Peritoneum ndi nembanemba yomwe imayika mimba yomwe imakhala ndi ziwalo zambiri za m'mimba monga m'mimba, ambiri m'matumbo, gawo lalikulu la matumbo, chiwindi, nthiti, ndi mchira wa kapangidwe. Dera lomwe lili kumbuyo kwake limatchedwa retroperitoneum, lomwe kwenikweni limatanthauza "kumbuyo kwa peritoneum". Dangali lili ndi ziwalo za m'magazi, mutu, ndi thupi la ziphuphu, impso ndi maselo am'mimba omwe amatchedwa retroperitoneal lymph nodes.
Mitsempha imeneyi imakhala ndi magulu ang'onoang'ono monga mlengalenga, zowonongeka, zowonongeka, zowonongeka, para-aortic, zinyama zapamwamba ndi zaacac.
Kodi Chitetezo cha Lymph Retroperitoneal Dissection N'chiyani?
Mitsempha yotchedwa Retroperitoneal disodection (RPLND) ndiyo kuchotsa opaleshoni ya maselo amtundu wa retroperitoneal. Kawirikawiri 40-50 mfundo amachotsedwa.
Kodi Zimapangidwa Motani?
Chombocho chimapangidwa pansi pa sternum (chifuwa cha mafupa) mpaka pansi pa umbilicus (batani la mimba). Kuchita opaleshoni yosawerengeka yosawerengeka kumapezeka m'madera ena, ngakhale kuti sizomwe zilili. Chifuwacho chimachoka kumalo osungirako malo. Iyi ndi malo omwe akuwonetsedwa ndi fanizo ili pamwamba, ngakhale kuti silikusonyeza opaleshoni yokha. Zida zazikuluzikulu zimadziwika pamodzi ndi maselo a retroperitoneal omwe amayenda mofanana. Mitsempha yamakono imakhala yosangalatsa kuti asamawononge mitsempha yoyandikana nayo.
Nodezi zimatumizidwa kwa odwala matenda kuti azindikire kukhalapo kwa khansa. Matumbowa amabwereranso kuntchito yake ndipo mabalawo amatsekedwa. Nthawi ya opaleshoni ikhoza kusiyana koma imawerengedwa maola.
Kodi Zimagwiritsidwa Ntchito Liti?
Chithandizo chachikulu cha khansa yambiri ya testicular ndi kuchotsedwa kwa khansa testis, opaleshoni yotchedwa orchiectomy.
Pambuyo pa orchiectomy yochuluka, pali njira zingapo zosiyana malinga ndi siteji ndi mtundu wa kansa ya testicular: kuyang'anira, chemotherapy ndi / kapena RPLND.
RPLND imagwiritsidwa ntchito makamaka mu mtundu wa khansara yamagulu yowononga majeremusi yotchedwa nonseminoma.
Kulemba masitepe n'kofunika kwambiri pakuzindikira njira zomwe mungapangire mankhwala. Kawirikawiri, khansara yamakono imangokhala pa testis, siteji yachiwiri imaphatikizapo maselo a retroperitoneal ndi gawo lachitatu likuphatikizapo ziwalo zina zilizonse monga mapapo. Gawo I likutsatiridwa ndi makalata A kapena B. Gawo la II likutsatiridwa ndi makalata A, B kapena C. Makalata awa amasonyeza momwe chiopsezo chachikulu chimayambira mu siteji I kapena momwe ziwalo zazikuluzikulu zilili pa siteji II.
Pulogalamu ya IA (chotupa chomwe chili pafupi ndi testis ndi epididymis ), RPLND ndi njira, koma kuyang'anitsitsa (kungoyang'anitsitsa zinthu) kumasankhidwa. Komabe, mu siteji IB matenda (zotupa zomwe zimayambitsa magazi kapena zida zamadzimadzi, chingwe kapena spermatic), mwina RPLND kapena chemotherapy ikulimbikitsidwa. Pulogalamu ya IIA (maselo osapitirira 2 cm m'mimba mwake) RPLND ndi chithandizo chovomerezeka. Pa siteji ya IIB (nthendayi imakhala pakati pa 2-5 masentimita m'mimba mwake) RPLND imatha kuganiziridwa mwapadera, koma chemotherapy ndizochiza chithandizo.
Khansara ya Stage II ingathandizidwenso ndi chemotherapy kutsogolo. Ngati palinso umboni wotsalira khansara pambuyo chemotherapy (minofu kapena masentimita> 1 cm), RPLND ndi mwayi, ngakhale kuti n'zovuta kwambiri kuchita mankhwala awa.
Pamene Silikugwiritsidwa Ntchito
Sitiyenera kugwiritsidwa ntchito pa mitundu ina ya khansa ya testicular monga seminoma. Siziyenera kuchitika ngati maselo amphamvu kwambiri ali oposa 5 masentimita awiri. Sitiyenera kugwiritsidwa ntchito ngati zizindikiro zamagazi za magazi sizinabwererenso kumalo ochiritsira omwe amatsatira kwambiri orchiectomy. Sitiyenera kugwiritsidwa ntchito pamtundu wina uliwonse pamene opaleshoni ndi anesthesia sangathe kulekerera.
Ubwino, Zowononga, ndi Zotsatira Zotsatira
Chinthu chabwino kwambiri kwa RPLND ndi kuchiza khansa. Ubwino wina ndiwodziwa ngati maselo amphongo ali ndi khansara kapena ayi. Komanso, ambiri a nonseminoma khansa testicular adzakhala ndi teratoma. Teratoma ndi chotupa choipa kwambiri ndipo kawirikawiri sichifalikira palokha. Komabe, ikhoza kufalikira pokhudzana ndi mitundu ina ya nonseminoma. Nchifukwa chiyani izi zikudetsa nkhaŵa? Teratoma sichimvetsetsa mankhwala a chemotherapy kapena mankhwala a radiation kotero kuti njira yokhayo yothetsera iyo ngati imafalikira ku maselo am'mimba ndi kudzera opaleshoni. Ngati teratoma yatsalira mankhwala awa, akhoza kukula ndi kuyambitsa zizindikiro kapena kusintha kukhala khansa yaukali kwambiri.
RPLND ikhoza kuwonetsa chonde chifukwa chakumvetsetsa komwe kumadziwika kuti kubwezeretsa kubwezeretsa. Mukamasambira nthawi zonse, mitsempha yothyola mimba kuteteza nyemba kuti isabwererenso (retrograde) mu urethra ndi kutha kwa chikhodzodzo kusiyana ndi kutulutsa mkati ndi kunja kwa mbolo. Izi zikhoza kuchitika chifukwa mitsempha yothyola minofu imeneyi ikuyenda motsatira ma lymph nodes ndipo ikuwonongeka pakapita opaleshoni. Komabe, pogwiritsa ntchito njira zamakono zamakono, vutoli ndilopitirira 10% nthawi zambiri.
Zotsatira zina zowonjezera za mankhwala ndi zofanana ndi ma opaleshoni ena a m'mimba: ziwalo zobvuta, matenda, ndi zochita kwa anesthesia.
Chigamulo chopitilira ndi RPLND ndi chimodzi chimene chiyenera kukambirana bwino ndi katswiri wanu wa khansa kuti mudziwe ubwino wake ndi kukambirana zina.