Ukuhlukumeza okumbi kabi kuyinkimbinkimbi ehilela ukwakhiwa kwamanzi anesifo somdlavuza phakathi kwamagundane afaka amaphaphu. Kwenzeka cishe ezingamaphesenti angama-30 wamanqamu wamaphaphu, kodwa futhi kungenzeka nangamanye amagciwane, njengomdlavuza webele, umdlavuza we-ovarian, i-leukemias, ne-lymphomas. Ngomdlavuza wamaphaphu, ukuxuba okubi kabi kwe-pleural kungase kube uphawu lokuqala lomdlavuza, noma kungase kube khona ukuhlukunyezwa okuphelile komdlavuza wamaphaphu ophakeme .
Yini okudingeka ukwazi ngezimpawu, izimbangela, kanye nokwelashwa kwalezi zinkinga?
Sibutsetelo
Imfucumfucu yesikhala isichazwa njengenani elingavamile lomkhuhlane esikhaleni phakathi kwezingxenye zezicubu (i- pleura ) ezibeka emaphashini. Uma umdlavuza wamangqamuzana akhona kulokhu oketshezi (isikhala samanzi), kuthiwa yi-effusion enonya (engumdlavuza). I-effusion engalungile yesikhalazo ingaba enkulu futhi isakazeke noma incane iphinde ihilele ingxenye encane yesigxobo se- pleural . I-effusion ingahle ibe yinye endaweni eyodwa, noma kungenzeka kube nezindawo ezimbalwa zokuxoshwa (i-pleated pleural effusions).
Izimbangela
Cishe noma yiluphi uhlobo lomdlavuza lungabangela ukuxoshwa kwe-pleural uma ikhona noma isakazeka (i-metastasizes) endaweni yesifuba. Okuvamile kakhulu umdlavuza webele, umdlavuza wamaphaphu, umdlavuza we-ovarian, kanye nezinye izinhlobo ze-leukemi ne-lymphomas. Ukuxoshwa komzwelo kungase kubangelwe ukwelashwa komdlavuza wamaphaphu, njengokuhlinzwa, ukwelapha imisebe, noma i-chemotherapy.
Izimpawu
Izimpawu zephunga elibi eliyingozi lomsindo lingenakukhathazeka kakhulu. Ukuphefumula kungumqondo ovame kakhulu, okwenzeka kubantu abangamaphesenti angaba ngu-80. Ukukhwehlela kungase kube khona, futhi lokhu kuvame ukungabi nesimo, okusho ukuthi kungase kube kubi nakwezinye izikhundla ezifana nokugxila phambili noma ukulala ngakolunye uhlangothi.
Ukucindezeleka kwesifuba noma uhlobo oluthile lokuzwa kwesifuba kungavamile.
Ukuxilongwa
Kubalulekile ukwenza ukuxilongwa okunembile kwenhlanhla embi ye-pleural kusukela ukubikezela nokwelapha kuhluke kakhulu kunezingasebenzi ezingenabungozi (ezinobungozi). Kubalulekile ukuqaphela ukuthi ngisho nangomdlavuza, amaphesenti angaba ngu-50 e-pleural effusions ahlanzekile.
Ngokuvamile ukuxolisa okubi kabi kwecala kunomsolo wokuqala ngenxa yezimpawu noma okufundwayo okubonwe esikhwameni se-X-ray noma nge-CT scan. Uma udokotela wakho esolisa ukuhlukumeza okumbi kabi, isinyathelo esilandelayo ngokuvamile i- thoracentesis , inqubo lapho inaliti ifakwa khona ngodonga lwesifuba singene esikhaleni se-pleural ukuthola isampula ketshezi. Lokhu kusetshenziselwa uketshezi ngaphansi kwe-microscope ukubona ukuthi kukhona yini umdlavuza wamangqamuzana.
Uma i-thoracentesis ingenakwenziwa, noma uma imiphumela ingavumelani, izinqubo ezengeziwe zingadingeka zenziwe ukuze zithole ukuhlonza okuqondile. Kwezinye izimo, i- thoracoscopy (inqubo lapho i-thoracoscope efakwe esifubeni) ingadinga ukuthi yenziwe ukuze ithole i-biopsy ukuze ihlolwe ukuxoshwa okubi kabi kwe-pleural.
Ukwelapha
Umgomo wokwelapha i-effusion ebulalayo yesikhulumi ivame ukwanda , okungukuthi, ukuthuthukisa ikhwalithi yokuphila nokunciphisa izimpawu kodwa hhayi ukwelapha umdlavuza.
Uma i-effusion iyingcosana kakhulu, ngezinye izikhathi ingashiywa yedwa.
Thoracentesis
Njengoba kuphawuliwe ngenhla, i-thoracentesis ngokuvamile iyisinyathelo sokuqala esisetshenzisiwe, kokubili ukuhlolisisa i-effusion (sinquma ukuthi amaseli amangqamuzana akhona yini emthonjeni nakakhulu), futhi asuse umkhuhlane. Ngeshwa, lezi zinhlawulo zivame ukubuya.
Ngama-effusions amanga ahlambalazayo aphinde abuyele, kunezinketho eziningi zokwelapha ukuphefumula okuphefumulayo nokuphefumula. Ngalesi sikhathi kusekhona ukuphikisana okuphawulekayo mayelana nokuthi iyiphi inqubo engcono kakhulu, futhi ukhetho luvame ukwenziwa ngokusekelwe ebucayi bezimpawu, ukuthi isisu sikhuluma kanjani ekwelapheni, nesimo sakho sokusebenza -kuthi umdlavuza uphazamisa kangakanani ikhono lokuqhuba imisebenzi evamile yansuku zonke.
Pleurodesis
Enye inqubo esebenza ngamaphesenti angama-60 kuya kwangu-90 abantu kuthiwa yi- pleurodesis . Kule nqubo, ithubhu ifakwe endaweni yokukhalaza futhi into, ngokuvamile ebizwa ngokuthi i-talc, ifakwa phakathi kwezingqimba ezimbili ezihlanganisa amaphaphu. Lezi zimakhemikhali zibangela ukuvuvukala emgodini wesikhala owenza ukuthi i-linings emibili ibambe ndawonye (fuse) ukuvimbela uketshezi ukuthi uphinde uqoqe isikhala somlomo.
Indwelling Pleural Catheters
Enye inqubo i- catheter ehlala ngaphakathi , eyaziwa nangokuthi i-cathéter ye-pleural tunneled. Kule nqubo, ithubhu encane ifakwe endaweni evulekile futhi ikhonjiswe ngaphansi kwesikhumba, ngokuvula okuncane ohlangothini lwakho okungahlanganiswa ne-bandage. Lokhu kuvumela iziguli ukuba zichithe iziqu zazo (ngosizo lomuntu othandekayo) ngokufaka isiqukathi sokugcoba ekuvuleni esikhumbeni. I-catheter ene-tunne ngezinye izikhathi iyasebenza nakakhulu uma kusetshenziselwa ukuxuba emaceleni omabili esifubeni (ngamanye amazwe) noma uma kunezindawo ezinkulu zokuqoqwa kwamanzi kagesi (izindawo ezisetshenzisiwe.) Le nqubo ivame ukubhekwa njengento engavamile kune-pleurodesis futhi isebenza kahle Amaphesenti angu-80 kuya kubantu abangamaphesenti angu-100. Abacwaningi abaningi manje banomuzwa wokuthi ukuhlala kwama-catheters (pleated catheters) (IPCs) okumele kube khona kufanele kubhekwe njengomugqa wokuqala kubo bonke abantu abanomthelela omubi.
Kube khona impikiswano yokuthi ngabe i-pleurodesis (ukufakwa kwe-talc) noma i-catheter engenawo indawo ingcono kunazo zonke kubantu abanomdlavuza ophuthumayo kanye ne-pleural effusion. Ucwaningo lwe-2017 olushicilelwe ku- JAMA , lwafuna ukuphendula lo mbuzo. Abacwaningi bathola ukuthi labo ababenamakhemikhali ahlala emakhaya ababa nezibhedlela ezimbalwa kunabo abano-pleurodesis, ikakhulukazi abahlobene nesidingo senqubo yokususa i-pleural fluid. Uma kungenjalo, kwakungekho ukuhluka okuphawulekayo kunoma yimuphi umuzwa wokuphefumula noma ikhwalithi yokuphila kwabahlanganyeli.
Izinketho ezengeziwe zokwelapha
Uma i-effusion ephikisanayo yesikhalazo iphikelela naphezu kwalawo amanye amasu, kungenziwa ukwenziwa ukuhlinza uketshezi esiswini, noma i- pleurectomy (inqubo eyosusa ingxenye ye-pleura) ingenziwa. Ukwelapha okusha (njengokwelashwa kwe-medical pleuroscopy ) kuvela ukuphatha ukulimaza okumbi kabi. I-Chemotherapy ingasiza ngemisindo emibi yomsindo ngenxa yomdlavuza omncane we-cell lung , kodwa ngokuvamile awuphumelelanga kakhulu nalabo abanomdlavuza we-cell wamaphaphu okungewona omncane .
Ukukhetha indlela yokwelashwa engcono kakhulu
Ngaphambi kwe-pleurodesis noma i-catheter ene-tunnel ye-pleural, kunconywa izinto ezimbalwa. Okokuqala, udokotela wakho uzofuna ukuqinisekisa ukuthi une-effusion engalungile yesikhala nokuthi izimpawu zakho azibangelwa esinye isizathu. Okwesibili, kufanele ube nenhlanhla ye-pleural ephindela emuva (ngemuva) ngemuva kwe-thoracentesis. Futhi okubaluleke kakhulu, ukukhipha uketshezi oluvela emkhathini wakho wesikhala kufanele kusize ngezimpawu zakho zokuphefumula. Akudingekile ukususa uketshezi ngoba nje kukhona, kodwa kuphela uma kubangela izinkinga (njengokuphefumula). Leli phuzu elibaluleke kakhulu ukuphindaphinda. Uma ukuphefumula kwakho kungenxa yenye imbangela eyisizathu, nokususa uketshezi ngeke kwenze umehluko omkhulu, ngokuvamile akusikho inzuzo ekususeni uketshezi.
Isibikezelo
Ngokudabukisayo, isikhathi esiphezulu sokuphila komdlavuza wamaphaphu sinomthelela omubi wesikhalazo singaphansi kwezinyanga ezingu-6. Isikhathi sokusinda esiphakathi (isikhathi lapho abantu abangamaphesenti angu-50 bafa khona kanti amaphesenti angu-50 asekhona) izinyanga ezingu-4, nakuba abanye abantu basinde isikhathi eside. Ukubikezela ukuthi kungcono kakhulu kulabo abanemiphumela emibi yomsindo ehlobene nomdlavuza webele noma umdlavuza we-ovarian ikakhulukazi. Njengoba sekufika ukwelapha okusha okufana nezinqubo ezithintekayo kanye nokuzivikela , kuthenjelwa ukuthi lezi zinombolo zizoshintsha esikhathini esizayo esiseduze. Kukhona nokuhlolwa okuningi kwemitholampilo okuqhubekayo ekubhekeni ukwelashwa okunamandla kulawa mafutha.
Ukubhekana
Ukungahambi kahle komonakalo obulalayo wesikhala kungaba nzima kakhulu. Bambisana ukuthi ngokufunda kokuthola ukuhlolwa kwakho nokuhlushwa kwayo, futhi lokho okuhlangenwe nakho kungabangela ukucindezeleka kunoma ubani-ikakhulukazi labo asebevele benesifo esibuhlungu lapho beqala ukutholakala benomdlavuza. Buza imibuzo. Cela usizo kwabanye, futhi uvumele ukuba bayinike. Khuluma nodokotela wakho mayelana nokuphatha ubuhlungu besifo somdlavuza wamaphaphu . Cabanga ngokujoyina iqembu lokusekela . Imizwelo yakho ingase ibe nomthelela omkhulu ekudumeni kuya ekungakholweni, ekucindezelekeni. Lokho kuvamile. Funa abangane nabathandekayo abazimisele ukulalela nokukusekela ngempela. Funda kabanzi mayelana nesigaba 4 (imetastatic) yomdlavuza wamaphaphu .
Kwabathandekayo
Abantu abambalwa kakhulu abathola umdlavuza wamaphaphu ngedwa, futhi kulabo abathandayo lesi sifo singase sibe nomuzwa oqhaqhaqisayo futhi esabisayo futhi senezela kulokho kungumqondo okhuthazayo wokungabi namandla. Yini okufanele ukwazi uma othandekayo wakho enomdlavuza ?
> Imithombo:
> Azzopardi, M., Porcel, J., Koegelenberg, C., Lee, Y., no-E. Fysh. Izingxabano zamanje ekuphathweni kwezingcingo ezimbi ezimbi. Ama-Seminar in Medicine Care and Respiratory Care . 2014. 35 (6): 723-31.
> Clive, A., Jones, H., Bhatnagar, R., Preston, N. noN. Maskell. Ukungenelela ekuphathweni kwezingcingo ezimbi ezimbi: ukuhlaziywa kwe-network meta-analysis. I-Cochrane Database yezibuyekezo ezihleliwe . 2016. 5: CD010529.
> Kheir, F. et al. I-Pleural Catheter ene-Tunneled for Treatment of Malignant Pleural Effusion: Ukubuyekezwa Okuhlelekile nokuhlaziywa kwe-Meta. Journal of Therapeutics . 2015 Feb 2. (i-Epub ngaphambi kokuphrinta)
> UThomas, R., Fysh, E., Smith, N. et al. Umphumela we-Indwelling Pleural Catheter vs Talc Pleurodesis kwi-Hospitalization Izinsuku ezigulini ezine-Malignant Pleural Effusion: I-AMPLE I-Randomised Clinical Trial. I-JAMA . 2017. 318 (19): 1903-1912.