Cholelithiasis lossis cholelithiasis yog ib yam kab mob uas tshwm sim los ntawm kev tsim cov pob zeb hauv lub gallbladder thiab ducts. Qhov no yog vim muaj teeb meem hauv cov roj cholesterol metabolism thiab tsim cov bilirubin.
Pob zeb tuaj yeem muaj ntau, thiab lawv zoo li pob zeb tuab. Qhov loj ntawm lub pob zeb txawv ntawm ob peb millimeters mus rau ob peb centimeters, cov duab yog puag ncig (ib txwm rau lub gallbladder) thiab oblong (rau cov ducts). Nyob rau hauv lub ducts ntawm daim siab, pob zeb yuav kis tau ib tug branched duab. Nyob ntawm seb muaj pes tsawg leeg, cov calculi muab faib ua cov xim, sib xyaw, cov roj (cholesterol) thiab calcareous.
leej twg cuam tshuam
Cholelithiasis yog ib yam kab mob sib xws. Ntawm tag nrho cov kab mob sau npe ntawm qhov xwm txheej ntev, tus kab mob no nyob hauv qhov chaw thib 3, tsuas yog thib ob tsuas yog mob plawv thiab vascular pathologies, nrog rau ntshav qab zib mellitus.
Yeej, cholelithiasis yog ib yam rau cov neeg laus dua 70 xyoo (kwv yees li 45%). Nyob rau tib lub sijhawm, qhov pathology no tau kuaj pom hauv cov poj niam tsib zaug ntau dua li cov txiv neej. Cov menyuam yaus raug kuaj pom tus kab mob no tsawg heev.
Kab mob tshwm sim li cas
Pob zeb yog tsim nyob rau hauv lub gallbladder nyob rau hauv ob txoj kev: inflammatory thiab metabolic. Vim muaj teeb meem kev noj haus thiab qee cov txheej txheem pathological hauv lub cev, qib roj cholesterol thiab cov kua tsib hloov pauv. Cov kua tsib muaj pes tsawg leeg ua atypical, nws tseem hu ua lithogenic. Nws muaj pes tsawg leeg tuaj yeem ua dej nag thiab hloov mus ua cov muaju, yog li tsim cov pob zeb cholesterol.
Cov txheej txheem inflammatory ntawm pob zeb tsim tshwm sim vim kev loj hlob ntawm daim siab kab mob, tshwj xeeb yog jaundice. Hauv qhov no, bilirubin tso tawm, uas ua rau tsim cov pob zeb hauv lub gallbladder.
Kab mob ntawm lub gallbladder, uas kis tau los yog reactive, kuj tuaj yeem ua rau cov kua tsib kua qaub ua kua qaub. Yog li ntawd, muaj tsawg dua cov protein ntau, thiab bilirubin pib crystallize. Laying ntawm mucous secretions, epithelial hlwb, txiv qaub impurities ua rau tsim thiab nce pob zeb. Cholelithiasis yog ib qho ua ke ntawm txhua yam saum toj no.
Kev txhim kho kab mob
Ntawm cov laj thawj tseem ceeb uas ua rau muaj tus kab mob gallstone, nws tsim nyog hais txog cov hauv qab no:
- ntau cov roj cholesterol tso rau hauv cov ntshav;
- hloov pauv hauv cov kua tsib, tsim cov kua tsib lithogenic, uas muaj cov roj ntau dhau;
- faib tus nqi txophospholipids;
- ua txhaum ntawm cov kua tsib, uas yog, cholestasis;
- kev txhim kho cov kab mob sib kis hauv kab mob biliary.
Kab mob uas tuaj yeem ua rau muaj tus kab mob cholelithiasis yog:
- mob ntshav qab zib mellitus;
- ntshav ntshav thiab lwm yam kab mob ntshav;
- gout;
- teeb meem nrog cov metabolism (protein, lipid, ntsev);
- cirrhosis, kab mob siab;
- mob ntawm qhov xwm txheej neuroendocrine, suav nrog kev ua haujlwm tsis zoo ntawm cov qog nqaij hlav parathyroid thiab cov thyroid caj pas;
- kab mob siab;
- mob plab gallbladder;
- congenital abnormalities thiab kab mob ntawm lub plab kab mob, xws li stenosis, bile duct cyst, thiab lwm yam.;
- kab mob parasitic;
- cov qog nqaij hlav hauv lub cev.
Yam uas tuaj yeem ua rau muaj kab mob
Cov yam ntxwv no suav nrog:
- zaub mov muaj cov khoom noj muaj roj ntau;
- predisposition rau kab mob ntawm lub gallbladder thiab siab;
- tsis muaj fiber ntau;
- kev ua neej nyob tsis tu ncua;
- obesity;
- laus, poj niam;
- rov yug dua tshiab;
- poob ceeb thawj;
- xeeb tub;
- khoom noj khoom haus mus sij hawm ntev niam txiv;
- Yhormonal contraceptives.
daim duab kho mob
Nws yog ib qho tseem ceeb kom paub tias txij li lub sijhawm tsim cov calculi pib rau thawj cov tsos mob ntawm cholelithiasis, nws yuav dhau mus.ob peb xyoos.
Cov tsos mob tseem ceeb ntawm tus kab mob gallstone:
- jaundice;
- mob nraub qaum, tshwj xeeb hauv thaj tsam ntawm lub xub pwg nyom sab xis;
- mob hauv txoj cai hypochondrium, hauv thaj av epigastric;
- mob ntxiv tom qab noj zaub mov muaj roj;
- qee zaum xeev siab thiab ntuav;
- kev mob nkeeg, qaug zog;
- tso quav tsis tu ncua;
- belching tom qab noj;
- xav qhov hnyav hauv lub epigastrium;
- zis tig tsaus;
- qee zaum, khaus ntawm daim tawv nqaij pib.
theem ntawm tus kab mob
Thaum lub sijhawm ntawm kev loj hlob nquag, cholelithiasis mus rau theem hauv qab no:
- Latent, uas tus kab mob no nyuam qhuav pib thiab tsis pom muaj tsos mob.
- Dyspeptic chronic, uas yog tus cwj pwm los ntawm qhov mob me, qhov kev xav ntawm qhov hnyav ntawm lub gallbladder thiab plab, qee zaum muaj kev tawm tsam ntawm xeev siab thiab kub siab. Twb tau nyob rau theem no, kev kho mob cholelithiasis yog xav tau.
- Mob ntev rov tshwm sim - tus cwj pwm los ntawm ntu ntu ntawm colic.
- Angina, uas tshwm sim nws tus kheej hauv daim ntawv mob plawv. Tej zaum yuav tshwm sim txawm tias tom qab thawj theem thiab ntws mus rau qhov thib peb.
- Saint's triad yog ib hom kab mob tsis tshua muaj, uas, ntxiv rau cholelithiasis, kuj tseem nrog diaphragmatic hernia thiab diverticula ntawm txoj hnyuv loj.
Cov Teeb Meem thiab qhov tshwm sim
Kev tsim cov pob zeb hauv lub gallbladder ua rau tsis yog ua haujlwm tsis zoontawm lub cev no, tab sis kuj ua rau lwm tus puas tsuaj. Yog li ntawd, nws yog ib qho tseem ceeb kom nrhiav kev pab kho mob raws sij hawm los txiav txim cov tsos mob thiab kho tus mob cholelithiasis.
Mob mob tshwm sim thaum pob zeb txhaws cov ducts. Yog li ntawd, lawv cov phab ntsa o. Ulcers, fistulas, hernias tshwm sim, txawm tias ib qho rupture yog ua tau. Cov teeb meem xws li peritonitis, toxic shock, mob plawv, raum thiab mob siab tsis txaus ua rau muaj kev phom sij loj.
Ib qho teeb meem ntawm tus kab mob gallstone yog plab hnyuv thiab los ntshav los ntawm txoj hnyuv. Thaum cholelithiasis nyuaj los ntawm cov kab mob sib kis, jaundice, cholangitis, fatty hepatosis, cholecystitis, pancreatitis tuaj yeem tshwm sim. Ntawm qhov tshwm sim loj ntawm tus kab mob gallstone, nws yog ib qho tsim nyog yuav tsum tsis txhob haus dej cawv thiab empyema ntawm lub gallbladder, cirrhosis ntawm daim siab, abscess thiab cancer ntawm lub gallbladder.
Keeb Kwm ua lub luag haujlwm tseem ceeb hauv kev txiav txim siab cholelithiasis. Txhawm rau kuaj xyuas qhov tseeb, tam sim ntawd hu rau tus kws kho mob, kws kho mob plab thiab tus kws kho mob hepatologist. Ib tus kws tshaj lij paub txog kev paub txog txhua yam ntawm cov tsos mob thiab kev kho mob cholelithiasis hauv cov neeg laus. Nws yuav kuaj xyuas kom raug thiab muab tshuaj kho.
ntsuas ntsuas
Kev kho tus mob cholelithiasis hauv tsev kho mob pib nrog kev kuaj mob, uas muaj ntau theem:
1. Laboratory diagnostics:
- kuaj ntshav rau bilirubin, transaminase thiab leukocyte qib;
- kev tshawb fawb ntawm microscopic thiab biochemical bile hom.
2. Cov txheej txheemCov cuab yeej kuaj mob:
- duodenal suab;
- plab x-ray thiab cholecystography intravenously, qhov ncauj lossis los ntawm infusion;
- nyob rau hauv daim ntawv mob hnyav, thaum xav tau kev phais, lawv mus rau cholangiography, laparoscopic cholecystography lossis choledochoscopy thaum phais;
- ultrasound, xam tomography, magnetic resonance imaging lossis radioisotope kuaj mob ntawm lub gallbladder.
Kev kuaj mob sib txawv yog ua tiav rau kab mob siab, duodenal ulcer, pancreatitis, appendicitis thiab oncology ntawm cov kabmob sab hauv, nrog rau urolithiasis.
Kev kho mob
Kev kho mob ncaj qha nyob ntawm theem ntawm tus kab mob, qhov loj thiab cov pob zeb, nrog rau lawv qhov xwm txheej. Thaum pib ntawm cholelithiasis, thaum cov tsos mob me me, lawv mus rau cov kev kho mob hauv qab no:
- ua raws li niaj zaus thiab mus sij hawm ntev hauv tsev kho mob, kuaj ultrasound ntawm lub gallbladder;
- ua raws li kev noj haus tshwj xeeb.
Yog tias tus kab mob twb tau nrog cov mob colic tsis tu ncua, tus neeg mob tau mus rau hauv tsev kho mob, qhov kev kho mob hauv qab no tau siv:
- Kev tshem tawm cov tsos mob mob. Rau qhov no, cov tshuaj analgesic siv: No-shpa, Baralgin hauv daim ntawv txhaj tshuaj, Papaverine. Kev siv tshuaj tua kab mob opioid yog txwv nruj, vim tias lawv tuaj yeem ua rau cov kab mob ntawm cov kua tsib.
- Yog qhov txiaj ntsig zootsis tuaj, mus rau pararenal novocaine blockade.
- Yog tus neeg mob kub taub hau, qhia tshuaj tua kab mob, piv txwv li Paracetamol, Aspirin.
- Yog tias tsis muaj cov txheej txheem inflammatory, koj tuaj yeem siv qhov ntsuas sov hauv thaj chaw mob.
- Tom qab kev tawm tsam hnyav tau raug tshem tawm, UHF, av nkos thiab dej ntxhia, nrog rau kev kho microcurrent.
- Hauv cholelithiasis, tshuaj choleretic raug txwv, vim qhov no ua rau lub pob zeb loj thiab txaus ntshai.
kho mob qhov txhab loj
Yog tias lub ntsuas ntsuas tsis tshaj ob centimeters thiab muaj cov roj cholesterol, cov txheej txheem ntawm lawv cov kev sib cais yog siv. Cov no suav nrog kev siv tshuaj tshwj xeeb cholelitholytic:
- chenodeoxycholic acid (cov kev kho mob yog ib xyoos tag nrho, koob tshuaj tau nce ib ntus);
- ursodeoxycholic acid (ntev tau ob xyoos);
- txhais tau tias muaj immortelle xuab zeb, yog tias tus kab mob tau kuaj pom thaum ntxov thiab qhov loj ntawm pob zeb me me.
Tsis tas li, kom yaj cov pob zeb, lawv mus rau qhov kev taw qhia ntawm methyl tert-butyl ether ncaj qha mus rau hauv lub lumen ntawm cov ducts los yog mus rau hauv lub lumen ntawm lub gallbladder.
Extracorporeal shock yoj lithotripsy yog siv los ua ib txoj kev kho vajtse rau tshem tawm cov calculi. Tib txoj kev yog siv los tshem tawm cov pob zeb me me hauv cov roj cholesterol txhawm rau khaws cov haujlwm ntawm lub gallbladder. Txawm li cas los xij, qhov noTxoj kev muaj ntau tus contraindications.
Yog tias lub pob zeb yog ib qho, tab sis loj, laparoscopic cholecystectomy yog siv, uas yog, tshem tawm ntawm lub gallbladder nrog pob zeb. Yog tias ntau lub pob zeb loj tau tsim nyob rau hauv lub zais zis, kev ua haujlwm hauv plab yog ua tiav, lub cev raug tshem tawm thiab cov ducts tau ntws. Tam sim no koj paub tias tus kab mob no yog dab tsi - cholelithiasis, koj nkag siab nws qhov hnyav.
