Ukutshalaliswa kwezitho kanye nezicubu. Ukufakelwa kwezakhi zomzimba eRussia

Inkinga yokuntuleka komzimba kokufakelwa kabusha kubalulekile kubo bonke isintu sonke. Abantu abangaba ngu-18 bafa nsuku zonke ngenxa yokungabi nabanikazi bomzimba nezicubu ezithambile, ngaphandle kokulinda isikhathi sabo. Ukuguqulwa kwamagciwane ezweni lanamuhla ikakhulukazi kwenziwa kubantu abashonile abathi, ngesikhathi sokuphila kwabo, basayina imibhalo efanele mayelana nemvume yabo yokunikela emva kokufa.

Kuyini ukufakelwa kabusha?

Ukufakelwa kwezakhi zomzimba ukususwa kwezitho noma izicubu ezithambile ezivela kumnikeli futhi zidlulisele kumamukeli. Isiqondiso esiyinhloko se-transplantology ukuguqulwa kwezitho ezibalulekile - okungukuthi, lezo zitho ezingenakwenzeka ukuba khona. Lezi zitho ziyinhliziyo, izinso, amaphaphu. Nakuba ezinye izitho, njenge-pancreas, zingashintsha ukwelashwa endaweni. Kuze kube manje, ithemba elikhulu lokukhuliswa komuntu wesintu ukufakelwa komzimba. Ukufakelwa kwesitshalo sekuvele kwenziwe ngempumelelo. Lokhu kuyinhliziyo, izinso, isibindi, i-thyroid, i-cornea, i-pleen, i-lung, isitsha, isikhumba, i-cartilage kanye nokufakelwa kwamathambo ukudala isidumbu ukuze kutholakale izicubu ezintsha esikhathini esizayo. Ngokokuqala ngqá, ukuhlinzwa kwesifo sezinso ekuqedeni ukuhluleka komzimba kwesiguli kwenziwa ngo-1954, umnikeli wayefana newele elifanayo. Ukufakelwa kwezakhi zomzimba eRussia kwaqhutshwa okokuqala yi-academician Petrovsky BV ngo-1965.

Ziyini izinhlobo zokufakelwa kabusha?

Kuwo wonke umhlaba, kunabantu abaningi abagulayo abadinga ukufakelwa izitho zangaphakathi nezicubu ezithambile, ngoba izindlela zendabuko zokwelapha isibindi, izinso, amaphaphu nenhliziyo zinikeza ukuphumula okwesikhashana nje kuphela, kodwa ungaguquki isimo soguli. Ukufakelwa kwezakhi zomzimba kukhona ngezinhlobo ezine. Okwokuqala - ukuhlukaniswa kwezitshalo - kwenzeka lapho umnikeli nomamukeli bezinhlobo ezifanayo, kanti uhlobo lwesibili lubandakanya i-xenotransplantation - zombili lezi zihloko ziyizinhlobo ezahlukene. Uma kwenzeka ukuthi ukufakelwa kwezicubu noma izitho zenzeke ngamawele afanayo noma izilwane ezikhulile ngenxa ye-inbreeding, lo msebenzi ubizwa ngokuthi i-isotransplantation. Ezimweni ezimbili zokuqala, umamukeli angase abhekane nokulahlwa kwesikhumba, okubangelwa ukuvikelwa komzimba kwamanye amangqamuzana angaphandle. Futhi kubantu abahlobene, izicubu ngokuvamile ziba ngcono. Uhlobo lwesine lubandakanya ukukhiqizwa kwe-autotransplantation - ukufakelwa kwezitshalo nezicubu ngaphakathi kwenyama eyodwa.

Izinkomba

Njengoba umkhuba ubonisa, ukuphumelela kwemisebenzi eyenziwe ikakhulukazi ngenxa yokuxilongwa ngesikhathi esifanele nokuzimisela okunembile kokutholakala kokuphikisana, kanye nesikhathi sokufakelwa komzimba. Ukufakelwa kwezitshalo kumele kubikezelwe ukucabangela isimo sesiguli kokubili ngaphambi kokuhlinzwa nokulandela. Isibonakaliso esiyinhloko sokusebenza kukhona ukukhubazeka okungenakuphulukiswa, izifo kanye ne-pathologies ezingenakekelwa izindlela zokwelapha nezokuhlinzwa, kanye neziguli ezisongela ukuphila. Uma kwenziwa ukufakelwa kwezitshalo ezinganeni, isici esibaluleke kakhulu kunquma isikhathi esifanele sokusebenza. Njengoba ochwepheshe beziko elifana ne-Institute of Transplantology befakazela, ukuhlehliswa kokusebenza akufanele kwenziwe ngenxa yesikhathi eside esingenangqondo, ngoba ukubambezeleka ekuthuthukiseni isilwane esincane kungenakwenzeka. Ukutshala izihlahla kuboniswa uma kwenzeka ukubikezelwa kokuphila okuhle emva kokusebenza, kuye ngokuthi uhlobo lwe-pathology.

Ukutshalaliswa kwezitho kanye nezicubu

Ku-transplantology, okuvame kakhulu ukukhiqizwa kwe-autotransplantation, njengoba kungabandakanyi ukungahambisani kwamathambo nokulahlwa. Ngokuvamile, isikhumba, amafutha nama-muscle izicubu, i-cartilage, izingcezu zethambo, izinzwa, i-pericardium zifakelwa kabusha . Ukutshalaliswa kwemifino nemikhumbi kufandelwe. Lokhu kwenzeke ngenxa yokuthuthukiswa kwezinto ezincane zokusebenza kwemishini kanye nemishini kulezi zinhloso. Ukuphumelela okukhulu kwe-transplanatology ukuguqulwa kweminwe kusukela ezinyaweni kuya kwesandla. I-autotransplantation ihlanganisa nokumpontshelwa kwegazi lakho siqu ngokulahlekelwa kwegazi elikhulu ngesikhathi sokungenelela kokuhlinzwa. Uma i-allotransplantation ivame ukutshalwe umnyosa wethambo, izitsha, izicubu zethambo. Leli qembu lihlanganisa ukumpontshelwa kwegazi ezihlotsheni. Ukufakelwa kwezitshalo zobuchopho kungavamile ukwenza, njengoba lokhu kuhlangene nakho kubhekene nobunzima obukhulu, noma kunjalo, ezilwaneni, ukufakelwa kabusha kwamagatsha ngamunye kwenziwa ngokuphumelelayo. Ukufakelwa kwe-Pancreas kungamisa ukuthuthukiswa kwesifo esinzima njengesifo sikashukela. Eminyakeni yamuva, imisebenzi engu-7 kuya kweziyishumi eqhutshwa yenziwe yimpumelelo. Kulesi simo, isilwane sonke asifakelwa ngokuphelele, kodwa ingxenye kuphela yileli amangqamuzana angama-insulin.

Umthetho we-Organ Transplantation eRussia Federation

Emkhakheni wezwe lakithi, imboni yokufakelwa ilawula umthetho weRussia Federation of 22.12.92 "Ekufakweni kabusha kwezitho kanye (noma) izicubu zomuntu". ERussia, ukuguqulwa kwezinso kuvame ukwenziwa, kaningi inhliziyo neyesibindi. Umthetho wokuguqulwa komzimba uthatha lesi sici njengendlela yokulondoloza impilo nempilo yesakhamuzi. Ngesikhathi esifanayo, umthetho ubheka ukulondolozwa kwempilo yomnikeli ngokuphathelene nempilo yomamukeli njengento ephambili. Ngokusho kwe-Federal Law mayelana nokufakelwa komzimba, izinto zingathatha umongo, inhliziyo, imaphaphu, izinso, isibindi nezinye izitho zangaphakathi nezicubu. Ukususwa kwezitho kungenziwa kokubili nomuntu ophilayo kanye nomuntu oshonile. Ukufakelwa kwezitshalo kwezitho kwenziwa kuphela ngemvume ebhaliwe yomamukeli. Abanikeli bangaba abantu abanekhono kuphela abaye bathola ukuhlolwa kwezokwelapha. Ukufakelwa kwezakhi zomzimba eRussia mahhala, njengoba ukuthengiswa kwezitho kungavunyelwe umthetho.

Abanikeli be-transplantation

Ngokusho kwe-Institute of Transplantology, wonke umuntu angaba umnikezeli we-transplantation yomzimba. Kubantu abangaphansi kweminyaka eyishumi nesishiyagalolunye, imvume yabazali ekusebenzeni kuyadingeka. Uma usayina imvume yemibandela emva kokufa, ukuxilongwa nokuhlolwa kwezokwelapha kwenziwa, okuvumela ukuthi kunqume ukuthi yiziphi izitho ezingafakelwa kabusha. Abathwali be-HIV, isifo sikashukela, isifo somdlavuza, isifo sezinso, isifo senhliziyo nezinye izifo ezingathí sina azifakiwe ohlwini lwababanikeli bokufakelwa kabusha izitho nama-tissue. Ukufakelwa okuhlobene okuvame ukuqhutshwa izitho ezihlangene - izinso, amaphaphu, kanye nezitho ezingasebenzi - isibindi, intumbo, ama-pancreas.

Ukuqhathaniswa kokufakelwa kwezitshalo

Ukufakelwa kwezakhi zomzimba kunezinombolo eziningi zokungabikho ngenxa yezifo ezingaba zimbi ngenxa yokusebenza futhi zibe usongo empilweni yesiguli, kuhlanganise nokufa. Zonke izinqunquthela zihlukaniswe ngamaqembu amabili: okuphelele nesihlobo. Okuphelele yilokhu:

• Izifo ezithathelwanayo kwezinye izidumbu ezihambisana nalabo abahlela ukufaka esikhundleni, kubandakanya nokuba khona kwesifo sofuba, i-AIDS;
• Ukuphazanyiswa kokusebenza kwezitho ezibalulekile, ukulimala ohlelweni lwezinzwa zomphakathi;
• Izicubu ezinomdlavuza;
• Ukuba khona kwezinkinga nokukhubazeka kokuzalwa, akuhambisani nokuphila.

Kodwa-ke, ngesikhathi sokulungiselela ukusebenza, ngenxa yokwelashwa nokuqedwa kwezimpawu, ukuphikisana okuningi okuphelele kunesivumelwano.

Ukufakelwa kwezinso

Okubaluleke ngokukhethekile emithini ukuguqulwa kwezinso. Njengoba lokhu kuyilungu elihlangene, lapho lisuswa kumnikeli, akukho ukuphazamiseka ekusebenzeni komzimba okusongela ukuphila kwayo. Ngenxa yobunqunu bokunikezwa kwegazi, izinso ezitshalwe kabusha zisekelwe kahle kulabo abamukeliyo. Ngokokuqala ngqa, ukuhlolwa kokufakelwa kwezinso kwenzelwa ezithombeni ngo-1902 ngumcwaningi uElman. Ekufakweni kwezitshalo, umamukeli, ngisho nangabe kungekho khona izinqubo ezisekela ukuvimbela ukwenqatshwa kwelungu elithile, waphila isikhathi esingaphezu kwezinyanga eziyisithupha. Ekuqaleni, izinso zafakwa kabusha emthangeni, kodwana ngokuhamba kwesikhathi ngokuthuthukiswa kokuhlinzwa, ukusebenza kokufakelwa kabusha endaweni yesigodi kwaqala, le nqubo isasebenza. Ukufakelwa kwezinso zokuqala kwezinso kwenziwa ngo-1954 phakathi kwamawele afanayo. Ngaleso sikhathi, ngo-1959, ukuhlolwa kokufakelwa kwezinso kwenzelwa izinogwaja namawele, futhi inqubo yasetshenziselwa ukulwa nokukhishwa kokufakelwa, futhi yaphumelela ekusebenzeni. Kutholakale izitho ezintsha ezingavimbela izindlela zemvelo zomzimba, kuhlanganise nokutholakala kwe-azathioprin, okuvimbela ukuzivikela komzimba. Kusukela ngaleso sikhathi, izivikeli ze-immunosuppressants zisetshenziswe kabanzi kwi-transplantology.

Ukulondolozwa kwezitho

Noma yiluphi uhlaka olubalulekile olwenzelwe ukufakelwa kabusha, ngaphandle kokunikezwa kwegazi kanye ne-oksijeni kuncike ekushintsheni okungenakuguqulwa, okwathi ngemva kwalokho kuthathwa njengokungafanelekile ukufakelwa kabusha. Kuzo zonke izitho le nkathi ibalwa ngezindlela ezahlukene - ngoba isikhathi senhliziyo sibalwa ngamaminithi, ngoba izinso - amahora amaningana. Ngakho-ke, umsebenzi oyinhloko we-transplantology ukugcinwa kwezitho nokugcinwa kwamandla abo okusebenza kuze kube yilapho kuguqulwa kwesinye isimo. Ukuze uxazulule le nkinga, ukusetha kuyasetshenziswa, okuhlanganisa ekunikezeni umzimba nge-oxygen nokupholisa. Izinso ngale ndlela zingagcinwa izinsuku ezimbalwa. Ukulondolozwa kwegciwane kuvumela ukwandisa isikhathi sokutadisha kwawo kanye nokukhethwa kwabamukeli.

Ngamanye amalungu emva kokuthola itholakala ngokulondolozwa, ngenxa yalokhu, ifakwa esitsheni esinamaqanda angenayo, ngemva kwalokho igcinwe ngesisombululo esikhethekile ekushiseni kwama-degrees Celsius angu-40. Ngokuvamile, isixazululo esibizwa ngeCustodiol sisetshenziselwa le njongo. I-Perfusion ibhekwa njengeyiphelele, uma kusuka emilonyeni ye-veins yokufakelwa kuvela ikhambi elihlanzekile lokulondoloza ngaphandle kokungcola kwegazi. Ngemuva kwalokho, isitho sigcinwe kwisisombululo sokuvikela, lapho sishiywa khona kuze kuqhutshwe umsebenzi.

Ukulahlwa kwe-Graft

Lapho ukufakelwa kufakwe endaweni yokuthola umzimba, uba yinto yokuphendula nge-immunological yezinto eziphilayo. Ngenxa yempendulo yokuzivikela yamasosha omzimba womamukeli, izinqubo eziningana zenzeka ezingeni leselula, okuholela ekwenqatsweni kwendikimba yokufakelwa. Lezi zinqubo zichazwe ngokuthuthukiswa kwamagciwane okuxhaswa ngemali, kanye nama-antigen we-immune system of the receiver. Kunezinhlobo ezimbili zokulahlwa Ngamafomu alula, izindlela zombili zokwenqaba zithuthuka.

Ukuvuselelwa nokuphathwa kwe-immunosuppressive

Ukuvimbela lo mphumela ohlangothini, ukwelashwa kwe-immunosuppressive kunqunywe kuye ngohlobo lwenqubo eyenziwa, iqembu legazi, izinga lokuhambisana lomnikeli nomamukeli, nesimo sesiguli. Ukulahlwa okuncane kunazo zonke kubonakala kuleso sakhiwo esihlobene nokufakelwa kwezicubu, njengoba kulesi simo, njengoba umthetho, ama-antigens 3-4 avela ku-6. Ngakho-ke, kudingeka umthamo ophansi we-immunosuppressants. Izinga eliphakeme lokusinda liboniswa ukufakelwa kwesibindi. Ukuzivocavoca kubonisa ukuthi isitho sibonisa iminyaka engaphezu kwengu-10 yokusinda ngemuva kokuhlinzwa kuma-70% weziguli. Ngokusebenzisana kwesikhathi eside komamukeli kanye nokufakelwa, i-microchimerism kwenzeka, okuvumela kancane kancane ukwehlisa umthamo we-immunosuppressants kuze kugcwaliswe ukwenqatshwa nesikhathi.