Iziguli eziningi ezinomdlavuza wesibindi ezingafaneleki ukuhlinzwa noma ezinye izindlela zokwelapha zinokukhetha.
Ukubuyekezwa Kwecala
Icala 1 Lokwelashwa Komdlavuza Wesibindi:
Isiguli: Owesilisa, umdlavuza wesibindi oyinhloko
Ukwelashwa kokuqala kwe-HIFU emhlabeni komdlavuza wesibindi, kwasinda iminyaka eyi-12.
Icala 2 Lokwelashwa Komdlavuza Wesibindi:
Isiguli: Owesilisa, oneminyaka engu-52 ubudala, umdlavuza wesibindi oyinhloko
Ngemva kokususwa kwe-radiofrequency, kwatholakala isimila esisele (isimila siseduze ne-inferior vena cava). Ngemva kokwelashwa kwesibili kwe-HIFU, kwatholakala ukususwa okuphelele kwesimila esisele, ngokuvikelwa okuphelele kwe-inferior vena cava.
Icala 3 Lokwelashwa Komdlavuza Wesibindi:
Umdlavuza wesibindi oyinhloko
Ukulandelela ngemuva kwamasonto amabili okwelashwa kwe-HIFU kubonise ukuthi lesi simila siyanyamalala ngokuphelele!
Icala 4 Lokwelashwa Komdlavuza Wesibindi:
Isiguli: Owesilisa, oneminyaka engu-33 ubudala, umdlavuza wesibindi osakazeke kakhulu
Kutholakale isilonda esisodwa ku-lobe ngayinye yesibindi. Ukwelashwa kwe-HIFU kwenziwa ngasikhathi sinye, okwaholela ekuqhekekeni kwesimila kanye nokumuncwa kwezicubu ezinyangeni ezintathu ngemuva kokuhlinzwa.
Icala 5 Lokwelashwa Komdlavuza Wesibindi:
Isiguli: Owesilisa, oneminyaka engu-70 ubudala, umdlavuza wesibindi oyinhloko
Isimila esisele sabonwa ku-MRI ngemva kokufakwa kwamafutha e-iodine ngemva kokufakwa kwe-transarterial embolization. Ukuthuthukiswa kwe-patchy kwanyamalala ngemva kokwelashwa kwe-HIFU, okubonisa ukususwa kwesimila ngokuphelele.
Icala 6 Lokwelashwa Komdlavuza Wesibindi:
Isiguli: Owesifazane, oneminyaka engu-70 ubudala, umdlavuza wesibindi oyinhloko
Isimila esinomfutho wegazi ophezulu esingama-120mm* Kutholakale u-100mm engxenyeni yesokudla yesibindi. Ukususwa okuphelele kwesimila kufezwe ngemuva kokwelashwa nge-HIFU, kancane kancane kungene ngokuhamba kwesikhathi.
Icala 7 Lokwelashwa Komdlavuza Wesibindi:
Isiguli: Owesilisa, oneminyaka engu-62 ubudala, umdlavuza wesibindi oyinhloko
Isilonda esitholakala eduze kophahla lwe-diaphragmatic, i-inferior vena cava, kanye nesistimu ye-portal vein. Ngemva kwezikhathi ezi-5 ze-radiofrequency kanye nezikhathi ezi-2 ze-TACE, isimila esisele satholakala ku-MRI yokulandelela. Ukwelashwa kwe-HIFU kwaqeda ngempumelelo isimila ngenkathi kulondolozwa imithambo yegazi ezungezile.
Icala 8 Lokwelashwa Komdlavuza Wesibindi:
Isiguli: Owesilisa, oneminyaka engu-58 ubudala, umdlavuza wesibindi oyinhloko
Ukuphinda kubonakale ngemva kokuhlinzwa komdlavuza wesibindi se-lobe kwesokudla. Ukususwa okuphelele kwesimila kufezwe ngokwelashwa kwe-HIFU, okuqinisekiswa ngokumuncwa kwesimila ezinyangeni ezingu-18 kamuva.
Ukushisa Okuphezulu Komdlavuza Wesibindi - Ucwaningo Olujwayelekile
I-HIFU (i-High Intensity Focused Ultrasound) ingasetshenziswa ukwelapha umdlavuza wesibindi. Izindlela zokwelapha zendabuko zomdlavuza wesibindi zifaka phakathi ukuhlinzwa, ukufakelwa kwemithambo yegazi, kanye nokwelashwa ngamakhemikhali. Kodwa-ke, iziguli eziningi zitholakala zisesigabeni esithuthukile noma zinezimila eduze kwemithambo yegazi emikhulu, okwenza ukuhlinzwa kungasebenzi. Ngaphezu kwalokho, ezinye iziguli azikwazi ukuhlinzwa ngenxa yesimo sazo somzimba, futhi izinqubo zokuhlinzwa ngokwazo zithwala ingozi yezinkinga.
Ukwelashwa kwe-HIFU komdlavuza wesibindi kunikeza izinzuzo eziningana:Akuhlaseli kakhulu, kubangela ubuhlungu nomonakalo omncane, kuphephile, kunezinkinga ezimbalwa, futhi kungaphindaphindwa uma kudingeka. Kungathuthukisa izimpawu zesiguli futhi kwandise isikhathi sokuphila kwaso.
Ngemva kokwelashwa nge-HIFU, akubikiwe amacala okuqhekeka kwesimila, i-jaundice, ukuvuza kwenyongo, noma ukulimala kwemithambo yegazi, okubonisa ukuthi ukwelashwa kuphephile.
(1) Izinkomba:Ukwelashwa okudambisa ubuhlungu kwezimila ezithuthukile, umdlavuza wesibindi owodwa ku-lobe yesokudla enobubanzi obungaphansi kuka-10cm, izimila ezinkulu ku-lobe yesokudla ezinamaqhubu ahlala eboshelwe esibindini sesokudla, ukuphinda kwalesi sifo endaweni ethile ngemva kokuhlinzwa, i-portal vein tumor thrombus.
(2) Izimo ezingahambisani nalokhu:Iziguli ezine-cachexia, umdlavuza wesibindi osabalalayo, ukungasebenzi kahle kwesibindi okukhulu esigabeni sokugcina, kanye nokusabalala kwe-metastasis okude.
(3) Inqubo yokwelapha:Iziguli ezinezimila engxenyeni yesokudla kufanele zilale ngakwesokudla, kuyilapho lezo ezinezimila engxenyeni yesobunxele zivame ukufakwa zilele phansi. Ngaphambi kwenqubo, kusetshenziswa i-ultrasound ukuthola isimila ukuze kuqondiswe kahle futhi kuhlelwe ukwelashwa. Isimila bese selashwa ngenqubo yokususwa okulandelanayo, kusukela emaphuzwini ngamanye bese kuqhubekela phambili emigqeni, ezindaweni, bese ekugcineni umthamo wesimila sonke. Ukwelashwa kuvame ukwenziwa kanye ngosuku, kanti ungqimba ngalunye luthatha cishe imizuzu engama-40-60. Inqubo iyaqhubeka nsuku zonke, ungqimba nongqimba, kuze kube yilapho isimila sonke sesisusiwe. Ngemva kokwelashwa, indawo elashwe iyahlolwa ukuthi ayinawo yini umonakalo wesikhumba, kulandelwe ukuskena kwangaphandle kwe-ultrasound yendawo yonke eqondiwe ukuze kuhlolwe ukusebenza kahle kokwelashwa.
(4) Ukunakekelwa ngemva kokwelashwa:Iziguli ziqashwe ukuze kutholakale ukusebenza kwesibindi kanye namazinga e-electrolyte. Ukwelashwa okusekelayo kufanele kunikezwe iziguli ezingasebenzi kahle kwesibindi, i-ascites, noma i-jaundice. Iningi leziguli linokushisa komzimba okuvamile ngesikhathi sokwelashwa. Inani elincane leziguli lingase lithole ukwanda okuncane kwezinga lokushisa zingakapheli izinsuku ezingu-3-5, ngokuvamile ngaphansi kuka-38.5℃. Ukuzila ukudla ngokuvamile kunconywa amahora angu-4 ngemva kokwelashwa, kuyilapho iziguli ezinomdlavuza wesibindi we-left lobe kufanele zizile ukudla amahora angu-6 ngaphambi kokuba zishintshele kancane kancane ekudleni okuwuketshezi. Ezinye iziguli zingase zizwe ubuhlungu obuncane besisu esingaphezulu izinsuku ezingu-3-5 ngemva kokwelashwa, okuziqeda kancane kancane.
(5) Ukuhlolwa kokusebenza kahle:I-HIFU ingabhubhisa izicubu zomdlavuza wesibindi, okubangela ukonakala okungenakuguqulwa kwamaseli omdlavuza. Ukuskena kwe-CT kubonisa ukwehla okuphawulekayo kwamanani okuncipha kwe-CT ezindaweni eziqondiwe, kanti i-CT ethuthukisiwe ngokuqhathanisa iqinisekisa ukungabikho kokunikezwa kwegazi lemithambo yegazi kanye ne-portal endaweni eqondiwe. Ibhendi yokuthuthukisa ingabonakala emngceleni wokwelashwa. I-MRI ibona izinguquko ekuqineni kwesignali yesimila ezithombeni ezinesisindo se-T1 kanye ne-T2 futhi ikhombisa ukunyamalala kokunikezwa kwegazi endaweni eqondiwe ezigabeni zemithambo yegazi kanye ne-portal, kanye nesigaba esilibazisekile esibonisa ibhendi yokuthuthukisa emngceleni wokwelashwa. Ukuqapha kwe-ultrasound kubonisa ukwehla kancane kancane kosayizi wesimila, ukunyamalala kokunikezwa kwegazi, kanye ne-tissue necrosis ekugcineni emuncwa.
(6) Ukulandelela:Eminyakeni emibili yokuqala ngemva kokwelashwa, iziguli kufanele zibe nokuvakasha kokulandelela njalo ezinyangeni ezimbili. Ngemva kweminyaka emibili, ukuvakasha kokulandelela kufanele kwenzeke njalo ezinyangeni eziyisithupha. Ngemva kweminyaka emihlanu, kunconywa ukuhlolwa kwaminyaka yonke. Amazinga e-Alpha-fetoprotein (AFP) angasetshenziswa njengesibonakaliso sokuphindeka kwesimila. Uma ukwelashwa kuphumelele, isimila sizoncipha noma sinyamalale ngokuphelele. Ezimweni lapho isimila sisakhona kodwa singasenawo amaseli asebenzayo, kufanele kuqashelwe lapho isimila esinobubanzi obungaphezu kuka-5cm sibonakala ezithombeni, futhi ama-PET scan angasetshenziswa ukuze kucaciswe kabanzi.
Ukuqashelwa kwezokwelapha kwemiphumela yangaphambi nangemva kokwelashwa, okuhlanganisa amazinga e-alpha-fetoprotein, ukusebenza kwesibindi, kanye nokuskena kwe-MRI,babonise izinga lokuphulukiswa kwemitholampilo elingaphezu kuka-80% kwiziguli ezinomdlavuza wesibindi ezelashwe nge-HIFU.Ezimweni lapho ukuphakelwa kwegazi ezimila zesibindi kucebile, ukwelashwa kwe-HIFU kungahlanganiswa nokungenelela kwe-transarterial. Ngaphambi kokwelashwa kwe-HIFU, i-transcatheter arterial chemoembolization (TACE) ingenziwa ukuvimba ukuphakelwa kwegazi endaweni yesimila esiphakathi, kanye ne-embolic agent esebenza njengophawu lwesimila ukusiza ekuqondisweni kwe-HIFU. Amafutha e-iodine aguqula i-acoustic impedance kanye ne-absorption coefficient ngaphakathi kwesimila, okwenza kube lula ukuguqulwa kwamandla ekugxilweni kwe-HIFU futhi kuthuthukise.
Isikhathi sokuthunyelwe: Agasti-08-2023