Cov txheej txheem inflammatory ntawm cov kab mob ntawm cov kab mob uas tshwm sim los ntawm cov kab mob tsis tshwj xeeb hu ua cholangitis. Qhov no yog ib qho mob hnyav heev, thiab nyob ntawm qhov kev hloov pauv pathological uas tshwm sim hauv cov phab ntsa ntawm cov ducts, cholangitis yog qhov txawv: purulent, necrotic, catarrhal thiab diphtheric. Kab lus no yuav tsom mus rau daim ntawv purulent ntawm tus kab mob.
cov ntaub ntawv dav dav
Yav dhau los, cholangitis feem ntau tau kuaj pom hauv cov hnub nyoog laus, thiab hauv kaum xyoo tsis ntev los no nws tau kuaj pom ntau ntxiv hauv cov neeg muaj hnub nyoog plaub caug xyoo. Feem ntau cov poj niam raug kev txom nyem los ntawm no pathology. Tus kab mob no feem ntau tshwm sim tawm tsam keeb kwm yav dhau los ntawm lwm yam kab mob ntawm txoj hnyuv - gastro- thiab duodenitis, cholelithiasis, gastritis, kab mob siab, cholecystitis, pancreatitis. Nyob rau hauv no hais txog, lub chav kawm ntawm tus kab mob yog heev hnyav. Tsis tas li ntawd, cov kab mob sib xyaw ua ke tsim qee qhov cuam tshuam rau kev tshem tawm sai sai ntawm qhov ua rau tus kab mob. Mob purulent txheej txheem ntawm o nyob rau hauv lub biliary ib ntsuj av, uas yog tsim tawm tsam keeb kwm ntawm tsis zoo outflow ntawm bile vim ua tiavlos yog ib feem ntawm cov blockage ua rau purulent daim ntawv ntawm cholangitis.
Tus kab mob no tshwm sim los ntawm qhov chaw kho mob hauv qab no: jaundice, uas loj hlob sai, mob ntawm sab xis hauv qab tav, kub taub hau, txias. Ib qho ntawm cov teeb meem ntawm tus kab mob yog kev sib xyaw ua ke ntawm cov tshuaj tiv thaiv kab mob rau cov txheej txheem hauv cov kab mob biliary nrog kev tsis nco qab, hemodynamics, lub raum ua haujlwm thiab lwm yam kabmob. Kev kuaj mob yog tsim los ntawm kev pom qhov pom ntawm cov khoom siv kho qhov muag pom los ntawm CT lossis ultrasound ntawm lub plab zom mov. Decompression ntawm lub biliary ib ntsuj av nrog kev tshem tawm ntawm kev cuam tshuam yog nqa tawm los ntawm kev phais, tom qab uas cov tshuaj tua kab mob yog muab. Ntxiv mus, lwm yam kev ua txhaum cai yuav raug kho.
Ua rau kev loj hlob ntawm pathology
Purulent cholangitis yog kab mob hauv qhov xwm txheej. Nws yog tus cwj pwm los ntawm qhov muaj qhov txhab ntawm cov phab ntsa ntawm cov kua tsib, uas fester tom qab qee lub sijhawm. Qhov no yog ib qho kev phais mob hnyav, uas, yog tias tsis kho, ua rau tus neeg tuag. Kwv yees li ib nrab ntawm tag nrho cov neeg mob nrog qhov kev kuaj mob no muaj cov txheej txheem purulent inflammatory nyob rau hauv lub ductal system.
Cov kab mob duct obstruction los ntawm cov pob zeb tsim nyuaj yog qhov ua rau purulent cholangitis. Lwm yam ua rau ua rau tsis ua tiav ntawm cov kua tsib thiab ua rau mob xws li:
- nqaim ntawm cov ducts tom qab raug mob;
- cicatricial hloov pauv;
- neoplasms hauv cheeb tsam ntawm papilla loj ntawm duodenum 12.
Cov kab mob Pathogenic nquag ua rau hauv cov kab mob biliary vim yog kev tso tseg lossis tsis ua tiav ntawm cov kua tsib. Nyob rau hauv ib tug me me, microbes nyob rau hauv cov kua tsib, nkag mus rau nws los ntawm lub jejunum hematogenously los yog nrog duodenobiliary reflux. Nrog rau qhov tshwm sim ib txwm, qhov mob tsis tshwm sim, thiab microflora tswj lub cev tsis muaj zog. Yog tias cov txheej txheem no ua tsis tiav, tus naj npawb ntawm cov kab mob hauv cov kua tsib nce ntxiv. Provoke kev loj hlob ntawm purulent cholangitis tsuas yog gram-negative microbes, nyob rau hauv tsawg zaus - streptococci, staphylococci, pseudomonads.
Qhov nce hauv siab hauv cov ducts ntawm lub siab ua rau qhov tseeb tias cov kua tsib uas muaj nyob hauv lawv, vim muaj kev hloov pauv hauv kev tiv thaiv, yuav nkag mus rau hauv cov hlab ntsha. Qhov tshwm sim yog bacteremia. Feem ntau, Klebsiella lossis E. coli raug kuaj pom. Leaks ntawm cov kab mob mus rau hauv cov hlab ntsha system provokes qhov tshwm sim ntawm biliary septic shock. Tsis tas li ntawd, kev loj hlob ntawm sepsis tshwm sim los ntawm endotoxemia. Cov kab mob endotoxins, endowed nrog cov nyhuv pyrogenic, txhawb cov ntshav coagulation system, uas provokes intravascular clot tsim. Raws li qhov tshwm sim ntawm kev tiv thaiv kab mob humoral, kev ua haujlwm ntawm lub raum tsis ua haujlwm. Hauv kev loj hlob ntawm toxemia, lub luag haujlwm tshwj xeeb yog ua los ntawm kev ua haujlwm tsis zoo ntawm ob qho tib si kev tiv thaiv kab mob hauv zos thiab hauv zos.
Lwm yam ua rau tus kab mob
Tom qab tshem lub gallbladder, cholangitis tshwm sim ntau tshaj li tsib caug feem pua ntawm cov neeg mob. Nyob rau hauv cov ntaub ntawv no, tus kab mob yog nrog los ntawm ib tug muaj zogkab mob o. Cov laj thawj hauv qab no provoke pathology:
- -cua nab nyob hauv cov kua txiv ducts;
- kab mob siab;
- postcholecystectomy syndrome;
- nkag mus ntawm cov kab mob pathogenic los ntawm txoj hnyuv hauv plab mus rau txoj hnyuv;
- tsis kho cholecystitis;
- cysts ntawm cov kua tsib.
daim duab kho mob
Nrog ib feem lossis ua tiav ntawm cov kua tsib, cov kab mob purulent cholangitis tshwm sim. Txhua yam tshwm sim tam sim ntawd thiab pib nrog qhov kub thiab txias mus rau plaub caug degrees, ua daus no, xeev siab, kev xav ntawm kev puv thiab hnyav hauv txoj cai hypochondrium. Jaundice nyob rau hauv cov ntaub ntawv no manifests nws tus kheej sai heev. Nrog rau daim ntawv uas tsis yog-obstructive purulent, icterus ntawm palate, dermis thiab sclera yog tsis tuaj los yog tshwm sim tom qab.
Cov triad classic ntawm cov kab mob hnyav, uas yog mob, ua npaws, jaundice, nrog kev ua tiav ntawm cov kua tsib ducts tau pom nyob rau tsib caug feem pua ntawm cov tib neeg. Biliary sepsis yeej ib txwm muaj, ib lo lus siv nyob rau hauv gastroenterology thiab nyob rau hauv lub plab phais los piav txog qhov mob hnyav heev ntawm ib tug neeg. Nrog cov tsos mob ntawm cov kua tsib stasis, sepsis tshwm sim hauv ob peb teev. Tsis tas li ntawd, nws tuaj yeem tshwm sim ntawm xob laim nrawm thiab tuaj yeem nrog ntau lub cev tsis ua haujlwm thiab ntau lub siab ua paug. Cov cim tseem ceeb ntawm biliary sepsis yog oliguria, tsis nco qab thiab ntshav siab.
ntsuas ntsuas
Thawj zaug, tus kws kho mob tshuaj xyuas keeb kwm thiab kev tsis txaus siab ntawm tus kheej. Yog xav tias o ntawm lub gallbladderducts, tus neeg mob tau sab laj los ntawm tus kws phais plab. Nws ua qhov kev kuaj mob ua ntej. Cov tsos mob hauv qab no qhia txog kev loj hlob ntawm biliary sepsis: jaundice, kub taub hau thiab siab, nce qhov mob, tachypnea, thiab lub plawv dhia tsis zoo. Nyob rau hauv cov ntaub ntawv no, tus neeg mob lub cev tsis teb rau intravenously ntawm 500 ml ntawm saline, muaj ib tug paub tseeb hais tias bacteremia, muaj cov kua paug tuab nyob rau hauv cov kua tsib ducts. Cov tsos mob ntawm tus mob hnyav raug txheeb xyuas raws li kev kuaj sim:
- Nyob rau hauv kev soj ntsuam dav dav ntawm cov ntshav - nce tus nqi sedimentation ntawm cov qe ntshav liab, neutrophil leukocytosis.
- Hauv daim siab kuaj - hyperphosphatemia, hyperbilirubinemia, cov roj cholesterol siab. Qee zaum, kev ua haujlwm transaminase tau nce.
Rau qhov kev kuaj mob ntawm purulent cholangitis, ultrasound ntawm lub plab plab yog ua tiav. Nrog hom kev tshawb fawb kho vajtse:
- qhia lub hauv paus uas ua rau tus kabmob;
- pom qhov kev cuam tshuam ntawm kev siv tshuab thiab nthuav dav ntawm cov kua tsib ducts siab dua qib ntawm kev cuam tshuam;
- kuaj xyuas kev hloov pauv ntawm parenchyma thaum tsim cov txheej txheem purulent-inflammatory hauv daim siab.
Ntawm CT, cov txiaj ntsig tau qhia meej thiab lees paub. Tsis tas li ntawd, esophagogastroduodenoscopy yog ua. Yog tias tsim nyog, piv txwv li, yog tias tus kws kho mob tsis muaj cov ntaub ntawv tiav, tom qab ntawd endoscopic retrograde cholangiopancreatography raug pom zoo. Yog tias nws tsis tuaj yeem ua tau, siv percutaneous transhepaticcholangiography.
Cov ntsiab lus ntawm cov kab mob biliary tau txais thaum lub sijhawm kawm raug xa mus rau kev tshuaj xyuas kab mob bacteriological, qhov kev txiav txim siab ntawm cov kab mob pathogenic microorganisms rau tshuaj tua kab mob. Cov kua tsib raug soj ntsuam pom qhov pom los ntawm tus kws pab kuaj mob. Daim ntawv purulent ntawm tus kab mob yog pov thawj los ntawm muaj cov kua paug nyob rau hauv nws.
txoj kev phais
Kev kho tus mob cholangitis, cov tsos mob ntawm daim ntawv purulent uas tau piav qhia saum toj no, yuav tsum muaj kev kho mob tam sim ntawd. Thaum cov kab mob biliary sepsis tau tsim, kev kho mob ceev ceev ntawm cov kab mob biliary yog tsim nyog. Yog hais tias qhov ua rau ntawm pathology yog cicatricial hloov, ces vim lub installation ntawm endoprosthesis nyob rau hauv lub choledochus, txaus compression yog tiav.
Vim qhov tseeb tias kev phais qhib tau raug mob rau cov neeg mob thiab muaj teeb meem tsis tu ncua, niaj hnub no cov kws kho mob nyiam qhov kev cuam tshuam tsawg kawg nkaus:
- Percutaneous transhepatic cholangiostomy yog qhov kev kho mob rau cov mob hnyav. Hauv lwm qhov xwm txheej, qhov no yog kev npaj ua ntej, thaum lub sij hawm cov kua tsib ntws mus txog thaum qhov cuam tshuam raug tshem tawm sai.
- Mechanical lithotripsy.
- Endoscopic papillosphincterotomy - tshem tawm tag nrho cov kua tsib stasis thiab obstructive jaundice. Nws yog siv rau etiology ntawm ib tug calculous-inflammatory xwm.
- thiab lwm yam.
Nyob ntawm cov cim qhia ntawm cov kua tsib stagnation, theem ntawm kev ua txhaum ntawm nws cov dej ntws tawm, qib ntawm kev cuam tshuam ntawm kev siv tshuab, kev xaiv txoj kev raug xaiv. Tom qab thaum muaj xwm ceev decompression, kev kho radical yog ua - cholecystectomy, cholangioduodenostomy los yogrecanalization, yog tias daim ntawv purulent yog tshwm sim los ntawm cicatricial nqaim ntawm biliodigestive anastomosis.
kev kho mob
Tom qab kev nrawm nrawm, kev kho tshuaj tua kab mob tau qhia, nws ua lub luag haujlwm pabcuam. Cov teeb meem nyob rau theem no ntawm kev kho yog vim qhov tseeb tias kev txheeb xyuas cov kab mob pathogenic microorganisms siv sijhawm ntev, thiab ntxiv rau, tom qab cov kua dej tawm sab nraud, cov muaj pes tsawg leeg ntawm cov nroj tsuag hloov pauv..
Hauv kev xyaum, cov tshuaj tua kab mob tau pom zoo los kho cov tsos mob ntawm cholangitis ua ntej cov txiaj ntsig ntawm kev kuaj kab mob bacteriological tau npaj. Qhov no yog qhov tsim nyog los tiv thaiv bacteremia thiab sepsis. Thaum pib, ureidopenicillins thiab cephalosporins yog siv ua ke nrog Metronidazole. Qee tus kws kho mob pom zoo tetracyclines, penicillins, aminoglycosides.
Ib theem tseem ceeb ntawm kev kho mob yog detoxification, txij li ib qho ntawm cov tsos mob hnyav yog endotoxemia hauv purulent cholangitis. Cov tshuaj "Polymyxin B" yog cov tshuaj endotoxin-binding, uas tau pom zoo kom siv. Txo cov ntshav plasma concentration ntawm Lactulose lipopolysaccharide, uas zoo heev. Tsis tas li ntawd, kev siv plasmaphoresis ua rau nws muaj peev xwm tshem tawm cytokines, endotoxins thiab ncig lub cev tiv thaiv kab mob los ntawm cov ntshav plasma. Nrog kev pab los ntawm enterosorption, co toxins raug tshem tawm ntawm lub lumen ntawm lub plab zom mov, tiv thaiv lawv los ntawm kev nkag mus rau hauv cov hlab ntsha portal. Peb kuj muab kev tiv thaiv kab mob thiab kev noj haus.
Huab cua
Purulent cholangitis lossis cov txheej txheem inflammatory uas cuam tshuam rau cov ducts nyob rau hauvvim tsis ua hauj lwm los yog ua kom tiav blockage ntawm cov kua tsib yog suav tias yog ib qho kev phais mob loj heev. Qhov kev cia siab rau tus kab mob no yog txiav txim siab tsis yog los ntawm theem ntawm kev sib tshooj ntawm cov kua tsib ducts, tab sis kuj los ntawm lub sijhawm ntawm kev muab kev pabcuam tshwj xeeb. Hmoov tsis zoo, qhov kev tuag ntawm tus kab mob no yog siab heev. Qhov phom sij ntawm daim ntawv purulent ntawm tus kab mob yog qhov chaw kho mob zoo ib yam li lwm yam ntawm cov kab mob no, thiab kev kho tsis raws sijhawm thiab tsis raug ua rau muaj qhov tshwm sim loj heev - purulent intoxication, siab tsis ua haujlwm, tsim cov abscesses hauv daim siab.
Kev Tiv Thaiv
Cov teeb meem hnyav tuaj yeem tiv thaiv nrog kev kho mob endoscopic ntawm cholelithiasis. Tsis tas li ntawd, qhov no tau yooj yim los ntawm cov cuab yeej siv phais mob tshiab thiab kev tsim nyog ntawm tus kws phais mob plab. Cov tib neeg uas tau txais kev kho mob ntawm purulent cholangitis, nrog rau cov neeg mob uas muaj keeb kwm ntawm obstructive jaundice, yog nyob rau hauv dispensary soj ntsuam ntawm ib tug gastroenterologist. Rau lawv, niaj hnub kev tshuaj xyuas yog nqa tawm, uas yog tsom rau kev txheeb xyuas lub xub ntiag ntawm pob zeb thiab cicatricial strictures ntawm biliary ib ntsuj av. Lawv nyob noj mov tas lawv lub neej. Nws pab kom tsis txhob ua txhaum ntawm cov kua tsib excretion thiab tsim cov kua tsib. Yog tias tsim nyog, noj cov tshuaj uas kws kho mob pom zoo.
Tus kws phais plab: nws yog leej twg thiab nws kho dab tsi?
Nov yog tus kws kho mob uas ua cov kev phais mob siv ntau yam txuj ci tshiab thiab cov cuab yeej kuaj mob. Nws ua haujlwm:
- raug mob ntawm kev lag luam thiab hauv tsevcim;
- kab mob ntawm daim ntawv ntxiv ntawm caecum;
- polyps, varicose veins ntawm peritoneal kab mob;
- xav qhov txhab;
- kev loj hlob tshiab;
- kab mob sib kis thiab kis kab mob hauv plab;
- retroperitoneal chaw.
Ntxiv rau, kho tus mob pancreatitis, kab mob gallstone, kab mob ulcerative, thiab tseem cuam tshuam nrog kev tiv thaiv cov teeb meem thiab kev kho mob ntawm tib neeg.
Hauv cov xwm txheej niaj hnub no, cov kws phais plab plab ua haujlwm xwm txheej ceev thiab npaj ua haujlwm nyuaj:
- Ntawm qhov deb (video phais) - thaum tus neeg mob nyob rau hauv ib qho nyuaj mus cuag, tus kws kho mob coj tus kws kho mob ua los ntawm video link.
- Kev hloov pauv ntawm lub cev thiab cov ntaub so ntswg.
- Minimally invasive endoscopic operations (laparoscopy). Nyob rau hauv cov ntaub ntawv no, tus kws phais yog sab nraum qhov chaw phais thiab, siv 3D duab ntawm lub monitor screen thiab tus neeg hlau, ua hauj lwm nrog lub siab tshaj plaws precision.
Rau txhua qhov kev phais mob, cov kws kho mob siv cov cuab yeej siv tshuab thiab cov cuab yeej tshuaj ntsuam xyuas zoo. Hauv cov tsev kho mob ntau yam, muaj qhov tshwj xeeb nqaim ntawm cov kws phais mob plab - menyuam yaus, kws kho mob siab, kws kho mob oncologist, kws kho mob plab, kws kho mob plab, coloproctologist.
Tam sim no koj paub tias tus kws phais plab yog leej twg thiab nws kho dab tsi.
