Cryoablation rau Pulmonary Nodule
Mob ntsws cancer ntau heev thiab txhawj xeeb Pulmonary Nodules
Raws li cov ntaub ntawv los ntawm Lub Chaw Haujlwm Saib Xyuas Kev Tshawb Fawb Thoob Ntiaj Teb rau Kev Tshawb Fawb Txog Kev Kho Mob ntawm Lub Koom Haum Ntiaj Teb Kev Noj Qab Haus Huv, kwv yees li 4.57 lab tus neeg mob qog noj ntshav tshiab tau kuaj pom hauv Suav teb xyoo 2020,nrog rau mob ntsws cancer suav txog kwv yees li 820,000 tus neeg mob.Ntawm 31 lub xeev thiab lub nroog hauv Suav teb, qhov tshwm sim ntawm mob ntsws cancer hauv cov txiv neej yog thawj zaug hauv txhua cheeb tsam tshwj tsis yog Gansu, Qinghai, Guangxi, Hainan, thiab Tibet, thiab cov neeg tuag coob tshaj plaws tsis hais poj niam los txiv neej.Tag nrho qhov tshwm sim ntawm pulmonary nodules hauv Suav teb yog kwv yees li ntawm 10% txog 20%, nrog rau qhov muaj feem ntau dua ntawm cov neeg muaj hnub nyoog tshaj 40 xyoo.Txawm li cas los xij, nws yuav tsum tau muab sau tseg tias feem ntau ntawm pulmonary nodules yog benign lesions.
Kev kuaj mob ntawm Pulmonary Nodules
Pulmonary nodulesxa mus rau focal puag ncig-zoo li tus duab ntxoov ntxoo ntom ntom hauv lub ntsws, nrog ntau qhov ntau thiab tsawg thiab pom meej lossis qhov muag plooj, thiab txoj kab uas hla tsawg dua lossis sib npaug li 3 cm.
Kev Ntsuas Kev Ntsuas:Tam sim no, lub hom phiaj scanning imaging txheej txheem, hu ua av-iav opacity nodule imaging diagnosis, yog dav siv.Qee cov kws tshaj lij tuaj yeem ua tiav qhov kev sib raug zoo ntawm cov kab mob mus txog 95%.
Pathological Diagnosis:Txawm li cas los xij, kev kuaj pom tsis tuaj yeem hloov kho cov ntaub so ntswg pathology, tshwj xeeb tshaj yog nyob rau hauv cov mob ntawm cov qog nqaij hlav tshwj xeeb kev kho mob uas yuav tsum muaj kev kuaj mob molecular pathological ntawm qib cellular.Kev kuaj mob pathological tseem yog tus qauv kub.
Txoj Kev Diagnostic and Therapeutic Approaches for Pulmonary Nodules
Percutaneous Biopsy:Kev kuaj mob ntawm cov nqaij mos pathology thiab kev kuaj mob molecular pathology tuaj yeem ua tiav nyob rau hauv cov tshuaj loog hauv zos ntawm percutaneous puncture.Qhov nruab nrab qhov ua tiav ntawm kev kuaj ntshav biopsy yog li 63%,tab sis muaj teeb meem xws li pneumothorax thiab hemothorax tuaj yeem tshwm sim.Txoj kev no tsuas yog txhawb kev kuaj mob thiab nyuaj rau kev kho mob ib txhij.Kuj tseem muaj kev pheej hmoo ntawm qog cell shedding thiab metastasis.Pa percutaneous biopsy muab cov ntaub so ntswg tsawg,ua rau lub sijhawm tiag tiag ntawm cov nqaij mos pathology kuaj mob nyuaj.
General Anesthesia Video-Assisted Thoracoscopic Surgery (VATS) Lobectomy: Txoj hauv kev no tso cai rau kev kuaj mob thiab kev kho mob ib txhij, nrog kev ua tiav nce mus txog 100%.Txawm li cas los xij, txoj kev no yuav tsis haum rau cov neeg mob laus lossis cov neeg tshwj xeebuas yog intolerant rau general tshuaj loog, cov neeg mob uas muaj cov qog pulmonary me dua 8 hli hauv qhov loj lossis qis dua (<-600), cov nodules nyob sib sib zog nqus ntawm ntu ntu, thiabnodules nyob rau hauv lub mediastinal cheeb tsam nyob ze ntawm lub hilar lug.Tsis tas li ntawd, kev phais yuav tsis yog qhov kev kuaj mob tsim nyog thiab kev xaiv kho mob rau cov xwm txheej cuam tshuampostoperative recurrence, recurrent nodules, los yog metastatic qog.
Txoj Kev Kho Tshiab rau Pulmonary Nodules - Cryoablation
Nrog kev txhim kho txuas ntxiv ntawm kev kho mob thev naus laus zis, kev kho mob qog tau nkag mus rau lub sijhawm ntawm "precision kuaj thiab precision kho".Niaj hnub no, peb yuav qhia txog ib txoj kev kho mob hauv zos uas muaj txiaj ntsig zoo rau cov qog nqaij hlav uas tsis yog mob qog nqaij hlav thiab cov qog nqaij hlav uas tsis yog vascular proliferative pulmonary nodules, nrog rau cov qog nqaij hlav thaum ntxov (tsawg dua 2 cm) -cryoablation.
Kev kho mob Cryotherapy
Ultra-low temperature cryoablation txheej txheem (cryotherapy), tseem hu ua cryosurgery los yog cryoablation, yog ib qho kev kho mob phais uas siv khov kho cov ntaub so ntswg.Raws li CT kev taw qhia, qhov tseeb qhov chaw yog ua tiav los ntawm kev xuas cov qog nqaij hlav.Tom qab ncav cuag qhov txhab, qhov kub thiab txias hauv cheeb tsam ntawm qhov chaw yog sai sai txo mus rau-140 ° C rau -170 ° Csivargon rojhauv feeb, yog li ua tiav lub hom phiaj ntawm kev kho mob qog ablation.
Lub hauv paus ntsiab lus ntawm Cryoablation rau Pulmonary Nodules
1. Ice-crystal effect: Qhov no tsis cuam tshuam rau cov kab mob pathology thiab ua rau muaj kev kuaj mob sai sai.Cryoablation lub cev tua cov qog hlwb thiab ua rau microvascular occlusion.
2. Cov nyhuv Immunomodulatory: Qhov no ua tiav qhov kev tiv thaiv kab mob nyob deb ntawm cov qog. Nws txhawb nqa kev tso tawm antigen, ua kom lub cev tiv thaiv kab mob, thiab txo qis kev tiv thaiv kab mob.
3. Kev ruaj khov ntawm cov kabmob ntawm lub cev (xws li lub ntsws thiab lub siab): Qhov no ua rau muaj kev vam meej ntawm kev kuaj ntshav. Lub pob khov khov yog tsim, ua kom yooj yim kom ruaj khov, thiab cov npoo yog qhov tseeb thiab pom ntawm daim duab.Daim ntawv thov patented no yooj yim thiab siv tau zoo.
Vim yog ob tus yam ntxwv ntawm cryoablation -"khov anchoring thiab fixation effect" thiab "cov ntaub so ntswg zoo tom qab khov yam tsis muaj kev cuam tshuam rau kev kuaj mob pathological", nws tuaj yeem pab hauv lub ntsws nodule biopsy,ua tiav lub sij hawm khov kho pathological thaum lub sij hawm tus txheej txheem, thiab txhim kho qhov ua tau zoo ntawm biopsy.Nws tseem hu ua "cryoablation rau pulmonary nodule biopsy".
Qhov zoo ntawm Cryoablation
1. Hais txog kev ua pa tsis zoo:Lub hauv paus khov khov ua rau lub ntsws cov ntaub so ntswg (siv coaxial lossis bypass khov txoj kev).
2. Hais txog pneumothorax, hemoptysis, thiab kev pheej hmoo ntawm huab cua embolism thiab qog noob: Tom qab tsim lub pob khov, kaw qhov tsis zoo siab extracorporeal channel yog tsim los rau kev kuaj mob thiab kho lub hom phiaj.
3. Ua tiav qhov kev kuaj mob thiab kho cov hom phiaj ntawm qhov chaw: Cryoablation ntawm lub ntsws nodule ua ntej, tom qab ntawd rov ua kom sov thiab 360 ° multidirectional biopsy kom nce cov ntaub so ntswg.
Txawm hais tias cryoablation yog ib txoj hauv kev rau kev tswj cov qog hauv zos, qee cov neeg mob tuaj yeem pom cov tshuaj tiv thaiv kab mob nyob deb.Txawm li cas los xij, ntau cov ntaub ntawv qhia tau hais tias thaum cryoablation ua ke nrog kev siv xov tooj cua, kws khomob, kev kho mob, kev tiv thaiv kab mob, thiab lwm yam kev kho mob, kev tswj cov qog nqaij hlav ntev tuaj yeem ua tiav.
Indications rau Percutaneous Cryoablation nyob rau hauv CT Guide
B-zone lub ntsws nodules: Rau lub ntsws nodules xav tau segmental lossis ntau segmental resection, percutaneous cryoablation tuaj yeem muab kev kuaj mob ua ntej.
A-zone ntsws nodules: Bypass los yog oblique mus kom ze (lub hom phiaj yog tsim kom muaj lub ntsws cov ntaub so ntswg channel, nyiam dua nrog ib tug ntev ntawm 2 cm).
Cov lus qhia
Non-malignant hlav thiab non-vascular proliferative pulmonary nodules:
Qhov no suav nrog cov kab mob precancerous (atypical hyperplasia, nyob rau hauv cov kab mob carcinoma), lub cev tsis muaj zog tiv thaiv kab mob, cov kab mob inflammatory pseudotumors, cov hlwv hauv zos thiab abscesses, thiab cov caws pliav proliferative nodules.
Early-stage qog nodules:
Raws li cov kev paub dhau los, cryoablation kuj yog ib txoj kev kho mob zoo piv rau kev phais phais rau hauv av-iav opacity nodules me dua 2 cm nrog tsawg dua 25% khoom tivthaiv.
Post lub sij hawm: Sep-05-2023