I-thoracotomy yinkqubo ephambili yokuhlinzwa eyenza oogqirha bafikelele kwisibilini ngexesha lotyando. Ukukhangela kwenziwa kwindonga yesifuba, kwaye ukufikelela kwiimpawu zesifuba senziwa ngesigxina kwaye mhlawumbi kususa inxalenye yembambo. Inkqubo eyenziwa ekamelweni lokusebenza phantsi kwe-anesthesia jikelele.
Izizathu zokungena omnye
I-thoracotomy inokwenziwa ngezizathu ezininzi, kungekhona nje ukususwa komhlaza.
Ukuvula nokutyhila isigxina somfuba kunye ne-mediastinum (indawo phakathi kwemiphunga) inokunika abagqirha ukuba bafikelele entliziyweni, emaphaphu, kwindawo ephezulu (thoracic) okanye i-aorta, nangaphambili (inxalenye yangaphandle) yomgudu. Ezinye izibonakalisi ziquka:
- Ukuhlinzwa komhlaza
- Ukuhlinzwa komhlaza we-Esophageal
- Intliziyo / ukuhlinzwa kwe-aortic
- Ixinzelelo
- I-pneumothorax eqhubekayo (iphosi epholileyo)
- Ulawulo lweCOPD
- Isifo sofuba
- I-Biopsy kunye nokuvavanywa kobunzima obungaziwayo be-mediastinal
- Ugqirha ukuya emthonjeni wangaphambili
- I-thoracotomy yokuvuselela (i-thoracotomy yexakeka) -Le yinkqubo eyenziwa kwigumbi lokuxakeka ngokukhawuleza ngokusongela ubomi njengokwenza isifo se-chest hemorrhage
Iintlobo zeNkqubo
Kukho iintlobo ezahlukeneyo ze-thoracotomy ezinokuthi zenziwe, kuxhomekeke kwisiboniso sokuhlinzwa kunye nemeko ephathwayo. Ezi ziquka:
- I-thorotomy ye-Postolateral - Le yinkqubo eqhelekileyo kunye nendlela eqhelekileyo yokufikelela kwimiphunga ukuze kususwe imiphunga okanye inxalenye yomphunga ukuphatha umhlaza wamaphaphu . Isicatshulwa senziwe ngasecaleni lesifuba ukuya ngasemva phakathi kwezimbambo. Iimbambo ziza kwasasazeka (intambo ingasuswa kwakhona) ukujonga imiphunga. Abagqirha bangasusa umphunga ( pneumonectomy ), i-lobe enye yemiphunga ( lobectomy ), okanye inxalenye encinane yomphunga
- I-thoracotomy ye-median - Kwi-thoracotomy ephakathi, oogqirha benza i-inctern ngokusebenzisa i-sternum (isifuba) ukufikelela kwisifuba. Le nkqubo iqhutyelwa ukwenza utyando entliziyweni.
- I-thoxotomy ye-Axillary - Kwi-thoracotomy ye-axillary, oogqirha bafumana ukufikelela kwisifuba ngokusebenzisa isicatshulwa esiseduze ne-armpit. Oku kuqhutyelwa ukunyanga i- pneumothorax (i-lung ephahlekileyo), kodwa inokuthi yenzelwe intliziyo ethile kunye nokuhlinzwa kwemiphunga.
- I-anterolateral thoracotomy - Le nkqubo yinkqubo yokukhawuleza ebandakanya ukufakwa kwecala phambi kwesifuba. Kungenziwa emva kweengxaki ezinkulu zesifuba, okanye ukuvumela ukufikelela ngqo entliziyweni emva kokubanjelwa komzimba.
Ukucwangciswa nokuCwangciswa
Ngaphambi kokuba ube ne-thoracotomy uza kuba neembali eziqinileyo kunye nokwenziwe ngokomzimba, kwaye unokukwazi ukuba neengcaphephe ukujonga kwintliziyo yakho nomsebenzi wephunga. Ukuba isifo sakho se-thoracotomy senziwa ngomhlaza wamaphaphu, kubalulekile ukuba ufumane umbono wesibini . Uphononongo lubonisa ukuba abantu ababenokuhlinzwa okwenziwe kumaziko omhlaza okwenza imimandla emikhulu yale nkqubo ingaba neziphumo ezingcono. Kwabanye abantu, inqubo engaphantsi yongeniso ebizwa ngokuba yi -VATS) ingasetyenziswa endaweni ye-thoracotomy, kodwa oku akufumaneki kuzo zonke izibhedlele.
Inkqubo
I-thoracotomy idlalwa phantsi kwe-anesthesia jikelele kwigumbi lokusebenza. Ukufakwa kwexesha elide kwenziwe eceleni kwelinye isifuba, kwaye izibambo ziyahlukana ukuze zifikelele esifubeni. Kuyo yonke inkqubo, iimpawu ezibalulekileyo zijongwa ngokunyamekileyo ukuqinisekisa ukuba ubekezelela inkqubo kakuhle. Xa utyando lugqityiwe, ityhubhu yesifuba ijwayele ukufakwa kwisifuba esifubeni kwaye ihambe endaweni ethile ixesha elide.
Iingxaki ezinokwenzeka
Abanye abantu badlula kwi-thoracotomy ngaphandle kokufumana nayiphi na ingxaki, kanti abanye banokuhlangabezana nesingqinisiso esinye okanye ngaphezulu. Kubalulekile ukuthetha ngenyameko kunye nodokotela wakho ogqirha malunga nokuhlinzwa okhethekileyo kunye noko ukulindele. Ngokuqinisekileyo, abo baphilile ngokubanzi phambi kwenkqubo baya kuba nekhosi elula kunabo bajongana neengxaki ezongezelelweyo zezokwelapha. Kwaye kunye naluphi na utyando, ukutshaya kunokunyusa umngcipheko weengxaki ezinzulu.
Ezinye iziphumo ezichaphazelekayo kunye neengxaki ze-thoracotomy zingaquka:
- Isidingo eside ixesha lokuncedisa umoya emva kokuhlinzwa
- Ukunyuka komoya okuqhubekayo kubangelwa isidingo eside ixesha lesibhubhu emva kokuhlinzwa
- Sulelo
- Ukuhlamba
- Amacwecwe egazi - I-deep vein thrombosis (i-blood clots) kunye ne-pulmonary emboli (iingubo zegazi ezityhutyhayo kwaye ziye emiphakeni) yinto eqhelekileyo kunye nengxaki enkulu yokuhlinzwa
- Iingxaki ze-anesthesia jikelele
- Ukuhlasela kwentliziyo okanye i-arrhythmias
- Intambo yokungasebenzi okanye ukukhubazeka
- I-bronchopleural fistula - Le ngxaki apho inqabileyo engafaniyo phakathi kwebheysi ye-bronchial kunye ne-space phakathi kweembrane (i-pleura) ibeka imiphunga
- I-Postpneumonectomy syndrome okanye i-post-thoracotomy syndrome - Intlungu kwindawo yesifo se-thoracotomy ngamanye amaxesha ingaphikelela ixesha elide emva kokuhlinzwa
Imibuzo Yokubuza Ngaphambili
Cinga ukucela ugqirha imibuzo elandelayo, ubhale phantsi eminye imibuzo onokuyenza.
- Ngubani oza kwenza utyando?
- Zingaphi kwezi nkqubo oyenzile?
- Ziziphi ezinye iingxaki enginokuzilindela?
- Kuya kuthatha ixesha elingakanani le nqubo?
- Ndiza kube nini ndibe esibhedlele emva kokuhlinzwa?
- Ndingakhawuleza njani ndibuyele emsebenzini?
- Ngaba uyincoma ukuba ndinokubuyiswa kwamapulmoni emva kokuhlinzwa?
- Yintoni endiyilindeleyo kwixesha elide - lithetha, unyaka ukususela ngoku okanye iminyaka emi-3 ukususela ngoku?
- Ngubani omele ndibize ukuba ndijamelana neengxaki emva kokuba ndibuyele ekhaya?
Umzekelo: Udokotela we-Jim wathi kuye uza kwenza i-thoracotomy ukuze afumane imiphunga yakhe kwaye enze i-lobectomy yomdlavuza wamaphaphu.
Imithombo:
Bendixen, M., Jorgensen, O., Kronborg, C., Andersen, C., kunye noP. Licht. Intlungu eqhubekayo kunye nomgangatho wobomi emva kwe-lobectomy nge-intanethi ye-thoracoscopic ukuhlinzwa okanye i-anterolateralthoracotomy ekuqaleni komdlavuza wamaphaphu: ityala elilawulwa ngokungapheliyo. Lancet Oncology . 2016. 17 (6): 836-44.
Fernandez, R., Kosinski, A., Burfeind, W. et al. I-Society of Thoracic Surgeons I-Lung Cancer Resection Risk Model: I-Data Quality Higher kunye neziphumo eziPhezulu. Ama-Annal of Surgery Thoracic . Ngo-2016 ngoMeyi 19. (Epub ngaphambi kokushicilela).
I-Sengupta, i-Post-operative pulmonary complications emva kwe-thoracotomy. Indian Journal of Anesthesia . 2015. 59 (9): 618-26.
Inkqubo yeMpilo yeNyuvesi yaseMichigan. Ukulungiselela i-Thoracotomy yakho. Http://surgery.med.umich.edu/thoracic/pdf/preparingforyourthoracotomy.pdf