Nyob rau hauv tsab xov xwm peb yuav xav txog dab tsi apoplexy yog. Pathology yog tam sim ntawd rupture ntawm cov ntaub so ntswg ntawm lub cev, uas provokes txoj kev loj hlob ntawm los ntshav mus rau hauv lub plab kab noj hniav. Ovarian rupture yog nrog los ntawm qhov mob hnyav heev.
Kev piav qhia tus kab mob
Feem ntau, muaj kev ua txhaum ntawm kev ncaj ncees ntawm corpus luteum lossis cystic tsim ntawm cov qauv no. Raws li txoj cai, qhov no tshwm sim raws li qhov tshwm sim ntawm pathological vascular hloov tawm tsam keeb kwm yav dhau ntawm cov txheej txheem khaus khaus. Feem ntau apoplexy tshwm sim thaum lub sij hawm ovulation los yog nyob rau theem ntawm vascularization ntawm lub corpus luteum. Cov poj niam hluas feem ntau cuam tshuam los ntawm tus kab mob no.
Tsis yog txhua tus paub tias apoplexy yog dab tsi. Nws yog ib qho xwm txheej gynecological uas tshwm sim los ntawm zes qe menyuam rupture. Nrog apoplexy, hemorrhage tsim nyob rau hauv cov ntaub so ntswg ntawm zes qe menyuam, los ntshav ntawm qhov sib txawv ntawm qhov hnyav mus rau hauv lub plab kab noj hniav thiab ib qho mob ntawm qhov mob hnyav.
Apoplexy yog qhov ua rau lub plawv nres, hematoma, zes qe menyuam tawg. Qhov no pathology tshwm sim nyob rau hauv 1-3% ntawm cov poj niam uas muaj ntau yam gynecologicalkab mob, feem ntau yog thaum muaj hnub nyoog 20 txog 35 xyoo. Apoplexy ntawm txoj cai zes qe menyuam tshwm sim me ntsis ntau dua, vim nws cov ntshav ntau dua los ntawm txoj cai zes qe menyuam, uas tawm ncaj qha los ntawm aorta. Lub zes qe menyuam ntawm sab xis yog qhov txawv ntawm nws qhov loj me, qhov hnyav thiab tsim cov kab mob lymphatic. Lub zes qe menyuam sab laug yog muab los ntawm cov hlab ntsha ntawm zes qe menyuam, uas tawm ntawm lub raum hlab ntsha.
Los ntawm kev kho mob thiab cov yam ntxwv morphological, ib tus tuaj yeem paub qhov txawv ntawm hemorrhages los ntawm follicular ovarian cysts, mature follicles thaum lub sij hawm ovulation, corpus luteum cysts, zes qe menyuam stroma, dysfunctional zes qe menyuam. Qhov rupture ua rau los ntshav hauv plab hauv kwv yees li 0.5-2.5% ntawm cov poj niam cuam tshuam.
Cas of apoplexy
Pathogenetically, txoj kev loj hlob ntawm zes qe menyuam apoplexy yog txuam nrog cov tshwj xeeb ntawm zes qe menyuam cov ntaub so ntswg. Lub predisposing yam ntawm tus kab mob no yog cov yam ntxwv ntawm cov ntshav muab rau lub plab hnyuv siab raum, kev hloov nyob rau hauv lub permeability ntawm zes qe menyuam hlab ntsha nyob rau hauv ntau theem ntawm lub cev ntas zes qe menyuam. Thaum muaj kev cuam tshuam nyob rau hauv cov qauv ntawm cov phab ntsa vascular vim vascular expansion thiab ntshav, lawv permeability tuaj yeem nce mus txog qhov tshwm sim ntawm kev ua txhaum cai.
Cov keeb kwm yav dhau los ntawm zes qe menyuam apoplexy tshwm sim tuaj yeem ua rau sclerotic thiab dystrophic hloov pauv hauv cov ntaub so ntswg ntawm zes qe menyuam vim yog zes qe menyuam varicose leeg, polycystic zes qe menyuam, oophoritis, o ntawm appendages, rho menyuam, thiab lwm yam.tshuaj stimulation ntawm ovulation, uas feem ntau ua rau pathological teeb meem ntawm ovulatory txheej txheem thiab tsim ntawm corpus luteum. Qee tus kws sau ntawv hu rau neuroendocrine pathologies, uas yog nrog los ntawm kev hloov pauv hauv kev ua haujlwm ntawm cov hlab ntsha ntawm cov ntaub so ntswg ntawm zes qe menyuam, nrog rau kev siv tshuaj anticoagulant, uas yog ua rau apoplexy..
Kev raug mob plab, kev tawm dag zog lub cev ntau dhau, caij nees, kev ua kis las, kev sib deev lossis kev cuam tshuam kev sib deev thiab lwm lub sijhawm cuam tshuam nrog kev nce hauv lub plab hauv plab tuaj yeem ua rau muaj mob. Txawm li cas los xij, zes qe menyuam apoplexy kuj tau pom nyob rau hauv qhov tsis muaj cov xwm txheej saum toj no. Ib qho tshwm sim yog qhov xwm txheej thaum lub zes qe menyuam tawg ua ke nrog kev txhim kho ntawm appendicitis. Apoplexy tuaj yeem tshwm sim nyob rau hauv txhua theem ntawm kev coj khaub ncaws, tab sis feem ntau nws tshwm sim thaum lub sij hawm ovulatory lub sij hawm los yog nyob rau hauv ua ntej ntawm kev coj khaub ncaws, thaum lub concentration ntawm gonadotropic cov tshuaj hormones nce mus txog qhov siab tshaj plaws. Tsis tas li ntawd, muaj qhov sib txawv ntawm kev loj hlob ntawm tus kab mob nrog ncua sij hawm ntawm kev coj khaub ncaws.
Tom ntej no, nrhiav seb cov qauv ntawm apoplexy yog dab tsi.
Kev faib cov hom apoplexy
Muab cov tsos mob tseem ceeb ntawm cov kab mob pathological no, cov hauv qab no tuaj yeem paub qhov txawv:
- daim ntawv mob, thaum muaj qhov mob ci ntsa iab yam tsis muaj cov tsos mob ntawm los ntshav sab hauv;
- hom hemorrhagic lossis anemic yam muaj feem ntau ntawm cov tsos mob ntawm los ntshav rau hauv plab kab noj hniav;
- mixed form thatua ke cov tsos mob ntawm qhov mob thiab anemic hom apoplexy.
Txawm li cas los xij, txij li qhov tseeb ntawm qhov tshwm sim pathological ib txwm nrog los ntshav ntawm qhov sib txawv ntawm qhov kev siv zog, tam sim no yog ib txwm ua kom faib cov kab mob mus rau qib ntawm qhov hnyav. Thaum noj mus rau hauv tus account tus nqi ntawm cov los ntshav, mob me, nruab nrab thiab hnyav degrees ntawm tus kab mob yog txawv. Cov tsos mob kiag li nyob ntawm daim ntawv ntawm apoplexy.
Symptomatics
Qhov tshwm sim tseem ceeb ntawm cov xwm txheej pathological yog qhov mob thiab cov tsos mob ntawm los ntshav sab hauv.
Mob hauv zes qe menyuam apoplexy los ntawm qhov mob hnyav thiab feem ntau nyob hauv plab plab. Nyob rau tib lub sij hawm, irradiation ntawm qhov mob nyob rau hauv lub lumbar thiab umbilical cheeb tsam, lub perineum, thiab lub qhov quav yog pom. Kev mob tuaj yeem yog qhov sib txawv - tas li lossis paroxysmal, stabbing lossis cramping hom. Qhov mob tshwm sim los ntawm 30 feeb mus rau ob peb teev, thiab ib ntus rov qab los thaum nruab hnub.
Qhov tshwm sim los ntshav thaum lub sij hawm apoplexy yog nrog los ntawm kev txo qis hauv cov ntshav siab, pallor ntawm daim tawv nqaij, ua kom tsis muaj zog thiab ua kom lub plawv dhia, kev qaug zog, qaug zog, kiv taub hau, ua daus no, ntuav, dryness ntawm mucous daim nyias nyias ntawm lub qhov ncauj, yaum kom defecate, tso zis ntau zaus. Tom qab ncua sijhawm ntawm kev coj khaub ncaws, los ntshav los ntawm qhov chaw mos yog feem ntau sau tseg. Yog tias tsis muaj kev ntsuas kub ntxhov hauv qhov xwm txheej no, cov ntshav sab hauv pib nce zuj zus thiab tuaj yeem ua rau muaj kev hem thawj rau lub neej. Cov cim qhia ntawm apoplexy yog qhov tseem ceeb kom paub txog lub sijhawm.
Nrog rau qib me me ntawm pathology, lub sijhawm luv luv ntawm qhov mob tshwm sim, poob siab, tsis muaj qhov tshwm sim ntawm peritoneal, xeev siab tuaj yeem tshwm sim.
Dab tsi yog apoplexy nruab nrab? Nws tshwm sim nrog mob hnyav, tsis muaj zog, qaug zog, ntuav, me me peritoneal tshwm sim, poob siab ntawm qib 1. Nyob rau hauv cov ntaub ntawv loj ntawm zes qe menyuam apoplexy, muaj qhov mob hnyav heev, flatulence, vau, ntuav, tachycardia, hws txias, qib 2-3 poob siab, qhov hnyav ntawm peritoneal cov tsos mob, qhov txo qis hauv hemoglobin concentration ntau dua 50% ntawm cov nqi ib txwm muaj. Lub tsev kho mob tuaj yeem ua rau muaj kev mob tshwm sim los ntawm kev mob plab hnyuv, ectopic cev xeeb tub, cev xeeb tub, lub zes qe menyuam cyst torsion, raum colic, peritonitis, mob pancreatitis, uas yuav tsum tau ceev faj kev kuaj mob.
Cyst apoplexy
Rupture of a cystic formation on the ovary is a pathology in which there is a hemorrhage into the tissue, ua txhaum ntawm kev ncaj ncees ntawm lub cystic capsule nrog tso tawm ntawm nws cov ntsiab lus rau hauv lub plab kab noj hniav.
Tus kab mob no feem ntau tshwm sim hauv cov ntxhais hluas thiab hauv cov poj niam thaum lub caij yug me nyuam. Ntawm cov mob phais mob pathology - yog kwv yees li 11%, thiab ntawm cov kab mob gynecological - txog 10-27%, noj qhov chaw thib 3. Tus naj npawb ntawm exacerbations ntawm tus mob no tshwm sim li ntawm 40-69% ntawm cov poj niam hluas.
Cyst apoplexy tuaj yeem tshwm sim thaum ovulation cuam tshuam, vim qhov tshwm sim ntawm cov corpus luteum yog tsim los ntawm kev tsim cov cyst uas tsis yog ovulating.follicle (kev ua haujlwm cyst). Hauv 90-95% ntawm cov neeg mob apoplexy, xws li cyst tshwm sim nyob rau hauv nruab nrab ib feem ntawm kev coj khaub ncaws los yog nyob rau hauv nws theem kawg. Ntawm no, nyob rau hauv lub sij hawm ovulatory, txog 17%, nyob rau hauv lub thib ob ib feem ntawm lub voj voog - nyob rau hauv 82%.
Ua rau pathology ntawm ntau yam thiab cov tsos mob tseem ceeb
Ntawm cov txheej txheem tshaj tawm rau kev tawg ntawm zes qe menyuam, qhov kev nyiam yog muab rau cov txheej txheem uas tshwm sim los ntawm lub sijhawm ovulation (hnub 12-14 ntawm lub voj voog) txog thaum pib ntawm cev xeeb tub. Cov txheej txheem no feem ntau yog nrog cov ntshav ntau dhau ntawm lub tsev menyuam appendages, nrog rau kev nce hauv permeability ntawm lawv cov hlab ntsha. Lub luag haujlwm tseem ceeb hauv cov txheej txheem pathological no yog ua los ntawm qhov tsis txaus ntawm cov tshuaj hormones pituitary - luteinizing, follicle-stimulating hormones, nrog rau prolactin.
Predisposing factors
Predisposing factors rau tus mob no hauv cov poj niam suav nrog:
- ua haujlwm tsis zoo ntawm cov kab mob endocrine, tshwj xeeb, tsis txaus ntseeg hauv kev ua haujlwm ntawm hypothalamus-pituitary-ovarian system;
- kev ua haujlwm tsis zoo ntawm lub paj hlwb, kev puas siab puas ntsws lability provoked los ntawm cov xwm txheej ntxhov siab, kev puas siab puas ntsws thiab kev ua haujlwm ntau dhau;
- cov txheej txheem inflammatory ntawm cov kab mob urinary thiab qhov chaw mos, ua rau cov ntshav khiav mus rau cov appendages thiab impaired microcirculation, nrog rau kev hloov pauv fibrotic thiab sclerotic hauv lawv cov ntaub so ntswg;
- dysmenorrhea thiab muaj ntau qhov rho menyuam;
- qog nqaij hlav lossis cov txheej txheem nplaum hauv thaj tsam mepelvis;
- qhov txawv txav ntawm lub tsev menyuam;
- pelvic congestion, zes qe menyuam varicose leeg;
- txhawb nqa ntawm zes qe menyuam ua haujlwm, polycystic.
nce los ntshav kuj tseem txhawb nqa los ntawm kev mob ntshav txhaws hauv ntau yam kab mob lossis thaum noj qee yam tshuaj (antiplatelet agents thiab anticoagulants, acetylsalicylic acid, thiab lwm yam).
Qhov tshwm sim ntawm rupture ntawm zes qe menyuam cyst yog nyob rau hauv feem ntau cov kev loj hlob ntawm ib tug nplaum txheej txheem nyob rau hauv lub pelvic cheeb tsam nrog rau ntxiv tsim ntawm tubal-peritoneal infertility, tshwj xeeb tshaj yog nrog conservative txoj kev kho mob. Vim qhov tshwm sim ntawm adhesions tom qab rupture ntawm lub cystic tsim ntawm zes qe menyuam, zaus ntawm conception tsuas yog hais txog 26%.
Qhov tshwm sim ntawm zes qe menyuam apoplexy tau piav qhia hauv qab no. Tam sim no qhov tseeb yog dab tsi.
Kev mob nkeeg
Tsuas mus pw hauv tsev kho mob xwm txheej ceev thiab kev siv txhua yam kev ntsuas tsim nyog rau cov kab mob pathological ntawm zes qe menyuam yuav pab tiv thaiv ntau yam teeb meem loj thiab khaws cia lub cev xeeb tub ntawm poj niam. Yog tias koj tsis nrhiav kev pab kho mob uas tsim nyog thaum muaj xwm txheej ceev, qhov tshwm sim tuaj yeem txaus ntshai heev.
Kev tshawb fawb tau ua pov thawj tias kev kho mob ntawm zes qe menyuam apoplexy tsis tas yuav pab kom ua tiav qhov txiaj ntsig zoo. Cov ntshav uas tau nkag mus rau hauv lub plab kab noj hniav tsim ib qho chaw yug me nyuam rau cov kab mob pathogenic microorganisms, qhov twg cov txheej txheem ntawm aseptic o pib. Yuav ua li casYog li ntawd, adhesions yog tsim uas cuam tshuam lub ntuj tsim ntawm zes qe menyuam thiab cov ntaub so ntswg nyob ze. Nyob rau hauv cov xwm txheej zoo li no, qhov teeb meem feem ntau yog kev ua haujlwm ntawm kev ua me nyuam ntawm cov neeg mob. Mob tom qab apoplexy kuj tsis tshua muaj.
Ntshav los ntshav tsis txaus ntshai li ntshav hnyav, tab sis kuj tuaj yeem ua rau muaj qhov tshwm sim loj.
Cov txheej txheem ua mob hauv thaj chaw pelvic, rov qab hemorrhage nyob rau hauv zes qe menyuam, txheej txheem nplaum, peritonitis, poob ntawm kev ua me nyuam yaus yog qhov tshwm sim loj tshaj plaws ntawm apoplexy. Nyob rau hauv cov ntaub ntawv hnyav ntawm tus kab mob no, cov kws phais yuav txiav txim siab tshem tawm cov zes qe menyuam, uas ua rau muaj menyuam tsis taus. Txawm li cas los xij, tus kab mob no hauv nws tus kheej tsis cuam tshuam txog kev xeeb tub. Adhesions uas tshwm sim nyob rau hauv cheeb tsam ntawm zes qe menyuam thiab fallopian raj ua ib tug txiav txim obstacles rau fertilization. Tom qab lub zes qe menyuam apoplexy los yog cyst, ectopic cev xeeb tub feem ntau pom nyob rau hauv cov poj niam. Yog tias tsis tiv thaiv los ntshav hauv lub sijhawm, ces lub zes qe menyuam apoplexy tuaj yeem ua rau tus neeg mob tuag.
Thaum cev xeeb tub, cov kab mob no tsis tshwm sim ntau zaus. Hauv cov xwm txheej zoo li no, kev phais yog ua los ntawm laparotomy. Lwm qhov tsis zoo ntawm apoplexy yog qhov muaj feem pheej hmoo ntawm nchuav menyuam.
Yog tias koj ua raws li tag nrho cov lus pom zoo kho mob thiab ua raws txhua yam kev kho mob, koj tuaj yeem zam qhov tshwm sim tsis zoo ntawm tus kab mob no lossis txo qis. anti-inflammatory kev kho mob thiabphysiotherapy sessions yog ib qho yuav tsum tau kawm tom qab phais. Tsis tas li ntawd, nws yog ib qho tseem ceeb uas yuav tau siv cov tshuaj hormonal thiab kev tiv thaiv kab mob rau rau lub hlis. Raws li kev txheeb cais, nrog kev mus pw hauv tsev kho mob xwm txheej ceev thiab kho kom raug ntawm cov neeg mob apoplexy, qhov kev cia siab feem ntau yog qhov zoo.
Diagnosis
Txheeb cais hais tias qhov kev kuaj pom tseeb ntawm apoplexy tsuas yog 5%. Qhov feem pua me me no yog vim qhov tseeb tias tus kab mob no tsis muaj tus yam ntxwv thiab qhia tau meej, thiab feem ntau pom tau tias yog lwm yam kab mob.
Kev kuaj mob apoplexy yuav tsum tau ua kom sai, vim tias lub sijhawm kuaj mob ntau dua, qhov poob ntshav ntau dua, thiab qhov no yog ib qho kev hem thawj rau poj niam lub neej.
Txoj kev kuaj mob zoo tshaj plaws yog:
- Ultrasound rau apoplexy, uas tso cai rau koj pom lub cev luteum nyob rau hauv zes qe menyuam thiab cov yam ntxwv los ntshav rau hauv nws lossis cov kua dej dawb nyob rau hauv lub posterior fornix lossis plab;
- laparoscopy, uas tso cai nrog 100% lav los kuaj mob, thiab tseem ua rau nws tuaj yeem kho txawm tias nyuaj pathologies.
Rupture ntawm zes qe menyuam cov ntaub so ntswg zoo li laparoscopy raws li qhov chaw nce mus txog 0.5 cm nyob rau hauv txoj kab uas hla nrog ib tug tshwj xeeb hemorrhage los yog nyob rau hauv daim ntawv ntawm ib tug corpus luteum nrog ib tug pronounced defect los yog cov ntaub so ntswg rupture, uas yog feem ntau nrog los ntshav.
Ntxiv rau, cov kev kuaj mob hauv qab no tau siv:
- kuaj ntshav dav dav, thaum lub sijhawm txo hemoglobin yuav pom tau;
- puncture ntawm posterior fornix,uas ua rau nws muaj peev xwm xav tias muaj ntshav hauv plab;
- tus yam ntxwv mob mob uas tshwm sim hauv nruab nrab lossis qhov kawg ntawm kev coj khaub ncaws.
Kev kuaj mob zaum kawg feem ntau yog ua thaum phais, nrog kev pom ncaj qha ntawm cov ntaub so ntswg puas.
Cov lus qhia kho mob rau apoplexy yog dab tsi?
Kev kho mob
Lub hom phiaj tseem ceeb ntawm kev kho apoplexy yog los tiv thaiv kev txhim kho los ntshav thiab rov ua kom lub cev muaj kev ncaj ncees thaum khaws tag nrho cov kabmob. Nws yog ib qho tseem ceeb uas tus neeg mob khaws cov kev ua me nyuam. Yog tias muaj qhov tsis txaus ntseeg ntawm apoplexy, tus neeg mob yuav tsum tam sim ntawd coj txoj haujlwm kab rov tav. Tsis tas li ntawd, tus poj niam yuav tsum tau coj mus rau lub tsev kho mob gynecological sai sai.
Txoj kev kho kom zoo tuaj yeem ua tau rau hauv cov ntaub ntawv yooj yim ntawm pathology. Xws li kev kho mob muaj nyob rau hauv kev noj tshuaj hemostatic, vitamins thiab antispasmodics. Tus neeg mob yuav tsum tau txias lub plab thiab so. Kev kho mob yog nqa tawm nyob rau hauv qhov chaw nyob ruaj khov. Nyob rau hauv cov ntaub ntawv ntawm deterioration ntawm kev noj qab haus huv thiab cov tsos ntawm intracavitary los ntshav, nws yog ib qhov tsim nyog yuav tsum tau mus rau kev phais.
Kev phais rau apoplexy yog suav tias yog qhov ua tau zoo tshaj plaws, vim tias nws tso cai rau koj kuaj xyuas cov kab mob kom raug thiab ntsuas qhov tsim nyog. Kev phais mob yog ua los ntawm laparoscopic lossis laparotomic nkag. Nrog laparotomy, nws muaj peev xwm coagulate lub nkoj puas. Thaum lub sij hawm laparoscopy, cov ntshav ntau dhau raug tshem tawmlub plab kab noj hniav, tom qab uas ntxuav nrog antiseptic daws yog nqa tawm, thiab cov hlab ntsha puas yog sutured. Txawm li cas los xij, yog tias qhov pathology ntawm lub cyst tshwm sim, ces lawv mus rau nws tshem tawm thiab suturing ntawm zes qe menyuam. Kev ua haujlwm rau apoplexy tsis ua rau muaj kev cuam tshuam loj ntawm cov tshuaj pleev ib ce thiab ua raws li tshuaj loog. Nws tso cai rau koj kom ua tiav qhov kev rov ua haujlwm sai tshaj plaws, thiab kev ua haujlwm ntawm kev ua me nyuam tseem tsis cuam tshuam. Tom qab apoplexy thaum lub sij hawm phais, lub zes qe menyuam raug tshem tawm tsuas yog thaum muaj mob hnyav, yog tias nws cuam tshuam rau lub cev. Thaum cev xeeb tub, nws yog sutured, resection tsis ua.
Peb tau saib seb qhov apoplexy yog dab tsi. Qhov no yog ib qho kev phom sij txaus ntshai uas muaj teeb meem kev noj qab haus huv.
