Kunezinzuzo ezinengi nezingozi ze- lymph node dissection ekwelapheni i-melanoma.
Uma i- melanoma isesikhumba , ingasuswa ngempumelelo nangunaphakade ezimweni eziningi. Ngezinye izikhathi, noma kunjalo, landa ( metastasizes ) kwezinye izingxenye zomzimba, ngokuvamile zihamba kuqala ezithombeni eziseduzane ezithombeni, entanyeni, noma ekuguleni kwakho. Uma udokotela wakho esolwa ukuthi lokhu kwenzekile, ukuhlolwa okubizwa ngokuthi i- sentinel node biopsy kuzokwenziwa ukuze kutholakale futhi kususwe i-lymph node lapho umdlavuza kungenzeka ukuthi usakaze khona ku-tumor oyinhloko.
Uma i-sentinel node biopsy inempilo (iqukethe amaseli anomdlavuza), sekuyisikhathi sesinqumo. Ingabe kufanele ube nazo zonke ezinye izilonda zamagciwane kule ndawo zisusiwe, enkambweni yokuhlinzwa ebizwa ngokuthi ukuqeda i-lymph node dissection (CLND, noma i-lymphadenectomy)? Umqondo wukuthi i-CLND iqinisekisa ukuthi amangqamuzana e-melanoma kuwo wonke amanye ama-lymph nodes asusiwe, okuyinto engavimbela lesi sifo ukuba sisakaze phambili.
Ngeshwa, ubufakazi abuhambisani, ngakho-ke lesi sinqumo asiqondile, ngisho nodokotela. Nazi ezinye izinzuzo nezindleko zokucabangela.
Izinzuzo ze-Lymph Node Dissection
1. I-CLND iyasiza ekunqumeni ngokunembile isigaba se-melanoma, esisiza udokotela ekwenzeni izincomo zokwelapha ngemuva kokuhlinzwa (adjuvant).
2. Inani lezinombolo eziqukethe amangqamuzana e-melanoma yindlela yokuphila kweziguli ezinezifo zesigaba sesi- III, kanti kuphela i-CLND inganikeza lolu lwazi.
3. Ucwaningo oluthile lubonisa ukuthi amaphesenti angu-20 eziguli ezithatha i-CLND ngokushesha ngemuva kokuthola ukuthi banesipiliyoni esihle se-sentinel lymph node isipiliyoni sokusinda. Lokhu kuyiqiniso ikakhulukazi ezigulini ezaba nezicubu eziphakathi komzimba (1.2 kuya 3.5 mm).
4. Ngokumisa ukusabalala kwe-melanoma kuma-lymph nodes, i-CLND yenza amathuba okuphulukiswa.
Ngisho nezinani ezincane kakhulu ze-melanoma ezithombeni zamagciwane zingagcina zithuthuka ngokuhamba kwesikhathi zibe eziphawulekayo nezingozi.
I-Cons Lymph Node Dissection
1. Izinkinga ze-CLND ziphawuleka futhi zenzeka ngamaphesenti angaba ngu-67, ikakhulu kulabo abangaphezu kuka-60. Lokhu kufaka:
- I-Buildup ye-fluid endaweni yokuhlinzwa ( seroma )
- Ukutheleleka
- Ukuvuvukala kwesitho esithintekayo ngokususwa kwe-lymph nodes ( lymphedema )
- Ubungcweti, ubuhlungu noma ubuhlungu endaweni yokuhlinza
- Ukwehlukanisa (isikhukhula) sesikhumba ngaphezu kwendawo
Nakuba ukuvuvukala ngemuva kokuhlinzwa kungavinjelwa noma kulawulwe ukusetshenziswa kwama-antibiotic, amasitokisi e-elastic, massage, kanye ne-diuretics, kungaba yinkimbinkimbi enzima.
2. Ukusebenza kwe-CLND kungase kuxhomeke ebukhulu besisu se-melanoma. Izicubu ezincane (0.1 mm noma ngaphansi ububanzi) ku-lymph node ye-sentinel angeke iholele kumetastasis nhlobo, ngakho ukwenza i-CLND kungase kungadingekile. Ucwaningo olwenziwa ngo-2009 lubonise ukuthi izinga lokuphila nokuphindaphindiwe kweziguli ezinezikhonda ezincane zifana nalabo ababengenayo i-melanoma e-lymph node yabo ye-sentinel. Ngakho-ke, lezi ziguli "ezingozi kakhulu" zingakwazi ukugwema i-CLND futhi zibe nomphumela ofanayo.
Okubalulekile
Ukukhetha ukwenza inqubo enkulu yokuhlinzwa efana ne-CLND akuyona isinqumo okufanele uthathe kalula, ikakhulukazi uma i-biopsy yakho ikhombisa kuphela inani elincinci le-melanoma kuma-lymph nodes akho.
Kunezici eziningi ezibandakanyekayo, kuhlanganise nobukhulu kanye nendawo ye-melanoma yakho eyinhloko, imiphumela ye-sentinel lymph node biopsy nezinye izivivinyo, kanye nobudala bakho. Ungathola ukuthi kuyasiza ukufuna umbono wesibili.
Izinkomba:
I-Boughton B (2009). Ingabe i-lymphadenectomy kufanele ibe yindlela yokunakekelwa kwe-melanoma metastasis kuya kuma-lymph nodes? I-Oncology News Intl. 18 (5).
Morton DL, Thompson JF, Cochran A, et al (2006). I-Sentinel-node biopsy noma i-nodal observation ku-melanoma. N Engl J Med. 2006 Sep 28; 355 (13): 1307-17.
UThomas JM (2005). Isikhathi Sokuhlola kabusha i-Sentinel Node Biopsy eMothanoma Post-I-Lymphadenectomy Ekhethiwe Yokukhetha I-Lymphadenectomy. J Clin Oncol. 2005 Dec 20; 23 (36): 9443-4.
van Akkooi AC, Rutkowski P, van der Ploeg IM, et al (2009). Ukulandelwa kwesikhathi eside kweziguli ezine-tumor burden (0.1mm) ngokwemigomo ye-Rotterdam: Ucwaningo lwe-EORTC Melanoma Group. J Clin Oncol 27: 15s, 2009 (suppl; abstr 9005).