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BNH C T CUNGMc tiu hc tp 1- Trnh by c v tr gii phu v cu trc m hc bnh thng ca c t cung. 2- M t v phn tch c 4 loi vim c t cung. 3- nh ngha v m t c lon sn, ung th biu m ti ch v ung th biu m xm nhp c t cung.

I. NHC LI V GII PHU V CU TRC M HC C T CUNG- C t cung l phn ni lin t cung vi m o, cn thn t cung l ni pht trin v cha ng bo thai. C t cung c dng nh ming c, ng knh t 2-4cm ngi ph n cha sinh hay nhiu. Nu bc l bng m vt, c t cung c mu hng nht v trung tm l l c t cung. -L c t cung chia t cung lm 2 phn: phn trn m o v phn nm trong m o v hai phn c xem nh c trong v c ngoi t cung. C ngoi c lp bi biu m lt tng khng sng ha, cn c trong lp bi biu m tr n. - Biu m lt tng gm nhiu lp: lp y gm cc t bo hnh khi vung, nhn bu dc v c trc vung gc vi mng y. Lp cn y vi cc t bo bu dc hoc a din, gia cc t bo c cc cu ni lin bo. Lp vy (Malpighi) gm 6-12 hng t bo sng, bo tng nhiu v cu ni lin bo r rt. Lp b mt gm cc t bo dt, nhn vn nh. - Biu m tr n: gm mt hng t bo hnh tr cao, nhn nm cc y v bo tng cha nhiu cht nhy.

II. VIM C T CUNG1. Vim c t cung khng do nhim trng Hu ht cc vim xy ra do tc nhn c hc hay ha hc v gy mt phn ng vim khng c hiu. Cc tc nhn c th l nhng cht trong thuc ra m o hay cc cht l nh vng nng t cung, vng trnh thai. - Vim c t cung cp: c xung huyt, m m bn di ph n v xm nhp nhiu BCN. V lm sng, c t cung sng . - Vim c t cung mn: c xm nhp nhiu lympho bo m m km tng bo, m bo, tng sinh t chc x, c khi to nang lympho. 2. Vim c t cung do nhim khun Vim c t cung do nhim khun bao gm: lin cu nhm B, lu cu, xon khun giang mai, Chlamydia Trachomatis, Gardnerella vaginalis, Actinomyces, trc khun lao, nhim virus, do nm (Aspergillus, Candida Albicans), do k sinh trng (Amp, Trichomonas vaginalis)... 2.1. Vim c t cung do vi khun y l nguyn nhn ph bin thng gp, xy ra trn mt c t cung teo t lp biu m, chn thng, do thay i pH. Vim do vi khun thng i km vi vim ni mc thn t cung, vim vi trng v vim phc mc qua nhau v thai nhi.

101 - Vim do Chlamydia trachomatis: Bnh ph bin thng gp ph n phng Ty, hnh nh vi th biu hin l cc th vi bn trong bo tng ca cc t bo biu m v thng tn cng vo lp biu m tr c trong. Do vy, m o t khi b vim nhng li gy vim niu o v trc trng, huyt trng c dng nh m mu vng xanh c km vim ni mc thn t cung, vi trng, do vy d gy tc nghn vi trng v gy v sinh.

Hnh 1-2: Hnh nh i th v vi th ca vim c t cung - Vim do actinomyces: Bnh thng gp ph n t vng trnh thai hoc no thai. Tn thng vim c dng ht lm chm mu vng, d gy x ha c t cung. - Vim do trc khun lao: Bnh thng th pht sau lao vi trng, lao ni mc thn t cung v lao phi. Biu hin c khi bnh thng hoc tn thng si ging nh ung th th xm nhp. Hnh nh vi th l cc nang lao vi trung tm nang l t chc hoi t dng b u, xung quanh l cc t bo dng bn lin (thoi bo), cc t bo khng l nhiu nhn (i bo langhans) v bao quanh nang l cc lympho bo v t bo x.

Hnh 3-4: Vim do Gardnerella vaginalis 2.2. Vim c t cung do nm Vim c t cung do nm ph bin gp l loi Candida Albicans, bnh thng i km vi vim m o v m h, gp nhng ph n dng nhiu khng sinh ko di, bnh i ng. Kh h c mng trng v rt nga, phin m o thng thy cc si t nm v men nm.

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Hnh 5: Bo t nm Candida

Hnh 6: Si nm Candida

Hnh 7-8: Si nm Leptothrix (dng tc ri) 2.3. Vim c t cung do k sinh trng Ph bin l do Trichomonas vaginalis, dch kh h thng c nhiu bt trng nh x phng hoc mu vng nht km nga. Soi phin c th gp Trichomonas c hnh dng bu dc hoc hnh qu l, kch thc bng t bo cn y hoc c kch thc bng bch cu a nhn v t khi thy cn cc vi ca loi k sinh trng ny. Bnh thng c chn on ch yu da vo soi ti pht hin Trichomonas vaginalis. Vim do Amp rt him gp. 2.4. Vim c t cung do virus Tri ngc vi vim do vi trng, loi virus thng tn cng vo biu m lt tng c ngoi c t cung v thng t c biu hin lm sng. Cc tc nhn virus hay gp l HPV (Human papilloma virus). HSV (Herpes simplex virus) gp ch yu cc ph n tr, ly lan qua ng tnh dc, biu hin bi cc lot nng rt au, au trong lc quan h tnh dc, lc i tiu, dch kh h lng nh nc. Trn phin c cc t bo ln nhiu nhn cha cc th vi, trong lp biu m lt tng c cc bng nc.

103 Nhim virus c th gy sy thai t nhin, d dng thai nhi hoc c vai tr trong bnh sinh ung th c t cung hoc gy tn sn ni biu m vy c t cung (Cervical intraepithelial neoplasm, C.I.N). Nhim HPV thng c cc t bo bng (t bo rng) nm lp trung gian v gn b mt ca biu m lt tng. T bo to, bo tng khng u, quanh nhn c khong sng. T bo rng l hu qu ca virus xm nhp vo trong t bo v lm cht t bo. Thng thy 1/3 trn cng ca lp biu m lt tng, cc t bo biu m c khi qu sn mnh to thnh nh.

III .UNG TH C T CUNG1. nh ngha Ung th c t cung l s bin i c tnh ca cc lp biu m c t cung. 95% ung th xut pht t lp biu m lt tng. - Ung th c t cung l bnh rt ph bin, chim hng u trong cc loi ung th ca ng sinh dc n. - Tn sut tng cao ca bnh c lin quan r rt n cc yu t nh quan h tnh dc sm, giao hp vi nhiu ngi, sinh nhiu, ph n c hon cnh kinh t x hi thp, nhim virus ng sinh dc. 2. Tn thng gii phu bnh 2.1. Lon sn (dysplasia) L tn thng biu m vy c t cung vi hnh nh tng sinh cc t bo biu m non khng trng thnh c th km d dng nhn, cc t bo mt nh hng v mt s sp xp lp ca chng. V vi th, lon sn c cc c im sau: - Tng sinh biu m vi cc t bo non, mt cc tnh, cc t bo y, cn y chim n 1/3 b dy hoc gn ht b dy ca biu m. - Nhn bt thng, to nh khng u, t l nhn trn bo tng tng, nhim sc cht tng m. - Nhiu hnh nh nhn chia.

Hnh 9: CIN 1

Hnh 10: CIN 2

Ty theo chiu cao ca cc lp t bo non cha trng thnh, ngi ta chia lm 3 loi lon sn:

104 + CIN 1: tng sn t bo y, cn y khng qu 1/3 b dy ca biu m. + CIN 2: tng sn t bo y, cn y 2/3 b dy + CIN 3: cc t bo y, cn y chim gn ht b dy ca biu m, trn b mt ch cn vi lp t bo trng thnh. Tui hay gp ca lon sn l 20-35 tui v chn on da vo t bo phin m o v sinh thit bm c t cung. iu tr vi CIN 2,3 bng khot chp c t cung. Mt nghin cu cho thy nu khng iu tr th 50% CIN 1 chuyn thnh CIN 3, thoi trin ch xy ra vi CIN 1, khong 70% CIN 3 pht trin thnh ung th ti ch v ung th xm nhp. 2.2. Ung th biu m ti ch (in situ carcinoma) Ung th c t cung ti ch l s bin i c tnh ca cc t bo biu m nhng vn ch khu tr trong lp biu m lt tng cn lp mng y cn nguyn vn. - V i th: khng c g c bit, khi soi c t cung ch n cc vng trng si, vng mt glycogen (vng i mu), vng c d sn. - V vi th: cc t bo cn non mt tnh cht bit ha v s sp xp lp, nguyn sinh cht kim tnh, nhn ln, nhn qui d, ht nhn to. 2.3. Ung th biu m xm nhp 2.3.1. Ung th biu m vy xm nhp y l loi ung th ph bin, thng gp v c lin quan n nhim HPV. - i th: U c dng mt nt cng hoc mt lot nng hoc si g ln trn b mt, rt d chy mu khi ng vo. V tr thng thy l vng ni tip gia c trong v c ngoi ca c t cung, xung quanh gc u to mt nn cng. - Vi th: c chia lm 3 bit ha + 1 (bit ha tt): gm cc t bo ln, bo tng nhiu, to nh khng u, nhn to qui d, hnh nh nhn phn chia. Chng ng vi nhau tng m ln, gia cc t bo c cc phin sng cun li gi l cu sng. + 2 (bit ha va): gm cc t bo c tnh a dng hn, t bo tng, rt t thy cu ni lin bo. + 3 (bit ha km): gm cc t bo c tnh dng t bo y, nhn kim tnh, bo tng t r, rt nhiu hnh nh nhn phn chia. 2.3.2. Ung th biu m tuyn xm nhp Loi ny chim khong 5-7% ca ung th xm nhp. Hnh nh vi th gm cc m t bo c tnh to nh khng u, nhn ln, qui d. Chng sp xp thnh cc dng ng tuyn. 2.3.3. Ung th biu m tuyn - vy Loi ny him gp, v m hc gm c 2 thnh phn vy v tuyn c tnh. Tm li: Ung th biu m xm nhp c t cung l bnh ph bin v c t l t vong cao. Do vy, vn tm sot nhm pht hin cc tn thng giai on sm v iu tr phi hp phu thut vi x tr, nhm ko di tui th cho ngi bnh l ht sc cn thit.