iindaba

Ukuvezwa kwimitha ye-ionizing ebuntwaneni kwakunxulunyaniswa kakhulu nomhlaza we-thyroid we-papillary (1.3 ukuya kwi-35.1 iimeko / iminyaka eyi-10,000 yomntu). Uphononongo lwe-cohort oluvavanye abantwana be-13,127 abangaphantsi kweminyaka eyi-18 ubudala abahlala e-Ukraine emva kwengozi yenyukliya yaseChernobyl ngo-1986 yomhlaza we-thyroid ifumene iimeko ze-45 zomhlaza we-thyroid kunye nomngcipheko ongaphezulu we-5.25 / Gy womhlaza we-thyroid. Kukwakho ubudlelwane bokusabela kwethamo phakathi kwemitha ye-ionizing kunye nomhlaza wegilo. Ubuncinci beminyaka apho imitha ye-ionizing yafunyanwa khona, iyanda ingozi yokuba nomhlaza wegilo onxulumene nemitha, kwaye lo mngcipheko uqhubekile malunga neminyaka engama-30 emva kokuba sesichengeni.

Uninzi lwemingcipheko yomhlaza we-thyroid ayiguquki: ubudala, isondo, uhlanga okanye ubuhlanga, kunye nembali yentsapho yomhlaza we-thyroid yiyona nto ibalulekileyo yokuqikelela ingozi. Okukhona umntu emdala, kokukhona enyuka izehlo kwaye kokukhona esezantsi izinga lokusinda. Umhlaza wedlala ledlala uxhaphake ngokuphindwe kathathu kwabasetyhini kunasemadodeni, umlinganiselo othe gqolo rhoqo ehlabathini lonke. Ukwahluka kwe-Germ kumgca we-germ ye-25% yezigulane ezine-medullary thyroid carcinoma zidibene ne-endocrine tumor syndromes efunyenwe njenge-2A kunye ne-2B. I-3% ukuya kwi-9% yezigulane ezinomhlaza we-thyroid ohluke kakuhle zinofuzo.

Ukulandelwa kwabahlali abangaphezu kwezigidi ze-8 eDenmark kubonise ukuba i-nodular goiter engeyona inetyhefu ihambelana nomngcipheko wokwanda komhlaza we-thyroid. Kuphononongo lwe-retrospective cohort lwezigulane ze-843 ezenza utyando lwe-thyroid kwi-nodule ye-thyroid ye-unilateral okanye i-bilateral ye-thyroid, i-goiter, okanye i-autoimmune isifo se-thyroid, amanqanaba aphezulu e-serum thyrotropin (TSH) aphezulu adibaniswa nomhlaza we-thyroid: i-16% yezigulane ezinamazinga e-TSH ngaphantsi kwe-0.06 mIU / L yavelisa i-thyroid ye-thyroid yezigulane, ngelixa i-TSH ye-52% izigulane eziphuhliswe ngumhlaza we-thyroid kunye ne-52 mI2.

Abantu abanomhlaza wedlala lengqula badla ngokungabi nazimpawu. Uphononongo oluhlaziyiweyo lwezigulane ze-1328 ezinomdlavuza we-thyroid kumaziko e-16 kumazwe e-4 abonise ukuba kuphela i-30% (183 / 613) eneempawu zokuxilongwa. Izigulana ezinobunzima bentamo, i-dysphagia, imvakalelo yangaphandle kunye ne-hoarseness zihlala zigula kakhulu.

Umhlaza wethyroid ngokwesiko ubonakala njengeqhuqhuva legilo elibonakalayo. Isiganeko somhlaza we-thyroid kumaqhuqhuva abonakalayo kubikwa ukuba malunga ne-5% kunye ne-1%, ngokulandelanayo, kubasetyhini kunye namadoda kwiindawo ezine-iodine ezaneleyo zehlabathi. Okwangoku, malunga ne-30% ukuya kwi-40% ye-thyroid cancers ifumaneka nge-palpation. Ezinye iindlela eziqhelekileyo zokuxilonga ziquka imifanekiso engahambelani nedlala lengqula (umzekelo, i-carotid ultrasound, intamo, umqolo, kunye nesifuba); Izigulane ezine-hyperthyroidism okanye i-hypothyroidism ezingakhange zichukumise amaqhuqhuva zifumana i-thyroid ultrasonography; Izigulane ezinamaqhuqhuva e-thyroid esele zikhona ziphinda ziphindwe nge-ultrasound; Ukufunyaniswa okungalindelekanga komhlaza we-thyroid occult kwenziwa ngexesha lovavanyo lwe-post-operative pathologic.

I-Ultrasound yindlela ekhethwayo yokuvavanya amaqhuqhuva e-thyroid aphathekayo okanye ezinye iziphumo zokufunyaniswa kwamaqhuqhuva e-thyroid. I-Ultrasound ibuhlungu kakhulu ekunqumeni inani kunye neempawu ze-thyroid nodules kunye neempawu ezinobungozi obuphezulu obunxulumene nomngcipheko we-malignancy, ezifana nezitenxo ze-marginal, punctate echoic focus eyomeleleyo, kunye nokuhlasela kwe-thyroid engaphezulu.

Okwangoku, i-overdiagnosis kunye nokunyangwa komhlaza we-thyroid yingxaki oogqirha abaninzi kunye nezigulane ezihlawula ingqalelo ekhethekileyo, kwaye oogqirha kufuneka bazame ukuphepha ukuxilongwa ngokugqithiseleyo. Kodwa le bhalansi inzima ukuyifeza kuba ayizizo zonke izigulane ezinomhlaza we-thyroid, i-metastatic ye-thyroid inokuziva ii-nodules ze-thyroid, kwaye ayizizo zonke izifo zomhlaza we-thyroid ezinomngcipheko ophantsi. Ngokomzekelo, i-thyroid microcarcinoma enokuthi ingaze ibangele iimpawu okanye ukufa kunokufunyaniswa njenge-histologically emva kotyando lwe-benign thyroid disease.

Unyango olungenelelayo oluncinci olufana ne-ultrasound-guided radiofrequency ablation, i-microwave ablation kunye nelaser ablation zibonelela ngenye indlela ethembisayo kunotyando xa umhlaza wedlala lengqula ufuna unyango. Nangona iindlela zokusebenza zeendlela ezintathu zokukhupha zihluke kancinane, zifana ngokusisiseko ngokwemigaqo yokukhetha ithumba, impendulo yethumba, kunye neengxaki zasemva kotyando. Okwangoku, oogqirha abaninzi bayavuma ukuba i-tumor echanekileyo i-intervention invasive invasive intervention internal thyroid papillary carcinoma <10 mm ububanzi kunye> 5 mm ukusuka kwizakhiwo ezinobushushu ezifana ne-trachea, esophagus, kunye ne-recurrent laryngeal nerve. Eyona ngxaki ixhaphakileyo emva kokuba unyango luhlala lusenzakala ngokungalindelekanga ubushushu kwi-nerve ye-laryngeal eqhubekayo ekufutshane, okubangela ukushwabana kwethutyana. Ukunciphisa umonakalo kwizakhiwo ezijikelezileyo, kucetyiswa ukuba ushiye umgama okhuselekileyo kude nesilonda esijoliswe kuyo.

Uninzi lwezifundo zibonise ukuba ungenelelo oluncinci kunyango lwe-thyroid papillary microcarcinoma lusebenza kakuhle kunye nokhuseleko. Nangona ungenelelo oluncinci olungenabungozi kumhlaza we-thyroid we-papillary luye lwavelisa iziphumo ezithembisayo, uninzi lwezifundo ziye zabuyela emva kwaye zijolise eChina, eItali, naseSouth Korea. Ukongeza, akukho thelekiso oluthe ngqo phakathi kokusetyenziswa kongenelelo olungephi kunye nokuhlolwa okusebenzayo. Ke ngoko, i-ultrasound-guided thermal ablation ifaneleka kuphela kwizigulana ezinomhlaza we-thyroid esemngciphekweni osezantsi abangabaviwa bonyango lotyando okanye abakhetha olu khetho lonyango.

Kwixesha elizayo, kwizigulane ezinomdlavuza we-thyroid obaluleke kakhulu, unyango oluncinci lwe-invasive interventional lunokuba lolunye ukhetho lonyango olunomngcipheko ophantsi weengxaki kunotyando. Ukususela ngo-2021, iindlela zokukhupha i-thermal ablation ziye zasetyenziselwa ukunyanga izigulane ezinomhlaza we-thyroid ngaphantsi kwe-38 mm (T1b ~ T2) ezineempawu eziphezulu zomngcipheko. Nangona kunjalo, ezi zifundo zangaphambili zibandakanya iqela elincinci lezigulane (ukusuka kwi-12 ukuya kwi-172) kunye nexesha elifutshane lokulandela (lithetha i-19.8 kwiinyanga ze-25.0). Ngoko ke, uphando olongezelelweyo luyafuneka ukuze kuqondwe ixabiso le-thermal ablation kunyango lwezigulane ezinomhlaza we-thyroid obaluleke kakhulu.

Utyando luhlala luyindlela ephambili yonyango lwe-thyroid carcinoma ekrokrelwayo okanye eqinisekisiwe nge-cytologically. Kubekho ukuphikisana malunga neyona ndawo ifanelekileyo ye-thyroidectomy (lobectomy kunye ne-thyroidectomy epheleleyo). Izigulana eziphantsi kwe-thyroidectomy epheleleyo zisengozini enkulu yokuhlinzwa kunezo zenza i-lobectomy. Imingcipheko yotyando lwedlala lengqula ibandakanya ukonakaliswa kwemithambo ye-laryngeal, i-hypoparathyroidism, iingxaki zenxeba, kunye nesidingo sokuxhaswa kwehomoni yegilo. Ngaphambili, i-thyroidectomy iyonke yayilunyango olukhethwayo kuwo onke ama-cancer e-thyroid ahlukeneyo> 10 mm. Nangona kunjalo, isifundo sika-2014 nguAdam et al. ibonise ukuba akukho ntlukwano ephawulekayo yokusinda kunye nomngcipheko wokuphindaphinda phakathi kwezigulane ezithatha i-lobectomy kunye ne-thyroidectomy iyonke ye-10 mm ukuya kwi-40 mm yomhlaza we-thyroid we-papillary ngaphandle kweempawu eziphezulu zeklinikhi.

Ngoko ke, okwangoku, i-lobectomy idla ngokukhethwa kwi-unilateral well-differentiated thyroid cancer <40 mm. Iyonke i-thyroidectomy iyacetyiswa ngokubanzi kumhlaza wegilo owahlulwe kakuhle we-40 mm okanye ngaphezulu kunye nomhlaza we-thyroid. Ukuba i-tumor isasazeke kwii-lymph nodes zengingqi, i-dissection ye-lymph nodes ephakathi kunye ne-lateral yentamo kufuneka yenziwe. Izigulana kuphela ezinomhlaza we-medullary thyroid kunye nezinye ezahlulwe kakuhle zomhlaza we-thyroid, kunye nezigulana ezinobundlavini bangaphandle, zidinga i-prophylactic central lymph node dissection. I-prophylactic lateral cervical lymph node dissection inokuqwalaselwa kwizigulane ezinomhlaza we-medullary thyroid. Kwizigulane ezikrokreleka ukuba yi-medullary thyroid carcinoma, amanqanaba e-plasma ye-norepinephrine, i-calcium, kunye ne-hormone ye-parathyroid (PTH) kufuneka ahlolwe ngaphambi kokuhlinzwa ukuchonga i-MEN2A syndrome kwaye ugweme ukulahleka kwe-pheochromocytoma kunye ne-hyperparathyroidism.

I-Nerve intubation isetyenziselwa ikakhulu ukudibanisa ne-monitor ye-nerve efanelekileyo ukubonelela nge-airway engabonakaliyo kunye nokubeka iliso kwi-intraoperative muscle kunye nomsebenzi we-nerve kwi-larynx.

EMG Endotracheal Tube Product cofa apha