{"id":6194,"date":"2023-10-28T11:28:00","date_gmt":"2023-10-28T11:28:00","guid":{"rendered":"https:\/\/ambercell.pixel-dev.lt\/radioemboolia-uuenduslik-individuaalne-protseduur-mitteoperatiivse-maksavahi-raviks\/"},"modified":"2024-02-08T17:28:38","modified_gmt":"2024-02-08T17:28:38","slug":"radioemboolia-uuenduslik-individuaalne-protseduur-mitteoperatiivse-maksavahi-raviks","status":"publish","type":"post","link":"https:\/\/ambercell.eu\/et\/uudised\/radioemboolia-uuenduslik-individuaalne-protseduur-mitteoperatiivse-maksavahi-raviks\/","title":{"rendered":"Radioemboolia \u2013 uuenduslik individuaalne protseduur mitteoperatiivse maksav\u00e4hi raviks"},"content":{"rendered":"\n<p>Primaarne maksav\u00e4hk on \u00fcks pahaloomulisemaid maksahaigusi. Vastavalt sellele, millised rakud moodustavad kasvaja, eristatakse mitut t\u00fc\u00fcpi maksav\u00e4hki. K\u00f5ige tavalisemad neist, moodustades umbes 75-80 protsenti. juhud \u2013 hepatotsellulaarne kartsinoom (HCC). See on viies k\u00f5ige levinum onkoloogiline haigus ja kolmas onkoloogilise haiguse surmap\u00f5hjus maailmas , mille \u00fcldine viie aasta elulemus on vaid 18%. Kuid meditsiini kiire arenguga tekivad uued ravimeetodid, mis annavad selle haigusega patsientidele uut lootust. Neist r\u00e4\u00e4gib l\u00e4hemalt Vilniuse \u00dclikooli Haigla <a href=\"https:\/\/www.santa.lt\/\">Santarose kliiniku <\/a>(VUL SK) k\u00f5hukirurgia arst dr Rokas Ra\u010dkauskas, nukleaarmeditsiini osakonna juhataja, radioloog, nukleaarmeditsiini spetsialist. Renata Komiagien\u0117 ja dr Marius Kurminas, radioloog, menetlusradioloogia osakonna juhataja.<\/p>\n\n<div style=\"height:47px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n<p style=\"font-size:28px\"><strong><strong>Maksav\u00e4hi ravimeetodid<\/strong><\/strong><\/p>\n\n<p>Dr Roko Ra\u010dkauskase s\u00f5nul s\u00f5ltub maksav\u00e4hi ravi taktika haiguse levikust, v\u00e4himarkerite tasemest ja maksafunktsioonist. Samuti on oluline hinnata, kas patsiendil on viirushepatiit, krooniline maks v\u00f5i muud kaasnevad haigused. K\u00f5ige tavalisemad haiguse ravimiseks kasutatavad kirurgilised ravimeetodid on maksa resektsioon ja maksa siirdamine. S\u00f5ltuvalt staadiumist v\u00f5ib m\u00e4\u00e4rata ka kohalikku ravi &#8211; ablatsioon, transarteraalne kemoemboolia, selektiivne arterisisene radioemboolia. Lokaalset kasvajaravi v\u00f5ib kombineerida ka s\u00fcsteemse &#8211; s\u00fcsteemse keemiaravi v\u00f5i bioloogilise raviga. Kui patsient ei saa operatsiooni l\u00e4bi viia, kaalutakse tema lisamist maksa siirdamise nimekirja. Sellisel juhul v\u00f5ib haiguse leviku peatamiseks ja patsiendi elulemuse pikendamiseks doonororgani ootamise ajal patsiendile teha minimaalselt invasiivseid (sild (sild (sild)) protseduure.<\/p>\n\n<p>&#8220;See, milline ravimeetod konkreetsele patsiendile valitakse, s\u00f5ltub Barcelona kriteeriumidest, mida kasutatakse haiguse prognoosi ja ravi tulemuse hindamiseks. Milline minimaalselt invasiivne meetod valida, otsustatakse tavaliselt interdistsiplinaarse arutelu k\u00e4igus, milles osalevad maksakirurgid, radioloogid, sekkumisradioloogid, kemoterapeudid, gastroenteroloogid,&#8221; \u00fctleb k\u00f5hukirurgia arst.<\/p>\n\n<div style=\"height:37px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n<figure class=\"wp-block-image size-large\"><img fetchpriority=\"high\" decoding=\"async\" width=\"2560\" height=\"1440\" src=\"https:\/\/ambercell.eu\/wp-content\/uploads\/2024\/01\/Komanda-Gyd-Renata-Komiagiene-dr-Marius-Kurminas-technologai-Ruta-Urbanaviciute-ir-Mindaugas-Martinkus-edited-scaled.jpg\" alt=\"\" class=\"wp-image-2078\" srcset=\"https:\/\/ambercell.eu\/wp-content\/uploads\/2024\/01\/Komanda-Gyd-Renata-Komiagiene-dr-Marius-Kurminas-technologai-Ruta-Urbanaviciute-ir-Mindaugas-Martinkus-edited-scaled.jpg 2560w, https:\/\/ambercell.eu\/wp-content\/uploads\/2024\/01\/Komanda-Gyd-Renata-Komiagiene-dr-Marius-Kurminas-technologai-Ruta-Urbanaviciute-ir-Mindaugas-Martinkus-edited-300x169.jpg 300w, https:\/\/ambercell.eu\/wp-content\/uploads\/2024\/01\/Komanda-Gyd-Renata-Komiagiene-dr-Marius-Kurminas-technologai-Ruta-Urbanaviciute-ir-Mindaugas-Martinkus-edited-1024x576.jpg 1024w, https:\/\/ambercell.eu\/wp-content\/uploads\/2024\/01\/Komanda-Gyd-Renata-Komiagiene-dr-Marius-Kurminas-technologai-Ruta-Urbanaviciute-ir-Mindaugas-Martinkus-edited-768x432.jpg 768w, https:\/\/ambercell.eu\/wp-content\/uploads\/2024\/01\/Komanda-Gyd-Renata-Komiagiene-dr-Marius-Kurminas-technologai-Ruta-Urbanaviciute-ir-Mindaugas-Martinkus-edited-1536x864.jpg 1536w, https:\/\/ambercell.eu\/wp-content\/uploads\/2024\/01\/Komanda-Gyd-Renata-Komiagiene-dr-Marius-Kurminas-technologai-Ruta-Urbanaviciute-ir-Mindaugas-Martinkus-edited-2048x1152.jpg 2048w\" sizes=\"(max-width: 2560px) 100vw, 2560px\" \/><\/figure>\n\n<div style=\"height:32px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n<p style=\"font-size:28px\"><strong><strong>Radioemboolia \u2013 isikup\u00e4rastatud ravimeetod, mis v\u00f5imaldab teil<s>tagada ti maksimaalse<\/s>efekti<\/strong><\/strong><\/p>\n\n<p>\u00dcks uuenduslikumaid minimaalselt invasiivseid maksav\u00e4hi ravimeetodeid, mida praegu kasutatakse, on transarteriaalne radioemboliseerimine (TARE). VUL SK nukleaarmeditsiini osakonna juhataja R. Komiagien\u0117 s\u00f5nul kasutatakse seda ravimeetodit mitteoperatiivsete (ei sobi operatiivseks raviks) maksakasvajate ja maksa metastaaside korral. Protseduur on keeruline ja n\u00f5uab meeskonna keskendumist. Iga kaasatud spetsialist hindab patsiendi sobivust protseduurile ja selle teostamise tehnilisi v\u00f5imalusi. Selle protseduuri absoluutsed vastun\u00e4idustused \u2013 rasedus ja tundlikkus jodokontrastse aine suhtes.<\/p>\n\n<p>Radioembolisatsiooni protseduur koosneb 2 etapist \u2013 invasiivne diagnostika ja ravi etapp. M\u00f5lema etapi kulg on sama, ainult s\u00fcstitud radioisotoobi kogus erineb. Diagnostilise faasi ajal s\u00fcstitakse v\u00e4ike annus radioaktiivset preparaati. &#8220;See etapp on vajalik selleks, et saaksime t\u00e4pselt n\u00e4ha, millistesse piirkondadesse preparaat siseneb, et saaksime patsiendile l\u00e4bi viia ohutu raviprotseduuri. Parima v\u00f5imaliku efekti saavutamiseks arvutatakse eriprogrammide abil, millist annust on vaja konkreetse fookuse ja konkreetse patsiendi jaoks. Sel viisil l\u00e4heneme isikup\u00e4rastatud ravile, kui selle taktika &#8211; ravimi annus, lokaliseerimine &#8211; valitakse isikup\u00e4rastatud viisil, &#8220;\u00fctleb arst radioloog R. Komiagien\u0117.<\/p>\n\n<p>Protseduur n\u00f5uab haigla osakonnas \u00fchep\u00e4evast haiglaravi ja patsient peab saabuma invasiivseks protseduuriks valmis. Radioemboolia viiakse l\u00e4bi sekkumisradioloogia operatsiooniruumis, mille k\u00e4igus rakendatakse lokaalanesteesiat, nii et patsient j\u00e4\u00e4b teadvusele, surutakse maha ainult ebameeldivad aistingud.<\/p>\n\n<div style=\"height:63px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n<p style=\"font-size:28px\"><strong><strong>Kohalik ravimeetod m\u00f5jutab kasvaja fookust seestpoolt<\/strong><\/strong><\/p>\n\n<p>Renata Komiagien\u0117 juhib t\u00e4helepanu sellele, et erinevalt s\u00fcsteemsest ravist, mis m\u00f5jutab kogu keha, on radioemboolia lokaalne ravimeetod, mille puhul maksimaalne kiirgusefekt on koondunud kasvajasse ja seda \u00fcmbritsevasse maksakoesse.<\/p>\n\n<p>&#8220;Kasvaja fookuse m\u00f5jutamiseks seestpoolt kasutatakse isotoope, mis kiirgavad suurt kiirgusenergiat. VUL SK poolt teostatavate protseduuride puhul kasutatakse radioaktiivsete holmide isotoopi (|Ho 166), mis on ette n\u00e4htud plastist mikrosf\u00e4\u00e4ride (mikrograanulite) kujul. Madala invasiivse sekkumisprotseduuri ajal levivad holmiumi mikrosf\u00e4\u00e4rid kasvajakoes ja isotoobi eralduv beetakiirgus m\u00f5jutab kasvaja bioloogiat ja soodustab kasvajarakkude surma. Holmio isotoobil on unikaalsed omadused t\u00e4iendavalt kiirgava madala energiaga gammakiirguse ja paramagnetilise kiirguse kujul, t\u00e4nu millele on isotoop diagnostikaseadmetes n\u00e4htav. See v\u00f5imaldab teil protseduuri suure t\u00e4psusega planeerida ja arvutada individuaalselt m\u00e4\u00e4ratud radioaktiivsuse annuse, nii et ravi on edukam ja sellel ei ole t\u00f5siseid k\u00f5rvaltoimeid, &#8220;\u00fctleb radioloog.<\/p>\n\n<p>VUL SK menetlusradioloogia osakonna juhataja dr M. Kurmini s\u00f5nul on kiiresti kasvavatel maksakasvajatel palju toitvaid veresooni, just seda omadust p\u00fc\u00fctakse \u00e4ra kasutada. &#8220;Meie \u00fclesanne on tuvastada need veresooned ja kasutada nendesse p\u00e4\u00e4semiseks spetsiaalseid navigatsioonilisi angiograafilisi programme. Ravi ajal torkame k\u00e4e v\u00f5i reie arterit, siseneme maksaarteritesse spetsiaalsete juhtkateetritega ja veelgi \u00f5hemate mikrokateteritega (l\u00e4bim\u00f5\u00f5duga 0,6-0,8 mm) j\u00f5uame kasvajat toitvate arteriteni ja s\u00fcstime aeglaselt verevooluga radioaktiivseid osakesi. T\u00e4pselt arvutatud osakeste kogus &#8220;takerdub&#8221; kasvaja mikropragudesse, toimub sisemine kiiritamine \u2013 radioaktiivsus h\u00e4vitab l\u00e4hedal asuvad kasvajarakud,&#8221; \u00fctleb ta.<\/p>\n\n<p>P\u00e4rast protseduuri l\u00e4biviimist selgitatakse radioloogiliste seadmetega (gammakamber) skaneerimise teel mikrosf\u00e4\u00e4ride asukohta. \u00d6\u00f6sel p\u00e4rast protseduuri j\u00e4\u00e4b patsient haiglasse \u00fcldise seisundi j\u00e4lgimiseks. T\u00fcsistuste puudumisel vabastatakse hommikul koju. Edasiseks raviks suunatakse patsient tavaliselt k\u00f5hu\u00f5\u00f5nekirurgia spetsialisti v\u00f5i arsti onkoloog-kemoterapeudi juurde. Sageli viiakse 3 kuud p\u00e4rast radioembooliat l\u00e4bi radioloogilise uuringu kontroll.<\/p>\n\n<div style=\"height:54px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n<p style=\"font-size:28px\"><strong><strong>Protseduuri ohutuse tagab kvalifitseeritud spetsialistide meeskond<\/strong><\/strong><\/p>\n\n<p>R\u00e4\u00e4kides selle protseduuri ohutusest, \u00fctleb R. Komiagien\u0117, et see ei kujuta endast patsiendile suuremat ohtu ning v\u00f5imalikud t\u00fcsistused on seotud minimaalselt invasiivse protseduuri sekkumisega. Vahepeal minimeeritakse kokkupuutega seotud t\u00fcsistuste sagedus dosimeetria ja individuaalse planeerimise protsessi ajal kuni radioisotoopide terapeutilise annuse sisseviimiseni kasvajasse. Harvadel juhtudel v\u00f5ib patsiendil tekkida iiveldus, oksendamine, maksaens\u00fc\u00fcmide ajutine t\u00f5us veres, neutropeenia. K\u00f5iki neid k\u00f5rvaltoimeid saab ravimitega kontrollida.<\/p>\n\n<div style=\"height:32px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" width=\"768\" height=\"576\" src=\"https:\/\/ambercell.eu\/wp-content\/uploads\/2024\/01\/Radioembolizacijos-proceduros-metu-edited.jpg\" alt=\"\" class=\"wp-image-2082\" srcset=\"https:\/\/ambercell.eu\/wp-content\/uploads\/2024\/01\/Radioembolizacijos-proceduros-metu-edited.jpg 768w, https:\/\/ambercell.eu\/wp-content\/uploads\/2024\/01\/Radioembolizacijos-proceduros-metu-edited-300x225.jpg 300w\" sizes=\"(max-width: 768px) 100vw, 768px\" \/><\/figure>\n\n<div style=\"height:36px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n<p>Avatud kiirgusallikatega t\u00f6\u00f6tamisel on vaja hoolitseda ka operatsiooniruumi personali ohutuse eest. R. Komiagien\u0117 s\u00f5nul tagab selle kvalifitseeritud koolitatud spetsialistide meeskond. Isotoobi ettevalmistamisel protseduuri jaoks ja selle ajal, j\u00e4\u00e4kide taaskasutamisel jne kasutatakse spetsiaalseid kaitsevahendeid. Mikrosf\u00e4\u00e4ride infusiooniks kasutatakse protseduuri teostavate spetsialistide kaitsmiseks spetsiaalset varjestuss\u00fcsteemi.<\/p>\n\n<p>&#8220;Radioemboolia on alates 2022. aastast \u00fcks kohaliku ravi t\u00fc\u00fcpe. Sisaldub rahvusvahelistes maksav\u00e4hi ravijuhendites. See protseduur meie riigis h\u00fcvitatakse kohustusliku tervisekindlustuse eelarvest. Sarnase p\u00f5him\u00f5tte kohaselt oleme TACE (transarteriline kemoemboolia) l\u00e4bi viinud rohkem kui 12 aastat, ainult sel juhul on lubatud osakesed k\u00fcllastunud kemopreparaatidega &#8211; nii saavutab kasvajakoe ravimi palju suurema kontsentratsiooni, v\u00e4ltides s\u00fcsteemset toimet. Seega h\u00e4vitame mittekirurgilise maksav\u00e4hi, kahjustamata patsiendi elukvaliteeti. Veel \u00fcks hea uudis hepatotsellulaarse kartsinoomiga patsientidele on see, et neid lokaalse ravi meetodeid saab rakendada ka s\u00fcsteemse keemiaravi taustal,&#8221; m\u00e4rgib dr Marius Kurmin vestluse l\u00f5pus.<\/p>\n\n<div style=\"height:38px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" width=\"2448\" height=\"1836\" src=\"https:\/\/ambercell.eu\/wp-content\/uploads\/2024\/01\/Operacine-edited.jpg\" alt=\"\" class=\"wp-image-2086\" srcset=\"https:\/\/ambercell.eu\/wp-content\/uploads\/2024\/01\/Operacine-edited.jpg 2448w, https:\/\/ambercell.eu\/wp-content\/uploads\/2024\/01\/Operacine-edited-300x225.jpg 300w, https:\/\/ambercell.eu\/wp-content\/uploads\/2024\/01\/Operacine-edited-1024x768.jpg 1024w, https:\/\/ambercell.eu\/wp-content\/uploads\/2024\/01\/Operacine-edited-768x576.jpg 768w, https:\/\/ambercell.eu\/wp-content\/uploads\/2024\/01\/Operacine-edited-1536x1152.jpg 1536w, https:\/\/ambercell.eu\/wp-content\/uploads\/2024\/01\/Operacine-edited-2048x1536.jpg 2048w\" sizes=\"(max-width: 2448px) 100vw, 2448px\" \/><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>Primaarne maksav\u00e4hk on \u00fcks pahaloomulisemaid maksahaigusi. Vastavalt sellele, millised rakud moodustavad kasvaja, eristatakse mitut t\u00fc\u00fcpi maksav\u00e4hki. K\u00f5ige tavalisemad neist, moodustades umbes 75-80 protsenti. juhud \u2013 hepatotsellulaarne kartsinoom (HCC). See on viies k\u00f5ige levinum onkoloogiline haigus<\/p>\n","protected":false},"author":8,"featured_media":6204,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[37],"tags":[],"class_list":["post-6194","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uudised"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Radioemboolia \u2013 uuenduslik individuaalne protseduur mitteoperatiivse maksav\u00e4hi 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\/radioembolizacija-inovatyvi-individualizuota-neoperabilaus-kepenu-vezio-gydymo-procedura\/\" \/>\n<meta property=\"og:locale\" content=\"et_EE\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Radioemboolia \u2013 uuenduslik individuaalne protseduur mitteoperatiivse maksav\u00e4hi raviks - Ambercell\" \/>\n<meta property=\"og:description\" content=\"Primaarne maksav\u00e4hk on \u00fcks pahaloomulisemaid maksahaigusi. Vastavalt sellele, millised rakud moodustavad kasvaja, eristatakse mitut t\u00fc\u00fcpi maksav\u00e4hki. K\u00f5ige tavalisemad neist, moodustades umbes 75-80 protsenti. juhud \u2013 hepatotsellulaarne kartsinoom (HCC). 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