Iyo mesothelium inhengo inoisa mitsara yakawanda yenhengo dzemukati kuitira kuvhara nekudzivirira. Inoumbwa nezvikamu zviviri zvemasero akatsetseka, imwe yacho, iyo yemukati, inoputira nhengo dzakasiyana-siyana dzakadai semapapu, mwoyo uye dumbu, uye yechipiri, yekunze, inoumba rudzi rwesaga rakakomberedza mukati. . Fluid iripo pakati pezvikamu zviviri izvi zvemasero, izvo zvinofambisa kufamba kwenhengo.

Iyo mesothelium dzimwe nguva inogona kukanganiswa nebenign tumors, uye zvakanyanya kashoma, kenza inonzi mesotheliomas. Iko ipapo mu pleura ndiyo inowanzowanzoita, ndiko kuti mesothelium inovhara mapapu; muhuwandu hwakawanda hwezviitiko, imhaka yekusangana neasbestos. Asi mamiriro aya anoramba ari mashoma, kune, maererano nenhamba kubva kuHigh Authority yeHutano, mazana matanhatu kusvika mazana mapfumbamwe emakesi matsva anoonekwa gore rega rega muFrance.

Iyo mesothelium inoumbwa nezvikamu zviviri zvemasero akafuratirwa anonzi mesothelial masero. Pakati pezvikamu zviviri izvi pane mvura. Mesothelium inoisa mutsetse wemukati wemukati weiyo yakatsetseka mutsara wemakumbo emuviri wemunhu (anonzi serous membranes). Saka, aya maviri maserura akaturikidzana anodzivirira thorax, dumbu kana moyo.

Iyo mesothelium ine mazita akasiyana zvichienderana nekwairi mumuviri: maererano nemapapu i pleura, membrane yakavhara dumbu, pelvis kana viscera inonzi peritoneum, uye pakupedzisira mesothelium inodzivirira moyo inonzi pericardium (iyo pericardium inovharawo mavambo emidziyo mikuru).

Mvura inenge iripo pakati pezvikamu zviviri zvemesothelium inobatsira kufambisa kufamba kwenhengo. Kutaura zvazviri, mupendero wemukati unoputira zvakananga nhengo dzomukati idzi, nepo kunze kunoumba bhegi rakatenderedza mukati.

Basa guru re epithelium nderokudzivirira nhengo dzomukati dzinoputira:

• iyo mesothelium yakakomberedza mapapu inonzi pleura: saka inoratidza maitiro eepithelial lining cells. Asi iyo inewo mukana wekuvhara masero: chokwadi, inovanza, kunyanya, cytokines pamwe chete nekukura kwezvinhu. Uye zvakare, kutenderera kweiyo lymph pamwe nekufamba kweiyo pleural fluid yakabatana kune zvimwe zvimiro zvepleura. Izvi zvinosanganisira, kunyanya, pores pamwero weparietal pleura, iyo inobvumira lymphatic circulation kuti ibatane zvakananga nepleural space;
• iyo peritoneum ndiyo chaiyo mesothelium yemudumbu. Iyi peritoneum inofanirwa, kutaura zvazviri, kutorwa senhengo. Anatomy yaro inotsanangura kunyanya kutenderera kwe peritoneal fluid, iyo mota huru iri diaphragm chaiyo. Mukuwedzera, iyo peritoneal membrane zvakare inzvimbo yakakosha yekutsinhana. Pakupedzisira, zvinoitika kuti iyi membrane inewo akawanda immunological specificities;
• Iyo pericardium, inova mesothelium yakatenderedza moyo, ine physiological basa rekuchengetedza iyo myocardium, asiwo yekuibvumira kutsvedza panguva yekumisikidza kwayo.

Masero emesothelium dzimwe nguva anogona kuchinja izvo zvinoita kuti akure kana kuzvibata zvisina kujairika:

• izvi dzimwe nguva zvinokonzera kuumbwa kwezvinonzi zvipembenene zvisiri zvekenza, saka inotanga: somuenzaniso, fibrous tumor yepleura, kana kunyange iyo inonzi multcystic mesothelioma;
• kune zvakare magomarara emesothelium, asi igomarara risingawanzo: chete mazana matanhatu kusvika mazana mapfumbamwe emakesi anoverengwa gore rega rega muFrance. Iri mukati me pleura iyo inowanzoitika kakawanda, sezvo 600% yemesothelioma yakaipa inokanganisa iyi pleura, ichitora zita repleural mesothelioma. Iyi yakashata pleural mesothelioma, kazhinji, inokonzerwa nekuratidzwa kune asbestos. Inenge 900% yezviitiko zvepleural mesothelioma zvinoitika muvanhu. Asi izvo, iyo inofungidzirwa chikamu chemesothelioma kune kuratidzwa kwakadai kune asbestos inofungidzirwa pa90% muvarume uye 70% muvakadzi, maererano nenhamba kubva kuHaute Autorité de Santé (HAS). Mukuwedzera, hukama hwehuwandu hwehuwandu hwakaratidzwa;
• muzviitiko zvisingawanzoitiki, zvakapoteredza 10%, kenza iyi inogonawo kukanganisa peritoneum, uye inonzi peritoneal mesothelioma;
• chekupedzisira, nyaya dzakasarudzika dzine chekuita nepericardium, kenza iyi inonzi pericardial mesothelioma, uye zvakatonyanya, inogona kukanganisa chibereko che testicular.

Iyo yekurapa manejimendi, muchiitiko chemesothelioma, iyi kenza isingawanzoitiki, inonyanya hunyanzvi: inofanirwa kukurukurwa mumusangano wekubvunzana wakawanda. Kune nzvimbo dzenyanzvi dzakatsaurirwa gomarara iri muFrance, idzo dziri chikamu chenetiweki inonzi MESOCLIN. Kurapa pachayo kunotungamirirwa neboka remunharaunda. Chemotherapy ine pemetrexed uye platinamu munyu ndiyo yakajairika kurapwa.

Kuvhiyiwa kwezvinangwa zvekurapa kunosanganisira yakawedzera pleuropneumonectomy asi inoramba iri yakasarudzika: chokwadi, inogona kungonetsa yekutanga uye inogadzirika matanho emesothelioma. Ikozvino iri kuitwa mumakiriniki ekuedzwa.

Nzvimbo yakakosha inofanirwa kupihwa kutsigira kutsigirwa pamwe nekuchengetedza nyoro, kuitira kuchengetedza zvakanyanya kuchengetedza kwehupenyu hwemurwere. Rutsigiro uye vatsigiri zvakakosha, pamwe nekuteerera, kuperekedza, kuvapo. Asi isu tinofanira kunyatso kuyeuka kuti rudzi urwu rwebundu rakashata harisi nyore uye rinoramba rakasiyana. Kana dziri nzira dzazvino dzekutsvagisa, ivo vari kuvimbisa uye vatakuri vetariro:

• saka, pane zvidzidzo zvakawanda zvinotarisa interferon, nechinangwa chekuvhara nzira yekufambira mberi kwekenza iyi nekukurudzira maitiro ekudzivirira kwekuzvarwa;
• uyezve, zvichiri padanho rekutsvagisa parizvino, zano rekushandisa antitumor virotherapy rinosanganisira kutapurira maseru egomarara nehutachiona nechinangwa chekutungamira mukubviswa kwavo. Zvisinei, zvinoitika kuti mesothelioma masero anonyanya kukoshesa kurapwa uku. Chikwata cheNantes chinotungamirwa naJean-François Fonteneau chichangobva kuona kuti sei aya masero egomarara emesothelial achinetseka nekurapwa uku ne virotherapy: izvi zvine chekuita nenyaya yekuti, mune mazhinji acho, vakaona kutsakatika kwemajini encoding yerudzi. 1 interferon, mamorekuru ane antiviral properties. Kuwanikwa uku kunovhura nzira yekuongororwa kwekufungidzira, kunyanya, izvo zvaizoita kuti zvikwanise kufanotaura mhinduro yekurapwa ne virotherapy, uye kune nzira dzekuwedzera kushanda kwayo.

Kuongororwa kwemesothelioma yemapapu kwakaoma kuziva kwekutanga, uye kunosanganisira matanho anoteedzana.

Kuongorora kwepanyama

Zviratidzo zvekutanga zvinowanzova zvisina kujeka:

• zviratidzo zvekubatanidzwa kwepleural: kurwadziwa kwechipfuva, chikosoro chakaoma, dyspnea (kuoma kwekufema kunowedzera nekushanda);
• kuderera kwemamiriro ezvinhu, nekurasikirwa kwehuremu;
• zviratidzo zvekupinda munharaunda: chipfuva kana kurwadziwa kwepfudzi.

Kuongororwa kwekiriniki kunofanirwa kusanganisira, nenzira yakarongeka, kubvunza kunozotsvaga kuratidzwa kweasbestos yapfuura, ingave munzvimbo yehunyanzvi kana neimwe nzira, uye ichaongororawo kutsamira kunobvira pafodya. Kurega kusvuta kuchakurudzirwa.

MAPOSTER

Iyo yakarongeka imaging workup inosanganisira:

• x-ray yechipfuva. Chero mufananidzo unofungira unofanirwa kutungamira kukukurumidza kwekuita kwe thoracic scanner;
• chepfu scanner, ine jekiseni reiyo iodine musiyano chigadzirwa (pasipo contraindication). Kana kufungira kwakasimba, mazano anoratidza panguva imwechete achiita mazamu epamusoro emimba.

Biology

Parizvino, hapana chinoratidza kuongororwa kweserum tumor mamaki nekuda kwekuongorora.

Anatomopathology

Pakupedzisira, kuongororwa kuchasimbiswa nebiopsy samples. Kuverenga kaviri nenyanzvi yekuongorora mesothelioma kwakakosha (vanachiremba veMESOPATH network).

Cell theory ndiyo imwe yedzidziso huru dzakakosha dzemazuva ano biology. Nheyo dzayo nhatu dzinokosha ndedzinotevera: kune rumwe rutivi, zvipenyu zvose zvinoumbwa nemasero (sero rimwe rezvipenyu zvisingashandisi, masero akawanda ezvimwe zvipenyu zvose, zvingava mhuka, zvirimwa kana howa). Saka, sero ndiyo chikamu chakakosha chechimiro nekurongeka muzvisikwa. Pakupedzisira, masero ose anobva mumaseru anga agara aripo.

Iyi sero dzidziso inotora nheyo dzayo kubva kuXVI^e muNetherlands, nekuda kwekugadzirwa kweiyo yekutanga maikorosikopu yakashongedzerwa nemalenzi maviri, naZacharais Janssen. Musayendisiti wechiDutch Antoine Van Leuwenhoek zvakare achagadzira maikorosikopu yake yekutanga, nekuda kwaanowana utachiona nekuona zvidimbu zvetartar kubva mumazino ake. Masero ekutanga anozopedzisira awanikwa neshamwari yaLeuwenhoek, musayendisiti wechiRungu Robert Hooke.

Dzidziso dzeSainzi dzinogara dziri muchero wetsanangudzo refu, kazhinji yakaunganidzwa: zvirokwazvo, dzinowanzobatanidza basa rekuvaka kutanga kubva pane zvakawanikwa nevamwe vanhu. Kuti tidzoke zvakanyanya kumesothelial masero, ndezvemusayendisiti kubva pakutanga kwezana ramakore re1865 isu tine chikwereti chakakosha kuwanikwa. Iyi yekutanga cell biologist inonzi Edmund B. Wilson (1939-XNUMX) yakanyatsocherechedza uye yakatsanangura kuti zai rakasanganiswa rinopatsanurwa sei kuita mazana emaseru kuita "embryo", uye ndedzipi nhengo dzemuviri dzinokura kubva mumasero api. Uyezve, kune rekodhi, akazove mudzidzi wake Walter Sutton akawana basa rekromosomes sezvikamu zvenhaka.

Chekupedzisira, zvese zvakawanikwa zvakateerana izvi zvakaunza ruzivo rwakanyanya nezvenyaya yemesothelial masero: zvakaratidza kuti izvi, zvechokwadi, zvinobva mumesoblast, iyo yepakati cellular layer yeembryo (embryo saka ine mitsara mitatu iyo iri pamavambo. yemasero ese emuviri: endoderm, mesoderm uye ectoderm). Pakupedzisira, inofanira kuonekwa kuti masero ose anobva ku mesoderm anoumba zvose kana chikamu chezvikamu zvakasiyana-siyana zvemukati, kunze kwenheyo iyo pachayo inobva ku ectoderm.