Mirizzi ciwo: rarrabuwa, ganewar asali, magani

Sunan "Mirizzi ciwo" hade da sunan Likita daga Argentina Mirizzi, wanda shi ne marubucin da yawa ayyukan alaka da Physiology na biliary tukar tumbi, kazalika da na asibiti yi a fagen intraoperative cholegraphy.

A shekara ta 1948, ya kimiyya aikin likita bayyana radiological semiotics hanta ciwo, bayyanar cututtuka na abin da ya bayyana haske bile stasis da contracture na bile bututu. Har ila yau, hoton calculouse ciwo da aka gabatar, wanda aka bayyana, a bayyanar da fitsari tsakanin gallbladder da hepaticocholedochus.

Akwai rikitarwa

Ba kowa ba ne saba da wannan cuta a matsayin Mirizzi ciwo. Mene ne shi, da muka bayyana a kasa. Amma da farko shi ne ya kamata a lura da cewa ya zuwa yanzu a magani sosai ra'ayi ba da cikakken bayyana. Alal misali, mutane da yawa likitoci yi imani da cewa dalilin da cuta ne a takaita da lumen a cikin ducts na hanta. Mai kumbura halitta ciwo ya shafi ganewa na cutar hanta da stenosis yanki bututu ko aljihu Hartmann ilimin lissafi, wanda yana tare da kumburi da gall mafitsara da kuma bayyana kanta a cikin filin cholangitis ko jaundice.

Mirizzi ciwo, wanda rarrabuwa da aka gabatar a wannan labarin shi ne ra'ayi na masana kimiyya da dama, halin ba kawai takaita na lumen. A pathological tsari ya shafi dama na kowa da kowa bile bututu.

Babu shakka daban bi da ciwo na masana kimiyya suka yi ĩmãni da cewa dalilin da cuta ne puzyrnoholedohealny fitsari. Akwai tsaurin ra'ayi a kan sarrafawa na pathological tsari. A wasu kimiyya articles ake magana a wuri tsakanin gallbladder da kowa hanta bututu, da kuma cikin wasu bincike takardunku ne misalai na kasancewa fitsari tsakanin gall mafitsara da kowa bile bututu.

Alal misali, a cikin rarrabuwa na MV Corlette, H. Bismuth (1975) ya wakilci bilio-biliary fitsari iri biyu dangane da sarrafawa da maha? Ar (sama ko a kasa da babban fili na cystic bututu da kuma gall).

Wasu masu bincike siffantãwa da buɗi na cuta ga takaita da lumen da kuma samuwar hepaticocholedochus holetsistoholedohealnogo fitsari.

Bambance bambancen fassarar da gaske ciwo dagula ji na ta ainihi da mutum sami tasiri hanyoyi don mu bi da shi.

A cikin 'yan shekaru, sau da yawa za ka iya samun wani sabon fassarar wannan Pathology kamar yadda Mirizzi ciwo? Nau'in daga gare aka nuna bambance-bambancen karatu guda biyu da cuta:

• m tsari, a cikin abin da quntata lumen hepaticocholedochus.
• kullum nau'i, wanda tsokani bayyanar da fitsari tsakanin hepaticocholedochus kuma gallbladder lumen.

A gargajiya description

The classic bayanin irin cuta tsari kamar yadda Mirizzi ciwo, wani photo na wanda aka gabatar a cikin wannan takarda kunshi hudu babban arziki:

• kusa da matsayi a layi daya bututu na gallbladder da hanta na babban bututu.
• A gaban duwatsu a cikin gallbladder ko bututu a cikin wuyansa,
• obstructive hanta aiwatar da kwarara, wanda aka sa a cikin wani tsayayyen concrement bututu da kuma gallbladder kumburi a kusa da shi.
• gaban jaundice tare da ko ba tare da cholangitis shi.

ka'idodinta rarrabuwa

Abin da irin wannan cuta da aka raba kamar yadda Mirizzi ciwo? A rarrabuwa ya shafi halaka matakin da babban bututu bango hanta puzyrnoholedohealnym fitsari (Csendes):

• Rubuta I - squeezing na kowa bututu duwatsu wuyansa hanta gallbladder ko bututu.
• Type II - gaban vesico-holedohealnogo fitsari mamaye kasa da 1/3 daga cikin jimlar karkara na bututu na hanta.
• Type III - gaban vesico-holedohealnogo fitsari, wanda bautarka 2/3 na karkara na bututu na hanta.
• Type IV - gaban vesico-holedohealnogo fitsari, wanda daukan cikakken karkara hanta bututu, cikinsa da bututu bango an hõre kammala halaka.

Sanadin da ciwo ci gaba

Babban haddasawa da wannan cuta a matsayin Mirizzi ciwo ne:

• matsawa lumen bile bututu externally tsokani calculous m cholecystitis.
• gaban bile bututu stricture located wajen yankin na hanta.
• hepaticocholedochus samuwar perforations a gaban stricture.
• ci gaban vesicovaginal fitsari holedohealnogo layi daya kawar da stricture.

Dangane da tsarin da biliary ducts, da size da kuma nauyi na duwatsu, kazalika da hanyoyin da magani aiwatar iya dakatar a wani na sama matakai, amma da canji daga kadan matsawa da bile bututu a vesico-holedohealny fitsari za a iya lura kawai a gallstone cuta.

Matsawa degenerates cikin bile bututu stricture idan tiyata an jinkirta da kuma cutar da zama na kullum tsari, a cikin abin da lokaci na gafarta musu ana maye gurbin peaking. Sa'ad da lokaci na gallbladder bango da hepaticocholedochus fara lamba cewa jawo wani babban dutse a cikin aljihu na Hartmann. A karkashin matsin lamba daga nauyi tabarbarewar trophism taso decubitus gallbladder bango da kuma bututu. Sa'an nan puzyrnoholedohealny fitsari ne kafa.

Ta hanyar irin wannan pathological rahotanni daga gallbladder cikin lumen hepaticocholedochus fall concretions. Fitsari ya karu a diamita ta rage ta nama matsawa zone. A sakamakon haka, da takaita da proximal bangare na hepaticocholedochus ci gaba, da gallbladder an rage a cikin size, shi vuya wuyansa, Hartmann aljihu da kuma babban ɓangare na jiki. A sakamakon haka, da gallbladder zama kamar divertikulopodobnoe ilimi, wanda shi ne wani sako da lumen na extrahepatic bile bututu ta amfani da mai fadi da anastomosis. Matsayin mai mulkin, babu wani kumfa kwarara.

symptomatology

Ta yaya Mirizzi ciwo? Alamun halayyar cholecystitis auku a m ko na kullum fom da ci gaban inji jaundice. Mafiya yawan marasa lafiya a cikin likita bayanin kula kara data kasance gallstone cuta da m harin, cyclical inji jaundice. Game da kimiyya data, da haske da kuma mafi sau da yawa bayyana bayyanar cututtuka sun hada da ciwo a cikin sama dama ciki. Zafi da jaundice damu a 60-100% na lokuta.

Jaundice bayyana sau da yawa a gaban vesico-holedohealnogo fitsari.
Lokacin da cholangitis lura zazzabi. Wani lokacin ta da zafi a cikin hypochondrium, abin mãye da ci gaba da pancreatitis (ayyukan kamar yadda wani mai rufi a kan wani na kowa cuta). A cikin jini qara kudi na bilirubin, Alt, AST, kuma alkaline phosphatase.

Wane ne ya fi kowa?

Mirizzi ciwo ya auku a 0.1% da marasa lafiya da gaban gallstone cuta. Idan m baki aka lura a 0.7-2.5% da marasa lafiya. Marasa lafiya, maza da mata da cikakken duk jinsi da kasashe. A tsufa, cuta ya auku fiye da akai-akai.

hanyoyin da ganewar asali

Mene ne mawuyaci na lura da irin cututtuka kamar Mirizzi ciwo? Ganewar asali da kuma m m bata da cikakken bayyana.

A zamani magani, babu wani kullum yarda da dokoki domin gudanar da bincike hanyoyin. Duk da ci gaba a fannin kiwon lafiya Dabarar cututtuka daban-daban, da ganewar asali aiki ne kafa tare da wata wahala ba. Wannan aiki game da 20% na lokuta. Kawai 'yan masu bincike sun bayyana cewa, duban dan tayi da cutar kafin aiki ya kai daidai manufa da 67,1% na lokuta, MRI - a 94,4%, intraductal duban dan tayi - at 97% da kuma endoscopic retrograde cholangiopancreatography - 100%.

Duk wannan ya nuna cewa, hanyoyin zamani na instrumental ganewar asali ba ko da yaushe sa shi yiwuwa a gano Mirrizi ciwo a lokacin gabanin da aiki.

Mafi sau da yawa, a lokacin da duban dan tayi samu da wadannan cututtuka:

• tsawo bututu a cikin hanta, kazalika da ta proximal kamanta layi daya da na kowa bututu unexpanded gallbladder.
• gano gallbladder wrinkled jihar.

CT Mirizzi ciwo Manuniya zo daidai da siffofin gano ta duban dan tayi. Ko da yake CT ba zai iya samar da muhimmanci karin bayanai zuwa wani ultrasonic hanya, da rawar a kayyade gaban ciwon daji a cikin proximal ducts na gallbladder ne wajen high, wanda yana da muhimmanci a cikin bambantawa Mirrizi ciwo da gaban ciwon daji.

Magnetic rawa Dabarar, endoscopy da retrograde cholangiopancreatography (ERPHG) diagnostic hanyoyin su ne m, a game da gano da kuma stricture holetsistoholedohealnogo fitsari. A hotunan a cikin yanayin T1 da T2 iya zama mafi daidai rarrabe kumburi daga ciwon daji, shi ne ba ko da yaushe mai nagarta CT da kuma duban dan tayi. Duk da haka, saboda da babban farashi na jarrabawa ta MRI wannan bincike Hanyar ba amfani a duk cibiyoyin kiwon lafiya.

Magnetic rawa cholangiopancreatography ne mai gwada sabon, amma kadan karatu irin ganewar asali. Da dama da masana kimiyya duba shi a matsayin alamar rahama ra'ayoyi designate irin Pathology kamar yadda Mirrizi ciwo.

Wasu masana kimiyya ce a cikin rubuce-rubucen da abũbuwan amfãni daga laparoscopic ultrasonography pancreatoduodenal yankin. A lokacin tiyata domin da ake zargi da ganewar asali CM wannan hanyar sa ya yiwu a gina wani real-lokaci image na bile ducts a dama jirage 'ya'yan na da kusurwoyi mabambanta. A halin yanzu, duk da haka, wannan hanya ya rage m da kuma unexplored har karshen.

Ya kamata a lura da cewa, duk da kasancewar hanyoyin daban-daban na ganewar asali, kafa gaban CM ne har yanzu da wuya matuƙa, wanda zai iya gabatar da wani likita ɓace, kuma haifar da lalacewar da na kowa bile bututu, wanda aka kuskure riskarsa kamar wani gall mafitsara ko mai fadi da ya kwarara. A rashin kullum yarda da hanyoyin da ganewar asali kafin tiyata da aka turawa wajen samar da mafi kyau hanyoyi.

magani Jagororin

Yadda shafe Mirizzi ciwo? Jiyya ya shafi biyu main yankunan: rentgenoendoskopichesky Hanyar da m baki.

Rentgenoendoskopichesky irin magani za a iya amfani da a matsayin na farko mataki kafin tiyata a cikin shiri domin tiyata. Ya abubuwa a matsayin mai zaman kanta Hanyar magani na marasa lafiya da gaban SM a cikin hali na high m hadarin.

A disadvantages Rev da yawa masu bincike sun hada da:

• radiation daukan hotuna zuwa marasa lafiya da kuma likita ma'aikatan.
• high farashin for endoscopy da X-ray jarrabawa.
• da rashin kawar da takaita na lumen na proximal ɓangare na kowa bile bututu.

Bisa ga kimiyya adabi bambanta ƙwarai a tsakãninsu hanyoyi na gudanar da sa baki. Akwai daban-daban zabin ga m gudanar a SM.
Wasu likitoci yi imani da cewa Mirrizi bi da ta laparoscopy ciwo ne cikakken contraindicated.

By da more kowa nau'i na aiki a lokacin da na farko irin shi ne cholecystectomy ciwo, wanda aka supplemented da draining choledoch.

Yadda kuranye daga kasancewar wani fitsari biliobiliarnogo Mirizzi ciwo? Situational aiki na bukatar rabuwa da kuma dawo da hloledoha mutunci. Kamar yadda daya daga cikin hanyoyi na rufe da na kowa bile bututu, wanda aka yi amfani da da yawancin likitoci ne ya kawar da lahani na ta bango ta hanyar bar wani ɓangare na gall mafitsara. Duk da haka, wasu likitoci yi imani da cewa barin nama zai iya kara hadarin saura choledocholithiasis.

A gaban wani fitsari holetsistobiliarnogo shawarar aiwatar da kowa bile bututu stents robobi a kan wani wucin gadi yanayi. Bukatar irin wannan aiki, masana kimiyya da dama bayyana gaban dogon lokacin da canje-canje faruwa a yankin na kumburi yanayi hepatoduodenal jijiyoyin, inda SM za a iya riskarsa kamar lalacewar model bile bututu katangu. A da babba nakasawa bile bututu bango kunshe a cikin fitsari.
A lokacin tiyata, akwai wani babban matakin hadarin rikitarwa.

zai yiwu rikitarwa

Mafi sau da yawa da shi ya auku bayan tiyata ne mai wahala kamar yadda kowa bile bututu stricture. Bisa ga Rasha bincike GI Dryazhenkova (2009) na 46 marasa lafiya da suke tiyata, stricture faru a 6.5%.

Abin da sakamakon aiki a kan abin da ake kira batattu magudanun ruwa, wanda aka sanya hudu marasa lafiya da farko form CM (stenotic view)? Masu bincike V. S. Savelev, VI Revyakin (2003) ya lura da kyau muhimmancin da cutar, duk da haka, bayyana da kau da bututu yankin na magudanun ruwa tsarin to da wadannan dalilai:

• ci gaban jaundice.
• magudanun toshewa tsokani da samuwar kananan calculi.
• salts shaida a kan garun magudanun ruwa.
• jari na detritus, irin wannan a cikin daidaito da putty cewa tsokani maimaita hare-hare na cholangitis.

The mafi girma mataki na wahala na aiki ne a kan marasa lafiya da wani babban mataki na kowa bile bututu bango, halakarwa. Idan cutar ne a cikin na uku ko hudu mataki, shi ne lura da hakan mace-mace kudi bayan tiyata. Lokacin da cutar da ake located in ta uku ko hudu matakin, mafi Surgeons so a holedohoeyunoanastomoza.

Jiyya bayan tiyata

Kamar yadda docked Mirizzi ciwo? Jiyya bayan tiyata ya shafi jini count mika wuya gaba rana bayan da aiki, daya mako da rana daya kafin sallame shi daga asibiti. Sutures an cire kan 10th rana.

A talakawan tsawon na asibiti Yawara ne 10-12 kwanaki. A total tsawon na dawo lokaci ne watanni biyu.
Yawanci, marasa lafiya nuna sauran a wani sanatorium a fi sashen.

ƙarshe

Don kwanan Mirizzi ciwo, rarrabuwa, ganewar asali da kuma lura da abin da aka bayyana, a wannan labarin, magani ne a matsayin daya daga cikin matsalolin da na gallstone cuta. Duk da haka, a cikin filin na bincike da kuma tiyata ne har yanzu a yawan warware matsalar al'amurran da suka shafi.

Duk da cewa akwai mai fadi da kewayon daban-daban na m baki, magani sakamakon ba ko da yaushe hadu da sa ran.
A lokacin aiki, ta ƙara intra- da postoperative wahala kudi.

Matsalolin a gudanar da bincike ayyuka, hadarin lalacewar da bile bututu, da kananan yawan lura, da kuma wani mai arziki bakan da hanyoyin tiyata ne a bukata kafun ga mafi in-zurfin nazari na matsalar.

A gabatarwar da zamani ka'idojin bincike da kuma ci gaban da mafi kyau duka dabara a fagen tiyata dangane da mataki da cutar damar haƙuri ga inganta far tare da wannan wahala na cholelithiasis.