Mədə xərcəngi zamanı müalicə strategiyası

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

Dr. Kamran Beydullayev

Mədə xərcəngi onkoloji səbəbdən ölümə görə dünyada 4 cü yerdə dayanır.  Bu xəstələrin ümumilikdə 5 illik sağ qalma göstəricisi 25% dir. Təbii ki, bu ümumi statistikadır. Xəstəliyin aşkar edilmə mərhələsindən, və müalicə tədbirlərindən asılı olaraq bu statistika dəyişir. Xəstəlik nə qədər erkən mərhələdə aşkar edilərsə onun bu xəstəlikdən xilas olmaq şansı bir o qədər artır.

Mədə xərcənginin müalicəsində cərrahiyə, əməliyyatətrafı kimyəvi terapiyaradioterapiya üsullarından istifadə edilir. Şişin mümkün olan kimi tam kəsilib çıxarılması bu tip xəstələr üçün əsas müalicə üsulu sayılır.

Əgər şiş yalnız selikli qişa ilə məhdudlaşırsa bu zaman endoskopik əməliyyat da mümkündür. Əgər şiş yalnız selikli qişaları əhatə edirsə limfa düyünlərinin bulaşması ehtimalı 5% dir. Əgər bu selikaltı qişaya enə bilibsə o zaman bu göstərici 30% ə qədər artıq. Artıq Yaponiyada 15 ilə yaxındır ki, xəstəliyin ilkin mərhələsində aşkarlanmış xərcəgndə endoskopik rezeksiya üsulu tətbiq edilir, amma nəticələri hələ açıqlanmayıb. Bu üsul tətbiq edildiyi zaman uyğun xəstələrin seçilməsi və müalicənin kifayət qədər hazırlıqlı bir klinikada aparılması vacibdir ki, xəstənin şansları riskə atılmasın.

endoskopik selikli qişa rezeksiyası

Texniki mümkün olduqda mədə xərcənginə görə minimal invaziv əməliyyatlar da aparıla bilər. Laparoskopik əməliyyatlar adətən şişin ilkin mərhələlərində aparılır.

Hal hazırda bu məqsədlə ən çox icra edilən əməliyyat isə subtotal və total qastroektomiya əməliyyatlarıdır. Subtotal dedikdə mədənin ¾ hissəsinin kəsilib çıxarılması nəzərdə tutulur və mədənin distal 1/3 nahiyəsində yerləşən şişlər üçün icra edilir.  D2 limfodisseksiya bu vaxtlara qədər mübahisəli sayılsa da artıq bir neçə tədqiqatlar uzun dönəm üçün bunun çox faydalı olduğunu aşkar ediblər. Bu müalicələrə əməliyyat ətrafı kimyəvi terapiyanın da əlavə olunması müalicəni əhəmiyyətli dərəcədə effekli edir.

Total və subtotal qastroektomiya

Müalicə strategiyası seçilməmişdən əvvəl xəstəlik dərəcələnməlidir və endoskopik, radioloji müayinələrlə xəstəliyin hansı mərhələdə olduğu müəyyən edilməlidir.

Mədə xərcəngi

T1b və T2 mərhələdə olan şişlər üçün ilkin seçim kimi cərrahiyyə əməliyyatı götürülür.  Cərrahi müalicənin əsas səbəbi R0 rezeksiya əldə etməkdir ki, bu da şişin  və onun limfatik drenajlarında olan  regional limfa düyünlərinin tam kəsilib çıxarılması deməkdir. İrəliləmiş şişlər üçün isə ( T3 və daha yuxarı) uzaq metastazlar və peritoneal karsinomatoz olmadığı təqdirdə perioperativ kimyəvi terapiya nəzərdən keçirilməlidir. Uzaq metastazlar olduqda isə palliativ kimyəvi müalicə nəzərdə tutulur.

D1 limfodisseksiya mədə ətrafı limfa düyünlərinin çıxarılmasına deyilir. D2 lifmodisseksiya dedikdə isə pankreasın üstündə olan iri damarların ətrafındakı limfa düyünlərindən bəhs edilir. D3 limfodisseksiya zamanı isə para aortal və retropankreatik limfa düyünləri çıxarılır.

D2 limfodisseksiya

Əməliyyat ətrafı kimyəvi müalicənin faydası dəfələrlə sübut edilib. Bu müalicə xəstənin sağ qalma göstəricisinə müsbət istiqamətdə 5% -ə qədər təsir edir.

İrəliləmiş mədə xərcəngində əməliyyatda R0 sərhədlər almaq vacib şərdir. Bundan ötrü əməliyyat önü kimyəvi müalicə də istifadə edilir. Tədqiqatlar göstərir ki, bu müalicənin də sağ qalma göstəricisinə əhəmiyyətli qatqısı var.

Radikal müalicə mümkün olmadıqda palliativ kimyəvi müalicə istifadə edilə bilər. Xəstənin həyat keyfiyyətinin yaxşılaşmasında və ömrünün uzanmasında palliativ kimyəvi müalicənin aydın şəkildə effektli olduğu araşdırmalarda görsənmişdir.

Bunlar da maraqlı ola bilər

 

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