Postcholecystectomy syndrome: kev kho mob, tsos mob thiab kev kuaj mob

2024 Tus sau: Curtis Blomfield | [email protected]. Kawg hloov kho: 2023-12-16 21:10

Postcholecystectomy syndrome (PCES) - yog dab tsi? Qee tus ntseeg tias qhov no yog qee yam kab mob tshwj xeeb. Tsis yog, tsis yog. Qhov no yog tag nrho cov kev kho mob tshwm sim uas tuaj yeem pom tom qab tshem tawm (resection) ntawm lub gallbladder (GB), los yog los ntawm lwm yam kev phais uas tau ua rau ntawm cov kua tsib. Ntxiv mus, tus mob tuaj yeem tsim tau sai tom qab kev phais, lossis nws tuaj yeem tshwm sim tom qab ob peb lub hlis lossis xyoo.

Note! PCES muaj ntau dua rau cov poj niam dua li cov txiv neej.

Qee zaum, cov neeg mob tseem muaj qhov tshwm sim ntawm pathology uas tau pom ua ntej kev ua haujlwm, tab sis cov tshiab tuaj yeem tshwm sim. Ntxiv mus, cov tsos mob ntawm postcholecystectomy syndrome thiab kev kho mob ntawm tus kab mob ncaj qha nyob ntawm seb lub hauv paus ntawm pathology thiab cov kev hloov uas tau tshwm sim nyob rau hauv lub biliary system.

Note! Tsis tas li resection ntawm lub gallbladder yog qhov ua rau muaj kev txom nyem rau cov neeg mob. Qee zaum cov tsos mob no tuaj yeem cuam tshuam nrog pathologies ntawm lub plab,daim siab, duodenum los yog pancreas.

Kev faib tawm ntawm postcholecystectomy syndrome

PCES muab faib ua peb pawg:

• Tsis muaj kev cuam tshuam txog GB resection. Nws tsuas yog tias cov tsos mob no tuaj yeem tshwm sim los ntawm pathologies ntawm ib qho xwm txheej.
• Ncaj qha ntsig txog kev phais xws li tshem tawm lub gallbladder. Cov no tej zaum yuav yog suture granulomas, postoperative pancreatitis los yog bile duct raug mob.

Lub cev muaj zog (piv txwv li spasm ntawm lub sphincter ntawm Oddi lossis dyskinesia)

Yuav ua li cas ntawm PCES

Caus ntawm postcholecystectomy syndrome:

• Kev tsis haum xeeb hauv biliary system (hauv kev faib cov kua tsib).
• Qhov tshwm sim ntawm qee qhov neoplasm ntawm cov leeg nqaij hauv thaj tsam ntawm kev sib tshuam ntawm cov kua tsib thiab duodenum 12 (spasm ntawm sphincter ntawm Oddi).
• YDysbacteriosis.
• Kev ua txhaum ntawm lub suab thiab lub zog ntawm lub plab zom mov (BIT), lawv cov dyskinesia.
• Cov kua dej hauv cov kab noj hniav tsim tom qab phais.
• Kev muaj pob zeb hauv cov ducts.
• Kab mob ntawm duodenum 12.
• Cyst ntawm cov kab mob sib kis, uas yog nws qhov txuas ntxiv. Qhov kev tsis txaus ntseeg no sib koom ua ke nrog cov kab mob pancreatic.
• kab mob siab (xws li kab mob siab lossis cirrhosis).
• Teeb meem ntsig txog lub plab zom mov.
• Kev npaj ua ntej tus neeg mob tsis raug.
• Yuav ua yuam kev los ntawm cov kws phais thaum lub sij hawmphais (piv txwv li, raug mob rau cov hlab ntsha ntawm lub gallbladder lossis nws cov ducts).
• Musdiagnosis.
• Ua tsis tiav hauv kev ua haujlwm ntawm lub zais zis (piv txwv li, kev ua txhaum ntawm cov txheej txheem ntawm cov kua tsib tawm mus rau hauv txoj hnyuv lossis txo qis ntawm nws cov nyiaj).
• "Kev Ua Haujlwm" ntawm lub plab zom mov los ntawm cov kab mob microflora.
• Kev ua txhaum ntawm cov kua tsib, thaum nws tsis tuaj yeem nkag los ntawm qee cov ducts mus rau hauv duodenum, qhov no yuav yog vim lawv qhov txhaws lossis ib feem nqaim.
• Cov kab mob uas tshwm sim ua ntej kev phais ntawm lub plab biliary, lossis tsim tom qab (piv txwv li, pancreatic pancreatitis, duodenal ulcer, duodenogastric reflux, tus cwj pwm los ntawm reflux ntawm cov hnyuv rov qab rau hauv lub plab, khaus plob tsis so tswj).

Symptomatics

Yog tias muaj cov tsos mob hauv qab no tshwm sim, nrhiav kev pab tam sim ntawm lub tsev kho mob uas koj yuav raug kuaj xyuas tag nrho thiab sau cov kev kho mob tsim nyog:

• Kev rov tshwm sim ntawm qhov mob (hauv thaj tsam hypochondrium lossis epigastric, tawm mus rau sab xis ntawm lub xub pwg hniav lossis sab nraub qaum) uas kav li 20 feeb lossis ntau dua. Ntxiv mus, qhov mob hnyav zuj zus thaum hmo ntuj lossis tom qab noj mov tom ntej.
• Kev cuam tshuam hauv plab hnyuv.
• Mob plab, tshwm sim hauv cov kua thiab cov quav dej, uas tuaj yeem rov ua dua li 10 zaug hauv ib hnub.

• Kev muaj cov rog nyob hauv cov quav.
• Tsis muaj zog,qaug zog thiab qaug zog txuam nrog malfunctions ntawm lub hauv paus paj hlwb.
• Kev noj zaub mov tsis txaus ntawm cov vitamins hauv lub cev (piv rau lawv noj), txhim kho hypovitaminosis.
• Burping nrog iab saj.
• Cov khoom zom zom hauv cov hnyuv ntau dhau (flatulence).
• "Rumbling thiab seething" hauv plab.
• Micronutrient deficiency.
• poob ceeb thawj (theem 1 - poob txog 5-8 kg; theem 2 txog 8-10 kg; theem 3 - ntau tshaj 10 kg).
• Intolerance to fatty foods.
• Muaj cov kab nrib pleb hauv cov ces kaum ntawm daim di ncauj. Nws tshwm sim vim kev ua txhaum ntawm kev nqus cov as-ham hauv cov hnyuv me (malabsorption).
• Jaundice.
• Ntsuab, qee zaum ua ntuav.

• Hyperhidrosis (tawm hws ntau dhau).
• Hyperthermia txog 38-39 degrees.

Kev cais ntawm qhov mob siab

Luv luv txog postcholecystectomy syndrome, thiab kom meej meej, txog hom mob uas tuaj yeem ua tau:

• Pancreatic hauv xwm. Mob yog provoked los ntawm ib tug malfunction ntawm lub Westphal sphincter, uas muab kev sib cais ntawm duodenum thiab ducts haum rau lwm yam digestive kabmob. Muaj mob hauv hypochondrium ntawm sab laug, dhau mus rau sab nraub qaum thiab txo qis thaum lub cev tig mus rau pem hauv ntej.
• biliary xwm. Kev mob tshwm sim los ntawm kev cuam tshuam hauv kev ua haujlwm ntawm papilla ntawm Vater, los ntawm cov kua txiv pancreatic thiab cov kua tsib nkag mus rau duodenum. Mob yog localized nyob rau hauvhypochondrium ntawm sab xis thiab hauv plab plab, nws tuaj yeem muab rau hauv scapula ntawm sab xis thiab sab nraub qaum.
• Ciliary-pancreatic cim. Raws li qhov tshwm sim ntawm kev ua haujlwm tsis zoo ntawm lub sphincter ntawm Oddi (nyob rau hauv ib txwm lub xeev, nws txhawb nqa cov kua tsib thiab cov kua txiv pancreatic mus rau hauv duodenum 12, thiab tseem tiv thaiv kev thim rov qab ntawm cov txheej txheem ntawm cov hnyuv los ntawm cov hlab ntsha), qhov mob ntawm lub cev. tshwm.

Diagnosis

Kev kho mob ntawm postcholecystectomy syndrome feem ntau nyob ntawm qhov kev kuaj mob kom raug. Thaum tus neeg mob hu rau lub tsev kho mob, tus kws kho mob ua tib zoo mloog tag nrho cov lus tsis txaus siab, sau cov anamnesis (uas yog, cov ntaub ntawv hais txog cov kab mob yav dhau los, cov kab mob tshwm sim, nrog rau kev noj zaub mov thiab kev kho mob) thiab kev kuaj pom ntawm tus neeg mob. Tsis tas li ntawd, txhawm rau txiav txim siab qhov ua rau muaj tus kab mob, tus kws kho mob tshwj xeeb tau sau cov lus hauv qab no rau tus neeg mob:

• kuaj ntshav kuaj ntshav. Lawv ua qhov no txhawm rau tshem tawm qhov tshwm sim ntawm cov txheej txheem inflammatory.
• Plasma biochemical tsom xam los pab txiav txim siab npaum li cas ntawm lipase, bilirubin, enzymes (amylase) thiab alkaline phosphatase.
• Ultrasound ntawm plab.
• X-ray lub plab nrog barium.
• SCT (kauv suav tomography), uas muab cov duab tseeb ntawm lub xeev ntawm cov hlab ntsha thiab cov kabmob hauv plab kab noj hniav.
• Gastroscopy kom tshem tawm cov kab mob ntawm lub plab zom mov.
• ERCPG (endoscopic retrograde cholangiopancreatography). Ib txoj kev tshawb fawb uas tso cai rau koj los soj ntsuam cov ducts ntawm lub txiav thiab cov kab mob biliary sivx-ray unit.
• ECG los txiav txim qhov txawv txav hauv kev ua haujlwm ntawm cov leeg plawv.
• Scintigraphy. Tus txheej txheem tso cai rau koj los txiav txim seb qhov muaj (lossis tsis tuaj) ntawm cov kab mob hauv cov kua tsib. Radioactive isotopes uas emit ib co hluav taws xob yog txhaj rau hauv tus neeg mob lub cev. Raws li qhov tshwm sim, nws tuaj yeem tau txais daim duab ob sab.

Note! Yog tias tsis muaj cov ntaub ntawv txaus los kuaj xyuas, tus neeg mob tuaj yeem raug phais mob. Lawv tsis tshua ua li no.

Kev kho mob

Kev kho mob PCES (postcholecystectomy syndrome) nrog tshuaj kho mob:

• Anspasmodics los txo qhov mob (piv txwv li, "No-shpa" lossis "Spasmalgon").
• tshuaj choleretic uas txhawb kev tsim cov kua tsib thiab nws cov dej tawm ("Holenzim", "Allohol" lossis "Nicodin").
• Cholinolytics thaiv cholinergic receptors.
• Kev npaj muaj cov enzymes uas txhim kho txoj kev zom zaub mov (piv txwv li, Ermital, Gastenorm forte lossis Normoenzyme).
• Cov tshuaj tua kab mob xws li Doxycycline, Furazolidone lossis Metronidazole.
• Probiotics uas pab kho cov microflora ntuj (piv txwv li, Bifiform, Linex lossis Acipol).
• Prokinetics, zoo txhawb lub cev muaj zog ntawm lub plab zom mov thiab tiv thaiv kev tsim cov nthwv dej uas cuam tshuam nrog peristalsis ib txwm muaj ("Motilium", "Trimedat" lossis "Neobutin").
• Hepatoprotectors uas muaj txiaj ntsig zoo rau kev ua haujlwmlub siab.
• Sorbents. Lawv tsis cia cov co toxins nkag mus rau hauv cov ntshav. Sorbents xws li activated carbon, Sorbex (hauv capsules) los yog Carbolong pab tshem tawm cov tshuaj lom neeg lub cev.
• Cov tshuaj tua kab mob hauv plab uas tshem tawm cov tsos mob xws li fermentation (piv txwv li, Intetrix, Stopdiar lossis Enterofuril).
• Tsis txhob hnov qab txog multivitamin lossis vitamin complexes.
• Nitroglycerin. Relaxes cov leeg du ntawm cov ducts (piv txwv li, normalizes kev ua haujlwm ntawm sphincter ntawm Oddi) thiab tag nrho cov plab hnyuv siab raum.
• Tshuaj muaj nyob rau hauv pab pawg ntawm antacids. Neutralize cov hydrochloric acid tam sim no nyob rau hauv lub plab kua txiv thiab yog li pab mus rau normalization ntawm acidity nyob rau hauv lub plab.

Ntxiv nrog rau kev kho tshuaj, tus kws kho mob muab cov lus pom zoo txog kev ua lub cev muaj zog (xws li kev kho kev tawm dag zog), kev noj haus thiab kev noj haus, thiab muaj peev xwm siv qee yam zaub mov txawv. Kev kho mob niaj hnub ntawm PCES tuaj yeem cuam tshuam nrog kev phais. Qhov no ua tau, tau kawg, yog tias muaj pov thawj hnyav.

Note! Hauv Moscow, kev kho mob ntawm postcholecystectomy syndrome tuaj yeem ua tiav hauv cov chaw kho mob xws li "Capital" (ntawm Leninsky Prospekt), "Atlas" (ntawm Kutuzovsky Prospekt) lossis "European" (ntawm Shchepkina Street).

tshuaj ntsuab

Phytotherapy tuaj yeem txo qhov mob ntawm tus neeg mob los ntawm PCES tom qab tshem tawm cov khoom tseem ceeb xws li lub gallbladder. Nco ntsoov: tag nrho cov dej num cuam tshuam nrog kev siv cov zaub mov txawv tshuaj yuav tsum muajnyob rau hauv parallel nrog lub ntsiab tshuaj kho. Nov yog qee txoj hauv kev yooj yim los kho tus mob postcholecystectomy nrog tshuaj ntsuab:

• Nkauj 1. Nws yog siv los kho cov kev ua haujlwm ntawm biliary ib ntsuj av. Sib tov cudweed nyom, hop cones, marigold paj thiab valerian paus nyob rau hauv ib tug ratio ntawm 2: 1: 2: 1. Yuav ua li cas brew tau piav qhia hauv qab no, rau peb tus nqi ib zaug. Siv 2-3 zaug hauv ib hnub rau 1/3 khob. Kev kho mob yog li 1 lub hlis.
• Nkauj 2. Pom zoo kom tshem tawm cov txheej txheem inflammatory nyob rau hauv cov kua tsib ducts thiab stagnation ntawm cov kua tsib. Calamus cag, pob kws stigmas, celandine nyom, noog knotweed thiab centaury yog tov nyob rau hauv ib tug ratio ntawm 3: 2: 1: 2: 2. Noj tincture 2 zaug hauv ib xyoos (lub sijhawm ntawm ib chav kawm yog 30 hnub).
• Nkauj 3. Tsim nyog yog tias koj txhawj xeeb txog kev ua haujlwm tsis zoo ntawm cov kab mob biliary thiab sphincter ntawm Oddi. Elecampane hauv paus, paj chamomile thiab St. John's wort yog sib xyaw hauv qhov sib piv ntawm 1, 5: 1: 1.

Qhov tseem ceeb! Tag nrho cov nqi saum toj no yog brewed raws li nram no: cov tshuaj ntsuab sib tov (1 tablespoon) yog nchuav nrog boiling dej (200 ml), insisted rau 15-20 feeb, lim thiab qaug cawv ua ntej noj mov (20 feeb) los yog tom qab (tom qab 60 feeb). Kev kho mob rau txhua qhov kev sau tsis pub dhau 1 lub hlis.

• Ua ke nrog tshuaj kho mob ntawm postcholecystectomy syndrome, koj tuaj yeem haus cov tshuaj ntsuab infusions uas pab txo qhov mob thiab spasms, thiab tseem muaj cov teebmeem sedative thiab immunomodulatory. Piv txwv li, ib decoction ua los ntawm calendula paj, birch nplooj, knotweed thiab sawv hips yog ib qho zoo heev tshuaj.
• Lwm daim ntawv qhia los cuam tshuam nrog PCES. Rose hips, cov hauv paus hniav ntawm cov noog mountaineer thiab cyanosis, nettle thiab golden volodushka yog tov nyob rau hauv ib tug ratio ntawm 2: 1: 1: 2: 1. Ncuav cov zaub ntsuab (2 tablespoons) nrog dej kub (500 ml), insist nyob rau hauv lub hau rau 4-5 teev, lim thiab haus 150 ml 3 zaug ib hnub twg.
• Thaum thawj cov tsos mob, tam sim ntawd pib kho tus mob postcholecystectomy syndrome, piv txwv li, nrog ib lub decoction ntawm tshuaj ntsuab xws li cinquefoil, txiv qaub balm, celandine thiab peppermint. Sib tov lawv nyob rau hauv sib npaug zos proportions, ces ncuav lub npaj ntsuab sib tov (1 tablespoon) nrog boiling dej (200 ml), insist nyob rau hauv lub hau rau 2-3 teev, lim thiab haus ½ khob ob zaug ib hnub twg.
• Txhawm rau kom ua haujlwm ntawm lub plab zom mov kom zoo, nws raug pom zoo: thaum mob raws plab - sib tov quince syrup (50 ml) nrog cov kua txiv hmab txiv ntoo (50 ml) thiab haus qhov no hauv peb koob tshuaj thaum nruab hnub; yog hais tias cem quav, haus peb zaug ib hnub twg, ib teaspoon ntawm zaub roj (nyiam dua noob hnav).
• Crushed tshiab ivy (50 g) yog nchuav nrog qhuav liab cawu cub (0.5 l), sib tov yog infused rau ib lub lim tiam, nws yuav tsum tau noj tom qab txhua pluas noj (1-2 sips).

Kev kho mob ntawm postcholecystectomy syndrome nrog Ursosan

Lub cuab yeej ua haujlwm zoo nrog PCES. Lub ntsiab active ingredient ntawm cov tshuaj yog ursodeoxycholic acid. Hauv lub khw muag tshuaj, cov tshuaj tau nthuav tawm nyob rau hauv daim ntawv ntawm cov tshuaj ntsiav nyuaj, sab hauv uas muaj cov hmoov dawb.

Rau lub hom phiaj tiv thaiv tus mob cholelithiasis rov qab los tom qab PCES, cov neeg mob tau muab tshuaj ib ntsiav tshuaj (250 mg) 2 zaug hauv ib hnub.hnub (kev kho nyob rau hauv txoj kev no yog tsim nyog rau 1-2 lub hlis). Nws yog ib qho tsim nyog yuav tau noj cov tshuaj tom qab noj mov, lossis hauv nws cov txheej txheem. Tsis tas li ntawd, cov tshuaj ntsiav tsis tas yuav zom. Nws raug nquahu kom haus dej kom ntau.

Muaj qee qhov kev txwv tsis pub siv hauv kev kho mob postcholecystectomy syndrome nrog cov tshuaj xws li Ursosan:

• nce tus neeg rhiab heev rau lub ntsiab thiab cov khoom ntxiv;
• cov txheej txheem mob hnyav hauv cov hnyuv thiab cov ducts;
• cirrhosis ntawm daim siab;
• pob zeb pob zeb;
• qee yam ua haujlwm tsis zoo hauv kev ua haujlwm ntawm pancreas, siab thiab ob lub raum;
• kab mob siab ntev;
• tsis muaj JP;
• xeeb tub;
• pancreatitis;
• pub mis niam.

Qhov tseem ceeb! "Ursosan" tuaj yeem noj tsuas yog raws li kws kho mob qhia. Kev noj tshuaj rau tus kheej yog qhov txaus ntshai rau koj txoj kev noj qab haus huv.

Khoom noj khoom haus rau PCES

Cov lus pom zoo hais txog kev tswj hwm thiab kev noj haus rau postcholecystectomy syndrome (cov tsos mob thiab kev kho mob ntawm exacerbations tau piav qhia saum toj no):

• Haus li 2 litres dej ib hnub.
• Cov ntsiab lus calorie ntawm cov khoom noj yuav tsum tsis pub tshaj 300 kcal.
• Cov zaub mov ntsim, ntsim, kua qaub thiab choleretic, nrog rau cov khoom noj rog thiab kib yuav tsum zam.
• Cov roj ib hnub yuav tsum yog li 50-60 g; proteins - 100 g, thiab carbohydrates - 400 g.
• Nco ntsoov suav nrog cov vitamins B thiab A hauv koj cov zaub mov.
• Nyob nruab hnub koj xav tau 5-7sij hawm (hauv me me).

Khoom noj uas koj noj tau:

• rye bread and wheat bread;
• zaub mov: beetroot, borscht;
• bad pastries, ncuav qab zib, qhuav biscuit;
• nqaij nyug, menyuam yaj, qaib, qaib ntxhw thiab cov ntses ntshiv;
• acidophilus, kefir, quenelles, tsev cheese, mis nyuj thiab cheese;

Nyob zoo ib tsoom niam txiv kwv tij neej tsas sawv daws.

• zaub (ci los yog stewed);
• kua txiv, rosehip broth, tshuaj yej, jelly, kas fes nrog mis nyuj, unsweetened compotes;
• vitamin thiab zaub zaub xam lav, vinaigrette;
• vanillin, cinnamon;
• txiv hmab txiv ntoo thiab txiv hmab txiv ntoo (tsis yog acidic nkaus xwb), txiv hmab txiv ntoo qhuav;
• marmalade, jelly, candies tsis muaj chocolate, marshmallow, zib ntab, jam (yog siv sorbitol lossis xylitol siv cov suab thaj).

Khoom Noj Kom Zam:

• okroshka, zaub ntsuab zaub qhwv, kua zaub;
• fresh pastries, puff pastry;
• nqaij npuas, Goose, os, offal;
• -Hnyuv ntxwm, hnyuv ntxwm, cov zaub mov kaus poom, cov hnyuv;
• fatty fish, smoked meat;
• mis nyuj, cheese thiab tsev cheese loj;
• -nceb, radish, legumes, spinach, qej;
• kas fes dub, dej txias, cocoa;
• sorrel;
• chocolate;
• horseradish, mustard;
• zaub ntsuab;
• ice cream, ncuav thiab pastries.

Braug kaw

Tam sim no koj paub ntau yam txog postcholecystectomy syndrome (ua rau, kuaj mob thiab kho). Peb cia siab tias cov ntaub ntawv no yuav pab koj tiv thaiv tus kab mob no thiab muaj kev lom zem ntxiv mus. Kev noj qab haus huv rau koj thiab koj cov neeg koj hlub!