Raws li cov ntaub ntawv tseem ceeb ntawm Lub Chaw Haujlwm Thoob Ntiaj Teb rau Kev Tshawb Fawb Txog Kab Mob Cancer (IARC) ntawm Lub Koom Haum Kev Noj Qab Haus Huv Ntiaj Teb (WHO), mob qog noj ntshav ntsws tau dhau los ua ib qho ntawm cov qog nqaij hlav loj tshaj plaws, thiab kev tiv thaiv thiab kho mob qog noj ntshav ntsws tau dhau los ua qhov tseem ceeb tshaj plaws ntawm kev tiv thaiv thiab kho mob qog noj ntshav.
Raws li cov ntaub ntawv txheeb cais tseem ceeb, tsuas yog kwv yees li20% ntawm cov neeg mob qog nqaij hlav ntsws uas tsis yog me me tuaj yeem phais kho tauFeem ntau ntawm cov neeg mob qog nqaij hlav ntsws twb nyob hauvcov theem siab heevthaum kuaj pom tias muaj mob, thiab lawv yuav tau txais txiaj ntsig tsawg los ntawm kev kho mob radiotherapy thiab chemotherapy ib txwm muaj. Nrog rau kev nce qib tas mus li thiab kev txhim kho ntawm kev tshawb fawb kho mob, qhov tshwm sim ntawmkev kho mob ablativeua ib qho kev hloov pauv rau kev phais tau coj kev cia siab tshiab rau cov neeg mob qog noj ntshav ntsws.
1. Koj paub ntau npaum li cas txog kev kho mob qog nqaij hlav ntsws?
Kev kho mob qog nqaij hlav rau mob qog nqaij hlav feem ntau suav nrogkev kho mob microwave ablation thiab kev kho mob radiofrequencyLub hauv paus ntsiab lus ntawm kev kho mob suav nrog kev ntxig lub electrode ablative, tseem hu ua a"kev tshawb nrhiav,"mus rau hauv qhov mob qog hauv lub ntsws. Lub electrode tuaj yeem ua raukev txav mus los saintawm cov khoom me me xws li ions lossis cov dej hauv cov qog, tsim cua sov vim yog kev sib txhuam, ua raukev puas tsuaj uas tsis rov qab kho tau xws li coagulative necrosis ntawm cov hlwb qog.Tib lub sijhawm, qhov ceev ntawm kev hloov pauv cua sov txo qis sai sai hauv cov ntaub so ntswg ib puag ncig, khaws cia cua sov hauv qog, tsim ib qho"Cov nyhuv ntawm kev rwb thaiv tsev kub."Kev kho mob Ablative tuaj yeem tua tau cov qog nqaij hlav thaumua kom muaj kev tiv thaiv zoo tshaj plaws ntawm cov ntaub so ntswg ntawm lub ntsws.
Kev kho mob Ablative yog tus cwj pwm los ntawm nwsrov ua dua tau, tsis mob tus neeg mob tsawg, raug mob me me, thiab rov zoo sai,thiab tau lees paub dav thiab siv hauv kev kho mob. Txawm li cas los xij, xav txog tias kev kho mob ablative muaj ntau yam kev kawm xws li radiology, oncology, interventional radiology, thiab phais anatomy, nws xav tau qib siab ntawm kev txawj phais thiab cov yam ntxwv zoo los ntawm tus kws kho mob ua haujlwm.
Niaj hnub no, peb xav qhia rau koj ib tug kws tshaj lij nto moo hauv kev kho mob cuam tshuam,Dr. Liu Chen, uas tau ua haujlwm hauv daim teb no tau ntau xyoo thiab tau mob siab rau kev tshawb fawb txog kev txhais lus hauv kev kho mob thiab kev ua kom nrov npe ntawm kev kuaj mob thiab kev kho mob tsawg kawg nkaus xws li kev kuaj mob qog nqaij hlav nyuaj thiab muaj kev pheej hmoo siab, kev tshem tawm cua sov, thiab kev cog cov khoom me me.Dr. Liu yog lub npe hu ua "tus phab ej ntawm lub taub koob" thiab tau koom nrog kev tsim cov kev pom zoo ntawm cov kws tshaj lij thiab cov lus qhia rau ntau yam kev kho mob qog noj ntshav hauv Suav teb. Nws tau tsim lub tswv yim ntawm kev tswj hwm tag nrho ntawm cov qog noj ntshav hauv lub ntsws thiab tsim cov txheej txheem phais mob kom txhim kho kev txiav txim siab ntawm kev kho mob hauv zos rau qog noj ntshav theem pib, txhawb kev txhim kho tag nrho ntawm Tuam Tshoj txoj kev kuaj mob qog noj ntshav thiab kev kho mob.
"Tus phab ej ntawm lub taub koob" - Kws Kho Mob Liu Chen
Tshwj xeeb hauv kev kuaj mob thiab kho mob tsawg kawg nkaus rau cov qog nqaij hlav raws li kev taw qhia duab
1. Kev rho tawm ntawm lub tshuab hluav taws xob microwave/radiofrequency
2. Kev kuaj mob los ntawm kev siv koob txhaj tshuaj
3. Kev cog cov khoom me me uas muaj cov tshuaj radioactive
4. Kev tswj qhov mob los ntawm kev siv tshuaj kho mob
2. Lub hom phiaj thiab cov cim qhia ntawm kev kho mob ablative rau mob qog noj ntshav hauv lub ntsws
Cov "Kev Pom Zoo ntawm Cov Kws Tshaj Lij Txog Kev Kho Mob Ablative rau Cov Mob Qog Ntsws Primary thiab Metastatic"(Xyoo 2014 tsab) faib kev kho mob ablative rau mob qog noj ntshav hauv lub ntsws ua ob pawg: kho thiab palliative.
Kev kho mob ablationlub hom phiaj yog ua kom cov nqaij mob hauv zos puas tsuaj tag thiab tej zaum yuav ua tiav cov txiaj ntsig kho tau.Mob qog nqaij hlav ntsws theem pib yog qhov qhia tau tseeb rau kev kho mob ablative,tshwj xeeb tshaj yog rau cov neeg mob uas lub plawv ua haujlwm tsis zoo, hnub nyoog laus lawm, tsis muaj peev xwm ua phais, tsis kam phais, lossis cov neeg uas muaj ib qho qog rov qab los tom qab conformal radiotherapy, nrog rau qee cov neeg mob uas muaj ntau qhov mob qog nqaij hlav hauv lub ntsws uas xav tau kev tswj hwm lub ntsws ua haujlwm.
Kev tshem tawm ntawm kev mob nkeeglub hom phiaj rauua kom lub qog nqaij hlav tseem ceeb tsis ua haujlwm ntau tshaj plaws rau cov neeg mob uas muaj mob qog nqaij hlav ntsws theem siab, txo qhov hnyav ntawm lub qog nqaij hlav, txo cov tsos mob uas tshwm sim los ntawm lub qog nqaij hlav, thiab txhim kho tus neeg mob lub neej zoo.Rau cov neeg mob uas muaj mob qog nqaij hlav ntsws theem siab heev, cov qog nqaij hlav uas muaj qhov loj tshaj plaws >5 cm lossis muaj ntau qhov txhab tuaj yeem siv ntau koob, ntau lub ntsiab lus, lossis ntau zaus kho mob, lossis siv ua ke nrog lwm txoj kev kho mob kom ntev lub neej. Rau cov qog nqaij hlav ntsws theem kawg uas kis mus rau lwm qhov, yog tias kev tswj cov qog nqaij hlav sab nraud ntsws zoo thiab tsuas muaj me ntsis ntawm cov qhov txhab kis mus rau lwm qhov uas tseem tshuav nyob hauv ntsws, kev kho mob ablative tuaj yeem pab tswj tus kab mob thiab txhim kho tus neeg mob lub neej zoo.
3. Cov txiaj ntsig ntawm kev kho mob ablative
Kev phais mob tsawg kawg nkaus, rov zoo sai: Kev kho mob ablative yog suav tias yog kev phais mob me me. Lub koob ablative electrode siv feem ntau muaj txoj kab uas hla ntawm1-2 hli, ua rau muaj cov qhov me me ntawm kev phais mob uas loj li lub qhov koob. Txoj hauv kev no muaj cov txiaj ntsig xws litsawg qhov raug mob, tsawg qhov mob, thiab rov zoo sai dua.
Lub sijhawm phais luv luv, kev paub zoo:Kev kho mob Ablative feem ntau ua nyob rau hauv qab tshuaj loog hauv zos lossis ua ke nrog kev siv tshuaj loog rau hauv cov hlab ntsha, tshem tawm qhov xav tau kev ntxig raj endotracheal. Cov neeg mob nyob rau hauv lub xeev pw tsaug zog me ntsis thiab tuaj yeem sawv tau yooj yim nrog kev kov maj mam. Qee tus neeg mob yuav xav tias kev phais tau ua tiav tom qabpw tsaug zog sai sai.
Kev kuaj mob tib lub sijhawm kom paub tseeb tias yog:Thaum lub sijhawm kho mob ablative, siv cov cuab yeej coaxial guidance lossis synchronous puncture biopsy los kuaj qhov mob. Tom qab ntawdkev kuaj mob pathological thiab kev kuaj noob caj noob cesmuab cov ntaub ntawv tseem ceeb rau kev txiav txim siab kho mob tom ntej.
Cov txheej txheem rov ua dua: Muaj ntau txoj kev tshawb fawb los ntawm ob qho tib si hauv tebchaws thiab thoob ntiaj teb tau qhia tias tus nqi tswj hwm hauv zos ntawm cov neeg mob qog nqaij hlav thaum ntxov uas tau txais kev kho mob ablative zoo ib yam li kev phais mob lossis kev kho mob stereotactic radiation. Yog tias muaj kev rov tshwm sim hauv zos, kev kho mob ablativetuaj yeem rov ua dua ntau zauskom rov qab tswj tau tus kab mob thaum lub sijhawm ntawdua kom tus neeg mob lub neej zoo tshaj plaws.
Kev ua kom lub cev tiv thaiv kab mob ua haujlwm tau zoo lossis txhim kho kev tiv thaiv kab mob: Kev kho mob Ablative tsom mus rautua cov qog nqaij hlav hauv lub cev, thiab qee zaum, nws tuaj yeem ua kom tus neeg mob lub cev tiv thaiv kab mob ua haujlwm tau zoo lossis txhim kho, ua rau muaj qhov twg cov qog nqaij hlav tsis tau kho nyob rau lwm qhov ntawm lub cev qhia txog kev rov qab los. Tsis tas li ntawd, kev kho mob ablative tuaj yeem ua ke nrog kev kho mob thoob plaws lub cev los tsimib qho kev cuam tshuam synergistic.
Kev kho mob Ablative yog qhov tsim nyog rau cov neeg mob uas tsis tuaj yeem zam kev phais mob lossis kev siv tshuaj loog dav dav vim yogkev ua haujlwm ntawm lub plawv thiab lub ntsws tsis zoo, hnub nyoog laus, lossis ntau yam kab mob sib koom ua keNws kuj yog ib qho kev kho mob zoo rau cov neeg mob uas muajntau lub qog nqaij hlav theem thaum ntxov (xws li ntau lub qog nqaij hlav hauv av).
Lub sijhawm tshaj tawm: Lub Yim Hli-23-2023