Hepatocellular carcinoma ndiyo inonyanya kuzivikanwa yekenza yechiropa yekutanga. Inobata nhamba inowedzera yevanhu munyika dzekumadokero, kazhinji vane cirrhosis kana chimwe chirwere chechiropa. Pasinei nekufambira mberi kwekurapa, kazhinji kunouraya.

tsananguro

Hepatocellular carcinoma (inorehwa nechidimbu CHC) igomarara rinokura kubva kumaseru echiropa. Naizvozvo igomarara rekutanga rechiropa, kusiyana neanonzi "secondary" cancers inoenderana nemetastatic mafomu egomarara anoonekwa kumwe kunhu mumuviri.

Zvinokonzera

Muzviitiko zvakawanda, hepatocellular carcinoma inokonzerwa nehepatic cirrhosis, mhedzisiro yechirwere chechiropa chisingaperi: viral hepatitis, doro hepatitis, autoimmune hepatitis, nezvimwe.

Ichi cirrhosis chinoratidzwa nekusingaperi kuzvimba kwechiropa kunoperekedzwa nekuparadzwa kwemasero echiropa. Kudzoreredzwa kusingadzoreki kwemasero akaparadzwa kunoguma nekuonekwa kweabnormal nodules uye fibrous tissue (fibrosis). Aya maronda anokurudzira kushandurwa kwebundu remasero echiropa uye carcinogenesis (kuumbwa kwebundu rechiropa rakashata).

chirwere

Kuongororwa kwehepatic carcinoma kunowanzoenderana nekuonekwa kwenodule pane ultrasound kune varwere vanotariswa chirwere chisingaperi chechiropa. 

Pakaitika bundu repamusoro, kuongororwa kunogona kutariswa kana zviratidzo zvinoonekwa.

MAPOSTER

Kuongororwa kunosimbiswa nekumwe kuongorora kwekufungidzira. Chiremba anorayira abdominal scan (helical scan), dzimwe nguva MRI uye / kana musiyano ultrasound. 

Kuongororwa kwekuwedzera kwebundu kunogona kudaidza MRI yemudumbu uye thoracic kana thoraco-abdominal CT scan. Doppler ultrasound inogona kushandiswa kuongorora portal kuyerera kweropa abnormalities semhedzisiro yegomarara. Kunyanya kashoma, PET scan ichaitwa kuti itarise bundu iri zvirinani uye kutsvaga kupararira kunze kwechiropa.

Biological examinations

Muinenge hafu yehepatocellular carcinomas, kuongororwa ropa kunoratidza mwero wepamusoro-soro wealfafoetoprotein (AFP), iyo inovanzwa nebundu.

biopsy

Kuongororwa kwema tumor tissue samples kunobatsira kudzivirira zvikanganiso zvekuongorora uye kuratidza bundu rechiropa kutungamira kurapwa.

Vanhu vane hanya

Hepatocellular carcinoma ndiyo inonyanya kuzivikanwa kenza yechiropa. Ndeyechishanu mukukonzeresa gomarara pasi rose uye chechitatu mukukonzera kufa kwegomarara.

MuSoutheast Asia neAfrica, zvinogona kukanganisa vechidiki vane cirrhosis kubva kuhepatitis B.

Munyika dzekuMadokero, uko dzimwe nguva yakabatana nehepatitis C asi kwainoramba iri mhedzisiro yedoro cirrhosis kakawanda, yakawedzera zvakanyanya kubva kuma1980. 

MuFrance, nhamba yezviitiko zvitsva zvakawanikwa gore negore zvakawedzera kubva pa1800 muna 1980 kusvika pa7100 muna 2008 uye kusvika pa8723 muna 2012. Kuwedzera uku pasina mubvunzo kunoratidzawo chikamu chekuvandudzwa kwekuongorora uye kugadzirisa zviri nani kwemamwe matambudziko echirrhosis. Zvinoenderana neNational Institute for Public Health Surveillance (InVS), chiyero chekuonekwa kwenyaya nyowani muna 2012 yaive 12,1 / 100 muvarume uye 000 / 2,4 muvakadzi.

Pasinei nekudzora zviri nani denda reHepatitis B uye kudzikira kwese kwekunwa doro, hepatocellular carcinoma inoramba iri dambudziko guru rehutano hwevanhu nhasi.

Zvinhu zvinotyisa

Zera rinopfuura makore makumi mashanu neshanu, bonde rechirume uye advanced cirrhosis ndiyo inonyanya kuisa njodzi yehepatocellular carcinoma. MuFrance, kunwa doro zvakanyanya kunoramba kuri chinhu chikuru chengozi ye cirrhosis, uye nekudaro kenza yechiropa.

Kufutisa uye kukanganiswa kwayo kwemetabolism, iyo inokurudzira mafuta echiropa chirwere ("fatty chiropa"), inobatanidzwawo nekuwedzera kwengozi yekenza yechiropa.

Zvimwe zvinokonzera njodzi zvinogona kupindira:

• kusvuta,
• kuratidzwa kune zvimwe zvinodhaka (aflatoxins, thorium dioxide, vinyl chloride, plutonium, nezvimwewo),
• kutapukirwa nemamwe marudzi efluke,
• chirwere cheshuga,
• hemochromatosis (genetic disorder inokonzera iron kuwandisa muchiropa)…

Hepatocellular carcinoma inogona kufambira mberi chinyararire kwenguva yakareba. Zviratidzo zvinoratidzika kunonoka, padanho repamusoro rebundu, uye kazhinji harina kujeka kune kenza pachayo. Ivo vanobva ku cirrhosis kana kuvharika kweiyo portal vein uye / kana bile ducts.

Pain

Kazhinji kazhinji kurwadza kwakadzikama munzvimbo ye epigastric. Marwadzo akapinza haawanzoitiki.

Jaundice

Jaundice (jaundice), iyo inoita kuti ganda nezvichena zvemaziso zviratidzike zvakaita yero, inokonzerwa nekuwanda kwebilirubin (bile pigment) muropa.  

Distension yedumbu

Cirrhosis, pamwe chete nehepatocellular carcinoma pachayo, zvikonzero zve ascites, zvinoratidzirwa nekuputika kwemvura mudumbu.

Zvimwe zviratidzo:

• kubuda ropa mudumbu nekuputika kwebundu,
• kukanganisa kwemabasa ekugaya (kushaya chido, gasi, manyoka kana kuvimbiswa, nezvimwewo),
• utachiona,
• kutadza kufema kunokonzerwa nebundu guru rinodzvanya pa diaphragm
• kudzikira kwehutano…

Therapeutic manejimendi inosiyana zvichienderana nehunhu hwebundu, kunyanya kuwedzera kwaro, mamiriro echiropa uye mamiriro ehutano hwemurwere. Mugomarara repamusoro, fungidziro inoramba isina kujeka kunyangwe kufambira mberi mukurapa.

Chiropa chinotamisa

Inopa kurapa kurapa kwese bundu uye chikonzero chayo - cirrhosis - uye kazhinji inobvumira kuporeswa, chero murwere achinge asangana nemaitiro ekugoverwa kwegraft:

• bundu renzvimbo: 1 nodule kuyera kusvika masendimita matanhatu muhupamhi, kana 6 nodule isingasviki 4 cm kana alphafoetoprotein level iri pasi pe3 ng / ml,
• kusavapo kwechirwere chevascular chechiropa (portal kana hepatic thrombosis),
• hapana contraindication: kushingaira kudhakwa, murwere anyanya kuchembera kana kuti ane hutano husina kunaka, akabatana pathologies, nezvimwe.

MuFrance, vangangoita gumi muzana yevarwere vangave vanokodzera kuisirwa. Mumamiriro ezvinhu ekushomeka kwegrafts, inoitwa mu10 kusvika 3% yavo. Zvimwe zvinogoneka dzimwe nguva, semuenzaniso kuisirwa hemifoie zvichibva pamupiro wemhuri kana mupi akafa kana kuti chiropa chinotakura amyloid neuropathy, inoshanda nemazvo asi inogona kukonzera makore echirwere chetsinga. 

Macomplications ndeaya echero transplant.

Chemoembolization

Kurapa uku kunogona kunge kuri kurapwa kwekumirira kuisirwa, uye kunogona kudzokororwa mwedzi miviri kusvika mitatu yega yega. Inobatanidza chemotherapy inobaiwa kuburikidza nenzira ye arterial ne embolization, kureva kuvharwa kwekanguva kwehepatic artery pachayo kana yemapazi anopa bundu ne "embolization agents". Mukushaikwa kweropa, kukura kwebundu kunoderera, uye ukuru hwebundu hunogona kuderedzwa zvakanyanya.

Nzira dzekuparadzwa kwenzvimbo ne radiofrequency (tumors isingasviki 2 cm) kana microwaves (tumor ye 2 kusvika 4 cm) inoda kuonekwa kwakanaka kwebundu. Mishonga iyi inoitwa muimba yekushanda, pasi peanesthesia. Pane contraindications, kusanganisira ascites kana yakaderera ropa platelet count.

sejari

Sarudzo yekuvhiya kubvisa bundu, pakati pezvimwe zvinhu, pane nzvimbo yecarcinoma uye mamiriro emurwere. Kazhinji kazhinji, kupindira kunochengeterwa mamota epamusoro uye kwete akakurisa (murwere anofanira kuchengetedza hutano hwakakwana hwechiropa). Iko kunyatsoshanda kwakanaka.

External radiotherapy ndiyo imwe nzira yekuparadzwa kwenzvimbo yehepatic carcinoma inoratidzira imwe nodule isingasviki 3 cm, kunyanya kumusoro kwechiropa. Zvinoda zvikamu zvakawanda.

Classical intravenous chemotherapy haina kunyatsoshanda, kunyanya sezvo chirwere chechiropa chinoda mashoma dosages. Kwemakore gumi apfuura kana zvakadaro, marapirwo anonangwa egomarara akaunzwa mukurapa hepatocellular carcinomas. Nemuromo inorongedzerwa antiangiogenic agents (Sorafenib kana mamwe mamorekuru) anoshandiswa kunyanya, izvo zvinodzivirira kugadzirwa kwediki midziyo inodyisa bundu. Aya ndiwo marapirwo ekurapa, izvo zvinoita kuti zvikwanise kuwedzera kurarama.

Kudzivirirwa kwehepatocellular carcinoma kunonyanya kurwisa kudhakwa. Zvinokurudzirwa kuderedza kunwa doro kusvika ku3 zvinwiwa pazuva kune varume uye 2 zvinwiwa zvevakadzi.

Kuongororwa uye kutonga kwehepatitis inokonzera cirrhosis inewo basa rekuita. Kudzivirirwa kwepabonde uye kusvibiswa kwetsinga pamwe nejekiseni rekurwisa hepatitis B kunoshanda.

Kurwisana nekufutisa kunobatsira kudzivirira.

Chekupedzisira, kuvandudza kuongororwa kwekutanga inyaya yakakosha mukugonesa kurapwa kwekurapa.