Uhlalutyo lwe-Meta lubonisa ukuba ii-IUDs zinciphisa ingozi yomhlaza wesibeleko
Ngokuqinisekileyo, izixhobo ze-intrauterine (IUDs) zisebenza ngokuphawulekayo ekukhuseleni ukukhulelwa. Ngethuba lonyaka wokuqala wokusetyenziswa, i-IUDs ihluleka ngaphantsi kwe-1 ekhulwini yabasetyhini abayisebenzisa.
Ukongezelela ekukhuseleni ukukhulelwa, uphando olutsha lubonisa ukuba ii-IUD zinokukunceda ukunqanda umdlavuza wesibeleko- ngokukodwa phakathi kwabantu abancinci abafumana imali engaphantsi kwe-2 ekhulwini labasetyhini abagonywe kumpapillomavirus yabantu (HPV).
Nangona kungabikho bonke abafazi abane-HPV bahlakulela umdlavuza wesibeleko, i-HPV yimbangela ebalulekileyo yomhlaza wesibeleko.
Uphando
Ngomhla wokuhlaziywa ngo-Disemba ka-2017 kunye nokuhlaziywa kweemeta ezibizwa ngokuba yi-Intrauterine Usetyenziso lweCandelo leKhansela yomhlaza weCervical, uCortessis kunye noogxa baqeshwe izifundo ezili-16 eziphakamileyo zokufaka ukuhlaziywa kwazo. Idatha edibeneyo kulezi zifundo yabela abafazi abangama-12 482: abafazi abangama-4945 abanomdlavuza wesibeleko kunye no-7537 ngaphandle komhlaza.
Emva kokulawula ukuguqulwa kwemiba efana ne-HPV ukusabalalisa kunye nomhlaza wesifo somhlaza wesibeleko kwimiba yabantu, abaphandi bafumene ukuba umdlavuza wesibeleko wawungaphantsi kweyesithathu ephantsi kwabesetyhini basebenzisa ii-IUDs.
IUDs Isebenza njani?
Ibhinqa ixhunyiwe kwisibeleko ngumlomo wesibeleko , inqanawa yentamo. Ukusebenzisa i-speculum, ugqirha uya kubeka i-IUD ukuze abekwe kwisibeletho. IUD ikwabekwa kwisibeletho ngokusebenzisa isistim ekhethekileyo, kwaye ibanjwe endaweni ye-os.
Ngokutsho kwabalobi be- Medical Medical diagnosis kunye neNyango ye-Treaty 2018 , nalixesha lokufakwa kwe-IUD:
Ukufakela kungenziwa ngexesha okanye emva kwe-mens, kwi-midcycle ukukhusela ukufakelwa, okanye kamva kumjikelo ukuba isiguli singakhulelwa. Kukho ubungqina obukhulayo bokubonisa ukuba ii-IUD zingeniswa ngokukhuselekileyo kwixesha elizayo emva kokufa kunye nexesha lokuhamba.
I-IUDs yeCopper isebenza ngokunciphisa impendulo engumzimba oyinyumba ebangela ukuba umzimba ubulale umdaka. Ubhedu buyabonwa njengomzimba wasemzini apho umzimba uya kuhlasela nge-immune system.
I-prodasta ye-IUD ye-hormonal isebenza ngokukhupha i-hormone enefuthe le-spermicidal.
I-hormonal IUD Mirena inezinto ezilandelayo:
- Ukukhupha umlomo wesibeleko ukukhusela isidoda ukungena kwisibeletho
- Ukuvimbela isidoda sokufikelela okanye ukuchumisa iqanda
- Ukucoca i-lining of uterus
Ngokomlando, i- IUD ziye zadibaniswa nokuvuvukala kweplavic kunye nokungabikho komsebenzi; Nangona kunjalo, ii-device ezintsha zikhuselekileyo. Ukongezelela ekusebenzeni kakuhle, ii-IUDs zanamhlanje zinemiphumo embalwa emibi.
Abafazi abasemngciphekweni omkhulu wokuba banesifo sesifo sosulela ngesondo okanye ukuhlaselwa kwe-bacocial endocarditis akufanele basebenzise ii-IUDs. Ukongezelela koko, kubafazi abane- fibroids ye-uterine , i-IUD ayinakusebenza ngenxa yokuba iguqula umlo wesigxina se-uterine.
EUnited States, ii-IUD zisetyenziswa ngokugqithiseleyo. Iipesenti ezi-1 kuphela zamabhinqa aseMerika zisebenzisa ii-IUDs. EYurophu naseKhanada, phakathi kweepesenti ezili-15 kunye neepesenti ezingama-30 zamabhinqa zisebenzisa i-IUDs.
IUDs Ikhusela njani umdlavuza wesibeleko?
Akucaci ukuba i-IUDs ikhusela njani umdlavuza wesibeleko.
Nangona kunjalo, kukho iingcamango ezimbalwa ezahlukeneyo.
Ukubekwa kwe-IUD kunokunyusa i-immune system ukuba ijolise ukusuleleka kwe-HPV kunye nezilonda eziphambili (umdlavuza). Ngokukodwa, ii-IUD zifakwa phezu kwendawo yenguqu kwaye zigxininise impendulo yomzimba kwi-zone yenguqu. Indawo yenguqu yindawo yomlomo wesibeleko kunye nenzuzo ephezulu yeseli kunye nendawo eqhelekileyo yomhlaza wesibeleko ukuphuhlisa.
Iziphumo zophando ezixhasa le ngcamango yokuqala kukuba izilonda zomlomo ziqhubela phambili ngokukhawuleza kwabasetyhini abangaxilwanga. Ngaphezu koko, abaphandi baye bafumanisa ukuba izigulane ezinesilonda somlomo wesibeleko zisuswe bhetele xa izicubu ezinezilonda ziqukethe ii-CD4 + T-cell kunye neCD11c + zeeseli ze-dendritic.
Ubukho beli seli, eziyiyo iindidi ze-lymphocytes ezisebenzayo kwiimpendulo zokuzivikela, zibonisa ukungena kwe-immune.
Ngaphandle koko, kuphakanyiswe impendulo yokhuseleko lomzimba ongapheliyo ukuze uchaze umphumo wokukhusela we-IUDs. Ngokutsho kukaCortessis kunye nababhali-mbhali:
Iinkqubo ezibandakanya impendulo engapheliyo phambi kwe-IUD sele iphakanyisiwe .... IUDs inokuchaphazela ukuphikelela kwe-HPV ngokuthi 'utshintsho kwiimeko zangasese zomzimba ze-mucosal' ezibangelwa ukuvuvukala okungapheliyo kwi-endocervix kunye nomlomo wesibeleko okanye ngokutyunjwa 'kwendawo encinane ye-inflammation' engapheliyo ngenxa ye-IUD yokungeniswa okanye ukususwa kunye nokuhlala ixesha elide. ukumelana nomzimba.
Ngamanye amagama, ngokuhamba kwexesha, ukuvutha komgangatho ophantsi kancinci phambi kobuchule be-IUD kunokuqinisa amandla omzimba omzimba we-mucosa yomlomo wesibeleko. Okanye, iziqithi ezincinci zokuvuvukala okungapheliyo zingenza iimpendulo zempiliso yomzimba emva kokungena kwi-IUD okanye ukususwa, oku kuphumela ekuphenduleni kwexesha elide.
Ekugqibeleni, nangona kungenakwenzeka, kunokwenzeka ukuba xa i-IUD ingeniswa okanye isuswe, inokutshabalalisa iiseli zomhlaza.
Impembelelo
Kungekafiki ukufumana iziphumo zolu pho nonongo kwaye bacebise ukuba abafazi bafumana i-IUDs ukukhusela umdlavuza wesibeleko. Izixhobo ze-intrauterine zineenzuzo zabo-kubandakanya ukuphumelela okuphezulu kunye nemiphumo embalwa emibi-kodwa ngoku, kufuneka senze uphando olongezelelweyo lokuqinisa iziphumo zophando kwaye sibone indlela kunye neentlobo ze-IUD ezinokuthintela umdlavuza wesibeleko.
Nangona ininzi yabasetyhini kulesi sifundo basebenzisa ii-IUDs ezingekho ze-hormonal, abaphandi babengenalo ulwazi olwaneleyo ukuthelekisa iziphumo ezikhuselekileyo zobhedu ze-IUDs kunye nee-IUDs ze-hormone. Ukongezelela, ezinye izinto zinokudlala indima kwiziphumo ezinokukhusela, kubandakanywa ubude bokusetyenziswa okanye ubudala ekubekeni. Ezi zinto ziza kufuneka zihlolisiswe ngokupheleleyo ukuba zizise izikhokelo zeklinikhi.
Omnye umda we-meta-analysis ingabonakala ekuhlaleni izifundo ngokwazo. Abaphandi abanakuyibuza ukuyila kohlobo lwabo lokuhlalutya okanye ukuthembeka kweziphumo zabo. Ngokukodwa, abachazi iziphumo ezikhuselweyo zokukhusela ii-IUD kwizinto ezinjengokuyila i-study, i-bias yokushicilela, okanye ukutshatyalaliswa kokutshatyalaliswa ngumngcipheko wesibeleko somlomo wesibeleko kunye nezinto ezikhuselekileyo.
Uhlalutyo lwama-meta, kodwa ke lulo lungileyo nje ngezifundo zaloo ndawo, kwaye ngenxa yokuba lo mboniso ukhangelekile kwaye ubuyisela phambili-kunye nabaphandi bajonga emva komsebenzi owenziwe ngabanye-kunokwenzeka ukuba izifundo ngokwazo zazingekho phantsi. Ngokomzekelo, ababhali beephando ezili-16 abavavanyelweyo bangazibandakanya ngokungahambelani okanye ngokungafanelanga ukungafani kwimiba yengozi okanye izinto ezinokukhusela ezifana nokufikelela ekunyamekelweni kokukhusela okanye kwimpembelelo yesimo sezentlalo.
Nangona kusekuseni kakhulu ukuba kutholakale indlela yokufaka iziphumo zolu cwaningo kwintsholongwane, abaphandi babonelela inzuzo enkulu yolu cwaningo-ngakumbi kulabo abasengozini enkulu yomhlaza wesibeletho: abantu abangaphantsi kwemali abanokufikelela ngokukhawulelana nokuhlola kunye namaxesha aphezulu yomhlaza wesibeleko. La maninzi adlula ngaphesheya kwe-United States kwaye aquka abo belizwe eliphuhlisayo.
Abaphengululi baphetha isifundo sabo ngala mazwi alandelayo:
Ukuba iinzame ezinjalo zixhasa impembelelo yokukhusela i-IUD, ukululekwa kwexesha elizayo kungaphinda kuqulethe le nzuzo engenakuyithandabuzo ye-IUD. Amandla okuguqulela kule ngxelo yophando igxininiswa yimfuno ekhulayo kunye neenkqubela zeendlela zokukhusela umdlavuza wesibeleko ezingasetyenziswa ngokubanzi ngabafazi be-HPV abasetyhini kwizicwangciso eziphantsi kwezinto eziphathekayo, iimfuno ezikhuselekileyo zokukhulelwa kwala mabhinqa, kunye namaxwebhu aqinisekileyo iingeniso ezingenakuyamkela ze-IUDs.
Olunye ulwazi malunga neCervical Cancer
Umhlaza womlomo wesibeleko ngumhlaza wesifo somzimba wesifo somzimba, kunye nolwesithathu oluqhelekileyo lomhlaza emhlabeni jikelele. I-Arhente yamazwe ngamazwe yoPhando kwiCarcer iqikelele ukuba ngo-2030 emhlabeni wonke kuya kuba neziganeko ezingama-710,000 zomhlaza wesibeleko kunye ne-383,000 yomhlaza wesibeleko eshonile rhoqo ngonyaka.
Into ebalulekileyo yengozi yomhlaza wesibeleko yi-HPV, kodwa kukho ezinye izinto ezinobungozi, nazo ziquka ezi zilandelayo:
- Ukunyanya
- Ukutshaya
- Ufikelelo lwemfundo oluphantsi
- Yobudala
- Inani lokukhulelwa
- Intlupheko
- Ukudibanisa umlomo womlomo
- Ukuba neqabane elithile lezesondo ngexesha lokuphila
- Ukunyuswa kwamagciwane
Ngenxa yokuba abafazi abanomdla wesibeleko somlomo wesibeleko bahlala bengenazo iimpawu, yindlela kuphela ukuba ugqirha uyakwazi ukuchonga esi sifo kukuhlolwa kwePap kunye nokuhlolwa kwe-HPV. Ukongezelela, ukuxilongwa komhlaza wesibeleko kudla kufuna i-biopsy yomlomo wesibeleko, obizwa ngokuba yi-colposcopy. Okubaluleke kakhulu, izinto ezinobungozi njengentlupheko kunye nokufikelela kwezemfundo eziphantsi azithethi ukuqhubela phambili komhlaza womlomo wesibeleko, kodwa kuncipha amathuba okuba umfazi ahlolwe.
Ngokuqhelekileyo, isigaba sokuqala isifo sinokuphulukiswa kakhulu ngokususwa kokukhutshwa kwezilonda zomhlaza. Ukunyanga kwezifo eziphambili kuyaphumelela ngaphantsi kwaye kudinga i-chemoradiation.
Inqanaba leminyaka emihlanu yokusindiswa yipesenti yabasetyhini baphila iminyaka emihlanu emva kokuxilongwa. Ngokutsho kweMerika Society of Clinical Oncology:
Xa zifunyenwe kwinqanaba lokuqala, isilinganiso seminyaka emihlanu yokusindiswa kwabasetyhini abanomdlavuza wesibeleko somlomo ngu-91%. Phantse i-46% yabasetyhini abanomdlavuza wesibeleko bafumaneka kwixesha lokuqala. Ukuba umhlaza wesibeleko usasaze kwiimichilo okanye izitho zengqungquthela kunye / okanye i-lymph nodes zengingqi, izinga lokusinda iminyaka emi-5 li-57%. Ukuba umhlaza usasazeke kwiindawo ezikude zomzimba, izinga lokusinda iminyaka emi-5 li-17%.
Ngokubanzi, ukuhlanganiswa kwe-HPV yokugonywa kunye nokuhlolwa kweklinikhi kunika ukukhuselwa okuthe ngqo kumhlaza wesibeleko.
Njengoko kuthethwe kwiStransz Principals of Surgery :
Izilingo ezininzi ezinokwenziwa kweeklinikhi ezibandakanya ama-35 000 amabhinqa amancinci abonise ukuba ii-Gardasil kunye neCervarix [iigciwane ezimbini ze-HPV] zikhusela phantse i-100% ye-HPV subtype-eqhelekileyo yintsholongwane yeseli yomlomo wesi-4 ukuya kwimizuzu engama-4 emva kokugonywa kwabasetyhini abangenasifo. ixesha lokugonywa; ukugonywa kwenzeka ngaphambi kokuqala kwesondo .... Ukugonywa akukabonakalwanga ukukhusela abafazi abasele benesifo se-HPV-16 okanye i-HPV-18 ngexesha lokugonywa.
ILizwi
Uphando olutsha lubonisa ukuba ukubekwa kwe-IUD kunciphisa umngcipheko wesifo somhlaza wesibeleko. Nangona kunjalo, uphando olongezelelweyo lufuneka lwenziwe ukuxhasa ezi ziphumo kwaye ubone ukuba kutheni kwaye zinjani iintlobo ze-IUDs ezikhuselayo. Okwangoku, kufuneka ujonge i-IUD malunga nokuba yiyiphi into-efanelekileyo kwaye ekhuselekileyo yokulawula ukuzalwa. Ubungakanani be-IUDs ukukhusela umdlavuza wesibeleko kufuneka kubhekwe njengebhonasi.
Imithombo:
> Cortessis VK et al. Ukusetyenziswa kwezixhobo ze-Intrauterine kunye neengozi zeCervical Cancer Ingozi: Uhlolo lokuHlola kunye nokuhlaziywa kweMeta. I-Obstetrics & Gynecology . 2017. [epub phambi kokuprinta]
> IHO. Ukungenzi lutho kunye noNyango. Ku: Kasper D, Fauci A, Hauser S, uLongo D, Jameson J, Loscalzo J. eds. Imigaqo yeHarrison ye-Medicine yangaphakathi, i-19e eNew York, i-NY: i-McGraw-Hill; 2014.
> Hamilton C, Stany M, Gregory W, Kohn EC. Gynecology. Ku: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. eds. I-Schwartz Iimigaqo zoPhephelo, 10e eNew York, NY: McGraw-Hill; 2015.
> Woo J. Gynecologic Disorders. Ku: Papadakis MA, McPhee SJ, Rabow MW. eds. Ukuxilongwa kweZonyango kunye neNyango ye-Treaty 2018 eNew York, NY: iMcGraw-Hill.