I-Cryoablation ye-Pulmonary Nodule
Umhlaza wemiphunga oxhaphakileyo kunye neeNodules zemiphunga ezixhalabisayo
Ngokwedatha evela kwi-Arhente yeHlabathi yoPhando ngoMhlaza woMbutho wezeMpilo weHlabathi, malunga ne-4.57 yezigidi zeemeko zomhlaza zafunyaniswa e-China ngo-2020,Umhlaza wemiphunga ubalelwa malunga neemeko ezingama-820,000.Kumaphondo angama-31 kunye nezixeko zaseTshayina, umlinganiselo wabantu abanesifo somhlaza wemiphunga emadodeni ukwindawo yokuqala kuyo yonke imimandla ngaphandle kwaseGansu, eQinghai, eGuangxi, eHainan naseTibet, yaye izinga lokufa kwabantu lelona liphezulu kungakhathaliseki isini.Umlinganiselo weziganeko zemiphunga ye-pulmonary nodules e-China kuqikelelwa ukuba malunga ne-10% ukuya kwi-20%, kunye nokuxhaphaka okunokubakho okuphezulu phakathi kwabantu abangaphezu kweminyaka engama-40 ubudala.Nangona kunjalo, kufuneka kuqatshelwe ukuba uninzi lwamaqhuqhuva e-pulmonary lunezilonda ezinobungozi.
Ukuxilongwa kweeNqaku zePulmonary
Amaqhuqhuva emiphungenibhekisa kwizithunzi ezishinyeneyo ezimile okwengqukuva emiphungeni, ezinobukhulu obahlukeneyo kunye nemida ecacileyo okanye eluzizi, kunye nedayamitha engaphantsi okanye elingana ne-3 cm.
Uvavanyo loMfanekiso:Okwangoku, indlela yokucinga ekujoliswe kuyo yokuskena, eyaziwa ngokuba yi-ground-glass opacity imaging ye-nodule imaging, isetyenziswa ngokubanzi.Ezinye iingcali zinokufikelela kwinqanaba lokulungelelaniswa kwe-pathological ukuya kuthi ga kwi-95%.
Uxilongo lwePathological:Nangona kunjalo, ukuxilongwa kwe-imaging akunakuthatha indawo yokuxilongwa kwe-tissue pathology, ngakumbi kwiimeko zonyango oluchanekileyo lwe-tumor olufuna ukuxilongwa kwe-molecular pathological level.Ukuxilongwa kwe-pathological kuhlala kungumgangatho wegolide.
IiNdlela eziQhelekileyo zokuHlola kunye noNyango kwiiNodule zePulmonary
I-Percutaneous Biopsy:Ukuxilongwa kwe-tissue pathology kunye nokuxilongwa kwe-molecular pathology kunokufezekiswa phantsi kwe-anesthesia yendawo nge-percutaneous puncture.Umyinge wempumelelo ye-biopsy malunga nama-63%,kodwa iingxaki ezifana ne-pneumothorax kunye ne-hemothorax zingenzeka.Le ndlela ixhasa kuphela ukuxilongwa kwaye kunzima ukwenza unyango ngaxeshanye.Kukho umngcipheko wokuchithwa kweeseli zethumba kunye ne-metastasis.I-percutaneous biopsy eqhelekileyo ibonelela ngomthamo wezicubu ezincinci,ukwenza ukuxilongwa kwe-tissue ngexesha lokwenyani kube ngumngeni.
Uqhaqho lokuNceda ngeVidiyo ngokuNceda iThoracoscopic Jikelele (VATS) Lobectomy: Le ndlela ivumela ukuxilongwa kunye nonyango ngaxeshanye, kunye nezinga lokuphumelela elisondela kwi-100%.Nangona kunjalo, le ndlela isenokungafaneleki kubantu abadala okanye kubantu abakhethekileyoabangayinyamezeliyo i-anesthesia jikelele, izigulane ezinamaqhuqhuva emiphungeni amancinci kune-8 mm ngobukhulu okanye ubuninzi obuphantsi (<-600), amaqhuqhuva abekwe nzulu phakathi kwamacandelo angenasizathu, kwayeamaqhuqhuva kummandla mediastinal kufutshane izakhiwo hilar.Ukongeza, utyando alunakuba lukhetho olufanelekileyo lokuxilonga kunye nonyango kwiimeko ezibandakanyaukuphindaphinda emva kokuhlinzwa, amaqhuqhuva aphindaphindiweyo, okanye i-metastatic tumors.
Indlela eNtsha yoNyango lweeNodule zePulmonary - Cryoablation
Ngophuhliso oluqhubekayo lwetekhnoloji yezonyango, unyango lwe-tumor lungene kwixesha "ukuxilongwa ngokuchanekileyo kunye nonyango oluchanekileyo“.Namhlanje, siza kwazisa indlela yonyango lwendawo esebenza kakhulu kumaqhuqhuva angenabungozi kunye namaqhuqhuva e-pulmonary non-vascular proliferative pulmonary nodules, kunye namaqhuqhuva asekuqaleni (ngaphantsi kwe-2 cm) -ukulila.
Cryotherapy
Ubuchule bokucrywa kobushushu obusezantsi kakhulu (i-cryotherapy), ekwabizwa ngokuba yi-cryosurgery okanye i-cryoablation, bubuchule botyando bezonyango obusebenzisa umkhenkce ukunyanga izihlunu ekujoliswe kuzo.Ngaphantsi kwesikhokelo se-CT, indawo echanekileyo ifumaneka ngokubhoboza izicubu ze-tumor.Emva kokufikelela kwi-lesion, ukushisa kwendawo kwisayithi kuncipha ngokukhawuleza ukuya-140°C ukuya -170°Cusebenzisaigesi yeargonngaphakathi kwemizuzu, ngaloo ndlela kufezekiswa injongo yonyango lokukhupha ithumba.
Umgaqo weCryoablation yeeNodule zePulmonary
1. Isiphumo sekristale yomkhenkce: Oku akuchaphazeli i-pathology kwaye yenza ukuxilongwa ngokukhawuleza kwe-intraoperative pathological.I-cryoablation ibulala iiseli zethumba kwaye ibangela ukuvaleka kwe-microvascular occlusion.
2. Impembelelo ye-Immunomodulatory: Oku kufezekisa impendulo ekude yokuzivikela kwi-tumor. Ikhuthaza ukukhululwa kwe-antigen, isebenze amajoni omzimba, kwaye ikhulula ukunyanzeliswa komzimba.
3. Ukuzinziswa kwamalungu ahambahambayo (afana nemiphunga nesibindi): Oku kwandisa izinga lokuphumelela kwe-biopsy. Ibhola efriziwe yenziwe, okwenza kube lula ukuzinza, kwaye imiphetho icacile kwaye ibonakala kwimifanekiso.Esi sicelo sinelungelo elilodwa lomenzi silula kwaye siyasebenza.
Ngenxa yeempawu ezimbini ze-cryoablation -"I-anchoring ebanda kunye nefuthe lokulungiswa" kunye "nokwakheka kwezicubu eziqinileyo emva kokukhenkceza ngaphandle kokuchaphazela ukuxilongwa kwe-pathological", inokunceda kwi-nodule biopsy,ukufezekisa ukuxilongwa ngexesha lokwenyani lomkhenkce ngexesha lenkqubo, kunye nokuphucula izinga lempumelelo ye-biopsy.Ikwabizwa ngokuba “ukukhala kwe-pulmonary nodule biopsy“.
Izinto eziluncedo zeCryoablation
1. Ukujongana nokuphazamiseka kokuphefumla:Umkhenkce wendawo uzinzisa izicubu zemiphunga (usebenzisa iindlela zokukhenkceza ezicoaxial okanye ezidlulayo).
2. Ukujongana ne-pneumothorax, i-hemoptysis, kunye nomngcipheko we-air embolism kunye nembewu yethumba: Emva kokwenza ibhola engumkhenkce, itshaneli yoxinzelelo olubi oluvaliweyo lwe-extracorporeal lusekwe ukuxilongwa kunye neenjongo zonyango.
3. Ukufezekisa ukuxilongwa ngexesha elinye kwindawo kunye neenjongo zonyango: I-cryoablation ye-nodule ye-lung yenziwa kuqala, ilandelwa kukufudumala kwakhona kunye ne-360 ° ye-multidirectional biopsy ukwandisa inani le-biopsy tissue.
Nangona i-cryoablation yindlela yokulawula ithumba lendawo, ezinye izigulana zinokubonisa impendulo ekude yokuzikhusela.Nangona kunjalo, inani elikhulu ledatha libonisa ukuba xa i-cryoablation idibaniswa ne-radiotherapy, i-chemotherapy, unyango olujoliswe kuyo, i-immunotherapy, kunye nezinye iindlela zonyango, ulawulo lwe-tumor lwexesha elide lunokufezekiswa.
Iimpawu ze-Percutaneous Cryoablation phantsi kwe-CT Guidance
Amaqhuqhuva emiphunga kwindawo B: Kumaqhuqhuva emiphunga afuna ukuqhambuka kwecandelo okanye ukuphinda-phinda kwecandelo, i-percutaneous cryoablation inokubonelela ngoxilongo oluqinisekileyo lwangaphambili.
A-zone lung nodules: Indlela ye-Bypass okanye i-oblique (injongo kukuseka umjelo we-lung tissue, ngokukhethekileyo ubude be-2 cm).
Iimpawu
Amaqhuqhuva anganyangekiyo kunye namaqhuqhuva e-pulmonary non-vascular proliferative pulmonary:
Oku kubandakanya izilonda zangaphambi komhlaza (i-atypical hyperplasia, in situ carcinoma), izilonda eziphindaphindekayo ze-immune reactive, i-pseudotumors evuthayo, ama-cysts asekuhlaleni kunye namathumba, kunye namaqhuqhuva akhulayo.
Amaqhuqhuva e-tumor yenqanaba lokuqala:
Ngokusekwe kumava asele ekhona, i-cryoablation ikwayindlela yonyango esebenzayo enokuthelekiswa noqhaqho loqhaqho lwamaqhuqhuva opacity aphantsi kweglasi engaphantsi kwe-2 cm enecandelo eliqinileyo elingaphantsi kwe-25%.
Ixesha lokuposa: Sep-05-2023