Meigs' syndrome yog ib qho tshwj xeeb ntawm polyserositis uas tshwm sim hauv cov poj niam uas muaj cov qog ntawm zes qe menyuam thiab tsev menyuam. Nws ploj tag nrho tom qab tshem tawm neoplasia. Nyob rau tib lub sijhawm, muaj qhov nce hauv qhov ntim ntawm lub plab, qhov nce hauv qhov ua tsis taus pa, tachycardia, tsis muaj zog, qaug zog, pallor, qhov hnyav nce nrog lwm cov cim ntawm cachexia. Kev kuaj mob ntawm gynecological kuaj, nyob rau hauv tus txheej txheem ntawm ultrasound ntawm lub plab thiab pleural kab noj hniav, pelvic kabmob, pericardium. Kev kho yuav tsum tau khiav tawm ntawm exudate, kho cov kab mob ntawm lub cev thiab lub cev, kev phais extirpation ntawm cov qog.
Kev piav qhia tus kab mob
Meigs syndrome yog ib qho tsis tshua muaj kab mob paraneoplastic. Nws yog pom nyob rau hauv 3% ntawm cov neeg mob uas muaj volumetric formations nyob rau hauv lub cheeb tsam ntawm lub cev xeeb tub. Cov tsos mob complex nrog ascites thiab exudative effusion mus rau hauv lub pleural kab noj hniav nyob rau hauv cov poj niam uas muaj zes qe menyuam qog tau piav los ntawm J. Meigs. Ib me ntsis tom qab, R. W. Light tau nthuav dav kev txhais ntawm tus mob rau tag nrho cov neoplasms ntawm lub plab mog. Kev sib xyaw ua ke ntawm cov qog zes qe menyuam ntawm hydrothorax thiab ascites tau pom nyob rau hauv cov xwm txheej sib cais, feem ntau cov neeg mob raug kev txom nyem los ntawm plab hnyuv. Qhov nruab nrab hnub nyoog ntawm cov neeg mob uas muaj tus mob no yog 45 xyoo.
Qhov tseem ceeb ua rau muaj kua dej ntau hauv lub plab kab noj hniav hauv cov poj niam
Qhov ua rau pathology yuav tsum tau txiav txim siab ntau ntxiv. Kev loj hlob ntawm cov tsos mob yog nrog los ntawm neoplastic lesions ntawm zes qe menyuam cov ntaub so ntswg thiab myometrium. Feem ntau, nrog polyserositis, zes qe menyuam fibroma, zes qe menyuam, thiab uterine leiomyoma pom. Kev tsim ntawm pleural, peritoneal thiab pericardial effusion kuj tshwm sim nrog zes qe menyuam carcinoma yam tsis muaj metastasis. Cov xwm txheej ntawm polyserositis nrog degenerative hloov nyob rau hauv cov ntaub so ntswg ntawm zes qe menyuam yam tsis muaj cov qog hloov pauv, ntau zes qe menyuam edema, thiab hyperstimulation syndrome thaum IVF tau piav qhia.
Pathogenesis
Txog tam sim no, cov kab mob ntawm Meigs' syndrome tsis tau kawm tiav. Tsis muaj cov kab tshwj xeeb txuas rau zes qe menyuam thiab tsev menyuam nrog cov kab noj hniav pleural thiab pericardial tau raug txheeb xyuas. Muaj ntau qhov kev xav rau qhov tshwm sim ntawm exudate hauv cov qog ntawm cov poj niam cev xeeb tub. Raws li thawj zaug, muaj kev sib sau ntawm exudative effusion nyob rau hauv Demon-Meigs-Kass syndrome nyob rau hauv lub peritoneal kab noj hniav raws li ib tug tshwm sim ntawm ib tug "tsov tshuaj tiv thaiv" ntawm cov hlab ntsha mus rau ib tug loj hlob qog.
Ntau tus kws sau ntawv tsis suav nrog lub luag haujlwm pathogenetic ntawm cov hlab ntsha lymphatic uas provoke perforation ntawm diaphragmatic septum. Tsis muaj kev txhawb nqa rau lub tswv yim tias venous thiab lymphatic outflows impaired los ntawmmechanical compression ntawm cov ntaub so ntswg los ntawm neoplasia. Tom qab tag nrho, qee cov neeg mob tsim cov polyserositis loj heev nrog neoplasms uas nws txoj kab uas hla yog ntau tshaj tsib centimeters.
Cov tsos mob ntawm tus kab mob no
Cov tsos mob ntawm Meigs syndrome hauv cov qog ntawm zes qe menyuam nce zuj zus, tsis yog tshwj xeeb thiab, raws li txoj cai, yog qhov tshwm sim ntawm effusion siab ntawm cov khoom nruab nrog cev. Tus neeg mob ib txwm muaj los yog tas li muaj me ntsis, feem ntau unilateral mob nyob rau hauv lub plab mog. Hauv qee tus poj niam, qhov kev hnov mob yog mob, npub, tawg. Nrog rau qhov nce ntxiv hauv lub plab, tus neeg mob raug kev txom nyem los ntawm kev tsis muaj cua, kev ua tsis taus pa, tsis muaj zog, qaug zog, tawm hws, tsis qab los noj mov, daj ntseg ntawm daim tawv nqaij, o. Ib tug poj niam tau hnyav heev tiv thaiv keeb kwm ntawm cachectic syndrome. Cov zis yuav tsawg dua, cem quav tsis yog qhov txawv. Hauv lub hnub nyoog yug me nyuam, feem ntau pom cov ntshav uterine dysfunctional.
Kev nyuaj siab
Yog tias cov txheej txheem nce ntxiv thiab cov nyiaj ntau ntawm exudative effusion sib sau ua ke, cov mob ua rau lub plawv thiab lub ntsws tsis ua haujlwm, metabolic cardiomyopathy, anemia, thiab nce ischemia ntawm ntau yam kabmob thiab cov ntaub so ntswg. Oxygen starvation ntawm lub hlwb ua rau lub fact tias kev paub tsis meej tshwm sim (nco deteriorates, inattention yog pom), lub siab lub ntsws lability, irritability, thiab ib tug txo nyob rau hauv kev thuam rau ib tug lub xeev. Nrog irreversible cachectic kev hloov pauv, ntau lub cev tsis ua haujlwm tau sau tseg, uas ua rautuag.
Kev kuaj mob ntawm Meigs syndrome
Qhov muaj effusion hauv cov kab noj hniav raug kuaj pom thaum kuaj lub cev. Cov kua dej nyob rau hauv peritoneum yog qhia los ntawm dullness ntawm percussion suab saum lub hauv siab, nthuav nyob rau hauv ob qho tib si cov lus qhia ntawm ciam teb ntawm lub plawv. Muffled thiab nce lub plawv suab tau sau tseg. Lub xub ntiag ntawm exudate tau lees paub los ntawm lub hauv siab x-ray, ultrasound, echocardiography. Yog tias kuaj pom muaj kab mob peritoneal, pleural, pericardial effusion, tom qab ntawd kev kuaj mob oncological hauv qhov tob yog raug txiav txim kom tsis suav nrog neoplasms ntawm lub tsev menyuam lossis zes qe menyuam. Cov txheej txheem qhia ntau tshaj:
- kev xeem ntawm lub rooj zaum;
- pelvic sonography;
- pleural effusion tsom xam.
txhawm rau txheeb xyuas cov txheej txheem qog, kuaj mob laparoscopy, kev tshuaj xyuas rau CA-125 qog nqaij hlav.
Txoj kev tseem ceeb ntawm kev kho tus kab mob no
Thaum kho Meigs' syndrome, cov tsos mob ntawm lub cev compression yuav tsum tau kho sai sai, kho cov kab mob comorbid, thiab neoplasia phais tshem tawm. Cov theem tseem ceeb ntawm kev kho yog raws li hauv qab no:
- Exudate tshem tawm. Txhawm rau kom tshem tawm lub cev sai sai los ntawm cov kua dej ntau, thoracocentesis, laparocentesis tau sau tseg. Cov kua yog evacuated siv lub active aspiration apparatus los ntawm cov kua system. Nws yog ib qho tseem ceeb kom nkag siab tias cov kab mob pathognomonic ntawm tus kab mob yog nws cov tsub zuj zuj zuj zus.
- Kho ntau yam kab mob hauv nruab nrog cev. Nyob rau hauv thiaj li yuavtxhim kho plawv kev ua si, siv diuretics, mob plawv glycosides. Yog tias pom tachycardia, kev siv cov tshuaj inhibitors ntawm If-channels ntawm lub sinus node yog zoo, yog hais tias arrhythmia yog tam sim no, tshuaj antiarrhythmic. Nyob rau hauv cov ntaub ntawv ntawm electrolyte tsis txaus, cov neeg mob tau muab saline thiab oncotic daws.
- Kev cuam tshuam kev phais. Qhov kev ua haujlwm nyuaj npaum li cas yuav nyob ntawm seb tus kab mob gynecological tau txheeb xyuas, hnub nyoog, kev tsim menyuam ntawm tus poj niam.
Kev ntsuas rau kab mob no thiab tiv thaiv kab mob
Ua tiav resorption ntawm exudate tawm tsam keeb kwm yav dhau los ntawm kev kho kom zoo ntawm kev noj qab haus huv feem ntau yog pom ob lub lis piam tom qab tshem tawm cov qog. Qee cov poj niam muaj me me adhesions, nrog rau pleural thiab pericardial adhesions. Meigs pseudosyndrome nyuaj rau cov txheej txheem oncological. Qhov kev kwv yees nyob ntawm daim ntawv thiab theem ntawm tus kab mob. Kev tiv thaiv muaj xws li teem sijhawm kuaj los ntawm obstetrician-gynecologist thiab kuaj ultrasound tsis tu ncua kom kuaj tau raws sijhawm thiab kev kho mob txaus ntawm cov qog nqaij hlav ntawm lub tsev menyuam thiab cov nqaij mos ntawm zes qe menyuam.
