Computed tomography (CT) ntawm cov qog adrenal yog ib txoj kev tshawb fawb niaj hnub, qhia, maj mam tso cai tshawb pom lub sijhawm ntawm cov qog adrenal pathologies thiab txiav txim siab txog kev phais.
Lub luag haujlwm ntawm cov qog adrenal
Cov no yog cov khoom nruab nrog cev uas nyob saum toj kawg nkaus ntawm ob lub raum. Paub qhov txawv ntawm adrenal cortex (90%), nyob rau hauv lub capsule tam sim ntawd, thiab medulla. Cov qauv no raug suav hais tias yog ob lub qog endocrine sib cais, vim tias lawv tau sib cais los ntawm ib leeg los ntawm cov ntaub so ntswg capsule thiab zais cov tshuaj hormones ntawm cov haujlwm sib txawv thiab cov qauv.
Peb txheej yog qhov txawv ntawm cov khoom cortical: glomerular - tsim aldosterone, fascicular - tsim glucocorticoids (cortisone, cortisol, corticosterone), thiab reticular - pw ua kecov tshuaj hormones (txiv neej thiab poj niam). Lub medulla tsim adrenaline thiab norepinephrine.
Pathologies ntawm cov qog adrenal
Cov kab mob qog adrenal feem ntau yog:
- Hyperaldosteronism yog ib yam mob ntawm lub cev tshwm sim los ntawm kev tsim tawm ntau dhau ntawm cov tshuaj hormone aldosterone los ntawm adrenal cortex. Aldosterone tswj cov dej-ntsev metabolism: nws txhim khu cov reabsorption ntawm sodium los ntawm thawj cov zis thiab excretes poov tshuaj nyob rau hauv cov zis. Tshaj aldosterone ua rau sodium retention hauv lub cev. Txij li thaum sodium nyiam dej rau nws tus kheej, nws ua rau edema, nce cov ntshav thiab nce siab. Muaj cov laj thawj: thawj - cuam tshuam nrog kev puas tsuaj rau cov qog adrenal lawv tus kheej, theem nrab - cuam tshuam nrog kev ua haujlwm ntawm hypothalamic-pituitary system ntawm lub hlwb lossis lwm yam tsis muaj nyob hauv cov qog adrenal.
- Cortex deficiency. Hauv 98% ntawm cov neeg mob nws muaj keeb kwm autoimmune. Cov chav kawm ntawm pathology thiab cov cim qhia feem ntau yog vim tsis muaj cortisol thiab aldosterone. Kev kho mob yog kev kho tshuaj hormone hloov.
- Congenital hyperplasia ntawm adrenal cortex. Nws yog tus cwj pwm los ntawm kev tsim tawm tsis txaus ntawm corticosteroids thiab kev loj hlob ntawm adrenal cortex. Kev kho mob yog kev kho tshuaj hormone hloov.
- Pheochromocytoma yog cov qog uas zais adrenaline thiab norepinephrine. Malignant hauv 10% ntawm cov neeg mob.
Cov lus qhia rau kev suav tomography ntawm cov qog adrenal
Tus kws kho mob yuav xa mus ua CT scan ntawm cov qog adrenal yog tias:
- zoo lossis phemqog adrenal kuaj pom los ntawm ultrasound;
- qhov xav tau rau kev kuaj mob sib txawv ntawm hyperplasia thiab adenoma;
- qis dua lossis siab dua;
- kev sib sib zog nqus ntawm lub suab hauv cov poj niam, cov plaub hau loj hlob ntawm lub cev lossis lub ntsej muag;
- mis loj rau txiv neej;
- hnyav nce;
- leeg tsis muaj zog, txo cov leeg muaj zog;
- kab mob ntawm cov qog nqaij hlav hauv plab.
Dab tsi yog qhov sib txawv
CT ntawm ob lub raum thiab cov qog adrenal yog ib txwm ua los ntawm kev sib piv nruab nrab. Nws yog ib qho tsim nyog los txhim kho cov duab. Kev kuaj CT ntawm cov qog adrenal yam tsis muaj qhov sib txawv yuav tsis tso cai rau kev sib txawv ntawm ib tus neeg ntawm cov qog adrenal los ntawm cov ntaub so ntswg ib puag ncig, piv txwv li, los ntawm cov hlab ntsha ntawm tus po.
Raws li tus neeg sawv cev sib txawv, kev npaj iodine yog siv, uas tau muab tso rau hauv cov hlab ntsha lossis, thaum kuaj cov hnyuv, qhov ncauj. Rau CT ntawm cov qog adrenal nrog qhov sib txawv, cov tshuaj uas tsis yog-ionic low-osmolar npaj nrog cov ntsiab lus iodine ntawm 320-370 mg / ml yog siv. Cov tshuaj yog muab rau ntawm tus nqi ntawm 3-5 ml / s. Ib tus neeg mob hnyav 70-80 kg yuav raug txhaj nrog 70-120 ml ntawm cov tshuaj. 99% ntawm cov tshuaj tau tawm los ntawm lub raum.
YContraindications
CT yog ib txoj kev maj mam. Txawm li cas los xij, muaj qee yam txaus ntshai:
- X-rays ua rau muaj kev mob qog noj ntshav;
- tus neeg sawv cev sib txawv tuaj yeem ua rau muaj kev tsis haum;
- tus neeg sawv cev sib txawv muaj qhov tsis zoo rau lub raum.
Cov npe tau tshwm sim tau txiav txim siab cov npe ntawm cov tshuaj tiv thaiv rau CTAdrenal: Y
1. Absolute:
- cev xeeb tub, vim X-rays cuam tshuam rau kev loj hlob ntawm tus menyuam hauv plab;
- rog dhau - yog tias koj hnyav dua 120kg, xyuas seb lub tshuab CT puas muaj qhov hnyav;
- hlau prostheses lossis cog tsis tuaj yeem tshem tawm.
2. kwv tij:
- hnub nyoog txog 12 xyoos - txog peb xyoos tus menyuam yuav tsis tuaj yeem pw ntawm lub rooj ntawm lub cuab yeej, tab sis txawm rau cov menyuam loj, kev x-ray yog qhov txaus ntshai;
- hyperkinesis lossis convulsive syndrome, uas yuav tsis tso cai rau tus neeg mob tsis tuaj yeem;
- claustrophobia, mob hlwb;
- pub mis niam.
txhawm rau txo qis hluav taws xob cuam tshuam rau cov poj niam cev xeeb tub thiab menyuam yaus, txo lub sijhawm ntawm kev kawm, txo qhov tam sim no ntawm lub raj x-ray, txo cov theem ntawm tomography, nce lub sijhawm tig mus ntawm lub raj. Rau cov menyuam yaus, qee zaum, nws tuaj yeem siv sedatives. Cov qog mammary ntawm cov poj niam pub niam mis yog them nrog bismuth cov ntxaij vab tshaus.
3. Nrog qhov sib txawv:
- Kev ua xua rau cov neeg ua haujlwm sib txawv (shock, convulsions, ua pa nres) - qhia rau koj tus kws kho mob yog tias koj muaj kev fab tshuaj me me rau iodine lossis nqaij nruab deg (xeev siab, urticaria, Quincke's edema), nyob rau hauv rooj plaub twg koj yuav tsum tau nkag mus. tshuaj antiallergic (prednisolone) thiab siv cov tshuaj uas tsis yog-ionic contrast agents;
- mob hawb pob lossis kab mob ua xua;
- hnyavraum tsis ua hauj lwm - cov kab mob sib txawv hauv cov hlab ntsha tau tawm los ntawm lub raum thiab tuaj yeem cuam tshuam rau lawv txoj haujlwm;
- mob ntshav qab zib - Qhia rau koj tus kws kho mob yog tias koj noj cov tshuaj metformin, uas yog tshuaj lom rau lub raum, yog li ntawd koj yuav tsum tsis txhob noj nws qee lub sijhawm ua ntej qhov txheej txheem;
- hyperthyroidism,
- mob hnyav hnyav.
Kev Npaj rau Adrenal CT
Yog tias tsuas yog cov qog adrenal (tsis yog cov hnyuv) yuav tsum tau kuaj CT, tsis tas yuav tsum tau ntxuav lub plab lossis noj zaub mov. Yog tias CT scan ntawm cov qog adrenal nrog qhov sib txawv, nws yuav tsum tsis txhob noj 6 teev. Qhov no yuav txo tau qhov ntuav thiab xeev siab hauv cov lus teb rau qhov sib piv nruab nrab.
Npaj rau txheej txheem
A CT scan ntawm cov qog adrenal tsis pub dhau 10 feeb. Lub sijhawm no feem ntau yog siv los npaj tus neeg mob.
Npaj rau txheej txheem suav nrog:
- Hloov rau hauv lub tsho kho mob. Cov ntsiab lus nruj ntawm cov khaub ncaws zoo tib yam, xauv, khawm yuav tawm hauv cov duab ntxoov ntxoo thiab ua rau nws nyuaj rau kev kuaj mob.
- Kev tswj hwm tus neeg saib xyuas qhov sib txawv hauv cov hlab ntsha hauv qhov xwm txheej ntawm adrenal CT nrog qhov sib txawv.
Tus neeg mob yuav ntsib:
- cua sov thoob plaws lub cev;
- metal saj;
- nausea;
- sib kub hnyiab.
Cov kev xav no yuav dhau mus ob peb feeb. Nws yog qhov tsis tshua muaj tshwm sim tsis zoo rau qhov sib txawv ntawm cov hlab ntsha: Quincke's edema, ua tsis taus pa, bradycardia. Kom tshem tawm lawvAtropine, oxygen, beta-agonists, adrenaline yuav qhia. Cov tshuaj tiv thaiv hnyav - poob siab, ua pa nres, convulsions, vau - yuav tsum tau resuscitation. Tag nrho cov tshuaj tiv thaiv hnyav tshwm sim hauv 15-45 feeb tom qab txhaj tshuaj sib txawv. Yog li no, koj yuav tsum nyob rau hauv kev saib xyuas ntawm tus kws kho mob lub sijhawm no.
Qhia koj tus kws kho mob tam sim yog tias koj muaj:
- kiv taub hau;
- ntsej muag o;
- daim tawv nqaij khaus, pob khaus;
- mob qa;
- bronchospasm;
- kev tsis sib haum xeeb,
Muab tus neeg mob tso rau ntawm lub rooj tomography - koj yuav tsum tau pw ntawm koj nraub qaum nrog koj txhais tes. Txhua qhov kev txav mus los yuav ua rau cov duab fuzzy, thiab cov kab mob yuav nyuaj rau kev kuaj mob, yog li siv cov hauv ncoo lossis cov hlua khi yog tias tsim nyog.
txheej txheem
Cov txheej txheem adrenal CT nws tus kheej yuav mus zoo li no:
- Cov neeg ua haujlwm yuav tawm hauv chav ua ntej qhib lub tshuab. Koj tuaj yeem hu rau tus kws kho mob txhua lub sijhawm lossis siv lub khawm ceeb.
- Thaum tus txheej txheem, lub suab nrov me ntsis lossis tawg ntawm lub cuab yeej yuav hnov, qhov mob thiab qhov tsis xis nyob yuav tsum tsis txhob muaj.
- Thaum tus neeg mob nyob hauv lub cuab yeej, lub tshuab luam ntawv pib tig ib ncig ntawm nws. Cov duab txheej yuav pom ntawm lub computer saib - hlais 0.5-0.6 hli tuab. Thaum superimposed ntawm ib leeg, ib qho qauv peb-seem ntawm cheeb tsam adrenal tau txais. Tus neeg mob yuav tau hais kom tuav tes ob peb zaug thaum nqus pa.
- Thawj coj qee pab pawg txhaj tshuaj.
- Tom qab ntawd, qhov sib piv yog txhaj los ntawm lub catheter, cov duab raug coj mus rau hauv cov hlab ntsha thiab cov hlab ntsha, cov duab qeeb.
- Tom qabThaum kawg ntawm txoj kev, lub catheter raug tshem tawm ntawm cov leeg, tus neeg mob hloov mus rau hauv nws cov khaub ncaws.
Tus kws ntsuas hluav taws xob yuav xav tau 30-60 feeb los tshuaj xyuas cov duab thiab kos cov lus xaus nrog lub foob thiab kos npe.
Identified kab mob
Detected by CT:
- adrenal adenoma yog ib qho benign neoplasm;
- malignant neoplasms;
- lipomas, hematomas, cysts;
- adrenal tuberculosis;
- kev koom tes ntawm cov ntaub so ntswg nyob ze hauv cov txheej txheem pathological (piv txwv li, cov qog ntshav qog ntshav qab zib).
Yuav txawv ntawm CT ntawm cov qog adrenal:
1. Kore:
- hyperplasia - overgrowth;
- adenoma - benign qog;
- cortical carcinoma - mob qog noj ntshav ntawm epithelium ntawm adrenal cortex;
- mesenchymal qog (fibromas, angiomas) - benign lossis malignant qog los ntawm kev sib txuas, vascular, adipose, nqaij, thiab lwm yam nqaij mos;
- neuroectodermal qog - benign lossis malignant qog uas tsim los ntawm cov rudiments ntawm cov hlab ntsha;
- hematomas - hemorrhages;
- cysts - kab mob pathological hauv lub cev.
2. Medulla:
- chromaffin nqaij hlav;
- qog nqaij hlav tsis-chromaffin.
3. Mixed Education:
- corticomedullary adenoma;
- corticomedullary carcinoma.
Cov kab mob adrenal tau kuaj pom li cas?
Pathology ntawm cov qog adrenalpom nyob rau hauv ob kis.
1. Cov tsos mob ntawm cov tsos mob ntawm kev sib txuas ntawm cov tshuaj hormones ntau dhau.
Qhov ntau dhau ntawm txhua yam tshuaj hormones tshwm sim nws tus kheej hauv nws txoj kev. Piv txwv li, nyob rau hauv cov ntaub ntawv ntawm hyperaldosteronism (ntau tshaj aldosterone), tus neeg mob yws ntawm cov ntshav siab, ntuav, thiab cov leeg tsis muaj zog. Tom qab ntawd tus kws kho mob coj tus neeg mob mus kuaj ntshav thiab zis thiab ua ultrasound ntawm cov qog adrenal. Yog vim li cas rau cov ntsiab lus siab ntawm aldosterone tuaj yeem yog: cirrhosis ntawm daim siab nrog ascites, mob nephritis, plawv tsis ua hauj lwm, noj zaub mov tsis zoo hauv sodium, ntau cov poov tshuaj hauv cov zaub mov, toxicosis ntawm cov poj niam cev xeeb tub. Tag nrho cov xwm txheej no nce kev ua haujlwm ntawm renin, uas txhawb kev tsim cov aldosterone. Kev kuaj mob yuav raug tsim, kev kho mob yuav raug sau tseg. Tsis xav tau CT.
Yog tias qhov ua rau tseem tsis tau kuaj pom, lossis muaj cov qog adrenal pom ntawm ultrasound, tus neeg mob yuav raug xa mus rau CT ntawm ob lub raum thiab cov qog adrenal nrog qhov sib txawv. Tus neeg sawv cev sib txawv stains lub hlwb ntawm benign thiab malignant hlav txawv, uas ua rau nws muaj peev xwm paub qhov txawv ntawm ib leeg. CT yuav muab cov lus teb seb cov qog puas yog benign lossis malignant. Piv txwv li, ib qho ua rau ntau tshaj aldosterone yog adenoma ntawm glomerular cheeb tsam ntawm adrenal cortex, ib tug benign qog.
2. Kev kuaj pom ntawm cov qog adrenal thaum lub sij hawm ultrasound lossis CT scan yam tsis muaj qhov sib txawv ntawm cov kab mob hauv plab. Tus neeg mob yuav raug xa mus rau CT ntawm cov qog adrenal nrog kev txhim kho qhov sib txawv ntawm cov hlab ntsha. CT yuav muab lus teb: benign qog los yog malignant. Yog tias cov qog tau pom los ntawm lub sijhawm, raws li txoj cai, nws yog hormonally inactive.
Kev kho mob ntawm adenoma thiab lwm yam benign formations
Cov qog nqaij me me uas tsis tso cov tshuaj hormones tsis kho. Lawv raug saib xyuas los ntawm kev rov ua CT scans yam tsis muaj qhov sib txawv ib xyoos ib zaug, lawv txheeb xyuas qib ntawm cortisol thiab qee qhov ntsuas hauv cov ntshav. Piv txwv li, 20-40% ntawm cov qog kuaj pom uas nrog los ntawm qib siab ntawm aldosterone tsis raug tshem tawm. Cov qog nqaij hlav loj (ntau dua 4 cm) lossis cov qog tsim cov tshuaj hormones raug tshem tawm.
Kev phais kom tshem tawm cov qog nqaij hlav qog nqaij hlav tuaj yeem ua tau peb txoj hauv kev: qhib, laparoscopic thiab retroperitoneoscopic (lumbar). Feem ntau ua rau txoj kev qhib, txawm hais tias nws yog qhov mob siab tshaj plaws ntawm txhua tus.
Kev kho mob qog nqaij hlav
Kev kho mob tau zoo tshaj plaws rau qog nqaij hlav qog nqaij hlav qog nqaij hlav yog ua tiav kev tshem tawm. Nws yog ntshaw kom tshem tawm qhov ze tshaj plaws rau cov qog thiab cov qog nqaij hlav loj, uas yuav ua rau tus neeg mob lub neej. Thaum cov qog loj hlob mus rau hauv lub raum, lub raum kuj raug tshem tawm. Feem ntau, cov qog adrenal raug tshem tawm los ntawm txoj kev qhib. Laparoscopy tsis pom zoo rau cov qog loj dua 5 cm los yog rau cov qog nqaij hlav metastases.
