Ib qho xwm txheej ceev uas yuav tsum tau muaj kev phais mob yog qhov tawg (perforation) ntawm phab ntsa ntawm lub gallbladder. Raws li txoj cai, qhov no pathology tsim los ntawm cov kab mob ntev ntawm lub siab thiab kab mob biliary, qee zaum, qhov ua rau tuaj yeem raug mob rau lub plab. Nws yog tsim nyog hais tias cov tsos mob ntawm gallbladder rupture nyob rau hauv dev thiab miv zoo ib yam li cov tib neeg.
Yog vim li cas
Rupture (perforation) ntawm phab ntsa ntawm lub gallbladder yog ua ntej los ntawm qee yam ua rau. Yam yuavtsum tau kawm uantej rau txoj kev loj hlob ntawm tus kab mob no tej zaum yuav yog tej yam mob.
- Cov txheej txheem focal uas tshwm sim ncaj qha rau hauv lub gallbladder nws tus kheej, ua rau kev puas tsuaj ntawm cov phab ntsa ntawm lub cev, uas ua rau muaj kev tawg ntawm lawv. Raws li txoj cai, ruptures ntawm lub gallbladder yog tshwm sim los ntawm cholecystitis (ib tug kab mob ntev ntawm cov kua tsib ducts).txoj kev). Nrog rau tus kab mob no, qhov tso tawm ntawm cov kua tsib yog qhov nyuaj, uas ua rau perforation ntawm cov ntaub so ntswg ntawm lub zais zis.
- Kev tsim nyob rau hauv lub gallbladder ntawm ntau yam kab mob gallstones uas raug mob (nias) los yog ua rau necrosis ntawm phab ntsa ntawm lub cev nws tus kheej.
- Ntau yam kev raug mob, tshuab, txiav hauv txoj cai hypochondrium tuaj yeem ua rau cov neeg kho tshuab perforation thiab rupture ntawm phab ntsa ntawm lub gallbladder.
Symptoms of disease
Rau qhov kev pom zoo thiab kev kho mob zoo, kev kuaj mob raws sij hawm yog qhov tsim nyog, uas yog raws li kev npaj tam sim ntawm anamnesis. Nyob rau tib lub sijhawm, kev tshuaj xyuas thiab kev sib piv ntawm cov tsos mob ntawm cov gallbladder perforation ua lub luag haujlwm tseem ceeb. Rau txhua daim ntawv, cov tsos mob ntawm gallbladder rupture yog cais. Nws tsim nyog saib rau hauv lawv kom ntxaws ntxiv.
ntse zoo
Daim ntawv mob hnyav ntawm txoj kev loj hlob ntawm pathology yog cov cim zoo ib yam li mob cholecystitis, uas feem ntau ua rau perforation, suav nrog:
- cov cim qhia ntawm o: lub cev kub nce siab, tus neeg mob tsis kam noj, yws yws xeev siab thiab ntuav ntuav;
- daim tawv nqaij thiab qee qhov mucous ua daj;
- kaw qhov mob mob hauv txoj cai hypochondrium, palpation ua rau mob hnyav, qhov mob thiab cov tshuaj tiv thaiv ntawm daim tawv nqaij thiab cov leeg ntawm qhov chaw mob zoo ib yam li peritonitis.
Subacute form
Symptomaticssubacute gallbladder rupture (nyob rau hauv uas ib tug subhepatic abscess daim ntawv) muaj tej yam xws li nta, xws li:
- ua npaws dav dav (los ntawm txias mus rau qhov xav tias kub hauv lub cev), tsam plab thiab hnyav hauv plab, xeev siab, hypotension thiab palpitations;
- mob kuj tseem nyob hauv txoj cai hypochondrium;
- vim qhov tseeb tias kev tsim cov kab mob abscess cuam tshuam nrog nws cov suppuration, cov kab mob septic tuaj yeem txhim kho hauv lub cev raws li kev sib kis ntawm cov kab mob putrefactive thiab kab mob.
Chronic form
Yog tias qhov tawg me me ntawm lub gallbladder tsis kuaj tau raws sijhawm thiab tsis muaj kev kho mob txaus, tus kab mob tuaj yeem ua rau mob ntev, uas tshwm sim los ntawm kev tsim ntawm fistulas hauv lub biliary ib ntsuj av. Tus mob no muaj cov tsos mob hauv qab no:
- plab hnyuv vim yog pob zeb me me;
- dhau los ntawm cov tsim fistulas, ntau yam kab mob los ntawm txoj hnyuv, raws li txoj cai, nkag mus rau hauv lub biliary ib ntsuj av, uas ua rau cov txheej txheem inflammatory nrog cov tsos mob (ua npaws, ua npaws, tsis muaj zog, mob siab, yellowing ntawm daim tawv nqaij thiab mucous daim nyias nyias.).
Muaj cov tsos mob ntawm gallbladder rupture nyob rau hauv miv thiab dev.
Diagnosis
Nws yuav tsum tau muab sau tseg tias qhov kev loj hlob ntawm tus kab mob no tuaj yeem kuaj tau tsuas yog nrog kev pab los ntawm kev tshawb fawb ntsuas thaum laparoscopy. Thaum tsim ib qho anamnesis rauHais txog kev tawg ntawm lub gallbladder, nws yog ib qho tsim nyog yuav tsum tau ua tib zoo saib xyuas qhov muaj cov kab mob ntev ntawm daim siab thiab kab mob biliary hauv ib tus neeg, thaum soj ntsuam tus neeg mob cov lus tsis txaus siab yav dhau los txog kev zom zaub mov (cem quav, raws plab, tsim roj ntau dhau), cov tshuaj tiv thaiv. Cov zaub mov muaj roj thiab kib, kis ntawm qhov mob.
Tests
Kev tshuaj xyuas tus yam ntxwv ntawm cov kab mob gallbladder ruptures tsis tuaj yeem ua tsis tau yam tsis muaj kev kuaj mob tshwj xeeb uas tsim nyog los lees paub lossis tsis lees paub qhov kev kuaj mob.
- Kev kuaj ntshav txhawm rau txiav txim siab tag nrho cov leukocytes thiab kev loj hlob ntawm ESR. Cov ntsuas no pab txheeb xyuas cov cim qhia ntawm kev qaug cawv ntawm lub cev thiab kev txhim kho cov txheej txheem inflammatory hauv nws.
- Kev kuaj xyuas lub plab zom mov yog tsim los txiav txim siab qhov chaw ntawm qhov txhab (rupture) ntawm cov kab mob hauv nruab nrog cev thiab muaj cov kua dej hauv plab plab nws tus kheej.
- Cov txheej txheem kev tshawb fawb zoo li laparoscopy yog npaj rau qhov kev lees paub zaum kawg ntawm kev kuaj mob gallbladder ruptures. Cov txheej txheem feem ntau raug sau tseg yog tias cov phab ntsa ntawm lub gallbladder tsis raug puas tsuaj ncaj qha, thiab cov tsos mob tshwm sim los ntawm qhov muaj vesico-testinal fistulas.
Kev kho mob
Hais txog cov txheej txheem ntawm kev kho cov rupture ntawm phab ntsa ntawm lub gallbladder, nws yuav tsum tau muab sau tseg tias kev kho tus kheej nyob rau hauv cov kev tshwm sim ntawm kev loj hlob ntawm pathology yog tsis tsim nyog thiab yuav ua tau rau loj txim, xws li.peritonitis thiab sepsis, uas tuaj yeem ua rau tuag taus. Ua ntej tshaj plaws, nws yog ib qho tsim nyog los kho cov tsos mob ntawm lub gallbladder rupture thiab tom qab ntawd mus rau qhov kev tshem tawm ncaj qha ntawm pathology.
Txhua yam kev kho mob thiab lwm yam haujlwm cuam tshuam txog kev kho lub gallbladder rupture yuav tsum tau nqa tawm hauv tsev kho mob raws li kev saib xyuas ntawm tus kws kho mob. Nrog cov cim pom tseeb qhia txog kev puas tsuaj rau cov phab ntsa thiab cov ntaub so ntswg ntawm lub gallbladder, kev txiav txim siab yuav tsum tau ua nyob rau hauv ib teev mus pw hauv tsev kho mob tus neeg mob thiab phais tshem tawm cov kab mob.
- Yog tias phab ntsa tawg tau lees paub, ces qhov no, kev kho phais (suturing ntawm phab ntsa) ntawm lub cev yog ua.
- Thaum muaj kab mob peritonitis, lub plab kab noj hniav tau tso tawm los ntawm cov kua dej thiab kho nrog tshuaj tua kab mob.
- Yog tias pom pob zeb hauv lub gallbladder thaum phais hauv lub gallbladder kab noj hniav, ces txiav txim siab rau cholecystectomy (tshem cov pob zeb los ntawm lub gallbladder). Qhov no yog qhov tsim nyog los tiv thaiv kev loj hlob ntawm tus kab mob thiab nws rov tshwm sim.
- Yog tias qhov tawg ntawm cov phab ntsa ntawm lub gallbladder tsis yog tshwm sim los ntawm cov pob zeb hauv cov kab noj hniav ntawm lub cev, ces thaum kev phais yuav tsum tsim kom muaj qhov muaj lossis tsis muaj fistulas hauv lub biliary ib ntsuj av.
- Yog vim li cas rau kev loj hlob ntawm tus mob ceev yuav yog qhov loj ntawm cov txiav txiav, uas txwv tsis pub cov kua tsib los ntawm cov kab noj hniav.
- Tom qab kev phais, hauv lub sijhawm postoperativeTus neeg mob tau muab cov tshuaj tua kab mob tsim nyog los tiv thaiv kev txhim kho ntawm inflammatory foci ntawm qhov chaw ntawm sutures (ob leeg sab hauv thiab sab nraud).
Ntawm no nws yuav tsim nyog hais tias kev mus pw hauv tsev kho mob raws sijhawm ntawm tus neeg mob mob cholecystitis thiab kev kho tshuaj tsim nyog tuaj yeem tiv thaiv cov phab ntsa ntawm lub gallbladder, uas yog:
- txhawm rau txo cov txheej txheem inflammatory, ib chav kawm ntawm cov tshuaj tua kab mob tau sau nrog kev siv cov tshuaj antispasmodics ib txhij;
- mob tau kho nrog tshuaj tua kab mob;
- yog tias cov pob zeb me me tau pom nyob rau hauv cov kab noj hniav ntawm lub gallbladder, kev siv cov kev kho kom tshem tawm tau raug pom zoo (los ntawm kev sib cais nrog cov kws kho mob tshwj xeeb rau crushing cov pob zeb siv cov txheej txheem niaj hnub tshiab, xws li laser crushing).
Txhais tau
Ruptures ntawm phab ntsa ntawm lub gallbladder thaum tsis muaj kev kho mob txaus tuaj yeem ua rau muaj qhov tshwm sim tsis zoo. Cov tsos mob txaus ntshai tshaj plaws thiab qhov tshwm sim ntawm kev tawg ntawm lub gallbladder tuaj yeem suav hais tias yog kev txhim kho ntawm cov kua tsib peritonitis, subhepatic abscess lossis prolapse ntawm lub pob zeb hauv thaj tsam plab hnyuv, uas yog fraught nrog plab hnyuv. Tag nrho cov xwm txheej no xav tau kev kho mob tam sim.
