Lub lag luam kom tshem tawm gallstones. Kev npaj rau ib hoob kev tuamyeem phais

Gallstone tus kab mob tau tam sim no kuj yog ib qho ntawm feem ntau tshwm sim ntawm cov mob plab pathology, thiab phais kom tshem tawm gallstones - ib txoj kev ntawm yuav tsum muaj cov tshuaj rau qhov teeb meem.

Gallstone tus kab mob - yog dab tsi?

Tus kab mob no yog txuam nrog rau cov tsim nyob rau hauv cov kua tsib ducts thiab tsib lub zais zis pob zeb (calculi). Nws yog tsim rau cov nram qab no yog vim li cas:

• stagnation los yog hloov nyob rau hauv nyob tus yeees ntawm cov kua tsib;
• inflammatory dab;
• bilification txhaum (dyskinesia).

Nyob rau hauv muaj pes tsawg leeg, muaj peb hom pob zeb. Cov feem ntau (80-90% ntawm cov neeg) muaj cholesterol pob zeb. Lawv tsim muaj txhawb rau tshaj cholesterol cov ntsiab lus nyob rau hauv lub bile. Thaum zoo li no tshwm sim rau hauv lub tsim ntawm muaju vim deposition ntawm cholesterol nyob rau hauv excess precipitate. Yog hais tias lub kom ntawm lub tsib lub zais zis lawm, ces cov formations yuav tsis tso tawm nyob rau hauv lub plab hnyuv cheeb tsam, thiab nyob twj ywm tsis pub dhau nws thiab pib loj hlob tuaj.

Xim zeb tsim vim nce disintegration ntawm cov ntshav - ntshav liab. Feem ntau cov feem ntau nws yuav tsum muaj cai nyob rau hauv hemolytic anemia. Tseem muaj mixed kev kawm ntawv. Lawv yog ib tug ua ke ntawm ob cov ntaub ntawv. Nws yog tsim los ntawm cov roj uas txhaws taus, bilirubin thiab calcium.

Seb lub lag luam yog tsim nyog

Txhua leej txhua tus uas tau raug mob gallstones, ntxov los yog tom qab confronted nrog rau lo lus nug ntawm seb puas yuav hauj lwm kev pab los sis yuav muaj txaus rau conservative kev kho mob. Nws yog ib nqi hais tias cov pob zeb lawv tus kheej yog tsis thaj av kom tshem tawm cov gallbladder. Yog hais tias lawv tsis qhia lawv tus kheej, thiab tsis txhob cuam tshuam rau cov lag luam ntawm lwm yam lub cev, ib lub lag luam yuav tsis xav hais tias. Txawm li cas los, yog hais tias muaj kev mob kev nkeeg nyob rau hauv lub gallbladder, ib tug ua txhaum ntawm lub dav mob, yellowness, ceev yuav tsum tau sab laj ib tug kws phais neeg. Nws yog nws leej twg, tom qab lub daim ntawv ntsuam xyuas yuav txiav txim siab seb hauj lwm kev pab yog tsim nyog thiab nws yog dab tsi. Tab sis yuav tsum paub hais tias cholecystitis gallbladder txhais tau hais tias twb pib qhov kev inflammatory txheej txheem. Yog hais tias ntev li laug sij hawm mus rau kev txiav txim, qhov uas yuav kom restore noj qab haus huv tom qab phais dramatically txo. Txawm yog hais tias muaj ib zaug xwb nres, gallstones zoo rau tshem tawm.

Indications phais

Thaum txiav txim siab rau qhov yuav tsum tau rau kev phais, cov kws txawj feem ntau yog xav txog yam nram qab no:

• xub ntiag ntawm lub pob zeb (calculi) ntawm txawv ntau thiab tsawg, occupying ib feem peb ntawm lub tsib lub zais zis;
• yog hais tias tus kab mob no yog ib tug heev muaj ntau ntawm kev mob nyob rau hauv lub gallbladder (biliary Colic), lub lag luam yog nqa tawm hais txog ntawm lub qhov ntau ntawm concrements;
• Yog hais tias lub pob zeb cov txheej txheem ntawm nyob rau hauv lub tsib lub zais zis thiab nyob rau hauv lub ducts;
• thaum uas txo lub peev xwm ntawm lub gallbladder rau daim ntawv cog lus los yog nws cov kom tiav disconnection;
• txoj kev loj hlob ntawm biliary pancreatitis;
• los ntawm breakage ntawm lub gallbladder phab ntsa;
• nrog occlusion ntawm cov hepatic ciav.

Muaj thoob ntiaj teb raws li kev cai rau kev txiav txim qhov yuav tsum tau rau kev phais nyob rau hauv cholelithiasis. Summing li cov ntsiab lus uas yog muab mus rau ntau yam diagnostic indicators, As, tus kws kho mob yuav txiav txim seb phais yog yuav tsum tau, raws li tau zoo raws li tus txheeb ze thiab tsis indications rau nws.

hom hauj lwm

Feem ntau, cov txheej txheem ntawm tsim ntawm gallstones - nws yog tsis ceev ceev. Ntawm cov hoob kawm, yog hais tias koj unlucky, thiab tsheb thauj neeg mob yuav coj koj mus rau ib tug phais tsev kho mob nrog ib tug mob nres, uas kuaj mob raws li cholecystitis, gallbladder, cov kev xaiv uas koj muaj yog me me. Tab sis feem ntau ntawm cov neeg uas paub txog qhov teeb meem nyob rau hauv ua ntej nrog koj tus kws kho mob tag nrho cov sib cov lus, txiav txim seb lub hnub ntawm lub tswv yim npaj phais.

Nyob rau hauv niaj hnub tshuaj, muaj ob txoj kev ntawm tshem lub gallbladder (cholecystectomy)

• qhib cholecystectomy - cov tsoos txoj kev muab rau kev qhib rau mob plab kab noj hniav;
• laparoscopic cholecystectomy - ib tug niaj hnub txheej txheem uas yog dua hnub no.

qhib cholecystectomy

Qhov no lub lag luam kom tshem tawm gallstones yog ib tug classic phais. Tom qab ib tug seem raws midline ntawm lub plab mog yog ua soj ntsuam ntawm lub plab kab noj hniav, thiab tsib lub zais zis tshem tawm, yog tias tsim nyog, kua (installation hlab, nyob rau hauv thiaj li yuav kom cov outflow ntawm lub resulting exudate thiab lwm yam kua nruab nrog cev).

Dua li ntawm qhov rov tshwm sim ntawm ib tug niaj hnub thiab high-tech txoj kev, qhib cholecystectomy tseem tseem ceeb. Qhov no yuav ua tau piav los ntawm lub fact tias ib txhia tsev kho mob tsis muaj cov khoom los yog cov kws tshwj xeeb tsim nyog tsim nyog mus nqa tawm laparoscopic cov txheej txheem. Nyob rau hauv tas li ntawd rau tej no, muaj tej yam contraindications.

Laparoscopy gallbladder

Qhov no yog lwm daim ntawv ntawm kev phais nyob rau hauv gallstone tus kab mob. Rau hnub tim, qhov no txoj kev yog ua ntau ntau vim hais tias ntawm nws cov hauj lwm zoo, uas tsis muaj-tej yam, yuav txo tau ntawm rov qab cov ntsiab lus. Lub lag luam yog ua siv lub laparoscope - ib tug tshwj xeeb apparatus, uas tso cai rau nkag mus rau lub puas hloov khoom nruab nrog ntawm ntau punctures lub plab phab ntsa los ntawm kev uas lub manipulators yog qhia thiab, ua tau, ib tug laparoscope. Qhov no txoj kev tso cai rau koj mus tsis tau tsuas yog tshem tawm cov gallbladder yog tsis tawm hauv lub nti, tab sis nyob rau hauv tej rooj plaub tsuas tshem tawm cov pob zeb, tawm hauv lub cev nyob rau hauv qhov chaw. Ib tug zoo xws li cov qauv no yog siv tsis tau tsuas yog rau cov kev kho mob ntawm gallstone tus kab mob, tab sis kuj rau qhov kev tshem tawm ntawm hnyuv tws, cov kev kho mob ntawm inguinal hernias, ib co gynecological kab mob, thiab diagnostic hauj lwm. Dua li ntawm qhov tseeb zoo ntawm laparoscopic cholecystectomy, qhov no txoj kev nws muaj nws contraindications. Cov muaj xws li:

• rwj, nyob rau hauv lub cheeb tsam ntawm lub lag luam;
• peb lub hlis tas ntawm cev xeeb tub;
• mob loj heev cardiopulmonary kab mob.

Tsis tas li ntawd, nco ntsoov tias thaum lub sij hawm laparoscopic phais, nyob rau hauv cov ntaub ntawv ntawm lub slightest kev nyuaj nyob rau hauv nws tam sim no, cov neeg phais dhau mus rau qhib cholecystectomy. Yog li xaus txog 5% laparoscopic phais.

Kev npaj rau kev phais

Raws li cov kev phais, phais kom tshem tawm cov pob zeb nyob rau hauv lub gallbladder yuav tsum tau ib co kev cob qhia. Dhau li ntawm tus txheem daim ntawv ntsuam xyuas xws li ib tug me nyuam analyses (CBC thiab urinalysis, ntshav biochemistry, coagulation - kev tshawb nrhiav ntawm cov ntshav txhaws, daim siab muaj nuj nqi kev ntsuam xyuas), nws yog tsim nyog los ua mob plab ultrasonography, electrocardiography, hauv siab X-rays, raws li indications FGS thiab xoos hnyuv laus, thiab tau tus kws qhia. Ntxiv mus, kev npaj rau ib hoob kev tuamyeem phais muaj xws li tshem tawm cov tshuaj rau coagulability ntawm cov ntshav. Cov no muaj xws li ib tug ntau yam ntawm anticoagulants, vitamin E, uas tsis yog-tshuaj anti-inflammatory siv tshuaj. Ob peb hnub ua ntej lub lag luam yuav tsum tau tshwj xeeb mloog mus noj cov zaub mov nyob rau hauv cholelithiasis. Cov ntawv qhia zaub mov yuav tsum tsis txhob muaj ntau hauv cov zaub mov, thiab pib los ntawm ib tag hmo ntawm lub hnub thaum lub lag luam yog ua, nws yog tsim nyog los tshem tawm cov zaub mov thiab haus dej. Nyob rau Eve ntawm lub trading hnub rau tu lub plob tsis so tswj thaum sawv ntxov thiab yav tsaus ntuj ua kev ntxuav enemas los yog noj tshwj xeeb cov tshuaj. Nyob rau hauv thaum sawv ntxov muab ib tug da dej nrog antibacterial xab npum.

Lub postoperative lub sij hawm

Niaj hnub no nws yog ib qhov nyuaj rau surprise ib tug neeg cholecystectomy. Qhov no lub lag luam kom tshem tawm gallstones tau ntev muab tso rau "nyob rau kwj", thiab yog hais txog li ntau li cov ib appendectomy. Tus neeg mob twb plaub teev tom qab kawm tiav ntawm lub lag luam, lub sij hawm uas nws yog tsis yooj yim sua rau haus thiab ua ntse zog yog tso cai rau tig rau hauv txaj. Koj muaj peev xwm ces pib haus cov dej uas tsis roj nyob rau hauv me me (1-2 lub caj pas, tab sis tsis ntau tshaj li 500 ml). Tom qab rau lub sij hawm tom qab laparoscopic phais tus neeg mob yuav tau txais li. Ua nws zoo dua, yog hais tias muaj yog ib tug neeg los ntawm cov kev kho mob cov neeg ua haujlwm los yog cov txheeb ze, vim tom qab lub cev rau ib tug ntev lub sij hawm nyob rau hauv ib lub kab rov tav txoj hauj lwm thiab nyob rau hauv ib lub xeev ntawm tshuaj loog, thaum koj sim tau li tej zaum yuav muaj kiv taub hau thiab tsaus muag. Tus heev hnub tom ntej tom qab ua hauj rau tus neeg mob yuav tsiv mus nyob dawb nyob rau hauv lub tsev kho mob.

Tom qab muab hlais tawm lawm, kev noj haus yog tseem ceeb heev nyob rau hauv cholelithiasis. Ntawv qhia zaub mov ntawm lub hnub yuav muaj xws li ib tug kua noj haus - porridge nyob rau hauv dej, kev noj haus kua zaub, khoom noj siv mis. Ntxiv nyob rau hauv cov khoom noj muaj xws li hau nyuj, nqaij qaib mis, ci apples los yog txiv tsawb. Nws yuav tsum tau nco ntsoov tias twb nyob rau hauv thawj lub lim tiam tom qab lub lag luam yog txwv tsis pub haus dej haus cawv, muaj zog tshuaj yej los yog kasfes, qab zib, khoom kib thiab zaub mov muaj roj.

litholytic txoj kev kho

Yog hais tias kev phais kev pab yog tsis tau vim rau muaj mob loj Somatic kab mob los yog mob ntawm cov ntshav txhaws, raws li zoo raws li qhov tsis kam ntawm cov neeg mob los ntawm cov kev phais, muaj litholytic txoj kev kho. Qhov no txoj kev, uas siv formulations muaj kua tsib acids, npaj rau yaj tsim lub pob zeb. Txij li thaum nws yog tsim nyog los xav txog tias lub caij ntawm kev kho mob tej zaum yuav txawv ntawm ib lub xyoo los ob xyoos, thiab txawm yog hais tias nws yog ua tau rau yaj gallstones kiag li, nws tsis guarantee hais tias lawv yuav tsis rov tshwm dua. Nyob rau hauv tas li ntawd, nyob rau hauv lub chav kawm ntawm kev kho mob tej zaum yuav ntau yam teeb meem ntawm gallstone tus kab mob, nrog rau cov uas yuav tsum tau phais kev cuam tshuam.

Kev Cai litholytic Therapy

Lwm txwv litholytic txoj kev kho yog tej yam uas yuav tsum tau rau cov txheej xwm ntawm tus kab mob:

1. Gallstones cholesteric xav yuav, nrog qhov ntev tsis tshaj 20 mm.
2. Muaj nuj nqi ntawm lub gallbladder txais kev cawmdim thiab pob zeb tsis nyob ntau tshaj ib nrab ntawm nws volume.
3. Cystic thiab cov kua tsib duct yuav tsum muaj nws cov patency.
4. Txij li thaum lub tsim ntawm lub pob zeb tsis ntau tshaj li ob lub xyoos.
5. Nyob rau hauv keeb kwm yuav tsum muaj uncomplicated chav kawm ntawm tus kab mob - me me mob, nyob bouts ntawm Colic.

Kev kho mob yog nqa tawm nyob rau hauv ultrasound txhua txhua 3-6 lub hlis. Yog hais tias tom qab rau lub hlis yog tsis muaj txoj kev txhim kho, ces nws yog tswv ices, thiab ib zaug dua tsa qhov teeb meem ntawm kev phais. Yog hais tias litholytic txoj kev kho tau kev vam meej, nyob rau hauv thiaj li yuav raws sij hawm ntes tus tshiab khiv tsim gallstones, US ua tsawg kawg ib zaug nyob rau hauv peb lub hlis.