I-Stenting

Ukuhlinzwa Kwenhliziyo Eqinile eHyderabad, India

I-Stenting imayelana nokufaka ama-stents emithanjeni evalekile. I-stent isakhiwo esincane esifana neshubhu udokotela ohlinzayo asifaka ephaseji lomthambo ovalekile ukuze uhlale uvulekile. Ama-stents abuyisela ukugeleza kwegazi, kuye ngendawo abekwe kuyo.

Ama-stents enziwe ngazo zombili izinsimbi namapulasitiki. Ama-stents amakhulu abizwa ngokuthi ama-stent-grafts futhi asetshenziselwa imithambo emikhulu. Zenziwe ngendwangu ekhethekile. Amanye ama-stents nawo ambozwa ngemithi ukuvimbela umthambo ovalekile ukuba uvaleke. Ezibhedlela ze-CARE, sinethimba lodokotela abasezingeni lomhlaba abanolwazi oluningi oluqinile nolwazi olujulile. 

Izinhlobo zama-Stents

Ngokuvamile, ama-stents ayizinhlobo ezimbili,

1. Ama-stents aqeda izidakamizwa- Kuyi-peripheral noma i-coronary stent efakwe emithanjeni emincane ethinteke nesifo ededela kancane kancane umuthi ukumisa ukwanda kwamaseli. Lokhu kuvimbela ukuphola kwesilonda okungavimba umthambo onelungelo lobunikazi ohlanganiswe namahlule. I-stent ifakwa ngaphakathi kwe-coronary artery yi-interventional radiologist noma i-cardiologist ngesikhathi sokuhlinzwa kwe-angioplasty.
2. I-stent yensimbi engenalutho- Iyitende elingenasimbozo noma esinalekwe. Kuwucingo oluncane olunesakhiwo esinjenge-mesh. I-Bare-metal stainless steel (isizukulwane sokuqala) ama-stents ayengawokuqala anelayisensi asetshenziswa ekuhlinzeni inhliziyo. Lawa ma-stents asetshenziswa ezimeni zesisu se-gastro duodenum, i-biliary ducts, i-colon, ne-oesophagus. Ekwenzeni ama-stents esizukulwane sesibili, i-cobalt-chromium alloy isetshenziswa.

Ama-stents a-eluting izidakamizwa athandwa kakhulu kune-bare-metal stents njengoba enciphisa ubungozi be-restenosis. Kulesi simo, imithambo yegazi iyancipha, okunciphisa ukugeleza kwegazi.

Iyini i-Stent yelapha?

Ama-stents asiza ekuthuthukiseni ukusebenza kwemithambo yegazi ngemva kokususwa kwe-plaque enqwabelene ngumhlinzeki wakho wokunakekelwa kwezempilo. Ukwakheka kwe-plaque kungenzeka ezimweni ezahlukahlukene:

• I-peripheral (imilenze) isifo se-artery
• I-carotid (intamo) isifo se-artery
• Isifo semithambo yezinso (izinso).
• I-Coronary (inhliziyo) isifo se-artery

Ama-stents nawo anenzuzo ezimeni ezifana ne-deep vein thrombosis (ihlule legazi emlenzeni, engalweni, noma okhalweni), i-aorta aneurysm yesisu, noma ezinye izinhlobo ze-aneurysms. Ukwengeza, ama-stents awagcini emithanjeni yegazi futhi angasetshenziswa ukubhekana nokuvinjelwa kwemigudu yokuphefumula, i-bile ducts, noma i-ureters.

Kudingeka i-stent

Ama-stents ngokuvamile ayadingeka lapho ukwakheka kwe-cholesterol namaminerali, okwaziwa ngokuthi ama-plaque, kufakwa emithanjeni yegazi. Lezi zinto zinamathela emithanjeni yegazi ngaleyo ndlela ziyinciphise futhi zinqande ukugeleza kwegazi.

Isiguli singase sidinge i-stent ngesikhathi senqubo ephuthumayo. Inqubo ephuthumayo yenzeka lapho umthambo wenhliziyo uvalekile. Udokotela ohlinzayo kuqala ufake i-catheter noma ishubhu emthanjeni wenhliziyo (uvinjiwe). Lokhu kubavumela ukuthi benze i-balloon angioplasty ukuze basuse ama-clogs futhi bavule umthambo. Khona-ke, babeka i-stent ukugcina umthambo uvulekile.

Ama-stents nawo asetshenziselwa ukuvimbela ama-aneurysm (amaqhuqhuva amakhulu emithanjeni) ukuthi angaqhumi i-aorta, ubuchopho, noma eminye imithambo yegazi futhi angavula lemigudu elandelayo ngaphandle kwemithambo yegazi.

• I-Bronchi - Izindlela zomoya ezincane emaphashini.

• I-Bile ducts- Imigudu yesibindi ehambisa ijusi ye-bile kwezinye izitho zokugaya.

• Ureters- Amashubhu athutha umchamo usuka ezinso uye esinyeni.

Ukulungiselela i-stent

Ukulungiswa kwama-stents kuncike ohlotsheni lwama-stents oluzosetshenziswa ngesikhathi sokuhlinzwa. Kufanele uzilungiselele ukuba nemithambo yegazi ngama-stents ngokusebenzisa lezi zinyathelo ezilandelayo.

• Kufanele utshele udokotela wakho ohlinzayo ngezidakamizwa, izithasiselo kanye nemithi oyiphuze esikhathini esidlule.

• Ungathathi noma yimuphi umuthi ngaphandle kwencwadi kadokotela. 

• Landela imiyalelo kadokotela mayelana nezidakamizwa okudingeka uyeke ukuzithatha.

• Yeka ukubhema.

• Yazisa umhlinzeki wezempilo nganoma yisiphi isifo esifana nomkhuhlane noma umkhuhlane.

• Ungaphuzi amanzi nanoma yiluphi olunye uketshezi ngobusuku bangaphambi kokuhlinzwa.

• Thatha imithi ngokwencwadi kadokotela.

•  Finyelela esibhedlela ngaphambi kwesikhathi ukuze ulungiselele ukuhlinzwa.

• Landela ezinye iziqondiso ezinikezwa udokotela ohlinzayo ezibalulekile ukuba zicatshangelwe.

• Ngesikhathi sokuhlinzwa, uthola umuthi obangela ukuba ndikindiki ukuze ungezwa ubuhlungu lapho usika endaweni ethintekile. Ungase futhi uthole imishanguzo ye-intravenous ukuze uzigcine ukhululekile phakathi nenqubo.

Inqubo ye-stenting

Udokotela ohlinzayo ngokuvamile ufaka i-stent esebenzisa inqubo ehlasela kancane. Benza ukusika okuncane futhi basebenzise ishubhu noma i-catheter ukuze baqondise amathuluzi akhethekile kuyo yonke imithambo yegazi ukuze bafinyelele endaweni edinga i-stent. I-incision yenziwa ngokuvamile engalweni noma e-groin. Kula mathuluzi akhethekile, elinye lawo linekhamera ekugcineni ukuze liqondise i-stent.

Phakathi nenqubo, udokotela ohlinzayo angase asebenzise i-angiogram (indlela yokuthwebula izithombe yokuqondisa ama-stents emithanjeni yegazi). Ngala mathuluzi, udokotela uthola ukuvinjelwa noma imithambo yegazi ephukile futhi abeke i-stent. Ngemva kwalokhu, ususa amathuluzi futhi avale ukusikeka.

Izinkinga ezihlobene ne-stenting

Ukufaka i-stent kudinga ukuhlolwa kwemithambo yenhliziyo. Nakuba kuyinqubo ephephile, kusenezingozi ezimbalwa ezihilelekile. Zihlanganisa;

• ukopha

• Ukuvaleka komthambo

• Ama-clots egazi

• Isifo senhliziyo

• Ukutheleleka kwemikhumbi

• Ukungezwani komzimba nodayi nemithi kusetshenziswa kule nqubo.

• Izinkinga zokuphefumula ngenxa ye-anesthesia noma ukufakwa kwama-stents ku-bronchi.

• Ukuncipha kabusha komthambo.

• Amatshe ezinso ngenxa yokufakwa kwama-stents ku-ureters.

•  imivimbo kanye nokuquleka kuyivelakancane imiphumela emibi yama-stents.

Xoxa ngalezi zinkinga nomhlinzeki wethu wokunakekelwa kwezempilo ukuze wazi kabanzi.

Yini ongayilindela?

Umhlinzeki wezempilo uxoxa ngenqubo nesiguli kusenesikhathi. Isiguli singalindela izinto ezilandelayo kuyo yonke inqubo.

Ngaphambi Kokuhlinzwa

Udokotela weluleka iziguli ngendlela yokuzilungiselela ukujova. Babazisa ngokuthi kufanele bayeke nini ukudla noma ukuphuza nokuthi baqale nini futhi baqede nini ukuphuza imithi. Iziguli ezihlushwa yinoma yisiphi isifo esinjengoshukela, izinkinga zezinso nanoma yiziphi ezinye izinkinga kufanele zitshele odokotela bazo abahlinzayo kusengaphambili. Kuye ngalokhu, udokotela angacabangela izinguquko ezithile kule nqubo.

Ngaphezu kwalokho, iziguli zithola izincwadi zokugcwalisa ngaphambi kokufakwa kwama-stents njengoba kudingeka ziqale ukuthatha leyo mithi ngokushesha nje lapho ukuhlinzwa kwazo kuqeda.

Ngesikhathi sokuhlinzwa

Inqubo ye-stent ithatha cishe ihora kuphela futhi ayidingi i-anesthesia ejwayelekile. Phakathi nayo yonke le nqubo, isiguli sihlala siphapheme ukuze sikwazi ukulalela iziqondiso zikadokotela ohlinzayo. Odokotela banikeza imithi ethile ukuze isiguli sikhululeke phakathi nokuhlinzwa. Benza ndikindiki indawo yokufakwa kwe-catheter.

Iziguli eziningi azizizwa i-catheter ixhuma emthanjeni, ngakho-ke zingase zizwe ubuhlungu lapho ibhaluni likhula futhi liphushela i-stent endaweni ekhethiwe.

Odokotela bacofa ibhaluni bese bekhipha i-catheter ngemva kokubeka i-stent endaweni. Bafaka ibhandishi endaweni yesikhumba lapho i-catheter ifakwe khona futhi bayicindezele ukuze bavimbele ukopha.

Ngemva kokuhlinzwa

Iziguli eziningi zidinga ukuhlala esibhedlela okungenani usuku olulodwa ngemva kokuhlinzwa. Ngesikhathi sokuhlala esibhedlela, isiguli sigadwa. Umhlengikazi uhlola umfutho wegazi wesiguli nokushaya kwenhliziyo ngezikhathi ezithile.

Isiguli singaphuma esibhedlela ngakusasa uma zingekho izinkinga.

Ngokuvamile, indawo yokufaka idala ifindo elincane lezicubu lapho liphulukisa. Nokho, iba yinto evamile kancane kancane ngokuhamba kwesikhathi. Futhi, indawo yokufaka ihlala ithenda okungenani isonto lonke.

Lokubuyisela

Inqubo ye-stenting eyimpumelelo inciphisa izimpawu ezifana nobunzima bokuphefumula kanye nobuhlungu besifuba. Abantu abaningi bangabuyela emsebenzini wabo noma ezimisweni zabo zansuku zonke ngemva kwesonto lokuhlinzwa.

Ngesikhathi sokululama, abahlinzeki bezempilo batusa izidakamizwa ze-antiplatelet ekwenzeni amahlule egazi eduze kwe-stent. Ngaphezu kwalokho, baphakamisa imiyalelo yokululama njengokugwema ukuvivinya umzimba okucindezelayo noma umsebenzi.

Ukusetshenziswa isikhathi eside kwama-stents

Ama-stents amaningi ahlala unomphela emthanjeni ukuze uwugcine uvulekile futhi uvimbele ukubhidlika nezinye izinkinga eziyingozi. Odokotela bangasebenzisa ama-stents esikhashana ambozwe emithini engabhodloza i-plaque futhi avimbele ukuphindeka kwawo. Lawa ma-stents ayancibilika ngokuhamba kwesikhathi. 

Ama-stents angadambisa izimpawu ezinjengobuhlungu besifuba, kodwa akulona ikhambi elihlala njalo lezimo ezifana nesifo senhliziyo kanye ne-atherosclerosis. Abantu abanezimo ezinjalo kudingeka bathathe izinyathelo ezithile ukuze bagweme izinkinga ngisho nangemva kokuba ne-stent.

Odokotela batusa indlela yokuphila enempilo ngemva kwama-stents ukuvimbela ukwakheka kwama-plaque emthanjeni. Izincomo ezijwayelekile zihlanganisa ukudla okunempilo, ukuvivinya umzimba njalo, ukulawula ukucindezeleka, njll.

Yiziphi izingozi noma izinkinga zokubekwa kwe-stent?

Izinkinga ezinkulu azivamile ngesikhathi se-angioplasty kanye nokubekwa kwe-stent. Izingozi ezingaba khona zihilela ukwakheka kwehlule legazi ngaphakathi kwe-stent, ukusabela okubi ku-stent noma ukumbozwa kwesidakamizwa, ukopha, ukudabuka kwe-arterial, ukuphindaphinda kokuncipha komthambo wegazi (i-restenosis), kanye nokushaywa unhlangothi.

Izibhedlela ZOKUNAKEKELA Zingasiza Kanjani?

Ingqalasizinda esezingeni eliphezulu eZibhedlela ze-CARE inikeza indawo enhle yokululama kweziguli. Izisebenzi zezokwelapha ezinolwazi olunzulu zelapha iziguli ngemishini ethuthukisiwe ukuze zinikeze ukwelashwa okuphelele. Odokotela abahlinzayo abaqeqeshiwe basebenzisa izinqubo ezingavamisile ukwenza ukuhlinzwa. Leli thimba lezokwelapha lenza ngcono izinga lempilo yeziguli.