Odwala ambiri a khansa ya chiwindi omwe sakuyenera kuchitidwa opaleshoni kapena njira zina zothandizira ali ndi chisankho.
Ndemanga ya Mlandu
Chithandizo cha Khansa ya Chiwindi 1:
Wodwala: Amuna, khansa yachiwindi yoyambirira
Chithandizo choyamba cha HIFU padziko lonse lapansi cha khansa ya chiwindi, chakhalapo kwa zaka 12.
Chithandizo cha Khansa ya Chiwindi 2:
Wodwala: Mwamuna, wazaka 52, khansara yachiwindi yayikulu
Pambuyo pa radiofrequency ablation, chotupa chotsalira chimadziwika (chotupa pafupi ndi inferior vena cava).Pambuyo pa chithandizo chachiwiri cha HIFU, kuchotsedwa kwathunthu kwa chotupa chotsalira kumatheka, ndi chitetezo chokwanira cha otsika mtsempha wamagazi.
Chithandizo cha Khansa ya Chiwindi 3:
Khansa yoyamba ya chiwindi
Kutsatira pambuyo pa milungu iwiri ya chithandizo cha HIFU kunawonetsa kuzimiririka kwathunthu kwa chotupacho!
Chithandizo cha Khansa ya Chiwindi Mlandu 4:
Wodwala: Mwamuna, wazaka 33, khansa ya chiwindi ya metastatic
Chotupa chimodzi chopezeka mu chigawo chilichonse cha chiwindi.HIFU mankhwala anachita imodzi, chifukwa chotupa necrosis ndi mayamwidwe miyezi itatu pambuyo opaleshoni.
Chithandizo cha Khansa ya Chiwindi Mlandu 5:
Wodwala: Mwamuna, zaka 70, khansara yachiwindi yoyamba
Chotupa chotsalira chomwe chimawonedwa pa MRI pambuyo pa kuyika kwa mafuta a ayodini pambuyo pa embolization ya transarterial.Kupititsa patsogolo kwapatchy kudazimiririka pambuyo pa chithandizo cha HIFU, zomwe zikuwonetsa kuchotsedwa kwathunthu.
Chithandizo cha Khansa ya Chiwindi Mlandu 6:
Wodwala: Mkazi, wazaka 70, khansara yachiwindi yoyamba
Chotupa cham'mitsempha kwambiri cholemera 120mm* 100mm imapezeka mu lobe yoyenera ya chiwindi.Complete chotupa ablation akwaniritsa pambuyo HIFU mankhwala, pang`onopang`ono odzipereka pakapita nthawi.
Chithandizo cha Khansa ya Chiwindi Mlandu 7:
Wodwala: Mwamuna, wazaka 62, khansara yachiwindi yayikulu
Chotupa chomwe chili pafupi ndi denga la diaphragmatic, inferior vena cava, ndi portal vein system.Pambuyo pa magawo a 5 a radiofrequency ndi magawo a 2 a TACE, chotupa chotsalira chodziwika pakutsatira MRI.Chithandizo cha HIFU chinayambitsa chotupacho bwino ndikusunga mitsempha yozungulira.
Chithandizo cha Khansa ya Chiwindi Mlandu 8:
Wodwala: Mwamuna, wazaka 58, khansara yachiwindi yayikulu
Kubwereza anati pambuyo opaleshoni lamanja lobe chiwindi khansa.Kuchotsa kwathunthu chotupa kumatheka ndi chithandizo cha HIFU, chotsimikiziridwa ndi kuyamwa kwa chotupa patatha miyezi 18.
Hyperthermia ya Khansa ya Chiwindi - Kafukufuku Wokhazikika
HIFU (High Intensity Focused Ultrasound) itha kugwiritsidwa ntchito pochiza khansa ya chiwindi.Njira zochiritsira zachikhalidwe za khansa ya chiwindi ndi monga kuchotsedwa kwa opaleshoni, embolization transarterial, ndi chemotherapy.Komabe, odwala ambiri amawapeza atakula kwambiri kapena amakhala ndi zotupa pafupi ndi mitsempha ikuluikulu ya magazi, zomwe zimapangitsa kuti opaleshoni ikhale yosatheka.Kuonjezera apo, odwala ena sangathe kuchitidwa opaleshoni chifukwa cha thupi lawo, ndipo maopaleshoni okhawo amakhala ndi chiopsezo cha zovuta.
Chithandizo cha HIFU cha khansa ya chiwindi chimapereka zabwino zingapo:imakhala yochepa kwambiri, imayambitsa kupweteka kochepa ndi kuwonongeka, imakhala yotetezeka, imakhala ndi zovuta zochepa, ndipo imatha kubwerezedwa ngati kuli kofunikira.Ikhoza kusintha zizindikiro za odwala ndikutalikitsa moyo wawo.
Chithandizo cha post-HIFU, palibe milandu ya chotupa chotupa, jaundice, kutuluka kwa bile, kapena kuvulala kwa mitsempha zomwe zanenedwa, zomwe zimasonyeza kuti mankhwalawa ndi otetezeka.
(1) Zizindikiro:Palliative mankhwala zotupa zapamwamba, yekha chiwindi khansa pa lobe lamanja ndi m'mimba mwake zosakwana 10cm, zotupa zazikulu pa lobe kumanja ndi tinatake tozungulira Kanema amene amakhalabe kumanja chiwindi misa, m`deralo zisadzachitikenso pambuyo opaleshoni, zipata mtsempha chotupa thrombus.
(2) Contraindications:Odwala cachexia, kufalitsa khansa ya chiwindi, kwambiri chiwindi kukanika mochedwa siteji, ndi metastasis kutali.
(3) Njira yothandizira:Odwala omwe ali ndi zotupa kumanja kumanja ayenera kugona kumanja kwawo, pomwe omwe ali ndi zotupa kumanzere kwa lobe nthawi zambiri amayikidwa pamalo opindika.Njirayi isanachitike, ultrasound imagwiritsidwa ntchito kuti ipeze chotupacho kuti chikhale cholunjika komanso kukonzekera chithandizo.Chotupacho chimachizidwa mwa njira yotsatizana ya ablation, kuyambira pamfundo ya munthu ndikupita ku mizere, madera, ndipo pamapeto pake kuchuluka kwa chotupacho.Chithandizo chimachitika kamodzi patsiku, ndipo gawo lililonse limatenga pafupifupi mphindi 40-60.Njirayi imapitirira tsiku ndi tsiku, wosanjikiza ndi wosanjikiza, mpaka chotupa chonsecho chitachotsedwa.Pambuyo pa chithandizo, malo ochiritsira amafufuzidwa chifukwa cha kuwonongeka kwa khungu, ndikutsatiridwa ndi ultrasound kunja kwa dera lonse lachindunji kuti awone momwe chithandizo chikuyendera.
(4) Chisamaliro pambuyo pa chithandizo:Odwala amayang'anitsitsa ntchito ya chiwindi ndi ma electrolyte.Chithandizo chothandizira chiyenera kuperekedwa kwa odwala omwe ali ndi vuto la chiwindi, ascites, kapena jaundice.Odwala ambiri amakhala ndi kutentha kwa thupi panthawi ya chithandizo.Odwala ochepa amatha kuwonjezereka kutentha mkati mwa masiku 3-5, nthawi zambiri pansi pa 38.5 ℃.Kusala kudya kumalimbikitsidwa kwa maola 4 mutalandira chithandizo, pomwe odwala omwe ali ndi khansa ya kumanzere ya chiwindi ayenera kusala kwa maola 6 asanasinthe pang'onopang'ono ku zakudya zamadzimadzi.Odwala ena amatha kumva kupweteka pang'ono m'mimba kwa masiku 3-5 pambuyo pa chithandizo, chomwe chimatha pang'onopang'ono paokha.
(5) Kuunika kwakuchita bwino:HIFU ikhoza kuwononga minofu ya khansa ya chiwindi, kuchititsa kuti maselo a khansa asasinthe.Ma CT scans akuwonetsa kuchepa kwakukulu kwa CT attenuation values mkati mwa madera omwe mukufuna, ndipo CT yowonjezereka imatsimikizira kusakhalapo kwa magazi a arterial ndi portal venous kudera lomwe mukufuna.Gulu lothandizira likhoza kuwonedwa pamphepete mwa chithandizo.MRI imawona kusintha kwamphamvu kwa chotupacho pazithunzi zolemedwa ndi T1 ndi T2 ndikuwonetsa kutha kwa magazi kumalo omwe akuwafunira m'mitsempha yamagazi ndi ma portal venous, ndikuchedwa kuwonetsa bandi yolimbikitsira m'mphepete mwamankhwala.Kuwunika kwa ultrasound kumawonetsa kuchepa kwapang'onopang'ono kukula kwa chotupa, kutha kwa magazi, ndi necrosis ya minofu yomwe pamapeto pake imayamwa.
(6) Kutsatira:M'zaka ziwiri zoyambirira atalandira chithandizo, odwala amayenera kuyendera maulendo obwereza miyezi iwiri iliyonse.Pambuyo pa zaka ziwiri, maulendo obwereza ayenera kuchitika miyezi isanu ndi umodzi iliyonse.Pambuyo pa zaka zisanu, ndiye kuti amayezedwa chaka chilichonse.Magulu a Alpha-fetoprotein (AFP) atha kugwiritsidwa ntchito ngati chizindikiro cha kuyambiranso kwa chotupa.Ngati chithandizo chikuyenda bwino, chotupacho chimachepa kapena kutha.Ngati chotupacho chikadalipobe koma mulibenso maselo otheka, kusamala kuyenera kuchitidwa ngati chotupa chokhala ndi m'mimba mwake kuposa 5cm chikuwoneka pazithunzi, ndipo ma scan a PET angagwiritsidwe ntchito kuti amveke bwino.
Kuwunika kwachipatala kwa zotsatira za mankhwala asanakhalepo ndi pambuyo pake, kuphatikizapo milingo ya alpha-fetoprotein, ntchito ya chiwindi, ndi MRI scans,awonetsa chikhululukiro chachipatala choposa 80% kwa odwala khansa ya chiwindi omwe amathandizidwa ndi HIFU.Pamene magazi kwa zotupa chiwindi ndi wolemera, HIFU mankhwala akhoza pamodzi ndi transarterial alowererepo.Asanalandire chithandizo cha HIFU, transcatheter arterial chemoembolization (TACE) imatha kuchitidwa kuti aletse magazi kupita kudera lapakati chotupa, ndi embolic agent yomwe imakhala ngati chotupa kuti ithandizire kutsata kwa HIFU.Mafuta a ayodini amasintha mphamvu yamayimbidwe ndi mayamwidwe mkati mwa chotupacho, kumathandizira kutembenuka kwamphamvu pamalingaliro a HIFU ndikuwongolera..
Nthawi yotumiza: Aug-08-2023