I-uterine fibroids iyimbangela evamile ye-menorrhagia kanye ne-anemia, futhi isigameko siphezulu kakhulu, cishe u-70% kuya ku-80% wabesifazane uzoba ne-uterine fibroids ekuphileni kwabo, lapho u-50% wabo ubonisa izimpawu. Njengamanje, i-hysterectomy iyindlela yokwelapha esetshenziswa kakhulu futhi ithathwa njengekhambi elinamandla le-fibroids, kodwa i-hysterectomy ayithwali nje kuphela izingozi ze-perioperative, kodwa futhi ingozi yesikhathi eside yesifo senhliziyo, ukukhathazeka, ukucindezeleka nokufa. Ngokuphambene, izinketho zokwelapha ezifana nokufakwa kwe-uterine artery, ablation yendawo, kanye nabaphikisi be-GnRH ngomlomo ziphephile kodwa azisetshenziswa ngokugcwele.
Isifinyezo secala
Owesifazane omnyama oneminyaka engu-33 ubudala owayengakaze akhulelwe wethule udokotela wakhe omkhulu isilumo esinamandla sokuya esikhathini kanye negesi yesisu. Unenkinga yokuntuleka kwe-iron anemia. Ukuhlolwa kwabuya kungenayo i-thalassemia ne-sickle cell anemia. Isiguli sasingenalo igazi esitokisini futhi singenawo umlando womndeni womdlavuza wekoloni noma isifo samathumbu esivuvukalayo. Wabika ukuya esikhathini okuvamile, kanye ngenyanga, isikhathi ngasinye sezinsuku eziyi-8, kanye nesikhathi eside esingashintshile. Ezinsukwini ezintathu ezanda kakhulu zomjikelezo ngamunye wokuya esikhathini, udinga ukusebenzisa ama-tampons angu-8 kuya kwangu-9 ngosuku, futhi ngezinye izikhathi uyopha ngokuya esikhathini. Ufundela ubudokotela kanti uhlela ukukhulelwa kungakapheli iminyaka emibili. I-Ultrasound ibonise isibeletho esikhulisiwe esinama-myomas amaningi nama-ovari avamile. Uzosiphatha kanjani isiguli?
Izigameko zezifo ezihambisana ne-uterine fibroids zihlanganiswa nezinga eliphansi lokutholwa kwalesi sifo kanye neqiniso lokuthi izimpawu zaso zibangelwa ezinye izimo, njengokuphazamiseka kokugaya ukudla noma ukuphazamiseka kwesimiso segazi. Ihlazo elihambisana nokuxoxa ngokuya esikhathini lenza abantu abaningi abanesikhathi eside noma abanesikhathi esinzima bangazi ukuthi isimo sabo asijwayelekile. Abantu abanezimpawu ngokuvamile abatholakali ngesikhathi. Ingxenye eyodwa kwezintathu yeziguli ithatha iminyaka emihlanu ukuthi ixilongwe, kanti ezinye zithatha iminyaka engaphezu kweyisishiyagalombili. Ukuxilongwa okubambezelekile kungase kuthinte kabi inzalo, ikhwalithi yokuphila, kanye nempilo enhle yezezimali, futhi ocwaningweni lwekhwalithi, amaphesenti angu-95 eziguli ezine-symptomatic fibroids abike imiphumela engokwengqondo yangemuva, okuhlanganisa ukucindezeleka, ukukhathazeka, intukuthelo, nokucindezeleka kwesithombe somzimba. Ukucwaswa kanye namahloni okuhambisana nokuya esikhathini kuphazamisa ingxoxo, ucwaningo, ukumela, kanye nokuqanjwa okusha kule ndawo. Phakathi kweziguli ezitholwe zine-fibroids nge-ultrasound, u-50% kuya ku-72% ngaphambili bezingazi ukuthi zine-fibroids, okuphakamisa ukuthi i-ultrasound ingase isetshenziswe kabanzi ekuhlolweni kwalesi sifo esivamile.
Isibalo se-uterine fibroids sikhula ngokuya ngeminyaka kuze kube yilapho sinqamuka futhi siphezulu kwabamnyama kunakwabamhlophe. Uma kuqhathaniswa nabanye abantu ngaphandle kwabantu abamnyama, abantu abansundu baba ne-uterine fibroids besebancane, babe nengozi ephakeme enqwabelene yokuba nezimpawu, futhi babe nomthwalo omkhulu wezifo. Uma kuqhathaniswa nabantu baseCaucasus, abantu abamnyama bayagula futhi kungenzeka ukuthi bahlinzwe i-hysterectomy kanye ne-myomectomy. Ukwengeza, abamnyama babenamathuba amaningi kunabamhlophe ukuthi bakhethe ukwelashwa okungahlaseli futhi bagweme ukudluliselwa kokuhlinzwa ukuze bagweme ukuthi kungenzeka ukuthi benze i-hysterectomy.
I-uterine fibroids ingaxilongwa ngokuqondile nge-ultrasound ye-pelvic, kodwa ukuthola ukuthi ubani ozohlolwa akulula, futhi okwamanje ukuhlolwa ngokuvamile kwenziwa ngemva kokuba ama-fibroids esiguli emakhulu noma izimpawu zivela. Izimpawu ezihlobene ne-uterine fibroids zingase zihlangane nezimpawu zokuphazamiseka kokuvuthwa kwamaqanda, i-adenomyopathy, i-dysmenorrhea yesibili, nokuphazamiseka kokugaya ukudla.
Ngenxa yokuthi kokubili ama-sarcomas nama-fibroids atholakala njengenqwaba ye-myometric futhi ngokuvamile ahambisana nokopha okungavamile kwesibeletho, kukhona ukukhathazeka ukuthi ama-sarcoma esibeletho angase aphuthelwe naphezu kokutholakala kwawo okungavamile (ukuvakasha oku-1 kokungu-770 kuya ku-10,000 ngenxa yokopha okungavamile kwesibeletho). Ukukhathazeka mayelana ne-leiomyosarcoma engaxilongwa kuye kwaholela ekwenyukeni kwezinga le-hysterectomy kanye nokuncipha kokusetshenziswa kwezinqubo ezihlasela kancane, okubeka iziguli engcupheni engadingekile yezinkinga ngenxa yokungabikezeli kahle kwe-uterine sarcomas esabalele ngaphandle kwesibeletho.
Ukuxilongwa nokuhlola
Ezindleleni ezihlukahlukene zokuthwebula izithombe ezisetshenziselwa ukuxilonga i-uterine fibroids, i-pelvic ultrasound iyindlela engabizi kakhulu ngoba inikeza ulwazi ngevolumu, indawo, kanye nenani le-uterine fibroids futhi ingakhipha ubuningi be-adnexal. I-ultrasound ye-pelvic yesiguli ingase isetshenziselwe ukuhlola ukopha okungavamile kwesibeletho, inqwaba ye-pelvic ezwakalayo ngesikhathi sokuhlolwa, nezimpawu ezihlobene nokwanda kwesibeletho, okuhlanganisa ukucindezela kwe-pelvic kanye negesi yesisu. Uma umthamo wesibeletho udlula u-375 mL noma inani lama-fibroids lidlula u-4 (okuyinto evamile), ukulungiswa kwe-ultrasound kunqunyelwe. I-imaging resonance magnetic iwusizo kakhulu lapho i-uterine sarcoma isolwa futhi lapho uhlela enye indlela yokukhishwa kwe-hysterectomy, lapho kwenzeka khona ulwazi olunembile mayelana nevolumu yesibeletho, izici ze-imaging, kanye nendawo kubalulekile emiphumeleni yokwelapha (Umfanekiso 1). Uma kusolwa i-submucosal fibroids noma ezinye izilonda ze-endometrial, i-saline perfusion ultrasound noma i-hysteroscopy ingase ibe usizo. I-computed tomography ayilusizo ekuxilongeni i-uterine fibroids ngenxa yokungacaci kahle kwayo kanye nokubonwa kwendiza yethishu.
Ngo-2011, i-International Federation of Obstetrics and Gynecology yashicilela uhlelo lokuhlukaniswa kwe-uterine fibroids ngenhloso yokuchaza kangcono indawo ye-fibroids maqondana ne-uterine cavity kanye ne-serous membrane surface, kunokuba kube nemigomo yakudala ye-submucosal, intramural, kanye ne-subserous membranes, ngaleyo ndlela ivumela ukutholakala okucacile kwethebula le-S3endi yokuxhumana okugcwele kanye nokwelashwa okugcwele kombhalo. isihloko ku-NEJM.org). Uhlelo lokuhlukanisa luwuhlobo 0 kuya ku-8, nenombolo encane ebonisa ukuthi i-fibroid iseduze ne-endometrium. I-uterine fibroids ehlanganisiwe imelwe izinombolo ezimbili ezihlukaniswe ngamakhonco. Inombolo yokuqala ikhombisa ubudlelwane phakathi kwe-fibroid ne-endometrium, futhi inombolo yesibili ikhombisa ubudlelwano phakathi kwe-fibroid ne-serous membrane. Lolu hlelo lokuhlukaniswa kwe-uterine fibroid lusiza odokotela ukuthi baqondise ekuxilongweni nasekulashweni okwengeziwe, futhi kuthuthukisa ukuxhumana.
Ukwelashwa
Ezinhlotsheni eziningi zokwelashwa kwe-menorrhagia ehambisana ne-myoma, ukulawula i-menorrhagia ngama-hormone okuvimbela inzalo kuyisinyathelo sokuqala. Izidakamizwa ezingezona ukuvuvukala kanye ne-tranatemocyclic acid esetshenziswa ngesikhathi sokuya esikhathini nazo zingasetshenziswa ekwehliseni i-menorrhagia, kodwa kunobufakazi obengeziwe bokusebenza kwalezi zidakamizwa ze-idiopathic menorrhagia, futhi izivivinyo zomtholampilo ngalesi sifo ngokuvamile azibandakanyi iziguli ezine-giant noma submucosal fibroids. Ama-agonists asebenza isikhathi eside e-gonadotropin-releasing hormone (GnRH) agunyazwe ukwelashwa kwesikhathi esifushane kwangaphambi kokuhlinzwa kwe-uterine fibroids, engabangela i-amenorrhea cishe ku-90% yeziguli futhi yehlise umthamo wesibeletho ngo-30% kuya ku-60%. Kodwa-ke, le mithi ihlotshaniswa nesigameko esiphezulu sezimpawu ze-hypogonadal, kuhlanganise nokulahlekelwa kwamathambo nokushisa okushisayo. Ziphinde zibangele "ama-steroidal flares" ezigulini eziningi, lapho ama-gonadotropin agciniwe emzimbeni akhululwa futhi abangele izikhathi ezinzima kamuva lapho amazinga e-estrogen ehla ngokushesha.
Ukusetshenziswa kokwelashwa okuhlanganisiwe komphikisi we-GnRH ekwelapheni i-uterine fibroids kuyintuthuko enkulu. Izidakamizwa ezigunyazwe e-United States zihlanganisa izitha zomlomo ze-GnRH (elagolix noma i-relugolix) kuthebhulethi eyinhlanganisela noma i-capsule ene-estradiol ne-progesterone, evimbela ngokushesha ukukhiqizwa kwe-ovarian steroid (futhi ingabangeli ukucupha kwe-steroid), kanye nemithamo ye-estradiol ne-progesterone eyenza amazinga esistimu aqhathaniswe namazinga okuqala e-follicular. Umuthi owodwa osuvele uvunyiwe ku-European Union (i-linzagolix) unemithamo emibili: umthamo ovimbela kancane ukusebenza kwe-hypothalamic kanye nomthamo ovimbela ngokuphelele ukusebenza kwe-hypothalamic, okufana nemithamo evunyelwe ye-elagolix ne-relugolix. Isidakamizwa ngasinye sitholakala ngokulungiswa noma ngaphandle kwe-estrogen ne-progesterone. Ezigulini ezingafisi ukusebenzisa i-exogenous gonadal steroids, ukwakheka kwe-linzagolix enedosi ephansi ngaphandle kokwengezwa kwe-gonadal steroids (i-estrogen ne-progesterone) kungafinyelela umphumela ofanayo nokwakhiwa kwenhlanganisela yomthamo ophezulu oqukethe amahomoni angaphandle. Ukwelapha okuhlanganisiwe noma ukwelashwa okuvimbela kancane ukusebenza kwe-hypothalamic kungadambisa izimpawu ngemiphumela efana ne-monotherapy yomthamo ogcwele we-GnRH, kodwa kube nemiphumela engemihle embalwa. Enye inzuzo ye-monotherapy ephezulu ukuthi inganciphisa ubukhulu besibeletho ngokuphumelelayo, okufana nomphumela wama-agonists we-GnRH, kodwa ngezimpawu eziningi ze-hypogonadal.
Idatha yesilingo somtholampilo ibonisa ukuthi inhlanganisela yomphikisi we-GnRH yomlomo iyasebenza ekunciphiseni i-menorrhagia (ukunciphisa i-50% kuya ku-75%), ubuhlungu (ukunciphisa u-40% kuya ku-50%), kanye nezimpawu ezihambisana nokukhuliswa kwesibeletho, kuyilapho kunciphisa kancane ivolumu yesibeletho (cishe i-10% yokunciphisa umthamo wesibeletho) nemiphumela embalwa ye-hot, i-napants ehlangene ne-hot, i-20% ehlangene nemiphumela emibi ye-hot. Ukusebenza kokwelashwa okuhlangene komphikisi we-GnRH ngomlomo kwakuzimele kubukhulu be-myomatosis (usayizi, inombolo, noma indawo ye-fibroids), ukuhambisana kwe-adenomyosis, noma ezinye izici ezikhawulela ukwelashwa kokuhlinzwa. Inhlanganisela yomphikisi ye-GnRH yomlomo okwamanje ivunyelwe izinyanga ezingu-24 e-United States futhi ukuze isetshenziswe unomphela e-European Union. Kodwa-ke, le mithi ayizange iboniswe ukuthi inomphumela wokuvimbela inzalo, okuvimbela ukusetshenziswa kwesikhathi eside kubantu abaningi. Izivivinyo zemitholampilo ezihlola imiphumela yokuvimbela inzalo yokwelashwa okuhlangene kwe-relugolix ziyaqhubeka (inombolo yokubhalisa i-NCT04756037 ku-ClinicalTrials.gov).
Emazweni amaningi, ama-modulators e-progesterone receptor akhethiwe awuhlelo lwezidakamizwa. Nokho, ukukhathazeka ngobuthi besibindi obungavamile kodwa obungathi sína bukhawulele ukwamukelwa nokutholakala kwezidakamizwa ezinjalo. Awekho ama-modulators e-progesterone receptor akhethiwe avunyelwe e-United States ukuze alaphe ama-uterine fibroids.
I-Hysterectomy
Nakuba i-hysterectomy ngokomlando ibibhekwa njengokwelashwa okukhulu kwe-uterine fibroids, idatha emisha ngemiphumela yezinye izindlela zokwelapha ezifanele iphakamisa ukuthi lokhu kungase kufane nokukhipha isisu ngezindlela eziningi phakathi nesikhathi esilawulwayo. Ukungalungi kwe-hysterectomy uma kuqhathaniswa nezinye izindlela zokwelapha kuhlanganisa ubungozi be-perioperative kanye ne-salpingectomy (uma kuyingxenye yenqubo). Ngaphambi kokuqala kwaleli khulu leminyaka, ukukhishwa kwawo womabili ama-ovari kanye nokukhishwa kwe-hysterectomy kwakuyinqubo evamile, futhi ucwaningo lweqembu elikhulu ngasekuqaleni kwawo-2000 lwabonisa ukuthi ukukhishwa kwawo womabili ama-ovari kwakuhlotshaniswa nengozi eyengeziwe yokufa, isifo senhliziyo nemithambo yegazi, ukuwohloka komqondo, nezinye izifo uma kuqhathaniswa nokwenza isibeletho nokugcina amaqanda. Kusukela lapho, izinga lokuhlinzwa le-salpingectomy liye lehla, kuyilapho izinga lokuhlinza le-hysterectomy liye lehla.
Ucwaningo oluningi luye lwabonisa ukuthi ngisho noma womabili ama-ovari agcinwe, ingozi yesifo senhliziyo, ukukhathazeka, ukucindezeleka, nokufa ngemva kokukhishwa kwe-hysterectomy iyanda kakhulu. Iziguli ezineminyaka engu-≤35 ubudala ngesikhathi se-hysterectomy zisengozini enkulu. Phakathi kwalezi ziguli, ingozi ye-coronary artery disease (emva kokulungiswa kwe-confounders) kanye nokuhluleka kwenhliziyo ehlangene kwakuphakeme izikhathi ezingu-2.5 kwabesifazane abahlinzekwe i-hysterectomy kanye nezikhathi ezingu-4.6 ngaphezulu kwabesifazane abangazange bahlinzwe i-hysterectomy ngesikhathi sokulandelela okuphakathi kweminyaka engu-22. Abesifazane ababehlinzwe i-hysterectomy ngaphambi kweminyaka engu-40 futhi bagcina izindlala ezikhiqiza amaqanda babengamaphesenti angu-8 kuya kwangu-29 amathuba okuba bafe kunabesifazane ababengazange bakhiphe isisu. Kodwa-ke, iziguli ezazihlinzekwe nge-hysterectomy zazinezinkinga eziningi, njengokukhuluphala ngokweqile, i-hyperlipidemia, noma umlando wokuhlinzwa, kunabesifazane abangazange bahlinzwe i-hysterectomy, futhi ngenxa yokuthi lezi zifundo zazibhekwa, imbangela nomphumela akukwazanga ukuqinisekiswa. Nakuba izifundo zilawule lezi zingozi ezingokwemvelo, kusengenzeka kube nezinto ezingakalinganiswa ezididayo. Lezi zingozi kufanele zichazwe ezigulini ezicabangela i-hysterectomy, njengoba iziguli eziningi ezine-uterine fibroids zinezinye izindlela ezingavamile.
Okwamanje awekho amasu okuvimbela ayisisekelo noma esibili e-uterine fibroids. Ucwaningo lwe-Epidemiological zithole izici ezihlukahlukene ezihambisana nokunciphisa ingozi ye-uterine fibroids, kuhlanganise: ukudla izithelo nemifino eminingi kanye nenyama ebomvu encane; Zivocavoce njalo; Lawula isisindo sakho; Amazinga e-vitamin D avamile; Ukuzalwa okuphilayo okuphumelelayo; Ukusetshenziswa kokuvimbela inzalo ngomlomo; Futhi amalungiselelo e-progesterone asebenza isikhathi eside. Izivivinyo ezilawulwa ngokungahleliwe ziyadingeka ukuze kunqunywe ukuthi ukuguqula lezi zici kungayinciphisa yini ingozi. Okokugcina, ucwaningo lubonisa ukuthi ukucindezeleka nokucwasa kungase kubambe iqhaza ekungabini nabulungisa kwezempilo okukhona uma kuziwa kuma-uterine fibroids.
Isikhathi sokuthumela: Nov-09-2024