breast cancer treatmenttment in premenopause women (georgian)

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sarZeve jirkvlis kibos mkurnalobis Tanamedrove kombinirebuli meTodebi simsivnis receptoruli statusis da Tanmxlebi ginekologiuri paTologiis gaTvaliswinebiT.:

sarZeve jirkvlis kibos mkurnalobis Tanamedrove kombinirebuli meTodebi simsivnis receptoruli statusis da Tanmxlebi ginekologiuri paTologiis gaTvaliswinebiT. med. mecn. doqtori, profesori j. ungiaZe; onkoqirurgi T. gogitiZe janmrTelobis centri “medina” baTumi

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sarZeve jirkvlis kibos mkurnalobis problemebis gadawyveta SesaZlebelia mxolod sxvadasxva specialobebis Tanamedrove mimarTulebebis kompleqsuri gamoyenebiT.

aqtualoba:

aqtualoba msoflios qalTa populaciaSi, iseve rogorc saqarTveloSi, yvelaze xSiria sarZeve jirkvlis avTvisebiani simsivneebi. yovelwliurad msoflioSi registrirdeba ZuZus kibos 650 aTasze meti axali SemTxveva.

avTvisebiani simsivneebiT daavadebulTa ganawileba qalebSi saqarTvelos skrinig centri, 2008 wlis statistika:

avTvisebiani simsivneebiT daavadebulTa ganawileba qalebSi saqarTvelos skrinig centri, 2008 wlis statistika 3364 axali SemTxvevidan qalebSi, 1211 – sarZeve jirkvlis kiboze modis, rac yvela avTvisebiani simsivnis 36% Seadgens; sarZeve jirkvlis 44% Seadgens 55 wlamde asakis qalebi (premenopauza). avTvisebiani simsivnis lokalizacia sul maT Soris avadmyofebi asakis mixedviT 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85 da meti avTvisebiani simsivneebi sul: 3364 3 7 8 12 18 26 67 124 252 389 463 477 321 439 361 234 131 32 sarZeve jirkvlis 1211 4 24 52 115 157 168 189 115 147 117 64 50 9

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ZuZus kibos mkurnalobis efeqturoba Tanamedrove medicinaSi damokidebulia pirvel rigSi aRniSnuli daavadebis droul diagnostikaze , xolo meores mxriv, mkurnalobis radikalobaze da adeqvaturobaze , rac SemdegSi sicocxlis gaxangrZlivebis da cxovrebis xarisxis gaumjobesebis sawindaria.

mizani:

mizani kombinirebuli operaciebis rolis Seswavla sarZeve jirkvlis kibos mkurnalobaSi, simsivnis hormonaluri statusis gaTvaliswinebiT. gansakuTrebuli yuradReba eZRvneba pacientebs, romelTac aqvT Tanmxlebi ginekologiuri daavadebebi.

mdgomareoba diagnozis dasmis droisTvis:

mdgomareoba diagnozis dasmis droisTvis 35% - radikalurad ikurneba lokaluri meTodebiT. 30% - klinikurad gamovlenili metastazebiT. 35% - mikrometastazebiT, romlebic ar vlindeba Tanamedrove gamokvlevebiT. (Fisher В., Carbone Р., 1983).

Slide 8:

sarZeve jirkvlis kibos mkurnaloba umravles SemTxvevaSi adgilobriv meTodebTan erTad (operacia, dasxiveba), unda Seicavdes damatebiT sistemur zemoqmedebasac. sistemuri mkurnalobis mniSvnelovani komponentia endokrinuli Terapia.

endokrinuli Terapia:

endokrinuli Terapia endokrinuli Terapiis yvela meTods safuZvlad udevs simsivnur ujredebze steroiduli hormonebis zemoqmedebis Semcireba-Sewyveta. dReisaTvis endokrinuli Terapiis ZiriTadi gza sakvercxeebis funqciis gaTiSva - kastraciaa.

Early Breast Cancer Collaborative Group (EBCCG):

Early Breast Cancer Collaborative Group (EBCCG) 12 randomizirebuli kvleviT dadginda ararecidiuli da saerTo gamojanmrTelebis momateba adiuvanturi kastraciis fonze 40 welze axalgazrda pacientebSi; 40 wlamde asakis qalebSi sarZeve jirkvlis kibo 40-70%-Si Seicavs steroiduli hormonebis receptorebs. am populaciaSi sakvercxeebis mocileba xSirad eqvivalenturia qimioTerapiisa, rac naCvenebia minimum 8 randomizirebuli kvleviT (Aebi S., 2003).

kastraciis meTodebi :

kastraciis meTodebi sxivuri medikamentozuri qirurgiuli

sxivuri kastracia:

sxivuri kastracia yovelTvis efeqturi ar aris; iwvevs irgvlivmdebare struqturebis sxivuri dazianebas da organizmze zogad zemoqmedebas; samkurnalo efeqtis dagvianeba 2-8 kviriT; ukunaCvenebia sakvercxebSi paTologiis arsebobis dros.

medikamentozuri kastracia:

medikamentozuri kastracia gamoiyeneba gonadotropin rilizing hormonis analogis depo forma preparati zoladeqsi (gozerelini) 3,6 mg. 1 ineqciis fasi daaxloebiT 350 lari iniSneba 28 dReSi erTxel wliuri kursi – 4500 lari

qirurgiuli kastracia:

qirurgiuli kastracia Tanamedrove eqimTa umravlesoba irCevs qirurgiul kastracias, miTumetes iseTi mcireinvaziuri Carevis SesaZleblobis arsebobisas, rogoricaa endoskopiuri ovarieqtomia. laparoskopiuli kastraciis warmoebis usafrTxoeba da misi upiratesoba Ria ovarieqtomiasTan SedarebiT, damtkicebulia mravali kvleviT.

Slide 15:

amave dros, literaturaSi mciredaa gaSuqebuli sakiTxi erTdrouli operaciebis Sesaxeb sarZeve jirkvlis kibosa da ginekologiuri paTologiis arsebobis dros.

Tanamedrove meTodebiT diagnostika, rogorc kombinirebuli operaciebis Catarebis winapiroba:

Tanamedrove meTodebiT diagnostika, rogorc kombinirebuli operaciebis Catarebis winapiroba wvrilnemsovani punqciuri aspiraciuli biofsia citologiuri da imunocitoqimiuri diagnostikiT. mcire zomis simsivneebis dros tardeba eqoskopiuri an mamograifiuli kontroliT.

imunocitoqimiuri meTodi:

imunocitoqimiuri meTodi ar saWiroebs did dros, tardeba ramdenime saaTSi; kvlevebiT naCvenebia rom membranuli citoplazmuri markerebi dadebiTad ufro xSiarad iRebeba citologiur, vidre histologiur preparatebSi. es ganpirobebulia citopreparatebis faqizi damuSavebiT, receptorebze histologiuri kvlevisTvis gamoyenebadi agresiuli qimiuri reagentebis ararsebobiT. Глузман Д.Ф., Скляренко Л.М., Надгорная В.А., Крячок И.А. Диагностическая иммуноцитохимия опухолей. Киев, Морион; 2003. с. 28—31. Волченко Н.Н., Савостикова М.В. Опыт применения иммуноцитохимического исследования в онкологической практике. Новые диагностические и лечебные технологии в онкологии. Томск, 2003.

Cytospin :

Cytospin citopreparatebSi ujredTa mcire raodenobis SemTxvevaSi gamoiyeneba e.w. “siTxovani sistemebi”, rodesac miRebuli punqtatebi SeyavT saWiro garemoSi da specialuri centrifugiT Rebuloben ujredTa mono-Sres. es meTodi gacilebiT amaRlebs gamokvlevis efeqturobas. Nizzoli R., Bozzetti C., Naldi N. et al. Comparison of the results of immunocytochemical assays for biologic variables on preoperative fine-needle aspirates and on surgical specimens of primary breast carcinomas. Cancer Cytopathol 2000;90:61—6.

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imunocitoqimiuri da imunohistoqimiuri gamokvlevebis Sedegebis Sedarebisas miRebulia dadebiTi korelacia: Sedegebis Tanxvedra 92%-mde. Makris A., Allred D.C., Powles T.J. et al. Cytological evaluation of biological prognostic markers from primary breast carcinomas. Breast Cancer Res Treat 1997;44:65-74. Nizzoli R., Bozzetti C., Savoldi L. et al. Immunocytochemical assay of estrogen and progesterone receptors in fine needle aspirates from breast cancer patients. Acta Cytol 1994;38:933-8.

kombinirebuli operaciebi:

kombinirebuli operaciebi premenopauzaSi sarZeve jirkvlis kibos dros simsivneSi hormonaluri receptorebis arsebobis dadgenis SemTxvevaSi, sarZeve jirkvlis radikaluri operacia tardeba erTdroul laparoskopiul ovarieqtomiasTan erTad. ginekologiuri paTologiis arsebobis SemTxvevaSi operaciis moculoba farTovdeba saSvilosnos eqstirpaciamde danamatebTan erTad.

kombinirebuli operaciebi ginekologiuri paTologiis dros:

kombinirebuli operaciebi ginekologiuri paTologiis dros Catarebulia 3 kombinirebuli operacia premenpauzaSi sarZeve jirkvlis kibos dros. samive pacients Cautarda neoadiuvanturi poliqimioTerapia daavadebis stadiidan gamomdinare. ovarieqtomiis Cveneba ganisazRvreboda winasaoperacio trepan boifsiiT da imunohistoqimiuri gamokvleviT. erTdrouli saSvilosnos eqstirpaciis sakiTxi ganisazRvreboda ginekologiuri paTologiidan gamomdinare.

Slide 22:

ist # 479 (2010) 142 (2011) 3 asaki 45 31 diagnozi Ca mammae sin Ca mammae sin Ca mammae sin TNM T2N0M0 (I) T2N2M0 (III) T2N0M0 (I) stadia II III I qimioTerapia 2 kursi 3 kursi 3 kursi ginekologiuri paTologia endometriumis hiperplazia saSvilosnos yelis paTologia saSvilosnos didi zomis mioma operaciis xangrZlivoba 120 (40 + 60) 180 (60 + 90) 45 + 40 sisxlis danak. 500 150 160 sawol dRe 3 3 4

anesTeziologiuri uzrunvelyofa:

anesTeziologiuri uzrunvelyofa kombinirebuli operaciebis dros didi mniSvneloba eniWeba anesTeziologiur uzrunvelyofas, romelic unda sruldebodes Tanamedrove meTodebiT da anesTetikebiT, rac saSualebas iZleva xangrZlivi operaciebi Catardes minimaluri garTulebebiT da adreuli reabilitaciiT.

ekonomiuri aspeqtebi:

ekonomiuri aspeqtebi saerTo fasis Semcireba 16-20%-iT; saerTo sawol-dReebis Semcireba; garTulebebis minimalizacia pacientTa adreuli aqtivaciiT; pacientTa adreuli reabilitacia da Sromisunarianobis aRdgena;

maRalteqnologiuri meTodebi:

maRalteqnologiuri meTodebi ultrabgeriT koagulatoris, “harmonikis” gamoyenebiT mcirdeba saoperacio dro, sisxlis danakargi, minimaluria Termuli dazianeba da mcirdeba operaciis Semdgomi limforea.

Harmonic laparoskopiuli saSvilosnos eqstirpacia :

Harmonic laparoskopiuli saSvilosnos eqstirpacia

laparoskopiuli saSvilosnos eqstirpacia danamatebTan erTad:

laparoskopiuli saSvilosnos eqstirpacia danamatebTan erTad

limfodiseqcia “Harmonic”-is gamoyenebiT:

limfodiseqcia “ Harmonic ”-is gamoyenebiT

daskvna:

daskvna sarZeve jirkvlis kibos mkurnaloba unda daigegmos simsivnis hormonaluri statusis gaTvaliswinebiT, romelic dgindeba mkurnalobis dawyebamde iseTi Tanamedrove meTodebis gamoyenebiT, rogoricaa imunocitoqimiuri gamokvleva. sarZeve jirkvlis mkurnalobis taqtikis gadawyvetis dros aucilebelia ginekologiuri sferos dawvrilebiTi gamokvleva, Tanmxlebi reproduqciuli sistemis paTologiis dasadgenad.

daskvna:

daskvna premenopauzis periodSi, simsivneSi hormonoreceptorebis arsebobis SemTxvevaSi naCvenebia ovarieqtomia, Tanmxlebi ginekologiuri paTologiis dros ki operacia sWiroa gafarTovdes saSvilosnos eqstirpaciamde danamatebTan erTad da gakeTdes erTdroulad. kombinirebuli operaciis ginekologiuri nawili unda Sesruldes mcirenvaziruad, laparoskopiuli ovarieqtomiis an saSvilosnos eqstirpaciis saxiT.

daskvna:

daskvna Tanamedrove maRalteqnoogiuri meTodebi saSualebas gvaZlevs vawarmooT kombinirebuli operaciebi minimaluri garTulebebiT.

madloba yuradRebisaTvis!:

madloba yuradRebisaTvis!