YUterine polyp yog ib yam kab mob uas muaj ntau heev uas yuav rov tshwm sim dua. Recurrent endometrial hyperplasia nyob rau hauv 1.5% ntawm cov neeg mob yog malignant. Qhov zoo tshaj plaws ntawm kev tsim mob qog noj ntshav ntawm lub tsev menyuam yog txuam nrog adenomatous polyps (adenomas). Tus kab mob tuaj yeem tshwm sim thaum twg los tau. Txoj kev zoo tshaj plaws ntawm kev kho mob yog hysteroscopy (tshem tawm ntawm endometrial polyp). Kev ua haujlwm yog qhov cuam tshuam me me thiab ua haujlwm siab, uas txo qis qhov tshwm sim ntawm kev rov tshwm sim ntawm pathology thiab kev loj hlob ntawm qhov tshwm sim tsis zoo.
uterine polyp yog dab tsi?
Pathological tsim, nce saum npoo ntawm endometrium (mucosa) ntawm cov leeg nqaij ntawm qhov chaw mos, uas tus me nyuam yug los, hu ua uterine polyp hauv tshuaj. Lawv muaj ib tug txawv configuration, sib xws, nqaim los yog dav puag, du, villous los yog lobed.nto. Neoplasia tuaj yeem muaj qhov loj me los ntawm cov noob noob hnav mus rau lub pob golf. Polyps ntawm mucous daim nyias nyias ntawm lub tsev menyuam yog ib leeg thiab ntau yam. Lo lus "polyposis" yog siv yog tias tus naj npawb ntawm neoplasias ntau dua nees nkaum.
Raws li nws cov qauv, polyp muaj peb yam. Qhov saum npoo ntawm qhov tsim yog them nrog cov ntaub so ntswg epithelial, stalk muaj fiber ntau hauv paus thiab cov hlab ntsha tuab. Neoplasia tuaj yeem ua rau mob, kis kab mob, metaplasia cellular, necrotic.
Polyps tau faib feem ntau los ntawm cov qauv morphological. Cov kab mob pathological hauv qab no yog qhov txawv:
- Glandular polyps yog tsim los ntawm cov ntaub so ntswg endometrial uas muaj qog.
- Glandular-fibrous yog sawv cev los ntawm cov txheej mucosal hauv kab noj hniav ntawm cov kab mob hauv nruab nrog cev thiab cov ntaub so ntswg sib txuas (stroma).
- Fibrous yog tsim los ntawm cov ntaub so ntswg tuab.
- Adenomatous polyps yog sawv cev los ntawm glandular epithelium thiab nquag hloov mus rau qog nqaij hlav endometrial.
Endometrioid polyps tsis tshua loj hlob dhau ntawm lub uterine kab noj hniav. Lawv raug kuaj pom ob qho tib si hauv cov ntxhais hluas thiab hauv cov poj niam cev xeeb tub. Nyob rau hauv gynecology, tus mob yog suav hais tias yog precancerous, thiab nyob rau hauv feem ntau, txoj kev phais yog teem kom tshem tawm cov endometrial polyp.
txoj kev kho
Raws li kev txheeb cais qhia, pathological tsim ntawm lub tsev menyuam feem ntau tsim tawm tsam keeb kwm yav dhau los ntawm kev tsis sib haum xeeb hauv kev ua haujlwm hormonal ntawm zes qe menyuam thiab nce qib estrogen. Tab sis kev kho tshuaj hormone liKev kho thawj zaug tsis tshua siv.
Kev kho zoo tshaj plaws yog hysteroscopy - resection ntawm uterine polyp siv cov khoom siv endoscopic. Cov formations ntawm ceg yog "unscrewed", thiab lub txaj yog cauterized los ntawm txoj kev cryogenic los yog electrocoagulation. Cov neoplasias tshem tawm tom qab raug xa mus rau kev kuaj mob histological, cov txiaj ntsig ntawm kev txiav txim siab ntxiv kev kho mob.
Tshem tawm ntawm fibrous polyp ntawm endometrium yog ua los ntawm polyectomy nrog curettage (curettage) ntawm lub tsev menyuam. Thaum resection ntawm glandular pathological formations, ntxiv hormonal kho yuav tsum tau. Rau kev kho mob ntawm adenomatous polyps ntawm lub tsev menyuam, radical txoj kev kho (supravaginal amputation, panhysterectomy) yog siv.
Hysteroscopy Benefits
Kev siv cov cuab yeej siv niaj hnub no thaum lub sijhawm ua haujlwm txhim kho nws qhov zoo thiab txo qhov kev pheej hmoo ntawm cov teeb meem. Hauv kev phais, cov kev kho mob zoo li no tau dav heev. Lub ntsiab lus ntawm kev ua haujlwm feem ntau yog muab los ntawm lub npe ntawm cov khoom siv uas nws tau ua.
Hysteroscopy ntawm endometrial polyp yog kev tshem tawm ntawm focal uterine hyperplasia siv lub tshuab endoscopic tshwj xeeb hauv daim ntawv ntawm lub raj nrog lub fiber ntau optic thiab illumination. Kev ua haujlwm yog endovision, uas yog, nws tsis muab rau qhib lub kab noj hniav. Tab sis qhov no tsis yog ib qho ntxiv ntawm hysteroscopy.
- Kev phais phais tsis tas yuav muaj kev npaj tshwj xeeb.
- Kev kho ntawm focal uterine hyperplasia nrogCov khoom siv endoscopic, tsis tshua muaj kev puas tsuaj ntau dua li classic curettage.
- Qhov tshwm sim tsis zoo ntawm hysteroscopy (tshem tawm ntawm endometrial polyp) tsis tshua muaj.
- Lub sijhawm rov ua haujlwm luv luv.
- Vim kev tswj qhov muag pom, qhov tshwm sim ntawm kev tshem tawm tsis tiav ntawm polyp yog tsawg.
- Tom qab hysteroresectoscopy, lub txaj neoplasia yog cauterized, uas txo tus naj npawb ntawm rov tshwm sim.
- Yog tias qhov kev tswj hwm tau ua tiav siv lub hysteroscope nruj, ces nws raug tso cai siv ntau txoj hauv kev rau kev tso dej (qhov dej mus ntev ntawm cov kab noj hniav) thiab kev aspiration. Kev ua haujlwm siv cov cuab yeej zoo li no muaj tus nqi qis dua.
Tshem tawm ntawm endometrial polyp (hysteroresectoscopy): cov lus qhia
Kev ua haujlwm, txawm hais tias muaj kev cuam tshuam me me, tseem yog kev cuam tshuam kev phais. Qhov kev txiav txim siab nqa tawm yog ua tom qab ntau qhov kev ntsuam xyuas. Cov kab mob uas yog cov cim qhia rau hysteroresectoscopy tsuas yog tsim los ntawm kws kho mob. Cov no suav nrog:
- Ntau yam endometrial hyperplasia uas yog ib txwm muaj (uterine polyposis).
- Ib leeg ib leeg polyps uas yog asymptomatic.
- Endometrial neoplasia ntawm txhua qhov loj me nrog cov uterine los ntshav.
- Kev loj hlob ntawm anemia tshwm sim los ntawm qhov chaw mos los ntshav ntau zaus.
- Ntau qhov chaw mos tawm nrog qhov mob hnyav.
- kev coj khaub ncaws tsis zoo.
- Kev tsis muaj peev xwm lossis teeb meem tom qab kho.
- Adenomatous (glandular) polyps. Xws lineoplasms, muaj feem ntau ntawm degeneration los ntawm ib tug benign mus rau ib tug malignant qog.
- Ntxhais nchuav menyuam.
- Hormonal tsis ua haujlwm. Hormonal imbalances tuaj yeem ua rau muaj kev loj hlob ntawm neoplasms.
Kev tshem tawm ntawm endometrial polyp nyob rau hauv lub tsev me nyuam thaum lub sij hawm cev xeeb tub npaj yog nqa tawm los tsim tej yam kev mob rau implantation ntawm embryo.
YContraindications
Ua ntej sau npe rau kev txiav txim, tus kws kho mob, thaum kuaj lub cev thiab thaum kuaj xyuas, txheeb xyuas tag nrho cov kab mob uas tiv thaiv kev siv txoj kev kho mob no. Cov npe dav dav ntawm kev noj qab haus huv nyob rau hauv uas kev phais yog ib ntus lossis tas mus li tsis tau qhia suav nrog contraindications rau classical ectosomatic phais.
- Kab mob kis tau yooj yim ntawm txoj kev ua pa (flu, tonsillitis, pneumonia).
- Kab mob raum kab mob ntawm cov kab mob etiology.
- Ua pa tsis ua haujlwm.
- Decompensated heart failure.
- Lub raum tsis ua haujlwm.
- Ua txhaum lub siab ua haujlwm, nrog rau cov kab mob metabolic, intoxication, kev loj hlob ntawm hepatic coma.
- Tshuaj.
- Kev mob ntawm cov kab mob hemostasis.
Contraindications rau kev tshem tawm ntawm uterine endometrial polyps los ntawm lub cev xeeb tub yog:
- Cov kab mob inflammatory ntawm qhov chaw mos (vulvitis, cervicitis, salpingo-oophoritis thiab lwm yam).
- Bacterial vaginosis.
- IV degree ntawm kev huv ntawm qhov chaw mos.
- Malignant neoplasms ntawm uterine mucosa.
- Uterine fibroids ntawm qhov loj me.
- Submucosal fibroids tshaj 5 cm inch.
Rau cov kab mob uas kho tau, kev phais yuav ncua kom txog thaum rov zoo tag nrho. Hauv kev mob hnyav hnyav, cov kev kho mob tau teeb tsa tus kheej.
Npaj rau kev phais
Kev phais yog ib theem tseem ceeb hauv kev kho tus neeg mob. Tag nrho cov manipulations yog nqa tawm tsuas yog nrog kev tso cai ntawm tus neeg mob. Resection ntawm neoplasia ntawm uterine mucosa yog ib qho kev npaj phais. Kev npaj tshwj xeeb rau kev ua haujlwm kom tshem tawm cov kab mob endometrial polyp (hysteroscopy) tsis tas yuav tsum tau ua. Kev sim kuaj thiab ntsuas ntsuas yog tus qauv rau cov txheej txheem cuam tshuam feem ntau.
- Kev kuaj mob los ntawm gynecologist ntawm lub rooj zaum.
- Bimualual (ob txhais tes) xeem.
- Kev kuaj mob ntawm lub ncauj tsev menyuam qhov chaw mos siv lub colposcope.
- Smears rau qhov chaw mos huv thiab cytology.
- Kev kuaj mob plab pelvic.
- kuaj ntshav kuaj.
- ntshav biochemistry (glucose).
- Kev kuaj ntshav rau cov tshuaj tiv thaiv kab mob rau saum npoo ntawm tus kab mob siab B.
- Cov tshuaj tiv thaiv kab mob siab C.
- Tshuaj ntsuam xyuas cov tshuaj tiv thaiv kab mob HIV.
- Wassermann test (RW) - kuaj mob syphilis sai.
- YFluorography.
- Electrocardiogram nrog cov ntawv sau.
Y Hysteroresectoscopy yog ua rau hnub 5-15 ntawm kev coj khaub ncaws. Rau cov neeg mobnoj hluavtaws analogues ntawm estrogen thiab progesterone, kev ua haujlwm tuaj yeem ua tau rau txhua hnub ntawm lub voj voog.
Thaum sawv ntxov ua ntej polypectomy, tus qauv kev tu cev thiab depilation ntawm thaj chaw sib raug zoo tau ua tiav. Nws yog ib qho tsim nyog yuav tsum tsis kam noj zaub mov. Kev ua haujlwm yog ua tom qab ntxuav cov hnyuv los ntawm enema thiab nrog lub zais zis.
Hysteroscopy technique
Kev phais mob yog ua los ntawm kev siv mono- lossis bipolar hysteroresectoscope. Qhov no yog ib qho cuab yeej nyuaj, suav nrog optics, tso cai rau pom kev tswj xyuas cov txheej txheem thiab cov cuab yeej phais.
Kev tshem tawm ntawm endometrial polyp (hysteroscopy) yog ua nyob rau hauv cov tshuaj loog. Sab nraud genitalia, qhov chaw mos thiab lub ncauj tsev menyuam raug kho nrog tshuaj tua kab mob. Qhov qis dua ntawm lub tsev menyuam yog tsau nrog cov mos txwv forceps. Nrog kev pab los ntawm lub kaus uterine, qhov tob, txoj hauj lwm thiab kev mob ntawm lub uterine kab noj hniav yog kuaj. Lub ncauj tsev menyuam kwj dej yog nthuav kom pub dawb tso rau ntawm qhov ntsuas endoscopic. Lub uterine kab noj hniav yog sau nrog roj los yog kua. Qhov no muab qhov chaw txaus rau kev ntsuas thiab kev pom kev ntawm kev ua haujlwm.
Ib lub tshuab kuaj pom thiab lub koob yees duab yees duab tau muab tso rau hauv lub tsev menyuam kab noj hniav, uas xa cov duab mus rau lub vijtsam saib. Tus kws kho mob tshuaj xyuas lub tsev menyuam, tshuaj xyuas qhov mob ntawm cov mucous membrane (endometrium), txiav txim siab qhov chaw ntawm pathological neoplasms. Resection ntawm polyps yog ua los ntawm endoscopist.
Ib leeg polyps nrog lub cim zoo raug tshem tawm,siv txiab endosurgical los yog ib lub voj tshwj xeeb. Lub voj electrode feem ntau yog siv los tshem tawm cov neoplasia loj nyob ze ntawm phab ntsa uterine lossis muaj cov qauv fibrous. Txhawm rau tiv thaiv los ntshav thiab txo qhov yuav tshwm sim ntawm tus kab mob, lub txaj ntawm kev tsim yog cauterized.
Tom qab tshem tawm cov kab mob endometrial polyp, tus kws kho mob tshem tawm tag nrho cov cuab yeej ntawm lub tsev menyuam thiab tshem tawm cov pa roj lossis kua. Lub sijhawm nruab nrab ntawm kev ua haujlwm yog 20-40 feeb. Nrog ntau yam polyps, kev nyuaj siab, kev ua haujlwm yuav siv sijhawm ntev dua. Lub sijhawm tshuaj loog tuaj yeem txuas ntxiv mus.
After surgery
Tom qab kev phais, tus neeg mob raug xa mus rau pawg ntseeg. Yog tias qhov kev tshem tawm ntawm endometrial polyp mus yam tsis muaj teeb meem, tus neeg mob raug tso cai rov qab mus tsev li ob peb teev tom qab nws rov qab los ntawm tshuaj loog.
Nyob rau lub sijhawm tomqab phais, tau muab tshuaj tua kab mob los tiv thaiv kab mob sib kis. Thaum ntxov, ib tug poj niam yuav muaj mob. Txhawm rau tshem tawm lawv, tus kws kho mob sau tshuaj kho mob.
Tom qab ua haujlwm, ib tug poj niam ib txwm muaj qhov tsis pom kev. Lawv feem ntau mus deb ntawm lawv tus kheej li ntawm 3-5 hnub.
Tshem tawm polyps raug xa mus rau kev kuaj mob. Cov txiaj ntsig feem ntau yog npaj txhij hauv ib lub lis piam, tib lub sijhawm tus neeg mob yuav tsum tau mus ntsib kws kho mob gynecologist txhawm rau txiav txim siab cov kev kho mob tom ntej. Tom qab tshem tawm cov glandular polyp ntawm lub endometrium, kev kho mob nrog tshuaj hormonal raug sau tseg yam tsis tau ua tsis tiav.
Lub sijhawm rov qab los
Lub sijhawm kho mob rau txhua tus poj niam txawv. Nws tag nrho yog nyob ntawm qhov hnyav ntawm pathology, muaj cov kab mob sib kis, hnub nyoog ntawm tus neeg mob, kev ua haujlwm zoo.
Nyob rau ob peb hnub thawj zaug, qhov kub nce me ntsis tuaj yeem ua tau. Cov txheej txheem kho yuav raug nrog los ntawm qhov mob spasmodic tsawg. Lawv lub sijhawm yog nyob ntawm tus yam ntxwv ntawm lub cev. Txhawm rau kom lub sijhawm rov qab los tom qab tshem tawm ntawm endometrial polyp (hysteroscopy) mus kom zoo, qee cov lus pom zoo yuav tsum ua raws.
- Tsis da dej 2 lub lis piam tom qab phais.
- Cov cua kub hnyav yuav tsum tau tso tseg.
- Ncua tseg ib ntus lossis rov teem sijhawm qee cov txheej txheem kho lub cev (electrophoresis, kho laser).
- txwv tsis pub ua luam dej hauv pas dej thiab pas dej.
- Tsis suav nrog kev tawm dag zog thiab kis las.
- Koj tsis tuaj yeem douche thiab siv qhov chaw mos suppositories yam tsis muaj tshuaj los ntawm kws kho mob gynecologist.
- Qhov chaw mos tampons yuav tsum zam.
- Koj yuav tsum zam kev sib deev rau 3-4 lub lis piam.
Muaj Teeb Meem
Cov teeb meem hauv kev ua haujlwm tsis tshua muaj tsawg. Qhov tshwm sim ntawm lawv qhov tshwm sim yog tsawg, tab sis tsis suav nrog tag nrho. Cov npe ntawm cov xwm txheej tsis xav tau suav nrog:
- Ntsuag. Electrocoagulation ntawm cov hlab ntsha endometrial puas yog siv los txwv tsis pub los ntshav.
- Kev mob ntawm lub tsev menyuam vim kev puas tsuaj (kev raug mobsoj ntsuam, curette).
- Kev raug mob raug mob los ntawm qhov kub thiab lub zog raug.
- Nyhav cuam tshuam nrog kev siv txhais tau tias ncab lub uterine kab noj hniav.
Cov teeb meem tuaj yeem tshwm sim tsis yog thaum lub sijhawm ua haujlwm, tab sis kuj tom qab nws. Qhov tshwm sim tsis zoo ntawm hysteroscopy (tshem tawm ntawm endometrial polyp) tuaj yeem pom nws tus kheej hauv daim ntawv ntawm cov kab mob hauv qab no:
- Qhia cov ntshav hauv lub tsev me nyuam.
- mob plab hauv plab ntawm lub tsev menyuam.
- Kab mob. Qhov tshwm sim ntawm cov teeb meem no tsis tshaj 0.17-3%. Feem ntau yog sepsis, kab mob shock.
- Kev tawm mus ntev ntev tom qab tshem tawm ntawm endometrial polyp los ntawm hysteroscopy, raws li txoj cai, tshwm sim vim tsis ua raws li cov tshuaj kho mob.
- Kev tsis muaj menyuam. Tag nrho ablation ntawm uterine mucosa tuaj yeem ua rau kev loj hlob tsis muaj peev xwm xeeb tub lossis nchuav menyuam.
- Stenosis ntawm lub ncauj tsev menyuam kwj dej. Anatomical nqaim feem ntau tshwm sim tom qab electro- los yog laser coagulation ntawm lub mucous daim nyias nyias ntawm lub ncauj tsev menyuam kwj dej.
Kev kho mob tom qab tshem tawm ntawm endometrial polyp
Qee zaum, tus kws kho mob yuav sau tshuaj ntxiv. Cov tshuaj tsis yog ib txwm muab tshuaj, nws tag nrho yog nyob ntawm hom neoplasm. Feem ntau, kev kho mob yog sau tseg tom qab tshem tawm ntawm glandular polyp ntawm endometrium. Hom neoplasia no feem ntau pom thaum muaj hnub nyoog yau. Kev kho tshuaj Hormone yog tsom rau kev kho kom tiav ntawm tus poj niam txoj kev ua me nyuam.
Kev xaiv cov tshuaj tiv thaiv hormonal yog ua los ntawm kws kho mob. Kev sib xyaw ntawm "Ethinylestradiol" (ib qho tshuaj estrogen) nrog "Dienogest" (suppresses trophic nyhuv ntawm estrogens) los yog "Desogestrel" yog suav tias yog qhov zoo tshaj plaws. Kev kho mob tuaj yeem yog 3 txog 6 lub hlis.
Tsis tas li, txhawm rau ua kom cov txheej txheem hormonal normalizes, Mirena lossis Jaydes intrauterine li raug teeb tsa. Cov khoom xyaw nquag ntawm cov tshuaj tiv thaiv kab mob yog levonorgestrel, uas ua rau txo qis hauv kev cog qoob loo ntawm endometrium. Kauv teem tau 5 xyoos.
Yog tias qhov kev kuaj mob histological qhia pom cov kab mob ntxiv, tom qab ntawd kev kho mob yuav raug tshuaj nyob ntawm seb hom kab mob. Yog tias pom muaj cov kab mob malignant hauv polyps, ib qho kev ntsuam xyuas ntxiv yuav raug sau tseg thiab, feem ntau yuav, kev kho mob radical ntau dua yuav raug ua.
Reviews
Cov poj niam feem ntau txaus siab rau qhov kev ua haujlwm mus li cas. Lawv nco txog qhov yooj yim ntawm kev tuaj yeem mus tsev ob peb teev tom qab kev phais.
Feem ntau, cov neeg mob hauv kev tshuaj xyuas txog qhov tshwm sim ntawm hysteroscopy (tshem tawm ntawm endometrial polyp) sau txog kev los ntshav ntev uas qhib ob peb hnub tom qab kev phais. Tab sis tom qab noj tshuaj, txhua yam rov qab sai sai. Tab sis feem ntau, cov poj niam teb tau zoo, tshwj xeeb tshaj yog cov uas tau sau tseg kev kho mob, uas tau ua tsis tau zoo.
Ntau tus neeg mob nco txog tus nqi siab ntawm kev ua haujlwm, tab sis lawv tus kheej hais tias qhov kawg tshwm sim yog tsim nyog. Tom qab hysteroscopy, cov kws kho mob feem ntau sau cov tshuaj tiv thaiv qhov ncauj. Cov poj niam uas tsis tau siv cov tshuaj no yav dhau los qhia txog kev phiv thiab kev kawm ntev heev.
Kev cev xeeb tub tom qab hysteroscopy
Kev muaj menyuam tsis taus tom qab tshem tawm cov kab mob neoplasm ntawm lub tsev menyuam endometrium tsuas yog tshwm sim yog tias kev ua haujlwm tau ua tiav nrog tus kabmob hnyav lossis yog tus poj niam muaj teeb meem xeeb menyuam lossis cev xeeb tub ua ntej.
Hauv kev tshuaj xyuas ntawm hysteroscopy (tshem tawm ntawm endometrial polyp), cov poj niam hluas hais tias lawv cev xeeb tub sai heev, thiab tag nrho lub sijhawm zoo li qub. Raws li kev soj ntsuam, cov kws kho mob pom zoo kom npaj lub cev xeeb tub tom qab 3-4 kev coj khaub ncaws. Nws ntseeg tau hais tias los ntawm lub sij hawm no lub mucous daim nyias nyias tau rov qab tag, uas txo qhov kev pheej hmoo ntawm nchuav menyuam.
Y Hysteroscopy yog ib txoj hauv kev niaj hnub thiab zoo ntawm kev kho cov kab mob endometrial polyps. Tab sis qhov txiaj ntsig tau zoo yog nyob ntawm tsis yog tsuas yog kev tshaj lij ntawm tus kws phais mob xwb, tab sis kuj tseem nyob ntawm kev thov kev pab raws sijhawm thiab kev ua raws li tag nrho cov lus pom zoo tom qab phais.
