Imithi yokwelashwa

Ngoba iningi i-fibroids yama-uterine musa ukubangela izimpawu (kuthiwa "asymptomatic"), odokotela bavame ukunikeza "ukubuka okuqaphile" kokuthuthukiswa kwe-fibroid. Imvamisa, i-fibroid engazibangeli izimpawu ayidingi ukwelashwa.

Lapho kudingeka ukwelashwa, isinqumo sokukhetha omunye phezu komunye sincike ezicini ezahlukahlukene: ukuqina kwezimpawu, isifiso sokuba nezingane noma cha, ubudala, okuthandwa nguwe, njll. Kuphelahysterectomy, okungukuthi, ukususwa kwesibeletho, kunikeza isisombululo esichazayo.

Amathiphu okususa izimpawu

• Ukufaka ukucindezela okufudumele (noma iqhwa) ezindaweni ezibuhlungu kungasiza ekunciphiseni ubuhlungu. ubuhlungu.
• Imithi yasesitolo isiza ukukhulula amajaqamba esiswini nobuhlungu beqolo. Le mithi ifaka i-acetaminophen noma i-paracetamol (kufaka neTylenol®,) ne-ibuprofen (njenge-Advil® noma iMotrin®).
• Ukuphikisana ne- ukuqunjelwa, kufanele udle ama-servings amahlanu kuya kwayishumi wezithelo nemifino ngosuku, kanye nenani elihle le-fiber yokudla. Lokhu kutholakala emikhiqizweni yokusanhlamvu okusanhlamvu (isinkwa esiphelele sokusanhlamvu ne-pasta, irayisi elinsundu, irayisi lasendle, ama-muffin e-bran, njll.).

  NB Ukuze uhambisane nokudla okunothe nge-fiber, kubalulekile ukuphuza kakhulu ukuze ugweme ukuvala umgudu wokugaya ukudla.

• Uma ukuqunjelwa iyaqhubeka, singazama i-laxative yesisindo (noma i-ballast), ngokususelwa ku-psyllium ngokwesibonelo, esebenza ngobumnene. Ama-laxatives okukhuthaza ayacasula kakhulu futhi ngokuvamile awanconywa. Ukuthola amanye amathiphu, bheka ishidi lethu lamaqiniso weConstipation. Lezi zeluleko azisebenzi ngempela lapho uhlushwa i-fibroid enkulu, ngoba ukuqunjelwa kuxhunyaniswa nokucindezelwa kwendlela yokugaya, hhayi ekudleni okungalungile noma kokuhamba okubi.
• Uma kwenzeka'ukunxenxa kaningi ukuchama, uphuze ngokwejwayelekile emini kodwa ugweme ukuphuza ngemuva kuka-18 ntambama ukuze ungavuki kakhulu ebusuku.

izidakamizwa

Izidakamizwa zisebenza ku- umthethonqubo womjikelezo wokuya esikhathini ukunciphisa izimpawu (ikakhulukazi ukuphuma kwegazi okunzima), kepha azinciphisi ubukhulu be-fibroid.

Kunezixazululo ezintathu zabesifazane abane-fibroids enzima:

- IUD (Mirena®). Ingafakwa kuphela esibelethweni ngombandela wokuthi i-fibroid ayiyona i-submucosal (ukuphikisana okusemthethweni) kanye ne-fibroids ayinkulu kakhulu. Le IUD ikhipha kancane kancane i-progestin okuholela ekwehliseni okukhulu ukopha. Kufanele ishintshwe njalo eminyakeni emihlanu.

I-tranexamic acid (i-Exacyl®) ingase inqunywe isikhathi sokuphuma kwegazi.

- i-mefenamic acid (i-Ponstyl®), umuthi olwa nokuvuvukala ungabekwa ngesikhathi segazi.

Uma i-fibroid inkulu kakhulu noma isopha kakhulu, ezinye izidakamizwa ze-hormonal zingase zinqunywe ukunciphisa usayizi we-fibroid ngaphambi kokuhlinzwa. Isengezo sensimbi singabekwa kwabesifazane abahlushwa ukopha okukhulu, ukuze banxephezele ukulahleka kwensimbi emzimbeni wabo.

Ukwelashwa kwangaphambi kokuhlinzwa kwe-uterine fibroids.

- Ama-analogue we-Gn-RH (i-gonadorelin noma i-gonadoliberin). I-Gn-RH (i-Lupron®, i-Zoladex®, i-Synarel®, i-Decapeptyl®) yi-hormone eyehlisa amazinga e-estrogen aye ezingeni elifanayo nelowesifazane ose-postmenopausal. Ngakho-ke, lokhu kwelashwa kunganciphisa usayizi we-fibroids ngo-30% kuye ku-90%. Lo muthi ubangela ukunqamuka kwesikhashana futhi uhambisana nezimpawu, njengokushisa okushisayo nokuqina kwamathambo okuphansi. Imiphumela yayo emibi miningi, evimbela ukusetshenziswa kwayo kwesikhathi eside. I-Gn-RH ngakho-ke inqunyelwe esikhathini esifushane (ngaphansi kwezinyanga eziyisithupha) ngenkathi ilinde ukuhlinzwa. Kwesinye isikhathi udokotela ungeza i-tibolone (Livial®) kuma-analogues we-Gn-RH.

- IDanazol (iDanatrol®, iCyclomen®). Lo muthi uvimbela ukukhiqizwa kwe-estrogen ngama-ovari, okuvame ukuholela ekuphazamiseni imijikelezo yokuya esikhathini. Kungasiza ekwehliseni ukopha, kepha imiphumela yayo emibi ibuhlungu: ukuzuza kwesisindo, ukukhanya okushisayo, ukwanda kwamazinga e-cholesterol, induna, ukukhula kwezinwele ngokweqile… Isebenza ngaphezu kwezinyanga ezintathu, ukunciphisa izimpawu ze-fibroids, kepha alukho ucwaningo olungazange luzihlole ukusebenza kahle isikhathi eside. Kubukeka kunemiphumela emibi eminingi nokusebenza ngempumelelo okuncane kunezifaniso ze-GnRH. Ngakho-ke akusaphakanyiswa

ukuhlinzwa

Ukuhlinzwa kuboniswa ikakhulu ukopha okungalawuleki, ukungabi nenzalo, ubuhlungu obukhulu besisu noma ubuhlungu beqolo.

La umabhebhana ukususa i-fibroid. Ivumela owesifazane ofisa ukuba nezingane. Kufanele wazi ukuthi i-myomectomy ayisona isixazululo ngaso sonke isikhathi. Ezimweni ezingu-15%, amanye ama-fibroids avela futhi ku-10% yamacala, sizophinde singenele ngokuhlinzwa.6.

Lapho i-fibroids incane futhi ingaphansi, i-myomectomy ingenziwa nge-hysteroscopy. I-Hysteroscopy kwenziwa kusetshenziswa insimbi efakwe isibani esincane kanye nekhamera yevidiyo udokotela ohlinzayo ayishutheka esibelethweni ngowesifazane nomlomo wesibeletho. Izithombe ezivezwe esikrinini bese ziqondisa udokotela ohlinzayo. Enye inqubo, i-laparoscopy, ivumela ithuluzi lokuhlinza ukuthi lifakwe ngokusebenzisa imbobo encane eyenziwe esiswini esingezansi. Ezimweni lapho i-fibroid ingatholakali kulezi zindlela, udokotela ohlinzayo wenza i-laparotomy, ukuvulwa okudala kodonga lwesisu.

THEembolisationi-fibroids inqubo ye-endosurgical eyomisa i-fibroids ngaphandle kokuyikhipha. Udokotela. I-fibroid, engasatholi i-oksijeni nezakhi zomzimba, kancane kancane ilahlekelwa yi-50% yevolumu yayo.

Ngaphezu kokulondolozwa kwesibeletho, le nqubo ayibuhlungu kangako kune-myomectomy. Ukululama kwezinsuku eziyisikhombisa kuya kweziyishumi kwanele. Uma kuqhathaniswa, i-hysterectomy idinga okungenani amasonto ayisithupha e-convalescence. Ngokuya ngocwaningo olushicilelwe ngo-2010, i-uterine artery embolization (UAE) inikeza imiphumela engaqhathaniswa neminyaka emihlanu uma iqhathaniswa naleyo ye-hysterectomy, evumela ukuthi isibeletho sigcinwe. Noma kunjalo, le nqubo ayinakusetshenziselwa yonke i-fibroids. Isibonelo, akunconywa ukwelashwa kwe-submucosal fibroids.

Indlela ebizwa nge-uterine artery ligation nayo ingenziwa nge-laparoscopy. Kuqukethe ukubeka iziqeshana emithanjeni. Kepha kubonakala kungasebenzi kangako kunokuhlanganiswa kokuhamba kwesikhathi.

- Ukwehliswa kwe-endometrium (ulwelwesi lwesibeletho), kwezinye izimo, kungalungela abesifazane abangasafuni ezinye izingane ukuze banciphise ukopha kakhulu. Lapho i-endometrium isuswa ngokuhlinzwa, ukopha kokuya esikhathini ezimweni eziningi kuyaphela, kepha akusakwazi ukukhulelwa. Lokhu kuhlinzwa kwenziwa ikakhulukazi ezimweni zokopha kakhulu kanye nama-fibroids amancane amancane amancane.

Ezinye izindlela zakamuva zitholakala kaningi:

I-Thermachoice® (ibhaluni lifakwa esibelethweni bese ligcwaliswa uketshezi olufudunyezwa luze lufike ku-87 ° imizuzu eminingana), i-Novasure® (ukubhujiswa kwe-fibroid nge-radiofrequency nge-electrode efakwe esibelethweni), i-Hydrothermablabor® (i-saline serum futhi ifuthumele I-90 ° ifakwe emgodini wesibeletho ngaphansi kolawulo lwekhamera), i-thermablate® (ibhaluni eligcwele uketshezi ngo-173 ° elethwe emgodini wesibeletho).

Amanye amasu we-myolysis (ukubhujiswa kwe-myoma noma i-fibroma asesensimini yocwaningo): i-myolysis yi-microwave, i-cryomyolysis (ukubhujiswa kwe-fibroid ngamakhaza), i-myolysis nge-ultrasound.

- I-Hysterectomy, noma ukukhishwa kwesibeletho, kugcinelwe amacala anzima kakhulu lapho izindlela zangaphambilini zingenakwenzeka, kanye nabesifazane abangasafuni ukuba nezingane. Kungaba ingxenye (ukugcinwa komlomo wesibeletho) noma kuphelele. I-hysterectomy ingenziwa esiswini, ngokusikwa okwenziwa ngaphansi kwesisu, noma ngesitho sangasese sowesifazane, ngaphandle kokuvuleka kwesisu, noma nge-laparoscopy lapho ubukhulu be-fibroid buvumela. Lesi yisisombululo "esinamandla" ngokumelene ne-fibroids, ngoba ngeke kube khona ukuphindaphinda ngemuva kokususwa kwesibeletho.