Thaum lub zes qe menyuam tawg, ib tug poj niam muaj kev mob hnyav thiab lwm yam tsos mob tsis zoo. Yog tias koj tsis pom tus kws kho mob hauv lub sijhawm, qhov tshwm sim no tuaj yeem ua rau tuag taus. Tus kws kho mob yuav tsum xa tus neeg mob mus rau kev ua haujlwm, nrog rau kev ua tiav zoo ntawm qhov muaj feem yuav xeeb tub. Kab lus yuav tham txog qhov ua rau thiab qhov tshwm sim ntawm zes qe menyuam rupture nyob rau hauv cov poj niam.
Kev faib tawm
Nyob ntawm seb cov tsos mob ntawm zes qe menyuam tawg yog qhov tseem ceeb, muaj 3 hom kab mob no:
- anemic - lub rupture yog nrog los ntawm profuse los ntshav thiab zoo ib yam li rupture ntawm lub fallopian raj thaum lub sij hawm cev xeeb tub ectopic;
- pseudoappendicular - cov tsos mob tseem ceeb: autonomic dysfunction thiab mob;
- mixed - muab cov yam ntxwv ntawm ob hom saum toj no.
Raws li qib ntawm kev loj hlob ntawm pathology, lawv paub qhov txawv:
- daim ntawv teeb - nrog ntshav poob txog 150 ml;
- medium - 150-500ml;
- hnyav - tshaj 500 ml.
Qhov txaus ntshai tshaj plaws yog cov kab mob anemic thiab cov ntawv sib xyaw nrog qib kawg ntawm cov ntshav poob, vim lawv ua rau muaj ntshav tsis txaus.
Pseudoappendicular kua muag yog ib qho yooj yim tshaj plaws. Feem ntau, nrog daim ntawv no, lawv tsis siv rau kev cuam tshuam kev phais. Hematoma tshwm sim nyob rau hauv cov ntaub so ntswg ntawm zes qe menyuam, tab sis tsis muaj qhib hemorrhage mus rau hauv lub plab kab noj hniav. Qhov pib ntawm tus kab mob yog tus cwj pwm los ntawm ib qho kev ntse piv rau rab riam. Qhov mob maj mam kis mus rau tag nrho lub plab mog, sab hauv ncej puab, sab nraub qaum.
Daim ntawv sib xyaw yog tshwm sim ua ntej los ntawm qhov mob, thiab tom qab ntawd los ntawm kev los ntshav. Nyob rau tib lub sijhawm, kev xav tsis zoo ua npub lossis ploj tag, vim tias tus poj niam ncua sijhawm mus ntsib kws kho mob. Qhov no ua tsis tau. Tam sim ntawd tom qab thawj cov tsos mob ntawm tus kab mob, koj yuav tsum mus ntsib kws kho mob gynecologist.
Etiology
Qhov ua rau thiab qhov tshwm sim ntawm zes qe menyuam rupture yuav tham hauv qab no.
Nyob rau hauv cov kabmob no, ib tug poj niam laus hlob hauv cov follicles uas cov qe loj hlob tuaj. Qhov pib ntawm kev coj khaub ncaws tshiab ua rau muaj kev loj hlob ntawm cov follicle tseem ceeb, ncav cuag qhov loj ntawm li 20 mm los ntawm nruab nrab ntawm lub voj voog. Thaum lub sij hawm ib txwm ua ntawm lub voj voog no, follicular membrane ruptures nrog kev tso tawm ntawm lub qe, uas txhais tau hais tias pib ntawm ovulation txheej txheem. Nyob rau hauv qhov chaw ntawm ruptured follicle, ib tug corpus luteum yog tsim, nyob rau hauv uas cov tshuaj hormones yog tsim los npaj tus poj niam lub cev rau cev xeeb tub.
Nyob rau hauv cov ntaub ntawv ntawm sclerotic thiab dystrophic dynamics nyob rau hauv cov ntaub so ntswg ntawm zes qe menyuam, uas tsim nyob rau hauv ntau yam. Cov txheej txheem inflammatory thiab stimulation ntawm ovulation nrog kev pab los ntawm cov tshuaj, kev cuam tshuam tshwm sim nyob rau hauv nws cov txheej txheem thiab tsim cov corpus luteum.
Qhov no ua rau:
- txo qis cov hlab ntsha ntawm qhov chaw tawg;
- a hematoma cov ntaub ntawv nyob rau hauv lub corpus luteum;
- nce ntshav hauv plab plab.
Tsis tas li, qhov ua rau ntawm zes qe menyuam tawg tuaj yeem yog cov hauv qab no:
- cov txheej txheem inflammatory hauv plab hnyuv;
- cov tshuaj hormones, suav nrog cov uas tshwm sim los ntawm kev tshem tawm cov tshuaj tiv thaiv kab mob;
- tsim cov hlwv ntawm corpus luteum lossis zes qe menyuam - feem ntau cov hlwv loj thiab cov qog uas muaj txoj kab uas hla ntau tshaj 50 hli rupture;
- ntshav txhaws vim muaj ntau yam ua rau;
- kev ntxhov siab ntau dhau ntawm cov hlab ntsha thaum pib ntawm kev coj khaub ncaws;
- nquag douching;
- pathologies hauv cov hlab ntsha;
- tsim cov kab mob nplaum rau ntawm lub cev xeeb tub;
- ua kom lub cev muaj zog;
- tsis tsim nyog douching;
- lub cev hnyav dhau, uas ua rau cov hlab ntsha tawg;
- mus ntsib sauna lossis da dej;
- kev sib tw;
- caij;
- mob plab;
- curvature ntawm lub tsev menyuam;
- retroflection;
- sov lub zes qe menyuam los ntawm cov qog ntawm lub cev nyob ze;
- sclerocystosis;
- ovarian varicose leeg;
- kev kuaj gynecological ntxhib;
- siv sijhawm ntev ntawm cov tshuaj tiv thaiv coagulants.
Zoo tshajTus naj npawb ntawm cov kab mob pathology tau pom hauv cov poj niam hnub nyoog 25-30 xyoo.
Cov tsos mob ntawm zes qe menyuam rupture
Nws tsis tuaj yeem txiav txim siab tsis meej los ntawm qee cov cim tshwj xeeb uas lub zes qe menyuam tau tawg. Cov tsos mob tseem ceeb ntawm lub zes qe menyuam tawg yog qhov tshwm sim ntawm qhov mob hnyav hauv plab plab, uas maj mam nce thiab pib tawg mus rau hauv puab tais thiab sab nraub qaum.
Lwm cov tsos mob tshwm sim:
- ntshav tawm qhov chaw mos;
- txo cov ntshav siab;
- mob siab;
- nquag tso zis;
- nrog cov ntshav tawm sab hauv - qhov pom ntawm hws txias thiab blanching ntawm daim tawv nqaij;
- xeev siab thiab ntuav;
- nce kub;
- kev tsis sib haum;
- tsis muaj zog;
- plab nro;
- dry mouth.
Cov tsos mob ntawm zes qe menyuam rupture nyob rau hauv cov poj niam nyob ntawm seb lub etiology ntawm tus kab mob thiab cov degree ntawm nws manifestation. Thaum muaj qhov xwm txheej zoo li no tshwm sim, lub xeev ntawm kev poob siab thiab qaug zog tuaj yeem tshwm sim. Lawv tshwm sim nyob rau hauv cov ntaub ntawv ntawm ib tug loj heev pathology.
Qhov feem ntau kuaj pom sab xis ntawm zes qe menyuam apoplexy (lub npe tshawb fawb ntawm tus kab mob). Qhov no yog vim qhov tseeb tias lub cev no tau txais cov ntshav ntau tshaj plaws thiab nyob ze ntawm lub aorta. Dominant follicles yog tsim nyob rau hauv feem ntau ntawm cov poj niam nyob rau hauv txoj cai zes qe menyuam.
Diagnosis
Qhov ua rau thiab qhov tshwm sim ntawm zes qe menyuam rupture yog sib cuam tshuam. Qhov tseeb kev kuaj mob ntawm zes qe menyuam rupture yogtsuas yog 4-5% ntawm cov neeg mob. Qhov no yog vim qhov tseeb tias daim duab kho mob tsis yog tus yam ntxwv thiab tuaj yeem txhim kho zoo li lwm yam kab mob ntawm lub plab me me thiab plab kab noj hniav.
Tus neeg mob raug xa mus rau tsev kho mob nrog kev kuaj mob "mob plab". Kev piav qhia ntawm qhov ua rau yog ua thaum mus pw hauv tsev kho mob. Kev ncua kev kuaj mob tuaj yeem ua rau muaj ntshav ntau ntxiv thiab ua rau tus poj niam noj qab haus huv.
Cov kev kuaj mob siv tau raws li hauv qab no:
- kev tsis txaus siab ntawm qhov mob plab hauv plab, uas tsim los ze rau qhov thib ob ntawm kev coj khaub ncaws;
- lub zes qe menyuam raug mob, muaj cov tsos mob ntawm peritoneal irritation;
- anemic thiab sib xyaw cov ntaub ntawv yog tus cwj pwm los ntawm qib qis ntawm hemoglobin hauv cov ntshav;
- lub posterior fornix yog punctured kom pom cov ntshav hauv plab;
- ultrasound yog ua, nrog kev pab los ntawm qhov loj corpus luteum pom nyob rau hauv lub zes qe menyuam nrog rau cov ntshav nyob rau hauv nws los yog nyob rau hauv lub plab mog, qhov sib txawv nws tus kheej yog tsis txiav txim siab;
- nyob rau hauv rooj plaub ntawm kev txiav txim siab ua haujlwm rau zes qe menyuam rupture, nws yog ua los ntawm laparoscopy, uas tso cai rau koj los tsim cov hom pathology nrog 100% tseeb; Yog hais tias muaj hemorrhagic shock los yog cov txheej txheem adhesion ntev, ces tus txheej txheem no yog contraindicated, nyob rau hauv cov ntaub ntawv no, ib tug kws kho mob thiab diagnostic laparotomy yog sau.
Palpation thiab kuaj ntawm lub rooj zaum gynecological qhia qhov mob ntawm sab hauv plab. Thaum siv qhov chaw mos ntawm qhov chaw mos, pom cov zes qe menyuam loj,hos qhov loj ntawm lub tsev menyuam tseem zoo li qub.
Yog li, qhov kev kuaj mob zaum kawg yog ua thaum lub sijhawm ua haujlwm.
kev kho mob
Txhawm rau tiv thaiv qhov tshwm sim tsis zoo ntawm zes qe menyuam rupture nyob rau hauv ib tug poj niam, cov ua rau tus kab mob no yuav tsum tau muab tshem tawm nyob rau hauv lub sij hawm. Kev kho mob tuaj yeem ua tiav raws li lub hauv paus ntsiab lus ntawm kev saib xyuas kev kho mob lossis kev phais.
thawj txoj kev tuaj yeem siv tau thaum muaj ntshav me me (txog 150 ml) rau cov poj niam uas tau dhau lub sijhawm xeeb tub lossis tsis npaj cev xeeb tub yav tom ntej.
Nyob rau hauv cov ntaub ntawv no, cov dej num thiab tshuaj hauv qab no tau sau tseg:
- "Fenyuls", "Tardiferon" thiab lwm yam khoom muaj hlau;
- "No-shpa", "Drotaverine", "Baralgin" thiab lwm yam tshuaj tua kab mob thiab tshuaj tua kab mob rau kev kho mob;
- hemostatic pain relievers: vitamins B1, B6, B12, C, Vikasol, Etamzilat;
- roj hmab ice ntim rau hauv plab kom ua rau vasospasm, uas yuav txo qhov mob los ntawm kev tso ntshav;
- siv tswm ciab nrog belladonna;
- daws txoj kev kho yog siv los tiv thaiv adhesions, tshuaj tiv thaiv kab mob, kev npaj enzyme, vitreous lub cev siv;
- nruj txaj so.
Kev kho ntawm zes qe menyuam rupture yog txuas ntxiv tom qab cov tsos mob nyem. Tus neeg mob tau muab tshuaj electrophoresis nrog calcium chloride, kho nrog Bernard tam sim no, diathermy.
Kev kho mob ntau zaus ua rau muaj menyuam tsis taus, 50% ntawm cov poj niam uas tau txais kev kho mob zoo li no tau rov ua dua. Qhov no yog vim qhov tseeb tias cov ntshav thiab cov hlab ntsha uas raug tshem tawm ntawm lub plab kab noj hniav thaum lub sij hawm phais, tab sis nyob twj ywm rau hauv nws, pab tsim cov adhesions nyob rau hauv lub me me pelvis.
Surgery
Nws tau ua los kho thiab tiv thaiv qhov ua rau thiab qhov tshwm sim ntawm zes qe menyuam tawg. Kev ua haujlwm yog ua los ntawm laparoscopy lossis laparotomy nrog qhov zoo dua ntawm thawj txoj kev. Nws qhov zoo:
- me me txaus ntshai ntawm adhesion tsim nrog preservation ntawm kev ua me nyuam;
- txo qis cov tshuaj kho mob tom qab phais;
- tsev kho mob luv;
- rov qab los ntawm tshuaj loog;
- poj niam ua kom ntxov;
- tsis muaj qhov caws pliav hauv plab.
Laparotomy yog ua nrog adhesions, hemorrhagic shock, thiab tsis muaj cov cuab yeej tsim nyog rau kev siv thawj hom kev ua haujlwm.
Thaum kev cuam tshuam kev phais:
- txhaj ntshav;
- nws tshem tawm nrog cov hlab ntsha hauv plab;
- yaug nrog tshuaj tua kab mob.
Nrog cov hemorrhage loj nyob rau hauv cov ntaub so ntswg ntawm zes qe menyuam, tom kawg tuaj yeem tshem tawm tag nrho.
Txhais tau
Feem ntau, kev kho mob tau zoo.
Kev tawg ntawm zes qe menyuam hauv cov poj niam tuaj yeem ua rau muaj kev nyuaj siab heevqhov tshwm sim:
- ua haujlwm tsis zoo ntawm lub cev xeeb tub - ntau dua 40% ntawm cov poj niam tsim kev xeeb tub vim muaj cov txheej txheem inflammatory, hormonal imbalance thiab adhesion tsim, yog tias ib qho zes qe menyuam noj qab haus huv, txoj hauv kev xeeb tub tseem nyob;
- peritonitis;
- ectopic cev xeeb tub - tsim los ntawm torsion thiab khoov ntawm cov hlab ntsha fallopian thiab tsim cov adhesions nyob rau hauv lub plab mog, qhov tshwm sim ntawm nws tshwm sim nce thaum ib qho ntawm zes qe menyuam raug tshem tawm;
- kev tsim tawm - pom nrog kev saib xyuas kev kho mob thiab ncua sijhawm nrog kev ua haujlwm, teeb meem tshwm sim los ntawm nws qhov kev siv, laparotomy, kev phais mus ntev, mob ntev ntawm cov appendages;
- hemorrhagic shock;
- rov qab los ntawm tus kab mob - raws li ntau qhov chaw, nws tuaj yeem tshwm sim hauv 16-50% ntawm cov neeg mob, feem ntau yog vim muaj kev ua haujlwm tsis zoo hauv endocrine system;
- faus.
Yog li, qhov tshwm sim ntawm zes qe menyuam tawg tuaj yeem ua rau tsis zoo rau poj niam txoj kev noj qab haus huv, yog li koj yuav tsum mus ntsib kws kho mob kom sai.
Rehab
Tom qab ua haujlwm, tus neeg mob yuav tsum tau ua cov txheej txheem uas yuav tso cai rau nws rov qab kho nws txoj kev noj qab haus huv.
Txhawm rau tiv thaiv kev tsim cov adhesions, kev kho lub cev tuaj yeem raug sau pib txij li 3-4 hnub tom qab ua haujlwm:
- UHF;
- electrophoresis nrog hydrocortisone, lidase, zinc;
- qis siv laser kho;
- hluav taws xob stimulation ntawm cov hlab ntsha fallopian;
- SMT;
- qis zaus ultrasound.
Txhawm rau kho cov tshuaj hormonal, cov neeg mob yuav tsum tau noj tshuaj tiv thaiv kab mob hauv qhov ncauj me me rau 1-3 lub hlis. Kev tiv thaiv kab mob tom qab kev kho mob tuaj yeem mus txog rau lub hlis.
Txhua tus poj niam uas tau ua haujlwm cuam tshuam nrog kev tshem tawm ntawm zes qe menyuam tawg, tsis pub dhau ib xyoos tom qab nws, yuav raug xa mus rau npe hauv tsev kho mob antenatal. Kev kuaj thawj zaug yog ua tiav ib hlis tom qab kev phais mob, tom qab - tom qab 3 lub hlis thiab rau lub hlis.
Ua ntej npaj cev xeeb tub, nws yog qhov zoo dua rau tus neeg mob ua qhov kuaj mob laparoscopy, thaum lub sijhawm kuaj mob ntawm lub plab hnyuv siab raum. Nws yuav tsum tau npaj yog tias tsis muaj qhov txawv txav thaum lub sijhawm ua haujlwm no.
Kev Tiv Thaiv
Yog li ntawd, tsis muaj ib qho xwm txheej tshwj xeeb ntawm hom no. Txhua tus poj niam yuav tsum mus ntsib kws kho mob gynecologist tsis tu ncua. Nws tuaj yeem qhia tau tias tus poj niam lub zes qe menyuam puas yuav tawg thiab thaum twg nws yuav tshwm sim.
Kev sib deev ncaj ncees yuav tsum tsis txhob thab nqa qhov hnyav, kev ua kis las yuav tsum tsis txhob nruj heev. Nws yog ib qho tsim nyog los nqa tawm kev tiv thaiv kab mob ntawm cov kab mob ntawm qhov chaw mos, tswj cov tshuaj hormonal tom qab, xyuas qhov xwm txheej ntawm cov hlab ntsha. Kev sib deev nrog tus khub yuav tsum mos. Tom qab ua haujlwm, nws yog qhov zoo dua los tsis kam sib deev rau 1-2 lub hlis.
Yog tias koj mob plab thiab tsis ntseeg, koj yuav tsum sab laj nrog kws kho mob. Txhawm rau ua qhov kev kuaj mob kom raug, ntxiv rauGynecologist, urologist thiab kws phais yuav koom nrog.
Kev tshwm sim ntawm pathology thaum cev xeeb tub
Vim vim muaj kev hloov pauv hormonal hauv lub cev thaum lub sijhawm no, qhov tshwm sim no tsis tshua muaj. Tab sis thaum nws tshwm sim, raws li txoj cai, sparing therapy yog nqa tawm. Qee zaum kev ua haujlwm yuav tsum tsis txhob ua rau tus menyuam hauv plab puas. Kev kho mob txaus ntshai tshaj plaws yog nyob rau thawj peb lub hlis twg ntawm cev xeeb tub, vim tias nws tuaj yeem ua rau rho menyuam tsis tu ncua.
Kev kho tshuaj hormone tuaj yeem muab tshuaj tom qab kev phais kom muaj kev xeeb tub. Ib lub qe fertilized tuaj yeem nkag mus rau hauv lub uterine kab noj hniav. Hauv qhov no, kev puas tsuaj rau lub zes qe menyuam lossis txawm tias nws qhov tsis tuaj yeem yuav tsis cuam tshuam rau kev xeeb tub ntxiv.
In xaus
Kev tawg ntawm zes qe menyuam tuaj yeem tshwm sim rau ntau yam, uas tuaj yeem ua rau sab hauv thiab sab nraud. Tus mob no txaus ntshai heev rau poj niam txoj kev noj qab haus huv. Nws muaj peev xwm provoke qhov tsos ntawm ntau yam txim, mus txog rau kev tuag. Txhawm rau kom tsis txhob coj koj tus kheej mus rau lub xeev zoo li no, koj yuav tsum mloog koj lub cev, tsis txhob ua haujlwm dhau, tsis tu ncua mus kuaj los ntawm gynecologist. Kev kho mob tuaj yeem ua tau raws li kev kho mob thiab phais. Thawj yog siv rau cov ntaub ntawv me me ntawm tus kab mob thiab tuaj yeem nrog ntau yam rov qab los. Yog li, laparoscopy feem ntau yog siv. Nyob rau hauv cov ntaub ntawv loj ntawm pathology thiab fainting, lub plab ua haujlwm yog ua, raws li qhov tshwm sim ntawm lub plab kab noj hniav yog tso tawm los ntawm adhesions, commulations.ntshav thiab ntshav. Thaum lub sij hawm kho mob, nws yuav tsum tau mus rau ntau yam kev kho mob physiotherapy raws li kws kho mob tau sau tseg.
Yog li, peb tau saib qhov ua rau ntawm zes qe menyuam tawg.
