Imvukuzane ye-Hydatidiform

I-Hydatidiform mole (HM) isisindo noma ukukhula okungavamile okwenzeka ngaphakathi kwesibeletho (isibeletho) ekuqaleni kokukhulelwa. Luhlobo lwe-gestational trophoblastic disease (GTD).

I-HM, noma ukukhulelwa kwe-molar, kubangelwa ukukhulelwa okungajwayelekile kwe-oocyte (iqanda). Kuba nomphumela wombungu ongajwayelekile. I-placenta ikhula ngokujwayelekile ngokukhula okuncane noma okungekho nhlobo kwezicubu zombungu. Izicubu zomzimba zakha isisindo esibelethweni. Ku-ultrasound, lo bunzima kaningi bunokubukeka okufana nokwamagilebhisi, njengoba kuqukethe ama-cysts amaningi amancane.

Ithuba lokwakheka kwemvukuzane liphezulu kwabesifazane asebekhulile. Umlando wemvukuzane eminyakeni eyedlule nawo uyingozi.

Ukukhulelwa kweMolar kungaba ngezinhlobo ezimbili:

• Ukukhulelwa kwe-molar ngokwengxenye: Kukhona i-placenta engajwayelekile kanye nokukhula okuthile kombungu.
• Qedela ukukhulelwa kwe-molar: Kukhona i-placenta engavamile futhi ayikho i-fetus.

Ayikho indlela yokuvimbela ukwakheka kwalezi zindimbane.

Izimpawu zokukhulelwa kwe-molar zingafaka:

• Ukukhula okungajwayelekile kwesibeletho, kungaba kukhulu noma kuncane kunokujwayelekile
• Isicanucanu esikhulu nokuhlanza
• Ukopha kwesitho sangasese sowesifazane phakathi nezinyanga ezintathu zokuqala zokukhulelwa
• Izimpawu ze-hyperthyroidism, kufaka phakathi ukungabekezelelani kokushisa, indle evulekile, ukushaya kwenhliziyo okusheshayo, ukungahlaliseki noma ukwethuka, isikhumba esifudumele nesimanzi, izandla eziqhaqhazelayo, noma ukuncipha kwesisindo okungachazeki
• Izimpawu ezifana ne-preeclampsia ezenzeka ku-trimester yokuqala noma ekuqaleni kwe-trimester yesibili, kufaka phakathi umfutho wegazi ophakeme nokuvuvukala ezinyaweni, emaqakaleni nasemilenzeni (lokhu cishe njalo kuyisibonakaliso semvukuzane ye-hydatidiform, ngoba i-preeclampsia ayivelakancane kakhulu lokhu ekuqaleni ukukhulelwa okujwayelekile)

Umhlinzeki wakho wokunakekelwa kwezempilo uzokwenza ukuhlolwa kwe-pelvic, okungakhombisa izimpawu ezifana nokukhulelwa okujwayelekile. Kodwa-ke, ubukhulu besibeletho bungahle bungajwayelekile futhi kungahle kungabi nemisindo yenhliziyo evela enganeni. Futhi, kungahle kube nokuphuma kwegazi esithweni sangasese.

I-ultrasound yokukhulelwa izokhombisa ukubonakala kwesiphepho nge-placenta engajwayelekile, ngokukhula kwengane noma ngaphandle kwayo.

Ukuhlolwa okwenziwe kungafaka:

• I-hCG (amazinga amaningi) ukuhlolwa kwegazi
• I-ultrasound yesisu noma yesitho sangasese sowesifazane
  
• I-x-ray yesifuba
• I-CT noma i-MRI yesisu (ukuhlolwa kwe-imaging)
• Qedela ukubalwa kwegazi (CBC)
• Ukuhlolwa kwegazi
• Ukuhlolwa kokusebenza kwezinso nesibindi

Uma umhlinzeki wakho esola ukukhulelwa kwe-molar, ukususwa kwezicubu ezingavamile nge-dilation kanye ne-curettage (i-D & C) kungenzeka kuphakanyiswe. I-D & C nayo ingenziwa kusetshenziswa ukuncela. Lokhu kubizwa ngokuthi ukuncela (Indlela isebenzisa inkomishi yokudonsa ukususa okuqukethwe esibelethweni).

Kwesinye isikhathi ukukhulelwa kwe-molar ngokwengxenye kungaqhubeka. Owesifazane angakhetha ukuqhubeka nokukhulelwa kwakhe ngethemba lokuzala ngempumelelo nokubeletha. Kodwa-ke, lokhu ukukhulelwa okuyingozi kakhulu. Izingozi zingabandakanya ukopha, izinkinga ngomfutho wegazi, nokubeletha ngaphambi kwesikhathi (ukuba nengane ngaphambi kokuba ikhule ngokugcwele). Ezimweni ezingavamile, umbungu ujwayelekile ngokwezakhi zofuzo. Abesifazane kudingeka baxoxe ngokuphelele ngezingozi nomhlinzeki wabo ngaphambi kokuqhubeka nokukhulelwa.

I-hysterectomy (ukuhlinzekwa ukukhipha isibeletho) kungaba yindlela yabesifazane asebekhulile abangafisi ukukhulelwa ngokuzayo.

Ngemuva kokwelashwa, kuzolandelwa izinga lakho le-hCG. Kubalulekile ukugwema okunye ukukhulelwa futhi usebenzise umuthi wokuvimbela inzalo onokwethenjelwa izinyanga eziyisithupha kuya kweziyishumi nambili ngemuva kokwelashwa kokukhulelwa kwe-molar. Lesi sikhathi sivumela ukuhlolwa okunembile ukuqiniseka ukuthi izicubu ezingavamile azibuyeli emuva. Abesifazane abakhulelwa ngokushesha okukhulu ngemuva kokukhulelwa kwe-molar basengozini enkulu yokuba nokukhulelwa okunye kwe-molar.

Iningi lama-HM alinomdlavuza (alinangozi). Ukwelashwa kuvame ukuphumelela. Vala ukulandelwa ngumhlinzeki wakho kubalulekile ukuqinisekisa ukuthi izimpawu zokukhulelwa kwe-molar sezihambile namazinga ama-hormone wokukhulelwa abuyela kokujwayelekile.

Cishe i-15% yamacala e-HM angaba namandla. Lezi zimvukuzane zingakhula zijule odongeni lwesibeletho futhi zibangele ukopha noma ezinye izinkinga. Lolu hlobo lwemvukuzane luvame ukuphendula kahle emithini.

Ezimweni ezimbalwa kakhulu ze-HM ephelele, ama-moles akhula abe yi-choriocarcinoma. Lo ngumdlavuza okhula ngokushesha. Imvamisa iphathwa ngempumelelo nge-chemotherapy, kepha ingaba yingozi empilweni.

Izinkinga zokukhulelwa kwe-molar zingafaka:

• Shintshela kwisifo se-molar noma i-choriocarcinoma
• Preeclampsia
• Izinkinga ze-thyroid
• Ukukhulelwa kweMolar okuqhubekayo noma okubuyayo

Izinkinga ezivela ekuhlinzeni ukususa ukukhulelwa kwe-molar zingafaka:

• Ukopha ngokweqile, mhlawumbe okudinga ukumpontshelwa igazi
• Imiphumela emibi ye-anesthesia

Imvukuzane Hydatid; Ukukhulelwa kweMolar; I-Hyperemesis - molar

• Isibeletho
• I-anatomy yesizalo ejwayelekile (isigaba esisikiwe)

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

IGoldstein DP, iBerkowitz RS. Isifo se-Gestational trophoblastic. Ku: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, abahleli. I-Abeloff’s Clinical Oncology. Umhlaka 5. IPhiladelphia, PA: Elsevier Saunders; 2014: isahluko 90.

USalani R, uCopeland LJ. Izifo ezimbi nokukhulelwa. Ku: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Ama-Obstetrics: Ukukhulelwa Okujwayelekile Nenkinga. Umhla wesi-7. IPhiladelphia, PA: Elsevier; 2017: isahluko 50.

I-Salhi BA, i-Nagrani S. Izinkinga ezinzima zokukhulelwa. Ku: Walls RM, Hockberger RS, Gausche-Hill M, ama-eds. Imithi Ephuthumayo yaseRosen: Imiqondo kanye Nokuzijwayeza Komtholampilo. Umhlaka 9. IPhiladelphia, PA: Elsevier; 2018: isahluko 178.