U xo tu cung
Hdf: Tdi di kham sdc khde djnh kjf, ph^t hidn cduxdtO cung kk^ thudc 1cm x 1,2cm. Xin cho bi& tinh trang cd nguy hiSm khdng? Cach diSu tn ra sao? Cd inh hudng dSn viec mang thai hay khdng?
TrUdng Thj Hong Ph.
DAP; U xtf td cung la khtfi u lanh tinh d td cung, thudng gap d phu nd trong do tuoi sinh de, td 30 - 50 tutfi. Yeu ttf chinh i n h hudng dtfn sU phdt tritfn eua khtfi u xtf td cung Id tinh trang titft estrogen - la mtft ntfi titft ttf sinh due do b u l i ^ trdiig titft ra, se thuc diy khoi u phat trien. Thtfng thudng, u xtf ctf khuynh hudng to Idn td td, dac bidt se to ra nhanh trong khi mang thai va eo khuynh hudng nho lai khi vdo tutfi man kinh (do Iddng estrogen do cd thtf titft ra tang eao trong thai ky va giim xutfng khi man kinh).
Hi?n nay, khuynh hddng dilu tri u xtf td eung Id ehi giii quytft khtfi u khi ctf bitfn chdng hay khi anh hddng dtfn kha ndng sinh san. Nguydn tac dilu tri Id liy di khtf^i u, c6 the d l lai td cung hay cat td cung tuy theo ngddi bdnh ctf mutfn sinh con hay khong hoac tinh trang khtfi u.
Cde budc diiu tri u xtf td cung gom:
- Theo doi: khi khtfi u eon nho vd ehua gdy anh hudng ^ cho ngudi b?nh. Viec khdm dinh ky 3 thang/
l i n se eho phep theo doi td'c dd phdt trien cua u vd phdt hien bitfn chdng (neu co). Khi co edc tridu chiftig, ctf thtf dung thutf^c dilu tri tridu ehdng nhU thutfc giam dau non-steroids hoac paracetamol, dilu tri rong kinh..
- Biiu tri hang thud'c Id cac loai npi t i l t ttf sinh due, dUa vdo ctf the ngUdi benh dtf gdy dc che rung trdng, buong trdng tam thdi khong tie't estrogen, nhdm Iam cho khtfi u nhd lai (gitfng nhd tinh trang man kinh). Sau khi ngitog thuo'c, butfng trdng se Iam
Ndi soi Idng tO cung
vi$c trd lai va khtfi u titfp tuc phdt tritfn. Ddy Id cdch diiu tri tam thdi nham ldm gidm kich thudc khtfi u dtf de dang phau thudt sau do. Tuy nhitfn, thutfc cung Idm eho ngudi bdnh ctf nhdng bitfu hidn gitfng man kinh nhu btfc htfa, t r i m cam, khd ngd, dau khdp, gidm tinh due. Cac Ioai thutfc khdng hormon (mifepriston)iCung etf thtf ldm chdm sU phdt tritfn cua u. T i t c i nhi2ng Ioai thutfc ke trdn chi tam thdi Iam giim tridu chdng eua u xd, hoac Idm ch^ra sd phdt t r i l n cua u xo, kbi ngddi btfnh ngung dilu tri, u xd se phdt tritfn tid l^i.
- Dieu tri phau thuqt cd nhilu dang. Bdc nhdn xa td cung Id chl btfc khtfi u xtf vd d l td cung lai. PhUdng phdp nay dp dung cho nhdng phu nd ctfn trd, ctfn c6 nhu ciu sinh d l . PhSu thudt cdt tH cung bdn phdn hay todn phdn. Ngay nay, khuynh hudng cdt tH cung bdn phdn vdi muc dich de lai mtft p h i n etf td eung khtfng ctfn duoc Ua ehutfng, do vide d l lai ctf t^ cung CO the gdy viem nhilm hay ung thu etf td cung sau ndy. Vide liy di buing trdng khi phiu thudt cdn tiiy vao dtf tutfi cua btfnh nhdn. Ntfu bdnh nhdn cdn trd, se de lai buong trdng, nham duy tri n^i titft ttf sinh due nd, khtfng gdy ra tinh trang man kinh qud sdm.
Cdt ta cung todn phdn la phUdng phdp dilu tri tri§t de u xtf td cung, ddnh cho nhitog bdnh nhdn ctf u xcr to, cudng kinh hodc rong kinh dd dpi, g i n hodc da vio tutfi man kinh, khtfng etf nhu ciu sinh con. Cd nhilu each de c i t td eung: c i t td eung qua dUdng m l bung, cat td cung qua ntfi soi hoac qua nga am dao. Phiu thu^t duoc chi dinh khi u xtf to htfn td cung ctf thai 12 tuin, khi u xtf gay bitfn ehdng chdn dp ed quan ldn cdn, khi u xtf gay dau nhieu, kinh nhilu hodc thitfu mdu, hoac nghi ngd dc tinh. Khi khtfi u qud to se khd phiu thudt vi ctf thtf gdy ttfn thUtfng ctf quan Ifin ctfn nhu ddt nitfu quin, rdch bdng quang, r i c h trt^ trdng.
- Ap dinh ngi mgc tu! cung: ddng dung cu sinh nhitft phd huy ntfi mac td cung. PhUtfng phdp ndy dp dung cho nhitog tniitng hdp u xtf dddi nitfm mac gfiy rong kinh rong huytft vd khdng ctf nhu ciu sinh dd.
THUOC & SCfC K H 6 E stf 498 (15.4.2014)
Durt km gan got
•» BS. N G U Y I N HUY T O A N
B
tfnh nhdn Nguyin Thi O.56 tutfi, trong mtft buoi di tdp t h i due butfi sdng bi trd^t chdn td chin thuong vung ctf chdn trdi, gtft chdn cua cd bi n i p ctfng ddp vdo. Btfnh nhdn dtfn cip cdu dUdc khdm, eho chup X quang khtfng t h i y dau hitfu bat thudng ntfn htfi chtfn vdi chuytfn khoa chin thUtfng chinh hinh. Qua htfi bdnh sd vd thdm khdm, chung ttfi ghi nhfin b§nh nhan ctf diu hi^u lom m i t sau CO chan trdi, vung gan gdt, khi bdp vdo ctfng chdn - vimg ctf bung chdn, btfnh nhdn ctf cdm gidc dau chdi vdng gtft. T i t cd diu hitfu gtfi ^ b$nh nhdn hi ddt gdn gdt. Btfnh nhdn khtfng t h i tin Id chi mtft chin thUtfng dtfn gidn md minh bi ddt gdn gtft vd khdng ctf
diu hitfu b i m tim ndo. Chung tdi thUc hitfn nghidm phdp Thompson d l chin dodn, so sdnh cd 2 chfin cho b#nh nhan vd ngudi nhd cung vdi vitfc gidi thich phdi mo de khdu ntfi lai gdn gtft. Trong mtf ghi nhfin gdn gtft bi ddt hodn todn.
Ddt kin gan got Id mdt chdii thUtfng thudng gdp khi gan dang cdng do dtfng tde dudi co cban md bi mtft vdt c6 canh td ddp vdo vung gtft. Lue mdi chin thUdng vung ndy tri$u chdng thudng kin dao do khdng c6 vtft triy sudc hay vtft b i m do mdu tu, do dd dl hi bo sdt hodc nhJTn lin vdi cac chin thUtfng bong gfin viing ctf chdn. Gdn gtft Id mtft trong nhdng gan Idn n h i t cua ctf thtf, c6 vai trd dfic bi§t quan trpng trong dpng tdc chay nhdy, vi vfiy
Nghidm phdp Thompson
Ddt gdn gdt ho^n todn khi bi ddt se i n h hddng r i t nhilu dtfn sinh boat cua ngddi b$nh.
Dtf chin dodn ddt gdn gtft c6 nghidm phdp Thompson, dUtfc thdc hien bang edeh eho bdnh nhfin ndm sip, nhic chdn khtfi mdt bdn.
Ngdtfi khdm htfp vdo khtfi etf bung chdn (vung mdt sau cing chdn), binh thddng tbi bdn chdn s6 bi kdo gfip xutfng, kbi ddt gdn gdt thi bdn chdn m i t d$ng tdc ndy, ding thdi ngudi b0nh cam thiy dau chtfi quanh vung gtft chdn.
Ntfu ddt gdn gdt hi bd sdt sau 3 - 4 tuin thi gdn hi eo rdt, khtf hode khdng thtf khdu gdn lai nhu cii. Khi dd phii sd dung phUtfng phdp chuyin gdn hodc keo ddi gdn gdt vdi dudng mtf Idn vd phdc t^p htfn nhilu. 3^
- ThuySn tdc d^ng mgch tiC cung qua da. Tai P h i p , thuytfn t i c mach m i u nu6i u xd td cung da trd thdnh mtft k? thufit phtf bitfn, thay the cho phiu thufit c i t td cung hodc btfc u xo. Ld phddng phdp ddng thutfc tidm vdo dtfng mach td cung hai bdn gdy t i c nhitog nhdnh mach mdu nudi u xd td cung. Thu thudt dd^c thi/c hitfn dddi chyp dtfng mach lien tuc - ky thufit chi^p mach mdu xda n i n (DSA). Sd dung mot catheter dua vdo dtfng mach ben, hddng dtfn dtfng m^ch td cung, xdc dinh vi trf mach mdu cua khtfi u vd tilm c h i t polymer ttfng hdp (nonabsorbable) vdo. Thu thufit kdo ddi khoing mOt gid. Ngay sau khi can thitfp vd trong cdc tuin titfp theo, kich thude ciJa u xtf td cung gidm d i n theo thdi gian. Cdc tri^u chdng thuydn giim nhanh chtfng trddc khi u xtf giim kich thddc.
M^t Uu diim khdc: Thdi gian hii phuc ngin hdn, ft md't mdu hun so vdi phSu thufit. Btfnh nhdn ctf thtf THI i d r . ^ J C KH<^F- atf d08 (1 S d 2014)
xuit vitfn trong ngdy sau khi thdc hi^n thii thudt.
Mtft so nghitfn cdu gin ddy cho thtfy ty I? tdi phdt u xd r i t thtfp, PhUdng phdp thuygn t i c mach mdu ndy dUtfc chi dinh trong ede trUdng hdp: u xd td cung gfiy cudng kinh; u xd td cung gdy dau, chdn dp bdng quang, true trdng; b^nh nhfin khtfng mutfn phau thufit; btfnh nhfin khdng cd nhu ciu sinh con.
Cdch nay bi ban chtf khi u xd td eung da nhdn.
Tinh trang dau, stft do khoi u hoai td c6 thtf gdy philn todi cho bpnh nhdn. Mpt stf trUdng hop nhilm trimg ctf thtf khtfng chtf bing khdng sinh. NgUdi b^nh cd k h i ndng bi m i t kinh mpt thdi gian sau khi du^c dp dung bitfn phdp ndy, do tinh trang mdu dtfn nudi td cung hi i n h hudng sau thu thudt. Mtft so trudng hgp c6 nhdng hat thutfc nhtf theo mach mdu di vdo vd gdy tic dtfng mach buong trdng, ldm mat chdc ndng budng trdng tam thdi hode vinh viln.
-•BS. C A M V I £ N
