Wilms 'puku: tohu, Treatment

I roto o te tinana tangata, ko kahore he tinana e e tonu me i raro i huru katoa ki te noho hauora. Kia aroha mai, kua whakatakotoria maha mate me hapanga noa i roto i te utero. I tetahi o ratou ka kōrero tatou i roto i to tatou tuhinga. He tokomaha te iwi tauhou ki puku Wilms '. He aha te mea te reira, e kore e etahi ara mohio. Ka tamata tēnei tuhinga ki te mahi ki nga tohu, take me tātai o te maimoatanga o tenei mate.

Ko te ariā o te puku Wilms '

puku Wilms ', rite ranei e kiia ana ko, nephroblastoma, e pā ana ki mate mārere o te whatukuhu, e kitea te nuinga o maha i roto i te tamarikitanga. Kei te nuinga o te wā pāngia te reira i waenganui i nga tau o 2-5 tau. puku Wilms 'i roto i ngā pakeke he onge, pera iti ako.

K Kia aroha mai, he tino maha ngā tamariki e mamae i tenei mate, me te tahi atu abnormalities i roto i te whanaketanga. Kei te whakapono te reira e te hanganga o te pukupuku e taea timata i roto i te utero, no te mea kua i roto i te rua wiki e taea e te tamaiti kitea reira.

Kei te nuinga o te wā puku Wilms 'paetata ki tetahi taha, engari i reira he take, me më pāpaka tākihi. Ki te titiro koe i te tinana mate, kia tuhia ai i te reira e te mea pāhiwihiwi tona mata, te tarai ngā wāhi kitea o te toto, me te necrosis, i roto i te tahi mau wahi i reira he cysts. I roto i tenei take e mea tatou e te manawanui he whēwhē puku Wilms.

I te tuatahi, paetata te puku i roto i whatukuhu. Ki te whanaketanga muri tupu ia ki te kikokiko, me okana karapoti - metastases kupu horahia.

te atamira mate

Tenei puku mārere i roto i tona whanaketanga i te torutoru kaupae:

1. I te timatanga o te nephroblastoma ko tetahi anake tākihi. e kore e tamariki i roto i tenei wā wheako hūhi, a kahore e whai kahore amuamu.
2. tīmata te puku ki te horapa ki tua atu i te tākihi, engari e kore e wātea ano metastases.
3. tahi whanaketanga anō e te capsules germination me pānga hinga nga whekau tata me taikiri.
4. metastases kitea i roto i te ate, pūkahukahu, wheua.
5. I te wā whakamutunga o te whanaketanga o Wilms puku i roto i ngā tamariki pānga whai whatukuhu e rua.

Koe e kore e pea whakamārama e te mua pāngia te puku te, ka taea e te outlook atu anaanatae hoatu te manawanui.

tohutanga o te mate

Mai taea e te tātaritanga o te māuiuitanga i roto i ngā wāhanga rerekē, te tohu me te ki runga reira rānei kia rerekē. More maha atu i te kore, ki te mea i reira he puku he Wilms ', kei te kitea nga tohu e whai ake:

• ahuatanga whānui;
• ngoikore, a ki te he iti rawa te tamaiti, ko reira tonu ara;
• hiahia whakaiti;
• whakaiti taimaha i kitea ai;
• I roto i ētahi wā, i reira te mea he nui te kirika;
• riro koma kiri;
• Ka taea e whakanui i te pēhanga toto;
• E whakaatu ana tātaritanga toto te ESR nui haere me te pūtoto iti;
• reira he toto i roto i te mimi;
• i roto i ngā take kino, e taea te kite i te reira tukuna ai intestinal, rite te puku kokopi reira.

Ki te te te huri i tetahi mate te whanonga o te tamaiti, me te puku Wilms 'i roto i ngā tamariki he kahore okotahi. Mama tonu e taea te whakapae tonu e te tamaiti e te tahi mea he he.

A, no te haere atu i te mate, na te puku he nga korero ringa pai. I roto i tenei take, mana'o te tamaiti mamae, no te mea i reira he kōpeketanga o whekau pātata, e ārai ratou i te mahi tikanga. I roto i te tahi mau tūroro, e faarahi te reira kopu, ki te pāngia puku Wilms '. Ko te whakaahua i raro nei ko te whakaaturanga pai.

A, no te he maha nui o metastases, tīmata te tamaiti ki te ngaro tere taimaha. Nuinga o ngā wā, puta mate rite ki te hua o te kore romahā me te te rohirohi nui. Ua, te takanga o metastases, tei, kaua, e kore i runga i te rahi o te puku, engari atu i runga i tau o te manawanui. Huri i te reira i roto i taua tamariki rawa taitama ki tenei tātaritanga te tupono pai o te ora tonu.

Otiia maha neke atu i te kore pāngia anake puku Wilms ', kei te nuinga o te wā haere tahi ai i te tahi atu disorders whanaketanga.

Comorbidities

uaua nui e pāngia te puku kei te rite anake te ine mahora i roto i te whanaketanga. Nuinga o ngā wā e haere tahi i te reira e te comorbidities:

• hypospadias, ka whakatuwheratia te taiawa mimi i roto i te mau tamaroa e wahi i roto i te waenganui o te ure ranei ara i roto i te crotch;
• whekau rahi, mo te tauira, arero nui;
• kotahi neke atu i te tahi atu e alangá;
• cryptorchidism;
• ngaro o te iris o te kanohi (te mana'o e kore te te tauira karapotia e tetahi mea).

Tātarihia te Wilms puku

A, no te he nephroblastoma anake i te timatanga rawa o tona whanaketanga, he uaua te tātaritanga tika, mai i reira he kahore tohu korerotia. Hoki tenei take, i roto i te nuinga o te wā tīmata kua maimoatanga ina ko te puku i te wāhanga 3 ranei 4.

Me mau metua ki te aroturuki āta te mana o te tamaiti, me te mea i reira he ataahua, pēhanga toto tiketike, heke reo, he reira taea ki te whakamatautau i te puku, kia mamae tonu koe i te whakamātautau tonu. Te reira i te tikanga ngā te momo e whai ake nei o tātaritanga:

1. Tātaritanga o toto me te mimi. Kitea i roto i nga proteinuria mimi, nui haere hematuria, me te toto ngeniwhero auau parataiao te, i reira he anemia.
2. Urography taea tātaritanga tika i roto i neke atu i te 70% o te wā. Kāore e taea te tiro i te takiwa o te tākihi, me i te aroaro o te puku kitea te huringa iti i roto i te āhua tinana me te pōrearea.
3. Mā te Ultrasound atahanga he ngāwari ki te kite i te rahi o te puku, me ona wāhi hoki.
4. rite te hanganga kore-ōrite o cysts roto puku Wilms 'i runga i ultrasound titiro.
5. e kore e taea e Mā te tomography rorohiko X-ray e kite e kore e anake te puku i roto i te kotahi whatukuhu, engari ano ki te tātari te rua te kāwanatanga, ka tiro te aroaro o metastases i roto i whekau pātata.
6. Hoki rahi nui o te puku kei te nuinga o te wā whakaritea angiography. meatia tenei i roto i te tikanga ki te whakamārama i atu te whanaunga wāhi nephroblastoma ki oko toto nui, kia e i roto i te mahi i te taote i te whakaaro o te āhuatanga.
7. Ultrasonography ko CT taea whakatau i te tohu o te metastasis i roto i whēkau me te kopa.

I tēnei wā, he tikanga rangahau hauora i te taumata taua o te whanaketanga e tukua te tātaritanga tika i roto i tata 95% o te wā. Ko tupu 5% te taua hape katoa, hei tauira, ki te he whēwhē multilokulyarnuyu ultrasound hape mō te puku Wilms ', ko reira anake i roto i te mahi ka taea ki te kitea. A, no te te tika matawai ultrasonic ko 97%, me te paku iti iho i RT. Ahakoa i reira he take ka ngā te puku Wilms te ki te whēwhē.

whakahaua whakamātautau atu te ki te rapunga o metastases, ka ki te whiriwhiri i te tātai tika maimoatanga o te mate. Ki te whakawhanake Wilms puku i roto i ngā tamariki, faaterehia maimoatanga i roto i te take ia takitahi, he whakaaro ki te tinana, me te wā o te mate.

Take o te nephroblastoma

Ki te tika ki te mea e te take o te whanaketanga puku, e kore e taea. Kei te whakapono te reira e te take o tenei ko te irakētanga i roto i te DNA o ngā pūtau. I roto i te ōrau iti o te wā, kua tuku i te reira i te mau metua ki ngā tamariki. Ko atu pinepine, e kore e kitea kairangahau te hononga i waenganui i whakapapa me te whanaketanga o te puku Wilms '.

Doctors whakapono e reira e te tahi mau āhuatanga mōrearea e arahi ki te putanga o te nephroblastoma. Ko ētahi o ēnei te whai ake:

1. Wahine. E ai ki ngā tatauranga, mamae maha kotiro i tenei mate i te tamariki.
2. tauatanga tuku. Ahakoa he tino onge take o mate te utuafare,.
3. No ki te iwi Negroid. I roto i puta tenei momo o te mate taupori i roto i te 2 nga wa atu pinepine.

I roto i te whānui, kia tuhia te reira e kore i pera matara whakapumautia nga take tangohia o te whanaketanga o te puku Wilms '.

maimoatanga nephroblastoma

Ka rite ki te ture, e taea te whakatata maimoatanga o tetahi mate i koki rerekē. A, no te kitea Wilms puku i roto i ngā tamariki, i homai maimoatanga kei i runga i te hua o te whakamātautau histological. Tohunga whakapono e te histology pai homai te waitohunga atu pai. Otiia e kore e tenei tikanga e tätari kino mahi rite te tohu ki te aukati i te maimoatanga.

Ki te kōrero tatou e pā ana ki nephroblastoma, kua whakamahia te tikanga e whai ake nei ki te hamani i te reira:

• pokanga;
• iraruke.

whai hoki pai hua hahau mo te puku Wilms '.

whiriwhiri tātai o te maimoatanga te takitahi hoki ia manawanui iti. ka whakawhirinaki te reira i runga i te atamira o te whanaketanga puku kore anake, engari ano hoki i runga i te huru te tinana o te tamaiti.

wawaotanga hāparapara

Tangohanga o te whatukuhu - he nefroektomiya. Ko reira o te maha ngā momo:

1. Simple. I roto i tenei take, te tākuta i roto i te mahi tino tango te tākihi pāngia. Ki te he hauora tuarua te tinana, na kia pai te mahi i te reira "no te rua".
2. nefroektomiya Motunga. I roto i tenei pokanga, te tango i te tākuta anake te puku matepukupuku i roto i te tākihi me te a tawhio noa kino kiko. Nuinga o ngā wā taua whawhe i ki te whakapau, ki te mea kua rua nga tākihi kua nekehia ranei mate rawa.
3. tango tuwhena. ka mau te reira i te tākihi e kore anake ki te hanganga e karapoti ana, engari ano hoki te awa mimi, te repe adrenal. kia hoki kia nekehia atu taikiri, ki te roto i ratou e kitea pūtau mate pukupuku.

I roto i taea kitea tonu te mahi i pakaru te kikokiko e karapoti ana te, na te mea e tika ana ki te arotahi ki runga i te āhuatanga, me te ki te tango contamination katoa. I roto i ngā take kino, ina pā nephroblastoma (Wilms 'puku) whatukuhu e rua i te tamaiti, he mea e tika ana ki te whakaora i te ora o te tamaiti ki te tango i te tinana e rua.

I muri i te tamaiti nephrectomy më whakaritea tātari ki te pure i te toto o tāoke. Hanga ora i muri e taea e oti tango o whatukuhu e rua i muri i huaranga o te okana i te kaituku, i te mea rawa uaua ki te kitea anake. Ēnei tūroro ētahi wā mō ngā tau kei roto i te rārangi mō te transplant.

I muri ka tono tangata pokanga ki te tango i tona puku te hoki tātari, ki te titiro i te pū o ngā pūtau mate pukupuku, ratou fakaaoao, tere o te uri. He mea tika ki te tīpako i te akoranga whai hua te nuinga o te hahau.

Hahau i roto i te maimoatanga o te nephroblastoma

Ki te kore te mea taea te puku ki te tango i te maimoatanga e heke ki ētahi atu tikanga pērā i te whakamahinga o te hahau.

I roto i tenei maimoatanga whakaritea drugs hahau, e whai wāhi ana ki te whakangaromanga o ngā pūtau mate pukupuku. I roto i te mahi haumanu, te tino pinepine whakaritea mo tenei whakaaro:

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

Ko te tino uaua mo te rauropi taua maimoatanga, huringa puta i roto i te mahi o te maha whekau, hei tauira:

• tukanga ohorere o te hematopoiesis;
• pakaru follicles makawe, ka meinga tenei e mate huruhuru i roto i te hahau;
• mamae pūtau gastrointestinal e whakaoho te mate o te hiahia, ruaki, whakapairuaki;
• heke te mate e hanga te tinana ngoikore ake ki mate.

Mau metua e i mua i te fariiraa i taero hahau ki te ui i tō tākuta e pā ana ki ngā pānga taha taea, me te ki te tango i nga mehua e tika ana ki te tautoko i te tinana o te tamaiti.

Ki te takoha te tamaiti te ki te whakarite i te tarukino nui-horopeta, me whakatupato i te tākuta koutou e kia meinga tenei whakangaromanga o nga pūtau wheua wheua, ka whakahere ratou ki whakatio. I muri i maimoatanga e taea te mea rewa ratou, ka hoatu ki roto ki te tamaiti tinana, tīmata ratou o ratou kawenga tika mo te hanga o ngā pūtau toto. Mai whara wheua wheua i roto i te hahau, faaho'ihia mai.

therapy radiation

Ki te kauneke puku kaha Wilms, hiahiatia maimoatanga te ki ngā atu me te iraruke. Kei te ngā reira ki te hahau, ki te he nephroblastoma 3-4 ngā wāhanga o te whanaketanga. tauturu radiation therapy patua pūtau mate pukupuku e kua "mawhiti" e te tākuta i roto i te pokanga.

I te wa o te tukanga taua, ko reira nui e takoto whakaroau te tamaiti, pera tika i runga i te rohe puku e whakahaua kurupae. Ki te he iti rawa te manawanui, me te hanga raruraru ona immobility, na te tukanga i mua i reira whakahaerea nei he horopeta iti o sedatives.

titau irradiation tautukunga ki tūtohutanga pau. Ka te wāhi i runga i nei kia tonoa hihi, tapaina ki te tae. hipokina katoa e kore me e taka ki roto ki te rohe irradiation e whakangungu rakau motuhake.

whakatūpatotanga katoa, Heoi, e kore e tiaki ki te pānga taha e ka whakatika:

• whakapairuaki;
• ngoikore;
• ritenga kiri i te pae o te irradiation;
• korere.

kia whakarite i te rata taero e ngā huru o te manawanui, a ka kia nekehia atu nga pānga taha.

Therapy rite ki te atamira o te mate

Hoki tetahi maimoatanga mate e tīpakohia tonu takitahi. Ko rawa pono mō ngā tamariki tenei. titau hoki Wilms puku tātari tupato, me te kōwhiringa o tīkina e tika ana. E te reira ki pūkete te wā o te mate, te whanaketanga kore anake, engari ano hoki te tau o te tamaiti, tona huru, rawa te tinana.

1. Ko te wāhanga tuatahi me te tuarua o te whanaketanga puku ina tā te tukanga kotahi anake pūtau tākihi mate pukupuku, me te kore e rerekē fakaaoao, te tikanga tā maimoatanga te tango o te okana pāngia, me te hahau muri. kia hiahia atu me te iraruke koe.
2. 3 me 4 nephroblastoma atamira rapu i te huarahi rerekē. toro te puku tera taha te tākihi, na he reira kore taea ki te tango i waho patu nga whekau pātata. I roto i tenei take tautapa i te tango hāparapara o te puku, aru i te hahau, me te irradiation.
3. Kaupae 5 āhuatanga e te ahua o te mate i roto i nga whatukuhu e rua. Te whakahaere i te tango puku wāhanga, a ko te kupu pā te taikiri tata. I muri i te mahi, kawea atu he akoranga o radiation me te hahau. Ki te whai koe ki te tango whatukuhu e rua, e taea te dialyzed te manawanui, a ka hiahia koe ki te transplant whekau hauora.

He rerekē katoa ngā tamariki, me ia tauhohenga takitahi o te kaiao ki te therapy puku. I mua i whakaae ki te mahere maimoatanga, Me mātua nga take katoa kōrero ki te tākuta. Me ratou ki te mohio he aha te pānga taero i runga i te tinana, me pehea ki te karo faaiti i te pānga taha i roto i te maimoatanga ranei.

mau tamataraa haumanu

Katoa tau i reira he tikanga, me ngā tikanga mo te maimoatanga o etahi mate hou. Ko te tino pono hoki mate pukupuku me te tahuti tenei i te mea nui ki a ratou.

I roto i te whenua maha, e kore anake ngā pakeke, engari ka taea e ngā tamariki te tango hoki te wahi i roto i te mau tamataraa haumanu o maimoatanga hou mō te tetere Wilms. Ka taea e ngā mātua te ui i te tākuta mehemea e kawea taua whakamātautau i roto i to tatou whenua, i reira he ha faingamālie ki te tango i tetahi wahi i roto i a ratou.

Ki te he i reira te tūponotanga, e hoatu i te tākuta mōhiohio tonu i runga i te haumaru o te maimoatanga. E tano ia tapao e maha whai wāhi i roto i taua whakamātautau whakamātautau homai he tupono anō i roto i te whawhai ki te mate.

Ko te tākuta me whakatupato ano e pā ana ki te meka i roto i te akoranga o te maimoatanga kia whai pānga taha ohorere kihai i i tutaki i mua, me te 100% rongoa kahore tetahi e kore e taea te kī.

matahoki

He mea nui e kore anake ki akakoromaki i te mate, engari ano hoki ki te whakarite kia kore i whai i te reira i te matahoki. Kia aroha mai, tupu tenei ki nephroblastoma e rua i roto i te maimoatanga, me te i muri i te reira. Whakatutuki i tätari, me te mea he pai ratou, ka tautapa tārua taero kaupapa chemotherapeutic:

• "Vincristine".
• "Doxorubicin".
• "Cyclophosphamide" i roto i ngā ki "dactinomycin" ranei "ifosfamide".
• "Carboplatin".

He rerekē i ia take, me i te take o te tahi mau tūroro matahoki whakahaere he horopeta nui o hahau, aru i te transplantation kakau pūtau toto. Best o katoa ko te pānga, ki te ngā tatou pokanga ki iraruke me polychemotherapy.

puku Wilms 'ko te hītori o te wahine hapu

Ko te whatukuhu i roto i te tinana tangata, ki te mahi tetahi o nga mahi matua - purenga toto o tāoke me ngā hua pūkoro tinana. I roto i te hapū, mau ratou kawenga rua mō te huru o te whaea e kore anake, engari ano hoki mo te ora o te hou, te whakawhanake i rauropi.

Ki te Nōna te whaea expectant pokanga mō te tango tākihi roa i mua i te hapū, ka taea e te waitohunga e tino maitai. pai tokomaha nga wahine kawe i te hapūtanga me te hoatu whanau ki ngā tamariki hauora.

Ko reira he okotahi, te wahi i taea e te āhua hou tīmata te matahoki. Na ka whai koe i te materoto ki te whakaora ora o te wahine.

I te tahi taime ite i roto i te puku kōhungahunga Wilms 'kia whakapataritari i te whanaketanga o te pyelonephritis, me te reira e taea te pā i te whanaketanga mahi o te kukune. Ahakoa ahakoa te meka e te nuinga o te putanga pai o hapūtanga, te mōrea o te metastasis, me sohraniyaetsya 10-20 tau i muri i te tango tākihi.

Ko te waitohunga mō ngā tūroro ki nephroblastoma

Hei hoatu i te matapae motuhake i roto i te aroaro o te puku Wilms ', he mea e tika ana ki te whakatau tata i tona rahi, atamira o te whanaketanga me te tātari histological. Ko te kino tino ko te aroaro o te puku nui ake i 500 g, me te 3-4 wāhanga o te whanaketanga ki te histology rawakore.

Ki te tohua integrated iahiko therapy tika, te auau oranga manawanui ko e pā ana ki te 60%. I roto i te wāhanga tuatahi o te puku he Nireaha ki te maimoatanga whai hua ake, puta whakaora i roto i te 80-90% o te iwi.

Hoatu e kore e te tīariari te mehua motuhake o te ārai o te mate, ka taea anake tatou tūtohu waha tirohanga auau, ki te ko te tamaiti i mōrearea. Ko te mua kitea he puku te, te pai nga tūponotanga o te ora.