Pancreatic khansa ya mutu - Zizindikiro, magawo, chithandizo

Pakati pa matenda onse a oncological, khansa ya pancreatic ndiyosowa kwambiri, koma ili m'malo lachinayi muimfa. Nthawi zambiri, madokotala amakumana ndi khansa ya mutu wa kapamba, chotupa m'mbali zina za thupi sichachilendo. Khansa ya kapamba imayamba kugwiritsidwa ntchito ndi amuna, ndipo mwayi waukulu wokumana ndi matendawa umachitika pambuyo pa zaka makumi asanu ndi limodzi mphambu zisanu. M'magawo oyamba, ma oncology amutu wa kapamba samawonekera, ndipo pambuyo pake zizindikirozo zimatha kukhala zolakwika pazizindikiro za matenda ena. Pazifukwa izi, matenda a zam'mimba nthawi zambiri amapezeka kuti ali kumapeto, pomwe wodwalayo amakhala ndi miyezi ingapo.

Chotupa m'mutu wa kapamba amatha kulowa mu duodenum, matumbo akulu, ndi m'mimba. Metastasis imachitika m'magazi ndi kayendedwe ka zamitsempha. Zotupa zachiwiri zimalowa mu minyewa ya chiwindi, mapapu, mafupa, ndi zamitsempha. Oncopathology ya kapamba wokhala ndi metastases ya chiwindi imadziwika kwambiri, chifukwa chake jaundice ndiye chizindikiro chachikulu cha matendawa. Kuti mupeze matenda, ndikofunikira kuchita diagnostics mu gastroenterology: tomography (MRI, PET ndi CT), ultrasound, biopsy, ndi zina. Chithandizo cha mankhwala chimayikidwa molingana ndi kukula kwa maphunziro komanso kuchuluka kwa chitukuko cha oncology. 20% ya odwala omwe amachitidwa opaleshoni, ena onse amangopatsidwa chithandizo chamankhwala.

Zomwe zimachitika

Pakadali pano, zinthu zodziwika bwino zokha ndizomwe zimadziwika.

Itha kukulitsa chiopsezo cha khansa yapakhosi:

Zakudya zoperewera. Kuwonjezeka kwa kuchuluka kwa mafuta a nyama mumenyu kumabweretsa zochuluka mthupi la mahomoni ngati cholecystokinin. Zotsatira zake, cell hyperplasia imatha kuchitika.
Kusuta Kugonjetsedwa kwa thupi ndi carcinogens kumabweretsa kuwonjezeka kwa lipid, komwe kumakweza kuchuluka kwa timinyewa ta m'mapapo.
Matenda kapamba, kukhalapo kwa cysts kapena chosaopsa chotupa. Ndi kusayenda m'mutu wa pancreatic chobisalira, chiwopsezo cha zilonda zamtundu uliwonse wamakhalidwe achikhalidwe chikuwonjezeka.
Matenda a ndulu. Kukhalapo kwa matenda a ndulu mwa munthu, cholecystitis yayitali, kungayambitse chotupa cha khansa.
Mowa. Mwa anthu omwe amadalira zakumwa zoledzeretsa, chiopsezo cha pancreatitis yayitali chimakhala kangapo, chomwe chimayambitsa ngozi.

Kufotokozera kwa Pathology

Khansa yam'mutu ya pancreatic ndi m'gulu la zotupa zoyipa. Nthawi zambiri, matendawa amakhudza amuna, ndipo msambo womwe matenda amapezeka ndi pafupifupi zaka 65. Ngakhale kuti chidwi chambiri chimaperekedwa pa vuto la chotupa chakupweteka kwa mutu kapamba mu mankhwala, 99% ya odwala amwalira pasanathe zaka zisanu atapezeka matendawa. Mwa zotupa zonse zoyipa, khansa ya kapamba, ndipo makamaka mutu wake, imatenga malo khumi pamndandanda wa matenda a oncological, pomwe matenda am'mimba ali wachinayi muimfa.

Pafupifupi, ziwalo monga kapamba ndizofunika kwambiri pakugwira bwino ntchito kwa munthu. Dipatimenti yoyendetsa thupi imatulutsa michere yofunikira kugaya chakudya mu lipase ndi amylase, trypsin ndi chymotrypsin. Ma cell a endocrine amatulutsa mahomoni (glucagon, insulin, somatostatin) omwe amawongolera kagayidwe kazachilengedwe. Madzi a pancreatic, omwe amapangidwa ndi gland, amatumizidwa ku duodenum, komwe mtsogolomo mumakhala njira yopanga zinthu zomwe zimagwira ngati gawo losungira mphamvu kwa thupi lonse. Ntchito yolumikizidwa motere ndi yofanana ndi chomera chenicheni cha jenareta, komabe, zikondamoyo zikagwidwa ndi khansa, vuto lalikulu limachitika, pambuyo pake chiwalo sichingagwire ntchito moyenera.

70% yamatenda a khansa ya kapamba amachitika ndendende pamutu pa chiwalochi, pomwe 80% ya odwala amapezeka ndi adenocarcinoma. Chotupa ndi khungu lowala lomwe limakhala ndi mbewa yoyera kapena yopepuka, nthawi zina exophytic kapena kuphatikiza neoplasms imadziwika kuti imatuluka pamiyendo ndi tiziwalo tating'ono ta glandular.

Kuopsa kwa maphunzirowa kumatengera madipatimenti omwe amakhudzidwa ndi chotupa ndi metastases yake. Chifukwa chake, pakuletsa bile duct (duct yomwe imaphatikiza chiwindi ndi kapamba), kutuluka kwa ndulu m'matumbo aang'ono kumayima, chifukwa chake kumadzaza ndulu, potero kumayambitsa jaundice. Pamene kupweteka kwa mtsempha wa splenic ndikapindika, nduluyo imakulirakulira, yomwe imakwiyitsa splenomegaly ndi ascites (kuchuluka kwa madzimadzi m'mitsempha ya peritoneal). Panthawi ya kumera kwa metastasis m'matumbo akulu kapena aang'ono, kutsekeka kwamatumbo kumachitika.

Pali magawo angapo a kupita patsogolo kwa khansa ya mutu wapa pancreatic:

Zero ˗ koyambirira koyamba, komwe chotupa chake ndi chaching'ono, ndipo palibe metastase,
Woyamba, pamapangidwe omwe pali kuwonjezeka kwa neoplasm mpaka 2 cm, metastasis imapezekanso, chifukwa chake, pakudziwa matenda pano, kudalirika kwa wodwalayo kumakhalabe bwino,
Lachiwiri, lomwe limachitika ndi zilonda zapancreatic, koma popanda kulowa kwa metastasis kulowa ziwalo zoyandikana, wodwalayo amamuchita opaleshoni yotsatiranso maphunziro a chemotherapy, omwe amalola kutalikitsa moyo wa wodwalayo kwakanthawi kambiri,
Gawo lachitatu severe lakuthwa kwambiri, komwe mathero amitsempha ndi mitsempha yamagazi amakhudzidwa, ma metastase amawoneka mwachangu, chifukwa chomwe kuchitapo kanthu opaleshoni sikothandiza, gawo lalikulu lamankhwala limadziwika ndi mankhwala a chemotherapeutic kuti muchepetse kupweteka.
Chachinayi ˗ gawo lotsiriza, lomwe, mwatsoka, siligwiritsidwa ntchito poperekera chithandizo, metastases imakhudza madera ambiri, kulowa kwa mitsempha ya m'mimba ndi ziwalo zina, ngakhale zakutali, njira yodzetsa kwambiri thupi imayamba, ndipo zonse zomwe madokotala angachite zimangoyambitsa matenda a wodwala .

Ndi angati akukhala ndi izi?

Funso ndilotsutsana kwambiri, chifukwa chiyembekezo chamoyo m'mbali zonse ndi zosiyana. Choyamba, zimatengera gawo lomwe matendawa adapezeka, chifukwa ndi chomwe chimapangitsa kukula kwa chotupacho komanso kutulutsa kwake, kuchuluka kwa zowonongeka pamasamba oyandikana, komanso kukhalapo kapena kusowa kwa metastase mu ziwalo zapafupi kapena kutali ndi kapamba. Chofunika kwambiri ndi kuchita opareshoni.

Monga lamulo, ma neoplasms ang'onoang'ono omwe adachotsedwa panthawi yake ndi mankhwala ena apadera amapereka mwayi: 2-5% ya odwala amakhala ndi zaka zopitilira 5. Komabe, ndi 10% yokha mwa odwala 100 omwe amafunsa thandizo loyambira, magawo ambiri a khansa yapakhungu amadziwika m'magawo atatu a chitukuko. Ndi chotupa chosagwira ntchito chomwe chatulutsa ziwalo ndi ziwalo zapafupi, nthawi ya moyo imatsimikiziridwa ndi zaka zitatu, koma ngati wodwalayo ali ndi chotupa chokhala ndi metastases yakutali, opaleshoniyo imakhala yopanda tanthauzo, ndipo chiyembekezo cha moyo sichingakhale kuposa miyezi 6-12. Kukana kuchokera ku maphunziro a chemotherapy kumabweretsa kuti nthawi yotalikirapo ya moyoyi imangokhala miyezi yochepa chabe.

Ngakhale kuti madokotala sanapeze chinsinsi cha khansa, njira zonse zapangidwira kuti awonjezere moyo wa wodwalayo, komanso kukonza ndikusamalira momwe akukhalira, ndipo izi zikuphatikiza:

Radiation chithandizo ndi chemotherapy,
Kugwiritsa ntchito ma pinkiller ndi antidepressant,
Kukakamira kwa ma ducts kuti muchotse bile.

Kuphatikiza apo, odwala amalandila chithandizo cham'mutu komanso chisamaliro choyenera.

Khansa ya mutu wa zikondamoyo kapena papilla wamkulu wa duodenal?

Pulogalamu yayikulu ya duodenal papilla (BDS), kapena, monga momwe imatchulidwira mosiyana, Villa papilla, si dipatimenti yopanda phukusi. Mwina si anthu ambiri omwe amadziwa zomwe iye ali komanso komwe ali.

The Vater nipple ili mkati mwa gawo lapakati la duodenum, ndimayendedwe ofupikira pomwe madzi a pancreatic ndi bile amalowa m'matumbo ang'onoang'ono. Pamapeto pa kukweza kwake pali sphincter ya Oddi, yomwe ntchito yake yayikulu ndikuwongolera kuchuluka kwa ma enzymes kutengera momwe amapangira chakudya.

Chifukwa chakuti duquenal papilla yayikulu ili pafupi ndi kapamba, ma pathologies omwe amapezeka momwemo amatha kusokonezeka ndi matenda a chiwalo china. Mwa njira, izi sizongokhudza kapamba, popeza pafupi ndi Vater papilla palinso chikhodzodzo.

Neoplasms ya duodenal papilla yayikulu ndi kapamba ndizosiyana kwambiri, koma kuphwanya kwaletsa kutsekemera kwa ma BDS nthawi zambiri kumayambitsa kutupa ndi mapangidwe a bile stasis, chifukwa chomwe njira zoyipa za gawo loyandikana nalo limatha kuyambitsa.

Zizindikiro zazikulu za khansa ya BDS ndi:

Ululu mu peritoneum
Kusanza ndi kusanza
Kukongoletsa khungu ndi kuyabwa kwawo,
Kumva kulemera m'mimba
Kutsegula m'mimba
Kukhalapo kwa magazi mu chopondapo.

Ndikosatheka kudziwa mtundu wamatendawa pogwiritsa ntchito chithunzi chimodzi chazachipatala, makamaka ndizovuta kudziwa kuti chomwe chimayambitsa nkhawa ndi chiani: kapamba kapena BDS. Kutengera madandaulo a wodwala, adokotala amatha kungoganiza, komabe, kuti adziwe zolondola, maphunziro ena ndi ofunika: MRI kapena CT, esophagogastroduodenoscopy, endoscopic retrograde cholangiopancreatography, ndipo nthawi zina laparoscopy.

Zifukwa zachitukuko

Asayansi amakono amalipira chidwi kwambiri pamutu wakukula kwa khansa, kafukufuku akuchitika kuti amvetsetse zomwe zimayambitsa matenda, komanso kupeza mankhwala omwe angaimitse kupitilira kwa njirayi. Komabe, mwatsoka, mafungulo azithunzi izi sanapezekebe. Amaganiziridwa kuti zinthu zomwe zimathandizira kutsegula kwa zotupa zoyipa ndipo, makamaka, khansa ya mutu wapa pancreatic ikhoza kukhala:

Zolakwika mu zakudya: kudya kwambiri mafuta ochulukirapo komanso zakudya zamchere kwambiri, zakudya zosuta, mwachitsanzo, zimadziwika kuti zakudya zamafuta zimapangitsa kupanga kapamba wam'mimba, zomwe zimapangitsa kuti pakhale hyperplasia,
Kuledzera kwa zakumwa zoledzeretsa, chifukwa chomwe chiopsezo cha matenda opatsirana chimachulukanso,
Kusuta, limodzi ndi kulowetsedwa kosalekeza m'mitsempha, kumakulitsa kuchuluka kwa zamadzimadzi m'magazi, ndipo izi zingayambitsenso hyperplasia ya cell pancreatic cell.
Pancreatitis yosatha ndi kusayenda kwa zotupa zotupa zimayambitsa masinthidwe amtundu wa kapamba ndipo amathandizira kuwonongeka kwawo kwina,
Matenda a shuga angayambitsenso hyperplasia ya epithelium ya ma ducts.

Chomwe chimapangitsa chidwi cha khansa ya mutu wa kapamba chimatha kukhala matenda monga pachimake kapamba, cholecystitis, gastritis, zilonda zam'mimbazi, matenda am'mimba. Matendawa amapezeka limodzi ndi ma pancreatic neoplasms mu 90% ya milandu yonse.

Momwe zikuwonekeranso pakupanga chotupa pamutu wapachikondicho ndilinso:

Opaleshoni yochitidwa pa kapamba kale
Kugwiritsa ntchito mankhwala kwakanthawi
Gwirani ntchito zowonjezera zowopsa: asayansi samasankha kuti mapangidwe a zotupa za khansa amatha kuchitika chifukwa cholumikizana pafupipafupi ndi mankhwala owopsa ndi mafupizo.

Pankhani ya mayendedwe oyipa, munthu sayenera kuchotsera chibadwire. Khansa, kuphatikizanso kapamba, zimakonda kuchitika mwa anthu omwe abale awo apamtima adwala matenda awowa.

Zizindikiro za Cancer wa Pancreatic

Monga tafotokozera pamwambapa, kudalirika kwa matendawa kumachitika chifukwa choti koyambirira sikumawonekera mwanjira iliyonse, wodwalayo akumva bwino ndipo saganiza kuti njira yayikulu yakudutsa ikuchitika mthupi lake. Titafika pagawo lachitatu, zizindikiro zoyambirira zimawoneka, koma pofika nthawi iyi chotupacho chafika kale pamlingo wokulirapo, limodzi ndi metastase yomwe imakhudza mitsempha yamagazi, ma lymph node, komanso ziwalo ndi ziwalo zapafupi zimapezeka.

Choyambirira chomwe chimayamba kuvuta ndi "kupweteka kutchulidwa, kutanthauzira komwe nthawi zambiri kumakhala hypochondrium yoyenera, koma kupweteka kumatha kumangiriza: kuzungulira kumbuyo, kumbuyo kwam'mimba, ndiko kuti, nthawi zina zimakhala zovuta kumvetsetsa chomwe chimayambitsa vuto. Nthawi zambiri, mavuto ngati amenewa amawonjezeka usiku, komanso nthawi yamatsenga. A neoplasm yomwe ikukula pang'onopang'ono komanso mosalekeza imakakamiza mathero amitsempha, chifukwa chotsatira chomwe kupweteka kwambiri kumachitika. Mukamadya zakudya zamafuta kapena zakumwa zoledzeretsa, mawonekedwe owawa a ululu amasintha kukhala owala ndi owala.

Popeza kapamba ndi chimodzi mwazakudya zam'mimba, pamaso pa chotupa chokhwima mkati mwake, kusokonezeka kwa dyspeptic kumachitika, komwe kukufotokozedwa kuti:

Kusanza ndi kusanza, komwe nthawi zambiri kumakhala ndi khungu la khofi chifukwa cha kupezeka kwa magazi mkati mwake,
Kutsekula m'mimba kapena kudzimbidwa,
Kubetcha pafupipafupi (makamaka ndi fungo lovunda)
Kulemera m'mimba mutatha kudya.

Pamodzi ndi izi, chilakolako chakufa chimachepa ndipo mawonekedwe a pondowo amasokonekera, momwe zotsalira za chakudya chosasamba kapena zodetsa zamagazi zimawonekera.

Muzochitika zambiri za wodwalayo, kusintha komwe kumachitika kumakhalaponso: kufooka kosatha kumamvekedwa, kukumbukira ndi kuyika chidwi chochulukirapo, mphamvu yogwira ntchito imachepa, kugona kumasokonezeka. Komabe, chizindikiro chachikulu cha njirayi ndi kuwonda kwambiri. Depletion, kapena, mwasayansi, cachexia, imayamba chifukwa cha kusokonezeka kwa kapangidwe kazinthu kazakudya, kamene kamachitika chifukwa cha kuchuluka kosakwanira kwa michere ya pancreatic mthupi.

Chithunzi cha chipatala chimakula kwambiri ndi khansa ya mutu wa 3. Kuphatikiza pa zomwe zatchulidwa pamwambapa, zina zingapo zimachitika:

Mkodzo wakuda
Kutulutsa ndowe,
Kutentha kwa khungu,
Kukhalapo kwa fecal putrefactive fungo,
Kukhazikitsidwa kwa khansa yolepheretsa,
Kukula kwa kukula kwa kapamba ndi chiwindi, zomwe zikuwonekeratu ngakhale ndi palpation,
Anemia, thrombocytopenia kapena leukopenia yomwe imachitika pamene chotupa cha mtsempha wa splenic chakhudzidwa.

Nthawi zina mutu wowopsa komanso magazi am'munsi am'munsi, nosebleeds, tachycardia amathanso kuonedwa. Vuto lalikulu ndilo kupezeka kwamatumbo, kugunda kwa mtima kwa ndulu kapena mapapu, ascites.

Kutanthauzira kwa matenda a mtima

Khansa ya pancreatic yamutu imatchulidwa malinga ndi dzina lomwe TNM amavomereza padziko lonse lapansi, pomwe zotupa zimasiyanitsidwa ndi chilembo chilichonse ndi kukula kwawo (T), mwa kukhalapo kwa metastases mu lymph node (N), komanso kupezeka kwa metastases m'matumbo akutali (M).

Kutengera ndi komwe neoplasm ili, pali:

Khansa yapakansa
Njira zoyipa za thupi la kapamba,
Tumor wamutu wapachikondwerero, womwe tikukambirana.

Popeza onse omwe amapezeka ndi khansa ali ndi chilengedwe cha morphological, pali gulu lina, lomwe limatengera chikhalidwe cha histology. Malinga ndi izi, zotupa zonse zoyipa za mutu wa pancreatic zimagawidwa:

Ductal adenocarcinoma, yopangidwa ndi maselo otsegula,
Mucinous adenocarcinoma, wopangidwa ndi maselo okhala ndi chindapusa chachikulu cha mucin,
Cystadenocarcinoma chifukwa kufinya cyst.

Mwa chikhalidwe cha kukula, zotupa zonse zimasiyanitsidwa kukhala zotuluka, kupukusidwa ndi kupendekera, ndipo mwa mtundu wawo ˗ zimakhala waplastic komanso squamous.

Khodi ya ICD-10

Kuchepetsa koteroko monga khansa ya pancreatic kwalembedwa mu "Kugawika Kwa Matenda Padziko Lonse." Mu kalasi "Neoplasms" (C00-D48) pali gawo "Malignant neoplasms" (C00-C97) lomwe lili ndi gawo laling'ono la "Malignant neoplasms of localizations" (C00-C75). M'gululi, pali gawo lina la "Malignant neoplasms of thegesges system" (C15-C26), pomwe zotupa zoyipa zapansi pansi pa cholembera C25. C25.0 ˗ alphanumeric kusankhidwa kwa khansa ya mutu wapa pancreatic.

Zizindikiro

Mukayamba kukaonana ndi katswiri kuti mudziwe chifukwa chenicheni, sizotheka. Dokotala amaphunzira ma anamnesis, amamuwunika wodwalayo ndi palpation, ndipo, potengera madandaulo a wodwalayo, amasankha njira ina yoyeserera. Kuzindikira koyenera kumatha kupangidwa kokha pogwiritsa ntchito njira zama labotale ndi zothandizira.

Zoyambirira zikuphatikiza:

Kuyesedwa kwa magazi ˗ ndikofunikira kuti muphunzire kuchuluka kwa leukocytes ndi lymphocyte, mapulateleti ndi ESR (omwe ali ndi khansa ya pancreatic nthawi zambiri amakwezedwa), komanso hemoglobin: kuchepa kwa magazi kungakhale umboni wina wamabala.
Kuyesedwa kwa shuga kwa shuga: khansa ya kapamba, kuchuluka kwa shuga kumawonedwa nthawi zambiri,
Kuyesedwa kwa magazi pa biochemical pakukonzekera kwa bilirubin, diastase, transaminase (ast, alt), cholesterol ndi mapuloteni: mfundo zapamwamba za izi zingathenso kuwonetsa khansa yapachifungo,
Magazi pazotupa,
Urinalysis ˗ amalembedwa kuti apeze utoto wa bile ndi urobilin,
Kusanthula ndowe, komwe kumafunikira kuti pakhale kuyesa kwina kwa ndulu: mu khansa ya kapamba, kapangidwe kake ka ndowe ndizopanda pake, imakhala ndi zotsalira za chakudya chosapatsika ndi dontho lamafuta, zamkati limakhala ndi mafuta a sheen komanso fungo lovuta.

Njira zofufuzira zothandizira kuti mudziwe zambiri zimafotokozera zambiri:

Ultrasound
CT ndi MRI
Pancreatic ultrasonography,
MRPH (magnetic resonance pancreatography).

Kuwerenga kapamba ndi njirazi kumapereka chidziwitso chokwanira cha kukula ndi malo omwe neoplasm, mkhalidwe wa bile ndi pancreatic ducts, komanso kupezeka kwa metastases mu ziwalo zina.

Ngati nkhani zina sizinafotokozedwe bwino, njira zowonongera zimagwiritsidwa ntchito, zomwe zimaphatikizapo:

ERCP (endoscopic retrograde cholangiopancreatography), chomwe chimapangitsa ndalamayi ndikukhazikitsa kwa catheter ndi njira yomwe sing'anga yosiyanirana imadyetsedwa kudzera ku endoscope, izi zimakuthandizani kuti mutenge zithunzi za x-ray komanso mutatenga zitsanzo za biopsy,
Laparoscopy ˗ imagwidwa ndi chaching'ono chofiyira kukhoma lakunja kwa peritoneum, komwe imayikidwa ndi tepi yopyapyala ya laparoscope, yolumikizidwa ndi kamera ya kanema ndipo yokhala ndi nyali ya xenon, ndikudzaza pamimba pamimba ndi kaboni dioxide, madokotala opaleshoni amapanga malo ndikuchita mwayi wopanga opaleshoni.

Chithandizo cha khansa ya mutu wapa pancreatic

Pambuyo pakuzindikira matendawa, akatswiri amatsimikiza ndi njira zina zochiritsira, momwe mungachitire opaleshoni yothandizirana, komanso chemotherapy ndi radiation chithandizo, njira zambiri zotchulidwa zimagwiritsidwa ntchito palimodzi. Kutheka kwakukulu kumatheka ndi opareshoni, pomwe chotupa chimatuluka. Zotupa zoyipa kumayambiriro kwa chitukuko kudzera pancreatoduodenal resection. Chinsinsi cha njirayi ndikuchotsa mutu wa kapamba ndi matumbo ang'ono, kenako ndikumangidwanso kwa ducts ya bile ndi m'mimba thirakiti. Zombo zapafupi, ma lymph node, ndi fiber zimakhalanso ndikuchotsedwa.

Popeza chiopsezo chobwereranso kwa neoplasm pambuyo pakuchita opaleshoni ndikochuluka kwambiri, wodwalayo amapatsidwa maphunziro a chemotherapy, nthawi yomwe imatsimikiziridwa osati ndi kukula kwa chotupa chokhacho, komanso ndi kukhalapo kapena kusowa kwa metastases. Radiotherapy imagwiritsidwa ntchito ngati mawonekedwe oyipa apangidwe kachiwiri kapena akapezeka kuti ali kumapeto. Pankhaniyi, opaleshoni ndiyothekanso. Komabe, pali zotsutsana zina, kuphatikizapo jaundice, cachexia, leukopenia ndi zilonda zam'mimba.

Postoperative zakudya ndi njira zodzitetezera

Kutsatira zakudya zoyenera mutatha kuchita opaleshoni ndi imodzi mwama mfundo zazikuluzikulu zakuchira. Chifukwa cha zakudya, ntchito ya ziwalo zogaya chakudya imakhala yofanana komanso chitetezo chokwanira chimalimbikitsidwa kwambiri. Pazinthu zomwe zaletsedwa kugwiritsa ntchito, akatswiri azakudya amakonda:

Mowa ndi zakumwa zoledzeretsa,
Maapulo ndi ma pickles,
Kusamalira
Mafuta ndi nsomba
Zakudya zonunkhira
Zakudya zakumwa,
Zakudya zokazinga
Confectionery ndi makeke atsopano,
Khofi wamphamvu komanso tiyi.

Pofuna kuvulaza thupi lofooka, zakudya zimakhazikitsidwa pang'onopang'ono. M'masiku oyamba pambuyo pa opareshoni, wodwalayo amaloledwa supu zophika zokha zamadzimadzi, chimanga chamadzimadzi chokonzedwa pamadzi, zinthu zamkaka zokhala ndi mafuta ochepa, zodulira zamkati kuchokera ku nyama zopanda mafuta, masikono ndi mkate wowonda, komanso tiyi wopanda mafuta. Pakatha milungu iwiri, pokhapokha ngati palibe zovuta, masamba ophika, mafuta ophika, mafuta ophika amayamba nawo zakudya, pomwe chakudya chonse chimayenera kupakidwa chophweka kapena chosenda.

Njira yayikulu yazakudya ndi kutsindika zakudya zochepa zama calori, komanso zakudya zomwe zimakhala ndi mitundu yambiri yazomera. Kuphatikiza apo, wodwalayo ayenera kuyiwaliratu za kusuta fodya komanso kumwa ˗ zizolowezi zoyipazi zingakulitse kwambiri zinthu.

Kodi ndizotheka kuchiritsa khansa ya 4th pancreatic cancer

Gawo 4 la pancreatic malignant process ndi lomaliza. Pofika nthawi imeneyi, chotupa chija chikufika pakukula kwakukulu, ndipo maselo ake akupitiliza kugawa osagwirizana, koma mwachangu kwambiri. Pakadali pano chitukuko, thupi limakhudzidwa kwambiri ndi ma metastases, omwe amawonedwa ndi ziwalo kutali ndi kapamba, mwachitsanzo, muubongo ndi chingwe cha msana.

Matendawa amakula mwachilengedwe, zomwe zimapangitsa kuti wodwalayo akuipiraipira. Zizindikiro zazikulu zikuphatikiza:

Kuledzera kwakukulu kwa thupi,
A ananenedwa ululu matenda omwe amapezeka chifukwa cha kuchuluka kwa maselo a khansa pakumapeto kwa mitsempha ya ziwalo ndi zimakhala.
Kudzikundikira kwa malita 20 amadzi m'mimba,
Kutopa komwe kumachitika chifukwa cha kukomoka kwa m'mimba: kutulutsa kokwanira kwa timadziti tam'mimba kumabweretsa zovuta pakugaya chakudya komanso kuperewera kwa chakudya,
Kukula kwa Splenomegaly ˗ kukula kwa masentimita oposa 12,
Kukula kwa Hepatomegaly ˗ kuchuluka kwa chiwindi, komwe kumalumikizidwa ndi kuyesayesa kuchitidwa ndi thupi kukana kuledzera,
Kutupa kwa lymph node ˗ kumachitika pafupipafupi, popeza izi zimapangidwa kuti ayeretse zamitsempha, momwe ma cell a khansa amafalikira,
Thrombophlebitis, yomwe imayamba chifukwa cha kusokonekera kwa magazi.

Cholinga cha chithandizo pakadali pano ndikuwongolera zomwe zimachitika kwa wodwalayo, komanso kupewa zina zotupa ndi metastase. Kuti muchite izi:

Kutulutsa kwathunthu kapena pang'ono kwa kapamba ndi malo ozungulira,
Opaleshoni yodwala yomwe imathandizira kubwezeretsa matumbo komanso bile kumapangitsa kuti magazi asatayike,
Chemotherapy (Gemzar, Campto, Carboplatin, etc. amagwiritsidwa ntchito),
Radiation chithandizo pogwiritsa ntchito ma radiation a ionizing, njirayi imakhala ndi zowononga ma mamolekyulu a protein m'maselo owopsa, chifukwa chomwe neoplasm imachepa kukula,
Chithandizo cha mankhwala oletsa kupweteka, cholinga chachikulu chomwe ndikuchepetsa ululu, chifukwa chake, ma analgesics komanso zinthu zosokoneza bongo zimagwiritsidwa ntchito.

Kutalika kwa moyo wa gawo lachiberekero chachinayi kumatsimikiziridwa ndi zinthu zambiri: magawo a mapangidwe, kuchuluka kwa metastases, kuchuluka kwa kuledzera, kuyankha kwa thupi ku chemotherapy, komanso kupambana kwathunthu kapena kulephera kwa mankhwalawa. Chofunika kwambiri ndi malingaliro a wodwala: ndikosavuta kukaniza matendawa kwa anthu omwe amakhalanso ndi mizimu yabwino komanso chiyembekezo.

Mwanjira ina iliyonse, kutsimikizira kwa njira yoyipa yopitilira muyeso sikoyenera. 4-5% ˗ uwu ndi mulingo womwe umaphatikizapo odwala omwe akupulumuka kuposa chaka chimodzi atazindikira kuti ali ndi khansa ya kapamba pamapeto omaliza. Pafupifupi, nthawi yamoyo ya odwalawa imachokera pa mwezi umodzi mpaka umodzi.

Njira zina zochiritsira

Khansa ya kapamba ndimatenda oopsa, chithandizo chomwe chimafuna njira yophatikizika. Opaleshoni ya opaleshoni, kuphatikiza maphunziro a chemotherapy, imatha kukulitsa moyo wa wodwalayo ndikuwonjezera thanzi lake pang'onopang'ono. Odwala omwe akufuna kuti mwina athe kudzithandiza okha ali okonzeka kuyesa njira zosachiritsika, mwachitsanzo, kulandira chithandizo chamankhwala. Sayenera kusankhidwa ngati chithandizo chachikulu, chifukwa khansa imakhala yolimba kwambiri, ndipo njira zowonjezereka zimafunikira kuti izi zisachitike. Komabe, ngati muyeso wowonjezera, kugwiritsa ntchito mankhwala azitsamba ndizovomerezeka, chinthu chachikulu ndikufunsira kwa oncologist musanayambe chithandizo chanyumba.

Njira Shevchenko

Zimaphatikizapo kugwiritsa ntchito vodika ndi mafuta a masamba. Chilichonse mwazinthuzi ziyenera kutengedwa ndi kuchuluka kwa 30 ml. Pambuyo pophatikiza zinthuzo, osakaniza amayenera kuthiridwa mumtsuko, kutseka mwamphamvu, kenako ndikugwedezeka bwino. Ndikulimbikitsidwa kugwiritsa ntchito zomwe mwapeza katatu katatu patsiku mphindi 15 musanadye chakudya, ndikumadya nthawi yayitali pafupifupi maola 6. Chakudya chizigwira osachepera masiku 10, kenako ziyenera kusokonezedwa kwa masiku 5, kenako ndikubwereza masiku khumi kupumula kwa masiku asanu. Pamapeto pa maphunziro achiwiri, thupi liyenera kupumula pang'ono, motero ndikulimbikitsidwa kusiya kumwa osakaniza kwa milungu iwiri. Njira yofananira iyenera kutsatiridwa kwa zaka zingapo. Malinga ndi ndemanga zina, kusintha kwa thanzi kumadziwika pakapita miyezi ingapo, komabe, nthawi yochepetsetsa ya chithandizo chotere iyenera kukhala osachepera miyezi 8 ˗ panthawiyi, zotupa zazing'ono zimatha kuthana. Pali ma contraindication: anthu odwala matenda a kapamba sangathe kuthandizidwa pogwiritsa ntchito njira imeneyi.

Njira ya Alefirov

Zimatanthawuza kugwiritsidwa ntchito kwa ma tinctures a Aconite Dzhungarsky, dontho limodzi lomwe liyenera kuchepetsedwa mu kapu yamadzi oyera. Tsiku lililonse, mlingo uyenera kuwonjezeka ndi dontho limodzi, kotero kuchuluka kwa zinthu zomwe zimagwiritsidwa ntchito zidzafika 30 madola pakutha kwa mwezi. Kenako mlingo uyenera kuchepetsedwa mwachisawawa. Kumwa koteroko kumalimbikitsidwa kugwiritsa ntchito katatu patsiku mphindi 40 musanadye. Komabe, chithandizo malinga ndi njira ya Alefirova sichimathera pompo. Hafu ya ola mukatha kudya, muyenera kumwa mankhwala otsatirawa:

Kalamu muzu, nthangala za katsabola ndi maluwa a calendula (mu gawo loyamba),
Muzu wa iris umayenda modabwitsa, muzu wa cinquefoil ndi chulucho wamba hop (mbali ziwiri zilizonse),
Mankhwala azitsamba (magawo atatu).

10 g ya chopereka ichi chizikhala chodzaza ndi 250 ml ya madzi otentha, kenako madziwo amayenera kusungidwa mu madzi osamba kwa mphindi 20. Mu msuzi wozizira komanso wopindika, 1.5 ml wa tincture wa mutu wawukulu umawonjezeredwa. Ndi bwino kumwa mankhwala omwe analandiridwa mphindi 20 musanadye 30 ml katatu pa tsiku kwa miyezi iwiri.

Chemotherapy ya khansa ya kapamba

Kudziwitsidwa ndi chotupa cha khansa chokhala ndi mankhwala opha ululu ˗ awa ndi chemotherapy. Cholinga chake ndikuwononga maselo owopsa ndikuchepetsa kukula kwa zotupa. Komabe, othandizira awa amakhala ndi zowononga maselo athanzi, koma ochepera: ndizochulukirapo zomwe zimapangidwa ndi maselo, omwe ali ndi khansa, omwe amapezeka ndi poizoni. Mlingo wa mankhwala amasankhidwa mosamalitsa - izi ndizofunikira kuti mapangidwe oyipa agwere pansi pazowonjezera, pomwe thupi limawonongeka pang'ono.

Chemotherapy imapereka:

Kuchulukitsa kwa miyezi 6-9 pa avareji,
Kupititsa patsogolo kwa wodwalayo: kuchepetsa ululu, chifukwa chomwe kufunika kwa kugwiritsa ntchito mankhwala a narcotic ndi analgesics kumachepetsedwa pafupifupi 50%,
Kulemera.

Maothandizidwa ndi chemotherapeutic amasintha ma DNA a maselo owopsa, ndiye kuti, amakhudza chidziwitso chofunikira pakugawika. Ndi DNA yowonongeka, maselo a khansa sangathe kubereka ndipo posakhalitsa amafa, chifukwa chomwe kukula kwa neoplasm kumayambira ndikuchepa kwake komwe. Popeza khungu loyipa limakhudzidwa kwambiri panthawi yomwe limagawidwa, chemotherapy imachitika ikafika gawo lawo lobala. Chifukwa chake, dongosolo, lomwe limachitika ndi maphunziro.

Mankhwala, ndibwino kusiyanitsa mitundu iwiri ya chemotherapy:

Monochemotherapy ˗ kugwiritsa ntchito mankhwala amodzi aliwonse,
Polychemotherapy ˗ kugwiritsa ntchito mankhwala amodzi kapena angapo omwe akukhudzidwa mosiyanasiyana mosiyanasiyana kapena mosiyanasiyana.

Popeza zinthu zoopsa zimakhudza maselo achilendo, komanso minyewa yathanzi ndi ziwalo, odwala nthawi zambiri amakumana ndi mavuto osakhazikika chifukwa cha matenda otsegula m'mimba, kusanza ndi kusanza, kusowa kwa tsitsi, ndi hematopoiesis.

Mankhwala apamwamba kwambiri a chemotherapeutic omwe amagwiritsidwa ntchito pazachipatala ndi awa:

"Docetaxel" ˗ amachepetsa kupitilira kwa zilonda ndi 20% ndikuwongolera zomwe wodwalayo ali nazo.
"Gemcitabine" ˗ imagwiritsidwanso ntchito ngati monochemotherapy, imachepetsa kuchuluka kwa chotupa ndi kuchuluka kwa metastases ndi 10%,
"Cisplatin" ndi "Fluorouracil" ndi kuphatikiza komwe kumalola kupitilira kwazaka mpaka miyezi 10-12,
"Fluorouracil" ndi "Gemcitabine" mwina ndi njira yabwino kwambiri yophatikizira kutalika kwa chaka chimodzi kapena kupitilira apo.

Kodi opaleshoni ndiyofunikira liti?

Monga lamulo, opaleshoni ndiyofunikira mwachangu mu magawo oyamba a chitukuko cha zilonda. Chotupa cha khansa pakadali pano sichiri chofunikira, ndipo metastases nthawi zambiri imasowa, chifukwa chake, kuti tipewe kukula kwa khansa komanso kufalikira kwa maselo a khansa mthupi lonse, wodwalayo amamuchita opareshoni.

Pali mitundu ingapo ya maopareshoni, yomwe imasankhidwa ndi dokotala mogwirizana ndi wodwala: mapangidwe magawo, kapangidwe kake ka mbiri yakale, kukhalapo kapena kusowa kwa metastases, zovuta, ndi matenda osachiritsika amakumbukiridwa.

Ntchito yofufuzira, yomwe imatha kutchedwa diagnostic ˗ imachitika pofuna kufotokoza bwino za matendawa, pomwe maphunziro othandizira pazifukwa zina sanapereke chidziwitso chokwanira cha matenda.
Kusintha kwathunthu ˗ kuchotsa kwathunthu kwa chotupa cha khansa, chofunikira kwambiri poyambira kupangidwa kwake.
Palliative ntchito mbali ziwiri:

Kuchotsa pang'ono pang'onopang'ono ngati sikungatheke kuzithetsa,
Kuthetsa mavuto (m'mimba, kutsekeka kwa duct wa bile) komanso kuchotsa ma metastases omwe ali ziwalo zina.

Kuyambiranso komwe kumachitika modabwitsa, kuli ndi mitundu ingapo.

Kuchotsa kwathunthu kwa kapamba ˗ kumachitika ndi chotupa chachikulu, chomwe chimakhudza mbali zonse za thupi. Pancreas pakalibe, wodwalayo amapatsidwa mankhwala okonzekera enzyme, omwe cholinga chake ndi kugaya chakudya.
Distal pancreatic resection ˗ imagwira ntchito ngati chotupa chikukhudza mchira, komanso thupi. Ndi maopareshoni amtunduwu, mutu wa kapamba okha ndi womwe sungathe kuchotsedwa.
Segmental resection ya kapamba ˗ imayendera limodzi ndikuchotsa pakati penipeni ndi kusuntha kwamatumbo mpaka mchira ndi mutu wa kapamba, komwe ndikofunikira kubwezeretsa kutulutsa kwa pancreatic madzi.
Kodi ntchito ya ˗ imagwiritsidwa ntchito pochotsa zilonda zapakhosi pamutu wamanjenje. Idipatimenti iyi ya chiwalo imayambiranso ntchito, ndipo ndi matumbo ang'ono, chikhodzodzo, magawo a pylorous yam'mimba ndi bile ducts, ndi dera la mwanabele. Njira imeneyi imachepetsa kwambiri ngozi yobwereranso.
Njira ya cryogenic, chomwe tanthauzo lake limakhala momwe maselo a khansa amachepera kutentha, zomwe zimapangitsa kuwonongeka kwawo pambuyo pake. Njira imeneyi imawonedwa ngati yotetezeka kwambiri, chifukwa siyambitsa mkwiyo, ndipo kuphatikiza ilinso ndi mphamvu ya analgesic.

Pambuyo pa mtundu uliwonse wa opaleshoni, njira ya chemo- ndi radiation imachitika - izi ndizofunikira kuphatikiza zotsatira zomwe zimapezeka chifukwa cha opareshoni.

Pancreatic Cancer Anesthesia

Kugwiritsa ntchito mankhwala a ululu chifukwa cha zilonda zam'mimba ndi chimodzi mwazinthu zazikulu zothandizira. Pali chiwembu chovomerezeka nthawi zonse, malinga ndi komwe kumayikidwa ma analgesics kwa odwala omwe ali ndi khansa ya pancreatic.

Pa gawo loyamba la maphunziro a zamatenda, ululu wa ululu sukutchulidwa, motero palibe chifukwa chogwiritsira ntchito mankhwala osokoneza bongo. Ma analgesics amaperekedwa kwa wodwala: Paracetamol mu mawonekedwe apiritsi (500 mg maola 5 aliwonse) ndi Analgin, omwe amathandizidwa ndi intramuscularly kapena mtsempha wa magazi katatu patsiku.
Pa gawo lachiwiri, ma analgesics omwe si a narcotic sagwira ntchito, chifukwa chake ma opioids omwe amagwiritsidwa ntchito amagwiritsidwa ntchito: Promedol (25 mg maola 6 aliwonse), Tramadol (50-100 mg maola asanu ndi amodzi ndi asanu ndi limodzi), ndi Dihydrocodeine (maola 60 maola 12 aliwonse) -100 mg).
Gawo lomaliza limakhala, monga lamulo, pogwiritsa ntchito opiates wamphamvu. Chitsanzo chowoneka bwino ndi Fentanyl, womwe umaperekedwa kudzera m'mitsempha kapena kudzera pakaponya madzi, mankhwalawo ndi wamphamvu kuposa morphine, koma zotsatira zake ndizochepa. Fentanyl imapezekanso mu mtundu wa chigamba, mphamvu ya analgesic yomwe imakhala mpaka maola 72. Chithandizo china chodziwika bwino cha gululi ndi Prosidol, ndi piritsi la resorption kapena yankho la jakisoni. Mlingo wa tsiku ndi tsiku wa chinthucho sayenera kupitirira 200 mg, mwanjira zina, Prosidol ikhoza kukhala yosokoneza.

Funso la kufunikira kwa ma painkillers limasankhidwa ndi adokotala okha: samangopereka mankhwala enieni, komanso amawerengera mlingo woyenera wa wodwalayo payekhapayekha. Odwala omwe ali ndi chotupa cha khansa, ndipo makamaka, khansa ya kapamba, ali ndi ufulu wogula mankhwala pamtengo wa 50% kapena kuwalandira kwaulere. Ma mankhwalawa onse a mankhwalawa amaperekedwa mosamalitsa malinga ndi mankhwala, omwe amatsimikiziridwa ndi chisindikizo cha chipatala ndi dotolo wothandizira.

Zotsogola ndi kupewa

Ndizosatheka kunena motsimikiza za kuchuluka kwa anthu omwe amakhala atazindikira kuti ali ndi khansa ya kapamba, chifukwa zonse zimatengera munthu payekha.

Malinga ndi ziwerengero, 50% ya odwala omwe adziwa za matenda awo pa gawo lachiwiri la chitukuko chake amakhala pafupifupi zaka 5, pomwe zilonda zam'mimba za digiri 3 ndi 4, kupulumuka sizipitilira miyezi 6-12. Kuthandizira opaleshoni ndikofunikira popewa khansa ya pancreatic, koma popeza chotupacho chomwe chanyalanyazidwa kale, moyo wa wodwalayo umachepetsedwa kwambiri. Nthawi zambiri, pamkhalidwe wotere, mankhwala othandizira amagwiritsidwa ntchito, chifukwa chomwe mawonetsedwe amomwe amatsatira amachotsedwa, osati iye.

Chithandizo cha mankhwalawa chitha kukhala ndi zotsatira zabwino pokhapokha ngati neoplasm idapezeka koyambirira, komabe, pazifukwa zosavuta kuti khansa ya pancreatic isymptomatic poyamba, wodwalayo sakayikira ngakhale matenda opha ziwalo m'thupi mwake, chifukwa chake amafufuza thandizirani mukachedwa.

Khansa ya pancreatic - magawo, zizindikiro zoyambirira ndi mawonekedwe, chithandizo

Zakuti khansa ndi amodzi mwa matenda owopsa kwambiri, omwe nthawi zambiri samatha kuchiritsidwa, amadziwika kwa ambiri. Komabe, ngakhale chithandizo cha panthawi yake sichimakhala chotsimikizika kuchiritsidwa kwathunthu. Zachidziwikire, khansa ndi matenda oopsa, ndipo khansa ya kapamba imadziwika kuti ndi imodzi mwazinthu zoyipa kwambiri za oncological pathologies.

Amakula, monga lamulo, atatha zaka 70 (odwala opitilira 60%), kuwonjezera apo, mwa amuna 1.5 nthawi zambiri. Mwa matenda odziwika a oncological, khansa ya pancreatic ndiyotengera mawonekedwe omwe amakhala nawo, kuchuluka kwake sikupitilira 2-3% yazochitika zonse, komabe, chifukwa cha kuzindikira kwakanthawi, ambiri a milandu sangathe kupulumutsidwa.

Tsamba lofulumira

Khansa ya pancreatic ndikusintha kwa maselo a pancreatic mu zilonda, motsatiridwa ndi kuchuluka kwawo ndikupanga chotupa. Kutengera ndi zida zowonongeka, mitundu yosiyanasiyana ya oncopathologies imakula, yosiyana pa liwiro la kufalikira ndi zizindikiro.

Zikondamoyo sizingatulutse michere yokumba, komanso kupanga mahomoni. Ma cell a glandular omwe amachititsa kuti azipanga madzi a pancreatic amapezeka m'malo opezeka mkati mwa gawo lotchedwa mutu.

Kapangidwe ka maholide kumachitika m'magulu a ma cell omwe amatchedwa islets of Langerhans. Amapezeka makamaka kumbuyo kwa kapamba - mchira. Mahomoni akuluakulu ali motere:

gastrin, yolimbikitsa kupanga madzi am'mimba,
glucagon, cholinga chake ndikuwonjezera magazi,
insulin - kumawonjezera ntchito ya shuga kagayidwe, kuchepetsa ndende yake m'magazi.

Pakati pa mutu ndi mchira pali malo omwe amatchedwa thupi. Malinga ndi ziwerengero, khansa yam'mimbazi yamatenda nthawi zambiri imayamba, ndipo zotupa za ziwalo zina sizachilendo.

Ngati macocois a maselo a ma Langerhans amapezeka, endocrine ntchito ya thupi imavutika. Potengera izi, zotupa za gastrinomas, glucagonomas, insulinomas zimayamba.

Kugonjetsedwa kwa zinthu zopangika pamiyendoyo kumatchedwa squamous cell carcinoma ya kapamba. Maselo a glandular akakhala pa oncotransfform, adenocarcinoma amadziwika. Ndipo glandular squamous cell carcinoma ya kapamba ndi mawonekedwe osakanikirana omwe magawo onse omwe amapanga ma enzyme komanso maselo a ma pulling ducts amakhudzidwa.

Kuphatikiza apo, ma cysts mu kapamba amatha kupweteketsa. Pankhaniyi, chachikulu cell adenocarcinomas ndi mucinous cystadenocarcinomas amakula. Maselo obadwa mwatsopano akapangidwa mwanjira ya masango, amalankhula za khansa ya acinar.

Komabe, chowopsa kwambiri ndi mtundu wa khansa ya pancreatic. Amapita patsogolo mwachangu kuposa ena ndipo amakonda kwambiri metastasis.

Komabe, mitundu yonse ya khansa ya kapamba imapweteka kwambiri. Sipangadutse zaka zingapo kuchokera pomwe matenda amayambukira kupita kumalo owadwalitsa, monga zimakhalira ndi ma oncopathologies ena, koma miyezi 6-8 yokha.

Tsoka ilo, silinakhazikitsidwe bwino lomwe lomwe limayambitsa khansa ya pancreatic - akukhulupirira kuti magulu otsatirawa a anthu agwera pagulu langozi:

Amuna opitirira 60
kusuta anthu
oledzera
omwe ali ndi mbiri yamatenda a ndulu, chiwindi, zilonda zam'mimba, matenda am'mimba,
anthu omwe ali ndi matenda otupa a kumlomo wamkati (pulpitis, periodontitis),
odwala omwe amachitidwa zilonda zam'mimba,
anthu odwala matenda opatsirana: cysts, pancreatitis aakulu, zilonda zam'mimba, matenda a Crohn,
anthu omwe ali ndi choloŵa cha khansa ya kapamba.

Zowopsa pantchito zimachitanso gawo lofunikira: kukhudzana mwadongosolo ndi asbestos, utoto wazitsulo. Zimatsimikiziridwa kuti chiopsezo cha khansa ya pancreatic imachulukitsa chakudya cholakwika ndi kuchuluka kwa zakudya zamafuta ndi kuchuluka kwakukulu kwa zokometsera.

Nyama yowopsa, yokazinga, soseji, nyama zosuta, nyama yankhumba. Zikondamoyo zimakhalanso ndi zakudya zomwe zimakhala ndi shuga wambiri, zakudya zosavuta zam'mimba, zakumwa za kaboni.

Tiyenera kukumbukira kuti njira iliyonse yotupa yotupa imachulukitsa kwambiri khansa ya mu cell. Zomwezi zimagwiranso kwa kapamba, ndipo khansa imayamba kupezeka kumbuyo kwa zotupa zomwe zimapezeka m'thupi lathu, zomwe zimalumikizana ndi izi:

duodenum
chikhodzodzo
chiwindi.

Chodabwitsa ndichakuti machitidwe owopsa mthupi omwe akukhudzidwawo amakhala ndi "zomwe amakonda". Chifukwa chake, khansa ya kapamba imayamba kugwiritsidwa ntchito ndi anthu aku Africa.

Khansa ya pancreatic sikuti pachabe yotchedwa "wakupha mwakachetechete" - zizindikiro zake zimawonekera pokhapokha ngati chotupa chili pa gawo 3 kapena 4. Mu gawo loyambirira la khansa, kugwira ntchito kwa chiwalo sikuperewera, ndipo wodwalayo alibe zowonetsa.

Pa gawo loyamba, chotupa cha khansa m'mapazi sichidutsa 2 cm, sichitha kufalikira kunja kwa thupi, sichikukula m'matumbo.

Ngati neoplasm ikakhala kumtunda kumutu kwa kutulutsa, imatha kuyamba kufinya duodenum, yomwe imawonetsedwa ndi kusokonekera kwa chopondapo mu mawonekedwe am'mimba ndi mseru wamkati. Oncologists amatchula zomwe zafotokozedwazo m'malo mwa 1A. Gawo 1B imadziwika ndi kuwonjezeka kwa chotupa kukula kwake mpaka 2 cm kapena kupitilira apo ndi kutukuka kwake ngakhale mkati mwa ndulu.

Gawo lachiwiri la 2A limangotanthauza kukula kwa mitsempha ya ziwalo zam'mimba (ziwalo za ndulu, zilonda 12 zam'mimba), ndipo pa siteji ya 2B, ma lymph node omwe amakhala nawo amakhudzidwa.

Masiteji atatu a khansa ya pancreatic akuti ngati chotupa chilowerera mitsempha yayikulu ndi mitsempha, ndulu, m'mimba, matumbo. Ma metastases mu lymph node ndi ovomerezeka kapena mwina sangakhale.

Gawo lachinayi la khansa ndi metastases yakutali. Ndi khansa ya kapamba, amamera m'chiwindi, m'mapapu, muubongo, impso, m'mimba.

Zizindikiro zoyambirira za khansa ya kapamba, mawonetseredwe

kupweteka kumatha kuperekedwa kumbuyo kapena m'mimba

Chowoneka cha khansa ya pancreatic imakhala ndikuwonetsedwa kosiyanasiyana ndi kusapezeka kwa chithunzi chachipatala. Khansa imatha kukhala ndi zizindikiro za kapamba kapena kudzikongoletsa ngati matenda a shuga, ndikuwonetsa kuwawa komwe kumawonekera kumbuyo, ndikuwonongeka kumbuyo kwa chiwalo, odwala nthawi zambiri amadziwika kuti ndi radiculitis.

Kutengera ndi omwe maselo adakumana ndi oncotransfform, chithunzi cha zizindikiro zoyambirira za khansa ya kapamba chimasiyananso. Ndi gastrinoma, kupanga msuzi wamatumbo kumawonjezeka, motsutsana ndi komwe kutentha kwamtima kumayamba, chilonda chomwe sichitha kuthandizidwa. Kusanza kwa bulauni ndi chimbudzi, kutsegula m'mimba ndi zomwe zimapezeka m'matumbo a fetid, ululu mutatha kudya zimadziwika.

Glucagonoma imagwirizanitsidwa ndi kuwonjezeka kwa shuga wamagazi ndipo amawonetsedwa ndi zizindikiro za matenda ashuga:

polyuria (kuchuluka kwa mkodzo),
ludzu
kuwonda
kamwa yowuma
Odwala amalankhula ndikutulutsa lilime, totupa ta utoto.

Chithunzi cha chipatala cha insulinoma, m'malo mwake, chimagwirizanitsidwa ndi kuchepa kwa shuga m'magazi ndipo amadziwika ndi:

kufooka
manja akunjenjemera
kukomoka, kukomoka, kapena chikomokere
palpitations.

Zizindikiro zoyambirira za khansa ya pancreatic yoyambirira zimayendera limodzi ndi kuchepa kwa ntchito, kutopa, kufooka. Nthawi zambiri odwala amayamba kudya kapena amadana ndi zakudya zina. Ndikotheka kuwonetsa kupweteka pamimba, ndipo nthawi zina pakati, kumakulitsidwa ndikugwada kutsogolo ndikukhazikika m'malo a mluza.

Mukamapita patsogolo khansa ya kapamba, zizindikiritso zochulukirapo zophatikizana ndi zovuta za michere zimawonekera:

kulemera "pansi pa dzenje"
mafuta a m'mimba a fetid,
Kuchepetsa thupi chifukwa cholephera kuyamwa chakudya,
anorexia (kusowa kwa chakudya),
kulolera zakudya zama protein ndi mafuta,
kusanza ndi kusanza.

Ngati bile duct imapanikizika ndi chotupa, jaundice imayamba, yomwe imawonetsedwa ndi chikaso cha sclera ya maso, khungu, ndi mucous membrane. Fungo limawala, ndipo mkodzo, m'malo mwake, umachita khungu. Chikhodzodzo chimakulitsidwa, ndipo makristulo a bile acid nthawi zambiri amadziunjikira pakhungu, ndikuyambitsa kuyabwa.

Kuphatikizika ndi kupindika kwa ndulu kumayambitsa kulemera ndikuphulika kwa hypochondrium yamanzere. Kukula kwa chotupa mu khoma lamatumbo kumabweretsa kudzimbidwa ndi kutsekeka.

Pa magawo 3 ndi 4, zizindikiro za khansa ya pancreatic zimawonetsedwa ndi kudziunjikira kwamadzi mumimba yam'mimba (ascites). Chiwopsezo cha magazi amkati, thrombophlebitis ikukula. Wodwalayo watopa, akumva ululu womwe nthawi zambiri umakhala herpes zoster.

Kuthana ndi zinthu zowonongeka za chotupacho kumapangitsa kuti thupi lizitentha kwambiri.

Ngati chotupa sichinakhudze ziwiya zazikulu komanso ziwalo zambiri, sanapereke ma metastases akutali, chithandizo chabwino kwambiri ndichakuchita opareshoni. Popeza khansa ya kapamba imayamba msanga, simuyenera kuchedwetsa opaleshoni. Kutengera ndi gawo la chotupa, mitundu yotsatirayi ya chithandizo cha opaleshoni imasiyanitsidwa:

Kugwiritsidwa ntchito kwa Whipple - kuchotsa kwa mutu wa m'matumbo, ma lymph node, chikhodzodzo ndulu ndi chimbudzi, gawo la m'mimba, matumbo,
Full resection
Kutalikirana kwakapakati kapena kwakamagawo - kuchotsa thupi ndi mchira kapena kokha pakatikati, motero.

Ndi zotupa zosagwiritsidwa ntchito za gawo 3 ndi 4, kukomoka kwa ndulu ya dambo ndikotheka ngati neoplasm ikuletsa kutulutsa kwa bile.

Cancer compression yam'mimba ndi matumbo amachotsedwa ndikusunthika - ziwalo ziwiri izi zimasinthidwa kuti zidutse chotupacho.

Njira yamakono ndikuchita ntchito pogwiritsa ntchito mpeni wa gamma, womwe umakulolani kuti muthe kuchepetsa minofu nthawi yomweyo, ndikupha maselo osachiritsika.

Kuphatikiza pa chithandizo cha opaleshoni, ndi khansa ya pancreatic, radiation ndi chemotherapy amagwiritsidwa ntchito kwambiri. Zotsirizazo zimatha kuchitika ndi mankhwala angapo kapena amodzi (monotherapy). Mankhwala omwe amagwiritsidwa ntchito kwambiri ndi awa:

Mankhwala othandizira poizoniyu amasonyezedwa onse chifukwa cha zotupa zosagwirizana, komanso kuphatikiza chithandizo. Njirayi imachokera pakugwiritsa ntchito ma radiation a ionizing, omwe amapha makamaka kugawa maselo a neoplasm.

Kuphatikiza apo, m'zaka zaposachedwa, njira zatsopano zochizira khansa zidapangidwa ndikuchita kafukufuku: Pazomwe zili kumapeto, mankhwalawa amagwiritsidwa ntchito omwe amalimbikitsa chitetezo chawo kuti athane ndi neoplasm. Njira yochizira yomwe imakulolani kuti mupeze maselo okhawo omwe alibe. Kwa mankhwalawa, mankhwalawa Erlotinib amagwiritsidwa ntchito.

Kuneneratu - kuchuluka kwake komwe amakhala ndi khansa ya kapamba

Khansa ya kapamba imakhala ndi mbiri yabwino m'moyo. Ngakhale ndi opaleshoni ya Whipple yomwe idachitika panthawi yake, kupulumuka kwa zaka 5 sikupitirira 25%, koma ndi mitundu yosiyanasiyana ya matenda, zizindikiro zimasiyana kwambiri.

Chifukwa chake, odwala omwe ali ndi cell yayikulu adenocarcinomas amafa patatha chaka chimodzi atapezeka chotupa, ndipo ndi mucidous adenocarcinoma, 50% ya odwala amatha kukhala ndi moyo zaka 5.

Malinga ndi ziwerengero, khansa ya kapamba imapha anthu asanadutse miyezi isanu ndi umodzi atazindikira: matenda omwe ali ndi metastases m'chiwindi amayeza wodwalayo osaposa masabata 16, omwe ali ndi zotupa zachiwiri, nthawi imeneyi amatha kuchuluka mpaka miyezi 6 mpaka 12.

Ndi magawo anayi a matendawa, odwala 4% okha ndi omwe amakhala ndi moyo wopitilira chaka. Amadziwika kuti kuchuluka kwa kuledzera ndi kupweteka, kumakhala kochepa kwambiri kwa wodwalayo.

Rakhim, Khaitov Immunogenetics a mtundu 1 shuga mellitus / Khaitov Rakhim, Leonid Alekseev und Ivan Dedov. - M: LAP Lambert Academic Publishing, 2013 .-- 116 p.
Borisova, O.A. Mycosis ya kumapazi kwa odwala omwe ali ndi matenda a shuga a 2 mellitus / O.A. Borisov. - M: Tome, 2016 .-- 832 p.
Tsarenko, S.V. Kusamalidwa kwambiri kwa matenda a shuga mellitus / S.V. Tsarenko. - M: Mankhwala, 2008 .-- 615 p.
Dolzhenkova N.A. Matenda a shuga Buku la odwala ndi okondedwa awo. SPb., Nyumba yosindikiza "Peter", masamba 2000,151, kufalitsa makope 25,000.

Ndiloleni ndidziwitse. Dzina langa ndi Elena. Ndakhala ndikugwira ntchito ya endocrinologist kwa zaka zoposa 10. Ndikukhulupirira kuti pakadali pano ndili katswiri pantchito yanga ndipo ndikufuna kuthandiza alendo onse omwe amapezeka pamalowo kuti athetse zovuta osati ntchito. Zinthu zonse za tsambalo amazisonkhanitsa ndikuzikonza mosamala kuti athe kufotokoza zambiri zofunikira. Musanagwiritse ntchito zomwe zikufotokozedwa pa webusayiti, kukambirana ndi akatswiri ndizofunikira nthawi zonse.

Mitengo yamankhwala

Mtengo woyeserera zachipatala ndi chithandizo chowonjezereka cha khansa ya pancreatic likulu la dzikolo ndi dera lake zimatsimikiziridwa ndi mitengo zotsatirazi:

Kufunsidwa kwa gastroenterologist ˗ 2000-2100 p.,
Kufunsira kwa Oncologist ˗ 2500 p.,
Kuonana ndi Chemotherapist ˗ 4800-5000 p.,
Kufunsira kwa radiologist ˗ 4000 r.,
Kufunsira kwa Oncopsychologist ˗ 2500-2700 r.,
Ultrasound Ж 900-1000 p.,
MRI ˗ 6000 p.,
Coprogram ˗ 400-500 p.,
Oncomarker CA 19-9 ˗ 700-900 p.,
Ast, alt, bilirubin, Alpha-Amylase ˗ chilichonse mwazizindikiro chili pafupifupi 220-250 p.,
Diagnostic laparoscopy ˗ 34000 p.,
Kubwezeretsa cholangiopancreatography ˗ 11000-12000 p.,
Kusanthula kwa zamkati zam'munsi ˗ 450-650 p.,
Punct biopsy wa kapamba ˗ 9000-9500,
Kuyambiranso kwa mutu wa pancreatic ˗ 68000-70000 p.,
Onse duodenopancreatectomy ˗ 96000-97000 p.,
Gawo limodzi la chemotherapy ˗ 7500 p.,
Polychemotherapy ˗ 10000-11000 r,
Radiation chithandizo ˗ 3500 p.

Chotupa chilichonse chowopsa ndi matenda oopsa omwe amatha kupha. Chifukwa chake, musanyalanyaze thanzi lanu. Kukana zizolowezi zoyipa, kudya zakudya zoyenera komanso kupenda mayeso pafupipafupi malamulo awa ndi malamulo ofunika omwe ayenera kutsatiridwa ndi aliyense amene akufuna moyo wautali komanso wamtendere.

Okondedwa owerenga, lingaliro lanu ndilofunika kwambiri kwa ife - chifukwa chake tidzakhala okondwa kuwunika khansa yamutu pancreatic m'mawu, ingakhale othandiza kwa ogwiritsa ntchito ena a tsambali.

Olga

Khansa ya kapamba ndi amodzi mwa mitundu yoipitsitsa kwambiri ya khansa, ndipo monga momwe madotolo atiuziratu, kudwala matendawa ndi koipitsitsa. Wachibale wanga wina wapezeka kuti ali ndi chotupa chotere, ndi metastases kale mumsana ndi ntchafu imodzi. Palibe amene anayamba kutitsimikizira, zonse zili bwino. Zomwe zimaperekedwa ndi maphunziro ˗ chemotherapy.

Sergey

Inde, ndizovuta kwambiri kulimbana ndi chotupa cham'mimba. Ndipo palibe maphikidwe a wowerengeka angakuthandizeni. Ndidamva ambiri amalangiziwira bowa wa chaga. Ndi bowa wotani ameneyo. Ngakhale mankhwala amakono alibe mphamvu.