Kucheneswa kweMapupa ePulmonary Nodule
Kenza yeMapapu Yakapararira uye Mapundu Emapapu Anotyisa
Zvichienderana nedata kubva kuInternational Agency for Research on Cancer yeWorld Health Organization, vanhu vanosvika mamiriyoni 4.57 vakaonekwa vaine chirwere ichi muChina muna 2020,nekenza yemapapu inokonzeresa vanhu vanosvika 820,000Pakati pemapurovhinzi nemaguta makumi matatu nerimwe muChina, huwandu hwevanhu vane kenza yemapapu muvarume huri pamusoro munzvimbo dzese kunze kweGansu, Qinghai, Guangxi, Hainan, neTibet, uye huwandu hwevanhu vanofa ndihwo hwakanyanya pasinei nekuti murume kana mukadzi.Huwandu hwemapundu emumapapu muChina hunofungidzirwa kuti huri pakati pe10% kusvika 20%, iyo inogona kunge yakanyanya kupararira pakati pevanhu vane makore anopfuura makumi mana. Zvisinei, zvinofanira kucherechedzwa kuti ruzhinji rwemapundu emumapapu maronda asina njodzi.
Kuongororwa kweMapundu ePulmonary
Mapundu emapapuzvinoreva mimvuri yakakora yakaita sedenderedzwa mumapapu, ine saizi dzakasiyana uye mipendero yakajeka kana isina kujeka, uye dhayamita iri pasi kana kuti yakaenzana ne3 cm.
Kuongorora Mifananidzo:Parizvino, nzira yekufungidzira mifananidzo inotariswa, inozivikanwa se ground-glass opacity nodule imaging diagnosis, ndiyo inoshandiswa zvakanyanya. Dzimwe nyanzvi dzinogona kuwana pathological correlation rate inosvika 95%.
Kuongororwa kwezvirwere:Zvisinei, kuongororwa kwemifananidzo hakugone kutsiva kuongororwa kwezvirwere zvemuviri, kunyanya kana paine kurapwa kwakanyatsojeka kwegomarara kunoda kuongororwa kwezvirwere zvemasero.Kuongororwa kwezvirwere kunoramba kuri chiyero chakanaka.
Nzira Dzakajairika dzekuongorora uye dzekurapa dzeMapundu ePulmonary
Kuongororwa kwePercutaneous Biopsy:Kuongororwa kwezvirwere zvenyama uye kuongororwa kwezvirwere zvemamorekuru zvinogona kuitwa pasi peanesthesia yemunzvimbo kuburikidza nekuboorwa kwepercutaneous. Avhareji yekubudirira kwe biopsy inenge 63%,asi matambudziko akadai sepneumothorax nehemothorax anogona kuitika. Nzira iyi inotsigira kuongororwa kwechirwere chete uye inonetsa kurapwa panguva imwe chete.Panewo njodzi yekuti bundu ribude uye kuti masero arambe achiwedzera kukura. Kuongororwa kwemuviri nenzira yakajairika kunoita kuti masero arambe achiwedzera kukura,zvichiita kuti kuongororwa kwezvirwere zvemuviri panguva chaiyo kuve kwakaoma.
Kuvhiyiwa kweTsamba neAnesthesia (VATS) Kuvhiyiwa kweLobectomy: Nzira iyi inobvumira kuongororwa uye kurapwa panguva imwe chete, uye mwero wekubudirira uri kusvika 100%. Zvisinei, nzira iyi ingasakodzera varwere vakwegura kana mapoka akasiyana.avo vasingashiviriri anesthesia yakajairika, varwere vane mapundu emumapapu madiki pane 8 mm muhukuru kana density yakaderera (<-600), mapundu ari pakati pezvikamu zvakasiyana, uyemaronda ari munharaunda yepakati pestinal pedyo nezvivakwa zve hilarPamusoro pezvo, kuvhiyiwa kungasava sarudzo yakakodzera yekuongorora nekurapa mumamiriro ezvinhu anosanganisirakudzoka kwechirwere mushure mekuvhiyiwa, maronda anodzokorora, kana kuti bundu rinopararira.
Nzira Itsva Yekurapa Mapundu Emapapu - Kucheneswa Kwemvura
Nekufambira mberi kuri kuitwa tekinoroji yekurapa, kurapwa kwegomarara kwapinda munguva ye "kuongororwa kwakarurama uye kurapwa kwakarurama". Nhasi, tichaunza nzira yekurapa yemuno inoshanda zvikuru kumabundu asina kukuvadza uye mabundu emapapu asina kupararira, pamwe nemabundu emapapu ari padanho rekutanga (ari pasi pe2 cm) -cryoablation.
Kurapa nekuchemera
Nzira yekuchekerera ganda nekupisa kwakanyanya (cryotherapy), inozivikanwawo se cryosurgery kana cryoablation, inzira yekuvhiya inoshandisa kuomesa ganda kurapa nyama dzinoda kuvhiyiwa. Pasi penhungamiro yeCT, nzvimbo chaiyo inowanikwa nekuboora ganda nenyama yebundu. Mushure mekusvika pachironda, tembiricha yemunzvimbo yacho inodzikiswa nekukurumidza kusvika-140°C kusvika -170°Cuchishandisagasi reargonmukati memaminitsi, nokudaro vachizadzisa chinangwa chekurapa bundu.
Nheyo yeCryoablation yeMapundu ePulmonary
1. Mhedzisiro yechando-kristaro: Izvi hazvikanganisi pathology uye zvinoita kuti kuongororwa kwechirwere kuitike nekukurumidza panguva yekuvhiyiwa.Kucheneswa kweropa kunouraya masero egomarara uye kunokonzera kuvharika kwetsinga dzeropa.
2. Kubatsira kwekudzivirira muviri: Izvi zvinoita kuti muviri urambe uchirwisa bundu. Inokurudzira kuburitswa kweantigen, inomutsa masoja emuviri, uye inoderedza kudzikiswa kwemasoja emuviri.
3. Kugadzikana kwenhengo dzinofamba (dzakadai semapapu nechiropa): Izvi zvinowedzera mwero wekubudirira kwe biopsy. Bhora rakaomeswa nechando rinogadzirwa, zvichiita kuti zvive nyore kugadzikana, uye mipendero yacho yakajeka uye inoonekwa pamifananidzo. Kushandiswa uku kuri nyore uye kunoshanda.
Nekuda kwezvinhu zviviri zve cryoablation -"kuomesa nekusimbisa mhedzisiro yechando" uye "chimiro chenyama chakasimba mushure mekuomesa nechando pasina kukanganisa kuongororwa kwechirwere", inogona kubatsira mu biopsy yemapundu emapapu,kuwana kuongororwa kwechirwere panguva chaiyo panguva yekuvhiyiwa, uye kuwedzera mwero wekubudirira kwe biopsy.Inozivikanwawo se "cryoablation ye biopsy yemapundu emumapapu". (or) ". (or" . ".)
Mabhenefiti eCryoablation
1. Kugadzirisa matambudziko ekufema:Kuomesa nechando munharaunda kunosimbisa mapfupa emapapu (zvichishandisa nzira dzeoxial kana kuti dzekudzivirira nechando).
2. Kurapa pneumothorax, hemoptysis, uye njodzi ye air embolism uye bundu rinokura: Mushure mekuumbwa kwebhora rakaomesesa, nzira yekunze kwemuviri inogadzirwa kuti iongororwe uye irapwe.
3. Kuzadzisa zvinangwa zvekuongorora chirwere panguva imwe chete uye kurapwa: Kuchekwa kwebundu remapapu kunotanga kuitwa, kwozoteverwa nekudziyazve uye kuvhiyiwa kwe360° kwakasiyana-siyana kuti huwandu hwenyama yebiopsy huwedzere.
Kunyangwe cryoablation iri nzira yekudzivirira bundu remunzvimbo, vamwe varwere vanogona kuratidza mhinduro yekudzivirira muviri kure. Zvisinei, ruzivo rwakawanda runoratidza kuti kana cryoablation ikasanganiswa ne radiotherapy, chemotherapy, targeted therapy, immunotherapy, nedzimwe nzira dzekurapa, kudzora bundu kwenguva refu kunogona kuitwa.
Zviratidzo zvePercutaneous Cryoablation pasi peCT Guidance
Mapundu emapapu enzvimbo yeB: Kune mapundu emapapu anoda kubviswa zvikamu zvakasiyana kana kuti akawanda, percutaneous cryoablation inogona kupa ruzivo rwakakwana rwekuongorora chirwere chisati chaitwa kuvhiyiwa.
Mapundu emapapu eA-zone: Nzira yekupinda nepakati kana kuti yakatetepa (chinangwa ndechekugadzira nzira yekuisa mapapu, zviri nani ine urefu hwe2 cm).
Zviratidzo
Mabundu asina kukuvadza uye maronda emumapapu asingapararire:
Izvi zvinosanganisira zvipembenene zvinotanga kenza (atypical hyperplasia, in situ carcinoma), zvipembenene zvinopararira zvinodzivirira immune reactive, zvipembenene zvinoputika, ma cysts nemaabscesses emunharaunda, uye mapundu anopararira.
Mapundu egomarara rekutanga:
Zvichibva pane zvakaitika kare, cryoablation inzira inoshanda yekurapa yakafanana nekubvisa maronda egirazi repasi asina kujeka ari pasi pe2 cm ane chikamu chakasimba chisingasviki 25%.
Nguva yekutumira: Gunyana-05-2023