nkhani

Uterine fibroids ndizomwe zimayambitsa matenda a menorrhagia ndi kuchepa kwa magazi m'thupi, ndipo kuchuluka kwake ndikwambiri, pafupifupi 70% mpaka 80% ya azimayi amakhala ndi uterine fibroids m'moyo wawo, pomwe 50% amawonetsa zizindikiro. Pakali pano, hysterectomy ndi mankhwala omwe amagwiritsidwa ntchito kwambiri ndipo amaonedwa kuti ndi mankhwala ochiritsira kwambiri a fibroids, koma hysterectomy imanyamula osati zoopsa za perioperative, komanso chiopsezo chowonjezereka cha matenda a mtima, nkhawa, kuvutika maganizo, ndi imfa. Mosiyana ndi zimenezi, njira zothandizira mankhwala monga chiberekero cha uterine embolization, ablation m'deralo, ndi oral GnRH antagonists ndi otetezeka koma osagwiritsidwa ntchito mokwanira.

Chidule cha nkhani

Mayi wakuda wazaka 33 yemwe anali asanakhalepo ndi pakati adapereka kwa sing'anga wamkulu msambo komanso mpweya wotuluka m'mimba. Amadwala matenda osowa magazi m'thupi. Mayeso adabweranso kuti alibe thalassemia ndi sickle cell anemia. Wodwalayo analibe magazi mu chopondapo ndipo analibe mbiri ya banja ya khansa ya m'matumbo kapena matenda otupa. Ananena za kusamba nthawi zonse, kamodzi pamwezi, nthawi iliyonse ya masiku 8, komanso nthawi yayitali yosasinthika. Pamasiku atatu amene achulukirachulukira a msambo uliwonse, ayenera kugwiritsa ntchito ma tamponi 8 mpaka 9 patsiku, ndipo nthawi zina amataya magazi. Amaphunzira udokotala ndipo akufuna kutenga pakati pasanathe zaka ziwiri. Ultrasound anasonyeza chiberekero chokulirapo ndi angapo myoma ndi yachibadwa thumba losunga mazira. Kodi mungamuthandize bwanji wodwalayo?

Kuchuluka kwa matenda okhudzana ndi uterine fibroids kumaphatikizidwa ndi kuchepa kwa matendawa komanso kuti zizindikiro zake zimachokera kuzinthu zina, monga kusokonezeka kwa m'mimba kapena kusokonezeka kwa magazi. Manyazi okhudzana ndi kukambirana za kusamba amachititsa anthu ambiri omwe ali ndi nthawi yayitali kapena olemera kuti asadziwe kuti matenda awo ndi olakwika. Anthu omwe ali ndi zizindikiro nthawi zambiri sadziwidwa panthawi yake. Gawo limodzi mwa magawo atatu a odwala amatenga zaka zisanu kuti azindikire, ndipo ena amatenga zaka zoposa zisanu ndi zitatu. Kuchedwa kuzindikiridwa kumatha kusokoneza chonde, moyo wabwino, komanso chuma, ndipo mu kafukufuku wamakhalidwe abwino, 95 peresenti ya odwala omwe ali ndi symptomatic fibroids adanenanso za zotsatirapo zamaganizidwe, kuphatikiza kukhumudwa, nkhawa, mkwiyo, komanso kupsinjika kwa thupi. Kusalidwa ndi manyazi okhudzana ndi kusamba zimalepheretsa kukambirana, kufufuza, kulengeza, ndi luso lamakono pankhaniyi. Pakati pa odwala omwe adapezeka ndi fibroids ndi ultrasound, 50% mpaka 72% samadziwa kale kuti ali ndi fibroids, zomwe zikutanthauza kuti ultrasound ingagwiritsidwe ntchito kwambiri powunika matendawa.

Kuchuluka kwa uterine fibroids kumawonjezeka ndi zaka mpaka kumapeto kwa kusamba ndipo kumakhala kwakukulu mwa akuda kuposa azungu. Poyerekeza ndi anthu ena osati anthu akuda, anthu akuda amayamba uterine fibroids ali aang'ono, amakhala ndi chiopsezo chachikulu chokhala ndi zizindikiro, ndipo amakhala ndi matenda ambiri. Poyerekeza ndi anthu a ku Caucasus, anthu akuda amadwala kwambiri ndipo amatha kuchitidwa hysterectomy ndi myomectomy. Kuonjezera apo, anthu akuda anali ochuluka kusiyana ndi azungu kuti asankhe chithandizo chopanda chithandizo komanso kupewa kutumizidwa kwa opaleshoni kuti apewe mwayi woti apite ku hysterectomy.

Matenda a uterine fibroids amatha kutulukira mwachindunji pogwiritsa ntchito ultrasound ya m'chiuno, koma kudziwa yemwe angayang'anire sikophweka, ndipo panopa kuyezetsa kumachitika pambuyo poti zilonda zam'mimba zakhala zazikulu kapena zizindikiro zikuwonekera. Zizindikiro zomwe zimagwirizanitsidwa ndi uterine fibroids zimatha kukumana ndi zizindikiro za kusokonezeka kwa ovulation, adenomyopathy, secondary dysmenorrhea, ndi matenda a m'mimba.

Chifukwa ma sarcoma ndi ma fibroids amapezeka ngati kuchuluka kwa myometric ndipo nthawi zambiri amatsagana ndi magazi osadziwika bwino a uterine, pali nkhawa kuti ma sarcoma a uterine amatha kuphonya ngakhale ali ochepa (1 mu 770 mpaka 10,000 maulendo chifukwa cha kutulutsa magazi kwa chiberekero). Kudetsa nkhaŵa za leiomyosarcoma yosazindikirika kwachititsa kuti chiwerengero cha hysterectomy chiwonjezeke komanso kuchepa kwa kugwiritsira ntchito njira zowonongeka pang'ono, kuyika odwala pachiopsezo chosafunikira cha zovuta chifukwa cha kusauka kwa uterine sarcomas yomwe yafalikira kunja kwa chiberekero.

Matenda ndi kuunika

Mwa njira zosiyanasiyana zojambula zomwe zimagwiritsidwa ntchito pozindikira uterine fibroids, ultrasound ya pelvic ndiyo njira yotsika mtengo kwambiri chifukwa imapereka chidziwitso cha kuchuluka kwake, malo, ndi chiwerengero cha uterine fibroids ndipo ingaphatikizepo misa ya adnexal. Ultrasound ya m'chiuno ingagwiritsidwenso ntchito kuyesa magazi osadziwika bwino a chiberekero, fupa la m'chiuno pofufuza, ndi zizindikiro zokhudzana ndi kukula kwa chiberekero, kuphatikizapo kuthamanga kwa m'chiuno ndi mpweya wa m'mimba. Ngati uterine voliyumu iposa 375 ml kapena kuchuluka kwa fibroids kupitilira 4 (zomwe ndizofala), kusamvana kwa ultrasound kumakhala kochepa. Kujambula kwa maginito a maginito kumakhala kothandiza kwambiri pamene chiberekero cha sarcoma chikuganiziridwa komanso pokonzekera njira ina yopangira hysterectomy, momwemonso chidziwitso cholondola chokhudza kuchuluka kwa uterine, maonekedwe a zithunzi, ndi malo ndizofunika kwambiri pa zotsatira za chithandizo (Chithunzi 1). Ngati submucosal fibroids kapena zotupa zina za endometrial zikuganiziridwa, saline perfusion ultrasound kapena hysteroscopy zingakhale zothandiza. Computed tomography sizothandiza pozindikira uterine fibroids chifukwa chosamveka bwino komanso mawonekedwe a minofu.

Mu 2011, bungwe la International Federation of Obstetrics and Gynecology linasindikiza dongosolo la uterine fibroids ndi cholinga chofotokozera bwino malo a fibroids pokhudzana ndi chiberekero cha uterine ndi serous membrane pamwamba, osati mawu akale a submucosal, intramural, ndi subserous nembanemba, motero kulola kuti pakhale kulankhulana momveka bwino ndi tebulo la S3e nkhani pa NEJM.org). Dongosolo lamagulu ndi mtundu 0 mpaka 8, ndi nambala yaying'ono yosonyeza kuti fibroid ili pafupi ndi endometrium. Mixed uterine fibroids amaimiridwa ndi manambala awiri olekanitsidwa ndi hyphens. Nambala yoyamba imasonyeza kugwirizana pakati pa fibroid ndi endometrium, ndipo nambala yachiwiri imasonyeza mgwirizano pakati pa fibroid ndi serous nembanemba. Dongosolo logawa uterine fibroids limathandiza asing'anga kuyang'ananso pakuzindikira komanso kulandira chithandizo, komanso kulumikizana bwino.

Chithandizo

M'madongosolo ambiri ochizira matenda okhudzana ndi matenda a myoma, kuwongolera matenda a menorrhagia ndi mahomoni olerera ndi gawo loyamba. Nonsteroidal odana ndi yotupa mankhwala ndi tranatemocyclic asidi ntchito pa msambo Angagwiritsidwenso ntchito kuchepetsa menorrhagia, koma pali umboni wochuluka pa mphamvu ya mankhwala a idiopathic menorrhagia, ndipo chipatala mayesero pa matenda nthawi zambiri kupatula odwala chimphona kapena submucosal fibroids. Ma agonists a gonadotropin-release hormone (GnRH) omwe amagwira ntchito kwa nthawi yayitali avomerezedwa kuti athandizidwe kwakanthawi kochepa kwa uterine fibroids, zomwe zingayambitse amenorrhea pafupifupi 90% ya odwala ndikuchepetsa kuchuluka kwa chiberekero ndi 30% mpaka 60%. Komabe, mankhwalawa amagwirizanitsidwa ndi chiwerengero chachikulu cha zizindikiro za hypogonadal, kuphatikizapo kutayika kwa mafupa ndi kutentha kwamoto. Zimayambitsanso "steroidal flares" mwa odwala ambiri, momwe ma gonadotropin osungidwa m'thupi amamasulidwa ndipo amachititsa nthawi zolemetsa pambuyo pake pamene milingo ya estrogen imatsika mofulumira.

Kugwiritsa ntchito oral GnRH antagonist therapy pochiza uterine fibroids ndikupita patsogolo kwakukulu. Mankhwala ovomerezeka ku United States amaphatikiza oral GnRH antagonists (elagolix kapena relugolix) mu piritsi limodzi kapena kapisozi ndi estradiol ndi progesterone, zomwe zimalepheretsa msanga kupanga ovarian steroid (ndipo sizimayambitsa steroid triggering), ndi mlingo wa estradiol ndi progesterone womwe umapangitsa kuti machitidwe apangidwe mofanana ndi ma follicular oyambirira. Mankhwala amodzi omwe amavomerezedwa kale ku European Union (linzagolix) ali ndi milingo iwiri: mlingo womwe umalepheretsa pang'ono ntchito ya hypothalamic ndi mlingo womwe umalepheretsa ntchito ya hypothalamic, yomwe ili yofanana ndi yovomerezeka ya elagolix ndi relugolix. Mankhwala aliwonse amapezeka pokonzekera kapena popanda estrogen ndi progesterone. Kwa odwala omwe safuna kugwiritsa ntchito exogenous gonadal steroids, kupangika kwa linzagolix kwa mlingo wochepa popanda kuwonjezera ma gonadal steroids (estrogen ndi progesterone) kungathe kukwaniritsa zomwezo monga kuphatikiza kwa mlingo waukulu wokhala ndi mahomoni achilendo. Thandizo lophatikizika kapena chithandizo chomwe chimalepheretsa pang'ono kugwira ntchito kwa hypothalamic kumatha kuthetsa zizindikirozo ndi zotsatira zofanana ndi GnRH antagonist monotherapy, koma zokhala ndi zotsatirapo zochepa. Ubwino umodzi wa monotherapy wochuluka kwambiri ndikuti ukhoza kuchepetsa kukula kwa chiberekero bwino, zomwe zimakhala zofanana ndi zotsatira za GnRH agonists, koma ndi zizindikiro zambiri za hypogonadal.

Deta yachipatala yachipatala imasonyeza kuti oral GnRH antagonist antagonist amathandizira kuchepetsa menorrhagia (50% mpaka 75% kuchepetsa), kupweteka (40% mpaka 50% kuchepetsa), ndi zizindikiro zokhudzana ndi kukula kwa chiberekero, pamene kuchepetsa pang'ono uterine voliyumu (pafupifupi 10% kuchepetsa kwa uterine voliyumu) ​​ndi zotsatira zochepa za kupweteka kwa mutu, kupweteka kwa mutu, kupweteka kwa mutu, ndi zina zopweteka kwambiri (20%). Kuchita bwino kwa oral GnRH antagonist therapy kunali kosagwirizana ndi kukula kwa myomatosis (kukula, chiwerengero, kapena malo a fibroids), kuphatikizika kwa adenomyosis, kapena zinthu zina zomwe zimalepheretsa chithandizo cha opaleshoni. Kuphatikiza pakamwa kwa GnRH antagonist pano kwavomerezedwa kwa miyezi 24 ku United States komanso kugwiritsidwa ntchito kosatha ku European Union. Komabe, mankhwalawa sanawonetsedwe kuti ali ndi mphamvu zolerera, zomwe zimalepheretsa kugwiritsidwa ntchito kwa nthawi yaitali kwa anthu ambiri. Mayesero achipatala omwe amayesa zotsatira za kulera kwa mankhwala osakaniza a relugolix akupitirira (nambala yolembetsa NCT04756037 pa ClinicalTrials.gov).

M'mayiko ambiri, ma progesterone receptor modulators osankhidwa ndi mankhwala. Komabe, nkhawa za chiwopsezo cha chiwindi chosowa koma chachikulu chachepetsa kuvomereza ndi kupezeka kwa mankhwalawa. Palibe ma progesterone receptor modulators osankhidwa omwe avomerezedwa ku United States pochiza uterine fibroids.

Hysterectomy

Ngakhale kuti hysterectomy yakhala ikuwoneka ngati chithandizo chamankhwala cha uterine fibroids, zatsopano zokhudzana ndi zotsatira za njira zochiritsira zoyenera zimasonyeza kuti izi zikhoza kukhala zofanana ndi hysterectomy m'njira zambiri pa nthawi yolamulira. Kuipa kwa hysterectomy poyerekeza ndi njira zina zochiritsira kumaphatikizapo kuopsa kwa opaleshoni ndi salpingectomy (ngati ndi gawo la ndondomekoyi). Zaka 100 zisanayambike, kuchotsa thumba losunga mazira onse pamodzi ndi chiberekero chinali njira yodziwika bwino, ndipo kafukufuku wamagulu akuluakulu kumayambiriro kwa zaka za m'ma 2000 anasonyeza kuti kuchotsedwa kwa mazira onse awiri kunagwirizanitsidwa ndi chiopsezo chowonjezereka cha imfa, matenda a mtima, kusokonezeka maganizo, ndi matenda ena poyerekeza ndi kukhala ndi hysterectomy ndi kusunga mazira. Kuyambira pamenepo, chiwopsezo cha opaleshoni ya salpingectomy chatsika, pomwe maopaleshoni a hysterectomy sanachepe.

Kafukufuku wambiri wasonyeza kuti ngakhale mazira onse awiri atasungidwa, chiopsezo cha matenda a mtima, nkhawa, kuvutika maganizo, ndi imfa pambuyo pa hysterectomy chimawonjezeka kwambiri. Odwala ≤35 azaka zakubadwa pa nthawi ya hysterectomy ali pachiwopsezo chachikulu. Pakati pa odwalawa, chiopsezo cha matenda a mitsempha ya m'mitsempha (pambuyo pa kusintha kwa confounders) ndi kulephera kwa mtima kwamtima kunali 2.5 nthawi zambiri mwa amayi omwe anachitidwa hysterectomy ndi 4.6 nthawi zambiri mwa amayi omwe sanapatsidwe hysterectomy panthawi yotsatila zaka 22. Azimayi omwe anali ndi hysterectomy asanakwanitse zaka 40 ndipo amasunga mazira awo anali ndi mwayi wofa 8 mpaka 29 peresenti kusiyana ndi amayi omwe sanachotsepo chiberekero. Komabe, odwala omwe anali ndi hysterectomy anali ndi zovuta zambiri, monga kunenepa kwambiri, hyperlipidemia, kapena mbiri ya opaleshoni, kusiyana ndi amayi omwe sanachitepo opaleshoni, komanso chifukwa chakuti maphunzirowa anali owonetsetsa, chifukwa ndi zotsatira zake sizikanatsimikiziridwa. Ngakhale kuti kafukufuku wawongolera paziwopsezo zobadwa nazo izi, pangakhalebe zinthu zosokoneza zosayezedwa. Zowopsazi ziyenera kufotokozedwa kwa odwala omwe akuganizira za hysterectomy, monga odwala ambiri omwe ali ndi uterine fibroids ali ndi njira zina zochepetsera.

Pakali pano palibe njira zoyambirira kapena zachiwiri zopewera uterine fibroids. Maphunziro a Epidemiological apeza zinthu zosiyanasiyana zomwe zimagwirizanitsidwa ndi kuchepa kwa uterine fibroids, kuphatikizapo: kudya zipatso zambiri ndi ndiwo zamasamba komanso nyama yochepa yofiira; Kuchita masewera olimbitsa thupi nthawi zonse; Yesetsani kulemera kwanu; Mulingo wamba wa vitamini D; Kubadwa kopambana; Kugwiritsa ntchito njira zolerera pakamwa; Ndipo kukonzekera kwa progesterone kwa nthawi yayitali. Mayesero olamulidwa mwachisawawa amafunikira kuti adziwe ngati kusintha zinthuzi kungachepetse chiopsezo. Potsirizira pake, phunziroli likusonyeza kuti kupsinjika maganizo ndi tsankho likhoza kukhala ndi gawo mu chisalungamo cha thanzi chomwe chimakhalapo pankhani ya uterine fibroids.