Nrhiav seb yog vim li cas uterine endometriosis txaus ntshai. Qhov no yog pathological hormone-dependant kev loj hlob ntawm glandular uterine cov ntaub so ntswg sab nraum lub cev - nyob rau hauv lub fallopian hlab, zes qe menyuam, nyob rau hauv lub thickness ntawm lub tsev menyuam, nyob rau hauv lub peritoneum, nyob rau hauv lub zais zis, nyob rau hauv cov hnyuv, thiab kuj nyob rau hauv ntau yam kab mob. Nyob rau tib lub sij hawm, heterotopias (endometrial fragments), sprouting nyob rau hauv lwm yam kabmob, kuj hloov cyclically, zoo li lub endometrium nyob ncaj qha rau hauv lub tsev menyuam, uas yog, raws li lub cev ntas. Cov kev hloov no yog tshwm sim los ntawm qhov mob, qhov nce ntawm qhov ntim ntawm lub cev cuam tshuam, cov ntshav tawm los ntawm cov qauv ntawm heterotopias, kev coj khaub ncaws tsis ua haujlwm, muaj menyuam tsis taus, pathological tawm ntawm cov qog mammary.
Kev piav qhia
Tus kab mob no yog tus yam ntxwvbenign proliferation ntawm cov ntaub so ntswg uas ua haujlwm thiab morphologically zoo ib yam li endometrium ntawm lub tsev menyuam. Dab tsi yog hom lus siv tau? Qhov no yog cov ntaub so ntswg nyob rau hauv lub puab mucous daim nyias nyias ntawm lub cev ntawm tus poj niam qhov chaw mos kab mob (mucosal txheej). Kev kho mob tshwm sim ntawm tus kab mob no ncaj qha nyob ntawm qhov chaw ntawm cov txheej txheem pathological. Tus kab mob tuaj yeem ua rau tsim cov hlwv ntawm zes qe menyuam thiab kev coj khaub ncaws tsis zoo.
Ntau tus neeg mob xav tias nws puas tuaj yeem xeeb menyuam nrog uterine endometriosis. Peb yuav tham txog qhov no hauv qab no.
Tus kab mob no hauv cov poj niam yog qhov thib peb feem ntau gynecological pathology, tom qab uterine fibroids thiab ntau yam txheej txheem inflammatory. Nyob rau hauv feem ntau, endometriosis tshwm sim nyob rau hauv cov poj niam ntawm lub hnub nyoog yug me nyuam - 25-40 xyoo (kwv yees li 27%), yog pom nyob rau hauv 10% ntawm cov ntxhais thaum lub sij hawm tsim ntawm kev coj khaub ncaws thiab nyob rau hauv 2-5% - nyob rau hauv menopausal hnub nyoog. Dab tsi yog qhov txaus ntshai endometriosis ntawm lub tsev menyuam, nws yog ib qho tseem ceeb kom paub seb.
Kev faib kab mob
Kev tshwm sim ntawm tus kab mob nyob ntawm qhov chaw ntawm foci ntawm endometriosis. Hauv qhov no, nws tau muab faib ua cov ntaub ntawv extragenital thiab qhov chaw mos. Nrog rau qhov chaw mos daim ntawv, heterotopias nyob rau ntawm cov ntaub so ntswg ntawm qhov chaw mos, nrog rau kev loj hlob ntawm lub extragenital daim ntawv - sab nraum cov qauv ntawm lub reproductive system.
Nyob rau hauv qhov chaw mos ntawm tus kab mob txawv:
- peritoneal endometriosis, uas yog tus cwj pwm los ntawm kev puas tsuaj rau zes qe menyuam, hlab ntsha hauv plab, pelvic peritoneum;
- extraperitoneal endometriosis, uas yog nyob rau hauv qis qis ntawm cov txheej txheem ua me nyuam - hauv qhov chaw mos,Cov kab mob sib kis sab nraud, lub qhov quav hauv plab, lub ncauj tsev menyuam, thiab lwm yam;
- internal endometriosis, tsim nyob rau hauv cov leeg nqaij txheej ntawm lub tsev menyuam.
Localization ntawm endometriosis yog sib xyaw, uas feem ntau tshwm sim thaum cov txheej txheem pathological tsis saib xyuas. Nyob rau hauv hom extragenital, foci ntawm heterotopias tau sau tseg hauv cov hnyuv, ntsws, lub plab, ob lub raum.
Degrees of disease
Nyob ntawm qhov sib kis thiab qhov tob ntawm kev loj hlob ntawm focal growths ntawm endometrium, 4 degrees ntawm endometriosis ntawm lub tsev menyuam yog qhov txawv:
- I degree - ib leeg thiab sab saum toj foci;
- II degree - ntau foci;
- III degree - tob ntau foci, hlwv ntawm zes qe menyuam, adhesions hauv peritoneum;
- IV degree - tob ntau foci ntawm endometriosis, loj endometrioid zes qe menyuam hlwv (ntawm ob sab), germination ntawm hlwb nyob rau hauv cov phab ntsa ntawm lub qhov quav thiab qhov chaw mos, pronounced adhesions.
Ntxiv rau, kuj tseem muaj kev lees paub feem ntau ntawm cov kab mob hauv lub tsev menyuam endometriosis, nyob rau hauv txoj kev loj hlob ntawm plaub theem tau txawv raws li qib kev puas tsuaj rau cov leeg nqaij:
- I theem - pib germination ntawm myometrium;
- II theem - qhov txhab txuas mus rau ib nrab ntawm cov leeg nqaij hauv plab;
- III theem - germination los ntawm tag nrho cov tuab ntawm lub tsev menyuam;
- IV theem - sprouting mus rau lub plab kab noj hniav.
Pathological foci tuaj yeem sib txawv ntawm cov duab thiab qhov loj me: los ntawm qhov sib npaug ntawm ob peb millimeters mus rau kev loj hlob ntawm ob pebcentimeters nrog shapeless outlines. Lawv txawv ntawm cov xim cherry tsaus thiab sib cais los ntawm cov ntaub so ntswg ib puag ncig los ntawm cov ntaub so ntswg dawb.
Cov kab mob tau pom ntau dua ua ntej kev coj khaub ncaws vim lawv lub sijhawm ua kom tiav, nyob ntawm lub voj voog. Kev kis mus rau peritoneum thiab lwm yam kabmob, cov chaw endometriosis qee zaum loj hlob mus rau hauv cov ntaub so ntswg los yog nyob rau sab nraud.
Caus ntawm uterine endometriosis
Hauv cov tshuaj, tseem tsis tau muaj kev pom zoo ntawm qhov ua rau kev loj hlob ntawm endometriosis. Cov kws tshawb fawb feem ntau ua raws li txoj kev xav ntawm kev coj khaub ncaws retrograde. Raws li nws, hauv qee tus poj niam, cov poj niam cev xeeb tub nrog cov khoom ntawm endometrium nkag mus rau hauv lub plab kab noj hniav thiab cov hlab ntsha fallopian - retrograde kev coj khaub ncaws. Nyob ntawd, cov khoom ntawm endometrium ntawm lub tsev menyuam txuas nrog rau cov ntaub so ntswg ntawm lwm yam kabmob thiab ua haujlwm txuas ntxiv mus. Nws yog dab tsi, peb twb tau hais ua lus siv tau.
Yog tias tus poj niam tsis xeeb tub, lub endometrium thaum lub caij ua poj niam pib los ntawm lub tsev menyuam, thaum microbleeding pom nyob rau hauv lwm yam kabmob, provoking kev loj hlob ntawm ib tug inflammatory txheej txheem.
Txhob qhov muaj feem yuav tsim tau tus kab mob raws li cov yam ntxwv xws li kev xeeb tub, yam ntxwv ntawm cov qauv ntawm cov hlab ntsha fallopian, kev tiv thaiv kab mob. Lub luag haujlwm ntawm caj ces predisposition rau txoj kev loj hlob ntawm tus kab mob thiab nws kis tau los ntawm cov qub txeeg qub tes yog siab heev.
Pab txhawb rau txoj kev loj hlob ntawm cov txheej txheem pathological no kuj yog kev phais hauv tsev menyuam: ntu caesarean, khoom tsimrho menyuam tawm, cauterization ntawm erosions, thiab lwm yam. Yog li ntawd, tom qab kev phais mob ntawm hom no, kev saib xyuas kev kho mob yog tsim nyog los txheeb xyuas qhov txawv txav hauv kev ua haujlwm ntawm kev ua me nyuam.
Lwm txoj kev xav ntawm endometriosis tsis tau txais dav. Raws li cov laj thawj rau nws txoj kev loj hlob, lawv xav txog kev hloov pauv noob, ua haujlwm tsis zoo ntawm cov enzymes cellular thiab receptor cov tshuaj hormones.
Symptomatics
Cov kab mob tuaj yeem sib txawv, tab sis muaj qee cov tsos mob txhim khu kev qha uas qhia txog kev txhim kho ntawm endometriosis:
- mob plab - tshwm sim hauv 16-24% ntawm cov neeg mob. Nws muaj qhov pom tseeb hauv cheeb tsam lossis yog tus cwj pwm los ntawm kev nchuav thoob plaws hauv lub plab, tuaj yeem ua kom hnyav ua ntej kev coj khaub ncaws.
- Dysmenorrhea - pom hauv 40-60% ntawm cov neeg mob. Cov tsos mob no qhia tau meej tshaj plaws hauv thawj 3 hnub ntawm kev coj khaub ncaws.
- Kev sib deev mob siab.
- Mob thaum tso zis lossis tso quav.
- Menorrhagia - lub sij hawm ntev thiab hnyav hnyav. Muaj tshwm sim hauv kwv yees li 2-16% ntawm cov poj niam.
- Qhov tshwm sim ntawm post-hemorrhagic anemia.
- Kev tsis muaj menyuam.
Kuv puas tuaj yeem cev xeeb tub nrog endometriosis?
Nyob rau hauv lub xub ntiag ntawm no pathology, ib tug yuav tsum tsis txhob tham txog kiag li infertility, tab sis ib tug tsawg tshwm sim ntawm cev xeeb tub. Endometriosis txo qis txoj hauv kev muaj kev nyab xeeb ntawm tus menyuam thiab tuaj yeem ua rau nchuav menyuam, yog li ntawd, kev tswj hwm cev xeeb tub nrog cov kab mob no yuav tsum tau ua tas li.tswj cov kws tshwj xeeb. Qhov tshwm sim ntawm kev xeeb tub tom qab kho tus kab mob txawv ntawm 15 mus rau 56% hauv thawj 6-12 lub hlis.
Muaj teeb meem thiab qhov tshwm sim
Ntau tus poj niam txhawj xeeb txog cov lus nug: yog vim li cas uterine endometriosis txaus ntshai? Cicatricial hloov thiab hemorrhages ua rau tsim cov txheej txheem nplaum nyob rau hauv lub plab thiab plab kab noj hniav. Lwm qhov teeb meem ntawm tus kab mob no yog tsim cov kab mob endometrioid zes qe menyuam, uas muaj cov ntshav coj khaub ncaws qub. Ob qho teeb meem no tuaj yeem ua rau tsis muaj menyuam hauv cov poj niam. Compression ntawm lub paj hlwb ua rau muaj ntau yam kab mob neurological. Kev poob ntshav tseem ceeb thaum cev xeeb tub ua rau muaj kev loj hlob ntawm anemia, qaug zog, chim siab thiab kua muag. Qee zaum, malignant degeneration ntawm pathological foci raug pom. Yog li cov teeb meem thiab qhov tshwm sim ntawm endometriosis yuav tsum nco ntsoov.
Diagnosis
Nyob rau hauv tus txheej txheem ntawm kev kuaj mob no, lwm yam pathologies ntawm lub cev xeeb tub uas tshwm sim nrog cov tsos mob zoo sib xws yuav tsum raug cais tawm. Nws tseem yog ib qho tsim nyog los sau cov anamnesis thiab cov lus tsis txaus siab, qhov feem ntau qhia txog qhov mob, cov ntaub ntawv hais txog cov kab mob yav dhau los, kev ua haujlwm, thiab muaj cov kab mob gynecological hauv cov txheeb ze.
Kev tshuaj xyuas tom qab tuaj yeem suav nrog:
- kuaj gynecological (rectovaginal, qhov chaw mos, hauv daim iav) uas yog cov ntaub ntawv tshaj plaws ua ntej coj khaub ncaws;
- hysterosalpingoscopy thiab colposcopy kom paub meejlocalization thiab daim ntawv ntawm qhov txhab, cov ntaub so ntswg biopsy;
- Ultrasound ntawm lub plab thiab plab;
- CT lossis MRI kom paub meej qhov xwm ntawm endometriosis, nws txoj kev sib raug zoo nrog lwm yam kabmob, thiab lwm yam.;
- laparoscopy, uas tso cai rau koj los saib xyuas qhov pom ntawm pathological foci, ntsuas lawv tus lej, kev ua haujlwm, qib ntawm kev loj hlob;
- hysterosalpingography thiab hysteroscopy, tso cai rau kuaj tus kab mob nrog qhov tseeb ntawm 83%;
- laboratory kawm txog oncological markers CEA, CA-125 thiab CA 19-9, nrog rau kev kuaj RO, qhov muaj nyob hauv cov ntshav hauv tus kab mob no tseem ceeb.
Seb puas yog kho uterine endometriosis, nrhiav hauv qab no.
txoj kev kho
Thaum xaiv ib txoj hauv kev kho tus mob, cov kws kho mob raug coj los ntawm cov ntsuas xws li tus lej yug thiab cev xeeb tub, hnub nyoog ntawm tus neeg mob, qhov tshwm sim ntawm cov txheej txheem pathological, nws qhov chaw nyob, qhov mob hnyav, muaj cov kab mob concomitant, xav tau kev xeeb tub.
Txoj kev kho mob tau muab faib ua kev phais (laparoscopy nrog tshem tawm qhov txhab thiab khaws cia ntawm lub tsev menyuam lossis nws qhov kev tshem tawm tag nrho thiab oophorectomy), kev kho mob thiab complex.
Yuav siv tshuaj dab tsi rau uterine endometriosis?
kev kho mob
Cov lus qhia rau kev saib xyuas kev noj qab haus huv yog asymptomatic endometriosis, hnub nyoog hluas, xav tau los kho lossis khaws cia cov menyuam muaj nuj nqi, premenopause. Lub ntsiab hauv kev kho tshuaj yog kev kho tshuaj hormone nrog cov pab pawgTshuaj:
- Complex estrogen-gestagenic agents. Cov tshuaj no muaj cov tshuaj me me ntawm progestogens uas inhibit ovulation los ntawm kev txo cov tshuaj estrogen. Cov kev kho mob zoo li no tau pom nyob rau hauv thawj theem ntawm endometriosis, vim lawv tsis ua haujlwm zoo thaum cov txheej txheem endometrioid tsis saib xyuas thiab nyob rau hauv lub xub ntiag ntawm zes qe menyuam.
- Gestagens ("Norethisterone", "Gestrinone", "Progesterone", "Dydrogesterone"), uas tau qhia nyob rau txhua theem ntawm pathology, tsis tu ncua - mus txog 8 lub hlis. Kev noj cov tshuaj no tuaj yeem nrog los ntshav hauv nruab nrab ntawm lub voj voog, lub xeev nyuaj siab.
- Antigonadotropic tshuaj ("Danazol" thiab lwm yam), uas inhibit zus tau tej cov gonadotropins nyob rau hauv lub hypothalamic-pituitary qauv. Lawv tau siv tsis tu ncua rau 6-8 lub hlis thiab yog contraindicated rau cov poj niam uas muaj hyperandrogenism (ib qho ntau ntawm androgenic cov tshuaj hormones).
- Gonadotropic-hom tso cov tshuaj hormone agonists ("Goserelin", "Triptorelin", thiab lwm yam) Qhov zoo ntawm cov tshuaj hauv pawg no yog qhov muaj peev xwm siv ib hlis ib zaug thiab tsis muaj kev phiv tshwm sim. Cov tshuaj no ua rau muaj kev cuam tshuam ntawm ovulation thiab qib estrogen, uas ua rau inhibition ntawm kev loj hlob ntawm endometriosis foci.
Ntxiv rau cov tshuaj saum toj no, cov tshuaj immunostimulants kuj tau siv rau hauv kev kho mob endometriosis, thiab hauv kev kho mob - analgesics, antispasmodics, tshuaj tiv thaiv kab mob.
kev kho neeg zoo
Nrog endometriosis nyob rau hauv pej xeem cov tshuaj, siv ntau yam tshuaj ntsuab yog npaj. Tag nrho cov nroj tsuag tshuaj siv los kho tus kab mob no tau muab faib ua ob pawg:
- tshuaj tiv thaiv kab mob rau lub tsev menyuam endometriosis: chamomile, coltsfoot, calendula, St. John's wort, celandine. Decoctions thiab infusions ntawm cov tshuaj ntsuab no pab tua cov kev loj hlob ntawm cov txheej txheem inflammatory, muaj antiseptic zog.
- Specific: burnet, upland uterus, round-leaved wintergreen, liab txhuam. Xws li cov nroj tsuag sib ntaus ncaj qha nrog cov kab mob ntawm poj niam lub cev - lub tsev menyuam thiab appendages.
Propolis feem ntau siv rau hauv kev kho mob, kuj muaj cov lus pom zoo rau kev siv cov leeches.
Peb pom tias yog vim li cas uterine endometriosis txaus ntshai.
