He kōwhiringa kei te nuinga o ngā tūroro mate pukupuku ate kāore e tika ana kia pokangahia, kia whiwhi rānei i ētahi atu kōwhiringa maimoatanga.
Arotake Take
Te Maimoatanga Matepukupuku Ate Take 1:
Tūroro: Tāne, mate pukupuku ate tuatahi
Ko te maimoatanga HIFU tuatahi o te ao mō te mate pukupuku ate, i ora mō ngā tau 12.
Te Maimoatanga Matepukupuku Ate Take 2:
Tūroro: Tāne, 52 tau te pakeke, mate pukupuku ate tuatahi
I muri i te tango i te pūmua irahiko, i kitea te toenga o te pukupuku (te pūmua e tata ana ki te vena cava o raro). Whai muri i te maimoatanga HIFU tuarua, i tutuki te tango katoa o te pūmua toenga, me te tiaki pai o te vena cava o raro.
Te Maimoatanga Matepukupuku Ate Take 3:
Matepukupuku ate tuatahi
I whakaatuhia e te arotake i muri i ngā wiki e rua o te maimoatanga HIFU kua ngaro katoa te pukupuku!
Te Take Maimoatanga Matepukupuku Ate 4:
Tūroro: Tāne, 33 tau te pakeke, kua horapa te mate pukupuku ate
Kotahi te whara i kitea i ia pū o te ate. I mahia te maimoatanga HIFU i te wā kotahi, ā, i hua ake te nekrosis o te pukupuku me te mimiti i roto i ngā marama e toru i muri i te pokanga.
Te Take Maimoatanga Matepukupuku Ate 5:
Tūroro: Tāne, 70 tau te pakeke, mate pukupuku ate tuatahi
I kitea he pūtau matepukupuku toenga i runga i te MRI i muri i te whakatakotoranga hinu iodine whai muri i te embolization transarterial. I ngaro te kaha pakupaku i muri i te maimoatanga HIFU, e tohu ana i te tango katoa o te pūtau matepukupuku.
Te Maimoatanga Matepukupuku Ate Take 6:
Tūroro: Wahine, 70 tau te pakeke, mate pukupuku ate tuatahi
He pukupuku toto nui, he 120mm te rahi* I kitea he 100mm i te taha matau o te ate. I oti te tango katoa i te pukupuku i muri i te maimoatanga HIFU, ā, i mimiti haere i roto i te wā.
Te Take Maimoatanga Matepukupuku Ate 7:
Tūroro: Tāne, 62 tau te pakeke, mate pukupuku ate tuatahi
He whara kei te taha o te tuanui o te diaphragmatic, te vena cava o raro, me te pūnaha uaua portal. I muri i ngā wāhanga e 5 o te auau irirangi me ngā wāhanga e 2 o te TACE, i kitea te pukupuku toenga i runga i te MRI whai muri. I angitu te whakakorenga o te pukupuku e te maimoatanga HIFU me te tiaki i ngā oko toto e karapoti ana.
Te Take Maimoatanga Matepukupuku Ate 8:
Tūroro: Tāne, 58 tau te pakeke, mate pukupuku ate tuatahi
I kitea te hokinga mai i muri i te pokanga mō te mate pukupuku ate o te taha matau. I tutuki te tango katoa o te pukupuku mā te maimoatanga HIFU, ā, i whakaūtia e te mimiti o te pukupuku 18 marama i muri mai.
Te wera nui mō te mate pukupuku ate – Rangahau Paerewa
Ka taea te whakamahi i te HIFU (High Intensity Focused Ultrasound) hei rongoā i te mate pukupuku ate. Ko ngā tikanga rongoā tuku iho mō te mate pukupuku ate ko te tango pokanga, te transarterial embolization, me te chemotherapy. Heoi, he maha ngā tūroro kua kitea i te wā kua tino matatau, kua tata rānei ki ngā oko toto nui he pukupuku kei a rātou, ā, kāore e taea te pokanga. Hei tāpiri, kāore e taea e ētahi tūroro te pokanga nā te āhua o ō rātou tinana, ā, he mōrearea ngā raruraru o ngā mahi pokanga.
He maha ngā painga o te maimoatanga HIFU mō te mate pukupuku ate:He iti noa te urunga mai o te mate, he iti noa te mamae me te kino e puta mai ana, he haumaru, he iti ake ngā raruraru, ā, ka taea te mahi anō mēnā e tika ana. Ka taea e ia te whakapai ake i ngā tohu o te tūroro, me te whakaroa i tō rātou oranga.
I muri i te maimoatanga HIFU, kāore anō kia pūrongohia he kēhi o te pakaru o te pukupuku, te jaundice, te turuturu o te au, te whara rānei o ngā oko toto, e tohu ana he haumaru te maimoatanga.
(1) Ngā Tohu:Te rongoā whakamama i ngā pukupuku kua horapa, te mate pukupuku ate takitahi i te pito matau me te whānui iti iho i te 10cm, ngā pukupuku nunui i te pito matau me ngā pona amiorangi e mau tonu ana ki te papatipu ate matau, te hokinga mai ā-rohe i muri i te pokanga, te thrombus pukupuku uaua tomokanga.
(2) Ngā Ārai:Ngā tūroro e pāngia ana e te cachexia, te mate pukupuku ate horapa, te ngoikore nui o te ate i te wāhanga whakamutunga, me te metastasis tawhiti.
(3) Te tukanga maimoatanga:Me takoto ngā tūroro he pukupuku kei te taha matau o te puku, ko te hunga he pukupuku kei te taha maui o te puku ka whakatakotoria ki runga i te tūnga takoto. I mua i te tikanga, ka whakamahia te ultrasound hei kimi i te pukupuku kia tika ai te arotahi me te whakamahere maimoatanga. Kātahi ka rongoatia te pukupuku mā te tukanga tango i ngā puku, mai i ngā pūwāhi takitahi ka haere tonu ki ngā rārangi, ngā wāhi, ā, i te mutunga ko te rahinga pukupuku katoa. Ko te tikanga ka mahia te maimoatanga kotahi i te rā, me te roa o ia paparanga tata ki te 40-60 meneti. Ka haere tonu te tukanga i ia rā, paparanga i ia paparanga, tae noa ki te tango i te pukupuku katoa. Whai muri i te maimoatanga, ka tirotirohia te wāhi i rongoatia mō tetahi kino kiri, ā, ka whai ake ko te matawai ultrasound o waho o te wāhi ūnga katoa hei aromatawai i te whai huatanga o te maimoatanga.
(4) Te tiaki i muri i te maimoatanga:Ka tirotirohia ngā tūroro mō te mahi ate me ngā taumata electrolyte. Me whakarato he maimoatanga tautoko mō ngā tūroro he ngoikore te mahi ate, he ascites, he jaundice rānei. He pai te pāmahana o te nuinga o ngā tūroro i te wā e rongoatia ana. Tērā pea ka piki ake te pāmahana o te nuinga o ngā tūroro i roto i ngā rā 3-5, i raro iho i te 38.5℃ te nuinga. E taunakihia ana kia nohopuku mō ngā hāora e 4 i muri i te maimoatanga, ko ngā tūroro he mate pukupuku ate maui me nohopuku mō ngā hāora e 6 i mua i te neke haere ki te kai wai. Tērā pea ka mamae te puku o runga o ētahi tūroro mō ngā rā 3-5 i muri i te maimoatanga, ā, ka memeha haere.
(5) Aromatawai i te whai huatanga:Ka taea e te HIFU te whakangaro i te kiko o te mate pukupuku ate, ka puta te pirau o ngā pūtau mate pukupuku. E whakaatu ana ngā karapa CT i te hekenga nui o ngā uara whakaiti CT i roto i ngā wāhi ūnga, ā, e whakaū ana te CT whakarei ake i te rerekētanga i te korenga o te toto toto uaua me te toto toto ki te wāhi ūnga. Tērā pea ka kitea he whitiki whakarei ake i te taha maimoatanga. Ka whakaatuhia e te MRI ngā huringa o te kaha tohu o te pukupuku i runga i ngā whakaahua taumaha T1 me te T2, ā, e whakaatu ana i te ngaronga o te toto toto ki te wāhi ūnga i roto i ngā wāhanga uaua uaua me te toto toto, me te wāhanga whakaroa e whakaatu ana i te whitiki whakarei ake i te taha maimoatanga. E whakaatu ana te aroturukitanga ultrasound i te hekenga āta haere o te rahi o te pukupuku, te ngaronga o te toto toto, me te pirau kiko ka mimitihia i te mutunga.
(6) Te whai ake:I ngā tau tuatahi e rua i muri i te maimoatanga, me toro atu ngā tūroro ki te tākuta i ia rua marama. I muri i ngā tau e rua, me toro atu i ia ono marama. I muri i ngā tau e rima, me tirotirohia ā-tau. Ka taea te whakamahi i ngā taumata Alpha-fetoprotein (AFP) hei tohu mō te hokinga mai o te pukupuku. Mena ka angitu te maimoatanga, ka mimiti te pukupuku, ka ngaro katoa rānei. I ngā wā kei te noho tonu te pukupuku engari kāore he pūtau ora, me tūpato ina kitea he pukupuku he whānui neke atu i te 5cm i te whakaahua, ā, ka taea te whakamahi i ngā matawai PET hei whakamārama atu.
Te tirotiro haumanu i ngā hua o mua me muri i te maimoatanga, tae atu ki ngā taumata alpha-fetoprotein, te mahi ate, me ngā matawai MRI,kua whakaatuhia he reiti murunga haumanu neke atu i te 80% mō ngā tūroro mate pukupuku ate i rongoatia ki te HIFU.Mēnā he nui te rere o te toto ki ngā pukupuku ate, ka taea te whakakotahi i te maimoatanga HIFU me te wawaotanga transarterial. I mua i te maimoatanga HIFU, ka taea te mahi i te transcatheter arterial chemoembolization (TACE) hei aukati i te rere o te toto ki te rohe puku o waenganui, me te mahi a te kaihoko embolic hei tohu pukupuku hei āwhina i te arotahi HIFU. Ka whakarerekē te hinu iodine i te aukati oro me te tauwehenga mimiti i roto i te pukupuku, ka āwhina i te hurihanga pūngao i te arotahi HIFU me te whakapai ake..
Wā tuku: Akuhata-08-2023