ʻO Cholangiocarcinoma ka maʻi ʻaʻai o nā aʻa bile. Hoʻopilikia ia i ka epithelium o ka lāʻau biliary intra a i ʻole keu hepatic, ʻo ia hoʻi ka ʻiʻo i hana ʻia me nā cell juxtaposed pili i hoʻokumu ʻia i ka pūʻulu o nā ala e hōʻiliʻili ai i ka bile. ʻO ka bile kahi wai viscous melemele i hana ʻia e ke ake, no laila ke hiki ke ulu i ka maʻi intra a i ʻole keu hepatic.

ʻOiai ka liʻiliʻi i ʻike ʻia o ka maʻi, ʻo ka cholangiocarcinoma kahi kokoke i 3% o nā maʻi maʻi ʻōpū a ma kahi o 10 a 15% o nā maʻi maʻi hepato-biliary. Aia ka hapa nui o ke kāne i ka hoʻomohala ʻana o kēia pathology. Eia kekahi, ulu ka maʻi ma ka awelika ma waena o 50 a 70 mau makahiki.

ʻAʻole maopopo i ke kumu o ka ulu ʻana o kēia ʻōpū. Eia nō naʻe, me he mea lā he sporadic kona hanana ʻana, ʻo ia hoʻi ka pili ʻana i kekahi poʻe i loko o ka heluna kanaka me ka ʻole o ka "chain of transmission" i wehewehe ʻia. (1)

Hiki ke ulu kēia maʻi kanesa ma:

- nā ʻāpana bile intrahepatic. Hana ʻia kēia mau ala i nā auwai liʻiliʻi (canaliculi), nā ducts Herring a me nā auwai bile. Hoʻohui ʻia kēia pūʻulu o nā awāwa e hana i kahi ala maʻamau hema a ʻākau. Haʻalele kēia mau mea i ke akepaʻa a lilo i ʻauamo extrahepatic maʻamau. ʻO kekahi ʻano o ka maʻi maʻi e pili ana i ka hui ʻana ma waena o nā aʻa hepatic ʻākau a me ka hema: ʻo Klatskin's tumor;

- nā ʻākea bile extrahepatic, i hana ʻia me ka ʻawa bile nui a me ka ʻauʻau bile kōkua.

ʻOkoʻa nā hōʻailona e pili ana i kēia ʻano maʻi kanesa ma muli o ka pōʻino intra a i ʻole keu. Eia kekahi, ʻike pinepine ʻia nā hōʻike lapaʻau i ka wā e ulu ana ka maʻi.

He maʻi kakaʻikahi me ka loaʻa ʻana o 1 no 100 poʻe. (000)

Hōʻike ʻia nā hōʻailona o ka maʻi ma kahi pae kiʻekiʻe a ʻokoʻa ma muli o ka wahi o ka ʻōpū.

ʻOiaʻiʻo, inā he extrahepatic ke koko, ʻo nā hōʻailona pili: (1)

- nā hiʻohiʻona cholestatic: nā ʻōpala māmā, jaundice, ʻeleʻele mimi, pruritus, etc.

- ʻehaʻeha;

- Kaumaha emi;

- ka manaʻo o ka luhi a me ka nāwaliwali.

I loko o ka pōʻaiapili o ke komo ʻana o ka intrahepatic, ua wehewehe hou ʻia ka maʻi ma o ka ʻehaʻeha a me nā hōʻailona ʻōpū kikoʻī e like me:

- Kaumaha emi;

– anorexia;

- abdominal eha.

Hiki ke hui pū ʻia nā hōʻailona ʻē aʻe me ka maʻi: (2)

- wela;

- ʻāʻī ;

– ʻeha ma ka ʻaoʻao ʻākau o ka ʻōpū.

Ua wehewehe ʻia ka maʻi ma nā pae he nui: (3)

- pae 1a: aia ka ma'i 'a'ai ma loko o nā auwai bile;

- pae 1b: hoʻomaka ka maʻi 'aʻai e laha a laha ma nā moku lymphatic;

- pae 2: hoʻomaka ka maʻi kanesa e laha ma nā ʻiʻo (ka nui o ke ake) a me nā moku lymphatic;

- pae 3: aia ka maʻi kanesa ma ke ʻano metastatic i loko o ka hapa nui o ke koko a me nā kīʻaha lymphatic;

- pae 4: laha ka maʻi kanesa i nā ʻāpana āpau.

ʻO ke kumu maoli o ka maʻi maʻi bile duct a hiki i kēia lā, ʻaʻole ʻike ʻia. Eia naʻe, ʻoi aku ka maikaʻi o ka hoʻomaopopo ʻana i nā kumu pilikia no ka ulu ʻana o ka cholangiocarcinoma.

Puka mai ka maʻi maʻi mai nā hoʻololi ʻana i loko o ka mea lawe i ka ʻike genetic o nā cell: DNA.

ʻO kēia mau hoʻololi genetic i loko o nā pūnaewele e alakaʻi i ka hoʻonui ʻana a me ka ulu ʻole ʻana o nā cell i hopena i ke kūkulu ʻia ʻana o kahi puʻupuʻu cell i kapa ʻia he tumo.

Inā ʻaʻole ʻike ʻia ka maʻi kanesa i ka manawa a / a ʻaʻole mālama koke ʻia, a laila hiki ke ulu nui ka maʻi ʻaʻai a laha pololei i nā wahi ʻē aʻe o ke kino a i ʻole. by kahe koko. (3)

Hōʻike ʻia ʻo Cholangiocarcinoma e kahi maʻi maʻi e pili ana i nā ducts bile. Ke ulu mālie nei kēia a ua lohi pū kona hoʻololi ʻana i kahi kūlana metastatic.

Eia kekahi, hana pinepine ʻia ka nānā ʻana no ka maʻi ma ka pae kiʻekiʻe o ka ʻōpū.

Hiki ke ulu ka ʻōpū ma kēlā me kēia pae ma ka ʻawa bile a pale i ke kahe o ka bile.

ʻOiai ke kumu maoli o ka maʻi, a hiki i kēia lā, ʻaʻole ʻike ʻia, nui nā kumu pilikia e pili ana i ka maʻi. ʻO kēia ka hihia me: (2)

• ka hiki ʻana o nā cysts i loko o nā aʻa bile;
• ʻo ka mumū mau o ka ʻawa bile a i ʻole ka ate;
• ʻO ka sclerosing cholangitis mua a me ke kula kiʻekiʻe (ka necrotizing ʻana o nā aʻa bile e hōʻemi ai a hoʻopau i ke kahe maʻamau o ka bile);
• ulcerative colitis (ka maʻi ʻeha o ka ʻōpū nui);
• kaʻa typhoid mau loa (ka ulu ʻana o nā maʻi typhoid nona ke kumu mai kahi maʻi maʻi a hiki ke lawe ʻia mai kekahi kanaka i kekahi);
• nā maʻi parasitic e Opisthochis viverrini heʻelua Clonorchis sinensis ;
• ka ʻike ʻana i ka thorotrast (kahi mea hoʻohālikelike i hoʻohana ʻia i nā radiograph x-ray).

 Hoʻokomo pū kekahi mau mea pilikino ʻē aʻe i ka ulu ʻana o kēia ʻano maʻi ʻaʻai: (3)

• makahiki; ʻoi aku ka nui o ka poʻe ma luna o 65 i ka maʻi;
• ʻike i kekahi mau mea kemika. ʻO ka hōʻike ʻana i ka thorotrast ka laʻana hoʻohālike loa. ʻOiaʻiʻo, ua hōʻike ʻia ʻo ka hoʻolaha ʻana i kēia mea kemika i hoʻohana nui ʻia i ka lekiō, ma mua o kona pāpā ʻana i nā makahiki 1960, hoʻonui i ka pilikia o ka hoʻomohala ʻana i ka cholangiocarcinoma. Hoʻopili pū ʻia nā mea kemika ʻē aʻe i ka hoʻonui ʻana i ka pilikia o ka hoʻomohala ʻana i ka maʻi, e like me ka asbestos a i ʻole nā ​​PCB (polychlorinated biphenyls). Ua hoʻohana ʻia ka mea mua no ka manawa lōʻihi ma ke ʻano he mea pale ahi i ke kūkulu ʻana, hale a me nā ʻoihana. Ua hoʻohana pinepine ʻia nā PCB i ka ʻoihana a me ke kūkulu ʻana. Aia kēia mau mea kemika i nā hoʻoponopono koʻikoʻi;
• ka loaʻa ʻana o ka maʻi hepatitis B a i ʻole C;
• ka hele ʻana o ka cirrhosis;
• ka maʻi HIV (Human Immunodeficiency Virus);
• maʻi diabetes type I a me II;
• ka momona;
• ka paka.

Pono e hana ʻia nā hoʻāʻo ʻokoʻa no ka maʻi kanesa o nā awāwa bile i mea e ʻike ai i ka maʻi. (3)

• Hoʻohana ʻia ka hoʻāʻo koko i ka ʻike ʻana i ka cholangiocarcinoma. ʻO ka ʻoiaʻiʻo, i ka pōʻaiapili kahi e ulu ai ka maʻi ʻaʻai i loko o nā auwai bile, hoʻokuʻu nā cell cancer i kekahi mau ʻano kemika i hiki ke ʻike ʻia ma o ka hoʻāʻo koko. Eia naʻe, hiki ke hoʻokuʻu ʻia kēia mau māka ma lalo o nā kūlana ʻē aʻe. ʻAʻole pili ʻia ka loaʻa ʻana o kēia mau mea i ka hoʻomohala ʻana o ka maʻi kanesa o nā duct bile;
• ʻO ka scanner o ka bile ducts e hiki ai ke kiʻi i ke kiʻi o loko o kēia ʻāpana o ke kino i mea e ʻike ai i nā mea ʻino;
• ʻO ka Tomography, ma o nā X-ray o ke ake, hiki ke ʻike i nā kikoʻī kikoʻī o kēia okana ma o nā kiʻi 3-dimensional;
• MRI (Magnetic Resonance Imaging), me ka hoʻohana ʻana i kahi ʻōnaehana o nā māla magnetic a me nā hawewe lekiō e kiʻi i kahi kiʻi o loko o ke ake;
• ʻO ka retrograde cholangiopancreatography endoscopy kahi ala e hōʻike ai i nā ʻano kikoʻī ʻē aʻe o nā auwai bile;
• Hoʻohana pū ʻia ka percutaneous transhepatic cholangiography no ka loaʻa ʻana o kahi ʻike kikoʻī o ka gallbladder;
• hiki i ka biopsy ke hōʻoia i ka ʻike.

ʻAʻole hiki ke hoʻōla ʻia ka hapa nui o ka maʻi maʻi bile duct. Eia nō naʻe, ʻo nā lāʻau lapaʻau no ka maʻi he mau hōʻailona-specific.

Hoʻokō ʻia ka mālama ʻana i ka maʻi ma muli o kahi hui multidisciplinary i hana ʻia e kahi pūʻulu o nā loea (kauka, oncologist, radioologist, kahu hānai, gastroenterologist, etc.). (3)

ʻO nā lāʻau lapaʻau i hāʻawi ʻia ma muli o nā hōʻailona a me ka holomua o ka maʻi kanesa.

Ma nā pae 1 a me 2, hiki ke ʻoki ʻia no ka hoʻohou ʻana i kahi ʻāpana o ka gallbladder, bile ducts a i ʻole ate.

Ma ka pae 3, ʻo ka manawa o ka holomua o ka mālama ʻana e pili ana i ka pae o ka pōʻino i nā moku lymphatic.

ʻO ka hope, ma ka pae 4, he haʻahaʻa ka helu o ka holomua o ka mālama ʻana.

Hiki i ka lapaʻau ʻana i ka maʻi ke hopena i nā hana ʻokiʻoki e hiki ai ke hoʻohou i nā ʻiʻo maʻi maʻi: ʻāpana o nā aʻa bile i loaʻa nā sela maʻi maʻi, ka ʻōpū, kekahi mau moku lymphatic i pā a i ʻole kekahi hapa o ke ake.

ʻO ka maʻamau, ma waena o 20% a me 40% o ka poʻe me ka hana ʻoki a ola i 5 mau makahiki a ʻoi aku paha ma hope o ka hana.

E kūʻē i ke ʻano o ka ʻeha o ka ʻōpū, jaundice, a me nā mea ʻē aʻe, pono ka wehe ʻana i nā ducts bile i kekahi manawa. Hoʻokō ʻia kēia hoʻokuʻu ʻana me ka hoʻohana ʻana i kahi paipu lahilahi i hele ʻia ma nā ʻawa bile.

ʻAʻole ka lāʻau lapaʻau ka lāʻau lapaʻau maʻamau no ka cholangiocarcinoma, akā hiki ke hana maikaʻi i ka hōʻemi ʻana i nā hōʻailona a me ka kaupalena ʻana i ka hoʻolaha ʻana o nā metastases. ʻElua ʻano o ka lāʻau lapaʻau: ka lāʻau lapaʻau kukuna waho a me ka lāʻau lapaʻau kūloko.

Eia kekahi, hiki i ka radiotherapy ke hana i nā hopena ʻaoʻao e like me ka nausea, ka luaʻi a i ʻole ka luhi nui.

Hoʻohana ʻia ʻo Chemotherapy no nā kumu like me ka radiation therapy. A i ʻole no ka hōʻemi ʻana i nā hōʻailona, ​​i mea e kaupalena ʻia ai ka laha ʻana o ka maʻi koko a hoʻonui i ke ola o ka mea i hoʻopilikia ʻia. Hoʻohui pinepine ʻia ka Chemotherapy me ka radiotherapy. ʻO nā hopena ʻaoʻao e pili ana i ka chemotherapy ʻo ia hoʻi nā mea e pili ana i ka radiotherapy a me ka nalowale o ka lauoho.

Ua hōʻike kekahi mau noiʻi i nā pono e pili ana i ka hui pū ʻana o ʻelua mau lāʻau i hoʻohana ʻia i ka chemotherapy (Cisplatin a me Gemcitabine).

I kēia lā, ʻaʻole ʻoi aku ka maikaʻi o nā lāʻau lapaʻau e pili ana i ka maʻi kanesa o nā aʻa bile e like me nā ʻano maʻi maʻi ʻē aʻe. No laila, nui nā haʻawina e pili ana i kēia ʻano maʻi kanesa i mea e ʻimi ai i nā ala maikaʻi e mālama ai i ka maʻi.

Eia kekahi, ʻo ka noiʻi ʻana i ka hoʻomohala ʻana i nā lāʻau lapaʻau i hoʻopaʻa ʻia i kēia manawa. ʻO kēia nā lāʻau lapaʻau e kuhikuhi ana i kahi pae kūikawā o ka ulu ʻana o ka maʻi kanesa.