Katemera ndi njira yaikulu yopaleshoni yomwe imathandiza ochita opaleshoni kuti agwire ntchito pachifuwa pa opaleshoni. Kuphatikizidwa kumapangidwira mu khoma la chifuwa, ndipo kulumikizana kwa ziwalo za chifuwa kumapangidwira ndi kudula mbali ina ya nthiti. Ndondomekoyi imachitika mu chipinda chogwiritsira ntchito pansi pa anesthesia.
Zifukwa Zomwe Mungagwiritsire Ntchito Mmodzi
Thoracotomy ikhoza kuchitidwa pa zifukwa zingapo, osati kungochotsa khansa.
Kutsegula ndi kutsegula chifuwa ndi mediastinum (malo pakati pa mapapo) amatha kupereka madokotala opaleshoni kufika pamtima, m'mapapo, m'mimba, pamtunda (thoracic) kapena pa aorta, ndi kutsogolo (mbali yamkati) ya msana. Zizindikiro zina zikuphatikizapo:
- Opaleshoni ya khansa ya m'mimba
- Opaleshoni ya khansa ya opaleshoni
- Opaleshoni ya mtima / aortic
- Chifuwa cha chifuwa
- Piston pneumothorax (mapapo otumphuka)
- Utsogoleri wa COPD
- Chifuwa chachikulu
- Kuwongolera ndi kuyesa kwa misala yosadziŵika
- Kuchita opaleshoni kwa msana wamkati
- Matenda a thoracotomy (odwala thoracotomy). Izi ndizochitika mu chipinda chodzidzimutsa pofuna kuika moyo pachiswe monga chifuwa cha mimba
Mitundu ya Ndondomeko
Pali mitundu yambiri ya thoracotomy yomwe ingathe kuchitidwa, malinga ndi chitsimikizo cha opaleshoni ndi chikhalidwe chochiritsidwa. Izi zikuphatikizapo:
- Zojambulajambula zamtundu wa thoracotomy - Iyi ndiyo njira yodziwika kwambiri komanso njira yowonjezera yopeza mapapo kuti achotse mapapu kapena gawo la mapapo kuti apeze khansa ya m'mapapo . Kuphatikizidwa kumapangidwa pambali pa chifuwa kumbuyo kwa nthiti. Nthitizi zimatha kufalikira (nthiti imachotsedwanso) kuti ziwone m'mapapo. Ochita opaleshoni amatha kuchotsa mapapu ( pneumonectomy ), lobe wa m'mapapo ( lobectomy ), kapena mbali ya mapapo ( wedge resection ).
- Thoracotomy yamkati - Mu thoracotomy yamkati, madokotala opaleshoni amachititsa kuti chifuwacho chifike pamtima. Izi zimachitika kawirikawiri kuti achite opaleshoni pamtima.
- Matenda a thothokomiya - Mu thoracotomy, a opaleshoni amatha kupeza chifuwa pogwiritsa ntchito mankhwala osokoneza bongo. Izi zimachitidwa pochiza pneumothorax (mapapo otumphuka), koma akhoza kuchitidwa opaleshoni ina yamtima ndi mapapo.
- Matenda otchedwa Anterolateral thoracotomy - Njirayi ndi njira yodzidzimutsa yomwe imaphatikizapo kutsogolo kutsogolo kwa chifuwa. Zingatheke potsatira chipsinjo chachikulu cha chifuwa, kapena kulola kuti mtima ufike pamapeto pamapeto.
Kupanga ndi Kukonzekera
Musanayambe kukhala ndi thoracotomy mudzakhala ndi mbiri yosamalitsa komanso mwakuthupi, ndipo mutha kukhala ndi maphunziro kuti muwone mtima wanu ndi mapapo. Ngati thoracotomy yanu ikuchitidwa khansa yamapapo, zingakhale zofunikira kuti mutenge kachiwiri . Kafukufuku akusonyeza kuti anthu omwe opaleshoniyi anachitidwa pa malo opatsirana khansa omwe amachita zambiri mwa njirazi akhoza kukhala ndi zotsatira zabwino. Kwa anthu ena, njira yowonongeka yochepa yomwe imadziwika kuti opaleshoni yamagetsi (VATS) ingagwiritsidwe ntchito m'malo mwa thoracotomy, koma izi sizipezeka kuchipatala chonse.
The Procedure
Thoracotomy kawirikawiri imachitidwa pansi pa anesthesia mu chipinda chogwiritsira ntchito. Kutengeka kwautali kumapangidwa mbali imodzi ya chifuwa, ndipo nthiti zimagawanika kuti zipeze chifuwa. Pazochitika zonsezi, zizindikiro zofunika zimayang'aniridwa mosamala kuti muonetsetse kuti mukulekerera ndondomekoyi bwino. Pamene opaleshoniyo yatsirizidwa, chifuwa cha chifuwa chimayikidwa mu chifuwa ndipo chimachokapo kwa nthawi ndithu.
Zovuta Zilipo
Anthu ena amatha kupyolera mu thoracotomy popanda mavuto alionse, pamene ena angakumane ndi zovuta zina kapena zingapo. Ndikofunika kulankhula bwinobwino ndi dokotala wanu opaleshoni yokhudza opaleshoni yanu komanso zomwe muyenera kuyembekezera. Ndithudi, anthu omwe ali ndi thanzi labwino asanayambe ntchitoyi adzakhala ndi njira yosavuta kuposa omwe akulimbana ndi mavuto owonjezereka azachipatala. Ndipo monga momwe opaleshoni iliyonse imachitira, kusuta kungapangitse kuti pakhale mavuto aakulu.
Zina zowononga zotsatira ndi zovuta za thoracotomy zingaphatikizepo:
- Kusowa kwa nthawi yaitali kwa thandizo la mpweya pambuyo pa opaleshoni
- Kuthamanga kwa mpweya kumapangitsa kuti pakhale nthawi yochuluka ya chifuwa cha chifuwa pambuyo pa opaleshoni
- Kutenga
- Kusuta
- Kupha magazi - Mitsempha ya m'magazi (mapiritsi a magazi) ndi mapulmasi omwe amapezeka (magazi omwe amatha kuchoka ndi kupita kumapapo) ndi ovuta komanso ovuta opaleshoni ya chifuwa
- Mavuto a anesthesia ambiri
- Kuthamanga kwa mtima kapena arrhythmias
- Kusokonezeka kwa chingwe kapena kuuma
- Zilonda zamtundu wa fistula - Izi ndizovuta zomwe zimachitika pakati pa phokoso lamakono ndi malo pakati pa mapepala (pleura) kuwonjezera mapapu
- Matenda a Postpneumonectomy kapena post-thoracotomy pain - Mavuto m'dera la thoracotomy nthawi zina amapitirira kwa nthawi yaitali atatha opaleshoni
Mafunso Ofunsani Poyamba
Taganizirani kufunsa dokotala mafunso awa, ndipo lembani mafunso ena omwe mungakhale nawo.
- Ndani adzakhala akuchita opaleshoni?
- Kodi ndi njira zingati zomwe mwazichita?
- Ndi mavuto ati omwe ndingathe kuyembekezera?
- Kodi njirayi idzatenga nthawi yayitali bwanji?
- Ndidzakhala ndi nthawi yayitali bwanji kuchipatala mutatha opaleshoni?
- Kodi ndingabwerere mwamsanga bwanji kuntchito?
- Kodi mumandilimbikitsa kuti ndizitsitsimule pambuyo pa opaleshoni?
- Kodi ndiyembekeza chiyani kwa nthawi yaitali - ndinene, chaka kuchokera pano kapena zaka 3 kuchokera pano?
- Kodi ndizitani ngati ndikukumana ndi mavuto atabwerera kunyumba?
Zitsanzo: Dokotala wa opaleshoni wa Jim anamuuza kuti adzachita thoracotomy kuti apite kumapapu ake ndi kuchita khansa yake ya khansa ya m'mapapo.
Zotsatira:
Bendixen, M., Jorgensen, O., Kronborg, C., Andersen, C., ndi P. Licht. Kupweteka kwapopopayi ndi umoyo wa moyo pambuyo pa lobectomy kudzera opaleshoni yachipatala yothandizidwa ndi mavidiyo kapena anterolateralthoracotomy kwa khansa ya m'mapapo oyambirira: kuyesedwa kosasinthika. Lancet Oncology . 2016. 17 (6): 836-44.
Fernandez, R., Kosinski, A., Burfeind, W. et al. Sosaiti ya Thoracic Surgeons Lung Cancer Resection Risk Model: Dongosolo lapamwamba kwambiri ndi Zotsatira Zapamwamba. Annals of Surgery Opera . 2016 May 19. (Epub patsogolo pa kusindikiza).
Sengupta, S. Post-operative pulmonary mavuto pambuyo thoracotomy. Indian Journal of Anesthesia . 2015. 59 (9): 618-26.
Mchitidwe wa Zaumoyo wa University of Michigan. Kukonzekera Chikopa Chanu. Http://surgery.med.umich.edu/thoracic/pdf/preparingforyourthoracotomy.pdf