Tom qab muaj kev raug mob ntawm daim tawv nqaij, ib tug neeg muaj ib qho cim nco txog hauv daim ntawv caws pliav, uas txhais tau hais tias "hlawv" hauv German. Qee lub sij hawm cov cim no tsis ua teeb meem, vim lawv tsis nyob hauv qhov chaw pom, lossis yuav luag tsis paub qhov txawv ntawm thaj tsam ntawm daim tawv nqaij. Tab sis muaj cov xwm txheej thaum cov caws pliav pom dhau lawm, convex, tsaus nti, qee zaum nrog lub ntsej muag zoo nkauj. Cov no yog hypertrophic thiab keloid nti. Ntawm chav kawm, lawv yog ib qho tseem ceeb ntawm cov tshuaj pleev ib ce, tshwj xeeb tshaj yog tias lawv nyob ntawm lub ntsej muag, caj dab, hauv siab. Kev tshem tawm ntawm lawv tsis yooj yim, vim tias hom caws pliav no muaj cov qauv fiber ntau uas nyuaj rau kho.
Tseem ntis
Qee tus neeg, qhov txhab kho sai sai thiab yuav luag tsis mob. Rau lwm tus, cov txheej txheem no txuas mus rau lub lis piam, thiab thaum kawg, qhov txhab kho, cov cim tsis zoo nyob hauv lawv qhov chaw. Txawv "kev coj tus cwj pwm" ntawm cov ntaub so ntswg nyob ntawm ntau yam, piv txwv li, kev kis kab mob ntawm qhov txhab, lawv qhov chaw nyob (qhov chaw txawb lossistsis muaj), ntawm qhov loj thiab qhov tob ntawm kev puas tsuaj, ntawm tus kheej lub peev xwm ntawm lub cev rov tsim dua tshiab, ntawm hom tawv nqaij, thiab lwm yam. Kev sib xyaw ua ke ntawm tag nrho cov laj thawj no ua rau muaj qhov tseeb tias qee zaum cov caws pliav zoo li sunken (lawv hu ua atrophic), thiab lwm tus lawv nyob ntawm tib theem ntawm daim tawv nqaij (normotrophic).
Qhov teeb meem tshaj plaws, los ntawm qhov pom ntawm kev kho kom zoo nkauj, yog cov caws pliav hypertrophic. Lawv tshwm sim thaum fibroblasts nyob rau hauv cov ntaub so ntswg kho ntawm lub qhov txhab ua heev active thiab pib nce collagen synthesis. Nyob rau tib lub sijhawm, cov enzyme collagenase, uas rhuav tshem cov collagen ntau dhau, yog tsim los ntawm cov khoom tsis txaus. Yog li ntawd, cov ntaub so ntswg tshiab tsim ntau dhau lawm. Tsis muaj qhov twg rau qhov dhau mus, thiab lawv protrude hla qhov chaw raug mob. Qhov siab ntawm cov nti tuaj yeem ncav cuag 10 mm. Lawv cov xim feem ntau tsaus dua li ntawm daim tawv nqaij nyob ib puag ncig, thiab qhov chaw feem ntau yog ntxhib.
Keloids
Cov qauv no zoo ib yam li cov nti hypertrophic, tab sis muaj ntau qhov sib txawv tsis zoo. Qhov tseem ceeb tshaj plaws yog cov caws pliav keloid, tau tshwm sim ntawm qhov chaw raug mob, loj hlob mus rau qhov chaw ntawm daim tawv nqaij. Lub tshuab ua rau lawv tuaj yeem yog qhov txiav loj lossis hlawv, lossis kev txhaj tshuaj me me, txawm tias muaj kab tom, uas ntau tus tsis mloog. Keloid caws pliav pib loj hlob ib hlis lossis ntau dua tom qab lub qhov txhab zoo lawm. Kev loj hlob tuaj yeem kav ntev txog ob xyoos, tom qab ntawd pib qhov kev ruaj khov. Cov kev tshawb fawb histological hauv keloids qhia ib yam nkausActive loj heev fibroblasts tsis tu ncua tsim collagen. Thiab yog tias cov caws pliav hypertrophic, txawm tias dab tuag, tsis mob, ces keloids tuaj yeem ua rau khaus, mob, thiab ua rau tawv nqaij rhiab heev. Muaj cov keloids cuav uas tshwm sim ntawm qhov chaw raug mob, thiab qhov tseeb uas tshwm sim qhov chaw ntawm daim tawv nqaij tsis puas sab nraud.
Kev kho mob ntawm keloid thiab hypertrophic nti
Hnub no, cov hauv qab no ntawm kev kho cov caws pliav ntxhib tau siv:
- compression;
- silicon npaj (phaj, gel);
- laser kho;
- phais;
- xov tooj cua;
- kev kho mob khaub thuas;
- tshuaj kho mob;
- Ycorticosteroids.
Txhua ntawm lawv muaj nws qhov zoo thiab qhov tsis zoo. Qhov twg ntawm txoj kev siv, nyob rau hauv txhua rooj plaub, tus kws kho mob yuav tsum txiav txim siab. Nws yog ib qho tsim nyog yuav tsum tshem tawm cov hypertrophic, thiab ntau dua li cov caws pliav keloid, uas feem ntau kuaj tau tias yog dermatofibroma thiab txawm infiltrating mob qog noj ntshav, tsuas yog hauv cov chaw kho mob tshwj xeeb.
Surgery
Hypertrophic thiab keloid nti tsis tshua muaj kev phais, vim tias tom qab kho qhov no yuav luag ib txwm rov ua dua. Piv txwv li, yog tias peb tham txog keloids, qhov rov qab los ntawm qhov tsis xws luag tshwm sim hauv 80-90% ntawm tag nrho cov ntaub ntawv sau npe thiab tshwm sim nws tus kheej hauv kev tsim cov caws pliav txawm tias loj dua ua ntej tshem tawm. Nyob rau hauv cov ntaub ntawv ntawm hypertrophic nti, feem puaCov teeb meem yog me ntsis qis. Kev kho phais yog qhov zoo tshaj plaws zam los ntawm nqaim nti nrog cov npoo ntshiab. Thaum lub sij hawm ua hauj lwm, tus kws phais excises lawv, phim cov npoo ntawm qhov incision, ua ib tug sab hauv suture, uas yog tsis tshua pom. Qhov kev ua haujlwm no yog ua raws li kev siv tshuaj loog hauv zos. Tsis tas yuav mus pw hauv tsev kho mob.
Yog tias qhov caws pliav, xws li cov caws pliav, raug tshem tawm los ntawm kev phais, patchwork ntawm daim tawv nqaij (graft) ua tiav.
Hypertrophic nti yog xyaum tsis kho los ntawm txoj kev no, tab sis nyob rau hauv cov ntaub ntawv ntawm keloids, nws muab cov txiaj ntsig zoo. Lub ntsiab ntawm txoj kev yog siv cov ntaub qhwv nruj rau qhov caws pliav, uas tus neeg mob hnav tsis tau tshem tawm ntawm 3 lub hlis mus rau ib xyoos. Qee zaum daim ntaub qhwv tuaj yeem siv txhua 12 teev. Vim lub siab ntawm cov hlab ntsha ntawm lub caws pliav, nws cov khoom noj khoom haus nres. Tib lub sijhawm, cov npoo ntawm cov caws pliav yog compressed, uas tiv thaiv nws txoj kev loj hlob ntxiv.
Kev kho hluav taws xob
Txoj kev no suav tias yog qhov zoo tshaj plaws thiab siv thoob plaws ntiaj teb. Kev tshem tawm cov nti hypertrophic, keloids thiab lwm yam kev tsim ntawm daim tawv nqaij yog ua los ntawm lub npe hu ua Bucca rays (X-rays siv ultra-precise beta applicators). Yog li ntawd, fibroblasts raug rhuav tshem lossis nres lawv txoj kev loj hlob, collagen synthesis nres. Beams ntawm qhov sib txawv siv tau.
Txawm li cas los xij, 90% ntawm lawv tau nqus los ntawm cov txheej txheem sab saud ntawm daim tawv nqaij, thiab tsuas yog 10% nkag mus rau dermis. Feem ntau txoj kev no yog siv ua ke nrog kev phais tshem tawm qhov caws pliav. Relapses tom qab xws li kev kho mob tau sau npe nyob rau hauv 50% ntawm cov neeg mob. Nyob rau hauv kev saib ntawm peculiarities ntawm raug x-rays, txoj kev tsis yog siv los tshem tawm caws pliav nyob rau hauv lub taub hau, caj dab, thiab hauv siab. Contraindications:
- oncology;
- mob ntshav qab zib mellitus;
- kab mob plawv thiab hlab ntsha;
- kev mob ntau yam.
Cryotherapy
Qhov no yog ib txoj hauv kev nyab xeeb tshaj plaws thiab siv tau zoo tshaj plaws. Keloids tsis muaj rov tshwm sim nrog kev pab los ntawm kev mob khaub thuas ploj tag hauv 51% ntawm cov neeg mob. Thiab nyob rau hauv 76% ntawm cov neeg mob, hypertrophic nti raug tshem tawm. Kev kho mob yuav tsum yog complex (cryotherapy thiab lwm txoj kev - kev siv tshuaj pleev, silicone), ces nws ua rau kev txiav txim siab rau kev cia siab rau qhov yuav luag tag (90%) ploj ntawm nti, tsis muaj teeb meem thiab rov tshwm sim. Qhov tseem ceeb ntawm txoj kev yog qhov cuam tshuam ntawm caws pliav nrog kua nitrogen (kub yog li -196 ° C). Nws yog thov nrog ib tug swab los yog ib tug tshwj xeeb applicator. Yog li ntawd, cov dej khov nab kuab yog tsim nyob rau hauv lub hlwb, cytoplasm thiab organelles tuag. Yog li, fibroblasts raug rhuav tshem, collagen synthesis nres. Nitrogen raug ntau tshaj 30 vib nas this, tab sis feem ntau 5 vib nas this txaus. Txhawm rau kom tshem tawm tag nrho cov caws pliav, ob peb txheej txheem txaus. Disadvantages ntawm txoj kev:
- mob ntawm tus txheej txheem;
- muaj peev xwm ntawm hlwv tsim ntawm qhov chaw caws pliav;
- hyperpigmentation tom qab kho.
Kho nrog silicone
cov tuam txhab lag luam tam sim no tau tsim cov gels uas muaj silicone thiab cov ntawv tshwj xeeb silicone. Txoj CaiCov kev ua ntawm kev npaj yog kwv yees li qub - lawv ua haujlwm kom ua kom lub cev qhuav dej thiab ua kom lub cev ntawm cov caws pliav, thaiv kev nkag mus ntawm oxygen rau nws cov fibers thiab txo cov synthesis ntawm collagen.
Txoj kev no tshem tawm atrophic thiab hypertrophic nti. Nws tsis haum rau kev kho mob ntawm keloids. Cov phaj muaj nyob rau hauv ntau yam duab thiab ntau thiab tsawg. Ntawm qhov tod tes, lawv muaj cov nplaum nplaum uas muab qhov ntom ntom ntom ntom rau qhov caws pliav. Lawv cov qauv yog xws li tias lawv dhau huab cua mus rau ntawm daim tawv nqaij, thaum ua dej tsis zoo. Qhov zoo ntawm txoj kev yog yooj yim ntawm kev siv, tus nqi qis, tsis muaj mob thiab tsis muaj teeb meem, kev ua xua, kev phiv. Qhov tsis zoo: Lub sijhawm ntawm cov txheej txheem (ntau lub hlis) thiab cov nyhuv qis.
YCorticosteroids
Ntau tus neeg nug yuav ua li cas tshem tawm qhov caws pliav hypertrophic sai sai thiab muaj txiaj ntsig zoo. Kev txhaj tshuaj ntev ntev (ntev ua yeeb yam) corticosteroids ua tiav cov kev xav tau ntawm cov neeg mob, thiab cov txiaj ntsig zoo kuj tau ua tiav hauv kev kho mob keloids. Txog niaj hnub no, corticosteroids "Kenalog" thiab "Diprosan" tau siv. Cov txheej txheem ntawm lawv cov kev ua yog kwv yees li qub thiab muaj nyob rau hauv txo tus naj npawb ntawm leukocytes thiab cytokines, suppressing qhov kev loj hlob thiab kev loj hlob necrosis, inhibiting kev ua hauj lwm ntawm fibroblasts, tshem tawm kev tsis haum tshuaj, thiab txo cov theem ntawm collagen. Cov txheej txheem yog nqa tawm 1 zaug hauv 10-14 hnub. Cov kev mob tshwm sim:
- hypopigmentation;
- pom ntawm lub network ntawm capillaries ntawm daim tawv nqaij;
- tshwm sim ntawm steroidblackhead;
- daim tawv nqaij tawv;
- kev cuam tshuam tsis zoo rau lub cev.
Txhawm rau txo cov kev mob tshwm sim, corticosteroids raug txhaj nrog lidocaine (1:5), saline, pentoxifylline. Qhov txiaj ntsig zoo tshaj yog muab los ntawm cov txheej txheem no nrog rau kev kho mob cryotherapy.
Laser kho mob
Laser resurfacing ntawm hypertrophic caws pliav lossis keloid muab cov txiaj ntsig siab tshaj plaws. Lub ntsiab ntawm cov txheej txheem yog qhov tseeb thiab meej heev tshem tawm cov txheej txheem saum toj kawg nkaus ntawm daim tawv nqaij thiab caws pliav. Yog li ntawd, daim tawv nqaij yog rov ua dua tshiab, tshiab elastin thiab collagen yog tsim nyob rau hauv qhov chaw kho mob, bulge ntawm caws pliav txo qis, nws yog xyaum piv nrog ib puag ncig integument. Tom qab siv txoj kev no, hypertrophic caws pliav kiag li ploj hauv 80-95%, thiab keloid nti - hauv 60-70% ntawm cov neeg mob. Teeb meem tom qab tus txheej txheem:
- edema;
- hyperemia;
- nce daim tawv nqaij rhiab heev rau tshav ntuj;
- erythema;
- hyperpigmentation (daws tsis tau kho);
- pob txuv;
- cyst formation.
Laser raug tuaj yeem ua rau ablative (qhov tob) thiab tsis yog amblative (ntau dua). Hauv qhov thib ob, feem ntau muaj teeb meem tsawg dua, tab sis lub sijhawm kho mob ntev dua.
Drug therapy
Muaj kev kho mob sab nraud thiab los ntawm kev qhia tshuaj rau hauv lub cev ntawm qhov caws pliav. Rau kev txhaj tshuaj, kev npaj raws li hyaluronidase yog siv (ib qho enzyme vim qhov ua rau hypertrophic caws pliav.tsawg edematous, mos, lawv nyem yog flattened). Cov no suav nrog Lidaza, Alidaza, Longidaza, Vilidaza thiab lwm yam. Kev txhaj tshuaj yuav tsum tau ua txhua hnub lossis txhua 2 hnub rau 1-2 lub lis piam. Disadvantages ntawm txoj kev:
- enzyme instability;
- kev tsis txaus siab;
- kev tsis haum.
Kev kho mob sab nraud, tshuaj pleev, tshuaj pleev, tshuaj tsuag yog siv. Cov khw muag tshuaj muaj ntau yam kev npaj uas tshem tawm cov caws pliav. Qhov nrov tshaj plaws yog Contractubex, Dermatix, Kelo-Kot, Kelobibraza. Qhov zoo ntawm txoj kev yog nws yooj yim, muaj peev xwm kho tau hauv tsev, thiab tsis muaj kev phiv. Disadvantages - tsawg efficiency.
Tshuaj pleev thiab tshuaj tsis pab ntau tawm tsam keloid nti, thiab tsuas yog kev kho mob nyuaj xwb.
Yuav ua li cas kom tsis txhob muaj caws pliav
Yog qhov txhab loj dhau lawm, qhov caws pliav yuav nyob ib leeg. Tab sis qee zaum, koj tuaj yeem sim txo nws qhov tsos. Yog li, hypertrophic caws pliav tom qab tshem tawm ntawm mole yuav luag tsis tsim yog tias cov txheej txheem ua los ntawm cryotherapy, electrocoagulation, siv lub laser. Yog hais tias lub mole raug phais tshem tawm, caws pliav ib txwm nyob. Thiab thaum koj tshem tawm koj tus kheej, tom tsev, cov txheej txheem inflammatory yuav pib, uas yuav ua rau qhov xwm txheej hnyav ntxiv.
Txhua qhov kev raug mob ntawm daim tawv nqaij, txhawm rau kom lub qhov txhab zoo dua thiab sai dua, koj yuav tsum ua raws qee cov cai:
- zam kom tsis txhob muaj av ntawm cov tawv nqaij raug mob;
- zam kev txhuam thiab kovmus rau qhov txhab (piv txwv li, khaub ncaws);
- yuav tsis tev tawm ntawm qhov tshwm sim;
- pab lub qhov txhab los ntawm tshav ntuj ncaj qha;
- siv cov tshuaj pleev tshwj xeeb uas pab kho sai thiab txo qhov kev pheej hmoo ntawm nti (ib qho zoo tshaj ntawm cov tshuaj no yog Contractubex).
