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Radiotherapy

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Radiotherapy

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Radiotherapy

  1. 1. Ossama Anjak, AECS. PO BOX6091Damascys Page 1  ‫א‬‫א‬ Radiotherapy ‫ﻤﻘـﺩﻤـﺔ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﺃﻨﻭﺍﻉ‬ ‫ﺍﻹﺸﻌﺎﻋﻲ‬ ‫ﺍﻟﻌﻼﺝ‬ ‫ﺃﻨﻭﺍﻉ‬ ‫ﺍﻟﺩﺍﺨﻠﻲ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﺍﻟﺨﺎﺭﺠﻲ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﻟﻠﻤﻌﺎﻟﺠﺔ‬ ‫ﺍﻟﺘﺨﻁﻴﻁ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺃﺜﻨﺎﺀ‬ ‫ﺍﻟﻌﻨﺎﻴﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻲ‬ ‫ﻟﻠﻌﻼﺝ‬ ‫ﺍﻟﺠﺎﻨﺒﻴﺔ‬ ‫ﺍﻟﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﺍﻟﺠﺎﻨﺒﻴﺔ‬ ‫ﺍﻟﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﺇﺩﺍﺭﺓ‬ ‫ﻤﺭﺍﺠﻌﺔ‬‫ﺍﻟﻤﻌﺎﻟﺞ‬ ‫ﺍﻟﻁﺒﻴﺏ‬ ‫ﺍﻹﺸﻌﺎﻋﻲ‬ ‫ﻟﻠﻌﻼﺝ‬ ‫ﺍﻟﻤﺘﺄﺨﺭﺓ‬ ‫ﺍﻟﻤﻀﺎﻋﻔﺎﺕ‬
  2. 2. Ossama Anjak, AECS. PO BOX6091Damascys Page 2  ‫א‬‫א‬ Radiotherapy ‫ﻤﻘـﺩﻤـﺔ‬ ‫ﺍﻟﻁﺒﻴﺔ‬ ‫ﺍﻟﺘﻁﺒﻴﻘﺎﺕ‬ ‫ﺃﻫﻡ‬ ‫ﺃﺤﺩ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺘﻌﺩ‬‫ﺍﻟﻤﺨﺘﻠﻔﺔ‬‫ﺍﻟﻤﺅﻴﻥ‬ ‫ﻟﻺﺸﻌﺎﻉ‬‫ﻴﺴﺘﺨﺩﻡ‬ ‫ﺤﻴﺙ‬‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﺍﻟﻤﺅﻴﻥ‬،‫ﺍﻷﻭﺭﺍﻡ‬ ‫ﻭﻤﻌﺎﻟﺠﺔ‬ ‫ﺍﻟﺴﺭﻁﺎﻨﻴﺔ‬ ‫ﺍﻟﺨﻼﻴﺎ‬ ‫ﻨﻴﺔ‬‫ﺒ‬ ‫ﺘﻘﻭﻴﺽ‬ ‫ﻓﻲ‬،‫ﺍﻟﻤﺸﻌﺔ‬ ‫ﺍﻟﻨﻅﺎﺌﺭ‬ ‫ﻭ‬ ‫ﺍﻟﻌﻨﺎﺼﺭ‬ ‫ﺒﺎﺴﺘﺨﺩﺍﻡ‬ ‫ﺴﻭﺍﺀ‬ ‫ﺃﻭ‬‫ﺒﺎﺴﺘﺨﺩﺍﻡ‬‫ﺃﺸﻌﺔ‬-X‫ﻋﺎﻟﻴ‬‫ﺔ‬‫ﺍﻟﻁﺎﻗﺔ‬‫ﻭﺘﺴﻠﻴﻁﻬ‬‫ﺎ‬،‫ﹰ‬‫ﺎ‬‫ﻨﻬﺎﺌﻴ‬ ‫ﻋﻠﻴﻬﺎ‬ ‫ﺍﻟﻘﻀﺎﺀ‬ ‫ﻐﻴﺔ‬‫ﺒ‬ ،‫ﺍﻟﻭﺭﻤﻴﺔ‬ ‫ﺍﻟﺨﻼﻴﺎ‬ ‫ﻭ‬ ‫ﺍﻷﻨﺴﺠﺔ‬ ‫ﻋﻠﻰ‬ ‫ﻟ‬ ‫ﺍﻟﻭﺭﻡ‬ ‫ﻜﺘﻠﺔ‬ ‫ﺘﻘﻠﻴﺹ‬ ‫ﺃﻭ‬‫ﻭ‬ ،‫ﺘﻘﺩﻴﺭ‬ ‫ﺃﻗل‬ ‫ﻋﻠﻰ‬ ‫ﺘﺄﺜﻴﺭﺍﺘﻪ‬ ‫ﺘﺨﻔﻴﻑ‬‫ﺍﻟﻤﻭﻟـﺩﺓ‬ ‫ﺍﻟﺴـﻴﻨﻴﺔ‬ ‫ﺍﻷﺸـﻌﺔ‬ ‫ﺍﺴـﺘﺨﺩﺍﻡ‬ ‫ﻴﺘﻡ‬ ‫ﹰ‬‫ﺎ‬‫ﺘﻘﻠﻴﺩﻴ‬ ‫ﻟﻺﺸ‬ ‫ﻜﻤﺼﺩﺭ‬ ‫ﺍﻟﻜﺘﺭﻭﻨﻴﺎ‬‫ﺃﻀﻌﺎﻑ‬ ‫ﻋﺎﻟﻴﺔ‬ ‫ﺒﺠﺭﻋﺎﺕ‬ ،‫ﻌﺎﻉ‬‫ﺘﻠﻙ‬‫ﺇﻟـﻰ‬ ‫ﺇﻀـﺎﻓﺔ‬ ،‫ﺍﻟﺘﺼﻭﻴﺭﻴﺔ‬ ‫ﺒﺎﻷﺠﻬﺯﺓ‬ ‫ﺍﻟﻤﺴﺘﺨﺩﻤﺔ‬ ‫ﺃﺸﻌﺔ‬ ‫ﻤﺜل‬ ،‫ﺃﺨﺭﻯ‬ ‫ﻤﺼﺎﺩﺭ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬‫ﻏ‬‫ﺎﻤﺎ‬)‫ﺍﻟﻜﻭﺒﺎﻟﺕ‬ ‫ﻋﻥ‬ ‫ﺍﻟﺼﺎﺩﺭﺓ‬-60‫ﺍﻟﺴﻴﺯﻴﻭﻡ‬ ‫ﺃﻭ‬-137(‫ﺍﻟﻨ‬ ‫ﺃﻭ‬‫ﻴﻭﺘﺭﻭﻨﺎﺕ‬ ‫ﺍﻹﻟﻜﺘﺭﻭﻨﺎﺕ‬ ‫ﺃﻭ‬ ،‫ﺍﻟﺒﺭﻭﺘﻭﻨﺎﺕ‬ ‫ﺃﻭ‬‫ﻓـﻲ‬ ،‫ﺍﻟﺴﺭﻁﺎﻥ‬ ‫ﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﻟﺘﻁﺒﻴﻘﺎﺕ‬ ‫ﺍﻟﻭﺍﺴﻊ‬ ‫ﺍﻻﺴﺘﺨﺩﺍﻡ‬ ‫ﺴﺎﻫﻡ‬ ‫ﻗﺩ‬ ‫ﻭ‬ ، ‫ﺍﺭﺘ‬‫ﺍﻷﻭﺭﺍﻡ‬ ‫ﻤﻥ‬ ‫ﻟﻠﻌﺩﻴﺩ‬ ‫ﺍﻟﻔﻌﺎﻟﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺎﺕ‬ ‫ﺃﻫﻡ‬ ‫ﻤﻥ‬ ‫ﹸﻌﺩ‬‫ﺘ‬ ‫ﻭ‬ ،‫ﺍﻟﻨﺠﺎﺓ‬ ‫ﻓﺘﺭﺍﺕ‬ ‫ﺍﻤﺘﺩﺍﺩ‬ ‫ﻭ‬ ‫ﻜﺒﻴﺭ‬ ‫ﺒﺸﻜل‬ ‫ﺍﻟﺸﻔﺎﺀ‬ ‫ﻨﺴﺏ‬ ‫ﻔﺎﻉ‬ ‫ﺍﻟﺠﺴﻡ‬ ‫ﺃﺠﺯﺍﺀ‬ ‫ﺒﺄﻏﻠﺏ‬ ‫ﺍﻟﻨﺎﺸﺌﺔ‬. ‫ﻫﺫﻩ‬ ‫ﻓﺎﻋﻠﻴﺔ‬ ‫ﺘﻜﻤﻥ‬ ‫ﻭ‬‫ﺍﻟ‬‫ﻤ‬‫ﻌ‬‫ﺎﻟﺠﺔ‬‫ﺒﺎﻟﺨﻼﻴـﺎ‬ ‫ﺍﻟﻨـﻭﻭﻱ‬ ‫ﺍﻟﺤﻤﺽ‬ ‫ﺘﻔﺘﻴﺕ‬ ‫ﻭ‬ ‫ﺘﺩﻤﻴﺭ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﻤﻘﺩﺭﺓ‬ ‫ﻓﻲ‬ ‫ﺘ‬ ‫ﺍﻟﺘﻲ‬ ‫ﺍﻟﻜﻴﻤﻴﺎﺌﻴﺔ‬ ‫ﺍﻟﻤﺎﺩﺓ‬ ‫ﻭﻫﻭ‬ ،‫ﺍﻟﺴﺭﻁﺎﻨﻴﺔ‬‫ﺍﻟﺤﻴﻭﻴﺔ‬ ‫ﺍﻟﻌﻤﻠﻴﺎﺕ‬ ‫ﻓﻲ‬ ‫ﻭﺘﺘﺤﻜﻡ‬ ،‫ﺍﻟﻭﺭﺍﺜﻴﺔ‬ ‫ﻭﺍﻟﺸﻔﺭﺍﺕ‬ ‫ﺍﻟﻤﻌﻠﻭﻤﺎﺕ‬ ‫ﺤﻤل‬ ‫ﺒـﻭﺘﻴﺭﺓ‬ ‫ﻭﺘﺘﻜﺎﺜﺭ‬ ‫ﺘﻨﻤﻭ‬ ‫ﺍﻟﺘﻲ‬ ‫ﻓﺎﻟﺨﻼﻴﺎ‬ ‫ﻋﺎﻤﺔ‬ ‫ﻭﺒﺼﻔﺔ‬ ،‫ﺍﻟﺨﻠﻭﻴﺔ‬ ‫ﺍﻟﻭﻅﺎﺌﻑ‬ ‫ﻤﺨﺘﻠﻑ‬ ‫ﻭﺃﺩﺍﺀ‬ ،‫ﻭﺍﻟﻨﻤﻭ‬ ‫ﻟﻠﺘﻜﺎﺜﺭ‬ ‫ﺍﻟﻼﺯﻤﺔ‬ ،‫ﺴﺭﻴﻌﺔ‬‫ﻓﻲ‬ ‫ﺍﻟﺤﺎل‬ ‫ﻫﻭ‬ ‫ﻜﻤﺎ‬،‫ﺘـﺄﺜﺭﺍ‬ ‫ﻭﺃﺸـﺩ‬ ‫ﺍﻹﺸـﻌﺎﻉ‬ ‫ﻤﻔﻌـﻭل‬ ‫ﺘﺠﺎﻩ‬ ‫ﺤﺴﺎﺴﻴﺔ‬ ‫ﺃﻜﺜﺭ‬ ‫ﻫﻲ‬ ،‫ﺍﻟﺴﺭﻁﺎﻨﻴﺔ‬ ‫ﺍﻟﺨﻼﻴﺎ‬ ‫ﺍﻟ‬ ‫ﻭﺒﻁﺒﻴﻌﺔ‬،‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺃﺜﻨﺎﺀ‬ ‫ﻭﻗﺎﺌﻴﺔ‬ ‫ﺘﺩﺍﺒﻴﺭ‬ ‫ﺘﺘﺨﺫ‬ ،‫ﺤﺎل‬‫ﻨﺘﺠﻨﺏ‬ ‫ﻜﻲ‬‫ﻤـﻥ‬ ‫ﻤﻤﻜـﻥ‬ ‫ﻡ‬‫ﻜـ‬ ‫ﺍﻜﺒﺭ‬ ‫ﺘﻌﺭﺽ‬ ‫ﻭ‬ ‫ﻭﺍﻗﻴﺔ‬ ‫ﺩﺭﻭﻉ‬ ‫ﺒﺎﺴﺘﺨﺩﺍﻡ‬ ‫ﺤﻤﺎﻴﺘﻬﺎ‬ ‫ﻋﺎﺩﺓ‬ ‫ﺘﺘﻡ‬ ‫ﻭ‬ ،‫ﻟﻺﺸﻌﺎﻉ‬ ‫ﺍﻟﺴﻠﻴﻤﺔ‬ ‫ﺍﻟﻁﺒﻴﻌﻴﺔ‬ ‫ﻭﺍﻷﻋﻀﺎﺀ‬ ‫ﺍﻷﻨﺴﺠﺔ‬‫ﻤﺨﺘﻠﻔﺔ‬ ‫ﺘﻘﻨﻴﺎﺕ‬، ‫ﺍﻻ‬ ‫ﻫﺫﻩ‬ ‫ﻤﺜل‬ ‫ﻤﻥ‬ ‫ﺒﺎﻟﺭﻏﻡ‬ ‫ﻭ‬‫ﻭ‬ ‫ﺒﺎﻹﺸﻌﺎﻉ‬ ‫ﺘﺘﺄﺜﺭ‬ ‫ﺍﻟﻁﺒﻴﻌﻴﺔ‬ ‫ﺍﻟﺨﻼﻴﺎ‬ ‫ﺒﻌﺽ‬ ‫ﺃﻥ‬ ‫ﺇﻻ‬ ،‫ﺤﺘﻴﺎﻁﺎﺕ‬‫ﻗﺎﺩﺭﺓ‬ ‫ﻋﻤﻭﻤﺎ‬ ‫ﻜﺎﻨﺕ‬ ‫ﺇﻥ‬ ‫ﺍﻷﻀﺭﺍﺭ‬ ‫ﺘﺭﻤﻴﻡ‬ ‫ﻭ‬ ‫ﻹﺼﻼﺡ‬ ‫ﺍﻟﻁﺒﻴﻌﻴﺔ‬ ‫ﺍﻟﺠﺴﻡ‬ ‫ﺘﻘﻨﻴﺎﺕ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬ ‫ﻋﻠﻰ‬ ‫ﻟﻤﻘﺩﺭﺘﻬﺎ‬ ‫ﻨﻅﺭﺍ‬ ،‫ﺍﻜﺒﺭ‬ ‫ﺒﺤﻴﻭﻴﺔ‬ ‫ﺍﻟﺘﻌﺎﻓﻲ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻨﻭﻭﻱ‬ ‫ﺍﻟﺤﻤﺽ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻭﺍﻗﻌﺔ‬. ‫ﻭ‬‫ﹸ‬‫ﺘ‬‫ﺍﻟ‬ ‫ﻌﺩ‬‫ﻤ‬‫ﻌﺎ‬‫ﻟ‬‫ﺠ‬‫ﺔ‬‫ﺍﻹﺸﻌﺎﻋﻴ‬‫ﺔ‬‫ﹰ‬‫ﺎ‬‫ﻋﻼﺠ‬‫ﹰ‬‫ﺎ‬‫ﻤﻭﻀﻌﻴ‬،‫ﺇﺠﺭﺍﺀ‬ ‫ﻋﻨﺩ‬ ‫ﺍﻟﺤﺎل‬ ‫ﻫﻭ‬ ‫ﻜﻤﺎ‬‫ﺍﻟﺠﺭﺍﺤﺔ‬)‫ﺍﻟ‬ ‫ﻭﺒﺨـﻼﻑ‬‫ﻤ‬‫ﻌ‬‫ﺎﻟﺠـﺔ‬ ‫ﺍﻟﻜﻴﻤ‬‫ﻴ‬‫ﺎ‬‫ﺌﻴﺔ‬(‫ﻴﺘ‬ ‫ﻗﺩ‬ ‫ﻭ‬ ،‫ﻗﺩ‬ ‫ﻭ‬ ،‫ﺍﻷﺨﺭﻯ‬ ‫ﺍﻷﻭﺭﺍﻡ‬ ‫ﻋﻼﺠﺎﺕ‬ ‫ﻤﻊ‬ ‫ﻤﺸﺘﺭﻜﺔ‬ ‫ﺒﺼﻔﺔ‬ ‫ﺃﻭ‬ ،‫ﻭﺤﻴﺩ‬ ‫ﻜﻌﻼﺝ‬ ‫ﹰ‬‫ﺍ‬‫ﻤﻨﻔﺭﺩ‬ ‫ﺍﺴﺘﺨﺩﺍﻤﻪ‬ ‫ﻡ‬ ‫ﻤﻊ‬ ‫ﻤﺸﺘﺭﻜﺎ‬ ‫ﺃﻭ‬ ‫ﻤﻨﻔﺭﺩﺍ‬ ‫ﺴﻭﺍﺀ‬ ،‫ﻭﺃﺴﺎﺴﻲ‬ ‫ﺃﻭﻟﻲ‬ ‫ﻜﻌﻼﺝ‬ ‫ﺍﻷﻭﺭﺍﻡ‬ ‫ﺒﻌﺽ‬ ‫ﻋﻨﺩ‬ ‫ﺍﻟﺠﺭﺍﺤﺔ‬ ‫ﻋﻥ‬ ‫ﹰ‬‫ﻼ‬‫ﺒﺩﻴ‬ ‫ﻴﻭﺼﻑ‬‫ﺍﻟ‬‫ﻤ‬‫ﻌ‬‫ﺎﻟﺠﺔ‬ ‫ﺍﻟﻜﻴﻤ‬‫ﻴ‬‫ﺎ‬‫ﺌﻴﺔ‬‫ﺒـﺎﻟ‬ ‫ﻌﺭﻑ‬‫ﻴ‬ ‫ﻓﻴﻤﺎ‬ ،‫ﻟﻸﻭﺭﺍﻡ‬ ‫ﺍﻟﺠﺭﺍﺤﻴﺔ‬ ‫ﺒﺎﻟﻌﻤﻠﻴﺎﺕ‬ ‫ﺍﻟﻤﺒﺎﺸﺭﺓ‬ ‫ﻗﺒل‬ ‫ﺍﺴﺘﺨﺩﺍﻤﻪ‬ ‫ﻴﺘﻡ‬ ‫ﻗﺩ‬ ‫ﻜﻤﺎ‬ ،‫ﺍﻟﻤﺒـﺩﺌﻲ‬ ‫ﻌﻼﺝ‬ ‫ﺍﻟﻤﺴﺎﻋﺩ‬)neoadjuvant therapy(‫ﻋﻘـﺏ‬ ‫ﺍﺴﺘﺨﺩﺍﻤﻪ‬ ‫ﻴﺘﻡ‬ ‫ﺃﻭ‬ ،‫ﺍﺴﺘﺌﺼﺎﻟﻪ‬ ‫ﻟﺘﺴﻬﻴل‬ ‫ﺍﻟﻭﺭﻡ‬ ‫ﺤﺠﻡ‬ ‫ﺘﻘﻠﻴﺹ‬ ‫ﻐﻴﺔ‬‫ﺒ‬ ‫ﻀﺎﻑ‬‫ﻤ‬ ‫ﻜﻌﻼﺝ‬ ‫ﺍﻻﺴﺘﺌﺼﺎل‬ ‫ﺠﺭﺍﺤﺎﺕ‬)adjuvanttherapy(‫ﻏﻴـﺭ‬ ‫ﻭﺭﻤﻴـﺔ‬ ‫ﺨﻼﻴﺎ‬ ‫ﺃﻴﺔ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻘﻀﺎﺀ‬ ‫ﻐﻴﺔ‬‫ﺒ‬
  3. 3. Ossama Anjak, AECS. PO BOX6091Damascys Page 3  ،‫ﺍﻟﻭﺭﻤﻲ‬ ‫ﻟﻠﻨﺴﻴﺞ‬ ‫ﺍﻟﺘﺎﻡ‬ ‫ﺍﻻﺴﺘﺌﺼﺎل‬ ‫ﺘﻌﺫﺭ‬ ‫ﻋﻨﺩ‬ ‫ﺃﻭ‬ ،‫ﻤﺘﺒﻘﻴﺔ‬ ‫ﺘﻜﻭﻥ‬ ‫ﻗﺩ‬ ‫ﺯﺓ‬‫ﻴ‬‫ﻤﻤ‬‫ﺍﻟﺤـﺎﻻﺕ‬ ‫ﺒﻌﺽ‬ ‫ﻋﻨﺩ‬ ‫ﻴﻭﺼﻑ‬ ‫ﻗﺩ‬ ‫ﻭ‬ ‫ﻓﺤﺴﺏ‬ ‫ﹼﻥ‬‫ﻜ‬‫ﺴ‬‫ﻤ‬ ‫ﻜﻌﻼﺝ‬ ‫ﺍﻷﻋﺭﺍﺽ‬ ‫ﺘﺨﻔﻴﻑ‬ ‫ﺒﻐﺭﺽ‬)‫ﺃﻭ‬ ‫ﺍﻷﻟﻡ‬ ‫ﺘﺨﻔﻴﻑ‬ ‫ﺒل‬ ‫ﺍﻟﺸﻔﺎﺀ‬ ‫ﻟﻴﺱ‬ ‫ﺍﻷﺴﺎﺴﻲ‬ ‫ﻫﺩﻓﻪ‬ ‫ﺃﻥ‬ ‫ﺒﻤﻌﻨﻰ‬ ‫ﺍﻟﻭﺭﻡ‬ ‫ﻜﺘﻠﺔ‬ ‫ﻟﺤﺠﻡ‬ ‫ﺒﺘﻘﻠﻴﺼﻪ‬ ‫ﺫﻟﻙ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﺠﺎﻭﺭﺓ‬ ‫ﺍﻷﻨﺴﺠﺔ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻭﺭﻡ‬ ‫ﻜﺘﻠﺔ‬ ‫ﻀﻐﻁ‬ ‫ﺃﻭ‬ ‫ﺍﻟﻨﺯﻑ‬.( 2.‫ﺍﻹﺸﻌـﺎﻉ‬ ‫ﺃﻨﻭﺍﻉ‬ ‫ﻴ‬‫ﺴﺘﺨﺩﻡ‬‫ﺍﻟﻤﺅﻴﻥ‬ ‫ﺍﻹﺸﻌﺎﻉ‬)ionizing radiation(‫ﻓﻲ‬‫ﺍﻷ‬ ‫ﻤﻌﺎﻟﺠﺔ‬‫ﻭﺭﺍﻡ‬‫ﺍ‬ ‫ﻥ‬‫ﻭ‬‫ﻴﻜـ‬ ‫ﺃﻨﻪ‬ ‫ﺇﺫ‬ ،‫ﺃﺜﻨـﺎﺀ‬ ‫ﻴﻭﻨـﺎﺕ‬ ‫ﻹﺯﺍﺤﺔ‬ ‫ﻨﺘﻴﺠﺔ‬ ‫ﺍﻷﻨﺴﺠﺔ‬ ‫ﺨﻼل‬ ‫ﻋﺒﻭﺭﻩ‬‫ﺸﺤﻨ‬ ‫ﺍﻜﺘﺴﺒﺕ‬ ‫ﺫﺭﺍﺕ‬ ‫ﻫﻲ‬ ‫ﻭﺍﻻﻴﻭﻨﺎﺕ‬ ،‫ﺍﻟﺫﺭﺍﺕ‬ ‫ﻤﻥ‬ ‫ﺍﻻﻟﻜﺘﺭﻭﻨﺎﺕ‬ ‫ﺒﻌﺽ‬‫ﺔ‬ ‫ﻜﻬﺭﺒ‬‫ﺎﺌ‬‫ﺤﻴﻭﻴـﺔ‬ ‫ﺒﺘﻐﻴﺭﺍﺕ‬ ‫ﻴﺘﺴﺒﺏ‬ ‫ﺒﺎﻟﻤﻘﺎﺒل‬ ‫ﻓﺎﻟﺘﺄﻴﻥ‬ ‫ﻫﻨﺎ‬ ‫ﻤﻥ‬ ‫ﻭ‬ ،‫ﺍﻻﻟﻜﺘﺭﻭﻨﺎﺕ‬ ‫ﻷﺤﺩ‬ ‫ﺍﻜﺘﺴﺎﺒﻬﺎ‬ ‫ﺃﻭ‬ ‫ﻓﻘﺩﺍﻨﻬﺎ‬ ‫ﻨﺘﻴﺠﺔ‬ ‫ﻴﺔ‬ ‫ﺍﻟﺨﻠﻴﺔ‬ ‫ﺒﻤﻭﺭﺜﺎﺕ‬‫ﻤﻭﺘﻬﺎ‬ ‫ﺇﻟﻰ‬ ‫ﻴﺅﺩﻱ‬ ‫ﺃﻭ‬. ‫ﺭﺌﻴﺴﻴﻴﻥ‬ ‫ﻨﻭﻋﻴﻥ‬ ‫ﺇﻟﻰ‬ ‫ﺍﻟﻤﺅﻴﻥ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﺘﺼﻨﻴﻑ‬ ‫ﻴﻤﻜﻥ‬ ‫ﻋﺎﻤﺔ‬ ‫ﺒﺼﻔﺔ‬ ‫ﻭ‬: •‫ﺍﻟﻔﻭﺘﻭﻨﺎﺕ‬Photons:‫ﺃﺸﻌﺎﺕ‬ ‫ﻭ‬ ‫ﺍﻟﺴﻴﻨﻴﺔ‬ ‫ﺍﻷﺸﻌﺔ‬ ‫ﺘﺸﻤل‬ ‫ﻭ‬‫ﻏ‬‫ﺎﻤﺎ‬. •‫ﺇﺸﻌﺎﻉ‬‫ﺍﻟﺠﺴﻴﻤﺎﺕ‬particulate radiation:‫ﺍﻟﻨﻴﻭﺘﺭﻭﻨـﺎﺕ‬ ‫ﻭ‬ ‫ﺍﻟﺒﺭﻭﺘﻭﻨﺎﺕ‬ ‫ﻭ‬ ‫ﺍﻻﻟﻜﺘﺭﻭﻨﺎﺕ‬ ‫ﻴﺸﻤل‬ ‫ﻭ‬ ‫ﻭﺠ‬‫ﺃ‬ ‫ﺴﻴﻤﺎﺕ‬‫ﻟﻔﺎ‬Alpha particles‫ﺒﻴﺘﺎ‬ ‫ﻭ‬Beta particles. ‫ﺍﻜﺒـﺭ‬ ‫ﺍﻟﻁﺎﻗﺔ‬ ‫ﻜﺎﻨﺕ‬ ‫ﻜﻠﻤﺎ‬ ‫ﺍﻟﺤﺎل‬ ‫ﺒﻁﺒﻴﻌﺔ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﺅﻴﻥ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻤﺨﺘﻠﻔﺔ‬ ‫ﺍﻷﻨﻭﺍﻉ‬ ‫ﻟﺩﻯ‬ ‫ﺍﻟﻁﺎﻗﺔ‬ ‫ﻜﻤﻴﺔ‬ ‫ﻭﺘﺘﻔﺎﻭﺕ‬ ،‫ﺍﻷﻨﺴﺠﺔ‬ ‫ﺩﺍﺨل‬ ‫ﺍﺨﺘﺭﺍﻗﻪ‬ ‫ﻟﻺﺸﻌﺎﻉ‬ ‫ﻴﻤﻜﻥ‬ ‫ﺍﻟﺫﻱ‬ ‫ﺍﻟﻌﻤﻕ‬ ‫ﺯﺍﺩ‬ ‫ﻜﻠﻤﺎ‬‫ﺍﻟﻨـﻭﻉ‬ ‫ﺍﺨﺘﻴﺎﺭ‬ ‫ﻴﺘﻡ‬ ‫ﺍﻟﻨﻔﺎﺫ‬ ‫ﻋﻠﻰ‬ ‫ﻟﻠﻤﻘﺩﺭﺓ‬ ‫ﺘﺒﻌﺎ‬ ‫ﻭ‬ ‫ﺍﻟﻭﺭﻡ‬ ‫ﻟﻨﻭﻉ‬ ‫ﺍﻟﻤﻼﺌﻤﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺒﺎﻟﻁﺎﻗﺔ‬ ‫ﻭ‬ ‫ﺍﻟﻤﻨﺎﺴﺏ‬‫ﺍﻟﻤﺴﺘﺨﺩﻤﺔ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﺃﻨﻭﺍﻉ‬ ‫ﺘﺸﻤل‬ ‫ﻭ‬ ،‫ﻤﺭﻴﺽ‬ ‫ﻜل‬ ‫ﻋﻨﺩ‬: •‫ﺍﻟﻁﺎﻗﺔ‬ ‫ﻋﺎﻟﻴﺔ‬ ‫ﺍﻟﻔﻭﺘﻭﻨﺎﺕ‬:‫ﺍﻟﻜﻭﺒﺎﻟﺕ‬ ‫ﻤﺜل‬ ‫ﺇﺸﻌﺎﻋﻴﺎ‬ ‫ﻨﺸﻁ‬ ‫ﻋﻨﺼﺭ‬ ‫ﻤﻥ‬ ‫ﺴﻭﺍﺀ‬-60‫ﺍﻟﺴـﻴﺯﻴﻭﻡ‬ ‫ﻭ‬-137، ‫ﻤﻥ‬ ‫ﺃﻭ‬‫ﺘﻭﻟﻴﺩ‬ ‫ﻋﻠﻰ‬ ‫ﻴﻌﻤل‬ ‫ﺨﺎﺹ‬ ‫ﺠﻬﺎﺯ‬‫ﺍﻹﺸﻌﺎﻉ‬‫ﺍﻟﻁﺒﻴﺔ‬ ‫ﺍﻟﺨﻁﻴﺔ‬ ‫ﺍﻟﻤﺴﺭﻋﺎﺕ‬ ‫ﻤﺜل‬ •‫ﺃﺸﻌﺔ‬-X‫ﺍﻟﻁﺎﻗﺔ‬ ‫ﺍﻟﻤﻨﺨﻔﻀﺔ‬:‫ﺃﺸﻌﺔ‬-X‫ﺒ‬ ‫ﺍﻟﻤﻭﻟﺩﺓ‬‫ﺃﺸﻌﺔ‬ ‫ﺘﻭﻟﻴﺩ‬ ‫ﺄﻨﺎﺒﻴﺏ‬-X‫ﺍﻟﺘ‬‫ﻘﻠﻴﺩﻴﺔ‬. •‫ﺍﻹ‬ ‫ﺤﺯﻤﺔ‬‫ﻟﻜﺘﺭﻭﻨﺎﺕ‬Electron beams:‫ﻤﻔﻴﺩﺓ‬ ‫ﻫﻲ‬ ‫ﻭ‬‫ﺍﻟ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬‫ﺨﺎﺭﺠﻴﺔ‬‫ﻭﺍﻵﻓـﺎﺕ‬ ‫ﻟـﻸﻭﺭﺍﻡ‬ ‫ﺍﻟﺠﻠﺩﻴﺔ‬‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﺍﺨﺘﺭﺍﻕ‬ ‫ﻤﻥ‬ ‫ﻋﻤﻴﻘﺎ‬ ‫ﺍﻟﻤﺘﻭﺍﺠﺩﺓ‬ ‫ﺍﻷﻨﺴﺠﺔ‬ ‫ﻴﺤﻤﻲ‬ ‫ﻤﻤﺎ‬ ،‫ﺍﻟﺴﻁﺤﻴﺔ‬ ‫ﺃﻭ‬.‫ﻋﻠﻴﻬـﺎ‬ ‫ﻭﻨﺤﺼل‬ ‫ﻤﻥ‬‫ﺍﻟﻁﺒﻴﺔ‬ ‫ﺍﻟﺨﻁﻴﺔ‬ ‫ﺍﻟﻤﺴﺭﻋﺎﺕ‬‫ﺍﻟﺘﻲ‬‫ﺘ‬‫ﺍﻹﻟﻜﺘﺭﻭﻨﺎﺕ‬ ‫ﺤﺯﻡ‬ ‫ﺘﻭﻟﻴﺩ‬ ‫ﻋﻠﻰ‬ ‫ﻌﻤل‬. •‫ﺍﻟﺒﺭﻭﺘﻭﻨﺎﺕ‬ ‫ﺤﺯﻤﺔ‬Proton beam:‫ﺘﺴـﺒﺏ‬ ‫ﻻ‬ ‫ﺒﺄﻨﻬﺎ‬ ‫ﺘﺘﻤﻴﺯ‬ ‫ﺍﻟﺫﺭﺍﺕ‬ ‫ﻤﻥ‬ ‫ﺃﺠﺯﺍﺀ‬ ‫ﻫﻲ‬ ‫ﺍﻟﺒﺭﻭﺘﻭﻨﺎﺕ‬ ‫ﻭ‬ ‫ﺒﻨﻬﺎﻴﺔ‬ ‫ﺘﻭﺠﺩ‬ ‫ﺍﻟﺘﻲ‬ ‫ﺍﻷﻨﺴﺠﺔ‬ ‫ﺨﻼﻴﺎ‬ ‫ﻋﻠﻰ‬ ‫ﺘﺄﺜﻴﺭﻫﺎ‬ ‫ﻴﺘﺭﻜﺯ‬ ‫ﺒﻴﻨﻤﺎ‬ ،‫ﻋﺒﺭﻫﺎ‬ ‫ﺘﻤﺭ‬ ‫ﺍﻟﺘﻲ‬ ‫ﺒﺎﻷﻨﺴﺠﺔ‬ ‫ﺒﺎﻟﻐﺎ‬ ‫ﻀﺭﺭﺍ‬ ‫ﻤـﻊ‬ ‫ﺍﻟﻭﺭﻤﻴـﺔ‬ ‫ﺍﻟﺨﻼﻴﺎ‬ ‫ﻋﻠﻰ‬ ‫ﻤﻜﺜﻑ‬ ‫ﺇﺸﻌﺎﻋﻲ‬ ‫ﻡ‬‫ﻜ‬ ‫ﺘﺴﻠﻴﻁ‬ ‫ﻓﻲ‬ ‫ﻴﻔﻴﺩ‬ ‫ﻤﻤﺎ‬ ،‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺒﺤﻘل‬ ‫ﺃﺸﻌﺘﻬﺎ‬ ‫ﻤﺴﺎﺭ‬ ‫ﺍﻟﺨﻼ‬ ‫ﺘﻌﺭﺽ‬ ‫ﺘﻘﻠﻴل‬‫ﺍﻟﻤﺠﺎﻭﺭﺓ‬ ‫ﺍﻷﻨﺴﺠﺔ‬ ‫ﻭ‬ ‫ﻴﺎ‬. •‫ﺍﻟﻨﻴﻭﺘﺭﻭﻨﺎﺕ‬ ‫ﺤﺯﻤﺔ‬:‫ﻭﺍﻟﺭﻗﺒـﺔ‬ ‫ﺒـﺎﻟﺭﺃﺱ‬ ‫ﺍﻷﻭﺭﺍﻡ‬ ‫ﺃﻨـﻭﺍﻉ‬ ‫ﺒﻌـﺽ‬ ‫ﻟﻤﻌﺎﻟﺠـﺔ‬ ‫ﺘﺴﺘﺨﺩﻡ‬ ‫ﻋﺎﺩﺓ‬ ‫ﻫﻲ‬ ‫ﻭ‬ ‫ﻭﺍﻟﺒﺭﻭﺴﺘﺎﺘﺔ‬.
  4. 4. Ossama Anjak, AECS. PO BOX6091Damascys Page 4  ‫ﺍﻟ‬ ‫ﻭﺠﺭﻋﺎﺕ‬ ‫ﻤﻌﺩﻻﺕ‬ ‫ﻟﻘﻴﺎﺱ‬ ‫ﺍﻟﻤﺴﺘﺨﺩﻤﺔ‬ ‫ﺍﻟﻭﺤﺩﺍﺕ‬ ‫ﺇﻟﻰ‬ ‫ﺍﻹﺸﺎﺭﺓ‬ ‫ﺍﻟﻤﻔﻴﺩ‬ ‫ﻤﻥ‬ ‫ﺍﻟﺼﺩﺩ‬ ‫ﻭﺒﻬﺫﺍ‬‫ﻤ‬‫ﻌ‬‫ﺎ‬‫ﻟﺠ‬‫ﺔ‬‫ﺍﻹﺸـﻌﺎﻋﻴ‬‫ﺔ‬، ‫ﺍﻟﻘﻴﺎﺱ‬ ‫ﻓﻭﺤﺩﺓ‬‫ﺍﻟ‬ ‫ﻫﻲ‬ ‫ﺍﻷﺴﺎﺴﻴﺔ‬‫ﻐﺭﻱ‬Gy‫ﺍﻟ‬ ‫ﻗﻴﺎﺱ‬ ‫ﻭﺤﺩﺓ‬ ‫ﻭﻫﻲ‬‫ﺍﻟﻤﻤﺘﺼﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺠﺭﻋﺔ‬‫ﺒﺒﺴﺎﻁﺔ‬ ‫ﺘﻌﺒﺭ‬ ‫ﻭﺍﻟﺘﻲ‬ ‫ﻤﻘﺩﺍﺭﻫﺎ‬ ‫ﺍﻟﻁﺎﻗﺔ‬ ‫ﻤﻥ‬ ‫ﻜﻤﻴﺔ‬ ‫ﺍﻤﺘﺼﺎﺹ‬ ‫ﻋﻥ‬1 J)1‫ﺠﻭل‬(‫ﻜﺘﻠﻪ‬ ‫ﻤﺎﺩﻱ‬ ‫ﻭﺴﻁ‬ ‫ﻓﻲ‬1 kg)1‫ﻜﻎ‬(.‫ﻴﺒـﻴﻥ‬ ‫ﹰ‬‫ﺎ‬‫ﺃﻴﻀ‬ ‫ﺍﻟﺸﻜل‬)1(‫ﺍﻟﻤﻤﺘﺼﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﻟﻠﺠﺭﻋﺔ‬ ‫ﺍﻟﻤﺌﻭﻴﺔ‬ ‫ﺍﻟﻨﺴﺒﺔ‬Percentage Depth Dose PDD%‫ﺍﻟﻌﻤﻕ‬ ‫ﺒﺩﻻﻟﺔ‬ ‫ﺍﻟﻤﺨ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺤﺯﻡ‬ ‫ﻤﻥ‬ ‫ﻟﻌﺩﺩ‬ ‫ﺍﻟﻤﺎﺀ‬ ‫ﻓﻲ‬‫ﻋﻠﻰ‬ ‫ﻴﻅﻬﺭ‬ ‫ﺤﻴﺙ‬ ‫ﺍﻟﻁﺎﻗﺔ‬ ‫ﺘﻠﻔﺔ‬‫ﺤﺯﻤـﺔ‬ ‫ﻁﺎﻗـﺔ‬ ‫ﺍﺨﺘﻼﻑ‬ ‫ﺘﺄﺜﻴﺭ‬ ‫ﺍﻟﺸﻜل‬ ‫ﺍﻟﻔﻭﺘﻭﻨﺎﺕ‬)‫ﻭﺃﺸﻌﺔ‬ ،‫ﻏﺎﻤﺎ‬ ‫ﺃﺸﻌﺔ‬-x(‫ﺍﻟﻤﺎﺀ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺤﺯﻤﺔ‬ ‫ﻨﻔﻭﺫﻴﺔ‬ ‫ﻋﻠﻰ‬)‫ﺍﻹﻨﺴﺎﻥ‬ ‫ﺠﺴﻡ‬.( ‫ﺍﻟﺸﻜل‬)1(‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺤﺯﻡ‬ ‫ﻤﻥ‬ ‫ﻟﻌﺩﺩ‬ ‫ﺍﻟﻤﺎﺀ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻌﻤﻕ‬ ‫ﺒﺩﻻﻟﺔ‬ ‫ﺍﻟﻤﻤﺘﺼﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﻟﻠﺠﺭﻋﺔ‬ ‫ﺍﻟﻤﺌﻭﻴﺔ‬ ‫ﺍﻟﻨﺴﺒﺔ‬ ‫ﺍﻟﻁﺎﻗﺔ‬ ‫ﺍﻟﻤﺨﺘﻠﻔﺔ‬ 3.‫ﺍﻟ‬ ‫ﺃﻨﻭﺍﻉ‬‫ﻤﻌﺎ‬‫ﺍﻹﺸﻌﺎ‬ ‫ﻟﺠﺔ‬‫ﻋ‬‫ﻴﺔ‬: ‫ﹸ‬‫ﺘ‬‫ﺍﻟ‬ ‫ﺼﻨﻑ‬‫ﻤ‬‫ﻌ‬‫ﺎﻟ‬‫ﺠ‬‫ﺔ‬‫ﺍﻹﺸﻌﺎﻋﻴ‬‫ﺔ‬،‫ﻨﻭﻋﻴﻥ‬ ‫ﺇﻟﻰ‬‫ﺨﺎﺭﺠﻴﺔ‬ ‫ﺒﺤﺯﻤﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬)Beam Therapy EBTExternal(، ‫ﻤﻥ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﺒﺙ‬‫ﻴ‬ ‫ﺤﻴﺙ‬‫ﺇﻟﻰ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺤﺯﻤﺔ‬ ‫ﺘﻭﺠﻴﻪ‬ ‫ﻋﻠﻰ‬ ‫ﻭﻴﻌﻤل‬ ‫ﻟﻺﺸﻌﺎﻉ‬ ‫ﻤﺼﺩﺭ‬ ‫ﺠﻬﺎﺯ‬‫ﻤﺤـﺩﺩﺓ‬ ‫ﻤﻭﺍﻀﻊ‬ ‫ﻭ‬ ،‫ﺒﺎﻟﺠﺴﻡ‬‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻫﻭ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻤﻥ‬ ‫ﺍﻵﺨﺭ‬ ‫ﺍﻟﻨﻭﻉ‬‫ﺍ‬‫ﻟﺩﺍﺨﻠﻴ‬‫ﺔ‬)Internal Radiotherapy or Brachytherapy(‫ﻗﺭﻴﺒﺎ‬ ‫ﺃﻭ‬ ‫ﺍﻟﻭﺭﻡ‬ ‫ﺃﻨﺴﺠﺔ‬ ‫ﺩﺍﺨل‬ ‫ﻤﺒﺎﺸﺭﺓ‬ ‫ﺘﺜﺒﻴﺘﻬﺎ‬ ‫ﻴﺘﻡ‬ ‫ﺔ‬‫ﻌ‬‫ﻤﺸ‬ ‫ﻤﺎﺩﺓ‬ ‫ﻤﻥ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﻴﺄﺘﻲ‬ ‫ﺤﻴﺙ‬ ، ‫ﹰ‬‫ﺎ‬‫ﻤﻌ‬ ‫ﺍﻟﻨﻭﻋﻴﻥ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬ ‫ﻴﺘﻡ‬ ‫ﻗﺩ‬ ‫ﻭ‬ ،‫ﺩﺍﺌﻤﺔ‬ ‫ﺒﺼﻔﺔ‬ ‫ﺃﻭ‬ ‫ﻤﺅﻗﺕ‬ ‫ﺒﺸﻜل‬ ‫ﺴﻭﺍﺀ‬ ،‫ﻤﻨﻬﺎ‬‫ﺍﻟﺤﺎﻻﺕ‬ ‫ﺒﻌﺽ‬ ‫ﻟﺩﻯ‬. 3.1‫ﺍﻟﺩﺍﺨﻠﻴﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬)Internal Radiotherapy(:
  5. 5. Ossama Anjak, AECS. PO BOX6091Damascys Page 5  ‫ﺒﻐﺭﺱ‬ ‫ﺃﻤﺎ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻨﻤﻁ‬ ‫ﻫﺫﺍ‬ ‫ﺘﺘﻡ‬)implant(‫ﻤﺤﻴﻁـﺔ‬ ‫ﺃﻭ‬ ‫ﺍﻟﻭﺭﻤﻲ‬ ‫ﺍﻟﻨﺴﻴﺞ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻤﺸﻌﺔ‬ ‫ﺍﻟﻤﺼﺎﺩﺭ‬ ‫ﻴ‬‫ﻭ‬‫ﺴﻤ‬‫ﻗﺭﺏ‬ ‫ﻋﻥ‬ ‫ﺒﺎﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺃﻴﻀﺎ‬ ‫ﻰ‬)Brachytherapy(‫ﻤﻥ‬ ‫ﺒﺎﻟﻘﺭﺏ‬ ‫ﺍﻟﻤﺸﻌﺔ‬ ‫ﺍﻟﻤﺼﺎﺩﺭ‬ ‫ﻭﻀﻊ‬ ‫ﻴﺠﺭﻱ‬ ‫ﺤﻴﺙ‬ ‫ﺨﺎﺼﺔ‬ ‫ﻤﻁﺒﻘﺎﺕ‬ ‫ﻀﻤﻥ‬ ‫ﺍﻟﻭﺭﻡ‬ ‫ﺘ‬‫ﺴﺘﺨﺩﻡ‬‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺘﻘﻨﻴﺔ‬ ‫ﻫﺫﻩ‬‫ﻤﻥ‬ ‫ﺍﻟﻌﺩﻴﺩ‬ ‫ﻟﺩﻯ‬،‫ﺍﻟﺸـﺒﻜﻴﺔ‬ ‫ﻭﺃﻭﺭﺍﻡ‬ ،‫ﻭﺍﻟﺭﻗﺒـﺔ‬ ‫ﺍﻟـﺭﺃﺱ‬ ‫ﺃﻭﺭﺍﻡ‬ ‫ﻤﺜل‬ ،‫ﺍﻷﻭﺭﺍﻡ‬ ،‫ﺍﻟﺒﺭﻭﺴﺘﺎﺘﺔ‬ ‫ﻭ‬ ‫ﺍﻟﺭﺤﻡ‬ ‫ﻭ‬ ‫ﺍﻟﺩﺭﻗﻴﺔ‬ ‫ﻭ‬ ‫ﻭﺍﻟﺜﺩﻱ‬‫ﺍﻟﺸﻜل‬ ‫ﻓﻲ‬ ‫ﻤﺒﻴﻥ‬ ‫ﻫﻭ‬ ‫ﻜﻤﺎ‬)2.(‫ﻴـﺘﻡ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻨﻭﻉ‬ ‫ﻫﺫﺍ‬ ‫ﻭﻓﻲ‬ ‫ﻫﻴﺌـﺔ‬ ‫ﻋﻠﻰ‬ ‫ﹼل‬‫ﻜ‬‫ﺘﺸ‬ ‫ﺃﻭ‬ ‫ﻜﺒﺴﻭﻻﺕ‬ ‫ﺩﺍﺨل‬ ‫ﺘﻀﻤﻴﻨﻬﺎ‬ ‫ﻴﺘﻡ‬ ‫ﺍﻟﺘﻲ‬ ،‫ﺍﻟﻤﺸﻌﺔ‬ ‫ﺍﻟﻌﻨﺎﺼﺭ‬ ‫ﻟﺒﻌﺽ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﺨﺎﺼﻴﺔ‬ ‫ﺘﻭﻅﻴﻑ‬ ‫ﺘﻭ‬ ‫ﺃﻭ‬ ‫ﺃﺴﻼﻙ‬ ‫ﺃﻭ‬ ‫ﺤﺒﻴﺒﺎﺕ‬‫ﻗﺭﻴﺒـﺎ‬ ‫ﺃﻭ‬ ‫ﺍﻟـﻭﺭﻡ‬ ‫ﺃﻨﺴﺠﺔ‬ ‫ﺩﺍﺨل‬ ‫ﻤﺒﺎﺸﺭﺓ‬ ‫ﺘﺜﺒﻴﺘﻬﺎ‬ ‫ﻭ‬ ‫ﺯﺭﻋﻬﺎ‬ ‫ﻴﺘﻡ‬ ‫ﻭ‬ ،‫ﻗﺴﻁﺭﺓ‬ ‫ﺒﺄﺩﺍﺓ‬ ‫ﻀﻊ‬ ،‫ﺩﺍﺌﻡ‬ ‫ﺒﺸﻜل‬ ‫ﺃﻭ‬ ‫ﻓﺤﺴﺏ‬ ‫ﻗﺼﻴﺭﺓ‬ ‫ﻟﻔﺘﺭﺓ‬ ‫ﺴﻭﺍﺀ‬ ،‫ﻤﻨﻬﺎ‬‫ﺍﻟﻤﺯﺭﻭﻋـﺔ‬ ‫ﺍﻟﻤﺸـﻌﺔ‬ ‫ﺍﻟﻤـﻭﺍﺩ‬ ‫ﺇﻟﻰ‬ ‫ﻋﺎﺩﺓ‬ ‫ﺍﻷﻁﺒﺎﺀ‬ ‫ﻴﺸﻴﺭ‬ ‫ﻭ‬ ‫ﺭﺍﺱ‬‫ﻐ‬‫ﺍﻟ‬ ‫ﺒﺘﻌﺒﻴﺭ‬ ‫ﺒﺎﻟﺠﺴﻡ‬)implant(‫ﻋﻥ‬ ‫ﺍﻟﺤﺩﻴﺙ‬ ‫ﻋﻨﺩ‬‫ﺍﻟﺩﺍﺨﻠﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬‫ﺒﺼـﻔﺔ‬ ‫ﺍﺴﺘﺨﺩﺍﻤﻪ‬ ‫ﻴﺘﻡ‬ ‫ﻗﺩ‬ ‫ﺍﻟﺫﻱ‬ ‫ﻭ‬ ، ‫ﻤ‬‫ﺍﻟﺤﺎﻻﺕ‬ ‫ﺒﻌﺽ‬ ‫ﻟﺩﻯ‬ ‫ﺍﻟﺨﺎﺭﺠﻲ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﻤﻊ‬ ‫ﺸﺘﺭﻜﺔ‬ ‫ﺍﻟﺸﻜل‬)2(‫ﺍﻟﺩﺍﺨﻠﻴﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬)‫ﺭﺤﻡ‬ ‫ﻭﺭﻡ‬-‫ﻤﺭﻱ‬ ‫ﻭﺭﻡ‬-‫ﺍﻟﻬﻭﺍﺌﻴﺔ‬ ‫ﺍﻟﻘﺼﺒﺎﺕ‬ ‫ﻓﻲ‬ ‫ﻭﺭﻡ‬( ‫ﺍﻟﺭﺍﺩﻴﻭﻡ‬ ‫ﻋﻨﺎﺼﺭ‬ ،‫ﻋﺎﺩﺓ‬ ‫ﺍﻟﻤﺴﺘﺨﺩﻤﺔ‬ ‫ﺍﻟﻤﺸﻌﺔ‬ ‫ﺍﻟﻤﻭﺍﺩ‬ ‫ﻭﺘﺸﻤل‬-226)‫ﹰ‬‫ﺍ‬‫ﻤـﺅﺨﺭ‬ ‫ﺍﻟﺩﻭﻟﻴﺔ‬ ‫ﺍﻟﻬﻴﺌﺎﺕ‬ ‫ﺃﻭﺼﺕ‬ ‫ﻟ‬ ‫ﹰ‬‫ﺍ‬‫ﻨﻅﺭ‬ ‫ﺍﺴﺘﺨﺩﺍﻤﻪ‬ ‫ﺒﻌﺩﻡ‬‫ﺍﻟﻌﺎﻟﻴﺔ‬ ‫ﺨﻁﻭﺭﺘﻪ‬(‫ﺍﻻﻴﺭﻴﺩﻴﻭﻡ‬ ‫ﻭ‬-192‫ﻭﺍﻟﻜﻭﺒﺎﻟﺕ‬-60‫ﻭﺍﻟﺴﻴﺯﻴﻭﻡ‬-137‫ﻭﺍﻟﻴﻭﺩ‬-125 )‫ﺍﻟﺒﺭﻭﺴﺘﺎﺕ‬ ‫ﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺍﻟﺩﺍﺌﻡ‬ ‫ﺍﻟﻐﺭﺱ‬ ‫ﻓﻲ‬ ‫ﹰ‬‫ﺎ‬‫ﻏﺎﻟﺒ‬ ‫ﻴﺴﺘﺨﺩﻡ‬(‫ﻭﺍﻟﻔﺴﻔﻭﺭ‬-32،‫ﻭ‬‫ﻴﺒ‬‫ﻴ‬‫ﺍﻟﺠﺩﻭل‬ ‫ﻥ‬)1(‫ﺍﻟﻤﺸـﻌﺔ‬ ‫ﺍﻟﻤﻨﺎﺒﻊ‬ ‫ﺍﻟﻤ‬‫ﺴﺘﺨﺩﻤ‬‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﺔ‬‫ﺍﻟﻔﻴﺯﻴﺎﺌﻴﺔ‬ ‫ﻤﻴﺯﺍﺘﻬﺎ‬ ‫ﻭﺒﻌﺽ‬ ‫ﺍﻟﺩﺍﺨﻠﻴﺔ‬. Radionuclide Photon energy (MeV) Half-life Attenuation in lead (mm) Exposure rate constant (R h-1 mCi-1 cm2 ) AKR constant (µGy h-1 GBq-1 m2 ) Mean Maximum HVL TVL 60 Co 1.25 1.33 5.27 years 12 45 13.1 309 137 Cs 0.662 0.662 30.0 years 6.5 22 3.3 78 192 Ir 0.37 0.61 74 days 4.5 15 4.8 113 125 I 0.028 0.035 60 days 0.03 0.1 1.4 33 198 Au 0.42 0.68 2.7 days 3 11 2.35 55.5 226 Ra ca. 1 2.4 1600 years 16 45 8.25a 195 a) Radium source filtered by 0.5 mm platinum ‫ﺍﻟﺠﺩﻭل‬)1(‫ﺍﻟ‬‫ﻤﺼﺎﺩﺭ‬‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻤﺴﺘﺨﺩﻤﺔ‬ ‫ﺍﻟﻤﺸﻌﺔ‬‫ﻗﺭﺏ‬ ‫ﻋﻥ‬Brachytherapy
  6. 6. Ossama Anjak, AECS. PO BOX6091Damascys Page 6  ‫ﺍﻟﻌﺩﻴﺩ‬ ‫ﻭﺜﻤﺔ‬‫ﹰ‬‫ﺎ‬‫ﺘﺒﻌ‬ ‫ﺫﻟﻙ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﺸﻌﺔ‬ ‫ﺍﻟﻤﻭﺍﺩ‬ ‫ﺯﺭﻉ‬ ‫ﺃﺴﺎﻟﻴﺏ‬ ‫ﻤﻥ‬‫ﺘﺴـﻤﻴﺘﻬﺎ‬ ‫ﻁﺭﻴﻘﺔ‬ ‫ﻟﻜل‬ ‫ﻭ‬ ،‫ﻭﺤﺠﻤﻪ‬ ‫ﺍﻟﻭﺭﻡ‬ ‫ﻟﻤﻭﻀﻊ‬ ‫ﺍﻟﺒﻴﻨـﻲ‬ ‫ﺒﺎﻹﺸـﻌﺎﻉ‬ ‫ﻌـﺭﻑ‬‫ﻴ‬ ‫ﺒﻤﺎ‬ ‫ﺍﻟﻭﺭﻡ‬ ‫ﺃﻨﺴﺠﺔ‬ ‫ﺩﺍﺨل‬ ‫ﻤﺒﺎﺸﺭﺓ‬ ‫ﺯﺭﻋﻬﺎ‬ ‫ﻴﺘﻡ‬ ‫ﻓﻘﺩ‬ ،‫ﺍﻟﺤﺎل‬ ‫ﺒﻁﺒﻴﻌﺔ‬)interstitial radiation(‫ﺍﻟﺸـ‬ ‫ﻜﺭﻭﻴـﺔ‬ ‫ﺤﺒﻴﺒﺎﺕ‬ ‫ﻫﻴﺌﺔ‬ ‫ﻋﻠﻰ‬ ‫ﺃﻭ‬ ‫ﻗﺴﻁﺭﺓ‬ ‫ﺃﺩﺍﺓ‬ ‫ﺃﻭ‬ ‫ﻜﺒﺴﻭﻻﺕ‬ ‫ﺩﺍﺨل‬ ‫ﺍﻟﺤﺸﻭﺓ‬ ‫ﺘﻜﻭﻥ‬ ‫ﻭ‬ ،‫ﺃﻭ‬ ،‫ﻜل‬ ‫ﺍﻟﺭﺤﻡ‬ ‫ﺘﺠﻭﻴﻑ‬ ‫ﻤﺜل‬ ،‫ﺍﻟﺠﺴﻡ‬ ‫ﺩﺍﺨل‬ ‫ﻤﺎ‬ ‫ﺒﺘﺠﻭﻴﻑ‬ ‫ﺘﺯﺭﻉ‬)intracavitary(‫ﺍﻟﺠﺴـﻡ‬ ‫ﺩﺍﺨـل‬ ‫ﺒﻘﻨـﺎﺓ‬ ‫ﺘـﺯﺭﻉ‬ ‫ﺃﻭ‬ )intraluminal radiation(‫ﺍﻟﺸـﻌﺏ‬ ‫ﻤﺜـل‬ ‫ـﻲ‬‫ﻌ‬‫ﻤ‬ ‫ﺃﻭ‬ ‫ﻗﻨﺎﺓ‬ ‫ﺃﻭ‬ ‫ﻤﺠﺭﻯ‬ ‫ﺩﺍﺨل‬ ‫ﺍﻟﻤﺸﻌﺔ‬ ‫ﺍﻟﻤﻭﺍﺩ‬ ‫ﺘﻭﻀﻊ‬ ‫ﺒﺤﻴﺙ‬ ، ‫ﻭ‬ ‫ﺼﻐﻴﺭ‬ ‫ﺒﺤﺎﻤل‬ ‫ﺍﻟﺤﺸﻭﺓ‬ ‫ﺘﺜﺒﻴﺕ‬ ‫ﻴﺘﻡ‬ ‫ﺒﺤﻴﺙ‬ ،‫ﺍﻟﻭﺭﻡ‬ ‫ﺴﻁﺢ‬ ‫ﻋﻠﻰ‬ ‫ﺘﺯﺭﻉ‬ ‫ﺃﻭ‬ ،‫ﺍﻟﻤﺭﻱﺀ‬ ‫ﺃﻭ‬ ‫ﺍﻟﻬﻭﺍﺌﻴﺔ‬‫ﺩﺍﺨـل‬ ‫ﺘﻭﻀﻊ‬ ،‫ﺍﺴﺘﺌﺼـﺎﻟﻪ‬ ‫ﻋﻘﺏ‬ ‫ﺍﻟﻭﺭﻡ‬ ‫ﻤﻭﻀﻊ‬ ‫ﺃﻱ‬ ،‫ﺍﻟﻭﺭﻡ‬ ‫ﺒﻤﻬﺩ‬ ‫ﺍﻟﻤﺸﻌﺔ‬ ‫ﺍﻟﺤﺸﻭﺍﺕ‬ ‫ﻭﻀﻊ‬ ‫ﻴﺘﻡ‬ ‫ﺃﻭ‬ ،‫ﺍﻟﻭﺭﻡ‬ ‫ﻤﻭﻀﻊ‬ ‫ﻤﻘﺎﺒل‬ ‫ﺃﻭ‬ ‫ﺍﻟـﺩﻭﺭﺓ‬ ‫ﺩﺍﺨـل‬ ‫ﻤﺸﻌﺔ‬ ‫ﻨﻅﺎﺌﺭ‬ ‫ﻤﻥ‬ ‫ﺴﺎﺌل‬ ‫ﻫﻴﺌﺔ‬ ‫ﻋﻠﻰ‬ ‫ﻭﺭﻴﺩﻴﺎ‬ ‫ﺍﻟﻤﺸﻌﺔ‬ ‫ﺍﻟﻤﻭﺍﺩ‬ ‫ﻟﺒﻌﺽ‬ ‫ﺍﻟﺤﻘﻥ‬ ‫ﻁﺭﻴﻘﺔ‬ ‫ﺇﻟﻰ‬ ‫ﺇﻀﺎﻓﺔ‬ ‫ﺍﻟﻴﻭﺩ‬ ‫ﺤﻘﻥ‬ ‫ﺤﺎﻟﺔ‬ ‫ﻓﻲ‬ ‫ﻜﻤﺎ‬ ،‫ﺒﺎﻁﻨﻲ‬ ‫ﺒﺘﺠﻭﻴﻑ‬ ‫ﺃﻭ‬ ‫ﺍﻟﺩﻤﻭﻴﺔ‬-131‫ﺃﻭﺭﺍﻡ‬ ‫ﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺍﻟﻤﺸﻊ‬‫ﺍﻟﻐﺩﺓ‬‫ﺒﻁﺒﻴﻌـﺔ‬ ‫ﻭ‬ ،‫ﺍﻟﺩﺭﻗﻴﺔ‬ ‫ﻟﻠﻤﺭﻴﺽ‬ ‫ﺍﻟﺘﺎﻡ‬ ‫ﺃﻭ‬ ‫ﺍﻟﻤﻭﻀﻌﻲ‬ ‫ﺍﻟﺘﺨﺩﻴﺭ‬ ‫ﺘﺤﺕ‬ ‫ﺍﻟﺤﺸﻭﺍﺕ‬ ‫ﺃﻨﻭﺍﻉ‬ ‫ﺘﺜﺒﻴﺕ‬ ‫ﻭ‬ ‫ﻭﻀﻊ‬ ‫ﻋﻤﻠﻴﺎﺕ‬ ‫ﺘﺘﻡ‬ ‫ﺍﻟﺤﺎل‬. ‫ﻁﺭﻴﻘﺔ‬ ‫ﻭﺘﻀﻤﻥ‬‫ﺍﻟﺩﺍﺨﻠﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬‫ﻤـﻥ‬ ‫ﻤﺤﺩﻭﺩ‬ ‫ﺯ‬‫ﻴ‬‫ﺤ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﻤﻥ‬ ‫ﻤﻜﺜﻔﺔ‬ ‫ﺠﺭﻋﺎﺕ‬ ‫ﺘﺴﻠﻴﻁ‬ ‫ﻭ‬ ‫ﺘﻭﺠﻴﻪ‬ ‫ﺇﻟﻰ‬ ‫ﺇﻀﺎﻓﺔ‬ ،‫ﻟﻺﺸﻌﺎﻉ‬ ‫ﺍﻟﻁﺒﻴﻌﻴﺔ‬ ‫ﺍﻷﻨﺴﺠﺔ‬ ‫ﺽ‬‫ﺭ‬‫ﺘﻌ‬ ‫ﻤﻥ‬ ‫ﺒﺫﻟﻙ‬ ‫ﹸﻘﻠل‬‫ﺘ‬ ‫ﻭ‬ ‫ﺍﻟﺠﺴﻡ‬‫ﺠﺭﻋﺎﺕ‬ ‫ﺒﺈﻋﻁﺎﺀ‬ ‫ﻟﻸﻁﺒﺎﺀ‬ ‫ﺘﺴﻤﺢ‬ ‫ﺃﻨﻬﺎ‬ ‫ﻓﻌﺎﻟﺔ‬ ‫ﻁﺭﻴﻘﺔ‬ ‫ﺃﻨﻬﺎ‬ ‫ﻟﻭﺤﻅ‬ ‫ﻭ‬ ،‫ﺍﻟﺨﺎﺭﺠﻲ‬ ‫ﻟﻺﺸﻌﺎﻉ‬ ‫ﺍﻟﻼﺯﻡ‬ ‫ﺍﻟﻭﻗﺕ‬ ‫ﻤﻥ‬ ‫ﺍﻗﺼﺭ‬ ‫ﻭﻗﺕ‬ ‫ﻓﻲ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﻤﻥ‬ ‫ﻋﺎﻟﻴﺔ‬ ‫ﺇﺠﻤﺎﻟﻴﺔ‬ ‫ﹰ‬‫ﺎ‬‫ﺘﺒﻌـ‬ ‫ﺒﻤﻭﺍﻀﻌﻬﺎ‬ ‫ﺍﻟﺤﺸﻭﺍﺕ‬ ‫ﺒﻘﺎﺀ‬ ‫ﺯﻤﻥ‬ ‫ﺘﺤﺩﻴﺩ‬ ‫ﻴﺘﻡ‬ ‫ﺃﺨﺭﻯ‬ ‫ﺠﻬﺔ‬ ‫ﻤﻥ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﺒﻜﺭﺓ‬ ‫ﺒﻤﺭﺍﺤﻠﻬﺎ‬ ‫ﺍﻷﻭﺭﺍﻡ‬ ‫ﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﻤﻌﺎ‬ ‫ﺃﻗﺼﻰ‬ ‫ﻟﺘﺤﻘﻴﻕ‬ ‫ﺍﻟﻤﻁﻠﻭﺒﺔ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﻟﺠﺭﻋﺔ‬‫ﺍﻟﻌﻼﺠﻲ‬ ‫ﺍﻟﻤﺨﻁﻁ‬ ‫ﺤﺴﺏ‬ ‫ﺫﻟﻙ‬ ‫ﻭ‬ ،‫ﺎﻟﺔ‬‫ﻌ‬‫ﻓ‬ ‫ﻟﺠﺔ‬)‫ﺒـﺩﻭﺭﻩ‬ ‫ﺍﻟـﺫﻱ‬ ‫ﺍﻟ‬ ‫ﺍﻷﺨـﺭﻯ‬ ‫ﺍﻟﻌﻼﺠـﺎﺕ‬ ‫ﻭ‬ ‫ﻟﻠﻤﺭﻴﺽ‬ ‫ﺍﻟﻌﺎﻤﺔ‬ ‫ﺍﻟﺒﺩﻨﻴﺔ‬ ‫ﺍﻟﺤﺎﻟﺔ‬ ‫ﻭ‬ ‫ﻤﻭﻀﻌﻪ‬ ‫ﻭ‬ ‫ﺍﻟﻭﺭﻡ‬ ‫ﻨﻭﻉ‬ ‫ﻋﻠﻰ‬ ‫ﻴﻌﺘﻤﺩ‬‫ﺘﻠﻘﺎﻫـﺎ‬ ‫ﺘـﻲ‬ ‫ﺍﻟﻤﺭﻴﺽ‬(‫ﺠﺭﻋﺎﺕ‬ ،‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﺠﺭﻋﺔ‬ ‫ﻌﺩل‬‫ﻤ‬‫ﻟ‬ ‫ﹰ‬‫ﺎ‬‫ﺘﺒﻌ‬ ‫ﻨﻭﻋﻴﻥ‬ ‫ﺇﻟﻰ‬ ‫ﺍﻟﻤﺅﻗﺘﺔ‬ ‫ﺍﻟﺤﺸﻭﺍﺕ‬ ‫ﺘﺼﻨﻴﻑ‬ ‫ﻴﺘﻡ‬ ‫ﺍﻟﺼﺩﺩ‬ ‫ﺒﻬﺫﺍ‬ ‫ﻭ‬ ، ‫ﻤﻨﺨﻔﺽ‬ ‫ﻤﻌﺩل‬ ‫ﺫﺍﺕ‬)Low Dose Rate-LDR(‫ﺫﺍﺕ‬ ‫ﺠﺭﻋﺎﺕ‬ ‫ﻭ‬ ،‫ﺃﻴﺎﻡ‬ ‫ﻟﻌﺩﺓ‬ ‫ﺒﻤﻭﺍﻀﻌﻬﺎ‬ ‫ﺇﺒﻘﺎﺅﻫﺎ‬ ‫ﻴﻤﻜﻥ‬ ‫ﻭ‬ ، ‫ﻤﺭﺘﻔﻊ‬ ‫ﻤﻌﺩل‬)HDR High Dose-Rate(‫ﻤﻥ‬ ‫ﺩﻗﺎﺌﻕ‬ ‫ﺒﻀﻌﺔ‬ ‫ﻋﻘﺏ‬ ‫ﺇﺯﺍﻟﺘﻬﺎ‬ ‫ﺘﺘﻡ‬ ‫ﻭ‬ ،‫ﻏﺭﺴـﻬﺎ‬‫ﺒﻁﺒﻴﻌـﺔ‬ ‫ﻭ‬ ، ‫ﺍﻟﻤﺅﻗﺘﺔ‬ ‫ﺍﻟﺤﺸﻭﺍﺕ‬ ‫ﺇﺯﺍﻟﺔ‬ ‫ﺒﻌﺩ‬ ‫ﺒﺎﻟﺠﺴﻡ‬ ‫ﺇﺸﻌﺎﻉ‬ ‫ﺃﻱ‬ ‫ﻴﺘﺒﻘﻰ‬ ‫ﻻ‬ ‫ﺍﻟﺤﺎل‬.‫ﺍﻵﻟﻲ‬ ‫ﺍﻟﺤﻘﻥ‬ ‫ﺃﺠﻬﺯﺓ‬ ‫ﺍﻟﺤﺎﻟﺔ‬ ‫ﻫﺫﻩ‬ ‫ﻓﻲ‬ ‫ﻭﻴﺴﺘﺨﺩﻡ‬ ‫ﺍﻟﺸﻜل‬ ‫ﻓﻲ‬ ‫ﻜﻤﺎ‬)3(‫ﺃﻭ‬ ‫ﺍﻟﻬـﻭﺍﺀ‬ ‫ﻀﻐﻁ‬ ‫ﺘﺄﺜﻴﺭ‬ ‫ﺘﺤﺕ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﺠﺴﻡ‬ ‫ﺇﻟﻰ‬ ‫ﺍﻟﻤﺸﻌﺔ‬ ‫ﺍﻟﻤﺼﺎﺩﺭ‬ ‫ﺸﺤﻥ‬ ‫ﻴﺠﺭﻱ‬ ‫ﺤﻴﺙ‬ ‫ﺒﺴﻠﻙ‬ ‫ﻤﻭﺼﻭل‬ ‫ﺍﻟﻤﺸﻊ‬ ‫ﺍﻟﻤﺼﺩﺭ‬ ‫ﻴﻜﻭﻥ‬.‫ﺍﻟﺤﺭﻜﺔ‬ ‫ﻋﻤﻠﻴﺔ‬ ‫ﻴﺴﻬل‬.
  7. 7. Ossama Anjak, AECS. PO BOX6091Damascys Page 7  ‫ﺍﻟﺸﻜل‬)3(‫ﺍﻵﻟﻲ‬ ‫ﺍﻟﺤﺎﻗﻥ‬ ‫ﺠﻬﺎﺯ‬‫ﻴﺠﺭﻱ‬ ‫ﺤﻴﺙ‬‫ﻟ‬ ‫ﺍﻟﺘﺤﻀﻴﺭ‬‫ﻤﻭﻀﻊ‬ ‫ﺇﻟﻰ‬ ‫ﺍﻟﺠﻬﺎﺯ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻤﺸﻌﺔ‬ ‫ﺍﻟﻤﺼﺎﺩﺭ‬ ‫ﺸﺤﻥ‬ ‫ﺍﻟ‬‫ﻭﺭﻡ‬‫ﻗﺴﻁﺭﺓ‬ ‫ﺃﻨﺎﺒﻴﺏ‬ ‫ﺒﻭﺍﺴﻁﺔ‬ 3.1.1‫ﻓﻲ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻭﻗﺎﻴﺔ‬‫ﺍﻟﺩﺍﺨﻠﻴﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬: ‫ﺨﺎﺼﺔ‬ ‫ﻤﻨﻔﺭﺩﺓ‬ ‫ﻏﺭﻑ‬ ‫ﻀﻤﻥ‬ ‫ﻋﺎﺩﺓ‬ ‫ﺍﻟﺩﺍﺨﻠﻴﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺘﻁﺒﻴﻕ‬ ‫ﻴﺠﺭﻱ‬‫ﺍﻟﺠﺩﺭﺍﻥ‬ ‫ﺘﻜﻭﻥ‬ ‫ﺤﻴﺙ‬‫ﺫﺍﺕ‬ ٍ‫ﻑ‬‫ﻜﺎ‬ ‫ﺘﺩﺭﻴﻊ‬‫ﻭ‬‫ﺩﺍﺨل‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﻴﺒﻘﻰ‬‫ﺍﻟﻤ‬‫ﺸﻔﻰ‬‫ﻤﻌﺯ‬‫ﻭ‬‫ﹰ‬‫ﻻ‬‫ﺒ‬‫ﺎﻟ‬‫ﻭ‬ ،‫ﻋﺎﻟﻴﺔ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﻤﺴﺘﻭﻴﺎﺕ‬ ‫ﺘﻜﻭﻥ‬ ‫ﺤﻴﻥ‬ ‫ﻐﺭﻓﺔ‬‫ﻴﺠﺏ‬ ‫ﻋﻠﻰ‬‫ﻻ‬ ‫ﻭ‬ ‫ﻁﻭﻴﻠﺔ‬ ‫ﻟﻔﺘﺭﺍﺕ‬ ‫ﻏﺭﻓﺘﻪ‬ ‫ﻤﻼﺯﻤﺔ‬ ‫ﻋﺩﻡ‬ ‫ﺍﻟﻁﺒﻲ‬ ‫ﺍﻟﻔﺭﻴﻕ‬‫ﻭﻟﺯﻤﻥ‬ ‫ﺍﻟﻀﺭﻭﺭﺓ‬ ‫ﻋﻨﺩ‬ ‫ﺇﻻ‬ ‫ﻤﻌﻪ‬ ‫ﻴﺘﻼﻤﺴﻭﻥ‬ ‫ﻋﺩﺍﻫﻡ‬ ‫ﻤﺎ‬ ‫ﺯﻴﺎﺭﺍﺕ‬ ‫ﹸﺤﺩﺩ‬‫ﺘ‬ ‫ﻭ‬ ،‫ﺍﻟﺨﺼﻭﺹ‬ ‫ﻭﺠﻪ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﺤﻭﺍﻤل‬ ‫ﺍﻟﻨﺴﺎﺀ‬ ‫ﻭ‬ ‫ﺍﻷﻁﻔﺎل‬ ‫ﺯﻴﺎﺭﺍﺕ‬ ‫ﻋﻨﻪ‬ ‫ﹸﻤﻨﻊ‬‫ﺘ‬ ‫ﻭ‬ ،‫ﻗﺼﻴﺭ‬ ‫ﺃﻭ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﻤﻥ‬ ‫ﺍﻻﻗﺘﺭﺍﺏ‬ ‫ﻋﺩﻡ‬ ‫ﺍﻟﺯﻭﺍﺭ‬ ‫ﻋﻠﻰ‬ ‫ﻴﻨﺒﻐﻲ‬ ‫ﻭ‬ ،‫ﻨﺤﻭﻫﺎ‬ ‫ﺃﻭ‬ ‫ﺴﺎﻋﺔ‬ ‫ﺍﻟﻨﺼﻑ‬ ‫ﺘﺘﺠﺎﻭﺯ‬ ‫ﻻ‬ ‫ﻗﺼﻴﺭﺓ‬ ‫ﺒﻔﺘﺭﺍﺕ‬ ‫ﻗﺩ‬ ‫ﻭ‬ ،‫ﺴﺭﻴﺭﻩ‬ ‫ﻤﻥ‬ ‫ﻤﺘﺭﻴﻥ‬ ‫ﻋﻥ‬ ‫ﻴﻘل‬ ‫ﻤﺤﻴﻁ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺠﻠﻭﺱ‬‫ﻭﻀﻊ‬ ‫ﻴﺘﻡ‬‫ﺤﻭﺍﺠﺯ‬‫ﺴﺭﻴﺭ‬ ‫ﺒﻴﻥ‬ ‫ﻤﺎ‬ ‫ﺍﻟﺭﺼﺎﺹ‬ ‫ﻤﻌﺩﻥ‬ ‫ﻤﻥ‬ ‫ﺃﺨﺭﻯ‬ ‫ﻨﺎﺤﻴﺔ‬ ‫ﻤﻥ‬ ‫ﻭ‬ ،‫ﺍﻟﻁﺒﻲ‬ ‫ﺍﻟﻔﺭﻴﻕ‬ ‫ﺃﻭ‬ ‫ﺍﻟﺯﻭﺍﺭ‬ ‫ﻭ‬ ‫ﺍﻟﻤﺭﻴﺽ‬)‫ﺍﻟﺯﺭﻉ‬ ‫ﻤﻭﻀﻊ‬ ‫ﺤﺴﺏ‬ ‫ﻭ‬(‫ﺍﻷﻤﺭ‬ ‫ﻴﺘﻁﻠﺏ‬ ‫ﻗﺩ‬ ، ‫ﻤﻭﻀﻌﻬﺎ‬ ‫ﻋﻥ‬ ‫ﺍﻟﺤﺸﻭﺓ‬ ‫ﺘﺯﺤﺯﺡ‬ ‫ﻤﺨﺎﻓﺔ‬ ،‫ﺍﻟﺤﺭﻜﺔ‬ ‫ﻜﺜﺭﺓ‬ ‫ﹰ‬‫ﺎ‬‫ﻤﺘﺠﻨﺒ‬ ‫ﻟﻠﺴﺭﻴﺭ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﻤﻼﺯﻤﺔ‬. ‫ﻭﺘﺼ‬ ‫ﺒﺴﺭﻋﺔ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﻴﺔ‬‫ﺼ‬‫ﺨﺎ‬ ‫ﺍﻟﺤﺸﻭﺍﺕ‬ ‫ﺘﻔﻘﺩ‬ ،‫ﺍﻟﺩﺍﺌﻡ‬ ‫ﺍﻟﺯﺭﻉ‬ ‫ﻭﻋﻨﺩ‬،‫ﻗﺼـﻴﺭﺓ‬ ‫ﻓﺘـﺭﺓ‬ ‫ﻋﻘـﺏ‬ ‫ﺔ‬‫ﻌ‬‫ﺸ‬‫ﻤ‬ ‫ﻏﻴﺭ‬ ‫ﺒﺢ‬ ‫ﺍﻟﻤ‬ ‫ﻤﻐﺎﺩﺭﺓ‬ ‫ﻗﺒل‬ ‫ﺁﻤﻨﺔ‬ ‫ﻤﺴﺘﻭﻴﺎﺕ‬ ‫ﺇﻟﻰ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﻜﻤﻴﺎﺕ‬ ‫ﻭﺘﻨﺨﻔﺽ‬،‫ﺸﻔﻰ‬‫ﻭ‬‫ﻟﻜﻥ‬‫ﻭ‬‫ﻀـﺂﻟﺔ‬ ‫ﻤﻥ‬ ‫ﺍﻟﺭﻏﻡ‬ ‫ﻋﻠﻰ‬‫ﻜﻤﻴـﺔ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻤﺘﺴﺭﺒﺔ‬ ‫ﺍﻷﺸﻌﺔ‬‫ﹰ‬‫ﺎ‬‫ﻋﻤﻭﻤ‬‫ﺇﻻ‬ ،‫ﺃ‬‫ﺍﻟﻤﺒﺎﺸـﺭ‬ ‫ﺍﻻﺘﺼـﺎل‬ ‫ﻤﻥ‬ ‫ﺃﺴﺎﺒﻴﻊ‬ ‫ﻟﻌﺩﺓ‬ ‫ﻭ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﻤﻨﻊ‬ ‫ﻴﺘﻡ‬ ‫ﻗﺩ‬ ‫ﻨﻪ‬ ‫ﹰ‬‫ﺎ‬‫ﺘﺠﻨﺒ‬ ‫ﺍﻟﺤﻭﺍﻤل‬ ‫ﺍﻟﻨﺴﺎﺀ‬ ‫ﺃﻭ‬ ‫ﺍﻷﻁﻔﺎل‬ ‫ﺨﺼﻭﺼﺎ‬ ،‫ﺒﺎﻵﺨﺭﻴﻥ‬‫ﻻﺤﺘﻤﺎل‬‫ﻟﻺﺸﻌﺎﻉ‬ ‫ﺘﻌﺭﻀﻬﻡ‬. ‫ﺃﻭ‬ ‫ﺍﻟـﺩﻭﺍﺭ‬ ‫ﻤﺜل‬ ،‫ﺍﻟﺯﺭﻉ‬ ‫ﻋﻤﻠﻴﺔ‬ ‫ﻤﻥ‬ ‫ﺍﺴﺘﻴﻘﺎﻅﻪ‬ ‫ﻋﻘﺏ‬ ‫ﺍﻟﺘﺨﺩﻴﺭ‬ ‫ﺒﻤﻀﺎﻋﻔﺎﺕ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﻴﺸﻌﺭ‬ ‫ﻗﺩ‬ ‫ﺍﻟﺤﺎل‬ ‫ﺒﻁﺒﻴﻌﺔ‬ ‫ﻭ‬ ‫ﻻ‬ ‫ﻏﺎﻟﺒـﺎ‬ ‫ﻭ‬ ،‫ﺍﻟﺤﺎﺠﺔ‬ ‫ﺩﻋﺕ‬ ‫ﺇﻥ‬ ‫ﺍﻟﻤﺴﻜﻨﺔ‬ ‫ﺍﻷﺩﻭﻴﺔ‬ ‫ﺒﺒﻌﺽ‬ ‫ﺍﻻﺴﺘﻌﺎﻨﺔ‬ ‫ﻴﻤﻜﻥ‬ ‫ﻭ‬ ،‫ﺘﺯﻭل‬ ‫ﻤﺎ‬ ‫ﺴﺭﻋﺎﻥ‬ ‫ﺍﻟﺘﻲ‬ ‫ﻭ‬ ‫ﺍﻟﻐﺜﻴﺎﻥ‬ ‫ﺍﻹ‬ ‫ﺘﻠﻘﻲ‬ ‫ﺯﻤﻥ‬ ‫ﺃﺜﻨﺎﺀ‬ ‫ﺒﺈﺠﻬﺎﺩ‬ ‫ﺃﻭ‬ ‫ﺒﺄﻟﻡ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﻴﺸﻌﺭ‬‫ﺒﻌـﺽ‬ ‫ﺍﻟﺤﺸـﻭﺍﺕ‬ ‫ﻭﺠﻭﺩ‬ ‫ﻋﻥ‬ ‫ﻴﻨﺠﻡ‬ ‫ﻗﺩ‬ ‫ﻭ‬ ،‫ﺍﻟﺩﺍﺨﻠﻲ‬ ‫ﺸﻌﺎﻉ‬ ‫ﺍﻟﻀﺭﻭﺭﺓ‬ ‫ﻋﻨﺩ‬ ‫ﺍﻟﻤﺴﻜﻨﺎﺕ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬ ‫ﻴﺴﺘﺩﻋﻲ‬ ‫ﻗﺩ‬ ‫ﻤﻤﺎ‬ ،‫ﺍﻟﺯﺭﻉ‬ ‫ﺒﻤﻭﻀﻊ‬ ‫ﺍﻷﻟﻡ‬. 3.2.‫ﺒﺤﺯﻡ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬‫ﺨﺎﺭﺠﻴ‬‫ﺔ‬)External Beam Radiation Therapy EBRT(:
  8. 8. Ossama Anjak, AECS. PO BOX6091Damascys Page 8  ‫ﻴﺘﻡ‬ ‫ﻭ‬ ،‫ﺍﻷﻭﺭﺍﻡ‬ ‫ﺃﻨﻭﺍﻉ‬ ‫ﺃﻏﻠﺏ‬ ‫ﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﹰ‬‫ﻻ‬‫ﺘﺩﺍﻭ‬ ‫ﺍﻷﻜﺜﺭ‬ ‫ﺍﻟﻨﻭﻉ‬ ‫ﻌﺩ‬‫ﻴ‬‫ﺫﻟﻙ‬‫ﺒﺎﺴﺘﺨﺩﺍﻡ‬‫ﺨﺎﺼـﺔ‬ ‫ﺘﺠﻬﻴﺯﺍﺕ‬ ‫ﺍ‬ ‫ﻟﺘﻭﻟﻴﺩ‬‫ﺒﺎﻟﻤ‬ ‫ﺘﺴﻤﻰ‬ ‫ﻹﺸﻌﺎﻉ‬‫ﺴﺭﻉ‬‫ﺍﻟﺨﻁﻲ‬)linear accelerator(‫ﻫـﻭ‬ ‫ﻜﻤﺎ‬ ‫ﻤﺸﻊ‬ ‫ﻤﺼﺩﺭ‬ ‫ﻋﻠﻰ‬ ‫ﺘﺤﻭﻱ‬ ‫ﺃﻭ‬ ‫ﺍﻟﻜﻭﺒﺎﻟﺕ‬ ‫ﺃﺠﻬﺯﺓ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺤﺎل‬-60‫ﺍﻷﺠﻬﺯﺓ‬ ‫ﻫﺫﻩ‬ ‫ﻭﺘﻌﻤل‬ ،،‫ﻋﻠﻰ‬‫ﺘﻭﺠﻴﻪ‬،‫ﺍﻟﻭﺭﻤﻲ‬ ‫ﺍﻟﻨﺴﻴﺞ‬ ‫ﻨﺤﻭ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺤﺯﻤﺔ‬ ‫ﻀﻤﻥ‬‫ﻤ‬ ‫ﻤﺴﺎﺤﺔ‬‫ﹰ‬‫ﺎ‬‫ﻤﺴﺒﻘ‬ ‫ﺤﺩﺩﺓ‬‫ﺜﻤ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﺠﺎﻭﺭﺓ‬ ‫ﺍﻷﻨﺴﺠﺔ‬ ‫ﻤﻥ‬‫ﻫﺫﻩ‬ ‫ﻤﻥ‬ ‫ﻤﺨﺘﻠﻔﺔ‬ ‫ﺃﻨﻭﺍﻉ‬ ‫ﺔ‬‫ﺍﻟﺘﺠﻬﻴﺯﺍﺕ‬‫ﺘﻨـﺘﺞ‬‫ﺤـﺯﻡ‬ ‫ﺍﻟﻁﺎﻗﺔ‬ ‫ﻤﺨﺘﻠﻔﺔ‬ ‫ﺇﺸﻌﺎﻋﻴﺔ‬‫ﺍﻟﺠﺴﻡ‬ ‫ﺴﻁﺢ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻘﺭﻴﺒﺔ‬ ‫ﺍﻷﻭﺭﺍﻡ‬ ‫ﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﻴﺴﺘﺨﺩﻡ‬ ‫ﺒﻌﻀﻬﺎ‬ ‫ﻭ‬ ،)‫ﺒﺤـﺯﻡ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺍﻹﻟﻜﺘﺭﻭﻨﺎﺕ‬(‫ﺍﻟﺠﺴﻡ‬ ‫ﺩﺍﺨل‬ ‫ﻋﻤﻴﻘﺎ‬ ‫ﺍﻟﻤﺘﻭﺍﺠﺩﺓ‬ ‫ﺍﻷﻭﺭﺍﻡ‬ ‫ﺒﻤﻌﺎﻟﺠﺔ‬ ‫ﺃﺨﺭﻯ‬ ‫ﺘﺨﺘﺹ‬ ‫ﺒﻴﻨﻤﺎ‬ ،)‫ﻋﺎﻟﻴـﺔ‬ ‫ﺍﻟﻔﻭﺘﻭﻨﺎﺕ‬ ‫ﺤﺯﻡ‬ ‫ﺍﻟﻁﺎﻗﺔ‬(‫ﺍﻟﺴـﻴﻨ‬ ‫ﺍﻷﺸﻌﺔ‬ ‫ﹸﻌﺩ‬‫ﺘ‬ ‫ﻭ‬ ،‫ﺃﺨـﺭﻯ‬ ‫ﺃﻨـﻭﺍﻉ‬ ‫ﺜﻤﺔ‬ ‫ﻭ‬ ،‫ﺍﻟﻁﺎﻗﺔ‬ ‫ﻋﺎﻟﻲ‬ ‫ﻟﻺﺸﻌﺎﻉ‬ ‫ﻜﻤﺼﺩﺭ‬ ‫ﺍﺴﺘﺨﺩﺍﻤﺎ‬ ‫ﺍﻷﻜﺜﺭ‬ ‫ﻴﺔ‬ ،‫ﺍﻟﺠﺴﻡ‬ ‫ﺩﺍﺨـل‬ ‫ﺘﺨﺘﺭﻗﻪ‬ ‫ﺃﻥ‬ ‫ﺒﺎﻷﺸﻌﺔ‬ ‫ﺍﻟﻤﻔﺘﺭﺽ‬ ‫ﺍﻟﻌﻤﻕ‬ ‫ﻭ‬ ‫ﺍﻟﻭﺭﻡ‬ ‫ﻟﻨﻭﻉ‬ ‫ﺘﺒﻌﺎ‬ ‫ﻤﺴﺘﺨﺩﻤﺔ‬ ‫ﻋﺩﻴﺩﺓ‬‫ﺃﺸﻌﺔ‬ ‫ﻤﺜل‬‫ﻏ‬‫ـﺎﻤﺎ‬ gamma rays‫ﺍﻟ‬‫ﻨﻜﻠﻴﺩ‬ ‫ﻋﻥ‬ ‫ﺼﺎﺩﺭﺓ‬‫ﺍﻟﻜﻭﺒﺎﻟﺕ‬-60‫ﻊ‬‫ﺍﻟﻤﺸـ‬)Cobalt-60(‫ﺍﻟﻨﻴﻭﺘﺭﻭﻨــﺎﺕ‬ ‫ﻤـﻥ‬ ‫ﺤﺯﻤﺔ‬ ‫ﺃﻭ‬ ، )neutron beams(‫ﺍﻟﺒﺭﻭﺘﻭﻨﺎﺕ‬ ‫ﺃﻭ‬)beamsproton(‫ﺃﻭ‬ ،‫ﺍﻹﻟﻜﺘﺭﻭﻨﺎﺕ‬)electron beam.(‫ﻭﻴﺒـﻴﻥ‬ ‫ﺍﻟﺸﻜل‬)4(‫ﺍﻟﺸـﻜل‬ ‫ﻴﺒﻴﻥ‬ ‫ﻜﻤﺎ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻤﺴﺘﺨﺩﻡ‬ ‫ﺍﻟﻁﺒﻲ‬ ‫ﺍﻟﺨﻁﻲ‬ ‫ﺍﻟﻤﺴﺭﻉ‬ ‫ﺠﻬﺎﺯ‬)5(‫ﺠﻬـﺎﺯ‬ ‫ﺍﻟﻜﻭﺒﺎﻟﺕ‬-60. ‫ﺍﻟﺸﻜل‬)4(‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻤﺴﺘﺨﺩﻡ‬ ‫ﺍﻟﻁﺒﻲ‬ ‫ﺍﻟﺨﻁﻲ‬ ‫ﺍﻟﻤﺴﺭﻉ‬ ‫ﺠﻬﺎﺯ‬
  9. 9. Ossama Anjak, AECS. PO BOX6091Damascys Page 9  ‫ﺍﻟﺸﻜل‬)5(‫ﺍﻟﻜﻭﺒﺎﻟﺕ‬ ‫ﺠﻬﺎﺯ‬-60‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻤﺴﺘﺨﺩﻡ‬ 4.‫ﻭ‬ ‫ﻤﺤﺎﻜﺎﺓ‬‫ﺘﺨﻁﻴﻁ‬‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬)Treatment Planning and Simulation:( ‫ﺍﻟ‬ ‫ﺒﺎﺴﺘﺨﺩﺍﻡ‬ ‫ﺍﻟﻘﺭﺍﺭ‬ ‫ﺍﺘﺨﺎﺫ‬ ‫ﻭ‬ ‫ﺍﻟﻌﻼﺠﻴﺔ‬ ‫ﺍﻟﺨﻁﺔ‬ ‫ﺠﻭﺍﻨﺏ‬ ‫ﻟﺘﺤﺩﻴﺩ‬ ‫ﺍﻟﻤﺨﺘﻠﻔﺔ‬ ‫ﺍﻟﻁﺒﻴﺔ‬ ‫ﺍﻻﺴﺘﺸﺎﺭﺍﺕ‬ ‫ﻋﻘﺏ‬‫ﻤﻌﺎﻟﺠـﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬‫ﺍﻟﻌﺩﻴﺩ‬ ‫ﺒﺈﺠﺭﺍﺀ‬ ‫ﺍﻟﻤﺨﺘﺹ‬ ‫ﺍﻟﻁﺒﻴﺏ‬ ‫ﻴﻘﻭﻡ‬ ،‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻟﺤﻘل‬ ‫ﺍﻟﺩﻗﻴﻕ‬ ‫ﺍﻟﺘﺨﻁﻴﻁ‬ ‫ﻐﻴﺔ‬‫ﺒ‬ ‫ﺍﻟﺨﺎﺼﺔ‬ ‫ﺍﻟﻘﻴﺎﺴﺎﺕ‬ ‫ﻤﻥ‬ ‫ﺘﺸـﺒﻪ‬ ‫ﻭ‬ ،‫ﺍﻟﻔﻌﻠﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻗﺒل‬ ‫ﻤﺤﺎﻜﺎﺓ‬ ‫ﻭ‬ ‫ﺘﺼﻭﺭ‬ ‫ﺒﻌﻤﻠﻴﺔ‬ ،‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬‫ﺠﻬـﺎﺯ‬‫ﺍﻟﻤﺤﺎﻜـﺎﺓ‬)Radiotherapy Simulator(‫ﺃﺠﻬﺯﺓ‬‫ﺍﻟﻌﺎﺩﻴﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺘﺼﻭﻴﺭ‬‫ﺴـﻴﻨﻴﺔ‬ ‫ﺃﺸـﻌﺔ‬ ‫ﺒﺘﻭﻟﻴﺩ‬ ،‫ﺍﻟﺘﻨﻅﻴﺭ‬ ‫ﺘﻘﻨﻴﺔ‬ ‫ﺘﺴﺘﺨﺩﻡ‬ ‫ﺃﻨﻬﺎ‬ ‫ﻏﻴﺭ‬ ، )fluoroscopicx-ray(‫ﺨـﻼل‬ ‫ﺍﻟﻤـﺭﻴﺽ‬ ‫ﻭﻴﺴﺘﻠﻘﻲ‬ ،‫ﺍﻟﻤﺴﺘﻬﺩﻓﺔ‬ ‫ﺍﻟﻤﻨﻁﻘﺔ‬ ‫ﺘﺤﺩﻴﺩ‬ ‫ﻭ‬ ‫ﺒﺭﺅﻴﺔ‬ ‫ﻟﻠﻁﺒﻴﺏ‬ ‫ﺘﺴﻤﺢ‬ ، ‫ﻋﻠﻰ‬ ‫ﺍﻟﺘﺼﻭﺭ‬ ‫ﻋﻤﻠﻴﺔ‬‫ﻭﻫﻲ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺠﻬﺎﺯ‬ ‫ﻁﺎﻭﻟﺔ‬ ‫ﺇﻟﻰ‬ ‫ﻤﻤﺎﺜﻠﺔ‬ ‫ﻁﺎﻭﻟﺔ‬‫ﺘﺤﺭﻴﻜﻬـﺎ‬ ‫ﻴﻤﻜﻥ‬ ‫ﻤﺤﻭﺭ‬ ‫ﺫﺍﺕ‬ ‫ﺘـﺘﻡ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﺴـﺘﻬﺩﻓﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻤﻭﺍﻀﻊ‬ ‫ﻟﺘﺤﺩﻴﺩ‬ ‫ﺍﻟﺒﺸﺭﺓ‬ ‫ﻋﻠﻰ‬ ‫ﻤﺅﻗﺘﺔ‬ ‫ﻋﻼﻤﺎﺕ‬ ‫ﺭﺴﻡ‬ ‫ﻴﺘﻡ‬ ‫ﻭ‬ ،‫ﺍﻻﺘﺠﺎﻫﺎﺕ‬ ‫ﺒﻤﺨﺘﻠﻑ‬ ‫ﻋﺎﺩ‬‫ﻤﻨﺨﻔﻀﺔ‬ ‫ﻟﻴﺯﺭﻴﺔ‬ ‫ﻀﻭﺌﻴﺔ‬ ‫ﺃﺸﻌﺔ‬ ‫ﺘﺴﺘﺨﺩﻡ‬ ‫ﻟﻴﺯﺭﻴﺔ‬ ‫ﺒﺄﺠﻬﺯﺓ‬ ‫ﺍﻻﺴﺘﻌﺎﻨﺔ‬ ‫ﺓ‬‫ﺍﻟﻁﺎﻗﺔ‬)‫ﺒﻁﺒﻴﻌـﺔ‬ ‫ﺓ‬‫ﺭ‬‫ﻀـﺎ‬ ‫ﻟﻴﺴﺕ‬ ‫ﻭ‬ ‫ﺍﻟﺤﺎل‬(‫ﻟﺘﺤﺩﻴﺩ‬‫ﺨﻼل‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﻭﻀﻌﻴﺔ‬‫ﺒﺎﻟﺘﻘﺎﻁ‬ ‫ﺍﻟﻁﺒﻴﺏ‬ ‫ﻴﻘﻭﻡ‬ ‫ﺍﻟﻘﻴﺎﺴﺎﺕ‬ ‫ﺘﺩﻗﻴﻕ‬ ‫ﻤﻥ‬ ‫ﺍﻻﻨﺘﻬﺎﺀ‬ ‫ﻋﻘﺏ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺍﻟﺘ‬ ‫ﻓﻲ‬ ‫ﻻﺴﺘﺨﺩﺍﻤﻬﺎ‬ ‫ﺍﻷﺸﻌﺔ‬ ‫ﺼﻭﺭ‬ ‫ﺒﻌﺽ‬‫ﺤﻀﻴﺭ‬‫ﺍﻹ‬ ‫ﺍﻟﺘﺨﻁﻴﻁ‬ ‫ﺼﻭﺭ‬ ‫ﺫﻟﻙ‬ ‫ﻓﻲ‬ ‫ﺒﻤﺎ‬ ،‫ﻟﻠﻤﻌﺎﻟﺠﺔ‬‫ﺍﻟﻤﻘﻁﻌـﻲ‬ ‫ﺸﻌﺎﻋﻲ‬ ‫ﺍﻟﺤـﺩﻭﺩ‬ ‫ﻋﻠـﻰ‬ ‫ﻟﻺﺒﻘـﺎﺀ‬ ‫ﺍﻟﺨﻔﻴﻑ‬ ‫ﺍﻟﻭﺸﻡ‬ ‫ﺒﺎﺴﺘﺨﺩﺍﻡ‬ ‫ﺍﻟﻤﺅﻗﺘﺔ‬ ‫ﺍﻟﻌﻼﻤﺎﺕ‬ ‫ﺘﺤﺒﻴﺭ‬ ‫ﻏﺎﻟﺒﺎ‬ ‫ﻴﺘﻡ‬ ‫ﻭ‬ ،‫ﺍﻷﺤﻴﺎﻥ‬ ‫ﺒﻌﺽ‬ ‫ﻓﻲ‬ ‫ﻁﻭﻴﻠﺔ‬ ‫ﻟﻔﺘﺭﺍﺕ‬ ‫ﺍﻟﻤﺭﺴﻭﻤﺔ‬.
  10. 10. Ossama Anjak, AECS. PO BOX6091Damascys Page 10  ‫ﺍﻟﻤﺒﺎﺸـﺭﺓ‬ ‫ﻗﺒـل‬ ‫ﺇﺠـﺭﺍﺀﺍﺕ‬ ‫ﻋـﺩﺓ‬ ‫ﺍﺘﺨﺎﺫ‬ ‫ﻴﺘﻡ‬ ،‫ﺍﻟﺘﺨﻁﻴﻁ‬ ‫ﺠﻠﺴﺎﺕ‬ ‫ﻋﻘﺏ‬ ‫ﺍﻟﻤﺴﺘﺨﻠﺼﺔ‬ ‫ﺍﻟﻤﻌﻠﻭﻤﺎﺕ‬ ‫ﻋﻠﻰ‬ ‫ﺒﻨﺎﺀﺍ‬ ‫ﻭ‬ ‫ﻤ‬ ‫ﻭﺍﻗﻴﺔ‬ ‫ﺩﺭﻭﻉ‬ ‫ﺘﺠﻬﻴﺯ‬ ‫ﻤﺜل‬ ،‫ﺍﻟﻔﻌﻠﻴﺔ‬ ‫ﺒﺎﻟﻤﻌﺎﻟﺠﺔ‬‫ﺍﻟﺘﻌـﺭﺽ‬ ‫ﻤـﻥ‬ ‫ﺍﻟﺴﻠﻴﻤﺔ‬ ‫ﺍﻷﻨﺴﺠﺔ‬ ‫ﻟﺤﻤﺎﻴﺔ‬ ‫ﺭﺼﺎﺼﻴﺔ‬ ‫ﻗﻭﺍﻟﺏ‬ ‫ﻥ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺠﻠﺴﺎﺕ‬ ‫ﻋﺩﺩ‬ ‫ﻭ‬ ‫ﺍﻟﺯﻤﻨﻴﺔ‬ ‫ﺍﻟﺠﺩﻭﻟﺔ‬ ‫ﻭ‬ ‫ﺍﻟﻼﺯﻤﺔ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﺠﺭﻋﺎﺕ‬ ‫ﺘﺤﺩﻴﺩ‬ ‫ﻭ‬ ،‫ﻟﻺﺸﻌﺎﻉ‬. 5.‫ﺘﻁﺒﻴﻕ‬‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌـﺎﻟﺠﺔ‬: ‫ﺘﺘﻡ‬ ‫ﻭ‬ ،‫ﺍﻟﻔﻌﻠﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺒﺠﻠﺴﺎﺕ‬ ‫ﻟﻠﻤﺒﺎﺸﺭﺓ‬ ‫ﺍﻟﺘﺨﻁﻴﻁ‬ ‫ﺠﻠﺴﺎﺕ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻤﺴﺘﺨﻠﺼﺔ‬ ‫ﺍﻟﺒﻴﺎﻨﺎﺕ‬ ‫ﺒﺎﺴﺘﺨﺩﺍﻡ‬ ‫ﺍﻟﻁﺒﻴﺏ‬ ‫ﻴﻘﻭﻡ‬ ‫ﺍ‬‫ﻓـﻲ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﻟﺘﺜﺒﻴﺕ‬ ‫ﻭ‬ ،‫ﺒﺩﻗﺔ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﺘﻭﺠﻴﻪ‬ ‫ﻤﻭﺍﻀﻊ‬ ‫ﻟﺘﺤﺩﻴﺩ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻟﺤﻘل‬ ‫ﺍﻟﻤﺤﺩﺩﺓ‬ ‫ﺒﺎﻟﻌﻼﻤﺎﺕ‬ ‫ﻻﺴﺘﻌﺎﻨﺔ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﺼﺤﻴﺤﺔ‬ ‫ﺍﻟﻭﻀﻌﻴﺔ‬‫ﻁﺎﻭﻟﺔ‬‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺠﻬﺎﺯ‬‫ﺍﻷﻋﻀﺎﺀ‬ ‫ﻭ‬ ‫ﺍﻷﻨﺴﺠﺔ‬ ‫ﺤﻤﺎﻴﺔ‬ ‫ﺘﺘﻡ‬ ‫ﺍﻟﺤﺎل‬ ‫ﺒﻁﺒﻴﻌﺔ‬ ‫ﻭ‬ ، ‫ﹰ‬‫ﺎ‬‫ﺘﺠﻨﺒ‬ ‫ﺒﺎﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺍﻟﻤﺴﺘﻬﺩﻓﺔ‬ ‫ﻏﻴﺭ‬ ‫ﻭ‬ ‫ﺍﻟﺠﺴﻡ‬ ‫ﻤﻥ‬ ‫ﺍﻟﺴﻠﻴﻤﺔ‬‫ﺤﻴ‬ ،‫ﺍﻷﺸﻌﺔ‬ ‫ﻟﻤﻀﺎﻋﻔﺎﺕ‬‫ﺒﻭﻀـﻊ‬ ‫ﺍﻟﻁﺒﻴـﺏ‬ ‫ﻴﻘـﻭﻡ‬ ‫ﺙ‬ ‫ﺍﻟﺤﻤﺎﻴﺎﺕ‬‫ﺃﻭ‬ ‫ﺘﺠﻬﻴﺯﻫﺎ‬ ‫ﺴﺒﻕ‬ ‫ﺍﻟﺘﻲ‬‫ﺭﺼﺎﺼﻴﺔ‬ ‫ﻗﻭﺍﻟﺏ‬)Lead Dlocks(‫ﻫﺫﻩ‬ ‫ﺒﻴﻥ‬ ‫ﻭ‬ ‫ﺍﻷﺸﻌﺔ‬ ‫ﺁﻟﺔ‬ ‫ﺒﻴﻥ‬ ،‫ﺨﺎﺼﺔ‬ ‫ﺍﻟﻭﻀـﻌﻴﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﺇﺒﻘﺎﺀ‬ ‫ﻋﻠﻰ‬ ‫ﺘﺴﺎﻋﺩ‬ ‫ﻻﺼﻘﺔ‬ ‫ﺃﺸﺭﻁﺔ‬ ‫ﺃﻭ‬ ‫ﺒﻼﺴﺘﻴﻜﻴﺔ‬ ‫ﻗﻭﺍﻟﺏ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬ ‫ﻴﺘﻡ‬ ‫ﻗﺩ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﻭﺍﻀﻊ‬ ‫ﺍﻟ‬ ‫ﺠﻠﺴﺔ‬ ‫ﺯﻤﻥ‬ ‫ﻤﻌﻅﻡ‬ ‫ﺍﻟﺘﻬﻴﺌﺔ‬ ‫ﻋﻤﻠﻴﺔ‬ ‫ﺘﺴﺘﻐﺭﻕ‬ ‫ﻤﺎ‬ ‫ﻋﺎﺩﺓ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﻁﻠﻭﺒﺔ‬‫ﺒـﻴﻥ‬ ‫ﻤﺎ‬ ‫ﻴﺴﺘﻐﺭﻕ‬ ‫ﻗﺩ‬ ‫ﺒﺩﻭﺭﻩ‬ ‫ﺍﻟﺫﻱ‬ ،‫ﻤﻌﺎﻟﺠﺔ‬ ،‫ﺩﻗـﺎﺌﻕ‬ ‫ﺍﻟﺨﻤﺱ‬ ‫ﻭ‬ ‫ﺍﻟﺩﻗﻴﻘﺔ‬ ‫ﺒﻴﻥ‬ ‫ﻤﺎ‬ ‫ﺍﻟﻔﻌﻠﻴﺔ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﺘﻠﻘﻲ‬ ‫ﻓﺘﺭﺓ‬ ‫ﺘﺴﺘﻐﺭﻕ‬ ‫ﺒﻴﻨﻤﺎ‬ ،‫ﺩﻗﻴﻘﺔ‬ ‫ﺜﻼﺜﻴﻥ‬ ‫ﺇﻟﻰ‬ ‫ﻋﺸﺭ‬ ‫ﺨﻤﺴﺔ‬ ‫ﻤﺜل‬ ،‫ﻭﺍﻟﺨﻠﻊ‬ ‫ﺍﻻﺭﺘﺩﺍﺀ‬ ‫ﺴﻬﻠﺔ‬ ‫ﻤﺭﻴﺤﺔ‬ ‫ﻤﻼﺒﺱ‬ ‫ﺍﺭﺘﺩﺍﺀ‬ ‫ﺍﻟﻤﻔﻴﺩ‬ ‫ﻭﻤﻥ‬‫ﻓﻲ‬ ‫ﺍﻟﻤﺴﺘﺨﺩﻤﺔ‬ ‫ﺍﻟﻤﻼﺒﺱ‬‫ﻗﺒـل‬ ‫ﺍﻟﻤﺴﺘﺸـﻔﻴﺎﺕ‬ ‫ﺍﻟﻌﻼﺠﻴﺔ‬ ‫ﺒﺎﻟﺠﻠﺴﺔ‬ ‫ﺍﻟﺒﺩﺀ‬.‫ﺍﻟ‬ ‫ﻭﻴﺒﻴﻥ‬‫ﺸﻜل‬)6(‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺠﻠﺴﺔ‬ ‫ﺨﻼل‬ ‫ﺍﻟﻤﺭﻴﺽ‬. ‫ﻭ‬‫ﺒﺎﻟﻤ‬ ‫ﻟﻺﻗﺎﻤﺔ‬ ‫ﺍﻟﺤﺎﺠﺔ‬ ‫ﺩﻭﻥ‬ ‫ﺍﻟﺨﺎﺭﺠﻲ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﺘﻠﻘﻲ‬ ‫ﻴﺘﻡ‬ ،‫ﺍﻟﺤﺎﻻﺕ‬ ‫ﺍﻏﻠﺏ‬ ‫ﻟﺩﻯ‬‫ﺴﺘﺸﻔﻰ‬‫ﻭ‬‫ﺒﻴﻥ‬ ‫ﻤﺎ‬ ‫ﺘﺘﺭﺍﻭﺡ‬ ‫ﻟﻔﺘﺭﺍﺕ‬ ‫ﺃﺴﺎﺒ‬ ‫ﺜﻤﺎﻨﻴﺔ‬ ‫ﺇﻟﻰ‬ ‫ﺴﺘﺔ‬،‫ﺒﺎﻷﺴﺒﻭﻉ‬ ‫ﺃﻴﺎﻡ‬ ‫ﺨﻤﺴﺔ‬ ‫ﺒﻤﻌﺩل‬ ،‫ﻴﻊ‬)‫ﻭ‬‫ﺍﻟﻬﺩﻑ‬ ‫ﻴﻜﻭﻥ‬ ‫ﻋﻨﺩﻤﺎ‬ ‫ﺍﻗﺼﺭ‬ ‫ﺘﻜﻭﻥ‬ ‫ﺍﻟﻌﻼﺠﻴﺔ‬ ‫ﺍﻟﺩﻭﺭﺍﺕ‬ ‫ﺍﻟﺘﺨﻔﻴﻑ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻤﻥ‬‫ﻭ‬ ‫ﺍﻷﻋﺭﺍﺽ‬ ‫ﻤﻥ‬‫ﺇﻟـﻰ‬ ‫ﺍﻷﺴﺒﻭﻋﻴﻥ‬ ‫ﺒﻴﻥ‬ ‫ﺘﺘﺭﺍﻭﺡ‬ ‫ﻟﻔﺘﺭﺓ‬ ‫ﻋﺎﺩﺓ‬ ‫ﻭ‬ ،‫ﻓﺤﺴﺏ‬ ‫ﺍﻟﻭﺭﻡ‬ ‫ﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﺃﺴﺎﺒﻴﻊ‬ ‫ﺍﻟﺜﻼﺜﺔ‬(‫ﺤﺎﻟﺔ‬ ‫ﻜل‬ ‫ﻋﻨﺩ‬ ‫ﺍﻟﻤﺘﺒﻊ‬ ‫ﺍﻟﻌﻼﺠﻲ‬ ‫ﺍﻟﻤﺨﻁﻁ‬ ‫ﻭ‬ ‫ﺍﻟﻭﺭﻡ‬ ‫ﻨﻭﻉ‬ ‫ﺤﺴﺏ‬ ‫ﺫﻟﻙ‬ ‫ﻭ‬ ،. ‫ﻴﻌﺘﻤﺩ‬‫ﺍﻟﺤﺎﻟﺔ‬ ‫ﻭ‬ ،‫ﺤﺠﻤﻪ‬ ‫ﻭ‬ ‫ﻤﻭﻀﻌﻪ‬ ‫ﻭ‬ ‫ﺍﻟﻭﺭﻡ‬ ‫ﻨﻭﻉ‬ ‫ﻋﻠﻰ‬ ،‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺠﻠﺴﺎﺕ‬ ‫ﻭﻋﺩﺩ‬ ‫ﺍﻟﻜﻠﻴﺔ‬ ‫ﺍﻟﺠﺭﻋﺎﺕ‬ ‫ﺤﺴﺎﺏ‬ ،‫ﻟﻠﻤﺭﻴﺽ‬ ‫ﺍﻟﻌﺎﻤﺔ‬ ‫ﺍﻟﺼﺤﻴﺔ‬‫ﻭ‬ ،‫ﺍﻟﻤﺘﻠﻘﺎﺓ‬ ‫ﺍﻷﺨﺭﻯ‬ ‫ﺍﻟﻌﻼﺠﺎﺕ‬ ‫ﻭ‬‫ﺼـﻐﻴﺭﺓ‬ ‫ﻭ‬ ‫ﻋﺩﻴﺩﺓ‬ ‫ﺠﺭﻋﺎﺕ‬ ‫ﺇﻋﻁﺎﺀ‬ ‫ﻴﺘﻡ‬‫ﻴﻭﻤﻴـ‬‫ﹰ‬‫ﺎ‬ )‫ﹰ‬‫ﻻ‬‫ﺒﺩ‬‫ﻗﻠﻴﻠﺔ‬ ‫ﺠﻠﺴﺎﺕ‬ ‫ﻓﻲ‬ ‫ﻤﻜﺜﻔﺔ‬ ‫ﺠﺭﻋﺎﺕ‬ ‫ﻤﻥ‬(‫ﺘﺴـﺎﻋﺩ‬ ‫ﺒﻴﻨﻤﺎ‬ ،‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺒﻤﻭﻀﻊ‬ ‫ﺍﻟﺴﻠﻴﻤﺔ‬ ‫ﺍﻷﻨﺴﺠﺔ‬ ‫ﺤﻤﺎﻴﺔ‬ ‫ﺒﻐﻴﺔ‬ ، ‫ﺍﻷﻨﺴﺠﺔ‬ ‫ﻫﺫﻩ‬ ‫ﺘﻌﺎﻓﻲ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻷﺴﺒﻭﻋﻴﺔ‬ ‫ﺍﻟﺭﺍﺤﺔ‬ ‫ﻓﺘﺭﺍﺕ‬.
  11. 11. Ossama Anjak, AECS. PO BOX6091Damascys Page 11  ‫ﺍﻟﺸﻜل‬)6(‫ﺍﻹﺸﻌﺎﻋﻴ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺠﻠﺴﺔ‬ ‫ﺨﻼل‬ ‫ﺍﻟﻤﺭﻴﺽ‬‫ﺔ‬ ‫ﺍﻟﻤﺠـﺯﺃ‬ ‫ﺒﺎﻹﺸﻌﺎﻉ‬ ‫ﹸﻌﺭﻑ‬‫ﺘ‬ ،‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﺠﺭﻋﺎﺕ‬ ‫ﻟﺘﻘﺴﻴﻡ‬ ‫ﺃﺨﺭﻯ‬ ‫ﻁﺭﻴﻘﺔ‬ ‫ﻭﺜﻤﺔ‬)hyperfractionated(، ‫ﺍﺼـﻐﺭ‬ ‫ﺠﺭﻋـﺎﺕ‬ ‫ﺇﻟﻰ‬ ‫ﺍﻟﻴﻭﻤﻴﺔ‬ ‫ﺍﻟﺠﺭﻋﺎﺕ‬ ‫ﺘﻘﺴﻴﻡ‬ ‫ﻴﺘﻡ‬ ،‫ﻴﻭﻤﻴﺎ‬ ‫ﻭﺍﺤﺩﺓ‬ ‫ﺠﻠﺴﺔ‬ ‫ﺒﻤﻌﺩل‬ ‫ﺍﻷﺸﻌﺔ‬ ‫ﺘﻠﻘﻲ‬ ‫ﻤﻥ‬ ‫ﹰ‬‫ﻻ‬‫ﺒﺩ‬ ‫ﺤﻴﺙ‬ ‫ﺇﻟﻰ‬ ‫ﺃﺭﺒﻊ‬ ‫ﺒﻴﻥ‬ ‫ﻤﺎ‬ ‫ﺘﺘﺭﺍﻭﺡ‬ ‫ﺴﺎﻋﺎﺕ‬ ‫ﺒﻀﻊ‬ ‫ﺒﻔﺎﺼل‬ ،‫ﺍﻟﻭﺍﺤﺩ‬ ‫ﺍﻟﻴﻭﻡ‬ ‫ﻓﻲ‬ ‫ﻤﺭﺍﺕ‬ ‫ﻟﻌﺩﺓ‬ ‫ﹸﻌﻁﻰ‬‫ﺘ‬‫ﻴﺩﺭﺱ‬ ‫ﻭ‬ ،‫ﺴﺎﻋﺎﺕ‬ ‫ﺴﺕ‬ ‫ﺍﻟﻌﻼﺠـﻲ‬ ‫ﺍﻟﻤـﺭﺩﻭﺩ‬ ‫ﻓـﻲ‬ ‫ﺍﻟﺘﻤﺎﺜـل‬ ‫ﻤـﺩﻯ‬ ‫ﻭ‬ ،‫ﺍﻷﻭﺭﺍﻡ‬ ‫ﻤﺨﺘﻠـﻑ‬ ‫ﻋﻨﺩ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﺘﺠﺯﺌﺔ‬ ‫ﻓﺎﻋﻠﻴﺔ‬ ‫ﻤﺩﻯ‬ ‫ﺍﻷﻁﺒﺎﺀ‬ ‫ﺒﺤﻴـﺙ‬ ‫ﻤﺸﺠﻌﺔ‬ ‫ﺍﻷﻭﺭﺍﻡ‬ ‫ﺒﻌﺽ‬ ‫ﻋﻨﺩ‬ ‫ﺍﻟﻨﺘﺎﺌﺞ‬ ‫ﻜﺎﻨﺕ‬ ‫ﻗﺩ‬ ‫ﻭ‬ ،‫ﺍﻟﻴﻭﻤﻲ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﻁﺭﻴﻘﺔ‬ ‫ﻤﻊ‬ ‫ﺍﻟﻤﺘﺄﺨﺭﺓ‬ ‫ﻭﺍﻟﻤﻀﺎﻋﻔﺎﺕ‬ ‫ﻤﻌﺎﻟﺠﺘﻬﺎ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻁﺭﻴﻘﺔ‬ ‫ﻫﺫﻩ‬ ‫ﺍﻋﺘﻤﺩﺕ‬. ‫ﺜﻤﺔ‬ ،‫ﺒﺎﻟﺠﺭﺍﺤﺎﺕ‬ ‫ﻴﺘﻌﻠﻕ‬ ‫ﻭﻓﻴﻤﺎ‬‫ﺍﻟﺠﺭﺍﺤـﺔ‬ ‫ﺃﺜﻨـﺎﺀ‬ ‫ﺍﻹﺸﻌﺎﻋﻲ‬ ‫ﺒﺎﻟﻌﻼﺝ‬ ‫ﹸﻌﺭﻑ‬‫ﺘ‬ ‫ﻁﺭﻴﻘﺔ‬)Intraoperative radiation(‫ﻡ‬‫ﻜ‬ ‫ﺃﻜﺜﺭ‬ ‫ﺒﺎﺴﺘﺌﺼﺎل‬ ‫ﺍﻟﺠﺭﺍﺡ‬ ‫ﻴﻘﻭﻡ‬ ‫ﻤﺒﺩﺌﻴﺎ‬ ‫ﺤﻴﺙ‬ ،‫ﺍﻟﺠﺭﺍﺤﻴﺔ‬ ‫ﺒﺎﻟﻌﻤﻠﻴﺎﺕ‬ ‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺘﺩﻤﺞ‬ ‫ﺍﻟـﻭﺭﻡ‬ ‫ﻤﻬﺩ‬ ‫ﻨﺤﻭ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﻤﻥ‬ ‫ﻋﺎﻟﻴﺔ‬ ‫ﺠﺭﻋﺔ‬ ‫ﺘﺴﻠﻴﻁ‬ ‫ﻴﺘﻡ‬ ،‫ﺍﻟﺠﺭﺍﺤﻴﺔ‬ ‫ﺍﻟﻌﻤﻠﻴﺔ‬ ‫ﺨﻼل‬ ‫ﻭ‬ ،‫ﺍﻟﻭﺭﻡ‬ ‫ﺃﻨﺴﺠﺔ‬ ‫ﻤﻥ‬ ‫ﻤﻤﻜﻥ‬ )‫ﺍﻟ‬ ‫ﺃﻱ‬‫ﻤﻨﻪ‬ ‫ﺍﺴﺘﺅﺼل‬ ‫ﺍﻟﺫﻱ‬ ‫ﻤﻭﻀﻊ‬(‫ﺍﻟﺴـﺭﻁﺎﻨﻴﺔ‬ ‫ﺍﻟﺨﻼﻴﺎ‬ ‫ﻻﻨﺘﻘﺎل‬ ‫ﺘﺤﺴﺒﺎ‬ ‫ﺍﻟﻤﺠﺎﻭﺭﺓ‬ ‫ﺍﻷﻨﺴﺠﺔ‬ ‫ﻤﻥ‬ ‫ﻤﺴﺎﺤﺔ‬ ‫ﻤﻊ‬ ، ‫ﺇﺸـﻌﺎﻋﻲ‬ ‫ﻡ‬‫ﻜ‬ ‫ﺘﺴﻠﻴﻁ‬ ‫ﻴﻀﻤﻥ‬ ‫ﻤﻤﺎ‬ ،‫ﺍﻟﺨﺎﺭﺠﻲ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﺇﻟﻰ‬ ‫ﺒﺎﻹﻀﺎﻓﺔ‬ ‫ﺍﻟﻁﺭﻴﻘﺔ‬ ‫ﻫﺫﻩ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬ ‫ﺃﺤﻴﺎﻨﺎ‬ ‫ﻴﺘﻡ‬ ‫ﻭ‬ ،‫ﺇﻟﻴﻬﺎ‬ ‫ﺍﻟﺴﺭﻁﺎﻨﻴﺔ‬ ‫ﺍﻟﺨﻼﻴﺎ‬ ‫ﻋﻠﻰ‬ ‫ﻜﺜﺎﻓﺔ‬ ‫ﺃﻜﺜﺭ‬. ‫ﻴﺸﻌﺭ‬ ‫ﻻ‬ ‫ﺍﻟﻤﺭﻀﻰ‬ ‫ﺍﻷﻁﻔﺎل‬ ‫ﺃﻥ‬ ‫ﺒﺎﻟﺫﻜﺭ‬ ‫ﻴﺠﺩﺭ‬‫ﺍﻟﺘﻘـﺎﻁ‬ ‫ﺍﻷﻤـﺭ‬ ‫ﻴﺸﺒﻪ‬ ‫ﻭ‬ ،‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﺘﻠﻘﻲ‬ ‫ﺃﺜﻨﺎﺀ‬ ‫ﺍﻵﻡ‬ ‫ﺒﺄﻴﺔ‬ ‫ﻭﻥ‬ ‫ﺒـﺙ‬ ‫ﺍﻨﺘﻬـﺎﺀ‬ ‫ﻟﺤـﻴﻥ‬ ‫ﻭ‬ ،‫ﺤﺭﺍﻙ‬ ‫ﺩﻭﻥ‬ ‫ﺜﺎﺒﺕ‬ ‫ﺒﻭﻀﻊ‬ ‫ﺍﻟﻁﻔل‬ ‫ﻴﺴﺘﻜﻴﻥ‬ ‫ﺃﻥ‬ ‫ﻴﺘﻁﻠﺏ‬ ‫ﺍﻨﻪ‬ ‫ﺇﻻ‬ ،‫ﺍﻟﺴﻴﻨﻴﺔ‬ ‫ﺍﻷﺸﻌﺔ‬ ‫ﺼﻭﺭ‬ ‫ﻻ‬ ‫ﺍﻟﺤـﺎل‬ ‫ﺒﻁﺒﻴﻌـﺔ‬ ‫ﻭ‬ ،‫ﺍﻟﺴﻥ‬ ‫ﺼﻐﻴﺭ‬ ‫ﻜﺎﻥ‬ ‫ﺇﻥ‬ ‫ﺨﺼﻭﺼﺎ‬ ،‫ﺍﻟﻐﺭﺽ‬ ‫ﻟﻬﺫﺍ‬ ‫ﺘﺨﺩﻴﺭﻩ‬ ‫ﺍﻷﻤﺭ‬ ‫ﻴﺴﺘﺩﻋﻲ‬ ‫ﻗﺩ‬ ‫ﻭ‬ ،‫ﺍﻷﺸﻌﺔ‬ ‫ﺃﻭ‬ ‫ﻴﺴﻤﻌﻬﺎ‬ ‫ﺃﻭ‬ ‫ﺍﻷﺸﻌﺔ‬ ‫ﺍﻟﻁﻔل‬ ‫ﻴﺭﻯ‬‫ﺜﻤـﺔ‬ ‫ﻟﻴﺱ‬ ‫ﻭ‬ ،‫ﺇﺸﻌﺎﻋﻲ‬ ‫ﻨﺸﺎﻁ‬ ‫ﺃﻱ‬ ‫ﻋﻠﻰ‬ ‫ﺠﺴﻤﻪ‬ ‫ﻴﺤﺘﻭﻱ‬ ‫ﻟﻥ‬ ‫ﻭ‬ ،‫ﺭﺍﺌﺤﺘﻬﺎ‬ ‫ﻴﺸﻡ‬ ‫ﺍﻵﺨﺭﻴﻥ‬ ‫ﻤﻊ‬ ‫ﺍﻟﺘﻭﺍﺼل‬ ‫ﻤﻥ‬ ‫ﻤﻨﻌﻪ‬ ‫ﺃﻭ‬ ،‫ﺍﻟﺯﻭﺍﺭ‬ ‫ﻋﻥ‬ ‫ﻟﻌﺯﻟﻪ‬ ‫ﺤﺎﺠﺔ‬. ‫ﻭﺤﻴـﺩﺍ‬ ‫ﺴـﻴﺒﻘﻰ‬ ‫ﺃﻨـﻪ‬ ‫ﺤﻴﺙ‬ ،‫ﺍﻷﺸﻌﺔ‬ ‫ﺒﺠﻠﺴﺎﺕ‬ ‫ﺍﻟﻤﺒﺎﺸﺭﺓ‬ ‫ﻗﺒل‬ ‫ﻤﺨﺎﻭﻓﻪ‬ ‫ﺇﺯﺍﻟﺔ‬ ‫ﻭ‬ ‫ﺍﻟﻁﻔل‬ ‫ﺘﻁﻤﻴﻥ‬ ‫ﺍﻟﻤﻬﻡ‬ ‫ﻤﻥ‬ ‫ﻭ‬ ‫ﻟﻤﻌﺎ‬ ‫ﺍﻟﻤﺴﺘﺨﺩﻤﺔ‬ ‫ﺍﻵﻻﺕ‬ ‫ﻭ‬ ،‫ﺍﻟﺒﺙ‬ ‫ﺯﻤﻥ‬ ‫ﻁﻭﺍل‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺒﻐﺭﻓﺔ‬‫ﺒﻌـﺽ‬ ‫ﹸﺼـﺩﺭ‬‫ﺘ‬ ‫ﻭ‬ ‫ﺍﻟﺤﺠﻡ‬ ‫ﻜﺒﻴﺭﺓ‬ ‫ﺍﻷﺸﻌﺔ‬ ‫ﻟﺠﺎﺕ‬ ‫ﻤﺤﺎﺩﺜـﺔ‬ ‫ﺍﻟﻤﻤﻜـﻥ‬ ‫ﻤـﻥ‬ ‫ﻭ‬ ،‫ﺯﻭﺍﻴﺎ‬ ‫ﻋﺩﺓ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻤﺤﺩﺩﺓ‬ ‫ﺍﻟﻤﻭﺍﻀﻊ‬ ‫ﻟﺘﺴﺘﻬﺩﻑ‬ ،‫ﺍﻟﺠﺴﻡ‬ ‫ﺤﻭل‬ ‫ﺘﺤﺭﻜﻬﺎ‬ ‫ﺃﺜﻨﺎﺀ‬ ‫ﺍﻟﻀﺠﺔ‬
  12. 12. Ossama Anjak, AECS. PO BOX6091Damascys Page 12  ‫ﺴﻴﺯﻴﺩ‬ ‫ﻗﺭﺒﻪ‬ ‫ﺒﺘﻭﺍﺠﺩﻫﻡ‬ ‫ﺸﻌﻭﺭﻩ‬ ‫ﻭ‬ ‫ﻟﻭﺍﻟﺩﻴﻪ‬ ‫ﺭﺅﻴﺘﻪ‬ ‫ﺃﻥ‬ ‫ﻜﻤﺎ‬ ،‫ﺍﻷﺸﻌﺔ‬ ‫ﺒﻐﺭﻑ‬ ‫ﺍﻟﻤﺭﺍﻗﺒﺔ‬ ‫ﻨﻭﺍﻓﺫ‬ ‫ﻋﺒﺭ‬ ‫ﻁﻤﺄﻨﺘﻪ‬ ‫ﻭ‬ ‫ﺍﻟﻁﻔل‬ ‫ﺒﺯﻴﺎﺭﺓ‬ ‫ﺍﻟﻘﻴﺎﻡ‬ ‫ﺍﻟﻤﻔﻴﺩ‬ ‫ﻤﻥ‬ ‫ﻭ‬ ،‫ﻁﻤﺄﻨﺘﻪ‬ ‫ﻤﻥ‬‫ﺍﺴﺘﺌﻨﺎﺴﻪ‬ ‫ﻟﺯﻴﺎﺩﺓ‬ ‫ﺒﺎﻟﻤﻌﺎﻟﺠﺎﺕ‬ ‫ﺍﻟﻤﺒﺎﺸﺭﺓ‬ ‫ﻗﺒل‬ ،‫ﺒﺎﻟﻤﺴﺘﺸﻔﻰ‬ ‫ﺍﻷﺸﻌﺔ‬ ‫ﺃﻗﺴﺎﻡ‬ ‫ﻋﺎﻡ‬ ‫ﺒﺸﻜل‬ ‫ﺒﺎﻟﻭﻀﻊ‬ 6.‫ﺍﻹﺸﻌـﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺃﺜﻨﺎﺀ‬ ‫ﺍﻟﻌـﻨﺎﻴﺔ‬ ‫ﻭ‬ ‫ﺍﻟﺘﻔـﺎﻋﻼﺕ‬ ‫ﻫـﺫﻩ‬ ‫ﻤﺘﺎﺒﻌﺔ‬ ‫ﻴﺴﺘﻠﺯﻡ‬ ‫ﻤﻤﺎ‬ ،‫ﺍﻟﺨﺎﺼﺔ‬ ‫ﺒﻁﺭﻴﻘﺘﻪ‬ ‫ﺍﻹﺸﻌﺎﻋﻲ‬ ‫ﺍﻟﻌﻼﺝ‬ ‫ﻤﻊ‬ ‫ﻤﺭﻴﺽ‬ ‫ﻜل‬ ‫ﺠﺴﻡ‬ ‫ﻴﺘﻔﺎﻋل‬ ‫ﻟﺘﻁ‬ ‫ﺘﺒﻌﺎ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻨﻤﻁ‬ ‫ﺘﻌﺩﻴل‬ ‫ﺃﺤﻴﺎﻨﺎ‬ ‫ﻭ‬ ،‫ﻟﻬﺎ‬ ‫ﺍﻟﺘﺨﻁﻴﻁ‬‫ﺨﺎﺼﺔ‬ ‫ﻟﻌﻨﺎﻴﺔ‬ ‫ﺍﻟﻤﺭﻀﻰ‬ ‫ﻴﺤﺘﺎﺝ‬ ‫ﺍﻟﺤﺎل‬ ‫ﺒﻁﺒﻴﻌﺔ‬ ‫ﻭ‬ ،‫ﻭﺭﺍﺘﻬﺎ‬ ‫ﻟﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﺍﻟﺘﻁﺭﻕ‬ ‫ﻗﺒل‬ ‫ﺍﻟﻌﻨﺎﻴﺔ‬ ‫ﻫﺫﻩ‬ ‫ﻤﺜل‬ ‫ﺤﻭل‬ ‫ﺍﻟﻌﺭﻴﻀﺔ‬ ‫ﺍﻟﺨﻁﻭﻁ‬ ‫ﺒﻌﺽ‬ ‫ﻴﻠﻲ‬ ‫ﻓﻴﻤﺎ‬ ‫ﻭ‬ ،‫ﺍﻹﺸﻌﺎﻋﻲ‬ ‫ﺍﻟﻌﻼﺝ‬ ‫ﺃﺜﻨﺎﺀ‬ ‫ﺍﻹﺸﻌﺎﻋﻲ‬ ‫ﺍﻟﻌﻼﺝ‬: •‫ﺤﺴﺎﺴﻴﺔ‬ ‫ﺃﻴﺔ‬ ‫ﻋﻥ‬ ‫ﻭ‬ ‫ﺍﻟﺘﻨﺎﻭل‬ ‫ﻗﻴﺩ‬ ‫ﺃﺩﻭﻴﺔ‬ ‫ﺃﻴﺔ‬ ‫ﻋﻥ‬ ‫ﺍﻟﻤﻌﺎﻟﺞ‬ ‫ﺍﻟﻁﺒﻴﺏ‬ ‫ﺇﻋﻼﻡ‬ ‫ﻴﻨﺒﻐﻲ‬ ،‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺒﺩﺀ‬ ‫ﻗﺒل‬ ‫ﺍ‬ ‫ﺘﺠﺎﻩ‬‫ﻭ‬ ،‫ﺁﺨـﺭ‬ ‫ﻁﺒﻴﺏ‬ ‫ﺒل‬‫ﻗ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻤﻭﺼﻭﻓﺔ‬ ‫ﺤﺘﻰ‬ ‫ﻋﻘﺎﻗﻴﺭ‬ ‫ﺃﻴﺔ‬ ‫ﺘﻨﺎﻭل‬ ‫ﻗﺒل‬ ‫ﺍﺴﺘﺸﺎﺭﺘﻪ‬ ‫ﻴﻠﺯﻡ‬ ‫ﻜﻤﺎ‬ ،‫ﻟﻌﻘﺎﻗﻴﺭ‬ ‫ﺍﻟﻤﺜﺎل‬ ‫ﺴﺒﻴل‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻁﺒﻴﻌﻴﺔ‬ ‫ﺍﻷﻋﺸﺎﺏ‬ ‫ﺨﻠﻁﺎﺕ‬ ‫ﺃﻭ‬ ‫ﺍﻟﻁﺎﻗﺔ‬ ‫ﻤﺸﺭﻭﺒﺎﺕ‬ ‫ﺃﻭ‬ ‫ﺍﻟﻔﻴﺘﺎﻤﻴﻨﺎﺕ‬ ‫ﺘﻨﺎﻭل‬ ‫ﻗﺒل‬. •‫ﻟﻠﻜﺜﻴﺭ‬ ‫ﺍﻟﺠﺴﻡ‬ ‫ﻴﺤﺘﺎﺝ‬ ‫ﺇﺫ‬ ،‫ﺍﻹﺸﻌﺎﻋﻲ‬ ‫ﺍﻟﻌﻼﺝ‬ ‫ﻟﺘﻠﻘﻲ‬ ‫ﻤﺼﺎﺤﺏ‬ ‫ﻭ‬ ‫ﻤﻌﺘﺎﺩ‬ ‫ﺃﻤﺭ‬ ‫ﺍﻹﻋﻴﺎﺀ‬ ‫ﻭ‬ ‫ﺒﺎﻟﺘﻌﺏ‬ ‫ﺍﻟﺸﻌﻭﺭ‬ ‫ﺍ‬ ‫ﻤﻥ‬‫ﺨـﻼل‬ ‫ﺍﻟﺸﺩﺓ‬ ‫ﻤﺨﺘﻠﻑ‬ ‫ﺒﺈﺭﻫﺎﻕ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﻴﺸﻌﺭ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﺘﺭﺓ‬ ‫ﺍﻤﺘﺩﺍﺩ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻹﻀﺎﻓﻴﺔ‬ ‫ﻟﻁﺎﻗﺔ‬ ‫ﻭ‬ ،‫ﺍﻟﻴﻭﻤﻴﺔ‬ ‫ﺍﻟﻨﺸﺎﻁﺎﺕ‬ ‫ﺘﺤﺩﻴﺩ‬ ‫ﻭ‬ ،‫ﻜﺎﻓﻴﺔ‬ ‫ﻨﻭﻡ‬ ‫ﺴﺎﻋﺎﺕ‬ ‫ﻭ‬ ‫ﺍﻟﺭﺍﺤﺔ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻜﺜﻴﺭ‬ ‫ﻴﺘﻁﻠﺏ‬ ‫ﻤﻤﺎ‬ ،‫ﺍﻟﻴﻭﻡ‬ ‫ﺴﺎﻋﺎﺕ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺍﻨﺘﻬﺎﺀ‬ ‫ﻋﻘﺏ‬ ‫ﺃﺴﺎﺒﻴﻊ‬ ‫ﺴﺘﺔ‬ ‫ﺇﻟﻰ‬ ‫ﺃﺭﺒﻌﺔ‬ ‫ﺒﻴﻥ‬ ‫ﺘﺘﺭﺍﻭﺡ‬ ‫ﻟﻔﺘﺭﺍﺕ‬ ‫ﺍﻹﻋﻴﺎﺀ‬ ‫ﻴﺴﺘﻤﺭ‬ ‫ﺃﻥ‬ ‫ﺍﻟﻤﻌﺘﺎﺩ‬ ‫ﻤﻥ‬. •‫ﺍ‬،‫ﺒﺎﻟﻤﻐـﺫﻴﺎﺕ‬ ‫ﻏﻨﻴـﺔ‬ ‫ﻭ‬ ‫ﻤﻼﺌﻤﺔ‬ ‫ﻏﺫﺍﺌﻴﺔ‬ ‫ﺤﻤﻴﺔ‬ ‫ﺇﺘﺒﺎﻉ‬ ‫ﻴﻨﺒﻐﻲ‬ ‫ﻭ‬ ،‫ﺠﺩﺍ‬ ‫ﻤﻬﻡ‬ ‫ﺃﻤﺭ‬ ‫ﺍﻟﻜﺎﻓﻴﺔ‬ ‫ﻭ‬ ‫ﺍﻟﺠﻴﺩﺓ‬ ‫ﻟﺘﻐﺫﻴﺔ‬ ‫ﺍﻟﻭﺯﻥ‬ ‫ﻓﻘﺩﺍﻥ‬ ‫ﻭ‬ ‫ﺍﻟﻐﺫﺍﺌﻲ‬ ‫ﺍﻟﻌﻭﺯ‬ ‫ﻭ‬ ‫ﺍﻟﺘﻐﺫﻴﺔ‬ ‫ﻟﻤﺸﺎﻜل‬ ‫ﺘﺠﻨﺒﺎ‬. •‫ﺍﻟﻤﻨﺎﺴﺒﺔ‬ ‫ﺍﻟﻭﻗﺎﺌﻴﺔ‬ ‫ﺍﻟﺘﺩﺍﺒﻴﺭ‬ ‫ﺍﺘﺨﺎﺫ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺒﻤﻭﻀﻊ‬ ‫ﺍﻟﺒﺸﺭﺓ‬ ‫ﻭ‬ ‫ﺒﺎﻟﺠﻠﺩ‬ ‫ﺍﻟﻔﺎﺌﻘﺔ‬ ‫ﺍﻟﻌﻨﺎﻴﺔ‬ ‫ﻀﺭﻭﺭﺓ‬. 7.‫ﻟ‬ ‫ﺍﻟﺠﺎﻨﺒﻴﺔ‬ ‫ﺍﻟﺘﺄﺜﻴﺭﺍﺕ‬‫ﻠ‬‫ﻤ‬‫ﻌـ‬‫ﺎ‬‫ﻟﺠ‬‫ﺔ‬‫ﺍﻹﺸﻌـﺎﻋﻴ‬‫ﺔ‬: ‫ﺍﻹﺸـﻌﺎﻉ‬ ‫ﺘـﺄﺜﻴﺭﺍﺕ‬ ‫ﺃﻥ‬ ‫ﺇﻻ‬ ،‫ﺍﻹﺸـﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺘﻠﻘﻲ‬ ‫ﺃﺜﻨﺎﺀ‬ ‫ﺸﻲﺀ‬ ‫ﺒﺄﻱ‬ ‫ﻴﺸﻌﺭ‬ ‫ﻻ‬ ‫ﺍﻟﻤﺭﺀ‬ ‫ﺃﻥ‬ ‫ﻤﻥ‬ ‫ﺍﻟﺭﻏﻡ‬ ‫ﻋﻠﻰ‬ ‫ﺒﺸـﻜل‬ ‫ﺍﻟﻤﺼﺎﺤﺒﺔ‬ ‫ﺍﻟﺠﺎﻨﺒﻴﺔ‬ ‫ﺍﻟﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﺘﻌﺘﻤﺩ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﻌـﺎﻟﺠﺔ‬ ‫ﻓﺘﺭﺍﺕ‬ ‫ﺍﻤﺘﺩﺍﺩ‬ ‫ﻭ‬ ‫ﺍﻟﻭﻗﺕ‬ ‫ﻤﺭﻭﺭ‬ ‫ﻤﻊ‬ ‫ﺘﺩﺭﻴﺠﻴﺎ‬ ‫ﺘﺘﺭﻜﺯ‬ ‫ﻌﺎ‬‫ﻤ‬‫ﺍﻟ‬ ‫ﺍﻟﻤﻭﻀﻊ‬ ‫ﻭ‬ ‫ﺍﻟﻤﺴﺘﺨﺩﻡ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﺠﺭﻋﺔ‬ ‫ﻋﻠﻰ‬ ،‫ﺃﺴﺎﺴﻲ‬‫ﻭ‬ ،‫ﻟﻠﻤﺭﻴﺽ‬ ‫ﺍﻟﻌﺎﻤﺔ‬ ‫ﺍﻟﺒﺩﻨﻴﺔ‬ ‫ﻭ‬ ‫ﺍﻟﺼﺤﻴﺔ‬ ‫ﺍﻟﺤﺎﻟﺔ‬ ‫ﻭ‬ ،‫ﻟﺞ‬ ‫ﺘﺘﻠﻘﻰ‬ ‫ﺍﻟﺘﻲ‬ ‫ﺒﺎﻟﻤﻭﺍﻀﻊ‬ ‫ﻏﺎﻟﺒﺎ‬ ‫ﺘﺭﺘﺒﻁ‬ ‫ﻭ‬ ،‫ﻵﺨﺭ‬ ‫ﺸﺨﺹ‬ ‫ﻤﻥ‬ ‫ﺍﺴﺘﻤﺭﺍﺭﻫﺎ‬ ‫ﻓﺘﺭﺍﺕ‬ ‫ﻭ‬ ‫ﻨﻭﻋﻴﺘﻬﺎ‬ ‫ﻭ‬ ‫ﺸﺩﺘﻬﺎ‬ ‫ﻓﻲ‬ ‫ﺘﺘﻔﺎﻭﺕ‬ ‫ﺘﻁﺭﺃ‬ ‫ﻓﻬﻲ‬ ،‫ﺍﻟﻤﺴﺘﻤﺭ‬ ‫ﺍﻹﻋﻴﺎﺀ‬ ‫ﻤﺸﺎﻜل‬ ‫ﻭ‬ ‫ﺍﻟﺒﺸﺭﺓ‬ ‫ﻭ‬ ‫ﺍﻟﺠﻠﺩ‬ ‫ﻤﻀﺎﻋﻔﺎﺕ‬ ‫ﺫﻟﻙ‬ ‫ﻤﻥ‬ ‫ﺴﺜﺘﻨﻰ‬‫ﻴ‬ ،‫ﺒﻬﺎ‬ ‫ﺘﻨﺤﺼﺭ‬ ‫ﻭ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﻤﻭﻀﻊ‬ ‫ﺒﺄﻱ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﺘﻠﻘﻲ‬ ‫ﻋﻨﺩ‬‫ﻗـﺩ‬ ،‫ﺨﺎﺹ‬ ‫ﺒﺸﻜل‬ ‫ﺤﺎﺩﺓ‬ ‫ﻤﻀﺎﻋﻔﺎﺕ‬ ‫ﺘﻁﻭﺭ‬ ‫ﻋﻨﺩ‬ ‫ﻭ‬ ،‫ﺍﻟﺤﺎل‬ ‫ﺒﻁﺒﻴﻌﺔ‬ ‫ﻭ‬ ،‫ﺒﺎﻟﺠﺴﻡ‬ ‫ﺍﻟﺤﺎل‬ ‫ﺍﺴﺘﻘﺭﺍﺭ‬ ‫ﻟﺤﻴﻥ‬ ،‫ﺍﻟﻭﻗﺕ‬ ‫ﻟﺒﻌﺽ‬ ‫ﺘﺄﺠﻴﻠﻬﺎ‬ ‫ﺃﻭ‬ ‫ﺍﻷﺸﻌﺔ‬ ‫ﺠﺭﻋﺎﺕ‬ ‫ﺘﻌﺩﻴل‬ ‫ﻴﺘﻡ‬
  13. 13. Ossama Anjak, AECS. PO BOX6091Damascys Page 13  ‫ﺤﺎﺩﺓ‬ ‫ﺇﻟﻰ‬ ‫ﺍﻟﺠﺎﻨﺒﻴﺔ‬ ‫ﺍﻟﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﺘﺼﻨﻴﻑ‬ ‫ﻴﻤﻜﻥ‬ ‫ﻭ‬)acute(‫ﺒﻌـﺩ‬ ‫ﺘﻨﺸﺄ‬ ،‫ﺍﻟﻅﻬﻭﺭ‬ ‫ﺴﺭﻴﻌﺔ‬ ‫ﻭ‬ ‫ﻤﺒﻜﺭﺓ‬ ‫ﺃﻱ‬‫ﺃﻭ‬ ‫ﺃﻴـﺎﻡ‬ ‫ﻗﺼﻴﺭ‬ ‫ﻓﺘﺭﺍﺕ‬ ‫ﻋﻘﺏ‬ ‫ﻏﺎﻟﺒﺎ‬ ‫ﺘﺯﻭل‬ ‫ﻭ‬ ،‫ﺃﺴﺎﺒﻴﻊ‬‫ﻤﺯﻤﻨـﺔ‬ ‫ﺃﻭ‬ ،‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺍﻨﺘﻬﺎﺀ‬ ‫ﻤﻥ‬ ‫ﺓ‬)Chronic(‫ﻭ‬ ‫ﻤﺘـﺄﺨﺭﺓ‬ ‫ﺃﻱ‬ ‫ﺒﻁﺒﻴﻌﺔ‬ ‫ﻭ‬ ،‫ﻤﺴﺘﺩﻴﻤﺎ‬ ‫ﻴﻜﻭﻥ‬ ‫ﻗﺩ‬ ‫ﺒﻌﻀﻬﺎ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﻌﺎﻟﺠﺎﺕ‬ ‫ﺍﻨﺘﻬﺎﺀ‬ ‫ﻤﻥ‬ ‫ﺴﻨﻭﺍﺕ‬ ‫ﺃﻭ‬ ‫ﺍﺸﻬﺭ‬ ‫ﺒﻌﺩ‬ ‫ﺘﻅﻬﺭ‬ ‫ﻗﺩ‬ ،‫ﺍﻷﺠل‬ ‫ﺒﻌﻴﺩﺓ‬ ‫ﺤﺩﺘﻬﺎ‬ ‫ﻤﻥ‬ ‫ﺍﻟﺘﺨﻔﻴﻑ‬ ‫ﻭ‬ ‫ﺍﻟﺠﺎﻨﺒﻴﺔ‬ ‫ﺍﻵﺜﺎﺭ‬ ‫ﻹﺩﺍﺭﺓ‬ ‫ﺘﺘﺨﺫ‬ ‫ﻋﺩﺓ‬ ‫ﺘﺩﺍﺒﻴﺭ‬ ‫ﺜﻤﺔ‬ ‫ﺍﻟﺤﺎل‬. ‫ﺍﻟﺸﺎ‬ ‫ﺍﻟﻤﺒﻜﺭﺓ‬ ‫ﺍﻟﺠﺎﻨﺒﻴﺔ‬ ‫ﺍﻟﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﺘﺸﻤل‬ ‫ﻭ‬‫ﺃﺴﺎﺒﻴﻊ‬ ‫ﺃﻭ‬ ‫ﺃﻴﺎﻡ‬ ‫ﺨﻼل‬ ‫ﺘﻅﻬﺭ‬ ‫ﺍﻟﺘﻲ‬ ‫ﻭ‬ ‫ﺌﻌﺔ‬:‫ﺍﻟﺒﺸﺭﺓ‬ ‫ﻭ‬ ‫ﺍﻟﺠﻠﺩ‬ ‫ﻤﻀﺎﻋﻔﺎﺕ‬، ‫ﻭ‬‫ﺍﻹﻋﻴﺎﺀ‬‫ﻭ‬ ،‫ﺍﻟﻔﻡ‬ ‫ﻤﻀﺎﻋﻔﺎﺕ‬‫ﻭ‬ ،‫ﺍﻟﺸﻌﺭ‬ ‫ﺘﺴﺎﻗﻁ‬ ‫ﻭ‬ ،‫ﺍﻟﺠﻔﺎﻑ‬ ‫ﻭ‬ ‫ﺍﻟﺘﻘﺭﺤﺎﺕ‬ ‫ﻭ‬ ‫ﺍﻻﻟﺘﻬﺎﺒﺎﺕ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻤﺨﺘﻠﻔﺔ‬‫ﺍﻟﻐﺜﻴﺎﻥ‬ ‫ﺍﻟﺘﻘﻴﺅ‬ ‫ﻭ‬‫ﻭ‬ ،‫ﺍﻹﺴﻬﺎل‬ ‫ﻭ‬ ،‫ﺍﻟﺸﻬﻴﺔ‬ ‫ﻓﻘﺩﺍﻥ‬‫ﻭ‬ ،‫ﺍﻟﺘـﺫﻭﻕ‬ ‫ﻭ‬ ‫ﺍﻟـﺘﻁﻌﻡ‬ ‫ﺤﺱ‬ ‫ﺘﻐﻴﺭﺍﺕ‬ ‫ﻭ‬‫ﺍﻟﻌﻅﻤـﻲ‬ ‫ﺍﻟﻨﺨـﺎﻉ‬ ‫ﺇﺤﺒـﺎﻁ‬ )‫ﺘﻌﺩ‬ ‫ﺍﻨﺨﻔﺎﺽ‬‫ﺍﻟﺩﻡ‬ ‫ﺨﻼﻴﺎ‬ ‫ﺍﺩ‬.( ‫ﻤﻥ‬ ‫ﻓﺘﺭﺓ‬ ‫ﺨﻼل‬ ‫ﺍﻨﻪ‬ ‫ﺇﻟﻰ‬ ‫ﺍﻹﺸﺎﺭﺓ‬ ‫ﺘﺠﺩﺭ‬ ‫ﻭ‬4‫ﺇﻟﻰ‬8‫ﻟﺩﻯ‬ ‫ﻴﺘﻁﻭﺭ‬ ،‫ﻟﻠﺩﻤﺎﻍ‬ ‫ﺍﻹﺸﻌﺎﻋﻲ‬ ‫ﺍﻟﻌﻼﺝ‬ ‫ﺘﻠﻘﻲ‬ ‫ﻋﻘﺏ‬ ‫ﺃﺴﺎﺒﻴﻊ‬ ‫ﺍﻟﻨﻭﺍﻡ‬ ‫ﺒﻅﺎﻫﺭﺓ‬ ‫ﻌﺭﻑ‬‫ﻴ‬ ‫ﻤﺎ‬ ‫ﺍﻷﻁﻔﺎل‬ ‫ﺒﻌﺽ‬)somnolence syndrome(‫ﻓـﻲ‬ ‫ﺒﻭﻀﻭﺡ‬ ‫ﺘﻤﻴﻴﺯﻫﺎ‬ ‫ﻴﺘﻡ‬ ‫ﺍﻟﺘﻲ‬ ‫ﻭ‬ ، ‫ﺍﻟﺤﺭﻜﻲ‬ ‫ﺍﻟﺨﻤـﻭل‬ ‫ﻭ‬ ،‫ﺍﻟﻨﻌﺎﺱ‬ ‫ﻜﺜﺭﺓ‬)lethargy(‫ﻤﺴﺘ‬ ‫ﺍﻨﺨﻔﺎﺽ‬ ‫ﻭ‬ ،‫ﻓﻘﺩ‬ ‫ﺇﻟﻰ‬ ‫ﺇﻀﺎﻓﺔ‬ ،‫ﺍﻟﻁﺎﻗﺔ‬ ‫ﻭ‬ ‫ﺍﻟﻨﺸﺎﻁ‬ ‫ﻭﻴﺎﺕ‬ ‫ﻫﺫﻩ‬ ‫ﺘﻨﺘﻬﻲ‬ ‫ﻋﺎﺩﺓ‬ ‫ﻭ‬ ،‫ﺍﻟﻌﺼﺒﻲ‬ ‫ﺍﻟﺘﻭﺘﺭ‬ ‫ﻭ‬ ‫ﺍﻹﺜﺎﺭﺓ‬ ‫ﺴﻬﻭﻟﺔ‬ ‫ﻭ‬ ‫ﺍﻟﻁﺒﻊ‬ ‫ﺤﺩﺓ‬ ‫ﻤﻥ‬ ‫ﻨﻭﺒﺎﺕ‬ ‫ﻭ‬ ،‫ﻰ‬‫ﻤ‬‫ﺍﻟﺤ‬ ‫ﻭ‬ ،‫ﻟﻠﻁﻌﺎﻡ‬ ‫ﺍﻟﺸﻬﻴﺔ‬ ‫ﺃﺴﺎﺒﻴﻊ‬ ‫ﺜﻼﺜﺔ‬ ‫ﺇﻟﻰ‬ ‫ﺃﺴﺒﻭﻉ‬ ‫ﺒﻴﻥ‬ ‫ﻤﺎ‬ ‫ﺘﺘﺭﺍﻭﺡ‬ ‫ﻓﺘﺭﺍﺕ‬ ‫ﺨﻼل‬ ‫ﺍﻟﻌﻭﺍﺭﺽ‬. ‫ﺍﻷ‬ ‫ﻋﻼﺠﺎﺕ‬ ‫ﻋﻥ‬ ‫ﺘﻨﺘﺞ‬ ‫ﺍﻟﺘﻲ‬ ‫ﺍﻟﺒﻌﻴﺩ‬ ‫ﺍﻟﻤﺩﻯ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻤﺘﺄﺨﺭﺓ‬ ‫ﺍﻟﻤﻀﺎﻋﻔﺎﺕ‬ ‫ﺃﻤﺎ‬‫ﺘﻅﻬﺭ‬ ‫ﻗﺩ‬ ‫ﺍﻟﺘﻲ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﺨﺘﻠﻔﺔ‬ ‫ﻭﺭﺍﻡ‬ ‫ﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﺇﻟﻰ‬ ‫ﺇﻀﺎﻓﺔ‬ ،‫ﻟﻠﻁﻔل‬ ‫ﺍﻟﺫﻫﻨﻲ‬ ‫ﻭ‬ ‫ﺍﻟﺒﺩﻨﻲ‬ ‫ﺍﻟﻨﻤﻭ‬ ‫ﻋﻠﻰ‬ ‫ﺒﺎﻟﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﺇﺠﻤﺎﻻ‬ ‫ﻤﺭﺘﺒﻁﺔ‬ ‫ﻓﻬﻲ‬ ،‫ﺴﻨﻭﺍﺕ‬ ‫ﻋﺩﺓ‬ ‫ﻋﻘﺏ‬ ‫ﺍﻟﻌﺭﻀـﺔ‬ ‫ﻭ‬ ‫ﺍﻟﺨﻁـﻭﺭﺓ‬ ‫ﻋﻭﺍﻤل‬ ‫ﺯﻴﺎﺩﺓ‬ ‫ﻴﻜﻭﻥ‬ ‫ﻗﺩ‬ ‫ﺍﻷﻫﻡ‬ ‫ﺃﻥ‬ ‫ﺇﻻ‬ ،‫ﺍﻟﺤﻴﻭﻴﺔ‬ ‫ﺍﻷﻋﻀﺎﺀ‬ ‫ﺒﻌﺽ‬ ‫ﻋﻠﻰ‬ ‫ﺘﻅﻬﺭ‬ ‫ﻤﺘﺄﺨﺭﺓ‬ ‫ﻌﺎﻟﺞ‬‫ﻤ‬‫ﺍﻟ‬ ‫ﺍﻷﺼﻠﻲ‬ ‫ﺍﻟﻭﺭﻡ‬ ‫ﻏﻴﺭ‬ ‫ﺜﺎﻨﻭﻴﺔ‬ ‫ﺃﻭﺭﺍﻡ‬ ‫ﻟﺘﻁﻭﺭ‬‫ﺒـﻴﻥ‬ ‫ﻤـﺎ‬ ‫ﺜﺎﻨﻭﻱ‬ ‫ﻭﺭﻡ‬ ‫ﻟﻨﺸﻭﺀ‬ ‫ﺍﻟﺨﻁﺭ‬ ‫ﻨﺴﺒﺔ‬ ‫ﺘﺘﺭﺍﻭﺡ‬ ‫ﺤﻴﺙ‬ ، 3%‫ﺇﻟﻰ‬12%،)‫ﺍﻟﻤﺘﻠﻘﺎﺓ‬ ‫ﺍﻟﻌﻼﺠﺎﺕ‬ ‫ﻭ‬ ،‫ﺍﻷﺼﻠﻲ‬ ‫ﺍﻟﻭﺭﻡ‬ ‫ﻟﻨﻭﻉ‬ ‫ﺘﺒﻌﺎ‬(‫ﺍﻟﺘﺎﻟﻴـﺔ‬ ‫ﺴـﻨﺔ‬ ‫ﺍﻟﻌﺸــﺭﻴﻥ‬ ‫ﺨﻼل‬ ، ،‫ﺍﻟﻠﻭﻜﻴﻤﻴﺎ‬ ‫ﺃﻨﻤﺎﻁ‬ ‫ﺒﻌﺽ‬ ‫ﺘﻁﻭﺭ‬ ‫ﺨﺼﻭﺼﺎ‬ ‫ﻭ‬ ،‫ﺍﻷﻁﻔﺎل‬ ‫ﺃﻭﺭﺍﻡ‬ ‫ﻤﻥ‬ ‫ﻨﻭﻉ‬ ‫ﺃﻱ‬ ‫ﻤﻌﺎﻟﺠﺔ‬ ‫ﻭ‬ ‫ﻟﺘﺸﺨﻴﺹ‬ 8.‫ﺍﻟﺠﺎﻨﺒﻴﺔ‬ ‫ﺍﻟﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﺘﺩﺒﻴﺭ‬ ‫ﻨﻠﺨﺹ‬‫ﺍﻟ‬ ‫ﺍﻟﻔﻘﺭﺍﺕ‬‫ﺇﺩﺍﺭﺘﻬﺎ‬ ‫ﺘﺩﺍﺒﻴﺭ‬ ‫ﻭ‬ ‫ﺍﻹﺸﻌﺎﻋﻲ‬ ‫ﻟﻠﻌﻼﺝ‬ ‫ﺍﻟﺠﺎﻨﺒﻴﺔ‬ ‫ﺍﻟﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﻤﺠﻤل‬ ‫ﺘﺎﻟﻴﺔ‬: 8.1‫ﺍﻟﺤﻨﺠﺭﺓ‬ ‫ﻭ‬ ‫ﺍﻟﻔﻡ‬ ‫ﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﺒـﻭﺘﻴﺭﺓ‬ ‫ﺘﺘﻜﺎﺜﺭ‬ ‫ﻭ‬ ،‫ﺍﻟﻔـﻡ‬ ‫ﺫﻟﻙ‬ ‫ﻓﻲ‬ ‫ﺒﻤﺎ‬ ،‫ﺍﻟﻬﻀﻤﻴﺔ‬ ‫ﺍﻟﻘﻨﻭﺍﺕ‬ ‫ﻷﺠﺯﺍﺀ‬ ‫ﺍﻟﻤﻜﻭﻨﺔ‬ ‫ﺍﻟﻁﺒﻴﻌﻴﺔ‬ ‫ﺍﻟﺨـﻼﻴﺎ‬ ‫ﺘﻨﻤﻭ‬ ‫ﺍﻟﻌﻼﺝ‬ ‫ﺍﺀ‬‫ﺭ‬‫ﺠ‬ ‫ﺴﺭﻴﻌﺎ‬ ‫ﻟﻸﺫﻯ‬ ‫ﺘﺘﻌﺭﺽ‬ ‫ﻟﺫﻟﻙ‬ ‫ﻭ‬ ،‫ﺍﻻﺴﺘﺒﺩﺍل‬ ‫ﺩﺍﺌﻤﺔ‬ ‫ﻫﻲ‬ ‫ﻭ‬ ‫ﺴﺭﻴﻌﺔ‬‫ﻭ‬ ‫ﺍﻟـﺭﺃﺱ‬ ‫ﻟﻤﻨﻁﻘﺔ‬ ‫ﺍﻹﺸﻌﺎﻋﻲ‬ ‫ﺍﻟﻤﻌﻭﻱ‬ ‫ﺍﻟﺠﻬﺎﺯ‬ ‫ﺍﻤﺘﺩﺍﺩ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻤﺨﺎﻁﻴﺔ‬ ‫ﺍﻷﻏﺸﻴﺔ‬ ‫ﺍﻟﺘﻬﺎﺒﺎﺕ‬ ‫ﺘﻨﺸﺄ‬ ‫ﻗﺩ‬ ‫ﻭ‬ ،‫ﺍﻟﺒﻁﻨﻲ‬ ‫ﺍﻟﺘﺠﻭﻴﻑ‬ ‫ﻭ‬ ‫ﺍﻟﺼﺩﺭ‬ ‫ﻭ‬ ،‫ﺍﻟﺭﻗﺒﺔ‬.
  14. 14. Ossama Anjak, AECS. PO BOX6091Damascys Page 14  ‫ﺒﺎﻟﻔـﻡ‬ ‫ﺘﻨﺸﺎ‬ ‫ﺍﻟﺘﻲ‬ ‫ﺍﻟﻤﻌﺘﺎﺩﺓ‬ ‫ﺍﻟﺘﻌﻘﻴﺩﺍﺕ‬ ‫ﻤﻥ‬ ‫ﻭ‬:‫ﻭ‬ ‫ﺍﻟﺠﻔـﺎﻑ‬ ‫ﻭ‬ ،‫ﺍﻟﺘﻘﺭﺤﺎﺕ‬ ‫ﻭ‬ ‫ﺍﻟﻠﺜﺔ‬ ‫ﻭ‬ ‫ﺍﻟﻤﺨﺎﻁﻲ‬ ‫ﺍﻟﻐﺸﺎﺀ‬ ‫ﺍﻟﺘﻬﺎﺒﺎﺕ‬ ‫ﻭ‬ ‫ﺍﻟﻤﺫﺍﻕ‬ ‫ﺘﻐﻴﺭﺍﺕ‬ ‫ﺇﻟﻰ‬ ‫ﺇﻀﺎﻓﺔ‬ ،‫ﺍﻟﺒﻠﻊ‬ ‫ﺼﻌﻭﺒﺔ‬‫ﺍﻟﺸﻡ‬) .‫ﺼﻔﺤﺔ‬ ‫ﻤﺭﺍﺠﻌﺔ‬ ‫ﺭﺠﻰ‬‫ﻴ‬ ‫ﻭ‬‫ﺍﻟﻔـﻡ‬ ‫ﻤﻀﺎﻋﻔﺎﺕ‬‫ﻟﻺﻁـﻼﻉ‬ ‫ﺍﻟﻠﺜﺔ‬ ‫ﻭ‬ ‫ﺍﻟﻔﻡ‬ ‫ﺍﻟﺘﻬﺎﺒﺎﺕ‬ ‫ﺤﻭل‬ ‫ﺍﻟﻭﺍﻓﻴﺔ‬ ‫ﺍﻟﺘﻔﺎﺼﻴل‬ ‫ﻋﻠﻰ‬.( ‫ﺍﻟﻔـﻡ‬ ‫ﺍﻟﺘﻬﺎﺏ‬ ‫ﻭ‬ ‫ﺍﻟﻤﺨـﺎﻁﻴﺔ‬ ‫ﺍﻷﻏﺸﻴﺔ‬ ‫ﺍﻟﺘﻬﺎﺒﺎﺕ‬ ‫ﻭ‬ ،‫ﺍﻟـﺩﻭﺍﻡ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻷﺴﻨﺎﻥ‬ ‫ﻭ‬ ‫ﺒﺎﻟﻔﻡ‬ ‫ﺍﻟﺘﺎﻤﺔ‬ ‫ﺍﻟﺼﺤﻴﺔ‬ ‫ﺍﻟﻌﻨﺎﻴﺔ‬ ‫ﺍﻷﻤﺭ‬ ‫ﻴﺘﻁﻠﺏ‬ ،‫ﺍﻟﻠﺜﺔ‬ ‫ﻭ‬ ‫ﺍﻟﻔﻡ‬ ‫ﺍﻟﺘﻬﺎﺒﺎﺕ‬ ‫ﻨﺸﻭﺀ‬ ‫ﻋﻨﺩ‬ ‫ﻏﺴﻭﻻ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬‫ﺍﻷﻭل‬ ‫ﺍﻟﻤﻭﻀﻊ‬ ‫ﺘﻌﺘﺒﺭ‬ ‫ﺤﻴﺙ‬ ،‫ﺒﺎﻷﺴﻨﺎﻥ‬ ‫ﻟﻠﻌﻨﺎﻴﺔ‬ ‫ﺇﻀﺎﻓﻴﺔ‬ ‫ﺘﺩﺍﺒﻴﺭ‬ ‫ﺍﺘﺨﺎﺫ‬ ‫ﻭ‬ ،‫ﺩﻭﺭﻴﺎ‬ ‫ﺍﻟﻤﻁﻬﺭﺓ‬ ‫ﺍﻟﻔﻡ‬ ‫ﺕ‬ ‫ﺒﻌﻨﺎﻴﺔ‬ ‫ﻤﺨﺘﺎﺭﺓ‬ ‫ﺃﻁﻌﻤﺔ‬ ‫ﺘﻨﺎﻭل‬ ‫ﻭ‬ ،‫ﻤﻼﺌﻡ‬ ‫ﻭ‬ ‫ﺠﻴﺩ‬ ‫ﺘﻐﺫﻴﺔ‬ ‫ﻨﻅﺎﻡ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻤﺤﺎﻓﻅﺔ‬ ‫ﺇﻟﻰ‬ ‫ﺇﻀﺎﻓﺔ‬ ،‫ﺍﻵﻻﻡ‬ ‫ﻭ‬ ‫ﺍﻟﻌﺩﻭﻯ‬ ‫ﻟﻨﺸﻭﺀ‬ ‫ﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺘﻭﺼﻑ‬ ‫ﻤﺭﺍﻫﻡ‬ ‫ﻭ‬ ‫ﺃﺩﻭﻴﺔ‬ ‫ﺜﻤﺔ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﻠﺘﻬﺒﺔ‬ ‫ﺍﻷﻨﺴﺠﺔ‬ ‫ﺘﻬﻴﺞ‬ ‫ﻤﻥ‬ ‫ﺘﺯﻴﺩ‬ ‫ﻻ‬ ‫ﺒﺤﻴﺙ‬‫ﺍﺴـﺘﺨﺩﺍﻤﻬﺎ‬ ‫ﻴﻤﻜﻥ‬ ‫ﺍﻟﺤﺎﻟﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺞ‬ ‫ﺍﻟﻁﺒﻴﺏ‬ ‫ﺒﻤﻭﺍﻓﻘﺔ‬. ‫ﺍﻟﻔـﻡ‬ ‫ﺍﻟﺘﻬﺎﺏ‬ ‫ﻋﻨﺩ‬ ‫ﻤﻔﻴﺩﺓ‬ ‫ﺍﻟﺘﺎﻟﻴﺔ‬ ‫ﺍﻟﻤﻘﺘﺭﺤﺎﺕ‬: •‫ﺍﻟﺒﻠﻊ‬ ‫ﻭ‬ ‫ﺍﻟﻤﻀﻎ‬ ‫ﺴﻬﻠﺔ‬ ‫ﺍﻟﻠﻴﻨﺔ‬ ‫ﺍﻷﻁﻌﻤﺔ‬ ‫ﺘﻨﺎﻭل‬. •‫ﺍﻟﻤﺘﺒﻠﺔ‬ ‫ﺍﻷﻁﻌﻤﺔ‬ ‫ﻭ‬ ،‫ﺍﻟﺤﻤﻀﻴﺔ‬ ‫ﻋﺎﻟﻴﺔ‬ ‫ﺍﻟﻤﺸﺭﻭﺒﺎﺕ‬ ‫ﻭ‬ ‫ﺍﻷﻁﻌﻤﺔ‬ ‫ﻤﺜل‬ ،‫ﺍﻟﻔﻡ‬ ‫ﺘﻬﻴﺞ‬ ‫ﻗﺩ‬ ‫ﺍﻟﺘﻲ‬ ‫ﺍﻷﻁﻌﻤﺔ‬ ‫ﺘﺠﻨﺏ‬ ‫ﺃ‬ ،‫ﺍﻟﻤﻠﺤﻲ‬ ‫ﺍﻟﻤﺤﺘﻭﻯ‬ ‫ﻋﺎﻟﻴﺔ‬ ‫ﻭ‬ ،‫ﺍﻟﺤﺭﻴﻔﺔ‬ ‫ﻭ‬‫ﻻﺫﻋﺔ‬ ‫ﺒﻬﺎﺭﺍﺕ‬ ‫ﻋﻠﻰ‬ ‫ﺘﺤﺘﻭﻱ‬ ‫ﺍﻟﺘﻲ‬ ‫ﺃﻭ‬ ،‫ﺍﻟﺠﺎﻓﺔ‬ ‫ﺃﻭ‬ ‫ﺍﻟﺨﺸﻨﺔ‬ ‫ﻭ‬. •‫ﺼﻐﻴﺭﺓ‬ ‫ﻟﻘﻤﺎﺕ‬ ‫ﺘﻨﺎﻭل‬ ‫ﻭ‬ ،‫ﻁﺭﻴﺔ‬ ‫ﻭ‬ ‫ﻟﻴﻨﺔ‬ ‫ﺘﺼﺒﺢ‬ ‫ﺤﺘﻰ‬ ‫ﺘﺎﻤﺎ‬ ‫ﻁﻬﻴﺎ‬ ‫ﺍﻷﻁﻌﻤﺔ‬ ‫ﻁﻬﻭ‬. •‫ﻤـﺎ‬ ‫ﺃﻭ‬ ‫ﺍﻟﺯﺒﺩﺓ‬ ‫ﺃﻭ‬ ‫ﺍﻟﺼﻠﺼﺎﺕ‬ ‫ﺒﺎﺴﺘﺨﺩﺍﻡ‬ ‫ﺍﻟﻭﺠﺒﺎﺕ‬ ‫ﺘﺭﻁﻴﺏ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﺄﻜﻭﻻﺕ‬ ‫ﺇﻋﺩﺍﺩ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺨﻼﻁ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬ ‫ﺸﺎﺒﻪ‬. •‫ﺍﻟﻤﺨﺘﻠﻔﺔ‬ ‫ﺍﻟﺴﻭﺍﺌل‬ ‫ﺸﺭﺏ‬ ‫ﻋﻨﺩ‬ ‫ﺍﻟﻤﺎﺼﺔ‬ ‫ﺍﻟﻘﺸﺔ‬ ‫ﺍﺴﺘﻌﻤﺎل‬. •‫ﺘﻬﻴﺞ‬ ‫ﺤﺩﺓ‬ ‫ﻤﻥ‬ ‫ﺍﻟﺴﺎﺨﻨﺔ‬ ‫ﺍﻷﻁﻌﻤﺔ‬ ‫ﺘﺯﻴﺩ‬ ‫ﺤﻴﺙ‬ ،‫ﺍﻟﻐﺭﻓﺔ‬ ‫ﺤﺭﺍﺭﺓ‬ ‫ﺒﺩﺭﺠﺔ‬ ‫ﺃﻭ‬ ‫ﻗﻠﻴﻼ‬ ‫ﺍﻟﻤﺒﺭﺩﺓ‬ ‫ﺍﻷﻁﻌﻤﺔ‬ ‫ﺘﻨﺎﻭل‬ ‫ﺍﻟﻭﺍﻫﻥ‬ ‫ﺍﻟﻔﻡ‬. •‫ﻜـﺎﻥ‬ ‫ﺇﻥ‬ ‫ﻭ‬ ،‫ﺍﻷﺴـﻨﺎﻥ‬ ‫ﻟﺘﻨﻅﻴﻑ‬ ‫ﺍﻟﻘﻁﻨﻴﺔ‬ ‫ﺍﻟﻤﻤﺎﺴﺢ‬ ‫ﺃﻭ‬ ‫ﺍﻹﺴﻔﻨﺠﻴﺔ‬ ‫ﺍﻟﻔﺭﺍﺸﻲ‬ ُ‫ل‬‫ﺍﻟﻁﻔ‬ ‫ﻴﺴﺘﺨﺩﻡ‬ ‫ﺃﻥ‬ ‫ﻤﺭﺍﻋﺎﺓ‬ ‫ﺍﻹﺼﺒﻊ‬ ‫ﺤﻭل‬ ‫ﻋﺼﺒﻬﺎ‬ ‫ﻴﺘﻡ‬ ‫ﻤﻌﻘﻤﺔ‬ ‫ﺸﺎﺵ‬ ‫ﻗﻁﻌﺔ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬ ‫ﻓﻴﻤﻜﻥ‬ ‫ﺠﺩﺍ‬ ‫ﺼﻐﻴﺭﺍ‬ ‫ﺍﻟﻁﻔل‬‫ﺍﻟﺘﻨﻅﻴـﻑ‬ ‫ﻴﺘﻡ‬ ‫ﻭ‬ ‫ﺒﻨﻌﻭﻤﺔ‬. •‫ﺍﻟﻤﻠﻁﻔﺔ‬ ‫ﺍﻷﺴﻨﺎﻥ‬ ‫ﻤﻌﺎﺠﻴﻥ‬ ‫ﺍﺴﺘﻌﻤﺎل‬. •،‫ﺩﻭﺭﻴﺎ‬ ‫ﺍﻟﻔﻡ‬ ‫ﻟﺸﻁﻑ‬ ‫ﺍﻟﺼﻭﺩﺍ‬ ‫ﻭ‬ ‫ﺍﻟﻤﻠﺢ‬ ‫ﺘﺭﻜﻴﺒﺔ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬)‫ﻤﻠﻌﻘﺘﻴﻥ‬ ‫ﻤﻊ‬ ‫ﺍﻟﻤﻠﺢ‬ ‫ﻤﻥ‬ ‫ﺼﻐﻴﺭﺓ‬ ‫ﻤﻠﻌﻘﺔ‬ ‫ﻨﺼﻑ‬ ‫ﺍﻟﻤـﺎﺀ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻠﺘﺭ‬ ‫ﺤﻭﺍﻟﻲ‬ ‫ﻓﻲ‬ ‫ﻤﺫﺍﺒﺔ‬ ‫ﺍﻟﺼﻭﺩﻴﻭﻡ‬ ‫ﺒﻴﻜﺭﺒﻭﻨﺎﺕ‬ ‫ﻤﻥ‬ ‫ﻜﺒﻴﺭﺘﻴﻥ‬(‫ﺒﻴﻜﺭﺒﻭﻨـﺎﺕ‬ ‫ﻤﺤﻠـﻭل‬ ‫ﺃﻭ‬ ، ‫ﺍﻟﺼﻭﺩﻴﻭﻡ‬)‫ﺍ‬ ‫ﺤﻭﺍﻟﻲ‬ ‫ﻓﻲ‬ ‫ﺼﻐﻴﺭﺓ‬ ‫ﻤﻠﻌﻘﺔ‬‫ﺍﻟﻤـﺎﺀ‬ ‫ﻤﻥ‬ ‫ﻟﺘﺭ‬ ‫ﻟﺭﺒﻊ‬(‫ﻜـل‬ ،2–3‫ﻋﻘـﺏ‬ ‫ﻭ‬ ‫ﺴـﺎﻋﺎﺕ‬ ‫ﺍﻟﻭﺠﺒﺎﺕ‬. •‫ﺍﻟﻔﻡ‬ ‫ﺍﻟﺘﻬﺎﺒﺎﺕ‬ ‫ﺘﻬﻴﺞ‬ ‫ﻗﺩ‬ ‫ﺍﻟﺘﻲ‬ ‫ﻭ‬ ‫ﺍﻟﻜﺤﻭل‬ ‫ﻋﻠﻰ‬ ‫ﺘﺤﺘﻭﻱ‬ ‫ﺍﻟﺘﻲ‬ ‫ﺍﻟﻔﻡ‬ ‫ﻏﺴﻭﻻﺕ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬ ‫ﺘﺠﻨﺏ‬.
  15. 15. Ossama Anjak, AECS. PO BOX6091Damascys Page 15  ‫ﺒﺎﻟﻔﻡ‬ ‫ﻤﺅﻟﻤﺔ‬ ‫ﻤﻭﺍﻀﻊ‬ ‫ﺃﻭ‬ ‫ﻨﺎﺼﻌﺔ‬ ‫ﺒﻴﻀﺎﺀ‬ ‫ﺃﻭ‬ ‫ﺩﺍﻜﻨﺔ‬ ‫ﺤﻤﺭﺍﺀ‬ ‫ﺒﻘﻊ‬ ‫ﺃﻱ‬ ‫ﻭﺠﻭﺩ‬ ‫ﻋﻨﺩ‬ ‫ﺍﻟﻤﻌﺎﻟﺞ‬ ‫ﺍﻟﻁﺒﻴﺏ‬ ‫ﺇﺒﻼﻍ‬ ‫ﻴﻨﺒﻐﻲ‬. ‫ﺍﻟﻔـﻡ‬ ‫ﺠﻔﺎﻑ‬ ‫ﺍﻟ‬ ‫ﺠﻔﺎﻑ‬ ‫ﻌﺩ‬‫ﻴ‬‫ﺍﻟﻌـﻼﺝ‬ ‫ﺠـﺭﺍﺀ‬ ‫ﺍﻟﻠﻌﺎﺒﻴﺔ‬ ‫ﺍﻟﻐﺩﺩ‬ ‫ﺘﻀﺭﺭ‬ ‫ﻋﻥ‬ ‫ﻴﻨﺠﻡ‬ ‫ﻭ‬ ،‫ﺍﻷﻤﺩ‬ ‫ﻁﻭﻴل‬ ‫ﻭ‬ ‫ﻤﺯﻤﻨﺎ‬ ‫ﻋﺎﺭﻀﺎ‬ ‫ﻔﻡ‬ ‫ﻴـﺅﺜﺭ‬ ‫ﻤﺎ‬ ،‫ﺍﻟﺘﺫﻭﻕ‬ ‫ﻭ‬ ‫ﺍﻟﺒﻠﻊ‬ ‫ﻭ‬ ‫ﺍﻟﻤﻀﻎ‬ ‫ﻭ‬ ‫ﺍﻟﺘﺤﺩﺙ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﻤﻘﺩﺭﺓ‬ ‫ﻋﻠﻰ‬ ‫ﻤﺒﺎﺸﺭ‬ ‫ﺒﺸﻜل‬ ‫ﻴﺅﺜﺭ‬ ‫ﻭ‬ ،‫ﺍﻹﺸﻌﺎﻋﻲ‬ ‫ﺍﻟﺤﻴﺎﺘﻴﺔ‬ ‫ﺍﻟﻨﺸﺎﻁﺎﺕ‬ ‫ﻋﻠﻰ‬ ‫ﺴﻠﺒﺎ‬. ‫ﺍﻟﻔـﻡ‬ ‫ﺠﻔﺎﻑ‬ ‫ﻤﻊ‬ ‫ﻟﻠﺘﻌﺎﻤل‬ ‫ﻤﻔﻴﺩﺓ‬ ‫ﺍﻟﺘﺎﻟﻴﺔ‬ ‫ﺍﻟﻤﻘﺘﺭﺤﺎﺕ‬: •‫ﺍﻟﻤ‬ ‫ﻭ‬ ‫ﺍﻷﻁﻌﻤﺔ‬ ‫ﺘﻨﺎﻭل‬‫ﻤـﻊ‬ ،‫ﺍﻟﻠﻌـﺎﺏ‬ ‫ﺇﻓﺭﺍﺯ‬ ‫ﺯﻴﺎﺩﺓ‬ ‫ﻓﻲ‬ ‫ﺘﺴﺎﻋﺩ‬ ‫ﻗﺩ‬ ‫ﺍﻟﻠﻴﻤﻭﻨﺎﺩﺓ‬ ‫ﻤﺜل‬ ،‫ﺍﻟﺤﺎﻤﻀﺔ‬ ‫ﺸﺭﻭﺒﺎﺕ‬ ‫ﺒﺎﻟﻔﻡ‬ ‫ﺘﻘﺭﺤﺎﺕ‬ ‫ﺃﻭ‬ ‫ﺍﻟﺘﻬﺎﺒﺎﺕ‬ ‫ﻭﺠﻭﺩ‬ ‫ﻋﺩﻡ‬ ‫ﻤﺭﺍﻋﺎﺓ‬. •‫ﻟﻌﺼﺎﺌﺭ‬ ‫ﺍﻟﻤﺜﻠﺠﺔ‬ ‫ﺍﻟﺭﻗﺎﺌﻕ‬ ‫ﺃﻭ‬ ‫ﺍﻟﻤﺤﻼﺓ‬ ‫ﻏﻴﺭ‬ ‫ﺍﻟﻌﻠﻜﺔ‬ ‫ﺃﻭ‬ ‫ﺍﻟﺴﻜﺭﻴﺎﺕ‬ ‫ﻤﻨﺯﻭﻋﺔ‬ ‫ﺍﻟﺼﻠﺒﺔ‬ ‫ﺍﻟﺤﻠﻭﻯ‬ ‫ﺍﻤﺘﺼﺎﺹ‬ ‫ﺍﻟﻠﻌﺎﺏ‬ ‫ﺇﻓﺭﺍﺯ‬ ‫ﺯﻴﺎﺩﺓ‬ ‫ﻓﻲ‬ ‫ﻟﻠﻤﺴﺎﻋﺩﺓ‬ ،‫ﺍﻟﻔﻭﺍﻜﻪ‬. •‫ﺍ‬ ‫ﺭﻁﻭﺒﺔ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻤﺤﺎﻓﻅﺔ‬‫ﺍﻟﺸﻔﺎﻩ‬ ‫ﻤﺭﻁﺒﺎﺕ‬ ‫ﺒﺎﺴﺘﺨﺩﺍﻡ‬ ‫ﺍﻟﺩﻭﺍﻡ‬ ‫ﻋﻠﻰ‬ ‫ﻟﺸﻔﺘﻴﻥ‬. •‫ﺍﻟﺒﻠﻊ‬ ‫ﻭ‬ ‫ﺍﻟﻤﻀﻎ‬ ‫ﺴﻬﻠﺔ‬ ‫ﺍﻟﻠﻴﻨﺔ‬ ‫ﺍﻷﻁﻌﻤﺔ‬ ‫ﺘﻨﺎﻭل‬. •‫ﺍﻟﺒﻠﻊ‬ ‫ﻭ‬ ‫ﺍﻟﺘﺤﺩﺙ‬ ‫ﻓﻲ‬ ‫ﻟﻠﻤﺴﺎﻋﺩﺓ‬ ‫ﺍﻟﻭﻗﺕ‬ ‫ﻤﺩﺍﺭ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻤﺎﺀ‬ ‫ﻤﻥ‬ ‫ﺭﺸﻔﺎﺕ‬ ‫ﺘﻨﺎﻭل‬. •‫ﺍﻟﺴﻭﺍﺌل‬ ‫ﻤﻥ‬ ‫ﺍﻟﻤﺯﻴﺩ‬ ‫ﺘﻨﺎﻭل‬ ‫ﻭ‬ ،‫ﺩﺍﺌﻡ‬ ‫ﺒﺸﻜل‬ ‫ﺍﻟﻔﻡ‬ ‫ﺭﻁﻭﺒﺔ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻤﺤﺎﻓﻅﺔ‬. •‫ﺒﻤﻭﺍﻓﻘﺔ‬ ‫ﺍﺴﺘﺨﺩﺍﻤﻬﺎ‬ ‫ﻴﻤﻜﻥ‬ ‫ﻟﻠﻔﻡ‬ ‫ﻤﺭﻁﺒﺔ‬ ‫ﻤﺭﺍﻫﻡ‬ ‫ﺜﻤﺔ‬‫ﺍﻟﻤﻌﺎﻟﺞ‬ ‫ﺍﻟﻁﺒﻴﺏ‬. ‫ﻡ‬‫ﺍﻟﺸـ‬ ‫ﻭ‬ ‫ﺍﻟﻤـﺫﺍﻕ‬ ‫ﺤﺱ‬ ‫ﺘﻐـﻴﺭﺍﺕ‬ ‫ﺍﻟﺴـﺭﻁﺎﻥ‬ ‫ﻤﻥ‬ ‫ﺒﺴﺒﺏ‬ ‫ﺃﻭ‬ ‫ﺍﻹﺸﻌﺎﻋﻲ‬ ‫ﺍﻟﻌﻼﺝ‬ ‫ﺍﺀ‬‫ﺭ‬‫ﺠ‬ ‫ﺍﻟﺸﻡ‬ ‫ﻭ‬ ‫ﺍﻟﺘﻁﻌﻡ‬ ‫ﻭ‬ ‫ﺍﻟﺘﺫﻭﻕ‬ ‫ﺤﺱ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺘﻐﻴﺭﺍﺕ‬ ‫ﺘﻨﺸﺄ‬ ‫ﺃﻭ‬ ‫ﻻﺫﻋـﺎ‬ ‫ﻤـﺫﺍﻗﺎ‬ ‫ﻟﻸﻁﻌﻤﺔ‬ ‫ﺘﺠﻌل‬ ‫ﻋﺎﺩﺓ‬ ‫ﻫﻲ‬ ‫ﻭ‬ ،‫ﺍﻟﺘﺫﻭﻕ‬ ‫ﻋﻤﻰ‬ ‫ﺃﻭ‬ ‫ﺍﻟﻔﻡ‬ ‫ﺒﻌﻤﻰ‬ ‫ﺍﻟﺤﺎﻟﺔ‬ ‫ﻫﺫﻩ‬ ‫ﻤﺜل‬ ‫ﹸﻌﺭﻑ‬‫ﺘ‬ ‫ﻭ‬ ،‫ﻨﻔﺴﻪ‬ ‫ﻤﺫﺍﻗﺎ‬)‫ﻤﻌﺩﻨﻴﺎ‬(‫ﺘﻔﻘﺩ‬ ‫ﻭ‬ ،‫ﻫـﺫﻩ‬ ‫ﺘـﺯﻭل‬ ‫ﻤـﺎ‬ ‫ﻋﺎﺩﺓ‬ ‫ﻭ‬ ،‫ﻤﺨﺘﻠﻑ‬ ‫ﻤﺫﺍﻕ‬ ‫ﺇﻟﻰ‬ ‫ﺘﺘﻐﻴﺭ‬ ‫ﺃﻭ‬ ‫ﻤﺫﺍﻗﻬﺎ‬ ‫ﺍﻷﻁﻌﻤﺔ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻌﺩﻴﺩ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺎﺕ‬ ‫ﺍﻨﺘﻬﺎﺀ‬ ‫ﻋﻘﺏ‬ ‫ﺍﻟﺘﻌﻘﻴﺩﺍﺕ‬. ‫ﺍﻟﺘﺫﻭﻕ‬ ‫ﺘﻐـﻴﺭ‬ ‫ﻋﻨﺩ‬ ‫ﻤﻔﻴﺩﺓ‬ ‫ﺍﻟﺘﺎﻟﻴﺔ‬ ‫ﺍﻟﻤﻘﺘﺭﺤﺎﺕ‬: •‫ﺘﻐﻴﻴـﺭ‬ ‫ﻭ‬ ،‫ﺍﻟﺨﺯﻓﻴﺔ‬ ‫ﺃﻭ‬ ‫ﺍﻟﻤﻌﺩﻨﻴﺔ‬ ‫ﺍﻟﺼﺤﻭﻥ‬ ‫ﻤﻥ‬ ‫ﺒﺩﻻ‬ ‫ﻭﺭﻗﻴﺔ‬ ‫ﺃﻭ‬ ‫ﺒﻼﺴﺘﻴﻜﻴﺔ‬ ‫ﺼﺤﻭﻥ‬ ‫ﻭ‬ ‫ﺃﻭﻋﻴﺔ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬ ‫ﻤﻥ‬ ‫ﺍﻷﻜل‬ ‫ﻤﻭﻀﻊ‬ ‫ﻭ‬ ‫ﺍﻟﻭﺠﺒﺎﺕ‬ ‫ﻤﻅﻬﺭ‬‫ﺍﻟﻐﺭﻓﺔ‬ ‫ﺤﺭﺍﺭﺓ‬ ‫ﺒﺩﺭﺠﺔ‬ ‫ﺍﻟﻭﺠﺒﺎﺕ‬ ‫ﺘﻘﺩﻴﻡ‬ ‫ﻭ‬ ،‫ﻵﺨﺭ‬ ‫ﺤﻴﻥ‬. •‫ﺘﻘﺩﻴﻡ‬ ‫ﻭ‬ ،‫ﺍﻟﻭﺠﺒﺎﺕ‬ ‫ﺘﻨﻭﻴﻊ‬ ‫ﻭ‬ ،‫ﺴﺎﺒﻘﺔ‬ ‫ﺃﻭﻗﺎﺕ‬ ‫ﻓﻲ‬ ‫ﻤﺴﺘﺴﺎﻍ‬ ‫ﻏﻴﺭ‬ ‫ﻤﺫﺍﻗﺎ‬ ‫ﺴﺒﺒﺕ‬ ‫ﺍﻟﺘﻲ‬ ‫ﺍﻷﻁﻌﻤﺔ‬ ‫ﺘﻘﺩﻴﻡ‬ ‫ﺘﺠﻨﺏ‬ ‫ﺍﻟﺭﺍﺌﺤﺔ‬ ‫ﻭ‬ ‫ﺍﻟﻤﺫﺍﻕ‬ ‫ﻁﻴﺒﺔ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﻟﻠﻁﻔل‬ ‫ﺘﺒﺩﻭ‬ ‫ﺍﻟﺘﻲ‬ ‫ﺍﻷﻁﻌﻤﺔ‬. •‫ﺍﻟﻤﺨﺘ‬ ‫ﺍﻟﻠﺤﻭﻡ‬ ‫ﺘﻨﺎﻭل‬ ‫ﻭ‬ ،‫ﺍﻟﻭﺠﺒﺎﺕ‬ ‫ﻤﻊ‬ ‫ﺍﻟﻤﺨﺘﻠﻔﺔ‬ ‫ﺍﻟﻨﻜﻬﺎﺕ‬ ‫ﻭ‬ ‫ﺍﻟﺘﻭﺍﺒل‬ ‫ﺘﺠﺭﺒﺔ‬‫ﻏﻤﺴﻬﺎ‬ ‫ﺒﻌﺩ‬ ‫ﺍﻷﺴﻤﺎﻙ‬ ‫ﺃﻭ‬ ‫ﻠﻔﺔ‬ ‫ﺍﻟﻤﺫﺍﻕ‬ ‫ﺤﻠﻭﺓ‬ ‫ﺒﺼﻠﺼﺎﺕ‬. •‫ﺍﻟﺒﺭﺘﻘﺎل‬ ‫ﺃﻭ‬ ‫ﺍﻟﻠﻴﻤﻭﻨﺎﺩﺓ‬ ‫ﻤﺜل‬ ‫ﺍﻟﺤﺎﻤﻀﺔ‬ ‫ﺍﻷﻁﻌﻤﺔ‬ ‫ﺘﺠﺭﺒﺔ‬)‫ﺒﺎﻟﻔﻡ‬ ‫ﺍﻟﺘﻬﺎﺒﺎﺕ‬ ‫ﻭﺠﻭﺩ‬ ‫ﻋﺩﻡ‬ ‫ﻋﻨﺩ‬.(
  16. 16. Ossama Anjak, AECS. PO BOX6091Damascys Page 16  •‫ﺃﻭ‬ ‫ﺍﻟﺒﻴﻀـﺎﺀ‬ ‫ﺍﻟﻠﺤـﻭﻡ‬ ‫ﺇﻟـﻰ‬ ‫ﺍﻟﺘﻐﻴﻴﺭ‬ ‫ﻴﻔﻴﺩ‬ ،‫ﻤﺴﺘﺴﺎﻏﺔ‬ ‫ﻏﻴﺭ‬ ‫ﺭﺍﺌﺤﺔ‬ ‫ﺃﻭ‬ ‫ﺒﻁﻌﻡ‬ ‫ﺍﻟﺤﻤﺭﺍﺀ‬ ‫ﺍﻟﻠﺤﻭﻡ‬ ‫ﺒﺩﺕ‬ ‫ﺇﻥ‬ ‫ﺍﻷﻟﺒﺎﻥ‬ ‫ﻤﺸﺘﻘﺎﺕ‬ ‫ﺃﻭ‬ ‫ﺍﻟﺒﻴﺽ‬. 8.2‫ﺍﻟﺠ‬ ‫ﺘﻔﺎﻋﻼﺕ‬‫ﺍﻟﺒﺸﺭﺓ‬ ‫ﻭ‬ ‫ﻠﺩ‬ ‫ﺘﺘﻔﺎﻭﺕ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺒﻤﻭﺍﻀﻊ‬ ‫ﺍﻹﺸﻌﺎﻋﻲ‬ ‫ﻟﻠﻌﻼﺝ‬ ‫ﺍﻟﺸﺎﺌﻌﺔ‬ ‫ﺍﻟﺠﺎﻨﺒﻴﺔ‬ ‫ﺍﻟﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﻤﻥ‬ ‫ﺍﻟﺒﺸﺭﺓ‬ ‫ﻭ‬ ‫ﺍﻟﺠﻠﺩ‬ ‫ﺍﻟﺘﻬﺎﺒﺎﺕ‬ ‫ﹸﻌﺩ‬‫ﺘ‬ ،‫ﺍﻟﺸﻤﺱ‬ ‫ﺒﺤﺭﻭﻗﺎﺕ‬ ‫ﺍﻟﺸﺒﻴﻪ‬ ‫ﺍﻟﺠﻠﺩ‬ ‫ﺠﻔﺎﻑ‬ ‫ﻭ‬ ‫ﺒﺎﻟﻤﻭﻀﻊ‬ ‫ﻁﻔﻴﻑ‬ ‫ﺍﺤﻤﺭﺍﺭ‬ ‫ﻅﻬﻭﺭ‬ ‫ﻤﻥ‬ ‫ﺍﻹﺸﻌﺎﻉ‬ ‫ﺘﺠﺎﻩ‬ ‫ﺍﻟﺠﻠﺩ‬ ‫ﺘﻔﺎﻋﻼﺕ‬ ‫ﻭ‬ ‫ﺍﻟﺸﺩﻴﺩ‬ ‫ﺍﻟﺘﺴﻠﺦ‬ ‫ﻭ‬ ‫ﺍﻟﺘﻘﺸﺭ‬ ‫ﺇﻟﻰ‬ ،‫ﺍﻟﺒﺸﺭﺓ‬ ‫ﺘﺤﺴﺱ‬ ‫ﻭ‬ ‫ﺍﻟﺤﻜﺎﻙ‬ ‫ﻭ‬‫ﻓـﻲ‬ ‫ﺍﻟﻭﻀﻊ‬ ‫ﻤﻌﺎﻟﺠﺔ‬ ‫ﺍﻟﻤﻬﻡ‬ ‫ﻤﻥ‬ ‫ﻭ‬ ،‫ﺍﻟﻁﻔﺢ‬ ‫ﻨﺸﻭﺀ‬ ‫ﺍﻟﺴﻭﺍﺌل‬ ‫ﺯ‬‫ﺒﻨ‬ ‫ﺍﻟﻤﺼﺤﻭﺏ‬ ‫ﺍﻟﺘﺴﻠﺦ‬ ‫ﻭ‬ ‫ﺍﻟﺘﻘﻴﺢ‬ ‫ﺇﻟﻰ‬ ‫ﺘﺘﻁﻭﺭ‬ ‫ﻤﺎ‬ ‫ﻋﺎﺩﺓ‬ ‫ﺍﻟﺘﻲ‬ ‫ﻭ‬ ‫ﺍﻻﻟﺘﻬﺎﺒﺎﺕ‬ ‫ﻟﺘﻔﺎﻗﻡ‬ ‫ﺘﺠﻨﺒﺎ‬ ،‫ﺍﻟﻤﺒﻜﺭﺓ‬ ‫ﻤﺭﺍﺤﻠﻪ‬ ‫ﻭ‬ ‫ﺍﻟﺫﺭﻭﺭ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬ ‫ﻤﺜل‬ ،‫ﺍﻟﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﻫﺫﻩ‬ ‫ﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﺘﺴﺎﻋﺩ‬ ‫ﻤﺨﺘﻠﻔﺔ‬ ‫ﻋﻼﺠﺎﺕ‬ ‫ﻭ‬ ‫ﺃﺩﻭﻴﺔ‬ ‫ﺜﻤﺔ‬ ‫ﻭ‬ ،‫ﺍﻟﺒﺜﻭﺭ‬ ‫ﻅﻬﻭﺭ‬ ‫ﻭ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﻭﻀﻌﻴﺔ‬ ‫ﺍﻟﻤﺭﺍﻫﻡ‬‫ﻟﺘﺴـﺭﻴﻊ‬ ‫ﻭ‬ ‫ﺍﻟﺤﻜـﺔ‬ ‫ﻭ‬ ‫ﺍﻻﻟﺘﻬﺎﺒﺎﺕ‬ ‫ﻟﺘﺨﻔﻴﻑ‬ ‫ﺍﻟﺴﺘﻴﺭﻭﻴﺩﻴﺔ‬ ‫ﺃﻭ‬ ‫ﺍﻟﺤﻴﻭﻴﺔ‬ ‫ﺍﻟﻤﻀﺎﺩﺍﺕ‬ ‫ﻤﺭﺍﻫﻡ‬ ‫ﺍﻟﻤﻌﺎﻟﺞ‬ ‫ﺍﻟﻁﺒﻴﺏ‬ ‫ﺍﺴﺘﺸﺎﺭﺓ‬ ‫ﺩﻭﻥ‬ ‫ﺃﺩﻭﻴﺔ‬ ‫ﺃﻴﺔ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬ ‫ﻋﺩﻡ‬ ‫ﻴﻠﺯﻡ‬ ‫ﺍﻟﺤﺎل‬ ‫ﺒﻁﺒﻴﻌﺔ‬ ‫ﻭ‬ ،‫ﺍﻟﺠﻠﺩ‬ ‫ﺘﻌﺎﻓﻲ‬. ‫ﺍﻨﻪ‬ ‫ﻏﻴﺭ‬ ،‫ﺍﻹﺸﻌﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺍﻨﺘﻬﺎﺀ‬ ‫ﻤﻥ‬ ‫ﺃﺴﺎﺒﻴﻊ‬ ‫ﻋﺩﺓ‬ ‫ﻋﻘﺏ‬ ‫ﺘﺯﻭل‬ ‫ﺍﻟﺒﺸﺭﺓ‬ ‫ﻭ‬ ‫ﺍﻟﺠﻠﺩ‬ ‫ﺘﺄﺜﻴﺭﺍﺕ‬ ‫ﺍﻏﻠﺏ‬ ‫ﺃﻥ‬ ‫ﺭﻏﻡ‬ ‫ﻭ‬ ‫ﺒ‬ ‫ﻋﻨﺩ‬‫ﺒﺼـﻔﺔ‬ ‫ﺤﺴﺎﺴـﺎ‬ ‫ﻴﻜـﻭﻥ‬ ‫ﻭ‬ ،‫ﺩﺍﻜﻥ‬ ‫ﺒﻠﻭﻥ‬ ‫ﻴﻅﻬﺭ‬ ‫ﻭ‬ ‫ﻤﺨﺘﻠﻔﺎ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺒﻤﻭﻀﻊ‬ ‫ﺍﻟﺠﻠﺩ‬ ‫ﻴﻅل‬ ،‫ﺍﻟﺤﺎﻻﺕ‬ ‫ﻌﺽ‬ ‫ﺍﻟﺸﻤﺱ‬ ‫ﻷﺸﻌﺔ‬ ‫ﺨﺎﺼﺔ‬. ‫ﺍﻵﺜﺎﺭ‬ ‫ﻫﺫﻩ‬ ‫ﻤﺜل‬ ‫ﻤﻊ‬ ‫ﻟﻠﺘﻌـﺎﻤل‬ ‫ﻤﻔﻴﺩﺓ‬ ‫ﻤﻘﺘﺭﺤﺎﺕ‬ ‫ﺍﻟﺘﺎﻟﻴﺔ‬ ‫ﺍﻟﻨﻘﺎﻁ‬ ‫ﻓﻲ‬: •‫ﺍﺴـﺘﺨﺩﺍﻡ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﻌﺎﻟﺠـﺔ‬ ‫ﻤﻭﺍﻀـﻊ‬ ‫ﻋﻠﻰ‬ ‫ﻤﺜﻼ‬ ‫ﺍﻟﻨﺎﻋﻡ‬ ‫ﺍﻟﻘﻁﻥ‬ ‫ﻤﻥ‬ ‫ﻓﻀﻔﺎﻀﺔ‬ ‫ﻭ‬ ‫ﻭﺍﺴﻌﺔ‬ ‫ﻤﻼﺒﺱ‬ ‫ﺍﺭﺘﺩﺍﺀ‬ ‫ﺍﻟﻘﻁﻨﻴ‬ ‫ﺍﻟﻤﻼﺀﺍﺕ‬‫ﺘﺯﻴﺩ‬ ‫ﻷﻨﻬﺎ‬ ‫ﺍﻟﺼﻨﺎﻋﻴﺔ‬ ‫ﺍﻟﻤﻨﺴﻭﺠﺎﺕ‬ ‫ﺃﻭ‬ ‫ﺍﻟﺼﻭﻓﻴﺔ‬ ‫ﺍﻟﻤﻼﺒﺱ‬ ‫ﺇﺭﺘﺩﺍﺀ‬ ‫ﺘﺠﻨﺏ‬ ‫ﻭ‬ ،‫َﺓ‬‫ﺭ‬‫ﻟﻸﺴ‬ ‫ﺔ‬ ‫ﺍﻟﺠﻠﺩ‬ ‫ﺘﻬﻴﺞ‬ ‫ﺤﺩﺓ‬ ‫ﻤﻥ‬. •‫ﺘﺠﻨـﺏ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﻌــﺎﻟﺠﺔ‬ ‫ﻤﻭﻀﻊ‬ ‫ﺘﺤﺯﻴﻡ‬ ‫ﺃﻭ‬ ‫ﻋﺼﺏ‬ ‫ﺸﺄﻨﻪ‬ ‫ﻤﻥ‬ ‫ﻤﺎ‬ ‫ﺃﻭ‬ ،‫ﺍﻟﻀﻴﻘﺔ‬ ‫ﺍﻟﻤﻼﺒﺱ‬ ‫ﺍﺭﺘﺩﺍﺀ‬ ‫ﺘﺠﻨﺏ‬ ‫ﺍﻟﺨﺸﻨﺔ‬ ‫ﻭ‬ ‫ﺍﻟﻤﻨﺸـﺎﺓ‬ ‫ﺍﻟﺜﻴﺎﺏ‬. •‫ﻵﺨﺭ‬ ‫ﺤﻴﻥ‬ ‫ﻤﻥ‬ ‫ﻟﻠﻬﻭﺍﺀ‬ ‫ﺘﻌﺭﻴﻀﻬﺎ‬ ‫ﻭ‬ ‫ﺍﻟﻤﺘﻬﻴﺠﺔ‬ ‫ﺍﻟﻤﻭﺍﻀﻊ‬ ‫ﺘﻌﺭﻴﺔ‬. •‫ﺍﺴﺘ‬،‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺒﻤﻭﻀﻊ‬ ‫ﺍﻟﺒﺸﺭﺓ‬ ‫ﻭ‬ ‫ﺒﺎﻟﺒﺩﻥ‬ ‫ﻟﻠﻌﻨﺎﻴﺔ‬ ‫ﻤﺴﺘﺤﻀﺭﺍﺕ‬ ‫ﺃﻴﺔ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬ ‫ﻗﺒل‬ ‫ﺍﻟﻤﻌﺎﻟﺞ‬ ‫ﺍﻟﻁﺒﻴﺏ‬ ‫ﺸﺎﺭﺓ‬ ‫ﺍﻟﻭﺍﻗﻴـﺔ‬ ‫ﺍﻟﺯﻴﻭﺕ‬ ‫ﻭ‬ ‫ﺍﻟﻌﻁﻭﺭ‬ ‫ﻭ‬ ‫ﺍﻟﺩﻫﺎﻨﺎﺕ‬ ‫ﻭ‬ ‫ﺍﻟﻤﻌﺎﺠﻴﻥ‬ ‫ﻭ‬ ،‫ﺍﻟﺸﻌﺭ‬ ‫ﻏﺴﻭﻻﺕ‬ ‫ﻭ‬ ‫ﺍﻟﺼﻭﺍﺒﻴﻥ‬ ‫ﺫﻟﻙ‬ ‫ﻓﻲ‬ ‫ﺒﻤﺎ‬ ‫ﺍﻟﺫﺭﻭﺭ‬ ‫ﻭ‬ ‫ﺍﻟﺸﻤﺱ‬ ‫ﻤﻥ‬. •‫ﺒﻌ‬ ‫ﺍﻟﺠﻠﺩ‬ ‫ﻤﺭﻁﺒﺎﺕ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬ ‫ﻴﻤﻜﻥ‬ ‫ﻭ‬ ،‫ﺍﻟﺩﻭﺍﻡ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻤﻠﻁﻔﺔ‬ ‫ﺍﻟﺼﻭﺍﺒﻴﻥ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬‫ﺍﻟﻁﺒﻴـﺏ‬ ‫ﺍﺴﺘﺸـﺎﺭﺓ‬ ‫ﺩ‬ ‫ﺍﻟﻤﻌﺎﻟﺞ‬. •‫ﺒﺸﺩﺓ‬ ‫ﺩﻟﻜﻪ‬ ‫ﻭ‬ ‫ﻓﺭﻜﻪ‬ ‫ﺃﻭ‬ ،‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻤﻭﻀﻊ‬ ‫ﻋﻨﺩ‬ ‫ﺍﻟﺠﻠﺩ‬ ‫ﻫﺭﺵ‬ ‫ﻭ‬ ‫ﺍﻟﺤﻙ‬ ‫ﺘﺠﻨﺏ‬. •‫ﻴﻤﻜـﻥ‬ ،‫ﺍﻟﻀـﻤﺎﺩﺍﺕ‬ ‫ﻭﻀـﻊ‬ ‫ﻀـﺭﻭﺭﺓ‬ ‫ﻋﻨﺩ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﻭﻀﻊ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻼﺼﻘﺔ‬ ‫ﺍﻷﺸﺭﻁﺔ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬ ‫ﺘﺠﻨﺏ‬ ‫ﻟﻺﺸﻌﺎﻉ‬ ‫ﺍﻟﻤﺘﻌﺭﻀﺔ‬ ‫ﺍﻟﺠﻠﺩ‬ ‫ﻤﺴﺎﺤﺔ‬ ‫ﺨﺎﺭﺝ‬ ‫ﻴﺜﺒﺕ‬ ،‫ﻓﺤﺴﺏ‬ ‫ﻭﺭﻗﻲ‬ ‫ﻻﺼﻕ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬.
  17. 17. Ossama Anjak, AECS. PO BOX6091Damascys Page 17  •‫ﺍﻟﻤﻭﻀﻊ‬ ‫ﺘﺒﺭﻴﺩ‬ ‫ﺃﻭ‬ ‫ﺘﺴﺨﻴﻥ‬ ‫ﺘﺠﻨﺏ‬)‫ﺍﻟﺘﺴـﺨﻴﻥ‬ ‫ﻀـﻤﺎﺩﺍﺕ‬ ‫ﺃﻭ‬ ‫ﺍﻟﺜﻠﺠﻴـﺔ‬ ‫ﺍﻟﻌﺒﻭﺍﺕ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬ ‫ﻤﺜل‬(‫ﺃﻭ‬ ، ‫ﻭ‬ ‫ﺒﻠﻁـﻑ‬ ‫ﺍﻟﺘﻨﺸﻴﻑ‬ ‫ﻭ‬ ‫ﺍﻟﻤﻭﻀﻊ‬ ‫ﻏﺴل‬ ‫ﻋﻨﺩ‬ ‫ﺍﻟﻔﺎﺘﺭ‬ ‫ﺍﻟﻤﺎﺀ‬ ‫ﺒﺎﺴﺘﺨﺩﺍﻡ‬ ‫ﻴﻨﺼﺢ‬ ‫ﻭ‬ ،‫ﺍﻟﺴﺎﺨﻥ‬ ‫ﺍﻟﻤﺎﺀ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬ ‫ﻓﺭﻙ‬ ‫ﺩﻭﻥ‬. •‫ﻫﺫﻩ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻤﺭﻀﻰ‬ ‫ﺍﻷﻁﻔﺎل‬ ‫ﻤﺘﺎﺒﻌﺔ‬ ‫ﻭ‬ ،‫ﻟﺤﺭﻭﻗﺎﺘﻬﺎ‬ ‫ﺘﺠﻨﺒﺎ‬ ‫ﺃﻤﻜﻥ‬ ‫ﻤﺎ‬ ‫ﻟﻠﺸﻤﺱ‬ ‫ﺍﻟﺘﻌﺭﺽ‬ ‫ﻤﻥ‬ ‫ﺍﻟﺤﺫﺭ‬ ‫ﻴﻨﺒﻐﻲ‬ ‫ﺍﻟﺘﻭﺍﺠ‬ ‫ﻋﻥ‬ ‫ﺇﺒﻌﺎﺩﻫﻡ‬ ‫ﻭ‬ ‫ﺍﻟﻤﺴﺎﻟﺔ‬‫ﺍﻟﺘﻌـﺭﺽ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻤﻭﻀﻊ‬ ‫ﺤﻤﺎﻴﺔ‬ ‫ﺍﻟﻀﺭﻭﺭﻱ‬ ‫ﻤﻥ‬ ‫ﻭ‬ ،‫ﺒﺎﻟﻌﺭﺍﺀ‬ ‫ﺩ‬ ‫ﺍﺴﺘﺨﺩﺍﻡ‬ ‫ﻗﺒل‬ ‫ﺍﻟﻁﺒﻴﺏ‬ ‫ﺍﺴﺘﺸﺎﺭﺓ‬ ‫ﻴﻨﺒﻐﻲ‬ ‫ﻭ‬ ،‫ﺍﻟﺒﻴﺕ‬ ‫ﻤﻐﺎﺩﺭﺓ‬ ‫ﻗﺒل‬ ‫ﻨﺎﻋﻤﺔ‬ ‫ﺒﺜﻴﺎﺏ‬ ‫ﺘﻐﻁﻴﺘﻪ‬ ‫ﻭ‬ ،‫ﻟﻠﺸﻤﺱ‬ ‫ﻷﺸﻌﺔ‬ ‫ﺍﻟﺸﻤﺱ‬ ‫ﻤﻥ‬ ‫ﺍﻟﻭﺍﻗﻴﺔ‬ ‫ﺍﻟﺯﻴﻭﺕ‬ ‫ﺃﻭ‬ ‫ﺍﻟﺩﻫﺎﻨﺎﺕ‬. 8.3‫ﺍﻟﺸﻌﺭ‬ ‫ﺘﺴﺎﻗﻁ‬ ‫ﺍﻟﻤﻌﺎ‬ ‫ﺍﻟﻤﻭﺍﻀﻊ‬ ‫ﻓﻲ‬ ‫ﺍﻹﺸﻌﺎﻋﻲ‬ ‫ﺍﻟﻌﻼﺝ‬ ‫ﻋﻥ‬ ‫ﺍﻟﺸﻌﺭ‬ ‫ﺘﺴﺎﻗﻁ‬ ‫ﻴﻨﺠﻡ‬‫ﺫﻟﻙ‬ ‫ﻴﻁﺭﺃ‬ ‫ﺍﻟﺤﺎل‬ ‫ﺒﻁﺒﻴﻌﺔ‬ ‫ﻭ‬ ،‫ﻓﺤﺴﺏ‬ ‫ﻟﺠﺔ‬ ‫ﺍﻟﺒﺎﻟﻐﻴﻥ‬ ‫ﻟﺩﻯ‬‫ﺍﻟﺫﻱ‬ ‫ﺍﻟﺭﺃﺱ‬ ‫ﺸﻌﺭ‬ ‫ﻓﻘﺩﺍﻥ‬ ‫ﻫﻭ‬ ‫ﺍﻷﻁﻔﺎل‬ ‫ﻟﺩﻯ‬ ‫ﺍﻟﻤﻬﻡ‬ ‫ﺒﻴﻨﻤﺎ‬ ،‫ﺍﻟﺸﻌﺭ‬ ‫ﻴﻨﻤﻭ‬ ‫ﺤﻴﺙ‬ ‫ﺒﺎﻟﺠﺴﻡ‬ ‫ﻤﻭﻀﻊ‬ ‫ﺒﺄﻱ‬ ‫ﻓـﻲ‬ ‫ﹰ‬‫ﺎ‬‫ﻜﻠﻴـ‬ ‫ﻴﺘﺴﺎﻗﻁ‬ ‫ﺍﻨﻪ‬ ‫ﺇﻻ‬ ،‫ﺘﺴﺎﻗﻁﻪ‬ ‫ﺩﻭﻥ‬ ‫ﺍﻟﺸﻌﺭ‬ ‫ﻴﺘﻘﺼﻑ‬ ‫ﻗﻠﻴﻠﺔ‬ ‫ﺤﺎﻻﺕ‬ ‫ﻟﺩﻯ‬ ‫ﺍﻨﻪ‬ ‫ﺭﻏﻡ‬ ‫ﻭ‬ ،‫ﺘﺠﻨﺒﻪ‬ ‫ﺍﻟﻤﺘﻌﺫﺭ‬ ‫ﻤﻥ‬ ‫ﺍﻷﺤﻭﺍل‬ ‫ﺃﻏﻠﺏ‬. ‫ﻴﺒﺩ‬ ‫ﺃﻥ‬ ‫ﺍﻟﻤﻌﺘﺎﺩ‬ ‫ﻤﻥ‬ ‫ﻭ‬‫ﻭ‬ ،‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺒﺩﺀ‬ ‫ﻋﻘﺏ‬ ‫ﺃﺴﺎﺒﻴﻊ‬ ‫ﺜﻼﺜﺔ‬ ‫ﺇﻟﻰ‬ ‫ﺃﺴﺒﻭﻋﻴﻥ‬ ‫ﺒﻴﻥ‬ ‫ﺘﺘﺭﺍﻭﺡ‬ ‫ﻓﺘﺭﺍﺕ‬ ‫ﺨﻼل‬ ‫ﺍﻟﺘﺴﺎﻗﻁ‬ ‫ﺃ‬ ‫ﺒـﻴﻥ‬ ‫ﺘﺘـﺭﺍﻭﺡ‬ ‫ﻓﺘﺭﺍﺕ‬ ‫ﺒﻌﺩ‬ ‫ﺜﺎﻨﻴﺔ‬ ‫ﻟﻠﻨﻤﻭ‬ ‫ﺍﻟﺸﻌﺭ‬ ‫ﻴﻌﻭﺩ‬ ‫ﺤﻴﺙ‬ ،‫ﻤﺅﻗﺕ‬ ‫ﻋﺎﺭﺽ‬ ‫ﺍﻟﺸﻌﺭ‬ ‫ﻓﻘﺩﺍﻥ‬ ‫ﺃﻥ‬ ‫ﺭﻏﻡ‬6‫ﺇﻟـﻰ‬8 ‫ﻤ‬ ‫ﻋﺎﻟﻴﺔ‬ ‫ﻟﺠﺭﻋﺎﺕ‬ ‫ﺘﻌﺭﻀﺕ‬ ‫ﺍﻟﺘﻲ‬ ‫ﺒﺎﻟﻤﻭﺍﻀﻊ‬ ‫ﺜﺎﻨﻴﺔ‬ ‫ﻴﻨﻤﻭ‬ ‫ﻻ‬ ‫ﻗﺩ‬ ‫ﺍﻟﺸﻌﺭ‬ ‫ﺃﻥ‬ ‫ﺇﻻ‬ ،‫ﺍﻟﻤﻌﺎﻟﺠﺎﺕ‬ ‫ﺍﻨﺘﻬﺎﺀ‬ ‫ﻋﻘﺏ‬ ‫ﺃﺴﺎﺒﻴﻊ‬‫ﻥ‬ ‫ﻗﻠﻴﻼ‬ ‫ﻤﺨﺘﻠﻔﺔ‬ ‫ﻨﻴﺔ‬‫ﺒ‬ ‫ﺃﻭ‬ ‫ﺒﻠﻭﻥ‬ ‫ﺍﻟﺠﺩﻴﺩ‬ ‫ﺍﻟﺸﻌﺭ‬ ‫ﻴﻨﻤﻭ‬ ‫ﺃﻥ‬ ‫ﺍﻟﺸﺎﺌﻊ‬ ‫ﻤﻥ‬ ‫ﻭ‬ ،‫ﺍﻹﺸﻌﺎﻉ‬. ‫ﻟﺘﻐﻴـﺭ‬ ‫ﹰ‬‫ﺍ‬‫ﻨﻅﺭ‬ ‫ﺍﻷﻫل‬ ‫ﻋﻠﻰ‬ ‫ﺤﺘﻰ‬ ‫ﻭ‬ ‫ﺍﻟﻁﻔﻠﺔ‬ ‫ﺃﻭ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﺍﻟﻁﻔل‬ ‫ﻋﻠﻰ‬ ‫ﺍﻷﻤﺭ‬ ‫ﺘﻘﺒل‬ ‫ﻴﺼﻌﺏ‬ ‫ﻓﻘﺩ‬ ‫ﺍﻟﺤﺎل‬ ‫ﺒﻁﺒﻴﻌﺔ‬ ‫ﻭ‬ ‫ﻤﺴﺘﻌﺎﺭ‬ ‫ﺸﻌﺭ‬ ‫ﺍﺭﺘﺩﺍﺀ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻤﺭﻴﺽ‬ ‫ﻴﺭﻏﺏ‬ ‫ﻗﺩ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﺭﺽ‬ ‫ﺤﺎﻟﺔ‬ ‫ﻋﻠﻰ‬ ‫ﻟﺩﻻﻟﺘﻪ‬ ‫ﻭ‬ ‫ﻜﺒﻴﺭ‬ ‫ﺒﺸﻜل‬ ‫ﺍﻟﺨﺎﺭﺠﻲ‬ ‫ﺍﻟﻤﻅﻬﺭ‬ ‫ﺫ‬ ‫ﻭ‬‫ﺃﻏﻁﻴـﺔ‬ ‫ﺍﺭﺘﺩﺍﺀ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺒﺩﺀ‬ ‫ﻌﻴﺩ‬‫ﺒ‬ ‫ﺍﻟﺸﻌﺭ‬ ‫ﺘﻘﺼﻴﺭ‬ ‫ﻴﻔﻀل‬ ‫ﻭ‬ ،‫ﺜﺎﻨﻴﺔ‬ ‫ﺍﻟﺸﻌﺭ‬ ‫ﻨﻤﻭ‬ ‫ﻋﻠﻰ‬ ‫ﻴﺅﺜﺭ‬ ‫ﻻ‬ ‫ﻟﻙ‬ ،‫ﻟﻠﺒﺭﺩ‬ ‫ﺃﻭ‬ ‫ﻟﻠﺸﻤﺱ‬ ‫ﻤﺒﺎﺸﺭﺓ‬ ‫ﺍﻟﺭﺃﺱ‬ ‫ﻓﺭﻭﺓ‬ ‫ﺘﻌﺭﺽ‬ ‫ﻟﺘﺠﻨﺏ‬ ‫ﺍﻟﻤﻨﺎﺴﺒﺔ‬ ‫ﺍﻟﺭﺃﺱ‬‫ﺍﻟﺘﺴﺎﻗﻁ‬ ‫ﻓﺘﺭﺓ‬ ‫ﺃﺜﻨﺎﺀ‬ ‫ﺩﺍﺌﻤﺎ‬ ‫ﻨﺼﺢ‬‫ﻴ‬ ‫ﻜﻤﺎ‬ ‫ﺃﻭ‬ ،‫ﺍﻟﺼـﺒﻐﺎﺕ‬ ‫ﻤﺜـل‬ ،‫ﺍﻟﻜﻴﻤﺎﻭﻴﺎﺕ‬ ‫ﺃﻭ‬ ‫ﺍﻟﺸﻌﺭ‬ ‫ﻤﺠﻔﻔﺎﺕ‬ ‫ﺍﺴﺘﻌﻤﺎل‬ ‫ﻋﺩﻡ‬ ‫ﻭ‬ ،‫ﺍﻟﻤﻠﻁﻔﺔ‬ ‫ﺍﻟﺸﻌﺭ‬ ‫ﻏﺴﻭﻻﺕ‬ ‫ﺒﺎﺴﺘﻌﻤﺎل‬ ‫ﻏﻴﺭﻫﺎ‬ ‫ﻭ‬ ‫ﺍﻟﺸﻌﺭ‬ ‫ﻋﺎﻗﺼﺎﺕ‬ ‫ﻤﺜل‬ ‫ﺍﻟﻜﻬﺭﺒﻴﺔ‬ ‫ﺍﻷﺩﻭﺍﺕ‬. ‫ﺍﻟﺸﻌـﺭ‬ ‫ﻓﻘﺩﺍﻥ‬ ‫ﻤﻊ‬ ‫ﻟﻠﺘﻌﺎﻤل‬ ‫ﻤﻔﻴﺩﺓ‬ ‫ﺍﻟﺘﺎﻟﻴﺔ‬ ‫ﺍﻟﻤﻘﺘﺭﺤﺎﺕ‬: •‫ﺤﻭ‬ ‫ﺍﻟﺨﺎﺼﺔ‬ ‫ﻤﺸﺎﻋﺭﻫﻡ‬ ‫ﺒﺈﺒﻌﺎﺩ‬ ‫ﺍﻷﻫل‬ ‫ﻨﺼﺢ‬‫ﻴ‬‫ﺍﻟﻤـﺭﺀ‬ ‫ﻴﻜـﻭﻥ‬ ‫ﺃﻥ‬ ‫ﻋﺎﺩﻴﺎ‬ ‫ﺍﻷﻤﺭ‬ ‫ﺠﻌل‬ ‫ﻭ‬ ،‫ﺍﻟﻤﻭﻀﻭﻉ‬ ‫ل‬ ‫ﺃﺼﻠﻊ‬. •‫ﺘﻨﺎﺴﺒﻪ‬ ‫ﺍﻟﺘﻲ‬ ‫ﺒﺎﻟﻁﺭﻴﻘﺔ‬ ‫ﺸﻌﺭﻩ‬ ‫ﺘﻘﺼﻴﺭ‬ ‫ﻭ‬ ،‫ﺒﻤﻅﻬﺭﻩ‬ ‫ﺍﻟﺘﻐﻴﺭﺍﺕ‬ ‫ﻟﺘﻘﺒل‬ ‫ﺍﻟﻁﻔل‬ ‫ﺘﻬﻴﺌﺔ‬.

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