Kodi Zilonda za Pancoast ndi zotani?

Zamkati

• Zizindikiro za chotupa cha Pancoast
• Zomwe zimayambitsa chotupa cha Pancoast
• Momwe chotupa cha Pancoast chimadziwira
• Chithandizo cha chotupa cha Pancoast
• Kusinthana
• Chithandizo
• Kupweteka
• Mitengo yopulumuka ya chotupa cha Pancoast
• Chiwonetsero

Chidule

Chotupa cha Pancoast ndi khansa ya m'mapapo yosowa. Chotupachi chimakhala pamwambapa (pamwamba) pamapapu akumanja kapena kumanzere. Chotupacho chikamakula, malo ake amachilowetsa m'mitsempha, minofu, ma lymph node, mafupa olumikizana, nthiti zakumtunda, ndi mafupa am'munsi. Izi zimapweteka kwambiri paphewa ndi mkono.

Kuzindikira kwa zotupa za Pancoast nthawi zambiri kumachedwa, chifukwa chotupacho sichimawonetsa zizindikilo za khansa yamapapo, monga chifuwa.

Zotupa za pancoast zimadziwikanso kuti zotupa zopambana za sulcus. Zizindikiro zawo zimatchedwa Pancoast syndrome. Anthu omwe ali ndi chotupa choyambira ali ndi zaka pafupifupi 60. Amuna amakhudzidwa kuposa akazi.

Khansara iyi yatchulidwapo, katswiri wazamankhwala waku Philadelphia yemwe adalongosola zotupazo mu 1924 ndi 1932.

Matenda a khansa a zotupa za Pancoast ndi awa:

• khansa yowopsa yama cell
• adenocarcinomas
• ma cell-carcinomas akulu
• ma cell carcinomas ang'onoang'ono

Zizindikiro za chotupa cha Pancoast

Kupweteka kwa m'mapewa ndichizindikiro chodziwika kwambiri cha chotupa cha Pancoast kumayambiriro.Zizindikiro zina zimadalira malo omwe chotupacho chimalowa mozungulira chifuwa (thoracic inlet).

Pamene chotupacho chimakula, kupweteka kwamapewa kumakulirakulirakulira komanso kufooketsa. Amatha kuthamangira kumtunda (axilla), tsamba la phewa, ndi fupa lomwe limalumikiza phewa ndi mkono (scapula).

Nthawi zambiri chotupa cha Pancoast, chotupacho chimalowa m'zipinda zam'mbuyo komanso zapakati zachifuwa. Kupweteka kumatha kutulutsa:

• kutsika mkono mbali ya thupi kutsatira mitsempha ya ulnar (mitsempha yomwe imayenderera mbali ya dzanja lako kulowera pinky, kuyimilira pa dzanja)
• mpaka khosi
• ku nthiti zakumtunda
• ku maukonde omwe amafikira ku nthiti, msana, ndi khwapa

Zizindikiro zina ndizo:

• kutupa kwapamwamba
• kufooka m'minyewa yamanja
• kutaya mphamvu zanja
• Kuwonongeka kwa minofu mdzanja
• kumva kulasalasa kapena dzanzi m'manja
• kufinya pachifuwa
• kutopa
• kuonda

Zizindikiro zonsezi zimadziwika kuti Pancoast syndrome.

Mwa anthu omwe ali ndi zotupa za Pancoast, khansa imalowa m'mitsempha yomwe imafikira pankhope. Izi zimatchedwa matenda a Claude-Bernard-Horner, kapena matenda a Horner. Kumbali yomwe yakhudzidwa, mutha kukhala ndi:

• khungu la droopy (blepharoptosis)
• Kulephera kutuluka thukuta mwachizolowezi (anhidrosis)
• kuchapa
• kusuntha kwa eyeball yanu (enophthalmos)

Ululu wa chotupa cha Pancoast ndiwowopsa komanso wosasintha. Nthawi zambiri sichimayankha kuzolowera zowawa zapagulu. Ululu umakhalabe ngati mwakhala, kuyimirira, kapena kugona pansi.

Zomwe zimayambitsa chotupa cha Pancoast

Zomwe zimayambitsa chotupa cha Pancoast ndizofanana ndi za khansa zina zam'mapapo. Izi zikuphatikiza:

• kusuta
• kukhudzana ndi utsi wachiwiri
• Kutenga nthawi yayitali pazitsulo zolemera, mankhwala, kapena utsi wa dizilo
• Kutenga nthawi yayitali ku asibesito kapena radon

Nthawi zambiri, matenda a Pancoast amatha kukhala ndi zifukwa zina, monga khansa zina, matenda a bakiteriya kapena mafangasi, kapena chifuwa chachikulu (TB) ndi matenda ena.

Momwe chotupa cha Pancoast chimadziwira

Kuzindikira kwa chotupa cha Pancoast kumakhala kovuta ndipo nthawi zambiri kumachedwa chifukwa zizindikiro zake zimafanana ndi matenda am'mafupa komanso olumikizana. Komanso, zotupa za Pancoast ndizosowa ndipo mwina madokotala sazidziwa. Zotupa zam'mimba zimangokhala khansa zonse zam'mapapu.

Dokotala wanu adzakufunsani za zizindikilo zanu, pomwe zidayamba, komanso ngati zasintha pakapita nthawi. Adzakayezetsa thupi ndikuyitanitsa mayeso kuti ayang'ane chotupa ndi kufalikira kulikonse kwa khansa. Ngati chotupa chikupezeka, dokotala wanu atha kuyitanitsa mayeso ena kuti adziwe gawo la chotupacho.

Mayeso atha kuphatikiza:

• X-ray. Nthawi zina chotupacho chifukwa cha malo ake.
• Kujambula kwa CT. Malingaliro ake apamwamba amatha kuzindikira kufalikira kwa chotupacho kumadera oyandikira.
• Kujambula kwa MRI. Kuyesa kulingalira uku kumatha kuwonetsa kufalikira kwa chotupacho ndikupereka chitsogozo cha opareshoni.
• Mediastinoscopy. Chubu cholowetsedwa m'khosi chimalola dokotala kuti atenge ma lymph node.
• Chisokonezo. Kuchotsa minofu yotupa kuti iwonedwe kumayesedwa kuti ikutsimikizira chotupacho ndikupeza mankhwala.
• Makina othandizira thoracoscopy (VATS). Kuchita opareshoni pang'ono kumeneku kumapangitsa kuti minofu izitha kusanthula.
• Mini-thoracotomy. Njirayi imagwiritsa ntchito tinthu tating'onoting'ono, komanso kupezanso minofu kuti isanthulidwe.
• Zithunzi zina. Izi zitha kukhala zofunikira kuwunika kufalikira kwa khansa m'mafupa, muubongo, komanso mbali zina za thupi.

Chithandizo cha chotupa cha Pancoast

Ngakhale kale zimawoneka ngati zakupha, lero zotupa za Pancoast zimachiritsidwa, ngakhale sizinachiritsidwe.

Chithandizo cha chotupa cha Pancoast chimadalira momwe amapezera msanga, kufalikira kwake, madera omwe akukhudzidwa, komanso thanzi lanu.

Kusinthana

Chotupa cha Pancoast "chimachitidwa" mofananamo ndi khansa zina zam'mapapu, pogwiritsa ntchito manambala achiroma kuyambira I mpaka IV ndi zigawo zingapo A kapena B posonyeza momwe matendawo apitira patsogolo. Stage ndi chitsogozo cha mankhwala omwe mungalandire.

Kuphatikiza apo, zotupa za Pancoast zimasanjidwanso ndi zilembo ndi manambala 1 mpaka 4 omwe akuwonetsa kuopsa kwake:

• T amatanthauza kukula ndi kufalikira kwa chotupacho.
• N amalongosola kukhudzidwa kwa lymph node.
• M amatanthauza ngati malo akutali alowetsedwa (metastases).

Zotupa zambiri za Pancoast amadziwika kuti T3 kapena T4, chifukwa chakomwe amakhala. Zotupazo zimawerengedwa kuti T3 ngati zitha kulowera pachifuwa kapena misempha yachifundo. Ndi zotupa za T4 ngati zingalowe m'malo ena, monga ma vertebrae kapena mitsempha yama brachial.

Ngakhale zotupa zoyambirira za Pancoast zimapangidwa ngati IIB, kachiwiri chifukwa chakomwe amakhala.

Chithandizo

Chithandizo cha zotupa za Pancoast ndizosiyanasiyana ndipo zimaphatikizapo kuphatikiza chemotherapy, radiation, ndi opaleshoni.

Zotupa zam'mimba zomwe zimafalikira kumadera opitilira pachifuwa mwina sizingachitike opaleshoni.

Chemotherapy ndi radiation ndiwo masitepe oyamba asanachitike opareshoni. Kenako chotupacho chikuwunikidwanso ndi kuyesanso kwina kwa CT kapena mayeso ena azithunzi. Kuchita opaleshoni kumachitika patatha milungu itatu kapena isanu ndi umodzi chemotherapy ndi radiation, chisanachitike chilichonse chomwe chingayambitse opaleshoni.

Mu njira zina zamankhwala, operekera opaleshoni amatha kutsatiridwa ndi ma radiation owonjezera kuti aphe maselo amtundu uliwonse a khansa.

Cholinga cha opareshoni ndikuchotsa kwathunthu khansa m'mazimidwe ake. Izi sizingatheke nthawi zonse, ndipo matenda amatha kubwereranso. Kafukufuku wocheperako yemwe adachitika ku Maryland adapeza kuti matendawa adabwereranso mwa 50% mwa omwe adachita nawo opaleshoni ya Pancoast.

Kupita patsogolo kwa ukadaulo kwa ukadaulo wapangitsa kuti athe kuchita opareshoni pa zotupa za T4 Pancoast, koma mawonekedwe ake ndi oyipa kuposa magawo ena a matendawa.

Kupweteka

Kupweteka kwa zotupa za Pancoast masiku ano kumakhudza kugwiritsa ntchito ma opioid operekedwa ndi dokotala. Komabe, izi zimadza ndi zovuta zoyipa. Ofufuza ena akuti abwereranso ku njira za pre-opioid zomwe zimakhala zopanda zovuta.

Poizoniyu itha kugwiritsidwanso ntchito kuthana ndi zowawa pomwe opaleshoni siyotheka.

Kupweteka kwambiri ndi zotupa za Pancoast kumatha kuchepetsedwa ndi njira yochitira opaleshoni yomwe imalepheretsa mitsempha yopweteka m'mimba ya msana. Izi zimatchedwa cordotomy motsogozedwa ndi CT, momwe CT imagwiritsidwira ntchito kutsogolera dotolo.

Mu kafukufuku wina, mwa iwo omwe ali ndi chotupa cha Pancoast adanenanso zakusintha kwakumva kupweteka ndi njirayi. Cordotomy ngakhale m'masabata omaliza amoyo atha kupatsa ululu.

Njira zina zothetsera vuto la chotupa cha Pancoast ndizo:

• decompression laminectomy (opaleshoni yomwe imachotsa kupsyinjika kwa mitsempha ya msana)
• phenol block (kubayira phenol kutchinga mitsempha)
• kukondoweza kwa transdermal (pogwiritsa ntchito magetsi otsika kwambiri muubongo)
• stellate ganglion block (jekeseni wamankhwala oletsa kupweteka m'mitsempha m'khosi)

Mitengo yopulumuka ya chotupa cha Pancoast

Kuwonjezeka kwapakati pa chemotherapy, radiation, ndi opaleshoni kumasiyana. Lipoti la chipatala cha Cleveland linanena kuti zaka ziwiri zapitazi pambuyo pa opaleshoni ndi 55 mpaka 70 peresenti. Kuchuluka kwa zaka 5 za maopaleshoni omwe adachotsa chotupa choyambirira cha Pancoast anali 54% mpaka 77%.

Chiwonetsero

Kwa zaka zambiri, zotupa za Pancoast zimawonedwa ngati zosachiritsika. Chifukwa cha kupezeka kwa chotupacho, zimaganiziridwa kuti kuchitidwa opaleshoni sikungatheke.

Zaka makumi angapo zapitazi, malingaliro a anthu omwe ali ndi zotupa za Pancoast asintha kwambiri. Njira zatsopano zopangira maopareshoni zapangitsa kuti athe kuchita opareshoni zotupa zomwe poyamba zimawoneka ngati zosagwira. Chithandizo chamakono chokhudza chemotherapy, radiation, ndi opaleshoni chawonjezera kupulumuka.

Kuzindikira koyambirira kwa chotupa cha Pancoast ndikofunikira pakudziwitsa kupambana kwa mankhwala. Onani dokotala wanu nthawi yomweyo ngati muli ndi zizindikiro, ndipo chitani zinthu zodzitetezera monga kusiya kusuta mukasuta.