Pheochromocytoma - chii? Pheochromocytoma: zviratidzo, chirwere, kurapwa, mapikicha

Iko panowanikwa namamota mumuviri womunhu, kunyange benign? Yatova chikonzero yakakwana chokunetseka. Uye kuita kuti chokwadi akadaro anofanira kuva zvakasimba chaizvo, zvimwe kutarisana nengozi yematambudziko inowedzera yekudyidzana. Nokuda kwechikonzero ichi, hazvina musoro here kudzidza dzinokosha zviratidzo chimiro namamota, kunyanya kana tiri kutaura pamusoro isingawanzowanikwi fomu sezvo pheochromocytoma. Hatifaniri kufunga migumisiro maonero dambudziko zvavo mishonga uye dzimwe nzira nzira. Kushanya chiremba ndiye rakavimbika kupfuura mhinduro.

Pheochromocytoma - chii?

Izvi izwi anofanira kunzwisiswa sezvo bundu iri nyanyisa kana benign hunhu, anoumbwa masero chromaffin, izvo zvibereko catecholamines. Inogona kubereka zvose biogenic amines uye peptides izvo zvinosanganisira norepinephrine uye dopamine.

Muzviitiko zvizhinji (90%) kwaiita bundu ikabuda iri adrenal medulla, shoma zvikuru ayo chitarisiko wakaiswa pakati kutsemuka mutumbi, chiuno, abdominal kana thoracal mhango. The chidzoke munhu pheochromocytoma mumusoro kana mutsipa nharaunda inogona kunzi muchikwata che kunze.

Muna 10% vose zviitiko ose bundu mhando iri akaipa extraadrenal localization. Saka pane kugadzirwa dopamine. Kana nedanho metastasis panguva dambudziko rakadaro, bundu masero kuwa, kazhinji mumapapu, chiropa, mapfupa, tsandanyama, uye remunharaunda node nodes.

Zvikonzero chidzoke uye kukura

Vakawanda vakanzwa pamusoro chirwere ichi sezvo pheochromocytoma. Chii, zvinosuwisa, haasi munhu wose anoziva. Zvakakosha kunzwisisa nei dambudziko rakadaro kunoitika mumuviri womunhu. Zvino kamwe zvinofanira kucherechedzwa kuti yakajeka misoro mhinduro panyaya chinokonzera asi. Asi somugumisiro zvidzidzo takaitwa zvimwe ndezvipi pamusoro majini hunhu pheochromocytoma.

Most kazhinji chirwere rinowanikwa mune vanhu vane makore 25 kusvika 50 makore. Zvikurukuru, kukura uku kwakadai bundu ndee vakadzi repakati. Kana isu kutaura nevana, zvakadai chirwere kwakakura vakomana. Asi vose, pheochromocytoma bundu - a dererei chinoshamisa.

Saka vanenge 10% of uwandu matambudziko akadaro anorondedzera kuti rwapedyo chimiro. Izvi zvinoreva kuti ichi mhando bundu aivapo mune kupfuura rimwe vabereki murwere.

Kuramba kuongorora zvinokonzera chirwere chakadai, zvinokosha kuziva kuti anogona kuva mumwe zvinoumba ari chirwere siyana kwemakemikari anobudiswa neoplasia (mhando 2Vanhu uye 2b). Pheochromocytoma wakaiswa muna 1% wevarwere nechirwere diastolic BP.

symptomatology

Kudzidza namamota akadai pheochromocytoma, zviratidzo, chirwere uye kurapwa vari anokosha mashoko kutigumbura, hunoita kuti nyaya yacho akasiyana pamakona. Asi vanofanira kutanga pamwechete zvinoratidza chirwere. Symptomatology rakanyatsojeka siyana uye kazhinji sokunge munhu matambudziko zvishoma ngozi utano.

Unofanira kutanga kuti pane chimwe chiratidzo kuti akatsiga pane chirwere akadai pheochromocytoma. NeBP - izvi mimwe kuratidzwa bundu iri mubvunzo. Zvinogona kutora nzvimbo mudanga uye krizovoe fomu. Kana bundu hwapedyo panguva catecholamine vane chirwere cheBP dambudziko, BP inowedzerawo zvikuru nehasha. Asi mezhkrizovy nguva BP ugare nguva refu kana ari chakaipa siyana. Yakanyorwa zviitiko apo pheochromocytoma mberi pamwe chenguva refu kumanikidzwa, asi pasina nematambudziko.

Kuti uwane mamwe mashoko pamusoro sitiroko

Zvine musoro kuteerera chokwadi kuti yakadaro dambudziko sezvo pheochromocytoma dambudziko (neBP) kunowanzoguma gastrointestinal, zvemwoyo, metabolic uye neuro-vairwara nepfungwa. Achitaura pamusoro pokumuka ezvinhu akadaro, zvinofanira kucherechedzwa kuti kunoratidzwa anotevera zviratidzo: nemusoro, tremor, kufunganya, kupinduka pinduka, ganda rakachenuruka, kurutsa, chinyamunhari chinorwadza uye vangadikitira. Pangave kutyorwa mutinhimira, tachycardia uye kurwadziwa mwoyo.

Kana nechirwere pheochromocytoma, vane chirwere cheBP dambudziko anogona kutsamwisa kurutsa, kuda kurutsa uye muromo yakaoma. Asi ndachinja murwere ezvinhu utano haisi nguva dzose zvishoma. Namamota dzakadaro kazhinji kuchinja mamiriro ropa. Tiri kutaura matambudziko akadai lymphocytosis, hyperglycemia, leukocytosis, uye eosinophilia.

Crease kukwanisa kugara kubva kwemaminitsi mashomanana kuti kweawa kana kupfuura. To ichi hurumende hunhu ndiyo zvayo chisingatarisirwi shutdown. Kuderera BP uyewo kunoitika nokukurumidza, saka kuti kunyange pane mukana hypotension. Sezvo vanotsamwisa zviratidzo zvakadai zvingakonzera kuti muviri, kuita palpation zvakadzama mudumbu, doro uye zvinodhaka, hypothermia kana overheating, unopinza kufamba, mupfungwa nenyonganiso uye zvimwewo.

kunyanya kurwisa

Pfari vanowanzotevedzera kuva zvakasiyana kwenguva. Vanogona kuva vakafunga nguva 10 kusvika 15 pazuva kana kamwe pamwedzi. Kana kutanga kwazvo dambudziko iri pheochromocytoma, zvino musoro kutaura pamusoro chaiye ngozi sitiroko, ropa iri the retina, renal kukundikana, myocardial infarction, nokupatsanura aneurysm yacho yeropa, pulmonary edema, uye vamwe. The wakakura zvikuru kuomesa iyi mamiriro chinhu catecholamine kuvhunduka kunoratidza pacharo ne chin'a hemodynamics. Tiri kutaura nezvokuchinja hypo- uye BP, ndine kusingasaruri zvakasikwa uye haagoni kugadziriswa.

Saka, pheochromocytoma - chii? Tichifunga kuonekwa, anofanira kuteerera vakadzi pamuviri, nekuti vane bundu akadai anogona anoedzesera kuva eclampsia, pre-eclampsia uye toxaemia. Mhedzisiro zviratidzo zvakadaro kunogona kuva kwakaomarara pakuberekwa zvaitika.

Possible uye irambe pezvakaita bundu, umo BP ndiyo nguva refu. In mamiriro ichi, kazhinji wakanyorwa kuchinja netsvo, iyo fundus, uye myocardium. Zvinogonekawo kuchinja kamwe kamwe kwemanzwiro, nomusoro, kurukutika uye kugumbuka. Mumwe varwere 10 vane chirwere cheshuga kukura.

Pane zvimwe zvirwere kuti zvinowanzobatanidzwa pheochromocytoma. Zviri pamusoro Raynaud kuti urwere, gallstone chirwere, chirwere Cushing, neurofibromatosis, uye vamwe. Pane chiitiko kuti kuva akaipa bundu, marwadzo mudumbu, pane metastasis kusvikira kure nhengo, uye kukurumidza uremu.

Nyatsonanga zvekuchipatara kuratidzwa

Kune zvimwe zvaidiwa chirwere, izvo zvinogona kuita kuti mamwe matambudziko. Zviri pamusoro apa pezvakaitwa:

• Vana nechirwere pheochromocytoma kakawanda anovandudza neBP. A kota varwere pazera iri polydipsia yatarwa polyuria, uye pfari. Chimwe kuomesa anogona kukonzera pheochromocytoma mune vana - a slowdown ari kukura. Uyezve, kwakanga pazera duku pamwe nechirwere anoita pachayo akanzwa rakasimba uremu, vangadikitira, kuda kurutsa uye kurutsa, ziso nenyonganiso, uye vasomotor nenyonganiso.
• Vakadzi pheochromocytoma vanogona Kuipa utano nokuda nemafungu. Vakadzi vane pamuviri anogona kuva kutevedzera eclampsia uye pre-eclampsia.
• Muzviitiko apo bundu iri pedyo parusvingo dundira yaiva, weti anogona nechokuita pfari. Panewo ngozi nyarara hematuria, wakawedzera BP, nomusoro, kuda kurutsa uye palpitations.

nzira nechirwere

Kuti kuziva mamiriro murwere vakafunga chirwere akadai pheochromocytoma, taura ongororo muviri anofanira aisimbirira zvinotevera zviratidzo: paleness ganda chiso uye mazamu, ikawanda BP, tachycardia, orthostatic hypotension.

Saka zvinokosha kuti kungwarira palpation ari kuedza panyaya namamota zviri pamutsipa, kana dumbu. Chinonyanya kukosha ndechokuti zviito zvakadaro zvinogona kukonzera kukura catecholamine dambudziko.

Uyewo, yepamusoro chirwere muna namamota yakadaro inofanira kusanganisira kushanya kune ophthalmologist. Ichi anogona kunzi kune chokwadi kuti vanenge 40% vanhu kutambura kubva BP, chirwere cheBP retinopathy ari kuona, uye siyana kukuvadza.

Pane nokukanganisika dzekuziva nadzo chirwere pamusoro pheochromocytoma, mufananidzo hunoita kuti tikwanise kunzwisisa kukomba zvinhu. Saka tiri kutaura pamusoro vakawedzera kwevari catecholamines muropa, weti, ropa shuga uye chromogranin-A muropa serum. Dzimwe nguva kungava akakodzera mashoko pamusoro yakawedzera wevasungwa pamusoro parathyroid kemikari, cortisol, calcium, phosphorus, calcitonin, uye zvimwe zvinhu.

Under zvimwe zvinhu wevarwere rinoitwa differential chirwere kuti anomera. Tiri kutaura zvirwere zvakadai psychosis, neurosis, BP, hyperthyroidism, paroxysmal tachycardia, chepfu uye hadzina kufambiswa zvakanaka muna CNS.

Pakusarudza mhando bundu uye ukuru ayo budiriro inogona kushandiswa MRI uye CT, uyewo kudzidza murwere cardiac basa. Kana pheochromocytoma kunokwanisa kuonekwa, zviratidzo, chirwere uye kurapwa - ndiwo zvinhu zviri chaizvo kushanda sezvaakaita namamota akasiyana-siyana ari vachinyatsoziva vasabatwa matambudziko uye nokukurumidza kurapwa vari kiyi zvakanaka Zvaizobuda basa pamwe murwere.

How kurapa

Kune nzira simba-siyana bundu sezvo nyanyisa uye kwete ngozi. Muzviitiko zvakawanda, kuvhiya chichava chisarudzo zvakaringana, kana yakawanikwa pheochromocytoma. Removal achava kunyanya kushanda kune bundu iri adrenal shwanu.

Asi pangava kusara yakafanira varombo mwoyo, tsinga uye cheBP. Participation chiremba kana ezvinhu akadaro chaizvo pamamiriro kana kunyange isingagamuchiriki. Zvakaratidza zvakawanda pamusoro matambudziko bundu yakadaro sezvo pheochromocytoma. Treatment ipfupi kuti zvinodhaka kurapa, kazhinji zvinotora mazuva mashoma.

Kushandisa zvinodhaka zvakasiyana kuti bundu neutralization zvinoratidza kuti murwere achava pamubhedha, uye kutora hafu-agere chinzvimbo. Kuunza hwandaiva BP chiremba anogona mishonga Alpha-blockers. More zvakananga, zviri mishonga yakadai se "Tropafen" uye "phenoxybenzamine." Kana murwere ndee vane chirwere cheBP dambudziko, kukamura uchishandisa Kutarisirwa aizova "phentolamine" "Sodium nitroprusside" uye zvimwe zvinodhaka zvakafanana. Chinokosha ndechokuti munguva pre-kurapwa zvinokosha kuponesa murwere kubva kupera mvura mumuviri.

kushandisa kuvhiya

Kana pheochromocytoma akanga dzakaonekwa, marapirwo achishandisa scalpel anosarudzwa panyaya chii chaiyo zvichiitika bundu. Zvinonyanyozivikanwa zvabatanidzwa transbryushinny, extraperitoneal uye transthoracic nzira.

Kuri kuti ani bundu sezvayakawanikwa pashure pokuongororwa kwacho, fungidziro pamwe kuvhiya kurapwa kuchabatsirawo. Chokwadi, pangava zvazvo, asi vanoratidza pachavo chete muna 13-15% nyaya.

Asi kana paine mapundu akawanda, zvinhu zviri zvikuru kuoma. The inogutsa anogadzirisa kubvisa mapundu ose, asi dambudziko iri ndechokuti ndingangokuvara rakabudirira Mugumisiro zvikuru pasi. Hazvina kuti chikonzero ichi kuti kune vakawanda pheochromocytomas Kuvhiya rinoitwa mumatanho dzakawanda. Mune mamwe mamiriro ezvinhu, chete bundu rinobviswa omei.

Kana zviri kushanda, mukufamba kwaro Implementation anofanira kushandisa chete laparotomy kuwana. It akatsanangura ichi nzira ine ngozi extraadrenal bundu localization. Uyewo zviripo achiziva kuti kudzora hemodynamic (BP uye nechepakati venous kumanikidzwa) rakaitirwa yose kupindira.

Muzviitiko zvizhinji mushure pheochromocytoma rakabvisirwa, BP kunoderedza. Kana kwakadaro zvakaitwa nhengo asipo, saka pane chikonzero chose kufungidzira chokwadi pamusoro paumbwe ectopic bundu rinenge.

Kana pheochromocytoma yakawanikwa vakadzi pamuviri, kutanga aita Kudzikamiswa ropa kufurirwa, uye ipapo akaitawo cesarean chikamu, kana kubvisa pamuviri, uye chete ipapo kubvisa bundu racho pacharo.

Kana diagnosing munhu akaipa pheochromocytoma, panguva iyo kuparadzira metastases vanogamuchira mishonga ( "Dacarbazine" "Vincristine", "Cyclophosphamide").

Kazhinji, kana bundu rakanga dzakaonekwa vachiri pachikuva, uye murwere yakagadzirira zvakanaka kurapwa, mikana kukurira dambudziko iri yakakwirira zvikuru.

Zvii rinogona kurondedzerwa se ude

With kukura namamota mu muviri nguva dzose ngozi afunge kurwiswa. Saka zvinokosha kuziva, izvo zvingaita kuti kusembura weHurumende. Zviri mubvunzo pamusoro zvepabonde, muviri mamiriro kuchinja, hyperventilation, munomimina panguva bowel kufamba, panyama mutoro, excitation pfungwa uye kuitiswa munzvimbo apo vemunyika bundu. Kudai nechirwere pheochromocytoma, regai kurara doro, kunyanya waini uye doro, uyewo kudya chizi.

Pane yave nezvayo zviitiko apo kurwisa kwakatanga mushure mokugamuchira chikakananda, tricyclic antidepressants, phenothiazine nomukaka uye Beta-blockers.

zvabuda

Nokudaro tine dingindira "Pheochromocytoma" akanga amuudza. Chii, isu akatarira kupfuura zvizere. Zvazvinosarira kuti pachena mhedziso; dambudziko chakakomba zvikuru kurapa kurerutsa. Pakutanga zviratidzo kufanana zviratidzo pheochromocytoma, zvakafanira kuti chiremba, kuva akaonekwa uye kutanga kurapwa.