Zviratidzo zvePleurodesis, Nzira, uye Matambudziko
Pleurodesis inongororwa dzimwe nguva kuvanhu vane kenza yemapapu uye mamwe mamiriro. Izvi zvinosanganisirei uye zvinogona kukurudzirwa rini?
Pleurodesis - The Definition
Pleurodesis inzira inogadzirirwa kuwana zvikamu zviviri zvepapu rinopfuta ( pleura ) kuti ribatane pamwechete. Izvi zvinoshandisa kuparadza nzvimbo pakati pezvigadziro ( chiringi chemukati ) kuitira kuti mvura (mvura, ropa, kana pus) isisagoni kuvakazve pakati pezviteere.
Iko kune zvidimbu zvitatu kusvika kune zvina zvepasipuni dzemvura zvinosviba pakati pekunze (parietal) uye nechomukati (visceral) chiremera chemuviri. Kana kuwedzera kwechisimba kuchiitika, pamusana pese zvinokonzera uye zvinokonzera zvinokonzera, ichi chiyero chemvura inowedzera uye nzvimbo inoputika dzimwe nguva inogona kubata zvinyorwa zvishoma zvemvura.
Pamberi pe pleurodesis inokurudzirwa, vanachiremba vanotanga kutanga kuona kuti chirevo chinonzi pleural effusion (kana pneumothorax) chichadzokazve munguva yemberi. Kana iri chiitiko chenguva imwe chete, kuita thoracentesis kubvisa maridhi inowanzodiwa zvose zvinodiwa. Zvinosuruvarisa, kushaya chiremera chisingaiti (uye pneumothoraces) uye kunyanya kunyangadza kudengenyeka kwemazwi kunowanzodzoka zvakare.
Pleurodesis Procedure
Mune chirurodisisiti, kemikemikirini inoshandiswa pakati pezvinyorwa zviviri zvinotenderera kuburikidza nebhokisi redu . Aya makemikari anokonzera kuvhiringidza kunokonzera kukonzera. Iko kutsvaira kunokonzera uye kunobata zvidimbu zviviri pamwe kuitira kuti mvura kana mhepo isasagoni kuvaka uye kuunganidza munzvimbo.
Icho chinyorwa chemukati chinoputika chinonzi visceral pleura, uye kunze kwemuviri werufu kunonzi parietal pleura. Zvichienderana nemamiriro ezvinhu aripo, nzira yacho inogona kuitwa kuburikidza nekambiso kadiki (yakabatsirwa nevhidhiyo-thoracoscopy kana VATS) kana kuti thoracotomy (chirwere chekuvhara mapapu.)
Kune mhando mbiri dze pleurodesis, iyo inowanzoshandiswa pamwe chete:
- Mechanical pleurodesis inokonzera kuvhiringidza uye kupwanya nokugadzira parietal (panze) pleura ne gauze.
- Chikemikari pleurodesis inosanganisira kuvhara kemikemikari (kazhinji kacho talc) pakati pezvinyorwa zvinoputika kuti zvive nekuputika uye kupora (fibrosis.)
Zvikonzero zvePleurodesis Inogona Kuitwa
Pane mamiriro ezvinhu akawanda ayo chirurodesis chingaitwa, icho chinowanzobva mumamiriro ekurapa akadai semukenza wemapapu, mesothelioma, cystic fibrosis, nezvimwe zvirwere.
- Kuipa kwechirwere chisingaiti - Vanhu vane chirwere chepapupa , kenza yemvere , kana kuti metastases kumapapu kune mamwe kanzira inogona kukura kuipa kwechirwere chekunyengedza , kudhonza kwechisimba kune kenza masero. Apo iyi ndiyo mamiriro acho pane 2 zvisarudzo. Imwe ndeyekuita thoracentesis uye isa nzvimbo yakasimba iyo inoramba ichinyorova mumvura inopisa kune imwe chikamu chemuviri (an indwelling pleural catheter kana tunneled pleural catheter.) Izvo ndeye pleurodesis.
- Kudzokorora kuburitswa
- Persistent pneumothorax - A pneumothorax izwi rinoshandiswa kurondedzera mapapu akadonha. Kana pneumothorax ichiitika uye chikwama chechipfuva ichiiswa, pneumothorax inowanzogadzirisa. Kana pneumothorax ichiramba (inoramba ichiderera,) kana ichienda uye yobva yadzoka, inowedzera kurapwa kugadzirisa pneumothorax kana kudzivisa kudzokorora kunodiwa.
- Recurrent pneumothorax
Pleurodesis Pamberi - Kugadzirira
Pamberi pe pleurodesis inoitwa, vanachiremba vanotora zvinhu zvakasiyana.
Chinonyanya kukosha, zvakakosha kuti kubvisa ruvara rwemvura kunokonzera kuvandudza kwezviratidzo (kuderera kwekufema kwekufema) kune avo vane kenza. Chirwere chisingaiti chinokonzera zviratidzo zvakadai sekurwadziwa kwepfupa kana kuperevedza kwefema mumamiriro ezvinhu aya zvinowanzosiyiwa ndoga. Mukuwedzera kune izvi, vamwe vanachiremba vanorayira nzira iyo chete kana kutarisa kweupenyu kuchikuru kune mwedzi umwe.
Ukuwo, rumwe rutivi pneumothoraces inogona kuitika kuvanhu vari vaduku uye vane utano hwakanaka.
Muchiitiko ichi, nzira yacho inogona kuitwa kuitira kudzivisa imwe pneumothorax kuti irege kuitika munguva yemberi.
Matambudziko
Kazhinji, chirongwa che pleurodesis chakanyatsorambidzwa. Kune imwe nzvimbo yehuwandu hwevanhu, chirongwa chacho chichava chisingabatsiri uyezve kurapwa ne catheter inogaramo kubvisa mvura, kana pleurectomy (kubviswa kwekuchema) kuchadiwa . Chimwe chinetseka, nokuda kwevanhu vanogona kuva nekupfupudza mapapu mune ramangwana, ndeyekuti chirevo chekare chinogona kuita kuti nzira iyi ive yakaoma.
Kune avo vane chikonzero chekunyengedzera nekuda kwemamiriro maduku, kana kuti vane pneumothoraces anowanzogara (kazhinji anowirirana nemhaka,) pleurodesis inogona kuunza chivimbo chokuti imwe yenyuchi kana pneumothorax haigone kuitika kana rubatsiro rwekurapa ruchigere kuwanikwa.
Muenzaniso: Mukenza wemapapu waFrank wakanga uchikonzera kudzokorora mutsara, naizvozvo chiremba wake akarayira kuti ane nzira inonzi pleurodesis.
> Sources:
> Davies, H. et al. Migumisiro ye Indwelling Pleural Catheter vs Chest Tube neTalc Pleurodesis yekudzikinura Dyspnea muVachipatara neAlignant Pleural Effusions. Iyo TIME2 Randomized Controled Trial. JAMA . 2012. 307 (22): 2383-2389.
> Dugan, K., Laxmanan, B., Murgu, S., uye D. Hogarth. Kutungamirirwa kweMhepo Inoramba Ichimhanya. Chest . 2017 Mar 3. (Epub mberi kwekudhinda).
> Fortin, M., uye A. Tremblay. Pleural controversies: kugara mumuviri catheter vs pleurodesis nekuda kwekurwadza kwezwi rinotyisa. Zvinyorwa zveTrracic Disease . 2015. 7 (6): 1052-7.
> Lenker, A., Mayer, D., uye S. Bernard. Zvinyorwa Zvokubata Malignant Pleural Effusions. Clinical Journal of Oncology Nursing . 2015. 19 (5): 501-504.
> Thomas, J., uye A. Musani. Zvinonyadzisa: Makliniki mu Chest Medicine . 2013. 34 (3): 459-71.