nūhou

ʻO nā fibroid ʻōpū kahi kumu maʻamau o ka menorrhagia a me ka anemia, a he kiʻekiʻe loa ka hopena, ma kahi o 70% a 80% o nā wahine e hoʻomohala i nā fibroids uterine i ko lākou ola ʻana, a he 50% ka hōʻike ʻana i nā hōʻailona. I kēia manawa, ʻo ka hysterectomy ka lāʻau lapaʻau maʻamau a manaʻo ʻia he lāʻau lapaʻau no ka fibroids, akā ʻaʻole lawe wale ka hysterectomy i nā pilikia perioperative wale nō, akā, ʻoi aku ka nui o ka maʻi o ka maʻi cardiovascular, ka hopohopo, ke kaumaha, a me ka make. ʻO ka ʻokoʻa, ʻoi aku ka palekana o nā koho lapaʻau e like me ka embolization o ke ʻano o ka ʻōpū, ablation kūloko, a me nā antagonists GnRH waha akā ʻaʻole i hoʻohana piha ʻia.

Hōʻuluʻulu hihia

Ua hōʻike ʻia kahi wahine ʻeleʻele 33 ona makahiki ʻaʻole i hāpai i kāna kauka mua me ka maʻi menstruation kaumaha a me ke kinoea ʻōpū. Ua loaʻa ʻo ia i ka anemia hemahema hao. Ua hoʻihoʻi maikaʻi ʻia nā hoʻokolohua no ka talasemia a me ka maʻi maʻi maʻi anemia. ʻAʻohe koko o ka mea maʻi i loko o ka waihona a ʻaʻohe moʻolelo ʻohana no ka maʻi maʻi ʻaʻai a i ʻole ka maʻi ʻeha. Ua hōʻike ʻo ia i ka menstruation maʻamau, hoʻokahi manawa i ka mahina, i kēlā me kēia manawa o 8 mau lā, a lōʻihi ka loli ʻole. I nā lā ʻekolu o ka nui o kēlā me kēia menstrual cycle, pono ʻo ia e hoʻohana i ka 8 a i ka 9 tampons i ka lā, a i kekahi manawa ke kahe koko. Ke aʻo nei ʻo ia no kāna kauka kauka a manaʻo e hāpai i loko o ʻelua makahiki. Ua hōʻike ʻia ka ultrasound i kahi ʻōpū i hoʻonui ʻia me nā myomas a me nā ovaries maʻamau. Pehea ʻoe e hana ai i ka mea maʻi?

ʻO ka maʻi o ka maʻi e pili ana i ka fibroids uterine e hui pū ʻia e ka haʻahaʻa haʻahaʻa o ka ʻike ʻana o ka maʻi a me ka ʻike ʻana o kāna mau hōʻailona e pili ana i nā kūlana ʻē aʻe, e like me nā maʻi digestive a i ʻole nā ​​​​pilikia o ke koko. ʻO ka hilahila e pili ana i ke kūkākūkā ʻana i ka menstruation ke kumu i ʻike ʻole ai nā poʻe he nui me nā wā lōʻihi a i ʻole nā ​​​​kaumaha koʻikoʻi ko lākou kūlana. ʻAʻole ʻike pinepine ʻia ka poʻe me nā hōʻailona i ka manawa. ʻO ka hapakolu o nā maʻi e lawe i ʻelima mau makahiki e ʻike ʻia, a ʻoi aku kekahi ma mua o ʻewalu mau makahiki. Hiki ke hoʻopilikia i ka maʻi lohi, ka maikaʻi o ke ola, a me ka maikaʻi kālā, a ma kahi noiʻi qualitative, 95 pakeneka o nā maʻi me nā fibroids symptomatic i hōʻike i nā hopena psychological ma hope o ka hopena, e like me ke kaumaha, ka hopohopo, ka huhū, a me ke kaumaha o ke kino. ʻO ka stigma a me ka hilahila e pili ana i ka menstruation ke keʻakeʻa nei i ke kūkākūkā, ka noiʻi, ka hoʻolaha ʻana, a me ka hana hou ma kēia wahi. Ma waena o nā poʻe maʻi i ʻike ʻia me ka fibroids e ka ultrasound, 50% a 72% ʻaʻole i ʻike mua he fibroids ko lākou, e manaʻo ana e hoʻohana nui ʻia ka ultrasound i ka loiloi o kēia maʻi maʻamau.

Hoʻonui ka nui o nā fibroids uterine me ka makahiki a hiki i ka menopause a ʻoi aku ka kiʻekiʻe o nā ʻeleʻele ma mua o nā keʻokeʻo. Ke hoʻohālikelike ʻia me nā poʻe ʻē aʻe ma mua o ka poʻe ʻeleʻele, hoʻomohala ka poʻe ʻeleʻele i ka fibroids uterine i ka wā ʻōpio, ʻoi aku ka nui o ka nui o ka ulu ʻana o nā hōʻailona, ​​​​a ʻoi aku ka nui o ke kaumaha o ka maʻi. Ke hoʻohālikelike ʻia me nā Caucasians, ʻoi aku ka maʻi o ka poʻe ʻeleʻele a ʻoi aku ka nui o ka loaʻa ʻana o ka hysterectomy a me ka myomectomy. Eia kekahi, ʻoi aku ka maikaʻi o nā ʻeleʻele ma mua o ka poʻe keʻokeʻo e koho i ka lāʻau lapaʻau non-invasive a me ka pale ʻana i nā mea hoʻopiʻi i mea e pale ai i ka hiki ke komo i ka hysterectomy.

Hiki ke ʻike pololei ʻia ka ʻōpū o ka ʻōpū me ka ultrasound pelvic, akā ʻaʻole maʻalahi ka hoʻoholo ʻana i ka mea e nānā ai, a i kēia manawa ke hana mau ʻia ka nānā ʻana ma hope o ka nui o nā fibroids o ka mea maʻi a ʻike ʻia paha nā hōʻailona. ʻO nā hōʻailona e pili ana i ka fibroids uterine hiki ke uhi ʻia me nā hōʻailona o ka maʻi ovulation, adenomyopathy, dysmenorrhea lua, a me nā maʻi digestive.

Ma muli o ka loaʻa ʻana o nā sarcomas a me nā fibroids ma ke ʻano he myometric masses a hele pinepine ʻia me ke kahe ʻana o ka ʻōpū, aia ka hopohopo e nalowale paha nā sarcomas uterine me ko lākou ʻano liʻiliʻi (1 ma 770 a 10,000 kipa ma muli o ke kahe ʻana o ka ʻōpū). ʻO nā hopohopo e pili ana i ka leiomyosarcoma iʻikeʻoleʻia ua alakaʻi i ka piʻiʻana o ka hysterectomy a me ka emiʻana o ka hoʻohanaʻana i nā kaʻina hana liʻiliʻi, e waiho ana i nā maʻi i kahi pilikia kūponoʻole o nā pilikia ma muli o ka maikaʻiʻole o ka uterine sarcomas i laha ma waho o ka'ōpū.

ʻIke a me ka loiloi

ʻO nā ʻano hana kiʻi like ʻole i hoʻohana ʻia no ka ʻike ʻana i ka fibroids uterine, ʻo ka ultrasound pelvic ke ʻano kumu kūʻai nui loa no ka mea hāʻawi ia i ka ʻike e pili ana i ka leo, kahi, a me ka helu o nā fibroids uterine a hiki ke hoʻokaʻawale i nā nui adnexal. Hiki ke hoʻohana ʻia kahi ultrasound pelvic outpatient no ka loiloi ʻana i ke kahe ʻana o ka ʻōpū, kahi palpable pelvic mass i ka wā o ka hoʻokolokolo ʻana, a me nā hōʻailona e pili ana i ka hoʻonui ʻana o ka ʻōpū, me ke kaomi pelvic a me ke kinoea ʻōpū. Inā ʻoi aku ka nui o ka uterine ma mua o 375 mL a i ʻole ka helu o nā fibroids ma mua o 4 (ʻo ia ka mea maʻamau), ua kaupalena ʻia ka hoʻonā o ka ultrasound. He mea maikaʻi loa ke kiʻi hoʻonaʻauao magnetic i ka wā i manaʻo ʻia ai ka sarcoma uterine a i ka wā e hoʻolālā ai i kahi koho ʻē aʻe i ka hysterectomy, ma ia hihia he mea nui ka ʻike pololei e pili ana i ka nui o ka ʻōpū, nā hiʻohiʻona kiʻi, a me ka wahi no nā hopena lapaʻau (Figure 1). Inā manaʻo ʻia nā fibroids submucosal a i ʻole nā ​​​​ʻeha endometrial ʻē aʻe, hiki ke kōkua i ka saline perfusion ultrasound a i ʻole hysteroscopy. ʻAʻole pono ka computed tomography no ka ʻike ʻana i ka fibroids uterine no ka maikaʻi ʻole o ka akaka a me ka nānā ʻana o ka mokulele kiko.

I ka makahiki 2011, ua paʻi ka International Federation of Obstetrics and Gynecology i kahi ʻōnaehana hoʻokaʻawale no nā fibroids uterine me ka manaʻo e wehewehe maikaʻi i kahi o nā fibroids e pili ana i ka lua o ka ʻōpū a me ka serous membrane surface, ma mua o nā huaʻōlelo kahiko submucosal, intramural, a me subserous membranes, no laila e ʻae ai i ke kamaʻilio maʻalahi a me ka hoʻolālā lapaʻau. NEJM.org). ʻO ka ʻōnaehana hoʻonohonoho ʻano ʻano 0 a 8, me kahi helu liʻiliʻi e hōʻike ana ua kokoke ka fibroid i ka endometrium. Hōʻike ʻia nā fibroids uterine i hui ʻia e nā helu ʻelua i hoʻokaʻawale ʻia e nā hyphens. Hōʻike ka helu mua i ka pilina ma waena o ka fibroid a me ka endometrium, a ʻo ka helu ʻelua e hōʻike i ka pilina ma waena o ka fibroid a me ka membrane serous. ʻO kēia ʻōnaehana fibroid uterine e kōkua i nā kauka e hoʻopaʻa i ka maʻi a me ka mālama ʻana, a hoʻomaikaʻi i ka kamaʻilio.

Lapaʻau

I ka nui o nā regimens no ka mālama ʻana i ka menorrhagia pili i ka myoma, ʻo ka mālama ʻana i ka menorrhagia me nā hormones contraceptive ka hana mua. ʻO nā lāʻau anti-inflammatory nonsteroidal a me ka waikawa tranatemocyclic i hoʻohana ʻia i ka wā menstruation hiki ke hoʻohana ʻia e hōʻemi i ka menorrhagia, akā ʻoi aku ka nui o nā hōʻike e pili ana i ka pono o kēia mau lāʻau no ka idiopathic menorrhagia, a me nā hoʻokolohua lapaʻau ma ka maʻi maʻamau e hoʻokaʻawale i nā maʻi me ka pilikua a i ʻole nā ​​submucosal fibroids. Ua ʻae ʻia nā agonists lōʻihi e hoʻokuʻu ana i ka gonadotropin-releasing hormone (GnRH) no ka mālama ʻana i ka wā pōkole o ka fibroids uterine, hiki ke hoʻoulu i ka amenorrhea ma kahi o 90% o nā maʻi a hoʻemi i ka nui o ka uterine e 30% a 60%. Eia nō naʻe, pili kēia mau lāʻau lapaʻau me kahi kiʻekiʻe o nā hōʻailona hypogonadal, me ka nalowale o ka iwi a me ka wela wela. Hoʻokumu pū lākou i nā "steroidal flares" i ka hapa nui o nā maʻi, kahi i hoʻokuʻu ʻia ai nā gonadotropins i mālama ʻia i loko o ke kino a hoʻoulu i nā wā kaumaha ma hope ke hāʻule koke nā pae estrogen.

ʻO ka hoʻohana ʻana i ka lāʻau GnRH antagonist hui ʻana no ka mālama ʻana i nā fibroids uterine kahi holomua nui. ʻO nā lāʻau lapaʻau i ʻae ʻia ma ʻAmelika Hui Pū ʻIa e hui pū i nā antagonists GnRH waha (elagolix a i ʻole relugolix) i loko o kahi papa hoʻohui a i ʻole capsule me ka estradiol a me ka progesterone, ka mea e kaohi wikiwiki i ka hana steroid ovarian (a ʻaʻole e hoʻoulu i ka steroid), a me ka estradiol a me ka progesterone doses e hoʻohālikelike ai i nā pae ʻōnaehana me nā pae follicular mua. Hoʻokahi lāʻau lapaʻau i ʻae ʻia i ka European Union (linzagolix) he ʻelua mau ʻāpana: kahi ʻāpana e hoʻokaʻawale i ka hana hypothalamic a me kahi maʻi e hōʻole loa i ka hana hypothalamic, e like me nā dosis i ʻae ʻia no ka elagolix a me relugolix. Loaʻa kēlā me kēia lāʻau i ka hoʻomākaukau ʻana me ka estrogen a me ka progesterone a i ʻole. No nā poʻe maʻi ʻaʻole makemake e hoʻohana i nā steroid gonadal exogenous, hiki ke hoʻokō i ka hopena like me ka hoʻokumu ʻana o ka linzagolix haʻahaʻa me ka ʻole o ka hoʻohui ʻana o nā steroids gonadal (estrogen a me progesterone) i ka hopena like me ka hui pū ʻana kiʻekiʻe i loaʻa nā hormones exogenous. Hiki i ka hui hui ʻana a i ʻole ka lāʻau lapaʻau e hoʻokaʻawale hapa i ka hana hypothalamic hiki ke hōʻoluʻolu i nā hōʻailona me nā hopena e like me ka monotherapy antagonist GnRH piha piha, akā me ka liʻiliʻi o nā hopena ʻaoʻao. ʻO kahi pōmaikaʻi o ka monotherapy kiʻekiʻe ka hiki ke hoʻemi i ka nui o ka ʻōpū me ka maikaʻi, e like me ka hopena o nā agonists GnRH, akā me nā hōʻailona hypogonadal.

Hōʻike nā ʻikepili hoʻāʻo maʻi i ka hui ʻana o ka GnRH antagonist waha i ka hoʻohaʻahaʻa ʻana i ka menorrhagia (50% a 75% ka emi ʻana), ka ʻeha (40% a 50% ka emi ʻana), a me nā hōʻailona e pili ana i ka hoʻonui ʻana o ka ʻōpū, ʻoiai e hoʻemi iki ana i ka nui o ka uterine (ma kahi o 10% ka emi ʻana o ka nui o ka uterine) me ka liʻiliʻi o nā hopena ʻaoʻao (<20% o nā hopena ʻaoʻao). ʻO ka maikaʻi o ka GnRH antagonist hui ʻana o ka waha he kūʻokoʻa i ka nui o ka myomatosis (ka nui, helu, a i ʻole kahi o nā fibroids), ka paʻakikī o ka adenomyosis, a i ʻole nā ​​​​mea ʻē aʻe e kaupalena ana i ka lāʻau lapaʻau. Ua ʻae ʻia ka hui ʻana o ka waha GnRH antagonist i kēia manawa no 24 mau mahina ma ʻAmelika Hui Pū ʻIa a no ka hoʻohana mau ʻana i ka European Union. Eia naʻe, ʻaʻole i hōʻike ʻia kēia mau lāʻau lapaʻau i kahi hopena contraceptive, e kaupalena ana i ka hoʻohana lōʻihi no nā poʻe he nui. Ke hoʻomau nei nā hoʻokolohua lapaʻau e loiloi ana i nā hopena contraceptive o ka relugolix hui pū ʻana (helu helu NCT04756037 ma ClinicalTrials.gov).

I nā ʻāina he nui, koho ʻia nā modulators receptor progesterone koho i ka lāʻau lapaʻau. Eia nō naʻe, ʻo nā hopohopo e pili ana i ka ʻona o ka ate kakaʻikahi ka mea i kaupalena ʻia ka ʻae ʻana a me ka loaʻa ʻana o ia mau lāʻau lapaʻau. ʻAʻole i ʻae ʻia nā modulators receptor progesterone koho i ka United States no ka mālama ʻana i nā fibroids uterine.

Hysterectomy

ʻOiai ua noʻonoʻo ʻia ka hysterectomy i ka wā kahiko he lāʻau lapaʻau no ka fibroids uterine, ʻo ka ʻikepili hou e pili ana i nā hopena o nā lāʻau lapaʻau kūpono e hōʻike ana e like paha kēia me ka hysterectomy ma nā ʻano he nui i kahi manawa i mālama ʻia. ʻO nā hemahema o ka hysterectomy i hoʻohālikelike ʻia me nā lāʻau lapaʻau ʻē aʻe e pili ana i nā pilikia perioperative a me ka salpingectomy (inā he ʻāpana ia o ke kaʻina hana). Ma mua o ka hoʻomaka ʻana o ke kenekulia, he hana maʻamau ka wehe ʻana o nā ovaries ʻelua me ka hysterectomy, a ua hōʻike ʻia nā haʻawina cohort nui i nā makahiki 2000 e pili ana ka wehe ʻana o nā ovaries ʻelua me ka piʻi nui o ka make, ka maʻi cardiovascular, dementia, a me nā maʻi ʻē aʻe i hoʻohālikelike ʻia me ka hysterectomy a me ka mālama ʻana i nā ovaries. Mai ia manawa, ua emi ka nui o ke kaʻi ʻana o ka salpingectomy, ʻoiai ʻaʻole i loaʻa ka helu o ka hysterectomy.

Ua hōʻike ʻia nā haʻawina he nui ʻoiai inā mālama ʻia nā ovaries ʻelua, ua hoʻonui nui ʻia ka pilikia o ka maʻi cardiovascular, ka hopohopo, ke kaumaha, a me ka make ma hope o ka hysterectomy. ʻO ka poʻe maʻi ≤35 mau makahiki i ka manawa o ka hysterectomy he pilikia nui loa. Ma waena o kēia mau maʻi, ʻoi aku ka nui o ka maʻi o ka coronary artery (ma hope o ka hoʻoponopono ʻana no nā confounders) a me ka puʻuwai congestive he 2.5 mau manawa kiʻekiʻe i nā wahine i loaʻa i ka hysterectomy a me 4.6 mau manawa kiʻekiʻe i nā wahine i hele ʻole i ka hysterectomy i ka wā o ka hahai ʻana o 22 makahiki. ʻO nā wāhine i loaʻa i ka hysterectomy ma mua o ka makahiki 40 a mālama i kā lākou ovaries, he 8 a 29 ka nui o ka make ma mua o nā wahine i loaʻa ʻole i ka hysterectomy. Eia naʻe, ʻoi aku ka nui o nā maʻi maʻi i loaʻa i ka hysterectomy, e like me ka momona, hyperlipidemia, a i ʻole ka mōʻaukala o ka ʻoki ʻana, ma mua o nā wahine i hana ʻole i ka hysterectomy, a no ka nānā ʻana o kēia mau haʻawina, ʻaʻole hiki ke hōʻoia ʻia ke kumu a me ka hopena. ʻOiai ua hoʻomalu ʻia nā haʻawina no kēia mau pilikia kūlohelohe, aia nō paha nā kumu hoʻohālikelike i ana ʻole ʻia. Pono e wehewehe ʻia kēia mau pilikia i nā poʻe maʻi e noʻonoʻo ana i ka hysterectomy, no ka mea, ʻoi aku ka nui o nā maʻi me ka fibroids uterine i nā mea ʻē aʻe.

I kēia manawa, ʻaʻohe papa hana pale mua a lua paha no ka fibroids uterine. Ua loaʻa i nā haʻawina Epidemiological nā kumu like ʻole e pili ana i ka hōʻemi ʻana o ka fibroids uterine, ʻo ia hoʻi: ka ʻai ʻana i nā huaʻai a me nā mea kanu a me ka liʻiliʻi o ka ʻiʻo ʻulaʻula; E hooikaika mau; E hoomalu i kou kaumaha; Nā pae vitamina D maʻamau; Hanau ola holomua; Ka hoʻohana ʻana i nā lāʻau lapaʻau waha; A me nā hoʻomākaukau progesterone lōʻihi. Pono nā hoʻāʻo ʻokoʻa i hoʻopaʻa ʻia e hoʻoholo inā hiki i ka hoʻololi ʻana i kēia mau mea ke hōʻemi i ka pilikia. ʻO ka mea hope loa, hōʻike ka haʻawina e pili ana ke koʻikoʻi a me ka hoʻokalakupua i ka pono ʻole o ke olakino e pili ana i ka fibroids uterine.