Khansara ya chithokomiro ndiyo yachitatu yomwe imafala kwambiri kwa ana. Khansara ya anayi imakhala ndi zizindikiro zambiri ndi odwala akuluakulu a khansa ya kanseri yowonjezera kuphatikizapo zofala zomwe zimaphatikizapo papillary, follicular ndi medullary; ndipo chiwerengero cha akazi kwa amuna chiri pafupifupi 6: 1, pakati pa ena.
Ngakhale kuti kupulumuka kwa nthawi yaitali kwa khansa ya chithokomiro kumatchuka kwambiri, pakhala pali ziwerengero zazikulu zomwe zikudziwitsa zotsatira za matenda a ubwana uyu.
Kafukufuku ambiri akhala ndi ndemanga za bungwe limodzi. Kafukufuku wambiri wamakhalidwe achitika koma zoyesayesa kupanga deta yaikulu zikhoza kuchepetsedwa ndi zisankho zamakonzedwe. Zitsanzo za kukula kwazomwe zikuchitika mu maphunzirowa, kuphatikizapo kufunika kwa nthawi yayitali kutsatiridwa kwa matenda ndi kuchepa kwa chidziwitso, zakhala zovuta pofufuza zotsatira zabwino ndi zoipa zomwe zanenedwa kuchipatala.
Mutu wa otolaryngologist awiri ndi opaleshoni ya makosi amatsimikiza kuti zizindikiro zoterezi zikhoza kuchitika chifukwa chotsatira odwala ambiri pa nthawi yaitali ayenera kufufuza zomwe zimapewa chisokonezo. Iwo adafufuza kafukufuku wamkulu wa dziko pazaka khumi ndi ziwiri pofuna kuyesetsa kumvetsetsa zotsatira za matenda a chipatala, ngakhale kuti nthawi zina amafa, pamtundu wa ana onse. Kutalika kwa phunziroli kunapeweratu kusagwirizana kwapadera mu kafukufuku wamtundu uwu.
Olemba a Zotsatira za Population-Based Outcomes for Matenda a Chithandizo cha Chithokomiro cha Ana, ndi Nina L. Shapiro MD, Gawo la Mutu ndi Opaleshoni, UCLA School of Medicine, Los Angeles, CA; ndi Neil Bhattacharyya MD, ku Division of Otolaryngology, Brigham ndi Women's Hospital, ndi Dipatimenti ya Otology ndi Laryngology, Harvard Medical School, Cambridge, MA.
Zotsatira zawo ziyenera kuperekedwa pa 19th Annual American Society of Pediatric Otolaryngology http://www.aspo.us msonkhano womwe udzachitike pa May 2-3, 2004, ku JW Marriott Desert Ridge Resort & Spa ku Phoenix, AZ.
Malamulo: The database, Surveillance, Epidemiology, ndi End Results (SEER) (1988-2000) anawerengedwa, kuchotsa onse odwala matenda a chithokomiro pogwiritsa ntchito njira zotsatirazi: (1) Zaka zakubadwa kuyambira kuyambira kubadwa mpaka zaka 18; (2) Kukulitsa kwakukulu kwa chifuwa chachikulu cha chithokomiro; (3) Chithokomiro chotchedwa thyroid carcinoma (papillary kapena follicular) ndi (4) Chaka chodziŵika pakati pa 1988 ndi 2000. Odwala omwe ali ndi mitundu ina ya matumbo monga aplastic kapena medullary carcinoma sanapatsidwe. Dongosolo lachipatala komanso lachiberekero lomwe linachokera ku databata linaphatikizapo zaka zakubadwa, kugonana, chifuwa chachikulu, matumbo, chiwerengero cha matenda akuluakulu, matenda a nodal, chithandizo ndi opaleshoni ndi / kapena ayodini owononga mphamvu, ndi ziwerengero za moyo.
Deta zinalembedwa ndi kutumizidwa ku SPSS version 10.0. Kuchokera ku matenda osiyanasiyana, kukula kwa matenda oyambirira a malowa kunayambika monga momwe kunanenedwa kale. Matenda a nodal analembedwa ngati kukhalapo kapena kupezeka kwa nkhono za pakhosi pa nthawi yoyamba kugonana.
Kuchuluka kwa malo oyamba opaleshoni opaleshoni kumatchulidwa kuti ndi chiopsezo chokha, lobectomy, chithokomiro chotchedwa thyroidectomy, kapena chithokomiro chonse.
Zotsatira: Ofufuzawa anapeza makapata 566 a chithokomiro cha khate m'zaka 12. Zaka zakubadwa pa nthawiyi zinali zaka 16.0, ndi odwala 84 peresenti ya odwala. Mitundu ya khansa inali ya 378 (66.8 peresenti) ya papillary carcinomas, 137 (24.2 peresenti) ya papillary carcinomas ndi mitundu yosiyanasiyana ya follicular, ndi 51 (9.0 peresenti) follicular carcinomas. Zonsezi, pafupifupi chotupa kukula kwake chinali 2.6 centimita. Ponena za malo oyamba a matenda, ambiri mwa odwala (74.2 peresenti) anali ndi matenda a intrathyroidal okha.
Gulu laling'ono linali ndi chiwerengero chazing'ono (12.5 peresenti), ndipo owerengeka anali owonjezera kapena owonjezera (5,4 peresenti). Nthenda yothamangira nthendayi mu khosi inalipo 37.1 peresenti ya odwala atayamba kugonana. Odwala ambiri anali ndi chithokomiro chokwanira (72,8 peresenti) kenako chithokomiro chotchedwa thyroidectomy (13.4 peresenti) chotsatira ndi lobectomy yosavuta (7.2 peresenti). Chithandizo chamagazi cha iodin chinaperekedwa kwa 51.4 peresenti ya odwala.
Kupulumuka kwathunthu kwa gulu lonse kunali miyezi 153.8, yokhazikika kwa miyezi 155 yokwanira. Papillary carcinomas (kupulumuka kwapadera, miyezi 155.3) kunapambana bwino kuposa mapuloteni a follicular Matenda a msinkhu, kukhalapo kwa mankhwala abwino a chiberekero, kuchuluka kwa opaleshoni, ndi kugwiritsa ntchito mankhwala opatsirana a iodine sizinakhudze kwambiri moyo wonse. Mwamuna wamwamuna, nthano zake zapamwamba, ndi chiwopsezo choyamba cha matenda a m'dzikolo chinali ndi zotsatira zofunikira kwambiri pa kuchepa kwa nthawi yaitali.
Zotsatira zimagwirizana ndi zomwe apeza kuchokera ku maphunziro ena omwe amanena kuti khansa ya khansayi ya mwana imapezeka makamaka m'zaka zachinyamata, makamaka mwazimayi. Mtundu wambiri wamaphunziro ake ndi mapepala, monga momwe amachitira anthu akuluakulu. Kugawidwa kwa matenda a nodal (37.1 peresenti) kunali kofanana ndi zomwe zinawonedwa m'maphunziro oyambirira. Kafukufukuyu adawulula kuti pamene chithandizo cha chifuwa chachikulu chinachokera ku lobectomy yosavuta kupita ku chithokomiro chonse, kuchuluka kwa opaleshoni sikunakhudze zotsatira zapulumuka. Kupeza kumeneku kumasiyana ndi malipoti angapo omwe asanakhalepo omwe akufotokoza zotsatira zabwino zomwe odwala akuchita kwambiri zokhudzana ndi resection monga chiwerengero cha kachilombo ka HIV. Ukalamba ukadziwika, kudwala, komanso kuwonjezera pa mankhwala opatsirana a iodine sunakhalenso ndi mphamvu yaikulu pa moyo. Mwamuna, chiwerengero cha matenda oyamba, ndi follicular subtype onse anali ndi mphamvu zowononga kuti munthu apulumuke poyerekeza ndi zosiyana ndi malo ena. Zomwe mwapeza: Matenda a chithokomiro chotchedwa thyroid carcinoma amasonyeza zotsatira zabwino kwambiri zotha kupulumuka. Odwala omwe ali ndi mitundu yosiyanasiyana ya mapulogalamu amapanga zotsatira zosauka kwambiri kusiyana ndi omwe ali ndi mapepala osiyanasiyana. Ngakhale kuti matendawa ndi ofala kwambiri kuposa akazi, amuna omwe ali ndi khatekomiya amakhala ndi zotsatira zosauka kuposa akazi. Matenda apamwamba omwe ali pachilumba chapachiyambi amakhalanso ndi zizindikiro zosauka kwambiri poyerekeza ndi matenda osokoneza bongo okha. Ngakhale kuti ntchito yothandizira ndi kuyang'anira ikuyenera kugwiritsidwa ntchito kwa wodwala aliyense, kuwerengera zovuta zomwe zingakhale zochepa komanso za nthawi yaitali, kufufuza kwatsopano kumeneku kumapereka zowonongeka zokhudzana ndi odwala ndi chithandizo cha chithokomiro cha ana poyerekeza ndi kupulumuka ndi zifukwa zomwe zimakhudza zotsatira.