Cost of liver cancer surgery In India

Ukuhlinzwa kungenye yezindlela zokwelashwa ezinhle kakhulu ekwelapheni umdlavuza wesibindi esigabeni sokuqala. Kunezinhlobo ezahlukene zokuhlinzwa komdlavuza wesibindi okufanele zenziwe futhi kunqunywa udokotela ochwepheshe ohlinza umdlavuza wesibindi. Uhlobo lokuhlinzwa okufanele lwenziwe luncike esigabeni sesifo, ukusabalala kwesifo kwezinye izingxenye kanye nesimo sempilo yesiguli. Kanye nodokotela ohlinzayo wesimila futhi ususa ingxenye yezicubu ezizungeze amaseli wesimila. Kungenzeka kube yindlela yokwelapha ephumelela kakhulu eqondiswe yisifo, ikakhulukazi ezigulini ezisebenza kahle kwesibindi nezimila ezingasuswa ngokuphepha engxenyeni elinganiselwe yesibindi. Ukuhlinza kungase kungabi yinketho uma isimila sithatha kakhulu esibindini, isibindi silimele kakhulu, isimila sisabalele ngaphandle kwesibindi, noma isiguli sinezinye izifo ezimbi kakhulu. I-oncologist ehlinzayo ingudokotela ogxile ekwelapheni umdlavuza esebenzisa ukuhlinzwa. Udokotela ohlinza i-hepatobiliary naye unokuqeqeshwa okukhethekile ekuhlinzeni isibindi namanyikwe. Kwesinye isikhathi, odokotela abahlinzayo bokufakelwa isibindi bayabandakanyeka kulokhu kuhlinzwa. Ngaphambi kokuhlinzwa, khuluma nethimba lakho lokunakekelwa kwezempilo mayelana nemiphumela engemihle engaba khona evela ekuhlinzweni okuqondile oyokwenza.

Iziguli ezifanelekela ukuhlinzwa umdlavuza wesibindi

uchwepheshe wethu uzocabangela ukuhlinzwa kuphela uma umdlavuza uqukethwe endaweni eyodwa yesibindi sakho futhi ungazange usabalele kunoma iyiphi enye ingxenye yomzimba wakho. Lokhu ngokuvamile kusho isigaba 0 noma isigaba A kusukela ohlelweni lwesiteji lwe-BCLC. Ukuhlinzwa ngeke kwelaphe umdlavuza uma ususabalele. Ngeshwa ukuhlinzwa akunakwenzeka kubantu abaningi abanomdlavuza wesibindi oyinhloko.

Unochungechunge lokuhlolwa kwegazi ukuze uthole ukuthi isibindi sakho sisebenza kahle kangakanani ngaphambi kokuba udokotela wakho anqume ukuthi ukuhlinzwa kuyinketho yakho yini. Njengoba isibindi siyisitho esibaluleke kangaka, badinga ukwazi ukuthi ingxenye yesibindi sakho esele ngemva kokuhlinzwa kwakho izosebenza kahle ngokwanele ukuze ikugcine unempilo.

Izinhlobo zokuhlinzwa komdlavuza wesibindi

I-hepatectomy eyingxenye

Ingxenye yesibindi iwukuhlinzwa ukuze kukhishwe ingxenye yesibindi. Abantu abanomsebenzi omuhle wesibindi kuphela abaphile kahle ngokwanele ukuba bahlinzwe futhi abanethumba elilodwa elingakakhuli libe yimithambo yegazi abangawenza lo msebenzi.

Ukuhlolwa kwezithombe, njenge-CT noma i-MRI ene-angiography kwenziwa kuqala ukuze kubonakale ukuthi umdlavuza ungasuswa ngokuphelele yini. Noma kunjalo, ngezinye izikhathi phakathi nokuhlinzwa umdlavuza utholakala umkhulu kakhulu noma ususakazeke kakhulu ukuba ungasuswa, futhi ukuhlinzwa okuhleliwe akukwazi ukwenziwa.

Iningi leziguli ezinomdlavuza wesibindi e-United States nazo zine-cirrhosis. Kumuntu onesifo sokusha kwesibindi esinamandla, ukususa ngisho nenani elincane lezicubu zesibindi emaphethelweni omdlavuza kungase kungashiyi isibindi esanele ukuze senze imisebenzi ebalulekile.

Abantu abane-cirrhosis ngokujwayelekile bayakufanelekela ukuhlinzwa uma kunethumba elilodwa kuphela (elingakakhuli libe yimithambo yegazi) futhi basazoba nenani elizwakalayo (okungenani u-30%) lomsebenzi wesibindi osele lapho isimila sesisusiwe. Odokotela bavame ukuhlola lo msebenzi ngokunikeza isikolo se-Child-Pugh, okuyisilinganiso se-cirrhosis esisekelwe ekuhlolweni kwelebhu ethile nezimpawu.

Iziguli ezisekilasini A le-Child-Pugh cishe zizosebenza ngokwanele kwesibindi ukuze zihlinzwe. Iziguli ezisekilasini B mancane amathuba okuthi zingakwazi ukuhlinzwa. Ukuhlinzwa ngokuvamile akuyona inketho yeziguli ezisekilasini C.

Inqubo ye-Hepatectomy

Inqubo yokuhlinzwa yenziwa ngaphansi kwe-anesthesia ejwayelekile futhi yinde impela, idinga amahora amathathu kuya kwamane. Isiguli esilaliswe izinzwa sibheke phezulu futhi izingalo zombili zidonswe kude nomzimba. Odokotela abahlinzayo bavame ukusebenzisa i-pad yokushisisa nokusonga ezingalweni nasemilenzeni ukuze banciphise ukulahlekelwa kwezinga lokushisa lomzimba ngesikhathi sokuhlinzwa. Isisu sesiguli sivulwa ngokusikwa engxenyeni engenhla yesisu kanye nokusikwa okunwetshiwe okuphakathi nendawo kuze kufike ku-xiphoid (uqwanga olutholakala ngezansi maphakathi nezimbambo). Izinyathelo eziyinhloko ze-hepatectomy eyingxenye bese ziqhubeka kanje:

• Ukukhulula isibindi. Umsebenzi wokuqala kadokotela ohlinzayo ukukhulula isibindi ngokusika imicu emide eyisongayo.
• Ukususwa kwezigaba. Uma udokotela ohlinzayo esekhulule isibindi, ukususwa kwezingxenye kungaqala. Udokotela ohlinzayo kufanele agweme ukugqashuka kwemithambo yegazi ebalulekile ukuze agweme ukopha. Kungasetshenziswa izindlela ezimbili ezahlukene. Owokuqala uthi udokotela ohlinzayo enze ukusha okukha phezulu nge-lancet kagesi ebusweni besibindi ukumaka ukuhlangana phakathi kwezingxenye ezimakwe ukususwa kanye nesibindi sonke. Usika ingxenye, bese ekhala ebheke ku-hepatic parenchyma. Kungumehluko wokumelana phakathi kwe-parenchyma kanye nezitsha ezivumela udokotela ohlinzayo ukuthi abone ukuba khona komkhumbi. Kuleli qophelo, uhlukanisa umkhumbi ngokukhipha izicubu ezixhumene ezizungezile, bese uyawubopha. Khona-ke udokotela ohlinzayo angakwazi ukusika umkhumbi, ngaphandle kwengozi esigulini. Indlela yesibili ihlanganisa ukuhlonza imikhumbi emikhulu ephakela izingxenye ezizosuswa. Udokotela ohlinzayo usebenza kuqala ezingeni lemithambo ukuze akhulule bese ebopha imikhumbi edingekayo. Ekugcineni, udokotela ohlinzayo angakwazi ukusika ngaphandle kokukhathazeka ngokusika imikhumbi emincane.

Izingozi nemiphumela emibi ye-hepatectomy

Ukukhishwa kwesibindi kuwumsebenzi omkhulu, obucayi okufanele wenziwe kuphela odokotela abahlinzayo abanekhono nabanolwazi. Ngenxa yokuthi abantu abanomdlavuza wesibindi ngokuvamile banezinye izinkinga zesibindi ngaphandle komdlavuza, odokotela abahlinzayo kufanele basuse okwanele kwesibindi ukuze bazame ukuwuthola wonke umdlavuza, kodwa futhi bashiye okwanele ukuze isibindi sisebenze.

• Ukopha: Igazi eliningi lidlula esibindini, futhi ukopha ngemva kokuhlinzwa kuyinkinga enkulu. Futhi, isibindi ngokuvamile senza izinto ezisiza igazi ukuba lihlule. Ukulimala kwesibindi (kokubili ngaphambi kokuhlinzwa naphakathi nokuhlinzwa) kunganezela ezinkingeni zokopha ezingase zibe khona.
• Ukutheleleka
• Izinkinga ze-anesthesia
• Ama-clots egazi
• I-pneumonia
• Umdlavuza wesibindi omusha: Ngenxa yokuthi isibindi esisele sisenaso isifo esiholela kumdlavuza, ngezinye izikhathi umdlavuza wesibindi omusha ungakhula ngemva kwalokho.

Ukufakelwa kwesibindi

Uma kutholakala, ukufakelwa kwesibindi kungase kube inketho engcono kakhulu kwabanye abantu abanomdlavuza wesibindi. Ukufakelwa kwesibindi kungaba inketho kulabo abanamathumba angakwazi ukususwa ngokuhlinzwa, mhlawumbe ngenxa yendawo esikuyo noma ngenxa yokuthi isibindi sinesifo esiningi kakhulu ukuba isiguli singakwazi ukubekezelela ukukhipha ingxenye yaso. Ngokuvamile, ukufakelwa kusetshenziselwa ukwelapha iziguli ezinamathumba amancane (okungaba isimila esi-1 esingaphansi kuka-5 cm ububanzi noma amathumba angu-2 kuya kwangu-3 angekho ngaphezu kuka-3 cm) angakakhuli abe yimithambo yegazi eseduze. Kungase futhi kube okungavamile ukukhetha ezigulini ezinomdlavuza okhishwa kabusha (umdlavuza ongasuswa ngokuphelele). Ngokufakelwa, akukhona nje kuphela ukuthi ingozi yomdlavuza wesibindi omusha wesibili iyancipha kakhulu, kodwa isibindi esisha sizosebenza ngokujwayelekile.

Ngokusho kwe-Organ Procurement and Transplantation Network, cishe ukufakelwa kwesibindi kwe-1,000 kwenziwa kubantu abanomdlavuza wesibindi e-United States ngo-2016, unyaka wokugcina izinombolo ezitholakalayo. Ngeshwa, amathuba okufakelwa kwesibindi anqunyelwe. Zibalelwa ku-8,400 kuphela izibindi ezitholakalayo ukuze zifakelwe kabusha unyaka nonyaka, futhi eziningi zazo zisetshenziselwa iziguli ezinezifo ngaphandle komdlavuza wesibindi. Ukwandisa ukuqwashisa ngokubaluleka kokunikela ngezitho zomzimba kuwumgomo obalulekile wezempilo womphakathi ongenza lokhu kwelashwa kutholakale ezigulini eziningi ezinomdlavuza wesibindi nezinye izifo zesibindi ezinzima.

Izibindi eziningi ezisetshenziselwa ukufakelwa zivela kubantu abasanda kushona. Kodwa ezinye iziguli zithola ingxenye yesibindi kumnikeli ophilayo (imvamisa eyisihlobo esiseduze) ukuze zifakwe. Isibindi singakwazi ukuvuselela okunye ukusebenza kwaso okulahlekile ngokuhamba kwesikhathi uma ingxenye yaso isusiwe. Noma kunjalo, ukuhlinzwa kunezingozi ezithile kumnikeli. Cishe ukufakelwa kwesibindi somnikeli ophilayo okungaba ngu-370 kwenziwa e-United States unyaka ngamunye. Inani elincane kuphela labo eleziguli ezinomdlavuza wesibindi.

Abantu abadinga ukufakelwa kumele balinde kuze kutholakale isibindi, okungase kuthathe isikhathi eside kwabanye abantu abanomdlavuza wesibindi. Ezimweni eziningi umuntu angase athole ezinye izindlela zokwelapha, ezifana ne-embolization noma i-ablation, ngesikhathi elinde ukufakelwa kwesibindi. Noma odokotela bangase basikisele ukuhlinzwa noma ezinye izindlela zokwelapha kuqala bese ukufakelwa kabusha uma umdlavuza ubuya.

Obani abangafaneleki ekufakelweni isibindi?

• Isifo sezempilo esibi, esingenakulungiseka esibeka umkhawulo wokuphila kwesikhashana
• Umfutho wegazi ophakeme wamaphaphu (okusho umfutho we-pulmonary artery omkhulu kuno-50mmHg)
• Umdlavuza osusabalele ngaphandle kwesibindi
• Ukutheleleka ngesistimu noma okungalawuleki
• Ukusetshenziswa kabi kwezidakamizwa okusebenzayo (izidakamizwa kanye/noma utshwala)
• Ingozi engamukelekile yokusebenzisa kabi izidakamizwa (izidakamizwa kanye/noma utshwala)
• Umlando wokungathobeli imithetho, noma ukungakwazi ukunamathela kuhlelo lwezokwelapha oluqinile
• Isifo sengqondo esibi, esingalawuleki

Inqubo yokufakelwa kwesibindi

Ukufakelwa kwesibindi kuhilela ukususwa nokulungiswa kwesibindi esinikelayo, ukususwa kwesibindi esigulayo, nokufakwa kwesitho esisha. Isibindi sinokuxhuma okubalulekile okuningana okufanele kumiswe kabusha ukuze isitho esisha sithole ukugeleza kwegazi futhi sikhiphe i-bile esibindini. Izakhiwo okufanele zixhunywe kabusha yi-vena cava engaphansi, i-portal vein, i-hepatic artery, kanye ne-bile duct. Indlela eqondile yokuxhuma lezi zakhiwo iyahlukahluka kuye ngokuthi umnikeli othile kanye ne-anatomy noma izinkinga ze-anatomic zomamukeli futhi, kwezinye izimo, isifo somamukeli.

Kumuntu ofakelwa isibindi, ukulandelana kwezehlakalo egunjini lokuhlinza imi kanje:

1. Incision
2. Ukuhlolwa kwesisu kokungajwayelekile okungavimbela ukufakelwa kwesibindi (isibonelo: ukutheleleka okungatholakalanga noma ukonakala)
3. Ukuhlanganisa isibindi somdabu (ukuhlakazwa kokunamathiselwe kwesibindi endaweni yesisu)
4. Ukuhlukaniswa kwezakhiwo ezibalulekile (i-vena cava engaphansi ngenhla, ngemuva, nangaphansi kwesibindi; i-portal vein; i-bile duct evamile; i-hepatic artery)
5. Ukuguqulwa kwezakhiwo ezibalulwe ngenhla nokususwa kwesibindi somdabu, esinesifo.
6. Ukuthunga esibindini esisha: Okokuqala, ukugeleza kwegazi kwe-venous kumiswa kabusha ngokuxhuma i-vena cava yomnikeli kanye nomamukeli nemithambo ye-portal. Okulandelayo, ukugeleza kwe-arterial kumiswa kabusha ngokuthunga imithambo ye-hepatic yomnikeli nomamukeli. Okokugcina, ukuphuma kwe-biliary kufinyelelwa ngokuthunga imigudu yenyongo evamile yomnikeli nomamukeli.
7. Ukuqinisekisa ukulawula okwanele ukopha
8. Ukuvalwa kokusikwa

Izinkinga Zokuhlinzwa

Njenganoma iyiphi inqubo yokuhlinzwa, izinkinga ezihlobene nokusebenza zingase zenzeke, ngaphezu kwezinkinga eziningi ezingase zenzeke kunoma yisiphi isiguli esilaliswe esibhedlela. Ezinye zezinkinga eziqondene nokufakelwa kwesibindi ezingase zihlangatshezwe zihlanganisa:

Ukungasebenzi okuyisisekelo noma ukungasebenzi kahle kwesibindi esisanda kufakelwa kabusha kwenzeka cishe ku-1-5% wokufakelwa okusha. Uma umsebenzi wesibindi ungathuthuki ngokwanele noma ngokushesha ngokwanele, isiguli singase sidinge ngokuphuthumayo ukufakelwa kwesibili ukuze siphile.

• I-Hepatic artery thrombosis, noma ukujiya komthambo we-hepatic (umkhumbi wegazi oletha igazi elinomoya-mpilo osuka enhliziyweni uye esibindini) kwenzeka ku-2-5% wabo bonke abashonile abafakelwayo. Ingozi iphindwe kabili ezigulini ezithola ukufakelwa komuntu ophilayo. Amaseli esibindi ngokwawo awahlushwa ukulahlekelwa ukugeleza kwegazi emithanjeni ye-hepatic ngoba ondliwe ngokuyinhloko yigazi ukugeleza kwegazi lephothali. Ngokuphambene, imigudu yenyongo incike kakhulu emthanjeni we-hepatic ukuze uthole ukudla okunomsoco futhi ukulahlekelwa lokho kugeleza kwegazi kungase kuholele esibazini se-bile duct kanye nezifo. Uma lokhu kwenzeka, kungase kudingeke okunye ukufakelwa.
• I-Portal vein thrombosis noma ukujiya komthambo omkhulu oletha igazi elivela ezithweni zesisu (amathumbu, amanyikwe, kanye nobende - izitho eziyingxenye ye-portal circulation) esibindini zenzeka njalo. Le nkinga ingase idinge noma ingadingi ukufakelwa kwesibindi kwesibili.
• Izinkinga ze-biliary: Ngokuvamile, kunezinhlobo ezimbili zezinkinga ze-biliary: ukuvuza noma ukuqina. Izinkinga ze-biliary zithinta cishe u-15% wabo bonke abashonile abafakelwa omunye umuntu futhi kufika ku-40% wabo bonke abafakelwayo abaphilayo.
  • Ukuvuza kwe-biliary kusho ukuthi i-bile iphuma emgodini we-bile futhi ingena emgodini wesisu. Kaningi, lokhu kwenzeka lapho onikelayo kanye nomamukeli be-bile ducts bethungwa ndawonye. Lokhu kuvame ukwelashwa ngokubeka i-stent, noma ishubhu lepulasitiki, ngaphesheya kokuxhumana ngesisu namathumbu amancane bese kuvumela ukuxhumana ukuthi kuphole. Endabeni yokufakelwa kwesibindi esiphilayo noma ukuhlukaniswa kwesibindi, i-bile nayo ingavuza emaphethelweni asikiwe esibindi. Ngokuvamile, i-drain ifakwa futhi ishiywe ngesikhathi sokuhlinzwa kokufakelwa eceleni konqenqema olusikiwe ukuze kukhishwe noma iyiphi i-bile engase ivuze. Uma nje i-bile ingaqoqi esiswini, isiguli asiguli. Ukuvuza kuzophola ngokuhamba kwesikhathi, kodwa kungadinga izinqubo zokwelashwa ezengeziwe.
  • Ukuqina kwe-biliary kusho ukuncipha komgudu wenyongo, okuholela ekuvimbeni okuhlobene noma okuphelele kokugeleza kwenyongo kanye nokutheleleka okungenzeka. Ezikhathini eziningi, ukufinyela kwenzeka endaweni eyodwa, futhi lapho onikelayo nomamukeli amapayipi athungwe ndawonye. Lokhu kuncishiswa kuvame ukuphathwa ngokunwebisa indawo ewumngcingo ngebhaluni kanye/noma ukufaka i-stent ngaphesheya kokuqina. Uma lezi zindlela zingaphumeleli, ukuhlinzwa kuvame ukwenziwa ukuze kwakhiwe ukuxhumana okusha phakathi komgudu wesibindi wesibindi kanye nengxenye yamathumbu. Akuvamile, ukuqina kwebiliary kwenzeka ezindaweni eziningi noma ezingenakubalwa kuso sonke isihlahla se-biliary. Lokhu kwenzeka kaningi ngenxa yokuthi isihlahla se-biliary sasingalondolozwanga kahle ngesikhathi lapho isibindi singekho ekusakazweni komnikeli noma kumamukeli. Izibindi ezitholwe kubanikeli bokufa kwenhliziyo zisengozini enkulu kunaleyo evela kubanikeli abashonile ebuchosheni. Ngaphandle kwalokho, ukuqina kwe-biliary kungase kwenzeke uma isihlahla se-biliary singenalo igazi elanele ngenxa yokungajwayelekile komthambo we-hepatic.
• Ukopha kuyingozi yanoma iyiphi inqubo yokuhlinzwa kodwa ingozi ethile ngemva kokufakelwa kwesibindi ngenxa yobuningi bokuhlinzwa futhi ngenxa yokuthi ukujiyisa kudinga izici ezenziwe isibindi. Iziguli eziningi zokufakelwa zopha inani elincane futhi zingase zithole ukumpontshelwa okwengeziwe ngemva kokuhlinzwa. Uma ukopha kukhulu noma kushesha, ukubuyela egunjini lokuhlinza ukuze kulawulwe ukopha ngokuvamile kuyadingeka. Ngokuvamile, cishe u-10% wabamukeli bokufakelwa bazodinga ukuhlinzwa okwesibili ukuze ukopha.
• Ukutheleleka - Ukutheleleka kungenzeka ngesikhathi sokuphulukiswa kwesilonda esidalwe yinoma yikuphi ukuhlinzwa. Abamukeli bokufakelwa isibindi nabo basengozini yokutheleleka ekujuleni kwesisu, ikakhulukazi uma kukhona iqoqo legazi noma i-bile (kusuka ekuvuzeni kwebile). Imithi yokuzivikela komzimba kanye nomlando wokwehluleka kwesibindi kwandisa ingozi yomamukeli wokufakelwa isibindi yokuthola ukutheleleka ngemva kokufakelwa.

I-Immunosuppression

Umzimba womuntu uye wakha uchungechunge oluyinkimbinkimbi kakhulu lwezivikelo ezilwa namagciwane, amagciwane, nezimila. Imishini yesimiso sokuzivikela ezifweni iye yavela ezigidini zeminyaka ukuze ibone futhi ihlasele noma yini engaphandle noma okungezona “uqobo.” Ngeshwa, izitho ezitshaliwe ziwela esigabeni sangaphandle, hhayi sona. Inqwaba yemithi inikezwa abemukeli bokufakelwa ukuze kwehliswe izimpendulo zesistimu yabo yokuzivikela komzimba emzamweni wokugcina isitho siphephile futhi singenakho ukuhlaselwa kwe-immunologic. Uma isimiso somzimba sokuzivikela sibuthakathaka ngokwanele, khona-ke ukwenqatshwa - inqubo lapho isimiso somzimba sokuzivikela sihlonza, sihlasela, futhi silimaza isitho esifakwe kabusha - silandela.

Izidakamizwa ezivame ukusetshenziswa ukuvimbela ukwenqatshwa ngokucindezela amasosha omzimba zibalwe ngezansi. Basebenza ngezindlela ezihlukene ukuze benze buthaka ukuphendula kwamasosha omzimba ezintweni ezivusa amadlingozi futhi bahlotshaniswa nemiphumela engemihle ehlukene. Ngenxa yalokho, le mithi ivame ukusetshenziswa ezinhlanganisela ezihlukahlukene okwandisa umphumela immunosuppressive jikelele kuyilapho kuncishiswe side effects.

• I-Corticosteroids (i-methylprednisolone inikezwa nge-intravenously; i-prednisone inikezwa ngomlomo): I-Corticosteroids iyikilasi lama-anti-inflammatory agents avimbela ukukhiqizwa kwama-cytokines, ama-molecule abonisa amangqamuzana amasosha omzimba ukuze ahlele futhi aqinise ukuphendula komzimba. Ngakho-ke, i-corticosteroids ivimbela ukusebenza kwama-lymphocyte, amasosha ayinhloko we-immune reaction ngokumelene nezitho ezitshaliwe. Lokhu kucatshangwa ukuthi kuvimbela i-T-cell (isethi engaphansi yama-lymphocyte) ngendlela engaqondile. Imiphumela engemihle ye-corticosteroids ibanzi futhi ihlanganisa i-hyperglycemia, umfutho wegazi ophakeme, ukuncipha kwamathambo, nokulimala kwesilonda,
• I-Calcineurin inhibitors (i-cyclosporine, i-tacrolimus): Lesi sigaba sezidakamizwa sivimba umsebenzi we-calcineurin, i-molecule ebaluleke kakhulu endleleni ebaluleke kakhulu yokubonisa i-lymphocyte ebangela ukukhiqizwa kwama-cytokines amaningi. Le mithi, eyaqala ukwakhiwa cishe eminyakeni engama-20 edlule, yashintsha ukufakelwa kwezitho zomzimba. Banciphisa kakhulu izehlakalo zokwenqatshwa, bathuthukisa impilo ende yezitho ezitshaliwe futhi ngaleyo ndlela bangenisa inkathi yesimanje yokufakelwa kabusha kanye ne-immunosuppression. Ngeshwa, le mithi iza nephrofayili ebalulekile yomphumela. Ubuthi obuyingozi kakhulu, ikakhulukazi ngokusetshenziswa isikhathi eside, ukulimala kwezinso. Ama-Calcineurin inhibitors nawo aphakamisa umfutho wegazi, amazinga eglucose, kanye ne-cholesterol - futhi abangele ukuthuthumela namakhanda.
• I-Mycophenolate mofetil (Cellcept®, Myfortic®): Lesi sidakamizwa siguqulwa emzimbeni sibe yi-mycophenolic acid, evimbela ikhono lama-lymphocyte lokuphindaphinda i-DNA, izakhi zofuzo ezibalulekile kuwo wonke amangqamuzana. Uma ama-lymphocyte engakwazi ukuhlanganisa i-DNA, awakwazi ukuhlukana ukuze akhiqize amaseli engeziwe. Ngakho-ke, i-Mycophenolate mofetil inciphisa ukusabela komzimba ngokuvimbela ukwanda kwama-lymphocyte. Imiphumela emibi eyinhloko ye-mycophenolate mofetil ithinta isimiso samathumbu okuholela ekuphathekeni kwesisu kanye/noma isifo sohudo. Kungacindezela futhi ukusebenza komnkantsha wamathambo futhi ngaleyo ndlela, kunciphise amazinga egazi amangqamuzana amhlophe (amangqamuzana alwa nokutheleleka), amangqamuzana abomvu (amangqamuzana aphethe umoya-mpilo), namaplatelet (ama-clotting agents).
• i-mTOR inhibitors (sirolimus; everolimus): mTOR imele i-mammalian Target Of Rapamycin. I-mTOR iyingxenye yomndeni wama-enzyme aziwa ngokuthi ama-kinases futhi ibandakanyeka ekulawuleni indawo yokuhlola umjikelezo weseli, ukulungiswa kwe-DNA, nokufa kweseli. Ukuvinjelwa kwe-mTOR kumisa amaseli e-T ukuthi angathuthuki ezigabeni ezihlukahlukene zomjikelezo weseli, okuholela ekuboshweni komjikelezo weseli. Ngakho-ke, ama-lymphocyte awakwazi ukuhlukana ukuze akhulise impendulo yokuzivikela komzimba. Imiphumela emibi ye-mTOR inhibitors ihlanganisa ukucindezeleka komnkantsha, ukuphulukiswa kwesilonda okubi, kanye namazinga aphezulu e-cholesterol.
• Ama-antibodies aqondise isamukeli se-IL-2, i-molecule ekhombisayo ekhulisa ukusabela kwamasosha omzimba (i-basiliximab, i-daclizumab): Amaseli e-T, ama-ejenti wokwenqaba okunamandla, aveza amanani akhulayo ama-IL2-receptors lapho ekhuthazwa. I-IL-2 receptor ivumela ukukhuliswa okuqhubekayo kokuphendula komzimba. Ngakho-ke ukuvinjelwa kwale receptor kunciphisa ukusabela komzimba. Lawa ma-antibody asetshenziswa kakhulu isikhathi esifushane kusukela ngesikhathi sokufakelwa ukuze anikeze ukucindezelwa okwengeziwe kokuzivikela komzimba phakathi nalesi sikhathi sengozi enkulu yokwenqatshwa. Imiphumela emibi esheshayo ihlanganisa umkhuhlane, ukuqubuka, i-cytokine release syndrome, kanye ne-anaphylaxis. Kubonakala sengathi zandisa ingozi yokutheleleka kwenkukhu kuhlanganiswe neminye imithi yokuzivikela komzimba.
• Ama-antibodies asusa amaseli e-T ekujikelezeni (i-Thymoglobulin®, OKT-3®): Lawa ma-agent angama-molecule aqondise amangqamuzana ahlukene esimiso sokuzivikela komzimba, awabophe, awavule, futhi awasuse. Zingasetshenziswa ngesikhathi sokufakelwa kwesibindi. kodwa ngokuvamile zisetshenziselwa ukwelapha ukwenqatshwa okukhulu noma ukwenqatshwa okungaphenduli kumasu okwelapha amancane. Imiphumela emibi esheshayo yale mithi isukela kumkhuhlane kanye nokuqubuka kuya ku-cytokine release syndrome okuholela e-flash pulmonary edema kanye ne-hypotension. Lezi zidakamizwa zingase futhi zibangele ukwanda kwe-PTLD kanye nomdlavuza wesikhumba (bona ngezansi)
• izidakamizwa zophenyo - Njengoba ukuqonda kwethu amasosha omzimba kuba ngcono, abacwaningi bathole amangqamuzana amasha, ama-molecule, nezindlela ezidlala indima ekuphenduleni komzimba ezithweni ezitshalwe kabusha. Ukutholwa ngakunye kuveza amathuba amasha ngendlela entsha okuhloswe ngayo ukuthuthukiswa kwezidakamizwa. Eminye yale mithi okwamanje iyahlolwa ezivivinyweni zomtholampilo ukuze kutholwe ukuthi ingabe iphephile futhi iyasebenza yini ukuthi isetshenziswe ekufakelweni kabusha. Izizukulwane ezizayo zezidakamizwa ngethemba ukuthi zizocacisa kakhulu ekuvimbeleni ukwenqatshwa ngaphandle kokuphazamisa kakhulu eminye imisebenzi yamasosha omzimba noma ukubangela imiphumela engemihle ye-non-immunologic side effects.

Ukwenqaba

Ukwenqatshwa yigama elisetshenziselwa ukungasebenzi kahle kwesitho okubangelwa ukusabela kwamasosha omzimba omamukeli esithweni esitshaliwe. Ukulimala kwesibindi kuvame ukulamulwa ngamaseli omzimba, ama-T cell noma ama-T lymphocyte. Ukwenqatshwa ngokuvamile akubangeli zimpawu; iziguli azizizwa ngendlela ehlukile noma aziboni lutho. Uphawu lokuqala ngokuvamile imiphumela yokuhlolwa kwelebhu yesibindi ephakeme ngokungavamile. Uma kusolwa ukwenqatshwa, i-biopsy yesibindi yenziwa. I-biopsies yesibindi yenziwa kalula njengenqubo yombhede isebenzisa inaliti ekhethekile eyethulwa ngesikhumba. Izicubu zibe sezihlaziywa futhi zihlolwe ngaphansi kwesibonakhulu ukuze kutholwe iphethini yokulimala kwesibindi futhi kubhekwe ukuba khona kwamaseli omzimba.

Ukwenqatshwa okunamandla kwamaselula kwenzeka ku-25-50% wabo bonke abamukeli bokufakelwa kwesibindi phakathi nonyaka wokuqala ngemva kokufakelwa isikhathi esiyingozi kakhulu phakathi kwamasonto amane kuya kwayisithupha okuqala okufakelwa. Uma ukuxilongwa sekutholakele, ukwelashwa kuqondile futhi ngokuvamile kusebenza kakhulu. Umugqa wokuqala wokwelashwa umthamo omkhulu we-corticosteroids. I-regimen yesondlo ye-immunosuppression yesiguli nayo iyakhuphuka ukuze ivimbele ukwenqatshwa okulandelayo. Ingxenye encane yeziqephu zokwenqaba okunamandla, cishe i-10-20%, ayiphenduli ekwelashweni kwe-corticosteroid futhi ibizwa ngokuthi “i-steroid refractory,” edinga ukwelashwa okwengeziwe.

Umugqa wesibili wokwelashwa kokwenqatshwa amalungiselelo aqinile e-antibody. Ekufakelweni kwesibindi, ngokungafani nezinye izitho, ukwenqatshwa kwamangqamuzana abukhali akuthinti amathuba wonke okusinda kwe-graft. Lokhu kukholakala ukuthi kungenxa yokuthi isibindi sinekhono eliyingqayizivele lokuvuselela lapho silimala ngaleyo ndlela sibuyisela ukusebenza kwesibindi esigcwele.

Ukwenqatshwa okungapheli kwenzeka ku-5% noma ngaphansi kwabo bonke abamukeli bokufakelwa. Isici esinamandla sengozi yokuthuthukiswa kokwenqatshwa okungapheli iziqephu eziphindaphindiwe zokwenqatshwa okukhulu kanye/noma ukwenqatshwa okunamandla okuphikisayo. I-biopsy yesibindi ibonisa ukulahleka kwemigudu ye-bile kanye nokuqothulwa kwemithambo emincane. Ukwenqatshwa okungapheli, ngokomlando, bekunzima ukuhlehla, ngokuvamile okudinga ukuphinda ukufakelwa isibindi. Namuhla, ngokukhethwa kwethu okukhulu kwezidakamizwa ezivimbela ukuzivikela komzimba, ukwenqaba okungapheli kuvame ukuhlehliswa.

Isifo Esiphindaphindiwe

Ezinye zezinqubo ezaholela ekuhlulekeni kwesibindi sesiguli zingase zilimaze isibindi esisha futhi ekugcineni zisibhubhise. Mhlawumbe isibonelo esihle kakhulu isifo sokusha kwesibindi kohlobo B. Ekuqaleni kwawo-1990, iziguli ezafakelwa isibindi ngenxa yokutheleleka ngesifo sokusha kwesibindi kohlobo B zazineminyaka engaphansi kwama-50% yokuphila iminyaka emihlanu. Iningi lalezi ziguli lihlaselwe ukutheleleka kabusha kwesibindi esisha ngegciwane le-hepatitis B. Nokho, phakathi neminyaka yawo-1990, izidakamizwa namasu amaningana okuvimbela ukuphinda ukutheleleka kanye nokulimala kwesibindi esisha kwasungulwa futhi kwaqalwa kabanzi yizikhungo zokufakelwa kabusha. Lezi zindlela ziye zaba yimpumelelo kakhulu kangangokuthi isifo esiphindelelayo asiseyona inkinga. I-Hepatitis B, eyake yabhekwa njenge-contra-inkomba yokufakelwa kabusha, manje isihlotshaniswa nemiphumela emihle kakhulu, ephakeme kunezinye izinkomba eziningi zokufakelwa kwesibindi.

Njengamanje, inkinga yethu eyinhloko ngesifo esiphindaphindayo igxile ku-hepatitis C. Noma yisiphi isiguli esingena ekushintsheni ngegciwane le-hepatitis C elijikeleza egazini laso sizoba ne-hepatitis C eqhubekayo ngemva kokufakelwa. Nokho, labo abaye balisusa ngokuphelele igciwane labo futhi abangenaso isifo sokusha kwesibindi kohlobo C esilinganisekayo egazini ngeke babe nesifo sokusha kwesibindi kohlobo C ngemva kokufakelwa kabusha.

Ngokungafani ne-hepatitis B lapho isifo esiqhubekayo esiholela ekuhlulekeni kwesibindi kwenzeka ngokushesha okukhulu, ukusha kwesibindi kohlobo C ngokuvamile kubangela ukuwohloka kancane kancane kokusebenza kwesibindi. Iphesenti elincane kuphela labamukeli besifo sokusha kwesibindi kohlobo C, cishe u-5%, elibuyela ku-cirrhosis futhi liqede isifo sesibindi phakathi neminyaka emibili yokufakelwa kabusha.

Abaningi banezifo eziqhubeka kancane kancane kangangokuthi cishe uhhafu uzoba ne-cirrhosis cishe eminyakeni eyi-10 ngemva kokufakelwa. Amalungiselelo e-Interferon ngokuhlanganiswa ne-ribavirin, esetshenziswa kabanzi ezigulini ze-hepatitis C zangaphambi kokufakelwa, nazo zinganqunywa ngemuva kokufakelwa. Amathuba okwelashwa unomphela aphansi ngandlela thize kunokwelashwa ngaphambi kokufakelwa kabusha. Ngaphezu kwalokho, ukwelashwa kuhlotshaniswa nokuhambisana okuphawulekayo kwemiphumela emibi. Isifo esiphindelelayo sinembangela yokuthi abamukeli bokufakelwa kwesibindi se-hepatitis C banemiphumela emibi kakhulu yesikhathi esimaphakathi neside uma kuqhathaniswa nabamukeli bokufakelwa isibindi ngaphandle kwe-hepatitis C.

Ezinye izifo eziningi zingase zibuye ngemva kokufakelwa kabusha, kodwa ngokuvamile lesi sifo sithambile futhi siqhubeka kancane kancane. I-Primary sclerosing cholangitis (PSC) kanye ne-primary biliary cirrhosis (PBC) zombili zibuya cishe ngo-10-20% wesikhathi futhi, kuyaqabukela, kubangele ukuwohloka kwesibindi okuphindaphindiwe kanye nesifo sesibindi sokuphela. Mhlawumbe okukhulu okungaziwa esikhathini sanamuhla isifo sesibindi esinamafutha ngemva kokufakelwa njengoba kusobala ukuthi kuyinkinga yokwanda kwemvamisa. Isifo sesibindi esinamafutha singenzeka kulabo abafakelwa i-NASH kodwa nasezigulini ezatshalwa kabusha ngenxa yezinye izinkomba futhi zithuthukise izici eziyingozi zesifo sesibindi esinamafutha. Imvamisa, i-trajectory, kanye ne-prognosis yokubuya kwesifo sesibindi esinamafutha ngemva kokufakelwa kanye nenkambo yaso kuyizindawo ezisebenzayo zocwaningo.

Amagciwane Angosomathuba kanye Nomdlavuza

Njengoba kushiwo ngaphambili, indima eyinhloko yamasosha omzimba ukuhlonza nokuhlasela noma yini engaphandle noma engeyona yona. Okuhlosiwe okuyinhloko kwakungahloselwe ukuba izitho ezitshalwe kabusha, kodwa kunalokho amabhaktheriya, amagciwane, isikhunta, namanye ama-microorganisms abangela ukutheleleka. Ukuthatha i-immunosuppression kwenza buthaka izivikelo zomamukeli wokufakelwa ekuthelelekeni

Ngenxa yalokho, abemukeli bokufakelwa basengozini enkulu yokungathuthuki nje kuphela izifo ezivamile ezingase zithinte bonke abantu kodwa nezifo “ezingosomathuba”, izifo ezenzeka kuphela kubantu abanamasosha omzimba asengozini. Izinguquko ohlelweni lokuzivikela komzimba zenza abamukeli bokufakelwa bangene ezifweni ezihlukahlukene ngokusekelwe esikhathini esihlobene nokusebenza kwabo kokufakelwa.

Zingahlukaniswa zibe izinkathi ezintathu: inyanga eyodwa, inyanga eyodwa kuya kweziyisithupha, nangaphezulu kwezinyanga eziyisithupha. Ngenyanga yokuqala, izifo ezibangelwa amagciwane kanye nesikhunta zivame kakhulu. Izifo ezibangelwa amagciwane ezifana ne-cytomegalovirus nezinye izifo ezingavamile ezifana nesifo sofuba kanye ne-pneumocystis carinii zibonakala phakathi nezinyanga eziyisithupha zokuqala.

Ngaphezu kokulwa nezifo, amasosha omzimba alwa nomdlavuza. Kukholakala ukuthi amasosha omzimba anempilo athola futhi aqede amangqamuzana angavamile, anomdlavuza ngaphambi kokuba ande futhi akhule abe isimila. Kuyaziwa kahle ukuthi abemukeli bokufakelwa basengozini enkulu yokuthola izinhlobo ezithile zomdlavuza.

I-Post-Transplant Lymphoprolipherative Disorder (PTLD)

I-Post-Transplant Lymphoprolipherative Disorder (PTLD) wuhlobo olungavamile lomdlavuza oluvela kuphela kwabamukeli bokufakelwa, njengoba kuphakanyiswe igama lawo. Cishe ngaso sonke isikhathi kuhlotshaniswa ne-Epstein-Barr virus (EBV), igciwane elifanayo elibangela i- mononucleosis esithathelwanayo noma “isifo sokuqabula.”

Iningi labantu abadala liye lachayeka ku-EBV, ngokuvamile ebuntwaneni babo noma eminyakeni yobusha. Kulezi ziguli, i-PTLD ehlotshaniswa ne-EBV ingathuthuka ngemva kokufakelwa kabusha ngoba ukuzivikela komzimba kuvumela igciwane ukuthi liphinde lisebenze. Ngokuphambene, izingane eziningi ziza ekufakweni kwesibindi ngaphandle kokuba zivezwe ku-EBV. Uma iziguli zivezwa ku-EBV ngemva kokufakelwa futhi ngenxa yalokho ngaphansi kwethonya lokuzivikela komzimba, zingase zingakwazi ukulawula ukutheleleka.

I-PTLD ivela kunoma yisiphi isimo lapho amaseli B atheleleke nge-EBV (iqoqo elingaphansi lama-lymphocyte) ekhula futhi ehlukana ngendlela engalawuleki. Njengoba ngokuyisisekelo kuwumphumela wesimiso sokuzivikela ezifweni esisengozini, umugqa wokuqala wokwelapha umane umise noma unciphise kakhulu ukuvinjelwa kwamasosha omzimba. Nakuba le ndlela isebenza njalo, iphinda ibeke engcupheni ukwenqatshwa kokuxhunyelelwa okungase kudingeke ukuthi kunyuke umfutho wokuzivikela komzimba. Muva nje, umuthi oqeda ngokuqondile ama-B cell, amangqamuzana atheleleke nge-EBV, usuyatholakala.

Namuhla, indlela evamile ngakho-ke ukunikeza lesi sidakamizwa, i-rituximab, ngokuhambisana nokusikeka okuncane kakhulu kwezidakamizwa ze-immunosuppression. Uma le ndlela ingalawuli i-PTLD, khona-ke izindlela ezijwayelekile zemithi yokwelapha ngamakhemikhali ezivame ukunikezwa ukwelapha i-lymphomas eba ezigulini ezingenawo amandla omzimba, ziyasetshenziswa. Iningi lamacala e-PTLD angelashwa ngempumelelo ngokulondolozwa kwesitho esitshaliwe.

I-Non-Melanoma Skin Cancer (NMSC)

Umdlavuza wesikhumba yiwona bubi obuvame kakhulu emphakathini wangemva kokufakelwa. Izinga lomdlavuza wesikhumba ezigulini ezifakwe izitho zomzimba zingama-27% eminyakeni eyi-10, okukhombisa ukwanda okuphindwe ka-25 kwengozi uma kuqhathaniswa nenani labantu elijwayelekile. Ngenxa yale ngozi enkulu, kunconywa kakhulu ukuthi bonke abemukeli bokufakelwa banciphise ukuchayeka elangeni.

Ngaphezu kwalokho, bonke abemukeli bokufakelwa kufanele bahlolwe njalo ukuze kuqinisekiswe ukuxilongwa kusenesikhathi kanye nokwelashwa okushesha kwanoma yimuphi umdlavuza wesikhumba. Kunobunye ubufakazi obubonisa ukuthi i-sirolimus, i-immunosuppressant ekilasini lama-mTOR inhibitors ayiwandisi ingozi yomdlavuza wesikhumba.

Ngakho-ke, abemukeli bokufakelwa abahlakulela imidlavuza yesikhumba eminingi bangacatshangelwa ukushintshela kuhlelo lwe-sirolimus-based, calcineurin-inhibitor free immunosuppression regimen. Okwamanje, ayikho idatha ebonisa ukuthi abemukeli bokufakelwa kwesibindi basengozini enkulu yokuthuthukisa ezinye izinhlobo zomdlavuza ezivamile njengebele, ikholoni, i-prostate, noma eminye imidlavuza.

Izingozi nemiphumela emibi yokufakelwa kwesibindi

Njengengxenye ye-hepatectomy, ukufakelwa kwesibindi kuwukuhlinzwa okukhulu okunezingozi ezinkulu futhi kufanele kwenziwe kuphela odokotela abanekhono nabanolwazi. Izingozi ezingaba khona zihlanganisa:

• ukopha
• Ukutheleleka: Abantu abathola ukufakelwa kwesibindi banikezwa izidakamizwa ezisiza ukucindezela amasosha abo omzimba ukuvimbela imizimba yabo ukuthi ingalahli isitho esisha. Le mithi inezingozi zayo kanye nemiphumela engemihle, ikakhulukazi ingozi yokuthola izifo ezimbi kakhulu. Ngokucindezela amasosha omzimba, le mithi ingase ivumele noma yimuphi umdlavuza wesibindi owawusabalele ngaphandle kwesibindi ukuthi ukhule ngokushesha okukhulu kunangaphambili. Eminye yemithi esetshenziselwa ukuvimbela ukwenqatshwa nayo ingabangela umfutho wegazi ophakeme, i-cholesterol ephezulu, nesifo sikashukela; kungaba buthaka amathambo nezinso; futhi kungaholela ngisho nasemdlavuzeni omusha.
• Ama-clots egazi
• Izinkinga ze-anesthesia
• Ukwenqatshwa kwesibindi esisha: Ngemva kokufakelwa kwesibindi, ukuhlolwa kwegazi okuvamile kwenziwa ukuze kuhlolwe izimpawu zomzimba ezilahla isibindi esisha. Ngezinye izikhathi ama-biopsies esibindi nawo athathwa ukuze abone ukuthi ukwenqatshwa kuyenzeka futhi uma kudingeka izinguquko emithini evimbela ukwenqatshwa.