Wilms 'bundu: Zviratidzo, Treatment

Kunze yomuviri hapana muviri vaiwanzotsvinyirana uye mumamiriro ezvinhu ose neutano hwakanaka. Zvinosuruvarisa zvirwere zvakawanda uye zvikanganiso akaitwa kunyange utero. On mumwe wavo tichataura mu nyaya yedu. Vazhinji vanhu kujairana Wilms 'bundu. Chii, vamwe havazivi. Nyaya ino achaedza kubata zviratidzo, zvinokonzera uye nzira kurapa chirwere ichi.

Pfungwa Wilms 'mota

bundu Wilms ', kana sezvazvakanyorwa kunzi, nephroblastoma, rinoreva nyanyisa zvirwere itsvo, anoonekwa kazhinji muuduku. Zvinonzi Kazhinji chirwere pakati makore 2-5. Wilms 'bundu nedzevakuru hariwanikwi, saka zvishoma kudzidza.

K Zvinosuruvarisa vana vanotambura chirwere ichi vanowanzobatwa uye dzimwe abnormalities kukura. Zvinofungidzirwa kuti paumbwe anomera itange utero, nekuti atova mavhiki maviri mwana anogona kuona izvozvo.

bundu Wilms 'kazhinji vemunyika kune rimwe divi, asi pane nyaya, uye bilateral renal maronda. Kana iwe tarira muviri achirwara, zvinogona kucherechedzwa kuti kwayo pamusoro ndiye gogonera, kuti akachekwa anooneka nzvimbo ropa uye necrosis, mune dzimwe nzvimbo kune cysts. Muchiitiko ichi tichiti murwere ane cystic Wilms bundu.

Pakutanga, bundu iri mupasi mukati neitsvo. With haizopereri kukura iye inokura munzvimbo dzakapoteredza zvinyama uye nhengo - nokudaro vakaparadzira metastases.

chirwere rwakazara

Izvi akaipa bundu racho kukura nhanho shomanana:

1. Pakutanga nephroblastoma ndomumwe chete itsvo. Children iyi arege kuona kusanzwa, uye hapana zvichemo hazvina.
2. Bundu anotanga kupararira mhiri itsvo, asi metastases havasati kuwanika.
3. Pakuzadzisa achabatsirwa imwe kumera capsules uye kukundwa kunokanganisa pedyo nadzo uye node nodes.
4. Found metastases ari chiropa, mapapu, mapfupa.
5. Pakupedzisira pavaipfuura kukura Wilms bundu muvana chinobata vane netsvo mbiri.

Zvichida havafaniri tsanangura kuti kwokutanga bundu iri panoonekwa, zvikuru netariro maonero anogona kupa murwere.

symptomatology chirwere

Sezvo chirwere kuti zvokurwara kunogona kuva zvakasiyana-siyana zvokukura, zviratidzo uye zvichienderana zvingaita siyana. Kazhinji kacho, kana paine bundu rimwe Wilms ', zviratidzo aonekwa sezvinotevera:

• mukuru zvakawanda zvive;
• simba, uye kana mwana ari dikisa, zviri kuramba takamuka;
• Nzara rutapudzo;
• akaona uremu rutapudzo;
• Mune zvimwe zviitiko, pane nefivha yakasimba;
• ganda anova rakachenuruka;
• kungawedzera BP;
• Blood kuongorora kunoratidza chichiwedzera ESR uye kuderedzwa Chizenga;
• pane ropa weti;
• muna Muzviitiko zvakaipisisa, unogona kuonekwa intestinal mhingaidzo, sezvo bundu anorumanya izvozvo.

Kana chirwere anochinja unhu mwana, uye Wilms 'bundu nevana hapana anosara. Amai nguva dzose kunogona pakarepo vanofungidzira kuti mwana kuti chinhu chakaipa.

Kana chirwere anoenda kure, zvino bundu iri palpable maoko akanaka. Panyaya iyi, mwana anonzwa marwadzo, nekuti pane compression kuti pedyo nadzo, izvo kunotadzisa kwavari kushanda zvakanaka. Mune vamwe varwere, izvozvo anowedzera dumbu kana chirwere bundu Wilms '. The Photo pazasi kuratidzwa akanaka.

Apo vazhinji metastases, mwana anotanga nokukurumidza uremu. Kakawanda, rufu kunoitika somugumisiro kufema kukundikana uye kunyanya kuneta. Zvinoshamisa, panowanikwa metastases kunobva, ndingadaro, kwete kukura bundu, asi zvakawanda pamusoro murwere zera. Zvakaratidza kuti vana vaduku chaizvo neizvi chirwere mukana nani kunaya zvakakwana.

Asi kakawanda chete chirwere bundu Wilms ', kakawanda aine vamwe zvokukura zvirwere.

Comorbidities

Kashoma zvakakwana kuti bundu iri chirwere sezvo chete kutsauka iri kukura. Kakawanda iri pamwe comorbidities:

• hypospadias, kana urethra mune vakomana kuzarurwa kumwe pakati yemukomana kana kunyange crotch;
• chakawedzerwa zvomukati Somuenzaniso, rurimi guru;
• rimwe gumbo kupfuura vamwe;
• cryptorchidism;
• pasina maziso ziso (manzwiro mboni haisi akapoteredzwa chinhu).

Diagnosing Wilms mota

Kana nephroblastoma ndiyo chete pakutanga chaipo yawo kukura, yakarurama zvokuongorora kwakaoma, sezvo pasina raidudzwa zviratidzo. Nokuda kwechikonzero ichi, kazhinji kare kutanga kurapwa kana bundu uri 3 kana 4 nzendo.

Vabereki vanofanira kunyatsotevera kuongorora mamiriro mwana, uye kana pane pallor, BP, ungaderedza matauriro, zvinokwanisika kuti muedze bundu, unofanira pakarepo rakagara kuongorora zvizere. Kazhinji zvinosanganisira zvinotevera marudzi Diagnostics:

1. Analysis ropa uye weti. Zvinowanikwa weti proteinuria, hematuria, uye ropa erythrocyte sedimentation zvazvingava rwuchiwanzwa, pane kupererwa neropa.
2. Urography kunoita kuongororwa zvakarurama munyika dzinopfuura 70% nyaya. Havagoni kuona contours ari itsvo, uye pamberi bundu zvinoonekwa zvishoma kuchinja muviri chimiro uye dysfunction.
3. Uchishandisa Ultrassom kuri kuri nyore kuona kukura bundu yayo nzvimbo.
4. Wilms 'bundu iri Ultrasound sokunge asiri yakafanana inotungamirwa cysts mukati.
5. Kushandisa X-ray kombiyuta tomography havagoni kuona kwete chete bundu rimwe itsvo, asiwo kuongorora wechipiri mamiriro, uye vanoona kuvapo metastases vari pedyo nhengo.
6. For guru kukura bundu iri kazhinji ushandiswe angiography. Izvi zvinoitwa kuti kujekesa nephroblastoma nzvimbo hama kuti mikuru nemidziyo ropa, saka kuti panguva oparesheni chiremba aiva pfungwa yacho.
7. Ultrasonography uye CT anogona kuona ukuru metastasis mune nhengo uye munyama.

Pari, zvokurapa tsvakurudzo nzira vari yakadaro pamwero okukura kuti kubvumira akarurama zvokuongorora iri kusvika 95% nyaya. Asi 5% zvose zvakafanana zvikanganiso zviitike Somuenzaniso, kana Ultrasound multilokulyarnuyu chikofu kururama kuti Wilms 'bundu, ndiko chete panguva oparesheni zvinokwanisika kuona. Kana ultrasonic kushanda pakuvheneka zvakarurama ndiyo 97%, uye zvishoma zvishoma panguva RT. Kunyange paine zviitiko apo Wilms bundu unobatanidzwa ane chikofu.

Kuongorora inoendeswa kuziva miedzo metastases, ipapo kusarudza zvakarurama nzira kurapwa zvirwere. Kana dzichiri Wilms bundu nevana, kurapwa dzakabatwa mu nomumwe mhosva nomumwe, ane chokuita mumuviri uye padariro chirwere.

Zvinokonzera nephroblastoma

With yakarurama kutaura kuti chakakonzera bundu kukura, hazvibviri. Zvinofungidzirwa kuti mhaka iyi ndiyo mutation iri DNA nemasero. In chikamu chiduku kacho ari chakasvitswa kubva vabereki vana. Asi kakawanda, vatsvakurudzi havana kuwana ukama pakati yedzinza uye kukura Wilms 'bundu.

Vanachiremba vanodavira kuti pane zvimwe zvinokonzera njodzi kuti kutungamirira kwaita nephroblastoma. Izvi zvinosanganisira zvinotevera:

1. Female. Maererano nenhamba, vasikana kazhinji vanotambura nechirwere ichi pane vakomana.
2. Enhaka yakatevedzana. Kunyange zvazvo zviitiko rwapedyo zvirwere zviri zvisinganyanyi kuitika.
3. Kuva pasi Negroid rudzi. Pakati kwakadai hwevanhu chirwere rinowanikwa muna 2 nguva kakawanda.

Kazhinji, zvinofanira kucherechedzwa kuti saka kure havana kusimbiswa chaiyo zvinokonzera kukura Wilms 'bundu.

nephroblastoma kurapwa

Kazhinji, mabatiro chero chirwere chinogona akaswedera akasiyana pamakona. Kana akawana Wilms bundu nevana, mabatiro anopiwa pamusoro migumisiro histological bvunzo. Nyanzvi dzinodavira kuti zvakanaka histology anopa zvakawanda zvakanaka fungidziro. Asi izvi hazvirevi kuti Analyses zvakaipa kushumira somureza kumisa kurapwa.

Kana isu kutaura nephroblastoma, zvinotevera nzira inoshandiswa kurapa nayo:

• kuvhiya;
• radiotherapy.

Uyewo ichibereka yakanaka mishonga nokuti Wilms 'bundu.

Nzira kurapwa anosarudzwa kuti mumwe shoma murwere nomumwe. It kuchaenderana kwete chete padariro bundu kukura, asi pamusoro mwana wacho muviri ezvinhu.

kuvhiya kupindira

Kubviswa itsvo - iri nefroektomiya. Zvinokosha pakubhadhara akawanda:

1. Simple. Panyaya iyi, chiremba munguva oparesheni zvachose anobvisa njodzi itsvo. Kana muviri wechipiri akanaka, zvino zvingaita zvakanaka kushanda "mbiri".
2. Kukwana nefroektomiya. Pakuvhiya ichi, chiremba anobvisa chete kenza bundu mukati itsvo uye dzakapoteredza kukuvara tishu. Kakawanda evanhu vakadaro kupedza kana itsvo wechipiri chabviswa kana akanyanya kurwara.
3. Yakakura kubviswa. It Yakabata kwete chete itsvo kuti dzakapoteredza zvivako, asiwo ureter, ari adrenal shwanu. Node nodes zvinogona kubviswa kana dzine masero kenza anowanika.

Panguva oparesheni anogona nguva dzose kuwana kuti dzakapoteredza zvinyama wakaremara, ipapo zvakafanira kuti kutarisa mamiriro ezvinhu uye kuti abvise hutachiona zvose. In Muzviitiko zvakaipisisa, kana nephroblastoma (Wilms 'bundu) Kunochinja itsvo panguva mwana, zvakakosha kuti aponese upenyu mwana kubvisa miviri miviri.

Pashure bilateral nephrectomy mwana ushandiswe dialysis kuchenesa ropa muchetura. Ita upenyu pashure kubviswa zvose itsvo zvinogona kwakakwana chete pashure kuisirwa ari nhengo kubva anyatsoronga ndiro zvakaoma kuwana. Varwere ava dzimwe nguva kwemakore vari tungamidzana kuti nokuisazve.

Pashure pokuvhiyiwa kubvisa bundu wake akatuma pachisara kuongorora specificity masero kenza, avo sehasha, mwero wokuberekana. Zvakakodzera kusarudza nzira inobudirira zvikuru kuti mishonga.

Mishonga yokurapa nephroblastoma

Kana bundu zvisingaiti kubvisa kurapwa ipfupi kune dzimwe nzira dzakadai kushandisa mishonga.

Panguva iyi kurapwa ushandiswe mishonga zvinodhaka, izvo zvinokonzera kuparadzwa masero kenza. In kurapwa tsika, inonyanyoshandiswa nachiremba chinangwa ichi:

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

kurapwa kwakadaro zvakaoma kuti nhengo, kuchinja kuitika basa zhinji nhengo dzomukati, somuenzaniso:

• nokushushikana okumugamuchira hematopoiesis;
• zvakakuvadza bvudzi follicles, uye izvi zviri kukonzerwa bvudzi kurasikirwa panguva mishonga;
• kutambura masero gastrointestinal kuti chinokurwadzai kurasikirwa kudya, kurutsa, kuda kurutsa,
• akaderedza kutapata inoita muviri vade zvirwere.

Vabereki vanofanira asati kugamuchira mishonga zvinodhaka kubvunza chiremba wako pamusoro zvingakonzerwa nemishonga uye kutora matanho anodiwa kuti atsigire muviri wemwana.

Kana mwana anomanikidzwa kugadza mukuru-dose zvinodhaka, chiremba anofanira ndikuyambirei kuti izvi zvinogona kukonzera kuparadzwa mumwongo masero, uye kupa kuti -oma. Mushure kurapwa vanogona thawed uye aiswe muviri mwana, vanotanga mabasa avo zvakananga kuti masero eropa. Sezvo mwongo vakuvara panguva mishonga, akadzorerwa.

nemwaranzi kurapa

Kana zvakasimba Wilms bundu mberi, kurapwa kunodiwa kuwedzera uye radiotherapy. Zvinonzi pamwe mishonga kana nephroblastoma iri 3-4 zvokukura kukura. Radiation kurapa kunobatsira kuuraya kenza masero kuti "vakapukunyuka" pedyo chiremba pakuvhiya.

Panguva imwe nzira yakadaro, zvakakosha kuti mwana akarara rakamira, sezvo zvakananga bundu nzvimbo tinotungamirirwa matanda. Kana murwere iduku kwazvo uye ayo kutadza kufamba kuti matambudziko, ipapo nzira isati chinotarisirwa chiduku dose pamusoro sedatives.

Irradiation kunoda zvaidiwa chaiwo audzwa. The pfungwa iri iyo achatumirwa mwaranzi, wakanyorwa pamwe dhayi. All kuti haafaniri kuwira irradiation mapazi rinosanganisira nhoo inokosha.

zvokungwarira All, zvisinei, haadziviriri pamusoro nemishonga kuti ipapo simuka:

• svoto;
• simba;
• ganda kutsamwa ari nzvimbo irradiation;
• manyoka.

Chiremba Unofanira kugadza zvinodhaka kuti zviite murwere ezvinhu uye parutivi migumisiro vachabviswa.

Zvipatara maererano pavaipfuura chirwere

Nokuti chero chirwere kurapwa anogara vakasarudzwa nomumwe. Izvi ndezvechokwadi kunyanya vana. Wilms bundu anodawo nokungwarira kuongorora uye vakasarudzwa kurapa kwakakodzera. It inorangarira padariro chirwere, kwete chete kukura, asiwo makore mwana, mugariro wake, kunyanya muviri.

1. Rokutanga uye rechipiri padanho bundu kukura apo kwacho kunosanganisira kenza itsvo masero mumwe chete uye regai kusiyana sehasha, kurapwa zvinowanzosanganisira kubviswa njodzi nhengo, kwaizotevera mishonga. Ungada mamwe uye radiotherapy.
2. 3 uye 4 nephroblastoma Danho zvinoda ZVAKASIYANA. Bundu kunosvika mhiri itsvo, saka zviri vasingachakwanisi kubvisa pasina achirova pedyo zvomukati. Panyaya iyi kunan'anura kuvhiya kubviswa bundu, zvichiteverwa mishonga uye irradiation.
3. Stage 5 kunoratidzwa nechitarisiko zvirwere zvose neitsvo. Kuita zvishomanana bundu Kubviswa, uye nokudaro zvinokanganisa pedyo node nodes. Pashure pokuvhiyiwa, akaita nzira nemwaranzi uye mishonga. Kana uine kubvisa zvose netsvo, murwere anogona dialyzed, uye ipapo iwe uchida ndinobvisa utano nhengo.

Vana vari zvose zvakasiyana, uye mumwe nomumwe maitiro muviri kuti bundu mishonga. Usati paakabvuma kuti kurapwa plan, vabereki vanoda dzose nyaya dzinokurukurwa ane chiremba. Vanofanira kuziva kuti vanzwe zvinodhaka pane mutumbi, sei kudzivisa kana kuderedza parutivi migumisiro panguva kurapwa.

miedzo Clinical

Gore negore pane nzira itsva uye nzira nokuda kurapwa vamwe zvirwere. Izvi ndezvechokwadi kunyanya kenza uyewo hwenyama kwavari ari kumusoro.

Munyika dzakawanda, kwete chete vakuru asiwo vana vanogona kutora chikamu mune kurapwa nemiedzo kurapwa itsva zvimba Wilms. Vabereki vanogona kukumbira chiremba kana miedzo yakadaro yaitwa munyika yedu, pane mukana kutora chikamu maari.

Kana fungidziro uripo, chiremba anofanira kupa ruzivo zvizere pamusoro kuchengeteka kurapwa. Zvinokosha kucherechedza kuti kazhinji kubatanidzwa miedzo experimental kwakadaro kunopa imwe mukana mukurwisa chirwere.

Asi chiremba anofanira kuyambira nezvokuti mukufamba kurapwa angava nezvimwewo nemishonga kuti hamuna taonana, uyewo 100% mushonga hapana haagoni iko.

kuitazve

Zvakakosha kwete chete kutsungirira chirwere, asiwo nechokwadi kuti haina kuitazve. Zvinosuruvarisa ichi chinoitika nephroblastoma zvose panguva kurapwa uye pashure pacho. Ita Analyses, uye kana vari dzinogutsa, ipapo achiita negadziriro yeparutivi zano chemotherapeutic zvinodhaka:

• "Vincristine".
• "Doxorubicin".
• "Cyclophosphamide" akabatana "dactinomycin" kana "ifosfamide".
• "Carboplatin".

Nechimwe yakasiyana, uye kune vamwe varwere kuitazve raitongwa refu dose kuti mishonga, zvichiteverwa hunde sero transplantation Ropa. Kupfuura zvose ndiwo zvazviri, kana isu nokubatanidza kuvhiya pamwe radiotherapy uye polychemotherapy.

bundu Wilms 'ndiyo nhoroondo mukadzi pamuviri

Itsvo mumuviri womunhu kuita mumwe mukuru mashandiro - ropa kucheneswa muchetura uye metabolic zvigadzirwa. Panguva pamuviri, vanobereka basa kaviri kwete chete nokuda kwaamai ezvinhu, asiwo upenyu hutsva, kukura muviri.

Kana amai vanepamuviri akavhiyiwa kuti itsvo kubviswa refu asati pamuviri, asi fungidziro inogona kubatsira zvikuru. Vakadzi vazhinji akabudirira kutakura pamuviri uye kubereka vana hwakanaka.

Asi pane kunze, uko mutsva vaisagona pave nekukurukurirana ndambosvuta. Zvino iwe pamuviri kuponesa upenyu hwemukadzi.

Dzimwe nguva noruzivo pauduku Wilms 'bundu anogona kutsamwisa kukura pyelonephritis, uyewo izvozvo kunogona kukanganisa dzichipfekeka kukura azvarwa. Kunyange pasinei nokuti vakawanda yakanaka mugumisiro pamuviri, mukana metastasis uye sohraniyaetsya makore 10-20 mushure itsvo rokubvisa.

The fungidziro varwere vane nephroblastoma

Kupa yakananga for pamberi Wilms 'bundu, zvakakodzera kufungidzira saizi yaro, padanho kukura uye histological kuongorora. Chinonyanya vanoshorwa ndiyo kuvapo bundu kupfuura 500 d uye 3-4 padanho kukura ane murombo histology.

Kana wainyatsotaura revatema remudunhu zvakakwana kurapa, murwere wokurarama anenge 60%. In kwokutanga nzendo bundu iri amenable kuti hubudirire kurapwa, kupora rinowanikwa muna 80-90% yevanhu.

Yandakapiwa anokosha zviyero kudzivirira hosha hakuwaniki, zvino isu chete anogona kukuudza kumbotambudzika dzose rokuongorora, kana mwana ari pangozi. Kwokutanga bundu akawanikwa, nani mikana nokupora.