Qazaqstannyń balalar onkologiialyq jáne gematologiialyq qyzmeti ártúrli qaterli isigi bar naýqas balalardy emdeýdiń jańa jáne zamanaýi tehnologiialaryn engize otyryp, tiisinshe tabysty jetildirilip, damyp keledi. Jedel, himioterapiialyq jáne sáýlelik emdeý saldarynan emdelýshilerde oryn alǵan problemalar kóp jaǵdaida ýaqyt óte kele nemese shipajailyq-kýrorttyq spektrdiń ońaltý is-sharalaryn jáne psihologiialyq ádispen túzetý jumystaryn júieli túrde qabyldaǵan jaǵdaida túzetilýi múmkin. «Ult» portaly balalardaǵy onkologiialyq aýrýlardy emdeýdiń qazirgi tásilderin bilý maqsatynda, osy aýyr dertke shaldyqqandardy emdeýge múmkindik berip otyrǵan Pediatriia jáne balalar hirýrgiiasy ǵylymi ortalyǵynyń joǵary sanatty onkogematolog dárigeri, Pediatriialyq bloktyń basshysy Gúlnar Ábdilovany áńgimege tartyp kórdi.
– 15 aqpan dúniejúzilik obyrmen kúres kúni dep belgilengen. Qazir meditsina edáýir damyǵan ǵoi, jalpy osy «aty jaman aýrýdan» aiyǵý múmkindigi qanshalyqty? Ásirese balalar arasyndaǵy kúres qalai júredi?
– Durys aitasyz, búginde Halyqaralyq balalar onkologtary qoǵamynyń qamqorlyǵymen álemniń 90-nan astam elinde qaterli isikpen aýyratyn balalar kúni 15 aqpanda atap ótiledi. Ózińiz aitqandai, meditsina jetistikteriniń arqasynda onkologiialyq aýrýlarmen aýyratyn balalardyń ómir súrý uzaqtyǵy ulǵaiyp, al olar kóp jaǵdaida is júzinde saýyǵýǵa qol jetkizýi múmkin. Balalar onkologiiasy men gematologiiasyndaǵy serpilis molekýliarly-genetikalyq, tsitogenetikalyq, radiologiialyq jáne basqa da diagnostika ádisterin engizýmen bailanysty bolyp otyr.
Tyǵyz isikterdi emdeýdiń zamanaýi eýropalyq baǵdarlamalaryn engizýge bailanysty ómirsheńdiktiń uzaqtyǵy týraly aitýǵa áli erte. Biraq balalardaǵy keibir isikterdi emdeýdiń erte nátijelerin taldaý bar. Osylaisha, terapiiany engizýdiń alǵashqy kezeńderinde retinoblastomany emdeý tiimdiligi 35%-dan kem boldy, búgingi tańda ol shamamen 90%-dy quraidy. Bul aýrýdy aralas emdeýdiń joǵary tehnologiialyq ádisteri engizildi: organ saqtaýshy jergilikti terapiia-lazerkoagýliatsiia jáne himiopreparattardy intravitrialdy engizý, jedel emdeý, sáýlelik terapiia.
– Onyń jaqsy nátijeleri bar ma?
– Árine. Mysaly, jumsaq tinderdiń sarkomasyn emdeý kezinde – 85,3%; nefroblastomalar – 82,4%; limfomalar – 85%; osteosarkomalar – 71,7%. Degenmen genetikalyq irkilis nátijesinde damityn qaterli isik túrleri jáne olardyń emdeý nátijeleri áli de joǵary emes, biraq álemdik meditsina ornynda turmaidy, sondyqtan Qazaqstanda da búgingi kúni osyndai jaǵdailardy baqylaý jáne patsientterdiń ómirin uzartý múmkindigi bar.
– Qarapaiym halyq obyr derti balalarda bolmaidy dep oilaidy nemese sengisi kelmeidi. Bul aqparattyń azdyǵynan emes pe?
– Ras, kóptegen adamdar balalardy qaterli isikpen aýyrmaidy dep sanaidy. Al, balalardaǵy qaterli isiktiń 65%-y týa bitken jáne balalardaǵy obyrdyń 50%-y jaiylǵan, iaǵni júieli aýrýlar bolyp tabylatynyn jáne basqa da aýrýlardyń maskasymen júre alatynyn atap ótý qajet.
Pediatriia ortalyǵy qoǵamdy aqparattandyrý maqsatynda 15 aqpan - Búkilálemdik balalardaǵy qaterli isik aýrýyna qarsy kúres kúnine orai ótken aptada «Erte anyqtalsa, balalardaǵy qaterli dertti jeńýge bolady» degen uranmen aqparattyq-tanymdyq chelendj ótkizdi. Ondaǵy maqsatymyz - qoǵamnyń nazaryn qaterli isikpen kúreske aýdarý, aldyn ala tekserilýge shaqyrý, balalardaǵy qaterli isik aýrýlary týraly aqparattandyrý, bul aýrýdy jeńýge bolatynyn kórsetý. Ár beinerolikte Pediatriia ortalyǵynyń dárigerleri balalardaǵy qaterli dert kezinde kezdesetin belgiler men aýrý sipaty jóninde baiandady. Arnaiy beinerolik retinde túsirilgen jazbalardy ortalyqtyń feisbýk paraqshasynda jariialadyq.
Qazirgi tańda meditsina qaterli isik aýrýyn da emdeýge bolatynyn dáleldedi. Búgingi kúni ol dertti jeńip, qalypty ómir súrip jatqan balalar óte kóp. Qaterli isik - sońǵy úkim emes, aty jaman aýrýdy jeńýge bolady, árbir balanyń ómiri úshin kúresýge mindettimiz jáne kúrese alamyz. Eń bastysy - ómirge degen qushtarlyqty joǵaltpaý kerek.
Bizdiń elimizde onkologiialyq jáne gematologiialyq aýrýlarǵa shaldyqqan búldirshinder balalar onkologiiasy salasynda ǵana emes, sonymen qatar pediatriianyń ártúrli beiindegi mamandary bar kópbeiindi respýblikalyq balalar klinikalarynyń bazasy sanalatyn Pediatriia jáne balalar hirýrgiiasy ǵylymi ortalyǵynda (Almaty), sondai-aq Ana men bala ulttyq ǵylymi ortalyǵynda (Nur-Sultan) bilikti kómek alady.
– Bul dertpen aýyrǵan balanyń jazylý múmkindigi qandai?
– Bilesiz be, buryn mundai diagnozy bar balalardyń barlyǵy qaitys bolatyn. Al qazir elimizde balalardyń keibir onkologiialyq aýrýlarynda emdeý tiimdiligi 70-80% quraidy. Qazaqstanda jiti limfoblasty leikozy bar balalardyń ómirsheńdigi - 76%-dan astam, iaǵni álemdik nátijelerge jaqyndap keledi. Halyqaralyq jetekshi ortalyqtarda osy atalǵan aýrýy bar balalardyń ómirsheńdigi 80-85% quraidy. Búgingi kúni leikozǵa shaldyqqandar ólimge dýshar bolǵandar dep eseptelmeidi jáne bes jyldyq mejeni bastan keshken balalar is júzinde saýyǵyp ketken dep sanalady. Bizdiń eńbektiń tarihyna júginsek, 2013 jyldan bastap osteogendi sarkomasy bar balalardyń 80%-nyń aiaqtary saqtalyp qaldy. Bul múmkindik - alǵashqy kezeńde balalardyń 71%-yna derlik isikter regress bergen operatsiia aldyndaǵy joǵary dozaly himioterapiiany engizý nátijesinde paida boldy.
Búgingi kúni jiti leikozǵa shaldyqqan balalardyń ómir súrýi 76 paiyzdy quraidy. 2013 jyldan beri isikterdi emdeýdiń jańa ádisteri qoldanylýda. Al 2012 jyly balalardaǵy gemopoezdik diń jasýshalaryn transplantatsiialaý engizildi, osy jyldan beri súiek kemiginiń ishindegi allotransplantatsiia jáne aýtotransplantatsiia otasy 200-den asa balaǵa jasaldy. Buǵan deiin mundai aralasýlardy júrgizý úshin naýqastar shetelge jiberiletin, al qazir súiek kemigin transplantatsiialaýdyń barlyq túrlerin bizdiń elde tegin alýǵa bolady. Kórsetiletin meditsinalyq qyzmetterge qoljetimdilik pen sapasy jaqsarýda. Balalardyń ońaltý jaiy da qarastyrylǵan.
Gemopoezdik diń jasýshalary donorlarynyń qazaqstandyq tirkelimi belsendi tolyqtyrylýda, Ulttyq transfýziologiia ǵylymi-óndiristik ortalyǵynyń derekter bazasyndaǵy áleýetti súiek kemigi donorlary 6000-nan astam. Pediatriia jáne balalar hirýrgiiasy ǵylymi ortalyǵynyń bazasynda Qazaqstandaǵy onkopatologiiasy bar naýqas balalardy monitoringileý jáne esepke alý úshin popýliatsiialyq jáne klinikalyq tirkelimniń jumysy jolǵa qoiylǵan.
– Osy Pediatriia ortalyǵynda balalarda gemopoezdik diń jasýshalarynyń transplantatsiiasy engizilgen eken?
– Iá, 2012 jyldan bastap bizdiń Pediatriia ortalyǵynda balalarda gemopoezdik diń jasýshalarynyń transplantatsiiasy engizildi. Búgingi kúni leikoz, aplaziialyq anemiia, bastapqy immýndyq tapshylyq, mielodisplastikalyq sindrom, neiroblastom, Iýing sarkomasy, Hodjkin limfomasy bar jáne t.b. patsientterge transplantatsiia belsendi júrgizilýde.
2015 jyldan bastap gemopoezdik diń jasýshalarynyń joǵary tehnologiialyq gaplouqsas transplantatsiia júrgiziledi.
Gemopoezdik diń jasýshalaryn transplantatsiialaý (GDJT) joǵary qaýiptilik tobyndaǵy onkogematologiialyq aýrýlar kezinde jáne aýrýdyń qaitalanýy kezinde terapiianyń qajetti kezeńi bolyp tabylady. Bizdiń nátijeler boiynsha, búgingi kúni allogendik gemopoezdik diń jasýshalaryn transplantatsiialaý Mielodisplastikalyq sindrom kezinde (MDS), limfoblastyq leikoz (66,7%), aplaziialyq anemiia (50%) kezinde jaqsy tiimdilikke ie. Gemopoezdik diń jasýshalaryn transplantatsiialaýdyń oń nátijesi buryn júrgizilgen terapiiaǵa bailanysty, iaǵni emdeý baǵdarlamalyq, ýaqtyly, zamanaýi standartty hattamalar boiynsha bolýy tiis.
Keleshekte tehnologiiany jetildirý jáne transplantatsiia kólemin keńeitý, Qazaqstandyq jáne Qazaqstan-Resei registrlerinen donorlardy tarta otyryp týystyq emes gemopoezdik diń jasýshalaryn transplantatsiialaýdy engizý, odan ári qarai gaplouqsas gemopoezdik diń jasýshalaryn transplantatsiialaýdy damytý alda tur.
Biz osy baǵytta belsendi jumys istep kelemiz. Máselen, 2019 jyly gemopoezdik diń jasýshalaryn transplantatsiialaý gistotipti donorlarynyń Qazaqstandyq tirkeliminen týys emes donordan alǵashqy allogendik transplantatsiia júrgizildi.
– Ózińiz qyzmet atqaratyn Pediatriia jáne balalar hirýrgiiasy ǵylymi ortalyǵy kúrdeli otalardy jasap, janǵa arasha bolýǵa tyrysady eken...
– Pediatriia jáne balalar hirýrgiiasy ǵylymi ortalyǵy - bul kóp salaly pediatriialyq ǵylymi-klinikalyq ortalyq. Munda jyl saiyn jańa týǵan náresteden bastap 18 jasqa deiin 6000-nan astam bala em alady. Ortalyqta klinikalyq tájiribesi mol bilikti mamandar jumys isteidi. Bizdiń dárigerler klinikalyq qyzmetti ǵylymi zertteýlermen birge úilestiredi. Ortalyq jańa tehnologiialardy qoldana otyryp, pediatriia jáne balalar hirýrgiiasy salasynda joǵary meditsinalyq qyzmet kórsetedi. Táýelsizdik alǵan jyldardan beri ortalyqta álemdik standart sapasyna sai joǵary meditsinalyq tehnologiialar qoldanylyp keledi. Klinikada jylyna 2000-nan asa balaǵa jedel aralasýlar, operatsiialar jasalynady. Atap aitqanda, súiek kemiginiń tarsplantatsiiasy boiynsha biregei otalar jasalady, asqazan-ishek joldarynyń, keýde bóliginiń damý aqaýlary kezindegi kúrdeli hirýrgiialyq otalar júrgiziledi, ýrologiialyq jáne abdominaldy patologiialar kezinde shaǵyninvaziialyq beineendoskopiialyq aralasý sharalary engizilgen, balalardyń júrek-qantamyr júiesiniń týa bitken damý aqaýlary túzetiledi, interventsiialyq kardiohirýrgiia qoldanylady.
- Balalardaǵy onkologiia boiynsha qandai kúrdeli operatsiia jasalady?
Operatsiialardyń ońaiy joq. Búgingi kúni ortalyqta tyǵyz isikterdi hirýrgiialyq emdeýdiń barlyq spektri júrgiziledi. Hirýrgtar balalar jasynda kezdesetin túrli isikterdi jedel emdeý tehnikasyn meńgerdi. Mysaly, 5-7 jyl buryn osteosarkoma diagnozy qoiylǵan kezde hirýrgiialyq kezeń aiaq-qoldyń ampýtatsiiasyn júrgizýdi qamtydy. Osy aýrýdy diagnostikalaý men emdeýdiń joǵary tehnologiialyq eýropalyq hattamalarynyń engizilýi aýrýdyń aǵymy men ómirsheńdigin túbegeili ózgertti. Retinoblastomaǵa shaldyqqan naýqastardy da emdeýde jaqsy dinamika bar. Hirýrgiialyq kezeńdi qosa alǵanda, osyndai patsientterdi emdeýdiń qazirgi zamanǵy hattamalaryn engizý ómirsheńdikti shamamen 90%-ǵa arttyrýǵa múmkindik berdi.
Onkologiia boiynsha ortalyqta kúrdeli operatsiialardyń biri - balalardaǵy osteosarkomalar kezinde iri býyndardy endoprotezdeý boiynsha biregei operatsiialar jasalady. Osteosarkoma – súiektiń sirek kezdesetin qaterli isigi. Qaterli dert kóbine 10 jastan asqan balalarda jii kezdesedi. Elimizde jyl saiyn osteosarkomamen shamamen 15 jasóspirim aýyrady. Barlyq osteosarkomanyń 50%-dan astamy tize býynyna jaqyn ornalasady.
Sońǵy jyldary súiek isikteri kezinde joǵary mólsherli himioterapiiany engizý arqasynda basqa organdarǵa metastazdanýdyń tómendeýi jáne ómirsheńdik artty. Bul kóptegen jaǵdailarda (90%-dan astam) zaqymdanǵan aiaqtardy saqtaýǵa múmkindik berdi. Iaǵni, osy atalǵan patologiiasy bar balalarǵa keibir asqynǵan jaǵdailardy qospaǵanda, aiaq-qoldardy is júzinde ampýtatsiialamaidy.
Osteosarkomamen emdeýdiń jańa ádisterin engizý tiimdiliktiń álemdik nátijelerine jaqyndaýǵa múmkindik beredi.
– Pediatriia ortalyǵynda súiektiń qaterli isigine shaldyqqan 40-tan astam balaǵa kúrdeli ota jasalǵan eken. Osy týraly áńgimelep berińizshi.
– Pediatriia jáne balalar hirýrgiiasy ǵylymi ortalyǵynda balalar men jasóspirimderdiń súiek sarkomasy kezinde endoprotezderdi qoldaný arqyly aiaq-qoldardy saqtap qalý boiynsha ota jasaý 2012 jyldan beri júrgiziledi. Ortalyqtyń zamanaýi modýldik endoprotezderdi satyp alý múmkindiginiń jáne qarqyndy joǵary mólsherli himioterapiiany qoldanýdyń arqasynda organsaqtaýshy otalardy jasaýdyń múmkindigi artty, sondai-aq balalardaǵy osteosarkomany biriktirip emdeý nátijeleri de jaqsardy. Atap aitatyn jait, onkologiialyq endoprotezder ortopediialyq protezderge uqsas emes, erekshe megaprotezder bolyp tabylady. Qazirgi tańda hirýrgiialyq emdeýdiń osy túri osteosarkomaǵa shaldyqqan balalardyń 90%-dan astamyna jasalynady, ol óz kezeginde balanyń áleýmettik beiimdelýi men onyń ómir súrý sapasynyń jaqsarýyna múmkindik beredi.
Aiaq-qoldy saqtai otyryp emdeý aiaqtalǵannan keiin jalpy saýyǵyp ketý jaǵdailary elimizde 70%-dy quraidy. Bul nátije osteosarkomany zertteý jónindegi halyqaralyq mýltiortalyqtar nátijesiniń derekterimen sai keledi.
Ózińiz aitqandai, sońǵy 5 jyl ishinde Pediatriia jáne balalar hirýrgiiasy ǵylymi ortalyǵynda iri býyndardy endoprotezdei otyryp (tize, iyq, jambas) osteosarkoma kezinde 45 organ saqtaý operatsiialary jasaldy. Biregei operatsiialardyń nátijesinde balalardyń aiaq-qoldary saqtalyp qana qoimai, olardyń ómir súrý sapasy da jaqsardy. Búgingi kúni olar ózderiniń qurby-qurdastarymen qatar deńgeide mektepke baryp, ýniversitette oqyp, túrli qyzmette jumys isteidi. Tipti, sportpen ainalysyp, jattyǵý zaldaryna, basseinderge baryp, belsendi ómir súrip jatyr.
– Áńgimeńizge rahmet!
Suhbattasqan Aqbota Musabek
