ʻO ka maʻi maʻi pancreatic kekahi o nā maʻi hoʻokaumaha loa o ke kino o ke kanaka. ʻO ka mahele o kēia mahele e pili ana i ka maʻi ma kahi o 3-4% o nā oncology āpau. No nā 40 mau makahiki, ua ʻimi ke kahunikua olakino a puni ka honua i ka maʻi kanesa pancreatic.
Akā he holomua nui, ʻaʻole naʻe i ʻike ʻia ma kēia noʻonoʻo, ʻoiai ua paʻakikī ka hoʻomaka ʻana o ka maʻi maʻi. ʻIke ʻia kahi maʻi i ka wā ʻaʻole e haʻalele ka mea maʻi i ka mea maʻi inā ʻaʻole loaʻa kahi hopena maikaʻi loa.
ʻO nā mea koʻikoʻi e hāʻawi i ka hoʻomohala ʻana i ke kanesa:
- ʻO kahiʻoihana kāne.
- He makahiki ma hope o 45 makahiki.
- Naʻi maʻi mellitus.
- ʻO ka mōʻaukala o gastrectomy.
- ʻAno maikaʻi.
- ʻO ka maʻi Gallstone.
- Ka ʻai ʻana i nā meaʻai momona.
Hōʻike pinepine ʻia ke poʻo o ke poʻo o ka lepona i ka pae 4, kahi hiki ʻole ke lawelawe, ʻaʻole ola ka mea maʻi me ia no kekahi manawa lōʻihi. Ua wehewehe ʻia kēia ʻoiaʻiʻo e kahi mea huna a me ka maluhia o ka maʻi, kahi, ʻaʻole naʻe, ka mea maʻamau, ʻaʻole mālama ʻia ka maʻi kanesa.
I kēlā mau hihia, mai nā hōʻike liʻiliʻi a hōʻemi ʻia i nā haukaʻi, he mau hebedoma a hala paha mau mahina ke hala.
Ma ʻAmelika, ʻo ka make ma ka adenocarcinoma e lawe i ka wahi 4 "hanohano" ma waena o ka maʻi maʻamau oncological; i kahi manawa mua, me ka ʻike pono i ka manawa, mālama ʻia ka maʻi kanesa, akā ʻaʻole ka hopena.
Hoʻololi molecular hoʻomohala ʻana i ka hoʻolālā adenocarcinoma
ʻOi aku ka maikaʻi o ke kaʻina neoplastic i ka mutation KRAS 2 gen, ʻoi aku hoʻi i ka 12th codon. Hōʻike ʻia kēia mau maʻi ma ka punopure biopsy e PCR.
Eia kekahi, ma ka ʻike ʻana i ka maʻi pancreatic i 60% o nā hihia, ua ʻike ʻia kahi piʻi o ka haʻi ʻōiwi p53, akā ʻaʻole kēia wale nā hōʻailona o ka maʻi pankreatic.
ʻO ka kūlike o ka poʻo i hoʻopili ʻia i ke ʻano o ke oncopathology o ka pancreatic he 60-65%. ʻO ke koena 35-40% he hana neoplastic i ka huelo a me ke kino.
Loaʻa ka Adenocarcinoma ma mua o 90% o nā hihia o ka maʻi pancreatic, akā ʻaʻole maopopo loa nā kumu o ke kano pancreatic.
Nā hiʻohiʻona hiʻohiʻona o nā tumra pancreatic
ʻO nā tumra pancreatic mai nā moku e hoʻolako ana iā lākou e paʻa ʻia me kahi o nā mea hoʻoweliweli. ʻO ka mea maʻamau, hiki i kēia ke wehewehe i ka ʻike leʻa ʻole o ka adenocarcinoma i nā hana kuʻuna o ka maʻi ma ke ʻano o ke kaupalena ʻana i nā mea ulu ulu, nā mea hoʻokipa, a me ka hoʻolohi i ka angiogenesis.
ʻO ka holomua o ka metastases e holomua ana, ʻoiai nā cytostatic i kuhikuhi ʻia. Hoʻopili ʻia kēia ʻano me nā pilikia o ke a me ka immunosuppression. Inā he hope loa ka pae, a laila hiki iā ʻoe ke noho pōkole loa me kahi hoʻonaʻauao oncological like.
Hiki i nā Tumors ke kiʻi like lāʻau like, akā mai nā ʻano anatomical ʻano like ʻole.
- Nā ʻōhua a me nā ampou a Vater;
- ʻohi a ka maʻi pancreatic;
- mukosa duodenal;
- duct epithelium;
- ka lawepule o ka maʻamau maʻamau.
Hoʻohui ʻia kēia mau maʻi āpau i loko o kahi pūʻulu i kapa ʻia ʻo ka maʻi poʻo poʻo pancreatic a i ka maʻi maʻi periampicular, ʻo ka pau hope loa o ka manawa i waiho ʻole ʻia kahi mea maʻi
ʻO nā hiʻohiʻona o ka hoʻonohonoho anatomical o ka pancreas e wehewehe i ka hoʻomaka ʻana o nā hōʻailona pathological i kahi hihia o kona mau poho. ʻO ka nui o ka pancreas mai 14 a 22 cm. ʻO kahi wahi kokoke o ke poʻo o ka papa i ka dile bile maʻamau a me ka umeke o ka ʻōpū duodenal e hōʻike ʻia ana e nā malfunctions ma loko o ka huihue.
ʻO nā hōʻailona lapaʻau nui
Inā hoʻokomo ʻia ke kīkī i loko o ke poʻo poʻo, hiki ke hōʻike ʻia i nā hōʻike aʻe ma lalo nei i ka mea maʻi.
- He mau lāwā
- ʻEha i ka ʻona hypochondrium kūpono a me ka ʻāina umbilical. Hiki i ke ʻano o ke ʻano ke ʻano like, pili ka mea i ka lōʻihi. Hoʻonui ka ʻeha ma hope o ka inu ʻana i ka wai ʻawa a ʻai ʻana i nā meaʻai i ka palaoa, ʻoiai e moe ana.
- He 80% o nā maʻi e loaʻa ʻole me ka maʻi o ka maʻi, kahi i hele pū ʻia ai e nā ʻōpū o Courvoisier, ʻo ia hoʻi, i kahi ʻole o ka biliary colic, kahi palaki poli hoʻonui nui.
- ʻO ka heleʻana o nā hua bile ma ke koko e hoʻoheheʻe ai i ka ʻeha o ka ʻili, e hōʻike ana iā ia iho i ka wā preicteric.
- Nā hōʻailona neoplastic: pilikia ka hiamoe; ka nui o ka kaumaha kaumaha; luhi wikiwiki; ka hoʻoneʻe ʻana i ka ʻai, nā palaoa a me nā mea momona.
Naʻi hoʻolika
ʻO ka nānā ʻana i ka maʻi maʻi pancreatic i ka manawa kūpono ʻaʻole i maʻalahi maʻalahi. Ka ʻike ʻike ʻike i ka CT, ka ultrasound a me MRI ma kahi o 85%, no laila ke ʻike pinepine ʻia ka papa mua.
Me ke kōkua o ka CT, hiki ke hoʻoholo i ka hele ʻana o nā nahu mai ka 3-4 cm, akā ʻaʻole i ʻāpono ʻia nā ʻōhumu o kēia noiʻi ma muli o ke ʻano ikaika o ka radiation x-ray.
Hoʻohana ʻo Retrograde endoscopic cholangiopancreatography i nā pilikia paʻakikī. ʻO nā hōʻailona o ke kano pancreatic he mea e poʻopili a i ʻole ke dement stenosis o ka kelepa ponoʻī a i ʻole ka lolo dile maʻamau. I ka hapalua o nā hihia, hiki i nā mea maʻi ke hoʻomaopopo i nā loli i nā papa ʻelua.
Ma muli o nā ʻokoʻa ʻokoʻa o ka loea e pili ana i ka hana a me ka ʻike mua aʻe o ka adenocarcinoma, ka ʻohe a me ka lymphoma o nā ʻenika islet, he kūpono ka hōʻoia ʻana o ka histological kikoʻī (hōʻoia) o ka maʻi i kēia manawa. ʻO ka ʻohi ʻia a me ka hoʻohana ʻana nā ultrasound e hiki ai iā ʻoe ke kiʻi i nā haʻawina no ka hoʻopaʻa moʻolelo.
Eia naʻe, ʻaʻole hiki ke hana ʻia ka maʻi kūpono a hiki i ka wā laparotomy. ʻAʻole hiki ke hoʻoholo i ka hana o ka compaction i ke poʻo i ka palpation ma nā maʻi ʻelua a me ka maʻi pancreatitis.
Pākuʻi ʻia ka ʻiole maʻi me nā hōʻailona o ka edema a me ka hopena mai ka maʻi pancreatitis e hoʻopuni pinepine ana i kahi nūpepa malignant. No laila, ʻaʻole maopopo kahi manaʻo o ka biopsy o nā papa papa o ka neoplasm.
Hoʻohana aʻoaʻo
Manaʻo mau ka poʻe maʻi i ka nīnau: pehea ka lōʻihi e hiki iā lākou ke noho ma hope o ka hoʻomaʻemaʻe. ʻO ka hōʻemi maʻi ʻana i kēia lā ke hana wale nō ma ke ʻano mua o ke kano e hiki mau ai ke hoʻopakele mau i ka maʻi mai kēia maʻi. ʻO ka hōʻoia ʻana o ka hana he 10-15% o nā hihia a pau inā ʻaʻole i hoʻomohala ka pae. I ke ʻano maʻalahi, hiki i kahi meaʻai no ke kano pancreatic ke hāʻawi i kahi kōkua.
ʻO ka koho hou ʻana i ka Pancododuodenal I kēia hihia, aia kahi manawa e mālama ai i ka hana pancreatic exocrine, a me ia e kōkua i ka mea maʻi e pale aku i ka hoʻomohala ʻana i ke ʻano o ka maʻi diabetes mellitus type 1, ma ia ʻano kekahi mau pane i ka nīnau o ke lōʻihi e hiki ai ʻoe ke noho.
ʻOi aku ma mua o 5 mau makahiki 15-20% o nā maʻi i loaʻa i kahi hana like like ola. ʻOiai, inā e pālahalaha nā metastases i nā nū lymph a me ka topographically kokoke i nā kino, a laila kiʻekiʻe loa ka hopena o ka hoʻi ʻana. Eia ke kamaʻilio nei mākou e pili ana i ka maʻi pālua o pancreatic o ka pae 4, ʻaʻole hāʻawi kēia ʻano i ka nui o ka manawa.
Kahi Waho
Me ka maʻi kanesa pancreatic, maikaʻi ka prognosis. ʻO ka awelika, ʻo ka poʻe maʻi maʻa aku i ke kolu ʻehā e ola no kahi 6 mau mahina. Hōʻike lākou i ka lāʻau palliative. Me ka hoʻomohala ʻana o ka jaundice, pono e hana ʻia ka wai transhepatic a endoscopic.
Inā ʻae ʻia ke ʻano o ka mea maʻi, ua hoʻopili ʻia kahi anastomosis iā ia, ka mea e pono ai e hoʻokō i ka hana kahawai, akā naʻe, ʻo ka papa hana 4 ka mea ʻaʻole i loaʻa ka manawa kūpono no ka mea maʻi.
ʻAʻole hiki iā ʻoe ke ʻae i ka ʻeha a hoʻopaʻa ʻole i kahi maʻi kūʻokoʻa. ʻO ka hoʻopili wale ʻana i ka manawa kūpono me kahi loea he hopena kūpono maikaʻi loa no ke ola.
