I-fistula ye-bronchopleural iyindlela engavamile (i-sinus tract) eqhubekela phambili phakathi kwemikhumbi ehamba phambili emaphashini (i -bronchi ) kanye nendawo phakathi kwezingqimba ezibeka emaphashini (isikhala somlomo) . Uma indlela efana nalokhu iqala, umoya ophefumula emaphaphini ungahamba ngendlela ehambayo bese ufaka isikhala sokukhala.
Izimbangela
Kunezimo eziningana ezingabangela i-fistula ye-bronchopleural.
Ezinye zazo zihlanganisa:
- Ukuhlinzekwa komdlavuza we-Lung - Ukuthengiswa kwamapulmonary (ukususwa kwamaphaphu noma ingxenye yamaphaphu) umdlavuza wamaphaphu kungumphumela ovame kakhulu we-fistula ye-bronchopleural. Kungenzeka ukuthi kwenzeke nge- pneumonectomy (ukususwa okuphelele kwamaphaphu) kunenqubo efana ne- lobectomy (ukususwa kwe-lobe yamaphaphu) noma ukukhishwa kwemigqa (ukususwa kwesigaba somumo we-lobe wamaphaphu Ngesifundo se-2016, amaphesenti angu-1.4 abantu abane-lobectomy kanye namaphesenti angu-14,3 abantu abane-pneumonectomy bahlakulela i-fistula ye-bronchopleural emva kokuhlinzwa.
- Ukwelashwa (ikakhulukazi ezinye izinhlobo ze-pneumonia eziholela ekuqhekekeni kwezicubu ezibizwa nge-lung necrosis.)
- I-pneumothorax eqhubekayo eqhubekayo - Lokhu kubhekisela emaphashini ahlakazekile (i-pneumothorax) engekho.
- Ukwelashwa kwe-Chemotherapy noma imishanguzo yomdlavuza wamaphaphu - Noma imuphi ukwelashwa okubangela ukulimala kwamangqamuzana nokuphulukiswa okulandelayo endaweni yomngcele we-pleural kungaholela ekwakheni i-fistula.
- Isifo sofuba.
Kufana Kanjani?
Izifundo ezibhekene nezibalo ze-fistula e-bronchopleural ziyahlukahluka, kodwa kubonakala sengathi zenzeka phakathi kwamaphesenti angu-1.5 no-28 okuhlinzekwa okubandakanya ukususwa kwamaphaphu. Njengoba kuphawuliwe ekuqaleni, kungenzeka ukuthi kwenzeke ngokuhlinzwa okubanzi futhi kungenzeka ukuthi kwenzeke ngemuva kwe-pneumonectomy esekelwe ngakwesokudla, lapho umoya wokuphuza umoya udingwa isikhathi eside esilandelayo ngemva kokuhlinzwa, futhi uma ukukhishwa kwama-radiation aphezulu kunikwa kuqala ukuhlinzwa.
Ngokuvamile, i-fostula ye-bronchopulmonary izotholakala ngemva kwamasonto amabili emva kokuhlinzeka ngamaphaphu, nakuba i-fistula ingenzeka ngisho nenyanga ngemva kokuhlinzwa.
Izimpawu
Njengoba kuphawuliwe lapha ngezansi uma ucutshungulwa, i-fistula ye-bronchopleural ivame ukutholakala ngokusekelwe ekucabangeni okutholakele lapho kuqhuma umoya ophikisayo. Uma izimpawu zikhona, zingasuswa kalula njengoba ziyizimpawu ezingalindelwa ukulandela izifo zamaphaphu nokuhlinzwa, njengokukhwehlela okuqhubekayo, ukukhwehlela igazi, noma ukuphefumula.
Ukuxilongwa
Ukuxilongwa kwe-fistula e-bronchopleural ngokuvamile kwenziwa ngokusekelwe ekutholeni okutholakala nge-radiological. I-CT scan ngokuvamile iwuhlolo lokuzikhethela ukuhlola isimo futhi ingabonisa umoya okhulayo noma omswakama (ngokuvamile ukuqhuma noma i- empyema ) endaweni yokukhala.
I-fistula ye-bronchopleural ivame ukusola ngemitholampilo ngokubheka ukuqhuma komoya okuqhubekayo. Ngamanye amazwi, lezi fistula zivame ukutholakala uma ithubhu yesifuba ingakwazi ukususwa ngemuva kokuhlinzwa ngamaphaphu ngenxa yokuvuza okuqhubekayo emoyeni. Kungase kube nokuqhuma okuqhubekayo, noma kunalokho, ukuvuza kwemoya kungase kube khona ngesikhathi sokuphefumulelwa noma ukuphela kwesikhathi. Ngomoya ophansi ovuza, ukuqhuma kungase kube khona ngesikhathi sokuphelelwa yisikhathi noma ukukhwehlela.
Ukwelapha
Ukwelapha kungenziwa ngokuhlinzwa, noma ekugcineni nge-tube bronchoscopy (ngezinye izikhathi lokhu kuyindlela kuphela etholakalayo uma isiguli singahlali) futhi ucwaningo lwamuva lubonisa ukuthi izinqubo ze-endoscopic zingase zibe zombili eziphephile futhi zisebenzayo noma abantu abaningi.
Kungakhathaliseki ukuthi yenzani, ukugeleza kwamanzi kagesi endaweni ye-pleural (ngokusebenzisa i-thoracentesis noma ukugcina ithubhu lesifuba) kanye namagciwane we-antibactic kubalulekile.
- Ukuhlinzwa kungasetshenziswa ukuvala i-fistula.
- I-bronchoscopy - Kule nqubo, i-fistula ifinyelelwe futhi i-glues noma i-sealants ifakwe ukuvala umgwaqo. Lezi zimakhemikhali (ngokuvamile i-nitrate yesiliva) zibangelwa ukuvuvukala e-fistula eholela ekunqandeni nasekuvaleni, ngokuphumelelayo ukugcizelela ingqikithi engavamile.
Isibikezelo
I-fistula ye-bronchopleural iyinkimbinkimbi enkulu yokuhlinzekwa komdlavuza wamaphaphu nokufa (ukufa) amazinga afana namaphesenti angu-10 kuya kwangu-27 kuye ngokuthi isifundo.
Ngokuqashelwa ngokushesha kanye nokwelashwa okulindelekile, kungenzeka ukuthi ukubikezelwa kwe-fostula ye-bronchopleural kuzokwenza ngcono.
Futhi eyaziwa ngokuthi: umoya we-bronchopleural uvuza, i-BPF
Izibonelo: USam wahlakulela i-fistula ye-bronchopleural ngemuva kwe-pneumonectomy yakhe yomdlavuza wamaphaphu futhi kwakudingeka ahlale esibhedlela isikhathi eside kunalokho ayekulindele.
> Imithombo:
> Birdas, T. et al. Izici zengozi ye-fistula ye-bronchopleural emva kwe-pneumonectomy efanele: ingabe ukuqeda i-diverticulum ye-stump inikeza ukuvikelwa? . Ama-Annal of Oncology Yokuhlinza . 2012. 19 (4): 1336-42.
> Boudaya, M. et al. Ukuphathwa kokugcinwa kwemvelo kwe-fostula ye-bronchopleural postoperative. I-Journal ye-Thoracic and Surgery Cardiovascular . 2013. 146 (3): 575-9.
> Fuso, L., Varone, F., Nachira, D. et al. Ukukhubazeka Nokuphathwa Kwe-Post-Lobectomy ne-Pneumonectomy I-Bronchopleural Fistula. Lung . 194 (2): 299-305.