{"id":4382,"date":"2024-02-01T09:00:59","date_gmt":"2024-02-01T09:00:59","guid":{"rendered":"https:\/\/ambercell.pixel-dev.lt\/uuenduslik-ja-minimaalselt-invasiivne-ravi-kilpnaarme-solmede-raviks\/"},"modified":"2024-02-08T14:42:26","modified_gmt":"2024-02-08T14:42:26","slug":"uuenduslik-ja-minimaalselt-invasiivne-ravi-kilpnaarme-solmede-raviks","status":"publish","type":"post","link":"https:\/\/ambercell.eu\/et\/uudised\/uuenduslik-ja-minimaalselt-invasiivne-ravi-kilpnaarme-solmede-raviks\/","title":{"rendered":"Uuenduslik ja minimaalselt invasiivne ravi kilpn\u00e4\u00e4rme s\u00f5lmede raviks"},"content":{"rendered":"\n

Kilpn\u00e4\u00e4rme s\u00f5lmed on kilpn\u00e4\u00e4rme moodustised, mis v\u00f5ivad olla \u00fcksikud v\u00f5i mitmekordsed. Need \u00fcmbritsevast kilpn\u00e4\u00e4rme koest eraldatud, selgelt eristuvad massid on kliinilises praktikas tavaline leid ja nende raviks on t\u00e4nap\u00e4eval mitmeid v\u00f5imalusi. Santa Cl\u00ednicas on juba kolm aastat kasutanud t\u00e4iustatud, minimaalselt invasiivset ja t\u00f5husat menetlust – mikrolaineablatsiooni.<\/strong><\/p>\n\n

Ebaregulaarne patoloogia<\/strong><\/p>\n\n

Dr. A. Kalnin\u0161 jagas oma kogemusi dTRA protseduuridest oma igap\u00e4evapraktikas ning seej\u00e4rel kutsuti osalejad vaatama mitmeid protseduure otse\u00fclekandes dr A. Kalnin\u0161i juhendamisel. Praktika ajal viis \u0160iauliai Vabariikliku Haigla sekkumisangioloogia osakonna juhataja Vilmantas Smalinskas koost\u00f6\u00f6s dr A. Kalnin\u0161iga l\u00e4bi kolm keerulist operatsiooni. Kuigi k\u00f5ik kolm juhtumit olid keerulised, \u00f5nnestusid operatsioonid t\u00e4nu kogenud spetsialistidele.<\/p>\n\n

Santarose kliiniku endokrinoloogi dr Romena Laukien\u0117 s\u00f5nul v\u00f5ivad kilpn\u00e4\u00e4rmekoldeid p\u00f5hjustada nii healoomulised kui ka pahaloomulised haigused, kuid patsiendid ei tohiks kilpn\u00e4\u00e4rme k\u00fchmn\u00e4\u00e4rmekahjustuste leidmisel muretseda, sest 90-95% kilpn\u00e4\u00e4rmekoldeid on healoomulised. kilpn\u00e4\u00e4rmekoopad on healoomulised – as\u00fcmptomaatilised.<\/p>\n\n

“Kilpn\u00e4\u00e4rme s\u00f5lmede esinemissagedus palpeerimisel on 5-7%, samas kui ehhokardiograafias v\u00f5ib see olla kuni 67%.Lisaks leitakse kilpn\u00e4\u00e4rme s\u00f5lmed sageli juhuslikult erinevate kuvamisuuringute k\u00e4igus, nagu kompuutertomograafia, magnetresonantstomograafia, positronemissioonitomograafia jne,” \u00fctleb dr R. Laukien\u0117.<\/p>\n\n

Ta \u00fctles, et kilpn\u00e4\u00e4rme s\u00f5lmi leidub igas vanuses inimestel, nii naistel kui ka meestel, kuid neid esineb palju sagedamini vanematel inimestel, eriti naistel. Selle kasvajate, nagu ka teiste healoomuliste v\u00f5i pahaloomuliste kasvajate p\u00f5hjused ei ole siiski t\u00e4iesti selged, nagu ka teiste elundite healoomulised v\u00f5i pahaloomulised kasvajad.<\/p>\n\n

“Joodipuudus, ioniseeriv kiirgus, teatavate ravimite kasutamine ja toitumine m\u00e4ngivad arvatavasti rolli kilpn\u00e4\u00e4rme s\u00f5lmede tekkimisel. Ka geneetilised p\u00f5hjused on kilpn\u00e4\u00e4rme s\u00f5lmede tekkimisel olulised,” \u00fctleb endokrinoloog.<\/p>\n\n

Millal muretseda?<\/strong><\/p>\n\n

Kuigi, nagu eespool mainitud, ei p\u00f5hjusta kilpn\u00e4\u00e4rmekoldeid sageli kliinilisi s\u00fcmptomeid, v\u00f5ivad suured s\u00f5lmed, eriti kui need paiknevad kilpn\u00e4\u00e4rme alumises osas, s\u00fcgavamale rindkere sisse vajutades survestada naaberstruktuure, nagu hingetoru, s\u00f6\u00f6gitoru ja kaela veresooned.<\/p>\n\n

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“Sellised s\u00f5lmed v\u00f5ivad p\u00f5hjustada ebamugavustunnet kaelas, h\u00e4\u00e4le pigistust, hingamis- v\u00f5i neelamisprobleeme, samuti kosmeetilisi probleeme, sest deformeeruvad kaela. Hormoone tootev s\u00f5lmprobleem p\u00f5hjustab kilpn\u00e4\u00e4rme aktiveerumist, mis v\u00e4ljendub sagedase s\u00fcdamepekslemise, s\u00fcdame r\u00fctmih\u00e4irete, higistamise, kehakaalu languse jmt.”, – \u00fctleb dr Laukien\u0117.<\/p>\n\n\n\n

Seega, kui kilpn\u00e4\u00e4rmes avastatakse s\u00f5lmed, tuleb tema s\u00f5nul vastata kolmele peamisele k\u00fcsimusele: kas s\u00f5lme on healoomuline v\u00f5i pahaloomuline; kas s\u00f5lme p\u00f5hjustab kilpn\u00e4\u00e4rme talitlush\u00e4ireid; ja kas s\u00f5lme p\u00f5hjustab s\u00fcmptomeid, mis avaldavad survet \u00fcmbritsevatele struktuuridele? S\u00f5ltuvalt vastustest nendele k\u00fcsimustele otsustatakse, kas ja kuidas on vaja ravi.<\/p>\n<\/div><\/div>\n\n

<\/div>\n\n

Santara kliinikutes soovitatakse k\u00f5igile patsientidele, kellel on skaneerimisel tuvastatud kilpn\u00e4\u00e4rmekoopad, teha ultraheliuuring ja kui k\u00fchmud on suured, siis ka kompuutertomograafia.<\/p>\n\n

“K\u00f5rgresolutsiooniline ultraheli on k\u00f5ige tundlikum pildistamismeetod, mida kasutatakse kilpn\u00e4\u00e4rme s\u00f5lmede kahjustuste avastamiseks ja m\u00f5\u00f5tmiseks ning kilpn\u00e4\u00e4rme s\u00f5lmede eristamiseks teistest patoloogilistest struktuuridest kaelas. Kui kilpn\u00e4\u00e4rme s\u00f5lmed on v\u00e4ga suured, rindkere seinale langevad, siis tehakse kompuutertomograafia, et objektiivselt hinnata kilpn\u00e4\u00e4rme s\u00f5lmede poolt naaberorganitele avaldatava surve m\u00e4rke,” – \u00fctleb dr R. Laukien\u0117.<\/p>\n\n

Kui s\u00f5lme kahtlustatakse pahaloomulisuses, v\u00f5ib hiljem teha s\u00f5lme aspiratsioonipunktsiooni – peene n\u00f5elaga eemaldatakse materjali ts\u00fctoloogiliseks uuringuks.<\/p>\n\n

“See on “kuldstandard” ja k\u00f5ige olulisem katsemeetod healoomuliste ja pahaloomuliste s\u00f5lmede eristamiseks. Kilpn\u00e4\u00e4rmehormoonide vereanal\u00fc\u00fcsi kasutatakse kilpn\u00e4\u00e4rme funktsiooni hindamiseks. P\u00e4rast kilpn\u00e4\u00e4rme aktiivsuse aktiveerumise tuvastamist viiakse l\u00e4bi kilpn\u00e4\u00e4rme stsintigraafia, et hinnata s\u00f5lmede funktsionaalset aktiivsust, mille k\u00e4igus on v\u00f5imalik kindlaks teha, kas s\u00f5lme on h\u00fcperfunktsionaalne – “kuum” v\u00f5i h\u00fcpofunktsionaalne – “k\u00fclm”, – selgitab dr R. Laukien\u0117.<\/p>\n\n

Kui k\u00fchm on healoomuline, ei p\u00f5hjusta oma suuruse t\u00f5ttu surves\u00fcmptomeid ega h\u00e4iri kilpn\u00e4\u00e4rme funktsiooni, siis seda ei ravita. Kui aga s\u00f5lme t\u00f5ttu muutub kilpn\u00e4\u00e4re aktiivseks, ravitakse seda radioaktiivse joodiga v\u00f5i eemaldatakse kirurgiliselt.<\/p>\n\n

“Kui s\u00f5lmed p\u00f5hjustavad s\u00fcmptomeid, mis avaldavad survet \u00fcmbritsevatele struktuuridele v\u00f5i deformeerivad kaela kosmeetiliselt, eemaldatakse need kirurgiliselt,” \u00fctleb endokrinoloog.<\/p>\n\n

Alternatiiv kirurgilisele ravile<\/strong><\/p>\n\n

Alternatiivina operatsioonile on viimastel aastatel nii Euroopas kui ka USAs ja m\u00f5nes Aasia riigis laialdaselt kasutatud healoomuliste kilpn\u00e4\u00e4rme s\u00f5lmede, mis p\u00f5hjustavad survet ja kosmeetilisi s\u00fcmptomeid, raviks minimaalselt invasiivseid meetodeid, nagu raadiosagedus, laser v\u00f5i mikrolaineablatsioon.<\/p>\n\n

Santarose kliiniku radioloogi Juozas Jara\u0161\u016bnase s\u00f5nul ei ole eespool nimetatud ravimeetodid Leedus laialdaselt kasutusel, kuid nende haigla kasutab healoomuliste, s\u00fcmptomeid p\u00f5hjustavate s\u00f5lmede raviks mikrolaineablatsiooni – uuenduslikku ja minimaalselt invasiivset tehnikat, mis on k\u00e4ttesaadav 2020. aastal. Euroopa ja 2023 Ameerika kilpn\u00e4\u00e4rme spetsialistide organisatsioonid on juba esitanud \u00fcksikasjalikud suunised selle kohta, kellele ja millistel juhtudel seda soovitatakse.<\/p>\n\n

“Kilpn\u00e4\u00e4rmes\u00f5lme ablatsioon on Leedus uus protseduur, mille puhul kasutatakse n\u00f5ela kilpn\u00e4\u00e4rmes\u00f5lme eluj\u00f5ulise koe h\u00e4vitamiseks kuumuse abil. Kuumusega h\u00e4vitatud kilpn\u00e4\u00e4rmekoe kahaneb ja muutub aasta jooksul p\u00e4rast operatsiooni oluliselt v\u00e4iksemaks. Euroopa Kilpn\u00e4\u00e4rme Spetsialistide Organisatsioon soovitab seda protseduuri patsientidele, kellel on healoomuline kilpn\u00e4\u00e4rme s\u00f5lme, mis p\u00f5hjustab visuaalseid muutusi v\u00f5i survet v\u00f5i ebamugavustunnet kaelas,” selgitab J. Jara\u0161\u016bnas.<\/p>\n\n

Radioloogi s\u00f5nul on mikrolaine abil toimuv kudede h\u00e4vitamine juba ammu kasutusel teistes meditsiinivaldkondades, kuid alles hiljuti on seda rakendatud kilpn\u00e4\u00e4rme haiguste ravimisel.<\/p>\n\n

“Protseduuri \u00e4kiline populaarsus on tingitud asjaolust, et sellega saavutatakse operatsiooniga sarnane tulemus, kuid samal ajal on m\u00f5ju kilpn\u00e4\u00e4rme funktsioonile ja \u00fcmbritsevatele kudedele v\u00e4iksem. Kirjanduse andmetel v\u00e4heneb kilpn\u00e4\u00e4rmekolde maht aasta p\u00e4rast protseduuri 75-90% v\u00f5rra, samas kui edasised j\u00e4reluuringud on n\u00e4idanud, et vaid 5% s\u00f5lmedest on 4 aastat p\u00e4rast protseduuri uuesti v\u00e4lja kasvanud,” \u00fctleb Jarasunas, kes lisab, et kui ravi m\u00f5ju ei ole piisav v\u00f5i kui s\u00f5lm on tagasi kasvanud, on alati v\u00f5imalik protseduuri korrata v\u00f5i valida alles p\u00e4rast seda kirurgiline ravi.<\/p>\n\n

Ettevalmistus, kursus ja paranemisperiood<\/strong><\/p>\n\n

J. Jara\u0161\u016bnase s\u00f5nul saavad patsiendid, keda kaalutakse mikrolaineablatsiooni jaoks, otsejuhusliku konsultatsiooni, ultraheliuuringu, et hinnata nende kilpn\u00e4\u00e4rmekoonde, ning hinnangu selle kohta, kas protseduurile on n\u00e4idustused ja kas seda on v\u00f5imalik ohutult l\u00e4bi viia.<\/p>\n\n

“M\u00f5nikord on enne ravi vaja teha kilpn\u00e4\u00e4rme biopsia ja vereanal\u00fc\u00fcsid, et veenduda, et s\u00f5lme ei ole pahaloomuline. \u00dcldine ettevalmistus on samasugune nagu iga kirurgilise protseduuri puhul – tuleb teha teatavad laboratoorsed vereanal\u00fc\u00fcsid ja patsient peab protseduuri p\u00e4eval saabuma paastu. Haiglasse saabudes antakse patsientidele palatisse ja nad l\u00e4bivad protseduuri samal hommikul,” \u00fctleb radioloog.<\/p>\n\n

Nagu arst selgitab, viiakse kilpn\u00e4\u00e4rme mikrolaineablatsioon l\u00e4bi peene n\u00f5ela abil, mist\u00f5ttu ei j\u00e4\u00e4 kaelale armi, erinevalt kirurgilisest meetodist, mille puhul tehakse sissel\u00f5ige.<\/p>\n\n

“See protseduur j\u00e4tab vaid v\u00e4ikese n\u00f5elaj\u00e4lje, mis on m\u00f5nikord \u00fcks p\u00f5hjusi, miks inimesed valivad selle ravimeetodi. See on k\u00f5ige olulisem naiste puhul, kelle jaoks on kosmeetiline v\u00e4limus v\u00e4ga oluline,” \u00fctleb ta.<\/p>\n\n

Lisaks sellele tehakse see protseduur kohalikus anesteesias koos osalise sedatsiooniga. Patsiendid j\u00e4\u00e4vad kogu protseduuri jooksul valvsaks, mis v\u00e4hendab anesteesiaga seotud riske. P\u00e4rast seda protseduuri v\u00f5ivad patsiendid p\u00e4rastl\u00f5unal koju minna.<\/p>\n\n

“P\u00e4rast protseduuri v\u00f5ib teil olla paar p\u00e4eva paistes kael, ebamugavustunne ja v\u00e4ike valu neelamisel. Valuvaigisteid antakse paar p\u00e4eva, kuid enamasti ei tunne patsiendid kaelas mingeid vaevusi ja ei vaja ravimeid. P\u00e4rast protseduuri hindame ravi m\u00f5ju kordusuuringu k\u00e4igus ning patsiendid tulevad 1, 3, 6, 12 ja 24 kuu p\u00e4rast j\u00e4relkontrollk\u00e4igule,” \u00fctleb J. Jara\u0161\u016bnas.<\/p>\n\n

Kirjanduse andmetel esineb p\u00e4rast seda protseduuri t\u00fcsistusi harva, vaid 4%.<\/p>\n\n

“K\u00f5ige sagedasemad t\u00fcsistused on seotud termilise kahjustuse ja sellest tuleneva h\u00e4\u00e4le impeeriumi, kilpn\u00e4\u00e4rme talitlush\u00e4ire ja \u00fcmbritsevate kudede p\u00f5letustega. Kuid kolme aasta jooksul, mil mikrolaineablatsiooni kasutati, ei ole meil olnud \u00fchtegi kaebust – tulemused tunduvad t\u00f5esti head,” \u00fctleb arst.<\/p>\n\n

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Koost\u00f6\u00f6s Terumo Europe’iga korraldati \u0160iauliai Vabariigi Haiglas kroonilise totaalse oklusiooni (CTO) seminar sekkuvate kardioloogide jaoks. <\/p>\n","protected":false},"author":8,"featured_media":4395,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[37],"tags":[],"class_list":["post-4382","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uudised"],"yoast_head":"\nUuenduslik ja minimaalselt invasiivne ravi kilpn\u00e4\u00e4rme s\u00f5lmede raviks - Ambercell<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/ambercell.eu\/naujienos\/inovatyvus-ir-minimaliai-invazinis-budas-skydliaukes-mazgams-gydyti\/\" \/>\n<meta property=\"og:locale\" content=\"et_EE\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Uuenduslik ja minimaalselt invasiivne ravi kilpn\u00e4\u00e4rme s\u00f5lmede raviks - 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