Qhov Tseem Ceeb - PCOS vs Endometriosis
Ovaries ua lub luag haujlwm tseem ceeb hauv kev yug me nyuam thiab kev saib xyuas ntawm poj niam lub cev. Lawv tsim cov tshuaj hormones tsim nyog thiab pab kom loj hlob ntawm cov qe qe khaws cia hauv lub zes qe menyuam cortex. PCOS thiab endometriosis yog ob yam kab mob gynecological uas cuam tshuam rau zes qe menyuam thiab fertility ntawm tus neeg mob. PCOS los yog Polycystic zes qe menyuam syndrome yog ib qho kev mob ntawm zes qe menyuam uas muaj ntau yam me me hauv lub zes qe menyuam thiab los ntawm kev tsim cov androgen ntau dhau ntawm zes qe menyuam (thiab tsawg dua los ntawm adrenals). Qhov tshwm sim ntawm endometrial nto epithelium thiab / los yog cov qog endometrial thiab stroma sab nraud ntawm lub tsev menyuam kab noj hniav yog hu ua endometriosis. Txawm hais tias PCOS cuam tshuam rau zes qe menyuam nkaus xwb, endometriosis tuaj yeem cuam tshuam rau txhua yam kabmob ntawm lub cev nyob ntawm kev tsiv teb tsaws ntawm endometrial epithelial hlwb. Qhov no tuaj yeem suav tias yog qhov sib txawv tseem ceeb ntawm PCOS thiab endometriosis.
PCOS yog dab tsi?
Polycystic ovarian syndrome (PCOS) yog ib qho kev mob ntawm zes qe menyuam uas muaj ntau yam me me hauv lub zes qe menyuam thiab los ntawm ntau tshaj androgen ntau lawm ntawm zes qe menyuam (thiab tsawg dua los ntawm adrenals). Cov theem siab ntawm androgens muaj nyob rau hauv cov ntshav thaum lub sij hawm PCOS vim txo cov theem ntawm kev sib deev hormone binding globulin. Nws tau xav tias muaj ntau GnRH secretion hauv PCOS, uas ua rau nce LH thiab androgen secretion.
Hauv PCOS, hyperinsulinemia thiab insulin tsis kam yog nquag pom. Vim li no, qhov tshwm sim ntawm hom 2 mob ntshav qab zib mellitus yog 10 npaug ntawm cov poj niam uas muaj PCOS ntau dua li cov neeg ib txwm muaj. PCOS ua rau muaj kev pheej hmoo hyperlipidemia thiab kab mob plawv los ntawm ntau qhov quav. Cov txheej txheem uas txuas cov pathogenesis ntawm polycystic zes qe menyuam nrog anovulation, hyperandrogenism thiab insulin kuj tseem tsis tau paub. Feem ntau, muaj tsev neeg keeb kwm ntawm hom 2 mob ntshav qab zib lossis PCOS uas qhia txog kev cuam tshuam ntawm caj ces.
Tshuaj Kho Mob
Tsis ntev tom qab menarche, feem ntau cov neeg mob uas muaj PCOS muaj amenorrhea / oligomenorrhea thiab / los yog hirsutism thiab pob txuv.
- Hirsutism - Qhov no tuaj yeem ua rau muaj kev nyuaj siab loj hauv cov poj niam hluas thiab tuaj yeem cuam tshuam tsis zoo rau kev sib raug zoo ntawm tus neeg mob.
- Hnub nyoog thiab nrawm ntawm qhov pib - Hirsutism ntsig txog PCOS feem ntau tshwm nyob ib puag ncig menarche thiab nce qeeb thiab tsis tu ncua hauv cov hluas thiab thaum ntxov
- Nrog kev zoo siab
- rog dhau lossis rog
Nyob zoo ib tsoom niam txiv kwv tij neej tsas
Kev tshawb nrhiav
- Serum tag nrho Testosterone - Nws feem ntau nce siab
- Lwm cov qib androgen ex: Androstenedione thiab Dehydroepiandrosterone sulfate
- 17 alpha - hydroxyprogesterone ntau ntau
- Gonadotropin qib
- qib Estrogen
- Ovarian ultrasound - Qhov no tuaj yeem pom cov tshuaj ntsiav tuab, ntau yam 3-5 hli hlwv, thiab hyperechogenic stroma
- YSerum prolactin
Dexamethasone kev sim tshuaj tua kab mob, CT lossis MRI ntawm adrenals thiab xaiv cov venous sampling raug pom zoo yog tias tus qog androgen-secreting yog xav tias kho mob lossis tom qab tshawb xyuas.
Diagnosis
Ua ntej tuaj txog ntawm qhov kev kuaj pom tseeb ntawm PCOS qhov muaj peev xwm ntawm lwm yam ua rau xws li CAH, Cushing syndrome thiab virilizing qog ntawm zes qe menyuam lossis adrenals yuav tsum raug cais tawm.
Raws li Rotterdam Cov Txheej Txheem luam tawm xyoo 2003, tsawg kawg ob ntawm peb cov txheej txheem hais hauv qab no yuav tsum muaj tam sim no los kuaj xyuas PCOS.
- Tshuaj kho mob thiab / lossis biochemical pov thawj ntawm hyperandrogenism
- Oligo-ovulation thiab/los yog anovulation
- Polycystic zes qe menyuam ntawm ultrasound
Daim duab 01: Ultrasound Scan ntawm Polycystic Ovary
Kev tswj hwm
Kev Kho Mob Hauv Zos rau Hirsutism
Depilatory creams, waxing, bleaching, plucking lossis shaving feem ntau yog siv los txo tus nqi thiab faib cov plaub hau tsis xav tau. Cov txheej txheem zoo li no tsis ua rau mob hnyav lossis txhim kho qhov mob hnyav ntawm hirsutism. Siv ntau hom 'laser' tshem tawm cov plaub hau thiab electrolysis yog ntau qhov kev daws teeb meem. Cov txheej txheem no muaj txiaj ntsig zoo thiab kim heev tab sis tseem yuav tsum tau rov kho dua mus ntev. Eflornithine cream tuaj yeem cuam tshuam cov plaub hau kev loj hlob, tab sis tsuas yog siv tau rau qee tus neeg mob xwb.
YSystemic Therapy rau Hirsutism
Kev kho mob mus sij hawm ntev yog ib txwm xav tau vim qhov teeb meem zoo li rov tshwm sim dua thaum kev kho mob tsis txuas ntxiv. Cov tshuaj nram qab no tuaj yeem siv rau hauv kev kho mob ntawm hirsutism.
- Estrogen
- YCyproterone acetate
- Spironolactone
- Finasteride
- YFlutamide
Tshuaj Kho Mob Menstrual Disturbance
Kev tswj hwm ntawm cyclical estrogen / progestogen yuav tswj kev coj khaub ncaws thiab tshem tawm cov tsos mob ntawm oligo-lossis amenorrhea. Vim tias muaj kev sib koom ua ke ntawm PCOS thiab insulin tsis kam, Metformin (500mg peb zaug ib hnub) feem ntau muab rau cov neeg mob PCOS.
Kev kho rau Fertility hauv PCOS
- YClomifene
- Low-dose FSH
YEndometriosis yog dab tsi?
Kev muaj cov kab mob endometrial deg epithelium thiab / lossis cov qog endometrial thiab stroma sab nraud ntawm lub uterine kab noj hniav yog hu ua endometriosis. Qhov tshwm sim ntawm tus mob no yog siab heev ntawm cov poj niam uas muaj hnub nyoog ntawm 35-45 xyoo. Peritoneum thiab zes qe menyuam yog qhov chaw tshaj plaws uas cuam tshuam los ntawm endometriosis.
Pathophysiology
Qhov tseeb mechanism ntawm pathogenesis tsis tau to taub. Muaj plaub lub ntsiab lus lees paub.
Menstrual Regurgitation thiab Implantation
Thaum ua poj niam cev xeeb tub, qee cov qog nqaij hlav endometrial tuaj yeem txav mus rau hauv qhov kev taw qhia rov qab es tsis txhob txav mus los ntawm qhov chaw mos. Cov qog thiab cov ntaub so ntswg uas siv tau no tau cog rau ntawm qhov chaw peritoneal ntawm cov kab noj hniav endometrial. Qhov kev xav no tau txhawb nqa los ntawm qhov siab ntawm qhov tshwm sim ntawm endometriosis ntawm cov poj niam uas muaj qhov txawv txav ntawm qhov chaw mos uas pab txhawb kev txav mus los ntawm kev coj khaub ncaws.
YCoelomic Epithelium Transformation
Feem ntau ntawm cov hlwb hauv cov cheeb tsam sib txawv ntawm cov poj niam qhov chaw mos xws li Mullerian ducts, peritoneal nto thiab zes qe menyuam muaj keeb kwm. Txoj kev xav ntawm coelomic epithelium transformation qhia tias cov hlwb no redifferentiate rau hauv lawv cov primitive daim ntawv thiab ces hloov mus rau hauv lub endometrial hlwb. Cov cellular redifferentiations tau xav tias yuav tshwm sim los ntawm ntau yam tshuaj lom neeg tso tawm los ntawm endometrium.
Kev cuam tshuam ntawm caj ces thiab kev tiv thaiv kab mob
Qhov muaj peev xwm ntawm cov hlwb endometrial tsiv mus rau qhov chaw nyob deb ntawm cov kab mob endometrial los ntawm cov ntshav thiab cov hlab ntsha lymphatic tsis tuaj yeem raug cais tawm.
Ntxiv rau lawv, iatrogenic ua rau xws li kev cog hniav phais thiab digoxin raug mob kuj suav nrog ntau qhov ua rau endometriosis.
YOvarian Endometriosis
Ovarian endometriosis tuaj yeem tshwm sim los yog sab hauv lossis sab hauv.
Cov Kab Mob Tsis Txaus Siab
Cov kab mob loj heev feem ntau tshwm sim raws li cov cim hlawv ntawm lub zes qe menyuam. Muaj ntau cov kab mob hemorrhagic nyob rau saum npoo uas ua rau muaj qhov tshwm sim zoo li no. Cov kab mob no feem ntau cuam tshuam nrog kev tsim cov adhesions. Xws li adhesions tsim nyob rau tom qab nam ntawm zes qe menyuam ua rau nws fixation rau zes qe menyuam fossa.
Endometrioma
Endometriotic cysts lossis chocolate cysts ntawm zes qe menyuam muaj cov yam ntxwv xim av xim av. Cov hlwv no tshwm sim ntawm qhov chaw ntawm zes qe menyuam thiab maj mam nkag mus rau hauv lub cortex. Endometriotic cysts tuaj yeem tawg tawm lawv cov ntsiab lus tawm, ua rau tsim cov adhesions.
YPelvic Endometriosis
Uterosacral ligaments yog cov qauv cuam tshuam feem ntau los ntawm tus mob no. Cov ligaments tuaj yeem tau txais kev sib tw nodular thiab thicken vim yog kev cog qoob loo ntawm cov ntaub so ntswg endometrial.
YRectovaginal Septum Endometriosis
Cov kab mob endometrial nyob rau hauv lub uterosacral ligaments tuaj yeem nkag mus rau lub qhov quav ntawm lub qhov quav. Tom qab lawv tsiv mus rau lub qhov quav, cov ntaub so ntswg endometrial tsim cov adhesions ntom ntom uas thaum kawg ua rau tag nrho obliteration ntawm lub hnab ntawm Douglas. Dyspareunia thiab hloov cov cwj pwm hauv plab yog cov tsos mob ntawm cov kab mob endometriosis.
peritoneal endometriosis
Qhov no suav nrog cov hmoov hlawv hom kab mob tshwm sim ntawm peritoneum.
YDeep Infiltrating Endometriosis
Kev nkag mus ntawm cov qog endometrial thiab stroma ntau dua 5cm hauv qab lub peritoneal nto yog txheeb xyuas tias qhov tob infiltrating endometriosis. Qhov no ua rau mob pelvic hnyav thiab dyspareunia. Mob plab thiab dysmenorrhea yog lwm cov tsos mob ntawm qhov tob infiltrating endometriosis.
Daim duab 01: Endometriosis
Cov tsos mob ntawm endometriosis
- Congestive dysmenorrhea
- Ovulation mob
- Deep dyspareunia
- mob plab pelvic
- Kev mob ntshav qab zib sacral
- mob plab mob
- kev ua poj niam txawv txav xws li oligomenorrhea thiab menorrhagia
Cov tsos mob ntawm Endometriosis ntawm Distal Sites
- Lub plab - ib qho ntshav los ntawm lub qhov quav, kev mob plab zom mov, thiab dyschezia
- zais zis - dysuria, hematuria, zaus, thiab ceev
- Pulmonary – hemoptysis, hemopneumothorax
- Pleura - pleuritic mob hauv siab, ua tsis taus pa
Diagnosis
Kev kuaj mob yog raws li cov tsos mob classic.
Kev tshawb nrhiav
- CA 125 qib- nce hauv endometriosis
- Anti-endometrial antibodies nyob rau hauv cov ntshav thiab peritoneal kua
- YUltrasonography
- MRI
- Laparoscopy - qhov no yog qhov ntsuas kub rau kev kuaj mob endometriosis
- Biopsy
Kev tswj hwm
Kev tswj tus neeg mob endometriosis nyob ntawm plaub yam tseem ceeb
- poj niam hnub nyoog
- Nws xav kom cev xeeb tub
- Mob hnyav ntawm cov tsos mob thiab qhov twg ntawm qhov txhab
- Cov txiaj ntsig ntawm kev kho yav dhau los
Kev Tswj Xyuas Kev Kho Mob
- Tshuaj ntsuab tuaj yeem muab rau qhov mob nyem
- Kev kho hormonal nrog cov tshuaj tiv thaiv kab mob, progesterone, GnRH thiab lwm yam.
- Kev Tswj Xyuas Kev Kho Mob
- Kev phais phais (piv txwv li laparoscopy lossis laparotomy)
- Kho cov kev phais mob xws li adhesiolysis, ib feem ntawm kev txiav tawm ntawm cov ntaub so ntswg adenomyotic thiab tubal flushing nrog roj-soluble media
Dab tsi zoo sib xws ntawm PCOS thiab Endometriosis?
- Ob yam mob yog kab mob gynecological.
- Lawv cuam tshuam rau zes qe menyuam ncaj qha lossis tsis ncaj.
- Kev tsis muaj menyuam yog ib qho teeb meem ntawm ob qho xwm txheej no.
Qhov txawv ntawm PCOS thiab Endometriosis yog dab tsi?
YPCOS vs Endometriosis |
|
| Polycystic ovarian syndrome yog ib qho mob ntawm zes qe menyuam uas muaj ntau lub hlwv me me hauv lub zes qe menyuam thiab ntau dhau ntawm androgen ntau lawm los ntawm zes qe menyuam. | Kev muaj cov kab mob endometrial deg epithelium thiab / lossis cov qog endometrial thiab stroma sab nraud ntawm lub tsev menyuam kab noj hniav hu ua endometriosis. |
| Effect on Ovaries | |
| Qhov no tsuas cuam tshuam rau zes qe menyuam. | Qhov no tuaj yeem cuam tshuam ntau lwm yam hauv lub cev. |
| keeb kwm ntawm pathology | |
| Keeb kwm ntawm pathology yog nyob rau hauv zes qe menyuam. | Keeb kwm ntawm pathology yog sab nraum zes qe menyuam. |
Summary – PCOS vs Endometriosis
Polycystic zes qe menyuam syndrome yog ib qho kev mob ntawm zes qe menyuam uas muaj ntau yam me me hauv lub zes qe menyuam thiab los ntawm kev tsim cov androgen ntau dhau ntawm zes qe menyuam. Qhov tshwm sim ntawm endometrial nto epithelium thiab / los yog cov qog endometrial thiab stroma sab nraud ntawm lub tsev menyuam kab noj hniav yog hu ua endometriosis. Endometriosis tuaj yeem cuam tshuam rau ntau lub cev ntawm lub cev nrog rau zes qe menyuam thiab lwm qhov chaw xws li lub ntsws, tab sis PCOS tsuas cuam tshuam rau zes qe menyuam. Qhov no yog qhov txawv ntawm PCOS thiab endometriosis.
Download PDF Version ntawm PCOS vs Endometriosis
Koj tuaj yeem rub tawm PDF version ntawm kab lus no thiab siv nws rau offline hom phiaj raws li daim ntawv ceeb toom. Thov download PDF version ntawm no Qhov txawv Ntawm PCOS thiab Endometriosis
