ʻO ka maʻi maʻi pancreatic

ʻO ka maʻi maʻi pancreatic

ICD-10	C 25 25.
ICD-10-KM	C25.0, C25.1 a me C25.2
ICD-9	157 157
ICD-9-KM	157.1, 157.8, 157.0 a me 157.2
Omim	260350
Nā maʻi maʻi	9510
Medlineplus	000236
eMedicine	med / 1712
Mesh	D010190

ʻO ka maʻi maʻi pancreatic - neoplasm malignant e hele mai ana mai ka epithelium o ka puna glandular a i ʻole nā papa pancreatic.

Nā ʻano kūpuna

ʻO ka uluʻana i ka maʻi maʻi pancreatic e hoʻonui pinepine ʻia i kēlā me kēia makahiki. ʻO kēia maʻi ka ono o ka maʻi maʻamau i waena o ka pākeke pākeke. E pili pono ana i nā ʻelemakule, he mau kāne pinepine a me nā kāne. MaʻAmelika Hui Pū ʻIa, ʻo ka maʻi pancreatic i kēia manawa i ka wahi ʻehā ma waena o nā kumu o ka make ʻana i ka maʻi kanesa. Wahi a ka loiloi mua ʻana e ka American Cancer Society, i ka makahiki 2015, e ʻike ʻia kēia nahā i 48 960 poʻe, a he 40 560 mau mea maʻi e make. ʻO ka pilikia o ka maʻi kanesa i nā kānaka āpau o ʻAmelika i ka wā o ka ola ʻo 1.5%.

ʻO nā mea pilikia no ke kanesa pancreatic:

I nā maʻi precancerous e komo:

ʻO ka maʻamau, pili ka mea maʻi i ke poʻo o ka kelepona (50-60% o nā hihia), ke kino (10%), ka hiʻu (5-8% o nā hihia). Loaʻa kekahi makana piha o ka pancreas - 20-35% o nā hihia. ʻO ka pīkoi he poli tuberous hāpū me nā palena ʻole; i ka ʻāpana, keʻokeʻo a ʻeleʻele paha.

Ua ʻike ʻia kahi huapo i kēia manawa e pili i ke ʻano o nā maʻi pancreatic maʻamau, hiki ke hoʻopili i ka hoʻomohala ʻana i ka maʻi kanesa. Wahi a kahi noiʻi i paʻi ʻia ma ka nūpepa Nature Communications, ʻo ka kumu i huli ʻia ʻo ia ka P1 protein kinase gene (PKD1). Ma ka hana ʻana, hana e hiki ke hoʻokaʻawale i ke ulu o ka ʻōpū. PKD1 - ke hoʻomalu nei i nā ulu a me ka metastasis. I kēia manawa, luhi ka poʻe noiʻi i ka hana ʻana i kahi inhibitor PKD1 no laila hiki ke hoʻāʻo hou ʻia.

ʻO kahi noi i hana ʻia ma Langon Medical Center ma ke Kulanui o New York i ʻike ʻo ka maʻi pancreatic 59% ʻoi loa ka ulu ʻana i ka poʻe maʻi me ka microorganism i loko o ka waha. Porphyromonas gingivalis. ^ E Ha yM. Eia nō hoʻi, ʻoi aku ka lōʻihi o ka maʻi o ka maʻi inā ʻike ʻia ka mea maʻi Aggregatibacter actinomycetemcomitans. ^ E Ha yM. Ke hoʻomau ʻia nei kahi hoʻokolohua screening e hoʻoholo i ka hopena o ka hoʻomohala ʻana i ka maʻi pancreatic.

Hoʻoponopono nā hanana mōʻaukala |ʻAtikala lāʻau lapaʻau

Hoʻopuka ka maʻi pancreatic, e like me nā kumuwaiwai like, ma ka 1-7% o nā maʻi kanesa āpau, ʻoi aku ka nui o nā poʻe ma mua o 50 mau makahiki he nui, ʻoi aku ka nui o nā kāne.

ʻO kēlā me kēia makahiki, 30,500 nā hihia o ka maʻi pancreatic, ma mua o ka adenocarcinoma ductal, a he 29,700 make i hoʻopaʻa ʻia ma United States. Nā hōʻailona o ka maʻi o ka maʻi pancreatic i ka hoʻemi ʻana o ka momona, ka ʻeha o ka ʻōpū, a me nā maʻi kūloko. Hana ʻia ka maʻi maʻi e CT. Hoʻokomo ʻia i ka lapaʻau maʻi pancreatic ka hōʻola ʻana a me ka radiation hou a me ka chemotherapy. ʻAʻole pono ka prognosis, ʻoiai ua ʻike pinepine ʻia ka maʻi ma ke ala kiʻekiʻe.

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Nā kumu o ke kanesa o pancreatic

ʻO ka hapa nui o nā maʻi maʻi pancreatic he mau exocrine tumō e ulu ana mai nā kiniki a me nā acinar cell. Ke kūkākūkā ʻia nā tumors endocrine pancreatic ma lalo.

Loaʻa nā exenocarcinomas exocrine pancreatic mai nā ductal cells i ka manawa 9 mau manawa pinepine aʻe ma mua o nā acinar cells, a ʻo ke poʻo o ke aniani e pili ana i ka 80%. ʻIke mau ka Adenocarcinomas ma ka awelika i ka makahiki o 55 mau makahiki a me 1.5-2 manawa pinepine pinepine i nā kāne. ʻO nā mea koʻikoʻi e pili ana i ka ulaula, kahi mōʻaukala o ka pancreatitis kino, a me kahi papa lōʻihi o ka maʻi diabetes (ʻoi aku hoʻi i nā wahine). Hoʻokani ʻia kekahi kuleana e ka hoʻoilina. ʻO nā mea inu momona a me ka caffeine ka hopena ʻaʻole iʻoi aku ka hopena.

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Hōʻike pinepine ʻia nā ʻōmaʻomaʻo o ka maʻi pancreatic; i ka wā i hana ʻia ai kahi maʻi, 90% o nā mea maʻi he maʻi hoʻokūkū a puni e pili ana i nā hana retroperitoneal, nā nū lymph nīnūnē, a i ʻole a me nā metastases pūlū a i ʻole.

ʻO ka hapa nui o ka poʻe maʻi me ka hōʻeha ʻeha ma ka ʻōpū o luna, e kū pinepine ana i hope. Hiki ke emi ka ʻeha i ka wā e hele mua ʻia ai ke kino a i loko paha o kahi kūlana fetal. ʻO ke kaumaha ka mea maʻamau. ʻO ka adenocarcinomas pancreatic e hōʻeha ai i ka jaundice obstrate (ʻo ke kumu pinepine o ka ʻawa) i ka 80-90% o nā maʻi. ʻO ke kino o ke kino a me ka huelo o ka gland e hiki ke hoʻowalewale i ka hoʻowalewale o ka vevel splenic, alakaʻi i splenomegaly, varicose veins o ka esophagus a me ka ʻōpū, a me ke koko gastrointestinal. Ma muli o ka maʻi maʻi pancreatic i ka maʻi maʻi i ka 25-50% o nā mea maʻi, e hōʻike ana i nā hōʻailona o ka intolerance glucose (e.g. polyuria a me polydipsia), malabsorption.

Cystadenocarcinoma

ʻO Cystoadenocarcinoma ka maʻi maʻamau ʻo ka pankreatic adenomatous e hele mai ana ma muli o ka kahi hoʻopiʻi kino ʻana o ka mukona cystadenoma a hōʻike hou iā ia iho he ʻano nui volumetric o ka papa luna o ka ʻōpū o ka ʻōpū. Hana ʻia ka maʻi maʻi ʻana e ka CT a i ka MRI o ka ʻōpū o ka ʻōpū, kahi i hoʻoulu ʻia ai ka nui o ka cystic i loaʻa nā huahana decay, he ʻano volumetric e like me necrotic adenocarcinoma a pancreatic pseudocyst. ʻAʻole e like me ductal adenocarcinoma, ʻo ka cystoadenocarcinoma he maikaʻi prognosis maikaʻi. ʻO 20% wale nō o nā mea maʻi i loaʻa i ka metastases i ka wā o ka hōʻino ʻana; ʻo ka pau loa ʻana o ka hōʻeha i ka wā o ka pancreatectomy mamao a i ʻole paha i ka wā e kau ana ma ka whipple i hopena i ka 65% o ke ola o 5 mau makahiki.

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Pākuʻi papillary Intraductal-mucinous

ʻO kahi maʻi kihi papahiki Intraductal-mucinous (VPMO) kahi ʻano maʻamau o ka maʻi kanesa e alakaʻi i ka hypersecretion mucus a me ka papaʻi papaʻi. Hōʻike nā hōʻike loiloi i ka male benign, borderline, a i ʻole ka hōʻino ulu. ʻO ka hapa nui (80%) ʻike ʻia i ka poʻe wahine a ʻo ke kaʻina hana i kū pinepine i ka ʻoi o ka pancreas (66%).

ʻO nā hōʻailona o ke kanesa o ka pancreatic i loko o ka ʻeha a me ka hoʻihoʻi pinepine ʻana o ka pancreatitis. Hana ʻia ka maʻi me ka CT ma ka like me ka ultrasound endoscopic, MRCP a me ERCP paha. Hiki ke hoʻokaʻawale i kahi kaʻina male benign a me ka malignant wale nō ma hope o ka hoʻoili ʻana i ka maʻi, ʻo ia ke ʻano o ke koho. Me ka hana hoʻokō ʻana, ʻoi aku ka ola no ka 5 mau makahiki me ka ulu ʻana o ka benign a i ʻole ka palena palena ma mua o 95% a me 50-75% me kahi hana hōʻino.

Naʻi hoʻolika

ʻO nā ala e ʻike ai no ka maʻi ʻana i ka maʻi pancreatic he spiral CT o ka ʻōpū a me MRI o ka pancreas (MRTP). Inā ʻike ʻia ka maʻi ʻāpono a i ʻole nā hopena metastatic i ka wā o ka CT a i ka MRI o ka pancreas, e hana ʻia kahi biopsy o kahi palutan percutaneous o ka wahi i hoʻopili ʻia, no ka hoʻokolokolo histological o ka ʻōpū a me ka hōʻoia i ka hoʻāla ʻana. Inā hōʻike i kahi hōʻike CT e hōʻike i ka hiki ʻana o kahi maʻi ʻōpū a i ʻole kahi hōʻoki ʻole i ʻole, ke hōʻike ʻia ka pancreatic MRI a me ka endoscopic ultrasound e hōʻike ai i ke kaʻina hana a me nā node liʻiliʻi i ʻike ʻole ʻia e CT. Hiki i ka maʻi maʻi me ka jaundice obstrukture ke hana i ka ERCP e like me ka hoʻāʻo a ka diagnostic mua.

E hana ʻia nā hoʻokolohua hōʻike ʻōiwi. ʻO ka hoʻonui ʻana o ka phosphatase alkaline a me ka bilirubin e hōʻike ana i ka hana o ka bile duct a i ka metastasis i ka puʻuwai. ʻO ka manaʻo o ka antigen CA19-9 e pili ana me ka pancreas hiki ke hoʻohana no ka nānā ʻana i nā maʻi me nā maʻi lapaʻau maʻi pancreatic a no ka nānā ʻana i ke kīpē nui o ka maʻi maʻi. Eia naʻe, ʻaʻole ʻike iki kēia hōʻike i kā mākou hoʻohana ʻana no ka nānā ʻana i kahi heluna nui. E hoʻemi i nā pae antigen kiʻekiʻe i ka liʻiliʻi o ka mālama ʻana, kahi hoʻonui aʻe e hōʻike ana i ka holo mua o ke kaʻina o ke ake. Mālama nā pae amylase a me lipase i loko o nā palena maʻamau.

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Hoʻomaka maʻi maʻi pancreatic

Ma kahi o 80-90% o nā maʻi, ʻaʻole hiki ke hoʻokaʻawale ke ʻano ma muli o ka ʻike ʻana i nā metastases i ka hana diagnostic a 'ulu' ana paha i nā moku nui. Aia ma kahi o ke kūloko, ʻo ka hana o ke koho ke ʻano, ka maʻamau pinepine, i ka ʻoki ʻana o Whipple (pancreatoduodenectomy). ʻO ka maʻi hou me ka 5-fluorouracil (5-FU) a me ka radiation radiation waho e hōʻike pinepine ʻia, kahi e hiki ai ke ola no kahi o 40% o nā mea maʻi ma mua o 2 mau makahiki a 25% ma mua o 5 mau makahiki. Hoʻohana pū ʻia kēia mālama lapaʻau no ka maʻi maʻi pancreatic i nā mea maʻi me ka palena liʻiliʻi akā ʻaʻole i hiki i nā maʻi me ke aʻalopō a me nā hopena ma kahi o ke ola o ka 1 makahiki. ʻOi aku ka nui o nā lāʻau lapaʻau hou (e.g. gemcitabine) i ʻoi aku ka maikaʻi ma mua o ka 5-FU e like me ka chemotherapy basic, akā ʻaʻohe mea lapaʻau wale nō a i ʻole ka hoʻohui ʻana i ʻoi aku ka maikaʻi. Hiki ke hāʻawi ʻia i ka Chemotherapy i nā maʻi me nā metastases o ka ʻili a me nā metastases mamao paha i kahi ʻāpana o ka noiʻi, akā ke kūleʻa ʻia nei ke ola me ka loaʻa ʻole o ka mālama ʻana paha a koho paha kekahi mau maʻi i ka hiki ʻole.

Inā ʻike ʻia kahi lōkahi inoperable i ka wā o ka hana e hoʻokō ai i ka hakakā o ka gastroduodenal a i ʻole ka biliary tract, a inā he wikiwiki ka hoʻomohala ʻana o kēia mau ʻōuli, hana ʻia nā pālua o ka gastric a me ka wai hoʻowai. I nā mea maʻi me nā ʻeha hāpau a me ka jaundice, hiki i ka end Endopic stenting o ka biliary tract ke hoʻonā a hōʻemi paha i ka hakakā ʻana. Eia nō naʻe, i nā mea maʻi me nā hana i hiki ʻole ke manaʻolana ʻia ke ola e ʻoi aku ma mua o 6-7 mau mahina, ʻoi aku ka manaʻo e hoʻokomo i ka anastomosis bypass no nā mea hoʻopiʻi e pili ana me ka hoʻokalakupua.

Hoʻomaka maʻi maʻi maʻi maʻa

I ka hopena hope loa, ke kū nei ka hapa nui i nā maʻi kaumaha a me ka make. I kēia mea, ʻo ka mālama like ʻana o ka maʻi maʻi pancreatic ka mea nui e like me ka radical. Pono e mālama pono ʻia i ka poʻe maʻi me ka prognosis hōʻeha.

ʻO nā mea maʻi me ke kaumaha ʻeha a hōʻeha paha e hāʻawi i nā opiates waha i loko o nā pahuhopu i lawa no ka hoʻomaha ʻana o ke ʻeha. ʻO ka hopohopo e pili ana i ka hoʻohui ʻana ʻaʻole pono ke keʻakeʻa i ka hopena o ka ʻeha. I ka ʻehaʻeha koʻikoʻi, ʻoi aku ka hoʻomau ʻia o nā hoʻokele i hoʻolaʻa (e.g. subcutaneous hoʻokele o fentanyl, oxycodone, oxymorphone) e ʻoi aku ka maikaʻi. Hoʻopuka ka Percutaneous a i ʻole intraoperative visceral (celiac) i ka hoʻokō koʻikoʻi i ka maʻi i ka hapa nui o nā maʻi. I nā hihia o ka hōʻeha ʻole, ke mālama ʻia nā opiates e subcutaneously a i ʻole intravenously, epidural a intrathecal hoʻokō i hāʻawi i kahi hopena hou.

Inā ʻaʻole e hōʻemi ʻo ia i ka hōʻeha palliative a i ʻole ka hopena o ka stitalary o kaary me ka hopena o ka jaundice obstract, pono ka mea maʻi e kuhikuhi i ka cholestyramine (4 g maʻa 1 a 4 mau manawa i ka lā). ʻO Phenobarbital 30-60 mg oralally 3-4 mau lā i ka mana.

Me ka kakī pancreatic exocrine, hiki ke papa kuhikuhi ka papa ʻaina papa o nā enzyme pancreatic (pancrelipase). Pono ka mea maʻi e lawe i ka 16,000-20,000 hui o ka lipase ma mua o kēlā me kēia pāʻina. Inā e hoʻomaha lōʻihi nā meaʻai (e.g. i loko o kahi hale ʻaina), pono e lawe ʻia nā papa i ka wā o ka pāʻina. ʻO ka maikaʻi loa ʻo ka pH no nā enzyme i loko o ka pūpū he 8, i pili pū me kēia, ua kuhikuhi kekahi mau kauka no nā mea paʻa proton pipitors a i ʻole H₂—l mau laka. Pono ke kiaʻi ʻana o ka hoʻomohala ʻana o ka maʻi diabetes a me kāna mālama ʻana.

ʻO ke ʻano o ka maʻi. Nā kumu kumu o ka maʻi

ʻO ka maʻi maʻi pancreatic He maʻi hōʻino e ulu mai ana mai nā seleka pancreatic i hoʻololi ʻia.

ʻO ka maʻi maʻi pancreatic aia ma kahi eono i waena o nā hua momona ʻē aʻe i ka nui o ka hiki ʻana mai. Mai ka makahiki 1987, ua ulu ka nui o ka ulu ʻana o ka maʻi pancreatic ma ko mākou ʻāina ma o 30%, ʻo ka ulu ʻana ma waena o nā wahine he 7.6, i waena o nā kāne - 9.5 i 100 tausani kanaka. Ua ʻōlelo nā poʻe hōʻike, e hoʻonui ka maʻi o ka maʻi ma ka honua holoʻokoʻa. Wahi a nā wānana, ʻo ka nui o nā mea maʻi me ka maʻi pancreatic i 2020 i hoʻohālikelike ʻia me nā makahiki he iwakālua i hala iho nei, e 32% ʻoi aku ke kiʻekiʻe o nā ʻāina hoʻomohala, a i nā ʻāina kūkulu - e 83%, hiki aku i ka 168,453 a me 162,401 mau hihia, ma kēlā me kēia. I nā 75% o nā hihia, hoʻopilikia ka maʻi i ke poʻo o ka pancreas.

ʻO nā mea koʻikoʻi nui no ka maʻi maʻi pancreatic:

i ka ulaula (ma ka 1-2% o nā mea ulaula puhaka ulu i ka ulu ʻana).
diabetes mellitus (ʻo ka hopena o ka hoʻomohala ʻana i kahi maʻi i ka maʻi diabetes is 60% kiʻekiʻe),
ʻo ka pancreatitis maʻi maʻi (pancreatic cancer ulu i 20 mau manawa pinepine),
ʻoi aku ka nui o nā makahiki he nui ma mua o nā makahiki he 60 a me 80)
ka lāhui (Ua hōʻike ʻia nā haʻawina US e ʻoi aku ka nui o ka maʻi pankreatic i nā ʻAmelika ʻAmelika ma mua o ke keʻokeʻo. Maliʻa paha kēia ma muli o nā kumu socio-economic a me ka ulaula ulaula).
ʻanuʻu (ʻoi aku ka maʻamau o ka maʻi i nā kāne ma mua o nā wahine),
ʻoi (hoʻonui nui ʻia ka pilikia o ka hoʻomohala ʻana i ke kano pancreatic: 8% o nā hihia he hui pū me ia),
kaʻaiʻai (me nā meaʻai me ka nui o ka ʻiʻo, ke kolamu kiʻekiʻe, nā meaʻai kolo e hiki ke hoʻonui i ka ulu ʻana o ka maʻi)
genetics (he nui o nā syndromes hoʻoilina i hoʻoili i ka hoʻomohala ʻana, e like me ka laʻana, ka maʻi umauma o ka umauma, nā maʻi atypical familial o ka melanoma, nā maʻi ʻāpana o ka pakanikō.

Hoʻomaʻi ʻia nā ʻōmaʻomaʻo Pancreatic Cancer

I ka manawa pinepine, ma nā papa mua, ʻo ka maʻi he asymptomatic, a me nā manaʻo subjective e ʻae e kānalua i kona hele ʻana:

kaumaha a ʻeha ʻole paha i ka ʻōpū o luna,
nā helehelena o nā hōʻailona o ka maʻi hānai (make wai, nui ke kō koko, a me nā mea ʻē aʻe).
pinepine, kīnā paʻa.

Me ka holomua o ka maʻi, hiki paha i kekahi mau hōʻailona ke:

ʻeha i ka ʻōpū o luna e kū ana i ke kua,
ka māmā o ka ʻili a me ka protein o ka maka (ma muli o ke kahe mai o ka bile mai ka ate i ka pūpū),
ʻālaʻi a ka luaʻi (ma muli o ke kipi ʻana i ka ʻōpū o ka duodenum),
mea kaumaha.

Eia naʻe, ʻo kēia mau maʻi āpau he nonspecific, a i ka wā e kū ai, pono e pono ke kaʻina o ke kaʻina hana diagnostic.

Ka helu ʻana a me nā pae kūkulu ʻana o ka maʻi pancreatic

Mākaukau i kahi o ka ʻōpū:

ʻO ka poʻo pancreatic
kaheʻe ʻana o ka pancreas,
ka maʻi pancreas
ka lākole pancreatic,
hoʻopōʻino piha i ka pancreas.

Ke kuapo nei i ka ʻano hīmeni o ka maʻi (i hoʻoholo ʻia e nā hopena o ka hoʻokolokolo histological o ke ʻano):

Adenocarcinoma ductal (ʻike ʻia ma 80-90% o nā hihia),
nā koikoi neuroendocrine (insulinoma, gastrinoma, glucagonoma, etc.),
ka hanipela malstant mouss (mucinous, serous),
nā ʻano hanana palapala ʻē aʻe.

ʻO ka maʻi neuroendocrine pancreatic

Mamuli o ke kahua o ka maʻi.

Ke ʻano hana. Kākō ka liʻiliʻi, ʻaʻole e hele i waho aʻe o ka pancreas. ʻAʻole kahi metastases.

II kahua. ʻO ka pālahalaha o ke kinikona ma waho o ke kino, akā me ka ʻole e hoʻopili ana i nā moku arterial nui i ke kaʻina hana. Aia nā metastases i nā nika lymph, ʻaʻohe metastases i nā kino ʻē aʻe.

III hana. ʻO ka hōʻiliʻili ʻana o kahi hua maʻi i nā moku nui arterial i ka ʻole o nā metastases i nā kino ʻē aʻe.

IV kūlana. Aia nā metastases i nā kino ʻē aʻe.

ʻO nā ʻōleʻa maʻi maʻi pancreatic

Inā loaʻa ka hoʻokumu i loko o ke kino a i ʻole hoʻi o ka pancreas, a laila hele pinepine ka hoʻomohala ʻana o nā hoʻopiʻi i ka pae ʻehā o ka maʻi, a pili pū lākou me ka maʻi hauā.

Aia ka laka i kahi poʻo o nā pancreas, hiki i nā hoʻopiʻi hou i lalo:

ʻO kahi jaundice kikoʻī

Hōʻikeʻike: ʻili ʻōniʻoniʻo o nā ʻili o nā maka, ka ʻili, ke aniani o ka urine, māmā a maloʻo nā feces. ʻO ka hōʻailona mua o ka hoʻomohala ʻana i ka jaundice hanohano ka ʻili o ka ʻili. ʻO ka hana ʻana o kēia hoʻopiʻi e hoʻopili ʻia me ka hōʻiliʻili ʻana o ka pā i loko o nā pā, e hōʻoia ana i ka lawe ʻana i ka bile mai ka ate i ka duodenum. ʻO ka hapanui pinepine, ma mua o ka hoʻomau ʻana i ke ʻano lapaʻau ʻana me ka ʻōlohelohe, pono e pani i nā hōʻailona o ka jaundice (ʻo ke ala ʻae loa a minimally invasive drainage of the bile ducts under ultrasound scanning).

Kūweʻa Duodenal

Hōʻikeʻike: nausea, luaʻi, ka manaʻo o ka ʻeha a piha i ka ʻōpū. Hoʻopilikia kēia hoʻonāwili ma muli o ka loaʻa ʻana o ka maʻi o ke poʻo pancreas i ka duodenum, ma muli o ke kīia ʻana o ka lumen o ka ʻōpū, a i ʻole ka mea ʻai e waiho i ka ʻōpū ma nā ʻaoʻao o ka ʻili liʻiliʻi.

Kahe koko ʻana

Hōʻike nā luaʻi ʻeleʻele ("kīwī keke") a i ʻole ka nānā ʻana aku i nā moʻo ʻeleʻele. Loaʻa kēia ma muli o ka pala o ka ʻōpū, a, ʻo ia hoʻi, ke ʻike ʻia o ke kahe.

Kahi Waho Kāohi

ʻO ka manaʻo nui no ke kano o ke poʻo o ka pancreas e hilinaʻi ana i ka ʻano histological o ka maʻi.

I adenocarcinoma pancreatic ma hope o ka mālama maʻi ʻana ma hope a me nā ʻōnaehana chemotherapy systemic, ʻoi aku ma mua o 5 mau makahiki e ola 20-40% o nā mea maʻi. I ka mea pōʻino, ʻo kēia ka mea pinepine ka hopena o ka maʻi pancreatic, kokoke i ka relapses pinepine a me ka metastasis mua.
I nā koʻolau neuroendocrine ʻoi aku ka maikaʻi o ka prognosis, ʻoiai me ka maʻi maʻi IV. A hiki i ka 60-70% o nā maʻi e ola ma mua o 5 mau makahiki, ʻoiai me ka ʻike ʻole o ka hoʻōla radical. Ke ulu mālie nei ka nui o kēia mau ʻōuli, a ma kahi o ke ʻano kūpono i koho ʻia ai, hiki i kahi hoʻōla holoʻokoʻa ke kū mai.

Ke hoʻomake nei ka maʻi i ka ola olaola: hōʻole mai i ka ulaula ma ke ʻano he hopena pilikia, ʻo ka wehe ʻana i ka waiʻona, ʻo ia ka mea nui i ka wā i loaʻa mai ai ka pancreatitis maʻi. ʻO ka mālama ʻana i ke ola ikaika a me ka meaʻai kūpono e hoʻemi ana i ka hopena o ka hoʻomohala ʻana i ka maʻi diabetes a no laila ke ʻano nui o ka pilikia o ka maʻi pancreatic.

Hoike ʻike

ʻO ka manaʻo o ka "maʻi pancreatic" pili i kahi pūʻulu o nā neoplasm malignant e ulu ana i ka parenchyma pancreatic: ke poʻo, ke kino a me kona ʻili. ʻO nā hōʻike olakino koʻikoʻi o kēia mau maʻi ke ʻeha o ka ʻōpū, ka anorexia, lilo ʻana o ke kaumaha, nā nāwaliwali maʻamau, ka maʻi maʻamau. ʻO kēlā me kēia makahiki, ʻokoʻa ka poʻe 8-10 no kēlā me kēia haneli kaukani o ka honua i ka maʻi maʻi pancreatic. Ma mua o ka hapalua o nā hihia, loaʻa iā ia i nā elemakule (63% o nā mea maʻi me ka maʻi maʻi pancreatic ʻoi aku ma mua o 70 mau makahiki). ʻOi aku ka makemake o nā kāne ma kēia ʻano o ka hōʻino ʻana, ua maʻi lākou no ka maʻi pancreatic i hoʻokahi a me ka hapa i kekahi manawa.

Hoʻopilikia ka maʻi pancreatic i ka metastasis i nā lymph nīnūneka āpili, nā māmā a me nā pēpē. Hiki i ka proliferation pololei o ke kuʻi ke alakaʻi i kona komo i loko o ka duodenum, ʻōpū, nā ʻaoʻao kokoke i ka ʻōpū nui.

Nā kumu o ke kanesa o pancreatic

ʻAʻole maopopo ia ka etiology kūpono o ka maʻi pancreatic, akā ua kuhi ʻia nā mea i ʻike ʻia i kona hanana. Eia nō naʻe, ma ka 40% o nā hihia, hele mai ka maʻi pancreatic no kahi kumu ʻike ʻole ʻole. Kūʻai ʻia ka nui o ka hoʻoulu ʻana i ka maʻi kanesa i ka poʻe e ulaula i kahi ʻeke a i ʻole nā mea i ulaula i kēlā me kēia lā, e hoʻopau ana i kahi nui o nā huahana a me nā mea kālai nui i hana ʻia ma ka ʻōpū.

ʻO nā maʻi e hoʻoili i ka maʻi pancreatic i loaʻa:

huki diabetes mellitus (ke ʻano mua a me ke ʻano ʻelua)
ka pancreatitis kaulike (me ke ʻano pū kekahi)
nā maʻi hoʻoilina (hoʻoilina no ka lēpa polypous colorectal carcinoma, familial adenomatous polyposis, Gardner syndrome, Hippel-Lindau maʻi, ataxia-telangiectasia)

Hoʻonui ka ulu ʻana i ka maʻi kania me ka makahiki.

Kahi lipi ʻaʻa pancreatic

ʻO ka maʻi maʻi pancreatic e helu ʻia ma muli o ka papa inoa o ka honua no ka neoplasms malignant TNM, kahi o T kahi o ka nui o ka hoʻouka, N ʻo ka loaʻa o metastases ma nā lymph node kūloko, a me M metastases i nā ʻokoʻa ʻē aʻe.

Eia nō naʻe, ma kēia hihia, ʻaʻole lawa ka hoʻopuka e pili ana i ka lawelawe ʻana i ka maʻi maʻi a me ka ʻike mua ʻana i ka hopena o ka ʻola, ʻoiai ke ʻano nui o ke ʻano o ke kino i ka hopena o ka lāʻau lapaʻau.

ʻĀnō maʻi maʻi

Hōʻike ʻia kahi hōʻike koko ākea i nā hōʻailona o ka anemia, ka hoʻonui ʻia ʻana o ka helu platelet a me kahi wikiwiki o ka ESR ke hoʻomaopopo ʻia. Hōʻike ka hoʻāʻo ʻana i ka wai biochemical i ka bilirubinemia, he hoʻonui i ka hana o ka phosphatase alkaline, nā hana a loko o ka pēpē i ka luku ʻana i nā kahe bile a metastasis o ka palupalu. Eia nō naʻe, ʻike pono ʻia nā hōʻailona o ka maʻi malabsorption i hoʻonui ʻia i ke koko.
ʻO ka wehewehe ʻana i nā māka ʻaila. Hoʻoholo ʻia ʻo Marker CA-19-9 e hoʻoponopono i ka hihia o ka ʻōpū o ka pehu. I ka hoʻomaka mua, ʻaʻole i ʻike ʻia kēia māka ma ka maʻi maʻi pancreatic. Kuhi ʻia ka antigen embryonic maʻi ma ka hapa o nā mea maʻi me ka maʻi pancreatic. Eia nō naʻe, he mea kūpono e nānā i kēlā loiloi no kēia māka i maikaʻi paha i ka maʻi pancreatitis maʻi (5% o nā hihia), ʻo colitis ulcerative. Ua ʻike ʻia ka CA-125 i ka hapalua o nā maʻi. Ma nā hopena i hala o ka maʻi, hiki ke ʻike ʻia nā lāʻau antigens: CF-50, CA-242, CA-494, etc.

Nā maʻi diagnostics mea pono

ʻO ka ultrasonography transoskopika a transabdominal. ʻO ka ultrasound o ka ʻōpū o ka pūpū e hoʻokaʻawale i nā maʻi o ka ʻōpopīpī a me ka puʻuwai, hiki iā ʻoe ke ʻike i kahi maʻi pancreatic. ʻO ka hōʻike Endoscopic hiki iā ia ke hana i kahi hoʻohālike biopsy no ka hoʻokolokolo.
Hiki i ka tomography hoʻohālikelike a me ka MRI ke hōʻike i ka kiko pancreatic a ʻike i nā puka o ka pulupulu mai 1 cm (CT) a me 2 cm (MRI), me ka nānā ʻana i ke ʻano o nā ʻōpū o ka ʻōpū, ka hiki ʻana o nā metastases, a me ka hoʻonui ʻia o nā nū lymph.
Hiki i ka Positron emission tomography (PET) ke ʻike i nā hua ʻino, ʻikea i nā ʻoi a me nā metastases.
Hōʻike ka ERCP i ka maʻi o nā pancreas mai ka 2 cm i ka nui. Akā naʻe, ke komo nei kēia kaʻina a ua kōkua i ka hoʻolālā ʻana o nā hoʻopiʻi.

No ka ʻike i nā metastases liʻiliʻi i loko o ka ate, ma ka mesentery o ka ʻōpū a i ʻole peritoneum, hoʻokō ka laparoscopy diagnostic.

Polokalamu Hoʻomaʻomaʻo Pancreatic

Ke kāohi nei i ka maʻi ʻaʻai pancreatic e like me nā hana penei: ka haʻalele ʻana i ka ulaula a me ka inu ʻawaʻawa, ka wā kūpono a me ka hōʻuluʻulu ʻana i nā maʻi o ka pancreas a me ka palaka biliary, hoʻoponopono kūpono i ka metabolism ma ka hoʻomehana ʻana, ka hoʻomau ʻana i kahi ʻai, nā meaʻai hoʻokaʻawale ʻole me ka overeating a me ka makemake i nā meaʻai aʻai a me nā momona. Pono e nānā pono ai i nā hōʻailona o ka pancreatitis e pono ai i nā poʻe maʻi i hōʻeha i nā hōʻeha ma luna o ka ʻōpū.

ʻO ka maʻi kanoʻo pancreatic

ʻO nā poʻe e hōʻeha nei i ka maʻi maʻi pancreatic ma lalo o ka mālamaʻana o nā poʻe loea i ka gastroenterology, oncology, mea kauka a me ka radiologist.

I ka wa e ʻike ʻia ai ka maʻi paleka o ka pancreatic, i ka nui o nā hihia ke kolohe nui loa, e pili ana i ka 4 mau mahina o ke ola. ʻO 3% wale nō o nā mea maʻi e hoʻokō nei i ke ola ʻelima mau makahiki. Kuhi kēia hana ma muli o ka hapa nui o ka maʻi pankreatic i ʻike ʻia ma nā hope hope a i nā mea maʻi o ka makahiki senile, ʻaʻole ia e ʻae ʻia no ke kaohi ʻana o ka ʻōpū.