Kev phais ntawm cov thyroid caj pas yog ib txoj hauv kev yooj yim uas muaj cov pob txha hauv lub cev los ntsuas qhov kev pheej hmoo ntawm nws qhov mob. Qhov no yog ib qho kev ntsuam xyuas tseem ceeb hauv kev kuaj mob thyroid vim nws muab ntau cov ntaub ntawv nrog me me lossis tsis muaj kev pheej hmoo ntawm cov teeb meem.
Yuav ua li cas cov txheej txheem ua haujlwm
Kev txiav ntawm cov thyroid caj pas feem ntau yog ua los ntawm "eco-oriented" txoj kev - coj lub koob nrog ultrasound kom paub tseeb tias lub cev raug punctured nyob rau hauv qhov chaw.
Yog tias koj muaj teeb meem thyroid, koj xav tau kev pab tswv yim. Thaum twg yuav tsum tau ua qhov txheej txheem no? Txhua rooj plaub yuav raug kawm ntawm tus kheej. Cov kev xeem tseem ceeb los ua yog:
- ultrasound;
- tshuaj ntsuam hormonal;
- tshuaj ntsuam xyuas.
Yog tias, raws li cov ntaub ntawv no, muaj kev xav tias cov ntawm node yuav ua phem, ces ua rau cov thyroid caj pas. Cov yam tseem ceeb tshaj plaws hauv kev txiav txim siab qhov tsis txaus ntseeg ntawm nodule thiab, yog li ntawd, noj puncture, yog qhov loj thiab qhov tsos. Lub cev ntawm ultrasound.
Thaum xav tau kev nplawm
Feem ntau, cov nodules me dua kaum millimeters yuav tsis raug punctured tshwj tsis yog muaj kev pheej hmoo (xws li, "tsis xwm yeem ciam teb" lossis microcalcifications) pom ntawm ultrasound.
Cov tshuaj xyuas cov thyroid puncture qhia tias cov nodules loj (loj dua 15-20 mm) yuav luag txhua zaus punctured tshwj tsis yog ultrasound qhia tau tias lawv yog cov hlwv nkaus xwb (cov kua dej). Nyob rau hauv rooj plaub no, ib tug puncture yuav ua tau kom txo qhov loj ntawm nodule. Tab sis yuav muaj kev soj ntsuam me me, vim tsuas yog cov khoom siv, tsis yog kua, tuaj yeem txheeb xyuas.
Nco ntsoov tias cov thyroid nodules yog cov teeb meem tshwm sim, feem coob ntawm lawv yog qhov zoo. Yog li ntawd, lub luag haujlwm ntawm tus kws teev ntuj raug cai yog, ntawm ib sab tes, txhawm rau paub txog cov chaw ntawm nod uas muaj qhov tshwm sim qis heev ntawm kev ua phem.
Npaj rau txheej txheem
Kev txiav ntawm cov thyroid caj pas raws li kev tswj hwm ultrasound yuav tsum tau ua tib zoo npaj. Kev tsom xam ua ntej yog qhov tsim nyog, feem ntau yog rau ob qho laj thawj. Ua ntej kawm cov thyroid hormones, coagulation thiab xyuas kom meej tias tsis muaj kev pheej hmoo los ntshav. Tus neeg mob yuav tsum tau nrog. Qee cov neeg rhiab heev yuav muaj kiv taub hau tam sim ntawd tom qab tho, txawm hais tias cov tsos mob feem ntau ploj mus nyob rau lub sijhawm luv luv.
Tshuaj uas tuaj yeem cuam tshuam
Nws tseem ceeb heev uas yuav tau qhia koj tus kws kho mob txog txhua yam tshuaj uas koj noj tsis tu ncua thiab yog tias koj ua xua rau cov tshuaj lossis lwm yam khoom noj.
Yuav tsum tsis txhob noj cov tshuaj tiv thaiv kab mob ("cov tshuaj kom txo cov ntshav") xws li:
- "Acenocoumarol";
- "Warfarin";
- "Dabigatran";
- "Rivaroxaban";
- "Apixaban".
Koj yuav tsum zam cov tshuaj aspirin, ibuprofen thiab lwm yam tshuaj tiv thaiv kab mob rau ib lub lis piam ua ntej kuaj. Tsis tas yuav noj tshuaj ntxiv.
Khoom noj
Tsis muaj kev noj zaub mov tshwj xeeb, txawm hais tias qee lub chaw pom zoo kom tsis txhob noj li yim teev ua ntej kev xeem. Raws li txoj cai, nws yuav txaus tsis noj tshais lossis haus ib yam dab tsi ua ntej muaj cov thyroid puncture.
Khawm
Nws raug nquahu kom hnav khaub ncaws dav-caj dab lossis nws tuaj yeem qhib tau yooj yim (xws li lub tsho khawm-down) kom pub dawb rau cov thyroid. Tsis txhob hnav saw caj dab lossis lwm yam hniav nyiaj hniav kub nyob ib ncig ntawm koj lub caj dab.
Thyroid puncture tsis yog contraindicated thaum cev xeeb tub lossis pub niam mis, tab sis cov kws kho mob yuav tsum tau ceeb toom txog kev xeeb tub lossis xav tias xeeb tub. Qee cov tshuaj hormones hloov ib txwm nyob rau theem no, qhov no tuaj yeem cuam tshuam rau kev tshuaj ntsuam.
txheej txheem zoo li cas?
Yog hais tias lub nodule tseem ciaj sia, ultrasound-guided puncture tej zaum yuav ua tsis tau. Qee zaum, lub hauv siab nodules yuav raug kuaj los ntawm CT-guided puncture los yog kev tshawb nrhiav kev phais yuav tsum tau.
Kev txiav cov thyroid caj pas raws li kev saib xyuas ntawm cov kws tshaj lij yuav siv sijhawm li 15-20 feeb. Tau txais kev kuaj ntshav nws tus kheej yog qhov nrawm heev, lub sijhawm so yog npaj cov khoom siv thiab thaj chaw los ua biopsied.
Kev ua haujlwm ntawm cov thyroid nodule yog ua rau tus neeg mob pw ntawm nws nraub qaum hauv txoj haujlwm uas tawm ntawm cov thyroid caj pas qhib. Qee zaum lub hauv ncoo muab tso rau hauv qab lub xub pwg los pab nrog caj dab hyperextension. Tom qab tus neeg mob tau xav txog txoj haujlwm kab rov tav, ib qho tshuaj tua kab mob hauv zos yuav raug txhaj thiab tus kws kho mob yuav pom cov pob txha los ntawm ultrasound.
Kev txhaj tshuaj yog ua nrog rab koob nyias, uas yuav tsum ncav cuag cov thyroid caj pas (feem ntau nyias dua li cov thyroid caj pas). Nrog rau rab koob hauv lub pob caus, maj mam txav mus rau aspirate cov khoom kom paub tseeb tias cov ntaub so ntswg raug tshem tawm, ces rab koob yuav raug tshem tawm. Thaum lub sijhawm ua haujlwm no, tus kws kho mob ceeb toom tus neeg mob kom tsis txhob hnoos, nqos, lossis hais lus: thaum cov thyroid caj pas txav mus, nws yuav nyuaj rau kev kuaj mob.
Ob mus rau rau qhov punctures feem ntau yuav tsum tau, nyob ntawm qhov zoo ntawm cov qauv tau txais. Txoj kev no, tag nrho qhov loj ntawm cov nodule raug them, thiab kev kuaj mob kom raug ntau dua.
Yog tias nws yog cystic nodule, nws tuaj yeem tso nrog lub koob txhaj tshuaj rautxo qhov loj me thiab txo qhov tsis xis nyob. Tom qab qhov puncture tiav lawm, koj yuav raug hais kom nias rau ob peb feeb nyob rau hauv qhov chaw ntawm qhov puncture. Kev xav ntawm kiv taub hau tuaj yeem tshwm sim tom qab cov thyroid puncture. Txij li nws tsis xav tau tshuaj loog lossis sedation, tom qab ob peb feeb ntawm kev rov qab los, koj tuaj yeem rov qab los tsev yam tsis muaj teeb meem.
Cov teeb meem thiab kev pheej hmoo yog dab tsi?
Npaj ntawm cov thyroid caj pas, raws li kev tshuaj xyuas, tej zaum yuav muaj qhov tshwm sim. Qhov teeb meem tseem ceeb yog qhov mob me ntsis ntawm qhov chaw puncture. Nws tuaj yeem kho tau nrog kev kho mob tsis tu ncua thiab / lossis daim ntawv thov dej khov hauv zos.
Cov neeg raug mob yuav muaj kiv taub hau thaum lub sijhawm lossis tam sim tom qab txheej txheem. Yuav ua li cas tshwm sim rau cov khoom tau txais tom qab tus txheej txheem? Qee cov khoom siv tau nthuav dav ntau qhov swb (ib lub khob iav rau lub tshuab tsom iav), thaum lwm qhov yog khaws cia rau hauv cov tshuaj tshwj xeeb rau kev npaj ntxiv rau lub tshuab tsom.
Tom qab ua cov qauv, tus kws kho mob tuaj yeem txiav txim siab qhov kev kuaj mob. Cov txiaj ntsig tau ntev npaum li cas? Nws nyob ntawm qhov chaw uas koj tau sim, tab sis feem ntau yog los ntawm ob mus rau peb hnub mus rau ob mus rau peb lub lis piam. Dab tsi yog qhov tshwm sim tau: txhua lub chaw lossis lub tsev haujlwm yuav siv cov kev faib tawm sib txawv, tab sis qhov kev hu ua 6 pawg feem ntau siv tam sim no.
Nws yuav tsum tau nco ntsoov tias cov thyroid puncture nrog ultrasound tsis txheeb xyuas cov ntaub so ntswg blocks (biopsy), tab sis tsuas yog ib leeg hlwb (cytology). Yog li, nws yog ib qho kev ntsuam xyuas uas qhia tau hais tiastsuas yog muaj kev pheej hmoo ntawm malignancy, tab sis qhov kev kuaj mob zaum kawg yuav raug tsim los ntawm biopsy nrog kev phais.
Review results
Qhov tshwm sim ntawm cov thyroid puncture yuav raug nthuav tawm raws li cov txiaj ntsig hauv qab no:
- Qeb 1: Tsis kuaj / Tsis Zoo: Cov khoom no suav nrog cov qauv uas tsis muaj cov khoom txaus lossis cov khoom zoo los soj ntsuam. Nws sawv cev 10-20% ntawm punctures.
- Qeb 2: benign - txog li 70% ntawm kev sib tsoo. Qhov kev pheej hmoo ntawm malignancy tsawg dua 3%, uas zoo li tshem tawm nws. Ultrasound tswj yuav ua tau tom qab 18-24 lub hlis, thiab tom qab ntawd raws li qhov xwm txheej.
- Qeb 3: suav nrog cov qauv nrog qee qhov tsis txaus ntseeg thiab qee qhov tsis zoo. Qhov kev pheej hmoo ntawm malignant neoplasms yog 5-15%, txawm hais tias muaj kev hloov pauv nyob ntawm qhov chaw. Qee zaum kev kuaj caj ces tuaj yeem pab tau qhov no.
- Qeb 4: qhov tsis txaus ntseeg follicular neoplasm: kev pheej hmoo ntawm malignancy 15-30%. Kev kuaj mob thyroid tsis pom qhov txawv ntawm adenoma (benign) thiab follicular carcinoma (malignant), yog li kev kuaj histological yog qhov tsim nyog los txiav txim siab nws. Kev phais feem ntau yog ua los ntawm yam tsawg kawg tshem cov thyroid nruab nrab kom paub meej qhov kev kuaj mob thiab txiav txim siab txog kev kho mob tsim nyog.
- Qeb 5: qhov teeb meem tsis txaus ntseeg ntawm qhov tsis zooneoplasms - nws sawv cev rau cov yam ntxwv ntawm malignancy, tab sis tsis txaus kom paub meej tias nws. Qhov kev pheej hmoo ntawm mob qog noj ntshav hauv pawg no yog 60-75%. Kev kho mob feem ntau yog phais.
- Qeb 6: malignant - accounting rau 3-7% ntawm tag nrho cov biopsies thiab suav nrog cov ntaub ntawv pov thawj cytological ntawm malignancy, suav nrog papillary carcinoma thiab nws cov variants, medullary carcinoma, carcinoma anaplasia lymphoma, thiab metastases. Qhov kev pheej hmoo ntawm malignancy yog ze rau 100% (97.99%). Kev kho mob yog phais.
Puas tau txais qhov txiaj ntsig zoo lossis yog lub pob tiag tiag? Txawm hais tias tsis tshua muaj (1-2%), cov qog nqaij hlav malignant tuaj yeem ua rau cov qog nqaij hlav qog nqaij hlav. Qhov kev pheej hmoo me me no tsis tuaj yeem zam tau, yog li nws tseem ceeb heev rau kev npaj rau kev soj ntsuam kom txaus uas tso cai rau cov kws kho mob endocrinologist los saib xyuas cov txheej txheem. Yog tias muaj kev hloov pauv hauv kev tswj hwm evolutionary uas qhia tias muaj kev mob qog noj ntshav (piv txwv li kev loj hlob ntau dua 20%), theem thib ob lossis, yog tias tsim nyog, kev phais yuav raug ua.
Yog hais tias cov nodule malignant, kev kho ib txwm siv, txawm tias tom qab me ntsis. Hmoov zoo, hauv cov xwm txheej no, cov txiaj ntsig yuav luag zoo. Cov lus qhia tam sim no los ntawm Thyroid Association (ATA) yog npaj ua raws li cov yam ntxwv ntawm ultrasound thiab qhov tshwm sim ntawm qhov puncture.
Cov tshuaj ntsuam genetic siv dab tsi?
Nyob rau xyoo tas los no, tau tsim khogenetic txoj kev uas pab txiav txim seb lub nodule yog benign los yog malignant. Cov txheej txheem no kawm ntau cov noob caj noob ces hauv cov khoom muab rho tawm hauv qhov puncture. Cov no tsis tau ua tsis tu ncua niaj hnub no, tab sis feem ntau yog siv thaum qhov tshwm sim ntawm kev sib tsoo tsis paub tseeb.
Nws yuav tsum tau nco ntsoov tias kev kuaj mob caj ces kuj tsis yog qhov kawg, tab sis yuav pab txiav txim siab. Nws tuaj yeem ua tau ntawm thawj qhov puncture lossis tseg rau qhov thib ob puncture thaum tsis ntseeg.
Summarize
Ib qho ntawm cov laj thawj tseem ceeb rau qhov pom ntawm cov nodes, endocrinologists xav txog qhov tsis muaj iodine. Cov khoom no yog tsim nyog rau kev sib txuas ntawm cov tshuaj hormones; Yog hais tias lub cev muab nws nyob rau hauv tsis txaus, lub cev pib ua hauj lwm nyob rau hauv ib tug intensive hom thiab loj hlob nyob rau hauv loj. Cov thyroid ua haujlwm dhau tuaj yeem ua rau muaj kab mob goiter.
Lwm yam ua rau cov pob qij txha tuaj yeem yog hluav taws xob, kab mob sib kis, ib puag ncig tsis zoo. Yog hais tias cov qog loj dua 3 centimeters, tej zaum yuav muaj ntau cov tsos mob txaus ntshai: hoarseness, ua tsis taus pa luv thiab ib qho kev xav tsis tu ncua ntawm lub caj pas. Hauv cov xwm txheej zoo li no, txhawm rau tshuaj xyuas cov qog thiab tshem tawm txoj kev pheej hmoo ntawm mob qog noj ntshav, cov thyroid nodule raug punctured.
Rau qhov no, tus kws kho mob ua tus qauv. Txhawm rau txhim kho qhov tseeb ntawm cov txheej txheem, kev kuaj xyuas ultrasound yog ua. Puas yog txhua tus tau txais cov thyroid puncture? Ib qho biopsy tuaj yeem ua rau tus neeg mob nrog lub pob me me yog tias nws tau raug pom,muaj ib tug propensity rau hereditary tshwm sim ntawm mob qog noj ntshav los yog ultrasound pom muaj ib tug qog.
