Umkantsha itholakala maphakathi namathambo amaningi futhi yakhiwa izicubu ezithambile, imithambo yegazi nama-capillaries.
Umsebenzi oyinhloko womnkantsha wethambo ukukhiqiza amangqamuzana egazi asiza ekugcineni uhlelo lwe-vascular ne-lymphatic olunempilo, lukhiqiza amaseli angaphezu kwezigidi eziyizinkulungwane ezingama-200 nsuku zonke. Umnkantsha wethambo ukhiqiza amaseli egazi abomvu namhlophe.
Ukukhiqizwa okungapheli nokwenziwa kabusha kwalawa maseli kubalulekile ekusizeni umzimba ukuthi ulwe nezifo kanye nokutheleleka, futhi kugcina nohlelo lokuphefumula lusebenza.
Kunezimo eziningi zezokwelapha ezingavimbela umnkantsha ukukhiqiza amaseli kahle njenge-leukemias nomdlavuza, isifo sofuba kanye ne-sickle cell anemia. Uma zingalashwa, izifo ezithinta umnkantsha zingabulala. Uma sesitholakele, isinyathelo sokuqala ekwelapheni isifo somnkantsha ukukhipha umongo wethambo othintekile. Lokhu kuhlaziywa ukuhlinzekela ukuxilongwa nokuhlolwa ukuthi iyiphi indlela yokwelashwa efanelekile kakhulu. Uma kutholakala amangqamuzana anomdlavuza, isenzo esizokwenzeka kakhulu sizobandakanya i-chemotherapy noma i-radiotherapy, ngenhloso yokucekela phansi amangqamuzana omdlavuza nokuwavimbela ukuthi angasakazeki ngokuqhubekayo. Kule nqubo kuzolimala namaseli egazi abomvu namhlophe. Indlela ephumelela kunazo zonke yokwelapha isimo somnkantsha ukufakelwa umnkantsha wethambo, okubandakanya ukufakwa komnkantsha namaseli alimele kufakwe okusha, okunempilo. Ukufakelwa komnkantsha wethambo kuvame ukufaka amaseli ama-stem, angamaseli wokukhula okuqala angakhiqiza amaseli abomvu namhlophe egazi.
Amaseli esiqu ajovwa ngomnkantsha wegazi womnikeli, ongavela kumnikeli wangaphandle noma kwenye indawo emzimbeni wesiguli. Amaseli esiqu avela kumnikeli wangaphandle kufanele abe ukufana okusondele kakhulu kwesiguli, futhi imvamisa athathwa endaweni yokhalo. Amaseli wesiqu sabanikeli ahunyushelwa ethanjeni lesiguli ngomthambo kusetshenziswa ukumunca i-drip, inqubo engadingi i-anesthesia futhi engena kancane. Impahla yabanikeli iya emnkantsheni wethambo ngokuhamba kwamahora amaningana. Kuzothatha cishe amasonto amabili kuya kwamane ngaphambi kokuba amangqamuzana eziqu afakiwe aqale ukukhiqiza amangqamuzana egazi abomvu namhlophe, futhi nengozi enkulu yokutheleleka ngalesi sikhathi isiguli sizodinga ukuhlala sodwa.
Ngingakutholaphi ukufakelwa komnkantsha emhlabeni wonke?
Ukufakelwa komnkantsha wethambo inqubo eyinkimbinkimbi edinga ubuchwepheshe bochwepheshe abanolwazi, ngakho-ke kungabiza. Abantu abaningi bakhetha ukubheka ukwelashwa kwabo phesheya, noma ngabe konga imali noma ukuthola ukunakekelwa kongoti. Ukufakelwa Kwamathambo Emathanjeni eJalimane Ukufakelwa Kwamathumbu Emathambo eNdiya Ukufakelwa Kwethambo Lamathambo eTurkey Ngeminye imininingwane, funda yethu Umhlahlandlela Wezindleko Zokufakelwa Kwethambo Lomzimba.,
| # | Izwe | Izindleko ezilinganiselwe | Izindleko zokuqala | Izindleko eziphakeme kakhulu |
|---|---|---|---|---|
| 1 | India | $30000 | $28000 | $32000 |
Kunezici eziningi ezingathinta izindleko
Thola Ukubonisana kwamahhala
A ukufakelwa komnwe we-bone kwenzelwa ukufaka umongo wethambo owonakele noma owonakele. Umnkantsha wethambo ungayeka ukusebenza ngenxa yezifo ezinjenge-aplastic anemia noma i-sickle cell anemia, noma ukubhujiswa ngamakhemikhali noma ngemisebe yokwelapha esetshenziselwa ukwelapha umdlavuza noma ezinye izifo. Umnkantsha wamathambo yizicubu zesiponji ezitholakala ngaphakathi kwamathambo emzimbeni. Yenziwe ngamaseli ama-stem. Lezi ama-stem cells kuveza amanye amangqamuzana egazi, njengamaseli amhlophe okulwa nokutheleleka namaseli abomvu nama-platelet, asiza igazi ukuba liminyanise futhi lisakaze umoya-mpilo emzimbeni wonke. Kunezinhlobo ezi-3 ezihlukene zokufakelwa komnkantsha okuyi-autologous, i-allogenic, ne-syngeneic. Ukufakelwa komnkantsha we-Autologous kuvuna iziguli umnkantsha wethambo ngaphambi kokuthola i-chemotherapy noma i-radiation therapy, bese kukugcina efrijini kuze kuphele ukwelashwa.
Umnkantsha ophilile uphinde ubuyiselwe esigulini ngemuva kokuba usuqedile ngokwelashwa futhi usuthetheleleni. Ukufakelwa kwe-Allogenic kubandakanya ukuthatha umnkantsha wethambo kumnikeli, okuvame ukuba yilungu lomndeni, bese ukufakela lokhu esigulini. Ukufakelwa kwe-Syngeneic kubandakanya ukufaka umnkantsha emawele afanayo esiguli noma entanjeni yesibindi nokuwufaka esigulini.
Kunconyiwe I-leukemia Aplastic anemia Lymphoma Iziguli ezithole ukwelashwa ngamakhemikhali okucekele phansi umnkantsha we-Sickle cell anemia Izifo ezizimele zomzimba ezifana nezidingo ze-MS Isikhathi Isilinganiso sobude bokuhlala phesheya amasonto ama-4 - 8. Ubude bokuhlala esibhedlela obudingekayo buyahlukahluka ngohlobo ngalunye lokufakelwa olwenziwe kanye nesiguli ngasinye. Inani lohambo oluya phesheya liyadingeka 1. Umnkantsha wethambo uvame ukuvunwa kusuka ku-sternum noma enqeni usebenzisa inaliti ukuyikhipha. Izidingo zesikhathi Ubude obumaphakathi bokuhlala phesheya 4 - 8 amasonto. Ubude bokuhlala esibhedlela obudingekayo buyahlukahluka ngohlobo ngalunye lokufakelwa olwenziwe kanye nesiguli ngasinye. Inani lohambo lwaphesheya oludingekayo 1. Izidingo zesikhathi Isilinganiso sobude bokuhlala phesheya amasonto ama-4 - 8. Ubude bokuhlala esibhedlela obudingekayo buyahlukahluka ngohlobo ngalunye lokufakelwa olwenziwe kanye nesiguli ngasinye. Inani lohambo lwangaphandle oludingekayo 1. Umnkantsha wethambo uvame ukuvunwa kusuka ku-sternum noma okhalweni usebenzisa inaliti ukuyikhipha.,
Ngaphambi kokuthola i- ukufakelwa komnwe we-bone, iziguli zizohlolwa kabanzi ukuqinisekisa ukuthi kuyindlela engcono kakhulu kuzo. Kuzokwenziwa uchungechunge lwezivivinyo ukuqinisekisa ukuthi isiguli siphilile ngokwanele ukuthola ukufakelwa futhi kuzodingeka ukuthi sifike emtholampilo noma esibhedlela cishe ezinsukwini eziyi-10 ngaphambi kokufakelwa, ukuze kufakwe umugqa ophakathi esifubeni, ukulungiselela ukufakelwa kabusha. Kumnikeli, kufanele futhi ahlolwe uchungechunge nokuhlolwa ukuze kuqinisekiswe ukuthi kungumdlalo ofanele womamukeli.
Umnikeli uvame ukunikezwa umuthi ngaphambi kokunikela ngomnkantsha wamathambo njengendlela yokwandisa umkhiqizo womnkantsha. Umnkantsha wethambo ubese uvunwa kumnikeli, imvamisa kusuka esinqeni noma ku-sternum kusetshenziswa inaliti. Ngenye indlela, umnkantsha ungalandwa kusuka kumaseli egazi egazi, okubandakanya ukukhipha igazi nokulihluza ngomshini okhipha ama-stem cell, bese kubuyiselwa igazi elisele kumnikeli.
Izikhathi eziningi, umnkantsha wamathambo uthathwa esigulini ngaphambi kokwelashwa bese ubuyiselwa kubo, kunokusebenzisa umnikeli. Iziguli ezinezimo eziyinkimbinkimbi zingazuza ngokufuna umbono wesibili ngaphambi kokuqala uhlelo lokwelashwa. Umbono wesibili usho ukuthi omunye udokotela, imvamisa uchwepheshe onolwazi oluningi, uzobuyekeza umlando wesiguli, izimpawu, ukuskena, imiphumela yokuhlolwa, nolunye ulwazi olubalulekile, ukuze ahlinzeke ngohlelo lokuxilongwa nokwelashwa.
I-Chemotherapy noma i-radiation therapy ivame ukusetshenziswa njengengxenye yenqubo yokwelapha umdlavuza noma isifo ku umkantsha nokwenza indawo yokufakelwa komnkantsha ngokubhubhisa umongo wethambo owonakele. Lapho lesi sigaba sesiqediwe, umnkantsha wethambo ufakwa esigulini ungene egazini, ngokusebenzisa umugqa ophakathi esifubeni.
Amaseli ama-stem amasha azohamba ngegazi aye emnkantsheni wethambo bese eqala ukukhiqiza amangqamuzana amasha anempilo. I-Anesthesia Umnkantsha wethambo ojwayelekile uvunwa esigulini noma kumnikeli bese usetshenziselwa ukufaka umnkantsha ongenampilo.,
Iziguli zizodinga ukuchitha amasonto ambalwa esibhedlela ngemuva kwenqubo, ukuze zilulame. Ukubalwa kwegazi okujwayelekile kuzothathwa ezinsukwini eziqhubekayo ngemuva kokufakwa kanye nokumpontshelwa igazi.
Uma kwenzeka kwenziwa ukufakelwa kwe-allogeneic, isiguli sinikezwa imishanguzo yokuyithatha njengesivikelo ekuvikeleni isifo se-graft-versus-host-disease, lapho amangqamuzana amasha engaqala khona ukuhlasela izicubu zesiguli. Ukubuyiselwa esimweni sokufakelwa kungathatha izinyanga ngemuva kokuphuma kwesiguli esibhedlela futhi kuzodingeka baye emihlanganweni yokuhlolwa njalo.,
Okulandelayo yizibhedlela eziyi-10 ezihamba phambili zokufakelwa kweBone Marrow emhlabeni:
| # | Isibhedlela | Izwe | imizwa | Inani | |
|---|---|---|---|---|---|
| 1 | I-BLK-MAX Super Specialty Hospital | India | New Delhi | --- | |
| 2 | Isibhedlela saseChiangmai Ram | Thailand | Chiang Mai | --- | |
| 3 | IMedipol Mega University Hospital | igalikuni | Istanbul | --- | |
| 4 | Isibhedlela iZambrano Hellion | Mexico | Monterrey | --- | |
| 5 | I-Asian Heart Institute | India | Mumbai | --- | |
| 6 | Isibhedlela iThumbay | I-United Arab Emirates | Dubai | --- | |
| 7 | Isikhungo Sezokwelapha Sakwa-Samsung | INingizimu Korea | Seoul | --- | |
| 8 | Isibhedlela iMuro General | Spain | Mallorca | --- | |
| 9 | Isibhedlela iAmerican University of Beirut | Lebanon | Beirut | --- | |
| 10 | Isibhedlela sase-Columbia Asia | India | ukubeka | --- |
Okulandelayo odokotela abaphambili be-Bone Marrow Transplant emhlabeni:
| # | DOKOTELA | EZIKHETHEKILE | ISIBHEDLELA | |
|---|---|---|---|---|
| 1 | UDkt Rakesh Chopra | Udokotela Oncologist | Isibhedlela sase-Artemis | |
| 2 | UProfesa A. Bekir Ozturk | Udokotela Oncologist | U-Hisar Intercontinental Ho... | |
| 3 | UDkt Rahul Bhargava | Isazi se-Haemato Oncologist | Ucwaningo lwe-Fortis Memorial ... | |
| 4 | UDkt Dharma Choudhary | I-Oncologist Yokuhlinzwa | I-BLK-MAX Super Specialty H... | |
| 5 | UDkt Nandini. C. Hazarika | I-Oncologist yezingane | Ucwaningo lwe-Fortis Memorial ... | |
| 6 | UDkt Aniruddha Purushottam Dayama | Isazi se-Haemato Oncologist | Isibhedlela sase-Artemis | |
| 7 | UDkt Ashutosh Shukla | Udokotela | Isibhedlela sase-Artemis | |
| 8 | UDkt Sanjeev Kumar Sharma | I-Oncologist Yokuhlinzwa | I-BLK-MAX Super Specialty H... | |
| 9 | UDkt Deenadayalan | Udokotela Oncologist | Isibhedlela iMetro kanye nenhliziyo... |
Ukufakelwa komnkantsha kungadingeka uma:
Ukuze sikwazi ukufakelwa kabusha, kufanele sithole ama-stem cell kumnikeli. Inqubo yokuqoqa la maseli ibizwa ngokuthi ukuvuna. Kunezindlela ezimbili eziyisisekelo zokuvuna noma ukuqoqa ama-stem cells:
• Ukuvunwa komnkantsha wamathambo: Amaseli esiqu aqoqwa ngqo ethangeni lesinqe lomnikeli.
• Ukuvunwa kwamaseli egazi: Amaseli esiqu aqoqwa ngqo egazini (emithanjeni) yomnikeli.
Ithimba lokufakelwa lifaka phakathi ochwepheshe abalandelayo:
• Odokotela
• Abaxhumanisi Babahlengikazi Abangaphambi Kokufakelwa kabusha
• Abahlengikazi Abagulayo
• Abahlengikazi Bemitholampilo ye-BMT
• Abahlengikazi kanye Nabasizi Bodokotela
• Izazi zokudla
• Osokhemisi basemtholampilo
• Ongoti Bezobuchwepheshe Bebhange Legazi
• Abelaphi bomzimba / bomsebenzi
Ukulandela yizinyathelo:
• Ukubonisana kokuqala
• Ukuhlola Isimo Sezifo
• Ukuhlolwa Komsebenzi Womzimba
• Ukubonisana
• Uhlelo Lokunakekela
• Inqubo Yokugqugquzela Ukuqoqwa Kwamaseli E-stem
• Vuma ukufakelwa
Ukulandela yizinyathelo:
• Ukubonisana kokuqala
• Sesha umnikeli
• Ukuhlola Isimo Sezifo
• Ukuhlolwa Komsebenzi Womzimba
• Ukubonisana
• Uhlelo Lokunakekela
• Kubekwe Ipayipi le-IV
• Ukuhlolwa kokugcina
• Vuma ukufakelwa
Isiguli kufanele sinakekele:
Ukukhishwa kuyatholakala ezigulini uma zigcwalisa:
• Izimpawu ezizinzile ezibalulekile futhi akukho mafiva amahora angama-24
• Ukutheleleka nokuxhunyelelwa kuqhathaniswa nesifo esihlasela abantu (i-GVHD) kufanele kungabikho, kuzinze, noma kulawulwe
• Akudingi ukumpontshelwa nsuku zonke (ikakhulukazi ukumpontshelwa kweplatelet)
• Iyakwazi ukubekezelela imishanguzo yomlomo, ukudla, noketshezi
• Isebenza ngokwanele ukusebenza ngaphandle kwesibhedlela
• Ukucanuzela kwenhliziyo, ukuhlanza, uhudo olulawulwayo
• Ukutheleleka: Ngesikhathi nangemva kokufakelwa kabusha, uzoba sengozini yokuthola izinhlobo eziningi zezifo. Masinyane ngemuva kokufakelwa kwakho usengozini yokutheleleka ngamagciwane kanye nefungal, kanye nokuvuselelwa kwamagciwane athile ahlala emzimbeni wakho (ngokwesibonelo, umkhuhlane wezinkukhu noma i-herpes simplex virus). Ezinyangeni ezimbalwa zokuqala ngemuva kokufakelwa kwakho uzoqhubeka nokungenwa yizifo, ikakhulukazi ukutheleleka ngegciwane.
• Isifo iVeno-Occlusive Disease (VOD): Lokhu kuyinkinga ethinta isibindi. Kubangelwa imithamo ephezulu yokwelashwa ngamakhemikhali engasetshenziswa ngesikhathi sokufakelwa kabusha. Lapho kwenzeka i-VOD, kuba nzima kakhulu esibindini bese amaphaphu nezinso kusebenza ngokujwayelekile. Izimpawu nezimpawu ze-VOD zingafaka i-jaundice (isikhumba esiphuzi namehlo), isisu esivuvukile nesinethenda (ikakhulukazi lapho kutholakala isibindi sakho), nokuzuza kwesisindo. Ukwelashwa kwe-VOD kungafaka imishanguzo ehlukahlukene, ukumpontshelwa igazi, ukuqapha ngokucophelela ukusebenza kwesibindi sakho nezinso, nokuhlolwa kwegazi.
• Izinkinga Zomkhuhlane Nenhliziyo: I-pneumonias ijwayelekile ngemuva kokufakelwa kabusha. Cishe ama-30-40% eziguli ezithola ukufakelwa kwe-allogeneic futhi cishe iziguli ezingama-25% ezithola ukufakelwa nge-autologous zizokhula inyumoniya ngesikhathi esithile lapho zifundisa. I-pneumonia ingaba nzima, ize isongele nokuphila kwezinye izimo. Akuzona zonke i-pneumonia ezibangelwa izifo.
• Ukopha: Ukopha ngemuva kokufakelwa kujwayelekile, ikakhulukazi lapho amazinga wakho weplatelet ephansi kakhulu. Ukumpontshelwa kweplatelet kunikezwa ukuzama ukuvimbela ukopha okukhulu. Ukubalwa kweplatelet yakho nezimpawu zokopha kuzobhekwa kaningi yithimba lakho lezokwelapha ngesikhathi sokufakelwa kwakho. Igazi emchameni (elibizwa nge-hematuria) nalo livamile ngemuva kwezinhlobo ezithile zokufakelwa, futhi kaningi kungenxa yegciwane elithile elithelela isinye sakho
• I-Graft Versus Host Disease: Isifo esibizwa ngokuthi yi-Graft versus host (GVHD) siyinkinga eyenzeka lapho ama-stem cells amasha (i-graft) esabela emzimbeni wakho (umphathi). Kungaba kusuka enkingeni emnene kakhulu noma kungaqhubekela phambili kokubeka impilo engcupheni.
Eziningi zalezi zivikelo kanye nemikhawulo kuyadingeka ukuvikela ukutheleleka nokopha. Umnkantsha wakho udinga isikhathi sokuvuthwa ngaphambi kokuba kubhekwe ukuthi utholakale ngokuphelele. Kuze kube yileso sikhathi, kunezinto okufanele uzibukele futhi usize ekuzivimbeleni. Le mikhawulo izokwehla ngokuhamba kwesikhathi, njengoba umnkantsha wakho namasosha omzimba esebenza ngokugcwele.
• Izifihla-buso: Isifihla-buso asidingeki uma usekhaya noma uphumile ekuhambeni, kodwa siyadingeka uma uvakashele ezimeni ezingcolile.
• Abantu: Gwema ukusondelana kakhulu nanoma ngubani ogulayo. Gwema izindawo eziminyene, ikakhulukazi ngenkathi yamakhaza nemikhuhlane. Hlala kude nanoma ngubani ovezwa yisifo esithathelwanayo kanye / noma sobuntwana.
• Izilwane ezifuywayo nezilwane: Izilwane zasekhaya zingahlala ekhaya, ngaphandle kwezinyoni nezilwane ezihuquzelayo. Gwema konke ukuxhumana nezinyoni noma izilwane ezihuquzelayo kanye nobulongwe bazo; bathwala izifo eziningi. Gwema ukuxhumana nodoti wezilwane.
• Izitshalo nezimbali: Lezi zingahlala ekhaya. Gwema ukulima, ukugunda utshani kanye neminye imisebenzi evusa inhlabathi noma umhlabathi. Gwema ukuphatha izimbali ezisanda kusikwa ezitsheni; amanzi angathwala inani elikhulu lamagciwane.
• Ukuvakasha: Yazisa udokotela wakho ngaphambi kokuhamba. Ngokuvamile, kufanele ugweme ukubhukuda emachibini, amachibi omphakathi nokuhlala ezitsheni ezishisayo ngenxa yokuvezwa amagciwane amaningi.
• Ukuvivinya umzimba: Kubalulekile ukugcina uhlelo lomsebenzi oluchazwe esibhedlela ngudokotela wakho ongumzimba. Kukhona amathuba okuthuthukisa izifo emaphashini akho ngemuva kokufakelwa, futhi ukuhlala usebenza kungasiza ukugcina amaphaphu akho enamandla.
• Ukushayela: Ngeke ukwazi ukushayela okungenani izinyanga ezintathu ngemuva kokufakelwa kabusha. Lesi sikhathi singaba sifushane ezigulini ezithola amangqamuzana azo ama-stem. Ukuqina ngokomzimba kuyancishiswa futhi kungaholela ekwehleni kwesikhathi esisheshayo esidingekayo sokushayela okuphephile.
• Ukubuyela Emsebenzini noma Esikoleni: Ukubuyela kwakho emsebenzini noma esikoleni kuzoncika ohlotsheni lokufakelwa kabusha okutholayo nokuthi ukululama kwakho kuqhubeka kanjani. Ezinsukwini zokuqala eziyi-100 ngemuva kokufakelwa kwakho ngeke ubuyele emsebenzini noma esikoleni.
• Ukuphinda usebenze kabusha: Njengoba amasosha omzimba wakho ethinteka kakhulu ekufakelweni, kungenzeka ukuthi angabe esakhumbula ukuvezwa kwawo kwangaphambilini emigomeni yezingane. Ngakho-ke, uzophinde uvuselelwe kabusha "kokudutshulwa kwengane" yakho unyaka owodwa noma emibili ngemuva kokufakelwa kabusha.
• Ukudla: Ukulahlekelwa ukunambitheka nesifiso sokudla kwenzeka njalo ngemuva kokufakelwa kabusha. Uma unezinkinga zokudla ukudla okwanele kuma-calories namaprotheni, khuluma nesazi sethu sokudla.
Kulungile ukudla izithelo nemifino eluhlaza uma usuphumile esibhedlela. Lokhu kudla kufanele kuhlanzwe kahle ngaphansi kwamanzi agobhozayo kanye nemihuzuko noma izindawo ezimbi kufanele zisuswe. Izithelo nemifino engeke ihlanzwe kahle akufanele idliwe iluhlaza.
Upelepele namanye amakhambi omisiwe angangezwa ekudleni okuzobhakwa noma ukufudunyezwe ezingeni lokushisa elishisayo ku-microwave. Akufanele ungeze upelepele ekudleni osekuvele kufudunyeziwe noma okuzodliwa kungaphekiwe.
Kulungile ukudla ukudla okushisayo, okusanda kulungiswa futhi okuphekwe ngokuphelele. Izithelo, imifino kanye namasaladi okungavuthiwe noma okuthosiwe kufanele kugwenywe. Gwema imigoqo yesaladi, ama-smorgasbords, nama-potlucks. Cela ukuthi ukudla kulungiswe kusha, futhi u-ode ukudla ngaphandle kokufakwa okokuthambisa noma ama-condiments (ulethisi, utamatisi, imayonnaise). Inyama nenhlanzi kufanele kuphekwe kahle. Ungadli ukudla kwasolwandle okuluhlaza okufaka ama-oysters, i-sushi, i-sashimi, izinhlanzi zasolwandle ezinamanzi amancane njengezimbaza, izimbaza, neminenke.
Kungenzeka ulahlekelwe yimisipha ethile ngesikhathi ulaliswa esibhedlela. Ukudla amaprotheni anele kubalulekile ukubuyisa umzimba omncane futhi uvikele ukugcinwa koketshezi. Zama ukudla okuningi kwalokhu kudla: inyama yenkomo, inkukhu, inhlanzi, ushizi, amaqanda, imikhiqizo yobisi, ibhotela lamantongomane nobhontshisi. Uma ungenaso isifiso salokhu kudla okulandela ukufakelwa, cela i-Dietitian yakho ebhalisiwe ukuthola izindlela zokupheka ezinamaprotheni aphezulu
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