I-mesothelium ulwelwesi olugcoba izitho zangaphakathi eziningi ukumboza nokuvikela. Yakhiwa izingqimba ezimbili zamaseli ayizicaba, esinye sazo, ungqimba lwangaphakathi, lumboza izitho ezahlukahlukene ezifana namaphaphu, inhliziyo nesisu, kanti eyesibili, ungqimba olungaphandle, lwakha uhlobo lwesaka oluzungeze ungqimba lwangaphakathi. . Uketshezi lukhona phakathi kwalezi zingqimba ezimbili zamaseli, ezisiza ukuhamba kwezitho.

I-mesothelium ngezinye izikhathi ingathinteka yizimila eziyingozi, futhi okungavamile kakhulu, umdlavuza obizwa ngokuthi i-mesotheliomas. Kulapho-ke kuyi-pleura lapho kuvame khona kakhulu, okungukuthi i-mesothelium evala iphaphu; ezimweni eziningi kakhulu, kungenxa yokuvezwa kwe-asbestos. Kodwa lesi simo sisalokhu singavamile kakhulu, ngokusho kwezibalo zeHigh Authority for Health, kunamacala amasha angama-600 kuye kwangama-900 atholwa minyaka yonke eFrance.

I-mesothelium yakhiwa izingqimba ezimbili zamaseli acijile abizwa ngama-mesothelial cells. Phakathi kwalezi zingqimba ezimbili kukhona uketshezi. I-Mesothelium ilinganisa ingaphakathi langaphakathi lolwelwesi olubushelelezi lwemigodi yomzimba womuntu (okuthiwa ulwelwesi lwe-serous). Ngakho, lezi zingqimba ezimbili zamangqamuzana zivikela i-thorax, isisu noma inhliziyo.

I-mesothelium inamagama ahlukile kuye ngokuthi ikuphi emzimbeni: maqondana namaphaphu yi-pleura, ulwelwesi olumboze isisu, ukhalo noma i-viscera ibizwa nge-peritoneum, futhi ekugcineni i-mesothelium evikela inhliziyo ibizwa ngokuthi I-pericardium (i-pericardium nayo imboza umsuka wemikhumbi emikhulu).

Uketshezi olukhona phakathi kwezingqimba ezimbili ze-mesothelium lusiza ukwenza lula ukuhamba kwezitho. Eqinisweni, ungqimba lwangaphakathi lumboza ngokuqondile lezi zitho zangaphakathi, kuyilapho ulwelwesi olungaphandle luhlanganisa isikhwama esizungeze ungqimba lwangaphakathi.

Umsebenzi oyinhloko we-epithelium ukuvikela izitho zangaphakathi ezisembozayo:

• i-mesothelium ezungeze amaphaphu ibizwa ngokuthi i-pleura: ngaleyo ndlela ibonisa izici zamangqamuzana e-lining epithelial. Kodwa futhi inamandla okufihla amaseli: empeleni, ifihla, ikakhulukazi, ama-cytokines kanye nezici zokukhula. Ngaphezu kwalokho, ukusakazwa kwe-lymph kanye nokunyakaza koketshezi lwe-pleural kuxhumene nezakhiwo ezithile ze-pleura. Lokhu kuhlanganisa, ikakhulukazi, ama-pores ezingeni le-parietal pleura, okuvumela ukujikeleza kwe-lymphatic kuxhumane ngqo nesikhala se-pleural;
• i-peritoneum yi-mesothelium ethile yesisu. Le peritoneum kumele, empeleni, ibhekwe njengesitho. I-anatomy yayo ichaza ikakhulukazi ukusakazwa kwe-peritoneal fluid, imoto eyinhloko eyi-diaphragm efanele. Ngaphezu kwalokho, ulwelwesi lwe-peritoneal futhi luyindawo ebalulekile yokushintshanisa. Ekugcineni, kuvela ukuthi lolu ulwelwesi lubuye lunezici eziningi zokuzivikela komzimba;
• I-pericardium, eyi-mesothelium ezungeze inhliziyo, inomsebenzi womzimba wokugcina i-myocardium, kodwa futhi nokuyivumela ukuthi ishibilike ngesikhathi sokuncipha kwayo.

Amaseli we-mesothelium kwesinye isikhathi angahlangabezana nezinguquko ezenza indlela akhula ngayo noma aziphathe ngayo ngokungajwayelekile:

• lokhu kwesinye isikhathi kubangela ukwakheka kwezicubu okuthiwa azinomdlavuza, ngakho-ke begnins: isibonelo, isimila esiyindilinga se-pleura, noma ngisho nalokho okubizwa nge-multcystic mesothelioma;
• kukhona nomdlavuza we-mesothelium, kepha ngumdlavuza ongavamile ngempela: kuphela amacala angama-600 kuya ku-900 abalwa minyaka yonke eFrance. Kungaphakathi kwe-pleura lapho kwenzeka khona kaningi, njengoba ama-90% ama-mesothelioma amabi athinta le pleura, ethatha igama le-pleural mesothelioma. Le mesothelioma ebulalayo, ezimweni eziningi, ibangelwa ukuvezwa kwe-asbestos. Cishe ama-70% wamacala we-pleural mesothelioma avela kubantu. Eqinisweni, isabelo esichazayo sama-mesotheliomas ekuvezweni okunjalo ku-asbestos kulinganiselwa kuma-83% kwabesilisa kanye nama-38% kwabesifazane, ngokusho kwezibalo ezivela eHaute Autorité de Santé (HAS). Ngaphezu kwalokho, ubudlelwano bomphumela womthamo bubonisiwe;
• ezimweni ezingavamile kakhulu, cishe i-10%, lo mdlavuza ungathinta ne-peritoneum, futhi ubizwa nge-peritoneal mesothelioma;
• ekugcineni, izimo ezingavamile kakhulu zithinta i-pericardium, lo mdlavuza obizwa ngokuthi i-pericardial mesothelioma, futhi ngisho nangaphezulu, ungathinta isitho sangasese se-testicular.

Ukuphathwa kokwelapha, uma kwenzeka i-mesothelioma, lo mdlavuza ongavamile kakhulu, ukhethekile kakhulu: kufanele kuxoxwe ngakho emhlanganweni wokubonisana wemikhakha eminingi. Kunezikhungo zochwepheshe ezinikezelwe kulo mdlavuza eFrance, okuyingxenye yenethiwekhi ebizwa nge-MESOCLIN. Ukwelashwa uqobo kuphethwe yithimba lasendaweni. Ukwelashwa ngamakhemikhali nge-pemetrexed kanye ne-platinum usawoti ukwelashwa okujwayelekile.

Ukuhlinzwa ngezinhloso zokwelashwa kuqukethe i-pleuropneumonectomy enwetshiwe kepha ihlala ihlukile kakhulu: impela, ingathinta kuphela izigaba zokuqala nezingahle zibuyekezwe ze-mesothelioma. Okwamanje senziwa ezivivinyweni zomtholampilo.

Indawo ebalulekile kufanele inikezwe ukunakekelwa okwesekayo kanye nokunakekelwa okunciphisayo, ukuze kugcinwe kahle ukulondolozwa kwekhwalithi yempilo yesiguli. Ukwesekwa kanye nabahlanganyeli kuyisisekelo, kanye nokulalela, ukuhambisana, ukuba khona. Kepha kufanele sikhumbule impela ukuthi lolu hlobo lwesimila esibulalayo aluvamile futhi luhlala luhlukile. Ngokuqondene nezindlela zamanje zocwaningo, ziyathembisa futhi ziphethe ithemba:

• ngakho-ke, kunezifundo eziningana ezibheka ama-interferon, ngenhloso yokuvimbela umgwaqo ekuqhubekeleni phambili kwalo mdlavuza ngokuvuselela izindlela zokugonywa ngokwemvelo;
• ngaphezu kwalokho, kusesigabeni socwaningo okwamanje, isu elisebenzisa i-antitumor virotherapy liqukethe ukuthelela amangqamuzana omdlavuza ngegciwane ngenhloso yokuholela ekuqedweni kwawo. Kodwa-ke, kuvela ukuthi amaseli e-mesothelioma azwela kakhulu kulokhu kwelashwa. Ithimba lakwaNantes eliholwa nguJean-François Fonteneau lisanda kuthola ukuthi kungani la maseli womdlavuza we-mesothelial ezwela kakhulu kulokhu kwelashwa yi-virotherapy: lokhu kuxhumene neqiniso lokuthi, kwabaningi babo, babonile ukunyamalala kofuzo olufaka uhlobo lohlobo oluthile Ama-interferon ama-1, ama-molecule anezinto zokulwa namagciwane. Lokhu kutholakala kuvula indlela yokuhlolwa kokubikezela, ikakhulukazi, okuzokwenza kube nokwenzeka ukubikezela impendulo ekwelashweni nge-virotherapy, kanye namasu okwandisa ukusebenza kwayo.

Ukuxilongwa kwe-mesothelioma yamaphaphu kuyinkimbinkimbi kakhulu ukukhomba ekuqaleni, futhi kuhlanganisa izigaba eziningana ezilandelanayo.

Ukuhlolwa komzimba

Izimpawu zokuqala zivame ukungacacisi:

• izimpawu zokubandakanyeka kokuncenga: ubuhlungu besifuba, ukukhwehlela okomile, i-dyspnea (ubunzima bokuphefumula bukhuphukile ngokuzikhandla);
• ukuwohloka kwesimo esijwayelekile, ngokunciphisa umzimba;
• izimpawu zokuhlaselwa kwendawo: ubuhlungu besifuba noma behlombe.

Ukuhlolwa komtholampilo kumele kufake, ngendlela ehlelekile, imibuzo ezobheka ukuvezwa kwangaphambilini kuma-asbestosi, noma ngabe kusendaweni yobungcweti noma ngenye indlela, futhi kuzophinda kuhlolisise ukuncika okunokwenzeka kugwayi. Ukuyeka ukubhema kuzokhuthazwa.

AMAPOSA

Ukusebenza kwe-imaging okuhlelekile kufaka phakathi:

• i-x-ray yesifuba. Ngakho-ke noma yisiphi isithombe esisolisayo kufanele siholele ekusebenzeni okusheshayo kwesithwebuli se-thoracic;
• isithwebuli sesifuba, esinomjovo womkhiqizo ohlukile we-iodine (uma kungekho contraindication). Uma ukusola kunamandla, izincomo zikhomba ngasikhathi sinye ukwenza ukusikeka okuphezulu kwesisu.

Biology

Njengamanje, ayikho inkomba yokuhlolwa kwamamaki we-serum tumor ngezinhloso zokuxilonga.

I-Anatomopathology

Ekugcineni, ukuxilongwa kuzoqinisekiswa ngamasampuli e-biopsy. Ukufundwa kabili kwe-pathologist onguchwepheshe be-mesothelioma kubalulekile (odokotela abangaphansi kwenethiwekhi ye-MESOPATH).

Ithiyori yeseli ingenye yemibono emikhulu eyisisekelo ye-biology yanamuhla. Izimiso zayo ezintathu eziyisisekelo zimi kanje: ngakolunye uhlangothi, zonke izidalwa eziphilayo zakhiwe ngamangqamuzana (ingqamuzana elilodwa lezinto eziphilayo ezitholakala nge-unicellular, amangqamuzana amaningana azo zonke ezinye izinto eziphilayo, kungakhathaliseki ukuthi izilwane, izitshalo noma amakhowe). Ngakho-ke, iseli liyiyunithi eyisisekelo yesakhiwo nokuhleleka kwezinto eziphilayo. Ekugcineni, wonke amaseli avela kumaseli asevele ekhona.

Le mbono yeseli ithatha izisekelo zayo kwi-XVI^e kwekhulu eNetherlands, ngenxa yokwenziwa kwesibonakhulu sokuqala esine-lens ezimbili, nguZacharais Janssen. Usosayensi ongumDashi u-Antoine Van Leuwenhoek naye uzokwenza imicroscope yakhe yokuqala, lapho ezothola khona amabhaktheriya ngokubheka izingcezu ze-tartar emazinyweni akhe. Amaseli okuqala azogcina etholwe umngane kaLeuwenhoek, usosayensi oyiNgisi uRobert Hooke.

Ithiyori yesayensi ihlale iyisithelo sencazelo ende, evame ukuhlangana: empeleni, ivame ukubandakanya umsebenzi wokwakha oqala ekutholweni abanye abantu. Ukubuya ngokuqondile kancane kumaseli e-mesothelial, kusosayensi kusukela ekuqaleni kwekhulu le-1865 lapho sikweleta ukutholakala okubalulekile. Lesi sazi semvelo sokuqala samangqamuzana ogama lakhe lingu-Edmund B. Wilson (1939-XNUMX) sakubona futhi sachaza ukuthi iqanda elikhulelisiwe lihlukana kanjani libe ngamakhulu amangqamuzana ukwakha umbungu, nokuthi yiziphi izingxenye zomzimba ezakha kusuka kumaphi amaseli. Ngaphezu kwalokho, kwirekhodi, kamuva kwaba ngumfundi wakhe uWalter Sutton owathola indima yama-chromosomes njengamayunithi wobuzwe.

Ekugcineni, konke lokhu okutholayo okulandelanayo ikakhulukazi kwaletha ulwazi oluthile mayelana nodaba lwamaseli e-mesothelial: kwavela ukuthi lokhu, empeleni, kuvela ku-mesoblast, ungqimba oluphakathi lweselula lombungu (umbungu ngaleyo ndlela uqukethe izingqimba ezintathu ezisemvelaphi wawo wonke amaseli omzimba: i-endoderm, i-mesoderm ne-ectoderm). Ekugcineni, kufanele kwaziwe ukuthi wonke amangqamuzana asuselwa ku-mesoderm akha konke noma ingxenye yezitho zangaphakathi ezahlukahlukene, ngaphandle kwesistimu yezinzwa uqobo evela ku-ectoderm.