Ukufakelwa kwezinso ngasikhathi sinye kwe-pancreas

Uma ubheka:

Kuyini ukufakelwa kwe-pancreas nezinso ngasikhathi sinye?

Ukufakelwa kwezinso ngasikhathi sinye kuyindlela engcono kakhulu yokwelapha iziguli ezinesifo sikashukela ezinezinso ezingasebenzi kahle ngenxa yokuqala kwesifo sikashukela noma isifo sezinso esingamahlalakhona. Umgomo oyinhloko ukufaka esikhundleni se-pancreas nokunikeza isiguli inkululeko ephelele ekutholeni i-insulin ejoviwe. I-pancreas efakwe kabusha ayisebenzi ngokugcwele ekukhiqizeni i-insulin ukulawula amazinga kashukela egazini lomuntu oyitholayo, kodwa futhi ikhiqiza nama-enzyme okusekela ukugaya ukudla emathunjini. Ngakho-ke, i-SPK inikeza ikhwalithi yokuphila ethuthukisiwe kakhulu (i-QoL) yesiguli.

Ku-SPK, izinso kanye ne-pancreas kususwa kumuntu oshonile onikelayo bese kunikezwa umuntu ofanele ukuhlinzwa. I-SPK ayilona ikhambi kodwa iwusizo kakhulu hhayi nje ekulawuleni isifo sikashukela kodwa futhi nasekushintsheni izinso ezingasebenzi kahle.

Ukufakelwa kwe-pancreas-kidney (SPK) ngasikhathi sinye kuyindlela evame ukwenziwa kakhulu yokufakelwa kwezitho eziningi. Kuleli sonto, ithimba lodokotela ezibhedlela zaseYashoda liqede ngempumelelo ukufakelwa kwe-pancreas-kidney ngasikhathi sinye kowesilisa oneminyaka engu-32 ubudala onesifo sikashukela sohlobo 1 kanye nokwehluleka kwezinso. I-pancreas kanye nezinso zombili zithathwe kumnikeli oshonile oneminyaka engu-25. Ukuhlinzwa okuvulekile kwenziwa esikhathini esingamahora angu-12.

Ubani ofanelekela ukufakelwa i-pancreas nezinso?

Odokotela bangase batuse ukufakelwa i-pancreas uma: 

• I-insulin-dependent ene-C-peptide engu-2 ng/mL noma ngaphansi (iziguli ezinesifo sikashukela sohlobo 1)
• I-insulin-dependent ene-C-peptide engaphezu kuka-2 ng/mL kanye ne-body mass index 2 (mhlawumbe iziguli ezinesifo sikashukela sohlobo 2)

Kunoma yikuphi, i-pancreas yeziguli ayikhiqizi i-insulin eyanele, i-hormone ebalulekile elawula ushukela egazini emzimbeni. I-pancreas etshaliwe izokwazi ukulungisa isifo sikashukela sohlobo 1 ngokukhiqizwa kwe-insulin.

Odokotela bangancoma ukufakelwa kwe-pancreas nezinso ngasikhathi sinye uma:

• Isiguli sihlushwa ukungasebenzi kahle kwezinso ngenxa yesifo sikashukela sohlobo 1.
• Basola ukuthi ukuqala kokwehluleka kwezinso esigulini esinesifo sikashukela sohlobo 1.

Isinqumo sizothathwa udokotela kanye nodokotela ohlinzayo ofakelwa izitho ngokusekelwe esimweni sempilo yesiguli kanye nempilo yaso. Kuzodingeka nokuhlolwa kwangaphambi kokufakelwa izitho, okuzohlanganisa uchungechunge lwezivivinyo ezifana nokuhlolwa kwesinyi kanye nenhliziyo. 

Yiziphi izinzuzo zokufakelwa i-pancreas nezinso?

Ukufakelwa izinso kanye ne-pancreas ngempumelelo ngesikhathi esisodwa kuthuthukisa ikhwalithi yempilo ukuze umuntu angenza okulandelayo:

• Ukuqina namandla akhuphukile emisebenzini yansuku zonke.
• Ube nokuphila kocansi okuthuthukisiwe kanye nokuzala, ikakhulukazi kwabesifazane abaseminyakeni yokuzala.
• Ukulawulwa okungcono koshukela egazini ngaphandle kwesidingo se-insulin kanye nokuqapha njalo
• Yidla ukudla okunempilo okunezinga elijwayelekile lokuphuza uketshezi.
• Susa isidingo se-dialysis.
• Yiba namazinga kashukela egazini ajwayelekile ngaphambi nangemva kokudla.

Izinzuzo zokufakelwa i-pancreas nezinso ezihlanganisiwe zihlobene nezinkinga zemithambo yegazi ezihlobene nokuhlinzekwa kwegazi, izifo zenhliziyo njll. Iziguli zibhekana nezinkinga ezizinzile noma ezithuthukisiwe:

• I-nephropathy yesifo sikashukela kanye nokwehluleka kwezinso
• I-retinopathy yesifo sikashukela
• Isifo se-artery Coronary
• Stroke 
• I-neuropathy

Yiziphi izingozi zokufakelwa i-pancreas nezinso?

Ngenxa yokufakelwa kwezitho ezimbili emzimbeni, izingozi ezihambisana nale nqubo ziphakeme kunezo ezihambisana nokufakelwa isitho esisodwa. Zingaba:

• Ukwenqatshwa kwezitho zomzimba: Noma yikuphi ukuhlinzwa kokufakelwa kuzohlotshaniswa nengozi yokuthi umzimba wenqabe izitho ezisanda kufakelwa. Isiguli kuzodingeka sithathe imithi yokulwa nokwenqatshwa impilo yaso yonke ukuze sivimbele ukwenqatshwa.
• Ukungasebenzi kahle okuyinhloko kanye nokwehluleka kwe-pancreas: Ezimweni ezingama-5-10%, i-pancreas engasebenzi kahle kungadingeka isuswe phakathi nonyaka wokuqala wokufakelwa.
• Ukusebenza kwezinso okulibazisekile: Lokhu kungadinga i-dialysis kuze kube yilapho izinso ziqala ukusebenza
• Ukuphelelwa amanzi emzimbeni ngemuva kokuhlinzwa
• Ukutheleleka kanye nokulahlekelwa igazi

Ingabe isiguli esinesifo sikashukela sohlobo lwesibili siyakufanelekela ukufakelwa i-pancreas nezinso?

Umuntu onesifo sikashukela sohlobo lwesibili angafaneleka ukufakelwa i-pancreas nezinso ngasikhathi sinye, yize lokhu kwenzeka kaningi. Ngokuvamile, i-pancreas efakwe i-pancreas ayisebenzi kahle ezigulini ezinesifo sikashukela sohlobo lwesibili. Udokotela kanye nodokotela ohlinzayo ofake i-pancreas bangase bakhethe inqubo ngenxa yezimo ezihlukile kanye nezimo zempilo zesiguli. Ngakho-ke, kungcono ukubonisana nochwepheshe wezempilo mayelana nokuhlolwa kokufaneleka.

Ingabe izinso kanye ne-pancreas kungatshalwa ngokwahlukana?

Lokhu kungenzeka. Kwezinye izimo, isiguli esinenkinga yezinso ehlobene nesifo sikashukela sohlobo 1 singase siqale sithole ukufakelwa izinso ngenxa yezici ezahlukene. Lokhu kamuva kulandelwa ukufakelwa i-pancreas.

Ingabe isiguli singafakelwa i-pancreas ngaphandle kokufakelwa izinso?

Ngokusekelwe esimweni sesiguli, udokotela angase akhethe ukufakelwa i-pancreas kuphela, angafaki ukufakelwa kwezinso. Lokhu kungenzeka uma isiguli:

• Usuvele ufakwe izinso
• Ibonisa izinkinga ezihlobene nesifo sikashukela sohlobo 1 kodwa ayinaso isifo sezinso.

Lingakanani izinga lokusinda kokufakelwa kwe-pancreas nezinso?

Ngemva kokufakelwa, izinga lokusinda kwabantu abadala lingu-92.5% eminyakeni emithathu kamuva. Imiphumela emihle kakhulu ibonakala lapho i-pancreas kanye nezinso kuvela kumnikeli ofanayo okungukuthi umnikeli oshonile. Lokhu kunciphisa amathuba okuba umzimba wenqabe izitho zokufakelwa. Endabeni yomnikeli ophilayo, uma izinso zivela kumnikeli osondelene kakhulu (isihlobo noma umfowabo), khona-ke izinga lempumelelo lingcono kunokuba izitho zivela kumnikeli osondelene kakhulu.

Ngokwandayo, ukufakelwa kwe-SPK kuye kwenziwa muva nje ngomuntu ophilayo onikelayo, lapho kunikezwa khona izinso kanye nengxenye ye-pancreas.

Iyini ukuhlolwa kokufakelwa kwe-pancreas nezinso?

Isiguli sihlolwa yiqembu labathintekayo, okuhlanganisa nodokotela ohlinzayo wokufakelwa izitho kanye nodokotela wezinso (udokotela wezinso). Bazoqopha umlando wezokwelapha wesiguli, benze ukuhlolwa ngokomzimba, bese becela ukuhlolwa okulandelayo (phakathi kokuningi):

• Ukuhlolwa kwegazi
• Ukuhlolwa kwezinzwa
• Ukuhlolwa kokuqinisekisa isifo sikashukela sohlobo 1
• Ukuhlolwa kokuhlola ukusebenza kwenhliziyo namaphaphu
• Hlola ukuhlola izinso

Kuye ngemiphumela yokuhlolwa, isiguli sizokwamukelwa ekufakweni kwe-pancreas nezinso. Sizofakwa ohlwini lokulinda lwesikhungo sokufakelwa. Inqubo yokufuna umnikeli ophilayo nayo ingaqala.

Kwenzekani ngesikhathi sokufakelwa kwe-pancreas nezinso?

Ngesikhathi sokuhlinzwa, izinso eziphilile kanye nama-pancreas kufakwa emzimbeni ukuze kuthathelwe indawo imisebenzi ehlulekayo yezitho zokuqala. Izinso zokuqala kanye nama-pancreas ngokuvamile azisuswa, kanti izinso zifakwa ohlangothini lwesobunxele lwesisu esingezansi kuyilapho i-pancreas ibekwa ohlangothini lwesokudla lwesifunda esifanayo.

Ukuhlinzwa kuthatha amahora ama-4 kuya kwayi-12. Isiguli kungase kudingeke sihlale esibhedlela amasonto ama-2 kuya kwayi-4 ngemva kwalokho. I-pancreas iqala ukukhiqiza i-insulini zingakapheli amahora ambalwa ngemva kokuhlinzwa. Imijovo ye-insulini ngeke idingeke kusukela manje kuqhubeke.

Kwenzekani ngemva kokuhlinzwa kokufakelwa i-pancreas nezinso?

Inqubo elandelwayo ngemva kokuhlinzwa incike endleleni isiguli esisabela ngayo ekufakweni kwezicubu. Ngokuvamile ilandela kanje:

• Izinsuku zokuqala ezimbalwa zesigaba sangemva kokuhlinzwa zizochithwa e-ICU, lapho isiguli siqashwe khona ngokucophelela ukuqinisekisa ukusebenza kahle kwe-pancreas kanye nezinso.
• Uma nje kungekho ukwenqatshwa (kwezitho zomzimba) noma ukutheleleka, isiguli sizokhishwa esikhathini esiyizinsuku ezingu-7-10. 
• Isiguli kuzodingeka sithathe imithi yokulwa nokwenqatshwa impilo yaso yonke ukuze sivimbele umzimba waso ekwenqabeni izitho zokufakelwa.
• Kuzoba nokulandelela njalo nodokotela ukuqinisekisa ukusebenza kahle kwezitho ezitshaliwe.
• Isiguli kulindeleke ukuthi sibe nendlela yokuphila enempilo.  

Isiphetho:

Izinzuzo zokufakelwa i-pancreas-kidney (SPK) ngesikhathi esisodwa ziya ngokuya zicaca ngemiphumela yokuhlinzwa ethuthukisiwe kanye nokulawulwa kwesifo sikashukela. Ukufakelwa i-SPK kuyindlela yokuqala yokwelapha i-insulin yeziguli ezinesifo sikashukela ezincike ku-insulin. Ezinye izindlela zifaka phakathi ukufakelwa i-pancreas kuphela (i-PTA), ukufakelwa kwe-islet-cell. I-SPK ayilona ikhambi kodwa inenzuzo enkulu hhayi ekulawuleni isifo sikashukela kuphela kodwa futhi nasekushintsheni izinso ezihlulekayo. I-SPK iwukuhlinzwa okukhulu okuza nezingozi ezithile kanye nezinkinga. Khuluma nodokotela wakho ukuze uthole ulwazi olwengeziwe.

References:

• UThomas, uBeje. “Ukufakelwa Kwezinso Nepancreas”. Kuhlelwe nguRon Shapiro. I-Medscape. Kufinyelelwe ngo-16 Agasti 2019. https://emedicine.medscape.com/article/1830202-overview
• "Ukufakelwa Kwezinso Nepancreas". I-National Kidney Foundation. Kufinyelelwe ngo-16 Agasti 2018. https://www.kidney.org/atoz/content/kidpantx
• Ukufakelwa i-pancreas-kidney (SPK) ngesikhathi esisodwa. I-NHS. Kufinyelelwe ngo-16 Agasti 2019. https://www.guysandstthomas.nhs.uk/resources/patient-information/kidney/having-a-simultaneous-pancreas-kidney-(spk)-transplant.pdf