Diverticulum yog ib lub hnab zoo li protrusion ntawm lub plab hnyuv phab ntsa, txwv rau ob sab. Diverticulosis ntawm txoj hnyuv yog ib yam kab mob uas tshwm sim los ntawm kev tsim ntau lub diverticula thoob plaws hauv lub plab hnyuv phab ntsa.
Kab lus no yuav tham txog qhov ua rau, cov tsos mob, txoj kev kuaj mob thiab kev kho mob diverticulosis.
keeb kwm keeb kwm thiab kev txheeb cais
Thawj qhov kev tshaj tawm txog cov kab mob saccular protrusions ntawm phab ntsa plab hnyuv tau luam tawm rov qab rau xyoo 1769. Thiab xyoo 1853, cov tsos mob ntawm tus kab mob no tau piav qhia meej.
Raws li kev txheeb cais los ntawm World He alth Organization, colonic diverticulosis tshwm sim hauv 17 tus neeg rau 100,000 tus neeg. Solitary diverticula tau txiav txim siab qhov nruab nrab hauv 30% ntawm cov neeg thaum lub sijhawm kuaj x-ray. Feem ntau, tsis muaj qhov tshwm sim hauv chaw kho mob, thiab qhov kev tshawb pom yog qhov tsis sib xws.
Cov poj niam muaj kev cuam tshuam rau cov kab mob no ntau dua li txiv neej. Cov neeg sawv cevHauv ib nrab zoo nkauj, qhov kev kuaj mob no tau ua 1.5-2 zaug ntau zaus.
Yog peb tham txog hnub nyoog, diverticulosis feem ntau tshwm sim hauv cov neeg muaj hnub nyoog 50-60 xyoo.
Colon diverticulosis code raws li ICD-10 - K57.
Ua rau kab mob
Diverticulosis ntawm txoj hnyuv sab laug, nrog rau txoj cai, belongs rau pab pawg ntawm cov kab mob polyetiological. Qhov no txhais tau hais tias nws qhov laj thawj tsis tau raug tsim los. Tab sis cov kws tshawb fawb tau tsim ntau qhov kev xav ntawm lub hauv paus chiv keeb ntawm cov kab mob no:
- muab xeeb;
- mechanical: pulsion thiab hernial;
- mesenchymal;
- vascular.
Nyob rau hauv kev pom zoo ntawm txoj kev xav ntawm keeb kwm yog qhov muaj diverticulosis hauv cov menyuam mos. Tab sis qhov kev nthuav dav tshaj plaws hernial txoj kev xav. Hauv qhov no, qhov tsim ntawm diverticula yog txuam nrog kev ua kom tsis muaj zog ntawm cov fibers hauv cov hnyuv, nrog rau kev nce siab hauv lub plab kab noj hniav.
Tom qab nws tau pom tias qhov protrusion ntawm txoj hnyuv phab ntsa tuaj yeem cuam tshuam nrog kev ua haujlwm tsis zoo ntawm nws cov leeg nqaij. Qhov no yog vim lub malfunction ntawm paj hlwb plexuses nyob rau hauv lub thickness ntawm phab ntsa. Muaj cov leeg nqaij spasm thiab nce siab nyob rau hauv qee qhov ntawm cov phab ntsa hauv plab. Qhov twg cov hlab ntsha nkag mus rau hauv lub plab hnyuv phab ntsa, lub mucosa protrudes.
Dab tsi yog diverticulum?
Raws li tau sau tseg saum toj no, lub diverticulum yog ib qho protrusion ntawm txoj hnyuv phab ntsa ntawm qhov chaw txwv. Xws li diverticula yog hu ua hollow, los yog marginal. Los ntawm ib lub caj dab mus txog 1 cm inch, lawv txuas nroglumen ntawm txoj hnyuv plab.
Tseem tseem muaj cov kab mob hauv cov txheej txheem ntawm cov phab ntsa hauv plab hnyuv uas tsis txuas nrog lub lumen ntawm lub cev. Lawv hu ua tsis tiav, lossis stratifying.
Thaum qhov tshwm sim tshwm sim, cov kab mob plab hnyuv hauv lub xeev ib txwm muaj. Tab sis dhau sij hawm, cov mucous membrane puas, los ntshav thiab perforation (rupture ntawm txoj hnyuv phab ntsa) tshwm sim.
Feem ntau, diverticulosis tsim nyob rau hauv sigmoid thiab cov hnyuv loj zuj zus, uas yog, ntu ntu ntawm txoj hnyuv loj raug cuam tshuam.
Kev faib tawm
Nyob ntawm qhov chaw kho mob tshwm sim, cov kab mob hauv qab no yog qhov txawv:
- asymptomatic;
- nrog cov tsos mob hnyav lossis kab mob tsis sib haum xeeb;
- nrog kev txhim kho ntawm cov teeb meem.
Diverticulosis ntawm txoj hnyuv tuaj yeem ua rau muaj qhov tsis zoo hauv qab no:
- diverticulitis - mob ntawm txoj hnyuv protrusion, tuaj yeem muaj qhov mob hnyav thiab mob ntev;
- perforation - perforation ntawm lub plab hnyuv phab ntsa los yog ncaj qha mus rau hauv lub plab kab noj hniav, los yog npog;
- mob qog noj ntshav - malignancy ntawm diverticulum;
- xiav;
- fistulas - tsim ntawm txoj kab nruab nrab ntawm txoj hnyuv los yog txoj hnyuv thiab cov kab mob nyob sib ze;
- obstruction - ua txhaum ntawm txoj hnyuv hauv plab.
Kev kho mob tshwm sim
Cov tsos mob feem ntau ntawm cov kab mob plab hnyuv muaj xws li kev ua haujlwm tsis zoo ntawm txoj hnyuv thiab qhov mob.
Mob txhawj xeeb tus neeg mob tas li, hnyav zuj zusthaum noj mov, cem quav. Mob nyem tshwm sim tom qab defecation. Localization ntawm cov tsos mob tsis kaj siab nyob ntawm qhov chaw ntawm diverticulosis. Yog li, nrog diverticulosis ntawm sab laug txoj hnyuv, qhov mob yog nyob rau hauv sab laug iliac kab noj hniav. Yog tias cov seem raug cuam tshuam, qhov mob hauv cheeb tsam iliac yog yam ntxwv.
Impaired plab hnyuv motility yog qhia los ntawm cem quav lossis raws plab. Tej zaum kuj xeev siab thiab ntuav.
Nyob rau hauv 1% ntawm cov neeg mob, cov neeg mob diverticulosis tsim cov gallstones thiab diaphragmatic hernia, uas yog hu ua Seit's triad. Hauv qhov no, daim duab kho mob muaj ntau haiv neeg.
Symptoms of diverticulitis
Qhov teeb meem ntawm diverticulosis ntawm txoj hnyuv loj zuj zus raws li diverticulitis tshwm sim hauv 30-90% ntawm cov neeg mob. Nws tuaj yeem ua rau mob thiab mob ntev. Feem ntau, qhov thib ob variant txhim kho nrog cov chav kawm sluggish. Nws yog tshwm sim los ntawm qhov mob hnyav nyob rau hauv sab laug iliac cheeb tsam, siab lub cev kub, deterioration nyob rau hauv kev noj qab nyob zoo.
Hauv kev kuaj ntshav dav dav, tus neeg mob zoo li no tau nce ntawm cov leukocytes (leukocytosis), feem ntau yog vim cov neutrophils, qhov nce ntawm erythrocyte sedimentation tus nqi. Hauv kev tshuaj ntsuam biochemical ntawm cov ntshav, nce qib ntawm C-reactive protein tau sau tseg. Tag nrho cov txiaj ntsig no qhia tias muaj cov txheej txheem inflammatory.
Thaum palpation, tus kws phais pom tau tias lub foob nyob rau hauv qhov projection ntawm txoj hnyuv. Yog tias tsis kho raws sij hawm, qhov infiltrate suppurates thiab abscess tshwm sim. Yog hais tias lub abscess rupturesIb qho teeb meem loj hu ua peritonitis yuav tshwm sim.
Muaj ntau ntau txoj kev xaiv rau kev kawm ntawm diverticulitis:
- latent;
- nrog plab plab;
- colitis-zoo li.
Daim ntawv latent yog tus cwj pwm los ntawm qhov yuav luag tiav ntawm kev kho mob tshwm sim. Tej zaum yuav muaj mob ib ntus nyob rau hauv lub plab mog, defecation impaired.
Qhov sib txawv nrog kev mob plab plab yog yam ntxwv los ntawm kev kawm undulating. Lub sijhawm asymptomatic hloov nrog cov lus qhia: mob plab hnyav, uas yog nyob rau hauv thawj zaug, thiab tom qab ntawd kis mus rau tag nrho lub plab, kub cev, flatulence thiab raws plab. Nyob rau hauv cov quav, impurities ntawm hnoos qeev, ntshav thiab kua paug yog pom. Ntawm palpation, txoj hnyuv mob hnyav heev.
Daim ntawv zoo li colitis yog tshwm sim los ntawm qhov mob plab, raws plab lossis cem quav. Lub cev kub yuav nce siab. Cov kua paug thiab cov ntshav tshwm sim hauv cov quav.
Khab ntawm lwm yam teeb meem ntawm diverticulosis
Kev ua kom lub plab hnyuv loj hlob hauv yuav luag 40% ntawm cov neeg mob uas muaj kab mob plab hnyuv loj. Cov tsos mob ntawm perforation yog heev pronounced. Muaj qhov mob hnyav hauv plab, uas cov neeg mob sib piv nrog rab riam. Tus mob loj heev. Ntawm palpation, phab ntsa sab hauv plab yog mob heev thiab nruj, cov tsos mob ntawm peritoneal irritation yog qhov zoo. Qhov no qhia txog kev mob ntawm peritoneum - peritonitis.
Ntshav ntshav yog lwm yam teeb meem ntawm diverticulosis. Feem ntau nws yog qhov tsis tseem ceeb thiab tsis ua rau tsis yooj yim rau tus neeg mob. Tab sis loj heev ntshav poob yog ua tau nrogCov cim qhia ntawm anemia: pallor, lub plawv dhia qeeb, ntshav siab, tsis muaj zog thiab qaug zog. Hauv diverticulosis ntawm txoj hnyuv loj, muaj cov ntshav liab liab nyob rau hauv cov quav.
Cov plab hnyuv txhaws tshwm sim li ntawm 10% ntawm cov neeg mob. Feem ntau, nws yog txuam nrog kev sib tshooj ntawm txoj hnyuv lumen los ntawm tsim "pseudotumor". Cov cim qhia ntawm kev thaiv - khaws cia cov quav, mob plab.
Cov teeb meem hauv qab no nthuav dav me ntsis:
- purulent o ntawm cov leeg - phlebitis;
- abscesses ntawm lub cev hauv nruab nrog cev;
- sepsis;
- torsion ntawm diverticulum qia, uas ua rau ischemia thiab txoj hnyuv tuag.
Txoj kev kuaj mob
Thaum kuaj pom tus kab mob diverticulosis ntawm txoj hnyuv, tus kws phais ua ntej txhua tus ua cov lus qhia ntxaws nrog tus neeg mob. Nws yuav tsum nug nws txog kev tsis txaus siab, kev loj hlob ntawm kev tshwm sim hauv lub zog, muaj cov kab mob sib kis, thiab lwm yam.
Tom qab tus kws kho mob ua qhov kev ntsuam xyuas lub hom phiaj. Nws muaj nyob rau hauv palpation, percussion (tapping) thiab auscultation (saib) ntawm txoj hnyuv. Mob ntawm palpation, lub xub ntiag ntawm lub foob tuaj yeem ua rau tus kws phais mob kom kuaj tau qhov tseeb.
Tsuas yog tom qab cov lus nug ntxaws ntxaws ntawm tus neeg mob thiab kev tshuaj xyuas lub hom phiaj, tus kws kho mob muab cov lus qhia ntxiv rau kev kuaj mob ntxiv. Cov no suav nrog:
- kuaj ntshav dav dav thiab biochemical;
- irigography - x-ray ntawm txoj hnyuv;
- kuaj ultrasound (ultrasound) ntawm lub cevplab;
- xam tomography yog txoj kev xoo hluav taws xob uas tso cai rau koj los txiav txim siab qhov ua txhaum ntawm cov qauv hauv nruab nrog cev nrog qhov raug siab;
- colonoscopy - kuaj endoscopic ntawm txoj hnyuv loj;
- sigmoidoscopy - kev kuaj xyuas qhov quav ntawm qhov quav.
Kev kuaj cov nyuv siv irigography suav nrog kev qhia txog qhov sib txawv - barium sulfate - rau hauv txoj hnyuv. Tus neeg sawv cev sib txawv ua rau lub plab hnyuv, thiab nws pom meej meej ntawm x-rays. Lub diverticulum nyob rau hauv cov ntaub ntawv no zoo li ib tug protrusion ntawm phab ntsa ntawm ib puag ncig los yog oval duab. Nws muaj ib tug meej contour thiab ib txoj kab uas hla mus txog 1.5 cm. Yog hais tias lub diverticulum yog o, nws contours yuav uneven, jagged. Cov protrusions zoo kawg nkaus emptied yam tsis muaj kev hloov pauv, qhov sib piv sai sai tawm lawv. Thiab nrog diverticulitis, barium lingers nyob rau hauv lub protrusions thiab tawm los nrog nyuaj.
Sigmoidoscopy thiab colonoscopy - txoj kev kuaj xyuas endoscopic. Lawv lub ntsiab lus yog nyob rau hauv kev taw qhia ntawm lub koob yees duab rau hauv txoj hnyuv loj. Ntawm daim duab tso rau ntawm lub monitor, koj tuaj yeem pom lub diverticulum nws tus kheej, txiav txim siab qhov chaw ntawm los ntshav, thiab ua qhov kev kuaj mob sib txawv nrog lwm cov kab mob.
Computed tomography tsis siv ntau npaum li irigography thiab endoscopy. Lawv tig mus rau nws hauv cov xwm txheej hnyav thaum koj xav tau nrawm ntsuas qhov mob ntawm txoj hnyuv thiab txiav txim siab txog kev phais.
Kev kuaj mob ultrasound tsis yog qhov qhia tau zoo hauv kev kuaj mob ntawm diverticulosis, tab sis tuaj yeem pab kuaj mob sib txawv nrog lwm cov kab mob hauv plab.
txoj kev kho
Kev kho mob ntawm cov kab mob colonic diverticulosis muaj ob peb kauj ruam:
- khoom noj;
- tshuaj kho mob;
- surgery.
Cov lus pom zoo yog nyob ntawm qhov xwm txheej ntawm cov quav. Yog tias tus neeg mob raug cem quav, cov ntawv qhia zaub mov rau diverticulosis ntawm txoj hnyuv yuav tsum muaj fiber ntau ntau li ntau tau. Tus neeg mob yuav tsum nce cov zaub thiab txiv hmab txiv ntoo hauv cov khoom noj:
- cabbage;
- cucumbers;
- txiv lws suav;
- noob flax;
- bran;
- khob cij tag nrho;
- peas;
- legumes;
- apples;
- citrus.
Cov neeg mob cem quav tsis pom zoo kom haus mis nyuj, dej qab zib. Nws tsim nyog suav nrog hauv cov khoom noj khoom haus uas ua rau mob plab hnyuv receptors thiab txhawb nqa peristalsis: hiav txwv kale, psyllium noob. Rau lub hom phiaj no, cov tshuaj kuj raug sau tseg: "Mukofalk", "Gutalax", "Sterkulin".
Nyob hauv kev tsim cov khoom noj rau cov kab mob colonic diverticulosis hauv cov neeg mob raws plab, cov zaub mov muaj fiber ntau yuav tsum txwv kom ntau li ntau tau. Lawv kuj tau sau cov tshuaj uas muaj cov cuab yeej astringent: "Smekta", "Karolen".
Drug therapy
Cov tsos mob thiab tshuaj kho mob ntawm cov kab mob colonic diverticulosis yog inextricably txuas. Lub hom phiaj tseem ceeb ntawm kev sau tshuaj yog tshem tawm cov tsos mob thiab txo tus neeg mob tus mob. Radical tau tshem ntawm qhov ua rau ntawm tus kab mob - protrusions nyob rau hauv lub plab hnyuv phab ntsa - yog tsis yooj yim suanrog tshuaj ib leeg.
Cov tshuaj kho mob nyuaj suav nrog cov tshuaj hauv qab no:
- antispasmodics - "Drotaverine", "Papaverine" - tshem tawm cov hnyuv spasm thiab txo qhov mob;
- anticholinergics - "Atropine", "Platifillin" - muaj cov nyhuv zoo ib yam li cov tshuaj antispasmodics;
- tshuaj tua kab mob - "Ciprofloxacin", "Ampicillin", "Tetracycline" - rau kev tiv thaiv thiab kho cov kab mob sib kis;
- multivitamin npaj, uas yuav tsum muaj cov vitamins B1, B6 thiab B12;
- sedatives - decoction ntawm valerian - nyob rau hauv rooj plaub ntawm kev ntxhov siab ntawm tus neeg mob;
- kho lub cev thiab kev tawm dag zog.
Yog hais tias mob diverticulosis hnyav, tus neeg mob tau mus pw hauv tsev kho mob. Nws yog ntxiv nrog dej tsis txaus nrog kev pab los ntawm infusions ntawm saline daws, detoxification yog nqa tawm. Thawj 3 hnub, tus neeg mob tau pub niam txiv los ntawm kev tso ntshav qabzib thiab cov tshuaj albumin.
kho mob phais
Kev kho mob ntawm diverticulosis ntawm txoj hnyuv nrog kev pab ntawm kev phais tso cai rau koj tshem tawm cov pathology nws tus kheej - bulging hauv txoj hnyuv. Kev ua haujlwm yog ua tiav nrog qhov tsis muaj txiaj ntsig ntawm kev siv tshuaj thearpy. Tsis tas li ntawd, nws tau qhia hauv cov xwm txheej hauv qab no:
- diverticulosis nyuaj los ntshav loj uas tswj tsis tau nrog tshuaj;
- perforation ntawm txoj hnyuv phab ntsa;
- tsim cov kab mob abscess nyob rau hauv lub plab hnyuv phab ntsa lossis hauv cov kabmob sab hauvplab;
- plab hnyuv;
- tsim ntawm fistulous passages;
- malignant degeneration ntawm diverticulum.
Cov kws phais mob tam sim no nce kev ua haujlwm ntawm cov kab mob diverticulosis tsis yooj yim vim nws muaj tus neeg tuag tsawg dua.
Hom kev cuam tshuam kev phais yog xaiv tus kheej, nyob ntawm qhov hnyav ntawm cov kab mob, qhov ntau ntawm diverticulosis, thiab tus yam ntxwv ntawm tus neeg mob lub cev. Kev ua haujlwm zoo tshaj plaws rau diverticulosis yog resection (tshem tawm) ntawm qhov hloov pauv ntawm txoj hnyuv: hemicolectomy lossis resection ntawm sigmoid nyuv. Tom qab ntawd, qhov kawg ntawm txoj hnyuv yog sutured, thiab cov lus ntawm cov ntsiab lus hauv txoj hnyuv tau rov qab los.
Reviews
Cov neeg mob uas tau kuaj pom muaj kab mob diverticulosis nco ntsoov tias lub sijhawm ntev cov tsos mob me me. Kev txhawj xeeb tsuas yog cem quav los yog raws plab. Tab sis dhau sij hawm, tus mob hnyav zuj zus, thiab tom qab ntawd lawv tig mus rau kev pab. Feem ntau, kev kho kom zoo tau pab. Tsuas yog nyob rau hauv cov mob hnyav heev, thaum tus neeg mob tsis nrhiav kev pab kho mob raws sijhawm, xav tau kev ua haujlwm.
