Isifo sisoloko sichaphazela abantu asebekhulile, iziganeko eziphakamileyo ziwela kwiminyaka engama-60 ukuya kuma-80. Kwiminyaka yakutshanje, nangona kunjalo, iinkcukacha eziphazamisayo zinikezelwe ukwanda kwimizimba yezifo zesigaba esiphakathi (iminyaka engama-30-50). Izindlela zanamhlanje zokunyanga umdlavuza we-esophageal namhlanje kwinqaku.
IJografi yesifo
Ubukhulu becala lomdlavuza wesisu phakathi kwamazwe aseYurophu naseNyakatho Melika kubonakala eFransi. Kweminye imimandla yehlabathi, ephakathi kwintshona yeChina, eTranskei (e-Afrika esemazantsi), nakwi-Iran-mpuma, isifo singathathwa njengento ehleliyo, kuba iziganeko zingama-20 ukuya kuma-30 ukuya phezulu kuneNtshona.
Umngcipheko weengxaki zomhlaza wesifo somzimba uquka:
• ukubhema nokubhema nogwayi;
• Ukusetyenziswa kakubi kotywala - kwezinye iindawo zomhlaba, iziyobisi zendawo, ngenxa yokwenziwa kwazo okanye indlela yokonyango, ukuthanda ukuphuhliswa kwesisu;
• ukungondleki - ukungena ngokwaneleyo kwamavithamini athile kunye nezinto ezilandelelanayo, kunye neziqhamo kunye nemifuno, kunciphisa umgangatho wezinto zokukhusela;
• izinto eziphathekayo - ukushisa okushisayo kunye nokutya kushushu kakhulu kunye neziphuzo; ukubambelela kokutya okunesonka kunye neepleta, ezichaza iimpawu zendawo yokuziphatha.
Izifo zesifo
Iimeko ezihlukahlukeneyo zesifo se-epopus zibhekwa njengemingcipheko, kuquka:
• I-Achalasia - ukuphulwa komsebenzi wemoto yesigxina ngenxa yokutshatyalaliswa kwezinto ezinobungozi eludongeni lwesigxina;
• ukuhlambalaza kwe-reflux-esophagitis-okungapheliyo kwe-mucosa ye-esophagus ngenxa yokurhoxiswa kwangaphambili kwezinto ezinomdla we-gastric acidic;
• Ingqungquthela kaBarrett - utshintsho lweeseli eziqhelekileyo kwingxenyana engezantsi ye-esophagus kwiiseli zentlobo yesisu; isifo sandisa umngcipheko wesifo somhlaza ngokunyuka kwamaxesha angama-40;
• I-Plummer-Vinson syndrome - imeko iyahambelana
Iifom ezimbini ezibalulekileyo zesifo somhlaza esaziwayo:
• i-squamous cell carcinoma yifom eqhelekileyo (ngaphezulu kwama-90% amatyala);
• I-Adenocarcinoma - isandul 'ukuba ihlangane kaninzi (ukuya ku-8%).
Impawu zonyango
Isisu singakhula sibe yi-lumen ye-esophagus ngendlela yefungus (umdlavuza we-polyp - malunga nama-60% amacala), unokubonakala ngathi izilonda (25%) okanye zihlume izindonga ezingenasophelo (umhlaza wesifo). Umdlavuza we-Esophageal ubonakala ngokukhula ngamandla kunye ne-metastasis yangaphambili (ukusasazeka) ngaphakathi kwinqanaba le-thoracic nakwizitho ezikude ngeempahla zegazi kunye ne-lymph. I-foci eqhelekileyo yokuqothula i-tumor iyabonakala kwisibindi kunye nemiphunga. Phantse i-75% yezigulane ngexesha lokuxilongwa komhlaza wesifo sokuqhathaniswa nesifo somhlaza esinesifo somhlaza.
Forecast
Ukubhengezwa kwesi sifo, ubukho okanye ukungabikho kwe-metastases kubalulekile. Umda weeminyaka emihlanu unamava angaphantsi kwe-3% yezigulane ezineesifo se-tumor yesibini, nangona kungabikho kwe-metastase-engaphezulu kwe-40%.
Iimpawu
Isikhalazo esiphezulu sezigulane sisenza i-dysphagia eqhubekayo (ukwephulwa kokugwinya). Ekuqaleni, ukuvakalelwa kokutya "ukunamathela" xa kutyinwa kungabonakala ngokukhawuleza. Kancinci kukho ubunzima bokudlulisa ukutya okuqinileyo kokuqala, kwaye emva koko isigulane asikwazi ukugwinya nangomthi. Ezinye iimpawu:
• ukulahleka kwesisindo;
• intlungu esifuba;
• i-dysphagia (intlungu xa iginya);
• ukuhlanza kunye nokuxutywa kwegazi (uphawu olungabonakaliyo).
Ngenxa yezigulane ezisebekhulile ezineengxaki zomhlaza, isifo seentlungu singaphoswa ngenxa yesifo senhliziyo. Ngamanye amaxesha izigulane ezihlolwe izifo zentliziyo zifunyanwe zizifo zesifo se-esophageal. Injongo yoviwo kukuqinisekisa izinga lokukhula kwesisu kunye nokukhutshwa kwayo. Ezi zifundo zilandelayo ziqhutywa.
• Qhathanisa i-radiography. Isigulana singena ngaphakathi kwi-ejenti yokuphambene (ngokuqhelekileyo i-barium) ebonakalayo kwi-X ray. Umdlavuza we-Esophageal unesimo esifanekayo kwii-radiographs.
• I-Esophagoscopy. Ukuhlolwa kommandla wangaphakathi we-oopopus ngoncedo lwe-optical fiber endoscope inendima ebalulekileyo ekuxilongweni, kuba ivumela ukuba izinto eziphathekayo zisuke kwindawo engathandabuzekiyo kwi-biopsy. Uphando lwezinto eziphathekayo lubonisa uhlobo lwe-neoplasm kwaye, xa kwenzeka ukugula kwakhe, lichaza uhlobo lwesifo. I-Esophagoscopy ivumela ukuba kusekwe indawo echanekileyo yendawo yokutya - kwindawo ephezulu, ephakathi okanye engaphantsi kwesithathu.
• Ukutshekisha kwi-CT ye-thoracic and stomities cavities. Injongo yale sifundo kukuqinisekisa ukuba ubukho beemetastases, umzekelo, kwisibindi okanye kwimiphunga, kunye nomonakalo okondla kwi-lymph nodes. Ubukho be-metastase, njengomthetho, lubonisa ukuba i-tumor engasebenzi.
• I-bronchoscopy. Ukuhlolwa kwe-Endoscopic yendlela yokuphefumula eyenziwa ngokusola ngokusabalalisa kwe-tumor kumapapu. Kwimigangatho yokuqala yokuphucula i-tumor indlela efanelekileyo yokonyango yintengiso ye-esophagus. Kodwa kwiimeko ezininzi, ngelishwa, kufuneka sizincishise ngokwaneleyo unyango oluthile. Ukusasazeka kwe-tumor ngaphaya kwesigxina kwizigulane ezininzi akubandakanyi ithuba lokunyanga. Ukuba eso sifo asibanjwanga kwinqanaba lokuqala, unyango luyacetyiswa, kuphela kwinani elincinci lezigulane.
Ulwaphulo lwePilliative
Ulwaphulo olusisigxina lomhlaza wesisu lujolise ekunciphiseni iimpawu kwaye luhlose ukubuyisela amandla okugwinya. Ininzi iqhelo kule njongo intubation ye-esophagus eyenziwa, oko kukuthi, isikhungo se-tube ekhethekileyo (stent) egcina i-lumen yayo evulekile, eqinisekisa ukuhamba kokutya namanzi. I-stent iqalwe phantsi kolawulo lwe-radiological kwi-aneshesia yendawo okanye isebenza nge-anesthesia. Umsebenzi obizwa ngokuba yi-esophagectomy okanye isophagogastrectomy iquka:
• ukususwa kwendawo yonke, ngaphandle kweyona nxalenye ephezulu, kunye necandelo lokuqala lesisu ngokubambisana nezicubu ezizungezile kunye ne-lymph nodes;
• Ukubuyisela ingqibelelo yebhubhu yokutya ngokuxhuma ukuhlala kwesisu kunye nengxenye ephezulu (esezantsi) ye-esophagus - ngokuqhelekileyo eyenziwa kwinqanaba elingaphantsi kwentamo.
Ufikelelo lokuphengulula lunikezelwa ngokucatshulwa kwicala lasekhohlo (i-thoracotomy eseceleni kwesigxina), kwisiqingatha esifanelekileyo (i-thoracotomy yangasese), ngokuvula isisu esiswini (laparotomy) okanye ngokudibanisa zonke iindlela ezintathu. Ngokuqhelekileyo kukho imfuneko yokudala ukunyuswa okungekho kwicala lasekhohlo lentamo. Ezinye iindlela zokunyangwa ngonyango ziyancipha. Uninzi lwezifo ezichaphazeleka ngumhlaza zizigulane ezisebekhulile ezisesimweni esibi kakhulu ngokohlobo lwesifo esisisigxina.
Forecast
Isibhengezo sesininzi sezigulane asivumelekanga. I-80% yezigulane ezinomdlavuza onokuphelelwa zifa zingakapheli unyaka emva kokuba zifunyenwe, kungakhathaliseki ukuba zinjani iindlela zokwenza i-palliative. Phakathi kwezigulane ezithatha ukuhlinzwa, isiphumo sinqunywe ubungakanani kunye nokusabalalisa i-tumor, uhlobo lwalolo hlobo kunye nesantya sokubandakanyeka kwee-lymph nodes. Kwisigaba sokuqala somhlaza wesisu, umlinganiselo weminyaka emihlanu wokusinda ngowama-30-40%. Xa ukufumanisa ngokukhawuleza, ukufa kufana nokufana nezigulane ezinokukhubazeka. Xa kubuzwa, kwacaca ukuba le ntliziyo yayikhathaza isigulane iinyanga ezimbini. Ekuqaleni wazama ukunqoba ukuphazamiseka ngokutshintsha uhlobo lokutya kunye nesininzi sesitya se-liquid kunye nesiqingatha.