zeda ybis kibos mkurnalobis efeqturobis analiziJ., Yousem D.M., Loevner LA. 1997). tkivili umetesad lokalizdeba axalwarmonaqmnis areSi da iradirebs irgvlivmdebare organoebSi (Hamaker

naSromi Sesrulebulia saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministros profesor a. RvamiCavas saxelobis onkologiis nacionaluri centris Tavisa da kisris simsivneebis ganyofilebaSi

vladimer xutaSvili

zeda ybis kibos mkurnalobis

efeqturobis analizi

medicinis mecnierebaTa kandidatis samecniero xarisxis mosapoveblad wardgenili sadisertacio naSromi, specialobiT

onkologia _ 14.00.14

samecniero xelmZRvanelebi: _ konstantine mardaleiSvili medicinis mecnierebaTa doqtori, profesori

_ giorgi ormocaZe

biologiur mecnierebaTa doqtori.

1

s a r C e v i

Sesavali - - - - - - - - - - - - - - - - - - - 3

problemis aqtualoba - - - - - - - - - - - - - - 3

Temis mecnieruli siaxle - - - - - - - - - - - - 5

kvlevis Teoriul-praqtikuli Rirebuleba - - - - - - 6

Tavi 1. literaturuli mimoxilva - - - - - - - - - - - - 7

Tavi 2. kvlevis masalebi da meTodebi - - - - - - - - - - - 35

Tavi 3. zeda ybis avTvisebiani simsivneebis kliniko-morfologiuri daxasiaTeba da mkurnalobis Sedegebis analizi - - - - 51

Tavi 4. haimoris Rrus avTvisebiani simsivneebis mimdinareobisa da daavadebis gamosavlis prognozireba - - - - - - - - 81 Tavi 5. miRebuli Sedegebis gansja - - - - - - - - - - - - 103

praqtikuli rekomendaciebi - - - - - - - - - - - 119

daskvnebi - - - - - - - - - - - - - - - - - - 121

bibliografia - - - - - - - - - - - - - - - - - 124

2

Sesavali

zeda ybis wiaRis avTvisebiani simsivneebis xvedriTi

wona onkologiur daavadebaTa struqturaSi ar aRemateba

1_4%-s (Jeff H. Kim T. 1993). igi xasiaTdeba usimptomo

mimdinareobiT rac ganapirobebs avadmyofTa 80%-is

momarTvas specializirebul onkologiur dawesebulebebSi

simsivnis gavrcelebuli (III-IV stadia) procesebiT (Bridger

GP, Mendelsohn MS, Baldwin M. 1991). aRsaniSnavia, rom zeda ybis

wiaRis kibo 3-jer ufro xSirad gvxvdeba mamakacebSi, vidre

qalebSi (Markola A.T., Aronen H.J., Paavonen T. 1996). da rogorc

wesi igi 45-55 wlis asakis pacientTa xvedria (Phillips C.D.,

Futterer S.F., Lipper M.H. 1997).

avtorTa umravlesobas (Краевский Н.А., Смольянникова А.В.,

Саркисова Д.С. 1993; Antilia J., Sonnien P., Grenman R. 1993) miaCnia,

rom simsivnuri procesis ganviTarebas mniSvnelovnad

uwyobs xels duned mimdinare qronikuli anTebiTi

procesebi, romlis drosac aRiniSneba wiaRis amomfeni

lorwovanis hiperplazia, rasac SemdgomSi Tan sdevs

simsivnis ganviTareba.

miuxedavaT mravali Sromebisa, romlebic eZRvneba zeda

ybis avTvisebiani simsivneebis mkurnalobas, igi mainc rCeba

erTerT rTul da jer kidev gadauWrel problemad. erTis

mxriv, es ganpirobebulia haimoris Rrus agebulebis

anatomiuri TaviseburebebiT. xolo meores mxriv, misi

ganlagebiT saxis ConCxis siRrmeSi da uSualo siaxloviT

iseT sasicocxlo organoebTan, rogoric aris Tavis tvini,

Tvalebi, magistraluri sisxlZarRvebi da sxva. yovelive es

3

arTulebs rogorc sxivuri energiis maqsimaluri dozebiT

gamoyenebas, aseve radikaluri operaciis warmoebas. magram,

miuxedavaT amisa, miRebuli Sedegebis efeqturobis analizi

gviCvenebs, rom bolo erTi saukunis ganmavlobaSi

aRniSnuli daavadebis mkurnalobaSi miRweulia

mniSvnelovani progresi. gadarCenil avadmyofTa ricxvi 5%-

dan gaizarda 46%-mde. rac udaod teqnikurma progresma da

mkurnalobisadmi diferencirebulma midgomam ganapiroba

(Aisen A.M., Martel. W., Braunstein E.M., Mcmillen K.I., Phillips W.A. 1986;

Atlas S.W., Grossman R.J., Gomori J.N., Guerry D., Hackney D.B. 1987;

Annis J.A., Phelps P.D., 1989; Antilia J., Sonnien P., Grenman R. 1993;

Шацкая Н.Х. 1993; Черекаев В.А. 1995; Сдвижков А.М. 1997).

magram, miuxedavad amisa, jer kidev ar aris

dasabuTebulad warmodgenili erToblivi koncefcia zeda

ybis kibos mkurnalobis Sesaxeb daavadebis mimdinareobis,

morfologiuri Senebis da sxva klinikur TaviseburebaTa

gamovlinebis gaTvaliswinebiT. aRniSnuli maxasiaTeblebis

Seswavla, sxvadasxva meTodebiT namkurnaleb avadmyofTa

jgufebSi, SesaZleblobas mogvcemda gamogvevlina

informatiul niSanTa simptomo kompleqsi, romelic

mniSvnelovnad ganapirobebda mkurnalobis Sedegs da

Sesabamisad daavadebis gamosavalsa da prognozs.

samwuxarod, aseve ar arsebobs sistematizirebuli

monacemebi mkurnalobis individualuri modelirebis

Sesaxeb yovel konkretul SemTxvevaSi, rac mniSvnelovnad

Seuwyobda xels mkurnalobis efeqturobis amaRlebas.

aqedan gamomdinare, Cveni kvlevis mizans warmoadgenda,

informatiuli kliniko-morfologiuri niSnebis gamovlena,

4

romlebic mniSvnelovan zegavlenas axdendnen Catarebuli

konservatuli, qirurgiuli da kombinirebuli mkurnalobis

efeqturobaze. amisaTvis gamiznuli iyo Semdegi amocanebis

gadaWra:

1 Segveswavla zeda ybis avTvisebiani simsivneebis

mimdinareobis Taviseburebani, daavadebis kliniko-

morfologiur gamovlinebaTa gaTvaliswinebiT.

2 dagvedgina zeda ybis avTvisebiani simsivneebis

kliniko-morfologiuri maxasiaTeblebis ganawileba

sxvadasxva meTodebiT namkurnaleb avadmyofTa

jgufebSi, mkurnalobis Sedegis gaTvaliswinebiT.

3 gamogvevlina yvelaze informatiuli niSnebi, romlebic

mniSvnelovan zegavlenas axdenen mkurnalobis

efeqturobasa da aqedan gamomdinare sicocxlis

xangrZlivobaze.

4 miRebuli Sedegebis safuZvelze SegvemuSavebina

mkurnalobis individualuri modelirebis sqemebi, rac

mogvcemda saSualebas yovel konkretul SemTxvevaSi

SegverCia mkurnalobis optimaluri meTodi da

Sesabamisad gagvezarda gamojansarebul pacientTa

ricxvi.

Temis mecnieruli siaxle. pirvelad did klinikur

masalaze dayrdnobiT Seswavlilia zeda ybis avTvisebiani

simsivneebis mimdinareobis Taviseburebani, daavadebis

kliniko-morfologiur gamovlinebaTa gaTvaliswinebiT.

dadgenilia zeda ybis avTvisebiani simsivneebis

kliniko-morfologiuri maxasiaTeblebis ganawileba

5

sxvadasxva meTodebiT namkurnaleb avadmyofTa jgufebSi,

mkurnalobis Sedegis gaTvaliswinebiT.

gamovlenilia yvelaze informatiuli niSnebi,

romlebic mniSvnelovan zegavlenas axdenen mkurnalobis

efeqturobasa da aqedan gamomdinare sicocxlis

xangrZlivobaze.

miRebuli Sedegebis safuZvelze SemuSavebulia

mkurnalobis individualuri modelirebis sqemebi, ramac

saSualeba mogvca, SegverCia mkurnalobis optimaluri

meTodi yovel konkretul SemTxvevaSi da Sesabamisad

gagvezarda gamojansarebul pacientTa ricxvi.

mocemuli kvlevis Sedegebis praqtikaSi gamoyeneba

xels uwyobs aRniSnuli avadmyofebis mkurnalobis

efeqturobis da sicocxlis xarisxis amaRlebas.

kvlevis Teoriul-praqtikuli Rirebuleba. didi

klinikuri masalis analizis safuZvelze Sefasebulia

haimoris wiaRis kibos konservatuli da qirurgiuli

mkurnalobis meTodebis efeqturoba. dadgenilia tipiuri,

damzogveli da gafarToebuli operaciebis gamoyenebis

Cveneba-ukuCveneba, avTvisebiani simsivnis kliniko-

morfologiuri da topografo-anatomiuri maxasiaTeblebis

gaTvaliswinebiT.

6

Tavi I

literaturuli mimoxilva

zeda ybis wiaRis avTvisebiani simsivneebis xvedriTi

wona onkologiur daavadebaTa struqturaSi ar aRemateba

1_4%-s (Jeff H. Kim T. 1993). igi xasiaTdeba usimptomo

mimdinareobiT rac ganapirobebs avadmyofTa 80%-is


simsivnis gavrcelebuli (III-IV stadia) procesebiT (Bridger

GP, Mendelsohn MS, Baldwin M. 1991). aRsaniSnavia, rom zeda ybis

wiaRis kibo 3-jer ufro xSirad gvxvdeba mamakacebSi, vidre

qalebSi (Markola A.T., Aronen H.J., Paavonen T. 1996). da rogorc

wesi igi 45-55 wlis asakis pacientTa xvedria (Phillips C.D.,

Futterer S.F., Lipper M.H. 1997).

zeda ybis avTvisebiani simsivneebiT avadobis xvedriTi

wili monRoloiduri rasis warmomadgenlebSi

mniSvnelovnad aRemateba evropelTa avadobis maCveneblebs.

О.И. Бибер-ma 1982 wels aRniSna, rom yazaxeTis mosaxleobaSi

aRniSnuli paTologiis xvedriTi wili 7-jer aRemateboda

sabWoTa kavSiris danarCen mosaxleobaSi gamovlenil

maCveneblebs. aRniSnuli daavadebis ufro maRali cifrebi

moyavT С.Ш. Баимаканова-s (1989w) da М.Х. Ибрагимов-s (1988w)

yazaxeTis, yirgizeTisa da TurqmeneTis mkvidrTa Soris

aRmosavleT evropis mosaxleobasTan SedarebiT

(Sesabamisad 2,6 _ 0,6).

avtorTa umravlesobas miaCnia, rom simsivnuri

procesis ganviTarebas mniSvnelovnad xels uwyobs duned

mimdinare qronikuli anTebiTi procesebi (Краевский Н.А.,

7

Смольянникова А.В., Саркисова Д.С. 1993). gansakuTrebiT maSin,

rodesac aRiniSneba wiaRis amomfeni lorwovani garsis

hiperplazia, ganpirobebuli Cirqovani eqsudatis qronikuli

zemoqmedebiT (Antilia J., Sonnien P., Grenman R. 1993). Buchwarld C,

Nielsen LH, Ahlgren P, Nielsen PL, da Tos M-is mier 1990 wlis

monacemebiT, pacientebi simsivnis ganviTarebamde 5-10%-Si

aRniSnaven travmis arsebobas saxis areSi.

miuxedavad diagnostikuri meTodebis simravlisa,

avadmyofebis mxolod 20% iwyebs mkurnalobas daavadebis

sawyis stadiaSi (Dillon W.P., Som P.M., Fullerton G.D. 1990). am

dros simsivnis manifestaciis ZiriTad gamovlinebas

tkivilis simptomi warmoadgens (g. RoReliani 1998; Hirsch R.

J., Yousem D.M., Loevner LA. 1997). tkivili umetesad

lokalizdeba axalwarmonaqmnis areSi da iradirebs

irgvlivmdebare organoebSi (Hamaker RC, Singer MI 1986).

Joroisen M.-is (1996) azriT tkivilis simptoms xSirad Tan

axlavs cxviridan sunTqvis gaZneleba, yru da mRrRneli

xasiaTis tkivilebi. ufro gavrcelebuli stadiebis dros

tkivili iradirebs kbilebSi, safeTqlis, yuris da Tvalis

midamoSi (Hoff van S.C.J., Lamers R.J.S., Kessels A.G.H. 1995; Jing B.S).

xSirad tkivilis gamovlenas Tan axlavs sxvadasxva saxis

paresTeziebi, an vlindeba nevralgiuri xasiaTis tkivilebi

simsivnuri dazianebis mxareze (Hoe J.W. 1989). tkivilis

simptomi gansakuTrebiT maSin aris gamoxatuli, rodesac

procesi scildeba zeda ybis farglebs da azianebs

frTasasis fosos (Hamaker RC, Singer MI 1986).

8

sunTqvis calmxrivi gaZneleba, rogorc wesi

damokidebulia simsivnis sawyis lokalizaciasa da zrdis

mimarTulebaze (Belkin B.A., Papageorge M.b., 1988). yvelaze adre

es simptomi Cndeba daavadebis gavrcelebisas zeda ybidan

dacxriluli firfitis miarTulebiT (Fakitsas j., Bankoff M.S.

1989). am SemTxvevaSi aRiniSneba lorwovani garsis

hipersekrecia, rac ganapirobebs uxvi gamonadenis arsebobas

cxviris savalidan. mogvienebiT aRniSnuli gamonadeni

Rebulobs Cirqovan xasiaTs, romelsac Tan axlavs

perioduli sisxldenebi (Ang KK, Jiang GL, Frankenthaler RA 1992).

Catarebulma kvlevebma, haimoris Rrus epiTeluri da

araepiTeluri warmoSobis simsivneebis mimdebare anatomiur

struqturebze gavrcelebis Taviseburebis Seswavlis

Sesaxeb gviCvena, rom epiTeluri warmoSobis simsivneebi

azianeben Tvalbudes 20-25%-Si, cxviris Rrus lorwovans 30-

35%-Si, piris Rrus organoebs 15-20%-Si da loyis qsovilebs

20-22%-Si. araepiTeluri simsivneebi erTnairad xSirad

azianeben Tvalbudes (35-40%) da cxviris Rrus (40-45%), rac

Seexeba piris Rrus da loyis qsovilebs, maTi dazianeba

aRiniSneba Sesabamisad 10-15% da 2-5%-Si (LoRusso P, Tapazoglou

E, Kish JA, et al 1988).

tkivilis da sunTqvis gaZnelebis garda, zeda ybis

wiaRis simsivneebs procesis gavrcelebis mimarTulebis

gaTvaliswinebiT axasiaTebs: saxis SeSupeba, Tvalis kaklis

distopia, ekzofTalmi, cremldena, cxviridan sisxldena,

alveoluri morCisa da sasis gumbaTis cvlileba, kbilebis

moryeva, trizmi, ynosvis daqveiTeba da paresTeziebi (Bettez

M., Dolan K.d., Yuh W.T. 1989).

9

daavadebis klinikur gamovlinebaTa mravalferovnebam

maTi sistematizaciis aucilebloba Seqmna. 1995 wels g.m.

penkovskim zeda ybis kibos klinikur gamovlinebaTa

simptomatika gaaerTiana oTx ZiriTad jgufSi, romlis

mixedviTac SesaZlebeli iyo gvemsjela paTologiuri

procesis zrdis mimarTulebis Sesaxeb. pirveli jgufis

simptomebs man otorinolaringologiuri uwoda. am dros

aRiniSneboda cxviridan sunTqvis gaZneleba da sixlian-

serozuli gamonadeni, ynosvis daqveiTeba, tkivili wiaRis

midamoSi; meores nevrologiuri (Tavis tkivili, neiropaTia,

mgrZnobelobis moSla); mesames stomatologiuri (trizmi,

kbilis tkivili) da meoTxes ofTalmologiuri (diplopia,

mxedvelobis daqveiTeba, egzofTalmi). man aseve aRniSna,

rom SesaZlebelia arsebobdes am simptomTa ori an sami

jgufis erTdrouli gadamkveTi gamovlineba.

zeda ybis wiaRidan limfa ZiriTadad gaedineba xaxis

kisris nawilis zeda-Rrma limfur kvanZebSi, ybisqveSa

midamos limfur kvanZesa da ybayura jirkvlis midamos

limfur kvanZebSi (Kish J, Ensley J, et al 1987). magram, rogorc

klinikurma dakvirvebebma gviCvenes, regionuli metastazebi

haimoris Rrus avTvisebiani simsivneebis dros ufro

iSviaTad SeiniSneba, vidre analogiuri simsivneebis dros,

romlebic lokalizdebian zeda sasunTqi gzebis da piris

Rrus organoebSi (Buchwarld C, Nielsen LH, Ahlgren P, Nielsen PL,

Tos M. 1990).

zeda ybis wiaRis kibos avTvisebianobis xarisxis

Seswavlam, 1933 wels Svedi mecnieri L. Ohngren-i miiyvana im

daskvnamde, rom simsivneebi romlebic lokalizdebian zeda

10

ybis wiaRis zeda-ukana naxevarSi, xasiaTdebian ufro

agresiuli mimdinareobiT, adreuli metastazirebiTa da

mZime prognoziT, maSin, roca simsivnis lokalizaciisas

wiaRis qveda-wina naxevrSi daavadebis mimdinareoba da

prognozi ufro keTilsaimedoa. aqedan gamomdinare,

daavadebis prognozirebis mizniT, avtorma mizanSewonilad

CaTvala zeda ybis areSi frontaluri da sagitaluri

xazebis gatarebiT haimoris wiaRi pirobiTad gaeyo oTx

segmentad, rasac man simsivnis avTvisebianobis xazebi

uwoda. L. Ohngren-is mixedviT zeda ybis wiaRi iyofa Semdeg

segmentebad:

1. wina-qveda SigniTa segmenti;

2. wina-qveda gareTa segmenti;

3. zemo-ukana gareTa segmenti;

4. zemo-ukana SigniTa segmenti;

avtorebis monacemebiT (Shidnia H., Hornbak N., Saghafi N. et al.

1984; Воробьев В.И., Гарбузов М.И., 1989; Пучинина Е.И. с соавт., 1991),

zeda ybis kibos regionuli metastazebi simsivnis

lokalizaciisas zeda _ ukana segmentSi SeiniSneba

SemTxvevaTa 14-16%-Si, xolo qveda _ wina naxevrSi

lokalizaciisas maTi sixSire ar aRemateba 7-8%-Si

(Гогелиани Г.К. 1984). Tumca sakmaod xSirad vxvdebiT

simsivneebs, romlebic xangrZlivi drois ganmavlobaSi

arseboben, scildebian erTi anatomiur organos farglebs,

invazireben irgvlivdebare struqturebSi da ar iZlevian

regionul metastazebs (Draf W., Samii M. 1988).

11

sxvadasxva avtorTa monacemebiT, zeda ybis wiaRis

simsivneTa Soris epiTeluri genezis axalwarmonaqmnebi

gvxvdeba (70-80%-Si) (Afridi N, Taghian A, Nogueira C 1995;Vlock D,

Anderson J, Whiteside T, Herbeman R, Kirkwood J, Adams G. 1994). maT

Soris wamyvani adgili ukavia brtyelujredovan karcinomas

(65-90%) (Al-Kourainy K, Kish J, Ensley J, Tapazoglou E 1987). romelsac

diferencirebis xarisxis mixedviT yofen maRal-, saSualo-,

da dabaldiferencirebul kibod, radgan maT sxvadasxva

klinikuri mimdinareoba axasiaTebT (Cunnings G, Al-Sarraf M.

1987). aseve radikalurad gansxvavdeba adenikarcinomis,

cilindromis, epiTeluri da araepiTeluri warmoSobis

avTvisebiani simsivneebis klinikuri mimdinareobac (Jacobs J,

Weaver A, Crissman J 1988; Turner SL, Tiver KW, 1995). rac Seexeba

araepiTeluri warnoSobis simsivneebs, umetesad vxvdebiT

zeda ybis wiaRis egereTwodebul rbili da magari

qsovilovani warmoSobis sarkomebs, iseTi rogoricaa:

limfosarkoma, osteosarkoma, qondro da angiosarkomebi (

Kish JA, Ensley JF, Jacobs J, 1996).

2002 wels ВОЗ-is mier mowodebul zeda ybis wiaRis

kibos 19-e morfologiur klasifikaciaSi ZiriTadad ori

tipis simsivneebs ganixilaven:

epiTeluri simsivneebi araepiTeluri simsivneebi

• brtyelujredovani karcinoma • limfosarkoma

• adenokarcinoma • osteosarkoma

• mucinozuri adenokarcinoma • qondrosarkoma

• adenokistozuri karcinoma • angiosarkoma

• cilindroma • rabdomiosarkoma

12

13

• mukoepidermoiduli karcinoma • neiro sarkoma

• aradiferencirebuli kibo • Svanoma

• miksoma

• neirofibroma

• esTezioneiroblastoma

• melanoma

aRsaniSnavia, rom klasifikaciaSi warmodgenili

gansxvavebuli genezis simsivnur daavadebebs axasiaTebT

klinikuri mimdinareobis Taviseburebebani, rac moiTxovs

sxvadasxva diagnostikuri meTodebis kompleqsur

gamoyenebas. maTi Tanmimdevroba mniSvnelovnad aris

damokidebuli simsivnuri procesis lokalizaciasa da

gavrcelebaze. magram igi yovelTvis iwyeba saxis

vizualuri daTvalierebiT, gardamavali naoWis

mdgomareobis SefasebiT, daavadebul mxareze cxviris

savalidan sunTqvis xarisxis gansazRvriT. risTvisac,

rogorc wesi, aucilebeli xdeba palpaciisa da rinoskopiis

warmoeba (Som P.M., Shugar J.M., Troy K.M., Sacher M., Stollman A.L.

1988).

wina rinoskopia saSualebas gvaZlevs miviRoT

informacia simsivnis gavrcelebis Sesaxeb haimoris Rudan

cxviris savalSi, davadginoT misi zomebi, agebuleba, zrdis

forma da damokidebuleba irgvlivmdebare qsovilebTan

(Шацкая Н.Х. 1993). xolo ukana rinoskopiiT, fasdeba

cxvirxaxisa da cxviris niJarebis ukana ganyofilebebis

mdgomareoba (Tsujii H., Kamada T., Arimoto T. 1986). magram igi

ukavSirdeba mniSvnelovan sirTuleebs, romlebic

ganpirobebulia aRniSnuli organos rTuli anatomiuri

agebulebiT da moiTxovs eqimis maRalprofesionalizms wina

da ukana rinoskopiis Sedegebis Sefasebisas (Лопатин А.С.,

Арцыбашева М.В. 1996).

tradiciuli rinoskopiuli da fibroskopiuli

kvlevebis monacemebis Sefasebisas aRmoCnda, rom am

ukanasknels mniSvnelovani upiratesoba gaaCnia zeda ybis

wiaRisa da misi mezobeli anatomiuri struqturebis

paTologiuri cvlilebebis aRmoCenaSi, romelTa sizustec

92-93%-s uaxlovdeba (Annis J.A., Phelps P.D. 1989). rac ar

SeiZleba iTqvas rinoskopiaze, misi informatiulobis

maCvenebeli mxolod 66-67%-ia (Baker H.L. 1986). garda amisa,

fiboskopiis gamoyenebiT, gveZleva SesaZlebloba

vakontroloT mkurnalobis efeqturoba, rogorc misi

Catarebis procesSi, aseve mkurnalobis Semdgomi dinamiuri

dakvirvebisas. Ferrer Y. 1978, aRwers teleskopiuri milebis

gamoyenebis upiratesobas zeda ybis wiaRebis

daTvalierebaSi, romlebsac igi sxvadasxva daxris

kuTxeebiT iyenebs (0, 300, 700, 1200).

haimoris Rrus kibos gavrcelebis dros cxviris

savalSi da cxvirxaxaSi yvelaze informatiul meTodad

gvevlineba fibroskopia, igi 85-86%-Si iZleva zust

monacemebs daavadebis gavrcelebis masStabze (Chobe R,

McNeese M, Weber R, Fletcher GH 1988). aRniSnuli meTodi aseve

maRalinformatiulia mcire zomis simsivneebis dros

haimoroskopiis warmoebisas (Som PM, Lawson W, Lidov MK. 1991).

zeda ybis wiaRis gamokvleva drekadi fibroskopiT,

romelsac gaaCnda rTuli optikuri sistema saSualebas

gvaZlevs detalurad SeviswavloT aRniSnul organos yvela

14

anatomiuri ganyofileba, SevafasoT wiaRis dazianebis

moculoba, ganvsazRvroT simsivnis zrdis forma, misi

gamokidebuleba irgvlivmdebare qsovilebTan da bolos

ganvaxorcieloT damiznebiTi biofsia (Dresel S; Kang K. 1990).

magram aRmoCnda, rom aRniSnuli meTodi (rinoskopia,

fibroskopia da haimoroskopia) gavrcelebuli simsivneebis

SemTxvevaSi kargavs aqtualobas, radgan cxiris savalis

sruli opturaciis gamo SeuZlebeli xdeba wiaRSi Sesvla

da misi gamokvleva (Bilaniuk L.T; Grevers G. 1994). am dros

gansakuTrebul mniSvnelobas iZens zeda ybis

rentgenologiuri kvlevis meTodi (Афанасьева А.В.-c 1952). am

mxriv, yvelaze ufro informatiulia zeda ybis

rentgenogramebis gadaReba nikap-cxviris, gverdiT da

naxevradaqsialur proeqciebSi an seleqtiuri tomografiis

warmoeba. frontalur proeqciaSi gadaRebuli tomograma

mniSvnelovnad avsebs rentgenologiur suraTs da gvaZlevs

warmodgenas haimoris Rrusa da cxviris danamati wiaRebis

anatomiur struqturasa da formaze, iZleva saSualebas

gamovavlinod masSi paTologiuri procesis arseboba da

SevafasoT Zvlovani struqturebis mdgomareoba. igi iZleva

saSualebas davadginod daavadebis mxare, haimoris wiaRis

daCrdilvis intensivoba, misi irgvlivmdebare struqturebze

gavrcelebis mimarTuleba da vimsjelod Zvlovani kedlebis

mdgomareobaze!(Лихтенштейн Е.А.-d (1961-1970).!!

rentgenologiuri kvlevis aucilebloba zeda ybis

wiaRis kibos diagnostikaSi eWvs ar iwvevs. Tumca Файзуллин

М.Х.-s •")_"a! miaCnia, rom! daavadebis! gmiuflc! dogmcebid!

mikd! iuzmvuzkmcgvzkdocsg! f(lficg! mgdegd! dpkic!

15

mcgvzkqc8! vgzdgsftiu-ct! hzuewgocqciu-flc! pcgrcd! bkzqu9!

Грицман Ю.Я-i (1981) Tvlis, rom zeda ybis! rentgenografia

\jcigm! ver iZleva!dcwdcezcd!qfdo!vgwkdg\flu-gd!da!igx!

fbik! wxciug! dcwdcezfic! pgiwkzgnwzc8! wct! fbik! zgslu-gm!

juubgimu-g! iuzovuzologiuri! vgwkdg\flu-g! dcwdcezcd!

{ujwgico! qkwgd. klinikuri da rentgenologiuri

monacemebis SedarebiTma analizma gamoavlina maT Soris

mniSvnelovani sxvaoba, rac 34-35%-s aRwevs (Beck JC,

McClatchey KD, Lesperanse MM, Esclamado RM, Carey TE, Bredford CR.

1995). aseve xSiria simsivnis gavrcelebis sazRvrebis hipo

(31-32%) da hiperdiagnostika (3-4%) (Belkin B.A., Papageorge M.b.,

Fakitsas j., Bankoff M.S. 1988). o. olSanskis mier 1987 wels

dadgenil iqna, rom rentgenologiuri da klinikuri

monacemebis sruli damTxveva aRiniSneba mxolod 37-38%-Si.

yovelive es, uflebas gvaZlevs vamtkicod, rom zeda ybis

rentgenografia ar warmoadgens diagnostikuri problemis

ualternativo da gadamWrel meTods. am dros, maT

mniSvnelovnad miaCniad, zeda ybis radioizotopuri kvlevis

warmoeba (Bettez M., Dolan K.d. 1989). avtorTa azriT, kvlevis es

meTodi aseve arainvaziuri da umtkivneuloa. misi

gamoyenebis principi dafuZnebulia radioizotopis unarze

Calagdes simsivnur qsovilSi meti intensivobiT, vidre mis

garSemo arsebul saR da simetriulad ganlagebul

qsovilebSi (Yuh W.T. 1990). STanTqmuli radiogamosxivebis

aRricxvisaTvis, radiometriuli da gama-topografiuli

meTodebiT sargebloben. radiometriuli meTodi ZiriTadad

gamoiyeneba radiaqtiuli fosforis P32-is gamosxivebis

azomvisaTvis, romelsac axasiaTebs arCeviTi kumulacia

simsivnur ujredebSi. aRniSnuli meTodi informatiulia

16

diferencialuri diagnostikis TvalsazrisiT da naklebad

informatiulia daavadebis lokalizaciis da gavrcelebis

gansazRvrisaTvis (Mazinalli L, Goldschmidt B 1941).

rac Seexeba gama-topografiuli meTods, misi muSaobis

principi dafuZnebulia STanTqmuli radiaqtiuri

nivTierebis gamosaxulebis miRebaze skanirebis an

scintigrafiis saSualebiT. kvlevisaTvis ZiriTadad iyeneben

75 Se-meTionins da Ga 67 citrats •Горский А.А. c соавт. 1984a9

kibos skanografiuli suraTisaTvis damaxasiaTebelia

simsivnis mier radiofarmpreparatis intensiuri kumulacia,

sadac dagrovebis farTobi, rogorc wesi,

pirdapirproporciulia simsivnis zomisa da misi

lokalizaciisa (Приходько А.Г., Ефимцев Ю.П., Баженов В.В.,

Васина Н.Б., Санкин И.А., Смолякова Н.Е. 1991). magram samwuxarod,

aRniSnuli meTodi ver uzrunvelyofs 2sm-ze mcire zomis

simsivneTa diagnostikas, rac miRebul informacias eWvqveS

ayenebs da xSirad arasaimedos xdis!• Горский А.А., Приходько

А.Г., Габуния Р.И., Сенюков М.В. 1985; Коссовой А.Л. 1987). aseT

SemTxvevebSi metad faseulia kompiuteruli tomografia.

kompiuteruli tomografiis meTodi, rentgenologiuri

da radioizotopuri kvlevisgan gansxvavebiT, xasiaTdeba

rigi upiratesobebiT. upirvelesyovlisa, kt-ze qsovilebis

identificireba SesaZlebelia miRebul iqnas maTi

simkvriveebis 0,5%-iani sxvaobisas, maSin, rodesac

rentgenografiisas es ukanaskneli SesaZlebelia miRebul

iqnas 15-20%-iani simkvrivuli sxvaobebisas (Beck J.C;

McClatchey K.D; Lesperanse M.M. 1995). amrigad, kompiuteruli

tomografia iZleva saSualebas miviRod, Zvlovani,

17

xrtilovani, kunTovani, cximovani da a.S. qsovilebis zusti

gamosaxuleba (De Capua B., Marler E. et al. 1993). ufro metic, misi

saSualebiT SesaZlebelia davadginod wiaRisa da

irgvlivmdebare anatomiuri organoebis

urTierTdamokidebuleba simsivnur procesTan mimarTebaSi

(Esclamado RM, Carey TE, Bredford CR 1996). da bolos, rac

yvelaze mniSvnelovania, kt uzrunvelyofs gamosaxulebis

sxvadasxva WrilebSi miRebas, paTologiuri kerebis azomvis

warmoebas da aucileblobis SemTxvevaSi maT gadidebas.

kompiuteruli tomografiis damTxveva klinikur

monacemebTan 80-90%-s Seadgens (Comba P., Battista G., Belli S. 1992).

ufro metic, Фрейтаг Ю. (1991) da Nanakawa S-as (1989) azriT

aRniSnuli meTodis gamoyenebiT judg(lu-ulc! vg\mg!

dcwdcezfic! hikxudcd! ara marto! gmvclk-icei vgeixulu-cd!

sazRvrebis!mgmvuzg, aramed!lcwbfic!segz(u-cd!wuogdogqfic!

mgqcgzu-cd!grwkyuzg9!

magram aRmoCnda, rom yovelive es exeba zeda ybis

gavrcelebul procesebs. rac Seexeba mcire zomis pirvelad

da recidiul simsivneebs, maTi diferencireba

irgvlivmdebare anTebiTi da rbili qsovilebidan, kt-s

meSveobiT xSirad problematuria, aseve gaZnelebulia maT

Soros sazRvrebis diferencirebac (Денисов Л.Е., Терновой С.К.

1981; Сдвижков А.М. 1983). wgvzcofi.iuqkzgzdflc! kvlevis

danergvis Semdeg SesaZlebeli gaxda aRniSnuli

naklovanebebis nivelireba, rac tgzgwumikeu! dgwumcxczk!

ounzklkvccd!fmcmud! miRwevad iqna miCneuli (Lund.V.J. 1983;

Приходько А.Г., Ефимцев Ю.П. 1992). es meTodi xasiaTdeba ufro

maRali diferencirebis unariT rbili qsovilebis

18

kvlevisas, mravalsibrtyivi gamosaxulebis miRebis

SesaZleblobiT, aseve artefaqtebisa da maionizirebeli

gamosxivebis ararsebobiT (Овчинников Ю.М., Добротин В.Е. 1997).

wgvzcofi.iuqkzgzdflc! kvleva gvaZlevs, gmgwcgzcd!

kivgzcqwcd! aramarto t\ulc! jiuu-cd! vgwkdg\flu-gd d\egmgd\eg!(bikzoglfic8!dgvcoglfic8!gndcglfic!mg!cic-c!

sibrtyeebi)! dc-io/uu-jc8! aramed uzrunvelyofs!kivgzku-cd!

wkxflk-ctc!iuskzdoifnxcfl kvlevasac (Vogl Th. et al. 1993).

ufro metic, wgvzcofi.iuqkzgzdflc! okwkvigbcflc!

vgwkdg\flu-u-c! wzcjezulkezgm! vgzd\egemu-g! skwhcfouifl.

okwkvigbcflc! seluecd! monacemebisagan (Пеньковсий Г.М.,

Пионтковская М.Б. 1996) aqedan gamomdinare, igi c(lueg!

dgjfglu-gd,! qfdogm! mgmvczmud! dcwdcezfic! �ndkeclcd!

dgqreiu-c.! kvlevis sxva meTodebTan SedarebiT! vggyzcg!

fhcigoudk-g, vgwkgelczkd! dcwdcezcd! jcmg! doifnofiu-c! (R.

Rochels; R. Bleier 1987), ufro metic, misi gamoyenebiT

SesaZlebelia juegbgdkt! kisris! lcwbfic! segz(u-cd!

wmvkwgiuk-g! mg! wgtc! mgwkscmu-flu-g! magistralur

sisxlZarRvebTan,! mgwgou-ctc! czoigeuzfic! skzoigdociu-cd!

vgiuju9 (Ольшанский В.О., Корниенко В.Н., Кицманюк З.Д. и др. 1995).

magram rogorc klinikurma dakvirvebebma gviCvenes,

magnitur-rezonansuli tomografia ver cvlis kompiuterul

tomografias. radgan kompiuteruli tomografia ufro meti

informaciis matarebelia Zvlovani qsovilebis

mdgomareobis SefasebaSi, xolo magnitur-rezonansuli

tomografia ki rbili qsovilebis (Oot R.F., Parizel P.M., Weber

A.L 1986). aRniSnul diagnostikur meTodTa kompleqsuri

gamoyeneba mniSvnelovnad amcirebs pacientTa gamovlenas

19

daavadebis dagvianebuli stadiebSi 93%-dan 71%-mde, rac

radikaluri mkurnalobis erTerT mTavar winapirobas

warmoadgens! (Погосов В.С., Корниенко В.Н., Акопян Р.Г., Талалаев

В.Н., Туркин А.М. 1989a9!am mxriv, aseve mniSvnelovania kisris

regionuli limfuri kvlanZebis mdgomareobis adeqvaturi

Sefaseba ultrabgeriTi kvlevis gamoyenebiT.!

rogorc klinikurma dakvirvebebma gviCvenes,

ultrasonografiuli meTodi iZleva saSualebas

gamovavlinoT arapalpirebadi kvanZebi, romlebSic

SemTxvevaTa 25%-Si metastazuri dazianebebi aRiniSneba. rac

Seexeba namkurnaleb avadmyofebs, es cifri mniSvnelovnad

izrdeba da aRwevs 35-40%-s (Graamans K., Slootweg P.J., Grau C.,

Harbo G., BunDgaard T., Overgaard M. et al. 1995). yovelive es

uflebas gvaZlevs vamtkicod, rom, zemodxsenebuli meTodi

metad mniSvnelovania zeda ybis simsivnuri daavadebis

gavrcelebis diagnostikaSi. Leicher da E. Duber-i (1990w)

azriT, miRebuli informaciis sarwmunoeba mniSvnelovnad

izrdeba ultrabgeriTi meTodis gamoyenebiT kompiuterul

da magnitur-rezonansul tomografiasTan kombinaciaSi.

mkurnalobis strategiis dagegmarebaSi gadamwyvet

rols citologiur da morfologiur kvlevebs aniWeben

(Bachaud JM, David JM, Boussin G, Cantu G., Solero S., Matvelly F., et al.

1994). magram, samwuxarod misi ganxorcieleba ZiriTadad

maSin aris SesaZlebeli, rodesac daavadeba tovebs haimoris

Rrus sazRvrebs da vrceldeba cxviris RruSi, gardamaval

naoWze, cxvirxaxaSi da a.S. (Chong V.F.H., Fun Y. 1997). sxva

SemTxvevaSi masalis mosapoveblad morfologiuri

kvlevisaTvis aucilebeli xdeba haimorotomiis warmoeba. es

20

ukanaskneli ki operaciul Carevas warmoadgens, rac

arRvevs limfuri drenirebis bunebriv gzebs da amis gamo

uaryofiT zegavlenas axdens mkurnalobis uSualo da

Soreul Sedegebze (Comba P., Battista G., Belli S. De Capua B., Marler

E. et al. 1992). aqedan gamomdinare, zeda ybis wiaRis

dcwdcezuu-cd! morfologiuri verifikaciisaTvis, bolo

wlebSi! ZiriTadad iyeneben zeda ybis gamonarecxi wylebis!

xcoklkvcfi! seluegs9! Петрова А.С. и Контрадиева Т.Т. (1983)!

\gqd! fdegwuz8! ikw! aRniSnuli kvlevis meTodi! gmeclcg!

judgdiflu-lgm8! fdgbit\kg! mg! wcdc! gamoyeneba!

judg(lu-ulcg! hklcslczcsfi! hcik-u-jcx! sc.! TviTon!

wutkmcd! mcgvzkdocsfic! judg(lu-lk-u-c! u{ed! gi! cpeued,!

magram! -ueigm! gicd! mgwkscmu-flc! gru-flc! wgdglcd!

\gicd\cgzk-gqu9! aqedan gamomdinare,! ud! wutkmc!

vgzdgsftiu-ct!wgjcz!gicd!vgwkdgmuvc8!ikmudgx!dgnwu!vegned!

mggegmu-cd! dgp/cd! dogmcu-tgz! •Ионадис Г.П.1966, Теодор И.Л. c

соавт. 1970a9!

rac Seexeba! pcgrcd! hfznxcgd, qkvc! dhuxcglcdoc!

fhcigoudk-gd!gzc{u-d!pcgrcd!hfznxccd!oigmcxcfl!wutkmd!

.! x\ecicd! neumg! dgeglcmgz! (Kjos B., DeGroot J., Brant-Zawadzki

1992)9!xolo!Dillon W.P. da Mills C.M-is azriT (1993w.) /eulgqu!

fbik! igxckzglfic! mg! zgslu-gm! oigewflcg! punqciis

warmoeba,! lk/g.gleuklgiflc! wkiycd! lkipkegzc! vgidcd!

zgk{cd!giumgz9!!

mTlianobaSi SegviZlia davaskvnad, rom!xcoklkvcfic!

seluecd! wutkmc8! ikwulcx! u/imzk-g! gochcfi! f^iumtg!

vgwkeluzgd8! juc(lu-g! pgiwgou-ct! vgwkec/uzkt! qumg! /-cd!

pcgrcd! sc-kd! diagnostikaSi.! mgvikeclc! vgwkxmclu-g!

21

fblu-gd! veg(lued! egwoscxkd,! rom! xcoklkvcfic! da!

morfologiuri! seluecd! tgzgwumikeu! mkzu! iZleva

saSualebas! albaTobis maRali xarisxiT! moxdes

axalwarmonaqmnis zusti histologiuri verifikacia8!

ikvkix! getecdu-cgzc8! gdueu! keTilTvisebiani simsivneebis

dros. aRniSnuli kvlevis gamoyenebiT SesaZlebelia

SemTxvevaTa 82-90%-Si sarwmuno diagnozis dadgena! da

Sesabamisad, mkurnalobis adeqvaturi taqtikis SemuSaveba

•Краевский Н.А., и соавт. 1993a9!

zeda ybis avTvisebiani simsivneebis mkurnaloba

SeiZleba iTqvas, rom warmoadgens erTerT rTul da jer

kidev gadauWrel problemas. erTis mxriv, es

ganpirobebulia haimoris Rrus agebulebis anatomiuri

TaviseburebebiT, xolo meores mxriv, misi ganlagebiT saxis

ConCxis siRrmeSi da uSualo siaxloviT iseT sasicocxlo

organoebTan, rogoric aris Tavis tvini, Tvalebi,

magistraluri sisxlZarRvebi da sxva. yovelive es

arTulebs, rogorc sxivuri energiis maqsimaluri dozebiT

gamoyenebas, aseve radikaluri operaciis warmoebas. magram

miuxedavad amisa, miRebuli Sedegebis efeqturobis analizi

gviCvenebs, rom bolo erTi saukunis ganmavlobaSi,

aRniSnuli daavadebis mkurnalobaSi miRweulia

mniSvnelovani progresi. gadarCenil avadmyofTa ricxvi 5%-

dan gaizarda 46%-mde. rac udaod teqnikurma progresma da

mkurnalobisadmi diferencialurma midgomam ganapiroba

(Aisen A.M., Martel. W., Braunstein E.M., Mcmillen K.I., Phillips W.A. 1986;

Atlas S.W., Grossman R.J., Gomori J.N., Guerry D., Hackney D.B. 1987;

Annis J.A., Phelps P.D., 1989; Antilia J., Sonnien P., Grenman R. 1993;

Шацкая Н.Х. 1993; Черекаев В.А. 1995; Сдвижков А.М. 1997).

22

avtorTa erT nawils miaCniad, rom (Юшманов В. Е., Янцев

В. И., Плющ А.Л., Соколова И.С., Горбачева Л.Б., Сибельдина Л.А.,

Эмануель Н. М. 1985) tele-gamaTerapia efeqturia da sruliad

sakmarisia rogorc mkurnalobis damoukidebeli meTodi

daavadebis I-II stadiebSi. meoreni ki (Tsujii H., Kamada T.,

Arimoto T. et al 1986) Tvlian, rom tele-gamaTerapia rogorc

mkurnalobis damoukidebeli meTodi, naklebefeqturia da

gamoiyenebul unda iqnas kombinirebuli mkurnalobis

pirvel etapze an paliatiuri mizniT inoperabelur

pacientebSi.

Ю. И. Воробьев-is da И. П. Саранцева-s azriT (1982w),

sxivuri Terapia zeda ybis wiaRis kibos dros efeqturia

maSin, rodesac gamoiyeneba dasxivebis adeqvaturi meTodika

da gaTvaliswinebulia simsivnis gavrceleba, misi zrdis

forma da morfologiuri struqtura. am avtorTa

monacemebiT 3 da 5 wlianma gamojansaRebam Sesabamisad 61

da 48 procenti Seadgina. isini aseve aRniSnaven eleqtiuri

radioTerapiis mizanSewonilobas dabaldiferencirebuli

avTvisebiani simsivneebis mkurnalobisas (Shibnya H., Horinhi J.,

Suzuki S. et al. 1984). J. Parsons-is mier (1988w), sxivuri meTodiT

namkurnaleb 42 avadmyofTan, 5 da 10 wliani gamojansaReba

miRebul iqna 52 da 30 procentSi.

P. Levendag-is da J. Pomp-is mier (1990w), namkurnalebi

iqna 63 avadmyofi, romlebsac aReniSnebodaT zeda ybis

brtyelujredovani kibo T1N0 (35 avadmyofi), T2N0 (24

avadmyofi) da T2N1 (4 avadmyofi) gavrcelebiT. 17 avadmyofis

dasxiveba (60-70gr) warmoebda garegani meTodiT, xolo 37-is

ki _ wiaRSida meTodiT. kisris eleqtiuri dasxiveba, jamuri

23

doziT 40gr, Cautarda 25 pacients. yvela avadmyofisaTvis 5

wlianma gamojansarebam 90% Seadgina, maTgan recidivis

niSnebis gareSe 80%-ma gadalaxa sicocxlis aRniSnuli

barieri. regionuli metastazebis arsebobis SemTxvevaSi

avtorebi mizanSewonilad miiCneven qirurgiul mkurnalobas.

rogorc klinikurma dakvirvebebma gviCvenes, sxivuri

Terapiis Sedegi didad aris damokidebuli simsivnis

morfologiur Senebaze (Shidnia H., Hornbak N., Saghafi N. et al.

1984). kerZod, sxivuri energiisadmi maRalmgrZnobiareni

arian limfoepiTeliomebi, limfosarkomebi, romlebic

sxivuri energiis arc Tu ise didi dozebiT mkurnalobis

Semdeg mTlianad alagdebian xolme. rac Seexeba

brtyelujredovan kibos da adenokarcinomebs, maT

samkurnalod ufro didi dozebia saWiro. xolo osteo,

qondro, fibro, sarkomebi TiTqmis rezistentulni arian

sxivuri energiis mimarT (Zinreich SJ, Kennedy DW, Kumar AJ,

Rosenbaum AE , Arington JA,Johns ME. 1988). nelamzardi

simsivneebi infiltrirebuli zrdiT ufro naklebad

emorCilebian sxivur Terapias, vidre swrafi zrdis mqone

egzofituri simsivneebi (Som P.M., Lidov M. 1994).

sxivuri mkurnalobis efeqturobis amaRlebis mizniT К.

Валуцкас-is da А. Шуминас-is mier 1986 wels, II-IV stadiis

mqone zeda ybis simsivneebiT daavadebul 45 avadmyofs

Cautarda tele-gama Terapia lokalur hiperTermiasTan

erTad. am dros aRiniSna im simsivnuri ujredebis

dazianebac ki, romlebic imyofebodnen hipoqsiur

mdgomareobaSi, anu is ujredebi, romlebic maqsimalurad

mdgradebi arian maionizirebeli gamosxivebis mimarT.

24

В. Г. Пинчук-ma (1989w) Seiswavla ra zeda ybis kibos

morfo-histoqimiuri Taviseburebebi, sxivuri TerapiiTa da

hiperTermiiT namkurnaleb avadmyofebSi, daaskvna, rom

hiperTermias mivyavarT simsivnuri ujredebis mniSvnelovan

dazianebebamde, rac ganpirobebulia ukuqcevadi

distrofiuli cvlilebebiT. am dros viTardeba, ujredSida

membranebisa da ujreduli organelebis

ultrastruqturuli organizaciis darRveva, SeboWili

cilovani, cilovan-lipiduri da nukleotiduri

kompleqsebis xarjze. rac xels uwyobs mkurnalobis

uSualo Sedegebis amaRlebas.

Г. Г. Кудрявцев-ma da В. О. Ольшанский-im (1991w) zeda ybis

avTvisebiani simsivneebiT daavadebul 52 avadmyofs Cautares

qimio-sxivuri mkurnaloba. dasxiveba xorcieldeboda

betatronis tipis aparatiT, velebis individualuri

SerCeviT, erTjeradi doziT 2gr, jamuri doziT 60gr-mde.

medikamentozuri mkurnalobisaTvis iyenebdnen

metotreqsats, xolo dabaldiferencirebuli simsivneebis

SemTxvevaSi vinkristins ciklofosfanTan erTad. simsivnis

sruli regresia aRiniSna 66,7%-Si. 3 wlianma sicocxlis

xangrZlivobam Seadgina 45%, xolo 5 wlianma _ 34,3%.

dReisaTvis zeda ybis avTvisebiani simsivneebis

samkurnalod sakmaod xSirad da efeqturad gamoiyeneba

platinis preparatebis da sxivuri Terapiis kombinacia:

bleocinTan, ciklofosfanTan da adriamicinTan, 5-

ftoruracilTan da sxv. yvela avtori, romlebic iyeneben

Serwymul mkurnalobas qimiopreparatebis CarTviT,

25

afiqsireben karg klinikur efeqts (Chobe R, McNeese M, Weber

R, Fletcher GH. 1988).

magaliTad, В. П. Бойков-i (1987w) aRniSnavs rom, mis mier

Catarebuli poliqimioTerapia platidiamis, metotreqsatis,

5-ftoruracilis da vinblastinis gamoynebiT, dadebiTad

aisaxa zeda ybis simsivneebis mkurnalobis efeqturobaze. 17

avadmyofidan man SesZlo 15 SemTxvevaSi mieRo simsivnis

srul regresia.

simsivnuri agresiis daTrgunvis mizniT,

poliqimioTerapias sxivur mkurnalobasTan erTad aseve

sakmaod efeqturad iyeneben inoperabelur pacientTa

samkurnalod (Blacklock JB, Weber RS, Lee YY, Goepfert H. 1989).

R. Errington-is mier (1986w), 43 zeda ybis kiboTi

daavadebuli avadmyofis sakmurnalod gamoyenebul iqna

radioTerapia swrafi neitronebiT. simsivnis sxvadasxva

xarisxis regresia miRweul iqna 86%-Si. sicocxlis

saSualo xangrZlivobam 33 Tve Seadgina, xolo 5 wliani

gamojansaReba 30%-s ar aRemateboda. J. Spiro-s monacemebiT

(1989w), 63 avadmyofTan mimarTebaSi, am maCvenebelma 43%

Seadgina. avtorebi xazs usvamdnen, swrafi eleqtronebiT

dasxivebis upiratesobas tele-gama TerapiasTan SedarebiT,

radganac am ukanasknelis saSualebiT SesaZlebelia

dozirebis sxvadasxva velebis miReba, rac uzrunvelyofs

simsivneze sxivuri energiis maqsimalur zemoqmedebas da

irgvlivmdebare jansaRi qsovilebis mniSvnelovan dacvas.

konservatuli Terapiis aradamakmayofilebeli

Sedegebi xSir SemTxvevaSi ganapirobebda qirurgiuli

26

Carevis aucileblobas. unda aRiniSnos, rom qirurgiuli

meTodi, gasuli saukunis ganmavlobaSi, zeda ybis kibos

mkurnalobis erTaderT ZiriTad meTodad gvevlineboda

(Glick JH, Marcial V, Richter M, Velez-Garcia E. 1980). mizanmimarTuli

kvlevebis safuZvelze ixveweboda sxvadasxva qirurgiuli

Carevis Cvenebebi, maTi masStabebi da Sesrulebis teqnika.

(Laramore GE, Scott CB, Schuller DE, Haselow RE, Ervin TJ 1992; Wheeler

R, Al-Sarraf M, Gahbauer RA, Jacobs JR, Schwade JG, Campbell BH. 1993;).

ramac, gasuli saukunis bolos, mniSvnelovnad aamaRla

gamojansaRebul pacientTa ricxvi (Gollin FF, Ansfield FJ,

Brandenburg JH, Ramirez G, Vermund H. 1972). Adelstein DL, Kalish LA,

Adams GL, Wagner H, Oken MM, Remick SC-is (1993w) azriT,

Soreuli Sedegebis mniSvnelovani mateba ganpirobebuli

iyo eleqtroqirurgiuli meTodis danergviT, igi

uzrunvelyofda sisxlZarRvebisa da limfuri sadinrebis

srulfasovan koagulacias, rac sagrZnoblad amcirebda

regionuli metastazebis da recidivirebis ganviTarebis

sixSires. eleqtroqirurgiul meTods aseve upiratesoba

eniWeboda rigi adgilobrivi garTulebebis

profilaktikaSic. kerZod, igi iZleoda saSualebas,

minimumamde dagveyvana sisxlis danakargi. xolo nervul

dabolovebebze Termuli zemoqmedebis Sedegad, operaciis

Semdgom periodSi Segvemcirebina tkivilis sindromi (Vlock

D, Anderson J, Whiteside T, Herbeman R, Kirkwood J, Adams G. 1994).

В. С. Погосова-s (1984) monacemebiT, zeda ybis kiboTi

daavadebul eleqtroqirurgiuli meTodiT namkurnaleb

pacientebSi 5 wlianma gamojansaRebam 33,5% Seadgina.

27

ufro maRali maCveneblebi moyavT B. Strohmann-s da K.

Haake-es (1991w), 235 eleqtroqirurgiuli meTodiT

namkurnalebi avadmyofidan, sicocxlis 5 wliani barieri

gadalaxa 41,2%-ma.

g. RoRelianis (1996w) mier, mxolod

eleqtroqirurgiuli meTodiT namkurnaleb zeda ybis

kiboTi daavadebuli 18 avadmyofidan sicocxlis 3 wliani

barieri gadalaxa 7 (38,9%).

miuxedavad miRweuli progresisa, zeda ybis

avTvisebiani simsivneebis qirurgiuli meTodiT

mkurnalobaSi mravali avtori upiratesobas mainc

kombinirebul meTods aniWebs. jer kidev, 1933 wels L. Ohgren-

is da G. Holmgren-is mier pirvelad moxda

eleqtroqirurgiisa da sxivuri Terapiis Serwyma, ramac

isini im droisaTvis gansacvifrebel Sedegebamde miiyvana.

orwlianma gamojansaRebam 44-46%-s miaRwia.

kombinirebuli meTodis SemuSavebis da srulyofis

periodSi xdeboda sxivuri Terapiisa da operaciuli

Carevis gansxvavebuli Tanmimdevrobebis Seswavla. L. Larsson,

G. Maptensson, S. Gastigliano da C. Rominger-is dakvirvebebiT

(1954w) operaciamdeli dasxivebis gamoyenebisas 5 wlianma

gamojansaRebam 45-47%-s miaRwia.

kombinirebul mkurnalobaSi sxivuri Terapiis I etapze

gamoyenebis momxreebi aRniSnaven, rom sxivuri energia

uzrunvelyofs simsivnuri ujredebis biologiuri

aqtiurobis daTrgunvas, axalwarmonaqmnis zomebSi

Semcirebasa da Tanmxlebi anTebiTi procesebis moxsnas, rac

28

qmnis xelsayrel garemos operaciuli CarevisaTvis.

specialistebi, romlebic emxrobian sxivuri Terapiis II

etapze gamoyenebas Tvlian, rom igi mizanmimarTulia

saoperacio velSi SesaZlod darCenili simsivnuri

ujredebis ganadgurebaze.

A. Karimel-is (1990w) mier namkurnalebi iqna zeda ybis

kiboTi daavadebuli 45 pacienti. maT umravlesobas

CautardaT zeda ybis gafarToebuli operacia momdevno

distainciuri an (65gr 7 kviris ganmavlobaSi) wiaRSida

dasxivebiT, es ukanaskneli gamoiyeneboda 10 kviris

ganmavlobaSi da kerovani doza Seadgenda 82 gr-s. 5

wlianma gamojansaRebam 68% Seadgina. literaturaSi aseve

moipoveba calkeuli monacemebi pre, an postoperaciuli

dasxivebis Sesaxeb (Емельянов А.А. 1978; James T. et. al. 1988).

magram am meTodebis efeqturobis Sefaseba metad rTulia

dakvirvebebisa da publikaciebis simciris gamo.

Tumca bolo wlebis sazRvargareTul publikaciebSi

gamoCnda monacemebi sxivuri, qirurgiuli, kombinirebuli da

kompleqsuri mkurnalobebis efeqturobis Sesaxeb, romelTa

Sedegebsac isini procesis lokalizacias, daavadebis

gavrcelebasa da morofologiur struqturasTan

urTierTkavSirSi ganixilaven. W. Mann-is da C. Schuler-Vaith-is

(1983w) mier namkurnalebi 138 avadmyofidan, 22 –pacients

Cautarda qirurgiuli mkurnaloba, 64-s _ operacia da

dasxiveba, 20-s dasxiveba, xolo 12 avadmyofs ki operacia +

dasxiveba + qimioTerapia. 3 da 5 wlianma gamojansarebam 55

da 52 procenti Seadgina.

29

B. Hintz-ma da Tanaavtorebma (1984w) zeda ybis kiboTi

daavadebul 27 pacientis samkurnalod 14 SemTxvevaSi

gamoiyenes sxivuri Terapia, 10-Si dasxiveba da Semdgomi

operaciiT. 3 avadmyofs ki Cautarda operaciis Semdgomi

maionizirebeli dasxiveba jamuri doziT 70gr. aRniSnul

jgufSi 5 wlianma gamojansarebam 28, 60 da 33 procenti

Seadgina, miRebuli Sedegebidan naTlad Cans kombinirebuli

meTodis upiratesoba operaciamdeli dasxivebis gamoyenebiT.

J. Parsons-ma da misma Tanaavtorebma (1984w) awarmoes 48

pacientis mkurnaloba sxivuri da kombinirebuli meTodebis

gamoyenebiT. mxolod sxivuri Terapia gamoyenebul iqna 42

avadmyofTan, xolo kombinirebuli ki – 6 pacientTan. 10

wliani gamojansaReba I stadiis dros mirebul iqna 100%-Si,

xolo II da III stadiebis dros, 53 da 30 procentSi

Sesabamisad.

Glick JH, Marcial V, Richter M, Velez-Garcia E.-is (1990w) azriT,

kombinirebuli mkurnalobis Soreuli Sedegebi arc Tu ise

saxarbieloa da daaxloebiT 49%-s Seadgens. magram

miuxedavad am maCveneblisa, is mainc erTerT efeqtur

meTodad rCeba.

N. Nopkin-ma da Tanaavtorebma (1984w) 561 zeda ybis

kiboTi daavadebul pacients umkurnales sxvadasxva

meTodebis gamoyenebiT. am avtorTa monacemebiT, dasxivebisa

da operaciis kombinacia winamorbedi qimioTerapiis

gamoyenebiT, yvelaze efeqturi aRmoCnda. 5 wlianma

gamojansaRebam brtyelujredovani kibos dros 37,5%

30

Seadgina, xolo adenokarcinomas dros am ricxvma 47%-s

miaRwia.

yvela avtori aRniSnavs, rom zeda ybis kibos

mkurnalobis warumateblobis ZiriTad mizezs recidivebi

warmoadgenen, romelTa warmoqmnis sixSirec 58-80%-s

Seadgens. simsivnis recidivebi, rogorc wesi, viTardeba

mkurnalobis dasrulebidan pirveli 2 wlis ganmavobaSi. H.

Thiel-i da G. Pettinger-i (1986w) aRniSnaven, rom simsivnis

lokalizaciisas zeda-ukana naxevarSi recidivebis

raodenobam SesaZloa 71%-s miaRwios, maSin, roca wiaRis

qveda-wina naxevarSi lokalizaciisas maTi ricxvi 28%-s ar

aRemateba. recidivebis 76% gamovlindeba mkurnalobis

damTavrebidan erTi wlis ganmavlobaSi. mogvianebiTi

recidivebis raodenoba Zalzed mcirea da ar aRemateba 2,5%-

s. Browman GP, Goodyear MD, Levine MN, Russell R, Archibald SD, Young

JE.-s (1990w) azriT, avadmyofTa did kontingentSi recidivebi

viTardeba 1 wlis ganmavlobaSi, aqedan didi nawili pirvel

6 TveSi.

SedarebiT xSirad recidivireben adgilobrivad

gavrcelebuli simsivneebi, romlebic lokalizdebian saxis

ConCxis zeda sarTulebSi (Browman GP, Levine MN, Russell R,

Young JE, Archibald 1987). P. Zbaren-is monacemebiT (1987w) metad

mZime prognoziT xasiaTdeba SemTxvevebi, rodesac adgili

aqvs simsivnis gavrcelebas cxavis Zvalsa da frTa-sasis

fosoSi. aRniSnuli avadmyofebis 3 wliani gamojansaReba ar

aRemateba 19%-s. aseve agresiuli mimdinareobiT gamoirCeva

simsivneebi, romlebic vrceldebian frTasasis fosoSi,

solisebr wiaRSi da orbitaSi. (Chang H, Leone L, Tefft M, Nigri

31

PT 1988). zeda ybis wiaRis kibos recidivebi SemTxvevaTa 50-

93%-Si gvxvdeba (Bowman GP, Cripps C, Hodson DI, et al. 1994).

recidivebis aseTi maRali sixSire ganpirobebulia simsivnis

gavrcelebiT mniSvnelovan sasicocxlo organoebze, rac

praqtikulad SeuZlebels xdis radikaluri operaciis

warmoebas (Brachman DG, Graves D, Vokes E, Beckett M, Haraf D, Motag

A, Dunphy E, Mick R, Yandell D, Weichselbaum RR. 1992).

rac Seexeba haimoris Rrus avTvisebiani simsivneebis

mkurnalobis Semdgomi regionuli metastazebis warmoSobas,

mravali avtoris monacemebiT igi ar aRemateba 18-20%-s.

(Cognetti F, Carlini P, Pinnaro P, Ruggeri EM, Perrino A, Del Vecchio MR,

Ambesi Impiombato F, Calabresi F. 1989). maTgan regionuli

metastazebis 90-95% aReniSnebaT brtyelujredovani kiboTi

daavadebul, procesis III-IV stadiis gavrcelebis mqone

avadmyofebs (Dalley D, Beller E, Aroney R, et al 1995).

rac Seexeba zeda ybis avTvisebiani simsivneebis

Soreul metastazirebas, ZiriTadad metastazireben

acinozurujredovani (cilindroma) kibo da araepiTeluri

warmoSobis simsivneebi (Gasparini G, Recher G, Favretto S, Visona A,

Bevilacqua P, Del Fior S. 1989). mTlianobaSi, SegviZlia avRniSnod,

rom regionuli da Soreuli metastazebis ganviTareba

mniSvnelovnad aris damokidebuli pirveladi simsivnis

recidivebis warmoqmnasa da maT gavrcelebaze. rogorc

wesi, aRniSnuli jgufis pacientebi warmoadgenen

praqtikulad uperspeqtivo avadmyofta jgufs, romelTa

gadarCenis Sansi ar aRemateba 0-2%-s da

pirdapirdamokidebulebaSia simsivnis mgrZnobelobaze,

32

gamoyenebul qimiopreparatebis mimarT (Goldsweig HG,

Sundaresan N. 1990).

amrigad, warmodgenili masalidan naTlad Cans, rom

miuxedavad mniSvnelovani klinikuri gamocdilebisa, jer

kidev ar aris dasabuTebulad warmodgenili erToblivi

koncebcia zeda ybis kibos mkurnalobis Sesaxeb daavadebis

mimdinareobis, morfologiuri Senebis da sxva klinikur

TaviseburebaTa gamovlinebis gaTvaliswinebiT.

Tu gaviTvaliswinebT im faqts, rom zeda ybis kiboTi

daavadebul pacientTa umravlesoba, mimarTavs

specializirebul dawesebulebebs adgilobrivad

gavrcelebuli procesebiT maSin, rodesac simsivne tovebs

haimoris wiaRs da vrceldeba: loyis rbil qsovilebze,

frTisebr kunTebze, yvrimalis Zvalze, TvalbudeSi,

ZiriTadi Zvlis frTasasis morCze, cxviris RruSi,

frTasasisa da safeTqlis fosoebSi, cxvirxaxaSi an

mopirdapire zeda ybaSi, ar arsebobs konkretuli

rekomendaciebis erToblioba, romelTa Tanmimdevruli

Sesruleba mniSvnelovnad aamaRlebda mkurnalobis

efeqturobas.

samwuxarod ar iyo dasmuli sakiTxi imis Sesaxeb, Tu

romeli kliniko-morfologiuri maxasiaTeblebis

erToblioba ganapirobebs mkurnalobis tradiciuli

meTodebis gamoyenebis SemTxvevaSi damakmayofilebeli, an

aradamakmayofilebeli Sedegebis miRwevas da aqedan

gamomdinare, zemoqmedebs daavadebis gamosavalsa da

prognozze. CvenTvis xelmisawvdom literaturaSi, aseve ver

iqna moZiebuli sistematizirebuli monacemebi mkurnalobis

33

34

individualuri sqemebis da taqtikis arCeva_SemuSavebaze

simsivnis sxvadasxva parametrebis gaTvaliswinebiT. aseTi

individualuri midgoma TiToeul avadmyofTan, xels

Seuwyobs mkurnalobis efeqturobis amaRlebas.

Cvens mier xelmisawvdom literaturaSi, aseve ver

SevxvdiT monacemebs romlebic gamoiyeneba daavadebis

recidivebis SemTxvevaSi da moqmedebs profilaqtikurad am

problemis Tavidan asacileblad.

Tavi II

kvlevis masalebi da meTodebi

naSromi dafuZnebulia haimoris wiaRis kiboTi

daavadebuli 146 avadmyofis kliniko-morfologiuri

niSnebis analizze, romlebsac CautardaT mkurnaloba

saqarTvelos prof. a. RvamiCavas saxelobis onkologiis

nacionaluri centris Tav-kisris simsivneebis

ganyofilebaSi 1985-2000 wlebSi.

yvela avadmyofs mkurnalobis dawyebamde zogad

klinikur gamokvlevebTan erTad, rogorc wesi,

utardebodaT cxviris savalisa da cxvirxaxis fibroskopia,

zeda ybis wiaRebis rentgenografia. 60 SemTxvevaSi

aRniSnul kvlevebTan erTad ganxorcielebul iqna

kompiuteruli tomografia, xolo 25-Si magnitur-

rezonansuli tomografia. daavadebis verifikaciisaTvis

viyenebdiT citologiur da morfologiur kvlevis

meTodebs. kisris limfuri kvanZebis mdgomareobis Sefasebis

mizniT avadmyofebs uterdebodaT eqoskopia, xolo

metastazur dazianebaze eWvis mitanisas vatarebdiT

magnitur-rezonansul tomografiasa da dazianebuli

kvanZebis citologiur gamokvlevas. miRebuli informacia

gadagvqonda Cvens mier SemuSavebul ruqa-kodifikatorze,

rac iZleoda Semdgomi statistikuri damuSavebis

saSualebas.

35

cxrili #1

haimoris Rrus avTvisebiani simsivneebiT daavadebul avadmyofTa

ganawileba asakisa da sqesis mixedviT

mamakaci qali sul asaki

wlebSi avadmyofTa

raodenoba %

avadmyofTa

raodenoba %

avadmyofTa

raodenoba %

10-20 2 2,15 1 1,9 3 2,.05

21-30 3 3,22 5 9,4 8 5,47

31-40 10 10,75 6 11,3 16 10,95

41-50 17 18,27 3 5,66 20 13,69

51-60 20 21,5 11 20,75 31 21,23

61-70 19 20,4 15 28,3 34 23,28

71-80 18 19,5 11 20,75 30 20,54

81-90 3 3,22 2 3,7 5 3,42

sul 92 63 54 37 146 100

aRsaniSnavia, rom 146 pacientidan 92(63%) mamakaci iyo,

xolo 54(37%) ki _ qali. avadmyofTa ganawileba sqesisa da

asakis mixedviT warmodgenilia cxril#1-Si.

rogorc warmodgenili masalidan Cans, zeda ybis

wiaRis avTvisebiani simsivneebiT ufro xSirad avaddebian

kacebi, vidre qalebi. aRniSnuli paTologia ZiriTadad

gvxvdeba 50 wlis zeviT praqtikulad Tanabrad orive sqesis

warmomadgenlebSi.

Catarebuli morfologiuri (citologia da

histologia) kvlevis Sedegad 90 SemTxvevaSi

diagnostirebul iqna brtyelujredovani kibo, maT Soris

maRaldiferencirebuli brtyelujredovani kibo _ 60

SemTxvevaSi, saSualo diferenciaciis _ 12 SemTxvevaSi,

xolo dabaldiferencirebuli _ 18 SemTxvevaSi. 19

36

avadmyofs daudginda adenokarcinomas diagnozi, xolo 23

avadmyofs gamouvlinda cilindrulujredovani kibo.

cxrili #2

zeda ybis wiaRis avTvisebiani simsivneebis morfologiuri

daxasiaTeba

histomorfologiuri struqtura avadmyofTa

raodenoba

% Sefaredeba

avadmyofTa

saerTo

raodenobasTan

epiTeluri simsivneebi

brtyelujredovani karcinoma

adenokarcinoma

cilindroma

132

90

19

23

90,4%

61,7%

13,1%

15,75%

araepiTeluri simsivneebi

limfosarkoma

angio, qondro da osteosarkoma

14

9

5

9,6%

6,2%

3,4%

avadmyofTa jamuri raodenoba 146 100

rac Seexeba araepiTeluri warmoSobis simsivneebs,

isini diagnostirdnen 14 SemTxvevaSi. maTgan limfosarkoma

gamouvlinda 9 avadmyofs, xolo angio, qondro da

osteosarkomebi 5 avadmyofs. avadmyofTa ganawileba

simsivnis morfologiuri Senebis mixedviT warmodgenilia

cxrilSi #2.

kvlevis procesSi, zeda ybis wiaRis kibos

gavrcelebadobis gansasazRvrad, Cvens mier gamoyenebul

iqna TNM klasifikacia, romelic SemuSavebul iqna kibos

saerTaSoriso kavSiris (UICC) mier 2002 wels da farTo

gamoyenebas hpovebs msoflios wamyvan onkoklinikebSi.

37

TNM klasifikacia

T _ pirveladi simsivne

Tx _ arasakmarisi monacemebi pirveladi simsivnis

Sesafaseblad

T0 _ pirveladi simsivne ar gamovlindeba

Tis _ preinvaziuri karcinoma (carcinoma in situ)

T1 _ lorwovani garsiT Semofargluli simsivne, Zvlis

eroziis da destruqciis gareSe.

T2 _ simsivne iwvevs Zvlis erozias an destruqcias magar

sasaze da/an cxviris Suasavalze gavrcelebis CaTvliT,

magram ar gadadis zeda ybis wiaRis ukana kedelze da

frTisebr firfitaze.

T3 _ simsivne gavrcelebulia: zeda ybis wiaRis ukana

kedlis Zvlovan nawilze, kanqveSa qsovilebze, Tvalbudis

fskerze an Sua kedelze, frTisebr fosoze, cxavis

wiaRebze.

T4a _ simsivne Cazrdilia Tvalbudis wina struqturebSi,

loyis kanSi, frTisebr firfitaSi, safeTqelqveSa fosoSi,

dacxrilul firfitaSi, solisebr an Sublis wiaRebSi.

T4b _ simsivne Cazrdilia Tvalbudis zeda kideSi, tvinis

magar garsSi, Tavis tvinSi, qalas Sua fosoSi, qala-tvinis

nervebSi (garda samwvera nervis V2 totisa), cxvir-xaxaSi,

qalasfuZeze.

38

N _ regionuli limfuri kvanZebi, M _ Soreuli metastazebi

NX _ regionuli limfuri kvanZebis Sesafaseblad sakmarisi

monacemebi ar aris.

N0 _ ar aris metastazuri dazianebis niSnebi regionul

limfur kvanZebSi.

N1 _ metastazi mxolod erT regionul limfur kvanZSi,

zomiT araumetes 3sm-sa simsivnuri dazianebis mxares.

N2 _ metastazi mxolod erT regionul limfur kvanZSi,

zomiT 3sm-dan 6sm-mde simsivnuri dazianebis mxares; an

metastazi ramodenime limfur kvanZSi zomiT 6sm-mde

simsivnuri dazianebis mxares; an 6sm-mde zomis metastazi

limfur kavZebSi ormxrivad an kontrlateralurad.

N2a _ 3sm-dan 6sm-mde zomis metastazi erT regionul

limfur kvanZSi, dazianebis mxares.

N2b _ 6sm-mde zomis metastazi ramodenime regionul

limfur kvanZSi, dazianebis mxares.

N2c _ 6sm-mde zomis metastazi limfur kavZebSi, ormxrivad

an kontrlateralurad.

N3 _ 6sm-ze meti zomis metastazi limfur kvanZSi.

MX _ Soreuli metastazis Sesafaseblad sakmarisi

monacemebi ar aris.

M0 _ Soreuli metastazebis arsebobis niSnebi ar aris.

M1 _ aRiniSneba Soreuli metastazi.

39

TNM klasifikaciis mixedviT 146 avadmyofidan T1

gavrcelebis simsivne gamovlenil iqna mxolod 4 (2,74%)

avadmyofSi, T2 gavrcelebis _ 23-Si (15,7%), T3 daudginda _ 59

(40,4%) avadmyofs, xolo T4 ki _ 60 (41%) pacients.

avadmyofTa ganawileba TNM klasifikaciis mixedviT

mowodebulia cxrilSi #3.

cxrili #3

avadmyofTa ganawileba sqesisa da TNM klasifikaciis mixedviT

kaci qali sul

TNM

raodenoba

% raodenoba % raodenoba %

T1N0M0 3 3,26 1 1,85 4 2,74

T2N0M0 15 16,3 8 14,8 23 15,7

T3N0M0 26 28,3 24 44,5 50 34,2

T3N1M0 4 4,35 3 5,6 7 4,8

T3N2M0 1 1,1 1 1,85 2 1,37

T4N0M0 29 31,5 18 33,4 47 32,2

T4N1M0 6 6,5 1 1,85 7 4,8

T4N2M0 4 4,35 1 1,85 5 3,4

T4N3M0 1 1,1 _ 1 0,68

sul 92 63 54 37 146 100

zeda ybis rTuli anatomiuri agebulebis gamo TNM

klasifikacia ar iZleva srulyofil warmodgenas simsivnis

gavrcelebis Sesaxeb. amisaTvis Cvens mier TNM

klasifikaciis paralelurad gamoiyeneboda РАМН РОНЦ-s

40

mier 1985 wels dadgenili simsivnis gavrcelebis

stadiurobis ganmsazRvreli klasifikacia.

I stadia _ simsivne moicavs haimoris Rrus erT

kedels, lorwovans, axlomdebare anatomiuri midamoebis

dazianebis gareSe da ar iwvevs Zvlovani kedlis

destruqcias. metastazebi ar isinjeba.

II stadia _ a) simsivne gadazrdilia haimoris Rrus

meore kedelze, azianebs ra Zvlovan kedels ar gadis Rrus

farglebs gareT. regionuli metastazebi ar isinjeba. b)

simsivne dazianebis igive xarisxiT, magram isinjeba

erTeuli regionuli metastazi.

III stadia _ a) simsivne Cazrdilia axlomdebare

anatomiuri midamoebSi (cxviris RruSi, TvalbudeSi, sasaze

da sxv.) scildeba Zvlovani kedlis farglebs an gadadis

meore haimoris Rruze. regionuli da Soreuli metastazebi

ar isinjeba. b) igive stadiis simsivne an simsivne

adgilobrivi dazianebis naklebi xarisxiT, magram

mravlobiTi regionuli metastazebiT simsivnuri dazianebis

mxares, an ormxrivi regionuli metastazebiT.

IV stadia _ a) simsivne romelic vrceldeba qalas

fuZeze, cxvirxaxaze an saxis kanze Zvlovani qsovilis

farTe destruqciiT, magram regionuli da Soreuli

metastazebis gareSe. b) nebismieri stadiis simsivne uZravi

regionuli metastazebiT. c) nebismieri stadiis simsivne

Soreuli metastazebiT.

41

rac Seexeba 146 avadmyofis ganawilebas stadiis

mixedviT, igi warmodgenilia Semdegnairad: I stadia 4

avadmyofi, II stadia 23 avadmyofi, III stadia 59 avadmyofi da

IV stadia 60 avadmyofi. aRniSnuli ganawileba mocemulia

cxrilSi #4.

cxrili #4

avadmyofTa ganawileba stadiebis mixedviT.

kaci qali sul stadiuroba

raodenoba % raodenoba % raodenoba %

I stadia 1 25 3 75 4 2,74

II stadia 14 60,8 9 39,2 23 15,7

III stadia 35 59,3 24 40,7 59 40,4

IV stadia 39 65 21 35 60 41

sul 92 63 54 37 146 100

zeda ybis kibos mimdinareobis agresiulobis L. Ohngren

_ is dayofis mixedviT avadmyofebi Semdegnairad

gadanawildnen: zeda _ ukana naxevari 21 (14,4%) avadmyofi,

qveda _ wina naxevri 14 (9,6%) pacienti, xolo danarCen 111

(76%) SemTxvevaSi simsivnis warmoqmnis pirveladi keris

dadgena ver moxerxda adgilobrivad gavrcelebuli farTe

dazianebebis gamo.

Catarebuli klinikuri da eqoskopiuri kvlevebis

Sedegad 146 pacientidan 22-s gamouvlinda regionuli

metastazebi, aqedan erTeuli _ 14 SemTxvevaSi, mravlobiTi

_ 7 SemTxvevaSi, ormxrivi regionuli metastazebi

diagnostirebul iqna 1 SemTxvevaSi. maT Soris 3 sm-mde

zomis 12 SemTxvevaSi da 3 sm-ze meti zomis 10 SemTxvevaSi.

42

daavadebis morfologiuri formidan da gavrcelebidan

gamomdinare Cvens mier mkurnalobis pirvel etapze

gamoyenebul iqna Semdegi meTodebi: qimio-sxivuri

mkurnaloba 44 (30,13%) SemTxvevaSi, xolo 87 (59,6%)

avadmyofs ki mkurnalobis I etapze Cautarda mxolod

sxivuri Terapia.

qimio-sxivuri Terapia warmoadgens tele-gama Terapiisa

da qimioTerapiis kombinacias. igi upiratesad gamoiyeneba

brtyelujredovani da araepiTeluri avTvisebiani

simsivneebis dros, romlebsac gaaCniaT daavadebis

arsebobis xanmokle anamnezi da adgilobrivad

gavrcelebuli farTo dazianebebi.

haimoris wiaRis avTvisebiani simsivneebiT daavadebuli

pacientebi namkurnalebi iqnen sxvadsxava qimioTerapiuli

sqemebiT, rac ganpirobebuli iyo maTi morfologiuri

SenebiT.

brtyelujredovani kibos dros viyenebediT Semdeg

sqemebs:

1. I dRes intravenurad, wveTovnad, hiperhidrataciis

fonze Segvyavda cisplatini 100mg,

2. bleomicini 15mg 1, 3 da 5 dRes intravenurad bolusiT,

3. ftoruracili doziT 500mg 1, 2, 3, 4, 5 dRes 1sT-iani

intravenuri infuziiT.

1. I dRes karboplatini 300mg intravenurad wveTovnad.

2. bleomicini 15mg 1, 3 da 5 dRes intravenurad bolusiT.

3. ftoruracili 500mg 1, 2, 3, 4, 5 dRes 1sT-iani

intravenuri infuziiT.

43

araepiTeluri simsivneebis dros viyenebdiT ACOP-is

sqemas:

1. I dRes ciklofosfani 1000mg intravenurad, wveTovnad;

2. I dRes doksorubicini 70mg intravenurad, wveTovnad;

3. II, III dRes vinkristini 2mg intravenurad bolusiT;

4. I, II, III, IV, V dRes prednizoloni 60mg per os miReba.

tele-gama Terapia xorcieldeba «РОКУС М АГАТ-РС

КОБАЛТ-60»-is tipis aparatiT, ori Semxvedri veliT (wina

da gverdiTi), romelTa zoma varirebda 7X9 sm da

damokidebuli iyo simsivnuri dazianebis zomebze. rac

Seexeba TviTon procedurebs, tardeba yoveldRe, kviraSi 5

dRe, sadac dRiuri doza ar aRemateba 2 gr-s; xolo jamuri

doza ki _ 70-74gr-s odenobas. regionuli

metastazirebisas dasxiveba xorcieldeboda erTi mTliani

veliT, romlis zomebic daaxloebiT 11X10 da 12X10sm-s

Seadgenda, xolo jamuri doza ki 60-64gr-s.

aseve aRsaniSnavia, rom 15 avadmyofTan mimarTebaSi

mkurnalobis I etapze gamoyenebul iqna qirurgiuli Careva,

raTa mcire simsivnuri dazianebebis dros, rodesac

garTulebuli iyo daavadebis citologiuri diagnostika,

mogvexdina trepanirebuli wiaRidan aRebuli biofsiuri

masalis swrafi histomorfologiuri verificireba.

daavadebis verificirebis Semdgom, simsivnuri procesis

zomisa da lokalizaciidan gamomdinare, Cvens mier

gamoyenebuli iqna, rogorc zeda ybis nawilobrivi, aseve

totaluri eleqtrorezeqcia am avadmyofebTan mimarTebaSi.

44

konservatuli mkurnalobis efeqturoba ganisazRvreboda

uSualo SedegebiT, romlebic Semdeg kriteriumebad daiyo:

• sruli efeqti _ simsivnis 100%-iani regresia;

• nawilobrivi efeqti _ simsivnis regresia 50 da meti

procentiT;

• efeqtis gareSe _ simsivnis regresia 50%-de an

simsivnis zomebSi momateba.

Catarebuli konservatuli mkurnalobis Semdeg simsivnis

regresiisas 50% da meti avadmyofebs ugrZeldebodaT

sxivuri, an qimio-sxivuri mkurnaloba (sxivuri 70-74gr,

xolo qimioTerapia 5-6 kursamde). simsivnis sruli

eliminaciis SemTxvevaSi pacientebi gadagvyavda dinamiuri

dakvirvebis qveS.

konservatuli mkurnalobis araefeqturi, an arasruli

efeqtis SemTxvevaSi 3-5 kviris gasvlis Semdeg vawarmoebdiT

qirurgiul Carevas, romlis masStabic damokidebuli iyo

simsivnuri procesis gavrcelebasa da limfuri kvanZebis

mdgomareobaze. zeda ybis nawilobrivi eleqtrorezeqcia

Cautarda 3 (4,5%) avadmyofs; 14 (21,2%) pacients Cautarda

zeda ybis tipiuri eleqtrorezeqcia; gafarToebuli

operacia (orbitis ekzenteracia, yvrimalis Zvlis rezeqcia,

frontaluri wiaRis rezeqcia da a.S.) gamoyenebul iqna 40

(60,6%) SemTxvevaSi; xolo gafarToebul-kombinirebuli

operaciebi 9 (13,7%) SemTxvevaSi.

zeda ybis eleqtrorezeqciis gansaxorcieleblad

viyenebdiT veberis ganakveTs (sur. 17), romlis drosac

saxeze ikveTeboda kani, kanqveSa da kunTovani qsovilebi

45

Zvlamde. amis Semdgom xdeba kan-kunTovani nafleTis

aSreveba zeda da gareTa mimarTulebiT, zeda ybis wina

kedlis gaSiSvlebamde. kan-kunTovan- lorwovani nafleTis

mobilizaciis Semdeg eleqtrodanis saSualebiT xdeba

magari da rbili sasis lorwovan garsze, Sua xazidan rbil

sasamde saoperacio velis moniSvna (sur. 18). kbilebis

eqstraqciis Semdeg, bipolarebis saSualebiT vaxdenT zeda

ybis magari da rbili qsovilebis eleqtro nekrozs, ris

Semdegac xorcieldeba am qsovilebis mocileba sakvneti

maSebis gamoyenebiT.

sur. 17. veberis ganakveTi

sur. 18. zeda ybis sarezeqcio velis moniSvna sasaze eleqtrodanis

gamoyenebiT.

46

rogorc wesi, zeda ybis simsivneebis SemTxvevaSi

kisris limfuri kvanZebis profilaqtikuri amokveTa ar

xorcieldeboda, igi warmoebda mxolod realizebuli

metastazebis arsebobisas. kombinirebul-gafarToebuli

operaciebisas zeda ybis rezeqciis sazRvrebi damokidebuli

iyo simsivnis gavrcelebis sazRvrebze, xolo kisris

limfadeneqtomiis tipi ki, arsebuli metastazebis

lokalizaciaze.

qirurgiuli mkurnalobis efeqturoba ganisazRvreboda

2 da 5 wliani gamojansaRebiT.

mTeli informacia _ daavadebis mimdinareobis,

morfologiuri Senebis, procesis gavrcelebis,

metastazirebis, konservatiuli mkurnalobis,

ganxorcielebuli operaciebis masStabebis da mkurnalobis

Sedegebis Sesaxeb, gadagvqonda Cvens mier Seqmnil

specialur ruqa-kodifikatorebze. ruqa-kodifikatorebi

SemdgomSi eqvemdebarebodnen statistikur damuSavebas da

SesaZlebels xdidnen Segveswavla mTeli kliniko-

morfologiuri monacemebis ganawileba klinikurad

gamojanmrTelebul da daavadebis progresirebis gamo

gardacvlil pacientTa jgufebs Soris. es iZleoda

saSualebas gamogveyo informatiuli niSnebi, romlebic

mniSvnelovan zegavlenas axdenen mkurnalobis

efeqturobaze da statistikurad dagvedgina Cvens mier

gamoyenebuli mkurnalobis meTodebis efeqturoba.

aRniSnuli kvlevisaTvis Cvens mier gamoyenebul iqna

statistikuri kvlevis Semdegi meTodebi: klasteruli

analizi da logariTmul-wrfivi analizi.

47

klasteruli analizis mizania mravali niSan-Tvisebis

mqone obieqtTa erTobliobis dayofa msgavs (erTgvarovan)

obieqtTa klasebad (klasterebad). formalizebuli saxiT

klasteruli analizis amocana Semdegnairad Caiwereba:

gvaqvs {Gi} i=1n obieqti, romelTaganac TiToeuli

xasiaTdeba Xj parametriT, j – parametris nomeria. calkeuli

parametri axasiaTebs obieqtis raRac garkveul

Tvisobriobas, magaliTad simsivnis morfologiuri Seneba,

gavrceleba mimdebare anatomiur struqturebze, asaki da a.

S. obieqtTa msgavsebis raodenobrivi SefasebisaTvis

SemoaqvT maT Soris manZilis, anu metrikis cneba:

magaliTad evklides sivrceSi igi Seesabameba wertilebs

Soris Cveulebriv geometriul manZils – evklides metrikas

da gamoisaxeba Semdegi formuliT:

2/1

1

2)(),( ⎥⎦

⎤⎢⎣

⎡−= ∑

=

M

J

JK

JIKI XXGGD

sadac da dekartis koordinatTa sistemaSi I da K

wertilebis koordinatebia.

JIX J

KX

Cven mier gamoyenebuli obieqtTa klasterizaciis k-

saSualoTa meTodi ganekuTvneba iteraciuli

klasterizaciis meTods – meTodi pirvel iteraciaze yofs

obieqtTa simravles winaswar gansazRvrul k-raodenoba

klasterad, iTvlis klasterebs Soris msgavsebis xarisxs

SerCeuli metrikis gamoyenebiT. meore iteraciaze

garkveuli obieqti gadaaqvs erTi klasteridan meoreSi da

xelmeored iTvlis msgavsebis xarisxs. iteraciebi

48

grZeldeba manam, sanam maqsimalurad Semcirdeba

Sidaklasteruli dispersia da gaizardeba klasterTSorisi

dispersia.

obieqtTa maxasiaTebeli niSan-Tvisebebi SeiZleba

aRiwerebodes intervaluri cvladis saxiT (magaliTad

asaki), SesaZlebelia rangobriv (stadia, gavrceleba), an

nominalur (morfologia, lokalizacia) cvladebis saxiT.

am garemoebaTa gaTvaliswinebiT, klasteruli analizis

meTodi SeiZleba ganxiluli iqnas, rogorc monacemTa

dazverviTi analizis meTodi, romelic iZleva hipoTezis

xarisxobrivi Sefasebis saSualebas, xolo hipoTezis

statistikuri sarwmunoebis Sesafaseblad umetes

SemTxvevaSi ar gamodgeba.

klasteruli analizis meTodiT gamovlenili

kanonzomierebebis statistikuri sarwmunoebis Sefasebis

mizniT, Cvens mier gamoyenebuli iqna logariTmul-wrfivi

analizis meTodi.

logariTmul-wrfivi analizis meTodi ganekuTvneba 2X2

sixSiruli cxrilebis Semdgom ganviTarebas da

gankuTvnilia kategorialuri da nominaluri cvladebis

mravaganzomilebiani sixSirul tabulebSi, or an ramdenime

faqtors Soris SesaZlo urTierTqmedebis statistikuri

sarwmunoebis Sesafaseblad. faqtorebs Soris

urTierTgavlenis statistikuri sarwmunoebis Sefaseba

xdeba χ2 kriteriumis mixedviT, mowmdeba nulovani hipoTeza,

anu ramdenad sarwmunod gansxvavdeba gamovlenili

sixSireebi mosalodneli sixSireebisagan. Tu sarwmunoebis

p-done nulTan axlo myofi sididea, maSin hipoTeza, rom

faqtorebs Soris urTierTqmedeba ar arsebobs, sarwmunod

49

ar miiCneva. gamoTvlebs vawarmoebdiT statistikur

programul paket STATISTIKA 6-is operaciul areSi.

aRniSnuli kvlevebis safuZvelze miRebuli

informaciis gaTvaliswineba, avadmyofTa mkurnalobis

individualuri modelirebisas ukve arsebuli mkurnalobis

meTodebis gamoyenebiT, saSualebas iZleva mivaRwioT

maqsimalur Sedegs.

50

Tavi III

zeda ybis avTvisebiani simsivneebis kliniko-

morfologiuri daxasiaTeba da mkurnalobis Sedegebis

analizi

vinaidan, Cveni kvlevis ZiriTad mizans warmoadgenda

zeda ybis avTvisebiani simsivneebis im kliniko-

morfologiuri maxasiaTeblebis gamovlena, romlebic

mniSvnelovan zegavlenas axdendnen daavadebis

mimdinareobaze, mkurnalobis efeqturobasa da prognozze,

mizanSewonilad CavTvaleT miRebuli informaciis

detaluri analizis warmoeba, rogorc mTlian klinikur

masalaze aseve sxvadasxva meTodebiT namkurnaleb pacientTa

jgufebSi.

146 avadmyofidan 90 (68,2%) SemTxvevaSi

diagnostirebul iqna brtyelujredovani kibo, maT Soris

maRaldiferencirebuli kibo _ 50 (34,3%) SemTxvevaSi,

saSualo diferenciaciis _ 12 (8,2%) SemTxvevaSi, xolo

dabaldiferencirebuli kibo _ 18 (12,3%) SemTxvevaSi. 19

(13%) avadmyofs daudginda adenokarcinomas diagnozi, xolo

23 (15,7%) avadmyofs gamouvlinda cilindrulujredovani

kibo.

araepiTeluri warmoSobis simsivneebi gamouvlinda 14

(9,6%) pacients. maTgan limfosarkoma diagnistirebul iqna 9

(6,2%) SemTxvevaSi, xolo sxvadasxva saxis sarkomebi (angio,

qondro da osteosarkomebi) daudginda 5 (3,4%) avadmyofs.

aRniSnuli jgufis (146 avadmyofi) detalurma

klinikurma analizma gviCvena, rom zeda ybis wiaRis

51

avTvisebiani simsivneebis diagnostirebamde avadmyofTa

ZiriTadi masa anamnezSi aRniSnavda sxvadasxva qronikuli

anTebiTi procesebis arsebobas xangrZlivi (1-dan 9 wlamde)

drois ganmavlobaSi. maTgan 55,6%-s rentgenologiurad

aReniSneboda qronikuli polipomatozuri haimoritis

arseboba.

haimoris Rrus avTvisebiani simsivneebis gamovlinebis

pirvel simptomTa Soris ufro xSirad adgili hqonda yru

tkivilebisa da simZimis SegrZnebas (87,6%-Si). es simptomi,

rogorc wesi aReniSnebodaT im avadmyofebs, sadac

simsivnur process dakavebuli hqonda zemo-ukana SigniTa

segmenti. am jgufSi pacientebi aseve aranaklebi sixSiriT

uCiodnen cxvirdan sunTqvis mniSvnelovan gaZnelebas, rasac

Tan axlda lorwovan-Cirqovani gamonadeni cxviris

savalidan. zemoT aRniSnuli simptomebis raodenobrivi

gamovlinebebi Cvens mier warmodgenil avadmyofebSi

moyvanilia cxrilSi #8.

anamnezuri monacemebis Seswavlam gviCvena, rom

adgilobrivad gavrcelebuli epiTeluri simsivneebis

arsebobis SemTxvevaSi avadmyofTa ZiriTad CivilebTan

erTad pacientebs aReniSnebodaT cxviridan sisxldena (36

avadmyofi (24,7%)), ekzoftalmi (10 avadmyofi (6,8%)), trizmi,

(6 avadmyofi (4,1%)) rac ganpirobebuli iyo simsivnuri

procesis gavrcelebiT saReW kunTebSi.

52

cxrili #5

haimoris Rrus avTvisebiani simsivneebis gamovlinebis pirveladi klinikuri simptomebi

klinikuri

simptomebi

avadmyofTa

raodenoba

tkivilisa da

simZimis SegrZneba

cxviriT sunTqvis

gaZneleba

lorwovan-

Cirqovani

gamonadeni

trizmi

sisxldena

ekzofTalmi

simsivnis

lokalizacia

L. Ohngren -is

dayofis

mixedviT

wina-qveda

SigniTa

segmenti

8 4 _ 3 _ 1 _

wina-qveda

gareTa

segmenti

6 4 _ 1 _ _ _

zemo-ukana

gareTa

segmenti

11 10 _ 5 _ _ _

zemo-ukana

SigniTa

segmenti

10 5 1 1 _ 1 _

simsivne

moicavs

mTel Rrus

79 71 57 42 7 42 11

jami 117 94 58 52 7 43 11

zeda ybis simsivneebis mimdebare anatomiur

struqturebSi Cazrdisas daavadebis gamovlinebis

simptomatika ufro mravalferovani xdeboda. ase magaliTad,

simsivnis cxviris RruSi gavrcelebisas sunTqvis

gaZnelebas xSirad Tan erTvoda cxviris gamoxatuli

deformacia. xolo cxavis Zvlis labirinTSi gavrcelebisas,

aRiniSneboda Tvalbudis medialuri kedlis deformacia.

daavadebis lokalizaciisas haimoris Rrus qveda, wina-

gareTa an gareTa-lateralur kedelze simsivnur procesi,

rogorc wesi, vrceldeboda alveoluri morCis, rbili an

magari sasis mimarTulebiT, rac vlindeboda kbilTa

53

mwkrivis deformaciebSi, am ukanasknelTa moryeviT. xSirad

aseT avadmyofebs aReniSnebodaT nevralgiuri xasiaTis

tkivilebi kbilTa mwkrivis areSi.

simsivnis zeda-ukana SigniTa da gareTa

lokalizaciisas procesis gavrceleba ZiriTadad xdeboda

orbitis mimarTulebiT da am ukanasknelSi CazrdiT, rac

xSirad iwvevda Tvalis kaklis gadanacvlebas medialuri an

lateraluri mimarTulebiT. amas Tan axlda mxedvelobis

intensivobis daqveiTeba, cremldena da mxedvelobis

gaoreba. simsivnis ufro Rrma gavrcelebisas, qalas Rrusa

da fuZeze, adgili hqonda Tvalis mamoZravebeli nervebis

dazianebas, rac gamoixateboda Tvalis moZraobis

SezRudviTa da Zlieri Tavis tkivilebiT. haimoris Rrus

avTvisebiani simsivneebis gavrcelebis sixSire mimdebare

anatomiur struqturebze warmodgenilia cxrilSi #9,

xolo sqematurad gamoxatuli suraT #7-ze.

miuxedavad aRniSnuli klinikuri gamovlinebebisa,

pacientebs xangrZlivi drois ganmavlobaSi utardebodaT

mkurnaloba sxvadasxva profilis samedicino

dawesebulebebSi. anamnezuri monacemebis analizma gviCvena,

rom praqtikulad yvela avadmyofs specialuri

gamokvlevebis gareSe Cautarda konservatiuli mkurnaloba,

rac gamoixateboda: anTebis sawinaaRmdego mkurnalobaSi,

fizioTerapiaSi, da haimoris Rrus gamorecxvebSi da a.S. am

procedurebis Semdeg 32% avadmyofebisa aRniSnavda

daavadebis mkveTr progresirebas.

54

ცხრილი ¹6

ჰaიმორის ღრუს avთvისebიaნი სიმსიvნeebის gavრცeლeba მიმdebaრe aნaტომიურ სრუქტურebში.

სიმსიvნის ლოკaლიzaციa

L.Ohngren-is daყოფის მიხedvით

avadმყოფთa

რaოdeნოba თvaლbუde

ცხvირის ღრუ

პირის ღრუ რbილი da მagaრი

ქსოvილebი

წინa-ქveda შიgნითa

სegმeნტი 1 - 1 - -

წინa-ქveda gaრeთa

სegმeნტი 2 - 1 1 -

zeმო-უკaნa gaრeთa

სegმeნტი 3 1 - - -

zeმო-უკaნa შიgნითa

სegმeნტი 1 1 - - -

სიმსიvნe მოიცavს მთeლ

ღრუს 101 18 40 19 26

ჯaმი 108 20 42 20 26

35 (23,97%) avadmyofs cito da morfologiuri

verifikaciis gareSe sxvadasxva klinikebSi CautardaT

haimorotomia, 14 (9,6%) pacients zeda ybis areSi gausaZlisi

tkivilebis gamo kbilebis eqstraqcia, 12 (8,2%) avadmyofs

Tvalis klinikaSi egzofTalmis gamo simsivnis amokveTa,

xolo 7 (2,8%) avadmyofs Cautarda nevrologiuri

mkurnaloba. Cveni azriT, yovelive es ganpirobebuli iyo

imiT, rom ar iyo srulyofilad Segrovebuli anamnezi da

Catarebuli aucilebeli kliniko-diagnostikuri

gamokvlevebi, ramac ganapiroba diagnostikuri Secdomebi.

daavadebis pirveli simptomis gamovlenidan

specializirebul onko-dawesebulebas 1-dan 3 Tvis

55

periodSi mimarTa 39 (26,7%) avadmyofma, 81 (55,5%) 3-dan 6

TveSi, xolo 6-dan 12 TveSi 26 (17,8%) pacientma.

klinikurma gamokvlevebma gviCvena, rom rodesac Cndeba

eWvi zeda ybis avTvisebiani simsivnis arsebobaze,

aucilebeli xdeba avadmyofTa kompleqsuri gamokvleva, rac

gamoixateba kvlevaTa Semdeg TanmimdevrobaSi: anamnezis

detaluri Sekreba da Civilebis gaanalizeba; haimoris Rrus

wina da Tvalbudis qveda kedlis, alveoluri morCisa da

magari sasis palpacia; Semdeg xorcieldeba wina rinoskopia

da epifaringoskopia; zeda ybis rentgenografia; cxvirxaxis

da cxviris savalebis fibroskopia; simsivnis arsebobis

SemTxvevaSi citologiuri da punqciuri biofsiis warmoeba;

Zvlovani struqturebis mTlianobis dasadgenad

kompiuteruli tomografia; rac Seexeba simsivnis rbil

qsovilebSi gavrcelebis diagnostirebas, aucilebeli xdeba

magnitur-rezonansuli tomografiis warmoeba; romelic

dReisaTvis yvelaze informatulia.

aRsaniSnavia, rom kompiuteruli tomografiisas

avTvisebiani simsivneebis densinometriuli monacemebi

meryeobs 40-45 haufsvildis farglebSi da damokidebulia

simsivnis lokalizaciaze, struqturaze da gavrcelebaze.

Catarebuli kliniko-rentgenologiuri, kt da mrt

kvlevebis safuZvelze aRmoCnda, rom simsivnuri procesiT

marto haimoris Rru dainteresebuli iyo mxolod 38 (26%)

SemTxvevaSi. sxva pacientebSi aRiniSneboda procesis

gavrceleba cxviris savalSi 42 (28,7%), 20 (13,7%) SemTxvevaSi

magar da rbil sasaze, saReW kunTebze aRiniSna 10 (6,1%)

SemTxvevaSi, 2-Si (1,4%) eTmoidur wiaRSi, TvalbudeSi 20

56

(13%), yvrimalis Zvalze 9 (6,1%), loyis rbil qsovilebSi 2

(1,4%), SemTxvevaSi da frTasasis fosoSi 2 (1,4%)

SemTxvevaSi. amrigad, daavadebis gavrceleba erT anatomiur

struqturze diagnostirebul iqna 38 (26%) SemTxvevaSi, or

struqturaze 35-s (24%), samze 18 (12,3%) da oTx

struqturaze 17 (11,7%) SemTxvevaSi. mTlianobaSi T1

gavrcelebis simsivne gamovlenil iqna mxolod 4 (2,73%)

avadmyofSi, T2 gavrcelebis 23-Si (15,74%), T3 daudginda 59

(40,5%) avadmyofs, xolo T4 ki _ 60 (41%) pacients.

mkurnalobis dawyebamde regionuli metastazebi

aReniSna 22 (15%) avadmyofs. maT Soris, ybisqveSa midamosa

da kisris zeda mesamedis limfuri kvanZebis dazianebiT

simsivnuri procesis mxareze daudginda 14 (63,7%) avadmyofs,

aqedan, 3sm-de zomis metastazebi aReniSna 10-s (71,5%), xolo

3sm-ze meti ki _ 4 (28,5%) avadmyofs. mravlobiTi

metastazebi gamovlenil iqna 8 (36,3%) SemTxvevaSi, aqedan,

3sm-de zomis regionuli metastazebi daudginda 5 (62,5%)

avadmyofs, xolo 3sm-ze meti ki _ 3 (37,5%) pacients.

Catarebuli mkurnalobis efeqturobis gansazRvris

mizniT Cvens mier warmodgenili 146 avadmyofi mkurnalobis

meTodebis mixedviT ganawilebul iqna 4 klinikur jgufSi.

I jgufi _ Seadgina 44 (28,7%) pacientma, romelTac

mkurnalobis pirvel etepze CautardaT qimio-sxivuri

Terapia; qimioTerapia ZiriTadad atarebda sistemuri

poliqimioTerapiis saxes. 44 pacientidan mamakaci iyo 26

(59%), xolo 18 (41%) ki _ qali; maTi asaki meryeobda 20-dan

60 wlamde; tkivilis sindromi aReniSna 30 (68,2%) avadmyofs,

57

cxviridan sisxldena _ 4-s (9%), xolo Cirqovan-serozuli

gamonadeni _ 23-s (52,3%). daavadebis arsebobis xangrZlivoba

Seadgenda 1-6 Tves; TNM klasifikaciis mixedviT T2

gavrcelebis simsivne daudginda 7 (16%) pacients, T3 _ 15-s

(34%) da T4 gavrcelebis _ 22-s (50%); morfologiuri

kvleviT 24 (54,5%) SemTxvevaSi gamovlenil iqna

brtyelujredovani kibo, 3-Si (6,8%) adenokarcinoma, 3-Si

(6,8%) cilindroma, 9 (20,5%) SemTxvevaSi limfosarkoma da 5

(11,4%) avadmyofs daudginda sxvadasxva warmoSobis

SemaerTebelqsovilovani simsivneebi. daavadeba ar

vrceldeboda wiaRis farglebs gareT 12 (27,3%) SemTxvevaSi,

14 (31,8%) avadmyofs aReniSna daavadebis gavrceleba I

mimdebare anatomiur struqturaze (cxviris savali,

Tvalbude, sasa), II mimdebare anatomiur struqturaze 12-s

(27,3%), III (eTmoiduri wiaRi da frontaluri wiaRi)

struqturaze 4-s (9%) da IV anatomiur struqturaze 2 (4,5%)

pacients (saReW kunTebze, yvrimalis Zvalze, loyis rbil

qsovilebze, frTasasis foso); 9 (20,5%) avadmyofs

gamouvlinda calmxrivi regionuli metastazebi, aqedan 7

(77,8%) SemTxvevaSi erTeuli, xolo 2-Si (22,2%) ki _

mravlobiTi.

yvela avadmyofs mkurnalobis pirvel etapze Cautarda

sistemuri poliqimioTerapia I-dan III kursamde. ris

Semdegac, momdevno etapze utardebodaT sxivuri Terapia

wyvetili kursiT (40-30gr), romlis dRiuri doza Seadgenda

2 gr-s, xolo, jamuri ar aRemateboda 70gr-s. qimio da

sxivuri Terapiis damTavrebisTanave xdeboda mkurnalobis

Sedegebis Sefaseba, romelic efuZneboda subieqtur da

obieqtur monacemTa analizs. subieqturi monacemebidan

58

viTvaliswinebdiT tkivilis simptomis moxsnas, cxviriT

sunTqvis aRdgenas, cxviridan gamonadenisa da metastazebis

zomebSi Semcirebis xarisxs da sxva. obieqturi

kriteriumebi iTvaliswinebda fibroskopiul,

rentgenologiur da kompiuterul tomografiul monacemTa

analizs.

Catarebuli poliqimioTerapiuli mkurnalobis uSualo

Sedegebi moyvanilia cxril #10-Si. saidanac naTlad Cans

rom, poliqimioTerapiis Semdgom simsivnis sruli regresia

miRweul iqna SemTxvevaTa mxolod 29,5%-Si. aqedan 6 (46,15%)

avadmyofs aReniSneboda brtyelujredovani kibo, erTs

(7,7%) cilindroma, xolo 6-s (46,15%) limfosarkoma. yvela

avadmyofs mkurnalobis meore etapze gaugrZelda sxivuri

Terapia jamuri doziT 70gr-mde. aRniSnuli mkurnalobis

Semdeg mniSvnelovnad gaizarda simsivnis 100%-iani regresia

(29,5%-dan 61,4%-mde) (ix. cxril #1-Si). maTgan

brtyelujredovani kiboTi daavadebul avadmyofebidan

simsivnis 100%-iani regresia miRebul iqna 17 (71%)

SemTxvevaSi, 4-Si (16,7%) aRiniSna simsivnis regresia 50 da

meti procentiT, xolo 3-Si (12,3%) _ mkurnaloba aRmoCnda

araefeqturi. acinozurujredovani kiboTi daavadebuli

pacientebidan 2-s (66,6%) aReniSna simsivnis 100%-iani

regresia da erTs (33,4%) _ regresia 50 da meti procentiT.

limfosarkomiT daavadebuli 9 avadmyofidan 8-Si (88,9%)

miRebul iqna simsivnis 100%-iani regresia, xolo 1-Si (11,1%)

_ 50 da meti procentiT. rac Seexeba adenokarcinomiT da

sxvadasxva warmoSobis sarkomebiT (angio, qondro da

osteosarkomebi) daavadebul avadmyofebs, mxolod TiTo-

TiTo SemTxvevaSi iqna miRweuli simsivnis regresia 50 da

59

60

meti procentiT, xolo danarCen SemTxvevebSi mkurnalobam

Sedegi ver gamoiRo. (ix. cxrili #7).

cxrili # 7

zeda ybis wiaRis avTvisebiani simsivneebis konservatuli mkurnalobis uSualo Sedegebi.

mkurnalobis uSualo Sedegebi

I etapi

qimioTerapia


II etapi

sxivuri Terapia

simsivnis histologiuri

Seneba

saerTo raodenoba

100% regresia

50% regresia

araefeqturi 100%

regresia 50%

regresia araefeqturi

brtyelujredovani kibo

24 6 25% 9 37,5% 7 29,2% 17 71% 4 16,7% 3 12,3%

adenokarcinoma 3 - - 1 33,3% 2 66,7% - - 1 33,3% 2 66,7%

cilindroma 3 1 33,4% - - 2 66,6% 2 66,6% 1 33,4% - -

limfosarkoma 9 6 66,7% 2 33,3% - - 8 88,9% 1 11,1% - -

angio, qondro da osteosarkomebi

5 - - - - 5 100% - - 1 20% 4 80%

sul 44 13 29,5% 12 27,3% 16 36,4% 27 61,4% 8 18,2% 9 20,4%

61

amrigad, Catarebuli qimio-sxivuri mkurnalobis

Semdgom, 44 avadmyofidan simsivnis sruli rezorbcia

aRiniSna 27 SemTxvevaSi, ramac 61,4% Seadgina. simsivnis

regresia 50 da meti procentiT miRweul iqna 8 (18,2%)

SemTxvevaSi da mxolod 9-Si (20,4%) _ igi aRmoCnda uSedego

(ix. cxrili #8).

cxrili # 8.

zeda ybis wiaRis avTvisebiani simsivneebis klinikuri niSnebis ganawileba mkurnalobis uSualo Sedegebis mixedviT.

mkurnalobis uSualo Sedegebi simsivnis

histologiuri Seneba saerTo

raodenoba 100% regresia araefeqturi


24 17 71% 3 12,3%

adenokarcinoma 3 - - 2 66,7% cilindroma 3 2 66,6% - -

limfosarkoma 9 8 88,9% - - angio, qondro da osteosarkomebi

5 - - 4 80%

tkivili 30 17 56,7% 5 16,7% sisxldena 4 - - 3 75%

Cirqovan-serozuli gamonadeni

23 13 56,5% 2 8,7%

0 12 12 100% - - 1 14 13 93% - - 2 9 2 22,3% 1 11,2% 3 6 - - 5 83,4%

gavrceleba mezobel

struqturebze

4 3 - - 3 100% T2 7 7 100% -

T3 15 12 80% 1 6,7%

T4 22 8 36,4% 36,4% 8

regionuli metastazebi aris 9 1 11,1% 5 55,5%

ar aris 35 26 74,3% 4 11,4% sul 44 27 61,4% 9 20,4%

zeda ybis kibos kliniko-morfologiur maxasiaTebelTa

erTobliobidan im simptomokompleqsebis gamosayofad,

romlebic mogvcemdnen qimio-sxivuri Terapiis efeqturobisa

da daavadebis gamosavlis prognozirebis saSualebas,

gamoyenebuli iqna klasteruli analizi, kerZod K-

saSualoTa meTodi (ix. suraTi #2). statistikuri

sarwmunoebis Sesafaseblad gamoyenebul iqna logariTmul-

62

wrfivi analizis meTodi, romlis Sedegebi warmodgenilia

cxril #12.

suraTi 2. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis klasteruli analizi qimio-sxivuri meTodiT namkurnaleb avadmyofTa jgufSi.

cxrili 9. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis logariTmul-wrfivi analizi qimio-sxivuri meTodiT namkurnaleb avadmyofTa jgufSi.

statistikuri sarwmunoeba χ2 Pc1- c2 χ2 Pc1- c3 χ2 Pc2- c3

asaki 9,48 p=0,023 20,52 p<0,01 26,91 p<0,01

morfologia 6,35 p=0,095 19,45 p<0,01 13,06 p<0,01

destruqcia 3,62 p=0,16 30,86 p<0,01 15,36 p<0,01

gavrceleba 22,68 p<0,01 26,98 p<0,01 42,84 p<0,01

anamnezi 14,71 p<0,01 30,06 p<0,01 51,68 p<0,01

metastazireba 19,89 p<0,01 46,99 p<0,01 -0,04 p=1

efeqti 15,2 p<0,01 33,01 p<0,01 20,85 p<0,01

63

Catarebuli maTematikuri kvlevis safuZvelze

dadginda, rom kliniko-morfologiur maxasiaTebelTa

Soris yvelaze informatiul maCveneblebs warmoadgens

simsivnis morfologiuri Seneba; daavadebis arsebobis

xangrZlioba; daavadebis gavrceleba; Zvlovani destruqcia;

metastazebis arseboba, lokalizacia, zomebi da bolos

avadmyofTa asaki.

sxvadasxva SedegiT namkurnaleb avadmyofTa jgufebSi

daavadebis klinikur gamovlinebaTa da morfologiuri

Senebis analizma gviCvena, rom simsivnis 100%-iani regresia

ZiriTadad miRweuli iqna (74%) axalgazrda da saSualo

asakis (30-50w) pacientebSi, romelTac daudgindaT

daavadebis arsebobis xangrZlivoba 1-dan 6 Tvemde (82%);

morfologiuri Seneba ganisazRvreboda brtyelujredovani

kiboTi (59%), limfosarkomiT (89%) an cilindromiT (66%),

romelTa gavrceleba varirebda araumetes 1 anatomiuri

struqturisa (92,6%), haimoris Rrus Zvlovani kedlebis

destruqciis da regionuli limfuri kvanZebis dazianebis

gareSe (96,3%).

simsivnis 50%-iani regresia ZiriTadad miRweuli iqna

(81%) saSualo da xandazmuli asakis (50-70w) pacientebSi,

romelTac daudgindaT daavadebis arsebobis xangrZlivoba

3-dan 6 Tvemde (69,5%); morfologiuri Seneba ZiriTadad

ganisazRvreboda brtyelujredovani kiboTi (71%), da

adenokarcinomiT (34%), romelTa gavrceleba varirebda

araumetes 2 anatomiuri struqturisa (97,3%), haimoris Rrus

Zvlovani kedlebis destruqciiT an destruqciis gareSe,

64

aseve ar aRiniSneboba regionuli limfuri kvanZebis

metastazuri dazianebebi (91,2%).

avadmyofTa im jgufSi, sadac konservatulma

mkurnalobam Sedegi ver gamoiRo, pacientTa asaki

meryeobda 55-dan 74 wlamde (77,8%); romelTa daavadebis

arsebobis xangrZlivoba ar aremateboda 3 Tves (66,7%);

daavadebis morfologiiuri Seneba ganisazRvreboda

adenokarcinomiT (68%) an sxvadsxva warmoSobis sarkomebiT

(75%) (angio, qondro da osteosarkomebi); simsivne

vrceldeboda or da met mezobel anatomiur struqturaze

(82,4%); aRiniSneboda Zvlovani kedlebis sxvavasxva xarisxis

destruqcia (72,3%); mravlobiTi an erTeuli regionuli

metastazebi romelTa zomebi aRemateboda 3sm-s (17,8%).

qimio-sxivuri mkurnalobis Soreuli Sedegebis

analizma gviCvena, rom avadmyofTa im jgufSi, sadac

miRweul iqna simsivnis sruli rezorbcia (27 avadmyofi),

sicocxlis 2 wliani barieri davadebis progresirebis

niSnebis gareSe gadalaxa 19 avadmyofma, ramac 70,4%

Seadgina. daavadebis progresireba pirveli ori wlis

ganmavlobaSi aReniSna 8 (29,6%) avadmyofs. maTgan 6-s (75%)

daudginda recidiuli simsivne, xolo 2-s (25%) _ Soreuli

metastazebi.

II jgufi _ am jgufSi gaerTianebul iqna is 87

avadmyofi, romlebsac mkurnalobis pirvel etapze

CautardaT sxivuri Terapia. 87 pacientidan mamakaci iyo 55

(63,2%), 32 (36,8%) ki _ qali; maTi asaki meryeobda 40-dan 75

wlamde; tkivilis sindromi aReniSna 59 (67,8%) avadmyofs,

cxviridan sisxldena 32-s (36,8%), xolo Cirqovan-serozuli

65

gamonadeni 27-s (31%). aRniSnul jgufSi avadmyofebs

ZiriTadad daudgindaT daavadebis arsebobis xangrZlivoba

1-dan 6 Tvemde; TNM klasifikaciis mixedviT T2 gavrcelebis

simsivne daudginda 7 (8%) pacients, T3 _ 46-s (52,9%) da T4

gavrcelebis _ 34-s (39,1%); morfologiuri kvleviT 54 (62%)

SemTxvevaSi gamovlenil iqna brtyelujredovani kibo, 13-Si

(15%) _ adenokarcinoma, xolo 20-Si (23%) _ cilindroma.

daavadeba ar vrceldeboda wiaRis farglebs gareT 11

(12,6%) SemTxvevaSi, 18 (20,7%) avadmyofs aReniSna daavadebis

gavrceleba I mimdebare anatomiur struqturaze (cxviris

savali, Tvalbude, sasa), II mimdebare anatomiur

struqturaze 33-s (37,9%), III (eTmoiduri wiaRi da

frontaluri wiaRi) struqturaze 10-s (11,5%), IV da V

anatomiur struqturaze 5 (5,8%) pacients (saReW kunTebze,

yvrimalis Zvalze, loyis rbil qsovilebze, frTasasis

foso); 31 (35,6%) avadmyofs gamouvlinda Zvlovani kedlebis

destruqcia; 18 (20,7%) avadmyofs gamouvlinda regionuli

metastazebi, aqedan 11-s (61,1%) erTeuli, xolo 7-s (38,9%)

mravlobiTi.

yvela avadmyofs utardeboda sxivuri Terapia

wyvetili kursiT, I etapze pacienti sxivdeboda 40gr-s

odenobiT, xolo II-ze, orkviriani Sesvenebis Semdeg, 30gr-s

odenobiT. dasxivebis dRiuri doza Seadgenda 2 gr-s, xolo

jamuri ar aRemateboda 70gr-s. sxivuri Terapiis

damTavrebisTanave xdeboda mkurnalobis Sedegebis Sefaseba,

romelic efuZneboda subieqtur da obieqtur monacemTa

analizs. subieqturi monacemebidan viTvaliswinebdiT

tkivilis simptomis moxsnas, cxviriT sunTqvis aRdgenas,

cxviridan gamonadenisa da metastazebis zomebSi Semcirebis

66

67

xarisxs da sxva. obieqturi kriteriumebi iTvaliswinebda

fibroskopiul, rentgenologiur da kompiuterul

tomografiul monacemTa analizs.

mkurnalobis I etapis (40gr) Catarebis Semdeg, 54

brtyelujredovani kiboTi daavadebuli avadmyofidan

simsivnis 100%-iani regresia miRebul iqna 12 SemTxvevaSi

(22,2%), 13-s (24%) aReniSna simsivnis regresia 50 da meti

procentiT, xolo 29 (53,7%) SemTxvevaSi mkurnaloba

aRmoCnda araefeqturi (ix. cxrili #10). acinozurujredovani

kiboTi anu cilindromiT daavadebuli 20 avadmyofidan

simsivnis 100%-iani regresia aReniSna 5 (25%) pacients, 7-s

(35%) _ 50 da meti procentiT, xolo, 8 (40%) SemTxvevaSi

mkurnaloba aRmoCnda uSedego. rac Seexeba

pacientebs, romelTac diagnostirebuli hqondaT

adenokarcinoma, 13 avadmyofidan simsivnis 100%-iani

regresia ver iqna miRebuli verc erT SemTxvevaSi, regresia

50 da meti procentiT aRiniSna mxolod 2-Si (15,4%), xolo

11-Si (84,6%) igi uSedego aRmoCnda.

mkurnalobis II etapis (30gr) Catarebis Semdeg,

brtyelujredovani kiboTi daavadebul avadmyofTagan

simsivnis 100%-iani regresia sul miRweul iqna 25 (46,3%)

SemTxvevaSi, 7-Si (13%) aRiniSna simsivnis regresia 50 da

meti procentiT, xolo 22 (40,7%) SemTxvevaSi mkurnaloba

aRmoCnda araefeqturi. acinozurujredovani kiboTi

daavadebul pacientebidan, simsivnis 100%-iani regresia

aRiniSna 14 (70%) SemTxvevaSi, 2-Si (10%) 50 da meti

procentiT da mxolod 4 (20%) SemTxvevaSi igi aRmoCnda

uSedego. rac Seexeba adenokarcinomiT daavadebul

cxrili # 10

zeda ybis wiaRis avTvisebiani simsivneebis sxivuri mkurnalobis uSualo Sedegebi.

mkurnalobis uSualo Sedegebi mkurnalobis uSualo Sedegebi I etapi II etapi

100% regresia

50% regresia 100%

regresia araefeqturi 50% regresia araefeqturi

simsivnis histologiuri Seneba

saerTo raodenoba

40gr 40gr 40gr 70gr 70gr 70gr

brtyelujredovani kibo 54 12 22,2% 13 24% 29 53,7% 25 46,3% 7 13% 22 40,7%

adenokarcinoma 13 _ _ 2 15,4% 11 84,6% - - 2 15,4% 11 84,6%

cilindroma 20 5 25% 7 35% 8 40% 13 65% 3 15% 4 20%

sul 87 17 19,5% 22 25,3% 48 55,2% 38 43,7% 13,8% 12 37 42,4%

68

avadmyofebs, sxivuri Terapiis meore kursis Semdeg

mkurnalobis Sedegebi praqtikulad ar Secvlila. (ix. cxrili

#10).

amrigad, Catarebuli sxivuri mkurnalobis Semdgom,

saerTo jamuri doziT 70gr, 87 avadmyofidan simsivnis sruli

rezorbcia aRiniSna 38 SemTxvevaSi, ramac 43,7% Seadgina.

simsivnis regresia 50 da meti procentiT miRweul iqna 12

(13,8%) SemTxvevaSi da mxolod 37-Si (42,4%) igi aRmoCnda

uSedego (ix. cxrili #11).

cxrili # 11.



100% regresia araefeqturi

simsivnis histologiuri Seneba

saerTo raodenoba

70gr 70gr


54 25 46,3% 22 40,7%

adenokarcinoma 13 - - 11 84,6% cilindroma 20 13 65% 4 20%

tkivili 59 10 17% 22 37,3% sisxldena 32 3 9,4% 29 90,6%


27 11 40,7% 5 18,5%

0 11 11 100% - - 1 24 17 71% - - 2 26 10 38,5% 11 42,3% 3 12 - - 12 100%

gavrceleba mezobel

struqturebze

4 14 - - 14 100% T2 7 7 100% - -

T3 46 29 63% 8 17,4%

T4 34 2 5,9% 29 85,3% regionuli metastazebi

aris 15 1 6,7% 13 86,7% ar aris 72 37 51,4% 34 47,2%

sul 87 38 43,7% 42,4% 37

69

Catarebuli maTematikuri kvlevis safuZvelze dadginda

rom, kliniko-morfologiur maxasiaTebelTa Soris yvelaze

informatiul maCveneblebs warmoadgens simsivnis

morfologiuri Seneba; daavadebis arsebobis xangrZlioba;

daavadebis gavrceleba; Zvlovani destruqcia; metastazebis

arseboba, lokalizacia da zomebi; aseve avadmyofTa asaki.

xolo sxvadasxva SedegiT namkurnaleb avadmyofTa jgufebSi

daavadebis kliniko morfologiur maxasiaTebelTa analizma

gviCvena, rom simsivnis 100%-iani regresia ZiriTadad miRweul

iqna SedarebiT axalgazrda (30-50weli) asakis pacientebSi

(85,7%), sadac daavadebis arsebobis xangrZlivoba Seadgenda 3-

dan 6 Tves (86,5%); simsivnis morfologiuri Seneba

ganisazRvreboda brtyelujredovani kibos

dabaldiferencirebuli formiT (64%) an cilindromiT (84,6%),




gareSe (ix. suraTi #3 da cxrili #12).

simsivnis 50%-iani regresia ZiriTadad miRweuli iqna

(89%) saSualo asakis (45-55w) pacientebSi, romelTac

daudgindaT daavadebis arsebobis xangrZlivoba 3-dan 6 Tvemde

(79,5%); morfologiuri Seneba ZiriTadad ganisazRvreboda

saSualo diferencirebis brtyelujredovani kiboTi (91%),

romlis gavrceleba varirebda araumetes 2 anatomiuri


destruqciisa da regionuli metastazebis gareSe.

70

suraTi 3. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis klasteruli analizi sxivuri meTodiT namkurnaleb avadmyofTa jgufSi.

cxrili 12. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis logariTmul-wrfivi analizi sxivuri meTodiT namkurnaleb avadmyofTa jgufSi.


asaki 27,13 p<0,01 18,66 p<0,01 53,15 p<0,01

morfologia 30,82 p<0,01 21,97 p<0,01 44,1 p<0,01

destruqcia 69,61 p<0,01 14,79 p<0,01 4,62 p=0,099

gavrceleba 35,77 p<0,01 59,19 p<0,01 15,63 p<0,01

anamnezi 18,9 p<0,01 96,1 p<0,01 5,03 p=0,441

metastazireba 25,49 p<0,01 73,73 p<0,01 4,88 p=0,027

25,71 p<0,01 73,05 p<0,01 efeqti 27,27 p<0,01

71

konservatuli mkurnaloba uSedego aRmoCnda ZiriTadad

pacientTa im jgufSi, romelTa asaki meryeobda 50-dan 70

wlamde (78,6%); sadac daavadebis arsebobis xangrZlivoba

Seadgenda 1-dan 3 da 6-dan 12 Tvemde periods (87,3%);

morfologiuri Seneba ZiriTadad ganisazRvreboda

adenokarcinomiT (70%) an maRali diferencirebis

brtyelujredovani kiboTi (50%); iq, sadac simsivne

vrceldeboda orze met anatomiur struqturaze (69,3%),

aRiniSneboda Zvlovani kedlebis sxvavasxva xarisxis

destruqcia (76,9%) da gamovlenili iyo mravlobiTi an

erTeuli regionuli metastazebi, romelTa zomebic

aRemateboda 3sm-s (19%).

sxivuri mkurnalobis Soreuli Sedegebis analizma

gviCvena, rom avadmyofTa im jgufSi, sadac miRweul iqna

simsivnis sruli rezorbcia (38 avadmyofi), sicocxlis 2

wliani barieri daavadebis progresirebis niSnebis gareSe

gadalaxa 22 avadmyofma, ramac 57,9% Seadgina, xolo

daavadebis progresireba aReniSna 16 avadmyofs. maTgan

recidivi _ 9-s (56,3%), recidivi da regionuli metastazi

erTad _ 4-s (25%), xolo Soreuli metastazebi 3-s (18,7%).

III jgufi _ am jgufSi gaerTianebul iqna 51 avadmyofi im

65 pacientidan, romelTac Catarebuli konservatuli

mkurnalobis Semdeg aReniSnebodaT narCeni simsivne, xolo 15-

ma operaciul mkurnalobaze uari ganacxada. ris gamoc maT

gaugrZeldaT sxivuri Terapia paliatiuri mizniT.

72

51 avadmyofidan 2 (3,9%) SemTxvevaSi ganxorcielebul

iqna zeda ybis tipiuri eleqtrorezeqcia, xolo 40-Si (78,4%) _

kombinirebuli da 9-Si (17,7%) _ kombinirebul-gafarToebuli

operaciebi. maTgan mamakaci iyo 28 (54,9%), 23 (45,1%) ki _ qali;

maTi asaki meryeobda 35-dan 75 wlamde; daavadebis arsebobis

xangrZlivoba Seadgenda 1-dan 12 Tvemde periods; TNM

klasifikaciis mixedviT T3 gavrcelebis simsivne daudginda 16

(31,4%) pacients, xolo T4 gavrcelebis 35-s (68,6%);

morfologiuri kvleviT 27 (53%) SemTxvevaSi gamovlenil iqna

brtyelujredovani kibo, 13-Si (25,5%) _ adenokarcinoma, 6-Si

(11,7%) _ cilindroma, 2-Si (3,9%) limfosarkoma, xolo 3 (5,9%)

SemTxvevaSi angio, qondro da osteosarkomebi. daavadeba

haimoris Rrudan 4 (7,8%) SemTxvevaSi vrceldeboda I mimdebare

anatomiur struqturaze (cxviris savalSi, TvalbudeSi da

sasaze), 27-Si (52,9%) II struqturaze, 14-Si (27,5%) III

struqturaze, IV da met anatomiur struqturaze ki 6 (11,8%)

SemTxvevaSi; 5 (9,8%) avadmyofs aReniSna ekzofTalmi, 7-s

(13,7%) nistagmi, xolo 5 pacients (9,8%) sxvadsxva xarisxis

paresTeziebi; 38 (74,5%) avadmyofs daudginda zeda ybis wiaRis

Zvlovani kedlebis destruqcia; 9 (17,6%) avadmyofs

gamouvlinda 3 sm-de zomis erTeuli regionuli metastazebi,

aqedan 4-s (44,5%) ybisqveSa samkuTxedSi, 3-s (33,3%) _ saZile

samkuTxedSi, xolo 2-s (22,2%) _ kisris Sua mesamedSi.

daavadebis gavrcelebidan gamomdinare, Cvens mier 29

(59,2%) SemTxvevaSi zeda ybasTan erTad rezecirebil iqna I da

II mimdebare anatomiur struqtura; xolo 20 SemTxvevaSi

(40,8%) ganxorcielda zeda ybis rezeqcia III da met mimdebare

73

anatomiur struqturasTan erTad; 9 (17,6%) avadmyofidan,

romlebsac aReniSnebodaT regionuli limfuri kvanZebis

metastazuri dazianeba 6-s (66,7%) Cautarda kisris limfuri

kvanZebis fascialur-futliaruli amokveTa, xolo 3-s (33,3%)

_ krailis tipis operacia.

Catarebuli mkurnalobis Semdeg sicocxlis 2 wliani

barieri daavadebis progresirebis niSnebis gareSe gadalaxa

20 (39,2%) avadmyofma. maTgan mamakaci iyo 11 (55%), xolo 9

(45%) qali; maTi asaki meryeobda 40-dan 60 wlamde; daavadebis

arsebobis xangrZlivoba Seadgenda 3-6 Tves; morfologiurad

gamovlenil iqna brtyelujredovani kibo 13 (65%) SemTxvevaSi,

adenokarcinoma 3-Si (15%), xolo 2-2 (10%) SemTxvevaSi

cilindroma da limfosarkoma; 3 (15%) SemTxvevaSi simsivne

vrceldeboda I mimdebare anatomiur struqturaze, 15-Si (75%)

II mimdebare struqturaze da 2-Si (10%) III struqturaze; 3

(15%) SemTxvevaSi aRiniSna zeda ybis wiaRis zeda kedlis

destruqcia, 2-Si (10%) qveda kedlis, xilo 5-Si (25%)

medialuri kedlis destruqcia; 2 (10%) avadmyofs

mkurnalobis dawyebamde gamovlenili hqonda 3sm-de zomis

solitaruli metastazi ybisqveSa samkuTxedSi.

31 (60,8%) avadmyofs mkurnalobis Semdeg aReniSna

daavadebis progresireba, maTgan 17 (54,8%) SemTxvevaSi

diagnostirebul iqna recidiuli simsivne, 2-s (6,45%)

gamouvlinda regionuli metastazebi, 4-s (12,9%) recidiuli

simsivne da regionuli metastazebi erTad, xolo 8-s (25,8%)

74

Soreuli metastazebi, maTgan 5 (62,5%) SemTxvevaSi filtvebSi,

1-s (12,5%) RviZlSi da 2-s (25%) ZvlebSi.

suraTi 4. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis klasteruli analizi kombinirebuli meTodiT namkurnaleb avadmyofTa jgufSi.

cxrili 13. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis logariTmul-wrfivi analizi kombinirebuli meTodiT namkurnaleb avadmyofTa jgufSi.


asaki 14,17 p<0,01 5,24 p=0,156 11,45 p<0,01

morfologia 33,96 p<0,01 52,02 p<0,01 22,64 p<0,01

gavrceleba 27,13 p<0,01 28,43 p<0,01 61,3 p<0,01

anamnezi 11,45 p<0,01 2,36 p=0,5 13,32 p<0,01

metastazireba 29,44 p<0,01 14,78 p<0,01 8,86 p=0,011

9,53 p<0,01 23,84 p<0,01 recidivi 11,62 p<0,01

75

aRniSnuli avadmyofebidan 17 (54,8%) iyo mamakaci, xolo

14 (45,2%) ki qali; maTi asaki meryeobda 55-dan 75 wlamde;

daavadebis arsebobis xangrZlivoba Seadgenda 6-12 Tves;

morfologiurad brtyelujredovani kibo gamovlenil iqna 14

(45,1%) SemTxvevaSi, adenokarcinoma 10-Si (32,3%), 4-Si (12,9%)

cilindroma da 3 (9,6%%) SemTxvevaSi osteosarkoma; 1 (3,2%)

SemTxvevaSi simsivne vrceldeboda I mimdebare anatomiur

struqturaze, 12-12 SemTxvevaSi (38,7%) II da III mimdebare

anatomiur struqturaze, xolo 6-Si (19,4%) IV da met

struqturaze; 11 (35,5%) SemTxvevaSi aRiniSna zeda ybis wiaRis

ukana kedlis destruqcia, 9-Si (29%) lateraluri kedlis,

xolo 8-Si (25,8%) wina da zeda kedlis destruqcia; 7 (22,6%)

avadmyofs aReniSna erTeuli regionuli metastazebi saZile

samkuTxedsa da kisris qveda mesamedSi.

Catarebuli maTematikuri kvlevis safuZvelze dadginda,

rom kliniko-morfologiur maxasiaTebelTa Soris yvelaze


morfologiuri Seneba; daavadebis arsebobis xangrZlioba;

daavadebis gavrceleba; metastazebis raodenoba, lokalizacia

da zomebi; aseve avadmyofTa asaki. xolo sxvadasxva SedegiT

namkurnaleb avadmyofTa jgufebSi aRniSnuli kliniko-

morfologiur maxasiaTebelTa klasteruli analizis

safuZvelze dadginda, rom sicocxlis 2 wliani barieri

ZiriTadad gadalaxes SedarebiT axalgazrda (30-50weli)

asakis pacientebma (77,2%), romelTac morfologiurad

aReniSnebodaT brtyelujredovani kibos maRalferencirebuli

forma (76,5%) da cilindroma (83,4%), daavadebis gavrcelebiT

76

araumetas ori (81,8%) anatomiuri struqturisa da regionuli

limfuri kvanZebis dazianebis gareSe.

daavadebis progresireba ZiriTadad aReniSnebodaT 50-dan

70 wlamde (77,3%) asakis avadmyofebs; sadac morfologiurad

diagnostirebuli iyo dabali diferencirebis

brtyelujredovani kibo (68,3%) gavrcelebiT sam da met (80%)

anatomiur struqturaze, romelTac aReniSnebodaT 3 da meti

(77,8%) santimetris zomis regionuli metastazebi,

lokalizaciiT kisris zeda da Sua mesamedSi. aseve sxvadasxva

warmoSobis sarkomebi (80%) an adenokarcinoma (69,3%);

romelTa gavrceleba aRemateboda or (80%) anatomiur

struqturas regionuli limfuri kvanZebis dazianebis gareSe.

IV jgufi _ Seadgina 15 avadmyofma. pacientTa es jgufi

Camoyalibda Cvendauneburad, radgan miuxedavad Catarebuli

kvlevebisa ver moxerxda procesis morfologiuri

verifikacia, ris gamoc iZulebuli gavxdiT gvewarmoebina

haimorotomia biofsiuri masalis saswrafo morfologiuri

SeswavliT. aRniSnul jgufSi gaerTianebul iqna 10 (66,6%)

mamakaci da 5 (33,4%) qali; maTi asaki meryeobda 35-dan 65

wlamde; daavadebis arsebobis xangrZlivoba Seadgenda 1-dan 6

Tvemde periods; T1 gavrcelebis simsivne daudginda 4 (26,7%)

pacients, T2 gavrcelebis _ 9-s (60%), xolo T3 gavrcelebis _

2-s (13,3%); morfologiuri kvleviT 12 (80%) SemTxvevaSi

gamovlenil iqna brtyelujredovani kibo, xolo 3-Si (20%) _

adenokarcinoma. 5 (33,4%) SemTxvevaSi simsivne lokalizebuli

iyo haimoris Rrus qveda-wina naxevarSi, xolo 10-Si (66,6%)

77

zeda-ukana naxevarSi. Zvlovani kedlebis destruqcia da

simsivnis gavrceleba wiaRis farglebs gareT gamovlenili ar

iyo. am jgufis avadmyofebidan, daavadebis morfologiuri

verifikaciis Semdeg 3-s (20%) Cautarda zeda ybis nawilobrivi

rezeqcia, xolo 12 (80%) SemTxvevaSi Sesrulebul iqna zeda

ybis tipiuri eleqtrorezeqcia.

am avadmyofebidan sicocxlis or wliani barieri

daavadebis progresirebis niSnebis gareSe gadalaxa 9 (60%)

pacientma. aRniSnul jgufSi yvela avadmyofs daudginda

daavadebis arsebobis xangrZlivoba 3-dan 6 Tvemde; 4 (44,4%)

avadmyofs daudginda I stadiis mqone simsivneebi, xolo 5

(56,6%) ki II stadiis; am avadmyofebs aReniSnaT Semdegi

morfologiuri genezis simsivneebi: 6(66,7%)

brtyelujredovani kibo da 3-s (33,3%) adenokarcinoma; 6

(66,7%) SemTxvevaSi simsivne lokalizebuli iyo qveda-wina

naxevarSi, xolo 3-Si (33,3%) ki zeda-ukana naxevarSi.

danarCen 6 (40%) avadmyofs, romlebsac aReniSnaT

daavadebis progresirebis niSnebi pirveli ori wlis

ganmavlobaSi, 5-s (83,3%) gamouvlinda recidiuli simsivne,

xolo 1-s (16,7%) regionuli limfogenuri metastazebi. maTgan

4 (66,7%) avadmyofs daudginda II stadiis simsivneebi, xolo 2-s

(33,3%) III stadiis; rac Seexeba daavadebis arsebobis

xangrZlivobas, ZiriTadad aRiniSna 1-dan 3 Tvemde anamnezi;

yvela avadmyofs gamouvlinda brtyelujredovani kibo; 4

(66,7%) SemTxvevaSi intraoperaciulad aRmoCenili iyo

Zvlovani kedlebis kidiTi destruqcia.

78


rom kliniko-morfologiur maxasiaTebelTa Soris yvelaze


morfologiuri Seneba; misi lokalizacia RruSi; wiaRis

Zvlovani kedlebis destruqcia, daavadebis arsebobis

xangrZlivoba da avadmyofTa asaki. xolo sxvadasxva SedegiT

namkurnaleb avadmyofTa jgufebSi aRniSnuli kliniko-

morfologiuri maxasiaTeblebis klasteruli analizis

safuZvelze dadginda, rom sicocxlis 2 wliani barieri

ZiriTadad gadalaxes SedarebiT axalgazrda (30-50weli)

asakis pacientebma (77,2%), romelTac morfologiurad

aReniSnebodaT brtyelujredovani kibo (50%) da

adenokarcinoma (100%), simsivnis lokalizaciiT wiaRis qveda-

wina naxevarSi (96%), daavadebis arsebobis xangrZlivobiT 3-

dan 6 Tvemde (ix. suraTi #5 da cxrili #15).

gardacvlil pacientTa jgufSi ZiriTadad aRmoCndnen 50-

dan 70 wlamde (77,3%) asakis avadmyofebi; sadac

morfologiurad aRiniSneboda dabali diferencirebis

brtyelujredovani kibo (68,3%) lokalizaciiT wiaRis zeda-

ukana naxevarSi (87%); Zvlovani kedlebis destruqciiT (67%)

dadaavadebis arsebobis xangrZlivobiT 1-dan 3 Tvemde.

79

suraTi 5. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis klasteruli analizi qirurgiuli meTodiT namkurnaleb avadmyofTa jgufSi.

cxrili 15. ybis kibos kliniko-morfologiuri maxasiaTeblebis logariTmul-wrfivi analizi qirurgiuli meTodiT namkurnaleb avadmyofTa jgufSi.


asaki 8,69 p=0,03 3,97 p=0,41 2,5 p=0,47

morfologia 10,12 p<0,01 3,79 p=0,14 12,07 p<0,01

lokalozacia 11,31 p<0,01 10,01 p<0,01 1,29 p=0,54

destruqcia 12,06 p<0,01 10,34 <0,01 11,62 <0,01

anamnezi 14,15 p<0,01 12,33 <0,01 11,62 <0,01

11,03 p<0,01 11,15 p<0,01 recidivi 2,42 p=0,48

80

amrigad, Cvens mier yvela meTodiT namkurnaleb

avadmyofTa efeqturobis analizma gviCvena, rom dadebiTi

Sedegi SeiZleba miRweul iqnas, rogorc konservatuli, aseve

qirurgiuli da kombinirebuli meTodebis gamoyenebiT da igi

varirebs 43,1%-dan 61,4%-mde. amasTanave gamovlenilia mTeli

rigi kliniko-morfologiuri maxasiaTeblebi, romlebic

sxvadasxva sixSiriT gvxvdeba damakmayofilebeli da

aradamakmayofilebeli SedegiT namkurnaleb avadmyofTa

jgufebSi. am maxasiaTebelTa analizi cocxal da

gardacvlil pacientTa jgufebSi mogvcems saSualebas,

movaxdinoT daavadebis mimdinareobisa da gamosavlis

prognozireba.

81

Tavi IV

haimoris Rrus avTvisebiani simsivneebis mimdinareobisa da

daavadebis gamosavlis prognozireba

vinaidan Cveni kvlevis ZiriTad mizans warmoadgenda im

kliniko-morfologir gamovlinebaTa simptomokompleqsis

dadgena, romelic mniSvnelovan zegavlenas axdens daavadebis

mimdinareobasa da mkurnalobis Sedegebze, mizanSewonilad

CavTvaleT kliniko-morfologiri niSnebis ganawileba

Segveswavla ara calkeuli meTodebiT namkurnaleb

avadmyofTa jgufebSi, aramed mTel klinikur masalaze

dayrdnobiT. rac saSualebas gvaZlevda gamogveyo yvelaze

informatiuli niSnebi da gangvesazRvra maTi Sinagani

urTierTdamokidebuleba daavadebis mimdinareobis

prognozirebaSi.

rogorc wina qveTavebSi iyo warmodgenili, Cvens mier

sxvadasxva meTodebiT namkurnalebi avadmyofebidan

sicocxlis or wliani barieri daavadebis progresirebis

niSnebis gareSe 146 pacientidan gadalaxa 70 avadmyofma, ramac

48% Seadgina. xolo, 76-s (52%) daudginda daavadebis

progresirebis niSnebi. maTgan, 31 (40,8%) avadmyofs daudginda

recidiuli simsivne, 14-s (18,4%) regionuli metastazebi, 9-s

(11,8%) recidiuli simsivne da regionuli metastazebi erTad,

7-s (9,2%) recidiuli simsivne da Soreuli metastazebi erTad,

xolo 15-s (19,7%) Soreuli metastazebi.

82

cxrili # 16


simsivnis histologiuri

Seneba

saerTo raodenoba

ar aReniSna daavadebis

progresireba 2 da meti wlis ganmavlobaSi

aReniSna daavadebis

progresireba 2 wlamde

periodSi

brtyelujredovani kibo 85 44 51,8% 41 48,2%

adenokarcinoma 19 4 21% 15 79% cilindroma 23 14 60,8% 9 39,2%

limfosarkoma 11 7 63,6% 4 36,4% angio, qondro da osteosarkomebi

8 _ _ 8 100%

tkivili 92 39 42,4% 53 57,6% sisxldena 57 8 14% 49 86%


89 67 75,3% 22 24,7%

0 38 32 84,2% 6 15,8% 1 29 23 79,4% 6 20,6% 2 42 15 35,7% 27 64,3% 3 22 _ _ 22 100% 4 13 _ _ 13 100%

gavrceleba mezobel

struqturebze

5 2 _ _ 2 100% T1 4 4 100% _ _

T2 21 17 81% 4 19%

T3 59 36 61% 23 39%

T4 62 13 21% 49 79% aris 24 2 8,4% 22 91,6% regionuli

metastazebi ar aris 122 68 55,8% 54 44,2% sul 146 70 48% 52% 76

zeda ybis simsivneebiT daavadebul pacientTa kliniko-

morfologiuri maxasiaTeblebis ganawilebis Seswavla moxda

or klinikur jgufSi, anu daavadebis progresirebiT

gardacvlil da cocxal pacientebSi. aRsaniSnavia, rom

pirveli jgufi Seadgina 82 (56,16%) avadmyofma (maTgan, 12

pacienti recidivebiT da metastazebiT), romlebmac gadalaxes

sicocxlis orwliani barieri. xolo meore jgufSi

gaerTianebul iqna 64 (43,84%) pacienti, romlebic mkurnalobis

damTavrebis Semdeg, daavadebis progresirebis gamo

83

gardaicvalnen pirveli ori wlis ganmavlobaSi, aRsaniSnavia,

rom avadmyofebis ganawileba sqesis mixedviT orive jgufSi

praqtikulad identuri aRmoCnda, magram 82 avadmyofidan

romlebmac gadalaxes sicocxlis or wliani barieri 32

(54,4%) iyo qalTa sqesis warmomadgenli, xolo 50 ki (59,2%)

mamakaci.

diagrama 1. avadmyofTa ganawileba cocxal da gardacvlil

pacientTa jgufebSi sqesis mixedviT.

Catarebuli radikaluri mkurnalobis Semdeg 40-dan 60

wlamde asakis 75 (51,4%) avadmyofidan sicocxlis 2 wliani

barieri gadalaxa 56 pacientma, ramac Seadgina 74,7%. 60 da

meti asakis mqone 46 (31,5%) avadmyofidan 2 welze meti

icocxla mxolod 8 pacientma, ramac Seadgina 5,48%.

84

avadmyofTa ganawileba cocxal da gardacvlil pacientTa

jgufebSi asakis mixedviT warmodgenilia diagrama # 2-ze.

diagrama 2. avadmyofTa ganawileba cocxal da gardacvlil

pacientTa jgufebSi asakis mixedviT.

cocxal da gardacvlil pacientTa jgufebSi avadmyofTa

ganawilebis Seswavlam daavadebis arsebobis xangrZlivobis

mixedviT gviCvena, rom 1-dan 3 Tvemde anamnezis mqone

pacientebidan sicocxlis 2 wliani barieri gadalaxa 11-ma

avadmyofma, ramac 26,8% Seadgina. 3-dan 6 Tvemde anamnezis

mqone avadmyofebidan 2 wliani gamojansaReba miRweul iqna

79,5%-Si (66 avadmyofi 83-dan), xolo 6 Tvidan 1 wlamde

anamnezis mqone avadmyofebidan 2 welze meti icocxla 5-ma

(22,7%) pacientma. avadmyofTa ganawileba cocxal da

85

gardacvlil pacientTa jgufebSi daavadebis arsebobis

xangrZlivobis mixedviT warmodgenilia diagrama # 3-ze.

diagrama 3. zeda ybis wiaRis avTvisebiani simsivneebiT daavadebul

avadmyofTa ganawileba cocxal da gardacvlil pacientTa jgufebSi

daavadebis arsebobis xangrZlivobis mixedviT.

simsivnis morfologiuri Senebis Seswavlam cocxal da

gardacvlil avadmyofTa jgufebSi gviCvena, rom epiTeluri

warmoSobis simsivneebis mqone 132 avadmyofidan I klinikur

jgufSi aRmoCnda 74 (56,06%) avadmyofi, aqedan:

maRaldiferencirebuli brtyelujredovani kiboTi 37-ma

gadalaxa 2 wliani barieri, rac Seadgens 74%-s; saSualo

diferncirebis brtyelujredovani kibos dros es ricxvi

86

mcirdeba 41,6%-de (5 avadmyofi 12-dan) da dabali

diferencirebis brtyelujredovani kibos dros ki ar

aRemateba 38,8%-s (7 avadmyofi 18-dan); adenokarcinomas dros

am ricxvma 47,4% (9 avadmyofi 19-dan) Seadgina;

cilindrujredovani kiboTi daavadebuli avadmyofebidan 2

wliani barieri 23-dan 16-ma (69,6%) pacientma gadalaxa.

cxrili # 17

zeda ybis wiaRis avTvisebiani simsivneebiT daavadebul avadmyofTa ganawileba morfologiuri Senebis mixedviT.

morfologiuri formebi

avadmyofTa

saerTo

reodenoba

cocxalia

2 weli da meti

gardaicvala

2 wlamde

epiTeluri simsivneebi 132 90,4% 74 56,06% 58 43,94%

brtyelujredovani kibo 90 61,64% 49 54,44% 41 45,56%

maRaldiferencirebuli 50 34,24% 37 74% 13 26%

saSualo diferencirebis 12 8,21% 5 41,6% 7 58,4%

dabaldiferencirebuli 18 12,32% 7 38,8% 11 61,2%

adenokarcinoma 19 13,01% 9 47,37% 10 52,63%

cilindroma 23 15,7% 16 69,57% 7 30,43%

araepiTeluri simsivneebi 14 9,58% 8 57,14% 6 42,86%

limfosarkoma 9 6,16% 8 88,9% 1 11,1%

angio, qondro da

osteosarkomebi 5 3,42% 0 _ 5 100%

sul 146 82 56,16% 43,84% 64

araepiTeluri warmoSobis simsivneebis mqone 14

avadmyofidan I da II klinikur jgufebSi gamovlinda

87

pacientebis Semdegi ganawileba: limfosarkomiT daavadebuli

9 avadmyofidan 2 wliani gamojansaReba miRweul iqna 8

SemTxvevaSi, ramac 88,9% Seadgina, xolo angio, qondro da

osteosarkomebis dros es ricxvi 0-s utoldeba (ix. cxril #

17).

avadmyofTa ganawilebam or klinikur jgufSi simsivnis

sawyisi lokalizaciis mixedviT gviCvena, rom 14 (9,59%)

SemTxvevaSi aRiniSna simsivnis lokalizacia haimoris Rrus

zeda _ ukana naxevarSi. maTgan 2 welze meti icocxla 9

(64,29%) pacientma. maSin, rodesac qveda _ wina naxevrSi

lokalizebuli simsivneebiT daavadebuli 21 (14,38%)

pacientidan 85,71%-ma (18 avadmyofi) pacientma gadalaxa

sicocxlis or wliani barieri. 111 (76,03%) SemTxvevaSi ver

moxerxda simsivnis sawyisi lokalizaciis dadgena

adgilobrivad gavrcelebuli procesebis gamo. am

pacientebidan sicocxlis or wliani zRvari gadalaxa 55

(49,55%) avadmyofma. avadmyofTa ganawileba cocxal da

gardacvlil pacientTa jgufebSi simsivnis sawyisi

lokalizaciis mixedviT warmodgenilia diagrama # 4-ze.

88


avadmyofTa ganawileba simsivnis pirvelwarmoqmnis keris

lokalizaciis mixedviT.

cocxal da gardacvlil pacientTa jgufebis analizma,

simsivnis stadiurobis gaTvaliswinebiT gviCvena, rom am or

parametrs Soris aris pirdapiri damokidebuleba.

stadiurobis maCveneblis matebasTan erTad

pirdapirproporciulad izrdeba gardacvlil avadmyofTa

ricxvi. Cveni monacemebiT I_II stadiis mqone 27 pacientidan

mxolod 4 gardaicvala pirveli 2 wlis ganmavlobaSi,

cocxalia 85,2% avadmyofebis maSin, rodesac III stadiis mqone

59 avadmyofidan 2 welze meti icocxla 69,5% pacientebisa,

89

xolo IV stadiis mqone 60 avadmyofidan mxolod 18 pacientma,

ramac 30% Seadgina. avadmyofTa ganawileba cocxal da

gardacvlil pacientTa jgufebSi stadiis mixedviT

warmodgenilia warmodgenilia diagrama # 5-ze.


avadmyofTa ganawileba stadiis mixedviT.

klinikurma dakvirvebebma gviCvena, rom Tu simsivnuri

procesi ar scildeba lorwovanis farglebs da ar iwvevs

wiaRis Zvlovani kedlebis destruqcias, daaxloebiT 93%-s

pacientebisa aqvs Sansi gadalaxon sicocxlis 2 wliani

barieri. simsivnis mier wiaRis Zvlovan kedlebis dazianebis

90

SemTxvevaSi gadarCenil avadmyofTa ricxvi ar aRemateba 13%-s.


jgufebSi wiaRis Zvlovani kedlebis destruqciis mixedviT

warmodgenilia warmodgenilia diagrama # 6-ze.


avadmyofTa ganawileba wiaRis Zvlovani kedlebis destruqciis

mixedviT.

klinikurma dakvirvebebma aseve gviCvena, rom Tu

simsivnuri procesi lokalizebulia mxolod haimoris RruSi

da ar scildeba lorwovanis farglebs, daaxloebiT 84%-s

pacientebisa aqvs Sansi gadalaxon sicocxlis 2 wliani

barieri. maSin, rodesac simsivnuri procesi scildeba

91

haimoris Rrus farglebs da vrceldeba irgvlivmdebare

anatomiur struqturebze, es ricxvi mniSvnelovnad mcirdeba

da ar aRemateba 48,1%-s.

ase magaliTad, simsivnis cxviris savalSi gavrcelebisas

sicocxlis or wliani barieri gadalaxa 42-dan 24 (57,2%)

avadmyofma; procesis gavrcelebisas Tvalbudis qveda kideze

or wliani gamojansaReba 20 avadmyofidan aRiniSna 8

SemTxvevaSi, ramac 40% Seadgina, yvelaze kargi Sedegi

miRweul iqna simsivnis gavrcelebisas sasaze, am ricvma 85%

Seadgina.

cxrili # 18

zeda ybis wiaRis avTvisebiani simsivneebiT daavadebul avadmyofTa ganawileba cocxal da gardacvlil pacientTa jgufebSi sxvadasxva anatomiur struqturebze gavrcelebis mixedviT.

simsivnis gavrceleba

mimdebare anatomiur

struqturebze

avadmyofTa

saerTo

reodenoba

cocxalia

2 weli da

meti

gardaicvala

2 wlamde

marto haimoris Rru 38 26% 32 84,2% 6 15,8%

cxviris savalSi Cazrda 42 28,77% 24 57,14% 18 42,86%

sasa 20 13,7% 18 90% 2 10%

Tvalbude 19 13% 8 42,1% 11 57,9%

eTmoiduri wiaRi 3 2% _ _ 3 100%

loyis rbili qsovilebi 3 2% _ _ 3 100%

yvrimalis Zvali 10 6,8% - - 10 100%

saReWi kunTebi 9 6,1% - - 9 100%

frTasasis foso 2 2,74% - - 2 100%

sul 56,16% 82 64 146 43,84%

92

mkurnaloba praqtikulad uSedego aRmoCnda, rodesac

adgili hqonda simsivnuri procesis gavrcelebas loyis rbil

qsovilebze, saReW kunTebSi, yvrimalis Zvalsa da eTmoidur

wiaRSi, yvela gardaicvala pirveli ori wlis ganmavlobaSi.


jgufebSi sxvadasxva anatomiur struqturebze gavrcelebis

mixedviT warmodgenilia cxril # 18-Si.

aRmoCnda, rom simsivnuri procesis gavrcelebisas

haimoris Rrus farglebs gareT erT mimdebare anatomiur

struqturaze, or wliani gamojansaReba Seadgens 79%-s.

simsivnis or mimdebare anatomiur struqturaze

gavrcelebisas es maCvenebeli iklebs 40%-mde. xolo, rac

Seexeba sam da met anatomiur struqturaze gavrcelebas, es

maCvenebeli radikaluri mkurnalobis miuxedavaT

katastrofulad mcirdeba da 17,2%-s ar aRemateba. avadmyofTa

ganawileba cocxal da gardacvlil pacientTa jgufebSi

mimdebare anatomiur struqturebze simsivnis gavrcelebis

mixedviT warmodgenilia diagrama # 7-ze.

93



mimdebare anatomiur struqturebze gavrcelebis masStabebis

mixedviT.

cocxal da gardacvlil pacientTa jgufebSi avadmyofTa

ganawilebis Seswavlam regionuli metastazirebis

Taviseburebebis mixedviT gviCvena, rom pacientebs, romelTac

mkurnalobis dawyebamde regionuli metastazebi ar

aReniSnebodaT, ori weli da meti cocxalia 63,7%. rac Seexeba

pacientebs, sadac gamovlenil iqna erTeuli regonuli

metastazebi, es ricxvi mniSvnelovnad mcirdeba da ar

aRemateba 16,7%-s, xolo ormxrivi regionuli metastazebis

SemTxvevaSi or wliani gamojansaReba praqtikulad nuls

94

utoldeba. avadmyofTa ganawileba cocxal da gardacvlil

pacientTa jgufebSi regionuli metastazirebis mixedviT

warmodgenilia diagrama # 8-ze.



regionuli metastazirebis mixedviT.

haimoris Rrus kliniko-morfologiur gamovlinebaTa

ganawileba cocxal da gardacvlil avadmyofTa jgufebSi

warmodgenilia grafik # 9-ze.

95

grafiki 9. zeda ybis wiaRis avTvisebiani simsivneebis kliniko-

morfologiur gamovlinebaTa ganawileba cocxal da gardacvlil

pacientTa jgufebSi.

96

Cvens mier sxvadasxva meTodebiT namkurnaleb avadmyofTa

ganawilebis Seswavlam cocxal da gardacvlil pacientTa

jgufebSi gviCvena, rom konsevatuli mkurnalobis Semdeg 65

pacientidan 2 weli da meti icocxla 50 (76,9%) avadmyofma,

aqedan recidivebiTa da metastazebiT or wliani barieri

gadalaxa 5 (10%) avadmyofma.

kombinirebuli mkurnalobis Semdeg, romelic

gamoyenebul iqna 51 (34,9%) SemTxvevaSi, pirvel klinikur

jgufSi aRmoCnda 23 (45%) pacienti. rac Seexema 15 (10,3%)

avadmyofs, romlebsac intraoperaciiulad, diagnostikis

mizniT, jer CautardaT biofsia, xolo Semdgom zeda ybis

eleqtrorezeqcia, sicocxlis or wliani barieri gadalaxa 9

(60%) pacientma. avadmyofTa ganawileba cocxal da

gardacvlil pacientTa jgufebSi mkurnalobis meTodebis

mixedviT warmodgenilia cxril # 19-Si.

cxrili # 19

zeda ybis wiaRis avTvisebiani simsivneebiT daavadebul avadmyofTa

ganawileba cocxal da gardacvlil pacientTa jgufebSi

mkurnalobis meTodebis mixedviT

mkurnalobis meTodebi

avadmyofTa

saerTo

reodenoba

cocxalia

2 weli da meti

gardaicvala

2 wlamde

qimio-sxivuri Terapia 27 18,5% 23 85,2% 4 14,8%

sxivuri Terapia 38 26% 27 71% 11 29%

kombinirebuli mkurnaloba 51 34,9% 23 45% 28 55%

qirurgiuli mkurnaloba 15 10,3% 9 60% 6 40%

sul 146 82 56,16% 64 43,84%

97

imisaTvis, rom dagvedgina is maxasiaTeblebi, romlebic

mniSvnelovan zegavlenas axdenen daavadebis mimdinareobasa da

2 da 5 wlian gamosavlze, mizanSewonilad CavTvaleT,

miRebuli informacia dagvemuSavebina klasteruli analizis

meSveobiT, kerZod K-saSualoTa meTodiT. xolo statistikuri

sarwmunoebis Sesafaseblad ki, gamogveyenebina logariTmul-

wrfivi analizis meTodi.

maTematikuri kvlevis safuZvelze dadginda, rom

daavadebis gamosavlis prognozirebisaTvis 10 kliniko-

morfologiuri maxasiaTeblidan yvelaze informatiulia:

⎯ avadmyofTa asaki;

⎯ daavadebis arsebobis xangrZlioba;

⎯ simsivnis morfologiuri Seneba;

⎯ daavadebis gavrceleba;

⎯ Zvlovani kedlebis destruqcia;

⎯ metastazebis raodenoba, lokalizacia, da

zomebi.

cocxal da gardacvlil avadmyofTa jgufebis analizma

gviCvena, rom mkurnalobis damTavrebis Semdeg daavadebis

progresirebiT pirveli 2 wlis ganmavlobaSi gardaicvala

ZiriTadad is pacientebi, romelTa asaki aRemateboda 60 wels

(67,3%); sadac morfologiuri Seneba ZiriTadad

ganisazRvreboda adenokarcinomiT (72,3%), sxvadasxva

warmoSobis sarkomebiT (92%) an dabali diferencirebis

brtyelujredovani kiboTi (74,2%); iq sadac simsivne

98


aRiniSneboda Zvlovani kedlebis sxvadasxva xarisxis



aRemateboda 3sm-s (88,9%).

suraTi 6. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis klasteruli analizi cocxal da gardacvlil pacientTa jgufebSi.

99

cxrili 20.

zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis logariTmul-wrfivi analizi cocxal da gardacvlil pacientTa jgufebSi.


asaki 21,28 p<0,01 36,21 p<0,01 73,33 p<0,01

morfologia 52,63 p<0,01 141,44 p<0,01 165,22 p<0,01

destruqcia 12,37 p<0,01 52,21 p<0,01 71,94 p<0,01

gavrceleba 42,28 p<0,01 58,03 p<0,01 99,28 p<0,01

anamnezi 14,61 p<0,01 46,25 p<0,01 28,28 p<0,01

metastazireba 13,05 p<0,01 54,86 p<0,01 107,92 p<0,01

54,99 p<0,01 75,45 p<0,01 88,28 p<0,01 gadarCena

sicocxlis 2 wliani barieri, daavadebis progresirebis

niSnebis gareSe, ZiriTadad gadalaxes SedarebiT axalgazrda

(40-dan 50wlamde) asakis pacientebma (72,8%), sadac simsivnis


kiboTi (57,7%), limfosarkomiT (72,8%) an cilindromiT (75%),

sadac simsivnuri procesis gavrceleba ar aRemateboda 2

anatomiur struqturas (90%), haimoris Rrus Zvlovani

kedlebis destruqciis da regionuli limfuri kvanZebis

dazianebis gareSe (83,6%), an erTeuli regionuli limfuri

kvanZis metastazuri dazianebisas, romlTa zomebi ar


sicocxlis 5 wliani barieri, daavadebis progresirebis

niSnebis gareSe, ZiriTadad gadalaxes axalgazrda (30wlamde)

asakis pacientebma (80%), sadac simsivnis morfologiuri

Seneba ganisazRvreboda brtyelujredovani kiboTi (60%), an

100

cilindromiT (35%), sadac simsivne ar scildeboda wiaRis

farglebs da ar aRiniSneboda Zvlovani kedlebis destruqcia

da regionuli metastazebi.

cocxal da gardacvlil avadmyofTa jgufebSi

mkurnalobis meTodebis efeqturobis analizma klasteruli

meTodis gamoyenebiT gviCvena, rom arsebobs pacientTa jgufi,

sadac miuxedavad gamoyenebuli mkurnalobis meTodebisa

(konservatiuli, qirurgiuli da kombinirebuli), miRweul iqna

avadmyofTa sruli gamojansaReba. es jgufi Seadgines

pacientebma, romelTac morfologiurad aReniSnebidaT

limfosarkoma (88,9%), cilindroma (65,2%), da

brtyelujredovani kibo (60%); simsivne ar scildeboda wiaRis

farglebs (100%) an vrceldeboda erT mimdebare anatomiur

struqturaze (86,8%); Zvlovani kedlebis destruqciis da

regionuli metastazebis gareSe; daavadebis arsebobis

xangrZlivobiT 1-dan 6 Tvemde.

II jgufSi gaerTiandnen pacientebi, romelTac

kombinirebuli mkurnalobis I an II etapze aucileblad

esaWiroebaT qirurgiuli Carevis ganxorcieleba

kombinirebuli an kombinirebul-gafarToebuli operaciebis

saxiT. am jgufis pacientebs morfologiurad ZiriTadad

aReniSnebodaT brtyelujredovani kibo (31,2%) da

adenokarcinoma (78,9%); daavadebis gavrcelebiT 2 da met

mimdebare anatomiur organoze; haimoris Rrus Zvlovani

kedlebis destruqciiT an destruqciis gareSe; avadmyofTa

87% ar aReniSnebodaT regionuli limfuri kvanZebis

101

metastazuri dazianebebi; xolo daavadebis arsebobis

xangrZlivoba varirebda 1-dan 6 Tvemde.

suraTi 7. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis klasteruli analizi, mkurnalobis arsebuli meTodebis adeqvaturobis Sefasebis mizniT, cocxal da gardacvlil pacientTa jgufebSi.

cxrili 21. zeda ybis kibos kliniko-morfologiuri maxasiaTeblebis logariTmul-wrfivi analizi, mkurnalobis arsebuli meTodebis adeqvaturobis Sefasebis mizniT, cocxal da gardacvlil pacientTa jgufebSi.


morfologia 190,03 p<0,01 52,92 p<0,01 172,75 p<0,01

destruqcia 33,26 p<0,01 34,48 p<0,01 98,58 p<0,01

gavrceleba 82,61 p<0,01 65,03 p<0,01 120,93 p<0,01

anamnezi 27,02 p<0,01 56,65 p<0,01 14,71 p<0,01

metastazireba 105,41 p<0,01 84,96 p<0,01 125,5 p<0,01

109,18 p<0,01 62,7 p<0,01 mkurnaloba 137,63 p<0,01

102

da bolos, gamovlenil iqna prognostuli TvalsazrisiT

absoluturad uperspeqtivo pacientTa jgufi mkurnalobis im

tradiciuli meTodebisaTvis, romlebic gamoiyeneba

Tanamedrove onkologiaSi. III jgufis pacientebs ZiriTadad

aReniSnebodaT simsivnis gavrceleba 4 mimdebare anatomiur

struqturamde, wiaRis Zvlovani kedlebis destruqciebiT;

avadmyofTa 71,2%-s gamouvlinda erTeuli da mravlobiTi

regionuli metastazuri dazianebebi; xolo daavadebis

arsebobis xangrZlivoba ZiriTadad Seadgenda 1-3Tves (42%) da

6-12 Tves (51%). yovelive es metyvelebs imis Sesaxeb, rom

aRniSnuli kontingentis pacientTa mkurnalobisaTvis

SemuSavebuli da gamoyenebuli unda iqnas axali, jer kidev

araaprobirebuli meTodebi.

amrigad, miRebuli informacia sarwmunoebis maRali

albaTobiT iZleva zeda ybis avTvisebiani simsivneebiT

daavadebul avadmyofTa mkurnalobis efeqturobisa da

daavadebis gamosavlis prognozirebis saSualebas. aRniSnuli

informaciis gamoyeneba avadmyofTa mkurnalobis meTodebis

SerCevisas saSualebas mogvcems mniSvnelovnad avamaRloT

mkurnalobis, rogorc uSualo, aseve Soreuli Sedegebi.

103

Tavi V

miRebuli Sedegebis gansja

zeda ybis wiaRis avTvisebiani simsivneebi xasiaTdeba

usimptomo mimdinareobiT, rac ganapirobebs avadmyofTa 80%-is


simsivnis gavrcelebuli (III-IV stadia) procesebiT (Bridger GP,

Mendelsohn MS, Baldwin M. 1991; Jeff H. Kim T. 1993). ris gamoc, maTi

mkurnaloba erTerT rTul da jer kidev gadauWrel

problemad rCeba (Markola A.T., Aronen H.J., Paavonen T. 1996; Phillips

C.D., Futterer S.F., Lipper M.H. 1997). erTis mxriv, es ganpirobebulia

haimoris Rrus agebulebis anatomiuri TaviseburebebiT. xolo

meores mxriv, misi ganlagebiT saxis ConCxis siRrmeSi da

uSualo siaxloviT sasicocxlo organoebTan. yovelive es

arTulebs, rogorc sxivuri energiis maqsimaluri dozebiT

gamoyenebas, aseve radikaluri operaciis warmoebas. magram

miuxedavad amisa, miRebuli Sedegebis efeqturobis analizi

gviCvenebs, rom bolo erTi saukunis ganmavlobaSi, aRniSnuli

daavadebis mkurnalobaSi mainc miRweulia mniSvnelovani

progresi. gadarCenil avadmyofTa ricxvi 5%-dan gaizarda

46%-mde, rac udaod teqnikurma progresma da mkurnalobisadmi

diferencialurma midgomam ganapiroba (Aisen A.M., Martel. W.,

Braunstein E.M., Mcmillen K.I., Phillips W.A. 1986; Atlas S.W., Grossman R.J.,

Gomori J.N., Guerry D., Hackney D.B. 1987; Annis J.A., Phelps P.D., 1989;

Antilia J., Sonnien P., Grenman R. 1993; Шацкая Н.Х. 1993; Черекаев В.А.

1995; Сдвижков А.М. 1997).

104

avtorTa erT nawils miaCniaT, rom (Юшманов В. Е., Янцев В.

И., Плющ А.Л., Соколова И.С., Горбачева Л.Б., Сибельдина Л.А., Эмануель

Н. М. 1985), tele-gamaTerapia sruliad sakmarisia I-II stadiebis

mqone pacientTa samkurnalod. meoreni ki (Shibnya H., Horinhi J.,

Suzuki S. et al. 1984;Tsujii H., Kamada T., Arimoto T. et al 1986; J. Parsons

1988) Tvlian, rom tele-gamaTerapia, rogorc mkurnalobis

damoukidebeli meTodi, naklebefeqturia da gamoiyenebul

unda iqnas kombinirebuli mkurnalobis pirvel etapze an

paliatiuri mizniT inoperabelur pacientebSi.

Ю. И. Воробьев-is da И. П. Саранцева-s azriT (1982w), sxivuri

Terapia zeda ybis wiaRis kibos dros efeqturia maSin,

rodesac gamoiyeneba dasxivebis adeqvaturi meTodika da

gaTvaliswinebulia simsivnis gavrceleba, misi zrdis forma

da morfologiuri struqtura. am avtorTa monacemebiT 3 da 5

wlianma gamojansaRebam Sesabamisad 61 da 48 procenti

Seadgina.

Shidnia H., Hornbak N., Saghafi N-s (1984w) miaCniaT, rom sxivuri

Terapiis efeqturoba didad aris damokidebuli simsivnis

morfologiur Senebaze. kerZod, sxivuri energiisadmi

maRalmgrZnobiareni arian limfoepiTeliomebi,

limfosarkomebi, romlebic sxivuri energiis arc Tu ise didi

dozebiT mkurnalobis Semdeg mTlianad alagdebian xolme.

rac Seexeba brtyelujredovan kibos da adenokarcinomebs, maT

samkurnalod ufro didi dozebia saWiro. xolo osteo,

qondro, fibro, sarkomebi TiTqmis rezistentulni arian

105

sxivuri energiis mimarT (Zinreich SJ, Kennedy DW, Kumar AJ,

Rosenbaum AE , Arington JA,Johns ME. 1988; Som P.M., Lidov M. 1994).

Г. Г. Кудрявцев-ma da В. О. Ольшанский-im (1991w) zeda ybis

avTvisebiani simsivneebis mkurnalobis efeqturobis amaRlebis

mizniT gamoiyenes qimio-sxivuri mkurnaloba. medikamentozuri

preparatebidan ZiriTadad iyenebdnen metotreqsats, xolo

dabaldiferencirebuli simsivneebis SemTxvevaSi vinkristins

ciklofosfanTan erTad. simsivnis sruli regresia aRiniSna

66,7%-Si. 3 wlianma sicocxlis xangrZlivobam Seadgina 45%,

xolo 5 wlianma _ 34,3%.

dReisaTvis zeda ybis avTvisebiani simsivneebis

samkurnalod farTod gamoiyeneba platinis preparatebis da

sxivuri Terapiis kombinacia: bleocinTan, ciklofosfanTan da

adriamicinTan, 5-ftoruracilTan erTad. yvela avtori

aRniSnuli Terapiis Sedegad afiqsirebes karg klinikur

efeqts (R. Errington 1986; Chobe R, McNeese M, Weber R, Fletcher GH.

1988).

magram miuxedavad amisa, jer kidev xSiria konservatuli

Terapiis aradamakmayofilebeli Sedegebi, rac ganapirobebs

qirurgiuli Carevis aucileblobas, eleqtroqirirgiuli

meTodis gamoyenebiT (Gollin FF, Ansfield FJ, Brandenburg JH, Ramirez G,

Vermund H. 1972; Glick JH, Marcial V, Richter M, Velez-Garcia E. 1980;

Laramore GE, Scott CB, Schuller DE, Haselow RE, Ervin TJ 1992; Wheeler R,

Al-Sarraf M, Gahbauer RA, Jacobs JR, Schwade JG, Campbell BH. 1993;).

Adelstein DL, Kalish LA, Adams GL, Wagner H, Oken MM, Remick SC-is

106

(1993w) am meTodis gamoyeneba mniSvnelovnad zrdis

qirurgiuli Carevis radikalizms da sagrZnoblad amcirebs

regionuli metastazebis da recidivirebis ganviTarebis

sixSires.

bolo wlebSi sazRvargareTul publikaciebSi gamoCnda

monacemebi sxivuri, qirurgiuli, kombinirebuli da

kompleqsuri mkurnalobebis efeqturobis Sesaxeb, romelTa

Sedegebsac isini procesis lokalizacias, daavadebis

gavrcelebasa da morofologiur struqturasTan

urTierTkavSirSi ganixilaven (W. Mann, C. Schuler-Vaith 1983).

magram yvela avtori aRniSnavs, rom zeda ybis gavrcelebuli

kibos mkurnalobis Semdeg recidivebis ricxvi mainc maRali

rCeba da 58-80%-s Seadgens (H. Thiel, G. Pettinger 1986; Browman GP,

Goodyear MD, Levine MN, Russell R, Archibald SD, Young JE 1990).

amrigad, warmodgenili masalidan naTlad Cans, rom

miuxedavaT mniSvnelovani klinikuri gamocdilebisa, jer

kidev ar aris dasabuTebulad warmodgenili erToblivi

koncefcia zeda ybis kibos mkurnalobis Sesaxeb daavadebis

mimdinareobis, morfologiuri Senebis da sxva klinikur

TaviseburebaTa gamovlinebis gaTvaliswinebiT. ufro metic,

ar iyo dasmuli sakiTxi imis Sesaxeb, Tu romeli kliniko-

morfologiuri maxasiaTeblebis erToblioba ganapirobebs

mkurnalobis tradiciuli meTodebis gamoyenebis SemTxvevaSi

damakmayofilebeli, an aradamakmayofilebeli Sedegebis

miRwvas da aqedan gamomdinare, axdens zemoqmedebas daavadebis

gamosavalsa da prognozze. CvenTvis xelmisawvdom

107

literaturaSi, aseve ver iqna moZiebuli sistematizirebuli

monacemebi mkurnalobis individualuri sqemebis da taqtikis

arCeva-SemuSavebaze simsivnis sxvadasxva parametrebis

gaTvaliswinebiT. aseTi individualuri midgoma Cvenis azriT

xels Seuwyobs mkurnalobis efeqturobis amaRlebas.

aRniSnuli sakiTxis gadasaWrelad Cvens mier

gaanalizebulia haimoris wiaRis kiboTi daavadebuli 146

avadmyofis monacemebi, romlebsac CautardaT mkurnaloba

saqarTvelos prof. a. RvamiCavas saxelobis onkologiis

nacionaluri centris Tav-kisris simsivneebis ganyofilebaSi

1985-2000 wlebSi.

mTeli informacia pacientebis Sesaxeb: daavadebis

mimdinareobis, morfologiuri Senebis, procesis gavrcelebis,

metastazirebis, konservatiuli mkurnalobisa da

ganxorcielebuli operaciebis masStabebis da mkurnalobis

Sedegebis Sesaxeb gadagvqonda Cvens mier Seqmnil specialur

ruqa-kodifikatorebze, romlebic SemdgomSi eqvemdebarebodnen

statistikur damuSavebas. am mizniT Cvens mier gamoyenebul

iqna statistikuri kvlevis klasteruli da logariTmul-

wrfivi analizis meTodebi. gamoTvlebs vawarmoebdiT

statistikur programul paket STATISTIKA 6-is operaciul

areSi.

Catarebuli mkurnalobis meTodebis efeqturobis

gansazRvris mizniT Cvens mier namkurnalebi 146 avadmyofi

ganawilebul iqna 4 klinikur jgufSi.

108

I jgufi _ Seadgina 44 (28,7%) pacientma, romelTac

mkurnalobis pirvel etepze CautardaT qimio-sxivuri Terapia;

qimioTerapia ZiriTadad atarebda sistemuri

poliqimioTerapiis saxes. 44 pacientidan mamakaci iyo 26 (59%),

xolo 18 (41%) ki _ qali; TNM klasifikaciis mixedviT T2

gavrcelebis simsivne daudginda 7 (16%) pacients, T3 _ 15-s

(34%) da T4 gavrcelebis _ 22-s (50%); 9 (20,5%) avadmyofs

gamouvlinda calmxrivi regionuli metastazebi, aqedan 7

(77,8%) SemTxvevaSi erTeuli, xolo 2-Si (22,2%) ki _

mravlobiTi.

Catarebuli poliqimiaTerapiuli mkurnalobis Semdgom

simsivnis sruli regresia miRweul iqna SemTxvevaTa 29,5%-Si

(13 avadmyofi), 50 da meti procentiT _ 12 (27,3%) SemTxvevaSi,

xolo 16-Si (36,4%) _ igi uSedego aRmoCnda. aRniSnuli jgufis

yvela avadmyofs mkurnalobis meore etapze gaugrZelda

sxivuri Terapia jamuri doziT 70gr-mde. sxivuri Terapiis

Semdeg mniSvnelovnad gaizarda simsivnis 100%-iani anu sruli

rezorbciis Sedegebi (29,5%-dan 61,4%-mde). simsivnis regresia

50 da meti procentiT miRweul iqna 8 (18,2%) SemTxvevaSi da

mxolod 9-Si (20,4%) igi aRmoCnda uSedego.

27 avadmyofidan, romlebsac qimio-sxivuri mkurnalobis

Sedegad miRweul iqna simsivnis sruli rezorbcia,

sicocxlis 2 wliani barieri daavadebis progresirebis

niSnebis gareSe gadalaxa 19 avadmyofma, ramac 70,3% Seadgina,

xolo, 8 (29,7%) avadmyofs, aReniSna daavadebis progresirebis

niSnebi.

109

sxvadasxva SedegiT namkurnaleb avadmyofTa jgufebSi

Catarebulma klasterulma analizma gviCvena, rom simsivnis

100%-iani regresia ZiriTadad miRweuli iqna (74%) axalgazrda

da saSualo asakis (30-50w) pacientebSi, romelTac daudgindaT

daavadebis arsebobis xangrZlivoba 1-dan 6 Tvemde (82%);


kiboTi (59%), limfosarkomiT (89%) an cilindromiT (66%),




gareSe (96,3%).

avadmyofTa im jgufSi, sadac konservatulma

mkurnalobam Sedegi ver gamoiRo, pacientTa asaki meryeobda

55-dan 74 wlamde (77,8%); romelTa daavadebis arsebobis

xangrZlivoba, ar aRemateboda 3 Tves (66,7%); daavadebis

morfologiiuri Seneba ganisazRvreboda adenokarcinomiT

(68%) an sxvadsxva warmoSobis sarkomebiT (75%) (angio,

qondro da osteosarkomebi); simsivne vrceldeboda or da met

mezobel anatomiur struqturaze (82,4%); aRiniSneboda

Zvlovani kedlebis sxvavasxva xarisxis destruqcia (72,3%);

mravlobiTi an erTeuli regionuli metastazebi, romelTa

zomebi aRemateboda 3sm-s (17,8%).

II jgufi _ am jgufSi gaerTianebul iqna is 87 avadmyofi,

romlebsac mkurnalobis pirvel etapze CautardaT sxivuri

Terapia. 87 pacientidan mamakaci iyo 55 (63,2%), 32 (36,8%) ki _

qali; TNM klasifikaciis mixedviT T2 gavrcelebis simsivne

110

daudginda 7 (8%) pacients, T3 _ 46-s (52,9%) da T4 gavrcelebis

_ 34-s (39,1%); 18 (20,7%) avadmyofs gamouvlinda regionuli

metastazebi, aqedan 11-s (61,1%) erTeuli, xolo 7-s (38,9%)

mravlobiTi. yvela avadmyofs utardeboda sxivuri Terapia

wyvetili kursiT, I etapze pacienti sxivdeboda 40gr-s

odenobiT, xolo, II-ze, orkviriani Sesvenebis Semdeg 30gr-s

odenobiT. dasxivebis jamuri doza ar aRemateboda 70gr-s.

sxivuri mkurnalobis I etapis (40gr) Catarebis Semdeg,

simsivnis 100%-iani regresia miRebul iqna 17 SemTxvevaSi

(19,5%), 22-s (25,3%) aReniSna simsivnis regresia 50 da meti

procentiT, xolo 48 (55,2%) SemTxvevaSi mkurnaloba aRmoCnda

araefeqturi. mkurnalobis II etapis (30gr) Catarebis Semdeg,

simsivnis sruli rezorbcia aRiniSna 38 SemTxvevaSi, ramac

43,7% Seadgina. simsivnis regresia 50 da meti procentiT

miRweul iqna 12 (13,8%) SemTxvevaSi da mxolod 37-Si (42,4%)

igi aRmoCnda uSedego.

38 avadmyofidan, romlebsac sxivuri mkurnalobis

Sedegad miRweul iqna simsivnis sruli rezorbcia,

sicocxlis 2 wliani barieri daavadebis progresirebis

niSnebis gareSe gadalaxa 22 avadmyofma, ramac 57,9% Seadgina,

xolo 16 (42,1%) avadmyofs aReniSna daavadebis progresirebis

niSnebi pirveli ori wlis ganmavlobaSi.


rom simsivnis 100%-iani regresia ZiriTadad miRweul iqna

SedarebiT axalgazrda (30-50weli) asakis pacientebSi (85,7%),

sadac daavadebis arsebobis xangrZlivoba Seadgenda 3-dan 6

111

Tves (86,5%); simsivnis morfologiuri Seneba ganisazRvreboda

brtyelujredovani kibos dabaldiferencirebuli formiT

(64%) an cilindromiT (84,6%), romelTa gavrceleba

varirebda araumetes 1 anatomiuri struqturisa (97,8%),

haimoris Rrus Zvlovani kedlebis destruqciis da regionuli

limfuri kvanZebis dazianebis gareSe.

konservatuli mkurnaloba uSedego aRmoCnda ZiriTadad

pacientTa im jgufSi, romelTa asaki meryeobda 50-dan 70

wlamde (78,6%); sadac daavadebis arsebobis xangrZlivoba

Seadgenda 1-dan 3 da 6-dan 12 Tvemde periods (87,3%);

morfologiuri Seneba ZiriTadad ganisazRvreboda

adenokarcinomiT (70%) an maRali diferencirebis

brtyelujredovani kiboTi (50%); iq sadac simsivne


aRiniSneboda Zvlovani kedlebis sxvavasxva xarisxis


erTeuli regionuli metastazebi romelTa zomebic

aRemateboda 3sm-s (19%).

III jgufi _ am jgufSi gaerTianebul iqna 51 avadmyofi im

65 pacientidan, romelTac Catarebuli konservatuli

mkurnalobis Semdeg aReniSnebodaT narCeni simsivne. 14-ma

avadmyofma SeTavazebul operaciul mkurnalobaze uari

ganacxada, ris gamoc, isini gadayvanil iqnen simptomur

Terapiaze.

51 avadmyofidan 2 (3,9%) SemTxvevaSi ganxorcielebul

iqna zeda ybis tipiuri eleqtrorezeqcia, xolo 40-Si (78,4%) _

112

kombinirebuli da 9-Si (17,7%) _ kombinirebul-gafarToebuli

operaciebi. maTgan mamakaci iyo 28 (54,9%), 23 (45,1%) ki _ qali;

TNM klasifikaciis mixedviT T3 gavrcelebis simsivne

daudginda 16 (31,4%) pacients, xolo T4 gavrcelebis 35-s

(68,6%); 9 (17,6%) avadmyofs gamouvlinda 3 sm-de zomis

erTeuli regionuli metastazebi, aqedan 4-s (44,5%) ybisqveSa

samkuTxedSi, 3 (33,3%) saZile samkuTxedSi, xolo 2 (22,2%)

kisris Sua mesamedSi.

daavadebis gavrcelebidan gamomdinare, Cvens mier 29

(59,2%) SemTxvevaSi zeda ybasTan erTad rezecirebil iqna I da

II mimdebare anatomiur struqtura; xolo 20 SemTxvevaSi

(40,8%) ganxorcielda zeda ybis rezeqcia III da met mimdebare

anatomiur struqturasTan erTad; 9 (17,6%) avadmyofidan,

romlebsac aReniSnebodaT regionuli limfuri kvanZebis

metastazuri dazianeba 6-s (66,7%) Cautarda kisris limfuri

kvanZebis fascialur-futliaruli amokveTa, xolo 3-s (33,3%)

krailis tipis operacia.


daavadebis progresirebis niSnebis gareSe gadalaxa 20 (39,2%)

pacientma. xolo 31 (60,8%) avadmyofs aReniSna daavadebis

progresirebis niSnebi pirveli ori wlis ganmavlobaSi.

Catarebuli klasteruli analizis safuZvelze dadginda,

rom sicocxlis 2 wliani barieri daavadebis progresirebis

niSnebis gareSe ZiriTadad gadalaxes SedarebiT axalgazrda

(30-50weli) asakis pacientebma (77,2%), romelTac

morfologiurad aReniSnebodaT brtyelujredovani kibos

113

maRalferencirebuli forma (76,5%) da cilindroma (83,4%),

daavadebis gavrcelebiT araumetas ori (81,8%) anatomiuri

struqturisa da regionuli limfuri kvanZebis dazianebis

gareSe.



diagnostirebuli iyo dabali diferencirebis

brtyelujredovani kibo (68,3%) gavrcelebiT sam da met (80%)

anatomiur struqturaze, romelTac aReniSnebodaT 3 da meti

(77,8%) santimetris zomis regionuli metastazebi,

lokalizaciiT kisris zeda da Sua mesamedSi. aseve sxvadasxva

warmoSobis sarkomebi (80%) an adenokarcinoma (69,3%);

romelTa gavrceleba aRemateboda or (80%) anatomiur

struqturas regionuli limfuri kvanZebis dazianebis gareSe.

IV jgufi _ Seadgina 15 avadmyofma. pacientTa es jgufi

Camoyalibda Cvendauneburad, radgan miuxedavad Catarebuli

kvlevebisa ver moxerxda procesis morfologiuri

verifikacia, ris gamoc iZulebuli gavxdiT gvewarmoebina

haimorotomia biofsiuri masalis saswrafo morfologiuri

SeswavliT. aRniSnul jgufSi gaerTianebul iqna 10 (66,6%)

mamakaci da 5 (33,4%) qali; T1 gavrcelebis simsivne daudginda 4

(26,7%) pacients, T2 gavrcelebis 9-s (60%), xolo T3

gavrcelebis 2-s (13,3%); Zvlovani kedlebis destruqcia da

simsivnis gavrceleba wiaRis farglebs gareT gamovlenili ar

iyo. am jgufis avadmyofebidan daavadebis morfologiuri

verifikaciis Semdeg 3-s (20%) Cautarda zeda ybis nawilobrivi

114

rezeqcia, xolo 12 (80%) SemTxvevaSi Sesrulebul iqna ki zeda

ybis tipiuri eleqtrorezeqcia.


daavadebis progresirebis niSnebis gareSe gadalaxa 9 (60%)

pacientma. xolo danarCen 6 (40%) avadmyofs aReniSna

daavadebis progresirebis niSnebi pirveli ori wlis

ganmavlobaSi.

Catarebuli klasteruli analizis safuZvelze dadginda,

rom daavadebis progresirebis niSnebi 2 wlis ganmavlobaSi

ZiriTadad ar aReniSnaT 50 wlamde asakis pacientebs (77,2%),

romelTac morfologiurad gamouvlindaT brtyelujredovani

kibo (50%) da adenokarcinoma (100%), simsivnis lokalizaciiT

wiaRis qveda-wina naxevarSi (96%), daavadebis arsebobis

xangrZlivobiT 3-dan 6 Tvemde.



gamovlinda dabali diferencirebis brtyelujredovani kibo

(68,3%) lokalizaciiT wiaRis zeda-ukana naxevarSi (87%);

Zvlovani kedlebis destruqciiT (67%) da daavadebis

arsebobis xangrZlivobiT 1-dan 3 Tvemde.

amrigad, maTematikuri kvlevis safuZvelze dadginda, rom

mkurnalobis efeqturobis prognozirebisaTvis 10 kliniko-

morfologiuri maxasiaTeblidan yvelaze informatiulia:

115




⎯ daavadebis lokalizacia da gavrceleba;

⎯ Zvlovani kedlebis destruqcia da misi xarisxi;

⎯ metastazebis raodenoba, lokalizacia, da zomebi.

vinaidan Cveni kvlevis meore mniSvnelovan mizans

warmoadgenda radikaluri mkurnalobis Semdgom daavadebis

gamosavlis prognozireba, kvlevis Semdgom etapze

mizanSewonilad CavTvaleT, dagvedgina informatiuli

kriteriumebi, romlebic ganapirobeben daavadebis

mimdinareobas. amisaTvis gadavwyviteT, 146 avadmyofis

monacemebi Segveswavla cocxal da gardacvlil avadmyofTa

jgufebSi. pirveli jgufi Seadgina 82 (56,16%) avadmyofma.

xolo meore jgufSi gaerTianebul iqna 64 (43,84%) pacienti,

romlebic gardaicvalnen radikaluri mkurnalobis

damTavrebidan pirveli ori wlis ganmavlobaSi.

Catarebulma kvlevam gviCvena, rom sicocxlis 2 wliani

barieri daavadebis progresirebis niSnebis gareSe ZiriTadad

gadalaxes SedarebiT axalgazrda (40-dan 50wlamde) asakis

pacientebma (72,8%), sadac simsivnis morfologiuri Seneba

ganisazRvreboda brtyelujredovani kiboTi (57,7%),

limfosarkomiT (72,8%) an cilindromiT (75%), sadac

simsivnuri procesis gavrceleba ar aRemateboda 2 anatomiur

struqturas (90%), haimoris Rrus Zvlovani kedlebis


116

gareSe (83,6%), an erTeuli regionuli limfuri kvanZis

metastazuri dazianebisas, romlTa zomebi ar aRemateboda

3sm-s (13,3%).

mkurnalobis damTavrebis Semdeg daavadebis

progresirebiT pirveli 2 wlis ganmavlobaSi gardaicvalnen

ZiriTadad is pacientebi, romelTa asaki aRemateboda 60 wels

(67,3%); sadac morfologiuri Seneba ZiriTadad

ganisazRvreboda adenokarcinomiT (72,3%), sxvadasxva

warmoSobis sarkomebiT (92%) an dabali diferencirebis

brtyelujredovani kiboTi (74,2%); iq sadac simsivne


aRiniSneboda Zvlovani kedlebis sxvadasxva xarisxis




cocxal da gardacvlil avadmyofTa jgufebSi

mkurnalobis meTodebis efeqturobis analizma klasteruli

meTodis gamoyenebiT mogvca saSualeba gamogveyo pacientTa 3

jgufi. I jgufi Seadgines avadmyofebma, sadac miuxedavaT

gamoyenebuli mkurnalobis meTodebisa (konservatiuli,

qirurgiuli da kombinirebuli), miRweul iqna sruli

gamojansaReba. am jgufSi aRmoCndnen pacientebi, romelTac

morfologiurad aReniSnebidaT limfosarkoma (88,9%),

cilindroma (65,2%) da brtyelujredovani kibo (60%); sadac

simsivne ar scildeboda wiaRis farglebs (100%) an

vrceldeboda erT mimdebare anatomiur struqturaze (86,8%)

117

Zvlovani kedlebis destruqciis da regionuli metastazebis

gareSe, daavadebis arsebobis xangrZlivobiT 1-dan 6 Tvemde.

II jgufSi gaerTiandnen pacientebi, romelTac

kombinirebuli mkurnalobis I an II etapze aucileblad

esaWiroebaT qirurgiuli Carevis ganxorcieleba

kombinirebuli an kombinirebul-gafarToebuli operaciebis

saxiT. am jgufis pacientebs morfologiurad ZiriTadad

aReniSnebodaT brtyelujredovani kibo (31,2%) da

adenokarcinoma (78,9%); daavadebis gavrcelebiT 2 da met

mimdebare anatomiur organoze; haimoris Rrus Zvlovani

kedlebis destruqciiT an destruqciis gareSe; avadmyofTa

87% ar aReniSnebodaT regionuli limfuri kvanZebis

metastazuri dazianebebi; xolo daavadebis arsebobis

xangrZlivoba varirebda 1-dan 6 Tvemde.

III jgufi Seadgines avadmyofebma, romlebic

prognostuli TvalsazrisiT aRmoCndnen absoluturad

uperspeqtivoni mkurnalobis im tradiciuli meTodebisaTvis,

rac gamoiyeneba Tanamedrove onkologiaSi. am jgufis

pacientebs ZiriTadad aReniSnebodaT angio, qondro da

osteosarkomebi (80%), simsivnis gavrcelebiT 4 mimdebare

anatomiur struqturaze, wiaRis Zvlovani kedlebis

destruqciebiT; maT 71,2% SemTxvevaSi gamouvlindaT erTeuli

an mravlobiTi regionuli limfuri kvanZebis metastazuri

dazianeba, romelTa zomebi aRemateboda 3sm-s; xolo

daavadebis arsebobis xangrZlivoba meryeobda 1-dan 3 (42%) da

6-dan 12 Tvemde (51%). yovelive es metyvelebs imis Sesaxeb, rom

118

aRniSnuli kontingentis pacientTa mkurnalobisaTvis

SemuSavebuli da gamoyenebuli unda iqnas axali, jer kidev

araaprobirebuli meTodebi.

amrigad, miRebuli informacia sarwmunoebis maRali

albaTobiT iZleva zeda ybis avTvisebiani simsivneebiT

daavadebul avadmyofTa mkurnalobis efeqturobisa da

daavadebis gamosavlis prognozirebis saSualebas. aRniSnuli

informaciis gamoyeneba avadmyofTa mkurnalobis meTodebis

SerCevisas saSualebas mogvcems mniSvnelovnad avamaRloT

mkurnalobis, rogorc uSualo, aseve Soreuli Sedegebi.

119

praqtikuli rekomendaciebi

1. zeda ybis avTvisebiani simsivneebi xasiaTdebian

klinikuri gamovlinebis mravalferovnebiT, romlebic

erTiandebian oTx ZiriTad jgufSi. pirveli jgufis

simptomebs otorinolaringologiuri ewodeba, esenia: cxviriT

sunTqvis gaZneleba, sixlian-serozuli gamonadeni, ynosvis

daqveiTeba, tkivili wiaRis midamoSi. meores nevrologiuri

(Tavis tkivili, neiropaTia, mgrZnobelobis moSla saxis

areSi); mesames stomatologiuri (trizmi, kbilis tkivili) da

meoTxes ofTalmologiuri (diplopia, mxedvelobis

daqveiTeba, egzofTalmi). aseve aRsaniSnavia, rom SesaZlebelia

arsebobdes am simptomTa ori an sami jgufis erTdrouli,

gadamkveTi gamovlinebani.

2. rodesac Cndeba eWvi zeda ybis avTvisebiani simsivnis

arsebobaze, aucilebelia avadmyofTa kompleqsuri gamokvleva,

rac gamoixateba kvlevaTa Semdeg TanmimdevrobaSi: zeda ybis

Zvlovani struqturebis palpacia; Semdeg xorcieldeba wina

rinoskopia, epifaringoskopia da zeda ybis rentgenografia;

cxvirxaxis da cxviris savalebis fibroskopia. Zvlovani

struqturebis mTlianobis dasadgenad kompiuteruli

tomografia; xolo simsivnis irgvlivmdebare rbil

qsovilebSi gavrcelebis gamosavlenad _ magnitur-

rezonansuli tomografia. simsivnis arsebobis SemTxvevaSi

kvleva sruldeba citologiuri an punqciuri biofsiis

warmoebiT.

120

3. mkurnalobis taqtikis SerCevisaTvis aucilebeli xdeba

gaTvaliswinebul iqnas iseTi kliniko-morfologiuri

maxasiaTeblebi, rogoricaa:




⎯ daavadebis lokalizacia da gavrceleba;

⎯ Zvlovani kedlebis destruqcia da misi xarisxi;

⎯ metastazebis raodenoba, lokalizacia, da zomebi.

4. mkurnalobis dasrulebis Semdeg mizanSewonilia,

yvela avadmyofi eqvemdebarebodes dinamiur dakvirvebas.

radgan daavadebis recidivebi da regionuli metastazebi 90%-

Si viTardeba pirveli ori wlis ganmavlobaSi.

121

daskvnebi

1. saqarTvelos onkologiuri centris bolo 15 wlis

monacemebiT zeda ybis wiaRis avTvisebiani simsivneebis

xvedriTi wona Tavisa da kisris onkologiur daavadebaTa

struqturaSi Seadgens 3,45%-s da igi 62,7%-Si xasiaTdeba

usimptomo mimdinareobiT, rac ganapirobebs 81,4%-Si pacientTa

momarTvas specializirebul onkologiur dawesebulebebSi T3

_ T4 gavrcelebis mqone simsivnuri procesebiT.

2. zeda ybis wiaRis avTvisebian daavadebaTa Soris wamyvani

adgili uWiravs epiTeluri warmoSobis simsivneebs (90,4%),

romelTa Sorisac ufro xSirad gvxvdeba sxvadasxva

diferencirebis brtyelujredovani kibo (68,2%), cilindroma

(15,8%) da adenokarcinoma (13%). araepiTeluri genezis

simsivneebis xvedriTi wona ar aRemateba 9,6%-s. maTgan

limfosarkoma gamovlenil iqna 6,2%-Si, xolo osteo, qondro

da angiosarkomebis ricxvi 3,4%-s ar aRemateba.

3. zeda ybis avTvisebiani simsivneebis kliniko-morfologiuri

maxasiaTeblebis maTematikurma analizma gviCvena, rom

mkurnalobis efeqturobis da daavadebis gamosavlis

prognozirebisTvis yvelaze informatiulia Semdegi

kriteriumebi: avadmyofTa asaki; daavadebis arsebobis

xangrZlioba; simsivnis morfologiuri Seneba; daavadebis

lokalizacia da gavrceleba irgvlivmdebare anatomiur

struqturebze; Zvlovani kedlebis destruqcia da misi

xarisxi; metastazebis raodenoba, lokalizacia, da zomebi.

122

4. pacientebSi, romelTac morfologiurad aReniSnebodaT

limfosarkoma, cilindroma da brtyelujredovani kibo;

rodesac simsivne ar scildeboda wiaRis farglebs an

vrceldeboda erT mimdebare anatomiur struqturaze,

Zvlovani kedlebis destruqciis da regionuli metastazebis

gareSe, daavadebis arsebobis xangrZlivobiT 6 Tvemde,

SesaZlebelia gamoyenebuli iqnas mkurnalobis rogorc

konservatiuli, aseve qirurgiuli da kombinirebuli meTodebi,

rac iZleva saSualebas mivaRwioT pacientTa srul

gamojansaRebas.

5. pacientebs, romelTac morfologiurad aReniSnebaT

brtyelujredovani kibo, adenokarcinoma an

SemaerTebelqsovilovani simsivneebi, daavadebis gavrcelebiT

2 da met mimdebare anatomiur struqturaze; haimoris Rrus

Zvlovani kedlebis destruqciiT an destruqciis gareSe;

regionuli limfuri kvanZebis metastazuri dazianebebis

gareSe an mcire zomis (>3sm) erTeuli reginuli metastazebiT,

aucileblad esaWiroebaT mkurnalobis pirvel an meore

etapze qirurgiuli Carevis ganxorcieleba.

6. avadmyofebi, romelTac aReniSnebodaT simsivnis gavrceleba

4 mimdebare anatomiur struqturaze wiaRis Zvlovani

kedlebis destruqciiT, erTeuli an mravlobiTi regionuli

limfuri kvanZebis metastazuri dazianebiT, romelTa zomebi

aRemateba 3sm-s; xolo daavadebis arsebobis xangrZlivoba

meryeobs 1-dan 12 Tvemde, prognostuli TvalsazrisiT

absoluturad uperspeqtivoni arian mkurnalobis im

123

tradiciuli meTodebis mimarT, romlebic gamoiyeneba

Tanamedrove onkologiaSi. aRniSnuli kontingentis

mkurnaloba unda xorcieldebodes protokoluri sistemiT,

samecniero kvleviT dawesebulebebSi axali, jer kidev

araaprobirebuli meTodebis gamoyenebiT.

7. mkurnalobis taqtikis SerCevisas, daavadebis kliniko-

morfologiur gamovlinebaTa cvladi sidideebis

gaTvaliswineba saSualebas iZleva ganvaxorcielod

mkurnalobis meTodis diferencirebuli SerCeva yovel

konkretul SemTxvevaSi. rac Cveni winaswari gaangariSebiT

mniSvnelovnad aamaRlebs mkurnalobis rogorc uSualo, aseve

Soreul Sedegebs.

124

bibliografia

1. haimoris wiaRis kibo (klinika, diagnostika, mkurnaloba). g. RoReliani Tbilisi, 1998

2. vckivg(u!s9!�!dgwumcxczk!igmcklkvcg9!t-clcdc8!")+_!3. vkimulg(u! \98! wcwczkjeclc! m9! 4skwhcfouiflc! okwkvigbccd!iklc! hgigzgqglfic! pcgru-cd! kdoukwu-cd! mcvzkdocsgjc5!iuzovuzklkvccdg!mg!igmcklkvccd!wgxzu!"!•"*a8!t-clcdc8!A**A9!

4. tkmfg! b98! wcwczkjeclc! m98! -uigcg! w98! vkimulg(u! \9! �!4skwhcfouiflc! mg! wgvzcofi.iuqkzgzdflc! okwkvigbccd! iklc!hgigzgqglfic!pcgru-cd! getecdu-cgzc! dcwdcezuu-cd!mcgvzkdocsgjc5!8!iuzovuzklkvccdg!mg!igmcklkvccd!wgxzu!"!•'a8!t-clcdc8!A**"9!

5. tkmfg! b98! vkimulg(u! \9! �4hgigzgqglfic! pcgru-cd! dcwdcezuu-cd!czoigsigzcflc! vgeixulu-cd! skwhcfouifl.okwkvigbcflc!jubgdu-g58! iuzovuzklkvccdg! mg! igmcklkvccd! wgxzu! A! •+a8!t-clcdc8!A**"9!

6. А.И. Пачес Опухоли головы и шеи. Москва, «Медицина» 2000г. 7. Авотин А.Я. О диагностических и лечебных ошибках при

злокачественных новообразованиях придаточных пазух носа. Ж.У.Н.Гб.№3,1974.

8. Агранат В.З. Радиоизотопная диагностика злокачественных опухолей. /Матерьялы по применению Р32, У131, Аи198/, М., Медицина 1967.

9. Антонив В.Ф., Рабкин И.Х., Машарипов Р.Р. Компьютерная томография при заболеваниях лобных пазух // Вестник оториноларин. 1990 №3 , с 7-11

10. Анютин Р.Г., Колесникова Е. К., Туманов Л.Б. Возможности компьютерной томографии в диагностике новообразований носоглотки и придаточных пазух носа. Вестник оториноларингологии, 1983, №2, с.33-36.

11. Афанасьева А.В. Злокачественные опухоли верхней челюсти. В кн. Злокачественные опухоли, т.2 , под ред, Н.Н.Петрова и С.А Холдина, Л., 1952.

12. Ахмедов А.А. О значении некоторых симптомов в ранней диагностике злокачественных новообразований челюстей. Азербайджанский медицинский журнал. Баку, 1963,№6,стр.60

13. Барамидзе Т.Г. Радиоизотопная диагностика злокачественных опухолей различных органов. Автореферат диссер. док.мед.наук, Тбилиси,1973.

14. Благовещенская Н.С., Бухамеджанов Н.З., Туманова А.А., Туркин А.М. Магнитно-резонансная томография в диагностике параназальных синусов. Вестник оториноларингологии 1990. №1, с. 41-44

125

15. Быков В.Л. Анализ результатов лучевого лечения и продолжительности жизни больных со злокачественными опухолями полости носа и околоносовых пазухю //ЖУНГБ-1991.№ 1, с.49-50.

16. Воробьев Ю.И., Корниенко В.Н., Лесняк и др. Магнитно-резонансная томография в диагностике юношеских ангиофибром носоглотки // Вестн. рентгенол. 1989, №5,с.33-38

17. Воробьев Ю.И., Корниенко В.Н., Лесняк В.Н., Туркин А.М. Магнитно-резонансная томография в диагностике и оценке эффективности лучевой терапии опухолей верхних дыхательных путей //Мед. радиол. 1991, № 3, с.24-29.

18. Воробьев Ю.И., Лесняк В.Н. Магнитно-резонансная томография в диагностике и оценке результатов лучевой терапии злокачественных опухолей верхней челюсти //Мед. радиол. и радиац. безопасность. 1994,№2, с 21-28.

19. Воробьев Ю.И., Лесняк В.Н. Магнитно-резонансная томография в диагностике и оценке результатов лучевой терапии злокачественных опухолей верхней челюсти // Мед. радиол. и радиац. безопасность. – 1994.- №2.-С.21-28.

20. Воробьев Ю.И., Саранцева И.П. Лучевое лечение с применением метронидазола больных раком слизистой оболочки полости рта в поздних стадиях // Мед.Радиология.-1982. №9, с.9-13./7 Габуния Р.И., Колесникова Е.К. Компьютерная томография в клинческой диагностике, М., 1995, стр.29-35.

21. Гамбург Ю.Л., Гогелиани Г.К. Термография злокачественных опухолей гайморовых пазух. Всес. конф. Темп-82. Ленинград.

22. Гогелиани Г.К. Комплексная диагностика опухолей верхнечелюстной пазухи. III Респ.науч.конф. стоматологов Грузии, тез. док.., Тбилиси,1984.

23. Грицман Ю.Я. Диагностические и тактические ошибки в онкологии. М. Медицина, 1981.

24. Денисов Л.Е., Терновой С.К. Границы применение аксиальной КТ (АКРТ) в онкологии. Метериалы 2-го Всесоюзного симпозиума «Специальные метооды диагностики опухолей» Обнинск, 1981, с.8-9.

25. Дурнов Л.А., Поляков В.Г., Клиника, диагностика и лечение злокачественных опухолей верхних дыхательных путей и среднего уха у детей/ Методич. рекомендации – М. , 1989.

26. Кантин А.В., Шимановская Я.В., Григорьева Г.Д. О рентгенодиагностике злокачественных новообразований гайморовой пазухи. Вопросы онкологии, №8.

27. Коссовой А.Л. Ядерная магнитно-резонансная томография в диагностике заболеваний ЛОР-органов. Вестник оториноларингологии, 1987, №4, с.76-79.

126

28. Краевский Н.А., Смольянникова А.В., Саркисова Д.С. Цитологическое исследрвание в диагностике опухолей. Патологоанатомическая диагностика опухолей человека. Рук.для врачей, том 1, М., Медицина, 1993.

29. Лесняк В.Н. Магнитно-резонансная и компьютерная томография в диагностике злокачественных областей и смежных областей. Автореф. дисс. ... канд.мед.наук. – М, 1993.- 19 с.

30. Лопатин А.С., Арцыбашева М.В. МРТ в исследовании полости носа и околоносовых пазух // Российск. ринология.-1996.-№5.-С. 3-14.

31. Маградзе И.И., Бойков В.Л. Применение томографии при злокачественных опухолях придаточных пазух носа. Науч. конф. Темп-79, Москва.

32. Молоткова Н.Г. Лучевое и комбинированное лечение злокачественных опухолей верхней челюсти и полости носа // Диссерт. канд.мед. наук. Обнинск.-1995.с.147

33. Огольцова Е.С. Злокачественные опухоли верхних дыхательных путей / В кн. Злокачественные новообразования.- М. Медицина, 1984.-С.99-117.

34. Овчинников Ю.М., Добротин В.Е. Компьютерная томография при заболеваниях полости носа, околоносовых пазух, носоглотки и уха. Атлас. Т1. М., 1997.

35. Ольшанский В.О., Корниенко В.Н., Кицманюк З.Д. и др. Компьютерная томография при злокачественных опухолях верхней челюсти и полости носа. Изд.-во Томского университета,1985.

36. Ольшанский В.О., Корниенко В.Н., Липович М.М., Сдвижков А.М. Клиническое использование КТ при злокачественных опухолях верхней челюсти и полости носа. Вестник оториноларингологии, 1983, №2, с. 28-33.

37. Ольшанский В.О., Габибов Г.А., Сдвижков А.М. и др. Комбинированные и краниофациальные резекции при злокачественных опухолях верхней челюсти. Метод. рекоменд. МНИОИ им. П.А. Герцена.- М, 1991, С.3-9.

38. Павлов А.С., Стиоп Л.Д. Злокачественные опухоли носоглотки и их лучевое лечение. М., Медицина, 1985, с.92-113.

39. Пеньковсий Г.М., Пионтковская М.Б. Выбор объема хирургических вмешательств при злокачественных опухолях околоносовых пазух на основе алгоритма лучевой диагностики// Журн.ушных, носовых и горловых болезней. – 1996.-№4. – С.39-45.

40. Погосов В.С., Корниенко В.Н., Акопян Р.Г., Талалаев В.Н., Туркин А.М. ЯМР- томография в диагностике новообразований полости носа и околоносовых пазух. Вестник оториноларингологии, 1989, №5, с.38-40.

127

41. Подвязников С.О., Матякин Е.Г., Федотенко С.П., Уваров А.А. и др. Диагностика и лечение неэпителильных опухолей головы и шеи // I съезд онкологов стран СНГ. Тез. докл. – Т. 1.-М., 1996. – С. 259-285.

42. Приходько А.Г., Ефимцев Ю.П., Баженов В.В., Васина Н.Б., Санкин И.А., Смолякова Н.Е. Компьютерная томография в диагностике заболеваний головы и шеи. Вестник рентгенологии и радиологии, 1991, №4, с.38-43.

43. Приходько А.Г., Ефимцев Ю.П. Компьютерная томография в диагностике заболеваний околоносовых пазух и носоглотки. Метод. рекоменд. Кубанск. Мед.инс. Краснодар. 1992.

44. Сдвижков А.М. Значение компьютеной томографии в диагностике и выборе метода лечения злокачественных опухолей верхней челюсти и полости носа. В кн. Вопросы экспериментальной и клинической онкологии. М., 1981, с.121-125.

45. Сдвижков А.М. Клиническое значение компьютерной томографии при злокачественных опухолях верхней челюсти и полости носа. Автореф. дис. ... канд.мед.наук. М.,1983.

46. Сдвижков А.М. Хирургические аспекты лечения распространенных злокачественных опухолей носа, околоносовых пазух и верхней челюсти. Автореф. дисс. ... докт.мед.наук.- М.,1997.-32 с.

47. Черекаев В.А. Хирургия опухолей основания черепа, распространяющихся в глазницу и околоносовые пазухи. //Автореф.дис.д.м.н. М.1995 30 с.

48. Шацкая Н.Х. Усовершенствование онкологической помощи больным злокачественными опухолями ЛОР-органов //Автотреф. Диссер.к.м.н. Москва 1993, 33 с.

49. Юшманов В. Е., Янцев В. И., Плющ А.Л., Соколова И.С., Горбачева Л.Б., Сибельдина Л.А., Эмануель Н. М. ЯМР-томография экспериментальных злокачественных новообразований in vivo. Доклады Академии Наук СССР, 1985, т. 282, №3, с. 734-736.

50. Aisen A.M. , Martel. W., Braunstein E.M., Mcmillen K.I., Phillips W.A. et al. MRI and CT evaluation of primary bone and soft tissue tumors. AJR, 1986, v.146, # 4, p.749-759.

51. Annis J.A., Phelps P.D., croft C.B. A revealing CT examination in nasopharingeal carcinoma. J. Laringol. Otol. 1989, v.103, N. 8. p.801-802.

52. Antilia J., Sonnien P., Grenman R. MRI and radiographics in acute frontal sinus infections. //Rhinology 1993, vol 31,# 4, p 145-149

53. Atlas S.W., Grossman R.J., Gomori J.N., Guerry D., Hackney D.B. et al. MR imaging of intracranial metastatic melanoma. J.comput. assist. tomogr. 1987, v.11, N 4, p.577-582.

54. Baker H.L. The application of magnetic-resonance imaging in otolaryngology. Laryngoscope. 1986, v.96, N 1, p 19-26.

128

55. Ballenger J.J. SnowJ.B., Jr Otorhinolaringology: Head and Neck Surgery. 15 Ed.1996.

56. Beck JC, McClatchey KD, Lesperanse MM, Esclamado RM, Carey TE, Bredford CR. Human papillomavirus types important in progresion of inverted papilloma. Otolaryngol Head Neck Surg 1995;113:558-563.

57. Belkin B.A., Papageorge M.b., Fakitsas j., Bankoff M.S. a comparative study of magnetic-resonance imaging versus computed tomography for the evaluation of maxillary and mandibular tumors. J. Oral. Maxillofac. Surg. 1988, v.46, N 12, p.1039-1047.

58. Bettez M., maves m.d., Dolan K.d., Yuh W.T. Maxillary sinus neoplasm. Ann. Otol. Rhinol., Laryngol. 1989, v.98, N 12, p.988-990.

59. Buchwarld C, Nielsen LH, Ahlgren P, Nielsen PL, Tos M. Radiologic aspects of inverted papilloma. Eur. J. Radiol 1990;10:134-139

60. Bush S.E., Bagshaw H.H. Carcinoma of the nasal cavity and paranasal sinuses. // ORL 1983, v.450. p. 1-12.

61. Bronshtein AD. Nyberg DA. Schwartz AN. Shuman WP. Griffin BR. Soft-tissue changes after head and neck radiatiion: CT findings. Ajnrl: American Journal of Neuroradiology. 10(1): 171-5, 1989 Jan-Feb.

62. Bydder G.M. Recent developments in magnetic resonance imaging of tumors of the head and neck. Magn. Resonan. Cancer. Proc. Int. Conf., Banff,Apr 30-may 4, 1985. Toronto e.a. 1986, p 3-9.

63. Cantu G., Solero, S., Matvelly F. et al. Combined frontal, infratemporal and transfacial approach to extended skull base tumors. //Inter. Skull Base Symposium, St.Peterburg, Russia. 1994,4.

64. Castelijns JA. Diagnostic radiology of head and neck oncology. Current Opinion in Oncology. 3 (3): 512-8, 1991 Jun.

65. Chisisn R., Ragossino M.W., Flexon P.B., Joseph M.P., Weber A.L. et al. MR assessment of a hamartoma of the nasal cavity. AJR, 1987, v. 149, N 5, p 1083-1084.

66. Chong V.F.H., Fun Y. Detection of recurrent nasopharyngeal carcinoma: MR imaging Versus CT// Radiology. 1997.V.202.P.463-470.

67. Comba P., Battista G., Belli S./ De Capua B., Marler E. et al. A case-control study of canser of nose and paranasal sinuses and occupational exposures.//Am.J.Ind.Med 1992. 22(4) 511-20.

68. Dillon W.P., Mills C.M., Kjos B., DeGroot J., Brant-Zawadzki M.Magnetic Resonance imaging of the nasopharinx. Radiology 1984, v.152, N 3, p.731-738.

69. Dillon W.P., Som P.M., Fullerton G.D. Hypointense MR signal in chronically inspissated sinonasal secretion. Radiology, 1990, v. 174, N 1, p. 73-78.

70. Draf W., Samii M. Malignant tumours of the paranasal sinuses //Tumors of skull Base. Berlin, New york 1988, p.63-69.

129

71. Graamans K., Slootweg P.J. Orbital exenteration in surgery of malignant neoplasms of the paranasal sinuses. The value of preoperative computed tomography. Arch. Otolaryngol. Head neck Surg. 1989, v.115, N 8, p.977-980.

72. Grau C., Harbo G., BunDgaard T., Overgaard M. et al. Carcinoma of the nasal sinuses: A retrospective study of 169 patients.//EJC 1995. V 31 A, p.88-89.

73. Hesselink J.R., Weber A.Z. Pathways of orbital extension of orbital neoplasms. J. Comput. Assist. Tomogr 1982, vol. 6, N.3, p. 593-597.

74. Hirakawa K., Yajin K., tagashira N., Suzuki M., Hirata SH. et al. Long-term results of treatment for carcinoma of maxillary sinus // Pract. otol 1987. v.80, N 7, p 1093-1099.

75. Hirakawa K., Yajin K., tagashira N., Suzuki M. et al. A clinical study of carcinoma of the maxillary sinus // Pract. Otol. Kyoto 1988, v 81, Suppl 27, p 207-211.

76. Hirsch R. J., Yousem D.M., Loevner LA. et al. Synovial sarcomas of the head and neck: MR findings // A.J.R.1997. V.169.P.1185-1188.

77. Hoe J.W. Computed tomography of nasopharingeal carcinoma. A review of CT appearances in 56 patients. Eur. J. Radiol. 1989, v.9, N.2, p.83-90.

78. Hoff van S.C.J., Lamers R.J.S., Kessels A.G.H. et al. Mucosal pathology in paranasal sinus in symptomatic and asymptomatic patients: A prospective MR study//9th Europ.Congress of Radiology.-Vienna.-1995.-P.125

79. Jing B.S., Goepfert h., Close L. Computerised tomography of paranasal sinus neoplasms. Laryngoscope. 1978, vol. 88, N.9 p. 1485-1503

80. Joroisen M. Recent trends in the diagnosis and treatment of sinusitis // Europ. Radiol.-1996.-Vol.6, N 2.-P. 170-176.

81. Kulkarni M.V., Bonner F.M., Abdo G.J. Maxillary sinus hemangioma: MR and CT studies. J. Comput. Assist. Tomogr. 1989, v.13, N 2, p. 340-342.

82. Lam E.W., Hannam A G., Wood W.W., Fache J.S., Watanabe M. Imaging orofacial tissues by magnetic resonance. Oral Surg. Oral Med. Oral Pathol. 1989, v.68, N 1, p.2-8.

83. Lloyd G.A. Magnetic resonance imaging of nose and paranasal sinuses. J. Roy. Soc. Med. 1989, v.82. N 2, p. 84-87.

84. Lufkin R.B., Hanafee W. Magnetic resonance imaging of head and neck tumors. Cancer Metastasis Rev. 1988, v.7, p. 19-38.

85. Lund V.J., Howard D., Glyn A. CT evaluation of paranasal sinus tumors for cranio-facial resection. Br. J. Radiol. 1983, vol 56, N 667, p. 439-446.

86. Mancuso A.A., Harnberger H.R., Muraki A.S., Stevens M.H. Computed tomography of cervical and retropharyngeal nodes. Radiology. 1983, v. 148. N 3, p 709-714.

130

87. Markola A.T., Aronen H.J., Paavonen T. et al. Spin lock and magnetization transfer imaging of head and neck tumors// Radiology 1996. v.200. p 369-375.

88. McArdle C.B., Amparo E.G., Mirfakhraee M. Mr imaging of orbital blow-out fractures. J. Comput. Assist. Tomogr. 1986, v.10, N 1, p.116-119

89. Momose K.j., Grove A. Computed tomography for evaluation of sinus disorders involving the orbit. Int. Ophthalmol. Clin. 1982, vol.22, N.4, p.181.

90. Mukerij S.K., Castelijns J.A. et al. Modern Head and Neck Imaging. Ny.: Springer,2000.

91. Nehen A.M., Illum P., Ratjen E., Illum F., Elbrond O. et al. Computed Tomography and hypocycloid tomography in lesions of the nose, paranasal sinuses and nasopharynx. Acta Radiol. (Diagn). 1981, vol 22 N 3. p 285-287.

92. Oot R.F., Parizel P.M., Weber A.L. Computed Tomography of osteogenic sarcoma of nasal cavity and paranasal sinuses. J. Comput. Assist. Tomogr. 1986, vol 10, N 3 , p 409-414

93. Pandolfo I., Gaeta m., Blandino A., Longo M., Faranda C. Perineural spread of nasopharyngeal carcinoma. Radiological and CT demonstration. Eur. J. Radoil. 1988, vol.8, N.4, p. 231-235.

94. Parsons C., Hodson N. Computed tomography of paranasal sinus tumors. Radiology, vol. 132, N.3, p 641-645.

95. Phelps P.D. Magnetic resonance for tumours of the skull base and parapharyngeal ragion: discussion paper. J.R.Soc. Med. 1988, v.81, N11, p.649-652.

96. Phillips C.D., Futterer S.F., Lipper M.H. et al. Sinonasal undiferentiated carcinoma: CT and MR imaging of an uncommon neoplasm of the nasal cavity// Radiology 1997.V 202, P.477-480.

97. Ramos R., Som P.M., Solodnic P. Nasopharingeal melanotic melanoma: MR charasteristics. J. Comput. Assist. Tomogr. 1990, v. 14, N 6, p.997-999.

98. Reiner B., Siegel E., Sawyer R. et al.The Impact of routine CT of the chest on the diagnosis and manegment of newly diagnosed squamous cell carcinoma of the head and neck.// A.J.R. 1997.V.169.P.667-671.

99. Rotte K.H., Hebbar H.G., Gkonein I.M. The value of computed tomography in the diagnosis of tumors of the nasopharynx and paranasal sinuses. Radiol. Diagn. 1988, v. 29, N 3, p.391-396.

100. Takashima S., Noguchi Y., Okumira T. et at. Dynamic MR imaging in the head and neck // Radiology.- 1993.- Vol.189.-N 4.-P. 813-815.

101. Shankar-Giri P.G., Reddy E.K., Gemer L.S., et al. Optimum management of advanced squamous call carcinoma of the maxillary sinus.//int. J. of Rad. Onol Biol. Phys. 1990. v 19. suppl 1 p. 242.

131

102. Shibnya H., Horinhi J., Suzuki S. et al. Maxillary sinus сarсinoma: Results of radiation therapy //Int. J. Radiat. Onol. Biol.Phys 1984, v. 10, p. 1021-1026.

103. Shidnia H., Hornbak N., Saghafi N. et al. The role of radiation therapy in treatment of malignant tumours of the paranasal sinuses //Laryngosope 1984. #1,p. 102-106.

104. Schats C.J., Becker T. S. Normal CT anatomy of the paranasal sinuses. Radiol. Clin. north Am. 1984, V.22, N.1, p.107-118.

105. Som P.M., Dillon W.P., Curtin H.D., Fullerston G.D., Lidov M. Hypointense paranasal sinus foci: differntial diagnosis with MR imaging and relation to CT findings. Radiology. 1990, v. 176, N 3, p. 777-779

106. Som P.M., Dillon W.P., Sze G., Lidov M., Biller H.F. et al. Benign and malignant sinonasal lesions with intracranial extension: Diffentiation with MR imaging. Radiology 1989, v. 172, N 3, p. 763-766.

107. Som P.M., Lidov M. The significance of sinonasal radiodensifies: ossification, calcification, or residual bone? AJNR 1994;15:917-992.

108. Som P.M., Shugar J.M., Troy K.M., Sacher M., Stollman A.L. The use of magnetic resonance and computed tomography in the managment of a patient with infrasinus hemorrage. Arch. Otolaryngol. Head Neck Surg. 1988, v.114, N 2, p.200-202.

109. Stammberger H. Endoscopic endonasal surgery – Concepts in treatment of recurring rhinosinusitis. Part I. Anatomic and pathophysiologic considerations. Otoryngol Head neck Surg 1986,-94:143-7.

110. Trapp T.K., Yao-Shi F.U.Calcaterra TH.. Melanoma of the nasal and paranasal sinus mucosa .// Arch. Otolaryngol 1987 V. 113, N 10, p 1086-1089

111. Tsujii H., Kamada T., Arimoto T. et al . The role of Radiotherapy in the management of maxillary sinus carcinoma. //Cancer (Philad) 1986. v. 57. # 12. p.2261-2266.

112. Unger J.M., Shaffer K., Duncavage j. Computed tomography in nasal and paranasal sinus disease. Laryngoscope. 1984, vol 94, N. 10, p. 1319-1324.

113. Van Tassel P., Lee Y.Y., Jing B.S., Pena C.A. Mucoceles of the paranasal sinuses: MR imaging with CT correlation. AJNR. 1989, v.10, N 3, p. 607-612.

114. Vogl T.., Dresel S., Bilaniuk L.T., Grevers G., Kang K. et al. Tumors of the nasopharynx and adjacent areas: MR imaging with Gd-Dtpa. AJR. 1990, vol. 154, N 3,p.585-592

115. Weber A.L., Stanton A.C. Malignant tumors of the paranasal sinuses: radiologic, clinical and histopathologic evalution of 200 cases // Head Neck Surg. 1984, vol 761, # 6, p 769-776.

132

116. Zheng G.L., Zeng Q., Wu P., Yuan C. Computed tomography in the management of naso pharingeal carcinoma. Clin. Radiol. 1989, v.40, N 1, p.25-29.

117. Zinreich SJ, Kennedy DW, Kumar AJ, Rosenbaum AE , Arington JA,Johns ME. MR imaging of normal nasal cycle; comparison with sinus pathology. J Comput. Assist. Tomogr. 1988; v. 12; p.1014-1019.

118. Som PM, Lawson W, Lidov MK. Simulated aggressive skull base erosion

in response to benign sinonasal disease. Radiology 1991. 119. Burgener A. Francis, Kormano Martti "Differential Diagnosis in

Computed Tomography" 1996 120. Amendola BE, Eisert D, Hazra TA, King ER. Carcinoma of the maxillary

antrum: surgery or radiation therapy? Int J Radiat Oncol Biol Phys 1981;7: 743.

121. Isaacs JH, Mooney S, Mendenhall WM, Parsons JT. Cancer of the maxillary sinus treated with surgery and/or radiation therapy. Am Surg 1990;56: 327.

122. Moseley HS, Thomas LR, Everts EC, Stevens KR, Ireland KM. Advanced squamous cell carcinoma of the maxillary sinus: results of combined regional infusion chemotherapy, radiation therapy and surgery. Am J Surg 1981;141: 522.

123. Shigematsu Y, Sakai S, Fuchihata H. Recent trials in the treatment of maxillary sinus carcinoma with special reference to the chemical potentiation of radiation therapy. Acta Otolaryngol 1971;71: 63.

124. Blacklock JB, Weber RS, Lee YY, Goepfert H. Transcranial resection of tumors of the paranasal sinuses and nasal cavity. J Neurosurg 1989;71: 10.

125. Chobe R, McNeese M, Weber R, Fletcher GH. Radiation therapy for carcinoma of the nasal vestibule. Otolaryngol Head Neck Surg 1988;98: 67.

126. Goepfert H, Guillamondegui OM, Jesse RH, Lindberg RD. Squamous cell carcinoma of nasal vestibule. Arch Otolaryngol Head Neck Surg 1974;100: 8.

127. Goepfert H, Luna M, Lindberg R, White A. Malignant salivary gland tumors of the paranasal sinuses and nasal cavity. Arch Otolaryngol 1983;109: 662.

128. Schantz SP, Harrison LB, Forastiere AA: Tumors of the nasal cavity and paranasal sinuses, nasalpharynx, oral cavity, and oropharynx. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. Philadelphia, Pa: Lippincott-Raven Publishers, 5th ed., 1997, pp 741-801.

129. Hawkins RB, Wynstra JH, Pilepich MV, et al.: Carcinoma of the nasal cavity: results of primary and adjuvant radiotherapy. International Journal of Radiation Oncology, Biology, Physics 15(5): 1129-1133, 1988.

133

130. Ang KK, Jiang GL, Frankenthaler RA, et al.: Carcinomas of the nasal cavity. Radiotherapy and Oncology 24(3): 163-168, 1992.

131. Levendag PC, Pomp J: Radiation therapy of squamous cell carcinoma of the nasal vestibule. International Journal of Radiation Oncology, Biology, Physics 19(6): 1363-1367, 1990.

132. Wong CS, Cummings BJ: The place of radiation therapy in the treatment of squamous cell carcinoma of the nasal vestibule: a review. Acta Oncologica 27(3): 203-208, 1988.

133. Abele R, Clavel M, Rossi A, Bruntsch U, Pinedo HM. Iproplatin (CHIP, JM-9) in advanced squamous cell carcinoma of the head and neck. A phase II study of the EORTC early clinical trials group (abstract 575). Proc Am Soc Clin Oncol 1986;5: 147.

134. Abele R, Honegger HP, Grossenbacher R, Mermillod B, Kaplan E, Gervasi A, Wolfensbeager M, Lehmann W, Cavalli F. A randomized study of methotrexate, bleomycin, hydroxyurea with versus without cisplatin in patients with previously untreated and recurrent squamous cell carcinoma of the head and neck. Eur J Cancer Clin Oncol 1987;23: 47.

135. Adelstein DL, Kalish LA, Adams GL, Wagner H, Oken MM, Remick SC, Mansour E. G, Haselow RE. Concurrent radiation therapy and chemotherapy for locally unresectable squamous cell head and neck cancer. J Clin Oncol 1993;11: 2136.

136. Adelstein DJ, Sharan VM, Earle AS, Shah AC, Vlastou C, Haria CD, Damm D, Carter SG, Hines JD. Simultaneous versus sequential combined technique therapy for squamous cell head and neck cancer. Cancer 1990;65: 1685.

137. Afridi N, Taghian A, Nogueira C, et al. Interferon-�2a/13cis-retinoic acid enhance the radiation sensitivity of squamous cell carcinoma of the head and neck in vitro. Proc Am Soc Clin Oncol 1995;14: 295.

138. Vlock D, Anderson J, Whiteside T, Herbeman R, Kirkwood J, Adams G. Immunologic correlates in patients (PTS) with head and neck cancer (SCCHN) treated with interferon alpha (IFN): association between natural killer cell (NK) activity and prolonged survival (abstract 900). Proc Am Soc Clin Oncol 1994;13: 280.

139. Al-Kourainy K, Kish J, Ensley J, Tapazoglou E, Jacobs J, Weaver A, Crissman J, Cunnings G, Al-Sarraf M. Achievement of superior survival for histologically negative versus histologically positive clinically complete responders to cisplatin combination in patients with locally advanced head and neck cancer. Cancer 1987;59: 233.

140. Al-Sarraf M, Hussein M. Head and neck cancer: present status and future prospects of adjuvant chemotherapy. Cancer Invest 1995;13: 41–53.

141. Al-Sarraf M. Clinical trials with fluorinated pyrimidines in patients with head and neck cancer. Invest New Drugs 1989;7: 71.

134

142. Al-Sarraf M, Metch B, Kish J, Ensley J, Rinehart JJ, Schuller DE, Coltman CA Jr. Platinum analogs in recurrent and advanced head and neck cancer: a Southwest Oncology Group and Wayne State University study. Cancer Treat Rep 1987;71: 723.

143. Al-Sarraf M, Scott CB, Ahmad R, Schwade JG, Schuller D, Laramore GE, Jacobs J. Phase III study comparing sequential chemotherapy (CT) and radiotherapy (RT) to RT for resected and negative margins squamous cell carcinoma of the head and neck: intergroup study #0034. Proc Am Soc Clin Oncol 1992;11.

144. Al-Sarraf M, Tapazoglou F, Ensley JF, Ahmad K, Jacobs JR, Suchowski C, Kish JA. Significant loco-regional control of advanced head and neck cancer (HN-CA) with concurrent cisplatin and radiotherapy (RT) after initial response to induction chemotherapy (CT) (abstract 670). Proc Am Soc Clin Oncol 1990;9: 173.

145. Amiel JL, Sancho-Garnier H, Vandenbrouck C, Eschwege F, Droz JP, Schwaab G, Wibault P, Stromboni M, Rey A. First results of a randomized trial on immunotherapy of head and neck tumors. Recent results. Cancer Res 1978;68: 318.

146. Amrein PC. Cisplatin and 5-fluorouracil vs.the same plus bleomycin and methotrexate in recurrent squamous cell carcinoma of the head and neck (SCC H+N) (abstract 676). Proc Am Soc Clin Oncol 1990;9: 175.

147. Amrein PC, Fabian RL. Treatment of recurrent head and neck cancer with cisplatin and 5-fluorouracil vs. the same plus bleomycin and methotrexate. Laryngoscope 1992;102: 901–906.

148. Amrein PC, Fingert H, Weitzman SA. Cisplatin-vincristine-bleomycin therapy in squamous cell carcinoma of the head and neck. J Clin Oncol 1983;1: 421.

149. Ansfield FJ, Ramirez G, Davis HL Jr, Korbitz BC, Vermund H, Gollin FF. Treatment of advanced cancer of the head and neck. Cancer 1970;25: 78.

150. Arcangeli G, Nervi C, Righini R, Creton G, Mirri MA, Guerra A. Combined radiation and drugs: the effect of intra-arterial chemotherapy followed by radiotherapy in head and neck cancer. Radiother Oncol 1983;1: 101.

151. Bachaud JM, David JM, Boussin G, et al. Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced squamous cell carcinoma of the head and neck: preliminary report of a randomized trial. Int J Radiat Oncol Biol Phys 2 1991;0: 243-246.

152. Baker SR, Wheeler RH. Intraarterial chemotherapy for head and neck cancer, Part I: theoretical considerations and drug delivery systems. Head Neck Surg 1983;6: 664.

135

153. Bakowski MT, MacDonald E, Mould RF, Cawte P, Sloggem J, Barrett A, Dalley V, Newton KA, Westbury G, James SE, Hellman K. Double blind controlled clinical trial of radiation plus razoxane (ICRF 159) versus radiation plus placebo in the treatment of head and neck cancer. Int J Radiat Oncol Biol Phys 1978;4: 115.

154. Int J Radiat Oncol Biol Phys 1982;8: 1277. 155. Batsakis JG. Tumors of the head and neck. In Clinical and Pathological

Considerations. Edited by JG Batsakis. Baltimore: Williams & Wilkins, 1974.

156. Baugh RF, Wolf GT, McClatchey KD. Small cell carcinoma of the head and neck. Head Neck Surg 1986;8: 343.

157. Beatty JD, Terz JJ, Brown PW, Lawrence W Jr, Schuller GB, Kaplan AM. Adjuvant intralesional and systemic Corynebacterium parvum immunotherapy for surgically treated head and neck cancer. Surg Forum 1978;29: 155.

158. Bedwinek JM, Shukovsky LJ, Fletcher GH, Daly TE. Osteonecrosis in patients treated with definitive radiotherapy for squamous cell carcinomas of the oral cavity and naso- and oropharynx. Radiology 1976;119: 665.

159. Berenson JR, Yang J, Koga H, Slamon D, Mickel RA. bcl-1 and Int-2 coamplification in squamous cell carcinomas of the head and neck and lung (abstract 1749). Proc Am Assoc Cancer Res 1989;30: 440.

160. Bertino JR, Boston B, Capizzi RL. The role of chemotherapy in the management of cancer of the head and neck: a review. Cancer 1975;36: 752.

161. Bezwoda WR, de Moor NG, Deman DP. Treatment of advanced head and neck cancer by means of radiation therapy plus chemotherapy: a randomized trial. Med Pediatr Oncol 1979;6: 353.

162. Bowman GP, Cripps C, Hodson DI, et al. Placebo-controlled randomized trial of infusional fluorouracil during standard radiotherapy in locally advanced head and neck cancer. J Clin Oncol 1994;12: 2648–2653.

163. Boyle JO, Hakin J, Koch W, et al. The incidence of p53 mutations increases with progression of head and neck cancer. Cancer Res 1993;53: 4477–4480.

164. Braakhuis BJM, van Dongen GAMS, Vermorken JB, Snow GB. Preclinical in vivo activity of 2ґ, 2ґ-difluorodeoxycytidine (Gemcitabine) against human head and neck cancer. Cancer Res 1991;51: 211.

165. Brachman DG, Graves D, Vokes E, Beckett M, Haraf D, Motag A, Dunphy E, Mick R, Yandell D, Weichselbaum RR. Occurrence of p53 gene deletions and human papilloma virus infection in human head and neck cancer. Cancer Res 1992;52: 4832.

166. Brennan JA, Boyle JO, Koch WM, Goodman SN, Hruban RH, Eby YJ, Couch MJ, Forastiere AA, Sidransky D. Association between cigarette

136

167. Brennan JA, Mao L, Hruban RH, Boyle JO, Eby YJ, Koch WM, Goodman SN, Sidransky D. Molecular assessment of histopathological staging in squamous-cell carcinoma of the head and neck. N Engl J Med 1995;332(7):429–35.

168. Browman GP, Wong G, Hodson I, Sathya J, Russell R, McAlpine L, Skingley P, Levine MN. Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer. N Engl J Med 1993;328: 159.

169. Browman GP, Goodyear MD, Levine MN, Russell R, Archibald SD, Young JE. Modulation of the antitumor effect of methotrexate by low-dose leucovorin in squamous cell head and neck cancer: A randomized placebo-controlled clinical trial. J Clin Oncol 1990;8: 203.

170. Browman GP, Levine MN, Goodyear MD, Russell R, Archibald SD, Jackson BS, Young JE, Basrur V, Johanson C. Methotrexate/fluorouracil scheduling influences normal tissue toxicity but not antitumor effects in patients with squamous cell head and neck cancer: results from a randomized trial. J Clin Oncol 1988;6: 963.

171. Browman GP, Levine MN, Russell R, Young JE, Archibald SD. Survival results from a phase III study of simultaneous versus 1-hour sequential methotrexate-5-fluorouracil chemotherapy in head and neck cancer. Head Neck Surg 1986;8: 146.

172. Campbell JB, Dorman EB, McCormick M, Miles J, Morton KP, Rugman F, Stell PM, Stoney PJ, Vaughn ED, Wilson JA. A randomized phase III trial of cisplatinum, methotrexate, cisplatinum + methotrexate, and cisplatinum + 5-fluorouracil in end-stage head and neck cancer. Acta Otolaryngol 1987;103: 519.

173. Cann CI, Fried MP, Rothman KJ. Epidemiology of squamous cell cancer of the head and neck. Otolaryngol Clin North Am 1985;18: 367.

174. Carey TE, Wolf GT, Hsu S, Poore J, Peterson K, McClatchey KD. Expression of A9 antigen and loss of blood group antigens as determinants of survival in patients with head and neck squamous carcinoma. Otolaryngol Head Neck Surg 1987;91: 221.

175. Carter SK, Livingston RB. The chemotherapy of head and neck cancer. In Principles of Cancer Treatment. Edited by SK Carter, E Glatstein, RB Livingston. New York: McGraw-Hill, 1982.

176. Carugati A, Pradier R, de la Torre A. Combination chemotherapy (CT) pre radical treatment of head and neck squamous cell carcinoma (SCC) (abstract 589). Proc Amer Soc Clin Oncol 1988;7: 152.

177. Catimel G, Vermorken JB, Clavel M, et al. A phase II study of gemcitabine (LY188011) in patients with advanced squamous cell carcinoma of the head and neck. Ann Oncol 1994;5: 543–547.

137

178. Catimel G, Verweij J, Mattijssen V, et al. Docetaxel (Taxotere): an active drug for the treatment of patients with advanced squamous cell carcinoma of the head and neck. Ann Oncol 1994;5: 533–537.

179. Chang H, Leone L, Tefft M, Nigri PT. Simultaneous cis-platinum and radiotherapy as an induction therapy for advanced head and neck squamous cell carcinoma (abstract 579). Proc Am Soc Clin Oncol 1988;8: 150.

180. Choi K, Aziz H, Stark R, Sohn C, Rosenthal J, Braverman A, Khil S, Isaacson S, Marti J, Rotman M. Concomitant radiation and infusion cis-platinum in advanced cancers of the head and neck: Influence of radiation fractionation (abstract 607). Proc Am Soc Clin Oncol 1988;8: 157

181. lark J Fallon B, Weichselbaum R, Miller D, Norris C, Frei E, Ervin T. The influence of resectability on response to induction chemotherapy and survival in advanced squamous cell carcinoma of the head and neck (SCCHN) (abstract C-542). Proc Am Soc Clin Oncol 1985;4: 139.

182. Clark RM, Rosen IB, Laperriere NJ. Malignant tumors of the head and neck in a young population. Am J Surg 1982;144: 459.

183. Clavel M, Cognetti F, Dodion P, Wildiers J, Rosso R, Rossi A, Gignoux B, Van Rymenart M, Cortez-Funes H, Dalesio O. Combination chemotherapy with methotrexate, bleomycin, and vincristine with or without cisplatin in advanced squamous cell carcinoma of the head and neck. Cancer 1987;60: 1173.

184. Clavel M, Vermorken JB, Cognetti F, et al. Randomized comparison of cisplatin, methotrexate, bleomycin and vincristine (CABO) versus cisplatin and 5-fluorouracil (CF) versus cisplatin (C) in recurrent or metastatic squamous cell carcinoma of the head and neck. Ann Oncol 1994;5: 521–526.

185. Clayman GL, El-Naggar AK, Roth JA, et al. In vivo therapy with p53 adenovirus for microscopic residual head and neck squamous carcinoma. Cancer Res 1995;55: 1–6.

186. Cobleigh MA, Hill JH, Lad TE, Shevrin DE, Applebaum EL. Phase II study of etoposide in previously untreated squamous cell carcinoma of the head and neck. Cancer Treat Rep 1987;71: 321.

187. Cognetti F, Carlini P, Pinnaro P. Prospective randomized trial of neoadjuvant cisplatin and 5-FU followed by radiotherapy versus concurrent cisplatin and radiotherapy in locally advanced head and neck squamous cell cancer: preliminary results. Proceedings Second International Conference on Head and Neck Cancer. Boston: July 31–August 5, 1988.

188. Cognetti F, Carlini P, Pinnaro P, Ruggeri EM, Perrino A, Del Vecchio MR, Ambesi Impiombato F, Calabresi F. Preliminary results of a randomized trial of sequential versus simultaneous chemo and radiotherapy (CT-xRT) in patient (pts) with locally advanced unresectable squamous cell

138

carcinoma of the head and neck (SCCHN) (abstract 661). Proc Am Soc Clin Oncol 1989;8: 170.

189. Cognetti F, Pinnaro P, Carlini P, Ruggeri EM. Neoadjuvant chemotherapy in previously untreated patients with advanced head and neck squamous cell cancer. Cancer 1988;62: 251.

190. Cognetti F, Pinnaro P, Ruggeri EM, Carlini P, Perrino A, Impiobato FA, Calabresi F, Chilelli MG, Giannarelli D. Prognostic factors for chemotherapy response and survival using combination chemotherapy as initial treatment of advanced head and neck squamous cell cancer. J Clin Oncol 1989;7: 829.

191. Corvo R, Merlano M, Looney WB, Benasso M, Bacigalupo A, Margarino G. Integration of chemotherapy in an MFD-radiotherapy plan for advanced inoperable squamous cell carcinoma of the head and neck. Head Neck 1990;12: 60.

192. Corvo R, Merlano M, Scarpati D, Grimaldi A, Benasso M, Franzone P, Santelli A, Scasso F, Rosso R, Vitale V. Sequential or alternate chemo-radiotherapy in the treatment of advanced head and neck tumors. Results of a randomized study. Radiol Med 1988;75: 653.

193. Crissman JD, Liu WY, Gluckman JL, Cummings G. Prognostic value of histopathologic parameters in squamous cell carcinoma of the oropharynx. Cancer 1984;54: 2995.

194. Crissman JD, Pajak TF, Zarbo RJ, Marcial VA, Al-Sarraf M. Improved response and survival to combined cisplatin and radiation in non-keratinizing squamous cell carcinomas of the head and neck. An RTOG study of 114 advanced stage tumors. Cancer 1987;59: 1391.

195. Crissman JD, Liu WY, Gluckman JL, Cummings G. Prognostic value of histopathologic parameters in squamous cell carcinoma of the oropharynx. Cancer 1984;54: 2995.

196. Crissman JD, Pajak TF, Zarbo RJ, Marcial VA, Al-Sarraf M. Improved response and survival to combined cisplatin and radiation in non-keratinizing squamous cell carcinomas of the head and neck. An RTOG study of 114 advanced stage tumors. Cancer 1987;59: 1391.

197. Dalley D, Beller E, Aroney R, et al. The value of chemotherapy (CT) prior to definitive local therapy (DLT) in patients with locally advanced squamous cell carcinoma (SCC) of the head and neck (HN) (abstract 856). Proc Am Soc Clin Oncol 1995;14: 297.

198. Dasmahapatra KS, Citrin P, Hill GJ, Yee R, Mohit-Tabatabai MA, Rush BF Jr. A prospective evaluation of 5-fluorouracil plus cisplatin in advanced squamous cell cancer of the head and neck. J Clin Oncol 1985;3: 1486.

199. Dimery I, Lee YY, VanTassel P, Goepfert H, Byers R, Guillamondegui O, McCarthy K, Hong WK. Combined intra-arterial (I.A.) and systemic

139

chemotherapy (CT) for paranasal sinus carcinoma (PNSC). Proc Am Soc Clin Oncol 1988;7: 150.

200. Douple EB. Platinum-radiation interactions, NCI Monogr 1988;6: 315. 201. Fontanesi J, Kun LE, Beckford N, Babin R, Kavanagh K, Lester E, Pao

WJ, Tai D, Eddy T. Hyperfractionated irradiation and concomitant cisplatin for advanced squamous cell carcinoma of the head and neck: Early experience. Presented at Third International Head and Neck Oncology Research Conference, Las Vegas, 1990.

202. Franchin G, Gobitti C, Minatel E, Barzan L, De Paoli A, Boz G, Mascarin M, Lamon S, Trovo MG. Simultaneous radiochemotherapy in the treatment of inoperable, locally advanced head and neck cancers. Cancer 1995;75: 1025–1029.

203. Gallick GE, Sacks PG, Maxwell SA, Steck PA, Gutterman JU. Head and neck squamous cell carcinoma cell lines as a model system for the study of oncogene expression during tumor progression and metastasis. Prog Clin Biol Res 1986;212: 97.

204. Gasparini G, Recher G, Favretto S, Visona A, Bevilacqua P, Del Fior S. Simultaneous cis-platinum (CDDP) and radiotherapy (RT) in inoperable or advanced squamous cell carcinoma of the head and neck (H&N) (abstract 663). Proc Am Soc Clin Oncol 1989;8: 170.

205. Ghossein NA, Bataini JP. The role of radiotherapy in the treatment of neck metastases from head and neck cancer. In Head and Neck Cancer. Edited by GT Wolf. Boston: Martinus Nijhoff, 1984, pp 169–199

206. Glick JH, Marcial V, Richter M, Velez-Garcia E. The adjuvant treatment of inoperable stage III and IV epidermoid carcinoma of the head and neck with platinum and bleomycin infusions prior to definitive radiotherapy: An RTOG pilot study. Cancer 1980;46: 1919.

207. Goldsweig HG, Sundaresan N. Chemotherapy of recurrent esthesioneuroblastoma. Am J Clin Oncol 1990;13: 139.

208. Gollin FF, Ansfield FJ, Brandenburg JH, Ramirez G, Vermund H. Combined therapy in advanced head and neck cancer: a randomized study. Am J Roentgenol Radium Ther Nucl Med 1972;114: 83.

209. Gowan GF, deSuto-Nagy G. The incidence and sites of distant metastases in head and neck carcinoma. Surg Gynecol Obstet 1953;116: 603.

210. Guthrie TH, Brubaker LH, Porubsky ES, Isaacs JH, Erwin SA, Roberts WH. Circadian cisplatin (C), bleomycin (B) and 5-fluorouracil (F) in advanced squamous cell carcinoma of the head and neck (SCCH) (abstract 689). Proc Am Soc Clin Oncol 1990;9: 178.

211. Haas C, Anderson T, Byhardt R, Cox J, Duncavage J, Grossman T, Haas J, Libnoch J, Malin T, Ritch P, Toohill R. Randomized neo-adjuvant study of 5-fluorouracil (FU) and cis-platinum (DDP) for patients (PTS) with

140

advanced resectable head and neck squamous carcinoma (ARHSC) (abstract 735). Proc Am Assoc Cancer Res 1986;27: 185.

212. Harrison L, Bosl G, Fass D, Armstrong J, Pfister DG, Motzer R, Weisen S, Teeple C, Sessions R, Shah J, Spiro R, Strong E. A new chemo-radiation program for advanced, unresectable head and neck cancer. Presented at Third International Head and Neck Oncology Research Conference, Las Vegas, 1990.

213. Head and Neck Contracts Program: Adjuvant chemotherapy for advanced head and neck squamous carcinoma. Final report of the Head and Neck Contracts ProgrAm Cancer 1987;60: 301.

214. Hasegawa Y, Matsuura H, Fukushima M, et al. A randomized trial of neoadjuvant chemotherapy with cisplatin and 5FU in advanced head and neck cancer (abstract 926). Proc Am Soc Clin Oncol 1994;13: 286.

215. Hong WK, Bromer RH, Amato DA, Shapshay S, Vincent M, Vaughan C, Willett B, Katz A, Welch J, Fofonoff S, Strong MS. Patterns of relapse in locally advanced head and neck cancer patients who achieved complete remission after combined modality therapy. Cancer 1985;56: 1242.

216. Huang AT, Cole TB, Fishburn R, Jelovsek SB. Adjuvant chemotherapy after surgery and radiation for stage III and IV head and neck cancer. Ann Surg 1984;200: 195.

217. Huang AT, Fisher SR, Cole TB. A study of postoperative and/or postradiation adjuvant chemotherapy (abstract). Proceedings, second International Head and Neck Oncology Research Conference, Arlington, VA: September 10–13, 1987.

218. Jesse RH. Radiation in the treatment of squamous carcinoma of paranasal sinus. Am J Surg 1965;110: 552.

219. Johns ME, Kaplan MJ. Malignant neoplasms. In Otolaryngology Head and Neck Surgery, vol. II. Edited by CW Cummings, JM Fredreickson, LA Harker, CJ Krause, DE Schuller. St. Louis: Mosby, 1986, p 1049.

220. Kotwall C, Sako K, Razack MS, Rao U, Bakamjian V, Shedd DP. Metastatic patterns in squamous cell cancer of the head and neck. Am J Surg 1987;154: 439.

221. Laramore GE, Scott CB, Schuller DE, Haselow RE, Ervin TJ, Wheeler R, Al-Sarraf M, Gahbauer RA, Jacobs JR, Schwade JG, Campbell BH. Is a surgical resection leaving positive margins of benefit to the patient with locally advanced squamous cell carcinoma of the head and neck? A comparative study using the Intergroup Study 0034 and the Radiation Therapy Oncology Group database. Int J Radiat Oncol Biol Phys 1993;27: 1011.

222. Marcial VA, Pajak TF, Chang C, Tupchong L, Stetz J. Hyperfractionated photon radiation therapy in the treatment of advanced squamous cell carcinoma of the oral cavity, pharynx, larynx, and sinuses, using radiation

141

therapy as the only planned modality: (Preliminary report) by the Radiation Therapy Oncology Group (RTOG). Int J Radiat Oncol Biol Phys 1987;13: 41.

223. Merlano M, Vitale V, Rosso R, Benasso M, Corvo R, Cavallari M, Sanguineti G, Bacigalupo F, Margarino G, Brema F, Pastorino G, Marziano C, Grimaldi A, Scasso F, Sperati G, Pallestrini E, Garaventa G, Accomando E, Cordone G, Comella G, Daponte A, Rubagotti A, Bruzzi P, Santi L. Treatment of advanced squamous-cell carcinoma of the head and neck with alternating chemotherapy and radiotherapy. N Engl J Med 1992;327: 1115.

224. Merlano M, Carvй R, Margarino G, et al. Combined chemotherapy and radiation therapy in advanced inoperable squamous cell carcinoma of the head and neck: The final report of a randomized trial. Cancer 1991;67: 915–921.

225. Million RR, Parsons JT, Cassisi NJ. Twice a day irradiation technique for squamous cell carcinoma of the head and neck. Cancer 1985;55: 2096.

226. Laramore GE, Ed.: Radiation Therapy of Head and Neck Cancer. Berlin: Springer-Verlag, 1989.

227. Thawley SE, Panje WR, Batsakis JG, et al.: Comprehensive Management of Head and Neck Tumors. New York: W.B. Saunders Company, 1986.

228. Johns ME, Kaplan MJ: Advances in the management of paranasal sinus tumors. In: Wolf GT, Ed.: Head and Neck Oncology. Boston: Martinus Nijhoff Publishers, 1984, pp 27-52.

229. Slotman GJ, Cummings FJ, Glicksman AR, Doolittle CL, Leone LA. Preoperative simultaneously-administered cis-platinum plus radiation therapy for advanced squamous cell carcinoma of the head and neck. Head Neck Surg 1986;8: 159.

230. South East Cooperative Oncology Group: A randomized trial of combined multidrug chemotherapy and radiotherapy in advanced squamous cell carcinoma of the head and neck. Eur J Surg Oncol 1986;12: 289.

231. Spijkervet F, Vermey A, Panders AV, Saene H, Mehta D. Prevention of irradiation mucositis in head-neck cancer patients (abstract 673). Proc Am Soc Clin Oncol 1990;9: 174.

232. Laramore GE, Ed.: Radiation Therapy of Head and Neck Cancer. Berlin: Springer-Verlag, 1989.

233. Thawley SE, Panje WR, Batsakis JG, et al.: Comprehensive Management of Head and Neck Tumors. New York: W.B. Saunders Company, 1986.

234. Fowler JF, Lindstrom MJ: Loss of local control with prolongation in radiotherapy. International Journal of Radiation Oncology, Biology, Physics 23(2): 457-467, 1992.

142

143

235. Turner SL, Tiver KW, Boyages SC: Thyroid dysfunction following radiotherapy for head and neck cancer. International Journal of Radiation Oncology, Biology, Physics 31(2): 279-283, 1995.

236. Constine LS: What else don't we know about the late effects of radiation in patients treated for head and neck cancer? International Journal of Radiation Oncology, Biology, Physics 31(2): 427-429, 1995.

237. Kish JA, Ensley JF, Jacobs J, et al.: A randomized trial of cisplatin (CACP) + 5-fluorouracil (5-FU) infusion + CACP + 5-FU bolus for recurrent and advanced squamous cell carcinoma of the head and neck. Cancer 56(12): 2740-2744, 1985

238. Kraus DH, Sterman BM, Levine HL, et al.: Factors influencing survival in ethmoid sinus cancer. Archives of Otolaryngology, Head and Neck Surgery 118(4): 367-372, 1992.

239. Johnson CR, Schmidt-Ullrich RK, Wazer DE: Concomitant boost technique using accelerated superfractionated radiation therapy for advanced squamous cell carcinoma of the head and neck. Cancer 69(11): 2749-2754, 1992.

240. Stupp R, Weichselbaum RR, Vokes EE: Combined modality therapy of head and neck cancer. Seminars in Oncology 21(3): 349-358, 1994.

241. Al-Sarraf M: Head and neck cancer: chemotherapy concepts. Seminars in Oncology 15(1): 70-85, 1988.

242. Dimery IW, Hong WK: Overview of combined modality therapies for head and neck cancer. Journal of the National Cancer Institute 85(2): 95-111, 1993.

243. Jacobs C, Lyman G, Velez-Garcia E, et al.: A phase III randomized study comparing cisplatin and fluorouracil as single agents and in combination for advanced squamous cell carcinoma of the head and neck. Journal of Clinical Oncology 10(2): 257-263, 1992.

244. Kies MS, Levitan N, Hong WK: Chemotherapy of head and neck cancer. Otolaryngologic Clinics of North America 18(3): 533-541, 1985.

245. LoRusso P, Tapazoglou E, Kish JA, et al.: Chemotherapy for paranasal sinus carcinoma: a 10-year experience at Wayne State University. Cancer 62(1): 1-5, 1988.

246. Al-Kourainy K, Kish J, Ensley J, et al.: Achievement of superior survival for histologically negative versus histologically positive clinically complete responders to cisplatin combination in patients with locally advanced head and neck cancer. Cancer 59(2): 233-238, 1987.

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