Ukuqhawulwa kweSahluko (iCandelo leNgcaciso okanye iNgcaciso yeStlobar) vs Lobectomy
Ukuba ugqirha wakho uye wakhuthaza ukuthengiswa kwemigudu yomdlavuza wamaphaphu, mhlawumbi uyazibuza ukuba yintoni inkqubo efana nayo nendlela ihluke ngayo kwezinye iintlobo zokuhlinzwa komhlaza wamaphaphu . Kuza kunconywa nini i-resege wedage phezu kwezinye iinkqubo kwaye zeziphi iingxaki ezinokubakho? Ziziphi ezinye zezizathu zokubakho ukuchithwa kwamatyala kunokuqwalaselwa endaweni ye-lobectomy, kwaye bekungeke kuphakanyiswe nini?
Ukuqhawulwa komtshato: Inkcazo
Ukuthengiswa komda wokubandakanya kubandakanya ukususwa komdlavuza wamaphaphu kunye necandelo elenziwe ngengqamlezo yeethambo ezijikeleze i-tumor. Le nqubo isusa amathisiphini amancinci angaphantsi kwelobectomy (inqubo apho i-lobe yomphunga isuswe) okanye i-segmentectomy (inkqubo ekhupha inxalenye enkulu yompompo ngaphezu kwe-resection rebation, kodwa ayikho i-lobe epheleleyo njengelona lobectomy .) Xa ukhangela inqaku lo mzekelo ukuba umphunga omnene unama-3 lobes kunye nomphunga wesokunxele une-lobes 2.
Ukuthengiswa kwamagumbi okubhekiselele kubhekiswe kwakhona njengento yokuthengiswa kwe-lobar phantsi , njengendlela yecandelo elithile. Ekujongeni amanye amagama ongayibona inkqubo ebizwa ngokuba yi-nonanomic ngokungafani nezinye iinkqubo ezenziwe nge-anatomiki, okuthethi nje ukuba ayifaki ukukhipha isahluko esithile sodwa.
Iimpawu zoLungiso lweMigudu
Nangona i-lobectomy ingaba yinyango ekhethekileyo kubantu abaninzi, kukho izizathu ezahlukahlukeneyo zokuthi kungani ugqirha onokuthi aphakamise ukuchithwa kwe-wedge esikhundleni se-lobectomy: Ezi ziquka:
Amancinci amancinci
I-resection resection idla ngokukwenzela amancinci amancinci amancinci amancinci, njengama-cancer esiphumo samangqamuzana amancinci kunye namanqanaba amancinci amancinci amancinci . ( Ngamaxesha athile ukuhlinzwa kungenziwa kumdlavuza omncinci wamaphaphu kodwa oku akunqabile.)
Inkqubo idlalwa ukuba i-tumor ingaphantsi kwe-4 cm (malunga nee-intshi ezi-2) kwaye ingaphantsi kwe-2 cm ububanzi, ifumaneka kwiindawo zangaphandle zemiphunga (i-periphery,) kwaye ichazwa njenge- stage 0 , isigaba 1A okanye isigaba esincinci 1B esingekho encinci yesifo somhlaza wamaphaphu .
Ngokusekelwe kwisigaba se- TNM somdlavuza wamaphaphu , ezi zicubu ziya kuba yi-T1N0M0.
Izizathu zokuxilonga
Ngamanye amaxesha inqubo yenziwa njengemiphunga yemiphunga ukuphonononga ukufunyaniswa okukrokrelayo (i-glass glass opacities okanye ezinye iigululules zamangqamuzana).
Inkqubo inokuthi yenzelwe iimeko ezingenanto ezingaphazamiseki, ezifana nesifo sofuba, i-aspergillosis kunye nokususwa kwe-emphysema blebs.
Ngamanye amachiza, inqubo inokwenziwa ukwenzela ukususa i-metastase ehlukeneyo kwimiphunga emdlalweni wesibeleko sesifuba, i-melanoma, kunye namanye amachiza (njengomdlavuza wesiliva, umdlavuza we-colon, kunye ne-sarcomas) esasazeka emiphakeni.
Isimo sempilo esixhaswe
Xa kuqhutyelwa umgca werhafu kubantu abanomdlavuza wamaphaphu, ngokuqhelekileyo zenzelwe abantu abangenakubekezelela ukukhutshwa kwe-lobe yonke, njengabantu abadala aseba nomdlavuza wamaphaphu, abantu abanezinye izimo zonyango ezinzulu, okanye abo baye banciphisa imiphunga msebenzi. Xa kunjalo, injongo kukususa i-tumor ngenkathi igcina izicubu ezininzi zamaphaphu ngokusemandleni.
Abadala
Ingqalelo, kukuba abantu asebekhulile abanomdlavuza wamaphaphu bavame ukunyamezela unyango lomhlaza wemiphunga kunye nabantu abaselula abanesifo. Kwisifundo esinye, nokuba izigulane ezithe zahlala zine - pneumonectomy (ukususwa komphefumlo wonke), azibonakalanga umahluko ekukwazi ukunyamezela inkqubo.
Ucwaningo lwango-2018 lwafumanisa ukuba abantu asebekhulile abanomdlavuza wamaphaphu (abangaphezu kweminyaka engama-80) ukuhlinzwa ngokunyamezela kunye nabantu abatsha. Uphononongo luye lwafumanisa ukuba i-segmentectomy (i-resege resection) idibaniswe neziphumo ezingcono kunezifo ezingaphezulu zomhlaza womphunga.
Ukhetho lwaBomi
Esinye isizathu esilungileyo sokuqwalasela le nkqubo sinokuzikhethela. Abanye abantu bakhetha inkqubo encinci yokungena embi njengalezi ngezizathu zobomi bezobomi kunye nokwamkela umngcipheko ophezulu wokukhupha umdlavuza wamaphaphu .
Izizathu Zokuba Ukutshatyalaliswa Kwemigudu Akumelwe Kunconywe
Izidumbu ezinkulu kune-4 cm azikwazi ukususwa ngokucwangciswa kwemida.
Indawo yokuxhamla nayo ingenza le nkqubo ingenakwenzeka. Ngokuqhelekileyo, inkqubo echaphazelekayo efana ne-lobectomy ivame ukucetyiswa kubancinci, ngabanye baphilile, ngabanye, nangona oko kungatshintshwa ngokuphononongwa ngokutsha kweengxelo (jonga ngaphantsi kokuhlaziya kwangaphantsi.)
Ukulungiswa Ngaphambi kokuSungulwa komtshato
Ngaphambi kokuhlinzwa, ugqirha wakho uya kufuna ukuqinisekisa ukuba unako ukunyamezela inkqubo-kokubili kwimbono yokuphila kunye nokubhekiselele kwimisebenzi yemiphunga. Iziviwo kunye neemvavanyo zingabandakanya:
- Imbali yonyango epheleleyo kunye novavanyo lomzimba
- Iimvavanyo zegazi, kubandakanya iimvavanyo zengqondo kunye nesibindi
- Uvavanyo lwesimo sondlo
- ImiSebenzi yovavanyo
- Ukuhlola intliziyo
- Ucwaningo lokuphonononga ukuhlola indawo kunye nobukhulu be-tumor, kunye nokukhangela umdlavuza onokwenzeka kwimimandla yee-lymph kunye neendawo ezikude (ezifana nesibindi okanye amathambo.)
Inkqubo
Ukuthengiswa kwemigqomo kungenziwa okanye nge-thoracotomy (ukuvuleka kwesifuba) okanye nge-optics eye-assistated thoracoscopic (VATS). I-VATS yinkqubo encinci, kodwa akubona bonke oogqirha abenza lo msebenzi kwaye akusoloko kunokwenzeka ngokusekelwe kwindawo yokuxhamla.
Kuxhomekeke kwinkqubo eyenziwa, ugqirha (emva kokungena esifubeni) ubeka i-tumor. Uvavanyo oluqhelekileyo lwenziwe ukuhlola iimiphunga kunye neelymode eziseduze. I-tumor isuswe kunye nesincinci seesisu ezijikeleze i-tumor.
Utyando luya kudibaniswa ne-brachytherapy, inkqubo apho i-radiation isetyenziswe ngexesha lotyando ngokuthe ngqo kwisiza se-tumor.
Ukubuyisela
Emva kokuhlinzwa, ubude bexesha osesibhedlele kuya kuxhomekeka kukuphi uhlobo lwenkqubo eyenziwa (VATS vs thoracotomy) kunye nenkqubela yakho ngexesha lokuphucula. Ityhubhu yesifuba ifakwa kwisifuba sakho ngexesha lotyando, kwaye ngokuqhelekileyo, lihlala kwindawo yeeyure ezingama-24 ukuya kuma-48. Ngethuba le-ophrintiya yokuphefumula uza kutyelela, ekukhuthaza ukuba uphefumle ngokunyanisekileyo ukunciphisa umngcipheko wokusuleleka. Xa ukhutshwa ekhaya ugqirha wakho uya kukunika imiyalelo ecacileyo yokulandelelana kwaye anikezele umyalelo wonyango ukuze unciphise nayiphi na intlungu onayo xa ubuyela ekhaya.
Iingxaki ezinokubakho zoLungiso lweMigudu
Iingxaki aziqhelekanga, kodwa zingabandakanya:
- Iingxaki ze-anesthesia jikelele
- I-Hemothorax (ukuphuma ngegazi esifubeni)
- Sulelo
- I-Atelectasis (ukuwa kwe nxalenye, okanye yonke imiphunga)
- I-frontupleural fistula (indlela engavumelekanga eyenza phakathi kwemiphunga kunye neembumba ezihamba emiphakeni (pleura))
- Ukunyuka komoya okuqhubekayo kukudinga ixesha elide le-tube tube
- Unzima ukugxala kwi-respirator
Prognosis
Ukugxekwa kwe-resection resection kuyahlukahluka ngokuxhomekeka kwisisu sakho, impilo yakho jikelele kunye nezinye izibonelelo ozifumanayo.
Kwacatshangelwa ixesha elide lokuba ukusinda (kubantu abangakwazi ukunyamezela inkqubo) kuphakamileyo kubantu abafumana i-lobectomy ngokuchithwa kwe-wedge. Ukuphononongwa kwangoku kweziphumo ezingama-54 ezijonge kwizigulane ezingama-39,000 ezikufutshane ziye zatshintsha loo nto. Kubantu ababenokuqhawulwa kwemida kodwa bebenokunyamezela i-lobectomy (iqela apho i-resection wedction "ikhethwe ngokuzithandela,") izinga lokusinda alizange lihluke kakhulu phakathi kwezi nkqubo zimbini. Kubantu abanobudlelwane bentambo ngenxa yokuba bebengenako ukunyamezela i-lobectomy (iqela elibhaliweyo "iqela"), ukusinda kwakunzima nakakhulu kulabo abanokwenziwa ngokutsha.
Ukunyamezela emva kokuSungulwa kweMigodi yeSifo seLung
Ukuthengiswa komda, nangona kungaphantsi kwelobectomy okanye pneumonectomy, kuseyi-operesheni enkulu. Cela, kwaye vumela, abahlobo bakho kunye nosapho bancede. Ukulungiswa kwepulmonary emva kokuhlinzwa komdlavuza wamaphaphu sele kufundwe kodwa kungenza umehluko omkhulu kumgangatho wobomi kwabanye abantu. Ekubeni le ngcamango entsha, unokufuna ukucela ugqirha wakho ukuba uthunyelwe.
> Imithombo:
> Ambrogil, M. et al. Ukwandisa i-resection kunye ne-radiofrequency ablation kwi-stage I-nonsmall umhlaza wamaphaphu wamaphaphu. I-European Respiratory Journal . 2015. 45 (4): 1089-109.
> Cao, C., Chandrakumar, D., Gupta, S., Yan, T, kunye noDan. Ngaba ubuncinane bangaphezulu? - Ukuhlaziywa okuchanekileyo kunye nokuhlaziywa kwemeta ye-sublobar ukuthengiswa ngokubhekiselele kwimibectomy yesifo somhlaza wesifo samangcwaba esingekho encinci ngokubhekiselele ekukhetheni isiguli. I-Cancer Lung .2015 (Epub ngaphambi kokuprinta).
> IiChambers, A., Routledge, T., Pill, J., noMnu Scarci. Izigulane ezisebekhulile I-Cancer ye-Lung is Resection echanekileyo kwiMigangatho yokuShatshazwa, Ukufa nokuQiniseka koBomi? . I-Interactive Cardiovascular and Thoracic Surgery . 2010. 10 (6): 1015-21.
> Stamenovic, D., Messerschmidt, A., kunye noT. Schneider. Ukugqithwa kwee-Lung Tumors kwi-Elderly: Isifundo seKhuphiswano seCandelo eliPhezulu kwiCandelo eliPhezulu (iminyaka engaphezu kwe-80) ekuPhakanyisweni kweeNkathazo ngokusebenzisa uModeli wokuThengiswa koMngcipheko. International Journal of Surgery . 2018. 52: 141-148.