{"id":38648,"date":"2023-03-01T20:08:37","date_gmt":"2023-03-01T19:08:37","guid":{"rendered":"http:\/\/www.invarena.cz\/?p=38648"},"modified":"2023-03-01T20:10:53","modified_gmt":"2023-03-01T19:10:53","slug":"rakovinu-plic-umi-nejlepe-v-centrech","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=38648","title":{"rendered":"Rakovinu plic um\u00ed nejl\u00e9pe v centrech. Spustil se program \u010dasn\u00e9ho z\u00e1chytu"},"content":{"rendered":"\n

I tak z\u00e1va\u017en\u00e9 onemocn\u011bn\u00ed jako je rakovina plic, nemus\u00ed znamenat rozsudek smrti. Z\u00e1le\u017e\u00ed na rychlosti diagn\u00f3zy, ale tak\u00e9 na tom, kde se pacient l\u00e9\u010d\u00ed. Nejv\u011bt\u0161\u00ed \u0161anci na uzdraven\u00ed nebo co nejdel\u0161\u00ed \u017eivot m\u00e1, pokud se dostane do n\u011bkter\u00e9ho ze sedmi pneumoonkochirurgick\u00fdch center. P\u0159esto se 40 % pacient\u016f s\u00a0plicn\u00edm karcinomem ocit\u00e1 mimo tato centra. <\/strong><\/p>\n\n\n\n

\u201eV \u010cesku se dosud operuje bronchogenn\u00ed karcinom tam, kde by se operovat nem\u011bl. N\u011bkde zase pacient\u016fm nasazuj\u00ed l\u00e9\u010dbu a\u017e za n\u011bkolik m\u011bs\u00edc\u016f od diagn\u00f3zy. To je \u0161patn\u011b. Lid\u00e9 by se m\u011bli dostat do center vysoce specializovan\u00e9 pneumoonkochirurgick\u00e9 p\u00e9\u010de, kde je na jednom m\u00edst\u011b kvalitn\u00ed p\u0159\u00edstrojov\u00e9 vybaven\u00ed, zku\u0161enosti, l\u00e9ka\u0159i pat\u0159i\u010dn\u00fdch specializac\u00ed a v\u0161e navazuje na komplexn\u00ed onkologick\u00e1 centra,\u201c<\/em> \u0159\u00edk\u00e1 prof. MUDr. Martina Koziar Va\u0161\u00e1kov\u00e1, p\u0159edsedkyn\u011b \u010cesk\u00e9 pneumologick\u00e9 a ftizeologick\u00e9 spole\u010dnosti. Stav potvrzuje prof. MUDr. Robert Lischke, p\u0159ednosta III. chirurgick\u00e9 kliniky 1. LF UK a FN Motol. Podle n\u011bj se nyn\u00ed karcinom plic operuje na 21 pracovi\u0161t\u00edch, p\u0159esto\u017ee by se tak m\u011blo d\u00edt v sedmi specializovan\u00fdch centrech. Asi 40 % pacient\u016f se tedy ocit\u00e1 \u201emimo\u201c. <\/p>\n\n\n\n

\u201ePneumoonkochirurgick\u00fdch center je p\u0159itom dostatek. Pro srovn\u00e1n\u00ed v D\u00e1nsku s necelou \u0161estimilionovou populac\u00ed jsou obdobn\u00e1 centra dv\u011b a v Norsku dokonce jedno. Zda bude l\u00e9\u010dba pacienta \u00fasp\u011b\u0161n\u00e1, z\u00e1le\u017e\u00ed do velk\u00e9 m\u00edry na zku\u0161enosti odborn\u00edk\u016f. Tato zku\u0161enost p\u0159ich\u00e1z\u00ed s t\u00edm, \u017ee se dan\u00fdch operac\u00ed d\u011bl\u00e1 na pracovi\u0161ti hodn\u011b. Z poznatk\u016f ze zahrani\u010dn\u00ed v\u00edme, \u017ee vy\u0161\u0161\u00ed \u00fasp\u011b\u0161nost maj\u00ed ta odd\u011blen\u00ed, kde se soust\u0159ed\u00ed na konkr\u00e9tn\u00ed typ z\u00e1krok\u016f. M\u011b\u0159\u00edtkem nen\u00ed jen m\u00edra \u00famrtnosti, ale tak\u00e9 kvalita \u017eivota po operaci, n\u00e1sledn\u00e9 komplikace, bolest, jak dlouho trv\u00e1 rehabilitace a v jak\u00e9m stavu pacient vstupuje do dal\u0161\u00ed onkologick\u00e9 l\u00e9\u010dby,\u201c<\/em> vysv\u011btluje prof. Lischke. Podle n\u011bj je centralizovan\u00e1 l\u00e9\u010dba pro zdravotn\u00ed syst\u00e9m levn\u011bj\u0161\u00ed a za n\u011bkolik let k n\u00ed stejn\u011b dojde. \u201eZnakem kvalitn\u00edho centra se v brzk\u00e9 budoucnosti stane nap\u0159\u00edklad to, zda pou\u017e\u00edv\u00e1 pro operaci karcinomu plic robotick\u00e9 syst\u00e9my,\u201c <\/em>dod\u00e1v\u00e1.<\/p>\n\n\n\n

Ned\u00edlnou sou\u010d\u00e1st\u00ed specializovan\u00fdch center jsou zku\u0161en\u00e9 bronchoskopick\u00e9 t\u00fdmy, kter\u00e9 v\u00ed, jak a kde ide\u00e1ln\u011b odebrat vzorek n\u00e1doru, aby jej bylo mo\u017en\u00e9 d\u016fkladn\u011b prozkoumat. \u201eJe to um\u011bn\u00ed a je pot\u0159eba, aby bylo bronchoskopick\u00e9 odd\u011blen\u00ed vybaveno kvalitn\u00edmi n\u00e1stroji a m\u011blo \u0161ikovn\u00e9, zku\u0161en\u00e9 l\u00e9ka\u0159e,\u201c <\/em>\u0159\u00edk\u00e1 prof. MUDr. Jana Sk\u0159i\u010dkov\u00e1, p\u0159edsedkyn\u011b pneumoonkologick\u00e9 sekce \u010cPFS. Podle n\u00ed se d\u00edky nov\u00fdm terapi\u00edm \u017eivot pacient\u016f s rakovinou plic, a to i v neoperovateln\u00fdch stadi\u00edch, p\u0159ehoupl p\u0159es hranici 40 m\u011bs\u00edc\u016f v dobr\u00e9 kvalit\u011b. \u201eNeust\u00e1le p\u0159ich\u00e1zej\u00ed nov\u00e9 verze l\u00e9k\u016f, kter\u00e9 dob\u0159e dopl\u0148uj\u00ed st\u00e1vaj\u00edc\u00ed terapie, kombinuje se imunoterapie s chemoterapi\u00ed a biologickou l\u00e9\u010dbou. Abychom v\u0161ak u pacient\u016f dos\u00e1hli co nejlep\u0161\u00edho \u00fa\u010dinku, mus\u00edme n\u00e1dor spr\u00e1vn\u011b vy\u0161et\u0159it a poradit se v \u0161ir\u0161\u00edm t\u00fdmu l\u00e9ka\u0159\u016f r\u016fzn\u00fdch obor\u016f, jak l\u00e9\u010dbu v\u00e9st. Toho lze dos\u00e1hnout pouze v centrech vysoce specializovan\u00e9 pneumoonkochirurgick\u00e9 p\u00e9\u010de,\u201c<\/em> dod\u00e1v\u00e1 prof. Sk\u0159i\u010dkov\u00e1.<\/p>\n\n\n\n

V \u010cR v pr\u016fm\u011bru ka\u017edoro\u010dn\u011b rakovinou plic onemocn\u00ed p\u0159ibli\u017en\u011b 6 600 lid\u00ed a t\u00e9m\u011b\u0159 5 400 na ni zem\u0159e. Drtiv\u00e1 v\u011bt\u0161ina p\u0159ich\u00e1z\u00ed k l\u00e9ka\u0159i pozd\u011b, tedy v okam\u017eiku, kdy nelze onemocn\u011bn\u00ed vyl\u00e9\u010dit. To m\u00e1 zm\u011bnit nov\u011b spu\u0161t\u011bn\u00fd program \u010dasn\u00e9ho z\u00e1chytu karcinomu plic<\/strong>. Garantem je Ministerstvo zdravotnictv\u00ed a na proveden\u00ed se pod\u00edl\u00ed N\u00e1rodn\u00ed screeningov\u00e9 centrum \u00dastavu zdravotnick\u00fdch informac\u00ed a statistiky \u010cR s odborn\u00fdmi spole\u010dnostmi a dal\u0161\u00edmi institucemi. Pilotn\u00ed f\u00e1ze projektu potrv\u00e1 p\u011bt let a l\u00e9ka\u0159i si od n\u00ed slibuj\u00ed zv\u00fd\u0161en\u00ed pod\u00edlu pacient\u016f, kter\u00fdm lze n\u00e1dor operativn\u011b odstranit, ze sou\u010dasn\u00fdch 15 % a\u017e na 50 %. \u201eJi\u017e v prvn\u00edch m\u011bs\u00edc\u00edch pro\u0161lo programem p\u0159es 400 jedinc\u016f, kte\u0159\u00ed splnili krit\u00e9ria, jejich pr\u016fm\u011brn\u00fd v\u011bk \u010dinil 63 let. U 5,2 % v\u00fdsledek ukazoval na riziko n\u00e1doru, u 25,9 % vyk\u00e1zalo vy\u0161et\u0159en\u00ed zat\u00edm neur\u010dit\u00fd v\u00fdsledek a 68,8 % bylo v prvn\u00ed vln\u011b negativn\u00ed,\u201c <\/em>popisuje prof. Koziar Va\u0161\u00e1kov\u00e1. Podle prim. MUDr. Ivany \u010ciern\u00e9 Peterov\u00e9 z \u010cesk\u00e9ho ob\u010dansk\u00e9ho spolku proti plicn\u00edm nemocem a p\u0159edsedkyn\u011b Sekce ambulantn\u00edch pneumolog\u016f \u010cPFS se zapojilo 323 plicn\u00edch a 500 praktick\u00fdch l\u00e9ka\u0159\u016f. \u201eP\u0159edpokl\u00e1d\u00e1me, \u017ee v prvn\u00edch letech vy\u0161et\u0159\u00edme v r\u00e1mci programu des\u00edtky tis\u00edc osob,<\/em> \u0159ad\u011b z nich to zachr\u00e1n\u00ed \u017eivot<\/em>,\u201c dod\u00e1v\u00e1 MUDr. \u010ciern\u00e1 Peterov\u00e1.<\/p>\n\n\n\n

Plicn\u00ed l\u00e9ka\u0159i pos\u00edlaj\u00ed rizikov\u00e9 pacienty na akreditovan\u00e1 radiologick\u00e1 pracovi\u0161t\u011b k vy\u0161et\u0159en\u00ed n\u00edzkod\u00e1vkov\u00fdm CT. Pokud objev\u00ed podez\u0159el\u00fd n\u00e1lez, n\u00e1sleduj\u00ed dal\u0161\u00ed vy\u0161et\u0159en\u00ed a porada tzv. multidisciplin\u00e1rn\u00edho t\u00fdmu, jak\u00fd postup nejl\u00e9pe zvolit. Zapojeni jsou tak\u00e9 prakti\u010dt\u00ed l\u00e9ka\u0159i, kte\u0159\u00ed k pneumologovi pos\u00edlaj\u00ed ty, jim\u017e je mezi 55 a 74 lety a kou\u0159\u00ed bu\u010f po dobu 20 let asi 20 cigaret denn\u011b, nebo 10 let p\u0159ibli\u017en\u011b 40 cigaret za den.<\/p>\n\n\n\n

\u201eProgram se teprve rozb\u00edh\u00e1, zat\u00edm na na\u0161em pracovi\u0161ti prov\u00e1d\u00edme v pr\u016fm\u011bru \u010dty\u0159i vy\u0161et\u0159en\u00ed t\u00fddn\u011b. Celkem jsme vy\u0161et\u0159ili 40 lid\u00ed, n\u00e1dor m\u011bl jeden z nich. U p\u0159ibli\u017en\u011b t\u0159\u00ed \u010dtvrtin jsme na\u0161li tzv. plicn\u00ed uzly, v\u011bt\u0161inou drobn\u00e9 a nezhoubn\u00e9. To ale neznamen\u00e1, \u017ee n\u011bkter\u00fd z nich nem\u016f\u017ee b\u00fdt zat\u00edm neodhalen\u00fdm po\u010d\u00e1te\u010dn\u00edm stadiem n\u00e1doru, proto sledujeme jejich v\u00fdvoj na kontroln\u00edch vy\u0161et\u0159en\u00edch. V p\u0159\u00edpad\u011b, \u017ee je uzel v\u011bt\u0161\u00ed ne\u017e jeden centimetr nebo roste, riziko malignity stoup\u00e1 a je t\u0159eba prov\u00e9st podrobn\u011bj\u0161\u00ed a n\u00e1ro\u010dn\u011bj\u0161\u00ed vy\u0161et\u0159en\u00ed, kter\u00e9 up\u0159esn\u00ed jeho podstatu, nap\u0159\u00edklad biopsii. U ku\u0159\u00e1ku je v\u00fdskyt uzl\u016f \u010dast\u011bj\u0161\u00ed,\u201c<\/em> popisuje prim. doc. MUDr. Hynek M\u00edrka, Ph.D., prim\u00e1\u0159 Kliniky zobrazovac\u00edch metod FN Plze\u0148 a z\u00e1stupce Radiologick\u00e9 spole\u010dnosti \u010cLS JEP pro program. Vy\u0161et\u0159en\u00ed prov\u00e1d\u00ed 13 akreditovan\u00fdch radiologick\u00fdch pracovi\u0161\u0165, dal\u0161\u00edch 9 dostalo nov\u011b akreditaci v \u010dervenci. Snahou je, aby s\u00ed\u0165 m\u00edst, kde lze CT vy\u0161et\u0159en\u00ed podstoupit, byla rovnom\u011brn\u011b rozlo\u017een\u00e1.<\/p>\n\n\n\n

P\u0159esn\u011b 29 rizikov\u00fdch pacient\u016f, z toho 8 \u017een a 21 mu\u017e\u016f, vy\u0161et\u0159ili od \u00fanora do po\u010d\u00e1tku \u010dervna l\u00e9ka\u0159i na Plicn\u00ed klinice fakultn\u00ed nemocnice v Hradci Kr\u00e1lov\u00e9 \u2013 pouze 11 (40 %) z nich m\u011blo respira\u010dn\u00ed syst\u00e9m zcela v po\u0159\u00e1dku. \u201eV\u011bt\u0161ina (17; 60 %) t\u011bchto dosud zdrav\u00fdch osob trp\u00ed n\u011bjak\u00fdm respira\u010dn\u00edm posti\u017een\u00edm, kter\u00e9 jsme pr\u00e1v\u011b d\u00edky screeningu na\u0161li. U dvou pacient\u016f jsme nov\u011b diagnostikovali plicn\u00ed n\u00e1dor ur\u010den\u00fd k rychl\u00e9 opera\u010dn\u00ed l\u00e9\u010db\u011b, u t\u0159\u00ed pacient\u016f jsme objevili bronchiekt\u00e1zie \u2013 z\u00e1n\u011btlivou destrukci st\u011bny pr\u016fdu\u0161ek.<\/em> <\/em>P\u011bt osob m\u00e1 nejasn\u00fd n\u00e1lez nevylu\u010duj\u00edc\u00ed drobn\u00fd n\u00e1dor pl\u00edce \u010di jin\u00e9 plicn\u00ed posti\u017een\u00ed, u deseti se nov\u011b nalezlo chronick\u00e9 onemocn\u011bn\u00ed pr\u016fdu\u0161ek typu astma nebo CHOPN a u dvou pacient\u016f posti\u017een\u00ed pohrudnice. U jednoho pacienta byly nalezeny zv\u011bt\u0161en\u00e9 lymfatick\u00e9 uzliny v hrudn\u00edku, jejich\u017e p\u0159\u00ed\u010dina se nyn\u00ed akutn\u011b do\u0161et\u0159uje. Nov\u011b zji\u0161t\u011bn\u00e1 onemocn\u011bn\u00ed respira\u010dn\u00edho syst\u00e9mu se r\u016fzn\u011b kombinovala,\u201c<\/em> popisuje doc. MUDr. Vladim\u00edr Kobl\u00ed\u017eek, p\u0159ednosta Plicn\u00ed kliniky Fakultn\u00ed nemocnice a LF UK v Hradci Kr\u00e1lov\u00e9. Pr\u016fm\u011brn\u00fd v\u011bk vy\u0161et\u0159en\u00fdch pacient\u016f \u010dinil 63,8 let. Rakovinu plic m\u00e1 z 90 % na sv\u011bdom\u00ed kou\u0159en\u00ed. \u201eKu\u0159\u00e1ci by se nem\u011bli b\u00e1t po\u017e\u00e1dat sv\u00e9ho praktika nebo pneumologa, aby je rovnou odeslal na n\u00edzkod\u00e1vkov\u00e9 CT,\u201c<\/em> dod\u00e1v\u00e1 MUDr. Marcela Koudelkov\u00e1, projektov\u00e1 mana\u017eerka N\u00e1rodn\u00edho screeningov\u00e9ho centra \u00daZIS \u010cR. Informace o programu \u010dasn\u00e9ho z\u00e1chytu karcinomu plic lze nal\u00e9zt na https:\/\/prevenceproplice.cz<\/a>. Seznam pneumoonkochirurgick\u00fdch center je na: www.mzcr.cz\/cvs-pneumoonkochirurgicke-pece<\/a>.<\/p>\n\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

I tak z\u00e1va\u017en\u00e9 onemocn\u011bn\u00ed jako je rakovina plic, nemus\u00ed znamenat rozsudek smrti. Z\u00e1le\u017e\u00ed na rychlosti diagn\u00f3zy, ale tak\u00e9 na tom, kde se pacient l\u00e9\u010d\u00ed. Nejv\u011bt\u0161\u00ed […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":27092,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-38648","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zdravi"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/38648","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=38648"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/38648\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/27092"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=38648"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=38648"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=38648"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}