Ukuchithwa kwe-Cryoablation ye-Pulmonary Nodule
Umhlaza Wemiphunga Oxhaphakileyo kunye namaqhuqhuva ePulmonary Akhathazayo
Ngokwedatha evela kwi-International Agency for Research on Cancer ye-World Health Organisation, malunga ne-4.57 yezigidi zezehlo zomhlaza ezifunyenwe eTshayina ngo-2020,umhlaza wemiphunga ubangela abantu abamalunga nama-820,000Phakathi kwamaphondo nezixeko ezingama-31 eTshayina, izinga lokuxhaphaka komhlaza wemiphunga kumadoda liphezulu kuzo zonke iindawo ngaphandle kweGansu, Qinghai, Guangxi, Hainan, kunye neTibet, kwaye izinga lokufa liphezulu kungakhathaliseki ukuba isini sithini.Izinga lokwanda kwamaqhuqhuva e-pulmonary e-China liqikelelwa ukuba liphakathi kwe-10% ukuya kwi-20%, apho kusenokwenzeka ukuba kukho ukwanda okukhulu phakathi kwabantu abangaphezu kweminyaka engama-40 ubudala. Nangona kunjalo, kufuneka kuqatshelwe ukuba uninzi lwee-nodules zemiphunga zizilonda ezingenabungozi.
Ukuxilongwa kweeNgxala zePulmonary
Amaqhuqhuva eempumlobhekisa kwizithunzi ezixineneyo ezimile okwesangqa ezigxile kwimiphunga, ezinobukhulu obahlukeneyo kunye nemida ecacileyo okanye engacacanga, kunye nobubanzi obungaphantsi okanye obulingana ne-3 cm.
Ukuxilongwa kweMifanekiso:Okwangoku, indlela yokuskena ejolise ekujongeni, eyaziwa ngokuba yi-ground-glass opacity nodule imaging diagnosis, isetyenziswa kakhulu. Ezinye iingcali zinokufikelela kwizinga lokunxibelelana kwe-pathological ukuya kuthi ga kwi-95%.
Ukuxilongwa Kwezifo:Nangona kunjalo, ukuxilongwa kwemifanekiso akunakuthatha indawo yokuxilongwa kwesifo sezicubu, ingakumbi kwiimeko zonyango oluchanekileyo oluhambelana nomhlaza olufuna ukuxilongwa kwesifo seemolekyuli kwinqanaba leeseli.Ukuxilongwa kwezifo kuseyeyona ndlela ibalaseleyo.
Iindlela Eziqhelekileyo Zokuxilonga Nezonyango Zee-Pulmonary Nodules
I-Percutaneous Biopsy:Ukuxilongwa kwesifo sezicubu kunye nokuxilongwa kwesifo seemolekyuli kunokufezekiswa phantsi kwe-anesthesia yendawo ngokubhoboza nge-percutaneous. Izinga lempumelelo eliqhelekileyo le-biopsy limalunga ne-63%,kodwa iingxaki ezifana ne-pneumothorax kunye ne-hemothorax zinokwenzeka. Le ndlela ixhasa kuphela ukuxilongwa kwaye kunzima ukwenza unyango ngaxeshanye.Kukwakho nomngcipheko wokuqhekeka kweeseli zethumba kunye nokusasazeka kwe-metastasis. I-biopsy eqhelekileyo ye-percutaneous inika umthamo omncinci wezicubu,okwenza ukuxilongwa kwezifo zezicubu ngexesha langempela kube nzima.
Utyando lwe-Anesthesia oluQhelekileyo oluncediswa yiVidiyo yeThoracoscopic (VATS) Lobectomy: Le ndlela ivumela ukuxilongwa kunye nonyango ngaxeshanye, kunye nezinga lempumelelo elisondela kwi-100%. Nangona kunjalo, le ndlela isenokungafaneleki kwizigulane ezindala okanye kwiindawo ezikhethekileyo.abanganyamezelaniyo ne-anesthesia jikelele, izigulane ezinee-nodules zemiphunga ezincinci kune-8 mm ngobukhulu okanye uxinano oluphantsi (<-600), ii-nodules ezikwindawo enzulu phakathi kweendawo ezizimeleyo, kunyeamaqhuqhuva kummandla we-mediastinal kufutshane nezakhiwo ze-hilarUkongeza, utyando lusenokungabi lolona khetho lufanelekileyo lokuxilonga nonyango kwiimeko ezibandakanyaukuphinda-phinda emva kotyando, amaqhuqhuva aphindaphindayo, okanye iithumba ezisasazekayo.
Indlela Entsha Yonyango Lwee-Pulmonary Nodules – Cryoablation
Ngophuhliso oluqhubekayo lwetekhnoloji yezonyango, unyango lwe-tumor lungene kwixesha "ukuxilongwa ngokuchanekileyo kunye nonyango oluchanekileyo"Namhlanje, siza kwazisa indlela yonyango yasekuhlaleni esebenza kakhulu kwiithumba ezingezizo ezibangela umhlaza kunye neeqhubu zemiphunga ezingezizo ezemithambo yegazi, kunye neeqhubu zemiphunga ezikwinqanaba lokuqala (ngaphantsi kwe-2 cm) -ukucima.
Unyango lweCryotherapy
Indlela yokucoca izicubu ezinobushushu obuphantsi kakhulu (i-cryotherapy), eyaziwa ngokuba yi-cryosurgery okanye i-cryoablation, yindlela yonyango yotyando esebenzisa ukukhenkceza ukunyanga izicwili ekujoliswe kuzo. Phantsi kwesikhokelo se-CT, indawo echanekileyo ifumaneka ngokubhoboza izicwili zethumba. Emva kokufika kwisilonda, ubushushu bendawo kwindawo leyo buncitshiswa ngokukhawuleza ukuya kuthi ga-140°C ukuya kwi -170°Cukusebenzisaigesi ye-argonkwimizuzu embalwa, ngaloo ndlela kufezekiswa injongo yonyango lokususa ithumba.
Umgaqo weCryoablation kwiPulmonary Nodules
1. Isiphumo se-ice-crystal: Oku akuchaphazeli i-pathology kwaye kwenza ukuba kukhawuleze kuchongwe i-pathology ngexesha lotyando.I-Cryoablation ibulala iiseli zethumba ngokwasemzimbeni kwaye ibangela ukuvaleka kwemithambo yegazi emincinci.
2. Isiphumo sokusebenza komzimba: Oku kufezekisa impendulo yomzimba ekude nxamnye nethumba. Ikhuthaza ukukhululwa kwe-antigen, ivuselela inkqubo yomzimba yokuzikhusela, kwaye inciphise ukuxinana komzimba.
3. Ukuzinza kwamalungu ahambahambayo (njengemiphunga nesibindi): Oku kwandisa izinga lempumelelo ye-biopsy. Kwenziwa ibhola eqandisiweyo, okwenza kube lula ukuzinza, kwaye imiphetho icacile kwaye ibonakala kwimifanekiso. Olu setyenziso olunelungelo lobunikazi lulula kwaye lusebenza kakuhle.
Ngenxa yeempawu ezimbini ze-cryoablation -"impembelelo yokubambelela nokuqiniswa kwezicubu eziqandisiweyo" kunye "nesakhiwo esipheleleyo sezicubu emva kokuqandisa ngaphandle kokuchaphazela ukuxilongwa kwezifo", inokunceda kwi-biopsy ye-lung nodule,ukufezekisa ukuxilongwa kwe-pathological ngexesha langempela ngexesha lenkqubo, kwaye uphucule izinga lempumelelo ye-biopsy.Ikwaziwa ngokuba “i-cryoablation ye-pulmonary nodule biopsy".
Iingenelo zeCryoablation
1. Ukujongana nokuphazamiseka kokuphefumla:Ukuqandisa kwendawo kuzinzisa izicubu zemiphunga (kusetyenziswa iindlela zokuqandisa ezisebenza nge-coaxial okanye ze-bypass).
2. Ukujongana ne-pneumothorax, i-hemoptysis, kunye nomngcipheko we-air embolism kunye nokukhula kwethumba: Emva kokwenza ibhola eqandisiweyo, kwakhiwa umjelo ovaliweyo wengcinezelo engentle yangaphandle komzimba ukuze kufunyanwe isifo kunye neenjongo zonyango.
3. Ukufezekisa iinjongo zokuxilongwa kunye nonyango ngaxeshanye kwindawo yonyango: Ukususwa kweqhuqhuva lemiphunga kwenziwa kuqala, kulandele ukufudumala kwakhona kunye ne-360° multidirectional biopsy ukwandisa ubungakanani bezicubu ze-biopsy.
Nangona i-cryoablation iyindlela yokulawula i-tumor yasekuhlaleni, ezinye izigulana zinokubonisa impendulo yomzimba ekude. Nangona kunjalo, idatha eninzi ibonisa ukuba xa i-cryoablation idityaniswe ne-radiotherapy, i-chemotherapy, unyango olujoliswe kuyo, i-immunotherapy, kunye nezinye iindlela zonyango, ulawulo lwe-tumor oluhlala ixesha elide lunokufezekiswa.
Iimpawu zePercutaneous Cryoablation phantsi kwesikhokelo seCT
Amaqhuqhuva emiphungeni ekwindawo ye-B: Kwii-nodules zemiphunga ezifuna ukususwa kwe-segmental okanye i-multiple segmental resection, i-percutaneous cryoablation inokubonelela ngokuxilongwa okuqinisekileyo ngaphambi kotyando.
Amaqhuqhuva emiphungeni e-A-zone: Indlela yokudlula okanye yokuma ecaleni (injongo kukumisela umjelo wezicubu zemiphunga, kungcono ukuba ube nobude obuyi-2 cm).
Iimpawu
Iithumba ezingezizo ezibangela umhlaza kunye nee-node ze-pulmonary ezikhula ngokukhawuleza ezingezizo ezemithambo yegazi:
Oku kuquka izilonda ezingaphambi komhlaza (i-hyperplasia engaqhelekanga, i-in situ carcinoma), izilonda ezikhulayo ezisabela kwi-immune reaction, ii-pseudotumors ezivuthayo, ii-cysts kunye nama-abscesses asekuhlaleni, kunye nee-proliferative scar nodules.
Amaqhuqhuva e-tumor akwinqanaba lokuqala:
Ngokusekelwe kumava akhoyo, i-cryoablation ikwayindlela yonyango esebenzayo efana nokususwa kwezicubu ezingabonakaliyo zeglasi engaphantsi kwe-2 cm kunye nenxalenye eqinileyo engaphantsi kwe-25%.
Ixesha lokuthumela: Septemba-05-2023