Wedge Resection (Segmentectomy kana Sublobar Resection) vs Lobectomy
Kana chiremba wako akakurudzira kubhadhara kwekenza yemukenza wemapapu, unogona kunge uchishamisika kuti nzira iyi yakaita sei uye kuti yakasiyana sei nemamwe marudzi ekuvhiya kwekenza yemapapu . Ndeipi nguva iyo kubhadhara resection kunokurudzirwa pane dzimwe nzira uye ndeipi zvimwe zvingave zvipingamupinyi? Ndezvipi zvimwe zvikonzero zvinoita kuti kubhadhara kwekodzero kunzwe kuve kwakatarwa pane nzvimbo yelobectomy, uye ingadai isingakurudziri rini?
Wedzera Kugadzikana: Tsanangudzo
A wedge resection inosanganisira kubviswa kwekenza yemapapu pamwe chete nechikamu chakaita semakumbo ematenda akakomberedza chironda chacho. Iyi nzira inobvisa zviduku zvishoma zvemapapu pane selobectomy (iyo nzira iyo inovhara mapapu inobviswa) kana segmentectomy (chirongwa chinobvisa chikamu chikuru chemapapu pane kubviswa kwekodhi, asi kwete chirebe chakakwana selobectomy .) Pachitarisa mutsara wemufananidzo wekuti mapapu akanaka ane 3 lobes uye pfupa rekumucheche ine 2 lobes.
A wedge resection inonziwo se -sub-lobar resection , sezvinonzi segmentectomy . Mukutarisa mamwe mazwi iwe ungaona nzira inonzi inonzi nonanatomic kusiyana nemamwe maitiro ayo ari anatomic, zvinoreva chete kuti hazvirevi kubvisa chikamu chakasiyana chemaitiro.
Zviratidzo zveKutsvaga Kwekuwedzera
Kunyange zvazvo hobectomy inogona kunge iri chiremba anovhiya kune vanhu vakawanda, pane zvikonzero zvakasiyana-siyana zvakasiyana nei chiremba anokwanisa kukurudzira kubhadhara resection panzvimbo yelobectomy: Izvi zvinogona kusanganisira:
Small Tumors
A wedge resection inowanzoitwa kumakanzura maduku emapapu, akadai sepakutanga-pasati pasati iri duku chekenza mapepa emapapu uye maitiro mashomanana emakirini emakenza emapapu . ( Kuvhiya dzimwe nguva kunogona kuitirwa mukenza muduku wekenza yemapapu asi izvi hazvishamisi.)
Nzira yacho inowanzotaridzirwa kana chirwere chiri pasi pe 4 cm (inenge 2 masendimita) uye zvisingasviki masendimita 2, uye chiri pamativi epakure emapapu (panopera,) uye inotsanangurwa senzvimbo 0 , nzvimbo 1A kana nhanho duku 1B isiri duku duku yemukenza yemapapu .
Kubva pakurongeka kweTMM yemukenza yemapapu , izvi zvipembenene zvaizova T1N0M0.
Nezvikonzero Zvokuziva
Dzimwe nguva nzira inogadziriswa sepapapu inoputika kuti iongorore kutsvaga kuwanikwa (pasi girazi opacities kana zvimwe zvinoshungurudza mapupa emapapu).
Nzira yacho inogonawo kuitika kune dzimwe dzisina kukwana mapapu, zvakadai sechirwere cheshuga, aspergillosis, uye kubviswa kwe emphysema blebs.
Neimwe kenza, nzira yacho inogona kuitwa kuitira kuti ibvise masastases ari oga kune mapapu kubva kune kenza yemazamu, maranoma, uye mamwe mashoma emukenza (zvakadai sechirwere chechirwere chechirwere, kenza yemaroni, uye sarcomas) yakapararira kumapapu.
Utano Hwakagadziriswa
Apo bhanhire resection inowanikwa kune vanhu vane kenza yemapapu, inowanzoitwa kune vanhu vasingadi kubvumira kuva nerebe yose yakabviswa, sevanhu vakwegura vane kenza yemapapu, vanhu vane zvimwe zvirwere zvakakomba, kana avo vakagadzirisa mapapu basa. Kana izvi zviri izvo, chinangwa ndechokubvisa chiremera asi uchichengetedza mapepa akawanda emapapu sezvaunokwanisa.
Vakwegura
Nhoroondo, ndeyekuti vanhu vakwegura vane kenza yemapapu vanowanzoregerera kurapwa kwekenza yemapapu pamwe chete nevaduku vane chirwere. Mune rumwe ruzivo, kunyange varwere vakwegura vane chirwere chepneumonectomy (kubviswa kwepapu rose), havana kuratidza kusiyana kwekwanisi yekukwanisa kutsungirira nzira.
Chidzidzo che 2018 chakatorawo kuti vanhu vakwegura vane kenza yemapapu (avo vanopfuura makore makumi masere) vanovhiyiwa pamwe chete nevaduku. Chidzidzo chacho, zvisinei, chakawana kuti sectectectomy (wedge resection) yakabatanidzwa nemigumisiro yakanaka pane mamwe maprojekiti akazara emapapu emapapu.
Sarudzo Yokuzvisarudzira
Chimwe chikonzero chinoita kuti uongorore iyi nzira ndeyezvisarudzo zvako pachako. Vamwe vanhu vanosarudza nzira shoma dzisina kukonzera yakaita seyi nekuda kwezvikonzero zvehutano hwehupenyu uye vanobvuma mungozi wepamusoro wekenza yemapapu yekudzoka zvakare .
Zvikonzero Zvinoita Kuti Kurambidzwa Kwemhuri Kusapindirwe
Tumora huru kupfuura 4 cm haigoni kubviswa kuburikidza ne wedge resection.
Nzvimbo yemarara iyi inogona kuitawo kuti nzira iyi isabatsire. Nenzira yakawanda, imwe nzira inobatanidzwa yakadai selobectomy inowanzokurudzirwa kuva vaduku, vangave vane utano, vanhu, kunyange izvo zvingashandura pakuongorora kwekupedzisira kweongororo (ona pasi pekufungidzira pasi apa.)
Kugadzirira Usati Watanga Kusununguka
Usati wambovhiyiwa, chiremba wako anoda kuve nechokwadi kuti unokwanisa kutsungirira nzira-zvose kubva pakuona kwehutano huzhinji uye pamusoro pemabasa emapapu. Miedzo uye miedzo inogona kusanganisira:
- Nhoroondo yekurapa yakakwana uye kuongorora mumuviri
- Kuongororwa kweRopa, kusanganisira yeiyi uye chiropa chekushanda
- Kuongororwa kwemamiriro ekudya
- Pulmonary function tests
- Mwoyo kuongorora
- Kufungidzira zvidzidzo kuti uongorore nzvimbo uye chiyero chechirwere, pamwe nekutsvaga kukwanisika kwekenza mune lymph nodes uye kure kure (zvakadai sechiropa kana mapfupa.)
Nzira
A wedge resection inogona kuitwa kana kuburikidza ne thoracotomy (kuvhura chirwere chekuvhara cheputi) kana kuburikidza nevhidhiyo-yakabatsirwa chirwere chinonzi thoracoscopic (VATS). VATS ndiyo nzira isina kuderedza, asi havasi vashandi vanovhiya vanoita chirwere ichi uye hazviiti nguva dzose zvichienderana nenzvimbo yemarara.
Zvichienderana nezvinoitwa sei, chiremba (kana apinda mubhokisi) anowana tumarara. Kuongorora kwakanyatsogadzirwa kunoitwa kuongorora mapapu uye lymph node dziri pedyo. Chirwere chacho zvinobva chabviswa nechinguva chezvinyuchi zvakapoteredza chironda.
Kuvhiyiwa kunogona kusanganiswa ne brachytherapy, iyo nzira iyo mazai ayo anoshandiswa panguva yekuvhiyiwa zvakananga kune chimbo chemuviri.
Kudzorera
Mushure mekuvhiyiwa, urefu hwenguva iwe uri muchipatara huchaenderana nemhando ipi yekuita iyo yaitwa (VATS vs open thoracotomy) uye iwe unofambira mberi pakunatswa. Bhuku rebhokisi rinoiswa mubhokisi rako panguva yekuvhiyiwa, uye kazhinji, rinogara panzvimbo yemaawa 24 kusvika ku48. Munguva ino chiremba wekupema achakushanyira, kukukurudzira kuti ufukidze zvakanyanya kuderedza dambudziko rehutachiona. Paunosunungurwa kuenda kumusha chiremba wako achakupa mirayiridzo yakananga yekutevera uye anokupa mishonga yemishonga kunoderedza marwadzo aunayo paunodzokera kumusha.
Zvinokonzera Kukanganiswa kweKutsvaga Kwekuwedzera
Matambudziko haana kufanirwa, asi angasanganisira:
- Matambudziko evanhu vakawanda anesthesia
- Hemothorax (kubuda muchipfuva chechifu)
- Kurwara
- Atelectasis (kuwa kwechikamu, kana yose yemapapu)
- Bronchopleural fistula (imwe nzira isingawanzoitiki iyo inovapo pakati pemapapu uye membrane inotaridza mapapu (the pleura))
- Kupfuurira kumhepo kunokonzera kudikanwa kwenguva yakareba inoda chikwama chechipfuva
- Dambudziko rokuzorora kubva pamhepo
Prognosis
Kufanirwa kwebhanhire resection kuchasiyana zvichienderana nehutachiona hwako, hutano hwako hwose, uye dzimwe mishonga unogamuchira.
Zvaifungidzirwa kwenguva yakareba kuti kupona (muvanhu vanogona kubvumira nzira yacho) yakakwirira kune vanhu vanoita lobectomy vs wedge resection. Kuongororwa kwechangobva kuitwa kwemasvondo makumi mashanu (54) kutarisa kune vanenge vane 39 000 varwere vakashandura pfungwa iyo. Kune vanhu vaine wedge resection asi vangadai vakabvumira lobectomy (rimwe boka iro wedge resection "rakasarudzwa nemaune,") chiyero chekupona chakanga chisina kusiyanisa pakati pemitemo miviri. Kune vanhu vaiva neketge resection nokuti vangadai vasina kukwanisa kushivirira a lobectomy (boka rakanyorwa kuti "rakanganisa" boka,) kupona kwakanyanya kuipa kune avo vane wedge resection.
Kutsungirira Pashure Kokurambwa Kwemakumbo kweKenza Kanonzi
A wedge resection, kunyange zvisinganyanyi kuwedzera pane lobectomy kana pneumonectomy, ichiri chirwere chikuru. Kumbira, uye rega, shamwari dzako nemhuri zvikubatsire. Kugadziriswa kwepulmonary mushure mekuvhiyiwa kwekenza yemapapu kwakangobva kuongororwa asi kunogona kuita kusiyana kukuru muhupenyu hwevamwe vanhu. Sezvo iri iri pfungwa itsva, iwe ungada kubvunza chiremba wako kuti atumire.
> Sources:
> Ambrogil, M. et al. Wedzera resection uye radiofrequency ablation pamusana weshandi yemukenza wemapapu emapapu. European Respiratory Journal . 2015. 45 (4): 1089-109.
> Cao, C., Chandrakumar, D., Gupta, S., Yan, T., uye D. Tian. Zvingave zvishoma here? - Kuongorora kwakagadziriswa uye meta-analysis ye sublobar resection pamwe nelobectomy yekenza isiri duku yemapapu emapapu maererano nekusarudzwa kwevarwere. Lung Cancer .2015. (Epub mberi kwekudhinda).
> Chambers, A., Routledge, T., Pilling, J., uye M. Scarci. Mune Varwere Vakwegura Vanopinda Muchirwere Ndirwo Kurwisana Kwakagadziriswa Mumagariro Ekutadza, Kufa uye Kugara Kweupenyu Hwakanaka? . Interactive Cardiovascular and Thoracic Surgery . 2010. 10 (6): 1015-21.
> Stamenovic, D., Messerschmidt, A., naT. Schneider. Kuvhiya kweMapungamu Mumuviri muVakuru: A Retrospective Cohort Chidzidzo Pamusoro Pemazuva Akare (Makore Anopfuura 80) Mukuvandudzika Kwezvinetso nekushandisa Multivariate Risk Model. International Journal of Surgery . 2018. 52: 141-148.