Υστερεκτομή

Τι είναι η υστερεκτομή;

Υστερεκτομή είναι η χειρουργική επέμβαση για την αφαίρεση της μήτρας. Είναι ένα πολύ κοινό είδος χειρουργικής επέμβασης για τις γυναίκες σε όλο τον κόσμο.

Αφαίρεση της μήτρα σας σημαίνει ότι δεν μπορείτε πλέον να μείνει έγκυος.

Γιατί γίνεται υστερεκτομή;

Υστερεκτομή χρησιμοποιείται για τη θεραπεία πολλών προβλημάτων υγείας των γυναικών. Ορισμένες από αυτές τις συνθήκες περιλαμβάνουν τα ακόλουθα:

  • Τα ινομυώματα (αυτή είναι η πιο κοινή αιτία για υστερεκτομή)
  • Ενδομητρίωση
  • Προβλήματα στήριξης (όπως πρόπτωση της μήτρας)
  • Ανώμαλη αιμορραγία της μήτρας
  • Χρόνιο πυελικό άλγος
  • Γυναικολογικός καρκίνος

Υπάρχουν εναλλακτικές λύσεις της υστερεκτομής ;

Μερικές γυναίκες περιμένουν να έχουν μια υστερεκτομή μέχρι αφού έχουν ολοκληρώσει τις οικογένειές τους. Ειδικά φάρμακα και άλλου είδους πρακτικές χρησιμοποιούνται ως εναλλακτικές της υστερεκτομής πάντοτε εξατομηκευμένα. Εάν επιλέξετε μια άλλη επιλογή εκτός από υστερεκτομή, να έχετε κατά νου ότι μπορεί να χρειαστεί πρόσθετη παρακολούθηση και θεραπεία αργότερα.

Ποιες δομές απομακρύνονται κατά τη διάρκεια μιας υστερεκτομής;

Υπάρχουν διάφορα είδη υστερεκτομής:

  • Ολική υστερεκτομή: Ολόκληρη η μήτρα, συμπεριλαμβανομένου του τραχήλου της μήτρας.
  • Υφολική υστερεκτομή: Το ανώτερο τμήμα της μήτρας αφαιρείται, αλλά ο τράχηλος αφήνεται στη θέση του. Αυτό το είδος της υστερεκτομής μπορεί να πραγματοποιηθεί μόνο λαπαροσκοπικά ή κοιλιακά.
  • Ριζική υστερεκτομή: Αυτή είναι μια ολική υστερεκτομή, που περιλαμβάνει επίσης την αφαίρεση των δομών γύρω από τη μήτρα. Μπορεί να συστηθεί εάν διαγνωσθεί ή υπάρχει υπόνοια καρκίνου.

Ποια άλλα όργανα εκτός του τραχήλου και της μήτρας μπορεί να αφαιρεθούν κατά τη διάρκεια μιας ολική υστερεκτομή;

Η μία ή και οι δύο ωοθήκες σας και σάλπιγγες μπορεί να αφαιρεθούν, εάν διαγνωστεί ανωμαλία (για παράδειγμα, πλήττονται από ενδομητρίωση). Η διαδικασία αυτή ονομάζεται σαλπιγγοωοθηκεκτομή. Σαλπιγγεκτομή συμβαίνει αν αφαιρεθούν μόνο οι σάλπιγγες και ωοθηκεκτομή αν απλώς αφαιρεθούν οι ωοθήκες. Ο χειρουργός σας μπορεί να μην ξέρει αν οι ωοθήκες και οι σάλπιγγες θα πρέπει να απομακρυνθούν μέχρι την ώρα του χειρουργείου. Οι γυναίκες που κινδυνεύουν από καρκίνο των ωοθηκών ή καρκίνο του μαστού μπορούν να επιλέξουν να αφαιρεθούν και οι δύο ωοθήκες, ακόμα και αν αυτά τα όργανα είναι υγιή, προκειμένου να μειώσουν τον κίνδυνο εμφάνισης καρκίνου. Αυτό ονομάζεται μια εκλεκτική αφαίρεση.

Τι θα συμβεί αν οι ωοθήκες μου αφαιρεθούν πριν την εμμηνόπαυση;

Θα αντιμετωπίσετε άμεσα τα σημάδια και τα συμπτώματα της εμμηνόπαυσης. Μπορεί, επίσης, να αποκτήσετε αυξημένο κίνδυνο οστεοπόρωσης. Ορμονική θεραπεία μπορεί να δοθεί για την ανακούφιση από τα σημεία και τα συμπτώματα της εμμηνόπαυσης και μπορεί να βοηθήσει στη μείωση του κινδύνου οστεοπόρωσης. Ορμονική θεραπεία μπορεί να αρχίσει αμέσως μετά τη χειρουργική επέμβαση.

Ποιοι είναι οι διαφορετικοί τρόποι εκτέλεσης μιας υστερεκτομής;

Η υστερεκτομή μπορεί να γίνει με διάφορους τρόπους: μέσω του κόλπου, διαμέσου της κοιλιάς, ή με λαπαροσκόπηση. Η επιλογή θα εξαρτηθεί από τις ενδείξεις της χειρουργικής επέμβασης και από άλλους παράγοντες. Μερικές φορές, η απόφαση λαμβάνεται μετά την έναρξη της επέμβασης οπότε και ο χειρουργός είναι σε θέση να εκτιμήσει την κατάσταση.

Πώς γίνεται μια κολπική υστερεκτομή;

Σε μια κολπική υστερεκτομή, η μήτρα απομακρύνεται διαμέσου του κόλπου. Δεν υπάρχει κοιλιακή τομή. Δεν είναι όλες οι γυναίκες είναι σε θέση να έχουν μια κολπική υστερεκτομή. Για παράδειγμα, οι γυναίκες που έχουν συμφύσεις από προηγούμενες εγχειρήσεις ή που έχουν μια πολύ μεγάλη μήτρα μπορεί να μην είναι σε θέση να υποβληθούν σε αυτό το είδος της εγχείρησης.

Ποια είναι τα οφέλη και οι κίνδυνοι της κολπικής υστερεκτομής;

Κολπική υστερεκτομή, γενικά, προκαλεί λιγότερες επιπλοκές από ό, τι η κοιλιακή ή η λαπαροσκοπική υστερεκτομή. Ο χρόνος επούλωσης μπορεί να είναι μικρότερος από ό, τι με εγχείρηση στην κοιλιακή χώρα, με την ταχύτερη επιστροφή στην καθημερινότητα. Συνιστάται ως η πρώτη επιλογή για υστερεκτομή όταν αυτό είναι δυνατόν.

Πώς γίνεται μια κοιλιακή υστερεκτομή;

Σε μια κοιλιακή υστερεκτομή, η μήτρα απομακρύνεται μέσω μιας τομής στην κάτω κοιλιακή χώρα. Το άνοιγμα στην κοιλιά σας δίνει στον χειρουργό μια σαφή εικόνα των πυελικών οργάνων σας.

Ποια είναι τα οφέλη και οι κίνδυνοι της κοιλιακής υστερεκτομής;

Κοιλιακή υστερεκτομή μπορεί να πραγματοποιηθεί, ακόμη και αν υπάρχουν συμφύσεις ή αν η μήτρα είναι πολύ μεγάλη. Ωστόσο, κοιλιακή υστερεκτομή σχετίζεται με μεγαλύτερο κίνδυνο επιπλοκών, όπως η μόλυνση του τραύματος, αιμορραγία, θρόμβωση, βλάβη των ιστών, από ότι η κολπική ή η λαπαροσκοπική υστερεκτομή. Απαιτεί γενικά μεγαλύτερη παραμονή στο νοσοκομείο και μεγαλύτερο χρόνο ανάρρωσης από τις υπόλοιπες μεθόδους.

Πώς γίνεται η λαπαροσκοπική υστερεκτομή;

Η Λαπαροσκοπική επέμβαση απαιτεί μόνο μερικές μικρές τομές στην κοιλιά σας. Ένα λαπαροσκόπιο εισάγεται μέσω μιας από αυτές τις τομές επιτρέποντας στον χειρουργό να δει τα όργανα της πυέλου. Άλλα χειρουργικά εργαλεία χρησιμοποιούνται για να εκτελεστεί η επέμβαση μέσω χωριστών μικρών τομών. Η μήτρα σας μπορεί να αφαιρεθεί σε μικρά κομμάτια μέσα από τις τομές, μέσα από μια μεγαλύτερη τομή στην κοιλιά σας, ή μέσω του κόλπου σας (που ονομάζεται λαπαροσκοπικά υποβοηθούμενη κολπική υστερεκτομή).

Ρομποτικά υποβοηθούμενη λαπαροσκοπική υστερεκτομή εκτελείται με τη βοήθεια ενός ρομποτικού μηχανήματος το οποίο ελέγχεται από τον χειρουργό. Σε γενικές γραμμές, δεν έχει αποδειχθεί ότι με τη βοήθεια ρομπότ τα αποτελέσματα είναι σημαντικά καλύτερα από την επέμβαση που πραγματοποιήθηκε χωρίς ρομποτική βοήθεια.

Ποια είναι τα οφέλη της λαπαροσκοπικής υστερεκτομής;

Σε σύγκριση με την κοιλιακή υστερεκτομή, η λαπαροσκοπική έχει ως αποτέλεσμα λιγότερο πόνο, χαμηλότερο κίνδυνο μόλυνσης, και απαιτεί συντομότερη παραμονή στο νοσοκομείο. Μπορεί να είστε σε θέση να επιστρέψετε στις κανονικές δραστηριότητές σας νωρίτερα. Υπάρχουν επίσης κίνδυνοι . Μπορεί όμως να πάρει περισσότερο χρόνο σε σχέση με την κοιλιακή ή την κολπική χειρουργική επέμβαση, ειδικά αν αυτό γίνεται με ένα ρομπότ.

Είναι ασφαλής η υστερεκτομή;

Η υστερεκτομή είναι μια από τις ασφαλέστερες χειρουργικές διαδικασίες. Όπως με κάθε χειρουργική επέμβαση, ωστόσο, προβλήματα μπορούν να εμφανιστούν:

  • Πυρετός και μόλυνση
  • Βαριά αιμορραγία κατά τη διάρκεια ή μετά την επέμβαση
  • Τραυματισμός του ουροποιητικού συστήματος ή κοντινών οργάνων
  • Θρόμβοι αίματος στο πόδι που μπορεί να κινηθούν προς τους πνεύμονες
  • Αναπνευστικά ή καρδιακά προβλήματα που σχετίζονται με την αναισθησία
  • Θάνατος

Έχουν όλες οι γυναίκες τον ίδιο κίνδυνο επιπλοκών;

Όχι, μερικές γυναίκες διατρέχουν μεγαλύτερο κίνδυνο επιπλοκών από τους άλλους. Για παράδειγμα, εάν έχετε μια υποκείμενη παθολογική κατάσταση, που μπορεί να διατρέχετε μεγαλύτερο κίνδυνο που σχετίζεται με την αναισθησία.

Θα πρέπει να μείνω στο νοσοκομείο μετά την υστερεκτομή;

Μπορεί να χρειαστεί να παραμείνετε στο νοσοκομείο για λίγες ημέρες μετά την επέμβαση. Η διάρκεια της παραμονής σας στο νοσοκομείο θα εξαρτηθεί από το είδος της υστερεκτομής και το πώς έγινε. Θα κληθείτε να περπατήσετε  το συντομότερο δυνατό μετά την επέμβαση σας. Το περπάτημα θα βοηθήσει στην πρόληψη του σχηματισμού θρόμβων αίματος στα πόδια σας. Μπορείτε επίσης να λάβετε ιατρική ή άλλη αγωγή για να βοηθήσει στην αποφυγή σχηματισμού θρόμβων.

Τι πρέπει να περιμένω μετά την υστερεκτομή;

Μπορείτε να έχετε κάποιο πόνο για τις πρώτες ημέρες μετά την επέμβαση. Θα σας δοθεί φαρμακευτική αγωγή για την ανακούφιση του πόνου. Θα έχετε μικρή οροαιματηρή έκκριση από τον κόλπο σας για αρκετές εβδομάδες. Σερβιέτες μπορούν να χρησιμοποιηθούν μετά από τη χειρουργική επέμβαση. Η δυσκοιλιότητα είναι συχνή . Μερικές γυναίκες έχουν προσωρινά προβλήματα με την κένωση της κύστης . Άλλα ενοχλήματα μπορεί να είναι συναισθηματικής φύσεως. Δεν είναι ασυνήθιστο να έχουν μια συναισθηματική απάντηση σε υστερεκτομή. Μπορεί να έχετε ήπια κατάθλιψη.

Ποια είναι μερικά σημαντικά πράγματα που πρέπει να ξέρω κατά την ανάρρωση;

Ακολουθήστε τις οδηγίες του ιατρού σας. θα πρέπει να κινείστε όσο πιο συχνά μπορείτε. Κάνετε σύντομους περιπάτους και αυξήστε σταδιακά την απόσταση που περπατάτε κάθε μέρα. Δεν πρέπει να σηκώνετε βαριά αντικείμενα, έως ότου ο γιατρός σας πει ότι μπορείτε. Μη βάζετε τίποτα στο αιδοίο σας κατά τη διάρκεια των πρώτων 6 εβδομάδων. Αυτό περιλαμβάνει κολπικές πλύσεις, το σεξ, και τη χρήση ταμπόν.

Μετά την ανάρρωσή σας, θα πρέπει να συνεχίσετε να βλέπετε το γιατρό σας για εξετάσεις ρουτίνας . Ανάλογα με το λόγο της υστερεκτομής , μπορείτε ακόμα να χρειαστείτε κολπικές εξετάσεις του τραχήλου της μήτρας στα πλαίσια του ετήσιου ελέγχου σας .

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