Kafukufuku wamatenda akusonyeza kuti ma IUDs amachepetsa chiopsezo cha khansara ya chiberekero
Inde, zipangizo za intrauterine (IUDs) zimathandiza kwambiri popewera mimba. M'chaka choyamba cha ntchito, ma IUD amalephera kuchepa pa 1 peresenti ya amayi akugwiritsira ntchito.
Kuwonjezera pa kupewa kutenga mimba, kafukufuku watsopano amasonyeza kuti ma IUD angathandizenso kuteteza khansa ya chiberekero, makamaka pakati pa anthu ochepa omwe amapeza ndalama zosakwana 2 peresenti ya amayi omwe amatemera katemera wa papillomavirus (HPV).
Ngakhale si amayi onse omwe ali ndi HPV amayamba khansa ya pachibelekero, HPV ndiyo chifukwa chachikulu cha khansara ya chiwindi.
Kafukufuku
Mu ndondomeko yowonongeka ya December 2017 ndi kufotokozera mchitidwe wotchedwa Intrauterine Device Use and Cervical Cancer Risk, Cortessis ndi anzake adapeza maphunziro 16 apamwamba kuti awoneke. Deta zomwe zinachokera ku maphunzirowa zinkaimira amayi 12,482: 4945 akazi omwe ali ndi khansa ya pachibelekero ndi 7537 opanda khansa.
Pambuyo poyendetsa zowonongeka monga kukula kwa HPV ndi khansara ya chiberekero mumapezeka anthu ambiri, ofufuza anapeza kuti khansara ya chiberekero inali yochepa kwambiri mwa amayi omwe amagwiritsira ntchito IUDs.
Kodi IUDs Zimagwira Ntchito Motani?
Chikazi chimagwirizanitsidwa ndi chiberekero ndi kachilombo ka HIV. Pogwiritsa ntchito speculum, dokotala adzaika IUD kuti apereke chiberekero. Nthendayi imayikidwa mu chiberekero pogwiritsira ntchito cholembera chapadera, ndipo imagwiritsidwa ntchito ndi mafupa a chiberekero.
Malingana ndi olemba a Current Medical Diagnosis & Treatment 2018 , apa pali nthawi ya kukhazikitsa IUD:
Kuikidwa kungatheke pakapita kapena pamapeto pake, pakatikatikati pobisala, kapena patapita nthawi ngati wodwalayo asatenge mimba. Pali umboni wochulukirapo wosonyeza kuti ma IUD angapangidwe mosatetezeka nthawi yapambuyo posakhalitsa ndi pambuyo pake.
IUDs zamkuwa zimagwira ntchito pogwiritsa ntchito mankhwala osakanikirana omwe amachititsa thupi kupha umuna. Mkuwawo umadziwika ngati thupi lachilendo lomwe thupi lidzawombere mwa chitetezo cha mthupi.
Mafupa Ophwanya Madzi Amadzimadzi amachititsa kuti atulutse mahomoni omwe ali ndi zotsatira zowonongeka.
Mayina a IUDI amachititsa zotsatirazi:
- Mankhwalawa amachititsa kuti umuna usalowe m'chiberekero
- Kulepheretsa umuna kuti ufike kapena kukulitsa dzira
- Kupukuta chidebe cha chiberekero
Zakale, ma IUDs adagwirizanitsidwa ndi kutupa kwapakhosi ndi kusabereka; Komabe, zipangizo zatsopano zimakhala zotetezeka kwambiri. Kuwonjezera pa kukhala ogwira mtima kwambiri, IUDs zamakono zili ndi zotsatira zochepa zolakwika.
Azimayi omwe ali pachiopsezo chachikulu kuti ali ndi matenda opatsirana pogonana kapena kupanga mabakiteriya endocarditis sayenera kugwiritsa ntchito IUDs. Kuwonjezera pamenepo, kwa amayi omwe ali ndi uterine fibroids , ma ARVs sangakhale othandiza chifukwa amasintha mawonekedwe a uterine.
Ku United States, ma CDs amagwiritsidwa ntchito mosagwiritsidwa ntchito. Amayi amodzi okha a ku America amagwiritsa ntchito IUDs. Ku Ulaya ndi Canada, pakati pa 15 peresenti ndi 30 peresenti ya amayi amagwiritsira ntchito IUDs.
Kodi Mankhwalawa Amateteza Bwanji Khansara ya Khansa?
Sindikudziwa momwe ndondomeko za HIV zimapezera khansa ya chiberekero.
Komabe, pali zifukwa zosiyana zosiyana.
Kuyika kwa IUD kungapangitse chitetezo cha mthupi kuteteza matenda a HPV ndi zilonda zam'mimba (khansa). Mwachindunji, IUDs imayikidwa pamwamba pa malo osinthika ndikuyang'ana chitetezo cha chitetezo cha chitetezo ku chitetezo. Malo osinthika ndi malo a chiberekero chokhala ndi maselo akuluakulu komanso malo ofala kwambiri a khansa ya pachibelekero.
Zotsatira za kafukufuku zomwe zimachirikiza lingaliro loyambirira ndilokuti zilonda zam'chiberekero zimapita mofulumira kwa amayi omwe ali osasokonezeka. Komanso, ochita kafukufuku apeza kuti odwala omwe ali ndi zilonda zam'kamwa amachotsedwa bwino ngati minofu yomwe ili ndi zilondazi ili ndi CD4 + T-maselo ndi maselo a CD11c + dendritic.
Kukhalapo kwa maselowa, omwe ali mitundu ya ma lymphocytes yogwira ntchito muzitetezo za chitetezo cha mthupi, amasonyeza kusalowa m'thupi.
Mwinanso, kuyankha kwa chitetezo cha mthupi kwa nthawi yaitali kwatanthauzidwa kutanthawuzira momwe chitetezo cha ma ARV chimatetezera. Malingana ndi Cortessis ndi alembi ena:
Njira zowonjezera zowonjezereka zokhudzana ndi kupezeka kwa IUD zanenedwa kuti .... Mankhwalawa angakhudze kupitiriza kwa HPV kupyolera mu 'kusintha kwa malo a chitetezo cha mthupi' omwe amayamba chifukwa cha kutupa kwachilendo, kutentha kwapakati pamimba komanso chiberekero kapenanso kutsekedwa kwa 'kutupa kochepa kwa kutupa kwanthawi yaitali' chifukwa cha kuika kapena kuchotsedwa kwa IUD immune reaction.
Mwa kuyankhula kwina, patapita nthawi, kutupa kwapafupi kochepa kumbali ya kukhalapo kwa HIV kungapangitse kukhala ndi mphamvu yoteteza mthupi mwa mucosa wa chiberekero. Kapena, zilumba zazing'ono zopweteka kwambiri zingapangitse kuti chitetezo cha mthupi chitetezedwe mutatha kuika kapena kuchotsa, zomwe zimachititsa kuti chitetezo cha mthupi chitengeke nthawi yaitali.
Potsirizira pake, ngakhale kuti nkosayembekezereka, ndizotheka kuti pamene mankhwalawa atsekedwa kapena kuchotsedwa, akhoza kuchotsa maselo a khansa.
Zotsatira
Zisanayambe kutenga zotsatira za phunziroli ndikupatsanso amayi kuti atenge ma IUD pofuna kupewa khansara ya chiberekero. Zipangizo zamagetsi zimapindulitsa-kuphatikizapo mphamvu zowononga komanso zovuta zochepa-koma tsopano, tifunika kufufuza zambiri kuti tilimbikitse zomwe tafufuza ndikupeza momwe ndi mitundu iti ya ma ARV ingathetsere khansara ya chiberekero.
Ngakhale amayi ambiri mu phunziroli anali kugwiritsa ntchito mankhwala osadziwika a ma ARV, ochita kafukufukuwa analibe chidziwitso chokwanira kuti afanizire zotsatira zotetezera zamkuwa zamphongo ndi ma ARV. Kuwonjezera apo, zifukwa zina zingathandizenso zotetezera, kuphatikizapo nthawi yogwiritsira ntchito kapena msinkhu kuikapo malo. Zinthu zoterozo ziyenera kuyang'aniridwa bwino kuti mudziwe zolinga zachipatala.
Chinthu chinanso chokhazikitsa meta-yeniyeniyi chikhoza kukhala mukutengera kwa maphunziro aumwini okha. Ochita kafukufuku samatsutsa kapangidwe ka meta-kafukufuku wawo kapena kuwona kwa zotsatira zawo. Mwachindunji, iwo samapereka zotsatira zotetezedwa zotsimikizika za ma IUDs ku zinthu monga kupanga maphunzilo, kukondera zofalitsa, kapena kusokonezeka kwa chiopsezo cha khansa ya pachibelekero ndi zinthu zoteteza.
Kusanthula meta, komabe, ndibwino basi monga maphunziro ake, komanso chifukwa chakuti phunziroli linali lowonetsetsa komanso lachilendo-ndi ofufuza akuyang'ana kumbuyo ntchito zomwe ena amachita-ndikotheka kuti maphunziro omwewo anali olakwika. Mwachitsanzo, olemba a maphunziro 16 omwe adafukulidwa akhoza kusagwirizana kapena kusaganizira mozama kusiyana kwa chiopsezo chotere kapena zinthu zotetezera monga kupeza chithandizo chodziletsa kapena zotsatira za chikhalidwe cha anthu.
Ngakhale kuti ndikumayambiriro kwambiri kuti apeze momwe angagwiritsire ntchito zotsatira za phunziroli muzochitika zachipatala, ochita kafukufuku akuwoneratu phindu lalikulu la kafukufukuyu makamaka makamaka omwe ali ndi chiopsezo chachikulu cha khansara ya chiberekero. za khansa ya pachibelekero. Anthuwa akufutukula kutali kwambiri ndi United States ndipo akuphatikizapo anthu akutukuka.
Ochita kafukufukuwo anamaliza phunziro lawo ndi izi:
Ngati zoyesayesa zoterezi zimakhudza mphamvu zowononga za HIV, uphungu wotsatira njira zothandizira njira zokhudzana ndi kulera zingaphatikizepo phindu lopanda phindu lachinsinsi. Zochita zamasulidwe za kafukufukuyu zimatsimikiziridwa ndi zofunikira zowonjezereka za njira zoyenera zothandizira khansa yothandizira khansa yomwe ingagwiritsidwe ntchito kwambiri ndi amayi omwe ali ndi kachilombo ka HIV m'zinthu zochepa zomwe zimakhala zochepa, komanso zolemba zovomerezeka za amayi ena malingaliro opanda chidwi a ma IUDs.
Zambiri Zokhudza Kansa ya Chiberekero
Khansara ya chiberekero ndi khansa yowonongeka kwambiri, komanso khansa yachitatu yafala kwambiri padziko lapansi. International Agency for Research on Cancer akuganiza kuti pofika chaka cha 2030 padziko lapansi padzakhala milandu 710,000 ya khansa ya chiberekero ndi imfa ya khansa ya chiberekero 383,000 pachaka.
Choopsa chachikulu cha khansara ya chiberekero ndi HPV, koma palinso zinthu zina zoopsa, kuphatikizapo zotsatirazi:
- Kunenepa kwambiri
- Kusuta
- Maphunziro apansi
- Ukalamba
- Chiwerengero cha mimba
- Umphawi
- Kuphatikizako mankhwala opatsirana pakamwa
- Kukhala ndi zibwenzi zambiri pa nthawi yonse ya moyo
- Kugonjetsa
Chifukwa chakuti amayi omwe ali ndi magawo oyambirira a kansa ya pachibelekero nthawi zambiri amapereka popanda zizindikiro, njira yokha yomwe dokotala angadziwire matendawa ndi mapepala a Pap ndi HPV. Komanso, matenda a khansa ya pachibelekero imafuna kuti pakhale kachilombo koyambitsa chiberekero, chomwe chimatchedwa colposcopy. Zowonjezera, zifukwa zoopsya monga umphawi ndi kuchepetsa maphunziro apamwamba sizitsutsana ndi kukula kwa khansara ya chiberekero paokha, koma kuchepetsa mwayi woti mkazi ayang'anire.
Kawirikawiri, matenda oyambirira amatha kuchiritsidwa kwambiri pochotsa opaleshoni ya khansa. Chithandizo cha matenda apamwamba sichingapindule kwambiri ndipo chimafuna chizolowezi chokhazikika.
Zaka zisanu zomwe zimapulumuka ndi chiwerengero cha amayi omwe ali ndi moyo zaka zisanu pambuyo poti akudziŵa. Malingana ndi American Society of Clinical Oncology:
Mukadziwidwa kumayambiriro, zaka zisanu zapakati pa amayi omwe ali ndi kansa ya chiberekero yosauka ndi 91%. Pafupifupi 46 peresenti ya amayi omwe ali ndi kansa ya pachibelekero amapezeka kuti ali pachiyambi. Ngati kansa ya pachibelekero imafalikira kumatenda kapena ziwalo zozungulira komanso / kapena malo am'deralo, zaka zisanu zomwe zimakhalapo ndi 57%. Ngati khansara yafalikira kumbali yakutali ya thupi, msinkhu wa zaka zisanu ndi zisanu ndi zisanu ndi zisanu ndi zitatu (17%).
Zowonjezereka, kuphatikiza kwa katemera wa HPV ndi kuwonetsetsa zachipatala kumapereka chitetezo chabwino pa khansara ya chiberekero.
Monga tanenera mu Shwartz's Principles of Surgery :
Mayesero angapo opatsirana pogwiritsa ntchito makina okhudza achinyamata pafupifupi 35,000 asonyeza kuti Gardasil ndi Cervarix [ma katemera awiri a HPV] amapewa pafupifupi 100% ya kusintha kwa maselo amtundu wa kanseri kwapakati pa zaka 4 pambuyo pa katemera pakati pa amayi omwe alibe kachilombo ka HIV. nthawi ya katemera; katemera unayamba kale kugonana .... Katemera sichinawonetseke kuti amateteza akazi omwe ali ndi kachilombo ka HIV kapena kachilomboka ka HIV pa nthawi ya katemera.
Mawu Ochokera
Kafukufuku waposachedwapa amasonyeza kuti kusungidwa kwa kachilombo ka HIV kumachepetsa chiopsezo cha khansa ya pachibelekero. Komabe, kafufuzidwe kafukufuku amafunika kuchitidwa kuti athandizire zotsatirazi ndikupeza chifukwa chake ndi mitundu yanji ya IUDs yomwe imatetezera. Pakalipano, muyenera kuwona ma IUD chifukwa cha zomwe ali-njira zothandiza komanso zotetezeka zowononga. Zomwe zingathandize kuti matendawa asatengedwe kuti azipewa khansa ya chiberekero ayenera kuwonedwa ngati bonasi.
Zotsatira:
> Cortessis VK et al. Kugwiritsa ntchito zipangizo zamakono ndi khansa ya m'mimba: Kusanthula mwatsatanetsatane ndi kusanthula meta. Zovala zamaliseche & Gynecology . 2017. [epub patsogolo pa kusindikiza]
> Hall JE. Kupanda chithandizo ndi kulera. Mu: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Mfundo za Harrison za Internal Medicine, 19e New York, NY: McGraw-Hill; 2014.
> Hamilton C, Stany M, Gregory W, Kohn EC. Maginito. Mu: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. Mfundo za Schwartz za Opaleshoni, 10e New York, NY: McGraw-Hill; 2015.
> Woo J. Gynecologic Disorders. Mu: Papadakis MA, McPhee SJ, Rabow MW. eds. Kufufuza kwa Zamankhwala Zamakono ndi Chithandizo 2018 New York, NY: McGraw-Hill.