A chotupa cha neuroendocrine cha kapamba ndi m'mimba ndi adenoma kapena neoplasm, yomwe imadziwika kwambiri ndi zochitika za m'madzi zama cell zomwe zimapanga ziwalo zamkati, zomwe zimayambitsa kukhudzika kwa metabolite.
Gwero la neoplasms limawoneka ngati gawo lopangidwira la depuse neuroendocrine system, yomwe imaphatikizapo maselo opanga ma peptide mahomoni ndi ma biogenic amines, omwe amagwirizana pansi pa mawu akuti "APUD mifumo".
Maselo amdongosolo lino amatchedwa apudocytes, amagwira ntchito m'makina, amatha kugwira ma amine precursors, decarboxylate ndikupanga ma amines, ofunikira pakupanga ndi kuwongolera ma peptides a mahomoni.
Sayansi yamakono imadziwa mitundu yopitilira 20 ya ma apudocytes omwe ali mkati mwa kapangidwe ka thupi (hypothalamus ndi pituitary gland), mkati mwa gawo lamanjenje, m'mimba, duodenum, kapamba ndi zina zam'mimba.
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 imafuna kulingaliridwa mosiyana.
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 amtunduwu amaphatikizidwa limodzi kuzilumba zazing'ono kuzungulira pancreas. Amatchedwa ma cell a Langerhans kapena maselo a islet. Neoplasm yomwe imapezeka m'malo awa amatchedwa 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 chawo 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 chatumphuka m'mimba, ndiye kuti sikungatheke kuzindikira momwe matenda amapezekera mpaka neoplasm ipereka metastases ku ziwalo zina.
Zikondamoyo zaumunthu zimakhala ndi ziwalo - mutu, mchira ndi thupi. Ndi zotupa m'magawo awa, katulutsidwe ka timadzi tambiri timatupa, ndipo timayambitsa zizindikiro zoyipa. 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 kwa 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 zimalimbikitsa kutulutsidwa kwa madzi a m'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. M'mazithunzi ena, khalani m'matumbo aang'ono. Nthawi zambiri, mtundu woipa wa neoplasm umakhazikika.
- Insulinoma ndi kapangidwe kamene kamapangidwa m'maselo omwe amapanga insulin. Gawo lake limayang'anira zomwe glucose zili mthupi. Neoplasm iyi imakula pang'onopang'ono, samapatsa metastases. Imapezeka kumutu, mchira kapena thupi la zofunitsa. 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. Pazokambirana zambiri za 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 (kanyunyu wa kapamba) - chotupa, chotupa m'maselo omwe amapanga m'mimba; somatostatinoma ndi chotupa cha maselo omwe amatulutsa mahomoni somatostatin.
Somatostatinoma imawonetsedwa bwino ndi kupanga kwa 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, popanda 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 timene timagulu tambiri, tinthu timene timatulutsa timadzi pang'onopang'ono chifukwa cha kukula kwa neoplasm. Ndi gawo lalikulu la gastrin, zizindikiro zotsatirazi zimawonedwa:
- 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, ndi 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, kumakhala kupweteka, kutupa kapena manja, mapazi.
- Kusokoneza kwam'mimba.
- Kuchepetsa chilako.
- Ululu pakamwa, zilonda m'makona amkamwa.
Ndi kuwonjezeka kwa matumbo a m'mimba, kutsegula m'mimba kawirikawiri, komwe kumapangitsa kuti madzi asamayende bwino ndi chizindikiro chofananira - 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. Opaleshoniyo 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 maopaleshoni ndizovuta kuneneratu, motero njira yachipatala imatsimikiziridwa ndi choonadi - pambuyo poti dokotalayo ayamba opareshoni.
Zindikirani panthawi yake mawonetseredwe azachipatala a 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. Mankhwalawa otsatirawa amagwiritsidwa ntchito pakukopa kwachipatala:
- Chlorozotocin.
- Doxorubicin.
- Epirubicin.
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 zimapezeka 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 amafunidwa kuti athe kuchepetsa nkhawa. Kusankhidwa kwa mankhwala kumatengera mawonetseredwe azachipatala. Dokotala atha kukulemberani mankhwala:
- Octreotide.
- Omez.
- Ranitidine.
- Omeprazole
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.
