I-fistula engumonakalo yindlela engavamile (i-sinus tract) eqhubeka phakathi kwe-airways enkulu emiphakeni ( i-bronchi ) kunye nendawo phakathi kweembrane ezihamba emiphakeni (isikhalazo) . Xa indlela efana nale ikhula, umoya ophefumlelweyo kwimiphunga ungakwazi ukuhamba ngendleleni kwaye ungene kwisithuba sombongo.
Izizathu
Kukho iimeko ezininzi ezinokubangela i-fistula ye-bronchopleural.
Ezinye zezi ziquka:
- Ukuhlinzwa komhlaza womlenze - Ukuthengiswa kwepulmonary (ukususwa komphunga okanye inxalenye yomphunga) ngomhlaza wemiphunga yinto ebangela kakhulu into eqhelekileyo ye-fistula enobungozi. Kungenzeka ukuba kwenzeke nge- pneumonectomy (ukususwa ngokupheleleyo komphunga) kunokuba kube neenkqubo ezifana ne- lobectomy (ukususwa kwe-lobe yomphunga) okanye ukukhishwa kwe-wedge (ukususwa kwecandelo elenziwe ngombumba we-lobe yomphunga Ngophando lwango-2016, ama-1.4 ekhulwini abantu abane-lobectomy kunye nama-14.3 ekhulwini abantu abane-pneumonectomy bavelisa i-fistula emva kokuhlinzwa.
- Ukunyanga (ngokukodwa iintlobo ze-pneumonia ezibangele ukuphahlazeka kwezicubu ezibizwa nge-lung necrosis.)
- Ukuqhubeka okuqhubekayo kwepneumothorax - Oku kubhekisela kumpompo owawa (pneumothorax) ongekho.
- I-Chemotherapy okanye unyango lwe-radiation yomhlaza wemiphunga - Nayiphi na unyango obangela ukulimala kwiiseli kunye nokuphulukiswa okulandelayo kwimida yomda wesigxina kunokubangela ukubunjwa kwe-fistula.
- Isifo sofuba.
Ziyafana Kanjani?
Izifundo ezijonge iziganeko ze-fistula ezinobungozi ziyahluka, kodwa kubonakala ngathi ziphakathi kwe-1.5 no-28 ekhulwini lokuhlinzwa okubandakanya ukususwa kwemiphunga. Njengoko kuphawuliwe kwangaphambili, kunokwenzeka ukuba kwenzeke ngokuhlinzwa ngokubanzi kwaye kunokwenzeka ukuba kwenzeke emva kwe-pneumonectomy yangasese, xa ukuphuma kwemimoya kufunekayo ixesha elide elizayo emva kokuhlinzwa, kwaye xa kuphakanyiswa amayeza aphezulu. kutyando.
Ngokuqhelekileyo, i-fonchotula ye-bronchopulmonary iya kufumaneka kwiiveki ezimbini emva kokuhlinzwa kwemiphunga, nangona i-fistula inokwenzeka nokuba yinyanga emva kokuhlinzwa.
Iimpawu
Njengoko kuphawuliwe ngezantsi ngaphantsi kokuxilongwa, i-fistula enobungozi isoloko ixilongwa ngokusekelwe kwimifanekiso yokufunyanwa xa kuqhuma umoya oqhubekayo. Xa zikhona iimpawu, zinokuthi zikhutshwe kalula njengoko ziyimpawu ezinokulindela emva kokusulelwa kwimiphunga kunye nokuhlinzwa, njengokukhwehlela okuqhubekayo, ukukhwehlela igazi, okanye ukuphefumula okufutshane.
Ukuxilongwa
Ukuxilongwa kwe-fistula ye-bronchopleally kudla ngokusekelwe kwizinto ezifunyenwe kwi-radiological. I-CT scan kaninzi luvavanyo lokukhetha ukujonga imeko kwaye ingabonakalisa umoya okhulayo okanye utywala (ngokuphindaphindiweyo ukuqhuma okanye i- empyema ) kwindawo evulekileyo.
I-fistula ye-bronchopleural ivame ukukhankanywa ekliniki ngokuqwalasela ukuqhuma komoya okuqhubekayo. Ngamanye amazwi, le fistula ifunyaniswa xa ityhubhu yesifuba ingakwazi ukususwa emva kokuhlinzwa kwemiphunga ngenxa yokuvuza komoya okuqhubekayo. Kukho ukuqhuma okuqhubekayo, okanye endaweni yoko, ukuvuza kwamanzi kungakho kuphela ngexesha lokuphefumlelwa okanye ukuphelelwa yisikhathi. Ngomfutho omncinci womoya, ukuqhuma kungabikho kuphela ngexesha lokuphelelwa ngunyanzeliso okanye ukukhwehlela.
Unyango
Unyango lunokwenziwa ngokugqithiseleyo, okanye ngokusisigxina nge-tube ye-bronchoscopy (ngamanye amaxesha le yindlela kuphela ekhoyo xa isigulane singaqiniseki) kwaye uphando lwangoku lubonisa ukuba iinkqubo ze-endoscopic zingaba zikhuselekileyo kwaye ziphumelele okanye zininzi ngabantu.
Kungakhathaliseki ukuba yintoni inkqubo, umjelo wamanzi omswakhiwo kwindawo yokukhalaza (ngokusebenzisa i-thoracentesis okanye ukugcina ityhubhu yesifuba) kunye ne-antibiotics e-intravenous ibalulekile.
- Ukuhlinzwa kungasetyenziselwa ukuvala i-fistula.
- I-bronchoscopy - Kule nkqubo, i-fistula ifumaneka kwaye i-glues okanye i-sealants ifakwe kwisithuba sokuvalwa. Ezi ziikhemikhali (ngokuqhelekileyo i-nitrate yesilivere) zibangelwa ukuvuvukala kwi-fistula ekhokelela ekubambeni nasekuvaleni, ngokufanelekileyo ukuqhawula isicatshulwa esingavamile.
Prognosis
I-fistula enobungozi yinkxalabo enzima yokuhlinzwa komhlaza wemiphunga ngokufa (ama-death) amazinga ahluka kwi-10 ukuya kwi-27 ekhulwini kuye kuxhomekeke kwisifundo.
Ngokuqinisekiswa kokukhawuleza kunye nokunyango okulondolozayo, mhlawumbi ukuba ukuhlutha kwesifo se-fostula bhanxia kuya kuphucula.
Eyaziwayo Njengaye: ukuvuza kwe-bronchopleural air, BPF
Imizekelo: USam wavelisa i-fistula ye-bronchopleural emva kwe-pneumonectomy yomdlavuza wamaphaphu kwaye wayefuna ukuhlala esibhedlele isikhathi eside kunokuba wayelindele.
> Imithombo:
> Birdas, T. et al. Imiba yengozi ye-fostula ye-bronchopleural emva kwe-pneumonectomy efanelekileyo: iyakususa i-diverticulum ye-stump inokukhusela? . I-Annals ye-Oncology yokugada . 2012. 19 (4): 1336-42.
> Boudaya, M. et al. Ulawulo lwe-Conservative lwe-fistula ye-bronchopleural postoperative. I-Journal ye-Thoracic ne-Cardiovascular Surgery . 2013. 146 (3): 575-9.
> Fuso, L., Varone, F., Nachira, D. et al. Impembelelo noLawulo lwePost-Lobectomy kunye ne-Pneumonectomy Bronchopleural Fistula. Lung . 194 (2): 299-305.