I-atypical teratoid rhabdoid tumor

Iyini i-atypical teratoid rhabdoid tumor?

Izimila ze-teratoid rhabdoid ezingavamile (ATRT) ayivelakancane kakhulu, izimila zesimiso sezinzwa ezinolaka ezenzeka ikakhulukazi ku-cerebellum noma isiqu sobuchopho (ingxenye yobuchopho elawula ukunyakaza nokulinganisela) (ingxenye yobuchopho elawula imisebenzi eyisisekelo yomzimba).

• Ama-ATRT ngokuvamile avela ngeminyaka emi-3 kodwa kwesinye isikhathi avela ezinganeni ezindala.
• Ama-ATRT amele kuphela iphesenti elingu-1 kuya ku-2 lezimila ebuchosheni bezingane.
• Lezi izicubu ziyingxenye yeqembu elikhulu lezimila eziyingozi ezibizwa ngokuthi ama-rhabdoid tumors, okungenzeka ngaphandle kobuchopho (njenge-rhabdoid tumor of the kidney).
• Ama-ATRT angase enziwe abe owasendaweni engxenyeni eyodwa yobuchopho. Zingasakazekela kwezinye izindawo ebuchosheni, emgogodleni, noma emzimbeni.

I-atypical teratoid rhabdoid tumor (ATRT) iyithumba lobuchopho elingavamile futhi elikhula ngokushesha kanye nomdlavuza womgogodla. I-cerebellum noma isiqu sobuchopho siqala cishe ngesigamu salezi zicubu:

• I-cerebellum, etholakala phansi kobuchopho, ilawula ukunyakaza, ibhalansi kanye nokuma.
• Isiqu sobuchopho silawula ukuphefumula, ukushaya kwenhliziyo kanye nayo yonke imisipha esetshenziselwa ukubona, ukuzwa, ukuhamba, ukukhuluma nokudla.

I-ATRT ivame ukuvela ngenxa yezinguquko esakhini sofuzo esivame ukukhiqiza amaprotheni ukuze amise ukukhula kwezimila. Lesi sakhi sofuzo asisebenzi kahle ku-ATRT, amaprotheni awakhiqizwa, futhi ukukhula kwesimila akulawuleki. Lokhu kuntuleka kofuzo kuhlotshaniswa namaphesenti angaphezu kwama-90 wezigameko ze-ATRT. Nakuba lokhu kuguqulwa ngokuvamile kwenzeka kumdlavuza, lokhu kukhubazeka kwezakhi zofuzo kungazuzwa njengefa futhi isidingo sokuhlolwa kofuzo singasingathwa udokotela wakho.

Zivame kangakanani izimila ze-teratoid rhabdoid ezingavamile?

• I-ATRT ayivamile kakhulu futhi itholakala ezinganeni ezingaphansi kuka-10%. isimila sobuchopho.
• Lesi sifo sivame ukubonakala ezinganeni ezineminyaka engu-3 noma ngaphansi, kodwa kungenzeka futhi ezinganeni ezindala nakubantu abadala.

Izimpawu ze-atypical teratoid rhabdoid tumor

Ngokuya ngeminyaka yesiguli nendawo yesimila, izimpawu ze-ATRT ziyahlukahluka kakhulu. Njengoba ama-ATRT akhula ngokushesha, ngesikhathi esifushane, izimpawu zivame ukukhula ngokushesha.

Izimpawu ze-ATRT zingabandakanya okulandelayo:

• Ikhanda elibuhlungu ekuseni noma ikhanda elibuhlungu kancane ngemva kokuhlanza
• I-nausea nokuhlanza
• Izinguquko kumazinga omsebenzi
• Ukuzwa ubuthongo
• Ukulahlekelwa ibhalansi, izinkinga ezikhulayo zokuxhumanisa noma ukuhamba okungahambi kahle
• Ukunyakaza kwamehlo oku-asymmetric noma ukunyakaza kobuso
• Ukwanda kosayizi wekhanda (ezinsaneni)

Ukwelashwa kwe-atypical teratoid rhabdoid tumor

Ukwelashwa kuncike kusayizi wesimila nendawo, kanye neminyaka yesiguli. Iziguli eziningi zelashwa ngezindlela eziningi, okungase kuhlanganise ukuhlinzwa, ukwelashwa ngamakhemikhali kanye nemisebe, ngenxa yesimo esinolaka salezi zimila.

• Ukuhlinzwa - kusetshenziselwa ukuxilonga nokwelapha i-ATRT:
  • Udokotela ohlinzayo ukhipha ingxenye yogebhezi lwekhanda lesiguli, usebenzisa inaliti ukuze akhiphe isampula (biopsy) yesimila bese eluthumela elabhorethri. Lapho, ososayensi bahlola isampula ngaphansi kwe-microscope.
  • Uma umdlavuza uqinisekisiwe, udokotela ohlinzayo uyaqhubeka nokuhlinzwa ngokukhipha isimila esiningi njengoba kuphephile ukusikhipha.
• I-Chemotherapy (“i-chemo”) — isebenzisa imithi enamandla ukubulala amangqamuzana omdlavuza noma ukuwavimba ekukhuleni (ukuhlukana) nokwenza amangqamuzana omdlavuza engeziwe. I-Chemo ivame ukunikezwa ngemva kokuhlinzwa.
  • I-Chemo ingase ijovwe egazini, ukuze ikwazi ukuhamba emzimbeni wonke.
  • Enye ikhemo ingase inikezwe ngomlomo.
  • Ukwelapha ngenhlanganisela kusebenzisa uhlobo lwe-chemo olungaphezu kolulodwa ngesikhathi.
• Ukwelapha ngemisebe - kusebenzisa ama-X-reyi anamandla amakhulu noma ezinye izinhlobo zemisebe ukubulala amangqamuzana omdlavuza noma ukuwavimba ukuthi angakhuli.

Yiziphi izilinganiso zokusinda kwe-atypical teratoid rhabdoid tumor?

I-ATRT iwuhlobo lomdlavuza olunolaka futhi okunzima ukuyelapha. Ukusinda akunamandla, kodwa kwenziwa ngcono ekwelashweni. Izingane ezikhulile ziye zazuza ngentuthuko yakamuva ekwelashweni, futhi izingane ezinamathumba angasuswa ngokuphelele ziye zanda ukusinda. Ezivivinyweni zomtholampilo, ukwelashwa okusha kuyahlolwa. Ezinganeni ezincane kakhulu nasezinganeni ezinezifo ezingakwazi ukuhlinzwa zisuswe, inhloso ukukhulisa amazinga okwelapha nokuthuthukisa ukusinda.

I-Atypical Teratoid/Rhabdoid Tumor chemotherapy

Ocwaningweni lwesizukulwane sokuqala, okuhlanganisa novivinyo lwe-North American CCG9921 kanye ne-POG 9923, olubone amaphesenti angu-10 nje e-EFS, umthamo we-chemotherapy ongokwesiko wawungaselapheki iziguli ze-ATRT. Iqembu le-Dana-Farber, elihlanganisa i-doxorubicin ne-dactinomycin kuphrothokholi “ye-IRS-III elungisiwe”, liqophe ukusinda konyaka ongu-1 ngaphandle kokuqhubekela phambili okungamaphesenti angama-53 kusetshenziswa uhlobo olusekelwe ku-sarcoma. Nakuba amanye amaqembu abike izinzuzo ezivela kuzivumelwano ezisekelwe ku-methotrexate ne-anthracycline, amanye awazange aqaphele izinguquko ekusindeni. Ngokufanayo, kukhona futhi izifundo eziphikisanayo mayelana nokusetshenziswa kwe-ATRT platinum kanye nemithi ye-alkylating agent. Akukho ukuvumelana ngama-ejenti athembisayo futhi asebenzayo e-ATRTs, ngokwengxenye ngenxa yokwelapha okungafani, okunama-ejenti amaningi avame ukuhlinzekwa ezigulini ezine-ATRT, kodwa ikakhulukazi ngenxa yokuthi umnikelo ohlobene walezi ziguquguquko eziningi kulesi sifo esingajwayelekile awukwazanga ukuphenywa ngokuqinile. ngokuhlolwa komtholampilo okukhulu.

I-Atypical Teratoid/Rhabdoid Tumor Surgery (Craniotomy)

Kuyini a i-craniotomy?

Ukuveza ubuchopho, i-craniotomy iwukususwa ngokuhlinzwa kwengxenye yethambo ogebhezini. Ukuze kukhishwe ingxenye yethambo ebizwa ngokuthi i-bone flap, kusetshenziswa amathuluzi akhethekile. Ngemva kokuba inqubo yobuchopho isiqediwe, i-bone flap ikhishwa kafushane futhi ishintshwe.

Isiqondiso samakhompiyutha kanye nezithombe (imaging resonance magnetic [I-MRI] noma izikena ze-computerized tomography [CT]) zingasetshenziswa ezinqubweni ezithile ze-craniotomy ukuze kufinyelelwe endaweni ngqo ngaphakathi kobuchopho ukuze zelashwe. Le nqubo ihilela ukusetshenziswa kohlaka olugxunyekwe ogebhezini lwekhanda noma ithuluzi elingenafreyimu lisebenzisa omaka noma izimpawu zendawo ezibekwe kancane esikhumbeni. Ibizwa nge-stereotactic craniotomy uma enye yalezi zindlela zokuthwebula isetshenziswa kanye nenqubo ye-craniotomy.

Ngokuhambisana nale mishini namafreyimu asendaweni, izikena zobuchopho zinikeza umbono onezinhlangothi ezintathu wesimila esingaphakathi kobuchopho, isibonelo.

Kuyasiza ekuhlukaniseni izicubu zesimila esicutshini esinempilo futhi nasekufinyeleleni lapho ncamashi khona izicubu ezingajwayelekile.

I-stereotactic biopsy yobuchopho (inaliti iqondiswe endaweni engajwayelekile ukuze ucezu lwesicubu lukhishwe ngaphansi kwesibonakhulu ukuze luhlolwe), ukulangazelela okuqinile (ukususwa koketshezi kumathumba, i-hematomas, noma ama-cysts), kanye nokuhlinzwa kwe-stereotactic radiosurgery ezinye izinto ezisetshenziswayo. (njenge-gamma knife radiosurgery).

I-endoscopic craniotomy ingenye indlela ye-craniotomy ehlanganisa ukufaka isikophu esikhanyisiwe ngokusikwa okuncane ogebheni ngekhamera ebuchosheni.

Enye inqubo yokuhlinzwa engabandakanya i-craniotomy i-aneurysm clipping. I-cerebral aneurysm (ebuye ibizwe ngokuthi i-intracranial aneurysm noma i-brain aneurysm) iyindawo eqhumayo odongeni lomthambo wobuchopho osengozini, okuholela ekukhuleni okukhulu noma ibhaluni. Kukhona ithuba lokuqhekeka (ukuqhuma) kwe-aneurysm ngenxa yesifunda esilimele odongeni lomthambo. Ukubekwa kwesiqeshana sensimbi “entanyeni” ye-aneurysm kuhlukanisa i-aneurysm ngokukhawulela ukugeleza kwegazi kusuka kuwo wonke amanye amasistimu wokujikeleza kwegazi, ngaleyo ndlela kuvimbele ukuqhekeka.

I-Craniectomy iyinqubo efanayo lapho, ngemva kokuncipha kokuvuvukala, ingxenye yogebhezi ikhishwa unomphela noma ifakwe esikhundleni kamuva phakathi nokuhlinzwa kwesibili.

Ezinye izinqubo ezihlobene ezingase zisetshenziselwe ukuxilonga ukuphazamiseka kobuchopho zihlanganisa i-cerebral arteriogram, i-computed tomography (CT) scan yobuchopho, i-electroencephalogram (EEG), imaging resonance magnetic (MRI) yobuchopho, i-positron emission tomography (PET) scan, kanye ne-X. -imisebe yogebhezi . Sicela ubheke lezi zinqubo ukuze uthole ulwazi olwengeziwe.

Izinhlobo ze-Craniotomy

I-Bifrontal Craniotomy Enwetshiwe

Indlela evamile yesisekelo sogebhezi esetshenziselwa ukukhomba izimila eziyinselele ngaphambili kobuchopho i-bifrontal craniotomy ende ende. Kusekelwe embonweni wokuthi ukususwa kwethambo elengeziwe kungcono kunokuphatha ubuchopho ngokweqile.

I-bifrontal craniotomy ende ende ifaka ukusika ngemuva komugqa wezinwele esikhunjeni kanye nokukhipha ithambo elakha i-orbit ne-contour yesiphongo. Ekupheleni kokuhlinzwa, leli thambo liyashintshwa. Ukususwa kwesikhashana kwaleli thambo kwenza odokotela abahlinzayo bahlinze esikhaleni esiphakathi nakwesokudla ngemuva kwamehlo ngaphandle kokuphatha ubuchopho ngokweqile.

Kumathumba athile okungewona ikhandidethi lokususwa ngezindlela ezihlasela kancane, i-bifrontal craniotomy enwetshiwe ivamise ukusetshenziswa ngokunganaki ukwakheka kwesimila, ukugula okungaba khona kwesimila, noma izinhloso zokuhlinzwa.

Izinhlobo zezimila ezilashwa nge-bifrontal craniotomy enwetshiwe zifaka i-meningiomas, i-esthesioneuroblastomas namathumba esisekelo sogebhezi oluyingozi.

I-Craniotomy Encane Ye-Supra-Orbital "

I-Supra-orbital craniotomy (evame ukubizwa ngokuthi i-craniotomy “yeshiya”) iyinqubo esetshenziselwa ukususa izimila ebuchosheni. Kule nqubo, odokotela abahlinzayo benza ukusika okuncane phakathi kweshiya ukuze bafinyelele izimila ezingaphambili kobuchopho noma izimila ze-pituitary. Le ndlela isetshenziswa esikhundleni sokuhlinzwa kwe-endonasal endoscopic lapho isimila sikhulu kakhulu noma siseduze nezinzwa zamehlo noma imithambo ebalulekile.

Ngenxa yokuthi kuyinqubo ehlasela kancane, i-supra-orbital "eyebrow" craniotomy ingase inikeze

• Ubuhlungu obuncane kune-craniotomy evulekile
• Ukululama ngokushesha kune-craniotomy evulekile
• Izibazi ezincane

I-supra-orbital craniotomy ingase ibe yingxenye yokwelashwa kwamaqhubu ka-Rathke, amathumba esisekelo sogebhezi namanye amathumba e-pituitary.

I-Retro-Sigmoid "Keyhole" Craniotomy

I-Retro-sigmoid craniotomy (evame ukubizwa ngokuthi i-craniotomy “keyhole”) iyinqubo yokuhlinzwa ehlasela kancane eyenziwa ukuze kukhishwe izimila zobuchopho. Le nqubo ivumela ukukhishwa kwezimila zesisekelo sogebhezi ngokusikwa okuncane ngemuva kwendlebe, kunikeze ukufinyelela ku-cerebellum ne-brainstem. Odokotela abahlinzayo bangasebenzisa le ndlela ukuze bafinyelele izimila ezithile, njenge-meningioma kanye ne-acoustic neuromas (vestibular schwannomas).

Izinzuzo ze-craniotomy "ye-keyhole" ihlanganisa ubuhlungu obuncane ngemva kwenqubo kunangemva kwe-craniotomy evulekile, izibazi ezincane kanye nokululama okusheshayo.

I-retro-sigmoid craniotomy ingenziwa kulezi zinhlobo ezilandelayo zamathumba ebuchosheni:

• I-Acoustic neuromas (i-vestibular schwannomas)
• Meningiomas
• Ubuchopho be-Metastatic noma izimila zomgogodla
• Izimila ezisezingeni logebhezi

I-Orbitozygomatic Craniotomy

Indlela ejwayelekile yesisekelo sogebhezi esetshenziselwa ukukhomba izimila eziyinselele kanye ne-aneurysms i-orbitozygomatic craniotomy. Kusekelwe embonweni wokuthi ukususwa kwethambo elengeziwe kungcono kunokuphatha ubuchopho ngokweqile.

I-Orbitozygomatic craniotomy, evame ukusetshenziselwa lezo zilonda eziyinkimbinkimbi kakhulu ukuthi zingasuswa ngamasu ahlasela kancane, kuhlanganisa ukusika esikhunjeni sekhanda ngaphansi komugqa wezinwele nokukhipha ithambo elakha umjikelezo nesihlathi. Ekupheleni kokuhlinzwa, leli thambo liyashintshwa. Ukukhipha leli thambo kuvumela okwesikhashana odokotela abahlinzayo ukuthi bafinyelele ezindaweni ezijulile nezidinga kakhulu zobuchopho kuyilapho kuvimbela ukulimala okungapheli kobuchopho.

I-craniopharyngiomas, izicubu ze-pituitary, kanye ne-meningiomas zihlanganisa izimila zobuchopho ezingelashwa nge-orbitozygomatic craniotomy.

I-Translabyrinthine Craniotomy

I-translabyrinthine craniotomy iyinqubo ehilela ukususwa kwethambo le-mastoid kanye nelinye ithambo lendlebe yangaphakathi ngokusikwa esikhunjeni sekhanda ngemuva kwendlebe (ikakhulukazi, imisele eyisiyingi equkethe ama-receptors okulinganisa). Udokotela ohlinzayo uyobe esekhomba futhi akhiphe isimila, noma ingxenye enkulu yesimila ngangokunokwenzeka, ngaphandle kwanoma yiliphi ithuba lokulimala unomphela ebuchosheni.

I-acoustic neuroma (i-vestibular schwannoma) iphathwa ngenye yezindlela ezintathu: i-suboccipital, i-translabyrinthine, ne-middle fossa ye-translabyrinthine craniotomy.

Isixazululo se-translabyrinthine siyacatshangelwa futhi lapho kungekho ukuzwa okuzuzisayo noma ukulalelwa okufanele kwenziwe umhlatshelo. I-semicircular canals yendlebe isikwa ngesikhathi se-translabyrinthine craniotomy ukuze ifinyelele isimila. Njengomphumela wokuqedwa kwemisele ye-semicircular, ukulahlekelwa kwezindlebe okuphelele kwenzeka.

Ingozi yokulimala kwenzwa yobuso ingancishiswa, kuyilapho ukuzwa kulahleke nge-translabyrinthine craniotomy.

Izizathu zenqubo

I-craniotomy ingenziwa ngezizathu ezahlukahlukene, kufaka phakathi, kepha kungagcini nje, okulandelayo:

• Ukuxilonga, ukususa, noma ukwelapha izimila ebuchosheni
• Ukunqunywa noma ukulungiswa kwe-aneurysm
• Ukukhipha igazi noma amahlule egazi emithanjeni yegazi evuzayo
• Ukukhipha i-arteriovenous malformation (AVM) noma ukubhekana ne-arteriovenous fistula (AVF)
• Ukukhipha ithumba ebuchosheni, okuyiphakethe eligcwele ubomvu
• Ukulungisa ukuphuka kogebhezi
• Ukulungisa ukudabuka kulwelwesi oluhlanganisa ubuchopho (dura mater)
• Ukunciphisa ingcindezi ebuchosheni (ingcindezi ye-intracranial) ngokususa izindawo zobuchopho ezilimele noma ezivuvukele ezingase zidalwe ukulimala okubuhlungu noma unhlangothi.
• Ukwelapha isifo sokuwa
• Ukutshala amadivaysi e-stimulator ukwelapha ukuphazamiseka kokunyakaza okufana nesifo sika-Parkinson noma i-dystonia (uhlobo lokuphazamiseka kokunyakaza)

Kungase kube nezinye izizathu zokuthi udokotela wakho atuse i-craniotomy.

Izingozi zenqubo

Izinkinga zingenzeka, njengakunoma iyiphi inqubo yokuhlinzwa. Ingozi yokuhlinzwa kobuchopho ihlobene nendawo ethile ebuchosheni ezothintwa inqubo. Ngokwesibonelo, uma kukhona ukuhlinzwa engxenyeni yobuchopho elawula inkulumo, khona-ke inkulumo izophazamiseka. Okulandelayo kufaka phakathi kodwa akukhawulelwe kwezinye izinkinga ezijwayelekile:

• Ukutheleleka
• ukopha
• Ama-clots egazi
• Inyumoniya (ukutheleleka emaphashini)
• Umfutho wegazi ongazinzile
• ukuquleka
• Ubuthakathaka bemisipha
• Ukuvuvukala kobuchopho
• Ukuvuza kwe-cerebrospinal fluid (uketshezi oluzungeza futhi lubambe ubuchopho)
• Izingozi ezihlobene nokusetshenziswa kwezinzwa ezivamile

Lezi zinkinga ezilandelayo azivamile futhi ngokuvamile zibhekisela ezindaweni ezithile ngaphakathi kwengqondo, ngakho-ke kulabo bantu bangase babe yingozi noma bangabi yingozi:

• Izinkinga zememori
• Ubunzima bokukhuluma
• ukukhubazeka
• Ibhalansi engavamile noma ukuxhumanisa
• Coma

Kuye ngesimo sakho sezempilo esiyingqayizivele, kungase kube nezinye izingozi. Ngaphambi kokuhlinzwa, qiniseka ukuthi uphendula noma yimiphi imibuzo nodokotela wakho.

Ngaphambi kwenqubo

• Udokotela wakho uzokuchazela ngenqubo futhi ungabuza imibuzo.
• Uzocelwa ukuthi usayine ifomu lemvume elinikeza imvume yokwenza ukuhlinzwa. Funda leli fomu ngokucophelela bese ubuza imibuzo uma kukhona okungacacile.
• Ngaphezu komlando ophelele wezokwelapha, udokotela wakho uzohlola umzimba ukuze aqinisekise ukuthi unempilo enhle ngaphambi kokuba uhlinzwe. Ungase futhi udinge ukuhlolwa kwegazi nokunye ukuhlolwa kokuxilonga.
• Uzothola ukuhlolwa kwezinzwa ngaphambi kokuhlinzwa okuzosetshenziswa ukuqhathanisa nezivivinyo zangemva kokuhlinzwa.
• Uzocelwa ukuthi uzile ukudla ngaphambi kwenqubo, ngokuvamile ngemva kwamabili.
• Uma ukhulelwe noma ucabanga ukuthi ukhulelwe, tshela umhlinzeki wakho wezempilo.
• Tshela udokotela wakho uma uzwela noma uguliswa yimiphi imithi, i-latex, i-tape kanye nama-anesthetic agents (asendaweni noma jikelele).
• Tshela udokotela wakho ngayo yonke imithi (enqunyiwe kanye ne-counter-the-counter) kanye nezithako zemithi ozithathayo.
• Tshela udokotela wakho uma unomlando wezinkinga zokopha noma uma uthatha noma yimiphi imithi ye-anticoagulant (enciphisa igazi), i-aspirin, noma eminye imithi ethinta ukujiya kwegazi. Kungase kudingeke ukuthi uyeke le mithi ngaphambi kwenqubo.
• Uma ubhema, kufanele uyeke ukubhema ngokushesha ngangokunokwenzeka ngaphambi kwenqubo ukuze uthuthukise amathuba akho okululama ngempumelelo ngemva kokuhlinzwa futhi uthuthukise isimo sakho sezempilo sisonke.
• Ungase ucelwe ukuthi ugeze izinwele zakho nge-shampoo ekhethekile ye-antiseptic ngobusuku bangaphambi kokuhlinzwa.
• Ungase uthole i-sedative ngaphambi kwenqubo ukuze ukhululeke.
• Izindawo ezizungeze indawo yokuhlinzwa zizoshefa.
• Ngokusekelwe esimweni sakho sezokwelapha, udokotela wakho angase acele okunye ukulungiswa okuqondile.

Ngesikhathi senqubo

I-craniotomy ngokuvamile idinga ukuhlala esibhedlela izinsuku ezi-3 kuya kweziyi-7. Ungase futhi uye endaweni yokuvuselela izinsuku ezimbalwa ngemva kokuhlala esibhedlela. Izinqubo zingahluka kuye ngesimo sakho kanye nezinqubo zikadokotela wakho.

Ngokuvamile, i-craniotomy ilandela le nqubo:

1. Uzocelwa ukuthi ukhiphe noma yiziphi izingubo, ubucwebe, noma ezinye izinto ezingase ziphazamise inqubo.
2. Uzonikezwa ingubo yokugqoka.
3. Ulayini we-intravenous (IV) uzofakwa engalweni noma esandleni sakho.
4. I-catheter yomchamo izofakwa ukukhipha umchamo wakho.
5. Uzobekwa etafuleni lokusebenza ngendlela enikeza ukufinyelela okungcono kakhulu ohlangothini lobuchopho okufanele uhlinzwe.
6. Udokotela obulala izinzwa uzohlale eqapha izinga lokushaya kwenhliziyo yakho, umfutho wegazi, ukuphefumula, kanye nezinga le-oxygen egazini phakathi nokuhlinzwa.
7. Ikhanda lakho lizogundwa futhi isikhumba esiphezu kwendawo yokuhlinza sizohlanzwa ngesisombululo se-antiseptic.
8. Kunezinhlobo ezahlukene zokusika ezingasetshenziswa, kuye ngendawo ethintekile yobuchopho. Ukusika kungenziwa ngemuva komugqa wezinwele phambi kwendlebe yakho kanye nentamo yentamo yakho, noma kwenye indawo kuye ngendawo yenkinga. Uma kusetshenziswa i-endoscope, ukusikeka kungase kube kuncane.
9. Ikhanda lakho lizobanjwa umshini ozokhishwa ekupheleni kokuhlinzwa.
10. Ikhanda lekhanda lizodonswa phezulu futhi lisikwe ukuze kunqandwe ukopha ngenkathi kunikeza ukufinyelela ebuchosheni.
11. I-drill yezokwelapha ingase isetshenziselwe ukwenza izimbobo ze-burr ogebhezini. Isaha elikhethekile lingase lisetshenziswe ukusika ngokucophelela ithambo.
12. I-bone flap izokhishwa futhi ilondolozwe.
13. I-dura mater (ingxenye yangaphandle ewugqinsi yobuchopho ngokuqondile ngaphansi kwethambo) izohlukaniswa nethambo futhi isikwe ivuleke ngokucophelela ukuze iveze ubuchopho obala.
14. Uketshezi oluningi luzovunyelwa ukuthi luphume ebuchosheni, uma ludingeka. Amathuluzi okuhlinzwa amancane, njengesibonakhulu sokuhlinzwa ukuze kukhululwe indawo elashelwayo, angasetshenziswa. Lokhu kungenza udokotela ohlinzayo akwazi ukubona kangcono izakhiwo zobuchopho futhi ahlukanise phakathi kwezicubu ezingavamile nezicubu ezinempilo. Amasampula ezicubu angase athunyelwe elebhu ukuze ahlolwe.
15. Idivaysi, efana nedrayini noma uhlobo olukhethekile lwemonitha, ingase ibekwe esicutshini sobuchopho ukukala ingcindezi ngaphakathi kogebhezi, noma i-intracranial pressure (ICP). I-ICP ingcindezi edalwe izicubu zobuchopho, uketshezi lwe-cerebral spinal (CSF), kanye nokutholakala kwegazi ngaphakathi kogebhezi lwekhanda oluvaliwe.
16. Uma ukuhlinzwa sekuqediwe, udokotela ohlinzayo uzothunga (athunge) izingqimba zezicubu ndawonye.
17. I-flap yethambo izoxhunywa kabusha kusetshenziswa amapuleti, ama-sutures, noma izintambo.
18. Uma isimila noma ukutheleleka kutholakala ethanjeni, i-flap ingase ingashintshwa. Futhi, uma i-decompression (ukunciphisa ingcindezi ebuchosheni) iyadingeka, i-bone flap ingase ingashintshwa.
19. Isikhumba esisikiwe (i-scalp) sizovalwa nge-sutures noma izinto eziyisisekelo zokuhlinzwa.
20. Ibhandeshi eliyinyumba noma okokugqoka kuzofakwa phezu kokusikwa.

Ngemuva kwenqubo

Esibhedlela

Uzoyiswa egunjini lokululama ukuze ubhekwe ngqo ngemva kokuhlinzwa, ngaphambi kokuba uyiswe egunjini labagula kakhulu (ICU) ukuze uqashwe ngeso lokhozi. Noma ungase ulethwe usuka egunjini lokuhlinza uyiswe e-ICU.

Ungase unikezwe imithi yokunciphisa ukuvuvukala kobuchopho ku-ICU.

Ngokuya ngohlobo lomsebenzi owenziwe kanye nohlobo lwe-anesthesia enikeziwe, inqubo yokuphulukisa ingahluka. Ungalethwa e-ICU noma ekamelweni lakho lasesibhedlela kuze kube yilapho umfutho wakho wegazi, ishayela, nokuphefumula kuzinzile futhi uqaphile.

Ungathuthela ekamelweni egunjini labahlengikazi be-neurosurgical esibhedlela ngemva kokuhlala e-ICU. Uzohlala ezinye izinsuku esibhedlela.

Ngemva kokuhlinzwa, ungadinga umoya-mpilo isikhathi esithile. Umoya-mpilo ngokuvamile uyayekwa ngaphambi kokuba uye ekhaya.

Ukuze usize ukunweba kabusha amaphaphu futhi ugweme inyumoniya, uzofundiswa ukuvivinya umzimba kokuphefumula okujulile.

Abahlengikazi kanye nabasebenzi bezokwelapha bazokwenza ukuhlolwa kwezinzwa njalo ukuze bahlole ukusebenza kobuchopho bakho kanye nokuqinisekisa ukuthi izinhlelo zakho zomzimba zisebenza kahle ngemva kokuhlinzwa kwakho. Ukuze uhlole umthamo wobuchopho bakho, uzocelwa ukuthi ulalele uchungechunge lwemiyalelo elula, njengokushintsha izingalo nemilenze yakho. Abafundi bakho bazohlolwa ngesibani esikhanyayo, futhi imibuzo izobuzwa ukuze kutholakale ukuthi umi kuphi (njengegama lakho, idethi, nokuthi ukuphi). Kuzophinde kuhlolwe amandla ezingalo nemilenze.

Ukuze ugweme ukuvuvukala kobuso nezindlebe, ikhanda lombhede wakho lingase liphakanyiswe. Kuvamile ukuba nokuvuvukala okuthile.

Lapho amandla akho ekhula, uzokwazi ukuhambahamba ngendlela ubekezelelwa ngayo lapho ulele futhi uvuke embhedeni uhambehamba ngokusizwa ekuqaleni.

Uzocelwa ukuthi uhlole amandla akho, ibhalansi, nokuhamba ngomelaphi womzimba (PT) futhi akunikeze izincomo zokuzivocavoca ongakwenza kokubili esibhedlela nasekhaya.

Ukuze ugweme ukwakheka kwehlule legazi, ungase ube nemishini yokucindezela elandelanayo (ama-SCD) ebekwe emilenzeni yakho lapho ulele. Ama-SCD ane-compressor yomoya empompa umoya kancane ungene futhi uphume emikhonweni eklanyelwe etholakala emathangeni. Ngokucindezela kancane imithambo yomlenze ukuze igazi ligeleze, isiza ekuvimbeleni amahlule egazi ukuthi athuthuke.

Emahoreni ambalwa ngemva kokuhlinzwa, ungase unikezwe iziphuzo ozoziphuza, kuye ngesimo sakho. Uma ukwazi ukubekezelela, ukudla kwakho kungalungiswa kancane kancane ukuze kufake ukudla okuqinile okwengeziwe.

Usuku noma ezimbili, noma ngaphambi kokuthi uvuke embhedeni uhambe, ungaba ne-catheter esinyeni sakho ukuze ukhiphe umchamo wakho. Njengoba lezi kungase kube izimpawu zokutheleleka okungelapheka, qiniseka ukuthi ubika noma yikuphi ukuchama okubuhlungu noma ezinye izimpawu zomchamo ezenzeka ngemva kokukhishwa kwe-catheter.

Ungayiswa esikhungweni sokuhlunyeleliswa kwezimilo isikhathi esithile ukuze uthole amandla akho, kuye ngesimo sakho.

Ngaphambi kokuba ukhululwe esibhedlela, kwenziwa izinhlelo nodokotela wakho ukuze uthole isikhathi sokulandelela. Uzonikezwa neziqondiso ezivela kudokotela wakho zokwelashwa ekhaya.

Ekhaya

Kubalulekile ukugcina i-incision ihlanzekile futhi yomile uze ufike ekhaya. Iziyalezo zokugeza ezifanele unikezwa udokotela wakho. Ekuvakasheleni ihhovisi lokulandelela, uma kusetshenziswa izithungo noma izisekelo zokuhlinzwa, zizosuswa. Zigcine zomile uma kusetshenziswa imichilo yokunamathela, futhi zingawa phakathi nezinsuku ezimbalwa.

Kungase kugqokwe isigqoko esixegayo noma isigqoko esisikiwe. Akufanele ugqoke iwigi kuze kube yilapho ukusika sekuphuluke ngokuphelele (cishe amaviki amathathu kuya kwangu-3 ngemva kokuhlinzwa).

Kungase kube nobuhlungu ekusikeni nasekhanda, ikakhulukazi ngokuphefumula okujulile, ukukhwehlela, nokuzikhandla. Njengokwelulekwa udokotela wakho, thatha isidambisi sobuhlungu ukuze uthole ubuhlungu. Ingozi yokopha ingandiswa nge-aspirin noma eminye imithi yokunciphisa igazi. Qiniseka ukuthi imithi enconyiwe kuphela ephuzwayo futhi ubuze ukuthi awuqinisekile yini.

Ukumisa ukutheleleka kwamaphaphu, qhubeka nezivivinyo zokuphefumula ezisetshenziswa esibhedlela. Ukuvimbela ukuchayeka ezifweni eziphezulu zokuphefumula (amakhaza nomkhuhlane) kanye nezinto ezicasulayo njengentuthu kagwayi, intuthu, nezinto ezingcolisa umoya, uzotshelwa.

Uma ukwazi ukuwalawula, ungakwazi kancane kancane ukwandisa umsebenzi wakho womzimba. Ukubuyela ezingeni lakho langaphambilini lamandla namandla kungathatha amaviki ambalwa.

Ukuze uvimbele ukucindezelwa ekusikeni kwakho ngokuhlinzwa, ungase welulekwe ukuba ugweme ukuphakamisa izinto ezisindayo amasonto ambalwa.

Ungashayeli uze unikezwe imvume udokotela wakho.

Shayela udokotela wakho ukuze ubike noma yikuphi kokulandelayo:

• Umkhuhlane noma ukubanda
• Ububomvu, ukuvuvukala, ukugeleza kwamanzi, noma ukopha noma okunye ukugeleza okuvela endaweni yokusika noma ubuso
• Ukwanda kobuhlungu eduze kwendawo yokusikeka
• Umbono uyashintsha
• Ukudideka noma ukulala ngokweqile
• Ubuthakathaka bezingalo noma imilenze yakho
• Inkinga ngenkulumo
• Ukuphefumula kanzima, ubuhlungu besifuba, ukukhathazeka, noma ukushintsha kwesimo sengqondo
• Isikhwehlela esiluhlaza, esiphuzi, noma esiphuma igazi (phlegm)
• Umsebenzi wokubamba

Ukulandela i-craniotomy, udokotela wakho angakunikeza ezinye izikhombisi-ndlela, kuye ngesimo sakho esithile.

• Amazwana Avaliwe
• Septhemba 2nd, 2020