Cov tsos mob ntawm tib neeg papillomavirus yog tshwm sim nyob rau hauv daim ntawv ntawm qhov chaw mos warts, papillomas, warts thiab lwm yam neoplasms ntawm daim tawv nqaij. Lub sijhawm incubation tuaj yeem ncav cuag ntau xyoo. Nws yog txiav txim los ntawm lub xeev ntawm tib neeg kev tiv thaiv. Tam sim no, kwv yees li 600 hom kab mob no tau raug cais tawm, uas ua rau muaj kev phom sij ntau rau lub cev.
Kev faib tawm ntawm tib neeg papillomavirus
Nws muab 70 hom kab mob sib txawv uas tuaj yeem ua rau muaj ntau yam kab mob. Lawv muaj peev xwm kis tau cov hlwb epithelial ntawm daim tawv nqaij, mucous daim nyias nyias ntawm qhov chaw mos thiab lub qhov ncauj.
Muaj ntau hom kab mob, suav nrog cov muaj peev xwm ua rau muaj kev loj hlob ntawm malignant neoplasms. Yog li ntawd nws yog ib qho tseem ceeb kom paub cov tsos mob ntawm tib neeg papillomavirus nyob rau hauv cov poj niam thiab cov txiv neej. Raws li WHO, kwv yees li 70% ntawm tag nrho cov mob ua ntej thiab mob qog noj ntshav yog tshwm sim los ntawm ob hom HPV: 16 thiab 18.malignant qog ntawm noov. Ob tug poj niam tuaj yeem mob qog noj ntshav hauv qhov quav.
Txhua tus kab mob, nyob ntawm oncogenicity, muab faib ua hom hauv qab no:
- tsawg txaus ntshai - 53-55, 42-44, 11, 6;
- nrog kev ua haujlwm nruab nrab - 66, 58, 52, 51, 39, 35, 30-33;
- siab txaus ntshai - 56, 45, 18, 16.
1-4 hom ua rau pom cov kab mob cog qoob loo thiab muaj kev nyab xeeb ntawm oncology.
49, 28, 10 hom provoke kev loj hlob ntawm cov pob tw tiaj tus.
18 thiab 16 hom yog suav tias yog qhov txaus ntshai tshaj plaws, vim tias lawv pab txhawb kev loj hlob ntawm cov qog nqaij hlav cancer thiab ua rau cov tsos mob ntawm papillomas thiab cov kab mob hauv qhov chaw mos ntawm qhov chaw mos. Tab sis txawm tias muaj cov kab mob no hauv lub cev tsis yog kab lus. Raws li kev txheeb cais, tsuas yog 1% ntawm cov poj niam uas muaj tus kab mob no tsim mob qog noj ntshav.
Txoj kev kis kab mob
Muaj ntau txoj hauv kev kis kab mob nkag mus rau tib neeg lub cev:
- tus kheej kis kab mob thaum epilating lossis shaving;
- hauv tus menyuam yug tshiab, cov tsos mob ntawm tib neeg papillomavirus tshwm sim thaum kis los ntawm leej niam - papillomatosis lossis kab mob hauv qhov chaw mos tuaj yeem tsim;
- qhov quav lossis qhov ncauj ua rau muaj kab mob hauv qhov chaw mos;
- kev sib cuag-tsev neeg txoj kev thaum siv cov chaw sib xws: cov pas dej da dej, cov khoom siv qoj ib ce, chav dej, da dej, da dej - ntawm no tus kab mob no txuas ntxiv mus ntev thiab nkag mus rau hauv lub cev los ntawm daim tawv nqaij.
Cov neeg kis tus kabmob, raws li WHO, yog kwv yees li 70% ntawm cov neeg hauv ntiaj teb. Tus kab mob no kis tau yooj yim los ntawm ib qhotus neeg rau lwm tus.
Risk pawg
Tau kawg, tsis muaj leej twg tiv thaiv kab mob. Txawm li cas los xij, txhua yam kab mob tshwm sim sai dua thaum muaj qee yam kev mob zoo rau nws. Nyob rau hauv rooj plaub ntawm HPV nws yog:
- pib pib ntawm kev sib deev;
- kev tiv thaiv tsis muaj zog tom qab muaj mob;
- abbortion;
- STDs thiab comorbidities ntsig txog STIs: trichomoniasis, gonorrhea, chlamydia;
- kev sib deev thiab ntau tus khub sib deev.
Human papillomavirus tsos mob
Tom qab nkag mus rau hauv lub cev, cov kab mob pib ua haujlwm puas tsuaj, ua rau muaj ntau yam kab mob:
- Bowen's disease. Lawv provoke hom 18 thiab 16, vim li ntawd, cov txheej txheem malignant tsim nyob rau hauv qhov chaw mos. Nyob rau theem kawg, metastases kis mus rau lwm yam kabmob.
- Bovenoid papulosis tuaj yeem tshwm sim los ntawm tib hom HPV, nrog rau 31 thiab 33. Nyob rau hauv rooj plaub no, cov pob liab liab tshwm nyob rau ntawm qhov chaw mos ntawm tib neeg, lawv zoo li cov plaques nyob saum npoo av. ntawm daim tawv nqaij ntawm cov xim dawb los yog daj-liab. Tus kab mob tuaj yeem ua rau kev loj hlob ntawm malignant neoplasms.
- Laryngeal papillomatosis tshwm sim thaum tus kab mob 11 nkag mus rau hauv lub cev. Feem ntau, tus me nyuam mos los ntawm leej niam muaj mob kis tau. Kev sib kis thaum lub qhov ncauj deev kuj ua tau. Nws feem ntau manifests nws tus kheej li nyuaj nqos thiab hoarseness ntawm lub suab. Nrog ntau tus tsim papillomas, ua pa tsis zoo.
- Epidermodysplasiawarty feem ntau tshwm sim hauv cov tub ntxhais hluas. Eruptions tshwm nyob rau hauv lub cev, zoo li lub tiaj cev nqaij daim tawv-xim warts. Nws tuaj yeem tshwm sim los ntawm cov kab mob uas muaj kev pheej hmoo oncogenic (48, 8, 5), uas tuaj yeem ua rau mob qog noj ntshav, lossis nrog kev ua haujlwm qis (25, 20, 14).
- Condyloma acuminata - rough outgrowths ntawm ceg. Lawv feem ntau nyob hauv lub ncauj tsev menyuam, urethra, zais zis, nruab nrab ntawm qhov quav thiab qhov chaw mos.
- Papillomas yog mos elongated neoplasms ntawm cov tawv nqaij xim. Thaum xub thawj concentrated nyob rau hauv lub cheeb tsam ntawm cov qog mammary, armpits, puab tais, caj dab, tsis tshua muaj - lub ntsej muag. Tom qab ntawd, lawv tuaj yeem kis thoob plaws lub cev, nce qhov loj.
- Warts (senile, plantar, tiaj, zoo tib yam keratomas) yog benign neoplasms, qee zaum zoo li moles nrog ib tug ntxhib nto. Qhov loj thiab xim txawv. Lawv localization txawv. Plantar warts tshwm sim los ntawm hom 1 kab mob ua rau tsis xis nyob thaum txav mus los, lawv loj hlob mus rau sab hauv. Yog hais tias qhov ua rau ntawm lawv txoj kev loj hlob yog HPV hom 2, lawv coalesce nyob rau hauv daim ntawv ntawm mosaic thiab xyaum tsis hnov. Tag nrho cov formations tsis mob.
Mus ntsib koj tus kws kho mob tam sim yog tias koj muaj cov tsos mob ntawm tib neeg papillomavirus. Kev kho mob yuav tsum ua kom tiav thiab ceev ceev.
YKev txhim kho ntawm pathology
Tus kab mob tshwm sim hauv 4 theem:
- Lam. Tus kab mob no muaj nyob rau hauv lub cev, tsis tshwm sim nws tus kheej thiab tsis ua ib yam dab tsihloov hauv lub cev.
- Qhov tshwm sim ntawm kev kho mob. Kev faib tawm ntawm cov hlwb epidermal yog nrawm. Yuav kuaj tau los ntawm PCR tsom xam, histology thiab cytology.
- Dysplasia. Nyob rau theem no, tus neeg nqa khoom ntawm cov ntaub ntawv keeb kwm ntawm tus kab mob cuam tshuam nrog DNA ntawm lub cell thiab koom ua ke rau hauv nws. Koilocytosis tshwm sim, nrog rau kev hloov pauv ntawm cov qauv ntawm tes. Tus kab mob no tuaj yeem kuaj tau los ntawm tib txoj kev, colposcopy yog siv ntxiv.
- Txoj kab mob. Kev hloov pauv tshwm sim ntawm qib cellular, cov qog nqaij hlav cancer ua haujlwm. Pom tau los ntawm txhua txoj kev kuaj mob.
Daim duab ntawm cov tsos mob ntawm tib neeg papillomavirus tau nthuav tawm hauv kab lus.
papillomavirus kis rau poj niam
Nws tuaj yeem ua asymptomatic hauv daim ntawv latent, nrog rau hauv cov lus hais, ua rau muaj kev loj hlob ntawm cov kab mob hauv qab no:
- Cov kab mob hauv ncauj tsev menyuam: yaig thiab mob qog noj ntshav. Cov kab mob tom kawg yog tsim los ntawm txheej txheej epithelial.
- Dysplasia (tus mob precancerous). Hauv qhov no, muaj kev ua txhaum ntawm cell maturation. Ob theem pib ntawm tus kab mob nyob rau hauv cov poj niam nrog tib neeg papillomavirus yog suav hais tias kuj muaj kev nyab xeeb, tab sis kev hloov mus rau qhov thib peb qhia tau hais tias pib ntawm txoj kev loj hlob ntawm oncology. Hom 16 thiab 18 hu nws.
- Kev txhim kho ntawm qhov chaw mos ntawm qhov chaw mos. Lawv tshwm sim 3 lub hlis tom qab tus kab mob nkag mus rau hauv lub cev. Lawv tuaj yeem nyob rau ntawm labia minora, hauv qhov ncauj kab noj hniav, ncauj tsev menyuam, qhov chaw mos mucosa. Tib neeg papillomavirus hauv cov poj niam tuaj yeem ua rau cov tsos mob ntawm cov kab mob endophytic, uasloj hlob hauv lub cev thiab tsis raug kuaj pom los ntawm kev kuaj pom. Thaum lawv cov taw qhia ntau yam nyob rau ntawm lub ncauj tsev menyuam lossis nws cov kwj dej, qhov kev cia siab ntawm tus kab mob yog qhov tsis zoo, vim tias qhov kev pheej hmoo ntawm kev tsim kab mob oncology nce.
Qhov txaus ntshai yog qhov tsos mob ntawm tib neeg papillomavirus tsis tau qhia meej meej. Hauv gynecology, tus kab mob no tau txais kev saib xyuas me ntsis. Tus kab mob no nyob rau hauv lub xeev "pw tsaug zog" ntev, thiab ib tug neeg yuav tsis txawm paub txog nws lub neej. Nyob rau hauv ib tug poj niam, nws tuaj yeem ua rau lub cev tsis muaj zog.
Tib neeg papillomavirus hauv gynecology feem ntau kuaj pom hauv cov poj niam uas ua rau lub neej muaj kev sib deev thaum muaj hnub nyoog 16-30.
Neoplasms hauv qhov chaw mos tsis hnov. Txawm li cas los xij, lawv tuaj yeem raug mob thaum sib deev, ua rau cov tsos mob hauv qab no:
- pom qhov paug tawm ntawm qhov chaw mos;
- muaj ntshav nyob hauv lawv;
- mob thaum sib deev;
- kub thaum tso zis.
Yog li ntawd, nws yog ib qho tseem ceeb heev uas yuav tsum tau kuaj xyuas txhua xyoo, kev ua kom tus kab mob tuaj yeem tshwm sim txhua lub sijhawm. Tam sim no koj paub yuav ua li cas paub txog cov tsos mob ntawm tib neeg papillomavirus (duab) hauv cov poj niam.
Ntxhais txiv neej
Tus kab mob tuaj yeem latent lossis overt, tshwm sim nws tus kheej hauv daim ntawv ntawm papillomas ntawm noov lossis hauv qhov quav. Cov kab mob hauv qhov chaw mos muaj peev xwm degenerating mus rau hauv cov qog nqaij hlav cancer.
Cov tsos mob ntawm tib neeg papillomavirus hauvCov txiv neej tshwm sim raws li cov pob khaus sib xws hauv thaj chaw hauv qab no:
- anus cheeb tsam;
- urethral orifice;
- scrotum;
- taub hau thiab frenulum ntawm noov.
Tsis tas li ntawd, cov txiv neej yog tus cwj pwm los ntawm papillomatosis ntawm lub larynx nyob rau hauv daim ntawv rov qab. Tsis ntev los no, cov kab mob tshwm sim los ntawm tus kab mob no suav nrog cov txheej txheem malignant tshwm sim hauv lub zais zis. Kev kho mob ntawm cov tsos mob ntawm tus tib neeg papillomavirus nyob rau hauv cov txiv neej yuav tsum tau nqa tawm yam tsis poob, txawm lub fact tias feem ntau cov poj niam muaj zog yog tsuas yog ib tug neeg nqa khoom. HPV tuaj yeem ua rau mob qog noj ntshav, thiab txawm hais tias tus kab mob no tsis tshua muaj, kev kuaj xyuas thiab kev kho mob yuav tsum tau ua yog tias kuaj pom tus kab mob thaum ntxov.
Yog li, cov neeg sawv cev ntawm kev sib deev muaj zog yuav tsum tau kuaj xyuas kev tiv thaiv txhua xyoo los ntawm kws kho mob, tsis txhob hais txog cov xwm txheej uas cov txiv neej muaj cov tsos mob ntawm tib neeg papillomavirus. Hauv daim duab koj tuaj yeem pom ntau hom HPV tshwm sim lawv tus kheej li cas.
Diagnosis
Txoj kev yooj yim tshaj plaws yog kev kuaj pom ntawm tus neeg mob. Tsis tas li ntawd, ntau qhov kev ntsuam xyuas tau ua los txheeb xyuas hom kab mob. Cov no suav nrog:
- PCR;
- tissue histology;
- kev tshuaj xyuas cytological ntawm smear ntawm lub ncauj tsev menyuam rau kev kuaj pom ntawm tib neeg papillomavirus hauv cov poj niam;
- colposcopy.
Txoj kev qhia tshaj plaws yog PCR. Cov txheej txheem sim ua kom nws tuaj yeem tshawb pomtus kab mob, nrog rau txiav txim nws hom. Tsis tas li ntawd, qhov no tuaj yeem ua tiav los ntawm kev sim Digene.
Colposcopy yog muab rau cov poj niam tom qab kuaj pom los ntawm gynecologist ntawm qhov chaw mos thiab lub ncauj tsev menyuam. Tsis tas li, ntau zaus, kev kuaj ntshav biopsy - noj ib qho me me ntawm cov ntaub so ntswg rau kev kuaj histological.
txhawm rau kuaj pom cov tsos mob ntawm tib neeg papillomavirus hauv cov poj niam, lub ncauj tsev menyuam tuaj yeem kho nrog acetic acid, thiab sab saum toj nrog Lugol cov tshuaj ntawm iodine. Kev nqus tsis sib xws tom kawg qhia tias muaj tus kab mob.
kho lub cev
Hnub no tsis muaj kev kho mob rau cov tsos mob ntawm tib neeg papillomavirus hauv cov poj niam thiab cov txiv neej uas ua haujlwm nrog 100% lav. Cov kev xaiv ntawm txoj kev yog txiav txim los ntawm hom kab mob thiab cov pathology nws tshwm sim. Feem ntau, cov tshuaj tiv thaiv kab mob tau sau tseg, thiab cov qog raug tshem tawm.
Yog tias muaj cov tsos mob tshwm sim ntawm tib neeg papillomavirus hauv cov txiv neej, kev kho mob yog ua los ntawm txoj kev kho lub cev lossis kev phais. Tib txoj kev siv rau cov poj niam.
Cov no suav nrog:
Radiosurgery. Ib txoj hauv kev niaj hnub ntawm kev kho mob nrog lub sijhawm luv luv, kev ua haujlwm siab thiab tsis muaj teeb meem. Neoplasms raug tshem tawm los ntawm kev raug cov xov tooj cua ntau zaus. Txawm li cas los xij, txoj kev yog kim, uas tsis tau tso cai rau nws siv dav. Radiosurgical kho ntawm tib neeg papillomavirus - hauv daim duab hauv qab no
- Laser kho. Nrog nws cov kev pab, cov ntaub so ntswg neoplasm raug hlawv tawm thiab cov hlab ntsha yog cauterized, uas tshem tawm cov kev pheej hmoo ntawm cov kab mob thib ob thiab tiv thaiv los ntshav. Txawm li cas los xij, kev siv txoj kev no ua rau muaj qhov tshwm sim ntawm kev mob papillomas, uas yog, lawv degeneration mus rau hauv malignant formations.
- Electrocoagulation. Hlawv ntawm papillomas nrog high-frequency hluav taws xob tam sim no. Tom qab qhov kev sib kho, ib daim ntawv scab nyob rau ntawm qhov chaw ntawm neoplasm, uas dries thiab ntog tom qab ob peb hnub, thiab cov tawv nqaij huv si nyob rau hauv nws.
- Cryodestruction. Ntau yam neoplasms raug rau cov kua nitrogen, vim lawv raug rhuav tshem thiab ploj mus. Qhov no yog ib txoj haujlwm ntawm jeweler, vim hais tias nws yog ib qho tsim nyog los txiav txim siab qhov tob ntawm kev nkag mus ntawm tus neeg sawv cev thiab tsis ua rau cov ntaub so ntswg puas. Ua tau tsuas yog hauv tsev kho mob xwb.
- Tshuaj tua kab mob. Txoj kev no yog xyaum hauv tsev, thiab yuav tsum tau saib xyuas. Ib qho poob ntawm kev npaj muaj cov tshuaj aggressive (alkali, acid) yog siv rau neoplasm, rhuav tshem cov ntaub so ntswg ntawm neoplasm.
Kev phais txoj kev kho mob tam sim no siv tsis tshua muaj, vim tias lawv tuaj yeem ua rau muaj ntau yam teeb meem, yog qhov tshwm sim los ntawm lub sijhawm rov zoo thiab raug mob. Yog tias lawv tau siv, tom qab ib hlis tom qab kev ua haujlwm nws yuav tsum tau noj methionine, uas yuav zam tsis tau tus kab mob rov qab.
Kev tshem tawm tus kab mob tsis muaj kev lav phib xaub, kev rov qab los rau yav tom ntej tsis suav nrog. Qhov no yog vim qhov tseeb tias tus kab mob tseem nyob hauv tib neeglub cev, yog li physiotherapy txoj kev yuav tsum tau supplemented nrog antiviral kho.
Antivirals
Lawv thaiv kev rov ua dua ntawm tus kab mob thiab pab txhawb lub cev tiv thaiv kab mob. Cov nyiaj zoo sib xws raug tso tawm ntau hom:
- tshuaj daws tau;
- tshuaj;
- qhov quav thiab qhov chaw mos;
- -cream thiab ointments.
Cov pab pawg tseem ceeb ntawm cov tshuaj uas siv los kho tib neeg papillomavirus hauv gynecology thiab lwm yam tshuaj:
- txhais tau tias txwv cov txheej txheem ntawm kev faib cov hlwb cuam tshuam: "5-fluorouracil Kondilin", "Podophyllin";
- tshuaj uas txhawb kev tsim tawm ntawm lawv tus kheej interferons: "Cycloferon", "Amiksin";
- interferons yog cov tshuaj uas tsis yog tsuas yog tshuaj tua kab mob thiab cov tshuaj tiv thaiv kab mob, tab sis kuj muaj ntau yam kev phiv thiab contraindications, yog li tus kws kho mob yuav tsum xaiv lawv.
Cov tshuaj zoo tshaj yog:
- "Papillok" - los ntawm papillomas;
- "Epigen intima" yog ib yam tshuaj uas muaj cov tshuaj tiv thaiv kab mob thiab rov tsim dua tshiab, siv tawm tsam cov kab mob oncogenic heev;
- "Immunomax" - ib qho tshuaj tiv thaiv kab mob hauv daim ntawv ntawm cov hmoov rau kev txhaj tshuaj intramuscular;
- "Isoprinosine" - ib qho tshuaj tiv thaiv kab mob hauv daim ntawv ntawm cov ntsiav tshuaj;
- "Allokin-alpha" - ib qho tshuaj tiv thaiv kab mob thiab tshuaj tiv thaiv kab mob, yog siv tawm tsam oncogenic thiab non-oncogenic hom, nws yog siv los kho cov tsos mob ntawm tus kab mob.tib neeg papillomas nyob rau hauv ib tug poj niam nyob rau hauv txoj kev kho mob ntawm lub ncauj tsev menyuam;
- "Genferon" - ib lub zos immunomodulator nyob rau hauv daim ntawv ntawm qhov chaw mos thiab qhov quav suppositories, siv nrog rau lwm yam tshuaj tiv thaiv kab mob;
- "Viferon" - muaj cov tshuaj tiv thaiv kab mob hauv zos, pab nrog kev sib deev sib deev.
Tshuaj tiv thaiv
Nws qhov kev siv tau ua rau muaj qhov tshwm sim ntawm kev tiv thaiv tsis tu ncua, muab kev tiv thaiv zoo tiv thaiv tus kab mob hauv nqe lus nug rau lub neej. Nws yog qhov ua tau zoo tshaj plaws ua ntej pib kev sib deev.
Hnub no, ob qhov tshuaj tiv thaiv tau tsim los tiv thaiv tib neeg papillomavirus. Cervarix tab tom raug kev sim tshuaj. Cov tshuaj "Gardasil" raug tso cai nyob rau hauv feem ntau lub xeev, thiab nyob rau hauv ib co ntawm lawv (Lub teb chaws Yelemees, USA, Fabkis) nws muaj nyob rau hauv yuav tsum tau txhaj tshuaj tiv thaiv txoj kev npaj.
Kev txhaj tshuaj tiv thaiv yog ua nyob rau hauv peb theem. Lub sijhawm ntawm kev txhaj tshuaj thawj zaug thiab thib ob yog 2 lub hlis, qhov kawg txhaj tshuaj yog muab tom qab plaub lub hlis ntxiv. Kev ua tau zoo ntawm peb qhov kev txhaj tshuaj yog 95-100%.
Kev Tiv Thaiv
Txhawm rau tiv thaiv hom kev phom sij tshaj plaws los ntawm kev nkag mus rau hauv lub cev, nws yog ib qho tsim nyog yuav tsum tau ua cov lus piav qhia nrog cov tub ntxhais hluas txog cov cai tswj kev tiv thaiv kab mob thiab ua ntu zus los kuaj xyuas tus kab mob thaum ntxov. Cov poj niam yuav tsum mus ntsib kws kho mob gynecologist ib xyoos ib zaug rau kev kuaj xyuas uas yuav txheeb xyuasmob qog noj ntshav thaum ntxov, uas yuav cawm tau txoj sia.
Cov kws tshaj lij hu rau ntau yam kab mob cuam tshuam nrog tib neeg papillomavirus
HPV tuaj yeem ua rau muaj kab mob sib txawv, yog li cov kws kho mob koj yuav tsum mus ntsib kev pab txawv.
Yog li, txhawm rau tshem tawm cov pob khaus tiaj tus, koj yuav tsum mus ntsib kws kho hniav. Plantar masses tuaj yeem raug tshem tawm los ntawm ob tus kws tshaj lij yav dhau los thiab tus kws phais.
Yog hais tias ib tug txiv neej muaj kab mob ntawm qhov chaw mos ntawm lub foreskin los yog lub taub hau ntawm noov, koj yuav tsum tau hu rau ib tug kws kho mob. Yog hais tias muaj ib tug poj niam nyob rau hauv lub labia thiab nkag mus rau qhov chaw mos, teem sij hawm nrog gynecologist.
Yog tias condylomas nyob hauv thaj tsam ntawm qhov qhib qhov quav, ces lawv tig mus rau tus kws kho mob.
Thaum tsis muaj peb tus kws kho mob saum toj no, lawv mus ntsib kws kho mob teem caij.
Warty epidermodysplasia koom nrog kev mus ntsib kws kho hniav lossis tus kws kho mob oncologist, laryngeal papillomatosis - mus rau ENT kws kho mob lossis kws phais mob, bowenoid papulosis - mus rau urologist lossis venereologist.
Nyob hauv kaw
Tib neeg cov tsos mob papillomavirus tuaj yeem tshwm sim rau lawv tus kheej hauv ntau txoj kev. Qee hom HPV muaj kev nyab xeeb rau lub cev, lwm tus tuaj yeem ua rau muaj ntau yam kab mob oncological, feem ntau ntawm cov kabmob ntawm cov kab mob genitourinary. Ib tug neeg twg ntawm ib tug poj niam los txiv neej yuav tsum tau mus kuaj xyuas los ntawm cov kws kho mob uas tsim nyog los txheeb xyuas cov kab mob nyob rau theem pib, thaum lawv muaj peev xwm kho tau zoo.
