Lesi sifo sithinta kakhulu abantu asebekhulile, izigameko eziphakeme ziwela eminyakeni engama-60 kuya kwengu-80. Eminyakeni yamuva, kodwa idatha eyesabekayo yanikezwa ukwanda kwemvamisa yesifo esiqenjini lesikhathi esiphakathi (iminyaka engu-30-50). Izindlela zanamuhla zokwelapha umdlavuza osondelene kakhulu namuhla kulesi sihloko.
I-Geography yesifo
Ukuqhathaniswa okukhulu komdlavuza we-esophageal emazweni aseYurophu naseNyakatho Melika kubonakala eFrance. Kwezinye izindawo zomhlaba, okungukuthi engxenyeni esenyakatho yeChina, eTranskei (eningizimu ye-Afrika), kanye nasenyakatho-mpumalanga ye-Iran, lesi sifo singabhekwa njengento ejwayelekile, ngoba kuzo zonke izikhathi izikhathi ezingu-20-30 ziphakeme kunaseNtshonalanga.
Izingozi ezibangelwa umdlavuza we-esophageal zifaka:
• ukubhema nokubhema nogwayi;
• Ukusetshenziswa kabi kotshwala - ezindaweni ezithile zomhlaba, iziphuzo ezidakayo zendawo, ngenxa yokwakhiwa kwazo noma indlela yokwelapha, zithande ukuthuthukiswa kwesisu;
• ukungondleki - ukungeneli okwanele kwamavithamini athile kanye nezici zokulandelela, kanye nezithelo nemifino, kunciphisa izinga lezici ezivikelayo;
• izinto ezibonakalayo - ukushisa okushisayo ngokudla nokuphuza kakhulu; ukunamathela kokudla okwesibhakabhaka nama-pickle, okuchaza izici zendawo yokudoba.
Izifo zesifo
Izimo ezihlukahlukene ze-pathological of the esophagus zibhekwa njengezicabangela zengozi, kufaka phakathi:
• I-Achalasia - ukwephulwa komsebenzi we-motor ngenxa yezokubhujiswa kwezakhi zezinzwa emdongeni;
• Ukuvuvukala okungajwayelekile kwe-mucosa ye-esophagus ngenxa yokukhipha emuva kokuqukethwe kwe-esiswini;
• Isisindo sikaBarrett - ukuguqulwa kwamaseli avamile engxenyeni engezansi ye-esophagus zibe amangqamuzana ohlobo lwesisu; lesi sifo sandisa ingozi yesifo somdlavuza we-esophageal izikhathi ezingu-40;
• I-Plummer-Vinson syndrome - isimo sihlotshaniswa
Izinhlobo ezimbili ezibalulekile zomdlavuza we-esophageal ziyaziwa:
• i-squamous cell carcinoma ifomu elivame kakhulu (amacala angaphezu kwama-90%);
• I-Adenocarcinoma - isanda kuhlangana kaningi (kuze kube ngu-8%).
Ukubonakaliswa kwemitholampilo
I-tumor ingakhula ibe yi-lumen yesifo se-fungus (umdlavuza we-polyp - amacala angama-60%), ingaba nokubonakala kwezilonda (25%) noma ihlume izindonga ezingenasifo (umdlavuza ohlasela). Umdlavuza we-Esophageal ubonakala ngokukhula okukhukhumezayo nokusabalalisa kwangaphambili (ngaphakathi kwe-thoracic cavity) nasezikhungweni ezikude ngokusebenzisa izitsha zegazi nezethempeli. I-foci ejwayelekile kakhulu yokuqothula isisu ivela esibindi namaphaphu. Amaphesenti angaba ngu-75% ngesikhathi sokuxilongwa komdlavuza we-esophageal anezibalo zokuphila.
Isibikezelo
Ukubikezelwa kwesifo, ukutholakala noma ukungabikho kwe-metastase kubalulekile. Umngcele weminyaka emihlanu utholakala ngaphansi kweziguli ezingaphansi kwezingu-3% ezinezifo ezincane zesibhamu, nakuba kungabikho kwamamitha ayisithupha (40%).
Izimpawu
Ukukhononda okuyinhloko kweziguli kuqhubeka ngokuqhubekayo kwedysphagia (ukuphulwa kokugwinya). Ekuqaleni, ukuzwa "kokunamathela" kokudla uma kungenwa kungabonakala ngezikhathi ezithile. Kancane kancane kunzima ukudlula ukudla okuqinile okuqala, bese kuthiwa uketshezi, kuze kugcine isiguli singakwazi ukugwinya ngisho namathe. Ezinye izimpawu:
• ukulahlekelwa kwesisindo;
• ubuhlungu esifubeni;
• i-dysphagia (ubuhlungu lapho igwinya);
• ukuhlanza ngokuxubana kwegazi (isibonakaliso esingavamile).
Ngenxa yeziguli asebekhulile ezinomdlavuza we-esophageal, ubuhlungu besifuba bungaphutha nge-cardiac. Ngezinye izikhathi iziguli ezihlolwe isifo senhliziyo zitholakala ukuthi zinesifo sokuqeda amandla. Inhloso yocwaningo ukucacisa izinga lokukhula kwe-tumor kanye nokuthi kungenzeka yini ukukhishwa kwayo. Izifundo ezilandelayo zenziwa.
• Qhathanisa i-rayography. Isiguli sithatha ngaphakathi kwe-agent ehlukile (ngokuvamile i-barium) ebonakalayo kuma-X-ray. Umdlavuza we-Esophageal ngokuvamile unesimo esibuciko kakhulu kuma-radiographs.
• I-Esophagoscopy. Ukuhlolisiswa kwendawo yangaphakathi yesiguli ngosizo lwe-optical fiber endoscope kudlala indima ebalulekile ekuxilongweni, ngoba kuvumela ukuthatha izinto ezivela endaweni esolisayo kuya kwi-biopsy. Ucwaningo oluthile lwalolu daba lunikeza uhlobo lwe-neoplasm futhi, uma kwenzeka lubulawe, luveza uhlobo lwesisu. I-esophagoscopy ibuye ivumele ukusetha indawo yangempela ye-tumor - engxenyeni engenhla, ephakathi noma ephansi yesithathu.
• I-CT scan yezintambo ze-thoracic kanye nesisu. Inhloso yalolu cwaningo ukucacisa ukuba khona kwamathambo, isibonelo, esibindi noma emaphashini, kanye nokulimala okwesikhashana kuma-lymph nodes. Ukutholakala kwe-metastases, njengombuso, kubonisa ukuthi i-tumor engasebenzi.
• I-bronchoscopy. Ukuhlolwa kwe-endoscopic yendlela yokuphefumula kwenziwa ngokusola kokusabalalisa kwe-tumor emaphashini. Esikhathini sokuqala sokuthuthukiswa kwesisu, indlela enhle yokwelashwa yindlela yokwelapha. Kodwa ezimweni eziningi, ngeshwa, kufanele sizinciphise ngokweqile ukwelashwa okulula. Ukusabalala kwe-tumor ngaphezu kwe-patient iningi leziguli akubandakanyi ukuthi kungenzeka yini ukwelashwa. Uma lesi sifo singabanjwanga esiteji sokuqala, ukwelashwa okuhlinzekwayo kuphakanyiswa, kuphela enani elincane leziguli.
Ukwelashwa Okunama-Palliative
Ukwelashwa kwe-palliative yomdlavuza we-esophageal kuhloswe ukunciphisa izimpawu futhi kuhlose ukubuyisela ikhono lokugwinya. Ngokuvame ukwenzeka ngaleyo njongo intubation of the esophagus yenziwa, okungukuthi, isikhungo tube ekhethekile (stent) egcina lumen yayo evulekile, okuqinisekisa ukuhamba kokudla namanzi. I-stent iqalwe ngaphansi kokulawulwa kwe-radiological ku-anesthesia yendawo noma isebenza nge-anesthesia. Ukuhlinzwa okubizwa ngokuthi i-esophagectomy noma i-esophagogastrectomy kuhilela:
• ukususwa kwendawo yonke, ngaphandle kwengxenye ephezulu, kanye nesigaba sokuqala sesisu ngokubambisana nezicubu ezizungezile kanye nama-lymph nodes;
• Ukubuyisela ubuqotho bethubhu yokugaya ngokuhlanganisa ukuhlala kwesisu nesigaba esiphezulu (esingenhla) se-esophagus - ngokuvamile esenziwa ezingeni eliphansi lesithathu entanyeni.
Ukufinyelela okuhlinzekwayo kunikezwa ngokunqunywa ngakwesokunxele kwesifuba (thoracotomy eseceleni kwesokunxele), engxenyeni efanele (thoracotomy ehlangene kwesokudla), ngokuvula isisu esiswini (laparotomy) noma ngokuhlanganisa zonke izinketho ezintathu. Ngokuvamile kunesidingo sokwakha ukufakwa okungeziwe ngakwesokunxele kwentamo. Okunye okukhethwa kukho ukwelapha okuhlinzekwa ngokuyisisekelo kunamaphilisi. Iningi lesifo esithintekayo umdlavuza yiziguli ezikhulile ezisesimweni esibucayi ngokwemvelo yesifo esiyisisekelo.
Isibikezelo
Isibikezelo seziningi zeziguli asihambisani neze. Iziguli ezingama-80% ezingenakwenzeka umdlavuza zingakapheli unyaka ngemuva kokutholakala kwayo, kungakhathaliseki ukuthi zinjani izinyathelo zokwelapha. Phakathi kweziguli ezihlinzwayo, umphumela unqunywa usayizi nokusabalalisa kwe-tumor, uhlobo lwe-hertological kanye nezinga lokuzibandakanya kwama-lymph nodes. Esikhathini sokuqala somdlavuza we-esophageal, isilinganiso seminyaka emihlanu sokusinda singama-30-40%. Uma sekutholakala isikhathi eside, ukufa kufana nalokhu kweziguli ezine-tumor engasebenzi. Lapho ebuzwa, kwacaca ukuthi lo mzwa ubewukhathaza isiguli izinyanga ezimbili kakade. Ekuqaleni wazama ukunqoba ukuhlukumezeka ngokushintsha uhlobo lokudla okunomdla wokudla okuneziqu ezimanzi nezama-liquid.