Wilms 'chotupa: Zizindikiro, Chithandizo

Kunja kwa thupi palibe thupi nthawi zonse ndi m'mikhalidwe yonse kuti akhale athanzi. Mwatsoka, matenda ambiri ndi zilema anaika ngakhale utero. Pa mmodzi wa iwo tidzakambirana m'nkhani. anthu ambiri sadziwa Wilms 'chotupa. Nchiyani, ena sakudziwa nkomwe. Nkhaniyi adzayesa kuthana ndi zizindikiro, zinthu zomwe ndi njira ya chithandizo cha matenda.

Lingaliro la Wilms 'chotupa

Wilms 'chotupa kapena monga iwo ukutchedwa, nephroblastoma, amatanthauza matenda oopsa a impso, wosawoneka nthawi zambiri ana. Nthawi zambiri matenda a zaka zapakati pa zaka 2-5. Wilms 'chotupa akuluakulu ali osowa, choncho pang'ono kuphunzira.

K Mwatsoka, ana amene amadwala matenda ndi zambiri ndi kuvutika ena chitukuko. Akukhulupirira kuti mapangidwe zotupa angayambe mu utero, chifukwa kale mu masabata awiri mwanayo akhoza kudziwa zimenezo.

Wilms 'chotupa nthawi isanafalikire mbali imodzi, koma pali milandu, ndi zotupa amgwirizano aimpso. Ngati inu mukuyang'ana pa thupi odwala, mwina kudziŵika kuti pamwamba pake ndi m'goli, odulidwa mbali yapadziko lapansi ya kukha mwazi ndi necrosis, m'madera ena pali cysts. Pankhaniyi tinganene kuti wodwalayo enaake Wilms chotupa.

Poyamba, chotupacho isanafalikire mu impso. Ndi chitukuko wotsatira iye amalima mu minofu ndi ziwalo ozungulira - imfayo metastases.

siteji matenda

Izi chotupa zilonda mu chitukuko zinthu zingapo:

1. Kumayambiriro kwa nephroblastoma ndi impso chimodzi chokha. Ana mu nthawi iyi sangathe kulandira kusapeza, ndi kudandaula ayi mulibe.
2. Chotupa uyamba kufalikira kupitirira impso, koma metastases simunayambe zilipo.
3. pofuna limodzi ndi makapisozi ndi kumera ndi kugonja amakhudza ziwalo pafupi ndi lymph mfundo.
4. Anapeza metastases mu chiwindi, mapapo, mafupa.
5. Pa gawo lotsiriza la chitukuko cha Wilms chotupa ana amakhudza ndi impso ziwiri.

Inu mwina ayenera kufotokoza kuti kale chotupa amawapeza, maganizo kwabasi kundiposa akhoza wodwalayo.

symptomatology matendawa

Popeza matenda a kudwala angathe kukhala kosiyana, zizindikiro ndi kudalira pa izo zingasiyane. Nthawi zambiri, ngati pali Wilms 'chotupa zizindikiro ndi wapezeka motere:

• ambiri malaise;
• ufowoko ndi ngati mwana ali wamng'ono kwambiri, ndi zonse maso;
• kuchepetsa kudya;
• ananena kuchepetsa thupi;
• Nthawi zina, pali malungo;
• khungu amakhala wotumbululuka;
• angadwale magazi;
• kusanthula magazi chimasonyeza ndi ESR chinawonjezeka ndi kuchepetsedwa hemoglobin;
• pali mu mkodzo mukhale magazi;
• Zikavuta, izo zingaoneke kutsekeka m'matumbo, monga chotupa compresses izo.

Ngati matenda aliyense kusintha khalidwe la mwanayo, Wilms 'chotupa ana yotero. Mayi nthaŵi zonse athanso akuganiza kuti mwana kuti chinachake chalakwika.

Pamene matenda amachoka, ndiye chotupa ndi palpable manja wabwino. Pankhaniyi, mwana amavutika chifukwa pali psinjika a ziwalo pafupi, zomwe zimawalepheretsa bwinobwino. Odwala ena, izo kumawonjezera m'mimba ngati matenda Wilms 'chotupa. chithunzi pansipa chionetsero wabwino.

Pamene ambiri metastases, mwanayo akuyamba mofulumira kuonda. Nthawi zambiri, munthu amafa chifukwa cha kulephera kupuma ndiponso kutopa kwambiri. Chopambana pakutchulidwa wa metastases zimatengera, kani, osati pa kukula chotupa, koma zambiri pa zaka wodwalayo. Iwo likukhalira kuti ana aang'ono kwambiri ichi matenda mwayi bwino kuchira zonse.

Koma nthawi zambiri yekha anapezeka Wilms 'chotupa kaŵirikaŵiri limodzi ndi matenda ena kakulidwe.

Comorbidities

kawirikawiri zokwanira chotupa amawapeza ngati kupatuka okha chitukuko. Nthawi zambiri izo limodzi ndi comorbidities:

• hypospadias, pamene mkodzo anyamata lidzatsegulidwa penapake pakati pa mbolo kapena crotch ya;
• yatupa ziwalo Mwachitsanzo, lalikulu lilime;
• Phazi lina kuposa ena;
• cryptorchidism;
• pakalibe Iris wa diso (kumverera kuti mwana si atazungulira chilichonse).

Kupeza Vuto Wilms chotupa

Pamene nephroblastoma kokha pa chiyambi cha chitukuko, matenda lolondola ndi zovuta, popeza palibe zizindikiro kutchulidwa. Chifukwa cha zimenezi, nthawi zambiri kale kuyamba mankhwala pamene chophukacho chiri pa magawo 3 kapena 4.

Makolo ayenera kuwunika kwambiri udindo wa mwana, ndipo ngati pali pallor, kuthamanga kwa magazi, utachepa kamvekedwe, n'zotheka kuyesa chotupa, muyenera yomweyo kukumana kufufuza zonse. Nthawi zambiri zikuphatikizapo mitundu zotsatirazi diagnostics:

1. Analysis magazi ndi mkodzo. Opezeka mkodzo proteinuria, hematuria, ndi erythrocyte magazi sedimentation mlingo ndi kuchuluka, pali magazi.
2. Urography amalola matenda zolondola mu oposa 70% ya milandu. Simungathe kuona contours a impso, ndi pamaso pa chotupacho kuonekera kusintha pang'ono mu mawonekedwe thupi ndi kukanika.
3. Kugwiritsa ultrasound kulingalira ndi chosavuta kuchiona kukula kwa chotupa ndi malo ake.
4. Wilms 'chotupa pa ultrasound amaoneka ngati mapangidwe si yunifolomu ya cysts mkati.
5. Kugwiritsa X-ray kompyuta tomography sangathe kuona kuti chotupa mu impso chimodzi, komanso kudziwa boma wachiwiri, ndi kuona pamaso pa metastases ziwalo pafupi.
6. Chifukwa chachikulu chotupa pa nthawi zotchulidwa angiography. Izi zachitika kuti kulongosola mopitirira ndi nephroblastoma malo wachibale sitima yaikulu magazi, kotero kuti pa ntchito imene dokotala anali ndi malingaliro a zinthu.
7. Ultrasonography ndi CT angathe kudziwa mlingo wa metastasis ziwalo ndipo zimakhala.

Panopa njira yakuthandizani ali pamlingo wotere cha chitukuko kulola matenda zolondola pafupifupi 95% ya milandu. Koma 5% zolakwa zonse n'zimenenso zimachitikira Mwachitsanzo, ngati ultrasound multilokulyarnuyu chotupa kolakwika kwa Wilms 'chotupa yekha pa ntchito n'zotheka kudziwa. Pamene akupanga chindodo molondola ndi 97%, ndipo pang'ono zochepa pa RT. Ngakhale pali milandu pamene chotupa Wilms ali pamodzi ndi chotupa a.

Ndiponso, kupenda walangizidwa kudziwika metastases, ndiye kusankha machenjerero bwino chithandizo cha matenda. Ngati osauka Wilms chotupa ana, mankhwala kutumikiridwa mu nkhani iliyonse munthu, ali yense thupi ndi gawo la matenda.

Zimayambitsa nephroblastoma

Ndi molondola kunena kuti chifukwa cha chitukuko chotupa, sikutheka. Akukhulupirira kuti chifukwa cha zimenezi ndi kusintha mu DNA a maselo. Mu ochepa milandu, imafalikira kwa makolo ndi ana. Koma nthawi zambiri ofufuza samapeza ubale chibadwa ndi chitukuko cha Wilms 'chotupa.

Madokotala amakhulupirira kuti pali zinthu zina chiopsezo chopatsa zikamera wa nephroblastoma. Zikuphatikizapo zotsatirazi:

1. Female. Malinga ndi kafukufuku, atsikana nthawi zambiri amadwala matenda kusiyana ndi anyamata.
2. Cholowa motsatizana. Ngakhale milandu matenda banja n'zochepa kwambiri.
3. Kukhala mtundu Negroid. Mwa mtundu wa matenda alionse amapezeka nthawi 2 zambiri.

Ambiri, tisaiwale kuti mpaka ndiribe anakhazikitsa zimayambitsa yeniyeni ya chitukuko cha Wilms 'chotupa.

nephroblastoma chithandizo

Monga ulamuliro, mankhwala a matenda alionse kukhala anafika kumathandiza kupeza ngodya zosiyanasiyana. Popezeka Wilms chotupa ana, mankhwala wapatsidwa pa zotsatira za Kupenda histological. Akatswiri akukhulupirira kuti histology wabwino amapereka madokotala ananena zawo zabwino kwambiri. Koma zimenezi sizikutanthauza kuti nkhani zoipa kutumikira ngati mbendera kusiya mankhwala.

Ngati ife kulankhula za nephroblastoma, njira zotsatirazi ntchito pofuna kuchiza kuti:

• opaleshoni;
• radiotherapy.

Komanso ololera zotsatira zabwino chithandizo cha mankhwala Wilms 'chotupa.

Njira za chithandizo amasankhidwa payekha kwa wodwala aliyense pang'ono. Iwo kudzadalira osati pa siteji ya chitukuko chotupa, komanso pa mwana chikhalidwe thupi.

alowererepo opaleshoni

Kuchotsa impso - ndi nefroektomiya. Ndi mitundu angapo:

1. Zambiri. Pankhaniyi, dokotalayo pa ntchito kwathunthu amachotsa impso akhudzidwa. Ngati thupi chachiwiri ndi wathanzi, ndiye chikhoza ntchito "awiri".
2. Tsankho nefroektomiya. Pa opaleshoni imeneyi, dokotala amachotsa okha kansa yotupa mu impso ndi ozungulira kuwonongeka minofu. Nthawi zambiri mpheto zotero amathera ngati impso chachiwiri chachotsedwa kapena kudwala kwambiri.
3. Kwakukulu kuchotsa. Iwo anagwira osati impso ndi nyumba ozungulira, komanso ureter, ndi England adrenal. Lymph mfundo amathanso kuchotsedwa ngati muli maselo a khansa akupezeka.

Pa ntchito ya nthawi zonse tikupeza kuti minofu ozungulira chawonongeka, ndiye m'pofunika kuganizira zinthu ndi kuchotsa kuipitsidwa onse. Zikavuta, pamene nephroblastoma (Wilms 'chotupa) amakhudza impso onse pa mwanayo, m'pofunika kupulumutsa moyo wa mwanayo kuchotsa matupi awiri.

Pambuyo amgwirizano nephrectomy mwana Kwalamulidwa dialysis kutisambitsa mwazi wa poizoni. Moyo pambuyo kuchotsa impso onse angathe kuchita pokhapokha kupatsa wa limba kwa mwiniwake, amene ali kovuta kupeza. Odwala nthawi zina kwa zaka ali mu ima pamzere kwa kumuika munthu.

Pambuyo opaleshoni kuti achotse chotupa iye watumidwa kwa kusanthula, kupenda kulunjika kwa maselo a khansa, ndewu awo, mlingo wa kubalana. M'pofunika kusankha njira yabwino kwambiri mankhwala amphamvu.

Morning mankhwalawa nephroblastoma

Ngati chotupa si zotheka kuchotsa mankhwala yafupika njira zina monga kugwiritsa ntchito mankhwala amphamvu.

Pa mankhwala zotchulidwa izi mankhwala mankhwala amphamvu Zimenezi zimathandiza kuwonongedwa kwa maselo a khansa. Zochita matenda, anthu amakonda Kwalamulidwa kwa cholinga ichi:

• "Vincristine".
• "Dactinomycin".
• "Doxorubicin".

Zinthu zimenezi ndi kovuta chifukwa lake, kusintha kumachitika mu ntchito ziwalo zambiri mkati Mwachitsanzo:

• kutanganidwa ndondomeko hematopoiesis;
• kuonongeka tsitsi follicles, ndipo ichi ndi chifukwa cha imfa tsitsi pa mankhwala amphamvu;
• zowawa maselo m'mimba kuti amakwiya ndi kusowa chilakolako kusanza;
• yafupika chitetezo chokwanira kuti Limathandiza thupi kuti atengeke matenda.

Makolo ayenera asanalandire mankhwala mankhwala amphamvu kufunsa dokotala wanu za chingachitike mbali ndi kukhwimitsa zofunika kuthandiza thupi mwanayo.

Ngati mwana amakakamizidwa kusankha mankhwala apamwamba mlingo, dokotala ayenera ndikuchenjezeni inu kuti zimenezi zikhoza kuwonongedwa kwa maselo mafupa, ndipo akawapatsa kuti amaundana. Pambuyo mankhwala akhoza thawed ndi kuika mu mwana thupi, amayamba maudindo awo mwachindunji kwa kupanga maselo magazi. Popeza mafupa anavulala pa Morning, wobwezeretsedwa.

mankhwala cheza

Ngati kwambiri Wilms chotupa m'kati, chithandizo chofunika monga ndi radiotherapy. Iwo pamodzi ndi mankhwala amphamvu ngati nephroblastoma ndi magawo 3-4 chitukuko. Cheza mankhwala amathandiza kupha maselo a khansa amene "opulumuka" ndi dokotala pa opaleshoni.

Pa nthawi ya mwambo umenewo, n'kofunika kuti mwana anagona chete, monga mwachindunji pa malo chotupa akuuzidwa milimo. Ngati wodwalayo ndi laling'ono kwambiri ndi kulephera kuyenda ake kupanga mabvuto, ndiye ndondomeko musanagulitse kutumikiridwa mlingo ka mankhwala.

Walitsa amafuna kutsatira malangizo achindunji. Mfundo amene adzatumizidwa cheza, zimalembedwa utoto. Onse kuti ayenera kugwa mu zone walitsa aphimbidwa ndi zishango wapadera.

malangizo onse Komabe, amateteza mavuto kuti ndiye uka:

• nseru;
• kufooka;
• khungu likuyabwa pa malo walitsa;
• m'mimba.

dokotala Uike mankhwala kuti atsogolere alili ndi mavuto zidzachotsedwa.

Therapy malinga siteji ya matenda

Mankhwala aliwonse matenda nthawi zonse anasankha payekha. Izi ndi zoona makamaka kwa ana. Wilms chotupa imafunanso kupenda mosamala ndi kusankha njira yoyenera. Pamafunika nkhani siteji ya matenda, chitukuko osati kokha, komanso ndi zaka mwana, chikhalidwe chake, makamaka thupi.

1. Woyamba ndi wachiwiri siteji ya chitukuko chotupa pamene ndondomeko amatenda maselo a khansa impso umodzi wokha ndipo musati amasiyana ndewu, chithandizo zimatanthauza kuchotsa limba akhudzidwa ndi wotsatira mankhwala amphamvu. Mungafunike ndi radiotherapy.
2. 3 and 4 nephroblastoma siteji amafuna njira ina. Chotupa chimafikira kupitirira impso, kotero si zotheka kuchotsa popanda kumenya ziwalo pafupi. Pankhaniyi tisonyezeni kuchotsa opaleshoni ya chotupa cha kenako mankhwala amphamvu ndi walitsa.
3. Gawo 5 amakhala ndi maonekedwe a matenda mu impso onse. Agwire tsankho chotupa kuchotsa, chotero bwanji pafupi lymph mfundo. Pambuyo opaleshoni, anagwira Inde cheza ndi mankhwala amphamvu. Ngati muli ndi kuchotsa impso ziwiri, wodwala akhoza dialyzed, ndiyeno inu mukufuna kuti ndikasendeza ziwalo wathanzi.

Ana onse osiyana, ndipo aliyense anachita munthu wa chamoyo kuti chotupa mankhwala. Pamaso povomera dongosolo mankhwala, makolo ayenera nkhani anakambirana ndi dokotala. Ayenera kudziwa zimene zotsatira mankhwala pa thupi, mmene kupewa kapena kuchepetsa mavuto pa chithandizo.

mayesero chipatala

Chaka chilichonse pali njira zatsopano ndi njira zochizira matenda ena. Izi ndi zoona makamaka khansa komanso imfa kwa iwo ndi mkulu.

M'mayiko ambiri, akuluakulu komanso ana akhoza kutenga nawo mbali pa mayesero matenda chithandizo watsopano kutupa Wilms. Makolo angathe kufunsa dokotala ngati mayesero amenewa ikuchitika mu dziko lathu, pali mwayi gawo mu iwo.

Ngati Mwina pali dokotala ayenera kuulula zonse pa chitetezo cha mankhwala. Dziwani kuti nthawi zambiri nawo mavuto oterowo experimental amapereka mwayi owonjezera polimbana ndi matenda.

Koma dotolo tisatongwa kuchenjeza za chakuti m'kupita kwa chithandizo zingakhudze mmene sizimadziwika mbali zimene takomanapo kale, komanso 100% mankhwala palibe munthu angathe sitingakumane.

muyambirenso

Nkofunika osati kulimbana ndi matenda, komanso kuonetsetsa kuti analibe kumwa. Mwatsoka, izi zikuchitika kuti nephroblastoma onse pa mankhwala ndi pambuyo. Ntchito nkhani, ndipo ngati iwo ali zogwira mtima, ndiye perekani kubwerera chiwembu chemotherapeutic mankhwala:

• "Vincristine".
• "Doxorubicin".
• "Cyclophosphamide" osakaniza "dactinomycin" kapena "ifosfamide".
• "Carboplatin".

Onsewa ali osiyana, ndipo mu nkhani ya odwala ena muyambirenso kutumikiridwa mlingo mkulu mankhwala amphamvu, kenako maselo kupatsidwa zina Magazi. Best wa onse n'chakuti, ngati ife kuphatikiza opaleshoni ndi radiotherapy ndi polychemotherapy.

Wilms 'chotupa ndi mbiri za mkazi wapakati

Impso mu thupi kuchita imodzi mwa ntchito yaikulu - magazi kuyeretsa poizoni ndi mankhwala kagayidwe kachakudya. Woyembekezera, iwo ali ndi udindo awiri osati chifukwa cha mmene mayi, komanso moyo wa watsopano, kukhala chamoyo.

Ngati mayi woyembekezera opaleshoni kuti kuchotsa impso kale mimba, kuti madokotala ananena zawo kungakhale kothandiza kwambiri. akazi ambiri mopambana mimba ndi kubereka ana athanzi.

Koma pali kuchotserapo, pamene boma latsopano zingakubweretsereni kusuta. Ndiye muli ndi mimba kupulumutsa moyo wa mkazi.

Nthawi zina anakumana ana Wilms 'chotupa imfayo chitukuko cha pyelonephritis, komanso akhoza kudwala chitukuko zinchito wa mwana wosabadwayo. Ngakhale ngakhale kuti ambiri mwa zotsatira zabwino za mimba, chiopsezo metastasis ndi sohraniyaetsya zaka 10-20 pambuyo kuchotsa impso.

Kuti madokotala ananena zawo odwala ndi nephroblastoma

Kupereka Mapa zenizeni pamaso pa Wilms 'chotupa, m'pofunika amanena kukula kwake, siteji ya chitukuko ndi kusanthula histological. The akumane kwambiri ndi kukhalapo kwa chotupa chachikulu kuposa 500 ga ndi 3-4 siteji ya chitukuko ndi histology osauka.

Ngati chinaneneratu Integrated dera mankhwala okwanira, wodwala mlingo kupulumuka ndi pafupifupi 60%. Mu masiteji koyamba chotupa ndi amenable kuti mankhwala zambiri, kuchira amapezeka 80-90% ya anthu.

Popeza kuti miyezo wapadera wa kupewa matenda kulibe, ndiye ife tikhoza amalangiza kukumana anayendera zonse ngati mwanayo ali pangozi. The kale chotupa opezeka bwino mwayi wa kuchira.