nkhani

Pafupifupi 1.2 peresenti ya anthu adzapezeka ndi khansa ya chithokomiro m'moyo wawo wonse. M’zaka 40 zapitazi, chifukwa cha kufala kwa kugwiritsira ntchito kujambula zithunzi ndi kuyambika kwa njira yabwino yoboola singano, chiŵerengero cha kuzindikiridwa kwa kansa ya chithokomiro chawonjezereka kwambiri, ndipo chiŵerengero cha khansa ya chithokomiro chawonjezereka katatu. Chithandizo cha khansa ya chithokomiro chapita patsogolo kwambiri m'zaka zapitazi za 5 mpaka 10, ndi njira zosiyanasiyana zatsopano zomwe zikuvomerezedwa ndi malamulo.

Kuwonetsedwa kwa radiation ya ionizing paubwana kumalumikizidwa kwambiri ndi khansa ya chithokomiro cha papillary (1.3 mpaka 35.1 milandu / zaka 10,000 zamunthu). Kafukufuku wamagulu omwe adawunikira ana a 13,127 osakwana zaka 18 akukhala ku Ukraine pambuyo pa ngozi ya nyukiliya ya Chernobyl ya 1986 ya khansa ya chithokomiro anapeza chiwerengero cha 45 cha khansa ya chithokomiro ndi chiopsezo chopitirira 5.25 / Gy cha khansa ya chithokomiro. Palinso ubale wokhudzana ndi mlingo pakati pa radiation ya ionizing ndi khansa ya chithokomiro. Zaka zachichepere zomwe ma radiation a ionizing adalandilidwa, m'pamene amakhala ndi chiopsezo chotenga khansa ya chithokomiro chokhudzana ndi radiation, ndipo chiwopsezochi chidapitilira pafupifupi zaka 30 chitatha.

Zomwe zimayambitsa khansa ya chithokomiro sizingasinthe: zaka, kugonana, mtundu kapena fuko, komanso mbiri ya banja la khansa ya chithokomiro ndizofunika kwambiri zowonetsera chiopsezo. M'zaka zachikulire, kuchuluka kwa zochitika kumakwera komanso kutsika kwa moyo. Khansara ya chithokomiro imapezeka kwambiri mwa akazi kuwirikiza katatu kuposa amuna, ndipo izi sizichitikachitika padziko lonse. Kusiyanasiyana kwa majeremusi mu mzere wa majeremusi a 25% a odwala omwe ali ndi medullary thyroid carcinoma amagwirizanitsidwa ndi matenda obadwa nawo angapo amtundu wa 2A ndi 2B. 3% mpaka 9% ya odwala omwe ali ndi khansa ya chithokomiro yosiyana bwino amakhala ndi cholowa.

Kutsatira kwa anthu opitilira 8 miliyoni okhala ku Denmark kwawonetsa kuti goiter yopanda poizoni imalumikizidwa ndi chiopsezo chowonjezeka cha khansa ya chithokomiro. Pofufuza kafukufuku wamagulu a odwala 843 omwe amachitidwa opaleshoni ya chithokomiro chifukwa cha unilateral kapena awiri a chithokomiro, goiter, kapena autoimmune matenda a chithokomiro, milingo yapamwamba ya serum thyrotropin (TSH) inali yogwirizana ndi khansa ya chithokomiro: 16% ya odwala omwe ali ndi TSH pansi pa 0.06 mIU / L adapanga khansa ya chithokomiro, pamene TSH / 52% odwala khansa ya chithokomiro anali ndi TSH / 52.

Anthu omwe ali ndi khansa ya chithokomiro nthawi zambiri sakhala ndi zizindikiro. Kafukufuku wobwerezabwereza wa odwala 1328 omwe ali ndi khansa ya chithokomiro m'malo a 16 m'mayiko a 4 adawonetsa kuti 30% yokha (183 / 613) anali ndi zizindikiro pozindikira. Odwala omwe ali ndi khosi lalikulu, dysphagia, kutengeka kwa thupi lachilendo ndi kunjenjemera nthawi zambiri amadwala kwambiri.

Khansara ya chithokomiro nthawi zambiri imakhala ngati nodule ya chithokomiro. Chiwerengero cha khansa ya chithokomiro m'magulu omveka bwino akuti ndi pafupifupi 5% ndi 1%, motero, mwa amayi ndi amuna omwe ali ndi ayodini okwanira padziko lonse lapansi. Pakalipano, pafupifupi 30% mpaka 40% ya khansa ya chithokomiro imapezeka kudzera mu palpation. Njira zina zodziwira matenda ndi monga kujambula kosagwirizana ndi chithokomiro (mwachitsanzo, carotid ultrasound, khosi, msana, ndi chifuwa); Odwala ndi hyperthyroidism kapena hypothyroidism amene sanakhudze tinatake tozungulira kulandira chithokomiro ultrasonography; Odwala omwe ali ndi mitsempha ya chithokomiro adabwerezedwa ndi ultrasound; Kupezeka kosayembekezereka kwa khansa ya chithokomiro yamatsenga kunapangidwa panthawi ya kafukufuku wa postoperative pathological.

Ultrasound ndiyo njira yomwe imakonda kwambiri yowunikira tinthu tating'onoting'ono ta chithokomiro kapena zofufuza zina zamatenda a chithokomiro. Ultrasound imakhudzidwa kwambiri pozindikira kuchuluka ndi mawonekedwe a tinthu tating'onoting'ono ta chithokomiro komanso zinthu zomwe zimakhala ndi chiopsezo chachikulu chokhudzana ndi chiopsezo cha zilonda zam'mimba, monga kusakhazikika kwa m'mphepete mwa m'mphepete mwake, punctate wamphamvu echoic focus, ndi kuukira kwa chithokomiro chowonjezera.

Pakalipano, matenda ambiri ndi chithandizo cha khansa ya chithokomiro ndi vuto limene madokotala ambiri ndi odwala amamvetsera kwambiri, ndipo madokotala ayenera kuyesetsa kupewa matenda ambiri. Koma izi ndizovuta kukwaniritsa chifukwa si odwala onse omwe ali ndi khansa ya chithokomiro yapamwamba, yomwe imatha kumva minyewa ya chithokomiro, ndipo sikuti matenda onse a khansa ya chithokomiro omwe ali pachiwopsezo chochepa amatha kupewedwa. Mwachitsanzo, kachilombo ka chithokomiro kakang'ono kamene kamayambitsa matenda a chithokomiro kapena imfa amatha kuzindikiridwa ndi histologically pambuyo pa opaleshoni ya matenda a chithokomiro.

Njira zochiritsira zosachepera zochepa monga ultrasound-guided radiofrequency ablation, microwave ablation ndi laser ablation zimapereka njira yodalirika yopangira opaleshoni ngati khansa ya chithokomiro yocheperako ikufuna chithandizo. Ngakhale njira zogwirira ntchito za njira zitatu zochotseratu ndizosiyana pang'ono, ndizofanana kwambiri potengera kusankha kwa chotupa, kuyankha kwa chotupa, komanso zovuta zapambuyo pa opaleshoni. Pakalipano, madokotala ambiri amavomereza kuti chotupa choyenera chothandizira kuchepetsa pang'onopang'ono ndi mkati mwa chithokomiro cha papillary carcinoma <10 mm m'mimba mwake ndi> 5 mm kuchokera kuzinthu zowonongeka ndi kutentha monga trachea, esophagus, ndi mitsempha ya laryngeal. Chovuta chofala kwambiri pambuyo pa chithandizo chimakhalabe modzidzimutsa kutentha kuvulala kwa mitsempha yobwerezabwereza ya laryngeal pafupi, zomwe zimapangitsa kuti pakhale phokoso kwakanthawi. Kuchepetsa kuwonongeka kwa nyumba zozungulira, tikulimbikitsidwa kusiya mtunda wotetezeka kutali ndi chotupa chandamale.

Kafukufuku wambiri wasonyeza kuti kulowererapo pang'ono pochiza chithokomiro papillary microcarcinoma kumakhala kothandiza komanso kotetezeka. Ngakhale kuti njira zochepetsera pang'ono za khansa ya chithokomiro cha chithokomiro chochepa cha papillary zakhala ndi zotsatira zabwino, maphunziro ambiri akhala akubwerera mmbuyo ndipo akuyang'ana ku China, Italy, ndi South Korea. Kuonjezera apo, panalibe kuyerekezera kwachindunji pakati pa kugwiritsa ntchito njira zochepetsera zochepa komanso kuyang'anitsitsa mwakhama. Choncho, ultrasound-guided thermal ablation ndi yoyenera kwa odwala omwe ali ndi khansa ya chithokomiro yochepa omwe safuna chithandizo cha opaleshoni kapena omwe amakonda njirayi.

M'tsogolomu, kwa odwala omwe ali ndi khansa ya chithokomiro chachikulu, chithandizo chochepetsera pang'onopang'ono chingakhale njira ina yochizira yomwe ili ndi chiopsezo chochepa cha zovuta kusiyana ndi opaleshoni. Kuyambira 2021, njira zochotsera matenthedwe zakhala zikugwiritsidwa ntchito pochiza odwala omwe ali ndi khansa ya chithokomiro pansi pa 38 mm (T1b~T2) omwe ali pachiwopsezo chachikulu. Komabe, maphunziro obwerezawa adaphatikizapo gulu laling'ono la odwala (kuyambira 12 mpaka 172) ndi nthawi yochepa yotsatila (kutanthauza 19.8 kwa miyezi 25.0). Choncho, kafukufuku wochuluka akufunika kuti amvetse kufunika kwa kutentha kwapakati pochiza odwala omwe ali ndi khansa ya chithokomiro yofunika kwambiri.

Opaleshoni ikadali njira yayikulu yothandizira anthu omwe akukayikira kapena atsimikiziridwa ndi cytologically differentiated thyroid carcinoma. Pakhala pali mkangano pamlingo woyenera kwambiri wa thyroidectomy (lobectomy ndi chithokomiro chonse). Odwala omwe ali ndi chithokomiro chonse ali pachiwopsezo chachikulu cha opaleshoni kuposa omwe akuchitidwa lobectomy. Kuopsa kwa opaleshoni ya chithokomiro kumaphatikizapo kuwonongeka kwa mitsempha ya laryngeal, hypoparathyroidism, mavuto a zilonda, ndi kufunika kowonjezera mahomoni a chithokomiro. M'mbuyomu, chithokomiro chonse chinali chithandizo chomwe chimakonda kuchiza khansa ya chithokomiro> 10 mm. Komabe, kafukufuku wa 2014 wa Adam et al. adawonetsa kuti panalibe kusiyana kwakukulu pakupulumuka ndi chiopsezo chobwereranso pakati pa odwala omwe akudwala lobectomy ndi chithokomiro chonse cha khansa ya chithokomiro cha 10 mm mpaka 40 mm popanda zovuta zachipatala.

Chifukwa chake, pakali pano, lobectomy nthawi zambiri imakondedwa chifukwa cha khansa ya chithokomiro yosiyana kwambiri ndi <40 mm. Kuchotsa chithokomiro chonse kumalimbikitsidwa kwa khansa ya chithokomiro yosiyanitsidwa bwino ya mamilimita 40 kapena kukulirapo komanso khansa ya chithokomiro yamitundu iwiri. Ngati chotupa chafalikira ku dera mwanabele, dissection wa chapakati ndi ofananira nawo mwanabele a m`khosi ayenera kuchitidwa. Odwala okhawo omwe ali ndi khansa ya medullary chithokomiro ndi ena osiyanitsidwa kwambiri ndi khansa ya chithokomiro chachikulu, komanso odwala omwe ali ndi vuto lakunja la chithokomiro, amafunikira prophylactic chapakati lymph node dissection. Prophylactic lateral lymph node dissection ikhoza kuganiziridwa kwa odwala omwe ali ndi khansa ya medullary chithokomiro. Odwala omwe amaganiziridwa kuti ndi cholowa cha medullary thyroid carcinoma, mlingo wa plasma wa norepinephrine, calcium, ndi parathyroid hormone (PTH) uyenera kuyesedwa musanachite opaleshoni kuti mudziwe matenda a MEN2A komanso kupewa kusowa pheochromocytoma ndi hyperparathyroidism.

Kulowetsedwa kwa mitsempha kumagwiritsidwa ntchito makamaka kuti agwirizane ndi makina oyenera a mitsempha kuti apereke mpweya wosasunthika komanso kuyang'anira intraoperative minofu ndi mitsempha mu kholingo.

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