I-Cryoablation ye-Pulmonary Nodule
Umdlavuza Wamaphaphu Ovamile kanye Neziqhumane Ezibuhlungu Zamaphaphu
Ngokwemininingwane evela kwi-International Agency for Research on Cancer yeWorld Health Organisation, cishe abantu abayizigidi ezingama-4.57 batholakala benesifo somdlavuza eChina ngo-2020,ngomdlavuza wamaphaphu obala cishe izehlakalo ezingama-820,000.Ezifundazweni nasemadolobheni angu-31 eChina, izinga lokutholakala komdlavuza wamaphaphu kwabesilisa lihamba phambili kuzo zonke izifunda ngaphandle kwaseGansu, Qinghai, Guangxi, Hainan, naseTibet, futhi izinga lokufa liphakeme kakhulu kungakhathaliseki ukuthi ubulili buni.Isilinganiso sezigameko sezigaxa zamaphaphu e-China silinganiselwa ku-10% kuya ku-20%., okungenzeka kube nokusabalala okukhulu phakathi kwabantu abangaphezu kweminyaka engama-40 ubudala.Kodwa-ke, kufanele kuqashelwe ukuthi iningi lama-nodules we-pulmonary yizilonda ezinobungozi.
Ukuxilongwa kwe-Pulmonary Nodules
Izigaxa zamaphaphubhekisela emithunzini eminyene emise okwendilinga egxile emaphashini, enobukhulu obuhlukahlukene nemiphetho ecacile noma efiphele, kanye nobubanzi obungaphansi noma obulingana no-3 cm.
Ukuxilongwa Kwesithombe:Njengamanje, indlela yokuthwebula okuhlosiwe, eyaziwa ngokuthi i-ground-glass opacity nodule imaging maging, isetshenziswa kakhulu.Abanye ochwepheshe bangafinyelela izinga lokuhlangana kwe-pathological elifika ku-95%.
Ukuxilongwa kwe-Pathological:Kodwa-ke, ukuxilongwa kwe-imaging akukwazi ukuthatha indawo yokuxilongwa kwe-tissue pathology, ikakhulukazi ezimeni zokwelashwa okunembayo kwe-tumor okudinga ukuxilongwa kwe-molecular pathological level.Ukuxilongwa kwe-Pathological kuseyindinganiso yegolide.
Izindlela Ezivamile Zokuxilonga kanye Nezokwelapha zamaNodule e-Pulmonary
I-Percutaneous Biopsy:Ukuxilongwa kwe-tissue pathology kanye nokuxilongwa kwe-molecular pathology kungafinyelelwa ngaphansi kwe-anesthesia yendawo ngokubhoboza nge-percutaneous.Isilinganiso sempumelelo ye-biopsy cishe singama-63%,kodwa izinkinga ezifana ne-pneumothorax ne-hemothorax zingase zenzeke.Le ndlela isekela ukuxilongwa kuphela futhi kunzima ukwenza ukwelashwa kanyekanye.Kukhona futhi ingozi yokuchithwa kwamaseli we-tumor kanye ne-metastasis.I-conventional percutaneous biopsy inikeza umthamo wezicubu ezilinganiselwe,ukwenza ukuxilongwa kwe-tissue pathology ngesikhathi sangempela kube inselele.
I-General Anesthesia Video-Assisted Thoracoscopic Surgery (VATS) Lobectomy: Le ndlela ivumela ukuxilongwa nokwelashwa ngesikhathi esisodwa, ngezinga lempumelelo elisondela ku-100%.Nokho, le ndlela ingase ingafaneleki ezigulini esezikhulile noma abantu abakhethekileabangayibekezeleli i-anesthesia jikelele, iziguli ezinamaqhuqhuva wamaphaphu amancane kuno-8 mm ngosayizi noma ukuminyana okuphansi (<-600), amaqhuqhuva abekwe ajule phakathi kwamasegimenti angenasizathu, kanyeama-nodules esifundeni se-mediastinal eduze nezakhiwo ze-hilar.Ukwengeza, ukuhlinzwa kungase kungabi yindlela yokuxilonga neyokwelapha efanele ezimweni ezihilelaukuphindaphinda kwangemva kokuhlinzwa, amaqhuqhuva aphindelelayo, noma izimila ze-metastatic.
Indlela Entsha Yokwelapha Yamaqhubu Amaphaphu - Cryoablation
Ngokuthuthuka okuqhubekayo kobuchwepheshe bezokwelapha, ukwelashwa kwesimila sekungene enkathini “ukuxilongwa okunembayo kanye nokwelashwa okunembayo“.Namuhla, sizokwethula indlela yokwelapha yendawo esebenza kahle kakhulu kumathumba angewona amabi namaqhuqhuva akhula ngaphandle kwemithambo yamaphaphu, kanye namaqhubu aqala ekuqaleni (ngaphansi kuka-2 cm) -ukukhala.
I-Cryotherapy
Inqubo ye-cryoablation yezinga lokushisa eliphansi kakhulu (i-cryotherapy), eyaziwa nangokuthi i-cryosurgery noma i-cryoablation, iyindlela yokwelapha yokuhlinzwa esebenzisa ukubanda ukwelapha izicubu eziqondiwe.Ngaphansi kokuqondiswa kwe-CT, ukuma okunembile kufinyelelwa ngokubhoboza izicubu zesimila.Ngemva kokufinyelela isilonda, izinga lokushisa lendawo esizeni liyancipha ngokushesha-140°C kuya ku-170°Cusebenzisaigesi ye-argonemizuzwini embalwa, ngaleyo ndlela kufinyelelwe umgomo wokwelashwa kokukhishwa kwesimila.
Isimiso se-Cryoablation for Pulmonary Nodules
1. Umphumela we-ice-crystal: Lokhu akuthinti i-pathology futhi kuvumela ukuxilongwa okusheshayo kwe-intraoperative pathological.I-cryoablation ibulala amaseli wesimila futhi ibangele ukuvaleka kwe-microvascular.
2. Umphumela we-Immunomodulatory: Lokhu kufeza impendulo ekude yokuzivikela ngokumelene nesimila. Ikhuthaza ukukhululwa kwe-antigen, isebenze amasosha omzimba, futhi ikhulule ukucindezelwa komzimba.
3. Ukuqiniswa kwezitho eziphathwayo (ezifana namaphaphu nesibindi): Lokhu kuthuthukisa izinga lempumelelo ye-biopsy. Ibhola elifriziwe liyakhiwa, okwenza kube lula ukuzinza, futhi imiphetho icacile futhi ibonakala ekucabangeni.Lolu hlelo lokusebenza olunelungelo lobunikazi lulula futhi lusebenza kahle.
Ngenxa yezici ezimbili ze-cryoablation -"i-anchoring eqandayo kanye nomphumela wokulungisa" kanye "nokwakheka kwezicubu eziqinile ngemuva kokuqhwa ngaphandle kokuphazamisa ukuxilongwa kwe-pathological", ingasiza ekuhlolweni kwe-nodule yamaphaphu,finyelela ukuxilongwa ngesikhathi sangempela se-frozen pathological ngesikhathi senqubo, futhi uthuthukise izinga lempumelelo ye-biopsy.Yaziwa nangokuthi “cryoablation for pulmonary nodule biopsy“.
Izinzuzo ze-Cryoablation
1. Ukubhekana nokuphazamiseka kokuphefumula:Ukuqandisa kwendawo kuzinzisa izicubu zamaphaphu (kusetshenziswa izindlela zokuqandisa ze-coaxial noma ze-bypass).
2. Ukubhekana ne-pneumothorax, i-hemoptysis, kanye nengozi ye-air embolism kanye nokuvela kwesimila: Ngemva kokwenza ibhola eliqandisiwe, kusungulwe ishaneli yokucindezela engalungile engemihle ukuze kuhlonzwe izinjongo zokwelashwa.
3. Ukufeza izinjongo zokuxilongwa kanye nokwelashwa endaweni ngesikhathi esisodwa: Ukukhala kwenodule yamaphaphu kwenziwa kuqala, kulandelwa ukufudumala kabusha kanye ne-360° multidirectional biopsy ukuze kwandiswe inani lezicubu ze-biopsy.
Nakuba i-cryoablation iyindlela yokulawula isimila sendawo, ezinye iziguli zingase zibonise ukusabela okukude kokuzivikela komzimba.Kodwa-ke, inani elikhulu ledatha libonisa ukuthi lapho ukukhala kuhlanganiswe ne-radiotherapy, i-chemotherapy, ukwelashwa okuhlosiwe, i-immunotherapy, nezinye izindlela zokwelapha, ukulawulwa kwesimila eside kungafinyelelwa.
Izinkomba ze-Percutaneous Cryoablation ngaphansi kwe-CT Guidance
I-B-zone lung nodules: Kumaqhuqhuva wamaphaphu adinga ukuhlukaniswa kwezigaba noma ukuhlukaniswa kwezigaba eziningi, i-percutaneous cryoablation inganikeza ukuxilongwa okuqinisekile kwangaphambi kokuhlinzwa.
Ama-nodules wamaphaphu e-A-zone: Indlela ye-Bypass noma e-oblique (umgomo ukusungula isiteshi sezicubu zamaphaphu, okungcono ngobude obungu-2 cm).
Izinkomba
Amathumba angewona ama-malignant kanye nama-non-vascular proliferative pulmonary nodules:
Lokhu kuhlanganisa izilonda ezidala umdlavuza (i-atypical hyperplasia, in situ carcinoma), izilonda ezandayo ze-immune reactive, ama-pseudotumors avuvukalayo, ama-cysts namathumba, namaqhuqhuva ayandayo.
Izimpawu ze-tumor zesigaba sokuqala:
Ngokusekelwe kokuhlangenwe nakho okukhona, i-cryoablation iphinde ibe indlela yokwelapha ephumelelayo eqhathaniswa nokuhlinzwa kokuhlinzwa kwamaqhuqhuva angabonakali engilazi angaphansi kuka-2 cm anengxenye eqinile engaphansi kuka-25%.
Isikhathi sokuthumela: Sep-05-2023