Kuchita opaleshoni ya khunyu ndi njira yomwe ikugwiritsidwa ntchito mobwerezabwereza monga njira zowonongeka bwino komanso zotsatira zake zikupita patsogolo .
Mapulaneti ena amodzi mwa njira zakale kwambiri zopaleshoni za khunyu . Ndi njira yomwe imaphatikizapo kuchotsa mbali ya ubongo ndikuchotsa mbali za ubongo kuchepetsa kupweteka. Pazaka zapitazi, ndondomekoyi yasintha, ndi chitetezo chabwino ndi zotsatira.
Zisonyezo
Nthaŵi zambiri, hemispherectomy imagwiritsidwa ntchito kwa ana omwe ali ndi matenda a khunyu, koma akulu ena angapindule ndi ndondomekoyi.
Kachilombo ka HIV kamakhala kotheka kwa inu ngati muli ndi matenda a khunyu, zomwe zikutanthauza kuti kugwidwa ndifupipafupi, koopsa, ndipo sikungathe kulamulidwa ndi mankhwala olekerera.
Imeneyi ndi njira yoti mitundu ina ya matenda a khunyu idziwe kuti idzayankhidwe bwino ku hemispherectomy. Zowonjezereka zimaphatikizapo:
- Encephalitis ya Rasmussen : Iyi ndi matenda omwe sakhala nawo nthawi zambiri omwe amachititsa kuti zikhale zovuta, zovuta kuthetsa kufooka. Encephalitis ya Rasmussen ingafunikire kuchipatala pogwiritsa ntchito opaleshoni monga hemispherectomy kapena corpus callosotomy.
- Cortical malformation: Chifukwa chazifukwa zosadziwika, ana akhoza kubadwa ndi ziphuphu zolakwika za ubongo zimene zingayambitse matenda.
- Mliri wa Perinatal : Kukwapula kwapatsiku kumachitika mwana asanabadwe kapena posakhalitsa pambuyo pake. Izi zingayambitse ubongo ndi ubongo, monga kugwedezeka.
Mitundu
Pali mitundu yambiri ya hemispherectomy, ndipo gulu lanu lachipatala lidzasankha njira yabwino kwambiri yoyerekeza ndi matenda a khunyu. Njira zosiyana zogwiritsira ntchito mankhwalawa zimakhala ndi zinthu zambiri zomwe zimagwirizana, kuphatikizapo kuchotsa minofu ya ubongo ndi magawo opanga opaleshoni.
Cholinga chochotsa dera la ubongo ndiko kuthetsa dera kapena malo omwe asonyezedwa chifukwa cha kufooka kwa EEG yanu. Cholinga cholekanitsa kuyankhulana pakati pa ubongo ndikuteteza ntchito yowopsa yamagetsi mu ubongo kufalikira ndikupangitsa kuti agwire ntchito.
Mitundu yowonjezereka ya hemispherectomy ndi:
- Anatomic: Njirayi ndi mtundu waukulu wa hemipherectomy ndipo imaphatikizapo kuchotsa mbali za kumanzere kapena kumanja komwe kumachepetsa ntchito yokopa. Ngakhale kuti izi zikuwoneka ngati zopambanitsa, anthu omwe amatha anatomic hemispherectomy amatha kukhala ndi moyo, ndipo amatha kugwira bwino ntchito. Mwina pangakhale kusowa kwa luso, komabe, makamaka maluso okhudzana ndi kusiyanitsa kumanja ndi kulingalira kwa malo (kumatha kuyamikira miyeso itatu ndi kuzindikira ziwalo za thupi lanu).
- Zomwe zimagwira ntchito: Njira imeneyi imaphatikizapo kuchotsa kachigawo kakang'ono ka minofu ya ubongo kuchokera ku dziko lomwe limayambitsa kufooka, komanso kupatukana kwa corpus callosum.
- Peri: Njirayi ndi yoperewera pochotsa minofu ya ubongo kuposa njira zina zamakhalidwe. Zimaphatikizapo kuchotsedwa kwa minofu yochepa ya ubongo ndi kupaleshoni opaleshoni pakati pa ubongo, komanso kudula zonse kapena mbali imodzi ya corpus callosum.
Monga momwe mungayang'anire, njira zowonjezereka zowonjezereka zimakhala ndi mayanjano apamwamba.
Kukonzekera
Musanachite opaleshoni, mudzafunika kuyesedwa koyambirira. Mayeserowa amadziwa ngati opaleshoni ya khunyu ikuyenera kukuthandizani, opaleshoni yamtundu wanji ndi yabwino kwa inu, komanso kuthandizira kutsogolera madokotala anu pokonzekera ndondomeko yokha. Malo a madera omwe amachotsedwa amasankhidwa kuti asapangitse kuwonongeka kwa ubongo kugwira ntchito. Mayesero ena omwe mungawafunike asanakhalepo:
- EEG: EEG ndi electroencephalogram, yomwe ndiyeso yosasokoneza yomwe imayesa mphamvu za magetsi za ubongo mwa kuika magalasi apamwamba pamapiko. Mayesowa angathandize kudziwa malo omwe ubongo uli nawo chifukwa cha kugwidwa. Pa nkhani yokonzekera hemispherectomy, EEG ikhoza kudziwa malo omwe angachotsedwe kapena kupatulidwa chifukwa cha kulamulira kokwanira.
- EEG ya Video: Ichi ndi mayeso a EGG omwe amatsatiridwa ndi kuyang'anitsitsa mavidiyo. EEG ya Video imalola gulu lanu lachipatala kuti liwone momwe ntchito ya kulandirira EEG ikuwonetsera komanso pamene zovuta zanu zowonongeka zimayambira poyenderana ndi EEG yanu kusintha. Kuwonetsera mgwirizano umenewu kungakuthandizeni kukonzekera njira zanu, makamaka ngati muli ndi mitundu yambiri ya kugunda ndi madera angapo a ntchito zosayenera zomwe zalembedwa pa EEG.
- MRI ya ubongo: Ubongo MRI ndi chithunzi cha ubongo. Zingathe kudziwa kuti munthu wamba (wobadwira) ali wovuta komanso amapeza zovuta zomwe zingayambitse matendawa.
- Kuyezetsa PET: Ichi ndi chiyeso chojambula bwino chomwe chimayesa kusokoneza mphamvu (ntchito yowononga mphamvu) m'magulu osiyanasiyana a ubongo. Zingakhale zothandiza potengera malo a anatomic omwe mumagwira.
- Mayeso a WADA: Mayesowa akuyesa malo a chinenero ntchito mu ubongo wanu. Mayeso a WADA sakugwiritsidwa ntchito pozindikira ntchito kapena malo ogwiritsidwa ntchito koma amagwiritsidwa ntchito kuthandizira ndondomeko yanu kuti muchepetse kutaya kwa ntchito pambuyo pa opaleshoni.
Ndondomeko
Ndondomeko yanu inakonzedwera kwa inu pogwiritsa ntchito kuyesedwa kwanu musanayambe kupitako, ndipo sizingakhale zofanana ndi njira ya munthu wina.
Kuchita opaleshoni yamtunduwu kumaphatikizapo kutsegulira mbali ina ya fuga kuti apeze ubongo, ndi kuchotsa mosamala dera la ubongo lomwe linadziwika kuti lichotsedwe chisanachitike opaleshoni. Pa opaleshoni, madera omwe madokotala anu akukonzekera kuchotsa, monga corpus callosum, amachotsedwa mosamala. Ndipo fupa lililonse limene linachotsedwa pa opaleshoni limabwereranso pamalo opangira.
Ventricular Shunt
Anthu ambiri omwe ali ndi hemispherectomy amafunikira ventricular shunt , kawirikawiri. Iyi ndi chubu yomwe imatenga madzi amadzimadzi kuteteza madzi ochulukirapo kuti asamangidwe kuti asawononge ubongo.
Kuchita opaleshoni kwa ubongo kungapangitse madzi okwanira osakhalitsa. Kuchotsedwa kwa minofu ya ubongo kumayambitsanso kumanga madzi, komwe kumalowa mu malo osangomaliza kumene. Komabe, patapita nthawi, madzi okwanira amayenera kuimika. Ngati pali vuto lopitirizabe kumanga madzi, shunt ikhoza kusungidwa kwa nthawi yaitali.
Kubwezeretsa
Pamene mukuchira opaleshoni, muyenera kuyang'anitsitsa. Mudzagwedeza khungu lanu ndipo fupa lanu lidzachira pang'onopang'ono.
Pamene mukuchira, gulu lanu lachipatala limayang'anitsitsa msinkhu wanu wochenjeza ndi ntchito yanu ya ubongo kuyang'anira kuti ikuthandizidwe komanso kuzindikira mavuto alionse, monga kutaya mwazi kapena kutupa. Shunt yanu idzayang'aniridwa mosamala kuti madzi azitha, magazi, ndi zizindikiro za matenda. Izi zingathandize gulu lanu lachipatala kugwira ndi kupewa mavuto asanafike patsogolo.
Mutha kumverera ngati wamisala kapena osagwirizana ndipo mungafunikire thandizo mukamadya kapena ndi zina zomwe mumachita tsiku ndi tsiku, monga kupita kuchimbudzi ndi kusamba, kwa masiku angapo kapena masabata angapo. Muyenera kuyembekezera kuti mukhale olimba, yongolerani bwino ndikukhala odziimira paokha masiku ndi masabata mutatha opaleshoni.
Pamene mukuchira, onetsetsani kuti mumauza gulu lanu lachipatala za malingaliro amodzi omwe amawoneka ngati akuwombera kapena aura.
Zotsatira
Potsata ndondomeko, anthu ambiri omwe ali ndi vuto lotha kupweteketsa matendawa amakula kwambiri. Anthu ena amatha kusintha bwino matenda awo a khunyu ndipo amatha kumwa mankhwala osokoneza bongo atatha. Anthu ambiri omwe ali ndi hemispherectomy ayenera kupitiliza kumwa mankhwala opatsirana pogwiritsa ntchito mankhwala osokoneza bongo, koma amatha kumwa mankhwala ochepa kwambiri kuposa opaleshoni.
Nthawi zina, kubwezeretsa hemispherectomy kungafunikire, ndipo zotsatira zomwe zimaperekedwa kuchokera kubwereza hemispherectomy ndi zabwino kwambiri. N'kosavuta kuti kugwa mthupi kukhale kovuta kwambiri pambuyo pa hemispherectomy.
Mawu Ochokera
A hemispherectomy ndi njira yaikulu yopaleshoni. Ngati mwakhala mukuganiziranso njira yothetsera vutoli, muyenera kudziwa kuti ndondomekoyi imachitidwa ndi opaleshoni odziwa opaleshoni omwe aphunzitsidwa opaleshoni ya khunyu komanso akuchitidwa opaleshoni ya ubongo. Kupindula ndi kupwetekedwa kwa mankhwala, mitsempha yotsegula mtima, ndi kuyeza opaleshoni kumayang'aniridwa mwatcheru kuonetsetsa kuti zosankha zabwino kwambiri ndi zogwira mtima zimasankhidwa kuti muzitha kulamulira.
Ngati hemispherectomy ikusankhidwa ngati njira yabwino kwa inu, kuyesa kwanu koyambanso kusakaniza kungachepetse kapena kuthetseratu kutaya kwa ubongo kuchokera ku opaleshoni. Ngati mukufunikira kumwa mankhwala kapena kubwereza opaleshoni, zotsatira zokhudzana ndi kugwidwa ndi zotsatira zake zimakhala zabwino, ndipo anthu ambiri amatha kugwa mofulumira kwambiri pambuyo pa hemispherectomy kuposa momwe anachitira asanachite opaleshoniyo.
> Zotsatira:
> Chen S, Guan Y, Liu C, ndi al. Kuchiza kwa odwala omwe ali ndi matenda a khunyu osasokonezeka atatha kuchipatala. Matenda a khunyu. 2017; 139: 137-142. lembani: 10.1016 / j.eplepsyres.2017.11.021.