I-peritoneum yile membrane ebeka umgca ophethe izindlu ezininzi zesisu ezifana nesisu, ininzi yesilwanyana esincinci, inxalenye yesibindi esikhulu, isibindi, isitha kunye nomsila wepakreas. Ummandla emva kwalolu hlobo lubizwa ngokuba yi-retroperitoneum, okoqobo kuthiwa "emva kwe-peritoneum". Esi sithuba siqulethe iinxalenye zesibilini, intloko kunye nomzimba we-pancreas, izintso kunye ne-lymph node ezibizwa ngokuba yi-retroperitoneal lymph nodes.
Ezi i-lymph nodes ziqulethe amaqela angaphantsi, njenge-paracaval, precaval, interaortocaval, preaortic, para-aortic, i-parrahilar kunye ne-lymph nodes.
Yintoni I-Retroperitoneal I-Lymph Node Dissection?
I-retroperitoneal i-lymph node dissection (RPLND) yinkqubo yokukhutshwa kwe-lymph node. Ngokuqhelekileyo ama-40-50 amanqamu asuswa.
Yenziwa Kanjani?
Isicatshulwa senziwa phantsi kwe-sternum (ithambo lesifuba) ukuya ngaphantsi kwe-umbilicus (iqhosha lomlenze). Utyando oluthile olungabonakaliyo lwe-laparoscopic lufumaneka kwiindawo ezithile, nangona akusiyo imilinganiselo. Ubilwelwe lufuduka luye lwaveza indawo yokubuyisela indawo. Le yithuba elichazwe ngumzekeliso ongezantsi, nangona ayibonakali ukuhlinzwa. Iinqanawa ezinkulu zityhilwa kunye ne-retroperitoneal lymph nodes ezihamba ngokufanayo. I-lymph nodes zixhamle ngokunyamekela ukuba ziphephe ukulimaza iindumbu ezijikelezayo.
Iingcingo zithunyelwa kwi-pathologist ukuvavanya ngenxa yobukho bomhlaza. Ibilonda libuyiselwa kwindawo yalo eqhelekileyo kwaye amanxeba avaliwe. Ubungakanani bokuba utyando luyahluka kodwa lulinganiselwa kwieyure.
Yisetyenziswe nini?
Unyango oluphambili lwee- cancer ze-testicular ukususwa kwe-testis yomhlaza, inkqubo yokuhlinzwa ebizwa ngokuba yi-orchiectomy.
Ukulandela i-orchiectomy ephezulu, kukho iindlela ezahlukeneyo ezixhomekeke kwisigaba kunye nomhlaza wesifo somhlaza: uhlolo, i-chemotherapy kunye / okanye i-RPLND.
I-RPLND isetyenziswe ngokuyinhloko ngohlobo lomhlaza wesifo segciwane lesifo segciwane ebizwa ngokuba yi-nonseminoma.
Ukubaluleka kubaluleke kakhulu xa kuchongwa ukhetho lwonyango. Ngokuqhelekileyo, isigaba sam somhlaza sivalelwe kwi-testis, isigaba II siquka i-lymph nodes kunye ne-III yesigaba esichaphazelekayo iquka ezinye izitho okanye izakhi ezifana nemiphunga. I-Stage I ilandelwa yileta A okanye iBrade II ilandelwa yileta A, B okanye C. Ezi ileta zibonisa indlela engangena ngayo i-tumor yokuqala kwisigaba se-I okanye ukuba zinkulu kangakanani i-lymph nodes kwisigaba II.
Kwinqanaba le-IA (i-tumor egcinwe kwi-testis ne- epididymis ), i-RPLND iyinketho, kodwa ukuqwalasela (ukugcina iso kwizinto) ngokuqhelekileyo kukhethwa. Nangona kunjalo, kwisigaba se-IB (isifo esixhatshaza igazi okanye iinqwelo ze-lymph, i-scrotum okanye intambo ye-spermatic), okanye i-RPLND okanye i-chemotherapy iyacetyiswa. Kwinqanaba le-IIA (i-lymph nodes ezingaphezu kwe-2 cm ububanzi) RPLND yonyango olukhethiweyo. Kwi-IIB yesigaba (i-lymph nodes ziphakathi kwe-2-5 cm ububanzi) i-RPLND inokuqwalaselwa kwiimeko ezikhethiweyo, kodwa i-chemotherapy ngokuqhelekileyo unyango olukhethiweyo.
Umdlavuza weSigaba II ungaphathwa kunye ne-chemotherapy phezulu-phambili. Ukuba kusekho ubungqina bomdlavuza wokusalela emva kwe-chemotherapy (i-lymph nodes okanye i-masses> 1 cm), i-RPLND iyinketho, nangona kunjalo kunzima kakhulu ukwenza oku kulandelayo khemotherapy.
Xa Ingasetyenzisiwe
Akufanele isetyenziswe kwezinye iindidi zomhlaza wengqungquthela njenge-seminoma. Akufanele kwenziwe ukuba i-lymph nodes zikhulu kune-5 cm ububanzi. Akufanele isetyenziswe ukuba iimpawu ze-tumor zegazi azibuyelanga kwi-orchiectomy eqhelekileyo. Akufanele isetyenziswe nakweyiphi na imeko apho ukuhlinzwa kunye ne-aneshesia akunako ukunyanzeliswa.
Izinzuzo, Iintsilelo, kunye neempembelelo zecala
Inzuzo enkulu kunazo zonke kuRPLND uphilisa umhlaza. Enye inzuzo ikwazi ngokuqinisekileyo ukuba i-lymph nodes iqukethe umdlavuza okanye ayikho. Ukongezelela, ezininzi i-nonseminoma khancertic cereticular ziza kuba ne-teratoma. I-Teratoma isifo esibi kakhulu kwaye ngokuqhelekileyo asisasazi ngokwayo. Nangona kunjalo, iyakwazi ukusasazeka xa ihlanganiswe nezinye iindidi ze-nonseminoma. Kutheni le nkxalabo? I-Teratoma ayixhomekanga kakhulu kwi-chemotherapy okanye unyango lwe-radiation ukwenzela ukuba yindlela kuphela yokuyiqeda ukuba isasazeka kwii-lymph nodes ngokuhlinzwa. Ukuba i-teratoma ishiywe emva kwe-chemotherapy elandelayo, inokukhula kwaye ibangele iimpawu okanye zitshintshe zibe luhlobo lomdlavuza.
I-RPLND inokuchaphazela ukuvelisa ngokubangela inkathazo eyaziwa ngokuba yi-retrograde ejaculation. Ngexesha eliqhelekileyo, izivumelwano zomzimba zokhuseleko ukukhusela isisu ekubuyiseleni emuva (ukubuyisela kwakhona) kwi-urethra nokuphelisa kwisibilini kunokuba uqhutywe ngepenis. Oku kungenzeka ngenxa yokuba izisongelo ezijongene nokuqhekeka kwesi sihlunu zihamba kunye neelymode kwaye zonakaliswe ngexesha lotyando. Nangona kunjalo, kunye neendlela zamanqanaba ezidlulayo zamanje, le mngcipheko ungaphantsi kwe-10% kwiimeko ezininzi.
Ezinye iziphumo ezichaphazelekayo zonyango zifana nezinye ukuhlinzwa kwesisu: izikhuhlane, izifo, kunye nokuphendula kwi-anesthesia.
Isigqibo sokuqhubeka no-RPLND yinto efuna ukuxutyushwa ngokucacileyo kunye neengcali zomhlaza wakho ukufumanisa inzuzo yayo kwaye uxoxe ngezinye iindlela.