Cov thymus yog cov qog nyob tom qab nruab nrab ntawm koj lub hauv siab (sternum) thiab pem hauv ntej ntawm koj lub ntsws. Nws lub luag haujlwm tseem ceeb yog ua kom thymosin kom paub tab thiab tsim cov cell tiv thaiv kab mob (T cells) los pab tiv thaiv kab mob thiab tiv thaiv koj lub cev tiv thaiv kab mob los ntawm kev tawm tsam koj lub cev (tus mob hu ua autoimmunity). Cov thymus txhim kho feem ntau ntawm koj T cells los ntawm kev pub dawb, tom qab uas lub qog pib nqaim thiab hloov pauv nrog cov nqaij rog. Thymomas yog cov qog uas maj mam loj hlob los ntawm cov kab hauv cov qog thiab suav rau cuaj caum feem pua ntawm cov qog pom hauv cov thymus. Nws tsawg tsawg nrog kwv yees li 500 tus neeg Asmeskas kuaj mob txhua xyoo (feem ntau ntawm cov hnub nyoog 40 thiab 60). Los ntawm kev kawm paub dab tsi cov tsos mob ntawm thymomas mus nrhiav thiab ntsuas kev kuaj mob cuam tshuam nrog tus mob, koj tuaj yeem paub thaum twg mus ntsib kws kho mob thiab yuav cia siab li cas ntawm cov txheej txheem kuaj mob.
Cov kauj ruam
Ntu 1 ntawm 2: Paub Paub Cov tsos mob ntawm tus mob Thymoma
Kauj Ruam 1. Saib rau qhov ua tsis taus pa
Cov qog tuaj yeem nias tawm tsam lub raj cua (trachea) ua rau muaj cua nkag mus rau hauv koj lub ntsws. Nco tseg yog tias koj yooj yim dhau los ntawm kev ua pa lossis xav tias zoo li muaj qee yam nyam hauv koj lub caj pas kom ua rau lub siab xav.
Yog tias ua tsis taus pa tshwm sim tom qab kev ua ub no nco tseg yog tias koj muaj lub hawb pob (lub suab nrov nrov nrov) nrov nrov thaum ua pa. Qhov no tuaj yeem yog mob hawb pob
Kauj Ruam 2. Tshaj tawm qhov hnoos ntxiv
Cov qog tuaj yeem ua rau koj lub ntsws mob ntsws, ua pa (cua tshuab pa), thiab lub paj hlwb cuam tshuam nrog koj qhov hnoos qeev. Nco tseg yog tias koj tau hnoos hnoos los ntawm ntau lub hlis mus rau xyoo uas tsis muaj kev pab los ntawm kev tiv thaiv kab mob, tshuaj steroids, thiab tshuaj tua kab mob.
- Yog tias koj muaj acid reflux los ntawm cov khoom noj ntsim, rog, lossis acidic, nws tuaj yeem ua rau hnoos ntev. Yog tias hloov kho koj cov zaub mov kom txo qis hnoos, tom qab ntawd nws tsis zoo li thymoma.
- Yog tias koj nyob hauv lossis tau mus ncig rau thaj tsam uas muaj kab mob ntsws (TB) thiab tau hnov mob hnoos, hnoos hnoos (ntshav hnoos qeev tawm), tawm hws hmo ntuj, thiab ua npaws, ces koj yuav muaj kab mob TB uas koj tseem yuav pom kws kho mob tam sim.
Kauj Ruam 3. Nco tseg tias mob hauv siab
Vim yog cov qog thawb rau ntawm lub hauv siab ntawm phab ntsa thiab lub plawv, koj tuaj yeem txhim kho mob hauv siab los ntawm qhov kev xav zoo li lub siab thiab qhov chaw tsuas yog nyob hauv nruab nrab ntawm koj lub hauv siab. Tsis tas li, koj tuaj yeem txhim kho qhov mob tom qab pob txha lub mis uas tuaj yeem ua rau mob thaum siv lub siab rau thaj chaw.
Yog tias koj hnov mob zoo li mob hauv siab thiab muaj tawm hws, palpitations (hnov zoo li koj lub plawv dhia tawm ntawm koj lub hauv siab), ua npaws, lossis mob hauv siab thaum txav lossis ua pa, tom qab ntawd koj yuav muaj mob ntsws lossis mob plawv. Txawm hais tias yog dab tsi hauv paus, koj yuav tsum mus ntsib kws kho mob rau cov tsos mob no
Kauj Ruam 4. Saib rau teeb meem nqos
Cov thymus tuaj yeem loj hlob thiab thawb tawm ntawm txoj hlab pas, ua rau nyuaj rau nqos. Nco tseg yog tias koj muaj teeb meem nqos zaub mov lossis koj nyuam qhuav hloov mus rau cov zaub mov muaj kua ntau vim nws yooj yim dua. Qhov teeb meem kuj tseem tuaj yeem hnov zoo li ua pa.
Kauj Ruam 5. Ntsuas koj tus kheej
Vim tias cov qog thymus tuaj yeem ua rau mob qog noj ntshav thiab kis thoob plaws lub cev (tsis tshua muaj neeg pom), koj yuav poob qhov hnyav vim qhov xav tau ntau ntxiv ntawm cov nqaij mob qog noj ntshav. Txheeb xyuas koj qhov hnyav tam sim no tiv thaiv kev nyeem ntawv qub.
Yog tias koj poob qhov kev poob ceeb thawj yam tsis tau paub vim li cas, nrog koj tus kws kho mob tham. Ntau cov qog nqaij hlav tau poob qhov hnyav raws li cov tsos mob
Kauj Ruam 6. Tshuaj xyuas seb puas muaj kab mob vena cava zoo dua
Qhov zoo tshaj plaws vena cava yog lub nkoj loj uas khaws cov ntshav rov qab los ntawm cov leeg ntawm lub taub hau, caj dab, sab saud, thiab lub cev sab saud rov qab hauv plawv. Thaum cov hlab ntsha no raug teeb meem nws thim cov ntshav los ntawm cov chaw no los ntawm kev nkag mus rau hauv plawv. Qhov no ua rau:
- Kev o ntawm lub ntsej muag, caj dab, thiab lub cev sab saud. Nco tseg yog tias sab saud ntawm koj lub cev zoo li liab lossis yaug ntau dua.
- Dilated leeg nyob rau hauv lub cev. Saib cov leeg ntshav ntawm koj txhais caj npab, txhais tes, thiab lub dab teg kom pom tias lawv zoo li nthuav lossis nthuav dav. Cov no feem ntau yog cov kab tsaus lossis qhov av peb pom ntawm txhais tes thiab caj npab.
- Mob taub hau vim cov leeg leeg ua rau lub paj hlwb.
- Mob taub hau/teeb taub hau. Vim tias ntshav tau thim rov qab, lub plawv thiab lub hlwb tau txais cov ntshav oxygen oxygen tsawg. Thaum koj lub plawv tso ntshav tsawg rau lub hlwb lossis thaum koj lub hlwb tsis tau txais cov pa oxygen txaus, koj hnov lub teeb taub hau lossis kiv taub hau thiab yuav poob. Kev nqes peev pab tshem tawm lub zog ntawm lub ntiajteb txawj nqus koj cov ntshav tau tawm tsam los muab koj lub hlwb.
Kauj Ruam 7. Nco tseg cov tsos mob zoo ib yam nrog myasthenia gravis (MG)
MG yog cov kab mob paraneoplastic feem ntau, uas yog cov tsos mob tshwm sim los ntawm kev mob qog noj ntshav. Nrog MG, koj lub cev tiv thaiv kab mob tsim cov tshuaj tiv thaiv kab mob uas tiv thaiv cov cim qhia tshuaj uas qhia koj cov leeg kom txav mus. Qhov no ua rau cov leeg tsis muaj zog thoob plaws lub cev. Kwv yees li 30 txog 65 feem pua ntawm cov neeg uas muaj thymomas kuj muaj myasthenia gravis. Nrhiav rau:
- Ob los sis qhov muag tsis pom kev
- Drooping daim tawv muag
- Teeb meem nqos zaub mov
- Ua tsis taus pa vim tsis muaj zog hauv cov leeg hauv siab thiab/lossis daim diaphragm
- Hais lus tsis meej
Kauj Ruam 8. Saib cov tsos mob ntawm cov qe ntshav liab aplasia
Qhov no yog kev puas tsuaj ntawm cov qe ntshav liab ntxov ua ntej, uas ua rau pom cov tsos mob ntawm ntshav tsis txaus (cov qe ntshav liab tsawg). Txo RBC yuav ua rau tsis muaj oxygen thoob plaws lub cev. Qhov no tshwm sim hauv kwv yees li 5 feem pua ntawm cov neeg mob qog noj ntshav. Nrhiav rau:
- Ua tsis taus pa
- Qaug zog
- Kiv taub hau
- Tsis muaj zog
Kauj Ruam 9. Tshuaj xyuas cov tsos mob ntawm Hypogammaglobulinemia
Nov yog thaum koj lub cev txo qis kev tsim cov kab mob sib ntaus sib tua gamma globulins (cov tshuaj tiv thaiv kab mob). Kwv yees li tsib txog kaum feem pua ntawm cov neeg mob thymoma txhim kho hypogammaglobulinemia. Kwv yees li kaum feem pua ntawm cov neeg mob hypogammaglobulinemia muaj thymoma. Ua ke nrog thymoma, nws hu ua Good's syndrome. Nrhiav rau:
- Rov kis mob dua
- Bronchiectasis, uas suav nrog cov tsos mob xws li hnoos ntev, hnoos ntau heev uas yuav muaj hnoos tsis hnov tsw, ua tsis taus pa thiab hawb pob, mob hauv siab, thiab qoj ib ce (cov nqaij hauv qab koj cov rau tes thiab ntiv taw tau tuab dua).
- Mob raws plab
- Mucocutaneous candidiasis, uas yog tus kab mob hu ua fungal uas tuaj yeem ua rau mob plab (qhov ncauj sib kis ua rau thaj ua rau thaj dawb lossis mis nyuj curd-saib kev loj hlob ntawm tus nplaig).
- Kev kis tus kab mob, suav nrog tus kab mob herpes simplex, cytomegalovirus, varicella zoster (shingles), thiab tib neeg tus mob herpes 8 (kaposi's sarcoma), uas yog mob qog noj ntshav feem ntau cuam tshuam nrog AIDS.
Ntu 2 ntawm 2: Txheeb Xyuas Tus Mob Thymoma
Kauj Ruam 1. Mus ntsib koj tus kws kho mob
Koj tus kws kho mob yuav sau keeb kwm kho mob kom ntxaws, suav nrog tsev neeg keeb kwm thiab cov tsos mob. Nws lossis nws tseem yuav nug cov lus nug raws li cov tsos mob thymoma, suav nrog cov cuam tshuam nrog myasthenia gravis, aplasia ntawm tes liab, thiab cov tsos mob hypogammaglobulinemia. Koj tus kws kho mob yuav hnov zoo nyob hauv nruab nrab lub caj dab kom loj hlob ntawm cov thymus.
Kauj Ruam 2. Kuaj koj cov ntshav
Tsis muaj kev sim tshuaj rau kuaj mob thymoma, tab sis muaj kev kuaj ntshav txhawm rau txheeb xyuas myasthenia gravis (MG) hu ua anti-Cholinesterase antibody (AB). MG yog li muaj nyob rau hauv cov uas muaj thymomas uas nws tau txiav txim siab ua qhov taw qhia ua ntej yuav kim dua. Kwv yees li 84% ntawm cov neeg hnub nyoog qis dua 40 nrog qhov tshuaj tiv thaiv Cholinesterase AB zoo muaj thymomas.
Ua ntej yuav tshem tawm tus mob thymoma, koj tus kws kho mob tseem yuav kho tus MG vim tias yog tias tsis kho, nws tuaj yeem ua teeb meem nrog tshuaj loog thaum phais, xws li ua pa tsis ua haujlwm
Kauj Ruam 3. Xa mus rau x-ray
Txhawm rau pom qhov mob hnyav, koj tus kws kho mob yuav xub xaj xoo hluav taws xob ntawm lub hauv siab. Tus kws kho hluav taws xob hluav taws xob yuav nrhiav qhov hnyav lossis duab ntxoov ntxoo nyob ze ntawm lub hauv siab ntawm lub caj dab qis. Qee cov thymomas me me thiab yuav tsis tshwm ntawm x-ray. Yog tias koj tus kws kho mob tseem tsis txaus ntseeg lossis yog tias muaj qhov txawv txav tshwm ntawm lub hauv siab xoo hluav taws xob, nws lossis nws yuav xaj CT scan.
Kauj Ruam 4. Nkag mus kuaj CT
CT scan yuav siv ntau yam, cov duab ntxaws ntxaws hauv ntu ntu los ntawm qis dua mus rau ib sab ntawm koj lub hauv siab. Koj tuaj yeem tau txais cov xim sib txawv los piav qhia cov qauv thiab cov hlab ntshav hauv koj lub cev. Cov duab yuav muab cov ncauj lus ntxaws ntxaws txog qhov txawv txav, suav nrog cov theem ntawm cov qog ntshav lossis yog tias nws tau kis mus.
Yog tias muab qhov sib piv, koj yuav raug qhia kom haus dej ntau kom yaug tawm
Kauj Ruam 5. Nkag mus rau MRI
MRI yuav siv xov tooj cua thiab cov hlau nplaum los tsim cov duab ntxaws ntxaws ntawm koj lub hauv siab ntawm lub computer screen. Cov khoom sib piv hu ua gadolinium feem ntau tau txhaj rau hauv cov hlab ntshav ua ntej kev tshuaj xyuas kom pom cov ntsiab lus zoo dua. MRI ntawm lub hauv siab tuaj yeem ua tiav txhawm rau saib zoo dua ntawm cov qog ntshav lossis thaum koj tsis tuaj yeem tiv taus lossis tsis haum rau CT sib piv. MRI cov duab kuj tseem muaj txiaj ntsig tshwj xeeb hauv kev tshawb nrhiav mob qog noj ntshav uas yuav kis mus rau lub hlwb lossis tus txha caj qaum.
- MRIs nrov heev thiab qee qhov raug kaw lub ntsiab lus tias koj yuav raug tso pw hauv qhov chaw loj cylindrical. Qhov no tuaj yeem muab qhov kev xav ntawm claustrophobia (ntshai qhov chaw nyob ib puag ncig) rau qee tus neeg.
- Qhov kev xeem yuav siv sijhawm txog ib teev los ua kom tiav.
- Yog tias koj tau muab qhov sib piv, koj yuav raug qhia kom haus dej ntau kom yaug tawm.
Kauj Ruam 6. Xa mus rau PET scan
Qhov no yog kev tshuaj xyuas uas siv lub tshuab hluav taws xob atom hauv cov piam thaj (hom piam thaj) uas nyiam rau thymoma. Cov qog nqaij hlav qog noj ntshav tau siv tshuaj lom neeg thiab lub koob yees duab tshwj xeeb tau siv los tsim cov duab ntawm thaj chaw uas muaj cov tshuaj tua hluav taws xob hauv lub cev. Daim duab no tsis tau ua tiav zoo ib yam li CT lossis MRI, tab sis nws tuaj yeem muab cov ntaub ntawv muaj txiaj ntsig zoo txog koj lub cev tag nrho. Qhov kev ntsuas no tuaj yeem pab txiav txim siab seb puas muaj cov qog pom ntawm daim duab tiag tiag yog qog lossis tsis yog lossis mob qog noj ntshav tau kis mus rau lwm qhov hauv lub cev.
- Cov kws kho mob siv ua ke PET/CT ntau dua li tus tsiaj kuaj ib leeg thaum saib thymomas. Qhov no cia tus kws kho mob sib piv thaj tsam ntawm cov pa hluav taws xob ntau dua ntawm PET scan nrog cov duab ntxaws ntxaws ntawm CT scan.
- Koj yuav tau txais kev npaj qhov ncauj lossis txhaj tshuaj rau cov piam thaj hauv ntshav. Koj yuav tos peb caug mus rau rau caum feeb rau koj lub cev nqus cov khoom. Koj yuav tsum tau haus dej ntau ntxiv tom qab pab yaug qhov dej tawm ntawm koj lub cev.
- Kev tshuaj xyuas yuav siv sijhawm kwv yees li peb caug feeb.
Kauj Ruam 7. Tso cai rau koj tus kws kho mob ua qhov hnoos qeev zoo
Siv CT scan lossis tshuab ultrasound rau kev qhia pom kev, koj tus kws kho mob yuav tso rab koob ntev, hollow rau hauv koj lub hauv siab thiab mus rau qhov xav tias mob qog noj ntshav. Nws lossis nws yuav tshem tus qauv me me ntawm cov qog mus kuaj nws hauv qab lub tshuab tsom iav.
- Yog tias koj tab tom noj cov tshuaj thim ntshav (coumadin/warfarin), koj tus kws kho mob yuav hais kom koj tso tseg hnub ua ntej kuaj mob thiab tsis txhob noj lossis haus dej hnub ntawm tus txheej txheem. Yog tias lawv txiav txim siab siv tshuaj loog lossis IV sedation, koj yuav raug hais kom yoo mov ib hnub ua ntej tus txheej txheem ib yam.
- Qhov ua tau tsis zoo ntawm qhov kev sim no yog tias nws yuav tsis tas li tau txais cov qauv txaus los ua qhov kuaj mob raug lossis tso cai rau tus kws kho mob kom nkag siab zoo txog qhov loj ntawm cov qog.
Kauj Ruam 8. Muaj cov qog nqaij hlav tom qab phais tas
Qee lub sij hawm koj tus kws kho mob yuav ua qhov kev kuaj ntshav tawm (tshem tawm cov qog nqaij hlav) yam tsis muaj rab koob biopsy yog tias qhov pov thawj ntawm thymoma muaj zog (kuaj sim thiab kuaj pom duab). Lwm lub sij hawm kws kho mob yuav tsum tau ua rab koob biopsy ua ntej kom paub tseeb tias nws yog thymoma. Cov hnoos qeev raug xa mus rau tom chaw kuaj ntshav tom qab phais kom paub tseeb tias kuaj mob.
Kev npaj kuaj mob (yoo mov, thiab lwm yam) zoo ib yam li rab koob hnoos qeev, tshwj tsis yog kev phais yuav ua rau ntawm daim tawv nqaij kom nkag mus rau cov qog kom tshem nws
Kauj Ruam 9. Kom thymoma staged thiab kho
Cov theem ntawm cov qog hais txog kev kis mus rau lwm lub cev, cov nqaij thiab qhov chaw nyob deb ntawm lub cev. Yog li ntawd, muaj cov thymoma staged yog ib feem tseem ceeb ntawm kev txiav txim siab yam kev kho mob zoo tshaj plaws. Qhov feem ntau siv txheej txheem txheej txheem rau thymomas yog Masaoka staging system.
- Theem I yog cov qog nqaij hlav uas tsis muaj lub tshuab me me lossis ntxeem tau tag nrho. Kev phais phais yog kev kho mob uas xaiv
- Theem II yog thymoma nrog lub macroscopic ntxeem tau ntawm mediastinal rog lossis pleura lossis microscopic ntxeem tau ntawm cov tshuaj ntsiav. Kev kho mob feem ntau yog ua tiav kev tshem tawm nrog lossis tsis muaj kev kho hluav taws xob tom qab phais txhawm rau txhawm rau txo qhov tshwm sim ntawm kev rov tshwm sim.
- Theem III yog thaum cov qog tau ua rau lub ntsws, cov hlab ntsha loj, thiab pericardium. Kev phais kom tiav yog qhov tsim nyog ua ke nrog kev kho hluav taws xob tom qab phais kom tsis txhob rov tshwm sim.
- Theem IVA thiab IV B Hauv cov theem kawg no, muaj cov kis pleural lossis kis loj. Kev kho yog ua ke ntawm kev phais debulking, hluav taws xob, thiab tshuaj kho mob.
