xov xwm

Uterine fibroids yog ib qho ua rau menorrhagia thiab anemia, thiab qhov tshwm sim yog heev, li ntawm 70% mus rau 80% ntawm cov poj niam yuav tsim uterine fibroids nyob rau hauv lawv lub neej, uas 50% qhia cov tsos mob. Tam sim no, hysterectomy yog qhov kev kho mob uas siv ntau tshaj plaws thiab suav tias yog kev kho mob hnyav rau fibroids, tab sis hysterectomy tsis yog tsuas yog muaj kev pheej hmoo, tab sis kuj tseem muaj kev pheej hmoo ntev ntawm cov kab mob plawv, kev ntxhov siab, kev nyuaj siab, thiab kev tuag. Hauv qhov sib piv, cov kev kho mob xws li uterine artery embolization, lub zos ablation, thiab qhov ncauj GnRH antagonists muaj kev nyab xeeb dua tab sis tsis siv tag nrho.

Cov ntsiab lus

Ib tug poj niam dub hnub nyoog 33 xyoo uas tsis tau xeeb tub tau nthuav tawm rau nws tus kws kho mob thawj zaug nrog hnyav hnyav hnyav thiab plab plab. Nws raug kev txom nyem los ntawm hlau deficiency anemia. Cov kev ntsuam xyuas tau rov qab tsis zoo rau thalassemia thiab mob kab mob ntawm tes. Tus neeg mob tsis muaj ntshav hauv cov quav thiab tsis muaj tsev neeg keeb kwm ntawm mob qog noj ntshav lossis mob plab hnyuv. Nws qhia txog kev coj khaub ncaws tsis tu ncua, ib hlis ib zaug, txhua lub sijhawm 8 hnub, thiab lub sijhawm ntev tsis hloov. Nyob rau peb hnub tseem ceeb tshaj plaws ntawm txhua lub voj voog, nws yuav tsum siv 8 mus rau 9 tampons ib hnub, thiab qee zaus los ntshav. Nws tab tom kawm rau nws tus kws kho mob thiab npaj yuav xeeb tub hauv ob xyoos. Ultrasound pom lub tsev menyuam loj nrog ntau yam myomas thiab zes qe menyuam. Koj yuav kho tus neeg mob li cas?

Qhov tshwm sim ntawm cov kab mob cuam tshuam nrog uterine fibroids yog sib xyaw los ntawm qhov tsis tshua pom tus kab mob thiab qhov tseeb tias nws cov tsos mob raug ntaus nqi rau lwm yam mob, xws li digestive disorders los yog kev tsis haum xeeb ntawm cov ntshav. Kev txaj muag cuam tshuam nrog kev sib tham txog kev coj khaub ncaws ua rau ntau tus neeg uas muaj lub sijhawm ntev lossis lub sijhawm hnyav tsis paub tias lawv tus mob yog qhov txawv txav. Cov neeg uas muaj cov tsos mob feem ntau tsis kuaj tau raws sijhawm. Ib feem peb ntawm cov neeg mob siv tsib xyoos los kuaj xyuas, thiab qee qhov siv ntau tshaj yim xyoo. Kev kuaj mob qeeb tuaj yeem cuam tshuam rau kev xeeb tub, kev ua neej zoo, thiab kev noj qab haus huv nyiaj txiag, thiab hauv kev tshawb fawb zoo, 95 feem pua ​​​​ntawm cov neeg mob uas muaj cov tsos mob ntawm fibroids qhia txog kev puas siab puas ntsws tom qab, nrog rau kev nyuaj siab, kev txhawj xeeb, kev npau taws, thiab kev nyuaj siab ntawm lub cev. Kev qias neeg thiab kev txaj muag cuam tshuam nrog kev coj khaub ncaws cuam tshuam kev sib tham, kev tshawb fawb, kev tawm tswv yim, thiab kev tsim kho tshiab hauv cheeb tsam no. Ntawm cov neeg mob kuaj mob fibroids los ntawm ultrasound, 50% mus rau 72% tsis tau paub yav dhau los tias lawv muaj fibroids, qhia tias ultrasound yuav siv tau ntau dua hauv kev ntsuam xyuas ntawm tus kab mob no.

Qhov tshwm sim ntawm uterine fibroids nce nrog lub hnub nyoog mus txog rau thaum cev xeeb tub thiab siab dua hauv cov xim dub dua li cov dawb. Piv nrog rau cov neeg uas tsis yog cov neeg dub, cov neeg dub tsim cov uterine fibroids thaum muaj hnub nyoog yau, muaj kev pheej hmoo ntau dua ntawm kev tsim cov tsos mob, thiab muaj lub nra hnyav dua. Piv nrog rau cov neeg Caucasians, cov neeg dub muaj mob thiab muaj feem ntau yuav raug mob hysterectomy thiab myomectomy. Tsis tas li ntawd, cov neeg dub muaj feem ntau dua li cov neeg dawb xaiv rau kev kho mob uas tsis muaj kev cuam tshuam thiab zam kev xa mus rau kev phais kom tsis txhob muaj kev pheej hmoo ntawm hysterectomy.

Uterine fibroids tuaj yeem kuaj tau ncaj qha nrog lub pelvic ultrasound, tab sis txiav txim siab rau leej twg los tshuaj xyuas tsis yooj yim, thiab tam sim no kev tshuaj ntsuam feem ntau ua tiav tom qab tus neeg mob cov fibroids loj lossis cov tsos mob tshwm sim. Cov tsos mob txuam nrog uterine fibroids yuav sib tshooj nrog cov tsos mob ntawm ovulation disorders, adenomyopathy, theem nrab dysmenorrhea, thiab digestive disorders.

Vim hais tias ob qho tib si sarcomas thiab fibroids tam sim no raws li myometric masses thiab feem ntau nrog los ntawm qhov txawv txav ntawm uterine los ntshav, muaj kev txhawj xeeb tias uterine sarcomas yuav ploj txawm tias lawv cov txheeb ze tsis tshua muaj (1 ntawm 770 txog 10,000 mus ntsib vim qhov txawv txav ntawm lub tsev menyuam los ntshav). Kev txhawj xeeb txog qhov tsis tau kuaj pom tus kab mob leiomyosarcoma tau ua rau muaj qhov nce ntawm hysterectomy thiab txo qis ntawm kev siv cov txheej txheem minimally invasive, ua rau cov neeg mob tsis muaj kev pheej hmoo ntawm cov teeb meem vim qhov tsis zoo ntawm cov kab mob uterine sarcomas uas tau nthuav tawm sab nraud lub tsev menyuam.

Kev kuaj mob thiab kev ntsuam xyuas

Ntawm ntau txoj hauv kev siv los kuaj mob uterine fibroids, pelvic ultrasound yog txoj kev siv nyiaj ntau tshaj vim nws muab cov ntaub ntawv ntawm lub ntim, qhov chaw, thiab tus naj npawb ntawm uterine fibroids thiab tuaj yeem tshem tawm cov kab mob adnexal. Tus neeg mob sab nraud pelvic ultrasound kuj tseem siv los ntsuas qhov txawv txav ntawm lub tsev menyuam los ntshav, palpable pelvic loj thaum kuaj, thiab cov tsos mob cuam tshuam nrog uterine o, nrog rau lub plab pelvic thiab plab plab. Yog hais tias lub uterine ntim ntau tshaj 375 mL los yog tus naj npawb ntawm fibroids ntau tshaj 4 (uas yog ib txwm), qhov kev daws teeb meem ntawm ultrasound yog txwv. Sib nqus resonance imaging yog ib qho tseem ceeb heev thaum xav tias uterine sarcoma thiab thaum npaj ib qho kev hloov rau hysterectomy, nyob rau hauv cov ntaub ntawv no yog cov ntaub ntawv tseeb txog uterine ntim, imaging nta, thiab qhov chaw yog ib qho tseem ceeb rau kev kho mob (Daim duab 1). Yog tias cov kab mob submucosal fibroids lossis lwm yam kab mob endometrial raug xav tias, saline perfusion ultrasound lossis hysteroscopy yuav pab tau. Kev suav tomography tsis muaj txiaj ntsig rau kev kuaj mob uterine fibroids vim nws qhov tsis pom tseeb thiab pom ntawm cov ntaub so ntswg dav hlau.

Nyob rau hauv 2011, lub International Federation of Obstetrics thiab Gynecology tau luam tawm ib qho kev faib tawm rau uterine fibroids nrog lub hom phiaj ntawm kev piav qhia txog qhov chaw ntawm fibroids zoo dua nyob rau hauv kev sib raug zoo rau uterine kab noj hniav thiab serous membrane nto, es tsis yog cov laus cov nqe lus submucosal, intramural, thiab subserous daim nyias nyias, yog li tso cai rau kom muaj kev sib txuas lus zoo dua thiab cov lus qhia tag nrho. tsab xov xwm no ntawm NEJM.org). Cov txheej txheem kev faib tawm yog hom 0 txog 8, nrog tus lej me dua qhia tias cov fibroid nyob ze rau ntawm endometrium. Mixed uterine fibroids yog sawv cev los ntawm ob tug lej sib cais los ntawm hyphens. Thawj tus lej qhia txog kev sib raug zoo ntawm fibroid thiab endometrium, thiab tus lej thib ob qhia txog kev sib raug zoo ntawm fibroid thiab serous membrane. Qhov kev faib tawm ntawm lub tsev menyuam fibroid no pab cov kws kho mob lub hom phiaj ntxiv kev kuaj mob thiab kev kho mob, thiab txhim kho kev sib txuas lus.

Kev kho mob

Nyob rau hauv feem ntau cov kev kho mob ntawm myoma-koom nrog menorrhagia, tswj menorrhagia nrog cov tshuaj tiv thaiv kab mob yog thawj kauj ruam. Nonsteroidal anti-inflammatory tshuaj thiab tranatemocyclic acid siv thaum cev xeeb tub kuj tuaj yeem siv los txo qis menorrhagia, tab sis muaj pov thawj ntau ntxiv txog kev ua tau zoo ntawm cov tshuaj no rau idiopathic menorrhagia, thiab kev sim tshuaj rau tus kab mob feem ntau tsis suav nrog cov neeg mob loj lossis submucosal fibroids. Long-acting gonadotropin-tso hormone (GnRH) agonists tau pom zoo rau kev kho mob luv luv ntawm uterine fibroids, uas tuaj yeem ua rau amenorrhea ze li ntawm 90% ntawm cov neeg mob thiab txo cov uterine ntim los ntawm 30% mus rau 60%. Txawm li cas los xij, cov tshuaj no cuam tshuam nrog qhov tshwm sim ntau dua ntawm cov tsos mob hypogonadal, suav nrog cov pob txha poob thiab kub kub. Lawv kuj ua rau "steroidal flares" hauv cov neeg mob feem ntau, uas khaws cia gonadotropins hauv lub cev raug tso tawm thiab ua rau lub sijhawm hnyav tom qab thaum cov tshuaj estrogen poob sai.

Kev siv qhov ncauj GnRH antagonist ua ke kev kho mob rau kev kho mob ntawm uterine fibroids yog qhov ua ntej loj. Cov tshuaj pom zoo hauv Tebchaws Meskas muab cov tshuaj GnRH antagonists hauv qhov ncauj (elagolix lossis relugolix) hauv cov ntsiav tshuaj lossis tshuaj ntsiav nrog estradiol thiab progesterone, uas sai sai inhibit zes qe menyuam steroid ntau lawm (thiab tsis ua rau steroid triggering), thiab estradiol thiab progesterone koob tshuaj uas ua rau cov qib sib piv rau cov theem pib follicular. Ib qho tshuaj uas twb tau pom zoo nyob rau hauv European Union (linzagolix) muaj ob koob tshuaj: ib koob tshuaj uas ib nrab inhibits hypothalamic muaj nuj nqi thiab ib koob tshuaj uas inhibits hypothalamic muaj nuj nqi, uas zoo ib yam li cov tshuaj pom zoo rau elagolix thiab relugolix. Txhua yam tshuaj muaj nyob rau hauv kev npaj nrog lossis tsis muaj estrogen thiab progesterone. Rau cov neeg mob uas tsis xav siv exogenous gonadal steroids, ib qho tshuaj tsawg-linzagolix formulation yam tsis muaj qhov sib ntxiv ntawm gonadal steroids (estrogen thiab progesterone) tuaj yeem ua tiav cov txiaj ntsig zoo ib yam li cov tshuaj sib xyaw ua ke uas muaj cov tshuaj hormones exogenous. Kev sib xyaw ua ke lossis kev kho mob uas cuam tshuam ib feem ntawm kev ua haujlwm hypothalamic tuaj yeem txo cov tsos mob nrog cov teebmeem piv rau cov koob tshuaj GnRH antagonist monotherapy, tab sis muaj cov kev mob tshwm sim tsawg dua. Ib qho txiaj ntsig ntawm kev siv tshuaj monotherapy yog tias nws tuaj yeem txo qhov loj ntawm lub tsev menyuam tau zoo dua, uas zoo ib yam li cov nyhuv ntawm GnRH agonists, tab sis muaj cov tsos mob hypogonadal ntau dua.

Cov ntaub ntawv soj ntsuam kuaj pom tau hais tias qhov ncauj GnRH antagonist ua ke ua haujlwm zoo hauv kev txo qis menorrhagia (50% mus rau 75% txo), mob (40% mus rau 50% txo), thiab cov tsos mob cuam tshuam nrog uterine o, thaum me ntsis txo uterine ntim (kwv yees li 10% txo qis hauv uterine ntim) nrog tsawg dua kev mob tshwm sim, xeev siab thiab ntuav (20%). Qhov kev ua tau zoo ntawm qhov ncauj GnRH antagonist kev sib xyaw ua ke yog kev ywj pheej ntawm qhov ntau ntawm myomatosis (qhov loj, tus lej, lossis qhov chaw ntawm cov fibroids), qhov cuam tshuam ntawm adenomyosis, lossis lwm yam txwv kev kho phais. Qhov ncauj GnRH antagonist kev sib xyaw ua ke tam sim no tau pom zoo rau 24 lub hlis hauv Tebchaws Meskas thiab rau kev siv tsis tu ncua hauv European Union. Txawm li cas los xij, cov tshuaj no tsis tau pom tias muaj kev tiv thaiv kab mob, uas txwv kev siv mus sij hawm ntev rau ntau tus neeg. Cov kev sim tshuaj ntsuam xyuas cov tshuaj tiv thaiv kab mob ntawm cov tshuaj relugolix ua ke tau txuas ntxiv mus (tus lej sau npe NCT04756037 ntawm ClinicalTrials.gov).

Hauv ntau lub tebchaws, xaiv cov tshuaj progesterone receptor modulators yog cov tshuaj siv tshuaj. Txawm li cas los xij, kev txhawj xeeb txog qhov tsis tshua muaj tab sis mob siab rau lub siab tau txwv qhov kev lees paub thiab muaj cov tshuaj no. Tsis muaj kev xaiv progesterone receptor modulators tau pom zoo hauv Tebchaws Meskas rau kev kho mob ntawm uterine fibroids.

Hysterectomy

Thaum hysterectomy muaj keeb kwm tau suav tias yog kev kho mob hnyav rau uterine fibroids, cov ntaub ntawv tshiab ntawm cov txiaj ntsig ntawm cov kev kho mob tsim nyog qhia tias cov no yuav zoo ib yam li hysterectomy hauv ntau txoj hauv kev hauv lub sijhawm tswj hwm. Qhov tsis zoo ntawm hysterectomy piv rau lwm txoj kev kho mob muaj xws li perioperative txaus ntshai thiab salpingectomy (yog tias nws yog ib feem ntawm cov txheej txheem). Ua ntej lub xyoo pua puv, kev tshem tawm ntawm ob lub zes qe menyuam nrog rau hysterectomy yog ib txoj hauv kev, thiab cov kev tshawb fawb loj nyob rau xyoo 2000s pom tau hais tias kev tshem tawm ob lub zes qe menyuam tau cuam tshuam nrog kev pheej hmoo ntawm kev tuag, kab mob plawv, dementia, thiab lwm yam kab mob piv nrog hysterectomy thiab khaws cov zes qe menyuam. Txij thaum ntawd los, tus nqi phais ntawm salpingectomy tau poob qis, thaum qhov kev phais ntawm hysterectomy tsis tau.

Ntau qhov kev tshawb fawb tau pom tias txawm tias ob lub zes qe menyuam raug khaws cia, qhov kev pheej hmoo ntawm cov kab mob plawv, kev ntxhov siab, kev nyuaj siab, thiab kev tuag tom qab hysterectomy tau nce ntau. Cov neeg mob ≤35 xyoo thaum lub sijhawm hysterectomy yog qhov txaus ntshai tshaj plaws. Ntawm cov neeg mob no, qhov kev pheej hmoo ntawm cov kab mob plawv (tom qab hloov kho rau cov neeg tsis txaus siab) thiab lub plawv tsis ua haujlwm yog 2.5 npaug siab dua rau cov poj niam uas tau phais hysterectomy thiab 4.6 npaug ntau dua rau cov poj niam uas tsis tau txais hysterectomy thaum lub sijhawm nruab nrab ntawm 22 xyoo. Cov poj niam uas muaj hysterectomy ua ntej hnub nyoog 40 xyoo thiab khaws cia lawv lub zes qe menyuam yog 8 mus rau 29 feem pua ​​​​yuav tuag ntau dua li cov poj niam uas tsis tau muaj hysterectomy. Txawm li cas los xij, cov neeg mob uas tau txais hysterectomy muaj ntau yam mob, xws li kev rog rog, hyperlipidemia, lossis keeb kwm ntawm kev phais, ntau dua li cov poj niam uas tsis tau phais hysterectomy, thiab vim tias cov kev tshawb fawb no tau soj ntsuam, qhov ua rau thiab cov nyhuv tsis tuaj yeem lees paub. Txawm hais tias cov kev tshawb fawb tau tswj hwm rau cov kev pheej hmoo no, tseem yuav muaj qhov tsis txaus ntseeg tsis txaus ntseeg. Cov kev pheej hmoo no yuav tsum tau piav qhia rau cov neeg mob xav txog hysterectomy, vim tias ntau tus neeg mob uas muaj uterine fibroids muaj kev cuam tshuam tsawg dua.

Tam sim no tsis muaj cov tswv yim tiv thaiv thawj lossis theem ob rau uterine fibroids. Kev tshawb fawb txog kab mob kis tau pom ntau yam cuam tshuam nrog kev txo qis ntawm uterine fibroids, suav nrog: noj txiv hmab txiv ntoo thiab zaub ntau dua thiab cov nqaij liab tsawg; Kev tawm dag zog tsis tu ncua; Tswj koj qhov hnyav; Cov qib vitamin D li qub; Yug muaj kev vam meej; Kev siv tshuaj tiv thaiv qhov ncauj; Thiab ntev-ua yeeb yam progesterone npaj. randomized tswj kev sim yog xav tau los txiav txim seb puas hloov kho cov xwm txheej no tuaj yeem txo qhov kev pheej hmoo. Thaum kawg, txoj kev tshawb fawb qhia tias kev ntxhov siab thiab kev ntxub ntxaug tuaj yeem ua lub luag haujlwm hauv kev noj qab haus huv tsis ncaj ncees uas tshwm sim thaum nws los txog rau lub tsev menyuam fibroids.