Yini Ukuhlinzwa Ukuncishiswa Kwevolumu Yamaphaphu? Inhloso, Inqubo & Nemiphumela

Ukuhlinzwa ukuncishiswa kwevolumu yamaphaphu (LVRS) kuyinqubo esusa izingxenye ezilimele zamaphaphu akho ukusiza izicubu ezisele ezinempilo ukuthi zisebenze kahle. Cabanga ngakho njengokwenza indawo yokuthi izicubu zakho zamaphaphu ezinhle zikhule futhi zisebenze kangcono ngokususa izingxenye ezingakusizi ukuthi uphefumule.

Lokhu kuhlinzwa kuhloselwe ikakhulukazi abantu abanemphysema enkulu, isimo lapho izikhwama zomoya emaphaphu akho zilimazeka futhi zibambe umoya. Lapho odokotela behlinza besusa lezi zindawo ezilimele, i-diaphragm yakho ingahamba ngokukhululeka, futhi izicubu zakho zamaphaphu ezisele zingenza umsebenzi wazo ngempumelelo.

Yini ukuhlinzwa ukuncishiswa kwevolumu yamaphaphu?

Ukuhlinzwa ukuncishiswa kwevolumu yamaphaphu kuhilela ukususa u-20-30% wezicubu zakho zamaphaphu ezilimele kakhulu kuwo womabili amaphaphu. Umgomo uwukuthuthukisa amandla akho okuphefumula kanye nekhwalithi yempilo ngokuvumela izicubu zakho zamaphaphu ezinempilo ukuthi zikhule kahle.

Ngesikhathi senqubo, odokotela bahlinza babona izindawo zamaphaphu akho ezilinyazwe kakhulu yi-emphysema. Lezi zingxenye zivame ukubonakala njengamabhaluni aqhumile angakwazi ukushintshanisa kahle i-oxygen ne-carbon dioxide. Ngokususa lezi zindawo ezingasebenzi, ukuhlinzwa kusiza imisipha yakho yesifuba kanye ne-diaphragm ukuthi zisebenze kahle.

Le nqubo ingenziwa kusetshenziswa izindlela ezahlukene, okuhlanganisa ukuhlinzwa okuvulekile kwendabuko noma izindlela ezingahlaseli kakhulu. Udokotela wakho ohlinzayo uzokhetha indlela engcono kakhulu ngokusekelwe esimweni sakho esithile samaphaphu kanye nesimo sempilo esiphelele.

Kungani kwenziwa ukuhlinzwa ukuncishiswa kwevolumu yamaphaphu?

Lokhu kuhlinzwa kunconywa kubantu abanemphysema enkulu abaqhubeka nokuhlangabezana nobunzima bokuphefumula naphezu kokwelashwa okungcono kakhulu kwezokwelapha. Umgomo oyinhloko uwukuthuthukisa ikhwalithi yakho yempilo namandla okuphefumula lapho ezinye izindlela zokwelapha zinganikezanga usizo olwanele.

Ungase ube ngumuntu okufanele ahlinzwe i-LVRS uma une-emphysema yase-upper lobe, lapho umonakalo ugxile ezingxenyeni eziphezulu zamaphaphu akho. Lolu hlobo lomonakalo luvame ukusabela kangcono ekungeneleni kokuhlinzwa kunezinye izinhlobo ze-emphysema.

Ukuhlinzwa kungasiza ukunciphisa ukuphefumula kwakho okuncane, ukwandisa ukubekezelelana kwakho kokuzivocavoca, futhi kungenzeka ukuthi kwandise isikhathi sakho sokuphila. Iziguli eziningi zithola ukuthi zingabuyela emisebenzini ezingakwazanga ukuyenza ngaphambili, njengokuhamba amabanga amade noma ukukhuphuka izitebhisi.

Yini inqubo yokuhlinzwa ukunciphisa ivolumu yamaphaphu?

Ukuhlinzwa kuvame ukuthatha amahora angu-3-4 futhi kwenziwa ngaphansi kwe-anesthesia ejwayelekile. Ithimba lakho lokuhlinzwa lizosebenzisa enye yezindlela eziningana kuye ngesimo sakho esithile kanye nokukhetha kukahlinzayo.

Nakhu okwenzekayo ngokuvamile ngesikhathi senqubo:

1. Uzothola i-anesthesia ejwayelekile ukuze ikugcine ukhululekile futhi ungalazi lutho
2. Udkt. ohlinzayo wenza ukusikeka ukuze afinyelele emaphashini akho (kungaba ngokusebenzisa ukusikeka okuncane okuyizimbobo zokhiye noma ukusikeka okukhulu esifubeni)
3. Esebenzisa amathuluzi akhethekile, ukhomba izicubu zamaphaphu ezilimele kakhulu
4. Izingxenye ezilimele zisuswa ngokucophelela kusetshenziswa amadivayisi okubeka
5. Izicubu zamaphaphu ezisele ezinempilo zihlolwa ukuze kutholakale ukuvuza komoya
6. Kufakwa amashubhu esifuba ukusiza ukukhipha uketshezi nomoya
7. Ukusikeka kuvalwa ngama-sutures noma ama-staples

Indlela ethile esetshenziswayo ingahluka. Abanye odkt. ohlinzayo basebenzisa i-video-assisted thoracoscopic surgery (VATS), esebenzisa ukusikeka okuncane nekhamera encane. Abanye bangasebenzisa i-median sternotomy, ebandakanya ukuvula isifuba ngamathambo esifuba.

Ungalungela kanjani ukuhlinzwa kwakho ukunciphisa ivolumu yamaphaphu?

Ukulungiselela i-LVRS kuhilela amasonto amaningana okuhlola nokulungisa ukuze kuqinisekiswe ukuthi unempilo ngangokunokwenzeka ngaphambi kokuhlinzwa. Ithimba lakho lezokwelapha lizosebenza eduze nawe ukuze lithuthukise isimo sakho ngaphambi kwenqubo.

Ukulungiselela kwakho cishe kuzohlanganisa lezi zinyathelo ezibalulekile:

1. Uhlelo lokuvuselela amaphaphu ukuqinisa imisipha yakho yokuphefumula
2. Ukuhlolwa okubanzi komsebenzi wamaphaphu kanye nezifundo zokuthwebula izithombe
3. Ukuhlolwa kwenhliziyo ukuqinisekisa ukuthi inhliziyo yakho ingakwazi ukuhlinzwa
4. Ukuhlolwa kokudla kanye nokuthuthukiswa kwesisindo sakho
5. Umsebenzi ogcwele wegazi kanye nezinye izivivinyo zezokwelapha
6. Ukuyeka ukubhema uma usabhema (kubaluleke kakhulu)
7. Ukulungiswa kwemithi njengoba kunconywe udokotela wakho

Uzodinga futhi ukuyeka imithi ethile ngaphambi kokuhlinzwa futhi uhlele usizo ekhaya ngesikhathi sokululama kwakho. Iziguli eziningi zichitha amasonto angu-6-8 ekuvuseleleni amaphaphu ngaphambi kokuhlinzwa ukuze zakhe amandla azo kanye nekhono lokuphefumula.

Ungazifunda kanjani imiphumela yakho yokuhlinzwa ukunciphisa ivolumu yamaphaphu?

Impumelelo ngemva kwe-LVRS ilinganiswa ngokuthuthuka ekukhoneni kwakho ukuphefumula, ukubekezelela ukuzivocavoca, kanye nekhwalithi yempilo iyonke kunokuba nje izinombolo esivivinyweni. Odokotela bakho bazolandelela izinkomba ezimbalwa ezibalulekile ukuze bahlole ukuthi ukuhlinzwa kusebenze kahle kangakanani kuwe.

Nawa amasu amakhulu ithimba lakho lezokwelapha elizohlola ngayo imiphumela yakho:

• Ivolumu yokuphefumula ngamandla (FEV1) - ilinganisa ukuthi ungakanani umoya ongawukhipha ngomzuzwana owodwa
• Ukuhlolwa kokuhamba ngemizuzu eyisithupha - kulandelela ukuthi ungahamba ibanga elingakanani ngemizuzu eyisithupha
• Imibuzo yekhwalithi yempilo mayelana nemisebenzi yansuku zonke
• Amazinga okugcwala komoya-mpilo ngesikhathi sokuphumula nomsebenzi
• Ama-X-ray esifuba kanye ne-CT scans ukubona ukwanda kwamaphaphu
• Izivivinyo zegesi yegazi le-arterial ukuhlola amazinga omoya-mpilo ne-carbon dioxide

Iziguli eziningi zibona ukuthuthuka phakathi nezinyanga ezi-3-6 ngemva kokuhlinzwa. Ungase uqaphele ukuthi ungahamba ibanga elide ngaphandle kokuphelelwa umoya, ukukhuphuka izitebhisi kalula, noma ukubamba iqhaza emisebenzini obungeke ukwazi ukuyenza ngaphambi kokuhlinzwa.

Yini umphumela ongcono kakhulu wokuhlinzwa ukunciphisa ivolumu yamaphaphu?

Imiphumela emihle kakhulu yenzeka ezigulini ezinemphysema ye-upper lobe kanye nokungakwazi ukuzivocavoca ngaphambi kokuhlinzwa. Laba bantu bavame ukuzwa ukuthuthuka okukhulu kakhulu ekuphefumuleni, ekubekezeleni ukuzivocavoca, kanye nekhwalithi yempilo.

Abantu abafanelekayo ngokuvamile babona ukuthuthuka okungu-15-20% ezivivinyweni zabo zomsebenzi wamaphaphu futhi bangahamba ngamamitha angu-50-100 ngaphezulu esivivinyweni sokuhamba ngemizuzu eyisithupha. Iziguli eziningi zibika nokuzizwa zingenakuzwa ukuphefumula kanzima ngesikhathi semisebenzi yansuku zonke efana nokugeza, ukupheka, noma umsebenzi wasekhaya olula.

Izinzuzo zingahlala iminyaka eminingi, nakuba i-emphysema iyisimo esiqhubekayo. Ezinye iziguli zigcina umsebenzi wazo othuthukisiwe iminyaka engu-5-10 noma ngaphezulu, kanti ezinye zingase zibone ukwehla kancane kancane ngokuhamba kwesikhathi njengoba izicubu zamaphaphu ezisele ziguga.

Ziyini izici eziyingozi zemiphumela emibi yokuhlinzwa ukunciphisa ivolumu yamaphaphu?

Ezinye izici zingakhuphula ingozi yakho yezinkinga noma imiphumela emibi evela ku-LVRS. Ukuqonda lezi zici eziyingozi kusiza ithimba lakho lezokwelapha ukuthi linqume ukuthi ungumuntu ofanelekayo yini le nqubo.

Izimo eziningi zingenza ukuhlinzwa kube yingozi kakhulu kuwe:

• Umsebenzi wamaphaphu ophansi kakhulu (FEV1 ngaphansi kuka-20% wokujwayelekile)
• Isifo senhliziyo esibi noma i-pulmonary hypertension
• Ukuqhubeka nokubhema noma umlando wokubhema osanda kwenzeka
• Ukungondleki okukhulu noma ukuba nesisindo esiphansi kakhulu
• Ukuhlinzwa kwesifuba kwangaphambilini noma ukulimala kwesifuba okukhulu
• Izifo ezisebenzayo noma ukugula kokuphefumula kwakamuva
• Ubudala obuthuthukile (ngaphezu kweminyaka engu-75-80 ubudala)
• I-Homogeneous emphysema (ukulimala okusabalale ngokulinganayo kuwo wonke amaphaphu)

Ithimba lakho lezokwelapha lizohlola ngokucophelela lezi zici ngesikhathi sokuhlolwa kwakho ngaphambi kokuhlinzwa. Ngezinye izikhathi, ukubhekana nezici ezithile eziyingozi njengokudla okunomsoco noma ukulungisa kungathuthukisa ukufaneleka kwakho le nqubo.

Ingabe kungcono ukuhlinzwa ukunciphisa ivolumu yamaphaphu noma ukuphathwa kwezokwelapha?

Isinqumo phakathi kokuhlinzwa nokuqhubeka nokuphathwa kwezokwelapha sincike ohlotsheni lwakho oluthile lwe-emphysema, izimpawu zamanje, nesimo sempilo yakho esiphelele. Kubantu abafanele, i-LVRS inganikeza izinzuzo ezinkulu ezingafinyelelwa ukwelashwa kwezokwelapha kuphela.

Ukuhlinzwa kuvame ukuba yinzuzo enkulu uma une-emphysema ye-lobe engenhla enezindawo ezilimele kakhulu ezixutshwe nezicubu ezinempilo. Ezimweni ezinjalo, ukususa izindawo ezimbi kakhulu kungathuthukisa kakhulu ukuthi izicubu zakho zamaphaphu ezisele zisebenza kanjani.

Ukuphathwa kwezokwelapha kungase kube ngcono uma une-emphysema ye-homogeneous (ukulimala okusabalale ngokulinganayo kuwo wonke amaphaphu akho) noma uma umthamo wakho wokuzivocavoca usahle kahle. Udokotela wakho wamaphaphu uzokusiza ukuthi ulinganise izinzuzo ezingaba khona nezingozi zokuhlinzwa ngokuya ngesimo sakho somuntu ngamunye.

Ziyini izinkinga ezingaba khona zokuhlinzwa kokunciphisa ivolumu yamaphaphu?

Njenganoma yikuphi ukuhlinzwa okukhulu, i-LVRS ithwala kokubili izingozi ezivamile nezingavamile okuzoxoxwa ngazo ithimba lakho lezokwelapha nawe ngemininingwane. Ukuqonda lezi zinkinga ezingaba khona kukusiza ukuthi wenze isinqumo esinolwazi mayelana nokuthi ukuhlinzwa kulungile yini kuwe.

Nazi izinkinga ezivamile okufanele uzazi:

• Ukuvuza komoya okude kusuka endaweni yamaphaphu (kwenzeka kuma-30-50% eziguli)
• I-Pneumonia noma ezinye izifo zokuphefumula
• Ukuphuma kwegazi okudinga ukumpontshwa kwegazi
• Ukushaya kwenhliziyo okungajwayelekile ngesikhathi sokululama
• Ukudideka okwesikhashana noma i-delirium ngemva kwe-anesthesia
• Izinkinga zokuphola kwamanxeba noma ukutheleleka ezindaweni zokuhlinza
• Amahlule egazi emilenzeni noma emaphaphu

Izinkinga ezingathi sína kodwa ezingavamile zingabandakanya ukwehluleka kokuphefumula okudinga ukungeniswa komoya okude, ukuhlaselwa yinhliziyo, unhlangothi, noma ezimweni ezingavamile, ukufa. Izinga lokufa eliphelele le-LVRS cishe lingama-2-5% kuye ngesikhungo sezokwelapha nokukhethwa kwesiguli.

Kufanele ngibone nini udokotela ngemva kokuhlinzwa kokunciphisa ivolumu yamaphaphu?

Kufanele uthinte ithimba lakho lezokwelapha ngokushesha uma uhlangabezana nanoma yiziphi izimpawu ezikhathazayo ngesikhathi sokululama kwakho. Ukubona nokwelashwa kwangaphambi kwesikhathi kwezinkinga kungavimbela izinkinga ezingathi sína ukuthi zingathuthuki.

Shayela udokotela wakho ngokushesha uma uqaphela noma yiziphi lezi zimpawu zokuxwayisa:

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• Ukwanda okungazelelwe kokuphefumula noma ubuhlungu besifuba
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• Umkhuhlane ongaphezu kuka-100.4°F (38°C) noma izimpawu zokutheleleka
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• Ukukhwehlela igazi noma i-sputum ephuzi-luhlaza
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• Ububomvu, ukuvuvukala, noma ukukhipha emaceleni akho
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• Ukukhipha ngamashubhu esifuba okwanda ngokuzumayo noma okushintsha umbala
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• Ubuhlungu obukhulu obungalawulwa yimithi yakho echaziwe
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• Ukuvuvukala emilenzeni yakho noma ubunzima bokuphefumula lapho ulele phansi
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Uzoba nokuqokwa okulandelayo njalo ukuze uqaphe ukuphola kwakho futhi ulandelele ukuthuthuka kwakho. Lokhu kuvakasha kubalulekile ekubambeni noma yiziphi izinkinga kusenesikhathi nokulungisa uhlelo lwakho lokululama njengoba kudingeka.

Imibuzo evame ukubuzwa mayelana nokuhlinzwa kokuncishiswa kwevolumu yamaphaphu

Q.1 Ingabe ukuhlinzwa kokuncishiswa kwevolumu yamaphaphu kulungele zonke izinhlobo ze-emphysema?

Cha, i-LVRS isebenza kahle kakhulu ezinhlotsheni ezithile ze-emphysema, ikakhulukazi i-emphysema ye-lobe engenhla lapho umonakalo ugxile ezingxenyeni ezingenhla zamaphaphu akho. Lolu hlobo lwesibonelo somonakalo luvumela odokotela ukuthi basuse izindawo ezimbi kakhulu ngenkathi begcina izicubu ezinempilo ezinganwetshwa futhi zisebenze kangcono.

Uma une-homogeneous emphysema, lapho umonakalo usatshalaliswa ngokulinganayo kuwo wonke amaphaphu akho, ukuhlinzwa ngokuvamile akunconywa. Ezimweni ezinjalo, azikho izindawo ezithile ezi-

Kucabange njengokunikeza amaphaphu akho "ukuqala okusha" ngokususa izingxenye ezingasebenzi kahle. Lokhu kungahlinzeka ngeminyaka yokuphefumula okuthuthukisiwe kanye nekhwalithi yempilo, kodwa uzodinga ukuqhubeka nemithi yakho ye-emphysema nokunakekelwa okulandelayo.

Q.3 Kuthatha isikhathi esingakanani ukululama ngemuva kokuhlinzwa kokuncishiswa kwevolumu yamaphaphu?

Ukwelashwa kokuqala kuvame ukuthatha amasonto angu-6-8, kodwa ukululama okuphelele kungathatha izinyanga ezingu-3-6 noma ngaphezulu. Cishe uzochitha izinsuku ezingu-7-14 esibhedlela, nezinsuku ezimbalwa zokuqala ekunakekelweni okukhulu ukuze kuqashwe eduze.

Ngesikhathi samasonto ambalwa okuqala ekhaya, uzokwandisa kancane kancane izinga lakho lomsebenzi ngaphansi kokuqashwa kwezokwelapha. Iziguli eziningi ziqala ukubona izinzuzo zokuphefumula phakathi nezinyanga ezingu-1-3, ngentuthuko ephezulu evame ukwenzeka cishe ezinyangeni eziyisi-6 ngemuva kokuhlinzwa.

Q.4 Ngingahlinzwa yini ukuncishiswa kwevolumu yamaphaphu uma ngise-oxygen?

Ukuba ku-oxygen akukukhiphi ngokuzenzakalelayo ku-LVRS, kodwa kudinga ukuhlolwa ngokucophelela. Abantu abaningi abaphumelelayo basebenzisa i-oxygen eyengeziwe ngaphambi kokuhlinzwa, ikakhulukazi ngesikhathi sokuzivocavoca noma ukulala.

Ithimba lakho lezokwelapha lizohlola ukuthi ngabe izidingo zakho ze-oxygen zibangelwa yizinkinga zemishini ukuthi ukuhlinzwa kungazilungisa (njengomoya obanjwe) noma ezinye izinkinga ukuhlinzwa okungeke kuzisize. Ezinye iziguli zinganciphisa noma ziqede izidingo zazo ze-oxygen ngemuva kokuhlinzwa okuphumelelayo.

Q.5 Uyini umehluko phakathi kokuhlinzwa kokuncishiswa kwevolumu yamaphaphu nokufakelwa kwamaphaphu?

I-LVRS isebenza ngamaphaphu akho akhona ngokususa izingxenye ezilimele, kuyilapho ukufakelwa kwamaphaphu kuthatha amaphaphu akho ngokuphelele ngamaphaphu abanikeli. I-LVRS ngokuvamile icatshangelwa ezigulini ezinokugula okungathí sina kakhulu ezingadingi ukufakelwa okwamanje.

Ukwelashwa kusuka ku-LVRS ngokuvamile kufushane futhi akuyinkimbinkimbi kunokululama kokufakelwa. Kodwa-ke, ukufakelwa kungahlinzeka ngentuthuko enkulu ezigulini ezinokugula kwamaphaphu esigabeni sokugcina. Ithimba lakho lezokwelapha lizosiza ekunqumeni ukuthi iyiphi inketho efanele kakhulu isimo sakho esithile.