Cancer yePancost: Zvinokonzera, Zviratidzo, Kuongororwa uye Kurapwa

Cancer yePancost chirwere chinoputika chinowanikwa munzvimbo yepamusoro sulcus yemapapu. Pachiratidzo chechirwere ichocho chakafanana nehutachivha, chipfeko, echinococcus, pneumonia, matumire akanaka uye zvimwe zvirwere.

Zita rokuti Pancosta tumor rakatumidzwa zita remusayendisiti wenyika Henry K. Pancost. Akanga ari wekutanga kune avo vaaishanda navo kurondedzera chirwere ichi zvakadzama. Izvi zvakaitika muna 1924.

Mukuwedzera kune hutachiona hwehutachiona, zviratidzo zvakafanana zvinogona kukonzera dzimwe zvirwere zvinokonzera uye zvinokonzerwa nehutachiona, zvakare zviri munzvimbo yepamusoro yemapapu. Ichi chiitiko chainzi Pancost syndrome.

Kukurumidza kwechinetso chekenza yePancost iri mukutambudzika kwekutsvaga kwacho kutanga kwekuona nzvimbo chaiyo yechirwere, yakavharwa nemapfupa emapfupa. Kunyangwe nerubatsiro rwechirwere chemafirosi, inowanikwa mumakiriniki ezvemazuva ano, mumatambo ekutanga hausi kurega nguva dzose kukurumidza kuziva chirwere chacho.

Zvinokonzera kenza yepamusoro pepapu

Muzhinji, kuonekwa kwekenza yepancostic kunosangana nezvikonzero zvakafanana nekenza yemapapu yemamwe marudzi. Chii ichi? Chikonzero chikuru chekuratidzwa kwaro kusvuta: kushanda kana kusatenda. Basa rinokosha rinotaridzwa nenhamba yefodya yakasvuta zuva nezuva, kunaka kwefodya yakashandiswa, uye nguva yakareba yekusvuta. Zvakakosha kuziva kuti kana iwe ukarega kukanganisa, munhu anosiya nzvimbo yengozi pashure pemakore gumi.

Kuiswa pachena kune chirwere ichi kunogonawo kuva vanhu vasingatambudziki nekuda kusvuta. Iroji yekenza yePancost kenza yevasingadi kusvuta inokwira muna 1,7-2 nguva. Vana nevechiri kuyaruka, vane vabereki vanotsvaira nguva dzose pamberi pavo, vanowirawo muboka risina ngozi. Kusvuta fodya mu 85% yematambudziko ndicho chikonzero chekenza yepamusoro wepapu.

Mukuwedzera kune kusvuta, zvakatipoteredza uye zvigadzirwa zvemabhizimisi zvinogona kukonzera kenza yePankost. Kana ichiiswa kune zvinhu zvakadai semishonga inouraya, asbestos, zvinorema zvesimbi, arsenic, nickel kana chromium, muzana wevanhu vane kenza yepancostic inowedzerawo.

Basa rezvirwere zvakasiyana-siyana zvepemmune muAmnnesnesis zvakare rakakura: tuberculosis, pneumonia yakatorwa uye bronchiectasis, izvi zvose zvinowedzera mukana wekuonekwa kwechirwere chePancoast mumunhu.

Ichi chirwere chinokanganisa varume katatu kakawanda kakawanda kupfuura vakadzi, uye inozviratidza pashure pemakore makumi mashanu. Zvinoratidzwa kuti kusarudzwa kwekenza yePankost inoparidzirwa uye pajini yepamusoro.

Muzhinji, pane zvimwe zvinhu zvinokosha zvinokonzera kutanga kwekenza yepancostic:

• Age;
• Kusvuta;
• Zvakaitika mumamiriro ezvinhu munharaunda;
• Basa rezvemhizha mune zvekuvaka kana zvemakemikari indasitiri;
• Heredity.

Zviratidzo zvekenza

Kakawanda murwere anotsvaka rubatsiro nechokutanga chakatangira chirwere chacho. Dambudziko iri rinosanganiswa nekusavapo kwezviratidzo mumatangiro ekutanga: murwere haana hukomba, hemoptysis uye, inonyanya kukosha, kuoneka kwechiremera chemuviri mumhando yemakoni pamuviri. Pain incology yematanho ekutanga, sekutonga, usaratidze.

Zviratidzo chete zvinotyisa mu1 st uye 2 nditeguru zvekenza ndezvekushaya simba, nguva dzose kuneta, kuora kurasikirwa.

Syndromes of Pancost uye Horner

Nekuwedzera kwechirwere ichi, kune kuratidzwa kwePancost uye Horner syndromes, zvose zviri zviviri uye zvakabatana. Iwe unoda kuziva pamusoro peizvi.

Pancost syndrome inoratidzira muzviverengero zvezvi zviratidzo zvinotevera:

• Kutambudzika kwakanyanya kunokonzera kune rumwe rutivi rwechiremera panzvimbo - munharaunda yefudzi, pamwe nemironda yegunyu uye pasi pe scapula;
• Utera hwemasimba ezviso kune rumwe rutivi rwakavhiringidzika rwemuviri, paresthesia, kushaya simba kweminwe, musero atrophy yemuyo;
• Kuchinja kwezwi - kutaridzika kwekutyisa, kukwezva.

Apo bundu racho rinoratidzirwa kuva netsitsi, Honder's syndrome inoratidza ichi:

• Kuregererwa kweiyodhi yepamusoro (ptosis);
• Anhidrosis wechikamu chepamusoro uye chikamu chechiso nechiso chinokanganiswa nechemberi;
• Kuomeswa kwevadzidzi (miosis) uye kusvibiswa kweziso reziso (ethnophthalmus).

Kazhinji, kenza yePancost inopindirana nehutano hwehutsika vena cava pamusana wezvinetso pairi. Iyi syndrome inopindirana nezviratidzo zvinotevera:

• Chipfuva chepfu;
• Cough;
• Kufema kubata;
• Musoro uye kuwedzera kukurumidza;
• Kupopota kana kufema.

Kuongororwa kwemukenza wemapapu

Sezvatotaurwa pamusoro apa, kuongororwa kwechirwere chacho kwakaoma, nokuti mumatanho ekutanga echirwere, Pancoast haigoni kuona kunyange kuongorora kwe X-ray nokuti chiremera panzvimbo yekugara kwayo hachioneki.

Sezvo mutemo, varwere vanotanga kuenda kune imwe nyanzvi yezveuropiyo kana chiremba wechiremba ane zvikwangwani zvekutambudzika mukati memakumbo okumusoro uye pashure pekunge izvozvo zvichitambira kugamuchirwa kune vanyori-oncologists.

Zvichipa kuti chirwere chinotyisa pane zviratidzo zvayo chakafanana nezvimwe zvirwere zveBronchopulmonary system, kuongorora kwayo kunofanira kunge kwakakwana uye kunosanganisira mhando dzekuongorora:

1. Rhidhijaya - inogadza kuvapo kwechirwere pane zvikamu zvenguva pfupi nekuda kwekuwedzerwa kwezwi uye kuonekwa kwemafuro.
2. Computer tomography uye MRI-inotarisa kuwanda kwekubatanidzwa kwemidziyo, nenyundo, lymph nodes, vertebrae mukuita. Migumisiro yezvidzidzo izvi ndeimwe yezvinonyanya kukosha. Zvinoratidza kuvepo kwekuvhiyiwa.
3. Lymph node biopsy - inobvumira kutsanangurira danho rekuvandudzwa kwehutano.
4. Kuongororwa kweRopa - kunotarisa mamiriro emuviri pamwe chete.

Uyewo sekuwedzera kwekuongororwa kwebonchoscopy inoitwa (iyo inotarisa nzvimbo yebronchi uye trachea pedyo nenharaunda yakakanganiswa), arteriogram uye phlebogram (kuongorora mamiriro emavheya uye masheti mune nzvimbo ye clavicle).

Kurapa kwemukenza wemapapu

Kurapa kwekenza yepancostic inowanzoitika mumakiriniki chaiwo, asi chinonyanya kukosha ndechokuoma kwechirapa. Sezvo nhamba dzichiratidza, kenza yepancostic inonyanya kuonekwa pamusana wechitatu, apo marwadzo nehutachiona hwemhando iyi haagadziriswi. Kurapa munyaya iyi kunofanira kutanga nekutora mishonga inorwadza, kusanganisira narcotic analgesics.

Iyo nzira huru yekurapa tumarara yePancost ndeyikuti:

• Chemotherapy;
• Radiation therapy;
• Operative intervention.

Preoperative therapy

Chirwere chacho chinorapwa mumatanho akawanda: preoperative uye postoperative kurapwa, chirwere chinopindira.

Preoperative therapy is complex of chemotherapy and radiation, necessary to reduce the tumor and prevent the spread of metastases to the lymph nodes. Izvi zvinokubvumira kuita chirongwa chakanga chisingaitiki musati wadaro kurapwa.

Radiation therapy inogonawo kushandiswa senzira yekuzvimirira yekuzvidzivirira, apo kupindira kwekuvhiya hakugoneki. Kushandiswa kwechirwere munyaya ino kunoderedza marwadzo mumurwere, asi hahupikisi nguva yeupenyu.

Zvose radiotherapy uye chemotherapy zvinowanikwa mumatanho akawanda, nekuputsika pakati pavo mumavhiki maviri. Mushure mekuita radiotherapy uye chemotherapy, murwere anopiwa chirongwa chechipiri, maererano nechokupedzisira chinogadzirwa pamusoro pekugona kwekupindira.

Iko kukurumidzira kwebasa mukurapa mutsa wemapapu

Kurapa kushandiswa hakusi nguva dzose kunowanikwa mumatambudziko ose: kana pasina chivimbo chakazara chokuti hutano hwemurwere hunomubvumira kuti adzokerezve kushanda, kana kuti kune dzimwe nzvimbo dzakawanda dzomuviri dzakabviswa kubva pachirwere zvinoshungurudzwa, hazvina maturo kutungamirira kupindira. Kuparara kwehutano hwehutsika hwakadaro husina hanya nemurwere hushoma.

Mune zvimwe zviitiko, kana kuvhiyiwa kuchibvira, pane zvingasarudzwa zvekuitungamirira:

1. Pneumoectomy - kubviswa kwehuwandu hwemapapu akanganiswa.
2. Kuramba kwechikamu chemapapu.

Nekukura kukuru kwechirwere, zvinokwanisika kubvisa mitsara yakawanda uye vertebrae, midziyo, rufuro rusvingo, brachial plexus. Muzviitiko zvisingawanzoitiki, murwere anofanira kupiwa kuiswa kwemasimba ekumusoro.

Mushure mokuvhiyiwa, radiotherapy uye chemotherapy zvinowanikwawo kuti "kupedza" tumarara masero kuitira kuti tisaiti kuitika kwekudzoka zvakare.

Zviratidzo zvekenza yepamusoro yemukati

Kuponeswa kwevarwere vakapukunyuka kenza yepancostic, zvakananga kunobva pane imwe nzvimbo apo chirwere chacho chave chichionekwa.

Muzvirwere zvinowanikwa pachikamu chekutanga chechirwere, kupona kwaro kunenge 60%, mumutambo wechipiri - kwete kupfuura 40%, uye painoongororwa pachikamu chetatu chekenza, 20% chete yevarwere vanokunda muganhu wemakore mashanu.

Pamuganhu wechina, kenza yePancost inenge isingagoni kuraswa: muna 98% yematambudziko, rufu runoitika mwedzi 6-7 mushure mokurapa.