The oparesheni kubvisa matombo omunduru. Kugadzirira zvokuwedzera kuvhiyiwa

Gallstone chirwere yazova rimwe rakajairika mananara pakati abdominal zvokurwara, uye kuvhiya kubvisa matombo omunduru - nzira inokosha pakugadzirisa dambudziko.

Gallstone chirwere - chii?

chirwere ichi Rinobatanidzwa nokuumbwa ari bile ducts uye nenduru dundira matombo (calculi). Zvinonzi akagadzirirwa kwezvikonzero zvinotevera:

• kurega kunotanga kana yachinja Zvinoumba bile;
• anogumbura pezvakaitwa;
• bilification kutyora (dyskinesia).

In sezvamunoita, pane mhando nhatu namabwe. The Zvinonyanyozivikanwa (80-90% nyaya) pane remafuta akawandisa matombo. inotungamirwa yavo chinowedzera zvakawandisa remafuta akawandisa tigutsikane ari bile. Kana izvi zvaitika paumbwe crystals nokuda deposition kuti remafuta akawandisa rakawandisa precipitate. Kana motility pakati nduru dundira yaputswa, ipapo idzodzo izvi hazvina kuratidzwa mune intestinal nzvimbo, uye kuramba mukati maro uye kutanga kukura.

Ruvara Mabwe kuumbwa nokuda vawedzere disintegration masero eropa - red ropa masero. Kakawanda unogona kuonekwa hemolytic kupererwa neropa. Panewo yakavhenganiswa dzidzo. Ndivo zvose zviri zviviri siyana. It rinoumbwa remafuta akawandisa, bilirubin uye calcium yakawanda.

Kana oparesheni KWAKAKOSHA

Munhu wose nechirwere matombo omunduru, pakupedzisira nechisarudzo mubvunzo wokuti kuti kushanda kupindira kana achava kwakakwana kuchinja kurapwa. Zvinokosha kutaura kuti mabwe pachavo havasi chikonzero kubvisa gallbladder. Kana vasinganzwi vanozviratidza, uye regai kukanganisa chakaipa ichishanda nemamwe miviri, kuvhiyiwa haagoni kufunga. Zvisinei, kana paiva kurwadziwa vari gallbladder, kutyora vakawanda ezvinhu, yellowness, kudiwa kwokukurumidzira kunoona chiremba. Ndiye, mushure kuongorora achasarudza kana kushanda kupindira zvinokosha uye chii chaiva. Asi ziva kuti cholecystitis gallbladder kunoreva akatotanga kushoma. Kana kunyanyisa kumbosendeka chisarudzo, mikana kudzorera zvakazara utano pashure vavhiyiwa zvinoshamisa ipfupi. Kunyange kana paiva kurwiswa chete, matombo omunduru nani kubvisa.

Zvairatidza kunorapwa

Pavanosarudza pamusoro kudiwa kuvhiyiwa, nyanzvi kazhinji funga zvinhu zvinotevera:

• Kuvapo matombo (calculi) pakati inosiyana, achitora chetatu nduru dundira;
• kana hosha iri kakawanda yokurwiswa kurwadziwa gallbladder (biliary colic), kuvhiyiwa rinoitwa zvisinei kwakakura concrements;
• Kana Mabwe yakarongwa nduru dundira uye ducts;
• apo kuderedza mano gallbladder kuti kubata kana rakwo disconnection;
• kukura biliary pfungwa nomuviri zvemwana asati;
• kubudikidza breakage of gallbladder rusvingo;
• pamwe occlusion zvinowanzoitwa hepatic mutsinga dzinofamba nemukaka.

Kune dzakawanda nhungamiro nokuda kuona kudiwa pakuvhiya mu cholelithiasis. Achipfupikisa pfungwa vanotumirwa kune siyana chirwere zviratidzo, chiremba achasarudza kana vavhiyiwa kunodiwa, uyewo hama uye mhedziso zvairatidza kuti.

Mhando remapazi

Kazhinji, pfungwa inotungamirwa matombo omunduru - hazvisi kutsanya. Chokwadi, kana uri rombo rakaipa, uye amburenzi achatora iwe kuchipatara zvomusejari ane rikwanise kurwisa, iyo chirwere sezvo cholecystitis, gallbladder, chisarudzo zvaunazvo diki. Asi vakawanda vanoziva pamusoro dambudziko pachine nachiremba wako zvose taurirana mashoko, ona musi vakaronga kuvhiyiwa.

In mushonga ano, kune nzira mbiri nokubvisa gallbladder (cholecystectomy)

• rakavhurika cholecystectomy - tsika nzira dzokuvatsigira nokuvhura abdominal mhango;
• laparoscopic cholecystectomy - imwe nzira ano kuti Zvinosarudzwa nhasi.

rakavhurika cholecystectomy

oparesheni iyi kubvisa matombo omunduru chinhu chaiwo kuvhiyiwa. Pashure chikamu achitevedza midline ari mudumbu chinoitwa rokuongorora pamusoro abdominal mhango, uye nenduru dundira nokubviswa, kana zvichikodzera, abudise (kugadzwa sepombi, kuti tibu- water drainage of zvichizoita exudate nemamwe muviri zvinwiwa).

Pasinei chidzoke ane ano uye yepamusorosoro nzira, rakazaruka cholecystectomy richiri kushanda. Izvi zvinogona kutsanangurwa ndechokuti vamwe makiriniki vasina midziyo kana unyanzvi zvakafanira zvinodiwa kuti tiite laparoscopic dzokuvhiya. Kuwedzera kune izvi, pane zvimwe contraindications.

Laparoscopy gallbladder

Ndiyo imwe nzira kuvhiya mu gallstone chirwere. To musi, nzira iri kuramba vachiwanda nokuda kushanda kwayo, kucheka, zvinoderedza kuti kupora mazwi. The oparesheni rinoitwa kushandisa laparoscope - chaiyo midziyo, izvo anobvumira kuwana hunenge nhengo Via vakawanda punctures rusvingo abdominal panopinda manipulators nezvevanakomana uye, chaizvoizvo, mumwe laparoscope. Nzira iyi inobvumira kuti kubvisa kwete gallbladder haisi kusiya mavanga, asi mune zvimwe zviitiko chete bvisa mabwe, vachisiya muviri panzvimbo. A nzira dzakafanana chinoshandiswa kwete chete nokuda Mabatirwo gallstone chirwere, asiwo nokubviswa appendicitis, pakurapa inguinal hernias, zvimwe zvirwere gynecological, uye chirwere kushandiswa. Pasinei pachena zvakanakira laparoscopic cholecystectomy, nzira iyi ine contraindications ayo. Idzi dzinosanganisira:

• pute, iri mapazi kushanda;
• yekupedzisira mitatu akazvitakura;
• zvakakomba Moyo chirwere.

Uyewo, yeuka kuti munguva laparoscopic kuvhiyiwa, pakuparwa kuchangotanga kunetseka kwayo ano, vanachiremba vanovhiya zvakaitika kuvhura cholecystectomy. Saka anopedzisa vanenge 5% laparoscopic kuvhiyiwa.

Preparation kunorapwa

Kungofanana kuvhiyiwa, kuvhiya kubvisa matombo ari gallbladder kunoda basa. Kunze mureza kuongorora kusanganisira kukurukura Analyses (CBC uye urinalysis, nemakemikari omuviri ropa, coagulation - kuongorora ropa pakugwamba, chiropa basa kuongorora), zvinokosha kuti abdominal ultrasonography, electrocardiography, chipfuva maekisirei, maererano zviratidzo FGS uye colonoscopy, uye kuwana vaiita mushumo. Uyezve, kugadzirira zvokuwedzera kuvhiyiwa zvinosanganisira kukanzura zvinodhaka kukanganisa coagulability ropa. Izvi zvinosanganisira dzakasiyana-siyana anticoagulants, vhitamini E, vasiri steroidal Anti-anogumbura zvinodhaka. Mazuva mashoma asati oparesheni kunoda ngwariro chaiyo kudya mu cholelithiasis. The Muterere haafaniri zvine inorema zvokudya, uye kubvira pakati pousiku zuva kana mukushanda nevamwe, zvakakodzera asava zvokudya uye zvokunwa. Pausiku ari kutengesa zuva rokuchenesa bowel mangwanani uye manheru nohumwe kuzvichenesa enemas kana kushandisa zvinodhaka inokosha. Mangwanani kugeza pamwe antibacterial sipo.

The postoperative kumwedzi

Nhasi zvakaoma kushamisa munhu cholecystectomy. oparesheni iyi kubvisa matombo omunduru kare akaisa "riri rukova", uye ari pamusoro sehwakajairika ive appendectomy. Murwere akanga atova maawa mana pashure pokupedza pokuvhiyiwa, umo hazvibviri kunwa uye kuti inopinza sangano anobvumirwa kutendeukira pamubhedha. Unogona kutanga kunwa mvura pasina gasi mu migove diki (1-2 pharynx, asi kwete kupfuura 500 Rine mamiririta). Mushure maawa matanhatu pashure laparoscopic Kuvhiya murwere anogona kusimuka. Zviite nani, kana pane mumwe kubva yezvokurapa mudonzvo kana hama, sezvo mushure muviri kwenguva refu akagara ari chinjikira chinzvimbo uye vachingotya yokutindivadza, kana iwe edza kumuka pangava dzungu uye kufenda. Mangwana acho avhiyiwa murwere anogona kufamba takasununguka muchipatara.

Pashure pokuvhiyiwa, zvokudya rwakakosha cholelithiasis. Menu zuva zvingasanganisira imvura kudya - Porridge pamusoro pemvura, Mishonga soups, dheri zvigadzirwa. Uyezve zviri zvokudya ingasanganisira yakabikwa nyama, huku zamu, zvakabikwa maapuro kana mabhanana. Zvinofanira kurangarirwa kuti vhiki yokutanga avhiyiwa hakubvumidzwi doro, simba tii kana kofi, shuga, zvakakangwa uye mafuta zvokudya.

litholytic kurapa

Kana kuvhiya kupindira hazvibviri nokuda kwazvo somatic zvirwere kana kusagadzikana kweropa, uyewo kuramba murwere kubva avhiyiwa, akabata litholytic kurapa. nzira iyi, iyo inoshandiswa Formulations dzine bile acids, akaronga wokuparadza akaumba matombo. Sezvo zvakafanira kufunga kuti ya kurapwa dzinosiyana gore rimwe makore maviri, uye kunyange kana zvichibvira wokuparadza matombo omunduru zvachose, izvozvo hazvirevi kuti havangagamuchiri kuonekwa zvakare. Mukuwedzera, mukufamba kurapwa angava yematambudziko siyana gallstone chirwere, kusanganisira avo kuti zvinoda kuvhiya kupindira.

Zvinodiwa litholytic Therapy

Chimwe kukamurwa litholytic kurapa vamwe zvinodiwa kuti nzira dzekuziva chirwere:

1. Matombo omunduru cholesteric zvichifanira, pamwe kukura isingadariki 20 mm.
2. Kushanda gallbladder vakaponeswa uye matombo regai kugara vanopfuura hafu inzwi rayo.
3. Cystic uye zvakafanana bile mutsinga dzinofamba nemukaka vanofanira kuramba patency kwayo.
4. Sezvo paumbwe nematombo asina kupfuura makore maviri.
5. Munhau panofanira kuva nyore weboka chirwere - marwadzo vanyoro, neapo tichibatwa colic.

Treatment rinoitwa pasi Ultrasound ose 3-6 mwedzi. Kana pashure pemwedzi mitanhatu hapana kuvandudzika, zvino ari akaonekwa basa, uye akamutsa nyaya pakuvhiya kamwe zvakare. Kana litholytic kurapa kwave kuchibudirira, kuti nenguva kuona rekuUnited matombo omunduru, US kuti kanenge kamwe mumwedzi mitatu.