Phakathi kwezinkinga zokukhulelwa ezinyathelweni zokuqala zokukhipha isisu kungenye yephulwa njalo. Kwenzeka ngo-1.5-2% wabo bonke ukukhulelwa. Izigaba zokuqala zibonakala ngokungabikho kwezimpawu, ngakho-ke ukwephulwa kutholakala evikini lesihlanu kuya kwesithupha lokubeletha.
Ukukhulelwa kwepayipi - izizathu
Uma ukukhulelwa kwe-tubal kukhula, ukukhulelwa kwesisu akugwemeki. Nge-implantation ye-ectopic yeqanda le-fetal, lifa ngesikhathi, okuholela ekufeni kwe-fetus ezayo. Ezimweni eziningi, ukukhubazeka kubangelwa ukuphazanyiswa kokuthuthwa kweqanda elikhulelwe. Okuhlukile kwalokho okuthiwa umsebenzi owenziwe ngokweqile we-blastocyst nakho kungenzeka - kwesinye sezigaba zokuhlukana kweqanda lesisu, ukufakwa kwalo odongeni lwe-tube uterine kuqala. Phakathi kwezimbangela eziyinhloko zalesi sifo, odokotela baveza amaqembu amaningana wezinto:
1. I-Anatomical and physiological:
- izinqubo zokuvuvukala ezingxenyeni zangasese zangaphakathi, eziphula ubuciko be-tubes: ukunamathela, ukucindezela, amaphakethe, ukwephula umsebenzi we-contractile;
- inzalo yokuhlinza (ukubhoboza);
- ukusetshenziswa kwe- spiraluterine yemiklamo ;
- ukusebenza kwizinsizwa zobulili;
- izicubu ze-appendages nesibindi;
2. Izimo zeHormonal:
- ukwephula ukulawulwa kwama-ovari ngenxa yokungalingani kwesimiso se-hypothalamic-pituitary;
- ukwephula ukuhlanganiswa kwe-prostaglandins;
- ukusetshenziswa kwezizalo zokubeletha kwe-hormonal;
3. Ukwandisa umsebenzi we-biological fetus - ukusungulwa okusheshayo kwe-trophoblastoglyco- ne-proteolytic enzymes, okubangela izinqubo zokufaka izimpande.
4. Ezinye izici:
- i-endometriosis ;
- ukungabikho kokubeletha kwesisu;
- ukuhlukumezeka ekuthuthukiseni amashubhu wezintambo;
- izinga elibi lomuthi;
- izimo ezicindezelayo nokuhlukunyezwa kwengqondo.
Ukukhulelwa kwepayipi - izimpawu
Sekuyisikhathi eside, ukukhubazeka akuzizwanga, ngakho-ke ukukhulelwa kwe-tubal, izimpawu zazo ezikhonjisiwe ngezansi, kuvame ukutholakala esiteshini sokukhipha isisu - ukwenqatshwa kweqanda lesisu. Phakathi kwezimpawu ezibonisa ukuphulwa okungenzeka:
- ukukhulelwa kwamanzi okuphuma emzimbeni, ubuhlungu bezinye izikhathi eceleni komlingiswa wokudonsa;
- ukwehla ezingeni likaHCG egazini;
- ushintshe emphumela wokuhlolwa kokukhulelwa (okokuqala okuhle, bese kungakalungi).
Isikhathi sokuphazamiseka kwe-ectopic pregnancy
Ukuphazanyiswa kokukhulelwa kwe-ectopic ekuqaleni kungenxa yokuntuleka kweqanda lesibusiso ekuphileni okuvamile emgodini wethubhu. Kukhona ukukhipha isisu kaningi ngesonto eli-5-6, isikhathi sokugcina sithathwa njengesonto le-10. Ukudlulela kule nkathi kubhekene nezinkinga eziningi ezithinta impilo yabesifazane:
- ukuphuma kwegazi ngaphakathi;
- ukuphuka kwe-tube uterine;
- ukungabi namandla esikhathini esizayo.
Kuyini ukukhipha isisu?
Izimpawu zokuphulwa kwe-ectopic pregnancy zivela kaningi emavikini angu-4-8. Ngezikhathi ezinjalo owesifazane ufunda ngokuphulwa. Ukuphazamiseka kokukhulelwa kwe-ectopic kuvame ukukhipha isisu. Ngenxa yokuthi i-peristalsis ekhuphukile yama-tubes falsipian, iqanda le-fetal lixoshwa futhi lixoshwa emgodini wesibindi. Ukukhipha isisu kuhambisana nokuphuma kwegazi, ngakho kulula ukubona.
Kwezinye izimo, ukuthunjwa kwenzeka ngendlela ehlukile - kungena emgodini we-peritoneum. Kulesi simo, kunezinketho ezimbili zokuthuthukisa isimo:
- ukufa kweqanda lesisu;
- ukufakwa kwesinye kwesinye isitho noma izakhi zesistimu zesisu ngokuthuthukiswa kokukhulelwa (kukhona okungajwayelekile kakhulu).
Ukukhulelwa kwesisu kweT Tubal - izimpawu
Ukukhulelwa kwesisu kwe-Tubal nge-ectopic pregnancy kwenzeka njalo. Kulokhu, isimo sesiguli kanye nesithombe somtholampilo sincike ekutheni ukulahleka kwegazi kukhulu. Phakathi kwezikhalo eziyinhloko ezenziwe abesifazane abathintekayo nge-ectopic, kubalulekile ukuhlukanisa:
- Ukukhathazeka emathunjini aphansi. Izinhlungu zokucindezeleka ngezikhathi ezibangelwa yiziphazamiso ze-tube fallopian futhi zigcwalisa ngegazi. Ngokuvamile kukhona i-irradiation yobuhlungu endaweni ye-rectum noma ubuhlungu. Izinhlungu eziqhubekayo zibonisa ukuthi kungenzeka ukuphela kwesisu emgodini we-peritoneum.
- Ukukhulelwa kwamanzi kusuka emgodini wesifazane. Ukubukeka kwabo kuhlotshaniswa nokwenqatshwa kwe-endometrium nokuguqulwa emithanjeni yegazi. Umthamo wegazi elincinciwe lincane, ngoba ivolumu yalo eyinhloko ithululelwa nge-lumen yama-tubes falsipian kuya esikhaleni esiswini.
- Ukutholakala kwezibonakaliso zokuphuma kwegazi:
- ubuhlungu esiswini esingaphansi ne-irradiation ku-hypochondrium, endaweni ye-interscapular;
- ubuthakathaka;
- isiyezi;
- isicasuli;
- isimo sokuphelelwa amandla;
- ukwanda kwentando yenhliziyo;
- ukwehliswa kwengcindezi yegazi.
Ubuhlungu bokukhipha isisu kubonakala ngokuzumayo, ukuhlaselwa, kube nomlingiswa we-cramping (i-tubal nokukhipha isisu). Ngesikhathi sokuhlaselwa, umzwelo wokukhathazeka, izinto ezishaqisayo, izimpawu zokucasula i-peritoneum, ezinamazinga ahlukene obukhulu, zingaqoshwa. Ngesivivinyo somuntu wesiguli, kutholakala ukuthi isisu sikhulisiwe futhi sithandeka. Endaweni ye-appendages, ukwakheka okulinganiselwe ekuhambeni kuhamba kahle, ngokuvumelana okufana nenhlama.
Ukukhipha isisu kufanele kuhlukaniswe nezinye izifo ezithathelwanayo zokubeletha kanye nezifo zesitho zomzimba. Ngenxa yalokhu, kwenziwa i-ultrasound, lapho kungenzeka khona ukucacisa ngokucacile isimo seqanda lomntwana osesithombeni. Ngesikhathi esifanayo, udokotela ubeka usayizi weqanda lesisu bese ekhetha ukuthi uzoqhubeka yini ukwelashwa noma ukuhlinzwa.
Ukukhipha isisu esingaphelele
Izimpawu zokukhipha isisu, okukhonjisiwe ngenhla, ngemuva kokuphuma kweqanda lomntwana ongaphandle kuphele. Nokho, ngokuhamba kwesikhathi, ukubonakala kwezimpawu ezifanayo. Lokhu kwenzeka lapho ukukhipha isisu okungaphelele - ukuxoshwa kwamaqanda kusuka kumbhobho oma endaweni ethile. Emzungezile iqoqa isikhathi segazi, okwenza i-capsule, ngezinye izikhathi eseduze eduze ne-peritoneum. Ezimweni ezinjalo, ukuhlinzwa kuyadingeka.
Ukukhulelwa kombhobho - ukusebenza
Ukuhlinza okuningi kangakanani ngesikhathi sokukhipha isisu kubangelwa isigaba senqubo yokugula kanye nokuzibandakanya kwezinye izitho zomzimba. Ukuhlinzwa kwenziwa nge-laparotomy noma i-laparoscopy. Ukufinyelela kunqunywa ngesimo sesiguli: ngesifo segazi esiswini esiswini esiswini, i-laparotomy isetshenziselwa - ukufinyelela ngokusebenzisa udonga lwangaphakathi lwesisu. Ibuye isetshenziselwe ukunamathela okubizwayo. Kwezinye izimo, i-laparoscopy yenziwa.
Ukukhulelwa kwepayipi - lapho amacala asusa ithubhu?
Ukukhipha isisu, okwelashwa kuwukuphela kokuhlinzwa, akupheli njalo nge-salpingectomy. Isibonakaliso esiyinhloko sokususwa kwepayipi ukuphela kwayo. Kodwa-ke, ukukhulelwa kwesisu kwe-tubal kungahle kuhambisane nenkinga enjalo. Phakathi kwezinye izinkomba zokususwa kwe-tube fallopian:
- Ukweluleka okuqinile kodonga lwaso (2/3 womzimba kuthintwa);
- ukutholakala kokukhulelwa kwe-ectopic;
- ukuphindaphinda i-ectopic ukukhulelwa egumbini elifanayo;
- inani elikhulu lokunamathela emgodini wesisu.
Ukukhulelwa kwesisu kwe-Tubal nge-ectopic pregnancy - imiphumela
Ukukhulelwa kwesisu kwe-Tubal nge-ectopic pregnancy kungaholela kulokhu okulandelayo:
- ukugubha (ukukhushulwa) ukukhulelwa kwe-tubal - kuqeda ukukhipha isisu noma ukuthuthukiswa kwe-hydrosalpinx (ukuqoqwa kwamanzi e-tube);
- ukuthuthukiswa kokukhulelwa egumbini lesibeletho noma esiswini (okungavamile).