Embryonal rhabdomyosarcoma: chithandizo, madokotala ananena zawo

Rhabdomyosarcoma amatanthauza mawonekedwe a sarcoma - khansa minofu zofewa, fupa kapena minofu connective. Chotupa Mosakayika chidzachitika minofu Ufumuyo mafupa. Rhabdomyosarcoma - chotupa chija Chobwera mu minofu chigoba. Iwo amayamba mu aliyense mbali ina ya thupi kapena m'malo osiyanasiyana.

Microscopically rhabdomyosarcoma akuluakulu ali mawonekedwe a elongated kapena anamaliza maselo chodabwitsa. More khalidwe la chotupa ichi ubwana.

mitundu ya rhabdomyosarcoma

Rhabdomyosarcoma ya kapangidwe mkati anawagawa mitundu:

1. Embryonal maselo rhabdomyosarcoma imakhala yozungulira ndi fusiform amene kufufuza cytoplasm amasonyeza kotenga kapena yopingasa striations. Mtundu wa rhabdomyosarcoma zimachitika kawirikawiri. Zikuoneka embryonal rhabdomyosarcoma ana ndi unyamata. Ndi ili mu khosi kapena mutu, pa kumaliseche, mu nasopharynx lapansi. The tilinazo zotupa mankhwala poizoni koma sachedwa muyambirenso mofulumira.

2. Alveolar rhabdomyosarcoma wapangidwa ndi gulu maselo kuzungulira ndi chowulungika, amene amacheza ndi septa minofu connective. Mtundu wa zotupa yodziwika ndi maonekedwe pa miyendo kapena manja, pamimba, chifuwa, kumatako kapena ziwalo zoberekera. Nthawi zambiri angapezeke mu achinyamata komanso akuluakulu pa nthambi. Kulosera tsogolo la matenda ndi osauka.

3. Kaonekedwe pleomorphic rhabdomyosarcoma - polymorphic spindle woboola pakati, riboni ngati, nyenyezi woboola pakati maselo a chotupa amene angaoneke pa mapazi kapena manja a anthu. Monga ulamuliro, rhabdomyosarcoma kukula amene akupezeka mofulumira ndipo sayambitsa ululu ndi matenda zinchito. Zimachitika mitsempha yekha. Kawirikawiri kukula kudzera pakhungu wokutidwa ndi zilonda, kupanga exophytic, magazi chotupa.

Zina mwa zifukwa

Zina mwa zinthu zachilengedwe anapeza chotero, kuti kuonjezera Mwina yatsoka chotupa ichi. Izi umasiyana kwambiri khansa rhabdomyosarcoma.

Chifukwa chakuti si ndendende kudziwika zimayambitsa chitukuko chotupa, sitingathe kupereka malangizo aliwonse kupewa mapangidwe ake. Komabe, tiyenera kukumbukira kuti ndi chithandizo chokwanira cha odwala rhabdomyosarcoma zina kwathunthu anawachiritsa.

Zifukwa za maonekedwe a rhabdomyosarcoma embryonic wotere matenda osiyana anatsimikiza:

1. Li-Fraumeni syndrome ndi matenda osowa amene anatengera khalidwe, kuwonongeka jini pamene akusowa bambo kapena mayi pafupipafupi mkulu mitundu yosiyanasiyana chotupa anauka. Anatengera kudwala izi opatsirana kulunjika mosiyanasiyana chotupa minofu pamene kwambiri kumawonjezera Mwina kukhala zotupa pa m'badwo woyambirira (zaka 30).

2. Neurofibromatosis woyamba mtundu - ambiri tinatengera matenda omwe amachititsa maonekedwe a kumakhala kutengera kuti chotupa chija.

3. Syndrome Beckwith-Wiedemann - kudwala, amene amakhala ndi macrosomia, macroglossia ndi omphalocele. Ndi zopindika amamvekera ana a linga kutsogolo a pamimba, chophukacho, neonatal hypoglycaemia, ndi divergence minofu rectus.

4. Costello syndrome - matenda osowa, amene amakhala ndi malformations kobadwa nako: kukula retardation, coarse nkhope, kusintha khungu.

5. Noonan ndi matenda - matenda majini yodziwika ndi aafupi zimene zolakwika ndi chitukuko somatic. Iwo angayambe m'banja kapena aliyense wa anthu ake.

Ana amene anali kulemera kubadwa ndi kukula kuposa ena, ngozi za rhabdomyosarcoma embryonal. Monga ulamuliro Komabe, zimayambitsa rhabdomyosarcoma embryonal sakudziwika. Chizindikiro cha matenda ndi maonekedwe a chotupa likupitirirabe.

zizindikiro

Symptomatology ya matenda a khansa anatsimikiza. Amafuna yomweyo dokotala ngati ana kutchulidwa zizindikiro za khansa:

• edema kapena kutupa, kukula kukula kapena ayi likadutsa, nthawi zina chowawa;
• maso oumbidwa;
• aakulu mutu;
• bvuto ndi defecation ndi pokodza;
• magazi mu mkodzo;
• magazi mu rectum, mphuno komanso pakhosi.

diagnostics

Pakali pano, anayamba njira kudziwa rhabdomyosarcoma mpaka zizindikiro zake woyamba zoonekera.

Zizindikiro oyambirira a khansa - kutupa m'deralo kapena induration, sayambitsa mavuto poyamba kapena ululu. Chizindikiro chimenechi ndi khalidwe la rhabdomyosarcoma, mikono, miyendo ndi torso.

Ngati chotupa cha isanafalikire m'dera pamimba kapena m'chiuno zikhoza m'mimba ululu, kusanza kapena kudzimbidwa. Iwo embryonal rhabdomyosarcoma wa danga retroperitoneal. More kawirikawiri, osauka, kapepala kakuti biliary, rhabdomyosarcoma chimayambitsa matenda a chikasu ndiyo.

Ngati pali kukayikirana chotupa ichi, m'pofunika kuchititsa biopsy, umene mwachindunji wotani rhabdomyosarcoma zinayambira.

Nthawi zambiri, rhabdomyosarcoma ikutuluka malo kumene mosavuta wapezeka, mwachitsanzo, m'mphuno kapena kunja mwana wa m'diso la. Ngati maso oumbidwa, kapena secretions m'mphuno kuoneka, muyenera yomweyo dokotala ndi chotupa amaganiziridwa kuti apezeke pa siteji oyambirira a chitukuko. Ngati kumene rhabdomyosarcoma limapezeka padziko Thupi, izo mosavuta wapezeka popanda kufufuza. Izi otchedwa embryonal rhabdomyosarcoma zofewa minofu.

Mu 30% odwala ndi rhabdomyosarcoma embryonal ali pa siteji oyambirira pamene akhoza kwathunthu kuchotsedwa. Koma ambiri odwala zofunikila mupeza metastases yaing'ono, chithandizo chimene chimafuna pamaso mankhwala amphamvu.

Embryonal rhabdomyosarcoma, amene m'dera testicle zambiri kutulutsa ana ang'ono ndipo anapeza makolo a mwanayo pamene akutsuka. Ngati zotupa zimachitika thirakiti mkodzo, iwo amayambitsa vuto pokodza kapena wamagazi kumaliseche - zizindikiro kuti sitingakane.

siteji chotupa

1. Choyamba. Chotupa kungakhale kukula kulikonse, koma sanabadwe wakafika lymph mfundo za dongosolo ndipo ili mu imodzi mwa mbali prognostically chabwino cha thupi:

- maso kapena malo periocular;

- mutu ndi khosi (kupatulapo minofu ubongo ndi msana m'dera chingwe);

- ya ndulu ducts ndi chikhodzodzo ndulu;

- mu chiberekero kapena machende.

Places kunja ali, amaonedwa m'madera akumane.

2. Gawo lachiwiri. Kutupa ndi chimodzi mwa mabacteria akumane (mabacteria amene akusowa mu yabwino). Chotupa kukula ndi zosakwana 5 cm ndipo sinafalikire kwa mwanabele kwachitika.

3. Gawo lachitatu. chotupa ili m'dera la anthu, ndipo ndi umodzi wa zinthu zotsatirazi:

- kukula chotupa cha zosakwana masentimita 5, ndipo anali kufalitsa pa mwanabele lotsatira;

- chotupa ndi lalikulu kuposa masentimita 5, ndipo pali chiopsezo kuti zidzakhala zofalikira ku malo lymph mfundo.

4. Mbali chachinayi. Chotupa kukula akhoza kukhala chilichonse, ndipo anali kufalitsa kwa mwanabele lotsatira. Pakhala kufalikira Khansa m'madera akutali a thupi.

anthu okhudzidwa

Anatumizidwa mtima chiopsezo gulu Mzimuyo mosavuta zisadzachitikenso wa rhabdomyosarcoma. mwana aliyense amene walandira chithandizo kuchokera rhabdomyosarcoma embryonal, ayenera kulandira mankhwala amphamvu zina kukhala zochepa imabwera chotupa zisadzachitikenso. View anticancer mankhwala, mlingo ndi chiwerengero cha magawo - zonsezi anatsimikiza ndi chiopsezo kuti mwana aliyense anatchula - otsika, mungafike kapena mkulu.

chithandizo

Odwala rhabdomyosarcoma embryonal angachiritsidwe m'njira zosiyanasiyana.
Chithandizo kumafuna zotupa zilonda njira zosiyana zomwe akuti ndi chikhalidwe. njira zina pa nthawi zovuta matenda. mayesero matenda ayamba kusintha njira wogwila amachitira kapena kuwonjezera kuchuluka kwa deta ya njira zatsopano za odwala ndi rhabdomyosarcoma. Ngati chifukwa cha mayesero matenda, zikuoneka kuti njira zatsopano za mankhwala ndi apamwamba kuposa makolo mankhwala atsopano ikupitirirabe m'gulu la makolo.

Popeza zotupa zilonda amakonda kuonekera m'madera zosiyana za thupi, chikukhudza ambiri mankhwala. Chithandizo cha rhabdomyosarcoma ana loyang'aniridwa ndi oncologist Dokotala.

Mwa njira ya chithandizo, pali ena amene angathe kuyambitsa zotsatira zoyipa, ngakhale pamene mankhwala patha nthawi yayitali.

opaleshoni

Opaleshoni njira, kapena kuchotsa chotupa cha, chimagwiritsidwa ntchito pa matenda a rhabdomyosarcoma. Opaleshoni imeneyi imatchedwa "lonse m'dera excision". kulowererana uku ndi kuchotsa mbali ya chotupa ndi minofu ozungulira pamodzi ndi mwanabele kuti nawonso amakhudza rhabdomyosarcoma. Chithandizo zina ndi kuchita ntchito zingapo. Chigamulo pa poika ntchito ndi mtundu wake kumatengera zifukwa zotsatirazi:

- ikani malo oyamba chotupa ndi;

- ntchito iliyonse mwana wa thupi anakhudzidwa ndi chotupa ndi;

- chotupa poyankha radiotherapy kapena mankhwala amphamvu, amene angagwiritsidwe ntchito pa patsogolo maziko.

Ambiri mwa kuchotsa ana a buku lonse la chotupa ndi opaleshoni sizingatheke.

Embryonal rhabdomyosarcoma zofewa minofu amamuchititsa kupangidwa pa malo zosiyana za thupi, omwe amafuna ntchito yake. Opaleshoni alowererepo akusonyeza ngati kumaliseche rhabdomyosarcoma kapena maso, ngati biopsy anatsimikizira matenda. Pamaso opaleshoni awerenge mankhwala amphamvu kapena radiotherapy kuchepetsa zotupa zazikulu, amene sakhoza opareshoni, wosalira ntchito yochotsa khansayo.

Ngakhale ngati dokotala sangathe kuchotsa chotupa chonse, odwala kumapeto kwa ntchito ayenera pansi Morning kupondereza maselo a khansa kukhala ndi moyo. Pamodzi ndi mankhwala amphamvu, cheza mankhwala ntchito. Chithandizo umalimbana kuchepetsa chiopsezo zisadzachitikenso matendawa amatchedwa mankhwala adjuvant.

mankhwala cheza

Ndi mtundu uwu wa mankhwala ntchito X-ray kapena cheza zina. Cheza mankhwala amalandira chinachake, kupha maselo chotupa kapena kusiya kukula. tanthauzo lake mankhwala apeza njira ziwiri radiotherapy - kunja ndi mkati.

Kunja amagwiritsa cheza gwero kunja kwa thupi kwa irradiating chotupa. Internal cheza mankhwala kapena brachytherapy irradiates chotupa ndi mayikidwe a zinthu nyukiliya pafupi atangochimwa mkati mwa thupi la munthu. Iwo amagwiritsidwa ntchito pofuna kuchiza khansa ya m'chikhodzodzo, mutu ndi khosi, prostate, akumaliseche.

Mtundu wa chithandizo cheza ndi mlingo anatsimikiza ndi zaka mwanayo ndi mtundu chotupa kutanthauzira koyamba komanso pamaso pa chotupa yotsalira ndi digiri ya chotupa gulu yapafupi mwanabele pambuyo opaleshoni.

Morning

Mtundu uwu wa mankhwala khansa kuti amagwiritsa mankhwala kuletsa kukula kwa maselo a khansa. Morning mankhwala amathandiza kupha maselo amenewa kapena kupewa magawano awo. A zokhudza zonse Morning mankhwala akutengedwa pakamwa kapena jekeseni kudzera m'mitsempha kapena intramuscularly. Kufika mu magazi, mankhwala bwanji maselo a khansa thupi lonse. Pamene mankhwala mankhwala amphamvu dera ndi jekeseni mwachindunji mu ziwalo ndipo cavities thupi, komanso madzimadzi cerebrospinal. Kuphatikiza mankhwala amphamvu amagwiritsidwa ntchito amene ali mankhwala ntchito kuposa wina odana ndi khansa mankhwala. njira mankhwala amphamvu amusankha malingana ndi mtundu ndi siteji ya chitukuko cha neoplasm lapansi.

Morning lomwe kuti mwana aliyense amene akulandira thandizo rhabdomyosarcoma. Timatha inu kuchepetsa mosavuta zisadzachitikenso matenda. Kusankha mankhwala, mlingo komanso chiwerengero cha njira kumatanthauza chiopsezo gulu rhabdomyosarcoma.

mankhwala atsopano

ingapezeke chithandizo rhabdomyosarcoma kudutsa mayeso:

• Large Mlingo wa mankhwala amphamvu molumikizana ndi wozengereza maselo kumuika. njira limachititsa kukonza m'malo maselo hematopoietic kuti anawonongedwa pa mankhwala khansa. maselo mwana magazi amachotsedwa isanafike mankhwala a mafupa kapena magazi a wodwala ndi osungidwa. Pakutha Morning raskonserviruyut kokhazikika maselo tsinde ndi kubwezeretsedwa kwa odwalayo ndi kulowetsedwa. Choncho maselo magazi buluzi.
• Immunotherapy. Pamene mtundu umenewu mankhwala kulimbana khansa ntchito chitetezo cha m'thupi la wodwalayo. mankhwala kutumikiridwa ndi kusintha kapena kubwezeretsa chitetezo zachilengedwe ndi khansa. Mankhwalawa amatchedwa biotherapy a zotupa.
• Akulimbana mankhwala. mtundu wa mankhwala ukuperekedwa metastasis. mankhwala akulimbana zachokera ntchito chitetezo yeniyeni kuti kumumanga kwa maselo a khansa. chitetezo izi ofanana ndi chitetezo ochiritsira wa thupi. Choncho iwo akuimilira ndi zina zamakono mankhwala. Zikomo mankhwala akulimbana mankhwalawa "zasayansi" mungazipeze kuukira maselo a khansa yekha popanda kuvulaza maselo wathanzi. Pamene rhabdomyosarcoma mu zoletsa angiogenesis ntchito ngati chandamale mankhwala. Mankhwalawa kupewa mapangidwe mitsempha ya zotupa. Zimenezi zimabweretsa chakuti chotupa starves ndi oyima kukula. zoletsa Angiogenesis ndi chitetezo monoclonal - mitundu wothandizira ziyeso matenda kwa kulamulira embryonic rhabdomyosarcoma.