I-transjugular intrahepatic portosystemic shunt (iingcebiso)

I-transjugular intrahepatic portosystemic shunt (TIPS) yinkqubo yokwenza unxibelelwano olutsha phakathi kwemithambo yegazi emibini kwisibindi sakho. Ungayidinga le nkqubo ukuba uneengxaki zesibindi.

Le ayisiyinkqubo yotyando. Yenziwa ngugqirha wonyango osebenzisa isikhokelo se-x-ray. I-radiologist ngugqirha osebenzisa iindlela zokucinga ukufumanisa nokunyanga izifo.

Uya kucelwa ukuba ulale ngomqolo. Uya kudityaniswa kunye nabagadi abajongayo abaza kujonga ukubetha kwentliziyo yakho kunye noxinzelelo lwegazi.

Uya kufumana i-anesthesia yendawo kunye namayeza okuphumla. Oku kuyakwenza ungabi nazintlungu kwaye ulale. Okanye, unokuba ne-anesthesia ngokubanzi (ilele kwaye ayinazintlungu).

Ngexesha lenkqubo:

• Ugqirha ufaka i-catheter (ityhubhu eguqukayo) ngesikhumba sakho emthanjeni entanyeni yakho. Lo mthambo ubizwa ngokuba ngumgudu wejugular. Ekupheleni kwecatheter yibhaluni encinci kunye nesinyithi sentsimbi (ityhubhu).
• Usebenzisa umatshini we-x-ray, ugqirha ukhokela i-catheter kumthambo wesibindi sakho.
• Idayi (umahluko okhoyo) emva koko itofelwe emthanjeni ukuze ibonakale ngokucacileyo.
• Ibhaluni inyuselwe ukubeka i-stent. Unokuziva uqaqanjelwa xa oku kusenzeka.
• Ugqirha usebenzisa i-stent ukudibanisa i-portal vein yakho kwenye yeemvini zakho ze-hepatic.
• Ekupheleni kwenkqubo, uxinzelelo lwakho lwe-vein portal lulinganiswa ukuqinisekisa ukuba lwehlile.
• I-catheter kunye nebhaluni iyasuswa.
• Emva kwenkqubo, ibhandeji encinci ibekwe entanyeni. Ngokuqhelekileyo akukho ziqu.
• Inkqubo ithatha malunga nemizuzu engama-60 ukuya kuma-90 ukuyigqiba.

Le ndlela intsha izakuvumela igazi ukuba liphume ngcono. Iya kunciphisa uxinzelelo kwimithambo yesisu sakho, umqala, amathumbu kunye nesibindi.

Ngokwesiqhelo, igazi eliphuma kwisisu sakho, isisu, kunye namathumbu kuqala lihamba phakathi kwesibindi. Xa isibindi sakho sinomonakalo omkhulu kwaye kukho izithintelo, igazi alinakuhamba ngokulula. Oku kubizwa ngokuba yi-portal hypertension (ukunyuka koxinzelelo kunye nokugcinwa kwe-vein portal vein). Imithambo ke ingavuleka (iqhekeke), ibangele ukopha kakhulu.

Izizathu eziqhelekileyo zoxinzelelo lwe-portal zezi:

• Ukusetyenziswa kotywala kubangela ukonakala kwesibindi (i-cirrhosis)
• Igazi liyagungqa emthanjeni ophuma kwisibindi uye entliziyweni
• Intsimbi eninzi esibindi (hemochromatosis)
• IHepatitis B okanye hepatitis C

Xa uxinzelelo lwexinzelelo lwe-portal lwenzeka, unokuba:

• Ukopha kwimithambo yesisu, isisu, okanye amathumbu (ukuphuma kwegazi)
• Ukwakhiwa kolwelo esiswini (ascites)
• Ukwakhiwa kolwelo esifubeni (hydrothorax)

Le nkqubo ivumela igazi ukuba liphume ngcono kwisibindi sakho, isisu, umqala kunye namathumbu, emva koko ubuyele entliziyweni yakho.

Imingcipheko enokubakho ngale nkqubo yile:

• Ukonakala kwimithambo yegazi
• Ifiva
• I-hepatic encephalopathy (isifo esichaphazela uxinzelelo, ukusebenza kwengqondo, kunye nenkumbulo, kwaye kunokukhokelela kwi-coma)
• Usulelo, ukutyumka, okanye ukopha
• Impendulo kumayeza okanye kwidayi
• Ukuqina, ukutyumka, okanye ukukhathaza entanyeni

Iingozi ezinqabileyo zezi:

• Ukopha esiswini
• Ukuvaleka kwestent
• Ukusika kwemithambo yegazi esibindini
• Iingxaki zentliziyo okanye izingqisho zentliziyo engaqhelekanga
• Usulelo lwe-stent

Ugqirha wakho unokukucela ukuba ube nale mvavanyo:

• Uvavanyo lwegazi (ukubala okupheleleyo kwegazi, ii-electrolyte, kunye novavanyo lwezintso)
• I-x-ray yesifuba okanye i-ECG

Xelela umboneleli wakho wezempilo:

• Ukuba ukhulelwe okanye unokukhulelwa
• Nawaphi na amayeza owathathayo, kwanamachiza, amayeza ongezelelweyo, okanye amayeza owathengileyo ngaphandle kommiselo (ugqirha wakho angakucela ukuba uyeke ukuthatha abacoci gazi abanjenge-aspirin, i-heparin, i-warfarin, okanye amanye amacoci egazi kwiintsuku ezimbalwa phambi kwenkqubo)

Ngomhla wenkqubo yakho:

• Landela imiyalelo yokuba uyeke nini ukutya nokusela ngaphambi kwenkqubo.
• Buza ugqirha wakho ukuba ngawaphi amayeza ekufuneka uwathathe kumhla wenkqubo. Thatha la machiza ngesiphunga esincinci samanzi.
• Landela imiyalelo xa uhlamba ngaphambi kwenkqubo.
• Fika ngexesha esibhedlele.
• Kuya kufuneka ucwangcise ukulala esibhedlele.

Emva kwenkqubo, uya kuphila kwigumbi lakho lasesibhedlele. Uya kujongwa ukopha. Kuya kufuneka ugcine intloko yakho iphakanyisiwe.

Ngokuqhelekileyo akukho ntlungu emva kwenkqubo.

Uyakukwazi ukugoduka xa uzive ubhetele. Oku kunokuba lusuku emva kwenkqubo.

Abantu abaninzi babuyela kwimisebenzi yabo yemihla ngemihla kwiintsuku ezisi-7 ukuya kwezi-10.

Ugqirha wakho uya kwenza i-ultrasound emva kwenkqubo ukuqinisekisa ukuba i-stent isebenza ngokuchanekileyo.

Uya kucelwa ukuba uphindaphinde i-ultrasound kwiiveki ezimbalwa ukuze uqiniseke ukuba inkqubo ye-TIPS iyasebenza.

I-radiologist yakho inokukuxelela kwangoko ukuba inkqubo isebenza njani. Uninzi lwabantu luphilile.

IINKCUKACHA zisebenza malunga neepesenti ezingama-80 ukuya kuma-90% zamatyala oxinzelelo lwegazi.

Inkqubo ikhuseleke ngakumbi kunokuhlinzwa kwaye ayibandakanyi ukusika okanye imithungo.

IINKCUKACHA; Ukuqina - IINGCEBISO; Ukungaphumeleli kwesibindi-IINGCEBISO

• Isibindi - ukubhobhoza

• I-transjugular intrahepatic portosystemic shunt

UDarcy MD. I-transjugular intrahepatic portosystemic shunting: izikhombisi kunye nobuchule. Ku: Jarnagin WR, ed. Utyando lukaBlumgart lweSibindi, iTeknoloji yeBiliary, kunye neePancreas. Umhla wesi-6. IPhiladelphia, PA: Elsevier; Ngo-2017: isahluko 87.

UDariushnia SR, uHaskal ZJ, uMidia M, et al. Isikhokelo sokuphuculwa komgangatho we-transjugular intrahepatic portosystemic shunts. J iVasc yokuNgena kwiRadiol. Ngo-2016; 27 (1): 1-7. IINKCUKACHA: 26614596 www.ncbi.nlm.nih.gov/pubmed/26614596.