Cysts ndi fistulas a kapamba

Fistulas ya kapamba amatchedwa mauthenga a patuchute a magene a chinyezi ndi chilengedwe chakunja kapena ziwalo zamkati.

Pali mafistulas akunja mkamwa mwa fistula utatseguka pakhungu, ndi mkati pomwe fistula imalumikizana ndi chiwalo cham'mimba (m'mimba, yaying'ono kapena matumbo akulu). Amatha kukhala athunthu komanso osakwanira.

Polepheretsa gawo loyandikira la duct (fistula yathunthu), madzi onse a kapamba amatulutsidwa kunja. Ndi fistulas yosakwanira, gawo lalikulu la madzi a pancreatic limayenda mwachilengedwe mu duodenum ndipo gawo lokhalo lomwe limasiyanitsidwa ndi fistula.

fanculas yakunja imakonda kupweteka pambuyo pamimba kapena atachitidwa pa gland, kuphatikizika ndi kutseguka kwa ma ducts ake. Fistulas wamkati nthawi zambiri amakhala chifukwa cha masinthidwe owopsa m'matumbo omwe amapita kukhoma la gawo loyandikana nalo (pachimake pancreatitis, malowedwe ndi kupangika kwa pancreatic cyst).

Chipatala ndi Kuzindikira

kwa fanculas yakunja, kumasulidwa kwa madzi a pancreatic kudzera pakutseguka kwakunja kwa fistula ndi khalidwe. Kuchulukitsa kumatengera mtundu wa fistula. Ndi fistula yathunthu (osowa), mpaka 1 1.5 L ya madzi amadzimadzuwa tsiku lililonse, osakwanira, nthawi zambiri amatsika ochepa chabe. Kutengera ndi kuopsa kwa kusintha kowononga komanso kotupa m'matumbo ndi m'makoma a fistula, mwina madzi oyera a kapamba kapena pancreatic omwe amakhala ndi magazi ndi mafinya amawonekera.

Ndi fistulas yosakwanira chifukwa chakutulutsa kwamchere yambiri kunja, maceration a khungu limayamba msanga. Kuwonongeka kwakukulu kwa madzi a pancreatic kumabweretsa kuwonongeka kwakukulu mu mkhalidwe wa wodwalayo, kusokonezeka kwakukulu kwa mapuloteni, mafuta ndi chakudya, kuwonongeka kwakukulu kwa madzi, ma electrolyte ndi zovuta zama asidi. Nthawi zambiri kutayika kumeneku kumayambitsa kusowa kwamadzi, kutopa, kupweteka, komanso kuvulala kwambiri.

Ndi fistulas yamkati, kumasulidwa kwa madzi a pacreatic kumachitika mu lumen pamimba kapena m'matumbo. Pankhaniyi, kusintha kwakukuru kwa tizilombo ta fistulas yakunja sikuchitika.

Kuzindikira fistulas yakunja si vuto lalikulu. Kuzindikira komaliza kumatsimikiziridwa ndikuwunika zomwe zimapezeka mu michere ya pancreatic mu fistula yopatukana. Kuti mumvetse bwino za matendawa, fistulography iyenera kugwiritsidwa ntchito. Ngati kusiyanitsa kwa fistulography kumadzaza milomo ya kapamba, kudziwika sikungakayike.

fistulas yosakwanira nthawi zambiri imakhala yolumikizidwa ndi chithandizo cha mankhwala osokoneza bongo, omwe amaphatikizapo zinthu zomwe zimapangitsa kuti zinthu zikhale zambiri, kuthana ndi kutopa ndi madzi.

Kuti muchepetse ntchito yachinsinsi ya gland, cytostatics, antispasmodics ndi zakudya zapadera zimalembedwa kuti zimachepetsa kutulutsidwa kwa madzi a pancreatic (olemera m'mapuloteni komanso osauka a chakudya).

Chithandizo chakumaloko chimakhala ndi chisamaliro chokwanira cha khungu kuzungulira fistula, kupewa kukula kwake, ndikuyambitsa madzi mu fistula momwe momwe zimakhudzidwira ndipo fistula imatsukidwa ndi yofooka yankho la lactic acid kuti inactivate enzymes ya protein. Fistulas yosakwanira imakonda kutsekedwa mchikakamizo cha miyezi ingapo.

Ndi fistulas yathunthu, chithandizo cha opaleshoni chimasonyezedwa. Mitundu yodziwika kwambiri yogwira ntchito ndi iyi: kukomoka kwa fistula, kupindika kwa fistula m'mimba kapena matumbo aang'ono, kuyamwa kwa fistula ndikamayendedwe amodzi a chotupa cham'mimba zomwe zimakhudzidwa ndi matenda

Gastroenterology - Cysts ndi fistulas a kapamba

Cysts ndi fistulas a kapamba - Gastroenterology

Cysts ndi fistulas a kapamba sizachilendo. Cysts ndi makapisozi okhala ndi madzimadzi mkati. Zimapezeka pachithunzichi palokha, komanso pazinthu zowazungulira. Matendawa amapezeka pamibadwo iliyonse, komanso mosaganizira jenda. Pancreatic cysts - lingaliro limodzi.

Cysts agawidwa m'mitundu ingapo:

1. Congenital. Izi zikuphatikiza ma cysts, omwe adapangidwa chifukwa chakuwonongeka kwa minofu ya kapamba, komanso ductal system.
2. Walandidwa.

• Acquys cysts, nawonso amagawidwa posungidwa, kuchepa, kuchuluka, parasitic.
• Zoyeserera posakhalitsa zimatulukira chifukwa chokhwimitsa zinthu zakuluzikulu za ndulu, komanso ngati zimatchinga miyala kapena zotupa.
• Deyserative cysts imayamba chifukwa cha kuwonongeka kwa ma pancreatic minyewa pancreatic necrosis, pambuyo kukha mwazi, kuvulala kapena pakati pa chotupa.
• Pryscent cysts ndi m'mimba neoplasms. Awa ndi cystadenocarcinomas ndi cystadenomas.
• Parysic cysts imachitika pa matenda a ognism omwe ali ndi echinococcus ndi cysticercus.

A cyst kutengera ndi makoma ake.

Pali ma pancreatic cysts abodza komanso owona malinga ndi makoma ake. Cysts owona ndi kobadwa nako dysontogenetic cysts, cystadenomas ndi cystadenocarcinomas, olandidwa posungira. Cysts owona amapanga pafupifupi 20% ya zonyansa zonse zakufa. Chofunikira chake ndi kupezeka kwa chingwe cha epithelial, chomwe chimapezeka mkati mwake. Kukula kwa ma cysts owona kumakhala kwakukulu kwambiri kuposa zabodza. Ena mwa ma cysts a opereshoni akuyamba kupeza.

Makoma a cyst abodza amakhala a densified peritoneum ndi minofu ya fibrous. Mosiyana ndi cyst yeniyeni, yabodza siyimakhala ndi chibowo mkati. Mkati mwa mabala abodza amakutidwa ndi minofu ya granulation. Mumkati mumakhala madzi amtundu wa necrotic. Madzi awa ali ndi mawonekedwe osiyana. Monga lamulo, ichi ndi purulent ndi serous exudate wokhala ndi kuphatikizika kwa magazi ndi ma nsapato, ndipo madzi a pancreatic amathanso kukhala nawo. Masewera abodza amapezeka pamutu, thupi, ndi mchira wa kapamba. Kuchuluka kwamadzi komwe kumakhala mu cyst nthawi zina kumafika mpaka malita 1-2 kapena kupitilira. Ma cyst akuluakulu nthawi zambiri amafalikira mbali zosiyanasiyana. Itha kupezeka kutsogolo ndi mtsogolo kutsogolo kwa omentum yaying'ono, pomwe chiwindi chimakankha, m'mimba pansi. Mitsempha imathanso kupita ku gastro-colon ligament, kwinaku ikukankha m'mimba palokha, ndipo colon yopingasa imatsikira pansi.

Makina akulu.

Cysts yayikulu yayikulu nthawi zambiri imayamba kutayikira popanda chizindikiro chilichonse. Amachitika ngati ma cyst adachulukana kwambiri ndikuyamba kuponderezana ziwalo zapafupi. Zizindikiro zodziwika bwino za cysts ndizopweteka pamimba yapamwamba, zizindikiro za dyspeptic zimawonekera, mawonekedwe ambiri amasokonezeka, kufooka kumachitika, munthu amalemera, ndipo kutentha kwa thupi kumakwera. Pa nthawi yodutsa, mapangidwe ofanana ndi chotupa pamimba amakhala.

Wodwala amayamba kuwoneka wowuma, opweteka nthawi zonse, nthawi zina, ululu wa paroxysmal. Amamanga lamba, kupindika, pomwe wodwalayo akuyenera kuwerama kapena kuwerama. Kupweteka kwakukuru kwambiri kumawoneka pamene cyst imakanikiza pa solar plexus ndi celiac. Komabe, ndi ma cysts akuluakulu, ululuwu umafotokozedwa pang'ono, odwala amadandaula ndi zomverera za compression m'gawo la epigastric. Nthawi zambiri, zizindikiro za dyspeptic zimakhala nseru, nthawi zina kusanza, komanso malo osakhazikika.

Mukamawerengera, chizindikiro chachikulu ndikupanga chotupa. Ngati cyst ndi yayikulu, imatha kupezeka pamayeso oyamba. Malire ake ndiwowoneka bwino, mawonekedwe ake ndi ozungulira kapena ozungulira, mawonekedwe a cyst ndi osalala. Kupanga ngati tumor kutengera kutengera komwe kumatsimikiziridwa m'dera lachiwonetsero, mu epigastric, komanso kumanzere ndi kumanzere kwa hypochondrium.

Mavuto a chotupa.

Mavuto ochititsa chidwi kwambiri a pancreatic gland cyst ndimatumbo amkati mwake, njira zowoneka bwino, zovuta zina zomwe zimawonekera pambuyo pa kupindika kwa ziwalo zoyandikana ndi cysts, fistulas yakunja ndi yamkati, kuwombana ndi chitukuko cha peritonitis.

Pazindikiritso, zizindikiro zamatenda zimatengedwa, ndipo njira zapadera zochitira kafukufuku zimachitika. M'magazi ndi mkodzo, kuchuluka kwa michere ya pancreatic kumawonedwa. Ma tomography ophatikizidwa, kuphatikiza kupanga sikani ya ultrasound, kumathandiza kudziwa mawonekedwe opakidwa ndi madzimadzi.

Mankhwalawa amachitidwa opaleshoni. Gawo la kapamba wokhudzidwa ndi cyst imapangidwanso. Ndi ma pseudocysts, ntchito zamadzina zimagwiritsidwa ntchito.

Fistulas of the kapamba.

Ma pancreatic fistulas ndi mauthenga a patcreatic ducts omwe ali ndi ziwalo zamkati kapena ndi chilengedwe chakunja. Fistulas ndi yakunja pamene pakamwa pake pakapangika pakhungu, ndi mkati pomwe fistula imalumikizana ndi ziwalo zopanda kanthu (matumbo ang'ono ndi akulu, kapena m'mimba). Fistulas ali athunthu komanso osakwanira. Ndi fistula yathunthu, madzi a pancreatic amatulutsidwa kudzera fistula kupita kunja. Fistula yosakwanira imadziwika chifukwa chakuti madzi a pancreatic amatuluka mu duodenum ndipo mbali ina kunja kwa fistula.

Nthawi zambiri fistulas imachitika pakachitika zoopsa m'mimba kapena opaleshoni yam'mimba, atatsegula zitseko zake. Fistulas wamkati amawonekera chifukwa cha kusintha kwa kapamba omwe amapita khoma la chipinda choyandikana (ndi kapamba, kupindika kwa pancreatic cyst ndikulowerera).

Ndi fistulas yathunthu, chithandizo cha opaleshoni chimachitika. Mitundu yayikulu ya ntchito ndi kuwonekera kwa fistula, kutulutsa fistula wopangidwira m'mimba kapena matumbo aang'ono. Fistula imachotsedwa limodzi ndi kapamba wokhudzidwa.

Matenda a kapamba

Chronic pancreatitis (CP) ndi matenda obwera chifukwa cha kupweteka kwa kapamba (kapamba), wopita ku chiwonetsero cha glandular minofu ya chiwalo, cholowa m'malo mwa ma cell a ma cell a parenchyma, kuwonongeka kwa ma ducts, kupweteka ndi kutayika kwa ntchito za exo- ndi endocrine.

Kwazaka makumi angapo zapitazi, kufalikira kwa matenda a kapamba ambiri kwachulukanso, ndipo kwakhala kofunika kwambiri kuchipatala komanso chikhalidwe.

Zimayambitsa kapamba ndi zinthu zomwe zimathandizira kuti zizipezeka. Pali zinthu zoposa 140 zomwe zimadziwika zomwe zimatha kuyambitsa kapamba kapena kuthandizira kuchitika. Komabe, pakuchulukitsa kwa odwala opaleshoni, kapamba imakhudzana ndi zinthu zitatu zazikuluzikulu, zomwe zimagwira gawo limodzi la matenda. Izi ndi izi: (potsatira kufunika):

• 1) Kuledzera kwa nthawi yayitali komanso mopitirira muyeso.
• 2) matenda a ziwalo zoyandikana ndi kapamba, choyambirira, cha bile ducts (cholelithiasis), kawirikawiri ya duodenum, etc.,
• 3) kuvulala kwapancreatic, kuphatikizapo intraoperative.

Ndimakhulupirira ndi uchidakwa pafupifupi 3/4 milandu ya CP imalumikizidwa, ndipo kuwonjezereka kwachulukidwe kwa kuchuluka kwa uchidakwa, makamaka m'dziko lathu, kumatsimikizira kuwonjezeka kwakukulu kwa chiwopsezo cha kapamba m'zaka zaposachedwa, makamaka mwa amuna achichepere komanso azaka zapakati.

Matenda a Gallstone - Choyimira chachiwiri chofunikira kwambiri cha kapamba, chomwe chimagwira gawo lalikulu azimayi azaka zapakati komanso achikulire. Ndikudziwika bwino kuti kwanthawi yayitali m'maiko otukuka panali kuchuluka kwamankhwala odwala cholelithiasis, amenenso amatsimikiza kuwonjezereka kwa pafupipafupi kwa kapamba omwe amaphatikizidwa nawo.

Poyerekeza ndi zifukwa ziwiri zoyambirira kuvutika - onse "osasankhidwa", kuphatikiza zigawenga, ndikugwira ntchito - ndizosafunikira kwenikweni komanso zimayambitsa, monga lamulo, chilonda chachikulu cha pancreatitis, chomwe pambuyo pake chimatha kusintha kukhala mitundu yayikulu.

Monga chogwirira ntchito, kuvutika m'mavuto kumatha kukhala ndi zotsatirapo mwachindunji komanso zosakhudzana ndi zodwala. Ndi chiwonetsero chachindunji, kuwonongeka mwachindunji kwa minyewa ya minyewa kumachitika mothandizidwa ndi makina opanga (kutsekeka kapena kulowa mkati mwa m'mimba, kuchitidwa opareshoni pakhungu kapena ziwalo zozungulira, makamaka pa duodenal papilla). Zotsatira zoyipa zomwe zimachitika nthawi zambiri zimagwirizanitsidwa ndi kusokonekera kwa michere ya cellcircular pakachitika zoopsa, komanso kuzungulira kwa nthawi yayitali kapena kosakwaniritsidwa pakubala kwa mtima.

Chiwerengero cha zowopsa pancreatitis chimakhalanso chowonjezereka. Izi zikuchitika chifukwa cha kuchuluka kwa magwiridwe antchito a kapamba, mankhwalawa a endoscopic komanso kulowererapo kwa opaleshoni pa duodenal papilla yayikulu (retrograde cholangiopancreatography (RCP), endoscopic papillosphincterotomy (EPST).

Chifukwa chake, zovuta zonse zazikuluzikulu zitatu za kapamba zimakulirakulira, zomwe zikufotokozera kuchuluka kwakuchulukirachulukira kwa matendawa m'zaka zonse za XX.

Kumayambiriro kwa XX century. Pancreatitis idawonedwa ngati matenda osowa, ndipo dokotala wa opaleshoni waku France A. Mondor, yemwe anali wolamulira wamkulu panthawiyi pozindikira komanso kuchitira opaleshoni yamatumbo am'mimba, anali wonyadira kuti adazindikira kawiri pancreatitis pachimake. Pakadali pano, ngakhale dotolo wa novice yemwe amagwira ntchito mu ambulansi amatha kudzitama chifukwa cha kuchita zomwezi kapena wawonjezeranso patatha sabata limodzi, kapenanso wotchi imodzi.

Zinthu zina zambiri zomwe zimatengedwa kuti ndizomwe zimayambitsa kapena zimathandizira kukulitsa kapamba ndizosafunikira kwenikweni, sizimayambitsa zilonda zapakhansa, makamaka zomwe zimafunikira chidwi cha dokotala. Zodziwika kwambiri mwa zinthuzi ndi monga:

• • matenda a endocrine (hyperparathyroidism, matenda a Cushing),
• • hyperlipidemia ndi hyperglyceridemia, makamaka kuphatikiza pakati, komanso genesis,
• • mankhwala (pakamwa kulera, corticosteroids, azathioprine ndi ma immunosuppressants ena),

• • thupi lawo ndi autoimmune zinthu,
• • matenda obadwa nawo (cystic fibrosis ya kapamba monga chiwonetsero cha cystic fibrosis, chibadwa chomwe chimayambitsa matenda a metabolic ndi enzymatic, makamaka, kuperewera kwachulukidwe ka calcium, komwe kumakulitsa mawonekedwe a pancreatic secretion ndi mapangidwe a calculi calculi.
• • pancreatic ischemia, makamaka yokhudzana ndi kupindika kwa stenosis ya thunthu la celiac ndi zifukwa zina,
• • matenda a parasitic (ascariasis, etc.).

Pathogenesis. Itha kuganiziridwa ponseponse kuti pathogenesis ya kapamba mumadongosolo ambiri odwala imadalira kuwonongeka kwa minyewa ya m'mimba ndi michere yomwe imatulutsa. Nthawi zambiri, ma enzyme amenewa amasungidwa osagwira (kupatula amylase ndi zigawo zina za lipase) ndipo amayamba kugwira ntchito mutangolowa mu duodenum. Olemba amakono ambiri amasiyanitsa zinthu zitatu zazikulu za pathogenetic zomwe zimapangitsa kuti michere iwonongeke pang'onopang'ono:

• • kuvuta kwa kutulutsa kwa kutulutsa tizi tiziwalo timene timalowa mu duodenum ndi matenda oopsa a patraductal,
• • kuchuluka kwambiri modabwitsa ndi enzymatic ntchito yapancreatic madzi,
• • Reflux mu duct dongosolo la kapamba pazomwe zili mu duodenum ndi bile.

Kwa nthawi yayitali, trypsin imadziwika kuti ndi puloteni yayikulu yomwe imayambitsa matenda a pancreatic minofu pancreatitis (pambuyo poyambitsa mphamvu yake yaposachedwa ndi trypsinogen mwa cell cytokinase kapena duodenal enterokinase). Posachedwa, kufunikira kochulukirapo kumayikidwa ndi phospholipase Ah adapangidwa kuchokera ku proenzyme ndi bile acid ndi zinthu zina, makamaka trypsin. Enzyme iyi imatha kuwononga maselo amoyo amoyo mwa kuchotsa ziwalo zawo za phospholipid. Ma lipase ndi omwe amachititsa kuti pakhale kuchuluka kwa pancreatic ndi parapancreatic necrosis (steatonecrosis). Trypsin ndi ma enzymes ena ochulukitsa a proteinolytic (elastase, collagenase, kallikrein) amawononga zinthu zomwe zimapanga minyewa yambiri, ndipo zotengera zapamimba ndizofunikira kwambiri pakuchita kwawo, komwe kumalumikizidwa ndi chikhalidwe cha hemorrhagic cha pancreatic necrosis ena mwa odwala.

Mapangidwe a pathological anorganic activation a michere ndi kuwonongeka kwa minyewa minofu zimasiyana kutengera chifukwa cha kapamba.

Chifukwa chake, chimadziwika kuti mowa makamaka mu waukulu milingo, Reflex ndi amanyazi modabwitsa kumawonjezera kuchuluka kwa zochita ndi madzi a pancreatic. Kwa ichi ndiwonjezeranso chidwi chopatsa thanzi. Kuphatikiza apo, mowa umathandizira kupindika kwa sphincter ya hepatic pancreatic ampoule (sphincter of Oddi), imapangitsa kuwonjezeka kwa mawonekedwe a pancreatic secretion, mapangidwe a protein preipitates mmenemo, omwe pambuyo pake amasintha kukhala miyala yodziwika ndi mawonekedwe osakhazikika a matendawa. Zonsezi zimasokoneza kutuluka kwa katulutsidwe ndipo zimayambitsa kulowererapo kwa magazi, komwe, pamlingo wopitilira 350-400 mm, kumatha kuwononga maselo a epithelial a ducts ndi acini komanso kumasulidwa kwa ma cytokinases omwe amayambitsa njira ya enzyme activation. Sphincter wa Oddi spasm imatsogolera ku ndulu-pancreatic Reflux ndi kulowetsedwa kwina kwa michere chifukwa cha bile bile. Zowonongeka zenizeni zomwe zimachitika chifukwa cha kuchuluka kwa magazi m'magazi am'mimba sizimadziwikanso.

Ndi kapamba yemwe amayamba ndi matenda a biliary thirakiti chinthu chachikulu cha pathogenetic ndikuphwanya kutulutsa kwa pancreatic madzi mu duodenum, makamaka chifukwa cha kukhalapo kwa "njira wamba" yomwe yatchulidwa kale momwe miyala ya bile imadutsamo ndi komwe phata lalikulu la pancreatic limalowa. Ndi mayendedwe osiyana a ndulu ndi kapamba, komanso kutumphukira kwakumalowa kwa duodenum ya duct yowonjezera (santorinium), kulumikizana ndi kuperewera kwapakhungu, pancreatitis yothandizira.

Kudutsa Vates ampule, miyala ya bile imakhalapo kwakanthawi, ndikupangitsa kupindika kwa kupindika kwa Oddi komanso kuchepa kwa mpweya wocheperako, kupangitsa kuwonongeka kwa michere ya minyewa ndipo, mwina, kuukira kwa pancreatitis yovuta kwambiri, yomwe nthawi zina imakhala yofanana ndi asymptomatic kapena yolumikizidwa ndi kuukira kwa biliary colic. Kubwereza-bwereza mobwerezabwereza kwa ma gallstones chifukwa cha kuthamanga kwambiri chifukwa cha kupanikizika kwakukulu komanso kupindika kwa biliary kungayambitse kuvuta kwa mucosa wa duodenal papilla ndi stenotic papillitis, komwe kumapangitsa madzi a bile ndi pancreatic kukhala ovuta, komanso kubwezeretsa miyala. Reflux ya bile mu pancreatic duct amathanso kuchita mbali yamatenda a pancreatitis, komanso pamaso pa cholangitis, michere yachilengedwe imathandizanso kutsegula kwa michere ya pancreatic.

Udindo wodziimira payekha wa pathogenesis ya kapamba amathanso kuchita matenda a duodenum zogwirizana ndi duodenostasis ndi matenda oopsa mu lumen yonse ndikuthandizira kuyambiranso kwa duodenal mkati mwa pancreatic duct (kuphatikizapo "adductor loop syndrome" pambuyo pokhazikitsanso m'mimba malinga ndi mtundu wa Billroth-P). Parapapillary diverticulum ya duodenum imatha kuyambitsa kuphipha konse komanso (kawirikawiri) ma sphincter a Oddi.

At kuvulala mwachindunji mawotchi kuwonongeka kwa gland kumabweretsa intraorgan activation ya michere ndi kumasulidwa kwa ogwiritsa (cytokinases) ku maselo a necrotic komanso kukula kwa enzymatic iankreonecrosis kuwonjezera pa zovutitsa zina. Ndi kulowererapo kwa endoscopic pa duodenal papilla yayikulu (RCHP, EPST), mucous membrane wa Vater ampule ndi gawo lankhondo lalikulu la pancreatic duct nthawi zambiri limavulala. Chifukwa cha kuvutika m'mimba, kutaya magazi komanso kugwira ntchito edema, kutulutsa katulutsidwe ka kapamba kumatha kusokonekera ndipo matenda oopsa amatha kupezeka, omwe mbali yake ya pathogenesis ya kapamba idawerengedwa kale. Makoma a duct amathanso kuwonongeka pakuwonjezeka ndikumayambitsa wothandizira wosiyana ndi RCP.

At kuwonetsedwa mwachindunji mwachisawawa komanso ogwira ntchito kuvulala pa kapamba (zoopsa zam'mimba, zotupa za m'mimba, opaleshoni yamtima yokhala ndi mafuta a nthawi yayitali), kuwonongeka kwa minyewa ya m'mimba ndikutulutsa kwa activating zinthu makamaka kumalumikizana ndi zovuta zam'magazi komanso hypoxia yoyenderana.

Mu chifuwa chachikulu cha pancreatitis, chomwe sichiri chifukwa cha pachimake, palinso kuwonongeka kwa enzymatic, necrobiosis, necrosis ndi autolysis ya pancreatocytes, omwe amapezeka pang'onopang'ono, motsogozedwa ndi chinthu chomwe chimagwira ntchito kwa nthawi yayitali, komanso ndendende - panthawi yowonjezereka.

Kubwezeretsanso kwa kakang'ono kamene kamabalalitsidwa ka nancreonecrosis ndi kusinthika ndi minyewa kumabweretsa pancreatic sclerosis, kukakamira kwa ziphuphu, kusinthika ndi kusakhazikika kwa ma cicatricial a ma supreory ducts, omwe amathandiza kwambiri pakusokoneza kutulutsa kwachangu komanso pathogenesis ya pancreatitis yayikulu. Kupita patsogolo kwa njira ya cicatricial mu gland kumatha kuyambitsa kuchepa kwakukulu mu ntchito zakunja ndi zogwira ntchito (matenda am'mimba, matenda ashuga), komanso kukakamiza kwa duct wamba ya ndulu yomwe imadutsa makulidwe a mutu wapa pancreatic (oletsa jaundice), portal portal vein (portal hypertension).

Pankhani ya encapsulation yaung'ono foci wa necrosis, sekondale kuyerekezera makamaka yokhala ndi chidakwa cha CP komanso chifukwa cha kapamba yemwe amayamba chifukwa cha kuwonongeka kwa calcium calcium (hyperparathyroidism, calcium-stabilizing factor defence). Kuwunika kwa kapamba wa pancreatic parenchyma wovuta kupweteka kwa pancreatic kumakhala umboni wosatsutsika wakale wa kapamba wa neancosis, popeza mchere wamkati nthawi zambiri umasungidwa minofu yakufa.

Kukula kwakukulu kwa pancreatic necrosis, pakufuna kupita ku encaps, kumatha kuchitika mwanjira ina ndikusintha kukhala pancreatic, parapancreatic kapena kuphatikizika kwa cyst ndi makoma owumba, opangidwa koyambirira ndi kuzungulira kwa mapangidwe a necrotic, ndipo atatha kuwonongeka pang'onopang'ono ndikusungunuka - kwamitambo, pang'onopang'ono, kowala. pancreatic secretion michere. Matendawa amayambitsa kuyambika kwa pancreatic yaulesi kapena parapancreatic abscess, yomwe nthawi zambiri imakhala ndi mafinya ndi zinthu za pancreatic necrosis, zomwe zimakhala pamitundu yosiyanasiyana yoyipa. Komabe, kuwonjezera kwa kufalikira kwa kachilombo koyambitsa matenda kumatanthauza kusintha kwamtsogolo kwa minofu ya necrotic komanso kusintha kuchokera pakukhazikika kosagwirizana ndikuyamba kukanidwa.

Gulu. Kutengera zomwe zimayambitsa matendawa, chifuwa chachikulu chitha kukhala:

• 1) chidakwa
• 2) cholangiogenic (wophatikizidwa ndi matenda am'mimba),
• 3) zopweteka,
• 4) chifukwa cha zina.

Ndi chikhalidwe cha kusintha kwakachulidwe kakakulu m'matumbo a chimbudzi chikuyenera kusiyanitsidwa:

• 1) kuphatikiza ndi chifuwa chachikulu cha kapamba,
• 2) aakulu kapamba ndi kukhalapo kwa patsekeke mawonekedwe (encapsated maziko a kapamba necrosis, cysts abodza, waulesi abscesses).

Zonsezi ziwiri zamatenda zimatha kuchitika:

• a) popanda kuwerengera,
• b) ndi calcation wa gland parenchyma.

Malinga ndi momwe duct dongosolo, zotsatirazi ziyenera kusiyanitsidwa:

• 1) chifuwa chachikulu chopanda matenda oopsa
• 2) chifuwa chachikulu chokhala ndi matenda oopsa, kuphatikizapo:
  • a) wopanda zopanda tanthauzo,
  • b) ndi calculi wolowerera.

Kukula kwa chifuwa chachikulu chimadziwika:

• 1) chigawo chokhala ndi masinthidwe oyang'anira masinthidwe (zophatikizika):
  • a) mutu wa kapamba,
  • b) thupi la kapamba,
  • c) mchira wa kapamba,
• 2) zapamwamba,
• 3) chonse.

Kuphatikiza apo, chifuwa chachikulu chimapangidwanso:

• a) popanda chilonda chotchulidwa cha parapancreatic fiber (parapancreatitis),
• b) zowonongeka kwambiri parapancreatic fiber.

Pazachipatala, munthu amatha kusiyanitsa:

• 1) chachikulu kapamba,
• 2) yotsalira (yotsalira) pancreatitis, monga kupitiliza kwa kapamba.

Njira ya matenda a kapamba:

• 1) wodekha,
• 2) Nthawi ndi nthawi zomwe zikuchulukana:
  • a) kukokomeza,
  • b) kukhululuka,
• 3) latent (kuphatikizapo ndi zaka zambiri zakhululukidwa).

Mutha kusiyanitsa pakati pa mitundu yovuta ya kapamba malinga ndi kupezeka kwa zovuta ndi chikhalidwe chake:

• 1) chifuwa chachikulu popanda zovuta,
• 2) chifuwa chachikulu chovuta kudziwa:
  • a) pachimake chachikulu pancreatic necrosis,
  • b) kapamba wamafuta,
  • c) zovuta za jaundice komanso (kapena) cholangitis,
  • g) kuphwanya patency ya duodenum,
  • e) Matenda oopsa a portal,
  • e) magazi,
  • g) kutopa kwakuthupi,
• 3) matenda ashuga
• i) zovuta zina.

Chithunzi cha chipatala. Kuwonetsedwa pafupipafupi komanso koyambirira kwambiri kwa CP kuli ululu. Ululu nthawi zambiri umakhala waukulu. Zimaphatikizidwa ndi kuphwanya kwa kutuluka kwa pancreatic madzi ndi matenda oopsa a m'mimba, kuperewera kwa matenda osakanikirana ndi matenda a aseptic kapena matenda opatsirana, komanso kukhudzana ndi kusintha kwaposachedwa kotupa kwa mitsempha yotupa ya mitsempha yotupa ndi mitsempha yamagazi yopereka kufalikira kwa pancreatic (ischemia).

Zowawa nthawi zambiri zimatchulidwa kudera la epigastric, nthawi zina pafupi ndi kumanzere kapena kumanzere kwa hypochondrium, nthawi zambiri zimawongolera kumunsi kumbuyo kapena zimakhala ndi chomangira. The kufalikira ululu zimatengera komwe madera chachikulu kwambiri kapena chachikulu chotupa cha England (mutu, thupi, mchira). Nthawi zina ululu umakhala wopweteka, koma mwa odwala ambiri umaphatikizidwa ndi chakudya ndipo umayamba kapena umakulitsa ola limodzi kapena kupitiliza ukatha kudya. Nthawi zina, ululu wa usiku umadziwika. Ndi pancreatitis yobwerezabwereza, kupweteka kumatha kuwonekera pokhapokha pakuchulukana kapena kukulira panthawiyi.

Amawerengedwa kuti ndiwowawa pancreatitis yomwe nthawi zambiri amakhala akuwonjezeka m'malo a wodwalayo kumbuyo ndikuchepera mphamvu pakusintha kwa thupi. Kumwa zakumwa zoledzeretsa nthawi zina kumachepetsa ululu, koma kwa odwala ambiri kumathandizira. Matenda apakhungu ogwirizana ndi cholelithiasis, kupweteka kwa kapamba kumatha kuphatikizidwa ndi kupweteka mu hypochondrium yoyenera, yodziwika ndi cholecystitis.

Odwala omwe amati ndiopanda CP osapweteka kapena njira yake yaposachedwa (nthawi zambiri amakhala ndi pancreatitis yoledzera), kupwetekako kungakhale kochepa kapena kwanthawi yayitali konse, komwe, mwanjira zonse, kungakhale chifukwa chosowa matenda oopsa a ductal. Kuwonetsera kwamankhwala m'gululi la odwala nthawi zambiri kumagwirizanitsidwa makamaka ndi kuchepa kwakunja ndi (kapena) kubisala kwamkati kwa GI.

Gulu la zizindikiro zomwe zimachitika kawirikawiri pa XII zimatengera kuperewera kwa enzymatic komanso kutaya mtima kwina. Chifukwa chake, pafupifupi nthawi imodzi ndimapweteka, odwala ambiri amakhala ndi zodandaula kutulutsa ndi kuwononga m'mimba komanso nthawi zina kupulumuka mutatha kudya. Zizindikirozi zimakulitsidwa ndi mavuto azakudya ndikatha kumwa. Amakhalanso ndi chikhalidwe matenda amkuwa.

Nthawi zambiri, kudzimbidwa kumachitika koyamba, komwe kumakhazikitsidwa ndi mpando wosakhazikika womwe umasinthanitsa kudzimbidwa ndi kutsegula m'mimba. Nthawi zambiri zimawonedwa chithuzi ndowe zimakhala ndi mtundu wonyezimira, wamafuta owoneka bwino ndipo amatha kukhala ndi tinthu tating'onoting'ono ta chakudya chosatulutsidwa. Woopsa milandu, kulimbikira, kupukusa m'mimba kumachitika ndi madzi, chopondapo chamadzi chokhala ndi m'malovu amafuta. Mwanjira imeneyi, chikhumbo chimasungidwa, ndipo mwa ena odwala amachulukitsidwa.

Matenda am'mimba, omwe amakhala ndi zovuta za kugaya komanso kugwiritsa ntchito michere ndi mavitamini, amatsogolera kuwonda ndi anatentary kutopa kwa odwala, limodzi ndi hypovitaminosis.

Ngati njira yachiwiri ya matenda opatsirana ikupezeka m'mbali mwa nduyo (nthawi zambiri imakhala ndi kapamba). malungo Nthawi zina limodzi ndi kuzizira komanso thukuta, komanso kuphatikiza kwakukulu kwa malaise, komanso kuwonjezeka kwa ululu m'ndondomeko yokhudzana ndi pathological.

Pankhani yophwanya yachiwiri ya ndulu chifukwa cha kukakamiza kwa gawo lachiberekero la bile, limakulitsa mutu wozungulira wa gland kapena chotupa. jaundicendi cholangitis - kutentha thupi, kuwonda ndi kuwawa mu hypochondrium yoyenera.

Mukafinya duodenum, kumveka kwadzidzidzi kokwanira kungadziwike, kusanza ndi kusanza mutatha kudya.

Ndi ma pancreatic akuluakulu ndi pancreatic cysts, odwala nthawi zina amadandaula za asymmetry yam'mimba, kutupa kwakupweteka m'chigawo chake chapamwamba.

Mavuto a pseudocysts kapena chithupsa chodwala cha kutaya kwa magazi ndimadziwika ndi zotchuka zomwe zimatupa, ndipo ngati pali uthenga pakati pa patsekeke ndi kuwala kwa m'mimba (nthawi zambiri pseudocystoduodenal fistula). Ululu nthawi zina umakulirakulira, ndipo m'dera la cyst, mapangidwe a volumetric amayamba kulimba kapena kukula.

Madandaulo ogwirizana ndi endocrine pancreatic insuffidence nthawi zambiri amachitika mochedwa ndipo nthawi zonse samakopa chidwi cha wodwalayo. Zomwe zimapangitsa izi kukhala kuchepa kwa kufunika kwa insulini chifukwa cha kufooka kwa mafuta, komanso chifukwa chobisika cha okana, glucagon, amachepetsedwa pazifukwa zomwezo mu pulogalamu ya islet, yomwe imathandizira kukhazikika kwa glycemia komanso njira yofatsa. shuga mu odwala angapo omwe ali ndi CP.

Anamnesis odwala omwe ali ndi matenda kapamba Nthawi zambiri amakhala mwamakhalidwe. Ambiri aiwo ali ndi zaka zingapo isanayambike zovuta zomwe zimakhudzana ndi matenda a pancreatic, kumwa kwambiri chifukwa cha kudalira kwambiri mowa (uchidakwa) kapena zomwe zimadziwika kuti zakumwa zoledzera zimawonedwa. Ngakhale nthawi zambiri, odwala amafunikira kubisa kwa dokotala kuchuluka kwa mowa omwe amamwa, sizingadziwike kuti nthawi zina mowa wa XII ungatenge kumwa kwambiri, komanso chifukwa cha chidwi cha kapamba.

Gulu laling'ono la odwala, lomwe amayi achikulire ndi okalamba amakhala ndi mbiri ya cholelithiasis, kuphatikizapo zovuta za jaundice komanso (kapena) cholangitis, kupezeka kwa komwe kumatchedwa postcholecystectomy syndrome, komwe nthawi zambiri kumagwirizanitsidwa ndi otsalira a choledocholithiasis.Nthawi zina matenda a gallstone, ophatikizika ndi CP, amatha kuchitika popanda zizindikiro za classical, ndipo cholecysto- kapena ngakhale choledocholithiasis imapezeka wodwala wokhala ndi CP kokha ndi maphunziro apadera.

Pafupipafupi, mbiri yovulala kapena yotseguka pancreatic, opaleshoni ya ziwalo kapena chiwalo choyandikana nayo, kulowererapo kwa endoscopic pa duodenal papilla yayikulu.

Chiwerengero chochepa kwambiri cha odwala chili ndi mbiri ya zinthu zina zakumbuyo kapena zinthu zina zomwe zimayambitsa kapena zimayambitsa kuyambika kwa CP (hyperiarathyroidism, cystic fibrosis, matenda obadwa nawo monga metabolic, kugwiritsa ntchito kwina kwamankhwala ena, etc.).

At cholinga cha maphunziro azachipatala wodwala yemwe ali ndi XII yovuta kwambiri nthawi zambiri samatha kuzindikira zizindikiro zomwe zimayambitsa matendawa. Pakufufuzidwa, gawo lalikulu la odwala linanena kuti amachepetsa zakudya, zotuwa, nthawi zina zokhala ndi tulo kapena kutentemera, malilime ndi kuyamwa kwamayera.

Ndi kupsinjika ndi kukopa kwa chifuwa, nthawi zina, pamakhala kuphatikizika komwe kumapangidwa pafupipafupi kumanzere kwamanzere am'mimba ndipo kumalumikizidwa ndi fancula ya pancreatic kapena paranancreatic yomwe ili pansi pa dome lamanzere. Pleural mayendedwe omaliza amatchedwa othandizira.

Kuwonjezeka kwa asymmetric pamimba pamimba kumtunda kumatha kuonedwa pamaso pa pancreatic kapena parapancreatic pseudocysts.

Kukhalapo kwa ascites, komwe kumapangitsa kuwonjezereka kwakukulu pamlingo wam'mimba komanso kuzungulira kwa mawonekedwe am'mimba ndikusunthika kwa kusintha kwa malo m'malo mwake, kumalumikizidwa ndi matenda oopsa a portal, omwe amayamba chifukwa chokhudzana ndi gawo la zotupa komanso (kapena) thrombosis yamitsempha yam'mimbayo ndi zotulutsira zake zazikulu (kumtunda mitsempha ya mesenteric ndi splenic) ikudutsa pafupi ndi kapamba (subhepatic portal block). Pankhaniyi, ascites nthawi zambiri imatsimikiziridwa ndikuperekedwa ndi splenomegaly, yotsimikiziridwa ndi palpation kapena percussion.

Matenda osinthika a pancreas pawokha amatha kupakidwa pang'onopang'ono mwa odwala omwe ali ndi vuto lopanda ma puligastrium, komanso pamaso pamapangidwe ofunikira amtundu (ma pseudocysts, aulesi othandizira), kuphatikiza omwe akuchita ngati gawo la chotupa chotupa cha pancreatitis. . Nthawi zina kusamvana pakati pa ululu wambiri ndi kuwawa pang'ono chifukwa cha kupweteka kwamimba ndikofunikira.

Pankhani ya jaundice yolepheretsa yomwe imakhudzana ndi kukulitsa ndi kufinya kwa mutu wamapamba ozungulira gawo lachiberekero cha bile, nthawi zina zimatha kuyambitsa chikhodzodzo chazikulu ndi zopweteka (chosiyana ndi chisonyezo cha Courvoisier), ndipo ngati duodenum ili ndi mkanda wopweteka.

Nthawi zina mdera la xiphoid process systolic kung'ung'udza kumveka, kuwonetsa kukakamiza kwa steliosis ya celiac, yomwe ingayambitse ischemia ya G1G (ndi ziwalo zina zam'mimba zapamwamba) ndipo, monga tanena kale, imakhudzanso pathogenesis ya pancreatitis yayitali.

Laborator diagnostics. Pakufufuza kwa odwala omwe ali ndi pancreatitis yosatha, ma data a labotale amakhala ndi mwayi wothandiza wofufuzira. Pakuwunika kwa magazi ambiri, kuchuluka kapena kuchepa kwa magazi m'thupi ndi gawo zimasintha zomwe zikuwonjezera njira yotupa (leukocytosis, kusintha kwa njira ya neutrophilic kumanzere, kuwonjezeka kwa erythrocyte sedimentation rate - ESR). Kusanthula kwa biochemical kumawonetsa hypoproteinemia mwa odwala omwe ali ndi matenda opatsirana, komanso hyperglycemia mu shuga yachiwiri. Ndi CP yopitilira mosalekeza, kuwonjezeka kwa michere m'magazi, makamaka, hyperamilasemia, singayang'anidwe, ndipo panthawi yowonjezera, mulingo wa ma enzyme, monga lamulo, umakwera, ndipo nthawi zina kwambiri. Kuwonjezeka kofananira kwa mulingo wa michere kumawonedwanso mkodzo.

Mu ndowe zokhala ndi steatorrhea, mafuta osalowerera ndendende ndi sopo amapezeka, ndipo zomwe zidulo za bile zimayesedwa ngati zabwinobwino (kumene, ndi mawonekedwe abwinobwino a bile ducts). Ndi creatorrhea yolumikizana ndi kusakwanira kwa enzymatic ya mapuloteni, ndowe zimakhala ndi ulusi wa minofu wosapangidwa.

Njira yamakono yowunikira ntchito ya pocrreat pancreatic ndiyo mayeso a elastase. Elastase ndi enzyme yomwe imapangidwa ndi ma cell a acinar a gland, pakudutsa m'matumbo, NS imawonongedwa, motero, kutsimikiza kwake komwe kumayikidwa ndowe ndizofunikira pakuwunikira momwe ntchito ya exocrine gland ilili.

Kuwerenga kwa ma enzyme (makamaka ma amylase) m'magawo a zomwe zili ndi cysts zabodza, komanso kuphatikizira zotulutsa, nthawi zina kuphatikiza maphunzirowa a CP, kumakhala ndi phindu lofufuza.

Hardware ndi zida zothandizira kuzindikira matenda. Kafukufuku wa radiology wamimba wam'mimba (mkuyu. 20.1) ndiwofunikira kwambiri pakuwunika kwa CP, komabe, kusintha kwa mawonekedwe kumatha kupezeka mwa odwala omwe ali ndi calcation yayikulu ya kutupa kwa gland komanso (kapena) calculi yayikulu yowerengeka pamimba ya pancreatic duct.

Mkuyu. 20.1.Panoramic x-ray yam'mimba ziwalo zam'mimba zowonjezera pancreatitis.

Chithunzicho chikuwonetsa zowerengeka zazikuluzikulu zokhudzana ndi kapamba m'litali lonse (zowonetsedwa ndi mivi)

Fibrogastroduodenoscopy (FGDS) ndi kuwabweza cholangiopancreatography (RCP) amakupatsani mwayi wowona mwakusintha kwa duodenum ndi duodenal papilla (BDS), komanso kusiyanitsa ma pancreatic ndi bile ducts (mkuyu. 20.2).

Mkuyu. 20.2.Retrograde pancreatography mu chifuwa chachikulu.

Chithunzichi chikuwonetsa pang'onopang'ono waukulu pancreatic duct

Kafukufuku wosiyanitsa wa biliary thirakiti (cholangiography) ndikofunikira makamaka kwa odwala omwe ali ndi biliary CP kapena omwe akukayikira. Amachitika ndi njira yosalunjika pakamwa kapena yolowererapo yothandizirana ndi ena, mwatsoka, sizimapereka chithunzi chokwanira ndipo sizigwira ntchito makamaka kwa odwala omwe ali ndi vuto la kubisirana, kapena mwanjira yosiyanitsa mwachindunji. Zotsirizirazi zimatheka ndi RCHP (mkuyu. 20.3), komanso kugwiritsa ntchito chipangizo chogwiritsa ntchito pang'onopang'ono pa gallbladder kapena bile duct, kuphatikiza yoyang'aniridwa ndi ultrasound, computer tomography kapena laparoscope.

Mkuyu. 20.3.Kubwezeretsa cholangiopancreatography. Mitsempha ya bile, ndulu ya ndulu ndi kanyenya wamkulu wamkati amasiyana. Chithunzicho chikuwonetsa kupendekera kwakukulu (chizindikiro cha "mbewa mchira") wa gawo lachiberekero la bile duct (mbali ya pancreatic) komanso kukulira lakuthwa kwa pancreatic duct yovuta kwambiri

Ngati ndulu ndi yotsekedwa ndi miyala kapena siyikupezeka (pambuyo pa cholecystectomy), ndizotheka kupereka gawo lina mosiyana ndi kukwapula kwa ndulu ya intrahepatic bile ducts. Pamaso pa fistula ya bile, kusiyanasiyana kumachitika chifukwa cha fistulography.

Kutengera ndi cholangiography, munthu akhoza kuweruza kupezeka kwa bile calculi, kukulira, kusinthika kapena stenosis ya bile ducts, kukhalapo kwa zolepheretsa kutuluka kwa bile mu duodenum.

Kuunika kwa X-ray pamimba ndipo makamaka duodenum ndikofunikira kwambiri pakuwunika. Radiography yam'mimba imachotsa zotupa zake, zomwe zimatha kukhala zokhudzana ndi pathogenesis ya kapamba, ndipo nthawi zina zofooka zomwe zimakhudzana ndi kusintha kwa kapamba zimapezeka (mkuyu. 20.4), mwachitsanzo, kukhumudwa pakakhala pseudocyst, mawonekedwe a chotupa cha CP, etc.

Mkuyu. 20.4.Kusintha kwa kolimba kwa kutuluka kwa m'mimba ndi kutembenuka kwa duodenum ndi chotupa cha mutu wa kapamba

Duodenography imapangitsa kuwunika gawo laulere la barium kudzera mu duodenum kapena kukhalapo kwa duodenostasis, monga tanena kale, kufunikira kwa pathogenesis ya CP. Njira yophunzitsira ndiyo kuyesa kwa X-ray ya duodenum machitidwe okhudzana ndi mankhwala (ochita kupanga), omwe amapezeka ndi kukhazikitsidwa kwa antispasmodics, mwachitsanzo, atropine. Zizindikiro za pancreatitis yosatha, yomwe hypotension imathandizira, ndikuphatikiza kukula kwa khosalo la duodenum chifukwa cha kuwonjezeka kwa kukula kwa mutu wa kapamba komanso kupezeka kwa khoma la medial la gawo lomwe limatsikira m'matumbo a vuto lalikulu lodzaza lomwe nthawi zina limafinya lumen ndikulepheretsa gawo la barium (mkuyu. 20.5).

Kuti muchite duodenoscopy, ma endoscopes omwe ali ndi gawo lofananira ndikuwona amagwiritsidwa ntchito. Phunziroli nthawi zambiri limachitika pamimba yopanda kanthu, mchipinda cha X-ray chosinthidwa mwapadera chida chophatikizira ndi chosinthira ma elekitirodi ndi seriograph (ngati akukonzekera kuchita RHIG).

Mkuyu. 20.5.Duodeiography yokhala ndi hypotension. Chithunzichi chikuwonetsa kukulira kwa kavalo wa duodenum ndi kupindika kwa matumbo pamlingo woyenda ndi nthambi zotsikira zokhala ndi mutu wokulirapo wa pancreatic

Mothandizidwa ndi endoscope, ma emophagus amawunikiridwa koyambirira, komwe mitsempha yokulitsidwa ya gawo loyambira, nthawi zina imawonekera chifukwa cha matenda oopsa a portal, amawululidwa. M'mimba, nthawi zambiri mumakhala mawonekedwe a gastritis, kuphatikizapo kukokoloka (munthawi yakuchulukirachulukira). Nthawi zina zimawoneka kuti khoma lakhomalo la m'mimba limakankhidwira kunja (pamaso pancreatic nseudocyst, mawonekedwe a chotupa XII).

Mu duodenum, zizindikiro za duodenitis nthawi zambiri zimatsimikiziridwa, kusunthidwa kwa khoma la medial chifukwa cha kuwonjezeka kwa mutu wa gland, nthawi zina kumachepetsa lumen. Nthawi zambiri kukokoloka kumawonekera pa mucosa, nthawi zina kusintha kumakhala ndi gawo la duodenitis wotchedwa pseudotumorous duodenitis, pomwe khoma lamatumbo limakhazikika, kutuluka magazi mosavuta pakakhudzana, komwe kumafunikira biopsy kupatula khansa.

Kupenda kwa BDS nthawi zambiri kumawulula kusintha komwe kumachitika chifukwa cha kapamba (papillitis, stenosis, kukula kwa papillomatous, nthawi zina kumafunanso kuti biopsy ichotse khansa ya papillary, peripapillary duodenal diverticulum, ndi zina).

Ngati asankha kuchita RCP, Teflon catheter wapadera wokhala ndi mulifupi mwake wa 1.8 mm amaikika kudzera mu njira yolumikizira ya Vater ampoule, ndipo mankhwala osungunuka a radiopaque (verographin, urographin, ndi ena) amapangidwa kudzera mu izi, kupewa kuthinana kwambiri, kenako chithunzi.

Zizindikiro zokhala ndi pancreatitis yosatha imatha kupezeka pa x-ray: kukulira kwa pancreatic duct (nthawi zina mwa njira yofanana ndi "kufunika kwa nyanja"), kupezeka kwa matanga, miyala, komanso milomo yolumikizana ndi iyo (pseudocyst).

The okhazikika a terminal wamba wamba duct, kukulira owonjezera- ndi intrahepatic bile ducts, choledocholithiasis, etc. atha kupezeka pa munthawi yomweyo cholangiogram. Popeza mavuto a RCHP (pachimake pancreatitis, pachimake cholangitis mpaka kukula kwa mabakiteriya owopsa poyambitsa matenda m'matumba), kafukufukuyu amachitika makamaka paziwonetsero zisanachitike, asanachitike opareshoni kapena munthawi yomweyo kuwonongeka kwa ma ducts komanso kuvomerezedwa kwa OP (octreotide, antispasmics kulowetsedwa mankhwala).

Kufufuza kwa Ultrasound (mkuyu. 20.6) - imodzi mwanjira zophunzitsira, komanso, zosagwiritsa ntchito njira zophunzirira pancreatic - ziyenera kuchitika muzochitika zonse pamene matenda ake amakayikiridwa.

Mkuyu. 20.6.Kuyesa kwa Ultrasound kwa chifuwa chachikulu:

DP - densi yokulitsa, L - chiwindi P - kapamba, Vl - Msempha wa splenic, IVС - otsika vena cava AO - mawa

The prochnix ya projekitiyi imapezeka m'chigawo cha epigastric, ndipo imasunthidwa molingana ndi kuchuluka kwa zofunikira pa gland kumanzere ndi kumanja kwa hypochondria.

Nthawi zambiri, kapambayu amakhala, womveka bwino komanso wowoneka bwino, ndipo m'mimba mwake wa chinyontho chachikulu cha pancreatic sichidutsa 1.5-2 mm. Ndi matenda am'mimba, kuwonjezeka kwakukulu kwa kukula kwa chiwalo chokhala ndi kuchepa kwa mawonekedwe amodzi mwa echo, kuwonetsa kutupika, kumatha kupezeka. Kuchepa kwa kukula kwa kutulutsa, heterogeneity ya kapangidwe kake, kupezeka kwa malo ang'onoang'ono pakukonzanso minofu, komanso kuzizira kwa ma contours kumatha kuwonetsa kusintha kwa fibrotic mu gland, ndipo timinene ting'ono tating'ono tomwe timatchulidwa mosonyeza kuti tili ndi chiyembekezo timayang'ana kukhazikika kwawoko.

Malo okwera kwambiri omwe ali mu duct ndikupereka chodabwitsa cha "akupanga track" amagwira ntchito ngati chizindikiro cha calculi yovuta.

Mapangidwe amadzimadzi (ma cysts abodza, ma inscesses aulesi) amayimiriridwa pa echograph ngati magawo ozunguliridwa amitundu yochepetsedwa kwambiri osapangika bwino komanso kuwonekera kotsimikizika komanso kuwonekera kosavuta. Ma cysts abodza opangidwa ndi madzi amadzimadzi amakhala ozungulira kapena ozungulira, osalankhulika ndipo azunguliridwa ndi kaphatikizidwe kabwino. Zomwe zili ndi ma cysts osasinthika ndi ma abscesses zimatha kukhala zopatsa chidwi chifukwa cha kupezeka kwa minofu yolumikizana ndi chosakanizira kuwonjezera pa madzi.

Computed tomography (CT) ndi njira ya X-ray yokhazikika yomwe imagwiritsidwa ntchito kwambiri pophunzira kapamba (mkuyu. 20.7). Mwakutero, njirayi imalola kuti ipeze deta yofanana ndi echographic, koma nthawi zina zimapangitsa kufotokoza momveka bwino, mwachitsanzo, ngati kunenepa kwambiri kwa wodwalayo, flatulence, makamaka kutanthauzira kwa pathological kusintha kwa mchira kwa gland.

Mkuyu. 20.7.Yogwirizana tomography yoletsa kupweteka kwa kapamba. Chithunzichi chikuwonetsa kumaso kwa mutu wa kapamba (U), wuctung ductung ndi ma calcication mu lumen (2)

Nthawi yomweyo, pamakhala zochitika pamene kusintha kwakumanzere komwe kwawonedwa ndi ultrasound sikupezeka pa nthawi ya CT (isodennes) kapena mosemphanitsa (isoechogenic). Chifukwa chake, maphunziro onse awiriwa amathandizana. Popeza mtengo wokwera mtengo wa CT, kugwiritsidwa ntchito kwake kumayenera kuonedwa ngati koyenera ngati, pamaziko a ultrasound, sizingatheke kupanga lingaliro lomveka bwino la kusintha kwa pathological mu kapamba (mwachitsanzo, pamene gawo low isogengenic likuwoneka m'matumba).

Nthawi zambiri, kapamba amatsimikizika pamatomatomu ophatikizika amtundu wa mawonekedwe 5 osawoneka bwino. Zizindikiro za kuwonongeka kwa gland ndi heterogeneity ya nyengo yomwe ili ndi malo ochezera komanso kuwonjezeka, kuwonjezeka, kuchepetsedwa ndi kusinthika kwa ma ducts, mawonekedwe amodzi kapena angapo amadzimadzi am'mimba. Kwa cyst yabodza, monga ndi ultrasound, kupezeka kwa kapisozi ndi homogenible kapena heterogenible (pamaso pa sequestration patsekeke kapena putty detritus) zomwe zili ndizikhalidwe. Kukonzekera kwakukulu kwa Sc scan pamaso pa ziwonetsero mu gland ndi ductal calculi. Ma neoplasms oopsa omwe ali ndi CT amawoneka ngati foci omwe kachulukidwe kake kali kochepa kuposa kachulukidwe kakakhungu.

Pulogalamu yabwino ya singano biopsy (TIAB) imagwiritsidwa ntchito makamaka pothandiza kusiyanitsa mitundu yotupa yamatumbo a khansa yapakhungu ndi khansa ya kapamba. Imachitika kudzera mkati mwa khoma lam'mimba pansi pa mankhwala ochita dzanzi, ndipo kuwongolera kwa singano kumayang'aniridwa pafupipafupi pogwiritsa ntchito makina a ultrasound kapena makina a compact tomography.Kuwona bwino kwa njirayo kumatengera zomwe dokotala akuchita polemba, kukula kwa maphunziro ojambulidwa komanso kuchuluka kwa punctures, komanso chidziwitso cha katswiri wofufuza za ma cytologist akuwunika ma nuncates.

Ngakhale chiwerengero chokwanira komanso chidziwitso chokwanira cha njira zamakono zodziwira matenda othandizira, sizotheka kudziwa bwino momwe zilonda zam'mimba zimakhalira. Pankhaniyi, matenda othandizira ndi othandizira ndizofunikira kwambiri. Mulinso zinthu izi:

• • Kufufuza ndi kupweteka kwa kapamba, mapepala am'mimba, m'mimba, duodenum, kuphatikizapo dera la BDS,
• • kuwongolera mwachindunji kusiyanitsa kwa ma pancreatic ndi ma ducts wamba a bile ndi chithunzi patebulo logwiritsira ntchito,
• • kupukusa kapena kupangika kwa mapangidwe a mapangidwe a kapamba ndikusinthidwa kwa zigawo za m'mimba.

Kusiyanitsa mitundu. Matenda a kapamba amayenera kusiyanitsidwa makamaka ndi matenda owonetsa kupweteka kwambiri m'zigawo za epigastric, kuphatikizapo omwe amagwirizana ndi kudya komanso zomwe zimachitika nthawi ndi nthawi. Kafukufuku wosiyanitsa ndi X-ray, makamaka FGDS, imapangitsa kupatula chilonda cham'mimba kapena zilonda zam'mimba, komanso mitundu yopweteka ya gastritis yosatha. Koma ziyenera kukumbukiridwa kuti chilonda cholowera mu kapamba chingakhale chinthu chomwe chikuthandizira kuyambika kwa CP, chifukwa chake, kupezeka pachilonda sikungapatula matenda omwe akufunsidwa. Izi zitha kusiya mawonekedwe odziwika pakuwonekera kwa zilonda zam'mimbazi (kuzimitsa ululu wammbuyo, kuzungulira chikhalidwe chawo), koma nthawi zambiri sizivutitsa wodwala pambuyo pochiritsa chilondacho munjira ina.

Matenda a Gallstone nthawi zambiri samasiyanitsidwa ndi ultrasound ya dhetsolini ya extrahepatic (kusowa kwa calculi ndi kusintha kwina kwa ndulu). Komabe, cholelithiasis ndiyomwe imayambitsa kupanikizika, ndipo kupezeka kwa calculi mu chikhodzodzo sikumapatula matendawa. Chifukwa chake, madandaulo a wodwala yemwe ali ndi cholelithiasis yotsimikizika yokhudza kupweteka kwakunja kwa chiwonetsero cha gallbladder (mkati mwa epigastrium), makamaka kuwala kwa msana, kukupangitsani kuganiza za cholangiogenic (biliary) pancreatitis (kapena otchedwa cholecystopancreatitis) ndikupitiliza maphunziro apadera panjira iyi.

Mavuto akulu amatha kubwera ndi kusiyana kwa mtundu wa pseudotumorosis wa chifuwa chachikulu cha kapamba ndi chifuwa cha kapamba. The aakulu kapamba, kuchuluka kwa epithelial zinthu ndi ma cell atypism, amene amaonedwa ngati mkhalidwe, amatha kupezeka morphologically, ndipo muzochitika khansa yomwe imalepheretsa kupindika kwakukulu, kuwonetsa kwachiwiri kwapancreatitis. Kuphatikiza kwa matenda awiriwa monga mitundu yodziyimira payokha kumachitika, mwachiwonekere, modabwitsa.

Nthawi yomweyo, chifuwa chachikulu cha khansa, makamaka mawonekedwe ake a khansa ya m'mimba, chimayambitsa kupsinjika kwa gawo lachiberekero cha bile ndipo imapatsa matenda a jaundice a chikhodzodzo. khansa yapamwamba.

Pali mitundu ingapo yamatenda osiyanasiyana, nthawi zambiri yolola kusiyanasiyana kwamatenda omwe mukufunsidwa. Chifukwa chake, choyambirira, khansa imadziwika ndi mbiri yochepa, osapitilira masabata angapo kapena, ovuta kwambiri, miyezi, ikakhala chikhansa chodwala nthawi zambiri anamnesis amakhala nthawi yayitali. Opaleshoni yamatenda ochita opaleshoni sichiwonetsedwa ndi kupweteka kwambiri, ndipo jaundice yovuta kupangitsa chifukwa chake ambiri amapezeka motsutsana ndi maziko azaumoyo, chifukwa chomwe odwala nthawi zambiri amapita kuchipatala m'magulu opatsirana kupatula viral hepatitis. Nthawi yomweyo, ndi chifuwa chachikulu cha khansa, jaundice yodwalitsa imapezeka kwambiri mwa odwala omwe ali ndi mbiri yakale, omwe adadwalapo kale kapamba kapena amene adayamba kupweteka chifukwa cha kupweteka kwapafupipafupi komanso nthawi yayitali. Ngati jaundice yolepheretsa imapezeka kwa odwala omwe ali ndi chiyambi cha cholangiogenic ndipo amalumikizidwa ndi kuperewera kwa kuchuluka kwa bile kapena kuphwanya kokwanira mu mafuta ampoule, ndiye, monga lamulo, matenda opweteka kwambiri komanso zizindikiro zina zowonjezera kuchuluka kwa cholecystitis ndi cholangitis zomwe sizachilendo kwa jaundice. omwe amaphatikizidwa ndi khansa yapakhosi ya pancreatic.

Tsoka ilo, njira zapadera sizomwe zimapangitsa kuti zovuta zonse zitheke. Chifukwa chake, kuyesedwa kwa wodwala kwa carbohydrate antigen (CA 19-9) ndi khansa ya embryonic antigen (CEA) kumapereka mayankho omveka bwino pokhapokha ngati pali zotupa zazikulu kwambiri, zomwe nthawi zambiri zimakhala zosagwira. Kuyesedwa kwa kapamba ndi ultrasound kapena makina ojambula pamanja kumakulitsa kukula kwa ndulu, makamaka mutu wake, pancreatitis ndi khansa, komanso kuwonetsa mawonekedwe ofanana kukula kapena kuposerapo, kupangika kwa mapangidwe amodzi kumakhala kofanana ndi khansa, komanso matenda Pancreatitis ya kapamba nthawi zambiri imayambitsa, ndi hyperechoic (denser), yomwe imakhala ndi zowerengeka zingapo, ngakhale kuti ndizotheka kusiyanitsa molondola momwe matendawa amafotokozera.

Komabe, kukulira kofunikira kwa pancreatic duct makamaka kupezeka kwa calculi sikukukhala ndi khansa ndipo, monga lamulo, kumawonetsa pancreatitis yayitali. Kuzindikiritsa zingapo zolunjika mu chiwindi pamaso pa chotupa cham'mimba chikuwonetseratu kufalikira kwa khansa ya pancreatic.

Zomwe zatchulidwa kale bwino singano ya biopsy, yochitidwa kudzera khoma lamkati lomwe likuyang'aniridwa ndi ultrasound kapena CT, sikuti nthawi zonse imathetsa mavuto a matenda osiyanasiyana. Kuzindikira kuyesa kwa ma cytological ma sampuli a khansa mosakayikira kapena maselo awo, motero, akuwonetsa khansa. Komabe, kusakhalapo kwa zinthu za khansa mu zitsanzo za biopsy mulimonsemo sizimapangitsa kuti pakhale kupezeka kwa matenda oncological, kuphatikiza pobwereza maulendo mobwerezabwereza. Ngati nkotheka kupeza mafinya pakuwunika, ndiye kuti matendawa ndi a "pancreatitis" osachiritsika ndipo amakhala othandiza kwambiri, ngakhale kuti siwodalirika, chifukwa chotupa chododometsa chija chimayambitsa kutsekeka kwina mu ductal system ya gland.

Ndi mawonekedwe osakhala a chotupa a CP, ngakhale laparotomy yochitidwa ndi dotolo wodziwa ntchito pamtunduwu sikuti nthawi zonse amalola kuti khansa yokhala ndi khansa isaperekedwe mwa kupenda mwachindunji ndi palpation ya gland. Kuphatikizidwa kwa ma punopuropu a intraoperative kupangitsa kuti zitheke kupeza zinthu kuchokera patsamba lodzala ndi chidaliro chachikulu, koma ngakhale mutafufuza mwachangu ma cytological, sizodziwika bwino nthawi zonse.

Direct incision biopsy yokhudza khansa ya pancreatic imabweretsa zovuta zina zaluso, makamaka ndi malo ozika mutu. Komabe, ngakhale atapeza biopsy yabwino, ngakhale akatswiri odziwa zakuthambo sangathe kusiyanitsa khansa molimba mtima kuchokera ku epithelial proliferation yokhala ndi pancreatitis yodwala, makamaka mu maphunziro ofulumira. Chifukwa chake, ngakhale m'mabungwe omwe ali ndi zida zapadera zomwe zimatha kuthana ndi vutoli, nthawi zina amazindikira ndipo, mwakutero, zolakwitsa zanzeru zimapangidwa, zina mwazomwe zimadalira kuchepa kwa chiwonetsero chazopatsa thanzi. Zotsatira zake, odwala omwe ali ndi pseudotumor pancreatitis ya mutu amapita kwathunthu popanda mawonekedwe a pancreatoduodenal omwe amawonetsedwa, omwe cholinga chake ndi kuchotsa chotupa. Ndipo odwala omwe ali ndi khansa yomwe singathe kuthandizira omwe amachitapo kanthu ngati anteromoses anastomoses amakhala nthawi yayitali mosadziwika bwino ndipo nthawi zina amaganiziridwa molakwika kuti adachira mozizwitsa khansa yopanda chiyembekezo. Pakadali pano, madokotala ambiri omwe akuchita opaleshoni amakhulupirira kuti ngati ndizosatheka kupatula khansa intraoperatively, voliyumu imodzi kapena ina yake iyenera kuchitidwa.

Mankhwala othandizira. Chizindikiro chambiri chothandizira opaleshoni ya CP ndikuyenda bwino kwa chithandizo chamankhwala chosokoneza bongo cha gastroenterologists. Nthawi zina, zizindikiro zimatha kuganiziridwa ngati zadzidzidzi, mwachitsanzo, kutuluka kwamphamvu m'matumbo a pseudocyst ndi (kapena) kulowa pakatikati pa m'mimba, komanso kuphulika kwa chotupa chachikulu. Ntchito zogwiritsira ntchito mawonekedwe ofulumira zimachitidwa nthawi zambiri. Amawonetsedwa kuti akuwonjezera matenda opatsirana kapamba ndi minyewa yoyandikana nayo, chotchinga cha jaundice, komanso kutsekeka kwa duodenal. Nthawi zambiri, chithandizo cha CP chimachitika monga momwe anakonzera pambuyo pofufuza bwino wodwalayo. Kufunika kwazomwe zikuwonetsa ntchito za CP kumawonjezereka ngati nkosatheka kupatula khansa yapachifupa.

Mankhwala othandizira opaleshoni ya CP imagwirizanitsidwa ndi zovuta ziwiri zazikulu.

Yoyamba mwa iwo ndi yoti kusintha kwa ma pathological mu gland yomwe ikukhudzidwa ndi CP ndi yayikulu, yofalikira komanso yosasinthika. Nthawi yomweyo, ngakhale odwala omwe akudwala kwambiri, chitsulo chimapitiliza kukwaniritsa gawo lina la exo- ndi endocrine ntchito zofunika kwa wodwalayo. Chifukwa chake, kugwira ntchito mwamphamvu mokwanira ndi liwulo m'njira ya pancreatectomy mosakayikira kumatanthawuza chithandizo chovuta kwambiri komanso chodula kwambiri chomwe chimagwiritsidwa ntchito ndikugaya ma enzymes ndi mahomoni amoyo wonse, ndipo kuphatikiza apo, zimaphatikizidwa ndi zovuta zambiri zamakanema, zovuta zomwe zingachitike komanso ngozi yomwe ingachitike kwa wodwalayo. Zotsatira zake kuti njira zambiri zochizira opaleshoni ya CP, ngati sizipweteka, ndiye kuti agwirizana, i.e. afotokozere za kusungidwa ndi kugwira ntchito kwa minyewa yosinthidwa ya gland kapena, mulimonse, gawo lake.

Chovuta chachiwiri chofunikira ndikuti odwala ambiri omwe ali ndi CP, monga tafotokozera kale, ndi zidakwa zosatha, ndipo zotsatira za njira zambiri zopangira opaleshoni zimadalira kwakukulu momwe munthu wogwirira ntchitoyo akufunira ndipo amatha kuthana ndi vuto lake. Ngati odwala akupitiliza kumwa zakumwa zoledzeretsa atachitidwa opaleshoni, kusintha kwawo kumakhala kosakhalitsa, ngakhale atachitapo kanthu moyenera, nthawi zambiri komanso pamafunika ndalama zambiri. Chifukwa chake, chithandizo cha odwala omwe ali ndi chidakwa matenda a kapamba amayenera kuchitika motsatizana ndi madokotala ochita opaleshoni ndi a narcologists.

Mankhwalawa pancreatitis yayikulu, ntchito zazikulu zotsatirazi zitha kuchitika:

• 1) kumasulidwa kwa kapamba ndi parapancreatic CHIWEMBEKEZO kuchokera ku zigawo za kachilombo ka kapamba kachilombo ka necrosis komanso zotumphukira zake. Izi zothandizira, zochitidwa ndi zofala kwambiri pa opaleshoni, zam'mimba zokhala ndi chifuwa chachikulu, zitha kuganiziridwa kuti ndi mochedwa necondolaomy (sequestrectomy),
• 2) Kuchotsa matenda oopsa mwa kupatsa ziwalo zotulutsira madzi mkati mwa lumen,
• 3) ukhondo wa biliary thirakiti ndikuwonetsetsa kuti mapapo a ndulu sangathe kutuluka chifukwa cha cholelithiasis, komanso yachiwiri ya stenosis ya bile bile, yovutitsa mitundu ina ya matenda kapamba.
• 4) resection wa gawo losinthika kwambiri la kapamba wokhala ndi mitundu yotchuka ya kapamba (kapamba wam'mimba) (nthawi zambiri ngati sizingatheke kupatula khansa yam'mutu), mbali yapadera ya mutu kapamba, kapenanso wamanzere mbali ya kapamba),
• 5) kukhazikitsidwa kwa njira zapadera zomwe cholinga chake ndikuchotsa ma pseudocysts ndi ma fanculas akuluakulu a pancreatic omwe ali ofunikira pakudziyimira pawokha (nthawi zambiri ntchitoyi imathetsedwa pakapita ntchito zinayi zoyambirira, onaninso ndime 20.2, 20,3).

Njira zophera pancreatic zomwe zafunsidwa m'mbuyomu ndi njira yotchedwa ululu pancreatitis (post-ganglionic neurotomy malinga ndi Ioshioka-Wakabayashi, komanso kudzaza dongosolo la chithokomiro ndi pulasitiki wothinimitsa madzi mwachangu kuti athetse ntchito yowonekera) m'zaka zaposachedwa.

Zochita za opaleshoni yodwala matenda a kapamba ndi gawo limodzi kapena awiri. Ntchito za magawo awiri zimakonzedwa pasadakhale molingana ndi mawonekedwe a matenda omwe adadziwika mu phunziroli, kapena amakakamizidwa ndi zochitika zosayembekezereka zomwe zapezeka panthawi yolowererapo. Komabe, nthawi zambiri, odwala amayenera kuchita maopareshoni angapo a CP. Izi zitha kuchitika chifukwa cha kutha kwa njira zomwe zilipo kale, kapena chifukwa cha kusowa kwa maphunziro oyenerera omwe madokotala amathandizira omwe amatenga ntchito yovuta kwambiri kwa iwo, kapena kuphwanya malamulo a odwala omwe amamwa (kumwa mowa ndi zovuta zina zakudya).

Tiyeni tibwererenso m'kukwaniritsidwa kwa ntchito zisanu zofunika za opaleshoni ya CP yopangidwa pamwambapa pokhudzana ndi zochitika zina zamankhwala.

Ngati wodwala wavomerezedwa chifukwa cha kupweteka kwapakhungu komwe kumachitika nthawi ndi nthawi kapena nthawi yowonjezera (yomwe imachitika kawirikawiri), ndipo ali ndi zizindikiro zamankhwala zokhudzana ndi matenda (kutentha poyambira, kuwonjezeka kwa kupweteka kwa epigastrium, gawo lachiwopsezo la magazi oyera, etc. .), ndipo ultrasound kapena CT scan ya kapamba imawulula zazikulu, mwina zam'mimba, zotupa, muyenera kuganizira za m'mimba mawonekedwe osachiritsika a kapamba wokhala ndi ulesi kapena wowonjezera pakukula m'dera lakale kwambiri. kapamba. Odwala otere, kulowererapo kuyenera kuchitidwa mwachangu, ndi cholinga chachikulu chotsegulira, kuthira ndi kukhetsa pancreatic ndi parapancreatic foci yodwala matenda, i.e. pangani mawonekedwe amodzi mwa omwe tatchulidwa kale mochedwa necrectomy. Nthawi yomweyo, ngati pakufunika kuthandizidwa, opaleshoni nthawi zambiri amachitidwa pa biliary thirakiti.

Pambuyo pamankhwala apamwamba am'kati, wothandizirayo amayang'ana kaye kuti ali ndi vuto lotani ndipo, ngati matenda apezeka, amachititsa kufooka kwawo. Pamaso pa kuwerengera cholecystitis, cholecystectomy imachitika, ngati choledocholithiasis, choledochotomy ndikuchotsa miyala, kukonzanso gawo lachiwonetsero cha duct wamba ya bile, Komanso, kulowererapo kwa ducts ya bile nthawi zambiri kumatha ndi kukoka kwa duct ya bile.

Ngati pakalibe cholelithiasis pali zizindikiro za sekondale ina yopanga matenda ena (kukulitsa kwa ndulu, kukulitsa kwa duct ya bile), cholecystostomy imagwiritsidwa ntchito kuwola.

Gawo lalikulu la opaleshoni limayamba ndikugawanika kwa gastro-colon ligament ndikusanthula mokwanira mapaipi, ndikulowera kumbuyo kwa mutu, duodenum iyenera kulimbikitsidwa molingana ndi Kocher (Matini. 20.8 ndi 20.9).

Mkuyu. 20.8.Kusokoneza kwa parietal peritoneum m'mphepete mwa duodenum

Mkuyu. 20.9.The duodenum, pamodzi ndi mutu wa kapamba, mwachangu amachoka ku fayilo yoyambiranso, komanso palpation ya ziwalo zomwe zakhazikika

Minyewa yotupa yomwe imapezeka m'timabowo tating'onoting'ono komanso tating'onoting'ono tomwe timayandama (nthawi zambiri imakhala ndi kufinya kwamkati kapenanso kusinthasintha) imabowoleka, ndipo ikalandira madzi othinana, mafinya ndi chotsekemera chaching'ono, imatsegulidwa ndi singano, ndikuchotsa timiyeso tosungunuka pang'ono komanso mafinya amadzimadzi. Poyerekeza kupeza kwa opareshoni ndi data ya ultrasound ndi CT, muyenera kuonetsetsa kuti zofunika zonse za pancreatic necrosis zimapezeka ndikuthira. Zotseguka zotseguka zimatsitsidwa ndi machubu osiyana, omwe amapangika kuzinthu zowazungulira ndikuwonetsedwa khoma lakumbuyo kwam'mimba.

Mwambiri, pakulowererapo, pancreatic duct yomwe imakulitsidwa imatsegulidwa ndikukonzanso ndi kukhetsa kwakunja kwa magawo ovomerezeka ndi mabwalo (mkuyu. 20.10).

Mkuyu. 10.20.Kutulutsa kwakunja kwa chodutsa chachikulu cha kapamba pambuyo poti kudutsa kanyumba m'mbali ya thupi (mpaka khoma lakumaso kwa kapamba wamkulu wapa pancreatic)

Mwambiri, pancreatojejunoanastomosis wautali amapangika (nkhumba 20.11 ndi 20.12).

Mkuyu. 11/20.Gawo la ntchito mapangidwe a kotenga nthawi nanocreatojejunoanastomosis (Pustau-N). Pancreatic duct dissected longitudinally(1),jejunum yasokonekera kwa kapamba (2) (mlomo wakumbuyo wa anastomosis wapangidwa)

Mkuyu. 12/20.Fomu lomaliza la kugwira ntchito kwa mapangidwe autali wa nanocreatojejunoanastomosis (Pustau-I)

Kukhazikitsidwa kwa nancreatojejunoanastomosis (PEA) pakali pano pa opaleshoni yamankhwala kumapangidwa chifukwa cha matenda ndi kutupa komwe kumayambitsa gland kapena parapancreatic minofu. Muzochitika izi, nthawi zonse pamakhala chiopsezo cha kusiyanasiyana kwa sutures ya anastomosis, kotero muyenera kudzipatula kuti muthe kukokera kunja kwa main pancreatic duct.

Pakadutsa ntchito, ngati cholinga chotseguka chimalumikizana ndi ductal system ya gland, komanso pambuyo poti madzi atulutsidwe kunja, kawirikawiri pancreatic fistula (fistula) imapangidwa, yomwe imachiritsa mwachilengedwe kudzera mukutuluka kwa madzi a pancreatic, ndikupitilizabe kugwira ntchito ngati pali cholepheretsa kulowererapo mpaka chotsatira. gawo la mankhwalawa

Ntchito zomwe zimaperekedwa kuti zithetse kutulutsa kwa gland secretion m'matumbo zimachitidwa mwa odwala omwe ali ndi vuto lochepa kwambiri (kufalikira kwa duct chifukwa chotsimikizika kwa gawo lakelo, duct calculi, kulimbikira kwa pancreatic fistula). Zochitika za Endoscopic pa DB C (EPST) (mkuyu. 20.13) ndi ma opaleshoni a transduodenal monga papillosphincter- ndi virsungoplasty sizikuyenda bwino chifukwa, monga lamulo, stenosis ya nthawi yayitali ya pancreatic duct, komanso imagwirizananso ndi chiwopsezo chachikulu cha CP. Chifukwa chake, zokonda zimaperekedwa kwa NIT yakutali ndi gawo loyambirira la jejunum litazimitsidwa molingana ndi Ru malinga ndi mtundu wa ntchito ya Pustau-P.

Mkuyu. 20.13.Chiwonetsero chojambula cha kulowererapo kwa endoscopic pa chachikulu duodenal papilla

Odwala ndi CP omwe ali ndi kusintha kwakukulu kapena kosasinthika kwachilengedwe kwa gland (gawo lalikulu la sevdocyst kapena gulu la ma pseudocysts, mapangidwe akuchulukitsidwa kwamphamvu pamene sizingatheke kupatula chotupa, etc.), kuchotsedwa kwa magawo omwe akhudzidwa akuwonetsedwa. Pambuyo pokhapokha gawo loyambalala, amayesa kutulutsa mokhazikika pancreatic duct (kuchotsa ductal pancreatic hypertension) mwa kugwiritsa ntchito termolateral (termoterminal) anastomosis ya gawo lopingasa la gland ndi jejunum loop inazimitsidwa molingana ndi Ru (Puustau-1 opaleshoni) (mkuyu. 20.14).

Mkuyu. 20.14.Operation Pustau-I. Kukhazikitsa kwa pancreatoenteroanastomosis ndi msambo wa jejunum, kuzimitsidwa molingana ndi Ru, pambuyo pa reseal pancreas resection

Olemba ena, omwe amawaganizira kuti anastomosis ndiyosakwanira, amawonjezeranso matendawa ndikuwalumikiza ndi matumbo, ngati kuti akuphatikiza njira za Püstau-I ndi Püstau-N.

Mukayambiranso pakatikati pake (thupi) la chithokomiro, matumbo a matumbo atatsegulidwa mbali ya Ru amapangidwa kuti azikhala ndi malekezero a mbali zotsalira za ndulu (mkuyu. 20.15).

Mkuyu. 20.15.Mtundu womanganso pambuyo pokhazikika pancreatic resection

Pancreatoduodenal resection (PDR), ngati sizingatheke kupatula khansa yam'mutu ya pancreatic, nthawi zambiri imachitika malinga ndi luso la Whipple lomwe limapangidwa bwino (kuti mumve zambiri onani ndime 21.2).

Chizindikiro cha PDD mu pancreatitis yovuta ndi zovuta zomwe zimakhudzana ndi kuchuluka kwa msempha wamatumbo, makamaka ndi kumbuyo kwa mutu ndi njira yolumikizana, pakati pomwe pali mitsempha ya portal yokhala ndi mitsempha komanso mitsempha yayikulu ya mesenteric.

Zomwe zimachitika pazochitika zapadera zowonjezera zokhudzana ndi cholelithiasis ndizofunikira kwambiri makamaka kwa odwala omwe ali ndi vuto lopweteka kwambiri pancreatitis, yomwe kusintha kwakakulu m'matumbo nthawi zambiri kulibe, ndipo kuchulukitsa kwa cholecystitis kapena kupyola kwa calculi kudzera mu Vater ampulla kumayendetsedwa ndi kuphatikizika kwakanthawi kofananira Symbomatology.

Ntchito zoyesedwa kuchitira matenda a duodenum, omwe, monga tanena kale, ali ndi phindu mu pathogenesis ya matendawa (duodenostasis, duodenal, makamaka peripapillary, diverticulums, etc.), ndi ofunikira kwambiri pakuthandizira kwa CP.