Nyob rau hauv tsab xov xwm no, peb yuav saib cov tsos mob thiab kev kho mob ntawm postcholecystectomy syndrome.
Tus naj npawb ntawm kev phais mob rau kev kho mob cholecystitis ntev thiab cov teeb meem uas nws ua tau loj hlob txhua xyoo. Nyob rau hauv peb lub teb chaws, tus naj npawb ntawm xws li kev khiav hauj lwm txhua xyoo mus txog 150 txhiab. Txhua tus neeg mob thib peb uas tau ua tiav cholecystectomy, uas yog, tshem tawm ntawm lub gallbladder, muaj ntau yam kev tsis haum xeeb ntawm cov organic thiab kev ua haujlwm ntawm cov kab mob biliary thiab lwm yam kabmob. Tag nrho cov teeb meem no hauv kev kho mob hu ua postcholecystectomy syndrome, lossis PCES luv luv.
Ntau yam ntawm PCES
PCES feem ntau ntawm cov xwm txheej tsis tsim kho, raug ua rawsQee cov kev cai, suav nrog kev kuaj ua ntej ua ntej ntawm tus neeg mob, kev kuaj mob kom raug thiab qhia txog kev cuam tshuam kev phais, nrog rau kev ua haujlwm zoo cholecystectomy raws li cov txheej txheem.
Nyob ntawm keeb kwm ntawm tus kab mob, hom kab mob hauv qab no yog qhov txawv:
- True postcholecystectomy syndrome. Nws lwm lub npe yog ua haujlwm. Pom tias muaj teeb meem vim tsis muaj lub gallbladder los ua nws txoj haujlwm.
- Conditional, lossis organic. Qhov no yog cov tsos mob tshwm sim los ntawm kev ua yuam kev thaum lub sijhawm ua haujlwm lossis kev kuaj xyuas tsis tiav ntawm tus neeg mob hauv kev npaj rau cholecystectomy. Qee zaum, nyob rau theem ntawm kev npaj rau kev phais, qee qhov teeb meem ntawm calculous cholecystitis tsis quav ntsej.
Muaj ntau ntau cov ntaub ntawv organic ntawm PCES dua li cov haujlwm ua haujlwm.
Yog vim li cas
Yam uas ua rau muaj kev loj hlob ntawm postcholecystectomy syndrome ncaj qha nyob ntawm nws ntau yam. Yog li, cov laj thawj tseem ceeb rau qhov tshwm sim ntawm PCES qhov tseeb yog:
1. Kev ua haujlwm tsis zoo ntawm lub sphincter ntawm Oddi, uas yog lub luag haujlwm rau kev tswj cov kua tsib thiab cov kua tsib tso rau hauv duodenum.
2. Syndrome ntawm duodenal obstruction nyob rau hauv daim ntawv mob ntawm lub chav kawm, uas ua rau ib tug nce nyob rau hauv lub siab nyob rau hauv lub duodenum nyob rau hauv lub compensated theem, nws txo qis thiab nthuav dav nyob rau hauv lub duodenum.decompensated.
Yog vim li cas rau daim ntawv muaj cai
Daim ntawv kho mob ntawm postcholecystectomy syndrome (ICD-10 code - K91.5) tuaj yeem tshwm sim los ntawm cov kab mob hauv qab no:
1. Narrowing ntawm cov kab mob sib kis.
2. elongated thiab inflamed stump ntawm lub gallbladder duct.
3. Granuloma lossis neuroma nyob ib ncig ntawm qhov phais phais.
4. Tsim cov pob zeb hauv lub duct.
5. Qhov tshwm sim ntawm adhesions nyob rau hauv daim siab, uas ua rau nqaim thiab deformation ntawm cov kua tsib duct.
6. Kev puas tsuaj rau lub duodenal papilla los ntawm kev raug mob thaum phais.
7. Kev tshem tawm ib feem ntawm lub gallbladder, thaum lwm lub cev zoo sib xws tuaj yeem tshwm sim los ntawm qhov dav dua.
8. Kab mob ntawm biliary ib ntsuj av kis.
9. Hernia tsim ntawm esophageal qhib ntawm lub diaphragm.
10. Duodenal rwj.
11. Tus mob pancreatitis thib ob hauv daim ntawv mob ntev.
12. Papillostenosis.
13. Duodenal diverticulum nyob rau thaj tsam ntawm papilla loj.
14. Lub cyst nyob rau hauv cov kab mob uas muaj cov kab mob uas muaj teeb meem nyob rau hauv daim ntawv ntawm nws dilatation.
15. Mirizzi Syndrome.
16. Ntev fistula tsim tom qab phais.
17. Fibrosis, reactive hepatitis, hepatic steatosis.
Cov tsos mob ntawm postcholecystectomy syndrome
Nyob rau lub sijhawm tom qab phais, tus neeg mob yuav muaj kev hnyav thiab mob ntawm txoj caihypochondria. Muaj ntau qhov kev kho mob tshwm sim ntawm postcholecystectomy syndrome, tab sis tag nrho cov ntawm lawv yog cais raws li tshwj xeeb. Cov tsos mob tshwm sim tam sim ntawd tom qab ua haujlwm thiab tom qab qee lub sijhawm, hu ua lub sijhawm teeb.
Nyob ntawm cov xwm txheej uas ua rau cov tsos mob ntawm postcholecystectomy syndrome, cov tsos mob hauv qab no txawv:
1. Tshaj tawm qhov mob hnyav hauv txoj cai hypochondrium. Cov no yog hu ua biliary colic.
2. Zoo ib yam li mob pancreatic, tus cwj pwm zoo li girdle thiab radiating rau sab nraub qaum.
3. Yellow tint ntawm daim tawv nqaij, mucous daim nyias nyias thiab sclera, khaus.
4. Xav txog qhov hnyav hauv thaj tsam ntawm txoj cai hypochondrium thiab plab.
5. iab hauv qhov ncauj, xeev siab, ntuav, belching.
6. Txaus siab rau cov kab mob plab hnyuv, tshwm sim los ntawm ntuav lossis raws plab. Qhov no feem ntau yog vim tsis ua raws li cov lus pom zoo noj zaub mov tom qab phais.
7. Tsis tu ncua flatulence.
8. Psycho-emotional disorders, qhia raws li nro, tsis xis nyob, ntxhov siab vim, thiab lwm yam.
9. Ua npaws thiab ua npaws.
10. Kev tawm hws ntau ntxiv.
Diagnosis
Raws li tus neeg mob qhov kev tsis txaus siab thiab cov keeb kwm sau tseg, tus kws kho mob tuaj yeem txiav txim siab tias muaj tus mob postcholecystectomy. Txhawm rau kom paub meej lossis tsis suav nrog tus mob postcholecystectomy syndrome (ICD-10 - K91.5), kev tshuaj xyuas yog muab, suav nrog ob qho tib si ntsuas.txoj kev, thiab kev sim.
Kev Tshawb Fawb Kev Tshawb Fawb
Cov kev tshawb fawb soj ntsuam suav nrog kev kuaj ntshav biochemical, uas suav nrog cov ntsuas xws li tag nrho, pub dawb thiab sib xyaw bilirubin, Alat, AsAT, LDH, alkaline phosphatase, amylase, thiab lwm yam.
Instrumental method yog ib qho tseem ceeb hauv cov txheej txheem ntawm kev kuaj mob postcholecystectomy syndrome (code). Cov tseem ceeb yog:
- Qhov ncauj thiab qhov tso quav cholegraphy. Nws koom nrog kev qhia txog cov khoom tshwj xeeb (kev sib piv) rau hauv cov kab mob biliary, ua raws li fluoroscopy lossis radiography.
- Ib yam tshwj xeeb ntawm ultrasound hu ua transabdominal ultrasonography.
- Endoscopic hom ntawm ultrasound.
- kuaj kev ua haujlwm ntawm ultrasound, nrog rau kev noj zaub mov rog rog lossis nitroglycerin.
- YEsophagogastroduodenoscopy. Nws koom nrog kev kawm txog kev zom zaub mov nyob rau sab sauv los ntawm qhov endoscope.
- Sphincteromanometry thiab cholangiography nrog endoscope.
- YComputer hepatobiliary scintigraphy.
- Retrograde cholangiopancreatography endoscopic hom.
- Magnetic resonance cholangiopancreatography.
Kev kho mob rau postcholecystectomy syndrome yog dab tsi?
kev kho mob
Tus kab mob hauv nws daim ntawv tseeb yog kho nrog txoj kev khaws cia. Lub ntsiab lus pom zoo ntawm tus kws kho mob tshwj xeeb yuav yog kev hloov pauv kev ua neej, suav nrogmuab tus cwj pwm phem xws li haus thiab haus luam yeeb.
Lwm qhov tseem ceeb yog kev ua raws li kev noj zaub mov tshwj xeeb, uas suav nrog kev noj zaub mov raws li rooj 5. Cov zaub mov no muab rau cov khoom noj uas muaj feem ntau, uas ua kom cov kua tsib tso tawm thiab tiv thaiv nws los ntawm stagnation nyob rau hauv lub biliary ib ntsuj av.
Differentiated approach
Txhua qhov kev teem sijhawm rau postcholecystectomy syndrome KSD, suav nrog cov tshuaj, yuav tsum muaj kev sib txawv, qhia cov hauv qab no:
1. Ua kom lub suab nrov lossis spasm ntawm sphincter ntawm Oddi qhia txog kev noj cov tshuaj myotropic antispasmodics, xws li Spazmomen, No-shpa, Duspatalin. Tsis tas li ntawd, cov kws kho mob tau sau tshuaj peripheral M-anticholinergics, xws li Gastrocepin, Buscopan, thiab lwm yam. Tom qab tshem tawm hypertonicity, cholekinetics tau noj, nrog rau cov tshuaj uas ua kom cov txheej txheem tshem tawm cov kua tsib, xws li sorbitol, xylitol lossis magnesium sulfate.
2. Yog hais tias lub suab ntawm lub sphincter ntawm Oddi raug txo, tus neeg mob raug muab tshuaj prokinetics. Cov tshuaj no suav nrog Ganaton, Domperidone, Tegaserod, Metoclopramide, thiab lwm yam.
3. Txhawm rau tshem tawm duodenal obstruction nyob rau hauv daim ntawv ntawm cov dej ntws, prokinetics yog siv, uas yog Motilium, thiab lwm yam. Thaum tus kab mob nkag mus rau theem decompensated, rov qab ntxuav lub duodenum nrog cov tshuaj tua kab mob yog qhia rau hauv kev kho. Tom ntej no, tshuaj tua kab mob tau nkag mus rau hauv cov hnyuv, xws li "Dependal-M", "Intetrix", thiab lwm yam, nrog rau cov tshuaj tua kab mob los ntawm qeb ntawm fluoroquinolones.
4. Nrog kev tsim tawm tsis txaus ntawm cholecystokinin,Lub cev tau txhaj tshuaj nrog nws cov hluavtaws analogue ceruletide.
5. Nrog rau qhov tsis txaus ntawm somatostatin, nws cov analogue octreotide tau sau.
6. Rau cov tsos mob ntawm plab hnyuv dysbiosis, pre- thiab probiotics yog siv, xws li Dufalac, Bifiform, thiab lwm yam.
7. Hauv cov kab mob pancreatitis thib ob ntawm cov kab mob biliary-dependent, nws raug nquahu kom noj cov tshuaj polyenzymatic xws li Creon, Mezim-Forte, thiab lwm yam, nrog rau cov tshuaj tua kab mob thiab myotropic antispasmodics..
8. Yog hais tias muaj ntau yam kev nyuaj siab ntawm lub xeev nyuaj siab los yog autonomic dystonia ntawm lub paj hlwb raug kuaj, tranquilizers thiab tshuaj xws li Coaxil, Grandaxin thiab Eglonil raug suav hais tias yog siv tau.
9. Txhawm rau tiv thaiv kev tsim cov pob zeb tshiab, nws raug nquahu kom noj cov kua tsib acids, uas muaj nyob hauv cov tshuaj xws li Ursosan thiab Ursofalk.
Cov ntaub ntawv ntawm tus kab mob tsis tuaj yeem hloov kho rau txoj kev kho kom zoo. Postcholecystectomy Syndrome yog kho phais.
Txoj kev kho lub cev
Cov kws kho mob tshwj xeeb txaus siab rau qhov ua tau zoo ntawm kev kho lub cev kho mob ntawm PCES. Txhawm rau kom ceev cov ntaub so ntswg rov tsim dua, cov txheej txheem hauv qab no tau muab rau tus neeg mob:
1. Kev kho mob nrog ultrasound. Nws yog ua los ntawm kev nthuav tawm thaj chaw cuam tshuam rau oscillations nrog zaus ntawm 880 kHz. Cov txheej txheem rov ua dua ib zaug txhua ob hnub. Duration ntawm 10-12 txheej txheem.
2. Tsawg zaus magnetotherapy.
3. Kev kho decimeter wave therapy. Emitter nyob rau hauv daim ntawv ntawm ib lub tog raj kheej los yogCov duab plaub yog muab tso rau hauv kev sib cuag los yog ob peb centimeters saum toj no ntawm daim tawv nqaij nyob rau hauv daim siab projection cheeb tsam. Cov txheej txheem siv sijhawm 8-12 feeb thiab ua txhua hnub rau 12 zaug.
4. Infrared laser kho.
5. Radon lossis carbon dioxide da dej.
Cov lus pom zoo rau postcholecystectomy syndrome yuav tsum tau ua raws nruj me ntsis.
Techniques
Txhawm rau pab tus neeg mob kho qhov mob, siv cov txheej txheem hauv qab no:
1. Diadynamic therapy.
2. Amplipulse therapy.
3. Electrophoresis nrog analgesics.
4. Electroplating.
Txhawm rau txo qis ntawm cov leeg nqaij ntawm lub plab biliary, cov txheej txheem hauv qab no yog siv:
1. Electrophoresis siv antispasmodics.
2. Electroplating.
3. High zaus magnetotherapy.
4. Kev kho Paraffin.
5. Ozokerite applications.
Cov kua tsib tso rau hauv cov hnyuv yog yooj yim los ntawm cov txheej txheem ntawm kev kho lub cev xws li:
1. Hluav taws xob stimulation.
2. Tubage los yog qhov muag tsis pom kev soj ntsuam.
3. Mineral dej.
Cov txheej txheem kev kho lub cev tsis yog tsuas yog rau cov neeg mob postcholecystectomy syndrome (ICD-10 - K91.5), tab sis kuj yog kev tiv thaiv kev tiv thaiv tom qab cholecystectomy.
Kev Tiv Thaiv
Ob lub lis piam tom qab kev ua haujlwm kom tshem tawm lub gallbladder, tus neeg mob tuaj yeem raug xa mus rau kev rov zoo ntxiv hauv kev kho mob spa. Cov xwm txheej rau kev xa mus rau qhov no yog kev ntsuam xyuas ntawm tus neeg mob tus mobraws li qhov txaus siab thiab zoo ntawm cov caws pliav tom qab phais.
Txhawm rau tiv thaiv kev txhim kho ntawm tus mob postcholecystectomy, tus neeg mob yuav tsum tau tshuaj xyuas ob qho tib si ua ntej thiab thaum lub sijhawm phais, vim qhov no yuav pab txheeb xyuas cov teeb meem hauv lub sijhawm uas tuaj yeem cuam tshuam tus neeg mob lub neej yav tom ntej, ua rau postcholecystectomy syndrome (ICD code. - K91. 5) hom organic.
Lub luag haujlwm tseem ceeb sib npaug yog ua los ntawm cov kev tsim nyog ntawm tus kws phais neeg ua haujlwm, nrog rau cov ntaub so ntswg raug mob thaum cholecystectomy.
Zoo kawg
Tus neeg mob yuav tsum paub txog qhov yuav tsum tau ua kom muaj lub neej zoo tom qab kev phais. Qhov no suav nrog muab tus cwj pwm tsis zoo, noj zaub mov kom zoo, saib xyuas tsis tu ncua hauv lub tsev kho mob thiab ua raws li tag nrho cov tshuaj ntawm tus kws kho mob tuaj koom.
PCES yog qhov tsis zoo ntawm qhov tshwm sim ntawm cholecystectomy. Txawm li cas los xij, kev tshawb nrhiav ntxov thiab kev kho mob yuav pab txo qis kev pheej hmoo ntawm kev mob ntxiv.
Cov kab lus tau tham txog cov tsos mob thiab kev kho mob ntawm postcholecystectomy syndrome.
