Mole Hydatidiform

ʻO ka mole Hydatidiform (HM) kahi nui a ulu paha i loko o ka ʻōpū (uterus) i ka hoʻomaka o kahi hāpai. ʻO ia kahi ʻano o ka maʻi trophoblastic gestational (GTD).

ʻO ka HM, a i ʻole ka hāpai ʻana o molar, nā hopena mai ka fertilization pono ʻole o ka oosit (egg). ʻO nā hopena i kahi pēpē maʻamau. Ulu maʻamau ka placenta me ka ulu liʻiliʻi a ʻaʻohe o nā kiko fetal. Hoʻokumu kaʻiʻo placental i kahi nui i ka kōpū. Ma ka ultrasound, loaʻa i kēia nuipa he ʻano like me ka hua waina, no ka mea, he nui nā cist liʻiliʻi.

ʻOi aku ka kiʻekiʻe o ka hoʻokumu ʻana i ka mole i nā wahine makua. ʻO ka mōʻaukala o ka mole i nā makahiki i hala aku nei kahi mea weliweli pū kekahi.

ʻElua mau ʻano ke hāpai hāpai Molar:

• Hapai hapa molar: Aia kahi placenta kūpono a me kekahi ulu ʻana o ka fetal.
• Hoʻopiha piha i ka hāpai ʻana: Aia kahi placenta kūpono a ʻaʻohe fetus.

ʻAʻohe ala e pale ai i ka hoʻokumu ʻana o kēia lehulehu.

ʻO nā ʻōuli o kahi hāpai hāpai molar hiki ke hoʻopili ʻia:

• ʻO ka ulu maʻamau o ka kōpū, ʻoi aku ka nui a i ʻole ka liʻiliʻi ma mua o ka maʻamau
• Kaʻi nui a me ka luaʻi
• ʻO ke kahe o ke kīpē i loko o nā mahina 3 mua o ka hāpai ʻana
• Nā ʻōuli o hyperthyroidism, e like me ka hoʻomanawanui ʻole i ka wela, nā noho humuhumu, ka helu o ka puʻuwai wikiwiki, ka hoʻomaha ʻole a me ka makaʻu, ʻili mahana a me ka wai, nā lima haʻalulu, a i ʻole ka wehewehe kaumaha ʻole i wehewehe ʻia
• ʻO nā ʻōuli e like me ka preeclampsia e kū nei i ka trimester mua a i ʻole ka mua o ka trimester ʻelua, e pili ana i ke kiʻekiʻe o ke koko a me ka pehu ʻana o nā wāwae, nā kuʻekuʻe wāwae, a me nā wāwae (he hōʻailona pinepine kēia o kahi mole hydatidiform, no ka mea he mea nui loa ka preeclampsia i kēia mua o ka maʻamau hāpai keiki)

E hana kāu mea mālama ola i kahi hōʻike pelvic, i hōʻike ʻia i nā hōʻailona e like me ka hāpai maʻamau. Eia nō naʻe, he ʻokoʻa ka nui o ka ʻōpū a ʻaʻohe paha he kani naʻau o ka pēpē. Eia kekahi, aia paha kekahi kahe koko.

E hōʻike kahi ultrasound hāpai keiki i kahi ʻano snowstorm me kahi placenta maʻamau, me ka ʻole a me ka ulu ʻole o kahi pēpē.

Hiki i nā hoʻokolohua i hana ʻia ke:

• hCG (pae helu) hoʻāʻo koko
• ʻO ka ultrasound ʻōpū a i ʻole ke keu o ka pelvis
  
• Pākuʻi x-ray
• CT a MRI paha o ka ʻōpū (hōʻike i nā kiʻi)
• Helu piha koko (CBC)
• Nā hoʻāʻo ʻana o ke kāpili koko
• Nā hoʻāʻo ʻana o ka hakuʻala a me ke ake

Inā kuhi kāu mea hāʻawi i kahi hāpai hāpai molar, e hōʻike ʻia ka wehe ʻana i nā ʻaʻa ʻino me ka dilation a me curettage (D & C). Hana ʻia ʻo D & C me ka hoʻohana ʻana i ka omo. Kapa ʻia kēia he moʻo omo (Hoʻohana ke ʻano i kahi kīʻaha e lawe i nā ʻike mai ka uterus).

I kekahi manawa hiki ke hoʻomau i kahi hāpai hāpai molar. Koho paha ka wahine e hoʻomau i kona hāpai ʻana me ka lana o ka hānau maikaʻi a hānau. Eia nō naʻe, he hāpai hāpai kiʻekiʻe loa kēia. Pākuʻi ʻia paha nā pōpilikia me ke kahe ʻana i ke kahe, nā pilikia me ke kaomi koko, a me ka hānau mua ʻole (loaʻa ka pēpē ma mua o ka hoʻomohala piha ʻia ʻana). I nā hihia maʻamau, genetically ka fetus he maʻamau. Pono nā wahine e kūkā piha i nā pilikia me kā lākou mea hāʻawi ma mua o ka hoʻomau ʻana i ka hāpai ʻana.

ʻO kahi hysterectomy (ʻoki e wehe i ka uterus) he koho paha no nā wahine makua ʻaʻole makemake e hāpai i ka wā e hiki mai ana.

Ma hope o ka mālama ʻana, e ukali ʻia kāu pae hCG. He mea nui e hōʻalo i kahi hāpai hou a hoʻohana i kahi pale pale pono no 6 a 12 mau mahina ma hope o ka mālama ʻana no kahi hāpai wahine molar. ʻAe kēia manawa i ka hoʻāʻo pololei ʻana e ʻike pono ʻaʻole hoʻi e ulu hou nā mea ʻino. ʻO nā wahine hāpai koke ma hope koke o ka hāpai ʻana o ka molar i ka makaʻu nui i ka hāpai ʻana i kahi molar hou.

ʻO ka hapa nui o nā HM he noncancerous (ʻano maikaʻi). Hoʻomaʻamaʻa maʻamau ka hoʻomaʻamaʻa. He mea nui ka ukali kokoke ʻana e kāu mea lawelawe e hōʻoia i ka hala ʻana o nā hōʻailona o ka hāpai ʻana o ka molar a hoʻi i nā maʻamau o nā ʻano homone hāpai i ka maʻamau.

Ma kahi o 15% o nā hihia o ka HM hiki ke lilo i mea hoʻouka. Hiki i kēia mau mole ke ulu hohonu i loko o ka paia uterine a kumu i ke kahe ʻana a i ʻole nā ​​pilikia ʻē aʻe. ʻO kēia ʻano mole e pane pinepine i nā lāʻau.

I kekahi mau manawa o ka HM piha, hoʻomohala nā mole i kahi choriocarcinoma. He maʻi ʻaʻai ulu ulu kēia. Lapaʻau maikaʻi ʻia ia me ka chemotherapy, akā hiki ke hoʻoweliweli i ke ola.

Komo pū nā pilikia o ka hāpai ʻana o molar:

• Hoʻololi i ka maʻi molar invasive a i ʻole choriocarcinoma
• Preeclampsia
• Nā pilikia thyroid
• Molar hāpai keiki e hoʻomau a hoʻi paha

ʻO nā pilikia mai ke ʻoki e wehe i kahi hāpai hāpai molar e komo pū paha:

• Kahe nui ʻana o ke kahe, koi paha i ke koko
• Nā hopena ʻaoʻao o ka anesthesia

Mole Hydatid; Hāpai keiki Molar; Hyperemesis - molara

• Uterus
• Anatomy uterine maʻamau (ʻoki ʻoki)

ʻO Bouchard-Fortier G, ʻOihana A. A. ʻO ka maʻi trophoblastic Gestational: mole hydatidiform, nonmetastatic a me metastatic gestational trophoblastic tumo: ʻike hōʻoia a me ka hoʻokele. I: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Gynecology Comprehensive. ʻEpekema 7 Piladelapia, PA: Elsevier; 2017: chap 35.

ʻO Goldstein DP, Berkowitz RS. Maʻi maʻi trophoblastic I: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. ʻO Oncology Clinical ʻo Abboff. 5th lā. Piladelapia, PA: Elsevier Saunders; 2014: chap 90.

Salani R, Copeland LJ. Nā maʻi kūpilikiʻi a me ka hāpai keiki. I: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Nā Obstetrics: Nā Pregnancies Maʻamau a me nā pilikia. ʻEpekema 7 Piladelapia, PA: Elsevier; 2017: chap 50.

Salhi BA, Nagrani S. Kūpilikiʻi koʻikoʻi o ka hāpai ʻana. I: Nā paia RM, Hockberger RS, Gausche-Hill M, nā ʻaoʻao. ʻO Rosen's Emergency Medicine: Nā Manaʻo Manaʻo a me ka hana lapaʻau. 9th ed. Piladelapia, PA: Elsevier; 2018: chap 178.