Cryoablation yePulmonary Nodule
Yakapararira Kenza Yemapapu uye Inotyisa Pulmonary Nodules
Zvinoenderana nedata kubva kuInternational Agency for Research on Cancer yeWorld Health Organisation, vangangosvika mamirioni mana nemazana mashanu ezviuru zvegomarara zvakaonekwa muChina muna 2020,nekenza yemapapu inoverengera kumakesi anosvika 820,000.Pakati pemapurovhinzi nemaguta makumi matatu nerimwe eChina, huwandu hwechirwere chegomarara remapapu muvarume hunotanga mumatunhu ese kunze kweGansu, Qinghai, Guangxi, Hainan, neTibet, uye huwandu hwevanhu vanofa hwakanyanya zvakanyanya zvisinei nekuti murume kana murume.Huwandu hwehuwandu hwehuwandu hwemapulmonary nodules muChina hunofungidzirwa kuve hwakatenderedza 10% kusvika 20%, nehuwandu hunogona kuwedzera pakati pevanhu vanopfuura makore makumi mana.Nekudaro, zvinofanirwa kucherechedzwa kuti ruzhinji rwemapulmonary nodules ane benign maronda.
Kuongororwa kwePulmonary Nodules
Pulmonary nodulestarisa kune yakatarisana yakatenderedzwa-yakakora mimvuri mumapapu, ine hukuru hwakasiyana uye yakajeka kana isina kujeka miganho, uye dhayamita isingasviki kana kuenzana nemasendimita matatu.
Imaging Diagnosis:Parizvino, nzira yakanangwa yekufungidzira yekufungidzira, inozivikanwa seyepasi-girazi opacity nodule imaging diagnostic, inoshandiswa zvakanyanya.Dzimwe nyanzvi dzinogona kuwana pathological correlation rate inosvika 95%.
Pathological Diagnosis:Nekudaro, kuongororwa kwekufungidzira hakugone kutsiva matishu pathology kuongororwa, kunyanya muzviitiko zve tumor-chaiyo chaiyo kurapwa inoda ma molecular pathological diagnosis pa cellular level.Pathological chirwere chinoramba chiri chegoridhe chiyero.
Yakajairika Diagnostic uye Therapeutic Nzira dzePulmonary Nodules
Percutaneous Biopsy:Tissue pathology diagnostic uye molecular pathology diagnostic inogona kuwanikwa pasi peanesthesia yemunharaunda kuburikidza nepercutaneous puncture.Avhareji yekubudirira kweiyo biopsy inenge 63%,asi matambudziko akadai sepneumothorax uye hemothorax anogona kuitika.Iyi nzira inongotsigira kuongororwa uye yakaoma kuita kurapa panguva imwe chete.Kune zvakare njodzi yebundu sero kubuda uye metastasis.Yakajairika percutaneous biopsy inopa mashoma matishu huwandu,kuita chaiyo-nguva tishu pathology kuongororwa kunonetsa.
General Anesthesia Vhidhiyo-Akabatsira Thoracoscopic Surgery (VATS) Lobectomy: Iyi nzira inobvumira kuongororwa uye kurapwa panguva imwe chete, nekubudirira kunosvika 100%.Nekudaro, iyi nzira inogona kunge isingakodzeri varwere vakura kana vanhu vakasarudzikaavo vasingashiviriri kune general anesthesia, varwere vane pulmonary nodules idiki pane 8 mm muhukuru kana yakaderera density (<-600), nodules ari pakadzika pakati pezvikamu zvisina tsarukano, uyemapfundo munharaunda yemediastinal padyo nehilar zvimiro.Uyezve, kuvhiyiwa kunogona kunge kusiri sarudzo yakakodzera yekuongorora uye yekurapa kune mamiriro anosanganisirapostoperative recurrence, anodzokororwa nodule, kana metastatic tumors.
Itsva Kurapa Nzira yePulmonary Nodules - Cryoablation
Nekuenderera mberi kwekuvandudza tekinoroji yekurapa, kurapwa kwebundu kwapinda munguva ye "kunyatsoongororwa uye kunyatsorapwa“.Nhasi, tichaunza nzira yekurapa yemuno inoshanda zvakanyanya kune asiri-akaipa mamota uye asiri-vascular proliferative pulmonary nodules, pamwe nekutanga-stage bundu nodules (pasi pe2 cm) -cryoablation.
Cryotherapy
Ultra-yakaderera tembiricha cryoablation nzira (cryotherapy), inozivikanwawo secryosurgery kana cryoablation, inzira yekuvhiya yekurapa inoshandisa kutonhora kurapa kunonangwa tishu.Pasi pekutungamira kweCT, kunyatsomira kunowanikwa nekubaya bundu tishu.Mushure mokusvika kune chironda, kutonhora kwepanzvimbo panzvimbo yacho kunokurumidza kuderera kusvika-140°C kusvika -170°Ckushandisaargon gasimukati memaminitsi, nekudaro kuzadzisa chinangwa chekurapa bundu ablation.
Nheyo yeCryoablation yePulmonary Nodules
1. Ice-crystal effect: Izvi hazvikanganisi pathology uye inogonesa kukurumidza intraoperative pathological kuongororwa.Cryoablation mumuviri inouraya bundu masero uye inokonzera microvascular occlusion.
2. Immunomodulatory effect: Izvi zvinowana kureba kwekudzivirira kwekudzivirira kurwisana nebundu. Inosimudzira kusunungurwa kweantigen, inomutsa immune system, uye inobvisa kudzvinyirirwa.
3. Kudzikamiswa kwenhengo dzenhare (dzakadai semapapu nechiropa): Izvi zvinosimudzira budiriro yebiopsy. Bhora rakaomeswa rinoumbwa, zvichiita kuti zvive nyore kugadzikana, uye mipendero yakajeka uye inooneka pamifananidzo.Iyi patent application iri nyore uye inoshanda.
Nekuda kwemaitiro maviri e cryoablation -"kuomesa anchoring uye kugadzirisa mhedzisiro" uye "isina matishu chimiro mushure mekutonhora pasina kukanganisa pathological diagnosis", inogona kubatsira mumapapu nodule biopsy,zadzisa chaiyo-nguva yakaomeswa nechando pathological kuongororwa panguva yekuitwa, uye kuvandudza chiyero chebudiriro yebiopsy.Inozivikanwa zvakare se“cryoablation yepulmonary nodule biopsy“.
Zvakanakira Cryoablation
1. Kugadzirisa kukanganiswa kwekufema:Kutonhora kwepanzvimbo kunodzikamisa matishu emapapu (uchishandisa coaxial kana bypass nzira dzechando).
2. Kugadzirisa pneumothorax, hemoptysis, uye njodzi yemhepo embolism uye mbeu yebundu: Mushure mekugadzira bhora rakaomeswa nechando, yakavharwa yakashata yekumanikidza extracorporeal chiteshi inotangwa yekuongorora uye kurapwa.
3. Kubudirira panguva imwe chete pa-saiti kuongororwa uye kurapwa zvinangwa: Cryoablation yemapapu nodule inoitwa kutanga, ichiteverwa nekudziya zvakare uye 360 ° multidirectional biopsy kuwedzera huwandu hwebiopsy tishu.
Kunyangwe cryoablation iri nzira yekudzora bundu remuno, vamwe varwere vanogona kuratidza kure kure immune immune.Nekudaro, huwandu hukuru hwe data hunoratidza kuti kana cryoablation ichisanganiswa neradiotherapy, chemotherapy, yakanangwa kurapa, immunotherapy, uye dzimwe nzira dzekurapa, kudzora bundu kwenguva refu kunogona kuwanikwa.
Zviratidzo zvePercutaneous Cryoablation pasi peCT Guidance
B-zone lung nodules: Pamapundu emapapu anoda segmental kana multiple segmental resection, percutaneous cryoablation inogona kupa preoperative definitive diagnosis.
A-zone lung nodules: Bypass kana oblique nzira (chinangwa ndechekugadzira nzira yemapapu, zviri nani nehurefu hwe 2 cm).
Zviratidzo
Mamota asina-akaipa uye asiri-vascular proliferative pulmonary nodules:
Izvi zvinosanganisira precancerous maronda (atypical hyperplasia, in situ carcinoma), immune reactive proliferative maronda, kuzvimba pseudotumors, localized cysts nema abscesses, uye mavanga anowanda.
Ekutanga-danho tumor nodules:
Zvichienderana neruzivo rwuripo, cryoablation zvakare inzira inoshanda yekurapa inofananidzwa nekuvhiya resection yepasi-girazi opacity nodules idiki pane 2 cm ine isingasviki 25% yakasimba chikamu.
Nguva yekutumira: Sep-05-2023