Chiyanjano Chokwatira (Segmentectomy kapena Reslobar Resection) vs Lobectomy
Ngati dokotala wanu wakulimbikitsani kugwirizanitsa kansalu ya khansa, mumakhala mukudzifunsa kuti ndondomekoyi ndi yotani komanso kuti ndi yosiyana bwanji ndi mitundu ina ya opaleshoni ya khansa yamapapo . Ndi liti pamene resection resection ingakonzedwenso pazinjira zina ndi zina zotani zomwe zingakhale zovuta? Kodi ndi zifukwa zina ziti zomwe zingagwiritsire ntchito kubwezeretsa mphero m'malo mwa lobectomy, ndipo ndi liti pamene sizingakonzedwe?
Chiyanjano cha Mkwati: Tanthauzo
Kudzaza kansalu kumaphatikizapo kuchotsedwa kwa khansa yamapapu pamodzi ndi gawo lopangidwa ndi mphete pafupi ndi chotupacho. Njirayi imachotsa minofu yochepa yamapapu kusiyana ndi lobectomy (njira yomwe amachotsera mapapo amachotsedwa) kapena segmentectomy (njira yomwe imachotsa chigawo chachikulu cha mapapo kusiyana ndi mphete, koma osati lobectomy .) Poyang'ana papepala lafanizo lomwe mapapu abwino ali ndi ma lobes 3 ndipo mapepala akumanzere ali ndi ma lobes awiri.
Chombo chotchedwa resege resection chimatchulidwanso kuti sub-lobar resection , monga segmentectomy . Poyang'ana malemba ena mukhoza kuona njira yomwe imatchedwa osanatomic kusiyana ndi njira zina zomwe ali anatomic, kutanthauza kuti sizimaphatikizapo kuchotsa mbali imodzi ya anatomy.
Zisonyezero za Kukana Kwambiri
Ngakhale kuti lobectomy ikhoza kukhala dokotala wodziwa bwino opaleshoni kwa anthu ambiri, pali zifukwa zingapo zomwe dokotala angapangire kudandaula kuti awonongeke m'malo mwa lobectomy: Izi zingaphatikizepo:
Ziphuphu Zing'onozing'ono
Mphepete mwachitsulo umagwiritsidwa ntchito kwa khansa yaing'ono yamapapu, monga mapangidwe oyambirira omwe sali ang'onoang'ono a khansa mapapu a mapapu ndi kanthawi kochepa kansalu kakang'ono ka mapapo a mapapo . ( Kuchita opaleshoni nthawi zina kumachitika kwa khansara yaing'ono yamapapo ya m'mapapo koma izi sizodziwika.)
Kawirikawiri njirayi imaganiziridwa ngati chotupacho sichiri masentimita 4 (pafupifupi masentimita awiri) ndipo sichichepera masentimita awiri, chiri pamtunda wa mapapo (phokoso), ndipo chimaikidwa ngati siteti 0 , siteji 1A kapena siteji yaing'ono ya 1B ya khansa ya m'mapapo yopanda maselo .
Malinga ndi kafukufuku wa TNM ya kansa yamapapo , zotupa izi zidzakhala T1N0M0.
Zifukwa Zowunikira
Nthawi zina ndondomekoyi imakhala ngati mapapu a mapapu kuti ayese kufufuza zinthu (magalasi opacities kapena zina zotsekemera zamapapu).
Ndondomekoyi ikhoza kupangidwanso chifukwa cha matenda a chifuwa, monga chifuwa chachikulu cha TB, aspergillosis, ndi kuchotsa mabulupu a emphysema.
Ndi khansa zina, ndondomeko ikhoza kuchitidwa pofuna kuchotsa mitsempha yodzipatula m'mapapo kuchokera ku khansa ya m'mawere, khansa ya khansa, ndi khansa zina zochepa (monga khansa yapachifuwa ya khansa, khansa yamtundu, ndi mitsempha) yomwe imafalikira m'mapapu.
Chikhalidwe Chogonjetsedwa Chogonjetsedwa
Pamene kugwiritsidwa ntchito kwa ngongole kumachitika kwa anthu omwe ali ndi khansara yamapapu, nthawi zambiri amachitira anthu omwe sangalekerere kuchotsedwa kwathunthu, monga achikulire omwe ali ndi khansara yamapapu, anthu omwe ali ndi matenda ena aakulu, kapena omwe asokoneza mapapo ntchito. Ngati zili choncho, cholinga chake ndicho kuchotsa chotupacho pamene mukusunga mapepala ambiri a mapapo ngati n'kotheka.
Okalamba
Zindikirani, ndikuti anthu achikulire omwe ali ndi khansa ya m'mapapo nthawi zambiri amalolera chithandizo cha khansa yamapapo komanso achinyamata omwe ali ndi matendawa. Mu kafukufuku wina, ngakhale okalamba omwe anali ndi pneumonectomy (kuchotsedwa kwa mapapo onse), sanasonyeze kusiyana kulikonse kuti athe kulekerera ndondomekoyi.
Phunziro la 2018 linapezanso kuti anthu achikulire omwe ali ndi khansara yamapapo (omwe ali ndi zaka zoposa 80) opaleshoni yololedwa komanso achinyamata. Kafukufukuyu anapeza kuti segmentectomy (wedge resection) ikugwirizana ndi zotsatira zabwino kuposa opaleshoni yambiri ya khansa ya m'mapapo.
Zosankha Zanu
Chifukwa china chothandizira kulingalira izi ndi kusankha kwanu. Anthu ena amasankha njira zochepetsera zochepa monga izi ndi zifukwa zapamwamba za moyo ndi kuvomereza chiwopsezo chachikulu cha khansa ya m'mapapo .
Zifukwa Zomwe Kudzudzula Pakhomo Silingakonzedwe
Ziphuphu zazikulu kuposa masentimita 4 sizingathetsedwe kudzera mu mphero resection.
Malo a chotupacho angapangitsenso kuti njirayi ikhale yosagwira ntchito. Kawirikawiri, njira yowonjezereka monga lobectomy nthawi zambiri imalimbikitsidwa kwa achinyamata, osakhala ndi thanzi labwino, anthu ena, ngakhale kuti izo zingasinthe malinga ndi kafukufuku waposachedwapa wa maphunziro (onani zozizwitsa pansipa.)
Kukonzekera Musanayambe Kutsutsidwa Kwambiri
Musanachite opaleshoni, dokotala wanu adzafuna kutsimikiza kuti mungathe kulekerera ndondomekoyi-kuyambira paumoyo wathanzi komanso pankhani ya mapapo. Mayeso ndi mayeso angaphatikizepo:
- Mbiri yakale ya zamankhwala ndi kuyesedwa kwa thupi
- Mayeso a magazi, kuphatikizapo mayesero a impso ndi chiwindi
- Kuunika kwa chikhalidwe cha zakudya
- Kuyesera kochita ntchito
- Kufufuza kwa mtima
- Kufufuza zofufuza kuti mudziwe malo ndi kukula kwake kwa chotupacho, komanso kufufuza kansa yomwe imapezeka m'zigawo zam'mimba komanso m'madera akutali (monga chiwindi kapena mafupa).
The Procedure
Chombo chachitsulo chikhoza kuchitidwa kudzera mu thoracotomy (opaleshoni yamkati pamatsegulidwe) kapena kudzera opaleshoni yamagetsi (VATS). VATS ndi njira yochepetsetsa, koma si onse opaleshoni amachita opaleshoni iyi ndipo sizingatheke malinga ndi malo a chotupacho.
Malingana ndi ndondomeko yomwe imachitika, dokotala (atalowa m'bokosi) amapeza chotupacho. Kuyeza mosamala kumachitika poyesa mapapu ndi ma lymph nodes omwe ali pafupi. Kenako chotupacho chimachotsedwa ndi tizilombo tating'ono tozungulira chifuwacho.
Kuchita opaleshoniyo kungaphatikizepo ndi brachytherapy, njira yomwe ma radiation amagwiritsidwa ntchito pa opaleshoni mwachindunji ku malo a chotupacho.
Kubwezeretsa
Pambuyo pa opaleshoni, kutalika kwa nthawi yomwe mwakhala kuchipatala kumadalira mtundu wa ndondomeko yomwe yachitidwa (VATS vs open thoracotomy) ndi momwe mukupulumutsira. Chikwama cha chifuwa chimayikidwa mu chifuwa chanu pamene mukuchitidwa opaleshoni, ndipo kawirikawiri, amakhala m'malo a maola 24 mpaka 48. Pa nthawiyi odwala opaleshoni adzachezera nanu, kukulimbikitsani kupuma kwambiri kuti muchepetse chiopsezo cha matenda. Mukapita kunyumba, dokotala wanu akukupatsa malangizo omveka kuti akutsatirani ndikupatseni mankhwala a mankhwala kuti muthetse ululu uliwonse mukamabwerera kwanu.
Zingakhale Zovuta za Kuletsedwa Kwa Mkwati
Zovuta si zachilendo, koma zingakhalepo:
- Mavuto a anesthesia ambiri
- Hemothorax (kutuluka magazi m'chifuwa)
- Kutenga
- Atelectasis (kugwa kwa gawo, kapena mapapo onse)
- Zilonda zamtundu wa fistula (njira yosavuta yomwe imayamba pakati pa mapapu ndi nembanemba yomwe imayendera mapapo (pleura))
- Kuthamanga kwa mpweya kumaphatikizapo kusowa kwa nthawi yaitali chikwama cha chifuwa
- Kuvuta kutsitsimula kuchokera ku mpweya
Kuthamangitsani
Zomwe zimagwiritsidwa ntchito pakhomopo zimasiyana chifukwa cha chotupa chanu, thanzi lanu lonse, ndi mankhwala ena omwe mumalandira.
Zinkaganiziridwa kwa nthawi yaitali kuti kupulumuka (mwa anthu omwe amalekerera ndondomekoyi) ndipamwamba kwambiri mwa anthu omwe ali ndi lobectomy vs wedge resection. Kupenda kwaposachedwa kwa maphunziro 54 omwe akuyang'ana odwala pafupifupi 39,000 asintha malingaliro awo. Kwa anthu omwe anali ndi resection koma akhoza kulekerera lobectomy (gulu limene mphete resection "idasankhidwa mwachangu,") kusiyana kwake sikunali kosiyana kwambiri pakati pa njira ziwirizi. Kwa anthu omwe anali ndi resection chifukwa sakanatha kulekerera lobectomy (gulu lotchedwa "gulu losokonezeka"), kupulumuka kunali koipitsitsa kwambiri kwa iwo omwe ali ndi ndalama za resection.
Kulimbana ndi Pambuyo pa Kugonjetsa Mkwati wa Khansa Yam'mimba
Ndalama ya resection, ngakhale yochepa kwambiri kuposa lobectomy kapena pneumonectomy, ikadali opaleshoni yaikulu. Funsani, ndipo mulole, abwenzi anu ndi achibale anu akuthandizeni. Kukonzekera kwaulendo pambuyo pa opaleshoni ya khansa yamapapu yangoyamba kumene kufufuza koma ikhoza kusintha kusiyana kwakukulu kwa moyo wa anthu ena. Popeza ichi ndi lingaliro latsopano, mungafune kufunsa dokotala wanu kuti atumize.
> Zotsatira:
> Ambrogil, M. et al. Kuthetsa resection ndi kusokonezeka kwafupipafupi pulogalamu ya khansa ya khansa yapatali ya m'mapapo. European Respiratory Journal . 2015. 45 (4): 1089-109.
> Cao, C., Chandrakumar, D., Gupta, S., Yan, T., ndi D. Tian. Kodi pangakhale zochepa? - Kuwongolera mwatsatanetsatane ndi kufotokozera mwachidule machitidwe a sublobar mogwirizana ndi lobectomy kwa kansa yaing'ono ya mapapu ya mapapo molingana ndi kusankha kwa odwala. Khansa Yam'mimba .2015. (Epub patsogolo pa kusindikiza).
> Chambers, A., Routledge, T., Pilling, J., ndi M. Scarci. Odwala Okalamba Ndi Khansara Yam'mimba Ndi Kugonjetsedwa Kowonongeka pa Malamulo, Kufa ndi Kukhazikika kwa Moyo? . Kugwiritsa Ntchito Opaleshoni Yophatikizapo Opaleshoni Ndiponso Opaleshoni Yophulika . 2010. 10 (6): 1015-21.
> Stamenovic, D., Messerschmidt, A., ndi T. Schneider. Kuchita Opaleshoni kwa Matenda Akhungu Mwa Okalamba: A Cohort Retrospective Phunzirani pa Mphamvu ya Zaka Zaka Zoposa 80 pa Kukula kwa Mavuto mwa kugwiritsa ntchito Multivariate Risk Model. International Journal of Surgery . 2018. 52: 141-148.