He aha ēnei pukupuku e puta mai ana i roto i tō tinana, i roto i ō awa au? Me kōrero tātou mō ngā pukupuku Klatskin!

Kua rongo koe i te kōwhai o ō kanohi i te mamae o te puku? Tērā pea kei te ngaro tō taumaha? He mea ēnei kāore tātou e aro nui ana ki ēnei i ētahi wā, engari he tohu pea ēnei mō ētahi mate onge. I tēnei rā ka kōrero tātou mō tētahi mate he ahua kino, engari he mea nui kia mōhio. He mate tēnei e kiia nei ko te Klatskin Tumor .

He aha te Pūmua Klatskin?

He kupu ngāwari noa iho, ko ēnei pukupuku Klatskin he momo pukupuku matepukupuku e whanake ana i roto i ngā awaawa au i waho o tō tātou ate. Whakaarohia, ka puta he wai i roto i tō tātou ate e kiia nei ko te au, e āwhina ana i te nakunaku. Ka rere tēnei au mā roto i ngā awaawa iti, ka hono tahi hei hanga i te awaawa au matua. Ina koa, ko ēnei pukupuku te nuinga o te wā ka puta i te wāhi e kiia nei ko te 'hilum', te wāhi e hono ai ngā awaawa au matau me maui e puta mai ana i te ate hei hanga i te awaawa au matua. Ka karangatia hoki tēnei e ngā tākuta ko te 'Hilar Cholangiocarcinoma' . Mena ka kitea wawetia ēnei pukupuku, ā, ka rongoatia, tera pea ka taea te whakaora. Ko ngā mea pēnei i te pokanga me te whakawhitinga ate ngā maimoatanga matua. Kei reira anō hoki ngā maimoatanga hei whakaiti i ngā tohu. Kei te mahia anō hoki ngā rangahau mō ngā maimoatanga hou.

He pēhea te onge o tēnei?

He tino onge tēnei mate . E kiia ana kotahi i roto i te kotahi rau mano tāngata ka pāngia e tēnei mate. Arā, ehara tēnei i te mate e pāngia ana e te tini tāngata.

He aha ngā tohu o te Puku Klatskin?

Nō reira, ina puta mai ēnei pukupuku o te awa au, ka āraia te rere o te au mai i te pūkahukahu. Koinei te wā e puta mai ai ngā tohu maha. Ka puta mārire ēnei, nō reira i ētahi wā kāore pea tātou e kite.

• Mamae puku: He mamae puku e mau tonu ana, e kino haere ana i ētahi wā, inā koa ki te taha matau o runga o te puku.
• Ngenge: He kare ā-roto o te ngenge nui e kore e memeha ahakoa te moe pai o te pō.
• Whakapairuaki: He āhua e ruaki ana, tera pea ka ruaki.
• Te whakaheke taumaha: Te whakaheke taumaha kāore he take mārama, me te kore e kai tika.
• Te mate kiri mā: Te kōwhai o ngā mā o ngā kanohi me te kiri. Ka puta tēnei ina kore e rere tika te au o te ate, ka kohia he matū kōwhai e kiia nei ko te bilirubin ki roto i te toto. Ka huri pea te mimi ki te kōwhai pouri, ā, ka huri pea ngā tūtae ki te mā mārama.
• Kiri mākūkū: Ka pāngia pea ētahi tāngata e te mākūkū puta noa i ō rātou tinana, he raruraru anō hoki tēnei e pā ana ki te ate.

He uaua pea te noho tahi me ēnei tohumate, nō reira kaua e mangere ki te rapu tohutohu hauora. Ko te mea nui ko te kimi wawe i te pūtake.

He aha ngā take o te Klatskin Pumor?

Kāore anō kia kitea e ngā kairangahau te tino pūtake o ēnei pukupuku kiri.. Engari koinei te mea ka tupu: Ka puta ēnei pukupuku ina puta he huringa ira (whakarerekētanga ira) i roto i ngā pūtau noa o tō tātou tinana, ka wehea noatia aua pūtau, ka whakanuia hoki, kāore e taea te whakahaere.

Heoi anō, kua kitea ētahi mea e whakanui ake ana i te mōrearea o tēnei mate. Arā, ngā mea pēnei i ētahi mate me ngā huringa ira e puta ana i muri i te whānautanga.

Ko ētahi āhuatanga e whakanui ake ana i tēnei mōrearea ko:

• Te mate whakamahi waipiro: E mōhio ana te katoa kāore te waipiro i te pai mō te ate. Ka kino te ate ki te whakamahi waipiro nui mō te wā roa, ā, ka nui ake te mōrearea ki tēnei momo mate pukupuku.
• Ngā kōhatu o te pūhā (Choldocholithiasis): Ka taea e ngā kōhatu e ārai ana i ngā awaawa o te pūhā te whakararu i te mumura me ngā huringa pūtau mō te wā roa.
• Te mate pāwera mau tonu: Te mumura roa o te repe taiaki.
• Te Clonorchiasis: He mate tēnei i puta mai i te pirinoa ate Hainamana. Kei roto i ngā awaawa aukume tēnei pirinoa, ā, ka roa te wā e pā kino ai.
• Te mate kiriuhi toto tuatahi (PSC): He āhuatanga tēnei e mumura ai, e whara ai, e whaiti ai hoki ngā awaawa o te ate. He āhuatanga anō hoki tēnei e whakanui ake ai i te tūponotanga o ngā pukupuku Klatskin.
• Ētahi huaketo: Tērā pea ka pāngia te ate e ngā huaketo, inā koa ko te hepatitis B me te hepatitis C.
• Tau: He nui ake te mōrearea o te hunga neke atu i te 50 tau te pakeke.
• E whakaarohia ana hoki ka piki ake te mōrearea e te momonatanga me te mate huka .

He aha ngā raruraru ka pā mai i tēnei?

Ka taea e tēnei āhuatanga te whakararu i ngā raruraru nui .

• Ngā toto totoka: Ka horapa te mate pukupuku ki ngā uaua toto nui, ka hanga he toto totoka.
• Te cholestasis extrahepatic: Ka puta tēnei ina āraia he awa nui o waho o te ate e te pukupuku. Ka kino ake pea te jaundice.
• Matepukupuku metastatic: Ka horapa ēnei pukupuku Klatskin mai i ngā awaawa au i waho o te ate ki te ate tonu, ki ngā pukahukahu, ki ngā wheua, ki ngā kōpū lymph, me ētahi atu wāhanga o te puku.

Me pēhea te tautuhi i te mate pukupuku Klatskin?

Mena kei a koe ēnei tohu, ko te mea tuatahi ka mahia e tō tākuta ko te tirotiro i a koe. Ina koa ko tō puku. Ka tirohia e rātou mēnā kei te pupuhi tō puku, kei reira ētahi puku, kei te mamae rānei te pā atu. Ka tirohia anō hoki e rātou mēnā he kōwhai tō kiri me ō kanohi.

Kātahi ka whakahaerehia he whakamātautau toto, he whakamātautau whakaahua, me ētahi atu mea hei tirotiro i te āhua o ngā awaawa o te ate. Tērā pea ka whakahaerehia hoki he whakamātautau ira hei rapu i ngā huringa ira.

Ngā whakamātautau toto

• Ngā tohu pukupuku:Ka tirohia e ēnei ētahi matū i roto i te toto hei tohu pea mō te pukupuku Klatskin. Hei tauira, ka tirohia e rātou te taumata o tētahi matū e kiia nei ko te carbohydrate antigen (CA) 19-9 . Mena he tino teitei te taumata o tēnei, he tohu pea tēnei mō tēnei mate. Heoi, ehara i te mea ko te hunga katoa e pāngia ana e tēnei taumata he mate pukupuku, ā, ka taea hoki te teitei mō ētahi atu take.
• Ngā whakamātautau mahi ate: Kei roto i ēnei ko ngā whakamātautau bilirubin me ngā whakamātautau hei tirotiro mō ngā whākōkī ate kua teitei. Ka taea e ēnei te whakaatu mēnā kua pakaru te ate, kua āraia rānei te rere o te au.

Ngā whakamātautau whakaahua

Ka tangohia e ēnei whakamātautau ngā whakaahua o roto o te tinana. Ka taea hoki e ētahi whakamātautau whakaahua te tango i tētahi tauira kiko (he koiora) ka tirotirohia e te tohunga mate pukupuku. Mā tēnei ka whakatau mēnā he mate pukupuku, kāore rānei.

• Matawai ultrasound: He whakamātautau māmā noa iho tēnei ka mahia tuatahitia.
• Matawai CT (CT - Tomography Rorohiko): Ka taea e tēnei te tango pikitia mārama ake.
• MRI (Whakaahua Āhua Aukume): Ka taea hoki e tēnei te tango pikitia tino mārama, tino taipitopito.
• ERCP (Endoscopic Retrograde Cholangiopancreatography): I tēnei tikanga, ka whakaurua he endoscope (he ngongo angiangi me te kāmera) mā te waha, mā te puku, ki roto i ngā awaawa au. Ka taea te tango tauira mai i reira, ā, ka taea te whakanoho i tētahi stent ki te wāhi kua āraia hei āwhina i te rere o te au.
• MRCP (Aukumete Resonance Cholangiopancreatography): He rite tēnei ki te MRI, engari ka mahia motuhake hei tirotiro i ngā awaawa o te ate me ngā awaawa o te repeure. Kāore e hiahiatia he whakaurunga o tetahi mea ki roto i te tinana.

Ngā wāhanga o te mate pukupuku

Mena ka tāpaetia koe kei te pāngia koe e tēnei mate, ka whakatauhia e tō tākuta te wāhanga o te mate pukupuku (te wāhanga o te mate pukupuku) . He mea nui tēnei mō te whakamahere maimoatanga me te whakatau i te matapae i muri i te maimoatanga.

Ka whakarōpūtia ngā wāhanga o te mate pukupuku i runga i te rahi o te puku (T), mēnā kua horapa te mate pukupuku ki ngā kōpū lymph (N), me te mea kua horapa ki ngā whekau tawhiti (M - kua horapa). I ētahi wā, ka whakaarohia hoki te āhua o ngā pūtau mate pukupuku i raro i te karuārai (te taumata mate pukupuku) .

Ko ngā wāhanga o ngā pukupuku Klatskin e whai ake nei:

• Wāhanga 0: Kei roto noa i ngā paparanga o roto o te awaawa au te pukupuku. Kāore anō kia horapa ki ngā paparanga hohonu ake, ki ngā kōpū lymph, ki ētahi atu wāhanga rānei o te tinana.
• Wāhanga I: Kei roto i te pakitara o te awaawa o te ate te mate pukupuku, engari kāore anō kia horapa ki waho o te awaawa o te ate.
• Wāhanga II: Kua horapa te pukupuku ki te kiko ngako e tata ana, ki te kiko ate rānei e tata ana.
• Wāhanga IIIA: Kua horapa te mate pukupuku ki ngā peka o tētahi o ngā uaua toto matua o te ate (matau, maui rānei).
• Wāhanga IIIB: Kua horapa te pukupuku ki ngā taha e rua o ngā oko toto matua o te ate, ki ētahi atu awa toto rānei i te taha kotahi o te ate, me te oko toto matua i tērā taha.
• Wāhanga IIIC: Kua horapa te mate pukupuku ki te kotahi ki te toru ngā kōpū lymph e tata ana.
• Wāhanga IVA: Kua horapa te pukupuku ki ngā pona lymph e whā, neke atu rānei.
• Wāhanga IVB: Kua horapa te mate pukupuku ki ngā wāhanga tawhiti o ngā pukahukahu, wheua, ate rānei.

He aha ngā maimoatanga mō te Klatskin Tumor?

He maha ngā āhuatanga e whakawhirinaki ana ki ngā kōwhiringa maimoatanga, tae atu ki tō āhua, te taumata o te mate pukupuku, me tō hauora whānui. Heoi, ko te pokanga te maimoatanga tuatahi me te maimoatanga tino noa mō tēnei mate.

He rerekē ngā momo pokanga:

• Te tango i te wai pākawa waro: Ka mahia tēnei hei tango i te wai pākawa waro nui kua kohia ki roto i te ate. Ka taea e tēnei te whakaiti i ngā tohu pēnei i te jaundice. Ka taea tēnei te mahi mā te ERCP me te stent, mā te ngongo o waho rānei.
• Te tango i te ate i roto i te toto i te wā tōmua: Mō te hunga whai pukupuku i te wā tōmua, ka taea e te tango i te ate te tango i tetahi wāhanga o te ate, ngā awa waikura, te pūkahukahu, me ngā kōpū lymph tata.
• Te whakawhitinga ate: Ko te huarahi anake hei whakaora katoa i tēnei mate ko te tango i te/ngā pukupuku matepukupuku. Tērā pea me tango te ate katoa, me te mahi i te whakawhitinga ate. Kāore e taea tēnei e te katoa, ā, me whai mana.

Haunga te pokanga, i ngā wā kāore e taea te pokanga, ka whakamahia e ngā tākuta tētahi maimoatanga e kiia nei ko te chemoradiation . He huinga tēnei o te chemotherapy me te radiation therapy . Ka patua e ēnei maimoatanga ngā pūtau matepukupuku, ka whakahaere rānei i tō rātou tipu.

E rua ngā maimoatanga hou mō ngā pukupuku pūtau squamous metastatic:

• Te rongoā ārai mate: Hei tauira, ko ngā rongoā e kiia nei ko ngā 'aukati ārai mate' . Ka mahi ēnei mā te āwhina i tō ake pūnaha ārai mate ki te whawhai ki te mate pukupuku.
• Te rongoā arotahi: Ngā rongoā pēnei i ngā aukati i te fibroblast growth factor receptor (FGFR) me ngā aukati IDH . Ka aukatihia e ngā aukati FGFR te tipu o ngā pūtau matepukupuku, ā, ka patua rātou. Ka āraihia e ngā aukati IDH tētahi pūmua rerekē e pā ana ki te tipu pūtau noa. Kāore ēnei e whai hua mō te katoa, ā, ka hoatu noa ki te hunga he rerekētanga ira kei roto i ō rātou pūtau matepukupuku.

Ngā raruraru me ngā pānga taha o te maimoatanga

He pokanga nui ngā hepatectomy me ngā whakawhitinga ate, nō reira, ka pā mai pea ngā raruraru nui.

• Ascites: Te kohi wai i roto i te puku.
• Te turuturu o te au: I te wā e pokanga ana i te ate, ka pakaru pea ngā awa au o te ate, ka turuturu te au nui ki roto i te ate.
• Te toto toto hohonu (DVT): Ko te hanganga o te toto totoka i roto i ngā uaua hohonu o te tinana i muri i te pokanga.
• Mate urutā: Ka puta pea ngā mate urutā i te wāhi i pokaina ai, i roto i te ara mimi, i roto rānei i ngā pukahukahu.
• Te ngoikore o te whatukuhu: I ētahi wā ka pāngia ngā whatukuhu e te pokanga ate, ā, ka mutu ai tā rātou mahi.
• Te ngoikore o te ate: Ka pā tēnei ki te tangohia tetahi wāhanga o te ate (hepatectomy).
• Te whakakorenga okana: Ka whakakorea pea e te tinana te ate kua whakatōkia.

Ko ngā pānga taha noa o te rongoā irahiko me te rongoā matepukupuku ko:

• Ngenge.
• Te ngaro o te makawe.
• Whakapairuaki me te ruaki.
• Ngā mate waha.
• Te korere.
• Te mate toto iti.

Ka whakarato hoki ngā tākuta i ngā tohutohu me ngā rongoā hei whakahaere i ēnei pānga taha.

He aha te ōrau ora mō te pukupuku Klatskin?

Ina rongo koe mō tētahi mate pēnei, ko tētahi o ngā pātai tuatahi ka puta ake ki tō hinengaro ko te 'auau ora'. E pā ana tēnei ki te ōrau o te hunga whai momo matepukupuku motuhake e ora tonu ana i ngā tau e rima i muri i te tātaritanga.

Ko te National Cancer Institute (NCI) i te Hononga o Amerika e kohikohi ana i ēnei raraunga. Ahakoa kāore he raraunga motuhake mō ngā pukupuku Klatskin, kei reira ngā raraunga mō ngā momo mate pukupuku awaawa katoa e whanake ana i waho o te ate. Nō reira, i te katoa, e 9% o te hunga he mate pukupuku awaawa waho o te ate e ora ana i te rima tau i muri i te tātaritanga.

Engari ina whakaarohia ēnei tatauranga, me maumahara ki ngā mea e rua:

• He whakatau tata noa iho ēnei: ​​i ahu mai i ngā wheako o ētahi atu. Tērā pea ka rerekē rawa tō āhuatanga. Hei tauira, ko tō hauora whānui, tō tau, tō taumata o te mate pukupuku, me te urupare ki te maimoatanga ka pā ki ēnei reiti.
• He mea hītori ēnei tau: E whakaata ana i ngā tau o mua tata nei, ehara i te mea o nāianei. Ka inehia ēnei reiti i ia rima tau. Nō reira, kāore te pānga o ngā maimoatanga hou e whakaatahia ana i roto i tēnei.

Ko te mea nui, kāore ēnei tatauranga e whakaatu i te katoa o te kōrero. He rerekē te katoa, ā, kei te pai haere tonu ngā maimoatanga. He mea pai kia kōrero koe ki tō tākuta mō tēnei mea, kia pātai atu hoki ki a ia he aha te tikanga o ēnei kōrero ki a koe. He mea nui kia noho tumanako tonu, kia noho pai hoki.

Me pēhea taku tiaki i ahau anō?

Ko te pupuri i te kounga o tō oranga i muri i tēnei tātaritanga, maimoatanga, me te whakaoranga te mea pai rawa atu ka taea e koe te mahi māu ake. Anei ētahi whakaaro:

• Kai pai:Kai i tētahi kai taurite, kai totika. Kai atu i ngā pūmua kikokore, huawhenua, hua rākau, me ngā witi katoa. Whakawhitiwhiti kōrero ki tō tākuta, ki tētahi tohunga kai rānei mō ngā tohutohu.
• Āta karohia ngā kōrero teka: Nā te mea he mate onge tēnei, kāore pea koe e mōhio nui ana mōna. He mea whakapoauau, he mea whakamataku hoki te rapu kōrero i runga ipurangi. Engari ko te mātauranga te mana . Tikina noa ngā kōrero mai i ngā puna pono. Kia kaha ki te rangahau i ngā meka, ā, pātai atu ki tō rōpū hauora mō ngā pātai, ngā āwangawanga rānei kei a koe.
• Tautokohia tō hauora hinengaro: Mēnā he mate pukupuku onge pēnei, ka pā kino pea ki tō hauora hinengaro, nā te mea he maha ngā wā e hiahiatia ana he pokanga me te maimoatanga mō te wā roa. He mea noa te pouri, te mataku, me te manukanuka. Pātai atu ki tō rōpū hauora mō ngā kaupapa me ngā tohutohu hei āwhina i tēnei. Kōrero ki te whānau me ngā hoa.
• Whakaarohia ngā kaupapa oranga mō te mate pukupuku: Ko ēnei e arotahi ana ki te hauora, te oranga tinana, me te kounga o te oranga i a koe e noho tahi ana me te mate pukupuku.
• Pātai atu mō te tiaki mamae: Ko te tiaki mamae he maimoatanga kāore e taea te whakaora i te mate, engari ka taea te āwhina ki te whakahaere i ngā tohu me te whakapai ake i te kounga o te oranga. Ka taea e te tiaki mamae mō te mate pukupuku o te awaawa au te āwhina i te whakapairuaki, te whakamamae i te mamae, me te pupuri i te rere o te au i ngā wāhi e āraihia ana e te pukupuku.

Āhea ahau me kite i te tākuta?

Mena kua tāpaetia koe he pukupuku Klatskin, me whakapiri atu koe ki tō tākuta i ia wā, i ia wā.

• Pātai atu ki tō tākuta mō ngā huringa e tika ana kia pā mai (te kino haere o ngā tohu, ngā tohu hou).
• Ki te kino haere ngā tohu pēnei i te mamae, te whakapairuaki, me te ruaki, ki te puta mai rānei he tohu hou , me whakamōhio tonu atu ki tō tākuta .
• Mena he kino ngā pānga taha o te maimoatanga, kōrerotia ki a rātou.
• He maimoatanga ā tō tākuta hei āwhina i te whakaiti i ngā tohu e pā ana ki tō oranga o ia rā me te kounga o te oranga.

He aha ngā pātai me pātai atu e au ki te tākuta?

Kua nui pea āu pānui mō ngā pukupuku Klatskin, ā, he pātai āu mō tō āhua. Tuhia ēnei pātai ina haere koe ki te tākuta.

• Me pēhea koe i mōhio ai kei a au tēnei momo mate pukupuku?
• He aha te taumata o te mate pukupuku? He aha te tikanga o tēnei?
• He aha ngā kōwhiringa maimoatanga kei a au? He aha ngā painga me ngā huakore o ia mea?
• He rongoā tino pai mō tēnei?
• Ka pēhea rā tōku ao i muri i te maimoatanga?
• He whakamātautau haumanu anō kei reira hei whakaaroaro māku?
• Me whakarerekē taku kai me taku momo noho?
• Kei hea mātou ko tōku whānau e whiwhi āwhina ai hei whakatau i tēnei āhuatanga?

Hei whakamutunga, kia mahara...

He mate tino uaua, he mate kino hoki te pukupuku Klatskin (hilar cholangiocarcinoma).Kāore e kore he mate tēnei. He mea noa te mataku ina rongo koe i tēnei. Heoi, kāore ngā raraunga pēnei i te maha o ngā tāngata e ora ana e whakaatu ana i te pūrākau katoa o tēnei mate. He mate ka taea te rongoā, ā, kei te whakahaerehia e ngā kairangahau ngā whakamātautau haumanu mō ngā maimoatanga hou.

Mena kei a koe tēnei mate, ka taea e tō tīma hauora te āwhina i a koe ki te whakahaere i ō tohu me ngā pānga taha o te maimoatanga. Ka koa hoki rātou ki te tuku whakaaro mō ngā whakamātautau haumanu e hiahia ana koe ki te whakaaro. Kaua e mutu te tumanako. Ko te mea nui ko te whai i ngā tohutohu a tō tākuta me te whai i ngā tohutohu a tō tākuta.

` Pukupuku Klatskin, Hilar Cholangiocarcinoma, Matepukupuku Āpiti, Matepukupuku Ate, Kirika Kōwhai, Wairua, Ngā Tohumate Matepukupuku, Maimoatanga Matepukupuku