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Uterine fibroids ndiyo inowanzokonzera menorrhagia uye anemia, uye chiitiko chacho chakanyanya kukwirira, vanenge 70% kusvika 80% yevakadzi vachaita uterine fibroids muupenyu hwavo, iyo 50% inoratidza zviratidzo. Parizvino, hysterectomy ndiyo inonyanya kushandiswa kurapa uye inoonekwa semushonga wekurapa fibroids, asi hysterectomy inotakura kwete njodzi dzeperioperative chete, asiwo njodzi yakawedzera yenguva refu yechirwere chemoyo, kushushikana, kushushikana, uye kufa. Kusiyana neizvi, nzira dzekurapa dzakadai seye uterine artery embolization, ablation yemunharaunda, uye oral GnRH vanopikisa zvakachengeteka asi zvisingashandisi zvizere.

Nyaya pfupiso

Mumwe mukadzi ane makore makumi matatu nematatu ekuberekwa akange asati ambobata pamuviri akapa kuna chiremba wake wepamwedzi negasi remudumbu rinorema. Ane dambudziko rekushaya iron anemia. Miedzo yakadzoka isina thalassemia uye sickle cell anemia. Murwere akange asina ropa muchituru uye asina nhoroondo yemhuri yegomarara remukoloni kana chirwere chinoputika. Akashuma nguva dzose kuenda kumwedzi, kamwe chete pamwedzi, nguva imwe neimwe yemazuva 8, uye kwenguva refu isingashanduki. Pamazuva matatu akanyanya kuwanda ekuenda kumwedzi kwega kwega, anofanira kushandisa matamponi 8 kusvika ku9 pazuva, uye pano neapo anobuda ropa. Ari kuita zvidzidzo zvake zvedoctorate uye anoronga kubata pamuviri mukati memakore maviri. Ultrasound yakaratidza chibereko chakakura chine myoma dzakawanda uye maovari akajairwa. Uchabata sei murwere?

Chiitiko chechirwere chinosanganiswa ne uterine fibroids chinosanganiswa nekuderera kwekuonekwa kwechirwere uye kuti zviratidzo zvayo zvinokonzerwa nemamwe mamiriro ezvinhu, akadai sekukanganiswa kwekudya kana kukanganisa kweropa. Kunyara kunoenderana nekukurukura nezvekuenda kumwedzi kunokonzeresa kuti vanhu vazhinji vane nguva refu kana nguva yakaoma kuti vasazive kuti mamiriro avo haana kunaka. Vanhu vane zviratidzo havawanzoongororwa nenguva. Chikamu chimwe muzvitatu chevarwere chinotora makore mashanu kuti chiongororwe, uye vamwe chinotora makore anopfuura masere. Kunonoka kuongororwa kunogona kukanganisa kubereka, hupenyu hwehupenyu, uye kugara zvakanaka kwemari, uye muongororo yemhando yepamusoro, 95 muzana yevarwere vane symptomatic fibroids vakashuma mhedzisiro yepfungwa, kusanganisira kuora mwoyo, kunetseka, kutsamwa, uye kushushikana kwemuviri. Kuitwa chiseko uye kunyadziswa kwakabatana nekuenda kumwedzi kunotadzisa nhaurirano, tsvakiridzo, tsigiro, uye hunyanzvi munzvimbo iyi. Pakati pevarwere vakaonekwa kuti vane fibroids ne ultrasound, 50% kusvika 72% vakanga vasati vamboziva kuti vane fibroids, zvichiratidza kuti ultrasound inogona kushandiswa zvakanyanya mukuongororwa kwechirwere ichi.

Kuitika kweuterine fibroids kunowedzera nezera kusvika pakuguma kwekuenda kumwedzi uye kwakakwira kune vatema pane vachena. Kuenzaniswa nevanhu vasiri vanhu vatema, vanhu vatema vanokura uterine fibroids pazera diki, vane njodzi yakakwira yekuva nezviratidzo, uye vane chirwere chepamusoro chakaremerwa. Kuenzaniswa neveCaucasus, vanhu vatema vari kurwara zvakanyanya uye vane mukana wekuita hysterectomy uye myomectomy. Mukuwedzera, vatema vainyanya kudarika vachena kuti vasarudze kurapwa kusina-invasive uye kudzivisa kutumirwa kuvhiyiwa kuitira kuti vadzivise mukana wekuita hysterectomy.

Uterine fibroids inogona kuongororwa zvakananga nepelvic ultrasound, asi kuona kuti ndiani wekuvheneka hazvisi nyore, uye ikozvino kuongororwa kunowanzoitwa mushure mekunge mafibroids emurwere akura kana zviratidzo zvaoneka. Zviratidzo zvine chekuita neuterine fibroids zvinogona kupindirana nezviratidzo zveovulation kusagadzikana, adenomyopathy, yechipiri dysmenorrhea, uye kusagadzikana kwekugaya.

Nemhaka yokuti zvose sarcomas uye fibroids zviripo semiometric mass uye zvinowanzoperekedzwa nekubuda ropa kwechibereko chisina kujairika, pane kunetseka kuti uterine sarcomas inogona kupotsa pasinei nekushayikwa kwavo (1 mu770 kusvika ku10,000 kushanya nekuda kwekubuda ropa kwechibereko). Kunetseka pamusoro pekusaonekwa kweleiomyosarcoma kwakakonzera kuwedzera kwehuwandu hwehsterectomy uye kuderera kwekushandiswa kwemaitiro mashoma, kuisa varwere pangozi isingakoshi yematambudziko nekuda kwehurombo husina kunaka hwehutachiwana hutachiwana hwakapararira kunze kwechibereko.

Kuongororwa uye kuongorora

Panzira dzakasiyana-siyana dzekufungidzira dzinoshandiswa kuongorora uterine fibroids, pelvic ultrasound ndiyo nzira inodhura zvikuru nokuti inopa ruzivo pamusoro pehuwandu, nzvimbo, uye nhamba ye uterine fibroids uye inogona kusabvisa adnexal masses. An outpatient pelvic ultrasound inogonawo kushandiswa kuongorora uterine kubuda ropa kusina kujairika, chiuno chinonzwika panguva yekuongororwa, uye zviratidzo zvine chekuita nekukura kwechibereko, kusanganisira kumanikidzwa kwepelvic uye gasi remudumbu. Kana uterine volume inopfuura 375 mL kana nhamba ye fibroids inopfuura 4 (iyo inowanzoitika), kugadziriswa kwe ultrasound kunogumira. Magnetic resonance imaging inobatsira zvikuru kana uterine sarcoma ichifungidzirwa uye paunenge uchironga imwe nzira ye hysterectomy, iyo iyo ruzivo rwakarurama pamusoro pehuwandu hwechibereko, maitiro ekufungidzira, uye nzvimbo inokosha pamigumisiro yekurapa (Mufananidzo 1). Kana submucosal fibroids kana mamwe maronda eendometrial achifungidzirwa, saline perfusion ultrasound kana hysteroscopy inogona kubatsira. Computed tomography haibatsiri pakuongorora uterine fibroids nekuda kwekusajeka kwayo uye kuona kwetishu plane.

Muna 2011, International Federation of Obstetrics uye Gynecology yakabudisa chirongwa chekuisa uterine fibroids nechinangwa chekutsanangura zviri nani nzvimbo ye fibroids maererano ne uterine cavity uye serous membrane pamusoro, pane mazwi ekare anonzi submucosal, intramural, uye subserous membranes, nokudaro achibvumira kujekesa kwakajeka kwetafura yeS3endi yekukurukurirana uye kuronga tafura yeS3endi. chinyorwa paNEJM.org). The classification system is type 0 kusvika 8, ine nhamba diki inoratidza kuti fibroid iri pedyo neendometrium. Mixed uterine fibroids inomiririrwa nenhamba mbiri dzakapatsanurwa nemahyphens. Nhamba yekutanga inoratidza hukama pakati pe fibroid uye endometrium, uye yechipiri nhamba inoratidza hukama pakati pe fibroid uye serous membrane. Iyi uterine fibroid classification system inobatsira varapi kunanga kumwe kuongororwa uye kurapwa, uye inovandudza kutaurirana.

Kurapa

Mune mishonga yakawanda yekurapa myoma-yakabatana menorrhagia, kudzora menorrhagia nemahomoni ekudzivirira ndiyo danho rokutanga. Nonsteroidal anti-inflammatory drugs uye tranatemocyclic acid inoshandiswa panguva yekuenda kumwedzi inogonawo kushandiswa kuderedza menorrhagia, asi kune humwe humbowo hwekushanda kwemishonga iyi yeidiopathic menorrhagia, uye miedzo yekiriniki pachirwere inowanzobvisa varwere vane giant kana submucosal fibroids. Gonadotropin-releasing hormone (GnRH) yakareba-inobata agonist yakagamuchirwa kuti itange kurapwa kwenguva pfupi ye uterine fibroids, iyo inogona kukonzera amenorrhea munenge 90% yevarwere uye kuderedza uterine volume ne30% kusvika 60%. Zvisinei, mishonga iyi inosanganiswa nehuwandu hwezviratidzo zve hypogonadal, kusanganisira kurasikirwa kwepfupa uye kupisa kunopisa. Zvinokonzerawo "steroidal flares" muvarwere vakawanda, umo magonadotropins akachengetwa mumuviri anosunungurwa uye anokonzera nguva dzinorema gare gare apo mazinga eesrogen anodonha nokukurumidza.

Kushandiswa kwemuromo GnRH antagonist musanganiswa kurapa kwekurapa uterine fibroids kufambira mberi kukuru. Mishonga inotenderwa muUnited States inosanganisa oral GnRH antagonists (elagolix kana relugolix) muhwendefa remukomboni kana capsule ine estradiol uye progesterone, iyo inokurumidza kuvharidzira kugadzirwa kweovarian steroid (uye isingakonzerese steroid triggering), uye estradiol neprogesterone madosi anoita systemic mazinga anofananidzwa nekutanga follicular mazinga. Mushonga mumwe wakatotenderwa muEuropean Union (linzagolix) une madosi maviri: chipimo chemushonga chinodzivisa zvishoma kushanda kwehypothalamic uye dhizi rinodzivisa zvachose kushanda kwe hypothalamic, iyo yakafanana neinobvumirwa dosi re elagolix uye relugolix. Mushonga wega wega unowanikwa mukugadzirira kana pasina estrogen uye progesterone. Kune varwere vasingade kushandisa exogenous gonadal steroids, yakaderera-dose linzagolix kuumbwa pasina kuwedzera kwegonadal steroids (estrogen uye progesterone) inogona kuita zvakafanana seyepamusoro-dose musanganiswa wekugadzira ine exogenous mahormone. Combination therapy kana kurapa iyo inodzivirira zvishoma hypothalamic basa inogona kudzoreredza zviratidzo nemhedzisiro inofananidzwa neiyo yakazara-dose GnRH antagonist monotherapy, asi ine mishoma mhedzisiro. Imwe mukana wepamusoro-dose monotherapy ndeyokuti inogona kuderedza ukuru hwechibereko zvakanyanya, iyo yakafanana nemigumisiro yeGnRH agonists, asi ine zviratidzo zvakawanda zve hypogonadal.

Clinical test data inoratidza kuti muromo weGnRH anopikisa musanganiswa unoshanda mukuderedza menorrhagia (50% kusvika 75% kuderedza), marwadzo (40% kusvika 50% kuderedza), uye zviratidzo zvinosanganiswa nekuwedzera kwechibereko, asi zvishoma kuderedza uterine volume (inenge 10% kuderedzwa kweuterine volume) ine zvishomanana % zvemigumisiro yehutachi, kuputika kwemusoro, 20%. Kushanda kwemuromo weGnRH antagonist musanganiswa kurapa kwaive kwakazvimirira pahupamhi hwemyomatosis (saizi, nhamba, kana nzvimbo yefibroids), kuwirirana kweadenomyosis, kana zvimwe zvinhu zvinomisa kurapwa kwekuvhiya. Mubatanidzwa wemuromo weGnRH anopikisa parizvino wakatenderwa kwemwedzi makumi maviri nemana muUnited States uye nekushandiswa kusingagumi muEuropean Union. Zvisinei, mishonga iyi haina kuonekwa kuti ine simba rekudzivirira pamuviri, iro rinomisa kushandiswa kwenguva refu kwevanhu vakawanda. Miedzo yemakiriniki inoongorora maitiro ekudzivirira pamuviri erelugolix musanganiswa therapy irikuenderera mberi (nhamba yekunyoresa NCT04756037 paClinicalTrials.gov).

Munyika dzakawanda, inosarudza progesterone receptor modulators chirongwa chemishonga. Nekudaro, kunetseka nezve isingawanzo asi yakakomba huturu hwechiropa kwakaganhurira kugamuchirwa uye kuwanikwa kwemishonga yakadaro. Hapana yakasarudzika progesterone receptor modulators yakabvumidzwa muUnited States kurapwa kweuterine fibroids.

Hysterectomy

Kunyange zvazvo hysterectomy yakagara ichionekwa sekurapa kwakanyanya kune uterine fibroids, ruzivo rutsva pamusoro pemigumisiro yemamwe marapirwo akakodzera anoratidza kuti izvi zvinogona kufanana nehysterectomy nenzira dzakawanda munguva inodzorwa. Zvakaipa zvehysterectomy zvichienzaniswa nedzimwe nzira dzekurapa dzinosanganisira njodzi dzeperioperative uye salpingectomy (kana chiri chikamu chemaitiro). Makore zana asati atanga, kubviswa kwemazai ese ari maviri pamwe chete nekuvhiyiwa kwaiitwa hysterectomy yaive nzira yakajairika, uye ongororo huru dzeboka mukutanga kwema2000 dzakaratidza kuti kubviswa kwemazai ese ari maviri kwakabatana nenjodzi yekufa, chirwere chemoyo, dementia, uye zvimwe zvirwere zvichienzaniswa nekuita hysterectomy uye kuchengeta maovari. Kubva ipapo, chiyero chekuvhiya chesalpingectomy chadzikira, nepo chiyero chekuvhiya chehysterectomy hachina.

Ongororo dzakawanda dzakaratidza kuti kunyange kana mazai maviri akachengetedzwa, njodzi yechirwere chemwoyo, kuzvidya mwoyo, kuora mwoyo, uye rufu mushure mekuita hysterectomy inowedzera zvikuru. Varwere ≤35 yemakore panguva ye hysterectomy vari pangozi huru. Pakati pevarwere ava, njodzi yecoronary artery disease (mushure mekugadzirisa kune confounders) uye congestive heart failure yaiva 2.5 nguva dzakakwirira muvakadzi vakawana hysterectomy uye 4.6 nguva yakakwirira kune vakadzi vasina kutora hysterectomy panguva yekutevera kwepakati pemakore makumi maviri nemaviri. Vakadzi vane hysterectomy vasati vasvika makore makumi mana uye vakachengeta mazai avo vaiva 8 kusvika 29 muzana yengozi yekufa kupfuura vakadzi vakanga vasina kubvisa hysterectomy. Zvisinei, varwere vakanga vaitwa hysterectomy vaiva nemigumisiro yakawanda, yakadai sokufutisa, hyperlipidemia, kana nhoroondo yekuvhiyiwa, kupfuura vakadzi vakanga vasina kutora hysterectomy, uye nokuti zvidzidzo izvi zvaive zvekucherechedza, chikonzero nemigumisiro yaisagona kusimbiswa. Kunyangwe zvidzidzo zvakadzora kune idzi njodzi dzakasikwa, panogona kunge paine zvinhu zvisingayerwe zvinovhiringidza. Njodzi idzi dzinofanirwa kutsanangurirwa kune varwere vanofunga nezve hysterectomy, sezvo varwere vazhinji vane uterine fibroids vane dzimwe nzira dzisina kusimba.

Parizvino hapana nzira dzekutanga kana dzechipiri dzekudzivirira dzeuterine fibroids. Zvidzidzo zveEpidemiological zvakawana zvinhu zvakasiyana-siyana zvine chokuita nekuderedza ngozi ye uterine fibroids, kusanganisira: kudya michero yakawanda nemiriwo uye nyama shoma tsvuku; Rovedza muviri nguva dzose; Dzora uremu hwako; Normal vitamini D mazinga; Kubudirira kuberekwa kurarama; Kushandiswa kwemishonga yekudzivirira pamuviri; Uye kugadzirira kwenguva refu kweprogesterone. Randomized inodzorwa miedzo inodiwa kuti uone kana kugadzirisa zvinhu izvi kunogona kuderedza njodzi. Pakupedzisira, chidzidzo chacho chinoratidza kuti kushungurudzika uye rusarura zvinogona kuita basa mukusaruramisira kwehutano kuripo kana zvasvika kune uterine fibroids.