Nyob rau hauv daim ntawv teev cov kab mob ntawm lub plab zom mov, cov kws kho mob kuj hu ua mob cancer ntawm lub gallbladder. Txawm hais tias tsis tshua muaj tus kab mob no (tsuas yog 20% ntawm cov neeg mob los ntawm cov qog nqaij hlav cancer ntawm tag nrho cov plab hnyuv), qhov kev kuaj mob no txaus ntshai nrog kev kho mob ntev thiab tsis muaj cov tsos mob thaum ntxov.
Cov neeg uas twb tau ntsib qhov kev kuaj mob no yeej yuav muaj lus nug ntau heev. Yuav ua li cas txheeb xyuas oncology nyob rau theem pib? Puas yog tib neeg nyob nrog theem 4 mob qog noj ntshav hauv lub gallbladder? Puas muaj peev xwm tshem tau tus kab mob no? Cov lus nug no tseem ceeb heev, yog li txhua yam ntawm kev kuaj mob thiab kev kho mob yuav tsum tau txheeb xyuas raws li kev txiav txim.
Basic concepts
Dab tsi yog qhov tseem ceeb ntawm lub gallbladder? Qhov no yog ib qho me me taum-zoo li lub cev. Nws nyob hauv qab ntawm daim siab. Lub luag haujlwm tseem ceeb ntawm lub gallbladder yog khaws cov kua tsib - cov kua dej tshwj xeeb uas koom nrog hauv kev zom zaub mov.
mob qog nqaij hlav gallbladder yog kab mob oncological. Nws tshwm sim los ntawm cov tsos mob ntawm cov kab mob pathological hauv cov ntaub so ntswg ntawm lub cev. Nyob rau tib lub sijhawm, cov hlwb no pib loj hlob thiab sib faib, tsim cov qog. Xws lilub neoplasm thaiv kev ua haujlwm ntawm lub gallbladder thiab cov khoom nyob sib ze. Txoj cai rau kev faib thoob ntiaj teb cov kab mob ntawm lub gallbladder cancer (ICD-10) yog C23.
Nws pom tias poj niam ib nrab ntawm tib neeg muaj kev pheej hmoo ntau dua rau tus kab mob no: raws li kev txheeb cais, muaj yuav luag ob npaug ntawm cov poj niam uas muaj tus kab mob no li txiv neej. Yog li, nyob rau hauv 2013 nyob rau hauv Russia, cov qog ntawm extrahepatic biliary ib ntsuj av tau kuaj pom nyob rau hauv 2180 cov poj niam thiab 1122 txiv neej (cov ntaub ntawv cais ntawm lub gallbladder tsis muaj).
Raws li cov hnub nyoog, feem ntau ntawm cov neeg mob yog cov neeg muaj hnub nyoog 50 xyoo. Txawm hais tias cov kws kho mob sau tseg: dhau kaum xyoo dhau los, mob qog noj ntshav hauv lub zais zis tau kuaj pom ntau ntxiv hauv cov neeg 30 xyoo thiab laus dua. Cov neeg mob ntawm cov menyuam yaus kuj tau txheeb xyuas, tab sis lawv raug cais tawm.
Dab tsi yog qhov nyuaj ntawm kev kuaj mob thiab kev kho mob? Qhov laj thawj tseem ceeb yog qhov kev thov rov hais dua ntawm cov neeg mob feem ntau nyob rau theem kawg ntawm tus kab mob. Qhov no ua rau kev kho mob nyuaj dua.
Ua rau mob gallbladder
Npe cov laj thawj tshwj xeeb uas dhau los ua lub zog rau kev loj hlob ntawm cov hlwb atypical, cov kws tshawb fawb ua tsis tau. Txawm li cas los xij, kev txheeb xyuas tas li tau qhia txog yam uas yuav ua rau muaj kev pheej hmoo ntawm mob qog noj ntshav hauv lub gallbladder:
Cov no yog ntau yam kab mob ntawm lub gallbladder ntawm ib qho inflammatory xwm, muaj pob zeb. 85% ntawm cov neeg mob oncology ntawm hom no yav dhau los muaj teeb meem nrog lub gallbladder. Cov no yog cov kab mob ntev ntawm lub cev, thiab pob zeb. Nyob rau tib lub sijhawm, nws tau pom: qhov loj dua cov pob zeb hauv lub gallbladder, qhov kev pheej hmoo ntawm cov qog nqaij hlav ntau dua
- Kev tiv tauj tas li nrog qee yam tshuaj. Ntawm cov neeg mob muaj ntau tus neeg ua haujlwm hauv kev lag luam phom sij (rubber lossis metallurgical kev lag luam). Qhov no tau piav qhia los ntawm kev siv tshuaj lom neeg ntau.
- Y duct duct. Xws li ib tug pathological tshwm sim feem ntau hu ua precancerous. Qhov tseeb yog tias cyst yog neoplasm uas muaj cov kua tsib. Nyob rau hauv tej yam kev mob, lub cyst tuaj yeem loj hlob tuaj, thiab tom qab ntawd degenerate mus rau hauv cov qog nqaij hlav thiab pom cov tsos mob ntawm lub gallbladder cancer. Thaum thawj zaug xav tias muaj cyst, koj yuav tsum mus rau tom tsev kho mob sai li sai tau.
- "Porcelain" gallbladder. Lub sij hawm kho mob no yog siv los txhais cov kab mob pathological ntawm lub cev, nyob rau hauv uas tag nrho cov phab ntsa ntawm lub gallbladder yog them nrog calcium deposits. Cov mob no tshwm sim nrog mob hnyav. Kev lig kev cai, lub cev cuam tshuam raug tshem tawm, vim nws feem ntau ua rau oncology.
- mob npaws typhoid. Txog niaj hnub no, kev kis tus kab mob typhoid fever yog ib qho tshwm sim tsis tshua muaj tshwm sim, tab sis yog tias nws tshwm sim, tus neeg mob yuav luag 6 npaug ntau dua yuav tsim cov tsos mob ntawm gallbladder cancer.
- hnub nyoog hloov pauv. Nyob rau hauv lub cev ntawm txhua tus neeg uas muaj hnub nyoog, irreversible phenomena tshwm sim nyob rau hauv lub cellular theem, uas yuav provoke kev loj hlob ntawm atypical hlwb. Qhov no tau lees paub tag nrho los ntawm kev txheeb cais: feem ntau ntawm cov neeg mob koom nrog pawg neeg laus.
- Tus cwj pwm phem. Cov npe yuav suav nrog kev haus luam yeeb, haus cawv ntau dhau,malnutrition.
qog histology
mob qog nqaij hlav hauv lub gallbladder feem ntau muab faib ua ntau pawg raws li qee yam ntxwv.
Raws li cov qauv histological ntawm cov hlwb, ntau hom qog muaj qhov txawv:
- squamous cell cancer - cov qog uas tshwm sim hauv cov txheej txheem epithelial thiab mucous membrane;
- adenocarcinoma - xws li neoplasm tshwm sim los ntawm cov qog qog ntshav nyob rau hauv lub epithelium ntawm lub cev;
- scirrhous;
- solid - los ntawm Latin lo lus solidum (khoom), xws li qog yog ib pab pawg ntawm cov hlwb nyob rau hauv daim hlau;
- sib txawv tsis zoo - cov qog nqaij hlav cancer no feem ntau muaj cov nuclei tsis zoo thiab cov qauv txawv txav.
Tumor localization
Raws li qhov chaw ntawm cov qog nqaij hlav malignant neoplasm, muaj 2 hom mob qog noj ntshav hauv lub gallbladder:
- Localized. Qhov no yog hom qog uas nyob hauv lub gallbladder nws tus kheej thiab tsis cuam tshuam rau cov ntaub so ntswg thiab cov kabmob uas nyob ze. Feem ntau, daim duab no tau pom thaum pib ntawm txoj kev loj hlob ntawm lub gallbladder cancer. Kev kho mob prognosis yog qhov zoo heev.
- Ua tsis tau. Pawg no suav nrog cov qog uas twb tau metastasized lawm. Dab tsi yog?
Metastases yog kev sib kis ntawm cov hlwb tsis zoo los ntawm qhov tseem ceeb (qhov no, los ntawm lub gallbladder) mus rau ntau yam ntaub so ntswg thiab cov kabmob ntawm tib neeg lub cev. Feem ntau, metastases ntawm gallbladder cancer kis mus raulymphatic system, siab, hnyuv, plab.
theem ntawm gallbladder cancer
Rau qhov kev faib tawm yooj yim dua thiab kev piav qhia ntawm cov txheej txheem pathological tshwm sim hauv tib neeg lub cev, nws yog ib txwm ua rau kev sib txawv ntawm cov qog nqaij hlav gallbladder nyob rau theem:
- 0 theem - nws feem ntau hu ua precancerous. Nyob rau lub sijhawm no, cov kab mob pathological nyob rau ntawm daim tawv nqaij ntawm lub cev, thiab qhov loj ntawm cov qog yog me me heev. Pib kev kho mob ntawm theem 0 tso cai rau koj kom tshem tau tus kab mob tag nrho, tab sis nws yog qhov nyuaj heev los kuaj xyuas tus kab mob oncology - tsis muaj tsos mob dab tsi.
- 1 theem. Malignant hlwb nkag mus tsis tau tsuas yog mus rau hauv lub mucous daim nyias nyias, tab sis kuj mus rau hauv lub nyob ib sab txheej ntawm cov ntaub so ntswg. Txoj kab uas hla ntawm cov qog kuj loj tuaj. Nyob rau theem no, thawj cov tsos mob ntawm gallbladder cancer yuav tshwm sim, tab sis lawv xyaum tsis pom. Feem ntau, kev kuaj pom tus kab mob nyob rau theem no tshwm sim thaum lub sijhawm kuaj mob tau sau rau lwm yam laj thawj.
- 2 theem (nruab nrab). Cov theem no suav nrog lub sijhawm ntawm kev loj hlob ntawm qog nqaij hlav. Los ntawm lub sijhawm no, neoplasm nce mus txog qhov loj me, tab sis tsis mus dhau lub gallbladder. Cov tsos mob hnyav zuj zus lawm.
- 3 theem. Nws yog nyob rau theem no ntawm kev loj hlob qog uas ntau tus neeg mob tig mus rau hauv tsev kho mob, raws li cov tsos mob tshwm sim tsis tu ncua. Txog lub sijhawm no, cov qog twb muab ze rau metastases.
- 4 theem. Mob qog noj ntshav hauv lub gallbladder nyob rau theem no muaj ob peb yam ntxwv ib zaug. Qhov no yog qhov loj ntawm cov qog, kev puas tsuaj rau cov ntaub so ntswg nyob ze(uas yog, metastases mus rau lwm yam kabmob), muaj ntau cov tsos mob ntawm tus kab mob, tsis tshua muaj cov qog los kho.
daim duab kho mob
Qhov tseem ceeb uas paub qhov txawv ntawm kev mob qog noj ntshav ntawm ntau lwm tus yog qhov tsis muaj cov tsos mob tshwm sim thaum ntxov. Nov yog qhov teeb meem tseem ceeb uas piav qhia vim li cas ntau tus neeg mob mus ntsib kws kho mob lig.
Ntxiv rau, ntau cov tsos mob ntawm cov qog nqaij hlav hauv lub zais zis zoo ib yam li lwm cov kab mob uas tsis yog mob qog noj ntshav (xws li cholecystitis ntev). Tib lub sijhawm, nws tsis yog qhov tsim nyog uas txhua tus tsos mob tshwm sim - lawv yuav txawv nyob ntawm seb hom mob qog noj ntshav thiab nws qhov chaw nyob.
Ntawm cov tsos mob thawj zaug ntawm mob qog noj ntshav hauv lub gallbladder yog:
- mob nyob rau sab xis ntawm lub plab hauv qab tav (thaum xub thawj, qhov mob tshwm sim tsis tshua muaj thiab yog lub sijhawm luv, tab sis nce raws li cov qog loj tuaj);
- -bloating thiab hnov zoo li hnyav;
- tshwm sim ntawm xeev siab, ntuav;
- quav quav (flatulence tuaj yeem hloov tau los ntawm cem quav);
- tsis qab los lossis txo qis.
Yog tias nyob rau theem no tus neeg tsis mus ntsib kws kho mob thiab tsis pib kho, cov qog tseem nce ntxiv. Ib me ntsis tom qab, cov tsos mob ntawm lub gallbladder cancer tshwm sim, xws li:
- mob hauv qhov chaw precostal txoj cai ua ntau zaus thiab ntev dua, lawv tuaj yeem tawg thoob plaws hauv plab, nraub qaum, caj dab lossis xub pwg;
- xeev siabxaus nrog ntuav, tab sis txawm tias qhov no tsis tuaj yeem pab tau;
- qog hlav ua rau muaj qhov loj ntawm lub gallbladder - vim li ntawd, daim siab loj tuaj yeem hnov ntawm nws tus kheej;
- pom cov tawv nqaij daj me ntsis;
- kub hnyiab ntawm daim tawv nqaij;
- dyspnea tam sim no (tsis yog tom qab qoj ib ce xwb, tab sis txawm tias so);
- qab los noj mov yuav zoo lossis tsis tuaj yeem ua ke, thaum lub cev hnyav txo qis;
- Lub cev kub siab ntev (ntawm 37 txog 39 degrees);
- qaug zog, qaug zog, tsis txaus siab.
Lwm yam cim qhia tej zaum yuav yog qhov hloov xim ntawm cov zis thiab quav. Cov zis yuav tsaus, thaum quav, ntawm qhov tsis sib xws, sib dua.
Kev kuaj mob thawj zaug ntawm cov neeg mob
Lub sijhawm tsis muaj cov tsos mob nyob rau theem 1 ntawm lub zais zis qog noj ntshav ua rau muaj qhov tseeb tias hauv 70% ntawm cov neeg mob mus rau hauv tsev kho mob thaum cov qog tau nce mus txog qhov loj thiab xav tau kev kho mob mus ntev.
Txhawm rau sau cov kev kho kom zoo tshaj plaws, tus kws kho mob yuav tsum tau txais daim duab tiav ntawm tus kab mob. Txhawm rau ua qhov no, nws tau sau ntau qhov kev xeem, thiab tseem ua:
- Kev tshuaj xyuas tag nrho ntawm tus neeg mob. Thaum thawj zaug, tus kws kho mob yuav tsum tau txais cov ntaub ntawv ntau npaum li qhov ua tau los ntawm tus neeg mob cov lus. Qhov no yuav tso cai rau koj txiav txim siab qhov hnyav ntawm cov tsos mob. Raws li qhov no, qhov hnyav ntawm tus mob tam sim no tuaj yeem ua tiav.
- Kev paub txog tus yam ntxwv ntawm tus neeg mob lub neej thiab keeb kwm ntawm nws tus mob. Cov ntsiab lus no tso cai rau txiav txim qhov loj ntawm qhov kev pheej hmoo.kev loj hlob ntawm mob qog noj ntshav.
- kuaj lub cev. Lub tswv yim no suav nrog kev tshuaj xyuas tus neeg mob, ntsuas lub cev kub, palpation ntawm daim siab cheeb tsam (rau qhov nce hauv qhov loj ntawm lub cev), kev tshuaj xyuas ntawm daim tawv nqaij thiab qhov muag sclera kom pom cov xim daj.
Kev Tshawb Fawb
Kev kuaj sim yuav tsis qhia txog kev mob qog noj ntshav hauv lub gallbladder, tab sis cov txiaj ntsig kev sim yuav qhia meej txog cov kab mob pathological ntawm ib lub cev.
Cov kev xeem hauv qab no tau ua:
- Ua tiav urinalysis.
- Fecal tsom xam (coprogram).
- Biochemistry ntawm ntshav. Hauv cov kab mob ntawm lub gallbladder, nce qib ntawm transaminases, bilirubin, thiab alkaline phosphatase tau pom.
- Xa mus kuaj ntshav kom pom cov cim qog. Cov kev kuaj mob no tso cai rau kom tau txais cov ntaub ntawv hais txog qhov muaj cov kab mob malignant hauv lub cev.
Instrumental diagnostics
Cov txheej txheem kev tshawb fawb tuaj yeem raug hu ua lub hauv paus ntawm kev kuaj mob, vim nws yog los ntawm cov txiaj ntsig ntawm cov kev tshawb fawb no uas tus kws kho mob tau txais cov ntaub ntawv hais txog lub xeev ntawm lub gallbladder, qhov muaj lossis tsis muaj qog, nws qhov chaw, qhov loj me. thiab muaj cov metastases:
- Ultrasound ntawm lub gallbladder thiab cov kabmob sab hauv ntawm lub plab kab noj hniav. Siv txoj kev kuaj mob no, nws tuaj yeem txiav txim siab qhov loj thiab qhov chaw ntawm cov qog. Tsis tas li ntawd, koj tuaj yeem ntsuas qhov xwm txheej ntawm cov kabmob hauv nruab nrog cev thiab txheeb xyuas cov kabmob metastases.
- Computed tomography. Cov txheej txheem no yog nqa tawm ntawm ib qho tshwj xeeb apparatus thiab nthuav tawm tag nrho cov nyob ze thiabnyob deb metastases uas muaj nyob rau hauv lub cev.
- Magnetic resonance imaging. Muab cov ntaub ntawv hais txog lub xeev ntawm lub hlwb (muaj los yog tsis muaj metastases).
- Biopsy. Txoj kev tshawb no yog ib qho tseem ceeb tshaj plaws. Cov txheej txheem muaj xws li sau cov kab mob pathological los ntawm lub gallbladder. Tus kws kho mob coj tus qauv siv ib rab koob ntev ntev, thiab tom qab ntawd xa cov ntaub so ntswg mus kuaj histological. Raws li qhov tshwm sim, cov ntaub ntawv tseeb ntawm qhov xwm thiab histological nta ntawm cov qog nqaij hlav cancer tau txais.
- Cholecystography yog ib txoj kev kuaj mob uas siv tus neeg sawv cev sib txawv.
Kev kho mob qog nqaij hlav gallbladder
Txoj hauv kev tseem ceeb los kho tus kab mob no yog kev phais mob. Thaum lub sij hawm nws, tus kws phais tshem tawm lub gallbladder. Hauv qhov no, 2 txoj kev xaiv tau:
- Cholecystectomy. Kev phais mob uas lub gallbladder raug tshem tawm. Xws li txoj hauv kev kho mob tsuas yog ua tau thaum kuaj pom ntxov ntawm oncology.
- Cholecystectomy + daim siab ua haujlwm. Nyob rau theem 3, kev tshem tawm ntawm lub gallbladder yuav tsis muaj txiaj ntsig, vim tias cov kab mob malignant tau kis mus rau daim siab. Hauv qhov no, thaum lub sijhawm ua haujlwm, txoj cai lobe ntawm daim siab kuj raug tshem tawm. Qee zaum, yuav tsum tau txiav tawm cov qog ntshav qab zib nyob ze.
Nyob rau theem kawg ntawm tus kab mob, mob qog noj ntshav hauv lub gallbladder yog suav tias yog siv tsis tau, yog li kev phais tsis raug sau tseg. Qhov no tau piav qhia los ntawm ntau cov metastases cuam tshuam rau lymphatic system, siab, ntsws, thiab hlwb. Hauv qhov no, hauvRaws li kev kho mob, cov chav kawm ntawm xov tooj cua- thiab kws khomob tau sau tseg.
Radiotherapy yog ib txoj hauv kev kho mob oncology, uas tus neeg mob raug ionizing hluav taws xob. Lub ntsiab lus ntawm txoj kev yog cov hlwb malignant rhiab heev rau hluav taws xob, yog li ntawd, nyob rau hauv xws li raug, lawv raug puas tsuaj. Feem ntau, kev kho mob hluav taws xob kuj tseem siv los ua ib qho txiaj ntsig ntxiv ua ntej lossis tom qab kev phais. Txoj kev kho no zoo heev, tab sis muaj kev phiv loj heev.
Tshuaj khomob yog lwm txoj hauv kev los cuam tshuam cov qog tsis tas siv daim tawv nqaij. Hauv qhov no, kev kho mob yog ua raws li kev noj cov tshuaj muaj zog uas muaj kev cuam tshuam rau cov qog hlwb pathological. Nyob ntawm theem, cov kab mob sib kis thiab cov xwm txheej dav dav ntawm tus neeg mob, tus kws kho mob tau sau cov tshuaj infusion ntawm cov tshuaj lossis kev tswj hwm qhov ncauj. Kev noj tshuaj thiab lub sijhawm yog tswj hwm nruj los ntawm tus kws kho mob tuaj koom. Tag nrho lub sijhawm kho mob tau muab faib ua cov chav kawm nrog so ob peb lub lis piam.
Special diet for gallbladder cancer
kab mob Oncological yog ib qho kev sim nyuaj rau tib neeg lub cev. Nyob rau tib lub sijhawm, nws tseem ceeb heev uas lub gallbladder koom nrog hauv kev zom zaub mov, thiab yog li kev noj zaub mov muaj teeb meem rau lub sijhawm no yuav tsum tau ua tib zoo saib.
Kev noj zaub mov ntawm tus neeg mob qog noj ntshav yuav tsum tau tsim ua ib txoj hauv kev kom txo tau lub gallbladder thiab daim siab kom ntau li ntau tau.
Cov zaub mov yuav tsum tsawg kawg 5-6 ib hnub, thiab feem yuav tsum me me.
Koj yuav tsum muab qhov nyiampluas mov nrog fiber ntau thiab protein uas yooj yim zom.
Muab zaub mov hnyav: rog, ntsev, kib, haus luam yeeb, qab zib.
Kev noj haus yuav tsum muaj ntau yam xws li zaub thiab txiv hmab txiv ntoo, nqaij ntshiv, ntses.
Yuav tsum tau noj cov vitamins uas kws kho mob tau sau tseg. Kev noj zaub mov zoo li no yuav pab txhawb kev tiv thaiv tib neeg.
Huab cua
Txhua tus neeg mob uas muaj qhov kev kuaj mob no yeej xav paub tias lawv nyob nrog mob qog noj ntshav ntev npaum li cas. Qhov tseeb, tsis muaj leej twg tuaj yeem muab qhov kev kwv yees tseeb. Cov txiaj ntsig ntawm kev kho mob yog nyob ntawm ntau yam hauv ib zaug, xws li: theem ntawm tus kab mob, hnub nyoog ntawm tus neeg mob qog noj ntshav, kab mob sib kis, hom thiab qhov chaw ntawm cov qog.
Thaum theem 1, ntau dua 60% ntawm cov neeg mob tuaj yeem kho tau ntawm oncology.
Kev pib kho nyob rau theem 2 muab kev muaj sia nyob tsib xyoos ntawm cov neeg mob hauv 30% ntawm tus neeg mob.
Nyob rau theem 3, qhov muaj sia nyob tsib xyoos tau pom hauv 10% ntawm tus neeg mob.
Tus nqi kho qis tshaj plaws rau theem 4 mob qog noj ntshav qis qis dua 10%.
Cov ntaub ntawv no tau txais ua tsaug rau kev saib xyuas tas li ntawm kev txheeb cais rau ntau xyoo lawm. Cov ntaub ntawv txheeb xyuas tsuas yog qhia tias qhov feem pua ntawm cov ciaj sia tuaj yeem nyob ntawm ib theem ntawm tus kab mob, tab sis nyob rau hauv txhua rooj plaub, qhov kev txheeb xyuas no yuav tsis ua haujlwm. Txawm tias nyob rau theem kawg, muaj feem yuav rov qab los, yog li koj yuav tsum tau tawm tsam tus kab mob hauv txhua kis.
