Mechanical jaundice yog ib yam kab mob pathological ua los ntawm kev ua txhaum ntawm qhov tawm ntawm cov kua tsib los ntawm cov kua tsib mus rau hauv duodenum 12 vim kev cuam tshuam cov tshuab. Cov lus txhais ntawm cov kabmob muaj xws li cov ntsiab lus: obstructive hom jaundice, achau jaundice.
Kev rhuav tshem ntawm lub bile ducts tshwm sim vim qhov kev tsis zoo ntawm cov pab pawg coob ntawm pathologies ntawm lub txiav thiab lub biliary system ntawm tus neeg (lub sij hawm hais txog kev kaw lus ntawm cov kua tsib lub plab thiab cov lus sib dhos uas yog tsom rau kev tswj qhov ntws tawm ntawm cov kua tsib). Cov tsos mob tshwm sim suav nrog: kev daj tawv nqaij, ua pa ntawm daim tawv nqaij, nti ntawm lub qhov muag, thiab lwm yam.
Yog tias koj tsis tau sau ntawv kho kom tsim nyog uas pab kho qhov kev tso tawm ntawm cov kua tsib, tom qab ntawv qhov muaj feem yuav muaj teeb meem - mob siab / lub raum tsis ua haujlwm, purulent daim ntawv ntawm cholangitis, sepsis, mob siab daim siab. Hauv cov xwm txheej nyuaj, tawm tsam keeb kwm ntawm tsis muaj kev pab kho mob, tus neeg mob tuag.
Cov teeb meem tshwm sim uas muaj mob txha nqaj qaum: mob cholelithiasis (feem ntau muaj hnub nyoog qis dua 30 xyoo), mob qog ua ntshav, ua pa ntawm lub plab zom mov. Tus mob tsis tuaj yeem kis ntawm ib tus neeg mus rau lwm tus. Xav saib cov tsos mob ua ke nrog tus kab mob thiab yuav kho nws li cas.
Etiology ntawm kev muaj nqaij tawv daj
Hauv cov tshuaj niaj hnub, pathanatomy ntawm tus kab mob yog to taub zoo. Ua raws li tus kabmob provoking, pathological syndrome tau faib ua tsib pawg loj. Thawj zaug suav nrog kev tsis pom qhov tsis zoo, vim tias biliary system tsis tuaj yeem tsim kho zoo.
Qhov thib ob pab pawg neeg hais txog kev hloov pauv benign hauv cov leeg ua haujlwm thiab cov tib neeg cov kua tsib, uas ua raws cholelithiasis. Piv txwv li, kev tsim ntawm kev suav ntawm cov kua dej ntawm cov kua dej, kev tawm tsam ntawm cov phab ntsa ntawm duodenum 12, txoj kev nqaim ntawm duodenal papilla, hlwv, inductive daim ntawv ntawm pancreatitis, pancreatic necrosis, thiab lwm yam.
Cov pab pawg thib peb yog txoj kev nruj ntawm cov kua tsib lub plab tseem ceeb vim yog kev phais mob. Qhov teeb meem tam sim ntawd suav nrog kev sib tsoo thaum lub sijhawm phais mob lossis suturing tsis raug.
Neoplasms thawj lossis theem nrab cov qog nqaij hlav (pawg plaub). Pauv qhia pathologies:
- Oncology ntawm lub zais zis.
- Pancreatic mob cancer ntawm lub taub hau.
- Lub xub ntiag ntawm daim siab metastases vim tias muaj cov qog ntawm ntau qhov chaw.
Qhov laj thawj thib tsib yog kab mob parasitic. Piv txwv, echinococcosis, vim tias cov hlwv nrog parasitic txheem daim ntawv. Tsis muaj kev pab kom raws sijhawm yog lub caij nyoog dhau 90%.
Txoj kev mob daj ntseg ntawm cov nqaij mos hauv cov menyuam mos yug los yog muaj ntau ntawm bilirubin hauv cov ntshav ntawm tus menyuam. Bilirubin yog ib yam khoom uas tsim los ntawm hemoglobin thiab protein ntau yam uas muaj hlau. Yog tias cov ntsiab lus bilirubin ntau zuj zus, ces tib neeg daim tawv nqaij yuav daj. Lub caj dab yog raws li nram no: kev yoog rau ib puag ncig cov kab mob, immaturity ntawm enzyme system hauv tus menyuam.
Feem ntau tshwm sim yog qog ntshav hlav. Cov qog yuav tuaj yeem nyob hauv thaj chaw mob siab, mob plab, mob plab, hlab pas, pancreatic taub hau.
Helminthiasis thiab ua mob qog nqaij hlav tawm ntawm qhov biliary yog qhov tsis tshua muaj tshwm sim.
Soj ntsuam qhov tsos mob txhaws qau
Muaj teeb meem txog kev sib daj sib deev raws li International Classification of Disease (ICD 10) tau txiav txim los ntawm tus lej K83.1. Cov kev kuaj mob tseem ceeb suav nrog kev hloov xim ntawm daim tawv nqaij, cov leeg thiab lub qhov muag daj.
Cov neeg mob feem ntau yws yws ntawm kev mob npub ntawm thaj av epigastric. Kev hnov mob hnov qab zuj zus. Lub rooj zaum yog kua, ntau zaus. Cov zis yuav tsaus hauv xim, lub ntxhiab tsw tshwj xeeb.
Khaus ntawm daim tawv nqaij kuj tseem muaj, qee zaus tus neeg mob tau mob, qee zaum ntuav. Tus neeg mob plam nws lub qab los noj mov, ntsig txog, qhov txo hauv lub cev qhov hnyav. Lub cev kub nce. Ultrasound qhia kev nce hauv daim siab.
Thaum lub pob zeb txhaws lub bile ducts, qhov mob yog ib txwm ntse, txhawm plhaw. Nws tuaj yeem raug muab rau sternum, lossis rau txoj cai axilla, scapula. Cov tsos mob sab nraud ib txwm kuaj pom 24-48 teev tom qab qhov mob tsawg dua. Ntawm palpation ntawm kev xam pom ntawm daim siab, tus neeg raug mob. Lub zais zis zais tsis yog palpable.
Thaum lub tshuab ntawm kev txhim kho qog nqaij hlav yog ua rau qog ntawm cov leeg voos, qhov ua txhaum ntawm txoj kev ua biliary, tsib lub plab, ces cov cim muaj raws li nram no:
- Hnov hnov mob hauv thaj chaw epigastric, dhau mus rau sab nraud;
- Nrog palpation, koj tuaj yeem qhia qhov ncauj lus ncua ntev, lub siab ua rau nws tsis ua rau hnov cov kev hnov mob;
- Lub siab ua dav, muaj cov qauv ntom;
- Yog hais tias qhov tsim ntawm malignant xwm, ces tus qauv muaj cov me tshaj nodules.
- Spleen tsis tshua muaj probed.
Kev nce siab yog qhov ua rau muaj tus mob ntev tshaj. Nws hloov pauv qhov loj vim stagnation ntawm bile thiab inflammatory txheej txheem hauv cov kua tsib lub raj tawm.
Pruritus ntawm daim tawv nqaij thab cov neeg mob txawm tias ua ntej cov tsos mob ntawm chaw kho mob yellowness ntawm daim tawv nqaij, ntau qhia meej meej hauv qog cov kab mob ntawm pathology. Nws muaj zog thiab mob txaus, ua rau ib tug neeg ntxhov siab ntau. Cov tshuaj tsis pab nres. Kev khawb tau tshwm sim ntawm daim tawv nqaij, qhov tsim muaj pob zeb me me tau kuaj. Kev hnyav hnyav nyob rau hauv cov qauv mob qog.
Yog hais tias tus neeg mob lub cev kub nce nrog rau lwm cov tsos mob, ces tus kab mob biliary ua paug yog xav tsis thoob. Qhov mob kub taub hau ntev yog lub cim txawv qhia qhov txawv txav ntsej muag daj ntseg ntawm kab mob siab. Kab mob siab yog kis tau, lawv tuaj yeem sib kis tau los ntawm kev sib cuag nrog tus neeg mob li ntawm 3-4 lub lim tiam ntawm lub sijhawm muab tus kab mob.
Lub plab zom tau nce ntxiv nrog cov qog ntawm qhov loj duodenal papilla, lub taub hau pancreatic thiab cov davhlau ya nyob twg ntawm cov hom kua tsib.
Lub siab ua haujlwm loj hauv 75% ntawm daim duab, thiab lub zais zis hauv 65% ntawm tus neeg mob, uas muaj nyob hauv kev kuaj mob laparoscopic hauv 100% ntawm cov neeg mob.
Kev kuaj mob ntawm cov nqaij daj
Txhawm rau kom paub tseeb qhov kev kuaj mob thiab muab tshuaj kho kom zoo txaus, ib qho kev kuaj mob txhij txhua yog ua tiav. Nws suav nrog qhov kev kuaj pom ntawm tus neeg mob, kev mob plab hauv plab, kuaj thiab cuab yeej txoj kev kuaj mob.
Yog hais tias tus neeg mob tau mob qog dhau, tom qab ntawd ua ntej kev kuaj mob yog qhov yooj yim heev, vim nws yooj yim palpated. Nyob rau theem pib ntawm kev tsim muaj lub ntsej muag daj, kev kuaj mob tuaj yeem ua rau qee qhov nyuaj, vim tias cov tsos mob tuaj yeem ua lub cim ntawm ntau lub pathologies.
Piv txwv li, nrog kev nce ntxiv ntawm qhov kev coj ua ntawm cov "cov" phom sij phom sij, bilirubin, cov kev ua si alkaline phosphatase, daj ntseg thiab kab mob siab tuaj yeem xav tias yog.
Txhawm rau txhawm rau kuaj pom qhov tseeb, kev kuaj ntshav dav dav. Nws tso cai rau koj txhawm rau txo qis cov ntshav liab, hemoglobin. Muaj leukocytosis, siab ESR - cim ntawm cov txheej txheem inflammatory; tseem ua kev tshawb nrhiav biochemical.
Txoj kev kuaj mob:
- Ultrasound kev soj ntsuam Siv cov txheej txheem tsis ncaj, ib tus tuaj yeem kuaj pom qhov nthuav dav ntawm cov kua tsib lub raj, muaj cov pob zeb nyob hauv lawv, thiab focal mob siab. Ntxiv rau, ib qho ultrasound ntawm cov txiav thiab lwm yam khoom hauv nruab nrog cev tuaj yeem tsim kho.
- Duodenography. Qhov no yog kev xoo hluav taws xob ntawm duodenum 12 tawm tsam keeb kwm yav dhau los ntawm kev tsim dag ntxias, pab tshawb nrhiav qhov tawv nqaij plob tsis so tswj - cov tsos mob ntawm Frostberg.
- RCHP yog siv rau hauv cov duab hauv chaw kuaj mob thaum lwm txoj hauv kev rau kev tshuaj xyuas cov lus qhia me ntsis, thaum thaiv ntawm cov duodenal papilla yog xav tias tsam tsis. Ib lub raj tshwj xeeb yog tso rau hauv qhov ntsaws, dhau ntawm qhov sib piv uas nkag mus rau tom qab, tom qab ntawd cov duab txuas ntxiv. Ua tsaug rau hom no, koj tuaj yeem tshawb pom qog, kawm cov ncauj lus ntawm cov channel. Cov txheej txheem yog kev qhia, tab sis vim nws yog ncaj qha, nws tau feem ntau nrog ntau yam mob.
- Qhov xaim hluav taws xob xoo ntawm lub siab pab tsom cov mob neoplasms thiab teeb meem tshwm sim los ntawm helminths.
Qee zaum laparoscopy siv - tus txheej txheem ntxeem tau uas pab txhawm rau txhawm rau kuaj metastases, los txiav txim siab qhov ntau ntawm lub siab ua haujlwm thaum lub sijhawm helminthiases - alveococcosis thiab echinococcosis.
Kev Kho Mob Lub Cev thiab Kev Tshuaj Ntsuam
Kev kho feem ntau yuav cuam tshuam qhov phais. Cov tshuaj muaj hom noj haus kom meej. Tus neeg mob tau hais kom tsom rau cov zaub mov zaub, noj txiv hmab txiv ntoo thiab cov khoom noj siv mis.
Noj li xya zaug ib hnub hauv seem me. Cov txheej txheem ntawm kev npaj yog npau npau. Nco ntsoov ua raws li cov kev haus dej haus cawv - ob peb tee kua dej ib hnub.
Cov kua nplaum thiab tshuaj vitamin B yog siv ua haujlwm raws lub cev.Muaj li cov kuj tseem siv cov tshuaj tiv thaiv lub siab thiab ua kom cov ntshav txaus hauv lub cev. Txhawm rau kho mob rau tus neeg mob, cov tshuaj tua kab mob tua tau siv yog tias tsim nyog. Ua ntej kev phais mob, kev kuaj ntshav coagulation ua tiav.
Kev phais mob ntawm lub ntsej muag txhaws:
- Yog tias txoj kev siv biliary txhaws, tom qab ntawd cov kua tsib yuav tsum tau txhawm dej kom rov muaj kua tsib tag nrho.
- Kev siv tshuab tawm ntawm lub zais zis.
- Tshem tawm ntawm kev txiav tawm nyob rau hauv lub gallbladder.
- Qee feem ntawm kev hloov kho lub siab ua haujlwm, uas cuam tshuam los ntawm qhov txheej txheem txawv txav.
Lub hom phiaj tseem ceeb ntawm kev ua haujlwm yog los kho qhov qub ntws tawm ntawm bile. Yog tias qhov xwm txheej nyuaj, tom qab ntawd ntau cov kev phais mob tuaj yeem ua ke tib lub sijhawm.
Lub sijhawm ntawm kev muaj teeb meem ntawm tawv nqaij muaj ntau yam sib txawv: los ntawm ob peb hnub nrog kev cuam tshuam luv nrog lub pob zeb mus rau ob peb lub hlis nrog qog. Yog li, kev soj ntsuam ntawm lub neej thiab kev muaj sia nyob ntawm tus neeg mob nyob ntawm chav kawm ntawm tus kab mob hauv qab.
Txog daj cev tau piav nyob rau hauv cov yeeb yaj kiab hauv tsab xov xwm no.
