Matenda a khansa ya pancreatic

Ma tumor ndi zotupa zoyipa za kapamba ndizofala kwambiri padziko lapansi. Kufikira 200,000 omwe adapezeka ndi zikondamoyo zatsopano amalembetsa chaka chilichonse. Kufalikira kotero kumakopa chidwi cha madokotala ochita opaleshoni ndi akatswiri a zamankhwala padziko lonse lapansi.

Mitundu ya zotupa

Morphologically, khansa mu kapamba imachokera ku epithelial, hematopoietic ndi lymphoid minofu. Mu 95% ya odwala, chotupacho chimayamba kuchokera ku minyewa ya epithelial. Itha kuyimiridwa ndi adenocarcinoma, adenoma ndi cystadenoma. Adenoma ndi cystadenoma ndi chosaopsa zotupa. Amasiyanitsidwa ndi kukula kwakutali ndi kupita patsogolo, kusapezeka kwa zizindikiro komanso chidziwitso chabwino cha maphunzirowa.

Munkhaniyi, zilonda zapadera za neoplasms (khansa) za kapamba zidzaganiziridwa. Khodi ya ICD-10 - C.25.

Gland Malignant Neoplasms

Glandular minofu ndi mtundu wa minofu ya epithelial. Chifukwa chake, khansa yomwe imapangidwa kuchokera ku maselo a glandular ndi gawo la zotupa za epithelial. Ndipo kukula kwazipidwe komweku kumatchedwa "adenocarcinoma." Uwu ndiye mtundu wa neoplasm womwe umadziwika kwambiri - mpaka 95% ya zotupa zonse zoyipa. Mu kapamba, adenocarcinoma amatha:

1. Kuchokera ku epithelium ya ma ducts.
2. Kuchokera ku ma cell a acinus (maselo a glandular).

Kuphatikiza apo, zotupa zoyipazi zimapangika kuchokera ku minyewa ya glandular: cystadenocarcinoma, cell ya acinar ndi cell squcinoma cell. Amapezeka mwa 5% yokha mwa odwala onse.

Gulu la magawo chitukuko cha adenocarcinoma

Russian Federation yatenga njira yophatikiza khansa yapancancicic yapadziko lonse lapansi monga gulu la TMN:

1. Gawo 1 - mawonekedwe a chotupa amakhala mkati mwa thupi, osaposa masentimita 2. Palibe metastases ku zigawo za lymph node. Palibe metastases yakutali ku ziwalo. Zizindikiro sizikuwoneka pano. Zoneneratu zabwino.
2. Gawo lachiwiri - chotupa chija chimatulutsa duodenum, bile duct komanso CHIKWANGWANI chokuzungulira. Palibe metastases kumayendedwe a lymph node. Palibe metastases yakutali ku ziwalo. Wodwalayo amayamba kuda nkhawa ndi zizindikiro zoyambira. Zoneneratu zabwino.
3. Gawo lachitatu - chotupacho chimaphukira duodenum, bile duct ndi fiber yoyandikana nayo. Pali metastasis imodzi mu gawo limodzi la lymph. Palibe metastases yakutali ku ziwalo. Zizindikiro zoyambirira zimawonedwa, matendawa amakayikira.
4. 4A siteji - ikutanthauza kumera kwa chotupa mu ziwalo zozungulira komanso ziwalo ndikuphwanya ntchito yawo. Pakhoza kukhala ma metastase amodzi kapena angapo kumayendedwe a lymph nodes. Palibe metastases yakutali ku ziwalo. Pochita mantha ndi zizindikiro zoopsa, matendawa amakayikira.
5. 4B siteji - imaperekedwa kwa odwala onse omwe amayang'ana metastasis yakutali kwa ziwalo ndi minofu. Kuda nkhawa ndi zizindikiro zoopsa. Zonenedweratu sizabwino.

Pancreatic chotupa kutulutsa

Anatomically zoyipa machitidwe kapamba amapezeka:

1. M'mutu - matenda ambiri (mpaka 70% ya milandu).
2. Mu thupi ndi mchira wa chiwalo - pamalo achiwiri malinga ndi kuchuluka (mpaka 24%).
3. Pakupanga ndizosowa kwambiri (mpaka 6% ya milandu).

Nthawi kuchokera kuzizindikiro zoyambirira mpaka kufa

Kutengera ndi momwe wodwalayo alili (wodwala kapena wongokhala), kupezeka kapena kusapezeka kwa zizolowezi zovulaza, cholowa ndi kupezeka kwa matenda ophatikizika (ngakhale kuchokera munzeru yamaganizidwe ake: matendawo kapena chiyembekezo), matendawa amatuluka mwachangu, kudutsa magawo angapo:

• zero (0-siteji),
• Ndili ndi magawo a IA ndi IB
• II, komwe magawo IIA ndi IIB nawonso ali osiyana,
• Wachitatu (woyamba)
• IV (wodwala, womaliza kapena womaliza).

Nthawi yodutsa kuchokera pachiwonetsero cha matenda oyamba mpaka kumayambiriro kwa gawo lomaliza ndilosiyana kwa aliyense.

Zimatsimikizika ndi kukula kwa vuto la kusokonezeka, dera lomwe kuwonongeka kwa gland ndi kapangidwe kazomwe zikuchitika, zochitika zomwe zimatsimikizira mkhalidwe wamkati wamthupi (kuyambira pH kupita kuntchito yoyipa ya magazi), womwe umatsimikizira zonse kuchuluka kwa matenda omwewo komanso kuchuluka kwa metastasis kuwonongeka kwa oyandikana nawo, kenako ziwalo zakutali.

Chifukwa chake, ndi kukula kwa chotupa kuchokera pa ductal epithelium, chizindikiro cha matendawa chimadalira kwambiri patency ya ma ducts, omwe amadziwitsa kuchuluka kwa zovuta zam'mimba.

Vuto la kuwonongeka kwa zida zogwiritsa ntchito mahomoni, kusokonekera kwa magwiridwe antchito amthupi kumakhala kofunikira kwambiri, chifukwa tikulankhula machitidwe omwe amayendetsa ndi kulumikizana kwa ziwalo mkati mwake - zokhudza masisitimu amanjenje.

Kukhalapo kwa pancreatitis yodwalayo komanso matenda a shuga (ndipo pang'ono ndi pang'ono kukhala gwero komanso chifukwa cha khansa) komanso kumayambitsa kutsika kwa chitetezo chokwanira komanso kuyambika kwa thupi losagwira ntchito.

Kutalika kwa gawo lililonse la matendawa ndi kosiyana kwa wodwala aliyense, monganso nthawi yomwe yayikidwira pamapeto a zonse.

Popeza kulibe zizindikiro zofunika kwambiri m'ndime 0 ndi gawo 1, wodwalayo nthawi zambiri amanyalanyaza mawonekedwe ake. Koma iyi ndi nthawi yokhayo yomwe opaleshoni ingayende bwino.

Kukhazikika kwa magawo otsatirawa (chotupa chikupita kupitirira England) ndikumawonetsedwa kwakanthawi kokwanira kumakhala ndi chithandizo chochepa kwambiri kapena sikumvekanso bwino konse (njira zamtunduwu zitha kungowonjezera moyo wa wodwalayo).

Kodi ingathe kuchiritsidwa?

Kukula kwake kumadalira gawo la nthendayo (komwe chotupa chili mkati kapena kumbuyo kwa chiwalo, kutengapo gawo kwa ziwalo zoyandikana ndi kupezeka kwa metastases mwa iwo), malo omwe chotupacho ndi gland, malo amachitidwe a thupi komanso kuchuluka kwa zida zogwirira ntchito ndi zida zofunika.

Pamaso pazochitika zilizonse zabwino za khansa, zinthu zomwe zingachitike:

1. Gawo 0 - mwa chidwi chotupa cha ma radiation wovomerezeka pa opaleshoniyo.
2. Mu I - kuchitapo kanthu kopambana kwambiri (mwina ndi kutulutsa kwa chithaphwi chonse, kapena kuchepa kwake, kapena kugwiritsa ntchito njira ya Whipple) ndi chithandizo cha radiation.
3. Pa magawo II ndi III, ntchito zodzipangitsa zokha zitha kuchitidwa kuti zithetse zopinga zomwe zimapangidwa kuti zigayike pakanthawi kake kapena chotchinga chake ndi ziwalo zoyandikana nazo (kuthana ndi kutsekeka, kutsekeka kwamatumbo) kapena njira zina zotengedwa kuti zithetsere kukomoka kwam'mimba ndi matumbo.
4. Mu gawo IV, chifukwa cha kudwalika kwambiri kwa wodwalayo, yemwe thupi lake silingathe kunyamula katundu aliyense, komanso metastasis ya chotupa kwa ziwalo zakutali, oncologists sangathe kupereka chilichonse kwa wodwala.

Chifukwa chake, machiritso athunthu amatheka pokhapokha 0 kapena koyambirira kwa siteji yoyamba.

Kanema wokhudza khansa yapakansa:

Kupulumuka mu magawo osiyanasiyana

Pali ziwerengero zamilandu yokhala ndi khansa yofananira komanso yosawoneka ya gland.

Mgawo la 0-I pambuyo pa chithandizo chovuta, matendawo ndi abwino (kuchuluka kwa kupulumuka zaka 5 kuchokera pa 65 mpaka 60), mtsogolomo, kupulumuka kumatsimikiziridwa ndi kuchuluka kwa kutuluka kwa neoplasm kupitilira kapangidwe kake ka ndulu ndi kumera kwa ziwalo zapafupi.

Pofika boma ili (gawo II A), kupulumuka kwa zaka 5 ndikulondola kwa 52-50% ya odwala omwe adalandira chithandizo chokwanira malinga ndi pulogalamu yonseyi; munjira ina (popanda kuchitira opareshoni, koma kugwiritsa ntchito chemotherapy ndi radiotherapy), chizindikiro ichi sichidutsa 15- 12%

Pa siteji yachitatu, kuthekera kochotsedwa kumangokhala mu 20% yamilandu (ndi kupulumuka kwa zaka 5%), ngati sizingatheke kuchotsa ziwerengero kumapereka chithunzi cha 3%.

Pagawo IV, chizindikiro cha kupulumuka kwa zaka 5 sichoncho - pafupifupi moyo wautali wa odwala osapezekanso miyezi 8, ndi chithandizo chophatikizidwa - zaka 1.5 kapena chaka chimodzi. Koma ngakhale ku chipatala chotsogola cha oncological padziko lapansi chokhala ndi khansa yatsopano, chizindikiro ichi sichidutsa 16%.

Kwa vuto losawonongeka, ziwerengero za zaka 5 zomwe zatsala kupulumuka kwa magawo a I-IV ndizo:

Gland Tail Cancer Prognosis

Chifukwa cha kusapezeka kwa zizindikiritso pakufalikira kwa njirayi, chotupacho chimafikika mosiyanasiyana, chifukwa chake matendawa akukhumudwitsa.

Chifukwa chakufuna kukometsa thupi ndi mchira wa ndulu pamodzi ndi ndulu ndi ndulu (zomwe zimakulitsa chiwopsezo cha matenda nthawi zambiri) pochita izi ndikuphatikizana ndi chemotherapy, kutalika kwa moyo sikupitilira miyezi 12-10, ndipo kuchuluka kwa kupulumuka kwa zaka zisanu kumasiyana pakati pa 8 ndi 5.

Kanema kochokera kwa Dr. Malysheva:

Maola omaliza

Amaphimbidwa kuti asamalire komanso achibale pokhapokha ngati wodwalayo ali ndi misala yoyang'ana kumbuyo chifukwa cha kufooka kwambiri (khansa). Kuyenda pawokha ndikosatheka, wodwalanso alibe chikhumbo chogona pakama (ndi thandizo lakunja).

Kuphatikiza pa kupindika kwambiri, pallor wokhala ndi khungu lozama komanso khungu, pali zizindikiro zosintha kwambiri mu psyche - imakhala ngati ili mumtundu wa kukhumudwa kwambiri ndikuzimitsa, kapena ikuwonetsedwa motsutsana ndi chilichonse ndi zonse zomwe zili m'malo ake osafunikira.

Chithunzicho chikukulirakulira chifukwa cha mawonekedwe a nkhope (ndi kuwonongeka kwa ubongo), fungo la kuzungulira kuchokera mkamwa mwa wodwalayo, mawu amphuno, kusayankhula, komanso kuyesera kulira kuyimitsidwa ndi kutsokomola chifuwa chouma, zomwe zimatsogolera hemoptysis.

Zingamu zikutuluka, maonekedwe ndi malilime ake zimasinthidwa, kupuma pang'ono sikuyima ngakhale pang'ono.

Kusintha kwa kukomoka mu gawo lotsirizidwa kumalowedwa m'malo ndi kusakhudzidwa kwathunthu ndi chakudya, kufooketsa mphamvu za kukoma ndi kununkhira.

M'malo a supine, ndulu zokulira ndi chiwindi zimawonekera bwino, zizindikiro za ascites zimawoneka, ndipo chidziwitso chachilengedwe chimakhala ndi mtundu winawake: mkodzo umapeza mawonekedwe a mowa, ndowe zimawoneka ngati dongo loyera.

Mu gawo lomaliza, kusowa kwathunthu komanso kusakhoza kudzisamalira kosavuta kumabwera, pomwe imfa imachitika chifukwa cha kulephera kwa ziwalo zingapo (chiwindi, impso ndi mtima).

Kodi kupulumuka khansa yapachibale kumatsimikiziridwa bwanji?

Kupulumuka ndi kuchuluka kwa odwala omwe amakhala kwakanthawi (5, 10, 15 zaka) atazindikira. Oncologists pa kulosera nthawi zambiri amagwiritsa ntchito zaka 5 zapulumuka.

Ndikofunikira kudziwa kuti ziwerengero zamasiku asanu opulumuka zidawerengedwa zaka 4-5 zapitazo. Mankhwala akayamba, odwala khansa ya kapamba amatha kukhala ndi chidziwitso chabwino kuposa ziwerengero. Kupulumuka kumadaliranso pazinthu zingapo: zaka ndi thanzi la wodwalayo, mtundu wake ndi komwe chotupa chake, dongosolo lothandizira la mankhwala.

The chachikulu chotupacho, sichitha kuchotsedwa. Ngati vuto la neoplasm silinakulire ku ziwalo zapafupi komanso zakutali, matulukidwewo, pafupifupi, amakhala bwino katatu.

Kufotokozera za chotupa chowopsa

Kuwonetsedwa kwa zizindikiro kumadalira malo omwe chotupacho chili. Ngati khansa imakhudza mutu wa kapamba, ndulu ya bile imakanikizidwa. Wodwala amakula jaundice - khungu limakhala lacikuda, nseru komanso kusanza ndikusokoneza, mtundu wa mkodzo ukusintha. Zizindikirozi zimakupangitsani kuti muwonane ndi dokotala, chifukwa chake matendawa amatha kupezeka matenda asanafike metastasis. Mu 90% ya milandu, odwala omwe ali ndi chotupa m'mutu wa zikondamoyo akuwonetsedwa ntchito ya Whipple - kuchotsedwa kwa ndulu ndi ziwalo zozungulira.

Ma neoplasms mthupi ndi mchira wa tiziwalo timene timatulutsa mosakhazikika, chifukwa chake, amafika pamlingo waukulu ndipo amakwanitsa kufalikira asanafike pakuzindikira.

Amayambitsa adenocarcinoma

A pathogenetically yofunika etiological chinthu sichinadziwikebe, komanso kapangidwe ka kusintha kwa maselo athanzi kukhala maselo a khansa. Pali malingaliro oyerekeza okhudzana ndi gulu la zinthu zomwe zimayambitsa vuto zomwe zimathandizira kukulitsa maselo owopsa.

Zambiri zakutsogolo, zomwe zimatsimikiziridwa pakali pano poyesa sayansi:

• Kusuta. Zimatsimikiziridwa kuti mankhwala omwe amapezeka mu fodya amakhala ndi zotsatira zowononga m'mapapo zokha, komanso kapamba. Chiwopsezo cha chitukuko cha zotupa mwa omwe amasuta ndikuwonjezereka katatu kuposa momwe osasuta.
• Kunenepa kwambiri komanso kunenepa kwambiri - kumakulitsa maphunzirowa komanso kuperewera kwa matendawa.
• Zaka zambiri zogwira ntchito m'makampani ogulitsa mafakitale omwe amagwirizana ndi makampani opanga mankhwala.
• Kukhalapo mu mbiri ya nthawi yayitali pancreatitis kuphatikiza ndi matenda a shuga 1. Zizindikiro za matendawa kwa nthawi yayitali zimatchinga zizindikiro za khansa. Kuphatikiza apo, kapamba amadetsa matendawo.
• Kubadwa mwatsopano - kukhalapo kwa zotupa zoyipa mu banja lapafupi. Zimatsimikiziridwa kuti cholowa champhamvu chimalimbikitsa kudwala.

Zizindikiro zoyambira ndi zizindikiro

Monga chotupa chilichonse, palibe zizindikiro kapena mawonekedwe a khansa ya kapamba. Izi zimabweretsa zovuta pokhudzana ndi kuzindikira koyambirira kwa matenda. Poyambirira, khansa imatha kukayikiridwa pokhapokha ngati mukupimidwa muzipatala. Popanda chitsimikizo cha ma laboratori ndi njira zothandizira pakuwunika, matendawo sangakhalepo.

Zizindikiro zoyambirira za khansa ya kapamba:

• Ululu wokhala nawo kwanthawi yayitali kumtunda kwa epigastrium.
• Zizindikiro za kuchepa thupi mpaka kumaliza kutopa.
• Zizindikiro zam'mimba: kuchepa kwa chilala, kutsegula m'mimba, kusanza, kusanza.
• Jaundice madontho a sclera, mucous nembanemba ndi khungu.
• Chikhodzodzo chodzaza ndi ndulu.
• Ascites.
• Mapangidwe a volpetetum a palpable m'dera la kuchuluka kwa kapamba.
• Kukodza pafupipafupi.

Ngakhale kuphatikiza zizindikiro zingapo, munthu sangalankhule ndi chidaliro chonse cha kupezeka kwa vuto loyipa. Zilibe mwachindunji ndipo zilipo mu ma pathologies ena. Ngati alipo, adotolo ali ndi ufulu kukhazikitsa njira zina zowunika kwa wodwalayo, kuti adziwe chotupacho ndikuwonetsetsa kuti wapezeka.

Mawonetseredwe azachipatala a khansa yapamwamba ya kapamba

Odwala nawonso amafunafuna chithandizo chamankhwala pokha pakapita nthawi, zizindikiro zikayamba kuvuta. Monga lamulo, awa ndi zowawa zam'mimba zosadziwika kwamuyaya.

Zofunika! Malo omwe ululu wowawa umathandizira kuzindikira mitundu yosiyanasiyana. Ndi khansa ya mutu wa kapamba, ululu umalowetsedwa kudzenje la m'mimba kapena hypochondrium yoyenera. Ndi khansa ya thupi ndi mchira wa gland, amazungulira pamimba kapena kutulutsa epigastrium mu hypochondrium yakumanzere ndi radiation kupita kumunsi kumbuyo ndi kumbuyo.

Kuphatikiza pa zowawa, zizindikiro ndi mawonekedwe a khansa ya pancreatic m'magawo apambuyo atha kuphatikizira:

• Cachexia yosasinthika.
• Saffron Madontho a sclera, mucous nembanemba ndi khungu. Madontho a Jaundice ndi chifukwa cha compression ya bile ducts ndipo, chifukwa chake, kuphwanya kutuluka kwa ndulu. Bilirubin yowonjezera imazungulira m'magazi, ndikupatsa chikasu chachikaso.
• Kusinthanitsa ndi chakudya chomwe chidadyedwa dzulo, kutulutsa magazi m'mimba, kutulutsa, kubala.Zizindikiro zimawonedwa pang'onopang'ono khansa, pamene chotupacho chikuyamba kumera m'mimba ndi duodenum, kusokoneza ndikupulumutsira chakudya.
• Angapo thrombosis yamtopola kwambiri komanso yakuya kwambiri.
• Splenomegaly, ascites.

Laboratory matenda ndi chizindikiritso cha chotupa zolembera

M'mayambiriro a chitukuko, mayeso amodzi okha a maabara omwe angatsimikizire khansa: kuyezetsa magazi kwa kukhalapo kwa zotupa. Kwa kapamba, ndi carcinogenic (CEA) ndi carbonic anhydrate (CA-19-9 antijeni).

M'magawo amtsogolo, kuwonjezera pazowunikirazi, amatsatira:

• Kuyesedwa kwa matenda azachipatala, komwe kuchepa kwa hemoglobin ndi maselo ofiira amwazi, kuchuluka kwa erythrocyte sedimentation kwapezeka.
• Kusanthula kwa biochemical - kuphwanya kapangidwe ka magazi, kuchuluka kwa zamkati phosphatase ndi gamma glutamyl transpeptidase.
• Urinalysis - kuchuluka kwa glucose, mawonekedwe a diastase (pancreatic amylase).

Njira zopanga

Amachitika makamaka kwa odwala onse omwe ali ndi khansa yomwe akuyembekezeredwa. Amaonedwa kuti ndi othandiza kwambiri ndipo amapezeka pafupifupi kuchipatala chilichonse.

• Ultrasound kuwunika kwam'mimba ziwalo. Imachitika kudzera pakhungu la khoma lakunja kwam'mimba. Chizindikiro chachindunji cha chotupa ndi kukhalapo kwa volumetric imodzi kapangidwe kake kapena chifupiko chosafunikira chokhala ndi mzere womveka pakati pa mapangidwe ake ndi vuto wamba. Mutu ndi thupi la chithokomiro zimawonekera bwino kwambiri, chifukwa chake, zotupa za kutulutsa kwanyengo koyambirira zimapezeka mosavuta kuposa zotupa za mchira. Mothandizidwa ndi ultrasound, mutha kupezeka kuchokera mu mnthaka wa 1-2 masentimita. Njira ya ultrasound imakuthandizani kuti muwone kuchuluka kwa njira ya khansa komanso kupezeka kwa metastases m'mimba. Kuphukira kwa khansa kumanenedwa kuti pakakhala kuphuka kwa maselo owopsa m'mitsempha yoyandikana ndi magazi ndi ma lymph node.
• Kusintha kwazotengera zonyamula zikondamoyo. Imachitika mu nthawi yeniyeni komanso munthawi yomweyo. Chimakupatsani mwayi wamagazi ndi kuchuluka kwa mtima wa chotupa ngati mapangidwe ndi parenchyma, maubale a ziwalo zogwirizana. Phunziroli limachitika kwa odwala omwe omwe ma ultrasound adawulula zizindikiro za maselo a khansa omwe amalowa m'mitsempha yamagazi ndi msempha.
• Endoscopic ultrasound. Mtundu wa mwanjira yanthawi zonse wa ma endcutaneous ultrasound, pokhapokha ndi mphamvu yowonjezera endoscopic yomwe imagwiritsidwa ntchito. Sensor iyi imayikidwa kudzera m'mphepete ndi m'mimba mu lumen ya duodenum, komwe zimayambira. Njira yake ndi yabwino chifukwa imakuthandizani kuzindikira zotupa ndi mulifupi mwake wa 5 mm kapena kupitilira apo, zomwe sizingatheke ndi ultrasound wamba. Kuphatikiza apo, adokotala amawunika momwe ziwalo zapafupi ndi mitsempha yamagazi imayendera metastasis.

Helical computed tomography

Umu ndi "muyezo wodziwika bwino wagolide." Phunziroli ndi lothandiza kwambiri pakuwongolera panjira. Nthawi yomweyo, mapangidwe a khansa amadzisankhira masiyanidwe pazokha, zomwe zimapangitsa kuti athe kuyesa kukula, kutulutsa kwachilengedwe komanso kuchuluka kwa matenda a zam'mimba. Mothandizidwa ndi CT, boma la dera la ma lymph node, dongosolo la duct, mitsempha yamagazi ndi ziwalo zapafupi zimayesedwa. CT ndi njira yovutikira kwambiri. Ngati zilipo, metastases imapezeka mu 99% ya milandu.

Magnetic resonance imaging

Kugwiritsidwa ntchito ngati njira ina ku CT. Komabe, MRI ili ndi zovuta zina - ndizovuta kusiyanitsa vuto loipa lomwe lingachitike chifukwa chotupa. Nthawi zambiri, MRI imapangidwa kuti iwone bwino ma ducke.

Percutaneous suction biopsy ndi ultrasound kafukufuku

Njira yolowerera yozindikira yomwe imakulolani kuti muthe kutenga kuchokera kumalo omwe akhudzidwa kuti mukayesedwe pa histological. Njirayi ndiyofunikira kudziwa mtundu wa neoplasm komanso chigamulo chomaliza chazovuta zake kapena zodandaulitsa. Kutengera ndi zotsatira za biopsy, funso la kufunikira kwa chemoradiotherapy lasankhidwa.

Laparoscopy

Njira yowonongera ya m'badwo wotsiriza, yomwe imalola akatswiri a oncologists kuti azindikire momwe zimakhalira, kapangidwe kake ndi ziwalo zoyandikira nthawi yeniyeni ndi maso awo. Mapeto ake okhalapo khansa amaperekedwa komweko mchipinda chothandizira. Ngati zilipo, kufalikira, kutukuka, ndi metastasis zimayesedwa.

Mfundo ndi njira zamankhwala

Malangizo a achire zotsatira za chotupa:

1. Opaleshoni (yayikulu komanso yosasangalatsa).
2. Magetsi kapena chemotherapy.
3. Kuphatikizidwa.
4. Zizindikiro

Mtundu wa chithandizo umasankhidwa payekhapayekha. M'badwo wodwala, kukhalapo kwa concomitant somatic pathology, morphology ya khansa komanso kufalikira kwake imawerengedwa. Zizindikiro za zovuta zamagulu omwe akukayikira ndikuzindikira zimayesedwanso. Komabe, palibe mwanjira iliyonse iyi yomwe ili chidziwitso chokwanira chofanizira. Zizindikiro ndi ma contraindication opaleshoni ndi njira zamankhwala zimasankhidwa payekha ndi dokotala.

Mankhwala othandizira

Ntchito yochotsa ziphuphu zimachitika mosamalitsa monga momwe zikuwonekera.

Milandu yonse yopanga opaleshoni yayikulu:

• Zojambula za metastatic mu chiwindi ndi peritoneum.
• Zojambula za metastatic ku ma lymph node omwe sangafikire kuchotsedwa.
• Kumera kwa ziwiya za venous zokhala ndi metastases kukhoma lonse ndi kusintha kwake.
• Kuphatikizidwa kwa nthambi zazikulu za msempha mu njira ya khansa (thunthu la celiac, mesenteric ndi hepatic mitsempha).
• Zambiri zodziwika mwanjira inayake yamaphunziro.

Chithandizo cha opaleshoni chimaphatikizapo imodzi mwa mitundu itatu ya opaleshoni: pancreatoduodenal resection, pancreatoduodenectomy, kapena excation ya distal gland.

Pa pancreatoduodenal resection, mutu ndi mawonekedwe owumbidwa ndi gawo la m'mimba, wamba bile duct ndi duodenum amatsitsidwa.

Kusintha kwa zigawo zikuluzikulu kumatanthauza kuchotsedwa kwa gawo limodzi la gland (mutu, thupi, mchira, ndondomeko) ndi gawo la bile duct, duodenum ndi m'mimba.

Ndi pancreatoduodenectomy yathunthu, kapamba amaphatikizidwa kwathunthu ndimitundu yonse yoyandikana ndi lmph, ulusi, mitsempha yamagazi, ndi ma ligamu. Opaleshoni imeneyi imachitika kawirikawiri, chifukwa pamapeto pake wodwalayo amakhala ndi michere yokwanira komanso kusakwanira kwa mahomoni.

Ponena za opaleshoni yopanga, imagwiritsidwa ntchito kwa odwala ambiri. Opaleshoni yam'mimba imafunika makamaka kwa odwala omwe ali ndi vuto la jaundice wovuta, kutsekeka kwamatumbo komanso kuthamangitsidwa kwa chakudya. Pankhaniyi, amakonda kubala laparotomy, pomwe patency yam'mimba imakonzanso ndikuthira minyewa. Dokotalayo amawunikiranso mkhalidwe wa chiwalo, kuchuluka kwa kuwonongeka ndi kuchuluka kwa njira ya khansa.

Chithandizo cha opaleshoni chimasonyezedwa makamaka m'magulu apamwamba a khansa. Kutsogolo kwa kupulumuka kumawonjezeka ndi nthawi 5-7. Ambiri kupulumuka m'tsogolo pambuyo opaleshoni mpaka 2 zaka.

Chithandizo cha poizoniyu

Amachitidwa opareshoni isanachitike kapena itatha kapena kuti muchepetse ululu. Radiotherapy imasonyezedwanso zochizira zotupa m'magawo oyambilira pakakhala zotupa zazing'ono. Mankhwalawa amachitika m'masabata 5 okhala ndi Mlingo wokhazikika wa radiation. Mankhwalawa, kusanza, kusanza, kufooka kutha kuchitika, koma maphunzirowa atamaliza, mavuto ena amadzisintha pawokha. Mankhwala othandizira poizoniyu amakwaniritsa kudwala kwa matendawa, amachotsa zopweteka zowawa.

Chemotherapy

Chithandizo chimachitika ndi mankhwala apadera a chemotherapeutic omwe amatha kupha maselo a khansa kapena kuchepetsa kukula kwawo. Ndikwabwino kugwiritsa ntchito mitundu ingapo ya mankhwalawa kuti mupezeke mwachangu. Chemotherapy imaperekedwa m'makosi. Pa mankhwala, wodwalayo amakhala ndi chidwi chokhala ndi mseru komanso kusanza, khola, ulceration wa mucous nembanemba. Pamapeto pa maphunzirowa, zoyipa izi zimachoka. Chemotherapy imathandizanso kudwala kwa matenda komanso kupulumuka.

Chithandizo cha Zizindikiro chimaperekedwa kwa odwala omwe ali ndi chotupa chosagwirizana, pomwe palibe njira yomwe ili pamwambapa yomwe ingathetsere khansayo. Izi zimawongolera moyo wabwino, zimachotsa zisonyezo, zimathandizira matenda athupi lathunthu.

Zonenedweratu: kuchuluka kwake momwe ungakhalire

Kuchulukitsa kwamankhwala kumasiyana mosiyanasiyana ndipo kumatengera gawo la matendawa, kotero ngakhale adotolo opezekawo sangapereke chidziwitso cholondola. Nthawi yayitali yomwe munthu amakhala ndi khansa yapachifatse ndi motere:

• Pambuyo pakuchitidwa opaleshoni yayikulu, kupulumuka kwapakati kumakhala pafupifupi kuyambira zaka 1 mpaka 2,5. Pafupifupi 20% ya odwala amakhala ndi zaka zopitilira 5.
• Pambuyo pochita opaleshoni yayikulu, chemotherapy ndi radiation chithandizo, ngati wodwala akukana opaleshoni, kudwala kumakhala mpaka chaka chimodzi. Pafupifupi miyezi 6-8.

0 ndi 1 magawo a khansa ya pancreatic

Poyambirira, chotupacho chimapezeka mkati mwa gland, kukula kwake sikuposa masentimita 1.5. Ndizovuta kuzindikira, chifukwa sichimasokoneza ntchito za ziwalo komanso sapereka zizindikiro. Nthawi zambiri, khansa ya kapamba pamisempha 0 ndi 1 imathandizidwa. Malire a zaka 5 amakumana ndi 60-65% ya odwala.

Imfa

Khansa yapakansa ndi yomwe imayambitsa kufa kwakukulu kwa odwala khansa. Ngakhale kwa nthawi yayitali ndizovuta kuvomereza zisonyezo, popeza chidziwitsochi chinaperekedwa ku gulu lonse la "zotupa za ziwalo zina zogaya thupi ndi peritoneum". Koma titha kufananizira zomwe zikuchitika m'maiko ena ndi tanthauzo la matendawa ku Russia.

Zotsatira zakufa kwa khansa yapakhungu ku United States mu 2000 zinali zoposa 28,000 odwala, koma malinga ndi ziwerengero, kuchuluka kwachepa kwambiri (mpaka 0.9% pachaka) mwa amuna, koma kwachulukanso pakati pa azimayi.

Epidemiology

Khansa ya pancreatic ilinso yofanana mwa amuna ndi akazi, nthawi zambiri imalembedwa mwa anthu opitilira zaka 40, pomwe chiwopsezocho chimakwera kwambiri ndi zaka ndikufika pazaka 70 kwa amuna ndi zaka 50 kwa akazi.

Malinga ndi ziwerengero zaku UK, mchaka cha 2012 anthu oposa 8800 omwe adapezeka ndi khansa ya kapamba adawonekera pa 1: 1 mwa amuna ndi akazi, chifukwa chake matendawa anali 14: 100,000 aanthu. Zizindikiro za mayiko ena aku Europe sizimasiyana.

Momwe matendawa amasiyanasiyana. Nthawi zambiri, chotupa chimapezeka m'mayiko otukuka mosakhala bwino ku Africa, India, Vietnam, Japan ndi South America. Ndizotheka kuti kusiyana kumeneku kumachitika chifukwa chovuta kuzindikira chotupa komanso zinthu zingapo zowopsa, zomwe pakati pawo shuga, kunenepa kwambiri, kusuta, kapamba, cirrhosis, komanso kuchuluka kwa zakudya zama protein ndi mafuta ndizomwe zimatsogolera. Ndipo zinthu zoopsa zoterezi ndizodziwika bwino m'maiko otukuka.

Pakati pa maiko aku Europe, ziwonetsero zazikulu kwambiri zidalembedwa ku Austria, Finland, Ireland ndi Denmark; ku Russia, madera a Far Eastern, Northwest ndi West Siberian ndi omwe akukhudzidwa kwambiri.

M'mayiko a ku Europe ndi USA, kuchepa pang'ono kwa ziwonetsero kukuwoneka m'zaka zaposachedwa, koma ku Russia malo okhazikika azisonyezo amawonedwa, ngakhale kukula kwawo. Ku Europe, pakati pa 1979 ndi 2003, ziwonetserozo zidatsika ndi 18% mwa amuna, koma kuwonjezereka kwa 6% kudadziwika. Kutsika kwake kumalumikizidwa ndi kusuta, ndipo kukula kumayenderana ndi kuperewera kwa zakudya m'thupi komanso kunenepa kwambiri. Mwa amayi, kuchuluka kwa zaka zapakati pa 1979 ndi 2001 kunali kosasunthika, koma pamenepo panali kuwonjezeka kwa 10%. Izi mwina zimagwirizanitsidwa ndi kunenepa kwambiri komanso zinthu zina zowopsa pakukula kwa matenda.

Zizindikiro zamawu

Khansa ya kapamba imakonda kutchedwa "wakupha wakachetechete", izi zimachitika chifukwa cha nthawi yayitali ya matendawa chifukwa cha kufalikira kwa chiwalo. Mpaka chotupa chikafika pamtunda waukulu ndikuyamba kupanikiza madera oyandikana, wodwalayo samakumana ndi vuto lililonse. Izi ndi zomwe zidatsogolera pakupulumuka kochepa komanso zotsatira za chithandizo.

Nthawi zambiri, khansa ya mutu wa kapamba imayamba, motero pansipa pali zizindikiro za mtundu uwu wa chotupa. Mu 5% ya odwala, khansa imangokhala m'matumbo a minyewa ndipo amatha kuchitidwa opaleshoni, ali ndi jaundice mu 80% ya milandu, kupweteka 30%, jaundice wa khungu popanda kupweteka mu 55%, chiyembekezo cha moyo wa odwala chotere ndi pafupifupi Zaka 1.5 atazindikira kuti ali ndi matendawa.

Pafupifupi 45% ya odwala, chotupacho chimafalikira mpaka zimakhala, zomwe zimapangitsa kuti asagwire ntchito, chifukwa chake moyo wawo ndi pafupifupi miyezi 9.

Mu 49% ya milandu, metastasis kwa ziwalo zakutali ndi minofu imawonedwa. Odwala oterewa amamva kupweteka kwambiri mu 100%, osowa jaundice. Nthawi yawo yokhala moyo ndi yochepera miyezi isanu.

Madokotala nthawi zambiri amazindikira magawo a khansa ya pancreatic, chifukwa ndikofunikira kuchita bwino. Koma ndi omwe amawona njira zomwe angatswirire odwala, ngakhale kuti kuchitapo kanthu opaleshoni ndiye njira yofunika kwambiri yothandizira.

Magawo a khansa ya pancreatic ndi kuneneratu koyenera kwa chithandizo

Magawo agawidwa potengera momwe ntchitoyo ingathere:

Chotupa chowoneka. Mtundu uwu wa neoplasm yoyipa imapezeka mu 15-18% ya milandu. Chotupacho chimangokhala mkati mwa thupi, sichikhudza mitsempha yofunika komanso mitsempha, samapatsa metastases. Zotsatira zamankhwala zimasinthasintha, popeza pali chiopsezo chobwereranso, olemba ena amati kubwezeretsanso kumayamba ndi 100%.

Chotupa chakuthupi chakuno. Munthawi imeneyi, chotupa chimapezeka mu 40% ya odwala, pomwe chimafalikira kwa ziwalo ndi ziwalo zoyandikana, zimakula kukhala mitsempha yamagazi. Chifukwa chake, opaleshoniyo siyiyikidwa pambali.

Chotupa cham'mimba. Gawo ili la matendawa limalembedwa mu 55% ya milandu. Kukula kwa khansa ya kapamba ndi metastases ku chiwindi ndi madera ena sikuyeneretsa bwino.

Kuchotsa kuchotsedwa kwa zotupa paokha patokha njira zimapatsa mphamvu 15-25% yokha. Tiyeneranso kudziwa kuti kuchuluka kwa opereshoni pambuyo pakuchita opaleshoni kuli pafupifupi 10%, ndipo njira zowoneka bwino zimafikira 20%. Choyambitsa chachikulu cha kufa pambuyo pa chithandizo chamankhwala ndikubwezeretsanso.

Khansa yachiwiri ya 2 Pancreatic Cancer

Gawo lachiwiri, kukula kwa chotupa kupitilira 2 cm, kumayamba kukula mpaka m'mimba. Mu theka la milandu yam khansa yapachiwonetsero cha digiri yachiwiri, ndizotheka kuchitidwa opaleshoni ya Whipple. Malire a zaka 5 atachitidwa opaleshoni amakumana ndi 50-52% ya odwala. Ngati kuyambiranso sikungatheke, chemotherapy ndi radiotherapy amagwiritsidwa ntchito. Pankhaniyi, kulosera kumatsikira ku 12-15%.

Khansa 3 ya Pancreatic Khansa

Gawo lachitatu limatanthawuza kuti chotupacho chidapitilira kapamba, chinafalikira kuma ziwiya zikuluzikulu ndi misempha. Mu 20% ya milandu, kuchitidwa opaleshoni ndikotheka. Malire a zaka 5 amakumana ndi odwala 41%. Ngati opaleshoni ya Whipple singachitike, kupulumuka kwa zaka 5 ndi 3%.

Kupititsa patsogolo moyo ndi kuthetsa ululu, palliative mankhwala zotchulidwa.

Chithandizo cha khansa ya pancreatic pa magawo anayi

Pakadali pano, chithandizo cha palliative chikuwonetsedwa. Cholinga chake ndikuchepetsa ululu ndikukhazikitsa moyo wabwino. Amagwiritsa ntchito chemotherapy, radiation, painkiller. Nthawi zina, madokotala amatiuza opaleshoni yothandiza anthu. Muli gawo limodzi la malo akhudzidwa ndi kapamba, koma ndizosatheka kuchotsa maselo onse a khansa.

Maulosi Amodzi

Zachidziwikire, kuneneratu zokhala ndi njira ya oncological mu gland kwathunthu kumatengera gawo la matenda. Mtengo wake umatengera zaka za wodwalayo, kuthamanga kwa maselo a khansa, momwe zinthu zilili, kuchuluka kwa odwala khansa pachiwindi.

Chidziwitso chabwino kwambiri ndikuti kuzindikira ndi chithandizo chichitike koyambirira kwa khansa, mapangidwe ake sanachoke m'zigawozo, ndipo palibe metastasis. Panthawi ya chotupa chodwala, kuyambira zikuluzikulu mpaka kufa, miyezi ingapo imadutsa pomwe matendawa apezeka.

Gawo loyamba la oncology mu pancreatic IA limadziwika ndi chotupa chambiri, mpaka 2 cm, osatalikirana ndi gawo la gland. Ndi pathology, wodwalayo alibe chilichonse, kupatula momwe zimakhalira pakapangidwira pamalo opumira a duodenum 12. Kenako wodwalayo adzadwala, nthawi ndi nthawi matendawa amawonekera posintha zakudya.

Gawo loyamba IB - chotupa chirinso kupezeka kwa kapamba, koma kukula kwake ndi kale oposa 2 cm. Ngati khansa yapezeka m'mutu wa chiwalo, wodwalayo amadandaula za zotsatirazi:

• kutsegula m'mimba
• nseru
• kupweteka pang'ono pansi pa nthiti yakumanzere,
• Khungu limasanduka chikasu.

Pamaso pa maselo owopsa mthupi kapena gawo la mchira, zizindikilo za insulinoma, glucogonom, gastrinoma zimawonekera.

Kuti athetse matenda, opaleshoni ndi yololeka. Pambuyo podzinyenga, nkhope zomwe zimatsatira malangizo onse a dotolo zimakhala nthawi yayitali. Komabe, kuchira kwathunthu ndi opaleshoni sikutsimikiziridwa kuti 100%.

Matenda a patsogolo pa khansa ya kapamba ndi abwino mu 2-5% ya odwala, ngati malo a chotupa amachotsedwa moyenera panthawi yake. Mtsogolomo, wodwalayo amafunikira chithandizo cholowa m'malo, chomwe chimaphatikizapo kugwiritsa ntchito enzyme othandizira, kuti akhalebe olimba pazinthu zamagulu azakudya.

Zotsatira zakupha pambuyo pakuchita opaleshoni sizidutsa 10%. Pafupifupi 45% ya odwala amakhala zaka 5.

Ngati mankhwalawa adapezeka m'dera losafikika la England, kapena ngati chotupa ngakhale pachiwonetsero chachikulu, machiritso sangathe kuchitika. Panthawi imeneyi, wodwalayo adzapatsidwa mankhwala a chemotherapy ndi radiation.

Chotupa chovunda cham'mimba chimakhala ndi chidziwitso chabwino, chifukwa nthawi zina zimakhala zomwe zimakhala zosavomerezeka bwino. Mapangidwe akachulukanso, zovuta monga jaundice, invagination yamatumbo imatha kuchitika. Ngati chotupa chikuchotsedwa munthawi yake, ndizotheka kuchira kwathunthu.

Maulosi mu gawo lachiwiri

Gawoli silikhala ndi zotupa zazikulu, koma lili ndi zowonongeka mu dongosolo la lymphatic.
Madokotala oncological ndondomeko yachiwiri ya khansa amagawika pawiri.

Ndi 2A, kuwonongeka kwakukulu kwa fiber ndi mitsempha yamagazi kumachitika. Ma metastases sanapangidwe.

Njira ya matendawa mu gawo lachiwiri la 2B imadziwika ndi chotupa choyipa chachikulu. Itha kukhala yayikulupo, yopangidwira kupitirira malire a gland. Kapangidwe kamakoko kamakalowa mu minofu ya pancreatic ndi ma lymph node omwe amakhala pafupi. Ma metastases oyamba amachitika.

Zizindikiro za matenda otupa 2B.

1. Kuchepetsa thupi.
2. Ululu pamimba.
3. Kutsegula m'mimba
4. Kubweza

Digiri yachiwiri ya oncology imachepetsa kwambiri mwayi wopulumuka. Pakati pa madokotala, akukhulupirira kuti kupezeka kwa maphunziro otsika kwambiri pamutu ndi vuto lovuta ndi matenda a gland.

Khansa yamatenda am'mutu, chidziwitso ndi chiyani, ndi angati omwe amakhala ndi iyo? Pa opaleshoni, dokotalayo amatha kuwonetsa mutu, bile, nseru, duct, zilonda 12 zam'mimba. Ziwalo zonse zikachotsedwa m'thupi, dokotala amabwezeretsa kukhulupirika kwam'mimba ndi matumbo.

Zotsatira zakupha pambuyo pochitidwa opaleshoni chifukwa cha chotupa cha chotupa cha pancreatic zili pafupifupi 9-13%. Ngakhale atachita bwino matendawa atachitidwa opaleshoni ndikutha kwa chithandizo, pafupifupi 7% ya odwala amakhala pafupifupi zaka 5.

Kudziwitsa zakutsogolo kumatheka ngati, mutatha kuchita zodabwitsazi, metastases sikubwerezanso.

Ndi khansa yapancreatic, ndi angati akukhala? Tawulula digiri yachiwiri ya kupukusa, kuchotsa kwathunthu kwa kapamba kumachitika. Ndipo dotolo akhoza kuyesa gawo lam'mimba, ndulu, dera la maselo.
Zotsatira zakuchulukaku, dotolo amawalowetsa kutumphukira m'matumbo ang'ono. Vutoli ndikuti chifukwa chakuchotsedwa kwa ziwalo zambiri, mtundu wovuta wa shuga umatha kupanga opaleshoni.
Matendawa akakula mchira ndi thupi, adotolo amawonetsa malo omwe ali ndi khansa, chikhodzodzo ndi ndulu. Pafupifupi odwala 45% amakhala ndi moyo pafupifupi chaka chimodzi. Ngati wodwalayo akupatsidwa mankhwala a chemotherapy, ndiye kuti mpaka 10% amatha kukhala ndi zaka 5.

Pankhaniyi, nthawi zambiri zamatsenga zimapezeka mochedwa, pakakhala kugonjetsedwa kwamphamvu ndi metastases. Kenako padera pake wodwalayo amakhala kwa chaka chimodzi ndi theka.

Maulosi Atatu

Masiteji atatuwo amadziwika ndi kugonjetsedwa kosangalatsa ndi maselo a khansa a ndulu, ziwiya zokhala ndi mitsempha. Ma metastases amasamukira kumadera akutali ndikuwononga kotheratu ka lymph, kusankha impso ndi mitsempha ya mtima.

Ndi angati omwe akukhala ndi khansa ya pancreatic? Kusangalatsa kumatheka pokhapokha pazochitika 20%. Zaka zisanu zimakhala mpaka 41% ya odwala. Ngati pali contraindication ku opaleshoni, kuchuluka kwa pafupifupi zaka 5 ndi 3%.

Kuchotsa chotupacho nthawi zambiri sichingatheke chifukwa cha kuchuluka kwakukulu komanso komwe akukhala.

Pakadali pano, khansa ya pancreatic ya digiri ya 3 imakhala ndi zachilendo - kumachitika kwa kuledzera, komwe kumapangitsa kukula kwa matenda. Mankhwala othandizira opaleshoni amathandizira kuwonongeka pakukula kwa matenda obwera pano komanso thanzi la wodwalayo. Mankhwala omwe amaphatikizidwa amatsogolera pakulepheretsa kufalikira kwa metastases ndi kuwonjezeka kwa maphunziro, ndipo kwa nthawi yochepa kumatenga nthawi. Kugwiritsa ntchito maphunziro ochepa okha a chemotherapy sikumasintha moyo, koma kukula kwa chotupa kumayima. Zonenedweratu zimawonedwa ngati zosavomerezeka.

Maulosi Anayi

Uwu ndiye digiri yoopsa kwambiri ya oncology, yomwe yapezeka pafupifupi 50% ya anthu. Popeza kupangidwanso khansa kumatha kupezeka m'ziwalo zoyandikana - chiwindi, chikhodzodzo, mapapu, m'mimba, kuledzera kapena kuphatikizika kwamadzi mu peritoneum ndikotheka, zomwe zimapangitsa kuti magazi awonongeke kwambiri.
Kukula kwa khansa ya pancreatic pa gawo 4 kuli kwathunthu chifukwa cha:

• mulingo wa kuyika kwa khansa ziwalo zina,
• kupezeka kwa zowawa
• kukhala bwino
• kukhudzana ndi chemotherapy.

Kodi ndingakhale ndi khansa ya degree 4 mpaka liti? Ngakhale mankhwala ochiritsira atakwaniritsidwa, nthawi zambiri sipangadutse chaka chimodzi. Nthawi zambiri wodwala amakhala ndi miyezi 6 mpaka 6. Pafupifupi zaka 5 za moyo zili mu 4% ya odwala. Panthawi imeneyi akupeza mankhwala othandizira.

Ngati mukuwona kusintha pang'ono kwa kapamba, muyenera kupita kwa dokotala nthawi yomweyo. Uwu ndi mwayi pachigawo choyambirira kuti mudziwe zomwe zimayambitsa, zizindikilo ndi kupereka mankhwala, zomwe zingakulitse mwayi wokonzanso kwathunthu.