Tus kab mob no feem ntau tsis meej pem nrog cholecystitis, tab sis cov no yog cov kab mob sib txawv kiag li. Hauv tsab xov xwm, peb yuav ua tib zoo saib seb qhov mob cholangitis yog dab tsi thiab nws tshwm sim li cas. Cia peb paub txog qhov ua rau thiab cov tsos mob. Thaum kawg ntawm tsab xov xwm, peb yuav txheeb xyuas cov lus qhia ntawm kev kuaj mob, kev kho mob rau cov mob cholangitis. Thiab peb yuav pom tias kev tiv thaiv kab mob twg tuaj yeem ua tau.
Qhov no yog dab tsi?
Cov kab mob cholecystitis thiab cholangitis sib koom ua ke los ntawm qhov tseeb tias lawv yog cov kab mob ntawm lub gallbladder. Qhov txawv yog qhov chaw ntawm lub cev puas tsuaj, kab mob.
Chronic cholangitis yog ib qho mob ntawm cov ducts, ob qho tib si sab nraud thiab sab hauv. Nws yog tus cwj pwm los ntawm kev kawm ntev, rov qab los (uas yog vim li cas tus kab mob hu ua mob ntev). Thaum kawg tuaj yeem ua rau cholestasis.
Chronic cholangitis. Tus kab mob yog dab tsi? Cov txheej txheem o nyob rau hauv cov kua tsib ducts vim yog nkag mus rau ntawm cov kab mob mus rau hauv lawv los ntawm cov kab mob ntawm lub digestive ib ntsuj av (pob zais zis, hnyuv), cov hlab ntsha. Tsawg zaus, tus kab mob tuaj yeem kis tau los ntawm cov kab mob lymphatic. Ib qho laj thawjkab mob yog toxoplasmosis. Thiab cov neeg nqa khoom ntawm Toxoplasma nws tus kheej yog cov miv hauv tsev.
Cov ntaub ntawv qhia txog tus kab mob
Ntawm cov tsos mob tseem ceeb ntawm tus mob cholangitis yog mob hnyav hauv daim siab, ua npaws, ua daus no, daj ntseg. Lub ntsiab kev taw qhia ntawm kev kuaj mob niaj hnub no yog hu ua ultrasonography ntawm pancreas thiab cov kua tsib ducts ua rau nws. Lawv kuj siv txoj hauv kev xws li retrograde cholangiopancreatography, suav tomography ntawm cov kua tsib, nrog rau kev kuaj ntshav dav dav thiab biochemical.
Raws li kev kho mob cholangitis, qhov zoo tshaj plaws yog kev xaiv ua ke. Nws yog kev sib xyaw ua ke ntawm cov kab mob tua kab mob, kev kho mob analgesic, detoxification, nrog rau kev phais decompression ntawm biliary ib ntsuj av.
Raws li mob cholangitis nyob rau hauv ICD-10, nws raug xaiv raws li tus lej K83.0.
Statistics
Cia peb tig mus rau ntiaj teb cov ntaub ntawv kho mob. Tsis zoo li cholecystitis ntev, cholangitis tsis tshua muaj tshwm sim. Raws li nyob rau hauv kev sib piv nrog rau lwm yam inflammatory kab mob ntawm lub hepatobiliary system.
Feem ntau cov kab mob tshwm sim hauv cov neeg laus. Qhov nruab nrab hnub nyoog ntawm cov neeg mob yog 50 xyoo. Tsis muaj kev soj ntsuam ntau zaus ntawm cov txiv neej lossis poj niam kis tus kab mob.
Feem ntau, nws tshwm sim nws tus kheej tawm tsam keeb kwm yav dhau los ntawm cov kab mob uas twb muaj lawm ntawm daim siab thiab lub gallbladder. Nws tau sau tseg tias hauv 37% ntawm cov neeg mob yuav raug kuaj pom tom qab cholecystectomy.
Nws tsis tuaj yeem ua tsis tauHais txog hom kab mob tshwj xeeb - sclerosing cholangitis. Nws tshwm sim tawm tsam keeb kwm yav dhau ntawm tus txheeb ze kev noj qab haus huv ntawm tus neeg. Kev loj hlob qeeb hauv qhov nruab nrab ntawm 10 xyoo. Thiab yog li ntawd, nws ua rau irreversible daim siab puas. Tsis muaj cov ntaub ntawv txhim khu kev qha ntawm cov lej tseeb rau qhov tshwm sim ntawm daim ntawv sclerosing, txij li tam sim no nws qhov kev kuaj mob nyuaj. Tab sis, kuv yuav tsum hais tias nyob rau hauv xyoo tas los no tus naj npawb ntawm cov ntaub ntawv kaw tau nce. Qhov twg, ua ntej ntawm tag nrho cov, qhia txog kev txhim kho hauv kev kuaj mob zoo.
Yog tias peb tham txog kev tuag los ntawm tus mob cholangitis ntev, ces tsis muaj qhov tseeb. Nyob ntawm lub sij hawm ntawm kev kuaj pom tus kab mob, qhov tseeb ntawm kev kho, nws txawv ntawm 15 txog 90%.
Yog vim li cas
Puas muaj peev xwm tsim tau tus mob cholangitis ntev tom qab tshem tawm ntawm lub gallbladder? Yog, nyob rau hauv ntau yam. Cov kab mob no ntau dua ntawm cov kab mob. Yuav luag txhua yam kab mob uas muaj nyob rau hauv lub plab zom mov tuaj yeem ua rau nws:
- Protea.
- YEnterococci.
- E. coli.
- Klebsiella thiab lwm tus
Hauv yuav luag txhua qhov xwm txheej, kev kis mob nrog ob peb tus kab mob no tau sau tseg ib txhij. Thiab nyob rau tib lub sijhawm, tsis tshua muaj, tsuas yog ib tus neeg sawv cev nkaus xwb, tus kab mob, pom nyob rau hauv cov kab lis kev cai ntawm cov kua tsib. Feem ntau, nrog rau hom mob cholangitis, muaj cov kab mob hauv tus neeg mob cov ntshav tau kuaj pom (cov kab lis kev cai zoo rau ntshav tsis muaj menyuam).
Raws li peb tau hais lawm, ntau yam kev phais, kev kuaj mob,Cov kev kho mob cuam tshuam rau cov kab mob biliary. Lawv tuaj yeem ua tau tawm tsam keeb kwm yav dhau los ntawm ob qho tib si kev loj hlob tsis xws luag thiab ntau yam kab mob sib kis.
Yuav ua li cas pab rau kev loj hlob ntawm tus kab mob?
Dab tsi tuaj yeem ua rau nkag mus ntawm cov kab mob, plab hnyuv microflora rau hauv cov kab mob biliary? Qhov no feem ntau yog cov hauv qab no:
- Ua txhaum kev ua haujlwm ntawm duodenal papilla.
- Ob leeg lymphogenous thiab hematogenous kev nthuav tawm ntawm ntau yam kab mob.
Qhov kev tiv thaiv kab mob ntawm cov ducts tuaj yeem ua raws li hauv qab no:
- Kev tsis txaus ntseeg hauv kev txhim kho ntawm cov ducts lawv tus kheej, muaj cov kab mob hauv lub cev, thiab lwm yam.
- Stenoses thiab deformities ntawm biliary ib ntsuj av tom qab kev phais lossis endoscopic interventions.
- Cov kab mob ntawm cov kab mob biliary lossis pancreas nws tus kheej.
- Cholestasis vim cholelithiasis.
- Ntxhais kab mob.
Raws li txoj cai, tsim cov kab mob cholangitis ntev yuav tsum muaj kev sib xyaw ntawm peb yam:
- Kev hloov chaw (tau txais) ntawm plab hnyuv microflora rau hauv cov kua tsib.
- YCholelithiasis.
- Intraductal siab.
Nws yuav tsum tau muab sau tseg tias daim ntawv mob ntev ntawm cholangitis tuaj yeem tsim tau raws li kev txuas ntxiv ntawm tus mob cholangitis. Tab sis thawj hom kab mob no tsis tuaj yeem txiav tawm.
Cov tsos mob tseem ceeb thaum ntxov
Cov tsos mob tseem ceeb ntawm tus kab mob cholangitisCov neeg tawm tswv yim qhia txog qhov hu ua Charcot triad. Nws suav nrog cov hauv qab no:
- mob me ntsis xav tau nyob rau hauv txoj cai hypochondrium.
- Chills - nce tus neeg mob lub cev kub mus rau qib subfebrile.
- Jaundice.
Raws li cov tsos mob ntawm tus mob cholangitis ntev, tus neeg mob raug kev txom nyem los ntawm kev npub, tsis siv neeg, mob mob. Tom qab biliary colic, nws hnov mob ua npaws, txias me ntsis.
Raws li daim duab kho mob, ntawm no yog tshem tawm, rov tshwm sim dua. Yog li ntawd, cov neeg mob, raws li txoj cai, tsis tshua muaj kev xyuam xim rau thawj cov tsos mob ntawm tus kab mob.
Cov tsos mob tseem ceeb hauv theem siab
Yog tias koj mus rau cov tsos mob ntawm tus mob cholangitis ntev (cholecystitis yog ib yam kab mob sib txawv kiag li) twb nyob rau theem lig, koj yuav pom cov hauv qab no:
- Ictericity (hais lus yooj yim, yellowness) ntawm ob daim tawv nqaij thiab mucous daim nyias nyias.
- Nyob.
- Kev qaug zog dav dav (feem ntau qhia rau tus neeg mob laus).
Raws li lub hnub nyoog ntawm tus neeg mob tshaj 60 xyoo, kev kuaj mob hauv qhov no nyuaj heev. Daim duab kho mob yuav tsis sib haum mus rau qhov hnyav ntawm cov txheej txheem inflammatory tshwm sim nyob rau hauv cov kua tsib ducts. Cov tsos mob yog qhov muag plooj dhau, yog li nws nyuaj txawm tias tus kws kho mob tshwj xeeb los tsim qhov kev kuaj mob kom raug.
Kab mob sib kis
Daim ntawv kab mob no, zoo li purulent chronic cholangitis, tuaj yeem ua rau qhov tseeb tias tus kab mob nkag mus rau hauv lub cev. Thiab qhov no twb fraught nrog kev loj hlobseptic biliary shock. Nws tshwm sim hauv 30% ntawm cov neeg mob tuag taus.
Cov teeb meem hauv qab no tsis muaj tsawg txaus ntshai rau lub neej thiab kev noj qab haus huv ntawm tus neeg mob:
- Porto-caval thrombosis.
- Lwm yam ntawm kev quav dej quav cawv.
Raws li daim ntawv mob sclerosing, nws tuaj yeem ua rau muaj qhov tshwm sim hauv qab no:
- YHepatocellular carcinoma.
- Cirrhosis ntawm daim siab.
Lab kuaj mob
Yog tias koj txawm xav tias cov tsos mob ntawm tus mob cholangitis ntev, koj yuav tsum tau nrhiav tswv yim los ntawm kws kho mob plab. Txhawm rau kuaj xyuas ua ntej, tus kws kho mob ua kom tus neeg mob muaj Charcot's triad.
Ntxiv mus, kom paub meej qhov kev txiav txim, nws yog ib qho tsim nyog yuav tsum xeem dhau cov kev sim kuaj. Ntawm no yog nthuav tawm:
- suav ntshav kom tiav. Yog tias tus neeg mob muaj tus mob cholangitis, siab leukocytosis, nce ESR, nrog rau kev hloov pauv ntawm neutrophil hauv cov qauv leukocyte yuav raug kuaj pom.
- kuaj ntshav biochemical. Yog tias qhov kev kuaj mob tau raug, ces cov txiaj ntsig ntawm kev tshuaj ntsuam yuav yog nce qib ntawm bilirubin, kev ua haujlwm ntawm G-GTP thiab alkaline phosphatase.
- Kev tshawb fawb microbiological. Hauv yuav luag txhua tus neeg mob, plab hnyuv microflora muaj nyob hauv cov kua tsib. Hauv ib nrab ntawm cov neeg mob, cov kab mob kuj pom muaj nyob hauv cov ntshav.
Instrumental diagnostics
Tsis tas li, cov kws kho mob tig mus rau cov txheej txheem kuaj mob. Hauv particular, ultrasound ntawm cov kua tsibpathways thiab pancreatic pathway nws tus kheej. Ntawm no koj tuaj yeem pom thickening thiab qee qhov nthuav dav ntawm phab ntsa ntawm cov kab mob biliary.
Tsis muaj qhov tseem ceeb tsawg yog suav tomography, uas tau nthuav dav niaj hnub no. Nws tsis tsuas yog lees paub cov ntaub ntawv tau txais thaum lub sijhawm kuaj ultrasound, tab sis kuj tseem pab txheeb xyuas qhov teeb meem ntawm daim ntawv purulent ntawm tus mob cholangitis nyob rau lub sijhawm. Hauv particular, ntau yam purulent abscesses thiab pylephlebitis.
Txhawm rau ua kom rov qab kho cov cholangiopancreatography, yuav tsum muaj kev sab laj ntxiv nrog tus kws kho mob endoscopist. Qhov kev ntsuam xyuas no pab tsis tau tsuas yog ua kom pom cov lej nyob hauv cov kab mob biliary xwb, tab sis kuj tseem qhia txog lawv qhov tshwj xeeb txuas ntxiv.
Tsis ntev los no, ERCP tau hloov pauv los ntawm kev sib nqus resonance cholangiopancreatography. Nws undoubted kom zoo dua yog hais tias nws yog ib tug non-invasive diagnostic txoj kev. Nws tsis tsuas yog nthuav tawm cov tsos mob ntawm tus mob cholangitis ntev, tab sis kuj tseem pab tsim kom muaj qhov ua rau nws txoj kev loj hlob.
Yog tias kev kuaj mob tau ua ua ntej kev phais, yuav siv tau cov cholangiography transhepatic. Cov koob yog dhau los ntawm tus neeg mob daim tawv nqaij thiab tom qab ntawd los ntawm nws cov ducts. Qhov no yog qhov sib piv thiab qhov dej ntawm qhov kawg tau ua tiav.
Zoo sib xws rau lwm yam kab mob
Thaum kuaj mob cholangitis ntev, cov kws kho mob tshwj xeeb yuav tsum tau ceev faj tshwj xeeb - tus kab mob zoo ib yam hauv nws qhov tshwm sim, cov tsos mob nrog rau lwm cov kab mob thiab kab mob:
- duct blockage (saib nrog gallstones).
- Viral kab mob siab.
- Calculous thiab pungentcholecystitis.
- Cov qog ntawm cov kua tsib, daim siab lossis lub txiav.
- ducts ducts vim lwm yam.
Drug therapy
Nyob rau hauv tsab xov xwm, peb tsom xam, ntawm lwm yam, cov tsos mob thiab kev kho mob ntawm cholangitis. Raws li kev kho mob, nws feem ntau yog tus neeg mob sab nraud. Kev mus pw hauv tsev kho mob hauv lub tsev kho mob gastroenterology ntawm lub tsev kho mob tsuas yog xav tau tshwj xeeb:
- Malignant cholestasis.
- mob hnyav.
- Tus neeg mob lub hnub nyoog siab heev.
Kev kho tshuaj ntawm no yog qhov ua ntej - qhov no yog thawj theem ntawm kev phais tshem tawm cov kua tsib. Hauv particular, lub cev yog detoxified, tus neeg mob tau muab tshuaj tua kab mob thiab tshuaj tua kab mob. Ua ntej yuav tau txais kab lis kev cai kab lis kev cai, broad-spectrum tshuaj tua kab mob raug sau tseg. Cov no yog penicillins uas nkag mus rau hauv cov kua tsib, cephalosporins thiab aminoglycosides. Yog tias qhov xwm txheej ntawm tus kab mob yog kab mob parasitic, cov tshuaj tsim nyog tau sau ntxiv.
Surgery
Lub hom phiaj tseem ceeb ntawm kev phais mob rau cov kab mob cholangitis yog tshem tawm cov pob zeb los ntawm cov kua tsib, uas tuaj yeem txhim kho thiab ruaj khov ntawm cov kua tsib. Qhov ntawd yog, txoj hlab pas dej ntws tawm.
Rau lub hom phiaj no, cov haujlwm hauv qab no tau ua:
- External biliary drainage.
- Tshuaj ntsuab percutaneous.
- Nasobiliary hom kua (ua nrog RPCH).
- Txhob Cia SiabCalculi los ntawm choledochus.
- Kev tshem tawm cov calculi ntawm cov kua tsib nrog RAH.
- Balloon endoscopic dilatation ntawm sphincter ntawm Oddi.
- Endoscopic stenting ntawm cov kab mob sib kis.
Raws li kev kho mob hauv lub sijhawm postoperative, nws yog ib qho tseem ceeb heev uas yuav tsum tau ua raws li kev noj haus tshwj xeeb rau cov mob cholangitis. Nws yog sau los ntawm koj tus kws kho mob. Nws yog ib qho tseem ceeb kom suav nrog hauv cov khoom noj khoom haus uas muaj cov vitamins thiab zaub roj. Kev noj zaub mov yuav tsum tau ua ke nrog choleretic thiab tshuaj tua kab mob.
Tiv thaiv thiab huab cua
Tsis txhob hnov qab tias hom mob cholangitis yog ib yam kab mob loj heev, tsis quav ntsej txog qhov twg, tsis raug lossis kho tsis raws sijhawm tuaj yeem ua rau tuag taus. Qhov kev cia siab ntawm tus kab mob no ua rau cov hauv qab no:
- Poj niam.
- Nyob zoo ib tsoom phooj ywg.
- Nyob ntev hyperthermia - ntau tshaj ob lub lis piam (nce lub cev kub).
- Anemia.
- Kev tsis meej pem.
- Lub siab thiab lub raum ua haujlwm tsis txaus.
Kev tiv thaiv hauv qhov no yog qhov thib ob. Nqes los rau ob qhov tseem ceeb:
- Kev tiv thaiv kev kuaj mob ntawm daim siab, gallbladder thiab digestive ib leeg.
- kho raws sijhawm ntawm cov kab mob, kab mob, kab mob uas tuaj yeem ua rau cholangitis.
Peb tau paub txog tus kab mob hnyav heev - o ntawm cov kua tsib ntawm cov kab mob sib kis. Chronic cholangitis yog qhov txaus ntshai vim nws cov tsos mob(tshwj xeeb tshaj yog thaum ntxov) raug tshem tawm. Peb xav tau kev kuaj mob dav dav - ob qho tib si kuaj thiab ntsuas ntsuas. Tus neeg mob yuav muaj kev kho mob, kev kho mob phais, kev noj haus.
