Malinga ndi zidziwitso zoyenera za International Agency for Research on Cancer (IARC) ya World Health Organisation (WHO), khansa ya m'mapapo yakhala imodzi mwazotupa zowopsa kwambiri, ndipo kupewa ndi kuchiza khansa ya m'mapapo kwakhala chinthu chofunikira kwambiri. kupewa ndi kuchiza khansa.
Malinga ndi ziwerengero zoyenera, pafupifupi20% ya odwala omwe si aang'ono a khansa ya m'mapapo amatha kuchitidwa opaleshoni.Ambiri mwa odwala khansa ya m'mapapo ali kalemagawo apamwambaatapezeka, ndipo angapeze phindu lochepa kuchokera kumankhwala achikhalidwe a radiotherapy ndi chemotherapy.Ndi kupita patsogolo kosalekeza ndi chitukuko cha sayansi ya zamankhwala, kutuluka kwaablative therapym'malo mwa opaleshoni yabweretsa chiyembekezo chatsopano chamankhwala kwa odwala khansa ya m'mapapo.
1. Kodi mumadziwa bwanji za ablative therapy ya khansa ya m'mapapo?
Thandizo la ablative la khansa ya m'mapapo limaphatikizapokuchotsedwa kwa ma microwave ndi ma radiofrequency ablation.Mfundo ya chithandizo imaphatikizapo kuyika electrode ya ablative, yomwe imadziwikanso kuti a"fufuzani,"m'chotupa m'mapapo.Electrode ikhoza kuyambitsakuyenda mofulumiraTinthu ting'onoting'ono monga ma ion kapena mamolekyu amadzi mkati mwa chotupacho, kutulutsa kutentha chifukwa cha kukangana, zomwe zimatsogolerakuwonongeka kosasinthika monga coagulative necrosis yama cell chotupa.Panthawi imodzimodziyo, kuthamanga kwa kutentha kumachepetsa mofulumira m'mapapo ozungulira, kusunga kutentha mkati mwa chotupacho, ndikupanga"Thermal insulation effect."Ablative mankhwala akhoza kupha chotupa pamenekukulitsa chitetezo cham'mapapo wamba.
Chithandizo cha ablative chimadziwika ndi zakekubwereza, kusamva bwino kwa odwala, kuvulala pang'ono, ndikuchira msanga,ndipo wakhala akudziwika ndi kugwiritsidwa ntchito mu zochitika zachipatala.Komabe, poganizira kuti chithandizo cha ablative chimaphatikizapo maphunziro angapo monga radiology, oncology, radiology interventional, ndi anatomy ya opaleshoni, imafuna luso lapamwamba la opaleshoni komanso makhalidwe abwino kuchokera kwa dokotala wochita opaleshoni.
Lero, tikufuna kukudziwitsani katswiri wodziwika bwino pankhani ya chithandizo chamankhwala,Dr. Liu Chen, yemwe wakhala akugwira ntchito m'munda kwa zaka zambiri ndipo akudzipereka ku kafukufuku womasulira wachipatala ndi kutchuka kovomerezeka kwa matenda ochepetsera pang'ono ndi mankhwala ochiritsira monga zovuta komanso zoopsa kwambiri zotupa zotupa, kutulutsa matenthedwe, ndi kuikidwa kwa tinthu.Dr. Liu amadziwika kuti ndi "ngwazi pa nsonga ya singano" ndipo adagwira nawo ntchito popanga mgwirizano wa akatswiri ndi malangizo a njira zosiyanasiyana zothandizira khansa ya m'mapapo ku China.Adachita upainiya lingaliro la kasamalidwe kokwanira ka ma biopsies a khansa ya m'mapapo ndikukhazikitsa njira zofananira zopangira maopaleshoni kuti apititse patsogolo kusankha kwa chithandizo chamankhwala am'deralo a khansa ya m'mapapo yoyambilira, kulimbikitsa chitukuko chonse cha njira yowunikira komanso chithandizo cha khansa ya m'mapapo ku China.
"Hero on the Singano Tip" - Dokotala Liu Chen
Imakhazikika pakuwunika kocheperako komanso njira zochizira zotupa motsogozedwa ndi zithunzi
1. Microwave/Radiofrequency ablation
2. Percutaneous biopsy
3. Kuyika kwa ma radioactive particle implantation
4. Kuwongolera kupweteka kwapakati
2. Cholinga ndi zizindikiro za ablative mankhwala a khansa ya m'mapapo
"Kugwirizana kwa Katswiri pa Ablative Therapy for Primary and Metastatic Lung Tumors"(Edition la 2014) limagawanitsa chithandizo cha ablative cha khansa ya m'mapapo m'magulu awiri: kuchiritsa ndi kuchiritsa.
Kuchotsedwa kwa mankhwalaCholinga chake ndikupangitsa kuti minofu ya chotupa m'deralo ikhale necrotize ndipo imatha kuchiritsa.Khansara ya m'mapapo yoyambirira ndi chisonyezo chokwanira cha chithandizo cha ablative,makamaka kwa odwala omwe ali ndi vuto la mtima, ukalamba, kulephera kupirira opaleshoni, kukana kuchitidwa opaleshoni, kapena omwe ali ndi chotupa chimodzi chobwereranso pambuyo pa radiotherapy yovomerezeka, komanso odwala ena omwe ali ndi zotupa zingapo zazikulu za m'mapapo zomwe zimafunika kuteteza mapapu. .
Palliative ablationzolinga kuyambitsani chotupa chachikulu mwa odwala omwe ali ndi khansa ya m'mapapo yopita patsogolo, kuchepetsa kuchuluka kwa chotupa, kuchepetsa zizindikiro zobwera chifukwa cha chotupacho, ndikuwongolera moyo wa wodwalayo.Kwa odwala omwe ali ndi khansa ya m'mapapo yapamwamba, zotupa zokhala ndi m'mimba mwake> 5 cm kapena zotupa zambiri zimatha kuthandizidwa ndi singano zambiri, ma multipoint, kapena angapo, kapena kuphatikizidwa ndi njira zina zothandizira kuti apulumuke.Pakuti mochedwa siteji zilonda metastases m`mapapo, ngati ulamuliro wa extrapulmonary zotupa zabwino ndi ochepa chabe otsala zotupa metastatic alipo m`mapapo, ablative mankhwala angathandize kulamulira matenda ndi kusintha umoyo wa wodwalayo.
3. Ubwino wa mankhwala ablative
Opaleshoni yocheperako, kuchira mwachangu: Thandizo la ablative limaonedwa ngati opaleshoni yochepetsera pang'ono.Singano ya ablative electrode yomwe imagwiritsidwa ntchito nthawi zambiri imakhala ndi mainchesi ake1-2 mm, zomwe zimapangitsa kuti pakhale maopaleshoni ang'onoang'ono kukula kwa bowo la singano.Njira imeneyi imapereka ubwino mongakuvulala kochepa, kupweteka kochepa, ndi kuchira msanga.
Nthawi yachidule ya opaleshoni, kukhala omasuka:Thandizo la ablative limachitidwa kawirikawiri pansi pa anesthesia wamba kapena kuphatikiza ndi intravenous sedation, kuthetsa kufunikira kwa endotracheal intubation.Odwala ali m'malo ogona pang'ono ndipo amatha kudzutsidwa mosavuta ndi bomba lofatsa.Odwala ena angamve ngati opaleshoniyo yathakugona msanga.
Munthawi yomweyo biopsy kuti muzindikire molondola:Panthawi ya ablative therapy, coaxial guide kapena synchronous puncture biopsy angagwiritsidwe ntchito kuti apeze chotupacho.Zotsatiramatenda a pathological ndi kuyezetsa ma geneticperekani chidziwitso chofunikira pazosankha zotsatila za chithandizo.
Ndondomeko yobwerezedwa: Kafukufuku wambiri wochokera kumayiko akunyumba komanso ochokera kumayiko ena awonetsa kuti kuwongolera kwa odwala omwe ali ndi khansa ya m'mapapo achichepere omwe akulandira chithandizo cha ablative ndikofanana ndi kuchotsedwa kwa opaleshoni kapena stereotactic radiation therapy.Pankhani ya kubwereza kwanuko, chithandizo cha ablativeakhoza kubwerezedwa kangapokuti ayambenso kulamulira matenda pamenekukulitsa moyo wa wodwalayo.
Kuyambitsa kapena kupititsa patsogolo chitetezo chamthupi: Chithandizo cha ablative chimafunakupha maselo otupa mkati mwa thupi, ndipo nthawi zina, imatha kuyambitsa kapena kukulitsa chitetezo chamthupi cha wodwalayo, zomwe zimapangitsa kuti a kumene zotupa zosachiritsidwa m'zigawo zina za thupi zimawonetsa kuchepa.Kuphatikiza apo, chithandizo cha ablative chimatha kuphatikizidwa ndi mankhwala a systemic kuti apangemphamvu ya synergistic.
Thandizo la ablative ndiloyenera makamaka kwa odwala omwe sangathe kulekerera kuchotsedwa kwa opaleshoni kapena opaleshoni chifukwa chakusagwira bwino ntchito kwa mtima, ukalamba, kapena zovuta zingapo.Ndichithandizo chokondedwa kwa odwala omwe ali ndima nodule angapo oyambira (monga magalasi angapo apansi panthaka).
Nthawi yotumiza: Aug-23-2023