labarai

Fibroids na mahaifa ya zama sanadi na gama gari da anemia, kuma abin da ya faru ya yi yawa sosai, kusan kashi 70 zuwa 80% na mata za su sami fibroids na mahaifa a rayuwarsu, wanda kashi 50% na alamun bayyanar cututtuka. A halin yanzu, hysterectomy shine maganin da aka fi amfani da shi kuma ana daukarsa a matsayin magani mai mahimmanci ga fibroids, amma hysterectomy yana ɗaukar ba kawai haɗarin haɗari ba, amma har ma da haɗari na dogon lokaci na cututtukan zuciya, damuwa, damuwa, da mutuwa. Sabanin haka, zaɓuɓɓukan magani kamar kumburin jijiyoyin mahaifa, zubar da ciki, da masu adawa da GnRH na baka sun fi aminci amma ba a cika amfani da su ba.

Takaitaccen lamari

Wata bakar fata mai shekaru 33 da ba ta taba daukar ciki ba ta gabatar wa likitanta na farko da ciwon haila da iskar gas na ciki. Tana fama da karancin ƙarfe na anemia. Gwaje-gwaje sun dawo mara kyau ga thalassemia da sickle cell anemia. Mai haƙuri ba shi da jini a cikin stool kuma ba shi da tarihin iyali na ciwon daji na hanji ko ciwon hanji mai kumburi. Ta ba da rahoton haila akai-akai, sau ɗaya a wata, kowane tsawon kwanaki 8, kuma tsawon lokaci ba canzawa. A ranaku uku mafi yawan al'ada na kowace al'ada, tana buƙatar amfani da tampons 8 zuwa 9 a rana, kuma lokaci-lokaci yana zubar da jinin haila. Tana karatun digirinta na uku kuma tana shirin daukar ciki cikin shekaru biyu. Duban dan tayi ya nuna mahaifa mai girma tare da myomas da yawa da ovaries na al'ada. Yaya za ku bi da mara lafiya?

Abubuwan da ke tattare da cututtukan da ke tattare da fibroids na mahaifa suna haɗuwa da ƙarancin gano cutar da kuma gaskiyar cewa alamunta ana danganta su ga wasu yanayi, irin su rikice-rikice na narkewa ko rashin lafiya na tsarin jini. Abin kunyar da ke tattare da tattauna batun haila yana sa mutane da yawa masu yawan al'ada ko yawan al'ada ba su san cewa yanayinsu ba ne. Sau da yawa ba a gano mutanen da ke da alamun cutar cikin lokaci ba. Kashi uku na marasa lafiya suna ɗaukar shekaru biyar kafin a gano su, wasu kuma suna ɗaukar sama da shekaru takwas. Jinkirin ganewar asali na iya haifar da mummunar tasiri ga haihuwa, ingancin rayuwa, da kuma jin dadin kuɗi, kuma a cikin wani bincike mai mahimmanci, 95 bisa dari na marasa lafiya tare da fibroids na alamun bayyanar cututtuka sun ba da rahoton abubuwan da suka shafi tunanin mutum, ciki har da damuwa, damuwa, fushi, da damuwa na hoton jiki. Abin kunya da kunya da ke tattare da haila suna hana tattaunawa, bincike, shawarwari, da sabbin abubuwa a wannan fanni. Daga cikin marasa lafiya da aka gano da fibroids ta hanyar duban dan tayi, 50% zuwa 72% a baya basu san cewa suna da fibroids ba, yana nuna cewa ana iya amfani da duban dan tayi a cikin kimanta wannan cuta ta gama gari.

Abubuwan da ke faruwa na fibroids na mahaifa yana ƙaruwa da shekaru har zuwa lokacin al'ada kuma ya fi girma a cikin baƙar fata fiye da fararen fata. Idan aka kwatanta da mutane ban da baƙar fata, baƙar fata suna haɓaka fibroids na mahaifa tun suna ƙanana, suna da haɗarin haɓakar bayyanar cututtuka, kuma suna da nauyin cutar gaba ɗaya. Idan aka kwatanta da 'yan Caucasians, baƙar fata sun fi rashin lafiya kuma suna iya fuskantar hysterectomy da myomectomy. Bugu da ƙari, baƙar fata sun fi farar fata don zaɓar maganin da ba na cin zarafi ba kuma don kauce wa yin amfani da tiyata don kauce wa yiwuwar yin amfani da hysterectomy.

Za a iya gano fibroids na mahaifa kai tsaye tare da duban dan tayi, amma tantance wanda za a duba ba abu ne mai sauƙi ba, kuma a halin yanzu ana yin gwajin bayan fibroids na majiyyaci sun yi girma ko bayyanar cututtuka. Alamun da ke hade da fibroids na mahaifa na iya haɗuwa da alamun cututtuka na ovulation, adenomyopathy, dysmenorrhea na biyu, da cututtuka na narkewa.

Saboda duka sarcomas da fibroids suna kasancewa a matsayin ma'auni na myometric kuma sau da yawa suna tare da zubar da jini na mahaifa, akwai damuwa cewa za a iya rasa sarcomas na mahaifa duk da ƙarancin dangi (1 a cikin 770 zuwa 10,000 ziyara saboda zubar da jini na mahaifa). Damuwa game da leiomyosarcoma da ba a gano ba ya haifar da karuwa a cikin adadin hysterectomy da rage yawan amfani da ƙananan hanyoyi masu haɗari, yana sanya marasa lafiya a cikin hadarin da ba dole ba ne na rikitarwa saboda mummunan tsinkaye na sarcomas na mahaifa wanda ya yada a waje da mahaifa.

Bincike da kimantawa

Daga cikin hanyoyin hoto daban-daban da ake amfani da su don tantance fibroids na mahaifa, pelvic ultrasound shine hanya mafi inganci don samar da bayanai game da girma, wuri, da adadin fibroids na mahaifa kuma yana iya ware talakawan adnexal. Hakanan za'a iya amfani da duban dan tayi na pelvic na waje don kimanta zubar jini na mahaifa mara kyau, yawan ƙwanƙwasa a lokacin bincike, da alamun da ke da alaƙa da haɓakar mahaifa, gami da matsa lamba na pelvic da gas na ciki. Idan girman mahaifa ya wuce 375 ml ko adadin fibroids ya wuce 4 (wanda shine na kowa), ƙudurin duban dan tayi yana iyakance. Hoton magana na Magnetic yana da amfani sosai lokacin da ake zargin sarcoma na uterine da kuma lokacin da ake tsara wani madadin hysterectomy, wanda idan akwai cikakkun bayanai game da girman mahaifa, siffofi na hoto, da wuri yana da mahimmanci ga sakamakon magani (Figure 1). Idan ana zargin fibroids na submucosal ko wasu raunuka na endometrial, saline perfusion duban dan tayi ko hysteroscopy na iya taimakawa. Ƙididdigar ƙididdiga ba ta da amfani don bincikar fibroids na mahaifa saboda rashin kyawunsa da hangen nesa na jirgin nama.

A shekara ta 2011, Tarayyar kasa ta kasa da ta babletrics da na Gynecology suka buga tsarin rarrabuwa don fibranes na sama, kuma saboda haka ba da damar yin amfani da hanyar sadarwa ta Uter S3, akwai tare da Cikakken rubutu na wannan labari a NEJM.org). Tsarin rarrabuwa shine nau'in 0 zuwa 8, tare da ƙaramin lamba yana nuna cewa fibroids yana kusa da endometrium. Haɗaɗɗen fibroids na mahaifa ana wakilta ta lambobi biyu waɗanda aka raba ta hanyar saƙa. Lamba na farko yana nuna dangantakar dake tsakanin fibroid da endometrium, kuma lamba ta biyu tana nuna dangantakar dake tsakanin fibroid da membrane serous. Wannan tsarin rarraba fibroids na mahaifa yana taimaka wa likitocin da ke neman ƙarin bincike da magani, da kuma inganta sadarwa.

Magani

A mafi yawan tsarin kula da ƙwayar cuta mai alaƙa da myoma, sarrafa menorrhagia tare da hormones na hana haihuwa shine mataki na farko. Hakanan za'a iya amfani da magungunan da ba na steroidal anti-inflammatory da kuma tranatemocyclic acid da ake amfani da su a lokacin haila don rage yawan menorrhagia, amma akwai ƙarin shaida akan ingancin waɗannan magungunan don menorrhagia na idiopathic, kuma gwaje-gwaje na asibiti akan cutar yawanci suna ware marasa lafiya tare da giant ko submucosal fibroids. An ba da izinin agonists na gonadotropin-releasing hormone (GnRH) na dogon lokaci don maganin gajeren lokaci na uterine fibroids, wanda zai iya haifar da amenorrhea a kusan 90% na marasa lafiya da kuma rage girman mahaifa ta 30% zuwa 60%. Duk da haka, waɗannan kwayoyi suna da alaƙa da mafi girma na alamun hypogonadal, ciki har da asarar kashi da walƙiya mai zafi. Har ila yau, suna haifar da "flares steroidal" a yawancin marasa lafiya, inda aka saki gonadotropins da aka adana a cikin jiki kuma suna haifar da lokuta masu nauyi daga baya lokacin da matakan estrogen ya ragu da sauri.

Yin amfani da maganin haɗin gwiwa na GnRH na baka don maganin fibroids na mahaifa babban ci gaba ne. Magungunan da aka amince da su a Amurka sun haɗu da masu adawa da GnRH na baka (elagolix ko relugolix) a cikin kwamfutar hannu ko capsule tare da estradiol da progesterone, wanda ke hana samar da steroid na ovarian da sauri (kuma ba sa haifar da steroid) da kuma estradiol da progesterone allurai waɗanda ke yin matakan tsarin daidaitawa zuwa farkon matakan follicular. Ɗaya daga cikin miyagun ƙwayoyi da aka riga aka amince da shi a cikin Tarayyar Turai (linzagolix) yana da nau'i biyu: kashi wanda ke hana aikin hypothalamic da wani kashi wanda ya hana aikin hypothalamic gaba daya, wanda yayi kama da allurai da aka yarda don elagolix da relugolix. Kowane magani yana samuwa a cikin shiri tare da ko ba tare da estrogen da progesterone ba. Ga marasa lafiya waɗanda ba sa son yin amfani da ƙwayoyin cuta na gonadal na waje, ƙirar linzagolix mai ƙarancin ƙima ba tare da ƙari na steroids na gonadal (estrogen da progesterone) na iya cimma sakamako iri ɗaya azaman ƙirar haɗin gwiwa mai girma wanda ke ɗauke da ƙwayoyin cuta na waje. Haɗuwa da jiyya ko maganin da ke hana aikin hypothalamic a wani ɓangare na iya sauƙaƙe alamun bayyanar cututtuka tare da tasirin kwatankwacin cikakken adadin GnRH antagonist monotherapy, amma tare da ƙarancin sakamako masu illa. Ɗaya daga cikin fa'ida na babban maganin monotherapy shine cewa zai iya rage girman mahaifa da kyau, wanda yayi kama da tasirin GnRH agonists, amma tare da ƙarin alamun hypogonadal.

Bayanan gwaji na asibiti sun nuna cewa haɗin GnRH antagonist na baki yana da tasiri wajen rage yawan menorrhagia (50% zuwa 75% raguwa), zafi (40% zuwa 50% raguwa), da kuma alamun da ke hade da haɓakar mahaifa, yayin da dan kadan rage girman ƙwayar mahaifa (kimanin 10% raguwa a cikin ƙwayar mahaifa) tare da ƙananan sakamako masu illa (<20% nausea, ciwon kai). Ingancin maganin haɗin gwiwar antagonist na baka na GnRH ya kasance mai zaman kansa daga girman myomatosis (girma, lamba, ko wurin fibroids), ƙarancin adenomyosis, ko wasu abubuwan da ke iyakance aikin tiyata. Haɗin GnRH na baka a halin yanzu an yarda da shi na tsawon watanni 24 a cikin Amurka kuma don amfani mara iyaka a cikin Tarayyar Turai. Duk da haka, ba a nuna waɗannan magungunan suna da tasirin hana haihuwa ba, wanda ke iyakance amfani da dogon lokaci ga mutane da yawa. Gwaje-gwaje na asibiti da ke kimanta tasirin maganin hana haihuwa na maganin haɗin gwiwar relugolix suna gudana (lambar rajista NCT04756037 a ClinicalTrials.gov).

A cikin ƙasashe da yawa, masu haɓaka masu karɓar progesterone masu zaɓin tsarin magani ne. Koyaya, damuwa game da ƙarancin hanta amma mai tsananin cutar hanta sun iyakance karɓa da wadatar irin waɗannan magunguna. Babu zaɓaɓɓun masu karɓar mai karɓar progesterone da aka yarda a cikin Amurka don maganin fibroids na mahaifa.

Hysterectomy

Duk da yake an yi la'akari da tarihin hysterectomy a matsayin magani mai mahimmanci ga fibroids na uterine, sababbin bayanai game da sakamakon hanyoyin da suka dace na hanyoyin kwantar da hankali sun nuna cewa waɗannan na iya zama kama da hysterectomy a hanyoyi da yawa a kan lokaci mai sarrafawa. Rashin lahani na hysterectomy idan aka kwatanta da wasu madadin hanyoyin kwantar da hankali sun haɗa da haɗarin aiki da salpingectomy (idan yana cikin hanyar). Kafin farkon karni, kawar da ovaries biyu tare da hysterectomy wani tsari ne na kowa, kuma babban binciken da aka yi a farkon shekarun 2000 ya nuna cewa kawar da ovaries biyu yana da alaƙa da haɗarin mutuwa, cututtuka na zuciya da jijiyoyin jini, dementia, da sauran cututtuka idan aka kwatanta da ciwon mahaifa da kuma kiyaye ovaries. Tun daga nan, yawan aikin tiyata na salpingectomy ya ragu, yayin da yawan aikin tiyata na hysterectomy bai yi ba.

Nazarin da yawa sun nuna cewa ko da an adana ovaries biyu, haɗarin cututtukan zuciya, damuwa, damuwa, da mutuwa bayan hysterectomy yana ƙaruwa sosai. Marasa lafiya ≤35 shekaru a lokacin hysterectomy suna cikin haɗari mafi girma. Daga cikin waɗannan marasa lafiya, haɗarin cututtukan cututtuka na jijiyoyin jini (bayan daidaitawa ga masu rikice-rikice) da kuma ciwon zuciya na zuciya sun kasance sau 2.5 mafi girma a cikin matan da suka yi amfani da hysterectomy da 4.6 sau mafi girma a cikin matan da ba su yi amfani da hysterectomy ba a lokacin bin tsaka-tsakin shekaru 22. Matan da ke da mahaifa kafin shekaru 40 kuma suna kiyaye ovaries sun kasance kashi 8 zuwa 29 bisa dari sun fi mutuwa fiye da matan da ba su da mahaifa. Duk da haka, marasa lafiya da aka yi wa hysterectomy suna da cututtuka masu yawa, irin su kiba, hyperlipidemia, ko tarihin tiyata, fiye da matan da ba a yi musu tiyata ba, kuma saboda waɗannan binciken sun kasance masu lura, dalili da sakamako ba za a iya tabbatar da su ba. Ko da yake karatu ya sarrafa don waɗannan hatsarori masu haɗari, har yanzu ana iya samun abubuwan ruɗani marasa aunawa. Ya kamata a bayyana waɗannan haɗari ga marasa lafiya la'akari da hysterectomy, saboda yawancin marasa lafiya da fibroids na uterine suna da ƙananan hanyoyi masu haɗari.

A halin yanzu babu dabarun rigakafi na farko ko na biyu don fibroids na mahaifa. Nazarin cututtukan cututtuka sun gano abubuwa daban-daban da ke da alaƙa da rage haɗarin fibroids na mahaifa, ciki har da: yawan cin 'ya'yan itatuwa da kayan marmari da ƙananan nama mai ja; Motsa jiki akai-akai; Sarrafa nauyin ku; Matakan bitamin D na yau da kullun; Nasara raye-raye; Amfani da maganin hana haihuwa; Kuma shirye-shiryen progesterone na dogon lokaci. Ana buƙatar gwaje-gwaje masu sarrafa bazuwar don sanin ko gyara waɗannan abubuwan na iya rage haɗari. A ƙarshe, binciken ya nuna cewa damuwa da wariyar launin fata na iya taka rawa a cikin rashin adalci na kiwon lafiya da ke samuwa idan ya zo ga fibroids na mahaifa.