I-thoracotomy iyindlela enhle yokuhlinza abahlinzayo ukuba bafinyelele emgodini wesifuba ngesikhathi sokuhlinzwa. I-incision yenziwe ngodonga lwesifuba, futhi ukufinyelela kwezitho zesifuba kwenziwa ngesinqunyiwe futhi mhlawumbe kususa ingxenye yembambo. Inqubo yenziwa ekamelweni lokusebenza ngaphansi kwe-anesthesia jikelele.
Izizathu Zokungena Eyodwa
I-thoracotomy ingenziwa ngezizathu eziningana, hhayi nje ukususwa komdlavuza.
Ukuvula nokuvula isikhumba esifubeni kanye ne-mediastinum (indawo emkhatsini wamaphaphu) kunganika odokotela abahlinzayo ukufinyelela enhliziyweni, emaphashini, emaphasheni, engxenyeni engenhla (thoracic) noma e-aorta, nangaphambili (ingxenye yangaphakathi) yomgogodla. Ezinye izinkomba zifaka:
- Ukuhlinzwa komdlavuza we-Lung
- Ukuhlinzwa komdlavuza we-Esophageal
- Ukuhlinzwa kwenhliziyo / aortic
- I-traum trauma
- I-pneumothorax eqhubekayo (amaphaphu aphelile)
- Ukuphathwa kwe-COPD
- Isifo sofuba
- Ukuphikisana nokuhlolwa kwesimo esingaziwayo se-mediastinal
- Ukuhlinzwa kuya emthonjeni wangaphakathi
- I-thoracotomy yokuvuselela (isifo esiphuthumayo se-thoracotomy) - Lena yinkqubo eyenziwe ekamelweni eliphuthumayo lokuphuthumayo okusongela ukuphila okunjenge-chest hemorrhage
Izinhlobo Zenqubo
Kunezinhlobo eziningi ezahlukene ze-thoracotomy ezingenziwa, kuye ngokuthi kuboniswe kanjani ukuhlinzeka futhi isimo siphathwa. Lokhu kufaka:
- I-thoracotomy ye-Posterolateral - Lena yindlela evamile kakhulu futhi indlela evamile yokuthola amaphaphu ukususa amaphaphu noma ingxenye yamaphaphu ukuphatha umdlavuza wamaphaphu . I-incision isenziwa eceleni kwesifuba emuva emhlane phakathi kwezimbambo. Izimbambo ziyakwazi ukusabalalisa (isibambo singasuswa futhi) ukuze sibone ngamaphaphu. Odokotela abahlinzayo bangase basuse amaphaphu ( pneumonectomy ), i-lobe yeyodwa yamapayipi ( lobectomy ), noma ingxenye encane yamaphaphu (i- wedge resection ).
- I-thoracotomy ye-Median - E-thoracotomy ephakathi, odokotela abahlinzayo benza ukuchotshozwa nge-sternum (isifuba) ukuze bathole ukufinyelela esifubeni. Le nqubo ivame ukwenza okwenziwa ukuhlinzwa enhliziyweni.
- I-thoracotomy ye-Axillary - Ku-thoracotomy ye-axillary, odokotela abahlinzayo bayakwazi ukufinyelela esifubeni ngokusebenzisa umshini eduze kwe-armpit. Lokhu kuvame ukwenziwa ekuphatheni i- pneumothorax (amaphaphu awehliwe), kodwa kungenzeka futhi kwenziwe ngezinhlinzeko ezithile zenhliziyo nephuphu.
- I-anterolateral thoracotomy - Le nqubo yindlela yokuphuthumayo ehilela ukuhlambuluka phambi kwesifuba. Kungenziwa ngemuva kokuhlukunyezwa okukhulu kwesifuba, noma ukuvumela ukufinyelela okuqondile enhliziyweni ngemva kokuboshwa komzimba.
Ukuhlela nokulungiselela
Ngaphambi kokuba ube ne-thoracotomy uzothola umlando oqaphele futhi uyenziwe ngokomzimba, futhi ungase ube nezifundo ukuhlola umsebenzi wakho wenhliziyo nephuphu. Uma thoracotomy yakho yenziwa ngomdlavuza wamaphaphu, kungase kubalulekile futhi ukuthola umbono wesibili . Ucwaningo lubonisa ukuthi abantu abanezinhlinzeko ezihlinzekwe emitholampilo yomdlavuza okwenza amanani amaningi kakhulu kulezi zinqubo zingase zibe nemiphumela engcono. Kubantu abathile, inqubo encane engavumayo eyaziwa ngokuthi ukuhlinzeka nge-thoracoscopic (VATS) yevidiyo ingasetshenziswa esikhundleni se-thoracotomy, kodwa lokhu akutholakali kuzo zonke izibhedlela.
Inqubo
I-thoracotomy ivame ukwenza ngaphansi kwe-anesthesia jikelele ekamelweni lokusebenza. Ukugxila okude kuyenziwa eceleni kolunye uhlangothi lwesifuba, futhi izimbambo zihlukanisiwe ukuze zifinyelele esifubeni. Kuyo yonke inqubo, izimpawu ezibalulekile ziqashwe ngokucophelela ukuqinisekisa ukuthi ubekezelela inqubo kahle. Lapho ukuhlinzwa sekuphelile, ithubhu yesifuba ivame ukufakwa emgodini wesifuba futhi ihambe endaweni ethile isikhathi esithile.
Izinkinga ezingenzeka
Abanye abantu bahamba nge-thoracotomy ngaphandle kokubhekana nanoma yikuphi ukucindezeleka, kanti abanye bangase bahlangabezane nezinkinga ezithile noma ngaphezulu. Kubalulekile ukukhuluma ngokucophelela nodokotela wakho ohlinzayo mayelana nokuhlinzwa kwakho okuqondile nokuthi yini ongayilindela. Ngokuqinisekile, labo abanempilo ngokujwayelekile ngaphambi kwenqubo cishe bayoba nenkambo elula kunalabo ababhekana nokukhathazeka okwengeziwe kwezokwelapha. Futhi njengoba kunoma yikuphi ukuhlinzwa, ukubhema kungandisa ingozi yezinkinga ezinkulu.
Eminye imiphumela emibi engaba khona kanye nezinkinga ze-thoracotomy ingafaka:
- Isidingo eside sokwesekwa kwe-ventilatory ngemuva kokuhlinzwa
- Ukuqhuma emoyeni okuqhubekayo okuholela ekudleni kwesikhathi eside se-tube esifubeni ngemva kokuhlinzwa
- Ukutheleleka
- Ukuphuza
- Amaqabunga egazi - I-thrombosis ejulile yegazi (i-blood clots) kanye ne-pulmonary emboli (ama-clots egazi aphumula futhi ahambe aye emaphashini) iyinkimbinkimbi evamile futhi eyinkimbinkimbi yokuhlinzwa kwesifuba
- Izinkinga ze-anesthesia jikelele
- Ukuhlasela kwenhliziyo noma izi-arrhythmias
- Ukukhubazeka kwentambo noma ukukhubazeka
- I-fostula ye-bronchopleural - Lokhu kuyinkimbinkimbi lapho kuhamba khona indlela engavamile phakathi kwesikhuni se-bronchial kanye nesikhala phakathi kwezingqimba (pleura) ezifaka emaphashini
- I-postpneumonectomy syndrome noma i-post-thoracotomy syndrome - Ubuhlungu esifundeni se-thoracotomy ngezinye izikhathi kungaphikelela isikhathi eside ngemva kokuhlinzwa
Imibuzo Yokubuza Ngaphambi Kwamanje
Cabangela ukubuza udokotela wakho imibuzo elandelayo, bese ubhala phansi eminye imibuzo ongayithola.
- Ubani ozokwenza lo msebenzi?
- Zingaki zalezi zinqubo ozenzile?
- Yiziphi ezinye izinkinga engingayilindela?
- Kuzoze kube nini inqubo?
- Kuze kube nini ngingaba esibhedlela ngemuva kokuhlinzwa?
- Ngingashesha kanjani ukubuyela emsebenzini?
- Ingabe uncoma ukuthi nginokuvuselelwa kwepayipi emva kokuhlinzwa?
- Yini engingayilindela esikhathini eside - ukusho, unyaka kusukela manje noma eminyakeni emithathu kusukela manje?
- Ubani okufanele ngibize uma ngibhekana nezinkinga ngemva kokubuyela ekhaya?
Izibonelo: Udokotela ohlinzayo uJim utshele ukuthi uzokwenza i-thoracotomy ukuze athole amaphaphu akhe futhi enze lobectomy yakhe yomdlavuza wamaphaphu.
Imithombo:
IBendixen, M., Jorgensen, O., uKronborg, C., Andersen, C., noP. Licht. Ubuhlungu kanye nesimiso sokuphila emva kwe-lobectomy ngokusebenzisa ukuhlinzwa kwe-thoracoscopic okusizwa ngevidiyo noma i-anterolateralthoracotomy kumdlavuza wamaphaphu okuqala: isilingo esilawulwa ngokungahleliwe. I-Lancet Oncology . 2016. 17 (6): 836-44.
UFernandez, R., uKosinski, A., Burfeind, W. et al. I-Society of Thoracic Surgeons I-Lung Cancer Resection Risk Model: Idatha Ephezulu Yezinga eliphezulu kanye Nemiphumela Ephakeme. Ama-Annal of Surgery Thoracic . 2016 Meyi 19. (Epub ngaphambi kokuphrinta).
I-Sengupta, i-S. Post-operative amapulmonary complications emva kwe-thoracotomy. I-Indian Journal ye-Anesthesia . 2015. 59 (9): 618-26.
System of Health University System of Michigan. Ukulungiselela I-Thoracotomy Yakho. Http://surgery.med.umich.edu/thoracic/pdf/preparingforyourthoracotomy.pdf