EPoland, imibhangqwana engaba yizigidi ezingu-1,5 izama ukukhulelwa ingaphumeleli. Uma imbangela yenkinga iseceleni kowesifazane, kungase kube umphumela wokuphazamiseka kwe-ovulation, i-endometriosis, kanye nokwelashwa kwangaphambilini, isib ezifweni ze-oncological. Iziguli eziye zathola lolu hlobo lokwelashwa ngokuvamile aziboni iminyaka eminingi ukuthi zilahlekelwe inzalo. Baze baphuphe ingane.
- Ukwelashwa kwezinye izifo - ikakhulukazi eze-oncological - kulimaza inzalo yowesifazane, kodwa isidingo sokwelashwa ngokushesha senza lolu daba lube udaba lwesibili.
- Igatsha lezokwelapha elincane - i-oncofertility, libhekene nokubuyisela ukuzala okulahlekile ngale ndlela
- Enye yezindlela ze-oncofertility i-cryopreservation - ngemva kokuqeda ukwelashwa, isiguli sifakwe isiqeshana esinempilo, esitholwe ngaphambilini se-ovary, okufanele siqale ukusebenza. Lokhu ngezinye izikhathi kukuvumela ukuba ukhulelwe ngokwemvelo. Ngenxa yalokhu, izingane ezingu-160 kakade zazalwa emhlabeni, ezintathu ePoland
Ukuzala okukhubazekile kuwumphumela ovame kakhulu wokwelashwa. Imayelana nalokho okubizwa ngokuthi yi-gonadotoxic zokwelapha, ezisetshenziswa ezifweni ze-oncological kanye ne-rheumatic, izifo ezithinta izicubu ezixhumene, kanye nasesimweni se-fibroids noma i-endometriosis. Ikakhulukazi uma kukhulunywa ngezifo ze-neoplastic - isikhathi sokuqala ukwelashwa sibalulekile. Khona-ke ukuzala kuthatha isihlalo esingemuva. Eqinisweni, beliya phansi kuze kube muva nje, ngoba namuhla ziningi izindlela zokulilondoloza. Ngeziguli ezithola lolu hlobo lokwelapha engqondweni, isigaba somuthi sasungulwa - i-oncofertility. Kuyini ngempela? Kukuziphi izimo iwusizo? Sikhuluma ngakho noprof. uDkt. hab. n. med. Robert Jachem, inhloko yoMnyango Wezempilo Yezifo Zabesifazane kanye Nezifo Zabesifazane esibhedlela saseNyuvesi eKrakow.
UJustyna Wydra: Iyini i-oncofertility?
UProf. uDkt. n.med. URobert Jach: I-Oncofertility iyinkambu emngceleni we-gynecology, i-oncology, imithi yokuzala kanye ne-endocrinology ye-gynecological. Ngamafuphi, kuhlanganisa ukulondoloza inzalo nokuyibuyisela ngemva kokuphela komjikelezo wokwelashwa kwe-oncological, noma okunye ukwelashwa okusebenzisa izidakamizwa ze-cytotoxic. Leli gama ladalwa ngo-2005, kodwa belisebenza njengenqubo yezokwelapha kusukela ngo-2010. Lo mqondo wethulwa kwezokwelapha ngumcwaningi waseMelika - u-prof. Teresa K. Woodruff waseNyuvesi yaseNorthwestern eChicago. Kusukela ngoJanuwari kulo nyaka, e-United States, ngokusho kwesikhundla se-American Society for Reproductive Medicine ASRM, izicubu ze-ovarian eziqandisiwe, enye yezindlela ezisetshenziswa ku-oncofertility, ayisabhekwa njengokuhlola. E-Europe, kuhlanganisa ne-Poland, okwamanje umsebenzi uyaqhubeka ekuqashelweni kwawo okusemthethweni.
Yiziphi izindlela ezisetshenziswayo kulo mkhakha?
Esimweni sokuqala, uma kungenzeka, kusetshenziswa izitho zokuzala ezingahlinzwa. Esikhundleni sokukhipha isibeletho namaqanda, kwenziwa ukuhlinzwa ukuze kulondolozwe lezi zitho. Kodwa-ke, ingqikithi yenqubo yonke iyindlela yokusiza yokuzala eqinisekisa imisebenzi yokuzala ngesikhathi sokwelashwa.
Lezi zinhlobo zamasu zihlanganisa: ukuqandisa iqanda kwabesifazane, isidoda sabesilisa, inqubo ye-in vitro (ukuqhwaza kombungu), kanye nokuqandisa (i-cryopreservation) yocezu lwesicubu se-ovarian esiqoqwe ngesikhathi se-laparoscopy, ngisho nangaphambi kokuba kusetshenziswe i-chemotherapy noma i-radiotherapy. Ngemva kokuphothulwa kokwelashwa okunjalo kwe-gonadotoxic, isiguli sifakwa isiqeshana esinempilo, esikhishwe ngaphambili se-ovary, okumele sithathe umsebenzi wayo obalulekile, kokubili i-endocrine ne-germline. Ngenxa yalokho, ngezinye izikhathi kubangela ukuthi kungenzeka ukukhulelwa kwemvelo, ngaphandle kwesidingo sokuphazamisa ngendlela yokusiza izinqubo zokuzala, ezivame ukungamukeleki kumbhangqwana ngezizathu ezihlukahlukene.
Yiziphi izinzuzo zale ndlela?
Okokuqala, indlela ye-cryopreservation yezicubu ze-ovarian eziqoqwe nge-laparoscopically imfushane kunenqubo ye-in vitro. Kungenziwa ngosuku olulodwa nje. Isiguli esifunda ukuthi, ngokwesibonelo, emasontweni amabili uzoqala ukwelashwa kwe-oncological, ngemva kokuhlangabezana nemibandela efanelekile, kufanele afanelekele inqubo ye-laparoscopic encane engavamile. Kuthatha cishe imizuzu engama-45. Ngalesi sikhathi, kuqoqwe ucezu lwe-ovary (cishe 1 cm).2) futhi ngamasu e-oncofertility, lesi sigaba sezicubu siyagcinwa. Isiguli singase sibuyele ekhaya ngalo lolo suku noma ngakusasa. Ngemva kokululama isikhashana, usekulungele ukwelashwa okuyinhloko, ngokuvamile nge-oncological. Lezi zinhlobo zokwelapha zivame ukudala inzalo. Ngemva kokuqedwa kwabo, owesifazane angabuyela esikhungweni, lapho izicubu eziqoqwe ngaphambili neziqhwala zifakwe ku-ovary nge-laparoscopy. Ngokuvamile isitho sibe sesithatha umsebenzi waso olahlekile. Njengomphumela wezinqubo ze-oncofertility, isiguli esinjalo singase sikhulelwe ngokwemvelo. Ama-ovari abuyiselwa ekusebenzeni kwawo kwamagciwane cishe iminyaka emibili. Kwezinye izimo, lesi sikhathi sinwetshwa kakhulu.
Kungani isiguli singalahlekelwa inzalo ngemva kwe-radiotherapy noma i-chemotherapy?
Ukuchaza lo mshini, udinga ukwazi ukuthi umdlavuza ukhula kanjani. Iwukuhlukaniswa okusheshayo, okungalawuleki kwamangqamuzana ngezivikelo zemvelo zomzimba. Amangqamuzana aphindaphindeka ngokungalawuleki, enze isimila esingena ezicutshini eziseduze, okuholela nasekubunjweni kwama-metastases e-lymphatic nemithambo yegazi. Uma sikhuluma nje, umdlavuza ungachazwa ngokuthi yi-parasite ebulala umuntu owuphethe. Ngokulandelayo, ukwelashwa ngamakhemikhali noma nge-radiotherapy, okungukuthi ukwelashwa kwe-gonadotoxic, kuklanyelwe ukucekela phansi la maseli ahlukana ngokushesha. Ngaphezu kokuvimbela amangqamuzana omdlavuza, iphinde imise amanye amaseli ahlukanisa ngokushesha emzimbeni ukuthi ahlukane. Leli qembu lihlanganisa izinhlayiya zezinwele (okungakho ukulahlekelwa izinwele kuyisici sokwelashwa ngamakhemikhali), amangqamuzana omnkantsha wamathambo (okungabangela i-anemia ne-leukopenia) kanye nomgudu wokugaya ukudla (okubangela isicanucanu nokuhlanza), futhi ekugcineni, amangqamuzana okuzala - okuholela ekungazali.
- Impumelelo yodokotela baseFrance. Isiguli esalahlekelwa inzalo ngemva kokwelashwa ngamakhemikhali saba nengane ngenxa yendlela ye-IVM
Zingaki izingane ezizelwe kuze kube manje ngenxa ye-cryopreservation indlela esikhulume ngayo ekuqaleni?
Cishe izingane ezingu-160 zazalwa emhlabeni, ngenxa yendlela ye-cryopreservation kanye nokufakwa kabusha kwezicubu ze-ovarian ezinempilo emzimbeni weziguli ngemva kokwelashwa kwe-gonadotoxic. Uma sicabangela iqiniso lokuthi ezweni lakithi inqubo isabhekwa njengokuhlola futhi ayibuyiselwa yiSikhwama Sezempilo Sikazwelonke, manje siyazi mayelana nezingane ezintathu ezizalwa ngale ndlela ePoland. Ababili babo babelethele iziguli esikhungweni engisebenza kuso.
Kuyafaneleka futhi ukusho ukuthi kunezicubu ezimbalwa ze-ovarian eziqoqwe futhi eziqandisiwe ezivela ezigulini ezingakanqumi ukwenza le nqubo. Abanye babo basalashwa nge-oncological, kanti abanye abakaze banqume ukuzala okwamanje.
Ingabe iziguli okufanele zithole imishanguzo ye-gonadotoxic zazisiwe mayelana namathuba ezindlela ze-oncofertility? Odokotela bayazi ngale nqubo?
Ngeshwa, asinayo idatha emele ekuqwashiseni kodokotela, kodwa njengengxenye yomsebenzi weqembu elisebenzayo ekulondolozeni inzalo ezigulini ze-oncological ze-Polish Society of Oncological Gynecology, senze ucwaningo lwethu lwemibuzo. Babonisa ukuthi eqenjini eliqondiwe kabanzi lodokotela be-oncologists, odokotela bezifo zabesifazane, odokotela be-oncologists, ama-oncologists emitholampilo kanye nama-radiotherapist, kukhona ukuqwashisa ngalolu daba (ngaphezu kwama-50% abaphendulile bezwile ngale ndlela), kodwa kuphela ngaphansi kwama-20%. odokotela bake baxoxa ngalokhu nesiguli.
Uma sibuyela engxenyeni yokuqala yombuzo, amalungu ezinhlangano zeziguli ezihlukahlukene azi ngokugcwele kokubili inkinga kanye nezinkinga ezingase zibe khona, kanye nezixazululo ezingase zibe khona. Kodwa-ke, leli futhi akulona iqembu elimele. Ngeshwa, abesifazane abangahlangene nalolu hlobo lweqembu ngokuvamile abanalo ulwazi oluningi kangaka. Yingakho senza izinhlobo ezahlukene zokuqeqesha ngaso sonke isikhathi, futhi isihloko sivela phakathi nezinkomfa eziningi nama-webinars. Ngenxa yalokhu, ukuqwashisa kweziguli ngalesi sihloko kusakhula, kodwa ngombono wami kusenzeka kancane kancane.
Ulwazi mayelana nochwepheshe:
UProf. uDkt hab. n.med. URobert Jach unguchwepheshe wezokubelethisa kanye ne-gynecology, uchwepheshe we-gynecological oncology, uchwepheshe we-gynecological endocrinology kanye nemithi yokuzala. Umongameli wePolish Society of Cervical Colposcopy and Pathophysiology, umeluleki wesifundazwe emkhakheni we-gynecological endocrinology and reproduction. Uyinhloko yoMnyango Wezempilo Yezifo Zabesifazane kanye Nezifo Zabesifazane esibhedlela saseNyuvesi eKrakow. Uphinde welapha eSuperior Medical Center eKrakow.
Funda futhi:
- Ukucindezeleka kwangemva kokubeletha ngemva kwe-IVF. Inkinga okungakhulunywa ngayo neze
- Izinganekwane ezivame kakhulu nge-IVF
- Izono Eziyishumi Ezimelene Nenzalo