Uhlobo lwe-Lung Cancer Surgery
I-lobectomy luhlobo lomdlavuza womphunga apho i-lobe enye yomphunga isuswa. (Ilungelo lempompo linamathambo amathathu, kwaye umphunga wesobunxele unemilobe emibini.) I-lobectomy iyenziwa ngezinye iimeko kwezinye iimeko, ezifana nesifo sofuba, i-COPD eninzi, okanye i-trauma ephazamisa imithwalo yegazi emikhulu kufuphi nemipopu.
Iintlobo zeeNgqungquthela zengculaza
Oogqirha banquma njani ukuba i-lobectomy yindlela ekhethekileyo yokuhlinza umdlavuza wamaphaphu?
Uhlobo lomhlaza wesifo somphunga ugqirha ugunyazisa luya kuxhomekeka kwimibandela emininzi, kuquka:
- Indawo yakho yokudlala
- Ubungakanani besisu sakho
- Ingakhathaliseki ukuba isifo sakho sisifo sifikelele kumathambo asondeleyo
- Ubume bakho bempilo
- Impompo yakho isebenza kakuhle ngaphambi kokuhlinzwa
I-lobectomy yenziwa ngokuqhelekileyo kwii -cancer ezincinci zamangqamuzana emaphaphu apho i-tumor ivalwe kwi-lobe enye. Iyingenelo encinci kwaye igcina umsebenzi ongakumbi wemiphunga e- pneumonectomy , inkqubo equka ukukususa yonke imiphunga. Ngokwahlukileyo, kuluhlu olubanzi kunokwenziwa kwe- wedge , utyando olususa isisu kunye nesixa esincinci sazo.
Iintlobo zeLobectomy
I-lobe yomphunga wakho ingasuswa ngeendlela ezimbalwa ezahlukeneyo. Udokotela wakho ugqirha uya kuncomela enye yalezi zisekelwe kwizibini zomhlaza wakho kunye nendlela okhululekile ngayo nganye kwinkqubo:
- Vula i-lobectomy: Kwi-lobectomy evulekile, i-lobe yemiphophu isuswa ngokukhawuleza okude kwicala (thoracotomy).
- I-VATS (utyando lwe-thoracoscopic incedisa ngevidiyo): I-lobectomy: Kule nkqubo, i-lobe yempompo isuswa kwizinto ezimbalwa ezinokuthi zifakwe kwisifuba ngoncedo lwezixhobo kunye nekhamera. I-VATS lobectomy ingaqwalaselwa kwisigaba 1 somhlaza wamaphaphu kunye neesisu ezincinci (ngokuqhelekileyo zingaphantsi kwe-3 ukuya kwi-4 cm). Xa i-VATS lobectomy inokwenzeka, kunokubangela iingxaki ezincinci kunelobectomy evulekile.
VATS vs Open Lobectomy
Wena kunye nodokotela wakho ukhetha njani phakathi kwe-lobectomy evulekile kunye ne-VATS lobectomy, kwaye yintoni umehluko wokubuyisela phakathi kwezi nkqubo?
Izifundo ziye zafumanisa ukuba ixesha lokubuyiselwa emva kwe-VATS lobectomy lidla ngokufutshane, kunye neentlungu ezingaphantsi kokuhamba ngaphandle kwe-lobectomy evulekile. I-post-thoracotomy syndrome (ebizwa ngokuba yi-postpneumonectomy syndrome) yimeko yeentlungu zesifuba eziqhubekayo ezinyangeni ukuya kwiminyaka emva kokuhlinzwa komdlavuza wamaphaphu, kwaye zibonakala zichaphazela ama-50 ekhulwini abantu ababenokuhlinzwa. Nangona singenayo iinjongo ezijonge ngqo le nkxalabo mhlawumbi ukuba inkqubo ye-VATS iya kubangela intlungu engapheliyo.
Nangona kukho ukuphucula ngokukhawuleza, kukho amaxesha apho iiVATS zingenakwenzeka. Indawo yezinye iimvumba yenza kube nzima ukwenza ii-VATS, kwaye kula maxesha kunye ne-lobectomy evulekile inokuthi ikhuseleke kwaye inokuthi isuswe sonke isisu.
Akunabo bonke oogqirha abakhululekile ukuqhuba iVATS kwaye oku kungadlala indima kwisigqibo. Qinisekisa ukuba ubuze isizathu sokuba i-lobectomy evuliwe ukuba le yodwa yedwa unikwe.
Unokuba unqwenela ukufumana umbono wesibini kumgqirha onogqirha okhululekile ukwenza ii-VATS, kodwa khumbula ukuba nokuba oogqirha abagqibeleleyo abayi kwenza ii-VATS ukuba indawo ye-tumor ibonisa ukuba i-lobectomy evulekile yindlela yokuhlinzwa engcono. Kukho ukuphikisana malunga nokuba iinkqubo ze-VATS ziba ngumgangatho wokunyamekela, kodwa ezininzi iinkxalabo zikho kumava ogqirha abenza inkqubo. Ngomhlaza wesifo somhlaza wamandulo, i-VATS lobectomy ihlala yindlela efanelekileyo, kodwa ngeengcingo zamaphaphu eziphambili, mhlawumbi amava ogqirha abaluleke kakhulu kwisiphumo.
Esinye isizathu sokubangela ukuba imbono yesibini ibaluleke kakhulu ngomhlaza wemiphunga kukuba iifundo zibonisa ukuba iziphumo zabantu abanobuchopho bemiphunga kumaziko abenza imiba emikhulu yalezi zonyango ziba ngcono. Ngokuqhelekileyo, amathuba okuba nemiphumo emihle ngemiphunga yomdlavuza iphakame ukuba ibe ngcono kumaziko omhlaza omdala kunye nokufundisa izibhedlele kunezibhedlele ezincinane.
Ukulungiselela
Ngaphambi kwe-lobectomy yakho, ugqirha wakho uya kufuna ukuqinisekisa ukuba unempilo enokwenzeka. Uya kufuna ukwazi ukuba uya kuphefumula ngokukhawuleza emva kokuba i-lobe yomphunga yakho isuswe. Ukongeza kwimbali enononophelo kunye neemvavanyo zegazi kunye negazi, iimvavanyo zokuphefumla ( iimvavanyo zomsebenzi wamaphammori ) ziya kwenziwa ukwenzela ukuhlola umsebenzi wakho wamaphaphu ngaphambi kokuhlinzwa. Ngokuxhomekeke kwiminyaka yakho kunye nesimo somzimba, unokuncoma iimvavanyo ukujonga intliziyo yakho.
Udokotela wakho uya kuhlolisisa ngokucophelela onke amayeza akho ngexesha lokutyelela kwangaphambili kwaye unokuncoma ukuyeka amanye amayeza akho ixesha elide ngaphambi kokuhlinzwa. Kunceda ukuba uzisa iibhotile eziqulethe nayiphi na imishanguzo engagunyazisiyo, kunye neyiphi na isongezelelo, kuquka iivithamini, ozisebenzisayo.
Ukuba utshaya, uya kuncomela ukuba uhambe ngokukhawuleza. Ukuyeka ukutshaya phambi kokuhlinzwa kunokunciphisa umngcipheko weengxaki kunye nokwandisa ithuba lokuba utyando lwakho luya kuphumelela.
Funda kabanzi malunga nendlela yokulungiselela ukuhlinzwa komhlaza wamaphaphu .
Inkqubo
I-lobectomy yenziwa kwigumbi lokusebenza emva kokuba unikezwe i-anesthetic jikelele. Kukho iinkqubo ezimbini ezibalulekileyo ezenziwa rhoqo ukususa i-lobe yomphunga. Kwi-lobectomy evulekile, i-lobe yompompo isuswe nge-incision long eceleni kwesifuba. Kwi-VATS lobectomy, i-lobe isuswe kunye nokusetyenziswa kwekhamera kunye nezixhobo ezikhethekileyo ngokusebenzisa izinto ezincinci ezincinci kwisifuba.
Ngaphambi kokuba uvale i-incision (s), ugqirha uya kufaka ityhubhu yesifuba kwindawo yokugada ukuvumela ukuba umthamo ogqithiseleyo kunye nomoya uphume ngaphandle kwesifuba ixesha elide.
Ukubuyisela
Ukulandela i-lobectomy yakho , uya kujongwa kwiyunithi yonyango enzulu (i-ICU) ngosuku okanye ngaphezulu ngaphambi kokuya ekamelweni lesibhedlele rhoqo. Umphefumli wokuphefumula uza kusebenza nawe, ekucela ukuba uphefumle ngamandla kwaye uphefumule kwi-spirometer yokukhuthaza. Abongikazi baya kukunceda uvuke kwaye uhambe ngokukhawuleza xa unako. Iingxaki ezingenazo, abaninzi abantu bahlala esibhedlele phakathi kweentsuku ezi-4 neye-7, kuxhomekeke kuhlobo lwe-lobectomy eyenziwe.
Iingxaki
I-lobectomy yinkqubo enkulu yokuhlinzwa, kwaye iingxaki aziqhelekanga. Ugqirha wakho uya kuxoxa ngale nto phambi kokuhlinzwa. Ezinye iingxaki ezinokuba nazo zingabandakanya:
- Ukuvuza kwexesha elide, kufuna ukuba ityhubhu yesifuba ishiywe endaweni engaphezulu kweentsuku ezi-3 ukuya kwezi-4. Le ngxaki eqhelekileyo.
- Izifo, njenge-pneumonia.
- Ukuhlamba.
- Iingxaki zeentliziyo, ezifana nesifo senhliziyo okanye izitho zentliziyo engenangqondo.
- Igazi livale emilenzeni (i-DVTs) okanye ihamba kwimiphunga (i- pulmonary embolus .)
- I-Post-thoracotomy syndrome . Ubuhlungu obuqhubekayo emva kokuba i-lobectomy inokukhungathekisa, kodwa kuninzi okwenziwe ukuzama ukwenza umehluko. Kungenzeka ukuba kwenzeke emva kwe-lobectomy evulekile kuneenkqubo ze-VATS.
Prognosis
Isalathisi esilandelayo i-lobectomy incike kwiimeko ezininzi ezahlukeneyo. Ezinye zazo zibandakanya isigaba somhlaza wakho wemiphunga-oko kukuthi, kangakanani na ukusabalalisa-kunye nempilo yakho jikelele kunye nokuba unayo nayiphi na ingxaki yemiphunga ngaphezu kwomdlavuza wamaphaphu.
Ukufa kwabantu bonke (ingozi yokufa) kungaphantsi kwama-3 ekhulwini, kodwa abantu abaninzi banenkxalabo yesikhashana efana nokuvuza komoya.
Xa i-lobectomy iyenziwe ngempumelelo kumhlaza wesifo somhlaza wamaphaphu, inika ithuba lokuphila ixesha elide ngaphandle kokuphindaphinda umhlaza.
Inketho engagqithwanga ngokwaneleyo emva kokuhlinzwa komhlaza wamaphaphu yindlela yokuvuselela i-pulmonary. Ukuvuselelwa kwepulmonary yomdlavuza wamaphaphu usanda kuqaliswa kwamanye amaziko emhlaza kodwa kubonakala kunceda ngeempawu zokuphefumula kunye nezinye iimpawu.
> Imithombo:
> Chang, J., Sena, S., Paul, M. et al. I-Stereotactic Ablative Radiotherapy Versus Lobectomy kwi-Stage esebenzayo I-Non-Small-Cell I-Cancer Lung Cancer: Uhlalutyo oluPhezulu lweeNzululwazi ezimbini. I-Lancet Oncology . 2015. 1 (6): 630-637.
> Oncel, M., Sunam, G., no H. Yildiran. I-Video-Incediswe i-Loracctomy ye-Thoracoscopic kwi-Cancer yengoma. Ama-Annal of Surgery Thoracic . 2017. 104 (5): 1760.
> Vannucci, R., noD. Gonzalez-Rivas. Ngaba i-VATS Lobectomy Standard of Care ye-Can-Small-Cell Small Lung Cancer? . Cancer Lung . 2016. 100: 114-119.
> Ziarnik, E., no-E. Grogan. I-Post-Lobectomy Iingxaki zokuqala. Iiklinikhi zeeTraphic Surgery . 2015. 25 (3): 355-364.