Pambuyo, Panthawi, ndi Pambuyo Pambuyo Opaleshoni Kwa Adenoma Wachiweto
Chinthu chofunika kwambiri koma chochepa cha minofu chili m'munsi mwa ubongo. Minofuyi imatchulidwa ngati gland chifukwa imatulutsa mahomoni m'magazi kuti athetse ntchito zofunika za thupi, kuphatikizapo kubereka, kukula panthawi ya chitukuko cha mwana komanso ntchito ya chithokomiro. Chinthu chofunika kwambiri kuti thupi likhale lopweteka kwambiri m'thupi la munthu chifukwa limakhala ndi zinthu zambiri nthawi imodzi.
Mtundu wa pituitary umatseka ma hormones asanu ndi limodzi:
- Chithokomiro Chothandizira Kutulutsa Horoni (TSH): Imayang'anira ntchito ya chithokomiro
- Adrenocorticotropic Hormone (ACTH): Imayambitsa matenda a adrenal kutulutsa adrenalin
- Fulogalamu Yopangitsa Hormone (FSH): Imayesetsa kuchita msinkhu ndi kubereka
- Luteinizing Hormone (LH): Thandizani kulamulira kubereka komanso chitukuko cha kugonana
- Kukula kwa Hormone (GH): Kulamulira kukula kwa thupi panthaŵi ya ubwana ndi unyamata
- Prolactin (PRL): Amayang'anira kupanga mkaka wa m'mawere pambuyo pa mimba
Matenda ambiri amatulutsa hormone imodzi, choncho pituitary si zachilendo chifukwa cha zovuta za ntchito yake ndi malo ake apadera mu ubongo, kumbuyo kwa mphuno.
Sikuti kansalu kameneka kamatulutsa ma hormoni asanu ndi limodzi, ena mwa mahomoni amachititsa mitundu ina, kuphatikizapo chithokomiro chomwe chimagwiritsidwa ntchito pa chifuwachi chimakhudza kwambiri thanzi la munthu ndi thanzi lake.
Kusamvana kwa mahomoni, kaya kuchokera kumtenda wa pituitary kapena mbali ina ya thupi, ndizochiritsidwa ndi matenda opatsirana. Endocrinology ndizopadera zachipatala zomwe zimayambitsa matenda a hormone, kuphatikizapo mavuto a pituitary ndi mavuto ena a shuga monga shuga.
Chikumbumtima Choyipa
Mtundu wochuluka kwambiri wa chifuwa chachikulu ndi peniyo adenoma, chotupa chopanda khansa chomwe chimapangika pamtundu wa pituitary.
Palinso mitundu ina ya zotupa kuposa momwe zingakhalire, koma adenoma ndi yofala kwambiri.
Adenomas a pituitary amagawidwa m'njira zambiri. Iwo ndi owopsa (osakhala ndi khansa), osokoneza adenoma, kapena khansa. Chotupacho chikhoza kukhala chotupa chachinsinsi, kutanthauza kuti chotupa chimapangitsa mahomoni, kapena icho sichingakhoze. Amatchulidwa kuti macroadenoma ngati ali ndi masentimita kapena ambiri mu kukula ndipo amalingaliridwa ngati microadenoma ngati ali ang'onoang'ono kuposa mamitamenti.
Palinso mitundu ina ya zotupa zomwe zingathe kuchitika pazirombo, koma zambiri ndizosowa ndipo opaleshoni imachitidwa mofanana ndi njira zomwe zimachitira adenomas.
Kusanthula Mimba Yamanyazi
Matenda opuma amapezeka kawirikawiri pambuyo pa vuto looneka ngati losagwirizana nalo lomwe limayambitsa matendawa. Mwachitsanzo, mtsikana yemwe sanakhalepo ndi mwana angayambe kupanga mkaka wa m'mawere ndi zotsatira za labu zingathe kuwonetsa chotupa choyambitsa matenda chifukwa cha vutoli.
Izi zikuti, zotupa zambiri zamatenda zimatchulidwa kuti "zovuta" pamene zimapezedwa osati chifukwa cha zizindikiro kapena mavuto, koma pa ntchito kwa chinachake. Pachifukwa ichi, chotupa chotheka chimapezeka panthawi ya ubongo wa ubongo chifukwa wodwalayo anapita ku chipinda chodzidzimutsa kuti akaphedwe.
Pankhani iyi, panalibe zizindikiro kapena zizindikiro chifukwa cha adenoma, ndipo mwina sizinawoneke ngati CT sichinachitike.
Zizindikiro za Kutetezeka Kwachilengedwe
Zotsatirazi ndizo zizindikiro zomwe mungapeze ngati muli ndi chotupa:
- Mutu umene suli wabwino ndipo ukhoza kuwonjezeka pa nthawi
- Acromegaly , matenda omwe amayamba chifukwa cha kukula kwa hormone pambuyo poti anthu ambiri amasiya kukula, kutsogolo kwa manja ndi mapazi akulu kwambiri, ndipo ngati osapatsidwa, amaonekera nkhope. Pamene kukula kothamanga kwa hormone kumapangidwa pazaka zaunyamata, gigantism-kutalika kwambiri-kungabweretse.
- Hypopituitarism , vuto limene limayambitsa kukula kwa ana
- Matenda a Cushing , omwe angayambitsidwe ndi ACTH kwambiri kuchokera ku pituitary, nthawi zambiri amachititsa nkhope yozungulira ndi phokoso pakati pa mapewa.
- Matenda a Addison, matenda omwe amachititsidwa ndi ACTH kwambiri
- Masomphenya amasintha
- Mkaka wa m'mawere mwa amayi omwe sanabereke
- Kutenga msambo kungakhale kosasintha kapena kopanda
- Chikhalidwe chimasintha
- Kusadziletsa
- Kusokonekera kwa Erectile
- Kusintha kwa thupi
- Kutopa
- Mahomoni a chithokomiro ali okwera kwambiri kapena otsika kwambiri
Pamene Kuchita Opaleshoni Ndikofunika
Mankhwalawa amapezeka kwambiri, ndipo ambiri mwa odwala asanu ndi mmodzi ali ndi adenoma amodzi omwe amapezeka pamatenda ena nthawi zina. Mwamwayi, adenoma yomwe imayambitsa matenda ali ochepa kwambiri, ndi pafupifupi 1 penteitary adenoma pa zikwi zikwi zomwe zimayambitsa zizindikiro.
Odwala ambiri omwe ali ndi adenoma ya pituyo kapena mtundu wina wa chotupa chochititsa manyazi amatha kupewa opaleshoni. Kwa odwala omwe ali ndi adenoma yomwe siimayambitsa mavuto ndipo safuna mankhwala, opaleshoni ndizosafunikira. Odwala ena amatha kupeŵa opaleshoni mwa kumwa mankhwala omwe amachititsa kuti mavitamini asinthe chifukwa chotupa.
Anthu omwe amafunikira chithandizo cha opaleshoni ndi omwe samayankha bwino mankhwala, kapena amakhala ndi mavuto aakulu chifukwa chotupa. Mavuto amenewa angaphatikizepo kusintha kapena kutayika kwa masomphenya, kupweteka kwa mutu, kapena matenda ena omwe amachititsa kusamvana kwa homoni.
Kuopsa kwa Opaleshoni Yopuma
Kuphatikiza pa zoopsa zomwe zimagwiridwa ndi opaleshoni komanso kuopsa kwa matenda a anesthesia, opaleshoni kuchotsa chotupa chimakhala ndi zoopsa zapadera. Zowopsya kwambirizi ndizosayerekezereka kwa ma hormone zomwe zimawonongeka ndi chigoba cha pituitary panthawiyi. Kuwonongeka kwa mankhwalawa kungapweteke aliyense kapena ma hormoni asanu ndi limodzi omwe amadziwika ndi chifuwa cha pituitary, ndipo amatha kuyambitsa zovuta zomwe zingayambitse vuto labwino m'madera ambiri a thupi.
Zowonjezereka zomwe zingachitike pambuyo pa opaleshoni ya opaleshoni ndizo:
- Diabetes insipidus: Chifukwa cha kusamvetseka kwa mahomoni, vutoli limapangitsa thupi kukhala ndi mitsempha yambiri, zomwe zimayambitsa kutaya thupi, ludzu, komanso, povuta kwambiri, kusokonezeka.
- Madzi a m'madzi akuthawa: N'zotheka kuti madzi a m'mphepete amve m'mphuno pambuyo pa opaleshoni ya transsphenoidal. Izi zili choncho chifukwa dzenje linalowetsedwa m'mphuno kumbuyo kwa chingwe chomwe chimalola kuti opaleshoni ichitike. Ngati gulu wosabalayo amagwiritsidwa ntchito "kumanga" dzenjelo silidzadzaza dera lonselo, wodwalayo adzapeza mphuno yotumphuka, mofanana ndi ntchentche yoyera yomwe ili ndi chimfine.
- Mutu wa misinkhu: Mutu ululu wa opaleshoni uwu ukufala, ndipo nthawi zambiri umatchulidwa kuti uli ngati mutu wa sinus.
- Kusokonezeka kwapadera: Zidzatheka kuti ndime zamphongo zidzatulukidwe pambuyo potsatira njirayi, ndipo mpikisano uwu umakhalapo kwa sabata kapena awiri potsatira njirayi. Nthaŵi zambiri chisokonezo chidzakula bwino panthawi yopuma, ndipo kaŵirikaŵiri zotsatira za zipangizo zopangira opaleshoni zimakwiyitsa matenda osakanikirana mkati mwa mphuno.
- Matenda a mitsempha: Matenda a ubongo amatha kuchitika pambuyo pa opaleshoni ya ubongo, monga opaleshoni imawonjezera ngozi ya mabakiteriya akufika mu ubongo.
Asanayambe Kuchita Opaleshoni
Musanachite opaleshoni pamtenda wa chifuwa mungathe kuyembekezera kukhala ndi scan, MRI, kapena mwina onse awiri kuti muwone kukula ndi mawonekedwe a gland ndi chotupacho. Kuyezetsa ma labata kudzakhalanso gawo la matendawa, ndipo ambiri mwa mayesowa akhoza kubwerezedwa asanayambe opaleshoni ngati chotupa chikuyambitsa kusamvana kwa mahomoni. Maabara awa opanga opaleshoni adzayambitsa maziko oyerekeza atatha opaleshoniyo, ndipo angathe kuthandizira kudziwa ngati opaleshoniyo yayambitsa kusintha.
Zosamalidwa Zopweteka
Kuchita opaleshoni pofuna kuchotsa chotupa chachitetezo kumachitidwa ndi a neurosurgeon, dokotala wa opaleshoni yemwe amadziwika bwino kwambiri pochiza matenda osokoneza bongo, omwe amaphatikizapo ubongo ndi msana. Nthawi zina, opaleshoni ya ENT (khutu, mphuno ndi khosi) angakhale dokotala kapena opaleshoni. Kuchita opaleshoni kumachitidwa pansi pa anesthesia , yomwe imaperekedwa ndi munthu wodwala matenda a anesthesiologist kapena namwino wodwala anesthetist (CRNA).
Chifukwa cha malo amodzi opangira chigoba mkati mwa chigaza koma kunja kwa ubongo, pali njira ziwiri zomwe njirayi ingachitire.
Kusintha kwa njira
Njira yowonjezereka ya chifuwa chochotsa chifuwa ndichochotsedwa ndi njira yopita kuchipatala, kumene dokotalayo amapanga zipangizo kupyolera mu mphuno ndipo dzenje limapangidwa mu sinus yomwe imakhala pakati pa mphuno ndi ubongo. Kuyika kabowo kakang'ono m'fupa, lotchedwa fupa la sphenoid, limapereka mwayi wofikira ku chidziwitso cha pituitary.
Kuti ziwoneke bwino, ubongo umagwirizanitsa ubongo, koma umakhala pansi pa ubongo. Izi zimathandiza kuti chikhocho chipezeke pamphuno. Njirayi imagwiritsira ntchito endoscope, chubu chofewa chosakanikirana ndi zipangizo zoyera, kamera ndi zing'onozing'ono mkati. Endoscope imalowetsedwa ndipo dotoloyo amatha kuyang'ana zithunzi pazowunikira. Zida zing'onozing'ono mkati mwake zimagwiritsidwa ntchito kudula minofu yosafuna.
Kawirikawiri, mawonekedwe apamwamba kwambiri omwe atengedwa asanachitidwe opaleshoni pamodzi ndi zipangizo zamakono zomwe zimagwiritsidwa ntchito panthawiyi amathandizira dokotala wa opaleshoniyo njira yopita molunjika kupita kuchipatala. Njirayo ikatseguka, zida zazing'ono zotchedwa curettes zimagwiritsidwa ntchito kuchotsa minofu yosafunika yomwe imafuna.
Pambuyo pochotsa minofu, mafuta ochepa m'mimba amaikidwa pamalo omwe chotupacho chinachotsedwa, ndipo dokotalayo amatha kusindikiza dzenje lomwe linapangidwa m'phfupa ndi chitsulo chamatabwa. Kawirikawiri, mphuno zidzatsegulidwa kuti zisawonongeke kuti zisatseke kumapeto kwa ndime zamphongo.
Njira ya Craniotomy
Njira yowonjezeretsera opaleshoni ya opaleshoni ndiyo kupyolera mu craniotomy, kumene gawo la fuga lachotsedwa kuti lifike ku ubongo mwachindunji. Njirayi ndi yosavomerezeka kwambiri, ndipo nthawi zambiri amagwiritsidwa ntchito ngati opaleshoni si yoyamba kuchitidwa pamtundu wa pituitary. Angagwiritsidwenso ntchito ngati pali vuto lomwe likuwotha ubongo wa spinal pambuyo pa njira yoyamba pamtundu wa pituitary.
Pa opaleshoni imeneyi, njirayi imayambika pambuyo pa dera limene tsitsili lidzasambidwa tsitsi ndi chitsulo chimayikidwa pafupi ndi akachisi kuti azisunga mutu. Kuphatikizidwa kumapangidwa mu khungu ndipo khungu limatsegulidwa kuti liwulule fuga lachitsulo kumene mabowo ang'onoang'ono otchedwa burr mabowo amasunthira mu magawo awiri a chigaza. A saw amagwiritsidwa ntchito kuti agwirizane mabowo awiriwa, ndikupanga phala lamapangidwe lopangidwa ndi nsanganizo lomwe limachotsedwa pang'onopang'ono ndikuika pambali panthawiyi. Chophimba cha ubongo, chotchedwa dura, chimatsegulidwa ndipo ubongo umatha kuwoneka.
Ubongo ukadziwika, chipangizo chapadera choyesa chimagwiritsiridwa ntchito kuti chichotsere ubongo kuti chilowetse pansi pa ubongo wa ubongo kumene chigoba cha pituitary chimakhala. Dokotala wa opaleshoni amatha kuganiza mozama za gland ndipo akhoza kugwiritsira ntchito zida zomangidwa m'manja.
Mukamaliza kukonza, chidutswachi chimalowetsedwamo ndipo chimagwiritsidwa ntchito ndi glue kapena kusungidwa mufirire yapadera kuti ipitirire m'malo mwake. Khungu la scalp limatsekedwa ndi zakuya kapena guluu.
Pambuyo pa Opaleshoni Yopuma
Odwala ambiri amathera tsiku limodzi kapena awiri mu chisamaliro cha ubongo kapena opaleshoni pofuna kuyang'anitsitsa pambuyo pa opaleshoni. Pa nthawiyi ogwira ntchitoyi adzaonetsetsa kuti magazi akuyendera bwino pofuna kuchepetsa kusamvana kwa mahomoni, komanso kuyang'anitsitsa kayendedwe ka mkodzo kuti adziwe ngati opaleshoniyo yayambitsa matenda a shuga. Mudzayang'anitsanso mosamala kuti phokoso lidzatuluka kapena mphuno, zomwe zingakhale chizindikiro kuti chigamba chotsegula dzenje la spenoid sichinali ndi ubongo wa m'mimba.
Pambuyo pa masiku awiri kapena awiri ku ICU, wodwalayo akhoza kusamutsidwa ku chipinda choyendetsa pansi kapena kuchipatala. Odwala ambiri amatha kubwerera kwawo patatha masiku 3-5 atapatsidwa opaleshoni ndi malangizo osamveka kuti asamve mphuno zawo komanso malangizo a momwe angasamalirire pamimba.
Odwala ambiri amatha kubwerera kuntchito zawo zachilendo milungu iwiri itatha opaleshoni. Ntchito zina zomwe zingapangitse kupanikizika kwapadera (ubongo mkati mwa ubongo) monga kukweza kulemera kwa thupi, kuchita masewera olimbitsa thupi, kupindika, ndi kukweza ziyenera kupezedwa kwa mwezi umodzi pambuyo pa opaleshoni, koma ntchito monga kugwira ntchito pa desiki, kuyenda ndi galimoto nthawi zambiri N'zotheka pa sabata ziwiri.
Kwa masabata oyambirira a kuchiritsidwa ndizochidziwitso kwa mankhwala ochiritsira kuti apatsidwe chifukwa cha ululu wopaleshoni . Mankhwala owonjezera amaperekedwa kuti athetse kudzimbidwa , monga kuthandizira kuti thupi likhale ndi phokoso likhoza kuwonjezeranso kupanikizika kwapachirombo ndipo ayenera kupeŵa. Mukhoza kulandira mankhwala kuti muchepetse kusokonezeka kwa mphuno ndi kutupa.
Panthawiyi, ndi zachilendo kuti mutenge kutopa, kukhudzana kwa msana komanso mutu wa mutu wa sinus. Ndikofunika kufotokoza zotsatirazi kwa dokotala wanu opaleshoni: Kuthamanga kwa mphuno kapena mphuno yomwe siimatha, kutentha thupi, kuzizira, kukodza kwambiri, njala yochuluka, kupwetekedwa mtima kwambiri, ndi khosi lolimba lomwe limalepheretsa chigambacho kuchikhudza chifuwa.
Maulendo anu oyendayenda angayambe ndi a neurosurgeon anu, ENT kapena onse awiri. Mukhoza kuyembekezera kuti muyesedwe magazi kuti mupitirize kutsatira zomwe mukupita komanso kudziwa mankhwala omwe mukufuna, ngati mutachiritsa.
> Chitsime:
> Kuchiza Opaleshoni Mafunso: Wodwala Wotsogolera. Neuroendocrine ndi Pituitary Tumor Clinic Center. https://pituitary.mgh.harvard.edu/TranssphenoidalSurgery.htm