Ngati dokotala wanu wakupatsani chithandizo cha chemotherapy chifukwa cha chemotherapy , kodi izi zikutanthauzanji kwenikweni? Kodi ubwino ndi chiopsezo cha doko ndi chiani poyerekeza ndi njira zina zowonjezeramo monga mzere wa IV (IV) kapena mzere wa PICC?
Tiyeni tiwone bwinobwino kuti kukhala ndi doko kumaphatikizapo ubwino (zothandiza) ndi zovuta (chiopsezo) chokhala ndi doko kapena galimoto-njira, ndi njira zomwe mungathe kutetezera mavuto monga matenda kapena kutchinga kwa doko.
Kodi Port ya Chemotherapy ndi yotani?
Kachilombo ka chemotherapy (komwe kumatchedwanso "doko-njira") ndi chipangizo chochepa chomwe chimayikidwa pansi pa khungu lanu kuti mulowetse mosavuta magazi anu.
Kodi Galimoto Ikugwiritsa Ntchito Liti?
Gombe lingagwiritsidwe ntchito kukopa magazi ndikupatsa mankhwala ochizira mankhwala. Ikhoza kugwiritsidwanso ntchito ngati mukufuna kuikidwa magazi a maselo ofiira kapena mapiritsi. Popanda doko, kapena pICC mzere, singano yatsopano (IV) iyenera kuikidwa nthawi iliyonse yomwe muli ndi mankhwala a chemotherapy, ndipo mzere wolekanitsa wazitsulo uyenera kuikidwa ngati mutakhala ndi magazi kapena magazi.
Chemotherapy
Kaya dokotala wanu akuvomereza kuti doko lingadalire pazinthu zingapo. Mankhwala enaake amatha kuperekedwa kupyolera pa doko, chifukwa amatha kuperekedwa ku mitsempha ya m'mimba.
Ngati mutakhala ndi mankhwala enaake (chemotherapy ena) amalimbikitsa chitukuko ngati mutapereka mankhwala oposa oposa), doko ndilosavuta kuposa kuika IV nthawi iliyonse.
Ndipo anthu ena ali ndi mitsempha yomwe imakhala yovuta kwambiri kupeza, kutsegula galimoto kukhala njira yabwino kuposa kuika IV.
Kuti mupange chisankho chabwino kwa inu, dokotala wanu adziwe ngati akatswiri apeza kuti ndi zovuta kapena zovuta kutenga magazi kapena kuika IV m'manja mwako kapena mkono wanu m'mbuyomo. (Mwinamwake munamvapo chanzeru kuti ndinu "ndodo yosavuta" kapena "ndodo yolimba").
Kodi Pitani?
Nthawi zambiri phukusi limaphatikizidwa patsiku lomwelo lochita opaleshoni lomwe lingatheke ndi kupweteka kwa malo komweko. Ambiri amakhulupirira kuti muli ndi doko lanu lomwe lapangidwa sabata imodzi musanayambe chemotherapy (ngati n'kotheka) ndipo kafukufuku akusonyeza kuti kukhala ndi malo anu osachepera masiku asanu ndi atatu musanafike kulowetsedwa kumachepetsa chiopsezo cha mavuto. Ngati mukuchita opaleshoni ya khansara yanu, monga lobectomy ya kansa yamapapu kapena matenda opatsirana khansa ya m'mawere, dokotala wanu akhoza kuyika phukusi nthawi yomweyo opaleshoni yanu inachitidwa. Pamene doko liyikidwa pa opaleshoni, mutha kale kukhala ndi mankhwala osokoneza bongo.
Pomwe mutsembera, pang "ono kakang'ono kazitsulo kapena pulasitiki kamayikidwa pansi pa khungu lanu kupyolera mufupipafupi. Izi zikhoza kukhala pampando wanu wamtundu kapena nthawi zina mkono wanu wapamwamba. Pambuyo pake khomoli limaphatikizidwa ndi chubu la catheter limene limasungidwa mu mitsempha yaikulu pafupi ndi khosi lanu, monga mitsempha ya subclavia kapena mitsempha yambiri, ndipo imatha pafupi ndi mtima wanu wonse. Pambuyo pa doko lanu adayikidwa dokotala wanu adzachita x-ray kuti atsimikizire mapeto a doko lanu pamalo oyenera.
Pambuyo pa khomo lanu, mutha kuona pang'ono khungu lanu, pamtunda.
Pamene magazi amakoka kapena mankhwala a chemotherapy (infusions), namwino amaika singano padoko lanu kumalo otchedwa "septum," ndi resealing mphira pakati pa doko lanu. Popeza chipikacho chili pansi pa khungu lanu, mudzatha kutsuka ndi kusambira popanda kusamala za kupeza kachilombo koyambukira.
Ubwino ndi Ubwino
Monga momwe zilili ndi opaleshoni iliyonse, pali ubwino ndi kuipa kokhala ndi khomo la mankhwala a chemotherapy. Akulingalira kuti maiko oposa 5 miliyoni amaikidwa ku United States chaka chilichonse, kotero madokotala amadziwa bwino njirayi ndipo aphunzira bwino.
Phindu lokhala ndi chitsime cha chemotherapy pogwiritsa ntchito miyambo yachinayi ndizo:
- Kutonthozedwa kwakukulu: Nsonga imodzi yokha imamatira pakhungu lanu kawirikawiri zonse zomwe zimafunikira kuti mufike pa doko lanu. Ndi mankhwala opatsirana ndi ma ARV omwe amakoka, nthawi zina timagulu tomwe timagwiritsa ntchito singwe kuti tipeze mitsempha yabwino, makamaka ngati mitsempha yanu yayonongeka kuchokera ku magazi omwe amachitidwa mobwerezabwereza. (Chemotherapy ikhoza kuyambitsa kusintha mu mitsempha yanu yomwe imawapangitsa kukhala kovuta kwambiri kuti adziwe ndi singano.)
- Pewani kuchedwa: Sikuti mumapewa kuchedwa kwa kukhala ndi namwino wanu kuyesa kupeza mitsempha yabwino yogwiritsa ntchito magazi kapena kupatsa mankhwala a chemotherapy, koma kukhala ndi doko kungachepetse nthawi yomwe mukufuna kukonzekera dzanja lanu kapena mkono wanu.
- Kuchepetsa chiopsezo cha "extravasation:" Pamene mankhwalawa akugwiritsidwa ntchito, mankhwalawa amatha kutuluka (extravasate) m'zinthu zozungulira dzanja lanu kapena mkono wanu. Popeza mankhwala ambiri a mankhwala a chemotherapy amachititsa minofu, doko lingachepetse pangozi yotupa-yokhudzana ndi kuvulala kwa mankhwalawa.
- Kusamba kosavuta ndi kusambira: Popeza kuti panjapo ili pansi pa khungu, nthawi zambiri mumasamba komanso kusambira popanda kusamala za chiopsezo cha matenda.
Zowonongeka za Port Chemotherapy
Zowopsa ndi zovuta zomwe zimakhudzana ndi chinyama cha chemotherapy ndizo:
- Kuopsa koti opaleshoniyo ikhale yotseguka: Njira iliyonse yopaleshoni ikhoza kutenga kachilombo ka HIV. Mavuto osazolowereka (omwe amapezeka osachepera 1 peresenti ya anthu) angaphatikizepo kutaya mwazi (monga ngati mitsempha ya subclavia imatulutsidwa) ndi pneumothorax (kugwa kwa mapapo) ngati mapapu anu achita mwangozi panthawiyi.
- Kutenga: Kuopsa kwa kachilombo ka HIV kumasiyanasiyana ndi maphunziro koma si zachilendo. Ngati galimoto imatenga kachilombo ka HIV, kawirikawiri imafunika kuchotsedwa ndi kusinthidwa. Kafukufuku akufufuza njira zochepetsera chiopsezochi, choncho ndikofunika kulankhula ndi wanu oncologist za momwe mungasamalire bwino doko lanu.
- Thrombosis: Chophimba chingapangidwe pa doko kapena catheter, zomwe zimachititsa kuti asiye kugwira ntchito. Pakati pa 12 ndi 64 peresenti ya anthu omwe ali ndi doko lopatsidwa mankhwala a chemotherapy amatha kupanga thrombosis (clot) mu catheter (nthawi zambiri kuchititsa kusowa kwa malowa).
- Mavuto omwe amachititsa kuti doko lileke kugwira ntchito: Nthaŵi zina mavuto, monga kayendedwe ka catheter kapena kupatukana kwa doko la khungu, amachititsa kuti phukusi lileke kugwira ntchito.
- Zolepheretsa pa ntchito: Ngakhale kuti ntchito monga kusamba ndi kusambira zimakhala bwino, oncologist wanu angakulimbikitseni kuti mupitirize kuchita masewera olimbitsa thupi lanu kapena mikono yanu mpaka galimoto yanu itachotsedwa.
- Kuwombera: Chifukwa cha kukula kwake kwa khansa, chilonda chochokera pa doko ndi chochepa chokha. Koma anthu ena amatha kupeza chiwombankhanga pachifuwa chawo chosokoneza chifukwa cha zodzikongoletsera kapena chifukwa ndi chizindikiro chakuti munayamba mwadutsa mankhwala a chemotherapy.
Kuteteza Matenda
Maphunziro angapo m'zaka zaposachedwapa ayang'ana njira zochepetsera chiopsezo cha bakiteriya koloni pa doko komanso chiopsezo chotenga matenda ( sepsis ). Sepsis ndi matenda a "thupi lonse" omwe mabakiteriya amapezeka m'magazi ndipo akhoza kukhala ovuta kwambiri. Ngakhale kuti kugwiritsa ntchito mankhwala osokoneza bongo nthawi zonse sikukuthandizani, kuthamanga kwa catheter ndi mankhwala a antibiotic / heparin kumawoneka kuti kuchepetsa ngozi. Kuyeretsa khungu sikungakhale kopindulitsa kwambiri panthaŵiyi, koma kugwiritsa ntchito zovala zoikidwa ndi mankhwala opha tizilombo kungathandize. Zimaganiziranso kuti kutsegula chinyanja ndi njira ina osati sutures (stitches) kungachepetse chiopsezo cha matenda. Monga tawonera, izi ndi malo ofufuza mwakhama ndipo mukhoza kufunsa wanu oncologist zomwe mukulimbikitsidwa panopa.
Ngozi ya Thrombosis
Kuphimba kapena thrombosis mu doko ndizofala ndipo nthawi zambiri zimakhala zofunikira kuti panjapo lichotsedwe ndipo nthawi zambiri limalowetsedwa. Nthaŵi zambiri kuthamanga pa doko ndi heparin ndi saline sikukuwoneka kusiyana kwakukulu, komanso kuchepetsa kuchepa kwa mankhwala a heparin wambiri (ngakhale kunayambitsa magazi). Anthu omwe ali pachiopsezo chachikulu ndi omwe ali ndi mbiri ya mitsempha yambiri m'mbuyomo. Kumapeto kwa catheter kungapangitse kusiyana. Komabe, chiopsezo cha thrombosis pa doko ndi chochepa kwambiri kuposa mu PICC.
Mmene Zimasiyanirana ndi Mzere wa PICC
PICC imayimira "mwachindunji mwaika catheter yapakati." Mzere wa PICC nthawi zambiri umaikidwa mu mitsempha ya mankhwala achidule (mwachitsanzo, kuti upeze mwayi womwe udzafunikire kwa masabata umodzi kapena asanu okha). Mizere ya PICC imayikidwa mdzanja lanu pafupi ndi khungu lanu (subcutaneous) ndipo musayandikire pafupi ndi mtima wanu monga catheter yamatope.
Momwe Akuchotsedwera?
Pamene inu ndi dokotala wanu muli otsimikiza kuti doko lanu silikusowa, likhoza kuchotsedwa mwa njira yosavuta yopaleshoni.
Kodi Muyenera Kudziwa Chiyani Ngati Muli ndi Port?
Zidzakhala zofunikira kufunsa dokotala ngati chinyama chanu chikusowa chisamaliro chapadera, monga kusuntha ndi mankhwala kuti muteteze kutseka kuti musapange.
Nthawi yoitanira Dokotala Wanu
Popeza kuti matenda ndilo vuto lalikulu lokhala ndi doko, funsani dokotala ngati mukuyamba kutentha thupi kapena mukulemba chifuwa chilichonse, kutupa, kupweteka kapena kukhetsa pakhomo lanu.
> Zotsatira:
> American Society of Clinical Oncology. Cancer.Net. 09/2016. http://www.cancer.net/navigating-cancer-care/how-cancer-treated/chemotherapy/catheters-and-ports-cancer-treatment
> Heibl, C. et al. Mavuto okhudzana ndi kugwiritsira ntchito Port-a-Cath kwa odwala omwe ali ndi matenda oopsa kapena a hematological: malo amodzi omwe angakambirane. European Journal ya Cancer Care . 2010. 19 (5): 676-81.
> Madabhavi, I., Patel, A., Sarkar, M. et al. Phunziro la Kugwiritsa Ntchito Kathethala ya "PORT" Odwala Odwala Khansa: Chidziwitso Chokha. Clinical Medicine Zosintha: Oncology . 2017. 11: 1179554917691031.
> Narducci, F. et al. Zowonongeka zowonongeka ndi zoopsa zowonongeka ndi zovuta zapadera: chaka chimodzi chomwe chidzachitike pa malo odwala khansa. European Journal of Oncology Opaleshoni . 2011. 37 (10): 913-8.