zeda ybis kibos mkurnalobis efeqturobis analiziJ., Yousem D.M., Loevner LA. 1997). tkivili umetesad...
Transcript of zeda ybis kibos mkurnalobis efeqturobis analiziJ., Yousem D.M., Loevner LA. 1997). tkivili umetesad...
naSromi Sesrulebulia saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministros profesor a. RvamiCavas saxelobis onkologiis nacionaluri centris Tavisa da kisris simsivneebis ganyofilebaSi
vladimer xutaSvili
zeda ybis kibos mkurnalobis
efeqturobis analizi
medicinis mecnierebaTa kandidatis samecniero xarisxis mosapoveblad wardgenili sadisertacio naSromi, specialobiT
onkologia _ 14.00.14
samecniero xelmZRvanelebi: _ konstantine mardaleiSvili medicinis mecnierebaTa doqtori, profesori
_ giorgi ormocaZe
biologiur mecnierebaTa doqtori.
1
s a r C e v i
Sesavali - - - - - - - - - - - - - - - - - - - 3
problemis aqtualoba - - - - - - - - - - - - - - 3
Temis mecnieruli siaxle - - - - - - - - - - - - 5
kvlevis Teoriul-praqtikuli Rirebuleba - - - - - - 6
Tavi 1. literaturuli mimoxilva - - - - - - - - - - - - 7
Tavi 2. kvlevis masalebi da meTodebi - - - - - - - - - - - 35
Tavi 3. zeda ybis avTvisebiani simsivneebis kliniko-morfologiuri daxasiaTeba da mkurnalobis Sedegebis analizi - - - - 51
Tavi 4. haimoris Rrus avTvisebiani simsivneebis mimdinareobisa da daavadebis gamosavlis prognozireba - - - - - - - - 81 Tavi 5. miRebuli Sedegebis gansja - - - - - - - - - - - - 103
praqtikuli rekomendaciebi - - - - - - - - - - - 119
daskvnebi - - - - - - - - - - - - - - - - - - 121
bibliografia - - - - - - - - - - - - - - - - - 124
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Sesavali
zeda ybis wiaRis avTvisebiani simsivneebis xvedriTi
wona onkologiur daavadebaTa struqturaSi ar aRemateba
1_4%-s (Jeff H. Kim T. 1993). igi xasiaTdeba usimptomo
mimdinareobiT rac ganapirobebs avadmyofTa 80%-is
momarTvas specializirebul onkologiur dawesebulebebSi
simsivnis gavrcelebuli (III-IV stadia) procesebiT (Bridger
GP, Mendelsohn MS, Baldwin M. 1991). aRsaniSnavia, rom zeda ybis
wiaRis kibo 3-jer ufro xSirad gvxvdeba mamakacebSi, vidre
qalebSi (Markola A.T., Aronen H.J., Paavonen T. 1996). da rogorc
wesi igi 45-55 wlis asakis pacientTa xvedria (Phillips C.D.,
Futterer S.F., Lipper M.H. 1997).
avtorTa umravlesobas (Краевский Н.А., Смольянникова А.В.,
Саркисова Д.С. 1993; Antilia J., Sonnien P., Grenman R. 1993) miaCnia,
rom simsivnuri procesis ganviTarebas mniSvnelovnad
uwyobs xels duned mimdinare qronikuli anTebiTi
procesebi, romlis drosac aRiniSneba wiaRis amomfeni
lorwovanis hiperplazia, rasac SemdgomSi Tan sdevs
simsivnis ganviTareba.
miuxedavaT mravali Sromebisa, romlebic eZRvneba zeda
ybis avTvisebiani simsivneebis mkurnalobas, igi mainc rCeba
erTerT rTul da jer kidev gadauWrel problemad. erTis
mxriv, es ganpirobebulia haimoris Rrus agebulebis
anatomiuri TaviseburebebiT. xolo meores mxriv, misi
ganlagebiT saxis ConCxis siRrmeSi da uSualo siaxloviT
iseT sasicocxlo organoebTan, rogoric aris Tavis tvini,
Tvalebi, magistraluri sisxlZarRvebi da sxva. yovelive es
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arTulebs rogorc sxivuri energiis maqsimaluri dozebiT
gamoyenebas, aseve radikaluri operaciis warmoebas. magram,
miuxedavaT amisa, miRebuli Sedegebis efeqturobis analizi
gviCvenebs, rom bolo erTi saukunis ganmavlobaSi
aRniSnuli daavadebis mkurnalobaSi miRweulia
mniSvnelovani progresi. gadarCenil avadmyofTa ricxvi 5%-
dan gaizarda 46%-mde. rac udaod teqnikurma progresma da
mkurnalobisadmi diferencirebulma midgomam ganapiroba
(Aisen A.M., Martel. W., Braunstein E.M., Mcmillen K.I., Phillips W.A. 1986;
Atlas S.W., Grossman R.J., Gomori J.N., Guerry D., Hackney D.B. 1987;
Annis J.A., Phelps P.D., 1989; Antilia J., Sonnien P., Grenman R. 1993;
Шацкая Н.Х. 1993; Черекаев В.А. 1995; Сдвижков А.М. 1997).
magram, miuxedavad amisa, jer kidev ar aris
dasabuTebulad warmodgenili erToblivi koncefcia zeda
ybis kibos mkurnalobis Sesaxeb daavadebis mimdinareobis,
morfologiuri Senebis da sxva klinikur TaviseburebaTa
gamovlinebis gaTvaliswinebiT. aRniSnuli maxasiaTeblebis
Seswavla, sxvadasxva meTodebiT namkurnaleb avadmyofTa
jgufebSi, SesaZleblobas mogvcemda gamogvevlina
informatiul niSanTa simptomo kompleqsi, romelic
mniSvnelovnad ganapirobebda mkurnalobis Sedegs da
Sesabamisad daavadebis gamosavalsa da prognozs.
samwuxarod, aseve ar arsebobs sistematizirebuli
monacemebi mkurnalobis individualuri modelirebis
Sesaxeb yovel konkretul SemTxvevaSi, rac mniSvnelovnad
Seuwyobda xels mkurnalobis efeqturobis amaRlebas.
aqedan gamomdinare, Cveni kvlevis mizans warmoadgenda,
informatiuli kliniko-morfologiuri niSnebis gamovlena,
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romlebic mniSvnelovan zegavlenas axdendnen Catarebuli
konservatuli, qirurgiuli da kombinirebuli mkurnalobis
efeqturobaze. amisaTvis gamiznuli iyo Semdegi amocanebis
gadaWra:
1 Segveswavla zeda ybis avTvisebiani simsivneebis
mimdinareobis Taviseburebani, daavadebis kliniko-
morfologiur gamovlinebaTa gaTvaliswinebiT.
2 dagvedgina zeda ybis avTvisebiani simsivneebis
kliniko-morfologiuri maxasiaTeblebis ganawileba
sxvadasxva meTodebiT namkurnaleb avadmyofTa
jgufebSi, mkurnalobis Sedegis gaTvaliswinebiT.
3 gamogvevlina yvelaze informatiuli niSnebi, romlebic
mniSvnelovan zegavlenas axdenen mkurnalobis
efeqturobasa da aqedan gamomdinare sicocxlis
xangrZlivobaze.
4 miRebuli Sedegebis safuZvelze SegvemuSavebina
mkurnalobis individualuri modelirebis sqemebi, rac
mogvcemda saSualebas yovel konkretul SemTxvevaSi
SegverCia mkurnalobis optimaluri meTodi da
Sesabamisad gagvezarda gamojansarebul pacientTa
ricxvi.
Temis mecnieruli siaxle. pirvelad did klinikur
masalaze dayrdnobiT Seswavlilia zeda ybis avTvisebiani
simsivneebis mimdinareobis Taviseburebani, daavadebis
kliniko-morfologiur gamovlinebaTa gaTvaliswinebiT.
dadgenilia zeda ybis avTvisebiani simsivneebis
kliniko-morfologiuri maxasiaTeblebis ganawileba
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sxvadasxva meTodebiT namkurnaleb avadmyofTa jgufebSi,
mkurnalobis Sedegis gaTvaliswinebiT.
gamovlenilia yvelaze informatiuli niSnebi,
romlebic mniSvnelovan zegavlenas axdenen mkurnalobis
efeqturobasa da aqedan gamomdinare sicocxlis
xangrZlivobaze.
miRebuli Sedegebis safuZvelze SemuSavebulia
mkurnalobis individualuri modelirebis sqemebi, ramac
saSualeba mogvca, SegverCia mkurnalobis optimaluri
meTodi yovel konkretul SemTxvevaSi da Sesabamisad
gagvezarda gamojansarebul pacientTa ricxvi.
mocemuli kvlevis Sedegebis praqtikaSi gamoyeneba
xels uwyobs aRniSnuli avadmyofebis mkurnalobis
efeqturobis da sicocxlis xarisxis amaRlebas.
kvlevis Teoriul-praqtikuli Rirebuleba. didi
klinikuri masalis analizis safuZvelze Sefasebulia
haimoris wiaRis kibos konservatuli da qirurgiuli
mkurnalobis meTodebis efeqturoba. dadgenilia tipiuri,
damzogveli da gafarToebuli operaciebis gamoyenebis
Cveneba-ukuCveneba, avTvisebiani simsivnis kliniko-
morfologiuri da topografo-anatomiuri maxasiaTeblebis
gaTvaliswinebiT.
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Tavi I
literaturuli mimoxilva
zeda ybis wiaRis avTvisebiani simsivneebis xvedriTi
wona onkologiur daavadebaTa struqturaSi ar aRemateba
1_4%-s (Jeff H. Kim T. 1993). igi xasiaTdeba usimptomo
mimdinareobiT rac ganapirobebs avadmyofTa 80%-is
momarTvas specializirebul onkologiur dawesebulebebSi
simsivnis gavrcelebuli (III-IV stadia) procesebiT (Bridger
GP, Mendelsohn MS, Baldwin M. 1991). aRsaniSnavia, rom zeda ybis
wiaRis kibo 3-jer ufro xSirad gvxvdeba mamakacebSi, vidre
qalebSi (Markola A.T., Aronen H.J., Paavonen T. 1996). da rogorc
wesi igi 45-55 wlis asakis pacientTa xvedria (Phillips C.D.,
Futterer S.F., Lipper M.H. 1997).
zeda ybis avTvisebiani simsivneebiT avadobis xvedriTi
wili monRoloiduri rasis warmomadgenlebSi
mniSvnelovnad aRemateba evropelTa avadobis maCveneblebs.
О.И. Бибер-ma 1982 wels aRniSna, rom yazaxeTis mosaxleobaSi
aRniSnuli paTologiis xvedriTi wili 7-jer aRemateboda
sabWoTa kavSiris danarCen mosaxleobaSi gamovlenil
maCveneblebs. aRniSnuli daavadebis ufro maRali cifrebi
moyavT С.Ш. Баимаканова-s (1989w) da М.Х. Ибрагимов-s (1988w)
yazaxeTis, yirgizeTisa da TurqmeneTis mkvidrTa Soris
aRmosavleT evropis mosaxleobasTan SedarebiT
(Sesabamisad 2,6 _ 0,6).
avtorTa umravlesobas miaCnia, rom simsivnuri
procesis ganviTarebas mniSvnelovnad xels uwyobs duned
mimdinare qronikuli anTebiTi procesebi (Краевский Н.А.,
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Смольянникова А.В., Саркисова Д.С. 1993). gansakuTrebiT maSin,
rodesac aRiniSneba wiaRis amomfeni lorwovani garsis
hiperplazia, ganpirobebuli Cirqovani eqsudatis qronikuli
zemoqmedebiT (Antilia J., Sonnien P., Grenman R. 1993). Buchwarld C,
Nielsen LH, Ahlgren P, Nielsen PL, da Tos M-is mier 1990 wlis
monacemebiT, pacientebi simsivnis ganviTarebamde 5-10%-Si
aRniSnaven travmis arsebobas saxis areSi.
miuxedavad diagnostikuri meTodebis simravlisa,
avadmyofebis mxolod 20% iwyebs mkurnalobas daavadebis
sawyis stadiaSi (Dillon W.P., Som P.M., Fullerton G.D. 1990). am
dros simsivnis manifestaciis ZiriTad gamovlinebas
tkivilis simptomi warmoadgens (g. RoReliani 1998; Hirsch R.
J., Yousem D.M., Loevner LA. 1997). tkivili umetesad
lokalizdeba axalwarmonaqmnis areSi da iradirebs
irgvlivmdebare organoebSi (Hamaker RC, Singer MI 1986).
Joroisen M.-is (1996) azriT tkivilis simptoms xSirad Tan
axlavs cxviridan sunTqvis gaZneleba, yru da mRrRneli
xasiaTis tkivilebi. ufro gavrcelebuli stadiebis dros
tkivili iradirebs kbilebSi, safeTqlis, yuris da Tvalis
midamoSi (Hoff van S.C.J., Lamers R.J.S., Kessels A.G.H. 1995; Jing B.S).
xSirad tkivilis gamovlenas Tan axlavs sxvadasxva saxis
paresTeziebi, an vlindeba nevralgiuri xasiaTis tkivilebi
simsivnuri dazianebis mxareze (Hoe J.W. 1989). tkivilis
simptomi gansakuTrebiT maSin aris gamoxatuli, rodesac
procesi scildeba zeda ybis farglebs da azianebs
frTasasis fosos (Hamaker RC, Singer MI 1986).
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sunTqvis calmxrivi gaZneleba, rogorc wesi
damokidebulia simsivnis sawyis lokalizaciasa da zrdis
mimarTulebaze (Belkin B.A., Papageorge M.b., 1988). yvelaze adre
es simptomi Cndeba daavadebis gavrcelebisas zeda ybidan
dacxriluli firfitis miarTulebiT (Fakitsas j., Bankoff M.S.
1989). am SemTxvevaSi aRiniSneba lorwovani garsis
hipersekrecia, rac ganapirobebs uxvi gamonadenis arsebobas
cxviris savalidan. mogvienebiT aRniSnuli gamonadeni
Rebulobs Cirqovan xasiaTs, romelsac Tan axlavs
perioduli sisxldenebi (Ang KK, Jiang GL, Frankenthaler RA 1992).
Catarebulma kvlevebma, haimoris Rrus epiTeluri da
araepiTeluri warmoSobis simsivneebis mimdebare anatomiur
struqturebze gavrcelebis Taviseburebis Seswavlis
Sesaxeb gviCvena, rom epiTeluri warmoSobis simsivneebi
azianeben Tvalbudes 20-25%-Si, cxviris Rrus lorwovans 30-
35%-Si, piris Rrus organoebs 15-20%-Si da loyis qsovilebs
20-22%-Si. araepiTeluri simsivneebi erTnairad xSirad
azianeben Tvalbudes (35-40%) da cxviris Rrus (40-45%), rac
Seexeba piris Rrus da loyis qsovilebs, maTi dazianeba
aRiniSneba Sesabamisad 10-15% da 2-5%-Si (LoRusso P, Tapazoglou
E, Kish JA, et al 1988).
tkivilis da sunTqvis gaZnelebis garda, zeda ybis
wiaRis simsivneebs procesis gavrcelebis mimarTulebis
gaTvaliswinebiT axasiaTebs: saxis SeSupeba, Tvalis kaklis
distopia, ekzofTalmi, cremldena, cxviridan sisxldena,
alveoluri morCisa da sasis gumbaTis cvlileba, kbilebis
moryeva, trizmi, ynosvis daqveiTeba da paresTeziebi (Bettez
M., Dolan K.d., Yuh W.T. 1989).
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daavadebis klinikur gamovlinebaTa mravalferovnebam
maTi sistematizaciis aucilebloba Seqmna. 1995 wels g.m.
penkovskim zeda ybis kibos klinikur gamovlinebaTa
simptomatika gaaerTiana oTx ZiriTad jgufSi, romlis
mixedviTac SesaZlebeli iyo gvemsjela paTologiuri
procesis zrdis mimarTulebis Sesaxeb. pirveli jgufis
simptomebs man otorinolaringologiuri uwoda. am dros
aRiniSneboda cxviridan sunTqvis gaZneleba da sixlian-
serozuli gamonadeni, ynosvis daqveiTeba, tkivili wiaRis
midamoSi; meores nevrologiuri (Tavis tkivili, neiropaTia,
mgrZnobelobis moSla); mesames stomatologiuri (trizmi,
kbilis tkivili) da meoTxes ofTalmologiuri (diplopia,
mxedvelobis daqveiTeba, egzofTalmi). man aseve aRniSna,
rom SesaZlebelia arsebobdes am simptomTa ori an sami
jgufis erTdrouli gadamkveTi gamovlineba.
zeda ybis wiaRidan limfa ZiriTadad gaedineba xaxis
kisris nawilis zeda-Rrma limfur kvanZebSi, ybisqveSa
midamos limfur kvanZesa da ybayura jirkvlis midamos
limfur kvanZebSi (Kish J, Ensley J, et al 1987). magram, rogorc
klinikurma dakvirvebebma gviCvenes, regionuli metastazebi
haimoris Rrus avTvisebiani simsivneebis dros ufro
iSviaTad SeiniSneba, vidre analogiuri simsivneebis dros,
romlebic lokalizdebian zeda sasunTqi gzebis da piris
Rrus organoebSi (Buchwarld C, Nielsen LH, Ahlgren P, Nielsen PL,
Tos M. 1990).
zeda ybis wiaRis kibos avTvisebianobis xarisxis
Seswavlam, 1933 wels Svedi mecnieri L. Ohngren-i miiyvana im
daskvnamde, rom simsivneebi romlebic lokalizdebian zeda
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ybis wiaRis zeda-ukana naxevarSi, xasiaTdebian ufro
agresiuli mimdinareobiT, adreuli metastazirebiTa da
mZime prognoziT, maSin, roca simsivnis lokalizaciisas
wiaRis qveda-wina naxevrSi daavadebis mimdinareoba da
prognozi ufro keTilsaimedoa. aqedan gamomdinare,
daavadebis prognozirebis mizniT, avtorma mizanSewonilad
CaTvala zeda ybis areSi frontaluri da sagitaluri
xazebis gatarebiT haimoris wiaRi pirobiTad gaeyo oTx
segmentad, rasac man simsivnis avTvisebianobis xazebi
uwoda. L. Ohngren-is mixedviT zeda ybis wiaRi iyofa Semdeg
segmentebad:
1. wina-qveda SigniTa segmenti;
2. wina-qveda gareTa segmenti;
3. zemo-ukana gareTa segmenti;
4. zemo-ukana SigniTa segmenti;
avtorebis monacemebiT (Shidnia H., Hornbak N., Saghafi N. et al.
1984; Воробьев В.И., Гарбузов М.И., 1989; Пучинина Е.И. с соавт., 1991),
zeda ybis kibos regionuli metastazebi simsivnis
lokalizaciisas zeda _ ukana segmentSi SeiniSneba
SemTxvevaTa 14-16%-Si, xolo qveda _ wina naxevrSi
lokalizaciisas maTi sixSire ar aRemateba 7-8%-Si
(Гогелиани Г.К. 1984). Tumca sakmaod xSirad vxvdebiT
simsivneebs, romlebic xangrZlivi drois ganmavlobaSi
arseboben, scildebian erTi anatomiur organos farglebs,
invazireben irgvlivdebare struqturebSi da ar iZlevian
regionul metastazebs (Draf W., Samii M. 1988).
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sxvadasxva avtorTa monacemebiT, zeda ybis wiaRis
simsivneTa Soris epiTeluri genezis axalwarmonaqmnebi
gvxvdeba (70-80%-Si) (Afridi N, Taghian A, Nogueira C 1995;Vlock D,
Anderson J, Whiteside T, Herbeman R, Kirkwood J, Adams G. 1994). maT
Soris wamyvani adgili ukavia brtyelujredovan karcinomas
(65-90%) (Al-Kourainy K, Kish J, Ensley J, Tapazoglou E 1987). romelsac
diferencirebis xarisxis mixedviT yofen maRal-, saSualo-,
da dabaldiferencirebul kibod, radgan maT sxvadasxva
klinikuri mimdinareoba axasiaTebT (Cunnings G, Al-Sarraf M.
1987). aseve radikalurad gansxvavdeba adenikarcinomis,
cilindromis, epiTeluri da araepiTeluri warmoSobis
avTvisebiani simsivneebis klinikuri mimdinareobac (Jacobs J,
Weaver A, Crissman J 1988; Turner SL, Tiver KW, 1995). rac Seexeba
araepiTeluri warnoSobis simsivneebs, umetesad vxvdebiT
zeda ybis wiaRis egereTwodebul rbili da magari
qsovilovani warmoSobis sarkomebs, iseTi rogoricaa:
limfosarkoma, osteosarkoma, qondro da angiosarkomebi (
Kish JA, Ensley JF, Jacobs J, 1996).
2002 wels ВОЗ-is mier mowodebul zeda ybis wiaRis
kibos 19-e morfologiur klasifikaciaSi ZiriTadad ori
tipis simsivneebs ganixilaven:
epiTeluri simsivneebi araepiTeluri simsivneebi
• brtyelujredovani karcinoma • limfosarkoma
• adenokarcinoma • osteosarkoma
• mucinozuri adenokarcinoma • qondrosarkoma
• adenokistozuri karcinoma • angiosarkoma
• cilindroma • rabdomiosarkoma
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• mukoepidermoiduli karcinoma • neiro sarkoma
• aradiferencirebuli kibo • Svanoma
• miksoma
• neirofibroma
• esTezioneiroblastoma
• melanoma
aRsaniSnavia, rom klasifikaciaSi warmodgenili
gansxvavebuli genezis simsivnur daavadebebs axasiaTebT
klinikuri mimdinareobis Taviseburebebani, rac moiTxovs
sxvadasxva diagnostikuri meTodebis kompleqsur
gamoyenebas. maTi Tanmimdevroba mniSvnelovnad aris
damokidebuli simsivnuri procesis lokalizaciasa da
gavrcelebaze. magram igi yovelTvis iwyeba saxis
vizualuri daTvalierebiT, gardamavali naoWis
mdgomareobis SefasebiT, daavadebul mxareze cxviris
savalidan sunTqvis xarisxis gansazRvriT. risTvisac,
rogorc wesi, aucilebeli xdeba palpaciisa da rinoskopiis
warmoeba (Som P.M., Shugar J.M., Troy K.M., Sacher M., Stollman A.L.
1988).
wina rinoskopia saSualebas gvaZlevs miviRoT
informacia simsivnis gavrcelebis Sesaxeb haimoris Rudan
cxviris savalSi, davadginoT misi zomebi, agebuleba, zrdis
forma da damokidebuleba irgvlivmdebare qsovilebTan
(Шацкая Н.Х. 1993). xolo ukana rinoskopiiT, fasdeba
cxvirxaxisa da cxviris niJarebis ukana ganyofilebebis
mdgomareoba (Tsujii H., Kamada T., Arimoto T. 1986). magram igi
ukavSirdeba mniSvnelovan sirTuleebs, romlebic
ganpirobebulia aRniSnuli organos rTuli anatomiuri
agebulebiT da moiTxovs eqimis maRalprofesionalizms wina
da ukana rinoskopiis Sedegebis Sefasebisas (Лопатин А.С.,
Арцыбашева М.В. 1996).
tradiciuli rinoskopiuli da fibroskopiuli
kvlevebis monacemebis Sefasebisas aRmoCnda, rom am
ukanasknels mniSvnelovani upiratesoba gaaCnia zeda ybis
wiaRisa da misi mezobeli anatomiuri struqturebis
paTologiuri cvlilebebis aRmoCenaSi, romelTa sizustec
92-93%-s uaxlovdeba (Annis J.A., Phelps P.D. 1989). rac ar
SeiZleba iTqvas rinoskopiaze, misi informatiulobis
maCvenebeli mxolod 66-67%-ia (Baker H.L. 1986). garda amisa,
fiboskopiis gamoyenebiT, gveZleva SesaZlebloba
vakontroloT mkurnalobis efeqturoba, rogorc misi
Catarebis procesSi, aseve mkurnalobis Semdgomi dinamiuri
dakvirvebisas. Ferrer Y. 1978, aRwers teleskopiuri milebis
gamoyenebis upiratesobas zeda ybis wiaRebis
daTvalierebaSi, romlebsac igi sxvadasxva daxris
kuTxeebiT iyenebs (0, 300, 700, 1200).
haimoris Rrus kibos gavrcelebis dros cxviris
savalSi da cxvirxaxaSi yvelaze informatiul meTodad
gvevlineba fibroskopia, igi 85-86%-Si iZleva zust
monacemebs daavadebis gavrcelebis masStabze (Chobe R,
McNeese M, Weber R, Fletcher GH 1988). aRniSnuli meTodi aseve
maRalinformatiulia mcire zomis simsivneebis dros
haimoroskopiis warmoebisas (Som PM, Lawson W, Lidov MK. 1991).
zeda ybis wiaRis gamokvleva drekadi fibroskopiT,
romelsac gaaCnda rTuli optikuri sistema saSualebas
gvaZlevs detalurad SeviswavloT aRniSnul organos yvela
14
anatomiuri ganyofileba, SevafasoT wiaRis dazianebis
moculoba, ganvsazRvroT simsivnis zrdis forma, misi
gamokidebuleba irgvlivmdebare qsovilebTan da bolos
ganvaxorcieloT damiznebiTi biofsia (Dresel S; Kang K. 1990).
magram aRmoCnda, rom aRniSnuli meTodi (rinoskopia,
fibroskopia da haimoroskopia) gavrcelebuli simsivneebis
SemTxvevaSi kargavs aqtualobas, radgan cxiris savalis
sruli opturaciis gamo SeuZlebeli xdeba wiaRSi Sesvla
da misi gamokvleva (Bilaniuk L.T; Grevers G. 1994). am dros
gansakuTrebul mniSvnelobas iZens zeda ybis
rentgenologiuri kvlevis meTodi (Афанасьева А.В.-c 1952). am
mxriv, yvelaze ufro informatiulia zeda ybis
rentgenogramebis gadaReba nikap-cxviris, gverdiT da
naxevradaqsialur proeqciebSi an seleqtiuri tomografiis
warmoeba. frontalur proeqciaSi gadaRebuli tomograma
mniSvnelovnad avsebs rentgenologiur suraTs da gvaZlevs
warmodgenas haimoris Rrusa da cxviris danamati wiaRebis
anatomiur struqturasa da formaze, iZleva saSualebas
gamovavlinod masSi paTologiuri procesis arseboba da
SevafasoT Zvlovani struqturebis mdgomareoba. igi iZleva
saSualebas davadginod daavadebis mxare, haimoris wiaRis
daCrdilvis intensivoba, misi irgvlivmdebare struqturebze
gavrcelebis mimarTuleba da vimsjelod Zvlovani kedlebis
mdgomareobaze!(Лихтенштейн Е.А.-d (1961-1970).!!
rentgenologiuri kvlevis aucilebloba zeda ybis
wiaRis kibos diagnostikaSi eWvs ar iwvevs. Tumca Файзуллин
М.Х.-s •")_"a! miaCnia, rom! daavadebis! gmiuflc! dogmcebid!
mikd! iuzmvuzkmcgvzkdocsg! f(lficg! mgdegd! dpkic!
15
mcgvzkqc8! vgzdgsftiu-ct! hzuewgocqciu-flc! pcgrcd! bkzqu9!
Грицман Ю.Я-i (1981) Tvlis, rom zeda ybis! rentgenografia
\jcigm! ver iZleva!dcwdcezcd!qfdo!vgwkdg\flu-gd!da!igx!
fbik! wxciug! dcwdcezfic! pgiwkzgnwzc8! wct! fbik! zgslu-gm!
juubgimu-g! iuzovuzologiuri! vgwkdg\flu-g! dcwdcezcd!
{ujwgico! qkwgd. klinikuri da rentgenologiuri
monacemebis SedarebiTma analizma gamoavlina maT Soris
mniSvnelovani sxvaoba, rac 34-35%-s aRwevs (Beck JC,
McClatchey KD, Lesperanse MM, Esclamado RM, Carey TE, Bredford CR.
1995). aseve xSiria simsivnis gavrcelebis sazRvrebis hipo
(31-32%) da hiperdiagnostika (3-4%) (Belkin B.A., Papageorge M.b.,
Fakitsas j., Bankoff M.S. 1988). o. olSanskis mier 1987 wels
dadgenil iqna, rom rentgenologiuri da klinikuri
monacemebis sruli damTxveva aRiniSneba mxolod 37-38%-Si.
yovelive es, uflebas gvaZlevs vamtkicod, rom zeda ybis
rentgenografia ar warmoadgens diagnostikuri problemis
ualternativo da gadamWrel meTods. am dros, maT
mniSvnelovnad miaCniad, zeda ybis radioizotopuri kvlevis
warmoeba (Bettez M., Dolan K.d. 1989). avtorTa azriT, kvlevis es
meTodi aseve arainvaziuri da umtkivneuloa. misi
gamoyenebis principi dafuZnebulia radioizotopis unarze
Calagdes simsivnur qsovilSi meti intensivobiT, vidre mis
garSemo arsebul saR da simetriulad ganlagebul
qsovilebSi (Yuh W.T. 1990). STanTqmuli radiogamosxivebis
aRricxvisaTvis, radiometriuli da gama-topografiuli
meTodebiT sargebloben. radiometriuli meTodi ZiriTadad
gamoiyeneba radiaqtiuli fosforis P32-is gamosxivebis
azomvisaTvis, romelsac axasiaTebs arCeviTi kumulacia
simsivnur ujredebSi. aRniSnuli meTodi informatiulia
16
diferencialuri diagnostikis TvalsazrisiT da naklebad
informatiulia daavadebis lokalizaciis da gavrcelebis
gansazRvrisaTvis (Mazinalli L, Goldschmidt B 1941).
rac Seexeba gama-topografiuli meTods, misi muSaobis
principi dafuZnebulia STanTqmuli radiaqtiuri
nivTierebis gamosaxulebis miRebaze skanirebis an
scintigrafiis saSualebiT. kvlevisaTvis ZiriTadad iyeneben
75 Se-meTionins da Ga 67 citrats •Горский А.А. c соавт. 1984a9
kibos skanografiuli suraTisaTvis damaxasiaTebelia
simsivnis mier radiofarmpreparatis intensiuri kumulacia,
sadac dagrovebis farTobi, rogorc wesi,
pirdapirproporciulia simsivnis zomisa da misi
lokalizaciisa (Приходько А.Г., Ефимцев Ю.П., Баженов В.В.,
Васина Н.Б., Санкин И.А., Смолякова Н.Е. 1991). magram samwuxarod,
aRniSnuli meTodi ver uzrunvelyofs 2sm-ze mcire zomis
simsivneTa diagnostikas, rac miRebul informacias eWvqveS
ayenebs da xSirad arasaimedos xdis!• Горский А.А., Приходько
А.Г., Габуния Р.И., Сенюков М.В. 1985; Коссовой А.Л. 1987). aseT
SemTxvevebSi metad faseulia kompiuteruli tomografia.
kompiuteruli tomografiis meTodi, rentgenologiuri
da radioizotopuri kvlevisgan gansxvavebiT, xasiaTdeba
rigi upiratesobebiT. upirvelesyovlisa, kt-ze qsovilebis
identificireba SesaZlebelia miRebul iqnas maTi
simkvriveebis 0,5%-iani sxvaobisas, maSin, rodesac
rentgenografiisas es ukanaskneli SesaZlebelia miRebul
iqnas 15-20%-iani simkvrivuli sxvaobebisas (Beck J.C;
McClatchey K.D; Lesperanse M.M. 1995). amrigad, kompiuteruli
tomografia iZleva saSualebas miviRod, Zvlovani,
17
xrtilovani, kunTovani, cximovani da a.S. qsovilebis zusti
gamosaxuleba (De Capua B., Marler E. et al. 1993). ufro metic, misi
saSualebiT SesaZlebelia davadginod wiaRisa da
irgvlivmdebare anatomiuri organoebis
urTierTdamokidebuleba simsivnur procesTan mimarTebaSi
(Esclamado RM, Carey TE, Bredford CR 1996). da bolos, rac
yvelaze mniSvnelovania, kt uzrunvelyofs gamosaxulebis
sxvadasxva WrilebSi miRebas, paTologiuri kerebis azomvis
warmoebas da aucileblobis SemTxvevaSi maT gadidebas.
kompiuteruli tomografiis damTxveva klinikur
monacemebTan 80-90%-s Seadgens (Comba P., Battista G., Belli S. 1992).
ufro metic, Фрейтаг Ю. (1991) da Nanakawa S-as (1989) azriT
aRniSnuli meTodis gamoyenebiT judg(lu-ulc! vg\mg!
dcwdcezfic! hikxudcd! ara marto! gmvclk-icei vgeixulu-cd!
sazRvrebis!mgmvuzg, aramed!lcwbfic!segz(u-cd!wuogdogqfic!
mgqcgzu-cd!grwkyuzg9!
magram aRmoCnda, rom yovelive es exeba zeda ybis
gavrcelebul procesebs. rac Seexeba mcire zomis pirvelad
da recidiul simsivneebs, maTi diferencireba
irgvlivmdebare anTebiTi da rbili qsovilebidan, kt-s
meSveobiT xSirad problematuria, aseve gaZnelebulia maT
Soros sazRvrebis diferencirebac (Денисов Л.Е., Терновой С.К.
1981; Сдвижков А.М. 1983). wgvzcofi.iuqkzgzdflc! kvlevis
danergvis Semdeg SesaZlebeli gaxda aRniSnuli
naklovanebebis nivelireba, rac tgzgwumikeu! dgwumcxczk!
ounzklkvccd!fmcmud! miRwevad iqna miCneuli (Lund.V.J. 1983;
Приходько А.Г., Ефимцев Ю.П. 1992). es meTodi xasiaTdeba ufro
maRali diferencirebis unariT rbili qsovilebis
18
kvlevisas, mravalsibrtyivi gamosaxulebis miRebis
SesaZleblobiT, aseve artefaqtebisa da maionizirebeli
gamosxivebis ararsebobiT (Овчинников Ю.М., Добротин В.Е. 1997).
wgvzcofi.iuqkzgzdflc! kvleva gvaZlevs, gmgwcgzcd!
kivgzcqwcd! aramarto t\ulc! jiuu-cd! vgwkdg\flu-gd d\egmgd\eg!(bikzoglfic8!dgvcoglfic8!gndcglfic!mg!cic-c!
sibrtyeebi)! dc-io/uu-jc8! aramed uzrunvelyofs!kivgzku-cd!
wkxflk-ctc!iuskzdoifnxcfl kvlevasac (Vogl Th. et al. 1993).
ufro metic, wgvzcofi.iuqkzgzdflc! okwkvigbcflc!
vgwkdg\flu-u-c! wzcjezulkezgm! vgzd\egemu-g! skwhcfouifl.
okwkvigbcflc! seluecd! monacemebisagan (Пеньковсий Г.М.,
Пионтковская М.Б. 1996) aqedan gamomdinare, igi c(lueg!
dgjfglu-gd,! qfdogm! mgmvczmud! dcwdcezfic! �ndkeclcd!
dgqreiu-c.! kvlevis sxva meTodebTan SedarebiT! vggyzcg!
fhcigoudk-g, vgwkgelczkd! dcwdcezcd! jcmg! doifnofiu-c! (R.
Rochels; R. Bleier 1987), ufro metic, misi gamoyenebiT
SesaZlebelia juegbgdkt! kisris! lcwbfic! segz(u-cd!
wmvkwgiuk-g! mg! wgtc! mgwkscmu-flu-g! magistralur
sisxlZarRvebTan,! mgwgou-ctc! czoigeuzfic! skzoigdociu-cd!
vgiuju9 (Ольшанский В.О., Корниенко В.Н., Кицманюк З.Д. и др. 1995).
magram rogorc klinikurma dakvirvebebma gviCvenes,
magnitur-rezonansuli tomografia ver cvlis kompiuterul
tomografias. radgan kompiuteruli tomografia ufro meti
informaciis matarebelia Zvlovani qsovilebis
mdgomareobis SefasebaSi, xolo magnitur-rezonansuli
tomografia ki rbili qsovilebis (Oot R.F., Parizel P.M., Weber
A.L 1986). aRniSnul diagnostikur meTodTa kompleqsuri
gamoyeneba mniSvnelovnad amcirebs pacientTa gamovlenas
19
daavadebis dagvianebuli stadiebSi 93%-dan 71%-mde, rac
radikaluri mkurnalobis erTerT mTavar winapirobas
warmoadgens! (Погосов В.С., Корниенко В.Н., Акопян Р.Г., Талалаев
В.Н., Туркин А.М. 1989a9!am mxriv, aseve mniSvnelovania kisris
regionuli limfuri kvlanZebis mdgomareobis adeqvaturi
Sefaseba ultrabgeriTi kvlevis gamoyenebiT.!
rogorc klinikurma dakvirvebebma gviCvenes,
ultrasonografiuli meTodi iZleva saSualebas
gamovavlinoT arapalpirebadi kvanZebi, romlebSic
SemTxvevaTa 25%-Si metastazuri dazianebebi aRiniSneba. rac
Seexeba namkurnaleb avadmyofebs, es cifri mniSvnelovnad
izrdeba da aRwevs 35-40%-s (Graamans K., Slootweg P.J., Grau C.,
Harbo G., BunDgaard T., Overgaard M. et al. 1995). yovelive es
uflebas gvaZlevs vamtkicod, rom, zemodxsenebuli meTodi
metad mniSvnelovania zeda ybis simsivnuri daavadebis
gavrcelebis diagnostikaSi. Leicher da E. Duber-i (1990w)
azriT, miRebuli informaciis sarwmunoeba mniSvnelovnad
izrdeba ultrabgeriTi meTodis gamoyenebiT kompiuterul
da magnitur-rezonansul tomografiasTan kombinaciaSi.
mkurnalobis strategiis dagegmarebaSi gadamwyvet
rols citologiur da morfologiur kvlevebs aniWeben
(Bachaud JM, David JM, Boussin G, Cantu G., Solero S., Matvelly F., et al.
1994). magram, samwuxarod misi ganxorcieleba ZiriTadad
maSin aris SesaZlebeli, rodesac daavadeba tovebs haimoris
Rrus sazRvrebs da vrceldeba cxviris RruSi, gardamaval
naoWze, cxvirxaxaSi da a.S. (Chong V.F.H., Fun Y. 1997). sxva
SemTxvevaSi masalis mosapoveblad morfologiuri
kvlevisaTvis aucilebeli xdeba haimorotomiis warmoeba. es
20
ukanaskneli ki operaciul Carevas warmoadgens, rac
arRvevs limfuri drenirebis bunebriv gzebs da amis gamo
uaryofiT zegavlenas axdens mkurnalobis uSualo da
Soreul Sedegebze (Comba P., Battista G., Belli S. De Capua B., Marler
E. et al. 1992). aqedan gamomdinare, zeda ybis wiaRis
dcwdcezuu-cd! morfologiuri verifikaciisaTvis, bolo
wlebSi! ZiriTadad iyeneben zeda ybis gamonarecxi wylebis!
xcoklkvcfi! seluegs9! Петрова А.С. и Контрадиева Т.Т. (1983)!
\gqd! fdegwuz8! ikw! aRniSnuli kvlevis meTodi! gmeclcg!
judgdiflu-lgm8! fdgbit\kg! mg! wcdc! gamoyeneba!
judg(lu-ulcg! hklcslczcsfi! hcik-u-jcx! sc.! TviTon!
wutkmcd! mcgvzkdocsfic! judg(lu-lk-u-c! u{ed! gi! cpeued,!
magram! -ueigm! gicd! mgwkscmu-flc! gru-flc! wgdglcd!
\gicd\cgzk-gqu9! aqedan gamomdinare,! ud! wutkmc!
vgzdgsftiu-ct!wgjcz!gicd!vgwkdgmuvc8!ikmudgx!dgnwu!vegned!
mggegmu-cd! dgp/cd! dogmcu-tgz! •Ионадис Г.П.1966, Теодор И.Л. c
соавт. 1970a9!
rac Seexeba! pcgrcd! hfznxcgd, qkvc! dhuxcglcdoc!
fhcigoudk-gd!gzc{u-d!pcgrcd!hfznxccd!oigmcxcfl!wutkmd!
.! x\ecicd! neumg! dgeglcmgz! (Kjos B., DeGroot J., Brant-Zawadzki
1992)9!xolo!Dillon W.P. da Mills C.M-is azriT (1993w.) /eulgqu!
fbik! igxckzglfic! mg! zgslu-gm! oigewflcg! punqciis
warmoeba,! lk/g.gleuklgiflc! wkiycd! lkipkegzc! vgidcd!
zgk{cd!giumgz9!!
mTlianobaSi SegviZlia davaskvnad, rom!xcoklkvcfic!
seluecd! wutkmc8! ikwulcx! u/imzk-g! gochcfi! f^iumtg!
vgwkeluzgd8! juc(lu-g! pgiwgou-ct! vgwkec/uzkt! qumg! /-cd!
pcgrcd! sc-kd! diagnostikaSi.! mgvikeclc! vgwkxmclu-g!
21
fblu-gd! veg(lued! egwoscxkd,! rom! xcoklkvcfic! da!
morfologiuri! seluecd! tgzgwumikeu! mkzu! iZleva
saSualebas! albaTobis maRali xarisxiT! moxdes
axalwarmonaqmnis zusti histologiuri verifikacia8!
ikvkix! getecdu-cgzc8! gdueu! keTilTvisebiani simsivneebis
dros. aRniSnuli kvlevis gamoyenebiT SesaZlebelia
SemTxvevaTa 82-90%-Si sarwmuno diagnozis dadgena! da
Sesabamisad, mkurnalobis adeqvaturi taqtikis SemuSaveba
•Краевский Н.А., и соавт. 1993a9!
zeda ybis avTvisebiani simsivneebis mkurnaloba
SeiZleba iTqvas, rom warmoadgens erTerT rTul da jer
kidev gadauWrel problemas. erTis mxriv, es
ganpirobebulia haimoris Rrus agebulebis anatomiuri
TaviseburebebiT, xolo meores mxriv, misi ganlagebiT saxis
ConCxis siRrmeSi da uSualo siaxloviT iseT sasicocxlo
organoebTan, rogoric aris Tavis tvini, Tvalebi,
magistraluri sisxlZarRvebi da sxva. yovelive es
arTulebs, rogorc sxivuri energiis maqsimaluri dozebiT
gamoyenebas, aseve radikaluri operaciis warmoebas. magram
miuxedavad amisa, miRebuli Sedegebis efeqturobis analizi
gviCvenebs, rom bolo erTi saukunis ganmavlobaSi,
aRniSnuli daavadebis mkurnalobaSi miRweulia
mniSvnelovani progresi. gadarCenil avadmyofTa ricxvi 5%-
dan gaizarda 46%-mde. rac udaod teqnikurma progresma da
mkurnalobisadmi diferencialurma midgomam ganapiroba
(Aisen A.M., Martel. W., Braunstein E.M., Mcmillen K.I., Phillips W.A. 1986;
Atlas S.W., Grossman R.J., Gomori J.N., Guerry D., Hackney D.B. 1987;
Annis J.A., Phelps P.D., 1989; Antilia J., Sonnien P., Grenman R. 1993;
Шацкая Н.Х. 1993; Черекаев В.А. 1995; Сдвижков А.М. 1997).
22
avtorTa erT nawils miaCniad, rom (Юшманов В. Е., Янцев
В. И., Плющ А.Л., Соколова И.С., Горбачева Л.Б., Сибельдина Л.А.,
Эмануель Н. М. 1985) tele-gamaTerapia efeqturia da sruliad
sakmarisia rogorc mkurnalobis damoukidebeli meTodi
daavadebis I-II stadiebSi. meoreni ki (Tsujii H., Kamada T.,
Arimoto T. et al 1986) Tvlian, rom tele-gamaTerapia rogorc
mkurnalobis damoukidebeli meTodi, naklebefeqturia da
gamoiyenebul unda iqnas kombinirebuli mkurnalobis
pirvel etapze an paliatiuri mizniT inoperabelur
pacientebSi.
Ю. И. Воробьев-is da И. П. Саранцева-s azriT (1982w),
sxivuri Terapia zeda ybis wiaRis kibos dros efeqturia
maSin, rodesac gamoiyeneba dasxivebis adeqvaturi meTodika
da gaTvaliswinebulia simsivnis gavrceleba, misi zrdis
forma da morfologiuri struqtura. am avtorTa
monacemebiT 3 da 5 wlianma gamojansaRebam Sesabamisad 61
da 48 procenti Seadgina. isini aseve aRniSnaven eleqtiuri
radioTerapiis mizanSewonilobas dabaldiferencirebuli
avTvisebiani simsivneebis mkurnalobisas (Shibnya H., Horinhi J.,
Suzuki S. et al. 1984). J. Parsons-is mier (1988w), sxivuri meTodiT
namkurnaleb 42 avadmyofTan, 5 da 10 wliani gamojansaReba
miRebul iqna 52 da 30 procentSi.
P. Levendag-is da J. Pomp-is mier (1990w), namkurnalebi
iqna 63 avadmyofi, romlebsac aReniSnebodaT zeda ybis
brtyelujredovani kibo T1N0 (35 avadmyofi), T2N0 (24
avadmyofi) da T2N1 (4 avadmyofi) gavrcelebiT. 17 avadmyofis
dasxiveba (60-70gr) warmoebda garegani meTodiT, xolo 37-is
ki _ wiaRSida meTodiT. kisris eleqtiuri dasxiveba, jamuri
23
doziT 40gr, Cautarda 25 pacients. yvela avadmyofisaTvis 5
wlianma gamojansarebam 90% Seadgina, maTgan recidivis
niSnebis gareSe 80%-ma gadalaxa sicocxlis aRniSnuli
barieri. regionuli metastazebis arsebobis SemTxvevaSi
avtorebi mizanSewonilad miiCneven qirurgiul mkurnalobas.
rogorc klinikurma dakvirvebebma gviCvenes, sxivuri
Terapiis Sedegi didad aris damokidebuli simsivnis
morfologiur Senebaze (Shidnia H., Hornbak N., Saghafi N. et al.
1984). kerZod, sxivuri energiisadmi maRalmgrZnobiareni
arian limfoepiTeliomebi, limfosarkomebi, romlebic
sxivuri energiis arc Tu ise didi dozebiT mkurnalobis
Semdeg mTlianad alagdebian xolme. rac Seexeba
brtyelujredovan kibos da adenokarcinomebs, maT
samkurnalod ufro didi dozebia saWiro. xolo osteo,
qondro, fibro, sarkomebi TiTqmis rezistentulni arian
sxivuri energiis mimarT (Zinreich SJ, Kennedy DW, Kumar AJ,
Rosenbaum AE , Arington JA,Johns ME. 1988). nelamzardi
simsivneebi infiltrirebuli zrdiT ufro naklebad
emorCilebian sxivur Terapias, vidre swrafi zrdis mqone
egzofituri simsivneebi (Som P.M., Lidov M. 1994).
sxivuri mkurnalobis efeqturobis amaRlebis mizniT К.
Валуцкас-is da А. Шуминас-is mier 1986 wels, II-IV stadiis
mqone zeda ybis simsivneebiT daavadebul 45 avadmyofs
Cautarda tele-gama Terapia lokalur hiperTermiasTan
erTad. am dros aRiniSna im simsivnuri ujredebis
dazianebac ki, romlebic imyofebodnen hipoqsiur
mdgomareobaSi, anu is ujredebi, romlebic maqsimalurad
mdgradebi arian maionizirebeli gamosxivebis mimarT.
24
В. Г. Пинчук-ma (1989w) Seiswavla ra zeda ybis kibos
morfo-histoqimiuri Taviseburebebi, sxivuri TerapiiTa da
hiperTermiiT namkurnaleb avadmyofebSi, daaskvna, rom
hiperTermias mivyavarT simsivnuri ujredebis mniSvnelovan
dazianebebamde, rac ganpirobebulia ukuqcevadi
distrofiuli cvlilebebiT. am dros viTardeba, ujredSida
membranebisa da ujreduli organelebis
ultrastruqturuli organizaciis darRveva, SeboWili
cilovani, cilovan-lipiduri da nukleotiduri
kompleqsebis xarjze. rac xels uwyobs mkurnalobis
uSualo Sedegebis amaRlebas.
Г. Г. Кудрявцев-ma da В. О. Ольшанский-im (1991w) zeda ybis
avTvisebiani simsivneebiT daavadebul 52 avadmyofs Cautares
qimio-sxivuri mkurnaloba. dasxiveba xorcieldeboda
betatronis tipis aparatiT, velebis individualuri
SerCeviT, erTjeradi doziT 2gr, jamuri doziT 60gr-mde.
medikamentozuri mkurnalobisaTvis iyenebdnen
metotreqsats, xolo dabaldiferencirebuli simsivneebis
SemTxvevaSi vinkristins ciklofosfanTan erTad. simsivnis
sruli regresia aRiniSna 66,7%-Si. 3 wlianma sicocxlis
xangrZlivobam Seadgina 45%, xolo 5 wlianma _ 34,3%.
dReisaTvis zeda ybis avTvisebiani simsivneebis
samkurnalod sakmaod xSirad da efeqturad gamoiyeneba
platinis preparatebis da sxivuri Terapiis kombinacia:
bleocinTan, ciklofosfanTan da adriamicinTan, 5-
ftoruracilTan da sxv. yvela avtori, romlebic iyeneben
Serwymul mkurnalobas qimiopreparatebis CarTviT,
25
afiqsireben karg klinikur efeqts (Chobe R, McNeese M, Weber
R, Fletcher GH. 1988).
magaliTad, В. П. Бойков-i (1987w) aRniSnavs rom, mis mier
Catarebuli poliqimioTerapia platidiamis, metotreqsatis,
5-ftoruracilis da vinblastinis gamoynebiT, dadebiTad
aisaxa zeda ybis simsivneebis mkurnalobis efeqturobaze. 17
avadmyofidan man SesZlo 15 SemTxvevaSi mieRo simsivnis
srul regresia.
simsivnuri agresiis daTrgunvis mizniT,
poliqimioTerapias sxivur mkurnalobasTan erTad aseve
sakmaod efeqturad iyeneben inoperabelur pacientTa
samkurnalod (Blacklock JB, Weber RS, Lee YY, Goepfert H. 1989).
R. Errington-is mier (1986w), 43 zeda ybis kiboTi
daavadebuli avadmyofis sakmurnalod gamoyenebul iqna
radioTerapia swrafi neitronebiT. simsivnis sxvadasxva
xarisxis regresia miRweul iqna 86%-Si. sicocxlis
saSualo xangrZlivobam 33 Tve Seadgina, xolo 5 wliani
gamojansaReba 30%-s ar aRemateboda. J. Spiro-s monacemebiT
(1989w), 63 avadmyofTan mimarTebaSi, am maCvenebelma 43%
Seadgina. avtorebi xazs usvamdnen, swrafi eleqtronebiT
dasxivebis upiratesobas tele-gama TerapiasTan SedarebiT,
radganac am ukanasknelis saSualebiT SesaZlebelia
dozirebis sxvadasxva velebis miReba, rac uzrunvelyofs
simsivneze sxivuri energiis maqsimalur zemoqmedebas da
irgvlivmdebare jansaRi qsovilebis mniSvnelovan dacvas.
konservatuli Terapiis aradamakmayofilebeli
Sedegebi xSir SemTxvevaSi ganapirobebda qirurgiuli
26
Carevis aucileblobas. unda aRiniSnos, rom qirurgiuli
meTodi, gasuli saukunis ganmavlobaSi, zeda ybis kibos
mkurnalobis erTaderT ZiriTad meTodad gvevlineboda
(Glick JH, Marcial V, Richter M, Velez-Garcia E. 1980). mizanmimarTuli
kvlevebis safuZvelze ixveweboda sxvadasxva qirurgiuli
Carevis Cvenebebi, maTi masStabebi da Sesrulebis teqnika.
(Laramore GE, Scott CB, Schuller DE, Haselow RE, Ervin TJ 1992; Wheeler
R, Al-Sarraf M, Gahbauer RA, Jacobs JR, Schwade JG, Campbell BH. 1993;).
ramac, gasuli saukunis bolos, mniSvnelovnad aamaRla
gamojansaRebul pacientTa ricxvi (Gollin FF, Ansfield FJ,
Brandenburg JH, Ramirez G, Vermund H. 1972). Adelstein DL, Kalish LA,
Adams GL, Wagner H, Oken MM, Remick SC-is (1993w) azriT,
Soreuli Sedegebis mniSvnelovani mateba ganpirobebuli
iyo eleqtroqirurgiuli meTodis danergviT, igi
uzrunvelyofda sisxlZarRvebisa da limfuri sadinrebis
srulfasovan koagulacias, rac sagrZnoblad amcirebda
regionuli metastazebis da recidivirebis ganviTarebis
sixSires. eleqtroqirurgiul meTods aseve upiratesoba
eniWeboda rigi adgilobrivi garTulebebis
profilaktikaSic. kerZod, igi iZleoda saSualebas,
minimumamde dagveyvana sisxlis danakargi. xolo nervul
dabolovebebze Termuli zemoqmedebis Sedegad, operaciis
Semdgom periodSi Segvemcirebina tkivilis sindromi (Vlock
D, Anderson J, Whiteside T, Herbeman R, Kirkwood J, Adams G. 1994).
В. С. Погосова-s (1984) monacemebiT, zeda ybis kiboTi
daavadebul eleqtroqirurgiuli meTodiT namkurnaleb
pacientebSi 5 wlianma gamojansaRebam 33,5% Seadgina.
27
ufro maRali maCveneblebi moyavT B. Strohmann-s da K.
Haake-es (1991w), 235 eleqtroqirurgiuli meTodiT
namkurnalebi avadmyofidan, sicocxlis 5 wliani barieri
gadalaxa 41,2%-ma.
g. RoRelianis (1996w) mier, mxolod
eleqtroqirurgiuli meTodiT namkurnaleb zeda ybis
kiboTi daavadebuli 18 avadmyofidan sicocxlis 3 wliani
barieri gadalaxa 7 (38,9%).
miuxedavad miRweuli progresisa, zeda ybis
avTvisebiani simsivneebis qirurgiuli meTodiT
mkurnalobaSi mravali avtori upiratesobas mainc
kombinirebul meTods aniWebs. jer kidev, 1933 wels L. Ohgren-
is da G. Holmgren-is mier pirvelad moxda
eleqtroqirurgiisa da sxivuri Terapiis Serwyma, ramac
isini im droisaTvis gansacvifrebel Sedegebamde miiyvana.
orwlianma gamojansaRebam 44-46%-s miaRwia.
kombinirebuli meTodis SemuSavebis da srulyofis
periodSi xdeboda sxivuri Terapiisa da operaciuli
Carevis gansxvavebuli Tanmimdevrobebis Seswavla. L. Larsson,
G. Maptensson, S. Gastigliano da C. Rominger-is dakvirvebebiT
(1954w) operaciamdeli dasxivebis gamoyenebisas 5 wlianma
gamojansaRebam 45-47%-s miaRwia.
kombinirebul mkurnalobaSi sxivuri Terapiis I etapze
gamoyenebis momxreebi aRniSnaven, rom sxivuri energia
uzrunvelyofs simsivnuri ujredebis biologiuri
aqtiurobis daTrgunvas, axalwarmonaqmnis zomebSi
Semcirebasa da Tanmxlebi anTebiTi procesebis moxsnas, rac
28
qmnis xelsayrel garemos operaciuli CarevisaTvis.
specialistebi, romlebic emxrobian sxivuri Terapiis II
etapze gamoyenebas Tvlian, rom igi mizanmimarTulia
saoperacio velSi SesaZlod darCenili simsivnuri
ujredebis ganadgurebaze.
A. Karimel-is (1990w) mier namkurnalebi iqna zeda ybis
kiboTi daavadebuli 45 pacienti. maT umravlesobas
CautardaT zeda ybis gafarToebuli operacia momdevno
distainciuri an (65gr 7 kviris ganmavlobaSi) wiaRSida
dasxivebiT, es ukanaskneli gamoiyeneboda 10 kviris
ganmavlobaSi da kerovani doza Seadgenda 82 gr-s. 5
wlianma gamojansaRebam 68% Seadgina. literaturaSi aseve
moipoveba calkeuli monacemebi pre, an postoperaciuli
dasxivebis Sesaxeb (Емельянов А.А. 1978; James T. et. al. 1988).
magram am meTodebis efeqturobis Sefaseba metad rTulia
dakvirvebebisa da publikaciebis simciris gamo.
Tumca bolo wlebis sazRvargareTul publikaciebSi
gamoCnda monacemebi sxivuri, qirurgiuli, kombinirebuli da
kompleqsuri mkurnalobebis efeqturobis Sesaxeb, romelTa
Sedegebsac isini procesis lokalizacias, daavadebis
gavrcelebasa da morofologiur struqturasTan
urTierTkavSirSi ganixilaven. W. Mann-is da C. Schuler-Vaith-is
(1983w) mier namkurnalebi 138 avadmyofidan, 22 –pacients
Cautarda qirurgiuli mkurnaloba, 64-s _ operacia da
dasxiveba, 20-s dasxiveba, xolo 12 avadmyofs ki operacia +
dasxiveba + qimioTerapia. 3 da 5 wlianma gamojansarebam 55
da 52 procenti Seadgina.
29
B. Hintz-ma da Tanaavtorebma (1984w) zeda ybis kiboTi
daavadebul 27 pacientis samkurnalod 14 SemTxvevaSi
gamoiyenes sxivuri Terapia, 10-Si dasxiveba da Semdgomi
operaciiT. 3 avadmyofs ki Cautarda operaciis Semdgomi
maionizirebeli dasxiveba jamuri doziT 70gr. aRniSnul
jgufSi 5 wlianma gamojansarebam 28, 60 da 33 procenti
Seadgina, miRebuli Sedegebidan naTlad Cans kombinirebuli
meTodis upiratesoba operaciamdeli dasxivebis gamoyenebiT.
J. Parsons-ma da misma Tanaavtorebma (1984w) awarmoes 48
pacientis mkurnaloba sxivuri da kombinirebuli meTodebis
gamoyenebiT. mxolod sxivuri Terapia gamoyenebul iqna 42
avadmyofTan, xolo kombinirebuli ki – 6 pacientTan. 10
wliani gamojansaReba I stadiis dros mirebul iqna 100%-Si,
xolo II da III stadiebis dros, 53 da 30 procentSi
Sesabamisad.
Glick JH, Marcial V, Richter M, Velez-Garcia E.-is (1990w) azriT,
kombinirebuli mkurnalobis Soreuli Sedegebi arc Tu ise
saxarbieloa da daaxloebiT 49%-s Seadgens. magram
miuxedavad am maCveneblisa, is mainc erTerT efeqtur
meTodad rCeba.
N. Nopkin-ma da Tanaavtorebma (1984w) 561 zeda ybis
kiboTi daavadebul pacients umkurnales sxvadasxva
meTodebis gamoyenebiT. am avtorTa monacemebiT, dasxivebisa
da operaciis kombinacia winamorbedi qimioTerapiis
gamoyenebiT, yvelaze efeqturi aRmoCnda. 5 wlianma
gamojansaRebam brtyelujredovani kibos dros 37,5%
30
Seadgina, xolo adenokarcinomas dros am ricxvma 47%-s
miaRwia.
yvela avtori aRniSnavs, rom zeda ybis kibos
mkurnalobis warumateblobis ZiriTad mizezs recidivebi
warmoadgenen, romelTa warmoqmnis sixSirec 58-80%-s
Seadgens. simsivnis recidivebi, rogorc wesi, viTardeba
mkurnalobis dasrulebidan pirveli 2 wlis ganmavobaSi. H.
Thiel-i da G. Pettinger-i (1986w) aRniSnaven, rom simsivnis
lokalizaciisas zeda-ukana naxevarSi recidivebis
raodenobam SesaZloa 71%-s miaRwios, maSin, roca wiaRis
qveda-wina naxevarSi lokalizaciisas maTi ricxvi 28%-s ar
aRemateba. recidivebis 76% gamovlindeba mkurnalobis
damTavrebidan erTi wlis ganmavlobaSi. mogvianebiTi
recidivebis raodenoba Zalzed mcirea da ar aRemateba 2,5%-
s. Browman GP, Goodyear MD, Levine MN, Russell R, Archibald SD, Young
JE.-s (1990w) azriT, avadmyofTa did kontingentSi recidivebi
viTardeba 1 wlis ganmavlobaSi, aqedan didi nawili pirvel
6 TveSi.
SedarebiT xSirad recidivireben adgilobrivad
gavrcelebuli simsivneebi, romlebic lokalizdebian saxis
ConCxis zeda sarTulebSi (Browman GP, Levine MN, Russell R,
Young JE, Archibald 1987). P. Zbaren-is monacemebiT (1987w) metad
mZime prognoziT xasiaTdeba SemTxvevebi, rodesac adgili
aqvs simsivnis gavrcelebas cxavis Zvalsa da frTa-sasis
fosoSi. aRniSnuli avadmyofebis 3 wliani gamojansaReba ar
aRemateba 19%-s. aseve agresiuli mimdinareobiT gamoirCeva
simsivneebi, romlebic vrceldebian frTasasis fosoSi,
solisebr wiaRSi da orbitaSi. (Chang H, Leone L, Tefft M, Nigri
31
PT 1988). zeda ybis wiaRis kibos recidivebi SemTxvevaTa 50-
93%-Si gvxvdeba (Bowman GP, Cripps C, Hodson DI, et al. 1994).
recidivebis aseTi maRali sixSire ganpirobebulia simsivnis
gavrcelebiT mniSvnelovan sasicocxlo organoebze, rac
praqtikulad SeuZlebels xdis radikaluri operaciis
warmoebas (Brachman DG, Graves D, Vokes E, Beckett M, Haraf D, Motag
A, Dunphy E, Mick R, Yandell D, Weichselbaum RR. 1992).
rac Seexeba haimoris Rrus avTvisebiani simsivneebis
mkurnalobis Semdgomi regionuli metastazebis warmoSobas,
mravali avtoris monacemebiT igi ar aRemateba 18-20%-s.
(Cognetti F, Carlini P, Pinnaro P, Ruggeri EM, Perrino A, Del Vecchio MR,
Ambesi Impiombato F, Calabresi F. 1989). maTgan regionuli
metastazebis 90-95% aReniSnebaT brtyelujredovani kiboTi
daavadebul, procesis III-IV stadiis gavrcelebis mqone
avadmyofebs (Dalley D, Beller E, Aroney R, et al 1995).
rac Seexeba zeda ybis avTvisebiani simsivneebis
Soreul metastazirebas, ZiriTadad metastazireben
acinozurujredovani (cilindroma) kibo da araepiTeluri
warmoSobis simsivneebi (Gasparini G, Recher G, Favretto S, Visona A,
Bevilacqua P, Del Fior S. 1989). mTlianobaSi, SegviZlia avRniSnod,
rom regionuli da Soreuli metastazebis ganviTareba
mniSvnelovnad aris damokidebuli pirveladi simsivnis
recidivebis warmoqmnasa da maT gavrcelebaze. rogorc
wesi, aRniSnuli jgufis pacientebi warmoadgenen
praqtikulad uperspeqtivo avadmyofta jgufs, romelTa
gadarCenis Sansi ar aRemateba 0-2%-s da
pirdapirdamokidebulebaSia simsivnis mgrZnobelobaze,
32
gamoyenebul qimiopreparatebis mimarT (Goldsweig HG,
Sundaresan N. 1990).
amrigad, warmodgenili masalidan naTlad Cans, rom
miuxedavad mniSvnelovani klinikuri gamocdilebisa, jer
kidev ar aris dasabuTebulad warmodgenili erToblivi
koncebcia zeda ybis kibos mkurnalobis Sesaxeb daavadebis
mimdinareobis, morfologiuri Senebis da sxva klinikur
TaviseburebaTa gamovlinebis gaTvaliswinebiT.
Tu gaviTvaliswinebT im faqts, rom zeda ybis kiboTi
daavadebul pacientTa umravlesoba, mimarTavs
specializirebul dawesebulebebs adgilobrivad
gavrcelebuli procesebiT maSin, rodesac simsivne tovebs
haimoris wiaRs da vrceldeba: loyis rbil qsovilebze,
frTisebr kunTebze, yvrimalis Zvalze, TvalbudeSi,
ZiriTadi Zvlis frTasasis morCze, cxviris RruSi,
frTasasisa da safeTqlis fosoebSi, cxvirxaxaSi an
mopirdapire zeda ybaSi, ar arsebobs konkretuli
rekomendaciebis erToblioba, romelTa Tanmimdevruli
Sesruleba mniSvnelovnad aamaRlebda mkurnalobis
efeqturobas.
samwuxarod ar iyo dasmuli sakiTxi imis Sesaxeb, Tu
romeli kliniko-morfologiuri maxasiaTeblebis
erToblioba ganapirobebs mkurnalobis tradiciuli
meTodebis gamoyenebis SemTxvevaSi damakmayofilebeli, an
aradamakmayofilebeli Sedegebis miRwevas da aqedan
gamomdinare, zemoqmedebs daavadebis gamosavalsa da
prognozze. CvenTvis xelmisawvdom literaturaSi, aseve ver
iqna moZiebuli sistematizirebuli monacemebi mkurnalobis
33
34
individualuri sqemebis da taqtikis arCeva_SemuSavebaze
simsivnis sxvadasxva parametrebis gaTvaliswinebiT. aseTi
individualuri midgoma TiToeul avadmyofTan, xels
Seuwyobs mkurnalobis efeqturobis amaRlebas.
Cvens mier xelmisawvdom literaturaSi, aseve ver
SevxvdiT monacemebs romlebic gamoiyeneba daavadebis
recidivebis SemTxvevaSi da moqmedebs profilaqtikurad am
problemis Tavidan asacileblad.
Tavi II
kvlevis masalebi da meTodebi
naSromi dafuZnebulia haimoris wiaRis kiboTi
daavadebuli 146 avadmyofis kliniko-morfologiuri
niSnebis analizze, romlebsac CautardaT mkurnaloba
saqarTvelos prof. a. RvamiCavas saxelobis onkologiis
nacionaluri centris Tav-kisris simsivneebis
ganyofilebaSi 1985-2000 wlebSi.
yvela avadmyofs mkurnalobis dawyebamde zogad
klinikur gamokvlevebTan erTad, rogorc wesi,
utardebodaT cxviris savalisa da cxvirxaxis fibroskopia,
zeda ybis wiaRebis rentgenografia. 60 SemTxvevaSi
aRniSnul kvlevebTan erTad ganxorcielebul iqna
kompiuteruli tomografia, xolo 25-Si magnitur-
rezonansuli tomografia. daavadebis verifikaciisaTvis
viyenebdiT citologiur da morfologiur kvlevis
meTodebs. kisris limfuri kvanZebis mdgomareobis Sefasebis
mizniT avadmyofebs uterdebodaT eqoskopia, xolo
metastazur dazianebaze eWvis mitanisas vatarebdiT
magnitur-rezonansul tomografiasa da dazianebuli
kvanZebis citologiur gamokvlevas. miRebuli informacia
gadagvqonda Cvens mier SemuSavebul ruqa-kodifikatorze,
rac iZleoda Semdgomi statistikuri damuSavebis
saSualebas.
35
cxrili #1
haimoris Rrus avTvisebiani simsivneebiT daavadebul avadmyofTa
ganawileba asakisa da sqesis mixedviT
mamakaci qali sul asaki
wlebSi avadmyofTa
raodenoba %
avadmyofTa
raodenoba %
avadmyofTa
raodenoba %
10-20 2 2,15 1 1,9 3 2,.05
21-30 3 3,22 5 9,4 8 5,47
31-40 10 10,75 6 11,3 16 10,95
41-50 17 18,27 3 5,66 20 13,69
51-60 20 21,5 11 20,75 31 21,23
61-70 19 20,4 15 28,3 34 23,28
71-80 18 19,5 11 20,75 30 20,54
81-90 3 3,22 2 3,7 5 3,42
sul 92 63 54 37 146 100
aRsaniSnavia, rom 146 pacientidan 92(63%) mamakaci iyo,
xolo 54(37%) ki _ qali. avadmyofTa ganawileba sqesisa da
asakis mixedviT warmodgenilia cxril#1-Si.
rogorc warmodgenili masalidan Cans, zeda ybis
wiaRis avTvisebiani simsivneebiT ufro xSirad avaddebian
kacebi, vidre qalebi. aRniSnuli paTologia ZiriTadad
gvxvdeba 50 wlis zeviT praqtikulad Tanabrad orive sqesis
warmomadgenlebSi.
Catarebuli morfologiuri (citologia da
histologia) kvlevis Sedegad 90 SemTxvevaSi
diagnostirebul iqna brtyelujredovani kibo, maT Soris
maRaldiferencirebuli brtyelujredovani kibo _ 60
SemTxvevaSi, saSualo diferenciaciis _ 12 SemTxvevaSi,
xolo dabaldiferencirebuli _ 18 SemTxvevaSi. 19
36
avadmyofs daudginda adenokarcinomas diagnozi, xolo 23
avadmyofs gamouvlinda cilindrulujredovani kibo.
cxrili #2
zeda ybis wiaRis avTvisebiani simsivneebis morfologiuri
daxasiaTeba
histomorfologiuri struqtura avadmyofTa
raodenoba
% Sefaredeba
avadmyofTa
saerTo
raodenobasTan
epiTeluri simsivneebi
brtyelujredovani karcinoma
adenokarcinoma
cilindroma
132
90
19
23
90,4%
61,7%
13,1%
15,75%
araepiTeluri simsivneebi
limfosarkoma
angio, qondro da osteosarkoma
14
9
5
9,6%
6,2%
3,4%
avadmyofTa jamuri raodenoba 146 100
rac Seexeba araepiTeluri warmoSobis simsivneebs,
isini diagnostirdnen 14 SemTxvevaSi. maTgan limfosarkoma
gamouvlinda 9 avadmyofs, xolo angio, qondro da
osteosarkomebi 5 avadmyofs. avadmyofTa ganawileba
simsivnis morfologiuri Senebis mixedviT warmodgenilia
cxrilSi #2.
kvlevis procesSi, zeda ybis wiaRis kibos
gavrcelebadobis gansasazRvrad, Cvens mier gamoyenebul
iqna TNM klasifikacia, romelic SemuSavebul iqna kibos
saerTaSoriso kavSiris (UICC) mier 2002 wels da farTo
gamoyenebas hpovebs msoflios wamyvan onkoklinikebSi.
37
TNM klasifikacia
T _ pirveladi simsivne
Tx _ arasakmarisi monacemebi pirveladi simsivnis
Sesafaseblad
T0 _ pirveladi simsivne ar gamovlindeba
Tis _ preinvaziuri karcinoma (carcinoma in situ)
T1 _ lorwovani garsiT Semofargluli simsivne, Zvlis
eroziis da destruqciis gareSe.
T2 _ simsivne iwvevs Zvlis erozias an destruqcias magar
sasaze da/an cxviris Suasavalze gavrcelebis CaTvliT,
magram ar gadadis zeda ybis wiaRis ukana kedelze da
frTisebr firfitaze.
T3 _ simsivne gavrcelebulia: zeda ybis wiaRis ukana
kedlis Zvlovan nawilze, kanqveSa qsovilebze, Tvalbudis
fskerze an Sua kedelze, frTisebr fosoze, cxavis
wiaRebze.
T4a _ simsivne Cazrdilia Tvalbudis wina struqturebSi,
loyis kanSi, frTisebr firfitaSi, safeTqelqveSa fosoSi,
dacxrilul firfitaSi, solisebr an Sublis wiaRebSi.
T4b _ simsivne Cazrdilia Tvalbudis zeda kideSi, tvinis
magar garsSi, Tavis tvinSi, qalas Sua fosoSi, qala-tvinis
nervebSi (garda samwvera nervis V2 totisa), cxvir-xaxaSi,
qalasfuZeze.
38
N _ regionuli limfuri kvanZebi, M _ Soreuli metastazebi
NX _ regionuli limfuri kvanZebis Sesafaseblad sakmarisi
monacemebi ar aris.
N0 _ ar aris metastazuri dazianebis niSnebi regionul
limfur kvanZebSi.
N1 _ metastazi mxolod erT regionul limfur kvanZSi,
zomiT araumetes 3sm-sa simsivnuri dazianebis mxares.
N2 _ metastazi mxolod erT regionul limfur kvanZSi,
zomiT 3sm-dan 6sm-mde simsivnuri dazianebis mxares; an
metastazi ramodenime limfur kvanZSi zomiT 6sm-mde
simsivnuri dazianebis mxares; an 6sm-mde zomis metastazi
limfur kavZebSi ormxrivad an kontrlateralurad.
N2a _ 3sm-dan 6sm-mde zomis metastazi erT regionul
limfur kvanZSi, dazianebis mxares.
N2b _ 6sm-mde zomis metastazi ramodenime regionul
limfur kvanZSi, dazianebis mxares.
N2c _ 6sm-mde zomis metastazi limfur kavZebSi, ormxrivad
an kontrlateralurad.
N3 _ 6sm-ze meti zomis metastazi limfur kvanZSi.
MX _ Soreuli metastazis Sesafaseblad sakmarisi
monacemebi ar aris.
M0 _ Soreuli metastazebis arsebobis niSnebi ar aris.
M1 _ aRiniSneba Soreuli metastazi.
39
TNM klasifikaciis mixedviT 146 avadmyofidan T1
gavrcelebis simsivne gamovlenil iqna mxolod 4 (2,74%)
avadmyofSi, T2 gavrcelebis _ 23-Si (15,7%), T3 daudginda _ 59
(40,4%) avadmyofs, xolo T4 ki _ 60 (41%) pacients.
avadmyofTa ganawileba TNM klasifikaciis mixedviT
mowodebulia cxrilSi #3.
cxrili #3
avadmyofTa ganawileba sqesisa da TNM klasifikaciis mixedviT
kaci qali sul
TNM
raodenoba
% raodenoba % raodenoba %
T1N0M0 3 3,26 1 1,85 4 2,74
T2N0M0 15 16,3 8 14,8 23 15,7
T3N0M0 26 28,3 24 44,5 50 34,2
T3N1M0 4 4,35 3 5,6 7 4,8
T3N2M0 1 1,1 1 1,85 2 1,37
T4N0M0 29 31,5 18 33,4 47 32,2
T4N1M0 6 6,5 1 1,85 7 4,8
T4N2M0 4 4,35 1 1,85 5 3,4
T4N3M0 1 1,1 _ 1 0,68
sul 92 63 54 37 146 100
zeda ybis rTuli anatomiuri agebulebis gamo TNM
klasifikacia ar iZleva srulyofil warmodgenas simsivnis
gavrcelebis Sesaxeb. amisaTvis Cvens mier TNM
klasifikaciis paralelurad gamoiyeneboda РАМН РОНЦ-s
40
mier 1985 wels dadgenili simsivnis gavrcelebis
stadiurobis ganmsazRvreli klasifikacia.
I stadia _ simsivne moicavs haimoris Rrus erT
kedels, lorwovans, axlomdebare anatomiuri midamoebis
dazianebis gareSe da ar iwvevs Zvlovani kedlis
destruqcias. metastazebi ar isinjeba.
II stadia _ a) simsivne gadazrdilia haimoris Rrus
meore kedelze, azianebs ra Zvlovan kedels ar gadis Rrus
farglebs gareT. regionuli metastazebi ar isinjeba. b)
simsivne dazianebis igive xarisxiT, magram isinjeba
erTeuli regionuli metastazi.
III stadia _ a) simsivne Cazrdilia axlomdebare
anatomiuri midamoebSi (cxviris RruSi, TvalbudeSi, sasaze
da sxv.) scildeba Zvlovani kedlis farglebs an gadadis
meore haimoris Rruze. regionuli da Soreuli metastazebi
ar isinjeba. b) igive stadiis simsivne an simsivne
adgilobrivi dazianebis naklebi xarisxiT, magram
mravlobiTi regionuli metastazebiT simsivnuri dazianebis
mxares, an ormxrivi regionuli metastazebiT.
IV stadia _ a) simsivne romelic vrceldeba qalas
fuZeze, cxvirxaxaze an saxis kanze Zvlovani qsovilis
farTe destruqciiT, magram regionuli da Soreuli
metastazebis gareSe. b) nebismieri stadiis simsivne uZravi
regionuli metastazebiT. c) nebismieri stadiis simsivne
Soreuli metastazebiT.
41
rac Seexeba 146 avadmyofis ganawilebas stadiis
mixedviT, igi warmodgenilia Semdegnairad: I stadia 4
avadmyofi, II stadia 23 avadmyofi, III stadia 59 avadmyofi da
IV stadia 60 avadmyofi. aRniSnuli ganawileba mocemulia
cxrilSi #4.
cxrili #4
avadmyofTa ganawileba stadiebis mixedviT.
kaci qali sul stadiuroba
raodenoba % raodenoba % raodenoba %
I stadia 1 25 3 75 4 2,74
II stadia 14 60,8 9 39,2 23 15,7
III stadia 35 59,3 24 40,7 59 40,4
IV stadia 39 65 21 35 60 41
sul 92 63 54 37 146 100
zeda ybis kibos mimdinareobis agresiulobis L. Ohngren
_ is dayofis mixedviT avadmyofebi Semdegnairad
gadanawildnen: zeda _ ukana naxevari 21 (14,4%) avadmyofi,
qveda _ wina naxevri 14 (9,6%) pacienti, xolo danarCen 111
(76%) SemTxvevaSi simsivnis warmoqmnis pirveladi keris
dadgena ver moxerxda adgilobrivad gavrcelebuli farTe
dazianebebis gamo.
Catarebuli klinikuri da eqoskopiuri kvlevebis
Sedegad 146 pacientidan 22-s gamouvlinda regionuli
metastazebi, aqedan erTeuli _ 14 SemTxvevaSi, mravlobiTi
_ 7 SemTxvevaSi, ormxrivi regionuli metastazebi
diagnostirebul iqna 1 SemTxvevaSi. maT Soris 3 sm-mde
zomis 12 SemTxvevaSi da 3 sm-ze meti zomis 10 SemTxvevaSi.
42
daavadebis morfologiuri formidan da gavrcelebidan
gamomdinare Cvens mier mkurnalobis pirvel etapze
gamoyenebul iqna Semdegi meTodebi: qimio-sxivuri
mkurnaloba 44 (30,13%) SemTxvevaSi, xolo 87 (59,6%)
avadmyofs ki mkurnalobis I etapze Cautarda mxolod
sxivuri Terapia.
qimio-sxivuri Terapia warmoadgens tele-gama Terapiisa
da qimioTerapiis kombinacias. igi upiratesad gamoiyeneba
brtyelujredovani da araepiTeluri avTvisebiani
simsivneebis dros, romlebsac gaaCniaT daavadebis
arsebobis xanmokle anamnezi da adgilobrivad
gavrcelebuli farTo dazianebebi.
haimoris wiaRis avTvisebiani simsivneebiT daavadebuli
pacientebi namkurnalebi iqnen sxvadsxava qimioTerapiuli
sqemebiT, rac ganpirobebuli iyo maTi morfologiuri
SenebiT.
brtyelujredovani kibos dros viyenebediT Semdeg
sqemebs:
1. I dRes intravenurad, wveTovnad, hiperhidrataciis
fonze Segvyavda cisplatini 100mg,
2. bleomicini 15mg 1, 3 da 5 dRes intravenurad bolusiT,
3. ftoruracili doziT 500mg 1, 2, 3, 4, 5 dRes 1sT-iani
intravenuri infuziiT.
1. I dRes karboplatini 300mg intravenurad wveTovnad.
2. bleomicini 15mg 1, 3 da 5 dRes intravenurad bolusiT.
3. ftoruracili 500mg 1, 2, 3, 4, 5 dRes 1sT-iani
intravenuri infuziiT.
43
araepiTeluri simsivneebis dros viyenebdiT ACOP-is
sqemas:
1. I dRes ciklofosfani 1000mg intravenurad, wveTovnad;
2. I dRes doksorubicini 70mg intravenurad, wveTovnad;
3. II, III dRes vinkristini 2mg intravenurad bolusiT;
4. I, II, III, IV, V dRes prednizoloni 60mg per os miReba.
tele-gama Terapia xorcieldeba «РОКУС М АГАТ-РС
КОБАЛТ-60»-is tipis aparatiT, ori Semxvedri veliT (wina
da gverdiTi), romelTa zoma varirebda 7X9 sm da
damokidebuli iyo simsivnuri dazianebis zomebze. rac
Seexeba TviTon procedurebs, tardeba yoveldRe, kviraSi 5
dRe, sadac dRiuri doza ar aRemateba 2 gr-s; xolo jamuri
doza ki _ 70-74gr-s odenobas. regionuli
metastazirebisas dasxiveba xorcieldeboda erTi mTliani
veliT, romlis zomebic daaxloebiT 11X10 da 12X10sm-s
Seadgenda, xolo jamuri doza ki 60-64gr-s.
aseve aRsaniSnavia, rom 15 avadmyofTan mimarTebaSi
mkurnalobis I etapze gamoyenebul iqna qirurgiuli Careva,
raTa mcire simsivnuri dazianebebis dros, rodesac
garTulebuli iyo daavadebis citologiuri diagnostika,
mogvexdina trepanirebuli wiaRidan aRebuli biofsiuri
masalis swrafi histomorfologiuri verificireba.
daavadebis verificirebis Semdgom, simsivnuri procesis
zomisa da lokalizaciidan gamomdinare, Cvens mier
gamoyenebuli iqna, rogorc zeda ybis nawilobrivi, aseve
totaluri eleqtrorezeqcia am avadmyofebTan mimarTebaSi.
44
konservatuli mkurnalobis efeqturoba ganisazRvreboda
uSualo SedegebiT, romlebic Semdeg kriteriumebad daiyo:
• sruli efeqti _ simsivnis 100%-iani regresia;
• nawilobrivi efeqti _ simsivnis regresia 50 da meti
procentiT;
• efeqtis gareSe _ simsivnis regresia 50%-de an
simsivnis zomebSi momateba.
Catarebuli konservatuli mkurnalobis Semdeg simsivnis
regresiisas 50% da meti avadmyofebs ugrZeldebodaT
sxivuri, an qimio-sxivuri mkurnaloba (sxivuri 70-74gr,
xolo qimioTerapia 5-6 kursamde). simsivnis sruli
eliminaciis SemTxvevaSi pacientebi gadagvyavda dinamiuri
dakvirvebis qveS.
konservatuli mkurnalobis araefeqturi, an arasruli
efeqtis SemTxvevaSi 3-5 kviris gasvlis Semdeg vawarmoebdiT
qirurgiul Carevas, romlis masStabic damokidebuli iyo
simsivnuri procesis gavrcelebasa da limfuri kvanZebis
mdgomareobaze. zeda ybis nawilobrivi eleqtrorezeqcia
Cautarda 3 (4,5%) avadmyofs; 14 (21,2%) pacients Cautarda
zeda ybis tipiuri eleqtrorezeqcia; gafarToebuli
operacia (orbitis ekzenteracia, yvrimalis Zvlis rezeqcia,
frontaluri wiaRis rezeqcia da a.S.) gamoyenebul iqna 40
(60,6%) SemTxvevaSi; xolo gafarToebul-kombinirebuli
operaciebi 9 (13,7%) SemTxvevaSi.
zeda ybis eleqtrorezeqciis gansaxorcieleblad
viyenebdiT veberis ganakveTs (sur. 17), romlis drosac
saxeze ikveTeboda kani, kanqveSa da kunTovani qsovilebi
45
Zvlamde. amis Semdgom xdeba kan-kunTovani nafleTis
aSreveba zeda da gareTa mimarTulebiT, zeda ybis wina
kedlis gaSiSvlebamde. kan-kunTovan- lorwovani nafleTis
mobilizaciis Semdeg eleqtrodanis saSualebiT xdeba
magari da rbili sasis lorwovan garsze, Sua xazidan rbil
sasamde saoperacio velis moniSvna (sur. 18). kbilebis
eqstraqciis Semdeg, bipolarebis saSualebiT vaxdenT zeda
ybis magari da rbili qsovilebis eleqtro nekrozs, ris
Semdegac xorcieldeba am qsovilebis mocileba sakvneti
maSebis gamoyenebiT.
sur. 17. veberis ganakveTi
sur. 18. zeda ybis sarezeqcio velis moniSvna sasaze eleqtrodanis
gamoyenebiT.
46
rogorc wesi, zeda ybis simsivneebis SemTxvevaSi
kisris limfuri kvanZebis profilaqtikuri amokveTa ar
xorcieldeboda, igi warmoebda mxolod realizebuli
metastazebis arsebobisas. kombinirebul-gafarToebuli
operaciebisas zeda ybis rezeqciis sazRvrebi damokidebuli
iyo simsivnis gavrcelebis sazRvrebze, xolo kisris
limfadeneqtomiis tipi ki, arsebuli metastazebis
lokalizaciaze.
qirurgiuli mkurnalobis efeqturoba ganisazRvreboda
2 da 5 wliani gamojansaRebiT.
mTeli informacia _ daavadebis mimdinareobis,
morfologiuri Senebis, procesis gavrcelebis,
metastazirebis, konservatiuli mkurnalobis,
ganxorcielebuli operaciebis masStabebis da mkurnalobis
Sedegebis Sesaxeb, gadagvqonda Cvens mier Seqmnil
specialur ruqa-kodifikatorebze. ruqa-kodifikatorebi
SemdgomSi eqvemdebarebodnen statistikur damuSavebas da
SesaZlebels xdidnen Segveswavla mTeli kliniko-
morfologiuri monacemebis ganawileba klinikurad
gamojanmrTelebul da daavadebis progresirebis gamo
gardacvlil pacientTa jgufebs Soris. es iZleoda
saSualebas gamogveyo informatiuli niSnebi, romlebic
mniSvnelovan zegavlenas axdenen mkurnalobis
efeqturobaze da statistikurad dagvedgina Cvens mier
gamoyenebuli mkurnalobis meTodebis efeqturoba.
aRniSnuli kvlevisaTvis Cvens mier gamoyenebul iqna
statistikuri kvlevis Semdegi meTodebi: klasteruli
analizi da logariTmul-wrfivi analizi.
47
klasteruli analizis mizania mravali niSan-Tvisebis
mqone obieqtTa erTobliobis dayofa msgavs (erTgvarovan)
obieqtTa klasebad (klasterebad). formalizebuli saxiT
klasteruli analizis amocana Semdegnairad Caiwereba:
gvaqvs {Gi} i=1n obieqti, romelTaganac TiToeuli
xasiaTdeba Xj parametriT, j – parametris nomeria. calkeuli
parametri axasiaTebs obieqtis raRac garkveul
Tvisobriobas, magaliTad simsivnis morfologiuri Seneba,
gavrceleba mimdebare anatomiur struqturebze, asaki da a.
S. obieqtTa msgavsebis raodenobrivi SefasebisaTvis
SemoaqvT maT Soris manZilis, anu metrikis cneba:
magaliTad evklides sivrceSi igi Seesabameba wertilebs
Soris Cveulebriv geometriul manZils – evklides metrikas
da gamoisaxeba Semdegi formuliT:
2/1
1
2)(),( ⎥⎦
⎤⎢⎣
⎡−= ∑
=
M
J
JK
JIKI XXGGD
sadac da dekartis koordinatTa sistemaSi I da K
wertilebis koordinatebia.
JIX J
KX
Cven mier gamoyenebuli obieqtTa klasterizaciis k-
saSualoTa meTodi ganekuTvneba iteraciuli
klasterizaciis meTods – meTodi pirvel iteraciaze yofs
obieqtTa simravles winaswar gansazRvrul k-raodenoba
klasterad, iTvlis klasterebs Soris msgavsebis xarisxs
SerCeuli metrikis gamoyenebiT. meore iteraciaze
garkveuli obieqti gadaaqvs erTi klasteridan meoreSi da
xelmeored iTvlis msgavsebis xarisxs. iteraciebi
48
grZeldeba manam, sanam maqsimalurad Semcirdeba
Sidaklasteruli dispersia da gaizardeba klasterTSorisi
dispersia.
obieqtTa maxasiaTebeli niSan-Tvisebebi SeiZleba
aRiwerebodes intervaluri cvladis saxiT (magaliTad
asaki), SesaZlebelia rangobriv (stadia, gavrceleba), an
nominalur (morfologia, lokalizacia) cvladebis saxiT.
am garemoebaTa gaTvaliswinebiT, klasteruli analizis
meTodi SeiZleba ganxiluli iqnas, rogorc monacemTa
dazverviTi analizis meTodi, romelic iZleva hipoTezis
xarisxobrivi Sefasebis saSualebas, xolo hipoTezis
statistikuri sarwmunoebis Sesafaseblad umetes
SemTxvevaSi ar gamodgeba.
klasteruli analizis meTodiT gamovlenili
kanonzomierebebis statistikuri sarwmunoebis Sefasebis
mizniT, Cvens mier gamoyenebuli iqna logariTmul-wrfivi
analizis meTodi.
logariTmul-wrfivi analizis meTodi ganekuTvneba 2X2
sixSiruli cxrilebis Semdgom ganviTarebas da
gankuTvnilia kategorialuri da nominaluri cvladebis
mravaganzomilebiani sixSirul tabulebSi, or an ramdenime
faqtors Soris SesaZlo urTierTqmedebis statistikuri
sarwmunoebis Sesafaseblad. faqtorebs Soris
urTierTgavlenis statistikuri sarwmunoebis Sefaseba
xdeba χ2 kriteriumis mixedviT, mowmdeba nulovani hipoTeza,
anu ramdenad sarwmunod gansxvavdeba gamovlenili
sixSireebi mosalodneli sixSireebisagan. Tu sarwmunoebis
p-done nulTan axlo myofi sididea, maSin hipoTeza, rom
faqtorebs Soris urTierTqmedeba ar arsebobs, sarwmunod
49
ar miiCneva. gamoTvlebs vawarmoebdiT statistikur
programul paket STATISTIKA 6-is operaciul areSi.
aRniSnuli kvlevebis safuZvelze miRebuli
informaciis gaTvaliswineba, avadmyofTa mkurnalobis
individualuri modelirebisas ukve arsebuli mkurnalobis
meTodebis gamoyenebiT, saSualebas iZleva mivaRwioT
maqsimalur Sedegs.
50
Tavi III
zeda ybis avTvisebiani simsivneebis kliniko-
morfologiuri daxasiaTeba da mkurnalobis Sedegebis
analizi
vinaidan, Cveni kvlevis ZiriTad mizans warmoadgenda
zeda ybis avTvisebiani simsivneebis im kliniko-
morfologiuri maxasiaTeblebis gamovlena, romlebic
mniSvnelovan zegavlenas axdendnen daavadebis
mimdinareobaze, mkurnalobis efeqturobasa da prognozze,
mizanSewonilad CavTvaleT miRebuli informaciis
detaluri analizis warmoeba, rogorc mTlian klinikur
masalaze aseve sxvadasxva meTodebiT namkurnaleb pacientTa
jgufebSi.
146 avadmyofidan 90 (68,2%) SemTxvevaSi
diagnostirebul iqna brtyelujredovani kibo, maT Soris
maRaldiferencirebuli kibo _ 50 (34,3%) SemTxvevaSi,
saSualo diferenciaciis _ 12 (8,2%) SemTxvevaSi, xolo
dabaldiferencirebuli kibo _ 18 (12,3%) SemTxvevaSi. 19
(13%) avadmyofs daudginda adenokarcinomas diagnozi, xolo
23 (15,7%) avadmyofs gamouvlinda cilindrulujredovani
kibo.
araepiTeluri warmoSobis simsivneebi gamouvlinda 14
(9,6%) pacients. maTgan limfosarkoma diagnistirebul iqna 9
(6,2%) SemTxvevaSi, xolo sxvadasxva saxis sarkomebi (angio,
qondro da osteosarkomebi) daudginda 5 (3,4%) avadmyofs.
aRniSnuli jgufis (146 avadmyofi) detalurma
klinikurma analizma gviCvena, rom zeda ybis wiaRis
51
avTvisebiani simsivneebis diagnostirebamde avadmyofTa
ZiriTadi masa anamnezSi aRniSnavda sxvadasxva qronikuli
anTebiTi procesebis arsebobas xangrZlivi (1-dan 9 wlamde)
drois ganmavlobaSi. maTgan 55,6%-s rentgenologiurad
aReniSneboda qronikuli polipomatozuri haimoritis
arseboba.
haimoris Rrus avTvisebiani simsivneebis gamovlinebis
pirvel simptomTa Soris ufro xSirad adgili hqonda yru
tkivilebisa da simZimis SegrZnebas (87,6%-Si). es simptomi,
rogorc wesi aReniSnebodaT im avadmyofebs, sadac
simsivnur process dakavebuli hqonda zemo-ukana SigniTa
segmenti. am jgufSi pacientebi aseve aranaklebi sixSiriT
uCiodnen cxvirdan sunTqvis mniSvnelovan gaZnelebas, rasac
Tan axlda lorwovan-Cirqovani gamonadeni cxviris
savalidan. zemoT aRniSnuli simptomebis raodenobrivi
gamovlinebebi Cvens mier warmodgenil avadmyofebSi
moyvanilia cxrilSi #8.
anamnezuri monacemebis Seswavlam gviCvena, rom
adgilobrivad gavrcelebuli epiTeluri simsivneebis
arsebobis SemTxvevaSi avadmyofTa ZiriTad CivilebTan
erTad pacientebs aReniSnebodaT cxviridan sisxldena (36
avadmyofi (24,7%)), ekzoftalmi (10 avadmyofi (6,8%)), trizmi,
(6 avadmyofi (4,1%)) rac ganpirobebuli iyo simsivnuri
procesis gavrcelebiT saReW kunTebSi.
52
cxrili #5
haimoris Rrus avTvisebiani simsivneebis gamovlinebis pirveladi klinikuri simptomebi
klinikuri
simptomebi
avadmyofTa
raodenoba
tkivilisa da
simZimis SegrZneba
cxviriT sunTqvis
gaZneleba
lorwovan-
Cirqovani
gamonadeni
trizmi
sisxldena
ekzofTalmi
simsivnis
lokalizacia
L. Ohngren -is
dayofis
mixedviT
wina-qveda
SigniTa
segmenti
8 4 _ 3 _ 1 _
wina-qveda
gareTa
segmenti
6 4 _ 1 _ _ _
zemo-ukana
gareTa
segmenti
11 10 _ 5 _ _ _
zemo-ukana
SigniTa
segmenti
10 5 1 1 _ 1 _
simsivne
moicavs
mTel Rrus
79 71 57 42 7 42 11
jami 117 94 58 52 7 43 11
zeda ybis simsivneebis mimdebare anatomiur
struqturebSi Cazrdisas daavadebis gamovlinebis
simptomatika ufro mravalferovani xdeboda. ase magaliTad,
simsivnis cxviris RruSi gavrcelebisas sunTqvis
gaZnelebas xSirad Tan erTvoda cxviris gamoxatuli
deformacia. xolo cxavis Zvlis labirinTSi gavrcelebisas,
aRiniSneboda Tvalbudis medialuri kedlis deformacia.
daavadebis lokalizaciisas haimoris Rrus qveda, wina-
gareTa an gareTa-lateralur kedelze simsivnur procesi,
rogorc wesi, vrceldeboda alveoluri morCis, rbili an
magari sasis mimarTulebiT, rac vlindeboda kbilTa
53
mwkrivis deformaciebSi, am ukanasknelTa moryeviT. xSirad
aseT avadmyofebs aReniSnebodaT nevralgiuri xasiaTis
tkivilebi kbilTa mwkrivis areSi.
simsivnis zeda-ukana SigniTa da gareTa
lokalizaciisas procesis gavrceleba ZiriTadad xdeboda
orbitis mimarTulebiT da am ukanasknelSi CazrdiT, rac
xSirad iwvevda Tvalis kaklis gadanacvlebas medialuri an
lateraluri mimarTulebiT. amas Tan axlda mxedvelobis
intensivobis daqveiTeba, cremldena da mxedvelobis
gaoreba. simsivnis ufro Rrma gavrcelebisas, qalas Rrusa
da fuZeze, adgili hqonda Tvalis mamoZravebeli nervebis
dazianebas, rac gamoixateboda Tvalis moZraobis
SezRudviTa da Zlieri Tavis tkivilebiT. haimoris Rrus
avTvisebiani simsivneebis gavrcelebis sixSire mimdebare
anatomiur struqturebze warmodgenilia cxrilSi #9,
xolo sqematurad gamoxatuli suraT #7-ze.
miuxedavad aRniSnuli klinikuri gamovlinebebisa,
pacientebs xangrZlivi drois ganmavlobaSi utardebodaT
mkurnaloba sxvadasxva profilis samedicino
dawesebulebebSi. anamnezuri monacemebis analizma gviCvena,
rom praqtikulad yvela avadmyofs specialuri
gamokvlevebis gareSe Cautarda konservatiuli mkurnaloba,
rac gamoixateboda: anTebis sawinaaRmdego mkurnalobaSi,
fizioTerapiaSi, da haimoris Rrus gamorecxvebSi da a.S. am
procedurebis Semdeg 32% avadmyofebisa aRniSnavda
daavadebis mkveTr progresirebas.
54
ცხრილი ¹6
ჰaიმორის ღრუს avთvისebიaნი სიმსიvნeebის gavრცeლeba მიმdebaრe aნaტომიურ სრუქტურebში.
სიმსიvნის ლოკaლიzaციa
L.Ohngren-is daყოფის მიხedvით
avadმყოფთa
რaოdeნოba თvaლbუde
ცხvირის ღრუ
პირის ღრუ რbილი da მagaრი
ქსოvილebი
წინa-ქveda შიgნითa
სegმeნტი 1 - 1 - -
წინa-ქveda gaრeთa
სegმeნტი 2 - 1 1 -
zeმო-უკaნa gaრeთa
სegმeნტი 3 1 - - -
zeმო-უკaნa შიgნითa
სegმeნტი 1 1 - - -
სიმსიvნe მოიცavს მთeლ
ღრუს 101 18 40 19 26
ჯaმი 108 20 42 20 26
35 (23,97%) avadmyofs cito da morfologiuri
verifikaciis gareSe sxvadasxva klinikebSi CautardaT
haimorotomia, 14 (9,6%) pacients zeda ybis areSi gausaZlisi
tkivilebis gamo kbilebis eqstraqcia, 12 (8,2%) avadmyofs
Tvalis klinikaSi egzofTalmis gamo simsivnis amokveTa,
xolo 7 (2,8%) avadmyofs Cautarda nevrologiuri
mkurnaloba. Cveni azriT, yovelive es ganpirobebuli iyo
imiT, rom ar iyo srulyofilad Segrovebuli anamnezi da
Catarebuli aucilebeli kliniko-diagnostikuri
gamokvlevebi, ramac ganapiroba diagnostikuri Secdomebi.
daavadebis pirveli simptomis gamovlenidan
specializirebul onko-dawesebulebas 1-dan 3 Tvis
55
periodSi mimarTa 39 (26,7%) avadmyofma, 81 (55,5%) 3-dan 6
TveSi, xolo 6-dan 12 TveSi 26 (17,8%) pacientma.
klinikurma gamokvlevebma gviCvena, rom rodesac Cndeba
eWvi zeda ybis avTvisebiani simsivnis arsebobaze,
aucilebeli xdeba avadmyofTa kompleqsuri gamokvleva, rac
gamoixateba kvlevaTa Semdeg TanmimdevrobaSi: anamnezis
detaluri Sekreba da Civilebis gaanalizeba; haimoris Rrus
wina da Tvalbudis qveda kedlis, alveoluri morCisa da
magari sasis palpacia; Semdeg xorcieldeba wina rinoskopia
da epifaringoskopia; zeda ybis rentgenografia; cxvirxaxis
da cxviris savalebis fibroskopia; simsivnis arsebobis
SemTxvevaSi citologiuri da punqciuri biofsiis warmoeba;
Zvlovani struqturebis mTlianobis dasadgenad
kompiuteruli tomografia; rac Seexeba simsivnis rbil
qsovilebSi gavrcelebis diagnostirebas, aucilebeli xdeba
magnitur-rezonansuli tomografiis warmoeba; romelic
dReisaTvis yvelaze informatulia.
aRsaniSnavia, rom kompiuteruli tomografiisas
avTvisebiani simsivneebis densinometriuli monacemebi
meryeobs 40-45 haufsvildis farglebSi da damokidebulia
simsivnis lokalizaciaze, struqturaze da gavrcelebaze.
Catarebuli kliniko-rentgenologiuri, kt da mrt
kvlevebis safuZvelze aRmoCnda, rom simsivnuri procesiT
marto haimoris Rru dainteresebuli iyo mxolod 38 (26%)
SemTxvevaSi. sxva pacientebSi aRiniSneboda procesis
gavrceleba cxviris savalSi 42 (28,7%), 20 (13,7%) SemTxvevaSi
magar da rbil sasaze, saReW kunTebze aRiniSna 10 (6,1%)
SemTxvevaSi, 2-Si (1,4%) eTmoidur wiaRSi, TvalbudeSi 20
56
(13%), yvrimalis Zvalze 9 (6,1%), loyis rbil qsovilebSi 2
(1,4%), SemTxvevaSi da frTasasis fosoSi 2 (1,4%)
SemTxvevaSi. amrigad, daavadebis gavrceleba erT anatomiur
struqturze diagnostirebul iqna 38 (26%) SemTxvevaSi, or
struqturaze 35-s (24%), samze 18 (12,3%) da oTx
struqturaze 17 (11,7%) SemTxvevaSi. mTlianobaSi T1
gavrcelebis simsivne gamovlenil iqna mxolod 4 (2,73%)
avadmyofSi, T2 gavrcelebis 23-Si (15,74%), T3 daudginda 59
(40,5%) avadmyofs, xolo T4 ki _ 60 (41%) pacients.
mkurnalobis dawyebamde regionuli metastazebi
aReniSna 22 (15%) avadmyofs. maT Soris, ybisqveSa midamosa
da kisris zeda mesamedis limfuri kvanZebis dazianebiT
simsivnuri procesis mxareze daudginda 14 (63,7%) avadmyofs,
aqedan, 3sm-de zomis metastazebi aReniSna 10-s (71,5%), xolo
3sm-ze meti ki _ 4 (28,5%) avadmyofs. mravlobiTi
metastazebi gamovlenil iqna 8 (36,3%) SemTxvevaSi, aqedan,
3sm-de zomis regionuli metastazebi daudginda 5 (62,5%)
avadmyofs, xolo 3sm-ze meti ki _ 3 (37,5%) pacients.
Catarebuli mkurnalobis efeqturobis gansazRvris
mizniT Cvens mier warmodgenili 146 avadmyofi mkurnalobis
meTodebis mixedviT ganawilebul iqna 4 klinikur jgufSi.
I jgufi _ Seadgina 44 (28,7%) pacientma, romelTac
mkurnalobis pirvel etepze CautardaT qimio-sxivuri
Terapia; qimioTerapia ZiriTadad atarebda sistemuri
poliqimioTerapiis saxes. 44 pacientidan mamakaci iyo 26
(59%), xolo 18 (41%) ki _ qali; maTi asaki meryeobda 20-dan
60 wlamde; tkivilis sindromi aReniSna 30 (68,2%) avadmyofs,
57
cxviridan sisxldena _ 4-s (9%), xolo Cirqovan-serozuli
gamonadeni _ 23-s (52,3%). daavadebis arsebobis xangrZlivoba
Seadgenda 1-6 Tves; TNM klasifikaciis mixedviT T2
gavrcelebis simsivne daudginda 7 (16%) pacients, T3 _ 15-s
(34%) da T4 gavrcelebis _ 22-s (50%); morfologiuri
kvleviT 24 (54,5%) SemTxvevaSi gamovlenil iqna
brtyelujredovani kibo, 3-Si (6,8%) adenokarcinoma, 3-Si
(6,8%) cilindroma, 9 (20,5%) SemTxvevaSi limfosarkoma da 5
(11,4%) avadmyofs daudginda sxvadasxva warmoSobis
SemaerTebelqsovilovani simsivneebi. daavadeba ar
vrceldeboda wiaRis farglebs gareT 12 (27,3%) SemTxvevaSi,
14 (31,8%) avadmyofs aReniSna daavadebis gavrceleba I
mimdebare anatomiur struqturaze (cxviris savali,
Tvalbude, sasa), II mimdebare anatomiur struqturaze 12-s
(27,3%), III (eTmoiduri wiaRi da frontaluri wiaRi)
struqturaze 4-s (9%) da IV anatomiur struqturaze 2 (4,5%)
pacients (saReW kunTebze, yvrimalis Zvalze, loyis rbil
qsovilebze, frTasasis foso); 9 (20,5%) avadmyofs
gamouvlinda calmxrivi regionuli metastazebi, aqedan 7
(77,8%) SemTxvevaSi erTeuli, xolo 2-Si (22,2%) ki _
mravlobiTi.
yvela avadmyofs mkurnalobis pirvel etapze Cautarda
sistemuri poliqimioTerapia I-dan III kursamde. ris
Semdegac, momdevno etapze utardebodaT sxivuri Terapia
wyvetili kursiT (40-30gr), romlis dRiuri doza Seadgenda
2 gr-s, xolo, jamuri ar aRemateboda 70gr-s. qimio da
sxivuri Terapiis damTavrebisTanave xdeboda mkurnalobis
Sedegebis Sefaseba, romelic efuZneboda subieqtur da
obieqtur monacemTa analizs. subieqturi monacemebidan
58
viTvaliswinebdiT tkivilis simptomis moxsnas, cxviriT
sunTqvis aRdgenas, cxviridan gamonadenisa da metastazebis
zomebSi Semcirebis xarisxs da sxva. obieqturi
kriteriumebi iTvaliswinebda fibroskopiul,
rentgenologiur da kompiuterul tomografiul monacemTa
analizs.
Catarebuli poliqimioTerapiuli mkurnalobis uSualo
Sedegebi moyvanilia cxril #10-Si. saidanac naTlad Cans
rom, poliqimioTerapiis Semdgom simsivnis sruli regresia
miRweul iqna SemTxvevaTa mxolod 29,5%-Si. aqedan 6 (46,15%)
avadmyofs aReniSneboda brtyelujredovani kibo, erTs
(7,7%) cilindroma, xolo 6-s (46,15%) limfosarkoma. yvela
avadmyofs mkurnalobis meore etapze gaugrZelda sxivuri
Terapia jamuri doziT 70gr-mde. aRniSnuli mkurnalobis
Semdeg mniSvnelovnad gaizarda simsivnis 100%-iani regresia
(29,5%-dan 61,4%-mde) (ix. cxril #1-Si). maTgan
brtyelujredovani kiboTi daavadebul avadmyofebidan
simsivnis 100%-iani regresia miRebul iqna 17 (71%)
SemTxvevaSi, 4-Si (16,7%) aRiniSna simsivnis regresia 50 da
meti procentiT, xolo 3-Si (12,3%) _ mkurnaloba aRmoCnda
araefeqturi. acinozurujredovani kiboTi daavadebuli
pacientebidan 2-s (66,6%) aReniSna simsivnis 100%-iani
regresia da erTs (33,4%) _ regresia 50 da meti procentiT.
limfosarkomiT daavadebuli 9 avadmyofidan 8-Si (88,9%)
miRebul iqna simsivnis 100%-iani regresia, xolo 1-Si (11,1%)
_ 50 da meti procentiT. rac Seexeba adenokarcinomiT da
sxvadasxva warmoSobis sarkomebiT (angio, qondro da
osteosarkomebi) daavadebul avadmyofebs, mxolod TiTo-
TiTo SemTxvevaSi iqna miRweuli simsivnis regresia 50 da
59
60
meti procentiT, xolo danarCen SemTxvevebSi mkurnalobam
Sedegi ver gamoiRo. (ix. cxrili #7).
cxrili # 7
zeda ybis wiaRis avTvisebiani simsivneebis konservatuli mkurnalobis uSualo Sedegebi.
mkurnalobis uSualo Sedegebi
I etapi
qimioTerapia
mkurnalobis uSualo Sedegebi
II etapi
sxivuri Terapia
simsivnis histologiuri
Seneba
saerTo raodenoba
100% regresia
50% regresia
araefeqturi 100%
regresia 50%
regresia araefeqturi
brtyelujredovani kibo
24 6 25% 9 37,5% 7 29,2% 17 71% 4 16,7% 3 12,3%
adenokarcinoma 3 - - 1 33,3% 2 66,7% - - 1 33,3% 2 66,7%
cilindroma 3 1 33,4% - - 2 66,6% 2 66,6% 1 33,4% - -
limfosarkoma 9 6 66,7% 2 33,3% - - 8 88,9% 1 11,1% - -
angio, qondro da osteosarkomebi
5 - - - - 5 100% - - 1 20% 4 80%
sul 44 13 29,5% 12 27,3% 16 36,4% 27 61,4% 8 18,2% 9 20,4%
61
amrigad, Catarebuli qimio-sxivuri mkurnalobis
Semdgom, 44 avadmyofidan simsivnis sruli rezorbcia
aRiniSna 27 SemTxvevaSi, ramac 61,4% Seadgina. simsivnis
regresia 50 da meti procentiT miRweul iqna 8 (18,2%)
SemTxvevaSi da mxolod 9-Si (20,4%) _ igi aRmoCnda uSedego
(ix. cxrili #8).
cxrili # 8.
zeda ybis wiaRis avTvisebiani simsivneebis klinikuri niSnebis ganawileba mkurnalobis uSualo Sedegebis mixedviT.
mkurnalobis uSualo Sedegebi simsivnis
histologiuri Seneba saerTo
raodenoba 100% regresia araefeqturi
brtyelujredovani kibo
24 17 71% 3 12,3%
adenokarcinoma 3 - - 2 66,7% cilindroma 3 2 66,6% - -
limfosarkoma 9 8 88,9% - - angio, qondro da osteosarkomebi
5 - - 4 80%
tkivili 30 17 56,7% 5 16,7% sisxldena 4 - - 3 75%
Cirqovan-serozuli gamonadeni
23 13 56,5% 2 8,7%
0 12 12 100% - - 1 14 13 93% - - 2 9 2 22,3% 1 11,2% 3 6 - - 5 83,4%
gavrceleba mezobel
struqturebze
4 3 - - 3 100% T2 7 7 100% -
T3 15 12 80% 1 6,7%
T4 22 8 36,4% 36,4% 8
regionuli metastazebi aris 9 1 11,1% 5 55,5%
ar aris 35 26 74,3% 4 11,4% sul 44 27 61,4% 9 20,4%
zeda ybis kibos kliniko-morfologiur maxasiaTebelTa
erTobliobidan im simptomokompleqsebis gamosayofad,
romlebic mogvcemdnen qimio-sxivuri Terapiis efeqturobisa
da daavadebis gamosavlis prognozirebis saSualebas,
gamoyenebuli iqna klasteruli analizi, kerZod K-
saSualoTa meTodi (ix. suraTi #2). statistikuri
sarwmunoebis Sesafaseblad gamoyenebul iqna logariTmul-
62
wrfivi analizis meTodi, romlis Sedegebi warmodgenilia
cxril #12.
suraTi 2. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis klasteruli analizi qimio-sxivuri meTodiT namkurnaleb avadmyofTa jgufSi.
cxrili 9. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis logariTmul-wrfivi analizi qimio-sxivuri meTodiT namkurnaleb avadmyofTa jgufSi.
statistikuri sarwmunoeba χ2 Pc1- c2 χ2 Pc1- c3 χ2 Pc2- c3
asaki 9,48 p=0,023 20,52 p<0,01 26,91 p<0,01
morfologia 6,35 p=0,095 19,45 p<0,01 13,06 p<0,01
destruqcia 3,62 p=0,16 30,86 p<0,01 15,36 p<0,01
gavrceleba 22,68 p<0,01 26,98 p<0,01 42,84 p<0,01
anamnezi 14,71 p<0,01 30,06 p<0,01 51,68 p<0,01
metastazireba 19,89 p<0,01 46,99 p<0,01 -0,04 p=1
efeqti 15,2 p<0,01 33,01 p<0,01 20,85 p<0,01
63
Catarebuli maTematikuri kvlevis safuZvelze
dadginda, rom kliniko-morfologiur maxasiaTebelTa
Soris yvelaze informatiul maCveneblebs warmoadgens
simsivnis morfologiuri Seneba; daavadebis arsebobis
xangrZlioba; daavadebis gavrceleba; Zvlovani destruqcia;
metastazebis arseboba, lokalizacia, zomebi da bolos
avadmyofTa asaki.
sxvadasxva SedegiT namkurnaleb avadmyofTa jgufebSi
daavadebis klinikur gamovlinebaTa da morfologiuri
Senebis analizma gviCvena, rom simsivnis 100%-iani regresia
ZiriTadad miRweuli iqna (74%) axalgazrda da saSualo
asakis (30-50w) pacientebSi, romelTac daudgindaT
daavadebis arsebobis xangrZlivoba 1-dan 6 Tvemde (82%);
morfologiuri Seneba ganisazRvreboda brtyelujredovani
kiboTi (59%), limfosarkomiT (89%) an cilindromiT (66%),
romelTa gavrceleba varirebda araumetes 1 anatomiuri
struqturisa (92,6%), haimoris Rrus Zvlovani kedlebis
destruqciis da regionuli limfuri kvanZebis dazianebis
gareSe (96,3%).
simsivnis 50%-iani regresia ZiriTadad miRweuli iqna
(81%) saSualo da xandazmuli asakis (50-70w) pacientebSi,
romelTac daudgindaT daavadebis arsebobis xangrZlivoba
3-dan 6 Tvemde (69,5%); morfologiuri Seneba ZiriTadad
ganisazRvreboda brtyelujredovani kiboTi (71%), da
adenokarcinomiT (34%), romelTa gavrceleba varirebda
araumetes 2 anatomiuri struqturisa (97,3%), haimoris Rrus
Zvlovani kedlebis destruqciiT an destruqciis gareSe,
64
aseve ar aRiniSneboba regionuli limfuri kvanZebis
metastazuri dazianebebi (91,2%).
avadmyofTa im jgufSi, sadac konservatulma
mkurnalobam Sedegi ver gamoiRo, pacientTa asaki
meryeobda 55-dan 74 wlamde (77,8%); romelTa daavadebis
arsebobis xangrZlivoba ar aremateboda 3 Tves (66,7%);
daavadebis morfologiiuri Seneba ganisazRvreboda
adenokarcinomiT (68%) an sxvadsxva warmoSobis sarkomebiT
(75%) (angio, qondro da osteosarkomebi); simsivne
vrceldeboda or da met mezobel anatomiur struqturaze
(82,4%); aRiniSneboda Zvlovani kedlebis sxvavasxva xarisxis
destruqcia (72,3%); mravlobiTi an erTeuli regionuli
metastazebi romelTa zomebi aRemateboda 3sm-s (17,8%).
qimio-sxivuri mkurnalobis Soreuli Sedegebis
analizma gviCvena, rom avadmyofTa im jgufSi, sadac
miRweul iqna simsivnis sruli rezorbcia (27 avadmyofi),
sicocxlis 2 wliani barieri davadebis progresirebis
niSnebis gareSe gadalaxa 19 avadmyofma, ramac 70,4%
Seadgina. daavadebis progresireba pirveli ori wlis
ganmavlobaSi aReniSna 8 (29,6%) avadmyofs. maTgan 6-s (75%)
daudginda recidiuli simsivne, xolo 2-s (25%) _ Soreuli
metastazebi.
II jgufi _ am jgufSi gaerTianebul iqna is 87
avadmyofi, romlebsac mkurnalobis pirvel etapze
CautardaT sxivuri Terapia. 87 pacientidan mamakaci iyo 55
(63,2%), 32 (36,8%) ki _ qali; maTi asaki meryeobda 40-dan 75
wlamde; tkivilis sindromi aReniSna 59 (67,8%) avadmyofs,
cxviridan sisxldena 32-s (36,8%), xolo Cirqovan-serozuli
65
gamonadeni 27-s (31%). aRniSnul jgufSi avadmyofebs
ZiriTadad daudgindaT daavadebis arsebobis xangrZlivoba
1-dan 6 Tvemde; TNM klasifikaciis mixedviT T2 gavrcelebis
simsivne daudginda 7 (8%) pacients, T3 _ 46-s (52,9%) da T4
gavrcelebis _ 34-s (39,1%); morfologiuri kvleviT 54 (62%)
SemTxvevaSi gamovlenil iqna brtyelujredovani kibo, 13-Si
(15%) _ adenokarcinoma, xolo 20-Si (23%) _ cilindroma.
daavadeba ar vrceldeboda wiaRis farglebs gareT 11
(12,6%) SemTxvevaSi, 18 (20,7%) avadmyofs aReniSna daavadebis
gavrceleba I mimdebare anatomiur struqturaze (cxviris
savali, Tvalbude, sasa), II mimdebare anatomiur
struqturaze 33-s (37,9%), III (eTmoiduri wiaRi da
frontaluri wiaRi) struqturaze 10-s (11,5%), IV da V
anatomiur struqturaze 5 (5,8%) pacients (saReW kunTebze,
yvrimalis Zvalze, loyis rbil qsovilebze, frTasasis
foso); 31 (35,6%) avadmyofs gamouvlinda Zvlovani kedlebis
destruqcia; 18 (20,7%) avadmyofs gamouvlinda regionuli
metastazebi, aqedan 11-s (61,1%) erTeuli, xolo 7-s (38,9%)
mravlobiTi.
yvela avadmyofs utardeboda sxivuri Terapia
wyvetili kursiT, I etapze pacienti sxivdeboda 40gr-s
odenobiT, xolo II-ze, orkviriani Sesvenebis Semdeg, 30gr-s
odenobiT. dasxivebis dRiuri doza Seadgenda 2 gr-s, xolo
jamuri ar aRemateboda 70gr-s. sxivuri Terapiis
damTavrebisTanave xdeboda mkurnalobis Sedegebis Sefaseba,
romelic efuZneboda subieqtur da obieqtur monacemTa
analizs. subieqturi monacemebidan viTvaliswinebdiT
tkivilis simptomis moxsnas, cxviriT sunTqvis aRdgenas,
cxviridan gamonadenisa da metastazebis zomebSi Semcirebis
66
67
xarisxs da sxva. obieqturi kriteriumebi iTvaliswinebda
fibroskopiul, rentgenologiur da kompiuterul
tomografiul monacemTa analizs.
mkurnalobis I etapis (40gr) Catarebis Semdeg, 54
brtyelujredovani kiboTi daavadebuli avadmyofidan
simsivnis 100%-iani regresia miRebul iqna 12 SemTxvevaSi
(22,2%), 13-s (24%) aReniSna simsivnis regresia 50 da meti
procentiT, xolo 29 (53,7%) SemTxvevaSi mkurnaloba
aRmoCnda araefeqturi (ix. cxrili #10). acinozurujredovani
kiboTi anu cilindromiT daavadebuli 20 avadmyofidan
simsivnis 100%-iani regresia aReniSna 5 (25%) pacients, 7-s
(35%) _ 50 da meti procentiT, xolo, 8 (40%) SemTxvevaSi
mkurnaloba aRmoCnda uSedego. rac Seexeba
pacientebs, romelTac diagnostirebuli hqondaT
adenokarcinoma, 13 avadmyofidan simsivnis 100%-iani
regresia ver iqna miRebuli verc erT SemTxvevaSi, regresia
50 da meti procentiT aRiniSna mxolod 2-Si (15,4%), xolo
11-Si (84,6%) igi uSedego aRmoCnda.
mkurnalobis II etapis (30gr) Catarebis Semdeg,
brtyelujredovani kiboTi daavadebul avadmyofTagan
simsivnis 100%-iani regresia sul miRweul iqna 25 (46,3%)
SemTxvevaSi, 7-Si (13%) aRiniSna simsivnis regresia 50 da
meti procentiT, xolo 22 (40,7%) SemTxvevaSi mkurnaloba
aRmoCnda araefeqturi. acinozurujredovani kiboTi
daavadebul pacientebidan, simsivnis 100%-iani regresia
aRiniSna 14 (70%) SemTxvevaSi, 2-Si (10%) 50 da meti
procentiT da mxolod 4 (20%) SemTxvevaSi igi aRmoCnda
uSedego. rac Seexeba adenokarcinomiT daavadebul
cxrili # 10
zeda ybis wiaRis avTvisebiani simsivneebis sxivuri mkurnalobis uSualo Sedegebi.
mkurnalobis uSualo Sedegebi mkurnalobis uSualo Sedegebi I etapi II etapi
100% regresia
50% regresia 100%
regresia araefeqturi 50% regresia araefeqturi
simsivnis histologiuri Seneba
saerTo raodenoba
40gr 40gr 40gr 70gr 70gr 70gr
brtyelujredovani kibo 54 12 22,2% 13 24% 29 53,7% 25 46,3% 7 13% 22 40,7%
adenokarcinoma 13 _ _ 2 15,4% 11 84,6% - - 2 15,4% 11 84,6%
cilindroma 20 5 25% 7 35% 8 40% 13 65% 3 15% 4 20%
sul 87 17 19,5% 22 25,3% 48 55,2% 38 43,7% 13,8% 12 37 42,4%
68
avadmyofebs, sxivuri Terapiis meore kursis Semdeg
mkurnalobis Sedegebi praqtikulad ar Secvlila. (ix. cxrili
#10).
amrigad, Catarebuli sxivuri mkurnalobis Semdgom,
saerTo jamuri doziT 70gr, 87 avadmyofidan simsivnis sruli
rezorbcia aRiniSna 38 SemTxvevaSi, ramac 43,7% Seadgina.
simsivnis regresia 50 da meti procentiT miRweul iqna 12
(13,8%) SemTxvevaSi da mxolod 37-Si (42,4%) igi aRmoCnda
uSedego (ix. cxrili #11).
cxrili # 11.
zeda ybis wiaRis avTvisebiani simsivneebis klinikuri niSnebis ganawileba mkurnalobis uSualo Sedegebis mixedviT.
mkurnalobis uSualo Sedegebi
100% regresia araefeqturi
simsivnis histologiuri Seneba
saerTo raodenoba
70gr 70gr
brtyelujredovani kibo
54 25 46,3% 22 40,7%
adenokarcinoma 13 - - 11 84,6% cilindroma 20 13 65% 4 20%
tkivili 59 10 17% 22 37,3% sisxldena 32 3 9,4% 29 90,6%
Cirqovan-serozuli gamonadeni
27 11 40,7% 5 18,5%
0 11 11 100% - - 1 24 17 71% - - 2 26 10 38,5% 11 42,3% 3 12 - - 12 100%
gavrceleba mezobel
struqturebze
4 14 - - 14 100% T2 7 7 100% - -
T3 46 29 63% 8 17,4%
T4 34 2 5,9% 29 85,3% regionuli metastazebi
aris 15 1 6,7% 13 86,7% ar aris 72 37 51,4% 34 47,2%
sul 87 38 43,7% 42,4% 37
69
Catarebuli maTematikuri kvlevis safuZvelze dadginda
rom, kliniko-morfologiur maxasiaTebelTa Soris yvelaze
informatiul maCveneblebs warmoadgens simsivnis
morfologiuri Seneba; daavadebis arsebobis xangrZlioba;
daavadebis gavrceleba; Zvlovani destruqcia; metastazebis
arseboba, lokalizacia da zomebi; aseve avadmyofTa asaki.
xolo sxvadasxva SedegiT namkurnaleb avadmyofTa jgufebSi
daavadebis kliniko morfologiur maxasiaTebelTa analizma
gviCvena, rom simsivnis 100%-iani regresia ZiriTadad miRweul
iqna SedarebiT axalgazrda (30-50weli) asakis pacientebSi
(85,7%), sadac daavadebis arsebobis xangrZlivoba Seadgenda 3-
dan 6 Tves (86,5%); simsivnis morfologiuri Seneba
ganisazRvreboda brtyelujredovani kibos
dabaldiferencirebuli formiT (64%) an cilindromiT (84,6%),
romelTa gavrceleba varirebda araumetes 1 anatomiuri
struqturisa (97,8%), haimoris Rrus Zvlovani kedlebis
destruqciis da regionuli limfuri kvanZebis dazianebis
gareSe (ix. suraTi #3 da cxrili #12).
simsivnis 50%-iani regresia ZiriTadad miRweuli iqna
(89%) saSualo asakis (45-55w) pacientebSi, romelTac
daudgindaT daavadebis arsebobis xangrZlivoba 3-dan 6 Tvemde
(79,5%); morfologiuri Seneba ZiriTadad ganisazRvreboda
saSualo diferencirebis brtyelujredovani kiboTi (91%),
romlis gavrceleba varirebda araumetes 2 anatomiuri
struqturisa (97,3%), haimoris Rrus Zvlovani kedlebis
destruqciisa da regionuli metastazebis gareSe.
70
suraTi 3. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis klasteruli analizi sxivuri meTodiT namkurnaleb avadmyofTa jgufSi.
cxrili 12. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis logariTmul-wrfivi analizi sxivuri meTodiT namkurnaleb avadmyofTa jgufSi.
statistikuri sarwmunoeba χ2 Pc1- c2 χ2 Pc1- c3 χ2 Pc2- c3
asaki 27,13 p<0,01 18,66 p<0,01 53,15 p<0,01
morfologia 30,82 p<0,01 21,97 p<0,01 44,1 p<0,01
destruqcia 69,61 p<0,01 14,79 p<0,01 4,62 p=0,099
gavrceleba 35,77 p<0,01 59,19 p<0,01 15,63 p<0,01
anamnezi 18,9 p<0,01 96,1 p<0,01 5,03 p=0,441
metastazireba 25,49 p<0,01 73,73 p<0,01 4,88 p=0,027
25,71 p<0,01 73,05 p<0,01 efeqti 27,27 p<0,01
71
konservatuli mkurnaloba uSedego aRmoCnda ZiriTadad
pacientTa im jgufSi, romelTa asaki meryeobda 50-dan 70
wlamde (78,6%); sadac daavadebis arsebobis xangrZlivoba
Seadgenda 1-dan 3 da 6-dan 12 Tvemde periods (87,3%);
morfologiuri Seneba ZiriTadad ganisazRvreboda
adenokarcinomiT (70%) an maRali diferencirebis
brtyelujredovani kiboTi (50%); iq, sadac simsivne
vrceldeboda orze met anatomiur struqturaze (69,3%),
aRiniSneboda Zvlovani kedlebis sxvavasxva xarisxis
destruqcia (76,9%) da gamovlenili iyo mravlobiTi an
erTeuli regionuli metastazebi, romelTa zomebic
aRemateboda 3sm-s (19%).
sxivuri mkurnalobis Soreuli Sedegebis analizma
gviCvena, rom avadmyofTa im jgufSi, sadac miRweul iqna
simsivnis sruli rezorbcia (38 avadmyofi), sicocxlis 2
wliani barieri daavadebis progresirebis niSnebis gareSe
gadalaxa 22 avadmyofma, ramac 57,9% Seadgina, xolo
daavadebis progresireba aReniSna 16 avadmyofs. maTgan
recidivi _ 9-s (56,3%), recidivi da regionuli metastazi
erTad _ 4-s (25%), xolo Soreuli metastazebi 3-s (18,7%).
III jgufi _ am jgufSi gaerTianebul iqna 51 avadmyofi im
65 pacientidan, romelTac Catarebuli konservatuli
mkurnalobis Semdeg aReniSnebodaT narCeni simsivne, xolo 15-
ma operaciul mkurnalobaze uari ganacxada. ris gamoc maT
gaugrZeldaT sxivuri Terapia paliatiuri mizniT.
72
51 avadmyofidan 2 (3,9%) SemTxvevaSi ganxorcielebul
iqna zeda ybis tipiuri eleqtrorezeqcia, xolo 40-Si (78,4%) _
kombinirebuli da 9-Si (17,7%) _ kombinirebul-gafarToebuli
operaciebi. maTgan mamakaci iyo 28 (54,9%), 23 (45,1%) ki _ qali;
maTi asaki meryeobda 35-dan 75 wlamde; daavadebis arsebobis
xangrZlivoba Seadgenda 1-dan 12 Tvemde periods; TNM
klasifikaciis mixedviT T3 gavrcelebis simsivne daudginda 16
(31,4%) pacients, xolo T4 gavrcelebis 35-s (68,6%);
morfologiuri kvleviT 27 (53%) SemTxvevaSi gamovlenil iqna
brtyelujredovani kibo, 13-Si (25,5%) _ adenokarcinoma, 6-Si
(11,7%) _ cilindroma, 2-Si (3,9%) limfosarkoma, xolo 3 (5,9%)
SemTxvevaSi angio, qondro da osteosarkomebi. daavadeba
haimoris Rrudan 4 (7,8%) SemTxvevaSi vrceldeboda I mimdebare
anatomiur struqturaze (cxviris savalSi, TvalbudeSi da
sasaze), 27-Si (52,9%) II struqturaze, 14-Si (27,5%) III
struqturaze, IV da met anatomiur struqturaze ki 6 (11,8%)
SemTxvevaSi; 5 (9,8%) avadmyofs aReniSna ekzofTalmi, 7-s
(13,7%) nistagmi, xolo 5 pacients (9,8%) sxvadsxva xarisxis
paresTeziebi; 38 (74,5%) avadmyofs daudginda zeda ybis wiaRis
Zvlovani kedlebis destruqcia; 9 (17,6%) avadmyofs
gamouvlinda 3 sm-de zomis erTeuli regionuli metastazebi,
aqedan 4-s (44,5%) ybisqveSa samkuTxedSi, 3-s (33,3%) _ saZile
samkuTxedSi, xolo 2-s (22,2%) _ kisris Sua mesamedSi.
daavadebis gavrcelebidan gamomdinare, Cvens mier 29
(59,2%) SemTxvevaSi zeda ybasTan erTad rezecirebil iqna I da
II mimdebare anatomiur struqtura; xolo 20 SemTxvevaSi
(40,8%) ganxorcielda zeda ybis rezeqcia III da met mimdebare
73
anatomiur struqturasTan erTad; 9 (17,6%) avadmyofidan,
romlebsac aReniSnebodaT regionuli limfuri kvanZebis
metastazuri dazianeba 6-s (66,7%) Cautarda kisris limfuri
kvanZebis fascialur-futliaruli amokveTa, xolo 3-s (33,3%)
_ krailis tipis operacia.
Catarebuli mkurnalobis Semdeg sicocxlis 2 wliani
barieri daavadebis progresirebis niSnebis gareSe gadalaxa
20 (39,2%) avadmyofma. maTgan mamakaci iyo 11 (55%), xolo 9
(45%) qali; maTi asaki meryeobda 40-dan 60 wlamde; daavadebis
arsebobis xangrZlivoba Seadgenda 3-6 Tves; morfologiurad
gamovlenil iqna brtyelujredovani kibo 13 (65%) SemTxvevaSi,
adenokarcinoma 3-Si (15%), xolo 2-2 (10%) SemTxvevaSi
cilindroma da limfosarkoma; 3 (15%) SemTxvevaSi simsivne
vrceldeboda I mimdebare anatomiur struqturaze, 15-Si (75%)
II mimdebare struqturaze da 2-Si (10%) III struqturaze; 3
(15%) SemTxvevaSi aRiniSna zeda ybis wiaRis zeda kedlis
destruqcia, 2-Si (10%) qveda kedlis, xilo 5-Si (25%)
medialuri kedlis destruqcia; 2 (10%) avadmyofs
mkurnalobis dawyebamde gamovlenili hqonda 3sm-de zomis
solitaruli metastazi ybisqveSa samkuTxedSi.
31 (60,8%) avadmyofs mkurnalobis Semdeg aReniSna
daavadebis progresireba, maTgan 17 (54,8%) SemTxvevaSi
diagnostirebul iqna recidiuli simsivne, 2-s (6,45%)
gamouvlinda regionuli metastazebi, 4-s (12,9%) recidiuli
simsivne da regionuli metastazebi erTad, xolo 8-s (25,8%)
74
Soreuli metastazebi, maTgan 5 (62,5%) SemTxvevaSi filtvebSi,
1-s (12,5%) RviZlSi da 2-s (25%) ZvlebSi.
suraTi 4. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis klasteruli analizi kombinirebuli meTodiT namkurnaleb avadmyofTa jgufSi.
cxrili 13. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis logariTmul-wrfivi analizi kombinirebuli meTodiT namkurnaleb avadmyofTa jgufSi.
statistikuri sarwmunoeba χ2 Pc1- c2 χ2 Pc1- c3 χ2 Pc2- c3
asaki 14,17 p<0,01 5,24 p=0,156 11,45 p<0,01
morfologia 33,96 p<0,01 52,02 p<0,01 22,64 p<0,01
gavrceleba 27,13 p<0,01 28,43 p<0,01 61,3 p<0,01
anamnezi 11,45 p<0,01 2,36 p=0,5 13,32 p<0,01
metastazireba 29,44 p<0,01 14,78 p<0,01 8,86 p=0,011
9,53 p<0,01 23,84 p<0,01 recidivi 11,62 p<0,01
75
aRniSnuli avadmyofebidan 17 (54,8%) iyo mamakaci, xolo
14 (45,2%) ki qali; maTi asaki meryeobda 55-dan 75 wlamde;
daavadebis arsebobis xangrZlivoba Seadgenda 6-12 Tves;
morfologiurad brtyelujredovani kibo gamovlenil iqna 14
(45,1%) SemTxvevaSi, adenokarcinoma 10-Si (32,3%), 4-Si (12,9%)
cilindroma da 3 (9,6%%) SemTxvevaSi osteosarkoma; 1 (3,2%)
SemTxvevaSi simsivne vrceldeboda I mimdebare anatomiur
struqturaze, 12-12 SemTxvevaSi (38,7%) II da III mimdebare
anatomiur struqturaze, xolo 6-Si (19,4%) IV da met
struqturaze; 11 (35,5%) SemTxvevaSi aRiniSna zeda ybis wiaRis
ukana kedlis destruqcia, 9-Si (29%) lateraluri kedlis,
xolo 8-Si (25,8%) wina da zeda kedlis destruqcia; 7 (22,6%)
avadmyofs aReniSna erTeuli regionuli metastazebi saZile
samkuTxedsa da kisris qveda mesamedSi.
Catarebuli maTematikuri kvlevis safuZvelze dadginda,
rom kliniko-morfologiur maxasiaTebelTa Soris yvelaze
informatiul maCveneblebs warmoadgens simsivnis
morfologiuri Seneba; daavadebis arsebobis xangrZlioba;
daavadebis gavrceleba; metastazebis raodenoba, lokalizacia
da zomebi; aseve avadmyofTa asaki. xolo sxvadasxva SedegiT
namkurnaleb avadmyofTa jgufebSi aRniSnuli kliniko-
morfologiur maxasiaTebelTa klasteruli analizis
safuZvelze dadginda, rom sicocxlis 2 wliani barieri
ZiriTadad gadalaxes SedarebiT axalgazrda (30-50weli)
asakis pacientebma (77,2%), romelTac morfologiurad
aReniSnebodaT brtyelujredovani kibos maRalferencirebuli
forma (76,5%) da cilindroma (83,4%), daavadebis gavrcelebiT
76
araumetas ori (81,8%) anatomiuri struqturisa da regionuli
limfuri kvanZebis dazianebis gareSe.
daavadebis progresireba ZiriTadad aReniSnebodaT 50-dan
70 wlamde (77,3%) asakis avadmyofebs; sadac morfologiurad
diagnostirebuli iyo dabali diferencirebis
brtyelujredovani kibo (68,3%) gavrcelebiT sam da met (80%)
anatomiur struqturaze, romelTac aReniSnebodaT 3 da meti
(77,8%) santimetris zomis regionuli metastazebi,
lokalizaciiT kisris zeda da Sua mesamedSi. aseve sxvadasxva
warmoSobis sarkomebi (80%) an adenokarcinoma (69,3%);
romelTa gavrceleba aRemateboda or (80%) anatomiur
struqturas regionuli limfuri kvanZebis dazianebis gareSe.
IV jgufi _ Seadgina 15 avadmyofma. pacientTa es jgufi
Camoyalibda Cvendauneburad, radgan miuxedavad Catarebuli
kvlevebisa ver moxerxda procesis morfologiuri
verifikacia, ris gamoc iZulebuli gavxdiT gvewarmoebina
haimorotomia biofsiuri masalis saswrafo morfologiuri
SeswavliT. aRniSnul jgufSi gaerTianebul iqna 10 (66,6%)
mamakaci da 5 (33,4%) qali; maTi asaki meryeobda 35-dan 65
wlamde; daavadebis arsebobis xangrZlivoba Seadgenda 1-dan 6
Tvemde periods; T1 gavrcelebis simsivne daudginda 4 (26,7%)
pacients, T2 gavrcelebis _ 9-s (60%), xolo T3 gavrcelebis _
2-s (13,3%); morfologiuri kvleviT 12 (80%) SemTxvevaSi
gamovlenil iqna brtyelujredovani kibo, xolo 3-Si (20%) _
adenokarcinoma. 5 (33,4%) SemTxvevaSi simsivne lokalizebuli
iyo haimoris Rrus qveda-wina naxevarSi, xolo 10-Si (66,6%)
77
zeda-ukana naxevarSi. Zvlovani kedlebis destruqcia da
simsivnis gavrceleba wiaRis farglebs gareT gamovlenili ar
iyo. am jgufis avadmyofebidan, daavadebis morfologiuri
verifikaciis Semdeg 3-s (20%) Cautarda zeda ybis nawilobrivi
rezeqcia, xolo 12 (80%) SemTxvevaSi Sesrulebul iqna zeda
ybis tipiuri eleqtrorezeqcia.
am avadmyofebidan sicocxlis or wliani barieri
daavadebis progresirebis niSnebis gareSe gadalaxa 9 (60%)
pacientma. aRniSnul jgufSi yvela avadmyofs daudginda
daavadebis arsebobis xangrZlivoba 3-dan 6 Tvemde; 4 (44,4%)
avadmyofs daudginda I stadiis mqone simsivneebi, xolo 5
(56,6%) ki II stadiis; am avadmyofebs aReniSnaT Semdegi
morfologiuri genezis simsivneebi: 6(66,7%)
brtyelujredovani kibo da 3-s (33,3%) adenokarcinoma; 6
(66,7%) SemTxvevaSi simsivne lokalizebuli iyo qveda-wina
naxevarSi, xolo 3-Si (33,3%) ki zeda-ukana naxevarSi.
danarCen 6 (40%) avadmyofs, romlebsac aReniSnaT
daavadebis progresirebis niSnebi pirveli ori wlis
ganmavlobaSi, 5-s (83,3%) gamouvlinda recidiuli simsivne,
xolo 1-s (16,7%) regionuli limfogenuri metastazebi. maTgan
4 (66,7%) avadmyofs daudginda II stadiis simsivneebi, xolo 2-s
(33,3%) III stadiis; rac Seexeba daavadebis arsebobis
xangrZlivobas, ZiriTadad aRiniSna 1-dan 3 Tvemde anamnezi;
yvela avadmyofs gamouvlinda brtyelujredovani kibo; 4
(66,7%) SemTxvevaSi intraoperaciulad aRmoCenili iyo
Zvlovani kedlebis kidiTi destruqcia.
78
Catarebuli maTematikuri kvlevis safuZvelze dadginda,
rom kliniko-morfologiur maxasiaTebelTa Soris yvelaze
informatiul maCveneblebs warmoadgens simsivnis
morfologiuri Seneba; misi lokalizacia RruSi; wiaRis
Zvlovani kedlebis destruqcia, daavadebis arsebobis
xangrZlivoba da avadmyofTa asaki. xolo sxvadasxva SedegiT
namkurnaleb avadmyofTa jgufebSi aRniSnuli kliniko-
morfologiuri maxasiaTeblebis klasteruli analizis
safuZvelze dadginda, rom sicocxlis 2 wliani barieri
ZiriTadad gadalaxes SedarebiT axalgazrda (30-50weli)
asakis pacientebma (77,2%), romelTac morfologiurad
aReniSnebodaT brtyelujredovani kibo (50%) da
adenokarcinoma (100%), simsivnis lokalizaciiT wiaRis qveda-
wina naxevarSi (96%), daavadebis arsebobis xangrZlivobiT 3-
dan 6 Tvemde (ix. suraTi #5 da cxrili #15).
gardacvlil pacientTa jgufSi ZiriTadad aRmoCndnen 50-
dan 70 wlamde (77,3%) asakis avadmyofebi; sadac
morfologiurad aRiniSneboda dabali diferencirebis
brtyelujredovani kibo (68,3%) lokalizaciiT wiaRis zeda-
ukana naxevarSi (87%); Zvlovani kedlebis destruqciiT (67%)
dadaavadebis arsebobis xangrZlivobiT 1-dan 3 Tvemde.
79
suraTi 5. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis klasteruli analizi qirurgiuli meTodiT namkurnaleb avadmyofTa jgufSi.
cxrili 15. ybis kibos kliniko-morfologiuri maxasiaTeblebis logariTmul-wrfivi analizi qirurgiuli meTodiT namkurnaleb avadmyofTa jgufSi.
statistikuri sarwmunoeba χ2 Pc1- c2 χ2 Pc1- c3 χ2 Pc2- c3
asaki 8,69 p=0,03 3,97 p=0,41 2,5 p=0,47
morfologia 10,12 p<0,01 3,79 p=0,14 12,07 p<0,01
lokalozacia 11,31 p<0,01 10,01 p<0,01 1,29 p=0,54
destruqcia 12,06 p<0,01 10,34 <0,01 11,62 <0,01
anamnezi 14,15 p<0,01 12,33 <0,01 11,62 <0,01
11,03 p<0,01 11,15 p<0,01 recidivi 2,42 p=0,48
80
amrigad, Cvens mier yvela meTodiT namkurnaleb
avadmyofTa efeqturobis analizma gviCvena, rom dadebiTi
Sedegi SeiZleba miRweul iqnas, rogorc konservatuli, aseve
qirurgiuli da kombinirebuli meTodebis gamoyenebiT da igi
varirebs 43,1%-dan 61,4%-mde. amasTanave gamovlenilia mTeli
rigi kliniko-morfologiuri maxasiaTeblebi, romlebic
sxvadasxva sixSiriT gvxvdeba damakmayofilebeli da
aradamakmayofilebeli SedegiT namkurnaleb avadmyofTa
jgufebSi. am maxasiaTebelTa analizi cocxal da
gardacvlil pacientTa jgufebSi mogvcems saSualebas,
movaxdinoT daavadebis mimdinareobisa da gamosavlis
prognozireba.
81
Tavi IV
haimoris Rrus avTvisebiani simsivneebis mimdinareobisa da
daavadebis gamosavlis prognozireba
vinaidan Cveni kvlevis ZiriTad mizans warmoadgenda im
kliniko-morfologir gamovlinebaTa simptomokompleqsis
dadgena, romelic mniSvnelovan zegavlenas axdens daavadebis
mimdinareobasa da mkurnalobis Sedegebze, mizanSewonilad
CavTvaleT kliniko-morfologiri niSnebis ganawileba
Segveswavla ara calkeuli meTodebiT namkurnaleb
avadmyofTa jgufebSi, aramed mTel klinikur masalaze
dayrdnobiT. rac saSualebas gvaZlevda gamogveyo yvelaze
informatiuli niSnebi da gangvesazRvra maTi Sinagani
urTierTdamokidebuleba daavadebis mimdinareobis
prognozirebaSi.
rogorc wina qveTavebSi iyo warmodgenili, Cvens mier
sxvadasxva meTodebiT namkurnalebi avadmyofebidan
sicocxlis or wliani barieri daavadebis progresirebis
niSnebis gareSe 146 pacientidan gadalaxa 70 avadmyofma, ramac
48% Seadgina. xolo, 76-s (52%) daudginda daavadebis
progresirebis niSnebi. maTgan, 31 (40,8%) avadmyofs daudginda
recidiuli simsivne, 14-s (18,4%) regionuli metastazebi, 9-s
(11,8%) recidiuli simsivne da regionuli metastazebi erTad,
7-s (9,2%) recidiuli simsivne da Soreuli metastazebi erTad,
xolo 15-s (19,7%) Soreuli metastazebi.
82
cxrili # 16
zeda ybis wiaRis avTvisebiani simsivneebis klinikuri niSnebis ganawileba mkurnalobis uSualo Sedegebis mixedviT.
simsivnis histologiuri
Seneba
saerTo raodenoba
ar aReniSna daavadebis
progresireba 2 da meti wlis ganmavlobaSi
aReniSna daavadebis
progresireba 2 wlamde
periodSi
brtyelujredovani kibo 85 44 51,8% 41 48,2%
adenokarcinoma 19 4 21% 15 79% cilindroma 23 14 60,8% 9 39,2%
limfosarkoma 11 7 63,6% 4 36,4% angio, qondro da osteosarkomebi
8 _ _ 8 100%
tkivili 92 39 42,4% 53 57,6% sisxldena 57 8 14% 49 86%
Cirqovan-serozuli gamonadeni
89 67 75,3% 22 24,7%
0 38 32 84,2% 6 15,8% 1 29 23 79,4% 6 20,6% 2 42 15 35,7% 27 64,3% 3 22 _ _ 22 100% 4 13 _ _ 13 100%
gavrceleba mezobel
struqturebze
5 2 _ _ 2 100% T1 4 4 100% _ _
T2 21 17 81% 4 19%
T3 59 36 61% 23 39%
T4 62 13 21% 49 79% aris 24 2 8,4% 22 91,6% regionuli
metastazebi ar aris 122 68 55,8% 54 44,2% sul 146 70 48% 52% 76
zeda ybis simsivneebiT daavadebul pacientTa kliniko-
morfologiuri maxasiaTeblebis ganawilebis Seswavla moxda
or klinikur jgufSi, anu daavadebis progresirebiT
gardacvlil da cocxal pacientebSi. aRsaniSnavia, rom
pirveli jgufi Seadgina 82 (56,16%) avadmyofma (maTgan, 12
pacienti recidivebiT da metastazebiT), romlebmac gadalaxes
sicocxlis orwliani barieri. xolo meore jgufSi
gaerTianebul iqna 64 (43,84%) pacienti, romlebic mkurnalobis
damTavrebis Semdeg, daavadebis progresirebis gamo
83
gardaicvalnen pirveli ori wlis ganmavlobaSi, aRsaniSnavia,
rom avadmyofebis ganawileba sqesis mixedviT orive jgufSi
praqtikulad identuri aRmoCnda, magram 82 avadmyofidan
romlebmac gadalaxes sicocxlis or wliani barieri 32
(54,4%) iyo qalTa sqesis warmomadgenli, xolo 50 ki (59,2%)
mamakaci.
diagrama 1. avadmyofTa ganawileba cocxal da gardacvlil
pacientTa jgufebSi sqesis mixedviT.
Catarebuli radikaluri mkurnalobis Semdeg 40-dan 60
wlamde asakis 75 (51,4%) avadmyofidan sicocxlis 2 wliani
barieri gadalaxa 56 pacientma, ramac Seadgina 74,7%. 60 da
meti asakis mqone 46 (31,5%) avadmyofidan 2 welze meti
icocxla mxolod 8 pacientma, ramac Seadgina 5,48%.
84
avadmyofTa ganawileba cocxal da gardacvlil pacientTa
jgufebSi asakis mixedviT warmodgenilia diagrama # 2-ze.
diagrama 2. avadmyofTa ganawileba cocxal da gardacvlil
pacientTa jgufebSi asakis mixedviT.
cocxal da gardacvlil pacientTa jgufebSi avadmyofTa
ganawilebis Seswavlam daavadebis arsebobis xangrZlivobis
mixedviT gviCvena, rom 1-dan 3 Tvemde anamnezis mqone
pacientebidan sicocxlis 2 wliani barieri gadalaxa 11-ma
avadmyofma, ramac 26,8% Seadgina. 3-dan 6 Tvemde anamnezis
mqone avadmyofebidan 2 wliani gamojansaReba miRweul iqna
79,5%-Si (66 avadmyofi 83-dan), xolo 6 Tvidan 1 wlamde
anamnezis mqone avadmyofebidan 2 welze meti icocxla 5-ma
(22,7%) pacientma. avadmyofTa ganawileba cocxal da
85
gardacvlil pacientTa jgufebSi daavadebis arsebobis
xangrZlivobis mixedviT warmodgenilia diagrama # 3-ze.
diagrama 3. zeda ybis wiaRis avTvisebiani simsivneebiT daavadebul
avadmyofTa ganawileba cocxal da gardacvlil pacientTa jgufebSi
daavadebis arsebobis xangrZlivobis mixedviT.
simsivnis morfologiuri Senebis Seswavlam cocxal da
gardacvlil avadmyofTa jgufebSi gviCvena, rom epiTeluri
warmoSobis simsivneebis mqone 132 avadmyofidan I klinikur
jgufSi aRmoCnda 74 (56,06%) avadmyofi, aqedan:
maRaldiferencirebuli brtyelujredovani kiboTi 37-ma
gadalaxa 2 wliani barieri, rac Seadgens 74%-s; saSualo
diferncirebis brtyelujredovani kibos dros es ricxvi
86
mcirdeba 41,6%-de (5 avadmyofi 12-dan) da dabali
diferencirebis brtyelujredovani kibos dros ki ar
aRemateba 38,8%-s (7 avadmyofi 18-dan); adenokarcinomas dros
am ricxvma 47,4% (9 avadmyofi 19-dan) Seadgina;
cilindrujredovani kiboTi daavadebuli avadmyofebidan 2
wliani barieri 23-dan 16-ma (69,6%) pacientma gadalaxa.
cxrili # 17
zeda ybis wiaRis avTvisebiani simsivneebiT daavadebul avadmyofTa ganawileba morfologiuri Senebis mixedviT.
morfologiuri formebi
avadmyofTa
saerTo
reodenoba
cocxalia
2 weli da meti
gardaicvala
2 wlamde
epiTeluri simsivneebi 132 90,4% 74 56,06% 58 43,94%
brtyelujredovani kibo 90 61,64% 49 54,44% 41 45,56%
maRaldiferencirebuli 50 34,24% 37 74% 13 26%
saSualo diferencirebis 12 8,21% 5 41,6% 7 58,4%
dabaldiferencirebuli 18 12,32% 7 38,8% 11 61,2%
adenokarcinoma 19 13,01% 9 47,37% 10 52,63%
cilindroma 23 15,7% 16 69,57% 7 30,43%
araepiTeluri simsivneebi 14 9,58% 8 57,14% 6 42,86%
limfosarkoma 9 6,16% 8 88,9% 1 11,1%
angio, qondro da
osteosarkomebi 5 3,42% 0 _ 5 100%
sul 146 82 56,16% 43,84% 64
araepiTeluri warmoSobis simsivneebis mqone 14
avadmyofidan I da II klinikur jgufebSi gamovlinda
87
pacientebis Semdegi ganawileba: limfosarkomiT daavadebuli
9 avadmyofidan 2 wliani gamojansaReba miRweul iqna 8
SemTxvevaSi, ramac 88,9% Seadgina, xolo angio, qondro da
osteosarkomebis dros es ricxvi 0-s utoldeba (ix. cxril #
17).
avadmyofTa ganawilebam or klinikur jgufSi simsivnis
sawyisi lokalizaciis mixedviT gviCvena, rom 14 (9,59%)
SemTxvevaSi aRiniSna simsivnis lokalizacia haimoris Rrus
zeda _ ukana naxevarSi. maTgan 2 welze meti icocxla 9
(64,29%) pacientma. maSin, rodesac qveda _ wina naxevrSi
lokalizebuli simsivneebiT daavadebuli 21 (14,38%)
pacientidan 85,71%-ma (18 avadmyofi) pacientma gadalaxa
sicocxlis or wliani barieri. 111 (76,03%) SemTxvevaSi ver
moxerxda simsivnis sawyisi lokalizaciis dadgena
adgilobrivad gavrcelebuli procesebis gamo. am
pacientebidan sicocxlis or wliani zRvari gadalaxa 55
(49,55%) avadmyofma. avadmyofTa ganawileba cocxal da
gardacvlil pacientTa jgufebSi simsivnis sawyisi
lokalizaciis mixedviT warmodgenilia diagrama # 4-ze.
88
diagrama 4. zeda ybis wiaRis avTvisebiani simsivneebiT daavadebul
avadmyofTa ganawileba simsivnis pirvelwarmoqmnis keris
lokalizaciis mixedviT.
cocxal da gardacvlil pacientTa jgufebis analizma,
simsivnis stadiurobis gaTvaliswinebiT gviCvena, rom am or
parametrs Soris aris pirdapiri damokidebuleba.
stadiurobis maCveneblis matebasTan erTad
pirdapirproporciulad izrdeba gardacvlil avadmyofTa
ricxvi. Cveni monacemebiT I_II stadiis mqone 27 pacientidan
mxolod 4 gardaicvala pirveli 2 wlis ganmavlobaSi,
cocxalia 85,2% avadmyofebis maSin, rodesac III stadiis mqone
59 avadmyofidan 2 welze meti icocxla 69,5% pacientebisa,
89
xolo IV stadiis mqone 60 avadmyofidan mxolod 18 pacientma,
ramac 30% Seadgina. avadmyofTa ganawileba cocxal da
gardacvlil pacientTa jgufebSi stadiis mixedviT
warmodgenilia warmodgenilia diagrama # 5-ze.
diagrama 5. zeda ybis wiaRis avTvisebiani simsivneebiT daavadebul
avadmyofTa ganawileba stadiis mixedviT.
klinikurma dakvirvebebma gviCvena, rom Tu simsivnuri
procesi ar scildeba lorwovanis farglebs da ar iwvevs
wiaRis Zvlovani kedlebis destruqcias, daaxloebiT 93%-s
pacientebisa aqvs Sansi gadalaxon sicocxlis 2 wliani
barieri. simsivnis mier wiaRis Zvlovan kedlebis dazianebis
90
SemTxvevaSi gadarCenil avadmyofTa ricxvi ar aRemateba 13%-s.
avadmyofTa ganawileba cocxal da gardacvlil pacientTa
jgufebSi wiaRis Zvlovani kedlebis destruqciis mixedviT
warmodgenilia warmodgenilia diagrama # 6-ze.
diagrama 6. zeda ybis wiaRis avTvisebiani simsivneebiT daavadebul
avadmyofTa ganawileba wiaRis Zvlovani kedlebis destruqciis
mixedviT.
klinikurma dakvirvebebma aseve gviCvena, rom Tu
simsivnuri procesi lokalizebulia mxolod haimoris RruSi
da ar scildeba lorwovanis farglebs, daaxloebiT 84%-s
pacientebisa aqvs Sansi gadalaxon sicocxlis 2 wliani
barieri. maSin, rodesac simsivnuri procesi scildeba
91
haimoris Rrus farglebs da vrceldeba irgvlivmdebare
anatomiur struqturebze, es ricxvi mniSvnelovnad mcirdeba
da ar aRemateba 48,1%-s.
ase magaliTad, simsivnis cxviris savalSi gavrcelebisas
sicocxlis or wliani barieri gadalaxa 42-dan 24 (57,2%)
avadmyofma; procesis gavrcelebisas Tvalbudis qveda kideze
or wliani gamojansaReba 20 avadmyofidan aRiniSna 8
SemTxvevaSi, ramac 40% Seadgina, yvelaze kargi Sedegi
miRweul iqna simsivnis gavrcelebisas sasaze, am ricvma 85%
Seadgina.
cxrili # 18
zeda ybis wiaRis avTvisebiani simsivneebiT daavadebul avadmyofTa ganawileba cocxal da gardacvlil pacientTa jgufebSi sxvadasxva anatomiur struqturebze gavrcelebis mixedviT.
simsivnis gavrceleba
mimdebare anatomiur
struqturebze
avadmyofTa
saerTo
reodenoba
cocxalia
2 weli da
meti
gardaicvala
2 wlamde
marto haimoris Rru 38 26% 32 84,2% 6 15,8%
cxviris savalSi Cazrda 42 28,77% 24 57,14% 18 42,86%
sasa 20 13,7% 18 90% 2 10%
Tvalbude 19 13% 8 42,1% 11 57,9%
eTmoiduri wiaRi 3 2% _ _ 3 100%
loyis rbili qsovilebi 3 2% _ _ 3 100%
yvrimalis Zvali 10 6,8% - - 10 100%
saReWi kunTebi 9 6,1% - - 9 100%
frTasasis foso 2 2,74% - - 2 100%
sul 56,16% 82 64 146 43,84%
92
mkurnaloba praqtikulad uSedego aRmoCnda, rodesac
adgili hqonda simsivnuri procesis gavrcelebas loyis rbil
qsovilebze, saReW kunTebSi, yvrimalis Zvalsa da eTmoidur
wiaRSi, yvela gardaicvala pirveli ori wlis ganmavlobaSi.
avadmyofTa ganawileba cocxal da gardacvlil pacientTa
jgufebSi sxvadasxva anatomiur struqturebze gavrcelebis
mixedviT warmodgenilia cxril # 18-Si.
aRmoCnda, rom simsivnuri procesis gavrcelebisas
haimoris Rrus farglebs gareT erT mimdebare anatomiur
struqturaze, or wliani gamojansaReba Seadgens 79%-s.
simsivnis or mimdebare anatomiur struqturaze
gavrcelebisas es maCvenebeli iklebs 40%-mde. xolo, rac
Seexeba sam da met anatomiur struqturaze gavrcelebas, es
maCvenebeli radikaluri mkurnalobis miuxedavaT
katastrofulad mcirdeba da 17,2%-s ar aRemateba. avadmyofTa
ganawileba cocxal da gardacvlil pacientTa jgufebSi
mimdebare anatomiur struqturebze simsivnis gavrcelebis
mixedviT warmodgenilia diagrama # 7-ze.
93
diagrama 7. zeda ybis wiaRis avTvisebiani simsivneebiT daavadebul
avadmyofTa ganawileba cocxal da gardacvlil pacientTa jgufebSi
mimdebare anatomiur struqturebze gavrcelebis masStabebis
mixedviT.
cocxal da gardacvlil pacientTa jgufebSi avadmyofTa
ganawilebis Seswavlam regionuli metastazirebis
Taviseburebebis mixedviT gviCvena, rom pacientebs, romelTac
mkurnalobis dawyebamde regionuli metastazebi ar
aReniSnebodaT, ori weli da meti cocxalia 63,7%. rac Seexeba
pacientebs, sadac gamovlenil iqna erTeuli regonuli
metastazebi, es ricxvi mniSvnelovnad mcirdeba da ar
aRemateba 16,7%-s, xolo ormxrivi regionuli metastazebis
SemTxvevaSi or wliani gamojansaReba praqtikulad nuls
94
utoldeba. avadmyofTa ganawileba cocxal da gardacvlil
pacientTa jgufebSi regionuli metastazirebis mixedviT
warmodgenilia diagrama # 8-ze.
diagrama 8. zeda ybis wiaRis avTvisebiani simsivneebiT daavadebul
avadmyofTa ganawileba cocxal da gardacvlil pacientTa jgufebSi
regionuli metastazirebis mixedviT.
haimoris Rrus kliniko-morfologiur gamovlinebaTa
ganawileba cocxal da gardacvlil avadmyofTa jgufebSi
warmodgenilia grafik # 9-ze.
95
grafiki 9. zeda ybis wiaRis avTvisebiani simsivneebis kliniko-
morfologiur gamovlinebaTa ganawileba cocxal da gardacvlil
pacientTa jgufebSi.
96
Cvens mier sxvadasxva meTodebiT namkurnaleb avadmyofTa
ganawilebis Seswavlam cocxal da gardacvlil pacientTa
jgufebSi gviCvena, rom konsevatuli mkurnalobis Semdeg 65
pacientidan 2 weli da meti icocxla 50 (76,9%) avadmyofma,
aqedan recidivebiTa da metastazebiT or wliani barieri
gadalaxa 5 (10%) avadmyofma.
kombinirebuli mkurnalobis Semdeg, romelic
gamoyenebul iqna 51 (34,9%) SemTxvevaSi, pirvel klinikur
jgufSi aRmoCnda 23 (45%) pacienti. rac Seexema 15 (10,3%)
avadmyofs, romlebsac intraoperaciiulad, diagnostikis
mizniT, jer CautardaT biofsia, xolo Semdgom zeda ybis
eleqtrorezeqcia, sicocxlis or wliani barieri gadalaxa 9
(60%) pacientma. avadmyofTa ganawileba cocxal da
gardacvlil pacientTa jgufebSi mkurnalobis meTodebis
mixedviT warmodgenilia cxril # 19-Si.
cxrili # 19
zeda ybis wiaRis avTvisebiani simsivneebiT daavadebul avadmyofTa
ganawileba cocxal da gardacvlil pacientTa jgufebSi
mkurnalobis meTodebis mixedviT
mkurnalobis meTodebi
avadmyofTa
saerTo
reodenoba
cocxalia
2 weli da meti
gardaicvala
2 wlamde
qimio-sxivuri Terapia 27 18,5% 23 85,2% 4 14,8%
sxivuri Terapia 38 26% 27 71% 11 29%
kombinirebuli mkurnaloba 51 34,9% 23 45% 28 55%
qirurgiuli mkurnaloba 15 10,3% 9 60% 6 40%
sul 146 82 56,16% 64 43,84%
97
imisaTvis, rom dagvedgina is maxasiaTeblebi, romlebic
mniSvnelovan zegavlenas axdenen daavadebis mimdinareobasa da
2 da 5 wlian gamosavlze, mizanSewonilad CavTvaleT,
miRebuli informacia dagvemuSavebina klasteruli analizis
meSveobiT, kerZod K-saSualoTa meTodiT. xolo statistikuri
sarwmunoebis Sesafaseblad ki, gamogveyenebina logariTmul-
wrfivi analizis meTodi.
maTematikuri kvlevis safuZvelze dadginda, rom
daavadebis gamosavlis prognozirebisaTvis 10 kliniko-
morfologiuri maxasiaTeblidan yvelaze informatiulia:
⎯ avadmyofTa asaki;
⎯ daavadebis arsebobis xangrZlioba;
⎯ simsivnis morfologiuri Seneba;
⎯ daavadebis gavrceleba;
⎯ Zvlovani kedlebis destruqcia;
⎯ metastazebis raodenoba, lokalizacia, da
zomebi.
cocxal da gardacvlil avadmyofTa jgufebis analizma
gviCvena, rom mkurnalobis damTavrebis Semdeg daavadebis
progresirebiT pirveli 2 wlis ganmavlobaSi gardaicvala
ZiriTadad is pacientebi, romelTa asaki aRemateboda 60 wels
(67,3%); sadac morfologiuri Seneba ZiriTadad
ganisazRvreboda adenokarcinomiT (72,3%), sxvadasxva
warmoSobis sarkomebiT (92%) an dabali diferencirebis
brtyelujredovani kiboTi (74,2%); iq sadac simsivne
98
vrceldeboda orze met anatomiur struqturaze (95,3%),
aRiniSneboda Zvlovani kedlebis sxvadasxva xarisxis
destruqcia (74,2%) da gamovlenili iyo mravlobiTi an
erTeuli regionuli metastazebi, romelTa zomebic
aRemateboda 3sm-s (88,9%).
suraTi 6. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis klasteruli analizi cocxal da gardacvlil pacientTa jgufebSi.
99
cxrili 20.
zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis logariTmul-wrfivi analizi cocxal da gardacvlil pacientTa jgufebSi.
statistikuri sarwmunoeba χ2 Pc1- c2 χ2 Pc1- c3 χ2 Pc2- c3
asaki 21,28 p<0,01 36,21 p<0,01 73,33 p<0,01
morfologia 52,63 p<0,01 141,44 p<0,01 165,22 p<0,01
destruqcia 12,37 p<0,01 52,21 p<0,01 71,94 p<0,01
gavrceleba 42,28 p<0,01 58,03 p<0,01 99,28 p<0,01
anamnezi 14,61 p<0,01 46,25 p<0,01 28,28 p<0,01
metastazireba 13,05 p<0,01 54,86 p<0,01 107,92 p<0,01
54,99 p<0,01 75,45 p<0,01 88,28 p<0,01 gadarCena
sicocxlis 2 wliani barieri, daavadebis progresirebis
niSnebis gareSe, ZiriTadad gadalaxes SedarebiT axalgazrda
(40-dan 50wlamde) asakis pacientebma (72,8%), sadac simsivnis
morfologiuri Seneba ganisazRvreboda brtyelujredovani
kiboTi (57,7%), limfosarkomiT (72,8%) an cilindromiT (75%),
sadac simsivnuri procesis gavrceleba ar aRemateboda 2
anatomiur struqturas (90%), haimoris Rrus Zvlovani
kedlebis destruqciis da regionuli limfuri kvanZebis
dazianebis gareSe (83,6%), an erTeuli regionuli limfuri
kvanZis metastazuri dazianebisas, romlTa zomebi ar
aRemateboda 3sm-s (13,3%).
sicocxlis 5 wliani barieri, daavadebis progresirebis
niSnebis gareSe, ZiriTadad gadalaxes axalgazrda (30wlamde)
asakis pacientebma (80%), sadac simsivnis morfologiuri
Seneba ganisazRvreboda brtyelujredovani kiboTi (60%), an
100
cilindromiT (35%), sadac simsivne ar scildeboda wiaRis
farglebs da ar aRiniSneboda Zvlovani kedlebis destruqcia
da regionuli metastazebi.
cocxal da gardacvlil avadmyofTa jgufebSi
mkurnalobis meTodebis efeqturobis analizma klasteruli
meTodis gamoyenebiT gviCvena, rom arsebobs pacientTa jgufi,
sadac miuxedavad gamoyenebuli mkurnalobis meTodebisa
(konservatiuli, qirurgiuli da kombinirebuli), miRweul iqna
avadmyofTa sruli gamojansaReba. es jgufi Seadgines
pacientebma, romelTac morfologiurad aReniSnebidaT
limfosarkoma (88,9%), cilindroma (65,2%), da
brtyelujredovani kibo (60%); simsivne ar scildeboda wiaRis
farglebs (100%) an vrceldeboda erT mimdebare anatomiur
struqturaze (86,8%); Zvlovani kedlebis destruqciis da
regionuli metastazebis gareSe; daavadebis arsebobis
xangrZlivobiT 1-dan 6 Tvemde.
II jgufSi gaerTiandnen pacientebi, romelTac
kombinirebuli mkurnalobis I an II etapze aucileblad
esaWiroebaT qirurgiuli Carevis ganxorcieleba
kombinirebuli an kombinirebul-gafarToebuli operaciebis
saxiT. am jgufis pacientebs morfologiurad ZiriTadad
aReniSnebodaT brtyelujredovani kibo (31,2%) da
adenokarcinoma (78,9%); daavadebis gavrcelebiT 2 da met
mimdebare anatomiur organoze; haimoris Rrus Zvlovani
kedlebis destruqciiT an destruqciis gareSe; avadmyofTa
87% ar aReniSnebodaT regionuli limfuri kvanZebis
101
metastazuri dazianebebi; xolo daavadebis arsebobis
xangrZlivoba varirebda 1-dan 6 Tvemde.
suraTi 7. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis klasteruli analizi, mkurnalobis arsebuli meTodebis adeqvaturobis Sefasebis mizniT, cocxal da gardacvlil pacientTa jgufebSi.
cxrili 21. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis logariTmul-wrfivi analizi, mkurnalobis arsebuli meTodebis adeqvaturobis Sefasebis mizniT, cocxal da gardacvlil pacientTa jgufebSi.
statistikuri sarwmunoeba χ2 Pc1- c2 χ2 Pc1- c3 χ2 Pc2- c3
morfologia 190,03 p<0,01 52,92 p<0,01 172,75 p<0,01
destruqcia 33,26 p<0,01 34,48 p<0,01 98,58 p<0,01
gavrceleba 82,61 p<0,01 65,03 p<0,01 120,93 p<0,01
anamnezi 27,02 p<0,01 56,65 p<0,01 14,71 p<0,01
metastazireba 105,41 p<0,01 84,96 p<0,01 125,5 p<0,01
109,18 p<0,01 62,7 p<0,01 mkurnaloba 137,63 p<0,01
102
da bolos, gamovlenil iqna prognostuli TvalsazrisiT
absoluturad uperspeqtivo pacientTa jgufi mkurnalobis im
tradiciuli meTodebisaTvis, romlebic gamoiyeneba
Tanamedrove onkologiaSi. III jgufis pacientebs ZiriTadad
aReniSnebodaT simsivnis gavrceleba 4 mimdebare anatomiur
struqturamde, wiaRis Zvlovani kedlebis destruqciebiT;
avadmyofTa 71,2%-s gamouvlinda erTeuli da mravlobiTi
regionuli metastazuri dazianebebi; xolo daavadebis
arsebobis xangrZlivoba ZiriTadad Seadgenda 1-3Tves (42%) da
6-12 Tves (51%). yovelive es metyvelebs imis Sesaxeb, rom
aRniSnuli kontingentis pacientTa mkurnalobisaTvis
SemuSavebuli da gamoyenebuli unda iqnas axali, jer kidev
araaprobirebuli meTodebi.
amrigad, miRebuli informacia sarwmunoebis maRali
albaTobiT iZleva zeda ybis avTvisebiani simsivneebiT
daavadebul avadmyofTa mkurnalobis efeqturobisa da
daavadebis gamosavlis prognozirebis saSualebas. aRniSnuli
informaciis gamoyeneba avadmyofTa mkurnalobis meTodebis
SerCevisas saSualebas mogvcems mniSvnelovnad avamaRloT
mkurnalobis, rogorc uSualo, aseve Soreuli Sedegebi.
103
Tavi V
miRebuli Sedegebis gansja
zeda ybis wiaRis avTvisebiani simsivneebi xasiaTdeba
usimptomo mimdinareobiT, rac ganapirobebs avadmyofTa 80%-is
momarTvas specializirebul onkologiur dawesebulebebSi
simsivnis gavrcelebuli (III-IV stadia) procesebiT (Bridger GP,
Mendelsohn MS, Baldwin M. 1991; Jeff H. Kim T. 1993). ris gamoc, maTi
mkurnaloba erTerT rTul da jer kidev gadauWrel
problemad rCeba (Markola A.T., Aronen H.J., Paavonen T. 1996; Phillips
C.D., Futterer S.F., Lipper M.H. 1997). erTis mxriv, es ganpirobebulia
haimoris Rrus agebulebis anatomiuri TaviseburebebiT. xolo
meores mxriv, misi ganlagebiT saxis ConCxis siRrmeSi da
uSualo siaxloviT sasicocxlo organoebTan. yovelive es
arTulebs, rogorc sxivuri energiis maqsimaluri dozebiT
gamoyenebas, aseve radikaluri operaciis warmoebas. magram
miuxedavad amisa, miRebuli Sedegebis efeqturobis analizi
gviCvenebs, rom bolo erTi saukunis ganmavlobaSi, aRniSnuli
daavadebis mkurnalobaSi mainc miRweulia mniSvnelovani
progresi. gadarCenil avadmyofTa ricxvi 5%-dan gaizarda
46%-mde, rac udaod teqnikurma progresma da mkurnalobisadmi
diferencialurma midgomam ganapiroba (Aisen A.M., Martel. W.,
Braunstein E.M., Mcmillen K.I., Phillips W.A. 1986; Atlas S.W., Grossman R.J.,
Gomori J.N., Guerry D., Hackney D.B. 1987; Annis J.A., Phelps P.D., 1989;
Antilia J., Sonnien P., Grenman R. 1993; Шацкая Н.Х. 1993; Черекаев В.А.
1995; Сдвижков А.М. 1997).
104
avtorTa erT nawils miaCniaT, rom (Юшманов В. Е., Янцев В.
И., Плющ А.Л., Соколова И.С., Горбачева Л.Б., Сибельдина Л.А., Эмануель
Н. М. 1985), tele-gamaTerapia sruliad sakmarisia I-II stadiebis
mqone pacientTa samkurnalod. meoreni ki (Shibnya H., Horinhi J.,
Suzuki S. et al. 1984;Tsujii H., Kamada T., Arimoto T. et al 1986; J. Parsons
1988) Tvlian, rom tele-gamaTerapia, rogorc mkurnalobis
damoukidebeli meTodi, naklebefeqturia da gamoiyenebul
unda iqnas kombinirebuli mkurnalobis pirvel etapze an
paliatiuri mizniT inoperabelur pacientebSi.
Ю. И. Воробьев-is da И. П. Саранцева-s azriT (1982w), sxivuri
Terapia zeda ybis wiaRis kibos dros efeqturia maSin,
rodesac gamoiyeneba dasxivebis adeqvaturi meTodika da
gaTvaliswinebulia simsivnis gavrceleba, misi zrdis forma
da morfologiuri struqtura. am avtorTa monacemebiT 3 da 5
wlianma gamojansaRebam Sesabamisad 61 da 48 procenti
Seadgina.
Shidnia H., Hornbak N., Saghafi N-s (1984w) miaCniaT, rom sxivuri
Terapiis efeqturoba didad aris damokidebuli simsivnis
morfologiur Senebaze. kerZod, sxivuri energiisadmi
maRalmgrZnobiareni arian limfoepiTeliomebi,
limfosarkomebi, romlebic sxivuri energiis arc Tu ise didi
dozebiT mkurnalobis Semdeg mTlianad alagdebian xolme.
rac Seexeba brtyelujredovan kibos da adenokarcinomebs, maT
samkurnalod ufro didi dozebia saWiro. xolo osteo,
qondro, fibro, sarkomebi TiTqmis rezistentulni arian
105
sxivuri energiis mimarT (Zinreich SJ, Kennedy DW, Kumar AJ,
Rosenbaum AE , Arington JA,Johns ME. 1988; Som P.M., Lidov M. 1994).
Г. Г. Кудрявцев-ma da В. О. Ольшанский-im (1991w) zeda ybis
avTvisebiani simsivneebis mkurnalobis efeqturobis amaRlebis
mizniT gamoiyenes qimio-sxivuri mkurnaloba. medikamentozuri
preparatebidan ZiriTadad iyenebdnen metotreqsats, xolo
dabaldiferencirebuli simsivneebis SemTxvevaSi vinkristins
ciklofosfanTan erTad. simsivnis sruli regresia aRiniSna
66,7%-Si. 3 wlianma sicocxlis xangrZlivobam Seadgina 45%,
xolo 5 wlianma _ 34,3%.
dReisaTvis zeda ybis avTvisebiani simsivneebis
samkurnalod farTod gamoiyeneba platinis preparatebis da
sxivuri Terapiis kombinacia: bleocinTan, ciklofosfanTan da
adriamicinTan, 5-ftoruracilTan erTad. yvela avtori
aRniSnuli Terapiis Sedegad afiqsirebes karg klinikur
efeqts (R. Errington 1986; Chobe R, McNeese M, Weber R, Fletcher GH.
1988).
magram miuxedavad amisa, jer kidev xSiria konservatuli
Terapiis aradamakmayofilebeli Sedegebi, rac ganapirobebs
qirurgiuli Carevis aucileblobas, eleqtroqirirgiuli
meTodis gamoyenebiT (Gollin FF, Ansfield FJ, Brandenburg JH, Ramirez G,
Vermund H. 1972; Glick JH, Marcial V, Richter M, Velez-Garcia E. 1980;
Laramore GE, Scott CB, Schuller DE, Haselow RE, Ervin TJ 1992; Wheeler R,
Al-Sarraf M, Gahbauer RA, Jacobs JR, Schwade JG, Campbell BH. 1993;).
Adelstein DL, Kalish LA, Adams GL, Wagner H, Oken MM, Remick SC-is
106
(1993w) am meTodis gamoyeneba mniSvnelovnad zrdis
qirurgiuli Carevis radikalizms da sagrZnoblad amcirebs
regionuli metastazebis da recidivirebis ganviTarebis
sixSires.
bolo wlebSi sazRvargareTul publikaciebSi gamoCnda
monacemebi sxivuri, qirurgiuli, kombinirebuli da
kompleqsuri mkurnalobebis efeqturobis Sesaxeb, romelTa
Sedegebsac isini procesis lokalizacias, daavadebis
gavrcelebasa da morofologiur struqturasTan
urTierTkavSirSi ganixilaven (W. Mann, C. Schuler-Vaith 1983).
magram yvela avtori aRniSnavs, rom zeda ybis gavrcelebuli
kibos mkurnalobis Semdeg recidivebis ricxvi mainc maRali
rCeba da 58-80%-s Seadgens (H. Thiel, G. Pettinger 1986; Browman GP,
Goodyear MD, Levine MN, Russell R, Archibald SD, Young JE 1990).
amrigad, warmodgenili masalidan naTlad Cans, rom
miuxedavaT mniSvnelovani klinikuri gamocdilebisa, jer
kidev ar aris dasabuTebulad warmodgenili erToblivi
koncefcia zeda ybis kibos mkurnalobis Sesaxeb daavadebis
mimdinareobis, morfologiuri Senebis da sxva klinikur
TaviseburebaTa gamovlinebis gaTvaliswinebiT. ufro metic,
ar iyo dasmuli sakiTxi imis Sesaxeb, Tu romeli kliniko-
morfologiuri maxasiaTeblebis erToblioba ganapirobebs
mkurnalobis tradiciuli meTodebis gamoyenebis SemTxvevaSi
damakmayofilebeli, an aradamakmayofilebeli Sedegebis
miRwvas da aqedan gamomdinare, axdens zemoqmedebas daavadebis
gamosavalsa da prognozze. CvenTvis xelmisawvdom
107
literaturaSi, aseve ver iqna moZiebuli sistematizirebuli
monacemebi mkurnalobis individualuri sqemebis da taqtikis
arCeva-SemuSavebaze simsivnis sxvadasxva parametrebis
gaTvaliswinebiT. aseTi individualuri midgoma Cvenis azriT
xels Seuwyobs mkurnalobis efeqturobis amaRlebas.
aRniSnuli sakiTxis gadasaWrelad Cvens mier
gaanalizebulia haimoris wiaRis kiboTi daavadebuli 146
avadmyofis monacemebi, romlebsac CautardaT mkurnaloba
saqarTvelos prof. a. RvamiCavas saxelobis onkologiis
nacionaluri centris Tav-kisris simsivneebis ganyofilebaSi
1985-2000 wlebSi.
mTeli informacia pacientebis Sesaxeb: daavadebis
mimdinareobis, morfologiuri Senebis, procesis gavrcelebis,
metastazirebis, konservatiuli mkurnalobisa da
ganxorcielebuli operaciebis masStabebis da mkurnalobis
Sedegebis Sesaxeb gadagvqonda Cvens mier Seqmnil specialur
ruqa-kodifikatorebze, romlebic SemdgomSi eqvemdebarebodnen
statistikur damuSavebas. am mizniT Cvens mier gamoyenebul
iqna statistikuri kvlevis klasteruli da logariTmul-
wrfivi analizis meTodebi. gamoTvlebs vawarmoebdiT
statistikur programul paket STATISTIKA 6-is operaciul
areSi.
Catarebuli mkurnalobis meTodebis efeqturobis
gansazRvris mizniT Cvens mier namkurnalebi 146 avadmyofi
ganawilebul iqna 4 klinikur jgufSi.
108
I jgufi _ Seadgina 44 (28,7%) pacientma, romelTac
mkurnalobis pirvel etepze CautardaT qimio-sxivuri Terapia;
qimioTerapia ZiriTadad atarebda sistemuri
poliqimioTerapiis saxes. 44 pacientidan mamakaci iyo 26 (59%),
xolo 18 (41%) ki _ qali; TNM klasifikaciis mixedviT T2
gavrcelebis simsivne daudginda 7 (16%) pacients, T3 _ 15-s
(34%) da T4 gavrcelebis _ 22-s (50%); 9 (20,5%) avadmyofs
gamouvlinda calmxrivi regionuli metastazebi, aqedan 7
(77,8%) SemTxvevaSi erTeuli, xolo 2-Si (22,2%) ki _
mravlobiTi.
Catarebuli poliqimiaTerapiuli mkurnalobis Semdgom
simsivnis sruli regresia miRweul iqna SemTxvevaTa 29,5%-Si
(13 avadmyofi), 50 da meti procentiT _ 12 (27,3%) SemTxvevaSi,
xolo 16-Si (36,4%) _ igi uSedego aRmoCnda. aRniSnuli jgufis
yvela avadmyofs mkurnalobis meore etapze gaugrZelda
sxivuri Terapia jamuri doziT 70gr-mde. sxivuri Terapiis
Semdeg mniSvnelovnad gaizarda simsivnis 100%-iani anu sruli
rezorbciis Sedegebi (29,5%-dan 61,4%-mde). simsivnis regresia
50 da meti procentiT miRweul iqna 8 (18,2%) SemTxvevaSi da
mxolod 9-Si (20,4%) igi aRmoCnda uSedego.
27 avadmyofidan, romlebsac qimio-sxivuri mkurnalobis
Sedegad miRweul iqna simsivnis sruli rezorbcia,
sicocxlis 2 wliani barieri daavadebis progresirebis
niSnebis gareSe gadalaxa 19 avadmyofma, ramac 70,3% Seadgina,
xolo, 8 (29,7%) avadmyofs, aReniSna daavadebis progresirebis
niSnebi.
109
sxvadasxva SedegiT namkurnaleb avadmyofTa jgufebSi
Catarebulma klasterulma analizma gviCvena, rom simsivnis
100%-iani regresia ZiriTadad miRweuli iqna (74%) axalgazrda
da saSualo asakis (30-50w) pacientebSi, romelTac daudgindaT
daavadebis arsebobis xangrZlivoba 1-dan 6 Tvemde (82%);
morfologiuri Seneba ganisazRvreboda brtyelujredovani
kiboTi (59%), limfosarkomiT (89%) an cilindromiT (66%),
romelTa gavrceleba varirebda araumetes 1 anatomiuri
struqturisa (92,6%), haimoris Rrus Zvlovani kedlebis
destruqciis da regionuli limfuri kvanZebis dazianebis
gareSe (96,3%).
avadmyofTa im jgufSi, sadac konservatulma
mkurnalobam Sedegi ver gamoiRo, pacientTa asaki meryeobda
55-dan 74 wlamde (77,8%); romelTa daavadebis arsebobis
xangrZlivoba, ar aRemateboda 3 Tves (66,7%); daavadebis
morfologiiuri Seneba ganisazRvreboda adenokarcinomiT
(68%) an sxvadsxva warmoSobis sarkomebiT (75%) (angio,
qondro da osteosarkomebi); simsivne vrceldeboda or da met
mezobel anatomiur struqturaze (82,4%); aRiniSneboda
Zvlovani kedlebis sxvavasxva xarisxis destruqcia (72,3%);
mravlobiTi an erTeuli regionuli metastazebi, romelTa
zomebi aRemateboda 3sm-s (17,8%).
II jgufi _ am jgufSi gaerTianebul iqna is 87 avadmyofi,
romlebsac mkurnalobis pirvel etapze CautardaT sxivuri
Terapia. 87 pacientidan mamakaci iyo 55 (63,2%), 32 (36,8%) ki _
qali; TNM klasifikaciis mixedviT T2 gavrcelebis simsivne
110
daudginda 7 (8%) pacients, T3 _ 46-s (52,9%) da T4 gavrcelebis
_ 34-s (39,1%); 18 (20,7%) avadmyofs gamouvlinda regionuli
metastazebi, aqedan 11-s (61,1%) erTeuli, xolo 7-s (38,9%)
mravlobiTi. yvela avadmyofs utardeboda sxivuri Terapia
wyvetili kursiT, I etapze pacienti sxivdeboda 40gr-s
odenobiT, xolo, II-ze, orkviriani Sesvenebis Semdeg 30gr-s
odenobiT. dasxivebis jamuri doza ar aRemateboda 70gr-s.
sxivuri mkurnalobis I etapis (40gr) Catarebis Semdeg,
simsivnis 100%-iani regresia miRebul iqna 17 SemTxvevaSi
(19,5%), 22-s (25,3%) aReniSna simsivnis regresia 50 da meti
procentiT, xolo 48 (55,2%) SemTxvevaSi mkurnaloba aRmoCnda
araefeqturi. mkurnalobis II etapis (30gr) Catarebis Semdeg,
simsivnis sruli rezorbcia aRiniSna 38 SemTxvevaSi, ramac
43,7% Seadgina. simsivnis regresia 50 da meti procentiT
miRweul iqna 12 (13,8%) SemTxvevaSi da mxolod 37-Si (42,4%)
igi aRmoCnda uSedego.
38 avadmyofidan, romlebsac sxivuri mkurnalobis
Sedegad miRweul iqna simsivnis sruli rezorbcia,
sicocxlis 2 wliani barieri daavadebis progresirebis
niSnebis gareSe gadalaxa 22 avadmyofma, ramac 57,9% Seadgina,
xolo 16 (42,1%) avadmyofs aReniSna daavadebis progresirebis
niSnebi pirveli ori wlis ganmavlobaSi.
Catarebuli maTematikuri kvlevis safuZvelze dadginda,
rom simsivnis 100%-iani regresia ZiriTadad miRweul iqna
SedarebiT axalgazrda (30-50weli) asakis pacientebSi (85,7%),
sadac daavadebis arsebobis xangrZlivoba Seadgenda 3-dan 6
111
Tves (86,5%); simsivnis morfologiuri Seneba ganisazRvreboda
brtyelujredovani kibos dabaldiferencirebuli formiT
(64%) an cilindromiT (84,6%), romelTa gavrceleba
varirebda araumetes 1 anatomiuri struqturisa (97,8%),
haimoris Rrus Zvlovani kedlebis destruqciis da regionuli
limfuri kvanZebis dazianebis gareSe.
konservatuli mkurnaloba uSedego aRmoCnda ZiriTadad
pacientTa im jgufSi, romelTa asaki meryeobda 50-dan 70
wlamde (78,6%); sadac daavadebis arsebobis xangrZlivoba
Seadgenda 1-dan 3 da 6-dan 12 Tvemde periods (87,3%);
morfologiuri Seneba ZiriTadad ganisazRvreboda
adenokarcinomiT (70%) an maRali diferencirebis
brtyelujredovani kiboTi (50%); iq sadac simsivne
vrceldeboda orze met anatomiur struqturaze (69,3%),
aRiniSneboda Zvlovani kedlebis sxvavasxva xarisxis
destruqcia (76,9%) da gamovlenili iyo mravlobiTi an
erTeuli regionuli metastazebi romelTa zomebic
aRemateboda 3sm-s (19%).
III jgufi _ am jgufSi gaerTianebul iqna 51 avadmyofi im
65 pacientidan, romelTac Catarebuli konservatuli
mkurnalobis Semdeg aReniSnebodaT narCeni simsivne. 14-ma
avadmyofma SeTavazebul operaciul mkurnalobaze uari
ganacxada, ris gamoc, isini gadayvanil iqnen simptomur
Terapiaze.
51 avadmyofidan 2 (3,9%) SemTxvevaSi ganxorcielebul
iqna zeda ybis tipiuri eleqtrorezeqcia, xolo 40-Si (78,4%) _
112
kombinirebuli da 9-Si (17,7%) _ kombinirebul-gafarToebuli
operaciebi. maTgan mamakaci iyo 28 (54,9%), 23 (45,1%) ki _ qali;
TNM klasifikaciis mixedviT T3 gavrcelebis simsivne
daudginda 16 (31,4%) pacients, xolo T4 gavrcelebis 35-s
(68,6%); 9 (17,6%) avadmyofs gamouvlinda 3 sm-de zomis
erTeuli regionuli metastazebi, aqedan 4-s (44,5%) ybisqveSa
samkuTxedSi, 3 (33,3%) saZile samkuTxedSi, xolo 2 (22,2%)
kisris Sua mesamedSi.
daavadebis gavrcelebidan gamomdinare, Cvens mier 29
(59,2%) SemTxvevaSi zeda ybasTan erTad rezecirebil iqna I da
II mimdebare anatomiur struqtura; xolo 20 SemTxvevaSi
(40,8%) ganxorcielda zeda ybis rezeqcia III da met mimdebare
anatomiur struqturasTan erTad; 9 (17,6%) avadmyofidan,
romlebsac aReniSnebodaT regionuli limfuri kvanZebis
metastazuri dazianeba 6-s (66,7%) Cautarda kisris limfuri
kvanZebis fascialur-futliaruli amokveTa, xolo 3-s (33,3%)
krailis tipis operacia.
am avadmyofebidan sicocxlis or wliani barieri
daavadebis progresirebis niSnebis gareSe gadalaxa 20 (39,2%)
pacientma. xolo 31 (60,8%) avadmyofs aReniSna daavadebis
progresirebis niSnebi pirveli ori wlis ganmavlobaSi.
Catarebuli klasteruli analizis safuZvelze dadginda,
rom sicocxlis 2 wliani barieri daavadebis progresirebis
niSnebis gareSe ZiriTadad gadalaxes SedarebiT axalgazrda
(30-50weli) asakis pacientebma (77,2%), romelTac
morfologiurad aReniSnebodaT brtyelujredovani kibos
113
maRalferencirebuli forma (76,5%) da cilindroma (83,4%),
daavadebis gavrcelebiT araumetas ori (81,8%) anatomiuri
struqturisa da regionuli limfuri kvanZebis dazianebis
gareSe.
daavadebis progresireba ZiriTadad aReniSnebodaT 50-dan
70 wlamde (77,3%) asakis avadmyofebs; sadac morfologiurad
diagnostirebuli iyo dabali diferencirebis
brtyelujredovani kibo (68,3%) gavrcelebiT sam da met (80%)
anatomiur struqturaze, romelTac aReniSnebodaT 3 da meti
(77,8%) santimetris zomis regionuli metastazebi,
lokalizaciiT kisris zeda da Sua mesamedSi. aseve sxvadasxva
warmoSobis sarkomebi (80%) an adenokarcinoma (69,3%);
romelTa gavrceleba aRemateboda or (80%) anatomiur
struqturas regionuli limfuri kvanZebis dazianebis gareSe.
IV jgufi _ Seadgina 15 avadmyofma. pacientTa es jgufi
Camoyalibda Cvendauneburad, radgan miuxedavad Catarebuli
kvlevebisa ver moxerxda procesis morfologiuri
verifikacia, ris gamoc iZulebuli gavxdiT gvewarmoebina
haimorotomia biofsiuri masalis saswrafo morfologiuri
SeswavliT. aRniSnul jgufSi gaerTianebul iqna 10 (66,6%)
mamakaci da 5 (33,4%) qali; T1 gavrcelebis simsivne daudginda 4
(26,7%) pacients, T2 gavrcelebis 9-s (60%), xolo T3
gavrcelebis 2-s (13,3%); Zvlovani kedlebis destruqcia da
simsivnis gavrceleba wiaRis farglebs gareT gamovlenili ar
iyo. am jgufis avadmyofebidan daavadebis morfologiuri
verifikaciis Semdeg 3-s (20%) Cautarda zeda ybis nawilobrivi
114
rezeqcia, xolo 12 (80%) SemTxvevaSi Sesrulebul iqna ki zeda
ybis tipiuri eleqtrorezeqcia.
am avadmyofebidan sicocxlis or wliani barieri
daavadebis progresirebis niSnebis gareSe gadalaxa 9 (60%)
pacientma. xolo danarCen 6 (40%) avadmyofs aReniSna
daavadebis progresirebis niSnebi pirveli ori wlis
ganmavlobaSi.
Catarebuli klasteruli analizis safuZvelze dadginda,
rom daavadebis progresirebis niSnebi 2 wlis ganmavlobaSi
ZiriTadad ar aReniSnaT 50 wlamde asakis pacientebs (77,2%),
romelTac morfologiurad gamouvlindaT brtyelujredovani
kibo (50%) da adenokarcinoma (100%), simsivnis lokalizaciiT
wiaRis qveda-wina naxevarSi (96%), daavadebis arsebobis
xangrZlivobiT 3-dan 6 Tvemde.
daavadebis progresireba ZiriTadad aReniSnebodaT 50-dan
70 wlamde (77,3%) asakis avadmyofebs; sadac morfologiurad
gamovlinda dabali diferencirebis brtyelujredovani kibo
(68,3%) lokalizaciiT wiaRis zeda-ukana naxevarSi (87%);
Zvlovani kedlebis destruqciiT (67%) da daavadebis
arsebobis xangrZlivobiT 1-dan 3 Tvemde.
amrigad, maTematikuri kvlevis safuZvelze dadginda, rom
mkurnalobis efeqturobis prognozirebisaTvis 10 kliniko-
morfologiuri maxasiaTeblidan yvelaze informatiulia:
115
⎯ avadmyofTa asaki;
⎯ daavadebis arsebobis xangrZlioba;
⎯ simsivnis morfologiuri Seneba;
⎯ daavadebis lokalizacia da gavrceleba;
⎯ Zvlovani kedlebis destruqcia da misi xarisxi;
⎯ metastazebis raodenoba, lokalizacia, da zomebi.
vinaidan Cveni kvlevis meore mniSvnelovan mizans
warmoadgenda radikaluri mkurnalobis Semdgom daavadebis
gamosavlis prognozireba, kvlevis Semdgom etapze
mizanSewonilad CavTvaleT, dagvedgina informatiuli
kriteriumebi, romlebic ganapirobeben daavadebis
mimdinareobas. amisaTvis gadavwyviteT, 146 avadmyofis
monacemebi Segveswavla cocxal da gardacvlil avadmyofTa
jgufebSi. pirveli jgufi Seadgina 82 (56,16%) avadmyofma.
xolo meore jgufSi gaerTianebul iqna 64 (43,84%) pacienti,
romlebic gardaicvalnen radikaluri mkurnalobis
damTavrebidan pirveli ori wlis ganmavlobaSi.
Catarebulma kvlevam gviCvena, rom sicocxlis 2 wliani
barieri daavadebis progresirebis niSnebis gareSe ZiriTadad
gadalaxes SedarebiT axalgazrda (40-dan 50wlamde) asakis
pacientebma (72,8%), sadac simsivnis morfologiuri Seneba
ganisazRvreboda brtyelujredovani kiboTi (57,7%),
limfosarkomiT (72,8%) an cilindromiT (75%), sadac
simsivnuri procesis gavrceleba ar aRemateboda 2 anatomiur
struqturas (90%), haimoris Rrus Zvlovani kedlebis
destruqciis da regionuli limfuri kvanZebis dazianebis
116
gareSe (83,6%), an erTeuli regionuli limfuri kvanZis
metastazuri dazianebisas, romlTa zomebi ar aRemateboda
3sm-s (13,3%).
mkurnalobis damTavrebis Semdeg daavadebis
progresirebiT pirveli 2 wlis ganmavlobaSi gardaicvalnen
ZiriTadad is pacientebi, romelTa asaki aRemateboda 60 wels
(67,3%); sadac morfologiuri Seneba ZiriTadad
ganisazRvreboda adenokarcinomiT (72,3%), sxvadasxva
warmoSobis sarkomebiT (92%) an dabali diferencirebis
brtyelujredovani kiboTi (74,2%); iq sadac simsivne
vrceldeboda orze met anatomiur struqturaze (95,3%),
aRiniSneboda Zvlovani kedlebis sxvadasxva xarisxis
destruqcia (74,2%) da gamovlenili iyo mravlobiTi an
erTeuli regionuli metastazebi, romelTa zomebic
aRemateboda 3sm-s (88,9%).
cocxal da gardacvlil avadmyofTa jgufebSi
mkurnalobis meTodebis efeqturobis analizma klasteruli
meTodis gamoyenebiT mogvca saSualeba gamogveyo pacientTa 3
jgufi. I jgufi Seadgines avadmyofebma, sadac miuxedavaT
gamoyenebuli mkurnalobis meTodebisa (konservatiuli,
qirurgiuli da kombinirebuli), miRweul iqna sruli
gamojansaReba. am jgufSi aRmoCndnen pacientebi, romelTac
morfologiurad aReniSnebidaT limfosarkoma (88,9%),
cilindroma (65,2%) da brtyelujredovani kibo (60%); sadac
simsivne ar scildeboda wiaRis farglebs (100%) an
vrceldeboda erT mimdebare anatomiur struqturaze (86,8%)
117
Zvlovani kedlebis destruqciis da regionuli metastazebis
gareSe, daavadebis arsebobis xangrZlivobiT 1-dan 6 Tvemde.
II jgufSi gaerTiandnen pacientebi, romelTac
kombinirebuli mkurnalobis I an II etapze aucileblad
esaWiroebaT qirurgiuli Carevis ganxorcieleba
kombinirebuli an kombinirebul-gafarToebuli operaciebis
saxiT. am jgufis pacientebs morfologiurad ZiriTadad
aReniSnebodaT brtyelujredovani kibo (31,2%) da
adenokarcinoma (78,9%); daavadebis gavrcelebiT 2 da met
mimdebare anatomiur organoze; haimoris Rrus Zvlovani
kedlebis destruqciiT an destruqciis gareSe; avadmyofTa
87% ar aReniSnebodaT regionuli limfuri kvanZebis
metastazuri dazianebebi; xolo daavadebis arsebobis
xangrZlivoba varirebda 1-dan 6 Tvemde.
III jgufi Seadgines avadmyofebma, romlebic
prognostuli TvalsazrisiT aRmoCndnen absoluturad
uperspeqtivoni mkurnalobis im tradiciuli meTodebisaTvis,
rac gamoiyeneba Tanamedrove onkologiaSi. am jgufis
pacientebs ZiriTadad aReniSnebodaT angio, qondro da
osteosarkomebi (80%), simsivnis gavrcelebiT 4 mimdebare
anatomiur struqturaze, wiaRis Zvlovani kedlebis
destruqciebiT; maT 71,2% SemTxvevaSi gamouvlindaT erTeuli
an mravlobiTi regionuli limfuri kvanZebis metastazuri
dazianeba, romelTa zomebi aRemateboda 3sm-s; xolo
daavadebis arsebobis xangrZlivoba meryeobda 1-dan 3 (42%) da
6-dan 12 Tvemde (51%). yovelive es metyvelebs imis Sesaxeb, rom
118
aRniSnuli kontingentis pacientTa mkurnalobisaTvis
SemuSavebuli da gamoyenebuli unda iqnas axali, jer kidev
araaprobirebuli meTodebi.
amrigad, miRebuli informacia sarwmunoebis maRali
albaTobiT iZleva zeda ybis avTvisebiani simsivneebiT
daavadebul avadmyofTa mkurnalobis efeqturobisa da
daavadebis gamosavlis prognozirebis saSualebas. aRniSnuli
informaciis gamoyeneba avadmyofTa mkurnalobis meTodebis
SerCevisas saSualebas mogvcems mniSvnelovnad avamaRloT
mkurnalobis, rogorc uSualo, aseve Soreuli Sedegebi.
119
praqtikuli rekomendaciebi
1. zeda ybis avTvisebiani simsivneebi xasiaTdebian
klinikuri gamovlinebis mravalferovnebiT, romlebic
erTiandebian oTx ZiriTad jgufSi. pirveli jgufis
simptomebs otorinolaringologiuri ewodeba, esenia: cxviriT
sunTqvis gaZneleba, sixlian-serozuli gamonadeni, ynosvis
daqveiTeba, tkivili wiaRis midamoSi. meores nevrologiuri
(Tavis tkivili, neiropaTia, mgrZnobelobis moSla saxis
areSi); mesames stomatologiuri (trizmi, kbilis tkivili) da
meoTxes ofTalmologiuri (diplopia, mxedvelobis
daqveiTeba, egzofTalmi). aseve aRsaniSnavia, rom SesaZlebelia
arsebobdes am simptomTa ori an sami jgufis erTdrouli,
gadamkveTi gamovlinebani.
2. rodesac Cndeba eWvi zeda ybis avTvisebiani simsivnis
arsebobaze, aucilebelia avadmyofTa kompleqsuri gamokvleva,
rac gamoixateba kvlevaTa Semdeg TanmimdevrobaSi: zeda ybis
Zvlovani struqturebis palpacia; Semdeg xorcieldeba wina
rinoskopia, epifaringoskopia da zeda ybis rentgenografia;
cxvirxaxis da cxviris savalebis fibroskopia. Zvlovani
struqturebis mTlianobis dasadgenad kompiuteruli
tomografia; xolo simsivnis irgvlivmdebare rbil
qsovilebSi gavrcelebis gamosavlenad _ magnitur-
rezonansuli tomografia. simsivnis arsebobis SemTxvevaSi
kvleva sruldeba citologiuri an punqciuri biofsiis
warmoebiT.
120
3. mkurnalobis taqtikis SerCevisaTvis aucilebeli xdeba
gaTvaliswinebul iqnas iseTi kliniko-morfologiuri
maxasiaTeblebi, rogoricaa:
⎯ avadmyofTa asaki;
⎯ daavadebis arsebobis xangrZlioba;
⎯ simsivnis morfologiuri Seneba;
⎯ daavadebis lokalizacia da gavrceleba;
⎯ Zvlovani kedlebis destruqcia da misi xarisxi;
⎯ metastazebis raodenoba, lokalizacia, da zomebi.
4. mkurnalobis dasrulebis Semdeg mizanSewonilia,
yvela avadmyofi eqvemdebarebodes dinamiur dakvirvebas.
radgan daavadebis recidivebi da regionuli metastazebi 90%-
Si viTardeba pirveli ori wlis ganmavlobaSi.
121
daskvnebi
1. saqarTvelos onkologiuri centris bolo 15 wlis
monacemebiT zeda ybis wiaRis avTvisebiani simsivneebis
xvedriTi wona Tavisa da kisris onkologiur daavadebaTa
struqturaSi Seadgens 3,45%-s da igi 62,7%-Si xasiaTdeba
usimptomo mimdinareobiT, rac ganapirobebs 81,4%-Si pacientTa
momarTvas specializirebul onkologiur dawesebulebebSi T3
_ T4 gavrcelebis mqone simsivnuri procesebiT.
2. zeda ybis wiaRis avTvisebian daavadebaTa Soris wamyvani
adgili uWiravs epiTeluri warmoSobis simsivneebs (90,4%),
romelTa Sorisac ufro xSirad gvxvdeba sxvadasxva
diferencirebis brtyelujredovani kibo (68,2%), cilindroma
(15,8%) da adenokarcinoma (13%). araepiTeluri genezis
simsivneebis xvedriTi wona ar aRemateba 9,6%-s. maTgan
limfosarkoma gamovlenil iqna 6,2%-Si, xolo osteo, qondro
da angiosarkomebis ricxvi 3,4%-s ar aRemateba.
3. zeda ybis avTvisebiani simsivneebis kliniko-morfologiuri
maxasiaTeblebis maTematikurma analizma gviCvena, rom
mkurnalobis efeqturobis da daavadebis gamosavlis
prognozirebisTvis yvelaze informatiulia Semdegi
kriteriumebi: avadmyofTa asaki; daavadebis arsebobis
xangrZlioba; simsivnis morfologiuri Seneba; daavadebis
lokalizacia da gavrceleba irgvlivmdebare anatomiur
struqturebze; Zvlovani kedlebis destruqcia da misi
xarisxi; metastazebis raodenoba, lokalizacia, da zomebi.
122
4. pacientebSi, romelTac morfologiurad aReniSnebodaT
limfosarkoma, cilindroma da brtyelujredovani kibo;
rodesac simsivne ar scildeboda wiaRis farglebs an
vrceldeboda erT mimdebare anatomiur struqturaze,
Zvlovani kedlebis destruqciis da regionuli metastazebis
gareSe, daavadebis arsebobis xangrZlivobiT 6 Tvemde,
SesaZlebelia gamoyenebuli iqnas mkurnalobis rogorc
konservatiuli, aseve qirurgiuli da kombinirebuli meTodebi,
rac iZleva saSualebas mivaRwioT pacientTa srul
gamojansaRebas.
5. pacientebs, romelTac morfologiurad aReniSnebaT
brtyelujredovani kibo, adenokarcinoma an
SemaerTebelqsovilovani simsivneebi, daavadebis gavrcelebiT
2 da met mimdebare anatomiur struqturaze; haimoris Rrus
Zvlovani kedlebis destruqciiT an destruqciis gareSe;
regionuli limfuri kvanZebis metastazuri dazianebebis
gareSe an mcire zomis (>3sm) erTeuli reginuli metastazebiT,
aucileblad esaWiroebaT mkurnalobis pirvel an meore
etapze qirurgiuli Carevis ganxorcieleba.
6. avadmyofebi, romelTac aReniSnebodaT simsivnis gavrceleba
4 mimdebare anatomiur struqturaze wiaRis Zvlovani
kedlebis destruqciiT, erTeuli an mravlobiTi regionuli
limfuri kvanZebis metastazuri dazianebiT, romelTa zomebi
aRemateba 3sm-s; xolo daavadebis arsebobis xangrZlivoba
meryeobs 1-dan 12 Tvemde, prognostuli TvalsazrisiT
absoluturad uperspeqtivoni arian mkurnalobis im
123
tradiciuli meTodebis mimarT, romlebic gamoiyeneba
Tanamedrove onkologiaSi. aRniSnuli kontingentis
mkurnaloba unda xorcieldebodes protokoluri sistemiT,
samecniero kvleviT dawesebulebebSi axali, jer kidev
araaprobirebuli meTodebis gamoyenebiT.
7. mkurnalobis taqtikis SerCevisas, daavadebis kliniko-
morfologiur gamovlinebaTa cvladi sidideebis
gaTvaliswineba saSualebas iZleva ganvaxorcielod
mkurnalobis meTodis diferencirebuli SerCeva yovel
konkretul SemTxvevaSi. rac Cveni winaswari gaangariSebiT
mniSvnelovnad aamaRlebs mkurnalobis rogorc uSualo, aseve
Soreul Sedegebs.
124
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