Carotid endarterectomy: zizindikiro, zosokonezeka postoperative, opareshoni ndemanga, ubwino ndi kuipa

Aliyense akudziwa kuti sitiroko ndi chimodzi cha zomwe zimakonda imfa pakati pa anthu a dziko lapansi. matenda Izi zimachitika ndi pafupipafupi ofanana m'mayiko onse a dziko. Nthawi zambiri kufalitsa oziziritsa kumabweretsa ziwalo ndi paresis, kuchititsa zosakhalitsa kapena okhazikika chilema. Kupewa chitukuko cha matenda, muyenera nthawi matenda opha ziwalo zinthu Ochititsa ndi kuthana nawo. Chifukwa chachikulu cha sitiroko - ndi atherosclerosis a mitsempha ya khosi ndi mutu. embolism mu m'badwo pakati ndi zaka pali pafupifupi aliyense. anthu ambiri pa zaka 60 kupereka mankhwala kupewa atherosclerosis. Nthawi zina mankhwala sukhala ndi zotsatira ankafuna. Ndiye anasonyeza opaleshoni - carotid endarterectomy. Ndondomeko imeneyi imaphatikizapo kuchotsa chotengera gawo kuonongeka ndi atherosclerosis.

Chifukwa amawononga carotid endarterectomy?

Krovosnabzhnenie ubongo zimadalira mitsempha carotid. zotengera ndinu nthambi kwa msempha. Iwo anakonza symmetrically mbali zonse za khosi. Kulowa M'mimbamo cranial, mitsempha carotid anawagawa nthambi zing'onozing'ono ubongo. Mu odwala matenda atherosclerosis, chiopsezo magazi kuundana mu zotengera. Iwo wapangidwa mipukutuyi mafuta ndi minofu fibrous. Pamene magazi kuwonjezeka carotid thrombus akhoza kusiya khoma chotengera ndi kulowa ubongo. Chifukwa, iwo amayambitsa ischemia - kupanda kotunga mpweya zimakhala ndi. Chotero oziziritsa magazi kumabweretsa zotsatira zoipa. Pofuna kupewa sitiroko, carotid endarterectomy imagwiridwa. Imathandiza kupewa matenda opha ziwalo ndipo zotsatira zake.

ndondomeko mwachidule

Carotid endarterectomy - ndi opaleshoni, ndilo kuyeretsa M'kati chotengera ndi zolengeza atherosclerotic. Iwo anachita pa nthawi imene mankhwala alibe mphamvu kapena chiopsezo sitiroko ndi okwera kwambiri. Mankhwala sangathe kupereka zotsatira anakhumba pamene atherosclerotic zolengeza ali oposa theka m'mimba mwake wa mtsempha wamagazi ndi carotid. Kapena ngati mafuta atseka wa lumen chombocho ku mbali zingapo nthawi imodzi. Kuwonjezera pamenepo, ngozi za sitiroko kumawonjezera kwambiri pamaso pa matenda oopsa kusalankhula. Pankhaniyi, atheroma mulole nthawi iliyonse kuchokera endothelium, mosasamala kanthu za kukula kwake. Chifukwa mwina si blockage ambiri carotid mtsempha wamagazi ndi nthambi zake kuti kudyetsa ubongo. Chifukwa cha osauka ischemic sitiroko.

Zikuonetsa kuti carotid endarterectomy

Opaleshoni (carotid endarterectomy) ikuchitika osati aliyense. Kuti dokotala andipatsa chilolezo opaleshoni, ayenera kukhala umboni kwambiri. Nthawi zambiri ntchito ya imagwiridwa odwala ndi mbiri kale anasamutsa makope ubongo. Choncho, nthawi zina wolungama carotid endarterectomy? Zizindikiro izi:

1. The awiri chotengera chatsekedwa ndi zolengeza atherosclerotic ndi oposa theka.
2. Mobwerezabwereza zikwapu mu mbiri.
3. Kuphatikiza oopsa (malipiro sitepe) ndi atherosclerosis a mitsempha carotid.

Contraindications kwa opaleshoni

Ngakhale ubwino wa opaleshoni, zina, iwo sangakhoze ikuchitika. Monga ntchito ena, chiyenera contraindications ndi carotid endarterectomy. Reviews odwala ndi atherosclerosis, likuonetsera poyera kuti ambiri Kafukufuku osiyana anachita asanachite opareshoni. Only pamene dotolo amakhutitsidwa kuti palibe contraindications, wodwalayo akuyamba kukonzekera ntchito. Carotid endarterectomy ndikoletsedwa milandu zotsatirazi:

1. mankhwala kusalankhula (decompensated) oopsa.
2. Yaikulu pachimake ischemic sitiroko.
3. Wosakhazikika angina kapena posachedwapa m'mnyewa wamtima infarction.
4. Pachimake mtima kulephera.
5. Recent sitiroko.
6. Matenda magazi insufficiency 2 ndi madigiri 3.
7. matenda a Alzheimer.
8. Cancer ndi woopsa.

Kukonzekera carotid endarterectomy

Asanachite carotid endarterectomy n'kofunika kuchita kafukufuku zosiyanasiyana. Woyamba limasonyeza duplex ultrasound ziwiya za mutu ndi khosi. Njira imeneyi dokotala sangathe kuweruza mlingo wa kutsekedwa wa lumen wa mitsempha ya mipukutuyi atherosclerotic. Nthawi zina, ndi mtima angiography. Phunziro ili ndi oyamba mu m'magazi wothandizila Mosiyana namtsata ndi mphamvu X-ray. A njira yolondola ndi CT angiography. Iwo amalola kuti amayang'anitsitsa mawonekedwe, kukula ndi kutanthauzira kwa mafuta m'thupi overlays pa endothelium lapansi. Ngati dotolo akuganiza ischemia zina mbali ya ubongo imene anachita chapamwamba kwambiri. Adokotala anawulula zikuonetsa opaleshoni, m'pofunika kuti ajambule nkhani boma ambiri wodwala. Kuchita ichi kutsogolo kwa carotid endarterectomy kuchita ECG, KLA, kudali magazi umagwirira ndi coagulation. Ngati wodwalayo matenda ena, m'pofunika kufunsa akatswiri (m'thupi yemwenso, cardiologist).

Magawo a carotid endarterectomy

Gawo loyamba la opaleshoni ochititsa dzanzi. Kusankha mankhwala ochititsa dzanzi zimadalira maganizo a dokotala, komanso kufunitsitsa wodwala. Izo zikhoza kuchitidwa mankhwala oletsa ululu pamalopo kapena mankhwala ochititsa dzanzi ambiri. Kenako, dokotala wopanga ang'ambe thupilo m'dera limene zotsatira za ultrasound kapena angiography ndi mafuta mipukutuyi. Chotsatira ndi clamping chidebe. Komanso odulidwa wapangidwa ambiri mtsempha wamagazi ndi carotid. Pamene dotolo kuti zowoneka amayang'anitsitsa kukula ndi mmene zolengeza atherosclerotic, iye amanena kuti njira zimene kupitiriza ntchito. Pali njira zingapo. Nthawi zambiri amachita kutsegula endarterectomy. Mwa ichi ndi kutanthauza ang'ambe thupilo kotenga chotengera ndi "kuchipala" mafuta overlays. Pambuyo pake, m'malo mwa endothelium kuonongeka umagwiritsidwa "chigamba." njira ina - ichi eversion endarterectomy. Chifukwa chaichi chotengeracho anatembenuka mkati ndi kunja ndi kuyeretsa wa wt atherosclerotic. Ngati chotupa cha mtsempha wamagazi ndi carotid waukulu, m'malo ake imagwiridwa mu dera. Chifukwa chaichi, kupanga nsalu. Chomaliza carotid endarterectomy ndi wosanjikiza-stitching.

Kodi nthawi pambuyo ntchito?

Pambuyo carotid endarterectomy zimatenga nthawi kuti abwezeretse magazi. Pamafunika masabata ochepa. Popeza ang'ambe thupilo mu khosi kukula yaing'ono, anasonyeza zomverera pang'ono chopweteka. Komabe, analgesics ukafunidwe pa tsiku loyamba. Inu simungakhoze kukweza zinthu zolemera, ndi kuchita masabata angapo, chifukwa monga momwe carotid endarterectomy chitachitidwa. Njira postoperative anali wabwino, ngati onse a mankhwala ya adokotala, osati pamene mu chipatala, komanso pamene mtima wa akatulutsidwa. Sutures amachotsedwa masiku 7-10 pambuyo opaleshoni.

Zovuta za carotid endarterectomy

Tiyenera kukumbukira kuti opaleshoni iliyonse pangakhale ngozi. Nazonso ndi carotid endarterectomy. Zovuta pambuyo opaleshoni n'zochepa, za 3% ya milandu. Komabe, angapezeke ndi wodwala ayenera anachenjeza za izi.

Woyambirira postoperative Vuto ndi suture kulephera. Ndi opareshoni iyi, malowedwe a mabakiteriya pabala ndi choopsa kwambiri kwa moyo wa wodwala, monga odulidwa ikuchitika mwachindunji pa bedi mtima. Vuto Izi zingachitike chifukwa sanali kugwilizana ndi malamulo a antiseptics.

chikhalidwe china choopsa kugwirizana ndi CEA, ndi mwano. ngozi Cerebrovascular kumachitika chifukwa cha atherosclerotic zolengeza mpukutu kulekana pa ntchito ndi mutu wake anakumana ndi ziwiya. Vuto Izi kawirikawiri, mu 2-3% ya milandu.

Komanso, opaleshoni nthawi zina anati matenda zosakhalitsa mawu ndi kumeza. Izi amagwirizana ndi kuwonongeka kwa mathero mitsempha yomwe ili pakhosi.

zosokonezeka mochedwa carotid endarterectomy restenosis imatengedwa. Amenewa amanena za kukonzanso kuchepetsa wa lumen chotengera. Nthawi zambiri restenosis amapezeka odwala amene alibe kutsatira malamulo dokotala.

Kupewa mavuto postoperative

Zovuta monga sitiroko ndiponso kuwonongeka kwa mitsempha ya khosi, musati zimadalira mtima, monga iwo yanthanda pa njira ya opaleshoni. Komabe, kupewa zinthu zina zimatheka chifukwa cha ntchito ophatikizana a dokotala ndi wodwalayo. Makamaka izo nkhawa kukonzanso zosayembekezereka ya mipukutuyi atherosclerotic. Kamodzi ntchito ndi pa, wodwala ayenera nthawi zonse akuoneni katswiri. Kuwonjezera pa ndondomeko matenda dokotala amapereka mtima kuimilidwa zothandiza. Makamaka zimenezi zikugwira ntchito kwa moyo: wodwalayo ayenera kusiya kusuta fodya ndi mowa, kudya zakudya (kudya zakudya otsika-mafuta). Komanso kupewa restenosis Kwalamulidwa mankhwala. Wodwala ayenera tsiku kutenga mankhwala zamadzimadzi-kutsitsa ( "atorvastatin" mankhwala), otsatira antiplatelet ( "Cardiomagnyl" piritsi "Clopidogrel").

Opaleshoni "carotid endarterectomy": ubwino ndi kuipa

Pamene dongosolo lonse opaleshoni, opaleshoni ubwino ndi kuipa. Madokotala ena amalangiza carotid endarterectomy bola atherosclerosis angathe kuchizidwa conservatively, ndi odwala mulibe mawonetseredwe matenda a matenda. madokotala ena amakhulupirira kuti opaleshoni m'pofunika ndi kuchepetsa yofunika kwambiri lumen wa mtsempha wamagazi, mosasamala kaya zizindikiro alipo kapena ayi mu mtima. The ntchito njirayi ndi mokwanira yoyeretsa ya sitimayo mafuta m'thupi, kuwongolera magazi. opaleshoni angathe kuchepetsa chiopsezo cha matenda opha ziwalo. Komabe endarterectomy sizitanthauza kuti chotengeracho sangawonongeke kachiwiri. Komanso, pa opaleshoni mavuto angathe monga kuvulala mitsempha kapena kachigawo. madokotala ambiri amanena izi kwa mpheto zazing'ono za kayendetsedwe ndi zotsatira amaonedwa ndi watanthauzo.

Carotid endarterectomy: ndemanga za anthu opareshoni

Zabwino ndi zoipa malingaliro nawo pa zokambirana za chithandizo chilichonse opaleshoni. Nazonso ndi carotid endarterectomy. Reviews unathandizira anthu osiyana. Nthawi zambiri, anthu ali ndi ntchito. Zikomo kwa iye, ndi zizindikiro za ischemia (kulemala tcheru, kukumbukira, kugona), bwino zotsatira za kafukufuku ndi chikhalidwe ambiri. Odwala ena anati kusintha mawu, Pomeza matenda pambuyo endarterectomy. Nthawi zambiri, zizindikiro zimenezi unatha pafupi mwezi, ndiyeno kwathunthu mbisoweka.