Cholelithiasis (GSD), tseem hu ua cholelithiasis, yog ib yam kab mob loj uas tshwm sim los ntawm kev tsim cov pob zeb (calculi) hauv lub gallbladder thiab ducts. Qhov no yog ib hom kab mob loj hlob zuj zus uas tsis tshwm sim nws tus kheej hauv thawj 5-10 xyoo.
Yuav ua li cas? Yuav ua li cas thiaj nrhiav tau nws? Puas muaj cov tsos mob tshwj xeeb? Yuav kho li cas thiab qhov kev kwv yees yuav ua li cas? Zoo, muaj ntau cov lus nug thiab txhua yam cuam tshuam. Tam sim no yog lub sijhawm los teb lawv.
Etiology
Cholelithiasis, zoo li ntau lwm yam pathologies, tsis tau kawm txaus. Cov kws kho mob niaj hnub no tsuas paub txog qee yam ntawm ib qho exogenous thiab endogenous xwm uas ua rau kom muaj feem ntawm nws tsim.
Raws li kev txheeb cais, cov poj niam tsim cholelithiasis nyob nruab nrab 3-5 npaug ntau dua li cov txiv neej. Raws li txoj cai, feem ntau cov pob zeb pib tsim hauv cov poj niam uas tau yug ob peb tus menyuam.
Cov kws tshawb fawb kuj lees tias cov neeg noj movlub cev (full). Kwv yees li 2/3 ntawm cov neeg mob gallstone hnyav dhau.
Tsis tas li ntawd, congenital anomalies yog ib qho ua rau muaj qhov tshwm sim, vim qhov kev tawm ntawm cov kua tsib nyuaj. Cov no muaj xws li hepaticocholedochal cyst, stenosis, duodenal diverticula, thiab lwm yam. Ntawm cov kab mob kis tau, qhov kev pheej hmoo ntawm kev tsim cholelithiasis nce cirrhosis ntawm daim siab thiab kab mob siab ntev.
Ntau tus kws kho mob paub tseeb tias cov khoom noj khoom haus tseem ua lub luag haujlwm tseem ceeb. Feem ntau, cholelithiasis yog tsim nyob rau hauv cov neeg uas noj zaub mov nrog cov ntsiab lus ntawm cov tsiaj proteins thiab rog.
Tim kab mob gallstones
Cov neoplasms tshwj xeeb no muaj kev faib tawm. Thiab ua ntej tsiv mus rau kev xav txog cov tsos mob thiab kev kho mob ntawm tus kab mob gallstone, nws tsim nyog kawm nws. Yog li, muaj cov pob zeb hauv qab no:
- Cov roj (cholesterol) siab. Feem ntau. Cov roj (cholesterol) tsis ua tiav los ntawm lub cev ua rau feem ntau ntawm lawv, lossis tag nrho lawv. Lawv yog mos, loj, crumble yooj yim, muaj txheej txheej.
- Dub pigment pob zeb. Lawv tshwm sim hauv 10-25% ntawm cov neeg nyob hauv Tebchaws Meskas thiab Europe, tab sis hauv Asia daim duab no ntau dua. Lawv me me thiab tsis yooj yim. Lawv muaj calcium bilirubinate los yog nws cov polymer-zoo li cov tebchaw nrog impurities ntawm mucin-glycoproteins thiab tooj liab. Lawv tsis muaj cov cholesterol kiag li. Feem ntau pom muaj nyob rau hauv cov neeg uas muaj cirrhosis ntawm daim siab thiab mob hemolytic mob. Feem ntau tsiv mus rau cov ducts.
- Brown pigment pob zeb. Muaj cov ntsev calcium nrog impurities ntawm cov protein, cov roj cholesterol thiab ib qho me me ntawm cytoskeletons.kab mob. Tsim ob qho tib si hauv lub zais zis nws tus kheej thiab hauv cov ducts.
Pigment pob zeb yog tsim los ntawm kev ua txhaum ntawm acidification. Cov kua tsib yog supersaturated nrog calcium phosphate thiab carbonate, ua rau bilirubin precipitate thiab tsim pob zeb. Tab sis los ntawm txoj kev, cov neeg uas muaj xim dub pob zeb tsis muaj teeb meem nrog lub cev muaj zog ntawm lub gallbladder.
Symptoms
Raws li tau hais thaum pib, txheej txheem ntawm kev loj hlob ntawm cholelithiasis kav ntev heev. Nws tuaj yeem siv sijhawm 5-10 xyoo txij li lub sijhawm lub pob zeb pib tsim kom pom thawj zaug.
Qhov tseeb yog pob zeb tsis cuam tshuam ib tug neeg li. Mob tuaj yeem tshwm sim tsuas yog thaum pob zeb nkag mus rau hauv cov ducts. Lawv yuav raug mob vim qhov no, thiab tus neeg yuav, ntawm chav kawm, tsis xis nyob.
Tab sis feem ntau, thawj cov tsos mob ntawm tus kab mob gallstone suav nrog cov tsos mob hauv qab no:
- mob ntawm qhov ncauj mucosa.
- Pom daj ntawm daim tawv nqaij.
- Kev mob ntawm cov ntaub so ntswg txuas ntawm lub qhov muag.
- Cov kev xav tsis zoo nyob rau hauv txoj cai hypochondrium, tshwm sim los ntawm colic. Qhov no yog vim qhov tseeb tias lub pob zeb txav mus rau hauv cov kua tsib.
- Nquag burping, tsis tu ncua xeev siab thiab hnyav hauv plab txawm tias tom qab noj mov.
- Nyob hauv qhov ncauj.
Tom qab ntawd lwm cov cim pib qhia lawv tus kheej:
- Hepatic thiab biliary colic. Mob tshwm sim nyob rau hauv txoj cai hypochondrium thiab muab rau lub caj dab, sternum, forearm, sab nraub qaum, caj npab thiab lub xub pwg hniav. tshwj xeebxav tias tom qab noj rog, kib, ntsim, ntsev thiab ntsim. Tsis tas li qhov ua rau muaj kev ntxhov siab yog cawv, kev ntxhov siab, co lub cev thiab kev ua si lub cev.
- ntuav, feem ntau nrog cov kua tsib. Nws tsis yooj yim rau tus neeg tom qab nws.
- Zoo los yog cem quav, tsam plab.
- mob hnyav thiab qaug zog.
Tsis tas li, cov tsos mob ntawm tus kab mob gallstone muaj xws li tawm hws ntau thiab kub (37-38, 5 ° C), tsis muaj xim tsis muaj quav, mob plab thiab mob plab.
Kev nyuaj siab
Yog tias koj tsis xyuam xim rau kev tawm tsam ntawm tus kab mob gallstone hauv lub sijhawm, ces koj tuaj yeem them rau nws. Cov teeb meem loj heev, thiab ntawm no yog qhov lawv feem ntau pom lawv tus kheej hauv:
- Cholecystitis. Qhov no yog o ntawm lub gallbladder, tshwm sim los ntawm qhov mob tas li nyob rau sab xis sab xis ntawm lub plab thiab ua npaws. Nrog cholecystitis, cov kab mob ntawm cov kua tsib yog hnyav heev. Muaj kev pheej hmoo ntawm kev tshwm sim thiab kev loj hlob ntawm cov kab mob txaus ntshai.
- YCholangitis. Qhov no yog o ntawm cov kua tsib ducts. Nws tshwm sim vim kev nkag mus ntawm cov kab mob mus rau hauv lawv ncaj qha los ntawm lub zais zis, cov hlab ntsha thiab cov hnyuv. Nws manifests nws tus kheej nyob rau hauv siab kub thiab ib tug ntau ntawm cov qe ntshav dawb. Tej zaum yuav ua rau daim siab abscess lossis sepsis.
- Mob plab biliary pancreatitis. Kab mob ntawm tus txiav, pib uas tuaj yeem ua rau tuag taus. Nws manifests nws tus kheej nyob rau hauv frothy mushy quav, mob hnyav nyob rau hauv lub plab mog sab sauv, lub cev qhuav dej thiab tsis muaj zog heev.
- Fistulas. Cov no yog cov kab tsis zoo uas tsim los ntawm lub cev. Qhia qhov mob hnyavthiab digestive disorders.
- Peritonitis. Qhov no yog lub npe ntawm o ntawm lub serous cover ntawm lub plab kab noj hniav, uas manifests nws tus kheej nyob rau hauv ib tug dav deterioration nyob rau hauv lub mob ntawm tag nrho cov kab mob.
- Toxic hepatitis. Mob siab inflammatory kab mob, manifested los ntawm cov tsos mob ntawm intoxication. Cov cim tshwj xeeb muaj xws li tso zis tsaus, mob tam sim ntawd ntawm txoj cai hypochondrium, ntshav ntswg.
Qhov tshwm sim hnyav tshaj plaws ntawm cov kab mob gallstone ntawm lub gallbladder yog mob qog noj ntshav ntawm lub plab.
Ntshai
Exacerbation ntawm cholelithiasis, raws li txoj cai, manifests nws tus kheej nyob rau hauv dyspeptic syndrome. Ntawd yog, nyob rau hauv kev ua haujlwm tsis zoo ntawm txoj hnyuv plab, uas yog nrog los ntawm belching, xeev siab, ntuav, tsam plab, hnov mob hnyav, nrog rau qhov mob hnyav hauv thaj tsam epigastric thiab tsis xis nyob hauv cov hnyuv.
Kev kho mob tshwm sim thaum lub sij hawm exacerbation ntawm tus kab mob gallstone nyob ntawm qhov kev loj hlob ntawm cov teeb meem thiab nyob rau hauv lub xub ntiag los yog tsis muaj blockage ntawm lub ducts.
Qhov kawg yog qhov txaus ntshai tshwj xeeb. Vim tias blockage feem ntau ua rau muaj mob khaub thuas, thiab qhov no yog nrog los ntawm qhov mob txaus ntshai. Tsis tas li ntawd, ib qho kev kis kab mob feem ntau koom nrog tus kab mob no, vim qhov tshwm sim ntawm qhov tsis yog tsuas yog cov xwm txheej ntawm tus neeg mob hnyav zuj zus, tab sis kuj muaj cov ntshav hloov pauv. Hauv cov xwm txheej zoo li no, muaj qhov nce hauv erythrocyte sedimentation tus nqi thiab leukocytosis. Yog li nws yog qhov zoo dua los teb rau qhov mob ntawm tus kab mob gallstone thiab tsis txhob ntshai kev kho mob, txwv tsis pub qhov tshwm sim tuaj yeem ua rau muaj kev puas tsuaj.
Stagnation ntawm bile
Ib ob peb lo lus kuj yuav tsum tau hais txog qhov tshwm sim no. Tom qab tag nrho, nws feem ntau dhau los ua tus kab mob gallstone ntawm lub gallbladder.
Stagnation, tau kawg, ua rau muaj kev ua neej nyob tsis tu ncua, cev xeeb tub, puv puv, nrog rau cov khaub ncaws uas ua rau lub siab los yog txwv tsis pub txav ntawm lub diaphragm. Tag nrho cov no cuam tshuam rau kev khoov ntawm cov ducts.
Thaum stagnation tshwm sim, ntxiv rau qhov tsim ntawm cholelithiasis, cov txiaj ntsig hauv qab no kuj tshwm sim:
- Txo kev ua haujlwm ntawm plab hnyuv enzyme lipase.
- Kev tawg tsis tiav ntawm cov rog thiab lawv nkag mus rau hauv cov hlab ntsha, vim qhov kev hloov pauv ntawm cov piam thaj rau hauv glycogen yog qhov nyuaj. Qhov no, los ntawm txoj kev, yog fraught nrog kev loj hlob ntawm ntshav qab zib.
- Txo cov roj cholesterol tawm hauv lub cev. Nws tsis tsuas yog tsim cov pob zeb tsis zoo xwb, tab sis kuj tseem ua rau kev loj hlob ntawm atherosclerosis thiab provokes hypercholesterolemia.
- Kab mob ntawm lub gallbladder, qhov tsos mob ntawm tus mob cholecystitis.
- mob plab.
- YSclerosing cholangitis.
- Npaj plab hnyuv acidity.
- Local necrosis ntawm parenchyma.
Tom qab tag nrho, kev tawm tsam ntawm tus kab mob gallstone tsis yog qhov tshwm sim phem tshaj plaws. Yog hais tias stagnation tshwm sim, toxicity ntawm conjugated metabolic khoom nce ntau. Lub cev tsuas lom zem xwb.
Kev ua haujlwm - daws teeb meem
Cia qhov no yog txoj hauv kev radical, tab sis qhov ua tau zoo tshaj plaws. Nrog nws cov kev pab, koj tuaj yeem tshem tawm cov kab mob gallstone. Kev ua haujlwm yog txhawm rau tshem tawm lub thawv rau calculi thiab tshem tawm qhov tshwm simtshwm sim ntawm rov colic.
Nws kuj tseem siv tau los tiv thaiv qhov tshwm sim ntawm qhov tshwm sim xws li peritonitis, cholangiogenic sepsis thiab obstructive jaundice. Kev ua haujlwm raug suav tias muaj kev nyab xeeb, thiab lub sijhawm ntawm kev rov ua tiav tom qab nws nce mus txog 95%. Nws tau qhia nyob rau hauv cov xwm txheej hauv qab no:
- pob zeb loj dua 1 cm inch.
- Tsis muaj ib lub pob zeb - muaj ntau ntau.
- Cov calculi yog tsim los ntawm bilirubin ntsev thiab ntsev los yog muaj cov hauv paus chiv keeb.
- Ntshav plab zais zis "tawm".
- Qhov chaw ntawm lub calculi hem nrog kev thaiv thaum ntxov ntawm cov ducts.
- Ib tug neeg muaj ntshav qab zib.
- Ib tus neeg mob tau kuaj pom tias muaj "porcelain" gallbladder - nws cov phab ntsa zoo li tau ntim nrog cov ntsev calcium.
Rau cholelithiasis thiab pob zeb hauv lub zais zis, kev ua haujlwm tuaj yeem ua tau ob txoj hauv kev.
Thawj yog plab. Tus neeg tau txais kev tshuaj loog dav dav thiab kev phais loj yog ua nyob rau hauv lub anterior phab ntsa ntawm lub plab. Yog li cov kws phais neeg tau txais lub sijhawm los hnov thiab tshuaj xyuas txhua txoj hauv kev ntawm cov kua tsib tso tawm, coj x-rays thiab ultrasound.
Qhov thib ob yog laparoscopic. Ob peb qhov kev txiav me me yog ua rau ntawm phab ntsa ntawm lub plab, thiab kev nce qib ntawm kev cuam tshuam yog saib xyuas los ntawm cov khoom siv fiber ntau txuas nrog lub monitor. Txawm li cas los xij, muaj ntau yam contraindications. Txawm li cas los xij, tus kws kho mob tseem yuav txiav txim siab txog txoj kev ua haujlwm, suav nrog txhua tus yam ntxwv ntawm tus neeg mob.
Kev noj haus
Txhua tus neeg mob xav tausaib xyuas kev noj zaub mov tshwj xeeb rau cholelithiasis. Cov lus qhia ntxaws ntxaws tau muab los ntawm tus kws kho mob, tab sis ntawm no yog cov khoom noj uas koj xav tau kom tshem tawm ntawm kev noj haus:
- Butter khob noom cookie thiab qhob cij dawb.
- fried ncuav.
- -cov nqaij haus thiab cov hnyuv ntxwm.
- -qaub thiab cov txiv hmab txiv ntoo uas sau cia, sevas, sorrel, parsley.
- pasta.
- Soda, kas fes, cawv.
Kev noj zaub mov rau cov kab mob gallstone thiab zais zis pob zeb tso cai siv cov khoom noj hauv qab no:
- Ntsuab crackers thiab dub rye bread.
- qaib qe thiab butter.
- Ntses thiab nqaij ntshiv. Cov no suav nrog cov ntses dej, nqaij qaib, nqaij nyuj thiab luav.
- Cereals: oatmeal, nplej, buckwheat, mov, semolina.
- Tshuaj yej tsis muaj qab zib, paj npleg, txiv hmab txiv ntoo compotes, mousses thiab jelly.
Kuv puas tuaj yeem muaj cov khoom noj siv mis nrog cholelithiasis? Yog, tab sis tsuas yog rog-dawb. Cov kua zaub tau tso cai, tab sis tsis muaj nqaij thiab tshwj xeeb tshaj yog rau zaub broth. Nws yuav tsum nco ntsoov: txhua yam rog, hnyav, ntsev, ntsim thiab ntsim provokes ib contraction ntawm lub gallbladder thiab lub zog ntawm pob zeb. Thiab qhov no suav nrog kev thaiv cov ducts.
kev kho mob
Nws tuaj yeem ua tau zoo rau cholelithiasis, tab sis tsuas yog yog tias lub patency ntawm lub cystic duct thiab nws cov contractility yog khaws cia, thiab qhov loj ntawm lub pob zeb yog tsawg dua 15 hli. Raws li txoj cai, tus kws kho mob sau cov tshuaj no:
- "Allohol". Cov tshuaj choleretic, uas yog raws li cov khoom xyaw ntuj -activated charcoal, qej, nettle. Muaj cov nyhuv dav - txhawb kev tsim cov kua tsib acids, tshem tawm stagnation thiab intoxication, relieves mob ntawm lub zais zis thiab ducts.
- "Urolesan". Cov tshuaj muaj xws li spruce thiab mint roj, extract ntawm hop cones thiab qus carrot txiv hmab txiv ntoo. Ua kom cov kua tsib ntau ntxiv thiab txhawb nqa nws txoj kev tso tawm.
- "Hloos". Nws lub hauv paus yog qab zib thiab rosehips. Ntxiv nrog rau cov txiaj ntsig tau teev tseg saum toj no, nws txhim kho txoj hnyuv motility.
- Y "Berberine bisulfate". Nws yog ib qho alkaloid cais los ntawm barberry nplooj. Cov tshuaj txhawb kom cov kua tsib tso tawm.
- "Flamin". Lub ntsiab tivthaiv yog xuab zeb immortelle paj. Nws muaj cov tshuaj tua kab mob, tiv thaiv kab mob thiab choleretic nyhuv.
- "Holagol". Muaj magnesium salicylate, eucalyptus thiab peppermint roj, nrog rau frangulamodine thiab turmeric cag pigments. Cov tshuaj tsis yog tsuas yog txhawb kev tsim thiab tawm ntawm cov kua tsib, tab sis kuj tua kab mob.
Txhua yam tshuaj muaj contraindications. Kev kho tus kab mob gallstone nrog lawv cov kev pab tsuas yog pib yog tias tus kws kho mob tau tso cai.
kev kho neeg zoo
Cov kws kho mob feem ntau tsis ntseeg txog lawv. Nrog cholelithiasis, tshwj xeeb tshaj yog nyob rau theem siab, kev kho pej xeem tsis zoo li yuav pab tau. Tab sis raws li kev tiv thaiv, lawv tuaj yeem pab tau. Nov yog qee cov zaub mov yooj yim:
- Nyob rau hauv qhov sib npaug (1 tbsp txhua), sib tov xuab zeb immortelle, chamomile, pob kws kab nrog stigmas, fennel,dandelion, wormwood, calendula, tansy, peppermint thiab zoo celandine. Ncuav 10 grams ntawm lub resulting sau nrog ib khob ntawm boiling dej thiab xa rau 15 feeb nyob rau hauv ib tug da dej. Tom qab ntawd txias, lim thiab dilute nrog dej huv rau 200 ml. Haus cov txiaj ntsig ib hnub hauv peb koob tshuaj (txhua lub sijhawm ua ntej noj mov). Npaj no concoction txhua hnub.
- Ob tablespoons qhuav birch nplooj ncuav ib khob ntawm boiling dej thiab boil tshaj qis cua sov kom txog thaum ib nrab ntawm cov dej evaporated. Tom qab ntawd txias thiab lim. Haus ib diav peb zaug ib hnub twg ib teev ua ntej noj mov. Hoob no kav 3 lub hlis.
- Carrot noob (3 tablespoons) ncuav peb khob dej. Xa tsawg kawg yog 6 teev nyob rau hauv qhov cub. Haus cov nyiaj no peb zaug ib hnub.
- Ua kua txiv hmab txiv ntoo tshiab. Sib tov nyob rau hauv ib tug ratio ntawm 1: 1 nrog zib mu. Haus 3 tablespoons ib hnub twg. Nws raug nquahu kom ncab qhov ntim no rau hauv 3 koob tshuaj - sawv ntxov, tav su thiab yav tsaus ntuj.
- Blackcurrant berries (tshiab los yog khov) thiab kua zib ntab yog sib xyaw kom sib npaug. Nws yog ib advisable mus tuav lub loj nrog ib tug blender. Noj ib zaug ib hnub rau ib teaspoon ib nrab ib teev ua ntej noj mov. Hoob no yog 2 lub hlis yam tsawg kawg nkaus.
- 30 grams tshiab los yog khov rowan ncuav peb khob ntawm boiling dej. Cia nws brew rau 10 feeb, ces zuaj lub berries thiab tawm rau ib co sij hawm ntxiv. Haus ib khob peb zaug ib hnub.
Tsis tas li, nrog cholelithiasis, nws raug nquahu kom haus dej xws li Essentuki (No. 17 thiab No. 4), Borjomi, Smirnovskaya, Slavyanovskaya. Kev tiv thaiv zoo heev yog kev ua neej nyob, kev tsis lees paub cov roj cholesterolzaub mov thiab tswj lub cev qhov hnyav.
