Tej zaum koj tau raug mob plab ntev heev vim yog pob zeb hauv lub zais zis. Thaum kawg koj tau phais kom tshem koj lub zais zis tawm, tej zaum koj xav tias koj tsis muaj mob no lawm. Tab sis yog tias koj tseem muaj mob plab hnyav tib yam tom qab phais? Nws yog qhov ntxhov siab heev. Muaj ntau tus neeg ntsib hom kev paub no. Yog li hnub no peb yuav tham txog ib qho mob uas tuaj yeem ua rau mob plab txawv txawv no txawm tias tom qab tshem lub zais zis tawm lawm. Qhov ntawd yog Sphincter of Oddi Dysfunction .
Hais yooj yim xwb, Sphincter of Oddi Dysfunction yog dab tsi?
Yuav kom nkag siab qhov no, cia peb xub saib cov txheej txheem ntawm peb txoj kev zom zaub mov. Nws yooj yim heev. Thaum peb noj zaub mov, peb lub cev tsim ob lub kua tshwj xeeb uas pab zom nws.
1. Cov kua tsib: Qhov no yog ua los ntawm lub siab. Nws khaws cia rau hauv lub zais zis. Nws pab zom cov rog.
2. Cov kua txiv pancreatic: Qhov no yog ua los ntawm lub pancreas. Cov enzymes hauv nws pab zom cov protein thiab carbohydrates hauv cov khoom noj.
Ob qho kua txiv no mus rau peb txoj hnyuv me, qhov chaw uas lawv sib xyaw nrog zaub mov kom ua tiav cov txheej txheem zom zaub mov.
Tam sim no ntawm no yog qhov tseem ceeb. Qhov twg ob lub kua txiv no nkag mus rau hauv txoj hnyuv me, muaj ib daim nqaij me me uas zoo li lub rooj vag . Nws zoo li lub qhov (valve). Qhov no yog qhov peb hu ua Sphincter of Oddi . Feem ntau, thaum koj xav tau zom zaub mov, lub rooj vag no qhib, cov kua txiv nkag mus, thiab tom qab ntawd nws kaw dua.
Qhov ua rau lub qhov rooj ntawm lub sphincter of Oddi tsis ua haujlwm zoo yog thaum lub qhov rooj no tsis ua haujlwm zoo. Yog li ntawd, daim nqaij no tsis qhib thaum nws yuav tsum qhib thiab nruj. Tom qab ntawd cov kua tsib los ntawm lub siab thiab cov kua txiv ntawm lub txiav tsis tuaj yeem mus txog rau hauv txoj hnyuv me thiab daig. Nws zoo li tsheb sib tsoo. Thaum cov kua txiv hmab daig li no, qhov siab ntawm txoj kev uas cov kua txiv hmab ntawd los ntawm nce ntxiv, ua rau mob plab heev.
Feem ntau pom muaj tus mob no rau cov neeg uas tau phais lawv lub zais zis tawm. Yog li ntawd, qee zaum nws hu ua post-cholecystectomy syndrome .
Cov hom mob no tseem ceeb yog dab tsi?
Kev ua haujlwm tsis zoo ntawm lub sphincter of Oddi tuaj yeem cuam tshuam rau koj hauv ob txoj kev tseem ceeb.
- Biliary Dyskinesia: Qhov no yog ib qho mob uas cov kav dej ntawm cov kua tsib raug thaiv. Qhov teeb meem yog nyob rau hauv txoj kev uas cov kua tsib ntws.
- Kab mob Pancreatitis: Qhov no yog thaum cov kua txiv pancreatic raug thaiv, ua rau lub pancreas o thiab o.
Tsis tas li ntawd xwb, cov kws kho mob faib cov kab mob ua peb pawg (Pawg I, II, thiab III). Qhov no tseem ceeb heev vim tias kev kho mob raug txiav txim siab raws li pawg no.
| Hom kab mob | Kev piav qhia |
|---|---|
| Qeb I | Tus neeg mob mob plab. Tsis tas li ntawd xwb, muaj pov thawj tseeb txog qhov teeb meem no los ntawm kev kuaj ntshav thiab kev ntsuas (ultrasound) . (piv txwv li, cov enzymes siab dua, cov ducts bile nthuav dav). |
| Qeb II | Tus neeg mob mob plab, thiab tsuas yog ib qho ntawm cov kev kuaj ntshav lossis kev luam theej qhia txog qhov txawv txav. |
| Qeb III | Qhov no yog hom mob uas nyuaj kuaj mob tshaj plaws. Tus neeg mob mob plab, tab sis tsis muaj kev kuaj ntshav lossis kev ntsuas ntshav yuav pom dab tsi tsis raug. Tsuas muaj pov thawj xwb yog qhov mob uas tus neeg mob hnov. |
Cov tsos mob tseem ceeb ntawm tus kab mob no yog dab tsi?
Cov tsos mob tseem ceeb thiab feem ntau yog mob plab heev, uas zoo ib yam li qhov mob uas muaj pob zeb hauv lub zais zis.
- Qhov mob pib nyob rau sab xis saum toj ntawm lub plab.
- Qee zaum qhov mob no kuj mus rau sab xis ntawm xub pwg lossis nraub qaum .
- Qhov mob tsis yog mob tas li. Nws ploj mus nws tus kheej tom qab li 30 feeb lossis ib teev. Tom qab ntawd nws tuaj yeem rov qab los dua hauv ib hnub lossis ib lub lim tiam.
- Muaj tej hnub qhov mob tsis hnyav heev, tiam sis muaj tej hnub nws mob heev.
Ntxiv rau qhov mob tseem ceeb no, cov tsos mob hauv qab no kuj tseem yuav tshwm sim:
- Xeev siab thiab ntuav
- Kub taub hau thiab mob khaub thuas
- Mob raws plab
Qhov tseem ceeb yog tias cov tsos mob no tsis yog ib txwm muaj. Lawv feem ntau tuaj thiab mus.
Leej twg muaj feem yuav mob no ntau dua?
Qhov ua rau qhov no tseem tsis tau pom tseeb, tab sis muaj qee yam ua rau muaj kev pheej hmoo ntawm tus mob no.
| Qhov ua rau muaj kev pheej hmoo | Kev piav qhia |
|---|---|
| Kev tshem tawm cov qog ntshav | Qhov no yog qhov tseem ceeb thiab feem ntau muaj kev pheej hmoo. |
| Hnub nyoog thiab poj niam txiv neej | Tus mob no feem ntau tshwm sim rau cov poj niam hnub nyoog ntawm 20 thiab 50 xyoo. |
| Lwm yam kev phais mob | Kev phais kom poob phaus (piv txwv li phais plab hnyuv), hloov siab, thiab lwm yam. |
| Lwm yam mob nkeeg | Cov mob xws li mob pancreatitis rov tshwm sim, hypothyroidism, thiab irritable bowel syndrome (IBS). |
| Qee cov tshuaj | Siv cov tshuaj tua kab mob ntev (tshwj xeeb tshaj yog cov tshuaj opiates). |
Yuav kuaj mob li cas?
Yog tias koj tus kws kho mob xav tias qhov no tom qab hnov txog koj cov tsos mob, thawj qhov uas nws yuav ua yog xyuas kom meej tias tsis muaj lwm yam ua rau koj mob plab. Qhov no yog vim lwm yam mob xws li mob plab (peptic ulcers), gallstones, thiab mob qog nqaij hlav pancreatic lossis bile duct kuj tuaj yeem ua rau muaj cov tsos mob zoo sib xws. Qee zaum, mob plawv (angina) kuj tuaj yeem zoo li mob plab.
Tom qab paub tseeb tias cov no tsis muaj, cov kev ntsuam xyuas hauv qab no tuaj yeem ua tau los xyuas seb puas muaj Sphincter of Oddi Dysfunction:
- Kev kuaj ntshav:Tshawb xyuas seb puas muaj cov enzymes hauv siab thiab pancreatic ntau ntxiv.
- Kev Ntsuas: Kev ntsuas xws li kev siv ultrasound hauv plab, CT scan, thiab MRCP yog siv los xyuas seb cov kav dej kua tsib lossis cov kav dej pancreatic puas o/nthuav.
- Endoscopy: Ib lub raj nrog lub koob yees duab raug ntxig los ntawm qhov ncauj los kuaj lub plab thiab txoj hnyuv me.
Kev kuaj ERCP
Muaj tej lub sij hawm, tshwj xeeb yog tias xav tias muaj hom I lossis II, yuav muaj kev kuaj tshwj xeeb hu ua ERCP (Endoscopic Retrograde Cholangiopancreatography) . Hauv qhov no, yuav muaj ib lub raj koob yees duab, zoo li lub endoscope, raug ntxig rau hauv lub sphincter of Oddi, thiab ib lub raj me me raug ntxig los ntsuas qhov siab hauv cov leeg nqaij ntawd (manometry). Qhov no thiaj li paub tseeb tias nws puas qhib lossis kaw zoo.
Txawm li cas los xij, qhov kev kuaj ERCP no yog qhov kev kuaj me me uas muaj kev pheej hmoo. Muaj ib feem pua me me ntawm cov neeg uas muaj nws tuaj yeem mob pancreatitis tom qab kev kuaj. Yog li ntawd, tus kws kho mob pom zoo kom ua qhov kev kuaj no tom qab ua tib zoo ntsuas qhov xav tau thiab kev pheej hmoo.
Yuav kho li cas?
Cov kev xaiv kho mob nyob ntawm seb koj muaj hom (pawg) ntawm Sphincter of Oddi Dysfunction li cas.
- Rau Qeb III: Qhov no nyuaj rau kuaj mob, yog li feem ntau tsis pom zoo kom phais. Tus kws kho mob yuav sau ntawv kom noj tshuaj tua kab mob thiab tshuaj txo qhov mob kom tswj tau qhov mob.
- Rau Qeb I & II: Yog tias qhov mob hnyav thiab nyuaj rau tswj nrog tshuaj, koj tus kws kho mob yuav qhia kev kho mob hu ua sphincterotomy nrog rau ERCP .
Qhov kev phais mob sphincterotomy no yog dab tsi?
Qhov no suav nrog kev txiav ib daim ntaub me me hu ua Sphincter of Oddi nrog ib lub cuab yeej me me uas raug xa mus rau hauv lub raj xa duab thaum lub sijhawm kuaj ERCP. Tom qab ntawd, qhov qhib nruj yuav qhib tas mus li. Tom qab ntawd, cov kua zaub mov ntws mus rau hauv txoj hnyuv me yam tsis muaj kev thaiv. Qhov no yuav luag tshem tawm qhov mob tag nrho.
Tiam sis qhov no kuj yog ib qho kev kho mob uas muaj qee qhov kev pheej hmoo. Kuj tseem muaj kev pheej hmoo ntawm kev mob pancreatitis. Yog li ntawd, kev kho mob no raug siv thaum lwm yam kev kho mob tsis tau txais txiaj ntsig zoo.
Cov Lus Qhia Txog Kev Coj Mus Tsev
- Yog tias koj tseem mob plab tom qab koj lub zais zis raug tshem tawm lawm, tsis txhob tsis quav ntsej nws. Tej zaum nws yog Sphincter of Oddi Dysfunction.
- Txawm hais tias qhov mob no tsis yog qhov txaus ntshai rau lub neej, qhov mob tuaj yeem ua rau muaj kev cuam tshuam loj rau koj lub neej txhua hnub.
- Cov tsos mob tsis yog ib txwm muaj, nws yog qhov xwm txheej ntawm tus kab mob no los thiab mus ib ntus.
- Koj tus kws kho mob yuav txiav txim siab seb koj muaj hom kab mob twg (I, II, lossis III) los ntawm kev kuaj mob thiab yuav muab kev kho mob zoo tshaj plaws.
- Muaj ib txhia neeg tsuas siv tshuaj kho mob xwb thiaj tswj tau lawv qhov mob. Lwm tus neeg yuav xav tau kev kho mob xws li phais lub qhov ntswg.
- Ua ntej yuav kho mob li cas los xij, tham nrog koj tus kws kho mob txog qhov zoo thiab qhov tsis zoo.
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Tsis muaj lus teb tau muab tso tawm. Ntxiv koj cov lus tawm ntawm no thawj zaug.
Ntxiv koj cov lus