Pheochromocytoma - ndichiyani? Pheochromocytoma: zizindikiro, matenda, mankhwala, zithunzi

The kwambiri mfundo za zosayembekezereka ya zotupa mu thupi la munthu, ngakhale chosaopsa? Kale akukwana kalipokalipo. Ndipo kulabadira zoona zimenezi ayenera kudya kwambiri, mwinamwake maso chiopsezo mavuto ukuwonjezeka kwambiri. Pachifukwa ichi, ndi bwino kuphunzira zizindikiro zoyambirira za maonekedwe a zotupa, makamaka ngati tikulankhula za mtundu osowa monga pheochromocytoma. Sitiyenera kuganizira zotsatira zokhudzana pa vuto la mankhwala wowerengeka ndi njira ina. Ulendo kwa dokotala ndi njira yodalirika.

Pheochromocytoma - ndichiyani?

Mawu amenewa ayenera kumvetsa ngati chotupa ndi zilonda kapena chosaopsa chikhalidwe lopangidwa ndi maselo chromaffin, imene chakudya makatekolamaini. Ungatithandize amines onse biogenic ndi mapeputisayidi monga norepinephrine ndi dopamine.

Nthawi zambiri (90%) a mtundu umenewu chotupa akufotokozera mu medulla adrenal, makamakanso chikuoneka anakonza thupi kung'ambika, mafupa a chiuno, m'mimba kapena thoracic patsekeke. Zikamera wa pheochromocytoma mu mutu kapena khosi dera akhoza zimachitika m'gulu la kuchotserapo.

10% milandu onse a mtundu umenewu chotupa ndi zilonda extraadrenal kutanthauzira. Choncho pali yopanga dopamine. Koma ndondomeko metastasis pa vuto, maselo chotupa kugwa, kawirikawiri mu mapapo, chiwindi, mafupa, minofu, ndi mfundo dera lymph.

Chifukwa zikamera ndi kukula

Ambiri amva za matenda monga pheochromocytoma. Chimene icho chiri, mwatsoka, osati aliyense amadziwa. Nkofunika kumvetsa chifukwa vuto kumachitika m'thupi la munthu. Ndipo kenaka tisaiwale kuti bwino yankho mabuku okhudza chifukwa cha panobe. Koma chifukwa cha maphunziro tapangidwa mfundo zina zokhudza chikhalidwe cha majini a pheochromocytoma.

Nthawi zambiri matendawa amapezeka anthu zaka 25 mpaka 50. Kwenikweni, kupanga mtundu wa chotupa chili mu akazi pakati-zaka. Ngati ife kulankhula za ana, monga matenda ndi wamkulu anyamata. Koma ambiri, pheochromocytoma chotupa - chodabwitsa n'chosoŵa.

Pafupifupi 10% ya chiwerengero cha mavuto amenewa anafotokoza kuti mawonekedwe a m'banja lako. Izi zikutanthauza kuti mtundu uwu wa chotupa analipo mmodzi wa makolo a wodwalayo.

Kupitiriza tione zimene zimayambitsa mtundu uwu matenda, ndi Dziwani kuti akhoza kukhala mmodzi wa zigawo zikuluzikulu za matenda a angapo endocrine neoplasia (mtundu 2A ndi 2B). Pheochromocytoma anakonza 1% odwala matenda ndi zovuta diastolic magazi.

symptomatology

Mu kuphunzira zotupa monga pheochromocytoma, zizindikiro, matenda ndi mankhwala ziri zofunikira kudziwa midadada, moti kulingalira za phunziro kuchokera kumathandiza kupeza ngodya zosiyanasiyana. Koma ayenera kuyamba ndi maonekedwe a matenda. Symptomatology ndi osiyanasiyana ndithu ndipo amaona ngati mavuto zochepa oopsa thanzi.

Muyenera kuyamba ndi chakuti pali chizindikiro chimodzi kuti ndi wolimba pa matenda monga pheochromocytoma. Matenda oopsa - izi ndi zina mwa maonekedwe a chotupa mu funso. Zimatenga malo mu khola ndi krizovoe mawonekedwe. Pamene chotupa kumakhala catecholamine hypertensive mavuto, kuthamanga kwa magazi ukuwonjezeka kwambiri yokhudza ufiti. Koma mu nthawi mezhkrizovy BP zikhale zonse mkulu kapena kukhala mu osiyanasiyana yachibadwa. Wolembedwa milandu pamene pheochromocytoma anapita ndi sanasiye kutiuza mkulu, koma popanda mavuto.

Kuti mudziwe zambiri zokhudza Sitiroko

N'chinthu chanzeru kulabadira chakuti ndi vuto monga pheochromocytoma mavuto (matenda oopsa) Kawirikawiri limodzi ndi m'mimba, mtima, kagayidwe kachakudya ndi matenda neuro-maganizo. Ponena za chitukuko cha okhumudwa, tisaiwale kuti amakhala ndi zizindikiro izi: litsipa, kugwedeza, nkhawa, m'chikaiko chowakaikitsa, wotumbululuka khungu, kusanza, kupotokola ndi thukuta. Pangakhale kuphwanya mungoli, tachycardia ndi ululu mtima.

Pamene anapezeka ndi pheochromocytoma, hypertensive mavuto imfayo kusanza ndi pakamwa youma. Koma kusintha mu ukupeza wodwalayo si nthawi zonse okha. Ndi zotupa zimenezi nthawi kusintha boma la magazi. Tikuyankhula zokhudza mavuto monga lymphocytosis, hyperglycemia, leukocytosis, ndi eosinophilia.

Crease amatha lapitali mphindi zochepa kwa ola limodzi kapena kuposa. Kuti anayerekezera zimene boma ndi shutdown ake mosayembekezereka. Kuchepa magazi likugwiritsidwanso mofulumira, kotero kuti ngakhale pali chiopsezo hypotension. Pamene zizindikiro zoyambitsa zinthu zikhoza kupanga thupi, wozengereza palpation zozama za pamimba, mowa ndi mankhwala, hypothermia kapena kutenthedwa, kayendedwe lakuthwa, zipolowe maganizo ndi zinthu zina.

makamaka kuukira

Khunyu amakonda kukhala pafupipafupi osiyana. Iwo akhoza kufika nthawi 10 15 patsiku kapena kamodzi pamwezi. Ngati isanayambike mavuto aakulu mu pheochromocytoma, ndiye n'zomveka kuti kulankhula za chiopsezo chenicheni cha sitiroko, magazi mu diso, aimpso kulephera, m'mnyewa wamtima infarction, kugaŵa aneurysm kwa msempha, edema m'mapapo mwanga, ndi ena. The Vuto chachikulu kwambiri chikhalidwe ichi ndi catecholamine mantha kumaonekera mwa amavutitsa hemodynamics. Tikuyankhula zokhudza kusintha hypo- ndi oopsa, ndi chosaneneka mu chikhalidwe ndi sizingasinthe.

Choncho, pheochromocytoma - chiyani icho? Poganizira mawonetseredwe ake, ayenera tcheru amayi oyembekezera, chifukwa ali ngati chotupa akhoza masquerade monga eclampsia chisanafike eclampsia ndi toxaemia. Zotsatira za zizindikiro wotero ungayambe chowawa zakambidwa kubadwa.

N'zotheka ndi khola mawonekedwe a chotupa, imene kuthamanga kwa magazi ndi zonse mkulu. Mu chikhalidwe ichi, nthawi zambiri olembedwa kusintha mu impso, ndi fundus, ndi myocardium. Ndi zotheka kusintha mwadzidzidzi maganizo, kupweteka kwa mutu, kutopa ndiponso irritability. Mmodzi mwa odwala 10 ndi chitukuko shuga.

Pali matenda ena amene amaganizira pheochromocytoma. Ndi za matenda Raynaud matenda gallstone, syndrome Cushing, neurofibromatosis, ndi ena. Kukachitika kuti kukhala ndi chotupa zilonda, kupweteka m'mimba, pali metastasis ziwalo lakutali, ndi imfa mofulumira kulemera.

Specific mawonetseredwe matenda

Pali mbali zina za matendawa, tingayambe ena zosokonezeka. Ndi za njira izi:

• Ana anapezeka ndi pheochromocytoma nthawi zambiri akufotokozera oopsa. A kotala ya odwala ali wamng'ono ndi amodzi polydipsia, polyuria, ndi khunyu. Vuto lina zomwe zingachititse pheochromocytoma ana - wina slowdown kukula. Komanso anali adakali oyambirira ndi matenda amapanga lokha anamva amphamvu kuwonda, thukuta, kunyansidwa ndi kusanza, zipolowe pophunzitsa, ndipo vasomotor chisokonezo.
• Akazi ndi pheochromocytoma angakhale nayo kuwonongeka thanzi chifukwa mafunde a. Amayi oyembekezera kungakhale potsanzira eclampsia ndi chisanadze eclampsia.
• Pa nthawi imene chotupa ndi ili pafupi ndi mpanda wa chikhodzodzo, pokodza likhoza kulumikizidwa ndi khunyu. Palinso chiopsezo hematuria sabweretsa chisoni, kuthamanga magazi, kupweteka kwa mutu, nseru, palpitations.

njira matenda

Pofuna kudziwa mmene wodwalayo ndi matenda amaganiziridwa monga pheochromocytoma, kusanthula boma thupi liziyang'ana makamaka zizindikiro zotsatirazi: paleness wa khungu la nkhope ndi mawere, kuthamanga magazi, tachycardia, orthostatic hypotension.

Choncho m'pofunika kukhala osamala palpation wa pofuna mu nkhani ya zotupa mu khosi, kapena pamimba. Mfundo yofunika kuti zimenezi zingachititse chitukuko cha mavuto catecholamine.

Komanso, apamwamba matenda mu zotupa ngati pazikhalanso ulendo maso a. Matenda akhoza zimachitika chakuti pafupifupi 40% ya anthu akuvutika oopsa, hypertensive retinopathy ndi wapezeka, ndi mosiyanasiyana mwamphamvu.

Pali i amuzolengedwa kwa matenda a pheochromocytoma, chithunzi chimene amatithandiza kudziwa kuopsa kwa zinthu. Choncho tikulankhula za kuchepetsa makatekolamaini mu magazi, mkodzo, shuga magazi ndi chromogranin-A ku seramu magazi. Nthawi zina kukhala deta zogwirizana pa kuwonjezeka mu ndende ya timadzi parathyroid, tochepa, calcium, phosphorous, calcitonin, ndi zinthu zina.

Akamaziwononga odwala ikuchitika masiyanidwe matenda a zotupa. Tikuyankhula zokhudza matenda monga psychosis, gwero lachisokonezo, matenda oopsa, hyperthyroidism, paroxysmal tachycardia, poyizoni ndipo monyanyira mu CNS.

Kudziwa mtundu wa chotupa ndi mlingo wa chitukuko angagwiritsidwe ntchito Kujambula ndi CT, komanso kuphunzira ntchito wodwalayo mtima. Ngati pheochromocytoma amawapeza, zizindikiro, matenda ndi mankhwala - ndi zochitika zina zomwe ndi zogwirizana kwambiri monga zotupa amitundumitundu ali kudziwika yake ya mavuto ndi chithandizo mwamsanga ndi kiyi kuti ziyende bwino ntchito ndi wodwalayo.

Kodi kuchitira

Pali njira zosiyanasiyana za chikoka pa chotupacho monga zilonda ndipo si vuto. Nthawi zambiri, opaleshoni adzakhala chisankho ambiri zomveka, ngati anatulukira pheochromocytoma. Kuchotsa zidzatithandiza makamaka zogwirizana mu nkhani ya chotupa mu England adrenal.

Koma pangakhale kuchotserapo chifukwa osasamalika mtima, mitsempha ya magazi ndi kuthamanga kwa magazi. Kutenga dokotala pamene chikhalidwe choterocho kwambiri osafunika kapena n'zosayenera. Iwo likukhalira kwambiri pa zotsatira za chotero chotupa monga pheochromocytoma. Chithandizo yafupika mankhwala, amatenga masiku angapo.

Kugwiritsa ntchito mankhwala osiyana chotupa neutralization zikutanthauza kuti wodwalayo kukhala mu bedi, ndi kutenga theka pansi udindo. Kubweretsa yachibadwa magazi dokotala angakupatseni alpha-blockers. Komanso mwapadera, ndi mankhwala monga "Tropafen" ndi "phenoxybenzamine." Ngati wodwala chili mavuto hypertensive, utsogoleli apakhungu adzakhala "phentolamine" "Sodium nitroprusside" ndi mankhwala ena ofanana. Chofunika ndi chakuti pa chisanadze mankhwala n'kofunika kupulumutsa wodwalayo madzi m'thupi.

kugwiritsa opaleshoni

Ngati pheochromocytoma anali wapezeka, mankhwala ntchito scalpel amasankhidwa ndi nkhani zimene ndondomeko makamaka ndi chotupa. Ambiri amaphatikiza, transbryushinny, extraperitoneal ndi njira transthoracic.

Kukachitika kuti chotupa adzadziwire anapeza pambuyo kumupima, kuti madokotala ananena zawo ndi chithandizo opaleshoni zabwino. Kumene, pangakhale kumwa, koma iwo zimapezeka kokha mwa 13-15% ya milandu.

Koma pamene pali zotupa angapo, zinthu kwambiri zovuta. Yankho lanzeru ndi kuchotsa zotupa zonse, koma vuto lagona chakuti Mwina zotsatira bwino ndi otsika kwambiri. Ndi chifukwa chake pa nkhani ya pheochromocytomas angapo opaleshoni ikuchitika mu magawo angapo. Nthawi zina, kokha chotupa atachotsedwa pang'ono.

Koma mbali ya opaleshoni, m'kupita kwa kukhazikitsa adzakhala ntchito mwayi yekha laparotomy. Iwo anafotokoza zimenezi njira yayenda extraadrenal chotupa kutanthauzira. Ndi ofunika podziwa kuti ulamuliro wa hemodynamic (magazi ndi venous kuthamanga chapakati) umachitika mu phukusi la.

Mu kwambiri milandu pambuyo pheochromocytoma linamasuka, magazi amachepetsa. Ngati zochita za chamoyo palibe, ndiye pali zifukwa kuganiza Khrisu mapangidwe ectopic chotupa minofu.

Ngati pheochromocytoma chinapezeka mwa amayi apakati, poyamba anapanga olimba a magazi, ndipo kenako anachita gawo cesarean, kapena kutaya mimba, ndi pamenepo pokha yochotsa chotupacho yokha.

Mu nkhani ya Kupeza Vuto ndi pheochromocytoma zilonda, limene kufalitsa metastases kulandira mankhwala amphamvu ( "Dacarbazine" "Vincristine", "Cyclophosphamide").

Ambiri, ngati chotupa anali wapezeka pa siteji oyambirira, ndipo wodwala okonzeka mankhwala, mwayi kuthetsa vutoli sizovuta mkulu.

N'chiyani chingachititse kuti chimatanthauza akapsa

Ndi kukula zotupa mu thupi nthawi zonse chiopsezo n'zothandiza nkhondo. Choncho n'kofunika kudziwa, kungachititse aggravation ya boma. Ndi funso za kugonana, kusintha thupi kaimidwe, hyperventilation, Yosefera pa kayendedwe matumbo, thupi katundu, malemeredwe maganizo ndi kuthamanga kwa malo isanafalikire chotupa. Ngati inu anapezeka ndi pheochromocytoma, simukhala nawo ndi mowa, makamaka vinyo ndi mowa, komanso kudya tchizi.

Pali akhala zalembedwa milandu pamene kuukira anayamba atalandira chikonga, antidepressants tricyclic, phenothiazine ena ofanana ndi beta-blockers.

zotsatira

Motero tili ndi mutu wa "Pheochromocytoma" anali kuwuluridwa. Kodi izo, ife anayang'ana pa mwatsatanetsatane kwambiri. Patsalanso kuti mapeto zoonekeratu: vuto kwambiri moti kuchitira mopepuka. Zizindikiro woyamba tofanana zizindikiro za pheochromocytoma, m'pofunika dokotala, kukhala anapezeka ndi kuyamba chithandizo.