Miyom Nedir?
Rahimde görülen anormal düz kas çoğalması olan miyomlar rahmin en sık görülen iyi huylu tümörüdür. Düzgün sınırlı kitleler olup farklı yerleşimlerde (intramural, subseröz, intrakaviter, saplı vb .) olabilirler. Neden olarak östrojen hormonu suçlanmakla birlikte, ailesel yatkınlığın rol oynadığı bilinmektedir. Hormon bağımlı bir tümör olup, üreme döneminde 5 kadından birinde(%20) görülmektedir. Menapozla birlikte hormon düzeylerinin azalmasına bağlı olarak boyutlarında küçülme izlenmektedir. Obez ve doğum yapmayan hastalarda daha sık izlenirler.
Gebelikte Miyom
Gebelikte, boyutları artıp ağrıya neden olmanın yanında, büyük boyutlardaki ve rahim kavite boşluğuna bası yapan subseröz miyomlar kısırlık, düşük, tekrarlayan gebelik kaybı, erken doğum tehtidine neden olmaktadırlar.
Miyom Belirtileri
Genellikle semptom vermezken, rahmin kasılma yeteneğini olumsuz etkilemesi bağlı olarak kliniğe en sık başvuru nedeni düzensiz, uzun, şiddetli kanama ve bunun yol açtığı anemidir. Çoğu zaman hastalar kanamaların normal olduğunu düşünüp adaptasyon geliştirdiklerinden karşımıza derin anemi, erken yorulma vb. şikâyetler ile başvurmaktadırlar.
Büyük boyutlara ulaşan miyomlar karında şişlik, ağrı, hazımsızlık, kabızlık, gaz şikâyetlerine sebep olmakla birlikte idrar torbasına bası yaparak sık idrara çıkma, böbrek problemlerine neden olmaktadırlar.
Nadiren kavite içindeki saplı miyomlar rahim kavitesinin dışına çıkarak, ilişki sonrası kanama, enfeksiyona bağlı olarak kötü koku ve akıntıya sebep olabilirler.
Miyom Tedavisi
Pelvik muayene ve ultrason ile çok rahat tanı alabilmektedirler. Tanı ve tedavi aşamasında üç boyutlu USG, MR ve tomografiden de yararlanılabilir.
Genelde iyi huylu olup %0.1-0.5 oranında kötü huylu tümöre dönüşüm izlenmekte olup , ani büyüme, şüpheli görünümü olan miyomlar tedavi edilmeli ve miyomu olan hastalar düzenli aralıklarla kontrol edilmelidir.
Tedavide hastanın yaşı, semptomların varlığı ve şiddeti, myom boyutu ve yerleşim yerine göre değişmekte olup gözlemsel, medikal ve cerrahi tedavi (açık, histeresopik,laparaskopik olarak ) seçenekleri uygulanmaktadır.
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