Hauv gynecology, uterine malformations yog ib qho tshwm sim ntau zaus, tshwj xeeb tshaj yog thaum nws los txog rau uterine infantilism. Lwm lub npe rau pathology yog hypoplasia. Nws tshwm sim hauv 4-6% ntawm cov poj niam. Qhov kev kuaj mob no yog dab tsi?
Infantile (me nyuam yaus, tsis tau tsim) uterus yog thaum lub cev tsim kom zoo, tab sis lags hauv kev loj hlob. Cov txheej txheem tau txais, kuaj pom thaum puberty, pib tom qab yug me nyuam. Lub tsev me me tuaj yeem tshwm sim raws li cov tsos mob ntawm lwm yam ntawm qhov chaw mos infantilism (ua tiav lossis ib nrab), nrog hypogonadism (kev ua haujlwm tsis txaus ntawm gonads).
Lub tsev menyuam tom qab yug menyuam yog txawv ntawm tus neeg laus nkaus xwb, tab sis tsis nyob hauv cov qauv. Tag nrho cov follicles twb muab tso rau hauv nws, thiab nws yog nyob rau hauv lub plab kab noj hniav. Qee qhov ntawm cov follicles tuaj yeem suav tias yog qhov loj. Tom qab yug me nyuam, qhov ntev ntawm lub tsev menyuam hauv ib tug ntxhais yog 4 cm. Thaum muaj 4 xyoos, nws nqis los rau hauv lub plab me me.
Tom qab 7-8 xyoo, cov theem ntawm uterine loj hlob pib. Txij thaum muaj hnub nyoog 8 xyoo, thawjhloov pauv ntawm ib tug ntxhais mus rau ib tug ntxhais. Thaum pib ntawm kev puberty (los ntawm lub hnub nyoog ntawm 11-13), lub tsev menyuam yuav tsum twb muaj tib qhov ntev li ib tug neeg laus nulliparous ntxhais. Txwv tsis pub (yog tias lub tsev menyuam tsis ncav cuag qhov loj me), tus ntxhais raug kuaj pom tias "tsis muaj kev loj hlob". Qhov ua rau yog kev ua txhaum ntawm cov tshuaj hormonal.
Ib tug menyuam mos lub tsev menyuam ua rau nws nyuaj rau xeeb menyuam thiab yug menyuam. Kev kho mob nyuaj thiab tsis tas yuav ua tiav - nws nyob ntawm qhov kev txhim kho tsis zoo.
Cas of infantilism
Cov menyuam yaus lub tsev menyuam feem ntau tshwm sim rau cov poj niam uas muaj lub ntsej muag thiab lub cev: luv stature, nqaim lub xub pwg nyom, lub mis qis. Ntau tus tub ntxhais hluas, ua ib txwm nyob rau hauv kev loj hlob, pib poob ceeb thawj ntawm xiav nyob rau hauv kev nrhiav kev hlub 90 × 60 × 90. Qhov no tsis yog tsuas yog hem nrog anorexia, tab sis kuj nrog uterine hypoplasia.
Ntxiv rau kev noj zaub mov hnyav, kev kis kab mob - qhua pias, rubella, kab mob autoimmune - rheumatism kuj tuaj yeem pab txhawb. Qhov ua rau lub tsev me me feem ntau yog:
- kev phem kev qias (predisposition kis los ntawm poj niam kab);
- endocrinopathy (pathology ntawm tag nrho cov peripheral endocrine qog);
- kab mob hauv lub cev hauv thawj peb lub hlis twg ntawm kev loj hlob ntawm fetal, thaum lub genitourinary system tau tso;
- cuam tshuam ntawm hluav taws xob thiab tshuaj lom (xws li tshuaj thiab haus luam yeeb);
- kab mob somatic;
- meager thiab monotonous noj zaub mov nrog cov ntsiab lus tsawg ntawm cov protein thiab cov vitamins;
- kev ua haujlwm nyuaj;
- mob siab thiab ntxhov siab hauv tsev kawm ntawv thiab tsev neeg;
- kev nyuaj siab.
tseem ceeb heev yog qhov ua txhaum ntawm cov saw "hypothalamus - pituitary gland - zes qe menyuam - uterus".
Sizes OK
Qhov loj ntawm tus menyuam lub tsev menyuam hauv cov poj niam nulliparous yog 4.2-4.8 cm ntev thiab 4.2-5.0 cm dav. Qhov ntev ntawm cov kab noj hniav yog 7 cm. Qhov ntev ntawm lub ncauj tsev menyuam tsis ntau tshaj 2.5 cm..
Nyob rau hauv ib tug poj niam nulliparous nrog keeb kwm ntawm cev xeeb tub - 4.8-5.4 cm nyob rau hauv ntev, 4.5-5.5 cm nyob rau hauv dav, nyob rau hauv ib tug poj niam yug - 5.5-6.1 cm nyob rau hauv ntev, 4,8-6 cm - wide. Cavity ntev - 8 cm.
Me nyuam mos txhais tau tias tsis yog qhov me me ntawm lub tsev menyuam, tab sis kuj yog qhov piv ntawm cov kab noj hniav thiab lub ncauj tsev menyuam.
Degrees of infantilism
Cov qib hauv qab no ntawm kev txhim kho tsis zoo yog qhov txawv:
- Rudimentary, lossis fetal, embryonic uterus.
- Cov menyuam mos yug menyuam.
- Hypoplastic uterus.
Fetal uterus of the third degree
Tag nrho qhov ntev - 1-3 cm. Qhov kev kawm ntau dua vim muaj kev loj hlob ntawm lub cev. Tsis muaj txhua hli. Vim qhov mob tsis zoo, kho tsis tau.
2nd degree
Tus me nyuam mos los yog me nyuam mos lub tsev menyuam yog li 3-5 cm ntev, lub ncauj tsev menyuam yog tib yam. Hauv cov poj niam laus, nws sib haum rau hnub nyoog 9-10 xyoo. Lub zes qe menyuam tsis tsim, yog siab tshaj qhov qub, cov hlab ntsha fallopian yog tortuous thiab nqaim.
Txawm tias lub voj voog yuav yog, tab sis nrog kev ua txhaum cai. Muaj lwm yam tshwm sim ntawm qhov chaw mos infantilism. Kev kho kom zoo tuaj yeem ua rau me nyuam muaj nqis.
1st degree
ThaumNyob rau hauv lub me nyuam mos lub tsev me nyuam ntawm lub 1st degree, underdevelopment yog tsis pronounced, qhov ntev yog 6-7 cm nrog ib tug caj dab, kev loj hlob muaj nuj nqi yog khaws cia. Qhov kev cia siab yog qhov zoo tshaj plaws, thiab nrog qhov pib ntawm kev sib deev, qhov loj ntawm cov khoom nruab nrog cev tawm.
Pathogenesis
Kev ua haujlwm ntawm zes qe menyuam yog tswj los ntawm "hypothalamus-pituitary" system. Lub hypothalamus tsim cov tshuaj hormones pituitary. Nws muab kev txiav txim rau lub caj pas pituitary, ua "tus coj". Nws cov tshuaj hormones txhawb lub caj pas pituitary los tsim gonadotropins uas ua rau cov qog nqaij hlav (ovaries).
Lub qog pituitary yog qhov piv txwv tam sim "tus thawj coj" ntawm gonads lub luag haujlwm rau kev tsim cov tshuaj steroids. Qhov kev sib txuas no yog kev sib nrig sib. Qhov no txhais tau hais tias nrog tsis muaj cov tshuaj hormones ntawm zes qe menyuam, lub teeb liab raug xa mus rau lub caj pas pituitary, thiab los ntawm qhov ntawd mus rau hypothalamus, txog qhov txo qis ntawm cov tshuaj hormones poj niam txiv neej. Yog tias cov teeb liab kis tau raug cuam tshuam hauv ib cheeb tsam, qhov tshwm sim yog kev loj hlob ntawm lub tsev menyuam mos.
Kev kho mob tshwm sim
Kev loj hlob ntawm lub tsev menyuam tsis yog ib qho tsos mob. Nws yeej yuav tau ua ke nrog kev infantilism.
Kev sib deev infantilism yog:
- small, underdeveloped labia;
- qhov chaw mos me me;
- clitoris protrudes tshaj qhov chaw mos.
Lub zes qe menyuam me thiab tseem tsis tau tsim dua, siab dua lawv txoj haujlwm ib txwm muaj. Cov hlab ntsha fallopian tsis tuaj yeem ua tiav lawv txoj haujlwm vim lawv qhov kev txhim kho tsis zoo: lawv qhov qis qis, ntev thiab winding.
Ib qho khoom nruab nrog cev tsis muaj zog (ib lub tsev me me hauv poj niam) tsis pub nws xeeb tub thiab yug menyuam. Yog hais tias conception tshwm sim, thiab ntau zaus nws yog tsis yooj yim sua,cev xeeb tub yuav ectopic.
Cov tsos mob tseem ceeb qhia txog kev tsim ntawm lub tsev menyuam yog qhov tsis txaus thiab luv luv, tsis xwm yeem lossis tsis tuaj.
Kev mob plab ib txwm mob. Tsis tas li ntawd, premenstrual syndrome nyob rau hauv xws li cov ntxhais manifests nws tus kheej nyob rau hauv tag nrho nws lub yeeb koob - classical. Raws li kev txheeb cais, hauv 90% ntawm cov neeg mob uterine infantilism muaj PCOS - polycystic zes qe menyuam.
Cov cim qhia thib ob suav nrog tsis muaj libido thiab orgasm. Kev loj hlob ntawm lub cev ntawm cov ntxhais zoo li no kuj tau qeeb. Lub pubis thiab armpits tsis npog nrog cov plaub hau. Lub cev muaj zog.
Gynecologist thaum kuaj pom tias muaj me me ntawm lub tsev menyuam thiab cov appendages uas tsis sib haum rau hnub nyoog. Muaj qhov chaw mos nqaim, lub ncauj tsev menyuam ntev thiab tib lub sijhawm lub cev flattened. Cov pob txha pelvic yog nqaim, lub hauv siab yog underdeveloped thiab nqaim, kev loj hlob yog luv rau lub hnub nyoog.
Nrog kev loj hlob, libido thiab orgasm yeej tsis tshwm sim. Nrog rau lub tsev menyuam me me, cov neeg mob tau tsim muaj cov kab mob endometritis, cervicitis, o thiab kis kab mob ntawm cov khoom nruab nrog cev thiab cov kab ke.
Diagnosis
Kev kuaj mob infantilism pab ultrasound ntawm lub plab hnyuv siab raum. Nws tseem yog ib qho tsim nyog yuav tsum tau kuaj xyuas hauv gynecologist lub rooj zaum, kuaj ntshav rau cov tshuaj hormones: qib ntawm poj niam thiab txiv neej cov tshuaj hormones - estradiol, testosterone, progesterone, thyroid hormones.
Kev kuaj mob tso cai rau koj tam sim ntawd xav tias hnyavlub sij hawm ntawm cev xeeb tub, yug me nyuam thiab cov txheej txheem ntawm conception nws tus kheej. Qhov no yog thawj zaug thiab qhov chaw tseem ceeb. Yog vim li cas thiaj li muaj qhov kev kuaj mob no yuav tsum tau kho nrog kev kho mob tas li. Los ntawm txoj kev, nws yog complex thiab lengthy.
Lub plab menyuam mos thiab cev xeeb tub yog qhov tsis sib xws. Txoj hauv kev xeeb tub thiab yug me nyuam hauv plab yog txo qis. Feem ntau, lub kaum sab xis ntawm lub tsev menyuam thiab lub ncauj tsev menyuam yog obtuse, qhib anteriorly thiab tsis pub tshaj 120 degrees; Nrog rau qhov me nyuam mos ntawm lub tsev menyuam, nws nce, uas ua rau nws nyuaj rau xeeb tub, ua rau muaj kev nyuaj rau kev yug menyuam. Lub contractility ntawm lub tsev menyuam yog sharply txo. Lub zes qe menyuam yog nyob ntau dua li cov qauv. Cov kav dej yog nqaim, winding thiab nyias.
Dab tsi nws muab rau hauv tag nrho: circulatory disorders nyob rau hauv qhov chaw mos. Nyob rau hauv lub xub ntiag ntawm ib tug me nyuam mos lub tsev me nyuam, conception yog heev nyuaj nyob rau hauv dav dav. Thaum cev xeeb tub, nws yuav ua rau mob toxicosis hnyav thiab muaj kev hem thawj ntawm kev cuam tshuam.
Thaum cev xeeb tub, tus menyuam mos yuav tsis tau txais cov khoom noj kom raug. Lub tsev menyuam tas li nyob rau hauv zoo, uas ua rau muaj kev pheej hmoo ntawm nchuav menyuam los yog yug ntxov ntxov. Yog tias cev xeeb tub tas lawm, lawv yuav tsis muaj zog, lub ncauj tsev menyuam yuav nthuav dav heev thiab lub sijhawm ua haujlwm yuav ntev dua.
Kev kho mob
Kev kho tus menyuam mos hauv tsev menyuam yog ua raws li kev saib xyuas kev kho mob tas li thiab yuav tsum ua kom tiav. Kev kho mob suav nrog kev kho lub cev, kev kho lub cev, tab sis qhov tseem ceeb yuav, tau kawg, yog HRT - kev kho tshuaj hormone hloov.
Nrog rau kev kho mob raws sijhawm thiab kuaj mob, qib me me ntawm hypoplasia, tag nrho cov haujlwm tau tso tsegxwm, ib tug poj niam yuav ntse ua. Tab sis lub sijhawm kho yuav tsum tau ua siab ntev.
Cov menyuam ntxhais tau muab cov zaub mov sib npaug ntawm cov vitamins thiab proteins, tiv thaiv kev noj cov vitamins. Nyob rau hauv rooj plaub ntawm kev ua txhaum ntawm txoj kev xav, tus kws kho mob yuav tsum ua haujlwm nrog tus neeg mob.
Hormonotherapy yog qhov yuav tsum tau ua vim tias hauv lub cev ntawm cov neeg sawv cev ntawm kev sib deev tsis muaj zog muaj ib txwm muaj ob peb cov tshuaj hormones, uas yog vim li cas lub tsev menyuam tsis tsim.
HRT yog muab rau hauv me me. Qee zaum kev kho tshuaj hormonal yog ua tiav thoob plaws lub xyoo yug.
Kev kho tshuaj hormone yog txhawb nqa thiab txhawb kev xeeb tub. Physiotherapy suav nrog kev kho cov hlau nplaum, kev kho paraffin, kho av nkos, inductothermy, laser kho. Gynecological massage thiab ce therapy yog sau.
Physiotherapy txhim kho cov ntshav ncig hauv lub plab me me thiab yog li pab txhawb rau qhov normalization ntawm lub cev qhov ntev.
Los ntawm cov tshuaj pej xeem, cov kws kho mob tsis xav noj cov tshuaj thiab cov tshuaj tua kab mob ntawm lub tsev menyuam, uas tuaj yeem yuav ntawm txhua lub tsev muag tshuaj.
Kev Tiv Thaiv
Txhawm rau kom tsis txhob hais txog qhov tsis zoo ntawm lub tsev menyuam hauv cov menyuam ntxhais hluas, nws yog qhov txaus los xyuas kom meej qhov kev loj hlob ntawm tus hluas lub cev - saib xyuas kev noj haus, tsis txhob muaj kev ntxhov siab. Tus poj niam thaum cev xeeb tub yuav tsum tau saib xyuas tshwj xeeb rau nws txoj kev noj qab haus huv hauv thawj peb lub hlis twg.
