I- DA! CU'CTNG
3. Hinh thai ton thuong lac no im ac tir cung qua noi soi: xac dinh theo vi trf va mure do t6n th uo ng
a) P h u c mac:
Vi trf hay g a p tui c u n g D ou g l a s , d a y c h a n g tu c u n g c u n g , ho b u o n g tr un g, c u n g c o the tha y o tui c u n g ba ng q u a n g tu c u n g. C ac d a n g t6n t h u a n g tuy theo giai d o a n ton tai. Co the la m a n g , n h u n g d ie m m a u do, n au, ma u so col a, nau, s eo xa . Giai docin s om co hinh anh m a n g t ra ng m a . T h e d a n g viem: p h uc m a c ma t m a u bong, n hi eu 6 lac noi m a c tu c u n g no n, m a u do, giau m a c h m a u , c h a m va o de c h a y ma u . M u o n c h a n d o a n c h i n h x a c phai sinh thiet o lac noi m a c tu c u n g tim noi m a c d a n g hoat d o n g.
b) Ton th u o n g dinh:
Do c o p h a n Ung v ie m ga y nen dfnh, k h o n g k ha c so vai dfnh do n h i l m k hudn. T h u a n g t h a y sau tu c u n g , sau b u o n g t rung lam tir c u n g , b u o n g trufng k h o n g di d o n g . Q u a trinh tao m a n g dfnh: 6 lac noi ma c tir c u n g da c tim do, c h a y m a u tao n en q u a trinh viem sau do tao nen m a n g m o n g , ft m a c h m a u . c a n g ve sau c a n g nhi eu m a n g dfnh day, n h i l u m a c h m a u , m a c noi lan, ruot de n dfnh vao.
c) Ton th u o n g b u o n g trung:
H a y g a p n h a t h a n ca the p hu c ma c. T o n thuo'ng tren be ma t ha y sau t r ong b u o n g tr un g. N h u n g t6n t h u a n g dien hinh t h u a n g a sau, tao n a n g chira di ch m a u d a m d ac n h u dich s o c o l a non g. T h a n h n a n g m o n g , c hi c o m o t l a p te ba o hat vai p h a n u ng viem x un g q u a n h ne n kho b oc ta ch khi p h a u thuat. Tr e n lam s a n g ch dn d o a n p ha n biet voi n a n g h o a n g the k h o n g de.
d) Ton th u o n g vdi Irdng:
Co the ton t h u a n g d o a n gan, xa, b o n g loa voi t h u p h a t sau q u a trfnh dfnh tiSu k h u n g . N i e m m a c ft bi ton t h u o n g h a n . To n t h u a n g voi trufng g a n k h o ly giai. Co the noi m a c tir c u n g c u tru tao polip d o a n ke voi. T 6 n t h u a n g voi trufng xa t h u a n g ket h a p voi tcm t h u a n g ph uc m a c , c u n g c o the n g u y e n phat sau n h i l m k h u a n vai s u di c h u y e n ciia te ba o noi m a c tir c u n g d e n b d m lai.
e) Ton th u o n g sau:
Ton t h u a n g d a n g u c u c t h a m n h i e m vao t h a n h true t ra n g am d ao, c o the a tui c u n g sau.
Ill- DIEU TRj
D i l u tri khi c o trieu c h u n g da u va nghi n g o lien q u a n g ay vo sinh. Co hai p h u o n g p h a p dieu tri c hi nh : noi k h o a va phdu thuat. V i e c lira c h o n p h u a n g p h a p p h au t huat phu t h uo c va o mire do va vi trf ton t h u a n g .
1. Noi k h o a
- D u n g h o r m o n k h a n g e s t r o g e n de lam teo o lac noi m a c tir c u n g tao ne n c a c seo xo.
- P r og es t in lieu c a o lam teo n i e m m a c tu- c u n g , g a y ma t k in h t r o n g thoi gian dai ( gia c o thai). T r o n g t r u o ng h o p c h a y m a u phai t a n g liSu. T a c d u n g phu tang can , ta ng h u y et ap, g ia m c h o l e s t e r o n D H L .
- Danazol: tac d u n g n a m h o a nhe. D u n g 3 vien 2 0 0 m g / n g a y , lien tuc trong 3-6 t h a n g de’ gay mat kinh do thieu n a n g h u o n g s inh d u e va t hieu na ng e s t r o g e n . Bit dau tu n g a y t h u nha t c u a v on g k in h d6 loai trir b e n h nhan co thai ga y hoi churng n a m h o a a thai gai.
- G n R H a n a l o g u e : D e c a p e p t i n , E n a t o n , Z o l a d e x . Sau n h u n g v o n g ki ch thfch n gdn ( Flare - up ) se ga y ire c he c he tiet FSH thieu n a n g e s t r o g e n
Klidng cd anh hudng chuyen hod nhung gdy rdi loan m u o i kliodng n h u ngudi man kinh tu nhien ddn den tai hien lodng xifong, hoc hod. T d c du ng nay m at san ngifng dien tri 6 thdng. T u y nhien gid con dat.
Ta c d u n g dieu tri noi rat tot voi trieu c h u n g dau, co the’ do ngirng d u o c k inh n g uy e t nen o lac noi m a c tir c u n g k h o n g p h a t triSn. T r o n g di6u tri vo s i n h t a c d u n g ga y p h o n g n oa n. Voi lac noi m a c tir c u n g tai b u o n g t r u n g c o t he g i a m rat ft the tich n a n g n h u n g k h o n g mat d u o c nen chi di eu tri bo t r o s au p h a u thuat. Tai o lac noi m a c tir c u n g lam gi a m ro ret p ha n Ung v i e m tai c h o tao seo xo, k h o n g hoat d o n g . K h o n g c o tac d u n g ma t m a n g dfnh.