Umdlavuza we-pancreatic ungenye yezifo ezitholakala kalula emzimbeni womuntu. Isabelo salokhu kugula sibalelwa cishe ku-3-4% wayo yonke i-oncology. Sekuyiminyaka engaphezu kwengu-40, umphakathi wezokwelapha emhlabeni wonke ubhekisisa umdlavuza we-pancreatic.
Kepha inqubekela phambili enkulu, ngeshwa, ayibonwa kulokhu, ngoba ukusheshe kutholakale lesi sifo kunzima. Isifo siyatholakala lapho isigaba sawo singasasishiyi isiguli ithuba lokuthola imiphumela emihle.
Izinto ezibalulekile ezifake isandla ekuthuthukiseni umdlavuza:
- Ukuhlangana kwabesilisa.
- Iminyaka ngemuva kweminyaka engama-45.
- Isifo sikashukela mellitus.
- Umlando we-gastrectomy.
- Imikhuba emibi.
- Isifo se-Gallstone.
- Ukudla ukudla okunamafutha.
Umdlavuza wekhanda lendlala uvame ukutholakala usuvele esiteji 4, ongasebenziseki, futhi iziguli azihlali nawo isikhathi eside. Leli qiniso lichazwa yinkambo efihlekile yalesi sifo, okuthi, ngeshwa, ivame, futhi umdlavuza awuphathwa kahle.
Ezimweni ezinjalo, kusukela kokuncane kuya kokubonakaliswa okutholwe ngumtholampilo, kungadlula amasonto ambalwa noma izinyanga.
EMelika, ukufa kwabantu nge-adenocarcinoma kuthatha indawo yesi-4 “ehloniphekile” phakathi kwabantu abajwayelekile bokushona kwe-oncological; kusenesikhathi, kutholakale isikhathi, umdlavuza usalashwa, kepha hhayi ekugcineni.
Umshini wamangqamuzana wokuthuthukiswa kwe-adenocarcinoma
Inqubo ye-neoplastic ivezwa kakhulu kuguquko lwofuzo lwe-KRAS 2, ikakhulukazi ku-codon ye-12. Lokhu kuphazamiseka kutholwa yi-puncture biopsy yi-PCR.
Ngaphezu kwalokho, lapho kuthola umdlavuza we-pancreatic emaphesenti angama-60 wamacala, kuye kwanda ukwanda kwesakhi sofuzo se-p53, kepha lezi akuzona ukuphela kwezimpawu zomdlavuza we-pancreatic.
Ingxenye yekhanda ethintekile ekwakhiweni kwe-pancreatic oncopathology ingu-60-65%. Ama-35-40% asele inqubo yenqubo yomsila nomzimba.
Ama-Adenocarcinoma enza ama-90% ezimo zomdlavuza we-pancreatic, kepha izimbangela zomdlavuza we-pancreatic azikaqondakali ngokuphelele.
Izici zesakhiwo sezinsolo ze-pancreatic
Ama-tumic e-pancreatic avela emikhunjini ebanikeza yona iboshwe ngesahluko samaseli wokufaka. Ngokunokwenzeka, lokhu kungachaza ukuvezwa okungekuhle kwe-adenocarcinoma ezindleleni zokwelapha ezisuselwa ekuvinjweni kokukhula kwemisipha, ama-receptors, kanye nokunciphisa i-angiogeneis.
Ukusakazeka ngesihluku kwe-metastases kuyaqhubeka, naphezu kwe-cytostatics ebekiwe. Lesi simo sihambisana nokukhubazeka kokugaya kanye ne-immunosuppression. Uma isigaba kungokugcina, khona-ke ungaphila kafushane kakhulu ngemfundo ye-oncological enjalo.
Ama-tumors angaba nesithombe somtholampilo esifanayo, kepha aqhamuka ekwakhiweni okuhlukile kwe-anatomical:
- Ingono yamaVater nama-ampoules;
- i-pancreatic ikhanda i-acini;
- i-duodenal mucosa;
- duct epithelium;
- i-epithelium ye-duct ejwayelekile.
Wonke la makhaza ahlanganiswa abe yiqembu elilodwa elibizwa ngokuthi umdlavuza we-pancreatic noma umdlavuza we-periampicular, okuyisigaba sokugcina sawo esishiya ithuba leziguli.
Izici zesakhiwo se-anatomical se-pancreas sichaza ukwenzeka kokubonakaliswa kwe-pathological uma kwenzeka wehlulwa. Ubukhulu bama-pancreas buqala kusuka ku-14 kuye ku-22 cm. Indawo esondele kakhulu yekhanda lesibeletho kuya emgodini ojwayelekile we-bile duct kanye ne-bulb yamathumbu e-duodenal kuboniswa ukungasebenzi kahle kwendlela yokugaya ukudla.
Izimpawu eziphambili zomtholampilo
Uma isimila senziwa endaweni esifundeni senhloko, ukubonakaliswa okulandelayo kungatholakala kwisiguli:
- Ukungajabuli
- Ubuhlungu endaweni efanele i-hypochondrium nesifunda se-umbilical. Uhlobo lobuhlungu bungahluka kakhulu, okufanayo kusebenza esikhathini. Ubuhlungu buyaqina ngemuva kokuphuza utshwala noma ukudla ukudla okuthosiwe, ngenkathi ulele phansi.
- Ama-80% eziguli ane-jaundice ngaphandle komkhuhlane, ohambisana ne-Courvoisier syndrome, okungukuthi, uma kungekho-colic biliary, i-blallder yandisiwe iyabekwa.
- Ukuba khona kwe-bile acid egazini kubangela ukulunywa kwesikhumba, okuzibonakala esikhathini sangaphambi kokudla.
- Izimpawu ze-Neoplastic: ukuphazamiseka kokulala; ukunciphisa umzimba okuqhubekayo; ukukhathala okusheshayo; ukuphambukela inyama, ukudla okuthosiwe nokunamafutha.
Ukuxilonga
Ukuthola umdlavuza we-pancreatic ngendlela esesikhathini akulula kangako. Okuqukethwe okunolwazi kwe-CT, i-ultrasound ne-MRI kucishe kube ngama-85%, ngakho-ke isigaba sokuqala akuvamile ukutholwa.
Ngosizo lwe-CT, kungenzeka ukunquma ukuba khona kwama-tumors kusuka ku-3-4 cm, kepha indinyana evamile yalolu cwaningo ayinconywa ngenxa yomuthi onamandla wemisebe ye-x-ray.
I-Retrograde endoscopic cholangiopancreatography isetshenziswa ezimweni ezinzima zokuxilonga. Izimpawu zomdlavuza we-pancreatic yizithiyo noma i-duct stenosis ye-gland uqobo noma i-bile duct ejwayelekile. Engxenyeni yamacala, iziguli zingabona ushintsho kuwo womabili ama-ducts.
Ngenxa yokuhluka okusobala emaqhinga wokulapha kanye nokuqhubeka kwesikhathi kwe-adenocarcinoma, isimila ne-lymphoma yamaseli we-islet, ukuqinisekiswa okuyiqiniso komlando (ukuqinisekiswa) kokuxilongwa kuyadingeka ngalesi sikhathi. Ukulawulwa kwe-CT noma i-ultrasound kukuvumela ukuthi uthole impahla yezifundo zomlando.
Kodwa-ke, ukuxilongwa okunembile akukwazi ukwenziwa ngisho nangesikhathi sokuhlinzwa kwengqondo. Ukugxila kokuqina okubonwa ekhanda ngeke kunqunywe yi-palpation kuwo womabili umdlavuza kanye ne-pancreatitis engamahlalakhona.
Izicubu ezivuvukelayo ezinobunzima be-edema futhi okubangelwa i-pancreatitis engapheli zivame ukuzungeza isimila esibuhlungu. Ngakho-ke, idatha ye-biopsy yezingqimba ezingaphezulu ze-neoplasm azihlali zinengqondo.
Ukwelapha okunengqondo
Iziguli zihlala zinentshisekelo kulo mbuzo: zingaphila isikhathi esingakanani ngemuva kokuhlinzwa. Ukuhlinzwa ngokuhlinza namuhla kuyindlela kuphela yokuthi esigabeni sokuqala somdlavuza ingasindisa isiguli ngokuphelele kulokhu kugula. Isizathu sokuhlinzwa ngu-10-15% wawo wonke amacala uma isigaba singakathuthukisi. Esigabeni esiphansi, ukudla umdlavuza we-pancreatic kunganikeza usizo oluthile.
Ukuphakanyiswa kabusha kwe-Pancododuodenal kukhethwa kakhulu. Kulokhu, kunethuba lokulondolozwa kokusebenza kwe-pocrreatic pancreatic, futhi lokhu kuzosiza isiguli ukuthi sigweme ukukhulisa uhlobo olubi lwe-1 isifo sikashukela, esimweni lapho kunezimpendulo ezithile zombuzo wokuthi ungaphila isikhathi esingakanani.
Ngaphezu kweminyaka engu-5- 15% yeziguli ezike zasebenza ngokufanayo zihlala. Noma, uma i-metastases isakazeka kuma-lymph node kanye nasezitho zomzimba ezisondelene kakhulu, khona-ke amathuba okuphinda abuyele phezulu aphezulu kakhulu. Lapha sikhuluma ngomdlavuza we-pancreatic we-4th degree, lesi sigaba asinikezi noma ngabe isikhathi esingakanani.
Isimo sezulu
Ngomdlavuza we-pancreatic, i-prognosis imbi. Ngokwesilinganiso, iziguli ezingasebenziseki ezine degree lesine ziphila cishe izinyanga eziyisithupha. Baboniswa ukwelashwa okulapha. Ngokukhula kwe-jaundice, kufanele kudlulwe amanzi nge-transhepatic noma endoscopic drainage.
Uma isimo sesiguli sivumela, kusetshenziswa i-anastomosis kuye, okudingekayo ukwenza umsebenzi wokudonsa, noma kunjalo, isigaba sesine asishiyi thuba lesiguli.
Awukwazi ukubekezelela ubuhlungu futhi uzitholele isifo ngokuzimela. Ukuxhumana kuphela nochwepheshe okufika ngesikhathi kungumphumela omuhle empilweni.
