Izimpawu zePleurodesis, Inqubo, kanye Nezinkinga
I-Pleurodesis yinkqubo ngezinye izikhathi eyenziwa ngabantu abanomdlavuza wamaphaphu nezinye izimo. Iyini le nqubo okubandakanya futhi kungabe kunconywa nini?
I-Pleurodesis - Incazelo
I-Pleurodesis iyinkqubo eyenzelwe ukuthola izingxenye ezimbili zamapayipi amancane (i -pleura ) ukunamathela ndawonye. Lokhu kusetshenziselwa ukuqeda isikhala phakathi kwezingqimba ( isikhala se-pleural ) ukuze amanzi (igazi, igazi, noma ipus) angeke akwazi ukwakha phakathi kwezingqimba.
Kukhona ngokuvamile amathisipuni amathathu kuya kwamane oketshezi phakathi kwamaphandle (parietal) nangaphakathi (visceral) izinyembezi zamagama. Uma kwenzeka ukuqhuma kwesibindi, ngenxa yezimbangela ezinobungozi nezimbi, lesi silinganiso soketshezi sakha futhi isikhala somlomo singase sibambe amalitha ambalwa kagesi.
Ngaphambi kokunconywa kwe-pleurodesis, odokotela bafuna ukubona kuqala ukuthi ukuxoshwa kwamapulangwe (noma i-pneumothorax) kuzophinde ibuyele esikhathini esizayo. Uma kungumcimbi owodwa, ukwenza i-thoracentesis ukususa uketshezi ngokuvamile kuvame konke okudingekayo. Ngeshwa, i-effusion ye-pleinous (kanye ne-pneumothoraces) enobungozi kanye nokukhwabanisa okubuhlungu ngokuphindaphindiwe kuvame ukubuya.
Inqubo yePleurodesis
Ku-pleurodesis, i-chemicals ijojowe phakathi kwezingxenye ezimbili zezikhalazo nge-tube chest . Lawa makhemikhali abangela ukuvuvukala okubangelwa ukulimala. Lokhu kudonsa futhi kudonsa izinambuzane ezimbili ndawonye ukuze amanzi noma umoya ungakwazi ukwakha futhi ukuqoqa isikhala.
I-pleural lining yangaphakathi ibizwa ngokuthi i-plecer visceral, kanti isikhumba somlomo sangaphandle sibizwa ngokuthi i-parietal pleura. Kuncike esimweni esibucayi, inqubo ingenziwa nge-incision encane (i-thoracoscopy noma iVATS) noma i-thoracotomy (ukuvuleka kwamaphaphu avulekile.)
Kunezinhlobo ezimbili ze-pleurodesis, ezivame ukusetshenziswa ndawonye:
- I-pleurodesis ye-mechanical ibangela ukuvuvukala nokuqeda ngokugubha i-parietal (ngaphandle) i-pleura nge-gauze.
- I-pleurodesis yamakhemikhali ihlanganisa ukujova amakhemikhali (kaningi ngokuvamile i-talc) emkhatsini wezingxube ze-pleural ukudala ukuvuvukala nokuqeda (fibrosis.)
Izizathu zePleurodesis zingenziwa
Kunezimo eziningana okungenziwa ngazo i-pleurodesis, okuphumela emiphumeleni yezokwelapha ezifana nomdlavuza wamaphaphu, i-mesothelioma, i-cystic fibrosis, nezinye izifo.
- Ukuxoshwa okubi kabi kwamagama - Abantu abanomdlavuza wamaphaphu , umdlavuza webele , noma ama- metastase emaphashini kwamanye amagciwane angase ahlakulele ukuxuba okubi kabi kwamapulangwe , ukuxuba okunamandla okuqukethe amangqamuzana omdlavuza. Uma kunjalo kunjalo kunezinketho ezimbili. Omunye ukwenza i-thoracentesis bese ubeka isitebe esizoqhubeka siphuza umfutho emfucumfuceni kwenye ingxenye yomzimba (i-cathéter ye-pleural or catheter ene-tunnel). Enye i-pleurodesis.
- Ukuphinda kwamanje kwe-pleural
- I-pneumothorax eqhubekayo - I- pneumothorax iyigama elisetshenziselwa ukuchaza amaphaphu aphelile. Uma i-pneumothorax yenzeka futhi ithaja lesifuba lifakwa, i-pneumothorax ivame ukuxazulula. Uma i-pneumothorax iqhubeka (ukuphika umoya okuqhubekayo,) noma ihamba futhi iphinde ibuyele, ukwelashwa okwengeziwe ukuxazulula i-pneumothorax noma ukuvimbela ukuphindaphinda kuyadingeka.
- I-pneumothorax evamile
Ngaphambi kwePleurodesis - Ukulungiselela
Ngaphambi kwe-pleurodesis, odokotela babheka izinto eziningana.
Okubaluleke nakakhulu, kubalulekile ukuthi kususwe umphumela we-pleural fluid ekuthuthukiseni izimpawu (ukwehlisa ukuphefumula) kulabo abanomdlavuza. Ukuxuba okunamandla okungazange kubangele izimpawu ezifana nobuhlungu besifuba noma ukuphefumula komoya kulezi zilungiselelo ngokuvamile kusale yedwa. Ngaphezu kwalokhu, abanye odokotela batusa inqubo kuphela uma isikhathi sokuphila sikhulu kunenyanga eyodwa.
Ngakolunye uhlangothi, i-pneumothoraces engavamile ingenzeka kubantu abasha futhi bephilile.
Kulesi simo, inqubo ingenziwa ukuvimbela enye i-pneumothorax ukuba ingabikho esikhathini esizayo.
Izinkinga
Ngokuvamile, inqubo ye-pleurodesis ibekezelela kahle. Ngamaphesenti athile abantu, le nqubo izoba yindlela engcono futhi yokwelapha nekhamera elihlala ngaphakathi ukukhipha umthamo, noma i- pleurectomy (ukususwa kwesibindi) kuyodingeka. Okunye ukukhathazeka, kubantu abangase babe nokufakelwa kwamaphaphu esikhathini esizayo, ukuthi i-pleurodesis yangaphambilini ingenza le nqubo ibe nzima nakakhulu.
Kulabo abanobudlova obukhulu ngenxa yezimo ezincane, noma babe nama-pneumothoraces aphindaphindiwe (avame ukuhlobene nesici,) i-pleurodesis ingenza isiqiniseko sokuthi enye i-effusion noma i-pneumothorax ngeke yenzeke uma usizo lwezokwelapha lungatholakali.
Isibonelo: Umdlavuza wamaphaphu kaFrank wabangela ukuphindaphindiwe kwe-pleural effusions, ngakho udokotela wakhe watusa ukuthi unenqubo ebizwa nge-pleurodesis.
> Imithombo:
> Davies, H. et al. Umphumela we-Indwelling Pleural Catheter vs I-Chest Tube ne-Talc Pleurodesis yokuxoshwa kwe-Dyspnea ezigulini ezine-Malignant Pleural Effusions. Isivivinyo Esilawulwa Ngokwe-Randomized Randomised TIME2. I-JAMA . 2012. 307 (22): 2383-2389.
> Dugan, K., Laxmanan, B., Murgu, S., noD. D. Hogarth. Ukuphathwa Kwezinguquko Zomoya Oqhubekayo. Isifuba . 2017 Mashi 3. (Epub ngaphambi kokuphrinta).
> Fortin, M., no-A. Tremblay. Izimpikiswano ze-Pleural: i-cathterter pleural vs pleurodesis yezingqinamba ezimbi ezimbi. I-Journal ye-Thoracic Disease . 2015. 7 (6): 1052-7.
> Lenker, A., Mayer, D., no S. Bernard. Izinyathelo Zokubhekana Nezifo Ezimbi Zama-Malignant Pleural Effusions. I-Clinical Journal of Oncology Nursing . 2015. 19 (5): 501-504.
> UThomas, J., no-A. Musani. Ama-effusions angalungile we-pleural: ukubuyekezwa. Imitholampilo e-Chest Medicine . 2013. 34 (3): 459-71.