Ukukhishwa Kwegazi Kwe-Pulmonary Nodule
Umdlavuza Wamaphaphu Ovamile kanye nama-Pulmonary Nodules Akhathazayo
Ngokusho kwedatha evela kwi-International Agency for Research on Cancer of the World Health Organization, cishe amacala amasha omdlavuza ayizigidi ezingu-4.57 atholakale eShayina ngo-2020,kanti umdlavuza wamaphaphu ubangela amacala angaba ngu-820,000Phakathi kwezifundazwe namadolobha angu-31 eShayina, izinga lokwanda komdlavuza wamaphaphu kwabesilisa lihamba phambili kuzo zonke izifunda ngaphandle kweGansu, Qinghai, Guangxi, Hainan, kanye neTibet, kanti izinga lokufa liphezulu kakhulu kungakhathaliseki ubulili.Izinga lokusabalala kwamaqhubu emaphaphu eShayina lilinganiselwa ku-10% kuya ku-20%, okungenzeka ukuthi kusakazeke kakhulu kubantu abangaphezu kweminyaka engama-40 ubudala. Kodwa-ke, kufanele kuqashelwe ukuthi iningi lamaqhubu emaphashini ayizilonda ezingenabungozi.
Ukuxilongwa Kwama-Pulmonary Nodules
Amaqhubu ephaphubhekisela ezithunzini eziqinile ezimise okwendilinga emaphashini, ezinobukhulu obuhlukahlukene kanye nemingcele ecacile noma engacacile, kanye nobubanzi obungaphansi noma obulingana no-3 cm.
Ukuxilongwa Kwezithombe:Njengamanje, inqubo yokuthwebula izithombe eziqondiwe, eyaziwa ngokuthi i-ground-glass opacity nodule imaging diagnosis, isetshenziswa kabanzi. Abanye ochwepheshe bangafinyelela izinga lokuxhumana kwezifo elifinyelela ku-95%.
Ukuxilongwa Kwezifo:Kodwa-ke, ukuxilongwa kwezithombe akukwazi ukuthatha indawo yokuxilongwa kwezifo zezicubu, ikakhulukazi ezimweni zokwelashwa okunembile okuqondene nesimila okudinga ukuxilongwa kwezifo ze-molecular ezingeni lamaseli.Ukuxilongwa kwezifo kuseyiyona ndlela eyinhloko.
Izindlela Ezivamile Zokuxilonga Nokwelapha Amaqhubu Ephaphu
I-Biopsy Yesikhumba Esingaphandle:Ukuxilongwa kwezifo zezicubu kanye nokuxilongwa kwezifo zama-molecule kungatholakala ngaphansi kwe-anesthesia yendawo ngokubhoboza nge-percutaneous. Izinga lempumelelo elimaphakathi le-biopsy licishe libe ngu-63%,kodwa izinkinga ezifana ne-pneumothorax kanye ne-hemothorax zingase zibe khona. Le ndlela isekela kuphela ukuxilongwa futhi kunzima ukwenza ukwelashwa ngasikhathi sinye.Kukhona futhi ingozi yokuphuma kwamangqamuzana esimila kanye nokusabalala kwaso. I-biopsy evamile ye-percutaneous inikeza ivolumu yezicubu elinganiselwe,okwenza ukuxilongwa kwezifo zezicubu ngesikhathi sangempela kube nzima.
Ukuhlinzwa Kwe-Thoracoscopic Okusekelwe Kuvidiyo (i-VAT) Okwenziwa Nge-Anesthesia: Le ndlela ivumela ukuxilongwa nokwelashwa ngasikhathi sinye, kanti izinga lempumelelo lisondela ku-100%. Kodwa-ke, le ndlela ingase ingafaneleki ezigulini ezikhulile noma ezinhlanganweni ezikhethekile.abangabekezeleli i-anesthesia ejwayelekile, iziguli ezinezigaxa zamaphaphu ezincane kuno-8 mm ngobukhulu noma ukuminyana okuphansi (<-600), izigaxa ezitholakala ngokujulile phakathi kwezingxenye ezingahleliwe, kanyeamaqhubu esifundeni se-mediastinal eduze kwezakhiwo ze-hilarNgaphezu kwalokho, ukuhlinzwa kungase kungabi yindlela efanele yokuxilonga nokwelapha ezimweni ezihilelaukuphinda kuvele ngemva kokuhlinzwa, amaqhubu aphindaphindayo, noma izimila ezisakazekile.
Indlela Entsha Yokwelapha Amaqhubu Ephaphu - Ukuhlanza
Ngokuthuthuka okuqhubekayo kobuchwepheshe bezokwelapha, ukwelashwa kwesimila sekungene enkathini ethi “ukuxilongwa okunembile kanye nokwelashwa okunembile"Namuhla, sizokwethula indlela yokwelapha yendawo ephumelela kakhulu ezimila ezingezona ezibulalayo kanye nezimila ezikhula ngokushesha emaphashini, kanye nezimila ezikhula ngokushesha (ezingaphansi kuka-2 cm) -ukuhlanza.
Ukwelashwa nge-Cryotherapy
Indlela yokwelapha ngokushisa okuphansi kakhulu (i-cryotherapy), eyaziwa nangokuthi i-cryosurgery noma i-cryoablation, iyindlela yezokwelapha yokuhlinzwa esebenzisa ukubanda ukwelapha izicubu eziqondiwe. Ngaphansi kwesiqondiso se-CT, indawo eqondile ifinyelelwa ngokubhoboza izicubu zesimila. Ngemva kokufika esilondeni, izinga lokushisa lendawo endaweni lehla ngokushesha liye ku--140°C kuya ku-170°Cusebenzisaigesi ye-argonngemizuzu embalwa, ngaleyo ndlela kufezwe umgomo wokwelashwa kokususwa kwesimila.
Isimiso Sokucwiliswa Kwama-Nodules E-Pulmonary
1. Umphumela we-ice-crystal: Lokhu akuthinti i-pathology futhi kwenza kube lula ukuthola i-pathology ngokushesha ngesikhathi sokuhlinzwa.I-Cryoablation ibulala amangqamuzana esimila ngokoqobo futhi ibangele ukuvaleka kwemithambo yegazi emincane.
2. Umphumela wokulawula amasosha omzimba: Lokhu kufeza impendulo yokuzivikela ekude ngokumelene nesimila. Ikhuthaza ukukhululwa kwe-antigen, ivuselela isimiso somzimba sokuzivikela, futhi inciphise ukucindezelwa komzimba.
3. Ukuqina kwezitho ezihambayo (njengephaphu nesibindi): Lokhu kuthuthukisa izinga lempumelelo ye-biopsy. Kukhiwa ibhola eliqandisiwe, okwenza kube lula ukuzinza, futhi imiphetho icacile futhi iyabonakala ezithombeni. Lolu hlelo lokusebenza olunelungelo lobunikazi lulula futhi lusebenza kahle.
Ngenxa yezici ezimbili ze-cryoablation -"umphumela wokubambelela nokubamba okuqandisiwe" kanye "nesakhiwo sezicubu esiphelele ngemva kokubanda ngaphandle kokuthinta ukuxilongwa kwezifo", kungasiza ekuhlolweni kwamaqhubu emaphashini,ukufeza ukuxilongwa kwezifo okuqandisiwe ngesikhathi sangempela ngesikhathi senqubo, futhi kuthuthukiswe izinga lempumelelo ye-biopsy.Kwaziwa nangokuthi “i-cryoablation ye-biopsy yamaqhuqhuva e-pulmonary“.
Izinzuzo ze-Cryoablation
1. Ukuxazulula izinkinga zokuphefumula: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 nokuhluma kwesimila: Ngemva kokwakha ibhola eliqandisiwe, kwakhiwa isiteshi esivaliwe se-negative pressure extracorporeal ukuze kutholakale imbangela kanye nokwelashwa.
3. Ukufeza imigomo yokuxilongwa kanye nokwelashwa ngasikhathi sinye endaweni: Ukususwa kweqhubu lamaphaphu kwenziwa kuqala, kulandelwe ukufudumala kabusha kanye ne-biopsy engama-360° ngezindlela eziningi ukwandisa inani lezicubu ze-biopsy.
Nakuba i-cryoablation iyindlela yokulawula isimila sendawo, ezinye iziguli zingase zibonise impendulo yokuzivikela yomzimba ekude. Kodwa-ke, inani elikhulu lemininingwane libonisa ukuthi lapho i-cryoablation ihlanganiswa ne-radiotherapy, i-chemotherapy, ukwelashwa okuqondisiwe, i-immunotherapy, nezinye izindlela zokwelapha, ukulawulwa kwesimila isikhathi eside kungafinyelelwa.
Izinkomba ze-Percutaneous Cryoablation ngaphansi kwesiqondiso se-CT
Amaqhubu amaphaphu e-B-zone: Kumaqhubu amaphaphu adinga ukususwa kwezingxenye noma izingxenye eziningi, i-percutaneous cryoablation inganikeza ukuxilongwa okuqondile kwangaphambi kokuhlinzwa.
Amaqhubu amaphaphu e-A-zone: Indlela yokudlula noma yokugoba (umgomo uwukusungula isiteshi sezicubu zamaphaphu, okungcono sibe nobude obungu-2 cm).
Izinkomba
Izimila ezingezona eziyingozi kanye namaqhubu okuphefumula angewona awemithambo yegazi:
Lokhu kufaka phakathi izilonda ezingaphambi komdlavuza (i-hyperplasia engavamile, i-in situ carcinoma), izilonda ezikhulayo ezisabela ekulweni nomzimba, ama-pseudotumor avuvukalayo, ama-cyst nama-abscesses asendaweni, kanye nama-proliferative scar nodules.
Amaqhubu esimila asekuqaleni:
Ngokusekelwe kokuhlangenwe nakho okukhona, i-cryoablation iyindlela yokwelapha ephumelelayo efana nokuhlinzwa kokususa amaqhubu angabonakali kahle engilazini engaphansi kuka-2 cm anengxenye eqinile engaphansi kuka-25%.
Isikhathi sokuthunyelwe: Septhemba-05-2023