Odwala ambiri a khansa ya chiwindi omwe sali oyenerera opaleshoni kapena njira zina zochiritsira ali ndi mwayi wosankha.
Kuwunikanso Nkhani
Nkhani Yoyamba Yokhudza Chithandizo cha Khansa ya Chiwindi:
Wodwala: Mwamuna, khansa yoyamba ya chiwindi
Chithandizo choyamba cha HIFU padziko lonse cha khansa ya chiwindi, chakhalapo kwa zaka 12.
Nkhani Yachiwiri Yokhudza Chithandizo cha Khansa ya Chiwindi:
Wodwala: Mwamuna, wazaka 52, khansa yoyamba ya chiwindi
Pambuyo pa kuchotsa ma radiofrequency, chotupa chotsala chinapezeka (chotupacho chili pafupi ndi inferior vena cava). Pambuyo pa chithandizo chachiwiri cha HIFU, kuchotsa kwathunthu chotupa chotsalacho kunatheka, ndi chitetezo chokwanira cha inferior vena cava.
Nkhani Yachitatu Yokhudza Chithandizo cha Khansa ya Chiwindi:
Khansa yoyamba ya chiwindi
Kutsatira pambuyo pa milungu iwiri ya chithandizo cha HIFU kunawonetsa kuti chotupacho chinatha kwathunthu!
Nkhani 4 Yokhudza Chithandizo cha Khansa ya Chiwindi:
Wodwala: Mwamuna, wazaka 33, khansa ya chiwindi yofalikira
Chilonda chimodzi chinapezeka mu lobe iliyonse ya chiwindi. Chithandizo cha HIFU chinachitidwa nthawi imodzi, zomwe zinapangitsa kuti chotupa chifalikire komanso kuyamwa kwa maselowo miyezi itatu pambuyo pa opaleshoni.
Nkhani 5 Yokhudza Chithandizo cha Khansa ya Chiwindi:
Wodwala: Mwamuna, wazaka 70, khansa yoyamba ya chiwindi
Chotupa chotsalira chomwe chinapezeka pa MRI pambuyo poti mafuta a ayodini aikidwa pambuyo pa embolization ya m'mitsempha yamagazi. Kuwonjezeka kwa mawanga kunatha pambuyo pa chithandizo cha HIFU, zomwe zikusonyeza kuti chotupacho chinachotsedwa kwathunthu.
Nkhani 6 Yokhudza Chithandizo cha Khansa ya Chiwindi:
Wodwala: Mkazi, wazaka 70, khansa yoyamba ya chiwindi
Chotupa chachikulu cha mitsempha yamagazi chofika 120mm* 100mm yapezeka mu lobe yakumanja ya chiwindi. Kuchotsa kwathunthu chotupa kumachitika pambuyo pa chithandizo cha HIFU, pang'onopang'ono kumayamwa pakapita nthawi.
Nkhani 7 Yokhudza Chithandizo cha Khansa ya Chiwindi:
Wodwala: Mwamuna, wazaka 62, khansa yoyamba ya chiwindi
Chotupa chomwe chili pafupi ndi denga la diaphragmatic, inferior vena cava, ndi portal vein system. Pambuyo pa magawo 5 a radiofrequency ndi magawo awiri a TACE, chotupa chotsala chinapezeka pa MRI yotsatira. Chithandizo cha HIFU chinathetsa chotupacho bwino pamene chikusunga mitsempha yamagazi yozungulira.
Nkhani 8 Yokhudza Chithandizo cha Khansa ya Chiwindi:
Wodwala: Mwamuna, wazaka 58, khansa yoyamba ya chiwindi
Kubwerezabwereza kwa khansa ya chiwindi cha mbali yakumanja kunawonedwa pambuyo pa opaleshoni. Kuchotsa kwathunthu kwa chotupa kumachitika ndi chithandizo cha HIFU, chomwe chinatsimikiziridwa ndi kuyamwa kwa chotupa patatha miyezi 18.
Kutentha Kwambiri kwa Khansa ya Chiwindi - Kafukufuku Wokhazikika
HIFU (High Intensity Focused Ultrasound) ingagwiritsidwe ntchito pochiza khansa ya chiwindi. Njira zachikhalidwe zochiritsira khansa ya chiwindi zimaphatikizapo opaleshoni yochotsa ziwalo, transarterial embolization, ndi chemotherapy. Komabe, odwala ambiri amapezeka ali pamlingo wapamwamba kapena ali ndi zotupa pafupi ndi mitsempha yayikulu yamagazi, zomwe zimapangitsa kuti opaleshoni ikhale yosagwira ntchito. Kuphatikiza apo, odwala ena sangathe kuchitidwa opaleshoni chifukwa cha vuto lawo la thupi, ndipo opaleshoni yokhayo imakhala ndi chiopsezo cha zovuta.
Chithandizo cha HIFU cha khansa ya chiwindi chili ndi ubwino wambiri:Sizimayambitsa kupweteka kwambiri, sizimayambitsa kupweteka ndi kuwonongeka kwakukulu, sizimavulaza kwambiri, sizimayambitsa mavuto ambiri, ndipo zimatha kubwerezedwanso ngati pakufunika kutero. Zingathandize kuchepetsa zizindikiro za wodwalayo ndikuwonjezera moyo wake.
Pambuyo pa chithandizo cha HIFU, palibe milandu yotupa ya chotupa, jaundice, kutuluka kwa ndulu, kapena kuvulala kwa mitsempha yamagazi komwe kwanenedwa, zomwe zikusonyeza kuti chithandizocho ndi chotetezeka.
(1) Zizindikiro:Chithandizo chochepetsa ululu wa zotupa zomwe zakula, khansa ya chiwindi yokhayokha pa lobe yakumanja yokhala ndi mainchesi osakwana 10cm, zotupa zazikulu pa lobe yakumanja zokhala ndi timibulu tomwe timatsalira ku chiwindi chakumanja, kubwereranso kwapafupi pambuyo pa opaleshoni, kutuluka kwa chotupa cha mtsempha wa portal.
(2) Zoletsa:Odwala omwe ali ndi cachexia, khansa ya chiwindi yomwe imafalikira, chiwindi chawo sichikugwira ntchito bwino kwambiri kumapeto kwa siteji, komanso kufalikira kwa maselo a khansa m'magawo akutali.
(3) Njira yothandizira:Odwala omwe ali ndi zotupa pa chigawo chakumanja ayenera kugona chamanja, pomwe omwe ali ndi zotupa pa chigawo chakumanzere nthawi zambiri amaikidwa chagada. Odwala asanachite opaleshoniyi, ultrasound imagwiritsidwa ntchito kupeza chotupacho kuti apeze njira yoyenera yochizira komanso kukonzekera chithandizo. Chotupacho chimachiritsidwa kudzera mu njira yochotsera chotupacho motsatizana, kuyambira pa mfundo zosiyanasiyana mpaka kufika pa mizere, madera, ndipo pamapeto pake kuchuluka kwa chotupacho. Chithandizochi chimachitika kamodzi patsiku, ndipo chigawo chilichonse chimatenga pafupifupi mphindi 40-60. Njirayi imapitirira tsiku lililonse, chigawo ndi chigawo, mpaka chotupa chonsecho chitachotsedwa. Pambuyo pa chithandizo, malo ochiritsidwawo amafufuzidwa kuti awone ngati pali kuwonongeka kulikonse pakhungu, kutsatiridwa ndi ultrasound scan yakunja ya malo onse ofunikira kuti awone momwe chithandizocho chikugwirira ntchito.
(4) Chisamaliro pambuyo pa chithandizo:Odwala amayang'aniridwa kuti adziwe ngati chiwindi chikugwira ntchito bwino komanso kuchuluka kwa ma electrolyte. Chithandizo chothandizira chiyenera kuperekedwa kwa odwala omwe ali ndi vuto la chiwindi, ascites, kapena jaundice. Odwala ambiri amakhala ndi kutentha kwabwinobwino kwa thupi panthawi ya chithandizo. Odwala ochepa amatha kuwona kutentha pang'ono mkati mwa masiku 3-5, nthawi zambiri pansi pa 38.5℃. Kusala kudya nthawi zambiri kumalimbikitsidwa kwa maola 4 pambuyo pa chithandizo, pomwe odwala omwe ali ndi khansa ya chiwindi ya left lobe ayenera kusala kudya kwa maola 6 asanayambe pang'onopang'ono kudya zakudya zamadzimadzi. Odwala ena amatha kumva kupweteka pang'ono m'mimba kwa masiku 3-5 pambuyo pa chithandizo, zomwe zimatha pang'onopang'ono zokha.
(5) Kuwunika momwe ntchito ikuyendera:HIFU imatha kuwononga minofu ya khansa ya chiwindi, zomwe zimapangitsa kuti maselo a khansa asawonongeke. Kujambula kwa CT kumasonyeza kuchepa kwakukulu kwa CT attenuation values m'malo omwe akufunidwa, ndipo CT yowonjezereka imatsimikizira kuti magazi a m'mitsempha ndi m'mitsempha ya m'mapazi sakupezeka m'malo omwe akufunidwa. Mzere wowonjezera ukhoza kuwonedwa pamalire a chithandizo. MRI ikuwonetsa kusintha kwa mphamvu ya chizindikiro cha chotupa pazithunzi za T1 ndi T2 ndipo ikuwonetsa kutha kwa magazi kupita kumalo omwe akufunidwa m'malire a m'mitsempha ndi m'mitsempha ya m'mapazi, ndi gawo lochedwa kusonyeza mzere wowonjezera pamalire a chithandizo. Kuwunika kwa Ultrasound kumasonyeza kuchepa pang'onopang'ono kwa kukula kwa chotupa, kutha kwa magazi, ndi kutha kwa minofu komwe pamapeto pake kumayamwa.
(6) Zotsatira:M'zaka ziwiri zoyambirira pambuyo pa chithandizo, odwala ayenera kukaonana ndi dokotala miyezi iwiri iliyonse. Pakatha zaka ziwiri, ayenera kukaonananso ndi dokotala miyezi isanu ndi umodzi iliyonse. Pakatha zaka zisanu, akulimbikitsidwa kukayezetsa chaka chilichonse. Ma alpha-fetoprotein (AFP) angagwiritsidwe ntchito ngati chizindikiro cha kubwereranso kwa chotupa. Ngati chithandizocho chayenda bwino, chotupacho chidzachepa kapena kutha kwathunthu. Ngati chotupacho chikadalipo koma sichilinso ndi maselo olimba, muyenera kusamala pamene chotupa chokhala ndi mainchesi opitilira 5cm chikuwoneka pazithunzi, ndipo ma PET scan angagwiritsidwe ntchito kuti amveke bwino.
Kuwona zotsatira za chithandizo chisanachitike komanso chitatha, kuphatikizapo kuchuluka kwa alpha-fetoprotein, ntchito ya chiwindi, ndi MRI scans,awonetsa chiwopsezo cha kuchira kwa odwala khansa ya chiwindi omwe adalandira chithandizo cha HIFU chopitilira 80%.Ngati magazi akupita ku zotupa za chiwindi ndi ochuluka, chithandizo cha HIFU chingaphatikizidwe ndi transarterial intervention. Musanayambe chithandizo cha HIFU, transcatheter arterial chemoembolization (TACE) ikhoza kuchitidwa kuti ilepheretse magazi kupita kudera lapakati la chotupa, ndipo embolic agent imagwira ntchito ngati chizindikiro cha chotupa kuti ithandize HIFU kuyang'ana. Mafuta a ayodini amasintha mphamvu ya acoustic impedance ndi mayamwidwe mkati mwa chotupa, zomwe zimathandiza kusintha mphamvu pamalo a HIFU ndikuwongolera..
Nthawi yotumizira: Ogasiti-08-2023