Chirwere ichi chinowanzokonzera vakwegura, nhamba yepamusoro inowira pamakore makumi matanhatu kusvika ku80. Mumakore achangobva kupfuura, zvakadaro, nhamba inotyisa yakapiwa pamusoro pekuwedzera kwekuitika kwechirwere iri pakati pezera remakore (30-50 makore). Nzira dzemazuva ano dzekurapa kenza yekushayikwa nhasi munyaya.
Geography ye chirwere
Kuwanda kwekupararira kwekenza yepamusoro kune dzimwe nyika muEurope neNorth America kunoonekwa muFrance. Mune dzimwe nzvimbo dzenyika, iyo iri kuchamhembe kweChina, muTranskei (kumaodzanyemba kweAfrica), uyewo kumabvazuva kwakadziva kumabvazuva kweIrish, chirwere chinogona kuonekwa sechigarire, sezvo mazviri chiitiko chacho chinopfuura 20-30 pane kupfuura kumadokero.
Zvimwe zvinokonzera kukanganisa kenza yemukati zvinosanganisira:
• fodya - kusvuta uye kutsva fodya;
• Doro rinoshandiswa - kune dzimwe nzvimbo dzenyika, doro rekudhakwa, nekuda kwekugadzirwa kwavo kana nzira yekurapa, kunobatsira kugadzirwa kwechirwere;
• kusakwana kwezvokudya - kusadya kwakakwana kwevamwe mavitamini uye kutsvaga zvinhu, pamwe nemichero nemiriwo, kunoderedza hutano hwezvinhu zvinodzivirira;
• zvinhu zvepanyama - zvinopisa zvinopisa zvine zvokudya zvinopisa kwazvo uye zvinwiwa; kunamatira zvokudya zvinonhuwira uye pickles, izvo zvinotsanangura nzvimbo dzenharaunda dzoropa.
Zvirwere zvepopu
Mamiriro ezvinhu akasiyana-siyana ehutachiona anotorwa sehuwandu hunokonzera, kusanganisira:
• Achalasia - kutyora kwemotokari yehutachiona nekuda kwekuparadzwa kwehutachiona huri mumadziro eopopu;
• reflux-esophagitis-chisingagumi kuputika kwemuyosa mucosa nekuda kwekudzoka shure kwezvinyorwa zvinokonzerwa nemakumbo;
• Bhokisi reBarrett - kushanduka kwemasero ezvakakwana emukamu wepasi weeophagus muzvikamu zvegastric type; chirwere chacho chinowedzera mukana wekenza yekusaphageal ka40;
• Simba-Vinson syndrome - iyo inosanganiswa
Mhando mbiri dzekenza yekusaphageal dzinozivikanwa:
• squamous cell carcinoma ndiyo inonyanya kufanana (inopfuura 90% yezviitiko);
• Adenocarcinoma - ichangobva kuonana kakawanda (kusvika 8%).
Clinical manifestations
Chirwere chacho chinogona kukura kuva lumen chepopu nenzira yemafungi (kenza yemhando yepamusoro-inenge 60% yematambudziko), inogona kuva nechitarisiko chezvipembenene (25%) kana kuti inokura sophageal masvingo (kanha inopararira). Kanzera reEsophageal inoratidzwa nekukura kwechisimba uye metastasis yekare (kupararira) mukati mechipfuva chemuviri uye kune nhengo dziri kure kuburikidza neropa uye lymph vessels. Ikoko inonyanya kufanana nehutu hwekudzima inowanikwa muropa uye mapapu. Inenge 75 muzana yevarwere munguva yekuongororwa kwekenza yekusaphage ine metastases.
Forecast
Nokuda kwechirevo chechirwere ichi, kuvapo kana kusavapo kwemasastases kunokosha. Muganhu wemakore mashanu unotarisana nevatadzi vashoma kusvika 3% vane yechirwere chechipiri, kunyange zvazvo kusina kwemasastases - inopfuura 40%.
Zviratidzo
Kunyunyuta kukuru kwevarwere kunopfuurira dysphagia (kuputsa kwekumedza). Pakutanga, manzwiro e "kunamatira" zvokudya kana ingwa inogona kuonekwa nguva nenguva. Zvishoma nezvishoma pane kuoma mukupfuura kudya kwekutanga kwakasimba, uye ipapo kunwa mvura, kusvikira pakupedzisira murwere haagoni kumedza kunyange saliva. Zvimwe zviratidzo:
• kuora muviri;
• kurwadziwa mubhokisi;
• dysphagia (kurwadziwa kana kuchimedza);
• kurutsa nehuwandu hweropa (chiratidzo chisingawanzozivikanwa).
Nemhaka yevakwegura vakwegura vane kenza yemajozi, kurwadziwa kwepfupa kunogona kukanganisa mwoyo. Dzimwe nguva varwere vanoongororwa nehutano hwemwoyo vanoonekwa kuti vane chirwere chesophageal. Chinangwa chekuongororwa ndechekuona kuwanda kwechiremera chekukura nekukwanisa kushandiswa kwayo. Dzidzo dzinotevera dzinoitwa.
• Kusiyanisa mafirimu. Murwere anotora mukati mutengi wemuenzaniso (kazhinji bhayoum) anooneka pa X-rays. Kenza yeesophageal inowanzova nehuwandu hwemaitiro e radiographs.
• Esophagoscopy. Kuongororwa kwemukati kweeophagus nerubatsiro rwetopfiber fiber endoscope inobata basa rinokosha pakuongororwa, sezvo richibvumira kutora mashoko kubva munzvimbo inoshungurudzika kuenda kunzvimbo yakashata. Pathohistological kudzidza pamusoro pezvinyorwa zvinotarisa kuti chii chinonzi neoplasm uye, kana chakaipa, chinoratidza rudzi rwechirwere. Esophagoscopy inobvumirawo kugadzirisa nzvimbo chaiyo yepamuviri - mupamusoro, pakati kana kuti pasi chechitatu chesophagus.
• CT kuongorora kwezviputi zve thoracic uye mimba. Chinangwa chechidzidzo ichi ndechekuona kuvepo kwemasimisita, somuenzaniso, muropa kana mumapapu, pamwe nekukuvadzwa kwechipiri kune lymph nodes. Kuvapo kwemasastases, sekutonga, kunoratidza chirwere chisingaiti.
• Bronchoscopy. Endoscopic kuongororwa kwepurogiramu yokufema kunoitwa nekushushikana kwekupararira kwemarara kune mapapu. Mune matanho ekutanga ekutukurwa kwechiremera nzira yakanakisisa yekurapa ndeyekugadziriswa kwemasimba. Asi muzviitiko zvakawanda, zvinosuruvarisa, isu tinofanira kuzvipira kuzvipatisa kurapa. Kupararira kwechirwere chinopfuura cheputi mune varwere vakawanda hakusipo kuvepo kwekurapa. Kana chirwere chisina kubatwa pakutanga, chirwere chokuvhiya chinonzwisisika, kunze kwechidiki chevarwere.
Palliative Therapy
Kurapa kwechirwere chepachirwere chesophageal chinangwa chokuderedza zviratidzo uye chinangwa chekudzorera kukwanisa kumedza. Kazhinji kacho nekuda kwechinangwa ichi intubation yeeophagus inogadzirwa, kureva, chigadzirwa chepipe chaiyo (stent) ichichengetedza chigadziko chayo chakazaruka, icho chinoita kuti chikafu chekudya nemvura zvivepo. Iyo stent inotanga pasi pehutongi hwehutachiona munzvimbo yechipfuva anesthesia kana kushanda neanesthesia. Kuvhiyiwa kunonzi esophagectomy kana esophagogastrectomy kunosanganisira:
• kubviswa kwepasi rose, kunze kwerutivi rwepamusoro, pamwechete nechikamu chekutanga chemuviri pamwe chete nemasukirwo akakomba uye lymph nodes;
• Kudzorera kutendeseka kwegomba rekudya nekubatanidza zvakasara zvemuviri pamwe nechepamusoro (kumusoro) chikamu chesophagus - kazhinji chinowanikwa pachikamu chetatu chemuhuro.
Kugadziriswa kwekuvhiya kunopiwa kuburikidza nekucheka kuruboshwe rwechifuva (kuruboshwe rwetsiracotomy), muhafu yakarurama (thoracotomy yakagadzikana nechepamusoro), nekuzarura chivako chepamuviri (laparotomy) kana nekubatanidza zvese zvitatu. Kakawanda pane chido chekugadzira kuwedzera kwekuwedzera kune rumwe rutivi rworuboshwe rwetsipa. Zvimwe zvingasarudzwa zvekurapwa zvinonyanya kupisa. Vazhinji vechirwere chinokonzerwa nekenza ndivo vakwegura vane varwere vari mumamiriro ezvinhu akaoma maererano nejeri rechirwere chepakati.
Forecast
Kufanirwa kwevakawanda vevarwere hakuna kunaka. 80% varwere vane kenza isingashandisi vanopera mukati megore mushure mekunge yaonekwa, pasinei nemhando yehutano hwehutano. Pakati pevarwere vari kuvhiyiwa, mugumisiro unotsanangurwa nehukuru uye kupararira kwechirwere, mhando yake yezvechirevo uye chiyero chekubatanidzwa kwemakirini. Mukati yekutanga kwekenza yekusaphageal, makore mashanu ekupona kwemazuva anenge 30-40%. Nekuona kwenguva pfupi, kufa kunofananidzwa neicho mune varwere vane chirwere chisingagoneki. Paakabvunzwa, zvakava pachena kuti manzwiro aya ainge achivhiringidza murwere kwemwedzi miviri kare. Pakutanga akaedza kukunda kusagadzikana nekuchinja mararamiro ezvokudya nemuwandu wezvokudya zvewairi uye zvisikwa-mvura.