Kab mob ntawm lub plab zom mov yog cov kab mob tshwm sim uas tshwm sim hauv feem coob ntawm cov neeg nyob hauv ntiaj teb. Txawm li cas los xij, tsis yog txhua tus paub tias ntau yam kab mob ntawm lub plab zom mov tshwm sim vim muaj cov kab mob pathological ntawm duodenal papilla loj. Los ntawm cov ntaub ntawv ntawm peb tsab xov xwm, tus nyeem yuav kawm txog dab tsi OBD yog dab tsi, hom kab mob ntawm cov qauv no paub txog cov tshuaj, cov kab mob pathological raug kuaj thiab hom kev kho mob li cas.
The concept of BDS
Qhov loj duodenal papilla (MDP) yog cov qauv hemispherical anatomical nyob rau ntawm lub mucosa ntawm qhov nqis los ntawm duodenum. Nyob rau hauv cov ntaub ntawv kho mob, OBD tuaj yeem pom nyob rau hauv lwm lub npe - loj duodenal papilla, lossis papilla ntawm Vater. Thiab tseem, BDS yog dab tsi? Qhov no yog ib qho qauv ntawm qhov loj ntawm 2 hli mus rau 2 cm, uas ua haujlwm tseem ceeb heev - nws txuas nrog ntau yam.cov kua tsib, lub ntsiab pancreatic duct thiab duodenum. BDS tswj kev ntws ntawm cov kua tsib thiab kua txiv pancreatic rau hauv cov hnyuv me thiab tiv thaiv cov plab hnyuv nkag mus rau hauv cov ducts.
Kev hloov pauv pathological tuaj yeem tshwm sim hauv cov qauv ntawm OBD raws li kev cuam tshuam ntawm ntau yam - ntau yam pathogenic microflora, kev hloov pauv siab thiab kev hloov pauv hauv cov kua qaub-puag, congestion hauv kab noj hniav, thiab lwm yam. Cov qauv ntawm lub cev tuaj yeem cuam tshuam los ntawm kev tsiv teb tsaws ntawm pob zeb los ntawm cov kua tsib los yog lwm cov qauv ntom ntom.
BDS pathologies
Kab mob ntawm duodenal papilla muaj ntau haiv neeg. Nrog rau kev txhim kho cov txheej txheem kuaj mob niaj hnub no, cov lus xaus txog kev ua haujlwm tsis zoo hauv cov qauv no muaj ntau dua li qhov kev xav yav dhau los. Txawm li cas los xij, vim tsis muaj sijhawm thiab nyuaj rau kev kuaj mob, kev kho mob feem ntau ntsib ntau qhov tsis txaus ntseeg hauv kev kho mob ntawm cov neeg mob cholelithiasis lossis pancreatitis, uas tau tsim tawm tsam keeb kwm ntawm kev cuam tshuam hauv OBD qauv.
Tumor-like neoplasms yog suav tias yog ib qho pathology ntawm OBD - hyperplastic polyps account rau txog 87% ntawm benign neoplasms. Polyps, raws li txoj cai, tsis degenerate rau hauv cov ntaub so ntswg malignant. Adenomas yog ib yam kab mob uas tsis tshua muaj; OBD mob qog noj ntshav muaj txog li 25% ntawm tag nrho cov mob neoplasms. OBD stenosis tau kuaj pom hauv 4-40% ntawm cov neeg mob. Raws li txoj cai, OBD pathologies cuam tshuam nrog cholelithiasis (GSD), uas tshwm sim hauv txhua tus neeg nyob hauv kaum.
Kev faib cov kab mob OBD
Kab mob ntawm duodenal papilla loj tau muab faib ua ob pawg loj:
- primary,
- secondary.
Cov kab mob tseem ceeb suav nrog cov kab mob uas tshwm sim thiab nyob hauv cheeb tsam hauv cov qauv ntawm OBD - papillitis (tus kab mob inflammatory); spastic stenosis ntawm BDS, uas tuaj yeem hloov mus rau papillosclerosis tom qab; Hnub nyoog txog kev hloov pauv hauv BDS; congenital anomalies; benign thiab malignant neoplasms - lipomas, melanomas, fibromas, adenomas, polyps, papillomas.
Cov kab mob thib ob ntawm OBD yog stenoses los ntawm kab mob gallstone. Cov tsos mob ntawm tus kab mob yog ncaj qha ntsig txog qhov ua rau nws tshwm sim. Yog li, yog hais tias tus txheej txheem pathological yog tshwm sim los ntawm ib tug kab mob ntawm lub biliary system, lub chav kawm ntawm tus kab mob yuav zoo ib yam li cov cim qhia ntawm cholelithiasis, ib tug pathology yam ntxwv los ntawm kev tsim ntawm pob zeb nyob rau hauv lub gallbladder los yog cov kua tsib ducts, nrog rau kev xav. ntawm qhov hnyav hauv hypochondrium, flatulence, kub siab, thiab quav tsis ruaj.
Muaj ib lub tswv yim ntawm kev sib koom ua ke stenosis - kev ua txhaum ntawm kev ua haujlwm ntawm OBD, uas tau tshwm sim tawm tsam keeb kwm ntawm cov kab mob duodenal. Hauv qhov no, tsis muaj BDS.
YPancreatitis
Yog tias cov txheej txheem pathological hauv cov qauv ntawm OBD yog tshwm sim los ntawm kev mob pancreas, qhov tshwm sim ntawm tus kab mob yuav zoo ib yam li cov kab mob pancreatitis.
Pancreatitis yog ib qho txheej txheem inflammatory hauv pancreas. Nws yog noteworthy tias daim duab ntawm chav kawm ntawm tus kab mob yuav txawv - lub pathology yuav loj hlob sai heev, noj ib tug mob.daim ntawv, los yog tsis manifest nws tus kheej rau ib ntev lub sij hawm, uas yog ib qho tseem ceeb rau daim ntawv ntev ntawm cov chav kawm.
Cov tsos mob tseem ceeb ntawm tus mob pancreatitis yog mob hnyav heev hauv plab plab - sab xis lossis sab laug hypochondrium. Qhov mob tuaj yeem yog girdle hauv qhov xwm txheej thiab tsis nres txawm tias tom qab noj tshuaj antispasmodics lossis analgesics. Qhov no yog qhov BDS yog dab tsi thiab cov no yog qhov tshwm sim ntawm kev ua txhaum ntawm nws txoj haujlwm.
Ntxiv rau qhov mob pancreatitis, muaj gag reflex, leeg tsis muaj zog, kiv taub hau. Cov cim tseem ceeb ntawm tus mob pancreatitis ntawm ultrasound yog kev hloov pauv ntawm cov duab thiab cov npoo tsis sib xws ntawm cov txiav. Thaum kuaj pom, cov cysts tuaj yeem kuaj pom hauv lub cev. Kuv yuav tsum hais tias tus kab mob no hnyav heev. Thiab nrog kev cuam tshuam tsis tu ncua, nws tuaj yeem ua rau tuag.
Spastic stenosis OBD
BDS stenosis yog ib qho kab mob uas muaj cov kab mob benign, uas yog tshwm sim los ntawm kev cuam tshuam ntawm cov kua tsib thiab cov kab mob pancreatic vim muaj kev hloov pauv thiab cicatricial nqaim ntawm papilla. Txhua yam mus li cas? Txoj kev hla ntawm lub pob zeb ua rau raug mob rau papilla, thiab cov txheej txheem kis tau zoo nyob rau hauv cov quav ua rau kev loj hlob ntawm cov ntaub so ntswg thiab stenosis ntawm thaj chaw ntawm OBD ampulla.
Raws li koj paub, tus qauv ntawm OBD cuam tshuam ncaj qha los ntawm lub hnub nyoog ntawm tus neeg. Cov neeg laus uas muaj cholelithiasis raug kev txom nyem los ntawm atrophic-sclerotic daim ntawv ntawm tus mob papillitis. Tus neeg uas muaj hnub nyoog tsis tau mus txog rau caum xyoo yog raug rauhyperplastic hloov hauv BDS (adenomatous, adenomyomatous).
Nyob rau hauv xyoo tas los no, vim qhov tseeb tias endoscopes tau siv los kuaj xyuas cov kab mob OBD, nws tau ua kom pom tseeb qhov txawv ntawm stenosing thiab catarrhal (non-stenosing) papillitis. Thawj daim ntawv ntawm pathology yog txuam nrog cov kab mob gallstone. Yog hais tias pob zeb tsis tsim nyob rau hauv lub cev, ces txoj kev loj hlob ntawm tus kab mob yog tshwm sim los ntawm ib tug kab mob ntev uas kis tau nrog cov lymph.
Forms of OBD stenosis
Nyob ntawm cov yam ntxwv morphological, muaj peb hom stenosis:
- mob rwj sclerotic stenosis yog ib qho kev mob tshwm sim los ntawm ntau qib ntawm fibrosis;
- fibrocystic stenosis - ib qho teeb meem uas, nrog rau kev tsim ntawm fibrosis, cov hlwv me me tau tsim - cov qog loj loj vim yog compression los ntawm cov leeg nqaij;
- adenomyomatous stenosis yog ib hom kab mob uas tshwm sim adenomatous hyperplasia ntawm cov qog, nrog rau hypertrophy ntawm cov leeg nqaij thiab kev loj hlob ntawm cov fibers, kev ua txhaum feem ntau tshwm sim hauv cov neeg laus.
Ntxiv rau, cicatricial stenosis ntawm OBD yog cais:
- rau thawj,
- secondary.
Primary stenosis tsis ua rau muaj kev hloov hauv cov ducts. Pathology yog tshwm sim los ntawm degenerative hloov nyob rau hauv papilla nws tus kheej, uas manifest nws tus kheej nyob rau hauv atrophy ntawm cov leeg nqaij txheej. Qee zaum thawj stenosis yog congenital.
Secondary stenosis yog qhov tshwm sim ntawm cov kev hloov pauv uas twb muaj lawm hauv cov qauv vim raug mob rau papilla los ntawm kev tsiv teb tsaws ntawm pob zeb lossisphais.
Nyob ntawm seb qhov kis ntawm tus kab mob, stenosis ntawm OBD faib:
- ntawm kev cais,
- common.
Diagnosis
Hnub no, tshuaj siv ntau txoj hauv kev zoo rau kev kuaj mob OBD. Cia peb saib ib co ntawm lawv.
Endoscopic ultrasonography yog ib qho txheej txheem uas siv cov khoom siv kho qhov muag - endoscope - yog siv los kawm cov qauv ntawm OBD. Daim duab ntawm ib tug papilla coj thaum lub sij hawm kawm zoo sib xws yog qhia saum toj no.
Transabdominal ultrasonography yog ib txoj hauv kev tshuaj ntsuam xyuas siv ultrasound, uas tso cai rau koj los txheeb xyuas cov kev hloov pauv hauv lub gallbladder, daim siab, txiav, thiab ducts. Tsis tas li ntawd, cov txheej txheem txiav txim siab homogeneity ntawm cov kab noj hniav ntawm lub gallbladder thiab nws cov contractility, muaj / tsis muaj intracavitary inclusions.
Txoj kev tom ntej no rau kev kuaj mob OBD pathologies yog ultrasound cholecystography, kev tswj xyuas uas tshuaj xyuas lub cev muaj zog khiav tawm ntawm lub gallbladder li ntawm ob teev txij li lub sijhawm noj tshais choleretic.
Dynamic hepatobiliary scintigraphy yog txheej txheem raws li kev soj ntsuam ntawm lub siab nqus-excretory muaj nuj nqi. Fractional chromatic duodenal suab tso cai rau koj los txiav txim siab lub suab ntawm lub gallbladder; colloidal stability ntawm lub siab feem ntawm cov kua tsib thiab nws cov bacteriological muaj pes tsawg leeg. Nrog gastroduodenoscopyKev ntsuam xyuas ntawm OBD yog ua tiav, nrog rau kev saib xyuas qhov xwm txheej ntawm cov kua tsib. Ntxiv rau cov txheej txheem no, muaj kev suav tomography thiab kuaj kuaj.
OBD: kho
Kev kho ntawm OBD stenosis yog ua raws li txoj haujlwm ntawm kev rov ua kom cov kua tsib thiab cov kua txiv pancreatic tso rau hauv duodenum. Raws li txoj haujlwm no, muaj ntau lub hauv paus ntsiab lus, hauv qab no uas yuav pab ua tiav kev kho mob:
- kev puas siab puas ntsws, kev kho mob ntawm neurosis, stabilization ntawm cov tshuaj hormones, txo qis kev ntxhov siab, so, noj zaub mov kom zoo;
- kho mob ntawm cov kab mob hauv plab,
- tshem tawm cov yam ntxwv dyspeptic.
Txhawm rau tshem tawm cov kab mob neurotic, sedatives, infusions lossis decoctions ntawm ntau yam tshuaj ntsuab raug siv. Tsis tas li ntawd, tus neeg mob tau qhia txog kev kho mob hlwb.
Ib feem tseem ceeb ntawm kev kho kom zoo yog kev noj haus:
- fiav zaub mov;
- zam cawv thiab dej qab zib, nrog rau haus luam yeeb thiab kib;
- txwv tsis pub noj qe qe, muffins, cream, kas fes thiab tshuaj yej;
- nquag noj zaub qhwv, nplej bran thiab buckwheat porridge;
- noj tshuaj antispasmodics uas txo qhov mob tawm tsam.
Stenosis ntawm OBD feem ntau kho nrog txoj kev phais. Muaj kev kho kom raug thiab tsis kho. Thawj pab pawg suav nrog endoscopic PST, BDS bougienage.
Thaum lub sijhawm tso cai, ntxiv rau kev noj haus, cov neeg mob tau pom zoo txhawb nqaKev kho mob - taug kev txhua hnub, kev tawm dag zog thaum sawv ntxov, kev ua luam dej.
Summarizing cov saum toj no, peb tuaj yeem xaus tias ntau yam kab mob ntawm lub plab zom mov tshwm sim tawm tsam keeb kwm ntawm kev ua haujlwm tsis zoo ntawm ib qho qauv me me. Cov kev ua txhaum cai no ua rau muaj teeb meem loj hauv lub cev thiab feem ntau tuaj yeem kho tau los ntawm kev phais nkaus xwb. Qhov ntawd yog qhov BDS yog.
