kab mob Trophoblastic yog ib pawg ntawm cov qog nqaij hlav qog nqaij hlav uas tshwm sim los ntawm placental trophoblasts. Lub sij hawm muaj xws li pathologies xws li hydatidiform mole (ib nrab thiab tiav), invasive hydatidiform mole, placental site trophoblastic qog, choriocarcinoma, thiab trophoblastic epithelioid qog. Pathology raug kuaj pom tsuas yog nrog kev pab ntawm ultrasound thiab CT scans, kev kuaj xyuas uas tsim los kuaj xyuas qhov concentration ntawm hCG hauv cov ntshav. Kev kho mob yog sau nyob rau hauv daim ntawv ntawm hysterotomy, chemotherapy, tshem tawm cov mole.
Kev piav qhia tus kab mob
kab mob Trophoblastic hauv kev xyaum gynecological yog tsawg - hauv 1-3% ntawm cov neeg mob tawm ntawm ib puas - thiab suav tias yog kab mob tsawg heev. Txoj kev loj hlob ntawm no pathology yog tsis yooj yim sua yam tsis muaj lub xub ntiag ntawm cev xeeb tub, txij li thaum nyob rau hauv feem ntau lub tsev menyuam yog lub ntsiab qhov chaw ntawm localization. Nws yuav tsum raug sau tseg tias nws muaj ntau tshaj ib daim ntawv. Xav txog ntau hom ntawv,Ib nrab cystic drift tso nyiaj rau 5% ntawm cov neeg mob, chorioncarcinoma - 17%, ua tiav drift - 72.2%, thiab lwm hom - 5.3%.
Thaum tus kab mob trophoblastic, cov kab mob loj hlob ntawm cov txheej txheej sab nrauv ntawm cov embryonic hlwb tsim, uas, nyob rau hauv lem, koom ncaj qha rau kev tsim cov epithelial npog ntawm chorionic villi. Xws li ib tug pathology tuaj yeem tshwm sim tom qab qhov kawg ntawm cev xeeb tub thiab thaum lub sij hawm cev xeeb tub. Nws tuaj yeem tshwm sim hauv daim ntawv malignant thiab benign. Tab sis ib txoj kev los yog lwm qhov, pathology yog ib qho mob txaus ntshai heev uas tuaj yeem ua rau cov txiaj ntsig tsis zoo.
Yam uas ua rau muaj kev pheej hmoo ntawm pathology
Thaum qhov ua rau thiab muaj kev pheej hmoo ntawm tus kab mob no tau kawm, nws tau pom tias cov qog nqaij hlav trophoblastic raug kuaj pom ntau dua hauv cov poj niam ntawm ib lub hnub nyoog, anamnesis thiab obstetric keeb kwm yog tus yam ntxwv, thiab thaj chaw muaj peev xwm ua tau ib qho tseem ceeb. luag hauj lwm hauv no. Yog li, qhov xwm txheej txaus ntshai yog:
- poj niam muaj hnub nyoog 20-50 xyoo, lub sijhawm txaus ntshai tshaj plaws yog 40 xyoo thiab laus dua;
- thib ob thiab tom qab cev xeeb tub;
- History of nchuav menyuam.
Ntawm cov poj niam uas nyob rau sab hnub tuaj, cov kab mob no tshwm sim. Yog tias tus neeg mob twb tau kuaj pom tias muaj mole, muaj kev pheej hmoo ntawm tus kab mob thiab choriocarcinoma. Metastasis feem ntau yuav tshwm sim hauv cov neeg uas saib cov tsos mob ntawm pathology thiab lub sijhawm latent rau lub sijhawm ntev.
Kev faib tawm ntawm tus kab mob trophoblastic
raws liKev faib tawm thoob ntiaj teb qhia qhov txawv ntawm cov qauv zoo thiab cov kab mob tsis zoo neoplasms.
Yog li, malignant neoplasm yog subdivided rau hauv:
- rau invasive mole;
- trophoblastic qog ntawm placental txaj;
- choriocarcinoma;
- emitters ntawm unicellular trophoblastic qog.
Malignant neoplasm muaj metastatic thiab tsis-metastatic kev soj ntsuam kev nthuav qhia, qis lossis siab.
Thiab, daim ntawv benign ntawm kab mob trophoblastic hauv gynecology tau muab faib ua:
- rau ib nrab hydatidiform drift (mild form);
- nplua nuj.
Tus cwj pwm txawv
Kev qhia txog kab mob trophoblastic qhia tau tias nws tuaj yeem muaj tus cwj pwm txawv. Ib txoj kev lossis lwm qhov, nws yuav yog ib qho tseem ceeb los txiav txim siab ntau theem ntawm kev loj hlob ntawm tus kab mob, uas tso cai rau peb nkag siab txog qib ntawm kev phom sij ntawm tus kab mob.
Raws li qhia los ntawm FIGO kev soj ntsuam kev faib tawm, muaj cov theem:
- Thawj theem. Tsuas yog lub tsev menyuam raug cuam tshuam, tsis muaj metastases nyob rau theem no.
- theem thib ob. Metastases tau kis mus rau qhov chaw mos, pelvis thiab appendages.
- Thib peb. Metastases tau nkag mus rau hauv lub ntsws, tsis hais txog qhov chaw mos uas cuam tshuam.
- theem plaub. Ntau yam metastases nyob deb tshwm sim (lub raum, siab, spleen, plab hnyuv, hlwb).
Huab cua
Yog tus kab mob ntawm lub tsev menyuam kho tau raws sijhawm thiab raug, ces txhua yam yuav dhau mus yam tsis muaj teeb meem. Tshuaj kho mob muaj 70% kev vam meej nrog daim ntawv metastatic thiab 100% kev vam meej nrog daim ntawv tsis-metastatic.
Ntau zaus, cov poj niam hluas tuaj yeem khaws lawv cov kev ua haujlwm zoo. Yuav kom cev xeeb tub tom ntej kom ua tiav, koj yuav tsum ua raws li tag nrho cov lus pom zoo thiab cov tshuaj ntawm tus kws kho mob. Nws yog ib qho tsim nyog yuav tsum tau mus kuaj ob zaug hauv ib xyoos thiab nyob rau hauv kev saib xyuas ntawm tus kws kho mob tas li, siv tshuaj tiv thaiv kab mob.
Relapse tsuas yog tshwm sim hauv 4-8% ntawm tus neeg mob.
Txhua yam kab mob raug txiav txim siab hauv oncology ua ib qho txheej txheem etiopathogenetic. Qhov ua rau muaj tus kab mob trophoblastic tuaj yeem yog kab mob khaub thuas, cov khoom tshwj xeeb ntawm lub qe, chromosomal aberrations, immunological yam, kev ua haujlwm siab hyaluronidase, protein deficiency.
Leej twg tau ntau zaus?
Pathology feem ntau tshwm sim rau cov poj niam hnub nyoog plaub caug xyoo (tej zaum 5 zaug), cov poj niam hnub nyoog qis dua 35 raug mob los ntawm tus kab mob no ntau dua. Lwm qhov chaw ntawm kev pheej hmoo tuaj yeem raug txheeb xyuas, cov uas yog rho menyuam, cev xeeb tub rau tus kheej lossis yug menyuam. Muaj ib qho qauv uas tus kab mob no feem ntau pom nyob rau hauv cov poj niam los ntawm sab hnub tuaj, tab sis cov poj niam los ntawm sab hnub poob tsis tshua pom tus kab mob no.
Tom qab cov hydatidiform mole tau raug xa mus, kev loj hlob ntawm choriocarcinoma yuav pib. Nrog rau tag nrho daim ntawv ntawm cystic drift, ib tug invasive drift tsim. Kev skid ib nrab muaj kev cuam tshuam tsawg dua ntawm cov txheej txheem no.
Tom qab qhov kawg ntawm kev xeeb tub,rho menyuam, nchuav menyuam, yug menyuam, lossis thaum cev xeeb tub (ib txwm lossis ectopic), kev hloov pauv hauv cov qauv ntawm trophoblast yuav tshwm sim.
Cia peb xav txog cov tsos mob tseem ceeb ntawm tus kab mob trophoblastic.
Symptoms
Cov cim tseem ceeb ntawm tus kab mob yog:
- qhov nce ntawm qhov loj ntawm lub tsev menyuam uas tsis sib haum xeeb ntawm lub hnub nyoog gestational (50%);
- bilateral thecalutein cysts (hauv 40% ntawm tus neeg mob);
- Vaginal los ntshav (kwv yees li 90%).
Feem ntau, cov txheej txheem ntawm hydatidiform mole tuaj yeem nyuaj los ntawm preeclampsia, toxicosis ntawm tus poj niam cev xeeb tub (ntuav ntuav), arterial hypertension, rupture ntawm zes qe menyuam, cov tsos mob ntawm hyperthyroidism (hyperthermia, tachycardia). Cov txheej txheem no tseem cuam tshuam tsis zoo los ntawm kev los ntshav ntau. Qee zaum, daim ntawv no ua rau PE thiab DIC.
Yog tias peb xav txog kev kho mob tsis txaus ntseeg ntawm hydatidiform mole hauv kab mob trophoblastic, ces nws yog qhov tsim nyog los qhia txog:
- metastasis rau qhov chaw mos, ntsws, qhov chaw mos;
- kev loj hlob;
- nce kev pheej hmoo ntawm kev hloov pauv mus rau choriocarcinoma.
Chorioncarcinoma tuaj yeem ua rau muaj kev phom sij vim tias nyob rau hauv nws cov phab ntsa ntawm lub tsev menyuam tuaj yeem tawg. Yog li ntawd, hom kab mob no feem ntau ua rau los ntshav hnyav. Los ntawm choriocarcinoma, metastases sai sai kis mus rau lub plab hnyuv siab raum, ces mus rau daim siab, ob lub raum, spleen, ntsws, plab, thiab hlwb.
Thiab, cov qog trophoblastic puas tsuajserous txheej ntawm lub tsev menyuam, uas yuav ua rau los ntshav. Cov qog no ua rau muaj kev nkag mus ntawm metastases mus rau hauv lub plab kab noj hniav, qhov chaw mos thiab lub hlwb.
Ib kab mob epithelioid cell nyob rau hauv lub tsev me nyuam kwj dej los yog hauv qab ntawm lub tsev menyuam. Cov qog no hauv nws cov tsos mob yuav zoo li mob qog noj ntshav. Hom kab mob trophoblastic no ua rau nws tus kheej hnov tom qab ob peb xyoos ntawm cev xeeb tub.
Dab tsi ua rau metastases?
Qhov tshwm sim ntawm metastases provokes mob taub hau, mob hauv siab, hnoos nrog cov hnoos qeev, plab hnyuv, ntshav ntshav, plab hnyuv, cachexia, intoxication thiab lwm yam.
Muaj cov kab mob zoo li no uas tuaj yeem ua rau mob plab, rupture thiab torsion ntawm ob txhais ceg ntawm hlwv, compression ntawm cov hlab ntsha pob tw, perforation ntawm lub tsev menyuam.
Koj yuav tsum paub tias cov tsos mob ntawm tus kab mob tuaj yeem sib txawv. Tab sis thaum thawj cov cim tshwm sim, koj yuav tsum sab laj nrog kws kho mob tam sim ntawd.
Kev kuaj mob trophoblastic
Cov poj niam uas kuaj pom tus kab mob no tau muaj cev xeeb tub uas xaus rau kev rho menyuam tawm (yug los yog tshwm sim), tubctomy rau cev xeeb tub, lossis yug menyuam.
Cov poj niam feem ntau yws yws ntawm acyclic uterine los ntshav, mob taub hau, amenorrhea, oligomenorrhea, menorrhagia, hnoos, hauv siab thiab mob plab, hemoptysis.
Thaum kuaj gynecological, qhov ntev ntawm lub tsev menyuam tau txiav txim siab, uas qee zaum tsis sib xwspostpartum los yog gestational age. Feem ntau tus kws kho mob gynecologist tuaj yeem kuaj pom cov qog nqaij hlav hauv qhov chaw mos, tsev menyuam, thiab lub plab me me los ntawm palpation.
txhawm rau kuaj cov qog nrog me me txog li 5 hli, transvaginal ultrasound yog qhov zoo tagnrho. Ib qho cim ntawm tus kab mob yuav loj thecalutein zes qe menyuam.
Txoj Kev Pab
Kev kuaj pom ntawm metastases hauv lub plab thiab lwm yam kabmob yog txiav txim siab siv txoj hauv kev pabcuam:
- CT;
- MRI ntawm lub hlwb;
- Ultrasound ntawm lub plab kab noj hniav, raum, siab;
- PET;
- CT ntsws;
- x-ray.
Yog tias kuaj pom metastases, sab laj nrog tus kws phais plab plab, kws kho mob hlwb, kws kho mob urologist, pulmonologist.
Tus kab mob trophoblastic kho li cas?
Kev kho mob
Cov txheej txheem ntawm kev ntsuas kev kho mob yog txiav txim siab rau tus kab mob muab los ntawm nws theem thiab daim ntawv.
Kev kho mob ntawm hydatidiform drift yog ua los ntawm kev siv lub tshuab nqus tsev nrog cov kev tswj xyuas yav tom ntej ntawm lub tsev menyuam kab noj hniav. Thaum cov mole tau raug tshem tawm, kev siv tshuaj tiv thaiv yuav tsum tau siv rau ib xyoos. Kev kho tshuaj khomob nrog kev txo qis hauv qib hCG mus rau tus nqi ib txwm tsis tau sau tseg.
Cov lus qhia kho mob rau cov kab mob trophoblastic yuav tsum tau ua nruj me ntsis.
Tshuaj khomob
Yog tias muaj cov kab mob pathology nrog cov tsos mob tsis zoo, tom qab ntawd tshuaj kho mob tau muab tshuaj. Cov txheej txheem ntawm kev kho mob yuav ua tau raws li hauv qab no:
- Cisplatin thiab Etoposide;
- "Dactinomycin" thiab "Methotrexate";
- Methotrexate, Cisplatin, Dactinomycin, Vincristine.
Thaum muaj qhov perforation ntawm phab ntsa ntawm lub tsev menyuam, los ntshav los ntawm qhov pib qog thiab tsis kam mus rau kws khomob, txoj kev phais yog qhia. Organ-sparing hysterotomy yog pom zoo rau cov neeg mob uas muaj hnub nyoog me nyuam. Nyob rau hauv rooj plaub thaum ib tug poj niam tsis npaj yuav yug me nyuam, ib tug radical hysterectomy los yog supravaginal tshem tawm.
Tom qab qhov kawg ntawm kev kho mob ntawm gestational trophoblastic kab mob, nws raug nquahu kom ua raws li kev soj ntsuam hCG, echographic tswj, thiab dynamic ntsws radiography ob peb zaug hauv ib xyoos.
Tom qab muaj kab mob, cov poj niam yuav muaj peev xwm npaj cev xeeb tub tsis ntxov tshaj li 11-17 lub hlis.
Peb tau tshuaj xyuas cov lus qhia tseem ceeb rau tus kab mob trophoblastic.
