Meta-analysis inoratidza kuti IUDs inoderedza ngozi yemukenza wechibereki
Zvechokwadi, zvirongwa zve intrauterine (IUDs) zvinoshamisa zvinoshanda pakudzivirira kubata pamuviri. Pakati pegore rokutanga rekushandisa, IUDs inokundikana mune zvishoma pasi pe1 muzana yevakadzi vanoishandisa.
Mukuwedzera pakudzivisa kubata, kutsvakurudza kutsva kunoratidza kuti IUDs inogonawo kubatsira kudzivirira chirwere chemukondombera- kunyanya pakati pevanhu vanowanikwa mari shoma apo pasi pe2 muzana yevakadzi vanoropirwa kurwisa papillomavirus (HPV) yevanhu.
Kunyange zvazvo havasi vakadzi vose vane HPV vanoita kenza yemukomana, HPV ndiyo inonyanya kukonzera chirwere chemukondombera.
Kutsvakurudza
MuDisemba 2017 kurongeka kwakagadziriswa uye meta-analysis yakanzi Intrauterine Device Use uye Cervical Cancer Risk, Cortessis uye vashandi pamwe navo vakawana zvidzidzo zvepamusoro 16 zvekubatanidzwa mukuongorora kwavo. Dhiyabhorosi yakabudiswa kubva kuongororo idzi yakamirira vakadzi 12 482: 4945 vakadzi vane kenza yemukomana uye 7537 vasina kenza.
Mushure mokunge mave nekugadzirisa kuyananisa zvipembenene zvakafanana nehuwandu hweHIVV uye chirwere chekenza chepachirwere chinowanikwa munzvimbo inowanikwa vanhu, vatsvakurudzi vakawana kuti chirwere chepachivha chechirwere chakanga chave chinenge chikamu chechitatu chiduku pane vakadzi vanoshandisa IUDs.
IUDs Inoshanda Sei?
Ihwo hutano hwakabatana nechiberekero nemukati mutsara, mutsetse wemutsipa. Achishandisa speculum, chiremba achaisa IUD kuti aise muchibereko. IUD inobva yaiswa mubereki uchishandiswa mucherechedzo chaiwo, uye inobatwa panzvimbo neyochivharo chesaiti.
Maererano nevanyori veAradic Diagnosis & Treatment 2018 , pano ndiyo nguva yekuisa IUD:
Kuiswa kunogona kuitwa panguva kana mushure mekuvhara, pakati pemitikiti kuti kudzivirira kuiswa, kana kuti gare gare mukufamba kana murwere asina kutora pamuviri. Pane humwe huri kukura hunoratidza kuti IUDs inogona kuiswa zvakachengetwa munguva pfupi inotevera postabortal uye pashure pemazuva.
IUDs yemhangura inoshanda nekuita kuti muviri usakanganise hunoita kuti muviri uuraye chirume. Mhangura inozivikanwa semumwe mutumbi uyo muviri unorwisa kuburikidza nehutachiona hwemuviri.
Iro hormonal IUD Progestasert inoshandisa nekubudisa mahomoni ane chinonzi spermicidal effect.
Hemoni IUD Mirena ine zviito zvinotevera:
- Chirwere chinokonzera mhondi yekuchengetedza mbeu kuti isapinda mubereki
- Kuvhara mbeu yekusvika kana kusungira mazai
- Kukonzera chigadziko chechibereko
Nhoroondo yekare, IUDs dzakabatanidzwa mukuputika kweplavic uye kusabereka; zvisinei, zvigadzirwa zvitsva zvakachengeteka zvikuru. Mukuwedzera pakuve yakabudirira zvikuru, IUDs dzemazuva ano dzinewo maitiro mashoma akaipa.
Vakadzi vari pangozi yakakura yekutapukirwa nehutachiona hwepabonde kana kukura endocarditis yebhakitiriya havafaniri kushandisa IUDs. Uyezve, kuvakadzi vane uterine fibroids , IUDs inogona kunge isingashandisi nokuti inoshandura maitiro euterine cavity.
MuUnited States, IUDs inoshandiswa zvakanyanya. Iga 1 muzana yevakadzi veAmerica vanoshandisa IUDs. MuEurope neKanada, pakati pe15 muzana ne30 muzana yevakadzi vanoshandisa IUDs.
IUDs Inorambidza Sei Kenza Chirwere Chechibereko?
Hazvinyatsozivikanwa kuti sei IUDs chaiyo inodzivirira kenza yemukomana.
Kunyange zvakadaro, kune zvishoma maonero akasiyana.
Kuiswa kweiyo IUD kunogona kuita kuti maitiro ezvirwere zvekuzvidzivirira apinde kurwisa zvirwere zveHIVV uye preinvasive (cancerous) zvipembenene. Kunyanya, IUDs inogadziriswa pamusoro pekushandura kwenzvimbo uye inotarisa mhinduro dzekuzvidzivirira pamuviri panzvimbo yekushandura. Iko kushanduka kwenzvimbo inzvimbo yemukiriniki ine high cell repover uye nzvimbo yakajairika yemukenza wechibereki kukura.
Kutsvakurudza kutsvaga kunotsigira pfungwa iyi yekutanga ndeyekuti zvipembenene zvechibereki zvinokurumidza kukurumidza kuvakadzi vasina kudzivirirwa. Uyezve, vatsvakurudzi vakaona kuti varwere vane zvipembenene zvechibereki vanobviswa zvakanaka kana mishonga ine zvipembenene izvi ine CD4 + T-cells uye CD11c + dendritic masero.
Kuvapo kwemasero aya, ayo ari maitiro e-lymphocytes anoshanda muzvirwere zvekuzvidzivirira, anoratidza zvirwere zvekuzvidzivirira.
Zvimwewo, kupindira kwenguva refu kwekuzvidzivirira kwekuzvidzivirira kwezvirwere kwakave kwakarongedzerwa kutsanangura kudzivirira kwekuita kweIUDs. Maererano naCortessis uye vanyori vanyori:
Nzira dzakabatanidza kupindura kusingaperi kwekuvapo kweIUD zvakare kwakataurwa .... IUDs inogona kuchinja kupfuurira kweHIVV kuburikidza ne "kuchinja mumamiriro ezvinhu emunogara mumuviri" anokonzerwa nechirwere chisingaverengeki, chechikwereti chepamusoro mumagumo ekupedzisira uye chibereko chechirwere kana kuti kuiswa kwe 'nzvimbo duku yechirwere chisingagumi' chinobva kuIUD kuiswa kana kubviswa uye inotevera kwenguva refu immune reaction.
Mune mamwe mazwi, nekufamba kwenguva, kupera kwegorosi kunoputika kusvika kune iko kweIUD kunogona kusimbisa simba rekudzivirirwa mumuviri we mucosa yemukati. Kana kuti, zvitsuwa zviduku zvekugara zvisingagoneki zvinogona kuita kuti mushure mokunge iUID iiswe kana kubviswa, zvichiita kuti zvirwere zvemazuva akawanda zvigadziriswe.
Pakupedzisira, kunyange zvazvo zvisingaiti, zvinogoneka kuti kana iyo IUD ikaiswa kana kubviswa, inogona kubvisa masero anouraya.
Zvinetso
Nguva isati yakwana kutora mhinduro dzekudzidza ichi uye inoratidza kuti vakadzi vanowana IUDs kudzivirira kenza yemukomana. Intrauterine zvishandiso zvine zvikomborero zvavo-kusanganisira kukwanisa kushanda uye zvishoma zvingakanganisa-asi zvino, tinoda kuita tsvakurudzo dzakawanda kuti titsigire zvakawanikwa zvidzidzo izvi uye tione kuti ndeapi uye kuti ndeapi maitiro eIUD anogona kudzivirira kenza yemukondombera.
Kunyange zvazvo vazhinji vevakadzi vari muchidzidzo ichi vakanga vachishanda pasina ma-hormonal IUDs, vatsvakurudzi vakanga vasina ruzivo rwakakwana kuti vaenzanise nemigumisiro inodzivirira yemhangura IUDs maererano nehomoni yeIUDs. Uyezve, zvimwe zvinhu zvinogonawo kuita basa mune zvinogona kudzivirirwa, kusanganisira nguva yekushandiswa kana yezera pakuisa. Zvinhu zvakadaro zvinoda kuongororwa zvakanyanya kuti zvizivise mazano ekurapa.
Chimwe chiyamuro chemeta-analysis inogona kunge iri muhutano hwezvidzidzo pachavo pachavo. Vatsvakurudzi havangavhiringidzi maitiro ekuti vawane meta-tsvakurudzo kana kuti zvakajeka zvezvibereko zvavo. Kunyanya, havatauri maitiro ekudzivirira anonzi ma-IUD kune zvinhu zvakadai sekugadzira zvinyorwa, kushamwaridzana kwemashoko, kana kusara kunopesana nekenza yemukondombera uye zvinodzivirira.
Meta-tsvakurudzo, zvisinei, inongobatsira chete sezvikamu zvayo zvidzidzo, uye nokuti chidzidzo ichi chaiva chekucherechedza uye chekudzoka-pamwe nevatsvakurudzi vachitarisa kumashure kwebasa rakaitwa nevamwe-zvinogona kuti dzidzo yega yega yaive isina kukanganisa. Semuenzaniso, vanyori vezvedzidzo gumi nemakumi matanhatu zvakaongororwa vangave vasina kukanganisa kana kutadza kufunga nezvekusiyana kwezvinhu zvinotyisa kana zvimwe zvidziviriro zvakadai sekukwanisa kuchengetedzwa kwekuchengetedza kana zvinokonzerwa nemamiriro ehupfumi hwevanhu.
Pasinei nokuti ichinyanya kuvepo kuti ione kuti ingabatanidza sei mhinduro dzechidzidzo ichi muchipatara, avo vanotsvakurudza vanoona zvakakosha kubatsirwa kwekutsvakurudza uku-zvikurukuru kune avo vari pangozi yekenza yemukondombera: pasi pevanhu vane ruzivo rushoma rwekuona kuongorora uye kukwirira kwepamusoro yemukenza wechibereki. Vanhu ava vanoenderera kure neUnited States uye vanosanganisira avo vari munyika inosimudzira.
Vatsvakurudzi vanogumisa kudzidza kwavo nevanotevera:
Kana kuedza kwakadaro kusimbisa simba rekudzivirira kweIUD, kupa nekuronga kwekuzadzivirira kwemazuva mashoma kunogona kuisa mukana uyu unogona kusabatsiri weIUD. Shanduro dzekushandura dzemunharaunda ino yekutsvakurudza dzinosimbiswa nehukuru uye huri kukura kwezvinoenderana nekudzivirira chirwere chekenza chekudzivirira iyo inogona kushandiswa zvakanyanya nevakadzi veVVV-vakapararira vari pasi pezvigadzirwa zvepamusoro, vanowanzodikanwa pakubata pamuviri pakati pevakadzi ava, uye zvinyorwa zvinodikanwa zvevamwe zvisingabatsiri zvinobatsira zveIUDs.
Mamwe Mashoko Pamusoro peCervical Cancer
Mukenza wechibereki ndiyo inowanzosangana nekenza yegynecological, uye yechitatu inonyanya kurudzi rwekenza pasi rese. Sangano reInternational Agency for Research on Cancer rinofungidzira kuti muna 2030 pasi pose ikoko kuchaita zvirwere zvinomwe 710 000 zvekenza yemukomana uye 383,000 chirwere chekenza chechirwere gore negore.
Icho chinonyanya kukonzerwa nekenza yemukondombera ndeye HPV, asi pane zvimwe zvinokonzera ngozi, uye zvinosanganisira zvinotevera:
- Kuwedzera muviri
- Kusvuta
- Dzidzo yepamusoro yekuwana
- Age akwegura
- Nhamba yekudzivirira
- Urombo
- Kusanganiswa kweminzwi ekudzivirira kubata pamuviri
- Kuva nevanowanzoita zvepabonde munguva yeupenyu hwose
- Immunosuppression
Nokuti vakadzi vane maitiro epakutanga emukenza wechibereki vanowanzouya pasina zviratidzo, nzira chete iyo chiremba anokwanisa kuziva chirwere ichi nePe test uye HPV kuongorora. Uyezve, kuongororwa kwechirwere chemuviri wemukati kunowanzodikanwa nehupsy yemuchechi, iyo inonzi colposcopy. Zvinonyanya kukosha, zvinhu zvinopisa njodzi seurombo uye zvishoma nezvekuwana dzidzo hazvirevi kufambira mberi kwechirwere chemukondombera pane imwe chete, asi kunowedzera mikana yokuti mukadzi achaongororwa.
Muzhinji, chirwere chepakutanga chirwere chinoporesa zvikuru nekubviswa kushandiswa kwezvipembenene zvine kenza. Kurapwa kwezvirwere zvakanyanya hazvibudiriri uye zvinoda makoradiation.
Iko makore mashanu ekupukunyuka kwehuwandu ihuwandu hwevakadzi vanorarama makore mashanu mushure mekuongororwa. Maererano neAmerican Society of Clinical Oncology:
Kana ichionekwa pamusana pekutanga, makore mashanu ekupukunyuka kwevakadzi vakadzi vane chirwere chepachirwere chechirwere chisingawaniki 91%. Inenge 46% yevakadzi vane chirwere chepachivha chechirwere vanoongororwa munguva yekutanga. Kana kenza yemukomana inopararira kumatunhu kana nhengo dzakapoteredza uye / kana nzvimbo dzomunharaunda dzenharaunda, makore mashanu okupona ari 57%. Kana kenza yakapararira kune imwe nzvimbo iri kure, inosvika makore makumi maviri nemashanu.
Kakawanda, kusanganiswa kweHIVV uye kliniki yekuongorora kunopa chidziviriro chakanakirwa nekenza yemukomana.
Sezvakataurwa kuShwartz's Principles of Surgery :
Mamiriyoni emakiriniki anosangana nemakiriniki anosanganisira vanenge 35 000 vechidiki vechidiki akaratidza kuti zvose Gardasil neCervarix [zvirwere zviviri zveVVV] zvinodzivirira inenge 100% yeHIVV subtype-specific precancerous cervical cell kushanduka kwemakore mana mushure mekudzivirira pakati pevakadzi vasina kutapukirwa nguva yekupemha; chirwere chakaitika musati waita zvepabonde .... Hemukisi haisati yaratidzwa kuchengetedza vakadzi avo vakatotapukirwa neHIVV-16 kana HPV-18 panguva yekudzivirira.
Shoko Rinobva
Ongororo yapfupi inoratidza kuti kuiswa kweIUD kunoderedza ngozi yemukenza wechibereki. Zvisinei, kutsvakurudza kwakawanda kunofanirwa kuitwe kutsigira izvi zvitsva uye kuongorora nei uye kuti ndeapi marudzi eIUDs anodzivirira. Iko zvino, unofanira kuona maIUD nokuda kwezvavari-zvakakosha uye nzira dzakachengeteka dzekudzivirira kuberekwa. Izvo zvingaita kuti IUDs idzivirire chirwere chemucheche inofanira kuonekwa semubhonasi.
Sources:
> Cortessis VK et al. Intrauterine Dhidhiyo Kushandiswa uye Kiradzi yeCervical Cancer: Kuchengetedzwa Kwakarongeka uye Meta-analysis. Obstetrics & Gynecology . 2017. [epub mberi kwekunyora]
> Hall JE. Kusabereka uye kubata pamuviri. Muna: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 19e New York, NY: McGraw-Hill; 2014.
> Hamilton C, Stany M, Gregory W, Kohn EC. Gynecology. Mu: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Schwartz's Principles of Surgery, 10e New York, NY: McGraw-Hill; 2015.
> Woo J. Gynecologic Matambudziko. Mu: Papadakis MA, McPhee SJ, Rabow MW. eds. Kurapa Kwazvino Kwemishonga uye Kurapa 2018 New York, NY: McGraw-Hill.