Kuchiza kwa Miyala ya Impso
Pafupifupi 12 peresenti ya anthu onse adzakhala ndi impso miyala panthawi ina m'miyoyo yawo. Ndipotu, impso ndizochitatu zomwe zimayambitsa matenda a prostate.
Miyendo ya impso ndi yopweteka kwambiri ndipo imabweretsa ululu wammbuyo, wam'mimba kapena wowawa. Chikhalidwe cha ululu uwu nthawi zambiri chimakhala chamkati. Zizindikiro zina zomwe zimagwirizana ndi impso zimakhala malungo, kuzizira, kunyoza, kusanza, mkodzo wamagazi ndi mkodzo wamitundu.
Kwa anthu ambiri, kupweteka kwa mwala wa impso kumalimbikitsa ulendo wopita kuchipinda chodzidzimutsa.
Miyala ingapangidwe mu chikhodzodzo, ureters kapena impso. Pamene miyala ija imapezeka mu impso, imatha kutchulidwa kuti renal calculi kapena nephrolithiasis. Miyendo ya impso ikhoza kubisa kapena kusokoneza. Kuletsa miyala ya impso ndi yaikulu (kuposa 7 mm) ndipo imatseka njira yamakono yomwe imafuna kuti anthu aziwachitira nkhanza. Mitsempha yaing'ono yopanda zibongo ndi yaying'ono ndipo nthawi zambiri imadutsa payekha ndipo safuna chipatala. M'malo mwake, ngati mupita ku chipinda chodzidzimutsa ndi miyala yomwe idzadutsa, mudzalandira mankhwala opweteka (NSAIDs kapena opanda opioids) ndi malangizo kuti musamalidwe ndi kutsata ndi dokotala wanu.
Mafuta a impso amakhala ndi calcium oxalate. Komabe, malingana ndi chifukwa chawo, maonekedwe a impso amasiyana, ndipo amatha kupangidwa ndi calcium phosphate, struvite, cystine kapena uric acid.
Pamene miyala ya impso imalowa mu mkodzo, imatha kuwoneka ngati dothi lomwe lingathandize kuthana ndi vutoli.
Munthu akamapereka chipinda chodzidzimutsa ndi matenda omwe amapezeka kuti ali ndi matenda a impso. Mankhwala a impso angathenso kugwiritsidwa ntchito pogwiritsa ntchito njira zina zozindikiritsira monga ultrasound, x-ray, MRI, ndi fluoroscopy.
Kuonjezera apo, urinalysis imalangizidwanso kuti ayang'ane mkodzo kwa makristasi ndi maselo ofiira a magazi (omwe amasonyeza kuwukha magazi).
Mitengo yaikulu ya impso yomwe imalepheretsa kukonza mkodzo kungafunikire opaleshoni kuti ichotsedwe. Komabe, opaleshoni ya miyala ya impso siyikuchitika kawirikawiri. M'malo mwake, chowopsya chotchedwa "thotripsy" (ESWL) chimakhala chotsatira poyendetsa nkhungu.
Ndi ESWL, mafunde amphamvu amphamvu amagwiritsidwa ntchito kuthyola miyala ya impso yomwe imawonekera pogwiritsa ntchito ultrasound. Mitsuko imeneyi ya miyala ya impso ingathe kudutsa mumtsinje. Chochititsa chidwi, kachipangizo kamene kakugwiritsidwa ntchito pokonza ESWL chimazikidwa pa teknoloji yogwiritsidwa ntchito popanga ndege zowonongeka.
Pali njira ziwiri zomwe ESWL ingagwiritsire ntchito. Choyamba, ESWL ikhoza kugwiritsidwa ntchito pogwiritsa ntchito madzi osambira pamene mumadzimadzira mumadzi ndipo mafunde amphamvu amatha kutumizidwa m'madzi. Mwinamwake, mafunde amphamvu awa amatha kupyolera mumtsinje wa madzi womwe umayikidwa pakhungu lanu. Njira ziwirizi zikhoza kukhala zosasangalatsa ndipo aneshesia imaperekedwa nthawi zambiri panthawiyi. Anesthesia imakhalanso nthawi yowonjezera pambuyo pa ESWL.
Ngakhale pogwiritsira ntchito anesthesia, ESWL ikhoza kukhala yopweteka kwambiri.
Makamaka, ESWL imakhala yopweteka kwambiri pamene kuwerengera kwa sing'anga komwe kumveka mafunde akuyenda monga pakati pa madzi ndi minofu kapena minofu ndi miyala. Choncho, ululu umakhala wofala kwambiri, womwe umakhala mkati mwa impso kumene mwala umapezeka.
Ngakhale kuti ESWL nthawi zambiri imakhala yotetezeka, kawirikawiri imayambitsa mtima wamagetsi kapena chisokonezo ndi zokondweretsa. Kuphatikiza apo, ESWL nthawi zina ikhoza kusokoneza ndi kuthamanga kwa magazi ndi kuchulukitsa mtima kulephera. Kuvulala kwina kwa nthendayi ndi kutuluka magazi ndizochibadwa pambuyo pogwiritsira ntchito ESWL.
Kuphatikiza pa opaleshoni kapena ESWL, muzochitika zina, ureteroscopy ndi endoscopy zingagwiritsidwe ntchito kuganiza ndi kuchotsa miyala ya impso.
Ureteroscopy imagwiritsidwa ntchito pobwezeretsa miyala yomwe imagwidwa mu ureters.
Miyendo ya impso imachokera ku zotsatira zofanana za chibadwa ndi chilengedwe. Malingana ndi chifukwa chake, nthawi zina mungachitepo kanthu kuti muteteze miyala ya impso. Mwachitsanzo, chiopsezo chachikulu chomwe chimagwirizanitsidwa ndi impso miyala ndi kutaya madzi; Choncho, kumwa madzi ochuluka kapena kutenga mankhwala odzola (mapiritsi a madzi) kungathandize kuchepetsa miyala ya impso. (Dokotala wanu ayenera kulamula diuretics.) Komanso, zakudya zina zingathandize kuti pakhale mtundu wina wa miyala ya impso. Mwachitsanzo, sipinachi imakhala ndi oxalate, yomwe ili ndi ziwalo za impso zopangidwa ndi calcium oxalate. Kuwonjezera apo, kuchepetsa kuchuluka kwa nyama ndi sodium yomwe mumadya kungathenso kupewa calcium oxalate impso miyala.
Zosankha Zosankhidwa
Hwang JQ, Poffenberger C. Hwang JQ, Poffenberger C Hwang, James Q., ndi Cori McClure Poffenberger. Chaputala 10. Mu: Carmody KA, Moore CL, Feller-Kopman D. Carmody KA, Moore CL, Feller-Kopman D Eds. Kristin A. Carmody, ndi al.eds. Buku Lopereka Chithandizo Chachikulu ndi Emergency Ultrasound . New York, NY: Hill ya McGraw; 2011. Idafika pa December 12, 2015.
Cereda M, Kennedy S. Cereda M, Kennedy S Cereda, Maurizio, ndi Sean Kennedy. Chaputala 61. Kuganizira Zochita Zoganizira za Kuchita Zochita Zachilengedwe ndi Kuchita Zachiwerewere. Mu: Longnecker DE, Brown DL, Newman MF, Zapol WM. Longnecker DE, Brown DL, Newman MF, Zapol WM Eds. David E. Longnecker, ndi al.eds. Anesthesiology, 2e . New York, NY: Hill ya McGraw; 2012. Idapezeka pa December 12, 2015.