Ku Poland, okwatirana pafupifupi 1,5 miliyoni amayesa kutenga mimba koma osapambana. Ngati chifukwa cha vuto ndi mbali ya mkazi, zikhoza kukhala chifukwa cha ovulation matenda, endometriosis, komanso yapita mankhwala, mwachitsanzo mu oncological matenda. Odwala omwe adalandira chithandizo chamtunduwu nthawi zambiri samazindikira kwa zaka zambiri kuti ataya mphamvu zawo zakubala. Mpaka amalota mwana.
- Kuchiza matenda ena - makamaka oncological - kumawononga kubereka kwa amayi, koma kufunikira kwa chithandizo chachangu kumapangitsa kuti nkhaniyi ikhale yachiwiri.
- Nthambi yaying'ono yamankhwala - oncofertility, imagwira ntchito yobwezeretsa chonde chotayika motere
- Imodzi mwa njira za oncofertility ndi cryopreservation - atamaliza chithandizo, wodwalayo amaikidwa ndi kachigawo kakang'ono kamene kamapezeka kale ka ovary, kamene kamayenera kuyamba kugwira ntchito. Izi nthawi zina zimakulolani kuti mukhale ndi pakati mwachibadwa. Chifukwa cha izi, ana 160 adabadwa kale padziko lapansi, atatu ku Poland
Kusabereka kwapang'onopang'ono ndizomwe zimachitika kwambiri pamankhwala. Ndi za otchedwa gonadotoxic mankhwala, amene ntchito oncological ndi misempha matenda, connective minofu matenda, komanso pa nkhani ya fibroids kapena endometriosis. Makamaka pankhani ya matenda a neoplasm - nthawi yoyambira chithandizo ndiyofunikira. Ndiye chonde chimatenga mpando wakumbuyo. M'malo mwake, idatsika mpaka posachedwa, chifukwa lero pali njira zambiri zosungira. Ndi odwala omwe amalandira chithandizo chamtunduwu m'maganizo, gawo lamankhwala linakhazikitsidwa - oncofertility. Ndi chiyani kwenikweni? Ndi zinthu ziti zomwe zimathandiza? Timakambirana ndi Prof. dr. hab. n. med. Robert Jachem, wamkulu wa Clinical department of Gynecological Endocrinology and Gynecology pa University Hospital ku Krakow.
Justyna Wydra: Kodi oncofertility ndi chiyani?
Prof Dr. n.med. Robert Jach: Oncofertility ndi gawo lomwe lili m'malire a gynecology, oncology, mankhwala obereketsa ndi gynecological endocrinology. Mwachidule, zimakhala ndi kusunga chonde ndikubwezeretsa pambuyo pa kutha kwa chithandizo cha oncological, kapena chithandizo china chilichonse chomwe chimagwiritsa ntchito mankhwala a cytotoxic. Mawuwa adapangidwa mu 2005, koma akhala akugwira ntchito ngati chithandizo chamankhwala kuyambira 2010. Lingaliroli linayambitsidwa kwa mankhwala ndi wofufuza wa ku America - prof. Teresa K. Woodruff wochokera ku yunivesite ya Northwestern ku Chicago. Kuyambira Januwale chaka chino, ku United States, malinga ndi udindo wa American Society for Reproductive Medicine ASRM, kuzizira kwa ovarian minofu, imodzi mwa njira zomwe zimagwiritsidwa ntchito pa oncofertility, sizilinso ngati zoyesera. Ku Ulaya, kuphatikizapo Poland, ntchito ikuchitika pakudziwika kwake.
Ndi njira ziti zomwe zimagwiritsidwa ntchito pankhaniyi?
Poyamba, ngati n'kotheka, opaleshoni yoteteza ziwalo zoberekera imagwiritsidwa ntchito. M’malo mochotsa chiberekero ndi mazira, opaleshoni imachitidwa pofuna kusunga ziwalozi. Komabe, chinsinsi cha ndondomeko yonseyi ndi njira zothandizira kubereka zomwe zimatsimikizira ntchito zoberekera panthawi ya chithandizo.
Mitundu ya njira izi ndi izi: kuzizira kwa dzira kwa amayi, umuna kwa amuna, njira ya m'mimba (kuzizira kwa embryo), komanso kuzizira (cryopreservation) ya chidutswa cha minofu yam'mimba yomwe imasonkhanitsidwa panthawi ya laparoscopy, ngakhale mankhwala amphamvu kapena radiotherapy asanayambe. Akamaliza chithandizo cha gonadotoxic, wodwalayo amabzalidwa ndi kachidutswa kakang'ono ka ovary, komwe kamayenera kuganiza kuti ndikofunikira, onse endocrine ndi majeremusi. Zotsatira zake, nthawi zina zimapangitsa kuti pakhale mimba yachibadwa, popanda kufunikira kusokoneza njira zothandizira kubereka, zomwe nthawi zambiri zimakhala zosavomerezeka kwa okwatirana pazifukwa zosiyanasiyana.
Kodi ubwino wa njirayi ndi yotani?
Choyamba, njira ya cryopreservation wa laparoscopically anasonkhanitsa yamchiberekero minofu ndi lalifupi kuposa m`galasi ndondomeko. Zitha kuchitika tsiku limodzi lokha. Wodwala yemwe amaphunzira kuti, mwachitsanzo, pakatha milungu iwiri ayamba chithandizo cha oncological, atakwaniritsa zofunikira, ayenera kukhala oyenerera kuti azitha kuchita opaleshoni ya laparoscopic. Zimatenga pafupifupi mphindi 45. Panthawi imeneyi, chidutswa cha ovary (pafupifupi 1 cm) chimasonkhanitsidwa2) ndi njira za oncofertility, gawo ili la minofu limasungidwa. Wodwalayo akhoza kubwerera kunyumba tsiku lomwelo kapena tsiku lotsatira. Pambuyo pakuchira kwakanthawi, amakhala wokonzeka kulandira chithandizo chachikulu, nthawi zambiri oncological. Mankhwala amtunduwu nthawi zambiri amayambitsa kusabereka. Akamaliza, mkazi akhoza kubwerera ku likulu, kumene kale anasonkhana ndi frostbitten minofu ndi wodzala mu ovary ndi laparoscopy. Kawirikawiri chiwalocho chimayamba kugwira ntchito yake yotayika. Chifukwa cha njira za oncofertility, wodwala wotere amatha kutenga pakati mwachibadwa. The thumba losunga mazira ndi kubwezeretsedwa kwa majeremusi ntchito kwa pafupifupi zaka ziwiri. Nthawi zina, nthawi iyi imakula kwambiri.
Chifukwa chiyani wodwala amatha kutaya chonde pambuyo pa radiotherapy kapena chemotherapy?
Kuti mufotokoze njira iyi, muyenera kudziwa momwe khansa imakulira. Ndiko kugawikana kofulumira, kosalamulirika kwa maselo ndi chitetezo chachilengedwe cha thupi. Maselo amachulukana mosayang’aniridwa, n’kupanga chotupa chimene chimaloŵa m’minyewa yoyandikana nayo, kuchititsanso kuti ma lymphatic ndi mitsempha ya m’mitsempha ipangike. Kunena zoona, khansa tinganene kuti ndi tizilombo tomwe timawononga tizilombo toyambitsa matenda. Komanso, chemotherapy kapena radiotherapy, mwachitsanzo, gonadotoxic mankhwala, adapangidwa kuti awononge maselo omwe amagawika mwachangu. Kuphatikiza pa kutsekereza maselo a khansa, imaletsanso maselo ena omwe amagawikana mwachangu m'thupi kuti asagawikane. Gululi limaphatikizapo minyewa ya tsitsi (motero kutayika tsitsi kwa chemotherapy), maselo a m'mafupa (omwe angayambitse kuchepa kwa magazi m'thupi ndi leukopenia) ndi njira ya m'mimba (yomwe imayambitsa nseru ndi kusanza), ndipo pamapeto pake, maselo obala - omwe amachititsa kuti munthu asabereke.
- Kupambana kwa madokotala aku France. Wodwala yemwe anataya mphamvu yake yobereka atalandira mankhwala a chemotherapy anali ndi mwana chifukwa cha njira ya IVM
Ndi ana angati omwe abadwa mpaka pano chifukwa cha njira ya cryopreservation yomwe takambirana kale?
Pafupifupi ana 160 anabadwa mu dziko, chifukwa cha njira cryopreservation ndi kukonzanso implantation wathanzi yamchiberekero minofu mu thupi la odwala pambuyo gonadotoxic mankhwala. Poganizira kuti m'dziko lathu ndondomekoyi imatengedwa ngati yoyesera ndipo sikubwezeredwa ndi National Health Fund, tsopano tikudziwa za ana atatu obadwa motere ku Poland. Awiri a iwo anaberekera odwala pakatikati pomwe ndimagwira ntchito.
Ndikoyeneranso kutchula kuti pali pafupifupi khumi ndi awiri omwe asonkhanitsidwa ndi kuzizira minyewa yamchiberekero kuchokera kwa odwala omwe sanaganizepo kuti achite izi. Ena mwa iwo akulandirabe chithandizo cha oncological, ndipo ena onse sanasankhebe kubereka.
Kodi odwala omwe akuyenera kulandira chithandizo cha gonadotoxic amadziwitsidwa za kuthekera kwa njira za oncofertility? Madokotala amadziwa za njira imeneyi?
Tsoka ilo, tilibe deta yoyimira pa kuzindikira kwa madokotala, koma monga gawo la ntchito ya gulu logwira ntchito poteteza chonde kwa odwala oncological a Polish Society of Oncological Gynecology, tinachita kafukufuku wathu wa mafunso. Akuwonetsa kuti m'gulu lomwe limamveka bwino la oncologists, gynecologists, oncologists, oncologists ndi radiotherapists, pali chidziwitso cha nkhaniyi (oposa 50% ya omwe adafunsidwa adamva za njirayi), koma osakwana 20%. madokotala anakambiranapo zimenezi ndi wodwala.
Kubwereranso ku gawo loyamba la funsoli, mamembala a mabungwe osiyanasiyana odwala amadziwa bwino za vutoli komanso mavuto omwe angakhalepo, komanso njira zothetsera mavuto. Komabe, ilinso si gulu loyimira. Tsoka ilo, amayi omwe sali ogwirizana ndi gulu lamtunduwu nthawi zambiri sakhala ndi chidziwitso chotere. Ichi ndichifukwa chake timaphunzitsa mitundu yosiyanasiyana nthawi zonse, ndipo mutuwu umapezeka pamisonkhano yambiri ndi ma webinars. Chifukwa cha izi, kuzindikira kwa odwala pamutuwu kukukulirakulirabe, koma m'malingaliro mwanga zikuchitikabe pang'onopang'ono.
Zambiri za akatswiri:
Prof. Dr hab. n.med. Robert Jach ndi katswiri wa zachikazi ndi gynecology, katswiri wa gynecological oncology, katswiri wa gynecological endocrinology ndi mankhwala obereka. Purezidenti wa Polish Society of Cervical Colposcopy ndi Pathophysiology, mlangizi wachigawo pankhani ya gynecological endocrinology ndi kubereka. Iye ndi wamkulu wa Clinical department of Gynecological Endocrinology and Gynecology pa University Hospital ku Krakow. Amathandizanso ku Superior Medical Center ku Krakow.
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