Phakathi kweengxaki zokukhulelwa kwezigaba zokuqala zokukhupha isisu ngenye yezophulo eziqhelekileyo. Kwenzeka ngo-1.5-2% wokukhulelwa konke. Izigaba zokuqala zibonakaliswa ngokungabikho kwezibonakaliso, ngoko ulwaphulo lufunyaniswa kwiveki yesihlanu ukuya kweyesithandathu.
Ukukhulelwa kombhobho - izizathu
Xa ukukhulelwa kwe-tubal kukhula, ukuphuphuma kwesisu akuphepheki. Ngokufakela i-ectopic yeqanda, ifa ngexesha, elikhokelela ekufeni komntwana ozayo. Kwiimeko ezininzi, i-pathology iyaqhubeka ngenxa yokuphazamiseka kwindlela yokuthuthwa kweqanda elichumayo. Uhlobo oluthile olubizwa ngokuba yi-blastocyst lusetyenziswe ngokugqithiseleyo lunokuthi lwenzeke - kwelinye lamanyathelo okuhlukana kweqanda lomntwana, ukuqaliswa kwalo eludongeni lwe-tube uterine luqala. Phakathi kwezimbangela eziphambili zolu daba, oogqirha bajonga amaqela amanqaku eempawu:
1. I-Anatomical and physiological:
- iinkqubo ezivuthayo kwizitho zangasese zangaphakathi, eziphambene nobuchule beethubhu: ukunamathela, izibambiso, iipokotshi, ukuphulwa komsebenzi wesivumelwano;
- ukutyalwa kwentsholongwane (ukubhobhoza);
- ukusetyenziswa kwemimoya ye- intrauterine ;
- imisebenzi kwizitho zangasese;
- izicubu zee-appendages kunye nesisu;
2. Izinto zeHormonal:
- ukuphulwa komthetho wee-ovari ngenxa yokungalingani kwenkqubo ye-hypothalamic-pituitary;
- ukuphulwa kwe-prostaglandin;
- ukusetyenziswa kwee-contraceptive ze-hormonal;
3. Ukwandisa umsebenzi we-biological of egg fetal - isantya esiphuthumayo se-trophoblastoglyco kunye ne-proteolytic enzymes, ezibangele iinkqubo zokufakelwa.
4. Ezinye izinto:
- endometriosis ;
- ukungabikho komntwana okwenzelwe ngumntwana;
- iimpazamo ekuphuhlisweni kwamathambo;
- umgangatho ompofu wesilisa;
- imeko ezixinzelelekileyo kunye nokukhathazeka kwengqondo.
Ukukhulelwa kombhobho - iimpawu
Ngexesha elide, ukukhubazeka akuzivezi, ngoko ke ukukhulelwa kwe-tubal, imiqondiso ebonisiwe apha ngezantsi, idlalwa rhoqo kwisigaba sokukhupha isisu - ukukhishwa kweqanda lomntwana. Phakathi kweempawu ezibonisa ukuphulwa okungenzeka:
- Ukuphuma kwegazi kumfazi, ubuhlungu bexesha elide kwicala lomlingisi wokudonsa;
- kuncipha kwinqanaba leHCG egazini;
- utshintsho kwisiphumo sokuvavanya ukukhulelwa (okokuqala kulungile, koko kungenanto).
Isikhathi sokuphazamiseka kokukhulelwa kwe-ectopic
Ukuphazamiseka kokukhulelwa kwe-ectopic kwimimiselo yokuqala kubangelwa ukungakwazi kweqanda lomntwana kwiindawo eziqhelekileyo kwisigxina se-tube. Kukho ukukhupha isisu ngokuphindaphindiweyo kwiiveki ezi-5-6, umhla wokugqibela uthathwa njengeyonto e-10. Ukugqithisa eli xesha kubangele iingxaki ezininzi ezichaphazela impilo yabasetyhini:
- ukuphuma kwegazi kwangaphakathi;
- ukuphuka kwiphubhu ye-uterine;
- ukungabi nantoni kwixesha elizayo.
Yisiphi isilongo sokukhupha isisu?
Izibonakaliso zokuphulwa kokukhulelwa kwe-ectopic zivela rhoqo kwiiveki ezi-4-8. Ngamaxesha athile umfazi ufunda malunga nokuphulwa. Ukuphazamiseka kokukhulelwa kwe-ectopic kubakho ngokukhawuleza njengokukhupha isisu. Ngenxa yokunyuka kwe-peristalsis yamathambo e-fallopian, iqanda le-fetal lixoshwa kwaye lixoshwa kwi-uterine cavity. Ukukhupha isisu kuhamba kunye negazi, ngoko kulula ukuchonga.
Kwezinye iimeko, ukuthunjwa kwenzeka kwindlela eyahlukileyo - kwisigxina se-peritoneum. Kule meko, kukho iindlela ezimbini ezikhoyo zokuphuhlisa imeko:
- ukufa kweqanda lomntwana;
- ukufakelwa kwelinye lamalungu okanye izakhi zesisu esiswini kunye nokuphuhlisa okuqhubekayo kokukhulelwa (kunqabile kakhulu).
Ukuphuphuma kwesisu sikaTubal - iimpawu
Ukukhulelwa kwe-tubal nokukhulelwa kwe-ectopic kudla rhoqo. Kule meko, imeko yesigulane kunye nomfanekiso wekliniki kuxhomekeke kubukhulu belahleko yegazi. Phakathi kwezikhalazo eziphambili ezenziwe ngabasetyhini abane-ectopic pregnancy, kubalulekile ukuhlula:
- Ukukhathazeka kwisisu esisezantsi. Iintlungu zokudambisa ngezikhathi zibangelwa yimivalo yebhuthi ye-fallopian kwaye igcwalise ngegazi. Ngokuqhelekileyo kukho i-irradiation yentlungu kwindawo yerandi okanye i-groin. Ubunzima obuqhubekayo bunzima bubonisa ukubola kwegazi kwi-peritoneum.
- Ukukhukhulwa kwamanzi kwi-vaginal cavity. Ukubonakala kwabo kuhambelana nokugatywa kwe-endometrium kunye nokulimala kwimithambo yegazi. Umthamo wegazi elikhutshiwe lincinci, kuba umthamo walo ophezulu udluliselwa nge-lumen yee-tublopian tubes kwisithuba somzimba.
- Ukuvela kwimiqondiso yokuphuma kwegazi:
- intlungu kwisisu esezantsi kunye ne-irradiation kwi-hypochondrium, kwindawo engapheliyo;
- buthathaka;
- ukungcola;
- isicefe
- imeko yokuphazamiseka;
- ukwanda kwenani lentliziyo;
- ukunciphisa uxinzelelo lwegazi.
Intlungu yokukhupha isisu kubonakala ngokukhawuleza, ukuhlaselwa, kunomlinganiso we-cramping (i-tubal nokukhipha isisu). Ngethuba lokuhlaselwa, ukuvakalelwa, ukuphazamiseka, iimpawu zokucaphukisa i-peritoneum, enezinga elithile lobunzima, lingabhalwa. Ngokuhlolwa kwemibuzo yesigulane, kufunyaniswa ukuba isisu sikhulisiwe kwaye sithe tye. Kwiindawo ezixhamliweyo, isakhiwo esinqunyiwe ekuhambeni sikhatywe, ngokuhambelana okufana neentlama.
I-Tubal isisu sifanele sahluke kunye nezinye izifo zesifo somzimba kunye nezifo zeplasvic. Kule nto, i-ultrasound yenziwa, apho kunokwenzeka ukucacisa ngokucacileyo isikhundla seqanda lomntwana kwi-tube. Ngelo xesha, ugqirha usetha ubungakanani beqanda lomntwana kwaye anqume ukuba aqhubeke unyango okanye utyando.
Ukukhipha isisu esingapheliyo
Izibonakaliso zokukhipha isisu, kuboniswe ngasentla, emva kokuphuma kweqanda lokuphuma ngaphandle kwanyamalala. Nangona kunjalo, emva kwexesha, ukubonakala kweempawu ezifanayo. Oku kwenzeka xa ukukhipha isisu esingaphelelanga - ukuxoshwa kwamaqanda ukusuka kumbhobho oma kwindawo ethile. Umzungeze uqokelele kwixesha elide legazi, elenza i-capsule, ngamanye amaxesha elikufutshane kufuphi ne-peritoneum. Kwiimeko ezinjalo, uvavanyo luyimfuneko.
Ukukhulelwa kombhobho - ukusebenza
Ubungakanani utyando olwenziwa ngexesha lokukhupha isisu kuxhomekeke kwinqanaba leprogram ye-pathological and degree of involvement of other organes. Ugqirha lwenziwe nge-laparotomy okanye laparoscopy. Ukufikeleleka kugqitywa ngumqathango wesigulane: kunye nesifo sokuqhekeza kwisisu esiswini, i-laparotomy isetyenziswe-ukufikelela kwidonga langasemva lomzimba. Kwakhona kusetyenziselwa ukuhambelana okubhaliweyo. Kwezinye iimeko, i-laparoscopy yenziwa.
Ukukhulelwa kombhobho - apho iimeko zisusa ityhubhu?
Isisu sokukhupha isisu, unyango lwayo luphethwe ngokukhawuleza, aluhlali luphela nge-salpingectomy. Isalathiso esiyinhloko sokususwa kwebhoyiphi ukuphuka kwayo. Nangona kunjalo, ukukhulelwa kwe-tubal kungabikho kunye nale nkathazo. Phakathi kwezinye izibonakaliso zokususwa kwebhubhu ye-fallopian:
- Ukwelula olomeleleyo kwodonga lwayo (2/3 yomzimba kuchaphazelekayo);
- ubukho bokukhulelwa kwe-ectopic;
- ukukhulelwa kwe-ectopic ngokuphindaphindiweyo kwiphubhu enye;
- inani elikhulu lokunamathela kwisigxina esiswini.
Ukutshatyalaliswa kwe-tubal nokukhulelwa kwe-ectopic - iziphumo
Ukukhulelwa kwe-tubal ngokukhulelwa kwe-ectopic kunokubangela oku kulandelayo:
- ukugqithisa (ukugqitywa) ukukhulelwa kwe-tubal - iphetha ngokukhipha isisu okanye ukuphuhlisa i-hydrosalpinx (ukuqokelela kwamanzi kwi-tube);
- ukuphuhliswa kokukhulelwa kwi-ovary okanye kwisisu esisisigxina (ngokungaqhelekanga).