Ingabe Udinga I-Thyroidectomy Yonke? Kuthiwani Nge-Radioiodine (RAI)?
I-papillary microcarcinoma yindlela yomdlavuza wegciwane le-papillary elincane kakhulu ngobukhulu. Lezi zincane zamangqamuzana - ama-microcarcinomas - enza cishe ingxenye yesifo segciwane lesifo segilo esitholakale e-United States naseYurophu kule minyaka engamashumi amathathu edlule.
Indlela Encane Ngayo I-Microcarcinoma Ye-Papillary?
Kancane kangakanani encane? Imihlahlandlela ithi umdlavuza we-papillary "i-microcarcinoma" uma encane kunama-intshi angu-1 (1 cm ubukhulu).
Isigameko nokuThola
Isimo se-microcarcinoma sanda, ikakhulukazi ngenxa yokuthola okungcono. Lezi zicubu ezincane, ezingenakuqhathaniswa zivame ukutholakala ngesikhathi se-ultrasound ne-X-rays ezindaweni eziyinhloko nentamo.
Izingxabano zokwelapha
I-papillary microcarcinoma ithathwa njengengozi ephansi kakhulu yokufa. Kodwa-ke, kuvamile ukubuyela emuva, noma ukuphikelela, ngakho-ke ukuhlinzwa kuvame ukuphakanyiswa.
Abacwaningi e-European Congress of Endocrinology (i-ECE) ye-10 babika ucwaningo olulandelayo olulandelayo olwalubheka imiphumela yeziguli ze-Mayo Clinic ezine-microcarcinoma ye-papillary ye-thyroid. Leso sifundo sathola ukuthi:
- Phakathi kweziguli ezingaba ngu-900 ezazingenwa izidumbu, akukho muntu owaba nokwanda kwamanqamu eminyakeni engama-20 yokulandela
- Iminyaka engu-20 neminyaka engama-40 yokuphindaphinda kwama-tumor ye -roid yayingu-6% no-9%.
- Phakathi kwendawo yonke yokutadisha, iziguli ezingaphansi kuka-3 kuphela (0.3%) zafa nge-microcarcinoma ye-stillary yegciwane
- Izinga lokusinda nokufa kweqembu lokucwaninga alifani neze kakhulu kubantu abalawulayo
Abacwaningi baphetha ngokuthi ukutholakala kwabo kuqinisekisa lokhu okulandelayo:
- I-microcarcinoma ye-papillary ye-thyroid inezibonelo ezinhle kakhulu uma i-tumor yokuqala isuswe ngokuphelele ngesikhathi sokuhlinzwa.
- Iziguli ezingaphezu kwezingu-99% ezine-microcarcinoma ye-papillary ye-papillary azikho engozini yokusabalalisa okude kakhulu komdlavuza noma ukufa komdlavuza we-thyroid.
- I-postoperative ye-radioiodine insal ablation ayizange ikhulise ingozi yokuphindaphinda noma yokufa komdlavuza wegciwane lesiguli eminyakeni engama-40.
Imikhombandlela ye-American Thyroid Association iphakamisa i-thyroidectomy yakho yonke ye-microcarcinoma yamaphilisi okutholwa ngaphambi kokuhlinzwa, kanye nezilambu ezisezingeni eliphezulu noma ezingenayo, ukusiza ukuqinisekisa ukuthi i-tumor isusiwe ngokuphelele.
I-European Thyroid Association (ETA) neBritish Thyroid Association (BTA), nokho, uncoma i- thyroidectomy ne-lobectomy ngokulandelana ezigulini ezinobungozi obuphansi abangenawo umlando wokuvezwa kwemisebe. Futhi i-American Association of Clinical Endocrinologists iphakamisa ukuthi i-lobectomy (ukususwa kwesigamu segciwane le-thyroid) kanye ne-isthmectomy (ukususa isakhiwo esithinta i-lobes) kunconywa iziguli ezincane ezingenabungozi ze-microcarcinoma.
Okunye okuphikisanayo ukuthi ngabe i-iodine ye-radioactive (RAI) - eyaziwa nangokuthi i-radioiodine - ukwelashwa iyadingeka ukuhlinzwa ngemuva kokuhlinzeka ukunikeza umphumela ongcono kakhulu. Ngenkathi isifundo seMayo singatholi nzuzo, kuvunyelwene ukuthi kuvunyelwe ukuthi iziguli ezinomdlavuza we-microcarcinoma ezingozi kakhulu, okungukuthi, labo abaphindaphindiwe, banezicubu eziningi, ama-lymph nodes amnandi, kanye / nanoma yibuphi ubufakazi obusakazekayo .
Ucwaningo olwenziwa ngo-2009 olwanyatheliswa encwadini yeTheyroid lwalungumphumela omangalisayo ophikisana nesifundo seMayo Clinic. Ucwaningo lwango-2009 lwathola ukuthi amaphesenti angama-43 ama-microcarcinoma asetshenziselwa ukusabalala asetshenziselwa umdlavuza wabo emitholampilo engakapheli iminyaka engu-3 yokuhlinzwa nokuthi izindlela ezincane ezingavumelani ne-iodine ezingasebenzi zivumelekile.
Isihloko se-2012 ku- Journal of Oncology , Nokho, sathola ukuthi ukwelashwa kwe-radioiodine akudingekile futhi akuphuculisi imiphumela / ukubikezela kwe-microcarcinoma yamaphilisi ngokujwayelekile - futhi kwakuyisizuzo kuphela ezigulini ezinobungozi eziphezulu ezinezicubu ezinkulu, lapho i-RAI yanciphisa khona izinga lokuphindaphindiwe.
Imiphumela yeziguli
Iningi leziguli ezine-thyroidectomy elincanyana liphela lidinga imithi yokwelapha i-hormone ye-thyroid. Ngakho-ke kungase kube okuzwakalayo, uma uzohlinzwa, futhi udinga imithi ngemuva kwalokho, ukuxoxa ngezinzuzo nezindleko ze-thyroidectomy yakho ephelele kanye nengxenye kanye nodokotela wakho.
Kuze kufike ku-RAI, kufanele uxoxe ngezinzuzo ezingenzeka uma unezici eziyingozi, kuhlanganise nomlando womndeni, ukuvezwa kwemisebe, umdlavuza wegciwane lesandulela, noma ezinye izinto ezikhathazayo. Futhi qiniseka ukuthi udokotela wakho uyazi izinkombandlela zakamuva ukuze akwazi ukuhlola izingozi zakho, futhi enze izincomo ezingcono kakhulu ngokuphathelene ne-RAI yangemva kokusebenza.
> Imithombo:
> Arora, N et. al. "I-papillary thyroid carcinoma kanye ne-microcarcinoma: ingabe kunesidingo sokuhlukanisa lawa mabili? U-2009 we- Thyroid ; 19: 473-77 PDF
> Carballo, Marilee et. al. "Ukwelashwa Noma Ukungafanele Ukhathazeke: Indima Ye-Adjuvant Radioiodine Ukwelashwa Kwamagciwane Wegciwane Le-Thyroid," I- Journal of Oncology . September 2012, ku-intanethi
> Hay, Ian et. al. "Isifo sakho se-thyroidectomy noma umsakazo we-radioiodine esiphuthumayo siphuthumise isikhathi eside kulezi ziguli ezingu-900 ezine-microcarcinoma ye-papillary ephathwayo phakathi kwe-1945 kuya ku-2004," i- Endocrine Abstracts , (2008) 16 P685 Online
> Noguchi, S. et. al. "I-papillary microcarcinoma." I-World Journal of Surgery , uMqulu 32, Issue 5, amakhasi 747-53. May 2008, Abstract
> Pearce, E. kanye neBraverman, L. "Imiphumela ye-Papillary Thyroid Microcarcinoma kanye Nemiphumela Yokwelashwa," I- Journal of Clinical Endocrinology & Metabolism , Julayi 02, 2013 Online
> Roti, Elio (2008) I-microcarcinoma ye-thyroid ye-Thyroid: isifundo esichazayo nesichazamayo. I-European Journal of Endocrinology, (2008) 159 659-673