{"id":12555,"date":"2016-09-16T10:21:07","date_gmt":"2016-09-16T10:21:07","guid":{"rendered":"http:\/\/medical-clinic.cmsmasters.net\/?page_id=12555"},"modified":"2020-05-22T21:22:46","modified_gmt":"2020-05-22T19:22:46","slug":"kirurgjia-e-aortes","status":"publish","type":"page","link":"https:\/\/kojqiqi.com\/sherbimet\/kirurgjia-e-aortes\/","title":{"rendered":"Kirurgjia e Aortes"},"content":{"rendered":"
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Kirurgjia e Aort\u00ebs<\/h2>\n<\/div>
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Hyrje<\/strong><\/p>\n

Aorta \u00ebsht\u00eb organi ose ena kryesore e gjakut n\u00eb trupin e njeriut, nga e cila deg\u00ebzohen t\u00eb gjitha en\u00ebt tjera t\u00eb gjakut. Ajo furnizon gjitha organet me gjak, q\u00eb do t\u00eb thot\u00eb gjaku i oksigjenuar q\u00eb del nga zemra kalon p\u00ebrmes Aort\u00ebs.<\/p>\n

Aorta del nga zemra dhe ndahet ne disa pjes\u00eb:\u00a0aorta ascendente<\/strong>,\u00a0harku i aort\u00ebs<\/strong>,\u00a0aorta descendente<\/strong>,\u00a0aorta thorakale\u00a0<\/strong>dhe\u00a0aorta abdominale<\/strong>. Pjesa ascendente ka rr\u00ebnjen e aort\u00ebs dhe sinus valsalve, apo pjesa e zgj\u00ebruar e aort\u00ebs, nga e cila dalin Arteriet koronare q\u00eb furnizojn\u00eb zemr\u00ebn me gjak.<\/p>\n

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Aorta dhe funksioni i saj<\/strong><\/p>\n

Aorta ka tri shtresa: Tunica interna, media dhe externa (Shtresa e brendshme, e mesme dhe e jashtme). Shtresa e mesme \u00a0p\u00ebrb\u00ebhet nga fije muskulare. Diametri normal i Aort\u00ebs \u00ebsht\u00eb n\u00ebn 4 cm dhe kjo madh\u00ebsi ndryshon minimalisht nga mosha dhe gjinia.<\/p>\n

P\u00ebrmes Aort\u00ebs \u00e7do dit\u00eb kalojn rreth 9000 litra gjak, brenda nje viti kalojn mbi 3 milion litra nd\u00ebrsa deri n\u00eb mosh\u00ebn 60 vjeqare kan kaluar mbi 200 milion litra gjak. Aorta \u00ebsht\u00eb pothuajse gjithmon\u00eb n\u00ebn nj\u00eb presion t\u00eb caktuar, t\u00eb cilin edhe e p\u00ebrballon shum\u00eb mir\u00eb. N\u00ebse kjo shtypje kalon vlerat normale, ajo me koh\u00eb e dob\u00ebson murin e Aort\u00ebs dhe ajo zgj\u00ebrohet. Poashtu edhe defektet gjenetike t\u00eb indeve mund t\u00eb prekin \u00a0shtresat e Aort\u00ebs, siq \u00ebsht\u00eb tek Sindromi i Marfanit, Sindromi i Ehlers-Danlos apo Sindromi Loeys-Dietz, t\u00eb cilat shkaktojn zgjerim t\u00eb aort\u00ebs.<\/p>\n

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S\u00ebmundjet e aort\u00ebs<\/strong><\/p>\n

Aneurizma (zgj\u00ebrimi i aort\u00ebs), Disekcioni (\u00e7arjet e aort\u00ebs), infekcionet dhe kalcifikimet e aort\u00ebs jan\u00eb s\u00ebmundjet m\u00eb t\u00eb shpeshta t\u00eb saj.<\/p>\n

Aneurizma<\/strong>\u00a0\u00ebsht\u00eb zgjerim i aort\u00ebs mbi 4 cm. \u00a0Kjo s\u00ebmundje e aort\u00ebs nuk paraqet ndonj\u00eb simptom\u00eb. N\u00eb shum\u00eb raste ajo zbulohet rast\u00ebsisht. N\u00eb rastin kur ajo zbulohet, duhet b\u00ebr\u00eb kontroll e rregullt\u00eb n\u00eb periudh\u00eb kohore 6 mujore apo \u00e7do vit. Kontrollet e rregullta b\u00ebhen me echokardiogafi dhe m\u00eb sakt\u00ebsisht duhet b\u00ebr\u00eb Compjuter Tomografi (CT).<\/p>\n

Disekcioni<\/strong>\u00a0i aort\u00ebs \u00ebsht\u00eb \u00e7arja e murit t\u00eb aort\u00ebs. Kjo s\u00ebmundje karakterizohet me dhimbje t\u00eb forta n\u00eb form t\u00eb therrj\u00ebs ose prerjes n\u00eb gjoks apo shpin\u00eb. N\u00eb raste kur i t\u00ebr\u00eb muri i aort\u00ebs \u00e7ahet , do t\u00eb thot\u00eb gjaku del nga aorta dhe mbush gjithe hap\u00ebsirat n\u00eb thorax, n\u00eb k\u00ebto raste vdekshm\u00ebria \u00ebsht\u00eb e pa evituar. Ka raste kur nga plasja e murit t\u00eb aort\u00ebs, mbetet vet\u00ebm nj\u00eb shtres\u00eb shum\u00eb e holl\u00eb 1 mm Adventicia, e cila mban ende gjakun mbrenda lumenit t\u00eb aort\u00ebs. N\u00eb k\u00ebto raste, pacient\u00ebt duhet operuar urgjentisht. Disekcionet e aort\u00ebs njihen p\u00ebr vdekshm\u00ebrin e lart\u00eb. Ato q\u00eb nga paraqitja e simptomeve t\u00eb para, vet\u00ebm 40 % e tyre, arrijn q\u00eb t\u00eb shtrihen n\u00eb spital dhe t\u00eb marrin trajtimin kirurgjik. Operacionet \u00a0kan nj\u00eb vdekshm\u00ebri deri n\u00eb 30 %. N\u00eb rast t\u00eb mosoperimit pothuajse 98% e k\u00ebtyre rasteve vdesin pas 14 dit\u00ebve.<\/p>\n

Infekcionet<\/strong>\u00a0dhe\u00a0kalcifikimet<\/strong>\u00a0e aort\u00ebs d\u00ebmtojn murin e saj me \u00e7\u2018rast vjen deri tek Disekcioni i aort\u00ebs.<\/p>\n

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Klasifikimi i Disekcioneve<\/strong><\/p>\n

Disekcionet mund t\u00eb prekin pjes\u00eb t\u00eb ndryshme t\u00eb aort\u00ebs. Var\u00ebsisht nga vendi dhe pjes\u00ebt e aort\u00ebs q\u00eb ka prekur, b\u00ebhet edhe klasifikimi dhe planifikimi i tyre p\u00ebr operim.<\/p>\n

Disekcionet e aort\u00ebs tip A dhe tip B sipas Stanford dhe Disekcionet e tipit I,II dhe III sipas De Bakey.<\/p>\n

Kur \u00e7arja ndodh n\u00eb aort\u00ebn ascendente dhe harkut e saj, kemi t\u00eb b\u00ebjm\u00eb me Disekcion t\u00eb tipit A.<\/p>\n

Kur \u00e7arja e aort\u00ebs ndodh pas harkut t\u00eb aort\u00ebs, n\u00ebn arterien subklavia t\u00eb majt\u00eb, kemi t\u00eb b\u00ebjm\u00eb me Disekcion t\u00eb tipit B, pra disekcionet e aort\u00ebs thorako-abdominale klasifikohen si Disekcion t\u00eb tip B dhe ndah\u00ebn n\u00eb tip B t\u00eb \u201ckomplikuara\u201d dhe \u201cjo komplikuara\u201d.<\/p>\n

Disekcionet e tipit A k\u00ebrkojn nj\u00eb intervenim t\u00eb menj\u00ebhersh\u00ebm-urgjent kirurgjik\u00eb. Rrezikshm\u00ebria gjate operacionit \u00ebsht\u00eb nga 10-30 %.<\/p>\n

Disekcionet e tipit B k\u00ebrkojn\u00eb nj\u00eb planifikim.<\/p>\n

Tek tip B \u201cjo t\u00eb komplikuara\u201d<\/strong> jan\u00eb raste q\u00eb nuk operohen<\/strong>, k\u00ebrkohet monitorim i tensionit t\u00eb gjakut, pulsit t\u00eb zemr\u00ebs dhe dhimbjeve. N\u00eb k\u00ebto raste duhet b\u00ebr\u00eb kontroll i rregullt\u00eb i aort\u00ebs, diagnostika e rregullt\u00eb dhe trajtim konservativ pra pa operacion.<\/p>\n

Tek Disekcionet e tipit B \u201ct\u00eb komplikuara\u201d<\/strong> jan\u00eb raste ku dhimbjet nuk ndalen, organet e tjera nuk furnizohen me gjak dhe ne raste kur aorta \u00ebsht\u00eb ruptuara e t\u00ebra dhe kemi gjakderdhje aktive. K\u00ebto raste duhet operuar<\/strong> menj\u00ebher\u00eb n\u00eb form\u00eb t\u00eb intervenimeve angiografike p\u00ebrmes stentave dhe kateterve proceduar q\u00eb quhet TEVAR- Thoracic EndoVascular Aortic Repair . N\u00eb rastet kur nuk mund t\u00eb b\u00ebhet procedura TEVAR (munges\u00eb t\u00eb protezave-stenta) b\u00ebhen edhe operacione klasike kirugjike.<\/p>\n

Klasifikimet e Disekcioneve t\u00eb aort\u00ebs sipas DeBakey n\u00eb tip I, II, dhe III jan\u00eb klasifikime q\u00eb b\u00ebjn\u00eb nj\u00eb p\u00ebrshkrim m\u00eb t\u00eb detajuar t\u00eb aort\u00ebs. \u00a0(shife Foton).<\/p>\n

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Protezat e aort\u00ebs<\/strong><\/p>\n

Protezat e aort\u00ebs punohen nga materiali Poliester dhe jan\u00eb t\u00eb mb\u00ebshtjellura me nj\u00eb material Kollagen q\u00eb ndalin rrjedhjen e gjakut. K\u00ebto materiale me fije artificiale jan\u00eb shum\u00eb rezistente dhe mund t\u00eb lakohen. N\u00eb ket\u00eb m\u00ebnyr\u00eb Protezat kan mund\u00ebsin e marrjes s\u00eb formave t\u00eb ndryshme, form\u00eb harku apo dhe t\u00eb zgjat\u00ebn.<\/p>\n

Protezat e aort\u00ebs ofrohen n\u00eb forma dhe madh\u00ebsi t\u00eb ndryshme.<\/p>\n

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Kur duhet b\u00ebr\u00eb operacioni tek Aneurizma e aort\u00ebs?<\/strong><\/p>\n

-Tek Aneurizmat (zgj\u00ebrimet) e aort\u00ebs ascendente, operacioni duhet planifikuar kur diamteri i aort\u00ebs arrin mbi 5 cm.<\/p>\n

-Kur zgj\u00ebrimi i aort\u00ebs ascedente \u00ebsht\u00eb prej 4-5 cm, n\u00eb k\u00ebto raste pritet duke b\u00ebr\u00eb kontroll\u00eb t\u00eb rregullt\u00eb \u00e7do 6 muaj.<\/p>\n

-Kur zgj\u00ebrimi i aort\u00ebs ascedente \u00ebsht\u00eb mbi 5,5cm k\u00ebto raste duhet operuar.<\/p>\n

-Kur zgj\u00ebrimi i aort\u00ebs ascendente \u00ebsht\u00eb mbi 6 cm operacioni duhet b\u00ebr\u00eb sa m\u00eb shpejt.<\/p>\n

-Tek aorta thorako-abdominale me nj\u00eb zgj\u00ebrim mbi 5,5 cm duhet b\u00ebr\u00eb intervenim me metoden TEVAR.<\/p>\n

-Tek aorta thorako-abdominale me zgj\u00ebrim mbi 6 cm, n\u00eb rast t\u00eb pamundesis\u00eb s\u00eb intervenimit me metoden TEVAR, duhet b\u00ebr\u00eb intervenimi kirugjik klasik i hapur.<\/p>\n

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Mbani mend:<\/strong><\/p>\n

Disekcionet e aort\u00ebs \u00a0Tip A duhet operuar urgjentisht. P\u00ebr \u00e7do or\u00eb pritjeje (vones\u00eb) rrezikshm\u00ebria e vdekj\u00ebs rritet me 1% n\u00eb or\u00eb.<\/p>\n

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Operacioni<\/strong><\/p>\n

Var\u00ebsisht sa \u00ebsht\u00eb e d\u00ebmtuar Aorta nga \u00e7arja, b\u00ebhet edhe planifikimi dhe lloji i operacionit. N\u00ebse \u00e7arja ka prekur vet\u00ebm aort\u00ebn ascendente, pa prekur harkun e saj, at\u00ebher\u00eb b\u00ebhet zav\u00ebndsim i aort\u00ebs ascendente. N\u00eb rastet m\u00eb t\u00eb shpeshta kur \u00e7arja prek aort\u00ebn ascendente me harkun e saj, valvul\u00ebn aortale dhe arteriet koronare at\u00ebher\u00eb operacionet jan\u00eb me t\u00eb komplikuara, zgjasin m\u00eb gjat\u00eb dhe k\u00ebrkojn\u00eb nje planifikim m\u00eb t\u00eb mir\u00eb, \u00a0p\u00ebr t\u00eb evituar operacionet e dyta dhe p\u00ebr te ruajtur valvulen e pacientit. K\u00ebto operacione ku b\u00ebhet nj\u00eb rekonstruksion i rr\u00ebnj\u00ebs s\u00eb aort\u00ebs, valvul\u00ebs aortale dhe arterieve koronare k\u00ebrkojn\u00eb nje experienc\u00eb t\u00eb madhe.<\/p>\n

Operacionet jan\u00eb te ndryshme: David operacione, Yacoub \u00a0operacione, Bentall operacione, Bio-Bentall operacione si dhe operacione tjera q\u00eb jan\u00eb modifikime t\u00eb David dhe Yacoub-it.<\/p>\n

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Kontrollet pas operacionit <\/strong><\/p>\n

Kontrollet pas operacionit jan\u00eb t\u00eb obliguara. N\u00eb rast te z\u00ebvend\u00ebsimit t\u00eb aort\u00ebs ascendente, mjaftojn kontrollet echokardiografike.<\/p>\n

N\u00eb rastet kur \u00ebsht\u00eb b\u00ebr\u00eb z\u00ebvend\u00ebsimi edhe i harkut t\u00eb aort\u00ebs at\u00ebher\u00eb dueht b\u00ebr\u00eb nj\u00eb CT. Kontrollet me echokardiografi dhe CT b\u00ebh\u00ebn para se pacienti t\u00eb lirohet nga spitali. Kontrollet tjera b\u00ebhen pas gjasht\u00eb muajve dhe m\u00eb pas \u00e7do vit.<\/p>\n

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Rehabilitimi<\/strong><\/p>\n

Pas lirimit nga spitali preferohet trajtimi n\u00eb nj\u00eb qend\u00ebr rehabilitimi. Q\u00ebllimi i rehabilitimit \u00ebsht\u00eb p\u00ebrmir\u00ebsimi i aktiviteve fizike duke ushtruar \u00e7do dit\u00eb n\u00eb aktivitete l\u00ebvizje, frym\u00ebmarrje dhe gradualisht n\u00eb rikthimin e forc\u00ebs muskulare. Pacientet duhej q\u00eb pas lirimit nga rehabilitimi t\u00eb jen\u00eb n\u00eb gjendje ti kujdesen p\u00ebr vet\u00ebvet\u00ebn n\u00eb sht\u00ebpi.<\/p>\n

Q\u00ebllim tjt\u00ebr i rehabilitmit \u00ebsht\u00eb monitorim i tensionit, sheqerit sidhe stabilizim psikologjik\u00eb.<\/p>\n

Rehabilitimi mund t\u00eb b\u00ebhet edhe ne form\u00eb ambulatore.<\/p>\n

N\u00eb rast t\u00eb munges\u00ebs s\u00eb rehabilitimit siq \u00ebsht\u00eb tek ne n\u00eb Kosov\u00eb, pacientet lirohen direkt n\u00eb sht\u00ebpi dhe realizimi i k\u00ebtyre aktivteteve b\u00ebhet nga pacienti vet\u00eb, apo n\u00eb raste t\u00eb ralla me ndihm\u00ebn e fizioterapeutit.<\/p>\n

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Doktor\u00eb profesionist p\u00ebr sh\u00ebndetin tuaj<\/h2>\n<\/div>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n
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\"Dr.<\/a><\/figure>

Dr. med. Fatos Kojqiqi<\/a><\/h3>
Kardiokirurg<\/h6><\/header><\/div>\t<\/div>\r\n<\/article>\r\n\r\n\r\n\r\n
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\"Dr.<\/a><\/figure>

Dr. med. Arben Kojqiqi<\/a><\/h3>
Kardiokirurg - Kirurg Torakal<\/h6><\/header><\/div>\t<\/div>\r\n<\/article>\r\n\r\n\r\n\r\n
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\"Dr.<\/a><\/figure>

Dr. med. Besnik Kojqiqi<\/a><\/h3>
Kirurg-Kardiovaskular<\/h6><\/header><\/div>\t<\/div>\r\n<\/article>\r\n\r\n\r\n<\/div>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":12208,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_oct_exclude_from_cache":false,"_glsr_average":0,"_glsr_ranking":0,"_glsr_reviews":0,"footnotes":""},"class_list":["post-12555","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/kojqiqi.com\/wp-json\/wp\/v2\/pages\/12555","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kojqiqi.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/kojqiqi.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/kojqiqi.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kojqiqi.com\/wp-json\/wp\/v2\/comments?post=12555"}],"version-history":[{"count":10,"href":"https:\/\/kojqiqi.com\/wp-json\/wp\/v2\/pages\/12555\/revisions"}],"predecessor-version":[{"id":14189,"href":"https:\/\/kojqiqi.com\/wp-json\/wp\/v2\/pages\/12555\/revisions\/14189"}],"up":[{"embeddable":true,"href":"https:\/\/kojqiqi.com\/wp-json\/wp\/v2\/pages\/12208"}],"wp:attachment":[{"href":"https:\/\/kojqiqi.com\/wp-json\/wp\/v2\/media?parent=12555"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}