Wilms 'isimila: Izimpawu, Ukwelashwa

Out of the umzimba womuntu awuyona umzimba ukuthi ngaso sonke isikhathi yena naphansi kwazo zonke izimo ukuba uhlale uphilile. Ngeshwa, izifo eziningi kanye zamehlo abekwa ngisho utero. On omunye wabo sizobe ukukhuluma ku-athikili yethu. Abantu abaningi abasazi isimila Wilms '. Kuyini, abanye alazi. Le ndatshana izozama ukubhekana izimpawu, izimbangela kanye amaqhinga ukwelapha lesi sifo.

Umqondo isimila Wilms '

isimila Wilms ', noma njengoba ibizwa, nephroblastoma, libhekisela izifo ebulalayo of izinso zivame ukubonakala ebuntwaneni. Ivame kutholakala ukuthi uphethwe yini abaneminyaka ephakathi kwengu-2-5. isimila Wilms 'e abadala iyindlala, ngakho kancane wafunda.

K Ngeshwa, abantwana abaphethwe yilesi sifo avame nezinye kwezinso ekuthuthukiseni. Kukholakala ukuthi ukwakheka izimila kungaqala utero, ngoba kakade emavikini amabili ingane kungathola ke.

isimila Wilms 'ngokuvamile yenziwe yaba yasendaweni nganxanye, kodwa kukhona izimo, kanye izilonda zamazwe amabili kwezinso. Uma ubheka umzimba ogulayo, kungase kuqashelwe ukuthi ubuso bayo kuyinto engalingani, Imi izindawo ebonakalayo ukopha futhi necrosis, kwezinye izindawo kukhona izinhlumba. Kulokhu sithi isiguli fibrosis Wilms lwesimila.

Ekuqaleni, isimila itholakala ngaphakathi nezinso. Nge ukuthuthukiswa okwalandela utshala phakathi enyameni ezungezile kanye nezinhlaka - ngaleyo ndlela ukusakaza metastases.

esigabeni isifo

Lokhu isimila esibulalayo esikhula ekuthuthukisweni yayo izinyathelo ezimbalwa:

1. Ekuqaleni nephroblastoma kuyinto izinso eyodwa kuphela. Izingane kulesi sikhathi bangase bangakuboni ukungakhululeki, futhi akukho izikhalazo azikashintshi.
2. Ithumba iqala ukusakaza ngaphesheya izinso, kodwa metastases ayikatholakali.
3. ukuqhubeka kuhambisana amaphilisi ukuhluma futhi ukuhlulwa kuthinta izitho eseduze futhi zamanzi.
4. metastases Found esibindini, amaphaphu namathambo.
5. Ngesikhathi esigabeni yokugcina ukuthuthukiswa Wilms isimila ezinganeni kuthinta babe ezimbili nezinso.

Cishe akufanele ukuchaza ukuthi ngaphambili isimila sitholakale, isimo sokulindela okuhle ngaphezulu anganikeza nesineke.

symptomatology lesi sifo

Njengoba sitholakele zokugula kungaba ngezigaba ezahlukene, nezibonakaliso kuye ingahluka. Ngokuvamile, uma kukhona isimila i Wilms ', izimpawu kutholwa kanje:

• ukucobeka jikelele;
• ubuthakathaka, futhi uma ingane incane kakhulu, kuba njalo uphapheme;
• esesuthi ukuncishiswa;
• waphawula ukunciphisa isisindo;
• Kwezinye izimo, kukhona imfiva;
• isikhumba kuba eliphaphathekile;
• kungenyusa umfutho wegazi;
• Igazi ukuhlaziywa sikhombisa lo ESR anda futhi athwala umoya-mpilo encishisiwe;
• kukhona igazi umchamo;
• ezimweni ezimbi kakhulu, it kungabonakala nasemkhakheni isimiso emathunjini, njengoba isimila licindezele ke.

Uma kukhona isifo siyashintsha ukuziphatha umntwana, futhi isimila Wilms 'ezinganeni iyathinteka. Umama njalo ngokushesha usola ukuthi ingane ukuthi kukhona okungalungile.

Lapho lesi sifo amuke, ke Ithumba izandla ezinhle palpable. Kulokhu, ingane uyazwelana nathi ebuhlungwini, ngoba kukhona kokucindezelwa kwezitho eduze, okuyinto kubavikela usebenza kahle. Kwezinye iziguli, it kwandisa isisu uma kutholakala ukuthi uphethwe yini isimila Wilms '. Isithombe ngezansi ungukukhombisa ezinhle.

Lapho inqwaba metastases, ingane iqala ngokushesha ukunciphisa umzimba. Ngokuvamile, abantu bayafa ngenxa nokuvaleka kwemigudu yokuphefumula nokukhathala ngokweqile. Ngokuphawulekayo, okuvela kuyo metastases kuncike, kunalokho, hhayi usayizi isimila, kodwa okwengeziwe yobudala lesiguli. It kuvela ukuthi izingane ezincane kakhulu nale Ihlahlubo ithuba elingcono ukululama ngokugcwele.

Kodwa kaningi kunakuqala hhayi kuphela kutholakala ukuthi uphethwe yini isimila Wilms ', ngokuvamile ehambisana nezinye izifo zentuthuko.

Comorbidities

akuvamile ngokwanele ukuthi isimila sitholakale njengoba ukuphambuka kuphela ukuthuthukiswa. Ngokuvamile kuhambisana comorbidities:

• hypospadias, lapho urethra kubafana ivulekile endaweni ethile phakathi umthondo noma ngisho nasezinsukwini ukuxhuma;
• lakhulisiwe izitho zangaphakathi, isibonelo, ulimi ezinkulu;
• owodwa zokwenziwa kunabanye;
• cryptorchidism;
• ukungabi iris we iso (umuzwa wokuthi umfundi akuyona sizungezwe lutho).

Ukuhlonza Ukugula Wilms isimila

Lapho nephroblastoma kuphela ekuqaleni sokuthuthuka, uphethwe yini kunzima, ngoba akukho izimpawu evelele. Ngenxa yalesi sizathu, ezimweni eziningi kakade uqale ukwelashwa lapho Ithumba ngesikhathi izigaba 3 noma 4.

Abazali kudingeka ukuqapha eduze isimo umntwana, futhi uma kukhona pallor, umfutho wegazi ophakeme, kwehle ithoni, kungenzeka ukuhlola isimila, kufanele ngokushesha ahlolwe ngokugcwele. Kujwayele kuhlanganisa lezi zinhlobo ezilandelayo ukuhlola:

1. Ukuhlaziya egazi noma omchamo. Utholakala proteinuria umchamo, hematuria, futhi igazi erythrocyte sedimentation izinga luyanda, kukhona igazi.
2. Urography ivumela ukusazi ngokunembile isifo esikuphethe e ezingaphezu kuka-70% of amacala. Ayikwazi ukubuka wabuka izinso, naphambi yesimila ebonakalayo ushintsho kancane esimeni sokwakheka komzimba nokuphazamiseka okuhambisana.
3. Ukusebenzisa ultrasound futhi kulula ukubona ukuthi usayizi isimila nendlala okuthiwa i indawo yayo.
4. isimila Wilms 'ku ultrasound ifana kumiswa non-umfaniswano izinhlumba ngaphakathi.
5. Ukusebenzisa-X-ray ikhompyutha tomography abakwazi ukubona nje kuphela isimila nendlala okuthiwa i kwelinye izinso, kodwa futhi ukuba sihlaziye isimo yesibili, futhi ukubuka khona metastases kwezitho zomzimba eduze.
6. Uma ubheka ubungako enkulu isimila ngokuvamile ebekiwe angiography. Lokhu kwenziwa ukuze eminye ukucacisa isihlobo nephroblastoma indawo emikhunjini ezinkulu igazi, ukuze ngesikhathi ukusebenza udokotela ohlinzayo-Anansi wathola isu leli thuba.
7. Ultrasonography nakuma-CT kungacacisa ukuthi lokuphuma phambili okumisiwe Ukudlulela e kwezitho nezicubu.

Okwamanje, izindlela ocwaningweni lwezokwelapha kukhona ezingeni yentuthuko ukuthi uvumele okuyikona cishe 95% Ezimweni ezinjalo. Kodwa 5% wonke amaphutha efanayo kwenzeke, isibonelo, uma ultrasound multilokulyarnuyu simila eyiphutha isimila Wilms ', kuba ngesikhathi ukusebenza kungenzeka ukuthola kuphela. Lapho ultrasonic ukuskena ukunemba 97%, futhi kancane kancane ngesikhathi RT. Nakuba zikhona izimo lapho Wilms isimila is kuhlangene nginesimila.

Ukuhlolwa okwengeziwe siqondiswe ukuthola metastases ke ukukhetha ukwelashwa amacebo kwesokudla isifo. Uma uthuthukisa Wilms isimila ezinganeni, impatho yaphathwa ngamunye icala ngabanye kokubhekela umzimba kanye nesigaba lesi sifo.

Izimbangela nephroblastoma

Nge olunembile ukusho ukuthi imbangela ukuthuthukiswa isimila, akunakwenzeka. Kukholakala ukuthi imbangela lena ngokuguqula izakhi zofuzo DNA amaseli. Ngo inani elincane lomphakathi wabo izimo, sisuka abazali izingane. Kodwa ngokuvamile, abacwaningi abatholi ubudlelwano phakathi ufuzo kanye nokuthuthukiswa isimila Wilms '.

Odokotela bakholelwa ukuthi kukhona ezinye izinto ezandisa le ngozi eziholela ukuvela nephroblastoma. Lezi zihlanganisa lokhu okulandelayo:

1. Female. Ngokwezibalo, amantombazane ngokuvamile yilesi sifo kunentsha.
2. ngokulandelana Ukubambezeleka. Nakuba izimo izifo ngofuzo abasakwazi ezingavamile.
3. Ukuba Ngowenkolo emncintiswaneni Negroid. Phakathi lolu hlobo isifo labantu kwenzeka ngezikhathi 2 kaningi.

Ngokuvamile, kufanele kuphawulwe ukuthi kuze kube manje sezisungule hhayi izimbangela esiqondile ukuthuthukiswa isimila Wilms '.

ukwelashwa nephroblastoma

Njengomthetho, ukwelapha yisiphi isifo kungenziwa wasondela-engeli lehlukene. Lapho kutholakala Wilms isimila ezinganeni, impatho onikezwayo imiphumela luhlolo histological. Ochwepheshe bacabanga ukuthi Histology ezinhle inika Izibikezelo izindawo ezingconywana. Kodwa lokhu akusho ukuthi cwaningo ezimbi akhonze njengephayona isignali ukuyeka impatho.

Uma sikhuluma nephroblastoma, izindlela ezilandelayo zisetshenziselwa ukwelapha ke:

• ukuhlinzwa;
• radiotherapy.

Futhi ukuhoxa omuhle Imiphumela ngamakhemikhali isimila Wilms '.

Amaqhinga ukwelashwa ikhethwa ngamunye isiguli ngasinye kancane. It kuzoncika hhayi kuphela komqondo nezinga lokukhula kwengane isimila, kodwa futhi ku isimo umzimba wengane.

kokungenela kuhlinzwa

Ukususwa kwezimiso izinso - kuyinto nefroektomiya. Kuyinto ngezinhlobo eziningi:

1. Simple. Kulokhu, lo dokotela ngesikhathi ukusebenza kususa ngokuphelele izinso ethintekile. Uma umzimba yesibili enempilo ke kungase kungasebenzi kahle "amabili".
2. nefroektomiya kwengxenye. Ngalesi kokuhlinzwa, udokotela kususa kuphela isimila esinomdlavuza ngaphakathi izinso kanye ezizungezile umonakalo izicubu. Ngokuvamile zokukhwabanisa enjalo kufanele uchithe uma izinso yesibili isusiwe noma agula kakhulu.
3. ukususwa Radical. It ashaqe hhayi kuphela izinso ukuba izakhiwo ezizungezile, kodwa futhi ureter engeziwe, le ndlala adrenal. Lymph node angasuswa uma aqukethe amangqamuzana omdlavuza sebetholiwe.

Phakathi ukusebenza angahlala akuthola ukuthi nezicubu eziseduze lilimele ke kubalulekile ukugxila isimo futhi ususe wonke ukusilaphazeka. Ezimweni ezimbi kakhulu, lapho nephroblastoma (Wilms 'isimila) sithinta kokubili izinso ngesikhathi ingane, kubalulekile ukuze ulondoloze impilo umntwana ukususa izindikimba ezimbili.

Ngemva zamazwe amabili nephrectomy ingane ebekiwe isebenzisa umshini wezinso wokuhlanza igazi ubuthi. Yenza ukuphila emva ukususwa kokubili izinso kungaba kuphela nje ngemva Ukufakelwa isitho kusukela donor, okuyinto okunzima ngempela ukuthola. Lezi ziguli kokunye kuze kuphele iminyaka ku emgqeni ukufakelwa.

Ngemva kokuhlinzwa ukususa isimila uthunyelwa i-ukuhlaziywa, ukuhlola ngokucacile zamangqamuzana omdlavuza, ulaka lwabo, isilinganiso yokuzalana. Kuyadingeka ukuba ukhethe okuphumelela kakhulu ngamakhemikhali.

Ukwelashwa ngamakhemikhali nokushiswa ekwelapheni nephroblastoma

Uma isimila akunakwenzeka ukususa ukwelashwa kuyehla kube nezinye izindlela ezifana ukusetshenziswa ngamakhemikhali.

Ngalesi ukwelashwa ebekiwe chemotherapy, ezinomthelela ukubhujiswa zamangqamuzana omdlavuza. Ngo umkhuba emtholampilo, evame kakhulu ebekiwe le njongo:

• "Vincristine".
• "Dactinomycin".
• "Doxorubicin".

Impatho enjalo ngempela nzima umzimba, izinguquko zenzeka nokusebenza kwezitho eziningi zangaphakathi, isibonelo:

• inqubo okhathazekile of hematopoiesis;
• ezilimele izinwele follicle, futhi lokhu kubangelwa nezinwele ngesikhathi ngelashwa nangemithi;
• ahlupheke amaseli emathunjini ukuthi kuphakamisa ukungakuthandi ukudla, ukuhlanza, isicanucanu;
• encishisiwe amasosha omzimba eyenza umzimba usengozini yokuthola izifo.

Abazali kufanele ngaphambi kokuthola chemotherapy ukucela udokotela wakho mayelana imiphumela engemihle futhi sithathe izinyathelo ezidingekile ukuze asekele umzimba wengane.

Uma ingane uphoqelekile ukuba amise izidakamizwa umthamo ephezulu, udokotela kufanele ngikuxwayise ukuthi lokhu kungadala ukubhujiswa amaseli umnkantsha, futhi ubaphe ukumisa. Ngemva ukwelashwa kungenziwa incibilikiswa bafakwa ingane umzimba, sebengaqala imithwalo yabo yemfanelo eqondile ukuze ukukhiqizwa kwamangqamuzana egazi. Njengoba umnkantsha balimala nokwelashwa ngamakhemikhali, abuyiselwe.

ukwelashwa ngemisebe

Uma isimila kakhulu Wilms iqhubeka, impatho liyadingeka zihlanganisa nezinhlobo ezingaphezu futhi welashwa ngemisebe. It is kuhlangene nokwelashwa ngamakhemikhali uma nephroblastoma kuyinto 3-4 izigaba yentuthuko. ukwelashwa ngemisebe kusiza ukubulala amangqamuzana omdlavuza eziye "waphunyuka" by udokotela ohlinzayo phakathi nokuhlinzwa.

Ngesikhathi inqubo enjalo, kubalulekile ukuthi ingane walala kungahambi, njengoba ngqo endaweni isimila baqondiswa imishayo. Uma isiguli lincane kakhulu baxhashazwe yayo ukwenza eziyinkinga ke inqubo phambi iqondiswa umthamo elincane sedatives.

Ngemisebe kudinga ukuhambisana nezincomo eqondile. Iphuzu lapho kuzothunyelwa imisebe, anelebuli udayi. Konke akumelwe siwele indawo ngemisebe imbozwe izihlangu ekhethekile.

Zonke babeqaphile, Nokho, akusho ukuvikela imiphumela emibi ukuthi ke kuphakama:

• isicanucanu;
• ngenxa yobuthakathaka;
• isikhumba ukucasuka endaweni ngemisebe;
• uhudo.

Udokotela kufanele aqoke izidakamizwa ezihambisa isimo lesiguli kanye imiphumela emibi kuzosuswa.

Ukwelashwa ngokuvumelana nesigaba lesi sifo

Ukuze noma iyiphi inqubo yokwelapha ukugula njalo kukhethwe ngamunye. Lokhu kuyiqiniso ikakhulukazi izingane. Wilms isimila nayo idinga ukuhlolisisa ngokucophelela ukukhethwa zokwelapha ezifanele. Ucabangela esigabeni lesi sifo, ukuthuthukiswa hhayi kuphela, kodwa futhi yobudala kwengane, isimo sakhe, ikakhulukazi emzimbeni.

1. Isigaba sokuqala nesesibili ukuthuthukiswa isimila lapho kuhilela amangqamuzana omdlavuza izinso eyodwa kuphela futhi musa ihluke ulaka, impatho ngokuvamile kuhilela ukususwa isitho ethintekile, ngelashwa nangemithi okwalandela. Ungase udinge kakhudlwana futhi welashwa ngemisebe.
2. 3 no-4 nephroblastoma esiteji zidinga indlela ehlukile. Ithumba budlulela ngale izinso, ngakho-ke engasakwazi ukususa ngaphandle ukushaya izitho eduze. Kulokhu aqoke ukususwa kuhlinzwa yesimila, kulandele nokwelashwa ngamakhemikhali kanye irradiation.
3. Isiteji 5 libhekene ukubukeka isifo kuzo zombili nezinso. Feza ngokwengxenye isimila ukususwa, futhi ngaleyo ndlela nomthelela ama-lymph node eseduze. Ngemva kokuhlinzwa, eyenziwa inkambo ngemisebe nangamakhemikhali. Uma une ukususa kokubili izinso, nesineke kungaba dialyzed, bese ufuna ukufakela izitho enempilo.

Izingane zonke ezahlukene, futhi ngamunye ukuphendula ngabanye umzimba yokwelapha lwesimila. Ngaphambi uvumelana indlela yokwelashwa, abazali kudingeka zonke izingqinamba nalabaya udokotela. Badinga ukwazi ukuthi yini umphumela mithi emzimbeni, indlela yokugwema noma nokunciphisa imiphumela emibi ngesikhatsi ukwelashwa.

Isiyazanywa

Minyaka yonke kukhona amasu amasha nezindlela for ekwelapheni izifo ezithize. Lokhu kunjalo ngokukhethekile umdlavuza kanye nokushona kwezingane kuzo kuphezulu.

Emazweni amaningi, abantu abadala kuphela kodwa futhi izingane ongabamba iqhaza zokwelapha zokwelapha ezintsha ngoba Wilms evuvukele. Abazali ungacela udokotela ukuthi ukuhlolwa enjalo kwenziwe ezweni lethu, kukhona ithuba iqhaza nabo.

Uma amathuba ekhona, udokotela kufanele ukukhipha konke akwaziyo akutshele ekuphepheni ukwelashwa. Kuyaphawuleka ukuthi ngokuvamile iqhaza ezifana ukuhlolwa zokuhlola ikunika ithuba owengeziwe kule ekulweni nezifo.

Kodwa udokotela kumelwe futhi khuza lokuthi kule Inkambo yokwelashwa ingase ibe ezingalindelekile side effects ukuthi singakaze sibonane ngaphambili, kanye 100% ikhambi akekho ayikwazi ukuqinisekisa.

lokubuya kwesifo

Akubalulekile nje kuphela ukuze ubhekane ngokuphumelelayo nalesi sifo, kodwa futhi ukuqinisekisa ukuthi akazange futhi uhileleke. Ngeshwa, lokhu kwenzeka nephroblastoma kokubili ngesikhatsi ukwelashwa futhi ngemva kwaso. Ukwenza cwaningo, futhi uma ngendlela eyanelisayo, bese babela isipele isikimu chemotherapeutic izidakamizwa:

• "Vincristine".
• "Doxorubicin".
• "Cyclophosphamide" lihambisana "dactinomycin" noma "ifosfamide".
• "Carboplatin".

Esimweni ngasinye sihlukile, esimweni ezinye iziguli lokubuya kwesifo iqondiswa umthamo omkhulu ngamakhemikhali, kulandele lwama-stem cell ukufakelwa Igazi. Okuhle kunakho konke ukuthi umphumela, uma sihlanganisa ukuhlinzwa nge ngemisebe polychemotherapy.

isimila Wilms 'ngumlando nokuthumba owesifazane owayezithwele,

Izinso emzimbeni womuntu ukwenza omunye wemisebenzi eyinhloko - ngegazi lenkawu ubuthi futhi imikhiqizo umzimba. Phakathi nenkathi yokukhulelwa, bathwale umthwalo double hhayi kuphela isimo sikamama ngokujovwa, kodwa nezalo impilo entsha, umzimba asathuthuka.

Uma umama okhulelwe Ngahlinzwa ngoba ukususwa izinso eside ngaphambi kokukhulelwa, onalesi sifo kungaba yinzuzo ngempela. Abesifazane abaningi ngempumelelo baphathe sokukhulelwa futhi ubelethe banezingane eziphile kahle.

Kodwa kunokuningi okungakhulunywanga ngakho, lapho isimo esisha babekwazi kubangele kokushelela. Khona-ke kufanele asikhiphe isisu ukuze asindise sowesifazane.

Ngezinye izikhathi enokuhlangenwe nakho ekukhalipheni isimila ebuntwaneni Wilms 'kungase kumkhathaze ukuthuthukiswa pyelonephritis, kanye-ke kungathikameza ukukhula obusebenzayo umbungu. Ngisho naphezu kweqiniso lokuthi iningi umphumela omuhle yokukhulelwa, ingozi Ukudlulela futhi sohraniyaetsya iminyaka 10-20 emva ukususwa izinso.

Onalesi sifo iziguli nephroblastoma

Ukuze anikeze umhlahlo specific khona isimila Wilms ', kubalulekile ukucabangela lingakanani, komqondo nezinga lokukhula kwengane kanye nokuhlaziywa histological. I ezingezinhle kakhulu khona kuwuphawu lwesimila okukhulu kuka-500 g futhi 3-4 komqondo nezinga lokukhula kwengane nge Histology abampofu.

Uma kucacisiwe integrated circuit yokwelapha ezanele, isiguli isilinganiso lokusinda imayelana 60%. Ezigabeni kokuqala Ithumba amenable ukuba ukwelashwa ngendlela ephumelela kakhudlwana, yokutakula kwenzeka 80-90% wabantu.

Njengoba sazi ukuthi izinyathelo ezikhethekile nokuvinjelwa sifo akekho, singasijabulela ukuncoma kuphela ibhekane ukuhlolwa njalo, uma ingane isengozini. I ngaphambili isimila kutholakala, lo amathuba yokutakula kangcono.