Chithandizo chamankhwala

Chifukwa ambiri uterine fibroids sizimayambitsa zizindikiro (zimanenedwa kuti ndi "asymptomatic"), madokotala nthawi zambiri amapereka "kuyang'anitsitsa" kwa chitukuko cha fibroid. Nthawi zambiri, fibroids zomwe sizimayambitsa zizindikiro sizifuna chithandizo.

Pamene chithandizo chikufunika, chisankho chosankha chimodzi pa chimzake chimadalira pazifukwa zosiyanasiyana: kuopsa kwa zizindikiro, chikhumbo chokhala ndi ana kapena ayi, zaka, zomwe amakonda, ndi zina zotero.hysterectomy, ndiko kuti, kuchotsa chiberekero, kumapereka njira yotsimikizirika.

Malangizo ochotsera zizindikiro

• Kupaka ma compress otentha (kapena ayezi) kumalo opweteka kungathandize kuchepetsa ululu. ululu.
• Mankhwala opezeka m'sitolo amathandizira kuchepetsa kupweteka kwa m'mimba ndi kupweteka kwa msana. Mankhwalawa akuphatikizapo acetaminophen kapena paracetamol (kuphatikizapo Tylenol®,) ndi ibuprofen (monga Advil® kapena Motrin®).
• Kulimbana ndi kudzimbidwa, muyenera kudya magawo asanu kapena khumi a zipatso ndi ndiwo zamasamba patsiku, komanso kuchuluka kwa zakudya zopatsa thanzi. Izi zimapezeka muzakudya zambewu zonse (mkate wa tirigu wonse ndi pasitala, mpunga wa bulauni, mpunga wakuthengo, ma muffin a chimanga, etc.).

  NB Kuti mukhale ndi zakudya zokhala ndi fiber, ndikofunikira kumwa madzi ambiri kuti musatseke chimbudzi.

• ngati kudzimbidwa amalimbikira, tingayesetse misa mankhwala ofewetsa tuvi tolimba (kapena ballast), zochokera psyllium Mwachitsanzo, amene amachita modekha. Ma stimulation laxatives amakwiyitsa kwambiri ndipo nthawi zambiri samalimbikitsidwa. Kuti mudziwe zambiri, onani tsamba lathu la Constipation. Malangizowa sakhala othandiza ngati akudwala fibroid yayikulu, chifukwa kudzimbidwa kumalumikizidwa ndi kupsinjika kwa m'mimba, osati kudya koyipa kapena kuyenda koyipa.
• Ngati 'kulakalaka kukodza pafupipafupi, imwani nthawi zonse masana koma pewani kumwa pambuyo pa 18pm kuti musamadzuke nthawi zambiri usiku.

Mankhwala

Mankhwalawa amagwira ntchito pa dongosolo la msambo kuchepetsa zizindikiro (makamaka magazi ochuluka a msambo), koma samachepetsa kukula kwa fibroid.

Pali njira zitatu zothandizira amayi omwe ali ndi vuto la fibroids:

- IUD (Mirena®). Ikhoza kuikidwa mu chiberekero pokhapokha ngati fibroid si submucosal (formal contraindication) ndipo fibroids si yaikulu kwambiri. IUD imeneyi pang’onopang’ono imatulutsa progestin yomwe imachititsa kuti magazi azichepa kwambiri. Iyenera kusinthidwa zaka zisanu zilizonse.

- tranexamic acid (Exacyl®) ikhoza kuperekedwa kwa nthawi yonse yotaya magazi.

- mefenamic acid (Ponstyl®), mankhwala oletsa kutupa angaperekedwe panthawi ya magazi.

Ngati fibroid ndi yaikulu kwambiri kapena ili ndi magazi ambiri, mankhwala ena a m'thupi akhoza kuperekedwa kuti achepetse kukula kwa fibroid musanachite opaleshoni. Chowonjezera chachitsulo chikhoza kuperekedwa kwa amayi omwe akudwala kwambiri magazi, kuti athe kulipira kutaya kwachitsulo m'thupi lawo.

Pre-opaleshoni mankhwala a uterine fibroids.

- Gn-RH analogues (gonadorelin kapena gonadoliberin). Gn-RH (Lupron®, Zoladex®, Synarel®, Decapeptyl®) ndi hormone yomwe imachepetsa milingo ya estrogen pamlingo wofanana ndi wa mayi wapakati. Chifukwa chake, mankhwalawa amatha kuchepetsa kukula kwa fibroids ndi 30% mpaka 90%. Mankhwalawa amayambitsa kusintha kwa kanthaŵi kochepa ndipo amatsagana ndi zizindikiro, monga kutentha ndi kutsika kwa mafupa. Zotsatira zake ndi zambiri, zomwe zimalepheretsa kugwiritsidwa ntchito kwake kwa nthawi yayitali. Chifukwa chake Gn-RH imayikidwa pakanthawi kochepa (osakwana miyezi isanu ndi umodzi) podikirira opaleshoni. Nthawi zina adotolo amawonjezera tibolone (Livial®) ku ma analogue a Gn-RH.

- Danazol (Danatrol®, Cyclomen®). Mankhwalawa amalepheretsa kupanga estrogen ndi mazira, zomwe nthawi zambiri zimabweretsa kusokoneza kwa kusamba. Zingathandize kuchepetsa magazi, koma zotsatira zake zimakhala zowawa: kunenepa kwambiri, kutentha thupi, kuchuluka kwa mafuta m'thupi, ziphuphu, kukula kwa tsitsi ... Ndikothandiza kwa miyezi itatu, kuchepetsa zizindikiro za fibroids, koma palibe kafukufuku amene sanayese kugwira ntchito kwa nthawi yayitali. Zikuwoneka kuti zili ndi zotsatirapo zambiri komanso sizigwira ntchito bwino kuposa ma analogue a GnRH. Choncho sichikulimbikitsidwanso

opaleshoni

Opaleshoni imasonyezedwa makamaka chifukwa cha kutuluka magazi kosalamulirika, kusabereka, kupweteka kwambiri m'mimba kapena kupweteka kwa msana.

La myomectomy ndi kuchotsa fibroids. Zimalola mkazi amene akufuna kukhala ndi ana. Muyenera kudziwa kuti myomectomy si njira yotsimikizika nthawi zonse. Mu 15% ya milandu, ma fibroids ena amawonekera ndipo mu 10% ya milandu, tidzalowereranso mwa opaleshoni.6.

Pamene fibroids ndi yaing'ono komanso submucosal, myomectomy ikhoza kuchitidwa ndi hysteroscopy. Zachikal amachitidwa pogwiritsa ntchito chida chokhala ndi nyali yaing’ono ndi kamera ya kanema imene dokotalayo amalowetsa m’chibaliro kudzera m’nyini ndi pachibelekero. Zithunzi zomwe zikuwonetsedwa pazenera ndiye zimatsogolera dokotalayo. Njira ina, laparoscopy, imalola kuti chida chopangira opaleshoni chilowetsedwe kudzera m'kang'ono kakang'ono kopangidwa kumunsi kwa mimba. Pamene fibroid sichipezeka kwa njirazi, dokotala wa opaleshoni amapanga laparotomy, kutsegula kwachidule kwa khoma la m'mimba.

THEembolisationfibroids ndi njira yopangira opaleshoni yomwe imawumitsa ma fibroids popanda kuwachotsa. Dokotala (wothandizira radiologist) amayika catheter mumtsempha womwe umathirira chiberekero kuti alowetse ma microparticles opangira omwe ali ndi zotsatira zotsekereza mtsempha womwe umapereka fibroid. Fibroid, yomwe sichilandiranso mpweya ndi zakudya, pang'onopang'ono imataya pafupifupi 50% ya voliyumu yake.

Kuphatikiza pa kuteteza chiberekero, njirayi imakhala yopweteka kwambiri ngati myomectomy. Kuchira kwa masiku asanu ndi awiri kapena khumi ndikokwanira. Poyerekeza, hysterectomy imafuna osachepera masabata asanu ndi limodzi a kuchira. Malinga ndi kafukufuku yemwe adasindikizidwa mu 2010, chiberekero cha uterine embolization (UAE) chimapereka zotsatira zofanana ndi zaka zisanu poyerekeza ndi za hysterectomy, zomwe zimapangitsa kuti chiberekero chisungidwe. Komabe, njirayi singagwiritsidwe ntchito pa ma fibroids onse. Mwachitsanzo, sikulimbikitsidwa kuchiza submucosal fibroids.

Njira yotchedwa uterine artery ligation ingathenso kuchitidwa ndi laparoscopy. Amakhala ndi kuika tatifupi pa mitsempha. Koma zikuwoneka zocheperako kuposa embolization pakapita nthawi.

- Kutulutsa kwa endometrium (mkapo wa chiberekero) nthawi zina kungakhale koyenera kwa amayi omwe sakufunanso ana kuti achepetse magazi ambiri. Pamene endometrium imachotsedwa ndi opaleshoni, magazi a msambo nthawi zambiri amachoka, koma sikuthekanso kutenga pakati. Opaleshoniyi imachitika makamaka pakatuluka magazi ambiri komanso ma submucosal fibroids ang'onoang'ono.

Njira zina zaposachedwa ndizopezeka pafupipafupi:

Thermachoice® (baluni imalowetsedwa m'chiberekero ndikudzazidwa ndi madzi otentha mpaka 87 ° kwa mphindi zingapo), Novasure® (kuwonongeka kwa fibroid ndi radiofrequency ndi electrode yomwe imalowetsedwa m'chiberekero), Hydrothermablabor® (saline seramu ndi kutenthedwa kuti iwonongeke). 90 ° analowetsedwa mu uterine patsekeke pansi pa ulamuliro wa kamera), thermablate® (baluni wodzazidwa ndi madzi pa 173 ° analowa mu uterine patsekeke).

Njira zina za myolysis (kuwonongeka kwa myoma kapena fibroma akadali pa kafukufuku): myolysis ndi microwave, cryomyolysis (kuwonongeka kwa fibroid ndi kuzizira), myolysis ndi ultrasound.

- Hysterectomy, kapena kuchotsedwa kwa chiberekero, kumasungidwa pazovuta kwambiri zomwe njira zam'mbuyomu sizingatheke, komanso kwa amayi omwe sakufunanso kukhala ndi ana. Zitha kukhala zapang'onopang'ono (kutetezedwa kwa khomo lachiberekero) kapena kwathunthu. The hysterectomy ikhoza kuchitidwa m'mimba, kudzera m'mimba pansi pamimba, kapena kumaliseche, popanda kutsegula m'mimba, kapena ndi laparoscopy pamene kukula kwa fibroid kumalola. Iyi ndi njira "yachikulu" yolimbana ndi fibroids, chifukwa sipangakhale kubwereza pambuyo pochotsa chiberekero.