E mōhio ana pea koe he tino uaua te rongoā i te mate pukupuku ina horapa mai i tētahi wāhanga o te tinana ki tētahi atu. Engari nā ngā whanaketanga o te rongoā i ēnei rā, kei reira ngā maimoatanga motuhake ka taea te aro ki ngā pūtau mate pukupuku pērā i te pere, ā, ka pakaru noa iho i a rātou. I tēnei rā, e kōrero ana tātou mō tētahi tikanga rongoā tino matatau e whakamahia ana hei rongoā i tētahi momo mate pukupuku e kiia nei ko te 'neuroendocrine tumors (NETs). Ko te PRRT te ingoa, arā, ko te 'Peptide Receptor Radionuclide Therapy'.
He aha te tikanga o te maimoatanga PRRT?
He rongoā mate pukupuku arotahi te PRRT. Ko te tikanga he tuku tika i tētahi matū irahiko ki roto i ngā pūtau mate pukupuku, ā, ka whakangaromia rātou. Whakaarohia he rite ki te patu i ngā pūtau mate pukupuku me te kore e whara i ngā pūtau hauora o te tinana.
He pēhea te mahi a tēnei? He mīharo!
Hei mārama ki tēnei, me tango he tauira iti. He kaiwhakawhiwhi motuhake kei te mata o ia pūtau matepukupuku, pērā i te kōhao kī i roto i te tatau. Ina huihui ngā pūmua motuhake e ōrite ana ki ēnei kaiwhakawhiwhi anake, pērā i te kī, ka tuwhera te tatau hei tuku i ngā mea ki roto i te pūtau.
Koinei te mahi a te maimoatanga PRRT:
1. Te waihanga i te "kī": Ka hangaia he pūmua (peptide) e ōrite ana ki ngā kaiwhakawhiwhi i te mata o ngā pūtau matepukupuku i roto i te taiwhanga.
2. Te tāpiri i te "poma": Kātahi ka tāpirihia he huānga irahiko e kiia nei ko te irahiko, e patu ana i te pūtau matepukupuku, ki te pūmua i hangaia.
3. Te haere ki te ūnga: Ina whakaurua tēnei rongoā ki roto i te tinana, ka kitea e te pūmua tōna ara ka herea ki ngā kaiwhakawhiwhi i runga i ngā pūtau matepukupuku.
4. Te whakangaromanga o te pūtau matepukupuku: Pērā i te kī e whakatuwhera ana i te tatau, ina herea te pūmua ki te kaiwhiwhi, ka uru te rongoā irahiko ki roto i te pūtau. Kia uru ki roto, ka pakaru te irahiko e tukuna ana e ia i te DNA o te pūtau matepukupuku, ka whakangaro i te pūtau mai i roto.
Ko te painga nui o tēnei tikanga ko te arotahi ki ngā pūtau matepukupuku anake, nō reira he iti noa te kino ki ngā pūtau hauora e karapoti ana.
He aha ngā momo PRRT e whakamahia ana i te ao?
Ko te rongoā PRRT matua kua whakaaetia i te ao tae noa mai ki tēnei wā ko te `lutetium Lu 177 dotatate (LUTATHERA®).` I roto i tēnei, ko te `dotatate`, he pūmua hangai, e piri ana ki te huānga irahiko `lutetium-177`.
He rite tonu tēnei pūmua e kīia nei ko te `dotatate` ki te homoni `somatostatin` i roto i tō tātou tinana. He momo `NET` ngā pūtau matepukupuku he kaiwhiwhi motuhake mō tēnei homoni `somatostatin`. Ka haere tēnei pūmua e kīia nei ko te `dotatate` ki aua kaiwhiwhi, ā, ka piri pūmau. Nō reira, ka haere tika te rongoā ki roto i te pūtau matepukupuku.
Hei tāpiritanga, kei te rangahauhia ētahi atu matū PRRT, ko ētahi o ēnei kei roto i ngā whakamātautau haumanu.
Mā wai tēnei maimoatanga PRRT e tika ana?
I tēnei wā, ko te maimoatanga PRRT te nuinga e whakamahia ana mō ngā mate pukupuku e kiia nei ko ngā 'gastroenteropancreatic NETs', arā, ngā mate pukupuku e puta ana i roto i te ara nakunaku. Hei tauira:
- Pancreas
- Te tūnga
- Ngā whekau iti me ngā whekau nui
- Puku
E whakawhirinaki ana ki ētahi āhuatanga te pai o tēnei maimoatanga mō tētahi tangata. Tirohia te ripanga i raro nei.
| Tūnga | Whakaahuatanga |
|---|---|
| Kāore e tika ana mō te pokanga | Mena kua horapa te mate pukupuku ( metastasized ) ki ngā wāhi maha o te tinana, he uaua ki te whakaora mā te pokanga anake. Mō te tini o te hunga kua tāpaetia he mate pukupuku NET, kua horapa kē te mate pukupuku. |
| Te kore e aro ki ētahi atu maimoatanga | Mena kāore e taea te pokanga, ka hoatu te rongoā homoni. Heoi, i roto i ētahi tāngata, ka tipu tonu ngā pukupuku me te kore e taea te whakahaere ahakoa ēnei maimoatanga. |
| Te aroaro o ngā kaiwhakawhiwhi Somatostatin i roto i ngā pūtau matepukupuku | Koinei te mea tino nui. Kia mahi ai te rongoā PRRT, me whai ngā pūtau matepukupuku i aua kaiwhakawhiwhi motuhake. Ka mahia e tō tākuta he matawai motuhake, pērā i te matawai octreotide, hei whakaū mēnā kei reira ēnei kaiwhakawhiwhi. |
Me pēhea te whakarite i mua i te maimoatanga?
Mena kei te tango kē koe i ētahi atu rongoā mō te mate pukupuku NET, ka tohutohu pea tō tākuta kia mutu te tango i ētahi o aua rongoā mō te wā poto i mua i te maimoatanga PRRT.
- I te nuinga o te wā, me whakamutu ngā werohanga somatostatin roa te mahi i te iti rawa i te 4 wiki i mua i te maimoatanga.
- Tērā pea i mutu te whakamahi i ngā werohanga somatostatin poto-mahi i ngā hāora 24 i mua i te maimoatanga.
- Me karo hoki i te tango i ngā steroids nui te horopeta pērā i ngā 'glucocorticosteroids' i te wā e rongoatia ana.
He wiki i mua i ia maimoatanga, ka whakamātauria tō toto kia kitea ai mēnā kua rite tō tinana mō taua maimoatanga.
He aha ngā mea ka tupu i te rā o te maimoatanga?
Ko te tikanga ka tukuna te maimoatanga PRRT i ia rua marama, mō ngā wā e whā, mō te wā e waru marama. He tikanga tēnei mō waho o te hōhipera, arā, kāore koe e hiahia ki te noho ki te hōhipera. E 5-6 hāora te roa o te tikanga katoa.
1. Tuatahi, ka whakauruhia he cannula intravenous (IV) ki roto i te uaua i tō ringa.
2. Ka hoatu he rongoā hei ārai i te whakapairuaki me te ruaki i te haora kotahi i mua i te tīmatanga o te maimoatanga.
3. Kātahi ka tukuna he wai waikawa amino mā te werohanga IV mō te 4 hāora pea hei tiaki i ō whatukuhu.
4. Tata ki te 30 meneti i muri i te tīmatanga o te otinga waikawa amino, ka tukuna te rongoā PRRT mā roto i tētahi atu werohanga IV mō te 30-45 meneti.
5. Kia oti ngā otinga katoa te hoatu, ka tangohia te ipu werohanga.
I te rā i muri i te maimoatanga, ka mahia he matawai motuhake hei tirotiro me pēhea te horapa o te rongoā puta noa i te tinana.
He aha ngā painga me ngā mōrearea o te maimoatanga PRRT?
He aha ngā painga?
He maimoatanga tino angitu te PRRT. Mō te tini o te hunga e whiwhi ana i tēnei rongoā, ka ngaro, ka mutu rānei te tipu o ō rātou pukupuku. Mā tēnei ka roa ake te ora o ngā tūroro, ka mau tonu hoki te kounga o te oranga .
Engari kia maumahara, ehara te PRRT i te rongoā mō te mate pukupuku. Mō te tini o te tangata, ka hoki mai anō te mate pukupuku i muri i tētahi wā.
Ngā tūponotanga me ngā pānga taha
Ko te ruaki me te whakapairuaki ngā pānga taha tino kitea o tēnei maimoatanga, engari ka taea te whakahaere i ēnei mā te rongoā i hoatu i mua i te maimoatanga.
Ko ētahi atu raruraru pea ko:
- Ngā raruraru o te whatukuhu, o te ate rānei.
- Te iti o te maha o ngā pūtau toto. Ka uaua pea te manawa, ka nui ake te mōrearea o ngā mate, me te toto, te marō rānei.
- He tino onge te tūponotanga o te whakawhanake i ngā mate pukupuku toto pērā i te myelodysplastic syndrome me te leukemia.
Ka tirotirohia koe e tō tākuta mā te whakamātautau toto auau puta noa i ngā marama e 8 o te maimoatanga. Mēnā ka puta he raruraru, ka whakatau ia me whakarerekē, me whakamutu rānei tō maimoatanga.
Te āhuatanga tino whāiti: Te raruraru Carcinoid
He mate onge tēnei engari he kino, ā, ka taea te whakamate i te ora. Ka puta mai i te pikinga ohorere o ngā homoni mai i ngā pūtau matepukupuku. Ko ngā tohumate ka puta i roto i ngā haora 48 o te whiwhinga o te maimoatanga.
Ki te pāngia koe e tētahi o ēnei tohu, haere tonu ki te Tari Ohotata (ETU) o te hōhipera tata rawa atu.
* Uaua ki te manawa
* Te whero, te wera rānei o te kiri i te mata, i te kaki rānei (te whero o te kiri)
* Te toto toto iti (hypotension)
* Ngā palpitations (te tere o te manawa)
* Korere kino
Te whakaoranga me te oranga o ia rā
He pai te aro o te nuinga o te tangata ki te maimoatanga PRRT, ā, ka tere te ora.
Ka taea e au te hoki ki te mahi?
He iti noa te nui o te rauemi irahiko e whakamahia ana e te PRRT. Ka tukuna atu tēnei rauemi irahiko i roto i tō tinana i roto i tō mimi me tō tūtae mō ētahi rā i muri i te maimoatanga. Ka tohutohu tō tākuta kia noho tawhiti koe i te iti rawa i te kotahi mita mai i ētahi atu tāngata i tēnei wā, inā koa ko ngā wāhine hapu me ngā tamariki nohinohi . He mea nui hoki kia horoia ō ringaringa i ngā wā katoa.
Ka taea te haereere i tēnei wā?
Tērā pea he iti noa te nui o te irahiko kei roto i tō tinana tae atu ki te 3 marama i muri i tō maimoatanga. Hei tauira, ka taea tēnei te kitea mā roto i ngā taputapu tirotiro irahiko i ngā taunga rererangi. Ka hoatu e tō tākuta he kāri motuhake ki a koe e whakaatu ana i ngā taipitopito o te maimoatanga kua riro i a koe. He mea nui kia mau tonu tēnei kāri me tētahi kape o ō tuhinga maimoatanga ki a koe i ngā wāhi katoa e haere ana koe tae atu ki te 3 marama i muri i tō maimoatanga.
Karere Tangohia ki te Kāinga
- He tikanga maimoatanga matatau te PRRT e aro ana ki ngā pūtau matepukupuku anake, ā, e whakamahi ana i te irahiko hei whakangaro i a rātou.
- Ko te nuinga o te wā ka whakamahia mō ngā pukupuku neuroendocrine (NET) kua horapa puta noa i te tinana, ā, kāore e aro ki te pokanga, ki ētahi atu maimoatanga rānei.
- Ahakoa ehara tēnei i te maimoatanga e whakaora katoa i te mate pukupuku, he tino āwhina ki te whakahaere i te mate me te whakapai ake i te wā e ora ai me te kounga o te oranga.
- He mea nui kia whai i ngā tohutohu a te tākuta hei tiaki i a koe mai i te irahiko mō ētahi rā i muri i te maimoatanga.
- Ki te puta ngā tohu o te Carcinoid Crisis , pērā i te uaua ki te manawa, te whero o te kiri, me te tere o te ngakau, haere tonu ki te Tari Whawhati Tata o te hōhipera (ETU) .
- Mena ka puta he raruraru, he pānga taha rānei e pā ana ki te maimoatanga, kōrero ki tō tākuta.











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