Nzira Yokuvhidzira Yokuderedza Dambudziko reSroke
Carotid endarterectomy inoshandiswa pakuvhiya umo ibwe rinodzingwa kubva mutiriyoti. Mabheti ndiyo nzvimbo dzekuvaka mafuta mumidziyo yeropa. Muchitema carotid, chidimbu chinogona kuderedza kuzarura, kuderedza kubuda kweropa kusvika muuropi uye kuwedzera njodzi yezviputi zvinoputika kubva pamucheka uye uchifamba nemidziyo yeperesi kuti iite sitiroko.
Uku kuderedza ropa kwemukati kunonzi stenosis .
Commonality
Vanachiremba vave vachiita carotid endarterectomy kwemazuva mazhinji, uye vanoaita zvakanaka nguva dzose mune zvipatara zvakakura. Yokutanga CEA yakaitwa muna 1953 naDkt DeBakey muHouston, Texas. Parizvino, nguva inopfuura 100 000 magaro ekupedzisira emakaroti anoitwa gore negore muUnited States.
Nzira
Munguva yecarotid endarterectomy, chiremba anovhiya anozarura ariti carotid uye anobvisa danda rakaumbwa mukati maro mukati, rinonzi known endothelium.
Danho rokutanga nderokuita kuti murwere agadziriswe kushandisa aneshehesia. Vamwe varwere vanosarudza anesthesia yemunharaunda kuitira kuti vangave vakamuka uye vaudze chiremba chiremba kana vakanzwa chero chavasingafaniri. Nzira iyi inobvumirawo chiremba kuti aedze mamiriro ehutano hwehutano nekuvakumbira kuti vaite zvinhu zvakanyanyisa maoko avo. Vamwe vangada kurara kuburikidza nenzira iyi.
Muchiitiko ichi, intraoperative electrophysiologic yekuongorora nemaitiro se electroencephalography (EEG) inogona kushandiswa kuita kuti huropi hurambe huripo. Hapana uchapupu hwakaratidza musiyano muugumisiro pakati pekushandisa musha kana aneshehesia yakawanda mu carotid endarterectomy.
Mushure mokunge anesthesia inoshandiswa, chiremba anovhiya anovhara ariti kuti achengetedze kubva pakubuda ropa panguva inoitwa.
Kunyange zvazvo arteri ichivharidzirwa, uropi huchabva pane arteri carotid kune rumwe rutivi rworumwe rutivi nokuda kweropa rayo. An incision inoshandiswa muyeri yakanyungudutswa, uye humwe hutema huri nehutu hunobviswa. Kana imwechete yacho ikasunungurwa, chiremba anovhiya anoisa ariti zvakare pamwe chete, uye kubwinya kunobviswa.
Vadzidzi
Dambudziko rekurohwa nesitiroko inenge 1 kusvika 2 muzana gore kune vanhu vane carotid stenosis. Sangano reNational Institute for Health uye Clinical Excellence rakaratidza kuti varwere vane muongorori kusvika kune vane simba stenosis avo vachangobva kutambudzwa nekurohwa kana kupedzisira kusvikidzika kwechikwereti vane endarterectomy mukati memavhiki maviri.
Makirini makuru emakirini akaonesa kuti kana murwere ane zviratidzo, anotarisirwa kugara kwemakore mashanu kana kupfuura, uye ane chiremba anyanzvi ane chirwere chinodarika 3 peresenti yematambudziko, murwere uyo angabatsirwa ne endarterectomy.
Zvikomborero zvakaderera kune vanhu vasina zviratidzo, asi mumatambudziko akaoma, endaroere inonzi carotid inogona kunge yakakodzera. Pane humwe nharo pakati pechiremba pamusoro penguva yekuita endarterectomy kune vanhu vanoratidzira, kunyanya sekurapa kwepamusoro pemishonga yevarwere ava vanovandudza nenguva.
Contraindications
Carotid endarterectomy haifaniri kuedzwa kana mukati maro carotid yakavharwa zvachose. Kunyange zvazvo zvingaita sezvisinganzwisisike, hapana chakazivikanwa kubatsirwa kwokuzarura mishonga yakavharwa zvachose, zvichida nokuti kana arteri yakavharwa, hapana nzira yekuti bits of clot iparuke kubva pachidimbu uye inofamba kusvika kuuropi.
Kana pane kakatove nekurohwa kukuru kune rumwe rutivi rweuropi hupi neripi rakaoma, pane zvishoma zvingabatsiri kuita kuti nzira yacho iite. Zvakawanda zvekukuvadza zvinogona kuitwa zvatoitika, uye nzira yacho inogona kuwedzera dambudziko rekubuda ropa munzvimbo iyo inobatwa nechirwere.
Kana chiremba chiremba kana anesthesiologist achisarudza kuti mumwe munhu ane zvinetso zvakawanda zvezvehutano uye angangodaro anoremerwa nenyaya kubva pakuvhiyiwa, zvino chirwere hachifaniri kuenda mberi.
Initial Testing
Kufananidza mishonga yeropa mumutsipa kunofanira kuitwa kuti uone kuoma uye nzvimbo yepaki. Kune nzira shomanana dzakasiyana dzekutarisa mukatikati carotid arteri. Duplex ultrasound inoshandisa mazaya anonzwika kuratidza kuti ropa rinoyerera sei mumidziyo. Chirwere chemaitiro chinonzi cerebral angiography chinosanganisira kuvhara dye yakasiyana mumidziyo yeropa uye kutarisa kuti inopararira sei nemidziyo pa x-ray. Nepo izvi zvichionekwa sechinhu chegoridhe mumifananidzo yepascular, inopisa, uye mifananidzo yakanaka kwazvo inogonawo kuitwa neC CT angiogram (CTA) kana MR angiogram (MRA). Kana imwe nzira yekucherechedza midziyo inotungamirira kumigumisiro yakaipa, chiremba anogona kuraira zvinopfuura imwechete.
Zvinokonzera Matambudziko
CEA inogona kuwirirana nematambudziko sezvinongoita sitiroko kana kufa nekuda kwekugadzirisa, zvisinei, dambudziko racho rakaderera. Inenge 3 muzana yevarwere vasina zviratidzo uye 6 muzana yevarwere vane zviratidzo vanotambura zvinetso izvi. Ichi ndicho chikonzero nei zvakakosha kuva noutano hwakanaka nokuda kwekuvhiyiwa: Pamusana pengozi yepamusoro yeproke ye1 peresenti pagore pasina kuvhiyiwa, zvinogona kutora makore mashomanana kuitira kuti zvibatsiro zvekushanda zvive zvakakonzera njodzi. Izvozvo zvakati, iyo inonyanya kukuvara yekuva nesitiroko nemhaka yechipfupa carotid arteri nguva pfupi mushure mekunge urohwa, pane imwe nguva chirwere chinofanira kukurudzirwa nokukurumidza.
Hyperperfusion syndrome ndeimwe imwe inogona kunge ine ngozi yechirwere checarotid endarterectomy. Apo chikamu cheuropi chave chichidziviswa kuteuka kweropa kwenguva yakareba, chinogona kurasikirwa nekwanisiro yekudzivirira kuti ropa rinowanzofamba sei kuburikidza nemidziyo iyoyo yeropa. Kana ropa rinopera kamwe kamwe mushure mekugadziriswa kwakagadziriswa, kukwanisa kweuropi kutadza kuti ropa riyerere kunogona kukonzera kuvhara uye kuderedzwa basa, iyo inogona kutevedzera chirwere .
Pasinei nezvinetso zvakakomba zvehutano zvinosanganisira kukanganisa kwenzara ye hypoglossal , iyo isingatauri rurimi, iyo inogona kutungamirira kururimi rwakasimba kune rumwe rutivi. Uye, sekuita upi noupi, kune humwe hutachiwana hwehutachiona uye kubuda ropa.
Sources:
Komiti Yakatarisa yeAymptomatic Carotid Atherosclerosis Study (ACAS). Endarterectomy yeAymptomatic carotid artery stenosis. Jama. 1995; 273: 1421-1428.
Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, Thomas D. Kudzivirira kwekuremara uye kuurayiwa kwevakafa kuburikidza nekubudirira kwekarotid endarterectomy kune varwere vasina zviratidzo zvemazuva ano zvishoma: zviratidzo zvisinganzwisisiki zvechirwere. Lancet. 2004; 363: 1491-1502.
Sharon Swain, Claire Turner, Pippa Tyrrell, Anthony Rudd vachitsvaga Guideline Development Group, Kuziva uye kutanga kutungamirirwa kwechirwere chakasimba uye chenguva ischemic attack: summary of NICE mazano, BMJ 2008; 337: a786, inoti: 10.1136 / bmj.a786 (Yakabudiswa musi waJuly 24, 2008)