Chithandizo cha kuphipha kwa kupindika kwa Oddi

Kutha kwa sphincter ya Oddi (English sphincter of Oddi dysfunction) - matenda (mkhalidwe wamankhwala), wodziwika ndi kuphwanya pang'ono patency ya ndulu ya bile ndi kapamba wa pancreatic mu sphincter wa Oddi. Malingana ndi malingaliro amakono, zikhalidwe zovomerezeka za chipatala zosawerengeka zokha zomwe zimangotchulidwa ndi zovuta za sphincter za Oddi. Imatha kukhala ndi zojambula (zopangidwa) komanso zofunikira zogwirizana ndi vuto la galimoto yolumikizana.

Malinga ndi 1999 Rome Consensus on Functional Digestive Disways ("Roman Criteria II"), mawu akuti "sphincter of Oddi dysfunction" akulimbikitsidwa kuti agwiritsidwe ntchito m'malo mwa mawu akuti "postcholecystectomy syndrome", "bysary dyskinesia" ndi ena.

Sphincter wa ku Oddi - valavu ya minofu yomwe ili mu duodenal papilla yayikulu Vater papilla) duodenum, yomwe imayang'anira kutuluka kwa madzi a bile ndi pancreatic mu duodenum ndikuletsa matumbo kuti asalowe mu ndulu wamba ya pancreatic (wirsung).

Postcholecystectomy syndrome

Kuphipha kwa phula la Oddi (English spasm of sphincter of Oddi) - matenda a sphincter a Oddi, otchulidwa ICD-10 okhala ndi code K 83.4 83.4. Mu 1999 Consensus ya Roma imanena za kupendekeka kwa kukanika kwa Oddi.

Postcholecystectomy syndrome edit |Kodi kukanika kwa Oddi ndi chiyani?

Sikuti aliyense amadziwa komwe kakhalire ka Oddi, komwe kamapangidwa ndi ma minyewa yolumikizana ndi minofu. Kapangidwe kameneka kamazungulira mbali zomalizira za ndulu ndi ndulu, zomwe zimakupatsani mwayi wopanga zotulutsa m'mimba, zimalepheretsa kuponyedwa kwamatumbo m'matumbo, zimawonjezera kuthinikizidwa, komanso zimathandizira kudzazidwa kwa ndulu.

Sphincter ya Oddi kukomoka kumachitika ndi kuwonjezeka kwa kamvekedwe ka chiwalo, kotero ma ducts amakula, pali chobisalira chosavomerezeka mu duodenum. Pankhaniyi, ndende ya bile ingafike pamakhalidwe oyenera, omwe amachititsa matenda, kukula kwa zizindikiro za kutupa.

Zotsatira zake, kuphwanya zotsatirazi kumachitika:

• Sinthani kapangidwe ka microflora yamatumbo,
• Katemera wamkati amataya ntchito ya bactericidal,
• Njira yogawa mafuta ndikusokoneza mafuta yasokonekera,
• Kuzungulira kwachilendo kwa mafuta acids kumasintha.

Sphincter ya kufooka kwa Oddi kumachitika pamene limba limataya mwayi wake wokhoza kuthana ndi mavuto. Zikatero, bile secretion imabisidwa mosalekeza m'matumbo a lumen, yomwe imayambitsa kukula kwa matenda otsekula m'mimba. Popita nthawi, mankhwalawa amadzetsa kuwonongeka m'matumbo, m'mimba, zomwe zimayambitsa kuwoneka kwa dyspepsia.

Zoyambitsa matenda

Sphincter wa Oddi spasm ndimatenda omwe amapezeka, omwe amayambitsa ndi minofu ya minyewa. Zinthu zotsatirazi zimayambitsa matenda:

• Zosintha pakuphatikizika ndi mawonekedwe a rheological a bile,
• Kuphwanya phokoso
• Dysbiosis wamkati,
• Opaleshoni
• Kusintha kwazomwe zimapangidwa mu sphincter, zomwe zimapangitsa kukulitsa kwa stenosis,
• Duodenitis.

Matenda a ndulu ndi sphincter ya Oddi amapezeka mwa odwala omwe ali pachiwopsezo:

• Amayi pa nthawi ya kusintha kwa kubereka, pakati, pa mankhwala a mahomoni
• Anthu amatsenga
• Kukhazikika kwa kulumikizika kwa malingaliro mwa achinyamata,
• Anthu omwe ntchito kapena moyo wawo umalumikizidwa ndi kupsinjika kwakanthawi,
• Odwala pambuyo cholecystectomy (kuchotsa ndulu),
• Odwala omwe ali ndi mbiri yodwala matenda a shuga,
• Anthu omwe ali ndi matenda a hepatobiliary system,
• Odwala omwe anachitidwa opareshoni ya ziwalo zam'mimba.

Mitundu ya matenda

Malinga ndi gulu la masiku ano, kupindika kwa Oddi kukanika kumatha kutenga mitundu iyi:

• Mtundu wa Biliary I. Ndi chikhalidwe kuphatikiza pano zovuta zomwe zimayambitsa kuwoneka koopsa mu hypochondrium yoyenera. Kutalika kwa kuukila sikupita mphindi 20. Ku ERPC, kuchepa kwamphamvu yakuchotsa kusiyana kumatsimikiziridwa, zizindikiro zotsatirazi zikuwonjezeka: AST, alkaline phosphatase,
• Mtundu Wachiwiri wa II. Ndi mawonekedwe amtunduwu wa sphincter wa Oddi malingana ndi mtundu wa biliary, kumverera kowawa kwakumveka, mawonekedwe a 1-2 okhala ndi mtundu wa mtundu wa I.
• Mtundu wa Biliary III. Kupweteka kokhako kumawonekera, zizindikiro zina sizikupezeka.
• Mtundu wa kapamba. Sphincter ya Oddi spasm imayambitsa kupweteka m'dera la epigastric, lomwe limapereka kumbuyo. Zowawa zimachepa pakukweza thupi kutsogolo. Kuwonjezeka kwa amylase kapena lipase ndizodziwika.

Chithunzi cha kuchipatala

Sphincter wa Oddi spasm amadziwika ndi kukhazikika kwa matenda omwe amadziwika kuti akupweteka, omwe amadziwika mu hypochondrium, epigastrium yoyenera. Zowawa nthawi zambiri zimawongolera kumbuyo kapena tsamba lamanzere. Kutalika kwa kupweteka sikawonjeza mphindi 30. Matenda a ululu amatha kukhala osiyanasiyana, nthawi zambiri amabweretsa mavuto kwa wodwalayo.

Kupweteka kwamankhwala kumakhala limodzi ndi zizindikiro zotere:

• Kusanza ndi kusanza
• Kulawa kwamkamwa kwambiri
• Kulumikizana ndi mpweya
• Mwina kuwonjezeka pang'ono kwa kutentha kwa thupi,
• Mawonekedwe akumva kuwawa.

Zizindikiro zolembedwazo nthawi zambiri zimachulukitsidwa mutatha kudya mafuta ndi zonunkhira.

Zizindikiro zamatenda okazungulira a Oddi ndi monga:

• Kuchulukitsa michere ya chiwindi,
• Kuchepetsa kutuluka kwa sing'anga pakati pa ERCP,
• Kukula kwa wamba bile duct.

Kukanika kugwira ntchito kumayamba kupezeka mkati mwa zaka 3-5 pambuyo pa cholecystectomy. Pankhaniyi, odwala amawona kuwonjezeka kwa zowawa, zomwe zimagwirizanitsidwa ndikuchotsa kosungirako kwa bile.

Zofunika! Ululu nthawi zambiri umayamba usiku, sungathe kuyimitsidwa potenga ma pinkiller, kusintha mawonekedwe a thupi.

Njira zoyesera

Kuti adziwe kupezeka kwa kukomoka kwa sphincter, madokotala amakupatsirani kuyesa kwa magazi, komwe kumachitika popanga ululu wammbuyo kapena mkati mwa maola 6 mutatha. Izi zimakuthandizani kuti muzindikire milingo yokwezeka ya amylase ndi lipase, aspartate aminotransferase, alkaline phosphatase ndi gamma-glutamyl transpeptidase.

Zizindikiro zamankhwala zingasonyeze kukula kwa matenda ena am'mimba omwe amayamba chifukwa cha kutsekeka kwa ndulu. Chifukwa chake, njira zodziwitsira zothandizirazi zimagwiritsidwa ntchito kwambiri kutsimikizira matenda:

• Ultrasound Kujambula kumachitika motsutsana ndi kumbuyo kwa zotengera zomwe zimakupatsani inu, zomwe zimakupatsani mwayi kusintha momwe mukusinthira. Ndi kuwonjezeka kwa zizindikiro zoyenera ndi 2 mm, kufalikira kosakwanira kwa ma bile ducts titha kukayikira,
• Cholescintigraphy. Njira imalola kuzindikira kuphwanya kwa sphincter motility ndi kuthamanga kwa kayendedwe ka isotope kuchokera chiwindi kupita kumtumbo wam'mimba,
• Endoscopic retrograde cholangiopancreatography (ERCP). Njirayi ikuphatikiza kuyambitsa ma duodenoscopes okhala ndi maofesi ofananira nawo kuti awone kukula kwa milatho, kuti adziwe kuthamanga kwawo,
• Manometry. Njirayi idakhazikitsidwa ndikuwonetsa catheter ya atatu-lumen kudzera pa duodenoscope kulowa m'malo amiyeso kuti athe kuyeza kuthamanga kwa sphincter.

Mawonekedwe a Chithandizo

Chithandizo cha kupindika kwa kukomoka kwa Oddi kumaphatikizapo kupumula kwa zowawa ndi zizindikiro zina, kufalikira kwa ziwalo mwamphamvu ndikuchotsa zinsinsi zam'mimba. Ndi chitukuko cha kutupa ndi dysbiosis, kuthetsedwe kwa bakiteriya matenda ndi matenda a matumbo biocenosis adzafunika. Chifukwa chaichi, mankhwala othandizira, mankhwala othandizira pakudya, endoscopy ndi chithandizo cha opaleshoni amagwiritsidwa ntchito kwambiri.

Mankhwala

Magulu otsatirawa a mankhwala amagwiritsidwa ntchito kwambiri kuthetsa vuto:

• Nitrate (Nitrosorbide, Nitroglycerin). Mankhwala amatha kuchepetsa ululu,
• Anticholinergics (Biperiden, Akineton) amathandiza kuthetsa kuphipha kwa minofu,
• Ma calcium calcium blockers amathandizira kuzungulira kwa Oddi. Nthawi zambiri zimayambitsa zovuta, chifukwa sizigwiritsidwa ntchito kawirikawiri,
• Antispasmodics (Papaverine, Pinaveria bromide, Drotaverinum) amachotsa kuphipha ndi kupweteka,
• Myotropic antispasmodics. Mebeverin amachepetsa kamvekedwe ka sphincter ndi kusuntha kwa minofu yosalala. Gimekromon amachotsa kuphipha, ali ndi mphamvu ya choleretic,
• Kuti athetse matenda obwera chifukwa cha bakiteriya, dysbiosis, mankhwala a antibacterial m'matumbo (Rifaximin, Enterofuril, fluoroquinolones), prebiotic ndi probiotics (Lactulose, Bifiform, Hilak forte) amagwiritsidwa ntchito,
• Njira zozikidwa pa ursodeoxycholic acid (Ursosan, Ursofalk) zitha kuthetsa kuchepa kwa biliary.

Zakudya zamankhwala

Kugwiritsa ntchito moyenera matenda am'mimbamo kumatheka popanda kutsatira zakudya zapadera. Potsutsana ndi sphincter ya Oddi, akatswiri azakudya amalimbikitsa kusiyanitsa mafuta, zakudya zonunkhira, chakudya mwachangu. Kudya zakudya kuyenera kulemekezedwa ndi ulusi wopaka, womwe umathandizira kuti minyewa yake izigwira bwino ntchito.

Muyenera kukana kulandira masamba ndi zipatso - zinthuzo ziyenera kupita kuchipatala. Zakudya ziyenera kuwiritsa, kuphika, kuphika, kuwotedwa. Zakudya za tsiku ndi tsiku ziyenera kugawidwa m'magulu ofanana a 6-7, omwe akulimbikitsidwa kuti atenge maola atatu aliwonse atatu ndi atatu.

Zofunika! Chakudya chamadzulo kwambiri asanagone chimapewa kuchepa kwa bile.

Maphikidwe a mankhwala achikhalidwe

Kuti muwonjezere mphamvu ya mankhwala, mungathe kuthandizidwa ndi wowerengeka azitsamba. Komabe, kugwiritsa ntchito maphikidwe a mankhwala achikhalidwe kumatheka pokhapokha kukambirana ndi katswiri. Kusintha ntchito ya sphincter, zopangira mankhwala ngati izi zimagwiritsidwa ntchito kwambiri:

• Milandu yoyesedwa. Chomera chimagwiritsidwa ntchito pochiza matenda ambiri a hepatobiliary system. Zida zowonongeka zanenanso choleretic, anti-yotupa. Kukonzekera kulowetsedwa, ndikokwanira kuthira 20 g ya stigmas ya chimanga ndi 200 ml ya madzi otentha, kunena kuti zikuchokera kwa ola limodzi. Mankhwala amatengedwa 40 ml mpaka 5 patsiku,
• Chitsamba cha Hypericum. Zida zapakhungu zimagwiritsidwa ntchito poteteza chiwindi ndi ndulu, kuchiritsa kwa dyskinesia. Kukonzekera decoction, ndikokwanira kupera supuni 1 ya zopangira, kutsanulira zikuchokera mu 250 ml ya madzi otentha. Chipangizocho chimabweretsedwa ndi chithupsa mumadzi osamba, chikuthandizidwa kwa ola limodzi. Msuzi amatengedwa 50 ml mpaka katatu pa tsiku,
• Maluwa a Helichrysum. Chomera chimagwiritsidwa ntchito pothana ndi bile, hepatitis, cirrhosis. Kukonzekera mankhwalawa, ingotsanulira supuni ziwiri za maluwa osankhidwa mu 250 ml ya madzi otentha. Kuphatikizikako kumawiritsa kwa mphindi 10, utakhazikika, kusefedwa. Zochizira matenda a hepatobiliary dongosolo, tikulimbikitsidwa kumwa 50 ml ya decoction mphindi 30 asanadye katatu katatu patsiku,
• Grass repeshka. Zida zowonongeka zimatha kuchepetsa mayendedwe a hepatitis yovuta komanso yosatha, cirrhosis, cholecystitis, dyskinesia wa biliary. Kukonzekera kulowetsedwa, ndikokwanira kuthira 200 ml ya madzi otentha supuni 1 ya zida zosaphika. Kuphatikizikako kumakakamizidwa maola 2, mutatha 100 ml katatu patsiku.

Endoscopic ndi opaleshoni yothandizira

Ngati chithandizo cha Conservative sichikubweretsa zabwino, gwiritsani ntchito njira zotsatirazi:

• Endoscopic papillosphincterotomy. Njirayi imaphatikizira kupukusa papilla wamkulu wa duodenal,
• Kuchulukitsa kwa sphincter ndikukhazikitsa zitsulo zosakhalitsa,
• Transduodenal sphincteroplasty,
• Botulinum toxin jakisoni wa duodenal papilla. Chithandizo cha mankhwalawa chikupitilira kwa miyezi 3-4, kenako chinthucho chimaperekedwa kwathunthu m'thupi.

Zotsogola ndi njira zopewera

Wosokonekera sphincter wa Oddi motility amadziwika ndi zabwino zakutsogolo. Ndi chithandizo chokwanira chokwanira choteteza thupi, ndizotheka kuthetseratu zizindikiro zosasangalatsa za matendawa.

Palibe prophylaxis yeniyeni ya matenda. Komabe, pofuna kupewa kugaya chakudya m'mimba, akatswiri am'magazi amalimbikitsa kudya mokwanira, kukhala ndi thupi lokwanira, komanso kuchita masewera olimbitsa thupi pafupipafupi.

Sphincter wa Oddi ndi gawo lofunikira la hepatobiliary system. Ngati ntchito yake yasokonekera, matenda oyamba a ziwalo zam'mimba amayamba. Chifukwa chake, ndikofunikira kutsatira moyo wathanzi, ndipo pazizindikiro zoyambirira za matenda, pemphani thandizo kwa katswiri.

Kodi kupindika kwa Oddi ndi kotani?

Mu 1681, woyamba amafotokoza za kuzungulira kwa Oddi. Izi zidachitika ndi dotolo waku Britain a Francis Glisson, koma sphincter adatchulidwa pambuyo pa wasayansi wa ku Italy a Oddi Ruggiero. Ndi yemwe adasindikiza mapepala asayansi okhudza za morphological mu 1888, komanso koyamba kuchita zolemba zamatsenga.

Komanso, akatswiri azachipatala a ku Italy ndi omwe amafotokozedwa koyamba pakukula kwa duct yayikulu atayikidwanso ndulu ya gallbladder (cholecystectomy).

Sphincter ya ku Oddi ili mdera lalikulu la duodenal papilla. Mukuwoneka, ndi minofu yosalala, magwiridwe ake omwe amayang'anira kulowetsedwa kwa zilonda 12 zam'mimba za kapamba wa pancreatic ndi bile. Zimalepheretsanso zamkati kuchokera ku duodenum kuti zisalowe m'mizere.

The pancreatic mtundu sphincter wa Oddi spasm, makamaka, chipatala cha matendawa, chimafanana ndi zovuta zina zam'mimba, chifukwa chake gulu la zovuta izi lidawunikiridwa kangapo. Muzochita zachipatala, matenda a pathology ndi vuto losiyana la njira yothandizira.

Chithunzi chachipatalachi chimapezeka kwambiri mwa amayi kuyambira zaka 35 mpaka 60, ndizotsatira za cholecystectomy, yomwe idachitika pochiza mtundu wa cholecystitis.

Ntchito yogwira pancreatic ya sphincter ya Oddi imapezeka mu pathological pancreatobiliary fusion komanso pafupipafupi mawonekedwe a kapamba.

Kuphatikiza kwa kusokonezeka kwa sphincter ndi chifuwa chachikulu cha kapamba kumapezeka kawiri kuposa CP popanda zovuta zamagulu.

Kugawika kwa Sphincter Oddi Dysfunction

Muzochita zachipatala, mitundu ingapo ya kusokonekera kwamphamvu imasiyanitsidwa. Yoyamba ndikuwona mwatsatanetsatane. 1. Fomu iyi imaphatikizapo zovuta zamagulu zomwe zimayendera limodzi ndi kupweteka kwapang'onopang'ono kapena kupweteka kwambiri mu hypochondrium kapena mu epigastric zone.

Zowawa zambiri zimawonedwa mkati mwa mphindi 20-30. Endoscopic retrograde cholangiopancreatography ikuwonetsa kuchepa kwapang'onopang'ono kwa magawo osiyanitsa (kuchepera kuposa maminiti 45). Mukamapenda kawiri ma enzymes a chiwindi, kuphatikiza kwazizolowereka kwamankhwala ambiri a alkaline phosphatase amapezeka kawiri. Komanso, kukula kwa duct ya bile kumadziwika ndi oposa masentimita 1.2.

Mawonekedwe a Biliary 2. Ndi mawonekedwe awa, kukhalapo kwa zomverera zowawa zomwe zimafanana ndi zowawa za mtundu woyamba zimadziwika. Manometry amatsimikizira kuwonongeka kwa sphincter mu 50% ya zithunzi zamankhwala. Matenda omwe amadziwika kuti ali ndi matendawa amagwira ntchito kapena amagwiritsidwa ntchito mwachilengedwe.

Maonero a Biliary 3. Pali ululu wammbuyo, koma pali kusowa kwa zovuta zomwe zimapezeka mwa odwala a mtundu woyamba. Manometry amawonetsa kukomoka kwa sphincter mu 10-30% ya zithunzi.Kuphwanya mtundu wamtundu wotchuka kwambiri (mu 80% ya milandu).

Ndi yogwira pancreatitis, kudwala kumayendera limodzi ndi zowawa, zomwe zimabwezeretsa. Ngati wodwala akutsamira ndi thupi, ndiye kuti ululuwo umachepa. Kuzindikira kwa labotale kukuwonetsa kuwonjezeka kwakukulu kwa lipase ndi amylase.

Manometry amatsimikizira kuti Oddi sphincter dysfunction mu 40-85% ya milandu.

Etiology ndi zomwe zimapangitsa

Pancreatic mtundu dyskinesia wa sphincter wa Oddi amakula mwa odwala chifukwa cha pathological stenosis (kulimbikira kupatulira) kwa sphincter kapena pathogenesis chifukwa cha kuphwanya kwapakati. Kuchepetsa kwamatenda kumayamba chifukwa cha chotupa, ma fibrosis, komanso pazithunzi zina zamankhwala, zomwe zimayambitsa ndikuloweka kwa mucous nembanemba.

Kusintha kwa chiberekero komanso zotupa ndi chotsatira chotsatira cha mphamvu ya calculi yaying'ono yomwe imadutsa wamba bile duct. Chiphunzitsochi chimafotokozeredwa ndi momwe kusinthika kwachikondwerero kumayambitsa kufalikira kwa mawonekedwe a kapamba.

Kulekanitsidwa kwa zovuta zogwira ntchito ndi ma organic ndizovuta kwambiri, chifukwa nthawi ziwiri zovuta zimakhala ndi gwero limodzi. Matenda ambiri amapezeka mwa odwala omwe ali ndi mbiri ya chikhodzodzo chodzola. Odwala amapezeka ndi sphincter ya kuchepa kwa Oddi, chifukwa cha momwe bile limapitirira kulowa lumen kwa duodenum.

Ngati munthu ali ndi thanzi labwino, ndiye kuti akuwongoleredwa ndi mahomoni a neuropeptide, ndulu imayenera kugwira, bile imalowa mu duodenum, ndipo sphincter ya Oddi imatsitsimuka. Mukamachotsa ndulu, mutha kuwona kamvekedwe kakang'ono ka sphincter komanso kuwonjezeka kwa m'mitsempha ya bile.

Nthawi zina, atachitidwa opaleshoni, kamvekedwe kamacheperachepera, motero ndulu yopanda kukhazikika imalowa m'mimba. Zotsatira zake, matenda amadzimadzi amawonekera, zomwe zimayambitsa kutupa kwambiri.

Biliary-pancreatic syndrome imayambitsa kusokonezeka kwa njirayi, pomwe ma bile nthawi mobwerezabwereza amalowa m'matumbo, chifukwa chake, munthu amayamba kuwonetsa zizindikiro zingapo za matenda am'mimba.

Ngati bile ikalowa m'matumbo mosasamala, izi zimawonetsedwa ndi chipatala chotere:

• Kusokonezeka kwa enterohepatic kufalitsidwa kwa bile acid,
• Zovuta pantchito yokumba chakudya, kuchepetsa mayamwidwe a michere,
• Mphamvu za bactericidal zomwe zili m'matumbo zimachepa.

Chomwe chimapangitsa kuti dyskinesia ichitike ndi kusakhazikika kwa mahomoni komwe kumachitika nthawi yokhala ndi pakati, kusintha kwa thupi, komanso kugwiritsa ntchito mankhwala a mahomoni. Komanso nkhawa, matenda a shuga, matenda am'mimba, 12 duodenal ulcer, kuphwanya chiwindi ntchito, kuchitapo kanthu kwa opaleshoni yam'mimba komanso m'mimba.

Zizindikiro za dyskinesia wa sphincter wa Oddi

Monga tawonera kale, matenda am'mimba akuwonekera ndi ululu, makamaka, kugwidwa kwakanthawi kwa mphindi 20-30. Ululu wake ndi wapakati kapena wowopsa. Kutalika kwa matendawa ndi kupitirira miyezi itatu.

Odwala amadandaula kuti amamva kulemera pamimba, ululu wosalala pansi pa nthiti yakumanja. Zizindikiro za Dyspeptic chifukwa chophwanya njira ya kugaya chakudya zimawonetsedwa. Izi zimaphatikizapo nseru, kusanza, kugudubuza pamimba, kuchuluka kwa mpweya, kupanga malamba, ndi zina zambiri.

Osowa kwambiri, kupweteka kumawonetsedwa ndi colic. Komabe, ngati matenda a m'magazi amaphatikizidwa ndi mawonekedwe osakanikirana a kutupa kwa kapamba, ndiye kuti zopweteka zimadziwonetsa m'njira zosiyanasiyana.

Poyambirira kwa njira ya pathological, zovuta zam'mimba ndizosowa kwambiri, koma zimatha mpaka maola angapo. Palibe kupweteka pakati pa kuukiridwa, mkhalidwe wa wodwalayo umayenda bwino kwambiri. Nthawi zina kuwonjezeka kwa kugwidwa kumawonekera ndipo kumverera kowawa kumapezekanso pakatikati.

Ululu umayamba maora ochepa mutatha kudya. Komabe, ndizosatheka kulumikiza ndi chikhalidwe cha chakudya, popeza aliyense amadandaula za mawonekedwe osiyanasiyana amtendawa.

Muubwana, dyskinesia ya sphincter ya Oddi imawonetsedwa ndi boma la febrile (silitenga nthawi yayitali) komanso zovuta zingapo za autonomic.

Mwanayo sangathe kuyesa ululu wamaderawo, chifukwa chake, nthawi zambiri amawonetsa malo oyambitsirana.

Kuzindikira ndi njira zochizira

Kuti mudziwe njira yodutsira matenda, kudziwa kuchuluka kwa michere m'thupi, zomwe zili mu michere ya chiwindi. Ndi chiwopsezo, zizindikirozo zimachulukana kangapo kuposa zizolowezi. Amatha kuwonjezeka chifukwa cha matenda ena am'mimba, motero, kuwunika kosiyanako kumanenedwa.

Kuti adziwitse matenda, ultrasound imachitika ndikumayambitsa sing'anga ina, yomwe imathandizira kudziwa kukula kwa bile duct komanso njira yayikulu ya kapamba.

Ngati njira zosasokoneza sizikuthandizira kukhazikitsa matenda, pitani njira zina zowonekera. ERCP imachitidwa. Njira imalola kukhazikitsa mainchesi a duct, kusiyanitsa kuphwanya magwiridwe antchito a sphincter a Oddi ku ma pathologies ofanana. Ndikothekanso kuzindikira nthawi yakumatula ma ducts a bile.

Manometry ndi njira yophunzitsira yomwe imayeza mwachindunji katundu wa sphincter. Nthawi zambiri, kupsyinjika komwe kumakhalapo sikuyenera kupitirira mamilimita 10 a Mercury. Komabe, ngati pali zovuta, kafukufukuyu akuwonetsa zotsatira za 115 ± 20.

Pafupifupi 10% ya zithunzi, kukhazikitsa kwa manometry kumabweretsa kukula kwa kapamba, ndiye kuti kafukufukuyu ndiwowonjezera kwambiri pamene njira zina zodziwonera zathandizira kulephera.

Mankhwalawa akuphatikizapo izi:

1. Mankhwala othandizira omwe amawongolera amayang'ana kuchepetsa zovuta komanso mawonekedwe a dyspeptic.
2. Zakudya
3. Kuchepetsa chithandizo ndikofunikira pakachitika vuto la bakiteriya m'mimba.
4. Kuthetsa kusowa kwa biliary.

Pofuna kuchepetsa ululu, mankhwala amalembedwa ndi belladonna, zinthu monga buscopan ndi metacin. Pa ululu wapakati, No-shpa amalimbikitsidwa. Pofuna kuthana ndi zochitika za dyspeptic, mankhwalawa amagwiritsidwa ntchito - Creon, Pancreatin.

Mankhwala othandizira pakudya amachokera pazakudya zopatsa thanzi - mpaka kasanu ndi kawiri patsiku m'magawo ang'onoang'ono. Ndikofunikira kudya kuchuluka kwamizere yazakudya, zomwe zimathandizira kubwezeretsanso matumbo.

Kuchepetsa mankhwalawa kumaphatikizapo kugwiritsa ntchito ma proiotic, matumbo antiseptics ndi maantibayotiki. Biliary insufficiency amathandizidwa ndi Urosan.

Mavuto a kapamba akufotokozedwa mu kanema munkhaniyi.

Mtundu wa Biliary

Gulu ili ndiwambiri kuchuluka kwa DSO, zizindikilo ndi izi:

• kupweteka kumakumana ndi biliary colic - kupindika kolimba, kufikira kumbuyo, phewa lamanja, nthawi zina khosi,
• zambiri zofufuzira - kukula kwa ndulu wamba kuposa 12 mm,
• kuchuluka kwakuchotsa nthawi yoposa mphindi 45,
• kuchuluka kwa labu - kuwonjezeka kwa milingo ya ma transaminases ndi alkaline phosphatase osachepera 2 pakupenda mobwerezabwereza.

Malinga ndi kafukufuku wopanga ma manometric, mtundu wa biliary umagawika m'mitundu itatu, pomwe mtundu woyamba umakhala ndi stenosis (wocheperako) wa sphincter, mu mtundu wachiwiri wopezeka umapezeka mu 63% ya odwala, wachitatu - mu 28%. Zovuta zina zonse ndizowonekera (zosinthika, dyskinetic) mawonetsedwe.

Mtundu wa kapamba

DSO yamtunduwu pakuwonetsedwa kwachipatala imafanana ndi chifuwa chachikulu, ndipo kuwunika kokwanira kokha komwe kumakupatsani mwayi wodziwikitsa. Zizindikiro zake zazikulu ndi:

• kupweteka kwa epigastric kutizira kumbuyo,
• kuchuluka kwa plasma ya amylase ndi lipase michere.

Mkhalidwe wofanana ndi pancreatitis yayitali imapumira ndi kupweteka kofanana ndi hepatic colic. Zambiri zasayansi zimangosinthidwa pokhapokha ngati zomwe zasungidwazo zidasankhidwa panthawi yamapweteka. Munthawi yakachetechete, pafupifupi palibe kupatuka komwe kungapezeke.

Mawonetseredwe apadera a mitundu yosiyanasiyana ya matenda

Nthawi yomweyo, pali zizindikiro zomwe zimapangitsa kuti zithe kusiyanitsa mitundu yosiyanasiyana ya DSL.

Zoyambitsa ndi Zoopsa

Chifukwa chachikulu chimatengedwa ngati vuto la metabolic m'chiwindi, komanso ndilofunikanso:

• kusintha kapangidwe ka bile,
• kuphwanya kwamisempha ya bile, kusayenda kwake,
• dyskinesia wamba duct kapena gawo la bile ndi kapamba wa ma pancreatic.
• Opaleshoni yopanda opaleshoni yomwe sphincter ya Oddi imavulala, ngakhale pang'ono,
• kukula kwambiri kwamatumbo microflora.

Gastroenterologists amaonabe kuti hepatocellular dyscholia ndi chifukwa chachikulu chopanga DLS. Ichi ndi chikhalidwe chomwe cholecystokinin yoperewera amapangidwira. Katunduyo ndiwowongolera mwachilengedwe kamvekedwe ka ndulu ndi mitsitsi yake. Mothandizidwa ndi cholecystokinin, kamvekedwe ka sphincter kamawonjezeka mpaka chikhodzodzo chimadzaza ndi bile. Ikadzaza, sphincter imapumula kuti bile ipite kuyenda momasuka. Pambuyo pa cholecystectomy, kamvekedwe ka sphincter amasintha, ndipo bile limasunthika kapena kumayenda mosalekeza. Izi zimasintha kapangidwe kazinthu ngati mahomoni zomwe zimayendetsa kagayidwe mu kapamba, kapamba wachiwiri amapezeka.

Kafukufuku wa Laborator

• bilirubin ndende
• zamchere phosphatase
• aminotransferase
• lipases ndi ma amylases.

Kusintha kwa ndende kumaonedwa kuti ndikofunika kuzindikira ngati magazi a venous asanafike pasanathe maola 6 kuchokera ku kuukira.

Kufufuza kwazida

• Ultrasound yam'mimbamo yam'mimba - kukulira kwa wamba bile duct ndi pancreatic duct kutsimikiza. Kuti mumvetse bwino, perekani chakudya cham'mawa chambiri, ndikuwunikira kusintha kwa kukula kwa dambo wamba la mphindi 15 zilizonse kwa ola limodzi. Kukula kopitilira 2 mm ndi chizindikiro chomveka cha DLS. Kuti muwone ntchito ya pancreatic duct, kuyesedwa ndi secretin kumachitika. Nthawi zambiri, pambuyo pakupereka mankhwalawa, duct iyenera kukulira, koma mkati mwa theka la ola kubwerera ku kukula kwake koyambirira. Ngati kuchotsedwako kudatenga zoposa mphindi 30, ndiye kuti nawonso ndi chizindikiro cha DSO,
• CT ya hepatoduodenal dera - kukula ndi mawonekedwe ake zikuwonekera bwino,
• ERCP - kubwezeretsa cholangiopancreatography. Njira yake ndi yovuta, ndiye kuti ikulowa mwachindunji mu sphincter ndi ducts. Kugwiritsa ntchito kafukufuku, kusiyanitsa kumayambitsidwa, ndiye kuti x-ray imachitika. Ngati dambo wamba laubweya limakulitsidwa ndi oposa 12 mm, ndipo kusiyanitsa kuchuluka kwa madzi opitilira mphindi 45, ndiye kuti matendawo sangakhale osatsutsika,
• Manometry ndi muyeso wolunjika wa kamvekedwe ka sphincter. Pa phunziroli, kupumula kwa minofu yosalala kumatha kugwiritsidwa ntchito. Njirayi ndiyovuta, ili ndi ma contraindication ambiri, pali zovuta zina, kotero kugwiritsidwa ntchito kwake kumakhala kochepa.

Chithandizo chili ndi njira zingapo zingapo zomwe zimagwiritsidwa ntchito nthawi imodzi.

Izi ndiye maziko a moyo wopanda chifukwa popanda kutsatira malamulo osavuta, thanzi labwino ndizosatheka. Ndikofunikira:

• Zakudya 4 patsiku, chakudya chamadzulo asanagone - zimapangitsa kuti chikhodzodzo chithe.
• kuletsa kwa mafuta nyama (pazambiri - mafuta pang'ono msuzi),
• kupatula kwathunthu yokazinga,
• kuchuluka kwa zipatso ndi ndiwo zamasamba ambiri, kuchuluka kwake kumayenera
• kugwiritsa ntchito chinangwa.

Mankhwala

Pambuyo cholecystectomy kwa masabata 24, mankhwala amalembedwa - antispasmodics, yabwino kwambiri yomwe ndi Duspatalin, yomwe imatengedwa m'mawa ndi madzulo.

Kuchepetsa njira yovunda m'matumbo a 1 kapena 2 pachaka, maantibayotiki ndi mankhwala othana ndi kutupa amathandizidwa, nthawi iliyonse mosiyana. Mankhwala amasankhidwa ndi adotolo, Ciprofloxacin, Biseptol, Enterol, Tetracycline ndi zina zomwe amagwiritsidwa ntchito.

Mukamwa maantibayotiki, pro- ndi prebiotic amalembedwa: Bifiform, Hilak Forte ndi ena.

Kudzimbidwa, mankhwala ogwiritsira ntchito mankhwalawa amagwiritsidwa ntchito, makamaka Dufalac, omwe amathandiza kukula kwama microflora abwinobwino.

Nthawi yoyamba atachitidwa opaleshoni, nthawi zina anti-acid agents (Maalox, Smecta), ma enzymes am'mimba (Creon, Mezim) amafunikira.

Ngati mayeso a labotale akusonyeza zonyansa pachiwindi, hepatoprotectors - LIV 52, Heptral, kukonzekera kwa asidi.

Seti yodziwika ya mankhwalawa imatengera chithunzi cha chipatala.

Zambiri

Sphincter wa Oddi spasm ndi chikhalidwe chodziwika bwino mu gastroenterology, chofala kwambiri mwa akazi. Zowerengeka zolondola pa nosology iyi sizikupezeka, koma ndikudziwika kuti pakati pa odwala omwe adakumana ndi cholecystectomy, kupweteka kwam'mimba komanso kusokonekera kwa dyspeptic komwe kumachitika chifukwa cha kukomoka kwa sphincter kumapitirira 15% yamilandu. Ntchito ya sphincter ya Oddi imawonetsetsa kuti ntchito zonse zogwirizanirana ziziyenderana. Pamene chikhodzodzo mgwirizano, minyewa ya sphincter imapumula, ndipo mosemphanitsa. Izi zimathandizira kulowa kwa ma enzymes munthawi yake mu lumen ya duodenum. Kusintha kolumikizana kwa kachipangizo ka sphincter kumayambitsa kuphwanya kutuluka kwa bile, kupweteka ndi dyspepsia.

Zoyambitsa za Sphincter Oddi Spasm

Sphincter ya Oddi spasm ndi njira yodziwika yopezera matenda, yomwe imayambitsa chachikulu ndi minofu ya dyskinesia. Malinga ndi mawonedwe azachipatala, kupindika kwa sphincter ya Oddi kumafanana ndi stenosis yake yoyambitsidwa ndi kusokonezeka kwapangidwe, ndipo nthawi zambiri zosinthazi zimaphatikizidwa. Hypertonicity ya sphincter imayamba chifukwa cha kuphipha kwamkati mwa minyewa yake (ma sphincters ozungulira mbali yakumanzere ya bile duct, pancreatic duct ndi ampulla ya ngalande m'dera la fusion la ma ducts awa). Zotsatira zake, kupanikizika kwa dongosolo la duct la biliary ndi kapamba kumakulirakulira.

Zomwe zimayambitsa kupanikizika kwakutalika kwa Oddi sizinakhazikitsidwe; kutupa kwa duodenal papilla ndi duodenitis ndi zina mwa zifukwa. Predisposes pakukula kwa matenda amtunduwu, akazi, zaka 30-50 zaka, asthenic physique, kulimbitsa thupi, kusowa kwa thupi.

Zizindikiro za kuphipha kwamkaka kwa Oddi

Kuwonetsedwa kwachipatala kwa kuphipha kwa sphincter ya Oddi ndikumva kupweteka kwakanthawi komwe kumakhala mu hypochondrium kapena epigastrium, ndikuwunikira kumbuyo kapena dera la scapula. Kutalika kwa vuto la kupweteka nthawi zambiri kumakhala mphindi makumi atatu kapena kupitilira, kulimba kwake kumatha kukhala kwakukulu, kumapangitsa kuvutika kwa wodwalayo. Zowawa sizisiya kumwa maantacid, kusintha maonekedwe a thupi. Matenda a ululu amaphatikizidwa ndi zizindikiro za dyspeptic: nseru, kusanza.

Nthawi zambiri, koma osati mobwerezabwereza tsiku lililonse, kusaloleza zakudya zamafuta ndi chikhalidwe. Pakufinya kwa kupindika kwa Oddi, kukhazikitsidwa kwa ululu usiku ndikwachilendo, komwe ndi njira yotsatsira matendawa ku matenda ena angapo okhala ndi vuto lochita kupatsirana matenda amisempha, komanso kusowa kwa matenda oopsa pa nthawi yopweteka. Ubwenzi wamapweteka ndi kudya kwa wodwala aliyense ndiwofanana. Nthawi zambiri, ndikomoka ndimatha maola awiri kapena atatu nditadya. Nthawi zambiri, wodwalayo amadziwa chakudya chomwe chimakwiyitsa gawo (zonunkhira, mafuta).

Odwala ambiri omwe akukayikira kuphipha kwa ku Oddi ali ndi mbiri ya cholecystectomy.Pambuyo pa opaleshoni, nthawi zambiri kupweteka kwamkati mu hypochondrium yoyenera kumachepa, koma pakapita kanthawi kuwukira kumayambiranso. Pankhaniyi, mawonekedwe a ululu wamankhwala pafupifupi ali ofanana ndi opareshoni asanachitike. Nthawi zambiri, kuyambiranso kumachitika patapita zaka zitatu kapena zisanu chitatha kulowererapo. Nthawi zina, atangochita opaleshoni, kupweteka kumawonjezeka, izi zimagwirizanitsidwa ndi kuchotsedwa kwa madzi osungirako bile.

Kuzindikira kuphipha kwa kupindika kwa Oddi

Kufunsidwa kwa gastroenterologist kumawonetsa kuti wodwalayo ali ndi sphincter ya Oddi spasm pamaso pa kupweteka kwamankhwala ngati kupweteka kwa colic posakhalitsa choledocholithiasis, mawonekedwe a bile duct, komanso matenda osapatsirana a hepatobiliary omwe ali ndi zizindikiro zofanana.

Kusintha kwa mawonekedwe pazotsatira za mayeso a labotore ndiwonjezere mu ntchito ya bilirubin, transaminases, amylases panthawi youkira. Kuyesedwa kwa magazi ambiri, palibe umboni wa kutupa. Urinalysis sinasinthe. Kusiyana pakati pazotsatira za mayeso a labotale panthawi ya kuphipha komanso kunja kwawonekera.

Ultrasound imakhala ndi ma ultrasound a chiwindi komanso ma biliary thirakiti. Njira yofufuzira iyi imalola kusiyanitsa kuphipha kwa kupindika kwa Oddi ku hyperkinetic gallbladder dyskinesia ndi matenda ena. Phunziroli limazindikira kuchuluka kwa duct ya bile asanafike kapena itayesedwa. Sphincter manometry imachitidwanso, pomwe mawonekedwe a diagnostion ndiwowonjezera kukakamizidwa pamtunda wa 40 mm Hg. Art. Komanso pakupanga ma menometry, ma frequency ambiri a sphincter, kuyankha kwamtunduwu kukondoweza kwa cholecystokinin, mgwirizano wolakwika umatsimikizika.

Njira ina yopangira ma sphincter manometry ndi kusintha kwa hepatobiliscintigraphy ndi kuphwanya kwa cholecystokinin. Zotsatira za njira yofufuzira izi mu 100% ya milandu zimakhudzana ndi zotsatira zomwe zimapezeka ndi ma manometry, pomwe palibe zotsatira zoyipa zomwe zimadziwika chifukwa cha matenda omwe akupezeka. Kupatula ma sphincter, ma pancreatitis otsalira mu duct ya bile pambuyo pa cholecystectomy ya calculi, komanso kupeza bile, endoscopic retrograde cholangiopancreaticography imachitika.

Kusiyanitsa kosiyanasiyana kumachitika ndi cholecystitis yopanda kuwerengetsa, stenosis ya bile kapena pancreatic duct, ndi njira yotupa. Mukazindikira matenda awa, tiyenera kukumbukira kuti kuphipha kwa kupindika kwa Oddi nthawi zambiri kumakhala kophatikizana ndi matenda ena omwe amaphatikizidwa ndi vuto la m'mimba motility, matumbo opanda kanthu, komanso matumbo osakwiya.

Chithandizo cha kuphipha kwa kupindika kwa Oddi

Chithandizo cha matenda amtunduwu chimachitika pang'onopang'ono, koma nthawi zina ndimatanthauzidwe opweteka kwambiri, wodwalayo amatha kuchipatala kuchipatala kuti apewe zovuta m'matumbo ndikuwonetsa. Njira zazikulu zochizira kuphipha kwa kupindika kwa Oddi ndi kupumula kwa minofu yake, kupumula kwa ululu, kuphatikizidwa kwa kutuluka kwa ndulu ndi kapamba wa pancreatic. Chithandizo cha zakudya ndizopatula zakudya zamafuta ndi zonunkhira, zonunkhira, adyo ndi anyezi. Ndikofunikira kuteteza kulemera kwa thupi, komanso kusiya kusuta.

Kuti athetse kuphipha kwa sphincter ya Oddi, nitrate, anticholinergics (metocinium iodide), calcium njira blockers (nifedipine) ndi mankhwala. Chifukwa chakuti mankhwalawa ali ndi zovuta, komanso zamtima, ndikofunikira kuti muzigwiritsa ntchito muyezo wocheperako. Antispasmodics (papaverine, pinaveria bromide, drotaverine) amagwiritsidwanso ntchito, mebeverin ali ndi kusankha kokwanira kwa sphincter ya Oddi. Pofuna kuthetsa kuphipha, kukwaniritsa choleretic kwenikweni, kuchepetsa kuchepa kwa biliary, gimecromon ndi mankhwala.

Palibe chifukwa choyenera kuchokera ku chithandizo chokhazikika, kupweteka kwapafupipafupi komanso kupweteka kwa khansa, opaleshoni imachitidwa: endoscopic sphincterotomy, kuchepa kwakanthawi kwa balloon, kuchepa kwakanthawi. Ngati njira ina, kuyang'anira poizoni wa botulinum mu sphincter kumagwiritsidwa ntchito.

Kuneneratu ndi kupewa kuphipha kwa sphincter ya Oddi

Kuzindikira kwa kuphipha kwa sphincter ya Oddi ndikabwino. Nthawi zambiri, chithandizo chokwanira chodalirika chathanzi chimathandizira kukonza kwakanthawi kachipatala; pakalibe, sphincterotomy imakhala yokhutiritsa. Palibe njira yolepheretsa kuphipha kwa sphincter ya Oddi. Iwo m`pofunika kuti zomveka zakudya, kukhalabe olimbitsa thupi, munthawi yake matenda ena am'mimba thirakiti.

Mitundu ya matenda

Chotsatira chazomwe chimasiyanitsa mitundu iyi:

• choyambilira (kupanga popanda zam'mbuyomu),
• sekondale (chifukwa cha matenda oyamba).

Pogwira ntchito:

• dyskinesia ndi hyperfunction,
• dyskinesia ndi hypofunction.

Kuti afotokoze mtundu wa sphincter wa kusowa kwa Oddi malinga ndi chidziwitso cha nthawi ya Rome Consensus (1999), njira zodziwitsa:

• kupweteketsa kwapweteka kwapulogalamu
• kuchuluka kuwirikiza kawiri pamlingo wa michere ya chiwindi (AST, alkaline phosphatase) m'maphunziro osachepera awiri,
• Kuchepetsa kupulumutsidwa kwa kusiyana kwapakati pa mphindi 45 panthawi ya endoscopic retrograde cholangiopancreatography,
• Kukula kwa wamba bile duct 12 mm kapena kupitilira.

Mitundu ya kukomoka yotsimikiza mogwirizana ndi njira:

1. Biliary I - yodziwika ndi kupezeka kwa zizindikiro zonse pamwambapa.
2. Biliary II - chiwopsezo chapadera cha kupweteka kwa bile kuphatikiza ndi njira imodzi kapena yodziwira matendawa.
3. Biliary III ndi vuto lakunja lopweteka lopanda zizindikiro zina.
4. Pancreatic - ululu womwe ulipo wokhudzana ndi kutupa mu kapamba (pophatikizana ndi kuchuluka kwa michere ya kapamba).

Chithunzi cha chipatala cha kukomoka kwa kukomoka kwa Oddi ndizosiyanasiyana:

• kupweteka m'dera la epigastric, mu hypochondrium yoyenera ya kuphulika, mawonekedwe osakhazikika, nthawi zina - wodwala, osakhalitsa, wolimbikitsidwa ndi cholakwika mu chakudya, kuchuluka kwa psychoemotional, kuchita masewera olimbitsa thupi mopitirira muyeso. Ululu umatha kuwonekera mpaka kumaso kwa scapula, phewa, kumbuyo, ndi mtundu wa pancreatic, ndi pachimake herpes zoster,
• kumva kuwawa mkamwa
• kusanza, kusanza kwa bile,
• kutulutsa, kupweteka m'dera lodetsa,
• kudzimbidwa,
• kutopa,
• kusakhazikika
• zosokoneza tulo.

Matenda a ululu amakhala paroxysmal mwachilengedwe, nthawi zambiri palibe zodandaula panthawi yopitilira.

Ndi kukanika kwa sphincter ya Oddi, kutuluka kwa ndulu ndi katemera wa pancreatic kumasokonezeka, kuphatikizidwa kwa chakudya chimbudzi kumachitika molakwika, zomwe zimayambitsa zovuta zina zam'mimba.

Mavuto omwe angakhalepo komanso zotsatirapo zake

Mavuto a kukanika kwa sphincter ya Oddi akhoza:

• cholangitis
• matenda a ndulu
• kapamba
• gastroduodenitis.

Zoneneratu zabwino. Ndi pharmacotherapy yomwe imayamba panthawi yake, zizindikiro za matendawa zimayamba kutchulidwa m'nthawi yochepa. Kuchita bwino kwa zowononga zachilengedwe kumaposa 90%.

Maphunziro: apamwamba, 2004 (GOU VPO "Kursk State Medical University"), apadera "General Medicine", oyenerera "Doctor". 2008-2012 - Wophunzira wa PhD, dipatimenti ya Clinical Pharmacology, SBEI HPE "KSMU", wolemba zamankhwala azachipatala (2013, apadera "Pharmacology, Clinical Pharmacology"). 2014-2015 - katswiri wophunzirira, wapadera "Management mu maphunziro", FSBEI HPE "KSU".

Chidziwitsocho chimapangidwa ndikupatsidwa chidziwitso chokhacho. Onani dokotala wanu chizindikiro choyamba cha matenda. Kudzipatsa nokha mankhwala kuopsa!