Tani ma tahay daaweyn qiimo leh oo loogu talagalay restenosis?
Angioplasty iyo stenting waxay is-beddeleen sida loo daweeyo cudurka loo yaqaan 'coronary artery disease' , laakiin daawooyinkan ayaa soo bandhigay dhibaatooyin cusub oo cusub. Tani waa dhibaatada hurdada - dib u soo noqoshada goobta daaweynta. Horraantii sannadkii 2000s, daawada brachytherapy, ama daaweynta shucaaca raadiyaha wadnaha, waxay noqotay daweyn cusub oo loogu talagalay restenosis.
Laakiin iyada oo brachytherapy uu ahaa (oo wali) waa mid waxtar u leh hudheelka nasashada, waxaa hadda lagu soo rogay isticmaalka stent-dhibcaha daroogada .
Dib-u-bogsashada ka dib marka cudurka angioplasty ama stenting uu keeno koritaanka xad-dhaafka ah ee unugyada goobta daaweynta. Waxaa keena fal-celin-bogsiin xad-dhaaf ah, oo soo saara unugyada "endothelial" kaas oo sida caadiga ah xira xididdada dhiigga. Koritaanka unugyada ayaa si tartiib tartiib ah dib ugu celin kara halbowlaha.
Brachytherapy waxay daaweyn kartaa restenosis by dilida unugyada xad-dhaaf ah iyo ka hortagga koritaanka unugyada.
Sidee loo adeegsadaa Brachytherapy?
Brachytherapy waxaa la qaadaa inta lagu jiro habka kateetarka wadnaha oo gaar ah. Shucaaca laftiisa ayaa waxaa keena nooc gaar ah ee kateetarka loogu talagalay in lagu isticmaalo shucaaca ka soo baxa halbowlaha wadnaha. Kateetarka waxaa loo gudbiyaa halbowlayaasha wadnaha iyo dhammaan xannibaadyada ay sababaan restenosis. Marka meelaha bartilmaameedka ee "kareemo" ay ka soo baxaan kateetarka, shucaaca ayaa la adeegsadaa.
Laba nooc oo shucaac ah ayaa loo isticmaali karaa: shucaaca gaaska iyo shucaaca beta. Labada nooc ee shucaaca ayaa ah mid aad u adag in la isticmaalo, waxayna ubaahan tahay joogitaanka qalabka gaarka ah ee shaybaarka, oo qaata habraacyo taxadar gaar ah, iyo shakhsiyaad si gaar ah loo tababaray, badanaa oo ay ku jiraan sheybaarka shucaaca.
Dhakhtarka wadnaha ee isticmaala "brachytherapy" ayaa isku raacay in furaha guusha ay tahay waayo-aragnimada shaqaaleysiinta. Kuwani waa nidaamyo adag oo u baahan in ka badan khibradda caadiga ah ee ka-hortagga dhexdhexaadiyaha caadiga ah.
Waxtarka
Daraasad cilmiyadeed ayaa muujisay in brachytherapy ay si fiican u shaqeyso marka la nadiifiyo restenosis ee halbowlayaasha wadnaha, iyo in la yareeyo khatarta hudheelka dheeraadka ah. Intaa waxa dheer, daraasado ayaa u muuqda inay muujinayaan in bukaanka qaba khatarta sare ee restenosis - (sida dadka qaba sonkorowga ) -se si ay u helaan faa'iidada ugu badan ee daaweynta shucaaca.
Dhibaatooyinka
Brachytherapy ma aha dhibaato la'aan. Mid ka mid ah dhibaatada gaarka ah ee lagu arkay brachytherapy ayaa ah "saameynta cirridka" - muuqaalka kore ee xirmooyinka cusub ee dhinacyada labada dhinac ee shucaaca (aagga lagu daaweeyo shucaaca). Saameyntan saameynta cirridka, taas oo qaadata muuqaalka muraayadda ama "nacnac" -ka marka la arko angiogram, waa natiijo xun oo dhib badan in lagu daaweeyo. Dhibaatooyinkaan saameynta leh ee caatada ah waxay u badan tahay inay sababaan meeleyn hoose ee kateetarka marka la maamulo brachytherapy.
Sidoo kale, bukaanjiifka lagu daaweeyo brachytherapy waxay u muuqdaan inay halis dheeraad ah ugu jiraan inay ku dhacaan dhiig-xinjirowga xididada (xinjir dhiig).
Caadi ahaan, haddii thrombosis uu dhaco ka dib marka cudurka angioplasty ama stenting, badanaa waxay ku dhacdaa 30 maalmood gudahood ee qalliinka. Laakiin goor dambe ee dhiigxinjirowga (oo dhacaya 30-kii maalmood ee ugu horreeya) ayaa ku dhowaad 10% bukaannada qaata brachytherapy. Xinjirta goor dambe waxay caadi ahaan la xiriirtaa xanuunka miyoogada (wadno-qabad ) ama angina aan xasilloonayn . Si loo yareeyo khatartan, dhiig-yare yaryar ayaa lagula talinayaa ugu yaraan hal sano ka dib markaad isticmaasho brachytherapy.
Sababta Sababta loo Leeyahay Brachytherapy?
Restenosis waxay ahayd dhibaatadii ugu weynayd ee la xallilay ee maalmaha hore ee angioplasty iyo stenting, iyo dhowr sano brachytherapy waxay u egtahay hab rajo leh oo wax looga qaban karo restenosis.
Si kastaba ha ahaatee, waxaa hadda loo isticmaalaa oo keliya marar dhif ah.
Muuqashada daawooyinka daroogadu u dhaqsaha badan ayaa si dhaqso ah u sameeyaan brachytherapy oo ku dhowaad ka baxday. Daraasadaha si toos ah u barbardhigaya nabadgelyada iyo waxtarka taranka ee brachytherapy ee daawooyinka daroogada loo isticmaalo ee lagu daaweynayo restenosis ayaa si cad u qeexay in stent ay siiyaan natiijooyin wanaagsan. Waxaa intaa dheer, kalkaaliyeyaasha wadnaha waxay ku raaxaystaan meelo raaxo leh, stent uma baahna dhibaatada, kharashka, iyo qibrada khaaska ah ee looga baahan yahay brachytherapy. Looma qaadin mudo dheer oo loogu talagalay brachytherapy si aad ugu faraartid khariidada.
Weli, brachytherapy waxtar leh oo macquul ah oo ammaan ah waxaana loo oggolaaday isticmaalka Maamulka Cuntada iyo Maandooriyaha. Qaar ka mid ah xarumaha takhasuska ah ayaa weli u soo bandhigaya sidii doorasho loogu daaweyn lahaa restenosis.
Maanta, brachytherapy ayaa guud ahaan loo tixgelinayaa ikhtiyaarka kaliya ee loogu talagalay dadka bukaanka ah ee dib-u-soo-ceshadaynta dib-u-soo-kabashada ka dib, iyo mashiinka daroogada daroogada ah ee ay ku fashilmeen inay ku dhameeyaan dhibaatada. Si loo helo bukaanka bukaanka bukaankan waxaa loo baahan yahay in loo gudbiyo mid ka mid ah xarumaha yar yar ee bixiya daaweynta noocan ah.
Ilaha:
Teirstein PS, Massullo V, Jani S, iyo al. Saddex sano oo daaweyn ah iyo daaweyn angiografi ah ka dib shucaac ka baxsan: natiijooyinka tijaabada daaweynta ee la kala doortay. Wareegga 2000; 101: 360.
Sapirstein W, Zuckerman B, Dillard J. FDA ogolaansho ah oo lagu magacaabo 'brachytherapy' oo loo yaqaan 'coronary-artery brachytherapy'. N Engl J Med 2001; 344: 297.
Holmes DR Jr, Teirstein PS, Satler L, et al. Seddex sano oo la socoshada SISR (Sirolimus-Eluting Stents Versus Vascular Brachytherapy for In-Stent Restenosis). JACC Cardiovasc Interv 2008; 1: 439.