mob qog noj ntshav, raws li kev txheeb cais, yog tus thib ob feem ntau cov kab mob oncological nyob rau hauv lub plab zom mov. Tsis tas li ntawd, tus kab mob no occupies 5-6% ntawm tag nrho cov oncological pathologies. Ob peb xyoos dhau los no, muaj ntau qhov tshwm sim ntawm hom mob qog noj ntshav ntawm ob leeg poj niam txiv neej. Qhov kev pheej hmoo yog qhov tshwj xeeb tshaj yog rau cov neeg muaj hnub nyoog tshaj 55 xyoos. Tus naj npawb ntawm cov neeg tuag los ntawm cov kab mob qog noj ntshav kuj tseem nce ntxiv. Hauv ob xyoos, 85% ntawm cov neeg mob tuag los ntawm tus kab mob.
mob qog noj ntshav feem ntau tshwm sim hauv cov tebchaws tsim kho uas tib neeg nyiam noj zaub mov tsis zoo, ua kom zoo. Tus kab mob no feem ntau tshwm sim hauv Australia thiab North America. Tus kab mob no tsis tshua muaj nyob hauv Europe, thiab hauv cov tebchaws Esxias, Africa thiab South America nws tsawg heev. Hauv peb lub tebchaws, qhov kev kuaj mob zoo sib xws tau tsim muaj txog 17 tus neeg ntawm 100,000 tus neeg.
Localization
Colontxoj hnyuv yog qhov loj tshaj plaws nyob rau hauv txoj hnyuv loj, uas cov quav yog tsim los ntawm cov kua chyme. Qhov no ntawm txoj hnyuv yog nquag koom nrog hauv kev ua haujlwm ntawm txoj hnyuv, yog li congestion nyob rau hauv nws yog heev undesirable. Noj ntau cov khoom noj ua kom zoo, tshuaj lom neeg ntxiv ua rau muaj kev ua haujlwm tsis zoo hauv txoj hnyuv, kev loj hlob ntawm polyps thiab kev loj hlob ntawm adenomas, uas tuaj yeem ua rau mob qog noj ntshav.
Cov nyuv nyob ncaj qha tom qab caecum thiab suav nrog ob peb ntu: nce mus, hla, nqis los thiab taug qab. Muaj ob peb qhov yooj yim thiab rhiab qhov chaw nyob hauv txoj hnyuv. Cov no yog, piv txwv li, ntau yam khoov thiab nqaim vim physiology, nyob rau hauv uas cov quav loj yuav sib sau thiab stagnate. Nyob rau hauv ib nrab ntawm cov mob, cov qog yog nyob rau hauv lub sigmoid nyuv. Hauv 23% ntawm cov neeg mob, caecum cuam tshuam. Lwm lub tuam tsev raug cuam tshuam tsawg dua. Tab sis mob qog noj ntshav ntawm txoj hnyuv ascending yog kuaj tau ntau zaus.
Yog vim li cas
Qhov laj thawj ntawm kev loj hlob ntawm tus mob qog noj ntshav tsis tau tsim. Txawm li cas los xij, muaj ntau yam uas tau raug pov thawj los ua rau kev tsim cov qog nqaij hlav malignant. Ntawm lawv:
- YGenetic predisposition. Qhov tshwm sim ntawm hom mob qog noj ntshav ntawm cov neeg txheeb ze tau nce zuj zus.
- Kev noj zaub mov tsis zoo, noj zaub mov zoo thiab tsiaj rog.
- Kev ua neej tsis muaj zog, tsis muaj lub cev ua si,rog dhau, lub cev tsis muaj zog.
- Kev cem quav nyob rau hauv daim ntawv ntev. Nyob rau hauv rooj plaub no, qhov kev pheej hmoo ntawm kev raug mob rau cov hnyuv quav los ntawm cov quav hnyav heev nce.
- Hypotension thiab plab hnyuv atony hauv cov neeg laus.
- Keeb kwm ntawm cov kab mob precancerous xws li tsev neeg polyposis, Crohn tus kab mob, diverticulosis, non-specific ulcerative colitis, ib leeg adenomatous polyps.
- Hnub nyoog ntawm tus neeg mob. Qhov tshwm sim yog nce ntawm cov neeg mob laus dua 50.
- Ua haujlwm ua haujlwm txaus ntshai ntawm kev ua haujlwm.
Tim thiab theem
Cov mucous daim nyias nyias uas ntim cov nyuv muaj lub npe hu ua glandular epithelium. Hauv feem ntau ntawm cov neeg mob, mob qog noj ntshav ntawm txoj hnyuv loj tau kuaj pom los ntawm ntau yam hauv qab no:
- Adenocarcinoma. Neoplasm tshwm sim los ntawm cov hlwb epithelial.
- Mucoid adenocarcinoma. Ib tug malignant neoplasm uas muaj ntau cov mucus.
- Ricoid cell carcinoma. Cov qog nqaij hlav cancer zoo li cov vesicles uas tsis txuas rau ib leeg.
- Squamous lossis glandular-squamous. Hom qog no yog nyob ntawm cov hlwb squamous epithelial lossis nws cov qog ntau yam.
- Undifferentiated carcinoma.
Nws feem ntau lees txais los faib cov kab mob qog noj ntshav rau hauv cov theem hauv qab no:
- Zero. Tsuas yog cov mucous membrane raug cuam tshuam, tsis muaj cov cim qhia ntawm kev loj hlob infiltrative, nrog rau metastases.thiab kab mob hauv cov qog nqaij hlav.
- Thawj. Nws yog tus cwj pwm los ntawm kev loj hlob ntawm cov qog me me ntawm thawj hom, uas yog tsim nyob rau hauv cov mucous los yog submucosal thickness. Tsis muaj cov metastases hauv cheeb tsam lossis nyob deb.
- Second. Lub neoplasm tsis nyob hauv ib lub voj voog ntawm cov phab ntsa hauv plab hnyuv, tsis koom nrog cov kabmob uas nyob ib sab, thiab tsis ntev tshaj li cov hnyuv. Tej zaum qhov tshwm sim ntawm metastases nyob rau hauv cov qog nqaij hlav.
- thib peb ntawm mob qog noj ntshav. Cov qog pib loj hlob mus rau tag nrho cov tuab ntawm lub plab hnyuv phab ntsa, cuam tshuam rau cov kabmob uas nyob sib ze. Metastases muaj ntau, txawm li cas los xij, hauv zos tsuas yog hauv cov qog nqaij hlav xwb.
- Plaub. Cov qog muaj feem cuam tshuam rau cov kabmob uas nyob ib sab, muaj qhov loj. Ntau yam metastases tau pom, suav nrog cov nyob deb.
Kos npe thiab daim ntawv
Daim duab tsos mob nyob ntawm hom neoplasm thiab nws qhov chaw nyob, nrog rau theem ntawm kev loj hlob thiab loj. Thawj theem ntawm cov qog nqaij hlav hauv plab pib, raws li txoj cai, nyob rau hauv daim ntawv latent, thiab tus kab mob no tau kuaj pom thaum lub sijhawm kuaj mob niaj hnub thaum kuaj xyuas lwm yam pathologies. Ntau tus neeg mob, thaum hu rau tus kws kho mob, yws yws ntawm cem quav tas li, mob thiab tsis xis nyob hauv cov hnyuv, kev qaug zog thiab kev tsis zoo ntawm kev noj qab haus huv.
Yog tias qhov neoplasm nyob rau sab xis ntawm txoj hnyuv, ces cov neeg mob feem ntau yws yws ntawm qhov mob plab hauv plab, malaise thiab qaug zog. Qhov kev ntsuam xyuas qhia tau hais tias qhov nruab nrab ntawm cov ntshav tsis txaus, txawm tias nyob rau theem pib ntawm kev loj hlob ntawm tus kab mobua tau palpation ntawm cov qog.
Rau rau sab laug-sab hauv cheeb tsam ntawm kev mob qog noj ntshav ntawm txoj hnyuv ascending yog yam ntxwv los ntawm: mob npub, nrog rau flatulence, tsam plab, rumbling, cem quav tsis tu ncua. Cov quav zoo ib yam li yaj dung, thiab pom cov kab xo thiab ntshav hauv nws.
Mob yog tshwm sim los ntawm cov txheej txheem inflammatory thiab tuaj yeem muaj tus cwj pwm txawv, rub, ntse, cramping nyob rau hauv rooj plaub thaum lub plab zom mov tshwm sim. Cov neeg mob yws yws ntawm xeev siab, tsis qab los noj mov, belching, xav tias hnyav hauv plab. Cov kab mob nyob rau hauv cov hnyuv provokes nqaim thiab dysmotility, uas ua rau alternating cem quav thiab raws plab, tsam plab thiab rumbling nyob rau hauv lub plab mog. Lub cev qhuav dej ntawm cov qog ua rau cov tsos ntawm impurities nyob rau hauv cov quav ntawm cov ntshav, kua paug thiab hnoos qeev. Intoxication ntawm lub cev nce, uas yog tshwm sim los ntawm kub taub hau, qaug zog, anemia, qaug zog thiab poob phaus.
Nws yog ib qho tseem ceeb kom paub txog cov tsos mob ntawm mob qog noj ntshav hauv lub sijhawm.
Tshuaj cais ntau hom kab mob tseem ceeb ntawm oncology, txhua tus uas yog tus yam ntxwv los ntawm qee cov tsos mob:
- Txoj kev. Cov tsos mob tseem ceeb yog mob plab hnyuv. Ib nrab blockage ua rau rumbling, ib qho kev xav ntawm fullness, cramping mob tawm tsam, nyuaj dhau gases thiab quav. Nrog rau qhov nqaim ntawm txoj hnyuv lumen, mob hnyav tshwm sim, uas yuav tsum tau muaj kev phais.
- Toxico-anemic. Daim ntawv no yog tus yam ntxwv los ntawm qhov tsis muaj zog thiab ntshav liab, qaug zog thiab tawv nqaij daj.
- Dyspeptic. Presents nrog xeev siab thiab ntuavbelching, mob nyob rau hauv lub plab mog, aversion rau zaub mov, tsam plab thiab hnyav.
- YEnterocolitic. Nws yog tus cwj pwm los ntawm kev mob plab hnyuv, thaum raws plab hloov nrog cem quav, cov neeg mob yws yws ntawm qhov kev xav ntawm lub plab, plab thiab rumbling ntawm lub plab, nrog rau qhov mob npub. Ntshav thiab hnoos qeev tshwm hauv cov quav.
- Pseudo-inflammatory. Nrog rau qhov mob hnyav hauv plab, ua npaws. Cov kab mob plab hnyuv tau qhia me ntsis. ESR thiab leukocytes nce hauv cov ntshav.
- Tumorous. Cov tsos mob ntawm mob qog noj ntshav yog mob me lossis tsis tuaj. Hauv qhov no, lub neoplasm tuaj yeem ua palpated.
Kev nyuaj siab
Thaum tsis muaj kev kho mob tsim nyog, cov tsos mob nce ntxiv raws sijhawm, thiab kev kis tus kab mob ntxiv ua rau muaj teeb meem xws li plab hnyuv, abscess, phlegmon, los ntshav, perforation ntawm lub plab hnyuv phab ntsa nrog peritonitis, thiab lwm yam.
Kev mob plab hnyuv yog tshwm sim los ntawm neoplasm thaiv cov plab hnyuv lumen. Qhov teeb meem no tshwm sim hauv 15% ntawm cov neeg mob. Feem ntau nws tau pom nrog sab laug-sab hauv qhov chaw ntawm cov qog hauv txoj hnyuv.
Cov txheej txheem mob qog noj ntshav hauv cov qog nqaij hlav siab ntawm txoj hnyuv tau pom nyob rau hauv txhua feem kaum thiab siv cov phlegmon lossis purulent abscess. Qhov no feem ntau tshwm sim nyob rau hauv neoplasms ntawm caecum los yog ascending sigmoid nyuv. Cov txheej txheem no yog provoked los ntawm ingress ntawm pathogenic microorganisms los ntawm cov qog nqaij hlav rau hauv cov ntaub so ntswg ib puag ncig.
Perforation ntawm lub plab hnyuv phab ntsa yog qhov tsawg heev, txawm li cas los xij, qhov no yog qhov tseebkev nyuaj siab tuaj yeem ua rau tuag taus. Lub rupture ua rau ulceration ntawm cov qog thiab nws disintegration. Cov ntsiab lus ntawm txoj hnyuv nkag mus rau hauv peritoneum thiab ua rau peritonitis. Thaum cov ntsiab lus ntawm txoj hnyuv nkag mus rau hauv fiber ntau tom qab txoj hnyuv, ib qho abscess lossis phlegmon tshwm sim.
Qee zaum, kev loj hlob ntawm neoplasm thiab kev puas tsuaj rau cov kab mob hauv nruab nrog cev yog ua tau, uas ua rau fistulas. Cov teeb meem loj zuj zus ntxiv rau tag nrho cov kev kwv yees rau cov neeg mob uas muaj kab mob qog nqaij hlav hauv plab.
Diagnosis
Kev txheeb xyuas cov qog hauv cov nyuv yog tsis yooj yim sua tsuas yog siv rau hauv tus account sau keeb kwm thiab kuaj ntawm tus neeg mob. Cov cim sab nraud ntawm lub xub ntiag ntawm neoplasm, raws li txoj cai, tsis tuaj. Hauv kev kuaj xyuas, tus kws kho mob tshwj xeeb ntsuas lub cev ntawm tus neeg mob, tsam plab, pallor ntawm daim tawv nqaij, palpation yuav qhia tau tias muaj cov kua dej hauv peritoneum. Palpation ntawm neoplasm los ntawm lub plab phab ntsa yog ua tau tsuas yog nrog ib tug loj qog loj. Txhawm rau kom paub meej qhov kev kuaj mob, nws yog ib qho tsim nyog yuav tsum tau ua qhov kev ntsuam xyuas zoo uas siv ob qho tib si ntsuas thiab ntsuas kev tshawb fawb.
Kev kuaj mob rau kev kuaj mob qog noj ntshav muaj xws li kuaj ntshav rau kev tshuaj ntsuam biochemical txhawm rau txheeb xyuas cov antigens tshwj xeeb, nrog rau kev kuaj quav rau cov ntshav occult.
Instrumental txoj kev tshawb fawb yog:
- Sigmoidoscopy. Tso cai rau koj los ntsuas qhov xwm txheej ntawm cov hnyuv. Txoj kev tshawb fawb yooj yim tshaj plaws thiab feem ntau.
- Colonoscopy. Txoj kevkev tshawb fawb los ntawm qhov endoscope, uas ua rau nws muaj peev xwm ua tiav kev kuaj pom ntawm txoj hnyuv thiab nqa cov khoom siv rau kev soj ntsuam histological.
- X-ray kuaj. Nws yog ua los ntawm kev siv barium suspension. Ib tus neeg sawv cev sib txawv yog siv nrog ib qho enema lossis los ntawm lub qhov ncauj, tom qab uas cov duab raug coj mus. Txoj kev tshawb no tso cai rau koj los txiav txim qhov loj thiab cov duab ntawm neoplasm, muaj qhov nthuav dav lossis nqaim ntawm txoj hnyuv.
- Ultrasound thiab xam tomography. Nrog lawv cov kev pab, nws muaj peev xwm ua kom paub meej qhov luaj li cas ntawm cov qog thiab kom tau txais cov duab ntawm cov qauv anatomical. Cov txheej txheem no muaj kev nyab xeeb thiab tsis mob.
kho mob qog noj ntshav
Kev kho mob tsuas yog ua los ntawm txoj kev phais xwb. Nyob rau tib lub sijhawm, ntxiv rau kev phais radical, kws khomob thiab kev kho hluav taws xob kuj tau ua.
Cov txheej txheem kho mob thiab hom kev phais mob yog raug xaiv los ntawm tus kws kho mob oncologist, suav nrog kev sib xyaw ua ke ntawm ntau yam. Hom neoplasm thiab nws qhov chaw nyob, theem ntawm kev loj hlob ntawm qog, muaj metastases thiab teeb meem, nrog rau tus neeg mob lub hnub nyoog thiab kev noj qab haus huv. Yog tias tsis muaj teeb meem thiab metastases, ces txoj kev radical nyiam dua. Cov chaw cuam tshuam ntawm txoj hnyuv raug tshem tawm nrog rau cov qog ntshav hauv cheeb tsam thiab cov mesentery.
Nrog rau sab xis ntawm thaj chaw ntawm neoplasm, qhov hu ua hemicolectomy tau ua. Raws li qhov tshwm sim ntawm kev ua haujlwm zoo li no, caecum raug tshem tawm, nrog rau qhov nce thiab thib pebtransverse colon ua ke nrog ib feem ntawm lub davhlau ya nyob twg ileum. Nrog rau cov kev tswj hwm no, kev tshem tawm cov qog ntshav hauv cheeb tsam tau ua tiav. Tom ntej no, ib qho anastomosis yog tsim, uas yog, cov hnyuv me thiab cov hnyuv loj txuas nrog.
Yog tias txoj hnyuv raug cuam tshuam rau sab laug, ua qhov tsim nyog hemicolectomy, taw qhia rau sab no. Nyob rau tib lub sij hawm, ib feem peb ntawm transverse thiab tag nrho cov hnyuv descending, ib feem ntawm cov hnyuv sigmoid, lub mesentery thiab lymph nodes ntawm lub regional hom raug tshem tawm. Thaum kawg, ib yam li hauv rooj plaub dhau los, ib qho anastomosis tau tsim.
Yog tias cov neoplasm me me thiab nyob hauv nruab nrab ntawm txoj hnyuv loj, ib qho kev txiav tawm, uas cov omentum thiab cov qog ntshav poob. Yog tias cov qog pom nyob rau hauv nruab nrab thiab qis ntawm cov nyuv sigmoid, kev txiav tawm ntawm mesentery thiab cov qog ntshav qab zib yog ua. Tom ntej no, ib qho anastomosis yog tsim.
Yog tias qhov mob neoplasm tau cuam tshuam rau cov khoom nruab nrog cev thiab cov ntaub so ntswg, ua haujlwm ua ke kom tshem tawm cov chaw cuam tshuam.
Yog tias pom tus kabmob kheesxaws nyob rau hauv daim ntawv siab heev thiab ua haujlwm tsis tau, ces ua haujlwm palliative. Rau lub hom phiaj no, bypass anastomoses los yog fecal fistula yog ua. Qhov no yuav pab tiv thaiv txoj hnyuv, vim qhov teeb meem no ua rau tus neeg mob lub cev tsis muaj zog thiab ua rau muaj kev cuam tshuam rau kev phais. Thaum muab cov txheej txheem phais mob, tus kws phais yuav tsum ntsuas tus neeg mob kom txaus.
Txoj tactics ntawm kev phais mob qog noj ntshav yog xaiv rau txhua tus neeg mob ib leeg. Yog tias muaj qhov ua tiav ntawm kev ua tiav ntawm kev ua haujlwm thiab muaj peev xwm ua haujlwm ntxiv, kev kho mob phais yog ua tiav. Nyob rau hauv rooj plaub no, ua ntej ib tug resection yog ua thiab ib tug colostomy yog tsim, thiab nyob rau theem tom ntej, lub stoma yog sutured. Yog tias tus neeg mob tus mob raug ntsuas tias tsis muaj zog thiab cov hlab plawv tsis tuaj yeem tiv thaiv kev kho mob, ib qho kev ua haujlwm tau ua.
Kev phais yuav tsum ua kom tiav los ntawm kev kho hluav taws xob. Cov txheej txheem kho mob tuaj yeem ua tiav ob peb lub lis piam tom qab ua haujlwm. Qhov chaw ntawm cov qog loj hlob yog irradiated. Nyob rau tib lub sijhawm, kev kho hluav taws xob tuaj yeem ua rau muaj kev phiv ntau, vim tias cov hnyuv mucosa puas thaum lub sij hawm irradiation. Cov kev phiv tshwm sim muaj xws li xeev siab, ntuav, thiab tsis qab los noj mov.
Tshuaj kho mob yog theem tom ntej ntawm kev kho mob. Txog niaj hnub no, cov tshuaj niaj hnub siv uas ua rau muaj kev phiv tsawg kawg nkaus. Txawm li cas los xij, qee zaum, xeev siab thiab ntuav, ua xua pob, leukopenia, thiab lwm yam.
Kev ntsuas rau cov neeg mob
Kev mob qog noj ntshav plab yog qhov zoo me ntsis. Nyob ntawm theem ntawm tus kab mob thiab qhov chaw ntawm neoplasm, qhov kev kwv yees muaj sia nyob tsib xyoos yog ib nrab ntawm cov neeg mob, raug rau kev kho mob phais plawv. Yog tias cov neoplasm tsis tau kis mus rau lwm yam kabmob, txhua tus neeg mob yuav muaj peev xwm nyob tau tsib xyoos.
Nyob zooQhov kev kwv yees ncaj qha nyob ntawm qhov pom thiab kis ntawm metastases hauv cov qog ntshav hauv cheeb tsam. Nyob rau hauv lawv qhov tsis tuaj, peb tuaj yeem tham txog kev muaj sia nyob tsib xyoos hauv 80% ntawm cov neeg mob. Nyob rau hauv lub xub ntiag ntawm metastases los ntawm txoj hnyuv, daim duab no yog halved. Feem ntau lawv nyob hauv lub siab.
Metastases tuaj yeem tshwm sim txawm tias xyoo tom qab phais. Hauv qhov xwm txheej zoo li no, kev kho mob ua ke tau ua tiav, txhawm rau tshem tawm lawv qhov phais, ua raws li kev siv tshuaj khomob.
Tus ciaj sia rau tus mob qog noj ntshav yog dab tsi, ntau tus neeg xav.
Txoj hauv kev zoo tshaj plaws rau kev cuam tshuam kev phais thiab kev pom zoo yog cov neeg mob uas tau kuaj pom tus kab mob thaum pib ntawm txoj kev loj hlob. Thaum tsis muaj kev kho mob thiab mob hnyav, kev tuag hauv tsib xyoos yog ib puas feem pua. Kev kuaj mob qog noj ntshav ntawm txoj hnyuv ascending tsis zoo.
Kev Tiv Thaiv
Txhua yam kev tiv thaiv hauv qhov no yog txhawm rau kuaj mob qog noj ntshav thaum ntxov, uas suav nrog kev kuaj mob tsis tu ncua ntawm cov pejxeem. Nyob rau hauv cov ntaub ntawv no, automated kev tshuaj ntsuam xyuas yog ib qho tseem ceeb heev, uas ua rau nws muaj peev xwm mus faib tus neeg mob raws li ib tug muaj kev pheej hmoo siab pab pawg neeg nrog ntxiv xa mus rau endoscopy. Kev kuaj mob thiab kev kho mob ntawm cov neeg mob uas tau kuaj pom muaj mob qog noj ntshav lossis mob precancerous yog qhov tseem ceeb heev. Txawm tias mob qog nqaij hlav zoo li cas los mus kuaj.
Kev tiv thaiv kabmob kheesxaws koom nrogtswj txoj kev noj qab haus huv nrog kev tsis suav cov cwj pwm phem thiab tswj kev noj zaub mov kom zoo. Nws yog ib qho tsim nyog yuav tsum coj mus rau pej xeem cov ntaub ntawv hais txog qhov yuav tsum tau noj kom zoo thiab ua kom zoo, kom tsis txhob suav cov zaub mov ua kom zoo thiab cov tsiaj rog kom pom zoo rau cov khoom noj uas muaj fiber ntau, txiv hmab txiv ntoo, zaub thiab khoom noj siv mis.
Ntxiv rau, nws yuav tsum tau ua lub neej nquag, ua si, taug kev, ua luam dej, khiav, thiab lwm yam. Cov kev tiv thaiv zoo li no tuaj yeem txo qis kev pheej hmoo ntawm kev mob qog noj ntshav.
Kev tshuaj xyuas mob qog noj ntshav
Tshuaj xyuas txog kev kho mob ntawm cov kab mob no muaj ntau. Hmoov tsis zoo, nws tau kuaj pom ntau zaus. Qhov txaus ntshai yog tias nws tau kuaj pom nyob rau theem kawg, thaum kev kho mob feem ntau tsis zoo. Nws yog ib qho tseem ceeb rau kev kuaj xyuas kom raws sijhawm, tiv thaiv cov kab mob ntev, thiab ua kom muaj kev ua neej nyob. Tom qab ntawd koj tuaj yeem txo qhov kev pheej hmoo ntawm cov kab mob no.
