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

5.2.2. Main stage:

Polls and surveys patients spend most students alternately under the control of the teacher. To evaluate the accuracy of surveys consistently attracted other students.

When patients surveyed students' attention is drawn to the medical history of the disease, the presence of chronic inflammatory percent and human rights of precancers.

There tumor renal parenchyma and renal pelvis:

A. Benign: adenoma, lipoma, fibroma, leiomyoma, hemangioma, a tumor of the dermis.

B. Malignant tumors adenokartsinoma, sarcoma, Wilms tumor mixed.

V. Metostatychni kidney tumors.

II. Tumors of the renal pelvis.

A. Benign tumors papilloma, endometrioma.

B. Malignant tumors: papillary carcinoma, squamous cell carcinoma, sarcoma.

Epidemiology. Incidence of kidney tumors is 2-3%. Men are twice as likely to suffer from women. Among malignant tumors of the kidney parenchyma dominates adenocarcinoma.

Causes of kidney tumors studied enough. It is believed that the balance of estrogen leads to the development of kidney tumors, tumors may also occur under the influence of radiant energy.

PatAnatomy. Malignant tumors of the kidney with a rounded shape, m  yakoelastychnu texture sizes up to 15 - 20 cm. Characteristically for hipernefromy sprouting kidney and inferior vena cava as a "tongue", metastases to the lungs, liver, brain, bone metastases lymphogenous - in perirenal nodes.

Classification of kidney cancer in stages:

T1 - tumor to 2.5 cm, limited to kidney

T2 - Tumor more than 2.5 cm, limited to kidney

T3 - Tumor extends into major veins or adrenal gland or surrounding renal tissue

T4 - Tumor extends beyond the fascia Herota

N1 - metastasis in one liter / node to 2 cm

N2 - Metastasis in one or in several l / nodes to 5 cm

N3 - Metastasis in l / node more than 5 cm

M0 - no metastasis

M1 - there are distant metastases

Clinic. Complaints of fever, pain, intoxication, bleeding due to the collapse of the tumor, anemia, increased erythrocyte sedimentation rate, the appearance of varicocele obturation renal and inferior vena cava.

Diagnosis: pronounced symptom, which is typical of late stage - anemia, increased ESR, hematuria, symptom Shtauffera (hypoalbuminemia, hipohlobulinemiya, pidvyshennya blood levels of alkaline phosphatase and lactate dehydrogenase activity in the urine).

Plain radiography, excretory urography and retrograde pyelography, arteriovenohrafiya.

Pathognomonic signs arteriohrafichnymy hipernefromy is chaotic accumulation of contrast in the region of the kidneys, which looks like "lakes and puddles."

Differential diagnosis of tumors of the kidney is from a cyst and polycystic hydronephrosis, abscess, tuberculosis and anthrax retroperitoneal tumors and kidney.

Treatment: Radical nephrectomy is the main treatment. Appointed 5-fluorouracil, anti-estrogens (tamoxifen, zitazonium) Radiation therapy is not effective. Life is not operated patients 3 years after surgical treatment of 1 - to several years.

Nefroblastoma - Wilms' tumor - it is 30% morbidity in children, usually from 2 to 5 years. Treated it complex - surgical nephrectomy, and cyto static treatment.

Malignant n uhlyny bladder is about 4% in the structure of bladder tumors.

Benign - papilloma, fibroma, uterine, leiomyoma treated surgically.

Causes of bladder cancer: chemical carcinogens: sentytychni dyes alpha - nafatalamin beta - naftalamin, benzidine in - aminodefenil. Most cancer arises from the production of aniline dyes.

Often happens bladder cancer, which appears on the background of papillomas.

Perehidnoklitynnyy cancer looks Polyanica with ulceration, squamous cell carcinoma macroscopically similar plaques or limpet.

Adenokartsinoma (colloid carcinoma, mucosal cancer is rare).

Tumors of the ureter - a rare tumor of the urinary tract, which manifest themselves hematuria and symptoms subrenalnoyi obstruction, often chronic, as slow growth. The vast majority of malignant tumors and often only represent a transitional cell carcinoma (PAC). Squamous cell carcinoma occurs only rarely in chronic inflammation and infection.

Specific risk factors - abuse of analgesics, papillary necrosis and "Balkan" nephropathy. Smoking is a risk factor for PAC all bodies covered with urothelium.

Diagnosis is radiographic methods. On excretory urography revealed filling defect and signs of urodynamics (hydronephrosis, ureterohydronephrosis) of varying degrees of severity. Retrograde ureteropiyelohrafiya confirms the stability of defect filling. In doubtful cases the diagnosis clarifies ureteropiyeloskopiya biopsy. An essential aid in the differential diagnosis renthennehatyvnoho concrement and PACs ureter can do sonography and computed tomography "thin slices "of a pre-determined" area of interest ".

The standard treatment for PAC ureter with functionally complete contralateral kidney is nefrureterektomiya because PAC is uretelialnu disease "change fields", characterized by a tendency to polihronotropizmu (multiple recurrences in time and space).

In metastatic and locally common forms of the disease shown combined treatment (polychemotherapy, radiotherapy).

The clinic bladder cancer dominate hematuria and dysuria. Bleeding can be clots, constant or intermittent pain, dizuricheskie pain, difficulty urinating, genuine and compelling urge.

Tsytoskopiya - the main method of study of bladder cancer with biopsy and histological examination.

Cystography - gives a filling defect in the hub cancer, bladder distortion circuit and its asymmetry indicate infiltrative tumor growth.

Transurethral resection with excision of the tumor, large tumor size and its infiltrative growth require tsystoektomiyi. Ureter peresazhuyut the colon. In inoperable cancers - palliative radiotherapy courses distance. Cytostatics - tsyklofosan, adriablastyn; vnutrishnomihurovi instillation dybunolu.

Weather unfavorable 5ti year survival - 36%, and 10richne - 20%.

 

Соседние файлы в папке Преподавателям