Ukuhlaziywa kwe-meta kusikisela ukuthi ama-IUD anciphisa ingozi yomdlavuza wesibeletho
Yiqiniso, amadivaysi e-intrauterine (iUDs) asebenza ngokuphawulekayo ekuvimbeleni ukukhulelwa. Ngonyaka wokuqala wokusetshenziswa, ama-IUD ahluleka ngaphansi kwamaphesenti angama-1 abesifazane abasebenzisa.
Ngaphezu kokuvimbela ukukhulelwa, ucwaningo olusha lubonisa ukuthi ama-IUD angasiza futhi ukuvimbela umdlavuza womlomo wesibeletho- ikakhulukazi phakathi kwabantu abahola kancane abahlala ngaphansi kwamaphesenti angaphansi kwamaphesenti amabili kwabesifazane abagonywe ngokumelene ne-papillomavirus yabantu (HPV).
Nakuba kungekhona bonke abesifazane abane-HPV abahlakulela umdlavuza wesibeletho, i-HPV iyimbangela eyinhloko yomdlavuza wesibeletho.
Ucwaningo
Esikhathini sokubuyekezwa okuhleliwe kukaDisemba 2017 kanye nokuhlaziywa kwe-meta okubizwa nge-Intrauterine Device Use and Risk Cervical Cancer, uCortessis kanye nozakwethu baveze izifundo ezingu-16 eziphakeme zokufakwa ekuhlaziyweni kwazo. Idatha ehlanganisiwe kulezi zifundo yayimame abesifazane abangu-12 482: 4945 abesifazane abanekhanda lomlomo wesibeletho kanye no-7537 ngaphandle komdlavuza.
Ngemuva kokulawula iziguquguquko eziphazamisayo ezifana nesandulela se-HPV nomdlavuza womlomo wesibeletho emithonjeni yomthombo, abacwaningi bathola ukuthi umdlavuza wesibeletho wawungaphenduka kancane kwesithathu kubantu besifazane abasebenzisa i-IUDs.
Ama-IUDs asebenza kanjani?
Ubulili buxhunywe esibelethweni ngomlomo wesibeletho , i-necklike pass passage. Ukusebenzisa i-speculum, udokotela uzobeka i-IUD ukuze abekwe esibelethweni. I-IUD isetjenziswa esibelethweni ngokusebenzisa i-inserta ekhethekileko, begodu igcinwe endaweni ye-os wesibeletho.
Ngokusho kwabalobi be- Current Medical Diagnosis & Treatment 2018 , nansi isikhathi sokubekwa kwe-IUD:
Ukufakwa kungenziwa ngesikhathi noma ngemva kwe-mens, emkhatsini we-midcycle ukuvimbela ukufakelwa, noma kamuva emjikelezweni uma isiguli singakhulelwe. Kukhona ubufakazi obukhulayo bokuphakamisa ukuthi ama-IUD angasetshenziswa ngokuphephile esikhathini esilandelayo ngemuva kokuzalwa nokuhamba kwesikhathi.
Ama-IUDs e-Copper asebenza ngokunciphisa ukusabela okungumzimba oyinyumba obangela umzimba ukuba ubulale isidoda. Ithusi ithathwa njengomzimba wangaphandle ozohlasela umzimba ngokuzivikela komzimba.
I-progestasert ye-IUD ye-hormonal isebenza ngokukhulula ama-hormone anethonya le-spermicidal.
I-hormonal IUD Mirena inezenzo ezilandelayo:
- Ukupheka komlomo wesibeletho ukuvimbela isidoda ukungena esibelethweni
- Ukuvimbela isidoda ekufinyeleleni noma ekukhuliseni iqanda
- Ukuthinta uhlaka lwesibindi
Ngokomlando, i- IUDs iye yaxhunyaniswa nokuvuvukala kwe-pelvic nokungazalwa; Nokho, amadivaysi amasha aphephile kakhulu. Ngaphandle kokuphumelela kakhulu, i-IUDs yanamuhla nayo inezimbangela ezimbalwa ezingemihle.
Abesifazane abasengozini enkulu yokutheleleka ngesifo socansi noma ukuthuthukisa i-endocarditis ye-bacterium akufanele basebenzise i-IUDs. Ngaphezu kwalokho, kwabesifazane abane- uterine fibroids , ama-IUD angase aphumelele ngoba ashintsha isimo se-uterine cavity.
E-United States, ama-IUD asetshenziswa kakhulu. Amaphesenti angu-1 kuphela aseMelika asebenzisa ama-IUDs. EYurophu naseCanada, phakathi kwamaphesenti angu-15 namaphesenti angu-30 abesifazane basebenzisa i-IUDs.
Ama-IUDs avimbela kanjani umdlavuza wesibeletho?
Akucaci ukuthi i-IUDs impela ivikela kanjani umdlavuza wesibeletho.
Noma kunjalo, kunamaphuzu ambalwa ahlukene.
Ukubekwa kwe-IUD kungenza ukuthi amasosha omzimba ahlose ukutheleleka kwe-HPV kanye nezilonda ezithathelwanayo (umdlavuza). Ngokuqondile, i-IUDs ibekwa phezu kwendawo yokuguqula futhi igxile ekuphenduleni kwe-immune endaweni yenguquko. Indawo yokuguqulwa yindawo yomlomo wesibeletho ene-cell high yield and indawo evamile kakhulu yomdlavuza womlomo wesibeletho ukuthuthukisa.
Iziphumo zokucwaninga ezisekela lo mbono wokuqala ziwukuthi izilonda zomlomo ziqhubekela phambili ngokushesha nakwabesifazane abangenakho ukuzivikela. Ngaphezu kwalokho, abacwaningi bathole ukuthi iziguli ezinomlenze wesibeletho zisusiwe kangcono uma izicubu eziqukethe lezi zilonda ziqukethe i-CD4 + T-cell kanye nama-CD11c + amangqamuzana e-dendritic.
Ukuba khona kwala maseli, okuyizinhlobo zama-lymphocytes asebenzayo ekuphenduleni kwe-immune, akhombise ukungena kwe-immune.
Ngaphandle kwalokho, kuphakanyiswe impendulo yokuzivikela komzimba isikhathi eside ukuze kuchazwe umphumela wokuvikela we-IUDs. Ngokusho kukaCortessis nabalobi ababambisene nabo:
Izindlela ezibandakanya impendulo engapheliyo ekufikeni kwe-IUD nazo ziphakanyisiwe .... Ama-IUD angathinta ukuphikelela kwe-HPV ngokusebenzisa 'ushintsho esimweni sesimo somzimba samasosha omzimba' esibangelwa ukuvuvukala okungapheli, okuphansi kwe-endocervix nomlomo wesibeletho noma ngokufakwa kwe 'foci encane yendawo yokuvuvukala okungapheli' okubangelwa ukufakwa kwe-IUD noma ukususwa nokuhlala okuhlala isikhathi eside ukuzivikela ngomzimba.
Ngamanye amazwi, ngokuhamba kwesikhathi, ukuvuvukala okuphansi okuphansi kokuya kwe-IUD kungaqinisa amandla omzimba omzimba we-mucosa wesibeletho. Noma, iziqhingi ezincane zokuvuvukala okungapheli kungaholela ekuphenduleni kwe-immune okuzuzisayo ngemuva kokufaka i-IUD noma ukususwa, okuholela ekuphenduleni komzimba isikhathi eside.
Okokugcina, nakuba kungenakwenzeka, kungenzeka ukuthi uma i-IUD ingeniswa noma isuswe, ingase isuse amangqamuzana anomdlavuza.
Imiphumela
Kungakabiphi ukuthatha imiphumela yalolu cwaningo futhi kusikisela ukuthi abesifazane bathola i-IUD ukuvimbela umdlavuza wesibeletho. Amadivayisi we-intrauterine anezinzuzo zawo-kuhlanganise nokusebenza okuphezulu kanye nemiphumela emibi embalwa-kepha manje, kudingeka senze ucwaningo olwengeziwe lokuqinisa lokho okufundwayo futhi sibone nokuthi yiziphi izinhlobo ze-IUD ezingavimbela umdlavuza wesibeletho.
Nakuba iningi labesifazane kulolu cwaningo lisebenzisa ama-IUD angewona ama-hormone, abacwaningi babengenalo ulwazi olwanele lokuqhathanisa imiphumela yokuzivikela ye-IUDs yethusi ngokumelene nama-IUD ama-hormonal. Ngaphezu kwalokho, ezinye izinto zingabamba iqhaza emiphumeleni enokuvikela, okufaka isikhathi sokusebenzisa noma ubudala ekubekeni. Izinto ezinjalo kuzodingeka zihlolwe kabanzi ukuze zazise imihlahlandlela yemitholampilo.
Enye imingcele yalokhu kuhlaziywa kwe-meta ingase ilale ekuhloleni kwezifundo ngabanye ngokwayo. Abacwaningi ababaza ukuthi ukuklanywa kobuchwepheshe babo be-meta noma ubuqiniso bemiphumela yabo. Ngokukodwa, abachazi imiphumela evikelekile yokuzivikela ye-IUDs ezintweni ezinjengokuklanywa kocwaningo, ukukhishwa kwezincwadi, noma ukuphazamiseka kwezinsalela ngomdlavuza wesibeletho somlomo wesibeletho kanye nezici zokuzivikela.
Kodwa-ke, ukuhlaziywa kwe-meta kuhle kakhulu njengokufundiswa kwezinto zalo, futhi ngenxa yokuthi lolu cwaningo lwalubukele futhi lubuyele emuva-nabacwaningi babheka emuva emsebenzini owenziwe ngabanye-kungenzeka ukuthi izifundo ngabanye zazingalungile. Isibonelo, abalobi bezifundo ezingu-16 abahloliswe bangahle bacatshangelwe ngokungahambisani noma ngokungenakuqhathaniswa ukuhlukana kokungcupheni noma izici zokuzivikela ezifana nokufinyelela ukunakekelwa kokuvimbela noma imiphumela yesimo sezenhlalakahle.
Naphezu kokuba kusencane kakhulu ukuze kunqume ukuthi kufaka kanjani imiphumela yalolu cwaningo ekusebenzeni komtholampilo, abacwaningi bayabona kuqala inzuzo enkulu yalolu cwaningo-ikakhulukazi kulabo abasengozini enkulu yomdlavuza womlomo wesibeletho: abantu abahola imali encane abanokufinyelela okulinganiselwe ekuhlolweni kanye nemvamisa ephezulu yomdlavuza wesibeletho. Lezi zizwe zidlula ngaphesheya kwe-United States futhi zihlanganisa nalabo abasezweni elithuthukayo.
Abacwaningi baphetha isifundo sabo ngalokhu okulandelayo:
Uma imizamo enjalo iqinisekisa ithonya lokuvimbela i-IUD, ukululekwa kokubeletha esikhathini esizayo kungase kubandakanye le nzuzo okungenakuphikisana nayo ye-IUD. Amandla okuhumusha alo mbono wocwaningo agcizelelwa yizidingo ezinkulu nezikhulayo zezindlela zokuvimbela umdlavuza wesibeletho somlomo wesibeletho ezingasetshenziswa kabanzi ngabesifazane abavulwe yi-HPV ezilungiselelweni eziphansi, izidingo ezivame ukuvimbela ukukhulelwa phakathi kwalaba besifazane, kanye nemibhalo ethembekile yezinye izinzuzo ezingenasisindo ze-IUDs.
Ulwazi olwengeziwe mayelana nekhanda lomlomo wesibeletho
Umdlavuza womlomo wesibeletho ngumdlavuza wesifo sofuba ovame kakhulu, kanti uhlobo lwesithathu oluvame kakhulu lomdlavuza emhlabeni wonke. I-International Agency for Research on Cancer ilinganisela ukuthi ngo-2030 emhlabeni jikelele kuyoba khona amacala angu-710 000 omdlavuza wesibeletho kanye nokufa komdlavuza wesibeletho ka-383,000 ngonyaka.
Into eyingozi enkulu yomdlavuza womlomo wesibeletho i-HPV, kodwa kunezinye izici eziyingozi, futhi kufaka phakathi okulandelayo:
- Ukukhuluphala
- Ukubhema
- Ukufinyelela okuphansi kwezemfundo
- Ubudala obudala
- Inani lokukhulelwa
- Ubumpofu
- Ukuhlanganiswa kokubeletha ngomlomo
- Ukuba nabalingani abaningi bezocansi phakathi nenkathi yokuphila
- I-Immunosuppression
Ngenxa yokuthi abesifazane abanezigaba zokuqala zomdlavuza wesibeletho bavame ukuletha ngaphandle kwempawu, indlela kuphela ukuthi udokotela angakwazi ukubona lesi sifo yi-Pap test kanye nokuhlolwa kwe-HPV. Ngaphezu kwalokho, ukuxilongwa komdlavuza womlomo wesibeletho kudinga ukuthi kube ne-biopsy yomlomo wesibeletho, okuthiwa i-colposcopy. Okubalulekile, izici ezinobungozi njengobumpofu nokufinyeleleka okuphansi kwezemfundo azihambisani nokuqhubeka komdlavuza womlomo wesibeletho, kodwa kunciphisa amathuba okuba owesifazane ahlolwe.
Ngokuvamile, izifo zesandulela-ngculazi ziyaphathwa kahle ngokususwa kokuhlinzwa kwezilonda zomdlavuza. Ukwelashwa kwezifo ezithuthukisiwe akuphumelelanga kakhulu futhi kudinga ukwenziwa kwemvelo.
Inani leminyaka emihlanu lokusinda liyingxenye yabesifazane abaphila iminyaka emihlanu emva kokuxilongwa. Ngokusho kwe-American Society of Clinical Oncology:
Uma kutholakala esiteji sokuqala, isilinganiso seminyaka emihlanu sokusinda yabesifazane abanomdlavuza womlomo wesibeletho singenayo 91%. Abesifazane abangaba ngu-46% abanomdlavuza womlomo wesibeletho baxilongwa ekuqaleni. Uma umdlavuza womlomo wesibeletho usakaze emaqenjini noma izitho ezizungezile kanye / noma izakhi zamakhansela zesifunda, izinga lokusinda iminyaka engu-5 liyi-57%. Uma umdlavuza usakaze endaweni ekude yomzimba, izinga lokusinda iminyaka engu-5 liyi-17%.
Ngokubanzi, ukuxilongwa kwe-HPV yokugoma kanye nokuhlolwa kwe-clinic kunikeza ukuvikeleka okuvelele emdlalweni wesibeletho somlomo wesibeletho.
Njengoba kushiwo kuStwartz's Principles of Surgery :
Izivivinyo eziningana ezinomtholampilo ezibandakanya izingane ezincane ezingaba ngu-35 000 ziye zabonisa ukuthi kokubili i-Gardasil neCervarix [imithi emibili ye-HPV] ivimbela cishe amaphesenti angama-100% we-HPV subtype-specific precancerous cell-change changes for up to 4 years after vaccination phakathi kwabesifazane abangenasifo isikhathi sokugoma; ukugoma kwenzeka ngaphambi kokuqala kocansi .... Ukugoma akukakabonakali ukuvikela abesifazane asebevele benesifo se-HPV-16 noma i-HPV-18 ngesikhathi sokugoma.
Izwi elivela
Ucwaningo lwakamuva lubonisa ukuthi ukubekwa kwe-IUD kunciphisa ingozi yomdlavuza wesibeletho. Kodwa-ke, ucwaningo olwengeziwe luzodingeka lwenziwe ukusekela lezi zithole bese uthola ukuthi kungani futhi yiziphi izinhlobo ze-IUDs ezivikelayo. Okwamanje, kufanele ubuke ama-IUD ngalokho okuyikho-izindlela eziphumelelayo neziphephile zokulawulwa kokuzalwa. Ikhono le-IUDs lokuvimbela umdlavuza wesibeletho kufanele libhekwe njengebhonasi engaba khona.
Imithombo:
> Cortessis VK et al. Ukusetshenziswa kweDivaysile yeDivaysi yeDivaysi kanye neHlelo lomdlavuza womlomo wesibeletho: Ukubuyekezwa kwesistimu kanye nokuhlaziywa kwe-Meta. I-Obstetrics & Gynecology . 2017. [i-epub ngaphambi kokuphrinta]
> Hall JE. Ukungenzi lutho nokubeletha. Ku: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. eds. Izimiso zikaHarrison ze-Internal Medicine, 19e eNew York, NY: McGraw-Hill; 2014.
> Hamilton C, Stany M, Gregory W, Kohn EC. I-Gynecology. Ku: Brunicardi F, Andersen DK, B Billiar, Dunn DL, Hunter JG, Matthews JB, Pollock RE. ama-eds. Izimiso zokuhlinza zikaSchwartz, 10e eNew York, NY: McGraw-Hill; 2015.
> Woo J. Gynecologic Disorders. Ku: Papadakis MA, McPhee SJ, Rabow MW. ama-eds. Ukuxilongwa Kwezokwelapha Nokwelashwa Kwamanje 2018 eNew York, NY: McGraw-Hill.