Khansa ya Pancreatic Neuroendocrine: Zotsatira zalemba la Medical Therapy zolemba zasayansi mwapadera

Cholinga. Kuti muwunikire zotsatira zaposachedwa komanso za nthawi yayitali za opaleshoni yamankhwala odwala omwe ali ndi neuroendocrine tumors (NEO) ya kapamba (kapamba). Zida ndi njira. Odwala a 121 omwe ali ndi zotupa za neuroendocrine pancreatic adachitidwa opareshoni. Zotsatira za opaleshoni zotsatirazi zidachitidwa: distal pancreatic resection, nthawi zambiri mu mawonekedwe a distal subtotal pancreatic resection ndi splenectomy mu 60 (49.6%) odwala, gastropancreatoduodenal resection 54 (44.6%), pancreatectomy 2 (1.7%) , yapakatikati resection wa kapamba 1 (0,8%), chotupa enucleation 3 (2,5%). Kubwereza kwa multivariate ndikuyembekeza kusanthula kwakukulu kwazinthu zakuchipatala kunachitika, njira zokwanira zothandizira opaleshoni ya zotupa za pancreatic neuroendocrine zimatsimikiziridwa kutengera kuchuluka kwa njirayo ndi zotsatira za maphunziro a morphological, makamaka pokhudzana ndi zotupa zotsika. Zotsatira Zotsatira zaposachedwa komanso za nthawi yayitali za opaleshoni yothandizira odwala omwe ali mgululi adasanthula. Onse kupulumuka mitengo pambuyo pancreatic neoplasia anali 1 chaka 91 ± 3%, 3 wazaka 83 ± 4%, 5 wazaka 79 ± 4%, 10 wazaka 66 ± 7%. Kupulumuka kwapakatikati kunali miyezi 161. Kuthanso kwa moyo wosathanso: wazaka 1 85 ± 4%, wazaka zakubadwa 76 ± 5%, wazaka 72 72 5%, wazaka 53 ± 8%. Kubwereranso pakati kwa miyezi 137. Pomaliza Zotsatira za nthawi yayitali za opaleshoni ya opaleshoni ya odwala omwe ali ndi pancreatic neoplasia yomwe yatipeza mu kafukufuku wathu imawonetsa kudalirika kwakanthawi kwa gululi poyerekeza ndi zotupa za histancois. Izi zimathandiza kugwiritsa ntchito njira yonse ya opaleshoni odwala omwe ali ndi zotupa za neuroendocrine pancreatic.

NEUROENDOCRINE PANCREATIC CANCER: Zotsatira ZOTHANDIZA KWAULERE

Cholinga Kuwunika zotsatira zapafupi komanso zakunja za opaleshoni yamankhwala a odwala a neuroendocrine zotupa za kapamba. Zida ndi njira. Phunziroli lidaphatikizapo odwala 121 omwe ali ndi zotupa za neuroendocrine za kapamba chifukwa cha opaleshoni. Zosankha za opaleshoni zinali izi: distal pancreatectomy, nthawi zambiri mwa mawonekedwe a distal subtotal resection a splenectomy 60 (49.6%), gastropancreatoduodenal resection 54 (44.6%), pancreatectomy 2 (1.7%), Median resection wa kapamba 1 (0,8%), kuwonjezeka kwa chotupa 3 (2,5%). Kubwezeretsanso kwaubwino komanso kuyembekezera kusanthula kwakukulu kwazinthu zakuchipatala kunachitika, njira zokwanira zamankhwala opangira ma neuroendocrine zotupa za kapamba zimatsimikiziridwa, kutengera kuchuluka kwa njirayo ndi zotsatira za maphunziro a morphological, makamaka pokhudzana ndi zotupa zapamwamba. Zotsatira Zotsatira zaposachedwa komanso zakutali za chithandizo chamankhwala opaleshoni zidasanthulidwa. Miyezo yonse yopulumuka pambuyo pochita opaleshoni yamankhwala yotupa ya pancreatic neuroendocrine anali: 1-chaka 91 ± 3%, 3-zaka 83 ± 4%, 5 wazaka 79 ± 4%, 10-wazaka 66 ± 7%. Kupulumuka kwapakatikati kunali miyezi 161. Kupulumuka wopanda matenda: 1-chaka 85 ± 4%, 3-zaka 76 ± 5%, 5-zaka 72 ± 5%, 10-zaka 53 ± 8%. Mlingo wapakati wobwezeranso wopanda magazi anali miyezi 137. Pomaliza Zotsatira za nthawi yayitali za opaleshoni yamankhwala a odwala omwe ali ndi zotupa za pancreatic neuroendocrine omwe amapezeka mu phunziroli akuwonetsa kupitilira kwakukondweretsedwa kwa odwalawa poyerekeza ndi zotupa za pancreatic za histogeneis ina. Izi zimalola kugwiritsa ntchito kwambiri opaleshoni njira mwa odwala.

Mawu a ntchito yasayansi pamutu wakuti "Neuroendocrine pancreatic cancer: zotsatira za chithandizo cha opaleshoni"

Podluzhny D.V., Solovieva O.N., Kotelnikov A.G., Delektorskaya V.V., Kozlov N.A., Ding Xiaodong, Patyutko Yu.I.

Khansa ya Pancreatic Neuroendocrine: Zotsatira ZOTHANDIZA KWAULERE

FSBI Russian Cancer Research Center yotchedwa N.N. Blokhina »Unduna wa Zaumoyo ku Russia, Kashirskoye sh., 24, Moscow, 115478, Russian Federation

Cholinga. Kuti muwunikire zotsatira zaposachedwa komanso za nthawi yayitali za opaleshoni yamankhwala odwala omwe ali ndi neuroendocrine tumors (NEO) ya kapamba (kapamba).

Zida ndi njira. Odwala a 121 omwe ali ndi zotupa za neuroendocrine pancreatic adachitidwa opareshoni. Zotsatira za opaleshoni zotsatirazi zidachitika: reseal pancreas resection, mu milandu yathunthu ya distal subtotal pancreatic resection ya splenectomy - 60 (49.6%), gastropancreatoduodenal resection - 54 (44.6%), pancreatectomy - 2 (1, 7%), yapakatikati pancreatic resection - 1 (0,8%), chotupa chambiri - 3 (2,5%). Kubwereza kwa multivariate ndikuyembekezeredwa kwa kuchuluka kwazinthu zakuchipatala kunachitika, njira zokwanira zamankhwala opaleshoni ya zotupa za pancreatic neuroendocrine zimatsimikiziridwa kutengera kuchuluka kwa ndondomekoyi komanso zotsatira za kafukufuku wazamakhalidwe, makamaka pokhudzana ndi zotupa zamagetsi otsika.

Zotsatira Zotsatira zaposachedwa komanso za nthawi yayitali za opaleshoni yothandizira odwala omwe ali mgululi adasanthula. Onse kupulumuka mitengo pambuyo pancreatic neoplasia anali wazaka 1 - 91 ± 3%, 3 wazaka - 83 ± 4%, wazaka 5 - 79 ± 4%, wazaka 10 - 66 ± 7%. Kupulumuka kwapakatikati kunali miyezi 161. Kuthanso kwa moyo wosathanso: wa zaka 1 - 85 ± 4%, wazaka zitatu - 76 ± 5%, wazaka 5 - 72 ± 5%, wazaka 10 - 53 ± 8%. Kubwezeranso kupulumuka kwapakatikati - miyezi 137.

Pomaliza Zotsatira za nthawi yayitali za opaleshoni ya opaleshoni ya odwala omwe ali ndi pancreatic neoplasia yomwe yatipeza mu kafukufuku wathu imawonetsa kudalirika kwakanthawi kwa gululi poyerekeza ndi zotupa za histancois. Izi zimathandiza kugwiritsa ntchito njira yonse ya opaleshoni odwala omwe ali ndi zotupa za neuroendocrine pancreatic.

Mawu ofunikira: chotupa cha neuroendocrine, kapamba, zotsatira zazitali komanso zamanthawi yomweyo, kupulumuka kwathunthu, kupulumuka kosapulumuka.

Mwacitsanzo: Podluzhny D.V., Solovieva O.N., Kotelnikov A.G., Delektorskaya V.V., Kozlov N.A., Din Xiaodong, Patyutko Yu.I. Pancreatic neuroendocrine khansa: zotsatira za opaleshoni. Annals of opaleshoni. 2017, 22 (3): 152-62. DOI: http://dx.doi.org/10.18821/1560-9502-2017-22-3-155-162

Kwa makalata: Solovyova Olesya Nikolaevna, wophunzira womaliza maphunziro, Imelo: [email protected]

Podluzhny D.V., Solov'eva O.N., Kotelnikov A.G., Delektorskaya V.V., Kozlov N.A., Din Syaodun, Patutko U.I. NEUROENDOCRINE PANCREATIC CANCER: Zotsatira ZOTHANDIZA KWAULERE

Blokhin Russian Cancer Research Center, Moscow, 115478, Russian Federation

Cholinga Kuwunika zotsatira zapafupi komanso zakunja za opaleshoni yamankhwala a odwala a neuroendocrine zotupa za kapamba.

Zida ndi njira. Phunziroli lidaphatikizapo odwala 121 omwe ali ndi zotupa za neuroendocrine za kapamba chifukwa cha opaleshoni. Zosankha za opaleshoni zinali zotsatirazi: distal pancreatectomy, nthawi zambiri mu mawonekedwe a distal subtotal resection wa spancectomy - 60 (49.6%), gastropancreatoduodenal resection - 54 (44.6%), pancreatectomy - 2 (1.7%) ,, kuphatikiza kwapakatikati kwa kapamba - 1 (0,8%), kuchuluka kwa chotupa - 3 (2,5%). Kubwezeretsanso kwaubwino komanso kuyembekezera kusanthula kwakukulu kwazinthu zakuchipatala kunachitika, njira zokwanira zamankhwala opangira ma neuroendocrine zotupa za kapamba zimatsimikiziridwa, kutengera kuchuluka kwa njirayo ndi zotsatira za maphunziro a morphological, makamaka pokhudzana ndi zotupa zapamwamba.

Zotsatira Zotsatira zaposachedwa komanso zakutali za chithandizo chamankhwala opaleshoni zidasanthulidwa. Miyezo yonse yopulumuka pambuyo pochita opaleshoni yamankhwala yotupa ya pancreatic neuroendocrine anali: 1-chaka - 91 ± 3%, 3-zaka - 83 ± 4%, zaka 5 - 79 ± 4%, zaka 10 - 66 ± 7%. Kupulumuka kwapakatikati kunali miyezi 161. Kupulumuka kopanda matenda: 1-chaka - 85 ± 4%, zaka 3 - 76 ± 5%, 5-zaka - 72 ± 5%, 10-zaka - 53 ± 8%. Mlingo wapakati wobwezeranso wopanda magazi anali miyezi 137.

Pomaliza Zotsatira za nthawi yayitali za opaleshoni yamankhwala a odwala omwe ali ndi zotupa za pancreatic neuroendocrine omwe amapezeka mu phunziroli akuwonetsa kupitilira kwakukondweretsedwa kwa odwalawa poyerekeza ndi zotupa za pancreatic za histogeneis ina. Izi zimalola kugwiritsa ntchito kwambiri opaleshoni njira mwa odwala.

Mawu osakira: neuroendocrine chotupa, kapamba, zotsatira zazitali komanso zamanthawi zamankhwala, kupulumuka kwathunthu, kupulumuka popanda matenda.

Pochenjeza: Podluzhny D.V., Solov'eva O.N., Kotelnikov A.G., Delektorskaya V.V., Kozlov N.A., Din Syaodun, Patutko U.I. Khansa ya pancreatic ya Neuroendocrine: zotsatira za chithandizo cha opaleshoni. Annaly Khirurgii (Mtolankhani Wakuchita Zaku Russia). 2017, 22 (3): 155-62 (ku Russian.). DOI: http://dx.doi.org/10.18821/1560-9502-2017-22-3-155-162

Kwa makalata: Solov'eva Olesya Nikolaevna, MD, Omaliza Maphunziro, Imelo: [email protected]

Zambiri zakulemba:

Podluzhny D.V., http://orcid.org/0000-0001-7375-3378 Kotelnikov A.G., http://orcid.org/0000-0002-2811-0549

Magawo omwe alandiridwa. Phunziroli linalibe ndalama.

Mikangano yachidwi. Olembawo alengeza kuti palibe kusagwirizana kwa chidwi.

Pancreatic neuroendocrine tumors (NEOs) amapanga gulu la osowa kwambiri a epithelial neoplasms, gawo lomwe, monga momwe limaganizira kale, limafika 12% mumapangidwe am'mimba othandizira dongosolo la NEO ndi 2% mu mawonekedwe a zilonda zonse zapancancic. Tisaiwale kuti kuchuluka kwa odwala omwe ali ndi zotupa za neuroendocrine pancreatic kumawonjezeka pamene mawonekedwe amtundu wa patomorphological apezeka bwino.

Pancreatic NET amadziwika ndi maphunziro osiyanasiyana azachipatala. Kukula kwa matendawa kwa odwala omwe akuchitidwa opaleshoni yamankhwala othandizira a pancreatic NET kumayenderana kwambiri ndi mawonekedwe a morphological a chotupa, omwe amawunika pamaziko a magawidwe a World Health Organisation 2010 (WHO 2010) ndi kachitidwe kodziwitsira kuchuluka kwa kuvulala kwa NET (kalasi - G). Malinga ndi gawoli, magulu atatu akuluakulu a NEO kapamba amadziwika: NEO G1, NEO G2 ndi neuroenocrine khansa G3 (mitundu yayikulu komanso yaying'ono ya cell). Tiyenera kudziwa kuti timagwiritsa ntchito mawu akuti "neuro-endocrine chotupa" kutanthauza gulu lonse la zilonda zapachifuwa za ma pancreatic neuroendocrine zotupa zosiyanasiyana, komanso magulu ena a NEO (G1 / G2, G3). M'magulu a 2006 WHO, mawu akuti "neoplasm" amatanthauzanso gulu lonse la NEO.

Kutengera ndi zomwe takumana nazo m'chipatala, timakhulupirira kuti gulu lonse la NEC ya pancreatic NEO imatha kutchedwa kuti neuroendocrine khansa, chifukwa, malinga ndi njira za oncological, ali ndi kuthekera koopsa, ali ndi zowononga, kuphatikizapo periangioneural, metastasis.

Solov'eva O.N., http://orcid.org/0000-0002-3666-9780 Patutko U.I., http://orcid.org/0000-0002-5995-4138

Zalandilidwa pa Epulo 20, 2017 Zalandiridwa pa Epulo 27, 2017

Chinsinsi chachikulu cha digiri ya pancreatic neoplasic neoplasia ndi kuchuluka kwa zochitika za maselo a chotupa U-67, magawo omwe ali 2% (01-02) ndi 20% (02-03). Kuwunika kwa m'tsogolo komanso kuthekera kwa mankhwalawa kwa mankhwala opatsirana a pancreatic neoplasm ya kapamba amakhalanso ntchito yovuta ndipo zimatengera kutsimikiza ndendende kwa index ya U-67, yomwe ingasinthe pakukula kwa chotupa. Gulu la WHO ku 2010 lidabweretsa kusiyana pakati pa zotupa zomwe zimasiyanitsidwa kwambiri (NEO 01/02) ndi khansa yosiyanitsa mitundu (NER 03). Gulu latsopanoli la WHO la endocrine organ tumors, lomwe likupezeka mu 2017, likuwonjezeranso kuwonjezerakuzindikira kwa pancreatic NET. Makamaka, ma subgroups atsopano mu neuroendocrine tumors of low kusiyanitsa (NEO 03) adzasiyanitsidwa. Chifukwa chake, akuyenera kupatula zotupa za morphology zosiyanasiyananso ndizochulukirapo zomwe zimagwirizana ndi gawo loyambirira la 03 (index Yu-67 mu gawo lino limasiyana pakati pa 20 ndi 55%). Gulu lina lothandizira lidzayanjanitsa odwala omwe ali ndi Yu-67 oposa 55% - kwenikweni a khansa ya neuroendocrine yotsika. Kugawikidwako kwa NEO kumene kumakhala ndi chisonyezo chokulirapo m'maselo a chotupa opitilira 20% ndikofunikira kwambiri pakuchipatala. Odwala omwe ali ndi NEO 03 (S-67 20-55%) ali ndi chidziwitso chabwinoko poyerekeza ndi otsika kwambiri NER (S-67 kupitirira 55%). Amayankha molakwika ku chemotherapy yokhala ndi platinamu ndipo amalimbikitsidwa ngati othandizira opaleshoni ya cytoredative.

Odwala omwe ali ndi pancreatic NEO, chithandizo cha opaleshoni ndiyo njira yayikulu komanso yokhayo yomwe imapereka zotsatira zogwira mtima zazitali. Zisonyezero zochizira

Kukula kwake ndi kuchuluka kwa operekera kumatsimikiziridwa ndi izi: - kupezeka kwa mahomoni azakumbuyo, chotupa, kuchuluka kwa chotupa, kuchuluka kwa chotupa, kupezeka kwa vuto la mtima ndi kuvulala, zovuta chifukwa cha chotupa komanso metastases yake, metastase pachiwindi ndi ziwalo zina. zinchito wodwala. Mankhwala othandizira odwala omwe ali ndi pancreatic neoplasic neoplasia imakhala ndi mitundu yosiyanasiyana ya njira zochitikira opaleshoni: pancreatectomy, gastropancreatoduodenal resection, pyloric kusunga pan-creatoduodenal resection, distal pancreas resection of main saizi with or splenectomy, midline resection of subrenocceric gland zotupa zosaposa 2 cm komanso popanda kulumikizana ndi duct chachikulu cha pancreatic), zosagwirizana ndikuphatikizika ndipo pamene wamba njira neoplastic, kuphatikizapo ntchito munthawi yomweyo chifukwa metastases synchronous chiwindi. Popeza kuti ma pancreatic NEO ali ndi vuto loipa, kuchititsa dera neuro- ndi lymphatic dissection ndi gawo lofunikira pakuchita opareshoni.

Malinga ndi olemba ambiri, sikulimbikitsidwa kugwira ntchito kwa odwala omwe ali ndi NER (03) ya kapamba, popeza zotupa izi panthawi yodziwikiratu zimafalikira makamaka, kupatula kuthekera kochita opaleshoni yayikulu kapena pali metastases yakutali. Komabe, zotsatira zabwino mu gulu ili la odwala atachitidwa opaleshoni, poyerekeza ndi zotupa zina zoyipa za pancreatic, nthawi zambiri zimaloleza kuchitidwa kwa ma cytored pokhapokha ngati 90% ya zotupa zimachotsedwa, zomwe zimathetsa zizindikiro za mahomoni ndi zakomweko, zimapangitsa kuti pakhale zina mwadongosolo. mankhwala osokoneza bongo ndi njira zina zowonekera kwanuko, makamaka kuwonongeka kwa wayilesi pafupipafupi. Zonsezi, limodzi ndi zotsatira zoyenera za opaleshoniyo, zimapangitsa kuti matendawo azikhala kutali.

Dziwani kuti panthawi yodziwidwa koyamba, kuchuluka kwa chiwindi cha bilobar kuwonongeka kokwanira kwambiri, chifukwa chake, opaleshoni yayikulu, kapena otchedwa opaleshoni yoyenera kwambiri, amatha ku 10 peresenti ya odwala. Komabe, malinga ndi kafukufuku wa multicenter, kupulumuka kwa zaka 5 pambuyo pakupezekanso kwa chiwindi ndi metastases ya khansa ya pancreatic neuroendocrine

khansa ya gland imasiyana kuchokera pa 47 mpaka 76% yomwe imabwezerekeranso 76%, ndipo mwa omwe sagwira ntchito ndi 30-40% 4-7.

Zida ndi njira

Zotsatira zamankhwala opaleshoni a odwala a 121 omwe ali ndi zotupa za neuroendocrine zimaperekedwa. Kusanthulaku kudakhazikitsidwa pa kuwunika kwa zotsatira zamankhwala komanso kupulumuka kwakanthawi.

Kugwira ntchito khansa ya pancreatic NE inapezeka mwa odwala 8: insulinoma (1), gastrinoma (3), somatostatinoma (1), chotupa chomwe chimatulutsanso ma adrenocorticotropic mahomoni (1), mu kapangidwe ka cholowa cholowa - MEN I (1), matenda a Hippel - Landau (1).

Zotupa zosagwira ntchito zapezeka mwa odwala 113. Anapezeka pamaziko a zidziwitso zamankhwala (kukhalapo kwa ululu, zovuta zam'mimba) kapena anali mwangozi pofufuzidwa mwazomwe anali kuchita poyeserera ngati njira yotsatira. Kafukufuku wa labotale odwala adaphatikizanso kuwunika kwa chikhazikitso cha pancreatic NEO (chromogranin A, pancreatic polypeptide, etc.). Kwa zotupa zokhala ndi mahomoni, mndandanda wounikira udaphatikizira maphunziro a zikwangwani monga insulin, gastrin, vasoactive matumbo peptide, ndi zina. Pofufuza mosiyanasiyana ndi adenocarcinoma, zotupa zamagazi zimayesedwa (CEA, CA19-9) ndi chotupa cha pancreatic. . Punuction cytobiopsy yotsatiridwa ndi mayesedwe a immunocytochemical imathandizanso kudziwa kuchuluka kwa ntchito ya Yu-67 chotupa chisanachitike. Pofuna kuthana ndi matendawa, njira zotsatirazi zinagwiritsidwa ntchito: ultrasound, kuphatikizapo endo-ultrasound, X-ray computed tomography (CT). RKT inali yofunikira pakuwunika momwe tumor inenso. Angiography adapangidwa kuti ayese mtima wamatumbo m'dera la ntchito yomwe ikubwera, komanso ubale wa chotupacho ndi zotengera zikuluzikulu, ngati mavuto awa sanathetsedwe pa RCT. Кроме того, ангиография являлась дополнительным подспорьем в уточнении природы нейроэндокринной опухоли, поскольку большинство нейроэндокринных образований имеют более высокую васкуляриза-цию по сравнению с опухолями экзокринной природы. Магнитно-резонансную томографию использовали для решения следующих задач: определение взаимоотношения опухоли поджелудочной железы с главным панкреатическим

протоком и общим желчным протоком, исключение или подтверждение метастазов в печени и за-брюшинных лимфоузлах.

Malinga ndi zotsatira za kafukufuku wakapangidwe wa morphological wazinthu, kafukufuku wa immunohistochemical adachitidwa ndi kuwunika kwa chidziwitso cha chotupa pakuwongolera kwakukulu komwe kumatsimikiza njira zina zamankhwala.

Zipangizo zamankhwala zimakonzedwa ndikugwiritsa ntchito pulogalamu ya kompyuta ya Exell ndi pulogalamu ya Statistica 10.0. Kusankhidwa kwa mawonekedwe apakati pazosankhidwa zomwe zidachitika ataphunzira mawonekedwe omwe amagawidwa. Kutalika kwathunthu komanso kwachibale, mtengo wapakati komanso malire ake a 95%, kulakwitsa kwa matanthauzidwe, komanso olemba anzawo komanso otha kusintha kwa chizindikirocho amawerengedwa. Kufunikira kwa kusiyana kwakutali kwa maphunzirowa kunawunikidwa pogwiritsa ntchito mayeso a Ophunzira; pazitsanzo zazing'ono, mayeso enieni a Fisher adatsimikizika. Tidawerengera mtengo wofanana wa p (zosiyanazi zidawoneka kuti ndizofunikira p. Sindikutha kupeza zomwe mukufuna? Yesani ntchito yosankha mabuku.

1 GCP - machitidwe abwino azachipatala.

zombo za histological kuzungulira kapamba, kuwukira kwa ziwalo zapafupi, digiri ya zilonda. Zizindikiro zakukula kwa pancreatic neoplasm of the pancreas adatsimikiza kugwiritsa ntchito njira zodziwira matenda ndi maphunziro a patomorphological, kuphatikizapo maphunziro a immunohistochemical and immunocytochemical: zotupa zazikuluzikulu kuposa 3 cm, kukula kwa kulowerera ndikuwukira kwa ziwalo zapafupi ndi zotengera zazikulu, kukhalapo kwa zigawo zachigawo komanso kutali kwambiri, kuchuluka kwa zochitika zochulukirapo. maselo.

Zotsatira za opaleshoni zotsatirazi zidachitidwa: distal pancreatic resection, nthawi zambiri mu mawonekedwe a distal subtotal pancreatic resection ndi splenectomy - 60 (49.6%), gastropancreatoduodenal resection (DHD) - 54 (44.6%), omaliza HDR yeniyeni - 41, yowonjezera HDR - 3, yokhala ndi zotengera zapamwamba - 7, kuphatikiza odwala 3 omwe ali ndi ma cell opanga ma mesenteric vein prosthetics, palliative HDR - 3 (chifukwa cha metastases yambiri ya chiwindi champhamvu, kuwukira kwa mesentery yayikulu echnoy mtsempha wamagazi) unachitikira pancreatectomy 2 (1.7%) odwala, apakatikati pancreatectomy anachita mu 1 (0.8%) ngati enucleation a zotupa - 3 (2.5%) milandu. Ntchito zophatikizika ndi resection ya zotengera zazikuluzo, gland ya adrenal, m'mimba, ovariectomy, nephrectomy idachitika mwa odwala 20 (16.5%).

Tisaiwale kuti gastropancreatoduodenal resection, pancreatectomy ndi distal pancreas resection ndi splenectomy ndizophatikiza zomwe zimaphatikizidwa, koma ziwalo zomwe zimapangidwanso kapena kuchotsedwa pakanthawi kantchitoyi zimapanga kuchuluka kwake. Kuphatikiza pamodzi

timaphatikizanso ntchito izi ndi kufanana ndi ziwiya zikuluzikulu pafupi, chiwindi, diaphragm, impso, matumbo a adrenal, m'mimba yaying'ono kapena yayikulu, ndiko kuti, ziwalo ndi zida zomwe sizikuphatikizidwa mu kukula kwa kulowererapo.

Mwa odwala omwe ali ndi magawo ochepa a ma pancreatic chotupa (20), ophatikizidwa adachitidwa mwa odwala 8 (40%). Pomaliza, zikondamoyo ziwiri zokhala ndi zotengera zazombo zazikuluzo zidachitidwa. Kuphatikiza kosakanikirana m'magulu a 01 ndi 02 kunachitika: 01 - mu milandu 1 mwa 30 (3%), 02 - mu 20 mwa milandu 71 (28%). Odwala omwe ali ndi synchronous chiwindi metastases adachitidwa 21 nthawi yomweyo (17,4%). Microscopically radical activated in 110 odwala, K2-resection - mwa 11 odwala. Pazowerengera, panalibe odwala omwe adachitidwa opaleshoni yopanda michere (I1).

Mavuto a postoperative omwe amapezeka mwa odwala 29 (24%).

Gome 2 ikuwonetsa mtundu wa zovuta za munthu aliyense payekha.

Pafupipafupi pamavuto amakhudzana: kukhudzika kwa magazi ndi mankhwala a anticoagulant - 1 kesi, kutuluka kwa magazi kuchokera m'matumbo a gastroenteroanostomosis - 2, thrombosis yamitsempha yamitsempha, minyewa yam'mitsempha ndi mtsempha waukulu wamisempha Gastrostasis yopezeka mwa 7 odwala. Malinga ndi 1 kuwunika, matumbo oyamba ochepa olimbitsa mtima, kuchepa kwa mitsempha ya m'mimba pambuyo pakuchepetsa kwa kuchepa kwa mankhwalawa, kuperewera kwa hepaticoenteroanostomosis, chotupa cha parapancreatic, ndi kulephera kwa chiwindi. Pancreatic fistula idapangidwa mwa odwala 8, omwe adakhala ovuta kwambiri (6.6%). Mochedwa zovuta zinapezeka odwala 3:

Gome 2 Chikhalidwe ndi pafupipafupi za zovuta za postoperative mwa odwala pambuyo pochitidwa opaleshoni ya neuroendocrine pancreatic chotupa

Kodi chotupa cha neuroendocrine ndi chiyani?

Pancreatic NEO imatchedwa islet cell chotupa muzochita zamankhwala. Mitundu yotere yam'mimba yotupa ndi yotsimikizika, chifukwa chake, mu endocrinology imafunikira kulingaliridwa kosiyana.

Mu kapamba, pali mitundu iwiri ya maselo - endocrine ndi exocrine. Gulu loyamba la maselo limathandizira kuti pakhale mitundu ingapo ya zinthu za mahomoni - zimapereka kuwongolera kwa maselo ena kapena machitidwe mu thupi la munthu. Mwachitsanzo, hormone insulin imayang'anira ndende ya glucose.

Maselo amenewa amakhala m'magulu azilumba zazing'ono kuzungulira pancreas. Amatchedwa ma cell a Langerhans kapena maselo a islet. Neoplasm yomwe imapezeka m'malo awa imatchedwa chotupa cha maselo a islet. Mayina ena - endocrine neoplasm kapena NEO.

Maselo a mbali ya thupi amatulutsa michere yomwe imatulutsidwa m'matumbo ang'onoang'ono. Cholinga chake ndikuthandizira njira yogaya chakudya. Zambiri mwa zikondamoyo zimakhala ndi njira yaying'ono yokhala ndi ma secs ang'onoang'ono momwe maselo awa amapezeka.

Zotupa za Neuroendocrine mwina zili zovomerezeka mwachilengedwe (osati khansa) kapena zilonda zam'chilengedwe (khansa). Ngati matendawa akuwonetsa vuto loipa, ndiye kuti amalankhula za endocrine oncology ya kapamba kapena insuloma.

Chotupa cha pancreatic neuroendocrine chimachitika pafupipafupi kuposa chotupa cha cell cha exocrine, chokhala ndi chidziwitso chabwino cha kupulumuka kwa wodwala.

Gulu la NEO kapamba

Pochita zachipatala, NEO imasiyanasiyana kutengera malowa. Ngati chotupa chabuka m'mimba, ndiye kuti sizingatheke kudziwa matenda omwe ali m'mayambiriro mpaka neoplasm ipereka ma metastases ku ziwalo zina.

Zikondamoyo zaumunthu zimakhala ndi ziwalo - mutu, mchira ndi thupi. Ndi zotupa m'magawo awa, kubisala kwa mahomoni kumayipa, zizindikiro zoyipa zimayamba. Ngati moona, ngakhale sayansi yatukuka, ndizovuta kwambiri kuzindikira matenda ngati amenewo.

Kutengera ndi komwe kuli, wodwalayo ali ndi zizindikilo. Amasiyana kwambiri. Chifukwa chake, maphunziro ena owonjezerawa amatsimikizidwa ndi zinthu zambiri - malo, kukula kwake, maphunziro, ndi zina zambiri.

Neuroendocrine ntchito pancreatic zotupa, zomwe nthawi zambiri zimapezeka motere:

Gastrinoma ndi neoplasm yotchukitsidwa m'maselo omwe amapanga mahomoni a gastrin. Izi zimathandizira kutulutsa madzi am'mimba, zimathandizira kugaya chakudya. Ndi chotupa, zomwe zili ndi madzi am'mimba komanso kuchuluka kwa mahomoni kumawonjezera. Gastrinoma pazithunzi zambiri amadziwika m'mutu mwa chiwalo chamkati. Mu zithunzi zina, kupezeka m'matumbo aang'ono. Nthawi zambiri, mtundu woipa wa neoplasm umakhazikika.
Insulinoma ndi kapangidwe kamene kamapangika m'maselo omwe amapanga insulin. Gawo lake limayang'anira zomwe glucose zili mthupi. Neoplasm iyi imakula pang'onopang'ono, samapatsa metastases. Imapezeka m'mutu, mchira kapena m'thupi la chithokomiro. Nthawi zambiri zimakhala zachilengedwe.
Glucagonoma. Chotupacho chimadziwika m'maselo omwe amapanga glucagon m'thupi. Izi zimawonjezera shuga zomwe zimachitika kudzera mukuwonongeka kwa glycogen m'chiwindi. Ndi kuchuluka kwa glucagon, dziko la hyperglycemic limawonedwa. Pancreatic mchira neuroendocrine chotupa nthawi zambiri zimakhala zoyipa.

Mankhwala, mitundu ina ya chotupa neoplasms imasiyanitsidwa, yomwe siyofala kwambiri. Amaphatikizidwanso ndikupanga mahomoni, kuphatikizapo zinthu zomwe zimayang'anira shuga, zomwe zimakhala mumchere komanso zamadzimadzi.

Vipoma (cholembera cham'mimba) ndi cholephera kuphatikizika m'maselo omwe amapanga matumbo a peptide, somatostatinoma ndi chotupa cha maselo omwe amatulutsa timadzi tamadzi totchedwaatin somatostatin.

Somatostatinoma imawonetsedwa bwino ndi makina a radionuclide.

Mawonetseredwe azachipatala kutengera mtundu wa chotupa

Zizindikiro za pathological neoplasm zimayamba chifukwa cha chotupa komanso / kapena chifukwa cha kuperewera kwa mahomoni. Mitundu ina ya zotupa siziwonetsa kukula kwawo ndi zizindikiro zilizonse, chifukwa chake, zimapezeka m'magawo omaliza, omwe amatsogolera ku chidziwitso chosavomerezeka.

Mawonekedwe mu kapamba wa chamoyo chosagwira ntchito amatha kukula kwa nthawi yayitali, pomwe palibe zizindikiro zotchulidwa. Amatha kufalikira ku ziwalo zina zamkati. Zizindikiro zazikulu zimaphatikizira kusokoneza kwam'mimba, kutsekula m'mimba, kupweteka m'mimba kapena kumbuyo, kutsekeka kwa khungu ndi sclera ya ziwalo zam'maso.

The Symbomatology ya inagwira pancreatic zotupa zimachitika chifukwa cha mtundu wa timadzi tambiri tomwe timapanga timadzi tambiri, timagulu tambiri tomwe timatulutsa. Ndi gawo lalikulu la gastrin, zizindikiro zotsatirazi zimawonekera:

Zilonda zam'mimbazi.
Ululu pamimba, kufikira kumbuyo. Ululu umawonedwa nthawi zonse kapena umachitika nthawi ndi nthawi.
Kutalika kwa m'mimba.
Gastroesophageal Reflux.

Poyerekeza ndi kuchuluka kwa insulin yambiri, dziko la hypoglycemic limayamba (shuga wochepa m'thupi). Nawonso, hypoglycemia imabweretsa mutu, chizungulire, kufooka, matenda amanjenje, kuchuluka thukuta. Komanso, odwala amadandaula za kugunda kwamtima mwachangu komanso zimachitika.

Ndi kukula msanga kwa glucagon, mawonetseredwe azachipatala amawululidwa:

Zing'onoting'ono kumaso, m'mimba komanso m'munsi.
Kuwonjezeka kwa shuga m'thupi, komwe kumabweretsa mutu, kuwonjezeka kwamikodzo mwachindunji patsiku, kuuma pamkamwa ndi pakhungu, njala, ludzu, komanso kufooka kosalekeza.
Magulu ama magazi. Ngati magazi amapezeka m'mapapo, izi zimapangitsa kupuma pang'ono, chifuwa, kupweteka pachifuwa. Ndi malo omwe magazi amawoneka kumtunda kapena m'munsi m'munsi, mumakhala ululu, kutupa kapena manja, mapazi.
Kusokoneza kwam'mimba.
Anachepetsa chilako.
Ululu pakamwa, zilonda m'makona amkamwa.

Ndi kuwonjezeka kwa matumbo a m'mimba, kutsegula m'mimba kosalekeza, komwe kumabweretsa kuchepa kwa madzi ndi mawonekedwe ophatikizika - kufunitsitsa kosamwa, kutsika kwamkodzo, khungu lowuma komanso mucous nembanemba mkamwa, kupweteka mutu pafupipafupi komanso chizungulire, komanso malaise wambiri.

Kuyeserera kwa labotale kukuwonetsa kuchepa kwa kuchuluka kwa potaziyamu m'magazi, komwe kumakwiyitsa minofu, kupweteka, malo osakhazikika, kutsekemera ndi kugunda kwa malekezero, kukodza pafupipafupi, kugunda kwamtima mwachangu, kupweteka kwam'mimba komanso kuwonda kwa etiology yosadziwika.

Ndi kuwonjezeka kwa milingo ya somatostatin, zizindikiro zazikulu ndi hyperglycemia, kutsegula m'mimba, kupezeka kwa mafuta mu ndowe, ma gallstones, khungu la khungu ndi mapuloteni amaso, kuchepa thupi.

Chithandizo cha chotupa cha pancreatic

Mankhwala a neuroendocrine pancreatic chotupa, kulowererapo kwa thupi kumafunika. Opereshoni imatchedwa gastrectomy. Komabe, njira yogwirira ntchito imakhala ndi zovuta zake, zomwe zimachitika chifukwa cha ma neoplasms angapo, omwe ali oyipa komanso owopsa mwachilengedwe.

M'mazithunzi ena azachipatala, kuchuluka kwa njira zopangira opaleshoni ndizovuta kuneneratu, motero njira yachipatala imatsimikiziridwa ndikuti - dokotala atamuchita opaleshoniyo ayamba opareshoni.

Zindikirani panthawi yake mawonetseredwe azachipatala omwe ali ndi chotupa cha pancreatic, motero, kuyamba chithandizo chokwanira, ndi dokotala wokhazikika amene angatero. Koma ma neoplasms ndi osowa kwambiri, kotero sizotheka nthawi zonse kuzindikira matendawa kumayambiriro.

Ngati chotupa chikukula msanga, pomwe mawonekedwe osiyanako amapezeka, ndiye kuti wodwalayo ndi mankhwala a chemotherapy. Mankhwala otsatirawa amagwiritsidwa ntchito popusitsa mano:

Nthawi zina kukhazikitsidwa kwa mahomoni opanga somatostatin amafunikira, ndiye kuti, mankhwala a mahomoni amachitika. Dongosolo la odwala mankhwala, Mlingo wa mankhwala, pafupipafupi awo makonzedwe - onse mosasamala. Chithandizo champhamvu chimaperekedwa pokhapokha mutazindikira mozama, njira zingapo zimaganiziridwa.

Mphamvu ya chemotherapy ndiyochepa. Ziwerengero zimazindikira kuti zotsatira zabwino zimachitika mu 15-20% ya milandu. Ngati chemotherapy ikupereka zotsatira zabwino pambuyo maphunziro angapo, ndiye kuti wodwalayo amatha kukhala ndi moyo kuyambira zaka ziwiri mpaka zisanu.

Kuphatikiza pa chemotherapy, mankhwala ena amalembedwa omwe cholinga chake ndi kuchepetsa nkhawa. Kusankhidwa kwa mankhwala kumatengera mawonetseredwe azachipatala. Dokotala atha kukulemberani mankhwala:

Pakakhala palibe zabwino chifukwa cha chemotherapy, funso limadzuka la kulowererapo. M'mankhwala amakono, amayesa kugwiritsa ntchito njira zothandiza kwambiri. Chimodzi mwa izo ndi chithandizo cha radionuclide.

Mwayi wochira kwathunthu (prognosis) zimatengera magawo ambiri: mitundu ya maselo a khansa, komwe chotupa, kupezeka / kusowa kwa metastases, matenda opatsirana, gulu la odwala. Chidziwitso chabwino kwambiri cha zotupa zopatsirana ndizosaposa masentimita awiri, omwe sanafanane ndi zamitsempha ndi chiwindi.

Zotupa za pancreatic zafotokozedwa mu kanema munkhaniyi.

Gulu la neuroendocrine pancreatic chotupa

Ndi chizolowezi kusiyanitsa NEO kumalo komwe zimakhazikitsidwa. Ngati neoplasm yatuluka m'matumbo am'mimba, ndiye kuti ndizovuta kuzindikira kuti kumayambiriro kwa chitukuko, pomwe NEO imamera mu ziwalo zina.

Mitundu yotchuka kwambiri ya zotupa za neuroendocrine pancreatic ndi:

Insulinoma - chotupa cha endocrine chomwe chimapangika m'maselo omwe amapanga insulin. Insulin imalimbikitsa kusuntha kwa glucose kupita ku maselo. Ma insulinomas amakula pang'onopang'ono ndipo nthawi zambiri samamera mu ziwalo zina. Izi neoplasms nthawi zambiri zachilendo.

Nthawi zambiri ndi insulinoma, hypoglycemia imayamba - kuchepa kwa shuga m'magazi. Matendawa amapezeka ndi zizindikiro zotsatirazi:

thukuta lolemera
malungo
kuzizira
khungu
kusokonezeka kwa chikumbumtima.

Kuti adziwe matendawa, m'mimba yopanda kanthu mumayesedwa magazi kuti mupeze shuga, proinsulin, C-peptide ndi insulin. Kuwonjezeka kwa C-peptide ndi proinsulin kumawonjezera insulin.

Gastrinoma - chotupa chomwe chimapangika m'maselo omwe amapanga gastrin. Gastrin ndi timadzi timene timayambitsa kutulutsidwa kwa asidi m'mimba, zomwe zimayambitsa chimbudzi cha chakudya. Ndi matenda amtunduwu, katulutsidwe ka hydrochloric acid m'mimba kumawonjezeka, chifukwa chake:

zilonda zam'mimba, limodzi ndi matenda am'mimba,
kupweteka kwam'mimba
zilonda zam'mimba zophatikizira,
gastroesophageal Reflux,
zilonda zam'mimba za jejunum
kutsegula m'mimba
zilonda zam'mimba
zilonda zingapo.

Mothandizidwa ndi zotupa za gastrin zimatuluka, zomwe nthawi zambiri zimatchulidwa m'mutu wa kapamba kapena duodenum wodwala. Ndi kukula, chotupa chimalira khansa. Ndi gastrinoma, zizindikiro zotsatirazi zimachitika:

Kutetezedwa kwa Atypical ndi zilonda zam'mimba zambiri zomwe sizingagwiritsidwe ntchito kapena kuyesedwa kwa Helicobacter pylori kwa wodwala zilonda zam'mimba.
Kupezeka kwa gastrinoma chifukwa cha kusintha kwachilengedwe komwe kumachitika ziwalo zina, kuphatikizapo neoplasms. Mwanjira imeneyi, munthu amakhala ndi ma endocrine neoplasia ambiri.

Glucagon - mapangidwe omwe amawoneka m'maselo omwe amapanga glucagon. Mtundu wa neoplasm nthawi zambiri umawonedwa mchira wa gland ndipo ndimapangidwe oyipa. Kukhazikika kwa matendawa kumatha kudzutsa:

kutsegula m'mimba
chitsulo chinachepa m'magazi,
mafinya ofiira m'thupi kapena erythema yosamukira kwina, malowo atasowa, kuchepa kwa mankhwalawa kukuwonekera pamalo ano,
matenda ashuga
kuwonda
kuchuluka magazi.

Kudziwitsa koyipa - madotolo amaika khansa ngati magazi a glucagon atakwera, palinso zizindikiritso zina zodziwika bwino za matendawa.

Vipoma - chotupa chomwe chimayamba m'maselo omwe amapanga chotupa cham'mimba cha Vasoactive. Dzina lina la matendawa ndi Werner-Morrison kapena cholera cha kapamba.

Ndi njoka, puloteni ya VIP imatulutsidwa, zomwe zimapangitsa kuti wodwalayo akhale ndi vuto lofanana ndi kolera:

kutayika kwakukulu kwa madzi, potaziyamu ndi chloride zimachitika
kutsegula m'mimba
kuperewera kwa madzi m'thupi, limodzi ndi ludzu, mkodzo wosatuluka, kukamwa kowuma, kupweteka mutu, chizungulire komanso kufooka kwakanthawi.
kuwonda
kukokana, kupweteka pamimba.

Kuti muzindikire matendawa, kuchuluka kwa VIP m'magazi kumayezedwa.

Somatostatinoma ndi mtundu wa zotupa zobisika zochuluka somatostatin. Matendawa amadziwika ndi:

matenda a ndulu
shuga, limodzi ndi khungu louma, kuyanika kuchokera mucous membrane wamkamwa, kuwukira kwadzidzidzi kwanjala, kufooka kwambiri,
kutsegula m'mimba
mu mpando, pamakhala mafuta ambiri omwe amapatsa fungo losasangalatsa,
yellowness sclera,
kuwonda, popanda chifukwa.

Somatostatinoma imawoneka bwino ndikuwunika kwa radionuclide.

Ma NEO onse amadziwika ndi zizindikiro wamba. Ganizirani zodziwika za matenda:

Kutsegula m'mimba
Mpando wosakhazikika.
M'mimba, wodwalayo amamva kupindika.
Kupweteka kwam'mimba kumbuyo.
Chikasu sclera.

Kuzindikira kwa Tumor

Chotupa chachikulu cha neuroendocrine (mivi) ya kapamba

Pofuna kudziwa nthawi yake zotupa za pancreatic neuroendocrine, ndimamaliza kuzindikira:

Wodwalayo amawunika, adotolo amawerengera mbiri yamatenda ake.
Gawirani umagazi kuti mupeze kuchuluka kwa shuga.
Mayeso a chromogranin A m'magazi. Kuwonjezeka kwa chizindikiro ichi ndi mahomoni ena (gastrin, insulin, glucagon) amawonetsa chotupa cha pancreatic.
CT ndi MRI.
Kuwunika kwa radionuclide kumachitika kuti apeze zotupa zazing'onoting'ono. Njira imeneyi imatchedwa kuti Octreotide ndi kusanthula kwa SRS.
Perekani endoscopic ultrasound.
Ngati akuwonetsedwa, endoscopic retrograde cholangiopancreatography (ERCP) imachitidwa.
Nthawi zina madokotala amapita ku laparotomy, pomwe dokotalayo amatenga tinthu tating'onoting'ono kuti timaliziritse.
Biopsy
Bone scan
An angiogram amachitidwa, zomwe zimapangitsa kuti aziyang'ana mitsempha yamagazi. Angiogram ikabayidwa, kusiyanasiyana kumayikidwa m'mitsempha, ndiye kuti kupezeka kwa neoplasms kumayesedwa pogwiritsa ntchito x-ray.
Intraoperative ultrasound. Phunziroli limachitika pochita opaleshoni kuti muwunike mwatsatanetsatane chiwalo cham'mimba. Poyerekeza ndi intraoperative ultrasound imaposa njira yofufuzira.

Chithandizo cha NEO

Nthawi zambiri, chithandizo cha opaleshoni (gastrectomy) chimasonyezedwa pochiza chotupa cha pancreatic.

Koma chithandizo chamtunduwu ndi chovuta chifukwa cha kuchulukana kwa mitundu, komwe sikungokhala koyipa kokha, komanso kunyoza. Nthawi zina kuchuluka kwa maopareshoni kumakhala kovuta kulosera, ndipo madokotala ochita opaleshoni amazindikira ma neoplasms akangoyamba opaleshoni.

Katswiri wodziwa bwino yekha ndi amene angazindikire zizindikiro za chotupa cha pancreatic munthawi ndikuyamba chithandizo.

Chemotherapy imalembedwa kwa wodwala ngati neoplasm ikukula msanga, ndipo kusiyanitsa kumakhala kotsika. Ndi chemotherapy, mankhwala otsatirawa amagwiritsidwa ntchito:

chlorozotocin,
5-fluorouracil,
streptozocin,
epirubicin
doxorubicin,
Somatostin analog jakisoni (mahomoni othandizira).

Ndalama zomwe zili pamwambazi zimagwiritsidwa ntchito palimodzi, ndipo njira zochiritsira wodwalayo sizothandiza aliyense payekhapayekha, potengera malangizo omwe amaperekedwa pamabuku a oncological.

Zowona, mphamvu ya chemotherapy ndiyotsika kwambiri ndipo imathandiza odwala 15-20%. Ndi zotsatira zabwino za chemotherapy, zomwe zimachitika m'maphunziro, wodwalayo amatha kukhala ndi moyo atazindikiridwa zaka ziwiri mpaka 9.

Kuphatikiza apo, chemotherapy imapereka chithandizo kwa odwala kuti athetse vuto lawo. Mankhwala ambiri amagwiritsidwa ntchito:

Ngati chithandizo cha nthawi yayitali ndi chemotherapy sichinaperekenso vuto, ndiye kuti pamabuka funso lokhudza opareshoni.

Masiku ano, njira yatsopano yochizira odwala NEO pogwiritsa ntchito radionuclide mankhwala imagwiritsidwa ntchito.

Ndizofunikira kudziwa kuti akatswiri ambiri pantchito zamankhwala azachipatala nthawi zambiri amakhala akulakwitsa amapanga matenda. Chifukwa, mwachitsanzo, pali chikhulupiriro chakuti ma endocrine pathologies ndi ofunika masiku ano. Nthawi zambiri, madokotala saganiza kuti mwina matendawa amatha kulumikizana ndi NEO, kotero chotupa choyipa chimayamba kusokonezeka m'thupi mpaka kukachedwa.

Odwala ambiri amakhulupirira kuti chithandizo choyenera cha chotupa cha pancreatic chimachitika kokha kunja, mwachitsanzo, ku Israeli. Koma machitidwe aku Russia awonetsa kupambana kwa chithandizo cha NEO ku Russia, komwe sikotsika poyerekeza ndi luso la anzawo akunja.

Zambiri

Popanda magwiridwe antchito amanjenje, zotulutsa zotulutsa, thupi la munthu silingathe kugwira ntchito ndikuchita bwino. Mankhwala amakono amawona zinthu zonsezi, ndikuzipanga mu neuroendocrine. Maselo apadera odziwika mu endocrine glandular nyumba ndi omwe amapangitsa kuti pakhale mankhwala omwe amagwira ntchito. Chimodzi mwazinthu zofunika kwambiri za kapamba ndiz zisumbu za Langerhans. Kuyika kwamilandu pakaonekere chiphuphu m'derali ndi C25.4 malinga ndi ICD. Chotupa cha pancreatic neuroendocrine cha mawonekedwe amtunduwu chikhoza kupanga ngati maselo amtunduwu wowonetsedwa ayamba kugawikana, kugwira ntchito, ndikufa m'njira yolakwika, yolakwika.

Zosiyanasiyana za ma pathologies sizomwe zimaperekedwa mwangozi pagulu lina. Mawonetsedwe ake, mfundo zodziwikitsa bwino za matendawo, njira zamankhwala ndizosiyana kwambiri ndi zomwe zimagwiritsidwa ntchito ndi neoplasms yopangidwa ndi maselo a epithelial.

Anatomy ndi mankhwala

Mchitidwe wamanjenje, zinthu zamafuta zopangidwa ndi ma endocrine zimagwira ntchito mosiyanasiyana. Zizindikiro za dongosolo lamanjenje zimalowa mu hypothalamus, pomwe zimapangitsa kupanga mahomoni. Zomwezo, zimakhudzanso gland, zimayambitsa kapena kuchepetsa ntchito zamnjira. Zinthu zokhala ndi kayendedwe ka magazi zimafalikira thupi lonse, zomwe zimapangitsa kuti chinsinsi chake chizigwira bwino ntchito.

M'badwo wama mahomoni umatsimikiziridwa osati kokha ndi zokopa za mitsempha. Zofunikira ndi njira zomwe zimachitika mthupi, momwe munthu alili chonse komanso ziwalo ndi kapangidwe kake. Mitsempha yapakati komanso chinsinsi cha makina ndizolumikizana onse: chifukwa cha mahomoni kudzera mu gren ya adrenal, ntchito ya mitsempha imayendetsedwa. Izi zimadziwika kudzera kutulutsidwa kwa adrenaline m'magazi.

Pancreas: momwe imagwirira ntchito

Mothandizidwa ndi chotupa cha neuroendocrine cha kapamba C25 amatanthauza matenda omwe amachitika chifukwa chogwira ntchito molakwika kwa gastroenteropancreatic NES. Mu thupi la munthu, imalamulira ma NES ena kukula. Ndi dongosolo lino lomwe asayansi adaphunzira kwambiri. Zinali zotheka kukhazikitsa kuti NES imapangidwa ndi ma neurons, apudocytes, opanga mahomoni ophatikizana. Maselo awa amabalalikana m'matumbo amtumbo, amapezeka mu ziwalo zonse.

Malo ofunikira kwambiri pancreatic kuchokera pamenepa ndi zisumbu za Langerhans, ndiye kuti, zone zone. Zokhudzana ndi chiwalo chonsecho, zisumbu izi ndizomwe zimangokhala 2% ya kuchuluka, ndiye kuti, pafupifupi 1.5 g. Chiwerengero cha zilumba ndizodabwitsa kwambiri - zadziwika kuti chiwerengero chawo chili pafupi miliyoni.

Neoplasms: nuances of mapangidwe

Pancreatic neuroendocrine chotupa (G2, G1) imatha kupangidwa kuchokera ku selo iliyonse yamtunduwu. Makina owoneka ngati matendawa ndi njira yogawa maselo osalamulirika. Pakadali pano, maubwino a mapangidwe a neoplasms sanaphunzire bwino. Zinafotokozedwa kuti odwala ambiri amawonetsa kusintha kwachisanu ndi chimodzi cha chromosome. NEO ili m'gulu la matenda osowa kwambiri, omwe amakwaniritsa kuchuluka kwa vutoli: ndi dokotala yekha wodziwa bwino yemwe angazindikire zomwe zikuwonetsa.

Pafupipafupi kuchuluka kwa milandu, chotupa cha neuroendocrine cha mitundu ya zikondamoyo ngati kuwira kapena mbale. Dzina lovomerezeka la mitundu iyi (motsatana): alveoli, trabeculae. Mwa odwala ena, kupita patsogolo kwamatenda kumayamba pang'onopang'ono, pomwe ena amadziwika ndi maphunziro abwino. Mwambiri, monga chidziwitso chomwe mankhwala omwe amapezeka ndi mankhwala chikuwonetsa, matenda am'mimba ndi osadalirika kwambiri. Vuto laling'ono lotalikirana kwambiri silikhala loyipa nthawi zonse. Mapeto ake pamachitidwe ake amapangidwa mwa kudziwa kuthamanga kwa chitukuko. Nthawi zina, chotupacho chimapangidwa m'chiwalo chimodzi, nthawi zina chimafalikira kumitundu yoyandikana.

Malingaliro owonetsera

Zizindikiro za chotupa cha pancreatic neuroendocrine kumayambiriro kwa chitukuko cha matendawa kulibe kapena mafuta ambiri. Chiwerengero chachikulu cha milandu imatha kupezeka pokhapokha paliponse, pomwe vuto la matenda amisempha lakhala likuchitika kwa zaka 5-8. Mawonetsero apadera m'magawo oyamba a zotupa zambiri sakhala ndi chikhalidwe. Mavuto ena azaumoyo a odwala amasokonezeka, koma sangathe kulumikizidwa ndi dongosolo la neuroendocrine, ndipo chithandizo cha matenda osiyanasiyana ndi omwe chimalembedwa.

Ndizotheka kuganiza kuti pali chotupa cha neuroendocrine cha kapamba (wokhala ndi kapena popanda metastases, zimatsimikiziridwa pambuyo pakupenda kwathunthu), ngati mukukhudzidwa ndi kupweteka pamimba. Zisoni zimatha kubwera nthawi ndi nthawi kapena zimatha kukhala zosasinthika. Wodwala amachepetsa thupi, akumakhala wotopa nthawi zonse. Pali chopondapo chopumira, mseru komanso kusanza. Poyerekeza ndi zakumaso, shuga m'magazi amachepa, zimachitika zimakonda kumachitika, zimapangitsa nkhawa.

Magulu ndi mitundu

Munjira zambiri, kudalirika kwa chotupa cha neuroendocrine pancreatic kutengera mtundu wa mlanduwo. Njira yakhazikitsidwa yogawa iwo m'magulu angapo. Choyimira chachikulu chakuwunika ndikutha kupanga zinthu zamahomoni, ntchito ya njirayi. Pali mitundu inayi: yogwira, yosagwira, yosagwira ntchito komanso yogwira ntchito.

Mtundu woyamba ndi chotupa cha neuroendocrine cha kapamba, yemwe maselo ake amapanga zinthu zomwe zimayang'anira thupi. Mwa chiwerengero chonse cha neoplasms, akaunti yogwira pafupifupi 80%. Mtundu wocheperako wamba ndi wopanda ntchito. Kuzindikira matenda amtunduwu ndizovuta kwambiri. Ma NEO osagwira ntchito amatha kubisa mankhwala okhala ndi mahomoni. Mlanduwo suzindikirika ndi zizindikiro zapadera. Pomaliza, gulu lomaliza ndi NSO, yomwe imapanga zochulukirapo kuposa momwe zimakhalira, kuchuluka kwa mahomoni. Izi nthawi zambiri zimatha kutsimikiziridwa koyambirira. Kupanga mahomoni ochulukirapo nthawi zambiri kumawonedwa motsogozedwa ndi chinthu chodetsa nkhawa. Izi zitha kukhala yankho la mankhwala oletsa kupindika, a biopsy.

Zosintha Zinthu

Kuzindikira chotupa cha neuroendocrine pancreatic sichinthu chovuta kwa dokotala amakono. Ndizotheka kukayikira kuti zovuta zaumoyo wa wodwalayo zimachitika chifukwa chazifukwa izi, kuchokera kwa dokotala wodziwa bwino komanso wodziwa zambiri yemwe adakumana ndi izi kale. Ngati pali lingaliro lonena za kuthekera kwa kukhalapo kwa NEO, ndikofunikira kuchita maphunziro angapo kuti mutsimikizire kapena kutsutsa lingaliro. Yambani kuphunzira mbiri yakale ya munthu ndi banja lake. Kufotokozera za cholowa cha makolo ndi chidziwitso chofunikira pofufuza zomwe zimayambitsa. Komanso, pakuyikidwa koyamba, wodwalayo amawunikira mosamala, madandaulo onse amafotokozedwa ndipo chidziwitsochi chimakonzedwa.

Gawo lotsatira pakupanga chotupa cha pancreatic neuroendocrine ndikutenga zitsanzo zamadzimadzi ndi minofu ya kafukufuku wa labotale. Ndikofunikira kuti wodwalayo apeze maselo okhala ndi zinthu za mahomoni, zomwe mwina zimapangidwa ndi neoplasm. Dokotala amakhalanso mndandanda wazinthu zina zomwe zimagwira, kuwunika kwake komwe kungathandize kupeza chidziwitso chofunikira chokhudza mlanduwo. Sankhani malo amisempha kuti mulandire zitsanzo za biopsy, perekani scintigraphy ndi somatostatin. Gawo lotsatira ndi CT, ultrasound, MRI, X-ray. An ultrasound ikhoza kutumikiridwa pogwiritsa ntchito endoscope.

Kuzindikira kwatsimikiziridwa: kenako?

Chithandizo cha chotupa cha pancreatic neuroendocrine chimasankhidwa potengera mtundu womwe uli. Pali njira zingapo zoyambira: njira zochizira, radiation, chemotherapy, opaleshoni, kufalitsa ma wayilesi, njira yachilengedwe. Palibe njira zoteteza neoplasms zamtundu womwe mukuwunikiridwa. Izi zikuchitika chifukwa cha kuperewera kwa milandu yotere ndi kusazindikira kokwanira pokhudza mapangidwe awo. Makina opezekapo sanadziwikebe molondola, zomwe zimapatula mwayi wopewa bwino.

Mwambiri pazochitika zambiri, njira yochizira imaphatikizapo opaleshoni. Gawo lofotokozedwa la neoplasms limalola zinthu zowononga pang'ono. Ndikotheka kugwiritsa ntchito laparoscope. Izi zimachotsa malo ocheperako odwala, omwe amachepetsa zovuta ndikufulumizitsa kukonzanso wodwalayo. Ngati metastases yapezeka, iyenera kuchotsedwa.

Njira yabwino yothandizira chotupa cha neuroendocrine pancreatic ndi chithandizo cha nyukiliya. Njirayi imayendetsa njira zowonongeka mu intracellular. Mutha kusintha njira izi nokha kapena kuphatikiza ndi opareshoni. Mwambiri, chidziwitso cha chotupa cha neuroendocrine pancreatic ndichabwino kwambiri kuposa mitundu ina yambiri yamankhwala opweteka m'matumbo am'mimba. Ziyembekezero zabwino kwambiri ndi za anthu omwe ali ndi vuto lothandizira omwe adakhazikitsidwa kumayambiriro koyambira, ngati kuli kotheka kuyamba chithandizo chokwanira popanda kuwononga nthawi.

Mitundu yogwira: insulinoma

Mitsempha yotereyi imakhala ndi maselo a beta omwe amapanga insulin. Mwa zina za NEO, mtundu uwu umakhala mpaka 75%.Mokulira momwe mapangidwe a chotupa mu akazi, msambo womwe uli pachiwopsezo ndi zaka 40-60. Mwa kuchuluka kwakukulu kwa milandu, chotupa chimodzi chapezeka, malo omwe ali m'gululi ndi osadziwika. Peresenti yaying'ono yamilandu imachitika mu chitukuko kunja kwa kapamba. Miyeso ya neoplasm si kawirikawiri yoposa masentimita 1.5. Mtundu - wofanana ndi chitumbuwa, imvi kapena chikasu. Mpaka 15% yamilandu yoyipa.

Chotupa chamtunduwu chimapanga kuchuluka kwakukulu kwa insulin, komwe kumapangitsa chizindikiro chachikulu: shuga wambiri amachepetsedwa kwambiri m'thupi. Hypoglycemia imatchulidwa kwambiri pambuyo pochita masewera olimbitsa thupi kapena pakudya kwakutali pakati pa chakudya. Kuchepetsa mphamvu ya shuga kumabweretsa mphamvu zamagetsi zosayenera, zomwe zimakhudza thupi ndi ubongo subcortex. Wodwala amamva kufooka, ali ndi njala. Tiziwopsezo tambiri timatakatika kwambiri kuposa zabwinobwino, pafupipafupi komanso kuthamanga kwa kugunda kwa mtima kumasokonezeka, kunjenjemera ndi kusokonezeka m'mlengalenga, nthawi zina nthawi, kumakhala kosokoneza. Pang'onopang'ono, kukumbukira kumakhala koipa, chikumbumtima chimasokonezeka, wodwalayo amakhala wopanda chidwi komanso amavutika ndi kukhumudwa. Vuto lalikulu kwambiri la chotupa cha pancreatic neuroendocrine yamtunduwu ndi hypoglycemic coma.

Case Nuances

Kuzindikira insulin sikophweka. Ichi ndi chopanda pake pang'ono, chomwe zizindikiro zake ndizofanana ndi mitundu yambiri ya ma endology. Maphunziro olondola kwambiri ndi scintigraphy, endoscopic ultrasound, CT. Pafupifupi 50% ya milandu imapezeka kudzera pama radiation diagnostics. Ngati malowa sakudziwika bwino, positron emission tomography akuwonetsedwa kuti amvetse bwino za mlanduwo. Ndikothekanso kupereka lingaliro pazachilengedwe pounika mayendedwe a angiographic.

Mankhwala a neuroendocrine pancreatic chotupa cha kalasi iyi ndi othandiza kwambiri. Ndi miyeso yaying'ono, chotupacho nthawi yomweyo chimachotsedwa. Ndi masentimita atatu kapena kupitilira, chiwonetsero cha chinthu chachiwonetsero chikuwonetsedwa. Izi ndizofunikira makamaka ngati NEO ili yoyipa. Chochitika chochitika bwino ndichinsinsi chofuna kuchira kwathunthu.

Gastrinoma

Mwa mitundu yonse ya NEO, mtundu uwu ndiwachiwiri wofala kwambiri. Zimakhala mpaka 30% ya milandu yonse. Kuthekera kwakukulu kwa mapangidwe a neoplasm mu kugonana kwamphamvu, gulu la zaka zangozi ndi zaka 30-50. Pafupifupi milandu itatu iliyonse imakupatsani mwayi wodziwa NEO muzida zakunja zogwirizana ndi thupi. Makulidwe nthawi zambiri amakhala osapitirira 3 cm. Chowoneka mosiyana ndi mawonekedwe awa ndi chizolowezi choyambirira pakupanga ma metastases. Matendawa amadziwonetsa ndi mbadwo wa gastrin wambiri, ndikuyambitsa kupanga madzi m'mimba. Izi zimapangitsa zilonda kupanga m'matumbo. Kuchita koteroko nthawi zambiri kumakhala chisonyezo choyamba chotupa.

Gastrin imatha kukayikiridwa ndi chimbudzi chomasuka komanso zovuta zam'mimba zomwe zimafanana ndi colic. Matenda a zilonda zam'mimba zimawonetsa kukana chithandizo. Kuthekera kwakukulu kwa NEO ngati kupezeka kotereku kudachitika kwa makolo.

Glucagon

Fomuyi ndiyosowa kwambiri. Itha kuwoneka pakati pa kusintha kwa ma cell a alpha a glucagon. Pali kuthekera kwakukulu kopezeka ndi matendawa mu akazi achichepere komanso okhwima. Pafupifupi, pakati theka la akazi, matenda a zam'mimba amapezeka katatu konse kuposa amuna. Ambiri mwa milandu amapezeka pamalo omwe amapangidwira mu caudal kapena gawo lalikulu la gland. Nthawi zambiri, NEO ndi yosakwatiwa, yopanda masentimita 5 kapena kuposerapo. Mpaka 70% ya milandu yonse ndiyopweteka. Kupanga yogwira glucagon kumalimbikitsa m'badwo wa insulin, ndipo glycogen imawonongeka m'chiwindi.

Matendawa atha kukayikiridwa ndi erythema yosamukasamuka, limodzi ndi madera a necrotic. Kugundika kwa magazi kumawonekera mkati mwa venous system, wodwalayo amadandaula. Matenda a shuga achiwiri amatha. Poyezetsa magazi, ma glucagon indices amapitilira kawiri. Kulongosola bwino kwachilengedwe, ultrasound, CT akuwonetsedwa.

Zotsatira pambuyo chotupa

Amayi omwe ali ndi chizindikiritso chotere amakhala ndi nkhawa kwambiri ndi: kodi kubereka kumatha pambuyo pa zotupa za neuroendocrine pancreatic? Monga momwe machitidwe azachipatala adawonetsera, izi sizotheka zokha, komanso zimachitika m'moyo weniweni. Kuphatikiza apo, milandu yopambana yobereka ndi kubereka mwana imadziwika ngakhale motsutsana ndi chiyambi cha kuchotsedwa kwachikondwerero chifukwa cha NEO yoyipa yomwe yadziwika kale. Zachidziwikire, choyamba muyenera kupita kukalandira chithandizo chonse ndikuchira, dikirani mpaka vutolo litakhazikika, kenako ndikuganiza za kupitiriza kwa mtunduwo. Ndipo komabe chowonadi chiripo: kutenga pakati pambuyo pa neuroendocrine pancreatic chotupa ndikotheka, kuchitidwa, kuchita bwino, ndipo ana amatha kubadwa athanzi kwathunthu.

Malinga ndi madotolo, gawo lalikulu la chidziwitsochi ndikugwira ntchito moyenera munthawi yokwanira. Chochitika chomwe chimachitika moyenera chokhudza madokotala oyenerera chimathandizira kuti munthu akhale ndi moyo wautali komanso wathanzi.