Opaleshoni ya m'mapapo

Opaleshoni ya m'mapapo ndi opaleshoni yochitidwa kuti akonze kapena kuchotsa minofu yam'mapapo. Pali maopareshoni ambiri wamba, kuphatikiza:

• Chiwopsezo chakukula kosadziwika
• Lobectomy, kuchotsa gawo limodzi kapena angapo am'mapapo
• Kuika mapapo
• Pneumonectomy, kuchotsa mapapo
• Kuchita opaleshoni yoteteza kumangirira kapena kubwerera kwamadzimadzi pachifuwa (pleurodesis)
• Kuchita opaleshoni kuti muchotse matenda m'chifuwa (empyema)
• Opaleshoni yochotsa magazi m'chifuwa, makamaka pambuyo povulala
• Kuchita opaleshoni kuti muchotse tinthu tating'onoting'ono tomwe timakhala ngati buluni (ma bulbs) omwe amayambitsa mapapo kugwa (pneumothorax)
• Kuchotsa mphero, kuchotsa gawo la lobe m'mapapu

Thoracotomy ndi kudula komwe opaleshoni imapanga kuti atsegule chifuwa.

Mudzakhala ndi anesthesia musanachite opaleshoni. Mudzakhala mukugona ndipo simungamve ululu. Njira ziwiri zodziwika bwino zochitira opaleshoni m'mapapu anu ndi thoracotomy komanso opaleshoni yothandizira makanema (VATS). Opaleshoni ya robotic itha kugwiritsidwanso ntchito.

Opaleshoni yamapapo pogwiritsa ntchito thoracotomy amatchedwa opaleshoni yotseguka. Pa opaleshoni iyi:

• Mudzagona mbali yanu pagome logwirira ntchito. Dzanja lanu lidzaikidwa pamwamba pamutu panu.
• Dokotala wanu azidula pakati pa nthiti ziwiri. Kuduladwako kumachokera kutsogolo kwa khoma lanu pachifuwa kupita kumbuyo kwanu, ndikudutsa pansi pamanja. Nthitizi zidzasiyanitsidwa kapena nthiti ikhoza kuchotsedwa.
• Mapapu anu mbali iyi adzasungunuka kuti mpweya usalowe mkati ndi kutuluka mkati mwa opaleshoni. Izi zimapangitsa kukhala kosavuta kwa dokotalayo kuti azigwira ntchito m'mapapo.
• Dokotala wanu sangadziwe kuchuluka kwa mapapo anu ayenera kuchotsedwa mpaka chifuwa chanu chitseguke ndipo mapapo awoneke.
• Dokotala wanu amathanso kuchotsa ma lymph node mderali.
• Pambuyo pa opaleshoni, machubu amodzi kapena angapo adzaikidwa m'chifuwa mwanu kuti muthe madzi omwe amadzikweza. Machubu amenewa amatchedwa machubu pachifuwa.
• Pambuyo pa opaleshoni yamapapu anu, dokotalayo amatseka nthiti, minofu, ndi khungu ndi suture.
• Opaleshoni yamapapu yotseguka imatha kutenga maola awiri mpaka 6.

Opaleshoni ya thoracoscopic yothandizidwa ndi makanema:

• Dokotala wanu amapanga mabala ang'onoang'ono opangira opaleshoni pachifuwa panu. Kanema wa kanema (chubu chokhala ndi kamera yaying'ono kumapeto) ndi zida zina zing'onozing'ono zitha kudutsa podula izi.
• Kenako, dokotalayo akhoza kuchotsa gawo limodzi kapena mapapo anu onse, kukhetsa madzimadzi kapena magazi omwe apanga, kapena kuchita njira zina.
• Machubu amodzi kapena angapo adzaikidwa m'chifuwa chanu kukhetsa madzi omwe amadzaza.
• Njirayi imabweretsa kupweteka pang'ono komanso kuchira msanga kuposa opaleshoni yamapapo yotseguka.

Thoracotomy kapena chithandizo cha kanema cha thoracoscopic chitha kuchitidwa kuti:

• Chotsani khansa (monga khansa ya m'mapapo) kapena biopsy kukula kosadziwika
• Chitani zovulala zomwe zimayambitsa minofu yamapapo (pneumothorax kapena hemothorax)
• Sungani minofu yamapapo yomwe yasokonekera (atelectasis)
• Chotsani minofu yam'mapapo yomwe ili ndi matenda kapena yowonongeka kuchokera ku emphysema kapena bronchiectasis
• Chotsani magazi kapena magazi (hemothorax)
• Chotsani zotupa, monga kusungulumwa kwam'mapapo
• Onjezani minofu yamapapo yomwe yagwa (Izi zitha kukhala chifukwa cha matenda monga matenda osokoneza bongo, kapena kuvulala.)
• Chotsani matenda pachifuwa (empyema)
• Lekani kupangika kwamadzimadzi pachifuwa (pleurodesis)
• Chotsani magazi m'mitsempha yama pulmonary (pulmonary embolism)
• Chitani zovuta za chifuwa chachikulu

Opaleshoni ya thoracoscopic yothandizidwa ndi makanema itha kugwiritsidwa ntchito kuthana ndi izi. Nthawi zina, opaleshoni ya kanema imatha kukhala yosatheka, ndipo dokotalayo amatha kupita ku opareshoni yotseguka.

Zowopsa za opaleshoniyi ndi izi:

• Kulephera kwa mapapo kukulira
• Kuvulaza mapapu kapena mitsempha yamagazi
• Kufunika kwa chubu pachifuwa pambuyo pa opaleshoni
• Ululu
• Kutulutsa kwa mpweya kwakanthawi
• Kubwereza kwamadzimadzi kambiri pachifuwa
• Magazi
• Matenda
• Kusokonezeka kwamalingaliro amtima
• Kuwonongeka kwa diaphragm, esophagus, kapena trachea
• Imfa

Mudzayendera kangapo ndi omwe amakuthandizani azaumoyo ndikukuyesani kuchipatala musanachite opareshoni. Wopereka wanu adza:

• Chitani mayeso athupi lathunthu
• Onetsetsani kuti matenda ena omwe mungakhale nawo, monga matenda ashuga, kuthamanga kwa magazi, kapena mavuto amtima kapena mapapo akuyang'aniridwa
• Yesetsani kuyesa kuti muwonetsetse kuti mudzatha kupirira kuchotsedwa kwa minofu yanu yamapapu, ngati kuli kofunikira

Ngati mumasuta, muyenera kusiya kusuta milungu ingapo musanachite opareshoni. Funsani omwe akukuthandizani kuti akuthandizeni.

Nthawi zonse muuzeni omwe akukuthandizani:

• Ndi mankhwala ati, mavitamini, zitsamba, ndi zina zowonjezera zomwe mukutenga, ngakhale zomwe mudagula popanda mankhwala
• Ngati mwakhala mukumwa mowa wambiri, kuposa 1 kapena 2 zakumwa patsiku

Sabata isanachitike opaleshoni yanu:

• Mutha kupemphedwa kuti musiye kumwa mankhwala omwe amalepheretsa magazi anu kuphimba. Zina mwa izi ndi aspirin, ibuprofen (Advil, Motrin), vitamini E, warfarin (Coumadin), clopidogrel (Plavix), kapena ticlopidine (Ticlid).
• Funsani omwe amakupatsani mankhwala omwe muyenera kumwa patsiku la opareshoni yanu.
• Konzani nyumba yanu kuti mudzabwerere kuchipatala.

Patsiku la opareshoni yanu:

• Musadye kapena kumwa chilichonse pakati pausiku usiku musanachite opareshoni.
• Tengani mankhwala omwe dokotala adakupatsani ndi madzi pang'ono.
• Wothandizira anu adzakuuzani nthawi yoti mufike kuchipatala.

Anthu ambiri amakhala mchipatala masiku 5 mpaka 7 kutseguka kwa thoracotomy. Kukhala kuchipatala kuti athandizidwe opaleshoni yamankhwala a thoracoscopic nthawi zambiri kumakhala kofupikitsa. Mutha kukhala nthawi yayitali kuchipatala cha anthu odwala mwakayakaya (ICU) mukatha kuchitidwa opaleshoni.

Mukakhala kuchipatala, mudzachita izi:

• Afunseni kuti mukhale pambali pa kama ndikuyenda mwachangu mukatha opaleshoni.
• Khalani ndi ma chubu omwe akutuluka m'chifuwa chanu kuti akhetse madzi ndi mpweya.
• Valani masitonkeni apadera pamapazi ndi miyendo popewa magazi.
• Landirani akatemera kupewa magazi kuundana.
• Landirani mankhwala opweteka kudzera mu IV (chubu chomwe chimalowa m'mitsempha mwanu) kapena pakamwa ndi mapiritsi. Mutha kulandira mankhwala anu opweteka kudzera mumakina apadera omwe amakupatsani mankhwala azopweteka mukakankha batani. Izi zimakuthandizani kuwongolera kuchuluka kwa mankhwala opweteka omwe mumalandira. Mwinanso mungakhale ndi malo oopsa. Ichi ndi catheter kumbuyo chomwe chimapereka mankhwala opweteka kuti achepetse mitsempha kumalo opangira opaleshoni.
• Afunseni kuti muzipumira kwambiri kuti muteteze chibayo ndi matenda. Kuchita masewera olimbitsa thupi kumathandizanso kufinya m'mapapo omwe adachitidwa opaleshoni. Mapaipi anu pachifuwa amakhalabe mpaka mapapu anu atakhuta.

Zotsatira zimadalira:

• Mtundu wamavuto akuchiritsidwa
• Kuchuluka kwa minofu yam'mapapo (ngati ilipo)
• Thanzi lanu lonse musanachite opaleshoni

Thoracotomy; Kuchotsa minofu m'mapapo; Chibayo; Lobectomy; Mapapu biopsy; Thoracoscopy; Kuchita opaleshoni yothandizidwa ndi kanema; MAVITI

• Chitetezo cha bafa cha akulu
• Momwe mungapume mukakhala ndi mpweya wochepa
• Opaleshoni m'mapapo - kumaliseche
• Kuteteza kwa oxygen
• Ngalande zapambuyo pake
• Kupewa kugwa
• Chisamaliro cha bala la opaleshoni - chotseguka
• Kuyenda ndi mavuto apuma
• Kugwiritsa ntchito mpweya kunyumba
• Kugwiritsa ntchito mpweya kunyumba - zomwe mungafunse dokotala wanu

• Pulmonary lobectomy - mndandanda

Alfille PH, Wiener-Kronish JP, Bagchi A. Kuyeserera koyambirira. Mu: Broaddus VC, Mason RJ, Ernst JD, et al, olemba. Murray ndi Nadel's Bookbook of Respiratory Medicine. Lachisanu ndi chimodzi. Philadelphia, PA: Elsevier Saunders; 2016: chap 27.

Feller-Kopman DJ, Wopanda MM. Njira zopangira ndi zopangira matenda am'mapapo. Mu: Goldman L, Schafer AI, olemba. Mankhwala a Goldman-Cecil. 26 wa. Philadelphia, PA: Elsevier; 2020: chap 93.

Lumb A, Thomas C. Opaleshoni ya m'mapapo. Mu: Lumb A, Thomas C, olemba. Nunn ndi Lumb's Applied Respiratory Physiology. 9th ed. Philadelphia, PA: Elsevier; 2021: chaputala 33.

Putnam JB. Mapapu, khoma pachifuwa, pleura, ndi mediastinum. Mu: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Buku Lopanga Opaleshoni. Wolemba 20th. Philadelphia, PA: Elsevier Saunders; 2017: mutu 57.