tso tawm ntawm lub tsev menyuam uas tsis cuam tshuam nrog cov kab mob hauv lub cev, kab mob ntawm cov kab mob organic lossis cev xeeb tub yog hu ua uterine los ntshav. Lawv raug sau ua DMK, qhov zaus ntawm cov kab mob no tshwm sim hauv 15-20 feem pua ntawm tag nrho cov neeg mob gynecological, tsis hais tus poj niam hnub nyoog li cas. Los ntawm ib txwm tso tawm thaum cev xeeb tub, lawv txawv ntawm lub sijhawm thiab qhov ntim ntawm cov ntshav poob. Ib qho ua rau muaj kev tawm tsam hnyav feem ntau yog ua txhaum ntawm kev ua haujlwm ntawm zes qe menyuam.
Vim li cas rau DMK
ua kom muaj kev cuam tshuam hauv lub hnub nyoog me nyuam yog:
- Lub sijhawm Postoperative ua ntej los ntawm kev kuaj mob, tshem tawm cov polyps lossis rho menyuam.
- Kev mob ntawm zes qe menyuam ua haujlwm, tshwm sim los ntawm kev tsim cov tshuaj hormones tsis txaus, polycystic.
- Pathology ntawm cov poj niam lub cev tseem ceeb - mob qog nqaij hlav, polyps,fibroids.
- kab mob thyroid. Cov tsos mob los ntshav pab txhawb kev tsim cov thyroid-stimulating hormonal tshuaj.
- Siv qee yam tshuaj hormonal, suav nrog cov tshuaj tiv thaiv kab mob, thiab cov tshuaj uas tsis yog steroidal anti-inflammatory.
- Kev tsis ua haujlwm ntawm cov qog adrenal.
- Impaired zus tau tej cov tshuaj hormonal uas cuam tshuam rau kev coj khaub ncaws.
Kev ua haujlwm tsis zoo ntawm lub tsev menyuam los ntshav thaum lub sijhawm premenopause yog tshwm sim los ntawm:
- ntshav txhaws tsis meej;
- hloov pauv hauv hypothalamus;
- neoplasms hauv tsev menyuam ntawm qhov xwm txheej phem;
- tsis muaj estrogen thiab progesterone;
- polyps ntawm glandular xwm;
- Yendometrial hyperplasia.
Kev faib tawm ntawm DMK
uterine los ntshav tau muab faib raws li cov txheej txheem pathogenetic rau hauv:
- Anovulatory. Nyob rau hauv cov ntaub ntawv no, lub follicle tsis mature, tsis muaj ovulation, thiab lub voj voog yog yus muaj los ntawm ib theem. Tom qab ncua sij hawm luv luv ntawm kev coj khaub ncaws, los ntshav hnyav tshwm sim.
- Ovulatory. Qhov ua rau los ntshav yog nce los yog, qhov sib txawv, tsis tshua muaj cov tshuaj hormones kev sib deev los ntawm zes qe menyuam.
Kev faib tawm ntawm qhov tsis ua haujlwm ntawm lub tsev menyuam los ntawm qhov ntim ntawm cov ntshav poob thiab nyob ntawm qhov kev coj khaub ncaws yog raws li hauv qab no:
- Menorrhagia. Nyob rau hauv lwm txoj kev, nws yog hu ua breakthrough los ntshav. Gynecological pathology provokes lawv tshwm sim.
- Metrorrhagia, lossis los ntshavacyclic xwm. Cov hom no yog cov los ntshav tom qab los yog ua ntej kev coj khaub ncaws.
- Hypermenorrhea yog qhov tso tawm ntau lub hli nrog los ntawm kev poob ntshav loj.
- YPolymenorrhea. Kev coj khaub ncaws ntev dua li niaj zaus. Lub ntim ntawm cov ntshav secretions nce.
Qhov kev faib tawm hauv qab no ntawm qhov tsis ua haujlwm ntawm lub tsev menyuam los ntshav yog nyob ntawm hnub nyoog:
- juvenile;
- reproductive;
- climacteric.
Diagnosis
Cov txheej txheem kuaj mob suav nrog:
- Cawm anamnesis.
- Kev kuaj lub ncauj tsev menyuam - kuaj pom qhov hloov pauv pom.
- Kev tshuaj ntsuam cytological ntawm kev khawb ntawm lub ncauj tsev menyuam.
- Ultrasound - txhawm rau txheeb xyuas zes qe menyuam pathology, endometriosis lossis fibroids.
- Kev kuaj ntshav rau cov tshuaj hormonal, dav dav, biochemistry.
- Diagnostic curettage - nrhiav pom cov hlwb atypical, hyperplasia.
- MRI - kuaj pom cov teeb meem hauv pituitary thiab hypothalamus.
Yog qhia tau, cov kev kuaj ntxiv thiab kev sab laj nrog kws kho mob tshwj xeeb raug pom zoo.
YPathogenetic mechanism
Kev tsis ua haujlwm ntawm lub tsev menyuam los ntshav (ICD-10 code: N92) yog qhov tshwm sim ntawm qhov tsis ua haujlwm hormonal thiab kev tsis sib haum xeeb hauv kev tswj hwm ntawm zes qe menyuam ua haujlwm, uas yog tswj hwm los ntawm hypothalamic-pituitary system. Kev ua tsis tiav ntawm lub qog pituitary ua rau muaj kev cuam tshuam ntawm kev loj hlob ntawm follicle thiab kev ua haujlwm ntawm lub cev. Yog li ntawd, nyob rau hauv tus poj niam lub cevestrogen qib nce. Vim tsis muaj kev sib txuas ntawm corpus luteum hauv zes qe menyuam, progesterone tsis tsim. Nyob rau hauv lub tsev me nyuam, muaj ib tug overgrowth ntawm lub endometrium, uas yog tom qab tsis kam lees thiab ntshav tshwm sim. Kev siv thiab lub sijhawm los ntshav yog nyob ntawm kev ua haujlwm fibrinolytic, platelet aggregation thiab vascular tone. Kev faib tawm tuaj yeem nres ntawm lawv tus kheej, tab sis muaj kev pheej hmoo ntawm lawv rov tshwm sim. Cov cim tseem ceeb ntawm cov ntshav los ntshav:
- kiv taub hau;
- mob plab plab;
- tsis muaj zog;
- qis zog;
- muag qhov muag;
- tsis xis nyob hauv cheeb tsam lumbar;
- kev tshaib plab;
- thirst;
- ntau ntau ntawm kev faib;
- lub sijhawm tsis xwm yeem;
- lengtheing menstruation.
Kev kho mob. Kev tshwm sim
Raws li kev soj ntsuam cov lus qhia, uterine los ntshav tsis zoo yog vim li cas rau tsev kho mob, thiab ceev. Cov ntsiab cai ntawm kev kho mob yog raws li nram no:
- tso tseg los ntshav;
- kev tiv thaiv rov qab;
- scraping;
- hormonal hemostasis;
- tshem tawm qhov tshwm sim ntawm hemorrhage;
- siv cov tshuaj hloov ntshav plasma rau kev poob ntshav loj.
Ntshav yog kho ob qho tib si kev saib xyuas thiab phais. Hauv thawj kis, nws tshwm sim:
- Hormonal, uas yog, cov tshuaj hormonal raug sau los pab kho lub cev kev coj khaub ncaws. Cov kev kho mob yog ntev, mus txog rau yim lub hlis. Cov kev npaj "Jess", "Rigevidon", "Yarina" tau ua pov thawj lawv tus kheej zoo. Txoj kev kho mob yog xaiv los ntawm tus kws kho mob.
- Non-hormonal - tsom rau kev ntxiv dag zog thiab lub zog ntawm cov hlab ntsha.
Rau cov hom phiaj no, Ascorutin, Detralex, Phlebodia thiab lwm yam txhais tau tias yog siv. Nyob rau hauv cov ntaub ntawv ntawm cov ntshav tsis txaus, tus kws kho mob pom zoo cov tshuaj uas txhim kho platelet aggregation.
noj tshuaj uas normalize prolactin ntau lawm
Txoj kev phais rau kev ua haujlwm tsis zoo ntawm lub tsev menyuam los ntshav hauv gynecology yog siv rau hauv cov kab mob pathological uas yuav tsum tau muaj kev phais sai, piv txwv li, thaum kuaj pom fibroids lossis polyps.
Thaum xaiv ib txoj kev kho mob, tus kws kho mob yuav siv sij hawm mus rau hauv tus account lub hnub nyoog, lub sij hawm thiab kev siv ntawm tso tawm, ua rau tsis ua hauj lwm ntawm lub cev ntas, raws li tau zoo raws li cov tshuaj ntawm pathology.
Nrog rau kev kho raws sijhawm, qhov kev cia siab tau zoo. Kev pib kho tsis zoo yuav ua rau muaj ntshav tsis txaus thiab ntxiv mus rau kev xeeb tub. Yog tias qhov ua rau los ntshav yog kev ua haujlwm ntawm zes qe menyuam thiab hormonal cuam tshuam, ces muaj kev pheej hmoo siab ntawm endometrial degeneration mus rau hauv malignant neoplasm. Qhov tshwm sim loj tshaj plaws yog kev tuag los ntawm kev tso tawm ntev ntev.
Yam uas ua rau lub tsev menyuam los ntshav hauv lub hnub nyoog yug me nyuam
Ua rau qhov tsis ua haujlwm ntawm lub tsev menyuam los ntshav ntawm lub sijhawm menyuam yaus cuam tshuam nrog:
- ua rau cov ntshav khiav tsis zoo raws li qhov tshwm sim ntawm thrombosis thiab vasodilation;
- tsis ua haujlwm hauv qhov systemhypothalamus-pituitary caj pas-ovaries-adrenal qog; Raws li qhov tshwm sim, anovulatory los ntshav tshwm;
- cuam tshuam ntawm hormonal homeostasis tom qab rho menyuam;
- kis kab mob, endocrine pathologies;
- cov xwm txheej ntxhov siab;
- kev npam ntawm lub cev;
- noj tshuaj hormonal thiab non-steroidal anti-inflammatory tshuaj.
Kev kho cov uterine los ntshav hauv cov poj niam uas muaj hnub nyoog me nyuam muaj kev phais thiab tiv thaiv los ntshav ntxiv. Ua phais hemostasis. Txhawm rau tiv thaiv kev rov qab los, kev kho tshuaj hormone yog qhia. Lawv raug xaiv ib tus zuj zus nyob ntawm qhov tshwm sim ntawm histology. Qhov kev cia siab yog qhov zoo nrog kev kho kom raug. Txhawm rau tiv thaiv uterine los ntshav, cov poj niam uas muaj hnub nyoog yug me nyuam raug pom zoo:
- khoom noj zoo;
- kev kawm lub cev;
- kev ua haujlwm thiab so;
- khaw;
- kho mob raws sijhawm;
- noj tshuaj tiv thaiv qhov ncauj raws li pom zoo nrog tus kws kho mob.
Uterine los ntshav hauv cov poj niam laus
Kev tsis ua haujlwm ntawm lub tsev menyuam los ntshav (ICD code ntawm kev kho thib kaum thaum lub sijhawm premenopause - N92.4) yog ib hom kab mob gynecological uas tshwm sim hauv cov poj niam hnub nyoog 45-55 xyoo. Qhov laj thawj yog cuam tshuam nrog cov kab mob metabolic thiab kev ua haujlwm ntawm endocrine system. Lub sijhawm no, los ntshav yog qhov nyuaj heev piv rau lwm lub sijhawm muaj hnub nyoog. Pab txhawb nqalos ntshav:
- hnub nyoog-txog kev hloov pauv hauv cov qauv ntawm hypothalamus, uas tswj hwm zes qe menyuam ua haujlwm;
- qog ntawm zes qe menyuam ntawm qhov xwm txheej hormonal.
Tus yam ntxwv rau pubertal lossis lub hnub nyoog me nyuam ua txhaum ntawm cov ntshav txhaws hauv lub sijhawm premenopause, tsis tshwm sim. Ib txhij nrog kev kho mob, tus kws kho mob nthuav tawm cov kab mob organic:
- puas khawb cov mucous ntawm lub cev thiab lub ncauj tsev menyuam;
- ua ultrasound ntawm zes qe menyuam.
yav tom ntej, cov tswv yim ntawm kev kho cov uterine los ntshav hauv lub sijhawm premenopausal yuav nyob ntawm seb muaj cov kab mob sib kis thiab lwm yam kab mob. Thaum kho, manipulations yuav tsum tau nqa tawm uas pab tshem tawm cov metabolic thiab endocrine ntshawv siab. Feem ntau, qhov kev cia siab nrog kev kho kom raug yog qhov zoo. Muaj pov thawj tias cov poj niam siv cov tshuaj tiv thaiv qhov ncauj tsis tshua muaj kev los ntshav premenopausal. Yog li ntawd, cov kws kho mob txiav txim siab noj cov tshuaj no ua ib feem ntawm kev tiv thaiv ntawm uterine los ntshav.
uterine los ntshav hauv lub sijhawm menyuam yaus
Cov menyuam yaus los yog pubertal uterine los ntshav yog tso tawm thaum lub hnub nyoog laus dua los ntawm thawj coj khaub ncaws mus txog 18 xyoo. Cov kab mob pathological no suav hais tias yog ib qho mob hnyav ntawm cov kab mob hauv cov menyuam yaus thaum lub sij hawm puberty rau cov menyuam yaus thiab cov tub ntxhais hluas. Muaj tseeb pubertal uterine los ntshav muaj xws li los ntshav uas tshwm simvim muaj kev ua haujlwm tsis zoo ntawm qhov sib npaug ntawm cov tshuaj hormones thiab tsis muaj cov hauv paus hauv paus, piv txwv li, cov kab mob organic ntawm qhov chaw mos. Cov ntshav tawm hauv cov ntxhais feem ntau yog anovulatory hauv qhov xwm txheej. Muaj cov menyuam yaus ua haujlwm tsis zoo ntawm lub tsev menyuam los ntshav tom qab tsim kev coj khaub ncaws tom qab ob lossis peb xyoos. Pab txhawb rau txoj kev loj hlob ntawm qhov tshwm sim:
- kev npam ntawm lub cev;
- Kev hloov pauv hauv cov tshuaj hormonal vim yog puberty, noj tshuaj hormonal;
- kab mob kis tau tus mob ntev lossis mob hnyav;
- xov xwm ntxhov siab;
- hypovitaminosis tshwm sim los ntawm kev noj zaub mov tsis txaus;
- pathology ntawm endocrine system;
- kev tsim kho ntawm lub tsev menyuam.
Cov cim tseem ceeb ntawm cov menyuam yaus los ntshav:
- tso tawm ntawm qhov chaw mos rau ntau tshaj yim hnub;
- lub sijhawm los ntshav tsawg dua 21 hnub;
- ntshav poob ntau dua 120 ml ib hnub;
- tachycardia;
- tsis muaj zog;
- thirst;
- mob taub hau;
- faus;
- siab txo;
- dermis thiab mucous daim nyias nyias ntawm xim daj ntseg.
Kev ntshav ntau thiab ntev ua rau muaj ntshav tsis txaus, uas yog nrog rau kev tsis zoo ntawm kev noj qab haus huv. Qhov tshwm sim txaus ntshai yog qhov hloov pauv ntawm cov mucous membrane ntawm cov poj niam lub cev tseem ceeb, thiab vim li ntawd, muaj kev pheej hmoo ntawm kev tsim cov qog nqaij hlav ntawm lub tsev menyuam. Qee zaum, nws tuaj yeem nyuaj rau qhov txawv ntawm kev coj khaub ncaws tsis tu ncua thiab los ntshav. Rau cov hom phiaj no, tag nrho ntau yam ntawmkev ua ub no, suav nrog kev ntsuas ntsuas thiab kuaj kuaj. Thaum kawg ntawm kev puberty, qhov tshwm sim ntawm cov menyuam yaus ua haujlwm tsis zoo ntawm lub tsev menyuam los ntshav (ICD-10 - N92.2) txo qis. Nyob rau yav tom ntej, kev coj khaub ncaws tsis zoo tuaj yeem ua tau, tab sis cov laj thawj yuav txawv, piv txwv li, kev sib deev tsis sib haum xeeb ua rau rho menyuam. Kev tshem tawm ntawm cev xeeb tub thaum lub sij hawm tsim ntawm hormonal keeb kwm yav dhau ua rau ua txhaum loj thiab provokes los ntshav. Tsis tas li ntawd, cov txheej txheem inflammatory ua rau muaj kev hem thawj rau zes qe menyuam, uas ua rau hormonal tsis ua haujlwm.
Txoj kev kho cov menyuam yaus los ntshav
Kev kho yog nyob ntawm qhov chaw kho mob thiab qhov ua rau lawv tshwm sim. Qee zaum, nws txaus los tshem tawm qhov cuam tshuam sab nraud, xws li kev ntxhov siab lossis kev ua lub cev. Yog tias qhov tso tawm tsis tau nrog mob ntshav qab zib hnyav, ces kev kho mob yog nqa tawm ntawm tus neeg mob sab nraud. Txawm li cas los xij, feem ntau, yuav tsum tau mus pw hauv tsev kho mob, vim qhov chaw kho mob hnyav. Kev txwv tsis pub pubertal uterine los ntshav yog ua tiav ib txhij nrog kev tshawb nrhiav qhov ua rau ua rau tus mob no. Lawv siv cov tshuaj uas muaj hemostatic, sedative, nce lub suab ntawm lub tsev menyuam, nrog rau cov tshuaj uas ntxiv dag zog rau cov hlab ntsha. Thaum tsim qhov ua rau ntawm qhov tso tawm, kev kho mob yog qhia rau nws tshem tawm. Txhawm rau kom tsis txhob los ntshav, cov tshuaj hormonal "Dufaston", "Utrozhestan" lossis cov neeg ua haujlwm ua ke uas muaj cov tshuaj estrogens thiab progestogens. Tsis tas li ntawd, kev kho dua tshiab ntawm kev ua haujlwm hormonal yog ua nrog kev pab ntawm cov tshuaj hauv qab no:
- Marvelon.
- Logest.
- Mersilon.
- "Dufaston".
- "Clomiphene" - qhia txog kev rov qab los rau cov menyuam yaus hnub nyoog qis dua 16 xyoo.
Tus kws kho mob xaiv qhov ntau npaum li cas, kev kho mob thiab lub sijhawm ntawm kev kho tus kheej.
Raws li kev kho mob xwm txheej ceev rau kev ua haujlwm tsis zoo ntawm lub tsev menyuam los ntshav (hauv ICD ntawm kev kho thib kaum, cov kab mob no muaj tus lej N92), cov tshuaj hormonal yuav siv nrog cov tshuaj hemostatic. Kev kho mob ntawm cov menyuam yaus los ntshav yuav tsum ua kom tiav thiab suav nrog kev kho lub cev, kev sab laj nrog kws kho mob hlwb, kws kho mob hlwb, kws kho mob endocrinologist.
Ntxiv rau kev kho kom zoo, cov tub ntxhais hluas kuj tseem siv phais hemostasis, piv txwv li curettage ntawm uterine mucosa. Txoj kev no yog siv rau hauv cov xwm txheej uas muaj kev phom sij rau lub neej. Thaum ua tiav qhov kev tswj hwm no, muaj qhov cuam tshuam tsawg kawg nkaus ntawm lub tsev menyuam. Lub hymen yog khaws cia. Lub voj voog tag nrho ntawm kev coj khaub ncaws yog rov qab nyob rau hauv ib xyoos tom qab kev kho mob. Txhawm rau tiv thaiv kev rov qab los, cov ntxhais raug saib xyuas los ntawm kws kho mob.
Kev Tiv Thaiv
Kev tiv thaiv rau txhua lub hnub nyoog suav nrog:
- kho mob ntawm qhov chaw mos;
- tshawb pom lub sijhawm ntawm kev cuam tshuam hormonal;
- khoom noj zoo;
- mus ntsib kws kho mob ntawm thawj qhov cim ntawm qhov los ntshav txawv txav;
- exclusion of phem cwj pwm;
- kev tawm dag zog;
- kev tiv thaiv kab mob;
- noj tshuaj hormonal hauv kev pom zoo nrogtus kws kho mob.
Nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias cov ntshav los ntawm lub tsev menyuam tau ua tiav thaum kho ntxov. Kev kho raws sij hawm txo qhov kev pheej hmoo ntawm cov teeb meem.
