Ukuhlukaniswa Kwemishado (Isigaba se-Segmentectomy noma Isihluthulelo se-Sublobar) vs Lobectomy
Uma udokotela wakho ekhuthaze ukuvuselelwa komgqa womdlavuza wamaphaphu, cishe uyazibuza ukuthi inqubo yenzani nokuthi ihluke kanjani kwezinye izinhlobo zokuhlinzwa komdlavuza wamaphaphu . Ngabe ukuthengiswa komgodla kunganconywa nini kwezinye izinqubo futhi yiziphi ezinye izinkinga ezingase zibe khona? Yiziphi ezinye zezizathu zokuthi ukuthengiswa komgqa kungacatshangelwa esikhundleni se-lobectomy, futhi bekungeke kunconywe nini?
Ukwehlukaniswa komshado: Incazelo
Ukuthengiswa komgogodla kuhilela ukukhishwa komdlavuza wamaphaphu kanye nesigaba somzimba ohlotshiswe ngamathambo azungeze lesi sifo. Le nqubo isusa izicubu ezincane zamapayipi kune- lobectomy (inqubo esuswa ngayo i-lobe yamaphaphu) noma i-segmentectomy (inqubo esusa ingxenye enkulu yamaphaphu ngaphezu kokubuyiswa komkhawulo, kodwa hhayi yonke i-lobe njenge-lobectomy Uma ubheka inothi lemifanekiso ukuthi iphaphu elilungile linama-lobes amathathu futhi ipulaphu lesobunxele linama-2 lobes.
Ukuthengiswa komgqa nakho kubizwa ngokuthi ukuthengiswa kwe-sub-lobar , njenge- segmentectomy . Uma ubheka amanye amagama ungabona inqubo ebizwa ngokuthi i-nonanatom ngokuphambene nezinye izinqubo ezenziwe nge-anatomic, okusho kuphela ukuthi akubandakanyi ukukhipha ucezu oluhlukile lwe-anatomy.
Izinkomba zokuSungulwa kweNdleko
Ngisho noma i-lobectomy ingaba udokotela ohlinzayo ongcono kubantu abaningi, kunezizathu eziningana ezahlukahlukene zokuthi kungani udokotela ohlinzayo angase ancoma ukuvuselelwa komgqa esikhundleni se-lobectomy: Lokhu kungafaka:
Amathumba amancane
Ukuthengiswa kwamakhansela kuvame ukuwenzelwa amancane kancane amaphasitiki emaphaphu, njengama-cancers amancane asesincane amaseli amaphaphu amaphaphu kanye namanqamu amancane amaphaphu amaphaphu amancane . ( Ngezinye izikhathi ukuhlinzwa kungenziwa ngomdlavuza omncane wamaphaphu kodwa lokhu akuvamile.)
Inqubo ivame ukucatshangwa uma isisu singaphansi kuka-4 cm (cishe amasentimitha amabili) futhi singaphansi kuka-2 cm ububanzi, sitholakala ezingxenyeni zangaphandle zamaphaphu (i-periphery,) futhi sibalwa njengesiteji esingu-0 , isigaba I-1A noma isigaba esincane se-1B esingeyona encane yomdlavuza wesifo samaphaphu .
Ngokusekelwe kohlelo lwe- TNM lomdlavuza wamaphaphu , lezi zicubu ziyoba T1N0M0.
Izizathu zokuxilonga
Ngezinye izikhathi inqubo yenziwa njengendlela ye-lung biopsy ukuhlola okutholakala okusolisayo (ukukhanya kwamagalasi emhlabathini noma ezinye izigulane zamaphaphu ezisolisayo).
Inqubo ingase yenziwe nakwezinye izimo zamaphaphu ezingenangqondo, ezifana nesifo sofuba, i-aspergillosis, nokususwa kwe-emphysema blebs.
Ngamanye amagciwane, inqubo ingenziwa ukuze kususwe imithi ehlukanisiwe yodwa emaphashini emdlavuza webele, i-melanoma, nezinye izifo zamanyevuza (ezifana nomdlavuza wamangqamuzana e-renal, umdlavuza we-colon, kanye nama-sarcomas) asakazeka emaphashini.
Isimo sezempilo esixhaswe
Uma kusetshenziselwa ukuthengiswa komgudu kubantu abanomdlavuza wamaphaphu, kuvame ukuwenzelwa abantu abangenakubekezelela ukukhishwa kwe-lobe yonke, njengabantu abadala aseba nomdlavuza wamaphaphu, abantu abanezinye izimo ezibucayi, noma labo abaye baphazamisa amaphaphu umsebenzi. Uma kunjalo, umgomo ukukhipha isisu ngenkathi kulondolozwa izicubu eziningi zamapayipi ngangokunokwenzeka.
Abadala
Inothi, ukuthi abantu asebekhulile abanomdlavuza wamaphaphu bavame ukubekezelela ukwelashwa komdlavuza wamaphaphu kanye nabantu abancane abanesifo. Esinye isifundo, ngisho neziguli ezindala ezazithola i- pneumonectomy (ukususwa kwephasi lonke), azibonanga umehluko ekukwazi ukubekezelela inqubo.
Ucwaningo lwango-2018 lwathola nokuthi abantu asebekhulile abanomdlavuza wamaphaphu (labo abangaphezu kweminyaka engama-80) ukuhlinzwa okubekezelelwe kanye nabantu abancane. Ucwaningo lwenzile, kodwa, thola ukuthi ingxenye ye-segmentectomy (ukuguqulwa komgqa) ihlotshaniswe nemiphumela engcono kunezohlinzeko eziningi zomdlavuza wegazi wamaphaphu.
Ukukhetha komuntu siqu
Esinye isizathu esingahle sokucubungula le nqubo yisinqumo somuntu siqu. Abanye abantu bakhetha inqubo encane engavumelani nalokhu ngenxa yezizathu zekhwalithi yokuphila futhi bayamukele ingozi ephakeme kakhulu yomdlavuza we- lungs .
Izizathu Zokuthi Ukuhlaselwa Kwemishado Kungase Kungavunyelwe
Amathumba amakhulu kunama-4 cm ayikwazi ukukhishwa ngokuthengiswa kwemigqa.
Indawo ye-tumor ingenza le nqubo ingasebenzi. Ngokuvamile, inqubo ehilelekile efana ne-lobectomy ivame ukuphakanyiswa kwentsha, kungenjalo enempilo, ngabanye, nakuba lokho kungashintsha ngokubuyekezwa kwamuva kwezingcwaningo (bheka ngaphansi kokuchazwa ngezansi ngezansi.)
Ukulungiselela Ngaphambi Kokuhlushwa Kwemali
Ngaphambi kokuhlinzwa, udokotela wakho ohlinzayo uzofuna ukuqinisekisa ukuthi uyakwazi ukubekezelela inqubo-kokubili kokubukwa kwezempilo jikelele nangokuphathelene nomsebenzi wamaphaphu. Izivivinyo nokuhlolwa kungafaka:
- Umlando wezokwelapha ngokuphelele nokuhlolwa ngokomzimba
- Ukuhlolwa kwegazi, kufaka phakathi izivivinyo zomsebenzi wezinso nesibindi
- Ukuhlolwa kwesimo somsoco
- Ukuhlolwa kokusebenza kwamapulmonary
- Ukuhlola kwenhliziyo
- Ukucubungula ukuhlola ukuhlola indawo kanye nobukhulu be-tumor, kanye nokubheka umdlavuza ongase ube khona emaphethini we-lymph nasezindaweni ezikude (njengebindi noma amathambo.)
Inqubo
Ukuthengiswa komgqa kungenziwa noma nge-thoracotomy (ukuhlinzwa okuvulekile kwesifuba) noma ngokuhlinzwa okuthandwa yi-video (VATS). I-VATS yinkambiso encane encane, kodwa akuwona wonke odokotela abahlinzayo abahlinza lokhu kuhlinzeka futhi akunakwenzeka ngaso sonke isikhathi ngokususelwa endaweni ye-tumor.
Ngokuya ngokuthi iyiphi inqubo eyenziwa, udokotela ohlinzayo (ngemuva kokungena esifubeni) uthola lesi sifo. Ukuhlolwa okucophelile kwenziwa ekuhloleni amaphaphu namadayimane aseduze. I-tumor isuswe bese inesisindo esincane esiseduze ne-tumor.
Ukuhlinzwa kungase kuhlanganiswe ne-brachytherapy, inqubo lapho imisebe isetshenziswa ngesikhathi sokuhlinzwa ngokuqondile kwisayithi se-tumor.
Ukubuyisela
Ukuhlinzwa okulandelayo, ubude besikhathi osesibhedlela buyoxhomekeka kunjani uhlobo lwenqubo eyenziwe (VATS vs thoracotomy evulekile) nokuthuthuka kwakho ngesikhathi sokuphumula. I- tube yamathumba ifakwa esifubeni sakho ngesikhathi sokuhlinzwa, futhi ngokuvamile, ihlala endaweni yamahora angu-24 kuya kwangu-48. Phakathi nalesi sikhathi uchwepheshe wokuphefumula uzovakashela nawe, ekukhuthazeni ukuba uthuthuke ngokujulile ukunciphisa ingozi yokutheleleka. Uma usukhishwa ekhaya udokotela wakho ohlinzayo uzokunikeza imiyalelo ecacile yokulandelela futhi akunikeze imithi kadokotela ukuze unciphise noma yibuphi ubuhlungu obunakho uma ubuyela ekhaya.
Izinkinga Ezingenzeka Zokuqokwa Kwemishado
Izinkinga azivamile, kodwa zingabandakanya:
- Izinkinga ze-anesthesia jikelele
- I-Hemothorax (ukuphuma ekhanda esifubeni)
- Ukutheleleka
- I-Atelectasis (ukuwa kweyingxenye , noma yonke yamaphaphu)
- I-fostula ye-bronchopleural (indlela engavamile eyenziwa phakathi kwamaphaphu namagundane afaka amaphaphu (i-pleura))
- Ukuqhuma emoyeni okuqhubekayo kudinga isidingo eside somuthi webhubhu
- Kunzima ukugaya ukuphefumula
Isibikezelo
Isibikezelo sokuthengiswa kwemigqa sizohluka ngokuya kwesifo sakho, impilo yakho jikelele kanye nezinye izifo ozithola.
Kwacatshangwa isikhathi eside ukuthi ukusinda (kubantu abangakwazi ukubekezelela inqubo) kuphakeme kubantu abahamba nge-lobectomy nge-resege wedge. Ukubuyekezwa kwamuva kwezifundo ezingu-54 ezibheke ezitheni ezifinyelela ku-39,000 kushintshile lokho okucabangayo. Kubantu ababenomkhawulo wamakhansela kepha bebengabekezelela i-lobectomy (iqembu lapho ukuthengiswa komgqa "kukhethwe ngokuzithandela,") izinga lokusinda alizange lihluke kakhulu phakathi kwezinqubo ezimbili. Kubantu ababenomthengisi wezinhlanga ngoba bebengeke bakwazi ukubekezelela i-lobectomy (iqembu elibiza ngokuthi "liyekethisiwe" iqembu,) ukusinda kwaba kubi nakakhulu kulabo abanomsebenzi wokukhishwa kwemali.
Ukubhekana Nokubhekana Nokuqeda Umshado Ngomdlavuza We-Lung
Ukuthengiswa kwemigqa, nakuba kuncane kakhulu kune-lobectomy noma i-pneumonectomy, kuseyi-operation enkulu. Cela, futhi vumela, abangani nomndeni bakho bakusize. Ukuvuselelwa kwamapulmonary emva kokuhlinzwa komdlavuza wamaphaphu kuvele kufundwe kodwa kungenza umehluko omkhulu emkhakheni wokuphila kwabanye abantu. Njengoba lokhu kungumqondo omusha, kungase kudingeke ucele udokotela wakho ukuthi adluliselwe.
> Imithombo:
> Ambrogil, M. et al. Ukwandisa ukuthengiswa kwemikhiqizo kanye ne-radiofrequency ablation esiteji I-monsmall cell umdlavuza wamaphaphu. Journal European Respiratory Journal . 2015. 45 (4): 1089-109.
> Cao, C., Chandrakumar, D., Gupta, S., Yan, T., noDan Tian. Kungenzeka ukuthi kube okungaphezulu? - Ukubuyekezwa okuhlelekile nokuhlaziywa kwe-meta-reselobar nge-lobectomy ye-non-encane yomdlavuza wesifo samaphaphu ngokusho kokukhetha isiguli. I-Cancer Lung .2015. (Epub ngaphambi kokuphrinta).
> Chambers, A., Routledge, T., Pilling, J., noMnu Scarci. Iziguli Ezigugile Zinomdlavuza We-Lung yi-Resection eqinisekisiwe emigomo yokuhlukumeza, ukufa nokuphila okuhlala njalo? . I-Interactive Cardiovascular and Thoracic Surgery . 2010. 10 (6): 1015-21.
> Stamenovic, D., Messerschmidt, A., noT. Schneider. Ukuhlinzwa Kwezingculaza Zama-Lung Kubantu Abakhulile: Ukutadisha KwamaKhosi Okubuyiselwayo Emthonjeni Wezephuthumayo (Eminyakeni Engaphezu Kwengu-80) ekuthuthukiseni Izinkinga Ngokusebenzisa Isibonelo Somngcipheko We-Multivariate. I-International Journal of Surgery . 2018. 52: 141-148.