Phekolo ea spasm ea sphincter ea Oddi

Ho se sebetse ha sphincter ea Oddi (Sphincter ea Senyesemane ea dysfunction ea Oddi) - bokuli (boemo ba bongaka), bo khetholloang ka mokhoa o sa lekanyetsoang oa patency ea ducts ea bile le lero la pancreatic ho sphincter ea Oddi. Ho ea ka mehopolo ea sejoale-joale, ke maemo a tlatselletsang a kliniki a boleo bo sa reroang a boletsoeng litsong tsa sphincter tsa Oddi. E ka ba le sebopeho (sebopeho) le sebopeho se sebetsang se amanang le ts'ebetso ea koloi e senyehileng ea sphincter.

Ho latela 1999 Rome Consensus on Functional Digestive Dis shida ("Roman Criteria II"), "sphincter of Oddi dysfunction" e khothalletsoa hore e sebelisoe ho fapana le polelo ea "postcholecystectomy syndrome", "bysary dyskinesia" le tse ling.

Sphincter ea Oddi - vala ea mesifa e fumanehang ka har'ailla e kholo ea duodenal papilla Villa papilla) duodenum, e laolang ho phalla ha lero le lero la pancreatic ho duodenum le e thibelang litaba tsa ka mpeng ho kena ka har'a li-ducts tse tloaelehileng tsa pancreatic (wirsung).

Postcholecystectomy syndrome

Spasm ea sphincter ea Oddi (Spasm ea Senyesemane ea sphincter ea Oddi) - lefu la sphincter ea Oddi, le khethiloeng e le ICD-10 le khoutu ea K 83.4 83.4. 1999 Consensus ea Roma e bua ka sphincter ea dysfunction ea Oddi.

Postcholecystectomy syndrome edit |Sphincter ea dysfunction ea Oddi ke eng?

Ha se motho e mong le e mong ea tsebang hore na sphincter ea Oddi e entsoe ka eng le likarolo tsa mesifa le mesifa ea mesifa. Karolo ena ea sebopeho e potoloha likarolo tsa qetellong tsa methapo ea gallbladder le manyeme, tse u lumellang ho laola ho tsoa ha li-ligation tsa tšilo, li thibela ho lahleloa ha likarolo tsa mala kahare, ho eketsa khatello ka hara duct, le ho potlakisa ho tlatsoa ha gallbladder.

Sphincter ea Oddi dysfunction e etsahala ka keketseho ea molumo oa setho, ka hona li-ducts lia atoloha, ho na le sephiri se sa sebetsoeng ho duodenum. Maemong ana, ho bokellana ha bile ho ke ke ha fihlela litekanyetso tse tloaelehileng, tse hlahisang tšoaetso, nts'etsopele ea matšoao a ho ruruha.

Ka lebaka leo, ho ba le litlolo tse latelang:

• Fetoha sebopeho sa microflora ea mala,
• Sephiri sa kahare se lahleheloa ke ts'ebetso ea bactericidal,
• Mokhoa oa ho petsoha le ho ts'oasa mafura oa ferekanngoa,
• Ho potoloha ho tloaelehileng ha mafura a acid ho fetoha.

Sphincter ea khaello ea Oddi e etsahala ha setho se lahleheloa ke bokhoni ba ho tšoara khatello. Maemong a joalo, secretion ea bile e lula e pateloa kahare kahare ho lumen, e leng ho qholotsang nts'etsopele ea lets'ollo la chologenic. Ha nako e ntse e tsamaea, lefu lena le baka tšenyo ea ka mpeng ea mala, mokokotlong, e bakang ponahalo ea dyspepsia.

Lisosa tsa pathology

Sphincter ea Oddi spasm ke lefu le fumanoeng, sesosa se ka sehloohong sa eona ke dyskinesia ea mesifa. Lintho tse latelang li baka boemo ba ts'oaetso:

• Liphetoho mabapi le sebopeho le litšobotsi tsa rheological tsa bile,
• Tlolo ea molao
• Dysbiosis ea kahare,
• Ho buoa
• Liphetoho tsa sebopeho sa sphincter, se bakang kholo ea stenosis,
• Duodenitis.

Mathata a gallbladder le sphincter ea Oddi a hlaha ho bakuli ba kotsing:

• Basali nakong ea ho khaotsa ho ilela khoeli, ho ima, kalafong ea lithethefatsi tsa lihormone,
• Batho ba linaleli
• Nts'etsopele ea khatello ea maikutlo ho bacha,
• Batho bao mosebetsi kapa bophelo ba bona bo amanang le khatello ea maikutlo khafetsa,
• Bakuli ka mor'a cholecystectomy (ho tlosoa ha gallbladder),
• Bakuli ba nang le nalane ea lefu la tsoekere,
• Batho ba nang le pathologies ea hepatobiliary system,
• Bakuli ba sebelisitseng kalafo ea litho tsa ka tlung tsa tšilo.

Mefuta ea pathology

Ho latela sehlopha sa sejoale-joale, sphincter ea ho hlaseloa ke Oddi e ka nka mefuta e latelang:

• Mofuta oa mofuta oa Biliary I. Ke tloaelo ho kenyelletsa mafu a mona a qholotsang ponahalo ea ho opeloa ke soreps ho hypochondrium e nepahetseng. Nako ea litlhaselo ha e fete metsotso e 20. Ho ERPC, ho fokotseha hoa tekanyo ea ho felisoa ha phapang ho khethollo, matšoao a latelang a eketseha: AST, alkaline phosphatase,
• Mofuta oa II oa Biliary. Ka mofuta ona oa ho se sebetse hantle ha sphincter ea Oddi ho latela mofuta oa biliary, ho utloahala ho utloisang bohloko bo utloisang bohloko, matšoao a 1-2 a mofuta oa mofuta oa mofuta oa lefu la tsoalo,
• Mofuta oa Bobeli oa Biliary. Ke matšoao a bohloko feela a hlahang, matšoao a mang ha a eo.
• Mofuta oa pancreatic. Sphincter ea Oddi spasm e baka bohloko sebakeng sa epigastric, se khutlang. Ho opeloa ke pelo ho fokotseha nakong ea ho koba 'mele pele. Keketseho ea li-amylase kapa lipase ke tšobotsi.

Setšoantšo sa Clinical

Sphincter ea Oddi spasm e tšoauoa ka nts'etsopele ea polelo e bohloko ea morao-rao ea bohloko, e khethiloeng ho hypochondrium e nepahetseng, epigastrium. Hangata bohloko bo utloahala ka lehare le ka morao. Nako ea bohloko ha e atise ho feta metsotso e 30. Letšoao la bohloko le ka ba le matla a mangata, hangata le tlisetsa mokuli mahlomola.

Hangata, Pain syndrome e tsamaea le matšoao a joalo:

• Ho nyekeloa ke pelo le ho hlatsa
• Tatso e bolileng ka hanong
• Ho kopanya le moea
• Mohlomong keketseho e nyane ea mocheso oa 'mele,
• Ponahalo ea ho ikutloa eka o boima.

Matšoao a thathamisitsoeng hangata a mpefatsa kamora ho nka lijana tse mafura le tse tsoekere.

Matšoao a kliniki a hore sphincter e holofetseng ea Oddi a kenyeletsa:

• Ho eketsa li-enzyme tsa sebete,
• Ho fokotsa phepelo ea phapang e mahareng nakong ea ERCP,
• Ho hola ha duct e tloaelehileng.

Ho se sebetse hangata ho ba teng ka mor'a lilemo tse 3-5 kamora cholecystectomy. Tabeng ena, bakuli ba hlokomela ho eketseha ha bohloko, bo amanang le ho tlosoa ha polokelo ea bile.

Bohlokoa! Bohloko hangata bo ba teng bosiu, bo ke ke ba emisoa ka ho nka li-painkillers, ho fetola boemo ba 'mele.

Mehato ea ho khetholla

Ho fumana boteng ba ho se sebetse hantle ha sphincter, lingaka li fana ka tlhahlobo ea mali ea laboratori, e etsoang nakong ea ho theha lefu la bohloko kapa kamora lihora tse 6 kamora lona. Sena se u lumella ho khetholla maemo a phahameng a amylase le lipase, amartotine ea li-spartate, alkaline phosphatase le gamma-glutamyl transpeptidase.

Matšoao a kliniki a ka bontša nts'etsopele ea maloetse a mang a tšilo ea lijo a bakoang ke ho thijoa ha methapo ea methapo. Ka hona, mekhoa e joalo ea ho khetholla e sebelisoa haholo ho netefatsa lefu lena:

• Ultrasound Scanning e etsoa khahlano le semelo sa ho nka li-provocative agents, tse o lumellang ho lekola liphetoho tsa duct. Ka keketseho ea matšoao a tloaelehileng ka 2 mm, ho koaloa ho sa sebetseng hantle ha li-ducts tsa bile ho ka belaelloa.
• Cholescintigraphy. Mokhoa o lumella ho khetholla tlolo ea ts'ebetso ea sphincter ka lebelo la motsamao oa ts'ebetso ea isotope ho tloha ho sebete ho ea mpeng e kaholimo,
• Endoscopic retrograde cholangiopancreatography (ERCP). Mokhoa ona o kenyelletsa ho hlahisoa ha li-duodenoscopes tse nang le li-optics tsa morao-rao ho lekola bophara ba li-ducts, ho bona hore na li felloa ke matla hakae,
• Manometry. Mokhoa ona o thehiloe kenyelletsong ea catheter e meraro e nang le khanya e meraro ka duodenoscope ka har'a li-ducts ho lekanya khatello ea sphincter.

Litšobotsi tsa kalafo

Phekolo ea sphincter ea dysfunction ea Oddi e kenyelletsa ho imoloha ha bohloko le matšoao a mang, ho tloaeleha ha sebopeho sa litho le ho tlosoa ha liphiri tsa tšilo. Ka nts'etsopele ea ho ruruha le dysbiosis, ho felisoa ha ts'oaetso ea baktheria le ho tloaela tlhaho ea biocenosis ea mala. Bakeng sa morero ona, kalafo ea lithethefatsi, kalafo ea ho ja, endoscopy le kalafo ea ho buoa e sebelisoa haholo.

Phekolo ea lithethefatsi

Lihlopha tse latelang tsa lithethefatsi li sebelisoa haholo ho felisa khatello ea kelello:

• Nitrate (Nitrosorbide, Nitroglycerin). Lithethefatsi li ka fokotsa khatello ea maikutlo,
• Anticholinergics (Biperiden, Akineton) e thusa ho tlosa mesifa ea mesifa,
• Lithala tsa calcium calcium li khatholla sphincter ea Oddi. Khafetsa li baka tsitsipano, ka hona, ha li sebelisoe hangata,
• Antispasmodics (Papaverine, Pinaveria bromide, Drotaverinum) felisa spasm le bohloko,
• Myotropic antispasmodics. Mebeverin e fokotsa molumo oa sphincter le ho sisinyeha ha mesifa e boreleli ea mesifa. Gimekromon e felisa spasm, e na le phello ea choleretic,
• Ho felisa tšoaetso ea baktheria, dysbiosis, lithethefatsi tsa antibacterial tsa ka mpeng (Rifaximin, Enterofuril, fluoroquinolones), li-prebiotic le li-probiotic (Lactulose, Bifiform, Hilak forte) li sebelisoa,
• Mekhoa e thehiloeng ho ursodeoxycholic acid (Ursosan, Ursofalk) e ka tlosa ho haella ha biliary.

Phekolo ea bongaka

Kalafo e sebetsang ea mafu a tšilo ea lijo ha e khonehe ntle le ho latela lijo tse khethehileng. Mabakeng a tlolo ea sphincter ea Oddi, litsebi tsa phepo e ntle li khothaletsa ho lahla ka ho felletseng lijo tse nang le mafura, lijo tse nang le linoko. Lijo tse jang li lokela ho matlafatsoa ka likhoele tse kopaneng, tse thusang ho fetisa ts'ebetso ea litho tsa tšilo ea lijo.

O lokela ho hana ho amohela meroho le litholoana tse ncha - lihlahisoa li tlameha ho fuoa kalafo ea mocheso. Lijana li lokela ho belisoa, ho feptjoa, ho apehoe, ho ts'oaroe. Lijo tsa letsatsi le letsatsi li lokela ho aroloa ka li-servings tse lekanang tsa 6-7, tse khothalletsoang hore li nkuoe lihora tse ling le tse ling tse 3 ho isa ho tse tharo.

Bohlokoa! Lijo tsa mantsiboea pele feela ka nako ea ho robala li qoba ho sisinyeha ha bile.

Lisebelisoa tsa meriana ea setso

Ho eketsa katleho ea kalafo ea lithethefatsi, o ka alafshoa ka litlhare tsa setso. Leha ho le joalo, ts'ebeliso ea litlhare tsa setso tsa litlhare li ka etsahala feela kamora ho buisana le setsebi. Ho fetola mosebetsi oa sphincter, lisebelisoa tse joalo tsa litlama li sebelisoa haholo:

• Stigmas tsa poone. Semela se sebelisetsoa ho phekola li-pathologies tse ngata tsa tsamaiso ea hepatobiliary. Lisebelisoa tse tala li phatlalalitse litlamorao tsa choleretic, anti-inflammatory. Ho lokisa infusion, ho lekane ho tšela 20 g ea stigmas ea poone le 200 ml ea metsi a belang, tsitlella ho hlophisoa ha hora e le 'ngoe. Moriana o nooa 40 ml ho isa makhetlo a 5 ka letsatsi,
• Hypericum herb. Thepa e sa tloaelehang e sebelisetsoa ho etsa hore lesapo la mokokotlo le nyooko e le tloaelehileng, kalafo ea dyskinesia. Ho lokisa decoction, ho lekane ho sila 1 thispone ea lihlahisoa tse tala, tšela motsoako o tlang ka 250 ml ea metsi a belang. Sesebelisoa se tlisoa ho pheha ka bateng ea metsi, e ts'oaroang hora e le 'ngoe. Moro o nkuoa 50 ml ho isa makhetlo a 3 ka letsatsi,
• Lipalesa tsa Helichrysum. Semela se sebelisoa haholo ho phekola ho tsitsipana ha bile, hepatitis, cirrhosis. Ho lokisa moriana, tšela likhaba tse peli tsa lipalesa tse khaotsoeng ka 250 ml ea metsi a belang. Moetso o phehiloe ka metsotso e 10, o halikiloe, o tlhotliloe. Bakeng sa kalafo ea li-pathologies tsa hepatobiliary system, ho kgothaletsoa ho nka 50 ml ea decoction metsotso e 30 pele ho lijo makhetlo a mararo ka letsatsi,
• Grass repeshka. Lisebelisoa tse tala li ka fokotsa nako ea ho ba le hepatitis e mpe le e sa foleng, cirrhosis, cholecystitis, dyskinesia ea biliary. Ho lokisa infusion, ho lekane ho tšela 200 ml ea metsi a belang 1 thispone ea lisebelisoa tse tala tse halikiloeng. Moetso o phehelloa lihora tse peli, ka mor'a ho nka 100 ml makhetlo a mararo ka letsatsi.

Phekolo ea Endoscopic le ea ho buoa

Haeba kalafo e hlokofatsang e sa tlise litholoana tse ntle, sebelisa mekhoa e latelang.

• Endoscopic papillosphincterotomy. Mokhoa ona o kenyelletsa ho hlapolla papilla e kholo ea duodenal,
• Ho atolosoa ha bulhone le ho kenngoa ha litema tsa nakoana,
• Transduodenal sphincteroplasty,
• Botulinum toxin ente ea duodenal papilla. Phello ea kalafo ea lithethefatsi e phehella bakeng sa likhoeli tse 3-4, kamora moo ntho eo e hlakotsoe ka botlalo 'meleng.

Forecast le mehato ea thibelo

Tlolo ea koloi ea sphincter ea Oddi e tšoauoa ka tsoelo-pele e ntle. Ka kalafo e loketseng ea nako e telele ea kalafo, ho ka etsahala hore o felise ka botlalo matšoao a bohloko a lefu lena.

Ha ho na prophylaxis e khethehileng ea pathology. Leha ho le joalo, ho thibela tšilafalo ea tšilo ea lijo, litsebi tsa gastroenter li khothaletsa ho ja ka tsela e leka-lekaneng, ho boloka boima ba 'mele bo lekaneng le ho ikoetlisa kamehla.

Sphincter ea Oddi ke karolo ea bohlokoa ea tsamaiso ea hepatobiliary. Haeba mosebetsi oa hae o khathatsehile, ho ba le methapo e tebileng ea litho tsa tšilo. Ka hona, ho bohlokoa ho latela bophelo bo phetseng hantle, 'me matšoao a pele a ts'oaetso ea methapo, batla thuso ho setsebi.

Sphincter ea Oddi ke eng?

Ka 1681, oa pele o hlalositse sphincter ea Oddi. Sena se entsoe ke ngaka ea Borithane ea bitsoang Francis Glisson, empa sphincter o ile a reha lebitso ka mor'a rasaense oa Motaliana Oddi Ruggiero. Ke eena ea phatlalalitseng lipampiri tsa mahlale ka sebopeho sa morphological ka 1888, 'me hape a qala ho etsa pampiri e ngotsoeng ea biliary.

Hape, ngaka ea mafu a kelello ea Mataliana ke ea litlhaloso tsa pele tsa ho atolosoa ha duct ea mantlha kamora ho khutlisetsoa hoa gallbladder (cholecystectomy).

Sphincter ea Oddi e sebakeng se seholo sa duodenal papilla. Ka ponahalo, ke mesifa e boreleli, e leng ts'ebetso ea ona e le ho laola ho kenella ka har'a seseng sa 12 sa duodenal sa lero la pancreatic le bile. E boetse e thibela se kahare ho duodenum ho kena ka ducts.

Mofuta oa pancreatic sphincter oa Oddi spasm, haholo-holo, tleliniki ea lefu lena, e tšoana le mathata a mang a ts'ebetso ea tšilo ea lijo, ka hona ho hlophisoa ha lefu lena ho hlahlojoe makhetlo a 'maloa. Ts'ebetsong ea bongaka, pathology ke bothata bo ikhethileng ba tšebeliso ea methapo.

Setšoantšo sena sa kliniki se atisang ho fumanoa ho basali ho tloha ho lilemo tse 35 ho isa ho tse 60, ke phello ea cholecystectomy, e ileng ea etsoa ho phekola mofuta oa palo ea cholecystitis.

Ts'ebetso ea pancreatic e sebetsang ea sphincter ea Oddi e bonoa ho pathological pancreatobiliary fusion le ka mokhoa o iphetohelang oa pancreatitis.

Ho kopana ha sphincter dysfunction le pancreatitis e sa foleng ho fumanoa hangata makhetlo a mane ho feta CP ntle le ts'ebetso ea ts'ebetso.

Tlhophiso ea Sphincter Oddi Dysfunction

Ts'ebetsong ea bongaka, mefuta e mengata ea ts'ebetso e holofetseng ea khetholoha. Ea pele ke maikutlo a biliary 1. Foromo ena e kenyelletsa mathata a sebetsang a tsamaeang le bohloko bo boholo kapa bo tebileng ho hypochondrium e nepahetseng kapa sebakeng sa epigastric.

Litlhaselo tse bohloko hangata li bonoa nakong ea metsotso e 20-30. Endoscopic retrograde cholangiopancreatography e bonts'a ho tlosa butle ha likarolo tsa phapang (ho lieha ho feta metsotso e 45). Ha u etsa lipatlisiso tse peli tsa li-enzyme tsa sebete, ho fetisoa ho tloaelehileng ha alkaline phosphatase ho fumanoa ke sesosa sa tse peli. Hape, ho hola ha duct ea bile ho fumanoe ke lisenthimithara tse fetang 1,2.

Pono ea Biliary 2. Ka foromo ena, ho ba teng ha maikutlo a bohloko a tsamaisanang le bohloko ba mofuta oa pele ho bonoa. Manometry e tiisa ts'ebetso e senyehileng ea sphincter ho 50% ea litšoantšo tsa kliniki. Mathata a tšoaelitsoeng a na le ts'ebetso kapa a sebopeho ka sebopeho.

Pono ea Biliary 3. Ho na le lefu la bohloko, empa ho na le ho haella ha mathata a sepheo a fumanoang ho bakuli ba mofuta oa pele. Manometry e bontša ho se sebetse hantle ha sphincter ho 10-30% ea litšoantšo.Tlolo ea mofuta o sebetsang ka ho fetisisa (maemong a 80%).

Ka pancreatitis e sebetsang, bokuli bo tsamaea le bohloko, bo khutlang. Haeba mokuli a itsamaela le 'mele, bohloko bo ea fokotseha. Tlhahlobo ea laboratori e bontša keketseho e kholo ea lipase le amylase.

Manometry e tiisa dysfunction ea Oddi sphincter ho 40-85% ea linyeoe.

Etiology le mabaka a susumetsang

Pancreatic mofuta dyskinesia ea sphincter ea Oddi e hlaha ho bakuli ka lebaka la pathological stenosis (ho phehella ho fokotseha) ha sphincter kapa pathogenesis ka lebaka la mokokotlo oa mokokotlo. Pathological shrink e hlaha ka lebaka la ts'ebetso ea ho ruruha, fibrosis, le litšoantšong tse ling tsa bongaka, sesosa ke ho eketsoa ha li-membrane tsa mucous.

Liphetoho tsa mofuta oa ho ruruha le ho ruruha ke phello e tobileng ea tšusumetso ea calculi e nyane e fetang ka har'a duct e tloaelehileng. Khopolo eo e totobala ho latela hore na ke liphetoho life tse ka fokolisang mofets'e tse fetisang mofuta o sa feleng oa pancreatitis.

Ho arohana ha mathata a sebetsang le a manyolo ho rarahane haholo, hobane maemo a mabeli a sa tloaelehang a ka ba le mohloli o le mong. Boholo ba ho hloka taolo bo fumanoa ho bakuli ba nang le nalane ea senya ea nyooko. Bakuli ba fumanoa ba e-na le sphincter ea khaello ea Oddi, ka lebaka leo bile e kenang kahare ho lumen ea duodenum.

Haeba motho a phela hantle 'meleng, joale tlas'a tšusumetso ea lihormone tsa neuropeptide, gallbladder e lokela ho kenella, bile e kenella ka har'a duodenum,' me sphincter ea Oddi e ea phomola. Ha o tlosa gallbladder, o ka bona molumo o feteletseng oa sphincter le keketseho ea methapo ea methapo ea methapo.

Maemong a mang, ka mor'a ho buuoa, molumo oa fokotseha, ka hona, bile e thehiloeng ka ho se sebetse hantle e kena ka seterateng sa ka mpeng. Ka lebaka leo, ts'oaetso ea mokelikeli e bonoa, e lebisa ho ruruhileng e matla.

Biliary-pancreatic syndrome e lebisa pherekanong ea ts'ebetso, eo ka nako eo bile e kenang ka makhetlo le ka nako e telele lipelong, ka lebaka leo, motho o qala ho bonts'a matšoao a fapaneng a khaello ea tšilo ea lijo.

Haeba bile e kena ka mpeng ka mokhoa o sa tsamaeeng, sena se bontšoa ke tleliniki e joalo:

• Mathata a ho potoloha ha lipilisi tsa bile acid,
• Ho se sebetse hantle hantle molemong oa ho sila lijo, ho fokotsa ho monya hoa limatlafatsi.
• Melemo ea bactericidal ea li-duodenal e fokotsehile.

Ntho e susumetsang nts'etsopele ea dyskinesia ke ho se leka-lekane ha li-hormone tse amanang le nako ea kemaro, ho khaotsa ho ilela khoeli le tšebeliso ea lithethefatsi tsa lihormone. Hape khatello ea maikutlo e sa foleng, lefu la tsoekere, lefu la manyeme, leqeba la mokokotlo la 12, ho fokola ha ts'ebetso ea sebete, ho kenella ts'ebetsong ea methapo ea mali le mpeng.

Matšoao a dyskinesia ea sphincter ea Oddi

Joalokaha ho se ho hlokometsoe, lefu la kelello le bonahatsoa ke bohloko, haholo, ho ts'oaroa ke metsotso e 20-30. Bohloko bo lekane kapa bo tebile. Nako ea lefu lena e feta likhoeli tse tharo.

Bakuli ba tletleba ka maikutlo a ho imeloa ke mpeng, ka bohloko bo bobebe ka tlas'a lehare le letona. Matšoao a dyspeptic ka lebaka la tlolo ea ts'ebetso ea tšilo ea lijo a bonahala. Tsena li kenyelletsa ho nyekeloa, ho hlatsa, ho ruruha ka mpeng, ho eketsa peterole, belching, jj.

Ka seoelo, bohloko bo bonahatsoa ke colic. Leha ho le joalo, haeba psychology e kopantsoe le mofuta o sa foleng oa ho ruruha ha manyeme, maikutlo a bohloko a iponahatsa ka tsela e fapaneng haholo.

Mehatong ea pele ea ts'ebetso ea methapo ea methapo, litlhaselo tsa bohloko ha li na seoelo, empa li ka qeta lihora tse 'maloa. Ha ho na bohloko pakeng tsa litlhaselo, boemo ba mokuli bo ntlafala haholo. Ka linako tse ling keketseho ea khafetsa ea ho ts'oaroa hoa fumanoa ebile ho na le maikutlo a bohloko a bileng teng lipakeng tsa bona.

Bohloko bo ba teng lihora tse 'maloa ka mor'a lijo. Leha ho le joalo, ho ke ke ha khoneha ho e hokahanya le mofuta oa lijo, hobane e mong le e mong o tletleba ka lipontšo tse fapaneng tsa lefu lena.

Bongoaneng, dyskinesia ea sphincter ea Oddi e bontšoa ke boemo ba febrile (ha e tšoarelle nako e telele) le mathata a fapaneng a autonomic.

Ngoana ha a khone ho hlahloba bohloko ba lehae, ka hona, hangata o supa sebaka sa umbilical.

Ho hlahloba le mekhoa ea kalafo

Ho fumana ts'ebetso ea methapo ea methapo ea methapo ea methapo ea methapo ea methapo 'meleng, lintlha tsa li enzyme tsa sebete. Ka tlhaselo, matšoao a eketseha makhetlo a 'maloa ho feta tloaelo. Li ka eketseha ka lebaka la maloetse a mang a makhopho a ka mpeng.

Ho theha ts'oaetso, ho etsoa ultrasound ka ho hlahisa se fapaneng, se thusang ho tseba hantle boholo ba duct ea bile le mocha o moholo oa manyeme.

Haeba mekhoa e sa hlaseleng e sa thusa ho theha tlhahlobo ea tšoaetso, sebelisa mekhoa e hlaselang ea tlhahlobo ea tšoaetso. ERCP e etsoa. Mokhoa o lumella ho theha bophara ba duct, ho khetholla phallo ea ts'ebetso ea sphincter ea Oddi ho tsoa ho li-pathologies tse tšoanang. Hape hoa khoneha ho tseba nako ea ho tlosa li-ducts tsa bile.

Manometry ke mokhoa oa ho ruta o lekanyang ka kotloloho mojaro oa sphincter. Ka tloaelo, khatello e ho eona ha ea lokela ho feta millimeter ea 10. Leha ho le joalo, haeba ho sa sebetse hantle, thuto e bontša sephetho sa 115 ± 20.

Hoo e ka bang 10% ea litšoantšo, ts'ebetsong ea manometry e lebisa ho nts'etsopele ea manyeme, joale thuto ke tekanyo e fetelletseng ha mekhoa e meng ea ho hlahloba e lebisitse ho se atleheng.

Phekolo e kenyelletsa tse latelang:

1. Phekolo ea Conservative e shebile ho fokotsa matšoao a fosahetseng le lipontšo tsa dyspeptic.
2. Lijo
3. Pheko e silafatsang e ea hlokahala ha ho bonahala likokoana-hloko tse bakang mafu ka mpeng.
4. Ho felisoa ha biliary ho haella.

Ho fokotsa bohloko, meriana e fanoa ka belladonna, lintho tse kang buscopan le metacin. Bakeng sa bohloko bo lekanyelitsoeng, No-shpa e khothalletsoa. Ho felisa liketsahalo tsa dyspeptic, ho sebelisoa lithethefatsi - Creon, Pancreatin.

Pheko ea lijo li thehiloe ho phepo e nepahetseng - ho fihlela makhetlo a supileng ka letsatsi ka likarolo tse nyane. Hoa hlokahala ho sebelisa palo e lekaneng ea fiber ea lijo, e tlatsetsang ho khutliseng mohopolo oa mala.

Pheko e silafatsang e kenyelletsa tšebeliso ea li-probiotic, antiseptics tsa mala le lithibela-mafu. Ho haella ha biliary ho phekoloa ka lithethefatsi Urosan.

Mathata a pancreatitis a hlalositsoe videong ena.

Mofuta oa biliary

Sehlopha sena se ikarabella bakeng sa bongata ba DSO, matšoao ke:

• bohloko bo hlasela bo tloaelehileng ba biliary colic - e bohale cramping, e fihla mokokotlong, lehetleng le letona, ka linako tse ling molala,
• datha ea lipatlisiso tse sebetsang - ho hola ha duct e tloaelehileng ho feta 12 mm,
• keketseho ea nako ea ho tloswa ha nako e fetang metsotso e 45,
• ya data ea laboratori - keketseho ea boemo ba transaminase le alkaline phosphatase bonyane makhetlo a 2 litlhahlobisong tse phetoang.

Ho latela lipatlisiso tsa manometric, mofuta oa biliary o arotsoe ka mefuta e meraro, ha mofuta oa pele ho na le "stenosis" ("shripter") ea sphincter, ea mofuta oa bobeli e fumanehang ho bakuli ba mashome a robeli le metso e meraro (85%) ho la boraro - ho 28%. Mathata a mang kaofela ke lipontšo (tse fetohileng, dyskinetic).

Mofuta oa pancreatic

Mofuta ona oa DSO lipontšong tsa bongaka o tšoana le pancreatitis e sa foleng, 'me ke tlhahlobo e felletseng feela eu lumellang ho fumana tlhahlobo e nepahetseng ea lefutso. Matšoao a sehlooho ke:

• bohloko ba mahlaba bo emisa ka morao,
• keketseho ea plasma ea amylase le lipase enzymes.

Boemo bo tšoanang le pancreatitis e sa foleng bo emisoa ke bohloko bo tšoanang le ba hepatic colic. Lintlha tsa laboratori li fetoloa feela haeba boitsebiso ba thuto bo khethiloe nakong ea tlhaselo ea bohloko. Nakong e khutsitseng, hoo e ka bang ha ho litšitiso tse ka bonoang.

Lipontšo tse ikhethang tsa mefuta e fapaneng ea pathology

Ka nako e ts'oanang, ho na le matšoao a etsang hore ho khonehe ho khetholla pakeng tsa mefuta e fapaneng ea DSL.

Lisosa le Lintho Tse Kotsi

Lebaka le ka sehloohong le nkoa e le mathata a metabolism ka har'a sebete, empa a bohlokoa hape:

• Phetoho ea sebopeho sa bile,
• tlolo ea ts'ebetso ea bile, ho thekesela ha eona,
• dyskinesia ea duct e tloaelehileng kapa junction ea bile le pancreatic excretory ducts,
• kalafo e sa tsotelleng eo ka eona sphincter ea Oddi e lemetseng, esita le hanyane,
• kholo e feteletseng ea pathological microflora ea mala.

Gastroenterologists e ntse e nka dyscholia ea hepatocellular e le lona lebaka le ka sehloohong la ho thehoa ha DLS. Ona ke maemo ao ho 'ona ho nang le cholecystokinin e sa lekaneng. Ntho ke mohloli oa tlhaho oa molumo oa gallbladder le methapo ea teng. Tlas'a tšusumetso ea cholecystokinin, molumo oa sphincter o eketseha ho fihlela bladder e tletse bile. Ha e se e tletse, sphincter e ea phomola e le hore bile e khone ho phalla ka bolokolohi. Kamora cholecystectomy, molumo oa sphincter oa fetoha, 'me bile e ea thella kapa e tsoela pele ho phalla. Sena se fetola tlhahiso ea lintho tse kang lihormone tse laolang metabolism ho manyeme, pancreatitis ea bobeli e etsahala.

Patlisiso ea laboratori

• mahloreho a bilirubin
• alkaline phosphatase
• aminotransferase
• lipase le li-amylase.

Phetoho ea khatello ea maikutlo e nkuoa e le bohlokoa ka ho hlaka haeba sampole ea venous ea mali e sa etsoa ka mor'a lihora tse 6 kamora tlhaselo.

Bafuputsi ba liletsa

• Ultrasound ea mokokotlo oa mpa - ho eketsoa ha duct e tloaelehileng ea li-duct le pancreatic diff ho ikemiselitsoe. Ho hlakisa, fa lijo tsa hoseng tsa mafura, 'me u shebe phetoho ea boholo ba duct e tloaelehileng metsotso e meng le e meng e 15 bakeng sa hora. Ho hola ho feta limilimithara tse peli ke letšoao le hlakileng la DLS. Ho tseba ts'ebetso ea pancreatic duct, ho etsoa tlhahlobo e nang le sephiri. Ka tloaelo, kamora ts'ebetso ea ts'ebetso ea moriana, duct e lokela ho hola, empa ka nako ea halofo ea hora e khutlele ka boholo ba eona ba pele. Haeba phokotso e nkile metsotso e fetang 30, e tla boela e le sesupo sa DSO,
• CT ea sebaka sa hepatoduodenal - boholo le sebopeho li bonahala hantle,
• ERCP - ho khutlisa cholangiopancreatography. Mokhoa ona oa ho kenella, ke hore, o kenella ka kotloloho ho sphincter le ducts. U sebelisa phuputso, ho hlahisoa phapang, ebe ho etsoa x-ray. Haeba duct e tloaelehileng ea bile e atolosoa ke limilimithara tse fetang 12, 'me boemo ba phallo bo pharalletseng bo feta metsotso e 45, ebe tlhahlobo eo ea tšoaetso e ke ke ea latoloa.
• Manometry ke tekanyo e tobileng ea molumo oa sphincter. Nakong ea thuto, ho phutholoha mesifa bakeng sa mesifa e boreleli ho ka sebelisoa. Mokhoa o rarahane ka botekgeniki, o na le li-contraindication tse ngata, ho na le mathata, ka hona ts'ebeliso ea ona e na le moeli.

Phekolo e na le mekhoa e mengata ea bohlokoa e sebelisoang ka nako e le ngoe.

Ena ke motheo oa bophelo bo botle. Ntle le ho latela melao e bonolo, bophelo bo botle ha bo khonehe. Hoa hlokahala:

• Lijo tse 4 ka letsatsi, lijo tsa mantsiboea pele ho robala - li etsa maemo a ho hlatsoa bladder ka botlalo,
• thibelo ea mafura a liphoofolo (boholo - mafura a manyane moro),
• ho se kenyelelloe ka botlalo mekhabiso,
• palo e kholo ea litholoana le meroho tse halikiloeng, palo eo e lokela ho lekana setulo sa letsatsi le letsatsi,
• ts'ebeliso ea korong.

Meriana

Kamora ho qeta cholecystectomy bakeng sa libeke tse 24, ho fanoa ka meriana - antispasmodics, e ntle ka ho fetisisa e leng Duspatalin, e nooa hoseng le mantsiboea.

Ho fokotsa mekhoa ea ho belisoa ka mpeng makhetlo a 1 kapa a mabeli ka selemo, ho phekoloa lithibela-mafu le litlhare tse thibelang mafu, nako le nako ho fapana. Meriana e khethoa ke ngaka e eang teng, Ciprofloxacin, Biseptol, Enterol, Tetracycline le tse ling li sebelisoa.

Kamora ho nka lithibela-mafu, ho fanoa ka li-probiotic le li-prebiotic: Bifiform, Hilak Forte le ba bang.

Bakeng sa ho sokela, ho sebelisoa li-laxatives, haholo-holo Dufalac, e tšehetsang kholo ea microflora e tloaelehileng.

Lekhetlo la pele kamora ho buuoa, ka linako tse ling li-anti-acid (Maalox, Smecta), li-enzyme tsa tšilo ea lijo (Creon, Mezim) lia hlokahala.

Haeba liteko tsa laboratori li bontša ho hlonama sebeteng, ho sebelisoa li-hepatoprotectors - LIV 52, Heptral, litokisetso tsa acid tsa acid.

Setha se tobileng sa lithethefatsi se ipapisitse le setšoantšo sa kliniki.

Tlhahisoleseling ka kakaretso

Sphincter ea Oddi spasm ke boemo bo tloaelehileng bo tloaelehileng ho gastroenterology, e atileng haholo ho basali. Lipalo-palo tse nepahetseng mabapi le nalology ena ha li fumanehe, empa hoa tsebahala hore har'a bakuli ba kileng ba tšoaroa ke cholecystectomy e sebetsang, bohloko ba ka mpeng ba mpa le bothata ba dyspeptic bo amanang le ho se sebetse hantle ha sphincter bo phehella ho 15% ea linyeoe. Mosebetsi oa sphincter oa Oddi o netefatsa tšebetso e hokahaneng ea lisebelisoa tsohle tsa biliary. Ha konteraka ea senya ea senya, mesifa ea sphincter ea phomola, 'me ka lehlakoreng le leng. Sena se tiisa ho kenngoa ha li-enzyme ka nako nakong ea lumen ea duodenum. Ho fetola ts'ebetso e lumellanang ea lisebelisoa tsa sphincter ho lebisa ho tlolo ea ts'ebetsong ea bile, bohloko le dyspepsia.

Lisosa tsa Sphincter Oddi Spasm

Sphincter ea Oddi spasm ke boemo ba pathological bo fumanoeng, sesosa se ka sehloohong sa eona ke dyskinesia ea mesifa. Ho ea ka lipontšo tsa kliniki, mokokotlo oa sphincter oa Oddi o tšoana le stenosis ea hau e bakoang ke pherekano e hlophisitsoeng, mme khafetsa liphetoho tsena li kopane. Hypertonicity ea sphincter e bakoa ke ho foqoha ha mesifa ea mesifa ea metsoako ea eona (li-sphincters tse potileng karolo e ka thoko ea bile duct e tloaelehileng, danc pancreatic duct le ampulla ea canal sebakeng sa fusion ea li-ducts tsena. Ka lebaka leo, khatello ea ts'ebetsong ea duct ea pampiri ea biliary le manyeme lia eketseha.

Lisosa tse ikhethileng tse bakang ho foqoha ha nako e telele ea sphincter ea Oddi ha li e-so thehisoe, ho ruruha ha pereilla e kholo ea duodenal le duodenitis ke lintho tse ka etsahalang. Predisposes ea nts'etsopele ea lefu lena, botšehali ba basali, lilemo tse 30-50, mmele oa asthenic, matla a maikutlo, ho hloka boima ba 'mele.

Matšoao a spasm ea sphincter ea Oddi

Pontšo ea kliniki ea spasm ea sphincter ea Oddi e utloisoa bohloko bo sa khaotseng sebakeng sa hypochondrium kapa epigastrium, e chaba mokokotlong kapa sebakeng sa scapula. Nako ea ho hlaseloa ke bohloko hangata e ba metsotso e mashome a mararo kapa ho feta, botebo bo ka ba ba bohlokoa, ba baka mahlomola ho mokuli. Bohloko ha bo emise ho nka litlhare, ho fetola boemo ba 'mele. Ramatiki e kopantsoe le matšoao a dyspeptic: ho nyekeloa ke pelo, ho hlatsa.

Khafetsa, empa eseng ka mehla, ho se mamelle lijo tse mafura ho na le tšobotsi. Bakeng sa sekhahla sa sphincter sa Oddi, nts'etsopele ea ketsahalo ea bohloko bosiu ke ntho e tloaelehileng, e leng sesupo sa ho kenyelletsoa ha mafu ana a mafu a mangata ho tsoa ho mafu a mang a mangata a nang le ho se sebetse hantle ka lebaka la ho se sebetse hantle ha pelo. Kamano ea bohloko le tšebeliso ea lijo bakeng sa mokuli ka mong ke motho ka mong. Khafetsa, ho tsietsana ho hlaha lihora tse peli ho isa ho tse tharo ka mor'a lijo. Ka tloaelo, mokuli oa tseba hore na ke lijo life tse qholotsang ketsahalo (e nokiloeng ka linoko).

Bakuli ba bangata ba nang le mokoloto o belaetsang oa sphincter oa Oddi ba na le nalane ea cholecystectomy.Kamora ho buuoa, hangata ho teba ha bohloko ho hypochondrium e nepahetseng hoa fokotseha, empa kamora nakoana nakoana litlhaselo li tsoela pele. Maemong ana, mofuta oa lefu la bohloko o batla o tšoana le pele ho ts'ebetso. Hangata, ho khutlela morao ho etsahala lilemo tse tharo ho isa ho tse hlano kamora ho kenella. Maemong a mang, hang ka mor'a ho buuoa, bohloko bo eketseha haholo, hona ho amana le ho tlosoa ha polokelo ea bile.

Tlhahlobo ea spasm ea sphincter ea Oddi

Kopano ea ngaka ea mafu a gastroenterologist e fana ka maikutlo a hore mokuli o na le sphincter ea Oddi spasm moo ho nang le litlhaselo tse tloaelehileng tsa bohloko ba colic-like ho ba teng ha choledocholithiasis, methapo ea methapo ea bile, hammoho le mafu a se nang hepatobiliary a nang le matšoao a tšoanang.

Liphetoho tsa semelo liphelong tsa liteko tsa laboratori ke keketseho ea ts'ebetso ea bilirubin, transaminases, li-amylase nakong ea tlhaselo. Tlhahlobong e akaretsang ea mali, ha ho na matšoao a ho ruruha. Urinalysis ha e fetohe. Phapang lipakeng tsa sephetho sa liteko tsa laboratori nakong ea mokoloko le ka ntle ke tšobotsi.

Ultrasound e na le ultrasound ea sebete le pampiri ea biliary. Mokhoa ona oa ho etsa lipatlisiso o lumella ho khetholla spasm ea sphincter ea Oddi ho tsoa ho hyperkinetic gallbladder dyskinesia le maloetse a mang. Boithuto bo khetholla bophara ba "duct" e tloaelehileng pele le kamora liteko tsa peleho. Manphry ea Sphincter le eona e etsoa, ​​ha tlhahlobo ea tlhahlobo ea mafu e le keketseho ea khatello e kaholimo ho 40 mm Hg. Art. Hape, nakong ea manometry, mekhahlelo e phahameng ea maqhubu a sphincter, karabelo e senyehileng ea ts'usumetso ea cholecystokinin, ho emisoa ka likonteraka tse fosahetseng.

Mokhoa o mong oa sphincter manometry ke matla hepatobiliscintigraphy ka ho phatloha ha cholecystokinin. Liphetho tsa mokhoa ona oa ho etsa lipatlisiso ho 100% ea linyeoe li lumellana le sephetho se fumanoeng ka manometry, leha ho se na litla-morao tse bonts'ang ts'oaetso e sa sebetseng. Ho kenyelletsa litheko tsa sphincter, pancreatitis e setseng ka har'a duct e tloaelehileng ka mor'a cholecystectomy ea calculi, hammoho le ho fumana bile, endoscopic retrograde cholangiopancreaticography e etsoa.

Tlhahlobo e fapaneng e boetse e etsoa ka cholecystitis e sa balang, stenosis ea bile kapa pancreatic duct, le ts'ebetso ea tumor. Ha ho hlahlojoa lefu lena, ho lokela ho hopoloa hore spasm ea sphincter ea Oddi hangata e kopantsoe le maloetse a mang a tsamaeang le lefu la mokokotlo la mokokotlo, ho hloka metsi ka mpeng, le lefutso le sa utloahaleng la mokokotlo.

Phekolo ea spasm ea sphincter ea Oddi

Phekolo ea lefu lena e etsoa ntle le tšenyo ea nako, empa ka linako tse ling ka polelo e bohloko ea polelo, mokuli a ka kena sepetlele lefapheng la gastroenterology ho qhelela ka thipa litlokotsi tsa kahara mpa le ho etsa liteko. Litlhahlobo tsa mantlha tsa kalafo bakeng sa spasm ea sphincter ea Oddi ke boikhathollo ba mesifa ea hae, phomolo ea bohloko, ho tloaeleha ha ho tsoa ha lero le lero la pancreatic. Pheko ea lijo ke ho kenyelletsoa ha lijo tse mafura le tse nokiloeng, linoko, konofolo le eiee. Ho bohlokoa ho etsa hore boima ba 'mele bo be bobebe hammoho le ho tlohela ho tsuba.

Ho felisa spasm ea sphincter ea Oddi, nitrate, anticholinergics (metocinium iodide), calcium Channel blockers (nifedipine) li laetsoe. Ka lebaka la hore lithethefatsi tsena li na le litla-morao, hammoho le litlamorao tsa pelo, ho bohlokoa hore u li sebelise ho regimen e nyane ea lethal dose. Li-antispasmodics (papaverine, pinaveria bromide, drotaverine) le tsona li sebelisoa, mebeverin e na le khetho e lekaneng bakeng sa sphincter ea Oddi. E le ho felisa spasm, fihlella phello ea choleretic, fokotsa ho haella ha biliary, gimecromon e laetsoe.

Ha ho sa be le sephetho se nepahetseng ho tsoa kalafo e hlokofatsang, khafetsa ho khutlisetsa bohloko le pancreatitis, kalafo ea ts'ebetso e etsoa: endoscopic sphincterotomy, dilaton temporary balloon, ducting temporary. E le mokhoa o mong, ho sebelisoa taolo ea chefo ea botulin ho sphincter.

Phatlalatso le thibelo ea spasm ea sphincter ea Oddi

Tsoelo-pele ea spasm ea sphincter ea Oddi e monate. Maemong a mangata, kalafo e loketseng ea nako e telele ea nakoana e lumellang ntlafatso ea tleliniki; ho e-na le hoo, sphincterotomy e na le phello e khotsofatsang. Ha ho na thibelo e tobileng ea spasm ea sphincter ea Oddi. Ho eletsoa phepo e nepahetseng, ho boloka boima ba 'mele bo sebetsa hantle, kalafo e tlang ka nako e loketseng ea mafu a mang a pampitšana ea mala.

Mefuta ea lefu lena

Ntho ea tlhaho e khethollang mefuta e latelang:

• ea mantlha (e nts'etsopele ntle le ts'ebetso ea morao-rao)
• bobeli (bo bakoang ke bokuli bo tlase).

Ka boemo ba ts'ebetso:

• dyskinesia e nang le khatello ea maikutlo,
• dyskinesia ka hypofunction.

Bakeng sa ho khetholla mofuta oa sphincter oa ho se sebetse hantle ha Oddi ho latela datha ea sepheo nakong ea Consensus ea Roma (1999), ho ile ha khothalletsoa mekhoa ea tlhahlobo:

• tlhaselo ea bohloko ba khale
• bonyane keketseho e habeli tekanyetso ea li-enzyme tsa sebete (AST, alkaline phosphatase) bonyane lithutong tse peli tse latellanang,
• fokotsa lebelo phallo ea phapang pakeng tsa metsotso e fetang e 45 ka nako ea endoscopic retrograde cholangiopancreatography,
• Katoloso ea bile duct e tloaelehileng ho 12mm kapa ho feta.

Mefuta ea ho se sebetse hantle ho latela maemo a latelang:

1. Biliary I - e tšoauoa ka ho ba teng ha matšoao ohle a kaholimo.
2. Biliary II - tlhaselo ea khale ea bohloko ba bile hammoho le mekhoa ea 1 kapa ea 2 ea tlhahlobo ea tlhaho.
3. Biliary III ke letšoao la bohloko bo ikhethileng ntle le matšoao a mang.
4. Pancreatic - mofuta oa bohloko ba tšenyo ea ts'ebetso ea ho ruruha manyeme (hammoho le keketseho ea boemo ba li-enzymes tsa pancreatic).

Setšoantšo sa kliniki sa sphincter ea dysfunction ea Oddi se fapane:

• bohloko sebakeng sa epigastric, ho hypochondrium e nepahetseng ea ho phatloha, tlhaho e bobebe, ka linako tse ling - e le lerootho, e khuts'oane, e ts'oaroa ke phoso ho lijo, khatello ea maikutlo e feteletseng, ho ikoetlisa ka ho feteletseng. Bohloko bo ka khanya ho scapula e nepahetseng, mahetleng, morao, ka mofuta oa pancreatic, ke li-herpes zoster tse bohloko,
• boikutlo ba ho hlonama ka hanong
• ho nyekeloa ke pelo, ho hlatsa ka bile,
• bloating, bohloko sebakeng sa umbilical,
• tloaelo ea ho sokela,
• mokhathala,
• ho se khonehe
• likhathatso tsa boroko.

Sesepa sa bohloko ke paroxysmal ka tlhaho, maemong a mangata ha ho na litletlebo nakong ea nako ea lipakeng.

Ka ho se sebetse ha sphincter ea Oddi, phallo ea secretion ea bile le pancreatic e khathatsehile, ho kenyelletsoa ha bona ts'ebetsong ea tšilo ea lijo ho etsahala ka mokhoa o sa nepahalang, e leng se lebisang ho ts'oenyehong e fapaneng ea mokhoa oa ho silafatsa.

Ho ka ba le mathata le litlamorao

Mathata a ho se sebetse hantle ha sphincter ea Oddi e ka ba:

• cholangitis
• lefu la gallstone
• pancreatitis
• gastroduodenitis.

Boemo ba leholimo bo monate. Ka pharmacotherapy e qalileng ka nako, matšoao a lefu lena a hlahella ka nako e kgutshwane. Katleho ea kalafo e hlaselang e feta 90%.

Thuto: e phahameng, 2004 (GOU VPO "Kursk State Medical University"), ikhethang "General Medicine", " 2008-2012 - Moithuti oa PhD, Lefapha la Clinical Pharmacology, SBEI HPE "KSMU", moemeli oa saense ea bongaka (2013, ikhethang "Pharmacology, Clinical Pharmacology"). 2014-2015 - "Professional Management", FSBEI HPE "KSU" e sebetsang ka bokhabane.

Tlhahisoleseling e kopantsoe mme e fanoe molemong oa tlhahisoleseling feela. Bona ngaka ea hau pontsong ea pele ea bokuli. Ho ikoetlisa ho kotsi bophelong!