I roto i te ao e whanake tonu ana o ngā tātaritanga hauora,ngira koiorahe mahi nui tā rātou ki te kohi tauira kiko mō te whakamātautau mate tika, ā, ko tā rātou whiriwhiringa he mea e pā tika ana ki te tika o te koiora, te haumaru me te wheako o te tūroro. E whai ake nei he tātaritanga o ngā tikanga koiora,ngā momo ngira koiora, ngā ōwehenga ngira matua-ki-ngira angiangi, me ngā āhuatanga whiriwhiri matua hei whakarato aratohu pūnaha mō te mahi haumanu.
1. Te mārama ki ngā tikanga koiora
Ko te whāinga matua o te tikanga koiora ko te tiki i tētahi tauira kiko kounga teitei hei whakamārama i te āhua o te whara, hei whakawhanake rānei i tētahi mahere maimoatanga. He rerekē te hiahia mō te ngira koiora i waenga i ngā āhuatanga koiora:
- Te tātaritanga o te pukupuku: me nui te rahinga kiko hei tautoko i te whakatau i te mate me te whakamātautau ira (hei tauira, te EGFR, ngā whakarerekētanga ALK).
- Ngā mate mumura: me whai i te tātaritanga pūtau hei whakamārama i te momo huaketo, te momo pūtau ārai mate rānei.
- Aromatawai i mua i te pokanga: me tere te kohikohi tauira hei ārahi i ngā tikanga pokanga (hei tauira, te tautuhi i ngā puku o te ū pai me te kino).
2. Ngā momo ongira koiorame ngā tono haumanu
- Mātāpono: Te tiki i tētahi rīpene tauira kiko mā te tapahi ā-ringa.
- Ngā Painga:
He tauira katoa, he pai mō te pukupuku totoka (hei tauira, te ū, te repeure) me te koiora kiko wheua.
He rawaka te rahi o te tauira hei tautoko i te matū ārai mate me te whakamātautau ngota.
- Ngā herenga: he nui te whara, me mārama pū ki ngā tohu.
(2) Ngira Biopsy Whakapūngao Maeneene
- Mātāpono: Te whakamahi i te momi pēhanga kino hei whiwhi i te whakatārewatanga pūtau.
- Ngā Painga:
He iti ake te mamae, he pai mō ngā mate o ngā kōpū lymph, te tairoi me ngā pūkahukahu.
He ngāwari ki te mahi, ka taea te tiki wawe i ngā whakatārewatanga pūtau.
He māmā te mahi, ka taea te tere te tautuhi i te mate pūtau.
- Ngā herenga: te pakaru o te tauira, kāore e taea te whakatutuki i ngā hiahia o te whakamātautau histological.
(3) Ngira Koiora Āwhina-Korehau (VAB)
- Mātāpono: Ka whakakotahi i te tapahi ā-ringa me te momi pēhanga kino hei whakapai ake i te whai huatanga o te tauira.
- Ngā Painga:
Ka taea te tiki tauira maha i roto i te poka kotahi, he mea e tika ana mō ngā arotahi moroiti o te ū.
Ka whakaiti i te mōrearea o te werohanga anō, ka whakapai ake hoki i te manawanui o te tūroro.
(4) Te Tapahi i te Ngira Biopsy
- Mātāpono: Ka tapahia te kiko mā te pito whai awaawa, mā te mata hurihuri rānei.
- Ngā momo:
Ngira Kōhao: hei tauira, Ngira Koiora Tru-Cut, mō ngā kiko ngohengohe.
Ngira Wiri Mowhiti: hei tauira, Ngira Kohikohi Huango Wheua, mō te kiko wheua.
3. te koiora ngira matua me te tango ngira pai
| Tohu | Te koiora ngira matua | Te mimiti ngira pai |
| Ngā Momo Tauira | Tauira kiko tītaha | Whakatārewatanga pūtau |
| Te tika o te tātaritanga | Teitei (histology) | Waenga (cytology) |
| Te nui o te whara | Nui ake | Iti ake |
| Te wā mahi | Roa ake | Poto ake |
| Ngā horopaki | Ngā pukupuku totoka, te kiko wheua | Ngā whara o te mata, ngā kōpū lymph |
4. Ngā mea matua hei whakaaroaro māu i te wā e whiriwhiri ana i ngā ngira koiora tika
(1) Te wāhi whainga mō te koiora
- Ngā whekau o waho (hei tauira, te tairoi, te ū): he pai ake ngā ngira iti, ngā ngira matua rānei hei whakataurite i ngā matea whara me ngā matea tātaritanga.
- Ngā whekau hohonu (hei tauira, te ate, te whatukuhu): he pai ake ngā ngira koiora roa hei whakarite i te hohonu o te werohanga.
- Kiko wheua: me whakamahi ngā ngira wiri porowhita (hei tauira, ngā ngira kohi wheua) hei karo i te pakaru o te kiko.
(2) Ngā āhuatanga motuhake ki te tūroro
- Tau me te āhua tinana: me whiriwhiri e ngā tamariki, e ngā tūroro ngoikore rānei he ngira angiangi (hei tauira, 20G) hei whakaiti i ngā raruraru.
- Te mahi toto totoka: me karo ngā tūroro he mate toto totoka i ngā ngira matotoru (hei tauira, 16G) hei whakaiti i te tūponotanga o te toto.
- Āhua hinengaro: Ka pai ake pea ki ngā tūroro manukanuka ngā ngira koiora āwhina-korehau hei whakapoto i te wā pokanga.
(3) Te mātotoru o te kiko me tōna wāhi
- Ngā kiko mātotoru (hei tauira, te repeure, te ate): whiriwhiria he ngira koiora he kaha te tapahi (hei tauira, he ngira kōhao 18G).
- Ngā uaua toto/io e tata ana: me whai i te mahi ultrasound/CT hei whiriwhiri i tētahi ngira koiora kua tohua ki te whanaketanga.
(4) Te rahi me te roa o te ngira
- Kōwhiringa Whakatakotoranga:
Ngira angiangi (20-22G): mō te cytology, mō ngā whara o waho rānei.
Ngira matotoru (14-18G): he pai mō te tirotiro histological, mō ngā whara hohonu rānei.
- Kōwhiringa roa: ka whakatauhia e te hohonutanga o te pokanga (hei tauira, me ≥15cm te rahi o te kohi pūkahukahu).
(5) Te hoahoa o te pito ngira
- Te pito ngira piko: he pai mō ngā kiko ngohengohe hei whakaiti i te ātete.
- Mata toru-kōtaha: e tika ana mō te kiko wheua, hei whakarei ake i te urunga.
- Te Tohu: Me tapa ngā ngira koiora e arahina ana e te MRI ki te koranu titanium.
(6) Hototahi ki ngā momo whakaahua
- Aratohu Ultrasound: Me whiriwhiri ngā ngira koiora me ngā mowhiti e whanake ana.
- Aratohu CT/MRI: me whiriwhiri he rauemi kore-aukume, he rauemi iti-taonga rānei (hei tauira, he koranu titanium).
(7) Te tikanga tango tauira
- Te tapahi ā-ringa: e tika ana mō ngā pukupuku totoka me te tauira katoa.
- Momi pēhanga kino: he pai mō te whakamātautau pūtau, he ngāwari ki te whakahaere.
- Āwhina-korehau: e tika ana mō te kohi tauira maha-wāhi, hei whakarei ake i te whai huatanga.
(8) Te whakamarie me te haumaru o te tūroro
- Te whakahaere mamae: he iti ake te mamae o te ngira pai, ā, he māmā ake ki ngā tūroro.
- Te ārai i ngā raruraru: karohia te werohanga auau ki te ngira matotoru, whakaitihia te tūponotanga o te pneumothorax me te toto.
(9) Te utu me te wātea
- Te whai hua o te utu: he nui ake te utu o ngā ngira koiora aunoa katoa (hei tauira, TSK), engari he teitei te reiti angitu o te tauira.
- Te kapinga inihua hauora: me whiriwhiri ngā hua kei roto i te whānuitanga o te utu whakahoki e ai ki ngā kaupapa here ā-rohe.
5. Whakamutunga
Te kōwhiringa ongira koiorame arotake whānuitia te āhua o te whara, te āhua o te tūroro, ngā āhuatanga hangarau me ngā āhuatanga ōhanga. I roto i te mahi haumanu, me whai i ngā mātāpono e whai ake nei:
1. te taurite tika: whiriwhiria te momo ngira kia rite ki te wāhi e hiahiatia ana te kohi (hei tauira, ngira whai awaawa 14G mō te ū, ngira angiangi 20G mō te tairoi).
2. Whakatairangahia te haumaru: karohia ngā ngira matotoru mō ngā tūroro he mate toto toto tiketike, ā, whakahaerehia i raro i te arataki a te whakaahua mō ngā whara toto tata.
3. Whai huatanga me te whakamarie: ka taea e ngā ngira kopa āwhina-korehau te whakapai ake i te whai huatanga, ā, ka taea e ngā ngira angiangi te whakaiti i te mamae o te tūroro.
Mā te whiriwhiri pūtaiao i ngā ngira koiora, ka taea te whakapai ake i te tika o te tātaritanga, ka taea te whakaiti i te mōrearea o ngā raruraru, ā, i te mutunga ka taea te whakatutuki i te rongoā tika e tika ana mō ia tangata.
Wā tuku: Mei-19-2025