Phlegmonous cholecystitis: ua rau, tsos mob, kuaj mob thiab kho

Cov txheej txheem:

Phlegmonous cholecystitis: ua rau, tsos mob, kuaj mob thiab kho
Phlegmonous cholecystitis: ua rau, tsos mob, kuaj mob thiab kho

Video: Phlegmonous cholecystitis: ua rau, tsos mob, kuaj mob thiab kho

Video: Phlegmonous cholecystitis: ua rau, tsos mob, kuaj mob thiab kho
Video: Qhia cub tshuaj tiv thaiv kab mob li cas Feb 13/2021 2024, Kaum ib hlis
Anonim

Kev mob ntawm lub gallbladder, nrog rau kev tsim cov pob zeb hauv lub cev thiab nws cov ducts, yog cholelithiasis (GSD) lossis calculous cholecystitis. Lub phlegmonous variant ntawm pathology yog nws cov teeb meem. Nws raug kuaj pom feem ntau hauv cov neeg muaj hnub nyoog 40 xyoo, thiab cov poj niam raug cuam tshuam ntau dua.

daim ntawv pov thawj kho mob

Cholecystitis tuaj yeem mob hnyav lossis mob ntev. Mob, nyob rau hauv lem, yog xam, thaum lub pathological txheej txheem yog nrog los ntawm tsim ntawm pob zeb nyob rau hauv lub cev, thiab stoneless.

Raws li qhov hnyav ntawm kev puas tsuaj, tus kab mob tau muab faib ua cov ntaub ntawv hauv qab no:

  1. Catarrhal. Nyob rau hauv cov ntaub ntawv no, muaj o thiab liab ntawm lub mucous daim nyias nyias ntawm lub zais zis, nws nce. Lub lumen ntawm lub cev yog maj mam ntim nrog cov kua dej inflammatory.
  2. Phlegmonous. Muaj ib qho mob ntawm txhua daim nyias nyias ntawm lub gallbladder. Hauv qhov no, purulent infiltrates thiab ulcers yog tsim.
  3. Nkauj hmoob. Qhov no yog theem kawgtxheej txheem pathological. Nws yog tus cwj pwm los ntawm necrosis ntawm ntu ntawm lub zais zis phab ntsa. Feem ntau qhov no ua rau lub cev tawg thiab tuag ntawm tus neeg mob.

Kev txiav txim siab ntawm tus kab mob tso cai rau koj xaiv cov kev kho mob zoo tshaj plaws.

Cov tsos mob ntawm phlegmonous cholecystitis
Cov tsos mob ntawm phlegmonous cholecystitis

Txoj Kev Tiv Thaiv Kab Mob

Raws li kev cuam tshuam ntawm qee yam, congestion thawj zaug hauv lub gallbladder. Raws li qhov tshwm sim ntawm kev ua txhaum ntawm cov dej ntws tawm, nws cov ntsiab lus hloov pauv. Cov kab mob kis tau zoo sib xws hauv nws. Maj mam, lub siab sab hauv ntawm phab ntsa ntawm lub cev nce, uas ua rau o thiab tsim cov kua paug. Nyob rau theem no, cholecystitis ua phlegmonous. Cov theem nws tus kheej yog hu ua kev puas tsuaj, vim nws ua rau irreversible hloov nyob rau hauv cov qauv ntawm lub gallbladder.

Cov kab mob ua paug thiab cov kua paug impregnate cov phab ntsa ntawm lub cev, uas ua rau lawv thickening. Tej zaum yuav muaj me me hemorrhages. Cov txheej txheem inflammatory provokes pathological hloov nyob rau hauv lub mucosa. Cov caws pliav pib tsim rau ntawm nws.

Cov phab ntsa ntawm lub gallbladder nthuav dav sai nyob rau hauv siab. Cov kua tsib nrog impurities ntawm mucus, pus thiab calculi tawg, ua kom nws. Yog li ntawd, tus neeg mob tau txais kev mob hnyav, uas yuam nws mus nrhiav kev kho mob.

Qhov laj thawj tseem ceeb

Cov yam hauv qab no ua rau muaj kev loj hlob ntawm phlegmonous cholecystitis:

  • hloov pauv hauv cov kua tsib;
  • kev nce qib hauv cov txheej txheem hauv lub cev;
  • relapse of inflammatory.

Qhov tshwm sim ntawm tus kab mob tshwm sim raws livim tsis muaj kev kho mob ntawm thawj o ntawm lub gallbladder los yog tsis raug xaiv tactics ntawm kev kho mob. Txoj kev loj hlob ntawm phlegmonous daim ntawv yog ib txwm ua ntej los ntawm lub sij hawm ntev calculous cholecystitis. Nws, nyob rau hauv lem, yuav tshwm sim nyob rau hauv tus ntawm cov nram qab no yam:

  • malnutrition;
  • kev ua neej tsis muaj zog;
  • txo qis kev tiv thaiv;
  • tshuaj mus sij hawm ntev;
  • hormonal hloov thaum cev xeeb tub;
  • pathology ntawm txoj hnyuv;
  • kev hloov pauv.

Raws li International Classification of Diseases of the 10th revision, phlegmonous cholecystitis yog hais txog cov kab mob ntawm lub gallbladder, biliary tract thiab pancreas. Nws daim ntawv mob hnyav muaj tus lej K81.0, thiab daim ntawv mob ntev muaj tus lej K81.1.

ua rau cholecystitis
ua rau cholecystitis

daim duab kho mob

Thaum lub calculous daim ntawv ntawm tus kab mob ua phlegmonous, tus neeg mob pom meej meej pom qhov chaw kho mob tshwm sim ntawm pathology. Cov chav kawm ntawm cov txheej txheem purulent yog ib txwm nrog los ntawm kev nce hauv qhov kub thiab txias. Tus neeg mob maj mam tsim cov tsos mob ntawm intoxication. Yog tias qhov mob mus dhau ntawm lub cev cuam tshuam, nws pib cuam tshuam rau kev ua haujlwm ntawm tag nrho cov kab mob.

Nyob rau theem phlegmonous ntawm tus kab mob, qhov mob hnyav zuj zus. Kev tsis xis nyob yuav nce ntxiv thaum tus neeg mob ua txhaum txoj kev noj haus, haus dej haus cawv los yog raug rau lub cev hnyav. Tsis tas li ntawd, kev puas siab puas ntsws overstrain lossis lub xeev kev ntxhov siab tuaj yeem ua qhov ua rau muaj qhov mob ntxiv.

mob phlegmonousCalculous cholecystitis tshwm sim nrog cov tsos mob hauv qab no:

  • arterial hypotension;
  • kev qaug zog;
  • ntuav, iab iab;
  • |

  • kev ua kom txias txias.

Kev hnov mob feem ntau tshwm sim nyob rau sab xis thiab tsuas yog ua kom hnyav nrog kev hloov hauv lub cev, ua pa tob. Qee lub sij hawm muaj plab zom mov vim kev ua haujlwm tsis zoo ntawm cov leeg nqaij ntawm txoj hnyuv.

Mob thiab mob phlegmonous cholecystitis

Cov keeb kwm kho mob ntawm cov neeg mob feem ntau cuam tshuam nrog nws txoj kev mob hnyav. Thawj cov tsos mob nyob rau hauv cov ntaub ntawv no yog mob nyob rau hauv txoj cai hypochondrium, uas muaj peev xwm tawg mus rau sab nraub qaum los yog caj dab, ntuav heev. Tsis tas li ntawd, muaj tachycardia.

Hauv chav kawm mob ntev, daim duab kho mob tau hloov kho me ntsis. Qhov mob syndrome yog periodic. Txawm li cas los xij, tus neeg mob txhawj xeeb txog qhov tsis tu ncua belching thiab hnov qhov iab hauv qhov ncauj, tsis muaj zog thiab kiv taub hau.

Cov tsos mob ntawm phlegmonous cholecystitis
Cov tsos mob ntawm phlegmonous cholecystitis

Obstructive phlegmonous cholecystitis

mob cholecystitis mob yog ib yam mob uas feem ntau tshwm sim tawm tsam keeb kwm yav dhau ntawm daim ntawv suav ntawm tus kab mob. Nws yog tus yam ntxwv los ntawm blockage ntawm lub gallbladder ducts los ntawm pob zeb, uas ua rau lawv obstruction. Tus kab mob yog nrog los ntawm mob hnyav syndrome. Tsis tas li ntawd, muaj qhov nce hauv lub gallbladder loj, kom tus neeg mob tuaj yeem hnov nws ntawm nws tus kheej. Daim duab kho mob yog qhia los ntawm xeev siab thiab ntuav, tsis muaj zog. Zoo li lub xeevkav los ntawm ob peb teev mus rau tag nrho cov hnub. Thaum lub pob zeb rov qab mus rau hauv lub cev, tag nrho cov tsos mob ploj mus.

Qhov tsis muaj kev kho mob ntawm tus mob phlegmonous calculous cholecystitis yog qhov txaus ntshai rau kev loj hlob ntawm sepsis thiab cirrhosis ntawm daim siab. Qee tus neeg mob tsim lub siab tsis ua haujlwm, bilirubin encephalopathy.

Txoj kev kuaj mob

Kev kuaj mob pib nrog tus neeg mob keeb kwm kho mob. Phlegmonous cholecystitis ib txwm tsim los ntawm catarrhal daim ntawv ntawm pathology. Nyob rau tib lub sijhawm, cholecystitis nws tus kheej hauv 95% ntawm cov neeg mob yog ib qho teeb meem ntawm cov pob zeb hauv lub zais zis ducts.

Tom qab ntawd kev tshuaj xyuas lub cev tau ua tiav, kawm txog tus neeg mob qhov kev tsis txaus siab. Tus kws kho mob yuav hnov mob ntawm palpation. Thaum nias rau ntawm thaj tsam ntawm txoj cai hypochondrium, tus neeg mob ntsib qhov mob hnyav. Tus kws kho mob kuj yuav hnov mob gallbladder.

Kev kuaj ntshav thiab zis yog ib theem kev kuaj mob. Nyob rau hauv cov ntaub ntawv ntawm ib tug inflammatory txheej txheem, muaj ib tug acceleration ntawm ESR, nce nyob rau hauv cov leukocytes. Rau kev ntsuam xyuas pom ntawm lub cev cuam tshuam, ultrasound, kuaj radiographic, CT thiab MRI tau ua. Hauv qhov xwm txheej hnyav, yuav tsum tau kuaj ntshav biopsy.

ultrasound diagnostics
ultrasound diagnostics

Kev Tiv Thaiv Kev Tiv Thaiv

Kev kho tus mob phlegmonous cholecystitis yog nqa tawm tshwj xeeb hauv tsev kho mob. Nrog rau daim ntawv tsis muaj pob zeb, kev siv tshuaj kho tau txais. Nyob rau hauv cov ntaub ntawv ntawm ib qho kev mob hnyav ntawm cov kab mob phlegmonous, kev ua haujlwm tau qhia.

Kev kho mob nrog rau cov hauv qab noTxheej xwm:

  1. Noj tshuaj antispasmodic thiab mob, nrog rau cov tshuaj narcotic. Cov tshuaj pab txo qhov mob.
  2. Tshuaj tua kab mob txhawm rau txo cov txheej txheem kis. Cov tshuaj tua kab mob qhia tau hais tias muaj txiaj ntsig zoo hauv daim ntawv suav ntawm tus kab mob. Nyob rau hauv cov ntaub ntawv ntawm phlegmonous, vim muaj kev puas tsuaj, cov ntshav khiav yog cuam tshuam. Qhov no ua rau nyuaj rau kev thauj mus los ntawm cov khoom xyaw nquag ntawm cov tshuaj mus rau qhov txhab.
  3. Kev noj haus. Thawj ob hnub, tus neeg mob tau yoo mov. Ces cov zaub mov nthuav me ntsis. Cov khoom uas ua rau lub plab zom mov yog nruj me ntsis txwv. Cov zaub mov yog sparing li sai tau, thiab cov tais diav yog steamed thiab hauv av. Cov pluas noj feem ntau yog feem ntau.

Ntxiv rau, nws tseem ceeb rau tus neeg mob kom so lub cev thiab lub siab. Yog tias koj xav tias tsis zoo, qhov teeb meem ntawm kev ua haujlwm tau txiav txim siab.

kev kho mob rau cholecystitis
kev kho mob rau cholecystitis

Surgery

Kev kho mob rau cholecystitis yog ua los ntawm peb txoj kev sib txawv. Kev xaiv ntawm ib qho kev xaiv tshwj xeeb yog nyob ntawm tus neeg mob tus mob thiab cov txiaj ntsig ntawm nws qhov kev ntsuam xyuas:

  1. Laparoscopic phais yog suav tias yog qhov nyiam tshaj plaws. Thaum lub sij hawm tus txheej txheem, tus kws kho mob ua ob peb punctures ntawm lub plab phab ntsa, los ntawm uas nws ntxig cov cuab yeej rau kev kho mob manipulations.
  2. Kev phais plab plab tsis tshua siv niaj hnub no, piv txwv li thaum muaj kab mob gallbladder lossis adhesions. Kev rov qab los feem ntau yog ntev thiab nyuaj heev.
  3. Nyob zoocholecystostomy yog siv los kho cov neeg mob hnyav. Kev ua haujlwm yuav tsum ua qhov me me hauv lub plab, los ntawm qhov uas lub raj xa dej tom qab tso rau hauv lub gallbladder.

Yog tias qhov kev ua haujlwm tsis tuaj yeem ua tau raws li qhov qhia tau, tus neeg mob tau pom zoo rau txheej txheem crushing pob zeb siv extracorporeal shock yoj lithotripsy. Nws yog ib txwm nrog kev siv cov tshuaj tshwj xeeb. Txawm li cas los xij, nrog rau qhov kev xaiv kho mob no, kev rov qab tuaj yeem ua tau.

Tom qab ua haujlwm, nws yog ib qho tseem ceeb rau txhua tus neeg mob, yam tsis muaj kev zam, ua raws li kev noj zaub mov nruj thiab tswj kev noj qab haus huv. Thawj ob peb hnub, noj mov thiab cov kua dej yog nruj me ntsis txwv. Hnub peb, cov txiv hmab txiv ntoo thiab zaub mashed, dej cereals, compotes tau tso cai.

laparoscopy
laparoscopy

Muaj Teeb Meem

Yog tias tsis kho lossis xaiv cov tswv yim tsis raug, phlegmonous cholecystitis tuaj yeem ua rau muaj teeb meem. Ntawm lawv, feem ntau yog cov hauv qab no:

  1. Kev hloov pauv ntawm tus kab mob mus rau hauv daim ntawv gangrenous, uas tuaj yeem ua rau muaj kev puas tsuaj ntawm lub gallbladder, tawm ntawm nws cov ntsiab lus mus rau hauv cov kab noj hniav peritoneal. Yog li ntawd, peritonitis tshwm sim.
  2. Kev tsim ntawm fistulas thiab abscesses.
  3. Kev koom tes ntawm cov khoom nyob sib ze hauv cov txheej txheem pathological. Peb tab tom tham txog kev puas tsuaj rau cov hnyuv, daim siab thiab pancreas.

Tsis tas li, tus kab mob tuaj yeem cuam tshuam los ntawm sclerosis ntawm lub gallbladder. Tib lub sijhawm, cov hlwb noj qab haus huv tau hloov los ntawm cov ntaub so ntswg ntom ntom.

teeb meemphlegmonous cholecystitis
teeb meemphlegmonous cholecystitis

Txoj Kev Tiv Thaiv

Txhawm rau tiv thaiv kev txhim kho ntawm daim ntawv nyuaj ntawm kev suav cholecystitis - phlegmonous, koj yuav tsum ua raws li tus kws kho mob cov lus pom zoo. Kev tiv thaiv kev tiv thaiv feem ntau yog txhawm rau txo qhov kev pheej hmoo ntawm kev rov qab los ntawm tus kab mob. Txhawm rau ua qhov no, koj yuav tsum:

  • lo rau kev noj zaub mov tsawg;
  • zam kev puas siab puas ntsws ntau dhau;
  • noj tshuaj kho mob.

Nrhiav kev pab kho mob nyob rau theem ntawm kev loj hlob ntawm calculous cholecystitis yuav luag txhua zaus zam nws daim ntawv phlegmonous.

Pom zoo: