Mwachidule
Pali njira zingapo zomwe zilipo pakuthandizira kunenepa kwambiri. Izi zikuphatikizapo zakudya ndi kusintha kwa moyo, mankhwala osokoneza bongo , ndi zipangizo ndi njira zomwe zimachokera ku opaleshoni yonse ya bariatric kupita kumagetsi atsopano, omwe amawonongeka.
M'chilimwe cha 2016, US Food and Drug Administration (FDA) inavomereza chipangizo chopweteka kwambiri chotchedwa AspireAssist, chogulitsidwa ndi Aspire Bariatrics.
Kodi AspireAssist ndi Chiyani?
AspireAssist ndi chida chogonjetsa chovomerezedwa kuti chithandizo cha kunenepa kwambiri kwa anthu akuluakulu omwe ali ndi zaka zoposa 22 ndipo omwe ali ndi chiwerengero cha thupi kufika pa 35 mpaka 55. Chipangizocho chimapangitsa omvera kukhetsa gawo la Mimba yawo imapezeka m'mimba yamkati (yotchedwa gastrostomy tube) kupita kuchimbudzi pambuyo pa chakudya.
Chipangizo cha AspireAssist chimagwiritsidwa ntchito kwa nthawi yaitali anthu akuluakulu oyenerera omwe satha kukwanitsa kulemera kochepa mwa njira zopanda ntchito monga kusintha kwa moyo ndi mankhwala ochepetsa kulemera.
Momwe Ikugwirira Ntchito
Monga tanenera pamwambapa, AspireAssist amagwiritsa ntchito chubu yomwe imayikidwa kudzera m'mimba, ndipo imalola kuti m'mimba mwake mukhale chakudya chamkati. Phunziro la oyendetsa ndege la Sullivan ndi ogwira nawo ntchito, izi zapezeka kuti kuchepetsa chiwerengero cha makilogalamu omwe amapezeka ndi pafupifupi 30 peresenti.
Chipangizo cha AspireAssist chili ndi chubu la gastrostomy, monga tawonera pamwambapa, komanso valavu yamagetsi, chipangizo china chomwe chimakhala ndi chojambulira, madzi osungiramo madzi, ndi chubu yamakina yopindika.
Mphindi 20 mpaka 30 mutatha kudya, wogwiritsa ntchito chipangizo chotchedwa AspireAssist akugwiritsira ntchito chipangizo cha gastrostomy kupita ku chipangizo chamkati ndikutsegula valavu, ndipo izi zimalola kuti m'mimba mukhale chimbudzi ndi mphamvu yokoka.
Ndikofunika kuzindikira kuti chakudya chiyenera kuti chinkafufuzidwa bwino pa chakudya cham'mbuyomu kuti chigwirizane ndi chubu, yomwe ndi yaikulu mamita 6 okha.
Kamwedwe kameneka kamatha, wogwiritsira ntchito AspireAssist akuyenera kugwedeza chubu ndi m'mimba ndi madzi oyera, omwe amatha kutuluka m'chitsime cha madzi chomwe chimabwera ndi chipangizochi.
Zonsezi zikuyenera kutenga pafupifupi 5 mpaka 10 mphindi.
Ngati muli ogwiritsa ntchito chipangizochi, kumbukirani kuti kudzakhala koyenera kuti mupitirize kuika malo otsogolera ndi dokotala wanu, popeza chojambuliracho chiyenera kutengedwa pambuyo pa 115 masabata (pafupifupi masabata asanu kapena asanu ndi limodzi).
Ndifunikanso pa maulendo otsogolerawa kuti atsimikizire kuti chipangizo cha AspireAssist chikugwira bwino ntchito. Kutalika kwa chubu kungafunikirenso kusintha ngati mutayalemera. Dokotala wanu adzapitirizabe kupereka uphungu ndi zamoyo paulendo uliwonse wotsatira.
Mtengo
Malinga ndi kalatayi ya zamankhwala yokhudza mankhwala osokoneza bongo ndi mankhwala, pogwiritsa ntchito mfundo zochokera kwa wopanga, ndondomeko zomwe zimagwiritsidwa ntchito panthawi yoyamba kuphatikizapo chaka choyamba chotsatira chikuyenera kukhala madola 8,000 mpaka $ 13,000.
Mphamvu
Olemba kafukufuku wa PATHWAY anapeza kuti odwala omwe anapatsidwa mankhwala ndi AspireAssist kuphatikizapo uphungu wa moyo kwa chaka chimodzi amapeza kuperewera kwa chiwerengero cha 31.5 peresenti ya kulemera kwakukulu, poyerekeza ndi 9,8 peresenti ya kulemera kwakukulu komwe kunatayika mu gulu lomwe lapatsidwa uphungu wamoyo wokha.
Zotsatira zina kuchokera ku maphunziro a nthawi yayitali sizipezeka, kotero zimakhala zovuta kudziwa momwe zotsatira za nthawi yaitali pa kulemera kwa thupi ndi khalidwe la moyo zidzakhala ndi AspireAssist.
Zotsatira Zotsatira
Mu PATHWAY mayesero omwe atchulidwa pamwambapa, odwala asanu ndi atatu aliwonse amakhala ndi zotsatira zoyanjanitsidwa ndi chipangizo cha AspireAssist.
Zotsatira zake zimakhudza kupweteka kwa m'mimba, kunyozetsa ndi / kapena kusanza, kusintha mthupi, ndi kutupa kapena kukwiya pafupi ndi gastrostomy tube. Zotsatira zina zomwe zimatchulidwa ndi matenda, kutuluka m'magazi, ndi / kapena kutuluka kumayambiriro kwa mimba.
Zambiri mwa zotsatirazi zinkawoneka kuti zithetsedwe mkati mwa masiku 30.
Odwala 4 mwa 111 aliwonse omwe amachitidwa ndi AspireAssist mu trial PATHWAY, chipangizocho chinagwirizanitsidwa ndi zoopsa zazikulu, monga kufunika kwa m'malo mwa gastrostomy tube, matenda a m'mimba, ndi zilonda.
Ndipotu, polemba ndondomeko ya chipangizocho, Kalatayi ya Zamankhwala pa Mankhwala Osokoneza Bongo ndi Therapeutics inamaliza kuti: "Chipangizo cha AspireAssist sichitha kuwononga kwambiri kuposa opaleshoni yachipatala kuti athetse kunenepa kwambiri ndipo zingakhale zothandiza kwa odwala ena, koma deta yomwe ilipo ndi yoperewera ndipo mndandanda wa zotsutsana ali ochuluka. "
Zina Zopangidwira Zopangidwira Zowononga Kulemera
Chida china chakhala pamsika wochizira kunenepa kwambiri kuyambira mu January 2015. Chipangizo ichi cha FDA, chomwe chimadziwika kuti Maestro Rechargeable System , chimagwira ntchito pogwiritsa ntchito njira ya mitsempha pakati pa ubongo ndi m'mimba zomwe zimakhala ndi ulamuliro pa njala ndi chidzalo . Zimapangidwa ndi magetsi oyendetsa magetsi omwe angathe kubwezeretsedwa, pamodzi ndi waya oyendetsa ndi electrodes. Izi zimaikidwa opaleshoni m'mimba. Icho chimatumiza mphamvu zamagetsi ku mitsempha ya vagus, yomwe imathandiza kuchepetsa kusamba kwa mimba ndi kutumiza zizindikiro ku ubongo kuti mimba imakhala yopanda kanthu kapena yodzaza.
Malinga ndi EnteroMedics Inc., kampani yomwe imapangitsa chipangizochi, Maestro Rechargeable System amalepheretsa zizindikiro kuti vagus nerve nthawi zambiri amatumizira ku ubongo, motero kuchepetsa kukhudzidwa ndi njala ndikupangitsa odwala kumva bwino kwambiri kuposa momwe angachitire.
Pa July 28, 2015, a FDA adalengeza kuti adzalandila chipangizo china chochiza kunenepa kwambiri: chipangizo cha bulloon chomwe chimatchedwa ReShape Integrated Dual Balloon System (ReShape Dual Balloon.
Monga chipangizo cha AspireAssist, ReShape Dual Balloon imapanganso njira yotherapoyi kuti iike chipangizocho, chomwe chimayikidwa mmimba kudzera pakamwa ndi pamphuno. Monga tawonera ndi FDA, "Chipangizocho sichimasintha kapena kusintha maonekedwe a chibadwa cha m'mimba," ndipo odwala amalimbikitsidwa kuti "atsatire chakudya choyang'aniridwa ndi mankhwala komanso kuchita masewero olimbitsa thupi kuti athe kuwonjezera mphamvu zawo" pamene akugwiritsa ntchito chipangizochi. Izi zimathandiza kuonetsetsa kuti odwala amatha kupitiriza kulemera kwawo pokhapokha ngati chipangizocho chikuchotsedwa.
Chipangizocho chiyenera kukhala cha kanthawi ndipo, malinga ndi FDA, ayenera kuchotsedwa miyezi isanu ndi umodzi itangoyamba kuikidwa.
Zimaganiziridwa kuti ReShape Dual Balloon amagwira ntchito potenga mpata m'mimba, zomwe zimayambitsa chidziwitso chokwanira, koma pangakhale njira zina zogwirira ntchito zomwe sizinazindikiridwe.
Njira Zopangira Opaleshoni Zowononga Kulemera
Zowonjezereka kwambiri komanso njira zamakono opaleshoni zimakhala pansi pa gulu la opaleshoni ya opaleshoni, ndipo zimaphatikizapo opaleshoni yowakomera m'mimba, mimba yamimba yapamimba (lap band), ndi kumanja kwa manja (pakati pa ena).
Kuti akhale woyenera pa opaleshoni ya bariatric, munthu ayenera kukhala ndi BMI ya 40 kapena kuposa, kapena BMI ya 35 kapena wamkulu mwa munthu yemwe ali ndi matenda ena (omwe amadziwika kuti "comorbid conditions") chifukwa cha kunenepa kwambiri. .
Opaleshoni yotchuka kwambiri yochitidwa opaleshoni imakhala njira yothandizira mimba, kapenanso kugwiritsira ntchito manja. Ndipotu, makamaka chifukwa cha mphamvu zake ndi chitetezo poyerekeza ndi njira zina, malinga ndi Bariatric Surgery Source, njira yothandizira mimba imapezeka kuti ikugwiritsira ntchito chapamimba monga "ndondomeko ya golidi" yatsopano.
Ntchito yowongoka manja imalimbikitsa odwala kuchepetsa kudya, potero amachepetsa kulemera. Mwa njirayi, pafupifupi 60 peresenti ya m'mimba imachotsedwa (kawirikawiri imatuluka mwachisawawa ), kotero kuti mbali yotsala ya m'mimba imakhala mawonekedwe a chubu kapena malaya.
Chifukwa chakuti m'mimba muli yaying'ono pambuyo pa opaleshoni, wodwala wamanja wapamimba adzamva bwino mofulumira ndipo ali ndi chakudya chochepa. Pazifukwa izi, ndondomeko yamanja ya m'mimba imadziwika ngati "choletsa" mtundu wa opaleshoni ya bariatric.
Mmene Mungakambirane ndi Dokotala Wanu
Ngati muli ndi kunenepa ndikumverera kuti mwayesapo kale njira zamankhwala zingapo komanso zakudya ndi kusintha kwa moyo wanu, ndipo izi sizikugwirani ntchito, kambiranani zomwe mungachite ndi dokotala wanu. Ndikofunika kuika malingaliro ndi kulingalira kwakukulu mu chisankho chilichonse chochita ndi opaleshoni yosankhidwa, makamaka opaleshoni yothandizira.
Dokotala wanu angakambirane ndi inu zomwe mungasankhe nokha monga momwe mungaperekere, kupatsidwa BMI yanu ndi matenda ena onse omwe mungakhale nawo. Pa zokambiranazi, mutha kuyeza ubwino ndi kupwetekedwa kwa opaleshoni yowonongeka.
Ndikofunika kwambiri kuti mutsimikizire kuti mukukambirana ndikudziŵa zotsatira za njira iliyonse, opaleshoni, kapena chipangizo chomwe mukuchiganizira, popeza njira iliyonse imabwera ndi zotsatira zina, zina zomwe zingakhale zovuta.
Komabe, ngati ndinu woyenera pa ntchito inayake yowonjezera kulemera kapena kuchitidwa, ndipo muli ndi chidziwitso chabwino ndipo mwakonzekera kutsatizana ndi gulu lanu lachipatala kapena lachipatala panthawi yokhazikika potsatira ndondomeko, opaleshoni yowonongeka akhoza kukhala ndi ubwino wambiri wathanzi, kuphatikizapo matenda a shuga komanso kuthamanga kwa magazi komanso kuchepetsa matenda a mtima.
Zotsatira:
AspireAssist-chipangizo chatsopano cha kulemetsa. Med Lett Mankhwala Ther. 2016; 58: 109-110.
Durkin M. Kuyeza zotsatira za opaleshoni ya bariatric. ACP Internist 2016; 36 (1): 1.
FDA News Release. FDA imavomereza chipangizo cha bulauni chosakhalitsa chapakati kuti athetse kunenepa kwambiri. Inapezeka pa intaneti pa http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm456296.htm pa July 29, 2015.
Sullivan S, Stein R, Jonnalagadda S, Mullady D. Edmundowicz S. Mankhwala opatsirana amachititsa kuti thupi likhale lolemera kwambiri: phunziro loyendetsa ndege. Gastroenterology. 2013; 145: 1245.
Thompson CC ndi al. AspireAssist ndi chida chothandizira kuchiza kalasi yachiwiri ndi yachitatu III kunenepa kwambiri: zotsatira za kuyesa kwa chaka chimodzi. Gastroenterology. 2016; 150 (suppl1): S86, umboni 381.