Ukukhulelwa kwe-molar kubangelwa ukungavamile okwenzeka ngesikhathi sokuvundiswa okubangela ukukhula okungavamile kwe-placenta. Kunezinhlobo ezimbili zokukhulelwa kwe-molar:

• ukukhulelwa okuphelele kwe-molar (noma imvukuzane ephelele ye-hydatidiform) kuvela ekuvundiseni phakathi kwe-ovum e-nucleated (ngaphandle kwe-nucleus ngakho-ke ngaphandle kofuzo) kanye ne-haploid spermatozoa eyodwa noma ezimbili (eziqukethe ikhophi eyodwa ye-chromosome ngayinye). Umkhiqizo walokhu kukhulelwa awuqukethe i-embryo kodwa i-placenta kuphela ekhula ngendlela yama-cysts amaningi (abizwa ngokuthi "iqoqo lamagilebhisi").
• ingxenye yokukhulelwa kwe-molar (noma ingxenye ye-hydatidiform imvukuzane) kubangelwa ukuhlangana phakathi kweqanda elivamile nama-spermatozoa amabili noma isidoda esingavamile. Kukhona umbungu, kodwa awukwazi ukuphila, futhi i-placenta ikhula ngendlela engavamile.

Kuzo zombili izimo iqanda alinayo yonke izakhi zofuzo, ngakho ukukhulelwa kuzohluleka.

Ukukhulelwa kwe-molar kungazibonakalisa ngezindlela ezahlukene:

• esimweni sawo esijwayelekile kuphumela ekopheni okunzima okubangela i-anemia kanye nokwanda komthamo wesibeletho. Ukwanda kwezibonakaliso zokukhulelwa noma i-toxemia yokukhulelwa ngezinye izikhathi kubonakala. I-ultrasound ye-pelvic ye-endovaginal elandelwa yisilinganiso se-serum hCG ephelele izokwenza kube nokwenzeka ukuxilonga ukukhulelwa kwe-molar.
• ngesimo sokuphuphuma kwesisu okuzenzakalelayo. Khona-ke i-pathology yomkhiqizo we-curettage ezovumela ukuthi kutholakale ukukhulelwa kwe-molar.
• ngendlela engabonakali, ukukhulelwa kwe-molar kuzotholakala ngenhlanhla ku-ultrasound.

Isihloko isigaba sesithathu

Ukusekelwa kuni?

Isigaba sesithathu

Ukukhulelwa okuphelele noma okungaphelele, i-molar ayikwazi ukusebenza, ngakho-ke kuyadingeka ukukhipha ngokushesha umkhiqizo wokukhulelwa. Lokhu kwenziwa ngokufisa kwesibeletho okwenziwa ngaphansi kokulawulwa kwe-ultrasound. I-anatomopathology yomkhiqizo wokukhulelwa ngokuvamile yenziwa ukuze kuhlonzwe uhlobo lwemvukuzane.

Ukuhlolwa kwe-ultrasound kwenziwa ngokuhlelekile ezinsukwini eziyi-15 kulandela ukulangazelela ukuze kuqinisekiswe ukungabikho kokugcinwa, inkinga evame kakhulu yokukhulelwa kwe-molar. Uma kwenzeka kugcinwa, kuzokwenziwa isifiso sesibili.

Ngemuva kokukhishwa kwemvukuzane, izinga le-hCG liqashwe ngokucophelela ngesilinganiso sokuhlolwa kwegazi kwamasonto onke. Lokhu kuqapha kufanele kuqhutshekwe ngemuva kokuthi izinga liweliwe (okungukuthi amanani ama-3 alandelanayo alandelanayo):

• izinyanga ezingu-6 uma kwenzeka imvukuzane ingxenye ye-hydatidiform;
• izinyanga eziyi-12 uma kwenzeka imvukuzane ye-hydatidiform ephelele;
• izinyanga ezingu-6 uma, esimweni semvukuzane ye-hydatidiform ephelele, izinga le-hCG liba libi emasontweni angu-8 (2).

Izinga le-hCG elimile noma elikhulayo liphakamisa isimila se-trophoblastic, inkinga yokukhulelwa kwe-molar ethinta cishe u-15% wama-moles aphelele kanye no-0,5 kuya ku-5% wama-moles ayingxenye (3). Kwenzeka ukuthi izicubu ze-molar zihlala esibelethweni, zanda futhi ziguqulwa zibe izicubu zesimila ezinolaka futhi zingahlasela izindonga zesibeletho futhi ngezinye izikhathi izitho ezikude. Lokhu kubizwa ngokuthi imvukuzane ehlaselayo, noma i-choriocarcinoma. Kuyobe sekwenziwa ukuhlolwa futhi kuye ngemiphumela, kuzokwenziwa i-chemotherapy. Kuye ngengozi yesimila (esungulwe ngokohlelo lwe-FIGO 2000), izinga lokwelapha lilinganiselwa phakathi kuka-80 no-100% (4). Ngemuva kokuphela kokwelashwa, isikhathi sokuqapha esinomthamo wanyanga zonke we-hCG sinconywa izinyanga eziyi-12 kuya kweziyi-18.

Ngokushesha lapho ukulandelwa kwemvukuzane sekuphelile, kungenzeka ukuthi uqale ukukhulelwa okusha. Ingozi yokukhulelwa kwe-molar futhi iphansi: phakathi kuka-0,5 no-1% (5).

Uma kwenzeka i-trophopblastic tumor, ukwelashwa nge-chemotherapy akuphazamisi ukuzala. Ngakho-ke okunye ukukhulelwa kungenzeka ngemva kokuphela kwesikhathi sokuqapha. Kodwa-ke, umthamo we-hCG hormone uzokwenziwa ezinyangeni ezi-3 zokukhulelwa bese kuthi ngemva kokukhulelwa, izikhathi ezimbili ezisengozini yokuvela kabusha kwesifo.