Khansa ya kapamba ndi imodzi mwamatenda obisika kwambiri m'thupi la munthu. Gawo la matendawa limakhala pafupifupi 3-4% ya ma oncology onse. Kwa zaka zopitilira 40, achipatala padziko lonse lapansi akhala akuwunika khansa ya kapamba.
Koma kupita patsogolo kwakukulu, mwatsoka, sikuwoneka pankhaniyi, chifukwa kuzindikira koyambirira kwa matendawa ndikovuta. Matendawa amadziwika pomwe gawo lake silikusiya wodwalayo kuti sangapeze mwayi wowapeza.
Zinthu zazikulu zomwe zimathandizira kukulitsa khansa:
- Chiyanjano cha amuna.
- Zaka ndi zaka 45.
- Matenda a shuga.
- Mbiri yakale ya gastrectomy.
- Zizolowezi zoipa.
- Matenda a Gallstone.
- Kudya zakudya zamafuta.
Khansa ya mutu wa gland imadziwika kawirikawiri pa siteji 4, yomwe singagwire ntchito, ndipo odwala sakhala nayo nthawi yayitali. Izi zikufotokozedwa ndi njira yobisika yamatendawa, yomwe, mwatsoka, imakhala yofala, ndipo khansa siyichira.
Muzochitika zotere, kuchokera koyambira koyamba mpaka mawonetseredwe odwala, masabata angapo kapena miyezi ingadutse.
Ku America, kufa kwa adenocarcinoma kumatenga malo 4 "olemekezeka" pakati pa anthu wamba omwe amafa ndi khansa, kumayambiriro, atapezeka ndi nthawi yake, khansa ikadali kuchitidwa, koma osati pamapeto pake.
Maselo limagwirira a adenocarcinoma chitukuko
Njira ya neoplastic imatchulidwanso mu kusintha kwa majini a KRAS 2, makamaka mu codon ya 12. Matendawa amadziwika ndi puncture biopsy ndi PCR.
Kuphatikiza apo, mukazindikira khansa ya pancreatic mu 60% ya milandu, kuwonjezeka kwa mafotokozedwe a jini la p53 kumadziwika, koma izi sizizindikiro zokha za khansa ya pancreatic.
Gawo la mutu womwe wakhudzidwa ndi kapangidwe ka pancreatic oncopathology ndi 60-65%. 3540% yotsala ndi njira ya neoplastic mchira ndi thupi.
Adenocarcinoma imakhala ndi milandu yoposa 90% ya khansa ya kapamba, koma zomwe zimayambitsa khansa ya pancreatic sizimamveka bwinobwino.
Zojambulajambula zamatumbo a pancreatic
Zotupa za pancreatic kuchokera ku ziwiya zomwe amaziperekera ndizokhoma ndi chipinda cha maselo otentha. Mwambiri, izi zitha kufotokozera kuwonetsa kwa adenocarcinoma njira zachikhalidwe zochizira zotsekera kukula kwa minyewa, ma receptor, ndikuchepetsa.
Kufalikira kwamphamvu kwa metastases kumayenda bwino, ngakhale kuli ngati cytostatics yoikidwa. Vutoli limaphatikizidwa ndi zovuta zam'mimba komanso immunosuppression. Ngati siteji ndi yomaliza, ndiye kuti mutha kukhala mwachidule kwambiri ndi maphunziro oncological awa.
Tumors amatha kukhala ndi chithunzi chofanana ndi zamankhwala, koma amachokera ku mitundu yosiyanasiyana ya anatomical:
- Vato wam'mimba ndi ma ampoules;
- pancreatic mutu acini;
- duodenal mucosa;
- duct epithelium;
- epithelium ya wamba duct.
Zotupa zonsezi zimaphatikizidwa m'gulu limodzi lotchedwa khansa ya pancreatic kapena khansa ya periampicular, gawo lotsiriza lomwe sililetsa mwayi kwa odwala.
Zomwe zimapanga kapangidwe kake ka kapamba zimafotokoza kupezeka kwa mawonetseredwe a pathological ngati atagunda. Kukula kwa kapamba kumayambira 14 mpaka 22 cm.Malo apafupi ndi mutu wa chithokomiro ndipo matumbo ambiri am'mimba amasonyezedwa ndi kuperewera kwa chakudya m'mimba.
Zizindikiro zazikulu zamankhwala
Ngati chotupa chapezeka m'dera la mutu, mawonetseredwe otsatirawa amatha kupezeka mwa wodwala:
- Kusakhumudwitsidwa
- Ululu mu hypochondrium yoyenera ndi dera la umbilical. Mtundu wa ululu umatha kukhala wosiyana kwambiri, womwewo umagwira ntchito pakapita nthawi. Ululuwu umakulirakumwa ndikumwa mowa kapena kudya zakudya yokazinga, ndikugona.
- 80% ya odwala ali ndi jaundice popanda kutentha, komwe kumayendera limodzi ndi Courvoisier syndrome, ndiye kuti, pakalibe colic biliary, chikhodzodzo cha ndulu chimakulidwa.
- Kupezeka kwa ma acid acids m'magazi kumayambitsa kuyabwa kwa khungu, lomwe limadziwonetsa lokha nthawi ya preicteric.
- Zizindikiro za Neoplastic: Kusokonezeka kwa kugona; kuchepa thupi; kutopa msanga; kupewera nyama, nyama yokazinga ndi mafuta.
Zizindikiro
Kuzindikira khansa ya pancreatic munthawi yake sikophweka. Zambiri zazomwe zili mu CT, ultrasound ndi MRI zili pafupifupi 85%, choncho gawo loyambirira silipezeka kawirikawiri.
Mothandizidwa ndi CT, ndizotheka kudziwa kukhalapo kwa zotupa kuchokera ku 3-4 masentimita, koma ndime yapita pafupipafupi iyi siyikulimbikitsidwa chifukwa cha kuchuluka kwa ma radi-x ray.
Retrograde endoscopic cholangiopancreatography imagwiritsidwa ntchito pazindikira zinthu zovuta. Zizindikiro za khansa ya pancreatic ndimatchinga kapena masisitidwe a stenosis a England kapena wamba duct. Mu theka la milandu, odwala amatha kudziwa kusintha kwa magawo onse awiri.
Chifukwa chodziwikiratu pamayendedwe azachipatala ndi kupitirira kwina kwa adenocarcinoma, zotupa ndi ma lymphoma a maselo a islet, kutsimikizika kolondola kwa mbiriyakale (kutsimikizira) kwazindikirika ndikofunikira panthawiyi. CT kapena ultrasound yowongoleredwa imakupatsani mwayi wopeza zolemba zam'mbuyomu.
Komabe, kudziwika moyenera sikungachitike ngakhale pa laparotomy. Cholinga cha kupangika komwe kumayikidwa m'mutu sichingadziwike ndi kupweteka kwa khansa komanso chifuwa chachikulu.
Tizilombo totupa totupa tambiri tokhala ndi zizindikiro za edema komanso chifukwa cha chifuwa chachikulu nthawi zambiri timazungulira chotupa chovunda. Chifukwa chake, kusanthula kwamtundu wa mapangidwe a neoplasm sikuti kumveka nthawi zonse.
Chithandizo chanzeru
Odwala nthawi zonse amakhala ndi chidwi ndi funso: amakhala bwanji atatha opareshoni? Opaleshoni yayikulu lero ndi njira yokhayo yomwe gawo loyambirira la khansa limapulumutsira wodwalayo matenda amtunduwu. Kulungamitsidwa kwa opareshoni ndi 10-15% ya milandu yonse ngati gawo silinayambike. Mu gawo lofewa, chakudya cha khansa ya pancreatic imatha kupereka thandizo.
Pancododuodenal resection ndimakonda kwambiri. Pankhaniyi, pali mwayi wopitilira ntchito ya pancreatic, ndipo izi zithandiza wodwalayo kupewa kukulitsa mtundu woyamba wa matenda ashuga, momwe mumakhala mayankho ena ku funso loti mungakhale ndi moyo wautali bwanji.
Zoposa zaka 5 15% ya odwala omwe adachitidwa opareshoni yofananira amakhala. Ngakhale, ngati metastases idafalikira ku ziwalo za m'mimba ndi ziwalo zapafupi, ndiye kuti kuyambiranso kumakhala kwakukulu kwambiri. Pano tikulankhula za khansa ya kapamba ya digiri ya 4, gawo ili silimapereka ngakhale kuti ndi nthawi yochuluka bwanji.
Ziwonetsero
Ndi khansa ya kapamba, matendawo sakhala bwino. Pafupifupi, odwala osagwira ntchito omwe ali ndi digiri yachinayi amakhala pafupifupi miyezi isanu ndi umodzi. Amawonetsedwa palliative mankhwala. Ndi chitukuko cha jaundice, ngalande za transhepatic kapena endoscopic ziyenera kuchitidwa.
Ngati wodwalayo alola, anastomosis imagwiritsidwa ntchito kwa iye, yomwe ndiyofunikira kuchita ntchito ya kukhetsa, komabe, gawo la 4 limasiyira mwayi wodwalayo.
Simungalekerere kupweteka ndikudziyimira nokha matendawa. Ndi kulumikizana ndi panthawi yake kokha ndi katswiri komwe kuli zotsatira zabwino za moyo.
