Neuromata (ib leeg neuroma) yog kev loj hlob, tuab lossis qog ntawm cov leeg nqaij uas tuaj yeem tsim tawm hauv txhua qhov chaw ntawm lub cev. Neuromata feem ntau yog tsim los ntawm cov hlab ntshav txhaws thiab ua rau khaus uas ua rau cov hlab ntsha o thiab tuaj yeem ua rau cov hlab ntsha puas tas mus li. Muaj ntau hom kab mob ntawm cov leeg nqaij uas muaj cov tsos mob sib txawv: acoustic neuromata, Morton's neuromata, thiab ganglioneuromata. Dab tsi ntxiv, kev raug mob lossis lub paj puas thaum lub sijhawm phais tuaj yeem ua rau raug mob neuromata ib yam. Pib nrog Kauj Ruam 1 hauv qab no kom paub txog cov tsos mob ntawm txhua hom neuroma.
Cov kauj ruam
Ntu 1 ntawm 4: Paub txog Cov tsos mob ntawm Acoustic Neuromata
Kauj Ruam 1. Ceev faj ntawm kev hnov lus ib sab
Cov tsos mob tshwm sim feem ntau ntawm tus neeg mob nrog lub suab nrov neuroma yog mob hnyav, ib leeg hnov ib sab tsis hnov lus. Feem ntau koj yuav tsis hnov lub suab ntse; txawm li cas los xij, cov suab tsis zoo yuav nyob li qub. Qhov tseeb ua rau tus mob no tsis paub tab sis peb qhov kev xav yuav zoo li piav qhia txog kev hnov lus tsis hnov lus hauv neuroma tshwm sim li cas:
- Compression ntawm cov hlab ntsha vestibulocochlear. Cov hlab ntsha vestibular yog rau kev saib xyuas ntawm kev tshuav nyiaj li cas thiab yog ib qho uas cov suab paj nruag neuroma txhim kho qhov cochlear lossis hnov lub paj hlwb yog rau kev hnov lus. Kev sib zog ntawm lub suab paj nruas neuroma mus rau lub pob ntseg hnov lus yog theorized ua rau maj mam ua rau hnov tsis hnov lus.
- Kev thaiv ntawm cov hlab ntsha sab hauv. Kev thaiv ntawm cov hlab ntsha sab hauv sab hauv (uas muab cov pob ntseg sab hauv qhov twg yog lub paj hlwb thib yim nyob), yuav ua rau lub cev pob ntseg puas xws li lub paj hlwb yim thiab ua rau hnov tsis hnov lus.
- Kev hloov pauv biochemical hauv cov kua hauv lub pob ntseg sab hauv. Qhov kev piav qhia no tseem yog kev xav. Kev tshawb fawb tseem tsis tau qhia tias yuav hloov pauv li cas biochemical hauv cov kua hauv pob ntseg yuav ua rau hnov pob ntseg.
Kauj Ruam 2. Ceev faj txog lub suab nrov hauv koj lub pob ntseg
Tinnitus, lossis lub suab nrov hauv pob ntseg cuam tshuam, tuaj yeem nrog qhov hnov tsis hnov lus. Tinnitus feem ntau yog qhov ua tau zoo hauv tus cwj pwm thiab tshwm sim los ntawm tib lub tswv yim uas ua rau hnov tsis hnov lus thaum hnov mob neuroma.
Thaum twg los xij koj zaum hauv qhov chaw muaj kev thaj yeeb lossis thaum sim pw tsaug zog, nws yuav tshwm sim ua rau lub suab nrov nrov lossis nrov nrov. Txhua leej txhua tus tau ntsib qhov no, tab sis feem ntau tsis raug kev txom nyem tinnitus li niaj zaus zoo li cov uas muaj suab nrov neuroma
Kauj Ruam 3. Saib xyuas koj mob taub hau
Vim yog lub suab neuroma, koj yuav hnov mob taub hau ntau yam tsis cuam tshuam nrog lwm qhov "ua" li, xws li lub cev qhuav dej lossis kev ntxhov siab. Qhov no tshwm sim los ntawm kev ua kom nrawm thiab ua rau cov hlab ntsha puas tsuaj, cov hlab ntshav, thiab cov khoom sib nqus ntawm sab hauv lub pob ntseg sab hauv thiab/lossis cov pob zeb me me dura.
- Kev mob taub hau tuaj yeem tshwm sim hla thaj tsam hauv ntej lossis sab nraum qab ntawm lub taub hau (lub qhov muag sab hauv), thiab tuaj yeem tshwm sim ntev ua ntej tsis hnov lus.
- Mob taub hau tshwm sim hauv 20% ntawm cov neeg uas muaj 1 centimeter (0.4 in) -to-3 centimeter (1.2 in) -size qog thiab hauv 43% ntawm cov uas muaj> 3 cm (1.2 in) -sum qog.
Kauj Ruam 4. Saib xyuas qhov xwm txheej ntawm vertigo
Vertigo yog qhov kev xav tias lub ntiaj teb tab tom ncig koj. Tej zaum koj yuav hnov kiv taub hau thiab tej zaum yuav ntog qee zaum vim nws zoo li yog lub ntiaj teb tig. Qhov no yog vim yog lub paj hlwb neuroma cuam tshuam nrog kev ncig ntawm cov kua hauv lub pob ntseg sab hauv thiab cuam tshuam ntawm kev sib kis ntawm kev sib npaug ua rau lub paj hlwb.
- Lub pob ntseg sab hauv muaj cov kab ke ntawm cov kwj dej thiab cov hnab ntim nrog cov hlwb hnov hauv lawv. Kev ncig cov kua hauv cov kab ke no pab lub cev kom tswj tau qhov sib npaug.
- Vertigo tshwm sim hauv 27% ntawm cov neeg mob acoustic neuroma.
Kauj Ruam 5. Khaws cov kev xav ntawm kev kiv taub hau lossis kev nkag siab
Kev kiv taub hau tshwm sim hauv 48% ntawm cov mob acoustic neuroma. Qhov no qee zaum ua rau nyuaj rau tswj kev tshuav nyiaj ib yam nkaus. Nws tshwm sim los ntawm kev nrawm lossis puas tsuaj ntawm cov hlab ntsha vestibular lossis txhaws ntawm ob sab ntawm lub paj hlwb lossis lub paj hlwb peduncles (thaum lub suab paj nruas neuroma qog loj heev nws ua rau thaj tsam ntawm lub paj hlwb dhau sab hauv pob ntseg sab hauv).
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Kev ua haujlwm ntawm kev sib npaug yog kev ua haujlwm ntawm cerebellum thiab cov hlab ntsha vestibular. Yog tias cerebellum raug cuam tshuam, txhob txwm ua rau tshee thiab taug kev ataxia tuaj yeem tshwm sim.
- Kev tshee tshee yog tshee qeeb ntawm txhais tes thiab taw uas tshwm sim thaum kawg ntawm kev mob siab rau xws li kev tshee thaum kov ib lub qhov ntswg.
- Gait ataxia yog qhov txawv txav tsis txav txav ntawm cov leeg ntawm kev taug kev.
Kauj Ruam 6. Txheeb xyuas ib nrab lossis ua kom tuag tes tuag taw ntawm ib sab ntawm lub ntsej muag
Cov tsos mob no tshwm sim yog tias lub ntsej muag (lossis VII) cov hlab ntsha cranial tau nrawm los ntawm cov qog nqaij hlav qog nqaij hlav loj. Qhov no tshwm sim qhov twg lub ntsej muag lub ntsej muag nkag mus rau hauv lub pob ntseg sab hauv. Txawm li cas los xij, lub ntsej muag loog tsuas yog tshwm sim hauv 10% ntawm cov neeg mob acoustic neuroma.
Kev sib zog ntxiv ntawm cov hlab ntsha trigeminal yuav ua rau tuag tes tuag taw (ib nrab lossis ua tiav) ntawm cov leeg rau zom thiab noj mov (mastication). Cov tsos mob no tshwm sim hauv 33% txog 71% ntawm cov neeg mob acoustic neuroma uas tau ntsib thawj lub ntsej muag tuag tes tuag taw
Kauj Ruam 7. Yog tias tsis kho, ua tib zoo saib xyuas hydrocephalus
Nov yog kev tsim cov kua dej sab hauv pob txha taub hau uas ua rau lub paj hlwb o. Qhov no yog qhov xwm txheej lig uas tshwm sim thaum lub suab nrov neuroma tau nrawm thiab thaiv lub ventricle thib plaub ntawm lub hlwb.
Nrog hydrocephalus yog mob taub hau, xeev siab thiab ntuav, thiab kev hloov pauv ntawm kev xav ntawm tus neeg mob. Nws yog ib yam mob hnyav heev uas yuav tsum tau kho tam sim
Kauj Ruam 8. Qhia koj tus kheej txog dab tsi yog acoustic neuroma tiag tiag
Acoustic neuroma (lossis vestibular Schwamoma lossis vestibular neuroma) yog cov qog nqaij hlav uas tsis muaj qog lossis qog ntshav uas yog los ntawm vestibular (tshuav nyiaj li cas) cov hlab ntsha pom nyob hauv cov hlab ntsha sab hauv, tom qab pob ntseg sab hauv. Vim nws qhov chaw nyob, nws feem ntau ua rau muaj teeb meem hnov lus thiab sib npaug. Acoustic neuromata tsis tshua muaj kev cuam tshuam kwv yees li ntawm 1 ntawm 75, 000 thiab 1 hauv 100, 000 tus tib neeg hauv ib xyoos.
Hom qog no loj tuaj ntawm kwv yees li 1 hli txog 3 hli ib xyoos twg txog thaum lawv puv tag nrho lub qhov hnov pob ntseg sab hauv. Cov qog no tuaj yeem loj hlob dhau 20 hli thiab tuaj yeem ua rau lub paj hlwb qis yog tias tsis kho, ua rau muaj teeb meem hauv lub paj hlwb, thiab thaiv kev ntws ntawm cov kua dej hauv lub paj hlwb hla qhov chaw hauv lub hlwb thiab tus txha caj qaum. Kev loj hlob ntawm cov qog no tuaj yeem ncua 20 xyoo txij li lub sijhawm cov qog pib loj tuaj
Kauj Ruam 9. Tham nrog koj tus kws kho mob txog qhov ua rau koj hnov mob neuroma
95% ntawm cov xwm txheej tshwm sim tsis tu ncua, txhais tau tias tsis muaj laj thawj paub. Qhov kawg 5% ntseeg tias yog vim yog ib feem ntawm tus kab mob neurofibromatosis II. Yog tias koj ntseeg tias koj raug kev txom nyem los ntawm hom neuroma no, tham nrog koj tus kws kho mob kom paub ntau ntxiv txog qhov ua tau thiab kho tau.
Qhov ntawd tau hais, ib txoj kev tshawb nrhiav pom tias siv xov tooj ntawm tes "tsawg kawg 10 xyoo" ua rau muaj kev pheej hmoo nce ntxiv ntawm kev tsim cov suab paj nruag neuroma. Qhov no ntseeg tau tias yog vim muaj kev nce hluav taws xob ntau dua
Ntu 2 ntawm 4: Paub txog Cov tsos mob ntawm Morton's Neuromata
Kauj Ruam 1. Xav tias muaj qhov mob rov tshwm sim ntawm koj cov ntiv taw uas los ntawm kev tawm tsam tus kheej
Ib ntawm cov tsos mob tseem ceeb ntawm Morton's neuroma yog ntu ntu ntawm qhov mob tshwm sim tshwm sim ntawm ob qhov kev tawm tsam hauv ib lub lis piam thiab tom qab ntawd tsis muaj sijhawm ntev (txog ib xyoos). Cov mob rov tshwm sim hauv koj cov ntiv taw yog vim kev txhawb nqa ntawm cov hlab ntsha cuam tshuam, feem ntau yog los ntawm qhov hnyav.
- Qhov mob no feem ntau tshwm sim vim tias cov pob txha hauv koj txhais taw tau nrawm cov hlab ntsha nruab nrab ntawm lawv. Qhov no tuaj yeem tshwm sim vim tias koj muaj lub ntsej muag dav, lossis nws tuaj yeem tshwm sim yog tias koj hnav khau nruj dhau.
- Mob kis los ntawm pob mus rau tus lej lossis ntiv taw ntawm ko taw. Kev mob hnyav tuaj yeem kav ntev li ob peb feeb mus rau ntau lub hlis, nrog lub sijhawm ntev nyob nruab nrab ntawm yam tsis muaj tsos mob. Thaum lub sijhawm ntu no, thaj tsam ntawm neuroma mob heev rau kov. Cov cheeb tsam cuam tshuam yuav yog lub vev xaib ntawm tus ntiv taw thib ob thiab thib peb, lossis ntawm tus ntiv taw thib peb thiab plaub.
- Qhov mob yog rov tshwm sim thiab hnyav zuj zus los ntawm kev taug kev ntev, khiav, zaum, sawv ntawm ib tus ntiv taw, thiab hnav nruj, khau khau siab. Yog tias neuroma muaj qhov loj txaus, qhov mob yuav tshwm sim thaum taug kev ib txwm, ib yam nkaus.
Kauj Ruam 2. Xav tias tingling lossis loog
Nrog Morton's neuromata, muaj ntau zaus tingling, hlawv, lossis hnov mob ntawm loog ntawm thaj chaw cuam tshuam, qee zaum nrog los ntawm kev ua kom mob lossis tua hom mob ntawm qhov chaw ib yam nkaus.
- Kev tua hom mob, ua rau tawv nqaij, kub hnyiab, lossis ua rau loog yog txhua yam tsos mob ntawm cov hlab ntsha cuam tshuam.
- Tingling-thiab-hlawv kev xav zoo ib yam rau "pins-thiab-koob" kev xav ntawm keeb kwm ntawm neuroma.
Kauj Ruam 3. Xav tias muaj qee yam hauv pob ntawm koj txhais taw
Nrog hom neuroma no, feem ntau muaj qhov hnov tias muaj qee yam hauv pob ntawm ko taw. Koj yuav pom koj tus kheej tshem koj lub khau thiab ua kom lub ko taw cuam tshuam, xav paub thiab vim li cas qhov mob pib. Qhov no, ib yam nkaus, yog qhov kev xav uas tuaj yeem mus thiab ploj mus, ploj mus ntev
Kauj Ruam 4. Nug koj tus kws kho mob txog Morton's neuroma tiag tiag yog dab tsi
Morton's neuroma, uas tshwm sim ntawm tus ntiv taw thib peb thiab plaub, tseem hu ua intermetatarsal lossis interdigital neuroma. Lub npe no piav qhia nws qhov chaw nyob ntawm pob ntawm ko taw ntawm cov pob txha metatarsal (cov pob txha los ntawm cov ntiv taw mus rau thaj tsam ib nrab taw).
Kwv yees li tsib tus poj niam rau ib tug txiv neej muaj Morton's neuroma, thiab feem ntau ntawm cov neeg mob hnub nyoog 15 xyoos txog 50 xyoos
Kauj Ruam 5. Kawm paub dab tsi uas yuav ua rau koj Morton's neuroma, ib yam
Paub txog qhov ua rau Morton's neuroma yuav pab koj paub yog tias koj muaj nws thiab yog tias koj yuav tsum nqis tes ua ntxiv. Hauv ntej, Morton's neuroma txhim kho vim yog mob hlab ntsha ntev, raug mob (raug mob rau lub paj hlwb), muaj kev ntxhov siab, thiab ua rau khaus, tshwj xeeb tshaj yog nrog cov ntiv taw ntau dhau lossis dorsiflexion (tsa cov ntiv taw nce), hnav nruj, khau siab, thiab ntau dhau los lossis ntau dhau ntawm cov nyom nyom (muab ko taw qis qis.
- Cov hlab ntsha ib txwm cuam tshuam yog cov hlab ntsha interdigital. Hauv ib txoj kev tshawb fawb, Morton's neuroma yog vim muaj kev cuam tshuam lossis puas tsuaj ntawm cov hlab ntsha thiab cov hlab ntsha uas tshwm sim los ntawm kev loj hlob ntawm cov nqaij sib txuas (lossis caws pliav) hla thaj chaw raug mob.
- Lwm qhov kev xav ntawm qhov tshwm sim ntawm Morton's neuroma yog cuam tshuam ntawm cov hlab ntsha vim qhov thaiv lossis caws pliav ntawm cov hlab ntsha muab cov hlab ntsha no ua rau ischemia lossis poob oxygen rau cov hlab ntsha no.
Kauj Ruam 6. Tham nrog koj tus kws kho mob txog txoj hauv kev los daws koj qhov mob vim Morton's neuroma
Koj tus kws kho mob yuav pom zoo kom koj siv tshuaj pleev tiv thaiv kab mob rau koj txhais taw, lossis lawv yuav qhia koj kom noj tshuaj tiv thaiv qhov ncauj, zoo li ibuprofen. Lawv kuj tseem yuav pom zoo kom txhaj tshuaj cortisone. Qee zaum ib qho txhaj tshuaj yuav txaus kom yooj yim rau koj tsis xis nyob, tab sis koj yuav xav tau 2-3 kom tau txais kev pab-thiab qee zaum, kev txhaj tshuaj cortisone yuav tsis pab tau ntau lossis tag nrho.
- Sim siv cov ntiv taw cais thaum hmo ntuj los pab daws qee qhov kev nyuaj siab ntawm lub qab haus huv.
- Koj tseem tuaj yeem sim dov lub raj mis dej khov hauv qab koj txhais taw li 15-20 feeb hauv ib hnub.
- Koj tus kws kho mob kuj tseem yuav hais qhia lwm yam kev kho mob, suav nrog kho lub cev, Shockwave, lossis cryosurgery kom khov cov hlab ntsha ua rau mob.
Ntu 3 ntawm 4: Paub txog Ganglioneuromata
Kauj Ruam 1. Saib xyuas koj cov ntshav siab
Hom qog no tuaj yeem ua rau muaj kev tsim cov tshuaj hormones sympathomimetic ntau ntxiv. Cov tshuaj hormones no yog lub luag haujlwm rau kev nce ntshav siab. Txawm li cas los xij, vim ntshav siab ntau heev, sab laj nrog koj tus kws kho mob ua ntej ua ib qho lus xaus.
Ganglioneuroma tuaj yeem tsim qee yam tshuaj thiab tshuaj hormones, ua rau muaj ntau yam tsos mob sib txawv, tshwj xeeb tshaj yog piv rau lwm hom neuromata
Kauj Ruam 2. Ua xyem xyav txog plaub hau ntawm lub cev
Ganglioneuroma qee zaum tuaj yeem ua rau nce cov txiv neej cov tshuaj hormones. Qhov no yuav ua rau cov plaub hau tsis tau piav qhia thoob plaws lub cev.
Yog tias koj pom cov tsos mob no, hu rau koj tus kws kho mob tam sim. Txawm hais tias nws yog ganglioneuroma lossis tsis yog, hirsutism thiab dav dav plaub hau kev loj hlob yog cov xwm txheej uas xav tau kev kho mob
Kauj Ruam 3. Saib xyuas koj qhov kev tawm hws
Qee lub sij hawm ganglioneuroma tuaj yeem ua rau cov tshuaj hormones uas ua rau cov ntshav nkag rau ntawm daim tawv nqaij. Qhov no yuav tig mus ua rau muaj kev tawm hws ntau ntxiv hauv lub cev. Txawm hais tias koj nquag tawm hws ntau dhau lossis tsis yog, koj yuav muaj kev tawm hws ntau dhau yog tias koj raug mob los ntawm ganglioneuroma.
Kauj Ruam 4. Yog tias muaj kev loj hlob nyob hauv siab, koj yuav hnov cov tsos mob hauv qab no:
- Ua pa nyuaj. Cov qog no tuaj yeem pom nyob hauv ib feem ntawm lub hauv siab uas tuaj yeem tso siab rau ntawm lub raj cua. Qhov no tuaj yeem ua rau ua pa nyuaj, ua rau koj zoo li koj tab tom hnoos.
- Mob hauv siab. Qee lub sij hawm cov qog no tuaj yeem nias rau qee qhov hloov pauv hauv lub hauv siab xws li npog lub ntsws. Qhov no yuav ua rau cov hlab ntsha hla cov ntu ntawd. Nws yuav ua rau mob.
Kauj Ruam 5. Yog tias muaj qog nyob hauv lub plab, koj yuav zoo li cov tsos mob no:
- Mob plab. Cov qog no tuaj yeem nias lub cev tseem ceeb hauv plab. Nws kuj tseem tuaj yeem ua rau khaus khaus hauv qab cheeb tsam. Qhov no yuav ua rau hnov mob hauv plab.
- Bloating. Bloating yog qhov kev xav ntawm lub plab puv lossis qhov kev xav tias koj lub plab puv roj. Qhov no yog vim los ntawm cov kua qaub ntau hauv cov kua qaub hauv lub plab, uas tej zaum yuav yog vim nws tau txhawb los ntawm lub paj hlwb.
Kauj Ruam 6. Yog tias muaj qog nyob ze ntawm tus txha nqaj qaum, saib cov tsos mob hauv qab no:
- Tsis muaj zog thiab mob hauv koj qhov kawg. Nco tseg qhov mob thiab hnov qhov tsis muaj zog ntawm koj txhais caj npab thiab txhais ceg. Qhov no yog vim muaj kev txhaws ntawm tus txha caj qaum los ntawm cov qog, qhov twg cov qog nqaij hlav tuaj yeem nias ntawm tus txha caj qaum thiab ua rau ib feem ntawm nws puas.
- Tus txha nqaj deformity. Qee lub sij hawm tus txha nqaj qaum puas tsuaj vim lub siab ua los ntawm cov qog ntawm tus txha nqaj qaum yuav zoo heev uas nws ua rau lub deformation ntawm tus nqaj qaum.
Kauj Ruam 7. Kawm paub ntau ntxiv txog cov ntsiab lus ntawm ganglioneuromata
Nov yog hom qog nqaij hlav ntawm lub paj hlwb nyob sab nraum lub paj hlwb thiab tus txha caj qaum, cuam tshuam rau lub paj hlwb ib leeg. Cov no yog cov qog qog tso tawm tsawg heev uas tuaj yeem tshwm sim hauv ib feem ntawm lub cev.
Cov tsos mob ntawm ganglioneuroma nyob ntawm ib feem ntawm lub cev qhov twg cov qog no nyob thiab cov tshuaj hormones tso tawm li cas. Ganglioneuroma txawv ntawm qog mus rau qog. Lawv tuaj yeem tshwm sim hauv ntau qhov chaw, cuam tshuam ntau yam tshuaj hormones, lossis tsis cuam tshuam rau koj cov tshuaj hormones txhua
Ntu 4 ntawm 4: Paub Txog Kev Puas Hlwb Neuromata
Kauj Ruam 1. Siv qhov siab rau thaj tsam txhawm rau ntsuas koj qhov mob
Yog tias koj kov thaj tsam thiab siv lub siab, koj yuav zoo li mob hnyav heev tuaj ntawm qhov chaw neuroma pib. Qee lub sij hawm vim hyperactivity ntawm cov hlab hlwb tuaj yeem mob txawm tias tsis muaj kev nyuaj siab.
Tom qab kev raug mob rau cov hlab ntsha nws loj hlob mus rau qhov sib txawv tab sis qee lub sij hawm nws yuav loj hlob tsis zoo. Nws tuaj yeem tsim kev loj hlob ntawm cov hlab ntsha uas yuav tua hluav taws hauv txhua qhov kev coj ua uas ua rau mob hnyav
Kauj Ruam 2. Ua tib zoo xav txog kev nyuaj siab thiab qaug zog, ib yam
Qee zaum koj yuav hnov mob hnyav heev uas qhov tsos mob nws tus kheej muaj cov tsos mob. Nws zoo li tsis muaj qhov kawg thiab ua rau koj lub cev thiab kev xav sab sab. Nws yog ib qho yooj yim kom tau txais kev nyuab siab, uas ua rau mob hnyav rau khau raj.
Txawm hais tias tus neuroma nws tus kheej yuav tsis ploj mus, hauv qhov no nws yog qhov zoo tshaj los ua kom tsis muaj kev ntxhov siab ntau. Xav txog kev siv kev xav, yoga, lossis ua pa tob tob rau hauv koj li niaj hnub ua. Thiab, zoo li ib txwm, tham nrog koj tus kws kho mob. Mob ntev thiab qaug zog tsim nyog kho tam sim
Kauj Ruam 3. Paub tias kev raug mob neuromata tej zaum yuav tshwm sim los ntawm kev phais lossis lwm yam raug mob lub cev
Nrog hom neuroma no, muaj thaj tsam ntawm kev mob siab rau uas tuaj yeem ua rau mob. Nws tsim los vim raug mob rau lub paj hlwb. Qhov tshwm sim feem ntau ntawm cov neuroma no yog kev phais, tab sis nws kuj tseem tuaj yeem tshwm sim los ntawm kev txiav thiab puas tsuaj rau cov hlab ntsha los ntawm koob.
