Fistula ya bronchoplegu ndi njira yopanda malire (tsamba la sinus) limene limayamba pakati pa mpweya waukulu m'mapapu ( bronchi ) ndi malo pakati pa nembanemba yomwe imayendera mapapo (chifuwa chachisomo) . Pamene njira ngati iyi ikukwera, mpweya umene umapuma m'mapapo ukhoza kuyenda kudutsa njirayo ndikulowa malo opempherera.
Zimayambitsa
Pali zinthu zambiri zomwe zingayambitse fostula.
Ena mwa awa ndi awa:
- Opaleshoni ya khansa ya m'magazi - Kupanga mpweya (kuchotsa mapapu kapena gawo la mapapo) kwa khansa ya m'mapapo ndi chifukwa chachikulu chomwe chimayambitsa fostula. Zikutheka kuti zimachitika ndi pneumonectomy (kuchotsedwa kwathunthu kwa mapapo) kusiyana ndi njira monga lobectomy (kuchotsedwa kwa lobe yamapapo) kapena kubwezeretsa mphero (kuchotsedwa kwa gawo lopangidwa ndi khola la mapafu Mufukufuku wa 2016, 1.4 peresenti ya anthu omwe ali ndi lobectomy ndipo 14.3 peresenti ya anthu omwe ali ndi pneumonectomy anayamba matenda a fostula pambuyo pa opaleshoni.
- Matenda (makamaka mitundu ina ya chibayo yomwe inachititsa kuti ziwonongeke za mapapu a nekrosis zisokoneke.)
- Kupitirizabe pneumothorax - Izi zimatanthawuza mapaipi otayika (pneumothorax) omwe sapita.
- Chemotherapy kapena mankhwala opatsirana pogwiritsa ntchito khansa ya m'mapapo - Chithandizo chilichonse chimene chimawononga maselo ndi machiritso am'deralo m'dera lachitsulo chodandaulira chingayambitse fistula.
- Chifuwa chachikulu.
Kodi Zimakhala Zofanana Motani?
Kafukufuku akuyang'ana zochitika za fostula za bronchopleural zosiyana, koma zikuwoneka kuti zikuchitika pakati pa 1.5 ndi 28 peresenti ya opaleshoni yokhudza kuchotsedwa kwa mapapo. Monga tanenera poyamba, zikutheka kuti zimachitika ndi opaleshoni yambiri ndipo nthawi zambiri zimachitika pambuyo pa pneumonectomy, pomwe mpweya wabwino umakhala wofunikira kwa nthawi yayitali yotsatira opaleshoni, komanso pamene mazira akuluakulu aperekedwa patsogolo kwa opaleshoni.
Kawirikawiri, bronchopulmonary fistula idzapezeka kamodzi kapena milungu iwiri pambuyo pa opaleshoni yamapapo, ngakhale kuti fistula ikhoza kuchitika ngakhale mwezi utatha opaleshoni.
Zizindikiro
Monga tafotokozera m'munsimu pamene mukupeza matenda, fostula ya bronchopleal imapezeka kuti imachokera ku zojambula zojambulapo pamene mpweya ukupitirira. Ngati zizindikiro zilipo, zimatha kupezeka mosavuta ngati zizindikiro zomwe zingakhale zoyembekezereka kutsata matenda a mapapo ndi opaleshoni, monga chifuwa chosatha, kukhetsa magazi, kapena kupuma pang'ono.
Kudziwa
Kafukufuku wa fostula ya bronchopleural nthawi zambiri amapangidwa malinga ndi zomwe zimachitika patsiku. Kafukufuku wamtundu wa CT ndi njira yabwino yosankhira matendawa ndipo amatha kuwonetsa mpweya kapena madzi (nthawi zambiri pus kapena empyema ) m'malo opempherera.
Fistula ya bronchopleural nthawi zambiri imakhala ikudandaula mwachipatala mwa kuwona kuti mpweya umatha. Mwa kuyankhula kwina, fistula imeneyi imapezeka nthawi zambiri pamene chifuwa cha chifuwa sichikhoza kuchotsedwa pambuyo pa opaleshoni ya m'mapapo chifukwa cha kuphulika kwa mpweya. Mwina pangakhale kupunthira mosalekeza, kapena mmalo mwake, mpweya umatha kutuluka pokhapokha mutapuma kapena kutsirizika. Ndi mpweya wochepa, kuthamanga kungakhalepo pokhapokha ngati mutakakamizika kutha kapena chifuwa.
Chithandizo
Chithandizochi chikhoza kuchitidwa opaleshoni, kapena kupitirira pogwiritsa ntchito chubu (bronchoscopy tube) (nthawi zina iyi ndi njira yokhayo yomwe ingapezeke ngati wodwala asakhazikika) ndipo kafukufuku waposachedwapa amasonyeza kuti njira zowonjezereka zingakhale zabwino komanso zogwira mtima kapena anthu ambiri.
Mosasamala kanthu ka ndondomekoyi, ngalande ya madzi mu phokoso lamakono (kupyolera mu thoracentesis kapena kukhala ndi chifuwa chopangira chifuwa) ndi mankhwala opha tizilombo ndi mankhwala ofunika kwambiri.
- Opaleshoni ingagwiritsidwe ntchito kutseka fistula.
- Bronchoscopy - Mwa njirayi, fistula imapezeka ndipo zimagwiritsidwa ntchito kuti zitseke. Mankhwalawa (kawirikawiri siliva nitrate) amachititsa kutupa mu fistula yomwe imawombera ndi kutsekedwa, ndikugwiritsira ntchito bwino ndimeyi.
Kuthamangitsani
Fistula ya bronchoplegu ndi vuto lalikulu la opaleshoni ya khansa ya m'mapapo ndi imfa (chiwerengero cha anthu) imfa imakhala yosiyana ndi 10 mpaka 27 peresenti malinga ndi kuphunzira.
Mwachidziŵitso chodziŵika ndi chithandizo chowongolera, ndizotheka kuti zizindikiro za fostula za bronchopleural zidzasintha.
Komanso: bronchopleural air leak, BPF
Zitsanzo: Sam anapanga fistula ya bronchopleural pambuyo pa pneumonectomy kwa khansara yamapapo ndipo anafunikira kukhalabe m'chipatala motalika kuposa momwe ankayembekezera.
> Zotsatira:
> Birdas, T. et al. Zowopsa za bronchopleural fistula pambuyo pa pneumonectomy yolondola: kodi kuchotsa nthunzi diverticulum kumateteza? . Zolemba za Oncology Opaleshoni . 2012. 19 (4): 1336-42.
> Boudaya, M. et al. Udindo wodalirika wa matenda osokoneza bongo. Journal of Surgery ndi Opaleshoni Zambiri . 2013. 146 (3): 575-9.
> Fuso, L., Varone, F., Nachira, D. et al. Kuchulukana ndi Kulamulira kwa Post-Lobectomy ndi Pneumonectomy Bronchopleural Fistula. Mphungu . 194 (2): 299-305.