Te Cryoablation mō te Podule Pūkahukahu
Te Matepukupuku Pūkahukahu e Whānui Ana me ngā Pona Pūkahukahu Whakararuraru
E ai ki ngā raraunga mai i te Tari Rangahau mō te Mate Pukupuku o te Whakahaere Hauora o te Ao, tata ki te 4.57 miriona ngā mate pukupuku hou i kitea i Haina i te tau 2020,me te mate pukupuku pūkahukahu e pā ana ki te 820,000 ngā takeI roto i ngā kawanatanga me ngā tāone 31 o Haina, ko te reiti mate pukupuku pūkahukahu i roto i ngā tāne te tuatahi i ngā rohe katoa engari ko Gansu, Qinghai, Guangxi, Hainan, me Tibet, ā, ko te reiti mate te teitei rawa atu ahakoa te ira tangata.Ko te reiti whānui o ngā pona pūkahukahu i Haina e kiia ana he tata ki te 10% ki te 20%, me te mea pea he nui ake te horapa i waenga i te hunga neke atu i te 40 tau te pakeke. Heoi, me mōhio ko te nuinga o ngā pona pūkahukahu he whara pai.
Te Tātaritanga o ngā Pona Pūkahukahu
Ngā pona pūkahukahue pā ana ki ngā atarangi matotoru, porowhita te āhua, i roto i te pukahukahu, he rerekē ngā rahi, he mārama, he pōuri rānei ngā taha, ā, he iti iho i te 3 cm te whānui, he ōrite rānei ki te 3 cm.
Tātaritanga Whakaahua:I tēnei wā, e whakamahia whānuitia ana te tikanga whakaahua matawai arotahi, e mōhiotia ana ko te tātaritanga whakaahua pona ground-glass opacity. Ka taea e ētahi tohunga te whakatutuki i te reiti hononga pathological tae atu ki te 95%.
Te Tātaritanga Matepukupuku:Heoi, kāore e taea e te tātaritanga whakaahua te whakakapi i te tātaritanga mate kiko, inā koa i ngā wā e tika ana te maimoatanga tika mō te pukupuku e hiahia ana ki te tātaritanga mate ngota i te taumata pūtau.Ko te tautuhi i ngā mate pāwera tonu te paerewa koura.
Ngā Huarahi Tātaritanga me te Whakaora Tuku Iho mō ngā Pūngāwerewere Pūkahukahu
Te Kohikohi Kiri:Ka taea te whakatutuki i te tātaritanga mate kiko me te tātaritanga mate ngota i raro i te mate whakamoe ā-rohe mā te werohanga kiri. Ko te ōrau angitu toharite o te koiora he tata ki te 63%,engari tera pea ka puta ngā raruraru pēnei i te pneumothorax me te hemothorax. Ka tautoko noa tēnei tikanga i te tautuhi mate, ā, he uaua ki te mahi maimoatanga i te wā kotahi.Tērā anō hoki te mōrearea o te whakahekenga o ngā pūtau pukupuku me te horapa ki te tinana. He iti noa te rahinga o te kiko ka puta mai i te koiora kiri tuku iho.he uaua te tautuhi i te mate kiko i te wā tūturu.
Te Whakamamae Whānui Pokanga Tākihi Ataata-Āwhina (VATS) Lobectomy: Mā tēnei huarahi ka taea te tātaritanga me te maimoatanga i te wā kotahi, ā, e tata ana te ōrau angitu ki te 100%. Heoi, kāore pea tēnei tikanga e pai mō ngā tūroro kaumātua, mō ngā rōpū motuhake rānei.te hunga kāore e manawanui ki te mate whakamoe whānui, ngā tūroro he iti iho i te 8 mm te rahi, he iti iho rānei te mātotoru (<-600), he hohonu ngā pona i waenganui i ngā wāhanga rerekē, mengā pona i te rohe mediastinal e tata ana ki ngā hanganga hilar. Hei tāpiri, kāore pea te pokanga e tika hei whiringa tātaritanga me te rongoā mō ngā āhuatanga e pā ana kite hokinga mai anō i muri i te pokanga, ngā ponarua hoki e puta mai ana, ngā pukupuku kua horapa rānei.
Tikanga Maimoatanga Hou mō ngā Pona Pūkahukahu – Cryoablation
I te whanaketanga tonu o te hangarau hauora, kua tae te maimoatanga pukupuku ki te wā o "te tātaritanga tika me te maimoatanga tika". I tēnei rā, ka whakauruhia e mātou tētahi tikanga maimoatanga ā-rohe e tino whai hua ana mō ngā pukupuku kore-kino me ngā pona pūkahukahu kore-toto e horapa ana, tae atu ki ngā pona pukupuku wā-tōmua (iti iho i te 2 cm) -te whakakāhoretanga o te kiri.
Te rongoā kiri
Ko te tikanga cryoablation pāmahana tino iti (cryotherapy), e mōhiotia ana ko te cryosurgery, cryoablation rānei, he tikanga pokanga hauora e whakamahi ana i te whakatio hei rongoā i ngā kiko e hiahiatia ana. I raro i te arataki CT, ka tutuki te tūnga tika mā te wero i te kiko pukupuku. I muri i te taenga ki te whara, ka tere te heke o te pāmahana o te rohe ki te-140°C ki te -170°Cte whakamahihau ākonai roto i ngā meneti, ā, ka tutuki te whāinga o te maimoatanga tango i te pukupuku.
Te Mātāpono o te Cryoablation mō ngā Pona Pūkahukahu
1. Te pānga tio-kiriata: Kāore tēnei e pā ki te mate pukupuku, ā, ka taea ai te tautuhi tere i te mate pukupuku i roto i te pokanga.Ka patua ā-tinana e te cryoablation ngā pūtau pukupuku, ā, ka puta te aukati o ngā oko toto iti.
2. Pānga ārai mate: Ka tutuki i tēnei he urupare ārai mate tawhiti ki te pukupuku. Ka whakatairanga i te tukunga o ngā antigen, ka whakahohe i te pūnaha ārai mate, ā, ka whakamamae i te pehi o te ārai mate.
3. Te whakau i ngā whekau nekeneke (pērā i te pukahukahu me te ate): Ka whakanui ake tēnei i te angitu o te koiora. Ka hangaia he pōro tio, kia māmā ai te whakau, ā, ka mārama, ka kitea hoki ngā taha i te whakaahua. He māmā, he whai hua hoki tēnei tono kua patenttia.
Nā ngā āhuatanga e rua o te cryoablation –"te pānga o te punga me te whakau tio" me te "hanganga kiko tonu i muri i te tio me te kore e pā ki te tautuhi mate", ka taea te āwhina i te koiora o ngā pūkahukahu,te whakatutuki i te tautuhi mate pāwera i te wā tūturu i te wā o te tikanga, me te whakapai ake i te reiti angitu o te koiora.E mōhiotia ana hoki ko "cryoablation mō te koiora pona pūkahukahu"."
Ngā Painga o te Cryoablation
1. Te aro atu ki ngā raruraru manawa:Ka whakau te tio ā-rohe i te kiko o te pukahukahu (mā te whakamahi i ngā tikanga tio coaxial, bypass rānei).
2. Te aro atu ki te pneumothorax, te hemoptysis, me te mōrearea o te embolism hau me te purapura pukupuku: I muri i te hanganga o tētahi pōro tio, ka whakatūria he hongere pehanga kino kati i waho o te tinana hei tātaritanga me te maimoatanga.
3. Te whakatutuki i ngā whāinga tātaritanga me te maimoatanga i te wā kotahi i te papaanga: Ka mahia tuatahitia te cryoablation o te pona pukahukahu, ā, muri iho ka whakamahana anō me te koiora maha-aronga 360° hei whakanui ake i te nui o te kiko i kohia.
Ahakoa he tikanga te cryoablation mō te whakahaere i te pukupuku ā-rohe, ka whakaatu pea ētahi tūroro i tētahi urupare ārai mate tawhiti. Heoi, he nui ngā raraunga e whakaatu ana ina whakakotahihia te cryoablation me te radiotherapy, te chemotherapy, te rongoā arotahi, te immunotherapy, me ētahi atu tikanga maimoatanga, ka taea te whakatutuki i te whakahaere pukupuku mō te wā roa.
Ngā Tohu mō te Cryoablation Percutaneous i raro i te Aratohu CT
Ngā pona pukahukahu rohe-B: Mō ngā pona pukahukahu e hiahia ana kia tangohia te wāhanga wāhanga, te wāhanga maha rānei, ka taea e te cryoablation percutaneous te whakarato i te tautuhi whakamutunga i mua i te pokanga.
Ngā pona pukahukahu rohe-A: Te huarahi karo, te huarahi whakarara rānei (ko te whāinga he whakatū i tētahi awaawa kiko o te pukahukahu, ko te roa pai ko te 2 cm).
Ngā tohu
Ngā pukupuku kore-kino me ngā pona pūkahukahu kore-toto e tipu haere ana:
Kei roto i tēnei ko ngā whara o mua i te matepukupuku (te hyperplasia atypical, te carcinoma in situ), ngā whara tipu tere o te pūnaha ārai mate, ngā pseudotumor mumura, ngā cysts me ngā abscesses rohe, me ngā pona koha tipu haere.
Ngā pūngāwerewere pukupuku o te wā tōmua:
I runga anō i ngā wheako o nāianei, he tikanga maimoatanga whai hua anō hoki te cryoablation, he rite ki te tango pokanga mō ngā pona opacity karāhe whenua he iti iho i te 2 cm te rahi me te iti iho i te 25% o te wāhanga totoka.
Wā tuku: Hepetema-05-2023