Njira Yopangira Opaleshoni Yothetsera Mliri wa Stroke
Carotid endarterectomy ndi opaleshoni yomwe chipika chimachotsedwa ku mitsempha ya carotid. Mipata ndi malo omwe amamanga mafuta mu mitsempha ya m'magazi. Mu mitsempha yamakono, chipika chimatha kuchepetsa kutsegula, kuchepetsa kuthamanga kwa magazi ku ubongo komanso kuonjezera chiopsezo chokhala ndi zitsulo zochotsa pamphuno ndikuyendetsa zida za ubongo kuti zisawonongeke.
Kutsekemera kwa magazi kumeneku kumatchedwa stenosis .
Commonality
Madokotala akhala akuchita carotid endarterectomy kwa nthawi yayitali, ndipo nthawi zambiri mumawachitira madera akuluakulu azachipatala. Yoyamba CEA inachitika mu 1953 ndi Dr. DeBakey ku Houston, Texas. Pakalipano, malo opitirira 100,000 amtundu wa carotid amachitika chaka chilichonse ku United States.
Ndondomeko
Pakati pa carotid endarterectomy, dokotala wina opaleshoni amatsegula mitsempha ya carotid ndipo amachotsa chipika chomwe chimapanga mkati mwake, chotchedwa endothelium.
Choyamba ndikutsimikizira kuti wodwalayo amatha kugwiritsa ntchito anesthesia wamba kapena wamba. Odwala ena amakonda anesthesia kumudzi kuti athe kudzuka ndikudziwitsa dokotala ngati atamva chilichonse chomwe sakuyenera. Njirayi imathandizanso dokotala kuti ayese matenda a mitsempha mwa kuwafunsa kuti achite zinthu monga kufanana. Ena amafuna kuti agone mokwanira.
Pachifukwa ichi, kuyang'aniridwa kwa intraoperative electrophysiologic ndi njira monga electroencephalography (EEG) zingagwiritsidwe ntchito poonetsetsa kuti ubongo ulipobe. Palibe umboni umene wasonyeza kusiyana pakati pa kugwiritsira ntchito anesthesia wamba kapena wamba mu carotid endarterectomy.
Pambuyo poti aesthesia akuyendetsedwa, dokotalayo amathyola mitsempha yoteteza kuti magazi asatuluke panthawiyi.
Ngakhale kuti mitsempha imamveka, ubongo umadalira mitsempha ya carotid kumbali inayo chifukwa cha magazi ake. Kuphatikizidwa kumapangidwa mu mitsempha yosakanizika, ndipo minofu yambiri yomwe ili ndi chipikacho imachotsedwa. Chidutswacho chitachotsedwa, dokotalayo akugwiritsanso ntchito mitsempha pamodzi, ndipo ntchentche imachotsedwa.
Olemba
Kuopsa kokhala ndi stroke ndi pafupifupi 1 mpaka 2 peresenti pachaka kwa anthu okhala ndi carotid stenosis. Nyuzipepala ya National Institute for Health ndi Clinical Excellence yatsimikizira kuti odwala omwe ali ndi matenda ovuta kwambiri omwe amavutika ndi stroke kapena masewera osakanikirana omwe ali ndi matenda a ischemic amatha masiku awiri.
Mavuto akuluakulu a zachipatala asonyeza kuti ngati wodwalayo ali ndi zizindikiro, ayenera kukhala ndi moyo kwa zaka zisanu kapena kuposerapo, ndipo ali ndi dokotala wodziwa bwino yemwe ali ndi vuto locheperapo pa 3 peresenti, wodwalayo angapindule ndi endarterectomy.
Zopindulitsa ndizochepa kwa anthu opanda zizindikiro, koma powopsa kwambiri, endarterectomy ya carotid ikhoza kukhala yoyenera. Pali kutsutsana kwakukulu pakati pa madokotala okhudza nthawi yeniyeni yothetsera maginito pakati pa anthu omwe ali ndi matenda, makamaka ngati kasamalidwe ka mankhwala a odwalawa amakula bwino ndi nthawi.
Contraindications
Matenda a karotidi sayenera kuyesedwa ngati makina amtundu wa carotid amaletsedwa. Ngakhale zikhoza kuwoneka zosamvetsetseka, palibe phindu lotsegula kutsegula mitsempha yonse yotsekedwa, mwinamwake chifukwa ngati mitsempha yatsekedwa, palibe njira yoti zitsulo zichoke pa chipika ndikupita ku ubongo.
Ngati pangakhale kale sitiroko yaikulu pambali ya ubongo yomwe imaperekedwa ndi mitsempha yopapatiza, sipangakhale phindu phindu kuti ndondomeko ichitike. Zambiri zomwe zimawonongeka zakhala zikuchitika kale, ndipo ndondomekoyi ikhoza kuonjezera chiopsezo chokhala ndi magazi m'madera omwe akugwidwa ndi stroke.
Ngati dokotala wa opaleshoni kapena wodwalayo akuganiza kuti wina ali ndi mavuto ambiri azachipatala ndipo mwina akhoza kuvutika kuchokera ku opaleshoniyo, ndiye kuti opaleshoni sayenera kupita patsogolo.
Kuyesa koyambirira
Kujambula mitsempha ya m'mitsempha mu khosi kuyenera kuchitidwa kuti mudziwe kukula kwake ndi malo ake. Pali njira zingapo zosiyana siyana zogwiritsira ntchito zida zamkati za carotid. Duplex ultrasound amagwiritsa ntchito mafunde amphamvu kuti asonyeze momwe magazi akuyenderera mumitsuko. Nthenda yamakono ya angiography imaphatikizapo kulumikiza dye kusiyana ndi mitsempha ya mitsempha ndikuyang'ana momwe imafalikira kudzera mu zotengera pa x-ray. Ngakhale kuti izi zimaonedwa ngati golidi mu kujambulira, zimakhala zosautsa, ndipo zithunzi zabwino kwambiri zingathekanso ndi CT Angiogram (CTA) kapena MR angiogram (MRA). Ngati njira imodzi yowonera zitsulo imabweretsa zotsatira zosavuta, dokotala akhoza kulamula mayeso oposa umodzi.
Zovuta Zilipo
CEA ikhoza kugwirizanitsa ndi mavuto monga stroke kapena imfa chifukwa cha ndondomekoyi, komabe, chiopsezo n'chochepa. Pafupifupi 3 peresenti ya odwala opanda zizindikiro ndipo 6 peresenti ya odwala omwe ali ndi zizindikiro amavutika ndi mavutowa. Ndicho chifukwa china chomwe chirili chofunikira kukhala ndi thanzi labwino pa opaleshoni: Pa chiopsezo chowopsa cha 1 peresenti pachaka popanda opaleshoni, zingatenge zaka zingapo kuti phindu la opaleshoni likhale lopambana. Izi zati, ndizoopsa kwambiri kuti mukhale ndi stroke chifukwa cha mitsempha yopapatiza ya carotid posakhalitsa atapwetekedwa, pomwepo opaleshoni ayenera kuchitidwa mwamsanga mwamsanga.
Matenda a hyperperfusion ndi ena omwe angayambitse matenda a carotid endarterectomy. Pamene gawo la ubongo lakhala likuchotsedwa mwazi kwa nthawi yayitali, likhoza kutaya mphamvu yake yowonetsera momwe magazi amatha kudutsa mumitsinje ija. Pamene magazi amatha mwadzidzidzi pang'onopang'ono kutayika, ubongo sungathe kulamulira kuti kuthamanga kwa magazi kungachititse kutupa ndi kuchepa ntchito, zomwe zingafanane ndi kupwetekedwa .
Zovuta zochepa za njirayi zimaphatikizapo kuwonongeka kwa mitsempha ya hypoglossal , yomwe imasokoneza lilime, zomwe zingapangitse kufooka kwa lilime kumbali imodzi. Ndipo, monga opaleshoni iliyonse, pali chiopsezo chotenga matenda ndi magazi.
Zotsatira:
Komiti Yogwira Ntchito ya Asymptomatic Carotid Atherosclerosis Study (ACAS). Endarterectomy yodabwitsa kwambiri kuti mitsempha yotchedwa starotic stereosis. Jama. 1995; 273: 1421-1428.
Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, Thomas D. Kupewa kukhumudwitsa ndi kupha miyendo ndi carotid endarterectomy mwa odwala omwe alibe zizindikiro zaposachedwapa zamaganizo: kuyesedwa kosadziwika bwino. Lancet. 2004; 363: 1491-1502.
Sharon Swain, Claire Turner, Pippa Tyrrell, Anthony Rudd m'malo mwa Guideline Development Group, Kuzindikira ndi kuyang'aniridwa koyambitsa matenda osokoneza bongo ndi osakhalitsa afupikisoni: chidule cha malangizo a NICE, BMJ 2008; 337: a786, do: 10.1136 / bmj.a786 (Lofalitsidwa 24 July 2008)