Kubwezeretsa pambuyo pochotsa pituitary adenoma: momwe mungachepetse mavuto?

Gland pituitary ndi gawo la dongosolo la endocrine lomwe limatulutsa mahomoni omwe amalowa m'magazi. Ili ndi mawonekedwe ozungulira ndipo imapezeka "chishalo cha Turkey" pakati pamutu.

Mitsempha ya optic imapezeka mwachindunji pamtunda wa pituitary gland. Amathandizira pakuwongolera magwiridwe antchito a ziwalo za adrenal komanso gland ya munthu.

Zotsatira zakuchotsa adenoma zimatengera kukula kwake koyamba. Mwambiri, pafupifupi 85% ya odwala amachira. Njira yochiritsira imadalira zotsatira zoyeserera za opaleshoni yotsana ndi endocrinological zinthu. Ndizofunikira kudziwa kuti mukachira, dokotala amayenera kupereka njira ya mankhwala a mahomoni potengera kupenda kwa chithokomiro cha chithokomiro. Zakudya zapadera zitha kuperekedwanso, zomwe ziyeneranso kupangidwa poganizira kusanthula kwa magazi, mkodzo, shuga, ndi zina za wodwala wina.

Adenoma ndi matenda ofala kwambiri. Nthawi zambiri, ndi chotupa chaching'ono chaching'ono. Imachitika m'munsi mwa chigaza ndipo ndimachokera m'maselo a kutsogoloku kwa England.

Pali mitundu yambiri ya adenomas, koma onse ndi ofanana pazizindikiro zawo. Awa ndimavuto pokodza, thyrotoxicosis, kukula kwa tsitsi la thupi komanso kunenepa kwambiri. Mutu wolimba kapena wosakhazikika, kuwonongeka kwa mawonekedwe, kusokonezeka kwammphuno ndi madzimadzi a cerebrospinal kumawonekeranso. Zizindikiro zoterezi zimawonetsedwa ndi zotupa mkati mwake. Ndikofunika kudziwa kuti kupsinjika kwambiri, magazi osayenda bwino kapena matenda opatsirana angayambitse kuchuluka kwa adenoma.

Ngati mumatsatira malingaliro onse a dokotala, ndiye kuti kubwezeretsa ntchito zonse kumachitika mwachangu kwambiri. Monga lamulo, kuyambira 1 mpaka 3 months. Zonse zimatengera gawo la chotupa, ngati adayamba, ndiye kuti pali milandu yoti atachotsa pituitary adenoma matendawa amabwerera. Pogwiritsa ntchito kufufuza kozindikira, mutha kudziwa gawo la chitukuko cha chotupa ndi chithandizo chomwe mungagwiritse ntchito. Kutengera ndi matendawa, amatha kutha ndi mankhwala, mankhwala a radiation, kapena opaleshoni.

Chithandizo chothandiza kwambiri ndikuchita opaleshoni yochotsa pituitary adenoma. Njirayi ikhoza kukhala yamitundu iwiri. Loyamba ndi lovuta kwambiri, chifukwa limalumikizana ndi kulowa mwachindunji kuubongo, ndiko kuti, kuwonongeka. Njira yachiwiri ndi yokhulupirika kwambiri. Kuchotsa kwa adenoma kumachitika kudzera pamphuno, ndipo ntchito imatenga pafupifupi maola awiri. Opaleshoniyo ndi yodalirika ngati zotupa mkati mwa chotupa. Pambuyo pakuchita opaleshoni, munthu amakhala ndi chisamaliro chachikulu tsiku limodzi. Kenako amasamutsidwa kumalo wamba ndipo amakakamizidwa kuti ayambe kuyenda pang'ono. Koma tiyenera kukumbukira kuti pambuyo pochotsa pituitary adenoma pamakhala chiwopsezo cha kupangika kwa chotupa chatsopano. Kuphatikiza apo, opareshoniyi ndi yowopsa ndipo imatha kubweretsa zotsatirapo zosasangalatsa ku thanzi la munthu. Kutanthauza: kufooka, kugona, kusanza, kudwala, kusanza komanso kusowa kwa adrenal.

Chothandiza kwambiri ndi mankhwala, omwe amachepetsa njira yopanga adenoma. Mankhwala amangoletsa kutulutsidwa kwa mahomoni owonjezera. Ponena za chithandizo cha radiation, chimangotchulidwa pokhapokha ngati kuli kovuta kuchita opareshoni. Ndizofunikira kudziwa kuti siothandiza kwambiri, chifukwa imagwira timinyewa tambiri tating'onoting'ono. Kwenikweni, chithandizo cha radiation chimachitika pambuyo pa opaleshoni kuti aphatikize zotsatira zake.

Pali mtundu wochepa wa adenoma womwe sungathe kuchotsedwa. Izi ndichifukwa cha kukula kwawo kwakukulu ndi malo. Makamaka owopsa ndi zotupa zomwe zimakhala pafupi kwambiri ndi venous plexus ya ubongo. Popeza pakuchita opaleshoni, madokotala a opaleshoni amatha kuwononga mitsempha, yomwe imayambitsa kukwiya, kapena mitsempha yofunikira kuwona. Ma adenomas oterowo amangokhala kuchotsedwa kwina ndi chithandizo chowonjezereka cha radiation.

Kuchotsa chotupacho kumakhudza kwambiri kuphatikizidwa kwa pituitary gland ndipo zotsatira zake pochotsa adenoma ya pituitary ndizosiyanasiyana. Odwala ambiri amadera nkhawa za kuyambiranso kuona. Kusintha kwamawonedwe kumawonedwa patatha masiku angapo. Koma izi zimachitika pokhapokha ngati vutoli lidalibe kwa nthawi yayitali. Ngati masomphenya adasokonekera chaka chimodzi kapena miyezi isanu ndi umodzi yapitayo, ndiye kuti kutheka kwathunthu ndikosatheka.

Munthawi ya ntchito, munthu amakhala akuwunikidwa mozama ndi madokotala. Mulimonse momwe zingakhalire, kuchiritsa kwa adenoma kumadalira momwe munthu amafunira thandizo kuchokera kwa akatswiri.

Mkhalidwe wodwala atatha opaleshoni

Ndi chitukuko cha pituitary adenoma, chithandizo cha opaleshoni nthawi zambiri ndiyo njira yokhayo. Opaleshoniyo imalepheretsa kuwonongeka chifukwa cha kuwonongeka kwa mitsempha ya maso, kusokonezeka kwa mitsempha chifukwa cha kutsekeka kwa minyewa yaubongo, zotsatira za kukondoweza kwa mahomoni a tiziwalo togonana, chithokomiro. Komabe, zovuta mu nthawi yothandizanayi nthawi zambiri zimachitika. Amafuna kuzindikiridwa ndi nthawi yake.

Kuchuluka kwa chiwopsezo cha ntchito

Kuzindikira kwamphamvu kwa odwala nthawi zina kumagwirizanitsidwa ndi opaleshoni ndikuchita opaleshoni palokha. Chiwopsezo cha opaleshoni chikuwonjezeka mwa okalamba. Mu gulu la odwala nthawi zambiri amapezeka:

Kusintha kowopsa kwa kuthamanga kwa magazi - kusintha kuchokera pakugwa kwa mtima kupita ku vuto la matenda oopsa,
kusakwanira pakuyamwa, kusowa zotsatira,
kusokonezeka kwa mtima (tachycardia, bradycardia, arrhythmia),
kukulitsa kwa mtima ndi mtima,
kufalikira kwamitsempha yakuya ya malekezero, kulekanitsa kwa magazi omwe ali ndi pulmonary embolism,
chibayo pambuyo
zilonda zam'mimba zopsinjika ndi matumbo otulutsa magazi akulu.

Chifukwa chake, asanachotsere adenoma, dokotala wa opaleshoni ndi opaleshoni kuti adziwe kuopsa kochotsa adenoma, kuyanʻanila kolondola kwa mtima. Pambuyo pa opaleshoni, odwala oterewa amawonetsedwa kuti azitha kuyang'anira ECG, ultrasound yam'mimba.

Ndipo izi ndizambiri pazakupezeka kwa matenda a chithokomiro.

Zochita za nyumba zoyandikana

Zovuta za m'mimba zimaphatikizapo:

matenda edema,
kuvutika kwakanthawi kwamatumbo
intracerebral and subarachnoid hematomas,
ischemic stroke.

Mukamayimitsa magazi kuchokera kunthambi ya carotid artery, nitha kuuletsa, kupendekera kapena kupangika kwa aneurysm yabodza, kuchepa kwa magazi nthawi yomwe imatuluka kudzera m'mphuno.

Kusokoneza kwa adrenal gland ndi hypothalamus

Kuperewera kwa mapangidwe a catecholamines (adrenaline, norepinephrine ndi dopamine) chifukwa kuchotsedwa kwa adenoma ndizovuta. Itha kuphatikizidwa ndi kuwonongeka kwa pituitary gland pakuchita opaleshoni, komanso kupsinjika kwaposachedwa kwa minofu yaubongo yomwe imapanga mahomoni a adrenocorticotropic. Izi zimachepetsa wodwalayo kulekerera kupsinjika kwa magwiridwe antchito.

Ndi matenda a edema m'magazi a hypothalamus, hematoma kapena magazi m'derali, kuphatikizika kwa mitsempha ya bwalo la Willis, vuto la hypothalamic limachitika. Mawonetsero ake akuluakulu:

kutentha kwambiri kwa thupi kapena kutsika kwake kosalamulirika,
zabodza, kusilira, kusangalala kwadzidzidzi,
kugona kwanthawi yayitali komanso kusinthana ndi kukomoka,
kusinthasintha kwa mtima - kugunda kwa mtima pamphindi kumatha kuwonjezeka mpaka kumamenyedwa mpaka 200 kutentha kokhazikika kapena kutentha pang'ono kwa thupi, ndipo kukwera kumachitika zambiri
kupumira msanga
kusintha magazi acid.

Momwe mtima umaperewera komanso kuperewera kwa mapapo kumabweretsa imfa.

Liquorrhea ndi Meningitis

Kutuluka kuchokera m'mpweya wam'madzimadzi amadzimadzi otupa kapena am'madzi amadzimadzi otupa (tumorhea) kumawonekera pambuyo pochotsa chotupacho chifukwa cha kufooka kwamfupa komwe opaleshoni idutsamo. Itha kuwoneka m'masiku oyambira kapena ngakhale patatha zaka zochepa. Postoperative meningitis (kutukusira kwa zotupa za muubongo) kumachitika malo opangira opaleshoni atapatsidwa kachilombo, chiwopsezo chawo chimawonjezeka ndikuchitapo kanthu kwa nthawi yayitali.

Khazikika

Wodwala amangowonetsa kupsinjika - kutentha, kuthamanga kwamkati, kupanikizika kosasunthika, kusokonezeka kwa malingaliro pambuyo pa opaleshoni (kusokonezeka kwa chikumbumtima, kusokonezeka), kusintha kwa tendon Reflex. Monga lamulo, kuphwanya kotero kumadutsa tsiku lonse. Wodwalayo akuwonetsedwa akuwonekera kwa masiku 5-7 ndi kuchotsera komwe amakhala.

Ndi kuchuluka m'dera lomwe lakhudzidwa

Zizindikiro za vuto la hypothalamus zikupita patsogolo - kutentha thupi, tachycardia. Zimaphatikizidwa ndi kusinthasintha kwakuthwa mkakamizo, odwala amakhala ndi mawu osakwanira, nkhawa yamagalimoto, miyendo yanjenjemera. Kusintha kotere kumakhala kosachepera masiku 7-10, kenako kuchepa pang'onopang'ono. Odwala amakhalabe kuchipatala akuwunikiridwa, amawonetsedwa ngati mankhwala osokoneza bongo ndikuwatsatila mayeso asanatuluke.

Zizindikiro zakuchita opareshoni

Kuchotsa chotupa cha pituitary sikuyenera kulangizidwa nthawi zonse, chifukwa chitha kutsagana ndi chiwopsezo chachikulu kuposa kupeza chotupa m'thupi. Kuphatikiza apo, ndi pituitary adenomas, chithandizo chokhazikika chimapereka bwino.

Opaleshoni ndikulimbikitsidwa pazizindikiro izi:

Chotupacho ndi mahomoni, i.e. amatulutsa mahomoni ambiri, zomwe zimakhala ndizowopsa kwa wodwala.
Adenoma imakakamiza minyewa ndi mitsempha yoyandikana, makamaka, zowoneka, zomwe zimapangitsa kuti khungu lizigwira ntchito.

Kugwiritsa ntchito ma radiyo odekha Zovomerezeka pazotsatirazi:

Mitsempha ya optic siyikhudzidwa.
Chotupa sichikulitsa kupitirira chishalo cha Turkey (kupangika mu pfupa la sphenoid, pakuzama komwe ma pituitary gland).
Chishalo cha ku Turkey chili ndi zazikulu kapena zazikulu kukula.
Adenoma imayendera limodzi ndi neuroendocrinal syndrome.
Kukula kwa neoplasm sizidutsa 30 mm.
Kukana kwa wodwalayo njira zina zochitira opaleshoni kapena kupezeka kwa ma contraindication kuti akwaniritse.

Zindikirani Njira zowunikira zingagwiritsidwe ntchito pochotsa zotsalira za chotupacho pambuyo pothandizidwa ndi opaleshoni yam'mbuyo. Itha kugwiritsidwanso ntchito pambuyo pa chithandizo chamankhwala cha radiation.

Kuchotsa kwa transnasal wa pituitary adenoma unachitika ngati chotupa chija chimangoyambika kupitirira chishalo cha Turkey. Ma neurosurgeon ena odziwa zambiri amagwiritsa ntchito njira ya neoplasms yayikulu.

Zizindikiro za craniotomy (ntchito ndi kutsegula chigaza) Zizindikiro izi ndi:

Kupezeka kwa masekondi am'mimba mu chotupa,
Kukula kwa asymmetric adenoma ndikukula kwake kupitirira chishalo cha Turkey.

Chifukwa chake, kutengera mtundu wofikira, opaleshoni yochotsa mankhwalawa kuti ichotse pituitary adenoma imatha kuchitidwa transcranial (pakutsegula chigaza) kapena transnasal (kudzera pamphuno). Pankhani ya radiotherapy, machitidwe ngati cyber-mpeni amakulolani kuti muziyang'ana radiation mosamala pa chotupacho ndikukwaniritsa kuchotsa kwake kosasokoneza.

Kuchotsa kwa transnasal wa pituitary adenoma

Opaleshoni yotere nthawi zambiri imachitidwa pansi pa opaleshoni yanyumba. Dokotala wa opaleshoni amaika endoscope mu mphuno - chida chosinthika ngati chubu chopangidwa ndi kamera. Itha kuyikidwa m'mphuno limodzi kapena onse awiri kutengera ndi chotupa. Dongosolo lake silidutsa 4 mm. Dokotala amawona chithunzichi. Kuchotsa kwa endoscopic kwa pituitary adenoma kumatha kuchepetsa kuwonongeka kwa ntchito, ndikukhalabe ndi mwayi wokhala ndikuyerekeza kwathunthu.

Zitatha izi, dokotalayo adalekanitsa nembanemba ndikumveketsa fupa la sinus yakunja. Pobowola chimagwiritsidwa ntchito pofika pachisoni cha ku Turkey. Septum mu sinus yakunja imadulidwa. Wopanga opaleshoni amatha kuwona pansi pa chishalo cha Turkey, chomwe chimayikidwa pansi pang'onopang'ono (dzenje limapangidwa mmenemo). Kuchotsa mbali zosiyanasiyana za chotupacho kumachitika.

Zitatha izi, magazi amaleka. Kuti muchite izi, gwiritsani ntchito thonje lomwe limasungunuka ndi hydrogen peroxide, masiponji apadera ndi mbale, kapena njira yamagetsi (yosindikiza) mwa kuwononga pang'ono mapuloteni oyambira.

Potsatira, dokotalayo amasindikiza chishalo cha Turkey. Mwa izi, zimakhala ndi guluu la wodwala zimagwiritsidwa ntchito, mwachitsanzo, mtundu wa Tissucol. Pambuyo pa endoscopy, wodwalayo amatha kuyambira masiku 2 mpaka 4 kuchipatala.

Craniotomy

njira yolowera mu ubongo ndi craniotomy

Kufikira kutha kuchitika kutsogolo (mwakutsegulira mafupa a chigaza) kapena pansi pa mafupa akakanthawi, kutengera malo omwe chotupacho ndi chotupa. Mtundu woyenera wa ntchito ndi malo mbali. Zimalepheretsa kupanikizika kwamitsempha yamitsempha yam'mimba ndi mitsempha yomwe imapereka magazi ku ubongo. Njira ina ndi malo apamwamba ndi mutu wake. Mutu pawokha ndi wokhazikika.

Opaleshoniyo nthawi zambiri imagwiritsidwa ntchito pochita opaleshoni. Namwino amameta tsitsi pamalo omwe anachitidwa opaleshoniyo, nkumuchotsa. Dokotala amafufuza kuchuluka kwa zida ndi ziwiya zofunika, zomwe amayesera kuti asazigwire. Pambuyo pake, amadula minofu yofewa ndikudula mafupawo.

Pa opaleshoni, adokotala amavala magalasi okulitsa, omwe amalola kupenda mwatsatanetsatane magawo onse amitsempha ndi mitsempha yamagazi. Pansi pa chigaza pali chomwe chimatchedwa dura mater, chomwe chimafunanso kudulidwa kuti ifike pakatundu kakang'ono ka pituitary. Adenoma yomweyo imachotsedwa pogwiritsa ntchito katswiri wothandizira kapena wamagetsi wamagetsi. Nthawi zina chotupa chimayenera kuchotsedwa limodzi ndi chithito chifukwa cha kumera kwake mkati mwa minofu yathanzi. Pambuyo pake, dokotala wochita opaleshoniyo amabwezeretsa mafupawo m'malo mwake ndikusokonekera.

Pambuyo pakuchitika kwa opaleshoni, wodwalayo amayenera kugona tsiku linanso mosamala kwambiri, komwe mawonekedwe ake amayang'aniridwa mosamala. Kenako adzatumizidwa ku wodi yonse, nthawi yayitali yogonekedwa m'chipatala ndi masiku 7-10.

Mawailesi

Kulondola kwa njirayi ndi 0.5 mm. Izi zimakupatsani mwayi woloza adenoma popanda kunyengerera minofu yoyanjana yozungulira. Zochita ngati chipangizo cha cyber sichimadziwika. Wodwalayo amapita kuchipatala ndipo pambuyo pa mndandanda wa MRI / CT, chithunzi cholondola cha 3D cha chotupacho chimapangidwa, chomwe chimagwiritsidwa ntchito ndi kompyuta kulemba pulogalamu ya loboti.

Wodwalayo amaikidwa pabedi, thupi lake ndi mutu zimakhazikika kuti zisamayende mwangozi. Chipangizocho chimagwira ntchito kutali, chimatulutsa mafunde ndendende komwe kuli adenoma. Wodwala, monga ulamuliro, samakumana ndi zopweteka. Kugonekedwa kuchipatala pogwiritsa ntchito kachitidwe sikunawonetsedwa. Patsiku la opareshoni, wodwalayo amatha kupita kwawo.

Mitundu yamakono kwambiri imakulolani kuti musinthe kolowera kutengera njira iliyonse, ngakhale kayendedwe kakang'ono kwambiri ka wodwalayo. Izi zimapewa kukonzekera komanso zovuta zomwe zimagwirizana.

Zotsatira za opaleshoni ndi zovuta

Malinga ndi a B. M. Nikifirova ndi D. E. Matsko (2003, St. Petersburg), kugwiritsa ntchito njira zamakono kumathandiza kuchotsetsa chotupacho m'maperesenti 77 mwa milandu. Mu 67% ya mawonekedwe a wodwala amabwezeretsedwa, mu 23% - endocrine. Imfa chifukwa cha opareshoni yochotsa pituitary adenoma imachitika mu 5.3% ya milandu. 13% ya odwala ayambiranso matendawa.

Kutsatira njira zachikhalidwe zopangira opaleshoni ndi endoscopic, zotsatirazi ndizotheka:

Zowonongeka chifukwa cha kuwonongeka kwa mitsempha.
Kupuma.
Kutha kwa madzimadzi a cerebrospinal (madzi a cerebrospinal).
Meningitis chifukwa cha matenda.

Ndemanga za Odwala

Okhala m'mizinda yayikulu (Moscow, St. Petersburg, Novosibirsk) omwe adakumana ndi pituitary adenoma akuti mulingo wazithandizo zamatendawa ku Russia pakadali pano siwotsika poyerekeza ndi akunja. Zipatala ndi malo opangira ma oncology ali ndi zida zambiri, ntchito zimachitika pa zida zamakono.

Komabe, odwala ndi abale awo akulangizidwa kuti asathamangire kuchita opareshoni. Zochitika za odwala ambiri zimawonetsa kuti choyamba muyenera kuyesedwa mokwanira, kufunsa akatswiri angapo (endocrinologist, neurologist, oncologist), ochiritsa matenda onse. Kuopsa kwa chotupa kwa wodwala kuyenera kutsimikiziridwa mosatsimikiza. Nthawi zambiri, kuwunikira kwamphamvu kwamachitidwe a neoplasia kumalimbikitsidwa.

Odwala azindikira mu malingaliro awo kuti kuzindikira kwa nthawi yake kwakhala kofunikira pakuthandizira. Ngakhale ambiri kwanthawi yayitali sanasamale za kusokonezeka kwa mahomoni komwe kumawasokoneza, atatembenukira kwa akatswiri, adalandira mwachangu kutumizidwa kwa MRI / CT, zomwe zidapangitsa kuti azitha kupereka upangiri mwachangu pazamankhwala.

Si odwala onse, ngakhale madokotala akuyesetsa, kuthana ndi matendawa. Nthawi zina matenda a wodwalayo amawipira, ndipo chotupacho chimakulanso. Zimakhumudwitsa wodwala, nthawi zambiri amakhala ndi nkhawa, nkhawa komanso nkhawa. Zizindikiro zoterezi ndizofunikanso ndipo zimatha kukhala chifukwa cha chithandizo cha mahomoni kapena chotupa. Ayenera kukumbukiridwa ndi endocrinologist ndi neurologist.

Mtengo wogwira

Mukakumana ndi achipatala a boma, wodwalayo amachitidwa opaleshoni yaulere. Poterepa, ndi ma craniotomy okha kapena opaleshoni yokhala ndi transnasal access yomwe ingatheke. Dongosolo la CyberKnife limapezeka makamaka m'makliniki azinsinsi. Za zipatala za boma, zimagwiritsidwa ntchito ndi N. N. Burdenko Research Institute of Neurosurgery. Kwa chithandizo chaulere, muyenera kupeza kuchuluka kwa boma, komwe sikungachitike ndi matenda a "adenoma".

Mukamaganiza zogwiritsa ntchito ntchito zolipira, muyenera kukonzekera kulipira pakati pa 60-70 rubles kuti muchite opareshoni. Nthawi zina mumayenera kulipira zowonjezera kuti mukhale kuchipatala padera (kuchokera ku ma ruble 1000 patsiku). Komanso, nthawi zina, mankhwala oletsa kuphatikizira sawonjezedwa pamtengo. Mitengo ya ogwiritsa ntchito pa cyberknives imayamba ku ruble 90,000.

Kuchotsa pituitary adenoma ndi opareshoni yabwino, mphamvu yake yomwe imakhala yapamwamba pakuwunika matendawa. Popeza chotupacho sichikhala ndi matchulidwe nthawi zonse, muyenera kuyang'anira thanzi lanu ndikuyang'anira zizindikiro zazing'ono ngati kukodza pafupipafupi, kupweteka kwamutu kwakanthawi, komanso kuona kwakanthawi popanda chifukwa. Ma neurosurgery amakono ku Russia amalola ngakhale ntchito zovuta kuubongo kuti zizichitidwa ndi chiopsezo chochepa cha zovuta.

Chowopsa choperewera pamsewu

Chifukwa cha kuwonongeka kwa mtima pamalo opangira opaleshoni, kusokonezeka kwakutali kwa hemodynamic kumachitika. Amayambitsa kuphipha kapena kufinya kwam'mitsempha yamagama ya Willis. Odwala amapeza zisonyezo zosakhazikika za kukoka, kupanikizika, kutentha, kugwidwa, malankhulidwe ndi mitsempha. Odwala amasamutsidwa kudipatimenti yamitsempha mpaka kufalikira kwamitsempha.

Mavuto atachotsedwa chotupa

Kuchulukana kwamavuto pambuyo pakuchita opaleshoni kumalumikizidwa ndi kukula kwa chotupa, kuchuluka kwa magwiridwe ake antchito (mapangidwe a mahomoni), ndikufalikira. Chovuta kwambiri kulekerera kuchotsedwa kwa odwala omwe matendawa adapezeka kumapeto.

Adenoma wawo kwa nthawi yayitali amakula kwambiri ndikufinya minofu yoyandikana nayo, kupanga ma mahomoni mwamphamvu, kulowa mkati mwa nyumba zoyandikana.

Zikatero, kuchuluka kwa opareshoni kumawonjezeka, komwe kungayambitse kuwonongeka kwa pafupi ndi kutali kwambiri ndi maubongo. Mu gululi, kuthekera kwamavuto ndi zotsatira zoyipa ndizokwera.

Kutaya fungo

Kuwonongeka kwa fungo kumatha chifukwa cha kuwonongeka kwa zolakwika m'mitsempha ya m'mphuno ndikuchotsa chotupa. Vutoli limawonedwa ngati lalifupi, nthawi zambiri kuchira kumachitika ngati mucous membrane amachiritsa kwa mwezi umodzi.

Mkhalidwe wowopsa kwambiri womwe ungachitike ngati mphamvu yochepa ya kununkhira ili gawo la kuchepa kwa mahomoni a pituitary - panhypopituitarism. Imachitika chifukwa cha kupanikizika kwa ziwalo zomwe zikula ndi adenoma.

Komanso, matenda amtunduwu amachitika pakuchiritsa kwa radiation, komwe kumafunika ndikuchotsa kwathunthu zotupa zazikulu. Odwala oterowo, nthawi yokhala ngati fungo limakhala lalitali. Kuchita bwino kwake kumatengera chithandizo chamankhwala cha mahomoni.

Matenda a shuga

Panthawi ya vuto lotupa la vasopressin yotsekedwa ndi thumbo lachiberekero, vuto lotchedwa shuga insipidus limayamba mwa odwala. Ndi matendawa, pali ludzu losatha, ndipo kuchuluka kwa mkodzo wotulutsidwa kumatha kufika malita 5-20 patsiku. Wodwala sangathe kuchita popanda madzimadzi kwa mphindi zoposa 30.

Chifukwa cha malo a pituitary gland, kuphatikizika uku kumakhala kofala kwambiri ndikuchotsa chotupa. Mwa chithandizo chake, pali analog yopanga ya vasopressin mwanjira ya madontho kapena kutsitsi lammphuno.

Mutu

Mutu umadziwika kuti ndi chimodzi mwazizindikiro zowonjezera pituitary adenoma. Pambuyo pakuchita opareshoni, chizindikirocho chimazimiririka pang'onopang'ono. Kuthamanga kwa njirayi kumadalira kukula koyamba kwa chotupacho komanso mkhalidwe wa kufalikira kwa ubongo

Zinapezeka kuti mkati mwa mwezi woyamba kuchepa kwakukulu kwa mutu kumadziwika mu zosakwana theka la opareshoni. Odwala ambiri amafunika miyezi itatu kapena isanu. Ndi kupweteka kosalekeza, kuwonjezeranso kuyenera kuchitika.

Mutu umadziwika kuti ndi chimodzi mwazizindikiro zowonjezera pituitary adenoma

MRI atachotsa pituitary adenoma

Pazowona zotupa zam'mimba, njira ya MRI imadziwika kuti ndiyo yodalirika kwambiri. Komanso zimakupatsani mwayi wofufuza momwe adenoma amakhudzira minofu yoyandikana nayo. Kuti muwonjezere kulondola, imayikidwa pamodzi ndi kuyambitsa sing'anga. Adenomas amatha kuzikundikira, zomwe zimawonetsedwa mu tomography.

Pambuyo pa opaleshoni, diagnostic amagwiritsidwa ntchito poyesa kuchuluka kwa chotupa, kufunikira kwa chithandizo cha radiation, komanso zizindikiro za zovuta zamankhwala opaleshoni. Kuti mayesowo akhale ndi phindu lofufuza, liyenera kuchitika pa chipangizo champhamvu champhamvu champhamvu cha osachepera 1 T.

Chithandizo cha mavuto

Kuphatikiza pa MRI, odwala amafunikira kuti aphunzire mahomoni azinthu zomwe zimayendetsa:

thyrotropin ndi thyroxine,
adrenocorticotropic timadzi ndi 17-hydroxyketosteroids, cortisol,
follicle-zolimbikitsa ndi luteinizing, prolactin,
somatomedin (kapena kukula kwa insulin monga IRF1),
testosterone ndi estrogen.

Kutengera ndi zotsatira za kupezeka kwa matendawa, kulandira chithandizo chamankhwala kumalembedwa - mahomoni a chithokomiro (Eutirox), mahomoni opanga kukula (kwa ana), mankhwala a mahomoni ogonana amuna ndi akazi. Pankhani ya kuchepa kwa adrenal, prednisone ndi hydrocortisone amasonyezedwa. Matenda a shuga a insipidus amawongoleredwa ndi Desmoproessin. Pankhani ya ngozi ya cerebrovascular, ma mtima ndi ma neuroprotectors amalumikizidwa ku chithandizo.

Ndipo izi ndizambiri zokhudzana ndi opaleshoni yoperekera poyizoni.

Opaleshoni yochotsa pituitary adenoma imatha kutsagana ndi zovuta mu nthawi ya postoperative. Chiwopsezo chawo chikuwonjezeka mwa okalamba komanso ndi zotupa zazikulu. Pali zosokoneza pakuyenda kwa ziwalo, kuwonongeka kwa ma hypothalamus oyandikana ndi ziwalo zomwe gland imalamulira.

Kuti muwone zoyipa za opaleshoni, MRI ndi kuyesa kwa magazi kwa mahomoni kumayikidwa. Chithandizo chimachitika ndikusintha kuchepa kwa mahomoni ndi ma analogi opangira.

Kanema wothandiza

Wonerani vidiyo yokhudza chotupa cha pituitary:

Ndizovuta kudziwa hypothyroidism, ndi dokotala wodziwa yekha yemwe angazindikire zizindikiritso ndi chithandizo. Ndiwachiphamaso, chofunda, nthawi zambiri chobisika mpaka pamlingo wina. Mwachitsanzo, mwa azimayi amatha kuzindikirika pambuyo pobadwa, mwa amuna atachitidwa opaleshoni, kuvulala kwambiri.

Ngati kachilombo kamene kamakula mofulumira kakuyamba kupezeka, ndiye kuti mukuyenera kuyeseza zabwino ndi zochotsa, chifukwa zotsatira zake zimakhala zazikulu. Zizindikiro zothandizira pakuchita opareshoni ndikuchepa kwa mayankho a chithokomiro. Pambuyo kuyambiranso kumachitika.

Ngati mukupeza mankhwala oopsa, opaleshoni imakhala mwayi wopulumutsa moyo. Opaleshoni yamkati pa chithokomiro cha chithokomiro imatha kuchitika, ndipo imatha kukhala yovuta kwambiri. Koma mulimonsemo, kuchira pambuyo pamafunika.

Subclinical toxicosis imapezeka makamaka m'malo osavomerezeka malinga ndi ayodini. Zizindikiro zake mwa amayi, kuphatikiza pa nthawi yoyembekezera, zimapaka mafuta. Ndi nthawi zosakhazikika zokha zomwe zingawonetse vuto la kulowera kwam'mutu.

Kuzindikira kwathunthu matenda a chithokomiro kumaphatikizapo njira zingapo - ultrasound, labotale, masiyanidwe, morphological, cytological, radiation. Pali mawonekedwe a mayeso mu amayi ndi ana.

Epidemiology: zoyambitsa, zochitika

Chomwe chimalimbikitsa chitukuko cha chotupa cha pituitary sichinadziwikebe, chifukwa chake, chidali chinthu chachikulu chofufuzira. Malinga ndi zifukwa zotheka, akatswiri okha mitundu yamawu:

kuvulala kwamtopola
ubongo neuroinawon
zizolowezi
mimba katatu kapena kuposerapo,
cholowa
kumwa mankhwala a mahomoni (mwachitsanzo, njira zakulera),
kupsinjika kwakanthawi
matenda oopsa,

Neoplasm siosowa kwambiri, momwe mawonekedwe onse amtundu waubongo amakhala chifukwa cha 12.3% -20% ya milandu. Pafupipafupi mwadzidzidzi, imatenga malo a 3 pakati pa neuroectodermal neoplasias, yachiwiri kokha kwa zotupa za glial ndi meningiomas. Matendawa nthawi zambiri amakhala achilengedwe. Komabe, ziwerengero zamankhwala zalemba zambiri pazochitika zodetsa nkhawa za kusintha kwa adenoma ndikupanga kwachiwiri kwa (ma metastases) mu ubongo.

Njira ya pathological imakonda kupezeka mwa akazi (pafupifupi kawiri) kuposa amuna. Chotsatira, timapereka deta yakugawika kwa mibadwo kutengera 100% ya odwala omwe adatsimikiziridwa ndi matenda. Mliri wa matenda opatsirana umapezeka wazaka 35-40 (mpaka 40%), wazaka 30-35, matendawa amapezeka ndi 25% ya odwala, wazaka 40-50 wazaka - 25%, 18-35 ndi wamkulu kuposa zaka 50 - 5% pa aliyense gulu.

Malinga ndi ziwerengero, pafupifupi 40% ya odwala ali ndi chotupa chogwiritsa ntchito chomwe sichimapanga kuchuluka kwa mahomoni ndipo sichimakhudza gawo la endocrine. Pafupifupi 60% ya odwala amatsimikiza mawonekedwe omwe amasiyanitsidwa ndi hypersecretion yamahomoni. Pafupifupi 30% ya anthu amakhala olumala chifukwa cha zovuta za pituitary adenoma.

Gulu la pituitary adenomas a ubongo

Chowunikachi chimayang'ana mu gawo lakumaso kwa gland (mu adenohypophysis), yomwe imapanga kuchuluka kwa chiwalo (70%). Matendawa amakula pomwe khungu limodzi limasinthasintha, chifukwa, limasiya kuyang'anitsitsa kwa chitetezo cha mthupi ndipo limayamba kugonja. Pambuyo pake, mwakugawika mobwerezabwereza kwa progenitor cell, kumakula kukula, komwe kumakhala gulu la maselo ofanana (monoclonal). Awa ndi adenoma, uku ndi njira yotukukira pafupipafupi kwambiri. Komabe, nthawi zina, chidwi chimatha kuchokera ku cell imodzi, kenako nkuyambiranso.

Mawonekedwe a pathological amasiyanitsidwa ndi zochitika, kukula, mbiri, momwe amagawidwira, mtundu wa mahomoni obisika. Tapeza kale kuti pali mitundu yanji ya ma adenomas, yogwira mahomoni komanso mahomoni ofooka. Kukula kwa minofu yowonongeka kumadziwika ndi gawo laukali: chotupa chimatha kukhala chosakhala chaukali (chaching'ono komanso chosakonda kuwonjezeka) komanso chankhanza chikakhala chachikulu ndikuwukira nyumba zoyandikana (mitsempha, mitsempha, nthambi zamitsempha, ndi zina).

Yaikulu adenoma atachotsedwa.

Ma adenomas akuluakulu a pituitary adenomas a GM ndi amitundu:

microadenomas (ochepera masentimita awiri),
mesadenomas (1-3 cm),
chachikulu (3-6 cm),
Giant adenomas (wamkulu kuposa 6 cm kukula).

AGGM pa magawidwe agawidwa:

endosellar (mkati mwa pituitary fossa),
endo-extrasellar (ndi kupitirira zopyola pazisoni), zomwe zimagaidwa:

► suprasellar - munthawi yamkati,

► pambuyo pake - m'malo osanja kapena pansi pamatope,

► infrasellar - ikulirani mpaka ku sphenoid sinus / nasopharynx,

► ma antesellar - zimakhudzana ndi labyrinth ya ethmoid ndi / kapena orbit,

► retrocellularly - mu posterior cranial fossa ndi / kapena pansi pa Blumenbach stingray.

Malinga ndi umboni wa mbiriyakale, adenomas amapatsidwa mayina otsatirawa:

Chromophobic - neoplasia yopangidwa ndi maselo otumbululuka, ophatikizika ndi adenohypophysial ma chromophobes (mtundu wamba woimiridwa ndi NAG),
acidophilic (eosinophilic) - zotupa zopangidwa ndi maselo a alpha okhala ndi zida zopangidwa mwaluso,
basophilic (mucoid) - mapangidwe a neoplastic omwe amapanga kuchokera ku basophilic (beta cell) adenocytes (chotupa chosowa kwambiri).

Pakati pa adenomas omwe amagwira ntchito pama cell, pali:

prolactinomas - mwachangu prolactin (mtundu wamba),
somatotropinomas - ochulukitsa kupanga somatotropin timadzi,
- corticotropinomas - imalimbikitsa kupanga adrenocorticotropin,
- gonadotropinomas - phatikizani kaphatikizidwe ka chorionic gonadotropin,
- thyrotropinomas - perekani kutulutsidwa kwakukulu kwa TSH, kapena mahomoni olimbikitsa a chithokomiro.
- kuphatikiza (polyhormonal) - chinsinsi kuchokera ku mahomoni awiri kapena angapo.

Mawonetseredwe a kanyama a chotupacho

Zizindikiro zambiri za odwala, monga iwonso amatsimikizira, poyamba sizitengedwa mozama. Matenda nthawi zambiri amakhudzidwa ndi ntchito yoletsedwa kapena, mwachitsanzo, kupanikizika. Inde, mawonetsedwe amatha kukhala osazindikirika ndikuphimbidwa kwa nthawi yayitali - zaka 2-3 kapena kupitirira. Dziwani kuti mawonekedwe ndi kukula kwa zizindikiro zimatengera kuchuluka kwa kupsa mtima, mtundu, malo, kuchuluka kwake, ndi zina zambiri za adenoma. Chipatala cha neoplasm chili ndi magulu atatu a zisonyezo.

Zizindikiro za Neurological:

mutu (ambiri amadwala),
kusokoneza kutulutsa kwa minofu ya maso, komwe kumayambitsa matenda a oculomotor,
kupweteka m'mphepete mwa nthambi zamitsempha yamagalamu atatu,
Zizindikiro za hypothalomic syndrome (kusintha kwa VSD, kusalingalira bwino m'maganizo, mavuto a kukumbukira, kukonza amnesia, kusowa tulo, kusokonekera kwa zinthu zina, ndi zina zotere),
mawonetseredwe a occlusal-hydrocephalic syndrome chifukwa cha blockage ofbrbrinalinal fluid yotuluka pamlingo wotseguka kwapakati (chikumbumtima champhamvu, kugona, kugunda mutu ndikasuntha mutu, etc.).

Ophthalmic Zizindikiro za neural mtundu:

kusiyanasiyana koonekera pakubwera kwa diso limodzi kuchokera pa linzake,
kuwonongeka pang'onopang'ono kwa masomphenya
kutha kwa minda yakumaso m'maso onse,
kutayika kwa gawo lamasamba am'mphuno kapena kwakanthawi,
kusintha kwa atrophic mu fundus (wozindikira ndi ophthalmologist).

Mawonetseredwe a Endocrine kutengera kapangidwe ka mahomoni:

hyperprolactinemia - excretion ya colostrum kuchokera pachifuwa, amenorrhea, oligomenorrhea, kusabereka, polycystic ovary, endometriosis, kuchepa kwa libido, kukula kwa tsitsi lakumimba, kuchotsa mimba mosadzipangitsa, abambo ali ndi vuto la potency, gynecomastia, kutsika kwa umuna wapakati, etc.
hypersomatotropism - kuchuluka kukula kwa zigawo zam'mphepete zam'mphepete zam'mphepete, mphuno, nsagwada ya m'munsi, masaya kapena ziwalo zamkati, kutha mphamvu ndi kuphatikizika kwa mawu, minyewa ya misempha, kusintha kwa mafupa, mafinya, zina,.
Itsenko-Cushing's syndrome (hypercorticism) - kunenepa kwambiri, matenda amkati, mafupa, mafupa a msana ndi nthiti, kusowa kwa ziwalo zoberekera, matenda oopsa, pyelonephritis, striae, immunodeficiency, encephalopathy,
Zizindikiro za hyperthyroidism - kuchuluka kwa mkwiyo, kugona osagona, nkhawa zosinthika ndi nkhawa, kuchepa thupi, manja akunjenjemera, hyperhidrosis, kusokonezeka kwa mtima wanu, kuda kwambiri, matumbo.

Pafupifupi 50% ya anthu omwe ali ndi pituitary adenoma ali ndi matenda a shuga. 56% amadziwika kuti ataya ntchito. Pafupifupi aliyense amakhala ndi zomwe ubongo umakumana nazo mu ubongo: mutu (woposa 80%), kusokonezeka kwa mitsempha, metabolic, matenda amtima.

Njira zodziwira matenda amisempha

Akatswiri amatsatira njira imodzi yodziwitsira munthu yomwe akuganiza kuti wapezeka ndi izi, yomwe imapereka:

kuyesedwa ndi katswiri wa zamitsempha, endocrinologist, Optometrist, Dokotala wa ENT,
mayeso a labotale - kuyezetsa magazi ndi mkodzo kambiri, kuyesa kwa magazi, kuyesa kwa shuga ndi kuchuluka kwa mahomoni (prolactin, IGF-1, corticotropin, TTG-T3-T4, hydrocortisone, mahomoni achimuna ndi amuna).
kupenda kwamtima pa zida za ECG, ma ultrasound a ziwalo zamkati,
kuyesa kwa ultrasound kwa ziwiya zam'mitsempha ya m'munsi,
X-ray yamafupa a chigaza (craniography),
computer tomography yaubongo, nthawi zina pamakhala kufunikira kowonjezereka kwa MRI.

Dziwani kuti kufunikira kwa kusonkhanitsa ndi kuphunzira kwachilengedwe kwa mahomoni ndikuti palibe zotsimikizira zomwe zimachitika mutawunika koyamba. Pa kudalirika kwa chithunzi cha mahormoni, kuwunika mu mphamvu ndikofunikira, ndiye kuti, zidzakhala zofunikira kupereka magazi kuti mufufuze kangapo ndi kangapo.

Mfundo zakuchiritsa matenda

Nthawi yomweyo pezani, pofufuza, wodwalayo amafunikira chithandizo chamankhwala chofunikira kwambiri ndikuwonetsetsa nthawi zonse. Chifukwa chake, simukuyenera kudalira mlanduwo, poganiza kuti chotupacho chithetsa ndipo zonse zitha. Makutu sangathe kukhazikika! Pakusowa chithandizo chokwanira, ngoziyo imakhala yayikulu kwambiri kuti ikhale yolumala yomwe singasinthe, mabvuto amunthu omwe amadza chifukwa chotsatira amayambikanso.

Kutengera ndi kuopsa kwa chithunzi chachipatalachi, odwala amalimbikitsidwa kuti athetse vutoli pochita opaleshoni kapena / ndi njira zosasamala. Njira zoyambira zazitsamba zimaphatikizapo:

mitsempha - Kuchotsa kwa adenoma mwa kupyola kwa transnasal (kudzera pamphuno) poyang'aniridwa ndi endoscopic kapena mwa njira yopatsirana (craniotomy yodziwika kutsogolo imachitidwa) motsogozedwa ndi fluoroscope ndi ma microscope,

90% ya odwala omwe amachitidwa opaleshoni ya transnasal, 10% amafunika transctanial ectomy. Luso lomaliza limagwiritsidwa ntchito pazotupa zazikulu (zopitilira 3 cm), kuchuluka kwa asymmetric kufalikira, kutuluka kunja kwa chisa, zotupa zokhala ndi masikono.

mankhwala - kugwiritsa ntchito mankhwala kuchokera kwa akatswiri angapo a dopamine receptor agonists, mankhwala okhala ndi peptide, mankhwala ogwiritsidwa ntchito pofuna kukonza mahomoni.
radiotherapy (radiation chithandizo) - proton tiba, chithandizo chakuthengo cha gamma kudzera mu kachitidwe ka Gamma Knife,
kuphatikiza mankhwala - Maphunzirowa aphatikiza zingapo mwazithandizo izi nthawi imodzi.

Dokotala atha, pakakhala kusokonezeka kwakukulu kwa mitsempha ndi ophthalmic ndi mahomoni osagwira mu chotupa, osagwiritsa ntchito opaleshoni, koma amalimbikitsa kuwunika munthu yemwe wapezeka ndi pituitary adenoma. Kuwongolera kwa wodwala kotereku kumachitika ndi neurosurgeon mogwirizana ndi endocrinologist ndi ophthalmologist. Wadi imayesedwa mwadongosolo (nthawi kawiri pachaka), imatumizidwa kuti ikawonetsetse MRI / CT, maso ndi mitsempha, muyezo wa mahomoni m'magazi. Mofanananso ndi izi, munthu amakumana ndi maphunziro othandizira olimbikitsa.

Popeza opaleshoni yolowerera ndi njira yotsogola yothandizira pituitary adenoma, timawunikira mwachidule njira ya opaleshoni ya opaleshoni ya endoscopic.

Opaleshoni yochotsa pituitary adenoma: ikafunika, khalani ndi zotsatira

The pituitary adenoma ndi chotupa cha chotupa tating'onoting'ono tomwe timakhala muubongo. Neoplasia imatha kupititsa patsogolo kupanga mahomoni ena ndikupangitsa wodwala kusokonezeka kwa madigiri osiyanasiyana, kapena kuti asadziwonetsere wokha. Chotupa nthawi zambiri chimadziwika pakompyuta kapena pakamayikidwe kamatsenga.

Kuchotsa kwa adenoma pituitary kumachitika ndi opaleshoni yakale, endoscopy kapena zotulutsa wailesi. Njira yotsirizirayi imadziwika kuti ndiyo yosamalira kwambiri, koma ili ndi zoletsa zingapo pa kukula ndi komwe chotupacho.

Kuchotsa chotupa cha pituitary sikuyenera kulangizidwa nthawi zonse, chifukwa chitha kutsagana ndi chiwopsezo chachikulu kuposa kupeza chotupa m'thupi. Kuphatikiza apo, ndi pituitary adenomas, chithandizo chokhazikika chimapereka bwino.

Opaleshoni ndikulimbikitsidwa pazizindikiro izi:

Chotupacho ndi mahomoni, i.e. amatulutsa mahomoni ambiri, zomwe zimakhala ndizowopsa kwa wodwala.
Adenoma imakakamiza minyewa ndi mitsempha yoyandikana, makamaka, zowoneka, zomwe zimapangitsa kuti khungu lizigwira ntchito.

Kugwiritsa ntchito ma radiyo odekha Zovomerezeka pazotsatirazi:

Mitsempha ya optic siyikhudzidwa.
Chotupa sichikulitsa kupitirira chishalo cha Turkey (kupangika mu pfupa la sphenoid, pakuzama komwe ma pituitary gland).
Chishalo cha ku Turkey chili ndi zazikulu kapena zazikulu kukula.
Adenoma imayendera limodzi ndi neuroendocrinal syndrome.
Kukula kwa neoplasm sizidutsa 30 mm.
Kukana kwa wodwalayo njira zina zochitira opaleshoni kapena kupezeka kwa ma contraindication kuti akwaniritse.

Zizindikiro za craniotomy (ntchito ndi kutsegula chigaza) Zizindikiro izi ndi:

Kupezeka kwa masekondi am'mimba mu chotupa,
Kukula kwa asymmetric adenoma ndikukula kwake kupitirira chishalo cha Turkey.

Chifukwa chake, kutengera mtundu wofikira, opaleshoni yochotsa mankhwalawa kuti ichotse pituitary adenoma imatha kuchitidwa transcranial (pakutsegula chigaza) kapena transnasal (kudzera pamphuno). Pankhani ya radiotherapy, machitidwe ngati cyber-mpeni amakulolani kuti muziyang'ana radiation mosamala pa chotupacho ndikukwaniritsa kuchotsa kwake kosasokoneza.

Zitatha izi, magazi amaleka. Kuti muchite izi, gwiritsani ntchito thonje lomwe limasungunuka ndi hydrogen peroxide, masiponji apadera ndi mbale, kapena njira yamagetsi yamagetsi (yosindikiza) mwa kuwononga pang'ono mapuloteni oyikira.

njira yolowera mu ubongo ndi craniotomy

Kutsatira njira zachikhalidwe zopangira opaleshoni ndi endoscopic, zotsatirazi ndizotheka:

Zowonongeka chifukwa cha kuwonongeka kwa mitsempha.
Kupuma.
Kutha kwa madzimadzi a cerebrospinal (madzi a cerebrospinal).
Meningitis chifukwa cha matenda.

Okhala m'mizinda yayikulu (Moscow, St. Petersburg, Novosibirsk) omwe adakumana ndi pituitary adenoma akuti mulingo wazithandizo zamatendawa ku Russia pakadali pano siwotsika poyerekeza ndi akunja. Zipatala ndi malo opangira ma oncology ali ndi zida zambiri, ntchito zimachitika pa zida zamakono.

Mukakumana ndi achipatala a boma, wodwalayo amachitidwa opaleshoni yaulere. Poterepa, ndi ma craniotomy okha kapena opaleshoni yokhala ndi transnasal access yomwe ingatheke. Dongosolo la CyberKnife limapezeka makamaka m'makliniki azinsinsi. Za zipatala za boma, zimagwiritsidwa ntchito ndi N. N. Burdenko Research Institute of Neurosurgery. Kwa chithandizo chaulere, muyenera kupeza kuchuluka kwa boma, komwe sikungakhale ndi matenda a "adenoma".

Kanema: Malingaliro a akatswiri pa mankhwalawa pituitary adenoma

Opaleshoni yochotsa pituitary adenoma: ikafunika, khalani ndi zotsatira

Pituitary adenoma ndi chotupa chaching'ono cha tinthu timene timakhala muubongo. Neoplasia imatha kupititsa patsogolo kupanga mahomoni ena ndikupangitsa wodwalayo kusokonezeka kwa madigiri osiyanasiyana, kapena osadziwonetsa konse. Chotupa nthawi zambiri chimadziwika pakompyuta kapena pakamayikidwe kamatsenga.

Kuchotsa chotupa cha pituitary sikuyenera kulangizidwa nthawi zonse, chifukwa chitha kutsagana ndi chiwopsezo chachikulu kuposa kupeza chotupa m'thupi.Kuphatikiza apo, ndi pituitary adenomas, chithandizo chokhazikika chimapereka bwino.

Opaleshoni ndikulimbikitsidwa pazizindikiro izi:

Chotupacho ndi mahomoni, i.e. amatulutsa mahomoni ambiri, zomwe zimakhala ndizowopsa kwa wodwala.
Adenoma imakakamiza minyewa ndi mitsempha yoyandikana, makamaka, zowoneka, zomwe zimapangitsa kuti khungu lizigwira ntchito.

Kugwiritsa ntchito ma radiyo odekha Zovomerezeka pazotsatirazi:

Mitsempha ya optic siyikhudzidwa.
Chotupa sichikulitsa kupitirira chishalo cha Turkey (kupangika mu pfupa la sphenoid, pakuzama komwe ma pituitary gland).
Chishalo cha ku Turkey chili ndi zazikulu kapena zazikulu kukula.
Adenoma imayendera limodzi ndi neuroendocrinal syndrome.
Kukula kwa neoplasm sizidutsa 30 mm.
Kukana kwa wodwalayo njira zina zochitira opaleshoni kapena kupezeka kwa ma contraindication kuti akwaniritse.

Zizindikiro za craniotomy (ntchito ndi kutsegula chigaza) Zizindikiro izi ndi:

Kupezeka kwa masekondi am'mimba mu chotupa,
Kukula kwa asymmetric adenoma ndikukula kwake kupitirira chishalo cha Turkey.

njira yolowera mu ubongo ndi craniotomy

Kutsatira njira zachikhalidwe zopangira opaleshoni ndi endoscopic, zotsatirazi ndizotheka:

Zowonongeka chifukwa cha kuwonongeka kwa mitsempha.
Kupuma.
Kutha kwa madzimadzi a cerebrospinal (madzi a cerebrospinal).
Meningitis chifukwa cha matenda.

Kanema: Malingaliro a akatswiri pa mankhwalawa pituitary adenoma

Clinical endocrinology / Yosintha ndi E.A. Kuzizira. - M: Medical News Agency, 2011. - 736 c.
Chithandizo cha matenda a endocrine mwa ana, Perm Book Publishing House - M., 2013. - 276 p.
Matenda a Okorokov A.N. Matenda a ziwalo zamkati. Gawo 4. Kuzindikira matenda am'magazi, Mabuku azachipatala - M., 2011. - 504 c.

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.

Nkhani Zina:

Carbohydrate kagayidwe pambuyo pochotsa pituitary gland sasintha pang'ono. Pali kuchepa pang'ono pokha kwa kusala kudya kwa magazi, kuzama kwa gawo la hypoglycemic pambuyo poti katundu wa carbohydrate, kumva kwa insulin kumakulitsidwa pang'ono. Odwala omwe ali ndi matenda a shuga a mellitus, atachotsa gland planditary, kufunika kwa insulin kumachepetsedwa kwambiri. Izi siziri chifukwa cha kutayika kwa ntchito ya adrenocorticotropic ya pituitary gland, chifukwa kuchuluka kwa chidwi cha insulin kumapitirira kwa odwala omwe amalandila cortisone, koma kusiya kwadzimadzi pobzala kukula kwa adenohypophysis.

Kukhazikitsidwa kwa odwala matenda a shuga ndi matenda am'kati mwa kukula kwa timadzi timene timatulutsa.

Kutha kuchiritsa mabala ndi kuwonongeka kwa odwala omwe ali ndi pituitary gland kuchotsa kumatsalira. Palibe kusintha mu kagayidwe kake ka calcium ndi phosphorous. Kulemera kwa thupi sikusintha kwenikweni, ngakhale kuli kwina kuti amakonda kulemera.

Opaleshoni ya transnasal kuchotsa pituitary adenoma ya ubongo

Izi ndi njira zowononga zachilengedwe zomwe sizifuna craniotomy ndipo sizisiya zolakwika zilizonse zodzikongoletsera. Amachitidwa nthawi zambiri pansi pa opaleshoni yakumaloko; endoscope ndiye chida chachikulu cha opaleshoni. Ma neurosurgeon kudzera pamphuno pogwiritsa ntchito chipangizo chowongolera amachotsa chotupa muubongo. Kodi zimachitika bwanji?

Wodwalayo amakhala m'malo okhala kapena theka atakhala munthawi ya njirayi. Chubu yopyapyala ya endoscope (yoposa 4 mm m'mimba mwake), yokhala ndi kamera ya kanema kumapeto, imayikidwa mosamala mumkono wammphuno.
Chithunzi cha nthawi yeniyeni yazowongolera ndi zoyandikana nazo zidzatumizidwa kwa owunikira. Pamene kafukufuku wa endoscopic akupita patsogolo, dokotala wa opaleshoniyo amapanga mndandanda wambiri wotsatira kuti afike pagawo laubongo lokhala ndi chidwi.
Choyamba, mucosa wammphuno umasiyanitsidwa kuti udzutse ndi kutsegula khoma lakutsogolo. Kenako septum yopyapyala imadulidwa. Kumbuyo kwake ndi chinthu chomwe mukufuna - chishalo cha ku Turkey. Bowo laling'ono limapangidwa pansi pa chisa cha Turkey polekanitsa kachidutswa kakang'ono ka fupa.
Kupitilira apo, mothandizidwa ndi zida zowonera maikulosikopu zomwe zimayikidwa mu endoscope chuanji, minyewa ya m'magazi imapangidwa pang'onopang'ono kudzera muupangiri wopanga mpaka opaleshoniyo itachotsedwa kwathunthu.
Pamapeto omaliza, dzenje lomwe limapangidwa pansi pa chishalo limatsekeka ndi chidutswa cha mafupa, chomwe chimakhazikika ndi guluu wapadera. Ndime zamkamwa zimathandizidwa bwino ndi antiseptics, koma osapumira.

Wodwalayo adamulowetsa kumayambiriro - kale pa tsiku loyamba pambuyo pa zovuta zaurouroation. Pafupifupi masiku 3-4, zomwe zimachokera kuchipatala zimapangidwa, ndiye kuti mudzafunika kuchita maphunziro apadera okonzanso (mankhwala othandizira, mankhwala olimbitsa thupi, ndi zina). Ngakhale opaleshoni yomwe idachitidwa kuti iwonetsetse pituitary adenoma, odwala ena adzafunsidwa kuphatikizanso chithandizo chamankhwala cholowetsa mahomoni.

Zowopsa za zovuta za intra- ndi postoperative panthawi ya endoscopic zimachepetsedwa - 1% - 2%. Poyerekeza, kusinthaku kwakumtundu wina pambuyo poti kupangika kwa AGHM kupezeka mwa anthu 6-10. kuchokera kwa odwala 100 omwe adagwira ntchito.

Pambuyo pa gawo la transnasal, anthu ambiri amakumana ndi vuto la kupuma kwammphuno komanso kusapeza bwino mu mnofu wa nasopharynx kwakanthawi. Cholinga chake ndikuwonongeka kofunikira kophatikizana kwa kapangidwe ka mphuno, chifukwa chake, zizindikiro zopweteka. Zovuta m'dera la nasopharyngeal nthawi zambiri sizimawoneka ngati zovuta ngati sizikukulira komanso sizikhala nthawi yayitali (mpaka miyezi 1-1.5).

Kuunika kotsiriza kwa zotsatira za ntchito kumatheka pokhapokha miyezi 6 kuchokera pazithunzi za MRI ndi zotsatira za kusanthula kwa mahomoni. Mwambiri, ndi kuzindikira kwakanthawi komanso kolondola komanso kuchitapo kanthu opaleshoni, kukonzanso kwaukadaulo, kulosera zamtsogolo ndizabwino.

Pomaliza

Ndikofunikira kupempha chithandizo chamankhwala chabwino kwambiri kwa akatswiri odziwa bwino za mbiri ya neurosuction. Njira yosakwanira, zolakwika zazing'ono zazing'ono pakuchita opaleshoni yaubongo, zophatikizika ndi ma cell a mitsempha ndi njira, mitsempha yamitsempha, imatha kutaya moyo wodwala. M'mayiko a CIS, ndizovuta kwambiri kupeza akatswiri enieni omwe ali ndi zilembo zazikulu pagawo lino. Kupita kudziko lina ndi chisankho chanzeru, koma si aliyense amene angakwanitse kugula ndalama, mwachitsanzo, chithandizo cha "golide" ku Israel kapena Germany. Koma m'maiko awiriwa, kuwala sikunasinthe.

Chipatala Chapakati cha Asitikali a Prague.

Chonde dziwani kuti Czech Republic siyabwino kwenikweni pankhani yamaubongo. Ku Czech Republic, ma pituitary adenomas amagwiritsidwa ntchito mosamala pogwiritsa ntchito matekinoloje a adenomectomy apamwamba kwambiri, ndipo alibe vuto lililonse komanso ali ndi zoopsa zochepa. Vutoli pano ndilabwino komanso ndi kuperekedwa kwa chisamaliro chokhazikika ngati, malinga ndi zomwe zikuwonetsa, wodwala safunika opaleshoni. Kusiyana pakati pa Czech Republic ndi Germany / Israel ndikuti ntchito zakuchipatala ku Czech ndizochepa mtengo, ndipo pulogalamu yamankhwala nthawi zonse imaphatikizapo kukonzanso kwathunthu.