I-Mediastinoscopy iyindlela evumela ukuthi uhlole ingaphakathi le-mediastinum, isifunda sesifuba esiphakathi kwamaphaphu amabili, kusukela ekusikeni okuncane entanyeni, ngaphandle kokuvula izimbambo. Iphinde ivumele ukuthi kuthathwe ama-biopsies.

I-Mediastinoscopy i-endoscopy ye-mediastinum. Ivumela ukuhlolwa okuqondile okubonakalayo kwezitho ezitholakala phakathi kwamaphaphu amabili, ikakhulukazi inhliziyo, i-bronchi emibili eyinhloko, i-thymus, uqhoqhoqho kanye nomminzo, imithambo yegazi emikhulu (i-aorta ekhuphukayo, imithambo yamaphaphu, i-vein superior vena cava. , njll.) kanye nenani lama-lymph nodes. 

Iningi le-mediastinoscopy lihilela ama-lymph nodes. Ngempela, ama-x-ray, ama-scan kanye nama-MRIs angabonisa ukuthi bathole ivolumu, kodwa akusivumeli ukuthi sazi ukuthi lokhu i-adenomegaly kungenxa ye-pathology yokuvuvukala noma isimila. Ukuze unqume, kufanele uhambe uyobona, futhi ngokunokwenzeka uthathe i-lymph node eyodwa noma ngaphezulu ukuze ihlaziywe elabhorethri. Ngokuvamile, i-mediastinoscopy isetshenziselwa ukuhlola izixuku ezisolisayo ezitholwe ukuhlolwa kwesithombe ku-mediastinum futhi, uma kunesidingo, ukwenza i-biopsy.

Esikhundleni sokuvula i-rib cage yalokhu kuhlola okubonakalayo, i-mediastinoscopy isebenzisa i-probe ebizwa ngokuthi i-mediastinoscope. Leli shubhu elingenalutho, elifakwe imicu yokubona futhi okungadluliswa ngalo amathuluzi amancane okuhlinza, lingeniswa emgodleni wesifuba ngokusikwa okungamasentimitha ambalwa okwenziwa phansi kwentamo.

Le nqubo yokuhlinzwa iwukuhlola kuphela. Kutuswa ngemva kwamasu okwelapha avamile (ama-x-reyi, i-CT scan, i-MRI) lapho lokhu kuveza izixuku ezisolisayo ku-mediastinum. Ivumela: 

ukulawula uhlobo lwezilonda. Ama-lymph nodes ku-mediastinum, ngokwesibonelo, angavuvuka ngenxa yokutheleleka okufana nesifo sofuba noma i-sarcoidosis, kodwa futhi athinteke i-lymphoma (umdlavuza we-lymphatic system) noma ama-metastases avela kwamanye ama-cancer (amaphaphu, isifuba noma umminzo. ngokuqondene);

ukuthatha amasampula ezicubu noma ama-lymph nodes, uma kwenzeka ungabaza mayelana nobubi besimila noma ukucacisa ukuxilongwa. Lawa ma-biopsies, ahlaziywa elabhorethri, enza kube nokwenzeka ukusungula uhlobo lwesimila, isigaba saso sokuziphendukela kwemvelo kanye nokwandiswa kwaso;

ukulandela ukuvela kwezinhlobo ezithile zomdlavuza wamaphaphu, ezitholakala engxenyeni yangaphandle yalesi sitho, ngakho-ke kubonakala ku-mediastinum.

Ngokuqhubekayo, i-mediastinoscopy ithathelwa indawo yizindlela ezintsha zokuxilonga ezingangeneleli kakhulu: the Iskena se-PET, okwenza kube nokwenzeka, ngokuhlanganisa umjovo womkhiqizo okhipha imisebe ne-scanner, ukuxilonga imidlavuza ethile noma ukucinga ama-metastase; kanye / noma i-ultrasound-guided transbronchial biopsy, ehlanganisa ukudlulisa inaliti encane emlonyeni bese i-bronchi ibhoboza i-lymph node etholakala ngakolunye uhlangothi lodonga lwe-bronchi. Le nqubo yokugcina, engadingi noma yikuphi ukusika, manje isivunyelwe ukuthuthukiswa kwe thei-ultrasound bronchoscopy (ukusetshenziswa kwe-endoscope eguquguquka kakhulu, efakwe i-ultrasound probe encane ekugcineni kwayo). Kodwa ukushintshwa kwe-mediastinoscopy ngalezi zindlela ezimbili akunakwenzeka ngaso sonke isikhathi. Kuncike ikakhulukazi endaweni yesilonda. 

Ngokufanayo, i-mediastinoscopy ayisebenzi kuzo zonke izimo. Uma izilonda ze-biopsy nazo zingafinyeleleki ngale ndlela (ngoba zitholakala endaweni engaphezulu ye-pulmonary lobe), udokotela ohlinzayo kufanele akhethe enye inqubo yokuhlinzwa: i-mediastinotomy, okungukuthi ukuvulwa kokuhlinzwa kwe-mediastinum, noma i-thoracoscopy, i-endoscopy ye-thorax kulokhu idlula emigwaqweni emincane phakathi kwezimbambo.

Ngisho noma kuyisivivinyo sokuxilonga, i-mediastinoscopy iyisenzo sokuhlinzwa. Ngakho-ke kwenziwa udokotela ohlinzayo, endaweni yokuhlinza, futhi kudinga ukulaliswa esibhedlela izinsuku ezintathu noma ezine.

Ngemva kwe-anesthesia evamile, ukusika okuncane kwenziwa phansi kwentamo, endaweni engaphezulu kwethambo lesifuba. I-mediastinoscope, ishubhu elide eliqinile elifakwe isistimu yokukhanyisa, yethulwa ngalokhu kusika futhi yehlela ku-mediastinum, ilandela uqhoqhoqho. Udokotela ohlinzayo angabe esehlola izitho ezilapho. Uma kunesidingo, wethula ezinye izinsimbi nge-endoscope ukuze enze i-biopsy, ukuze kuhlaziywe ilabhorethri. Uma ithuluzi selikhishiwe, i-incision ivalwa nge-suture emuncekayo noma iglue ye-biological.

Lokhu kuhlolwa kuthatha cishe ihora. Ukukhishwa esibhedlela kuhlelelwe usuku olulandelayo noma ezimbili, uma odokotela abahlinzayo sebenelisekile ukuthi azikho izinkinga.

Ulwazi olubukwayo nolwe-histological olunikezwa yi-mediastinoscopy lwenza kube nokwenzeka ukuqondisa isu lokwelapha. Lokhu kuncike ku-pathology etholakele. 

Uma kwenzeka umdlavuza, izinketho zokwelashwa ziningi, futhi zincike ohlotsheni lwesimila, isigaba saso kanye nokunwetshwa kwaso: ukuhlinzwa (ukususwa kwesimila, ukususwa kwengxenye yamaphaphu, njll.), i-chemotherapy, i-radiotherapy, i-immunotherapy noma inhlanganisela eziningana zalezi ongakhetha.

Uma kwenzeka i-metastasis, ukwelashwa kuyingxenye yohlelo lokwelapha isimila esiyinhloko.

Uma kuwukuvuvukala noma ukutheleleka, imbangela yangempela izophenywa futhi ilashwe.

Izinkinga ezivela kulolu hlolo azivamile. Njenganoma yikuphi ukuhlinzwa, kunengozi ephansi yokusabela ku-anesthesia, ukopha nokulimaza, ukutheleleka noma izinkinga zokuphulukisa. Kukhona nengozi engavamile yokulimala kommizo noma i-pneumothorax (ukulimala emaphashini okubangela ukuvuza komoya emgodini we-pleural).

I-laryngeal nerve nayo ingacasuka, ibangele ukukhubazeka kwesikhashana kwezintambo zezwi, okuholela ekushintsheni kwezwi noma ukuhogela, okungahlala amasonto ambalwa.

Ubuhlungu buyezwakala ezinsukwini zokuqala ngemva kokuhlinzwa. Kodwa ama-painkillers abekiwe ayasebenza. Imisebenzi evamile ingaqalwa kabusha ngokushesha okukhulu. Ngokuqondene nesibazi esincane, siyaphela kakhulu phakathi nezinyanga ezimbili noma ezintathu.