Uterine kab noj hniav curettage yog qhov haujlwm feem ntau ua hauv gynecology. Cov txheej txheem no tseem hu ua curettage. Nrog kev pab los ntawm ib tug curette (ib qho kev phais tshwj xeeb), cov mucous txheej ntawm lub tsev menyuam raug tshem tawm. Nyob rau hauv cov ntaub ntawv no, tsuas yog cov superficial (functional) txheej ntawm lub mucosa raug tshem tawm.
Definition
Uterine kab noj hniav curettage yog ib txoj kev gynecological uas tus kws kho mob tshem tawm cov txheej txheem sab saum toj ntawm lub tsev menyuam uas siv lub tshuab nqus tsev los yog cov cuab yeej tshwj xeeb.
Feem ntau, cov txheej txheem yuav tsum tau ua kom lub ncauj tsev menyuam nthuav dav, uas yog siv cov cuab yeej lossis tshuaj.
Hnub no, cov txheej txheem yog ib txwm ua thiab feem ntau ua rau kev kho mob gynecological lossis kuaj mob.
Feem ntau, kev kho ntawm lub tsev menyuam kab noj hniav ua ke nrog hysteroscopy, uas ua rau nws muaj peev xwm "kuaj" sab hauv ntawm lub tsev menyuam tom qab.cov txheej txheem ntxuav thiab, yog tias tsim nyog, ua kev kho ntxiv ntawm thaj chaw tsis muaj kev cuam tshuam.
Tseem txheej txheem
Muaj ntau ntau yam kev qhia yooj yim rau kev ua qhov kev ntxuav no:
- Regular - cov txheej txheem no tsuas yog tshem tawm sab hauv ntawm lub mucosal kab noj hniav. Feem ntau ua rau mob, piv txwv li, tom qab rho menyuam, yug me nyuam nyuaj lossis lwm yam kab mob gynecological. Qhov tsis zoo tseem ceeb yog qhov txheej txheem ua tsis pom kev thiab tom qab nws muaj qee qhov teeb meem tshwm sim, piv txwv li, kev puas tsuaj rau lub tsev menyuam.
- cais curettage ntawm uterine kab noj hniav yog ib qho tseem ceeb ntawm kev kuaj mob thiab kho cov txheej txheem uas tau ua kom tau txais cov qauv tsim nyog rau kev kuaj histological lossis kho. Cov txheej txheem hu ua "sib cais", txij li kev khawb ntawm lub ncauj tsev menyuam thiab cov kwj dej ntawm ncauj tsev menyuam tau ua tiav hauv ntau theem. Txhawm rau ua cov txheej txheem, kev siv tshuaj loog sab hauv yog siv, vim tias tus neeg mob yuav tsum nyob hauv tsev kho mob. Thaum lub sijhawm ua haujlwm, kev sib cais yog nkag mus rau hauv lub tsev menyuam kwj dej thiab mus rau hauv lub ncauj tsev menyuam cais, uas yog siv rau kev khawb los ntawm cov mucous membrane kom tau txais cov khoom kuaj mob. Lub hom phiaj ntawm cov txheej txheem yog kom tau txais cov ntaub ntawv tsim nyog rau kev tshawb fawb tom ntej los ntawm chav kuaj. Sib cais curettage ntawm uterine kab noj hniav thiab lub ncauj tsev menyuam kwj dej yog ua ob peb hnub ua ntej pib ntawm kev coj khaub ncaws los yog thaum lub sij hawm los ntshav. Thaum lub sij hawm kho implantation, cov seem ntawm lub fetus qe los yog hloov chaw ntawm lub mucosa yog tshem tawm ntawm lub uterine kab noj hniav.plhaub.
- Muaj lwm hom txheej txheem - qhov no yog kho nrog kev txo qis ntawm hysteroscopy. Siv cov cuab yeej kho qhov muag tshwj xeeb (hysteroscope), nws tuaj yeem teeb lub tsev menyuam los ntawm sab hauv, thiab cov duab los ntawm nws qhov chaw loj heev. Qhov no ua rau muaj qhov tseeb tias tus kws kho mob tsis ua qhov muag tsis pom. Ua tsaug rau qhov nthuav tawm curettage ntawm uterine kab noj hniav, qhov kev pheej hmoo ntawm cov kab mob endometrial uas tseem tshuav tau txo qis, nrog rau ntau yam teeb meem tom qab txheej txheem.
Vim li cas kev tshem tawm
Digital curettage yog ua raws li kev kho mob thiab kuaj mob, thiab kev kho obstetric kuj tuaj yeem muab tso rau hauv ib pawg.
Cov no yog cov xwm txheej raws li kev kho mob tshwm sim:
- Uterine los ntshav - lawv tuaj yeem sib txawv hauv etiology thiab xwm. Nyob rau hauv rooj plaub no, qhov tseeb yog vim li cas rau lawv cov tsos yuav tsis meej kiag li. Cov txheej txheem ua tiav kom tsis txhob los ntshav.
- Endometritis yog ib qho mob hnyav ntawm lub tsev menyuam. Rau kev kho mob tag nrho ntawm kev kho mob, nws yog ib qho tsim nyog yuav tsum tau ua thawj zaug curettage ntawm endometrium ntawm uterine kab noj hniav.
- Synechia yog uterine kab noj hniav spliced ua ke. Cov txheej txheem nthuav tawm yog ua los txiav cov adhesions uas twb muaj lawm. Nws tsuas yog ua tiav siv hysteroscope thiab lwm yam cuab yeej ua haujlwm.
- Uterine kab noj hniav curettage rau endometrial hyperplasia yog ua nyob rau hauv cov ntaub ntawv ntawm ntau dhauthickening ntawm mucosa. Cov txheej txheem zoo li no yog tib txoj hauv kev los kho thiab kuaj xyuas qhov xwm txheej zoo li no. Tom qab tag nrho cov manipulations tau ua tiav lawm, tus neeg mob tau muab cov tshuaj uas pab kom sib sau ua ke qhov tshwm sim.
- Polyps ntawm mucous daim nyias nyias. Txij li nws tsis tuaj yeem kov yeej qhov teeb meem no nrog kev pab ntawm cov tshuaj, kev kho mob tau ua tiav.
Kev kuaj mob ntawm lub tsev menyuam kab noj hniav yog ua thaum:
- xav txog kev hloov pauv ntawm lub ncauj tsev menyuam thiab lub tsev menyuam mucosa;
- hnyav thiab ntev nrog txhaws;
- kev muaj menyuam;
- ntshav los ntshav ntawm qhov tsis paub etiology;
- npaj rau kev cuam tshuam rau uterine fibroids.
Obstetric curettage yog ua tiav hauv cov xwm txheej hauv qab no:
- rau kev rho menyuam (kev txiav tawm ntawm cev xeeb tub, ua rau lub sijhawm tsis pub dhau 12 lub lis piam);
- tom qab nchuav menyuam, thaum xav tau tshem cov placenta thiab cov seem ntawm cov qe menyuam hauv plab;
- nrog los ntshav hnyav nyob rau lub sijhawm tom qab yug menyuam, qhia tias kev tshem tawm tsis tiav ntawm cov placenta;
- thaum lub sijhawm cev xeeb tub, thaum tsim nyog yuav tsum tshem tawm tag nrho cov fetus tuag thiab ntxuav lub tsev menyuam kom tsis txhob mob.
YContraindications
Kev kho thiab kuaj mob ntawm lub uterine kab noj hniav yog txwv tsis pub nyob rau hauv cov xwm txheej hauv qab no:
- mob thiab subacute pathologies ntawm genitourinary system;
- teeb meem nrog raum, siab thiab lub plawv nyob rau theem mob;
- kab mob sib kis;
- muaj kev xav tias muaj kev hloov pauv ntawm cov phab ntsa ntawm lub tsev menyuam.
Yog tias muaj cov teeb meem nyuaj heev, ces tag nrho cov contraindications no tuaj yeem tsis quav ntsej, piv txwv li, los ntshav tom qab yug me nyuam heev.
Kev npaj
Yuav ua li cas kho lossis cais kev kuaj mob ntawm lub tsev menyuam kab noj hniav, nws yuav tsum tau ua qee yam kev npaj:
- Tsis txhob noj hmo ua ntej thiab hnub ua haujlwm.
- Da dej.
- Ua tshuaj ntxuav tes.
- Txiav tshem cov plaub hau los ntawm cov genitalia sab nraud.
- Nyob rau ntawm kev sab laj nrog tus kws tshuaj loog.
- Ua ib qho kev ntsuam xyuas dav dav ntawm OB/GYN.
Tests
Yuav kom tsis txhob muaj teeb meem tom qab kho cov kab noj hniav hauv tsev menyuam, nws yuav tsum dhau txhua qhov kev sim qhia txog lub xeev ntawm tib neeg kev noj qab haus huv:
- Kev tshuaj ntsuam rau HIV (tus kab mob tiv thaiv kab mob tib neeg).
- ntsuas rau kab mob siab B thiab C.
- Tests for RW (syphilis yog ib hom kab mob venereal uas muaj kab mob sib kis, nrog rau kev puas tsuaj rau ntawm daim tawv nqaij, mucous daim nyias nyias, cov kab mob hauv nruab nrog cev, pob txha thiab lub paj hlwb).
- Vaginal swab kom tshem tawm qhov mob.
- kuaj ntshav nrog kev txiav txim siab.
- Coagulogram - txhawm rau txheeb xyuas qhov ntsuas ntawm cov ntshav txhaws.
txheej txheem txheej txheem
Yuav ua li cas cais cov kab noj hniav ntawm lub tsev menyuam thiab lwm yam txheej txheem, koj yuav tsum ua raws li cov kauj ruam hauv qab no:
- bladder khoob;
- kho qhov chaw mos thiab qhov chaw mos;
- kuaj pom (siv daim iav) ntawm lub ncauj tsev menyuam;
- fastening nrog mos txwv forceps (ib qho cuab yeej phais uas zoo li cov hlua khi nrog hooks) ntawm lub ncauj tsev menyuam;
- -dilation ntawm cervical canal;
- curette scraping ntawm mucous membrane;
- kho lub tsev menyuam nrog tincture ntawm iodine;
- muab instruments.
Yuav ua li cas phais tau ua
Tom qab lub zais zis tas lawm, tus neeg mob tau muab tso rau ntawm lub rooj zaum gynecological rau kev kuaj ob txhais tes ntawm qhov chaw mos. Nws yog ib qho tsim nyog los tsim qhov loj thiab qhov chaw ntawm lub tsev menyuam. Tom ntej no, qhov chaw mos thiab lwm qhov chaw ntawm qhov chaw mos yog kho nrog cawv thiab iodine tincture. Tom qab ntawd tus kws kho mob tau koom nrog kev tshawb pom ntawm lub ncauj tsev menyuam siv rab diav-zoo li daim iav. Lub uterine sojntsuam (ib tug nyias, smoothly bent hlau ntsuas) pab txiav txim qhov ntev thiab orientation ntawm lub uterine kab noj hniav. Feem ntau lub tsev menyuam nyob rau hauv txoj hauj lwm anteflexio-versio, uas yog, nyob rau hauv ib txoj hauj lwm uas yog anatomically li qub. Hauv qhov no, tag nrho cov twj paj nruag tau nkag mus rau hauv lub cev nrog lub concavity rau pem hauv ntej. Thaum lub tsev menyuam nyob rau hauv lub xeev ntawm retroflexio uteri, uas yog thaum nws lub cev nyob rau hauv lub cheeb tsam ntawm lub internal os yog khoov rov qab, ces cov twj paj nruag txav concavely rov qab, ua tsaug uas nws muaj peev xwm zam tau.raug mob.
Qee zaum cov kws kho mob tsis tuaj yeem ua yam tsis muaj hlau Heger dilators (hlau pas nrig), ua tsaug uas nws muaj peev xwm ua kom lub ncauj tsev menyuam loj tuaj rau qhov loj tshaj plaws uas yuav tsum tau ua rau qhov loj tshaj plaws curette. Cov dilators tau qhia qeeb qeeb yam tsis muaj kev siv zog, thiab tsuas yog lub dilators me tshaj plaws tau tso rau thawj zaug.
Tom qab cov kwj dej ntawm ncauj tsev menyuam tau loj txaus, tus kws phais tau muab rab phom tua pov tseg. Nws yog ib qho tsim nyog yuav tau ua kom paub cov cuab yeej ua haujlwm zoo li no. Txhua zaus nws yuav tsum ncav cuag hauv qab ntawm lub tsev menyuam. Raws li kev rov qab txav mus, lawv yuav tsum muaj zog dua, nrog rau kev siv lub zog, kom ntes cov mucous membrane.
txheej txheem no yuav tsum tau ua kom tiav. Thaum xub thawj, lub hauv ntej yog scraped, thiab tom qab ntawd lub nraub qaum thiab sab phab ntsa. Hauv kev xaus, nws yuav tsum tau ua cov txheej txheem hauv cov ces kaum ntawm lub tsev menyuam. Manipulation yog ua kom txog thaum lub uterine phab ntsa ua tiav du rau qhov kov. Feem ntau, curettage ntawm uterine kab noj hniav thaum los ntshav thiab lwm yam pathologies yuav siv sij hawm los ntawm 15-25 feeb. Qhov tshwj xeeb ntawm kev ua haujlwm yog txiav txim siab los ntawm qhov xwm txheej ntawm cov kab mob. Piv txwv li, nrog submucosal myoma ntawm lub uterine kab noj hniav muaj ib tug bumpy nto, nws yog vim li no tias tag nrho cov txheej txheem tau ua tib zoo txaus kom tsis txhob ua puas lub capsule ntawm lub myomatous node.
Thaum cev xeeb tub, cov kev ua haujlwm zoo li no tau ua nrog ceev faj heev kom tsis txhob rhuav tshem cov khoom siv neuromuscular.
Thaum kawg ntawm txoj kev, cov mos txwv quab yuam raug tshem tawm, tom qab ntawd lub ncauj tsev menyuam rov kho nrog iodine thiab daim iav raug tshem tawm tag nrho. Lub scraping yog sau rau hauv ib lub thawv npaj nrog 10% tov ntawm farmazalin, thiab tom qab ntawd cov ntaub ntawv raug xa los ntawm cov kws kho mob mus kuaj histological. Nyob rau hauv cov ntaub ntawv ntawm xav tias muaj ib tug malignant neoplasm, ib tug scraping yog muab los ntawm lub mucous daim nyias nyias ntawm lub tsev me nyuam kab noj hniav thiab lub ncauj tsev menyuam kwj dej. Txhua qhov kev tshuaj ntsuam tau muab tso rau hauv ib lub thawv cais.
Nyob zoo
Yog tias qhov kev cuam tshuam tau npaj tiav tiav, cov txheej txheem kho kom rov zoo yuav siv sijhawm 4-5 lub lis piam. Pom zoo rau thawj 14-15 hnub:
- tsis kam siv qhov chaw mos tampons, suppositories, douching, thiab lwm yam kev siv hauv qhov chaw mos;
- tsis txhob sib deev;
- txwv kev ua haujlwm thiab kev ua haujlwm ntawm lub cev hauv qhov chaw ntawm lub cev;
- zam qhov kub tshaj plaws (saunas, da dej, hypothermia);
- tsis kam ua luam dej hauv pas dej, pas dej thiab da dej.
Nyob rau thawj hnub ntawm kev tso tawm tom qab kev kho ntawm lub tsev menyuam kab noj hniav hauv daim ntawv ntawm cov ntshav txhaws yog qhov qub thiab tsis tuaj yeem nres rau ob peb hnub. Cov ntshav tsawg tsawg tuaj yeem kav ntev txog 10 hnub. Txhawm rau tiv thaiv kev tsim ntawm hematomas (sau ntawm cov ntshav hauv lub tsev menyuam) thiab spasms ntawm lub ncauj tsev menyuam, nws yuav tsum tau siv cov tshuaj antispasmodic, uas yog kws kho mob sau rau tus kheej.
hli tom qab txheej txheem
thawj zaug kev coj khaub ncaws tom qab kev cog qoob loo feem ntau tuaj nrog qeeb me ntsis, tom qab li 4-5 lub lis piam, qee zaum ntau tom qab. Xws li kev ncua yuav tsum tsis txhob ua rau muaj kev txhawj xeeb. Tsuas yog nyob rau hauv rooj plaub thaumnws kav ntev tshaj peb lub hlis, koj yuav tsum mus ntsib kws kho mob.
Kev nyab xeeb ntawm txheej txheem
Ntau tus poj niam txaus siab rau qhov kev pheej hmoo ntawm cov txheej txheem zoo li no. Feem ntau, niaj hnub gynecologists sim siv cov cuab yeej xws li gyroscope rau kev tswj hwm ntxiv hauv lawv txoj haujlwm. Ua tsaug rau nws, nws muaj peev xwm saib xyuas qhov mob ntawm lub tsev menyuam, nrog rau pom cov cheeb tsam uas tau zam dhau qhov kis. Xws li kev tswj hwm yog qhov tseem ceeb heev nrog rau qhov tsis zoo ntawm lub tsev menyuam. Lub hygroscope feem ntau yog siv thaum lub tsev menyuam tsis muaj sij hawm kom txo qis tag nrho tom qab yug menyuam.
Nws yuav tsum tau muab sau tseg tias cov neeg mob feem ntau nyiam mus rau qhov txheej txheem ntawm gynecologist saib lawv lossis ntawm tus kws kho mob tshwj xeeb uas lawv paub. Tab sis qhov no tsis yog ib txwm muaj tseeb, thiab yog tias tus kws kho mob hais txog qee tus kws tshaj lij, ces nws yog qhov zoo dua los mloog nws lub tswv yim. Cov kws tshaj lij kev sab laj tsis yog ib txwm muaj peev xwm ua tau qhov kev xav tau zoo los ntawm qhov kev pom zoo. Tus kws tshaj lij yog qhov zoo tshaj plaws lav kev nyab xeeb.
Cov teeb meem tom qab kev phais
Cov no suav nrog:
- Kev txhim kho ntawm inflammatory pathologies. Cov teeb meem zoo li no tshwm sim thaum cov txheej txheem tau ua tawm tsam keeb kwm yav dhau los ntawm cov txheej txheem inflammatory lossis thaum kws kho mob tsis ua raws li tag nrho cov cai ntawm kev tua kab mob. Tshuaj tua kab mob yuav tsum tau kho.
- Kev ua txhaum ntawm kev ncaj ncees ntawm lub tsev menyuam (perforation) nrog txhua yam kev phais. Qhov laj thawj tseem ceeb ntawm kev ua txhaum cai yog kev nthuav dav tsis zoo thiab muaj zog friability ntawm cov ntaub so ntswg ntawm lub ncauj tsev menyuam. Kev kho tsis yogteem, raws li txhua yam kho ntawm nws tus kheej.
- Yog tias, tom qab kho lub tsev menyuam, qhov tso tawm tsis xaus rau peb lub hlis, qhov no qhia tau tias muaj tus kabmob. Cov tshuaj tua kab mob yog siv los kho.
- Kev raug mob rau cov mucous membrane. Qhov tshwm sim tshwm sim los ntawm kev tshem tawm ntau dhau, vim qhov kev loj hlob txheej ntawm endometrium yog kov. Hauv qhov no, lub mucosa tsis rov qab los. Txhua yam kev kho mob tsis muaj txiaj ntsig.
- Asherman's syndrome, nyob rau hauv cov xwm txheej no, kev coj khaub ncaws thiab kev ua me nyuam muaj kev cuam tshuam. Feem ntau nws ua rau tsim ntawm synechia. Rau kev kho mob, tshuaj hormonal thiab antibacterial, nrog rau cov txheej txheem physiotherapy yog siv.
- Hematometra yog ib qho kev txuam ntawm cov ntshav hauv lub tsev menyuam. Rau kev kho mob, siv cov tshuaj uas txo qhov spasm.
Kev xeeb tub ntxiv
Curettage, uas dhau los tsis muaj teeb meem, feem ntau tsis cuam tshuam rau kev yug menyuam thiab cev xeeb tub. Qhov ua tau ntawm kev xeeb tub feem ntau rov qab los rau cov poj niam ob peb lub lis piam tom qab tus txheej txheem. Txawm li cas los xij, cov kws kho mob tsis pom zoo npaj rau nws ua ntej peb lub hlis kawg.
Reviews
Uterine kab noj hniav curettage, raws li cov kws txawj, yog lub thiaj li hu ua tu. Thiab qhov tseeb, lub ntsiab lus ntawm cov txheej txheem yog ntxuav lub tsev menyuam los ntawm kev tshem tawm cov txheej txheem sab sauv ntawm cov mucosa. Raws li cov kws phais, yog tias ua tau zoo, cov txheej txheem muaj kev nyab xeeb kiag li thiab tsis cuam tshuam rau kev tsim ntawmkev nyuaj siab.
Raws li kev tshuaj xyuas ntawm cov neeg mob, thawj zaug hais txog qhov xav tau kev kho mob, lawv muaj kev ntshai thiab ntshai. Txog qhov no, cov kws kho mob teb tias cov txheej txheem yog siv rau kev kho mob hnyav, tab sis nws yuav tsum nco ntsoov tias nws tau ua los tiv thaiv poj niam txoj kev noj qab haus huv.
