Ukuhlinzwa kwamaphaphu

Ukuhlinzwa kwamaphaphu ukuhlinzwa okwenziwa ukulungisa noma ukususa izicubu zamaphaphu. Kunokuhlinzwa okuningi okuvamile kwamaphaphu, kufaka phakathi:

• I-biopsy yokukhula okungaziwa
• I-Lobectomy, ukususa i-lobes eyodwa noma ngaphezulu yamaphaphu
• Ukufakelwa komlenze
• I-pneumonectomy, ukususa iphaphu
• Ukuhlinzwa ukuvimbela ukwakheka noma ukubuya koketshezi esifubeni (pleurodesis)
• Ukuhlinzwa ukususa ukutheleleka esifubeni (empyema)
• Ukuhlinzwa ukususa igazi esifubeni, ikakhulukazi ngemuva kokuhlukumezeka
• Ukuhlinzwa ukususa izicubu ezincane ezifana namabhaluni (ama-blebs) adala ukuwa kwamaphaphu (pneumothorax)
• Wedge resection, ukususa ingxenye ye-lobe ephashini

I-thoracotomy ukusika okuhlinzwa okwenziwa udokotela ohlinzayo ukuvula udonga lwesifuba.

Uzoba ne-anesthesia ejwayelekile ngaphambi kokuhlinzwa. Uzobe ulele futhi ungakwazi ukuzwa ubuhlungu. Izindlela ezimbili ezijwayelekile zokuhlinzwa emaphashini akho yi-thoracotomy kanye ne-video-assisted thoracoscopic surgery (VATS). Ukuhlinzwa ngerobhothi nakho kungasetshenziswa.

Ukuhlinzwa kwamaphaphu usebenzisa i-thoracotomy kubizwa ngokuhlinzwa okuvulekile. Kulokhu kuhlinzwa:

• Uzolala ngohlangothi lwakho etafuleni elisebenzayo. Ingalo yakho izobekwa ngaphezu kwekhanda lakho.
• Udokotela wakho ohlinzayo uzosika phakathi kwezimbambo ezimbili. Ukusika kuzosuka ngaphambili kodonga lwesifuba sakho kuye emuva, kudlule ngaphansi nje kwekhwapha. Lezi zimbambo zizohlukaniswa noma kususwe ubambo.
• Iphaphu lakho kulolu hlangothi lizoxegiswa ukuze umoya ungangeni futhi uphume kulo ngesikhathi sokuhlinzwa. Lokhu kwenza kube lula ukuthi udokotela ohlinzayo ahlinze iphaphu.
• Udokotela wakho ohlinzayo kungenzeka angazi ukuthi kungakanani amaphaphu akho okudingeka asuswe kuze kube yilapho isifuba sakho sivulekile futhi iphaphu lingabonakala.
• Udokotela wakho ohlinzayo angasusa futhi ama-lymph node kule ndawo.
• Ngemuva kokuhlinzwa, kuzofakwa amashubhu owodwa noma amaningi wokuhambisa amanzi endaweni yakho yesifuba ukukhipha uketshezi olwakhayo. La mashubhu abizwa ngokuthi amashubhu wesifuba.
• Ngemuva kokuhlinzwa emaphashini akho, udokotela wakho ohlinzayo uzovala izimbambo, imisipha nesikhumba ngemisipho.
• Ukuhlinzwa kwamaphaphu okuvulekile kungathatha amahora amabili kuya kwayisithupha.

Ukuhlinzwa kwe-thoracoscopic okusizwa ngevidiyo:

• Udokotela wakho ohlinzayo uzokwenza ukusikeka okuncane okuningana odongeni lwesifuba sakho. I-videocope (ithubhu enekhamera encane ekugcineni) namanye amathuluzi amancane azodluliswa ngalokhu kusikeka.
• Ngemuva kwalokho, udokotela wakho ohlinzayo angasusa ingxenye noma wonke amaphaphu akho, akhiphe uketshezi noma igazi elakhekile, noma enze ezinye izinqubo.
• Ishubhu elilodwa noma amaningi azobekwa esifubeni sakho ukukhipha uketshezi olwakhayo.
• Le nqubo iholela ezinhlungwini ezingatheni kakhulu nasekululameni ngokushesha kunokuhlinzwa okuvulekile kwamaphaphu.

Ukuhlinzwa kwe-thoracotomy noma kwe-thoracoscopic okusizwa ngevidiyo kungenziwa ku:

• Susa umdlavuza (njengomdlavuza wamaphaphu) noma i-biopsy ukukhula okungaziwa
• Phatha ukulimala okwenza izicubu zamaphaphu ziwe (i-pneumothorax noma i-hemothorax)
• Phatha izicubu zamaphaphu eziwile unomphela (atelectasis)
• Susa izicubu zamaphaphu ezigulayo noma ezilimele ku-emphysema noma i-bronchiectasis
• Susa amahlule egazi noma egazi (hemothorax)
• Susa izicubu, njenge-nodular pulmonary nodule
• Gcwalisa izicubu zamaphaphu eziwile (Lokhu kungenzeka kungenxa yesifo esifana nesifo samaphaphu esingapheliyo, noma ukulimala.)
• Susa ukutheleleka emgodini wesifuba (empyema)
• Misa ukwakhiwa koketshezi esifubeni (pleurodesis)
• Susa i-clot yegazi emthanjeni we-pulmonary (pulmonary embolism)
• Phatha izinkinga zesifo sofuba

Ukuhlinzekwa kwe-thoracoscopic okusizwa ngevidiyo kungasetshenziswa ekwelapheni eziningi zalezi zimo. Kwezinye izimo, ukuhlinzwa ngevidiyo kungenzeka kungenzeki, futhi udokotela ohlinzayo kungadingeka ashintshele kokuhlinzwa okuvulekile.

Izingozi zalokhu kuhlinzwa zifaka:

• Ukwehluleka kwamaphaphu ukukhula
• Ukulimala emaphashini noma emithanjeni yegazi
• Isidingo seshubhu yesifuba ngemuva kokuhlinzwa
• Ubuhlungu
• Ukuvuza komoya isikhathi eside
• Ukuphindaphindeka kokwakhiwa kuketshezi esifubeni
• Ukopha
• Ukutheleleka
• Ukuphazamiseka kwesigqi senhliziyo
• Ukulimala kwe-diaphragm, esophagus, noma trachea
• Ukufa

Uzoba nokuvakashelwa okuningana nomhlinzeki wakho wezokunakekelwa kwempilo futhi uvivinywe ngaphambi kokuhlinzwa. Umhlinzeki wakho uzokwenza lokhu:

• Yenza ukuhlolwa okuphelele komzimba
• Qiniseka ukuthi ezinye izimo zezokwelapha ongahle ube nazo, njengesifo sikashukela, umfutho wegazi ophakeme, noma izinkinga zenhliziyo noma zamaphaphu ziyalawulwa
• Yenza izivivinyo ukuze uqiniseke ukuthi uzokwazi ukubekezelela ukususwa kwezicubu zakho zamaphaphu, uma kunesidingo

Uma ubhema, kufanele uyeke ukubhema emasontweni ambalwa ngaphambi kokuhlinzwa kwakho. Cela usizo kumhlinzeki wakho.

Njalo utshele umhlinzeki wakho:

• Yimiphi imishanguzo, amavithamini, amakhambi, nezinye izithako ozithathayo, ngisho nalezo ozithenge ngaphandle kadokotela
• Uma uphuze utshwala obuningi, uphuza iziphuzo ezingaphezu kwezingu-1 noma ezi-2 ngosuku

Phakathi nesonto ngaphambi kokuhlinzwa kwakho:

• Ungacelwa ukuthi uyeke ukuthatha izidakamizwa ezenza kube nzima ngegazi lakho ukuminyana. Ezinye zazo i-aspirin, ibuprofen (Advil, Motrin), uvithamini E, warfarin (Coumadin), clopidogrel (Plavix), noma ticlopidine (Ticlid).
• Buza umhlinzeki wakho ukuthi yiziphi izidakamizwa okufanele usaziphuza ngosuku lokuhlinzwa kwakho.
• Lungiselela ikhaya lakho ukubuya kwakho esibhedlela.

Ngosuku lokuhlinzwa kwakho:

• Ungadli noma uphuze noma yini ngemuva kwamabili ebusuku ngaphambi kokuhlinzwa kwakho.
• Thatha imishanguzo kadokotela oyinikeze ngamanzi amancane.
• Umhlinzeki wakho uzokutshela ukuthi ufika nini esibhedlela.

Iningi labantu lihlala esibhedlela izinsuku ezinhlanu kuya kwezi-7 ngemuva kwe-thoracotomy evulekile. Ukuhlala esibhedlela kokuhlinzwa okusizwa nge-thoracoscopic kuvame ukuba kufushane kakhulu. Ungachitha isikhathi egumbini labagula kakhulu (i-ICU) ngemuva kokuhlinzwa.

Ngesikhathi uhlala esibhedlela, uzo:

• Celwa ukuba uhlale eceleni kombhede uhambe ngokushesha okukhulu ngemuva kokuhlinzwa.
• Yiba namashubhu aphuma ohlangothini lwesifuba sakho ukukhipha uketshezi nomoya.
• Gqoka amasokisi akhethekile ezinyaweni nasemilenzeni ukuvimbela amahlule egazi.
• Thola isibhamu ukuvimbela amahlule egazi.
• Thola umuthi wezinhlungu nge-IV (ishubhu elingena emithanjeni yakho) noma ngomlomo onamaphilisi. Ungathola umuthi wakho wezinhlungu ngomshini okhethekile okukunikeza isilinganiso somuthi wezinhlungu lapho ucindezela inkinobho. Lokhu kukuvumela ukuthi ulawule ukuthi uthola umuthi wezinhlungu ongakanani. Ungase futhi ubeke i-epidural. Leli yipayipi elingemuva eletha umuthi wezinhlungu ukunqamula izinzwa endaweni yokuhlinzwa.
• Celwa ukuthi uphefumule kakhulu ukuze usize ukuvimbela inyumoniya nokutheleleka. Ukuzivocavoca okujulile kuphinde kusize ukufuthisa iphaphu ebelihlinzwa. Amashubhu wesifuba sakho azohlala endaweni kuze kube yilapho iphaphu lakho seligcwele ngokuphelele.

Umphumela uncike ku:

• Uhlobo lwenkinga elashwa
• Kususwe izicubu zamaphaphu ezingakanani (uma zikhona)
• Impilo yakho yonke ngaphambi kokuhlinzwa

Thoracotomy; Ukususwa kwezicubu zomzimba; I-pneumonectomy; ILobectomy; I-biopsy yamaphaphu; Thoracoscopy; Ukuhlinzekwa kwe-thoracoscopic okusizwa ngevidiyo; IVATS

• Ukuphepha kwamakamelo abantu abadala
• Ungaphefumula kanjani uma ushoda ngokuphefumula
• Ukuhlinzwa kwamaphaphu - ukukhipha
• Ukuphepha kwe-oksijeni
• I-postural drainage
• Ukuvimbela ukuwa
• Ukunakekelwa kwesilonda sokuhlinzwa - kuvulekile
• Ukuhamba nezinkinga zokuphefumula
• Usebenzisa i-oxygen ekhaya
• Usebenzisa i-oxygen ekhaya - ukuthi ubuze ini kudokotela wakho

• I-pulmonary lobectomy - uchungechunge

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UFeller-Kopman DJ, u-Decamp MM. Izindlela zokungenelela nezokuhlinzwa ezifweni zamaphaphu. Ku: IGoldman L, iSchafer AI, ama-eds. Imithi yeGoldman-Cecil. Umhla ka-26. IPhiladelphia, PA: Elsevier; 2020: isahluko 93.

I-Lumb A, Thomas C. Ukuhlinzwa kwamaphaphu. Ku: Lumb A, Thomas C, eds. I-Applied Respiratory Physiology kaNunn noLumb. Umhlaka 9. IPhiladelphia, PA: Elsevier; 2021: isahluko 33.

UPutnam JB. Amaphaphu, udonga lwesifuba, i-pleura, ne-mediastinum. Ku: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. ISabiston Incwadi Yokuhlinzwa. Umhla ka-20. IPhiladelphia, PA: Elsevier Saunders; 2017: isahluko 57.