I-bile yiketshezi elenziwe isibindi futhi ligcinwe ku-gallbladder. Ibile kusiza ukuphula amafutha atholakele ekudleni. I-bile duct ixhuma i- gallbladder nesibindi emathunjini amancane. I-bile duct isebenza njenge-passage ye-bile ukugeleza emathunjini amancane , lapho i-bile isiza ukugaya ukudla.
I-biliary tract (noma isimiso se-biliary) ibhekisela kuzo zonke izakhiwo ezenza futhi zilondoloze i-bile, kubandakanya i-bile idonsa ngaphakathi nangaphandle kwesibindi kanye ne-gallbladder.
I-bile idonsa ngaphakathi kwesibindi ibizwa ngokuthi i-intrahepatic, kanti i-bile idonsa ngaphandle kwesibindi ibizwa ngokuthi i-extrahepatic.
Izinhlobo ezimbili eziyinhloko zomdlavuza we-biliary umdlavuza we-bile duct (ie, i-cholangiocarcinoma) nomdlavuza we-gallbladder. Uma ebanjwe kusenesikhathi, umdlavuza wesibeletho kanye nomdlavuza we-bile wokuvuza ungaphathwa ngempumelelo ngokususa lezi zakhiwo. Kodwa-ke, iningi labantu abanikeze lala makhankaso benza kanjalo ngemuva kokuba amagciwane asakazeke kakade, noma anciphise umzimba . Kokubili lezi zomshukela zingakwazi ukumelana nesibindi, ezinye izingxenye zesigxobo esiswini, noma ezinye izingxenye zomzimba.
Ake sihlolisise umdlavuza we-bile duct.
Izibalo
Ngokusho kwe-American Cancer Society, unyaka ngamunye e-United States, kunabantu abangaba ngu-8 000 abatholakala benomdlavuza we-bile duct. Le nombolo ihlanganisa abantu abaxilongwe benomdlavuza we-intrahepatic bile duct kanye nomdlavuza we-bile we-bile. Ngaphezu kwalokho, nakuba umdlavuza we-bile umphumela ungathinta abantu abasha, isilinganiso seminyaka yokuxilongwa ngomdlavuza we-intrahepatic uneminyaka engu-70 kanti i-extrahepatic i-72.
Indawo yekhamera ye-bile yokudoba ingahle ibekwe ngezindlela ezintathu:
- Umdlavuza we-Intrahepatic : izicubu ezixoshwa ngaphakathi kwesibindi
- Umdlavuza we-Perihilar : izicubu eziphakathi nendawo esesibindi lapho ama-ducts angakwesokudla nangesobunxele ajoyina ukuze enze i-bile duct
- Umdlavuza we-bile we-bile : i-tumor eseduze kakhulu nesibindi engxenyeni engezansi ye-bile duct
Izidumbu ze-perihilar ziyi-tumor-type accounting-ejwayelekile kunazo zonke ezingamaphesenti angaba ngu-65 ama-cancer angama-biliary. Ama-tumor extrahepatic akhawunti ngamaphesenti angu-30. Izifo ezincane ze-intrahepatic zivame ukujwayelekile futhi zilandisa cishe ngamaphesenti anguhlanu ama-tumor.
Izicubu ze-perihilar nazo zibizwa ngokuthi izicubu ze-hilar noma izicubu ze-Klatskin. Amanqamu e-perihilar and distal buct cancers ahlanganiswe ndawonye njengamanyevuza e-extrahepatic.
Ukusinda kweminyaka emihlanu yi-metric evamile esetshenziswa odokotela ukuchaza umqondo womdlavuza noma ukubikezela. Ukusinda kweminyaka emihlanu kubhekisela kumaphesenti weziguli eziphila okungenani iminyaka emihlanu emva kokuxilongwa. Izinga leminyaka emihlanu yokusinda komdlavuza we-bile duct zidilizwa ngokuthi umdlavuza usakaze kangakanani-indawo, isifunda, noma ikude-nokuthi ngabe i-tumor i-intrahepatic noma i-extrahepatic.
Nazi izinyathelo zokusinda ezineminyaka emihlanu yezinhlobo ezahlukene zomdlavuza we-intrahepatic esekelwe ekusakazeni kwe-tumor:
| Indawo yangasese | 15% |
| Esifundazweni | 6% |
| Ekude | 2% |
Nazi ezinye zomdlavuza we-extrahepatic:
| Indawo yangasese | 30% |
| Esifundazweni | 24% |
| Ekude | 2% |
Izingozi Zezingozi
Into ebungozi yilokho okwandisa ingozi yomdlavuza. Izinhlobo ezahlukene zomdlavuza zinemikhakha ehlukahlukene yokubeka ingozi.
Kunezifo eziningana zesibindi ezikhonza njengengozi ezibangelwa umdlavuza we-bile duct:
- I-primary sclerosing cholangitis
- I-cirrhosis
- Amatshe okudoba amabhilidi
- Ama-cysts e-Choledochal
- I-hepatitis B
- I-Hepatitis C
- Cholitis esilonda
- Isifo sikaCrohn
- Pancreatitis
- Ukutheleleka nge-HIV
- Ukungabikho kwama-congenital we-pancreatic noma i-bile duct
- Isifo sesibindi sePolycystic
Nazi ezinye izici ezingozini zokuhlasela umdlavuza we-bile:
- Umlando womndeni
- Ubudala obudala
- Ubuhlanga (isib. IsiSpanishi, uMelika waseMelika, no-Asia)
- Ukukhuluphala
- Isifo sikashukela
- Ukubhema
- Pancreatitis
Sicela ugcine engqondweni ukuthi ezinye izinto eziyingozi zingaguquleka; kuyilapho, ezinye zingenakuguquguquka. Izinto ezingaguqulekayo ezingozini zingashintshwa-ungenza okuthile ukuzishintsha. Ngokwesibonelo, ukubhema nokukhuluphala kungaguquguquka ngoba umuntu angakwazi ukuyeka ukubhema noma ukulahlekelwa isisindo, ngokulandelana.
Ngaphezu kwalokho, ingozi yezifo ezithile zingashintshwa, futhi. Isibonelo, kukhona ukugonywa kwesifo sofuba esibhedlela. Izimo ezingekho ezingaguquguquki, ezifana nobudala bomlando nomndeni, azikwazi ukuguqulwa.
Uma unesithakazelo ekunciphiseni izingozi zakho zomdlavuza nezinye izifo, sicela uxoxe ngalezi zindlela nodokotela wakho. Kunezinto eziningi ongayenza ukuze ukhuthaze indlela yokuphila enempilo.
Izimpawu Nezibonakaliso
Umdlavuza we-biliary tract uveza njenge-jaundice, isikhumba esilula (okungukuthi, i-pruritis), nokulahleka kwesisindo. Uma isiguli sibonisa lezi zimpawu nezimpawu, izivivinyo zegazi kanye nezivivinyo zezimpawu ze-tumor zenziwa ukuze zibheke amazinga aphezulu wezinto ezithile egazini.
Amazinga aphezulu e-alkaline phosphatase ne-bilirubin ahlolwa ngesikhathi sokuhlolwa kwegazi yamakhemikhali akhombisa ukukhubazeka kwe-bile duct. Ngaphezu kwalokho, umdlavuza we-bile duct ungabangela amazinga aphezulu wezimpawu zomzimba we-tumor carcinoembryonic antigen (CEA), CA19-9, ne-CA-125.
Ngokusekelwe emiphumeleni yokuhlola kwegazi kanye nokuhlolwa kwe-tumor marker, ingcweti ingase ilandele i-biopsy ye-bile duct ukuze ibone ukuthi ingumdlavuza. Ukuphikisana nokubhebhethekisa kubhekisela ekususweni kwezinto ezincane zezicubu zokuhlolwa kwe-histological ngaphansi kwe-microscope.
Ukwelapha
Ngemuva kokuba isiguli sithola ukuthi sinomdlavuza we-biliary, ukucabanga (njengokuthi i-ultrasound ne-ERCP) kwenziwa ukunquma isiteji, noma ukusakazeka, kwesisu futhi ukucacisa lesi sifo.
Nakuba izidumbu eziningi ze-proximal ze-bile zingasebenzi, isigamu sazo zonke izidumbu ze-distal bile ezikhishwayo zingasuswa, noma zisuswe. Ukuze izicubu eziphambene, ukuthengiswa kwempahla kuhilela inqubo ye-pancreaticoduodenectomy noma ye-Whipple. Inqubo ye-Whipple yinkimbinkimbi enkulu futhi enzima kakhulu yokuhlinzwa okwenza lokhu kuhilela ukususwa kwekhanda lama-pancreas, i-gallbladder, i-bile duct ne-duodenum, okuyingxenye yokuqala yomathumbu amancane. Inqubo ye-Whipple yenziwa yi-oncologist yokuhlinzwa.
Ngeshwa, ngisho neziguli ezikhethwe ukuthengiswa kabusha futhi zikhishwe ipheshana lamabhilidi, amazinga okusinda ominyaka emihlanu aphansi: phakathi kwamaphesenti angu-20 no-25. Kulezi ziguli ezinomdlavuza ongasebenzi, ukusinda kungalinganiswa emasontweni noma ezinyangeni.
Indawo ebucayi ye-bile duct yenza ukuhlinzeka kuyinkimbinkimbi. Ukuhlinzwa kunqunywe ukuthi isifo sesisakaze kangakanani nokuthi usayizi wawo. Ama-tumors asebenze, noma asakazeka, ayasebenza. Ngokuya ngezici ezithile ze-bile duct tumor, ezinye izindlela zokuhlinzwa zingenziwa:
- I-hepatectomy ehlukile (okungukuthi, ukukhipha ingxenye yesibindi)
- Ukususwa kokuhlinzwa kwe-bile duct
- Ukufakelwa kwesibindi
Imithi yokwelapha yomdlavuza we-biliary ezifana ne-chemotherapy ne-radiotherapy inikeza inzuzo encane. Kodwa-ke, i-radiotherapy ingasetshenziswa ukubulala amangqamuzana omdlavuza avimbela i-bile duct noma ucindezeleke emithanjeni-ukwelashwa okunama-palliative.
Ukwelashwa kwe-palliative kunikelwa ukunciphisa ubuhlungu nokulawula izimpawu zesifo sekwephuzile. Ngaphandle kwe-radiotherapy ye-palliative, kunezinye izinketho eziningi zokunakekelwa kwe-palliative.
- Imithi yobuhlungu njengezidakamizwa ze-opioid
- Ukubekwa kwe-stent noma i-catheter ye-biliary ukugcina i-bile duct ivulekile futhi ilawule i-jaundice
- I-bypass ye-biliary lapho udokotela ohlinzayo edala ukuzungeza okuzungeze isisu esivimbela i-bile duct
- I-ablation ye-tumor esebenzisa ukushisa namandla kagesi ukubulala amangqamuzana omdlavuza
- Ukujova utshwala ukuze kubulawe izinzwa ezithuthukisa ubuhlungu emhlabeni we-bile duct nomathumbu omncane
- I-Photodynamic therapy isebenzisa izidakamizwa ezizwelayo ekukhanyeni kwenani elingakanani lokubhubhisa amangqamuzana omdlavuza
I-Cancer Tract Cancer vs. I-Liver Cell Carcinoma
Nakuba ipheshana le-biliary lihlotshaniswa kakhulu nesibindi, amakhemikhali wepheshana lezinhlamvu zebhayisikili ahluke kakhulu kulabo esibindi.
Njengoba igama lisho ukuthi, i-fover cell carcinomas ivela emangqamuzaneni wesibindi noma i-hepatocytes. Amagciwane we-biliary tract avela emangqamuzana e-epithelial we-biliary tract futhi ikakhulukazi ama-adenocarcinomas. I-Adenocarcinomas ibhekisela kuhlamba elibi elivela epithelium glandular, noma amaseli ahambisana ne-bile duct.
Faka eminye imibandela, nakuba i-biliary tract isondelene nesibindi, zenziwe ngezinhlobo ezahlukene zeseli. Izimbangela zivela kulezi zinhlobo zamaseli ezahlukene.
> Imithombo:
> I-American Cancer Society. Iyini i-Bile Can Cancer? www.cancer.org
> Society of American of Clinical Oncology. I-Cancer.Net. I-Bile Duce Cancer (Cholangiocarcinoma) Isingeniso. www.cancer.net
> Carr BI. Izicubu zesibindi nesibhilidi. Ku: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Izimiso zikaHarrison ze-Internal Medicine, 19e eNew York, NY: McGraw-Hill; 2014.
> Matheny SC, Long K, Roth J. Hepatobiliary Disorders. Ku: South-Paul JE, Matheny SC, Lewis EL. ama-eds. Ukuqapha Kokuqala Nokunakekelwa: Ukwelashwa Komndeni, 4e eNew York, NY: McGraw-Hill.