Plaget qe shkaktohen pas radioterapise (Radionekrozat) dhe roli i HBOT ne trajtimin e tyre

Pas Radioterapise (terapise me rreze), qe behet ne rastet e pacienteve me kancer, mund te ndodhe demtimi nga rrezatimi, i indeve te shendosha si indet e buta dhe kockave.

Fizika e rrezatimit
Ka dy lloj rrezatimesh jonizuese me efekte te rendesishme.
- Rrezatimi elektromanjetik: eshte kombinim i fushave elektrike dhe magnetike, qe konsiston tek energjia e pjesezave, qe quhen protone. Kjo forme e rrezatimit eshte emertuar, rrezet gama, qe e kane origjinen nga berthama e atomit, dhe rrezet x, qe e kane origjinen nga zona qe mbeshtjell nukleusin (berthamen).
- Rrezatimi i grimcave. Shembull per kete jane rrezatimet e renda te grimcave si protonet dhe neutronet.

Njesia e rrezatimit
Nje rad eshte sasia e rrezatimit e cila rezulton ne depozitimin e 100 ergs energji/ g te indit te rrezatuar.

Biologjia e rrezatimit
Ndryshimet kimike qe shkaktohen prej rrezatimit jane:
• Demtimi i struktures se proteinave
• Peroksidimi i lipideve
• Demtimi i ADN

Kur flitet per demtimet pas Radioterapise (Radionekrozat) duhen pasur parasysh, faza e hershme (ndodh ne javet e para pas rrezatimit) dhe e voneshme (ndodh vite pas rrezatimit). Demtimet qe ndodhin jane; iskemia qe vjen pas nderprerjes se furnizimit me gjak dhe demtimi i drejtperdrejte prej rrezatimit, i qelizave qe jane te ndjeshme ndaj tij.

Ne 1988 Heimbach renditi ne kater perioda ndryshimet Klinikopatologjike ne rastet e demtimeve nga rrezatimi:
Periudha akute. Jane 6 muajt e pare pas rrezatimit. Gjate kesaj periudhe ndodh demtimi akut i organeve dhe mundet te mos kemi shenja klinike.
Periudha subakute. Jane 6 muajt e dyte pas rrezatimit. Eshte perfundimi i periudhes akute dhe fillojne te ndodhin ndyshimet dhe demtimet, qe jane te qendrueshme dhe vazhdojne te ndodhin ne menyre progresive ne inde
Periudha kronike. Nga viti i dyte deri tek viti i peste pas rrezatimit. Ne kete periudhe kemi demtimin e eneve te vogla te gjakut (mikroqarkullimit), demtimi i parenkimes dhe ulja e rezistences qe tregon organizmi ndaj infeksioneve.
• Periudha e voneshme klinike. Pas vitit te peste pas rrezatimit.

Radionekrozat e indeve te buta:
Efekti i rrezatimit tek enet e gjakut, ndodh ne menyre progresive dhe te ngadalte pas rrezatimit dhe eshte referuar si endoarterit proliferativ dhe vaskulit nekrotizues. Demtohen kryesisht arteriolat (arteriet e vogla) dhe kapilaret, kurse enet e medha te gjakut nuk demtohen.
Demtimi (atrofia) i Lekures, qe me pas krijon mundesine per te bere ulceracion dhe te shnderrohet ne plage qe nuk sherohet
Problemet ne sistemin Genitourinar sic eshte:
- Cistiti prej Radiacionit (demtimi ose inflamacioni i fshikezes se urines).
- Proktiti (qe eshte inflamacioni i rektumit/zorres se trashe dhe anusit) qe con ne formimin e fistulave, abceseve dhe fibrozes
Demtimet e Larinksit te cilat shprehen me: - enjtje, - dhimbje, - veshtiresi ne gelltitje dhe ngjirrjet e zerit

Demtimi i kockes nga rrezatimi (osteoradionekrozat):
Shkaterrimi i qelizave kockore prej rrezatimit shkakton thyerjen e kockave (fraktura) dhe pengon ngjitjen e kockave pas thyerjes

Kocka ka dendesine 1,8 here me te madhe se indet e buta dhe absorbon (thith) me teper rrezatim sesa indet e buta. Rrezatimi demton qelizat kockore dhe enet e gjakut qe furnizojne kocken.

Vendet me te shpeshta te nekrozave ne kocka jane:
• Mandibula, qe shfaqet pas radioterapise se tumoreve te kokes dhe te qafes. Kocka e nofulles se poshteme (mandibula) absorbon me teper rrezatim, pra demtohet me teper se kocka e nofulles se siperme (maxilla) per arsye te dendesise me te madhe dhe numrit me te vogel te eneve te gjakut.
• Brinjet, klavikula dhe sternumi (kocka e derrases se kraharorit) zakonisht demtohen pas radioterapise te kancerit te gjirit.
• Kockat e kafkes, zakonisht demtohen pas radioterapise, qe behet per kancerin e trurit dhe kancerin e indeve te buta te skalpit.
• Kollona vertebrale, zakonisht ndodh pas radioterapise te tumoreve spinale.
• Pelvisi dhe koka e femurit, zakonisht demtohen pas radioterapise se tumoreve te pelvisit.

Demtimi i Sistemit Nervor Qendror dhe Medules Spinale
• Rrezatimi ne kete sistem shkakton respektivisht Encefalopatine dhe Myelitin.

Demtimi i syrit prej rrezatimit:
• Rrezatimi shkakton demtimin e nervit optik qe con ne humbjen e shikimit
Perdorimi klinik i HBOT (Terapia Hiperbarike me Oksigjen):
• HBOT duke formuar kapilaret e rinj (neoangiogenezis) permireson mikroqarkullimin dhe ne kete menyre ndihmon ne sherimin e shpejte te pjeses se demtuar nga rrezatimi
• HBOT pergatit dhe krijon ind te shendetshem ne vendin e demtuar dhe krijon nje ambjent te pershtatshem per te bere riparimin me kirurgji plastike ose vendosjen e dhembeve nese demtimi eshte aty.
• HBOT stimulon formimin e indit te ri kockor (osteogenezis) dhe ne kete menyre ben rimodelimin e indit kockor ne vendin e demtuar dhe riparimin e shpejte te thyerjeve
• HBOT parandalon ose frenon infeksionin nese eshte i pranishem (indet e demtuara nga rrezatimi duke qene se nuk kane nje qarkullim te mjaftueshem me gjak mund te infektohem me lehte se indet jo te demtuara)
• HBOT ka nje efekt parandalues ose profilaktik per vazhdimin e demtimeve te mevoneshme te rrezatimit

Paciente me Radionekroze (demtime nga rrezatimi pas radioterapise) te trajtuar me HBOT ne Kliniken “aymed”

Pacienti 1
Trajtohet me radioterapi pas Kancerit te Larinksit dhe pas trajtimit shfaqet demtimi (plage) ne zonen e qafes, qe nuk sherohet me mjekime lokale te plages dhe as me kirurgji.

Pacienti 2
E diagnostikuar me Kancer te Gjirit, eshte trajtuar me Radioterapi dhe Kirurgji (heqja e gjirit). Ka preferuar te kryeje operacion plastik qe konsistoi ne vendosjen e nje flepi ne vendin e gjirit te hequr. Ne fotot e bera para HBOT vihen re nekroza te shumta (inde te vdekura) te shkaktuara nga demtimi prej rrezatimit te indeve te buta. Pra kemi nje flep te pasuksesshem.
Pas 30 seancave te Terapise Hiperbarike me Oksigjen u be e mundur lidhja e flepit pra mosflakja e tij. Ne fotot e bera pas HBOT, vihet re nje plage e paster e mbushur me ind granular dhe e furnizuar mire me gjak. Kjo eshte nje plage qe mund te mbyllet vetem me mjekim lokal ose me nje operacion te dyte plastik.



Para terapise Hiperbarike me Oksigjen

Pas 30 seancash te Terapise Hiperbarike me Oksigjen

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