Kukho iinkqubo ezininzi kunye neengxaki ze- lymph node dissection ekuphatheni i-melanoma.
Xa i- melanoma isesikhumbeni , iyakususwa ngokusisigxina ngokusisigxina kwiimeko ezininzi. Ngamanye amaxesha, nangona kunjalo, isasazeka (i- metastasizes ) kwezinye iindawo zomzimba, ngokuqhelekileyo ukuhamba kuqala ukuya kwii- lymph nodes ezikufutshane kwintonga yakho, intamo, okanye i-groin. Ukuba ugqirha wakho uyangqinela ukuba oku kwenzekile, uvavanyo olubizwa ngokuba yi- sentinel node biopsy luza kwenziwa ukwenzela ukuchonga nokususa i-lymph node apho umhlaza unokusasazeka kwi-tumor yokuqala.
Ukuba i-nodeel yakho ye-node biopsy is positive (iqukethe iiseli zomhlaza), ngoko ixesha lesigqibo. Ngaba unayo yonke enye i-lymph nodes kule ndawo isuswe, kwinkqubo yokugqirha ekuthiwa i- lymph node dissection (CLND, okanye i-lymphadenectomy) yokugqiba? Iingcamango kukuba i-CLND iqinisekisa ukuba iiselmane zeelanoma kuzo zonke i-lymph nodes zisuswe, nto leyo inokuthi isithintele eso sifo ukusasazeka.
Ngelishwa, ubungqina bungahambelani, ngoko-ke isigqibo asikho ngqo, kwanoogqirha. Nazi ezinye iinkqubo kunye neengxaki zokuqwalasela.
Iinkqubo zeLymph Node Dissection
1. I-CLND inceda ukuchonga ngokuchanekileyo isigaba se-melanoma, esinceda ugqirha ekwenzeni iingcebiso malunga nokunyangwa kwe-post-surgery (adjuvant).
2. Inani elipheleleyo leenombolo eziqukethe iiseli ze-melanoma yi-predictor of survival kwizigulane ezinezigaba ze-III zesifo, kwaye kuphela i-CLND inokunika le ngcaciso.
3. Ezinye iingxelo zibonisa ukuba iipesenti ezingama-20 zezigulane ezithatha i-CLND ngokukhawuleza emva kokufumanisa ukuba zineziphumo ezinokuthi zenze i-lymph node iphile kakuhle. Oku kuyinyani ngokukodwa kwizigulane ezinama-tumors e-intermediate-thickness ekhumbeni (1.2 ukuya kwi-3.5 mm).
4. Ngokumisa ukusabalala kwe-melanoma kuma-lymph node, i-CLND iphakamisa ithuba lokunyanga.
Nangona ixabiso le-melanoma kwi-lymph node lingagqithisa ngokuhamba kwesikhathi ukuba lube lukhulu kwaye luyingozi.
I-Lymph Node Dissection
1. Iingxaki ze-CLND zibalulekileyo kwaye zenzeka kuma-67 eepesenti zezigulane, ngakumbi kulabo bangaphezu kwama-60. Ezi ziquka:
- I-Buildup yolwelo kwindawo yokuhlinzwa ( seroma )
- Sulelo
- Ukuvuvukala kwesitho esithintekayo ngokususwa kwe-lymph nodes ( lymphedema )
- Ubungqina, ukubetha, okanye intlungu kwindawo yokuhlinzwa
- Ukuphazamiseka (ukuhluma) kwesikhumba phezu kwendawo
Nangona ukuvuvukala emva kokuhlinzwa kunokuthintelwa okanye kulawulwa ngokusetyenziswa kwamagciwane, iisitokisti ezinama-elastic, i-massage, kunye ne-diuretics, inokuba yinkxalabo ebuthathaka.
2. Ukusebenza kwe-CLND kunokuxhomekeka kubukhulu besifo se-melanoma. Amathumba amancinci (0.1 mm okanye ngaphantsi ububanzi) kwi-lymph node ye-sentinel ayinakuze ikhokele kwi-metastasis, ngoko ukwenza i-CLND akunakufuneka. Uphononongo olwenziwe ngo-2009 lubonise ukuba izinga lokuphila kunye nokuphindaphinda kwezigulane ezinezi zifo ezincinci zifana nezo zingenalo i-melanoma kwi-lymph node yazo. Ngaloo ndlela, ezi zigulane "ezinobungozi obuphantsi" ziyakwazi ukuphepha i-CLND kwaye ibe nesiphumo esifanayo.
Ngaphantsi
Ukunyulwa ukuba ube nenkqubo ephambili yokucubungula njenge-CLND akuyiyo isigqibo omele uyenze ngokulula, ngakumbi ukuba i-biopsy yakho ibonisa kuphela inani elincinci le-melanoma kwi-lymph nodes yakho.
Zininzi izinto ezibandakanyekayo, kubandakanywa ubungakanani kunye nendawo ye-melanoma yakho eyinhloko, iziphumo ze-lymph node biopsy kunye nezinye iimvavanyo, kunye nobudala bakho. Unokufumana ukuba luncedo ukufuna umbono wesibini.
Iingxelo:
Boughton B (2009). Ngaba i-lymphadenectomy ibe ngumgangatho wokunyamekela kwi-melanoma metastasis kwi-lymph nodes? Iindaba ze-Oncology Intl. 18 (5).
Morton DL, Thompson JF, Cochran A, et al (2006). I-nodeinel-node biopsy okanye i-nodal observation kwi-melanoma. N Engl J Med. 2006 Septemba 28; 355 (13): 1307-17.
UTomas JM (2005). Isikhathi sokuphinda sihlole kwakhona i-Sentinel Node Biopsy kwiMelanoma Post-Multicenter Selective Lymphadenectomy Trial. J Clin Oncol. 2005 Umhla wama-20; 23 (36): 9443-4.
van Akkooi AC, Rutkowski P, van der Ploeg IM, et al (2009). Ukulandelelwa kwexesha elide lwezigulane ezinomthwalo osisigxina somthwalo we-tumor (<0.1mm) ngokwemigaqo yeRotterdam: Uhlolisiso lwe-EORTC I-Melanoma Group. J Clin Oncol 27: 15s, 2009 (umlenzele, u-9005).