Klatskin isimila: izici, izimpawu, ukwelashwa, onalesi sifo

Cholangiocarcinoma, kumphakathi zempilo zomhlaba wonke ukuba izibalo, mayelana 2% omdlavuza, kanye kuze kufinyelele ku-10% amacala isibindi biliary umdlavuza ipheshana. Ngesikhathi uphethwe efanayo lolu hlobo lwesimila sincane kakhulu:% 1.5-2 kuphela. Isimila Klatskin yaqanjwa sezifo Gerald Klatskin, udokotela lisuka eMelika. Ngo-1965, ngenkathi sisebenza baseYale University, ukuthi sithembele amacala 13, wachaza zonke izici yalesi sifo.

Cholangiocarcinoma, noma nomdlavuza wesibindi, futhi Bile imbobo

Klatskin isimila - isifo esiyingozi. Ngenxa yalesi neoplasm libhekene ukukhula kancane nokuthuthukiswa kamuva metastases. Ngenxa uphethwe ngasekupheleni kanye nokungakwazi ukuba afeze yokususa ukuhlinzwa, has isifo enkulu yokufa. Imiphumela yaloku kuhlola okungenhla ezimweni eziningi ibekwe phezu izigaba yokugcina ukuthuthukiswa kwemfundo, okuyinto ikhiphela ngaphandle ukuhlinzwa. Ukuthuthukiswa metastases ngqo obala isibindi, amasango isibindi, yesifunda lymph node kanye esiswini. Isimila kukhula kwenzeka kusukela isibindi EPITHELIAL amaseli. kwakhiwa ukuhlupheka ikakhulukazi ngemva kweminyaka engu-50, kodwa njalo ngonyaka engu iziguli kuyehla. Amadoda kancane usengozini yokuthola lesi sifo kunabesifazane.

Imbangela kungenzeka yesimila

Izimbangela isibindi cholangiocarcinoma alwaziwa. Kodwa ososayensi baye bathola imiphumela ezikhulisa ubungozi izimila. Nge umlando sklerotiziruyuschego eyinhloko cholangitis ezigulini 40 out amacala 100 kungase zimiswe Klatskin isifo. Isimila kwakhiwa ngaso amacala 25 aphume 100 ngesisekelo izifo ngofuzo, ezifana Caroli isifo. ukuphendula okuvuthayo ngenxa izimuncagazi intrahepatic kungabangela lwesimila.

Izejwayezi ezimbi ezithinta impilo isibindi: ukubhema, ukusebenzisa kabi utshwala, ukudla okungenamsoco, entailing ukukhuluphala - izici obungenakuphikwa ngoba ukuqhubekela phambili kwesifo. Ukuba khona cholelithiasis kwandisa amathuba izimila. Engozini abantu abavezwe contact isikhathi eside nge ubuthi izinto eziyingozi. izifo ezibangelwa amagciwane, ngokuyinhloko i-hepatitis, nesandla ekuthuthukiseni zomdlavuza.

symptomatology cholangiocarcinoma

Njengoba isimila esibulalayo esikhula esibindini kanzima ukuxilonga, kufanele ulalele emzimbeni wakho kusenesikhathi isifo Klatskin. Ithumba kungenzeka libhekene izimpawu ezifana:

• isici esiyinhloko sifo - jaundice obstructive;
• njalo ukulunywa umuzwa;
• buhlungu elalimbelesele engxenyeni engenhla kwesokudla esiswini;
• ukungakuthandi ukudla ngenxa yalokho ezinqala kwesisindo;
• ngokomzimba ukukhathala nobuntu isimila kumiswa;
• ashisa isigqugquzeli Klatskin izimila kwenzeke;
• izinguquko umchamo kanye sezinyawo umbala (umchamo onombala, sezinyawo njalo).

Izimpawu zavele futhi kuyaqhubeka. Jaundice ezitholakala amacala 90 100, futhi ingenye izimpawu njalo iningi isifo esinjengo isimila Klatskin. Izibuyekezo iziguli ngezinye izikhathi kuhluke. Ezinye iziguli kubika ukunamathela ukulunywa, ubuhlungu futhi kungazelelwe kwesisindo. Lezi kubonakaliswa kwamandla ngenxa yobuthakathaka izigaba eziphambili izimila ebulalayo. Kodwa abanye ungazizwa cishe akukho ngeziphambeko isimo sezempilo noma izimpawu exhumene abonakala nezinye izifo.

Isimila Ukuxilonga Klatskin

Ukuze uphethwe Kwenziwa eziningi izifundo zokwelapha ongakusho ngokunemba khona Klatskin isifo. Ithumba kuyabonakala ku-ultrasound ngo Ukuhlolwa kulandzelana nekuhlunga tinsita. Lena indlela sasivumela ukonga, friendly futhi kalula. Ngosizo Kuvunguza CT kulula ukubona ukushayisana esinyeni inyongo ukulimala kwesibindi, futhi ukubona-lymph. Ukusebenzisa i-MRI (magnetic resonance imaging), ukwethulwa Ngokuphambene fluid kwesibindi ngokunemba high ukucacisa isimo izicubu isibindi kanye nezinga ukuvaleka uvule imbobo Bile uphethwe Klatskin lwesimila. Photography libonisa yonke izingxenye Amapayipi isibindi Bile.

cwaningo Fluoroscopic futhi radiographic sikhombisa izinkinga nge izindlela biliary. Inqubo ukuxilongwa yethulwa Ngokuphambene ejenti, okuvumela ukuba ubone ukugeleza Bile. ukuhlolwa kwegazi kwamakhemikhali ukusiza kutholakale izinga enzyme bilirubin. CA 199, CA 125: Lemisebenti ingaphindze ukuhlolwa ukuhlonza umdlavuza tel kunikezelwe.

Kaningi, isimila izinqubo ukufinyelela Umthambo hepatic futhi portal umthambo igazi eligciniwe ukuze kwesibindi. Ngaphambi kokuba ahlinzwe kubaluleke kakhulu okuzobe kudlalelwa izimila, ukuze acacise ukuthi isifo sandile kuya imithambo yegazi. Kwezinye izimo, kokutshelwa ngokukhubazeka kwengane kunzima, bese umbuzo isikali isixazululekile resection phakathi nokuhlinzwa.

Izindlela neoplasms ekwelapheni

iziguli kungelashwa ezimweni eziningi isilinganiso sobude bokuphila ezinyangeni eziyi-6 emva ukuzimisela i ukusazi ngokunembile isifo esikuphethe. Okwakuhlalwa kuzo lapho kusaqalwa akuvamile zembula Klatskin isifo. Ithumba amenable ezigabeni yokugcina ukwelashwa siyasebenza ngempela.

Ukuhlinzwa - enye yezindlela eziyinhloko ukwelapha yesimila. Nokho, ukusebenza it has a ongaphakeme embundwini sokusinda (Kusho 20%) ngenxa uphethwe ngasekupheleni. nokususwa ngokuphelele ingxenye eyayonakele imbobo Bile isetshenziswa kuzuzwe nomphumela omuhle sikanye ukususwa eyodwa Lobe kwesibindi, ukuze ugweme isifo imithambo yegazi.

Ukuhlinzwa kungenzeka ezimweni ezimbalwa:

• imfundo akazange kuthinte isimiso sokujikeleza kwegazi kwesibindi; kuleli cala kungenzeka ukuba asuse yonke ingxenye noma ingxenyenamba kwesibindi ezilimele;
• imfundo akazange kuthinte imbobo Bile oyedwa wenu noma nobabili iyizingxenye kwesibindi.

Kubhekwe isifo unresectable, lapho isimila lingena imithambo yegazi kwesibindi noma Bile Amapayipi kokubili share yayo.

ukwelashwa okuthuthukisa

Ezimweni inoperable noma njengoba therapy adjunct esetshenziswa ukunakekelwa ngezokwelashwa okuthuthukisa.

Lezi zindlela zibandakanya:

• amanzi ipheshana biliary;
• ngelashwa nangemithi;
• ukwelashwa ngemisebe;
• ukuhlinzwa dlula;
• ukwelashwa photodynamic;
• vysokosfokusirovannymi ngemisebe lwemishayo ultrasonic.

Ngokuhlanganisa zokwelapha eziningana, kuhambisana ekuhlonzweni, ubude bempilo zingandiswa kusuka izinyanga 10 kuya eminyakeni emi-5.

Onalesi sifo emva kokwelashwa

Ngenxa yokuthi kumiswa izimila esibindini uyephuza ngokwanele, isilinganiso sobude bokuphila ivela nengxenye iminyaka emihlanu. Qedela ukususwa ezindaweni ezilimele kungaba ekwandiseni isikhathi sokuphila ngoba ukusazi ngokunembile isifo esikuphethe futhi ifike ngesikhathi lesi sifo Klatskin. Izimila ezitholakala kwesibindi, has izibikezelo okungekuhle. Lena ngenye yama-izinkomba okubi kakhulu babonakala in iziguli metastases inoperable kumiswa. Iziguli ezinjalo kungaba kuphela ancike amanzi ipheshana biliary. Uma kutholakala isimila isibindi Klatskin, isilinganiso sobude bokuphila lwabagulayo ngezinye izikhathi akukho esingaphezu kwamasonto ambalwa.

Imbangela yokufa, Isimanga siwukuthi, akusho iyakhula, kanye nezinkinga ezihlobene. Lezi zihlanganisa:

• isifo sokusha kubangelwa okungafanele Bile outflow;
• ukutheleleka, okuholela kwetinhlavu abscesses;
• yoma ingqikithi amasosha omzimba umzimba futhi ukwehluleka;
• ukuvuvukala suppurative.

izinyathelo

Ngokuba nokuvimbela izifo neoplastic we Amapayipi isibindi Bile kuyadingeka ukuba banamathele umsoco ofanele, hhayi kabi utshwala kanye ukuvimbela ukutheleleka yisinanakazana. Uma umlando sifo, zisekujuleni njengoba engcupheni, kufanele kube ukwelashwa esifike ngesikhathi neluhlolo ehlelekile for kusenesikhathi kwezinso ezindikimbeni Bile. Kuyadingeka ukuqeda imiphumela izidakamizwa eziyingozi, efana emsebenzini.

Ekuphetheni

imishini yesimanje zokuxilonga kungathola izimila kule Amapayipi isibindi Bile, futhi ukucacisa degree yinkimbinkimbi kuhlinzwa. Ukwamukelwa izindlela ezintsha zokusebenza ukuxazulula inkinga, ukufakelwa kwezitho nezinye izinyathelo zokwelapha kuholela ngcono ikhwalithi nobude besikhathi sokuphila iziguli.