Chii chinonzi Pancoast Tumors uye Vanorapwa Sei?

Zvemukati

• Zviratidzo zvePancoast bundu
• Zvinokonzera Pancoast bundu
• Iyo Pancoast bundu inoonekwa sei
• Kurapa kwePancoast bundu
• Stage
• Kurapa
• Kusunungurwa kwemarwadzo
• Kupona kwemitengo yePancoast bundu
• Outlook

Mhedziso

Iyo Pancoast bundu ndiyo isingawanzo fomu yekenza yemapapu. Rudzi urwu rwebundu ruripo kumusoro chaiko (musoro) wepapu yekurudyi kana yekuruboshwe. Sezvo bundu rinokura, nzvimbo yaro inoita kuti ikwanise kupinda mutsinga dzakakomberedza, mhasuru, lymph node, inosangana matishu, mbabvu dzepamusoro, uye vepamusoro vertebrae. Izvi zvinokonzeresa kurwadziwa kwakanyanya mubendekete neruoko.

Kuongororwa kwePancoast tumors kunowanzo kunonoka, nekuti bundu hariratidze zvekare zviratidzo zvekenza yemapapu, senge chikosoro.

Pancoast tumors inozivikanwawo sepamusoro sulcus tumors. Seti yavo chaiyo yezviratidzo inonzi iyo Pancoast syndrome. Iwo evamwe vanhu vane bundu kutanga ane makore makumi matanhatu ekuberekwa. Varume vanobatwa pane vakadzi.

Gomarara iri rakatumidzwa zita, Philadelphia radiologist uyo akatanga kutsanangura mamota muna 1924 na1932.

Iyo kenza maseru subtypes ePancoast mamota ndeaya:

• squamous kenza yesero
• adenocarcinomas
• hombe-sero carcinomas
• diki maseru carcinomas

Zviratidzo zvePancoast bundu

Kurwadziwa kwepafudzi kwepafudzi chiratidzo chakakurumbira chePancoast bundu mumatanho aro ekutanga.Zvimwe zviratidzo zvinoenderana nenzvimbo bundu rinopinda mukati mekuvhura chipfuva (thoracic inlet).

Sezvo bundu rinokura, marwadzo epafudzi anowedzera zvakanyanya uye kupera simba. Inogona kubhenekera yakanangana nehapwa (axilla), banga repafudzi, uye pfupa rinobatanidza bendekete paruoko (scapula).

Mune zvinopfuura zvePancoast bundu kesi, bundu rinopinda mukati uye pakati pezvikamu zvechifuva kuvhura. Iyo kurwadziwa kunogona kupenya:

• pasi ruoko parutivi rwemuviri uchitevera iyo ulnar nerve (iyo tsinga iyo inomhanya ichidzika nerutivi rweruoko rwako yakananga kune pinky, ichimira paruoko)
• kumutsipa
• kumabvu ekumusoro
• kune tsinga network iyo inosvika pambabvu, musana, uye muhapwa

Zvimwe zviratidzo zvinosanganisira:

• ruoko rwekumusoro kuzvimba
• kushaya simba mumhasuru dzeruoko
• kurasikirwa neunyanzvi hwemaoko
• kuparara kwetsandanyama munyama
• kurira kana kuti chiveve muruoko
• kuomesa pachipfuva
• kuneta
• kuonda

Pamwe chete zviratidzo izvi zvinozivikanwa sePancoast syndrome.

Mune vanhu vane Pancoast tumors, gomarara rinopinda mumitsipa inosvika kumusoro kumeso. Izvi zvinodaidzwa kuti Claude-Bernard-Horner syndrome, kana kungoti iyo Horner's syndrome. Padivi rakakanganiswa, unogona kunge uine:

• eyelid inodonha (blepharoptosis)
• kusakwanisa kutuka ziya kazhinji (anhidrosis)
• kufashaira
• kusuduruka kweziso rako (enophthalmos)

Iko kurwadziwa kwePancoast bundu kwakanyanya uye kunogara kuripo. Kazhinji hazvipindure kune zvakawandisa zvinopfuura-the-counter marwadzo anoderedza. Marwadzo anoramba aripo kunyangwe iwe ugere, wakamira, kana wakarara pasi.

Zvinokonzera Pancoast bundu

Izvo zvinokonzeresa Pancoast bundu zvakafanana neizvo zveamwe mamwe kanzura yemapapu. Izvi zvinosanganisira:

• kusvuta
• kusvibiswa neutsi hwechipiri
• kuratidzwa kwenguva refu kune simbi dzinorema, makemikari, kana dhiziri
• kuratidzwa kwenguva refu kune asbestosi kana mazinga epamusoro eradhoni

Muzviitiko zvisingawanzoitika, iyo Pancoast syndrome yezviratidzo inogona kunge iine zvimwe zvikonzero, senge mamwe magomarara, hutachiona kana hutachiona hutachiona, kana tibhii (TB) nezvimwewo zvirwere.

Iyo Pancoast bundu inoonekwa sei

Kuongororwa kwePancoast bundu kunonetsa uye kunowanzo kunonoka nekuti zviratidzo zvaro zvakafanana neizvo zvezvirwere zvepfupa uye zvakabatana. Zvakare, Pancoast tumors hazviwanzo uye zvinogona kunge zvisina kujairika kuna vanachiremba. Pancoast mamota anoumba chete eese mapapu ekenza.

Chiremba wako achakubvunza nezve ako zviratidzo, paakatanga, uye kana achinja nekufamba kwenguva. Vachaita bvunzo dzepanyama uye voorda bvunzo kuti vatarise bundu uye chero kupararira kwegomarara. Kana bundu rikaonekwa, chiremba wako anogona kuraira mimwe bvunzo kuti uone danho rebundu.

Miedzo inogona kusanganisira:

• X-ray. Dzimwe nguva bundu nekuda kwenzvimbo yaro.
• CT scan. Kugadziriswa kwaro kwepamusoro kunogona kuona kupararira kwethumba kunzvimbo dziri padyo.
• MRI scan. Iyi bvunzo yekufungidzira inogona kuratidza kuti bundu rinopararira uye ichipa gwara rekuvhiyiwa.
• Mediastinoscopy. Chubhu inoiswa kuburikidza nemutsipa inobvumira chiremba kutora sampuro yema lymph node.
• Biopsy. Kubvisa tumarara nyama yekuongororwa kunoonekwa sekusimbisa bundu renzvimbo uye kuona kurapwa.
• Vhidhiyo-yakabatsirwa thoracoscopy (VATS). Uku kuvhiyiwa kushoma kunoparadza kunobvumidza mukana wechipfuva kuti uongororwe.
• Mini-thoracotomy. Maitiro aya anoshandisa zvidiki zvidiki, zvakare kuwana tishu yekuongorora.
• Zvimwe zviongororwa. Izvi zvinogona kudikanwa kuti utarise kupararira kwekenza kumapfupa, uropi, uye nedzimwe nzvimbo dzomuviri.

Kurapa kwePancoast bundu

Kunyangwe yaimboonekwa seinouraya, nhasi Pancoast tumors dzinorapika, asi zvisati zvichirapika.

Kurapa kwePancoast bundu kunoenderana nekuti yakazivikanwa nekukurumidza zvakadii, kuti yapararira zvakadii, nzvimbo dzinobatika, uye hutano hwako hwese.

Stage

Bundu rePancoast "rakaiswa" nenzira yakafanana kune mamwe kanzura yemapapu, richishandisa manhamba echiroma I kusvika IV uye madiki A kana B kuratidza kukura kwakaita chirwere ichi. Iyo staging igwara rerapa chairo raunogamuchira.

Pamusoro pezvo, mamota ePancoast anoiswa patsva netsamba uye nhamba 1 kusvika ku4 dzinoratidza kuomarara:

• T inoratidza kukura uye kupararira kwebundu.
• N inotsanangura lymph node kubatanidzwa.
• M inoreva kana nzvimbo dziri kure dzakapambwa (metastases).

Mazhinji mamota ePancoast anoiswa seT3 kana T4, nekuda kwenzvimbo yavari. Mamota anorondedzerwa seT3 kana akapinda pamadziro echifuva kana tsinga dzinonzwira tsitsi. Iwo ari T4 mamota kana vakapinda mune zvimwe zvivakwa, senge vertebrae kana brachial tsinga.

Kunyangwe ekutanga anoonekwa Pancoast tumors akaiswa senge angangoita IIB, zvakare nekuda kwenzvimbo yavo.

Kurapa

Kurapa kwePancoast tumors kwakasiyana uye kunosanganisira musanganiswa wemakemikari, radiation, uye kuvhiyiwa.

Pancoast tumors dzakasangana nemastastasized kunzvimbo dzinopfuura chipfuva dzinogona kunge dzisiri mukana wekuvhiyiwa.

Chemotherapy uye radiation ndiwo matanho ekutanga usati wavhiyiwa. Ipapo bundu rinoongororwa zvakare neimwe CT scan kana imwe bvunzo yekufungidzira. Kuvhiya kunoitika kunoitika vhiki nhatu kana nhanhatu mushure mekemotherapy uye nemwaranzi, chero vanga risati rasvika munzira yekuvhiyiwa.

Mune zvimwe zvirongwa zvekurapa, kuvhiyiwa kunogona kuteverwa nemamwe marapirwo emwaranzi kuuraya chero masero egomarara asara.

Chinangwa chekuvhiyiwa ndechekubvisa zvachose izvo zvine cancer kubva muzvivakwa zvaakapinda. Izvi hazviwanzo kuitika, uye chirwere chinogona kudzokazve. Chidzidzo chidiki chakaitwa muMadganis chakaratidza kuti chirwere chakadzokazve mu50 muzana yeavo vatori vechikamu vane Pancoast tumarara kuvhiya.

Kufambira mberi kwehunyanzvi muhunyanzvi hwekuvhiya kwaita kuti zvikwanise kuita oparesheni paT4 Pancoast tumors, asi maonero akashata kupfuura mamwe matanho echirwere.

Kusunungurwa kwemarwadzo

Kusunungurwa kwemarwadzo ePancoast tumors nhasi kunosanganisira kushandiswa kunodzorwa kwemaopioid yakatemwa nachiremba. Nekudaro, izvi zvinouya nemhedzisiro isingadiwe. Vamwe vaongorori vakapokana kudzoka kune pre-opioid matanho anoshanda pasina mhedzisiro.

Radiation inogona zvakare kushandiswa kubvisa marwadzo kana kuvhiya kusingaiti.

Kushungurudzika kwakanyanya nemaPancoast tumors kunogona kurerutswa nehurongwa hwekuvhiya hunoremadza marwadzo-anoita tsinga mumutsipa wesipinha. Iyi inonzi CT-inotungamirwa cordotomy, umo CT scan inoshandiswa kutungamira chiremba wechiremba.

Mune kumwe kuongorora, kweavo vane Pancoast bundu rakashuma kukura kukuru kwekurwadziwa neiyi nzira. Cordotomy kunyangwe mumavhiki ekupedzisira ehupenyu inogona kupa zororo kurwadziwa.

Dzimwe nzira dzinogona kugadziriswa dzePancoast tumor pain dzinosanganisira:

• kudzvinyirira laminectomy (kuvhiya kunobvisa kumanikidza kumitsipa yemuzongoza)
• phenol block (jekiseni phenol kuvhara mitsipa)
• transdermal kukurudzira (kushandisa yakaderera-nhanho yakananga magetsi emagetsi pauropi)
• stellate ganglion block (kujekesa anesthetic mumitsipa mumutsipa)

Kupona kwemitengo yePancoast bundu

Kupona kwehuwandu mushure memakemikari, radiation, uye kuvhiyiwa zvinosiyana. Chirevo cheCleveland Clinic chakaratidza huwandu hwemakore maviri ekupona mushure mekuvhiyiwa se55 kusvika 70 muzana. Makore mashanu ekupona kweanovhiya akabvisa iyo yekutanga Pancoast bundu zvachose yaive makumi mashanu neshanu muzana kusvika makumi manomwe nenomwe muzana.

Outlook

Kwemakore mazhinji, Pancoast tumors yaionekwa seisingarapike. Nekuda kwenzvimbo yebundu, zvaifungidzirwa kuti kuvhiyiwa kwaisakwanisika.

Mumakumi emakore achangopfuura, maonero evanhu vane Pancoast tumors akagadzirisika zvakanyanya. Matekinoroji matsva ekuvhiya akaita kuti zvikwanisike kuvhiya mamota ayo aimboonekwa seasingashande. Ikozvino-yakajairwa kurapwa inosanganisira chemotherapy, radiation, uye kuvhiya kwawedzera huwandu hwekupona.

Kuonekwa kwekutanga kwechiropa chePancoast kwakakosha mukuona kubudirira kwekurapa. Ona chiremba wako ipapo kana uine zviratidzo, uye tora matanho ekudzivirira sekurega kusvuta kana uchisvuta.