Ibhetshi yelwelo elenziwe ngesibindi kwaye ligcinwe kwi-gallbladder. Ibhili inceda ukunciphisa amafutha atholakala ekudleni. I-bile duct idibanisa i- gallbladder nesibindi kumathumbu amancinci. I-duct ye-bile isebenza njengendinyana ye-bile ephuma emathunjini amancinci , apho i-bile ibinceda ukutya ukutya.
Iphepha lebhiliyari (okanye i-biliary system) libhekisela kuzo zonke izakhiwo ezenzayo kwaye zigcina i-bile, kubandakanya i-bile idonsa ngaphakathi nangaphandle kwesibindi kunye ne-gallbladder.
I-bile idonsa ngaphakathi kwesibindi kuthiwa yi-intrahepatic, kwaye i-bile ducts ngaphandle kwesibindi ibizwa ngokuba yi-extrahepatic.
Iintsholongwane ezimbini eziphambili zomhlaza womhlaza we-britry cancer (ie ie, cholangiocarcinoma) kunye nomhlaza we-gallbladder. Ukuba ubanjwe kusasa, umdlavuza wesibeletho kunye nomhlaza wesibeleko se-bile ungaphathwa ngempumelelo ngokususa ezi zakhiwo. Nangona kunjalo, uninzi lwabantu abanikezayo kunye nala makhansela benze njalo emva kokuba i-cancer isele isasazeka, okanye i- metastasized . Bobabini la ma-khansa angakwazi ukumelana nesibindi, ezinye iinxalenye zesisu esiswini, okanye ezinye iindawo zomzimba.
Masiqwalasele ngokuthe kratya umdlavuza we-bile duct.
Izibalo
Ngokwe-American Cancer Society, unyaka ngamnye e-United States, ubuncinane abantu abayi-8000 bafumaneka ngumhlaza we-bile. Le nombolo ibandakanya abantu abaxilongwa nge-intrahepatic umdlavuza we-bile kunye ne- extrahepatic ye-bile. Ngaphezu koko, nangona umdlavuza we-bacyduct unokubachaphazela abantu abatsha, iminyaka yobudala yokuxilongwa komdlavuza we-intrahepatic i-70 kwaye i-extrahepatic i-72.
Indawo yokuhlala kanomdlavuza we-bile yokudla ihlala ihlelwe ngenye yezindlela ezintathu:
- Umdlavuza we-Intrahepatic : izicubu ezinzima ngaphakathi kwesibindi
- Umhlaza wesifo se-Perihilar : iiswini eziphambili ezisemgangathweni yesibindi apho amathanga angama-right and left left ajoyina ukwenza i-bile duct
- Umdlavuza we-bile we-buct : i-tumors ezikude kude nesibindi kwingxenyana ephantsi ye-bile duct
Iimvumi zeperihilar ziyizona zinto zixhaphakileyo zolu hlobo lwe-tumor malunga neepesenti ezingama-65 zeengcingo ze-biliary tract. I-akhawunti ye-tumors ye-extrahepatic yeepesenti ezingama-30. Iimvumba ze-Intrahepatic ziqhelekileyo kwaye zilandelelana malunga neepesenti ezintlanu zamathumba.
Iimvumba zeperihilar zibizwa nangokuthi izicubu ze-hilar okanye izicubu ze-Klatskin. Amagciwane angama-perihilar kunye ne-distal buct ahlanganiswe ndawonye njengeengqungquthela ze-extrahepatic.
Iminyaka emihlanu yokusinda iyimetrikhi eqhelekileyo esetyenziswa ngamagqirha ukuchaza imbono yomhlaza okanye ukuxela. Ukusinda kweminyaka emihlanu kubhekisela kwipesenteji yezigulane eziphila okungenani iminyaka emihlanu emva kokuxilongwa. Umlinganiselo weminyaka emihlanu wokusinda komdlavuza we-bile ukuguqulwa phantsi komdlavuza wendawo-kwindawo ehlala kuyo, kwinqanaba, okanye ekude-nokuba ingaba i-tumor i-intrahepatic okanye i-extrahepatic.
Nantsi imirhumo yeminyaka emihlanu yokusindisa iintlobo ezahlukeneyo zomhlaza wesibeleko esekelwe kwi-tumor isasazeka:
| Indawo | 15% |
| KwiNgingqi | 6% |
| Kude | 2% |
Nazi ezo mdlavuza we-extrahepatic:
| Indawo | 30% |
| KwiNgingqi | 24% |
| Kude | 2% |
Izinto zobungozi
Umngcipheko nantoni na eyandisa ingozi yomhlaza. Iindidi ezahlukeneyo zomhlaza zineengxaki ezahlukileyo.
Kukho izifo ezininzi zesibindi ezikhonza njengengozi yeengxaki zomdlavuza we-bile:
- I-sclerosing cholangitis
- Cirrhosis
- Amatye edoti
- ICyledochal cysts
- I-hepatitis B
- I-Hepatitis C
- Cholitis esilonda
- Isifo sikaCrohn
- Pancreatitis
- Usulelo lweHIV
- Ukungabikho komntwabakho we-pancreatic okanye ye-bile
- Isifo sesibindi sePolycystic
Nazi ezinye izinto ezinobungozi zesifo somhlaza we-bile:
- Imbali yentsapho
- Yobudala
- Uhlanga (umzekelo, iSpanishi, iMative yaseMelika kunye neAsia)
- Ukunyanya
- Sikashukela
- Ukutshaya
- Pancreatitis
Nceda ugcine ukhumbule ukuba ezinye izinto ezinobungozi ziguqulwa; ngelixa abanye bengenakuguqulwa. Izinto ezinokuguqulwa kweengozi zingatshintshwa-unokwenza into yokuba utshintshe. Ngokomzekelo, ukutshaya kunye nokukhuluphala kunokuguqulwa kuba umntu unokuyeka ukutshaya okanye ukulahlekelwa isisindo, ngokulandelanayo.
Ukongezelela, umngcipheko wesifo esithile unokuguqulwa, kwakhona. Ngokomzekelo, kukho ugonyo lwe-hepatitis B. Izinto ezingenakuguqulwa kwengozi, njengembali yembali kunye neentsapho, ayikwazi ukutshintshwa.
Ukuba unomdla ekunciphiseni umngcipheko wakho wesifo somhlaza kunye nezinye izifo, nceda uxoxe ngale ndlela kunye nodokotela wakho. Kukho izinto ezininzi onokuzenza ukuze ukhuthaze indlela yokuphila enempilo.
Izimpawu kunye neMpawu
Umdlavuza womzila weBiliary ufana ne-jaundice, isikhumba esilula (okt, pruritis), kunye nokulahleka kwesisindo. Xa isigulane sibonisa le miqondiso kunye neempawu, iimvavanyo ze-chemistry zegazi kunye neemvavanyo ze-tumor zenzelwa ukujonga amanqanaba aphezulu ezinto ezithile kwigazi.
Amanqanaba aphakamileyo e-alkaline phosphatase kunye ne-bilirubin ehlolwayo ngexesha lovavanyo lwe-chemistry libonisa ukuba i-bile duct i-dysfunction. Ukongezelela, umdlavuza we-bile duct ungabangela amanqanaba aphezulu eempawu ze-tumor carcinoembryonic antigen (CEA), CA19-9, kunye ne-CA-125.
Ngokusekelwe kwiziphumo ezivela kwi-test chemistry yegazi kunye novavanyo lweempawu zecala, inzululwazi inokuthi ilandele i-biopsy ye-bile duct ukuze ibone ukuba ingaba ngumhlaza. I-Biopsy ibhekisela ekukhutshweni kwezinto ezincinci zezifundo ze-histological phantsi kwe-microscope.
Unyango
Emva kokuba isiguli sifumaneka ngumhlaza wesibeleko se-biliary, ukucinga (njenge-ultrasound kunye ne-ERCP) kwenzelwe ukucacisa isigaba, okanye ukusasazeka kwe-tumor kunye nokucacisa i-tumor.
Nangona ezininzi izidumbu ze-bile zingasebenzi, isiqingatha sazo zonke izidumbu ze-distal bile zingasuswa. Ukuze i-tumor distor, i-resection ibandakanya i-pancreaticoduodenectomy okanye inkqubo ye-Whipple. Inkqubo ye-Whipple yindlela yokuhlinzwa ngokubanzi kunye nobunzima ukukwenza oko kubandakanya ukususwa kwentloko ye-pancreas, i-gallbladder, i-bile duct kunye ne-duodenum, eyona nto inxalenye yokuqala yamathumbu amancinci. Inkqubo ye-Whipple eyenziwa ngu-oncologist.
Ngelishwa, kwanezigulane abaviwa be-resection kwaye banokukhishwa kwiphepha lebhiliyari, amazinga okusinda eminyaka emihlanu aphantsi: phakathi kwama-20 ne-25 ekhulwini. Kwala ma gulane anesifo esingumdlavuza, ukusinda kunokulinganiswa kwiiveki okanye kwiinyanga.
Indawo evelelekileyo ye-bile duct yenza ukuba utyando lukhohlise. Ugqirha lunqunywe ngumoya obude usasazeka ngayo kunye nobukhulu bawo. Izidumbu eziye zahluthwa, okanye zisasazeka, azikwazi ukusebenza. Ngokuxhomekeka kwiimpawu ezithile ze-bile duct tumor, ezinye iindlela zokuhlinzwa zingenziwa ngaphandle koku:
- I-hepatectomy ekhethekileyo (oko kukuthi, ukususwa kwenxalenye yesibindi)
- Ukutshatyalaliswa kokutshintshwa kwe-bile duct
- Ukufakelwa kwesibindi
Unonyango olusisigxina lomhlaza wesifo somhlaza njengokhemotherapy kunye ne-radiotherapy enika inzuzo encinci. Nangona kunjalo, i-radiotherapy ingasetyenziselwa ukubulala amangqamuzana omhlaza esithintela i-bile duct okanye ucinezele kwiimbilini-unyango olusisigxina.
Ulwaphulo olusisigxina lulawulwa ukunciphisa intlungu kunye nokulawula iimpawu zesifo sexesha elide. Ukongezelela kwi-radiotherapy esilula, kukho ezinye iindlela zokunyamekela.
- Amachiza enhlungu njengamayeza opioid
- Ukubekwa kwe-bientary stent okanye i-catheter ukugcina i-bile duct ivule kwaye ilawule i-jaundice
- I-Biliary bypass apho ugqirha odala ugqirha ejikeleze i-tumor ekhusela i-bile duct
- Ukuphuphuma kwe-tumor esebenzisa ubushushu kunye namandla kagesi ukubulala amaseli omhlaza
- Utywala lwamayeza ukubulala iintsholongwane ezibuyisela intlungu ebudeni be-bile kunye nomathumbu omncinci
- I-Photodynamic therapy isebenzisa isicatshulwa esichukumisayo ekukhanyeni kwinqanaba elithile lokutshabalalisa iiseli zomhlaza
I-Canary Tract Cancer ne-Liver Cell Carcinoma
Nangona iphetshana lebhiliyari lixhatshazwe ngokusondeleyo nesibindi, i-cancer yegriariary tract ihluke kakhulu kwiibindi.
Njengoko igama lithetha, i-cell cell carcinomas ivela kwiiseli zesibindi okanye i-hepatocytes. Amagciwane e-biliary tract avela kwiiseli ze-epithelial ze-biliary tract kwaye amaninzi adenocarcinomas. I-Adenocarcinomas ibhekisela kwisihlamba esibi esivela kwi-epithelium ye-glandular, okanye iiseli ezihamba ne-bile duct.
Faka eminye imiqathango, nangona iphetshana yebhiliyari isondele ngokusondele kwisibindi, zenziwe ngeentlobo ezahlukeneyo zeeseli. Izifo ezivela kwiintlobo ezahlukeneyo zeeseli.
> Imithombo:
> I-American Cancer Society. Yintoni I-Bile Can Cancer? www.cancer.org
> I-American Society of Clinic Oncology. Cancer.Net. I-Bile Duce Cancer (i-Cholangiocarcinoma) Isingeniso. www.cancer.net
> Carr BI. Ukuxhaphazwa kweMbindi kunye noMthi weBiliary. Ku: Kasper D, Fauci A, Hauser S, uLongo D, Jameson J, Loscalzo J. eds. Imigaqo yeHarrison ye-Medicine yangaphakathi, i-19e eNew York, i-NY: i-McGraw-Hill; 2014.
> Matheny SC, Long K, Roth J. Hepatobiliary Disorders. Ku: South-Paul JE, Matheny SC, Lewis EL. eds. UKUHLAWULWA KWENKQUBO Nonyango: Uncedo lwezonyango, 4e eNew York, NY: McGraw-Hill.