amakuru

Fibroide ya nyababyeyi ni yo mpamvu itera menorrhagia na anemia, kandi indwara ikaba ari ndende cyane, hafi 70% kugeza 80% by'abagore bazandura fibroide nyababyeyi mu buzima bwabo, muri bo 50% bagaragaza ibimenyetso. Kugeza ubu, hysterectomie niwo muti ukoreshwa cyane kandi ufatwa nk'umuti ukabije wa fibroide, ariko hysterectomie ntabwo itera ingaruka ziterwa na perioperative gusa, ahubwo inongera ibyago byigihe kirekire byindwara z'umutima-damura, guhangayika, kwiheba, no gupfa. Ibinyuranye, uburyo bwo kuvura nka embolisation ya nyababyeyi, gukuramo ibice, hamwe na GnRH yo mu kanwa birwanya umutekano ariko ntibikoreshwa neza.

Incamake y'urubanza

Umugore wumwirabura wimyaka 33 utarigeze atwita yagejeje kumuganga wibanze afite imihango iremereye na gaze yinda. Afite ikibazo cyo kubura fer. Ibizamini byagarutse nabi kuri thalassemia na anemia selile umuhoro. Umurwayi nta maraso yari afite ku ntebe kandi nta mateka y'umuryango ya kanseri y'amara cyangwa indwara zifata umura. Yatangaje imihango isanzwe, rimwe mu kwezi, buri gihe cyiminsi 8, kandi igihe kirekire kidahindutse. Ku minsi itatu yororoka cyane muri buri gihe cyimihango, akenera gukoresha tampon 8 kugeza 9 kumunsi, kandi rimwe na rimwe akagira amaraso. Yiga impamyabumenyi y'ikirenga kandi arateganya gusama mu myaka ibiri. Ultrasound yerekanye nyababyeyi yagutse hamwe na myoma myinshi hamwe nintanga ngore. Uzafata ute umurwayi?

Umubare w'indwara zifitanye isano na fibroide yo muri nyababyeyi ziyongera ku gipimo gito cyo gutahura iyi ndwara no kuba ibimenyetso byayo biterwa n'ibindi bihe, nk'indwara zifungura igifu cyangwa ihungabana ry'amaraso. Isoni zijyanye no kuganira ku mihango zitera abantu benshi bafite igihe kirekire cyangwa ibihe biremereye kutamenya ko ubuzima bwabo budasanzwe. Abantu bafite ibimenyetso ntibasuzumwa mugihe. Kimwe cya gatatu cyabarwayi bafata imyaka itanu kugirango basuzumwe, abandi bafata imyaka irenga umunani. Gutinda gutinda birashobora kugira ingaruka mbi ku myororokere, ubuzima bwiza, ndetse n’imibereho myiza y’amafaranga, kandi mu bushakashatsi bufite ireme, 95 ku ijana by’abarwayi bafite fibroide simptomatique bavuze ko nyuma y’ingaruka zo mu mutwe, harimo kwiheba, guhangayika, uburakari, no guhangayikishwa n’umubiri. Agasuzuguro n'ikimwaro bifitanye isano n'imihango bibuza ibiganiro, ubushakashatsi, ubuvugizi, no guhanga udushya muri uru rwego. Mu barwayi basuzumwe na fibroide na ultrasound, 50% kugeza 72% ntabwo bari basanzwe bazi ko bafite fibroide, byerekana ko ultrasound ishobora gukoreshwa cyane mugusuzuma iyi ndwara isanzwe.

Indwara ya fibroide nyababyeyi yiyongera uko imyaka igenda ishira kugeza igihe cyo gucura kandi ikaba myinshi mu birabura kuruta abazungu. Ugereranije n’abandi bantu uretse abirabura, abirabura barwara fibroide nyababyeyi bakiri bato, bafite ibyago byinshi byo guhura nibimenyetso, kandi bafite uburwayi bukabije muri rusange. Ugereranije na Caucase, abirabura bararwaye kandi birashoboka cyane ko barwara hysterectomie na myomectomy. Byongeye kandi, abirabura wasangaga kurusha abazungu bahitamo kwivuza badateye kandi bakirinda koherezwa kubagwa kugirango birinde amahirwe yo kwandura hysterectomie.

Fibroide yo muri nyababyeyi irashobora gupimwa neza na ultrasound pelvic, ariko kumenya uwo ugomba kwisuzumisha ntibyoroshye, kandi kuri ubu kwisuzumisha bikorwa nyuma yuko fibroide yumurwayi ari nini cyangwa ibimenyetso bigaragara. Ibimenyetso bifitanye isano na fibroide yo muri nyababyeyi birashobora guhura nibimenyetso byindwara ya ovulation, adenomyopathie, dysmenorrhea ya kabiri, hamwe nindwara zifungura.

Kubera ko sarcomas na fibroide zombi zigaragara nkimbaga ya myometric kandi akenshi ziherekezwa no kuva amaraso munda adasanzwe, hari impungenge zuko sarcomas yo muri nyababyeyi ishobora kubura nubwo idakunze kuboneka (1 kuri 770 kugeza 10,000) kubera kuva amaraso adasanzwe). Guhangayikishwa na leiomyosarcoma itaramenyekana byatumye kwiyongera k'umuvuduko wa hysterectomie no kugabanuka kw'ikoreshwa ry'ibitero byoroheje, bituma abarwayi bagira ibyago bitari ngombwa by'ingaruka ziterwa no kutamenya neza sarcoma yo muri nyababyeyi yakwirakwiriye hanze ya nyababyeyi.

Gusuzuma no gusuzuma

Muburyo butandukanye bwo gufata amashusho bukoreshwa mugupima fibroide nyababyeyi, ultrasound pelvic nuburyo buhenze cyane kuko butanga amakuru kubijyanye nubunini, aho biherereye, numubare wa fibroide nyababyeyi kandi birashobora gukuramo imbaga ya adnexal. Ultrasound yo hanze ya pelvic irashobora kandi gukoreshwa mugusuzuma amaraso adasanzwe ya nyababyeyi, misa ishobora kuvuka mugihe cyo kwisuzumisha, nibimenyetso bifitanye isano no kwaguka kwa nyababyeyi, harimo umuvuduko wa pelvic na gaze yo munda. Niba ingano ya nyababyeyi irenga 375 mL cyangwa umubare wa fibroide urenze 4 (ni ibisanzwe), gukemura ultrasound ni bike. Kwerekana amashusho ya Magnetic resonance ni ingirakamaro cyane mugihe hakekwa sarcoma ya nyababyeyi no mugihe utegura ubundi buryo bwa hysterectomie, muribwo buryo amakuru yukuri yerekeranye nubunini bwa nyababyeyi, ibimenyetso byerekana amashusho, hamwe n’ahantu ni ngombwa mubisubizo byo kuvura (Ishusho 1). Niba hakekwa fibroide ya subucosal cyangwa izindi ndwara zifata endometrale, ultrasound ya saline parfusion cyangwa hysteroscopi irashobora gufasha. Kubara tomografiya ntabwo ari ingirakamaro mu gusuzuma fibroide nyababyeyi kubera kutumvikana neza no kubona indege ya tissue.

Mu mwaka wa 2011, ihuriro mpuzamahanga ry’ububyaza n’umugore ryasohoye uburyo bwo gushyira mu byiciro fibroide yo mu nda hagamijwe gusobanura neza aho fibroide iherereye mu cyuho cy’inda ibyara ndetse no mu gice cya serous membrane, aho kuba amagambo ya kera subucosal, intramural, and subserous membrane, bityo bigatuma habaho itumanaho risobanutse neza hamwe n’umugambi wuzuye. Sisitemu yo gutondeka ni ubwoko 0 kugeza 8, hamwe numubare muto werekana ko fibroid yegereye endometrium. Fibroide ivanze na nyababyeyi igaragazwa nimibare ibiri yatandukanijwe na hyphen. Umubare wa mbere werekana isano iri hagati ya fibroide na endometrium, naho umubare wa kabiri werekana isano iri hagati ya fibroide na serous membrane. Ubu buryo bwa nyababyeyi fibroid sisitemu ifasha abaganga guhitamo ubundi gusuzuma no kuvura, kandi bitezimbere itumanaho.

Umuti

Muburyo bwinshi bwo kuvura menorrhagia ifitanye isano na myoma, kurwanya menorrhagia hamwe na hormone zo kuboneza urubyaro nintambwe yambere. Imiti igabanya ubukana bwa anti-inflammatory na acide tranatemocyclic ikoreshwa mugihe cyimihango irashobora kandi gukoreshwa mukugabanya menorhagie, ariko hari ibimenyetso byinshi byerekana ingaruka ziyi miti kuri menorrhagia idasanzwe, kandi ibizamini byamavuriro kuri iyo ndwara mubisanzwe ukuyemo abarwayi bafite fibroide nini cyangwa subucosal. Imisemburo ya gonadotropine irekura imisemburo (GnRH) agoniste yemerewe kuvura hakiri kare mbere yo kuvura fibroide yo munda, ishobora gutera amenorrhea ku barwayi bagera kuri 90% kandi bikagabanya 30% kugeza kuri 60%. Nyamara, iyi miti ifitanye isano ninshi yibimenyetso bya hypogonadal, harimo gutakaza amagufwa no gushyuha. Zitera kandi "steroidal flares" ku barwayi benshi, aho zibitse gonadotropine mu mubiri zirekurwa kandi bigatera ibihe bikomeye nyuma iyo urugero rwa estrogene rugabanutse vuba.

Gukoresha umunwa GnRH antagonist guhuza imiti yo kuvura fibroide nyababyeyi ni intambwe ikomeye. Ibiyobyabwenge byemewe muri Reta zunzubumwe zamerika bihuza umunwa wa GnRH mu kanwa (elagolix cyangwa relugolix) muri tablet compound cyangwa capsule hamwe na estradiol na progesterone, bibuza vuba umusaruro wa ovarian steroid (kandi ntibitera steroid triggering), hamwe na dosiye ya estradiol na progesterone ikora urwego rwa sisitemu ugereranije nurwego rwa folikique. Umuti umwe umaze kwemezwa mu muryango w’ubumwe bw’ibihugu by’Uburayi (linzagolix) ufite dosiye ebyiri: ikinini kibuza igice imikorere ya hypothalamic hamwe nigipimo kibuza rwose imikorere ya hypothalamic, kikaba gisa na dosiye yemewe ya elagolix na relugolix. Buri muti uraboneka mugutegura hamwe na estrogene cyangwa progesterone. Ku barwayi badashaka gukoresha exogenous gonadal steroid, formuline nkeya ya linzagolix itongeyeho hongeweho steroide ya gonadal (estrogene na progesterone) irashobora kugera ku ngaruka imwe nki misemburo ikabije irimo imisemburo ya exogenous. Ubuvuzi hamwe nubuvuzi bubuza igice hypothalamic imikorere irashobora kugabanya ibimenyetso ningaruka zigereranywa na dose yuzuye ya GnRH antagonist monotherapy, ariko hamwe ningaruka nke. Kimwe mu byiza byo kwivuza cyane ni uko ishobora kugabanya ubunini bwa nyababyeyi neza, ibyo bikaba bisa n'ingaruka za GnRH agoniste, ariko hamwe nibimenyetso byinshi bya hypogonadal.

Igeragezwa rya Clinical data ryerekana ko umunwa wa GnRH urwanya antagonist ufite akamaro mukugabanya menorrhagia (kugabanuka 50% kugeza 75%), kubabara (kugabanuka 40% kugeza 50%), nibimenyetso bifitanye isano no kwaguka kwa nyababyeyi, mugihe bigabanya gato ubwinshi bwa nyababyeyi (hafi 10% kugabanuka kwa nyababyeyi) hamwe n'ingaruka nke (<20% byabitabiriye bahuye nubushyuhe bukabije, kubabara umutwe), no kubabara umutwe. Ingaruka zo kuvura umunwa GnRH antagonist ivura ntizigengwa nubunini bwa myomatose (ingano, umubare, cyangwa aho fibroide iherereye), ubufatanyacyaha bwa adenomyose, cyangwa izindi mpamvu zibuza kuvura kubaga. Umunwa wa GnRH urwanya antagonist ubu wemejwe amezi 24 muri Reta zunzubumwe zamerika no gukoreshwa igihe kitazwi mu muryango w’ubumwe bw’ibihugu by’Uburayi. Nyamara, iyi miti ntabwo yagaragaye ifite ingaruka zo kuboneza urubyaro, igabanya imikoreshereze yigihe kirekire kubantu benshi. Igeragezwa rya Clinical risuzuma ingaruka zo kuringaniza imbyaro zo kuvura relugolix rirakomeje (nimero yo kwiyandikisha NCT04756037 kuri ClinicalTrials.gov).

Mu bihugu byinshi, modulators ya progesterone yatoranijwe ni ibiyobyabwenge. Nyamara, impungenge zuburozi bwumwijima budasanzwe ariko bukomeye bwagabanije kwemerwa no kuboneka kwimiti nkiyi. Nta modulatrice yatoranijwe ya progesterone yemewe muri Amerika kugirango ivurwe fibroide nyababyeyi.

Hysterectomy

Mugihe amateka ya hysterectomie yafashwe nkumuti ukabije wa fibroide nyababyeyi, amakuru mashya kubyavuye mu buvuzi bukwiye bwerekana ko ibyo bishobora kuba bisa na hysterectomie muburyo bwinshi mugihe cyagenwe. Ibibi bya hysterectomy ugereranije nubundi buryo bwo kuvura burimo ingaruka ziterwa na perioperative hamwe na salpingectomy (niba biri mubikorwa). Mbere yikinyejana cyatangiye, kuvanaho intanga zombi hamwe na hysterectomie byari uburyo busanzwe, kandi ubushakashatsi bunini bwakozwe mu ntangiriro ya 2000 bwerekanye ko kuvanaho intanga zombi byari bifitanye isano no kongera ibyago byo gupfa, indwara zifata umutima, indwara zifata umutwe, n'izindi ndwara ugereranije no kugira hysterectomie no gukomeza intanga ngore. Kuva icyo gihe, igipimo cyo kubaga salpingectomy cyaragabanutse, mu gihe igipimo cyo kubaga hysterectomie kitigeze.

Ubushakashatsi bwinshi bwerekanye ko nubwo intanga zombi zabitswe, ibyago byo kurwara umutima nimiyoboro y'amaraso, guhangayika, kwiheba, ndetse no gupfa nyuma ya hysterectomie byiyongera cyane. Abarwayi ≤35 yimyaka 35 mugihe cya hysterectomie bafite ibyago byinshi. Muri aba barwayi, ibyago byo kwandura indwara zifata imitsi (nyuma yo guhindura imvururu) no kunanirwa k'umutima byikubye inshuro 2,5 ku bagore batewe na hysterectomie ndetse no hejuru ya 4,6 ku bagore batigeze baterwa na hysterectomie mu gihe cyo gukurikirana hagati y’imyaka 22. Abagore barwaye hysterectomie mbere yimyaka 40 bagakomeza intanga zabo bashobora gupfa 8 kugeza 29% kurusha abagore batigeze barwara hysterectomie. Icyakora, abarwayi bari barwaye hysterectomie bari bafite ibibazo byinshi, nk'umubyibuho ukabije, hyperlipidemiya, cyangwa amateka yo kubagwa, kurusha abagore batigeze baterwa na hysterectomie, kandi kubera ko ubwo bushakashatsi bwakurikiranwe, impamvu n'ingaruka ntibishobora kwemezwa. Nubwo ubushakashatsi bwagenzuye izi ngaruka zishobora kubaho, hashobora kubaho ibintu bitavuguruzanya. Izi ngaruka zigomba gusobanurwa kubarwayi batekereza hysterectomie, kuko abarwayi benshi bafite fibroide nyababyeyi bafite ubundi buryo butagaragara.

Kugeza ubu nta ngamba zibanze cyangwa izisumbuye zo gukumira fibroide nyababyeyi. Ubushakashatsi bw’ibyorezo bwerekanye ibintu bitandukanye bifitanye isano no kugabanuka kwa fibroide nyababyeyi, harimo: kurya imbuto n'imboga nyinshi n'inyama zitukura; Imyitozo ngororamubiri buri gihe; Igenzura ibiro byawe; Urwego rwa vitamine D isanzwe; Kubyara neza; Gukoresha uburyo bwo kuboneza urubyaro; Kandi imyiteguro ndende ya progesterone. Ibigeragezo byateganijwe birakenewe kugirango hamenyekane niba guhindura ibyo bintu bishobora kugabanya ingaruka. Hanyuma, ubushakashatsi bwerekana ko guhangayika no kuvangura amoko bishobora kugira uruhare mukarengane k'ubuzima kabaho mugihe cya fibroide nyababyeyi.