Umhlaza Pancoast: Oonobangela, Iimpawu, diagnosis and Treatment

Pancoast Umhlaza - umhlaza ukuba yenzelwe emseleni eliphezulu kwemiphunga. Ziimpawu zayo ezifana nesifo sephepha, ithumba, echinococcus, inyumoniya, nangezilonda ebubonisayo, kunye nezinye izinto ezimbi.

Igama Pancoast yamathumba ezifunyenweyo egameni ray Henry K. Pancoast. Yena waba ngowokuqala oogxa bakhe wachaza sifo ngokwenkcukacha. Oku kwenzeka ngo-1924.

Ukongeza kule isifo esibulalayo, iimpawu ezifanayo kunokubangela ezinye izifo ukudumba kunye nomhlaza, nayo yaba ngaphezulu kwemiphunga. Le nto ibizwa ngokuba Pancoast syndrome.

Ukungxamiseka ingxaki Pancoast umhlaza ke kunzima loxilongo kwangoko engqondweni yakhe indawo ethile le ithumba, ivaliwe amathambo. Nokuba ngoncedo-x reyi kwenziwa iikliniki Oncology kakhulu obubalaseleyo usaqala akusoloko kusenzeka ukuba ukuchonga ngokukhawuleza esi sifo.

Izizathu phezulu umhlaza wemiphunga

Ngokubanzi, kukuvela umhlaza Pancoast abachatshazelwa yezizathu efanayo kwezinye iintlobo umhlaza wemiphunga. Yintoni na le nto? Esona sizathu siphambili sokuba ukubonakaliswa kwayo non-ukutshaya: osebenzayo okanye kwisixando sokwenziwa. Indima ebalulekileyo edlalwa inani imidiza watshaya ngosuku, umgangatho ukutshaya ezisetyenzisiweyo, kunye namava lulonke ukutshaya. Kufuneka kuqatshelwe ukuba iminyaka kwimeko yokusilela abantu likhoboka ephuma ummandla umngcipheko kuphela emva ezilishumi.

Bangenele le sifo nazo abantu andimvumeli ukuba amkhanuke ukutshaya. umhlaza Ipesenti ngokoyiswa Pancoast abatshayayo nje kwandisa ngamaxesha 1,7-2. Iqela ubungozi kwakhona kuquka abantwana abafikisayo abanabazali rhoqo ukutshaya phambi kwabo. Ukutshaya ngo-85% yamatyala unobangela izenzo phezulu umhlaza wemiphunga.

Ukongezelela ukutshaya kunokubangela umhlaza Pancoast imiba yokusingqongileyo kunye nezoshishino. Xa wadibana izinto ezifana zinambuzane, asbestos, izinyithi enzima, iarseniki, nickel okanye chromium kwandisa ipesenti izigulane ezinomhlaza Pancoast.

Omkhulu kunye nendima zizifo zamaphaphu ezahlukeneyo embalini: isifo sephepha, athwale-phambili yinyumoniya kunye bronchiectasis, - konke oku kwandisa amathuba okuba umntu Pancoast ithumba.

Esi sifo sichaphazela abantu izihlandlo ezihlanu qho ngaphezu abafazi, ngoxa kuziveza emva kweminyaka engama-50. Oku kubonakaliswa ukuba ukuthambekela umhlaza Pancoast ugqithele izakhi.

Ngokubanzi, kukho izinto ezininzi ezingundoqo enefuthe kukuvela somhlaza Pancoast:

• ubudala;
• ukutshaya;
• iimeko zokusingqongileyo kule ndawo;
• umsebenzi wabo ngakumbi kumashishini yokwakha kwemichiza;
• yofuzo.

zesifo somhlaza

Amaxesha amaninzi, izigulane bafune uncedo ukususela sesihambe zesi sifo. Le ngxaki enxulumene kukungabikho iimpawu kwi usaqala: isigulana akukho ukukhohlela, hemoptysis, kwaye okona kubalulekileyo - i iziphene zibonakale emzimbeni ngohlobo inezigingqi emzimbeni. ngokuqhelekileyo musa kuvela Ubuhlungu nisaqala zomhlaza.

Imiqondiso isilumkiso kuphela kwi zigaba 1 and 2 umhlaza zezi ubuthathaka, ukudinwa rhoqo, ukwehla kobunzima.

Syndromes and Pancoast Horner

Ebudeni ngakumbi esi sifo kukho sisibonakaliso syndromes kunye Pancoast Horner, ngokwahlukeneyo yaye xa zidityaniswe kunye nabanye. Le mfuneko ukwazi.

Pancoast syndrome kubonakala ngakumbi ezi mpawu zilandelayo:

• kakhulu isiba ubuhlungu ecaleni lethu ithumba - kummandla igxalaba, ngethuba le-luvo ulnar naphantsi igxalaba;
• izihlunu ingalo buthathaka kwicala abachaphazelekayo lomzimba, paresthesia, antsi yeminwe, yoma ze izihlunu imilenze;
• utshintsho ngezwi - ukuvela hoarseness, ukhohlokhohlo.

Xa baboniswa kwimicu novelwano ithumba ubonisa Horner engqondweni:

• netshiki of ijwabu eliphezulu (ptosis);
• anhidrosis imilenze yasentla, ubuso kunye namaqela achaphazelekayo ithumba;
• constriction lo umfundi (miosis) kunye elirhoxisa lweliso lakho (etnoftalm).

Kaninzi, umhlaza sikhatshwa Pancoast mkhulu Vena cava syndrome ithumba noxinzelelo kuyo. Esi sifo ihamba kunye mpawu zilandelayo:

• ubuhlungu esifubeni;
• ukukhohlela;
• ukuphelelwa umoya;
• ebuhlungu, yaye esozela ukwanda;
• impempe xa uphefumla.

Uxilongo kwamantloko umhlaza wemiphunga

Njengoko sele kukhankanyiwe ngentla apha, lokufunyaniswa sifo kunzima ngokwaneleyo, kuba xa nisaqala zomhlaza Pancoast akakwazi akusoloko uphawula x-reyi ngenxa yokuba nethumba kwindawo ye kwasendaweni yayo ayibonakali.

Njengomgaqo, izigulane zanyangwa kuloo ndawo iminyaka emine okanye ugqirha izikhalazo intlungu imilenze aphezulu yokuqala, yaye kuphela emva koko ukuze idinga a oncologists specialist.

Njengoko Pancoast thumba ze iimpawu zayo ziyafana nezinye izifo kwinkqubo bronchopulmonary, uphethwe wayo kufuneka ibe ebanzi kwaye zibandakanya ezi ndidi zilandelayo ngophengululo:

1. Ray - ibhaqa ubukho ithumba kwi zigaba kamva ngenxa ukuqina le pleura kunye ukubonakala ugesi.
2. Itomography ngekhompyutha MRI - ukujonga ubungakanani inxaxheba semithambo, iimbambo, iindawo, omqolo iye kule nkqubo. Iziphumo zezi zifundo ziphakathi ibalulekileyo. Zibonisa ithuba zotyando.
3. Nkovu node biopsy - ukujonga inqanaba lophuhliso sifo.
4. Uvavanyo igazi - imisela imeko umzimba uphela.

Kwakhona, bronchoscopy njengoko iisaveyi ezininzi eziqhutywa (umisela imeko bronchi kunye noqhoqhoqho, isifundo ekufutshane kummandla ochaphazelekayo), kunye arteriogram phlebogram (ukuhlola imeko imithambo yegazi kwindawo collarbone).

Lung Cancer Treatment

Unyango bomhlaza Pancoast lwenzeka kuphela kwiiklinikhi umhlaza eyodwa, into esisiseko ukuntsonkotha nothomalaliso. Iinkcukacha-manani zibonisa ukuba umhlaza Pancoast ibanjiwe kakhulu kwi kwisigaba sesithathu, xa intlungu zomhlaza olu hlobo iya ezinganyamezelekiyo. Unyango kulo mzekelo kuyimfuneko ukuba siqale ulwamkelo amayeza iintlungu, ukuya analgesics ezidakumbisayo.

Iindlela eziphambili unyango ithumba Pancoast:

• chemotherapy;
• therapy radiation;
• uqhaqho.

therapy ipreoperative

therapy Disease kwenzeka ngokwamanqanaba ezininzi: unyango ipreoperative kwaye postoperative, uqhaqho.

Pre-unyango imbaxa nechemotherapy kunye zokukhanya kuyimfuneko ukunciphisa nangezilonda, kuthintela ukusasazeka metastases kwiindawo nkovu. Oku kwenza kube lula ukuphumeza umsebenzi ukuba ngaphambi mpatho Yayingekho.

therapy Imitha nayo kusetyenziswa indlela oluzimeleyo unyango xa uqhaqho akwenzeki. Zokukhanya kulo mzekelo, kunciphisa uqaqanjelwa umguli, kodwa ngayo ubomi bakho.

Kwaye imitha, yaye ichemotherapy izifundo olwenziwe kumanqanaba aliqela, kunye ikhefu kwiiveki phakathi 2-3. Emva radiotherapy kunye ichemotherapy isigulane wabelwa ukuba alandele-up uviwo, iziphumo bagqibe malunga ithuba zotyando.

Ukufaneleka kwemisebenzi kwi unyango umhlaza wemiphunga

unyango Surgical alukho kuzo zonke iimeko: ukuba akukho siqinisekiso sokuba ubunakho yomguli uya kumvumela ukuba wenze utyando okanye sele bachukunyiswa abaninzi, kude ukusuka sisilonda esidumbileyoesingaphakathi, amalungu omzimba - ukwenza ungenelelo ngoncedo nto ngamampunge. Ipesenti zokuziphilisa ukwimeko enjalo kukutyeshela isiguli kuncinane.

Kwezinye iimeko, xa usebenzo kunokwenzeka, kukho ezahlukeneyo eziliqela ukuqonda yayo;

1. Pulmonectomy - ukususwa yonke ivolyum kwemiphunga ochaphazelekayo.
2. Resection kwemiphunga.

Ithumba imithana ebalulekileyo Ungasusa iimbambo ezininzi kunye omqolo, imithambo, udonga thoracic le plexus brachial. Kwiimeko ezinqabe kakhulu, isigulane kufuneka ubambe okwalandelwa imilenze eliphezulu.

Emva kotyando kunye radiotherapy kunye ichemotherapy zigcinelwe "ukugqibezela off" iiseli ithumba ukuthintela kukuvela likakade.

I-ALS zomhlaza phezulu emiphungeni

Survival lezigulane ethole umhlaza Pancoast, kuxhomekeke eqongeni apho sifo ibonakele.

Izigulane une eyabekwa kwi 1st inqanaba lesi sifo, ukusinda Ungeno 60%, inyathelo 2 - hayi ngaphezulu kwama-40%, kwaye lokufunyaniswa nqanaba 3 zomhlaza kumgca ezintlanu boyise-20% kuphela yezigulane.

On isigaba 4 umhlaza Pancoast phantse akanakunyangwa; ngo-98% amatyala, ukufa kwenzeka zingaphelanga iinyanga 6-7 emva unyango kuqhutywa.