mis mastalgia yog dab tsi? Lub tswv yim no yog sib sau ua ke thiab nws txhais tau hais tias ib qho kev mob tshwj xeeb ntawm cov qog mammary, tus cwj pwm los ntawm qhov mob thiab qhov tsis xis nyob. Cov kev xav zoo li no tau ntsib los ntawm 80% ntawm cov poj niam tsawg kawg ib zaug hauv lawv lub neej. Nws tuaj yeem qhia txog kev ua haujlwm lossis kev ua haujlwm tsis zoo hauv cov ntaub so ntswg ntawm lub caj pas mammary. Los yog muaj nyob rau hauv cov tsos mob ntawm lwm yam kab mob uas tsis ncaj qha ntsig txog lub mis. Qhov teeb meem ntawm mastalgia yog tias nws ua rau tus poj niam lub neej muaj zog heev, ua rau nws ntxhov siab thiab teeb meem hauv tsev neeg thiab kev sib deev.
Mastalgia thiab mastodynia - puas muaj qhov sib txawv?
Cov 2 lo lus no yog cov lus sib piv, tab sis mastalgia yog siv nyob rau hauv cov ntaub ntawv ntshiab, thiab mastodynia yog qhia nyob rau hauv International Classification of Diseases (ICD-10 code - 64.4.) Lo lus "mastalgia" tsis nyob rau hauv ICD.. Cov txheej txheem pathology yog nyob rau hauv ntu "Lwm yam kab mobmammary caj pas".
Ib yam ntawm 2 lub npe no tuaj yeem siv rau ntau yam ntawm mastalgia:
- ib leeg thiab ob sab;
- loj focal thiab diffuse;
- cyclic, acyclic, cuav;
- ntu lossis tas mus li.
Lo lus "mastodynia" tau qhia rau hauv cov tshuaj hauv xyoo 1880 los ntawm tus kws phais neeg German T. Billroth thiab txhais tau tias mob cyclic thiab lub mis engorgement. Ib qho ntxiv nuance tuaj yeem raug sau tseg: lawv hais txog mastalgia thaum tsis muaj kev hloov pauv hauv cov ntaub so ntswg ntawm cov qog, txawm tias diffuse lossis focal. Thaum kev ua txhaum cai tshwm sim hauv lub caj pas nws tus kheej, ib lo lus raug siv ntau dua uas qhia txog daim duab kho mob tiag tiag. Lo lus no yog mastodynia.
Ua rau mastodynia
Cov tsos mob thiab cov tsos mob ntawm mastalgia yog tshwm sim hauv cov poj niam hluas, tab sis kuj tuaj yeem tshwm sim ua ntej / tom qab lub cev tsis muaj zog. Thawj qhov kev hais tawm ntawm mastalgia tuaj yeem tshwm sim nyob rau hauv puberty, thaum lub maturation ntawm cov qog mammary tshwm sim nyob rau hauv tus ntawm cov tshuaj estrogens.
Mastalgia ntawm lub caj pas mammary tuaj yeem tshwm sim nws tus kheej nrog kev hloov pauv ntawm lub cev thiab pathological. Feem ntau, nyob rau hauv lub hnub nyoog fertile, mastodynia yog txuam nrog hormonal tsis txaus. Nws tuaj yeem yog, piv txwv li, ovulation - nws yog qhov kev loj hlob ntawm cov tshuaj estrogen uas muab cov cell proliferation ntawm lub mis thiab cov tsos mob ntawm lawv. Cov kev tshwm sim no raug suav hais tias yog lub cev nqaij daim tawv, thiab kuj tseem tuaj yeem qhia PMS syndrome - premenstrual.
Mob tshwm sim 3-4 hnub ua ntej lossis thaum koj lub sijhawm. Tsis tas li ntawd, mastalgia tuaj yeem tshwm sim thaumpoj niam cev xeeb tub, tshwj xeeb tshaj yog nyob rau hauv thawj peb lub hlis twg.
Cov tshuaj hormones tuaj yeem tshwm sim nrog:
- zes qe menyuam pathologies: oophoritis, cysts, qog;
- Yuterine pathologies - adenomatosis, endometriosis, mob qog noj ntshav;
- pathologies ntawm thaj chaw hypothalamic-pituitary, kab mob ntawm cov thyroid caj pas thiab qog adrenal;
- noj tshuaj tiv thaiv kab mob.
Qhov no yog vim qhov tseeb tias ntau OCs feem ntau muaj estrogen thiab progesterone. Lawv ua rau tib yam kev hloov pauv uas ib txwm tshwm sim thaum lub sij hawm ovulation.
Qhov no tsis tau txais kev saib xyuas, vim feem ntau hauv 2-3 lub hlis lub cev hloov mus rau kev noj tshuaj thiab qhov mob yuav ploj mus. Cov laj thawj kuj tseem tuaj yeem pw hauv inflammatory lossis lwm yam kab mob ntawm lub mis - mastitis, sclerosing adenosis, mastopathy, mob cancer mis. Yog tias qhov no tsis yog qhov teeb meem, mastalgia tuaj yeem tshwm sim tawm tsam keeb kwm ntawm psychogeny - nquag thiab ntev kev ntxhov siab, neuroses, kev nyuaj siab, hysteria, kev xav overstrain, thiab lwm yam.
Purely mechanical ua - squeezing lub mis tsis ncaj ncees lawm lub mis loj, blunt trauma, lub cev muaj zog heev.
Tseem muaj lub tswv yim ntawm vertebrogenic mastalgia - irradiation ntawm qhov mob hauv siab nrog cervicothoracic osteochondrosis ntawm tus txha nraub qaum, intercostal neuralgia, myalgia, Tietze's syndrome, chondropathy, uas 1 lossis 2-3 pob qij txha txuas cov tav mus rau. sternum yog aseptically inflamed.
Thaum kawg, mastalgia tuaj yeem ua rau lub plawv thiab mob siab. Lub sijhawm ua rau muaj kev ntxhov siab tuaj yeem yog:
- poj niam lub hnub nyoog;
- ntau zaus yug lossis rho menyuam;
- gestation, tshwj xeeb tshaj yog nyob rau hauv thawj 3hli;
- menopause;
- general thiab gynecological pathologies.
Pathogenesis
Lub tshuab ntawm qhov mob hauv hormonal tsis ua haujlwm yog vim qhov tseeb tias cov ntaub so ntswg ntawm lub mis ib txwm muaj thiab tseem nyob ntawm cov tshuaj hormones. Nyob rau hauv lub luteal theem, proliferative txheej txheem intensified nyob rau hauv lub epithelial hlwb ntawm cov qog mammary, kua yog khaws cia thiab sau nyob rau hauv lawv stroma.
Txhua yam no yog qhov tshwm sim ntawm kev loj hlob ntawm cov tshuaj estrogens hauv thawj theem ntawm MC. Tab sis nyob rau hauv lub thib ob theem ntawm lub voj voog, progesterone loj hlob thiab nws ua, rau feem ntau, ntawm cov qog nqaij hlav. Txij li thaum nws npaj ib tug poj niam lub cev rau cev xeeb tub, thaum raug rau nws, lub mis loj thiab loj hlob. Alveoli loj hlob, receptors nyob rau hauv lub thickness ntawm cov qog, lawv rhiab heev nce.
Ntxiv rau, progesterone muaj peev xwm cuam tshuam ncaj qha rau electrolyte thiab dej metabolism, provokes kua tuav hauv cov ntaub so ntswg, thiab, yog li ntawd, o. Cov ntaub so ntswg ua hydrophilic, xoob, compression ntawm cov hlab ntsha xaus los ntawm edema tshwm sim thiab mob hauv siab tshwm sim. Yog li ntawd, cov qog o, cov hlab ntsha xaus yog compressed, inflammatory mediators yog qhib thiab mob tshwm sim. Nrog rau kev hloov pauv hauv cov ntaub so ntswg ntawm lub caj pas, cov nociceptive receptors (cov no yog cov receptors tshwj xeeb uas tsim los pom tus neeg ua haujlwm puas tsuaj) yog khaus los ntawm cov khoom lwj vim o, necrosis lossis cov ntaub so ntswg compression vim neoplasm loj hlob.
Kev faib tawm
Qhov tseeb txhais ntawm qhov sib txawv ntawm mastalgia yog qhov tseem ceeb rau kev xaiv kev kho mob thiab kev kuaj mob raws sij hawm hauv oncology. Mammologists txheeb xyuas cov laj thawj hauv qab no thiab hom mastalgia:
- Cyclic.
- Acyclic.
- Nyob zoo.
Cyclic mastalgia - yog dab tsi? Nws tseem hu ua mastodynia tseeb los yog ua haujlwm. Feem ntau qhov no yog qhov cim ntawm PMS. Mob tshwm sim 2-7 hnub ua ntej kev coj khaub ncaws tom qab ovulation, thaum lub sij hawm tom qab hormonal hloov. Nws kuj hais txog qhov ua tau FKM, siv cov tshuaj tiv thaiv qhov ncauj mus ntev.
Acyclic lossis symptomatic mastalgia yog qhov zoo rau cov neeg muaj hnub nyoog tshaj 30 xyoo. Tom qab ntawd qhov mob mob tuaj yeem cuam tshuam nrog kev puas tsuaj rau cov ntaub so ntswg ntawm lub mis, cov teeb meem tom qab kev phais yas, cov txheej txheem inflammatory thiab qog nqaij hlav, kev loj hlob ntawm cov qog mammary, kev hloov pauv sclerotic thiab mastopathy. Nws tsis nyob ntawm lub voj voog.
Tsis tseeb (xav txog, tawg) mastalgia - tshwm sim raws li cov tsos mob ntawm lwm cov kab mob ntawm lub cev thiab cov tshuab tsis cuam tshuam nrog lub hauv siab. Cov no yog degenerative-metabolic ntshawv siab nyob rau hauv tus txha nraub qaum, pob qij txha, kab mob siab thiab kab mob plawv (angina pectoris, thrombophlebitis), endocrinopathy, esophageal pathology (diaphragmatic hernia), pleurisy, thiab lwm yam.
Cov tsos mob ntawm mastodynia
Feem ntau, cov neeg mob qhia qhov tshwm sim ntawm mastalgia xws li rub, nias, tawg, mob. Qee lub sij hawm lawv tuaj yeem ntse, stabbing.
Thaum lub mis o vim muaj cov tshuaj hormones, nws loj tuaj, qhov tactile rhiab heev ntawm lub txiv mis thiab daim tawv nqaij yog nce. Cov mob yog npub, tawg. Kev tsis xis nyob feem ntau yog ob sabtxuam nrog kev coj khaub ncaws. Kev mob tsis tas yuav kho thiab ploj mus ntawm nws tus kheej.
Rau acyclic mastalgia ntawm lub caj pas mammary, cov tsos mob yog cov yam ntxwv ntawm kev mob kub hnyiab, tsis nyob ntawm lub voj voog thiab feem ntau yog unilateral. Xws li mastalgias nyob ntawm, piv txwv li, ntawm kev ntxhov siab. Qhov mob tuaj yeem yog episodic lossis tas li, qhov kev siv zog sib txawv. Nws nyob ntawm qhov tshwm sim ntawm pathology. Mastalgia feem ntau ua ke nrog rau lwm yam kev tshwm sim ntawm pathology - lub xub ntiag ntawm loj tsim, kev hloov nyob rau hauv cov duab thiab qhov loj ntawm cov qog, tawm los ntawm lub txiv mis thiab nws sab nraud tsis xws luag, kev hloov ntawm daim tawv nqaij xim, lub zos kub taub hau, loj axillary lymph nodes.
Nrog mastodynia cuav (mastalgia), cov tsos mob ntawm kev puas tsuaj rau lwm yam kabmob kuj tuaj yeem txheeb xyuas tau. Feem ntau, lub suab ntawm cov leeg txha caj qaum yog nce, mob thoracic raws cov hlab ntsha, kev hloov ntshav siab thiab lub plawv dhia, thiab lwm yam.
Nyob ntawm cov lus piav qhia, cov tsos mob thiab cov tsos mob ntawm lub mis mastalgia tau muab faib ua 4 qib:
- Tsis mob.
- Mild degree - qhov mob sai sai sai thaum noj 1 tab. tshuaj loog.
- Medium degree - mob tshwm sim ib lub lim tiam ua ntej kev coj khaub ncaws, ua rau hnub ua ntej thiab tuaj yeem tshem tawm ib nrab los ntawm kev noj tshuaj.
- Qib Siab - qhov mob tas li, kho tsis tau hauv tsev. Ua txhaum poj niam lub neej zoo.
Cov tsos mob ntawm cyclic mastodynia
Cov tsos mob ntawm mastalgia ntawm lub caj pas mammary nyob rau hauv cov ntaub ntawv no feem ntau muaj tus cwj pwm ntawm bursting thiab yuav luag ib txwm nrog edema. Qhov ntawd yog qhov lawv hu nws - dyshormonalmastalgia. Lub tas li tshwm sim cyclic mastalgia ntawm lub caj pas mammary tsis tsuas yog provokes mob hnyav, tab sis kuj hloov mus rau lub siab ntawm tus poj niam - ua rau kev nyuaj siab, ib tug txo nyob rau hauv lub psycho-kev xav tom qab, thiab neuroses. Nrog rau normalization ntawm hormonal keeb kwm yav dhau, tus mob noticeably txhim kho.
Cov kev kho mob suav nrog tsis yog cov tshuaj hormones nkaus xwb, tab sis kuj kho lub cev, lwm txoj hauv kev, kho av nkos thiab kho spa raws li qhov profile. Qhov tseem ceeb ntawm qhov no yog kev kho mob ntawm cov teeb meem gynecological thiab kev huv ntawm foci ntawm tus kab mob.
Cov tsos mob ntawm acyclic mastalgia
Qhov kev tsis xis nyob thiab mob yog cuam tshuam ncaj qha rau cov kab mob uas twb muaj lawm. Cov tsos mob ntxiv thiab cov cim qhia ntawm lub mis mastalgia uas tsis yog-cyclic yog, ntxiv rau cov teev saum toj no:
- cephalgia;
- faus;
- tseem tsis paub;
- kev qaug zog;
- qhov kub yuav nce siab, qhov xwm txheej yuav hnyav dua.
Qhov no xav tau kev sab laj ceev nrog tus kws kho tsiaj.
Diagnosis
Lab tests:
- kuaj ntshav dav dav, tso zis;
- kuaj ntshav biochemical nrog ntsuas lub siab ua haujlwm;
- kev txiav txim ntawm cov tshuaj hormonal.
Thaum txiav txim siab txog qhov xwm txheej hormonal, qib ntawm estrogen, progesterone, prolactin, FSH, LH, thyroid hormones thiab TSH raug ntsuas.
Instrumental research:
- Ultrasound ntawm cov qog mammary thiab axillary lymph nodes;
- Mammography yog txoj hauv kev zoo tshaj plaws uas tso cai rau koj los txiav txim txog cov kab mob hauv thawj theem; ua nyob rau hauv 2-3qhov projections thiab aiming.
- Puncture lossis zoo koob aspiration biopsy nyob rau hauv kev taw qhia ultrasound, ua raws li biopsy histology.
- Microwave radiothermometry (RTM) - ntes lub cev tsis muaj zog nrog lub cuab yeej tshwj xeeb. Cov qauv no yog tsim los kuaj cov pathholies thaum ntxov, thaum muaj tsis muaj chaw kho mob tsis tau. Nws yog siv rau lwm yam kabmob thiab. Nws lub hauv paus ntsiab lus yog tias lub cev muaj kab mob nthuav dav nws cov hluav taws xob.
Qib ntawm oncomarker CA 15-3 hauv cov ntshav kuj raug txiav txim. Qhov no muaj tseeb tshwj xeeb tshaj yog nyob rau hauv cov neeg mob uas mastalgia thawj zaug tshwm sim nyob rau hauv ib tug poj niam thaum lub sij hawm cev xeeb tub. Yog tias muaj kab mob ntawm tus txha caj qaum, kev sab laj nrog kws kho mob hlwb yuav tsum tau.
Kev nyuaj siab
Lub cev nqaij daim tawv mastalgia tsis ua rau muaj kev hem thawj rau tus poj niam lub neej, tab sis ua rau lub neej tsis zoo ntawm qhov ua rau qaug zog, ntxhov siab ua ntej kev coj khaub ncaws, kev ntxhov siab thiab kua muag, lub siab tsis zoo, thiab lwm yam. Hypochondriacs tej zaum yuav muaj. mob cancerophobia syndrome.
Kev kho mob mastodynia
Kev kho tshwj xeeb rau lub mis mastalgia pib tsuas yog tom qab kev cais tawm ntawm cov kab mob organic thiab malignant ntawm lub mis.
Nrog rau cyclic mastodynia, kev soj ntsuam dynamic tau pom zoo nrog kev kuaj xyuas raws sij hawm los ntawm tus kws kho mob mammologist thiab ultrasound.
Cov tsos mob thiab kev kho mob ntawm mastalgia muaj feem cuam tshuam. Kev kho mob tactics rau kev puas siab puas ntsws yog tsom rau kev txhim kho lub siab ntsws keeb kwm yav dhau los ntawm kev siv sedatives, antidepressants, tranquilizers,physiotherapy, psychotherapy. Kev sib xyaw ua ke ntawm pathogenetic hormonal thiab non-hormonal kev kho mob ntawm mastalgia tshwm sim zoo tshaj plaws.
Cov neeg mob zoo li no tau qhia:
- Hormonotherapy - qhov kev xaiv yog qhov dav heev, nws yog ua tiav los ntawm cov theem thiab hom tshuaj hormone secretion thiab qhov hnyav ntawm cov tsos mob.
- Rau kev kho mob ntawm lub mis mastalgia, COCs ntawm hom monophasic ("Yarina", "Jess") lossis gestagens, antiestrogen, gonadotropin-tso tawm agonists yog siv.
- Targeted therapy - daim ntawv thov ntawm cov tshuaj pleev nrog progesterone ("Progestogel") rau lub mis, uas muaj lub hom phiaj tsom rau ntawm lub mis - txo qhov mob thiab o.
- Phyto- thiab tshuaj homeopathic - txhawm rau kho cov kab mob dyshormonal, cov nroj tsuag uas muaj phytoestrogens (cov roj primrose yav tsaus ntuj, sage, oregano, cumifuga roj) thiab cov tshuaj homeopathic uas muaj lawv tau siv.
- Los ntawm kev npaj homeopathic, ib tus tuaj yeem nco ntsoov Mastodinon, Mamoklam, Cyclodinone, thiab lwm yam. Lawv yuav tsum tau muab tshuaj los ntawm kws kho mob homeopathic kom tau txais txiaj ntsig zoo tshaj plaws. Feem ntau lawv tau siv rau hauv rooj plaub ntawm cov neeg mob tsis kam muab tshuaj kho tshuaj hormone.
- tshuaj sedative - SSRIs (Prozan, Paxil) tshwj xeeb tshaj yog nrov. Hauv cov mob me me, "Magne B6" raug pom zoo, tshuaj ntsuab - tshuaj ntsuab ntawm valerian, motherwort, peony; sedative nqi.
- Analgesics - Qhov no suav nrog NSAIDs (Ibuprofen, Diclofenca) thiab cov tshuaj tua kab mob.
- NSAIDs nthuav tawm cov khoom tiv thaiv kab mob viminhibit cov synthesis ntawm inflammatory mediators ntawm prostaglandins, tiv thaiv lawv los ntawm sensitizing mob receptors nyob rau hauv cov ntaub so ntswg ntawm cov qog mammary.
- Diuretics ("Furosemide", "Mannitol") - txo qhov o, thiab nrog lawv mob. Diuretics tuaj yeem txo qhov mob hnyav. Feem ntau, cov tshuaj poov tshuaj-sparing diuretics yog siv (ntau dua li lwm tus "Spironolactone"), uas kuj muaj antiandrogenic zog.
Physiotherapy (electrophoresis, magnetotherapy, galvanization, balneotherapy) kuj tuaj yeem muab ntxiv rau hauv txoj kev kho mob. Kev siv cov vitamin-mineral complexes kuj tseem siv tau.
Nyob rau hauv rooj plaub ntawm acyclic mastodynia, kev kho mob yog nqa tawm, ua ntej ntawm tag nrho cov, ntawm tus kab mob. Yog tias tsim nyog, feem ntau yuav tsum tau siv cov kev kho mob phais, xws li qhib thiab tso dej mastitis, enucleation ntawm cov qog, sectoral resection ntawm mammary caj pas los yog ua kom tiav tshem tawm - mastectomy.
Rau mastitis thiab abscesses, yuav tsum tau kho tshuaj tua kab mob.
Tshem tawm zes qe menyuam lossis tshem tawm lawv txoj haujlwm nrog cov tshuaj khomob lossis kev kho hluav taws xob yog qhov pab tau zoo rau qee yam mob. Endocrine mastodynia kho tau tag nrho.
Huab cua thiab tiv thaiv
Nrog cyclic mis mastalgia, qhov kev tshwm sim yog qhov zoo, nrog acyclic thiab cuav nws nyob ntawm tus kab mob hauv qab uas ua rau pom qhov mob. Tab sis nrog rau tag nrho cov txiaj ntsig zoo, kev kho tus kheej tsis suav nrog tag nrho. Tsis tas li ntawd, tsis txhob hnov qab xyuas koj cov qog txhua hli rauqhov pom ntawm cov pob caus thiab cov ntsaws ruaj ruaj hauv lawv.
Rau kev tiv thaiv ntawm mastalgia tshwm sim los ntawm hormonal imbalance, mammologists qhia ua raws li txoj cai ntawm kev ua haujlwm thiab so. Workaholism yuav tsum tsis muaj. Kev noj zaub mov yuav tsum raug kho kom txwv tsis pub ntsev, cov khoom noj uas muaj dej (ntsev, seasonings, khoom qab zib, kib, cawv).
Ntshav qeeb hauv cov metabolism thiab ua rau muaj kev xav rau edema. Kev noj zaub mov yuav tsum muaj cov vitamins thiab minerals txaus, muaj fiber ntau txaus, ntau zaub thiab txiv hmab txiv ntoo. Yog tias txaus iodine, magnesium, selenium thiab zinc tau muab nrog cov zaub mov, ces qhov no muaj txiaj ntsig zoo rau lub cev ntawm lub cev.
Ib qho chaw tseem ceeb yog muab rau kev kho mob raws sij hawm thiab ua tiav ntawm gynecological pathologies, tshwj xeeb tshaj yog tias lawv tau nrog cov kab mob hormonal. Kev tiv thaiv kuj tseem yuav ua kom muaj kev noj qab haus huv - kev ua haujlwm ntawm lub cev tsis zoo, tsis suav nrog lub cev tsis muaj zog, kev ntxhov siab, kev hloov pauv ntawm kev ua haujlwm thiab so kom raug, tag nrho cov nqi ntawm kev pw tsaug zog. Qhov yuav tsum tau ua yog qhov normalization ntawm qhov hnyav thaum nws tawm mus.
Mammologists ceeb toom tias kev rog rog yog qhov ua rau mob mastalgia, vim tias cov tshuaj estrogen yog tsim los ntawm cov ntaub so ntswg adipose. Kas fes, chocolate thiab tshuaj yej tsis suav nrog.
Koj yuav tsum tau saib xyuas lub siab, nws txoj haujlwm ib txwm yog daim thaiv kev ruaj ntseg rau hyperestrogenism. Koj yuav tsum xaiv cov ris tsho hauv qab kom zoo - kom nws tsis nruj thiab tsis nyem cov qog mammary. Qhov kev xaiv zoo tshaj plaws yog mos dav hlua ntawm ib lub hauv caug.
