Qaraciyər sistlərinin (kistalar) bədxassəli olma ehtimalı

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Op. Dr. Kamran Beydullayev, MRCS İngiltərə, Ümumi Cərrah və Cərrah Transplantoloq, 0504063853

Kamran Beydullayev
Kamran Beydullayev

Qaraciyər sistləri (kistalar) insanların 5% də mövcuddur. Bu sistlər 90% hallarda heç bir əlamət vermir, adətən təsadüfən xəstə tamamilə başqa bir xəstəliyə görə müayinə olarkən aşkar edilir. USM və KT müayinələrin geniş yayılması son vaxtlar bu sistlərin daha tez tez rastlanmasına gətirib çıxarıb. Qaraciyər sisti aşkar olunmuş xəstələri ən birinci narahat edən ,, bu bədxassəli şiş ola biləlmi?,, sualıdır.  Qaraciyər sistlərinin 95%-i xoşxassəlidir.

Qaraciyər sistlərinin xəstəni necə narahat edə bilər?

95% qaraciyər sisti olan xəstələrdə heç bir şikayət olmur. Sistin ölçüsü və yerləşməsinin əlamətlərin əmələ gəlməsində yeri ola bilər. Sistlər 5sm dən kiçik olduqda demək olar ki, heç vaxt heç bir əlamət vermirlər. Bəzən sistlər çox böyük olduqda ağrılar verə bilər. Bəzən isə öd yollarını sıxaraq bağlaya bilər. Sistlərin digər yaxınlıqda olan orqanları sıxmasından da əlamətlər əmələ gələ bilər. Məsələn mədə sıxıldıqda tez doymaq kimi şikayət yarana bilər. Amöb mənşəli sistlər zamanı yüksək hərarət müşahidə edilə bilər. Qaraciyərin sadə sistləri adətən laborator analizlərdə heç bir dəyişikliklər vermir.

Sistlərin bədxassəli olmasına nədən şübhələnə bilərik?

Bu adətən sistlərin USM və KT (komputer tomoqrafiya) görüntüsünə əsasən baş verir. Neoplastik (şişə bağlı) sistlərin adətən solid komponenti ( bərk hissəsi) olur.  Sadə kistaların bu cür komponentləri olmur, onların tərkibi aydın maye olur, içərisində arakəsmələr olmur, divrları hamar, sistin ətrafında isə heç bir toxuma reaksiyası olmur. Əgər radioloji müayinələr sistin təsvirində bu cür əlamətləri qeyd edirsə o zaman sistin ciddi qəbul edilməsi və tam araşdırılması lazım gəlir. Digər orqanlarda da eyni zamanda rast gəlinən ( böyrək, mədəaltı vəzi) çoxsaylı qaraciyər sistləri xoşxassəlidir. Zaman zaman sistin ölçülərinin böyüməsi mütləq o demək deyil ki, bu bədxassəlidir. Xoşxassəli sədə kistalar da böyüyürlər.

Qaraciyərin kistoz törəməsi
Qaraciyər sisti

Bəs qaraciyər sistlərinin radioloji görüntülərində şübhəli məqamlar varsa bu zaman nə etmək lazımdır?

Əgər sist 1sm-dən kiçikdirsə bu zaman radioloji müayinələr onun xarakterini təyin etməkdə çətinlik çəkə bilərlər. Bu sistlərin solid komponentini aşkar etmək olmur. Ona görə də bu ölçüdə olan sistlər yalnız müşahidə edilir. Xəstə müəyyən intervallardan bir təkrar müayinələr olunur. Əgər sistlər 5sm dən böyük olarlarsa o zaman onlar divarlarının irreqular olmasına, arakəsmələrin olmasına, solid komponentinin və tərkibində debrislərin olmasına görə baxılmalıdır. Həmişə nəzərə almaq lazımdır ki, bu əlamətlər olan sistlər də hamısı neoplastik olmur. Əvvəllər infeksiyalaşmış sadə sistlər, travma nəticəsində qaraciyər daxilində əmələ gəlmiş sistlər, parazitik sistlər də eyni oxşar görünüşə malik ola bilərlər.

Yaxşı bəs qaraciyər sistinin sadə deyil, mürəkkəb bir sist olduğu aşkar ediləndən sonra hansı addım atılmalıdır?

Növbəti addım mərkəzdən asılı olaraq dəyişir, vahid bir protokol yoxdur. Bəzi mərkəzlər hesab edir ki, bu sistlər artıq çıxarılmalıdır və histologiyaya göndərilməlidir. Çünki, yalnız bu üsulla bunun nə olduğunu demək olar və təhlükədən xilas olmaq olar. Bəzi mərkəzlər sistik mayeni aspirasiya edib musin adlanan maddənin miqdarını yoxlamağı və eyni zamanda orada olan onkomarkerləri təyin etməyi təklif edir. Bu biopsiyadan əvvəl mürəkkəb sistin exinokokk olmadığına əmin olmaq lazımdır. Amma nəzərə alınmalıdır ki, bu müayinənin də spesifikliyi və sensitivliyi yüksək deyil.

Qaraciyər sistlərinə görə əməliyyatın effektivliyi çox yüksəkdir. Mərkəzimizdə qaraciyərin cərrahi əməlliyyatlarını mütəmədə və sistematik icra edirik. Neoplastik qaraciyər sistlərinin tam kəsilib çıxarıla biləcəyi hallarda təkrar yaranma riskinin kifayət qədər az olduğunu deyə bilərik

Bunlar da maraqlı ola bilər.

 

 

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