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აშერმანის სინდრომი - მეორადი უნაყოფობის მიზეზი | ჯანმრთელობა | vidal.ge

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აშერმანის სინდრომი - მეორადი უნაყოფობის მიზეზი

თარიღი: 21 ოქტომბერი, 2022

აშერმანის სინდრომი მეორადი უნაყოფობის ერთ-ერთ ყველაზე ხშირი მიზეზია.

აშერმანის სინდრომი წარმოადგენს შეძენილ პათოლოგიას, რომლის დროსაც ადგილი აქვს შეხორცებითი პროცესების განვითარებას საშვილოსნოს ღრუსა და საშვილოსნოს ყელში. აშერმანის სინდრომის სინონიმებად ხშირად იყენებენ ტერმინებს: საშვილოსნოს შიდა შეხორცებები, საშვილოსნოს და/ან ყელის სინექიები. თუმცა უფრო მართებული აშერმანის სინდრომი გამოვიყენოთ მაშინ როდესაც საშვილოსნოს შიდა შეხორცებებს თან ახლავს კლინიკური ჩივილები.

საშვილოსნოს შიდა შეხორცებები (სინექიები) წარმოადგენს ე.წ. შემაერთებელქსოვილოვან, ფიბროზულ ჭიმემებს, რომლებიც ვითარდება საშვილონოს წინა და უკანა კედლებს შორის. პათოლოგიის სიმძიმე დამოკიდებულია ფიბროზული ჭიმების ზომასა და რაოდენობაზე; შეიძლება იყოს მსუბუქი ფორმის: ერთეული ფიბროზული ჭიმები საშვილოსნოს წინა-უკანა კედელს შორის. ან რთული: საშვილოსნოს ღრუს სრული დახურვით.

საშვილოსნოს შიდა შეხორცებების განვითარება ძირითადად განპირებებულია ენდომეტრიუმის (საშვილოსნოსშიდა შრის) მექანიკური დაზიანებით-ტრავმით. 90% შემთხევევებში უკავშირდება მშობიარობის შემდგომ ან აბორტის შემდგომ კიურეტაჟს (საშვილოსნოს ღრუს გამოფხეკა) (Nappi 2007). ჰისტეროსკოპიული მეტროპლასტიკის (დიდი ზომის ტიხარის ამოკვეთის) ან კონსერვატიული მიომექტომიის შემდგომ. ინფექციური პროცესების ეტიოლოგიური როლი საშვილოსნოს შიდა შეხორცებების განვითარებაში არ არის დადასტურებული. გამონაკლისია სასქესო ორგანოების ტუბერკულიოზი (Deans 2010).

საშვილოსნოს შიდა შეხორცებების კლინიკური გამოვლინება დამოკიდებულია პათოლოგიის სიმძიმეზე ანუ რამდენად არის გამოხატული შეხორცებები საშვილოსნოს ღრუში: მსუბუქი ფორმების დროს კლინიკური ჩივილი შეიძლება საერთოდ არ იყოს და მხოლოდ ადგილი ქონდეს სუბფერტილობას (ორსულობის დროებით შეუძლებლობა). საშუალო და მძიმე ფორმებისას უნაყოფობასთან ერთად, კლინიკური გამოვლინება შეიძლება იყოს ჰიპომენორეა (მენსტრუალური გამონადენის შემცირება), ამენორეა (მენსტრუალური გამონადენის არასებობა) და სხვადასხვა ინტენსივობის სპაზმური ტკივილები მენსტრუაციის დროს, მენსტრუალური გამონადენის მიუხედავად.

დიაგნოსტიკა: ექიმის მიერ აშერმანის სინდრომზე ეჭვის მიტანის შემთხვევაში, დიაგნოზის დაზუსტებისთვის ყველაზე ოპტიმალური კვლევის მეთოდია ჰისტეროსკოპია, რომელიც დროსაც დიაგნოზის დასმისთანავე შესაძლებელია შეხორცებითი პროცესის ქირურგიული მოცილება. დიაგნოსტიკისთვის ასევე ინფორმატიულია ულტრაბგერითი კვლევა და ჰისტეროსალპინგოგრაფია.

მკურნალობის დროს გასათვალისწინებელია პაციენტის ჩივილები დარეპროდუქციული გეგმები. თუ პაციენტი არ გეგმავს ორსულობას და კლინიკურად ჩივილები არ აქვს, ოპერაციული მკურნალობის აუცილებლობა არ არის. სხვა შემთხვევებში მკურნალობის ყველაზე ოპტიმალური მეთოდია ჰისტერორეზექტოსკოპიული ჩარევა