I-Transjugular intrahepatic portosystemic shunt (AMACEBISO)

I-Transjugular intrahepatic portosystemic shunt (AMACEBISO) inqubo yokwakha ukuxhumana okusha phakathi kwemithambo yegazi emibili esibindi sakho. Ungadinga le nqubo uma unezinkinga ezinzima zesibindi.

Lokhu akuyona inqubo yokuhlinzwa. Kwenziwa yi-radiologist engenelayo esebenzisa ukuqondiswa kwe-x-ray. I-radiologist ngudokotela osebenzisa izindlela zokucabanga ukuxilonga nokwelapha izifo.

Uzocelwa ukuthi ulale ngomhlane. Uzoxhumeka kubaqaphi okuzohlola izinga lokushaya kwenhliziyo yakho nomfutho wegazi.

Cishe uzothola i-anesthesia yendawo nemithi yokuphumula. Lokhu kuzokwenza ungabi nezinhlungu futhi uzele. Noma, ungaba ne-anesthesia ejwayelekile (ilele futhi ayinazinhlungu).

Ngesikhathi senqubo:

• Udokotela ufaka ipayipi (ishubhu eliguquguqukayo) esikhunjeni sakho emthanjeni entanyeni yakho. Lo mthambo ubizwa ngokuthi i-jugular vein. Ekupheleni kwe-catheter kunebhaluni elincane kanye nensimbi (meshubhu) yensimbi.
• Usebenzisa umshini we-x-ray, udokotela uqondisa i-catheter emthanjeni wesibindi sakho.
• Udayi (okokuqhathanisa nezinto) bese ufakwa emthanjeni ukuze ubonakale kahle.
• Ibhaluni ligcwele ukubeka i-stent. Ungase uzwe ubuhlungu obuncane uma lokhu kwenzeka.
• Udokotela usebenzisa i-stent ukuxhuma umthambo wakho we-portal kwenye yemithambo yakho ye-hepatic.
• Ekupheleni kwenqubo, ingcindezi yakho ye-portal vein ilinganiswa ukuqinisekisa ukuthi yehlile.
• I-catheter enebhaluni iyasuswa.
• Ngemuva kwenqubo, ibhandishi elincane libekwa ngaphezu kwendawo yentamo. Ngokuvamile azikho iziqu.
• Inqubo ithatha cishe imizuzu engama-60 kuya kwengu-90 ukuphothulwa.

Le ndlela entsha izovumela igazi ukuba ligeleze kangcono. Izokwehlisa ingcindezi emithanjeni yesisu sakho, imiphimbo, amathumbu nesibindi.

Imvamisa, igazi elivela emgodleni wakho, esiswini nasemathunjini aqala ukugeleza phakathi kwesibindi. Lapho isibindi sakho sinomonakalo omkhulu futhi kunama-blockages, igazi alikwazi ukugeleza kalula kulo. Lokhu kubizwa ngokuthi yi-portal hypertension (ingcindezi eyandisiwe kanye nokwenza isipele kwe-portal vein). Imithambo ingahle ivuleke (idabuke), ibangele ukopha kakhulu.

Izimbangela ezivamile ze-portal hypertension yilezi:

• Ukusetshenziswa kotshwala kubanga ukusha kwesibindi (i-cirrhosis)
• Ukuqina kwegazi emthanjeni ogeleza usuke esibindi uye enhliziyweni
• Insimbi eningi kakhulu esibindi (hemochromatosis)
• I-Hepatitis B noma i-hepatitis C

Lapho i-portal hypertension ivela, ungahle ube:

• Ukopha okuvela emithanjeni yesisu, imiphetho, noma amathumbu (ukuphuma kwegazi)
• Ukwakhiwa koketshezi esiswini (ascites)
• Ukwakhiwa koketshezi esifubeni (i-hydrothorax)

Le nqubo ivumela igazi ukuba ligeleze kangcono esibindini sakho, esiswini, emqaleni nasemathunjini, bese libuyele enhliziyweni yakho.

Izingozi ezingaba khona ngale nqubo yilezi:

• Ukulimala emithanjeni yegazi
• Imfiva
• I-hepatic encephalopathy (ukuphazamiseka okuthinta ukugxila, ukusebenza kwengqondo, nenkumbulo, futhi kungaholela ku-coma)
• Ukutheleleka, ukulinyazwa, noma ukopha
• Ukusabela emithini noma kudayi
• Ukuqina, ukulimaza, noma ubuhlungu entanyeni

Izingozi ezijwayelekile yilezi:

• Ukopha esiswini
• Ukuvinjelwa ku-stent
• Ukusika imithambo yegazi esibindini
• Izinkinga zenhliziyo noma isigqi senhliziyo esingajwayelekile
• Ukutheleleka kwe-stent

Udokotela wakho angakucela ukuthi ube nalezi zivivinyo:

• Ukuhlolwa kwegazi (ukubalwa okuphelele kwegazi, ama-electrolyte, nokuhlolwa kwezinso)
• I-x-ray yesifuba noma i-ECG

Tshela umhlinzeki wakho wezempilo:

• Uma ukhulelwe noma ungakhulelwa
• Noma imiphi imithi oyiphuzayo, ngisho nezidakamizwa, izithasiselo, noma amakhambi owathengile ngaphandle kadokotela (udokotela wakho angakucela ukuthi uyeke ukuthatha izinciphisi zegazi njenge-aspirin, i-heparin, i-warfarin, noma ezinye izinciphisi zegazi ezinsukwini ezimbalwa ngaphambi kwenqubo)

Ngosuku lwenqubo yakho:

• Landela imiyalo yokuthi ungakuyeka nini ukudla nokuphuza ngaphambi kwenqubo.
• Buza udokotela wakho ukuthi imiphi imithi okufanele uyithathe ngosuku lwenqubo. Thatha le mithi ngesiphuzo esincane samanzi.
• Landela imiyalo ngokugeza ngaphambi kwenqubo.
• Fika ngesikhathi esibhedlela.
• Kufanele uhlele ukulala esibhedlela.

Ngemuva kwenqubo, uzolulama egumbini lakho lasesibhedlela. Uzoqashwa ukopha. Kuzofanele ugcine ikhanda lakho liphakeme.

Ngokuvamile abukho ubuhlungu ngemuva kwenqubo.

Uzokwazi ukuya ekhaya lapho uzizwa ungcono. Lokhu kungaba usuku olulandelayo ngemuva kwenqubo.

Abantu abaningi babuyela emisebenzini yabo yansuku zonke ezinsukwini eziyi-7 kuya kwezingu-10.

Udokotela wakho uzokwenza i-ultrasound ngemuva kwenqubo ukuqinisekisa ukuthi i-stent isebenza kahle.

Uzocelwa ukuthi uphinde ube ne-ultrasound emasontweni ambalwa ukuze uqiniseke ukuthi inqubo ye-TIPS iyasebenza.

I-radiologist yakho ingakutshela zisuka nje ukuthi inqubo isebenze kanjani. Iningi labantu lilulama kahle.

AMACEBISO asebenza cishe kuma-80% kuya kuma-90% wamacala we-portal hypertension.

Inqubo iphephe kakhulu kunokuhlinzwa futhi ayibandakanyi ukusika noma imithungo.

AMACEBISO; I-Cirrhosis - AMACEBISO; Ukuhluleka kwesibindi - AMACEBISO

• I-cirrhosis - ukukhipha

• I-transjugular intrahepatic portosystemic shunt

UDarcy MD. I-Transjugular intrahepatic portosystemic shunting: izinkomba nobuchule. Ku: Jarnagin WR, ed. Ukuhlinzwa kukaBlumgart kwesibindi, iBiliary Tract, namaPancreas. Umhlaka 6. IPhiladelphia, PA: Elsevier; 2017: isahluko 87.

UDariushnia SR, uHaskal ZJ, uMidia M, et al. Imihlahlandlela yokwenza ngcono ikhwalithi yokuvinjelwa okungaphakathi kwe-intrahepatic portosystemic shunts. J Vasc Interv Imisebe. 2016; 27 (1): 1-7. I-PMID: 26614596 www.ncbi.nlm.nih.gov/pubmed/26614596.