Ntau yam kev cuam tshuam thiab kev ua haujlwm hauv lub tsev menyuam tau ua tiav los ntawm tus kws tshaj lij. Perforation ntawm lub tsev menyuam tuaj yeem tshwm sim tsuas yog ib feem pua ntawm tag nrho cov mob. Nws yog to taub raws li ib tug los ntawm lub qhov txhab ntawm lub tsev me nyuam phab ntsa nrog tus kws phais lub ntsuas.
Yog vim li cas
Txawm hais tias qhov tshwm sim ncaj qha, lub tsev menyuam perforation (raws li ICD-10 code - O71.5) ib txwm tshwm sim los ntawm kev ua txhaum cai thaum muaj kev phais hauv gynecological teb: rho menyuam, kuaj xyuas curettage, installation ntawm kauv., tshem tawm cov qe menyuam hauv plab thaum cev xeeb tub, sib cais ntawm synechiae hauv lub tsev menyuam, kuaj mob hysteroscopy, laser reconstruction ntawm uterine kab noj hniav, hysteroresectoscopy.
Ntau zaus, raws li kev txheeb cais, perforation ntawm phab ntsa uterine tshwm thaum lub sijhawm cev xeeb tub. Perforation nyob rau hauv cov ntaub ntawv no tuaj yeem tshwm sim nyob rau txhua theem ntawm kev phais: thaum soj ntsuam ntawm uterine kab noj hniav (los ntawm 2 mus rau5%), tshem tawm lub fetus qe nrog ib tug curette los yog rho menyuam collet (los ntawm 80 mus rau 90%), expansion ntawm lub ncauj tsev menyuam kwj dej (los ntawm 5 mus rau 15%). Yog hais tias perforation ntawm lub tsev menyuam thaum lub sij hawm curettage nrog ib tug pa sojntsuam feem ntau tsis ua rau hnyav sab hauv los ntshav thiab kev puas tsuaj rau lub plab hnyuv siab raum, ces vim tag nrho dilation ntawm ncauj tsev menyuam kwj dej los ntawm Hegar dilators, nws yuav ua rau kua muag ntawm lub sab hauv pharynx. Tsis tas li ntawd feem ntau muaj perforation nyob rau hauv qis ntu thiab isthmus ntawm lub tsev menyuam. Tshwj xeeb tshaj yog txaus ntshai yog perforation ntawm lub tsev menyuam thaum lub sij hawm rho menyuam nrog ib tug rho menyuam collet thiab ib tug curette - nyob rau hauv cov ntaub ntawv no, lub perforation qhov yuav nyob rau hauv lub cheeb tsam ntawm phab ntsa ntawm lub tsev menyuam los yog hauv qab, thiab yuav loj. Xws li perforation feem ntau nrog los ntawm kev poob ntshav hnyav thiab mob plab.
Predisposing factors
Predisposing yam uas ua rau kom muaj peev xwm ntawm uterine perforation yog hnyav uterine retroflexion, mob ntev thiab mob endometritis, uterine hypoplasia, endometrial cancer, organ involution nrog lub hnub nyoog, muaj caws pliav ntawm phab ntsa uterine tom qab phais.
Tsis tas li ntawd, qhov tshwm sim ntawm perforation yuav nce ntxiv thaum kev rho menyuam tawm sab nraum lub tsev kho mob, rau lub sijhawm ntau tshaj 12 lub lis piam, tus kws kho mob gynecologist thaum lub sijhawm ua haujlwm yog nrawm thiab ntxhib, cov cuab yeej tau muab tso rau hauv lub uterine kab noj hniav. tsis muaj endoscopic txaus, ultrasound lossis lub cev tswj qhov muag.
Muaj peev xwm uterine perforation los ntawm IUD.
Uterine coil raug mob
Cov khoom siv hauv lub cev yog ntxig rau qhov muag tsis pom kev, qhov tseeb ntawm cov txheej txheem yog ncaj qhanyob ntawm qhov kev xav ntawm tus kws kho mob thiab nws cov txheej txheem.
Yog vim li cas lub tsev menyuam perforation yog raws li qhov tseeb hais tias lub cev kab noj hniav tsis ib txwm coincide nrog lub tsev me nyuam kwj dej raws axis.
Qee lub sij hawm lub tsev menyuam phab ntsa nyias nyias nyob rau hauv qis qis, uas yog ib qho kev pheej hmoo. Tsis tas li ntawd, muaj kev pheej hmoo ntxiv tshwm sim thaum txhim kho lub kauv ua ntej tshaj li rau lub hlis tom qab yug menyuam, thiab tam sim ntawd tom qab kev rho menyuam tawm.
Tom qab cov kauv, qhov perforation ntawm lub tsev menyuam tau pom ob qho tib si tam sim ntawd tom qab cov txheej txheem, thiab raws li qhov tshwm sim tshwm sim tom qab qee lub sijhawm tom qab kev taw qhia. Qee zaum, qhov no tau kuaj pom thaum rho tawm cov kauv. Hauv qhov xwm txheej zoo li no, cov xov yuav ploj lossis tshem tawm cov kauv yuav nyuaj.
Nws muaj peev xwm ua rau lub tsev menyuam raug mob nrog lub helix ntawm lub sijhawm txhaj tshuaj, yog tias muaj kev ua haujlwm ntawm myometrium, uas yog, tshem tawm, uas tshem tawm cov tshuaj. Qhov no, lub ncauj tsev menyuam yog perforated, vim tsis muaj coincidence ntawm lub axis ntawm lub ncauj tsev menyuam kwj dej nrog lub axis ntawm lub cev.
Signs
Uterine perforation cov tsos mob yog txiav txim los ntawm nws cov yam ntxwv (tsis yooj yim / nyuaj, tsis tiav / tiav) thiab qhov chaw. Yog hais tias ib qho tsis tiav perforation tau tshwm sim los yog lub qhov uas tau tshwm sim raug kaw los ntawm ib yam khoom nruab nrog cev (piv txwv li, ib qho omentum), cov cim qhia yuav tsis muaj zog los yog tsis muaj tag nrho. Nws muaj peev xwm xav tias perforation ntawm lub tsev menyuam thaum lub sijhawm rho menyuam tsuas yog thaum, tom qab kev tswj hwm hauv lub cev, tus poj niam yws yws ntawm cov ntshav tawm hauv qhov chaw mos, mob hnyav hauv plab plab, tsis muaj zog thiab kiv taub hau. Rau qhov mob hnyav los ntshavmuaj qhov nro ntawm phab ntsa ntawm lub peritoneum, pallor ntawm daim tawv nqaij, txo qis, tachycardia.
Kev tshwm sim thiab teeb meem
Kev kuaj mob tsis tu ncua ntawm uterine perforation tuaj yeem ua rau muaj kev phom sij rau lub neej thiab ua rau muaj teeb meem loj thiab teeb meem. Cov no suav nrog kev raug mob plab lossis zais zis, mob hematomas, sepsis, peritonitis, los ntshav. Kev puas tsuaj rau sab hauv ntawm lub tsev menyuam tuaj yeem ua rau isthmic-cervical insufficiency, nrog rau kev nchuav menyuam thaum cev xeeb tub yav tom ntej. Uterine perforation tuaj yeem ua rau muaj qhov tshwm sim tseem ceeb thiab ua rau muaj menyuam tsis taus vim yog tsim cov adhesions hauv lub tsev menyuam (Asherman's Syndrome) lossis xav tau tshem tawm lub cev tag nrho.
Diagnosis
Ncaj nraim hauv cov txheej txheem ntawm kev cuam tshuam hauv tsev menyuam, nws muaj peev xwm xav tias muaj qhov perforation uas tau tshwm sim tsuas yog los ntawm kev hnov cov cuab yeej phais "poob" dhau ntawm thaj tsam ntawm lub tsev menyuam. Hauv cov xwm txheej nyuaj, perforation tuaj yeem qhia tau los ntawm kev rho tawm ntawm lub zes qe menyuam, omentum, lossis lub plab hnyuv. Cov tsos mob ntawm perforation thaum txhim kho cov tshuaj tiv thaiv kab mob hauv tsev menyuam yog qhov tsis muaj xov hauv thaj tsam ntawm lub tsev menyuam, uas pom tau thaum kuaj xyuas qhov chaw mos, yog tias lawv nyob, tsis muaj peev xwm rho tawm cov kauv los ntawm nws "whiskers" (mob taub hau thiab hnov qhov tsis kam).
Thaum ua kev tswj hwm raws li kev saib xyuas hysteroscopic, tus kws kho mob endoscopist tuaj yeem saib cov tsos mob hauv qab no: nyob rau hauv lub uterine kab noj hniav nws tsis tuaj yeem txhawb nqa.ruaj khov siab; tsis muaj cov kua dej tawm mus rau tus neeg mob; ntawm lub monitor, tus kws kho mob pom cov kab mob hauv plab hnyuv, peritoneum lossis lwm yam kabmob sab hauv. Yog tias tus kws tshaj lij kev ua haujlwm muaj laj thawj xav tias uterine perforation tau tshwm sim, nws yuav tsum tau muab tshem tawm tam sim ntawd thiab sim palpate lub ntsis ntawm lub ntsuas los ntawm lub plab phab ntsa kom paub tseeb tias nyob rau hauv qhov chaw ntawm nws localization.
Yog tias tsis pom qhov uterine perforation ntawm lub rooj ua haujlwm, tom qab ntawd ua tib zoo saib xyuas tus poj niam hauv thawj teev tom qab kev cuam tshuam pab kom pom cov teeb meem nrog kev kuaj mob raws sij hawm; tsom xam ntawm obstetric thiab gynecological keeb kwm thiab kev tsis txaus siab ntawm tus neeg mob. Cov ntaub ntawv ntxiv yog tau los ntawm transvaginal ultrasound, uas tso cai rau koj pom cov kua dej dawb hauv lub plab mog. Feem ntau ntawm uterine perforation, kuaj laparoscopy yog ua kom tsis suav nrog kev ua txhaum ntawm cov kab mob hauv lub cev.
Uterine perforation kho
Nyob rau yav tom ntej, cov tswv yim ntawm kev kho yog nyob ntawm kev tshawb pom raws sijhawm ntawm kev ua txhaum cai, lawv qhov chaw nyob, qhov loj me, cov txheej txheem ntawm kev raug mob, kev saib xyuas cov kabmob sab hauv. Nyob rau hauv cov ntaub ntawv ntawm tsis tiav perforation thiab ib tug me me qhov, yog hais tias muaj tiav kev ntseeg siab tias tsis muaj kev puas tsuaj rau lub OBP, tsis muaj intraperitoneal los ntshav thiab parametric hematoma, conservative observational tactics yuav xaiv tau. Hauv qhov no, tus poj niam xav tau kev pw tsaug zog, txias yog muab tso rau ntawm nws lub plab, siv tshuaj tua kab mob thiab tshuaj uterotonic (Enzaprost-F, Prepidil, Sigentin,"Erogometrin"). Ultrasonic dynamic kuaj nyob rau hauv kev kawm.
Lwm tus neeg mob (yog tias muaj cov tsos mob ntawm cov ntshav los hauv lub cev lossis muaj cov tsos mob ntawm peritoneal) yuav tsum tau laparotomy lossis laparoscopy, kev tshawb fawb txog OBP thiab OMT. Yog tias qhov ua txhaum me me tau pom nyob rau hauv phab ntsa uterine, ces txhua yam yog txwv rau suturing lub qhov txhab. Thaum txiav txim siab loj lossis ntau qhov tawg ntawm phab ntsa uterine, qhov teeb meem daws tau nrog kev pab ntawm supravaginal amputation (lub tsev menyuam raug tshem tawm yam tsis muaj caj dab) lossis hysterectomy (lub tsev menyuam raug tshem tawm tag nrho).
Nyob rau hauv cov ntaub ntawv ntawm uterine perforation, nyuaj los ntawm kev ua txhaum ntawm lub cev nyob sib ze, kev phais yog ntxiv nrog rau cov txheej txheem tsim nyog. Txhawm rau ua kom tsis muaj ntshav, kev kho mob infusion yog nqa tawm, nws cov khoom tau hloov pauv. Txhawm rau tiv thaiv qhov teeb meem ntawm tus kab mob sib kis, kev kho tshuaj tua kab mob yog ua tiav.
Rau lub neej ntawm tus neeg mob, qhov kev kuaj mob rau lub sijhawm kuaj thiab tshem tawm ntawm uterine perforation yog qhov zoo, tab sis qhov tshwm sim rau kev ua menyuam yaus tuaj yeem loj heev. Txhawm rau tiv thaiv perforation ntawm lub cev, nws yog ib qho tsim nyog yuav tsum tau soj ntsuam cov theem thiab cov txheej txheem ntawm kev ua ntau yam kev ua haujlwm hauv lub cev, ua kom paub cov cuab yeej rau hauv lub tsev menyuam kab noj hniav kom zoo, zoo tshaj plaws ntawm txhua qhov kev tswj xyuas qhov muag. Ncaj nraim, ib tug poj niam tuaj yeem txo qis qhov tshwm sim ntawm cov kab mob no yog tias nws tsis kam rho menyuam thiab mus ntsib kws kho mob gynecologist tsis tu ncua. Yog hais tias cov neeg mob raug kev txom nyem ib tug perforation ntawm lub tsev me nyuam phab ntsa, lawv muab tso rau ib tug dispensary ntaub ntawv. Xws liRau cov poj niam, cev xeeb tub muaj ntau yam txaus ntshai, tshwj xeeb tshaj yog uterine rupture thiab nchuav menyuam.
Reviews
Qhov tshwm sim ntawm uterine trauma nyob ntawm seb qhov kev puas tsuaj, lawv ntim. Cov neeg mob nco ntsoov tias qhov loj me zoo, tab sis daim ntawv caws pliav. Tom qab raug mob zoo li no, tus poj niam yuav tsum tau sau npe hauv tsev kho mob antenatal.
Qhov tshwm sim ntawm perforation tuaj yeem sib txawv. Cov neeg mob hais tias adhesions feem ntau tsim thaum muaj kev cuam tshuam hauv plab. Kev raug mob tuaj yeem zam tau nrog kev tiv thaiv kom raug.
Tsis tas li, cov poj niam nco ntsoov tias lawv yuav tsum tau npaj cev xeeb tub. Yuav tsum tau kawm ua ntej ntawm qhov caws pliav. Nws yog qhov zoo tshaj kom cev xeeb tub tsawg kawg ob xyoos tom qab perforation. Qhov tseem ceeb tshaj plaws uas tau sau tseg hauv kev tshuaj xyuas yog qhov xav tau rau tus cwj pwm zoo rau lub xeev kev noj qab haus huv thiab rov hais dua rau cov kws kho mob ntseeg siab.
