Apoplexy ntawm zes qe menyuam yog ib yam mob hnyav heev, uas yog nrog los ntawm kev tawg ntawm lawv cov ntaub so ntswg. Raws li cov txheej txheem no, cov ntshav nkag mus rau ntawm zes qe menyuam cov ntaub so ntswg thiab lub plab kab noj hniav. Tus kab mob yuav tsum tau kho tam sim ntawd, txwv tsis pub hemorrhagic shock yuav tshwm sim. Thaum tsis muaj kev pab raws sijhawm, cov kab mob yuav xaus rau ntawm tus neeg mob tuag.
Tau kawg, ntau tus poj niam xav paub ntau ntxiv. Vim li cas ovary apoplexy tshwm sim? Nws yog dab tsi? Cov txiaj ntsig ntawm pathology, nws thawj cov tsos mob thiab cov kev kho mob tseem ceeb yog cov ntaub ntawv tseem ceeb uas koj yuav tsum paub txog koj tus kheej. Qhov kuaj pom tus kab mob sai dua, qhov ua tau zoo dua qhov tshwm sim rau tus neeg mob.
Ovarian apoplexy: ICD-10 code, cov yam ntxwv ntawm tus kab mob
Pib nrog, nws tsim nyog nkag siab txog cov ntaub ntawv dav dav txog cov kab mob no. Ovarian apoplexy (ICD-10 code N83) yog ib qho mob hnyav uas tshwm sim los ntawm rupture ntawm zes qe menyuam cov ntaub so ntswg. Raws li txoj cai, ua ntejhematoma tshwm nyob rau hauv cheeb tsam ntawm lub cev cuam tshuam, raws li ib tug tshwm sim ntawm lub zes qe menyuam siab nce nyob rau hauv - qhov no yog nrog los ntawm kev mob ntse. Kev nce siab ua rau muaj kev ua txhaum ntawm kev ncaj ncees ntawm zes qe menyuam. Txawm tias qhov tawg me ntsis ntawm lub plhaub yog qee zaum nrog los ntshav loj.
Pathology tuaj yeem txhim kho ntawm ntau theem ntawm kev coj khaub ncaws. Feem ntau, txoj cai zes qe menyuam raug cuam tshuam, vim tias txoj cai zes qe menyuam tawm ncaj qha los ntawm aorta. Tsis tas li ntawd, lub cev ntawm sab no muaj cov kab mob lymphatic uas tsim dua, ntau dua thiab loj dua.
Raws li kev txheeb cais, feem ntau, cov poj niam hluas hnub nyoog 20 txog 35 xyoo ntsib teeb meem zoo sib xws.
Vim li cas thiaj tsim tau tus kab mob
Qhov tseeb, qhov ua rau ntawm zes qe menyuam apoplexy tuaj yeem sib txawv. Tab sis feem ntau, qhov sib txawv tshwm sim tawm tsam keeb kwm yav dhau los ntawm cov kab mob nrog dystrophic lossis sclerotic hloov pauv hauv cov ntaub so ntswg ntawm zes qe menyuam.
- Feem ntau apoplexy yog qhov tshwm sim ntawm kev loj hlob ntawm tus kab mob polycystic. Ib qho kab mob zoo sib xws hauv feem ntau pib tawm tsam keeb kwm yav dhau los ntawm cov tshuaj hormones hauv lub cev ntawm tus poj niam. Nyob rau hauv cov ntaub so ntswg ntawm zes qe menyuam, me me hlwv yog tsim uas nquag mus rau kev loj hlob - maj mam lub siab nyob rau hauv lub cev nce, uas yuav ua rau ib tug rupture ntawm nws cov ntaub so ntswg. Tsis tas li ntawd, tus kab mob no ua rau muaj kev pheej hmoo ntawm kev hloov pauv ntawm tes.
- Varicose veins ntawm zes qe menyuam yog lwm qhov laj thawj. Kev nthuav dav ntawm lumen ntawm cov hlab ntsha, qhov txo qis hauv lawv txoj haujlwm ua rau muaj ntshav ntau ntxiv. Muaj ib txwm muaj kev pheej hmoo ntawm kev tawg ntawm cov phab ntsa vascular hauv lub zes qe menyuam. Xws li ib tug pathology yog txuam nrog nce fragility ntawm phab ntsa venous, hereditary predisposition, nrog rau kev siv cov tshuaj tiv thaiv hormonal tsis raug.
- Apoplexy tuaj yeem yog qhov tshwm sim ntawm oophoritis. Tawm tsam keeb kwm ntawm tus kab mob no, o ntawm lub zes qe menyuam cov ntaub so ntswg yog pom, uas yog feem ntau nyuaj los ntawm hnyav edema, tsim thiab tsub zuj zuj ntawm purulent masses, uas, qhov tseeb, yuav ua rau rupture. Oophoritis feem ntau tsim tawm tsam keeb kwm ntawm cov kab mob sib kis (tshwj xeeb, tawm tsam keeb kwm ntawm kev ua haujlwm ntawm cov kab mob sib deev).
- Cov npe ua rau muaj xws li zes qe menyuam stromal sclerosis. Pathology yog nrog los ntawm kev loj hlob ntawm cov ntaub so ntswg, uas maj mam hloov cov kev ua haujlwm, glandular qauv ntawm lub cev.
- Hyalinosis yog ib hom protein degeneration, uas yog nrog los ntawm cov plasma proteins thiab lipids nyob rau hauv lub zes qe menyuam capsule, nrog rau cov phab ntsa ntawm cov hlab ntsha.
- Qhov ua rau muaj ntau yam kab mob nrog rau cov ntshav nyias. Tib daim duab tau pom tawm tsam keeb kwm yav dhau los ntawm kev siv cov tshuaj tiv thaiv kab mob mus ntev.
- Qee lub sij hawm apoplexy tsim tawm tsam keeb kwm ntawm cov kab mob neuroendocrine, uas yog nrog los ntawm qhov tseem ceeb hormonal imbalances.
Tsis tas li ntawd, cov kws kho mob txheeb xyuas qee qhov kev pheej hmoo uas, yog tias muaj qhov yuav tsum tau ua ua ntej, tuaj yeem ua rau zes qe menyuam tawg. Lawv cov npe suav nrog:
- rog rog (cov ntaub so ntswg adipose ntau dhau ntawm lub peritoneum feem ntau compresses cov hlab ntsha, cuam tshuam cov ntshav ncig hauv zes qe menyuam);
- equestrianism, hnyav nqa, khaus / dhaukev ua cev nqaij daim tawv;
- mob plab;
- kev sib deev;
- qee cov txheej txheem gynecological.
Nws tsim nyog sau cia tias qee zaum kev sib cais ntawm zes qe menyuam tshwm sim thaum so lossis txawm tias thaum pw tsaug zog.
Cov tsos mob tseem ceeb ntawm pathology
Cov tsos mob ntawm zes qe menyuam apoplexy tuaj yeem txawv. Lawv qhov kev siv ncaj qha nyob ntawm daim ntawv thiab theem ntawm kev loj hlob ntawm pathology, muaj cov kab mob sib kis, cov ntshav poob thiab qee yam.
thawj qhov tsos mob yog mob. Qhov mob syndrome yog txuam nrog kev khaus ntawm cov receptors nyob rau hauv cov ntaub so ntswg ntawm zes qe menyuam, nrog rau spasm ntawm lub vascular phab ntsa.
Raws li txoj cai, qhov mob tshwm sim sai sai, qee zaum tawm tsam keeb kwm ntawm kev noj qab haus huv. Kev hnov lus tsis zoo yog nyob rau hauv qis qis ntawm lub plab kab noj hniav, tab sis qee zaum lawv tuaj yeem kis mus rau sab nraub qaum thiab lub plab, perineum thiab qhov quav.
Mob feem ntau yog mob. Qee lub sij hawm nws tuaj yeem tshwm sim txhua lub sijhawm, hauv lwm qhov nws tuaj yeem tshwm sim thiab ploj mus raws li hom kev cog lus (paroxysmal). Lub sijhawm ntawm kev tawm tsam tuaj yeem nyob ntawm 30 feeb mus rau ob peb teev. Qee zaum xws li "kev cog lus" tau rov ua ob peb zaug hauv ib hnub. Palpation ntawm lub plab, nrog rau kev kuaj gynecological, yog nrog los ntawm kev tsis xis nyob.
Yog tias muaj ntshav poob, cov tsos mob ntawm zes qe menyuam apoplexy yuav txawv. Ntxiv rau qhov mob, cov kab mob hauv qab no kuj tshwm sim:
- tus neeg mob daim tawv nqaij tig daj ntseg, tawm hws ntau ntxiv;
- ntshav poob ua rautxo ntshav siab;
- thaum lub sijhawm kuaj, tus kws kho mob yuav pom tias lub plawv tsis muaj zog lossis nce siab (bradycardia lossis tachycardia);
- ntshav poob yog txuam nrog qhov tshwm sim ntawm qhov tsis muaj zog tam sim ntawd, kiv taub hau (qee zaum txawm tias qaug zog);
- feem ntau koj tuaj yeem soj ntsuam txias, ua npaws;
- cov neeg mob qee zaum yws ntawm xeev siab (cov ntu no feem ntau xaus rau ntuav);
- qhuav ntawm cov mucous hauv qhov ncauj tuaj yeem pom;
- ntshav tuaj yeem tawm hauv qhov chaw mos;
- tus neeg mob yws yws ntawm qhov tso zis ntau zaus, ntuav kom defecate.
Nws tsim nyog sau cia tias feem ntau, cov neeg mob raug coj mus rau hauv tsev kho mob nrog kev tsis txaus siab ntawm qhov mob hnyav, mob plab hauv plab. Tib yam symptomatology tau pom tawm tsam keeb kwm yav dhau los ntawm lwm yam kab mob, tshwj xeeb tshaj yog mob plab hnyuv, ectopic cev xeeb tub, lub raum colic, mob hnyav ntawm phab ntsa plab, mob pancreatitis. Yog vim li cas qhov kev kuaj mob sib txawv ua tau zoo yog qhov tseem ceeb.
Cov tsos mob saum toj no yog vim li cas thiaj li mus ntsib kws kho mob sai. Tsis muaj ib qho xwm txheej twg yuav tsum tsis quav ntsej qhov mob thiab tsis muaj zog, txij li tus poj niam lub neej nyob ntawm lub sijhawm kho.
Kev txhim kho kab mob
Hauv cov tshuaj niaj hnub no, muaj peb hom ntawm zes qe menyuam apoplexy, txhua tus muaj nws tus kheej cov tsos mob.
- Mob, lossis pseudoappendicular, apoplexy yog nrog los ntawm qhov mob tshwm sim, uasqee zaum cuam tshuam nrog xeev siab. Feem ntau, cov tsos mob no yuam kev rau tus mob appendicitis.
- Anemic / hemorrhagic zes qe menyuam apoplexy - daim duab kho mob hauv daim ntawv ntawm tus kab mob no yog tus cwj pwm los ntawm cov tsos mob ntawm los ntshav. Cov neeg mob yws yws ntawm qhov tsis muaj zog, kiv taub hau tas li, uas qee zaum kawg ntawm kev qaug zog. Cov tawv nqaij ntawm cov poj niam tsis tshua muaj xim daj ntseg, uas cuam tshuam nrog kev poob ntawm cov ntshav ntau.
- Kev sib xyaw ntawm cov kab mob sib xyaw ua ke cov tsos mob ntawm ob hom ntawv dhau los ntawm apoplexy.
Koj yuav tsum hu rau tus kws kho mob tam sim yog tias koj xav tias zes qe menyuam apoplexy. Kev saib xyuas xwm txheej kub ntxhov thiab kev kho kom raug rau qhov no yog qhov tseem ceeb heev.
Degrees ntawm kev loj hlob ntawm pathology
Rau tus kws kho mob, qhov ntim ntawm cov ntshav poob hauv tus neeg mob yog qhov tseem ceeb. Nyob ntawm qhov xwm txheej no, muaj peb theem ntawm kev loj hlob ntawm zes qe menyuam apoplexy:
- first degree (mob) - ntshav poob hauv plab tsis ntau tshaj 150 ml;
- degree thib ob (nruab nrab) - tawm tsam keeb kwm ntawm pathology, qhov ntim ntawm cov ntshav poob ntawm 150 txog 500 ml;
- thib peb (mob hnyav) - qib ntshav poob yog qhov loj heev (cov ntshav ntim siab tshaj 500 ml).
Tus kab mob ua rau muaj teeb meem dab tsi?
Koj twb paub tias yog vim li cas zes qe menyuam apoplexy tsim thiab nws yog dab tsi. Qhov tshwm sim ntawm xws li pathology tuaj yeem txaus ntshai heev:
- Pib nrog, nws tsim nyog sau cia tias nrog kev kuaj mob tsis tu ncua ntawm daim ntawv hemorrhagic ntawm apoplexy, qhov tshwm sim ntawm kev tuag yog siab, uas yog vim li cas.nrog rau cov ntshav tsis txaus thiab txuam nrog cov kua dej ntau hauv lub plab kab noj hniav.
- Kev tawg ntawm lub cev qee zaum cuam tshuam kev ua haujlwm ntawm kev ua me nyuam ntawm tus poj niam lub cev. Tshwj xeeb, tom qab yav dhau los apoplexy nyob rau hauv lub zes qe menyuam, nrog rau cov ntaub so ntswg ntawm cov hlab ntsha fallopian, adhesions yog tsim uas tiv thaiv qhov kev loj hlob ntawm lub qe - qhov no yog li cas teeb meem tshwm sim nrog fertilization.
- Raws li kev txheeb cais, apoplexy ua rau muaj kev pheej hmoo ntawm kev xeeb tub ectopic yav tom ntej.
- Tom qab xws li pathology, tsim cov adhesions hauv lub plab kab noj hniav yog ua tau. Tias yog vim li cas cov neeg mob thaum lub sij hawm kho kom rov zoo yog cov tshuaj tiv thaiv kab mob, nrog rau kev kho lub cev tshwj xeeb rau rau lub hlis - txoj kev no koj tuaj yeem tiv thaiv qhov tshwm sim ntawm cov teeb meem no.
- Yog tias tus neeg mob tau txais kev kho mob zoo, ces qhov tshwm sim ntawm kev rov ua dua apoplexy yav tom ntej yog kwv yees li 50%.
Apoplexy thiab cev xeeb tub
Nyob rau hauv nws tus kheej, xws li pathology tsis yog ua rau muaj menyuam. Txawm li cas los xij, txawm tias nrog kev kho kom raug ntawm zes qe menyuam apoplexy, muaj peev xwm ntawm adhesions nyob rau hauv cov hlab ntsha thiab plab kab noj hniav. Tias yog vim li cas cov poj niam muaj teeb meem ob qho tib si nrog fertilization thiab muaj kev vam meej ntawm tus me nyuam.
Yog tus neeg mob cev xeeb tub, nws yuav tsum ua tib zoo saib xyuas nws txoj kev noj qab haus huv. Txog tus mob apoplexy yav dhau los yuav tsum tau qhia rau tus kws kho mob. Raws li kev txheeb cais, muaj kev pheej hmoo siab ntawm kev nchuav menyuam lossis yug ntxov ntxov.
ntsuas ntsuas
Kev kuaj mob raws sij hawm ntawm zes qe menyuam apoplexy yog qhov tseem ceeb heev. Yog tias peb tab tom tham txog cov ntaub ntawv hemorrhagic, ces txawm tias qhov qeeb me ntsis tuaj yeem ua rau cov ntshav poob qis, hemorrhagic shock thiab tuag ntawm tus neeg mob.
Ua ntej ntawm tag nrho, nws yog qhov yuav tsum tau sau cov anamnesis thiab paub txog tus neeg mob cov lus tsis txaus siab. Kev kuaj gynecological yog qhov yuav tsum tau ua. Lub ntuj xim ntawm qhov chaw mos yog khaws cia, tsuas yog qee zaum muaj me ntsis pallor ntawm cov ntaub so ntswg. Qhov loj ntawm lub tsev menyuam kuj zoo li qub. Txawm li cas los xij, qhov cuam tshuam ntawm zes qe menyuam loj, thiab nws cov palpation yog nrog los ntawm kev mob hnyav, ntse.
Tshuaj kuaj ntshav thiab. Qee zaum muaj qhov nce me ntsis ntawm cov leukocytes, nrog rau qhov txo qis hauv hemoglobin, uas cuam tshuam nrog ntshav poob.
Pom zes qe menyuam apoplexy ntawm ultrasound. Thaum kuaj xyuas, tus kws kho mob tshwj xeeb tuaj yeem kuaj xyuas cov kab mob ntawm qhov chaw mos ntawm lub plab mog, pom qhov sib sau ntawm cov kua dej zoo thiab nruab nrab hauv lub zes qe menyuam, nrog rau hauv plab kab noj hniav. Kev txhaj tshuaj tom qab fornix ntawm qhov chaw mos yog ua tiav, uas ua rau nws muaj peev xwm txheeb xyuas qhov sib txuam ntawm cov kua dej, cov ntshav lossis cov kua paug hauv lub plab kab noj hniav. Kev tshuaj xyuas kuj tseem ua tiav rau qib ntawm chorionic gonadotropin - qhov no tso cai rau koj kom tsis suav nrog (lossis paub meej) qhov muaj ectopic cev xeeb tub.
Qee zaus laparoscopy tau ua ntxiv - kev phais mob, thaum lub sijhawm cov cuab yeej tshwj xeeb tau muab tso rau hauv lub plab me me los ntawm cov pob me me ntawm phab ntsa plab. Thaum lub sijhawm ua haujlwm, tus kws kho mob tshwj xeeb tuaj yeem kuaj ntshav thiab txhaws hauv cov kab noj hniav dawb, ntsuas qhov loj thiabKev mob ntawm lub tsev menyuam, txheeb xyuas qhov mob ntawm cov hlab ntsha hauv plab.
Thaum kuaj mob, nws yog ib qho tseem ceeb heev los txiav txim seb qhov ua rau ntawm zes qe menyuam apoplexy, nrog rau daim ntawv thiab theem ntawm kev loj hlob ntawm pathology. Kev ua tiav ntawm kev kho mob feem ntau yog nyob ntawm cov xwm txheej no.
Kev pab ib zaug
Yog tias muaj mob hnyav thiab lwm yam tsos mob tau piav qhia saum toj no, tus neeg mob yuav tsum tau coj mus rau lub tsev kho mob sai sai thiab, yog li ntawd, yuav tsum hu rau lub tsheb thauj neeg mob. Tsuas yog ib tus kws kho mob tom qab kuaj mob tuaj yeem kuaj xyuas zes qe menyuam apoplexy.
Yuav ua li cas thaum tos cov kws kho mob tuaj txog? Qhov tseeb, tsis muaj coob leej tuaj yeem pab tus poj niam hauv tsev. Nws tsuas yog tsim nyog los tso tus neeg mob nrog lub hauv ncoo hauv qab nws lub taub hau. Cov kws kho mob tsis pom zoo kom noj tshuaj analgesics, tshuaj tiv thaiv kab mob lossis lwm yam tshuaj los pab tswj kev mob, uas tuaj yeem ua rau cov txheej txheem kuaj mob nyuaj lossis ua rau mob hnyav dua.
Kev Tiv Thaiv Kev Tiv Thaiv
Kev kho mob ntawm zes qe menyuam apoplexy tsuas yog ua rau cov mob me me xwb, thaum cov tsos mob me me thiab tsis muaj los ntshav. Lub tswv yim ntawm kev kho nyob rau hauv cov ntaub ntawv no yog raws li nram no:
- tus neeg mob xav tau so lub cev tag nrho;
- Ice muab tso rau ntawm lub plab mog vim nws pab tswj cov hlab ntsha thiab txo qhov kev pheej hmoo los ntshav;
- tshuaj hemostatic kuj tseem siv, tshwj xeeb yog Ascorutin thiab Vikasol;
- antispasmodics yog siv los txo qhov mob, xws li "Papaverine" lossis "No-shpa";
- tus neeg mob yog cov tshuaj vitamin complexes (cov tshuaj siv, uas suav nrogmuaj cov vitamins B12, B1 thiab B6, thiab ascorbic acid).
Kev kho mob li no tsuas yog ua hauv tsev kho mob xwb - tus neeg mob yuav tsum tau saib xyuas kev kho mob tas li. Yog tias los ntshav tau qhib, ces tus poj niam yuav tsum tau ua haujlwm.
Apoplexy ntawm zes qe menyuam ua rau muaj kev pheej hmoo ntawm adhesions, tshwj xeeb tshaj yog thaum kho nrog tshuaj. Tias yog vim li cas qhov kev kho mob zoo li no tau muab rau cov poj niam uas tsis npaj yuav muaj menyuam yav tom ntej. Yog tias peb tham txog cov neeg mob hluas, qhov kev xaiv zoo tshaj plaws yog kev phais.
Kev cuam tshuam phais rau apoplexy
Feem ntau, apoplexy yog kho los ntawm kev phais. Hauv qhov no, laparoscopy yog ua. Cov txheej txheem no muaj ntau yam zoo:
- pib nrog, nws tsim nyog sau cia tias qhov no yog txoj kev maj mam tshaj plaws, txij li cov cuab yeej tau muab tso rau hauv los ntawm cov pob me me hauv cov plab hnyuv (tsis muaj qhov caws pliav loj ntawm daim tawv nqaij);
- tom qab kev ua haujlwm zoo li no, kev ua haujlwm ntawm cov menyuam yaus feem ntau khaws cia;
- lub sijhawm rov kho dua yog luv, tsis muaj qhov mob;
- Kev pheej hmoo ntawm cov ntaub so ntswg tsawg tsawg.
Technique ntau nyob ntawm daim ntawv ntawm apoplexy, ntim thiab tus nqi ntawm cov ntshav poob, nrog rau qee cov ntaub so ntswg.
- Feem ntau, tus kws kho mob tsuas yog xaws cov ntaub so ntswg zes qe menyuam ua ke maj mam.
- Yog tias tsim nyog, ua tiavcoagulation kua muag - rau lub hom phiaj no ib tug tshwj xeeb bipolar coagulator yog siv.
- Qee zaum cov ntaub so ntswg zes qe menyuam raug tshem tawm thiab tom qab ntawd sutured. Tib lub sijhawm, kev tsim cov adhesions tuaj yeem raug tshem tawm.
- Kev tshem tawm ntawm zes qe menyuam ua tiav tsuas yog muaj kev puas tsuaj rau nws cov ntaub so ntswg lossis los ntshav loj.
Thaum lub sijhawm rov kho mob, cov poj niam tau muab tshuaj tshwj xeeb. Tsis tas li ntawd, ntau txoj kev kho lub cev yog siv, suav nrog electrophoresis ntawm lidases thiab zinc, ultrasound kho, magnetotherapy thiab hluav taws xob stimulation ntawm cov hlab ntsha. Cov txheej txheem no pab tiv thaiv kev txhim kho ntawm ntau yam teeb meem, tshwj xeeb tshaj yog cov txheej txheem nplaum.
Ovarian apoplexy: cov lus qhia kho mob rau kev tiv thaiv tus kab mob thiab nws rov ua dua
Qhov tseeb, tsis muaj ib txoj kev tshwj xeeb rau kev tiv thaiv tus kab mob no. Cov poj niam raug qhia kom zam kom tsis txhob raug cuam tshuam los ntawm kev pheej hmoo. Tsis tas li ntawd, txhua yam kab mob gynecological, tshwj xeeb tshaj yog oophoritis thiab adnexitis, yuav tsum tau kho raws sijhawm.
Yog hais tias ib tug poj niam tau raug mob ntawm zes qe menyuam apoplexy, ces qhov kev tshwm sim yog qhov zoo - lub cev sai sai thiab rov zoo tag nrho. Tab sis tom qab daim ntawv hemorrhagic ntawm pathology, kev kho tshuaj hormone yog tsim nyog - qhov no yuav pab tiv thaiv kev rov qab los ntawm tus kab mob.
