Pamberi, Mukati, uye Pashure Pokuvhiya Kwechirwere Adenoma
Iyo plandishi gland inokosha zvikuru asi chiduku chiduku chemuviri uri pasi peuropi. Izvi zvinoshandiswa seglandu nokuti inovhara mahomoni muropa rekudzivirira kutakura mabasa anokosha emuviri, kusanganisira kubereka, kukura pakunamuka kwevana nekushanda kwetachiona. Iko plandishi gland ndiyo inonyanya kukosha gland mumuviri wemunhu nokuti inoita zvinhu zvakawanda panguva imwechete.
Iko pituitary gland inodzivirira mahomoni matanhatu akasiyana:
- Thyroid Inokurudzira Hormone (TSH): Inodzora basa rehutachiona hweganda
- Adrenocorticotropic Hormone (ACTH): Inokurudzira grenal adrenal kusunungura adrenalin
- Nyorera Inokurudzira Hormone (FSH): Inotanga basa mukuyaruka uye kubereka
- Luteinizing Hormone (LH): Inobatsira kudzora kubereka uye kukura kwepabonde
- Growth Hormone (GH): Kudzora kukura kwemuviri panguva yehuduku nekuyaruka
- Prolactin (PRL): Inodzora kubudiswa kwemukaka wemukaka mushure mekuberekwa
Zvizhinji zveganda zvinodzivirira imwe hormone, saka pituitary haina kujairika nekuda kwezvose zvakaoma zvebasa rayo uye nzvimbo yayo yakasiyana muuropi, iri shure kwemhino.
Handizvo chete chirwere chepituitary chinochengetedza mahomoni matanhatu akasiyana, mamwe mahomoni anoronga mamwe mazino-kusanganisira utachiona-saka kuchinja kwebasa repituitary gland kunogona kukanganisa utano hwehupenyu uye hutano hwakanaka.
Kusabatanidzwa kweHormone, kungave kwakabva gland repituitary kana imwe nzvimbo yomuviri, inowanzobatwa ne endocrinology. Endocrinology ndiyo inyanzvi yezvehutano inobata nhau dzehomoni, kusanganisira zvinetso zvepituitary nezvimwe zvinetso zvehomoni zvakadai sechirwere cheshuga.
Pituitary Tumor
Rudzi rwakawanda kwazvo rwepituitary tumor ndiro adituoma yepituitary, chirwere chisiri chekenza chinowanikwa pamucheka wepituitary.
Kune dzimwe mhando dzemakumbo kupfuura zvingaita, asi adenoma ndiyo inowanikwa zvikuru.
Pituitary adenomas inorongwa nenzira dzakawanda. Vane urombo (kwete kenza), anowedzera adenoma, kana kenza. Chirwere ichi chinogona kuva chiremera chekunyora, zvinoreva kuti chirwere chinovhara mahomoni, kana zvingave zvisina. Izvo zvinoshandiswa se macroadenoma kana iine masentimita kana kupfuura muhukuru uye inofungidzirwa kuti microadenoma kana iri duku kudarika masentimita.
Kune dzimwe mhando dzezviremera zvinogona kuitika pituitary, asi dzakawanda dzinowanikwa uye zvisingaiti uye kuvhiyiwa kunoitwa nenzira yakafanana kune nzira dzinobata adenomas.
Kuongorora Chiremera Chechiremera
Zvironda zveputi zvinowanzoongororwa mushure mekunge dambudziko rinoratidzika risina kukonzera rinotungamirira kuongororwa kwechirwere ichi chechirwere. Somuenzaniso, musikana muduku asati amboita mwana angatanga kubudisa mukaka wemuzamu uye maitiro anobatsira angangodonongodza tumorori sechikonzero chechinetso.
Izvozvo zvakati, zvipembenene zvakawanda zvinonzi "incidentalomas" pazvinowanikwa kwete nekuda kwezviratidzo kana matambudziko, asi panguva yebasa kune chimwe chinhu. Muchiitiko ichi, tumori yepituitary inogona kuwanikwa panguva yeC CT kuongorora kwehuropi huri kuitwa nokuti murwere akaenda kune imwe nzvimbo yekukurumidzira kuti awane chirwere.
Muchiitiko ichi, pakanga pasina nyaya kana zviratidzo zvichibva kune adenoma, uye zvingave zvisati zvambowanikwa kana CT scan yakanga isati yaitwa.
Zviratidzo zveMunhu Ane Chiremera
Izvi zvinotevera zviratidzo zvinogona kuitika kana iwe une tumor yepituitary:
- Musoro wemusoro unogara usingagumi uye unogona kukura kupfuura nguva
- Acromegaly , mamiriro ezvinhu anokonzerwa nekuwedzera kwehomoni shure kwekuwanda kwevanhu vachirega kukura, zvichiita kuti maoko nemaoko makuru kwazvo, uye kana zvisati zvarapwa, maziso akaoma. Apo huwandu hwakawanda hukura hunobudiswa mukati memakore ekuyaruka, gigantism-yakanyanya kure-inogona kuguma.
- Hypopituitarism , chiitiko chinokonzera kuwedzera kukura muvana
- Cushing's syndrome , mamiriro ezvinhu anogona kukonzerwa neAACTH yakawanda kubva pituitary, kazhinji inokonzera chiso chakakomberedza uye hump pakati pemapfudzi.
- Chirwere cheAdisonison, chirwere chinokonzerwa neCTHTH duku
- Vision inochinja
- Mukaka wepabonde mumukadzi asina kubereka
- Kuenda kumwedzi kunogona kunge kusina kukwana kana kusipo
- Maitiro anofamba
- Infertility
- Erectile dysfunction
- Weight changes
- Kushushikana kwokuneta kwokuneta
- Utachiona hweHyroid hwakawanda kwazvo kana hwakadzika
Apo Chiremba Kuvhiya Kunokosha
Pituitary adenomas yakajairika zvikuru, uye vakawanda sevamwe muvatanhatu vatanhatu vane adenoma duku iripo mune gland pituitary pane imwe nguva muupenyu hwavo. Nenguva isipi, chirwere chinokonzera matambudziko ehutano chakanyanya kurera, uye chinenge chikamu chimwe chepituitary adenoma kusvika kune chikuru chinokonzera zviratidzo.
Varwere vakawanda vane adenoma yepituitary kana kuti mamwe maitiro ebenzi ane tumor vanogona kudzivisa chirwere. Kune varwere vane pituitary adenoma isingakonzeri matambudziko uye inoda mishonga, chirwere chirwere chisina kufanira. Vamwe varwere vanogona kudzivisa kuvhiyiwa nokutora mishonga inodzora mahomoni anokonzerwa nechirwere chepituitary.
Vanhu avo vanonyanya kudikanwa kupindira kwekuvhiya ndevaya vasina kupindura zvakanaka nemishonga, kana kuti vane matambudziko makuru nekuda kwechirwere. Aya matambudziko anogona kusanganisira kuchinja kana kurasikirwa kwemaonero, misoro yakakomba, kana zvimwe zvehutano zvinokonzerwa nekusaenzana kwehomoni.
Ngozi dzePituitary Surgery
Mukuwedzera kune njodzi dzinowanzobatanidzwa nekuvhiya uye njodzi dzeanesthesia, kuvhiyiwa kubvisa chirwere chepituitary kune ngozi dzakasiyana. Iyo yakaipisisa zvikuru yezviitiko izvi inokonzerwa nekusaenzana kwehomoni kunokonzerwa nekuvhiringidzika kune gland pituitary munguva yekuita. Kukuvadza kune gland kunogona kukanganisa chero ipi zvayo kana kuti mahomoni matanhatu anokonzerwa nehutu hwepituitary, uye inogona kutungamirira kumamiriro ezvinhu akaoma anogona kukonzera nhau dzehutano munzvimbo zhinji dzomuviri.
Zvimwe zvingaitika zvinogona kuitika mushure mekuvhiyiwa kwechiremba zvinosanganisira:
- Chirwere cheshuga insipidus: Chinokonzerwa nekusawirirana kwehomoni, izvi zvinokonzera muviri kubudisa muto wakakura kwazvo, zvichiita kuti mvura isakanganise, nyota, uye, mumatambudziko akaoma, kushaya mhirizhonga.
- Mvura yepamuviri inoputika: Zvinogoneka kuti maruva emusipinha adedzere kubva mumhino mushure mekuvhiyiwa kwepisiphenoidal. Ichi ndechokuti gomba rakakandwa mufupa mushure meganda remvura kuti chibvumirano chiitwe. Kana iyo yakasvibiswa glue inoshandiswa "kuisa" gomba haifaniri kuzadza zvizere nzvimbo yacho, murwere achaona mhino inodonha, zvakadai semasukisi akajeka aripo nechando.
- Sinasi musoro wepamusoro: Kuora musoro mushure mekunge rudzi urwu rwekuvhiya rwakawanda kwazvo, uye rinowanzotsanangurwa sehutano hwetachiona.
- Nasal kudyidzana: Zvinotarisirwa kuti ndima dzemapapiro dzichazadzwa mushure mekuita izvi, uye kusangana uku kunowanzovapo kwevhiki kana maviri mushure mekuita. Muzviitiko zvakawanda kusanganiswa kunozovandudza zvakanyanya munguva yekudzikinura nguva, uye kazhinji inoguma yezvipembenene zvinopisa zvinokanganisa maviri akaoma mukati memhino.
- Meningitis: Utachiona hutachiona hunowanzoitika pashure pokuvhiyiwa kweuropi, sezvo chirwere chinowedzera ngozi yebhakitiriya inosvika muuropi.
Pamberi Pechipatara Surgery
Usati wambovhiyiwa pane chirwere chepituitary iwe unogona kutarisira kuva neC CT scan, MRI, kana kuti zvimwe zviri zviviri zvakaitwa kuti uongorore ukuru uye chimiro cheganda uye chiremara. Kuongorora mabhuku kuchavawo chikamu chekuongororwa kwedambudziko, uye dzakawanda dzematambudziko aya dzinogona kudzokororwa vasati vavhiyiwa kana bundu iri riri kukonzera kusaenzana kwehomoni. Aya ma-labs okuvhiya asati aita achagadzira nheyo yepamusoro yekuenzanisira mushure mekuvhiyiwa kwapera, uye kunogona kubatsira kusira kana chirwere ichi chakaguma nekuvandudza.
Pituitary Tumor Surgeries
Kuvhiya kubvisa tumarara yepituitary inowanzoitwa neurosurgeon, chiremba anovhima anonyanya kurapa kushungurudzika kwenheyo yenheyo, iyo inosanganisira uropi uye musana. Mune zvimwe zviitiko, chirwere chinonzi chirwere cheET (nzeve, mhuno, nehuro) chinogona kuva chiremba kana chikamu chechikwata chekuvhiya. Kuvhiyiwa kunoitwa pasi peanesthesia , iyo inopiwa neanesthesiologist kana mukoti anesthetist (CRNA).
Nemhaka yenzvimbo yakasiyana yehutu hwepituitary mukati mehenya asi kunze kweuropi, pane nzira mbiri nzira inogona kuitwa.
Transphenoidal Approach
Nzira inonyanya kufanana nehutu hwepituitary inobviswa ndiyo nzira inonzi transsphenoidal, apo chiremba anovhiya anoisa zviridzwa kuburikidza nemhino uye gomba rinoshandiswa muchirimusi chinosara pakati pemutsipa uye neuropi. Kuisa gomba mufupa rino, rinonzi sphenoid bone, rinobvumira zvakananga kusvika kune planditary gland.
Kuti zvive zvakajeka, chirwere chepituitary chakabatanidzwa neuropi, asi chinosara pamucheto wepfungwa. Izvi zvinobvumira gland kuti iwanikwe kuburikidza nemhino. Nzira yacho inoshandisa endoscope, iyo inogadziriswa yakaipira tube ine chiedza, kamera uye zviduku zviduku mukati. Endoscope inowanikwa uye chiremba anovhiya anokwanisa kutarisa mifananidzo pane kuongorora. Zvishandiso zviduku mukati mechipfuva zvinoshandiswa kuderedza zvisikwa zvisingadiwi kure.
Muzviitiko zvizhinji, huwandu hwakanyanya hunoonekwa huripo mberi kwekuvhiyiwa pamwe chete nemichina yakashandiswa inoshandiswa panguva iyo nzira inobatsira chirwere chiremba kunzira yakajeka kuenda kune gland pituitary. Imwe nzira iyo yakazaruka, zviduku zviduku zvinonzi curettes zvinoshandiswa kubvisa zvisingadiwi zvipembenene.
Kana imwechete yechipfuva ichibviswa, chiduku chiduku chemuviri chinoshandiswa munzvimbo inenge yabviswa gumbo racho, uye chiremba anovhiya achavhara gomba rakagadzirwa mumapfupa nemapfupa emapfupa, chirongwa chekuvhiya chisina kuchena kana maviri. Muzviitiko zvakawanda, mhino dzichave dzakasununguka kuti dzidzivirire kuvhara kubva pakuvhara zvachose kubva pamapapiro aya.
Craniotomy Approach
Iyo nzira inoshandiswa pakuvhiya kwepituitary iri kuburikidza ne-craniotomy, uko chikamu chedehenya chinobviswa kuti chiwane huropi zvakananga. Iyi nzira yakanyanya kudarika, uye inowanzoshandiswa kana chirwere ichi chisati chiri chekutanga kuitirwa gland pituitary. Inogonawo kushandiswa kana pane dambudziko rinokonzera kuberekwa kwepinja mumvura mushure mokutanga nzira yepituitary gland.
Munguva iyi chirwere chekuvhiya, chirongwa chinotanga mushure mezvimbo iyo kuiswa kwacho kuchave nekuveurwa kwebvudzi uye chigadzirwa chesimbi chinoiswa pedyo ne temberi kuitira kuti musoro ugare huripo. Iko kusanganisa kunogadzirwa mucheka uye ganda rinosvinudzwa kuti rizarure dhehenya apo masango maduku anonzi burr mashizha akadonhedzwa munzvimbo mbiri dzehenya. A saw ikozvino inoshandiswa kubatanidza mabhuni maviri, zvichiita kuti musanganiswa wembatya wakave wakagadzirirwa pfupa rakanyatsobviswa uye kuiswa pachigarire panguva iyo. Chifukidzo cheuropi, chinonzi dura, chinovhurwa uye uropi hunokwanisa kuonekwa.
Kana imwe nguva uropi huri pachena, chigadziro chinonyanya kushandiswa chinoshandiswa kunyatsonyatsogadzirisa uropi huchibvumira kupinda mukati meuropi apo gland rekuputi rinosara. Chiremba anovhiya anogona kuona zvakajeka gland uye anogona kushandisa zvishandiso zvakaitwa mumaoko.
Kana imwe nzira yapera, chikamu chedehenya chinogona kushandiswa uye chinosungirwa ipapo ne glue kana chinenge chichichengetwa mufiriji chaiyo kuitira kuti ichatsiviwa pane imwe nguva inotevera. Ganda rekatsva rinovharwa ne staples kana glue.
Pashure pekuchengetedza chirwere
Vazhinji varwere vachapedza zuva rimwe chete kana maviri muhutano hwepfungwa kana hwekuvhiya zvakanyanya pakuongorora zvakapedza mushure mekuvhiyiwa. Munguva iyoyo vashandi vachabhadhara zvakanyanya kuongororwa kweropa kuti vaone kana chirwere ichi chakabudirira mukuderedza kusaenzana kwehommone, uyewo kunyatsocherechedza urine zvakagadzirwa kuti aone kana chirwere ichi chakakonzera chirwere cheshuga insipidus. Iwewo uchatariswa zvakanyatsonaka nokuda kwekudonha kwepasina kana mhuno inoputika, iyo inogona kuva chiratidzo chokuti chigadziro chekuvhara gomba mufupa re sphenoid chakanga chisina kukwana zvachose cerebral spinal fluid.
Pashure pezuva rimwe kusvika kwemaviri muI ICU, murwere anogona kuendeswa kune imwe nhanho-pasi kana pasi pasi pachipatara. Vakawanda vanorwara vanogona kudzokera kumusha mazuva matatu mushure mekuvhiyiwa nemirairo yakasimba kuti varege kuputira mhino dzavo uye mirayiridzo yekuti vangatarisira sei kuiswa pamimba yavo.
Vazhinji varwere vanogona kudzokera kune huzhinji hwemabasa avo ezvisikwa mavhiki maviri mushure mekuvhiyiwa. Mimwe miitiro inogona kuwedzera kusagadzikana kwepfungwa (kukudzwa mukati meuropi) zvakadai sekusimudza muviri, kudzidzira kunetsa, kupfugama, nekusimudza kunofanira kudzivirirwa kwekanguva mwedzi mushure mekuvhiyiwa, asi mabasa akaita sekushanda padhesiki, kufamba uye kutyaira kazhinji zvinogoneka pavhiki mbiri.
Kwemavhiki ekutanga okudzikinura ndeyekuti inowanikwa mishonga inorayirwa kuti inopiwa nokuda kwekutambudza . Zvimwe mishonga inowanzopiwa kuti isapedze kubatwa , sekunyora pasi kuti kuve nekufamba kwechirwere kunogonawo kuwedzera kusagadzikana kwechisimba uye kunofanira kudziviswa. Iwe unogona kuwana mushonga unoderedza kusvibiswa kwemanzi nekudzivirira.
Munguva ino, zvakajairika kuti utye kuneta, kumisa kusanganisa uye sinus type headache. Zvakakosha kuudza zvinotevera kumushandi wako: chirwere chinoputika kana mhepo inopisa isingaregi, fivha, chills, kunyanya kunyura, nenyota yakanyanya, misoro yakaoma, uye mutsipa wakaoma unodzivirira chinetso kubva pakubata chifukidzo.
Zvaunotevera zvinoshanya zvinogona kuitika neuroseurgeon yako, ENT kana zvose. Iwe unogona kutarisira kuva neropa rekuedzwa rakaitwa kuti urambe uchichitevera kufambira mberi kwako uye kuti uone mishonga ipi yaunoda, kana iripo, kana wapora.
> Kwakabva:
> Kuparadzenoidal Chirwere Mibvunzo: Murairo Murwere. Neuroendocrine uye Pituitary Tumor Clinic Center. https://pituitary.mgh.harvard.edu/TranssphenoidalSurgery.htm