Ib choledochal cyst yog ib feem ntawm cov kab mob ntawm cov kua tsib zoo li lub hnab. Txawm hais tias tus kab mob no tsuas yog congenital (thawj) lossis tej zaum yuav muaj daim ntawv tau txais - tseem tsis muaj kev xav tsis meej txog qhov teeb meem no.
Hom kab mob pathological no tsis tshua muaj tshwm sim, tab sis nws tsis tsim nyog suav nrog qhov ua rau muaj cov tsos mob tsis zoo rau cov neeg laus thiab menyuam yaus, nrog rau kev nthuav tawm koj tus kheej kom muaj kev pheej hmoo ntawm kev tsim teeb meem, suav nrog kev mob pancreas. thiab rupture ntawm cystic kab noj hniav.
Hom thiab yam tseem ceeb ntawm kev loj hlob ntawm cov kab mob no
Kev faib tawm ntawm cov kab mob choledochal hauv cov neeg laus thiab cov menyuam yaus mus rau hauv qhov kis tau thiab qhov chaw yug yog suav tias yog qhov tsis sib haum xeeb, txij li ntau tus kws tshawb fawb tshawb fawb tau faib tag nrho cov neoplasms ua thawj, lwm tus lees paub hom hlwv. Cov nram qab no sib txawv ntawm pathological neoplasms, raws li lawv lub zos thiab cov duab, feem ntau pom tau hais tias:
- hom 1 - lub cyst yog tus cwj pwm los ntawm kev nthuav dav ntawm cov kav dej(diffuse), los yog ib qho ntawm nws ntu (segmental, raws li txoj cai, ntawm qhov taw tes ntawm inflection), feem ntau spindle-shaped;
- hom 2 - choledochal diverticulum, uas zoo li lub vesicle cais;
- hom 3 - diverticulum ntawm cov kab mob sib kis;
- hom 4 - zoo ib yam rau thawj zaug, tab sis ntxiv los ntawm cov kab mob cystic hauv cov kab mob siab;
- hom 5 - ntau cov ducts yuav luag tsis hloov, cov ducts intrahepatic muaj qee qhov cystic txawv txav;
- FF yog ib hom uas muaj kev hloov pauv me me hauv cov kab mob sib kis thiab cov kab mob cystic intrahepatic.
Ntau cysts
Cov cyst ntau tshaj plaws hom 1 thiab 4. Cov phab ntsa ntawm cov txheej txheem pathological yog tsim los ntawm kev sib txuas (fibrous) cov ntaub so ntswg. Nws tsis muaj cov leeg nqaij du thiab epithelium. Los ntawm sab hauv, xws li ib tug kab noj hniav yog sau nrog ib tug brownish kua, pib sterile. Kuj tseem muaj lub npe hu ua loj choledochal cyst, uas yog spindle-puab thiab loj heev.
Qhov laj thawj tseem ceeb ntawm cov kab mob no
Ntawm ntau qhov kev xav txog qhov ua rau choledochal cysts, ob lub ntsiab tuaj yeem paub qhov txawv:
- Txhua hlwv ntawm hom 1 thiab 4 yog tshwm sim los ntawm kev nkag mus ntawm pancreatic enzymes rau hauv choledochus, uas ua rau mob thiab tsis muaj zog ntawm phab ntsa, thiab nce siab hauv cov kav dej ua rau qhov xwm txheej hnyav dua.
- A choledochal cyst hauv menyuam yaus tuaj yeem ua rau los yog kis tau (piv los yog fusiform), hauv cov neeg laus nws yog qhov thib obyog hnav los ntawm tag nrho cov kab mob pathological.
Yog li, cysts hauv cov neeg laus tuaj yeem tsim tawm tsam keeb kwm yav dhau los:
- txoj kab txuas tsis zoo;
- kev puas tsuaj hauv cholelithiasis;
- ua haujlwm ntawm lub sphincter ntawm Oddi.
Cov kab mob sib kis ntawm cov kab mob sib kis, duodenal atresia thiab lwm yam pathologies uas tshwm sim hauv lub sijhawm cev xeeb tub ua pov thawj pom zoo ntawm qhov tshwm sim ntawm qhov tshwm sim ntawm cov hlwv.
Cov tsos mob ntawm tus kab mob no
Choledochal cyst hauv 70% yog kuaj pom hauv cov menyuam yaus hnub nyoog qis dua 12 xyoos. Tsis tas li ntawd, tus kab mob no muaj ntau zaus hauv cov poj niam.
Nyob rau hauv cov me nyuam mos, qhov sib txawv ntawm qhov tshwm sim ntawm pathology yog pom ntau dua. Qee lub sij hawm tej zaum yuav tsis muaj cov tsos mob ntawm tus kab mob, thiab qee zaum, cov tsos mob ntawm lub sij hawm stagnation ntawm cov kua tsib thiab palpable neoplasm tuaj yeem kuaj pom. Lwm cov cim suav nrog:
- Jaundice ntawm daim tawv nqaij thiab cov ntaub nyias nyias nyias;
- lub rooj zaum;
- tso zis tsaus;
- hnyav lossis mob nyob rau hauv txoj cai hypochondrium, uas tuaj yeem ua rau colic thiab tawg mus rau sab xis ntawm lub cev.
Cov menyuam yaus uas muaj choledocha cyst thaum muaj hnub nyoog laus dua tuaj yeem ntsib cov tsos mob hauv qab no:
- jaundice - nyob rau hauv daim ntawv ntawm kev tawm tsam los yog tas li;
- mob plab;
- palpable neoplasm hauv plab kab noj hniav.
Kev tshwm sim ntawm cysts hauv cov neeg laus
Hauv cov neeg laus, cov tsos mob feem ntau ua ke nrogQee qhov teeb meem ntawm cov txheej txheem pathological (stagnation ntawm cov kua tsib, calculi hauv lub gallbladder, kab mob thiab o). Nws suav nrog:
- mob plab lossis mob plab;
- fever;
- xeev siab thiab ntuav;
- mechanical jaundice.
Cov cim qhia tib yam, uas feem ntau nrog los ntawm kev poob phaus, yuav qhia tau tias muaj kev hloov pauv ntawm lub cyst.
Txoj kev kuaj mob no
Lub hauv paus rau kev kuaj pom cov hlwv yog tus neeg mob qhov kev tsis txaus siab lossis kev tawm tsam ntawm tus mob pancreatitis uas tsis paub keeb kwm. Thaum kuaj xyuas, tus kws kho mob yuav pom daj ntawm daim tawv nqaij thiab sclera thiab palpate ib lub qog zoo li neoplasm nyob rau hauv txoj cai hypochondrium. Tom ntej no, nws yog ib qho tsim nyog yuav tsum tau ua kom sib txawv ntawm cov cystic tsim ntawm choledoch los ntawm cholelithiasis, stricture, pancreatic cysts los yog oncological qog ntawm lub duct.
Qhov no yog ua tiav siv cov kev kuaj mob hauv qab no:
- Ultrasound (transabdominal ultrasonography), uas zoo, tab sis tsis yog ib txwm txiav txim siab qhov loj ntawm lub cyst;
- endoscopic ultrasonography, uas tso cai rau kev pom ntawm lub gallbladder ducts thiab tsis rhiab rau kev cuam tshuam hauv daim ntawv ntawm cov roj subcutaneous lossis roj;
- dynamic cholescintigraphy, uas yog ua los ntawm cov tshuaj radiopharmaceutical, thiab muaj 100% kev ua haujlwm zoo hauv hom 1 hlwv, tab sis tsis tuaj yeem pom cov kab mob intrahepatic deformities. Qhia nyob rau hauv cov me nyuam mos kom paub cov kab mob tseem ceebducts;
- CT, uas yog ua ntej ntawm ultrasound ntawm cov ntsiab lus ntawm cov ntaub ntawv thiab ua rau nws muaj peev xwm tshem tawm cov txheej txheem malignant;
- Percutaneous, intraoperative thiab retrograde endoscopic cholangiography - pab kom tau txais cov ntaub ntawv hais txog cov qauv ntawm cov kab mob biliary, suav nrog ua ntej kev phais. Qhov tsis zoo ntawm txoj kev tshawb no yog invasiveness, contraindications thiab teeb meem, nrog rau qhov xav tau kev tshuaj loog (thaum kuaj tus menyuam);
- Sib nqus resonance cholangiopancreaticography yog qhov ua tau zoo tshaj plaws hauv kev kuaj choledochal neoplasms, ua tau yooj yim, tsis cuam tshuam, me ntsis qis dua hauv rhiab heev rau ERCP.
Feem ntau, kev kuaj mob pib nrog ultrasound, thiab tom qab ntawd kev kuaj mob nyob ntawm seb hom cyst, cov cuab yeej siv kho mob ntawm lub tsev kho mob thiab qhov nyuaj ntawm kev kho phais tom ntej.
Kev kho mob
Kuv puas xav tau kev phais mob choledocha cyst hauv cov menyuam yaus thiab cov neeg laus?
Nws tuaj yeem ua rau lub cev tawm ntawm cov kua tsib thaum tsim cov kab mob tsuas yog los ntawm kev phais. Muaj peb txoj hauv kev rau kev cuam tshuam kev phais:
- Tsim ib qho kev tsim kho anastomosis ntawm pathological tsim nrog lub duodenum, yam tsis muaj resection ntawm lub cystic kab noj hniav, yog qhov tsawg tshaj plaws radical txheej txheem, qhov tsis zoo ntawm uas yog qhov tshwm sim ntawm postoperative teeb meem, exacerbations thiab oncological ntaub so ntswg degeneration.
- Ua tiav kev txiav tawm ntawm neoplasm ua raws li kev sib txuas nrog cov hnyuv me. Xws li kev ua haujlwm tuaj yeem ua tiavlos ntawm kev mob plab lossis laparoscopic.
- Cov kua dej tawm sab nraud, uas yog siv rau hauv qhov tshwj xeeb thiab yog ib qho kev ntsuas ntxiv uas txhim kho tus neeg mob txoj kev noj qab haus huv ua ntej kev phais.
Txawm li cas los xij txoj kev phais rau choledochal cyst raug xaiv, qhov tshwm sim ntawm cov teeb meem feem ntau yog nyob ntawm qhov txheeb xyuas theem ntawm cov txheej txheem pathological. Yog li ntawd, yog tias muaj cov tsos mob nrog kev kuaj mob ntawm lub cyst thiab kev kho mob phais, koj yuav tsum tsis txhob yig.
Kev nyuaj siab
Txawm tias lub cyst tsis ua rau muaj kev txhawj xeeb ntau, nws cuam tshuam cov dej ntws tawm, ua rau kev txhim kho ntawm o thiab tsim cov calculi, uas tau tshwm sim los ntawm cov kab mob hauv qab no:
- cholangitis - mob ntawm cov kab mob sib kis;
- calculous cholecystitis;
- pancreatitis - ib qho nyuaj ntawm cov tsos mob ntawm cov txheej txheem inflammatory hauv tus txiav;
- tawg ntawm lub cyst, nrog rau cov tsos mob ntawm "mob plab" lossis ntshav lom;
- kab mob gallstone;
- portal hypertension, uas tsim tawm tsam keeb kwm ntawm daim siab puas lossis compression ntawm lub portal leeg cyst;
- mob ntshav siab;
- degeneration ntawm ib lub cyst rau hauv cholangiocarcinoma - ib qho oncological neoplasm nyob rau hauv lub ducts;
- compression ntawm duodenum uas ua rau muaj kev cuam tshuam.
Kev tshem tawm ntawm choledochal cyst tuaj yeem muaj ntau yam tsis zoo. Qhov no siv nyob rau hauv feem ntau ntawm kev phais kev khiav hauj lwm yam tsis muaj resection los yog manipulation nyob rau hauvmenyuam yug tshiab.
Kev Tiv Thaiv
Kev tiv thaiv muaj kev ua tib zoo saib xyuas cov teeb meem ntawm txoj hnyuv thiab kev kuaj niaj hnub los ntawm tus kws tshaj lij.
Nws tseem ceeb heev los muab kev kho mob rau plab hnyuv pathologies, cov cim qhia uas yuav npog lub cystic neoplasm.
