I-Mediastinal Lymphadenopathy: Izimbangela, Izimpawu, Ukuxilongwa kanye Nokwelashwa

Ubuwazi ukuthi i-mediastinal lymphadenopathy ithinta izigidi zabantu emhlabeni jikelele? Ngokusho kocwaningo, iningi leziguli ezinomdlavuza wamaphaphu kanye ne-lymphoma ziba ne-mediastinal lymphadenopathy. Lesi simo esiyinkimbinkimbi singaba nezimbangela ezihlukahlukene, kusukela ekungenweni izifo kuya komdlavuza.

I-Mediastinal lymphadenopathy lapho itholakala ku-x ray yesifuba noma i-computed tomography scan idinga ukuhlolwa okwengeziwe njengoba ihlala ingenazimpawu ezimweni eziningi ize iguguleke noma iqhume ngesakhiwo se-mediastinal. Kodwa-ke, ngolwazi olulungile nokusekelwa, kungenzeka ukuphatha ngempumelelo i-mediastinal lymphadenopathy futhi uzuze umphumela omuhle. Kule bhulogi, sizohlola izimbangela, izimpawu, ukuxilongwa, nokwelashwa kwe-mediastinal lymphadenopathy, kanye nendlela entsha ye-EBUS-TBNA yokuxilongwa.

Kuyini i-mediastinal lymphadenopathy?

I-Mediastinal lymphadenopathy yisimo esibonakala ngokukhula okungavamile kwama-lymph nodes ku-mediastinum, okuyingxenye emaphakathi yesifuba sesifuba esiphakathi kwamaphaphu. I-mediastinum iqukethe izakhiwo ezimbalwa ezibalulekile, kufaka phakathi inhliziyo, uqhoqhoqho, umminzo, nemithambo yegazi emikhulu, kanye nama-lymph nodes esifuba esimaphakathi.

Ukwandiswa kwama-lymph nodes e-mediastinal kungaba uphawu lwezimo ezihlukahlukene zezokwelapha, njengezifo eziphansi zokuphefumula, Isifo sofuba, izimo zokuvuvukala, kanye umdlavuza. Lesi simo singaba sibi noma sibe yingozi futhi singabonisa izimpawu ezihlukahlukene, kuhlanganise ubuhlungu besifuba, ukuphelelwa umoya, nokukhwehlela okungapheli. Izimpawu zalezi zimo ngokuvamile aziqondile futhi azisizi ekwehlukaniseni kwazo esinye kwesinye. Ngakho-ke, ukuxilongwa kwe-histopathological kwezicubu kuyadingeka ekuphathweni kwe-mediastinal lymphadenopathy.

Yiziphi izimbangela ze-lymphadenopathy ye-mediastinal?

Izimo ezibangela i-mediastinal lymphadenopathy zihluke kakhulu ezihlanganisa (1)

• Izimbangela eziyingozi:
  • Umdlavuza wamaphaphu oyinhloko we-Metastatic Lymphoma
  • Izifo ze-Metastatic (Esophagus, GIT, Breast) Isifo sikaCastleman
• Izinkinga ezinhle:
  • Izifo:
    • Isifo sofuba
  • I-mycobacteria engeyona isifo sofuba i-Histoplasmosis Coccidioidomycosis Ukuvuvukala:
    • Sarcoidosis
    • Isifo se-beryllium esingamahlalakhona

Yiziphi izimpawu ze-mediastinal lymphadenopathy?

Izimpawu ze-mediastinal lymphadenopathy zingahluka kuye ngokuthi imbangela eyinhloko kanye nobukhulu besimo. Izimpawu zalezi zimo ngokuvamile aziqondile futhi azisizi ekwehlukaniseni kwazo esinye kwesinye.

Ezinye izimpawu ezivamile zihlanganisa:

• Ukukhwehlela okuqhubekayo
• Fever
• Ukwehla kwesisindo
• Ubuhlungu besifuba noma ukungakhululeki
• Ukuphelelwa umoya
• Ukushisa
• Kunzima ukugwinya
• Ukuthuthumela
• Ukuvuvukala kobuso, intamo, noma izingalo
• Ukukhathala
• Izithukuthuku ebusuku

Yiziphi izindlela zokuxilonga i-mediastinal lymphadenopathy?

• Ukuhlolwa Kwezithombe: Ukuhlolwa kwesithombe kuyizinqubo ezingahlanyisi ezisetshenziselwa ukuhlola ubukhulu nenombolo kanye nokuma kwama-lymph nodes esifubeni. Ama-CT scan azwela kakhulu kune-X-ray yesifuba. I-Contrast-enhanced computed tomography (CECT) yesifuba uphenyo lokuqala. I-PET CT izwela kakhulu futhi icacile kunesifuba se-CE CT sokuhlolwa kwama-lymph nodes aphakathi nendawo kanye nesiteji somdlavuza wamaphaphu namanye ama-metastatic cancer, kodwa anendima encane kwezinye izimo zesifo esiyingozi.
• Isampula: Uma imbangela ye-mediastinal lymphadenopathy ingaqinisekile, kungase kudingeke i-biopsy ukuze kutholakale isimo esiyisisekelo. Inqubo evamile i-mediastinoscopy, inqubo yokuhlinzwa ehilela ukusika okuncane ngenhla kwe-sternum ukuze kufakwe ithuluzi le-fibre-optic elibizwa ngokuthi i-mediastinoscope ukuze kutholwe isampula ye-lymph node eyodwa noma amaningana. Enye inqubo engavamile kakhulu, i-finenele aspiration (FNA) noma i-endobronchial noma i-esophageal ultrasound, nayo ingenziwa ukuze kutholwe isampula ye-biopsy. Akuvamile ukuthi i-thoracoscopy kanye ne-anterior mediastinotomy ingacatshangelwa ukuze kuthathwe isampula yama-lymph nodes e-mediastinal.
• I-Mediastinoscopy: I-mediastinoscopy iyinqubo yokuhlinzwa ehlola i-mediastinum, isikhala esifubeni phakathi kwamaphaphu. Inqubo ihilela ukusikwa okuncane ngenhla kwamakhanda e-clavicular kanye nokufaka indawo yokuhlola ama-lymph nodes esifubeni. Uma kukhona okungavamile kuqashelwa, kuzokwenziwa i-biopsy. I-Mediastinoscopy imvamisa yenziwa ngaphansi kwe-anesthesia ejwayelekile endaweni yesibhedlela.

Umugqa we-Ebus

I-Linear endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA full form) iyinqubo yokuxilonga ehlasela kancane evame ukusetshenziselwa ukuthola amasampula kuma-mediastinal lymph nodes ezigulini ezine-mediastinal lymphadenopathy.

I-EBUS-TBNA ihlanganisa ukubonwa kwe-endoscopic kwama-lymph nodes aphakathi ne-high-frequency ultrasound (USG) imaging futhi inikeze amandla ukuthola amasampula ezilonda ze-cytological and histological.

I-EBUS ihlanganiswe ne-ultrasound, esiza ukubona ngeso lengqondo izakhiwo emaphashini noma eduze kwendlela yomoya kanye naku-mediastinum(2)(3).

Inaliti ende, ezacile ibe isidluliswa kububanzi be-EBUS futhi iye ku-lymph node. Inalithi isetshenziselwa ukuqoqa isampula lamaseli noma izicubu ku-lymph node, bese ithunyelwa elabhorethri ukuze ihlaziywe.

Uhlu olubanzi lwe-mediastinal (ama-LNs e-paratracheal kwesokudla nakwesokunxele aphezulu naphansi, ama-LN angaphansi kwe-subcarinal) nama-lymph node ama-hilar kanye nezilonda ezizungeze imigudu yomoya kungafinyelelwa yi-EBUS–TBNA.

I-Linear EBUS - TBNA, izosiza kukho kokubili ukuxilongwa kanye nesiteji somdlavuza wamaphaphu.

Indlela ye-EBUS-TBNA yomugqa inezinzuzo ezimbalwa kunezinye izinqubo zokuxilonga. Ayihlaseleki kakhulu kunezinqubo zokuhlinzwa ze-biopsy ezifana ne-mediastinoscopy, engadinga i-anesthesia evamile kanye nokuhlala esibhedlela. Ukuhlolwa kwe-EBUS-TBNA kungenziwa ngesisekelo sokulaliswa esibhedlela, okungaba lula futhi kungabizi kakhulu ezigulini. I-EBUS-TBNA futhi inesivuno esiphezulu sokuxilonga, esinokuzwela okuphezulu nokucacisa, ukuze kuhlonzwe i-mediastinal lymphadenopathy.

I-Linear EBUS-TBNA iyithuluzi lokuxilonga eliphephile nelisebenzayo lokuhlola i-mediastinal lymphadenopathy. Ivumela amasampula anembile futhi ahlasele kancane ama-lymph nodes e-mediastinal, angahlinzeka ngokuxilongwa okuqondile futhi aqondise ukwelashwa okufanele.

Ezigulini ezinezinsolo ze-lymphoma kanye nezimo lapho sidinga izicubu ezengeziwe zokuhlaziywa kwamangqamuzana - singacabangela indlela entsha yenoveli EBUS- Transbronchial cryonodal biopsy ukuze uthole izicubu eziningi.

Kuyini ukwelashwa kwe-Mediastinal Lymphadenopathy?

Ukwelashwa kwe-mediastinal lymphadenopathy kuncike kumbangela eyisisekelo yalesi simo.

Okokugcina, ukuthola ukuxilongwa kwe-mediastinal lymphadenopathy kungaba okuhlangenwe nakho okunzima. Lesi simo esiyinkimbinkimbi singaba nezinhlobonhlobo zezimbangela, kusukela ekuthelelekeni kuya kumdlavuza, futhi ukuxilongwa kudinga ukuhlolwa okuphelele. Nokho, likhona ithemba. I-EBUS-TBNA iye yavela njengethuluzi elithembisayo nelingangeneleli kangako lokuxilongwa, futhi ngokutholwa kusenesikhathi nokwelashwa okufanele, umbono ungaba muhle. Kuyalulekwa ukuthi ufune usizo lwezokwelapha ngokushesha uma kutholakala ukuthi une-mediastinal lymphadenopathy ukuze uhlolwe futhi uphathwe. Abantu abaningi baphatha ngempumelelo isimo sabo, ngakho-ke ungesabi ukubamba iqhaza elibonakalayo ekunakekelweni kwakho kwezempilo futhi uhlale unethemba.