Świętokrzyskie Centrum Onkologii informuje, że przeprowadza nowe zabiegi z zakresu chirurgii rekonstrukcyjnej z wykorzystaniem odległych przeszczepów tkankowych z zespoleniami mikronaczyniowymi. Operacje wykonywane są u pacjentów z zaawansowanymi nowotworami jamy ustnej i gardła.
Specjaliści w Klinice Otolaryngologii, Chirurgii Głowy i Szyi Świętokrzyskiego Centrum Onkologii z pomocą nowych zabiegów ratują życie pacjentom z nowotworami w rejonie głowy i szyi, u których konieczne są rozległe amputacje i rekonstrukcje. Prof. Stanisław Góźdź, dyrektor Świętokrzyskiego Centrum Onkologii, wyjaśnia, że radykalne leczenie nowotworów wiąże się z okaleczeniem, w tym przypadku widocznym – obejmującym rejon twarzy i szyi. Narzędzia i działania, które wdrożono w ŚCO pozwalają jednak uzupełnić tę radykalność.
W ŚCO odbyły się już pierwsze zabiegi rekonstrukcyjne
Specjaliści ŚCO w przeciągu dwóch miesięcy przeprowadzili cztery operacje rekonstrukcji z pomocą odległych przeszczepów z zespoleniami mikronaczyniowymi.
2 lutego br. zabieg odbył się u pacjenta z rakiem dna jamy ustnej naciekającym żuchwę po lewej stronie z przerzutami do węzłów chłonnych. Dr n.med. Sławomir Okła, specjalista otorynolaryngolog, kierownik Kliniki Otolaryngologii, Chirurgii Głowy i Szyi ŚCO, podkreśla, że u pierwszego chorego konieczne było usunięcie ponad połowy żuchwy, a także bardzo dużej części dna jamy ustnej i błony śluzowej policzka oraz wargi dolnej.
Drugą operację przeprowadzono 18 lutego br. u pacjentki z rakiem migdałka podniebnego prawego ze wznową po radio-chemioterapii. Podczas zabiegu usunięto migdałek wraz z całą boczną ścianą gardła środkowego i fragmentem podniebienia miękkiego. Nieuniknione było również radykalne usunięcie węzłów chłonnych na szyi po prawej stronie z zaoszczędzeniem wszystkich nerwów, naczyń i mięśnia mostkowo- obojczykowo-sutkowego. Chirurdzy wskazują, że ich działania dodatkowo utrudniało osłabienie tkanek po przebytych naświetleniach. Dr Okła wyjaśnia, że zabieg był bardzo rozległy, jednak dał chorej o wiele lepszą jakość życia.
Metoda rekonstrukcji z pomocą odległych przeszczepów daje chorym szansę na powrót do prawidłowej funkcji i wyglądu. Pierwszy zoperowany pacjent opuścił szpital po 3 tygodniach, a pacjentka – po 10 dniach. Pacjenci mogą normalnie funkcjonować.
Wycięcie nowotworu nie musi wiązać się z maksymalnym zaoszczędzeniem tkanek
W obu przypadkach, ze względu na rozmiar ubytków tkanek, rekonstrukcja z użyciem uszypułowanego płata piersiowego (skórno-mięśniowego płata pobranego wraz z zachowanymi własnymi naczyniami krwionośnymi) była niemożliwa. Dlatego, jak wyjaśnia dr Okła, użyty został płat udowy, czyli fragment skóry z powięzią uszypułowanego na naczyniach krwionośnych: tętnicy i dwóch naczyniach żylnych.
– Te naczynia poprzez połączenie na szyi do tętnicy i żyły twarzowej pozwoliły na przywrócenie ukrwienia dla płata i zapewniły dobre gojenie. U pacjenta zastosowano również płytę tytanową do odtworzenia kości żuchwy – podkreśla ekspert.
Podczas zabiegów rekonstrukcji specjaliści wykorzystali mikroskop z możliwością obrazowania naczyń użyciem fluorescencji oraz z równoległym podłączeniem podglądu asystenckiego, tak by w jednym mikroskopie mogły operować dwie osoby siedzące po dwóch stronach stołu. Operacja trwa około 12 godzin i angażuje dwa zespoły chirurgów, instrumentariuszy i zespół anestetyczny.
– Tutaj mamy najlepszą zasadę w onkologii: jedna osoba resekuje, a druga rekonstruuje. Jest zespół dwóch liderów. Chirurg, który wycina nowotwór, nie musi iść na kompromis, żeby zaoszczędzić jak najwięcej tkanek, a więc wziąć mniejszy margines czyli ryzykować nieradykalność. Ponieważ możemy dobrać więcej pasujących tkanek z miejsc odległych, wzrasta szansa na radykalność. Wtedy też szanse na wyleczenie pacjenta są dużo większe – zaznacza dr Okła.
Przygotowanie zespołu do wykonywania rekonstrukcji z odległym przeszczepem trwało 3 lata
Pacjenci, którzy wymagali rekonstrukcji z pomocą przeszczepu tkankowego pobranego z miejsc odległych, do tej pory nie mogli być leczeni w ŚCO ze względu na brak odpowiednich narzędzi i specjalistów z dziedziny chirurgii naczyniowej. W Polsce funkcjonuje tylko kilka ośrodków, które zajmują się rekonstrukcjami tego typu, co sprawia, że pacjenci długo czekają na zabieg. Dr Okła podkreśla, że w ŚCO udało się jednak wyszkolić ludzi, a dzięki władzom województwa zakupić sprzęt.
Przygotowanie zespołu trwało około 3 lata – lekarze zagłębiali wiedzę na temat rekonstrukcji z wykorzystaniem zespoleń mikronaczyniowych w Samodzielnym Publicznym Szpitalu Klinicznym w Lublinie, pod okiem wybitnych specjalistów. Dr Okła wyjaśnia, że tego typu zabiegi wymagają perfekcyjnej znajomości anatomii miejsca, z którego pobierany jest fragment tkanek do późniejszej rekonstrukcji. Istotne naczynia muszą zostać zachowane, by zaopatrzyć dany region.
– Musimy też wiedzieć, który region da się w ten sposób pobrać, jakie są jego granice i jak znaleźć naczynia krwionośne, które trzeba bezwzględnie zaoszczędzić. Bo inaczej, nawet jeśli podłączymy te naczynia, a one będą gdzieś uszkodzone, te tkanki nie będą odżywiane i nie mają szans na przeżycie. Jest to ogromne wyzwanie – tłumaczy dr Okła.
Ekspert dodaje, że do połączenia wypreparowanych naczyń niezbędny jest również ogrom sprzętu, narzędzia mikrochirurgiczne. Wdrożenie nowych technik w ŚCO było możliwe dzięki dofinansowaniu zakupu narzędzi przez Urząd Marszałkowski Województwa Świętokrzyskiego na kwotę ponad 435 tys. zł, w tym dofinansowanie UE wyniosło ponad 373 tys. zł. Wartość całego sprzętu do operacji z mikrozespoleniami naczyniowymi to ponad 1,2 mln zł, w tym sam mikroskop kosztował 750 tys. zł.
Źródło: Świętokrzyskie Centrum Onkologii
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„그렇다면 Ouyang Qing의 가족은 칙령 작성을 담당합니다. „Hongzhi 황제는 Ouyang Zhi를 바라 보았습니다.
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Hongzhi 황제는 얼굴을 붉혔습니다. 내 … 내 생각?
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이들은 Fang Jifan의 제자이자 손자이기 때문에 Fang Jifan은 자연스럽게 존경합니다.
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며느리를 생각하며 Fang Jifan은 정신을 차리고 갑자기 용과 호랑이처럼 느껴졌습니다.
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먼저 그는 마차를 타고 홍치제를 만나기 위해 장소로 갔다.
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Liu Jian과 다른 사람들은 이때 모든 관리들이 흔들렸다는 것을 깨닫는 것 같습니다.
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Hongzhi 황제는 잠시 침묵했다가 스스로 떠났습니다.
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그날 밤 Deng Jian은 울고 텐트에 숨어 다시 울었습니다.
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말을 마친 홍지황제는 앞으로 나아가 누안각으로 향했다.
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몇 시간밖에 걸리지 않았습니다… 수십만 에이커의 땅이 즉시 주인이 바뀌었습니다.
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Fang Jifan이 첫 번째 자리에 앉았고 나머지는 순서대로 앉았습니다.
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Hongzhi 황제는 얼굴이 비참했고 „도둑 배는 어디에 있습니까? „라고 날카롭게 말했습니다.
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Fang Jifan은 말문이 막혔습니다. 이것은 약간 뻔뻔합니다. 여전히 도덕이 있습니까?
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이 세상에 진실보다 더 감동적인 것은 없기 때문입니다.
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Fang Zhengqing의 마음은 갑자기 차가워졌고 그는 답답한 표정을 보였습니다.
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Hongzhi 황제는 그것을 반박할 수 없었습니다. 왜냐하면 그는 정말 할 수 없었기 때문입니다.
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땅 값이 떨어졌는데, 그 땅이 아직 자기 손에 있고 팔지 않는 한 누가 자기 마음대로 할 수 있겠습니까?
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„요동 장 선생이 긴급 보고를 보냈다.”
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이때 인수궁에서 은주후 저우친이 눈물을 흘리고 있었다.
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이때 천막 밖에는 아침 햇살이 한 줄기 빛을 비추고 있을 뿐이었다.
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왜 그들은 돈을 벌기가 항상 그렇게 쉬운가요?
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Zhu Houzhao는 깜짝 놀랐고 즉시 긴장했습니다. „그럼 서둘러, 서둘러.”
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Fang Jifan은 자연스럽게 자금을 모으는 불성이며 사고 사고를 좋아하고 사지 않으면 떠날 것입니다.
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Xiao Jing은 계속해서 „그렇다면 편지를 보내고 싶습니까? „라고 말했습니다.
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Xu Jing은 서둘러 와서 절했습니다. „학생 … 스승님을 만났습니다.”
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이것은… Hongzhi 황제가 주의를 기울이지 않은 것입니다.
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그의 옆에는 그의 두 아들도 불안해 보였다.
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Xie Qian은 서둘러 „내시 Xiao, 광동 수석 사절 문제 …”
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그래서 Fang Jifan은 우연히 몇 마디 만 언급했고 Wang Shouren은 즉시 이해했습니다.따라서 Hongzhi 황제는 Fang Aiguo라는 말이 Zhang 여왕에게 들리는 것을 매우 두려워했습니다.
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반년이 지나면 새로운 시작인데 여러분이 너무 보고 싶어요.
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