Sardis buStis kibos qirurgiuli mkurnalobis taqtika
g. Tolordava
S.p.s. `afxazeTis~
stacionar-poliklinikuri gaerTianebis
urologiuri ganyofileba
Sardis
buStis kibos qirurgiuli mkurnaloba Tanamedrove onkologiis erT-erTi aqtualuri
problemaa. Sardsasqeso sistemis simsivnuri warmonaqmnebis 50%-s warmoadgens
avTvisebiani simsivneebi, romlebic yvela onkologiur daavadebaTa 3-4%-s
Seadgens. mTels msoflioSi dResac SeimCneva aRniSnuli daavadebis zrdis
tendencia.
mocemuli
kvlevis mizans warmoadgens Sardis
buStis kibos qirurgiuli mkurnalobis optimaluri taqtikis SerCeva.
masala da meTodebi: ukanasknel
wlebSi Cvens ganyofilebaSi 25 pacients Sardis
buStis simsivniT CautardaT operaciuli mkurnaloba, maT Soris iyo 2 qali da 23
mamakaci, 40-dan 76 wlamde asakis. Sardis
buStis papiloma _ 2, Sardis buStis
kibo T1N0M0
_ 6 avadmyofi, T1-3N0M0
_ 14, T4N1M0
_ 3. morfologiuri gamokvlevisas dadginda: papiloma _ 4, adenokarcinoma _ 5,
brtyelujredovani kibo _ 4, gardamavalujredovani kibo _ 12, garTulebebiT:
qronikuli pielonefriti _ 10 avadmyofi, anemia _ 10, Tirkmlis qronikuli
ukmarisoba _ 6, gul-sisxlZarRvTa sistemis daavadeba _ 5, Saqriani diabeti _ 3.
zogadklinikuri
kvlevebis garda avadmyofebs CautardaT Semdegi gamokvlavabi: Sardovanas
Semcveloba sisxlSi, eqoskopia, eqskretoruli urografia, cistografia,
kompiuteruli tomografia, cistoskopia, Sardis
analizi atipiur ujredebze, mizanmimarTuli biofsia, kerZo SemTxvevaSi P.S.A. gulmkerdis rentgenografia,
kardiologisa da Terpevtis konsultaciebi. aseve mkurnalobis taqtikis
SerCevisaTvis didi mniSvneloba aqvs Sardis
buStis magnito-rezonansul tomografias da fluroscentur cistoskopias, romliTac
dasturdeba simsivnis stadiuroba. axlomdebare organoebSi simsivnis gavrceleba,
metastazebi limfur jirkvlebSi da sxva aucilebeli informacia, romelic SemdgomSi
gansazRvravs qirurgiuli mkurnalobis taqtikas.
masalis
gansja: Sardis buStis
rezeqciis Cvenebas warmoadgens avTvisebiani simsivne, garTulebuli hematuriiT, Sardis
pasaJis darRveviT, Sardis buStidan
an zeda saSarde gzebidan, rac iwvevda ureTerohidronefrozs, mwvave da qronikul
pielonefrits, Tirkmlis ukmarisobas. progresirebadi anemia. winasaoperacio
momzadeba moicavda hemodinamikuri maCveneblebis da bioqimiuri monacemebis
koreqcias. saSarde gzebis sanacias. operaciebis dros gamoyenebuli iyo winaswar
momzadebuli 250-400 ml. autosisxli.
Catarda
Semdegi operaciuli mkurnaloba:
1. Sardis
buStis papilomis amokvaTa _ 2
2. Sardis
buStis rezeqcia, cistostomia _ 11
3. Sardis
buStis rezeqcia erTmxrivi ureTerocistoneostomiiT _ 7
4. Sardis
buStis rezeqcia ormxrivi ureTerocistoneostomiiT _ 2
5.
cisteqtomia ureTerokutaneostomiiT _ 3
ureTerocistoneostomiis
antirefleqsuri plastika sruldeboda Cvens mier SemuSavebuli modifikaciiT.
postoperaciul
periodSi aRiniSneboda Semdegi garTulebebi: gulsisxlZarRvTa mwvave ukmarisoba _
2, Tirkmlis mwvave ukmarisoba _ 1, anemia _ 10, gulsisxlZarRvTa ukmarisoba _ 5,
pnevmonia _ 1. sam avadmyofs, romelTac antirefleqsuri operacia ar gaukeTdaT Sardis
buSt-SardsawveTis refluqsis gamo ganviTarda mwvave pielonefriti da Semdgomi
Tirkmlis qronikuli ukmarisoba.
Cvens
masalaze Sardis buStis papilomis
amokveTa _ 2 avadmyofs 3-5 wlis Semdeg recidivi ar aReniSneboda.
T1N0M0 _
Sardis buStis rezeqcia _ 6
avadmyofi. 3-5 wlis Semdeg recidivi ar gamovlenila (4 avadmyofs). 2 avadmyofs
aReniSna meoTxe wels.
T2-3N0M0 _
Sardis buStis rezeqcia _ 14
avadmyofi. 3 avadmyofs 4 wlis Semdeg recidivis gamo gaukeTda ganmeorebiTi
operacia, xolo ori avadmyofi 3-4 welia cxovrobs recidivis gareSe.
7 avadmyofi
erTmxrivi ureTerocistoneostomiiT 4-7 da 11 welia operaciis Semdeg recidivis
gareSea, xolo erTi avadmyofi operaciidan ori wlis gasvlis Semdeg gardaicvala
Tirkmlis da gulis mwvave ukmarisobiT. erTi avadmyofis bedi ucnobia.
Sardis
buStis rezeqcia ormxrivi ureTerocistoneostomiiT _ 2 avadmyofi. erT SemTxvevaSi
avadmyofi 5 welia recidivis gareSea, meore avadmyofis Sesaxeb informacia ar
gvaqvs.
T4N1M0 _ cisteqtomia, ormxrivi
ureTerokutaneostomia. erTi avadmyofi gardaicvala operaciidan me-6 dRes. meore
ki 8 Tvis Semdeg gulis mwvave ukmarisobiT. xolo mesame avadmyofis mdgomareoba 3
welia damakmayofilebelia.
Cvens mier
Catarebuli analizis Sedegad SeiZleba iTqvas, rom Sardis buStis avTvisebiani
simsivnis qirurgiuli mkurnalobis taqtika damokidebulia ara marto simsivnis
zomebze, morfologiaze, adgilmdebareobaze, stadiasa da regionalur metastazebze,
aramed avadmyofis saerTo mdgomareobaze, gansazRvruli misi asakiT, Tanmxlebi
daavadebebis simZimiT, socialuri faqtoriT da sxva.
radikaluri
qirurgiuli mkurnalobisas Sardis buStis rezeqciis ared ar SeiZleba miRebul iqnas
makroskopulad Seucvleli lorwovani garsi 2-3 sm-iT daSorebuli simsivnis fuZidan,
rogorc amJamad aris miRebuli, aramed eqspresbiofsiiT unda ganisazRvros
adeqvaturi rezeqciis sazRvrebi, magram darCenili qsovilebis xarjze Tavisuflad
unda aRsdges Sardis buStis mTlianoba, Tu es procedura problematuria _ arCevis
operacias warmoadgens cisteqtomia cistenteroplastikiT.
Summary
Tactics of
surgical treatment of Urine Bladder Carcinoma
G.
Tolordava
Department
of Urology. Stationary-Outpatient Union. “Abkhazeti” Co. Ltd
Results of surgical treatment of 25 patients with Urine
Bladder malignant tumors underwent analisis. According to the results the autor
makes a conclusion: the borders for
Urine Bladde resection must be selected on the basis of findings after intraoperative express biopsy.
Cystectomy with cystoentroplasty is finded os method of choice.