Pancreatic qog

Feem ntau, benign pancreatic hlav, kom txog thaum lawv tau mus txog qhov ntau thiab tsawg, tsis txhob tshwm sim lawv tus kheej hauv txhua txoj kev, yog li kev kuaj mob tau ua los ntawm lub sijhawm, thaum lub sijhawm kuaj cov tshuaj tua kab mob (ultrasound) ntawm lub plab. Qhov tshwj tsis yog insuloma. Xws li cov qog txawm tias qhov ntau thiab tsawg me me cuam tshuam rau keeb kwm ntawm keeb kwm ntawm tus neeg thiab hloov nws - kev txo qis hauv cov ntshav qab zib ua rau cov kev tsis txaus siab sib xws:

• tsis muaj zog
• kev ntshai ntawm kev ntshai
• tawm hws ntau dhau
• kiv taub hau, qee zaum tsis nco qab.

Muaj ntau cov cim qhia uas paub qhov txawv qog cov qog ua haujlwm (hom hlwb zoo ib yam li cov keeb ntawm cov khoom hauv lub cev uas lawv los) ntawm malignant (hom hlwb sib txawv ntawm hom hlwb ntawm hloov khoom nruab nrog uas lawv los).

• Tsis muaj keeb kwm ua rau muaj mob qog noj qab zib.
• Qhov tsis pom tseeb tiag tiag hauv chaw kuaj mob (tsos mob).
• Qhaj ntawv ntawm cov qog intoxication (lom) - qhov tsis muaj zog txaus, qaug zog, tsis qab los, tsis xeev siab, ntuav, kub cev, cyanosis (blueness) thiab pallor ntawm daim tawv nqaij.
• Qib ib txwm ntawm qog nqaij hlav (tshwj xeeb cov protein tam sim no nyob rau hauv malignant neoplasms hauv ib qho nyiaj nce ntxiv) yog CA 19-9, KEA.
• Cov yam ntxwv ntawm kev muab ntshav (faib tsis sib luag ntawm cov hlab ntshav hauv cov qog) thaum lub sijhawm angiography (xoo hluav taws xob kuaj ntawm cov hlab ntsha).
• Tsis muaj cov qog hlav lossis nce me ntsis ntawm lub sijhawm ntev.
• Cov tsos mob tshwm sim rau txhua tus kab mob pancreatic.
• Mob Muaj tshwm sim thaum lub sij hawm kho tshuab ntawm ib qho ze ze los ntawm cov qog. Qhov mob tau nyob hauv cheeb tsam (nyob) ntawm sab xis lossis sab laug hypochondrium (sab), epigastrium (thaj chaw hauv qab ntawm pob tw, uas sib piv rau lub luag haujlwm ntawm lub plab ntawm lub plab phab ntsa anterior), ze rau ntawm lub pij ntaws, feem ntau muaj cov cim girdling (hnov thoob plaws ib puag ncig ntawm pob tw), feem ntau tsis yog nyob ntawm kev txais tos cov khoom noj tuaj yeem txuas ntxiv lossis paroxysmal.
• Qhov muag daj Cov qog loj zuj zus (ob leeg) ua rau cov kua tsib thiab lub plab ua pa, uas ua rau muaj tawv nqaij txhaws, uas yog los ntawm daim tawv nqaij daj, ua pob khaus, ua rau tso quav thiab quav tso zis.
• Xeev siab, ntuav, qhov kev mloog zoo li mob hnyav hauv plab tom qab noj mov - cov tsos mob ntawm lub plab hnyuv tawm (qhov tsis zoo ntawm cov zaub mov hla txoj hnyuv) thaum cov qog ua kom lub plab duodenum.

Hom mob benign pancreatic hlav.

• Insuloma (mob qog nqaij hlav tawm los ntawm cov leeg nqaij).
• Fibroma (mob qog nqaij hlav tawm los ntawm cov nqaij sib txuas).
• Lipoma (mob qog nqaij hlav tawm los ntawm cov nqaij mos adipose).
• Leiomyoma (mob qog nqaij hlav tawm los ntawm cov leeg nqaij).
• Hemangioma (mob qog nqaij hlav tawm los ntawm cov leeg ntshav).
• Neurinoma (mob qog nqaij hlav tawm los ntawm cov leeg nqaij)
• Schwanoma (mob qog ua hlav loj hlob tuaj ntawm Schwann cov hlwb (cov hlwb hauv txoj hlab ntshav)).
• Cystoma (tshuaj ntsiav nrog kua hauv).

Los ntawm localization (qhov chaw), cov hom hauv qab no cov qhov txawv:

• mob hlav ntawm lub taub hau ntawm lub txiav,
• lub cev nqaij hlav hlav
• hlav ntawm qaj txiav caj dab.

Vim li cas muaj kab mob tsis to taub zoo.

Ntawm yam pheej hmoo emit ib ob peb.

• Cov cwj pwm tsis zoo (haus cawv, haus luam yeeb).
• Cov mob muaj keeb (qhov kev pheej hmoo ntawm kev tsim mob qog nqaij hlav ntawm lub txiav yog ntau dua yog tias muaj keeb kwm ntawm cov txheeb ze nyob ze muaj qog).
• Cov yam ntxwv ntawm cov khoom noj muaj txiaj ntsig (noj zaub mov muaj roj ntau ntau (feem ntau ntawm cov tsiaj keeb kwm), tsis muaj cov khoom noj khoom noj muaj cov khoom noj muaj fiber (tseem mov, mov nplej, taum, buckwheat thiab pob kws, zaub, txiv hmab txiv ntoo)).
• Pancreatitis (mob rau hauv qab thiav).
• Cov nyom ib puag ncig cov nyom.

Oncologist yuav pab nrog kho tus mob

Kev kuaj mob

• Kev txheeb xyuas txog keeb kwm kev kho mob ntawm tus kab mob thiab kev yws yws (thaum (ntev npaum li cas) mob plab, daj tawv nqaij, khaus, tso quav thiab tso zis dub, uas tus neeg mob koom nrog qhov tshwm sim ntawm cov tsos mob no).
• Kev tshuaj xyuas txog tus neeg mob lub neej yav dhau los (tus neeg mob muaj mob hnyuv (tshwj xeeb, tus kws kho mob nyiam mob pancreatitis (mob rau hauv lub leeg)), lwm yam kab mob yav dhau los, kev coj tsis zoo (haus dej haus cawv, haus luam yeeb), noj zaub mov zoo.
• Kev txheeb xyuas tsev neeg keeb kwm (muaj mob qog noj ntshav nrog cov txheeb ze).
• Cov hom phiaj tshawb xyuas cov ntaub ntawv. Tus kws kho mob mob siab rau seb tus neeg mob puas muaj:
  • pallor ntawm daim tawv nqaij, lawv cov tawv nqaij daj, khaus,
  • nce hws
  • discoloration ntawm cov quav, ua paug ntawm cov zis.

• Cov ntaub ntawv seev cev thiab chaw kuaj.
  • Kev kuaj ntshav dav dav. Tshuaj Ntshav (anemia, kev txo qis hauv ntshav hemoglobin (protein uas nqa oxygen hauv cov ntshav)) tuaj yeem kuaj.
  • Kev kuaj ntshav biochemical. Muaj ib qho kev txo qis hauv qabzib (piam thaj) hauv cov ntshav (nrog insuloma).
  • Txog rau kev kuaj mob sib txawv (muaj qhov tsis txaus siab) ntawm kev mob qog thiab mob qog nqaij hlav ntawm tus txiav, txiav cov cim ntawm cov qog nqaij hlav CA 19-9, KEA (cov protein tshwj xeeb zais cia rau hauv cov ntshav nrog qee cov qog malignant (mob cancer ntawm lub mis, mob hlab ntsws, thiab lwm yam)) tau siv.
  • Kev soj ntsuam ntawm cov quav (muaj ib qho tsis muaj stercobilin (xim tawv xim (teeb meem xim quav) siv lub tsom tsom)).
  • Mob Lub Hlaus Urobilinogen (ib yam khoom tsim los ntawm bilirubin (ib qho ntawm cov bile pigments (staining substance)) thiab tom qab ntawd tig mus rau hauv urobilin (cov xim uas paug cov zis daj daj) tsawg dua thiab tom qab ntawd txiav kom kuaj pom nyob hauv cov zis. Qhov no tshwm sim vim lub cev txhaws qa (qhov xwm txheej uas kaw (kaw) ntawm cov kua tsib thiab ua kom cov kua tsib tsis ntws tawm).
  • Kev kuaj mob ultrasound (ultrasound) ntawm lub plab plab hnyuv plab - lub qog ntawm lub caj dab yog txiav txim siab.
  • Kev suav tomography (CT) scan tau ua kom pom cov qog nqaij hlav ntawm pancreatic.
  • Magnetic resonance imaging (MRI) - yog tau ua los kuaj xyuas cov qog ntshav pancreatic.
  • Endoscopic retrograde cholangiopancreatography (ERCP) yog txoj kev xoo hluav taws xob rau kev soj ntsuam cov kua tsib lub plab thiab qhov tseem ceeb ntawm txoj hlab ntaws ntawm tus txiav. Cov ducts puv rau ntawm qhov endoscope (lub tshuab tshwj xeeb pom zoo nkag rau hauv tib neeg lub cev) nrog cov xoo hluav taws xob xoo hluav taws xob (cov tshuaj uas pom ntawm X-ray), thiab tus kws kho mob saib lub xeev ntawm cov ducts los ntawm X-ray chav ntsuas. Nws yog qhia seb cov qog ntsws compresses lub ducts.
  • Sib nqus resonance pancreatocholangiography (MRPC, khoos phis tawj kuaj ntawm pancreatic, extrahepatic thiab intrahepatic bile ducts hauv ib qho chaw hluav taws xob). Nws yog nqa tawm los txiav txim siab qhov mob ntawm ducts, seb lawv puas tau nias ntawm cov qog.
  • Scintigraphy (kev qhia rau hauv lub cev ntawm cov khoom siv hluav taws xob uas muaj peev xwm tshaj tawm cov duab hluav taws xob yog siv los muab cov duab ntawm qhov twg thiab nyob rau qhov twg cov kabmob no tau ncua ntev) qhia cov kev thaj chaw (thaj chaw) ntawm cov qog, nws qhov loj me.
  • Angiography (xoo hluav taws xob xoo ntawm cov hlab ntsha). Nqa tawm hauv cov xwm txheej huab, yog qhov tshwm sim ntawm xam tomography (CT), cov duab hluav taws xob resonance (MRI) thiab scintigraphy tau tsis yooj yim.
  • Caws hno nplua koob koob hno me me (noj ib qho qog nqaij hlav rau keeb kwm (nqaij) tshuaj).
• Kev sab laj ntawm tus kws kho mob plab, tus kws kho mob kuj ua tau.

Kev kho cov qog benc pancreatic hlav

Kev Kho Mob benign pancreatic hlav xwb kev phais mob Nws yog thaum kawg ua tau los tsim kom muaj lub qog nqaij hlav los yog mob qog ua haujlwm tsuas yog tom qab ua haujlwm thiab ua txoj haujlwm keeb kwm (kawm txog nqaij hauv qab lub tshuab tsom) kom kawm txog cov qog tshem tawm.

Txog rau hnub no, cov haujlwm tseem ceeb kom tshem tawm cov qog nqaij hlav ntawm pancreatic suav nrog 4 tus.

• Resection (tshem tawm ntawm ib feem ntawm cov txiav). Raws li txoj cai, xws li kev khiav haujlwm yog siv thaum lub qog qog nyob rau hauv Tail lub caj pas.
• Lub qog ua kom tshem tawm (husking). Raws li txoj cai, lawv tau ua nrog cov qog ntshav tsim qog - cov qog uas tsim (tsim khoom) cov tshuaj hormones (piv txwv, nrog insuloma, cov tshuaj hormone insulin (ib yam tshuaj uas txo cov ntshav qabzib (suab thaj hauv ntshav) yog tsim).
• Pancreatoduodenal resection - tshem tawm cov qog nrog rau duodenum 12 thaum lub sijhawm ua haujlwm hauv zos (muab tso rau) ntawm cov qog hauv lub taub hau ntawm caj pas.
• Kev xaiv txoj hlab ntshav hauv txoj hlab ntsws (ua rau lub nkoj) - qee zaum ua nrog hemangioma (cov qog nqaij hlav loj hlob tuaj hauv cov hlab ntshav) kom nres nws cov ntshav.

Teeb meem thiab txim

Txawm hais tias qhov tseeb ntawm cov qog ua tau ntxaug, lawv tuaj yeem ua rau qee qhov hnyav hnyav.

• Malignancy (kev hloov ntawm cov qog benign rau hauv cov hlav hlav ntawm lub txiav).
• Obau lub cev txhaws (qhov uas cuam tshuam tus kua tsib lub raum tshwm sim thiab cov kua tsib yog cuam tshuam. Nws yog qhov zoo li yog los ntawm daim tawv nqaij daj, khaus, ua kom quav tso quav thiab tso zis dub).
• Kev ua txhaum ntawm kev zom ntawm cov zaub mov vim qhov txo qis hauv cov dej ntws tawm ntawm cov bile thiab enzymes (cov protein uas ua kom cov tshuaj lom neeg hauv lub cev) nkag mus rau lub plab hnyuv lumen.
• Kev cuam tshuam ntawm cov hnyuv (ib nrab lossis ua tiav kev cuam tshuam ntawm kev txav ntawm cov zaub mov hauv cov hnyuv) - tej zaum yuav tshwm sim vim yog lub qog loj thaiv cov pob txha feem ntau ntawm cov lumen ntawm duodenum.

Kev tiv thaiv ntawm cov benign pancreatic hlav

Tsis muaj kev tiv thaiv tshwj xeeb ntawm benign pancreatic neoplasms. Pom zoo:

• saib xyuas cov hauv paus ntsiab lus ntawm kev noj zaub mov zoo (txwv kev ua kom tau ntawm kib, oily, ntsim thiab haus luam yeeb, cov zaub mov ceev, dej haus, kas fes),
• noj cov zaub mov muaj fiber ntau (zaub, cov mov ci, buckwheat thiab pob kws nplej), zaub roj, zaub mov, cov khoom noj muaj cov khoom noj muaj roj (cellulose muaj nyob hauv cov txiv hmab txiv ntoo, zaub, legumes), muaj kua ntau ntau (tsawg kawg yog 2 litres hnub)
• tshem tawm cov kev coj ua tsis zoo (haus cawv, haus luam yeeb),
• kho kom raws sij hawm thiab muaj kev kho kho tus mob pancreatitis (mob ntawm tus txiav).

COV LUS QHIA PIV TXWV

Kev sab laj nrog kws kho mob yog qhov yuav tsum tau

• Cov Chaw Kho Mob: Lub Tebchaws Qhia: 3 Vol. / Ed. V.S. Savlyeva, A.I. Kiriyenko. - M: GEOTAR-MEDIA, 2009.
• Soj ntsuam kev kho mob txoj hnyuv. P.Ya. Grigoryev, A.V. Yakovlenko. Tuam Tsev Kho Mob, 2004
• Kev kuaj mob thiab cov txheej txheem kho rau cov mob sab hauv: Shulutko B.I., S.V. Makarenko. Thib 4 hloov kho thiab rov kho dua. "ELBI-SPb" SPb 2007.

Vim li cas rau kev muaj mob

Raws li tau hais los saum no, cov kws tshaj lij tseem tsis tuaj yeem hais tias vim li cas tus kab mob dev tom mob. Tab sis muaj cov paub paub uas ua rau muaj kev pheej hmoo ntawm cov qog tsim ntawm lub cev. Cov no suav nrog:

• muaj mob muaj keeb predisposition
• haus luam yeeb Qhov xwm txheej no ua rau muaj kev pheej hmoo los ntawm kev tsim los ntawm neoplasm los ntawm yuav luag peb zaug,
• rog dhau
• keeb kwm muaj ntshav qab zib
• Lub caij nyoog siv dej cawv,
• muaj ntawm pancreatitis nyob rau hauv tus neeg uas muaj tus mob ntev ntawm cov chav kawm,
• teeb meem ua hauj lwm mob. Kev pheej hmoo ntawm cov qog tsim ntawm lub taub hau ntawm lub caj pas nce yog tias ib tus neeg yuam kom mus rau hauv kev sib chwv nrog cov tshuaj carcinogenic los ntawm qhov nws ua.

Benign mob qog

Cov qog benign ntawm lub taub hau pancreatic muaj ntau lub ntsej muag - nws tsis metastasize, tsis tawg rau hauv cov kabmob uas nyob ib sab, thiab tsis ua txhaum cov khoom tshwj xeeb ntawm cov ntaub so ntswg uas nws tau tsim. Nyob ntawm cov qauv, xws li qog ntawm lub taub hau ntawm lub caj pas yog qhov txawv:

• leiomyoma
• adenoma
• tshuaj insulinoma
• fibroma,
• pab pawg neeg ganglioneuroma,
• hemangioma.

Ntev mus ntev ntev, cov qog ntawm cov yam ntxwv yuav tsis raug qhia tawm los ntawm cov cim qhia. Qhov tshwj xeeb tsuas yog tsim cov insulioma, uas ua rau muaj kev nce siab ntxiv rau cov tshuaj insulin zais cia. Raws li qhov tshwm sim, qhov no hloov pauv keeb kwm keeb kwm ntawm tus neeg. Nyob rau hauv dav dav, thawj cov yam ntxwv tshwm sim nyob rau hauv rooj plaub ntawm kev nce ntxiv tseem ceeb ntawm qog loj. Vim qhov tseeb tias nws compresses ze ze hauv cov plab hnyuv siab raum hauv zos, cov tsos mob hauv qab no tshwm sim hauv tus neeg:

• mob mob plab hauv plab ua kom sib txawv. Qee zaum lawv tuaj yeem muab sab caj npab lossis nraub qaum. Tsis txhob cia siab rau cov zaub mov noj,
• obau kev zawv plab. Nws zoo nkaus li yog tias neoplasm nyem qhov ntaws ntawm cov kua tsib,
• xeev siab thiab ntuav
• hnyav hauv plab thiab tsam plab,
• hnyuv tawm tsam.

Yog tias xws li cov duab hauv chaw kuaj mob tshwm sim, koj yuav tsum hu rau tus kws kho mob uas tsim nyog uas tuaj yeem kuaj mob, txiav txim siab hom qog thiab ua nws txoj kev tshem tawm. Kev siv cov tshuaj kho pej xeem hauv qhov no tsis pom zoo, vim tias lawv yuav tsis pab tshem tawm txoj kev kawm, tab sis tuaj yeem ua rau muaj qhov tsis zoo rau hauv cov mob ntawm tus neeg mob. Txhawm rau kho xws li tus kab mob yog qhia tsuas yog nyob rau hauv chaw mob.

Malignant hlav

Hom mob qog no tsis tsuas nyuaj rau kev kuaj mob, tab sis kuj nyuaj kho mob. Peb tuaj yeem hais tias nws yuav kho tsis tau. Koj tuaj yeem tsuas pub txoj sia ntawm tus neeg rau qee lub sijhawm. Nws yog qhov nyuaj heev los txiav txim siab qhov muaj qog, vim tias nws tsis tshwm sim txhua lub sijhawm thaum pib ntawm nws txoj kev tsim. Nws kuj tseem muaj cov xwm txheej thaum pom cov tsos mob khees xaws tuaj txog theem 4.

• squamous cell carcinoma
• adenocarcinoma
• endogenous mob cancer
• acinar cell mob cancer,
• cystadenocarcinoma.

Vim yog qhov tseeb tias lub qog ntawm lub taub hau yog nyob ze rau ntawm txoj hnyuv, ces ua ntej ntawm txhua yam nws ua rau nws tus kheej hnov ​​los ntawm cov tsos mob ntawm lub plab zom mov. Tus neeg muaj mob xeev siab thiab ntuav, raws plab, ntuav tawm mus ua xim, tsam plab yog teev, tso zis tsaus nti. Tsis tas li ntawd, muaj ntau cov tsos mob ntxiv:

• nce ntxiv nyob rau hauv cov piam thaj hauv cov hlab ntshav,
• tsis qab los
• poob phaus
• obau kev zawv plab. Cov tsos mob no yog ntaus nqi rau tus yam ntxwv. Tawv nqaij daj ntseg yog tshwm sim thaum cov qog ntxuag cov kua paug.

Qhov phom sij ntawm cov kab mob neoplasm tseem nyob hauv qhov tseeb tias nws tuaj yeem loj hlob mus rau lwm yam kabmob. Qhov no yog pom ntawm 2 lossis 3 theem ntawm nws tsim. Nyob rau ntawm 4, kev sib kis cov kab mob kis mus rau lwm qhov kabmob. Hauv qhov no, ib qho kev cuam tshuam tsis muaj nuj nqis yog tsis ua dhau los. Lub hauv paus ntawm kev kho yog kev txhawb nqa txoj kev kho.

Kev kuaj mob

Nws yog qhov nyuaj me ntsis los txhawm rau kuaj pom tias muaj qog nyob ntawm lub taub hau ntawm caj pas. Vim li no, kev kuaj mob tsuas yog qhia dav. Ob leeg kuaj sim thiab cuab yeej siv kho mob raug pom zoo. Thawj theem ntawm kev kuaj mob yog kev sojntsuam thiab kuaj tus neeg mob. Tsis tas li ntawd, nws yog ib qho tseem ceeb rau tus kws kho mob kom qhia meej qee yam ntsiab lus - qhov xwm txheej ntawm cov tsos mob qhia, lawv siv, seb ib tug ntawm cov txheeb ze muaj mob qog nqaij hlav (mob keeb), thiab lwm yam.

Cov qauv hauv txoj kev kuaj mob muaj raws li cov hauv qab no:

• kev saib xyuas ntshav dav,
• kuaj ntshav rau cov cim qog,
• kev soj ntsuam dav dav ntawm cov zis,
• ntshav biochemistry
• endoscopic kev soj ntsuam ntawm lub plab zom mov,
• Ultrasound
• CT thiab MRI
• me.Ib qho ntawm cov kev qhia tshaj plaws, vim tias nws ua rau nws muaj peev xwm ua kom meej meej seb puas muaj lub qog nqaij hlav loj lossis muaj kabmob.

Tom qab tau txais tag nrho cov txiaj ntsig sim, cov phiaj xwm kho tau zoo tshaj plaws tau muab coj los ua.

Kho kev ntsuas

Kev kho tus mob qog ntawm hlav hlav tsuas yog phais xwb. Cov tshuaj kho mob kom tshem tawm cov qog thaum tseem tsis muaj. Yog hais tias lub neoplasm muaj ntawm lub benign xwm, ces ib qho kev cuam tshuam kev tswj hwm yuav cia kom ua tiav kev kho rau tus neeg mob, thiab nws yuav muaj peev xwm txuas ntxiv lub neej zoo. Tsis tas li, cov tshuaj tuaj yeem raug hais kom txo qis qhov mob, thiab kev noj zaub mov tshwj xeeb kuj tseem tau sau tseg.

Lub qog hlav hlav muaj qhov tsis muaj peev xwm tshwm sim ntau dua. Vim yog qhov tseeb hais tias feem ntau pom tau hais hauv qib tom qab, ib tus neeg yuav tsis tuaj yeem mus phais, vim tias lub qog yuav hlav mus ua lwm yam kabmob lossis muab metastases. Kev Kho yog txhawm rau tswj kev ua neej ntawm tib neeg. Rau lub hom phiaj no, hluav taws xob thiab tshuaj tua kab mob, narcotic analgesics yog kho.