Cov pob zeb duct tau muab faib ua pob zeb zoo tib yam thiab pob zeb nyuaj. Niaj hnub no peb yuav kawm tau tias yuav tshem cov pob zeb ciav bile uas nyuaj uaErcp.
Qhov "nyuaj" ntawm cov pob zeb nyuaj yog feem ntau vim yog cov duab nyuaj, qhov chaw tsis txaus ntseeg, kev nyuaj thiab kev pheej hmoo ntawm kev tshem tawm. Piv nrogErcpRau cov qog zom ntshav duct, kev pheej hmoo yog sib npaug lossis siab dua. Thaum ntsib kev nyuaj siab hauv txhua hnubErcpUa haujlwm, peb yuav tsum tau muab peb lub siab nrog kev paub thiab qhia peb lub siab nyiam hloov peb cov kev txawj ntse.
01etiological kev faib tawm ntawm "Cov pob zeb nyuaj"
Cov pob zeb nyuaj tuaj yeem muab faib ua cov pab pawg pob zeb, cov pab pawg tsis sib haum, pawg kab mob tshwj xeeb raws li lawv cov laj thawj.
① Pawg Pob Zeb
Lub ntsiab tseem ceeb suav nrog cov bile duct pob zeb, ntau dhau (slam pob zeb), pob zeb slam), thiab muaj kev cuam tshuam ntawm AOSC). Cov no yog txhua qhov xwm txheej uas nws nyuaj rau tshem tawm cov pob zeb thiab cov lus ceeb toom ntxov.
Lub pob zeb tshwj xeeb tshaj yog loj (lub cheeb> 1.5 cm). Qhov kev nyuaj thawj zaug tshem lub pob zeb yog tias lub pob zeb tsis tuaj yeem tshem tawm lossis tawg ntawm cov khoom siv. Qhov nyuaj thib ob yog tias lub pob zeb tsis tuaj yeem raug tshem tawm lossis tawg tom qab raug tshem tawm. Lub taub hau kub ceev yog xav tau nyob rau lub sijhawm no.
Cov pob zeb me yuav tsum tsis txhob coj me me. Tshwj xeeb yog cov pob zeb me me tuaj yeem hloov tau yooj yim lossis khiav mus rau lub siab, thiab cov pob zeb me me kom pom thiab npog, ua rau lawv nyuaj rau kev kho mob endoscopic.
Rau cov pob zeb duct-plot-plot,ErcpKev tshem tawm pob zeb yuav siv sijhawm ntev thiab yog qhov yooj yim los ua kev raug kaw. Kev phais mob feem ntau yuav tsum tau tshem cov pob zeb.
②anatomical txawv txav
Anatomical Txawv Tebchaws suav nrog Bile Ciav Distortion, Firrizi Syndrome, thiab Cov Txheej Txheem Txawv Tebchaws nyob rau hauv qis dua ntu. Peripapillary diverticula kuj yog ib qho kev txawv txav anatomic.
· Tom qab lub LC phais, cov qauv ntawm cov nplais npuas yog qhov txawv txav thiab cov kua tsib leeg txhaws. ThaumErcpKev ua haujlwm, cov lus qhia hlau yog "yooj yim tso tab sis tsis yooj yim tso rau tom qab thaum kawg mus daws teeb meem ntawm cov lus qhia hlau prolapse thiab caij nplooj zeeg sab nraum qab ciav.
· Mirchizz syndrome yog ib qho kev txawv txav tsis zoo uas tau yooj yim tu thiab tsis quav ntsej. Kev tshawb fawb kev kawm: Tom qab LC phais, tus neeg mob nrog cov cystic duct pob zeb compressed cov bile ducted, ua rau muaj dab tsi ua rau pom muaj tseeb. Lub pob zeb yuav tsis raug tshem tawm hauv koj qhov kev soj ntsuam xoo hluav taws xob. Thaum kawg, qhov teeb meem tau daws tom qab kev kuaj mob thiab tshem tawm raws li lub zeem muag nrog eymax.
RauErcpBile Ciav Pob Zeb Tshem tawm hauv Parotric cov neeg mob tom qab Bi II kev phais, tus yuam sij yog mus txog lub txiv mis los ntawm cov kab mob. Qee lub sij hawm nws siv sijhawm ntev (uas yuav tsum muaj lub zog muaj zog) mus txog lub txiv mis, thiab yog hais tias tus neeg taw qhia tsis tswj tau zoo, nws tuaj yeem yooj yim tuaj.
③hertaryarations
Peripapvillary divericulum ua ke nrog cov pob zeb ciav hlau yog sib xws. Qhov nyuaj hauv kev ua haujlwm nyob rau lub sijhawm no yog qhov pheej hmoo ntawm lub txiv mis ntawm kev phais mob thiab nthuav dav. Qhov kev pheej hmoo no loj tshaj rau cov txiv mis nyob rau hauv lub divericulum, thiab kev pheej hmoo rau cov txiv mis nyob ze rau cov divericulum yog me dua.
Nyob rau lub sijhawm no, nws kuj tseem tsim nyog yuav tsum nkag siab txog kev nthuav dav. Lub hauv paus ntsiab lus dav dav ntawm kev nthuav dav yog kom txo qis kev puas tsuaj yuav tsum tau tshem pob zeb. Me dua kev puas tsuaj txhais tau tias muaj kev pheej hmoo tsawg. Tam sim no, zais pa nthuav ntau (CRE) ntawm lub txiv mis nyob ib ncig ntawm cov dab neeg feem ntau yog siv los zam kev.
Cov neeg mob uas muaj kab mob hematological, cardiopulmonary uas tsis tuaj yeem tiv tausErcp, lossis tus mob txha taub hau kev mob uas tsis tuaj yeem zam lub sijhawm ntev tshaj plaws yuav tsum tau them sai sai rau thiab ntsuas thaum ntsib cov pob zeb nyuaj.m
02 Lub Neej Psychology ntawm ntsib "cov pob zeb nyuaj"
Tsis ncaj ncees lub txim thaum ntsib "cov pob zeb nyuaj": Kev siab tawv thiab ua tiav, kev ua haujlwm tsis sib xws, thiab lwm yam.
Hely thiab kev hlub rau cov txiaj ntsig zoo
Thaum ntsib pob zeb bile, tshwj xeeb yog cov pob zeb, peb ib txwm xav kom tshem ntawm txhua lub pob zeb. Nov yog hom "siab hlob" thiab txoj kev vam meej zoo.
Qhov tseeb, nws yog qhov tseeb los coj tag nrho thiab kev dawb huv, tab sis noj cov ntshiab ntawm txhua tus nqi yog ib yam nkaus thiab "zoo tagnrho", uas tsis muaj kev nyuaj siab thiab muaj teeb meem. Ntau cov pob zeb duct yuav tsum tau txiav txim siab txiav txim siab raws li tus neeg mob qhov xwm txheej. Hauv cov xwm txheej tshwj xeeb, lub raj yuav tsum tau muab tso rau lossis tshem tawm hauv cov pob.
Thaum cov pob zeb pob zeb pob zeb loj loj loj yog qhov nyuaj rau tshem tawm ib ntus, "muaj kev sib cais" tuaj yeem txiav txim siab. Tsis txhob yuam kev tshem tawm cov pob zeb loj, thiab tsis txhob muab koj tus kheej rau qhov xwm txheej txaus ntshai heev.
· Tsis tu ncua
Ntawd yog, qhov muag tsis pom kev tsis muaj kev tsom xam thiab tshawb xyuas feem ntau ua rau pob zeb tshem tawm tsis ua haujlwm. Yog li ntawd, cov rooj plaub ntawm cov pob zeb duct yuav tsum tau kuaj xyuas txhua yam ua ntej kev phais, muaj feem tau ntsuas (xav tau lub peev xwm ntawmErcpCov kws kho mob los nyeem cov duab), ua tib zoo txiav txim siab thiab cov phiaj xwm xwm ceev yuav tsum tau ua kom tiv thaiv lub pob zeb tshem tawm.
TusErcpPob zeb extraction npaj yuav tsum yog scientific, lub hom phiaj, muaj txhij txhua, thiab muaj peev xwm tiv thaiv kev tsom xam thiab kev txiav txim siab. Peb yuav tsum ua raws li lub hauv paus ntsiab lus ntawm kev ua kom tus neeg mob tus neeg mob tau txais txiaj ntsig thiab tsis yog lam ua.
As
Cov pob zeb me me nyob rau hauv qis dua ntawm cov nplais nqaij yog qhov yooj yim los tsis quav ntsej. Yog tias lub pob zeb me me pom cov teeb meem kev teeb meem me me hauv qhov qis dua ntawm cov nplais bile thiab nws qhov hluav taws xob, nws yuav nyuaj heev kom tshem tau lub pob zeb.
ErcpKev kho rau cov pob zeb duct pob zeb muaj ntau yam hloov thiab muaj kev pheej hmoo siab. Nws yog qhov nyuaj thiab pheej hmoo li lossis siab duaErcpKev kho mob rau cov qog duct. Yog li ntawd, yog tias koj tsis coj nws maj mam, koj yuav tawm ntawm koj tus kheej txoj kev khiav dim.
03How los nrog "Cov pob zeb nyuaj"
Thaum ntsib cov pob zeb nyuaj, kev ntsuas kev ntsuas ntawm tus neeg mob yuav tsum tau ua, yuav tsum tau muaj kev nthuav dav txaus, aPob Zeb Roundivy Pob tawbYuav tsum tau xaiv thiab ib Lithotripter npaj, thiab prefabricated phiaj xwm thiab txoj kev npaj kho yuav tsum yog tsim.
Raws li lwm txoj kev xaiv, qhov zoo thiab cons yuav tsum raug ntsuas raws li tus neeg mob ua ntej ua tiav.
· Rooj ua
Qhov loj me ntawm kev qhib yog raws li qhov xwm txheej ntawm lub hom phiaj pob zeb thiab cov nplais. Feem ntau, kev phais me me + loj (nruab nrab) dilation yog siv los nthuav kev qhib. Thaum muaj, nws yog ib qho tsim nyog kom zam dhau qhov loj sab nraud thiab me me sab hauv.
Thaum koj tsis paub, nws yooj yim los ua kev phais uas yog "loj rau sab nraud tab sis me me rau sab hauv", yog tias tsis muaj phais nyob sab hauv. Qhov no yuav ua rau cov pob zeb tshem tawm kom swb.
Thaum ua yeeb yam ist yog phais, "Kev phais mob thiab qeeb phais" yuav tsum tau siv los tiv thaiv cov zipper phais. Kev phais yuav tsum ceev nrawm li txhua qhov phais. Lub riam yuav tsum tsis txhob "nyob twj ywm" thaum lub sijhawm phais kom tsis txhob cuam tshuam lub txiv mis thiab ua rau muaj kev cuam tshuam panb. Cov.
· Kev ntsuas kev ntawm qis dua seem thiab kev xa tawm
Pob zeb duct pob zeb yuav tsum tau soj ntsuam ntawm qhov qis dua ntu thiab qhov hluav taws xob ntawm cov nplais bile duct. Ob lub chaw yuav tsum raug ntsuas. Kev sib xyaw ntawm ob qho tib si txiav txim siab qhov kev pheej hmoo thiab kev nyuaj ntawm lub naps kev ua haujlwm.
· Atrotripssy
Ntau dhau ntawm cov pob zeb loj thiab tawv thiab pob zeb uas tsis tuaj yeem kho nrog ib qho xwm txheej kub ntxhov (Lithotripter thaum muaj xwm txheej ceev).
Bily xim pob zeb tau tuaj yeem tawg ua tej daim, thiab feem ntau ntawm cov roj (cholesterol nyuaj kuj tseem tuaj yeem daws txoj hauv kev no. Yog tias cov cuab yeej tsis tuaj yeem tso tawm tom qab khaws cia tom qab khaws cia, thiab cov Lithotripter tsis tuaj yeem tsoo pob zeb, nws yog qhov nyuaj tiag ". Nyob rau lub sijhawm no, eyamax tej zaum yuav tsum tau kuaj xyuas ncaj qha thiab kho pob zeb.
NCO TSEG: Tsis txhob siv litrotripsy nyob rau hauv qis seem thiab tawm ntawm cov kev sib txawv bile. Tsis txhob siv lub litrotrips puv thaum Lithotripsy, tab sis tawm chav rau nws. Lithotripss thaum muaj xwm ceev muaj kev pheej hmoo. Thaum lub sij hawm muaj xwm txheej ceev lithotripsys, kawg axis yuav tsis sib xws nrog bile duc axis, thiab cov nro yuav ua rau zoo heev rau kev ua kom zoo nkauj.
Daws cov pob zeb diam
Yog hais tias lub pob zeb loj dhau thiab nyuaj rau tshem tawm, koj tuaj yeem txiav txim siab stent dissolution - uas yog, tso cov yas ntim yas. Tos kom txog thaum lub pob zeb shrinks ua ntej tshem cov pob zeb, ces txoj kev vam meej ntawm kev ua tiav yuav muaj siab heev.
· Intratheepatic pob zeb
Cov kws kho mob hluas nrog kev paub me me yog qhov zoo tshaj plaws tsis yog ua rau kev kho kom zoo nkauj ntawm intrahepatic bile duct pob zeb duct pob zeb ciav pob zeb. Vim tias cov pob zeb nyob rau thaj chaw no tej zaum yuav tsis tuaj yeem raug khuam lossis ua haujlwm tob thiab tiv thaiv kev ua haujlwm ntxiv, txoj kev txaus ntshai heev thiab nqaim.
· Npab pob txha duct pob zeb ua ke nrog peripapillary divericulum
Nws yog qhov tsim nyog los ntsuas qhov kev pheej hmoo thiab kev cia siab ntawm nthuav dav. Qhov kev pheej hmoo ntawm Equinoent yog qhov tseem ceeb, tab sis tam sim no txoj kev zais pa nthuav dav yog qhov tseem xaiv. Kev nthuav dav loj yuav tsum yog qhov txaus kom tshem tau lub pob zeb. Tus txheej txheem nthuav dav yuav tsum qeeb thiab theem ntawm kauj ruam, thiab tsis pub muaj kev nthuav dav lossis nthuav dav. Koob txhaj tshuaj nthuav dav ntawm yuav. Yog tias muaj ntshav los ntshav tom qab dilation, tsim nyog kho kom tsim nyog.
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Lub Sijhawm Post: Jul-26-2024