Cholangiocarcinoma igomarara re bile ducts. Inobata epithelium ye intra kana yekuwedzera hepatic biliary muti, kureva kuti matishu anoumbwa nemaseru ari pedyo ari juxtaposed achigadzira seti yematanho ekuunganidza bile. Bile is yellowish viscous liquid inogadzirwa nechiropa, nokudaro mukana wekukura kwe intra or extra hepatic disease.

Pasinei nekuwanda kuchiri kuzivikanwa kwechirwere ichi, cholangiocarcinoma inosvika 3% yegomarara remudumbu uye 10 kusvika 15% yehepato-biliary malignancies. Pane kushomeka kwechirume kushoma mukukura kwechirwere ichi. Mukuwedzera, chirwere chinokura paavhareji pakati pe50 ne70 makore.

Mabviro ekukura kwebundu iri haasati anyatsojeka. Zvakangodaro, zvinoita sekunge kuitika kwayo kunoitika zvishoma nezvishoma, kureva kuti zvinongobata vamwe vanhu mukati mehuwandu pasina kuvepo kwe "cheni yekutapurirana" yakatsanangurwa. (1)

Gomarara iri rinogona kuitika pa:

- intrahepatic bile ducts. Idzi nzira dzakagadzirwa nediki ducts (canaliculi), Herring ducts uye bile ducts. Iyi seti yematanho anouya pamwechete kuti agadzire chiteshi chekuruboshwe nekurudyi. Izvi zvinosiya chiropa kuti zviitewo common extrahepatic duct. Imwe fomu yebundu inobata makutano pakati pekurudyi nekuruboshwe hepatic ducts inonzi: Klatskin's tumor;

- extrahepatic bile ducts, inogadzirwa neiyo huru bile duct uye accessory bile duct.

Zviratidzo zvine chekuita nerudzi urwu rwegomarara zvakasiyana zvichienderana nekukuvara kwemukati kana kuwedzera kwehepatic. Mukuwedzera, zviratidzo zvekliniki zvinowanzoonekwa kana chirwere chacho chiri padanho repamusoro rekukura kwayo.

Icho chirwere chisingawanzoitiki chine chiitiko che1 pa100 vanhu. (000)

Zviratidzo zvechirwere zvinoonekwa padanho repamusoro uye zvakasiyana zvichienderana nenzvimbo yebundu.

Chokwadi, mune iyo iyo bundu iri extrahepatic, zviratidzo zvakabatana ndezvi: (1)

- cholestatic kuratidzwa: marara akajeka, jaundice, weti yakasviba, pruritus, nezvimwewo;

- kusagadzikana;

- kuonda;

- kunzwa kuneta uye kushaya simba.

Muchirevo chekubatanidzwa kwe intrahepatic, chirwere chacho chinotsanangurwa zvakanyanya kuburikidza nekusagadzikana uye zviratidzo zvemudumbu zvakadai se:

- kuonda;

- anorexia;

- marwadzo emudumbu.

Zvimwe zviratidzo zvinogona kubatanidzwa nechirwere ichi: (2)

- kupindwa nechando ;

- itches;

- marwadzo ari kumusoro kurudyi chikamu chedumbu.

Chirwere ichi chinotsanangurwa mumatanho akati wandei: (3)

- danho 1a: kenza inowanikwa mukati me bile ducts;

- nhanho 1b: kenza inotanga kupararira uye kupararira kuburikidza nemidziyo ye lymphatic;

- danho rechipiri: kenza inotanga kupararira kuburikidza nematishu (kunyanya chiropa) uye lymphatic midziyo;

- danho rechitatu: kenza iripo mune metastatic fomu mune yakawanda yeropa uye lymphatic midziyo;

- Danho 4: gomarara rinopararira kunhengo dzese.

Chikonzero chaicho chegomarara rebile duct, kusvika nhasi, hazvisati zvazivikanwa. Nekudaro, izvo zvinokonzeresa mukukura kwecholangiocarcinoma zvinonzwisiswa zviri nani.

Cancer inomuka kubva mukushanduka mukati memutakuri weiyo genetic ruzivo rwemasero: DNA.

Aya majeneti ekuchinja mukati memasero anotungamirira mukuwedzera kukura uye kusingadzoreki kukura kwemasero izvo zvinoguma nekuumbwa kwesero clump inonzi bundu.

Muchiitiko chekuti gomarara rikasaonekwa nenguva uye / kana rikasarapwa nekukasira, ipapo bundu rinogona kukura uye rinopararira rakananga kune dzimwe nhengo dzemuviri kana by kubuda kweropa. (3)

Cholangiocarcinoma inoratidzwa nebundu rinokanganisa bile ducts. Izvi zvinowanzokura zvishoma nezvishoma uye kushanduka kwayo kune metastatic state inononoka zvakare.

Mukuwedzera, kuongororwa kwechirwere kunowanzoitwa padanho repamusoro rebundu.

Bundu racho rinogona kukura chero pamwero padivi pe bile duct uye kuvharira kubuda kwebile.

Kunyange zvazvo mavambo chaiwo echirwere ari, kusvikira nhasi, zvichiri kuzivikanwa, zvinhu zvakawanda zvine ngozi zvine chokuita nehosha yacho zviri pachena. Izvi zvinonyanya kuitika ne: (2)

• kuvapo kwema cysts mu bile ducts;
• kusingaperi kuzvimba kwe bile ducts kana chiropa;
• primary and secondary sclerosing cholangitis (necrotizing kuzvimba kwebile ducts zvichiita kuti itete uye ichikanganisa kuyerera kwe bile);
• ulcerative colitis (chirwere chisingaperi chinoputika chemukati mukuru);
• chisingaperi typhoid carriage (kukura kwefivha yetyphoid iyo yakabva kune inotapukira uye inogona kutapurirwa kubva kune mumwe munhu kuenda kune mumwe);
• zvirwere zveparasitic by Opisthochis viverrini a pair Clonorchis sinensis;
• kuratidzwa kune thorotrast (mushonga wekusiyanisa unoshandiswa mu x-ray radiographs).

 Zvimwe zvinhu zvemunhu zvinopindawo mukukura kwerudzi urwu rwebundu: (3)

• age; vanhu vanopfuura makore makumi matanhatu neshanu vane njodzi huru yekuva nechirwere ichi;
• kusangana nemamwe makemikari. Kuratidzira kune thorotrast ndiyo inonyanya kuratidza muenzaniso. Zvechokwadi, zvakaratidzwa kuti kuratidzwa kune iyi kemikari inoshandiswa zvakanyanya mu radiography, isati yarambidzwa muma1960, inowedzera njodzi yekugadzira cholangiocarcinoma. Mamwe makemikari anobatanidzwawo mukuwedzera njodzi yekukura kwechirwere, seasbestos kana PCBs (polychlorinated biphenyls). Yekutanga yakashandiswa kwenguva yakareba sechinhu chinodzoreredza moto muzvikamu zvekuvaka, kuvaka uye indasitiri. MaPCB ave achiwanzo shandiswa muindasitiri uye kuvaka. Makemikari aya ave pasi pemitemo yakasimba;
• kuvapo kwehepatitis B kana C;
• kuvapo kwe cirrhosis;
• utachiona hweHIV (Human Immunodeficiency Virus);
• Type I uye Type II chirwere cheshuga;
• kuneta;
• iyo fodya.

Kuongororwa kwakasiyana-siyana kwegomarara re bile ducts kunofanirwa kuitwa kuitira kuti chirwere chizivikanwe. (3)

• kuongororwa ropa kunoshandiswa mukuongororwa kwecholangiocarcinoma. Muchokwadi, mumamiriro ezvinhu apo bundu rinokura mubile ducts, maseru egomarara anoburitsa mamwe makemikari ehunhu anogona kuzivikanwa kuburikidza nekuongororwa ropa. Nekudaro, aya mamakisi anogona zvakare kuburitswa pasi pemamwe mamiriro. Kuvapo kwezvinhu izvi hakuna kurongeka kwakabatana nekukura kwekenza ye bile ducts;
• iyo scanner ye bile ducts inoita kuti zvikwanise kuwana mufananidzo wemukati wechikamu ichi chemuviri kuitira kuti uone chero kukanganisa;
• tomography, kuburikidza nehuwandu hwe-X-rays yechiropa, inobvumira kuongororwa kwakadzama kwenhengo iyi kuburikidza ne-3-dimensional mifananidzo;
• MRI (Magnetic Resonance Imaging), uchishandisa hurongwa hwemagineti uye mafungu eredhiyo kuwana mufananidzo wemukati wechiropa;
• retrograde cholangiopancreatography endoscopy inzira yekujekesa zvakanyanya kusakwana kweiyo bile ducts;
• percutaneous transhepatic cholangiography inoshandiswawo kuwana tsanangudzo yakazara ye gallbladder;
• biopsy inobvumira kusimbiswa kwekuongororwa.

Zviitiko zvakawanda zvekenza yebile duct hazvigone kurapwa. Zvisinei, kurapwa kwechirwere kunowanzova nezviratidzo-zvakananga.

Kutevera kwemurwere kunoitwa nekuda kweboka rakasiyana-siyana rinoumbwa neboka renyanzvi (vanovhiya, oncologist, radiologist, vanamukoti, gastroenterologist, nezvimwewo). (3)

Mishonga inopihwa inoenderana nezviratidzo pamwe nekufambira mberi kwegomarara.

Muzvikamu 1 ne2, kuvhiyiwa kunogoneka pakuvandudzwa kwechikamu che gallbladder, bile ducts kana chiropa.

Muchikamu chechitatu, mikana yekubudirira kwehutano hunoenderana nehuwandu hwekukuvadza kumidziyo ye lymphatic.

Pakupedzisira, muchikamu chechina, chiyero chekubudirira kwekurapa chakaderera.

Kurapa kwechirwere kunogona kukonzera kupindira kwekuvhiya kunobvumira kuvandudzwa kwekenza tishu: chikamu che bile ducts ine kenza masero, gall bladder, mamwe ma lymphatic midziyo yakakanganiswa kana kunyange chikamu chechiropa.

Kazhinji, pakati pe20% ne40% yevanhu vane uye vari kuvhiyiwa vanorarama makore mashanu kana kupfuura mushure mekuvhiyiwa.

Kutarisana nekumashure kwemarwadzo emudumbu, jaundice, nezvimwewo, kusunungura bile ducts dzimwe nguva kunodiwa. Kuburitswa uku kunoitwa pachishandiswa chubhu yakatetepa yakapfuura nemu bile ducts.

Radiation therapy haisi iyo yakajairwa kurapwa kwecholangiocarcinoma, zvisinei inogona kushanda mukuderedza zviratidzo pamwe nekudzikamisa kupararira kwemasastases. Kune marudzi maviri eradiation therapy: yekunze beam radiation therapy uye yemukati radiation therapy.

Uyezve, radiotherapy inogona kukonzera mhedzisiro yakadai sekusvotwa, kurutsa kana kutoneta zvakanyanya.

Chemotherapy inoshandiswawo kune zvinangwa zvakafanana neradiation therapy. Kana kuti kuderedzwa kwezviratidzo, kuitira kudzikisira kupararira kwebundu uye kuwedzera hupenyu hwemunhu anenge abatwa. Chemotherapy inowanzobatanidzwa neradiotherapy. Maside effects ane chekuita nechemotherapy ndiwo zvakare ane chekuita neradiotherapy pamwe nekurasikirwa nebvudzi.

Imwe tsvakurudzo yakaratidza mabhenefiti ane chekuita nekubatanidzwa kwemishonga miviri inoshandiswa muchemotherapy (Cisplatin neGemcitabine).

Parizvino, marapirwo ane chekuita negomarara reiyo bile ducts haashande seaya akabatana nemamwe marudzi egomarara. Nokudaro, zvidzidzo zvakawanda zvinotarisa pamhando iyi yegomarara kuitira kuti vawane nzira dziri nani dzekurapa chirwere ichi.

Pamusoro pezvo, tsvakiridzo yekuvandudza marapirwo anonangwa iripo zvakare. Iyi mishonga inotarisa imwe nhanho mukukura kwegomarara.