Kuchotsa Mafinya a M'mapapo
Khansa Yam'mapapo Yofala ndi Mafinya Oopsa a M'mapapo
Malinga ndi deta yochokera ku International Agency for Research on Cancer of the World Health Organization, milandu yatsopano ya khansa pafupifupi 4.57 miliyoni idapezeka ku China mu 2020,ndipo khansa ya m'mapapo imachititsa kuti anthu pafupifupi 820,000 amwalirePakati pa zigawo ndi mizinda 31 ku China, kuchuluka kwa khansa ya m'mapapo mwa amuna kumakhala koyambirira m'madera onse kupatula Gansu, Qinghai, Guangxi, Hainan, ndi Tibet, ndipo chiwerengero cha imfa ndichokwera kwambiri mosasamala kanthu za jenda.Chiwerengero chonse cha anthu omwe ali ndi matenda a m'mapapo ku China chikuyembekezeka kukhala pakati pa 10% ndi 20%., ndipo mwina anthu ambiri azaka zopitirira 40 ali ndi matendawa. Komabe, ziyenera kudziwika kuti ma nodule ambiri a m'mapapo ndi zilonda zabwino.
Kuzindikira Matenda a Matumbo a M'mapapo
Matumbo a m'mapapokutanthauza mithunzi yozungulira yozungulira m'mapapo, yokhala ndi kukula kosiyanasiyana komanso m'mphepete momveka bwino kapena kopanda mawonekedwe, komanso mainchesi ochepera kapena ofanana ndi 3 cm.
Kuzindikira Zithunzi:Pakadali pano, njira yowunikira zithunzi zojambulidwa pogwiritsa ntchito njira yowunikira, yomwe imadziwika kuti ground-glass opacity nodule imaging diagnosis, imagwiritsidwa ntchito kwambiri. Akatswiri ena amatha kupeza mgwirizano wa matenda mpaka 95%.
Kuzindikira Matenda:Komabe, kuzindikira matenda pogwiritsa ntchito zithunzi sikungalowe m'malo mwa kuzindikira matenda a minofu, makamaka pankhani ya chithandizo cholondola cha chotupa chomwe chimafuna kuzindikira matenda a maselo.Kuzindikira matenda a pathological kumakhalabe muyezo wabwino kwambiri.
Njira Zachikhalidwe Zodziwira ndi Kuchiritsa Ma Nodule a M'mapapo
Kufufuza kwa Percutaneous Biopsy:Kuzindikira matenda a minofu ndi kuzindikira matenda a mamolekyulu kumatha kuchitika pogwiritsa ntchito mankhwala oletsa ululu m'malo mwa munthu kudzera mu kubowola kwa percutaneous. Chiŵerengero chapakati cha kupambana kwa biopsy ndi pafupifupi 63%,koma mavuto monga pneumothorax ndi hemothorax angachitike. Njirayi imathandizira kuzindikira matendawa ndipo ndi yovuta kuchita chithandizo nthawi imodzi.Palinso chiopsezo cha kutayika kwa maselo a chotupa ndi kufalikira kwa maselo. Kuyeza kwapadera kwa percutaneous biopsy kumapereka kuchuluka kochepa kwa minofu,zomwe zimapangitsa kuti kuzindikira matenda a minofu nthawi yeniyeni kukhale kovuta.
Kuchotsa ululu pachifuwa pogwiritsa ntchito njira ya kanema (VATS) yotchedwa Anesthesia: Njira imeneyi imalola kuzindikira ndi kuchiza nthawi imodzi, ndipo chiwopsezo cha kupambana chikuyandikira 100%. Komabe, njira iyi singakhale yoyenera kwa odwala okalamba kapena magulu apadera.omwe salola mankhwala oletsa ululuodwala omwe ali ndi timibulu ta m'mapapo tosakwana 8 mm kukula kapena kucheperako (<-600), timibulu tomwe tili pakati pa magawo osinthasintha, nditimitsempha m'chigawo cha mediastinal pafupi ndi nyumba za hilarKuphatikiza apo, opaleshoni singakhale njira yoyenera yodziwira matenda ndi chithandizo pazochitika zokhudzana ndikubwereranso pambuyo pa opaleshoni, timibulu tobwerezabwereza, kapena zotupa zofalikira.
Njira Yatsopano Yochiritsira Ma Nodules a M'mapapo - Kutupa
Ndi chitukuko chopitilira cha ukadaulo wazachipatala, chithandizo cha khansa chalowa mu nthawi ya "kuzindikira molondola komanso chithandizo cholondola"Lero, tiyambitsa njira yochizira yapafupi yomwe ndi yothandiza kwambiri pa zotupa zosavulaza komanso zotupa za m'mapapo zomwe sizimafalikira, komanso zotupa zoyambirira (zosakwana 2 cm) -cryoablation.
Chithandizo cha Cryotherapy
Njira yochepetsera kutentha kwambiri (cryotherapy), yomwe imadziwikanso kuti cryosurgery kapena cryoablation, ndi njira yochizira opaleshoni yomwe imagwiritsa ntchito kuzizira pochiza minofu yomwe mukufuna. Motsogozedwa ndi CT, malo olondola amapezeka pobowola minofu ya chotupa. Pambuyo pofika pachilonda, kutentha kwapafupi pamalopo kumachepa mofulumira mpaka-140°C mpaka -170°Ckugwiritsa ntchitompweya wa argonmkati mwa mphindi zochepa, motero kukwaniritsa cholinga cha chithandizo chochotsa chotupa.
Mfundo Yogwiritsira Ntchito Cryoablation pa Ma Nodule a M'mapapo
1. Mphamvu ya ayezi-kristalo: Izi sizikhudza matenda a shuga ndipo zimathandiza kuzindikira matenda mwachangu panthawi ya opaleshoni.Kutsekeka kwa magazi kumapha maselo a chotupa ndipo kumayambitsa kutsekeka kwa mitsempha yamagazi.
2. Mphamvu yowongolera chitetezo chamthupi: Izi zimapangitsa kuti chitetezo chamthupi chikhale cholimba motsutsana ndi chotupacho. Zimathandizira kutulutsidwa kwa ma antigen, zimayambitsa chitetezo chamthupi, komanso zimachepetsa kutsekeka kwa chitetezo chamthupi.
3. Kukhazikika kwa ziwalo zoyenda (monga mapapo ndi chiwindi): Izi zimawonjezera kupambana kwa biopsy. Mpira wozizira umapangidwa, zomwe zimapangitsa kuti ukhale wosavuta kukhazikika, ndipo m'mbali mwake mumakhala omveka bwino komanso owoneka bwino pazithunzi. Kugwiritsa ntchito kovomerezeka kumeneku ndikosavuta komanso kogwira mtima.
Chifukwa cha makhalidwe awiri a cryoablation -"Kuzimitsa ndi kukhazikika kwa minofu yolimba pambuyo pa kuzizira popanda kukhudza matenda", ingathandize pa biopsy ya nodule ya m'mapapo,kupeza njira yodziwira matenda nthawi yomweyo panthawi ya opaleshoniyi, ndikuwonjezera kuchuluka kwa zotsatira zabwino za biopsy.Amadziwikanso kuti “cryoablation ya biopsy ya pulmonary nodule“.
Ubwino wa Cryoablation
1. Kuthetsa vuto la kupuma:Kuzizira kwa m'deralo kumalimbitsa minofu ya m'mapapo (pogwiritsa ntchito njira zoziziritsira za coaxial kapena bypass).
2. Kuthana ndi pneumothorax, hemoptysis, ndi chiopsezo cha air embolism ndi kubzala chotupa: Pambuyo popanga mpira wozizira, njira yotsekedwa yotsekeka yakunja kwa thupi imakhazikitsidwa kuti ipeze matenda ndi chithandizo.
3. Kukwaniritsa zolinga zodziwira matenda ndi chithandizo nthawi imodzi: Kuchotsa mphuno m'mapapo kumachitika kaye, kenako kutenthetsanso ndi kufufuzidwa ndi 360° multidirectional biopsy kuti muwonjezere kuchuluka kwa minofu ya biopsy.
Ngakhale kuti cryoablation ndi njira yowongolera chotupa chapafupi, odwala ena akhoza kusonyeza chitetezo chamthupi chakutali. Komabe, zambiri zikusonyeza kuti cryoablation ikaphatikizidwa ndi radiotherapy, chemotherapy, chithandizo cholunjika, immunotherapy, ndi njira zina zochiritsira, kuwongolera chotupa kwa nthawi yayitali kumatha kuchitika.
Zizindikiro za Percutaneous Cryoablation motsogozedwa ndi CT Guide
Manodule a m'mapapo a B-zone: Pa timibulu ta m'mapapo tomwe timafuna kudulidwa m'magawo angapo kapena m'magawo angapo, percutaneous cryoablation ingapereke chidziwitso chotsimikizika musanachite opaleshoni.
Ma nodule a m'mapapo a A-zone: Njira yodutsa kapena yopingasa (cholinga chake ndi kukhazikitsa njira ya minofu ya m'mapapo, makamaka yokhala ndi kutalika kwa 2 cm).
Zizindikiro
Zotupa zosaopsa komanso zotupa za m'mapapo zomwe sizimafalikira m'mitsempha:
Izi zikuphatikizapo zilonda zomwe zingayambitse khansa (atypical hyperplasia, in situ carcinoma), zilonda zomwe zimayambitsa khansa zomwe zimayambitsa khansa, kutupa kwa ziwalo zina, ma cysts ndi ma abscesses, ndi ma proliferative scar nodules.
Ma nodules a chotupa omwe ali pa siteji yoyambirira:
Kutengera ndi zomwe zachitika kale, cryoablation ndi njira yothandiza yochizira matenda yofanana ndi opaleshoni yochotsa ma nodules agalasi losawoneka bwino omwe ali ndi kutalika kwa 2 cm ndi gawo lolimba losakwana 25%.
Nthawi yotumizira: Sep-05-2023