Ngokwemininingwane efanele ye-International Agency for Research on Cancer (IARC) ye-World Health Organization (WHO), umdlavuza wamaphaphu usuphenduke esinye sezimila ezimbi kakhulu, futhi ukuvinjelwa nokwelashwa komdlavuza wamaphaphu sekuyinto ehamba phambili. wokuvimbela nokwelashwa komdlavuza.
Ngokusho idatha efanele yezibalo, kuphela mayelanaAma-20% eziguli ezinomdlavuza wamaphaphu okungewona amancanyana angahlinzwa.Iningi leziguli ezinomdlavuza wamaphaphu selingenileizigaba eziphambililapho bexilongwa, futhi bangase bathole izinzuzo ezilinganiselwe ekwelashweni kwendabuko nge-radiotherapy kanye nokwelashwa ngamakhemikhali.Ngokuqhubeka nokuthuthuka kwesayensi yezokwelapha, ukuvela kweukwelashwa kwe-ablativeesikhundleni sokuhlinzwa kulethe ithemba elisha lokwelashwa ezigulini ezinomdlavuza wamaphaphu.
1. Wazi kangakanani ngokwelashwa kwe-ablative yomdlavuza wamaphaphu?
Ukwelashwa kwe-ablative yomdlavuza wamaphaphu kuhlanganisa ikakhulukaziukukhishwa kwe-microwave kanye nokukhishwa kwe-radiofrequency.Umgomo wokwelapha uhilela ukufaka i-electrode ye-ablative, eyaziwa nangokuthi a"phenya,"esimila ephashini.I-electrode ingabangelaukunyakaza okusheshayoizinhlayiya ezifana nama-ion noma ama-molecule amanzi ngaphakathi kwesimila, adala ukushisa ngenxa yokungqubuzana, okuholelaumonakalo ongenakulungiseka njenge-coagulative necrosis yamaseli wesimila.Ngesikhathi esifanayo, ijubane lokudlulisa ukushisa liyancipha ngokushesha emathangeni avamile amaphaphu azungezile, okugcina ukushisa ngaphakathi kwesimila, kudala i-"umphumela we-thermal insulation."Ukwelashwa kwe-ablative kungasibulala ngempumelelo isimila ngenkathiukwandisa ukuvikelwa kwezicubu zamaphaphu ezivamile.
Ukwelashwa kwe-ablative kubonakala yikhoukuphindaphinda, ukungaphatheki kahle kwesiguli, ukuhlukumezeka okuncane, nokululama ngokushesha,futhi iye yaqashelwa kabanzi futhi isetshenziswa emisebenzini yomtholampilo.Kodwa-ke, uma kucatshangelwa ukuthi ukwelashwa kwe-ablative kuhilela iziyalo eziningi ezifana ne-radiology, i-oncology, i-radiology yokungenelela, kanye ne-anatomy yokuhlinzwa, kudinga izinga eliphezulu lamakhono okuhlinzwa kanye nezimfanelo eziphelele ezivela kudokotela osebenzayo.
Namuhla, sithanda ukwethula kuwe uchwepheshe owaziwayo emkhakheni wezokwelapha ngokungenelela,UDkt. Liu Chen, oseneminyaka eminingi esebenza kulo mkhakha futhi ozinikele ocwaningweni lokuhumusha lomtholampilo kanye nokwenza kwandiswe okujwayelekile kokuxilongwa kokungenelela okungangeneleli kanye nokwelashwa okufana ne-biopsies yesimila esiyinselele neyingozi enkulu, ukuphuma kwe-thermal, nokufakwa kwezinhlayiyana.UDkt. Liu waziwa “njengeqhawe enaliti ethiphu” futhi ubambe iqhaza ekwenziweni kokuvumelana kochwepheshe nemihlahlandlela yamasu ahlukene okwelapha okwelapha umdlavuza wamaphaphu e-China.Usungule umqondo wokuphathwa okuphelele kwe-biopsies yomdlavuza wamaphaphu futhi wasungula izinqubo zokuhlinza ezijwayelekile zokuthuthukisa ukuthathwa kwezinqumo zokwelashwa okungenele ekwelapheni kwasendaweni umdlavuza wamaphaphu osakhula, ukukhuthaza ukuthuthuka okuphelele kohlelo lokuxilongwa nokwelashwa komdlavuza wamaphaphu waseChina.
"Iqhawe Ethiphu Yenaliti" - UDokotela uLiu Chen
Ikhethekile ekuxilongweni okungangeneleli okungangeneleli kanye namasu okwelapha amathumba ngaphansi kokuqondisa kwesithombe
1. Ukukhishwa kwe-Microwave/Radiofrequency
2. I-Percutaneous biopsy
3. Ukufakwa kwezinhlayiyana ezinemisebe
4. Ukulawulwa kobuhlungu bokungenelela
2. Injongo kanye nezinkomba zokwelashwa kwe-ablative yomdlavuza wamaphaphu
“Ukuvumelana Kochwepheshe Nge-Ablative Therapy for Primary and Metastatic Lung Tumors”(Ushicilelo luka-2014) luhlukanisa ukwelapha okubulalayo kumdlavuza wamaphaphu kube izigaba ezimbili: ekwelapheni kanye ne-palliative.
Ukukhishwa kwezokwelaphaihlose ukwenza necrotize ngokuphelele izicubu zesimila sendawo futhi ingase izuze umphumela wokwelapha.Umdlavuza wamaphaphu wesigaba sokuqala uyinkomba ephelele yokwelashwa kwe-ablative,ikakhulukazi ezigulini ezinomsebenzi we-cardiopulmonary ompofu, ubudala, ukungakwazi ukubekezelela ukuhlinzwa, ukwenqaba ukuhlinzwa, noma lezo ezinethumba elilodwa lokuphindaphinda ngemva kwe-radiotherapy ehambisanayo, kanye nezinye iziguli ezinezilonda eziningi zomdlavuza wamaphaphu ezidinga ukulondoloza ukusebenza kwamaphaphu. .
Ukukhishwa kwe-Palliativeihlose ukuyenza isimila esiyinhloko singasebenzi ezigulini ezinomdlavuza wamaphaphu osesigabeni esithuthukisiwe, sinciphise umthwalo wesimila, sikhulule izimpawu ezibangelwa isimila, futhi sithuthukise izinga lempilo yesiguli.Ezigulini ezinomdlavuza wamaphaphu osesigabeni esithuthukile, izimila ezinobubanzi obungaphezulu kuka-5 cm noma ezinezilonda eziningi zingabhekana nezinaliti eziningi, i-multipoint, noma izikhathi eziningi zokwelashwa, noma zihlanganiswe nezinye izindlela zokwelapha ukuze ziphile isikhathi eside.Kuma-metastase amaphaphu ayingozi afika sekwephuzile, uma ukulawulwa kwamathumba angaphandle kwamaphaphu kuhle futhi kunenani elincane kuphela lezilonda ezisele ze-metastatic ezikhona emaphashini, ukwelashwa kwe-ablative kungasiza ngempumelelo ukulawula lesi sifo futhi kuthuthukise izinga lokuphila lesiguli.
3. Izinzuzo zokwelashwa kwe-ablative
Ukuhlinzwa okuhlaselayo okuncane, ukululama okusheshayo: Ukwelashwa kwe-ablative kubhekwa njengokuhlinzwa kokungenelela okuncane.Inalithi ye-ablative electrode esetshenziswa ngokuvamile inobubanzi be1-2 mm, okuholela ekuhlinzeni okuncane okulingana nembobo yenaliti.Le ndlela inikeza izinzuzo ezifanaukuhlukumezeka okuncane, ubuhlungu obuncane, nokululama ngokushesha.
Isikhathi esifushane sokuhlinzwa, umuzwa onethezekile:Ukwelashwa kwe-ablative kuvame ukwenziwa ngaphansi kwe-anesthesia yendawo noma kuhlanganiswe ne-intravenous sedation, okuqeda isidingo se-endotracheal intubation.Iziguli zisesimweni sokulala esincane futhi zingavuswa kalula ngokuthepha okuthambile.Ezinye iziguli zingase zizwe sengathi ukuhlinzwa kuqedwa ngemva kwalokhoukulala ngokushesha.
I-biopsy ngesikhathi esisodwa yokuxilongwa okunembile:Ngesikhathi sokwelashwa kwe-ablative, i-coaxial guide noma i-synchronous puncture biopsy instrument ingasetshenziswa ukuthola i-biopsy yesilonda.Okulandelayoukuxilongwa kwe-pathological kanye nokuhlolwa kofuzohlinzeka ngolwazi olubalulekile lwezinqumo zokwelashwa ezilandelayo.
Inqubo ephindaphindwayo: Ucwaningo oluningi oluvela emithonjeni yasekhaya neyamazwe ngamazwe lubonise ukuthi izinga lokulawula lendawo leziguli ezinomdlavuza wamaphaphu ezisheshe zathola ukwelashwa kwe-ablative liqhathaniswa nalolo lokuhlinza noma ukwelapha ngemisebe ye-stereotactic.Endabeni yokuphindaphinda kwendawo, ukwelashwa kwe-ablativeingaphinda izikhathi eziningiukubuyisela ukulawula isifo ngenkathiukwandisa izinga lempilo yesiguli.
Ukwenza kusebenze noma ukuthuthukiswa komsebenzi wokuzivikela komzimba: I-Ablative therapy ihlosebulala amaseli wesimila emzimbeni, futhi kwezinye izimo, ingenza kusebenze noma kuthuthukise ukusebenza kokuzivikela komzimba kwesiguli, okuholela ekubeni a lapho izimila ezingalashiwe kwezinye izingxenye zomzimba zibonisa ukwehla.Ukwengeza, ukwelashwa kwe-ablative kungahlanganiswa nemithi ye-systemic ukukhiqizaumphumela we-synergistic.
I-Ablative therapy ifaneleka kakhulu ezigulini ezingakwazi ukubekezelela ukuhlinzwa noma ukulaliswa kwezinzwa okuvamile ngenxaukungasebenzi kahle kwe-cardiopulmonary, iminyaka yobudala, noma izifo eziningi ezicashile.Futhi kuwukwelashwa okuncanyelwayo ezigulini ezineamaqhuqhuva amaningi asekuqaleni (njengamaqhuqhuva amaningi engilazi ephansi).
Isikhathi sokuthumela: Aug-23-2023