Iro peritoneum ndiyo nheyo inotenderera imba iyo ine dzimba dzakawanda dzemudumbu dzakadai semudumbu, ruzhinji rwechidiki chechidiki, chikamu chehombodo huru, chiropa, spleen, uye muswe wepakreas. Nharaunda iri seri kwemuviri uyu inonzi retroperitoneum, iyo inoreva kuti "shure kwe peritoneum". Iyi denga ine zvikamu zvemuviri, musoro, uye muviri wepakreas, itsvo uye lymph nodes inozivikanwa se retroperitoneal lymph nodes.
Izvi zvikwereti zvine madiki-mazana akadai separacaval, precaval, interaortocaval, preaortic, para-aortic, suprahilar uye liliac lymph nodes.
Chii Chinonzi Retroperitoneal Lymph Node Dissection?
Retroperitoneal lymph node dissection (RPLND) ndiko kubviswa kwekuchera kweiiiiiiiiiiii lymph node nodes. Kazhinji 40-50 node dzinobviswa.
Inoitwa Sei?
An incision inoshandiswa pasi pe sternum (chest bone) kusvika pasi pe umbilicus (bhomba bundu). Kuvhiyiwa kwepasipo-invasive laparoscopic inowanikwa kune dzimwe nzvimbo, kunyange zvazvo isiri iyo yakaenzana. Nhengo yemuviri inobva kune imwe nzvimbo ichizarura nzvimbo ye retroperitoneal. Iyi ndiyo nzvimbo inoratidzwa nemufananidzo uri pamusoro, kunyange zvazvo usingaratidzi chirwere chaicho. Iyo midziyo huru inoratidzwa pamwe chete ne retroperitoneal lymph nodes iyo inofananidzwa nenzira yakafanana. I-lymph nodes inonyanya kuratidza kuchenjerera kudzivisa kukuvadza mitsipa yakapoteredza.
Node idzi dzinotumirwa kunechiremba kuti aongorore kuvepo kwekenza. Chirwere chacho chinodzoserwa kune chinowanzogara uye maronda akavharwa. Nguva yekuvhiyiwa inogona kusiyana asi inotarwa mumaawa.
Rinoshandiswa Rini?
Kunyanya kurapwa kwekenza yepamusoro ye testicular kubviswa kwekenza kanonzi testis, chirongwa chinorapwa chinonzi radical orchiectomy.
Kutevera hutachiwana hukuru hwehutano, pane zvingasarudzwa zvakasiyana siyana zvichienderana nesiteji uye rudzi rwechirwere chepencerular: surveillance, chemotherapy uye / kana RPLND.
RPLND inoshandiswa kunyanya mumhando yemukirini yemasero ejeresi inozivikanwa sa nonseminoma.
Kuongorora kunokosha zvakanyanya pakusarudza nzira dzekurapa. Muzvinyorwa zvese, chirwere chekamuti ine kenza yakanyatsoiswa mu testis, chirongwa che II chinosanganisira retroperitoneal lymph nodes uye danho III rinosanganisira dzimwe nhengo kana node dzakadai semapapu. Chikamu I chinoteverwa netsamba A kana B. Chikamu II chinoteverwa netsamba A, B kana C. Tsamba idzi dzinoratidza kuti inopisa sei tumarara yekutanga iri muchitsauko I kana kuti yakakura sei lymph nodes iri muchitsauko II.
Muchitsauko IA (chiremera chakavharirwa ku testis ne epididymis ), RPLND isarudzo, asi kuongororwa (kungochengeta ziso) kunowanzosarudzwa. Zvisinei, muchitemukari IB chirwere (tumarara inopinda ropa kana lymph vessels, shrotum kana tambo yepermatic), kana RPLND kana chemotherapy inokurudzirwa. Muchikamu cheIIA (lymph nodes kwete chikuru kupfuura 2 cm muhupamhi) RPLND ndiwo mushonga unofanirwa. Muchitambo IIB (lymph nodes iri pakati pe2-5 cm muupamhi) RPLND inogona kuonekwa mumasarudzo akasarudzwa, asi chemotherapy inowanzoitwa kurapwa kwesarudzo.
Chirwere Chepachipiri II chinogonawo kurapwa ne chemotherapy kumusoro-mberi. Kana paine humwe uchapupu hwekugarisa kenza mushure mechemotherapy (lymph nodes kana masses> 1 cm), RPLND inosarudzwa, kunyange zvazvo zviri nyore zvikuru kuita izvi zvinotevera chemotherapy.
Apo Isingashandisi
Haifaniri kushandiswa mune dzimwe mhando dzekenza yepenticular seminoma. Hazvifanirwe kuitwa kana lymph nodes yakakura kupinda masendimita mashanu. Hazvifanirwe kushandiswa kana ropa rekutupa zvirwere zvisati zvadzokera kune zvakajairika mushure mekunyora orchiectomy. Haifaniri kushandiswa mune imwe mimwe mamiriro ezvinhu apo chirwere uye aneshesia hazvikwanisi kuchengetedzwa zvakanaka.
Kubatsirwa, Kukanganisika, uye Nhengo-Dambudziko
Chinhu chikuru kuna RPLND chiri kuporesa chirwere. Rimwe ruzivo ndechekuziva chokwadi kana lymph nodes ine kenza kana kwete. Mukuwedzera, vazhinji vese nonseminoma testicular kanzira ichava neatatoma. Teratoma inonyanya kuora mutezo uye kazhinji haina kupararira pachayo. Zvisinei, inogona kupararira kana yakavhenganiswa nemamwe marudzi evanhu vose. Sei izvi zvichiva nehanya nazvo? Teratoma haisi kunyatsoteerera chemotherapy kana kuti kurapa kwemaawa kuitira kuti iyo chete nzira yokuipedza nayo iyo yakapararira kune lymph nodes iri kuburikidza nekuvhiyiwa. Kana teratoma yasara kune chemotherapy inotevera, inogona kukura uye inokonzera zviratidzo kana kushanduka kuva rudzi rukuru rwekenza.
RPLND inogona kukanganisa kubereka kuburikidza nekuguma kwechinhu chinozivikanwa sekudzoka kwekudzoka kwemajeri. Pakugara kwenguva refu , mavhinga emisungo kudzivirira semenje kubva pakudzokera kumashure (retrograde) muchirwere uye kupedzisa mumucheka panzvimbo yekufambidzwa mukati uye kunze kwepenisi. Izvi zvinogona kuitika nokuti mishonga inokonzerwa nekuputika kwemuviri uyu inomhanya pamwe nemakirini uye ichikuvara panguva yekuvhiyiwa. Kunyange zvakadaro, nemasikirwo emanzwiro ezuva ranhasi, iri ngozi iri pasi pe10% muzviitiko zvakawanda.
Zvimwe zvinogona kukonzerwa nemigumisiro yemishonga yakangofanana nedzimwe chirwere chemuviri: kuvhara maronda, zvirwere, uye kugadzirisa kune anesthesia.
Chisarudzo chekuenderera mberi neRPLND ndechimwe chinoda kunyatsokurukurwa nekenza yako yekenza kuti uone kubatsirwa kwayo uye kukurukura dzimwe nzira.