Sclerosing cholangitis yog ib yam kab mob ntawm cov kab mob siab rau cov kab mob siab, uas mob ntev pib hauv lawv cov phab ntsa. Qhov tshwm sim ntawm nws qhov tshwm sim yog cov txheej txheem ntawm sclerosis, piv txwv li, hloov los ntawm caws pliav nqaij. Cov kab mob no tsis muaj kev sib raug zoo nrog lwm cov kab mob siab, tab sis feem ntau ua rau muaj teeb meem ntawm lub cev. Hauv tsab xov xwm niaj hnub no peb yuav qhia koj tias vim li cas sclerosing cholangitis tsim. Cov tsos mob thiab kev kho mob ntawm tus kab mob no kuj yuav qhia rau koj mloog.
Anatomical reference
Bile yog ib feem tseem ceeb ntawm cov txheej txheem digestive. Nws koom nrog hauv kev rhuav tshem cov rog, nce kev ua haujlwm ntawm pancreatic enzymes thiab txhawb txoj hnyuv motility. Cov kua tsib tsis tu ncua ua los ntawm daim siab hlwb - hepatocytes. Nyob rau hauv ib hnub, raws li ib tug tshwm sim ntawm lawv intensive kev ua hauj lwm, txog 1 liter ntawm kua yog tau. Cov kua tsib ces nkag mus rau hauv lub zais zis thiab duodenum.
Kev tawm ntawm qhov zais cia yog tsim los ntawm cov channel tshwj xeeb. Nyob ntawm qhov chaw, lawv yogintrahepatic thiab extrahepatic. Raws li qhov tshwm sim ntawm cov txheej txheem ruaj khov, nkag mus ntawm cov kab mob pathogenic, lossis rau ntau yam laj thawj, cov ducts tuaj yeem ua rau mob. Nyob rau tib lub sijhawm, lawv tham txog kev txhim kho ntawm cov kab mob xws li cholangitis. Cov txheej txheem pathological yeej ib txwm muaj qhov sib txawv etiology. Yog li ntawd, cov nram qab no hom ntawm nws txawv: tshuaj lom, kab mob, helminthic, sclerosing. Cov yav tas yog qhov tsawg kawg nkaus, tab sis yog tus cwj pwm los ntawm kev kawm hnyav.
Sclerosing cholangitis tau muab faib ua ob hom: thawj thiab theem nrab. Txhua tus ntawm lawv yog tus yam ntxwv los ntawm ib qho ntawm cov cim qhia thiab cov chav kawm. Nyob rau hauv thawj rooj plaub, tus kab mob yog implied, uas yog nrog los ntawm stagnation ntawm cov kua tsib thiab tsis-purulent o ntawm cov ducts, lawv puas thiab hloov nrog connective ntaub so ntswg. Daim ntawv thib ob ntawm pathology tsim nyob rau hauv kev cuam tshuam ntawm cov tshuaj lom. Muaj tsawg zaus, nws qhov tshwm sim yog vim muaj cov ntshav tsis txaus. Hauv tsab xov xwm no, peb yuav nyob hauv kev nthuav dav ntxiv ntawm thawj qhov sib txawv ntawm tus kab mob.
piav qhia txog kab mob
Primary sclerosing cholangitis belongs rau qeb ntawm cov pathologies tsawg ntawm cov kab mob biliary. Raws li kev txheeb cais, nws raug kuaj pom hauv txhua tus neeg plaub ntawm 100 txhiab tus neeg. Lub mechanism ntawm kev loj hlob ntawm tus kab mob yog txo mus rau qhov tsos ntawm ib tug inflammatory txheej txheem nyob rau hauv lub me me hepatic ducts. Hauv qhov no, lawv cov sclerosis tshwm sim. Cov ducts los ntawm cov kua tsib nkag mus rau hauv lub zais zis maj mam sib tshooj thiab deform. Cov txheej txheem congestive kis mus rau qhov chaw intercellular ntawm daim siab, ua rau cirrhosis.
Txawm tias thaum kawg ntawm ib puas xyoo dhau los, nws tuaj yeem kuaj tau tus kab mob tsuas yog tom qab kev phais lossis kev kho mob hauv lub cev. Ua tsaug rau txoj kev loj hlob ntawm cov tshuaj niaj hnub no, tus kab mob tuaj yeem kuaj pom ntau dhau lawm. Rau qhov ntau dua, nws cuam tshuam rau kev sib deev muaj zog hnub nyoog 25 txog 40 xyoo. Cov ciam teb no yog qhov tsis txaus ntseeg, txij li tus kab mob tuaj yeem ua asymptomatic rau lub sijhawm ntev. Qee zaum kev tshwm sim ntawm qhov mob yog yuam kev rau cov kab mob autoimmune, ulcerative colitis lossis cystic fibrosis.
Ua rau cholangitis
Qhov laj thawj ntawm kev txhim kho tus kabmob no tsis paub meej. Cov kws kho mob txheeb xyuas ib pawg ntawm cov xwm txheej uas ua rau muaj feem yuav tshwm sim. Cov no suav nrog:
- kev hloov pauv;
- kis kab mob hauv lub cev;
- nquag rau kab mob autoimmune;
- raug tshuaj lom.
Ntawm cov xwm txheej no, cov txheej txheem caj ces yog qhov tseem ceeb. Kev lees paub qhov hnyav ntawm qhov tseeb no yog kev tshawb fawb ntau ntawm tus kab mob ntawm cov tswv cuab ntawm tib tsev neeg.
daim duab kho mob
Tau ntau xyoo, tus kab mob tuaj yeem ua asymptomatic lossis nrog cov tsos mob me. Cov neeg mob feem ntau tsis tuaj yeem hais raws nraim thaum cov tsos mob qhia tias sclerosing cholangitis tshwm sim. Pathology feem ntau pom tshwm sim thaum mus ntsib kws kho mob rau lwm yam teeb meem kev noj qab haus huv. Thaum kuaj pom tus kab mob thawj zaug - qhov nce hauv daim siab enzymes.
Raws li kev ntsuasRaws li tus kab mob loj tuaj, daim duab kho mob kuj hloov. Ntawm nws cov tsos mob tseem ceeb, cov hauv qab no yuav tsum tau qhia:
- qaug zog, tsaug zog tas li;
- kev tshaib plab;
- daj ntawm mucous daim tawv nqaij;
- nce hauv qhov kub thiab txias rau cov nqi subfebrile;
- mob qhov mob hauv thaj tsam ntawm txoj cai hypochondrium, tawg mus rau caj dab lossis lub xub pwg hniav;
- tawv nqaij khaus;
- ntau xanthomas;
- tsis xis nyob nyob rau sab laug hypochondrium vim qhov loj spleen;
- nce daim tawv nqaij pigmentation.
Qee zaum thawj sclerosing cholangitis yog nrog los ntawm kev mob plab hnyuv pathologies. Cov no suav nrog ulcerative colitis, Crohn's disease.
Txoj kev kuaj mob
Yog tias koj xav tias muaj kab mob, koj yuav tsum nrhiav kev pab tam sim ntawm tus kws kho mob. Kev kuaj mob ntawm tus neeg mob pib nrog kev kawm txog nws anamnesis, kev tsis txaus siab thiab cov tsos mob tseem ceeb. Tom qab ntawd, mus rau kev kuaj lub cev. Tus neeg mob yuav muaj khawb ntawm daim tawv nqaij, jaundice hnyav. Palpation feem ntau nthuav tawm lub siab thiab tus po.
Yuav kom paub meej qhov kev kuaj mob ua ntej, tus neeg mob raug xa mus kuaj ntxiv. Nws suav nrog cov haujlwm hauv qab no:
- kuaj ntshav (qhov ntau dhau ntawm leukocytes thiab ESR qhia tias muaj cov txheej txheem inflammatory);
- Ultrasound ntawm lub plab kab noj hniav;
- daim siab elastography (tso cai rau koj los ntsuas qhov elasticity ntawm lub cev);
- retrograde cholangiopancreatography (X-ray kuajsiv qhov sib piv);
- ntshav biochemistry (nrog rau thawj sclerosing cholangitis, nce qib ntawm daim siab enzymes raug pom);
- MRI;
- daim siab biopsy (txoj kev tshawb fawb no pab txheeb xyuas thaj chaw ntawm fibrosis).
Cov txheej txheem kuaj tau tso cai kom paub meej tias thawj tus kab mob sclerosing cholangitis. Kev kuaj mob ntawm tus kab mob no kuj tseem pab txiav txim siab qhov hnyav ntawm cov txheej txheem pathological. Muaj plaub tag nrho:
- Portal. Nws yog tus cwj pwm los ntawm qhov pom ntawm fibrosis thiab o ntawm lub siab ducts.
- Periportal. Cov tsos mob ntawm thawj theem yog ua tiav los ntawm kev ua kom pom tseeb ntawm fibrosis thiab kev puas tsuaj ntawm cov ducts.
- Septal. Nyob rau theem no ntawm txoj kev loj hlob ntawm tus kab mob, thawj cov cim qhia ntawm cirrhosis tshwm.
- Cirrotic. Nws yog tus cwj pwm los ntawm kev txhim kho tag nrho ntawm biliary cirrhosis ntawm daim siab.
Raws li cov txiaj ntsig ntawm kev tshuaj ntsuam xyuas, tus kws kho mob muab tshuaj kho.
Txoj Cai Kev Kho Mob
Kev kho rau tus kab mob no tau ua kom pom tias tsis siv cov txheej txheem ua pa, rov kho cov kua tsib ntws thiab tshem tawm lub cev. Rau lub hom phiaj no, conservative thiab phais txoj kev kho mob yog siv nyob rau hauv niaj hnub tshuaj. Hauv thawj kis, nws txhais tau tias noj tshuaj thiab ua raws li kev noj zaub mov nruj. Kev cuam tshuam ntawm kev phais yog qhia hauv cov xwm txheej hnyav tshwj xeeb thaum kev kho mob tsis zoo. Kev xaiv ntawm ib txoj kev kho mob tseem nyob nrog tus kws kho mob.
Daim ntawv thovtshuaj
Nyob ntawm seb qhov mob hnyav npaum li cas, kev pw tsaug zog tuaj yeem raug sau tseg thiab tsis suav nrog kev tawm dag zog lub cev. Yog tias tus neeg mob txhawj xeeb txog qhov mob hnyav, nws tau muab tshuaj antispasmodics ("No-shpa", "Spasmobrew")
Cov tshuaj hauv qab no pab kom tsis txhob muaj cov txheej txheem inflammatory:
- Immunosuppressants ("Azathioprine"). Lawv txwv kev ua haujlwm ntawm lub cev tiv thaiv kab mob.
- Antifibrogenic cov neeg ua haujlwm. Lawv lub luag haujlwm tseem ceeb yog txhawm rau tshem tawm fibrosis thiab tiv thaiv lawv txoj kev loj hlob ntxiv.
- Glucocorticosteroid hormones ("Prednisolone"). Lawv pab txo qhov mob.
Kev siv cov tshuaj teev tseg tso cai rau koj kov yeej thawj sclerosing cholangitis ntawm thawj theem ntawm kev loj hlob. Cov tsos mob ntawm tus kab mob no feem ntau cuam tshuam rau txoj kev ua neej ib txwm muaj rau cov neeg mob. Cov tawv nqaij khaus, teeb meem nrog cov kab mob plab thiab cov kab mob dyspeptic - tag nrho cov teeb meem no cuam tshuam rau lawv txoj kev noj qab haus huv. Yog li ntawd, kev kho mob kuj tau sau tseg. Nws suav nrog kev noj tshuaj hepatoprotectors (Essentiale), gastric enzymes (Creon) thiab tshuaj tua kab mob. Cov tshuaj ib txwm xaiv ib tus zuj zus, suav nrog tag nrho cov duab kho mob thiab tus neeg mob tus mob.
Txoj Kev Noj Qab Haus Huv
Tus neeg mob tau muab zaub mov "rooj 5". Nrog rau kev noj zaub mov no, koj yuav tsum txwv tsis pub noj cov rog, kib thiab ntsim zaub mov. Nws yog qhov zoo dua los hloov cov tsiaj rog nrog zaub rog. Tsis tas li ntawd, nws yog ib qho tsim nyog kom tshem tawm tag nrhoKev noj haus ntawm muffins thiab khoom qab zib, txiv hmab txiv ntoo qaub thiab txiv hmab txiv ntoo, qhob noom xim kasfes, cawv, nqaij haus luam yeeb thiab marinades.
Cov nqaij tsis muaj rog / ntses, qee hom khob cij, porridge rau hauv dej tau tso cai. Koj tuaj yeem noj cov khoom noj mis nyuj, zib ntab, kua zaub pasta hauv zaub kua zaub.
Thaum kuaj pom tias muaj tus kab mob sclerosing cholangitis thawj zaug, kev kho mob nrog tshuaj thiab kev noj haus muab cov txiaj ntsig zoo tsuas yog thaum pib. Yog tias lub sijhawm no tsis tuaj, yuav tsum tau phais.
Surgery
Txoj kev tswj hwm kev kho mob yog siv rau cov ntaub ntawv tsis yooj yim ntawm cov txheej txheem pathological. Txawm tias mus ntsib kws kho mob raws sij hawm tsis tas yuav ua rau muaj txiaj ntsig zoo hauv kev kho mob tom ntej. Thaum kho nrog tshuaj tsis ua rau normalization ntawm tus mob los yog nws tsis muaj peev xwm los kho cov kua tsib li qub, lawv mus rau kev phais.
Hnub no, cov kws kho mob nyiam ua haujlwm endoscopic. Lawv koom nrog ua txhua yam kev ua haujlwm los ntawm kev txiav me me ntawm daim tawv nqaij. Txawm li cas los xij, cov txheej txheem zoo li no feem ntau ua rau muaj kev cuam tshuam luv luv thiab ua rau muaj teeb meem. Balloon dilatation nrog stenting ntawm cov ducts kuj tau ua. Thaum lub sij hawm tus txheej txheem, tus kws kho mob nthuav tawm cov channel nrog tshwj xeeb balloons thiab nruab meshes uas tiv thaiv lawv txoj kev nqaim. Yog tias muaj tus kab mob sclerosing cholangitis siab heev, kev kho mob yuav hloov lub siab.
Muaj Teeb Meem
Kab mobcharacterized los ntawm qeeb ntws. Nws yog ib qho nyuaj rau kev kho mob, thiab cov abundance ntawm systemic manifestations tsuas aggravates tus txheej txheem. Ntawm nws cov teeb meem feem ntau yog cov hauv qab no:
- Portal hypertension. Qhov no yog ib qho pathology nrog rau kev nce siab hauv cov hlab ntshav. Ascites suav hais tias yog nws qhov tshwm sim tseem ceeb.
- YCholestasis Syndrome. Tawm tsam keeb kwm ntawm sclerosis, cov kua tsib ducts maj mam nqaim, thiab lawv patency yog impaired. Qhov no piav qhia txog qhov tshwm sim ntawm jaundice thiab khaus ntawm daim tawv nqaij. Raws li tus kab mob loj tuaj, lub lumen nqaim ntau thiab ntau dua. Steatorrhea tshwm sim, uas yog nrog osteoporosis.
- Kab mob sclerosing cholangitis ntawm daim siab.
- mob pancreatitis.
- Cholangiocarcinoma (mob ntawm cov kua tsib).
- YCholelithiasis.
Cov teeb meem no tshwm sim ntawm 3-4 theem ntawm cov txheej txheem pathological.
Huab cua thiab kev tiv thaiv
Primary sclerosing cholangitis yog cais raws li tus kab mob maj mam zuj zus. Nws qhov tshwm sim nyob rau hauv feem ntau yog mob siab tsis ua hauj lwm. Cov tsos mob ntawm tus kab mob no cuam tshuam loj heev los ntawm lub hnub nyoog ntawm tus neeg mob, muaj cov kab mob hauv plab concomitant, thiab qhov tshwm sim ntawm cov teeb meem. Raws li txoj cai, txij li lub sijhawm pib cov tsos mob tshwm sim mus rau theem kawg ntawm tus kabmob, nws yuav siv sijhawm li 7 txog 12 xyoos.
Puas yog thawj sclerosing cholangitis tiv thaiv? Cov kws kho mob cov lus hais qhia tias vim qhov kev kawm tsis txaus ntawm tus kab mob, kev tiv thaiv tshwj xeeb tsis tau tsim.
