Cryoablation kwa Pulmonary Nodule
Khansara Yam'mapapo Yodziwika Kwambiri ndi Ma Nodule Owopsa a Pulmonary
Malinga ndi kafukufuku wochokera ku International Agency for Research on Cancer ya World Health Organisation, pafupifupi odwala 4.57 miliyoni a khansa adapezeka ku China mu 2020,ndi khansa ya m'mapapo yowerengera pafupifupi 820,000.Pakati pa zigawo ndi mizinda 31 ya ku China, chiwerengero cha odwala khansa ya m'mapapo mwa amuna ndi oyamba m'zigawo zonse kupatula Gansu, Qinghai, Guangxi, Hainan, ndi Tibet, ndipo chiwerengero cha anthu omwe amafa ndichokwera kwambiri mosasamala kanthu kuti ndi amuna kapena akazi.Chiwopsezo chonse cha ma pulmonary nodules ku China akuti pafupifupi 10% mpaka 20%, ndi chiwopsezo chokwera kwambiri pakati pa anthu opitilira zaka 40.Komabe, ziyenera kukumbukiridwa kuti ambiri mwa tinthu tating'onoting'ono ta m'mapapo ndi zotupa za benign.
Kuzindikira kwa Pulmonary Nodules
Matenda a m'mapapokutanthauza mithunzi yozungulira yozungulira yozungulira m'mapapo, yokhala ndi makulidwe osiyanasiyana ndi m'mphepete mwake owoneka bwino kapena osawoneka bwino, ndi m'mimba mwake wosakwana kapena wofanana ndi 3 cm.
Kuzindikira Kujambula:Pakali pano, njira yojambulira yowunikira, yomwe imadziwika kuti ground-glass opacity nodule imaging imaging, imagwiritsidwa ntchito kwambiri.Akatswiri ena amatha kukwaniritsa kuyanjana kwa pathological mpaka 95%.
Kuzindikira kwa Pathological:Komabe, kuwunika koyerekeza sikungalowe m'malo mwa matenda amtundu wa minofu, makamaka pakachitika chithandizo cholondola cha chotupa chomwe chimafunikira kuzindikira kwa ma cell a cell.Kuzindikira kwa pathological kumakhalabe muyezo wagolide.
Njira Zachidziwitso Zachidziwitso ndi Zochiritsira za Pulmonary Nodules
Percutaneous Biopsy:Kuzindikira kwa matenda a minofu ndi kuwunika kwa ma cell pathology kumatha kuchitika pansi pa anesthesia yakomweko pogwiritsa ntchito percutaneous puncture.Avereji yopambana ya biopsy ndi pafupifupi 63%,koma zovuta monga pneumothorax ndi hemothorax zikhoza kuchitika.Njirayi imangothandizira matenda ndipo ndizovuta kuchita chithandizo nthawi imodzi.Palinso chiopsezo chotaya maselo a chotupa ndi metastasis.Percutaneous biopsy imapereka kuchuluka kwa minofu,kupangitsa kuzindikira kwapathology munthawi yeniyeni kukhala kovuta.
General Anesthesia Video-Assisted Thoracoscopic Surgery (VATS) Lobectomy: Njirayi imalola kuti munthu azindikire ndi kuchiza nthawi imodzi, ndikuchita bwino kuyandikira 100%.Komabe, njirayi singakhale yoyenera kwa odwala okalamba kapena anthu apaderaamene salolera mankhwala oletsa ululu, odwala omwe ali ndi tinthu tating'onoting'ono tating'onoting'ono tochepera 8 mm kukula kapena kachulukidwe kakang'ono (<-600), tinthu tating'onoting'ono tating'onoting'ono tating'onoting'ono tating'onoting'ono tating'onoting'ono,tinatake tozungulira m'dera mediastinal pafupi ndi nyumba hilar.Kuonjezera apo, opaleshoni singakhale njira yoyenera yodziwira matenda ndi chithandizo chamankhwala pazochitika zomwe zikukhudzakubwereza kwa postoperative, nodule mobwerezabwereza, kapena zotupa za metastatic.
Njira Yatsopano Yochizira Matenda a Pulmonary Nodules - Cryoablation
Ndikukula kosalekeza kwaukadaulo wazachipatala, chithandizo cha chotupa chalowa munthawi ya "kuzindikira molondola ndi kuchiza molondola“.Lero, tikuwonetsa njira yochizira yomwe ili yothandiza kwambiri kwa zotupa zosawopsa komanso zotupa zam'mapapo zopanda mitsempha, komanso zotupa zoyambira (zosakwana 2 cm) -kulira.
Cryotherapy
Njira ya cryoablation yotsika kwambiri (cryotherapy), yomwe imadziwikanso kuti cryosurgery kapena cryoablation, ndi njira yachipatala yopangira opaleshoni yomwe imagwiritsa ntchito kuzizira pochiritsa minofu yomwe mukufuna.Motsogozedwa ndi CT, kuyika bwino kumatheka poboola minofu ya chotupacho.Pambuyo pofika pachilondacho, kutentha kwapafupi pamalopo kumachepetsedwa mofulumira-140°C mpaka -170°Ckugwiritsa ntchitompweya wa argonmkati mwa mphindi, potero kukwaniritsa cholinga cha chotupa ablation mankhwala.
Mfundo ya Cryoablation ya Pulmonary Nodules
1. Ice-crystal effect: Izi sizimakhudza ma pathological ndipo zimathandizira kuzindikira kwapang'onopang'ono kwa intraoperative.Cryoablation imapha maselo otupa ndipo imayambitsa kutsekeka kwa microvascular.
2. Immunomodulatory effect: Izi zimakwaniritsa kuyankhidwa kwa chitetezo chakutali motsutsana ndi chotupacho. Zimathandizira kutulutsidwa kwa ma antigen, kumayambitsa chitetezo chamthupi, komanso kumachepetsa kuponderezedwa kwa chitetezo chamthupi.
3. Kukhazikika kwa ziwalo zoyenda (monga mapapo ndi chiwindi): Izi zimakulitsa chiwopsezo cha biopsy. Mpira wozizira umapangidwa, zomwe zimapangitsa kuti zikhale zosavuta kukhazikika, ndipo m'mphepete mwake mumakhala omveka komanso owonekera pazithunzi.Kugwiritsa ntchito kovomerezeka kumeneku ndikosavuta komanso kothandiza.
Chifukwa cha mikhalidwe iwiri ya cryoablation -"Kuzizira kozizira ndi kukonza" ndi "mapangidwe a minofu pambuyo pozizira popanda kukhudza matenda", imatha kuthandizira pakupanga nodule biopsy,kupeza zenizeni zenizeni za matenda achisanu panthawi ya ndondomekoyi, ndikuwongolera bwino kwa biopsy.Amadziwikanso kuti “cryoablation kwa pulmonary nodule biopsy“.
Ubwino wa Cryoablation
1. Kuthana ndi vuto la kupuma:Kuzizira komweko kumakhazikika m'mapapo (pogwiritsa ntchito coaxial kapena bypass njira zozizira).
2. Kuthana ndi pneumothorax, hemoptysis, ndi chiopsezo cha air embolism ndi chotupa: Pambuyo popanga mpira wowumitsidwa, njira yotsekeka yotsekeka ya extracorporeal imakhazikitsidwa kuti izindikiridwe ndi chithandizo.
3. Kukwaniritsa zolinga zachipatala ndi chithandizo cha nthawi imodzi: Kulira kwa nodule ya m'mapapo kumachitidwa poyamba, kutsatiridwa ndi kutenthanso ndi 360 ° multidirectional biopsy kuti muwonjezere kuchuluka kwa minofu ya biopsy.
Ngakhale cryoablation ndi njira yochepetsera zotupa zakomweko, odwala ena amatha kuwonetsa kuyankha kwakutali kwa chitetezo chamthupi.Komabe, kuchuluka kwa deta kumasonyeza kuti pamene cryoablation ikuphatikizidwa ndi radiotherapy, chemotherapy, chandamale therapy, immunotherapy, ndi njira zina zothandizira, kulamulira chotupa kwa nthawi yaitali kungatheke.
Zizindikiro za Percutaneous Cryoablation pansi pa CT Guide
B-zone mapapo nodule: Kwa tinthu tating'onoting'ono ta m'mapapo timene timafunikira kuchotsedwa kwa magawo kapena magawo angapo, percutaneous cryoablation imatha kupereka chidziwitso chotsimikizika.
A-zone mapapo nodule: Njira yodutsa kapena oblique (cholinga chake ndikukhazikitsa njira yolumikizira minofu yamapapo, makamaka yokhala ndi kutalika kwa 2 cm).
Zizindikiro
Zotupa zosawopsa komanso zotupa zam'mapapo zopanda mitsempha zopanda mitsempha:
Izi zikuphatikizapo zotupa za precancerous (atypical hyperplasia, in situ carcinoma), zotupa zowononga chitetezo cha mthupi, pseudotumors yotupa, zotupa zam'deralo ndi zithupsa, ndi mabala ochulukirapo.
Zotupa zoyambira zoyambira:
Kutengera zomwe zidachitika kale, cryoablation ndi njira yothandiza kwambiri yochizira yofananira ndi opaleshoni yopangira ma opacity nodules apansi apansi a 2 cm okhala ndi gawo lolimba lochepera 25%.
Nthawi yotumiza: Sep-05-2023