{"id":52091,"date":"2023-10-27T16:17:50","date_gmt":"2023-10-27T09:17:50","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=52091"},"modified":"2024-05-06T11:07:51","modified_gmt":"2024-05-06T04:07:51","slug":"lac-noi-mac-tu-cung-la-gi-nguyen-nhan-va-phuong-phap-dieu-tri","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/lac-noi-mac-tu-cung-la-gi-nguyen-nhan-va-phuong-phap-dieu-tri\/","title":{"rendered":"L\u1ea1c n\u1ed9i m\u1ea1c t\u1eed cung l\u00e0 g\u00ec? Nguy\u00ean nh\u00e2n v\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"

L\u1ea1c n\u1ed9i m\u1ea1c t\u1eed cung (LNMTC) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd m\u1ea1n t\u00ednh, ti\u1ebfn tri\u1ec3n kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n, \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a m\u00f4 n\u1ed9i m\u1ea1c t\u1eed cung (NMTC) b\u00ean ngo\u00e0i khoang t\u1eed cung v\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam m\u1ea1n t\u00ednh ph\u1ee5 thu\u1ed9c estrogen c\u1ee7a c\u00e1c c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu b\u1ecb \u1ea3nh h\u01b0\u1edfng – th\u01b0\u1eddng l\u00e0 c\u00e1c c\u01a1 quan v\u00f9ng ch\u1eadu \u0110\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh ph\u1ee5 khoa ph\u1ed5 bi\u1ebfn nh\u1ea5t.<\/b><\/p>\n

<\/b>T\u1ea3i b\u1ea3n PDF<\/span> T\u1ea0I \u0110\u00c2Y<\/span><\/a><\/p>\n

Ngu\u1ed3n: S\u00e1ch \u0110\u1ea1i c\u01b0\u01a1ng s\u1ee9c kh\u1ecfe t\u00ecnh d\u1ee5c – Ch\u01b0\u01a1ng 2: R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c n\u1eef<\/span><\/p>\n

L\u1ea1c n\u1ed9i m\u1ea1c t\u1eed cung v\u00e0 ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c n\u1eef<\/span><\/p>\n

Nh\u00e0 xu\u1ea5t b\u1ea3n Y h\u1ecdc<\/span><\/p>\n

Ch\u1ee7 bi\u00ean: PGS.TS.BS. L\u00ea Minh T\u00e2m<\/span><\/p>\n

Bi\u00ean so\u1ea1n<\/span><\/p>\n

PGS.TS.BS. T\u00f4n N\u1eef V\u00e2n Anh<\/span><\/p>\n

ThS.BS. H\u1ed3 Tr\u1ea7n Tu\u1ea5n H\u00f9ng<\/span><\/p>\n

ThS.BS. Nguy\u1ec5n \u0110\u1eafc Nguy\u00ean<\/span><\/p>\n

ThS.BS. Tr\u1ea7n Th\u1ecb Nh\u01b0 Qu\u1ef3nh`<\/span><\/p>\n

KHAI TH\u00c1C TI\u1ec0N S\u1eec V\u00c0 KH\u00c1M L\u00c2M S\u00c0NG<\/b><\/h2>\nGI\u1edaI THI\u1ec6U<\/b><\/h2>\n
L\u1ea1c n\u1ed9i m\u1ea1c t\u1eed cung (LNMTC) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd m\u1ea1n t\u00ednh, ti\u1ebfn tri\u1ec3n kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n, d\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a m\u00f4 n\u1ed9i m\u1ea1c t\u1eed cung (NMTC) b\u00ean ngo\u00e0i khoang t\u1eed cung v\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam m\u1ea1n t\u00ednh ph\u1ee5 thu\u1ed9c estrogen c\u1ee7a c\u00e1c c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu b\u1ecb \u1ea3nh h\u01b0\u1edfng – th\u01b0\u1eddng l\u00e0 c\u00e1c c\u01a1 quan v\u00f9ng ch\u1eadu \u0110\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng b\u1ec7nh ph\u1ee5 khoa ph\u1ed5 bi\u1ebfn nh\u1ea5t. Ng\u01b0\u1eddi ta \u01b0\u1edbc t\u00ednh r\u1eb1ng t\u1ef7 l\u1ec7 m\u1eafc LNMTC d\u1ea1o \u0111\u1ed9ng t\u1eeb 2% \u0111\u1ebfn 17% \u1edf ph\u1ee5 n\u1eef trong \u0111\u1ed9 tu\u1ed5i sinh s\u1ea3n, \u0111\u1ea1i di\u1ec7n cho h\u01a1n 170 tri\u1ec7u ph\u1ee5 n\u1eef tr\u00ean to\u00e0n c\u1ea7u.<\/span><\/p>\n
C\u01a1 ch\u1ebf b\u1ec7nh sinh c\u1ee7a LNMTC c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c gi\u1ea3i th\u00edch qua s\u1ef1 di chuy\u1ec3n ng\u01b0\u1ee3c d\u00f2ng l\u1eb7p \u0111i l\u1eb7p l\u1ea1i v\u00e0 s\u1ef1 t\u1ed3n t\u1ea1i c\u1ee7a m\u00f4 NMTC b\u1ecb bong ra trong khoang b\u1ee5ng d\u01b0\u1edbi. C\u00e1c tri\u1ec7u ch\u1ee9ng ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a b\u1ec7nh bao g\u1ed3m \u0111au b\u1ee5ng kinh (60-80%), dau v\u00f9ng ch\u1eadu m\u00e3n t\u00ednh (30-50%), v\u00f4 sinh (30-40%) v\u00e0 \u0111au khi giao h\u1ee3p (25-40%). M\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh kh\u00f4ng t\u01b0\u01a1ng \u1ee9ng v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng tr\u00ean l\u00e2m s\u00e0ng.<\/span><\/p>\n
\u200b<\/span><\/p>\n
$\"\u200b\u200bH\u00ecnh$ <\/a>
\u200bH\u00ecnh 8.1. V\u1ecb tr\u00ed l\u1ea1c n\u1ed9i m\u1ea1c t\u1eed cung th\u01b0\u1eddng g\u1eb7p<\/figcaption><\/figure>\n
LNMTC \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n c\u00f3 \u1ea3nh h\u01b0\u1edfng ti\u00eau c\u1ef1c \u0111\u1ebfn th\u1ec3 ch\u1ea5t, t\u1ec9nh th\u1ea7n v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng. C\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 ghi nh\u1eadn LNMTC c\u00f3 t\u00e1c \u0111\u1ed9ng \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn ch\u1ea5t l\u01b0\u1ee3ng \u0111\u1eddi s\u1ed1ng t\u00ecnh d\u1ee5c \u1edf 33,5-71% ng\u01b0\u1eddi ph\u1ee5 n\u1eef. Vercellini v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 k\u1ebft lu\u1eadn nh\u1eefng ph\u1ee5 n\u1eef b\u1ecb LNMTC c\u00f3 ho\u1ea1t \u0111\u1ed9ng t\u00ecnh d\u1ee5c kh\u00f4ng th\u01b0\u1eddng xuy\u00ean v\u00e0 k\u00e9m h\u01a1n so v\u1edbi nh\u1eefng ph\u1ee5 n\u1eef kh\u00f4ng b\u1ecb, trong \u0111\u00f3, \u0111au khi giao h\u1ee3p b\u1ecb LNMTC s\u00e2u, 53% ph\u1ee5 n\u1eef b\u1ecb LNMTC \u1edf ph\u00fac m\u1ea1c v\u00e0\/ho\u1eb7c bu\u1ed3ng tr\u1ee9ng v\u00e0 \u1edf 26% nh\u00f3m ch\u1ee9ng. \u0110\u1eb7c bi\u1ec7t, LNMTC s\u00e2u, m\u1ed9t d\u1ea1ng LNMTC th\u00e2m nh\u1eadp s\u00e2u h\u01a1n Smm b\u1ec1 m\u1eb7t ph\u00fac m\u1ea1c, li\u00ean quan \u0111\u1ebfn d\u00e2y ch\u1eb3ng t\u1eed cung, \u00e2m d\u1ea1o, th\u00e0nh ru\u1ed9t, t\u00fai c\u00f9ng \u00e2m \u0111\u1ea1o, ni\u1ec7u qu\u1ea3n v\u00e0 b\u00e0ng quang, c\u00f3 li\u00ean quan ch\u1eb7t ch\u1ebd \u0111\u1ebfn s\u1ef1 suy gi\u1ea3m ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c. \u0110au khi giao h\u1ee3p l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p c\u1ee7a LNMTC s\u00e2u t\u1ea1i d\u00e2y ch\u1eb1ng t\u1eed cung. C\u00e1c b\u1ec7nh nh\u00e2n n\u1eb1m trong nh\u00f3m m\u1eafc LNMTC \u1edf t\u00fai c\u00f9ng sau \u00e2m \u0111\u1ea1o c\u00f3 nguy c\u01a1 kh\u00f4ng \u0111\u1ea1t \u0111\u01b0\u1ee3c th\u1ecfa m\u00e3n t\u00ecnh d\u1ee5c cao g\u1ea5p 3 l\u1ea7n v\u00e0 gi\u1ea3m kh\u1ea3 n\u0103ng \u0111\u1ea1t c\u1ef1c kho\u00e1i cao g\u1ea5p 2 l\u1ea7n. C\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a v\u1ec1 ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c gi\u1eefa ph\u1ee5 n\u1eef m\u1eafc LNMTC v\u1edbi ph\u1ee5 n\u1eef kh\u00f4ng m\u1eafc. g\u1eb7p \u1edf 67% ph\u1ee5 n\u1eef<\/span><\/p>\n
$\"\u200bH\u00ecnh$ <\/a>
\u200bH\u00ecnh 8.2. L\u1ea1c n\u1ed9i m\u1ea1c t\u1eed cung v\u00e0 t\u00e1c \u0111\u1ed9ng l\u00ean ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c<\/figcaption><\/figure>\n
T\u00ecnh d\u1ee5c n\u1eef ch\u1ecbu s\u1ef1 chi ph\u1ed1i \u0111a y\u1ebfu t\u1ed1 bao g\u1ed3m c\u1ea3 t\u00e2m l\u00fd n\u00ean t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u01a1n \u0111au x\u1ea3y ra khi giao h\u1ee3p c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c l\u00e0m gi\u1ea3m b\u1edfi nhi\u1ec1u y\u1ebfu t\u1ed1 kh\u00e1c nh\u01b0 m\u1ee9c \u0111\u1ed9 th\u00e2n m\u1eadt c\u1ee7a c\u1eb7p v\u1ee3 ch\u00f3ng ng\u01b0\u1ee1ng \u0111au c\u00e1 nh\u00e2n, h\u1ed7 tr\u1ee3 t\u00ecnh c\u1ea3m c\u1ee7a b\u1ea1n t\u00ecnh, s\u1ef1 quy\u1ebfn r\u0169 ho\u1eb7c c\u1ea3m x\u00fac \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh trong h\u00f4n nh\u00e2n v\u00e0 k\u1ebf c\u1ea3 ch\u1ea5t l\u01b0\u1ee3ng ch\u0103m s\u00f3c y t\u1ebf, nh\u1eefng y\u1ebfu t\u1ed1 c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edbng \u0111\u1ebfn nh\u1eadn th\u1ee9c c\u1ee7a ng\u01b0\u1eddi ph\u1ee5 n\u1eef.<\/span><\/p>\n
C\u01a0 CH\u1ebe B\u1ec6NH SINH<\/b><\/h2>\n
\u0110au<\/b><\/h3>\n
C\u01a1n \u0111au li\u00ean quan \u0111\u1ebfn LNMTC l\u00e0 y\u1ebfu t\u1ed1 ch\u00ednh l\u00e0m gi\u1ea3m ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng v\u00ec c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn gi\u1ea3m ch\u1ea5t l\u01b0\u1ee3ng gi\u1ea5c ng\u1ee7, gia t\u0103ng s\u1ef1 c\u0103ng th\u1eb3ng, gi\u1ea3m m\u1ee9c \u0111\u1ed9 ho\u1ea1t \u0111\u1ed9ng th\u1ebf ch\u1ea5t v\u00e0 g\u00e2y ra r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n nh\u01b0 lo l\u1eafng tr\u1ea7m c\u1ea3m hay th\u1eadm ch\u00ed l\u00e0 c\u1ea3m gi\u00e1c c\u00f3 l\u1ed7i v\u1edbi b\u1ea1n t\u00ecnh, g\u00e2y \u1ea3nh h\u01b0\u1edfng ti\u00eau c\u1ef1c \u0111\u1ebfn ho\u1ea1t \u0111\u1ed9ng t\u00ecnh d\u1ee5c c\u1ee7a ng\u01b0\u1eddi ph\u1ee5 n\u1eef. \u0110au khi giao h\u1ee3p \u0111\u1eb7c bi\u1ec7t g\u00e2y kh\u00f3 ch\u1ecbu v\u00ec c\u00f3 th\u1ec3 x\u1ea3y ra b\u1ea5t c\u1ee9 khi n\u00e0o c\u1ed1 r\u1eafn giao h\u1ee3p, trong khi \u0111au b\u1ee5ng kinh th\u01b0\u1eddng ch\u1ec9 \u0111au m\u1ed9t s\u1ed1 ng\u00e0y nh\u1ea5t \u0111\u1ecbnh m\u1ed7i th\u00e1ng. Tri\u1ec7u ch\u1ee9ng \u0111\u01b0\u1ee3c m\u00f4 t\u1ea3 ch\u1ee7 y\u1ebfu l\u00e0 \u0111au s\u00e2u b\u00ean trong \u00e2m \u0111\u1ea1o, \u1edf c\u00f3 t\u1eed cung v\u00f9ng b\u1ee5ng d\u01b0\u1edbi ho\u1eb7c \u0111au n\u00f4ng \u1edf v\u00f9ng \u00e2m h\u1ed9 v\u00e0 m\u1ed9t ph\u1ea7n \u00e2m \u0111\u1ea1o ngo\u00e0i.<\/span><\/p>\n
C\u1ef1c kho\u00e1i v\u00e0 th\u1ecfa m\u00e3n t\u00ecnh d\u1ee5c xu\u1ea5t ph\u00e1t t\u1eeb nhi\u1ec1u y\u1ebfu t\u1ed1 t\u00e2m l\u00fd, gi\u1ea3i ph\u1eabu v\u00e0 sinh l\u00fd. Do c\u1ea3m gi\u00e1c \u0111\u01b0\u1ee3c s\u1ef1 \u0111au \u0111\u1edbn, s\u1ee3 \u0111au c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m k\u00edch th\u00edch t\u00ecnh d\u1ee5c, gi\u1ea3m ti\u1ebft ch\u1ea5t b\u00f4i tr\u01a1n, co b\u00f3p c\u01a1 s\u00e0n ch\u1eadu d\u1eabn \u0111\u1ebfn nh\u1eefng ch\u1ea5n th\u01b0\u01a1ng c\u01a1 h\u1ecdc v\u1ec1 ni\u00eam m\u1ea1c \u00e2m \u0111\u1ea1o v\u00e0 c\u01a1 ni\u1ec7u \u0111\u1ea1o, c\u0169ng nh\u01b0 h\u1ea1n ch\u1ebf s\u1ef1 x\u00e2m nh\u1eadp c\u1ee7a \u00e2m d\u1ea1o.<\/span><\/p>\n
\u1ede b\u1ec7nh nh\u00e2n LNMTC, \u0111au l\u00e0 do s\u1ef1 \u0111\u1ea7y \u1ed1ng c\u1ed5 t\u1eed cung kh\u00f4ng \u0111\u00e0n h\u1ed3i, do ch\u00e8n \u00e9p l\u00e9n c\u00e1c n\u1ed1t LNMTC, do s\u1ef1 c\u1ed1 \u0111\u1ecbnh c\u1ee7a c\u00e1c c\u1ea5u tr\u00fac v\u00f9ng ch\u1eadu qua qu\u00e1 tr\u00ecnh h\u00ecnh th\u00e0nh m\u00f4 s\u1eb9o v\u00e0 x\u01a1 h\u00f3a th\u1ee9 ph\u00e1t v\u00e0 do ch\u1ea5n th\u01b0\u01a1ng th\u1ea7n kinh ho\u1eb7c c\u00e1c k\u00edch th\u00edch vi\u00eam. Ch\u1ec9 c\u1ea7n m\u1ed9t t\u00e1c \u0111\u1ed9ng nh\u1ecf l\u00ean n\u1ed1t LNMTC, c\u1ea3m gi\u00e1c dau c\u00f3 th\u1ebf t\u0103ng l\u00ean d\u1eef d\u1ed9i. Ng\u01b0\u1eddi ta \u0111\u00e3 ch\u1ee9ng minh \u0111\u01b0\u1ee3c r\u1eb1ng c\u00e1c s\u1ee3i th\u1ea7n kinh c\u1ea3m gi\u00e1c th\u01b0\u1eddng xuy\u00ean b\u1ecb t\u1ebf b\u00e0o m\u00f4 LNMTC x\u00e2m l\u1ea5n v\u00e0 \u0111\u01b0\u1ee3c bao quanh b\u1edfi m\u1ed9t s\u1ed1 ch\u1ea5t trung gian h\u00f3a h\u1ecdc do \u0111\u1ea1i th\u1ef1c b\u00e0o v\u00e0 t\u1ebf b\u00e0o mast c\u0169ng nh\u01b0 b\u1ea1ch c\u1ea7u \u0111\u01b0\u1ee3c ho\u1ea1t h\u00f3a t\u1ed5ng h\u1ee3p v\u00e0 gi\u1ea3i ph\u00f3ng trong c\u00e1c t\u1ed5n th\u01b0\u01a1ng LNMTC nh\u01b0 histamine, tryptase, y\u1ebfu t\u1ed1 ho\u1ea1i t\u1eed u alpha, prostaglandin, serotonin, interleukin-] v\u00e0 c\u00e1c y\u1ebfu<\/span><\/p>\n
t\u00f3 t\u0103ng tr\u01b0\u1edfng th\u1ea7n kinh. C\u00e1c t\u1ed5n th\u01b0\u01a1ng\u00a0 c\u00f3 \u0111\u1eb7c t\u00ednh sinh th\u1ea7n kinh r\u00f5 r\u1ec7t v\u1edbi s\u1ef1 gia t\u0103ng bi\u1ec3u hi\u1ec7n c\u1ee7a c\u00e1c s\u1ee3i th\u1ea7n kinh m\u1edbi, s\u1ef1 thay \u0111\u00f3i ph\u00e2n b\u1ed1 c\u1ee7a c\u00e1c s\u1ee3i c\u1ea3m gi\u00e1c v\u00e0 t\u1ef1 \u0111\u1ed9ng \u1ede m\u1ed9t s\u1ed1 v\u1ecb tr\u00ed v\u00e0 t\u0103ng c\u01b0\u1eddng \u0111i\u1ec1u h\u00f2a m\u1ed9t s\u1ed1 t\u1ebf b\u00e0o th\u1ea7n kinh. S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a LNMTC d\u1eabn \u0111\u1ebfn s\u1ef1 \u0111i\u1ec1u bi\u1ebfn b\u00e1t th\u01b0\u1edfng c\u1ee7a \u0111\u1ea7u v\u00e0o c\u1ea3m th\u1ee5 v\u1edbi s\u1ef1 ga t\u0103ng t\u00edn hi\u1ec7u th\u1ea7n kinh \u0111i l\u00ean v\u1ecf n\u00e3o, do \u0111\u00f3, c\u01a1n \u0111au b\u1eaft ngu\u1ed3n t\u1eeb c\u00e1c n\u1ed1t LNMTC \u0111\u01b0\u1eddng nh\u01b0 d\u1eabn \u0111\u1ebfn nh\u1ea1y c\u1ea3m trung t\u00e2m v\u00e0 qu\u00e1 m\u1eafn to\u00e0n th\u00e2n. V\u00ec v\u1eady, \u0111au khi giao h\u1ee3p c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem nh\u01b0 m\u1ed9t lo\u1ea1i \u0111au n\u1ed9i t\u1ea1ng th\u1ee9 ph\u00e1t sau vi\u00eam m\u1ea1n t\u00ednh v\u00e0 bao g\u1ed3m m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 nh\u01b0 t\u0103ng tr\u01b0\u01a1ng l\u1ef1c, t\u00edn hi\u1ec7u th\u1ea7n kinh t\u1ea1i v\u1ecf n\u00e3o v\u00e0 y\u1ebfu t\u1ed1 t\u00e2m l\u00fd.<\/span><\/p>\n
Tr\u00ean th\u1ef1c t\u1ebf, m\u1ed9t s\u1ed1 ph\u1ee5 n\u1eef h\u1ecdc c\u00e1ch th\u00edch nghi b\u1eb1ng c\u00e1ch thay \u0111\u1ed5i t\u01b0 th\u1ebf quan h\u1ec7 nh\u1eb1m gi\u1ea3m c\u01a1n \u0111au. Tuy nhi\u00ean, s\u1ef1 kh\u00f3 ch\u1ecbu n\u00e0y th\u01b0\u1eddng d\u1eabn \u0111\u1ebfn nh\u1eefng h\u1eadu qu\u1ea3 nh\u01b0 gi\u1ea3m kho\u00e1i c\u1ea3m, gi\u1ea3m s\u1ef1 th\u01b0 gi\u00e3n v\u00e0 th\u1ecfa m\u00e3n sau khi quan h\u1ec7 t\u00ecnh d\u1ee5c, h\u1ea1n ch\u1ebf t\u00e1n su\u1ea5t giao h\u1ee3p, t\u0103ng s\u1ef1 lo l\u1eafng, thi\u1ebfu t\u1ef1 tin v\u00e0 cu\u1ed1i c\u00f9ng l\u00e0 suy gi\u1ea3m s\u00f3ng th\u1ec3 ch\u1ea5t l\u01b0\u1ee3ng \u0111\u1eddi s\u1ed1ng t\u00ecnh d\u1ee5c. H\u01a1n n\u1eefa tr\u1ea3i nghi\u1ec7m \u0111au \u0111\u1edbn v\u00e0 m\u00e1t c\u1ef1c kho\u00e1i l\u1eb7p \u0111i l\u1eb7p l\u1ea1i t\u1ea1o ra nh\u1eefng ph\u1ea3n x\u1ea1 ti\u00eau c\u1ef1c g\u00e2y ra ri lo\u1ea1n ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c v\u00e0 n\u00e9 tr\u00e1nh giao h\u1ee3p, \u0111\u00e2y c\u0169ng c\u00f3 th\u1ec3 l\u00e0 nguy\u00ean nh\u00e2n \u0111\u1ed5 v\u1ee1 c\u1ee7a c\u00e1c c\u1eb7p v\u1ee3 ch\u1ed3ng B\u1ea1n t\u00ecnh c\u1ee7a nh\u1eefng ng\u01b0\u1eddi ph\u1ee5 n\u1eef m\u1eafc LNMTC \u0111\u01b0\u1ee3c khuy\u1ebfn kh\u00edch tham gia v\u00e0o vi\u1ec7c ki\u1ec3m so\u00e1t b\u1ec7nh ngay t\u1eeb \u0111\u1ea7u. Vi\u1ec7c t\u01b0 v\u1ea5n th\u00edch h\u1ee3p cho c\u00e1c c\u1eb7p \u0111\u00f4i v\u1ec1 b\u1ea3n ch\u1ea5t c\u00f9ng nh\u1eefng h\u1eadu qu\u1ea3 ti\u1ec1m \u1ea9n c\u1ee7a c\u0103n b\u1ec7nh n\u00e0y v\u1edbi \u0111\u1eddi s\u1ed1ng t\u00ecnh d\u1ee5c c\u00f3 th\u1ebf gi\u00fap c\u1ea3i thi\u1ec7n ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng.<\/span><\/p>\n
Tr\u1ea7m c\u1ea3m<\/b><\/h3>\n
T\u1ef7 l\u1ec7 tr\u1ea7m c\u1ea3m trong d\u00e2n s\u1ed1 n\u00f3i chung dao \u0111\u1ed9ng t\u1eeb 3-1 1%. Trong c\u00e1c nghi\u00ean c\u1ee9u li\u00ean quan \u0111\u1ec1n LNMTC v\u00e0 tr\u1ea7m c\u1ea3m cho th\u1ea5y c\u00e1c ch\u00ed s\u1ed1 t\u01b0\u01a1ng t\u1ef1 \u1edf b\u1ec7nh nh\u00e2n LNMTC v\u00e0 \u0111au khi giao h\u1ee3p. T\u00e1n su\u1ea5t m\u1eafc tr\u1ea7m c\u1ea3m v\u00e0o kho\u1ea3ng 86%, trong \u0111\u00f3, tr\u1ea7m c\u1ea3m m\u1ee9c \u0111\u1ed9 trung b\u00ecnh\/n\u1eb7ng chi\u1ebfm 52-54%. Nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y c\u1ee7a Donatti v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 quan s\u00e1t th\u1ea5y c\u00f3 m\u1ed1i li\u00ean quan gi\u1eefa c\u01b0\u1eddng \u0111\u1ed9 \u0111au do LNMTC v\u00e0 tr\u1ea7m c\u1ea3m nh\u01b0 sau: trong s\u1ed1 nh\u1eefng ng\u01b0\u1eddi ph\u1ee5 n\u1eef b\u1ecb tr\u1ea7m c\u1ea3m v\u1eeba \u0111\u1ebfn n\u1eb7ng, 91,7% b\u1ecb \u0111au b\u1ee5ng kinh d\u1eef d\u1ed9i (p < 0,001) v\u00e0 61,1% \u0111au v\u00f9ng ch\u1eadu m\u00e3n t\u00ednh n\u1eb7ng (p < 0,001). Ph\u00e2n t\u00edch c\u0169ng ch\u1ec9 ra r\u1eb1ng c\u01b0\u1eddng \u0111\u1ed9 c\u1ee7a tri\u1ec7u ch\u1ee9ng \u0111au c\u00f3 li\u00ean quan \u0111\u1ebfn s\u1ef1 hi\u1ec7n di\u1ec7n v\u00e0 m\u1ee9c \u0111\u1ed9 c\u0103ng th\u00e1ng t\u00e2m l\u00fd.<\/span><\/p>\n
\u0110I\u1ec0U TR\u1eca<\/b><\/h2>\n\u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa<\/b><\/h3>\n
LNMTC \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 t\u00e1i ph\u00e1t th\u01b0\u1eddng xuy\u00ean c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 t\u1ed3n th\u01b0\u01a1ng ngay c\u1ea3 sau khi \u0111\u00e3 ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf. Do v\u1eady, ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n t\u1eadp trung v\u00e0o m\u1ee5c ti\u00eau gi\u1ea3m tri\u1ec7u ch\u1ee9ng c\u1ee7a LNMTC h\u01a1n l\u00e0 kh\u1ecfi ho\u00e0n to\u00e0n v\u00e0 \u0111\u00f2i h\u1ecfi m\u1ed9t k\u1ebf ho\u1ea1ch qu\u1ea3n l\u00fd su\u1ed1t \u0111\u1eddi. M\u1ed9t s\u1ed1 lo\u1ea1i thu\u1ed1c \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng th\u00e0nh c\u00f4ng \u1edf nh\u1eefng ph\u1ee5 n\u1eef m\u1eafc ch\u1ee9ng \u0111au khi giao h\u1ee3p li\u00ean quan \u0111\u1ebfn LNMTC th\u1ebf th\u00e2m nhi\u1ec5m t\u1eed cung s\u00e2u bao g\u1ed3m ch\u1ea5t \u0111\u1ed1i v\u1eadn GnRH, danazol \u0111\u1eb7t \u00e2m d\u1ea1o, ch\u1ea5t \u1ee9c ch\u1ebf aromatase \u0111\u01b0\u1eddng u\u1ed1ng, progestin, vi\u00ean u\u1ed1ng tr\u00e1nh thai ph\u1ed1i h\u1ee3p v\u00e0 progesteron \u0111\u01a1n thu\u1ea7n. Gi\u1ea3i ph\u00e1p l\u00fd t\u01b0\u1edfng l\u00e0 gi\u1ea3m m\u1ee9c estradiol xu\u1ed3ng kho\u00e1ng 30-60 pg\/ml \u0111\u1ee7 \u0111\u1ec3 g\u00e2y v\u00f4 kinh v\u00e0 c\u1ea3i thi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng, \u0111\u1ed3ng th\u1eddi gi\u1ea3m nh\u1eb9 c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 nghi\u00eam tr\u1ecdng nh\u01b0 tri\u1ec7u ch\u1ee9ng b\u1ed1c h\u1ecfa v\u00e0 gi\u1ea3m t\u00ecnh tr\u1ea1ng lo\u00e3ng x\u01b0\u01a1ng,<\/span><\/p>\n
$\"C\u01a1$ <\/a>
C\u01a1 ch\u1ebf th\u1ea7n kinh li\u00ean quan \u0111\u1ebfn tri\u1ec7u ch\u1ee9ng \u0111au c\u1ee7a b\u1ec7nh l\u00fd l\u1ea1c n\u1ed9i m\u1ea1c t\u1eed cung<\/figcaption><\/figure>\n
\u200b<\/span><\/p>\n
$\"\u200bH\u00ecnh$ <\/a>
\u200bH\u00ecnh 8.4. M\u1ed9t s\u1ed1 c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c l\u00ean l\u1ea1c n\u1ed9i m\u1ea1c t\u1eed cung<\/figcaption><\/figure>\n
Danazol<\/b><\/p>\n
Li\u1ebfu 200 m\u1eb9\/ng\u00e0y x 12 th\u00e1ng \u0111\u01b0\u1eddng u\u1ed1ng:<\/span><\/i><\/p>\n
K\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u c\u1ee7a Razzi v\u00e0 cs \u0111\u00e3 cho th\u1ea5y c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111au b\u1ee5ng kinh, \u0111au v\u00f9ng ch\u1eadu m\u00e3n t\u00ednh, \u0111au khi giao h\u1ee3p \u0111\u00e3 bi\u1ebfn m\u1ea5t sau \u00f3 th\u00e1ng \u0111i\u1ec1u tr\u1ecb v\u00e0 hi\u1ec7u qu\u1ea3 t\u1ed3n t\u1ea1i \u0111\u1ebfn 12 th\u00e1ng. K\u00edch th\u01b0\u1edbc c\u00e1c n\u1ed1t LNMTC t\u1ea1i \u00e2m \u0111\u1ea1o gi\u1ea3m t\u1eeb 3,1 m\u00cd xu\u1ed1ng 1,2 m\u00cd sau 1 n\u0103m.<\/span><\/p>\n
Li\u1ec1u I00 mg\/ng\u00e0y x6 th\u00e1ng \u0111\u01b0\u1eddng u\u1ed1ng:<\/span><\/i><\/p>\n
M\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c s\u1eed d\u1ee5ng danazol li\u1ec1u n\u00e0y v\u00e0 cho th\u1ea5y hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng t\u1ef1. Tuy v\u1eady, h\u1ea1n ch\u1ebf c\u1ee7a c\u00e1c nghi\u00ean c\u1ee9u l\u00e0 c\u1ee1 m\u1eabu kh\u00e1 nh\u1ecf. C\u00f9ng v\u1edbi c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 \u0111\u01b0\u1ee3c ghi nh\u1eadn, hi\u1ec7n nay, tr\u00ean l\u00e0m s\u1ea3ng \u00edt s\u1eed d\u1ee5ng Danazol v\u1edbi vai tr\u00f2 gi\u1ea3m c\u01a1n \u0111au c\u1ee7a LNMTC.<\/span><\/p>\n
Vi\u00ean u\u1ed1ng tr\u00e1nh thai (OCP – Oral Contraceptive Pill)<\/b><\/p>\n
Nghi\u00ean c\u1ee9u c\u1ee7a Vercellini v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 k\u1ebft lu\u1eadn r\u1eb1ng vi\u00ean u\u1ed1ng tr\u00e1nh thai k\u1ebft h\u1ee3p c\u00f3 ch\u1ee9a ethinyl estradiol (FE) v\u00e0 progestin th\u1ebf h\u1ec7 th\u1ee9 hai v\u1edbi li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 th\u1ec3 n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng nh\u01b0 l\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tay trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p LNMTC nguy c\u01a1 th\u1ea5p v\u00e0 trung b\u00ecnh. B\u1ea3ng c\u00e1ch gi\u1ea3m kh\u1ed1i l\u01b0\u1ee3ng m\u00e1u ch\u1ea3y th\u1ee9 ph\u00e1t t\u1ed1i thi\u1ec3u t\u1eeb c\u00e1c t\u1ed5n th\u01b0\u01a1ng LNMTC, gi\u1ea3m thi\u1ec3u l\u01b0u l\u01b0\u1ee3ng m\u00e1u ch\u1ea3y ng\u01b0\u1ee3c, OCP \u0111\u00f3ng vai tr\u00f2 quan tr\u1ecdng trong vi\u1ec7c ki\u1ec3m so\u00e1t LNMTC. M\u1ed9t th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1edbi gi\u1ea3 d\u01b0\u1ee3c, vi\u1ec7c s\u1eed d\u1ee5ng OCP trong kho\u1ea3ng th\u1eddi gian t\u1ed1i thi\u1ec3u 4 th\u00e1ng cho th\u1ea5y c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au b\u1ee5ng kinh kho\u1ea3ng 50%. Tuy nhi\u00ean, nh\u1eefng nghi\u00ean c\u1ee9u kh\u00e1c l\u1ea1i b\u00e1o c\u00e1o r\u1eb1ng kh\u00f4ng c\u00f3 b\u00e1t k\u1ef3 t\u00e1c d\u1ee5ng c\u1ea3i thi\u1ec7n c\u01a1n \u0111au v\u00f9ng ch\u1eadu m\u00e3n t\u00ednh hay \u0111au khi giao h\u1ee3p. Theo Casper, nh\u1eefng b\u1ec7nh nh\u00e2n LNMTC c\u00f3 c\u01a1n \u0111au v\u00f9ng ch\u1eadu t\u00e1i ph\u00e1t khi \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1ea3ng OCP c\u1ea7n \u0111\u01b0\u1ee3c chuy\u1ec3n sang m\u1ed9t lo\u1ea1i OCP kh\u00e1c, \u0111\u00f3ng th\u1eddi c\u00f3 s\u1ef1 gia t\u0103ng nguy c\u01a1 m\u1eafc b\u1ec7nh \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea7y \u1edf nh\u1eefng tr\u01b0\u1eddng h\u1ee3p s\u1eed d\u1ee5ng OCP tr\u01b0\u1edbc \u0111\u00f3 v\u00e0 nguy c\u01a1 ti\u1ebfn tri\u1ec3n th\u00e0nh LNMTC x\u00e2m l\u1ea5n h\u01a1n khi s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i OCP c\u00f3 ch\u1ee9a li\u1ec1u l\u01b0\u1ee3ng cao estrogen. H\u01a1n n\u1eefa, t\u00ecnh tr\u1ea1ng \u0111\u1ec1 kh\u00e1ng Progesterone t\u1ea1o ra nhi\u1ec1u hi\u1ec7u qu\u1ea3 kh\u00f4ng mong mu\u1ed1n.<\/span><\/p>\n
Progestin<\/b><\/p>\n
Progestin l\u00e0 h\u1ee3p ch\u1ea5t t\u1ed5ng h\u1ee3p c\u00f3 t\u00e1c d\u1ee5ng \u1ee9c ch\u1ebf ti\u1ebft steroid bu\u1ed3ng tr\u1ee9ng th\u00f4ng qua feedback ng\u01b0\u1ee3c l\u00ean tr\u1ee5c h\u1ea1 \u0111\u1ed3i – tuy\u1ebfn y\u00ean – sinh d\u1ee5c l\u00e0m gi\u1ea3m s\u1ea3n xu\u1ea5t FSH v\u00e0 LH, l\u00e0m gi\u1ea3m l\u01b0\u1ee3ng m\u00e1u kinh, l\u00e0m gi\u1ea3m \u0111\u00e1ng k\u1ec3 l\u01b0\u1ee3ng h\u1ed3ng c\u1ea7u tr\u00e0o ng\u01b0\u1ee3c v\u00e0o khung ch\u1eadu, d\u1eabn \u0111\u1ebfn gi\u1ea3m stress oxy h\u00f3a v\u00e0 s\u1ef1 vi\u00eam nhi\u1ec5m. T\u01b0\u01a1ng t\u1ef1 v\u1edbi OCP,progestin \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au hi\u1ec7u qu\u1ea3 \u1edf 2\/3 ph\u1ee5 n\u1eef m\u1eafc LNMTC.<\/span><\/p>\n
M\u1ed9t nghi\u00ean c\u1ee9u so s\u00e1nh gi\u1eefa hai h\u1ee3p ch\u1ea5t ch\u1ee9a progestin l\u00e0 NETA v\u00e0 dienogest b\u00e1o c\u00e1o r\u1eb1ng 70% v\u00e0 72% b\u1ec7nh nh\u00e2n r\u1ea5t h\u00e0i l\u00f2ng ho\u1eb7c h\u00e0i l\u00f2ng v\u1edbi hi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c, \u0111\u00f3ng th\u1eddi ghi nh\u1eadn hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1ec1 gi\u1ea3m \u0111au b\u1ee5ng kinh, gi\u1ea3m tri\u1ec7u ch\u1ee9ng \u0111au khi giao h\u1ee3p hay \u0111au v\u00f9ng ch\u1eadu m\u00e3n t\u00ednh. Theo Vercellini v\u00e0 c\u1ed9ng s\u1ef1, li\u1ec7u ph\u00e1p progestin \u0111\u01a1n thu\u1ea7n n\u00ean d\u00e0nh cho nh\u1eefng ph\u1ee5 n\u1eef c\u00f3 nguy c\u01a1 cao m\u1eafc LNMTC s\u00e2u ho\u1eb7c nh\u1eefng tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng dung n\u1ea1p ho\u1eb7c ch\u00f3ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi OCP.<\/span><\/p>\n
T\u00f3m l\u1ea1i, nh\u1eefng \u0111\u00e1nh gi\u00e1 t\u1eeb c\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u cho th\u1ea5y vi\u1ec7c s\u1eed d\u1ee5ng OCP v\u00e0 Progestin c\u00f2n nh\u1eefng v\u1ea5n \u0111\u1ec1, c\u1ee5 th\u1ec3 l\u00e0: 2\/3 ph\u1ee5 n\u1eef c\u00f3 tri\u1ec7u ch\u1ee9ng gi\u1ea3m \u0111au v\u00e0 c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng chung v\u1ec1 ho\u1ea1t \u0111\u1ed9ng t\u00ecnh d\u1ee5c nh\u01b0ng 1\/3 c\u00f2n l\u1ea1i kh\u00f4ng \u0111\u00e1p \u1ee9ng do \u0111\u1ec1 kh\u00e1ng progesterone, t\u0103ng nguy c\u01a1 thuy\u00ean t\u1eafc \u0111\u1ed9ng t\u0129nh m\u1ea1ch, c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng progestin, t\u00e1c d\u1ee5ng gi\u1ea3m th\u1ebf t\u00edch t\u1ed3n th\u01b0\u01a1ng LNMTC kh\u00f4ng th\u1ebf d\u1ef1 \u0111o\u00e1n v\u00e0 \u00edt c\u00f3 \u00fd ngh\u0129a trong \u0111\u1ea1i \u0111a s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p.<\/span><\/p>\n
Ch\u1ee7 v\u1eadn GnRH<\/b><\/p>\n
M\u1ed9t li\u1ec7u ph\u00e1p kh\u00e1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng hi\u1ec7n nay l\u00e0 k\u1ebft h\u1ee3p thu\u1ed1c ch\u1ee7 v\u1eadn GnRH v\u1edbi li\u1ec7u ph\u00e1p b\u00f3 sung steroid sinh d\u1ee5c. Trong m\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng, ch\u1ea5t ch\u1ee7 v\u1eadn GnRH c\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n v\u1edbi OCP \u0111\u1ed1i v\u1edbi c\u01a1n \u0111au khi giao h\u1ee3p. M\u1eb7c d\u00f9 c\u00f3 hi\u1ec7u qu\u1ea3 trong b\u1ec7nh l\u00fd LNMTC song c\u00f3 nhi\u1ec1u h\u1ea1n ch\u1ebf do \u1ee9c ch\u1ebf qu\u00e1 m\u1ee9c n\u1ed3ng \u0111\u1ed9 estradiol g\u00e2y ra v\u00e0 kh\u1ea3 n\u0103ng \u0111\u1ea3o ng\u01b0\u1ee3c di\u1ec1u tr\u00ed c\u0169ng nh\u01b0 c\u1ea3n tr\u1edf k\u00edch th\u00edch v\u00e0 ham mu\u1ed1n t\u00ecnh d\u1ee5c kh\u00f4ng th\u1ec3 \u0111o\u00e1n tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i ch\u1ee7 v\u1eadn GnRH d\u1ef1 tr\u1eef d\u1ea1ng ti\u00eam.<\/span><\/p>\n
\u0110\u1ed1i v\u1eadn GnRH<\/b><\/p>\n
G\u1eafn \u0111\u00e2y, ch\u1ea5t \u0111\u1ed1i v\u1eadn GnRH \u0111\u01b0\u1eddng u\u1ed1ng v\u1edbi c\u01a1 ch\u1ebf c\u1ea1nh tranh c\u00f9ng c\u00e1c th\u1ee5 th\u1ec3 GnRH khi\u1ebfn \u1ee9c ch\u1ebf s\u1ea3n xu\u1ea5t FSH v\u00e0 LH n\u1ed3i l\u00ean nh\u01b0 m\u1ed9t li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb LNMTC hi\u1ec7u qu\u1ea3 v\u00e0 kh\u00f4ng g\u00e2y t\u00e1c d\u1ee5ng b\u1ed1c h\u1ecfa. Nh\u1eefng \u01b0u \u0111i\u1ec3m ch\u00ednh \u0111\u01b0\u1ee3c ghi nh\u1eadn g\u1ed3m: (1) t\u1ea1o ra s\u1ef1 \u1ee9c ch\u1ebf estrogen ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u l\u01b0\u1ee3ng, t\u1eeb \u1ee9c ch\u1ebf m\u1ed9t ph\u1ea7n \u1edf li\u1ec1u th\u1ea5p \u0111\u1ebfn \u1ee9c ch\u1ebf g\u1ea7n nh\u01b0 ho\u00e0n to\u00e0n \u1edf li\u1ec1u cao h\u01a1n; (2) c\u00f3 kh\u1ea3 n\u0103ng h\u1ed3i ph\u1ee5c s\u1ef1 ch\u1ebf ti\u1ebft hormone nhanh ch\u00f3ng sau khi ng\u01b0ng \u0111i\u1ec1u tr\u1ecb; (3) c\u00e2n b\u1eb1ng gi\u1eefa hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n v\u1edbi kh\u1ea3 n\u0103ng dung n\u1ea1p g\u1ee3i \u00fd \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u theo t\u1eebng tri\u1ec7u ch\u1ee9ng v\u00e0 mong mu\u1ed1n c\u00e1 nh\u00e2n. C\u00e1c ch\u1ea5t \u0111\u1ed1i v\u1eadn GnRH c\u00f3 tr\u00ean th\u1ecb tr\u01b0\u1eddng hi\u1ec7n nay nh\u01b0 elagolix, relugolix (TAK38S) v\u00e0 linzagolix (OBE-2109), trong \u0111\u00f3, elagolix \u0111\u00e3 \u0111\u01b0\u1ee3c FDA Hoa K\u1ef3 ph\u00ea duy\u1ec7t v\u00e0o th\u00e1ng 7 n\u0103m 2018.<\/span><\/p>\n
\u200b<\/span><\/p>\n
$\"H\u00ecnh$ <\/a>
H\u00ecnh 8.5. C\u01a1 ch\u1ebf t\u00e1c \u0111\u1ed9ng c\u1ee7a thu\u1ed1c \u0111\u1ed3ng v\u1eadn v\u00e0 \u0111\u1ed1i v\u1eadn GnRH l\u00ean l\u1ea1c n\u1ed9i m\u1ea1c t\u1eed cung.<\/figcaption><\/figure>\n
Elagolix \u0111\u01b0\u1ee3c h\u1ea5p thu nhanh ch\u00f3ng sau khi u\u1ed1ng v\u00e0 th\u1eddi gian b\u00e1n h\u1ee7y trung b\u00ecnh trong huy\u1ebft t\u01b0\u01a1ng d\u1ea1o \u0111\u1ed9ng t\u1eeb 2,4-6,3 gi\u1edd, chuy\u1ec3n h\u00f3a ch\u1ee7 y\u1ebfu qua gan v\u00e0 b\u00e0i ti\u1ebft qua d\u01b0\u1ee1ng ti\u1ec1u hoa. Vi\u1ec7t th\u00e1i nghi\u1ec7m m\u00f9 \u0111\u00f4i pha III v\u1ec1 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb LNMTC trong v\u00f2ng 6 th\u00e1ng. n\u1eef b\u1ecb LNMTC t\u1eeb m\u0169i b\u00ecnh \u0111\u1ebfn n\u1eb7ng dam chia ng\u1eabu nhi\u00ean \u0111\u00e3 ghi nh\u1eadn nh\u1eefng \u00ff k\u1ebft lu\u1eadn sau: Ph\u1ee5 n\u1eef c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng \u0111au b\u1ee5ng kinh l\u00e0 46,4%, 75,8% v\u00e0 19,6% v\u1edbi li\u1ec1u cla golix l\u1ea7n l\u01b0\u1ee3t 150 mgx1 l\u1ea7n\/ng\u00e0y v\u00e0 200mg x 2 l\u00e1n\/ ng\u00e0y so v\u1edbi nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c; (2) t\u1ef7 l\u1ec7 ph\u1ee5 n\u1eef c\u00e1i thi\u1ec7n tri\u1ec7u ch\u1ee9ng \u0111au v\u00f9ng ch\u1eadu m\u00e3n t\u00ednh l\u00e0 50,4%, S4,5% v\u00e0 36,5% t\u01b0\u01a1ng \u0111\u01b0\u01a1ng; (3) \u0111au khi giao h\u1ee3p gi\u1ea3m h\u01a1n sau 3 th\u00e1ng \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec1u elavil 200mg x 2 l\u1ea7n\/ng\u00e0y nhi\u1ec1u h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c. T\u00e1c d\u1ee5ng ph\u1ee5 b\u1ed1c h\u1ecfa v\u1ecb lo\u00e3ng x\u01b0\u01a1ng th\u01b0\u1eddng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o t\u00f9y thu\u1ed9c v\u00e0o li\u1ec1u l\u01b0\u1ee3ng li\u1ec1u elagolix c\u00e0ng cao, t\u1ef7 l\u1ec7 b\u1ed1c h\u1ecfa v\u00e0 lo\u00e3ng x\u01b0\u01a1ng \u0111\u01b0\u1ee3c ghi nh\u1eadn c\u00e0ng nhi\u1ec1u. \u1ede nh\u1eefng ph\u1ee5 n\u1eef c\u00f3 ch\u1ee9c n\u0103ng gan b\u00ecnh th\u01b0\u1eddng ho\u1eb7c suy gan nh\u1eb9, th\u1eddi gian \u0111i\u1ec1u tr\u1ecb t\u1ed1i \u0111a \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 24 th\u00e1ng v\u1edbi elago 150 mg x 1 l\u00e1n\/ng\u00e0y v\u00e0o th\u00e1ng v\u1edbi elapoli 200 mgx2 \/ng\u00e0y.<\/span><\/p>\n
Linzagolix sinh kh\u1ea3 d\u1ee5ng \u0111\u01b0\u1eddng u\u1ed1ng cao, th\u1eddi gian b\u00e1n h\u1ee7y t\u1eeb 15-18 gi\u1edd, kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn th\u1ef1c ph\u1ea9m. Donnez v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 nghi\u00ean c\u1ee9u t\u00e1c \u0111\u1ed9ng c\u1ee7a c\u00e1c li\u1ec1u l\u01b0\u1ee3ng linzagolix kh\u00e1c nhau \u0111\u01b0\u1ee3c d\u00f9ng l l\u00e1n\/ng\u00e0y trong \u00f3 th\u00e1ng tr\u00ean 328 b\u1ec7nh nh\u00e2n li\u00ean quan \u0111\u1ebfn LNMTC. K\u1ebft qu\u1ea3 cho th\u1ea5y t\u1ef7 l\u1ec7 ph\u1ee5 n\u1eef gi\u1ea3m tr\u00ean 30% t\u1ed5ng s\u1ed1 c\u01a1n \u0111au v\u00f9ng ch\u1eadu n\u00f3i chung sau 3 th\u00e1ng \u0111i\u1ec1u tr\u1ecb l\u00e0 61,5%, 56,4% v\u00e0 56,3% t\u01b0\u01a1ng \u1ee9ng l\u1ea7n l\u01b0\u1ee3t v\u1edbi c\u00e1c li\u1ec1u 75 mg, 100 mg v\u00e0 200 mg so v\u1edbi 34,5% \u1edf nh\u00f3m gi\u1ea3 \u0111\u01b0\u1ee3c. T\u00ecnh tr\u1ea1ng \u0111au v\u00f9ng ch\u1eadu \u0111\u01b0\u1ee3c nh\u1eadn th\u1ea5y r\u00f5 t\u1eeb 1-2 tu\u1ea7n sau khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb. T\u1ef7 l\u1ec7 gi\u1ea3m tr\u00ean 30% tri\u1ec7u ch\u1ee9ng \u0111au b\u1ee5ng kinh v\u00e0 \u0111au v\u00f9ng ch\u1eadu m\u00e3n t\u00ednh sau 6 th\u00e1ng \u0111i\u1ec1u tr\u1ecb l\u00e0 58,3% v\u00e0 72,9% v\u1edbi li\u1ec1u 75 mg, 82,1% v\u00e0 64,1% v\u1edbi li\u1ec1u 100 mg, 84,1% v\u00e0 72,7% v\u1edbi li\u1ec1u 200 mg. So v\u1edbi nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c, \u0111au khi giao h\u1ee3p gi\u1ea3m \u0111\u00e1ng k\u1ec3 sau 3 th\u00e1ng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng linzagolix 200mg, nh\u01b0ng kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3 khi s\u1eed d\u1ee5ng li\u1ec1u th\u1ea5p h\u01a1n (75 mg ho\u1eb7c 100 mg). \u0110i\u1ec1u n\u00e0y t\u01b0\u01a1ng t\u1ef1 v\u1edbi adolix, \u0111\u1ed1i v\u1edbi c\u00e1c l\u0129nh v\u1ef1c li\u00ean quan \u0111\u1ebfn c\u1ea3m x\u00fac, h\u1ed7 tr\u1ee3 v\u1ec1 t\u1ec9nh th\u00e1n hay s\u1ef1 t\u1ef1 tin ch\u1ec9 \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 khi s\u1eed d\u1ee5ng ch\u1ea5t \u0111\u1ed1i v\u1eadn GnRH li\u1ec1u cao nh\u1ea5t, 200mg\/ng\u00e0y. Tuy v\u1eady, c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng c\u1ea7n c\u00f3 s\u1ef1 c\u00e2n nh\u1eafc c\u1ea9n th\u1eadn tr\u01b0\u1edbc khi quy\u1ebft \u0111\u1ecbnh ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb v\u00ec s\u1ef1 xu\u1ea5t hi\u1ec7n th\u01b0\u1eddng xuy\u00ean h\u01a1n c\u00e1c c\u01a1n b\u1ed1c h\u1ecfa v\u00e0 m\u1ee9c \u0111\u1ed9 lo\u00e3ng x\u01b0\u01a1ng tr\u00ean b\u1ec7nh nh\u00e2n.<\/span><\/p>\n
Relugolix l\u00e0 h\u1ee3p ch\u1ea5t c\u00f3 th\u1eddi gian b\u00e1n h\u1ee7y t\u1eeb 37-42 gi\u1edd, chuy\u1ec3n h\u00f3a ch\u1ee7 y\u1ebfu qua gan. Ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p c\u00f3 h\u1ec7 th\u1ed1ng cho th\u1ea5y m\u1ee9c \u0111\u1ed9 \u0111au trung b\u00ecnh \u1edf tri\u1ec7u ch\u1ee9ng \u0111au v\u00f9ng ch\u1eadu m\u00e3n t\u00ednh v\u00e0 \u0111au b\u1ee5ng kinh b\u1eaft \u0111\u1ea7u gi\u1ea3m trong th\u00e1ng \u0111\u1ea7u ti\u00ean \u0111i\u1ec1u tr\u1ecb, tuy nhi\u00ean, tri\u1ec7u ch\u1ee9ng \u0111au khi giao h\u1ee3p l\u1ea1i kh\u00f4ng c\u00f3 xu h\u01b0\u1edbng r\u00f5 r\u1ec7t. Vi\u1ec7c s\u1eed d\u1ee5ng relugolix u\u1ed1ng I l\u1ea7n\/ng\u00e0y duy tr\u00ec tr\u00ean \u1ed1 th\u00e1ng c\u00f3 t\u00e1c d\u1ee5ng r\u00f5 r\u1ec7t gi\u1ea3m \u0111au b\u1ee5ng kinh v\u00e0 \u0111au v\u00f9ng ch\u1eadu m\u00e3n t\u00ednh trong khi t\u1ef7 l\u1ec7 xu\u1ea5t hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng v\u1eadn m\u1ea1ch t\u01b0\u01a1ng t\u1ef1 gi\u1ea3 d\u01b0\u1ee3c. T\u00f3m l\u1ea1i, c\u00f3 nh\u1eefng b\u1eb1ng ch\u1ee9ng l\u00e2m s\u00e0ng m\u1ea1nh m\u1ebd cho th\u1ea5y thu\u1ed1c \u0111\u1ed1i v\u1eadn GHRH \u0111\u01b0\u1eddng u\u1ed1ng c\u00f3 hi\u1ec7u qu\u1ea3 v\u00e0 \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb \u0111au do LNMTC m\u1ee9c \u0111\u1ed9 trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng.<\/span><\/p>\n
Ch\u1ea5t \u1ee9c ch\u1ebf men aromasc (Al)<\/b><\/p>\n
B\u00ean c\u1ea1nh li\u1ec7u ph\u00e1p n\u1ed9i ti\u1ebft t\u1ed1, t\u1eeb khi aromase P450 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 bi\u1ec3u hi\u1ec7n qu\u00e1 m\u1ee9c \u1edf c\u1ea3 n\u1ed9i m\u1ea1c t\u1eed cung v\u00e0 ngo\u00e0i t\u1eed cung tr\u00ean b\u1ec7nh nh\u00e2n b\u1ecb l\u1ea1c n\u1ed9i m\u1ea1c, m\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 \u0111\u00e3 s\u1eed d\u1ee5ng ch\u1ea5t \u1ee9c ch\u1ebf aromatase (AI) \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng \u0111au \u1edf ph\u1ee5 n\u1eef ti\u1ec1n m\u00e3n k\u00ednh b\u1ecb LNMTC v\u00e0 thu \u0111\u01b0\u1ee3c nh\u1eefng k\u1ebft qu\u1ea3 kh\u1ea3 quan. Nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng letrozole v\u00e0 norethisterone acetate c\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n trong vi\u1ec7c gi\u1ea3m tri\u1ec7u ch\u1ee9ng \u0111au khi giao h\u1ee3p h\u01a1n l\u00e0 norethisterone acetate \u0111\u01a1n thu\u1ea7n.<\/span><\/p>\n
T\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a AI nh\u01b0 \u0111au kh\u1edbp, \u0111au c\u01a1, l\u00e0m t\u0103ng ho\u1ea1t \u0111\u1ed9ng c\u1ee7a t\u1ebf b\u00e0o h\u1ee7y x\u01b0\u01a1ng v\u00e0 l\u00e0m m\u1ea5t m\u1eadt \u0111\u1ed9 kho\u00e1ng c\u1ee7a x\u01b0\u01a1ng c\u00f3 th\u1ec3 nghi\u00eam tr\u1ecdng h\u01a1n t\u00e1c d\u1ee5ng ph\u1ee5 g\u00e2y ra b\u1edfi Progesteron v\u00e0 OCP, do \u0111\u00f3 l\u00e0m gi\u1ea3m s\u1ef1 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb l\u00e2u d\u00e0i c\u1ee7a b\u1ec7nh nh\u00e2n. Do v\u1eady, vi\u1ec7c k\u1ebft h\u1ee3p AI v\u1edbi norethisterone acetate c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m nh\u1eefng t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n v\u00e0 l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 ng\u1eebng thu\u1ed1c h\u01a1n so v\u1edbi s\u1ef1 k\u1ebft h\u1ee3p gi\u1eefa AI v\u00e0 triptorelin.<\/span><\/p>\n
\u0110i\u1ec1u tr\u1ecb can thi\u1ec7p<\/b><\/h3>\n
\u0110\u1ed1i v\u1edbi nh\u1eefng tr\u01b0\u1eddng h\u1ee3p LNMTC s\u00e2u, t\u1ed5n th\u01b0\u01a1ng x\u00e2m nh\u1eadp v\u00e0o th\u00e0nh tr\u01b0\u1edbc tr\u1ef1c tr\u00e0ng v\u00e0 th\u00e0nh sau \u1ea3m \u0111\u1ea1o, d\u01b0\u1eddng nh\u01b0 kh\u1ea3 n\u0103ng t\u00e1i ph\u00e1t c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111au b\u1ee5ng kinh hay \u0111au khi giao h\u1ee3p th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n v\u00e0o nh\u1eefng th\u1eddi \u0111i\u1ec3m kh\u00e1c nhau sau khi ng\u01b0ng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p n\u1ed9i ti\u1ebft t\u1ed1 cho th\u1ea5y ph\u01b0\u01a1ng ph\u00e1p n\u00e0y kh\u00f4ng \u0111i\u1ec1u tr\u1ecb kh\u1ecfi d\u1ee9t \u0111i\u1ec3m. Do \u0111\u00f3, c\u1ea7n c\u00f3 s\u1ef1 c\u00e2n nh\u1eafc \u0111\u1ebfn \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i khoa.<\/span><\/p>\n
M\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf c\u00e1c t\u1ed5n th\u01b0\u01a1ng s\u00e2u trong LNMTC l\u00e0m gi\u1ea3m r\u00f5 r\u1ec7t m\u1ee9c \u0111\u1ed9 nghi\u00eam tr\u1ecdng c\u1ee7a tri\u1ec7u ch\u1ee9ng \u0111au khi giao h\u1ee3p v\u00e0 c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c. Tuy nhi\u00ean, ph\u1eabu thu\u1eadt l\u1ea1i \u0111\u00f2i h\u1ecfi tr\u00ecnh \u0111\u1ed9 k\u1ef9 thu\u1eadt cao, c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c l\u00e0m n\u1eb7ng h\u01a1n t\u00ecnh tr\u1ea1ng b\u1ec7nh v\u00e0 c\u00f3 th\u1ec3 hi\u1ec7u qu\u1ea3 m\u1ed9t ph\u1ea7n ho\u1eb7c t\u1ea1m th\u1eddi. Sau \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1eabu thu\u1eadt 6-12 th\u00e1ng, nhi\u1ec1u ph\u1ee5 n\u1eef \u0111\u00e3 c\u1ea3m th\u1ea5y tho\u1ea3i m\u00e1i h\u01a1n, t\u0103ng t\u1ea7n su\u1ea5t v\u00e0 t\u0103ng s\u1ef1 th\u1ecfa m\u00e3n khi giao h\u1ee3p do c\u1eaft b\u1ecf ho\u00e0n to\u00e0n c\u00e1c t\u1ed5n th\u01b0\u01a1ng LNMTC v\u00e0 ph\u1ee5c h\u1ed3i c\u1ea5u tr\u00fac gi\u1ea3i phu v\u00f9ng ch\u1eadu, do \u0111\u00f3 gi\u00fap c\u1ea3i thi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng tr\u1ea7m c\u1ea3m.<\/span><\/p>\n
Hi\u1ec7u su\u1ea5t \u1edf nh\u00f3m ph\u1eabu thu\u1eadt \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n \u0111\u00e1ng k\u1ec3 trong th\u1eddi gian ng\u1eafn v\u00e0 sau \u0111\u00f3 gi\u1ea3m d\u1ea7n. Sau 1 n\u0103m ph\u1eabu thu\u1eadt, ph\u1ee5 n\u1eef c\u00f3 khuynh h\u01b0\u1edbng duy tr\u00ec xu h\u01b0\u1edbng t\u00ecnh d\u1ee5c song c\u00f3 c\u1ea3m gi\u00e1c \u0111au h\u01a1n m\u1ed9t ch\u00fat khi giao h\u1ee3p. Nghi\u00ean c\u1ee9u cho th\u1ea5y ph\u1eabu thu\u1eadt k\u1ebft h\u1ee3p v\u1edbi li\u1ec7u ph\u00e1p progestin li\u1ec1u th\u1ea5p c\u00f3 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c, s\u1ee9c kh\u1ecfe t\u00e2m l\u00fd v\u00e0 ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng. Do v\u1eady, ng\u00e0y c\u00e0ng c\u00f3 nhi\u1ec1u s\u1ef1 \u0111\u1ed3ng thu\u1eadn cho r\u1eb1ng n\u00ean cung c\u1ea5p cho b\u1ec7nh nh\u00e2n LNMTC kh\u00f4ng c\u00f3 \u00fd \u0111\u1ecbnh th\u1ee5 thai li\u1ec7u ph\u00e1p n\u1ed9i ti\u1ebft t\u1ed1 sau ph\u1eabu thu\u1eadt m\u1ed9t c\u00e1ch c\u00f3 h\u1ec7 th\u1ed1ng.<\/span><\/p>\n
$\"\u200bH\u00ecnh$ <\/a>
\u200bH\u00ecnh 8.6. Ph\u1eabu thu\u1eadt n\u1ed9i soi lo\u1ea1i b\u1ecf t\u1ed5n th\u01b0\u01a1ng l\u1ea1c n\u1ed9i m\u1ea1c t\u1eed cung<\/figcaption><\/figure>\n
B\u00ean c\u1ea1nh \u0111\u00f3, vi\u1ec7c lo\u1ea1i b\u1ecf ho\u00e0n to\u00e0n LNMTC s\u00e2u c\u00f3 th\u1ec3 g\u00e2y r\u1ed3i lo\u1ea1n ch\u1ee9c n\u0103ng b\u1ed9 ph\u1eadn sinh d\u1ee5c, b\u00e0ng quang v\u00e0 ru\u1ed9t. Trong qu\u00e1 tr\u00ecnh b\u00f3c t\u00e1ch n\u1ed1t LNMTC kh\u1ecfi tr\u1ef1c tr\u00e0ng v\u00e0 d\u00e2y ch\u1eb1ng t\u1eed cung, c\u00e1c d\u00e2y th\u1ea7n kinh t\u1ef1 ch\u1ee7 t\u1ea1i tr\u1ef1c tr\u00e0ng v\u00e0 b\u00e0ng quang c\u00f3 th\u1ec3 b\u1ecb t\u1ed5n th\u01b0\u01a1ng d\u1eabn \u0111\u1ebfn r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng ti\u1ebft ni\u1ec7u, \u0111\u1ea1i ti\u1ec7n v\u00e0 t\u00ecnh d\u1ee5c. H\u01a1n n\u1eefa, ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf ru\u1ed9t v\u00e0 ph\u1ea7n l\u1edbn d\u00e2y ch\u1eb1ng t\u1eed cung c\u00f3 th\u1ec3 g\u00e2y ra s\u1eb9o t\u00fai c\u00f9ng Douglas, g\u00f3p ph\u1ea7n l\u00e0m suy gi\u1ea3m ch\u1ea5t l\u01b0\u1ee3ng \u0111\u1eddi s\u1ed1ng t\u00ecnh d\u1ee5c. Do v\u1eady, ng\u01b0\u1eddi ph\u1ee5 n\u1eef c\u1ea7n \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n v\u00e0 nh\u1eadn th\u1ee9c \u0111\u1ea7y \u0111\u1ee7 v\u1ec1 nh\u1eefng nguy c\u01a1 ti\u1ec1m \u1ea9n n\u00e0y tr\u01b0\u1edbc khi ph\u1eabu thu\u1eadt.<\/span><\/p>\n
Li\u1ec7u ph\u00e1p t\u00e2m l\u00fd<\/b><\/h3>\n
Tr\u1ea7m c\u1ea3m v\u00e0 c\u0103ng th\u1eb3ng \u1edf m\u1ee9c \u0111\u1ed9 n\u1eb7ng c\u00f3 xu h\u01b0\u1edbng g\u00e2y ra t\u1ed5n th\u01b0\u01a1ng c\u1ea3m x\u00fac cao h\u01a1n. Do v\u1eady, c\u1ea7n thi\u1ebft c\u00f3 m\u1ed9t bi\u1ec7n ph\u00e1p can thi\u1ec7p \u0111\u1ec3 h\u1ed7 tr\u1ee3 nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y gi\u00fap c\u1ea3i thi\u1ec7n ch\u1ee9ng tr\u1ea7m c\u1ea3m v\u1ecb c\u0103ng th\u1eb3ng. C\u00e1c ph\u01b0\u01a1ng ph\u00e1p ti\u1ebfp c\u1eadn g\u00f3c \u0111\u1ed9 t\u00e2m l\u00fd c\u1ee7a b\u1ec7nh nh\u00e2n m\u1eafc LNMTC c\u1ea7n gi\u1ea3i quy\u1ebft c\u00e1c v\u1ea5n \u0111\u1ec1 v\u1ec1 gia t\u0103ng ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng, gi\u1ea3i quy\u1ebft kh\u00f3 kh\u0103n v\u1ec1 c\u00e1c m\u1ed1i quan h\u1ec7 hay t\u00ecnh d\u1ee5c, v\u1ea5n \u0111\u1ec1 v\u1ec1 c\u00f4ng vi\u1ec7c, gi\u1ea3m thi\u1ec3u tr\u1ea7m c\u1ea3m v\u00e0 lo l\u1eafng khi \u0111\u1ed1i m\u1eb7t v\u1edbi nh\u1eefng kh\u00f3 kh\u0103n cho vi\u1ec7c \u0111i\u1ec1u tr\u1ecb hay s\u1ef1 hi\u1ec7n di\u1ec7n li\u00ean t\u1ee5c c\u1ee7a nh\u1eefng c\u01a1n \u0111au v\u00e0 c\u0103ng th\u1eb3ng, gia t\u0103ng t\u1ea7m quan tr\u1ecdng c\u1ee7a li\u1ec7u ph\u00e1p b\u1ed5 sung kh\u00e1c, trong \u0111\u00f3 m\u1ee5c ti\u00eau ch\u1ee7 y\u1ebfu l\u00e0 gi\u1ea3m \u0111au v\u00e0 lo l\u1eafng th\u00f4ng qua c\u00e1c b\u00e0i t\u1eadp th\u01b0 gi\u00e3n \u0111\u1ea7u \u00f3c, v\u1eadn \u0111\u1ed9ng th\u1ec3 ch\u1ea5t v\u00e0 thay \u0111\u1ed5i th\u00f3i quen \u0103n u\u1ed1ng. Th\u00eam v\u00e0o \u0111\u00f3, c\u00e1c chuy\u00ean gia s\u1ea3n ph\u1ee5 khoa tham gia v\u00e0o qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb v\u00e0 qu\u1ea3n l\u00fd LNMTC n\u00ean c\u00f3 nh\u1eefng cu\u1ed9c tr\u00f2 chuy\u1ec7n chuy\u00ean s\u00e2u h\u01a1n v\u1ec1 ch\u1ea5t l\u01b0\u1ee3ng t\u00ecnh d\u1ee5c c\u1ee7a b\u1ec7nh nh\u00e2n m\u1ed9t c\u00e1ch t\u1ebf nh\u1ecb.<\/span><\/p>\n
Ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t<\/b><\/h3>\n
S\u1ef1 suy gi\u1ea3m ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t \u1edf Ph\u1ee5 n\u1eef b\u1ecb LNMTC c\u00f3 th\u1ec3 li\u00ean quan \u0111\u1ebfn \u0111au v\u00f9ng ch\u1eadu. T\u1eadp th\u1ec3 d\u1ee5c l\u00e0 m\u1ed9t y\u1ebfu t\u1ed1 quan tr\u1ecdng trong vi\u1ec7c gi\u1ea3m \u0111au. Zhao v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng t\u1eadp luy\u1ec7n th\u01b0 gi\u00e3n c\u01a1 b\u1eafp c\u00f3 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c gi\u1ea3m \u0111au, gi\u1ea3m lo l\u1eafng v\u00e0 tr\u1ea7m c\u1ea3m \u1edf nh\u1eefng ph\u1ee5 n\u1eef b\u1ecb LNMTC \u0111ang \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec7u ph\u00e1p hormone. Stanton v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 ch\u1ee9ng minh t\u00e1c \u0111\u1ed9ng t\u00edch c\u1ef1c c\u1ee7a ho\u1ea1t \u0111\u1ed9ng th\u1ec3 ch\u1ea5t \u0111\u1ed1i v\u1edbi ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c.<\/span><\/p>\n
T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/b><\/h2>\n
\n
Bulun S.E. Yilmaz B.D.,Sison C., Miyazaki K, Bernardi L., Liu S\u201eKohlmeier A\u201eYinP.,MiladM. Wei J. Endometriosis. Endocr. Rev.2019;1:1048-1079.<\/span><\/li>\n
La Rosa V.L, De Franciscis P\u201e Barra \u00c8\u201e Schiattarella A, T\u00f6r\u00f6k P\u201e Shah M\u201e Karaman E\u201e Marques Cereniti T\u201e Di Guardo E\u201e Gullo G,, et al. Quality of life \u00a1n women with endometriosis: A narrative overview. \u00c0finerva Mced. 2020;111:68-78.<\/span><\/li>\n
Pessoa de Farias Rodrigues M., Lima Vilarino E., de Souza Barbeiro Munhoz A\u201e da Silva Paiva L\u201e, de Alcantara Sousa IV. Zaia V\u201e Parente Barbosa C. Clinical aspects and the quality of life among women with endometriosis and infertility: A cross-sectional study. BMC Worsens Health, 2020;12:124.<\/span><\/li>\n<\/ol>\n
C\u00c2U H\u1eceI L\u01af\u1ee2NG GI\u00c1<\/b><\/h2>\n
C\u00e2u 1. C\u00e2u n\u00e0o sau \u0111\u00e2y sai khi n\u00f3i v\u1ec1 b\u1ec7nh l\u00fd l\u1ea1c n\u1ed9i m\u1ea1c t\u1eed cung (LNMTC)?<\/span><\/i><\/p>\n
\n
LNMTC l\u00e0 b\u1ec7nh l\u00fd m\u1ea1n t\u00ednh, ch\u01b0a r\u00f5 nguy\u00ean nh\u00e2n.<\/span><\/li>\n
LNMTC \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 ph\u00e1t tri\u1ec3n m\u00f4 n\u1ed9i m\u1ea1c t\u1eed cung b\u00ean ngo\u00e0i khoang t\u1eed cung.<\/span><\/li>\n
LNMTC c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c h\u00ecnh th\u00e0nh do s\u1ef1 di chuy\u1ec3n ng\u01b0\u1ee3c d\u00f2ng trong m\u1ed9t chu k\u1ef3 kinh nguy\u1ec7t khi m\u00f4 n\u1ed9i m\u1ea1c t\u1eed cung b\u1ecb bong ra.<\/span><\/li>\n
LNMTC c\u00f3 t\u00e1c \u0111\u1ed9ng ti\u00eau c\u1ef1c \u0111\u1ebfn th\u1ebf ch\u1ea5t v\u00e0 t\u00ednh th\u1ea7n c\u1ee7a ng\u01b0\u1eddi ph\u1ee5 n\u1eef. :<\/span><\/li>\n<\/ol>\n
C\u00e2u 2. V\u1ecb tr\u00ed th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a LNMTC \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c l\u00e0:<\/span><\/i><\/p>\n
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Bu\u1ed3ng tr\u1ee9ng.<\/span><\/li>\n
D\u00e2y ch\u1eb1ng t\u1eed cung.<\/span><\/li>\n
Ph\u00fac m\u1ea1c.<\/span><\/li>\n
L\u1edbp c\u01a1 t\u1eed cung.<\/span><\/li>\n<\/ol>\n
C\u00e2u 3. Nguy\u00ean nh\u00e2n tr\u1ef1c ti\u1ebfp \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn ch\u1ee9c n\u0103ng t\u00ecnh d\u1ee5c c\u1ee7a ph\u1ee5 n\u1eef m\u1eafc b\u1ec7nh l\u00fd LNMTC?<\/span><\/i><\/p>\n
\n
\u0110au khi giao h\u1ee3p.<\/span><\/li>\n
Tr\u1ea7m c\u1ea3m.<\/span><\/li>\n
\u0110au theo chu k\u1ef3 kinh nguy\u1ec7t.<\/span><\/li>\n
Rong kinh.<\/span><\/li>\n<\/ol>\n
C\u00e2u 4. C\u00e2u n\u00e0o sau \u0111\u00e2y sai khi n\u00f3i v\u1ec1 nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb LNMTC?<\/span><\/i><\/p>\n
\n
\u01afu Ti\u00ean c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng \u0111au, n\u00e2ng cao ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng cho b\u1ec7nh nh\u00e2n.<\/span><\/li>\n
Trong \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n, c\u1ea7n l\u01b0u \u00fd c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 nghi\u00eam tr\u1ecdng do thu\u1ed1c g\u00e2y ra nh\u01b0 tri\u1ec7u ch\u1ee9ng b\u1ed1c ho\u1ea3 hay t\u00ecnh tr\u1ea1ng lo\u00e3ng x\u01b0\u01a1ng.<\/span><\/li>\n
Sau khi ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf LNMTC, c\u00f3 th\u1ec3 theo d\u00f5i trong th\u1eddi gian 3 th\u00e1ng sau \u0111\u00f3 v\u00e0 k\u1ebft th\u00fac theo d\u00f5i n\u1ebfu kh\u00f4ng t\u00e1i ph\u00e1t.<\/span><\/li>\n
Qu\u1ea3n l\u00fd LNMTC d\u1ea7n thi\u1ebft m\u1ed9t k\u1ebf ho\u1ea1ch qu\u1ea3n l\u00fd su\u1ed1t \u0111\u1eddi \u0111\u1ec3 tr\u00e1nh t\u00e1i ph\u00e1t.<\/span><\/li>\n<\/ol>\n
C\u00e2u 5. Trong c\u00e1c c\u00e2u sau, c\u00e2u n\u00e0o sai khi n\u00f3i v\u1ec1 t\u00e1c d\u1ee5ng c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ea3o t\u1ed3n trong b\u1ec7nh l\u00fd LNMTC?<\/span><\/i><\/p>\n
\n
Danazol l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay cho h\u1ea7u h\u1ebft tr\u01b0\u1eddng h\u1ee3p LNMTC.<\/span><\/li>\n
OCP \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au b\u1ee5ng kinh trong kho\u1ea3ng S0% tr\u01b0\u1eddng h\u1ee3p.<\/span><\/li>\n
Li\u1ec7u ph\u00e1p progestin \u0111\u01a1n thu\u1ea7n \u00edt \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho nh\u1eefng ph\u1ee5 n\u1eef m\u1eafc LNMTC s\u00e2u ho\u1eb7c nh\u1eefng tr\u01b0\u1eddng h\u1ee3p \u0111\u1ec1 kh\u00e1ng progesterone.<\/span><\/li>\n
\u0110\u1ed1i v\u1eadn GnRH \u0111\u01b0\u1eddng u\u1ed1ng hi\u1ec7n nay \u0111\u01b0\u1ee3c \u01b0u ti\u00ean s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb LNMTC s\u00e2u v\u1edbi t\u00e1c d\u1ee5ng gi\u1ea3m r\u00f5 r\u1ec7t tri\u1ec7u ch\u1ee9ng dau khi giao h\u1ee3p.<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"
L\u1ea1c n\u1ed9i m\u1ea1c t\u1eed cung (LNMTC) l\u00e0 m\u1ed9t b\u1ec7nh l\u00fd m\u1ea1n t\u00ednh, ti\u1ebfn tri\u1ec3n kh\u00f4ng r\u00f5 nguy\u00ean nh\u00e2n, \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 ph\u00e1t tri\u1ec3n c\u1ee7a m\u00f4 n\u1ed9i m\u1ea1c t\u1eed cung (NMTC) b\u00ean ngo\u00e0i khoang t\u1eed cung v\u00e0 t\u00ecnh tr\u1ea1ng vi\u00eam m\u1ea1n t\u00ednh ph\u1ee5 thu\u1ed9c estrogen c\u1ee7a c\u00e1c c\u1ea5u tr\u00fac gi\u1ea3i ph\u1eabu b\u1ecb \u1ea3nh h\u01b0\u1edfng – […]\n","protected":false},"author":1,"featured_media":52127,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[150],"tags":[],"class_list":["post-52091","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-sinh-ly-nam-nu"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/52091","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=52091"}],"version-history":[{"count":1,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/52091\/revisions"}],"predecessor-version":[{"id":72479,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/52091\/revisions\/72479"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/52127"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=52091"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=52091"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=52091"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}