Kurapa kwekutsvaga isarudzo inowanzoshandiswa kakawanda sekugadzirisa kunatsiridza zvakanakisisa uye semigumisiro inovandudza .
Hemispherectomy ndechimwe chezvigadzirwa zvekare zvekuvhima kwekufa . Iyo inzira inosanganisira kubvisa chikamu cheropi uye kubvisa zvikamu zveuropi kuti kuderedze kukanganisa. Mumakore apfuura, nzira yacho yakashanduka, uye yakagadziriswa kuchengetedzwa uye zvigumisiro.
Zviratidzo
Kazhinji yenguva, hemispherectomy inoshandiswa kune vana vane mamwe marudzi ehuputi, asi vamwe vanhu vakuru vanogonawo kubatsirwa kubva pamitemo.
Hemispherectomy inogona kufungidzirwa kuti inogona kuitika kwauri kana iwe uine chirwere chinoputika, izvo zvinoreva kuti kugumburwa kunowanzoitika, kwakanyanya, uye hakugoni kudzorwa nemishonga inorambidzwa mishonga.
Ichowo chisarudzo chekuti mamwe marudzi ehuputi anozivikanwa kuti apindure zvakanaka ne hemispherectomy. Zvinonyanyozivikanwa zvinosanganisira:
- Encephalitis yeRasmussen : Iyi isarabondu inowanzoguma inoguma mukuramba, zvakaoma kudzora kugunun'una. Encephalitis raRasmussen inogona kudikanwa kurapwa nekuvhiya zvakadai sa hemispherectomy kana corpus callosotomy.
- Cortical malformation: Nokuda kwezvikonzero zvisingatsanangurwi, vana vanogona kuberekwa nehupfungwa husina kujeka hweuropi dzinogona kukonzera kukanganisa.
- Kurapa kwePerinatal : Kurwisa kwePerinatal kunoitika mwana asati aberekwa kana nguva pfupi pashure pacho. Izvi zvinogona kukonzera matambudziko neuropi kushanda, zvakadai sekugumburwa.
Aina
Pane huwandu hwemhando ye hemispherectomy, uye boka rako rezvehutano richasarudza chirongwa chakanakisisa chinoenderana nehutano hwekufa kwako uye kuongorora kwako kusati kwapora. Kusiyana kwehemispherectomy nzira dzose dzine zvinhu zvakasiyana-siyana zvakafanana, kusanganisira kubviswa kwehutachi tissue nekuparadzanisa nzvimbo dzeuropi.
Chinangwa chokubvisa chikamu cheuropi ndechokubvisa nzvimbo kana nzvimbo dzakaratidzwa dzinokonzera kukanganisa paEEG yako. Chinangwa chekuparadzanisa kukurukurirana pakati penzvimbo dzouropi ndechekudzivirira kushandiswa kwemaitiro emagetsi muuropi pakuparadzira nekukonzera kugunun'una.
Mhando dzakawanda kwazvo dze hemispherectomy ndezvekuti:
- Anatomic: Iyi ndiyo nzira yakakura kwazvo yehemipherectomy uye inosanganisira kubvisa chikamu chekuruboshwe kana kurudyi kwemaodzanyemba kuti kuderedze basa rokubata. Kunyange zvazvo izvi zvichiita kunge zvakanyanyisa, vanhu vanofamba neatomic hemispherectomy vanogona kurarama, uye kunyange kushanda zvakanaka. Panogona kuva nekurashikirwa kwekwaniso, zvisinei, kunyanya muyanzvi hunoenderana nekusarura-kurudyi uye kuonekwa kwepakati (kukwanisa kuyananisa zviyero zvitatu uye kuziva mitezo yemuviri wako).
- Basa remutambo: Rudzi urwu rwe hemispherectomy runosanganisira kubviswa kwechikamu chiduku cheuropi zvisikwa kubva kune hemisphere inokonzera kukanganisa, pamwe nekuparadzaniswa kwekodpus callosum.
- Peri insular: Iyi nzira yakanyanya kuderera maererano nekubvisa uropi hwehuputi kupfuura humwe hutsika huripo. Inosanganisira kubviswa kwehuwandu hwehutano hwehupi uye kuvhara chirwere chepakati pakati penzvimbo dzeuropi, pamwe nekucheka zvose kana chikamu che corpus callosum.
Sezvaunogona kutarisira, iyo yakawanda yakarongeka ine sangano rakasangana nematambudziko.
Kugadzirira
Usati wambovhiyiwa, iwe uchada kuongororwa kusati kwatanga. Aya maedzo anoona kana chirwere chekushaya chirwere chinotarisirwa chinotarisirwa kuti chikubatsire, rudzi rwekuvhiya rwakakunakira iwe, uyewo rubatsiro kutungamirira vanachiremba mukuronga nzira yacho pachayo. Nzvimbo dzezvivako dzinofanira kubviswa dzinosarudzwa kuti dzirege kuita kuti kurasikirwa kweuropi kushande. Mimwe miedzo inogona kudiwa mushure me hemispherectomy inosanganisira:
- EEG: EEG ndiyo electroencephalogram, iyo inomira isiri iyo inoparadza iyo inoyera basa remagetsi reuropi nekuisa pamashonga emagetsi pasi. Uyu muedzo unogona kubatsira kuziva kuti inhara ipi yenharaunda yeuropi inokonzera kukanganisa. Muchirevo chekugadzira hemispherectomy, EEG inogona kuona kuti inofanira kubviswa kupi kana kuti yakasunungurwa kuti iwedzere kugadziriswa.
- Vhidhiyo EEG: Ichi chiratidzo cheEGG chinowirirana nekuona mavhidhiyo. Vhidhiyo EEG inobvumira kuti boka renyu rezvechipatara rione kuti sei kugadzirisa kweEEG basa kunoratidza uye kana matambudziko ako anonyanya kuoma anotanga maererano neEEG yako kuchinja. Kunyora izvi kushamwaridzana kunogona kubatsira mukuronga nzira yako, kunyanya kana iwe uine mhando dzakasiyana dzekugumburwa uye nzvimbo dzakawanda dzechiitiko chisina kujairika chinoonekwa paEEG.
- MRI yeBongo: Uropi MRI inoratidzika mufananidzo wehuropi. Inogona kuziva kuberekwa (kubva pakuberekwa) kusina kuipa pamwe nekuwana kusagadzikana kungave kuri kukonzera kukanganisa kwako.
- PET kuongorora: Ichi chiyero chekufungidzira chinoongorora metabolism (basa rinopedza simba) munzvimbo dzakasiyana dzeuropi. Inogona kubatsira mukugadzirisa nzvimbo yakatomic yako.
- WADA muedzo: Uyu muedzo unoongorora nzvimbo yemutauro unoshanda mupfungwa dzako. Chiyero cheWADA hachina kushandiswa kureva basa rekutora kana nzvimbo asi rinoshandiswa kubatsira rubatsiro kuronga nzira yako yekuderedza kurasikirwa kwebasa mushure mekuvhiyiwa.
Nzira
Nzira yako yakagadzirirwa iwe zvichienderana nekuedza kwako kusati kwapurwa, uye haikwanise kunge yakangofanana neyemumwe munhu hemispherectomy chirongwa.
Kuvhiyiwa kweHemispherectomy kunosanganisira kusika muvheti mune chikamu chehenyare kuwana ruzivo rweuropi, uye nekunyatsobvisa nzvimbo yeuropi iyo yakagadziriswa kubviswa kusati yambovhiyiwa. Panguva yekuvhiyiwa, nzvimbo iyo vanachiremba vako vakaronga kusunungura, zvakadai se corpus callosum, yakanyatsogadziriswa. Uye pfupa chero ripi zvaro rakabviswa panguva yekuvhiyiwa rinodzoserwa panzvimbo panzvimbo yekushanda.
Ventricular Shunt
Vanhu vazhinji vane hemispherectomy vanoda ventricular shunt , kazhinji kwenguva pfupi. Iyi ibhuku rinounganidza hutachiona kuti hudzivirire kuwedzera kwemvura kunowedzera kubva kukuvadza uropi.
Kuvhiyiwa kwebongo pachako kunogona kukonzera kushandiswa kwenguva pfupi kwemvura. Kubviswa kwehutachi tissue kunokonzera kuvaka-up ye-fluid, iyo inopinda munzvimbo isati isina kuzadzwa. Zvisinei, nokufamba kwemazuva, kutarisa kwemvura kunotarisirwa kumira. Kana pane dambudziko rinogona kuenderera mberi nekuvakwa kwemvura, shunt inogona kuchengetwa kwenguva refu.
Kudzorera
Sezvaunopora kubva pakuvhiyiwa, iwe unoda kuongorora zvakaperera. Iwe uchange uine stitches paecheka rako uye pfupa rako rinononoka kurapa pachako.
Sezvaunodzoka, boka rako rezvechiremba rinoongorora huwandu hwako hwekuchenjerera uye basa rako remagetsi kurongedza kuvandudza uyewo kuziva chero matambudziko, akadai sokubuda ropa kana kupfugama. Kuvhara kwako kuchave kwakanyatsoongororwa kuti uwedzere mvura, ropa, uye zviratidzo zvehutachiona. Izvi zvinogona kubatsira boka rako rezvehutano kubata nekudzivirira matambudziko vasati vafambira mberi.
Iwe unganzwa uchinetseka kana kuti uri kure uye iwe unogona kubatsirwa nekudya kana nezvimwe zvezvinhu zvako zvehupenyu hwezuva nezuva, zvakadai sekuenda kushambirwo nekugeza, kwemazuva mashomanana kana kunyange mavhiki mashoma. Iwe unofanirwa kutarisira kuti uwedzere kusimba, kuvandudza kusara kwako uye kuve wakanyanya kuzvimirira pamazuva nemavhiki mushure mekuvhiyiwa.
Sezvaunodzoka, iva nechokwadi chekutaurira boka rako rezvechiremba pamusoro pemanzwiro ose asina kunaka anoratidzika kunge akafanana nekutora kana ara.
Migumisiro
Pamusoro pekutevera, vanhu vakawanda vakave neruzivo rwe hemispherectomy hukuru hunovandudzwa hwekugumburwa. Vamwe vanhu vanoona kuvandudzwa kwakakwana kwehuputi hwavo uye vanogona kurega kutora mishonga yekurwisa-seizure mushure mekuita. Vanhu vazhinji vakave ne hemispherectomy chidimbu chekuenderera mberi nekushandisa mishonga yekurwisa-seizure yekudzivirira kutora, asi vanogona kutora mishonga yakareruka yemishonga kupfuura kutanga kwekuvhiyiwa.
Dzimwe nguva, kudzokorora hemispherectomy kunogona kudiwa, uye zviitiko zvinoratidzwa kubva mukudzokorora hemispherectomy zvakanaka kwazvo. Hazviwanzoiti kuti kugunun'una kuve kwakaipisisa pashure pehemispherectomy.
Shoko Rinobva
A hemispherectomy chirongwa chikuru chokuvhiya. Kana iwe wakanga uchitarisa hemispherectomy yekutora kugadzirisa, iwe unofanira kuziva kuti nzira yacho inoshandiswa nevarapi vezvikokota vanoziva vakarovedzwa mukuvhiya kwekufa uye kuonekwa muuropi europi. Kubudirira uye kurapa kwemishonga, nerve stimulators, uye kupindira kunopindira kunoremedzwa zvakanyatsoita kuti ivhu rakachengetedzeka uye rakanyatsogadziriswa risarudzwa nokuda kwekutonga kwako kwakananga.
Kana hemispherectomy inosarudzwa semukana wakanakisisa kwauri, kuedza kwako kusati kwapora kunogona kuderedza kana kubvisa zvachose kurasikirwa kwehuropi basa kubva pakuvhiyiwa. Kana uchida kutora mishonga kana kudzokorora kuvhiyiwa, zvinoguma maererano nekutora kugadzirisa uye nemigumisiro yakaipa inofadza, uye vanhu vazhinji vane zvishoma nezvishoma zvakanyanya kukunda pashure pokunge hemispherectomy kupfuura zvavakaita vasati vavhiyiwa.
> Sources:
> Chen S, Guan Y, Liu C, et al. Kurapa kwevarwere vane chirwere chekufa chisingawanzogadziriswa mushure mokutanga hemispherectomy. Epilepsy Res. 2017; 139: 137-142. doi: 10.1016 / j.eplepsyres.2017.11.021.