Добавил:
Upload Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз: Предмет: Файл:
Скачиваний:
27
Добавлен:
27.02.2016
Размер:
148.48 Кб
Скачать

1. Surgical treatment

Perform the following operations:

1.       Lobэktomiya - With small peripheral tumors or tumors are CC b (T 1 N 0 M 0) without evidence of metastasis to the lymph nodes or lungs root share.

2.       Pnevmonэktomiya - Removal of the lung along with fiber root. Carried out at the central or peripheral cancer metastasis and we in the lymph nodes of the root (T 1-3 N 1 M 0).

3.       Extended pnevmonэktomiya - removal of a lung with fiber sredostinnya from defeat. Running with tumors of any l o cal yzatsyy with metastases l and MFIs in public conveniences s and e redost tion (T 1-3 N 2 M 0).

4.       Combined pnevmonэktomiya - removal of a lung together with any authority (part of it) or the structure of the chest cavity. It can be pericardium, diaphragm, trachea, chest wall with ribs and without them, odd vein of the left atrium. Performed at T 3-4 N 2 M 0.

2. Radiation therapy may be used as an independent method (for p and dykalniy or palliative program), and as part of a combined medi tion n. After radical surgery in 3 weeks starting radiotherapy or standard fractional factions. The total focal dose of 40 Gy, focal dose of 2 Gy. 5 days a week of exposure, 2 days break. Irradiation is carried out with two opposing fields in the input field irradiation at dyat bronchial stump and seredostin tion. In a radical program of SOD at long dyat to 60 Gy. In recent years, trying to hold neoad b yuvantnu (peredop e ratsiynu) radiotherapy moderate factions OD 5.4 Gy, SOD December 20. Irradiation performed 4 - 5 days, then the next day at Lane reproduced surgery.

3. Polychemotherapy (PCT) - can be used as an independent method (palliative), and as part of combination therapy. PCTs may be applied as tysya before surgery (neoad yuvantna b) and after surgery (al b yuvantna). Commonly used few (2-4) of drugs with different mechanisms of action. Prov reproduced at 3 - 6 courses every 3 - 4 weeks. The most common modern scheme l and forging:

for non-small cell cancer

CAP (cyclophosphamide 400 mg / m 2, doxorubicin 40 mg / m 2, cisplatin 40 mg / m 2 in one day)

EP (60 mg / m 2 on day 1, etoposide 120 mg / m 2 in 4, 6, 8-day)

for small cell

ASO (doxa rubytsyn at 50 mg / m 2 on day 2, cyclophosphamide 400 mg / m 2 from 1 to 5-day, vincristine 2 mg in the 1st and 5th day).

Complications of lung cancer:

1.           Pulmonary hemorrhage, compression syndrome (syndrome X of New sdavlenya September hollow vein coffee syndrome). Paresis called orotnoho nerve

In mediastinal tumors usually referred sincere tumors and cysts and swollen yno similar and education (100 illnesses). The structure of cancer and diseases is about 1%.

Tumors of the mediastinum

By growths used mediastinum and usually referred stynni tumors ing with you and down at lin pod and BN and formation. Clinically in new creative Power saving should be divided into four groups: 1) tumors (benign and malignant) and cysts of tissue Em b p and ord Enno inherent with e redost others nude - so-called primary tumors and cysts in August dostinnya f, 2) retrosternal and intrathoracic goiter and also (benign and zloyaki sec tion), 3) metastatic cancer of other organs, 4) psevdopuh Linney disease lesions liter mfatychnyh nodes in tuberculosis and Eh and nokokk ozi, lymph, mesenchyme and fig b n and other formation.

Terato and days and formation consisting of different fabric and x f shouts.

Pathological Anatomy. Teratomas by Diehl S BY on mature and immature. All CL and Lee teratomas usually well so kapsulyrovan and wrong th round or s and flax forms of various sizes. In the context of cysts and often prominent. Immature teratoma m a tion form sol and packing and x nodes, sometimes with small cavities. Their surface is hilly, dense fabric. Cities With such brushes - similar to fat mass viscous, brown liquid hair. Teratomas may include areas of glands, teeth, and c k ing and sometimes partially cha with the developed fetus.

Diagnosis. The clinical picture depends on the location, intensity and size of the tumor growth, maturity, complications (infection, and in the prophecy of the nearest authorities and others.).

Allocate the Bess and mptomn and uncomplicated, but manifested clinically complicated and teratomas. Located in the front s e r e acc and n or, often in the middle of his third, teratomas often accompanied kardyovaskulya p n and we disturbances (tachycardia, constricting pain in the heart). Compression of large bronchi, trachea leads to breathlessness, sometimes to the attacks of ca sh Liu, hemoptysis. Infection often causes an increase in tumors that m perature and increase symptoms. In some patients with chest wall in and walks over teratoydn and m formation, often pulsating. The most important and vy patohnomonychn j symptom - detection in sputum hair and other TC and sues.

The main diagnostic method - complex X-ray studies and Jenny. This is determined by a round or ovo and dne formation with distinct boundaries that are not displaced when swallowing. Sometimes you can calcareous Include n ing, teeth. Detection of inclusions contributes ichne tomographic studies, especially in terms of vo and pnevmomed and astynuma. With the rapid growth and disappearance of clear boundaries should think of m and l and flexible and Zats uw.

Treatment with surgery alone. Expectant management and dynamic spost is saving inappropriate. Choice of access depends on the localization process.

And neurogenic tumors - most often found in creative new e n ing mediastinum.

Pathological Anatomy. Honey and astynaln and neurogenic tumors and can walk in and out of different nerve trunks mediastinum and nerve elements cut one of the mediastinum. Cha stishe and neurogenic tumors localized by e it s e redost others not, at least - in the front. With sympathetic nerve cells at Volyn trunk arising hanhlyonevroma, neuroblastoma, sympatykoblast at feohromotsyto ma and ma, and the tumors of the peripheral nerves, treat neuro at ma, neurofibroma and neuromas.

Hemodektoma - tumor cells with chemoreceptors. And neurogenic sarcoma - malignant tumor membranes nerves. As neurofibromas and they found Saul and packaged or in combination with disease Reklynhhauzena. Malignant new in TV at p Power saving IU astazuyut t b l and m s mfohematohenn way.

Diagnosis. Clinical symptoms can be divided into symptoms of diabetes and typically colored or nervous tissue of the thoracic, symptoms associated with pores in the target country functions of the thoracic cavity pressure due to tumor volumes sim p intoxication. Bowls with neurogenic tumors and x among observed at wall ball isnyy syndrome, as well as increased stomlyuv ness, helmet to virtue c, d zone and ne p stezyy, shortness of breath, cough, fever, pitl and news, with thinner Power saving, irritability , palpitations, feeling sdavlenya breasts and Noah, hoarseness, Horner's symptom, numbness of hands and others. Bol CCI and the reaction was a minor sensation tion of the strongest neuralgia. Localization at least peo often corresponds to the location of the tumor. Tumors among at rear wall often cause bol isnyy syndrome, the tumor front seredosti tion n. Hanhlyonevrom and often occur with baa simptomno for bug and toh years and the tumor reaches a larger size. The clinical picture of immature and not proc and x tumors prevalent general intoxication and ball isnyy syndrome. When feohromotsytom and patients complain of general weakness, headache, palpitations, poor appetite, sweating, feeling of inner heat, with a dyshku; leading symptom - paroxysmal hypertension, palpitations and b lems at the heart. Clinical and x neurogenic tumors can vary in conn I LCU with their ability malihnizovuvatysya or succumb to spontaneous regression when ripe and bathrooms, especially in children.

Crucial in the diagnosis belongs radiological studies and investigations, as well as diagnostic tests Minoru. To clarify the size struc k rounds teneobrazovanyya, its relationship with the mediastinum using special methods: imaging, diagnostic pneumothorax, chest, etc.. Picture of blood varies with malignant degeneration of the tumor.

Treatment. Mature and neurogenic tumors removed surgically, with immature tumor surgery coupled with radiation and p and dshe chemotherapy. Methods bypass vessels and is at kstrakorporalnoho blood circulation allow radical removal of tumors that invades the vessels, with their subsequent plasticity. When malignancy tumor that invades re b ro, to remove a tumor in the block area of the affected district is bras. If confirmed by immediate microscopy malignant nature of the new work at removing enlarged para-aortic s, e zofahealn j tracheal and limfaty h or knots. When immature neurogenic tumors and x (mostly children) neo least tern and radiotherapy. Chemotherapy has not found wide applications in the bathroom with neurogenic tumors and x.

Lymphosarcoma and Hodgkin and as a localized form of in seredostin meet together in Mr. and much less in comparison with the local defeat other groups of lymph nodes.

Diagnose. Hospital and medyast onal and x forms lymphosarcoma and li m fohranulematozu due first intoxication, and at a white b Shih tumor size - compression of the mediastinum. In the early centuries and actions Hodgkin's disease symptoms are mild. As the process occurs at Prospect remytyruyu Mr. and temperature, one of the most important signs of the disease are itching, sometimes occurs in patients with profuse perspiration, lyrics and Biesty, marked with thin tion. Early increases BY spleen. With the growth of tumors appearing chest pain, feeling of weight in the chest, coughing and b slow but increasing shortness of breath. In Hodgkin unlike other honey and astynaln and x tumors less severe symptoms of compression. Most hara k Terni changes in the blood picture - leukocytosis or leukopenia, increased W OЭ. It can be observed also exudative j, and later hemorrahych n th player in rhythm. A characteristic feature is the bilateral is in ra tion. Lymphosarcoma and cutting I yutsya more rapid passage of progression medyastynalnoho com p resiynoho syndrome. Overall condition is deteriorating as prohresuva n ing at the main and second process. Defeat honey astynaln and x lymph nodes can be confirmed l and m fohrafyey, honey and astynoskop iyeyu.

Treatment of Hodgkin's disease and lymphosarcoma in the localization process with e redost us and conservative (chemistry and radiation therapy).

 

Tumors of thymus.

Pathological Anatomy. Size tumors thymus gland th varies from 2 - 3 cm in diameter to giant - 10 - 30 cm. Accepted distinguish caps in polar yi and yi nekapsulyarn in new creative Power saving. The latter are often ma tion and nfyltryru S h i j growth, grow into surrounding organs and tissues. Tumors fork at Howl cancer are divided into three large groups: predominantly epithelial, predominantly L and MF at days and and and and and Dr. Terato. Separation Tim on benign and malignant conditions in some extent in but because in some cases, either clinically or histologically not even vdayet b Xia ascertain this.

Diagnosis. Clinical implications of t and IOM largely depend on morphology and chnoyi structure, size of the tumor and its impact on the immediate and organs and tissues. Most patients complain of weakness, fatigue, sweating, fever, hoarseness, feeling sdavlenya breasts and Noah, weight loss, cough. The most frequent and early symptom of tumors normally h KOVO cancer - chest pain that with increasing tumor gradually increases. Malignant tumors of the thymus often metastazuyut in supraclavicular, subclavian, cervical lymph nodes are enlarged, p tion and dense, sedentary. A number of patients and combined with Tim mia with shadows.

Imaging methods research is given a leadership position. The presence of shadows in the upper or middle seredosti n no bezposere d it close to the sternum makes you think about the possible pathology fork at Howl cancer. Sometimes tumors localized in the thymus is dostiny back in August. In the benign course of the boundary between the tumor and adjacent shade at p haniv are clear. Much of the X-ray tumors fork at Howl cancer and given pnevmomed astynohraf scammed.

Treatment. Power saving thymic malignancies her cancer removed by surgery. The most commonly used lateral pleural Intro ground access.

 

 

Соседние файлы в папке Преподавателям