Kupweteketsa mtima kwachinyengo ndikumvetsa komwe kumaphatikizapo kumanga madzi omwe ali ndi khansa pakati pa nembanemba yomwe imayendera mapapo. Zimapezeka pafupifupi 30 peresenti ya khansa ya m'mapapo, koma imatha kuchitika ndi khansa zina, monga khansa ya m'mawere, khansara ya ovari, ma leukemias, ndi ma lymphomas. Ndi khansara yamapapu, kupwetekedwa koopsa kwapempha kungakhale chizindikiro choyamba cha khansara, kapena kungathe kuchitika ngati kanthawi kosavuta ya khansa ya m'mapapo yapamwamba .
Kodi muyenera kudziwa chiyani za zizindikiro, zifukwa, ndi chithandizo cha mankhwalawa?
Mwachidule
Kufuula kumatanthauzira ngati kuchuluka kwa madzi m'thupi pakati pa zigawo za minofu ( pleura ) yomwe imapezeka m'mapapu. Ngati maselo ali ndi khansa mumadzimadziwa, amatchedwa kuti matenda oopsa kwambiri (khansa). Kupwetekedwa kwachisembwere kosayenera kungakhale kwakukulu komanso kofalikira kapena kochepa ndipo kumaphatikizapo gawo laling'ono la pempho lopempherera . Kuwotcha kungakhale konse kumadera amodzi, kapena pangakhale malo angapo owonongeka (omasulira pleural effusions).
Zimayambitsa
Pafupi mtundu uliwonse wa khansara ukhoza kuyambitsa chisokonezo chachikulu ngati chiripo kapena chikufalikira (metastasizes) ku chifuwa. Chofala kwambiri ndi khansa ya m'mawere, kansa ya m'mapapo, khansara ya ovari, ndi mitundu ina ya khansa ya m'magazi ndi maimfine. Kuchulukanso kwachinyengo kungayambitsenso ndi chithandizo cha khansa ya m'mapapo, monga opaleshoni, mankhwala odzola, kapena chemotherapy.
Zizindikiro
Zisonyezero za kupwetekedwa kwachisokonezo kosautsa zingakhale zovuta kwambiri. Kupuma pang'ono ndi chizindikiro chofala kwambiri, chikuchitika pafupifupi 80 peresenti ya anthu. Chifuwa chingakhalepo, ndipo izi nthawi zambiri zimakhala zochitika, zomwe zikutanthauza kuti zikhoza kukhala zoipitsitsa m'madera ena monga kutsamira patsogolo kapena kumbali imodzi.
Chifuwa cha chifuwa kapena mtundu wina wa chifuwa chosadziwika cha chifuwa chikhoza kuchitika.
Kudziwa
Ndikofunika kuti mudziwe bwinobwino kuti mankhwalawa ndi ovuta kwambiri chifukwa chiwerengero cha mankhwala ndi chithandizo n'chosiyana kwambiri ndi zovuta zowononga. Ndikofunika kuzindikira kuti ngakhale khansara, mpaka 50% ya pleural effusions ndi abwino.
Zowonongeka mobwerezabwereza kawirikawiri zimakayikiridwa poyamba chifukwa cha zizindikiro kapena zofukulidwa zomwe zimawoneka pa chifuwa cha X-ray kapena CT. Ngati dokotala akudandaula kuti akutsutsana ndi chinyengo, chotsatirachi nthawi zambiri chimakhala thoracentesis , njira yomwe singano imayikidwa kudzera mu khoma la chifuwa kuti mupeze chitsime cha madzi. Madzi oterewa amafufuzidwa pang'onopang'ono kuti aone ngati maselo a khansa alipo.
Ngati thoracentesis siingakhoze kuchitidwa, kapena ngati zotsatira sizikudziwika, njira zina zingathe kuchitidwa kuti mudziwe bwinobwino. Nthaŵi zina, thoracoscopy (njira imene thoracoscope imalowetsamo mu chifuwa) ingafunikire kuchitidwa kuti ipatsidwe chidziwitso chodziŵitsa kupweteka kosautsa kwachinyengo.
Kuchiza
Cholinga chochiza chithandizo choyipa chonyansa nthawi zambiri chimapangitsa kuti munthu akhale ndi moyo wabwino komanso kuchepetsa zizindikiro koma osati kuchiza khansa.
Ngati kuwonongeka kuli kochepa kwambiri, nthawi zina kungasiyidwe yokha.
Thoracentesis
Monga tafotokozera pamwambapa, thoracentesis nthawi zambiri amagwiritsidwa ntchito, kuti azindikire kuwonongeka kwa magazi (kudziwa ngati maselo a khansa alipo mu madzi ndi zina), ndi kuchotsa madzi. Mwamwayi, izi zimangobwereza nthawi zambiri.
Chifukwa cha kupwetekedwa mtima kosautsa komwe kumabwereza, pali njira zingapo zothandizira kupuma kwa mpweya ndi kuchepetsa mpweya. Panthawiyi pakadakali kutsutsana kwakukulu pa momwe ndondomeko ili yabwino, ndipo chisankhocho chimapangidwa chifukwa cha kukula kwake kwa zizindikiro, momwe chotupacho chikuyankhira mankhwala, ndi momwe mumachitira - momwe kansa imasokonezera luso lochita ntchito zachizolowezi za tsiku ndi tsiku.
Pleurodesis
Njira imodzi yomwe imagwira ntchito pafupifupi 60 mpaka 90 peresenti ya anthu imatchedwa pleurodesis . Mwa njirayi, chubu imalowetsedwa mu malo achondelero ndipo chinthu, makamaka talc, chimaphatikizidwa pakati pa ma membrane omwe amalowa m'mapapu. Mankhwalawa amachititsa kutupa m'mimba mwachangu yomwe imachititsa kuti 2 linings aziphatikizana palimodzi (kutsekemera) kuteteza madzi kuti abwererenso mu malo okhudzidwa.
Indwelling Pleural Catheters
Njira ina ndi catheter yodandaula , yomwe imadziwikanso kuti catheter yodandaula. Mwa njirayi, tiyi yaing'ono imalowetsedwa m'kati mwachitsulo ndikuyika pansi pa khungu, ndi katsegu kakang'ono pambali yanu yomwe ikhoza kuphimbidwa ndi bandage. Izi zimapangitsa odwala kuti azitsuka madzi awo (mothandizidwa ndi wokondedwa) mwa kuyika chophimba chotsuka pakhungu. Kathetti yamatini imakhala yothandiza kwambiri ngati phokoso liri pambali zonse za chifuwa (kumtunda) kapena ngati pali malo akuluakulu omwe amapezeka m'magulu amadzimadzi (loculated effusions.) Njirayi nthawi zambiri imawoneka ngati yopanda mphamvu kuposa pemurodesis 80 peresenti kwa 100 peresenti ya anthu. Ofufuza ambiri tsopano akuganiza kuti kukhala ndi catheters (plecathe catheters) (IPC) ayenera kukhala mzere woyamba mwa anthu onse omwe ali ndi vuto loipa.
Pakhala pali mkangano wosonyeza kuti pleurodesis (talc insertion) kapena catheter yodandaula ndi njira yabwino kwa anthu omwe ali ndi khansa yapamwamba komanso yowonongeka mobwerezabwereza. Phunziro la 2017 lofalitsidwa mu JAMA , linayankha kuyankha funso ili. Ofufuzawa adapeza kuti iwo omwe anali ndi catheters okhala ndi ziwalo zochepa amakhala ndi zipatala zochepa kusiyana ndi omwe anali ndi pleurodesis, makamaka okhudzana ndi kufunika kochotseramo mankhwala. Apo ayi, panalibe kusiyana kwakukulu mukumverera kwa kupuma pang'ono kapena khalidwe la moyo wa ophunzira.
Zowonjezera Zophatikiza Zosankha
Ngati kupwetekedwa kwachinyengo kukupitirirabe ngakhale kuti pali njira zinazi, opaleshoni ikhoza kuchitidwa kukhetsa madzi m'mimba, kapena pleurectomy (njira yomwe imachotsa gawo la pleura) ikhoza kuchitidwa. Mankhwala atsopano (monga mankhwala opatsirana mankhwala) akuyambanso kupweteka kwambiri. Kachimotherapy ikhoza kuthandizira kwambiri chifukwa cha kansa yaing'onoting'ono ya mapapu , koma nthawi zambiri sizothandiza kwambiri kwa anthu omwe ali ndi kansa ya m'mapapo yopanda maselo .
Kusankha Thandizo Labwino
Pambuyo pa pleurodesis kapena pakanati chedteral cementter ikulimbikitsidwa, zinthu zochepa ndi zofunika. Choyamba, dokotala wanu akufuna kutsimikizira kuti muli ndi vuto lopweteketsa mtima komanso kuti zizindikiro zanu sizimayambitsa vuto lina. Chachiwiri, muyenera kukhala ndi chikhumbo chomwe chimayambiranso (kubwerera) pambuyo pa thoracentesis. Ndipo chofunika kwambiri, kukhetsa madzi kuchokera ku malo anu opempherera kumathandizira ndi zizindikiro za kupuma pang'ono. Sikofunika kuchotsa madzi chifukwa ndi apo, koma ngati akubweretsa mavuto (monga kupuma pang'ono). Iyi ndi mfundo yofunikira kwambiri kuti muwerenge. Ngati kupuma kwanu kumakhala chifukwa china, ndipo kuchotsa madziwa sikungapangitse kusiyana kwakukulu, kawirikawiri palibe phindu pochotsa madzi.
Kuthamangitsani
N'zomvetsa chisoni kuti nthawi ya moyo wa khansara yamapapo ndi chonyansa choponderezeka ndi osachepera miyezi isanu ndi umodzi. Nthawi yopulumuka yapakatikati (nthawi yomwe anthu 50 peresenti yafa ndi 50 peresenti akadali moyo) ndi miyezi inayi, ngakhale kuti anthu ena apulumuka nthawi yayitali. Izi zimakhala zabwino kwa anthu omwe ali ndi matenda oopsa a khansa ya m'mawere kapena khansa yambiri. Pokubwera mankhwala atsopano monga chithandizo chamankhwala ndi ma immunotherapy , akuyembekeza kuti manambalawa adzasintha posachedwa. Palinso mayesero ambiri a zachipatala akupitiriza kuyang'ana pa chithandizo chabwino kwambiri cha mankhwalawa.
Kulimbana
Kukhumudwa ndi kuvulaza kwachinyengo kungakhale kwakukulu. Pezani kuti podziwa kuti mumapezeka kuti muli ndi khansa, ndipo zomwe zingakuchitikireni zingakhale zovuta kwa wina aliyense-makamaka omwe ali ndi kachilombo koyipa pamene akuyamba kuti ali ndi khansa. Funsani mafunso. Funsani thandizo kwa ena, ndipo aloleni kuti apereke. Lankhulani ndi dokotala wanu za kuthetsa ululu wa khansa ya m'mapapo . Ganizirani kulowetsa gulu lothandizira . Maganizo anu angayambe kupsa mtima ndi kusakhulupirira, kuvutika maganizo. Izi ndi zachilendo. Funani abwenzi ndi okondedwa omwe ali okonzeka kumvetsera ndi kukuthandizani. Phunzirani zambiri za khansa ya m'mapapo 4 .
Kwa Okondedwa
Anthu ochepa kwambiri amakhala ndi khansa ya m'mapapo mwaokha, ndipo kwa okondedwa matendawa amatha kumva kuti ndi oopsa komanso oopsya ndipo kuwonjezera apo ndikumverera kosautsika. Kodi muyenera kudziwa chiyani pamene wokondedwa wanu ali ndi khansa ?
> Zotsatira:
> Azzopardi, M., Porcel, J., Koegelenberg, C., Lee, Y., ndi E. Fysh. Zotsutsana zamakono zomwe zikuyendetsedwa ndi zovuta zowonongeka. Seminars mu Kuzizira ndi Zofunikira Kusamalira Mankhwala . 2014. 35 (6): 723-31.
> Clive, A., Jones, H., Bhatnagar, R., Preston, N., ndi N. Maskell. Njira zothandizira kuyendetsa zopweteka zowonongeka. Dongosolo la Cochrane la Zosintha Zogwirizana . 2016. 5: CD010529.
> Kheir, F. et al. Kutulutsa Pathera Catheter kwa Chithandizo cha Malignant Pleural Effusion: Kusanthula Mwadongosolo ndi Kusanthula Meta. Journal of Therapeutics . 2015 Feb 2. (Epub pamaso pa kusindikiza)
> Thomas, R., Fysh, E., Smith, N. et al. Mphamvu ya Catheter Indwelling ndi Talc Pleurodesis pa Zomwe Amapereka Kwa Odwala Pakati pa Odwala Ndi Zoopsa Zopweteka: MALANGIZO OTHANDIZA KUYAMBIRA KUGWIRITSA NTCHITO. JAMA . 2017. 318 (19): 1903-1912.