Kumvetsetsa Mapeto Anu Ammimba

by Lynne Eldridge, MD; Yofotokozedwa ndi Grant Hughes, MD

Mitundu, Ndondomeko ndi Zovuta za Matenda a Mphungu

Chiwopsezo cha mapapu chingalimbikitsidwe ngati muli ndi chifuwa cha mapapu kapena misala, kapena ngati dokotala akudandaula kuti mutha kukhala ndi matenda kapena matenda ena. Kodi phokoso lamapapu ndi lotani, nanga likuchitanji ndipo ndizovuta zotani?

Kodi Chimanga N'chiyani?

Chiwopsezo cha mapapo ndi njira yopezera zitsanzo zamakhungu zamakono. Poyang'ana chitsanzo cha minofu pansi pa microscope, madokotala amatha kudziwa bwino chimene chimayambitsa chisokonezo, ndipo ngati njirayo ndi khansa kapena ayi.

Ndi khansara yamapapu, chiwindi cha mapapu n'chofunika kwambiri kuti mudziwe mtundu wa khansara yamapapo komanso maselo kapena maonekedwe a chifuwacho.

Zifukwa Zopangira Matenda

Pali zifukwa zingapo zomwe zizindikiro za mapapu zingapangidwe:

Kufufuza kanthana kapena masewera omwe amawonedwa pamaphunziro a chifuwa cha chifuwa, ndikuwona ngati ndi oopsa kapena oopsa (khansa) Kodi khansa ya m'mapapo imapezeka bwanji?
Kuwongolera zotsatira zowonongeka pa kuyang'ana kansa ya m'mapapo. Kodi mwayi ndi khansara pamene kansa yanu ya kansa yamapapu imavumbulutsira nkhono ?
Kupeza matenda a mapapu. Matendawa amatha kukhala mabakiteriya (monga TB), mavairasi kapena fungal (monga aspergillosis kapena coccidiomycosis.)
Kupeza matenda a mapapu monga sarcoidosis , pulmonary fibrosis , granulomatosis ya Wegener kapena matenda a chifuwa chachikulu.
Kuchita zoyezetsa zamoyo (kanema) pa khansara yamapapu . Kuyesera uku kuyang'ana "zowonongeka" kusintha kwa majini-kutanthauza kusintha kwa maselo a kansa omwe "amayendetsa" khansara, ambiri mwa omwe tsopano ali ndi mankhwala omwe alipo.

Kuti mudziwe mtundu wa khansa yamapapo .
Kuthandiza kupeza siteji ya kansa yamapapo yodziwika.

Mitundu Yamakono ndi Ndondomeko

Pali njira zinayi zazikulu zomwe madokotala angapangire malo okayikitsa a mapapo:

Chinthu chabwino kwambiri cha singano (nthawi zina chimatchedwa chigoba chachikulu cha singano kapena biopsy ya singano)
Transbronchial biopsy (yochitidwa panthawi ya bronchoscopy ndi endobronchial ultrasound)

Thoracoscopic biopsy
Tsegulani ziphuphu zamapapu

Tiyeni tiwone mbali iliyonse ya njirazi padera.

Nthano Yong'onongeka

Mu singano yabwino ya mapulogalamu a mapapu , madokotala amaika singano yaitali kumbuyo kwanu ndi m'mapapu anu kuti mutenge minofu ya minofu. Izi zimachitika pogwiritsira ntchito CT scanner kapena ultrasound kuti athandizire kulumikiza singano pamalo oyenerera. Chidutswa cha singano ndi njira yochepetsetsa yoyeretsera dera lokayikira m'mapapu anu, koma nthawi zonse sizimakhala ndi minofu yokwanira kuti mudziwe bwinobwino. Nthenda yamapiritsi ya singano imatchedwanso "transthoracic" biopsy kapena "biotsy" yowona.

Transbronchial Biopsy

Biopsychial biopsy ikuchitika panthawi ya bronchoscopy , njira yomwe chiwerengerocho chimayendetsedwa kuchokera mkamwa mwako mpaka kumtunda wapamwamba wa mapapu ako. Mothandizidwa ndi ultrasound ( endobronchial ultrasound ), madokotala amatha kulumikiza singano m'malo okayikira ndikupeza zitsulo (transbronchial aspiration aspiration). Njirayi imakhala yothandiza kwambiri pamene chizoloŵezi kapena chotupa chiri pafupi kapena pafupi ndi ndege yaikulu mapapo.

Zovuta Zambiri Zojambula

Mu mapapu a thoracoscopic, chiwerengerochi chimayambitsidwa kudzera mu khoma la chifuwa mpaka kumadera ammapapu kuti azikhala ozungulira.

Pa kachipatala kameneka, kanema ya kanema imagwiritsidwa ntchito kuthandiza madokotala kupeza ndi kutchula malo a minofu. Mwa njirayi, yomwe imatchedwanso kuti opaleshoni yowonongeka mavidiyo (VATS), madokotala angathe kuchotsanso malo amodzi okhudzidwa kapena lobe wa mapapo omwe ali ndi khansa. (Dziwani: Sadzachita izi popanda kukambirana izi ndi inu musanayambe ndondomekoyi.)

Tsegulani Zovuta Zambiri

Monga njira yowopsya kwambiri yothetsera minofu, nthawi yowopsa yamapapu nthawi zina imayenera kuyesa minofu pamene njira zina zatha. Imeneyi ndi njira yaikulu yopaleshoni, yomwe imachitidwa ndi anesthesia. Zingafunike kulekanitsa nthiti kapena kuchotsa nthiti kuti mupeze mapapo.

Nthawi zina, chidziwitso chotseguka chikuchitidwa monga gawo la opaleshoni kuchotsa nkhono kapena misala, makamaka ngati dokotala wanu akudziwa kuti muli ndi khansa.

Zamadzimadzi

Chidziwitso cha madzi ndi malo atsopano omwe akuphunziridwa kuti ayese kansa ya m'mapapo. Njirayi, yomwe imafuna kuti magazi amveke, amayang'ana kuyendetsa maselo a khansa kuti ayambe kufufuza DNA ya khansa ya galimoto yotembenuza-kutanthauza kusintha kwa maselo a khansa omwe angapezeko mankhwala enaake. Nthawi zina pamene phokoso la mapapu latha, madokotala sangathe kutulutsa minofu yokwanira kuti ayesedwe, ndipo mankhwala osokoneza bongo angapangitse zotsatirazi kuti zisapezeke popanda kutsata ziwalo zina zotupa.

Mu June 2016 choyamba chizimwa chamadzimadzi chinavomerezedwa kuti chizindikire kusintha kwa EGFR kwa anthu omwe ali ndi kansa ya m'mapapo ya m'mapapo.

Zotsatira za Mphungu Yanu Yambiri

Ngati dokotala amatha kupeza minofu yabwino, mwina mumamva za zotsatira mu masiku awiri kapena atatu-ngakhale kuti nthawi zina zimatengera nthawi yaitali, makamaka ngati odwala ena ambiri akufuna kuwona zotsatira. Ndizothandiza kufunsa dokotala wanu panthawi yomwe mutha kuyembekezera kumva zotsatira zanu, ngati mutalandira foni kapena ngati mukufuna kupanga nthawi kuti muphunzire zotsatira. Madokotala ena ali okonzeka kukuitanani pa foni kuti akuuzeni zomwe apeza pamene ena angakonde kukhazikitsa chidziwitso chotsatira kuti adziwe zotsatira.

Nkhaniyi ikufotokoza momwe mungamvetsere mbiri yanu ya matenda kuchokera kumapapo anu a mapapo.

Ngakhale dokotala wanu atakhala ndi malingaliro abwino a zomwe zipezazo, si zachilendo kuti madokotala azilakwitsa atawona zitsanzo za minofu. Kukhalapo kwachilendo kukhala khansa kumadalira pazinthu zambiri, zomwe zimakhala kukula. Mitsempha ya mapuloteni (mawanga pamapapo omwe ali masentimita atatu kapena osachepera) amakhala ochepa kuposa ammapapu (mawanga pamapapo omwe ndi aakulu kuposa masentimita atatu mu kukula). Mndandanda wa zina mwazifukwa zomwe zingayambitse zingatheke powonekera pazowonjezera pansipa.

Nthaŵi zina, chinyama cha minofu sichikudziwitsani. Lipoti ngati ili likhoza kubwezeredwa ngati "losavomerezeka." Ngati ndi choncho, palinso njira zingapo. Ngati mwayi uli wotsika kwambiri kuti chizoloŵezi chomwe chili m'chifuwa chanu ndi khansara, mukhoza kusankha kuyembekezera ndikupitiriza kubwereza miyezi ingapo. Mofananamo, ngakhale malowo angakhale ndi khansa komanso kukhala ndi matenda osamalitsa sangasinthe mankhwala, mungasankhe kudikira.

Koma ngati matendawa ndi ofunikira, inu ndi dokotala mungasankhe kubwereza kachilomboko kapena kupeza njira zosiyana zopezera zowonongeka. Mungaphunzire zambiri za kusiyana pakati pa zotupa zowonongeka komanso zopweteka komanso chifukwa chake kusiyana nthawi zina zimakhala zovuta.

Molecular Profiling

Ndikofunika kuzindikira kuti aliyense amene ali ndi khansa ya m'mapapo yopanda maselo ayenera kukhala ndi kuyesedwa kwa majini (maselo opangidwa ndi maselo) opangidwa pa chotupa chawo. Lankhulani ndi dokotala wanu ngati simunamve zomwe takambirana. Pakalipano, mankhwala amavomerezedwa kwa omwe ali ndi rearrangements ALK , kusintha kwa EGFR , ndi rearrangements ROS1 ndi mankhwala kwa zina zowonongeka kusintha zikuchitika m'mayesero a zamankhwala.

Mavuto a Mphungu Yamimba

Kuopsa kwa chifuwa cha mapapo kumasiyana malinga ndi mtundu wa ndondomeko, malo a minofu ndi thanzi lanu lonse. Matenda omwe amapezeka kwambiri amachotsa magazi kapena mpweya umachoka m'mapapo. Mavuto ena omwe angakhalepo ndi awa:

Pneumothorax - kugwa kwa mapapo (mpweya wothamanga) - Ngati mukukula pneumothorax chifukwa cha chiwopsezo, dokotala wanu adzayenera kuika chifuwa cha chifuwa . Iyi ndi chubu yomwe imalola mpweya kuchoka m'mapapu anu mpaka mpweya utatsekedwa.
Kusuta.
Kutenga.
Kuopsa kwa anesthesia. Anesthesia komanso anesthesia amatha kunyamula zoopsa.
Kutulutsa mpweya wamatsenga - Kuthamanga kwa mpweya mu mitsempha yayikulu yomwe ingayende pamtima; wotchedwa systemic air embolism, amapezeka m'modzi mwa magawo oposa 100 alionse a ziphuphu zamapapu a singano.
Kutulutsa "mbeu" - Pali chiopsezo kuti chiwombankhanga chidzafalikira pambali ya singano ya singano pamene biopsy yapangidwa. Mavutowa ndi osowa, ndipo pakalipano, nthenda za singano zimayesedwa ngati njira yabwino kwambiri yothetsera mapapu ngati pakufunika.

Maganizo Anu Asanayambe Kutentha Kwambiri

Ziribe chifukwa chake dokotala wanu wakulimbikitsani kupuma kwa mapapu, kusautsika kungakhale kovuta kupirira. Anthu ambiri amanena kuti amakhala mwamtendere ndi matenda osadziwika bwino kuposa kukhala ndi moyo wosadziwa.

Khulupirirani banja lanu ndi anzanu komanso nthawi ino. Yesetsani kwa anthu omwe mukudziwa kuti adzakuthandizani kulimbana ndi kuyembekezera, monga omwe amakuukitsani nthawi zambiri. Imeneyi ndi nthawi yabwino kuti muwafunse okondedwa anu kuti asapitirize "kukudziwani" mpaka mutadziwa zambiri, komanso kuti musamawuze nkhani zawo (zomwe timazitcha nthano zowopsya) za ena omwe awona zofanana.

Ngati maganizo anu akukumana ndi zovuta kwambiri, kumbukirani kuti mankhwala nthawi zonse amasintha. Ngati muli ndi zofanana zomwe agogo anu aakazi anachita zaka zapitazo, sizikutanthauza kuti mudzakhala ndi zomwezo. Panali mankhwala atsopano omwe amavomerezedwa kuti azitha kuchiza khansa ya m'mapapo pakati pa 2011 ndi 2016 kusiyana ndi zaka 40 zisanafike 2011.

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