Wilms 'ithumba: Iimpawu, Treatment

Ubengekho na emzimbeni womntu akukho umzimba ukuba kusoloko naphantsi kwazo zonke iimeko ukuze uhlale usempilweni. Ngelishwa, izifo ezininzi kunye iziphene abantu babekwa nkqu Esibelekweni. Kolunye kuzo singathetha kwinqaku lethu. Abantu abaninzi Ye- ithumba Wilms '. Yintoni na loo nto, abanye nokumazi. Eli nqaku liza kuzama ukujongana iimpawu, izizathu kunye Amaqhinga unyango lwesi sifo.

Ingcamango ithumba Wilms '

ithumba Wilms ', okanye njengoko kuthiwa, nephroblastoma, ibhekisela izifo amabi, le nezintso, ezivelayo ngokufuthi ebuntwaneni. Oku kudla kwafunyaniswa phakathi kweminyaka eli-2-5. Ithumba Wilms 'abadala kunqabile, ngoko kancinane efunda.

K Ngelishwa, abantwana abaphethwe kwesi sifo kakhulu amaninzi kunye namanye ezingaqhelekanga kuphuhliso. Kukholelwa ukuba ukuyilwa yamathumba kungaqala Esibelekweni, ngenxa yokuba sele ngeeveki ezimbini usana uyakwazi ukubona oko.

Ithumba Wilms 'idla yenzelwe ukuya kwicala elinye, kodwa ke kukho iimeko, kunye izilonda sezintso abambiseneyo. Ukuba ujonga umzimba ogulayo, ukuze kuqwalaselwe ukuba kumphezulu wayo obungalinganiyo, lo cut kwiindawo ezibonakalayo legazi kunye necrosis, kwezinye iindawo kukho cysts. Kule meko sithi ogulayo esinganyangekiyo Wilms ithumba.

Ekuqaleni, nethumba yenzelwe phakathi ezintsweni. Nophuhliso olandelayo utyala emaphandleni ajikelezileyo inyama kunye namaziko - metastases ndlela twa.

Isigaba isifo

Le ithumba kuphuhliso balo amanyathelo ezimbalwa:

1. Ekuqaleni nephroblastoma ngomnye kuphela zezintso. Abantwana kweli thuba ukuze kugagana ubuhlungu, akukho zikhalazo abangenanto.
2. Ithumba iqalisa wayitwabulula ngaphaya kwizintso, kodwa metastases azikafumaneki.
3. Uphuhliso olulolunye sikhatshwa yi njengezingxobo ukuntshula kunye boyise luchaphazela amalungu ezikufuphi neendawo nkovu.
4. metastases efumaneka isibindi, imiphunga, amathambo.
5. Kwinqanaba lokugqibela kuphuhliso Wilms ithumba ebantwaneni kuchaphazela babe nezintso zombini.

Mhlawumbi kufuneka achaze ukuba ekuqaleni ithumba eso, abanethemba ngakumbi anganika isigulane.

symptomatology kwesifo

Ekubeni lokufunyaniswa leengxaki banokuba kumanqanaba ahlukeneyo, imiqondiso yaye ngokuxhomekeke ingahluka. Ngokufuthi, ukuba kukho ithumba a Wilms ', iimpawu ziyazibhaqekela ngolu hlobo lulandelayo:

• umkhuhlane jikelele;
• ubuthathaka, yaye ukuba umntwana mncinane kakhulu, sihlala siphaphile;
• zokunciphisa emnyama;
• zokunciphisa umzimba zaphawula;
• Kwezinye iimeko, kukho umkhuhlane omkhulu;
• isikhumba uba libunile;
• kunganyusa uxinizelelo wegazi;
• Uhlalutyo Igazi ibonisa ukuba ESR ukwanda nokuncipha athwala;
• kukho igazi umchamo;
• kwiimeko ezinzima, oku kungabonakala emathunjini, njengoko ithumba Oluma kuyo.

Ukuba nasiphi na isifo utshintsha imo sana, kwaye ithumba Wilms 'ebantwaneni kungekho ngaphandle. UMama bangasoloko nangoko sokukrokra ukuba umntwana ukuba kukho into engalunganga.

Xa isifo kude, ngoko ke Ithumba uvalo izandla elungileyo. Kulo mzekelo, usana lusiva intlungu, ngokuba kukho ucinezelo amalungu ezikufutshane, nto leyo ethintela ukuba usebenza kahle. Kwezinye izigulane, kwenyusa isisu xa kwafunyaniswa ukuba ithumba Wilms '. Ifoto ngezantsi umboniso elungileyo.

Xa inani elikhulu metastases, umntwana uqala ukuphulukana ngokukhawuleza ubunzima. Amaninzi, abantu bayafa ngenxa yokusilela yokuphefumla nokudinwa ngokugqithiseleyo. Okumangalisayo kukuba, xa kukuvela metastases luxhomekeke, kunoko, kungekhona kubungakanani ithumba, kodwa ngaphezulu kubudala yesigulane. Kubonakala ukuba abantwana abancinci kakhulu nale unesifo ithuba elingcono bachache ngokupheleleyo.

Kodwa ke amaxesha amaninzi nje kwafunyaniswa ukuba ithumba Wilms ', oko kudla kunye nezinye izifo yophuhliso.

Comorbidities

abafane ngokwaneleyo ukuba thumba banesifo njengoko ecaleni kuphela kuphuhliso. Amaninzi oko kukhatshwa comorbidities:

• hypospadias, xa urethra yamakhwenkwe ivulwe kwenye phakathi lobudoda okanye kwi uhanjiso;
• amalungu zangaphakathi ezandisiweyo, umzekelo, ulwimi enkulu;
• omnye umlenze ngaphezu enye;
• cryptorchidism;
• engekho iris iso (imvakalelo ukuba umfundi akukho singqongwe nto).

Ekuxilongweni Wilms Ithumba

Xa nephroblastoma kuphela kwasekuqaleni wophuhliso lwawo, uxilongo echanekileyo kunzima, ekubeni akukho zimpawu kubi. Ngenxa yesi sizathu, kwiimeko ezininzi sele ukuqala unyango xa Ithumba kumanqanaba-3 okanye ezi-4.

Abazali kufuneka esweni ngokusondeleyo iwonga lo mntwana, kwaye ukuba kukho pallor, uxinzelelo oluphezulu lwegazi, sinciphise ithoni, kunokwenzeka ukuba kukuvavanya ithumba, kufuneka ngoko nangoko bangenele uviwo olupheleleyo. Lidla kuquka ntlobo zilandelayo uxilongo:

1. Uhlalutyo igazi nomchamo. Sifumaneka proteinuria umchamo, umyinge neentlenge hematuria, yaye erythrocyte igazi siyandiswa, kukho igazi.
2. Urography ivumela ukuxilongwa angaphezu kwama-70% amatyala. Ayikwazi ukujonga iikhonto le zezintso, kwaye phambi ithumba ebonakalayo utshintsho incinane ukumila nokuphazamiseka.
3. Ukusebenzisa ultrasound kwakhona lula ukubona ubungakanani thumba kunye nendawo yayo.
4. Ithumba Wilms 'kwi ultrasound ikhangeleka ngathi ukuma non-efanayo cysts ngaphakathi.
5. Ukusebenzisa X-ray computer Itomography akakwazi ukubona kuphela ithumba enye kwizintso, kodwa ukuhlalutya imeko yesibini, kwaye ukujonga ubukho metastases kwizigqeba ezikufutshane.
6. Ngenxa yobukhulu enkulu nethumba idla emiselweyo angiography. Oku kwenziwa ukuze acacise ngakumbi nephroblastoma indawo kuthelekiswa imithambo yegazi ezinkulu, kangangokuba ngexesha ukusebenza ugqirha waba necebo le meko.
7. Ultrasonography and CT nako ukufumanisa iqondo Ukudlulela kwizigqeba kunye namalaphu.

Okwangoku, iindlela zophando zonyango kumgangatho onjalo wophuhliso ukuvumela uxilongo echanekileyo phantse-95% amatyala. Kodwa 5% zonke iimpazamo ezifanayo kungenzeka, umzekelo, xa ultrasound multilokulyarnuyu cyst ngokuphosakeleyo ithumba Wilms ', oko kuphela ngexesha lokusebenza kuyenzeka ukubona. Xa ukuskena accuracy cuke yi-97%, kwaye ngaphantsi kancinci kwi RT. Nangona kukho iimeko xa ithumba Wilms kudityaniswe a cyst.

Uviwo Eminye sibhekiswe ekufumanekeni of metastases, emva koko ukhethe unyango amaqhinga ekunene sifo. Ukuba ekuphuhliseni Wilms ithumba ebantwaneni, unyango elawulwa kwimeko nganye ngamnye, oko kusenziwa kunikwe ingqalelo umzimba kunye nenqanaba esi sifo.

Izinto ezibangela nephroblastoma

Kunye echanekileyo bathi unobangela uphuhliso ithumba, akunakwenzeka. Kukholelwa ukuba unobangela woku yemfuza-DNA yeseli. Xa ipesenti encinane amatyala, nokuba isasazeka ukusuka kubazali abantwana. Kodwa ke kaninzi, abaphandi musa ukufumana ubudlelwane phakathi ufuzo kunye nophuhliso nethumba Wilms '.

Oogqirha bakholelwa ukuba kukho ubungozi ezikhokelela ukuvela nephroblastoma. Ezi ziquka oku kulandelayo:

1. Female. Ngokutsho manani, amantombazana amaninzi ubunzima kwesi sifo ngaphezu amakhwenkwe.
2. zilandelana zamafa. Nangona iimeko zezifo kwiintsapho kakhulu inqabile.
3. Besive kugqatso Negroid. Phakathi kolu hlobo sifo sabantu kwenzeka ngamaxesha-2 rhoqo.

Ngokubanzi, kufuneka kuqatshelwe ukuba kunjalo ngokude hayi ndiyiqinise oonobangela ngqo kuphuhliso ithumba Wilms '.

unyango nephroblastoma

Njengoko umthetho, ukunyanga nasiphi na isifo ukuba banike kwiikona ezahlukeneyo. Xa wafumana Wilms ithumba ebantwaneni, unyango unikwa kwiziphumo zeemviwo histological. Iingcali zikholelwa ukuba histology elungileyo inika ALS kakuhle ngakumbi. Kodwa ke oku akuthethi ukuba kuhlalutyo ezimbi abe uphawu ukuyeka impatho.

Ukuba sithethe nephroblastoma, ezi ndlela zilandelayo zisetyenziselwa ukunyanga kuyo:

• utyando;
• radiotherapy.

Kwakhona evelisa HIV Iziphumo wayenyangwa ithumba Wilms '.

Amaqhinga unyango esikhethwe ngamnye ukuze isigulane encinane ngamnye. Oku kuya kuxhomekeka nje eqongeni kuphuhliso ithumba, kodwa kwi imeko emzimbeni yomntwana.

ukungenelela kuhlinzwa

Ukususwa izintso - is nefroektomiya. Kuyinto iintlobo:

1. Simple. Kulo mzekelo, ugqirha ngexesha lokusebenza ususa ngokupheleleyo kidney achaphazelekayo. Ukuba umzimba yesibini usempilweni, ngoko ukuze isebenze kakuhle "kuba ezimbini".
2. nefroektomiya Partial. Ngeli utyando, ugqirha ususa kuphela wayenomhlaza ngaphakathi wezintso kwaye ezingqonge umonakalo kwithishyu. Amaninzi izakhi ezinjalo kufuneka achithe ukuba yesibini kidney iye isusiwe okanye ugula kakhulu.
3. ukususwa olukhulu. Ngoko bambamba kuphela sezintso ukuba izakhiwo ezingqongileyo, kodwa ureter, le ndlala adrenal. iindawo nkovu kwakhona isuswe ukuba ziqulathe zifumaneka iiseli zomhlaza.

Ngexesha lo msebenzi ungasoloko ufumana ukuba izihlunu ezikufutshane yonakele, ngoko kuyimfuneko ukuba baqwalasele le meko kwaye asuse konke ukudyobheka. Kwiimeko kakhulu, xa nephroblastoma (Wilms 'ithumba) ichaphazela zombini izintso lo mntwana, kuyimfuneko ukuba usindise nobomi wosana ukususa izidumbu ezimbini.

Emva kokuba umntwana nephrectomy mazwe emiselweyo dialysis yokuhlambulula igazi ityhefu. Yenza ubomi emva ukususwa izintso zombini, kuba ngokupheleleyo kuphela emva nokufakelwa welungu ukusuka donor, nto leyo kakhulu kunzima ukufumana. Ezi zigulane maxa wambi iminyaka efolisiweyo ukuba esinye.

Emva kotyando ukususa ithumba wakhe wathumela uhlalutyo, ukuhlola ingakumbi iiseli umhlaza, ndlongondlongo yabo, izinga lokwanda. Kuyimfuneko ukuba ukukhetha ikhondo isebenzayo nechemotherapy.

Chemotherapy kwi unyango nephroblastoma

Ukuba Ithumba akwenzeki ukususa unyango lancitshiswa kwezinye iindlela ezifana nokusetyenziswa nechemotherapy.

Ngeli unyango emiselweyo iziyobisi ichemotherapy, isandla ekutshatyalalisweni iiseli zomhlaza. Ukuziqhelisa lwezonyango, sesona emiselweyo ukulungiselela le njongo:

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

unyango olunjalo zicwadi kunzima kakhulu ukuba ephilayo, utshintsho kwenzeka nokusebenza kwamalungu ezininzi zangaphakathi, umzekelo:

• inkqubo aphazamiseke hematopoiesis;
• yonakele zoboya, yaye oku kubangelwa ilahleko iinwele ngexesha ichemotherapy;
• ubunzima iiseli emathunjini ukuba kuphakamisa ukulahleka wokutya, ukugabha, isicaphucaphu;
• kunciphise okukwazi eyenza umzimba zizisulu ngakumbi ukuba ungenwe lula zizifo.

Abazali kufuneka ngaphambi kokufumana amachiza ichemotherapy ukubuza kugqirha wakho malunga neziphumo ebezingalindelekanga ezinokubakhona kunye ukuthatha amanyathelo ayimfuneko ukuxhasa umzimba womntwana.

Ukuba umntwana onyanzelwayo ukuba amisele ichiza idosi eliphezulu, ugqirha kufuneka axelele ukuba oku kubangele ukutshatyalaliswa iiseli lomongo wethambo, uzisondeze ukuba ngumkhenkce. Emva unyango zingakotshwa zinyibilikisiwe wazibeka usana umzimba, baze baqalise iimbopheleleko zabo ngqo ekuveliseni iiseli zegazi. Ekubeni wamathambo bonzakele ichemotherapy, wayibuyisela.

therapy radiation

Ukuba ithumba kakhulu Wilms liphakama, unyango kufuneka ukuba ufake kunye radiotherapy. It kudityaniswe ichemotherapy ukuba nephroblastoma na izigaba 3-4 zophuhliso. therapy Imitha inceda ukubulala iiseli umhlaza eziye "basinda" yi ugqirha xa kusenziwa utyando.

Ngelo xesha nkqubo onjalo, kubalulekile ukuba umntwana elele lanqumama, njengokuba ngqo kwi ndawo ithumba ibhekiswe iintsika. Ukuba isigulana lincinane kakhulu kunye nokungakwazi yayo wenze baseyingxaki, ngoko le nkqubo phambi kokuba ilawulwa igcuntswana leyeza nadlamkisayo.

Zokukhanya kufuna ngokuthotyelwa kwezo ngcebiso ngqo. Ingongoma kuyo ziza kuthunyelwa rays, ilebhile idayi. Konke ekufuneka mandingaweli kummandla zokukhanya ehlanganiswa izihlangu ezizodwa.

Yonke imiqathango, Noko ke, oku ukukhusela ngokuchasene side effects ke kuvela:

• isicaphucaphu;
• yobuthathaka;
• kwesikhumba kwisiza zokukhanya;
• norhudo.

Ugqirha kufuneka amisele iziyobisi eziququzelela imeko yomguli kunye neziphumo ebezingalindelekanga iza kupheliswa.

Unyango ngokungqinelana nenqanaba sifo

Kuba naluphi na unyango sifo isoloko ekhethiweyo ngamnye. Oku kuyinyaniso ngakumbi abantwana. Wilms Ithumba nayo ifuna uhlalutyo ngenyameko nokukhethwa amakhambi. Sithabathela ingqalelo nenqanaba esi sifo, uphuhliso nje kuphela, kodwa ubudala bomntwana, imeko yakhe, ingakumbi umzimba.

1. Inqanaba lokuqala nolwesibini kuphuhliso ithumba xa le nkqubo ibandakanya iiseli umhlaza kwezintso enye kuphela kwaye ayahlukanga ndlongondlongo, unyango ngokuqhelekileyo kubandakanya ukususwa organ achaphazelekayo, kunye nechemotherapy ezilandelayo. Kusenokufuneka ngakumbi radiotherapy.
2. 3 no-4 Inqanaba nephroblastoma kufuna indlela eyahlukileyo. Ithumba lingaphezu kwizintso, ngoko ke akusekho kunokwenzeka ukususa ngaphandle betha amalungu ezikufutshane. Kulo mzekelo Zimiseleni kususwe zoqhaqho nethumba, kulandele ichemotherapy kunye zokukhanya.
3. Isigaba 5 luphawulwa yimbonakalo sifo izintso zombini. Ukwenza ukususwa ithumba buso, yaye ngaloo ndlela kuchaphazela ezalathelwe nkovu ekufuphi. Emva kotyando, wenziwe kwikhondo kwemitha kunye nechemotherapy. Ukuba une ukususa izintso zombini, le Isigulana dialyzed, yaye ke ufuna lokususa amalungu esempilweni.

Abantwana zonke ezahlukeneyo, kwaye indlela ngamnye yento ephilayo nothomalaliso ithumba. Phambi kokuba livume ukwenza isicwangciso sonyango, abazali kufuneka yonke imiba kuxoxwe kunye nogqirha. Kufuneka bazi ukuba yintoni umphumo imithi emzimbeni, ukunqanda okanye ukunciphisa iziphumo ebezingalindelekanga ngexesha unyango ngayo.

Ulingo lwezonyango

Rhoqo ngonyaka kukho ubuchule neendlela ukulungiselela unyango lwezifo ezithile ezintsha. Oku kuyinyaniso ukuba umhlaza ngokunjalo ukufa kubo liphezulu.

Kumazwe amaninzi, abantu abadala kuphela, kodwa kananjalo abantwana babo bangathatha inxaxheba kwiimvavanyo zeklinikhi zonyango ezintsha idumbile Wilms. Abazali cela ugqirha ukuba mvavanyo zenziwa ngaphandle kwilizwe lethu, kukho ithuba lokuba athathe inxaxheba kuzo.

Ukuba amathuba ukho, ugqirha kufuneka anike ingcaciso epheleleyo malunga nokhuseleko unyango. Kubalulekile ukuphawula ukuba ngokufuthi inxaxheba kuvavanyo zovavanyo kunika ithuba engaphezulu ekulweni nezifo.

Kodwa ugqirha kufuneka alumkise malunga yokuba ngexa unyango inokuba neziphumo ebezingalindelekanga akungebikho kuqiniseka ukuba akukho wadibana ngaphambili, kwakunye 100% unyango Akukho namnye unako siqinisekiso.

zingabuyi

Kubalulekile kuphela ukumelana nesi sifo, kodwa ukuqinisekisa ukuba akazange abe likakade. Ngelishwa, oku kusenzeka nephroblastoma zombini ngexesha unyango kunye nasemva kwayo. Ukwenza analyses, kwaye ukuba zifanelekile, ngoko abele iziyobisi scheme chemotherapeutic backup:

• "Vincristine".
• "Doxorubicin".
• "Cyclophosphamide" nodibaniso 'dactinomycin "okanye" ifosfamide ".
• "Carboplatin".

Kwimeko nganye yahlukile, yaye kwimeko ezithile izigulane ezilawulwa zingabuyi idosi eliphezulu chemotherapy, kulandele cell stem abohlukeneyo Blood. Best zonke na isiphumo, xa sidibanisa utyando kunye radiotherapy kunye polychemotherapy.

Ithumba Wilms 'yimbali umfazi okhulelweyo

Izintso emzimbeni womntu ukwenza omnye weyona misebenzi engundoqo - igazi ukuhlanjululwa ityhefu kunye neemveliso metabolic. Ngexa lokukhulelwa, baya kuthwala uxanduva kabini hayi kuphela imeko kamama, kodwa ngenxa ubomi, nokuphuhlisa eziphilayo entsha.

Ukuba umama okhulelweyo wenziwa utyando ukuze ukususwa kwezintso elide phambi kokuba lokukhulelwa, ALS kunokuba luncedo kakhulu. abafazi abaninzi ukuthwala ngempumelelo ukukhulelwa uze uzale abantwana esempilweni.

Kodwa ke kukho iimeko, apho urhulumente omtsha isekude likakade. Ngoko isisu ukusindisa ubomi mfazi.

Ngamanye amaxesha abanamava ithumba ebuntwaneni Wilms 'ukuze bandiqumbise uphuhliso pyelonephritis, kwakunye oku kuchaphazela uphuhliso olusebenzayo olungekazalwa. Nkqu nangona uninzi ayaphumelela yokukhulelwa, ubungozi Ukudlulela kunye sohraniyaetsya kwiminyaka 10-20 emva ukususwa zezintso.

I-ALS izigulana nephroblastoma

Ukunika uqikelelo ethile phambi ithumba Wilms ', kuyimfuneko ukuqikelela ubungakanani bayo, ibakala uphuhliso kunye nohlalutyo histological. Eyona ezingaginyisi ke kukho ithumba mkhulu kuno-500 g kunye 3-4 inqanaba lophuhliso kunye histology olihlwempu.

Ukuba ikhankanyiwe integrated yesekethe unyango olufanelekileyo, izinga ukusinda isigulana malunga ne-60%. Kumanqanaba okuqala Ithumba efanele unyango olusebenzayo ngakumbi, ukuchacha kwenzeka ngo-80-90% yabantu.

Njengoko ayisekho amanyathelo akhethekileyo ekuthinteleni izifo, ke ukuncoma kuphela bangenele uhlolo rhoqo, ukuba umntwana usemngciphekweni. I ngaphambili ithumba ofunyenweyo, ngcono amathuba achache.