Chimwe chinonyangadza chisingaiti chisingaiti chinhu chinosanganisira kuvakwa kwemvura inenge ine kenza masero pakati pemakumbo anotevera mapapu. Izvo zvinowanikwa munharaunda inenge 30 muzana yemakirini emapapu emapapu, asi inogonawo kuitika kune dzimwe kenza, dzakadai sekenza yemazamu, kenza ye ovarian, leukemias, uye lymphomas. Nekenza yemapapu, kuora kwechisimba kunonyadzisa kunogona kuva chiratidzo chokutanga chekenza, kana kunogona kuitika sekumhanya kwenguva refu kwemupenza wemapapu wakatanga .
Chii chaunoda kuziva pamusoro pezviratidzo, zvinokonzera, uye kurapwa kwezvinhu izvi?
Overview
Chirevo chekudaidza chinorondedzerwa sechinhu chisingaenzaniswi chemvura inenge iri pakati pezvikamu zveiviri ( pleura ) iyo inongedza mapapu. Kana kenza masero aripo mumvura iyi (pleural cavity), inonzi inouraya (kanzira) inonyadzisa. Chimwe chinonyangadza chinonyangadza chingave chakakura uye chinoparadzanisa kana chiduku uye chinosanganisira chikamu chiduku chemuviri wekuchema . Izvo zvinogona kunge zviri munharaunda imwe, kana kune zvingangova nzvimbo dzakasvibiswa (dzakapetwa pleural effusions).
Zvinokonzera
Anenge chero mhando ipi neipi yekenza inogona kukonzera kudururwa kwepuresi kana iripo kana kupararira (metastasizes) kune chifuva. Yakawanda ndeye kenza yemazamu, kenza yemapapu, kenza yemuviri, uye mamwe marudzi eukemu nemarymymas. Chirwere chisingaiti chinogona kukonzerwawo nemishonga yemukenza wemapapu, zvakadai sokuvhiyiwa, remishonga yehutachiona, kana chemotherapy.
Zviratidzo
Zviratidzo zvekuvhiringidza kunonyadzisa kunogona kusanyanya kunetseka. Kupfupika kwefema ndeye chiratidzo chikuru kwazvo, chinoitika munenge ma80 kubva muzana yevanhu. Chifukidziro chinogona kuvapo, uye izvi zvinowanzoitika, zvichireva kuti zvingave zvakanyanya kuipa mune dzimwe nzvimbo dzakadai sekunamira mberi kana kurara kune rumwe rutivi.
Chifukidzo chepfupa kana chimwe chimiro chechifukidzo chechifu chinonzwa chingaitika zvakare.
Kuziva
Zvakakosha kuita sarudzo yakarurama yekushungurudza kunonyadzisa kubva pakutsvaga uye kurapwa kwakasiyana zvikuru kune kune zvisingaiti zvakaipa (zvinokuvadza) zvinokurudzira zvakasimba. Zvakakosha kucherechedza kuti kunyange nekenza, kusvika ku50 kubva muzana yezvinyorwa zvinokurudzira zvinopisa.
Chimwe chinonyangadza chinonyangadza chinowanzofungidzirwa nekuda kwezviratidzo kana kuwanikwa kunoonekwa mubhokisi X-ray kana CT scan. Kana chiremba wako achishushikana nechisimba chekunyengedzera, danho rinotevera rinowanzova thoracentesis , iyo nzira iyo ine nheyo inowanikwa kuburikidza nechidziro chechipfuva mukati mechivanze chemukati kuti uwane shanduro yemvura. Izvi zvinotaridzirwa pasi pema microscope kuona kana kenza yemasere aripo.
Kana thoracentesis isingagoni kuitika, kana kana zvikasa zvisingagoneki, dzimwe nzira dzinogona kudiwa kuti dziwanikwe zvakajeka. Mune zvimwe zviitiko, thoracoscopy (iyo nzira iyo thoracoscope inowanikwa mubhokisi) inogona kudiwa kuti iwane bhaopsy kuti iongorore huipi hunonyadzisa.
Mishonga
Chinangwa mukurapa kushata kwakanyanyisa kunonyanya kufadza, kureva, kuvandudza hupenyu hwehupenyu uye kuderedza zviratidzo asi kwete kuporesa kenza.
Kana kukanganiswa kwakanyanya kuduku, dzimwe nguva ingasara iri yoga.
Thoracentesis
Sezvambotaurwa pamusoro apa, thoracentesis inowanzotanga kushandiswa, zvose pakuongorora huwandu hwehutachiona (sarudza kana kenza dzemasere dziripo mumvura uye zvimwe), uye kuti abvise mvura. Zvinosuruvarisa, izvi zvinobudirira zvinowanzodzoka.
Nokuda kwezvinyorwa zvinopesana zvinoshandiswa zvinodzoka zvakare, pane zvimwe zvingasarudzwa zvekurapa kusvibiswa uye kuperesa kufema kwekufema. Panguva ino kunezve kukakavara kukuru pamusoro pekuti nzira ipi yakanakisisa, uye sarudzo inowanzoitwa zvichienderana nekuoma kwezviratidzo, kuti chirwere chacho chiri kupindura sei kurapwa, uye nhengo yako yehutano -yekuti kanesa inopesana neiko yako kukwanisa kuita mabasa ezuva nezuva.
Pleurodesis
Imwe nzira inoshanda munenge 60 kusvika 90 muzana yevanhu inonzi pleurodesis . Mune nzira iyi, tube inoshandiswa mukati mechirongwa chemukati uye chinhu, kazhinji tarenda, chinowanikwa pakati pe 2 membrane iri kuvhara mapapu. Ichi chikemikari chinokonzera kuvhiringidzika mumumvuri wechipupuriro iyo iyo inokonzera kuti 2 linings igare pamwechete (fuse) kudzivirira hutachiona kubva zvakare huchinge huchinge huchinge huchinge huri munzvimbo yakawanda.
Indwelling Pleural Catheters
Imwe nzira ndeyekugara mukati maro catheter , inozivikanwa se tunneled pleural catheter. Mune nzira iyi, duku tube inowanikwa munzvimbo yepuremu uye yakanyongedzwa pasi peganda, neine mukova muduku uri kurutivi rwako iyo inogona kuvharwa nebandage. Izvi zvinobvumira varwere kubvisa mvura yavo (kuburikidza nemubatsiro weaidiwa) nekubatanidza mudziyo wechipukisi kumusana paganda. Rimwe catheter rinogadziriswa dzimwe nguva rinobudirira kana kuputika kuripo kumativi maviri echifukidzo (pamwe chete) kana kuti kune nzvimbo huru dzenzvimbo dzinoshandiswa mvura inoshandiswa (yakagadziriswa.) Iyi nzira inowanzotorwa seisingaitiki pane inonzi pleurodesis uye inoshanda 80 muzana kusvika zana muzana yevanhu. Vakawanda vanotsvakurudza iye zvino vanofunga kuti kugara mukati mechedters catheters (IPCs) inofanira kuonekwa somuganhu wokutanga kune vanhu vose vane dambudziko rakaipa.
Pakava nenhaurirano pamusoro pekuti pleurodesis (talc insertion) kana kugara mune chedter cedter ndiyo nzira yakanakisisa yevanhu vane kenza yakanyanya uye inowanzoreva pleural effusion. Chidzidzo che 2017 chakabudiswa muJAMA , chakatsvaga kupindura mubvunzo uyu. Vatsvakurudzi vakawana kuti avo vakange vagere mutezo wekateta vaine vashoma vashanyi kupfuura avo vakange vane pleurodesis, zvikurukuru vachibatana nekudikanwa kwekugadziriswa kwekubvisa ruvara rwemvura. Kana zvisina kudaro, kwakanga kusina kusiyanisa kwakakosha mukati mekunzwa kwekufema kwekufema kana kuti hupenyu hwevadzidzi.
Zvimwe Zvokurapa Zvimwe
Kana chirwere chisina kunaka chinopfuurira kupfuurira pasinei nemamwe maitiro, chirwere chinogona kuitwa kuti chidimbure mumvura, kana chirurectomy (iyo nzira inobvisa chikamu che pleura) inogona kuitwa. Zviratidzo zvitsva (zvakadai sezvokurapa kwechiremba) zvinobuda pakurapa zvinonyangadza zvinokuvadza pamwe chete. Chemotherapy inogona kubatsira nehuipi hutsinye hunokonzerwa nechirwere chekenza yemapapu , asi hawanzobudirira chaizvo kune avo vane kenza isiri duku yemapapu emapapu .
Kusarudza Mushonga Wakanakisisa
Pamberi pe pleurodesis kana tunneled pleural catheter inokurudzirwa, zvinhu zvishoma zvinodiwa. Kutanga, chiremba wako achada kusimbisa kuti une dambudziko rinokuvadza remashoko uye kuti zviratidzo zvako hazviiti nekuda kweimwe chikonzero. Chechipiri, iwe unofanirwa kuva nechishuvo chakakanganisika chinodzoka (chinodzoka) mushure mokunge thoracentesis. Uye zvinonyanya kukosha, kubudiswa kwemvura kunobva munzvimbo yako yekunyanyisa kunofanira kubatsira nemararamiro ako ekufema kwekufema. Hazvina kudii kubvisa mvura nokuti iripo, asi bedzi kana iri kukonzera matambudziko (zvakadai sekupererwa kwemhepo). Iyi ndiyo pfungwa inokosha zvikuru yekudzokorora zvakare. Kana kuperevedza kwako kwepfungwa kunokonzerwa nechimwe chikonzero chinokonzera, uye kubvisa maridhi hazvizoiti misiyano yakakura, kazhinji hazvibatsiri mukubvisa mvura.
Prognosis
Zvinosuruvarisa kuti chiyero chekurarama kwemapapu emapapu nechisimba chinonyangadza chekunyengedzera chiri pasi pemwedzi mitanhatu. Nenguva yemazuva ekupona (nguva iyo 50 muzana yevanhu vakafa uye 50 muzana vachiri kurarama) ndeye mwedzi mina, kunyange vamwe vanhu vakapona kwenguva refu. Izvo zvinyorwa zvishoma zviri nani kune avo vane maitiro anonyadzisa anonyadzisa anokonzerwa nekenza yemazamu kana kenza yemukaka. Nekuuya kwemishonga mitsva yakadai seyakarongwa nemishonga uye immunotherapy , zvinotarisirwa kuti nhamba idzi dzichashanduka munguva yemberi iri mberi. Panewo mimwe miedzo yekliniki inoenderera mberi ichicherechedza zvakanakisisa kurapwa kweizvi.
Kutsungirira
Kuvhiringidzika kubva kunonyangadza kunonyadzisa kunogona kuwanda. Pair kuti nekudzidza kwekuongororwa kwako uye kushaya huwandu hwehurombo, uye ruzivo runogona kutambudza munhu wese-kunyanya avo avo vanotova nechishuvo chisina kunaka chekunyengedzera apo pavanotanga kuonekwa vane kenza. Bvunza mibvunzo. Kumbira rubatsiro kubva kune vamwe, uye uvatendere kuti vape. Taura nachiremba wako nezvokugadzirisa marwadzo emukenza wemapapu . Funga kubatana neboka rekutsigira . Manzwiro ako angangotarisa kunaka kubva pakutsamwa kusatenda, kuora mwoyo. Izvozvo zvinowanzoitika. Tsvaka shamwari neshamwari dzinoda kuteerera nekukutsigira. Dzidza zvakawanda pamusoro pechitsauko 4 (metastatic) yemukenza yemapapu .
Kune Vadiwa
Vanhu vashomanana vanhu vanove nemukenza wemapapu vari voga, uye kune vadikanwa chirwere ichi chinogona kunzwa sechinhu chinotyisa uye chinotyisa uye chakawedzerwa kune ichocho pfungwa inokurudzira yokusakosha. Chii chaunofanira kuziva kana mudiwa wako ane kenza ?
> Sources:
> Azzopardi, M., Porcel, J., Koegelenberg, C., Lee, Y., uye E. Fysh. Mhirizhonga yemazuva ano mukutungamira kwezvakaipa zvinopesana nemafungiro. Seminari muKufuridza uye Inonyanya Kurapa Mushonga . 2014. 35 (6): 723-31.
> Clive, A., Jones, H., Bhatnagar, R., Preston, N., naN. Maskell. Zvinyorwa zvehutungamiri hwezvinonyangadza zvinokuvadza zvakanyanyisa: mutezo meta-analysis. Cochrane Database yekuongorora kwakarongeka . 2016. 5: CD010529.
> Kheir, F. et al. Tunneled Pleural Catheter nokuda Kwechirwere cheMalignant Pleural Effusion: Ongororo Yakarongeka uye Meta-analysis. Journal of Therapeutics . 2015 Feb 2. (Epub pamberi pekunyora)
> Thomas, R., Fysh, E., Smith, N. et al. Migumisiro ye Indwelling Pleural Catheter vs Talc Pleurodesis pamusoro peHoritalitalation Mazuva Mavarwere Nemarignant Pleural Effusion: CHINHU CHENYANYA Randomized Clinical Trial. JAMA . 2017. 318 (19): 1903-1912.