I-peritoneum yi-membrane elinezinsika ezithwala izitho eziningi zesisu ezifana nesisu, iningi lesilwane esincane, ingxenye yesiguli esikhulu, isibindi, isilwane nomsila we-pancreas. Isifunda ngemuva kwalesi sithombeni sibhekwa ngokuthi i-retroperitoneum, okusho ngokwezwi nezwi "ngemuva kwe-peritoneum". Lesi sikhala siqukethe izingxenye zesibilini, ikhanda nomzimba we-pancreas, izinso nama-lymph nodes eyaziwa njenge-retroperitoneal lymph nodes.
Lezi zinhlayiya zinezigaba ezinjenge-paracaval, precaval, interaortocaval, preaortic, para-aortic, i-suprahilar ne-lymph nodes.
Kuyini Ukunciphisa I-Lymph Node Dissection?
I-retroperitoneal i-lymph node dissection (i-RPLND) iyisisindo sokukhishwa kwama-lymph node ecacisiwe. Ama-node angu-40-50 ngokuvamile asusiwe.
Kwenziwa Kanjani?
I-incision yenza ngaphansi kwe-sternum (ithambo lesifuba) phansi kwe-umbilicus (inkinobho yesisu). Ukuhlinzeka okuhlinzekwa kancane kwe-laparoscopic kuyatholakala ezindaweni ezithile, nakuba kungesiyo ejwayelekile. Isifuba sisezindlini ezidalula isikhala se-retroperitoneal. Lesi yisikhala esiboniswa ngumfanekiso ongenhla, nakuba awubonakali ukuhlinzwa ngokwayo. Izitsha ezinkulu zivezwe kanye nama-retroperitoneal lymph nodes esebenza ngokufanayo. Ama-lymph nodes ajabule ngokuziqaphela ukuze agweme ukulimaza izinzwa ezizungezile.
Ama-node athunyelwa ku-pathologist ukuhlola ukuthi kukhona umdlavuza. Lesi sifo sibuyiselwa esimweni esivamile futhi amanxeba avaliwe. Ubude bokuhlinzwa bungahlukana kepha bulinganiswa emahoreni.
Kuyasetshenziswa nini?
Ukwelashwa okuyinhloko kwamaningi amaningi omdlavuza we-testicular ukususwa kwe-testis yomdlavuza, inqubo yokuhlinzwa ebizwa ngokuthi i-orchiectomy eqinile.
Ukulandela i-orchiectomy eqinile, kunezinketho eziningi ezihlukene ngokuya ngesiteji nohlobo lomdlavuza we-testicular: ukubhekwa, i-chemotherapy kanye / noma i-RPLND.
I-RPLND isetshenziselwa ngokuyinhloko uhlobo lomdlavuza we-germ testicular owaziwa ngokuthi yi-nonseminoma.
Ukugxila kubaluleke kakhulu lapho kunquma izinketho zokwelashwa. Ngokwejwayelekile, umdlavuza wesigaba uvalwe e-testis, isigaba II sihilela izilonda ze-retroperitoneal kanye nesigaba sesi-III zihilela noma yiziphi ezinye izitho noma amantombazane afana namaphaphu. Isigaba I silandelwa yizinhlamvu A noma B. Isigaba II silandelwa yizinhlamvu A, B noma C. Lezi zincwadi zibonisa ukuthi zihlasela kanjani isisu esiyinhloko esiteji I noma ukuthi i-lymph nodes inkulu kangakanani esiteji II.
Esikhathini se-IA (isisu esivinjelwe ku-testis ne- epididymis ), i-RPLND iyindlela yokukhetha, kodwa ukubhekwa (ukugcina iso kuphela ezintweni) kuvame ukukhetha. Kodwa-ke, esigabeni se-IB (isisu esihlasela igazi noma izitsha zethempeli, isikhala se-scrotum noma i-spermatic), noma i-RPLND noma i-chemotherapy inconywa. Esikhathini se-IIA (ama-lymph nodes angaphezu kuka-2 cm ububanzi) i-RPLND yindlela yokwelashwa ethandwayo. Esikhathini se-IIB (amantombazane angama-lymph aphakathi kuka-2-5 cm ububanzi) i-RPLND ingacatshangwa ezimweni ezikhethiwe, kodwa i-chemotherapy ngokuvamile iyindlela yokwelashwa.
Umdlavuza we-Stage II nawo ungaphathwa nge-chemotherapy up-front. Uma kusekhona ubufakazi bokusinda komdlavuza ngemuva kwe-chemotherapy (i-lymph nodes noma izixuku> 1 cm), i-RPLND iyindlela yokukhetha, nakuba kunzima ngokwengeziwe ukwenza le-chemotherapy elandelayo.
Uma Ingasetshenzisiwe
Akufanele isetshenziswe kwezinye izinhlobo zomdlavuza we-testicular njenge-seminoma. Akufanele kwenziwe uma i-lymph nodes ingaphezulu kuka-5 cm ububanzi. Akufanele isetshenziswe uma izimpawu ze-tumor zegazi zingabuyiselanga ku-orchiectomy ejwayelekile. Akufanele isetshenziswe kunoma yisiphi esinye isimo lapho ukuhlinzeka nokuhlinzwa kwe-anesthesia kungenakubekezelela ngokuphepha.
Izinzuzo, Izinsalela, kanye Nemiphumela Ehlangothini
Inzuzo enkulu ku-RPLND iphilisa umdlavuza. Enye inzuzo ukwazi ngokuqinisekile ukuthi i-lymph nodes iqukethe umdlavuza noma cha. Ngaphezu kwalokho, eziningi ze-nonseminoma cancers testicular zizoqukatha i-teratoma. I-Teratoma iyisisu esinobuthi futhi ngokuvamile ayisakazeli ngokwayo. Noma kunjalo, ingasakazeka uma ixubene nezinye izinhlobo ze-nonseminoma. Kungani lokhu kukhathazeka? I-Teratoma ayiphenduli kakhulu ekhemotherapy noma ukwelashwa kwama-radiation ukuze indlela kuphela yokuyiqeda uma isakaze kuma-lymph nodes ngukuhlinzwa. Uma i-teratoma ishiywe ngemuva kwe-chemotherapy elandelayo, ingase ikhule futhi ibangele izimpawu noma zishintshe zibe uhlobo olunamandla lomdlavuza.
I-RPLND ingathinta ukuzala ngokwenza ukuthi kube nenkinga eyaziwa ngokuthi i-retrograde ejaculation. Ejaculation ejwayelekile, izikhwama zomzimba ukuvimbela isisu ukubuyela emuva (retrograde) ku-urethra nokuphela kwesinye isifiso esikhundleni sokuxoshwa ngaphakathi nangaphandle kwepeni. Lokhu kungase kwenzeke ngoba izinzwa ezibhekene nokuchotshozwa kwalesi musipha zigijima eduze kwe-lymph nodes futhi zonakaliswa ngesikhathi sokuhlinzwa. Kodwa-ke, ngezinkambiso zanamuhla zokuzikhandla, le ngozi ingaphansi kuka-10% ezimweni eziningi.
Eminye imiphumela emibi yokwelapha ifana nokunye ukuhlinzwa kwesisu: ukuvimbela isisu, ukutheleleka, kanye nokuphendula ku-anesthesia.
Isinqumo sokuqhubeka no-RPLND yiyona edinga ukuxoxwa ngokugcwele nomqeqeshi wakho womdlavuza ukuze unqume ukuzuza kwayo futhi uxoxisane nezinye izindlela.