Ukuvela komdlavuza we-pancreatic kubangelwa ukwahlukaniswa okungalawuleki futhi kwesiphithiphithi kwamaseli we-pancreas ngaphansi kwethonya lezinto eziningana. Lesi sifo kwesinye isikhathi sibizwa ngokuthi "buthule", ngoba iminyaka eminingi kungenzeka singazivezi.
Inkambo yakamuva yalesi sifo ichazwa ubumqoka bendawo yesitho, esizungezwe yisisu, i-duodenum, izindlala ze-adrenal kanye nobubanzi. Ngakho-ke, ukubonakaliswa komdlavuza we-pancreatic kuba yinto ebonakalayo kakade emabangeni sekwephuzile, lapho isimila sifinyelela usayizi obalulekile.
Imininingwane ejwayelekile
Phakathi kwazo zonke izifo zamanyikwe, i-pancreatitis (ukuvuvukala) ne-oncology zivame ukutholakala kakhulu. Isibalo samacala sikhuphuka njalo ngonyaka, hhayi nje ngenxa yomthelela wezinto ezingezinhle. Lokhu kungenxa yokwenziwa ngcono kwezindlela zokuxilonga, ezivumela ukuthola ukuphazamiseka okuningana kwesimo se-gland esigabeni sokuqala somdlavuza.
Lapho amaseli eqala ukuhlukana ngokungafani nokuhleleka kwemvelo, kuvela isimila somdlavuza. Amangqamuzana anesihlungu ayakwazi ukungena ezicutshini eziseduze futhi awonakalise. Ngaphezu kwalokho, ngokukhula kwesimila, ahlukaniswa neoplasm futhi afaka ukujikeleza kwe-systemic noma i-lymph. Lokhu kuholela metastasis, okungukuthi, ukusabalala komdlavuza kwezinye izitho nezinhlelo. Ukulimala okulimazayo kwamanyikwe kubonakaliswa nge-metastasis efanelekile ekuqaleni.
Ama-pancreas enza imisebenzi emibili emzimbeni: ukhiqiza ujusi wokugaya kanye nama-hormone. Ukusebenza okuningi okunjalo kanye nokugeleza kwegazi okuqinile esakhiweni kwenza kube sengozini yokuqhuma kwamathumba ahlukahlukene. I-adenocarcinoma evame ukubonwa kakhulu, eyakheka nge-githeular epithelium. Kuyaqapheleka ukuthi kwabesifazane lolu hlobo lomdlavuza luphinda kabili kunakulabesilisa.
ICystadenocarcinoma ingeyesibili ukwanda kokulimala: lesi simila ezimweni eziningi sinezimpawu ezinzima, ezisiza ukuxilongwa kwezigaba zokuqala. ICarcinoma yenzeka ikakhulukazi ngemuva kwesikhumba se-pancreatitis noma isifo sikashukela futhi ingathinta noma iyiphi ingxenye yomzimba - ikhanda, umzimba nomsila.
Umdlavuza womsila we-pancreas ushesha kakhulu ekwakhiweni kwama-metastases, noma kunjalo, cishe uhlala unempilo yokwelashwa okuhlinzwa. Ngesikhathi sokuhlinzwa, kuphuma umsila kanye nobubanzi, obunemithambo yegazi ejwayelekile namanyikwe.
Uma isimila sifinyelela usayizi omkhulu, khona-ke ukulimala kwezitho ezingomakhelwane - isisu namathumbu - kungenzeka. Amaseli omdlavuza ahlukanisiwe angahamba ngokugeleza kwe-lymph futhi enze nama-metastases esibindini nasemaphashini.
Izimbangela Nezingozi Zengozi
Izimbangela eziqondile zomdlavuza we-pancreatic azikasungulwa, naphezu kweminyaka yocwaningo. Kukholelwa ukuthi inkambiso eya ekusakazweni kwezifo ezinobungozi phakathi kwabantu ihlangene nokuwohloka kwesimo semvelo emhlabeni jikelele, ukwanda kokuphuza utshwala, ikakhulukazi utshwala osezingeni eliphansi, ukudla okungalingani kanye nokwehla kwezinga elijwayelekile lokuphila.
Lapho usebenza nama-asbestos, kumele kuqashelwe izinyathelo zokuphepha, ngoba into leyo isabalalisa izakhi zomzimba ezibanga umdlavuza.
Njengamanje, kunemibono eminingana yesayensi echaza ukuthi yini ebangela umdlavuza. Zonke zenzelwe ukulimala kwesakhiwo se-DNA, ngenxa yalokho kusebenze i-oncogene. Lokhu kuholela ekukhiqizweni okungalawulwa kwamaseli e-pathological akha i-tumor.
Kunezici zangaphandle nezangaphakathi ezifaka isandla ekuqalekeni komdlavuza. Okokuqala, mayelana nokuqagela izakhi zofuzo, lapho umzimba unciphise amandla okubuyisela i-DNA noma ukungavikeleki kwe-oncology.
Izici zengozi zangaphandle zibandakanya okulandelayo:
- i-irradiation, kufaka phakathi i-ultraviolet;
- udlulise ukuhlinzwa emgudwini wokugaya ukudla;
- ukudakwa ngezinto eziyingozi - uphethiloli, i-asbestos, njll;
- isifo sikashukela i-mellitus, ikakhulukazi uhlobo 1;
- ukudla okungalinganiseli nge-predominance yenyama ebomvu nenamafutha ekudleni.
Kuyajabulisa futhi ukuthi kunobudlelwano nesintu: Abantu baseYurophu nabase-Asia bahlushwa umdlavuza we-pancreatic kaningi kakhulu kunabantu base-Afrika. Imvamisa, izimbangela zangaphakathi nangaphandle zibafiphale kangangokuba ukunquma ubungako bazo akunakwenzeka.
Izimpawu
Izimpawu zomdlavuza we-pancreatic ezigabeni zokuqala azivamile kakhulu. Ngezikhathi ezithile kuphela lapho isiguli singabona ukwanda kobuhlungu besikhathi esithile esiswini esiphezulu kanye nokwanda okuncane kokushisa komzimba. Kwezinye izimo, uphawu lokuqala ngphuzi lesikhumba.
Izimpawu zokuqala zomdlavuza we-pancreatic zivela lapho isimila sicindezela izitho zomakhelwane noma zimila kuzo. Kwesinye isikhathi, ngokumelene nesizinda sempilo ephelele, ukuthuthukiswa kwe-pancreatitis eyingozi noma i-mellitus yesifo sikashukela kuyaphawulwa. Ngesikhathi sokuhlolwa, kutholakala ubukhona besimila, ukukhula kwawo okuholele ekuphulweni kokuphuma kwejusi le-pancreatic. Imbangela yesifo sikashukela kulokhu ukuhlulwa kwezichibi zamaLangerans, kuhlanganisa i-insulin yehomoni.
Ngokuya ngokuthi isitho siphi isimila esikuyo, izimpawu zizohluka. Ngakho-ke, lapho ikhanda le-gland lilimele, i-danc main pancreatic duct ivinjiwe, futhi i-bile ayingeni amathumbu ngokugcwele. Ngakho-ke, ukuphuzi kwe-sclera yamehlo nesikhumba kuyabonakala, kanti umchamo uthola umbala omnyama.
Uma isimila senziwe sendawo emzimbeni noma umsila, izimpawu zokuqala zivela ngemuva kwe-metastasis. Isibonakaliso esiyinhloko Ubuhlungu esiswini sangaphezulu, ngaphansi kwezimbambo, okubuyisela emuva. Isifo sezinhlungu sivame ukuqina ngemuva kokudla nalapho silele. Kuyenzeka kudambise izinhlungu lapho umzimba uhanjiswa phambili.
I-carcinoma eqhubekayo ibonakaliswa isicanucanu, ubuthakathaka, ukulahleka kokudla nesisindo. Ngomonakalo kuma-islets we-Langerans, ukukhiqizwa kwama-hormone kumanyikwe, ngakho-ke isiguli singaphazanyiswa ukuqina kwemisipha, isiyezi nesithukuthezi esicasulayo.
Izigaba
Kunezigaba ezi-4 zomdlavuza we-pancreatic, ngalinye liboniswa ngokubonakaliswa kwalo kwezokwelapha nezindlela zokwelashwa:
Ukuxilongwa kwe-insulinoma- Isigaba sokuqala. Isimila asidluli amasentimitha amabili futhi asidluli ngale kwemingcele yesifo;
- 2 isigaba. Amangqamuzana anesihlungu aqala ukusabalala futhi athinte ulwelwesi lwama-mucous lwezitho eziseduze namaphilisi we-lymph node wesifunda;
- 3 isigaba. Ama-metastases angena ajulile ezithweni ezithintekile;
- 4 isigaba. Isimila sifinyelela usayizi omkhulu, inani lama-metastases landa kakhulu kangangokuba izitho ezikude zibandakanyeka enqubweni yokudla, futhi ubuchopho buyahlupheka.
Kukhona nesigaba okuthiwa yi-zero, esiteji esinamandla. Ayihlobene ne-oncology, ngoba amangqamuzana alimele asezingeni eliphezulu le-epithelial. Kodwa-ke, ngaphansi kwethonya lezinto ezingezinhle, la maseli angavela abe yingozi.
Isigaba sesine, esibulalayo somdlavuza sibonakaliswa ngama-metastases amaningi, futhi isibindi cishe sithinteka njalo
Ukutholwa kwesimila sokweziqu zokuqala kuyinto ehlukile kunaleyo futhi kwenza kungabi ngaphezu kwe-5% yamacala. Kodwa-ke, i-prognosis yomdlavuza we-pancreatic, othinta ingxenye ethile yesitho, iyathandeka kakhulu. Ngokulashwa okukhulu futhi okuphelele, kungenzeka ukufezekisa ukusinda kweziguli zeminyaka emihlanu.
Usuka esigabeni sesibili, isithombe somtholampilo siba sobala kakhulu futhi sicacisiwe. Ezimweni eziningi, kufana nesifo sikashukela i-mellitus.
Ngezigaba ezi-2-3, kubonakaliswa izibonakaliso eziningi zokwehlukanisa:
- kuwo wonke amacala amathathu, ubukhulu besisu bukhuphuka;
- ukunciphisa umzimba ngokudla okujwayelekile kutholakala cishe kuzo zonke iziguli ezitholakala zinomdlavuza;
- Iziguli ezi-5 kwezili-10 zinenhliziyo yokucanuzelelwa inhliziyo nokugaya ukudla;
- ukukhathala, ukuqina komzimba kwenzeka kuma-25% wamacala.
Ukuqubuka komzimba noma umsila we-gland kuboniswa yizimpawu ezilandelayo:
- umuzwa wokoma njalo nomlomo owomile;
- ukwehla okukhulu kwesifiso sokudla;
- i-pallor kanye nokuqhuma kwesikhumba;
- ubomvu bolimi;
- ukungahambi kahle kokuya esikhathini kanye nokuncipha kwe-sex drive;
- ukubonakala kokulimala emzimbeni ngaphandle kwesizathu esibonakalayo nokwelashwa isikhathi eside kwamanxeba, imihuzuko.
Esigabeni sesine, izimpawu zimenyezelwa kakhulu, ngoba lesi sifo sisakazekela kwezinye izitho zomzimba. Iziguli zingahle zikhononde ngesikhumba esishisayo nomoya opholile. Ngenxa yokuqongelela kwenani elikhulu loketshezi, isisu sikhuphuka, umchamo okhishwe ubumnyama, bese kuthi isihlalo sithola umbala okhanyayo ongavamile.
I-insulinoma ingaba i-benign noma i-malignant, ithulula i-insulin ngokungalawuleki
Ngaphezu kwalokho, i-tint ephuzi ibonakala hhayi esikhunjeni kuphela, kepha futhi kulwelwesi lwe-mucous lwezindebe namehlo. Imvamisa kuba nezinsini ezikhipha igazi, obekungakaze kwenzeke ngaphambilini. Lapho amaphaphu ebandakanyeka enqubweni ebabayo, ukuphefumula nokukhwehlela kuyavela - ekuqaleni lezi zimpawu zihlukumeza umuntu ngemuva kokuzivocavoca ngokomzimba, kodwa bese zivuka futhi ziphumule.
Imiphumela emibi kakhulu ihambisana nama-metastases obuchopho. Kulokhu, i-acuity ebonakalayo nokuzwa kungancipha, ukuhlangana kungaphazamiseka. Ukuziphatha okungalungile nokudideka kwesinye isikhathi kuyabonakala.
Uma ukwelashwa komdlavuza we-pancreatic kungazange kwenziwe, khona-ke esigabeni sesi-4 kube nezinkinga ezinjengokuhluleka kwezinso nokuqina kwesibindi, ukushayisana kwegazi, ukuvinjwa kwamathumbu nokuncipha okukhulu kwesisindo, kuze kuqede ukukhathala, kungakhula. Uma okungenani enye yezinkinga ibonakala, amathuba okufa kwesiguli anda kaningana.
Ngingahlala isikhathi esingakanani ngithole ukuthi unomdlavuza webanga lesine? Lo mbuzo uqala ubuzwa isiguli. Impendulo kuyo ixhomeke ekwandeni kwe-metastases nokuthi izitho zomzimba zithinteka kuphi. Ngokwesilinganiso, abantu baphila ezinye izinyanga eziyisithupha, kepha le nkathi ingandiswa kabili, ngenxa yekhono lomzimba ngalinye lokulwa nalesi sifo. Ungathola ngezindlela zokwelashwa nokondliwa kweziguli ezinomdlavuza we-4th degree lapha.
Ukuxilonga
Ukuxilongwa komdlavuza we-pancreatic kuqala ngokuhlolwa kanye nokuhlolwa okuningiliziwe kwesiguli. Ukuhlolwa kwegazi, umchamo nezindunduma kuyimpoqo, kanye novivinyo olulodwa noma ngaphezulu:
- i-radiography yepheshana eliphakeme esiswini, noma indlela ye-barium porridge. Kwenziwa ngemuva kokuba isiguli sisebenzise isixazululo samanzi se-barium sulfate, esiveza imvuthuluka yezitho ngaphansi kwemisebe ye-x-ray;
- I-MRI noma i-CT. I-tomography ehlanganisiwe nayo ingenziwa ngokusebenzisa isixazululo esihlukile esinikezwe isiguli ngaphambi kokuthwebula;
- I-Ultrasound ifundeka ngokwengeziwe uma kuhlolwa abantu abanciphile, ngoba ungqimba lwamafutha eziguli ezikhuluphele lungahlanekezela amasiginali;
- I-ERCP, i-endoscopic retrograde cholangiopancreatography ichazwa kuphela uma izindlela zangaphambili zingafundisi ngokwanele. Lokhu kungenxa yobulukhuni nokuhlaseleka kwale nqubo, okungenziwa kuphela esibhedlela ngaphansi kwe-anesthesia yendawo;
- I-PTCA, i-percutaneous Transluminal coronary angioplasty iyadingeka ukunquma izindawo zokuvinjwa kwezixaka zesibindi;
- i-angiography isetshenziswa ukukhomba usayizi we-neoplasm, izinga lokuxhaphaka kwalo, ngesikhathi senqubo, ukuxhumana kwesimila nemikhumbi esemqoka kumisiwe;
- biopsy yendawo ethintekile ukuze kuqhutshekwe nokuhlolwa ngokomlando.
I-computer tomography ku-oncology isetshenziswa kaningi kune-MRI, ngoba inikeza imiphumela efanelekile yokuhlola ukwanda kwenqubo ye-pathological kuzicubu ezizungezile nama-lymph node. Le ndlela ifundiseka ikakhulukazi lapho isimila senziwe endaweni ethile emsileni wesitho.
Ukwelashwa
Ukuthi ulashwa kanjani futhi aphathwa kanjani ama-pancreas kuya ngemiphumela yokuhlolwa, uhlobo lomdlavuza kanye nesimo sempilo sesiguli. Uma isimila singeqi ngaphezu kwesitho, khona-ke kungenzeka ukusikhipha ngokungenelela kokuhlinzwa. Njengomthetho, ukwelashwa okunjalo cishe kuhlanganiswa njalo ne-chemotherapy nemisebe.
Ngabe umdlavuza we-pancreatic ungalapheka ngale ndlela ebukhali njengokususwa kokuhlinzwa? I-Pancreatoduodenal resection, noma ukuhlinzwa kukaWhipple, iyindinganiso yegolide ekwelapheni i-oncology futhi ibuyisa nethemba lokululama ezigulini ebezikade zithathwa njengezingelapheki.
I-Chemotherapy ingenziwa zombili ngaphandle nangesibhedlela. Kuya ngesimo sesiguli nokubekezelela izidakamizwa ezisetshenziswayo.
Isikhathi sokuhlinzwa sisebenza cishe amahora angama-4-5, lapho ikhanda lekhanda elinesimila sokuqala lisuswa khona. Ingxenye ye-bile duct, i-gall bladder, kanye nengxenye ye-duodenum enemithambo yegazi ejwayelekile enekhanda lamanyikwe nakho kuyabonakala.
Ngokuya kobufakazi, odokotela abahlinzayo banquma ukususwa okungenzeka kwengxenye yesisu, ama-omentum nama-lymph node aseduze. Uma isimila sesisabalale emthanjeni wesibindi, kuyadingeka ukwenza ingxenye ethile yengxenye ye-venous ngokwakhiwa kabusha kwemikhumbi okwalandela.
Isigaba sokugcina se-PDR ukwakheka kwamalunga wangaphakathi wamanyikwe namathumbu amancane, i-bile duct esele namathumbu, kanye namathumbu nesisu. Ekuphetheni, amashubhu akhethekile angeniswa emgodini wesisu wesiguli ukukhipha ukukhipha esikhathini sokuvuselela kabusha kwangaphambi kwesikhathi.
Uma kulimala umzimba noma umsila we-gland, kwenziwa i-pancreatectomy ephelele - ukususwa ngokuphelele kwama-pancreas nengxenye ye-duodenum 12. Uma isimila singeke sisuswe, khona-ke kwenziwa umsebenzi wokudlula noma wokufakelwa, lapho amathumbu noma amabele e-bile avinjelwe.
Indlela ye-chemotherapy isetshenziswa njalo, lapho umzimba uvuselelwa. Iningi lezidakamizwa lifakwa emithanjeni, kepha ezinye zenzelwe ukuphathwa ngomlomo.
I-Tramadol ingenye yezidakamizwa ezisebenzayo zokulwa nobuhlungu, ezithinta kabi isimo sengqondo nengokomzimba sesiguli
Kunezindlela eziningi 'zokunqanda' izinhlungu zomdlavuza we-pancreatic. Izidakamizwa ezingezona ze-steroidal ezilwa nokuvuvukala nama-opioid zizosiza ezinye iziguli (Tramadol, Tramal). Kwezinye izimo, akunakwenzeka ukuthi ususe imijondolo ebuhlungu ngosizo lwemithi, bese odokotela baphendukela kwezinye izindlela.
Isibonelo, ngenaliti ende efakwe ekujuleni kwesibeletho, injekishini yotshwala yenziwa eduze kwezindawo ezithile zezinzwa. Ukudakwa okunjalo cishe njalo kunikeza umphumela oyifunayo futhi akubangeli imiphumela emibi.
Ukususwa ngokwengxenye yezinzwa ze-peritoneal kungenzeka futhi ukuvimba izinhlungu. Lapho welashwa ngemisebe eyehlisa ubukhulu besimila, izinhlungu ziyancipha.
Kwezinye izimo, ukufakwa kwe-catheter ye-epidural kuyadingeka, okuqinisekisa ukulethwa okungaphazamiseki kwemithi yobuhlungu emzimbeni.
Ukusinda nokufa
I-futurenosis yolwelwesi lwe-pancreatic alunampilo ngesimo, ngoba lesi sifo sivame ukuvela. Inqubekela phambili kwezokwelapha zesimanje kanye nobuchwepheshe bamuva abuvumeli umdlavuza ukuthi welashwe ngokuphelele. Kungakho kungafanele ungabaze ukuvakashela udokotela uma usola ukungasebenzi kahle kohlelo lokugaya ukudla. Ukuhlola ama-pancreas kunconywa ngokubukeka okujwayelekile kobuhlungu ku-hypochondrium ephezulu nakwezinye izinkomba zezimpawu.
Zingaphezu kwama-80% iziguli ezifuna usizo ezigabeni zakamuva ze-oncology ezifayo ngonyaka wokuqala ngemuva kokuxilongwa. Cishe ingxenye yesine yazo zonke iziguli ziphila unyaka owodwa kuya kwemihlanu. Lapho umdlavuza utholakala ezigabeni zokuqala, ukusinda kungaphezu kwama-20%.
Ngemuva kweminyaka emihlanu kutholakale lesi sifo, izinga lokusinda lehliswa kancane kancane, futhi yi-1-2% kuphela yeziguli ephila iminyaka eyi-10. Isikhathi sokuphila sithonywa yizici ezinjengobudala, isimo sempilo kanye nezimpawu zomzimba ngamunye. Ezigulini ezinamaqhubu angasebenzi, ukufa kwenzeka ngemuva kwezinyanga eziyi-6 kuya kwezingu-12, kanti ukuba khona kwe-metastases kunciphisa isikhathi sokuphila cishe izinyanga eziyisithupha.
Izindlela zokuvikela ezingcono zokugwema izifo ze-pancreatic zingukudla okulinganiselayo, ukungabi bikho kwemikhuba emibi (ukubhema, utshwala) kanye nemfundo ehlelekile yomzimba. Futhi uma kunezici zobungozi, kunconyelwa ukuhlolwa njalo ngodokotela. Yiba nempilo!
