Klatskin chotupa: makhalidwe, zizindikiro, chithandizo, madokotala ananena zawo

Cholangiocarcinoma, dera umoyo padziko lonse ziwerengero za 2% odwala khansa, komanso mpaka 10% a milandu chiwindi ndi biliary khansa thirakiti. Pa matenda omwewo a mtundu umenewu chotupa ndi otsika: 1.5-2 yekha%. Chotupa Klatskin dzina pambuyo dokotala wodziwa za vutoli Gerald Klatskin, dokotala ku America. Mu 1965, pamene ntchito pa University Yale, iye kudalira milandu 13, anafotokoza mbali zonse za matenda.

Cholangiocarcinoma, kapena khansa chiwindi, ndi ya ndulu ritsa

Klatskin chotupa - matenda oopsa. Pakuti neoplasm ili yodziwika ndi kukula pang'onopang'ono ndipo kenako chitukuko cha metastases. Chifukwa cha matenda mochedwa ndi kulephera kugwira kuchotsa ndi opaleshoni, ali imfa mkulu matenda. Matenda nthawi zambiri aikidwa pa magawo yotsirizira ya chitukuko cha maphunziro, zomwe amakonda opaleshoni. Kukula kwa metastases mwachindunji poyera kwa chiwindi, zipata chiwindi, mfundo dera lymph ndi pamimba. Chotupa kukula amene akupezeka ku maselo chiwindi zaminyewa. Mavuto aumbike makamaka pambuyo zaka 50, koma chaka chilichonse zaka odwala yafupika. Amuna ndi pang'ono kuti atengeke matenda kuposa akazi.

The Nkosatheka chifukwa cha chotupa cha

Zimayambitsa cholangiocarcinoma chiwindi sakudziwika. Koma asayansi apeza zotsatira omwe amaonjezera ngozi ya zotupa. Ndi mbiri ya pulayimale sklerotiziruyuschego cholangitis odwala 40 mwa milandu 100 ungadzakhazikitsidwe matenda Klatskin. Chotupa anapanga pa milandu 25 mwa 100 pamaziko a matenda wobadwa nawo, monga matenda Caroli. Yotupa anachita chifukwa majeremusi intrahepatic zingachititse chotupa.

zizolowezi zoipa zimene zimakhudza thanzi la chiwindi: kusuta fodya, kumwa mowa, kudya zakudya osauka, entailing kunenepa - zinthu angatsutse kuti kupitilira matenda. Pamaso pa cholelithiasis kumawonjezera mwayi zotupa. Pachiopsezo anthu ongoyendayenda kukhudzana yaitali ndi poizoni ndi zinthu zoipa. matenda tizilombo, makamaka chiwindi, amathandiza kuti chitukuko cha khansa.

symptomatology cholangiocarcinoma

Popeza zilonda chotupa mu chiwindi zovuta oterewa, muyenera kumvetsera thupi lanu kwa kuzindikira mwamsanga matenda Klatskin. chotupa mwina yodziwika ndi zizindikiro monga:

• mbali yaikulu ya matenda - obstructive matenda a chikasu ndiyo;
• zonse kuyabwa zotengeka;
• ndi akuvutika ululu kumtunda lamanja la pamimba;
• kusafuna kudya ndipo potsatira kwambiri kuwonda;
• thupi kutopa khalidwe la mapangidwe chotupa;
• pa kutentha okwera Klatskin zotupa kudzali;
• kusintha mu mkodzo ndi chopondapo mtundu (mdima mkodzo, chopondapo nawala).

Zizindikiro kuwonekera mwadzidzidzi ndi patsogolo. Matenda a chikasu ndiyo anapeza milandu 90 100, ndipo ndi chimodzi cha zizindikiro zambiri za matenda monga chotupa Klatskin. Reviews odwala zina amasiyana. Odwala ena lipoti kutsatira kuyabwa, kupweteka ndipo mwadzidzidzi kuwonda. mawonetseredwe Awa chifukwa magawo zapamwamba a zotupa zilonda. Koma ena samaona pafupifupi palibe zolakwika mu udindo matenda kapena zizindikiro zogwirizana anaonekera ndi matenda ena.

Chotupa Diagnostics Klatskin

Pakuti matenda ikuchitika maphunziro ambiri a kuchipatala kuti akhoza kundiuza molondola pamaso Klatskin matenda. Chotupa ndi bwino kuonekera pa ultrasound mu zida mosamala. Izi ndi mwachilungamo ndalama, wochezeka ndipo mosavuta njira. Mothandizidwa ndi mwauzimu CT zosavuta kudziwa monyanyira mu ndulu, kuwonongeka chiwindi, ndi kuwona lymph mfundo. Kugwiritsa Kujambula (Maginito kumveka kulingalira), kumayambiriro Mosiyana madzimadzi kwa chiwindi ndi lolondola mkulu kudziwa udindo wa minofu chiwindi ndi digiri ya kuchepetsa wa ya ndulu ritsa pa matenda Klatskin chotupa. Photography limasonyeza m'madera onse a chiwindi ndi ya ndulu ducts.

phunziro Fluoroscopic ndi radiographic chimasonyeza mavuto ndi njira biliary. The ndondomeko ya matenda umayamba Mosiyana wothandizira, amene amalola kuti aone nthenda ya ndulu. MAGAZI amuzolengedwa kuthandiza kudziwa mlingo wa michere ndi bilirubin. Iwo akhoza kupatsidwa mayesero kudziwa khansa Tel: CA 199, CA 125.

Nthawi zambiri, njira chotupa kuwafika mtsempha wamagazi kwa chiwindi ndi zipata mtsempha kotunga magazi chiwindi. Matendawa ndikofunika staging zotupa, kuti kulongosola ngati matenda yafalikira kwa mitsempha. Nthawi zina, monga matenda ndi zovuta, ndipo ndiye funso lonse ndi kuthetsedwa resection pa opaleshoni.

Njira amachitira neoplasms

odwala Popanda kuchitapo kanthu nthawi zambiri pafupifupi moyo amayembekezeka miyezi 6 kuchokera pamene mtima wa matenda zolondola. Mu magawo oyambirira kawirikawiri awulule matenda Klatskin. Chotupa ndi amenable kuti magawo yotsirizira ya mankhwala othandiza kwambiri.

Opaleshoni - njira imodzi yaikulu kuchitira chotupa. Komabe, ntchito ali otsika pakhomo kupulumuka (zikutanthauza 20%) chifukwa cha matenda mochedwa. kuchotsa wathunthu wa gawo kuonongeka kwa ya ndulu ritsa ntchito kukwaniritsa ubwino kucheza ndi kuchotsa Lobe wina chiwindi, pofuna kupewa matenda ziwiya magazi.

Opaleshoni n'zotheka zina:

• maphunziro sanali bwanji mitsempha ya magazi a chiwindi; Pankhaniyi zotheka kuchotsa gawo lonse kapena kachigawo a chiwindi kuonongeka;
• maphunziro sanali bwanji ya ndulu ritsa chimodzi kapena lobes onse a chiwindi.

Akuti matenda unresectable, pamene chotupa likulowerera mtsempha wa chiwindi kapena ya ndulu ducts wa onse cholowa.

chithandizo Palliative

Nthawi inoperable kapena ngati mankhwala adjunct ntchito chisamaliro palliative zachipatala.

Njirazi ndi monga:

• ngalande pa mundawo biliary;
• Morning;
• cheza mankhwala;
• kulambalala opaleshoni;
• photodynamic mankhwala;
• vysokosfokusirovannymi walitsa wa matabwa akupanga.

Mwa kaphatikizidwe mankhwala angapo, pamodzi ndi matenda oyambirira, moyo amayembekezeka akhoza ziwonjezeke kwa miyezi 10 mpaka zaka 5.

Kuti madokotala ananena zawo mankhwala

Chifukwa chakuti mapangidwe zotupa mu chiwindi wosakwiya mokwanira, moyo amayembekezeka ndi kwa theka kwa zaka zisanu. Complete kuchotsa mbali zowonongeka angathe kuonjezera amakhala moyo chifukwa zolondola yake matenda a matenda Klatskin. Zotupa zopezeka mu chiwindi, ali Zoneneratu akumane. Ichi ndi chimodzi mwa zizindikiro koipa anali anamuona pa odwala inoperable metastases mapangidwe. odwala amenewa angadalire yekha pa ngalande pa mundawo biliary. Ngati matenda a chotupa chiwindi Klatskin, moyo amayembekezeka odwala ndi zina zosaposa masabata ochepa.

Chifukwa imfa, oddly mokwanira, sakhala metastasize ndi mavuto ofanana. Njirazi ndi monga:

• matenda enaake oyambitsidwa ndi zosayenera ya ndulu outflow;
• matenda, zikubweretsa mapangidwe abscesses;
• okwana manja a chitetezo chokwanira thupi ndi kulephera;
• suppurative kutupa.

zodzitetezera

Pakuti kupewa matenda neoplastic a chiwindi ndi ya ndulu ducts m'pofunika kutsatira zakudya zoyenerera, osati kumwa mowa ndi matenda parasitic. Ngati mbiri ya matenda, zimene pabwino ngati zinthu ngozi, ayenera mankhwala yake zoona mwadongosolo kuti kuzindikira mwamsanga kuvutika mu matupi ya ndulu. M'pofunikanso kuthetsa mavuto obwera chifukwa cha zinthu zoipa, monga kuntchito.

pomaliza

Modern matenda zida angazindikire zotupa mu chiwindi ndi ya ndulu ducts, komanso kudziwa mlingo wa Kuvuta opaleshoni. Kukhazikitsidwa kwa njira zatsopano ntchito pothetsa vuto, kupatsidwa zina ndi njira zina achire kumabweretsa kusintha khalidwe ndi nthawi ya moyo odwala.