Krukenberg metastasis yog dab tsi? Qhov no pathology yog mob qog noj ntshav theem nrab. Nws cuam tshuam rau cov poj niam nkaus xwb, vim nws pom muaj nyob hauv zes qe menyuam. Nws yog ib qho tsub zuj zuj ntawm cov hlwb atypical uas sib faib thiab tsim cov qog ntshav thib ob. Ntawm cov malignant neoplasms ntawm zes qe menyuam, nws nyob rau qib thib peb tom qab epithelial thiab embryonic hom mob qog noj ntshav. Ua hauj lwm raws li ib qho kev tsis pom zoo, qhia txog kev sib kis ntawm cov thawj malignant tsim thiab 3-4 degree ntawm cov txheej txheem.
Yog vim li cas
Krukenberg cancer yog ib qho mob qog noj ntshav ntawm zes qe menyuam. Metastasis circulates los ntawm lub plab hnyuv kab mob, feem ntau lub plab. Tsis tshua muaj, qhov chaw tseem ceeb yuav yog lub mis, thyroid, lossis uterus.
Mechanisms rau kev loj hlob ntawm pathology
Cov qog thawj zaug dhau los ua ib qho kev mob siab rau pathological, uas tau muab cov ntshav thiab cov as-ham. Nyob rau hauv tas li ntawd, lub hlwb faib uncontrollably thiab yuav bud tawm. Feem ntau lawv nkag mus rau hauv cov hlab ntsha thiab lymphatic systems ntawm lub cev. Nrog rau qhov ntws ntawm cov kua dej physiological no, cov qog nqaij hlav malignant tau nqa mus rau lwm lub cev thiab cov qog nqaij hlav loj. Krukenberg's metastasis feem ntau nyob hauv ob lub zes qe menyuam. qogpib nce qib thiab ua lub hauv paus ntawm metastases tshiab.
Muaj 4 theem ntawm cov txheej txheem mob qog noj ntshav:
- 1 theem - ib lub zes qe menyuam raug cuam tshuam.
- 2 theem - ib lossis ob lub zes qe menyuam thiab ib puag ncig cov ntaub so ntswg koom nrog hauv cov txheej txheem.
- 3 theem - cov qog pom muaj nyob rau hauv ib lossis ob lub zes qe menyuam, thiab tseem muaj cov metastases nyob rau hauv lub plab peritoneum lossis retroperitoneal lymph nodes.
- 4 theem - mob qog noj ntshav npog ob lub zes qe menyuam thiab ua qhov chaw rau cov kab mob metastases tshiab rau lwm lub cev.
Metastases ntawm Virchow, Krukenberg, Schnitzler thiab tus muam Yauxej hauv plab mob qog noj ntshav
Virchow's metastasis - kis nrog cov qog ntshav los ntawm cov kab mob qog nqaij hlav hauv lub cev thiab nyob hauv thaj tsam sab laug supraclavicular. Txaus siab rau kev xeem.
Krukenberg's metastasis yog nyob hauv lub zes qe menyuam. Schnitzler's metastasis nyob rau hauv cov ntaub so ntswg ntawm lub pelvis me me thiab palpable thaum lub sij hawm kuaj digital ntawm lub qhov quav. Muam Yauxej tus kab mob metastasis nyob rau hauv lub plab.
Cov tsos mob thiab kev kho mob ntawm Krukenberg metastasis
Krukenberg's metastasis yog nyob rau hauv lub zes qe menyuam, uas yog cov kab mob endocrine uas tsim cov tshuaj hormones. Kev sib tsoo tshwm sim. Kev hloov pauv hauv qib hormonal yog tshwm sim los ntawm ntau cov tsos mob:
- txo qis libido thiab tsis muaj peev xwm ua rau orgasm (frigidity);
- ntxhis heev;
- tshwm sim ntawm cov txiv neej cov plaub hau (zoo li tus kav hlau txais xov, plaub hau ntawm lub plab, hauv siab, nraub qaum) thiabhloov lub timbre ntawm lub suab kom qis dua;
- kev coj khaub ncaws tsis xwm yeem (kev coj khaub ncaws tuaj yeem hnyav lossis tsis txaus, muaj qhov txawv txav los ntawm qhov chaw mos);
- feem ntau qhov aggression ntawm cov qog provokes qhov pib ntawm menopause.
Nyob zoo ib tsoom phooj ywg;
Ib tug poj niam kuj yuav muaj qhov tsis xis nyob thiab mob hauv plab plab, uas cuam tshuam thaum so lossis thaum muaj kev sib deev, nrog rau ua ntej kev coj khaub ncaws. Qee qhov xwm txheej, muaj kev ua txhaum ntawm cov txheej txheem tso zis thiab qhov teeb meem tshwm sim nws tus kheej hauv daim ntawv ntawm cystitis. Cov qog tuaj yeem ua rau cov kab mob nyob ib puag ncig. Qib ntawm qhov tshwm sim ntawm cov tsos mob nyob ntawm seb qhov loj ntawm cov qog, hnub nyoog, qhov xwm txheej ntawm tus poj niam thiab muaj cov kab mob sib xyaw ua ke.
Cov tsos mob saum toj no yuav tsum tau nrog los ntawm kev tshwm sim ntawm tus mob qog noj ntshav thawj zaug.
Nrog oncological pathology ntawm lub plab, cov tsos mob tau pom:
- burping nrog putrid tsw;
- xeev siab thiab ntuav;
- hnyav hauv plab;
- bloating;
- mob hauv cheeb tsam epigastric;
- ascites - tsub kom cov kua dej hauv plab kab noj hniav.
Thaum cov txheej txheem mus rau hauv lub peritoneum, nws pib tsim cov kua dej, qhov ntim tuaj yeem ncav cuag li 10 litres. Nws tuaj yeem pom nyob rau hauv cov kab noj hniav pleural, uas yog tshwm sim los ntawm kev ua pa thiab cov hlab plawv tsis ua haujlwm.
Txhua txoj kev mob qog noj ntshav ua rau lub cev tsis txaus, vim tias nws yuav tsum muaj kev sib ntaus sib tua ntawm lub cev tiv thaiv kab mob nrog rau nws, thiab tseem yuav tsum muaj lub zog nrog cov khoom noj khoom haus rau nws txoj kev loj hlob.
Cov tsos mob ntawm mob qog noj ntshav cachexia (nkim)
muajCov cim qhia ntawm kev ua txhaum hauv qab no:
- kev qaug zog, qaug zog;
- nce hauv lub cev kub hauv 37.3-37.5 degrees;
- poob ceeb thawj hauv lub sijhawm luv;
- poob qab los yog tsis muaj;
- tseem tsis paub;
- plab hnyuv.
Krukenberg Metastasis Diagnosis
Ntau zaus, kev kuaj pom ntawm cov metastases nyob deb ua ntej kev kuaj mob plab. Hauv qhov no, cov txheej txheem tuaj yeem ua tiav nyob rau theem siab (3-4). Txoj kev kuaj mob yooj yim:
- Qhia txog kev tsis txaus siab thiab kawm txog keeb kwm ntawm kev txhim kho tus kabmob. Nws yog ib qho tsim nyog yuav tau piav qhia txog cov tsos mob, thaum nws pib, yog vim li cas, seb puas muaj lwm yam tsos mob los ntawm txoj hnyuv.
- Kev tshuaj xyuas. Kev kuaj mob gynecological siv daim iav, kuaj bimanual (ob txhais tes). Koj tuaj yeem pom cov duab sib npaug nrog lub ntsej muag du thiab tsis mob. Nco ntsoov xyuas cov qog mammary thiab hauv cheeb tsam (cov qog ntshav nyob ze). Kev kuaj digital ntawm lub qhov quav kom pom Schnitzler metastasis.
- Kev kuaj mob ultrasound ntawm lub plab hauv plab nrog lub zais zis, yog li cov appendages pom tau zoo dua. Tso cai rau koj los txiav txim siab sai sai ntawm cov kab mob pathological, nws cov duab, qhov loj me thiab qib ntawm kev sib kis. Muaj ib txoj kev ultrasound nrog rau kev kuaj ntshav.
- Percutaneous biopsy thiab tom qab kuaj cytological piav txog Krukenberg's metastasis. Tsis tshua siv tam sim no vimtsis tsim nyog thiab raug mob.
- MSCT nrog qhov sib txawv. Tso cai rau koj los kawm kom meej cov qog thiab cov ntaub so ntswg ib puag ncig, txhawm rau txiav txim siab muaj cov metastases. Siv thaum daim duab ultrasound tsis meej.
- Kev tshuaj xyuas ntawm qhov tseem ceeb: fibrogastroduodenoscopy, kuaj cov qog mammary, ultrasound ntawm lub plab kab noj hniav, kuaj cov thyroid caj pas.
- doppler kuaj ntawm cov qog yog tsim nyog los kawm txog cov ntshav ntws ntawm cov qog. Ib txoj hauv kev zoo rau cov kws phais.
- Kev txiav txim siab ntawm qib ntawm cov qog nqaij hlav hauv cov ntshav - cov qog ua ke nrog antigens. Lawv qib nce nrog kev nce qib ntawm cov txheej txheem oncological. Cov ntaub ntawv tshaj tawm yog C-125, CA-19-9, CA-72-4. Lawv pom nyob rau hauv 89-100% ntawm cov neeg mob.
Kev kho mob ntawm Krukenberg metastasis
Qhov ntim ntawm kev ntsuas ntsuas yog txiav txim siab los ntawm tus kws kho mob oncologist lossis tus kws kho mob-tus kws phais mob. Nws yog ib qho tsim nyog yuav tsum coj mus rau hauv tus account lub hnub nyoog ntawm tus neeg mob, qhov hnyav thiab theem ntawm tus kab mob. Yog hais tias qhov kev ua haujlwm yog contraindicated rau tus neeg mob, ces lawv mus rau cov kev kawm ntawm chemotherapy thiab radiation therapy, nrog rau kev tshem tawm ntawm qhov mob nrog narcotic analgesics (palliative therapy).
Kev kho mob phais yog qhov nyuaj thiab nyuaj rau tus neeg mob, vim nws tau ua ntau theem.
- Kev tshem tawm ntawm qhov tseem ceeb ntawm cov ntaub so ntswg thiab cov qog ntshav. Yog tias qhov no yog kev tshem tawm ntawm lub plab, tom qab ntawd theem kawg ntawm kev ua haujlwm yuav yog qhov kev txiav txim siab ntawm gastrostomy.
- Kev tshem tawm ntawm zes qe menyuam. Lub hnub nyoog yug me nyuam tsis raug coj mus rau hauv tus account vim nws yoglus nug txog tus neeg mob lub neej. Yog tias tsuas yog ib lub zes qe menyuam raug cuam tshuam, ces qhov thib ob raug tshem tawm rau kev tiv thaiv, vim tias qhov pom ntawm Krukenberg metastasis hauv nws tsuas yog lub sijhawm xwb.
Tshem tawm cov kabmob raug xa mus rau kev soj ntsuam histological kom nkag siab qhov xwm txheej ntawm cov qog, lub hauv paus ntawm nws txoj kev loj hlob.
Tom qab kev kho mob phais, kev kho tshuaj khomob thiab kev kho hluav taws xob tau muab tshuaj los tiv thaiv cov neoplasms rov qab thiab tiv thaiv cov hlwb uas tseem tshuav hauv lub cev.
Kev kho mob ntawm cov neeg mob tom qab kev kho mob yog tsom rau kev pabcuam kev puas siab puas ntsws, immunostimulating kho, kho kho dua tshiab, noj zaub mov, pw tsaug zog thiab so. Yog tias muaj gastrostomy, ces kev kho kom raug yog tsim nyog rau nws. Lub sijhawm no, kev txhawb nqa ntawm cov neeg hlub yog qhov tseem ceeb tshwj xeeb.
Huab cua
Tshuaj, poob siab. Raws li cov ntaub ntawv kho mob, kev tuag hauv thawj xyoo ntawm qhov tshwm sim yog 95%. Tab sis cov neeg muaj sia nyob tsib xyoos tau paub - 1% ntawm cov neeg mob. Yog vim li cas rau cov ntaub ntawv hnyav li no yog vim lub xeev tsis saib xyuas ntawm qhov tseem ceeb ntawm qhov tsis zoo.
Krukenberg Metastasis Tiv Thaiv
Nyob hauv peb lub teb chaws, kev xav ntawm pej xeem tsis pub lawv mus nrhiav kev pab kho mob raws sij hawm. Peb cov tshuaj feem ntau yog dawb, tab sis muaj chav kuaj mob. Polyclinics nquag caw cov neeg koom nrog mus kuaj mob. Nws yog tsom rau txhua ntu ntawm cov pej xeem thiab tso cai rau koj txheeb xyuas cov cim qhia ntawm thawj theem ntawm tus kab mob thiab pib kho raws sijhawm. Npajkev ntsuam xyuas los ntawm gynecologist kuj qhia qhov txawv txav ntawm tus poj niam lub cev. Hauv cov neeg mob uas muaj kab mob plab, kev npaj kho mob fibrogastroduodenoscopy yog qhov tsim nyog, vim tias muaj kev pheej hmoo ntawm kev mob qog noj ntshav plab.
Kev tiv thaiv kab mob qog noj ntshav thib ob ntawm zes qe menyuam tsuas yog ua tau los ntawm kev kuaj xyuas koj lub cev tsis tu ncua.
