Hepatocellular carcinoma ndi khansa yodziwika kwambiri yachiwindi. Zimakhudza anthu ambiri akumayiko akumadzulo, nthawi zambiri amakhala ndi matenda a cirrhosis kapena matenda ena a chiwindi. Ngakhale kuti chithandizo chamankhwala chikupita patsogolo, nthawi zambiri chimapha.

Tanthauzo

Hepatocellular carcinoma (yotchulidwa ndi chidule cha CHC) ndi khansa yomwe imayamba kuchokera ku maselo a chiwindi. Chifukwa chake ndi khansa yayikulu yachiwindi, mosiyana ndi zomwe zimatchedwa "zachiwiri" za khansa zomwe zimafanana ndi khansa ya metastatic yomwe imapezeka kwina kulikonse m'thupi.

Zimayambitsa

Nthawi zambiri, hepatocellular carcinoma imayamba chifukwa cha chiwindi cha chiwindi, chotsatira cha matenda a chiwindi: viral hepatitis, alcoholic hepatitis, autoimmune hepatitis, etc.

Izi matenda enaake yodziwika ndi aakulu kutupa kwa chiwindi limodzi ndi chiwonongeko cha chiwindi maselo. Kusinthika kosalamulirika kwa maselo owonongeka kumabweretsa kuoneka kwa tinthu tating'onoting'ono ndi minofu ya fibrous (fibrosis). Zotupazi zimalimbikitsa kusintha kwa chotupa cha maselo a chiwindi ndi carcinogenesis (kupanga chotupa choyipa cha chiwindi).

matenda

Kuwunika kwa hepatic carcinoma nthawi zambiri kumatengera kuzindikira kwa nodule pa ultrasound kwa odwala omwe amayang'aniridwa kuti ali ndi matenda a chiwindi. 

Ngati chotupa chapita patsogolo, matendawa angaganizidwenso pamene zizindikiro zikuwonekera.

ZITHUNZI

Matendawa amatsimikiziridwa ndi kuyesedwa kwina kwa zithunzi. Dokotala adzayitanitsa jambulani pamimba (helical scan), nthawi zina MRI ndi / kapena ultrasound yosiyana. 

Kuwunika kwa kukula kwa chotupa kumatha kuyitanitsa MRI yapamimba ndi thoracic kapena thoraco-mimba CT scan. Doppler ultrasound angagwiritsidwe ntchito kuyesa magazi a portal abnormalities chifukwa cha khansa. Nthawi zambiri, PET scan imapangidwa kuti iwonetse bwino chotupacho ndikuyang'ana momwe zingathere kufalikira kunja kwa chiwindi.

Kuyeza kwachilengedwe

Pafupifupi theka la hepatocellular carcinomas, kuyezetsa magazi kumawonetsa kuchuluka kwa alfafoetoprotein (AFP), yomwe imatulutsidwa ndi chotupacho.

biopsy

Kuwunika zitsanzo za minofu ya chotupa kumathandiza kupewa zolakwika za matenda ndikuwonetsa chotupa cha chiwindi kuti chiwongolere chithandizo.

Anthu okhudzidwa

Hepatocellular carcinoma ndi khansa yachiwindi yodziwika kwambiri. Ndilo nambala yachisanu yomwe imayambitsa khansa padziko lonse lapansi komanso yachitatu yomwe imayambitsa kufa kwa khansa.

Kum'mwera chakum'mawa kwa Asia ndi ku Africa, matendawa amatha kukhudza achinyamata omwe ali ndi matenda a chiwindi cha mtundu wa B.

M’maiko a Kumadzulo, kumene nthaŵi zina amagwirizanitsidwa ndi matenda a chiwindi a C koma kumene amakhalabe chotulukapo cha nthenda ya cirrhosis yoledzeretsa kaŵirikaŵiri, inakula kwambiri kuyambira m’ma 1980. 

Ku France, chiwerengero cha milandu yatsopano yomwe idapezeka chaka chilichonse idakwera kuchokera ku 1800 mu 1980 mpaka 7100 mu 2008 mpaka 8723 mu 2012. Kuwonjezeka kumeneku mosakayikira kukuwonetsanso pang'ono kusintha kwa matenda ndi kuwongolera bwino kwa zovuta zina za cirrhosis. Malinga ndi National Institute for Public Health Surveillance (InVS), kuchuluka kwa milandu yatsopano mu 2012 kunali 12,1 / 100 mwa amuna ndi 000 / 2,4 mwa akazi.

Ngakhale kuwongolera bwino kwa mliri wa hepatitis B komanso kuchepa kwakumwa mowa, hepatocellular carcinoma idakali vuto lalikulu laumoyo wa anthu masiku ano.

Zowopsa

Zaka zopitirira zaka 55, kugonana kwa amuna ndi matenda a cirrhosis ndizomwe zimayambitsa chiopsezo cha hepatocellular carcinoma. Ku France, kumwa mowa mopitirira muyeso kumakhalabe chiwopsezo chachikulu cha matenda a cirrhosis, motero khansa ya chiwindi.

Kunenepa kwambiri komanso zovuta zomwe zimagwirizana ndi kagayidwe kachakudya, zomwe zimalimbikitsa matenda a chiwindi chamafuta ("chiwindi chamafuta"), zimalumikizidwanso ndi chiopsezo chowonjezeka cha khansa ya chiwindi.

Ziwopsezo zina zitha kulowererapo:

• kusuta,
• kukhudzana ndi zinthu zina zakupha (aflatoxins, thorium dioxide, vinyl chloride, plutonium, etc.),
• matenda amtundu wina wa fluke,
• matenda ashuga,
• hemochromatosis (matenda a majini omwe amachititsa kuti iron ichuluke m'chiwindi).

Hepatocellular carcinoma imatha kupita mwakachetechete kwa nthawi yayitali. Zizindikiro zimawonekera mochedwa, pamlingo wapamwamba wa chotupacho, ndipo nthawi zambiri sizikhala za khansa yokhayo. Amayamba chifukwa cha matenda enaake kapena kutsekeka kwa mtsempha wa portal ndi / kapena ma ducts a bile.

ululu

Nthawi zambiri zimakhala zowawa kwambiri m'dera la epigastric. Zowawa zakuthwa sizichitikachitika.

Jaundice

Jaundice (jaundice), yomwe imapangitsa khungu ndi zoyera za maso kuoneka zachikasu, zimachitika chifukwa cha kuchuluka kwa bilirubin ( bile pigment) m'magazi.  

Kutuluka kwa m'mimba

Cirrhosis, komanso hepatocellular carcinoma yokha, ndizomwe zimayambitsa ascites, zomwe zimadziwika ndi kutuluka kwa madzi m'mimba.

Zizindikiro zina:

• kutuluka kwa magazi m'mimba mwa kupasuka kwa chotupacho,
• kusokonezeka kwa ntchito zam'mimba (kusowa kwa njala, mpweya, kutsegula m'mimba kapena kudzimbidwa, etc.),
• matenda,
• kupuma movutikira chifukwa cha chotupa chachikulu chomwe chikanikizira pa diaphragm
• kuwonongeka kwa thanzi…

Kasamalidwe kamankhwala amasiyanasiyana malinga ndi mawonekedwe a chotupacho, makamaka kufalikira kwake, momwe chiwindi chimakhalira komanso thanzi la wodwalayo. M'makhansa apamwamba kwambiri, matendawa amakhalabe opanda chiyembekezo ngakhale kuti njira zochiritsira zapita patsogolo.

Kuwedza kwa chiwindi

Amapereka chithandizo chochizira chotupacho komanso chomwe chimayambitsa - cirrhosis - ndipo nthawi zambiri chimalola machiritso, malinga ngati wodwalayo akwaniritsa zofunikira zogawidwira:

• chotupa chodziwika bwino: 1 nodule mpaka 6 cm m'mimba mwake, kapena tinthu tating'onoting'ono tosakwana 4 cm ngati mulingo wa alphafoetoprotein ndi wosakwana 3 ng / ml,
• kusowa kwa mitsempha ya chiwindi (portal kapena hepatic thrombosis),
• palibe contraindication: uchidakwa yogwira, wodwala yemwe ali wokalamba kwambiri kapena wathanzi, kugwirizana pathologies, etc.

Ku France, pafupifupi 10% ya odwala angakhale oyenera kuikidwa. Pakuchepa kwa ma grafts, zimachitika mu 3 mpaka 4% mwa iwo. Njira zina nthawi zina zimakhala zotheka, mwachitsanzo, kuikidwa kwa hemifoie chifukwa cha chopereka cha banja kapena wopereka wakufa kapena chiwindi chonyamula amyloid neuropathy, chomwe chimagwira ntchito bwino koma chingayambitse zaka zambiri za matenda a mitsempha. 

Zovuta zake ndi za kumuika kulikonse.

Chemoembolization

Mankhwalawa amatha kukhala chithandizo chodikirira kuti amuike, ndipo amatha kubwerezedwa miyezi iwiri kapena itatu iliyonse. Amaphatikiza mankhwala amphamvu omwe amabayidwa kudzera munjira yolumikizira ndi embolization, mwachitsanzo, kutsekeka kwakanthawi kwa mtsempha wamagazi wokha kapena nthambi zomwe zimapatsa chotupacho ndi "embolization agents". Kupanda magazi, kukula kwa chotupa kumachepa, ndipo kukula kwa chotupacho kumatha kuchepetsedwa kwambiri.

Njira zowonongera m'deralo ndi ma radiofrequency (zotupa zosakwana 2 cm) kapena ma microwave (zotupa za 2 mpaka 4 cm) zimafuna mawonekedwe abwino a chotupacho. Mankhwalawa amachitidwa m'chipinda cha opaleshoni, pansi pa anesthesia. Pali contraindications, kuphatikizapo ascites kapena otsika kwambiri kupatsidwa magazi kuwerengera.

opaleshoni

Kusankha kuchita opaleshoni kuchotsa chotupacho kumadalira, mwa zina, malo omwe ali ndi carcinoma ndi momwe wodwalayo alili. Nthawi zambiri, kulowererapo kumasungidwa kwa zotupa zowoneka bwino osati zazikulu kwambiri (wodwalayo ayenera kusunga minofu yachiwindi yokwanira). Kuchita bwino ndikwabwino.

Kunja radiotherapy ndi njira ina m`malo chiwonongeko cha kwa chiwindi carcinoma kupereka limodzi nodule zosakwana 3 cm, makamaka kumtunda kwa chiwindi. Pamafunika magawo angapo.

Classical intravenous chemotherapy sizothandiza kwambiri, makamaka popeza matenda a chiwindi amafunikira mlingo wochepa. Kwa zaka khumi kapena kuposerapo, njira zochizira khansa zakhala zikuyambitsidwa pochiza hepatocellular carcinomas. Ma antiangiogenic agents omwe amaperekedwa pakamwa (Sorafenib kapena mamolekyu ena) amagwiritsidwa ntchito makamaka, omwe amalepheretsa kukula kwa timitsempha tating'onoting'ono tomwe timadyetsa chotupacho. Awa ndi mankhwala ochepetsa mphamvu, omwe amapangitsa kuti munthu akhale ndi moyo wautali.

Kupewa kwa hepatocellular carcinoma kumakhala makamaka polimbana ndi uchidakwa. Ndikoyenera kuchepetsa kumwa mowa mpaka zakumwa zitatu patsiku kwa amuna ndi zakumwa ziwiri za amayi.

Kuwunika ndi kuyang'anira matenda a chiwindi omwe amayambitsa matenda a cirrhosis kulinso ndi gawo lofunikira. Kupewa kuipitsidwa kwa kugonana ndi mtsempha komanso katemera wa hepatitis B ndi wothandiza.

Kulimbana ndi kunenepa kwambiri kumathandizira kupewa.

Pomaliza, kuwongolera matenda am'mbuyomu ndi nkhani yofunika kwambiri pakupangitsa chithandizo chamankhwala.