Düz bağırsaq xərçəngi. Mezorektal eksiziya niyə lazımdır?

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Op. Dr. Kamran Beydullayev, MRCS İngiltərə, Ümumi və Transplant Cərrah, əlaqə nömrəsi 0504063853

Kamran Beydullayev
Dr. Kamran Beydullayev

Düz bağırsaq xərçəngi geniş yayılmış xərcəng növlərindən biridir. Köhnə tədqiqatlarda düz bağırsaq xərcənginə görə əməliyyat olunan xəstələrin 30%- dən çoxunda şişin təkrar əmələ gəlməsi  qeyd edilir. Düz bağırsaq xərcənginin cərrahi müalicəsinin əsas təməl prosedurları abdominoperineal rezeksiya (düz bağırsağın anusla birlikdə kəsilib çıxarılaraq daimi kolostomanın qoyulması) və aşağı ön rezeksiyasıdır . Bu əməliyyatların yüksək riskləri vardır. 1979 cu ildə Healed düz bağırsaq xərcənglərində lokal təkrarlanma riskini əhəmiyyətli dərəcədə azaldan daha bir cərrahi texnika təklif etdi. Bu cərrahi texnika total mezorektal eksiziya adlanır (TME). Bu üsulun mahiyyəti mezorektumu əhatə edən visseral fassiyanın çanağı örtən parietal fassiyadan iti üsulla kəsilərək disseksiya edilməsidir. Düz bağırsaq xərcənginin cərrahi əməliyyatı zamanı bu məntiqi müstəvidən mezorektumun tam kəsilib çıxarılması əməliyyatın nəticəsinə əhəmiyyətli dərəcədə təsir edir. Əməliyyat zamanı total mezorektal eksiziya edilməyən xəstələrlə müqayisədə şişin yaxın müddət üçün təkrar olunma göstəricisi bu prosedura tətbiq olunandan sonra  30% dən 5% ə qədər enmişdir.

Düz bağırsaq xərcəngi
Total mezorektal eksiziya

Araşdırmalar yuxarı düz bağırsaq xərcəngi zamanı şiş hüceyrələrinin mezorektumda şişin sərhəddindən 5 sm dən distala yayılmadığını göstərir.

Total mezorektal eksiziya əməliyyatının nisbətən daha yüksək ağırlaşma riskləri var. Bunlara anastomoz qaçaqları, yara infeksiyası, sidik və seksual disfunksiyalar, və daha tez tez defekasiya halları aiddir.

Son zamanlar bu əməliyyat laparoskopik icra edilir. İlk başlanğıcda əməliyatın laparaskopik icra edilməsinə şübhə ilə yanaşılsa da, sonralar tədqiqatlar göstərdi ki, şişin təkrar olunma riskində də, ağırlaşmaların olma riskində də laparoskopik üsul açıq üsuldan heç də fərqlənmir.

Total mezorektal eksiziya
Düz bağırsaq xərcəngi

Hal hazırda düz bağırsaq xərcənginin müalicəsində multidissiplinar yaxınlaşma tətbiq olunur. Bu müalicəyə kimyəvi və radioterapiya da daxildir. Əməliyyatdan öncə kimyəvi terapiya və ya radioterapiyanın tətbiq olunması şişin həcmcə kiçilməsinə səbəb olur və əməliyyatı texniki asanlaşdırır və lokal təkrar olunma riskini azaldır.

Dr. Kamran Beydullayev
Kamran Bedullayev

Bunlar da maraqlı ola bilər

 

 

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