Cryoablation no ka Pulmonary Nodule
ʻO ke Kanesa Mama Laulaha a me nā Nodules Mama Hopohopo
Wahi a ka ʻikepili mai ka International Agency for Research on Cancer of the World Health Organization, ua ʻike ʻia ma kahi o 4.57 miliona mau hihia maʻi kanesa hou ma Kina i ka makahiki 2020,me ka maʻi kanesa māmā e helu ana ma kahi o 820,000 mau hihiaMa waena o nā panalāʻau a me nā kūlanakauhale he 31 ma Kina, ʻo ka nui o ka maʻi ʻaʻai māmā i nā kāne ke kūlana mua ma nā ʻāina āpau koe wale nō ʻo Gansu, Qinghai, Guangxi, Hainan, a me Tibet, a ʻo ka nui o ka make ka mea kiʻekiʻe loa me ka nānā ʻole i ke kāne.Ua manaʻo ʻia ka nui o ka hanana o nā nodules pulmonary ma Kina ma kahi o 10% a 20%, me ka ʻoi aku ka nui o ka laha ma waena o ka poʻe ma luna o 40 mau makahiki. Eia nō naʻe, pono e hoʻomaopopo ʻia ʻo ka hapa nui o nā nodules pulmonary he mau ʻeha maikaʻi.
Ka ʻike ʻana i nā Nodules Pulmonary
Nā puʻupuʻu puʻuwaie pili ana i nā aka poepoe mānoanoa i loko o ka māmā, me nā nui like ʻole a me nā kaʻe maopopo a palalulu paha, a me ke anawaena i emi a like paha me 3 kenimika.
ʻIke Kiʻi:I kēia manawa, hoʻohana nui ʻia ke ʻano hana kiʻi scan i hoʻolālā ʻia, i ʻike ʻia ʻo ka ground-glass opacity nodule imaging diagnosis. Hiki i kekahi poʻe loea ke hoʻokō i kahi helu pilina pathological a hiki i ka 95%.
Ka Hōʻailona Pathological:Eia nō naʻe, ʻaʻole hiki i ka ʻike kiʻi ke pani i ka ʻike pathology o nā ʻiʻo, ʻoiai i nā hihia o ka mālama pololei ʻana i ka tumor e pono ai ka ʻike pathological molekala ma ka pae cellular.ʻO ka hōʻailona pathological ke kūlana gula mau loa.
Nā ʻAno Hana Diagnostic a me Therapeutic Kuʻuna no nā Nodules Pulmonary
ʻO ka Biopsy Percutaneous:Hiki ke hoʻokō ʻia ka ʻike ʻana i ka pathology o nā ʻiʻo a me ka ʻike ʻana i ka pathology molekala ma lalo o ka anesthesia kūloko ma o ka puncture percutaneous. ʻO ka awelika o ka holomua o ka biopsy ma kahi o 63%,akā hiki ke loaʻa nā pilikia e like me ka pneumothorax a me ka hemothorax. Kākoʻo wale kēia ʻano hana i ka ʻike ʻana a he paʻakikī ke hana i ka mālama like.Aia kekahi pilikia o ka hoʻokahe ʻana o nā cell tumor a me ka metastasis. Hāʻawi ka biopsy percutaneous maʻamau i ka nui o nā ʻiʻo i kaupalena ʻia,ʻO ia hoʻi ka paʻakikī o ka ʻike ʻana i nā pathology o nā ʻiʻo i ka manawa maoli.
ʻO ka Anesthesia Laulā ʻO ke ʻoki kino Thoracoscopic i kōkua ʻia e ke wikiō (VATS) Lobectomy: ʻO kēia ʻano hana e hiki ai ke hōʻoia a me ka mālama ʻana i ka manawa like, me ka pae holomua e kokoke ana i ka 100%. Eia nō naʻe, ʻaʻole kūpono paha kēia ʻano hana no nā poʻe maʻi ʻelemakule a i ʻole nā hui kūikawā.ka poʻe i hoʻomanawanui ʻole i ka anesthesia laulā, nā maʻi me nā nodules pulmonary i liʻiliʻi ma mua o 8 mm ka nui a i ʻole ka haʻahaʻa haʻahaʻa (<-600), nā nodules i loaʻa hohonu ma waena o nā ʻāpana like ʻole, anā nodules ma ka ʻāpana mediastinal kokoke i nā ʻano hilarEia kekahi, ʻaʻole paha he koho kūpono ke ʻoki ʻana no nā kūlana e pili ana ika hoʻi hou ʻana ma hope o ka hana hou ʻana, nā nodules e hoʻi hou ana, a i ʻole nā tumo metastatic.
ʻAno Hana Hou no nā Nodules Pulmonary - Cryoablation
Me ka hoʻomohala mau ʻana o ka ʻenehana lapaʻau, ua komo ka mālama ʻana i ka puʻupuʻu i ka wā o "ka ʻike pololei a me ka mālama pololei". I kēia lā, e hoʻolauna mākou i kahi ʻano lapaʻau kūloko i kūpono loa no nā puʻupuʻu ʻaʻole malignant a me nā nodules pulmonary proliferative non-vascular, a me nā nodules puʻupuʻu mua (ʻaʻole iʻoi aku ma mua o 2 cm) -ka hoʻopau ʻana i ka cryoablation.
ʻO ke ʻano hana Cryotherapy
ʻO ke ʻano hana cryoablation wela haʻahaʻa loa (cryotherapy), i ʻike ʻia hoʻi ʻo cryosurgery a i ʻole cryoablation, he ʻano hana lapaʻau ʻoki e hoʻohana ana i ka hau e mālama i nā ʻiʻo i manaʻo ʻia. Ma lalo o ke alakaʻi ʻana a CT, hoʻokō ʻia ke kūlana pololei ma ka hou ʻana i ka ʻiʻo tumor. Ma hope o ka hiki ʻana i ka lesion, hoʻemi koke ʻia ka mahana kūloko ma kahi i-140°C a i -170°Cme ka hoʻohana ʻanakinoea argoni loko o nā minuke, no laila e hoʻokō ai i ka pahuhopu o ka mālama ʻana i ka ablation tumor.
Kumumanaʻo o ka Cryoablation no nā Nodules Pulmonary
1. Ka hopena o ka hau-kristal: ʻAʻole kēia e hoʻopilikia i ka pathology a hiki ke hoʻomaopopo koke i ka pathology intraoperative.Hoʻopau kino ka Cryoablation i nā pūnaewele tumo a hoʻoulu i ka occlusion microvascular.
2. Ka hopena immunomodulatory: Hoʻokō kēia i kahi pane pale mamao e kūʻē i ka puʻupuʻu. Hoʻoulu ia i ka hoʻokuʻu ʻana o nā antigens, hoʻoulu i ka ʻōnaehana pale, a hōʻoluʻolu i ke kāohi ʻana o ka maʻi.
3. Ka hoʻopaʻa ʻana o nā ʻōpū neʻe (e like me ka māmā a me ke akepaʻa): Hoʻonui kēia i ka holomua o ka biopsy. Hoʻokumu ʻia kahi pōpō paʻahau, e maʻalahi ai ke hoʻopaʻa ʻia, a ua maopopo a ʻike ʻia nā ʻaoʻao ma ke kiʻi ʻana. He maʻalahi a kūpono hoʻi kēia noi i hoʻopaʻa ʻia.
Ma muli o nā ʻano ʻelua o ka cryoablation -"ka hopena hoʻopaʻa hau a me ka hoʻopaʻa ʻana" a me "ke ʻano o nā ʻiʻo paʻa ma hope o ka hau ʻana me ka ʻole o ka hoʻopilikia ʻana i ka hōʻailona pathological", hiki iā ia ke kōkua i ka biopsy nodule māmā,hoʻokō i ka hōʻoia pathological paʻa manawa maoli i ka wā o ke kaʻina hana, a hoʻomaikaʻi i ka kūleʻa o ka biopsy.Ua kapa ʻia hoʻi ʻo ia ʻo "cryoablation no ka biopsy nodule pulmonary".
Nā Pōmaikaʻi o ka Cryoablation
1. Ke hoʻoponopono nei i nā pilikia hanu:Hoʻopaʻa ka hau kūloko i ka ʻiʻo o ka māmā (me ka hoʻohana ʻana i nā ʻano hoʻopaʻa coaxial a i ʻole bypass).
2. Ke kamaʻilio ʻana i ka pneumothorax, hemoptysis, a me ka pilikia o ka embolism ea a me ka lūlū ʻana o ka tumor: Ma hope o ka hoʻokumu ʻana i kahi pōpō paʻahau, ua hoʻokumu ʻia kahi kahawai extracorporeal kaomi maikaʻi ʻole no ka hōʻoia ʻana a me nā kumu mālama.
3. Ke hoʻokō nei i nā pahuhopu hōʻoia a me ka mālama ʻana ma kahi: Hana mua ʻia ka cryoablation o ka nodule māmā, a ukali ʻia e ka hoʻomehana hou ʻana a me ka biopsy 360° multidirectional e hoʻonui i ka nui o nā ʻiʻo biopsy.
ʻOiai ʻo ka cryoablation kahi ʻano hana no ka kaohi ʻana i ka puʻupuʻu kūloko, hiki i kekahi mau maʻi ke hōʻike i kahi pane pale mamao. Eia nō naʻe, hōʻike ka nui o ka ʻikepili i ka wā e hui pū ʻia ai ka cryoablation me ka radiotherapy, chemotherapy, targeted therapy, immunotherapy, a me nā ʻano lapaʻau ʻē aʻe, hiki ke hoʻokō ʻia ka kaohi ʻana i ka puʻupuʻu lōʻihi.
Nā hōʻailona no ka Percutaneous Cryoablation ma lalo o ke alakaʻi CT
Nā puʻupuʻu māmā B-zone: No nā nodules māmā e pono ai ka resection segmental a i ʻole segmental multiple, hiki i ka cryoablation percutaneous ke hāʻawi i kahi hōʻailona paʻa ma mua o ke ʻoki ʻana.
Nā puʻupuʻu māmā A-zone: Ke ala ʻokiʻoki a i ʻole ke ala ʻokiʻoki (ʻo ka pahuhopu ka hoʻokumu ʻana i kahi ala o nā ʻiʻo māmā, ʻoi aku ka maikaʻi me ka lōʻihi o 2 cm).
Nā hōʻailona
Nā puʻupuʻu ʻino ʻole a me nā nodules pulmonary proliferative non-vascular:
Hoʻokomo pū kēia me nā lesions precancerous (atypical hyperplasia, in situ carcinoma), nā lesions proliferative immune reactive, nā pseudotumors inflammatory, nā cysts a me nā abscesses kūloko, a me nā nodules scar proliferative.
Nā puʻupuʻu puʻupuʻu mua:
Ma muli o ka ʻike i loaʻa, he ʻano lapaʻau kūpono nō hoʻi ka cryoablation e like me ka ʻoki ʻoki ʻana no nā nodules opacity aniani honua i ʻoi aku ka liʻiliʻi ma mua o 2 cm me ka emi ma mua o 25% o ka mea paʻa.
Ka manawa hoʻouna: Sep-05-2023