Hepatocellular carcinoma ka mea maʻamau o nā maʻi maʻi ate mua. Hoʻopilikia ia i ka nui o ka poʻe ma nā ʻāina komohana, maʻamau me ka cirrhosis a i ʻole nā ​​​​maʻi ate ʻē aʻe. ʻOiai ka holomua o nā lāʻau lapaʻau, pinepine pinepine ia i ka make.

Definition

ʻO ka maʻi maʻi hepatocellular (i ʻōlelo ʻia e ka abbreviation CHC) ʻo ia ka maʻi maʻi e ulu ana mai nā cell o ke ake. No laila, he ma'i 'a'ai mua ia o ke ake, e kū'ē i nā ma'i 'a'ai 'elua' e pili ana i nā 'ano ma'i 'a'ai metastatic e 'ike 'ia ana ma nā wahi 'ē a'e o ke kino.

Nā kumu

I ka hapa nui o nā hihia, hepatocellular carcinoma ke kumu o ka hepatic cirrhosis, kahi hopena o ka maʻi ate mau: viral hepatitis, alcoholic hepatitis, autoimmune hepatitis, etc.

Hōʻike ʻia kēia cirrhosis e ka mumū mau o ke ake i hele pū ʻia me ka luku ʻana o nā pūnaʻi ate. ʻO ka hana hou ʻole ʻana o nā pūnaewele i hoʻopau ʻia i ke ʻano o nā nodules a me nā ʻiʻo fibrous (fibrosis). Hoʻoikaika kēia mau ʻeha i ka hoʻololi ʻana o nā pūnaʻi ate a me ka carcinogenesis (ka hoʻokumu ʻana o kahi maʻi ate maʻi).

PalekanaEND_LINK

Hoʻokumu pinepine ʻia ka nānā ʻana no ka maʻi maʻi hepatic ma ka ʻike ʻana i kahi nodule ma ke ultrasound i nā maʻi i nānā ʻia no ka maʻi ate mau. 

Inā loaʻa kahi maʻi maʻi nui, hiki ke noʻonoʻo ʻia ka hōʻailona ke ʻike ʻia nā hōʻailona.

NA POSA

Hoʻopaʻa ʻia ka hōʻoia e nā hoʻokolohua kiʻi hou aʻe. E kauoha ke kauka i ka scan abdominal (helical scan), i kekahi manawa he MRI a / a i ʻole ultrasound contrast. 

ʻO ka loiloi o ka hoʻonui ʻia ʻana o ka maʻi maʻi hiki ke kāhea i kahi MRI ʻōpū a me kahi CT scan thoracic a thoraco-abdominal. Hiki ke hoʻohana ʻia ka ultrasound Doppler no ka nānā ʻana i nā ʻano like ʻole o ke kahe o ke koko ma muli o ke kanesa. ʻOi aku ka liʻiliʻi, e hana ʻia kahi PET scan e ʻike maikaʻi i ka ʻōpū a nānā i ka hoʻolaha ʻana ma waho o ke ake.

Nā hoʻokolohua olaola

Ma kahi o ka hapalua o nā maʻi maʻi hepatocellular, hōʻike nā hoʻāʻo koko i kahi kiʻekiʻe kiʻekiʻe o ka alfafoetoprotein (AFP), i hūnā ʻia e ka ʻōpū.

nā lāʻau kanu

ʻO ka nānā ʻana i nā laʻana o ka ʻiʻo maʻi maʻi e kōkua i ka pale ʻana i nā hewa diagnostic a me ke ʻano o ka ʻōpū o ke ake e alakaʻi i ka mālama ʻana.

Pili ka poʻe

ʻO ka maʻi maʻi hepatocellular ka maʻi maʻi maʻamau maʻamau. ʻO ia ka ʻelima kumu nui o ka maʻi kanesa ma ka honua a ʻo ke kolu o ke kumu nui o ka make maʻi kanesa.

Ma Asia Hikina Hema a me ʻApelika, hiki iā ia ke hoʻopilikia i ka poʻe ʻōpio me ka cirrhosis mai ka maʻi hepa B.

Ma nā ʻāina Komohana, kahi i pili ai i ka maʻi hepatitis C i kekahi manawa akā ma kahi e mau ai ka hopena o ka cirrhosis alcoholic i ʻoi aku ka pinepine, ua piʻi nui ia mai nā makahiki 1980. 

Ma Palani, ua hoʻonui ʻia ka nui o nā hihia hou i kēlā me kēia makahiki mai 1800 i 1980 a i 7100 i 2008 a i 8723 i 2012. ʻO kēia piʻi ʻana he hōʻike pū kekahi i ka hoʻomaikaʻi ʻana i ka maʻi maʻi a me ka hoʻokele maikaʻi ʻana i nā pilikia ʻē aʻe o ka cirrhosis. Wahi a ka National Institute for Public Health Surveillance (InVS), ʻo ka helu o nā hihia hou ma 2012 he 12,1 / 100 i nā kāne a me 000 / 2,4 i nā wahine.

ʻOiai ʻoi aku ka maikaʻi o ka mālama ʻana i ka maʻi maʻi hepa B a me ka emi ʻana o ka inu ʻona, ʻo ka maʻi hepatocellular carcinoma ka pilikia nui o ke olakino lehulehu i kēia mau lā.

Nā mea pilikino

ʻO ka makahiki ma luna o 55 mau makahiki, ʻo ke kāne kāne a me ka cirrhosis kiʻekiʻe nā kumu pilikia nui no ka maʻi maʻi hepatocellular. Ma Palani, ʻo ka inu ʻana i ka waiʻona ka mea nui o ka pilikia no ka cirrhosis, a no laila ka maʻi maʻi ate.

ʻO ka momona a me kona mau maʻi metabolic e pili ana, e hoʻoikaika ana i ka maʻi ate momona ("fatty liver"), pili pū ʻia me ka piʻi nui ʻana o ka maʻi maʻi ate.

Hiki ke hoʻopili ʻia nā kumu pilikia ʻē aʻe:

• puhipaka,
• ka ʻike ʻana i kekahi mau mea ʻona (aflatoxins, thorium dioxide, vinyl chloride, plutonium, etc.),
• nā maʻi me kekahi mau ʻano fluke,
• diabetes,
• hemochromatosis (ka maʻi genetic e hoʻoulu ai i ka hao i loko o ke akepaʻa)…

Hiki i ka maʻi maʻi hepatocellular ke holomua mālie no ka manawa lōʻihi. Hōʻike ʻia nā hōʻailona lohi, ma kahi pae kiʻekiʻe o ka maʻi ʻaʻai, a ʻaʻole kikoʻī pinepine i ka maʻi kanesa ponoʻī. ʻO ia ka hopena mai ka cirrhosis a i ʻole ke keʻakeʻa ʻana o ka vein portal a me / a i ʻole nā ​​ʻawa bile.

Pain

He ʻeha ʻeha loa ia ma ka ʻāina epigastric. Kakaikahi ka eha oi.

ʻO Jaundice

ʻO Jaundice (jaundice), ka mea e ʻikea melemele ai ka ʻili a me nā keʻokeʻo o nā maka, ma muli o ka nui o ka bilirubin (he puaʻa bile) i loko o ke koko.  

Opuu o ka opu

ʻO Cirrhosis, a me ka maʻi hepatocellular carcinoma ponoʻī, nā kumu o ka ascites, i hōʻike ʻia e ka hoʻoheheʻe ʻana o ka wai i loko o ka ʻōpū.

Nā hōʻailona ʻē aʻe:

• ʻo ka hemorrhage o ka ʻōpū ma muli o ka haki ʻana o ke koko,
• nā pilikia o nā hana digestive (ka ʻai ʻole, ke kinoea, ka diarrhea a i ʻole constipation, etc.),
• nā pīpī,
• pōkole o ka hanu ma muli o ke koko nui e kaomi ana i ka diaphragm
• ka pōʻino nui o ke olakino…

ʻOkoʻa ka hoʻokele therapeutic e like me nā ʻano o ka ʻōpū, ʻo ia hoʻi kona hoʻonui ʻana, ke kūlana o ke ake a me ke kūlana olakino o ka mea maʻi. I nā maʻi maʻi maʻi ʻoi loa, ʻeleʻele ka wānana ʻoiai nā holomua o nā lāʻau lapaʻau.

Ka hoʻoliʻiliʻi ate

Hāʻawi ia i kahi lāʻau lapaʻau no ka ʻōpū a me kona kumu - cirrhosis - a ʻae pinepine i ka ho'ōla ʻana, inā e hoʻokō ka mea maʻi i nā koina no ka hoʻokaʻawale ʻana:

• ʻO ka maʻi maʻi kūloko: 1 nodule e ana ana a hiki i 6 cm ka anawaena, a i ʻole 4 nodules ma lalo o 3 cm inā ʻoi aku ka nui o ka alphafoetoprotein ma lalo o 100 ng / ml,
• ka nele o ka maʻi vascular o ke ake (portal a i ʻole hepatic thrombosis),
• ʻAʻohe contraindication: ka waiʻona ikaika, ka mea maʻi i ʻelemakule a i ʻole ke olakino maikaʻi ʻole, nā pathologies pili, etc.

Ma Palani, ma kahi o 10% o nā mea maʻi e hiki ke hoʻololi. I ka pōʻaiapili o ka hemahema o nā grafts, lawe ʻia ia ma 3 a 4% o lākou. Hiki i nā mea ʻē aʻe i kekahi manawa, no ka laʻana, ka hoʻololi ʻana o ka hemifoie ma muli o ka hāʻawi ʻana i ka ʻohana a i ʻole ka mea hāʻawi i make a i ʻole ka ate e lawe ana i ka amyloid neuropathy, e hana pololei ana akā hiki ke hoʻoulu i ka maʻi neurological mamao. 

ʻO nā pilikia o kēlā me kēia transplant.

ʻO Chemoembolization

Hiki ke hana ʻia kēia lāʻau lapaʻau i ka lāʻau kali no ka hoʻololi ʻana, a hiki ke hana hou ʻia i kēlā me kēia ʻelua a ʻekolu mahina. Hoʻohui ia i ka chemotherapy i hoʻokomo ʻia ma ke ala arterial me ka embolization, ʻo ia hoʻi kahi keakea pōkole o ke aʻa hepatic ponoʻī a i ʻole nā ​​lālā e hāʻawi ana i ka ʻōpū me nā "embolization agents". I ka loaʻa ʻole o ke koko, emi ka ulu ʻana o ka maʻi maʻi, a hiki ke hoʻemi nui ʻia ka nui o ka ʻōpū.

ʻO nā ʻano o ka luku kūloko ʻia e ka radiofrequency (nā ʻōpū ma lalo o 2 knm) a i ʻole nā ​​microwaves (tumor o 2 a 4 knm) pono ke ʻike maikaʻi ʻia o ka ʻōpū. Hana ʻia kēia mau lāʻau lapaʻau i loko o ka lumi hana, ma lalo o ka anesthesia maʻamau. Aia nā contraindications, me ka ascites a i ʻole ka helu platelet haʻahaʻa loa.

ʻoki kino

ʻO ke koho o ka hana ʻana i ka ʻokiʻoki e wehe i ka maʻi maʻi e pili ana, ma waena o nā mea ʻē aʻe, ma kahi o ka carcinoma a me ke kūlana maʻamau o ka mea maʻi. ʻO ka pinepine, mālama ʻia ka hana no nā maʻi maʻi pāpaʻu a ʻaʻole nui loa (pono ka mea maʻi e mālama pono i ka ʻiʻo o ke ake olakino). ʻOi aku ka maikaʻi o ka hana.

ʻO ka radiotherapy waho kahi mea ʻokoʻa i ka luku kūloko o kahi maʻi maʻi hepatic e hōʻike ana i hoʻokahi nodule ma lalo o 3 knm, ʻoi aku ma ka ʻaoʻao o luna o ke ake. Pono ia i kekahi mau kau.

ʻAʻole maikaʻi loa ka chemotherapy intravenous maʻamau, ʻoiai ʻo ka maʻi o ke ake i lalo e koi i nā mea haʻahaʻa. No nā makahiki he ʻumi i hala iho nei, ua hoʻokomo ʻia nā lāʻau lapaʻau maʻi maʻi i hoʻopaʻa ʻia i ka mālama ʻana i nā carcinomas hepatocellular. Hoʻohana ʻia nā mea antiangiogenic waha (Sorafenib a i ʻole nā ​​​​molekole ʻē aʻe) i mea e pale ai i ka ulu ʻana o nā moku micro e hānai ana i ka ʻōpū. He mau lapaʻau palliative kēia, akā naʻe, hiki ke hoʻolōʻihi i ke ola.

ʻO ka pale ʻana i ka maʻi hepatocellular carcinoma ka mea nui i ka hakakā ʻana i ka waiʻona. Manaʻo ʻia e kaupalena i ka inu ʻona i 3 inu i ka lā no nā kāne a me 2 inu no nā wahine.

He kuleana ko ka nānā ʻana a me ka mālama ʻana i ka maʻi hepaʻa e hoʻoulu ai i ka cirrhosis. ʻO ka pale ʻana i ka hoʻopōʻino ʻana i ka moe kolohe a me ka hoʻopaʻa ʻana i ka maʻi hepa B he maikaʻi.

Hāʻawi ka hakakā ʻana i ka momona i ka pale ʻana.

ʻO ka mea hope loa, ʻo ka hoʻomaikaʻi ʻana i nā maʻi maʻi mua he mea koʻikoʻi ia e hiki ai i nā lāʻau lapaʻau.