Umzimba we-Hydatidiform

I-Hydatidiform mole (HM) ubunzima obunqabileyo okanye ukukhula okuvela ngaphakathi kwisibeleko (isibeleko) ekuqaleni kokukhulelwa. Luhlobo lwesifo se-trophoblastic disease (GTD).

I-HM, okanye ukukhulelwa kwe-molar, kubangelwa kukuchumisa okungaqhelekanga kwe-oocyte (iqanda). Isiphumo sombungu ongekazalwa. I-placenta ikhula ngesiqhelo ngokukhula kancinci okanye ukungabikho kokukhula kwezihlunu zomntwana. Izicubu ze-placental zenza ubunzima kwisibeleko. Kwi-ultrasound, obu bunzima buhlala bunokubonakala ngathi ngumdiliya, kuba iqulethe ii-cysts ezininzi ezincinci.

Ithuba lokuyilwa kwe-mole liphezulu kubafazi abadala. Imbali ye-mole kwiminyaka engaphambili ikwangumngcipheko.

Ukukhulelwa kwe-Molar kunokuba ziindidi ezimbini:

• Ukukhulelwa okwexeshana komlomo: Kukho i-placenta engaqhelekanga kunye nophuhliso oluthile lomntwana.
• Gcwalisa ukukhulelwa kwe-molar: Kukho i-placenta engaqhelekanga kwaye akukho mveku.

Akukho ndlela yokuthintela ukwakheka kwezi zimbumba.

Iimpawu zokukhulelwa kwe-molar zingabandakanya:

• Ukukhula okungaqhelekanga kwesibeleko, nokuba kukhulu okanye kuncinci kunesiqhelo
• Isicaphucaphu esomeleleyo kunye nokugabha
• Ukopha kwilungu lobufazi kwiinyanga ezintathu zokuqala zokukhulelwa
• Iimpawu zehyperthyroidism, kubandakanya ukunganyamezelani kobushushu, izitulo ezivulekileyo, ukubetha kwentliziyo ngokukhawuleza, ukungazinzi okanye ukoyika, isikhumba esifudumeleyo nesifumileyo, ukungcangcazela kwezandla, okanye ukwehla kobunzima obungachazwanga
• Iimpawu ezifanayo ne-preeclampsia eyenzeka kwikota yokuqala yokuqala okanye kwikota yokuqala yesibini, kubandakanya uxinzelelo lwegazi oluphezulu kunye nokudumba ezinyaweni, emaqatheni nasemilenzeni. ukukhulelwa okuqhelekileyo)

Umboneleli wakho wezempilo uya kwenza uvavanyo lwe-pelvic, olunokubonisa iimpawu ezifanayo nokukhulelwa okuqhelekileyo. Nangona kunjalo, ubungakanani besibeleko bunokungaqhelekanga kwaye kungabikho zandi zentliziyo zisuka emntwaneni. Kwakhona, kunokubakho ukopha kwilungu lobufazi.

Ukukhulelwa kwe-ultrasound kuya kubonisa ukubonakala kwesiphepho nge-placenta engaqhelekanga, kunye okanye ngaphandle kokuphuhliswa komntwana.

Uvavanyo olwenziwe lunokubandakanya:

• hCG (amanqanaba amanani) kuvavanyo lwegazi
• Isisu esiswini okanye sangasese se-pelvis
  
• I-x-ray yesifuba
• I-CT okanye i-MRI yesisu (iimvavanyo zokucinga)
• Gcwalisa ubalo lwegazi (CBC)
• Uvavanyo lokunqanda igazi
• Uvavanyo lwezintso kunye nesibindi

Ukuba umboneleli wakho ukrokrela ukukhulelwa kwe-molar, ukususwa kwezicubu ezingaqhelekanga ngokuthanjiswa kunye nonyango (iD & C) kuya kucetyiswa. I-D & C inokwenziwa kwakhona kusetyenziswa ukutsala. Oku kubizwa ngokuba ngumnqweno wokufunxa (Le ndlela isebenzisa ikomityi yokutsala ukususa umxholo kwisibeleko).

Ngamanye amaxesha ukukhulelwa okubonakalayo kunokuqhubeka. Umfazi unokukhetha ukuqhubeka nokukhulelwa ngethemba lokuzalwa ngempumelelo kunye nokuzala. Nangona kunjalo, oku kukubeka emngciphekweni kakhulu. Iingozi zisenokubandakanya ukopha, iingxaki zoxinzelelo lwegazi, nokuzala ngaphambi kwexesha (ukuba nosana ngaphambi kokuba lukhule ngokupheleleyo). Kwiimeko ezinqabileyo, umntwana ongekazalwa usisiqhelo ngokwemfuza. Abasetyhini kufuneka baxoxe ngokupheleleyo ngomngcipheko kunye nomnikezeli wabo ngaphambi kokuqhubeka nokukhulelwa.

I-hysterectomy (utyando lokususa isibeleko) kunokuba yinto enokubakho kwabasetyhini abadala abangafuniyo ukukhulelwa kwixa elizayo.

Emva konyango, inqanaba lakho le-hCG liya kulandelwa. Kubalulekile ukuthintela okunye ukukhulelwa kwaye usebenzise indlela ethembekileyo yokuthintela ukukhulelwa kwiinyanga ezi-6 ukuya kwezi-12 emva konyango lokukhulelwa. Eli xesha livumela uvavanyo oluchanekileyo ukuze kuqinisekiswe ukuba izihlunu ezingaqhelekanga azikhuli kwakhona. Abasetyhini abakhulelwa ngokukhawuleza emva kokukhulelwa kwe-molar basemngciphekweni omkhulu wokuphinda bakhulelwe.

Uninzi lwe-HMs alunomdlavuza (ubungozi). Unyango luhlala luphumelela. Vala ukulandelelwa ngumboneleli wakho kubalulekile ukuqinisekisa ukuba imiqondiso yokukhulelwa kwe-molar ihambile kwaye amanqanaba okukhulelwa kwehomoni abuyela esiqhelweni.

Malunga ne-15% yamatyala e-HM anokuthi angenelele. Ezi moles zinokukhula nzulu eludongeni lwebele kwaye zibangele ukopha okanye ezinye iingxaki. Olu hlobo lwe-mole luhlala luphendula kakuhle kumayeza.

Kwiimeko ezimbalwa kakhulu ze-HM epheleleyo, i-moles ikhula ibe yi-choriocarcinoma. Lo ngumhlaza okhula ngokukhawuleza. Ihlala inyangwa ngempumelelo ngekhemotherapy, kodwa inokubusongela ubomi.

Iingxaki zokukhulelwa kwe-molar zingabandakanya:

• Guqula isifo se-molar okanye i-choriocarcinoma
• Preeclampsia
• Iingxaki ze-thyroid
• Ukukhulelwa kweMolar okuqhubekayo okanye okubuyayo

Iingxaki ezivela kutyando lokususa ukukhulelwa kwe-molar zingabandakanya:

• Ukopha kakhulu, kusenokwenzeka ukuba kufuneka utofelwe igazi
• Iziphumo ebezingalindelekanga zeanesthesia

Imole yehydatid; Ukukhulelwa kweMolar; I-Hyperemesis - imolar

• Isibeleko
• I-anatomy yesibeleko yesiqhelo (icandelo elisikiweyo)

I-Bouchard-Fortier G, i-Covens A. Isifo se-trophoblastic sesifo: i-hydatidiform mole, i-nonmetastatic and metastatic gestational trophoblastic tumor: ukuxilongwa kunye nokulawulwa. Ku: Lobo RA, Gershenson DM, Lentz GM, Valea FA, ii-eds. Gynecology egqibeleleyo. Umhla wesi-7. IPhiladelphia, PA: Elsevier; Ngo-2017: isahluko 35.

IGoldstein DP, iBerkowitz RS. Isifo se-Gestational trophoblastic. Ku: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, ii-eds. I-Oncology yeklinikhi yase-Abeloff. Umhla we-5. IPhiladelphia, PA: Elsevier Saunders; 2014: isahluko 90.

USalani R, uCopeland LJ. Izifo ezinobungozi kunye nokukhulelwa. Ku: Gabbe SG, Niebyl JR, Simpson JL, et al, ii-eds. I-Obstetrics: Ukukhulelwa okuqhelekileyo kunye neengxaki. Umhla wesi-7. IPhiladelphia, PA: Elsevier; Ngo-2017: isahluko 50.

I-Salhi BA, i-Nagrani S.Iingxaki ezinzima zokukhulelwa. Ku: Iindonga RM, iHockberger RS, iGausche-Hill M, ii-eds. Unyango lukaRosen oluNgxamisekileyo: iikhonsepthi kunye nokuziqhelanisa neklinikhi. Umhla we-9. IPhiladelphia, PA: Elsevier; I-2018: isahluko 178.