Mediastinoscopy ndi njira yomwe imakulolani kuti muwone mkati mwa mediastinum, dera la chifuwa chomwe chili pakati pa mapapo awiri, kuchokera kumtunda waung'ono pakhosi, popanda kutsegula nthiti. Komanso amalola biopsies kutengedwa.

Mediastinoscopy ndi endoscope ya mediastinum. Amalola kuyang'ana kwachindunji kwa ziwalo zomwe zili pakati pa mapapo awiri, makamaka mtima, bronchi yayikulu, thymus, trachea ndi esophagus, mitsempha yayikulu yamagazi (kukwera kwa aorta, mitsempha yam'mapapo, mtsempha wapamwamba kwambiri wa vena cava). , etc.) ndi ma lymph nodes angapo. 

Nthawi zambiri mediastinoscopy imakhudza ma lymph nodes. Zowonadi, ma X-ray, ma scan ndi ma MRIs angasonyeze kuti apeza mphamvu, koma salola kuti tidziwe ngati izi adenomegaly chifukwa cha kutupa kwa pathology kapena chotupa. Kuti musankhe, muyenera kupita kukawona, ndipo mwina kutenga ma lymph nodes amodzi kapena angapo kuti akawunikidwe mu labotale. Nthawi zambiri, mediastinoscopy imagwiritsidwa ntchito poyang'ana unyinji wokayikitsa womwe mayeso oyerekeza apeza mu mediastinum ndipo, ngati kuli kofunikira, kupanga biopsy.

M'malo motsegula khola la nthiti kuti muwonetsere chithunzichi, mediastinoscopy imagwiritsa ntchito kafukufuku wotchedwa mediastinoscope. Kachubu kakang'ono kameneka, kokhala ndi ulusi woonekera komanso kamene tingadutsemo zida zazing'ono zopangira maopaleshoni, amalowetsedwa m'chifuwa mwa kudulidwa masentimita angapo m'munsi mwa khosi.

Opaleshoni imeneyi ndi yongodziwira matenda. Zimalimbikitsidwa pambuyo pa njira zamakono zojambula zamankhwala (x-ray, CT scan, MRI) pamene izi zimawulula anthu okayikitsa mu mediastinum. Zimalola: 

kulamulira pa chikhalidwe cha zotupa. Ma lymph nodes mu mediastinum amatha, mwachitsanzo, kutupa chifukwa cha matenda monga chifuwa chachikulu kapena sarcoidosis, komanso kukhudzidwa ndi lymphoma (khansa ya lymphatic system) kapena metastases ochokera ku khansa ina (ya m'mapapo, m'mawere kapena kum'mero). makamaka);

kutenga zitsanzo za minyewa kapena ma lymph nodes, ngati mukukayikira za vuto la chotupa kapena kuti mufotokoze bwino za matendawo. Ma biopsies awa, omwe amawunikidwa mu labotale, amathandizira kukhazikitsa mtundu wa chotupa, siteji yake yachisinthiko ndi kufalikira kwake;

kutsatira kusinthika kwa khansa ya m'mapapo yomwe ili kunja kwa chiwalo ichi, chifukwa chake imawonekera kuchokera ku mediastinum.

Mochulukirachulukira, mediastinoscopy ikusinthidwa ndi njira zatsopano zowunikira matenda: the PET kuyesa, zomwe zimapangitsa kuti zikhale zotheka, mwa kuphatikiza jekeseni wa mankhwala a radioactive ndi scanner, kuti azindikire khansa zina kapena kufufuza metastases; ndi / kapena ultrasound motsogozedwa transbronchial biopsy, zomwe zimaphatikizapo kudutsa singano yaing'ono pakamwa ndiyeno bronchi kuti puncture mwanabele yomwe ili mbali ina ya bronchial khoma. Njira yotsirizayi, yomwe sikutanthauza kudulidwa kulikonse, tsopano ikuloledwa ndi chitukuko cha ndiultrasound bronchoscopy (kugwiritsa ntchito endoscope yosinthika kwambiri, yokhala ndi kachipangizo kakang'ono ka ultrasound kumapeto kwake). Koma m'malo mediastinoscopy ndi njira ziwirizi si nthawi zonse zotheka. Zimatengera makamaka malo a chotupacho. 

Momwemonso, mediastinoscopy sikugwira ntchito muzochitika zonse. Ngati zotupa za biopsy sizikupezekanso motere (chifukwa zili pamtunda wapamwamba wa m'mapapo, mwachitsanzo), dokotalayo ayenera kusankha njira ina yopangira opaleshoni: mediastinotomy, kutanthauza kutsegula kwa mediastinum, kapena thoracoscopy, endoscopy ya thorax nthawi ino kudutsa m'mabowo ang'onoang'ono pakati pa nthiti.

Ngakhale ndi kuyesa kwa matenda, mediastinoscopy ndi opaleshoni. Choncho amachitidwa ndi dokotala wa opaleshoni, m'malo opangira opaleshoni, ndipo amafuna kuti agone m'chipatala masiku atatu kapena anayi.

Pambuyo pa anesthesia wamba, kudulidwa pang'ono kumapangidwira pansi pa khosi, mumphako pamwamba pa fupa la pachifuwa. The mediastinoscope, chubu lalitali lolimba lokhala ndi njira yowunikira, imayambitsidwa kudzera m'magawo awa ndikutsikira mu mediastinum, kutsatira trachea. Dokotalayo amatha kufufuza ziwalo zomwe zili pamenepo. Ngati ndi kotheka, amayambitsa zida zina kudzera mu endoscope kuti apange biopsy, kuti afufuze zasayansi. Chidacho chikachotsedwa, chotchingacho chimatsekedwa ndi suture kapena guluu wachilengedwe.

Mayesowa amatha pafupifupi ola limodzi. Kutulutsidwa kwa chipatala kumakonzedweratu tsiku lotsatira kapena awiri, kamodzi madokotala ochita opaleshoni akhutira kuti palibe zovuta.

Chidziwitso chowoneka ndi histological choperekedwa ndi mediastinoscopy chimapangitsa kuti zitheke kuwongolera njira yochizira. Izi zimatengera ma pathologies omwe amapezeka. 

Pakachitika khansa, njira zochizira zimakhala zingapo, ndipo zimadalira mtundu wa chotupa, siteji yake ndi kufalikira kwake: opaleshoni (kuchotsa chotupa, kuchotsedwa kwa gawo la mapapu, ndi zina), chemotherapy, radiotherapy, immunotherapy kapena kuphatikiza zingapo mwa zosankha izi.

Kukachitika metastasis, chithandizo ndi gawo la dongosolo la chithandizo cha chotupa chachikulu.

Ngati ndi kutupa kapena matenda, chifukwa chenichenicho chidzafufuzidwa ndikuchiritsidwa.

Zovuta za mayesowa ndizosowa. Mofanana ndi opaleshoni iliyonse, pali chiopsezo chochepa cha kuchitapo kanthu kwa anesthesia, kutuluka magazi ndi kuvulaza, matenda kapena machiritso. Palinso chiwopsezo chosowa chowononga kummero kapena pneumothorax (kuvulala m'mapapo kumapangitsa kuti mpweya ulowe mumphako).

Mitsempha ya laryngeal ingathenso kukwiyitsa, kuchititsa kufooka kwakanthawi kwa zingwe zapakhosi, zomwe zimapangitsa kusintha kwa mawu kapena kutulutsa mawu, komwe kumatha kwa milungu ingapo.

Ululu umamvekanso masiku oyambirira pambuyo pa opaleshoni. Koma mankhwala ochepetsa ululu amagwira ntchito. Zochita zanthawi zonse zitha kuyambiranso mwachangu kwambiri. Ponena za chilonda chaching’onocho, chimazimiririka kwambiri mkati mwa miyezi iwiri kapena itatu.