I-Asherman's Syndrome: Izizathu, iziganeko, Inkcazo, Ukuxilongwa kunye noNyango

Ukungabi nabantwana emtshatweni ngumnye weengxaki ezibalulekileyo zentlalo. Iingcali zenzululwazi ziye zabonisa indima elinganayo yabazali ngamnye abanakho kwisisombululo esingafezekanga kule ngxaki. Nangona kunjalo, ukuzala komntwana kunye nokuhanjiswa kuthathwa kumahlombe kamama. Ukufezekisa le mi sebenzi kunokwakheka komzimba wesifazane kuphela. Kwiminyaka embalwa edlulileyo kukho ukwanda kwimiba yokuzala, eyaphinde ikhuphe ukungasebenzi. Elizweni lethu, isikhundla esiphambili siyi- endometritis esingapheliyo. Enye yeembonakalo zayo ngu-Asherman's syndrome. Ngaba ukukhulelwa kunokwenzeka na kwesi sifo?

Inkcazo ye-pathology

I-Asherman syndrome iyaqondwa njengesimo se-pathological, ngenxa yokokuba iifiksi ifom. Bakhokelela ekuhlaseleni ngokukodwa okanye ngokugqibeleleyo kwesigxina sakhe. Esi sifo safumana igama layo ngegama lomfazi wesifo somzimba uJoseph Asherman. I-syndrome yaqale ichazwa ngokucacileyo ngowe-1894 nguHenry Fritsch. Kwincwadi yoncedo lwezokwelapha kukho amagama amaninzi aloo mzimba: i-intrauterine synechia, i-atrophy ephazamisayo kunye ne-sclerosis ye-endometrium.

I-Asherman's syndrome ifunyanwe kubasetyhini kungakhathaliseki ukuba bebudala nobume bentlalo. I-synechiae ye-intrauterine i-fusion tissue fusion, edibanisa kunye neendonga zelungu kwaye ibangele i-deformation yabo. Ngenxa yenkqubo ye-pathological, iintlobo ezininzi zeengxaki ziphuhliswa ezikhokelela ekuphazamiseni imisebenzi yokuya esikhathini. Iimpawu eziphambili ze-syndrome zibonakaliswa ngendlela yokukhupha ngokukhawuleza nokungabikho komntwana.

Kuthetha ukuthini inani lokusasazeka kwesi sifo? Emva kokuhluthwa kwabasetyhini ababelethayo, ingozi yokuphuhlisa i-syndrome yi-25%. Ngokukhulelwa okukhukhulayo, amathuba okubambelela kunye kunye nama-akhawunti angama-30%. Ngokuqhelekileyo ukukhulelwa komzimba ngokuqhelekileyo akunakubeka ingozi kwimpilo yowesifazane. Kule meko, umngcipheko wesifo awufihli ngaphezu kwe-7%.

Izizathu eziphambili

Isibeleko sisisigxina se-muscular. Ngaphandle, ihlanganiswe ne-peritoneum. Ukusuka ngaphakathi kuhlanganiswe ne-endometrium, equlethwe ngamacwecwe amabini-esebenzayo kunye nesiseko. Ngokuxhomekeka kwisigaba sesigxina sokuya esikhathini kwaye phantsi kweempembelelo ze-hormone zesondo, i-endometrium ihamba ngokutshintshwa kwintshukumo. Ngokusondele kumzuzwana we-ovulation, xa amathuba okukhulelwa komntwana ephakamileyo, i-uterus mucous ikhula. Kwimimandla ye-endometrium, ukuveliswa okusebenzayo kwezinto eziphilayo ezisebenzayo zenzeke. Emva kokuqumba kwesoqanda, lingena kwisibeletho, apho kufakwa khona ukufakelwa. Uqhagamshelwano lweembrom ebombrane kunye ne-endometrium enempilo yimeko esemgangathweni yokuphumelela kombono. Ukuba ukuchumisa akunakwenzeka, uluhlu olusebenzayo lunqatshelwe, njengoko kubonakaliswe yenyanga. Ngokuqala komjikelezo ngamnye, i-endometrium ikhula kwakhona.

I-synechia yilapho iphuma okanye ibambelela kwinqanaba elingaphakathi lesisu, ephula i-physiology ye-membrane. I-Asherman's syndrome iqala ngenxa yokulimala okanye ukuxakeka kwi-basal layout ye-endometrium ngexesha leenkqubo zengqondo. Oku kunokutshitshiswa emva kokukhipha isisu, icandelo lesahara okanye nayiphi na into yokuhlinzwa. Esinye isizathu esiqhelekileyo sesi sifo ngu-endometritis. I-Synechia ibunjwa ngokusesikweni semininzi ye-inflammation kwi-uterine mucosa.

Umfanekiso weklinikhi yesifo

Iimpawu zesifo zibangelwa yinkqubo yokubambelela kunye nempembelelo yayo kwinkqubo yokuzala. Phakathi kwabo kukho oku kulandelwa rhoqo:

• Ukungasebenzi kwimihla (ininzi / ukukhulelwa kancinci, isifo esibuhlungu kakhulu);
• Ukutshatyalaliswa kokutshatyalaliswa kokukhulelwa ;
• Nciphisa kwinani kunye nobude bexesha lokuya esikhathini;
• Ukungabikho koluntu;
• Ukuqokelela kwegazi kwi-uterine cavity.

Ziziphi ezinye iimpawu uAsherman analo? Esi sifo sihlala sihamba kunye ne-endometriosis yobunzima obuhlukahlukeneyo. I-Pathology ibonakaliswe ngokukhula kwe-ectopic yecala lokusebenza le-endometrium, elidlula ngaphaya kwesigxina se-uterine. Ukudibanisa okunjalo kuphazamisa ukuxela kunye nethuba lokunyanga.

Izidanga ezintathu zokunqongophala

Ukunikezelwa komonakalo kumgca we-basal we-endometrium, oogqirha bacebisa ukuhlulwa kwesifo se-Asherman:

• Isiqulatho sokukhanya (ukunamathela akuhlali ngaphezu kwe-25% yomsindo wesibeleko, ukutshabalaliswa ngokukhawuleza xa kwenzeka umonakalo osebenzayo);
• Isiganga esiphakathi (i-fusions idibene ngokugqithiseleyo kwi-uterine mucosa);
• Isiganga esinamandla (ukuxhamla kubandakanya ikakhulukazi izicubu ezixubileyo, vimba umlomo wezibilini ze-uterine kunye nezantsi kwelungu).

Ukuzimisela ngokukhawuleza kwinqanaba le-pathological process kuvumela ukukhawuleza ukuphilisa i-Asherman's syndrome.

Ngaba ukhulelwe?

Ubungqina boogqirha bubonisa ukuba amathuba okukhulelwa umntwana esi sifo kuxhomekeke kwizizathu kunye nesigaba. Ngesifo se-Asherman, inkqubo yokuzala ichaphazeleka kakhulu. Iindonga zesibindi zihlangene kunye, ukuphulwa kwefuthe lemibhobho. Ngenxa yoko, i-embryo ayikwazi ukufakwa. Ukongezelela, i-endometrium ilahlekelwa yikhono layo lokuphendula kwishintsho kwiimpawu ze-estrogen. Ngokukhawuleza ikhula ukungabikho komntwana, kwaye kunye ne-amenorrhea. Iipiksi kwingingqi yesibeleko zikhupha ukudibanisa kunye nokulibaziseka ekuhambeni kwexesha. Ukuphazamiseka komjikelezo ngokuqhelekileyo kubonisa izinga elibi lokugula. Ukukhulelwa kungokwemvelo ukuba kunokwenzeka ukuphilisa i-Asherman's syndrome ngexesha elifanelekileyo.

I-IVF inokwenzeka? Iingxelo zonyango ziqinisekisa ukuba i-vitro fertilization iyangqiqo xa eso sifo sisesigaba sokuqala sophuhliso. Kule meko, inani lokubambelela alinakugqithisa u-25% wevolumu yesisu, kufuneka ukuba ibekwe kwindawo engqinqiweyo.

Akunakwenzeka ukunika impendulo enye kwimibandela echazwe, kuba nganye imeko iyodwa. Ngokuxhomekeke kubukhulu benkqubo ye-pathological, kukho iindlela ezininzi zokuba ukhulelwe. Kwamanye amabhinqa, ukuzala akubangele iingxaki ezihambelanayo, ngelixa kwezinye zihamba neengxaki ezininzi. Inokwenzeka kwaye yesithathu inketho - ukukhupha isisu, ukuphazamiseka kwamathambo, ukungabikho komntwana. Yingakho bonke abesifazana bamele bahlolisise impilo yabo, bahlaziywe rhoqo nge-gynecologist, baphathe ngokukhawuleza zonke izifo.

Uvavanyo lwezoNyango

Ukuxilonga eso sifo, iindlela zokusebenzisa izixhobo zisetyenziselwa ukujonga ngeso lengqondo umtya wesifo. Ngokwegunya elifanelekileyo, ugqirha uhlola i-obstetric anamnesis yesigulane (inani lokukhulelwa, ukukhupha izisu, ukukhulelwa komzimba, njl.). I-ultrasound ithathwa njengeyona nto ifumaneke kakhulu kwaye ngexesha elifanayo indlela encinci ye-invasive yokuxilonga izitho zeplavic. I-Asherman's syndrome kwi-ultrasound inokuqinisekiswa, kodwa ukufumana iziphumo ezichanekileyo kuyimfuneko ukuphinda inqubo yezihlandlo eziliqela ngexesha lojikelezo.

I-Hysteroscopy ithathwa njengomgangatho wegolide wokuchonga i-synechia. Uhlolisiso olunjalo lwesigxina se-uterine lithetha ukusetyenziswa kwezixhobo ezikhethekileyo. Ijoyiwe ngomsele wentsholongwane, ukwenzela ukuba imeko yelungu ingahlolwa ngexesha langempela kwikhompyutheni yekhompyutha. I-Hysteroscopy ikuvumela ukuba unqume ubunzima beenkqubo zentsholongwane, ubungakanani kunye nendawo yokubambelela. Iziphumo zoviwo olupheleleyo lwesigulane kufuneka zidibaniswe ne-obstetric anamnesis kunye nemizame yangaphambili kunyango. Le ndlela isenza sikwazi ukuxela kwangaphambili ukuguqulwa kwamathambo.

Izindlela zokonyango

Isifo sobunzima obuphakathi nobunzima singaphathwa kakuhle. Ukuqulunqwa kweendlela zokukhubazeka nokukhulelwa akuhambelani. Kule meko, umama oza kuzalwa uya kuhlangulwa. Xa ukuxhaswa kwindawo ephantsi kwendawo yokugcina i-uterine, indlela ye-IVF inceda. Nangona kunjalo, kule meko, akubona bonke abafazi abanokuxilongwa "I-Asherman's syndrome" inokuzama inxaxheba kumama.

Unyango lubandakanya ukususwa kokubambisana kwindlela yokwenza i-hysteroscopy. Ukusebenza akudingi i-anesthesia jikelele, akukho zixazululo. Ngokwenene, le yinkqubo enzima kakhulu. Ukususwa kwe-synechia kwenziwa nge-micro-scissors ngenxa yokuba kunokwenzeka kakhulu ukulimala kwakhona. Kwixesha elilandelelweyo, unyango lwe-antibiotic lubekwe ukuba lukhusele iingxaki ezithintekayo. Ulwaphulo lwezonyango kufuneka luncediswe ngoncedo lwe-hormonal. Ukusetyenziswa kwe-estrogens kunye neprogesin kuboniswe ukukhuthaza ukukhula kwe-endometrium.

Forecast

Ngomlinganiselo omnene we-pathological process kunye nokunyangwa kwexesha elifanelekileyo, ukukhulelwa kubonakala kwi-93% yezigulane, nge-78% kuphela. Ulwaphulo olufanelekileyo lwabasetyhini abanefomu eliphambili le sifo lenza ukuba kube nokukhulelwa komntwana kwi-57% yamatyala. Nangona kunjalo, ukukhulelwa okuphumelelayo kunye ne-Asherman's syndrome akuqinisekisi ukuzalwa komntwana ngaphandle kweentsholongwane. Ubudala bezigulane kwakhona kuthethwa ngqalelo kwi-prognosis. Ngokomzekelo, i-66% yezigulane ezingaphantsi kweminyaka engama-35 ezine-diagnostic syndrome ezinokuthi zikwazi ukukhulelwa. Ngesondo esilungileyo ngaphezu kweminyaka engama-35, eli nani lingabi ngaphezu kwama-24%.

Amanyathelo okukhusela

Ngaba kunokwenzeka ukukhusela i-Asherman's syndrome? Ukucima okanye ukufunwa ngophulo - ezi zimbini iinkqubo zenziwa ngutitshala ngokuzenzekelayo, ngokuthembela kuphela kumava abo. Izicubu ze-Endometrial ngexesha lokukhulelwa libuhlungu, ngoko kuya kuphazamiseka lula. Ngenxa yoko, naluphi na ukuxilongwa okanye unyango lwezokwelapha luhlala luhamba kunye nexinzelelo kumgca we-basal.

Enye indlela kule nkqubo yokulahlekelwa ngamathambo yikhupha isisu. Kuthetha ukukhuthazwa kwabasebenzi ngokusebenzisa ukusebenzisa amayeza. Nangona kunjalo, ukuphumelela kwale ndlela kungama-80% kuphela. Kwi-10% yamatyala emva kokukhipha isisu, ukusuleleka kweembrane kuphawulwa, okufuna ukutshitshiswa. Ngaloo ndlela, ukukhusela i-Asherman's syndrome inokwenzeka, ukuba ngenxa yezizathu zonyango ukhetha ukukhipha isisu. Ngakolunye uhlangothi, le nkqubo ayinikezeli isiqinisekiso esingu-100% sesiphumo esihle.