Cishe u-1.2% wabantu bazotholakala benomdlavuza wegilo ngesikhathi sokuphila kwabo. Eminyakeni engu-40 edlule, ngenxa yokusetshenziswa kabanzi kokuthwebula izithombe kanye nokwethulwa kwe-biopsy yokubhoboza inaliti, izinga lokutholwa komdlavuza wegilo liye landa kakhulu, futhi izinga lomdlavuza wegilo liye landa ngokuphindwe kathathu. Ukwelashwa komdlavuza wegilo kuthuthuke ngokushesha eminyakeni eyi-5 kuye kweyi-10 edlule, ngezinqubo ezintsha ezahlukahlukene ezithola imvume yokulawula.
Ukuchayeka emisebeni ye-ionizing ebuntwaneni kwakuhlotshaniswa kakhulu nomdlavuza we-papillary thyroid (amacala angu-1.3 kuya kwangu-35.1 / iminyaka engu-10,000 yomuntu). Ucwaningo lweqembu olwahlola izingane ezingu-13,127 ezingaphansi kweminyaka engu-18 ubudala ezihlala e-Ukraine ngemva kwengozi yenuzi yaseChernobyl yango-1986 yomdlavuza wegilo bathola ingqikithi yamacala angu-45 omdlavuza wegilo onengozi eyengeziwe ye-5.25/Gy yomdlavuza wegilo. Kukhona futhi ubudlelwano bokuphendula umthamo phakathi kwemisebe ye-ionizing kanye nomdlavuza wegilo. Lapho bebancane ngeminyaka okwatholwa ngayo imisebe ye-ionizing, aba makhulu amathuba okuba nomdlavuza wegilo ohlobene nemisebe, futhi le ngozi yaqhubeka cishe iminyaka engu-30 ngemva kokuchayeka.
Izinto eziningi ezibeka engcupheni yomdlavuza wegilo aziguquki: iminyaka, ubulili, uhlanga noma ubuzwe, kanye nomlando womndeni womdlavuza wegilo yizibikezelo zengozi ezibaluleke kakhulu. Uma umdala, izinga lokusinda likhuphuka futhi liyancipha izinga lokusinda. Umdlavuza wegilo uvame ngokuphindwe kathathu kwabesifazane kunabesilisa, izinga elihlala likhona emhlabeni wonke. Ukuhlukahluka kofuzo emugqeni wamagciwane angama-25% eziguli ezine-medullary thyroid carcinoma kuhlotshaniswa ne-syndromes ye-endocrine tumor syndromes ezuzwe njengefa uhlobo 2A no-2B. I-3% kuya ku-9% yeziguli ezinomdlavuza we-thyroid ohluke kahle zinefa.
Ukulandelwa kwezakhamuzi ezingaphezu kwezigidi ezingu-8 eDenmark kubonise ukuthi i-non-toxic goiter nodular ihlotshaniswa nengozi eyengeziwe yomdlavuza we-thyroid. Ocwaningweni lwe-retrospective cohort lweziguli ze-843 ezihlinzwa i-thyroid ngenxa ye-nodule ye-thyroid ehlangene noma emibili, i-goiter, noma isifo se-autoimmune yegilo, amazinga aphezulu e-serum thyrotropin (TSH) angaphambi kokuhlinzwa ahlotshaniswa nomdlavuza we-thyroid: i-16% yeziguli ezinamazinga e-TSH angaphansi kwe-0.06 mIU / L zathuthukiswa umdlavuza we-thyroid we-thyroid, kuyilapho i-TSH / 52% yomdlavuza i-TSH.
Abantu abanomdlavuza wegilo ngokuvamile abanazo izimpawu. Ucwaningo lwe-retrospective lweziguli ze-1328 ezinomdlavuza we-thyroid ezikhungweni ze-16 emazweni we-4 lubonise ukuthi kuphela i-30% (183 / 613) enezimpawu zokuxilongwa. Iziguli ezinesisindo sentamo, i-dysphagia, ukuzwa komzimba wangaphandle kanye ne-hoarseness ngokuvamile zigula kakhulu.
Umdlavuza wegilo ngokwesiko uvezwa njengenodule yegilo ezwakalayo. Isigameko somdlavuza wegilo kumaqhuqhuva aphathekayo kubikwa ukuthi singaba ngu-5% no-1%, ngokulandelana, kwabesifazane nabesilisa ezindaweni ezine-iodine eyanele emhlabeni. Njengamanje, cishe u-30% kuya ku-40% womdlavuza wegilo utholakala nge-palpation. Ezinye izindlela zokuxilonga ezivamile zihlanganisa izithombe ezingezona ezegilo (isb, i-carotid ultrasound, intamo, umgogodla, nesifuba sokuthwebula); Iziguli ezine-hyperthyroidism noma i-hypothyroidism ezingazange zithinte ama-nodule zithola i-ultrasound ye-thyroid; Iziguli ezinezigaxa ze-thyroid ezikhona ziphindaphindiwe nge-ultrasound; Ukutholakala okungalindelekile komdlavuza wegilo wegilo kwenziwa ngesikhathi sokuhlolwa kwe-pathologic yangemva kokuhlinzwa.
I-Ultrasound iyindlela ekhethwayo yokuhlola izigaxana zegilo ezizwakalayo noma okunye ukutholwa kwezithombe zamaqhuqhuva egilo. I-Ultrasound izwela kakhulu ekunqumeni inombolo nezici zamaqhuqhuva egilo kanye nezici eziyingozi kakhulu ezihlobene nengozi yokonakala, njengokungahambi kahle kwe-marginal, punctate echoic focus eqinile, kanye nokuhlasela kwe-extra-thyroid.
Njengamanje, ukuxilonga ngokweqile nokwelashwa komdlavuza wegilo kuyinkinga odokotela abaningi neziguli ezinaka ngokukhethekile, futhi odokotela kufanele bazame ukugwema ukuxilonga ngokweqile. Kodwa le bhalansi kunzima ukuyifinyelela ngoba akuzona zonke iziguli ezinomdlavuza we-thyroid othuthukile, we-metastatic ongazizwa izigaxana ze-thyroid, futhi akuzona zonke izifo zomdlavuza we-thyroid ezisengozini encane ezingagwemeka. Isibonelo, i-microcarcinoma yegilo eyenzeka ngezikhathi ezithile engase ingalokothi ibangele izimpawu noma ukufa ingatholwa ngokomlando ngemva kokuhlinzwa kwesifo se-benign thyroid.
Izindlela zokwelapha ezingenelela kancane ezifana ne-ultrasound-guided radiofrequency ablation, i-microwave ablation kanye ne-laser ablation zinikeza enye indlela ethembisayo yokuhlinzwa lapho umdlavuza wegilo onobungozi obuncane udinga ukwelashwa. Nakuba izindlela zokusebenza zezindlela ezintathu zokukhipha isisu zihluke kancane, ziyefana ngokwemibandela yokukhetha isimila, ukusabela kwesimila, kanye nezinkinga zangemva kokuhlinzwa. Njengamanje, odokotela abaningi bayavuma ukuthi isici esihle se-tumor sokungenelela okuncane kakhulu yi-internal thyroid papillary carcinoma < 10 mm ububanzi futhi> 5 mm kusuka ezakhiweni ezizwela ukushisa ezifana ne-trachea, esophagus, ne-laryngeal nerve ephindaphindiwe. Inkinga evame kakhulu ngemva kokwelashwa ihlala ilinyazwa ukushisa okungaqondile kumthambo we-laryngeal oseduze, okuholela ekuhwebeni kwesikhashana. Ukuze unciphise umonakalo ezakhiweni ezizungezile, kunconywa ukuthi ushiye ibanga eliphephile kude nesilonda esiqondiwe.
Ucwaningo oluningi luye lwabonisa ukuthi ukungenelela okuncane kakhulu ekwelapheni i-papillary microcarcinoma yegilo kunokusebenza okuhle nokuphepha. Nakuba ukungenelela okuncane kokuhlaselwa komdlavuza we-papillary we-thyroid onobungozi obuphansi kuye kwaveza imiphumela ethembisayo, ucwaningo oluningi luye lwabheka emuva futhi lugxile eChina, e-Italy naseNingizimu Korea. Ukwengeza, kwakungekho ukuqhathanisa okuqondile phakathi kokusetshenziswa kokungenelela okuncane nokuqapha okusebenzayo. Ngakho-ke, i-ultrasound-guided thermal ablation ifaneleka kuphela ezigulini ezinomdlavuza wegilo wegilo osengozini ephansi ezingezona ukhetho lokwelashwa ngokuhlinzwa noma ezikhetha le nketho yokwelashwa.
Esikhathini esizayo, ezigulini ezinomdlavuza we-thyroid obalulekile emtholampilo, ukwelashwa kokungenelela okuncane kungase kube enye inketho yokwelashwa enengozi ephansi yezinkinga kunokuhlinzwa. Kusukela ngo-2021, amasu okukhipha i-thermal ablation asetshenziselwe ukwelapha iziguli ezinomdlavuza wegilo ngaphansi kwama-38 mm (T1b~T2) ezinezici ezinobungozi obukhulu. Kodwa-ke, lezi zifundo ze-retrospective zihlanganisa iqembu elincane leziguli (kusukela ku-12 kuya ku-172) kanye nesikhathi esifushane sokulandelela (kusho i-19.8 kuya ku-25.0 izinyanga). Ngakho-ke, ucwaningo olwengeziwe luyadingeka ukuze kuqondwe ukubaluleka kokukhishwa kwe-thermal ekwelapheni iziguli ezinomdlavuza we-thyroid obalulekile emtholampilo.
Ukuhlinzwa kuseyindlela eyinhloko yokwelashwa kwe-carcinoma ye-thyroid esolwayo noma eqinisekisiwe nge-cytologically. Kube khona ukuphikisana mayelana nobubanzi obufaneleka kakhulu be-thyroidectomy (i-lobectomy kanye ne-total thyroidectomy). Iziguli ezithola i-thyroidectomy ephelele zisengozini enkulu yokuhlinzwa kunezo ezenziwa i-lobectomy. Izingozi zokuhlinzwa kwegilo zihlanganisa ukulimala okuphindaphindiwe kwemizwa ye-laryngeal, i-hypoparathyroidism, izinkinga zamanxeba, nesidingo sokwengezwa kwamahomoni egilo. Esikhathini esedlule, i-thyroidectomy isiyonke kwakuyiyona ndlela yokwelapha ekhethwayo yawo wonke umdlavuza wegilo ohlukanisiwe> 10 mm. Kodwa-ke, ucwaningo lwango-2014 luka-Adam et al. wabonisa ukuthi kwakungekho umehluko ophawulekayo wezibalo ekusindeni kanye engozini yokuphindaphinda phakathi kweziguli ezithatha i-lobectomy kanye ne-thyroidectomy ephelele ye-10 mm kuya ku-40 mm yomdlavuza we-papillary we-thyroid ngaphandle kwezici eziyingozi kakhulu emtholampilo.
Ngakho-ke, okwamanje, i-lobectomy ivame ukuthandwa kumdlavuza we-thyroid ohluke kahle ongaphansi kwe-40 mm. Ingqikithi ye-thyroidectomy ngokuvamile inconywa kumdlavuza wegilo ohluke kahle wamamilimitha angu-40 noma ngaphezulu kanye nomdlavuza wegilo ohlangene namazwe amabili. Uma i-tumor isakaze kuma-lymph nodes wesifunda, ukuhlukaniswa kwe-lymph nodes ephakathi nendawo yentamo kufanele kwenziwe. Iziguli kuphela ezinomdlavuza we-medullary wegilo kanye namanye ahlukene kahle omdlavuza wegilo wegilo, kanye neziguli ezinolaka lwangaphandle lwegilo, zidinga i-prophylactic central lymph node dissection. I-prophylactic lateral cervical lymph node dissection ingase icatshangelwe ezigulini ezinomdlavuza we-medullary thyroid. Ezigulini ezisolakala ukuthi i-medullary thyroid carcinoma, amazinga e-plasma e-norepinephrine, i-calcium, ne-parathyroid hormone (PTH) kufanele ahlolwe ngaphambi kokuhlinzwa ukuze kutholakale i-MEN2A syndrome futhi kugwenywe ukulahleka kwe-pheochromocytoma ne-hyperparathyroidism.
I-nerve intubation isetshenziselwa kakhulu ukuxhumana ne-nerve monitor efanelekile ukuze inikeze indlela yokuphefumula engabonakali kanye nokuqapha umsebenzi we-intraoperative nomsebenzi wezinzwa ku-larynx.
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Isikhathi sokuthumela: Mar-16-2024