Kungenzeka ukuthi udokotela wakho wakhuthaza i-pleurectomy njengendlela yokuhlinzeka ngokuphindaphindiwe kwe-pleural effusions, i-pneumothoraces, noma i-mesothelioma. Iyini ngempela lolu hlobo lokuhlinzwa? Yiziphi izingozi kanye nezinkinga ezingenzeka, futhi yikuphi ukuchazwa?
I-pleurectomy yindlela yokuhlinza eyenziwa ukususa ingxenye ye- pleura , i-linings ejikeleze amaphaphu.
Amapayipi azungezwe izibilini ezimbili; i- parietal pleura ngaphandle, esiseduze nodonga lwesifuba, ne- plecer visuraal ngaphakathi, esiseduze namaphaphu. Phakathi kwe-pleura ubeka imigqa yesikhalazo . Ngokuvamile, kunomthamo omncane oketshezi kulesi sikhala (cishe amathisipuni amabili noma amathathu) okusiphazamisayo futhi kusiza ukugcoba amapayipi emaphaphu ngesikhathi sokuphefumula.
Izizathu zePleurectomy
Ngaphandle kwe-pleurectomy ye-mesothelioma (lapho i-pleura ngokwayo ingathinteka khona ngumdlavuza), i-pleurectomy ivame ukunconywa ngemva kokunye ukwelashwa kwehlulekile. Isibonelo, uma umuntu eqhubeka ethuthukisa uketshezi noma umoya endaweni yokukhalaza naphezu kokugonywa nge-thoracentesis.)
Kunezizathu ezimbalwa ezahlukahlukene zokuthi kungani udokotela wakho angancoma i-pleurectomy:
- Ukwelashwa kwe-mesothelioma - Isibonakaliso esivame kakhulu se-pleurectomy ukuphatha i-mesothelioma engalungile . Lo mdlavuza, ovame ukuhlobene nokuchayeka kwe-asbestos, ungabuka emanzini enxantathu (i-mesothelioma yesineke) kanye nezinsimbi zenhliziyo nesisu. Uma i-pleurectomy isetshenziselwa ukwelapha i-mesothelioma, ivame ukuhlanganiswa nenqubo ebizwa ngokuthi i-decortication (i-pleurectomy decortication.) Lezi zinqubo azibandakanyi nje ukususwa kwe-pleura kodwa kwanoma yisiphi isisu esisondelene esingase sibe khona emgodini wesifuba. Ukuhlinzwa okuhlukile kwe-mesothelioma yi-pneumonectomy engavamile, inqubo eyingozi kakhulu. Naphezu kwezinga eliphakeme lokucindezeleka nge-pneumonectomy engavamile, ukusinda kubonakala kufana phakathi kwe-pleurectomy decortication kanye ne-pneumonectomy eyengeziwe
- Ukunakekelwa kwamandla okuphindaphindiwe we-pleural noma ukuxoshwa okubuhlungu kwe-pleural - I-pleurectomy ingenziwa nakwabantu abanezinkinga eziqhubekayo noma eziphindaphindiwe lapho ezinye izinqubo (njenge- pleurodesis ) zehluleka ukuvimbela nokuvimbela uketshezi okwakhiwe phakathi kwezingxenye zokukhala. Esikhathini se-pleurodesis, ikhemikhali ifakwa phakathi kwezingxenye ezimbili zamapayipi emzamweni wokweba lezi zigaba ndawonye. Ngezinye izikhathi ukuxoshwa kwezwi elibizayo kuwu "multiloculated" okusho ukuthi kunezindawo eziningana ezihlukene lapho i-fluid ingakha khona. Lokhu kungenza ukufaka i-stent noma i-pleurodesis engasebenzi. Ngokususa i-pleura, ukwakheka kwe-fluid kungavinjelwa.
- Ukwelashwa kwamagciwane amabizo angalungile - I-Pleurectomy isetshenziselwa ngendlela efanayo ukuphatha ukuhlukumeza okungalungile kwezwi . Ukusetshenziswa kwamabizo angalungile kuyisimo esibucayi lapho amangqamuzana omdlavuza ekhona khona. Bangase bavele emdlalweni wamaphaphu oyinhloko, noma ngenxa yezinsalela ezivela kwamanye amagciwane efana nomdlavuza webele . Ngenkathi ukwelashwa kwama-effusions amahloni amabi kakhulu ngokuvamile, ukulawula ukwakhiwa kwe-fluid kungase kuthuthukise ukuphefumula nokunciphisa ubuhlungu.
- Ukwelashwa kwe-pneumothorax ephindaphindiwe - Uma uke wahlupheka ngamapneumothoraces amabili noma ngaphezulu (amaphaphu aphelile) i-pleurectomy ingenziwa ukuze kuvinjelwe ukuphindaphindiwe.
Inqubo
I-pleurectomy ivame ukwenza ngaphansi kwe-anesthesia ejwayelekile ekamelweni lokusebenza.
Ngaphakathi kwe-pleurectomy, ukuhlunga kwenziwa ngemuva kanye nokufana namaphaphu (i-thoracotomy.) Ngemva kokuthola ukufinyelela udokotela ohlinzayo ngokucophelela uphonsa futhi ususe izingxenye zokukhala. Izicubu ezengeziwe zingasuswa uma udokotela wakho esebenza nge-mesothelioma. Ngaphambi kokuvalwa kwe-incision, amashubhu e-drainage asetshenziselwa ukuthi asuswe ngemuva kwesikhathi lapho ukuphuma nokukhipha kwincane. Ukuchotshozwa kuvaliwe, kaningi nge-sutures okuzoqedwa ngokwabo.
Izingozi nezinkinga
Izingozi ze-pleurectomy zifana nezindlela eziningi zokuhlinzwa futhi zifaka:
- Ingozi ye-anesthesia (i-anesthetic jikelele ngokuvamile isetshenziselwa i-pleurectomy)
- Ukuphuza
- Ukutheleleka
- Ukulimala kwamapayipi nezinye izitho emgodini wesifuba
- Ukuqhuma emoyeni okuqhubekayo (ngezinye izikhathi kungase kube nzima ukususa ithubhu lesifuba kulandela i-pleurectomy ngenxa yokuvuza okuqhubekayo emoyeni)
Izinkinga zingase zibandakanye ukususwa okungenele kwezicubu zomlomo ukuze i-pleural effusion noma i-pneumothorax ibuyele. Izicubu zesikhumba (ukunamathela) kungathuthuka esifubeni futhi ubuhlungu obungapheli bungenzeka kwabanye abantu.
Nge-mesothelioma, izingozi ngokuvamile zixhomeke emkhakheni womdlavuza kanye nekhono lomhlinzeki wokuhlinza ukufinyelela nokususa izicubu zomdlavuza.
Ngemuva kokuhlinzwa
Ukwelapha okuphefumula kuvame ukubandakanya phakathi nesikhathi sakho sokuphumula, kukusiza ukuba uphefumule ngokujulile futhi uphume embhedeni ngokushesha ukuze unciphise ingozi ye-pneumonia, i-blood clots, nezinye izinkinga. Ukuvuselelwa kwepulmonary kunganconywa phansi komugqa kanye nokuthuthukisa ukuphefumula.
Isibikezelo
Ngokuvamile, i-pleurectomy ibekezelela kahle. Kubantu abanesifo se-mesothelioma esivuthayo, ngokuvamile kuvamise ukwelapha , okusho ukuthi kwenziwa ukunciphisa izimpawu nokuthuthukisa induduzo kodwa ayilulanga lesi sifo.
I-pleurectomy kubantu abane-mesothelioma ingathuthukisa isikhathi sokuphila, futhi ithuthukise izimpawu zokuphefumula.
Izibonelo
Ngemuva kokuthi uKen atholakale enesifo se-mesothelioma, udokotela wakhe watusa ukuthi abe ne-pleurectomy kanye nokuhlobisa ukukhipha isisu endaweni yakhe yesifuba nesifuba esiseduze.
> Imithombo:
> Cao, C. et al. Ukubuyekezwa okuhlelekile nokuhlaziywa kwe-meta yezokwelapha zokwelapha nge-mesothelioma engalungile yesikhalazo. I-Cancer Lung . 2014. 83 (2): 240-5.
> Hasegawa, S. I-pneumonectomy eyengeziwe noma i-pleurectomy / i-decortication ye-mesothelioma engamanga. I-General Thoracic and Surgery Cardiovascular . 2014. 62 (9): 516-21.
> Vlahu, T., noW.Vigneswaran. I-Pleurectomy ne-Decortication. Ama-Annal of Medicational Medicine . 2017. 5 (11): 246.