Matendawa ndi mankhwala a chloroquine lymphoblastic khansa. zizindikiro

Lymphoblastic khansa, magazi ndi kukhala ambiri kudwala ana oncological. Ndi pafupifupi 25% ya khansa wapezeka mu Pediatrics. Kenako, tione khansa magazi - icho chiri, chifukwa ndi kumeneko ndi zimene achire zikunena akutsatiridwa mu kudwala izi.

mwachidule

Khansa magazi - ndichiyani? Matendawa amatanthauza gulu la khansa. ONSE (pachimake lymphoblastic khansa), zizindikiro za tikambirana pansipa, ndi gulu sakanikira wa neoplasms maselo kuti ndi zenizeni majini ndi immunophenotypic makhalidwe. Zomwe kupanga ndi kudzikundikira maselo amenewa mu kuvutika mafupa zimathandiza kuchuluka sekondale, zosiyanasiyana kapena onse. Chifukwa, kusalola maselo a ziwalo parenchymatous ndi lymph mfundo. Ambiri (pafupifupi 80%) khansa onse (khansa), wapezeka ana, amachokera lymphoid.

kuwanda

matenda magazi zilonda mu dziko lero amapezeka paliponse. ONSE kuwanda m'mayiko olemera Nthawi 3-4 pa ana zikwi zana chaka. M'maiko a ku Central Asia ndi Africa kudwala ndi zochepa wamba. Kawirikawiri mu limati US la Japan, China, Europe. Kuchuluka pachimake ana akuti ndi zaka 2.5-5. The chosayenerera ambiri amapezeka anyamata.

zinanso ziti

Choyamba ayenera zimachitika m'badwo wa mayi kuchipatala kuti akalandire chithandizo, mkulu kubadwa kulemera - magilamu 4000, post- ndi akalandire chithandizo kukhudzana ionizing cheza. Nthawi zina mwina ngakhale zimachitika ndi pachimake lymphoblastic khansa? History matenda mayi zingaphatikizepo nkhani yoopsa imfa ndi mimba m'mbuyomu. Izi zikhoza zimachitika chifukwa zinthu chokhwima zachilengedwe, kapena chifukwa kutengera za kumtundu. Pankhani ya odwala khansa kwa acibale wowonjezera mosavuta kuti mibadwo ya m'tsogolo adzauka pachimake lymphoblastic khansa. Zimayambitsa matenda likhoza kulumikizidwa ndi chromosomal Kusakhazikika syndromes zinthu. Zikuphatikizapo, makamaka monga ozerezeka, neurofibromatosis, variable immunodeficiency, Fanconi magazi m'thupi, X-zogwirizana agammaglobulinemia (kobadwa nako) ndi ena. Chifukwa cha zimenezi, chiwerengero cha maphunziro, akatswiri afike pomvetsetsa kuti pachimake lymphoblastic khansa, komanso chitukuko cha Oncology ena, pali kusintha mowiriza maselo kholo. Iye kenako analumikiza launchers zinthu zachilengedwe kuti yambitsa kuchulukana. Izi chodabwitsa ambiri zomwe zingachititse khansa. Zifukwa vozniknovneniya kudwala ndi imodzi mwa mbali zofunika posankha mankhwala.

diagnostics

Pozindikiritsa Cancer aliyense kudwala adzatengedwa kuganizira makhalidwe matenda ndi mbali ya maselo amene amapanga chotupa gawo lapansi. matenda ONSE zachokera kuzionetsetsa thupi ndi paraclinical mbiri deta ndiponso zasayansi maphunziro.

chithunzi matenda

Zizindikiro za khansa ya m'magazi ndi zovuta zambiri syndromes:

• Kuledzera. Mu pachimake lymphoblastic khansa ndi Amowabu malaise, kuwonda, kutopa, malungo. Yotsirizira akhoza zidzayambike ndi tizilombo toyambitsa, protozoal (osowa), kapena matenda a mafangasi, makamaka odwala ndi neutropenia.
• Hyperplastic. Pamene pachimake lymphoblastic khansa ndi kusalola ndulu ndi chiwindi. Izi, mu zingathandize kuti hepatosplenomegaly, amene angasonyeze mwachikondi pamimba. Zizindikiro zoyambirira za khansa - pathological fractures mafupa yaitali kapena msana. Soreness ndi kutupa m'malo olumikizirana mafupa mwina poyamba kuonedwa ngati kuti ndi zizindikiro za nyamakazi kapena matenda ena. Bone matenda - chifukwa osteomyelitis. Pamene leukemic kusalola wa articular kapisozi ndi periosteum, mtima ndi mafupa chotupa kukula voliyumu kuoneka ululu kwambiri. Pa nthawi yomweyo pa X-ray wapezeka khalidwe la kusintha pathological. Makamaka iwo kuoneka bwino bwino pafupi mfundo zazikulu ndi mafupa yaitali. Soreness angagwe pambuyo chifukwa necrosis avascular ndi kufooka kwa mafupa.
• Magazi ochepa. Mu pachimake lymphoblastic khansa, chikondwerero tachycardia, pallor, magazi a nembanemba mucous m'kamwa, hemorrhagic matenda pakhungu. Chifukwa kuledzera ndi magazi m'thupi akufotokozera kufooka.

kudwala mawonetseredwe

Mu 5-30% a milandu yaikulu pachimake khansa limfblastnogo anyamata anati ANGACHITE testicular kukulitsa. Pali zipangano ziwiri kapena unilateral sabweretsa chisoni wandiweyani infiltrates. Zochita kuwonjezeka yokulirapo mu malipoti a impso. Pankhaniyi, sangakhale alipo matenda mawonetseredwe la kugonjetsedwa awo. Osowa mavuto monga pericarditis exudative ndi m'mnyewa wamtima kusalola lymph kutsekeka pa maziko pakati pa epicardium ndi endocardium. Ndi kuwonjezeka mu mwanabele mu mediastinum ndi kumachitika zipolowe ntchito ya dongosolo kupuma. Awa ndi makhalidwe a T-selo khansa mtundu kutsogolera kwa matenda aakulu vena cava. Komanso angayambe ndi kulephera kupuma. Nthawi zina leukaemic kusalola ya m'mapapo minofu kapena kukha magazi mwa iwo. Nthawi zina akatswiri kovuta kusiyanitsa deta ku matenda a pathologies opatsirana. Ena zizindikiro zosonyeza diso kuwonongeka ndi pachimake lymphoblastic khansa tisaiwale magazi mu diso, edema nipple mu mitsempha chamawonedwe, mtima kusalola. Pamene ophthalmoscopy angathe kuonedwa ndi zolengeza pansi pa mwana wa m'diso la. Mwinanso pamaso pa wandiweyani bluish infiltrative zinthu sabweretsa chisoni pa khungu. Infection angayambe chikuto aliyense kuwonongeka. Mu nkhani imeneyi, ndondomeko matenda akhoza kuzindikiridwa panaritiums, paronychia, tizilombo matenda uyo osiyana, punctures ndi mamita P..

zofufuza Paraclinical: thundu

Hemoglobin zikhoza kuchepetsedwa kapena zachilendo. Hematocrit, ndi wofiira achiyesa maselo a magazi ndi zambiri yafupika. Amowabu kuchepa kwa chiwerengero cha reticulocytes. White magazi selo achiyesa mwina kuchepetsedwa, kuchuluka kapena zachilendo. Komabe, si maselo mphamvu angathe kuonedwa milandu onse. Pakuti kudwala khalidwe "Kulephera leukemic." Tikuyankhula zokhudza kukhala maselo kuphulika chapansipansi chosowa njira wapakatikati - metamyelocytes ndi myelocytes - mu chilinganizo magazi. Zambiri zimachitika thrombocytopenia.

myelogram

Ndondomeko kutenga mafupa puncture. Mpanda zimene tiyenera kukhala ndi mfundo ziwiri. Ndondomeko ikuchitika makamaka pogonekedwa ndi mankhwala ambiri. Mu ana okulirapo kuposa zaka ziwiri, puncture wachotsedwa kutsogolo ndi zitunda kumbuyo ilium zaka 2 - kuchokera calcaneal tuberosity tibial zigawo kapena zinthu. Cytological morphological Kupenda zambiri limasonyeza hypercellular mafuta chuma ndi mwapang'ono zikumera dongosolo yachibadwa hematopoietic ndi kusalola kuwomba nyumba yotere.

kafukufuku cytochemical

Ichi ndi chimodzi mwa magawo zofunikira matenda. Ntchito kudetsa cytochemical anaululira a mzere selo. Onetsetsani kuti ntchito kafukufuku myeloperoxidase.

msana kachizindikiro

Ndi kuvomerezedwa yodziwira mu amaganiziridwa pachimake lymphoblastic khansa, zifukwa tatchulazi. Cerebrospinal puncture ayenera kuchitidwa pansi sedation choncho cha kukhalapo mu magazi zotumphukira wa osachepera 30 zikwi / othandiza magazi kuundana ml. Ngati ndi kotheka, pamaso ndondomeko imagwiridwa kuika trombovzvesi. Kukonzekera tsitopreparat kufunika Botolo osachepera awiri a mowa. Pa kudziwika kwa zinthu mphamvu ndi zizindikiro za kuwonongeka kwa mitsempha cranial matenda neuroleukemia - leukemic CNS. Tikumbukenso Komabe, malowedwe mu wamanjenje dongosolo la lymphoblasts ndi kusalola meninges zimachitika milandu onse, ngakhale sitili pa mawonetseredwe matenda ndi zasayansi. Ndi zofunika, ndipo kudziwika zizindikiro ubongo, onetsetsani kuti akugwira kompyuta kapena nyukiliya maginito tomography a chingwe msana kapena ubongo.

kafukufuku ena

Mothandizidwa ndi ultrasound retroperitoneal danga ndi peritoneal M'mimbamo akhoza kukhazikitsa kukula kwa ziwalo parenchymal walowerera, anaonjezera lymph mfundo m'madera pamimba ndi ena, ziwalo mu mafupa a chiuno, ndi machende. Monga mbali ya matenda ndi chifuwa radiography mu zolosera awiri. Izi ndi zofunika kudziwa kuchuluka mediastinum lapansi. Kodi anasonyeza, amasankhidwa X-ray zimfundo ndi mafupa. Mu kusanthula amuzolengedwa ikuchitika mwa maphunziro kwa zasayansi. Aliyense chikusonyeza kuwonjezeka woposa 500 LDH IU, nkotheka chisokonezo ndi ntchito ya chiwindi ndi impso. Asanayambe Morning analimbikitsa ndi echocardiography ndi ECG. Lero, mwa njira ina, mu phunziro selo kachilombo ntchito maselo majini ndi cytogenetic njira kudziwa topangira DNA, komanso kusintha structural.

Chithandizo: mwachidule

The mfundo zimene ano Dokotala oncohematology ng'ambidwa m'magulu odwala pa mankhwala mwamphamvu. Iwo anasankha malingana ndi kuopsa ndi amene atuluka ndi pachimake lymphoblastic khansa. Kuneneratu boma kumathandizanso. Mwachitsanzo, anthu amene kuthetsa kudwala zolimbitsa ndithu Morning mpofunikila kuti musalandire zipangizo zina poizoni ndi katundu. Komanso, anthu amene pafupifupi kupulumuka mlingo si kwambiri, ndi intensification wa zinthu zikhoza kukhala mwayi kuchira. Pamene kugawikana mu gulu la odwala matenda ndi khansa ya m'magazi, ulosi anapangidwa pamaziko a titani, ndi ndondomeko payekha m'gulu dongosolo olemba. Aliyense wa iwo aumbike mwa mmodzi kapena njira zina zochita achire a mwamphamvu ena. Mu gulu panopa anatengera pangano ambiri pa yogawa ndi gulu chiopsezo cha odwala amene anapezeka "pachimake lymphoblastic khansa". Chithandizo cha ana anayamba kupanga mu zaka zao za sikisite mochedwa Mu zaka zapitazo ku America. Mokulira mfundo imene machenjerero achire, sichoncho masinthidwe wapadera. Odwala osakwana zaka kudwala kumaonekera m'njira ankakwiya ndi amakhala neuroleukemia, leukocytosis.

Main achire njira

Mankhwalawa ntchito mankhwala ozunguza bongo monga "Prednisolone" ndi "Vincristine". Amagwiritsidwanso ntchito endolyumbalnoe oyamba amatanthauza "Methotrexate" ndi cranial walitsa pofuna kupewa neuroleukemia. Komanso, wapadera mankhwala pulogalamu anayamba kupanga. Izi zikutanthauza kuti odwala onse kulandira ena mlingo bwino ndi osakaniza wothandizila chemotherapeutic mu chimango yeniyeni nthawi, motero protocol. Pakutha makumi asanu ndi awiri a zinaonekeratu kuti pambuyo ndimeyi zionetsero zoterozo anachira pafupifupi 50% ya ana amene anapezeka ndi khansa. The zifukwa patsogolo pa matenda a matenda oyamba ndi tanthauzo la heterogeneity kwa ONSE ndipo kenako powapatsa dongosolo la mayiko cytological gulu ndi zinthu prognostic, kufalitsidwa kwa odwala magulu, kupanga mapulogalamu kusiyanitsidwa. Chofunika kwambiri anali gulu la kafukufuku multicenter kafukufuku wa pharmacokinetics wa cytostatics osiyana kwa regimens aluso chemotherapeutic, komanso kukula mofulumira zochitika m'munsili.

zoyamba za chithandizo

Zikomo zochita tafotokozazi, mapulogalamu analengedwa m'badwo himiolecheniya latsopano. ndondomeko kwambiri ntchito masiku ano mfundo cha koyamba mankhwala tima, cholinga chimene ndi kudzapeza chiwonongeko cha dziwe maselo nthenda. Pa mtima wa chilengedwe cha achire pulogalamu ntchito ndi mu mawonekedwe a osakaniza cytostatics, motsatizana (kasinthasintha), mkulu-mlingo chemotherapeutic regimens, komanso ndi tima kupewa matenda.

Features ntchito yokonzekera

Waukulu zochiritsa ndi njira zoyezera ndi neuroleukemia intrathecal ndi amatanthauza "Prednisolone" "Cytosar", "Methotrexate" (mu Mlingo mogwirizana ndi msinkhu) ndi cranial walitsa. inawo ikuchitika mu magawo oyambirira mankhwala. Pamene endolyumbalno mankhwala kutumikiridwa "MTX" ali ndi zotsatira zokhudza zonse. Pa nkhani imeneyi, pofuna kuchepetsa chotupa misa ayenera kukhala likhale oyambirira woyamba achire lumbar puncture. Cranial walitsa mavuto kutali ndi mwachindunji mbali. Pa nkhani imeneyi, maphunziro pa kukhathamiritsa mankhwala ONSE, anachititsa lero, umalimbana kuchepetsa mlingo ndi Kugawilidwa kwanthaka bwino odwala mu gulu otsika chiopsezo, zimene cheza mankhwala si chofunika. zikayenda zonsezi zathandiza mu Mipingo mochedwa Mu zaka zapitazo ali wokonzeka kuthana ndi 70 peresenti chotchinga zaka zisanu mlingo apulumuke khansa ana popanda musabise.

Modern mapulogalamu achire

A mankhwala ntchito lero tiyenera magawo angapo. Woyamba ndi kupatsidwa ulemu wa chikhululukiro ndi nthumwi zitatu kapena ambiri kutumikiridwa kwa masabata 4-6. The chachiwiri - ndi kuphatikiza la Mipikisano wothandizira wa gawo m'mbuyomu. Chachitatu - yokonza mankhwala. Monga ulamuliro, gawo lotsiriza la odana metabolites ntchito kwa zaka 2-3. Kuthandiza mankhwala kumathandiza ndi kuthetsa zambiri za mavuto kugwirizana ndi cytopenia anachititsa ndi immunosuppression. Kufunika ntchito yokonza mankhwala kwa zaka 2-3 zatsimikiziridwa ngakhale mu zaka za m'ma lomaliza. Bwinobwino pa nthawi tsiku lililonse wodwala amatenga mankhwala "6-Markaptopuriin". Mlungu uliwonse anayambitsa njira "Methotrexate". Malinga ndi kuchuluka kwa maselo chili mlingo. Khalani limasonyeza kuti odwala zogwira mtima tolerability ya chakudya chimenechi achire. Akuphedwa ntchito mothandizidwa ndi 80% ya m'buku chofunika imatengedwa kuti ndi osauka prognostic Chinthu kuti zisadzachitikenso.

Kuti mudziwe zambiri,

Pali mavuto pa matenda a ONSE. Makamaka ambiri odwala mutated chotupa selo oyeserera kugonjetsedwa ndi mankhwala amphamvu, kukwera mtengo ndi zochitika za zotsatira mochedwa mbali (matenda neuroendocrine, kukula kwa zotupa sekondale). Kulephera kwa mankhwala kupatsidwa ulemu odwala chifukwa msanga chifukwa mavuto poizoni kapena chotupa kugonjetsedwa. Komanso okha kwambiri njira kwa mankhwala a odwala amene salabadira chithandizo muyezo. Monga njira ndi njira ntchito monga "Teniposide" "Vepeside" "Cytosar". Today 70% la ana 5 chaka chikhululukiro. Pachimake lymphoblastic khansa akuluakulu recurs mu nkhani iliyonse chiwiri. Zimenezi zikusonyeza kuti nthawi ya nyengo ya chikhululukiro n'zotheka kukwaniritsa 20% ya milandu. Monga ulamuliro, adzabwerenso kudwala anamuona pa zaka 2 pambuyo matenda. Chikhululukiro chikhalidwe yodziwika monga kusowa mphamvu maselo magazi, pamaso pa osachepera 5% mabomba mu mafupa minofu, maonekedwe a zizindikiro za ayambe hematopoiesis ponseponse. Mu kusanthula madzimadzi cerebrospinal anaulula osachepera 5 mononuclear maselo / microliter. Pakuti bwino chithandizo kulephera mofulumira udindo chikhululukiro. 90% odwala amakhala maselo nthenda amazindikira mankhwala amphamvu.

pomaliza

Cholinga chachikulu cha mankhwala ndi lichotse kudwala mtima ndipo ulendo wake wobwerera ku moyo wabwinobwino chikhalidwe ndi thanzi labwino ndi osachepera mavuto chifukwa cha mankhwala. Pofuna kukwaniritsa izi kovuta lero. Ichi ndi chifukwa chakuti ambiri mwa mankhwala antileukemic si kusankha kwambiri ndi poizoni. Komabe, kudziwa zambiri za matenda ndi kwachilengedwenso heterogeneity matendawa, anapitiriza maphunziro osiyanasiyana chiyembekezo kuti pathogenesis maselo a matenda adakali kuwerenga mpaka kumapeto. Pankhaniyi, chidziwitso cha njira za kusintha zilonda chingathandize kukulitsa njira aluso ndi zochepa poizoni.