Chirwere chepracatomy ndiyo nzira huru yekuvhiya iyo inobvumira vanachiremba kuti vawane chifuva chechifu panguva yekuvhiyiwa. An incision inogadzirwa murusvingo rwechifuva, uye kuwanika kwezvikamu zvechifuva chechifu kunoitwa nekucheka kuburikidza uye zvichida kubvisa chikamu chebvu. Nzira yacho inowanikwa muimba yekushanda pasi peanesthesia yakawanda.
Zvikonzero Zvokupa Mumwe
Izvozvo zvinogona kuitwa nekuda kwezvikonzero zvakawanda, kwete kungobviswa kwekenza.
Kuzarura uye kuisa pachena chifukidzo chechifu uye mediastinum (nzvimbo iri pakati pemapapu) inogona kupa varapi vezvechiremba kupinda mumoyo, mapapu, sophagus, chikamu chepamusoro (thoracic) kana kuti aorta, uye mberi (chikamu chinonzi anterior) chepamusoro. Zvimwe zviratidzo zvinosanganisira:
- Kuvhiyiwa kwekenza yemaperembudzi
- Esophageal chirwere chekenza
- Mwoyo / chirwere chinonzi aortic
- Chest trauma
- Persistent pneumothorax (mapapu akadonha)
- Kutungamirirwa kweCOPD
- Tuberculosis
- Nyuchi uye kuongorora kwechizivikanwi chemazuva mashoma
- Kuvhiya kune anterior spine
- Tora thoracotomy (chirwere chinotyisa chinonzi thoracotomy) - Iyi ndiyo nzira inowanikwa muimba yepamhanho yekukurumidza kutyisidzira upenyu hwakadai sechifuyo chekushaya ropa
Mhando dzeNzira
Kune marudzi akasiyana-siyana ehutachiona anogona kuitwa, zvichienderana nezviratidzo zvekuvhiyiwa uye mamiriro ekurapwa. Izvi zvinosanganisira:
- Postolateral thoracotomy - Iyi ndiyo nzira yakajairika uye nzira inowanzoitwa yekuwana mapapu kubvisa mapapu kana chikamu chemapapu kuti apore mutanho wemapapu . Iko kusanganisa kunoitwa pamwe chete necheputi chechipfuva kumucheto pakati pemiti. Mbabvu acho anobva apararira kure (mubambo unogonawo kubviswa) kuoneka mapapu. Vanachiremba vangabva vabvisa mapapu ( pneumonectomy ), lobe yeimwe mapapu ( lobectomy ), kana chikamu chiduku chemapapu ( wedge resection ).
- Muchipata cheMidhiyani - Mune thoracotomy yemuviri, vanachiremba vanovhiya vanoita kuti vashongedze kuburikidza ne sternum (mazamu) kuitira kuwana chifukidzo chechipfuva. Iyi nzira inowanzoitwa kuita chirwere pamwoyo.
- Axillary thoracotomy - Mu thoracotomy inogadziriswa, vanovhiya vanogona kuwana chifuva kuburikidza nekukanganiswa pedyo neArmpit. Izvi zvinowanzoitwa mukurapa pneumothorax (kuputika mapapu), asi inogonawo kuitwa kune mamwe mapepa emwoyo nemapapu.
- Anterolateral thoracotomy - Iyi nzira inofanirwa kuitika inosanganisa kusanganisa pamberi pebhokisi. Izvo zvinogona kuitwa mushure mekukuvara kwechipfuva chikuru, kana kuti kubvumira kusangana zvakananga kumwoyo mushure mekusungwa kwemwoyo.
Kuronga nekugadzirira
Usati wava ne thoracotomy iwe uchava negore rakanyatsocherechedza uye unoitwa muviri, uye ungavewo une zvidzidzo kuongorora mwoyo wako uye mapapu. Kana thoracotomy yako ichiitwa nemukenza wemapapu, zvinogonawo kuva zvakakosha kuwana mhinduro yechipiri . Zvidzidzo zvinoratidza kuti vanhu vane chirwere ichi chakaitwa panzvimbo dzekenza dzinoita zvinyorwa zvakawanda izvi zvinogona kuva nemigumisiro yakanaka. Kune vamwe vanhu, chirongwa chiduku chisingazivikanwi chinozivikanwa semavhidhiyo-anobatsira chirwere chinonzi thoracoscopic (VATS) chinogona kushandiswa pane chetroracotomy, asi izvi hazviwaniki pane zvipatara zvose.
Nzira
Chirwere chinonzi thoracotomy chinowanzoitwa pasi peanesthesia yakawanda muimba yekushandisa. Kushandiswa kwenguva yakareba kunoitwa kune rumwe rutivi rwechifuva, uye mbabvu dzinoparadzaniswa kuti dziwanikwe mubhokisi. Mukati iyo yose, zviratidzo zvinokosha zvinonyatsoongororwa kuti uone kuti uri kubvumira nzira yacho zvakanaka. Kana chirwere ichi chapera, bhuti rechifu rinowanzoiswa muchipfuva chechifu uye rakasara panzvimbo panzvimbo kwenguva.
Zvinokonzera Matambudziko
Vamwe vanhu vanopinda nehutoriyumu asi vasina matambudziko chero ose, asi vamwe vanogona kusangana nemamwe matambudziko. Zvakakosha kutaura nemukuru wako chiremba pamusoro pekuvhiya kwako uye izvo zvaunotarisira. Zvechokwadi, avo vane hutano huzhinji musati maitiro aya vangave vane nzira iri nyore kune avo vari kurarama nezvimwe zvinetso zvezvechiremba. Uye sekuvhiya chero kupi zvako, kusvuta kunogona kuwedzera njodzi yezvinetso zvakakomba.
Zvimwe zvinokonzerwa nemigumisiro uye zvinetso zve thoracotomy zvinogona kusanganisira:
- Nguva yakawanda inoda rubatsiro rwemhepo inopera mushure mekuvhiyiwa
- Kupfuurira kumhepo kunokonzera kukonzera kudiwa kwenguva refu kwechifuva chechipfuva mushure mekuvhiyiwa
- Kurwara
- Bleeding
- Ropa rinoputika - Mvura yakadzika inopisa (ropa clots) uye mapapmona aripo (ropa rinoputika uye rinofamba kumapapu) inowanzobatana uye yakakomba dambudziko rekuvhiyiwa kwechifuva
- Matambudziko evanhu vakawanda anesthesia
- Kuchirwa kwemoyo kana arrhythmias
- Mucheche wechirwere unoshaya simba kana kupera simba
- Bronchopleural fistula - Ichi ndicho chinetso umo nzira isina kujairika inowanikwa pakati pebhanoni yepurasitiki uye nzvimbo pakati pe membrane (pleura) kuisa mapapu
- Postpneumonectomy syndrome kana post-thoracotomy pain syndrome - kurwadziwa munharaunda ye thoracotomy dzimwe nguva kunoramba kwenguva refu mushure mekuvhiyiwa
Mibvunzo Yokubvunza Pamberi
Funga kubvunza chiremba wako mibvunzo inotevera, uye nyora pasi mimwe mimwe mibvunzo yaunogona kuva nayo.
- Ndiani achange achizovhiya?
- Ndeapi maitiro aya mawakaita?
- Ndezvipi zvimwe zvinetso zvandinogona kutarisira?
- Inguva yakareba ichaita sei?
- Inguva yakareba sei ini ndichave ndiri muchipatara mushure mekuvhiyiwa?
- Ndinokurumidze sei kudzokera kubasa?
- Unokurudzira here kuti ndine chirongwa chekugadzirisa mapiritsi pashure pokuvhiyiwa?
- Chii chandingatarisira pamusoro penguva refu - kureva, gore kubva zvino kana makore matatu kubva zvino?
- Ndiani wandinofanira kudana kana ndikasangana nematambudziko mushure mokudzokera kumusha?
Mienzaniso: Chiremba weJim akamuudza kuti aizoita thoracotomy kuti apinde mumapapu ake uye aite lobectomy yake yekenza yemapapu.
Sources:
Bendixen, M., Jorgensen, O., Kronborg, C., Andersen, C., naP. Licht. Kushungurudzika kwepasipo uye hutano hwehupenyu mushure mokutenda kwemalabito kuburikidza nevhidhiyo-vakabatsirwa chirwere chetachiracoscopic kana anterolateralthoracotomy kumusana wepabonde wemapapu: chirongwa chisina kuongororwa chinotungamirirwa. Lancet Oncology . 2016. 17 (6): 836-44.
Fernandez, R., Kosinski, A., Burfeind, W. et al. Sangano reTrracic Surgeons Lung Cancer Resection Risk Model: Higher Quality Data uye Zvikuru Zvibereko. Annals of Thoracic Surgery . 2016 May 19. (Epub mberi kwekudhinda).
Sengupta, S. Post-operative pulmonary complications mushure mokunge thoracotomy. Indian Journal of Anesthesia . 2015. 59 (9): 618-26.
University of Michigan Healthcare System. Kugadzirira Chirongwa Chedu. Http://surgery.med.umich.edu/thoracic/pdf/preparingforyourthoracotomy.pdf