela noma afe.
Kungakho, uma kutholakala ukuthi i-atherosselotic lesion of the carotid artery, enye yezindlela ezikhethekile zokwelashwa ukuhlinzwa.
Umsebenzi udinga nini?
Ukwenza ukungenelela kokuhlinzwa kwenziwa kuphela uma kungembula isimo esithuthukile salesi sifo.
Ngaphezu kwalokho, lo msebenzi wenziwa ngokusebenza okuphansi kwezokwelapha ezisetshenziswayo, ezingakwazi ukuqinisa isimo sempilo.
Ukungenelela kokuhlinzwa okwelashwa kwe-carotid arteriossteosis kunezinkomba ezithile ezithile, ezisungulwe ngokucacile.
Izinkomba yi-stenosis (unciphisa) ye-lumen ye-carotid artery inamandla ngaphezu kwama-70%, kufaka phakathi lezo zimo lapho kungekho khona ukubonakaliswa komtholampilo okuhambisanayo; I-stenosis ye-carotid artery ingaphezu kwesigamu uma kunezimpawu ze-ischemia e-cerebral, futhi ngaphambili isiguli sathola ingozi yesikhashana ye-cerebrovascular (TIA) noma isifo sohlangothi.
Futhi, umsebenzi unqunyiwe uma kunqunywa i-lumen engaphansi kwengxenye uma amacala e-TIA nemivimbo eye abonwa ngaphambili; ukuwohloka okungazelelwe kwemisebenzi yobuchopho noma ukuqhubekela phambili kwe-ischemia yobuchopho obungamahlalakhona; ukulimala kwemithambo ye-carotid yesobunxele nakwesokudla; ukulimala kanyekanye emithanjeni ye-carotid, vertebral and subclavian.
Kukhona futhi nokuphikisana okuningi ekusebenzeni, ngoba ezimweni eziningi abantu asebekhulile beza nezinkinga ezifanayo.
Kubo, ukusebenza okunjalo kudabukisa kakhulu, futhi ngenxa yalokho kunokuphulwa okunjalo kokuziphatha kwabo:
- izifo ezingapheli zesifo senhliziyo, uhlelo lwe-bronchopulmonary nezinso esikhathini sokuqhuma - ziyinkinga yokuqala, ngoba umzimba ophethwe i-anesthesia ungavele ungabinamandla;
- ukudangala okukhulu kokuqwashisa, kuze kufinyelele kugcwala;
- isigaba esibi sokushaywa unhlangothi;
- hemorrhage kwezicubu zobuchopho nge-conecitant foci ye-ischemia.
Okunye futhi ukwephula umthetho kufa cishe kwesamba samangqamuzana obuchopho ngokuqhekeka okukhulu kwemithambo yemithambo yegazi.
Izinhlobonhlobo zokusebenza kumithambo ye-carotid artery
Ngaphambi kokuthi odokotela bathole ukuthi bazokwenzenjani emnyangweni wokuhlinzwa, iziguli zidinga ukuhlolwa okujwayelekile: ukuhlolwa kwegazi nokujwayelekile komchamo, ukuhlolwa kwegazi nge-biochemical, i-cardiogram (ukukhipha izinhliziyo zenhliziyo), i-fluorogra (isheke eligunyaziwe lesifo sofuba), ne-coagulogram (ukuzimisela kokuqina kwegazi).
Izindlela zokucwaninga ezingezekile kuleli cala, esicabanga ngazo, zifaka i-carotid artery angiography (i-angiography ukucwaninga kwemithambo yegazi isebenzisa i -oloka ephakathi), imithambo yegazi ephindwe kabili, i-computer tomography (i-CT), noma i-imagic resonance imaging (MRI).
Izinhlobo ezintathu eziyinhloko zokungenelela kokuhlinzwa emithanjeni ye-carotid ziyahlukaniswa: i-carotid endarterectomy, i-vasent stenting, vaster prostics.
Ukukhethwa kwendlela yokuhlinza kuya ngokuqondile ngezinga lokulimala kwemithambo, eminyakeni kanye nesimo esivamile sesiguli, kanye nasemtholampilo lapho inqubo ezokwenziwa khona.
- I-Carotid enadarterectomy iyindlela yokusebenza evamile kakhulu yemithambo yalokhu okungenhla. Kuqukethe ukususwa ngokuphelele kwe-cholesterol plaque kusuka odongeni lomkhumbi, okwenza sikwazi ukubuyisa ukujikeleza okugcwele. Imvamisa yenziwa kusetshenziswa i-anesthesia ejwayelekile, kepha kwesinye isikhathi kuyenzeka futhi. Kwenziwa nge-atherossteosis kanye ne-carotid artery thrombosis, lapho kuvezwa khona ukubonakaliswa kliniki ngengozi ye-cerebrovascular, noma nge-asymptomatic atherosclerosis, kepha nge-stenosis ebalulekile yemithambo. Ngesikhathi sokuhlinzwa, i-incision yenziwa ngemuva kwe-auricle 2 cm ngaphansi konqenqema lomhlathi ophansi; iyaqhubeka kanye nomsipha we-sternocleidomastoid ngamasentimitha ayishumi. Ngemuva kwalokho isikhumba nezicubu ezinamafutha angaphansi ziyahlakazwa. Ngemuva kwalokhu, ukwenziwa bifurcation (i-bifurcation) yomthambo ojwayelekile we-carotid kuyahlukaniswa bese kutholakala okwangaphakathi. I-Atherossteotic plaque kanye nezinto eziguqulwe ngokwasodongeni olusondelene ne-vascular isuswe ngokuphelele kusuka ku-lumen yayo. Ngemuva kwalokho le ndawo igezwa ngesisombululo somzimba se-sodium chloride. Udonga lwe-vascular luhlanzwa kusetshenziswa isichibi esikhethekile. Kungenziwa ngezinto zokwenziwa noma kwizicubu zesiguli uqobo. Ekupheleni kokuhlinzwa, isilonda sihlanjululwa ezingxenyeni, kusale umgodi (ishubhu) engxenyeni engezansi yokuphuma koketshezi.
- I-Stenting - njengamanje, lo msebenzi uya ngokuya uncanyelwa ngoba ngokwemvelo awuhlaseli kangako, futhi, ngenxa yalokho, kuyahlukumeza kakhulu kubantu. Ukuze ube stenting, kulawulwa i-x-ray eqhubekayo, lapho kuthunyelwa khona umenzeli ohlukile emkhunjini futhi ukuhanjiswa kwawo kubhekwe. Ukuhlinzwa kwenziwa ngaphansi kwe-anesthesia yendawo. Okokuqala, kwenziwa ukubhoboza (ukubhoboza) kwe-carotid artery. Ngemuva kwalokho, ngaphansi kokulawulwa kwe-X-ray, kufakwa ibhaluni elikhethekile kuyo, enwebisa umkhanyisi womkhumbi endaweni edingekayo. Ngemuva kwalokhu, kufakelwa i-stent - isiphethu sensimbi, esizogcina ukuvunyelwa kokuqina komthambo kuqhubeke. Ekupheleni kokuhlinzwa, ibhaluni liyasuswa. Lapho kunemisindo, izinkinga ezinjengokubhujiswa kwe-plaque, i-carotid artery thrombosis iyabonakala.
- Ama-Prosthetics mhlawumbe indlela enzima kunazo zonke yokungenelela kokuhlinzwa ngokuhlala isikhathi eside kakhulu. Isetshenziselwa izilonda ezibanzi ze-atherosclerotic, ukubekwa kukasawoti we-calcium odongeni lomkhumbi, kanye naphambi kokubhula noma ukweqisa kwe-artery. Ngesikhathi se-prosthetics, i-carotid artery yangaphakathi inqunywa, indawo ethintekile isuswe ngokuphelele, izikebhe ziyahlanzwa ngamachaphaza afakiweyo futhi ingxenye esele yomthambo we-carotid ongaphakathi ihlanganiswe ne-carotid artery ejwayelekile. Isihlanganisi iyi-prosthesis eyenziwe ngezinto zokwenziwa ezihambelana nobubanzi bezikejana. Isigaba sokugcina ukufakwa kwemisele yokukhipha uketshezi.
Isikhathi sokuvuselelwa ngemuva kokuhlinzwa kwe-atherosclerotic plaque ku-carotid artery kuyaqabukela lidlula isonto. Izinkinga zanda kakhulu. Umphumela wokuhlinzwa uvame ukuthandeka. Ukubuyekezwa kwalemisebenzi engenhla kuhle kakhulu.
I-Carotid arteriosulinosis ichazwa kuvidiyo kule ndatshana.
