Common kua tsib ciav - yog dab tsi? Physiological yam ntxwv thiab pathological dab

Leej twg paub tias qhov twg lub siab, hais txog nws lub luag hauj lwm nyob rau hauv lub physiology ntawm ib tug nyob kab mob. Tab sis qhov twg yog choledoch uas nws? Nws yog tsis txhua leej txhua tus paub. Chaw hauj lwm hauv nruab nrog cev ntawm kev zom yog lub gallbladder. Lub narrowest ib feem (caj dab) yog hloov mus rau hauv lub cystic ciav thiab merges nrog rau lub siab. Tsim ducts choledochus ntau cov kua tsib ciav, los yog tsuas yog hais lus, choledoch.

Nws extends raws tus ntug txheej ntug ntawm lub siab, nruab nrab ntawm cov ntawv txheeb nyob rau hauv lub peritoneal ligament hepatoduodenal, sinking down ntawm lub taub hau ntawm lub pancreas thiab cov duodenum (12PK). Ces ncua los ntawm lub sab hauv sab, los ntawm lub tsheb phab ntsa 12PK thiab poured rau hauv lub lumen nyob rau hauv lub papilla ntawm Vater.

Physiological tsis thiab qauv ntawm cov ntau cov kua tsib duct

Tej yam qauv muaj sia thiab choledoch. Cov cai yog sawv cev los ntawm cov hauv qab no qhia: qhov ntev yuav tsum 2-12 cm cai dependence ntawm cov yam ntxwv ntawm lub txuas ntawm lub cystic ciav .. Yog hais tias hepatic ciav lengthened, nws yuav luv choledoch. Ua li cas nws txhais li cas? Tsuas yog qhov tseeb hais tias qhov ntev ntawm tus neeg khiav. Cov kab uas hla mas nws txawv ntawm ib tug loj rau ib tug me daim duab nyob rau hauv lub chav kawm ntawm repetition. Nyob rau hauv lub pib nws yog 5-8 hli. Ces muaj ib tug kev hloov ntawm cov lumen, thiab nkag mus rau hauv cov hnyuv ciav narrows rau 3 hli. Lub phab ntsa thickness ntawm 0.5 mus 1.5 hli. Nyob rau hauv pathological tej yam kev mob vim lub loj hlob ntawm connective cov ntaub so ntswg choledoch yuav nkoog mus txog 3-4 hli.

Tag nrho cov kua tsib ciav muaj 4 seem.

1. Supraduodenal. Length -. Kis mus rau 4 cm raws tus ntug txheej ntug ntawm lub hepatic-duodenal ligament feem ntawm lub cystic ciav mus rau lub sab sauv ntug 12PK.
2. Retroduodenalny. Length -. Kis 1-2 cm rau retroperitoneal 12PK kom txog rau thaum nws nphav lub pancreas.
3. Pancreatic. Length -. 3 cm nyob rau hauv kev sib cuag nrog lub taub hau ntawm lub pancreas thiab yog surrounded los ntawm nws.
4. Intraduodenally. Qhov ntev ntawm -. 12 cm nyob rau hauv lub phab ntsa 12PK.

pathological kev hloov

Muaj ib tug xov tooj ntawm pathological kev hloov nyob rau hauv ntau cov kua tsib ciav. Ib tug ntawm lawv yog cov dilatation ntawm cov kua tsib ciav. Dilation ntawm lub Latin dilatation - expansion ntawm lub lumen ntawm lub duct. Nws yog vim tus neeg kho tshuab txwv ntawm ib tug downstream ib feem ntawm qhov hloov.

Ua dilation:

1. Congenital thiab mas yuav kis tau malformations (hypoplasia, hlwv).
2. Benign gallbladder tus kab mob (cholelithiasis, strictures ntawm cov kua tsib ducts).
3. Inflammatory dab (cholecystitis, cholangitis, pancreatitis).

Muaj ib tug xov tooj ntawm tsim nyog cov lus nug. Raws li qhov no mas nws txawv choledoch? Hais tias nws tej zaum yuav entail? Nyob rau hauv xws li mob muab ib tug xov tooj ntawm cov kev soj ntsuam hlw kom qis los mus txiav txim qhov ua rau ntawm lub lumen hloov thiab xaiv txoj kev ntxiv kev kho mob.

daim ntawv ntsuam xyuas txoj kev

Feem ntau thiab txhim khu kev qha txoj kev xeem ntawm daim siab yog lub SPL. Niaj hnub nimno pab kiag li lawm cia ultrasound kom tau ib tug ntshiab daim duab ntawm lub hepatic ducts. Tu siab, lub me me luaj li cas ntawm calculi nyob rau hauv lub dav dav ciav ultrasound feem ntau tsis tau visualized. Nyob rau hauv xws li mob nws yog tsim nyog mus rau chaw uasi rau lwm txoj kev kuaj mob, mus tshawb tag nrho choledoch. Yuav ua li cas yog cov kev?

1. Piv X-ray xeem.
2. Txoj kev ntawm ncaj qha tseg (duodenoscopy catheter, tej ntawm cov kua tsib ciav los ntawm ultrasound).

Cov kev ua rau nws tau mus nrhiav kom tau qhov ua rau ntawm cov ciav rhuav txhua ntau kom raug thiab nyob rau hauv ib qho nyuaj mus cuag qhov chaw.

Nws yuav tsum tau muab sau tseg qhov tseem ceeb ntawm kev thiab biochemical kev kuaj ntshav. Cov kev tshawb fawb kom muaj cov inflammatory dab.

Cov ua rau cov kab mob ntawm lub gallbladder thiab cov kua tsib duct

Cov kev hloov nyob rau hauv cov kua tsib ciav qhia lub hav zoov ntawm pathological dab nyob rau hauv daim siab thiab gallbladder. Los ntawm cov tshwm sim kabmob siab? Lub hauv paus ua yog yeej ib txwm yog ib txoj kev ntawm lub neej thiab kev noj haus, nquag siv cawv, haus luam yeeb. Hlub fatty, kib zaub mov, dhau lawm, ua ib tug luag hauj lwm, raws li zoo raws li uncontrolled, unjustified ntawm kev noj tshuaj. Tej zaum cov teeb meem yog vim tsis tseem ceeb cov yam ntxwv ntawm tus txiv neej. Tam sim no los yog yav tom ntej no yuav ua rau o, tus tsim ntawm lub pob zeb. Txhaws pib thiab expansion ntawm ntau cov kua tsib ciav. Yog hais tias lub pathological kev yog asymptomatic, qhov teeb meem no yog aggravated thiab ua rau mob loj txim, mus txog rau pancreatic necrosis.

kev kho mob

Kev kho mob yuav tsum tau kev. Yog hais tias lub hauv paus ua yog lub xub ntiag ntawm ntau cov kua tsib ciav pob zeb, cov kev kho mob kom pom tseeb feem ntau los cia rau kev phais. Lub possibilities uas niaj hnub tshuaj ua rau nws tau siv rau txoj kev reconstruction ntawm cov kua tsib duct kev puas tsuaj, tsawg puas phais.

Thaum cab thiab inflammatory kab mob txoj kev kho nrog tshuaj tua kab mob thiab duodenal intubation, aimed ntawm qhov kev tso tawm ntawm cov kua tsib ciav los ntawm stagnation. Qhov zoo tshaj txoj kev yog kev tiv thaiv. Healthy noj mov, lub cev ua ub ua no tsim nyog, raws sij hawm tiv thaiv kev kho mob kuaj kev pab rau ntau xyoo kom haum.