Mediastinoscopy inzira inobvumidza iwe kuti utarise mukati meiyo mediastinum, dunhu rechipfuva riri pakati pemapapu maviri, kubva pakucheka kudiki mumutsipa, pasina kuvhura mbabvu. Iyo zvakare inobvumira biopsies kutorwa.

Mediastinoscopy inonzi endoscopy ye mediastinum. Inobvumira kuongorora kwakananga kwenhengo dziri pakati pemapapu maviri, kunyanya moyo, maviri makuru bronchi, thymus, trachea uye esophagus, mitsipa mikuru yeropa (inokwira aorta, pulmonary arteries, vein superior vena cava. , nezvimwewo) uye nhamba ye lymph nodes. 

Mazhinji mediastinoscopy inosanganisira ma lymph node. Zvechokwadi, x-rays, scans uye MRIs zvinogona kuratidza kuti vakawana vhoriyamu, asi havatibvumiri kuziva kana izvi. adenomegaly imhaka yekuzvimba pathology kana bundu. Kuti usarudze, unofanirwa kuenda kunoona, uye pamwe nekutora lymph nodes imwe kana akawanda kuti aongororwe murabhoritari. Zvizhinji, mediastinoscopy inoshandiswa kuongorora masasi ekufungidzira ayo bvunzo yekufungidzira yakaonekwa mu mediastinum uye, kana zvichidikanwa, kugadzira biopsy.

Panzvimbo pekuvhura mbabvu yekuona ichi cheki, mediastinoscopy inoshandisa probe inonzi mediastinoscope. Iri chubhu ine hollow, yakashongedzerwa neoptical fibers uye kuburikidza nayo maturusi ekuvhiya anogona kupfuudzwa, inopinzwa muchipfuva kuburikidza nekuchekwa kwemasendimita mashoma kwakagadzirwa mujinga mehuro.

Kuvhiya uku kunongova kuongororwa. Inokurudzirwa mushure memaitiro echinyakare ekufungidzira ekurapa (x-rays, CT scan, MRI) apo izvi zvinoburitsa fungidziro huru mu mediastinum. Inobvumira: 

kutonga pamusoro pemhando yezvironda. Lymph nodes mu mediastinum inogona, semuenzaniso, kuzvimba mukupindura hutachiona senge tibhii kana sarcoidosis, asi zvakare kukanganiswa ne lymphoma (cancer ye lymphatic system) kana metastases kubva kune mamwe kenza (yemapapu, zamu kana esophagus. zvikuru sei);

kutora sampuli yemaviri kana ma lymph node, kana paine kusahadzika pamusoro pehuipi hwebundu kana kujekesa kuongororwa. Aya mabiopsies, akaongororwa murabhoritari, anoita kuti zvikwanise kumisa rudzi rwebundu, nhanho yekushanduka kwayo uye kuwedzera kwayo;

kutevera kushanduka kwemamwe magomarara emapapu, ari kunze kwenhengo iyi, saka anooneka kubva kumediastinum.

Zvakawanda uye zvakanyanya, mediastinoscopy iri kutsiviwa neutsva, zvishoma zvinokanganisa maitiro ekuongorora: iyo PET scan, izvo zvinoita kuti zvikwanisike, nekubatanidza jekiseni rechigadzirwa cheradioactive ne scanner, kuongorora mamwe kenza kana kutsvaga metastases; uye / kana Ultrasound-inotungamirirwa transbronchial biopsy, iyo inosanganisira kupfuudza tsono diki nemumuromo uyezve bronchi yekubaya lymph node iri kune rumwe rutivi rwebronchial madziro. Iyi nzira yekupedzisira, iyo isingade chero kuchekwa, ikozvino inotenderwa nekuvandudzwa kwe ariUltrasound bronchoscopy (kushandiswa kweendoscope inoshanduka-shanduka, yakaiswa nediki ultrasound probe pamagumo ayo). Asi kutsiva mediastinoscopy nemaitiro maviri aya hakugoneki nguva dzose. Izvo zvinoenderana zvakanyanya nenzvimbo yeronda. 

Saizvozvowo, mediastinoscopy haishandi mumamiriro ese ezvinhu. Kana maronda ebiopsy asingasvikike nenzira iyi (nekuti ari panzvimbo yepamusoro yepulmonary lobe, semuenzaniso), chiremba anovhiya anofanira kusarudza imwe nzira yekuvhiya: mediastinotomy, kureva kuvhurwa kwekuvhiya kwe mediastinum, kana thoracoscopy, endoscopy yechipfuva panguva ino ichipfuura nepadiki diki pakati pembabvu.

Kunyangwe iri bvunzo yekuongorora, mediastinoscopy chiito chekuvhiya. Naizvozvo inoitwa nachiremba anovhiya, muimba yemitambo, uye inoda kuiswa muchipatara kwemazuva matatu kana mana.

Mushure meanesthesia yakajairika, incision diki inoitwa pazasi pemutsipa, mune notch iri pamusoro pechipfuva. Iyo mediastinoscope, iyo refu yakasimba chubhu yakasungirirwa mwenje system, inounzwa kuburikidza neichi incision uye ichidzika mu mediastinum, ichitevera trachea. Chiremba anovhiya anogona kuongorora nhengo dziripo. Kana zvichidikanwa, anozivisa zvimwe zviridzwa kuburikidza ne endoscope kuita biopsy, yekuongorora marabhoritari. Kana chiridzwa ichi chabviswa, iyo incision inovharwa neabsorbeble suture kana biological glue.

Bvunzo iri rinotora nguva ingangoita awa. Kubuda muchipatara kunorongerwa zuva rinotevera kana maviri, kana vavhiyi vagutsikana kuti hapana matambudziko.

Iyo yekuona uye histological ruzivo rwakapihwa ne mediastinoscopy inoita kuti zvikwanise kutarisisa nzira yekurapa. Izvi zvinoenderana neiyo pathology yakaongororwa. 

Muchiitiko chegomarara, nzira dzekurapa dzakawanda, uye zvinoenderana nerudzi rwebundu, danho raro uye kuwedzera kwaro: kuvhiyiwa (kubviswa kwebundu, kubviswa kwechikamu chemapapu, nezvimwewo), chemotherapy, radiotherapy, immunotherapy kana kusanganiswa kwezvizhinji zvezvisarudzo izvi.

Kana paine metastasis, kurapwa chikamu chechirongwa chekurapa bundu rekutanga.

Kana iko kuzvimba kana hutachiona, iyo chaiyo chikonzero ichaongororwa uye kurapwa.

Zvinetso kubva pakuongorora uku hazviwanzo. Sezvakaita chero kuvhiyiwa, kune njodzi yakaderera yekuita kune anesthesia, kubuda ropa nekupwanya, hutachiona kana matambudziko ekuporesa. Kune zvakare njodzi isingawanzo kukuvara kune esophagus kana pneumothorax (kukuvadzwa kumapapu zvichiita kuti mweya uderedze mumuromo wepleural).

Iyo tsinga yelaryngeal inogonawo kutsamwiswa, inokonzera kupera kwenguva pfupi kwemazwi ezwi, zvichiita kuti pave nekuchinja kwezwi kana kuti hoarseness, iyo inogona kugara kwemavhiki mashomanana.

Marwadzo anonzwawo mumazuva ekutanga mushure mekuvhiyiwa. Asi mapiritsi anonyaradza marwadzo anoshanda. Mabasa akajairika anogona kutangwazve nekukurumidza. Kana riri vanga diki, rinopera zvakanyanya mukati memwedzi miviri kana mitatu.