Muaj tsawg tus neeg xav txog qhov twg lub qog qaub ncaug nyob. Thaum nws ua haujlwm tsis tu ncua thiab tsis ua rau tsis xis nyob, lawv tsis mloog nws ntau. Salivary caj pas adenomas yuav txawv nyob rau hauv lawv cov qauv histological thiab morphological. Lawv, zoo li lwm yam neoplasms, yog malignant thiab benign. Cov qog nqaij hlav loj hlob qeeb qeeb thiab tsis pom lawv tus kheej nrog kev tsis xis nyob lossis lwm yam tsos mob. Cov qog nqaij hlav loj hlob sai, los ntshav mus rau hauv cov khoom nruab nrog cev thiab cov ntaub so ntswg, ua rau mob thiab ua rau lub ntsej muag puas tsuaj.
Definition
lub qog qaub ncaug nyob qhov twg? Ua ntej ntawm tag nrho cov, nws yog tsim nyog sau cia hais tias qhov no yog ib tug khub alveolar-serous lub cev, nyob rau hauv daim tawv nqaij down thiab anterior mus rau lub auricle. Nws lub luag haujlwm tseem ceeb yog qhov zais cia thiab khaws cov qaub ncaug. Cov kua muaj ntau ntawm sodium thiab potassium chlorides, nrog rau amylase. Nws tsim ib qho acidic ib puag ncig hauv lub qhov ncauj nrog pH qis dua 6. Ob lub qog tuaj yeem tso tawm txog li ib nrab ib liter ntawm qaub ncaug ib hnub.
Adenomas ntawm cov qog qaub ncaug yog qhov zoo, nruab nrab lossis malignant neoplasms uas tsim los ntawm me lossis loj.qog salivary. Ntawm tag nrho cov txheej txheem qog, cov qog qaub ncaug suav txog li ib feem pua. Qhov no yog ib daim duab siab heev. Kev hloov pauv tuaj yeem pib ntawm txhua lub hnub nyoog, tab sis feem ntau tshwm sim hauv cov hnub nyoog nruab nrab thiab laus (40-60 xyoo) thiab muaj ob npaug ntawm cov poj niam xws li txiv neej.
Neoplasms yog qhov ua rau mob malignancy, rov ua dua thiab metastasis, yog li lawv txaus siab rau cov kws kho hniav thiab cov kws phais mob maxillofacial.
Yog vim li cas
Vim li cas cov qog qaub ncaug adenoma tshwm sim tsis paub meej. Cov kws kho mob muaj lus pom zoo tias qhov tshwm sim ntawm qog nqaij hlav tuaj yeem cuam tshuam nrog kev raug mob yav dhau los rau thaj chaw no lossis kab mob inflammatory, nrog rau kab mob qog noj ntshav (mumps). Tab sis tsis yog txhua tus neeg mob muaj keeb kwm ntawm cov xwm txheej zoo li no.
Qee cov kws tshawb fawb tau hais tias qhov tshwm sim dystopia ntawm cov ntaub so ntswg tuaj yeem ua rau cov qog nqaij hlav qog. Tsis tas li ntawd, cov kab mob oncogenic xws li Epstein-Barr, cytomegalovirus (tshwj xeeb yog hom 16, 18, 31 thiab 32) thiab tus kab mob herpes simplex yuav tsum tsis txhob txo qis.
Tab sis cov no tsis yog txhua yam thaum lub qog qaub ncaug adenoma tuaj yeem tsim. Cov laj thawj yuav tsum tau nrhiav hauv tus neeg txoj kev ua neej (khoom haus luam yeeb lossis siv tshuaj), nws qhov chaw nyob thiab kev ua haujlwm (hnub raug ntau dhau, nquag tawg ntawm lub taub hau thiab caj dab, kev kho hluav taws xob rau cov kab mob thymus lossis thyroid caj pas). Muaj kev xav tias pathology cuam tshuam nrog kev nce qib ntawm cov roj cholesterol, tsis muaj cov vitamins hauv cov zaub mov thiab hormonal ntshawv siab.
Nws ntseeguas muaj kev pheej hmoo yog cov neeg ua haujlwm hauv woodworking, metallurgical thiab tshuaj industries (deposition ntawm ntsev ntawm hnyav hlau), cov plaub hau.
TNM classification
Rau qhov yooj yim hauv kev kuaj mob thiab kho cov qog qaub ncaug adenoma, kev faib thoob ntiaj teb yog siv los ua kom yooj yim los txiav txim siab theem ntawm cov txheej txheem:
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T (tumor) - qog loj:
- T0 - adenoma tsis tuaj yeem kuaj pom;
- T1 - txoj kab uas hla ntawm neoplasm tsawg dua 2 cm;
- T2 - txoj kab uas hla mus txog 4 cm, tab sis tsis mus dhau lub caj pas;
- T3 - qhov loj ntawm 4 mus rau 6 cm, lub ntsej muag hlab ntsha tsis cuam tshuam;- T4 - txoj kab uas hla yog ntau dua 6 cm, kis mus rau cov ntaub so ntswg nyob sib ze, cuam tshuam rau cov hlab ntsha cranial.
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N (nodes) - cov qog hauv cheeb tsam:
- N0 - tsis muaj metastases;
- N1 - ib leeg cuam tshuam, qog mus txog 3 cm;
- N2 - cuam tshuam ntau lub pob, qhov loj ntawm cov qog yog los ntawm 3 mus rau 6 cm; - N3 - ntau cov nodes cuam tshuam, txoj kab uas hla ntawm neoplasm yog ntau tshaj 6 cm.
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M (metastasis) - metastases:
- M0 - tsis muaj metastases nyob deb; - M1 - muaj cov metastases nyob deb.
Ua tsaug rau qhov system no, nws tuaj yeem ua kom yooj yim rau kev kuaj mob thiab kev cia siab ntawm kev txhim kho tus kab mob. Thiab tus lej lej tso cai rau koj siv nws hauv txhua lub tebchaws hauv ntiaj teb.
Kev faib tawm Morphological
Adenoma ntawm lub caj pas parotid tuaj yeem ua tau ntau yam, sib txawv ntawm ib leeg hauv cov qauv histological thiab morphological:
- Epithelial qog. tuaj yeem tsim los ntawm cov ntaub so ntswgob qho tib si loj thiab me cov qog qaub ncaug. Nws yog tus yam ntxwv los ntawm kev loj hlob ntawm cov epithelium nyob rau hauv lub lumen ntawm lub ducts nyob rau hauv daim ntawv ntawm papillae, cribriform thiab tubular lug.
- Monomorphic adenoma. Ib tug benign tsim muaj xws li glandular cov ntaub so ntswg. Nws tsim imperceptibly, feem ntau nyob rau hauv cov txiv neej laus. Nws muaj ib puag ncig los yog oval zoo nrog ib qho elasticity.
- Adenolymphoma rov ua dua qhov morphology ntawm monomorphic adenoma, tab sis hauv cov qog nws kuj muaj cov qog ntshav.
- Sebaceous adenoma yog ib qho qog zoo uas tsim los ntawm ntau lub zes ntawm cystic sebaceous hlwb. Tej zaum yuav loj hlob thaum twg los tau. Tsis mob, muaj xim daj. Thaum tshem tawm, nws yeej tsis metastasizes.
- Canalicular adenoma muaj prismatic epithelial hlwb uas tau sau rau hauv pob. Qhov nruab nrab hnub nyoog ntawm cov neeg mob uas muaj hom qog no yog 65 xyoo. Ntxiv rau cov qog qaub ncaug, adenoma tseem cuam tshuam rau daim di ncauj thiab sab plhu.
- Basal cell adenoma. Benign, muaj cov basal hlwb. Raws li txoj cai, nws yog ib qho me me ntom ntom ntawm cov xim dawb. Tsis rov tshwm sim thiab tsis ua phem.
- Pleomorphic adenoma ntawm cov qog qaub ncaug tuaj yeem loj hlob mus rau qhov loj, lumpy thiab ntom. Feem ntau benign, tab sis nyob rau hauv cov theem siab, malignant hlwb yuav tshwm sim. Hauv nws muaj kua thiab fibroblasts. Kev phais tuaj yeem kho tau, tab sis vim nws nyob ze rau ntawm lub ntsej muag paj hlwb, cov kws phais yuav muaj teeb meem.
Symptoms
Benign adenomaparotid salivary caj pas loj hlob qeeb heev, qee zaum rau xyoo. Nws tsis ua rau muaj kev xav tsis thoob, tab sis dhau sijhawm nws tuaj yeem ua rau lub ntsej muag asymmetrical. Qhov no yog vim li cas thiaj mus ntsib kws kho mob. Tom qab tshem tawm, cov qog no tuaj yeem rov zoo dua hauv 6 feem pua ntawm cov neeg mob. Yog hais tias lub neoplasm nyob ze rau ntawm lub pharyngeal txheej txheem ntawm lub caj pas parotid salivary, ces qhov no yuav ua rau nqos teeb meem, mob pob ntseg thiab lockjaw nqaij.
Cov qog qaub ncaug nruab nrab ntawm adenoma tshwm sim li cas? Nws cov tsos mob zoo ib yam li ob qho tib si benign thiab malignant qog. Nws yog tus cwj pwm los ntawm kev loj hlob sai infiltrative, rhuav tshem cov ntaub so ntswg ncig nws. Tej zaum yuav rov muaj dua thiab muab cov metastases nyob deb rau lub ntsws thiab cov pob txha.
Malignant neoplasms tshwm sim ob leeg ntawm nws tus kheej thiab tom qab malignancy ntawm ib tug benign qog. Lawv loj hlob sai, nkag mus rau hauv cov ntaub so ntswg ib puag ncig. Cov tawv nqaij ntawm cov qog yog liab, kub, ncab. Tej zaum ulcerated. Tus cwj pwm los ntawm qhov mob, cuam tshuam ntawm cov leeg masticatory, nce hauv cov qog nqaij hlav nyob sib ze thiab muaj cov metastases.
Diagnosis
qog nqaij hlav qog nqaij hlav yog qhov yooj yim los kuaj pom. Txhawm rau ua qhov no, koj yuav tsum tau kuaj xyuas nrog kws kho hniav thiab tus kws kho mob oncologist, sau cov lus tsis txaus siab thiab tshawb nrhiav keeb kwm ntawm tus kab mob. Kev saib xyuas tshwj xeeb yuav tsum tau them rau morphology ntawm cov qog, nws qhov loj me, sib xws thiab kev txav mus los.
Los ntawm kev tshawb fawb, X-ray ntawm cov pob txha ntawm pob txha taub hau, ultrasound ntawm cov qog qaub ncaug, sialography (saib qhov patency ntawm cov qog ntawm cov qog) thiabsialoscintigraphy (kom pom cov metastases nyob deb). Txoj kev txhim khu kev qha tshaj plaws yog suav tias yog kev sib tsoo ntawm lub caj pas ua raws li kev soj ntsuam smear, nrog rau cov ntaub so ntswg biopsy rau kev tshawb fawb histological thiab pathomorphological.
Yuav kom paub meej txog qhov txheej txheem, CT ntawm cov qog qaub ncaug, hauv siab X-ray lossis cov pob txha ib leeg yuav xav tau.
Kev kho mob qog noj ntshav
Yog tus neeg mob tau kuaj pom tias muaj cov qog ua kua qaub, ces nws muaj txoj hauv kev ncaj qha rau tus kws phais. Cov txheej txheem rau "husking" cov qog no tau tsim los ntev. Ib qho kev phais me me yog ua los ntawm cov tshuaj ntsiav ntawm lub caj pas cuam tshuam, lub adenoma tau txav thiab tshem tawm. Tus kws kho mob tib lub sij hawm sim tsis txhob ua kom puas cov ntsiab lus ntawm cov qog. Qhov kev cuam tshuam no hu ua "excholeation".
Cov ntaub so ntswg tshem tawm yuav tsum tau muab rau kev kuaj macro- thiab microscopic kom paub meej qhov kev kuaj mob. Cov paj hlwb ntawm lub ntsej muag yeej tsis raug tshem tawm vim nws tsis tshua muaj kev cuam tshuam. Yog hais tias tus qog tsim nyob rau hauv cov qog submandibular, ces ob lub qog thiab lub caj pas yuav raug tshem tawm.
Kev kho mob qog nqaij hlav
Malignant adenoma ntawm caj pas qaub ncaug yuav tsum tau kho ua ke ua ke. Kev ua haujlwm mus li cas? Txawm tias ua ntej qhov kev cuam tshuam, nws yog ib qho tsim nyog yuav tsum tau ua ib qho kev kho gamma kom txo qhov loj ntawm cov qog, nrog rau kev tiv thaiv qhov tshwm sim ntawm cheeb tsam thiab nyob deb metastases. Kev ua haujlwm nws tus kheej yog ua ib hlis tom qab kev kho hluav taws xob.
Qee tus kws sau ntawv pom zoo kom tshem tawm tag nrho cov parotidcov qog ua ke nrog cov ceg ntawm cov hlab ntsha ntawm lub ntsej muag raws li ib qho thaiv, nrog rau cov extirpation ntawm cov qog ntshav hauv cheeb tsam. Yog hais tias thaum lub sij hawm kev ntsuam xyuas nws tau qhia tias cov neoplasm tau loj hlob mus rau hauv cov pob txha cov ntaub so ntswg ntawm lub puab tsaig sab, ces qhov chaw no kuj yuav tsum tau kho. Tab sis ua ntej kev phais, koj yuav tsum xav txog yuav ua li cas txhawm rau txhawm rau cov pob txha.
Nyob rau hauv cov neeg mob siab heev, tsuas yog palliative radiation kho tau raug pom zoo, vim cov qog tsis tuaj yeem raug tshem tawm vim cov ntaub so ntswg xoob dhau.
Huab cua
Rau cov qog nqaij hlav zoo tom qab kev phais mob, qhov kev cia siab rau lub neej thiab kev noj qab haus huv yog qhov zoo. Qhov tshwm sim ntawm kev rov tshwm sim yog tsawg, tsuas yog ib thiab ib nrab feem pua. Cov qog nqaij hlav qog ua haujlwm tsis zoo heev. Tus neeg mob tuaj yeem kho tau tsuas yog nees nkaum feem pua ntawm cov neeg mob, thiab txawm tias tom qab ntawd muaj qhov txaus ntshai uas cov neoplasm yuav rov tshwm sim. Metastases rau lwm yam kabmob tshwm sim nyob rau hauv yuav luag ib nrab ntawm cov mob.
