Focal adenomyosis ntawm lub tsev menyuam yog ib qho kab mob hauv zos, qhov tseem ceeb ntawm qhov uas yog nyob rau hauv overgrown endometrium. Raws li txoj cai, qhov chaw ntawm qhov txhab muaj qhov pom tseeb. Daim foos focal ntawm tus kab mob yog ib qho ntawm ntau yam ntawm endometriosis, uas distinguishes tus kab mob los ntawm tsuas yog uterine tis. Nyob ntawm theem ntawm qhov txhab thiab qhov tuab ntawm qhov germination ntawm myometrium, cov kws txawj paub qhov txawv peb theem tseem ceeb ntawm qhov mob hnyav:
- easy;
- medium;
- hnyav.
Tus yam ntxwv ntawm tus kab mob
Kom nkag siab tias nws yog dab tsi - focal adenomyosis, cia peb tham txog cov yam ntxwv ntawm cov kab mob. Cov txheej txheem endometrial yog nyob thoob plaws hauv lub tsev menyuam. Nws yog niaj hnub hloov kho nrog lub caij nyoog poj niam. Qhov no pab npaj tus poj niam lub cev kom muaj peev xwm fertilization thiab gestation ntawm lub embryo. Focal adenomyosis ntawm lub tsev menyuam tshwm sim, raws li txoj cai, nyob rau hauv cov poj niam laus uas twb muaj 40 xyoo thiab muaj cov tsos mob thawj zaug ntawm menopause.
Cov poj niam zoo li no taunco ntsoov qhov hloov pauv tsis tu ncua ntawm qib estrogen hauv lub cev. Nyob rau tib lub sijhawm, lawv muaj kev kub ntxhov, tawm hws ntau, thiab lawv lub taub hau pib tig. Yog hais tias xws li dhia mus ntev dhau lawm, ces tawm tsam lawv keeb kwm yav dhau, tus poj niam pib tsim adenomyosis ntawm daim foos focal ntawm qhov txhab.
Cov kab mob no yog ib hom kab mob endometriosis, uas tuaj yeem cuam tshuam thiab cuam tshuam rau tag nrho lub tsev menyuam kab noj hniav. Focal adenomyosis yog tus cwj pwm los ntawm qhov chaw tshwj xeeb ntawm endometrium nyob rau ntau qhov chaw ntawm lub tsev menyuam.
Cov teeb meem tseem ceeb hauv kev kuaj mob thiab kho tus kab mob yog txhawm rau txheeb xyuas qhov theem ntawm qhov txhab. Muaj ob peb hom kab mob no, ob qho tib si rau kev kho mob, thiab tus so tsuas yog tshem tawm los ntawm kev phais.
Kab mob kev loj hlob
Cov yam ntxwv ntawm kev tsim cov kab mob hauv daim foos focal ntawm adenomyosis zoo li no:
- formed lesions do not form ib capsule;
- lawv txawv ntawm lawv qhov kev loj hlob infiltrative thiab tuaj yeem txav mus rau cov ntaub so ntswg nyob ze;
- cov hlwb endometrioid ua rau qhov pib ntawm kev puas tsuaj ntawm cov ntaub so ntswg cuam tshuam;
- lawv, ib yam li cov hlwb tsis zoo, kis sai sai thoob plaws lub cev los ntawm cov hlab ntsha thiab cov qog ntshav.
Gynecologists qhia tias sab hauv daim ntawv ntawm endometriosis ntawm lub tsev menyuam yog ib yam kab mob txaus ntshai, uas tseem ceeb heev rau kev kho kom raws sijhawm, txwv tsis pub nws tuaj yeem ua rau muaj teeb meem loj.
Yog tsis muaj qhov tseebkev kho mob, tus neeg mob yuav muaj kev xeeb tub. Tsis tas li ntawd, cov tsos mob ntawm endometriosis feem ntau sawv cev rau qhov mob hnyav, uas tuaj yeem cuam tshuam rau tus poj niam lub cev, ua rau nws txoj kev noj qab haus huv thiab kev ua si.
hom kab mob tseem ceeb
Cov kws tshaj lij paub qhov txawv peb hom kab mob piav qhia:
- Diffuse focal adenomyosis ntawm lub tsev menyuam - cov hlwb endometrioid nyob hauv thaj chaw feem ntau nyob rau sab hauv ntawm lub tsev menyuam.
- Nodular adenomyosis - cov hlwb tsim cov pob uas muaj ntshav lossis exudate. Qhov no yog vim lub fact tias cov hlwb nyob rau hauv cov nodes txuas ntxiv ua lawv lub luag hauj lwm, tsom mus rau tus poj niam lub cev ntas. Nrog rau cov kab mob zoo li no, ib leeg lossis ntau lub pob tuaj yeem tsim nyob rau hauv kab noj hniav.
- Focal adenomyosis. Kev loj hlob ntawm endometrium nrog rau daim ntawv ntawm tus kab mob no tshwm sim nyob rau hauv tej qhov chaw ntawm lub tsev menyuam, nyob rau hauv cov phab ntsa ntawm lub cev muaj nws kim heev foci. Qhov luaj li cas ntawm qhov txhab nyob rau hauv cov ntaub ntawv no yuav txawv heev. Focal adenomyosis ntawm lub tsev menyuam nce, zoo li lwm yam kab mob, dhau los ntawm ntau theem. Tus kab mob no kho los ntawm tib txoj kev.
Risk factors
Cov feem ntau pheej hmoo rau adenomyosis yog:
- teeb meem endocrine;
- poj niam lub hnub nyoog;
- socio-economic xwm txheej.
Tsis tshua muaj yam xwm txheej:
- sijhawm lig;
- yug lig los yog yug nrog teeb meem;
- kev rho menyuam tsis tu ncua;
- muaj zog irradiation thiab kev kho cua sov tsom rau thaj chaw pelvic.
Hmoov tsis zoo, kev saib xyuas lossis kev kho mob sib xyaw ua ke hauv cov xwm txheej tsis tshua ua rau tus poj niam rov qab los ua tiav. Cov theem kawg ntawm tus kab mob yog ib qho ua rau tsis muaj menyuam. Tab sis kev kho mob raws sij hawm yuav pab kom ua tiav qhov kev tso cai ntev dua los yog tsawg dua, cev xeeb tub thiab yug me nyuam. Muaj tseeb tiag, qhov no nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias qhov kev pheej hmoo ntawm kev rho menyuam tawm tsis tu ncua lossis pib yug ntxov ntxov yog siab.
theem tseem ceeb
Cov kws kho mob tshwj xeeb faib focal adenomyosis ntawm lub tsev menyuam rau hauv cov theem hauv qab no:
- Nyob rau theem ntawm txoj kev loj hlob no, qhov tob ntawm kev loj hlob ntawm endometrial foci nyob rau hauv cov leeg nqaij txheej ntawm lub tsev menyuam mus txog 1/3 ntawm ib feem. Nrog rau kev tshawb pom raws sij hawm ntawm qhov tsim muaj txaus ntshai nyob rau hauv kab noj hniav ntawm lub cev muaj npe, nws tuaj yeem kho tau yooj yim thiab kho sai yam tsis muaj teeb meem.
- Lub endometrium nyob rau hauv lub tsev menyuam txuas mus rau 1/2 ib feem, yog li tus kws kho mob gynecologist tau sau ntawv rau tus neeg mob txog cov tshuaj hormonal, nrog rau cov txheej txheem kho lub cev kom tsim nyog.
- Nyob rau hauv cov ntaub ntawv no, lub endometrium yog dav faib nyob rau hauv ntau qhov chaw ntawm lub tsev menyuam, nyob rau hauv lub sab nrauv phab ntsa ntawm nws cov leeg nqaij txheej, ua rau muaj teeb meem loj thiab teeb meem nyob rau hauv tus neeg mob lub cev.
- theem 4 diffuse focal adenomyosis yog dab tsi? Hauv qhov no, endometrium pib nquag cuam tshuam cov ntaub so ntswg nyob sab nraum lub tsev menyuam. Neoplasms pib tsim ntawm cov kabmob uas nyob sib ze. Raws li txoj cai, tus kws kho mob sau ntawvtus neeg mob xav tau kev phais.
Qhov laj thawj tseem ceeb ntawm qhov tshwm sim
Cov kws tshawb fawb tseem tsis tau nkag siab txog qhov sib txawv ntawm daim foos ntawm adenomyosis thiab tsis tau txheeb xyuas tag nrho cov laj thawj uas ua rau nws tshwm sim. Nyob rau tib lub sijhawm, cov kws kho mob nco ntsoov tias qhov mob no feem ntau pom nyob rau hauv cov neeg mob uas nws keeb kwm hormonal loj thiab ntev cuam tshuam tshwm sim. Cov poj niam zoo li no nyob hauv thaj chaw muaj kev pheej hmoo tshwj xeeb, yog li ntawd, lawv yuav tsum ua tib zoo saib xyuas lawv txoj kev noj qab haus huv thiab, thaum thawj cov tsos mob tshwm sim, nrhiav kev pab los ntawm tus kws kho mob tam sim ntawd.
Lub ntsiab tseem ceeb uas ua rau pom qhov tshwm sim ntawm focal adenomyosis ntawm lub tsev menyuam muaj xws li: kev xeeb menyuam tsis tu ncua, qee yam kev phais mob, kev teeb tsa ntawm kauv, nquag tshem tawm lossis rho menyuam.
Tsis tas li ntawd, cov hauv qab no tuaj yeem raug ntaus nqi rau qhov ua kom yuam kev:
- Kev kis tus kab mob ntawm qib caj ces. Hauv qhov no, tus poj niam yuav tsis tsuas yog focal adenomyosis xwb, tab sis kuj muaj lwm hom endometriosis.
- Teeb meem nrog cov tshuaj hormones hauv lub cev: estrogen ntau dhau lossis tsis txaus progesterone.
- Kev ntxhov siab tsis tu ncua, kev txhawj xeeb, kev xav tawm tsam, kev ua tsis ncaj ncees ntawm lub neej, ntau dhau ntawm lub hlwb thiab lub cev.
- Txoj kev ua kis las.
- Kev muaj tus cwj pwm phem, nrog rau kev tswj tsis tau cov tshuaj uas tsis tau sau los ntawm tus kws kho mob tshwj xeeb, thiab tsis ua rawsdosage.
Theories of emergence
Cov kws kho mob tso siab rau cov kev xav hauv qab no los piav qhia qhov ua rau pom thiab kev loj hlob ntawm sab hauv endometriosis ntawm lub tsev menyuam:
- Tsis tshua muaj, muaj kab mob ntawm daim ntawv no kuaj pom hauv cov ntxhais hluas (ua ntej puberty). Nws ntseeg tau tias nyob rau hauv kev cuam tshuam ntawm intrauterine ntshawv siab, endometriosis foci nquag txav mus rau cov ntaub so ntswg nyob ze, uas pib ua tiav tam sim tom qab puberty.
- Thaum ua poj niam cev xeeb tub, qee cov ntshav uas muaj cov hlwb endometrial raug pov rau hauv cov kab noj hniav peritoneal. Cov txheej txheem no yog hu ua retrograde menstruation. Tab sis nyob deb ntawm txhua tus poj niam, cov khoom endometrioid feem ntau tuaj yeem siv hauv paus hauv peritoneum. Ua li no, cov ntsiab lus no yuav tsum tau muab qee yam kev mob, uas yuav muaj kev ua txhaum ntawm cov tshuaj hormonal thiab kev tiv thaiv kab mob.
- Ntau yam kab mob cuam tshuam nrog kev ua me nyuam yuav tsum tau kho los ntawm kev phais. Adenomyosis feem ntau tshwm sim tom qab kev ua haujlwm uas provokes kev puas tsuaj ntawm cov txheej txheem sab hauv ntawm lub tsev menyuam. Raws li qhov tshwm sim ntawm qhov tshwm sim, cov hlwb endometrioid tau txais tag nrho cov xwm txheej tsim nyog rau kev nkag mus rau hauv myometrium thiab tob txheej ntawm lub cev.
Internal endometriosis kuj tuaj yeem tshwm sim los ntawm kev raug cuam tshuam los ntawm sab nraud. Ib tug poj niam yuav tsum nco ntsoov tias yog tias kev kho mob raws sij hawm ntawm cov txheej txheem inflammatory hauv lub tsev menyuam thiab lwm yam kabmob ntawm qhov chaw mos tsis tau pib, yog li qhov no tuaj yeem cuam tshuam tsis tsuas yog kev ua me nyuam,tab sis kuj ua rau muaj teeb meem loj dua. Kev kis kab mob, kev ntxhov siab tsis tu ncua thiab kev ntxhov siab tuaj yeem ua rau muaj kev pheej hmoo ntawm qhov tshwm sim thiab kev loj hlob ntawm adenomyosis ntawm lub tsev menyuam los ntawm kev txo cov kev tiv thaiv ntawm tes.
Cov tsos mob tseem ceeb
Cov tsos mob tseem ceeb ntawm adenomyosis nyob rau hauv lub tsev me nyuam yog mob hnyav nyob rau hauv lub plab mog, nrog rau qhov pib ntawm los ntshav hnyav. Thaum lub sij hawm kev loj hlob ntawm tus kab mob, tus poj niam xav tias nkees thiab tsis xis nyob. Los ntawm txoj kev, feem ntau nws thawj ob theem yog asymptomatic, yog li nws tseem ceeb heev uas yuav tau mus ntsib kws kho mob tsis tu ncua txhawm rau kuaj mob.
Cov tsos mob tseem ceeb ntawm pathology ncaj qha nyob ntawm kev coj khaub ncaws. Cov kws tshaj lij tau pom tias foci ntawm tus kab mob coj khaub ncaws tib lub sijhawm nrog lub endometrium kom raug. Qhov tsis muaj peev xwm tshem tawm cov hlwb endometrial los ntawm kev tsom mus rau qhov pib ntawm cov txheej txheem inflammatory.
Cov kws kho mob txheeb xyuas cov cim hauv qab no ntawm focal adenomyosis:
- Paj. Nws tau pom tias qhov mob syndrome nyob rau hauv daim ntawv focal ntawm qhov txhab yog tus cwj pwm los ntawm nws cov cyclicity. Feem ntau, nws yuav muaj zog ua ntej thiab thaum lub sij hawm tseem ceeb. Mob yog nyob rau hauv feem ntau ntawm lub plab mog, thiab nyob rau hauv lub sacrum, irradiation mus rau lub qis extremities yuav tshwm sim. Qee zaum, qhov mob hnyav heev uas tus poj niam yuav tsum hu rau lub tsheb thauj neeg mob thiab mus kuaj hauv gynecological department.
- Los ntshav hnyav thaum cev xeeb tub. Feem ntau, tus neeg mob sau cov ntshav tawm ntau ntau. Tib lub sijhawm, lawv tuaj yeem ua taupom zoo li smearing ua ntej thiab tom qab kev coj khaub ncaws. Qee zaum, lub sijhawm muaj zog qhia tau hais tias muaj cov uterine fibroids, uas feem ntau tshwm sim nrog adenomyosis. Internal endometriosis thiab uterine fibroids tshwm sim vim muaj teeb meem nrog cov tshuaj hormonal.
- Los ntshav ntau dhau thaum tsis muaj poj niam cev xeeb tub. Cov tsos mob xws li los ntshav hnyav tuaj yeem qhia tau tias muaj cov txheej txheem ntawm kev txhim kho kab mob. Nyob rau tib lub sijhawm, lawv provoke kev loj hlob ntawm anemia thiab ntshav poob.
- Kev xeeb tub lossis nchuav menyuam. Vim muaj teeb meem nrog kev tsim cov tshuaj hormones, anovulation feem ntau tshwm sim nrog endometriosis. Cov txheej txheem degenerative tsis tso cai rau lub qe fertilized ib txwm ncav cuag lub cev thiab nce foothold hauv nws cov kab noj hniav. Nrog adenomyosis, qhov mob ntawm lub tsev menyuam tuaj yeem pib hauv tus poj niam lub cev, uas yuav cuam tshuam lub ntuj cog lus ntawm lub cev muaj npe thiab ua rau nchuav menyuam thaum ntxov ntawm kev loj hlob ntawm embryo.
Cov tsos mob tseem ceeb ntawm adenomyosis tuaj yeem txheeb xyuas thaum kuaj gynecological hauv tsev kho mob. Hauv qhov no, tus kws kho mob tshwj xeeb yuav qhia qhov mob ntawm lub cev ntawm lub tsev menyuam thiab tus nqi ntawm kev loj hlob ntawm qhov txhab. Tsis tas li ntawd, tus kws kho mob yuav txiav txim siab ntau yam kev hloov pauv ntawm cov duab thiab qhov sib xws ntawm lub tsev menyuam lub cev. Feem ntau, thaum lub sij hawm endometriosis sab hauv, lub cev yuav siv sij hawm nyob rau hauv ib tug spherical zoo, thiab nws ceev nce.
Kev ntsuas qhov mob tshwm sim
Txhawm rau txiav txim siab diffuse focal adenomyosis 13 thiab 15 mm, nws yog ib qho tsim nyog yuav tsum tau kuaj xyuas ultrasound, uas yuav pab txiav txim seb cov tsos mob ntawm tus kab mob. Kev kuaj ntshav transvaginal yuav pab txheeb xyuaskev kuaj mob kom raug. Yog tias tsis tau pib kho focal adenomyosis ntawm lub tsev menyuam raws sijhawm, vim li ntawd, raws li tau hais tseg lawm, tus neeg mob yuav muaj kev muaj menyuam tsis taus lossis nws yuav tau raug tshem tawm ib nrab lossis txawm tias tag nrho tshem tawm ntawm lub cev.
Feem ntau, kev kuaj mob ntawm tus kab mob no yog ua los ntawm kev siv ultrasound. Txhawm rau txheeb xyuas focal adenomyosis thiab mob qog noj ntshav hauv tsev menyuam, kev kuaj ntshav thiab tshuaj xyuas rau CA-125 yog ua. Tag nrho cov no tso cai rau koj kom zoo xav txog cov cim qhia ntawm pathology ntawm ob qho tib si hauv nruab nrog cev thiab cov ntaub so ntswg nyob sib ze. Nws yog qhov zoo tshaj los ua qhov kev ntsuam xyuas ua ntej ua poj niam cev xeeb tub. Tus kws kho mob tuaj yeem txheeb xyuas qhov xwm txheej ntawm tus kab mob, nws cov duab, qhov loj ntawm lub tsev menyuam lub cev, qhov tuab ntawm cov phab ntsa thiab cov qauv ntawm myometrium. Yuav kom kuaj ntshav biopsy, tus kws kho mob tau sau tshuaj hysteroscopy.
Txoj kev yooj yim los kho qhov txhab
Nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias tsuas yog thawj ob theem ntawm adenomyosis tuaj yeem kho tau. Tab sis rau cov neeg uas poob mob nrog xws li ib tug mob, hmoov tsis, ib tug tag nrho rov qab, raws li txoj cai, tsis tshwm sim. Qhov no tuaj yeem piav qhia los ntawm qhov tseeb tias daim foos focal ntawm adenomyosis hauv lub uterine kab noj hniav feem ntau rov tshwm sim, vim li no nws yog ib qho tseem ceeb rau tus neeg mob ua tib zoo saib xyuas cov tshuaj hormonal.
Txhua hom adenomyosis raug kho nrog ob txoj hauv kev. Hauv thawj kis, tus kws kho mob tshwj xeeb tshaj tawm cov tshuaj tiv thaiv adenomyosis. Yog tias qhov kev kho mob zoo li no tsis txhim kho tus mob ntawm tus neeg mob, cov kws kho mob tau sau ntawv rau kev phais. Txhua txoj hauv kev tshem tawm endometriosis ntawm daim ntawv sab hauv yuav txawv ntawm ib leeg nyob ntawm qhov hnyav thiabgermination ntawm qhov txhab, nrog rau lub xeev ntawm cov poj niam reproductive system.
Txoj kev uas feem ntau ntawm kev tshem tawm qhov txhab yog uterine artery embolization. Lwm cov txheej txheem los tshem tawm thaj tsam cuam tshuam, suav nrog kev tshem tawm, yog qhov txaus ntshai heev thiab tuaj yeem ua rau muaj menyuam tsis taus.
Txhawm rau pib kho tus kab mob uterine kom raug, tus kws kho mob tshwj xeeb yuav tso siab rau cov hauv qab no:
- poj niam lub hnub nyoog;
- muaj lossis tsis muaj menyuam, xav yug yav tom ntej;
- tsis muaj menyuam;
- kev txhim kho theem ntawm qhov txhab;
- cov tsos mob tseem ceeb ntawm qhov txhab thiab lawv qhov tshwm sim.
Yog tias tus poj niam muaj teeb meem nrog kev ua haujlwm ntawm lub raum, lub siab, cov hlab ntsha, lossis ntshav qab zib mellitus tshwm sim, ces nws tau sau ib chav kawm ntawm kev noj tshuaj hormonal. Txawm hais tias yuav ua li cas tshem tawm adenomyosis ntawm lub tsev menyuam, tus kws kho mob tuaj koom yuav txiav txim siab tom qab kuaj mob. Nws yuav kawm txog tus poj niam keeb kwm, txheeb xyuas qhov muaj mob hawb pob lossis rog. Thiab lub hom phiaj ntawm kev kho tus kab mob no yuav yog qhia tus poj niam mus rau hauv cov tshuaj tiv thaiv menopause.
Internal endometriosis yuav tsum tau kho nrog cov tshuaj hormonal, tab sis nws yog ib qho tseem ceeb kom nco ntsoov tias lawv feem ntau ua rau muaj kev phiv tshwm sim. Thaum kho, tus poj niam yuav tsum ua raws li kev noj zaub mov tshwj xeeb, tsis suav tag nrho cov khoom noj tsis zoo ntawm nws cov khoom noj. Cov ntawv qhia zaub mov yuav tsum suav nrog ntau cov khoom noj uas muaj cov protein thiab cov vitamins ntau npaum li qhov ua tau. Tsis tas li ntawd, tus kws kho mob tau sau tshuaj tiv thaiv kab mob thiab physiotherapy. Nrog rau daim ntawv focal ntawm uterine adenomyosis, ib tug poj niam feem ntau tsim cov kab mob neurotic tiv thaiv keeb kwm yav dhau, uas nws tseem ceeb heev.kev pab ntawm tus kws kho mob hlwb.
Kev kho mob
Kev kho mob nrog tshuaj tuaj yeem ua ke nrog cov tshuaj tsis yog ib txwm muaj. Cov no suav nrog hirudotherapy, lossis kev kho mob nrog leeches, homeopathy thiab tshuaj. Cov txheej txheem zoo li no ib txwm ua rau muaj txiaj ntsig zoo.
Tab sis kws kho mob txwv tsis pub cov neeg mob kho tus kheej thiab yuav cov tshuaj yam tsis muaj tshuaj, vim qhov no yog qhov txaus ntshai heev rau kev noj qab haus huv thiab kev mob ntawm tus poj niam nws tus kheej. Nyob rau tib lub sijhawm, nrog kev xaiv kom raug, cov tshuaj homeopathic yuav pab txhim kho cov txiaj ntsig ntawm kev noj lwm yam tshuaj.
Ntau tus poj niam tau sim leeches ntawm lawv tus kheej. Nws pab kom ceev cov ntshav khiav thiab tshem tawm cov txheej txheem ntawm o hauv lub cev.
kev kho mob niaj hnub
Tshuaj tau tsim txoj hauv kev tshiab los kho focal adenomyosis ntawm lub tsev menyuam:
- Electrocoagulation. Nyob rau hauv cov ntaub ntawv no, ib tug hluav taws xob paug ua rau pathological formations nyob rau hauv lub cev, uas rhuav tshem focal formations nyob rau hauv ib tug me me daim ntawv.
- Kev txhawb nqa. Txoj kev kho no yog ua raws li kev thaiv cov ntshav khiav, uas tuaj rau txhua qhov tsim. Vim tias tsis muaj oxygen, cov txheej txheem pib sai sai.
- Ablation pab ua kom puas lub tsev menyuam.
Txhua txoj kev kho mob tau piav qhia muaj qhov zoo, nrog kev pab los ntawm lawv ntau tus neeg mob tuaj yeem tshem tawm adenomyosis yam tsis muaj kev phom sij rau kev noj qab haus huv.
Ntxiv rau, cov kws kho mob qhia kom ua lub neej nquag,noj cov zaub mov noj qab nyob zoo, tawm dag zog tsis tu ncua thiab muaj lub neej kev sib deev noj qab haus huv. Nrog rau cov teeb meem tsis tu ncua ntawm kev coj khaub ncaws, nws yog ib qho tseem ceeb kom mus ntsib kws kho mob tam sim ntawd thiab ua ib qho kev ntsuam xyuas dav dav rau kev kuaj mob raws sij hawm.
