#1
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Àôñ + âàðôàðèí, ãèïåðïëàçèÿ + êðîâîòå÷åíèÿ. Ìèðåíà?
Çäðàâñòâóéòå!
Âîçðàñò 45. Ðîñò 178, âåñ 82-85. Äèàãíîç ÀÔÑ âûñòàâëåí áîëüøå 10 ëåò íàçàä, ïîñëå ÒÝËÀ è íåîäíîêðàòíî ïîäòâåðæä¸í. Òàê æå ãåòåðîçèãîòíûå ìóòàöèè â ôîëàòíîì öèêëå, äåôèöèò ïðîòåèíà Ñ, ãåòåðîçèãîòà â ôàêòîðå Õàãåìàíà. Ïðîÿâëÿåòñÿ ÀÔÑ ðåöèäèâèðóþùèìè òðîìáîôëåáèòàìè, áûëà ÒÝËÀ(ìàññèâíàÿ, 2011 ãîä), ïåðåâÿçàíû ÁÏ íà îáåèõ íîãàõ.Ñîîòâåòñòâåííî ÏÔÒÑ, âåíîçíàÿ íåäîñòàòîñíîñòü. Ïîñòîÿííî ïðèíèìàþ âàðôàðèí + àñïèðèí. Êîìïðåññèÿ 2 êëàññ. Ãèíåêîëîãèÿ - 1 áåðåìåííîñòü, 1 ðîäû (2006), âî âðåìÿ áåðåìåííîñòè, áûëî äâà òðîìáîôëåáèòà ïîâåðõíîñòíûõ âåí, áûë ãåñòîç. Ñåé÷àñ - àäåíîìèîç, äâà íåáîëüøèõ ìèîìàòîçíûõ óçëà, ãèïåðïëàçèÿ ýíäîìåòðèÿ, áûëè ïîëèïû. Çà ïîñëåäíèå 4 ãîäà - 3 ÐÄ ïî ïîâîäó àíîìàëüíîãî ìàòî÷íîãî êðîâîòå÷åíèÿ, äâàæäû áûëè ïîëèïû, ïîñëåäíåå ÐÄ ôåâðàëü 2022, ãèñòîëîãèÿ - æåëåçèñòàÿ ãèïåðïëàçèÿ áåç àòèïèè. Ìåñÿ÷íûå âñå âðåìÿ íà âàðôàðèíå ÷ðåçâû÷àéíî îáèëüíûå ïðè íóæíûõ çíà÷åíèÿõ ÌÍÎ (2-3). Ìåñÿ÷íûå âñåãäà áûëè îáèëüíûìè, íî ïîñëåäíèå ëåò 5 ÿ íå ìîãó âûõîäèòü èç äîìà íà 2-3-4 äåíü, ïðèõîäèòñÿ èñïîëüçîâàòü óðîëîãè÷åñêèå òðóñû. Öèêë 24-26 äíåé, ìåñÿ÷íûå 7-8 äíåé, Ãåìîãëîáèí íå ïîäíèìàåòñÿ âûøå 100, ôåððèòèí è æåëåçî äàëåêè îò íîðìàëüíûõ çíà÷åíèé. Ïðèíèìàþ ïîñòîÿííî ïðåïàðàòû æåëåçà, ïåðåîäè÷åñêè ìåíÿÿ äâóõâàëåíòíîå íà òðåõâàëåíòíîå è îáðàòíî, ïëþñ ôîëèåâóþ êèñëîòó. Èç ñîïóòñòâóþùèõ ÄÒÇ, ãèïåðòèðåîç, ñåé÷àñ ðåöèäèâ. Íàäåþñü â ýòîì ãîäó ïîïàñòü íà ðàäèéîä. Ìèãðåíè ñ àóðîé ïðèñóòñòâîâàëè, íî íà âàðôàðèíå ñâåëèñü ê ìàêñèìóì 1 ñëó÷àþ â ãîä. Äàâëåíèå 135-140/80-90 â ñîñòîÿíèè òèðåîòîêñèêîçà. Îáû÷íûå öèôðû 110-120/70-80. Áðàäèêàðäèÿ(âíå òèðåîòîêñèêîçà) Ñîáñòâåííî âîïðîñ - ìîæíî Ìèðåíó? Èíà÷å ïðåäëàãàþò òîëüêî óäàëÿòü îðãàí, ïîêà íå õîòåëîñü áû, ó÷èòûâàÿ ÷òî áîëüøîé âîïðîñ ñ âîçìîæíîñòüþ ÇÃÒ. Ìîÿ âðà÷ â êîíñóëüòàöèè ñîìíåâàåòñÿ íàñ÷¸ò ìèðåíû èç-çà àôñ, íî ãîâîðèò, ñ óäîâîëüñòâèåì ïîñòàâèò ïî ãèíåêîëîãè÷åñêèì ïîêàçàíèÿì. Ñïàñèáî! ÓÇÈ îò ôåâðàëÿ 22 è ðåçóëüòàòû ãèñòåðîñêîïèè è ãèñòîëîãèè, çàêëþ÷åíèå ðåâìàòîëîãà íîÿáðü'11 è ÎÀÊ îò ìàðòà 22. |
#2
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Äîáàâèëà åù¸ ãîðìîíû. Îêòÿáðü 21, âòîðàÿ ïîëîâèíà öèêëà, áëèæå ê mens.
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#3
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åñëè åùå èíòåðåñíî, òî ìîæíî, íî (!) íå ó âñåõ óëó÷øåíèå íà ôîíå Ìèðåíû - öèôðû ñðåäè 17 ðåñïîíäåíòîê íà Ìèðåíå è âàðôàðèíå:
The questionnaire was sent to 23 patients and returned by 17. The amount of bleeding was reduced with the LNG-IUS in 10 (58.8%) women; amenorrhea occurred in four (23.5%), no change in blood loss in one (5.9%) and greater blood loss in two (11.8%) patients. The number of sanitary pads used was less in 12 (70.6%) patients; same in one (5.9%) patient, more in two (11.8%) patients and two (11.8%) did not remember. Five patients (29.4%) had shorter duration of bleeding, four (23.5%) had amenorrhoea, four (23.5%) had longer periods and four (23.5%) had same duration by subjective assessment. Eight (47.1%) patients felt very satisfied, four (23.5%) felt satisfied, two (11.8%) felt dissatisfied with the treatment, one felt very dissatisfied (5.9%) and two (11.8%) did not respond to the question.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#4
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åùå: ïîëîæèòåëüíàÿ äèíàìèêà ÷åðåç 3 ìåñ., íî íå áåç ðèñêà îñëîæíåíèé
40 women with HMB receiving VKAs after cardiac valve replacement. Patients were randomly assigned to LNG-IUS or to a no-treatment group. In the LNG-IUS group, there was a significant decrease in the pictorial blood assessment chart bleeding score and the number of bleeding days per cycle at 3 and 6 months compared with baseline pre-insertion, whereas no change was noted in the control group. The mean of hemoglobin and ferritin levels were significantly increased at 3 months but not at 6 months in those randomly assigned to LNG-IUS. LNG-IUS may increase pelvic pain and breast tenderness. Breakthrough bleeding often occurs in the first 3 to 6 months. Other serious but rare complications of LNG-IUS include pelvic infection, device expulsion, and uterine perforation.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#5
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Ñïàñèáî! ß óñïåëà ïåðåíåñòè åù¸ îäíî âûñêàáëèâàíèå ñ ìàÿ, òåïåðü íà ãèñòîëîãèè ïîëèï. Ìèðåíó âðà÷è ñòàâèòü îòêàçàëèñü, îïàñàþòñÿ íåïðåäñêàçóåìîñòè ïîñëåäñòâèé. Êàê âàðèàíò ïðåäëîæèëè àáëÿöèþ(àáëàöèþ) ýíäîìåòðèÿ. Âåðíåå, ýòî ìíå ïîñëå âûñêàáëèâàíèÿ âðà÷ ïîñîâåòîâàëà, à ìîÿ ëå÷àùàÿ âðà÷ ñ ýòèì ñîãëàñèëàñü. Ãîòîâëþñü ê îïåðàöèè. Àáëÿöèÿ ìîæåò ñòàòü ðåøåíèåì ìîåé ñèòóàöèè? Ïîñëåäíÿÿ ìåíñòðóàöèÿ îïÿòü 14 äíåé, è ýòî âñåãî ÷åðåç 1 öèêë ïîñëå âûñêàáëèâàíèÿ (((
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#6
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â óìåëûõ ðóêàõ 10-20% íåóñïåõà, ó âàøèõ ìîæåò áûòü è âûøå
Endometrial ablation plays an important role in the management of heavy menstrual bleeding, but there is an associated 10–20% failure rate ïîòîì - ãèñòåðåêòîìèÿ 18.8% of patients still needed a hysterectomy after EA.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#7
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Ñïàñèáî! Ïî ñóòè òîò æå ïðîöåíò íåóäà÷è, êàê è ñî ñïèðàëüþ, íó ïðè óñëîâèè óìåëûõ ðóê. Íî, êàê ÿ ïîíèìàþ, è âàðèàíòîâ ó ìåíÿ îñîáî íå îñòà¸òñÿ? ß áåçóìíî óñòàëà îò ýòèõ êðîâîòå÷åíèé( . Ïðè ýòîì è ãèñòåðýêòîìèÿ äëÿ ìåíÿ òîæå ñïîðíîå ðåøåíèå, â âèäó ðèñêà ðåöåäèâà òýëà, îñîáåííî, åñëè âûïîëíÿòü ÷åðåç áðþøíóþ ñòåíêó, ÿ ïðàâèëüíî ïîíèìàþ?
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#8
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ìîæåò è òàê, íî ñïèðàëü - åòî íå àáëàöèÿ, åñëè ó âàñ çàáîëåëà ãîëîâà, òî Âû íà÷í¸òå ñ òàáëåòîê èëè ñðàçó ãèëüîòèíà?
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#9
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ïîñìîòðèòå êàðòèíêó 1 êàê âåäóò òàêèõ ïàöèåíòîâ; õèðóðãèÿ òîëüêî = êîãäà íåò ýôôåêòà îò ëåêàðñòâ
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#10
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Òàê ñïèðàëü îíè îòêàçûâàþòñÿ ìíå ñòàâèòü, íå ìîæåì áðàòü íà ñåáÿ ðèñê, ïîòîìó ÷òî âåðîÿòíîñòü òðîìáîçà èìååòñÿ. Íî ÿ, êîíå÷íî, åù¸ ðàç ïîïðîáóþ äî îïåðàöèè ïîëó÷èòü êîíñóëüòàöèþ åù¸ ó îäíîãî âðà÷à. Ñïàñèáî çà èíôîðìàöèþ!
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#11
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íåò, íà ìèðåíå ñ ëåâîíîðãåñòðåëîì ðèñê òðîìáîçà îòðèöàòåëüíûé; à âîò æä àíåìèÿ ïîâûøàåò ðèñê òðîìáîçà
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |