Nchoputa na ọgwụgwọ nke nnukwu ajọ leukemia. mgbaàmà

Ajọ ọrịa kansa ọbara, ọbara na-atụle ga-kasị nkịtị oncological daa ọrịa ụmụaka. Ọ bụ banyere 25% nke ọrịa cancer ahụrụ na ọrịa ụmụaka. Ọzọ, na-elerukwu anya leukemia ọbara - ihe ọ bụ, ya mere na ọ bụ n'ebe ahụ na ihe ọgwụgwọ-adọ na-rụrụ na a daa ọrịa.

Isi

Arịa ọrịa kansa ọbara ọbara - ihe ọ bụ? The ọrịa na-ezo aka a ìgwè nke cancer. ALL (nnukwu ajọ leukemia), mgbaàmà nke ga-atụle n'isiokwu n'okpuru, bụ a heterogeneous ìgwè nke neoplasms nke mkpụrụ ndụ ndị na-enwe kpọmkwem mkpụrụ ndụ ihe nketa na immunophenotypic e ji mara. Dịkwuo mmepụta na ìgwè ndị a na mkpụrụ ndụ na ụmị ọkpụkpụ abnormalities eme abụọ proliferation, iche ma ọ bụ abụọ. N'ihi ya, infiltration nke mkpụrụ ndụ nke parenchymatous akụkụ na Lymph. Kasị (80%) nke niile leukemia (leukemia), achọpụtara na ụmụaka, nwere lymphoid malite.

njupụta

Ịza aza ọbara ọrịa n'ụwa taa na-hụrụ n'ebe nile. ALL njupụta na mba ndị mepere emepe bụ 3-4 ikpe kwa narị puku ụmụ n'afọ ọ bụla. Na mba nke Central Asia na Africa daa ọrịa bụ obere nkịtị. ALL mgbe na US na-ekwu, nke Japan, China, Europe. Ọnụ ọgụgụ kasị elu omume na ụmụ na-ewere dị ka afọ 2.5-5 afọ. The kasị nhata n'akparamagwa ụmụ nwoke.

predisposing ihe

Mbụ niile ha ga-ekewet afọ nne prenatal na-elekọta, na-amụ ibu - karịa 4000 grams, post- na prenatal n'ebe ionizing radieshon. N'ọnọdụ ụfọdụ, ọ pụrụ ọbụna ime na nnukwu ajọ leukemia? History of nne ọrịa nwere ike na-agụnye ihe ọmụma banyere nwa ebu n'afọ na ọnwụ na a gara aga ime. Nke a nwere ike ime n'ihi na oghom gburugburu ebe obibi na ọnọdụ, ma ọ bụ n'ihi na a mkpụrụ ndụ ihe nketa pụrụ ịrịa. Na ikpe nke cancer ọrịa na n'ụlọ ndị ikwu, na-amụba ohere e n'ọdịnihu ga-ebilite nnukwu ajọ leukemia. Na-akpata ọrịa nwere ike na-metụtara ndị chromosomal akwusighi ọrịamkpokọta ọcha. A na-agụnye, akpan akpan, na-agụnye Down syndrome, neurofibromatosis, agbanwe immunodeficiency, Fanconi anaemia, X-jikọrọ agammaglobulinemia (congenital) na ndị ọzọ. N'ihi ya, a ọnụ ọgụgụ nke ọmụmụ, ndị ọkachamara na-na-na ọgwụgwụ na nnukwu ajọ ọrịa kansa ọbara, dị ka nke ọma dị ka mmepe nke ọzọ oncology, e nwere a n'amaghi mutation nke progenitor mkpụrụ ndụ. Ọ ekemende jikọtara launchers gburugburu ebe obibi ihe na rụọ ọrụ proliferation. Nke a bụ ihe kasị nkịtị onu na nwere ike ime ka arịa ọrịa kansa ọbara. Ihe Kpatara vozniknovneniya daa ọrịa bụ otu n'ime isi ihe akụkụ mgbe ahọpụta usoro ọgwụgwọ.

nchọpụta nsogbu

Mgbe a mara ọ bụla daa ọrịa Cancer ga-iwere n'ime akaụntụ adakarị e ji mara na atụmatụ nke mkpụrụ ndụ na-eme ka akpụ mkpụrụ. ALL nchoputa dabeere ahụ nnyocha na paraclinical data akụkọ ihe mere eme na laabu ọmụmụ.

adakarị picture

Ịrịba ama nke leukemia bụ ihe mgbagwoju ọrịamkpokọta:

• Igbu egbu. Na nnukwu ajọ leukemia bụ nnọọ malaise, arọ ọnwụ, ike ọgwụgwụ, ahụ ọkụ. Nke ikpeazụ nwere ike triggered site a malitere ịrịa, nje, protozoal (obere), ma ọ bụ fungal ọrịa, karịsịa na ọrịa na neutropenia.
• Hyperplastic. Mgbe nnukwu ajọ leukemia bụ infiltration nke splin na imeju na. Nke a, n'aka nke ya, na-eduga ná hepatosplenomegaly, nke pụrụ igosipụta ịdị nro na-afo. The mbụ ihe ịrịba ama nke leukemia - enweghị nchịkwa fractures nke ogologo ọkpụkpụ ma ọ bụ ọkpụkpụ azụ. Soreness na ọzịza nke nkwonkwo nwere ike ibido na-emeghe maka mgbaàmà nke ọrịa ogbu ogbu na nkwonkwo ma ọ bụ ndị ọzọ ọrịa. Ọkpụkpụ ọrịa - maka osteomyelitis. Mgbe leukemic infiltration nke articular Capsule na periosteum, obi na ụmị ọkpụkpụ akpụ amụba na olu na-egosi ọtụtụ ihe mgbu. N'otu oge ahụ na X-ray ahụrụ e ji mara nke enweghị nchịkwa mgbanwe. Karịsịa ha na-doro anya na anya nso nnukwu nkwonkwo na ogologo ọkpụkpụ. Soreness nwere ike ime mgbe e mesịrị n'ihi avascular necrosis na osteoporosis.
• Ụkọ ọbara. Na nnukwu ajọ ọrịa kansa ọbara, na-eme ememe tachycardia, pallor, na-agba ọbara nke mucous membranes ke inua, hemorrhagic syndrome na akpụkpọ. N'ihi igbu egbu na anaemia amalite adịghị ike.

daa ọrịa ediyarade

Na 5-30% nke ikpe nke isi nnukwu leukemia limfblastnogo ụmụ nwoke hụrụ mbụ testicular nditat. E nwere abụọ ma ọ bụ unilateral enweghi mgbu na ok infiltrates. Na omume, a ọkpụrụkpụ abawanye na kọrọ ikpe nke akụrụ. Na nke a, nwere ike ọgaghị adị na-adakarị ngosipụta nke ha meriri ha. Na-adịghị ahụkebe nsogbu gụnyere exudative pericarditis na myocardial infiltration nke Lymph mgbochi na ndabere n'etiti epicardium na endocardium. Na onye na-abawanye na Lymph na mediastinum nwere ike ime na-enwe nsogbu ndị ọrụ nke akụkụ okuku ume na usoro. Ndị a ji mara T-cell leukemia ụdị ebute ụzọ syndrome elu vena cava. Ọ nwere ike na-erukwa na akụkụ okuku ume ọdịda. Mgbe ụfọdụ e leukaemic infiltration nke akpa ume anụ ahụ ma ọ bụ hemorrhage na ha. Mgbe ụfọdụ, ndị ọkachamara na-na-esi ike di iche na data si nsogbu nke na-efe efe pathologies. Ihe ụfọdụ na-mgbaàmà nke anya mmebi na nnukwu ajọ leukemia ga-kwuru ọbara ọgbụgba na retina, edema ọnụ ara na optic akwara, vaskụla infiltration. Mgbe ophthalmoscopy nwere ike ahụrụ site e dere ede na ala nke nwa anya. Eleghị anya na-na ọnụnọ nke oké bluish infiltrative enweghi mgbu ọcha na akpụkpọ. Ọrịa nwere ike ime mgbe ọ bụla mmebi cover. Na nke a, ndị na-achọpụta ọrịa usoro nwere ike mata panaritiums, paronychia, oria ụmụ ahụhụ na-ata dị iche iche, punctures na m. P.

Paraclinical nnyocha: Oak

Haemoglobin nwere ike belata ma ọ bụ nkịtị. Hematocrit, na ọbara uhie cell ọnụ na-emekarị belata. Omume ya ọnụ ọgụgụ nke reticulocytes. White ọbara cell ọnụ nwere ike belata, mụbara ma ọ bụ nkịtị. Otú ọ dị, ọ na-adịghị ike na mkpụrụ ndụ nwere ike achọpụtara mgbe nile. N'ihi daa ọrịa e ji mara "leukemic ọdịda." Anyị na-ekwu okwu banyere ọnụnọ gbawara mkpụrụ ndụ na ndabere nke na enweghị n'etiti forms - metamyelocytes na myelocytes - n'ime ọbara usoro. Na-emekarị hụrụ thrombocytopenia.

myelogram

Nke a na usoro a na-ewere a ụmị ọkpụkpụ mgbapu. Ngere ihe onwunwe ga-mere si na ihe abụọ ihe. Usoro a rụrụ ọkacha mma n'okpuru general ná Nkụnwụ. Na ụmụaka okenye karịa afọ abụọ, a mgbapu na-e si n'ihu ma n'azụ ridges ilium ruo afọ 2 - si calcaneal tuberositi tibial agba ma ọ bụ ọcha. Cytological morphological nnyocha na-emekarị na-ekpughe hypercellular ụmị ihe onwunwe na narrowed puru na nkịtị hematopoietic usoro na infiltration nke fụrụ cellular owuwu.

cytochemical research

Nke a bụ otu n'ime ndị dị oké mkpa nkebi nke nchoputa. Iji cytochemical staining kpugheere nke a cell akara. Jide n'aka na-eme nnyocha na myeloperoxidase.

spinal tap

Ọ bụkwa amanyere bụ iwu na-achọpụta ọrịa usoro na-enyo enyo na nnukwu ajọ ọrịa kansa ọbara, ihe mere e kwuru n'elu. Cerebrospinal mgbapu ga-rụrụ n'okpuru ogwuura na na ikpe nke na ọnụnọ na elu ọbara nke dịkarịa ala 30 puku / ml platelet. Ọ bụrụ na ọ dị mkpa, tupu usoro a rụrụ mịnye trombovzvesi. Iji kwadebe tsitopreparat mkpa na ihe abụọ milliliters nke na-aba n'anya. N'elu nchọpụta nke ike ihe na ihe ịrịba ama nke mmebi cranial akwara chọpụtara neuroleukemia - leukemic CNS. Ọ ga-kwuru Otú ọ dị, na penetration n'ime ụjọ usoro nke lymphoblasts na infiltration nke meninges ime mgbe nile, ọbụna na-anọghị nke na-adakarị na laabu n'obiọma. Ọ bụkwa na-achọsi ike, na nchọpụta nke akwara ozi mgbaàmà, jide n'aka na-jide kọmputa ma ọ bụ nuclear magnetik tomography nke ọgidigi azụ ma ọ bụ na ụbụrụ.

ọzọ research

Site n'enyemaka nke ultrasound retroperitoneal ohere na peritoneal oghere nwere ike dee size nke parenchymal akụkụ abatawo, ikpọ Lymph ke afo na n'ebe ndị ọzọ, akụkụ ke pelvis, testicles. Dị ka akụkụ nke nchoputa bụ obi radiography abụọ projections. Nke a dị mkpa iji chọpụta-abawanye na mediastinum. Ebe gosiri, họpụtara X-ray nkwonkwo na ọkpụkpụ. Na Biochemical analysis a rụrụ n'ime laabu ọmụmụ. Ọ na-adịkarị na-egosi onye na-abawanye ukwuu karịa 500 LDH IU, gbochie ọgba aghara na ọrụ nke imeju na-na akụrụ. Tupu ịmalite na-anara ọgwụ na-atụ aro site echocardiography na ECG. Taa, ihe ndị ọzọ ụzọ, ke nje cell ọmụmụ eji a molekụla mkpụrụ ndụ ihe nketa na cytogenetic ụzọ kpebie ọnụ ọgụgụ nke chromosomes, nakwa dị ka bughi mgbanwe.

Ọgwụgwọ: Isi

N'ụkpụrụ bụ isi n'elu nke oge a na ụmụaka oncohematology kewara iche iche nke ọrịa na ọgwụ ike. Ọ na-ahọrọ dabere na ogo na nke na-esi na nnukwu ajọ leukemia. Prediction ala dịkwa mkpa. Ya mere, ihe atụ, ndị na-iwepụ daa ọrịa nnọọ agafeghị oke ọgwụ na-ike na-atụ aro na-enweta ihe na-egbu egbu na arọ ngwaọrụ. Ke adianade do, ndị ahụ e mere atụmatụ ịbụ lanarị ọnụego bụghị elu, na intensification nke na-eme nwere ike ịbụ a ohere nke mgbake. Mgbe nkewa n'ime otu ìgwè nke ndị ọrịa chọpụtara na ọrịa kansa ọbara, amụma a mere na ndabere nke tupu ahụmahụ, ma na onye na ogbugba ndu esịne ke labeling usoro. Onye ọ bụla n'ime ha na-kpụrụ otu ma ọ bụ ndị ọzọ na atụmatụ nke ọgwụgwọ omume nke a na-ike. N'okpuru ugbu a nhazi ọkwa nakweere a n'ozuzu nkwekọrịta na nkesa site n'ihe ize ndụ ìgwè nke ọrịa ndị na-a chọpụtara "nnukwu ajọ leukemia". Ọgwụgwọ nke ụmụ e mepụtara na mbubreyo sixties nke ikpeazụ nke narị afọ na America. Site na nnukwu, ụkpụrụ nke ọgwụgwọ si eme, na-agbanweela pụrụ iche mgbanwe. Na ọrịa n'okpuru afọ n'ịmụ banyere ọrịa na-egosipụta onwe ya na a nnọọ ike ike n'ụzọ na e ji neuroleukemia, leukocytosis.

Main ọgwụgwọ ụzọ

The ọgwụgwọ na-eji ọgwụ ọjọọ eme ihe ndị dị otú ahụ dị ka "Prednisolone" na "Vincristine". Ọ na-eji endolyumbalnoe iwebata pụtara "Methotrexate" na cranial irradiation maka igbochi neuroleukemia. Ọzọkwa, a pụrụ iche usoro ọgwụgwọ e mepụtara. Nke a pụtara na ihe niile ndị ọrịa na-enweta ụfọdụ doro anya onunu ogwu na n'ịgwa nke chemotherapeutic mmadụ na a kpọmkwem oge etiti, karị protocol. Site na njedebe nke seventies ọ bịara doo anya na mgbe Itie dị otú ahụ a usoro natara banyere 50% nke ụmụaka ndị e chọpụtara na-arịa ọrịa leukemia. Ihe mere maka inwekwu ọganihu na ọgwụgwọ nke ọrịa ndị na-definition nke heterogeneity nke nile na ekemende ewebata usoro mba cytological nhazi ọkwa na prognostic ihe, nkesa nke ọrịa na iche iche, na mmepe nke differentiated mmemme. Nke dị oké mkpa bụ na nzukọ nke multicenter nnyocha nke pharmacokinetics nke dị iche iche cytostatics maka a irè karị chemotherapeutic regimens, nakwa dị ka ngwa mmepe nke soro ihe.

Basic ụkpụrụ nke ọgwụ

Ekele na-eme ka akọwara n'elu, na mmemme e kere himiolecheniya ọgbọ ọhụrụ. Kasị ogbugba ndu-eji taa dabeere na ụkpụrụ nke mbụ kpụ ọkụ n'ọnụ ọgwụ, nzube nke nke bụ jirichaa mbibi nke a ọdọ mmiri nke ndiiche mkpụrụ ndụ. Na obi nke ihe e kere eke nke ọgwụgwọ ngwa usoro bụ n'ụdị n'ịgwa nke cytostatics, nke soje (adiana), elu-dose chemotherapeutic regimens, nakwa dị ka ọzụzụ kpụ ọkụ n'ọnụ na ọrịa mgbochi.

Atụmatụ nke ngwa nke preparations

Isi curative na mgbochi na intrathecal neuroleukemia bụ pụtara "Prednisolone" "Cytosar", "Methotrexate" (na Dosages dị ka afọ) na cranial irradiation. Nke ikpeazụ a rụrụ ná mmalite nkebi nke ọgwụ. Mgbe endolyumbalno ndinọ ọgwụ ọjọọ, "MTX" nwere a systemic mmetụta. Na nke a, iji belata akpụ uka ga-enwe n'oge nketa nke mbụ ọgwụgwọ lumbar mgbapu. Cranial irradiation nwere ime na kpọmkwem mmetụta. Na nke a, ọmụmụ na njikarịcha ALL ọgwụ, duziri taa, iji na mbenata dose na a doro anya oke nke ọrịa na ala n'ihe ize ndụ otu, n'ihi na nke radieshon ọgwụ bụ chọrọ. All ndị a rụzuru nwere mere ka o kwe na mbubreyo eighties nke ikpeazụ nke narị afọ dị njikere iji merie 70 percent mgbochi afọ ise lanarị ọnụego leukemia na ụmụaka na-enweghị nlọghachi.

Modern ọgwụgwọ mmemme

A ọgwụgwọ nke na-eji taa, na-agụnye ọtụtụ n'ụzọ. Nke mbụ bụ itinye n'ọkwa nke ngbaghara na atọ ma ọ bụ karịa mmadụ na-ndinọ maka 4-6 izu. Nke abụọ - na igba nke multi-gị n'ụlọnga nke gara aga na-adọ. Nke atọ - mmezi ọgwụ. Dị ka a na-achị, nke ikpeazụ na-adọ nke mgbochi metabolites eji maka 2-3 afọ. Kwado ọgwụ aka egbochi na-ewepu ọtụtụ nke nsogbu metụtara na rata cytopenia na immunosuppression. The mkpa itinye a mmezi ọgwụ maka 2-3 afọ a pụtara ọbụna n'etiti narị afọ gara aga. Nọmalị n'oge a ụbọchị ọ bụla na-enwe ndidi na-ewe ọgwụ "6-Markaptopuriin". Kwa izu, ọ na ẹkenam a n'aka "Methotrexate". Dabere na ọnụ ọgụgụ nke mkpụrụ ndụ bụ set onunu ogwu. Practice na-egosi na ọrịa na-eju afọ tolerability nke a ọgwụgwọ Usoro. Ogbugbu nke na-eme na-akwado site na 80% nke chọrọ olu-atụle ga-a ogbenye prognostic akpata nlọghachite.

Maka ozi ọzọ,

E nwere ọtụtụ nsogbu na ọgwụgwọ nke nile. Karịsịa, ihe ọtụtụ nke ọrịa na mutated akpụ cell clones eguzogide ọgwụ, elu na-eri na omume nke mbubreyo mmetụta (neuroendocrine ọrịa, uto nke abụọ etuto ahụ). The ọdịda nke itinye n'ọkwa ọgwụgwọ nke ọrịa n'ihi na n'oge ọnwụ n'ihi na-egbu egbu nsogbu ma ọ bụ akpụ eguzogide ọgwụ. Ọzọkwa arịasi obibia nke ọgwụ ndị ọrịa na-adịghị azaghachi usoro ọgwụgwọ. Dị ka onye ọzọ n'aka na-eji ndị dị otú ahụ dị ka "Teniposide" "Vepeside" "Cytosar". Taa banyere 70% nke ụmụ nwere a 5-afọ kwụsịtụkwara. Nnukwu ajọ leukemia okenye abịaghachikarị na asaa ọ bụla ikpe. Nke a na-egosi na oge nke oge nke ngbaghara-ekwe omume inwe naanị 20% nke ikpe. Dị ka a na-achị, nloghachi nke daa ọrịa hụrụ mbụ 2 afọ mgbe nchoputa. Ngbaghara ọnọdụ ji dị ka a enweghị ike na mkpụrụ ndụ ọbara, ọnụnọ nke na-erughị 5% fụrụ na ụmị ọkpụkpụ anụ ahụ, ọdịdị nke ihe ịrịba ama nke mgbake nke hematopoiesis norm. Na analysis of cerebrospinal ọmụmụ kpughere erughị 5 mononuclear mkpụrụ ndụ / microliter. N'ihi na ihe ịga nke ọgwụgwọ ngwa nweta nke ngbaghara ọnọdụ. Na 90% nke ọrịa ndị na-emekarị ndiiche mkpụrụ ndụ ndị chọrọ nlezianya ka anara ọgwụ.

Ná mmechi

Ebumnobi bụ isi nke ọgwụ bụ tufuo ọrịa daa ọrịa na ya laghachi a nkịtị na-elekọta mmadụ ndụ na ezi ahụ ike na a kacha nta nke nsogbu mere site na ọgwụgwọ. Iji mezuo ya nnọọ ike taa. Nke a bụ n'ihi na eziokwu na ọtụtụ n'ime antileukemic ọgwụ adịghị nnọọ nhọrọ na-egbu egbu. Otú ọ dị, Ọganihu na nghọta nke-adakarị na ndu heterogeneity nke ọrịa, nọgidere na-eduzi dị iche iche ọmụmụ enye olileanya na molekụla pathogenesis nke ọrịa ka ga na-kọwara ruo mgbe ọgwụgwụ. Na nke a, ihe ọmụma nke usoro nke ịza mgbanwe ga-enyere ịzụlite irè karị na-erughị na-egbu egbu usoro ọgwụgwọ.