Ka hō'ailona a me ka mālama'ana no ka ma'i leukemia lymphoblastic. Nā hō'ailona o ka ma'i

'O ka ma'i leukemia Lymphoblastic ka mea i'ike'ia e like me ke'ano o nā ma'i o nā keiki. 'O ia no ka 25% o ka helu helu o nā ma'i koko i'ike'ia i loko o nā pediatrics. Eia hou kekahi e no'ono'o nui loa i ka ma'i leukemia o ke koko - he aha ia, no ke aha i'ike'ia ai a me nā hana ho'oponopono ma'i i kēia ma'i.

Nā'ike nui

He ma'i leukemia - he aha? 'O kēia ma'i nā kānaka o ka ma'i kanesa. ALL (huʻi lymphoblastic leukemia), na symptoms o ka i ana au i ke lalo, mea he heterogeneous pūʻulu o neoplasms o aeee i i kekahi aaiaoe a me ka immunophenotypic ano. Ho'onui'ia ka hana a me ka ho'ohui'ana o kēia mau māmā i loko o ka iwi o ka iwi i mea kōkua'ia e nā luaomalies ki'eki'e o ka ulu, ke'ano like'ole o kekahi. 'O ka hopena, nā pūnaewele e ho'okomo i nā'āpana parenchymal a me nā kōlani lymph. 'O ka hapanui (e pili ana i 80%) o ka leukemia (leukemia) i'ike'ia i nā keiki he lymphoid i ke'ano.

'O ke kuhikuhina

Ke'ike'ia nei nā ma'i ma'i'eha ma nā wahi a pau o ke ao nei. 'O ka pi'i'ana o ALL ma nā'āina i ulu'ia he 3-4 mau hihia no ka haneri tausani mau keiki i kēlā me kēia makahiki. Ma Central Asia a me'Afelika, he'u'uku'ole nā'ano pilikino. Ua'ike pinepine'ia'o'Oll ma ka USA, Iapana, Kina,'Europa. 'O ka nui o ka hana i nā keiki he 2.5-5 mau makahiki. 'O ka pinepine'ana o nā hana pilikino e ulu ana ma nā keikikāne.

Nā kumu pilikino

'O ka mea mua,'o ia ka makahiki o ka makuahine i loko o ka manawa antenatal, ke kaumaha nui o ke keiki hānau - ma mua o 4000 g, ka post-a me ka'ike'ana o ka hānau'ana i ka ho'onaninani'ana i ka pāhawewe. I loko o nā nīnau hea i hiki ai ke ma'i leukemia lymphoblastic āpau? Hiki i nā mo'olelo o ka ma'i o ka makua ke loa'a i ka 'ike e pili ana i ka make'ana o ke keiki hānai i loko o ka hanu mua. Hiki paha i kēia ma muli o ke kūlana o ka nohona kūlohelohe a i'ole i ke'ano o ka predisposition genetic. Inā he po'e ma'i ma'i'ole ka'ohana ma ka'ohana, hiki i ka ma'i leukemia lymphoblastic ākea i ka wā e hiki mai ana. 'O nā hopena o kēia ma'i e pili ana i nā ma'i o ka pono'ole o ka'āpana kino. 'O kēia mau mea,'o ia ho'i, ma muli o Down syndrome, neurofibromatosis, immunodeficiency variables, Fanconi anemia, agammaglobulinemia (congenital) X-linked, a me nā mea'ē a'e. No ka hopena o nā ha'awina he nui, ua hō'oia nā kānaka lapa'au i ka ma'i leukemia lymphoblastic āpau, e like me ka ho'omohala'ana i kekahi mau mea'ē a'e, kahi hanana'ana o nā pūla'i hanana. Ma muli o ka hopena o ka hopena o ka hopena o ka hopena o ke kaiapuni e ho'oikaika i ka ho'onui. 'O kēia ka mea ma'amau loa e hiki ai ke ho'onā i ka ma'i leukemia. 'O nā kumu o ke'ano o nā ma'i pilikino kekahi o nā kumu kūpono i ka koho'ia'ana o nā'ano lapa'au.

Nā diagnostics

Inā'ike'ia kekahi'ano pilikino o ke ki'iku'u,'ike'ia nā'ano o ke kino a me nā hō'ailona o nā pūnaewele e ho'olālā i ke kinona tumo. Ua hana'ia ka wehewehe'ana o ka ALL ma ke'ano o nā hō'ailona pilikino a me nā'ike kino, nā'ike o ka hananesena a me nā ho'okolohua.

'O ke ki'i pa'i ki'i

'O nā hō'ailona o ka ma'i leukemia he pa'akikī ia o nā ma'i'eha:

• 'O ka mea'ona. Me ka ma'i leukemia lymphoblastic ākea, malaise, nā mea kaumaha, nāwaliwali, ke ahi. Hiki ke ho'onāukiuki'ia kēia hopena e nā ma'i viral, bacterial, protozoal (hā'ule) a i'ole ka ma'i fungal, ka mea nui ma nā ma'i me ka neutropenia.
• 'O Hyperplastic. I loko o ka ma'i leukemia lymphoblastic li'ili'i, hiki i ka'ōpū a me ke ake. 'O kēia, ma ke'ano, ke alaka'i aku i ka hepatosplenomegaly, hiki ke'ike'ia e ka ma'i nui ma ka'ōpū. Ka mua hoailona o ka leukemia - pathological fractures o nā iwi lōʻihi paha spine. Hiki ke mālama'ia ka pa'akikī a me ka paila'ana o nā hui i mea e'ike ai i ka ma'i o ka'ōhuma a me nā ma'i'ē a'e. Nā iwi o ka iwi - no ka osteomyelitis. Me ka hō'ailona leukemia o ka capsule hui a me ka manawa, ka'oki'ana a me ka piko o ka momona o ka iwi iwi, nui nā'eha i loko o ka leo. 'O kēia me ka roentgenogram e hō'ike ai i nā loli i loko o ka moku ma'i. Ke'ike maopopo loa'ia lākou ma nā pūpū nui a me nā iwi lolo. Hiki paha i ka ha'alulu ke hele ma hope, no ka necrosis a me ka osteoporosis.
• Anemic. I ka ma'i leukemia lymphoblastic li'ili'i, aia ka tachycardia, pallor, kahe mucous i loko o ka waha, ka ma'i hemorrhagic ma ka'ili. Ma muli o ka'ona a me ka anemia, nāwaliwali e ulu.

Nā hō'ike o ka pilikino

I loko o 5-30% o nā ma'i o ka lymphoblastic leukemia li'ili'i ma nā keikikāne, ua'ike'ia ka pi'i mua'ana o nā hō'ike. 'Elua mau'ao'ao ai'ole ho'okahi'ao'ao,'ele'ele,'eha'ole. I ka'oihana, ua hō'ike'ia nā mea nui o ka ho'onui'ia'ana. I kēia hihia, hiki'ole ke'ike'ia nā hō'ailona o ko lākou liona. Pohihihi keia complications nā exudative pericarditis a me myocardial infiltration o lymph iaʻi ma ka kāʻei kua ma waena o ka epicardium a me ka endocardium. Me ka ho'onui'ia'ana o nā kōpili lymph i ka mediastinum, hiki i ka hopena o ka hana o ka'ōpū hanu. Kēia mau 'ano o T-aeea leukemia type alakai i ka maʻi pale oi vena cava. Hiki paha ke hana i ka'ōmiko o ka'ōpiko. I kekahi mau mea, ua'ike'ia ka hō'ano lekemiki o ka'ūmāmā a me ka hemorrhage i loko o ia mau mea. I kekahi manawa he pa'akikī ka po'e lapa'au e ho'oka'awale i kēia mau pilikia mai nā ma'i pilikino. Ma waena o nā hō'ailona like'ole o ka'ino'ino maka e pili ana i ke'ano o ka leukemia lymphoblastic li'ili'i, ka hemorrhage i loko o ka peni, ka edema o ke ku'i ma ke a'alolo opic, a me ke kau'ana o ka ma'i. Me ka ophthalmoscopy, hiki ke'ike'ia nā pā pōhaku ma lalo o ka maka. Ma hope paha i ka hiki'ana o nā mea ho'olālā nui e ho'okomo i nā mea'ele'ele'ole ma ka'ili. Me ka hō'eha i ka uhi, hiki i kahi ma'i ke ulu. Ma kēia'ano, i ka manawa o ka hō'ailona hiki ke'ike'ia he panaritium, paronychia, nā ma'i pīpī o nā'ano'ēheu like'ole, kahi o nā ha'iko'i, a pēlā aku.

Ho'omākaukau Paclinical: UAC

Hiki ke ho'oku'u'ia he hemo a hemo'ole paha'o Hemoglobin. Ua ho'ēmi pinepine'ia ka hematocrit a me ka helu o erythrocytes. Loa'a ka emi'ana o ka helu o reticlolotes. Hiki ke ho'emi'ia ka helu o nā ke'oke'o ke'oke'o ke'oke'o, ho'onui a ki'eki'e. Eia na'e, i kēia hihia,'a'ole hiki ke'ike'ia nā mea a pau i nā pūnaewele mana. No ka ma'i pilikino, he "lapa'au ma'i leukemia" he'ano. Ke'ōlelo nei mākou e pili ana i ka hiki'ana o nā pūnaehu mana e pili ana i ke kumu o ka hiki'ole o nā'ano waena - metamyelocytes a me myelocytes - ma ke'ano koko. He mea ma'amau ka thrombocytopenia.

Mielogram

'O kēia ka'ina hana'o ka lawe'ana i ka momona o ka iwi. Pono e lawe'ia nā mea mai ka palena iki o'elua mau helu. 'O ke ka'ina hana'oi aku ma lalo o nā mea āpau. Ma na keiki mua ma mua o nā makahiki, ua laweʻia ka puncture, mai ke alo a me ka hope kualono ilium mai i ka 2 makahiki - mai ka calcaneal tuberosity tibial Hoʻohana a hehee wale. Ma ke a'o'ana i ka'ikehonua, he mea ma'amau, nā huahana medullar hypercellular me nā puka li'ili'i o ka pūnaehana hematopoiesis ma'amau a me ka infiltration o nā hanana pūnaewele puhi.

Ke kālepa'ōpiko

'O kēia kekahi o nā papa hana o ka hō'ailona. Me ka ho'ohana'ana i ke kāpili o ka cytochemical, ua hō'ike'ia i kahi laina o nā pūnaewele. He mea pono ke ho'ohana i ka myeloperoxidase.

'O ka'ō'ana o ka'ōpū

He hana ma'amau kēia no ka mea i mana'o'ia he leukemia lymphoblastic ākea, a'o nā kumu i hō'ike'ia ma luna. Pono e hana'ia ka punipuni āpau i ka ho'onāwaho'ana a ma mua o kahi 30 mano / μl o nā platelets i loko o ke koko. Inā kūpono, hana'ia ka ho'ohehe'e'ana o ka ho'olālā'umeke ma mua o ke ka'ina hana. No ka ho'omākaukau'ana i ka cytopreparation, e lawe i'elua milliliters o ka wai'ona. Ke'ike'ia nā mana mana a me nā hō'ailona o ka pō'ino ma nā kolala pilikino, ua'ike'ia kahi hō'ailona o ka neuroleukemia-leukemic CNS kino. Pono nō ho'i e ho'omaopopo'ia,'o ka komo'ana o nā lymphoblast i loko o ka pūpuni'ōpiopio a me ka ho'opili'ana o nā envelopes lolo ka hopena ma nā hihia a pau, i ka puka'ole o nā hō'ike'ike kino. He mea pono ho'i ia, a inā'ike'ia nā hō'ailona neurokala, pono e hana i kekahi kamepiula a i'ole ka pilikino pūniki o ka'enela a me ka lolo.

Nā'ike'ē a'e

Ma ka ho'ohana'ana i ka ultrasound o kahi'āpana retroperitoneal a me ka lua o ka'ōpū,'o ka nui o ka parenchymal e ho'okomo i nā'ōpū, nā kaula loko o ka lymph nui i loko o ka pūpū a me nā kumu'ē a'e, hiki ke ho'ohālikelike'ia nā'ōpū ma ke pelvis pelio. Ma ke'ano he hopena o ka hō'ailona, hana'ia kekahi pahu X-ray ma nā'ōkuhi'elua. Pono pono kēia e'ike i ka pi'i'ana o ka mediastinum. Inā he mau hō'ailona, ho'ohālikelike'ia nā hua'ōlelo-a me nā iwi. I loko o ke'ano o nā ho'ona'auao'enehana, hana'ia ka ho'opili'ana i nā meaola lā'au. Ma ke'ano he kānāwai, hō'ike ia i ka pi'i'ana o ka LDH o ka 500 IU, nā hana kūpono paha i ka hana o ke ake a me nā pu'upa'a. Ma mua o ka ho'omaka'ana o ka chemotherapy, mahalo'ia'o EchoCG a me ECG. I kēia lā, i waena o nā'ano'ē a'e, ho'ohana'ia nā'ōmole mole-a-genetic a me cytogenetic no ka ho'oholo'ana i ka heluna o nā chromosomes, a me ko lākou mau ho'ololi ho'ololi, i ka a'o'ana o nā pūnaewele i ho'opili'ia.

'O ke olakino: ka'ike nui

'O ke'ano kumu o ka kūkulu'ia'ana o ka mo'okū'auhau'onipili o nā keiki i kēia manawa'o ia ka māhele'ana o nā ma'i i loko o nā hui e like me ka ikaika o ka lā'au. Ua koho'ia'o ia ma muli o ka nui o ka ma'i lymphoblastic leukemia. He mea ko'iko'i ka ho'oponopono o ka moku'āina. No laila, no ka mea,'o nā mea i'ōlelo'ole'ia no ka loa'a'ana o nā mea'awa'awa a me nā mea ko'iko'i e hō'oki i nā ma'i o ka loiloi'ana i ka chemotherapy'a'ole i'ōlelo'ia. Eia nō na'e, no ka mea'a'ole i ki'eki'e ka ola o ka mea i mana'o'ia, hiki i ka ho'onui'ana o ka hana i hiki ke lilo i mea kūpono e ola ai. Ke ho'oka'awale'ia i nā hui o nā ma'i i loa'a ka ma'i leukemia, ua hana'ia ka'ōkuhi ma muli o ka'ike mua, a me nā ku'ina pilikino i komo'ia i loko o nā pūnaewele ho'onohonoho. I loko o kēlā me kēia mea, ua ho'okumu'ia kahi papahana o nā'ano ho'oponopono lā'au o kekahi'ano ikaika. Me ka ho'ohālikelike e kū nei, ua'ae'ia kekahi'aelike like'ole ma ka hā'awi'ana i nā'āpana o nā ma'i i loa'a i ka ma'i leukemia lymphoblastic. Ua mālama'ia ka ho'oma'ama'a'ana i nā keiki i nā makahiki he kanahiku o ka makahiki i hala aku nei ma'Amelika. 'O ka nui a me ka nui,'a'ole i ho'ololi'ia nā kumumana'o i kū'ia ai ke'ano o nā hana lapa'au. Ma nā ma'i ma lalo o ka makahiki o ho'okahi makahiki,'ike'ia ka ma'i pathology i loko o kahi'ano kaumaha loa a hō'ike'ia e ke neuroleukemia, leukocytosis.

'O ke'ano o nā'ano lapa'au

I loko o ka hō'ailona ho'ohana'ana i nā lā'au lapa'au e like me "Prednisolone" a me "Vincristine." Ke ho'ohana'ia nei ka ho'oponopono hope loa o ka lā'au lapa'au "Methotrexate" a me ka hō'ailona kalahala no ka pale'ana i ka neroleukemia. Ua ho'okumu'ia kekahi papahana kūikawā kūikawā. 'O ke'ano kēia i loa'a i nā po'e a pau kekahi mau dosages i'ike'ia a'ike'ia me ka hui pū'ana o nā lā'au lapa'au i nā manawa kūikawā, e like me ke ka'ina. Ma ka hopena o nā makahiki he'umikumamāhiku, ua ho'omaopopo'ia ma hope o ka holo'ana o kēlā papahana, 50% o nā keiki i loa'a i ka ma'i leukemia. 'O nā kumu o ka holomua hou'ana i ka hō'ailona o ka ma'i pilikino ma muli o ka ho'oholo'ana i ka hō'oko'a o ka ALL a me ka ho'okomo hou'ana o nā pūnaewele hō'ulu'ulu honua a me nā'ike hanana, ka māhele'ana o nā ma'i ma nā hui, ka ho'omohala'ana i nā papahana like'ole. 'O ke'ano nui o ka ho'onohonoho'ana i nā ha'awina multicenter, ke a'o'ana i nā pharmacokinetics o nā mea'oko'a cytotoxic ma'amau no ka ho'okumu'ana i nā'oihana ho'omōmalo kūikawā maika'i, a me ka ho'onui'ana i nā papa hana.

Nā kumuhana o ka lā'au ho'okele

Mahalo i nā mea i ho'ākāka'ia ma luna nei, ua ho'okumu'ia nā papahana ho'omōmā e hana i nā chemotherapy. Ka hapanui o Hola Pūnaewele i keia la hoʻohana i ka nānā 'ana ma luna o ka loina o ka loiloi mua mālama nui Inc, i ka manao o ka i mea e hoʻonui loa i ka make ana o ka wai auau o'āno'ē keena. 'O ke kumu o ka hana'ana o nā polokalamu ho'opōmaika'i,'o ia ka ho'ohana'ana i nā cytostatics ma ke'ano o nā hui e ho'ololi i kekahi i kekahi (rotation), nā māmā a me nā ma'i chemotherapy, a me ka māmā nui o ka ma'i.

Nā'ano o ka ho'ohana'ana i nā lā'au lapa'au

'O nā kumu lapa'au a me nā mea lapa'au no kēia neroleukemia he ho'oponopono āpau o ka lā'au lapa'au "Prednisolone", "Cytosar", "Methotrexate" (ma nā mea kūpono e like me ke'ano o ka makahiki) a me ka'ōkeli āpau. Hana'ia ka hopena ma nā kau mua o ka ho'okolohua. Me ka ho'ohana'ole'ia'ana o ka lā'au,'o ka lā'au "Methotrexate" he hana pa'a. I kēia mea, e ho'emi i ka nui o ka pēpē, pono ka punipō'ana o ka lā'au lapa'au mua. He mamao a me nā hopena o ka hopena o ke kino. Ma kēia'ano,'o nā ha'awina e ho'oholo ai i ke olakino a pau, i alaka'i'ia i kēia mau lā, e ho'omau'ia ka hō'emi'ana a me ka ho'oka'awale'ana o nā po'e mai ke'āpana li'ili'i, no lākou ka mea'ae'ole e ho'okae i kēia hō'ailona. 'O kēia mau hopena a pau i'ae'ia ka hopena o nā kanawalukumamāwalu i ho'omākaukau'ia no ka makahiki he hala e lanakila i ka 70 pakeneka paakiki o ka ola āpau makahiki i ka ma'i leukemia i nā keiki me ka hā'ule'ole.

Nā polokalamu ho'ona'auao kūikawā hou

'O ka ho'oma'ai'ana i ho'ohana'ia i kēia mau lā, e komo ana nā hanana. 'O ka mua,'o ia ka ho'okomo'ana i ka ho'oku'i'ana ma o nā mea lawelawe'ekolu a'oi aku paha i mālama'ia no 4-6 mau wiki. 'O ka lua, he ho'olālā'oko'a o ka lā mua. 'O ke kolu, he maintenancerapy. Ma ke'ano he kumu, ho'ohana'ia nā antimetabolites ma ka hope hope no 2-3 mau makahiki. 'O ka hui pū me ke kōkua e kāohi a ho'one'e i nā pilikia e pili ana i cytopenia i ho'okomo'ia a me ka immunosuppression. 'O ka pono o ka ho'ohana'ana i ke kāko'o ho'oikaika no 2-3 mau makahiki i hō'oia i ka waenakonu o ke kenekulia. I ka manawa ma'amau, i loko o kēia manawa i kēlā me kēia lā e lawe ai ka mea ma'i i ka lā'au "6-markaptopurian". I kēlā me kēia pule, hā'awi'ia'o ia i ka lā'au "Methotrexate". Ma muli o ka helu o nā leukocytes, ua ho'okumu'ia kekahi'ano. E like me ka hō'ike'ana i nā hō'ike, hiki i nā po'e ma'i ke kūpono i ka hiki'ole ke mālama'ia i kēlā'ano'oihana olakino. 'O ka ho'okō'ana i nā hana kāko'o i 80% o ka papa i makemake'ia he mea hō'eha kūpono'ole i ke'ano o ka ho'iho'i.

Nā'ike'ē a'e

Aia nō i ka nui o ka pilikia ma ka iapaau ana o ALL. I ka nui, he ulu ka helu o nā mea maʻi me ka aeea mutatedʻeho clones hoʻopale i ka chemotherapy, kiʻekiʻe kāki, a hanana o ka hopena oʻaoʻao 'ole (neuroendocrine kāna hana, ulu o nā haumāna hikoko). Ke ole o ka hoʻokomo iapaau ana o nā mea maʻi aie i kakahiaka make ma muli o kaʻawahia complications aʻeho hoʻopale. No hoi loa kaupalena 'hoʻokokoke i ka Inc o ka hoʻomanawanui iki mai ka poe mai i pane i ka maʻamau lapaau. Like i kekahi koho 'ana ua hoʻohana' ia e like me "Teniposide" "Vepeside" "Cytosar". I kēia lā ma kahi o 70% o nā keiki i ka 5-makahiki kala. Huʻi lymphoblastic leukemia i loko o nā mākua recurs i loko o na hiku o ka hihia. Ua paipai i ka lōʻihi o ka wā o ke kala, ua hiki ke hoʻokō wale 20% o ka hihia. E like me ka rula, i ka hoi ana mai o ka pathology malama i loko o ka 2 makahiki mua ma hope oʻike. Ke kala ana ano wehewehe aku me ka nele o ka mana i loko o nā keena koko, i ke alo o ka emi o 5% nouʻana mai ma ka iwi a ka lolo'aʻaʻa, i ke ano o na hoailona o ka hou ana o ka hematopoiesis kūmau. Ma ka Ikepili o cerebrospinal loli hoikeia emi o 5 mononuclear aeee / microliter. No ka pomaikai o ka iapaau ana i kokololio e piʻi like ana o ke kala you. I ka 90% o nā mea maʻi i IeAUPIIe, IAa IO'āno'ē aeee i ikepili koʻikoʻi i ka chemotherapy.

ma ka hopena

I ka papa kuhikuhiE Pahuhopu o ka Inc mea, e pakele no ka mea hoʻomanawanui pathology a me kona hoi ana i ka maʻamau nohona ola a me ka maikai ola me ka palena iki o ke complications, kena ae la ma ka iapaau ana. E loaʻa ai ka mea, i keia la he paʻakikī. O ke kumu ho i ka oiaio i ka hapanui o ka antileukemic lapaʻauʻia mea,ʻaʻole loa e wae a me kaʻawahia. Eia naʻe, hana 'ia he ma ka naauao o ka lapaʻau a me ka liluwelo heterogeneity o ka maʻi, wahi a e mālama nei i nā haʻawina e lana nei koʻu manao i ke hakakino pathogenesis o ka maʻi, e nō e deciphered a ka hopena. Ma keia hihia, ike o na maomeka o malignant loli, e kōkua i ka hoʻomohala oi pono a me ka emiʻawahia therapies.