Kwv yees li tsib feem pua ntawm tag nrho cov kab mob gynecological raug kuaj los ntawm kws kho mob ua "ovarian sclerocystosis". Tsis yog txhua tus poj niam xav txog qhov nws yog dab tsi, ntau tus pom zoo li kev kuaj mob raws li kab lus ntawm kev xeeb tub. Tseeb tiag, kwv yees li ib feem peb ntawm cov neeg uas tau kuaj pom tus kab mob no tsis tuaj yeem muaj lawv tus kheej cov menyuam. Tab sis tus so muaj feem yuav kho tau thiab yug tau tus me nyuam noj qab nyob zoo.
Sclerocystosis ntawm zes qe menyuam muaj lwm lub npe - Stein-Leventhal syndrome, vim nws tau piav qhia thawj zaug los ntawm ob tus kws kho menyuam yaus Asmeskas - Irving Stein thiab Michael Leventhal. Qhov no tshwm sim xyoo 1935. Tshaj li yim caum xyoo tom ntej no, pathogenesis ntawm tus kab mob tau raug tshawb fawb kom meej, cov txheej txheem rau nws txoj kev kho mob thiab kev kuaj mob tau tsim, tab sis cov kws tshawb fawb tseem tsis paub txog txhua qhov ua rau nws tshwm sim.
Yog tias koj tau txais kev kuaj mob tsis txaus siab thiab koj xav muaj menyuam tiag, tsis tas yuav poob siab. Hauv peb tsab xov xwm peb yuav sim qhia txhua tusQhov tseem ceeb tshaj plaws ntawm zes qe menyuam sclerocystosis thiab yuav ua li cas nrog nws.
Cov zes qe menyuam noj qab nyob zoo li cas
Kom nkag siab zoo dua li cas ntawm zes qe menyuam sclerocystosis thiab cev xeeb tub muaj feem cuam tshuam, koj yuav tsum paub seb cov kab mob no tau teeb tsa li cas thiab lawv ua haujlwm li cas yog tias tsis muaj kab mob hauv lawv. Lub zes qe menyuam yog cov poj niam ua ke cov kab mob hauv lub cev. Lawv tuaj yeem sawv cev ua ib hom hnab ntim nrog lub hlwb. Cov phab ntsa ntawm zes qe menyuam yog txoj kab nrog ib txheej ntawm cov ntaub so ntswg sib txuas, ntawm uas muaj ib txheej ntawm cov khoom cortical. Nws muaj ib tug complex qauv thiab qhov tseem ceeb. Nws yog nyob rau hauv cov txheej txheem no uas cov follicles tsim - cov txheej txheem tshwj xeeb hauv cov qe tsim. Follicles, hu ua thawj, nyob rau hauv tus nqi ntawm kwv yees li ib mus rau ob lab, yog nteg nyob rau hauv lub cev ntawm txhua tus ntxhais nyob rau hauv lub fetal theem. Thoob plaws hauv lub neej, pib los ntawm lub sij hawm puberty thiab xaus nrog lub sij hawm ntawm menopause, lawv maj mam noj, thiab cov tshiab tsis tsim. Yog li ntawd, lub sij hawm los txog thaum lawv cov khoom siv tas lawm.
Qhov no yuav luag tsis muaj tshwm sim rau cov poj niam ntawm lub hnub nyoog yug me nyuam, yog li qhov tsis muaj cov hauv paus hniav tsis tuaj yeem ua rau muaj menyuam tsis taus. Lwm qhov yog tias qee zaum muaj kev ua tsis tiav hauv lawv qhov kev loj hlob zuj zus. Yog li ntawd lawv yog cov culprits ntawm qhov tseeb hais tias lub siab xav xeeb tub tsis tshwm sim. Tsis tas li ntawd, kev loj hlob tsis zoo ntawm cov hauv paus hniav hauv ib puas feem pua ntawm cov neeg mob ua rau cov kab mob gynecological, yam tsis muaj kev kho mob uas cov poj niam ua rau muaj kev pheej hmoo ntawm thrombosis, thrombophlebitis, ntshav qab zib, plawv nres, malignant.tsim nyob rau hauv cov qog mammary.
Lub zes qe menyuam tshwm sim li cas thiab nws ua li cas rau kev xeeb tub
Thaum cov ntxhais dhau los ua kev sib deev, cov txheej txheem ntawm kev loj hlob ntawm thawj cov hauv paus hniav, uas txog rau tam sim no zoo li tsaug zog, pib ua haujlwm hauv lawv lub cev. Cov txheej txheem no yeej ib txwm cyclical. Hauv txhua lub voj voog, txog li 15 lub hauv paus "sawv". Lawv, nyob rau hauv tus ntawm cov tshuaj hormone FSH uas tsim los ntawm pituitary caj pas, pib loj hlob, nce nyob rau hauv txoj kab uas hla ntawm 50 mus rau 500 microns. Thaum lub sij hawm no, cov kua follicular yog tsim nyob rau hauv lawv, thiab ib tug kab noj hniav tshwm nyob rau hauv loj tshaj ntawm lawv. Qhov follicle no dhau los ua qhov tseem ceeb, loj hlob mus txog 20 millimeters, protrudes. Ib lub qe qe loj hlob sai hauv nws. Qhov seem follicles los ntawm pab pawg neeg ntawm "awakened" ib tug los ntawm ib tug tuag thiab yaj. Yog tias txhua yam mus raws li txoj cai, cov kab mob endocrine pib ua haujlwm hauv poj niam lub cev. Yog li ntawd, cov tshuaj hormones estrogen, progestins thiab androgens raug tsim, uas cuam tshuam rau kev loj hlob ntxiv ntawm cov follicle tseem ceeb. Nyob rau hauv qhov kev txiav txim ntawm luteinizing hormone (luteotropin, lutropin, abbreviated li LH), nws ruptures, lub qe los ntawm nws mus rau hauv lub fallopian raj, thiab nws hloov mus rau hauv ib tug corpus luteum thiab maj dissolves.
Yog tias qhov tawg tsis tshwm sim, lub qe uas tsis tau tso tawm yog rov yug dua tshiab, thiab lub zes qe menyuam qhov loj ntawm lub txiv ntoo tshwm nyob rau hauv qhov chaw ntawm lub hauv paus. Cov "tsim" follicles uas tsis muaj sij hawm tuag kuj tig mus rau hauv cov hlwv, tsuas yog me me. Ib lub cyst tsim los ntawm cov hauv paus hniav qee zaum loj hlob mus rau qhov loj me (40-60 millimeters), tab sis tib lub sijhawm nws tuaj yeem ua tau.tsis txhob qhia. Tsuas yog qee zaum, cov neeg mob yws ntawm qhov mob hauv thaj tsam zes qe menyuam. Tom qab tus poj niam cov tshuaj hormones normalizes, nws maj mam daws. Yog hais tias ovulation rov qab los rau hauv ib tug poj niam, lub follicular cyst nyob rau hauv lub zes qe menyuam thaum lub sij hawm ntawd tsis tiv thaiv kev xeeb tub, tab sis yog hais tias lub cyst tau loj hlob mus rau ib tug loj ntawm 90 millimeters, nws yuav tsum tau muab tshem tawm phais.
Ua rau kab mob
Cov kws tshawb fawb paub meej tias zes qe menyuam sclerocystosis tsim li cas. Cov laj thawj rau qhov tshwm sim no tseem tsis tau raug tsim los ntawm qhov tseeb, tsuas muaj kev xav xwb. Txij li thaum cov tshuaj hormones ua lub luag haujlwm tseem ceeb hauv kev loj hlob ntawm cov hauv paus hniav thiab kev tso tawm ntawm lub qe los ntawm nws, hormonal ntshawv siab, thiab tshwj xeeb tshaj yog tsis ua hauj lwm hauv cov txheej txheem ntawm cov tshuaj estrogen synthesis, suav hais tias yog lub ntsiab ua rau ntawm zes qe menyuam sclerocystosis. Cov hauv qab no ua rau muaj kev cuam tshuam hormonal hu ua:
- anomalies hauv cov qauv ntawm cov noob;
- cuam tshuam hauv pituitary-ovarian system;
- psychic trauma;
- teeb meem tom qab rho menyuam;
- kis kab mob thiab gynecological;
- mob tom qab yug menyuam;
- hloov pauv hauv kev ua haujlwm ntawm adrenal cortex.
Cov tsos mob
Hmoov tsis zoo, nws tuaj yeem kuaj pom zes qe menyuam sclerocystosis nyob rau hauv ib tug ntxhais tsuas yog thaum pib puberty. Cov tsos mob nyob rau theem no yog qhov muag plooj thiab feem ntau muaj kev coj khaub ncaws tsis xwm yeem. Tab sis qhov tshwm sim no tuaj yeem muaj ntau yam laj thawj, tsis hais txogkab mob ntawm zes qe menyuam, mus txog rau kev noj zaub mov tsis zoo thiab lub paj hlwb. Thaum muaj hnub nyoog nees nkaum, qhov siab tshaj plaws ntawm nees nkaum tsib xyoos, cov ntxhais muaj cov tsos mob ntawm zes qe menyuam sclerocystosis. Qhov tseem ceeb tseem yog kev ua txhaum ntawm cyclicity thiab xwm ntawm kev coj khaub ncaws (hauv 96 feem pua ntawm cov neeg mob). Feem ntau muaj kev ncua ntev ntawm kev coj khaub ncaws (kwv yees li rau lub hlis lossis ntau dua) lossis qis qis heev (hypomenstrual syndrome). Ntau zaus, cov neeg mob yws txog lub sijhawm thiab kev coj khaub ncaws ntau.
Lwm cov tsos mob qhia tias zes qe menyuam sclerocystosis yog raws li hauv qab no:
- hirsutism (kwv yees li 90 feem pua ntawm cov neeg mob muaj plaub hau nyob ib ncig ntawm lub txiv mis, nraub qaum, plab, puab tsaig thiab saum daim di ncauj);
- rog dhau (70 feem pua ntawm cov neeg mob);
- baldness thiab pob txuv ntawm lub ntsej muag (tshwj tsis tshaj 40 feem pua ntawm cov neeg mob);
- qee qhov kev hloov pauv hauv lub cev;
- cuam tshuam hauv kev ua haujlwm ntawm lub paj hlwb;
- asthenic syndrome;
- zes qe menyuam (kuaj los ntawm gynecologist thaum kuaj).
Tsis tas li ntawd, qee tus poj niam yuav muaj cov tsos mob tshwm sim rau ntau yam kab mob: mob hauv plab plab, malaise, inexplicably fatigued.
Kev Tshawb Fawb Kev Tshawb Fawb
Raws li cov cim qhia sab nraud, zes qe menyuam sclerocystosis tsuas yog xav tau, thiab qhov kev kuaj mob zaum kawg yog ua tom qab kuaj ntxiv. Cov no yog:
- ntshav kuaj rau testosterone (feem ntau yuav tsum tsis pub dhau 1.3 ng / ml, pub dawb rau cov poj niam hnub nyoog qis dua 41 - hauv 3.18 ng / ml, thiabmus txog 59 xyoo - tsis ntau tshaj 2.6 ng / ml);
- tshuaj ntsuam rau qabzib rhiab heev, ntshav qab zib thiab triglycerides;
- colpocytogram (cov khoom siv yog muab los ntawm qhov chaw mos, cov ntaub ntawv tsom xam pom tias puas muaj ovulation, nrog rau kev sau ntawv ntawm colpocytogram indices rau lub hnub nyoog ntawm tus neeg mob thiab theem ntawm nws lub cev xeeb tub);
- endometrial scraping (tso cai txiav txim siab tsis ua haujlwm hauv zes qe menyuam);
- saib xyuas kev hloov pauv hauv lub cev kub;
- kuaj rau qee cov thyroid, pituitary, zes qe menyuam cov tshuaj hormones (LH, FSH, PSSH, prolactin, cortisol, 17-hydroxyprogesterone);
- txiav txim siab tus nqi ntawm cov tshuaj estrogen excretion.
Tam sim no, cov neeg mob tuaj yeem ua qhov kev sim yooj yim uas tso cai rau lawv xav tias muaj kab mob zes qe menyuam. Qhov no yuav xav tau lub tshuab tsom iav (tuaj yeem yuav hauv khw muag tshuaj). Thaum sawv ntxov, tsuas yog sawv los thiab tsis tau noj lossis haus ib yam dab tsi tseem, koj yuav tsum tso koj cov qaub ncaug rau ntawm lub khob iav thiab cia nws qhuav. Thaum lub sij hawm ovulation, theem ntawm cov tshuaj estrogen ib txwm nce, uas, nyob rau hauv lem, hloov cov muaj pes tsawg leeg ntawm qaub ncaug. Yog hais tias muaj ovulation, cov qaub ncaug nyob rau hauv lub microscope yuav nyob rau hauv daim ntawv ntawm fern nplooj, thiab yog hais tias tsis muaj ovulation, nyob rau hauv daim ntawv ntawm dots.
Hardware diagnostics
Raws li txoj cai, txhawm rau kuaj pom tseeb thiab zaum kawg, cov neeg mob tau muab tshuaj xyuas nyuaj uas siv cov cuab yeej kho mob.
Txoj kev maj mam thiab tsis mob kiag li yog ultrasound-Kev kuaj mob ntawm zes qe menyuam sclerocystosis. Cov txheej txheem yog transabdominal (los ntawm lub plab), transvaginal (txoj kev qhia paub ntau tshaj), transrectal (tsuas yog ua rau cov ntxhais hluas thiab cov poj niam laus).
Y Siv ultrasound los txiav txim qhov loj ntawm zes qe menyuam, lawv cov duab, qauv, tus naj npawb ntawm cov follicles hauv lawv, txoj kab uas hla mus txog 8 hli, muaj lossis tsis muaj cov follicle tseem ceeb, muaj lossis tsis tuaj. ntawm ovulation, muaj cysts nyob rau hauv lub zes qe menyuam.
Lwm hom kev tshuaj ntsuam yog ib qho roj pelveogram qhia qhov sib txawv ntawm qhov loj ntawm lub zes qe menyuam thiab lub tsev menyuam.
Ib yam nyuaj tshaj plaws ntawm kev kuaj mob yog laparoscopy. Nws yog ua nyob rau hauv ib lub tsev kho mob raws li kev tshuaj loog. Lub algorithm ntawm cov txheej txheem yog raws li nram no: tus kws phais ua ib tug puncture nyob rau hauv lub peritoneal phab ntsa ntawm tus neeg mob thiab qhia ib tug apparatus uas txhaj cov pa roj carbon dioxide rau hauv tus neeg mob thiaj li yuav tsim volume nyob rau hauv lub peritoneum thiab zoo dua mus xyuas lub cev. Tom ntej no, lub laparoscope muab tso rau hauv tus neeg mob lub cev, uas qhia txog lub xeev ntawm zes qe menyuam ntawm qhov screen. Laparoscopy yog txoj kev kuaj pom tseeb tshaj plaws, tab sis tom qab nws tus poj niam xav tau lub sijhawm rov zoo.
Kev kho mob rau zes qe menyuam sclerocystosis
Tom qab kuaj pom tseeb, feem ntau tus poj niam tau muab tshuaj ua ntej. Nws lub hom phiaj yog los kho lub cev kev coj khaub ncaws li qub thiab rov pib ovulation. Yuav ua li cas kho zes qe menyuam sclerosis, gynecologist txiav txim siab ua ke nrog tus kws kho mob endocrinologist.
Yog tus neeg mob rog rog, kev poob phaus yog thawj kauj ruam hauv kev kho mob. poj niamnoj zaub mov, ua tau ib ce ua tau.
Kauj Ruam thib ob yog txhawm rau nce cov tshuaj insulin. Metformin yog tshuaj, uas yuav tsum tau noj rau 3-6 lub hlis.
theem peb yog qhov stimulation ntawm ovulation. Lawv pib kho nrog cov tshuaj yooj yim tshaj plaws - Clomiphene. Thawj chav kawm muaj nyob rau hauv kev noj cov tshuaj ntawm koob tshuaj 50 mg thaum hmo ntuj, pib txij hnub thib 5 ntawm lub voj voog rau 5 hnub ua ke. Yog tias tsis muaj qhov tshwm sim (mob khaub thuas), Clomiphene tau noj rau ib hlis. Yog tias cov nyhuv tseem tsis tau txais, koob tshuaj tau nce mus rau 150 mg ib hnub.
theem tom ntej (nyob rau hauv qhov tsis muaj qhov zoo ntawm qhov zoo) yog kev teem caij ntawm cov tshuaj "Menogon". Nws yog siv intramuscularly, thiab thaum kawg ntawm chav kawm, txhaj tshuaj "Horagon" yog ua. "Menogon" tuaj yeem hloov nrog "Menodin" lossis "Menopur".
Tom qab ua tiav tag nrho cov chav kawm, lawv ua cov ntshav biochemistry, thiab raws li cov txiaj ntsig ntawm kev tshuaj ntsuam (yog tias tsis muaj LH hormone txaus), Utrozhestan lossis Duphaston raug tshuaj.
Nyob rau tib lub sijhawm, cov kws kho mob tau sim tshem tawm cov plaub hau ntau dhau ntawm tus poj niam, nrog rau qhov uas nws tau muab tshuaj Ovosyton thiab Metronidazole.
Vitamin kho yog qhov yuav tsum tau ntxiv rau qhov kev kawm.
Sclerocystosis ntawm zes qe menyuam: kev kho mob phais
Yog tias tsis pom ovulation nyob rau hauv peb lub hlis tom qab kev kho tshuaj, tus poj niam yuav tsum tau phais. Nws yog ua nyob rau hauv ntau txoj kev. Qhov twg yuav siv yog nyob ntawm qhov qhia txog qhov mob ntawm zes qe menyuam.
Tam sim no, muaj cov haujlwm hauv qab no:
- cauterization ntawm cysts nroglaser;
- demedulation (tshem tawm nws qhov nruab nrab ntawm lub zes qe menyuam);
- ntxhiab resection (tshem tawm ntawm zes qe menyuam ntawm qhov cuam tshuam rau hauv daim ntawv ntawm ib daim kab xev);
- kho kom zoo nkauj (tus kws kho mob tshem tawm cov txheej txheem protein hloov pauv ntawm zes qe menyuam, tho cov hauv paus hniav nrog rab koob thiab khi lawv cov npoo);
- electrocautery (txog kev puas tsuaj hauv zes qe menyuam ntawm thaj chaw uas tsim cov tshuaj hormones ntau dhau lawm).
- notches (lawv tus kws phais ua rau lawv tob txog 1 cm hauv qhov chaw uas cov follicles ci dhau los kom lawv tso tau lub qe thaum lawv loj tuaj).
Huab cua
Cov poj niam uas pom zoo rau txhua txoj hauv kev los ntawm kws kho mob xav txog tib lo lus nug: nws puas tuaj yeem xeeb menyuam nrog zes qe menyuam sclerocystosis? Kev txheeb xyuas qhia tau tias tsis muaj kev kho mob, kev xeeb tub yog kuaj tau hauv 90% ntawm cov neeg mob. Kev kho tshuaj nrog Clomiphene txhim kho zes qe menyuam ua haujlwm hauv 90% ntawm cov neeg mob, tab sis kev xeeb tub tshwm sim tsuas yog 28% ntawm lawv. Muaj tseeb tiag, raws li qee cov lus ceeb toom, cov txiaj ntsig zoo tuaj yeem ncav cuag 80%.
Qhov tsis zoo ntawm Clomiphene yog tias nws muaj txiaj ntsig tsuas yog thaum pib ntawm tus kab mob lossis tom qab kev phais tas li.
Kev kho mob nrog cov tshuaj muaj zog, xws li "Gonadotropin", raws li kev txheeb cais, ua rau ovulation tsawg kawg yog 28% ntawm cov neeg mob, qhov siab tshaj plaws ntawm 97%. Tib lub sijhawm, los ntawm 7 txog 65% ntawm cov poj niam cev xeeb tub.
Yog tias zes qe menyuam sclerocystosis kho tau phais, cov txiaj ntsig zoo tau pom nyob ntawm tib zaus ib yam li kev kho kom zoo. Raws li kev txheeb cais, tom qab kev phais ntawm zes qe menyuam, 70-80% ntawm cov poj niam muaj lub caij nyoog xeeb tub.
Reviews
Rau ntau tus poj niam, nws dhau los ua qhov phem heev uas tau kuaj pom muaj zes qe menyuam sclerocystosis. Kev tshuaj xyuas tus neeg mob txog kev kho mob txawv heev. Cov tshuaj pab ib tug neeg, phais pab ib tug neeg, thiab ib tug neeg tsis tau xeeb tub, txawm muaj ib txoj kev coj.
Tseem tseem muaj feem me me ntawm cov neeg mob qhia txog kev xeeb tub yam tsis tau kho txhua, txawm tias qhov kev kuaj mob ntawm zes qe menyuam sclerocystosis tsis tau muab tshem tawm. Cov txiaj ntsig zoo li no tuaj yeem ua tau vim yog tus yam ntxwv ntawm txhua tus neeg thiab yuav tsum tsis txhob coj raws li tus qauv.
Tab sis feem coob ntawm cov poj niam sau txog kev txhim kho kev noj qab haus huv tom qab kev kho mob hauv kev tshuaj xyuas. Tsuas yog ob peb tus neeg mob tau tshaj tawm tias lawv lub sijhawm rov zoo li qub rau lub sijhawm luv luv, tom qab ntawd lawv rov xav tau tshuaj hormonal.
Thaum kawg, muaj qee qhov kev tshuaj xyuas uas cov poj niam nco txog qhov mob ntev ntawm lub zes qe menyuam thiab peritoneum tom qab kho nrog kev phais.
