MuPoland, vakawanda semamiriyoni 1,5 vakaroorana vanoedza kubata pamuviri vasingabudiriri. Kana chikonzero chechinetso chiri padivi remukadzi, inogona kunge iri mugumisiro weovulation disorders, endometriosis, pamwe chete nemishonga yapfuura, semuenzaniso mune oncological zvirwere. Varwere vakamborapwa nenzira iyi kazhinji havazivi kwemakore akawanda kuti varasikirwa nembereko. Kusvikira varota mwana.
- Kurapwa kwezvimwe zvirwere – zvikuru zveoncological – kunokanganisa mbereko yemukadzi, asi kuda kurapwa nekukurumidza kunoita kuti nyaya iyi ive yechipiri.
- Bazi rechidiki remishonga - oncofertility, rinotarisana nekudzorera kubereka kwakarasika nenzira iyi
- Imwe yenzira dze oncofertility ndeye cryopreservation - mushure mekupedza kurapwa, murwere anosimwa ane hutano, hwakambowanikwa chidimbu che ovary, iyo inofanira kutanga kushanda. Izvi dzimwe nguva zvinokutendera kuti utore pamuviri zvakasununguka. Nekuda kweizvi, vana 160 vatozvarwa munyika, vatatu muPoland
Kukanganisa kubereka ndiko kunonyanya kushandiswa kwemishonga. Zviri pamusoro pezvinonzi gonadotoxic kurapa, iyo inoshandiswa mune oncological uye rheumatic zvirwere, connective tishu zvirwere, uyewo panyaya fibroids kana endometriosis. Kunyanya kana zvasvika kune neoplastic zvirwere - nguva yekutanga kurapa inobata. Ipapo kubereka kunotora chigaro chekumashure. Muchokwadi, yaive ichidzika kusvika munguva pfupi yapfuura, nekuti nhasi kune dzimwe nzira dzekuchengetedza. Nevarwere vari kutora rudzi urwu rwekurapa mupfungwa, chikamu chemushonga chakagadzwa - oncofertility. Chii chaizvo? Inobatsira mumamiriro api? Tinotaura nezvazvo naProf. dr. hab. n. med. Robert Jachem, mukuru weClinical Dhipatimendi reGynecological Endocrinology uye Gynecology paYunivhesiti Hospital muKrakow.
Justyna Wydra: Chii chinonzi oncofertility?
Prof Dr. vane. n.med. Robert Jach: Oncofertility imunda uri pamuganho wegynecology, oncology, mushonga wekubereka uye gynecological endocrinology. Muchidimbu, inosanganisira kuchengetedza kubereka nekuidzoreredza mushure mekupera kweiyo oncological kurapwa kutenderera, kana chero kumwe kurapwa kunoshandisa cytotoxic zvinodhaka. Izwi iri rakasikwa muna 2005, asi rave richishanda senzira yekurapa kubva muna 2010. Pfungwa iyi yakaunzwa kumushonga nemuongorori weAmerica - prof. Teresa K. Woodruff anobva kuYunivhesiti yeNorthwestern muChicago. Kubva munaJanuary gore rino, muUnited States, maererano nechinzvimbo cheAmerican Society for Reproductive Medicine ASRM, kutonhora kwemaovarian tissue, imwe yenzira dzinoshandiswa mu-oncofertility, haisisiri kuonekwa sekuedza. MuEurope, kusanganisira Poland, basa riri kuenderera mberi pakuzivikanwa kwayo zviri pamutemo.
Ndedzipi nzira dzinoshandiswa mundima iyi?
Muchiitiko chekutanga, kana zvichibvira, nhengo yekubereka inochengetedza maitiro ekuvhiya inoshandiswa. Panzvimbo pokubvisa chibereko uye mazai, kuvhiyiwa kunoitwa kuchengetedza nhengo idzi. Nekudaro, iyo yakakosha yemaitiro ese anobatsirwa maitiro ekubereka anovimbisa mabasa ekubereka panguva yekurapa.
Mhando dzehunyanzvi idzi dzinosanganisira: kuomesa zai kuvakadzi, urume hwevarume, in vitro process (embryo freezing), pamwe nechando (cryopreservation) chechidimbu chetishu yeovarian inounganidzwa panguva yelaparoscopy, kunyangwe chemotherapy kana radiotherapy isati yaitwa. Mushure mekupedzwa kwekurapa kwegonadotoxic kwakadaro, murwere anosimwa ane hutano, chakambobviswa chidimbu cheiyo ovary, iyo inofanira kubva yatora basa rayo rakakosha, zvese endocrine uye germline. Somugumisiro, dzimwe nguva zvinoguma nemukana wekuita pamuviri wepanyama, pasina chikonzero chekupindira nenzira yekubatsira kubereka maitiro, izvo zvinowanzosagamuchirwa kune vakaroorana nekuda kwezvikonzero zvakasiyana-siyana.
Ndezvipi zvakanakira nzira iyi?
Chekutanga, nzira ye cryopreservation yelaparoscopically yakaunganidzwa ovarian tissue ipfupi pane in vitro process. Inogona kuitwa muzuva rimwe chete. Murwere anodzidza kuti, semuenzaniso, mumavhiki maviri anotanga kurapwa kweoncological, mushure mekusangana nemaitiro akakodzera, anofanirwa kuve akakodzerwa neashoma invasive laparoscopic maitiro. Zvinotora anenge maminitsi makumi mana nemashanu. Munguva iyi, chidimbu che ovary (inenge 45 cm) inounganidzwa2) uye nemaitiro oncofertility, chikamu ichi chetishu chinochengetedzwa. Murwere anogona kudzokera kumba pazuva rimwe chetero kana kuti zuva rinotevera. Mushure mekupora kwenguva pfupi, anenge agadzirira kurapwa kukuru, kazhinji oncological. Mhando dzekurapa idzi dzinowanzokonzera kushaya mbereko. Mushure mekupedzwa kwavo, mukadzi anogona kudzokera kupakati, uko iyo yakambounganidzwa uye inorohwa nechando tishu inosimwa muovary nelaparoscopy. Kazhinji nhengo inobva yatora basa rayo rakarasika. Nekuda kwemaitiro e-oncofertility, murwere akadaro anogona kutove nepamuviri poga. Maovari anodzoserwa kune yavo germinal basa kweanenge makore maviri. Mune zvimwe zviitiko, nguva ino inowedzerwa zvakanyanya.
Sei murwere achigona kurasikirwa nembereko mushure meradiotherapy kana chemotherapy?
Kuti utsanangure nzira iyi, unofanirwa kuziva kuti cancer inokura sei. Kukamukana kunokurumidza, kusingadzoreki kwemasero nedziviriro yomuzvarirwo yomuviri. Masero anowanda asingatarisirwi, oita bundu rinopinda mumatishu ari pedyo, zvichikonzerawo kuumbwa kwemalymphatic uye metastases yeropa. Mukutaura, gomarara rinogona kurondedzerwa separasite inoparadza mubati wayo. Nekudaro, chemotherapy kana radiotherapy, kureva gonadotoxic kurapwa, yakagadzirirwa kuparadza aya maseru ari kupatsanura nekukurumidza. Pamusoro pekuvhara maseru egomarara, inomisawo mamwe masero anokurumidza kupatsanura mumuviri kubva kupatsanura. Iri boka rinosanganisira bvudzi follicles (saka bvudzi kurasikirwa maitiro ekemotherapy), masero emapfupa emapfupa (anogona kukonzera anemia uye leukopenia) uye chirwere chekudya (chinokonzera kusvotwa uye kurutsa), uye pakupedzisira, masero ekubereka - izvo zvinotungamirira kukushaya mbereko.
- Kubudirira kwevanachiremba veFrance. Murwere akarasikirwa nembereko mushure mekurapa chemotherapy akaita mwana nekuda kweiyo IVM nzira
Vangani vacheche vazvarwa kusvika parizvino nekuda kweiyo cryopreservation nzira yatakataura nezvayo pakutanga?
Vanenge vana 160 vakazvarwa munyika, nekuda kwenzira ye cryopreservation uye kuisirwazve kwehutano hweovarian tishu mumuviri wevarwere mushure mekurapa gonadotoxic. Tichifunga nezvekuti munyika yedu nzira yacho ichiri kuonekwa seyekuedza uye haina kudzorerwa neNational Health Fund, tava kuziva nezvevana vatatu vakazvarwa nenzira iyi muPoland. Vaviri vavo vakasunungutsa varwere pakati pandinoshanda.
Izvo zvakakoshawo kutaura kuti kune angangoita gumi nemaviri akaunganidzwa uye akaomeswa ovarian tishu kubva kuvarwere vasati vafunga kuita maitiro aya. Vamwe vavo vachiri kurapwa oncological, uye vamwe vese havasati vafunga kubereka.
Varwere vari kuzoitwa gonadotoxic therapies vanoziviswa nezve mikana yeoncofertility nzira? Vanachiremba vanoziva nezvehunyanzvi uhu?
Nehurombo, isu hatina data inomiririra pamusoro pekuziva kwevanachiremba, asi sechikamu chebasa reboka rinoshanda pakuchengetedza kubereka muvarwere veponcological yePolish Society of Oncological Gynecology, takaita yedu yemibvunzo yekutsvaga. Vanoratidza kuti muboka rinonzwisiswa zvakanyanya revaoncologists, gynecologists, oncologists, kliniki oncologists uye radiotherapists, pane kuziva nezvenyaya iyi (vanopfuura 50% yevakapindura vakanzwa nezve nzira), asi isingasviki 20%. vanachiremba vakambokurukura izvi nomurwere.
Kudzokera kuchikamu chekutanga chemubvunzo, nhengo dzemasangano akasiyana-siyana evarwere dzinonyatsoziva zvose dambudziko uye zvinetso zvayo zvingangoitika, pamwe chete nemhinduro dzinogona kuitika. Zvisinei, iyi haisiwo boka rinomiririra. Sezvineiwo, vakadzi vasingadyidzani nerudzi urwu rweboka kazhinji havana ruzivo rwakakura kudaro. Ndokusaka tichiitisa marudzi akasiyana-siyana ekudzidziswa nguva dzese, uye nyaya yacho inoonekwa panguva dzakawanda dzemisangano uye webinars. Kutenda kune izvi, kuziva kwevarwere pamusoro penyaya iyi kuchiri kukura, asi mukuona kwangu kuchiri kuitika zvishoma nezvishoma.
Mashoko pamusoro penyanzvi:
Prof. Dr hab. n.med. Robert Jach inyanzvi mune zvekudzivirira uye gynecology, nyanzvi mune gynecological oncology, nyanzvi mune gynecological endocrinology uye mushonga wekubereka. Mutungamiri wePolish Society yeCervical Colposcopy uye Pathophysiology, gurukota rezvematunhu mumunda wegynecological endocrinology uye kubereka. Ndiye mukuru weClinical department of Gynecological Endocrinology and Gynecology paUniversity Hospital muKrakow. Anorapa zvakare kuSuperior Medical Center muKrakow.
Verenga zvakare:
- Kuora mwoyo kwePostpartum mushure meIVF. Dambudziko risingataurwe nezvaro
- Nhema dzinonyanya kuzivikanwa nezveIVF
- Zvivi Gumi Zvinopesana Nembereko