Ukuxhatshazwa kwesicengceko esibi kuyinkxalabo ebandakanya ukwakheka kwamanzi anesifo somhlaza phakathi kweembrane ezihamba emiphakeni. Iyenzeka malunga neepesenti ezingama-30 zamanomdlavuza emiphunga, kodwa iyakwenzeka nakwezinye i-cancer, ezifana nomhlaza wesifuba, umdlavuza we-ovari, i-leukemi, kunye ne-lymphomas. Ngomdlavuza wamaphaphu, ukuchithwa okubi kakubi kunokuba ngumqondiso wokuqala wesifo somhlaza, okanye kunokuthi kube yinto engaphantsi kwengxaki yomhlaza wamaphaphu .
Yintoni oyifunayo ukuba uyazi malunga neempawu, izizathu, kunye nonyango lwale miphumo?
Sibanzi
Ukuchithwa kwesigxina kuchazwa njengento engavumelekanga yomsinga phakathi kwendawo yamathambo (i- pleura ) edibanisa imiphunga. Ukuba umhlaza wentsholongwane ukhona kulo mkhuhlane (umthamo wesigxina), ubizwa ngokuba ngumonakalo obizayo (umhlaza). Ukuxhatshazwa okubi kakubi kunokuba kube mkhulu kwaye kwandiswe okanye kuyincinci kwaye kubandakanye inxalenye encinci yesigxina . Ukuxothwa kungabikho kuyo yonke indawo, okanye kukho indawo eninzi yokwenza umonakalo.
Izizathu
Phantse naluphina uhlobo lomhlaza lungabangela ukuxhatshazwa kwendlebe xa ikhona okanye isasazeka (i-metastasizes) kwindawo yesifuba. Okuqhelekileyo ngumhlaza wesifuba, umhlaza wamaphaphu, umdlavuza we-ovari, kunye neentlobo zeeukemi kunye ne-lymphomas. Ukuchithwa kwesigxina kunokubangelwa unyango lomdlavuza wamaphaphu, njengokuhlinzwa, unyango lwe-radiation, okanye i-chemotherapy.
Iimpawu
Iimpawu ze-effusion ezimbi ezimbi zingenakukhathazeka kakhulu. Ukuphefumula kufumaneka uphawu oluqhelekileyo, olwenzeka kuma-80 ekhulwini labantu. Ingqungqelo inokuthi ibe khona, kwaye oku kudla ngokubhekiselele kwiimeko ezithile ezifana nokugxila phambili okanye ukulala kwelinye icala.
Uxinzelelo lwesifuba okanye uhlobo oluthile lwesifo sesifuba esingavamile.
Ukuxilongwa
Kubalulekile ukwenza ukuxilongwa ngokuchanekileyo kokuxhatshazwa okubi kakubi ngenxa yokuhlengahlengiswa kunye nonyango zihluke kakhulu kunokuba kungabonakali kakubi. Kubalulekile ukuba uqaphele ukuba nangomdlavuza, ukuya kuma-50 ekhulwini weempembelelo zesikhalazo.
Ukutshatyalaliswa okubi kakubi kukuqala ukukhankanywa ngenxa yeempawu okanye iziphumo ezibonwe kwi-X-ray okanye CT scan. Ukuba ugqirha wakho uphonsela ukuxhatshazwa kwamangcwaba ambi, isinyathelo esilandelayo ngokuqhelekileyo si- thoracentesis , inqubo apho inaliti ifakwe kwisalathisi sesifuba kwisithuba sendawo yokufumana isampuli. Lo mthombo uhlolisiswa phantsi kwe-microscope ukubona ukuba ngaba iseli somhlaza lisekhona.
Ukuba i-thoracentesis ayikwazi ukuyenza, okanye ukuba iziphumo azihambelani, iinkqubo ezongezelelweyo zingadingeka zenziwe ukwenzela ukufumana ingxaki echanekileyo. Kwezinye iimeko, i- thoracoscopy (inkqubo apho i-thoracoscope efakwe kwisifuba) ingadinga ukuba yenziwe ukuze ifumane i-biopsy ukufumanisa ukuxhatshazwa okubi kakubi.
Unyango
Injongo yokunyanga ukuxhatshazwa kwesilumkiso esilumkileyo kudla ngokukhawuleza, oko kukuthi, ukuphucula umgangatho wobomi kunye nokunciphisa iimpawu kodwa kungaphilisi umhlaza.
Ukuba ukuhluthwa kakhulu kuncinci, ngamanye amaxesha kungashiywa yedwa.
ITraracentesis
Njengoko kuphawuliwe ngasentla, i-thoracentesis isisisinyathelo sokuqala esisetyenziswayo, kokubili ukuxilonga i-effusion (qinisekisa ukuba iiseli zomhlaza zikhoyo kwi-fluid kwaye ngaphezulu), kwaye ususe umbane. Ngelishwa, ezi zinto zihlala zibuyela.
Ngenxa yeempembelelo ezinobungozi ezibuhlungu eziphindaphindiweyo, kukho iindlela ezininzi zokuphatha ukuphefumula okuphefumulayo kunye nokuphefumula. Ngelo xesha kusekho ukuphikisana okubalulekileyo malunga nenkqubo eyona nto ibhetele, kwaye ukhetho luvame ukwenziwa ngokusekelwe kwimiqobo yeempawu, indlela i-tumor isabela ngayo kunyango, kunye nendlela osebenza ngayo -awuphi umhlaza ongaphazamisa yakho ukukwazi ukuqhuba imisebenzi yemihla ngemihla.
Pleurodesis
Enye inkqubo esebenza kuma-60 ukuya kuma-90 ekhulwini abantu kuthiwa yi- pleurodesis . Kule nkqubo, ityhubhu ifakwe kwisithuba sokuxhamla kunye nenkunkuma, into eqhelekileyo i-talc, ifakwa phakathi kweembrane ezi-2 ezifaka imiphunga. Le khemikhali ibangela ukuvuvukala kwisigxina esilungeleleneyo esenza ukuba iimbini ezi-2 zihlangane kunye (fuse) ukukhusela ukukhupha umbane kwakhona ukuqokelela kwithuba lesigxina.
Indwelling Pleural Catheters
Enye inqubo yindawo yokuhlala yecatheter , eyaziwa nangokuthi i-cathterter ye-pleine. Kule nqubo, ityhubhu encinci ifakwa kwisithuba sendawo kunye nesikhotho phantsi kwesikhumba, kunye nevulo elincinane kwicala lakho elinokuthi liboshwe ngebhanki. Oku kuvumela izigulane ukuba zitshise umbane wazo (ngoncedo lomntu othandekayo) ngokufakela isitya esingenanto ekuvukeni kwesikhumba. Ngamanye amaxesha i-catheter i-tneled iphumelela xa i-effusion ikhona kumacala omabini esifuba (okanye emibini) okanye ukuba kukho iindawo ezinkulu zeengqokelela zamanzi (located effusions.) Le nkqubo ibhekwa nje ingabonakali kakhulu kune-pleurodesis kwaye iyasebenza Ipesenti ezingama-80 ukuya kuma-100 ekhulwini labantu. Abaphandi abaninzi ngoku banomuvo wokuthi ukuhlala kwamacatheters (plecath catheters) (IPCs) kufuneka kuthathelwe ingqalelo kumgca wokuqala kubo bonke abantu abanefuthe elibi.
Kuye kwaba neengxoxo malunga nokuba i-pleurodesis (ukufakwa kwe-talc) okanye i-catheter ye-pleural ye-plea iyindlela engcono kubantu abanomhlaza ophezulu kunye nokuxhamla ngokuphindaphindiweyo. Ucwaningo lwe-2017 olupapashwe kwi- JAMA , lufuna ukuphendula lo mbuzo. Abaphandi bafumanisa ukuba abo babenama-catheters abahlala ngaphakathi babenemibhedlele encinane kunezo zine-pleurodesis, ezijoliswe ngokukodwa kwiimfuno zokususa i-pleural fluid. Ngaphandle koko, kwakungekho nantlukwano ebonakalayo kuyo nayiphi indlela yokuphefumula okufutshane okanye umgangatho wobomi babathathi-nxaxheba.
Iinketho zonyango olongezelelweyo
Ukuba ukuxhatshazwa kwesicengceko esibi kunokuqhubekayo nangona ezinye iindlela, utyando lunokwenziwa ukucima umbane kwisisu, okanye i- pleurectomy (inqubo ekhupha inxalenye ye-pleura) inokwenziwa. Iinkqubo ezintsha zonyango (ezinjengezonyango zonyango) ziyavela ukuze zisebenzise iziphumo ezinobungozi ezimbi. I-Chemotherapy inokunceda ngeempembelelo ezimbi ezinobungozi ngenxa yomdlavuza omncinci wamangqamuzana , kodwa akuqhelekanga kakhulu kulabo abanomdlavuza ongasetyenzana wesifo somhlaza .
Ukukhetha unyango olungcono
Ngaphambi kokuba i-pleurodesis okanye i-cathéter ye-pleural isongeniswe, kukho izinto ezimbalwa eziyimfuneko. Okokuqala, ugqirha wakho uya kufuna ukuqinisekisa ukuba unomfutho owonakalisayo weemfesane kwaye iimpawu zakho azibangelwa esinye isizathu. Okwesibini, kufuneka ube ne-pleusion effusion ephindayo (ubuya) emva kwe-thoracentesis. Kwaye okubaluleke kakhulu, ukucinywa kwamanzi okuphuma kwisithuba sakho sokunxusa kufuneka kuncede ngeempawu zakho zokuphefumula. Akuyimfuneko ukususa umbane ngenxa yokuba kukho, kodwa kuphela xa kubangela iingxaki (njengokuphefumula okufutshane). Le ngongoma ebaluleke kakhulu ukuphinda ibuye. Ukuba ukuphefumula okufutshane kukubangelwa kwenye imbangela, kwaye ukususa umkhuhlane akuyi kwenza umbahluko omkhulu, akusoloko kunenzuzo ekukhutsheni umkhuhlane.
Prognosis
Ngokudabukisayo, umyinge wokuphila komdlavuza wemiphunga kunye nokuhlambalaza okubi kakubi kunenyanga engaphantsi kwe-6. Isikhathi sokusinda esiphezulu (ixesha apho ama-50 ekhulwini labantu afile kwaye ama-50 ekhulwini ahlalayo) iinyanga ezine, nangona abanye abantu baye basinda ixesha elide. Ukugxekwa kukungcono kangcono kulabo abanemiphumo emibi yecala ehlobene nomhlaza wesifuba okanye umhlaza wesibeleko. Ngokuza kwonyango olutsha olunjengezonyango ezijoliswe kuyo kunye ne- immunotherapy , ithemba ukuba la manani aya kutshintsha ngexesha elizayo. Kukho ezininzi iinzame zeklinikhi eziqhubekayo zijonge unyango olufanelekileyo kulezi ziphumo.
Ukujamelana
Ukungahambi kakubi kumonakalo owonakalisayo wezonyaniso kunokuba luninzi. I-Pair ukuba ngokufunda kwakho ukuxilongwa kunye nokunyanzeliswa kwayo, kwaye amava angabandezeleka kunoma ubani-ingakumbi abo sele benesifo esibi esichengileyo xa beqala ukuba bafumana umdlavuza. Buza imibuzo. Cela uncedo kwabanye, kwaye ubavumele ukuba banike. Thetha ugqirha wakho malunga nokulawula intlungu yomdlavuza wamaphaphu . Cinga ukujoyina iqela lokuxhasa . Iimvakalelo zakho zinokuthi zenze iindawo ezivakalayo ngenxa yengqumbo ukungahloneli, ukuxinezeleka. Okuqhelekileyo. Funa abahlobo nabathandekayo abazimisele ukuphulaphula kwaye bakuxhase. Funda kabanzi malunga nesigaba 4 (imetastatic) yomhlaza wamaphaphu .
Kwabathandwa
Bambalwa kakhulu abantu abanomdlavuza wamaphaphu, kunye nabathandekayo eso sifo sinokuvakalelwa kwaye sisongela kwaye sisongezwa yinto engumngcipheko wokungancedi. Yintoni omele uyayazi xa umhlobo wakho enomdlavuza ?
> Imithombo:
> Azzopardi, M., Porcel, J., Koegelenberg, C., Lee, Y., no-E. Fysh. Iingxabano zamanje ekulawuleni iziphumo ezimbi ezimbi. Iimviwo kwiMpilo yeMpilo yokuHluma nokuHlola . 2014. 35 (6): 723-31.
> Clive, A., Jones, H., Bhatnagar, R., Preston, N., kunye N. Maskell. Amanyathelo okulawula ukusetyenziswa kakubi kwesilumkiso: ukuhlaziywa kwe-network meta-analysis. I-Cochrane Database yeeNkqubo eziPhezulu . 2016. 5: CD010529.
> Kheir, F. et al. I-Pleural Catheter yeTleed for the Treatment of Malignant Pleural Effusion: Uhlolo lokuHlola kunye nokuhlaziywa kweMeta. Journal of Therapeutics . 2015 Feb 2. (Epub ngaphambi kokuprinta)
> UTomas, R., Fysh, E., Smith, N. et al. Impembelelo ye-Indwelling Pleural Catheter vs Talc Pleurodesis kwi-Hospitalization Iintsuku Kwizigulane Ngeziphumo Ezimbi Zomzimba: I-AMLELE YONYAKA YONYAKA. JAMA . 2017. 318 (19): 1903-1912.