iindaba

I-uterine fibroids yimbangela eqhelekileyo ye-menorrhagia kunye ne-anemia, kwaye iziganeko ziphezulu kakhulu, malunga ne-70% ukuya kwi-80% yabasetyhini baya kuphuhlisa i-uterine fibroids ebomini babo, apho i-50% ibonisa iimpawu. Okwangoku, i-hysterectomy lolona nyango lusetyenziswa ngokuqhelekileyo kwaye luthathwa njengonyango olukhawulezayo lwe-fibroids, kodwa i-hysterectomy ayithwali kuphela ingozi ye-perioperative, kodwa kunye nomngcipheko wexesha elide wesifo senhliziyo, ukuxhalaba, ukudakumba kunye nokufa. Ngokwahlukileyo, iinketho zonyango ezifana ne-uterine artery embolization, i-ablation yendawo, kunye nabachasayo be-GnRH ngomlomo zikhuselekile kodwa zingasetyenziswanga ngokupheleleyo.

Isishwankathelo setyala

Ibhinqa elimnyama elineminyaka engama-33 ubudala elingazange lakhulelwa laziswa kugqirha walo oyintloko ngokuya exesheni okukhulu kunye negesi yesisu. Unengxaki yokunqongophala kwe-iron anemia. Uvavanyo lwabuya lungenayo i-thalassemia kunye ne-sickle cell anemia. Isigulana sasingenalo igazi kwi-stool kwaye akukho mvelaphi yentsapho yomhlaza wekoloni okanye isifo sesibindi esivuthayo. Wachaza ukuya esikhathini rhoqo, kanye ngenyanga, ixesha ngalinye leentsuku ze-8, kunye nexesha elide elingatshintshiyo. Kwezona ntsuku zintathu zinzima kakhulu kumjikelo ngamnye wokuya exesheni, kufuneka asebenzise iitamponi ezisi-8 ukuya kwezisi-9 ngosuku, yaye maxa wambi uyopha xa esexesheni. Ufundela isidanga sakhe sobugqirha kwaye uceba ukukhulelwa kwisithuba seminyaka emibini. I-Ultrasound ibonise i-uterus eyandisiweyo ene-myomas ezininzi kunye nama-ovari aqhelekileyo. Uza kusiphatha njani isigulana?

Iziganeko zezifo ezinxulumene ne-uterine fibroids zixutywe ngumlinganiselo ophantsi wokufumanisa isifo kunye nenyaniso yokuba iimpawu zayo zibangelwa ezinye iimeko, ezifana nokuphazamiseka kokutya okanye ukuphazamiseka kwenkqubo yegazi. Ihlazo elinxulumene nokuxubusha ukuya exesheni libangela ukuba abantu abaninzi abanexesha elide okanye ixesha elinzima bangazi ukuba imeko yabo ayiqhelekanga. Abantu abaneempawu badla ngokungafunyaniswa kwangethuba. Isinye esithathwini sesigulana sithatha iminyaka emihlanu ukuba sifunyanwe, kwaye abanye bathatha ngaphezulu kweminyaka esibhozo. Ukuxilongwa okulibazisekayo kunokuchaphazela kakubi ukuzala, umgangatho wobomi, kunye nempilo-ntle yezemali, kwaye kuphononongo olusemgangathweni, i-95 pesenti yezigulana ezine-symptomatic fibroids zichaze iziphumo ezisemva kwengqondo, kubandakanya ukudakumba, ukukhathazeka, umsindo kunye noxinzelelo lomzimba. Ibala kunye neentloni ezinxulumene nokuya exesheni zithintela ingxoxo, uphando, ukukhuthaza, kunye nokutsha kule ndawo. Phakathi kwezigulane ezifunyanwe zine-fibroids nge-ultrasound, i-50% ukuya kwi-72% yayingazi ngaphambili ukuba zine-fibroids, ebonisa ukuba i-ultrasound inokusetyenziswa ngokubanzi kuvavanyo lwesi sifo esiqhelekileyo.

Iziganeko ze-uterine fibroids zikhula ngokukhula de ukuya exesheni kwaye ziphezulu kwabamnyama kunabamhlophe. Xa kuthelekiswa nabantu ngaphandle kwabantu abamnyama, abantu abamnyama bahlakulela i-uterine fibroids besebancinci, banomngcipheko ophezulu wokuphuhlisa iimpawu, kwaye banomthwalo ophezulu wesifo. Xa kuthelekiswa nabantu baseCaucasus, abantu abantsundu bayagula ngakumbi kwaye kunokwenzeka ukuba bathathe i-hysterectomy kunye ne-myomectomy. Ukongezelela, abamnyama babenamathuba amaninzi kunabamhlophe ukuba bakhethe unyango olungathinteliyo kunye nokuphepha ukuthunyelwa kokuhlinzwa ukuze bagweme ithuba lokufumana i-hysterectomy.

I-uterine fibroids inokufunyaniswa ngokuthe ngqo nge-ultrasound ye-pelvic, kodwa ukufumanisa ukuba ngubani oza kukhuseleka akukho lula, kwaye ngoku ukuhlolwa ngokuqhelekileyo kwenziwa emva kokuba iifibroids zesigulana zinkulu okanye iimpawu zibonakala. Iimpawu ezinxulumene ne-uterine fibroids zinokudibana kunye neempawu zokuphazamiseka kwe-ovulation, i-adenomyopathy, i-dysmenorrhea yesibini, kunye nokuphazamiseka kokutya.

Ngenxa yokuba zombini i-sarcomas kunye ne-fibroids zikhoyo njengobunzima be-myometric kwaye zihlala zihamba kunye nokuphuma kwegazi okungaqhelekanga, kukho inkxalabo yokuba i-uterine sarcoma ingaphoswa nangona i-rarity yabo inqabile (i-1 kwi-770 ukuya kwi-10,000 yokutyelela ngenxa yokuphuma kwegazi okungaqhelekanga). Ukukhathazeka malunga ne-leiomyosarcoma engaxilwanga kuye kwakhokelela ekunyuseni kwinqanaba le-hysterectomy kunye nokunciphisa ukusetyenziswa kweenkqubo ezincinci, ukubeka izigulane engozini engadingekile yeengxaki ngenxa yokungazi kakuhle kwe-uterine sarcomas esasazeke ngaphandle kwesibeleko.

Uxilongo kunye novavanyo

Kwiindlela ezahlukeneyo zokucinga ezisetyenziselwa ukuxilonga i-uterine fibroids, i-pelvic ultrasound yeyona ndlela ibiza kakhulu kuba inika ulwazi malunga nomthamo, indawo, kunye nenani le-uterine fibroids kwaye ingabandakanyi i-adnexal mass. I-ultrasound ye-pelvic yangaphandle ingasetyenziselwa ukuvavanya ukopha okungaqhelekanga kwesibeleko, ubunzima obucacileyo be-pelvic ngexesha lokuhlolwa, kunye neempawu ezinxulumene nokwandiswa kwesibeleko, kubandakanywa uxinzelelo lwe-pelvic kunye negesi yesisu. Ukuba umthamo wesibeleko udlula i-375 mL okanye inani le-fibroids lidlula i-4 (eliqhelekileyo), isisombululo se-ultrasound silinganiselwe. I-Magnetic resonance imaging iluncedo kakhulu xa i-uterine sarcoma ikrokrelwa kwaye xa uceba enye indlela yokutshatyalaliswa kwe-hysterectomy, apho ulwazi oluchanekileyo malunga nomthamo wesibeleko, iimpawu ze-imaging, kunye nendawo zibalulekile kwiziphumo zonyango (Umfanekiso 1). Ukuba i-submucosal fibroids okanye ezinye izilonda ze-endometrial zikrokrelwa, i-saline perfusion ultrasound okanye i-hysteroscopy inokuba luncedo. I-computed tomography ayiloncedo ekuxilongeni i-uterine fibroids ngenxa yokungacaci kwayo kakuhle kunye nokubonwa kwe-tissue plane.

Kwi-2011, i-International Federation ye-Obstetrics kunye ne-Gynecology yapapasha inkqubo yokuhlelwa kwe-uterine fibroids ngenjongo yokuchaza ngcono indawo ye-fibroids ngokumalunga ne-uterine cavity kunye ne-serous membrane surface, kunokuba imimiselo yakudala ye-submucosal, intramural, kunye ne-subserous membranes, ngaloo ndlela ivumela unxibelelwano olucacileyo lwe-s3endi kunye nokucwangciswa kwesicatshulwa esipheleleyo kunye ne-Apply ye-Text efumanekayo. inqaku kwi-NEJM.org). Inkqubo yokuhlelwa luhlobo lwe-0 ukuya kwe-8, kunye nenani elincinci elibonisa ukuba i-fibroid isondele kwi-endometrium. I-mixed uterine fibroids imelwe ngamanani amabini ahlulwe ngamaqhina. Inombolo yokuqala ibonisa ubudlelwane phakathi kwe-fibroid kunye ne-endometrium, kwaye inombolo yesibini ibonisa ubudlelwane phakathi kwe-fibroid kunye ne-membrane ye-serous. Le nkqubo yokuhlelwa kwe-uterine fibroid inceda oogqirha ukuba bajolise ekuxilongeni ngakumbi kunye nonyango, kwaye iphucula unxibelelwano.

Unyango

Kwiirejimeni ezininzi zonyango lwe-myoma ehambelana ne-menorrhagia, ukulawula i-menorrhagia kunye namahomoni okukhulelwa kuyinyathelo lokuqala. Amachiza achasene nokudumba kwe-nonsteroidal kunye ne-tranatemocyclic acid esetyenziswa ngexesha lokuya exesheni nawo angasetyenziselwa ukunciphisa i-menorrhagia, kodwa kukho ubungqina obuninzi bokusebenza kwala machiza kwi-idiopathic menorrhagia, kunye nolingo lwezonyango kwesi sifo ludla ngokungabandakanyi izigulane ezine-giant okanye submucosal fibroids. I-Gonadotropin-releasing hormone (GnRH) ehlala ixesha elide i-agonists ivunyiwe kwi-preoperative yonyango lwexesha elifutshane le-uterine fibroids, enokubangela ukuba i-amenorrhea phantse i-90% yezigulane kunye nokunciphisa umthamo we-uterine nge-30% ukuya kwi-60%. Nangona kunjalo, la machiza adibaniswa nesiganeko esiphezulu seempawu ze-hypogonadal, kubandakanywa nokulahleka kwethambo kunye nokushisa okutshisa. Zikwabangela "i-steroidal flares" kwizigulana ezininzi, apho i-gonadotropins egciniweyo emzimbeni ikhutshwa kwaye ibangele amaxesha anzima kamva xa amanqanaba e-estrogen ehla ngokukhawuleza.

Ukusetyenziswa kwe-GnRH yonyango edibeneyo yonyango edibeneyo yonyango kunyango lwe-uterine fibroids yinkqubela phambili enkulu. Iziyobisi ezivunyiweyo eUnited States zidibanisa abachasi be-GnRH yomlomo (elagolix okanye i-relugolix) kwithebhulethi edibeneyo okanye i-capsule ene-estradiol kunye ne-progesterone, evimbela ngokukhawuleza ukuveliswa kwe-ovarian steroid (kwaye ingabangeli i-steroid triggering), kunye ne-estradiol kunye ne-progesterone idosi eyenza amanqanaba e-systemic afaniswe namanqanaba okuqala e-follicular. Ichiza elinye esele livunyiwe kwi-European Union (linzagolix) inamadosi amabini: idosi ethintela ngokuyinxenye ukusebenza kwe-hypothalamic kunye nedosi ethintela ngokupheleleyo ukusebenza kwe-hypothalamic, efana nedosi evunyiweyo ye-elagolix kunye ne-relugolix. Ichiza ngalinye liyafumaneka ekulungiseleleni okanye ngaphandle kwe-estrogen kunye neprogesterone. Kwizigulane ezinganqweneli ukusebenzisa i-gonadal steroids yangaphandle, i-linzagolix ye-dose ephantsi yokwenziwa ngaphandle kokongezwa kwe-gonadal steroids (i-estrogen kunye ne-progesterone) inokufikelela kwisiphumo esifanayo njengendlela yokudibanisa idosi ephezulu equlethe iihomoni zangaphandle. Unyango oludityanisiweyo okanye unyango oluthintela ngokuyinxenye ukusebenza kwe-hypothalamic lunokuphelisa iimpawu ezineziphumo ezithelekiseka nedosi epheleleyo ye-GnRH echasene ne-monotherapy, kodwa eneziphumo ebezingalindelekanga ezimbalwa. Enye inzuzo ye-monotherapy ephezulu kukuba inokunciphisa ubukhulu be-uterus ngokufanelekileyo, efana nefuthe le-agonists ye-GnRH, kodwa kunye neempawu ze-hypogonadal.

Idatha yovavanyo lweklinikhi ibonisa ukuba inhlanganisela yomlomo we-GnRH ephikisanayo iyasebenza ekunciphiseni i-menorrhagia (i-50% ukuya kwi-75% yokunciphisa), intlungu (i-40% ukuya kwi-50% yokunciphisa), kunye neempawu ezinxulumene nokwandiswa kwesibeletho, ngelixa linciphisa kancane umthamo wesibeleko (malunga ne-10% yokunciphisa umthamo we-uterine) kunye nemiphumo embalwa ye-headache ebuhlungu kunye ne-headaches, kunye ne-20% imiphumo engathandekiyo ye-flash. Ukusebenza konyango oludibeneyo lwe-GnRH yomlomo oluchasayo lwaluzimeleyo kubungakanani be-myomatosis (ubungakanani, inani, okanye indawo ye-fibroids), ukuhambelana kwe-adenomyosis, okanye ezinye izinto ezithintela unyango lotyando. Umdibaniso womlomo we-GnRH ochasayo okwangoku uvunyiwe kwiinyanga ze-24 e-United States kunye nokusetyenziswa okungapheliyo kwi-European Union. Nangona kunjalo, la mayeza awazange aboniswe ukuba anempembelelo yokuthintela, ethintela ukusetyenziswa kwexesha elide kubantu abaninzi. Ulingo lwezonyango oluvavanya iziphumo zokuthintela ukukhulelwa konyango oludityanisiweyo lwe-relugolix luyaqhubeka (inombolo yokubhalisa i-NCT04756037 kwi-ClinicalTrials.gov).

Kumazwe amaninzi, i-progesterone receptor modulators ekhethiweyo yirejimeni yeziyobisi. Nangona kunjalo, iinkxalabo malunga netyhefu enqabileyo kodwa enzulu yesibindi ithintele ukwamkelwa kunye nokufumaneka kwamachiza anjalo. Akukho zimodyuli ezikhethiweyo ze-progesterone receptor ezivunyiweyo e-United States kunyango lwe-uterine fibroids.

I-Hysterectomy

Ngelixa i-hysterectomy ngokwembali ithathwa njengonyango olukhawulezayo lwe-uterine fibroids, idatha entsha kwiziphumo zonyango olulolunye olufanelekileyo lubonisa ukuba ezi zinokufana ne-hysterectomy ngeendlela ezininzi kwixesha elilawulwayo. Ukungalungi kwe-hysterectomy xa kuthelekiswa nolunye unyango olulolunye lubandakanya iingozi ze-perioperative kunye ne-salpingectomy (ukuba yinxalenye yenkqubo). Ngaphambi kokuqala kwenkulungwane, ukususwa kwawo omabini ama-ovari kunye ne-hysterectomy kwakuyinkqubo eqhelekileyo, kwaye izifundo zeqela elikhulu ekuqaleni kweminyaka yoo-2000 zabonisa ukuba ukususwa kwawo omabini ama-ovari kwakunxulunyaniswa nomngcipheko wokufa, isifo sentliziyo, isifo sengqondo esiyingozi, kunye nezinye izifo xa kuthelekiswa nokuba ne-hysterectomy kunye nokugcina ama-ovari. Ukusukela ngoko, izinga lotyando lwe-salpingectomy liye lehla, ngelixa izinga lotyando lwe-hysterectomy liye lancipha.

Izifundo ezininzi zibonise ukuba nokuba zombini ii-ovari zigcinwe, umngcipheko wesifo senhliziyo, ukuxhalaba, ukudakumba, kunye nokufa emva kwe-hysterectomy yanda kakhulu. Izigulane ≤35 iminyaka yobudala ngexesha le-hysterectomy isengozini enkulu. Phakathi kwezi zi gulane, umngcipheko wesifo se-coronary artery (emva kokulungelelaniswa kwe-confounders) kunye nokungaphumeleli kwentliziyo ye-congestive yayingamaxesha e-2.5 aphezulu kubasetyhini abaye bafumana i-hysterectomy kunye namaxesha angama-4.6 aphezulu kubasetyhini abangazange baqhube i-hysterectomy ngexesha lokulandelwa kwe-median ye-22 iminyaka. Abasetyhini ababene-hysterectomy ngaphambi kweminyaka engama-40 kwaye bagcina ama-ovari abo babene-8 ukuya kuma-29 ekhulwini amathuba okuba bafe kunabasetyhini abangazange bakhuphe isisu. Nangona kunjalo, izigulane eziye zafumana i-hysterectomy zine-comorbidities ezininzi, ezifana nokukhuluphala, i-hyperlipidemia, okanye imbali yotyando, kunabasetyhini abangazange benziwe i-hysterectomy, kwaye ngenxa yokuba ezi zifundo ziqwalaselwe, isizathu kunye nesiphumo asikwazanga ukuqinisekiswa. Nangona uphononongo lulawule le mingcipheko yendalo, kusenokubakho izinto ezibhidayo ezingalinganiswanga. Le mingcipheko kufuneka icaciswe kwizigulana ezithathela ingqalelo i-hysterectomy, njengoko uninzi lwezigulana ezine-uterine fibroids zinezinye iindlela ezingangeneleliyo.

Okwangoku akukho zicwangciso zokuthintela eziphambili okanye zesibini kwi-uterine fibroids. Izifundo ze-Epidemiological zifumene izinto ezahlukeneyo ezihambelana nokunciphisa umngcipheko we-uterine fibroids, kubandakanywa: ukutya iziqhamo kunye nemifuno kunye nenyama ebomvu engaphantsi; Zilolonge rhoqo; Lawula ubunzima bakho; Amanqanaba e-vitamin D aqhelekileyo; Ukuzalwa okuyimpumelelo; Ukusetyenziswa kwezithinteli zokukhulelwa ngomlomo; Kwaye amalungiselelo e-progesterone ahlala ixesha elide. Ulingo olungenamkhethe olulawulwayo luyafuneka ukumisela ukuba ukuguqula le miba kunokunciphisa umngcipheko. Ekugqibeleni, uphando lubonisa ukuba uxinzelelo kunye nobuhlanga bunokudlala indima kwintswela-bulungisa yezempilo ekhoyo xa kuziwa kwi-uterine fibroids.