Izigulane ezininzi ezinomhlaza wesibindi ezingafanelekiyo utyando okanye ezinye iindlela zonyango zinokukhetha.
Uhlolo lweTyala
Ityala 1 loNyango loMhlaza weSibindi:
Isigulana: Indoda, umhlaza wesibindi oyintloko
Unyango lokuqala lwe-HIFU lomhlaza wesibindi emhlabeni, lwasinda iminyaka eli-12.
Ityala lesi-2 loNyango loMhlaza weSibindi:
Isigulana: Indoda, eneminyaka engama-52 ubudala, umhlaza wesibindi oyintloko
Emva kokususwa kwe-radiofrequency, kwafunyanwa i-residual tumor (i-tumor ikufutshane ne-inferior vena cava). Emva konyango lwesibini lwe-HIFU, kwafunyanwa i-residual tumor epheleleyo, kunye nokukhuselwa okupheleleyo kwe-inferior vena cava.
Ityala lesi-3 loNyango loMhlaza weSibindi:
Umhlaza wesibindi oyintloko
Ukulandelela emva kweeveki ezimbini zonyango lwe-HIFU kubonise ukuba ithumba liyanyamalala ngokupheleleyo!
Ityala lesi-4 loNyango loMhlaza weSibindi:
Isigulana: Indoda, eneminyaka engama-33 ubudala, umhlaza wesibindi osasazekileyo
Kufunyenwe isilonda esinye kwilobe nganye yesibindi. Unyango lwe-HIFU lwenziwa ngaxeshanye, nto leyo eyabangela ukudumba kunye nokufunxwa kwethumba emva kweenyanga ezintathu emva kotyando.
Ityala lesi-5 loNyango loMhlaza weSibindi:
Isigulana: Indoda, eneminyaka engama-70 ubudala, umhlaza wesibindi oyintloko
Ithumba eliseleyo elibonwe kwi-MRI emva kokufakwa kweoyile ye-iodine emva kokufakwa kwe-transarterial embolization. Ukwanda okungaqhelekanga kwanyamalala emva konyango lwe-HIFU, nto leyo ebonisa ukususwa ngokupheleleyo kwethumba.
Ityala lesi-6 loNyango loMhlaza weSibindi:
Isigulana: Ibhinqa, elineminyaka engama-70 ubudala, umhlaza wesibindi oyintloko
Ithumba elinamandla kakhulu lemithambo yegazi elinobukhulu obuyi-120mm* I-100mm ifunyenwe kwi-lobe yasekunene yesibindi. Ukususwa ngokupheleleyo kwethumba kufezekisiwe emva konyango lwe-HIFU, kwaye kutsalwa kancinci kancinci ngokuhamba kwexesha.
Ityala lesi-7 loNyango loMhlaza weSibindi:
Isigulana: Indoda, eneminyaka engama-62 ubudala, umhlaza wesibindi oyintloko
Isilonda esisecaleni kophahla lwe-diaphragmatic, i-inferior vena cava, kunye nenkqubo ye-portal vein. Emva kweeseshoni ezi-5 ze-radiofrequency kunye neeseshoni ezi-2 ze-TACE, i-tumor eseleyo yabonwa kwi-MRI elandelayo. Unyango lwe-HIFU lwayicima ngempumelelo i-tumor ngelixa igcina imithambo yegazi ejikelezileyo.
Ityala lesi-8 loNyango loMhlaza weSibindi:
Isigulana: Indoda, eneminyaka engama-58 ubudala, umhlaza wesibindi oyintloko
Ukuphinda kubonwe emva kotyando lomhlaza wesibindi kwi-lobe yasekunene. Ukususwa ngokupheleleyo kwethumba kufezekiswe ngonyango lwe-HIFU, oluqinisekiswe ngokufunxwa kwethumba emva kweenyanga ezili-18.
I-Hyperthermia yoMhlaza weSibindi - Uphando oluQhelekileyo
I-HIFU (i-High Intensity Focused Ultrasound) ingasetyenziselwa ukunyanga umhlaza wesibindi. Iindlela zonyango zemveli zomhlaza wesibindi ziquka ukususwa kotyando, ukufakelwa kwemithambo yegazi, kunye ne-chemotherapy. Nangona kunjalo, uninzi lwezigulane lufunyaniswa lukwinqanaba eliphezulu okanye lunezimila kufutshane nemithambo yegazi emikhulu, okwenza utyando lungasebenzi. Ukongeza, ezinye izigulane azikwazi ukwenza utyando ngenxa yemeko yazo yomzimba, kwaye iinkqubo zotyando ngokwazo zinomngcipheko weengxaki.
Unyango lwe-HIFU lomhlaza wesibindi lunezibonelelo ezininzi:Ayingeni kakhulu, ayibangeli ntlungu nomonakalo ungako, ikhuselekile, ayinazo iingxaki ezininzi, kwaye ingaphinda iphindwe ukuba kuyimfuneko. Ingaphucula iimpawu zesigulana kwaye iqhubeke ixesha elide nokuphila kwaso.
Emva konyango lwe-HIFU, akukho matyala okuqhekeka kwethumba, i-jaundice, ukuvuza kwenyongo, okanye ukwenzakala kwemithambo yegazi kuye kwaxelwa, nto leyo ebonisa ukuba unyango lukhuselekile.
(1) Iimpawu:Unyango lokudambisa iithumba eziphucukileyo, umhlaza wesibindi sodwa kwilobe yasekunene enobubanzi obungaphantsi kwe-10cm, iithumba ezinkulu kwilobe yasekunene ezinee-satellite nodules ezihlala zixhomekeke kwisibindi sasekunene, ukuphinda-phinda kwendawo emva kotyando, i-portal vein tumor thrombus.
(2) Izithintelo:Izigulane ezine-cachexia, umhlaza wesibindi osasazekileyo, ukungasebenzi kakuhle kwesibindi kwinqanaba lokugqibela, kunye nokusasazeka kwesifo esikude.
(3) Inkqubo yonyango:Izigulane ezineethumba kwi-lobe yasekunene kufuneka zilale ngecala lasekunene, ngelixa ezo zineethumba kwi-lobe yasekhohlo zihlala zilele. Ngaphambi kwenkqubo, i-ultrasound isetyenziselwa ukufumana ithumba ukuze kujoliswe ngokuchanekileyo kwaye kucwangciswe unyango. Emva koko ithumba linyangwa ngenkqubo yokususwa ngokulandelelana, ukuqala kwiindawo ezahlukeneyo ukuya kwimigca, iindawo, kwaye ekugqibeleni umthamo wethumba lonke. Unyango lwenziwa kube kanye ngemini, kwaye umaleko ngamnye uthatha malunga nemizuzu engama-40-60. Inkqubo iyaqhubeka imihla ngemihla, umaleko ngomaleko, de lonke ithumba lisuswe. Emva konyango, indawo enyangiweyo ihlolwa ukuba akukho monakalo wesikhumba, kulandele i-ultrasound scan yangaphandle yendawo yonke ekujoliswe kuyo ukuze kuvavanywe ukusebenza kakuhle konyango.
(4) Unyango emva konyango:Izigulana zijongwa ukuba zisebenza kakuhle na isibindi kunye namanqanaba e-electrolyte. Unyango oluxhasayo kufuneka lunikwe izigulana ezingasebenzi kakuhle kwesibindi, i-ascites, okanye i-jaundice. Uninzi lwezigulana lunobushushu obuqhelekileyo bomzimba ngexesha lonyango. Inani elincinci lezigulana linokufumana ukunyuka okuncinci kobushushu kwiintsuku ezi-3-5, ngesiqhelo ngaphantsi kwama-38.5℃. Ukuzila ukutya kudla ngokucetyiswa iiyure ezi-4 emva konyango, ngelixa izigulana ezinomhlaza wesibindi we-left lobe kufuneka zizile ukutya iiyure ezi-6 ngaphambi kokuba zitshintshele kancinci kwisidlo esilulwelo. Ezinye izigulana zinokufumana iintlungu eziphantsi zesisu esingaphezulu iintsuku ezi-3-5 emva konyango, eziphela kancinci kancinci zodwa.
(5) Uvavanyo lokusebenza kakuhle:I-HIFU inokutshabalalisa izicubu zomhlaza wesibindi, nto leyo ebangela ukubola okungaguqukiyo kweeseli zomhlaza. Ii-CT scan zibonisa ukwehla okuphawulekayo kwamaxabiso okuncipha kwe-CT kwiindawo ekujoliswe kuzo, kwaye i-CT ephuculweyo iqinisekisa ukungabikho kokunikezelwa kwegazi kwimithambo yegazi kunye ne-portal kwindawo ekujoliswe kuyo. Ibhendi yokuphucula inokubonwa kumda wonyango. I-MRI ibona utshintsho kubunzulu besignali yethumba kwimifanekiso enesisindo se-T1 kunye ne-T2 kwaye ibonisa ukunyamalala kokunikezelwa kwegazi kwindawo ekujoliswe kuyo kwizigaba zemithambo yegazi kunye ne-portal, kunye nesigaba esilibazisekileyo esibonisa ibhendi yokuphucula kumda wonyango. Ukubeka iliso kwi-ultrasound kubonisa ukwehla kancinci kancinci kubungakanani bethumba, ukunyamalala kokunikezelwa kwegazi, kunye ne-tissue necrosis ekugqibeleni ifunxwa.
(6) Ulandelelwano:Kwiminyaka emibini yokuqala emva konyango, izigulane kufuneka zilandelelwe rhoqo kwiinyanga ezimbini. Emva kweminyaka emibini, kufuneka zilandelelwe rhoqo kwiinyanga ezintandathu. Emva kweminyaka emihlanu, kuyacetyiswa ukuba kwenziwe uhlolo lonyaka. Amanqanaba e-Alpha-fetoprotein (AFP) angasetyenziswa njengophawu lokubuyela kwethumba kwakhona. Ukuba unyango luphumelele, ithumba liya kuncipha okanye liphele ngokupheleleyo. Kwimeko apho ithumba lisakhona kodwa lingasekho iiseli eziphilayo, kufuneka kuqatshelwe xa ithumba elinobubanzi obungaphezulu kwe-5cm libonakala kwimifanekiso, kwaye ii-PET scans zingasetyenziswa ukuze kucaciswe ngakumbi.
Ukujongwa kweklinikhi kweziphumo zangaphambi nasemva konyango, kubandakanya amanqanaba e-alpha-fetoprotein, ukusebenza kwesibindi, kunye ne-MRI scans,zibonakalise izinga lokuxolelwa kwezonyango elingaphezulu kwama-80% kwizigulane ezinomhlaza wesibindi ezinyangwe nge-HIFU.Kwimeko apho unikezelo lwegazi kwiithumba zesibindi lutyebile, unyango lwe-HIFU lunokudityaniswa nongenelelo lwe-transarterial. Ngaphambi konyango lwe-HIFU, i-transcatheter arterial chemoembolization (TACE) inokwenziwa ukuvimba unikezelo lwegazi kwindawo yethumba ephakathi, kunye ne-embolic agent esebenza njengophawu lwethumba ukunceda ekujoliseni i-HIFU. Ioyile ye-iodine itshintsha i-acoustic impedance kunye ne-absorption coefficient ngaphakathi kwethumba, iququzelela ukuguqulwa kwamandla kwindawo ye-HIFU kwaye iphucule..
Ixesha lokuthumela: Agasti-08-2023