Opaleshoni kuchotsa gallstones. Kukonzekera opaleshoni kusankidwa

matenda Gallstone n'kukhala wa zochitika ambiri mwa kudwala m'mimba, ndi opaleshoni kuti achotse gallstones - njira yothetsera kwambiri kuti vutolo.

Gallstone matenda - ndichiyani?

Matenda, amagwirizana ndi lomenyera ducts ya ndulu ndi miyala ndulu (calculi). Iwo anayamba pa zifukwa zotsatirazi:

• stagnation kapena kusintha zikuchokera ya ndulu;
• yotupa njira;
• bilification kuphwanya (dyskinesia).

Mu zikuchokera, pali mitundu itatu ya miyala. Ambiri (80-90% milandu) pali mafuta miyala. mapangidwe kumawathandiza owonjezera mafuta okhutitsidwa ya ndulu ya. Pamene izi zimachitika mapangidwe makhiristo chifukwa mafunsidwe a mafuta mu precipitate owonjezera. Ngati motility wa chikhodzodzo ndulu wasweka, ndiye formations awa sali chaonetsedwera mu malo matumbo, ndi kukhala mkati mwake ndi kuyamba kukula.

Inki miyala anapanga chifukwa kuchuluka azingokhala maselo magazi - maselo ofiira. Nthawi zambiri izi zingaoneke mu magazi m'thupi hemolytic. Palinso maphunziro losanganikirana. Iwo osakaniza njira zonsezi. Iwo wapangidwa ndi mafuta, bilirubin ndi calcium.

Kaya ntchito n'kofunika

Aliyense amene anawapeza ndi gallstones, posapita nthawi takumana ndi funso kaya alowererepo ntchito kapena angakhale okwanira mankhwala ndiwofatsa. Ndi ponena kuti miyala eni okha malo kuchotsa ndulu ofunika. Ngati satchula okha, ndipo musati bwanji ntchito yachibadwa ya matupi zina, opareshoni sangathe kuganiza. Komabe, ngati panali ululu mu ndulu, ndi kuphwanya chikhalidwe ambiri, yellowness, pakufunika kukaonana ndi dokotala. Ndipo Iye, pambuyo kafukufuku adzakhala kusankha ntchito watsala zofunika ndi chimene icho chinali. Koma dziŵani kuti cholecystitis ndulu kumatanthauza atayamba kale ndondomeko yotupa. Ngati kwambiri kusiya kaye za nkhaniyi, mwayi kuti abwezeretse kwathunthu thanzi pambuyo opaleshoni kwambiri yafupika. Ngakhale panali vuto limodzi, gallstones bwino kuchotsa.

Zikuonetsa kwa opaleshoni

Popanga kufunika opaleshoni, akatswiri zambiri tione zifukwa zotsatirazi:

• pamaso pa miyala (calculi) zamitundu yosiyanasiyana, agwilitse magawo atatu a chikhodzodzo ndulu;
• ngati matenda ndi kuukira kawirikawiri ululu mu ndulu (biliary colic), opaleshoni ikuchitika kaya ukulu wa concrements;
• Ngati miyala imakonzedwa mu chikhodzodzo ndulu ndi ducts ya;
• pamene kuchepetsa mphamvu ya ndulu ndi kutenga kapena disconnection yake;
• chitukuko cha kapamba biliary;
• ndi breakage wa pakhoma ndulu;
• ndi occlusion a wamba kwa chiwindi ritsa.

Pali malangizo padziko lonse kudziwa kufunika opaleshoni ku cholelithiasis. Polongosola mwachidule mfundo amawatumiza zizindikiro zosiyanasiyana matenda dokotala adzaona ngati opaleshoni chofunika, komanso wachibale ndipo mtheradi zizindikiro izo.

mitundu ya ntchito

Childs, ndondomeko ya mapangidwe gallstones - si kudya. Kumene, ngati muli unlucky, ndi ambulansi ndidzalandira inu kuchipatala opaleshoni nkhondo pachimake, amene anapezeka monga cholecystitis, ndulu, kusankha muli ndi yaing'ono. Koma anthu ambiri amene amadziwa za vuto pasadakhale ndi dokotala anu onse kukambirana mwatsatanetsatane, kudziwa tsiku opaleshoni anakonza.

Mu mankhwala amakono, pali njira ziwiri za kuchotsa ndulu (cholecystectomy)

• lotseguka cholecystectomy - njira chikhalidwe kusamalira kutsegula zonse m'mimba;
• laparoscopic cholecystectomy - njira zamakono kuti adalipo lero.

lotseguka cholecystectomy

opaleshoni kuchotsa gallstones ndi opaleshoni tingachipeze powerenga. Patapita gawo limodzi midline wa pamimba wapangidwa anayendera zonse m'mimba, ndi ndulu kuchotsa, ngati n'koyenera, ngalande (machubu unsembe, kuti kuonetsetsa outflow wa exudate chifukwa ndi madzi ena a m'thupi).

Ngakhale zikamera wa njira masiku ndi zina zamakono, lotseguka cholecystectomy Chinatha. Izi singalifotokoze kuti ena zipatala alibe kompyuta kapena akatswiri zofunika ziyeneretso kugwira njira laparoscopic. Kuwonjezera izi, pali contraindications ena.

Laparoscopy ndulu

Izi ndi mtundu winanso wa opaleshoni ku matenda gallstone. Pakali pano, njira imeneyi ndi kukhala wamba chifukwa cha nchito zake, otsika-amadza, kuchepetsa mawu kuchira. opaleshoni imagwiridwa ntchito laparoscope - ndi zida wapadera, amene amalola kupeza limba zowonongeka kudzera angapo punctures khoma m'mimba imene manipulators tikuuzidwa ndi, makamaka, ndi laparoscope. Njira imeneyi zimathandiza inu osati kuchotsa ndulu si kusiya mabala, koma nthawi zina yekha kuchotsa miyala, kusiya thupi malo. A njira zofanana ntchito osati zochizira matenda gallstone, komanso kuchotsa appendicitis, mankhwalawa hernias inguinal, matenda ena matenda, ndi ntchito matenda. Ngakhale ubwino bwino cholecystectomy laparoscopic, njira imeneyi ali contraindications ake. Njirazi ndi monga:

• abscess, ili mu zone ya ntchito;
• otsiriza miyezi itatu mimba;
• aakulu mouzirira matenda.

Komanso, musaiwale kuti pa opaleshoni laparoscopic, ngati vuto pang'ono masiku ano ake, madokotala pochitika kutsegula cholecystectomy. Choncho kumathetsa pafupifupi 5% laparoscopic opaleshoni.

Kukonzekera opaleshoni

Mofanana ndi opaleshoni iliyonse, opaleshoni kuti achotse miyala ndulu amafuna maphunziro ena. Kuwonjezera pa kafukufuku muyezo kuphatikizapo kufufuza ndi yobereka (malamulowa ndi urinalysis, magazi sayansi coagulation - Kufufuza clotting magazi mayesero chiwindi ntchito), m'pofunika kuti ultrasonography m'mimba, electrocardiography chifuwa X-ray, malinga ndi zizindikiro FGS ndi colonoscopy, ndipo lipotili ogwira ntchito a. Komanso, kukonzekera opaleshoni kusankidwa zikuphatikizapo Kulipira mankhwala zokhudza coagulability magazi. Izi zosiyanasiyana anticoagulants, vitamini E, si steroidal odana ndi yotupa mankhwala. Ndipo kutatsala masiku ochepa ntchito pamafunika chisamaliro chapadera kwa zakudya mu cholelithiasis. menyu sayenera muli chakudya katundu, ndi kuyambira usiku wa tsiku pamene opaleshoni wochititsidwa, m'pofunika kuti achotse zakudya ndi zakumwa. Madzulo a tsiku malonda kukonza matumbo m'mawa ndi madzulo wodzipangitsa kuyeretsa enemas kapena kumwa mankhwala apadera. M'mawa madzi osamba ndi sopo antibacterial.

Nthawi postoperative

Today n'kovuta kudabwa munthu cholecystectomy. opaleshoni kuchotsa gallstones kale kuika "pa mtsinje", ndipo watsala sikawirikawiri monga appendectomy ndi. Wodwalayo kale maola anayi nditamaliza opareshoni, imene n'zosatheka kumwa ndi kupanga kusuntha lakuthwa amaloledwa kutembenukira mu bedi. Inu amayamba kumwa madzi popanda mafuta chakudya chochepa (1-2 pharynx, koma osapitirira 500 ml). Pidagwanda maora pambuyo opaleshoni laparoscopic wodwala kudzuka. Kodi izo bwino, ngati pali munthu amene ndodo zachipatala kapena achibale, kuyambira pambuyo thupi kwa nthawi yaitali anakhala mu malo yopingasa ndi mu mkhalidwe mankhwala, pamene muyamba uko amachita chizungulire komanso kukomoka. Tsiku lotsatira pambuyo opaleshoni wodwala kusuntha momasuka chipatala.

Pambuyo pa opaleshoni, zakudya ndi yofunika kwambiri cholelithiasis. Menyu wa tsikulo monga zakudya madzi - phala pa madzi, soups zakudya, mkaka. Komanso mu chakudya zikuphatikizapo yophika ng'ombe, nkhuku m'mawere maapulo zophikidwa kapena nthochi. Kumbukirani kuti mu sabata loyamba pambuyo ntchito ndikoletsedwa mowa, tiyi wamphamvu kapena khofi, shuga, yokazinga ndi zakudya mafuta.

mankhwala litholytic

Ngati alowererepo opaleshoni sizingatheke chifukwa matenda aakulu somatic kapena matenda a clotting magazi, komanso kukana kwa wodwala opaleshoni, chomwe chinkachitika mankhwala litholytic. njira imeneyi, amene anali formulations chikukhudza ya ndulu zidulo, anafuna kupasuka miyala anapanga. Popeza m'pofunika tione kuti nthawi ya mankhwala zingasiyane chaka chimodzi mpaka zaka ziwiri, ndipo ngakhale n'zotheka kupasuka kwa gallstones kwathunthu, izo sizitanthauza kuti iwo siziwoneka kachiwiri. Komanso, mu njira ya mankhwala kungakhale mavuto matenda osiyanasiyana gallstone, kuphatikizapo anthu amene amafuna alowererepo pa opaleshoni.

I litholytic Therapy

Wina malire litholytic mankhwala ndi zina zofunika i matendawa:

1. Gallstones cholesteric mungafune, ndi miyeso si choposa 20 mm.
2. Ntchito ya ndulu ya opulumutsidwa ndi miyala musati zatenga oposa theka la buku lake.
3. Enaake ndi wamba ya ndulu ritsa ayenera kukhala patency ake.
4. Popeza mapangidwe miyala osapitirira zaka ziwiri.
5. Mu mbiri payenera kukhala wopepuka njira ya matenda - ululu wofatsa, nthawi zina ayi wa colic.

Chithandizo ikuchitika pansi ultrasound pa miyezi 3-6. Ngati patapita miyezi isanu palibe kusintha, ndiye kuti anaona osamveka, ndi kamodzinso ankanena za opaleshoni. Ngati mankhwala litholytic wakhala bwino, kuti panthawi yake kuona gallstones utangoyamba, US kupanga kamodzi pa miyezi itatu.