Cost of liver cancer surgery In India

Kuvhiya kuri pakati peyakanakisa kurapwa sarudzo mukutanga nhanho kurapwa kenza yechiropa. Kune marudzi akasiyana ekuvhiya kenza yechiropa kunofanirwa kuitwa uye zvinosarudzwa nachiremba anovhiya kenza yechiropa. Rudzi rwekuvhiya runofanira kuitwa rwunoenderana nedanho rechirwere, kupararira kwechirwere kune dzimwe nzvimbo uye mamiriro ehutano hwemurwere. Pamwe chete nachiremba anovhiya bundu anobvisawo chikamu chematishu akatenderedza bundu masero. Iyo inogona kunge iri yakanyanya kubudirira-inotungamirirwa nechirwere, kunyanya kune varwere vane chiropa chakanaka uye mapundu anogona kubviswa zvakachengeteka kubva kune chikamu chidiki chechiropa. Kuvhiya kunogona kunge kusiri sarudzo kana bundu rikatora chiropa chakawandisa, chiropa chakanyanya kukuvadzwa, bundu ratopararira kunze kwechiropa, kana murwere aine zvimwe zvirwere zvakakomba. Anovhiya oncologist chiremba anorapa kurapa gomarara achishandisa kuvhiya. A hepatobiliary surgeon anewo hunyanzvi kudzidziswa mukuvhiya pachiropa uye pancreas. Dzimwe nguva, vanachiremba vanovhiya chiropa vanobatanidzwa mukuvhiya uku. Musati mavhiyiwa, taurai neboka renyu rezvehutano pamusoro pezvamungaite kubva pakuvhiyiwa kwamunenge maitwa.

Varwere vanokodzera kuvhiyiwa kenza yechiropa

nyanzvi yedu inongofunga nezvekuvhiyiwa kana kenza iri mune imwe nzvimbo yechiropa chako uye isina kupararira kune chero chikamu chemuviri wako. Izvi zvinowanzoreva nhanho 0 kana nhanho A kubva kuBCLC staging system. Kuvhiyiwa kwacho hakugone kurapa gomarara kana ratopararira. Sezvineiwo kuvhiyiwa hakugoneki kune vanhu vazhinji vane gomarara rekutanga rechiropa.

Iwe une nhevedzano yekuongorora ropa kuti uone kuti chiropa chako chiri kushanda zvakanaka sei chiremba wako asati asarudza kana kuvhiyiwa kuri sarudzo yako. Sezvo chiropa chiri nhengo yakakosha zvakadaro, vanofanirwa kuziva kuti chikamu chechiropa chako chakasara mushure mekuvhiyiwa kwako chichashanda zvakakwana kuti uchengetedze hutano.

Mhando dzekuvhiya kenza yechiropa

Partial hepatectomy

Partial hepatectomy kuvhiyiwa kubvisa chikamu chechiropa. Vanhu chete vane chiropa chakanaka vane hutano hwakakwana hwekuvhiyiwa uye vane bundu rimwe chete risina kukura mutsinga dzeropa vanogona kuvhiyiwa uku.

Miedzo yekufungidzira, yakadai seCT kana MRI ine angiography inoitwa kutanga kuona kana gomarara rinogona kubviswa zvachose. Kunyange zvakadaro, dzimwe nguva pakuvhiyiwa kenza inowanikwa kuva yakakura zvikuru kana kuti yakapararira zvikuru kuti ibviswe, uye kuvhiyiwa kwakarongwa hakugoni kuitwa.

Vazhinji varwere vane kenza yechiropa muUnited States vanewo cirrhosis. Mune mumwe munhu ane chirwere che cirrhosis chakakomba, kubvisa kunyange chidimbu chidiki chechiropa kumucheto kwegomarara kunogona kusasiya chiropa chakakwana kumashure kuita mabasa akakosha.

Vanhu vane cirrhosis vanowanzokodzera kuvhiyiwa kana paine bundu rimwe chete (risati rakura kuita tsinga dzeropa) uye vachange vachine mwero (inenge 30%) yechiropa chinoshanda chasara kana bundu rabviswa. Vanachiremba vanowanzo ongorora basa iri nekupa Child-Pugh mamakisi, inova chiyero che cirrhosis yakavakirwa pane mamwe marabhu bvunzo uye zviratidzo.

Varwere vari muChild-Pugh class A vanogona kunge vaine chiropa chakakwana kuti vavhiyiwe. Varwere vari mukirasi B kashoma kuti vakwanise kuvhiyiwa. Kuvhiya haisiriyo sarudzo yevarwere vari mukirasi C.

Hepatectomy nzira

Kuvhiya kunoitwa pasi peanesthesia yakawanda uye yakareba, inoda maawa matatu kusvika mana. Murwere wekuti atindidzirwe akatarisa mudenga uye maoko ose anodhonzwa kure nemuviri. Vanachiremba vanovhiya vanowanzoshandisa pedhi yekudziya uye yekuputira pamaoko nemakumbo kuderedza kurasikirwa kwekushisa kwemuviri panguva yekuvhiyiwa. Dumbu remurwere rinovhurwa nekuchekwa kwepamusoro pedumbu uye nepakati-yekuwedzera-yakachekwa kusvika paxiphoid (kashwa kari kuzasi kwepakati pembabvu). Matanho makuru echikamu chehepatectomy anobva aenderera seizvi:

• Kusunungura chiropa. Basa rekutanga rechiremba wekuvhiya nderokusunungura chiropa nekucheka tambo refu dzinoputira.
• Kubviswa kwezvikamu. Kamwe chiremba anovhiya akasunungura chiropa, kubviswa kwezvikamu kunogona kutanga. Chiremba anovhiya anofanira kudzivisa kutsemuka tsinga dzinokosha dzeropa kudzivirira kubuda ropa. Nzira mbiri dzakasiyana dzinogona kushandiswa. Wekutanga anoita kuti chiremba anovhiya aite kupisa kwepamusoro nerenzi yemagetsi pamusoro pechiropa kuti atarise makutano pakati pezvikamu zvakatarwa kubviswa uye chiropa chakasara. Anocheka chikamu, uye anobva abvarura akananga kuhepatic parenchyma. Ndiyo mutsauko mukupikisa pakati peparenchyma nemidziyo inobvumira chiremba kuti aone kuvapo kwemudziyo. Panguva ino, iye / iye anoparadzanisa mudziyo nekubvisa yakatenderedza yekubatanidza tishu, uye obva aisunga. Chiremba anogona kubva acheka ngarava, pasina njodzi kumurwere. Nzira yechipiri inosanganisira kuziva midziyo mikuru inodyisa zvikamu zvinofanira kubviswa. Chiremba anovhiya anotanga ashanda pamwero wetsinga kuti asununguke obva asunga midziyo inodiwa. Pakupedzisira, chiremba anovhiya anogona kuita incision pasina kunetseka nezvekucheka midziyo midiki.

Ngozi & nemhedzisiro yehepatectomy

Kuvhiya chiropa chinhu chikuru, chakakomba chinofanira kuitwa chete nenyanzvi uye vane ruzivo rwekuvhiya. Nekuti vanhu vane kenza yechiropa vanowanzova nemamwe matambudziko echiropa kunze kwegomarara, vanovhiya vanofanirwa kubvisa zvakakwana zvechiropa kuti vaedze kutora kenza yese, asi zvakare kusiya zvakakwana kumashure kuti chiropa chishande.

• Kubuda ropa: Ropa rakawanda rinopfuura nemuchiropa, uye kubuda ropa mushure mekuvhiyiwa ndiko kunetseka kukuru. Zvakare, chiropa chinowanzogadzira zvinhu zvinobatsira kugwamba kweropa. Kukuvadzwa kwechiropa (zvose kuvhiyiwa kusati kwaitwa uye panguva yekuvhiyiwa) kunogona kuwedzera kumatambudziko ekubuda ropa.
• Kurwara
• Matambudziko kubva kune anesthesia
• Ropa rinovhara
• Pneumonia
• Chiropa chitsva chegomarara: Nekuti chiropa chasara chichiri nechirwere chakatungamira kugomarara, dzimwe nguva gomarara rechiropa idzva rinogona kuitika mushure.

Chiropa chinotamisa

Kana ichinge yavepo, kuisirwa chiropa kunogona kuve sarudzo yakanakisa kune vamwe vanhu vane cancer yechiropa. Kuiswa kwechiropa kunogona kuve sarudzo kune avo vane mapundu asingakwanisi kubviswa nekuvhiyiwa, kungave nekuda kwenzvimbo yemamota kana nekuti chiropa chine chirwere chakawandisa kuti murwere ashivirire kubvisa chikamu chacho. Kazhinji, kuisirwa kunoshandiswa kurapa varwere vane mapundu madiki (angave bundu 1 idiki pane masendimita mashanu kuyambuka kana 5 kusvika ku2 mapundu asina kukura kupfuura masendimita matatu) asina kukura kuita tsinga dzeropa dziri pedyo. Iyo inogona zvakare kashoma kuve sarudzo kune varwere vane rectable cancers (gomarara rinogona kubviswa zvachose). Nekuisirwa, kwete chete njodzi yekenza yechiropa yechipiri yakaderedzwa zvakanyanya, asi chiropa chitsva chinoshanda zvakajairika.

Sekureva kweOrgan Procurement uye Transplantation Network, nezve 1,000 kuisirwa chiropa kwakaitwa muvanhu vane cancer yechiropa muUnited States muna 2016, gore rapfuura iro nhamba dziripo. Nehurombo, mikana yekuchinja kwechiropa ishoma. Zviropa zvingangosvika zviuru zvisere nemazana mana zvinongowanikwa gore rega rega, uye mazhinji acho anoshandiswa kune varwere vane zvirwere kunze kwegomarara rechiropa. Kuwedzera ruzivo pamusoro pekukosha kwekupihwa kwenhengo ndicho chinangwa chakakosha chehutano hweveruzhinji chinogona kuita kuti kurapwa uku kuwanikwe kune varwere vazhinji vane cancer yechiropa uye zvimwe zvakakomba zvirwere zvechiropa.

Zviropa zvizhinji zvinoshandiswa pakusimwa zvinobva kuvanhu vachangobva kufa. Asi vamwe varwere vanogashira chikamu chechiropa kubva kumupi mupenyu (kazhinji hama yepedyo) yekuisirwa. Chiropa chinogona kudzorerazve chimwe chekushanda kwayo kwakarasika nekufamba kwenguva kana chikamu chacho chabviswa. Zvakadaro, kuvhiyiwa kunotakura dzimwe njodzi kune anopa. Vanosvika mazana matatu nemakumi manomwe echiropa chevanopa chiropa chinotapurwa chinoitwa muUnited States gore rega rega. Nhamba shoma chete yadzo ndeyevarwere vane kenza yechiropa.

Vanhu vanoda kuisirwa vanofanira kumirira kusvika chiropa chavepo, izvo zvinogona kutora nguva yakareba kune vamwe vanhu vane gomarara rechiropa. Muzviitiko zvakawanda munhu anogona kuwana mamwe marapiro, akadai se embolization kana ablation, achimirira kuisirwa chiropa. Kana kuti vanachiremba vangakurudzira kuvhiyiwa kana kumwe kurapwa kutanga uyezve kuisirwa kana gomarara rikadzoka.

Ndivanaani vasina kukodzera kukwikwidza chiropa?

• Chirwere chekurapa chakakomba, chisingadzoreki chinodzikamisa hupenyu hwenguva pfupi
• Yakanyanya pulmonary hypertension (kureva pulmonary artery pressure yakakura kupfuura 50mmHg)
• Gomarara rapararira kunze kwechiropa
• Utachiona hwehurongwa kana husingadzoreki
• Active kushandisa zvinodhaka (zvinodhaka uye/kana doro)
• Ngozi isingagamuchirwi yekushandisa zvinodhaka (zvinodhaka uye / kana doro)
• Nhoroondo yekusateerera, kana kusakwanisa kutevedzera chirongwa chakasimba chekurapa
• Chirwere chakanyanya, chisingadzoreki chepfungwa

Nzira yekuisa chiropa

Kuiswa kwechiropa kunosanganisira kubviswa uye kugadzirira kwechiropa chekupa, kubviswa kwechiropa chinorwara, uye kuiswa kwenhengo itsva. Chiropa chine makiyi akati wandei anofanirwa kumiswa zvakare kuti nhengo itsva iwane kubuda kweropa uye kubvisa bile kubva pachiropa. Izvo zvimiro zvinofanirwa kubatanidzwa zvakare ndeye inferior vena cava, portal vein, hepatic artery, uye bile duct. Iyo chaiyo nzira yekubatanidza zvimiro izvi inosiyana zvichienderana neakananga mupi uye anatomy kana anogashira anatomic nyaya uye, mune dzimwe nguva, chirwere cheanogamuchira.

Kune mumwe munhu ari kuisirwa chiropa, kutevedzana kwezviitiko mukamuri yekuvhiya ndekunotevera:

1. kucheka
2. Kuongororwa kwedumbu rezvisina kunaka izvo zvingatadzisa kuisirwa chiropa (semuenzaniso: hutachiona husina kuwanikwa kana hutsinye)
3. Kufambiswa kwechiropa chekuzvarwa (kupatsanurwa kwechiropa chinosungirirwa padumbu redumbu)
4. Kuparadzaniswa kwezvimiro zvakakosha (iyo yakaderera vena cava kumusoro, kumashure, uye pasi pechiropa; portal vein; iyo yakajairika bile duct; iyo hepatic artery)
5. Transection yezvimiro zvataurwa pamusoro uye kubviswa kwechiropa, chiropa chinorwara.
6. Kusona muchiropa chitsva: Chekutanga, kuyerera kweropa retsinga kunotangwa patsva nekubatanidza ari kupihwa neanogamuchira inferior vena cava uye portal veins. Tevere, kuyerera kwe arterial kunotangwa zvakare nekusona tsinga dzemupi uye dzemugamuchiri. Chekupedzisira, buriary drainage inowanikwa nekusona dhairekitori neanopa uye anogamuchira akajairika bile ducts.
7. Kuve nechokwadi chekutonga kwakakwana kwekubuda ropa
8. Kuvharwa kwekucheka

Kuvhiya Matambudziko

Sezvinoita chero nzira yekuvhiya, matambudziko ane chekuita nekuvhiya anogona kuitika, kuwedzera kune akawanda angangodaro matambudziko anogona kuitika kune chero murwere ari muchipatara. Mamwe ematambudziko akanangana nekuisirwa chiropa anogona kusangana anosanganisira:

Chekutanga kusashanda kana kusashanda zvakanaka kwechiropa chichangobva kuisirwa kunoitika munenge 1-5% yezvitsva zvinotapurirana. Kana kushanda kwechiropa kusinganatsirike zvakakwana kana nekukurumidza zvakakwana, murwere angada kukurumidza kuisirwa kechipiri kuti ararame.

• Hepatic artery thrombosis, kana kugwamba kwetsinga yeropa (mudziyo weropa unounza ropa rine mweya weokisijeni kubva pamoyo kuenda kuchiropa) unoitika mu2-5% yevose vakafa vanoisirwa. Ngozi inopetwa kaviri muvarwere vanogashira hupenyu hwevanopa. Maseru echiropa pachawo haawanzo kutambudzika nekurasikirwa nekuyerera kweropa kubva kune hepatic artery nekuti ivo vanonyanya kudyiswa neropa nekuyerera kweropa portal. Mukupesana, iyo bile ducts inotsamira zvakanyanya pane hepatic artery yekudya uye kurasikirwa kwekuyerera kweropa ikoko kunogona kukonzera bile duct scarring uye kutapukirwa. Kana izvi zvikaitika, ipapo kumwe kuisirwa kungave kuri madikanwa.
• Portal vein thrombosis kana kugwamba kwetsinga hombe inounza ropa kubva munhengo dzedumbu (matumbu, pancreas, uye spleen - nhengo dziri muchikamu chekutenderera) kuchiropa chinoitika zvisingawanzoitiki. Dambudziko iri rinogona kana kusada kuisirwa chiropa kechipiri.
• Zvinetso zveBiliary: Kazhinji, kune marudzi maviri ezvinetso zvebhairi: kuvuza kana kuomesa. Matambudziko eBiliary anokanganisa angangoita gumi neshanu muzana yevose vakafa vanopa vakaiswa uye anosvika makumi mana muzana ezvese zvipenyu zvinotapurirana.
  • Kubuda kweBiliary kunoreva kuti bile riri kubuda mugomba redumbu richipinda mugomba redumbu. Kazhinji kazhinji, izvi zvinoitika apo anopa uye anogamuchira bile ducts akasonanidzwa pamwechete. Izvi zvinowanzogadziriswa nekuisa stent, kana purasitiki chubhu, pakubatana kuburikidza nemudumbu uye mudumbu mudiki uyezve kubvumira kubatana kupora. Panyaya yeanopa anorarama kana kupatsanurwa kwechiropa, bile inogona zvakare kudonha kubva kumucheto kwechiropa. Kazhinji, dhiraini inoiswa uye inosiiwa panguva yekuchinjisa padivi pekuchekwa kuti ibvise chero bile rinogona kudonha. Chero bedzi iyo bile isingaunganidzi mudumbu, murwere haarware. Kuvuza kunowanzo pora nekufamba kwenguva, asi kungangoda mamwe maitiro ekurapa.
  • Biliary stricture inoreva kutetepa kwebile duct, zvichikonzera kuvharika kwehuwandu kana kuzara kwe bile kuyerera uye hutachiona hunogona kuitika. Kazhinji kazhinji, kudzikisira kunoitika panzvimbo imwe chete, zvakare apo mupi nemugamuchiri anosonanidzwa pamwechete. Uku kutetepa kunogona kazhinji kurapwa nekukwenenzvera nzvimbo yakamanikana nebharumu uye/kana kupinza stent mhiri kwestricture. Kana nzira idzi dzikasabudirira, kuvhiyiwa kunowanzoitwa kugadzira kubatana kutsva pakati pechiropa che bile duct uye chikamu cheura. Kashoma, kuomeswa kwebhiriyari kunoitika munzvimbo dzakawanda kana dzisingaverengeki mumuti webhiiri. Izvi zvinowanzoitika nekuti muti webhairi waive wakachengetedzwa zvisina kunaka panguva iyo chiropa chaive chisiri mukupa kana mugamuchiri kutenderera. Zviropa zvakatengwa kubva kune vanopa rufu rwemoyo zviri panjodzi huru pane izvo zvinobva kune huropi vakafa vanopa. Nerumwewo, diffuse biliary strictures inogona kuitika kana muti we biliary usina ropa rakakwana nekuda kwekusaenzana nehepatic artery.
• Kubuda ropa injodzi yekuvhiyiwa kupi zvako asi imwe njodzi mushure mekuisirwa chiropa nekuda kwekuwanda kwekuvhiya uye nekuti kugwamba kunoda zvinhu zvinogadzirwa nechiropa. Varwere vazhinji vanoisirwa ropa shoma uye vanogona kuwedzera kuwedzerwa mushure mekuvhiyiwa. Kana kubuda ropa kwakanyanya kana kukurumidza, dzokera mukamuri yekuvhiya kuti udzore kubuda kweropa kunowanzodikanwa. Kazhinji, vangangoita 10% yevanogamuchira vanoisirwa vanozoda kuvhiyiwa kechipiri pakubuda ropa.
• Utachiona - Utachiona hunogona kuitika panguva yekuporeswa kweronda rakagadzirwa nechero oparesheni. Vanogashira chiropa vari panjodzi yekutapukira mukati medumbu, kunyanya kana paine kuunganidzwa kweropa kana bile (kubva mubile leak). Iyo immunosuppressive mishonga pamwe nenhoroondo yekutadza kwechiropa inowedzera mukana weanogamuchira chiropa wekuita hutachiona mushure mekusimwa.

Kuzvidzivirira

Muviri wemunhu wakagadzira nhevedzano yakaomesesa yezvidziviriro kubva kumabhakitiriya, mavhairasi, nemamota. Muchina wemasoja ekudzivirira muviri wakashanduka kwemamiriyoni emakore kuti uone uye kurwisa chero chinhu chiri kunze kwenyika kana chisiri "chaiye." Nehurombo, nhengo dzakasimwa dzinowira muchikamu chevatorwa, kwete ivo. Mishonga yakati wandei inopihwa kune vanogashira vanogashira kuti vaderedze mhinduro dze immune system yavo mukuyedza kuchengetedza nhengo yakachengeteka uye isina immunologic kurwisa. Kana hurongwa hwekudzivirira husina simba hwakakwana, ipapo kurambwa - nzira iyo maitiro ekudzivirira zvirwere anozivisa, kurwisa, uye kukuvadza nhengo yakasimwa - inopinda.

Mishonga inowanzoshandiswa kudzivirira kurambwa nekudzvinyirira immune system yakanyorwa pazasi. Vanoshanda kuburikidza nenzira dzakasiyana dzekudzikisa simba rekudzivirira immune system kune zvinokurudzira uye zvinosanganiswa neakasiyana mhedzisiro. Nekuda kweizvozvo, mishonga iyi inowanzoshandiswa mumasanganiswa akasiyana-siyana ayo anowedzera iyo yakazara immunosuppressive maitiro uku ichideredza mhedzisiro.

• Corticosteroids (methylprednisolone inopiwa intravenously; prednisone inopiwa nemuromo): Corticosteroids ikirasi yemishonga inorwisa-kupisa inodzivisa kugadzirwa kwe cytokines, mamolekemu anobudisa zviratidzo anobudiswa nemasero ekudzivirira muviri kuti agadzirise uye awedzere simba rekudzivirira zvirwere. Corticosteroids saka inodzivirira activation ye lymphocytes, iwo mauto makuru ekudzivirira kwemuviri kurwisa nhengo dzakasimwa. Izvi zvinofungidzirwa kudzivirira T-cell (a subset of lymphocytes) activation nenzira isiri-yakananga. Maside effects ecorticosteroids akafara uye anosanganisira hyperglycemia, hypertension, kuderera kwemapfupa emapfupa, uye kukanganiswa kwemaronda kuporesa,
• Calcineurin inhibitors (cyclosporine, tacrolimus): Iri kirasi yemishonga inovhara basa re calcineurin, molecule inokosha kune yakakosha zvikuru lymphocyte signaling nzira iyo inokonzera kugadzirwa kwema cytokines akawanda. Mishonga iyi, yakatanga kugadzirwa makore angangosvika makumi maviri apfuura, yakashandura kuisirwa kwenhengo. Vakaderedza zvakanyanya chiitiko chekurambwa, vakavandudza hupenyu hurefu hwemitezo yakasimwa uye nekudaro vakaunza munguva yemazuva ano yekuisirwa uye immunosuppression. Nehurombo, mishonga iyi inouya neakakosha side effect profile. Kunyanya kutyisa, kunyanya nekushandiswa kwenguva refu, kukuvara kwetsvo. Calcineurin inhibitors inokwidzawo BP, mazinga eglucose, uye cholesterol - uye inokonzera kudedera nemusoro.
• Mycophenolate mofetil (Cellcept®, Myfortic®): Mushonga uyu unoshandurwa mumuviri kune mycophenolic acid, iyo inodzivisa kukwanisa kwe lymphocytes kudzokorora DNA, iyo genetic material inokosha kune yesero rimwe nerimwe. Kana lymphocytes isingakwanisi kugadzira DNA, saka haikwanisi kupatsanura kuti ibudise mamwe masero. Mycophenolate mofetil, saka, inoderedza mhinduro yekudzivirira nekudzivirira kupararira kwe lymphocytes. Mhedzisiro yekutanga ye mycophenolate mofetil inokanganisa intestinal system inokonzeresa kushushikana kwemudumbu uye / kana manyoka. Inogonawo kuderedza kushanda kwemwongo wemapfupa uye nokudaro, kuderedza mazinga eropa emasero machena (utachiona hunorwisa masero), masero matsvuku (masero anotakura oksijeni), uye maplatelet ( clotting agents).
• mTOR inhibitors (sirolimus; everolimus): mTOR inomirira mammalian Target Of Rapamycin. mTOR ndeyemhuri yema enzymes anozivikanwa sekinases uye inobatanidzwa mukutarisa kwekutarisa kwesero kutenderera, kugadzirisa kweDNA, uye kufa kwesero. Kuvharidzirwa kwemTOR kunomisa masero eT kubva pakufambira mberi kuburikidza nezvikamu zvakasiyana-siyana zvekutenderera kwesero, zvichiita kuti kusungwa kwesero kusungwa. Nokudaro, lymphocytes haikwanisi kupatsanurana kuwedzera simba rekudzivirira zvirwere. Zvimwe zvinokonzerwa nemTOR inhibitors zvinosanganisira kuora mwoyo kwemafupa, kupora kwemaronda, uye kuwedzera cholesterol mazinga.
• Masoja ekudzivirira chirwere anonangana neIL-2 receptor, mamorekuru anosaina anokwidziridza maitiro ezvirwere zvemuviri (basiliximab, daclizumab): Maseru eT, maajenti ekuramba kwakanyanya, anoratidza huwandu hunowedzera hweIL2-receptors paanenge amutswa. Iyo IL-2 receptor inobvumira kuenderera kunowedzera kwemhinduro yekudzivirira. Kuvharika kweiyi receptor nokudaro kunoderedza mhinduro yemuviri wemuviri. Aya masoja ekudzivirira chirwere anonyanya kushandiswa kwenguva pfupi kutanga panguva yekuisirwa kuti ape humwe hutachiona panguva ino yenjodzi yakanyanya yekurambwa. Migumisiro yepakarepo inosanganisira fivha, rash, cytokine release syndrome, uye anaphylaxis. Zvinoita sezvinowedzera njodzi yehuku yezvirwere zvakasanganiswa nemimwe immunosuppressive mishonga.
• Masoja ekudzivirira chirwere anobvisa maT cell kubva mukutenderera (Thymoglobulin®, OKT-3®): Aya maajenti mamorekuru anonangana nemasero akasiyana emasoja edziviriro, anoasunga, anoamisa, uye oabvisa. Vanogona kushandiswa panguva yekuiswa kwechiropa. asi kazhinji anoshandiswa kurapa kurambwa kwakanyanya kana kurambwa kusingapinduri kune nzira shoma dzekurapa. Pakarepo mhedzisiro yemishonga iyi kubva pafivha uye rash kusvika ku cytokine release syndrome zvichikonzera flash pulmonary edema uye hypotension. Iyi mishonga inogonawo kukonzera kuwedzera kwechiitiko chePTLD uye kenza yeganda (ona pazasi)
• mishonga yekuferefeta - Sezvo manzwisisiro atinoita immune system anovandudza, vaongorori vakaona maseru matsva, mamorekuru, uye nzira dzinoita basa mukupindura kwemuviri kune nhengo dzakasimwa. Kuwanikwa kwega kwega kunopa mikana mitsva muchimiro chezvinangwa zvitsva zvekuvandudza zvinodhaka. Mimwe yemishonga iyi pari zvino iri kuedzwa muzviedzo zvekiriniki kuti ione kana yakachengeteka uye inoshanda pakushandiswa mukuisirwa. Zvizvarwa zvenguva yemberi zvemishonga zvine tarisiro yakanyatsojeka mukudzivirira kurambwa pasina kupindira zvakanyanya nemamwe mabasa eiyo immune system kana kukonzera isiri-immunologic side effects.

kuramba

Kurambwa ishoko rinoshandiswa kureva kusashanda zvakanaka kwenhengo kunokonzerwa nemaitiro emuviri wemugamuchiri kunhengo yakasimwa. Kukuvadza kuchiropa kunowanzopindirana nemasero ekudzivirira muviri, T masero kana T lymphocytes. Kurambwa kazhinji hakukonzeri zviratidzo; varwere havanzwi zvakasiyana kana kuona chero chinhu. Chiratidzo chekutanga chinowanzo kwira zvisina kufanira chiropa cherabhoritari mhinduro. Kana kurambwa kuchifungidzirwa, biopsy yechiropa inoitwa. Chiropa biopsies inoitwa nyore nyore senzira yemubhedha uchishandisa tsono yakakosha inounzwa kuburikidza neganda. Iyo matishu inozoongororwa uye inoongororwa pasi pe microscope kuti ione maitiro ekukuvara kwechiropa uye zvakare kutarisa kuvepo kwemasero ekudzivirira.

Acute cellular rejection inoitika mu25-50% yevose vanogashira chiropa mukati megore rekutanga mushure mekutapurwa neiyo yakanyanya njodzi nguva mukati memavhiki mana kusvika matanhatu ekutanga ekutapurirana. Kana chirwere chacho chaitwa, kurapwa kwakanyatsojeka uye kunowanzoshanda zvikuru. Mutsara wekutanga wekurapa ndeyepamusoro dose corticosteroids. Kuchengetedza kwemurwere immunosuppression regimen inowedzerwawo kudzivirira kurambwa kunotevera. Chikamu chiduku chezvikamu zvekuramba zvakanyanya, zvinenge 10-20%, hazvipinduri kurapwa kwekorticosteroid uye inonzi "steroid refractory," inoda kuwedzerwa kurapwa.

Mutsara wechipiri wekurambwa kurapwa gadziriro yakasimba yeantibody. Mukuisirwa chiropa, kusiyana nedzimwe nhengo, kurambwa kwemasero hakuwanzokanganisa mikana yese yekupona kwegraft. Izvi zvinotendwa kuti imhaka yekuti chiropa chine hunyanzvi hwekugonesa patsva kana chakuvadzwa zvichidzoreredza kushanda kwechiropa chakazara.

Kurambwa kusingaperi kunoitika mu5% kana pasi pevose vanogashira. Chinhu chakasimba chenjodzi yekusimudzirwa kwekurambwa kusingaperi inodzokororwa zvikamu zvekuramba kwakanyanya uye / kana refractory acute kurambwa. Chiropa biopsy inoratidza kurasikirwa kwebile ducts uye kuparara kwetsinga diki. Kurambwa kwenguva refu, munhoroondo, kwave kwakaoma kudzosera, kazhinji zvichidikanwa kudzokorora kuisirwa chiropa. Nhasi, nesarudzo yedu huru yemishonga inodzivirira zvirwere, kurambwa kusingaperi kunowanzogadziriswa.

Recurrent Disease

Mamwe maitiro akakonzera kukanganisa kwechiropa chemurwere anogona kukuvadza chiropa chitsva uye pakupedzisira kuchiparadza. Zvichida muenzaniso wakanakisisa utachiona hwehepatitis B. Mukutanga kwema1990, varwere vakaisirwa chiropa nokuda kwechirwere chehepatitis B vaiva ne50% yekurarama kwemakore mashanu. Ruzhinji rwevarwere ava rwakatambura nekubatwazve kwechiropa chitsva neutachiona hwehepatitis B. Muma1990, zvisinei, mishonga yakawanda uye nzira dzokudzivisa kutapukirwazve uye kukuvara kwechiropa chitsva zvakagadziridzwa uye zvakatangwa zvikuru nenzvimbo dzokuisira. Aya maitiro akabudirira zvakanyanya zvekuti chirwere chinodzokororwa hachisisiri dambudziko. Hepatitis B, yakamboonekwa seyakapokana-chiratidzo chekuisirwa, ikozvino yakabatana nemhedzisiro yakanakisa, yepamusoro kune yakawanda yezvimwe zviratidzo zvekuisirwa chiropa.

Parizvino, dambudziko redu rekutanga nechirwere chekudzoka zvakare rinotarisa kune hepatitis C. Chero murwere anopinda muropa nehutachiona hweH hepatitis C hunotenderera muropa ravo huchava nehutachiona hweH hepatitis C hunoramba huripo mushure mekusimwa. Zvisinei, avo vakabvisa zvachose utachiona hwavo uye vasina hepatitis C inoyerwa muropa havazove nehepatitis C mushure mekutapurwa.

Kusiyana nehepataitisi B apo chirwere chinowanzoitika chinokonzera kukanganisa kwechiropa chinoitika nekukurumidza, hepatitis C inowanzoitika inowanzokonzera kupera zvishoma nezvishoma kwekushanda kwechiropa. Chikamu chidiki chevanhu vanogamuchira hepatitis C, vangangoita 5%, vanodzokera ku cirrhosis uye kupera kwechirwere chechiropa mukati memakore maviri ekutamiswa.

Vazhinji vane chirwere chinokura zvishoma nezvishoma zvekuti vanosvika hafu vanozoita cirrhosis pamakore gumi mushure mekusikwa. Kugadzirira kweInterferon pamwe chete ne ribavirin, inoshandiswa zvakanyanya mu-pre-transplant hepatitis C varwere, inogonawo kurongerwa mushure mekuiswa. Mikana yekurapa zvachose yakati dzikai pane kurapwa usati wadyarwa. Uyezve, kurapwa kunobatanidza nehuwandu hunobatsira hwemigumisiro. Chirwere chinodzokororwa chinokonzeresa kuti vanogashira chiropa chehepatitis C vane zvakaipisisa zvepakati uye zvenguva refu mushure mekutapurirana zvichienzaniswa nevanogamuchira chiropa vasina hepatitis C.

Zvimwe zvirwere zvakawanda zvinogona kudzoka zvakare mushure mekutamiswa, asi kazhinji chirwere chacho chinyoro uye chinongoramba chichifambira mberi. Primary sclerosing cholangitis (PSC) uye primary biliary cirrhosis (PBC) zvose zvinodzoka zvingangoita 10-20% yenguva uye, kashoma kwazvo, zvinoguma nechirwere chechirwere chechiropa chinoramba chichidzoka uye kupera kwechirwere chechiropa. Zvichida chikuru chisingazivikanwi muzera remazuva ano chirwere chechiropa chemafuta mushure mekusimwa sezvo zviri pachena dambudziko rekuwedzera kuwanda. Chirwere chemafuta chiropa chinogona kuitika kune avo vanoisirwa kuNASH asiwo kune varwere vakaisirwa zvimwe zviratidzo uye kukudziridza njodzi dzechirwere chechiropa chine mafuta. Iyo frequency, trajectory, uye prognosis yekudzokororwa kwefatty chiropa chirwere mushure mekuisirwa uye nzira yayo inzvimbo dzinoshanda dzekutsvaga.

Opportunistic Infections uye Cancer

Sezvambotaurwa, basa rekutanga remasoja edziviriro nderekuziva nekurwisa chero chiri kunze kana chisiri chako. Zvinangwa zvikuru hazvina kuitirwa kuve nhengo dzakasimwa, asi mabhakitiriya, mavhairasi, fungi, uye mamwe ma microorganisms anokonzera hutachiona. Kutora immunosuppression kunoderedza dziviriro yeanogamuchira pautachiona

Nekuda kweizvozvo, vanogashira vanogashira vari panjodzi yakawedzerwa yekukudziridza kwete chete hutachiona hunogona kubata vanhu vese asiwo "humwe mukana" hutachiona, hutachiona hunongoitika muvanhu vane immune system. Shanduko dzema immune system predispose vanogashira vanogamuchira kune hutachiona hwakasiyana zvichienderana nenguva inoenderana nekuita kwavo kufambisa.

Vanogona kugoverwa muzvikamu zvitatu: mwedzi wekutanga, mwedzi kusvika kumatanhatu, uye kupfuura mwedzi mitanhatu. Mumwedzi wokutanga, utachiona hune mabhakitiriya uye fungi zvinowanzoitika. Zvirwere zvehutachiona zvakadai se cytomegalovirus nezvimwe zvirwere zvisingawanzoitiki zvakadai sechirwere chetachiona uye pneumocystis carinii zvinoonekwa mukati memwedzi mitanhatu yekutanga.

Pamusoro pekurwisa utachiona, immune system inorwisa gomarara. Zvinotendwa kuti immune system ine hutano inoona uye kubvisa masero asina kujairika, ane kenza asati awanda uye kukura kuita bundu. Zvinonyatsozivikanwa kuti vanogashira vanogashira vari panjodzi yakawedzera yekugadzira akati wandei marudzi egomarara.

Post-Transplant Lymphoprolipherative Disorder (PTLD)

Post-Transplant Lymphoprolipherative Disorder (PTLD) imhando isina kujairika yegomarara inomuka chete mune vanoisirwa vanogamuchira, sekutaurwa kwazvinoitwa nezita rayo. Inenge nguva dzose yakabatana nehutachiona hweEpstein-Barr (EBV), hutachiona humwe hunokonzera infectious mononucleosis kana "chirwere chekutsvoda."

Ruzhinji rwevanhu vakuru vakasangana neEBV, kazhinji muhuduku hwavo kana makore ekuyaruka. Kune varwere ava, EBV-yakabatana PTLD inogona kukura mushure mekuisirwa nekuti immunosuppression inobvumira hutachiona kuti hutangezve. Kusiyana neizvi, vana vazhinji vanouya pakuisirwa chiropa vasina kumbobvira vasangana neEBV. Kana varwere vakasangana neEBV mushure mekutapurwa uye saka pasi pesimba rekudzivirira muviri, vangave vasingakwanisi kudzora hutachiona.

PTLD inomuka mune chero mamiriro ezvinhu apo EBV-inotapukirwa B masero (a subset ye lymphocytes) inokura uye inopatsanurwa nenzira isingadzoreki. Sezvo iri mhedzisiro yekukanganiswa immune system, mutsara wekutanga wekurapa uri kungomira kana kuderedza zvakanyanya immunosuppression. Nepo nzira iyi ichiwanzoshanda, zvakare ine njodzi yekurambwa kwegraft izvo zvinozoda kuwedzera immunosuppression. Munguva pfupi yapfuura, mushonga unonyatsobvisa B masero, masero ane utachiona neEBV, ave aripo.

Nhasi, nzira yakajairika ndeyokupa mushonga uyu, rituximab, pamwe chete nekucheka kuduku kwemishonga yekudzivirira zvirwere. Kana nzira iyi isingadzore PTLD, saka mamwe akajairwa chemotherapy drug regimens anowanzo kupihwa kurapa lymphomas anokura mune vasina-immunosuppressed varwere, anoshandiswa. Ruzhinji rwemakesi ePTLD anogona kurapwa zvinobudirira nekuchengetedzwa kweiyo nhengo yakasimwa.

Non-Melanoma Skin Cancer (NMSC)

Magomarara eganda ndiwo akanyanya kurwara muvanhu mushure mekutapurirana. Mwero wegomarara reganda muvarwere vakatapukirwa nenhengo inosvika makumi maviri nenomwe muzana pamakore gumi, zvichiratidza kuwedzera kwakapetwa makumi maviri neshanu munjodzi maererano nehuwandu hwevanhu. Tichifunga nezvenjodzi iyi yakakura, zvinokurudzirwa kuti vese vanogashira vaderedze kubuda kwezuva.

Zvakare, vese vanogashira vanogashira vanofanirwa kugara vachiongororwa kuti vave nechokwadi chekukurumidza kuongororwa uye kurapwa nekukurumidza kwechero cancer yeganda. Pane humwe humbowo hunoratidza kuti sirolimus, immunosuppressant mukirasi yeMTOR inhibitors haiwedzere njodzi yegomarara reganda.

Naizvozvo, vanogashira vanogashira vanogadzira akawanda egomarara reganda vanogona kutariswa sechinjo kune sirolimus-based, calcineurin-inhibitor yemahara immunosuppression regimen. Parizvino, hapana data inoratidza kuti vanogashira chiropa vari panjodzi yekuwedzera mamwe magomarara akadai sezamu, colon, prostate, kana mamwe magomarara.

Njodzi uye mhedzisiro yekuchinja kwechiropa

Kufanana nechikamu chehepatectomy, kuisirwa chiropa ibasa guru rine njodzi dzakakomba uye rinongofanira kuitwa chete nevavhiyi vane hunyanzvi uye vane ruzivo. Ngozi dzingangoitika dzinosanganisira:

• Bleeding
• Utachiona: Vanhu vanoiswa chiropa vanopihwa mishonga yekubatsira kudzvanya masoja ekudzivirira muviri kudzivirira miviri yavo kuramba nhengo itsva. Mishonga iyi ine njodzi dzayo uye nemhedzisiro, kunyanya njodzi yekubatwa nezvirwere zvakakomba. Nekudzvanyirira immune system, mishonga iyi inogona kubvumira chero gomarara rechiropa rakanga rapararira kunze kwechiropa kuti rikure nekukurumidza kupfuura kare. Mimwe yemishonga inoshandiswa kudzivirira kurambwa inogona kukonzerawo high blood pressure, high cholesterol, uye chirwere cheshuga; inogona kuderedza mapfupa neitsvo; uye zvinogona kutotungamirira kugomarara idzva.
• Ropa rinovhara
• Matambudziko kubva kune anesthesia
• Kurambwa kwechiropa chitsva: Mushure mekuisirwa chiropa, kuongororwa ropa nguva dzose kunoitwa kutarisa zviratidzo zvemuviri unoramba chiropa chitsva. Dzimwe nguva biopsies yechiropa inotorwawo kuti ione kana kurambwa kuri kuitika uye kana kuchinja kuchidiwa mumishonga inodzivirira kurambwa.