Những tiến bộ gần đây trong việc hiểu và quản lý u nội mạc tử cung

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Silvia Vannuccini1,2,3, Felice Petraglia4,3
1Department of Molecular and Developmental Medicine, University of Siena, Siena, viale Mario Bracci 16, 53100
2Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Florence, Largo Brambilla 3, 50134
3Obstetrics and Gynecology, Department of Maternity and Child Health, University Hospital Florence, Careggi University Hospital, Florence, Largo Brambilla 3, 50134
4Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Largo Brambilla 3, 50134

Tóm tắt

U nội mạc tử cung là một rối loạn lành tính của tử cung, trong đó các tuyến và mô đệm nội mạc được chứng minh bệnh lý trong cơ tử cung. Đây được coi là một thực thể cụ thể trong phân loại PALM-COEIN FIGO (polyp; u nội mạc tử cung; u xơ tử cung; ung thư và tăng sinh; rối loạn đông máu; rối loạn rụng trứng; nội mạc tử cung; do y học; và chưa được phân loại – Liên đoàn Quốc tế về Sản phụ khoa và Sản khoa) về nguyên nhân gây chảy máu tử cung bất thường (AUB). Mặc dù từ trước đến nay luôn được coi là tình trạng kinh điển của những phụ nữ đã sinh đẻ trên 40 tuổi có triệu chứng đau và chảy máu kinh nguyệt nhiều, được chẩn đoán khi phẫu thuật cắt bỏ tử cung, nhưng tình hình dịch tễ học đã hoàn toàn thay đổi. U nội mạc tử cung ngày càng được phát hiện ở những phụ nữ trẻ có triệu chứng đau, AUB, vô sinh, hoặc không có triệu chứng qua việc sử dụng các kỹ thuật hình ảnh như siêu âm qua âm đạo và cộng hưởng từ. Tuy nhiên, chưa có sự đồng thuận về định nghĩa và phân loại tổn thương u nội mạc từ góc độ mô bệnh học và hình ảnh, và việc chẩn đoán vẫn còn khó khăn và mơ hồ. Một hệ thống báo cáo đồng nhất và chia sẻ cần được thực hiện để cải thiện sự hiểu biết của chúng ta về các đặc điểm hình ảnh, mối quan hệ của chúng với các lý thuyết bệnh sinh, và tầm quan trọng của chúng về mặt triệu chứng lâm sàng và phản ứng với điều trị. Thực tế, cơ chế bệnh sinh của u nội mạc vẫn mơ hồ và không có lý thuyết nào có thể giải thích tất cả các kiểu hình khác nhau của bệnh. Hơn nữa, u nội mạc thường đồng xuất hiện với các tình trạng sản phụ khoa khác, như lạc nội mạc tử cung và u xơ tử cung, làm gia tăng tính không đồng nhất của dữ liệu có sẵn. Việc điều trị yêu cầu một kế hoạch quản lý suốt đời, vì căn bệnh này có ảnh hưởng tiêu cực đến chất lượng cuộc sống về mặt triệu chứng kinh nguyệt, khả năng sinh sản và kết quả thai kỳ, và có nguy cơ cao về sẩy thai và các biến chứng sản khoa.

Từ khóa


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