Pancreatoduodenal resection

Matenda a kapamba nthawi zambiri amadzutsa funso kwa dokotala ndi wodwala - njira ziti zamankhwala zomwe angasankhe - opaleshoni kapena chithandizo chamankhwala chosasamala.

Kuchita opareshoni ndi chithandizo champhamvu chomwe chimagwiritsidwa ntchito poti chithandizo cha mankhwala chimakhala chopanda tanthauzo ndipo sichimapereka zotsatira zabwino.

Zizindikiro zazikulu zamankhwala opaleshoni ndi:

• khansa yam'mimba,
• chifuwa chachikulu, pokhapokha ngati pali ululu wammbuyo womwe sungathe kuimitsidwa ndi ma analgesics,
• michere yambiri ya mutu wa kapamba,
• zotupa za gawo ili lachiwalo limodzi ndi stenosis ya duodenum kapena duct yomwe bile limatuluka,
• zovuta kapena stenosis pambuyo pancreatojejunostomy opaleshoni.

Kutupa kosafunikira kwa mutu kumawerengedwa kuti ndiko chisonyezo chachikulu cha opareshoni. Popeza kuwonjezera pa kupezeka kwa zowawa komanso zovuta zingapo, kutupa kumatha kutsagana ndi njira ya oncological kapena kubisa chotupa. Matendawa, mu etiology yomwe gawo lalikulu limachitika ndi mowa.

Chifukwa cha pathological zotsatira za Mowa, pamakhala kupangika kwa kutupa kosakhazikika m'matumbo a gland, kuphwanya kwa ntchito zake za endocrine ndi exocrine. Ma molekyulu ndi pathobiochemical machitidwe omwe amatsogolera pakupangika kwachimbudzi ndi pancreatic fibrosis sakudziwika kwenikweni.

Chodziwika mu chithunzi cha histological ndicho kulowetsedwa kwa leukocyte, kusintha kwa kapamba wa dansi komanso nthambi zina zamkati, chotchedwa necrosis komanso gawo lina la microsis.

Gastropancreatoduodenal resection mwa odwala omwe ali ndi chidakwa chachikulu cha pancreatitis, omwe njira yotupa imayambira mutu wa pancreatic, imabweretsa kusintha kwachilengedwe matenda:

1. Kusintha kwa kupweteka kwambiri.
2. Kuchepetsa pafupipafupi gawo lachiwopsezo
3. Kuthetsa kufunika kopitilira kuchipatala.
4. Kuchepetsa umunthu.
5. Kuwongolera moyo wabwino.

Ululu pamimba pamimba ndi chisonyezo chotsogola kwambiri chomwe chimakhudzana ndi kuwonjezeka kwa kupsinjika kwa ma ducts ndi zimakhala za kapamba. Kusintha kwa ma pathomorphological mu mitsempha yamatsitsi, kuwonjezeka kwa m'mimba mwa mitsempha ndi kulowetsedwa kwa cell ndi maselo otupa kumayesedwa ngati zomwe zimayambitsa kupweteka kwa ululu.

Zochita za Whipple

Gulu laling'ono la odwala omwe ali ndi pancreatitis yayikulu imakhala ndi amuna ochepera zaka 40. Odwala awa nthawi zambiri amakhala ndi ululu wam'mimba kwambiri womwe sugwirizana ndi chithandizo cha analgesic ndipo nthawi zambiri umakhala limodzi ndi zovuta zakumaloko.

Gulu ili la odwala ndi ofuna chithandizo chamankhwala othandizira, chifukwa kuphatikiza pa kusintha kwamphamvu kwa kapamba, nthawi zambiri amakhala ndi zotupa zina zamtunduwu komanso zapafupi, mwachitsanzo, chotupa cham'mimba, cham'mimba, kapena chotupa chamimba.

Opaleshoni ya Whipple kapena pacreatoduodenal resection ndi opaleshoni yayikulu yomwe imapangidwa nthawi zambiri kuti ichotse zotupa kapena zotupa za mutu wa pancreatic kapena chimodzi mwazinthu zomwe zimazungulira.

Njirayi imagwiritsidwanso ntchito pochiza kuvulala kwa kapamba kapena duodenum, kapena ngati njira yothandizira matenda kupweteka kwa kapamba.

Njira yodziwika kwambiri yodziwika bwino ya pancreatoduodenectomy imakhala ndikuchotsa izi:

• distal segment (antrum) yam'mimba,
• Gawo loyamba ndi lachiwiri la duodenum,
• mitu yapamba
• wamba bile duct
• chikhodzodzo
• zamitsempha ndi mitsempha yamagazi.

Kukonzanso kumapanganso kuphatikiza gawo lotsala la kapamba mpaka jejunum, kuphatikiza wamba duct kwa jejunum (choledochojejunostomy) kotero kuti timadziti tam'mimba ndi bile tulutsira m'matumbo amtumbo moyenerera. Ndikukonzekeretsa m'mimba ku jejunum (gastrojejunostomy) kuti ibwezeretse chakudya.

Kuphatikizika kwa njira zopangira opaleshoni pa kapamba ndiko kukhalapo kwa ntchito ya enzymatic ya chiwalochi. Chifukwa chake, ntchito ngati izi zimafunikira luso lochitira ntchito kuti zilepheretse pomwe kapamba amayamba kudzimbidwa. Ndikofunikanso kudziwa kuti minyewa ya m'mimba yake ndiyotetemera kwambiri ndipo imafunikira kusamala, nkovuta kuzimata. Chifukwa chake, ntchito zoterezi nthawi zambiri zimayendera limodzi ndi mawonekedwe a fistulas komanso magazi. Zopinga zina ndi izi:

Zomanga zimapezeka m'gawoli pamimba:

1. wamkulu komanso wotsika vena cava.
2. m'mimba msempha.
3. mitsempha yapamwamba ya mesenteric.
4. mitsempha.

Kuphatikiza apo, wamba duct ndi impso zili pano.

Dziwani musanachite opareshoni

Chilolezo cha opareshoni chimaperekedwa potengera zotsatira zakudziwikitsa bwino. Mitundu ya kafukufuku idzafunika:

• Kuyesa magazi kwa zotupa,
• X-ray kupatula metastases yamapapu,
• CT yofufuza zam'mimba komanso malo othandizirana,
• Endoscopic retrograde cholangiopancreatography,
• Endosonography,
• Kusiyanitsa X-ray kuwunika kwa mitsempha.

Njira Yogwirira Ntchito

Kwenikweni, njira yochotsa zidutswazo idalimbikitsidwa ndi wopanga maopaleshoni a Allen Oldfizer Whipple wa zaka za zana la 20. Kulandilidwa kwa wasayansi wotchuka kunathandizira kuchotsa madera omwe ali ndi metastases, kusiya chiwalo, koma chikhodzodzo, chomwe chimayambira m'matumbo ang'ono ndi gawo la m'mimba chimachotsedwa. Masiku ano, pali njira, mwina zophatikizira kusungidwa kwa ziwalo kapena zidutswa. Pyloric posungira resection - opaleshoni ndikusunga m'mimba pyloric. Njira za pancreatoduodenal resection zikuyimiridwa kwambiri masiku ano, ndizosintha zoposa 100. Mulimonsemo, magawo omwe akufunika opareshoni adadziwika:

• Kuchotsa lobe yopanda matenda a ziwalo ndi ziwalo zapafupi.
• Kubwezeretsa ngalande yamamental, maukidwe a tiziwalo timene timayamwa.

Gawo loyamba

Pambuyo pakutseguka ndi gawo la mtanda pachigawo choyamba, ndikofunikira kupereka mwayi kwa ziphuphu pochotsa m'mimba m'mwamba. Kenako, duodenum imakonzedwa molingana ndi Kocher. Parietal peritoneum imatulutsidwa m'mphepete lamanja lamatumbo ndipo duodenum imatulutsidwa kuchokera kumbuyo kwam'mimbamo mwa kuphwanya minofu yofewa osagwiritsa ntchito zida zakuthwa (njira yosamveka).

Choleoch chimasungidwa ndi swab probe kuchokera pakati mpaka mbali yeniyeni, chala chimayikiridwa mu dzenje yolumikizira thumba la gland kupita ku mbali yam'mphepete kumbuyo kwa duct, ndikupanga kubwereza kumbuyo. Chombo cha gastro-duodenal chimadutsana pakati pa ma clamp opangira opaleshoni ndipo imakhala ndi ulusi wapadera. Momwemonso, gastric artery artery imawoloka ndi mabande pafupi ndi malo ake.

Kenako thunthu la venous, lomwe limaphatikiza magazi kuchokera ku ziwalo zosatupa, limawululidwa, ndikusintha mayendedwe wamba a mbali, ndipo mwayi wochita opaleshoniyo kwathunthu umakhazikitsidwa.

Pambuyo pake, gallbladder imachotsedwa ndipo duct yolumikiza ndulu ndi hepatic duct imatha. Gawo la duct, lomwe lili pamwamba pa duodenum, limatchedwa supraduodenal, limadutsa kuchokera kumtunda ndi mtima womata, komanso kuchokera pansi ndi dothi.

Chitsa chakutali cha dambo chimamangidwa ndi ulusi wachilengedwe wosagwira. Chipolopolo chimagwiritsidwa ntchito paliponse ndipo pachilichonse cha notching tochi chomwe chikukulitsidwa m'mimba. Pogwiritsa ntchito chida chopangira opaleshoni kuti musokere kufanana komanso zamkati patali, khoma lam'mimba limadulidwa. Pakadutsa pakati pa yemwe amapangika ndi zamkati, chiwalocho chimadutsidwa ndi ma elekitirodi. Gawo lakutali la m'mimba ndi gawo loyambirira la m'matumbo aang'ono limasunthidwa kumanja, gawo pakati pa mutu ndi thupi la kapamba limawululidwa, ndipo gawo limalowa.

Matumbo ocheperako pafupi ndi minofu yomwe imayimitsa pakati pazigawo za duodenum pakati pa chida cholumikizira timinofu timene timalumikizira ndi kuuma. Chitsa chapafupi ndizomangidwa. Gawo lapafupi kwambiri la colon yopingasa imadutsana pakati pa chimangacho ndipo limamangidwa kuti magaziwo athe kusungidwa. Nthambi zing'onozing'ono zolumikizira za mesenteric artery ndi portal vein zimalumikizana ndikudutsana. Chipangizocho chimatumizidwa kuti chidzaphunzitsidwe morphological cha zothandizira.

Gawo lachiwiri

Pogwiritsa ntchito zotanuka, chitsa cha distal chaching'ono chimapangidwa m'malo otsetsereka ngati khomo lam'mimba, lomwe limakhala kumbuyo kwa m'mimba komanso omentum yaying'ono pansi pa zotengera. Chipini chachipatala cha 20 cm chimayikidwa mu Wirsung duct. Kenako imayambitsidwa kuchokera ku gland kupita ku lumen. Matumbo amaphatikizika ndi mucous wosanjikiza kunja ndi masentimita atatu; amasokonekera m'mphepete mwa m'mphepete mwa chitseko ndi pulglycol suture. Kenako matumbo amawongoka, zikondamoyo zimabisa ndikumapeto kwake, mzere wotsatira wa sutures umayikidwa, ndikulanda kapisozi ka m'mimba ndi m'mphepete mwa matumbo.

Choledochojejunoanastomosis imapangidwa pamalo agawo kagawo ka wamba bile. Jejunum imagwirizanitsa ndi dzenje pamimba pamtunda wa masentimita 45 kuchokera kudula. Kulumikiza kumachitika pamtunda wonse wa chitsa cha m'mimba ndi kulumikizana kwamizere iwiri.

Enterotomy imachitidwa moyang'anizana ndi chitsa cha m'mimba. Suture ya Mikulich imayikidwa, yomwe ndi msoko wamkati wolumikizana ndi ziwalo zopanda kanthu. Ulusi womwe umakhudzidwa ndikupanga mzere wokhotakhota umasunthidwa kukhoma lakutsogolo ndipo umasoka kutsogolo, potero kumalizitsa kubwezeretsanso kwa uthengawo pakati pamimba yokuya komanso matumbo.

Kuyambiranso kumatha ndikumayambitsa chubu cha nasogastric. Zovuta zowoneka bwino zochokera mu polyglycolic acid, kutuluka kwa matumbo aang'ono kumasokonekera pazenera lanyumba yolowera.

Kukonzanso

Nthawi ya postoperative imadziwika ndi kukonzanso kwakukulu. Pambuyo pakuchita opaleshoni, wodwalayo amamuthamangitsa kupita kumalo osamalidwa kwambiri, komwe munthuyu angokhala sabata limodzi. M'masiku oyambilira, omwe amadontha amakhala ndi shuga m'magazi. Dongosololi limapatsa thupi mankhwala ndi mavitamini ofunikira kuti achire. Pambuyo pake, wodwalayo amasamutsidwa ku wadi, komwe ndikotheka kuti adzuke pang'onopang'ono. Ndipo kutengera boma, lingalirani za zotulutsa zomwe zikubwera ngati palibe zovuta zomwe zili ngati zotupa kapena matenda.

Moyo wa wodwala sudzakhalanso womwewo. Dokotala adzakuuzani mwatsatanetsatane zazakudya ndi njira zovomerezeka. Zovuta pambuyo pa opaleshoni zimatsimikiziridwa. Wodwala adzathamangitsidwa ndi nseru, kusanza, matenda a shuga ndi zotupa zimatheka.

Nthawi zambiri, kukonzanso pambuyo pancreatoduodenal resection kumakhala kowawa. Nthawi zambiri, kupweteka pambuyo pa kulowererapo kumakhala kwamphamvu kwambiri kotero kuti amamuika analgesics.

Wodwalayo amayenera kupimidwa ndi oncologist wa chaka choyamba miyezi itatu iliyonse. Kenako kuyendera komwe kumachitika kumachitika miyezi isanu ndi umodzi iliyonse. Njira yotsatira yotsatira imapangidwa pamaziko a mayeso a oncological.

Thanzi pambuyo pamavuto oterewa liyenera kukhala lolondola. Masabata angapo oyamba, kadyedwe kake nkovuta, ndikuwunikira pafupipafupi kuchuluka kwa zopatsa mphamvu. Poyamba, chakudyacho chimaphikidwa kokha ndi nthunzi, ndiye amapanga kusintha kosavuta kwa zinthu zophika.

Pambuyo pake, tikulimbikitsidwa kupatula zakudya zamafuta kwathunthu, zonunkhira komanso zowawasa, zokazinga. Mchere suyenera kukhala wochepa - osaposa magalamu 10 patsiku, kupatsidwa zomwe zili mumalonda omalizidwa. Kofi, zakumwa zochokera mu kaboni ndizoletsedwa.

Zakudya ziyenera kukhala zazing'ono komanso pafupipafupi. Kudya kosapatsa thanzi kumayambitsa kupangika kwa mandimu ndi m'mimba, komwe kumatha kubweretsa kudzimbidwa ndi kutupa. Chakudya chomwe mumadya chikhale chotentha.

Chofunikira ndikumwa ma enzyme owonjezera, m'malo mwa zovuta zake.

Zotsatira zakutsatira mosagwirizana ndi chakudyacho zingakhudze kwambiri thanzi la munthu, ndikofunikira kuganizira malingaliro a adokotala.

Mavuto

Njira yakhalapo kwa zaka 80 ndipo yasinthidwa ndi madotolo, opaleshoni ya Whipple ndi kulowererapo kwakukulu, chiwopsezo cha zovuta pambuyo pabwino.

Pancreatic pancreatic pancreatitis yotsala ya gawo lachiwonetsero imakhala chiwonetsero chazovuta pambuyo pakuyambiranso. Zotsatira zosasangalatsa zingakhale kuphwanya mayamwidwe ndi chimbudzi cha chakudya. Reflux acid wa chapamimba madzi, zilonda zam'mimba - matenda omwe amapezeka kumbuyo kwa opaleshoni.

Kuchita mochiritsa mosavomerezeka kungayambitse madzi a pancreatic kutayikira, kupangitsa kuti munthu asakhale ndi chidwi cham'mimba komanso kukhumudwa m'mimba.

Kwa odwala ena, resection ya pancreatoduodenal ndi mwayi wokhawo wopulumuka ndikukhala ndi moyo pafupifupi wathunthu. Njira yamakono, ndipo yofunika kwambiri, yofikira panthawi yake imalola odwala osankhidwa kuti azikalamba.

Pancreatoduodenal resection: magawo a opaleshoni, kukonzanso

Pancreatoduodenal resection ndi njira yochizira, yophatikizira chithandizo cha opaleshoni, nthawi zambiri yokhala ndi vuto loyipa la kapamba.

Pa nthawi ya opareshoni, mutu wa chiwalo, gawo lomwe limakulitsa gawo logaya chakudya, chikhodzodzo, ndipo gawo loyambirira la m'matumbo aang'ono limachotsedwa.

Kugwirira ntchito kwa Whipple ndi njira yovuta kwambiri, zotsatira zake nthawi zambiri zimatengera ukatswiri wa opaleshoniyo komanso zida zam'chipatala. Nthawi zina opaleshoni ndiyo njira yokhayo, ngati singapulumutsidwe, kukulitsa moyo wa wodwalayo.

Chizindikiro chosatsutsika cha resection ndi khansa ya mutu wotsekemera ndi endocrine. Oncology ya duodenum, chotupa cha duct bile, adenocarcinoma, pseudotumor pancreatitis, mapangidwe ovuta a pancreatic ndi matenda omwe ma processor opaleshoni ogwiritsira ntchito Whipple amagwira ntchito.

Chithandizo chimawonetsedwa kwa odwala omwe zotupa za khansa zimapezeka mkati mwa kapamba ndipo sizifalikira kwa ziwalo zapafupi: chiwindi kapena mapapu. Njira yovomerezeka isanachitike, dokotala ayenera kuchita zofunikira kuti azindikire chotupa.

Khansa Yapancreatic

Pancreatoduodenal resection - zotsatira zazikulu mu Assuta Clinic | Assuta

Khansa ya kapamba - imodzi mwazinthu zodziwika bwino za oncology, imakhala ndi matenda osazindikira bwino.

Panthawi yodziwitsa, nthawi zambiri zimakhala kuti pali kale tumor foci yomwe yathandizanso ziwalo zina.

Izi zimachitika chifukwa khansa yamtunduwu nthawi zambiri imakula nthawi yayitali isanayambitse zizindikiro zilizonse. Odwala otere samachitidwa opaleshoni kuti achotse chotupa chachikulu.

Njira zowononga zachilengedwe zomwe zimagwiritsidwa ntchito ndi Assuta Clinic zimalola kulandira chithandizo chazovuta zazing'ono pakuchita opareshoni. Kutayika kwa magazi kumachepetsedwa, ndipo odwala amachira msanga. Mumathandizidwa ndi akatswiri othandizira opaleshoni, omwe mayina awo amadziwika padziko lonse lapansi. Timapereka:

• Mulingo wapamwamba wotonthoza.
• Mitengo yolondola yantchito.
• Zipangizo zatsopano m'mayunitsi ogwira ntchito, malo osamalirira odwala kwambiri, mabokosi okonzanso.

Werengani ndemanga za odwala pamankhwala ku Assuta, bwerani kwa ife, mudzatilimbikitse kwa achibale komanso anthu oyandikira.

Kuchita opaleshoni kumalimbikitsidwa ngati njira yochizira ngati chotupacho chadziwikiratu mkati mwa kapamba. Njira zamtunduwu zimakambidwa ndi dokotala kuti muone momwe zimathandizira.

Mtundu wa opaleshoni umatsimikizika potengera malo a neoplasm.

Chotupa chikakhala m'mutu wa kapamba kapena potseguka pancreatic duct, opaleshoni ya Whipple imachitidwa, ngati njira yoyipa ikhudza thupi kapena mchira wa gland, opaleshoni yomwe imadziwika kuti distal pancreatic resection (pacreatectomy) imachitika.

Assuta Clinic imagwira ntchito zambiri zamtunduwu. Magulu opanga opaleshoni amakhalanso akatswiri othandizira gastroenterologists, ma genetic, anamwino, ndi ena kuti apereke chithandizo chamankhwala chabwino kwambiri komanso chokwanira kwa odwala.

Kugwiritsidwa ntchito kwa Whipple (dzina lina la pancreatoduodenal resection) koyamba kufotokozedwa mu 1930 ndi Allan Whipple. Mu 60s ,imfa itatha kwambiri.

Lero ndi opaleshoni yotetezeka kwathunthu. M'malo azachipatala aku Israeli omwe ali ndi chithandizo chamankhwala chapadera kwambiri, pomwe njira zambiri zimagwirira ntchito, chiwerengero cha anthu omwalira chimakhala chochepera 4%. Malinga ndi kafukufuku, kupeza zotsatira zabwino kumatsimikiziridwa mwachindunji ndi zomwe wapeza kuchipatala komanso mwachidziwitso cha dokotala wa opaleshoni.

Kodi ntchito ya Whipple ndi chiyani?

Mukuchita opaleshoni iyi, mutu wa kapamba, gawo la ndulu ya bile, chikhodzodzo cha ndulu ndi duodenum amachotsedwa.

Nthawi zina, gawo la m'mimba limapangidwanso. Pambuyo pa izi, gawo lotsala la England, duct ya bile limalumikizidwa ndi matumbo. Njira zambiri zimatenga pafupifupi maola asanu ndi limodzi.

Pambuyo pa izi, odwala ambiri amakhalabe m'chipatala kwa sabata limodzi kapena awiri.

Opaleshoni ya Whipple Laparoscopic

Njira yocheperako kapena ya laparoscopic ingagwiritsidwe ntchito, ndipo mawonekedwe a chotupa amathandizira kusankha kwake. Opaleshoni yamtunduwu imalimbikitsa khansa yapamwamba.

Njira ya laparoscopic imachitika kudzera pakatikati kakang'ono pamimba. Kuchita opareshoni kumachitika pogwiritsa ntchito zida zapadera zamankhwala. Opaleshoni yamtundu wamankhwala amafunika kumanga, kutalika kwa nthawi yayitali, kutseguka kwam'mimba.

Kudzera m'njira zowononga zachilengedwe, kuchepa kwa magazi ndi chiwopsezo cha matenda zimachepetsedwa.

Oncologists ku Assut adzazindikira ngati wodwalayo akufuna kulandira opaleshoni ya laparoscopic. Amapereka zosankha zabwino kwambiri malinga ndi zosowa za wodwala aliyense.

Funsani dokotala wakuchipatala

Kodi opaleshoni ya Whipple imachitika liti?

Zisonyezero zamagulu apanyumba:

1. Khansa yapakhungu yamutu.
2. Khansa ya duodenum.
3. Cholangiocarcinoma (chotupa cha m'magazi a bile ducts kapena bile ducts).
4. Cancer ampoules (madera omwe bile ndi pancreatic duct amalowa mu duodenum).

Nthawi zina opaleshoni yamtunduwu imayang'aniridwa chifukwa cha vuto la chosaopsa - kapamba, chisa chotupa.

Odwala 20% okha ndi omwe angathe kuchita opareshoni iyi. Awa ndi odwala makamaka omwe njira yotupa imakhazikika pamutu wa kapamba ndipo sinafalikire kwa mitsempha yayikulu yayikulu, chiwindi, mapapu, zina.

Odwala ena ali ndi mwayi wopeza opaleshoni ya laparoscopic, yomwe imapereka kuchepa kwa magazi, kukhala kwakanthawi kuchipatala, kuchira msanga komanso zovuta zochepa.

Kwa odwala pafupifupi 40%, opaleshoni sangaganizidwe kuti ndi njira, popeza pali metastases. Nthawi zina, amagwiritsidwa ntchito ngati chotupa cham'deralo chomwe chalowa m'malo oyandikana nawo - mesenteric mtsempha kapena mitsempha, kapena pamene neoplasm yafalikira thupi lonse kapena mchira wa kapamba.

Zotsatira za pancreatoduodenal resection ndi ziti?

Kwa zaka 15 zapitazo ku Assuta zotsatira zabwino zakwaniritsidwa pambuyo pa opareshoni iyi, chiwerengero cha anthu omwalira ndi ochepera 5%. Kafukufuku wochitika ndi asayansi aku America akuwonetsa kuti zotsatira za opaleshoniyo mwachindunji zimadalira luso la chipatala komanso dokotala wochita opaleshoniyo.

Muzipatala komwe kuchuluka kwakukulu kwa njirazi kumachitika, anthu omwe amafa amakhala ochepera asanu.

Mabuku opanga opaleshoni amatchula ziwerengero zotsatirazi: zipatala zomwe sizichita kawirikawiri mitundu yotere ya opaleshoni, zovuta zambiri zimadziwika, chiwopsezo cha anthu amafa 15-20%.

Kodi kuyambitsanso pancreatoduodenal kudzapulumutsa moyo?

Mlingo wonse wopulumuka pancreatic adenocarcinoma pambuyo pa opaleshoni imeneyi ndi pafupifupi 20% pazaka zisanu. Ngati palibe metastasis mu ma lymph node, kuchuluka kwa kupulumuka kumafika 40%. Odwala omwe ali ndi matenda omwe amathandizidwa ndi chemotherapy, kupulumuka kumakhala kochepera 5%.

Kodi chithandizo china chimafunikira pambuyo pancreatoduodenal resection?

Pambuyo pa opaleshoni iyi, chemotherapy ndi radiotherapy tikulimbikitsidwa. Kafukufuku wochitika ndi asayansi ochokera ku yunivesite ya Johns Hopkins akuwonetsa kuti chithandizo cha cytostatic othandizira ndi ma radiation pambuyo pa opaleshoni ya pancreatic adenocarcinoma imawonjezera kupulumuka ndi 10%.

Mankhwala ena ali osavomerezeka kwa odwala omwe ali ndi chotupa cha neignlasop ndi neuroendocrine.

Kodi pali vuto lotani la matenda ashuga pambuyo pa opaleshoni ya Whipple?

Mukuchita opaleshoni imeneyi, mutu wa kapamba amachotsedwa - gawo la chiwalo. Tizilombo toyambitsa matenda timatulutsa insulini yofunika kuti tichepetse shuga. Kuyambiranso gland kumabweretsa kuchepa kwa kaphatikizidwe ka insulin, pamakhala ngozi yotenga matenda a shuga.

Monga momwe zikusonyezera, mwa odwala omwe ali ndi matenda osokoneza bongo osakwana opaleshoni, pali mwayi waukulu wodwala. Odwala omwe ali ndi shuga wabwinobwino komanso kuchepa kwa chifuwa chachikulu amakhala ndi chiopsezo chochepa cha matenda a shuga.

Kodi moyo usintha pambuyo pakuchita opaleshoni?

Kusintha pang'ono kwa moyo pambuyo pa ntchito ya Whipple, m'malo ovomerezeka. Odwala ambiri amabwerera ku zochitika wamba.

Pochita kafukufuku wina wasayansi waku America, kuwunika kwa moyo kunapangidwa.

Anthu omwe adachitidwa opareshoni adayankha mafunso okhudzana ndi kuthekera kwakuthupi, mavuto amisala, zokhudzana ndi chikhalidwe cha anthu, magwiridwe antchito komanso kulumala.

Kafukufukuyu adachitidwanso pagulu la anthu athanzi komanso gulu la anthu omwe adachotsedwa mu ndulu. Chiwerengero chokwanira kwambiri cha mfundo zinali 100%. Zotsatira zotsatirazi zidapezeka.

Chifukwa chake, zotsatirazi zikuwonetsa kusintha pang'ono kwa moyo.

Ndi zovuta ziti zomwe zimakonda kuchitika atangopanga opaleshoni?

Opaleshoni yamtunduwu ndi opareshoni yovuta ndi chiwopsezo chachikulu cha zovuta ngati dokotala wakuchita opaleshoniyo akudziwa bwino. Ngati dokotala wodziwa zambiri popanga opaleshoni imeneyi, kuchuluka kwa zovuta zake kumakhala kochepa kwambiri.

1. Pancreatic fistula. Pambuyo pochotsa chotupa, ndulu imalumikizidwa ndi matumbo. Chikhansa ndichinthu chofewa kwambiri, ndipo nthawi zina, suture samachiritsa bwino. Izi zikachitika, kutulutsa kwa pancreatic madzi kumawonedwa. Nthawi zambiri, dokotalayo amaika catheter ya draina m'mimba pamimba pakuchita opaleshoni, ndipo kutaya kulikonse kumatha. Pafupifupi odwala onse omwe amakhala ndi mbali iyi, amadzidalira okha. Nthawi zina, pamafunika opereshoni mobwerezabwereza.
2. Gastroparesis (ziwalo zam'mimba). M'masiku oyamba asanu ndi limodzi pambuyo pa opaleshoni, ma dontho amaikidwa mpaka ntchito yamatumbo ibwezeretsedwe. Pambuyo pakuyambiranso ntchito zake, adokotala amasamutsa wodwala kuchokera kumkati mwamakandidwe amthupi kupita ku zakudya zabwino.
3. Mu 25% ya odwala, ziwalo zam'mimbazi zimawonedwa pambuyo pakuchita opaleshoni, vutoli limatha kukhalapo mpaka masabata 4 mpaka 6, mpaka dongosolo lololera kusintha limalizidwa, ndipo gawo limayamba kugwira ntchito bwino. Pakhoza kukhala mavuto azakudya. Mwinanso, pakufunika zakudya zamafuta, pogwiritsa ntchito chubu chomwe chinayikidwa ndi dokotala wa opereshoni panthawi ya opareshoni yamatumbo. Odwala ambiri, ntchito yam'mimba imabwezeretseka milungu inayi kapena isanu ndi umodzi atachitidwa opareshoni.

Ndi zovuta ziti zomwe zingakhalepo kwakanthawi pambuyo pancreatoduodenal resection?

• Malabsorption. Zikondazo zimatulutsa ma enzyme ofunikira pakugaya chakudya. Mbali ya chiwalo ikachotsedwa, kaphatikizidwe ka michereyi kamachepa. Odwala amadandaula za kutsekula m'mimba akamadya zakudya zamafuta kwambiri. Chithandizo cha nthawi yayitali ndi mankhwala okhala ndi ma enzymes, monga lamulo, amachepetsa vutoli.
• Zosintha pazakudya. Pambuyo pa opaleshoni iyi, chipatala cha Assuta nthawi zambiri chimalimbikitsa kudya zakudya zazing'ono, kusakhazikika pakati pa chakudya, zomwe zithandizira kuyamwa bwino komanso kuchepetsa nkhawa ya m'mimba.
• Kuchepetsa thupi. Nthawi zambiri, odwala amachepetsa 5 mpaka 10% ya kulemera kwa thupi atachitidwa opaleshoni poyerekeza ndi kulemera kwa thupi matenda asanafike. Monga lamulo, zinthu zimakhazikika msanga, odwala ambiri atayika kulemera pang'ono amatha kukhalanso ndi kulemera kwenikweni.

Kugwiritsidwa ntchito kwa Whipple ku Israeli - ukadaulo wapamwamba wa khansa ya kapamba

Opaleshoni ndi imodzi mwanjira zazikulu zochizira matendawa. Mtundu wa opaleshoniwo umatsimikizika pamtundu wa kukula ndi kukula kwa chotupa, kupezeka kwa yachiwiri kwa thupi, kuthekera kwachotsedwa kwathunthu kwa mapangidwe opweteka.

Kafukufuku akuwonetsa kuti chithandizo cha khansa ya pancreatic ndiyabwino kwambiri ndipo imakhala ndi chiwopsezo chochepa ngati chikuchitika mu malo akulu a oncology ndikuchitika mothandizidwa ndi madokotala omwe ali ndi chidziwitso chochuluka.

Ngati mukufuna chithandizo chamankhwala chambiri, kampani yathu, MS "Tlv.Hospital", itha kupereka chithandizo ku Israeli. Utumikiwu umaphatikizapo kusankha madokotala omwe amakhazikika m'makliniki, kukonza ndi kuwongolera njira yonse yodziwira ndi kulandira chithandizo, kusungitsa nyumba, kutsagana ndi magawo onse, kumasulira zikalata, kutumiza, ngati mukufuna, pulogalamu yopuma, ndi zina zambiri.

MS "Tlv.Hospital" akudziwa zambiri pa ntchito zachuma ku Israeli - zaka zopitilira 10, ndi membala wa Israeli Association of Medical Tourism Companies.

Mankhwala othandizira opaleshoni ya pancreatic oncology ndiovuta kwambiri. Dokotalayo ayenera kukhala ndi luso komanso luso lokwanira kuti akwaniritse zotsatira zapamwamba.

Zachipatala zaku Israeli zitha kupereka ntchito za akatswiri oyenerera komanso odziwa ntchito zambiri. Mwayi wapamwamba kwambiri wa chithandizo chopambana umaperekedwa ndikuchotsa chotupa pa 100%.

Zimafunanso kupezeka kwa zida zamakono zamankhwala - kugwiritsa ntchito ma microscopes amphamvu.

Kuchita kwa khansa ya kapamba kuli ndi zolinga ziwiri - kuchotsedwa kwa zotupa zopweteka kwathunthu kapena kuchepetsa kupweteka ndi mawonekedwe ena a matendawa.

Pafupifupi 10% yokha, chotupa chija chimapezeka mkati m kapamba pomwe khansa yapezeka.

Ngakhale kugwiritsa ntchito bwino matendawa, madokotala sangathe kudziwa molondola matendawo popanda kuchita opareshoni. Kutengera ndi mayeso owonetsera, zimachitika kuti akatswiri amafika pangozi kuti chotupacho chikugwirika. Komabe, pakuchita opareshoni, zimapezeka kuti mapangidwe oyipirawo sagwira ntchito, kuti pali owoneka ngati apamwamba.

Ngati matenda a khansa yapakhungu akuwonetsa kuti chotupacho sichingathenso kuyambiranso, opaleshoni yodwala ingathe kuchitidwa. Cholinga chawo ndikuchepetsa ululu, kuchepetsa zizindikiro za matendawa.

Mitundu yotsatirayi yogwira khansa ya kapamba imachitika m'makliniki aku Israeli. Njira zina zochiritsira zingagwiritsidwenso ntchito musanachite opareshoni kapena pambuyo poti mupeze opaleshoni.

Ntchito za Whipple (pancreatoduodenal resection) ku Israeli

Kuchita kwa Whipple nthawi zambiri kumachitika ndi izi. Amagwiritsidwa ntchito pochotsa chotupa choyipa m'mutu wa kapamba kapena pakutsegulira kwa pancreatic duct. Pakati pa opaleshoni, kuyambiranso kumachitika:

• mitu ya zikondamoyo ndi gawo loyambirira la m'matumbo aang'ono (duodenum),
• chikhodzodzo
• gawo la wamba duct,
• pyloro (pyloro),
• zamitsempha pafupi ndi mutu wa kapamba.

Nthawi zina, opaleshoni ya Whipple yosinthidwa ikhoza kuchitika, sizikhudza ntchito yachilendo yam'mimba.

Kuyerekeza ndi pancreatectomy wamba

Lingaliro lalikulu la pancreatoduodenectomy ndikuti mutu wa kapamba ndi duodenum uli ndi magazi ofanana (gastroduodenal artery).

Mitsempha iyi imadutsa pamutu wa kapamba, kotero kuti ziwalo zonse ziyenera kuchotsedwa pamene magazi athunthu atsekedwa. Ndikadangotulutsa mutu wa kapamba, izi zitha kusokoneza magazi kulowa mumtsempha, womwe ungayambitse ziwalo zake.

Mayeso azachipatala sanathe kuwonetsa kupulumuka kwakukulu ndi pancreatectomy yodziwika bwino, makamaka chifukwa odwala omwe amachitidwa opaleshoni iyi nthawi zambiri amakhala ndi matenda oopsa a shuga.

Nthawi zina, chifukwa cha kufooka kwa thupi kapena kasamalidwe koyenera ka wodwalayo panthawi yothandizira, kupezeka ndi kufalikira kwa matenda m'matumbo am'mimba ndizotheka, zomwe zingafune kulowererapo, chifukwa chomwe gawo lotsala la kapamba, komanso gawo loyandikana ndi nduluyo, limachotsedwa.

Izi zimachitika pofuna kupewa kufalikira kwa matenda, koma, mwatsoka, zimabweretsa zowonjezera kwa wodwala.

Pylorus-pancreatoduodenectomy

M'zaka zaposachedwa, pyloric posungira pancreatoduodenal resection (yomwe imadziwikanso kuti Traverse-Longmire process) yatchuka, makamaka pakati pa madokotala othandizira aku Europe.

Ubwino wawukulu wa njirayi ndikuti pylorous ndipo, motero, kutaya kwachibadwa kwam'mimba kumayesedwa.

Komabe, amakayikira ena amakhalapobe ngati ili ndi ntchito yoyenera kuchokera pa malingaliro a oncological.

Mtsutso wina ndikuwonetsa ngati odwala ayenera kuchita retroperitoneal lymphadenectomy.

Poyerekeza ndi muyezo Whipple, pylorous, njira yosungirako pancreatoduodenectomy, imalumikizidwa ndi nthawi yofupikira ya opaleshoni, magawo ochepa opaleshoni, ndikuchepetsa kuchepa kwa magazi, komwe kumafunikira kuthiridwa magazi. Chifukwa chake, pali zoopsa zochepa zomwe zingapangitse munthu kuikidwa magazi. Mavuto a postoperative, kufa kwa zipatala, ndi kupulumuka sizosiyana pakati pa njira ziwiri.

Pancreatoduodenectomy ndi muyezo uliwonse umatengedwa ngati njira yofunika kwambiri yochitira opareshoni.

Kafukufuku wambiri akuwonetsa kuti zipatala momwe opareshoni iyi imachitikira nthawi zambiri zimakhala ndi zotsatirapo zabwino. Koma musaiwale zovuta ndi zotsatirapo za opaleshoni yotere, yomwe imawonedwa ndi ziwalo zonse zomwe zikuchitidwa opareshoni.

Mukamachita opaleshoni pamutu pancreatic:

• matenda ashuga
• postoperative abscess.

Kuchokera kumbali yam'mimba, pali kuthekera kwakukulu kwa zovuta monga kuchepa kwa vitamini B12 komanso kukula kwa kuchepa kwa magazi m'thupi.

Kuchokera pa duodenum, zovuta zotsatirazi zingachitike:

1. Dysbacteriosis
2. Kutsekeka kwamkati chifukwa cha anastomotic stenosis.
3. Depletion (cachexia).

Kuchokera panjira yantchito, mawonekedwe a zovuta zotere ndiwotheka:

• cholangitis
• biliary pancreatitis,
• biliary cirrhosis.

Kuphatikiza apo, pali zotupa za chiwindi.

Kuzindikira kwa odwala atachitidwa opaleshoni

Kutengera malangizo onse a dotolo panthawi yakukonzanso, wodwalayo amatha kuchepetsa zovuta pazovuta zochepa.

Ndikofunikira kuchita kukonzekera kwa enzyme, antibacterials, ndikofunikira kutsatira zakudya kuti muzikhala ndi gawo la m'mimba.

Ngati ndi kotheka, odwala khansa amayeneranso kukalandiridwa ndi chemotherapy kapena radiation.

Pakumayambiriro kogwira ntchito, ndikofunikira kukumbukira za zinthu zomwe zikuopseza moyo:

1. Kukula kwa mantha ndi kutsika kwa magazi.
2. Infection - malungo ndi malungo, leukocytosis,
3. Kulephera kwa anastomosis - kukula kwa zizindikiro za peritonitis,
4. Kuwonongeka kwa ziwiya za kapamba, kulephera kwa ma ligulin - kuchuluka kwa amylase m'magazi ndi mkodzo.
5. Kukula kwa postoperative pancreatitis, ngati opareshoniyo sinachitike poyerekeza ndi kutupa kwa pancreatic, kutsekeka kwa chimbudzi cha pancreatic kumayamba chifukwa cha kutupa kwa chiwalo.

Odwala khansa yam'mutu ya pancreatic amapatsidwa mwayi wowonjezera moyo wawo. Opaleshoniyo itachitidwa kumayambiriro, ndiye kuti madokotala amayembekeza kuchotsedwa kwathunthu, pambuyo pake, kuwonetsedwa kwa metastases ndikotheka, koma sizowopsa komanso zomwe sizowopsa.

Kwa odwala omwe ali ndi pancreatitis yovuta, zomwe zimachitika chifukwa cha opaleshoniyo zimatha kukhala zosiyana - ndi zotsatira zabwino, odwalawa amataya mphamvu zawo zamavuto ndi magwiridwe antchito am'mimba, popanda zovuta zina, chipatala cha kapamba amatha.

Odwala onse atachitidwa opaleshoni ya pancreatic amalembetsa ndipo amawunikira miyezi isanu ndi umodzi iliyonse. Ndikofunikira kuyang'anira momwe zinthu zonse zimapangidwira, chifukwa zovuta zakumbuyo monga stenosis ya anastomoses, chitukuko cha matenda ashuga chifukwa cha kapamba, komanso njira za oncological ndizotheka.

Za kuchira kwathamanga pambuyo pancreatoduodenal resection kufotokozedwa mu kanema munkhaniyi.

Chisankho chakuchita pancreatoduodenal resection chimachitika pamaziko a zotsatira za kuyesedwa kwa chipatala kwa wodwalayo komanso njira zofufuzira zowonera kuti adziwe gawo la khansa.

Kuchita opareshoni kumakhudzidwa ndikumatha kupeza kapamba, komwe kali pakhoma lakumaso kwa chifuwa cham'mimba pafupi ndi ziwalo zofunika. Chigawo chochepa chabe cha odwala ndi chomwe chimagwira.

Njira yapamwamba yosinthira pancreatoduodenal ndi Ntchito ya Whipple, yomwe imapangidwa nthawi yomweyo, kuchotsa ma resonar lymph node, duodenum yonse ndi distal yachitatu yam'mimba. Mu 1978

opaleshoni iyi idasinthidwa kuti isungire ntchito ya pylorous ndi antrum (pyloropancreatic pancreatoduodenal resection).

Chifukwa cha izi, chiwonetsero chazachipatala cha post-gastroresection syndrome ndi zovuta zam'milonda zimachepetsedwa, ndipo kugaya timayendedwe bwino. Kupulumuka sikusiyana ndi izi pambuyo pa ntchito yapamwamba.

Kubwezeretsa gawo la bile, wamba bile duct anastomose ndi jejunum. Kukwapula kwa gawo lotsala la kapamba kumapangidwanso ndi jejunum. Patency yam'mimba imabwezeretsedwa ndi duodenoejunostomy.

Onetsetsani kuti mwaphunzira za zigawo zouma za m'mbali mwa ziwalo zokhazikikazo.

Kukula kwake kumatsimikizika ndi kukula kwa chotupa, chomwe chimadziwika ndi mbiri yamitsempha yamagazi ndi chikhalidwe cha zamitsempha. Chithunzi chofunikira kwambiri m'mbiri pophunzira ma lymph node.

Ngati mulibe ma metastases mwa iwo, kuchuluka kwa zaka zisanu ndi 40-50%, ndipo ngati apezeka - 8%.

Izi zimatanthauzanso ndi mbiri yakubwezerera kwamitsempha (ngati apezeka, kuchuluka kwa moyo kumakhala pakati pa miyezi 11, osakhalapo - miyezi 39).

Pancreatoduodenal resection ndi njira yosankhira khansa yapamwamba. Nthawi zina, anthu oterewa amatulutsa chotupa cha m'matumbo (ampulectomy).

Odwala omwe sangathe kugwira ntchito, nthawi zina zimakhala zotheka kuti athe kuchotseredwa kapena kuchepetsa kukula kwa khansa yapakhungu ndi endoscopic Photochemotherapy.

Njirayi imakhala mu endoscopic walitsa chotupa chotupa ndi chotupa cha hematoporphyrin ndi kuwala kofiyira (wavelength 630 nm).

Kulowerera

Zochita za pang'onopang'ono zimaphatikizidwa ndi kuphatikiza kwa anpomu anastomoses ndi endoscopic kapena percutaneous transhepatic endoprosthetics (stenting).

Pamene kusanza kumachitika motsutsana ndi maziko a jaundice chifukwa cha kutsekeka kwa duodenum, choledochojejunostomy ndi gastroenterostomy amachitidwa.

Pankhani yokhala patokha yotsekemera kukonzedwa kwa bile, olemba ena amalimbikitsa kuti gastroenteroanastomosis ikhale prophylactically ntchito pa biliodigestive anastomosis.

Komabe, madokotala ambiri opanga maopaleshoni amathetsa nkhaniyi potengera kukula kwa chotupa ndi patency ya duodenum pakukonzanso kophatikiza.

Kusankha pakati pa chithandizo chamankhwala chosafunikira komanso chosafunikira kumatengera mkhalidwe wa wodwalayo komanso zomwe dokotala wakuchita.

Endoscopic stenting Zimayenda bwino 95% yamilandu (60% kuchokera pachiyeso choyambirira), pomwe anthu amafa patatha masiku 30 pambuyo poti athandizire ndi ochepa poyerekeza ndi kugwiritsa ntchito anastomosis ya biliodigestive. Ngati njira ya endoscopic siyikuyenda bwino, ma transdermal kapena ophatikizika ndi ma percinaneous ndi endoscopic stenting angathe kuchitika.

Zotsatira wosokoneza,imfa, kuchuluka kwa zovuta ndizofanana ndi zotsatira za ntchito yopweteka, pomwe nthawi yayitali yokhala ndi moyo wa odwala pambuyo pa izi ndi masabata 19 ndi 15, motsatana. Mavuto a kununkha amaphatikizapo kutuluka kwa magazi ndi magazi. Endoscopic endoprosthetics nthawi zambiri imakhala limodzi ndi zovuta komanso kufa kwa odwala kuposa ozungulira.

Mu 20-30% ya odwala mkati mwa miyezi itatu atakhazikitsa, zitsulo zapulasitiki ziyenera kusinthidwa chifukwa chotsekedwa ndi bile. Kubalalitsa zitsulo zopopera tinthu timene timayikidwira modzidzimutsa komanso modzidzimutsa.

Izi zimatha kupitilira nthawi yayitali kuposa pulasitiki (pafupifupi 273 ndi masiku 126).

Koma, potengera mtengo wokwera wa masenti oterewa, amawakhazikitsa makamaka mwa odwala omwe ali ndi khansa ya periampicular, yomwe, m'malo mwa pulasitikiyo chifukwa cha kubanika, amawonetsa chotupacho pang'onopang'ono ndikuwonetsa kutalika kwa nthawi yayitali.

Kuluma kwa bile ducts popanda kutsegula m'mimba kumachitika makamaka kwa odwala okalamba ochokera m'magulu omwe ali pachiwopsezo chachikulu omwe atawulula chotupa chachikulu, chosaoneka kapena chotupa chachikulu. Odwala achichepere omwe ali ndi chotupa chosawoneka, omwe amakhala ndi moyo wautali, mutha kugwiritsa ntchito anastomosis ya biliodigestive.

Malinga ndi njira zamakono zochizira khansa ya mutu wa kapamba, wodwalayo sayenera kufa ndi jaundice wosasunthika kapena kuvutika ndi kuyabwa kosatheka.

Chithandizo chothandizira

Zotsatira za chemotherapy yothandizira ndi radiotherapy ndizokhumudwitsa. Nthawi zina, kusintha kumatha kuchitika pogwiritsa ntchito X-ray ndi chemotherapy pambuyo pakuyambiranso. Ndi zotupa zosawonongeka, palibe radiation kapena chemotherapy regimens zomwe zidakhala ndi zotsatirapo zabwino.

Kubisa kwa celiac plexus (kosinthika pansi pa chiwongolero cha X-ray kapena intraoperative) kumachepetsa ululu kwa miyezi ingapo, koma pakupitilira theka la milandu imabweranso.

Kodi pancreatoduodenal resection imachitika bwanji?

Awa ndi opareshoni kwambiri, omwe amachitidwa pansi pa opaleshoni wamba. Zimatenga maola asanu ndi limodzi mpaka khumi ndi awiri. Dokotalayo amapanga chibwibwi m'mimba, amayang'ana ziwalo kuti zichotse chotupacho popanda kuwononga zida zofunika.

Ngati ndi kotheka, adotolo amawerengetsa khansayo ndi chidutswa cha minofu yathanzi (lotchedwa lakuthwa m'mphepete). Tizilombo totulutsidwa timatumizidwa ku labotale, komwe a psychologist amawasanthula, amawonetsa gawo la matendawa, kupezeka kwa maselo a khansa kumalo opangira opaleshoni.

Kutengera ndi zotsatira za lipoti la wazachipatala, adotolo azisankha chithandizo chotsatira chiti.

Panthawi ya opaleshoni ya Whipple, dokotalayo amachotsa mutu wa kapamba, chikhodzodzo, gawo loyambirira la matumbo aang'ono (duodenum), pylorous, gawo la wamba duct, ndi malo ozungulira a lymph.

Pambuyo pa ziwalo zonsezi, amalumikizanso m'mimba ndi jejunum - amapanga gastroeteroanastomosis. Gawo lotsalira la duct wamba la bile limalowereranso jejunum kuti timadziti tadzulu ndi ma pancreatic mulowe.

Athandizira kuti asidi asamayende bwino m'mimba, komanso achepetse vuto la zilonda m'derali.

Kugwiritsidwa ntchito kwa Whipple (pancreatoduodenal resection), zikuwonetsa, ntchito, kukonzanso

Opaleshoni ya Whipple kapena resection ya pancreatoduodenal ndiyo kulowererapo komwe kumachitika kwambiri chifukwa cha khansa ya kapamba. Zimaphatikizapo kuchotsedwa kwa mutu wa chiwalo, komanso gawo la m'mimba, chikhodzodzo ndulu ndi duodenum. Opaleshoni ndiyovuta, kukonzanso ndiyovuta komanso yayitali. Koma nthawi zina uwu ndi mwayi wokha wopulumutsa wodwalayo, kapena kuti atalikitse moyo wake.

Ntchito Zosinthidwa za Whipple

Mosiyana ndi muyeso wokhazikika wa pancreatoduodenal, pylorous, pylorous, amasungidwa munjira yosinthidwa. Opaleshoni yamtunduwu sichikhudza m'mimba; Pambuyo pakuchita opaleshoni yosinthidwa, palibe mavuto azakudya, monga pambuyo pa opaleshoni yokhazikika.

Kusintha pancreatoduodenal resection ndikulimbikitsidwa:

• Ngati chotupa choyipa m'mutu wa kapamba sichikulu komanso chachikulu.
• Ngati chotupa sichinakulire kukhala gawo loyambirira la m'mimba.
• Palibe maselo a khansa m'mitsempha yakazungulira pylorus.

Zoyambitsa khansa ya kapamba

Khansa yamtunduwu imatchedwa "wakupha mwakachetechete", chifukwa mu magawo oyamba samadziwonetsa, koma mwachangu ma metmases am'mimba, mapapu, chiwindi komanso mafupa. Matendawa akapezeka, chemotherapy yachedwa kwambiri, ndipo opaleshoni yokhayo yomwe ingakupulumutseni.

Ngakhale ndizovuta kuzitcha kuti chipulumutso, chifukwa ndi 5-10% yokha ya odwala omwe adachitidwa opaleshoni ya Whipple asanafikitsidwe metastases omwazika ziwalo zapafupi ali ndi mwayi wochira kwathunthu.

Zomwe zimayambitsa khansa ya pancreatic sizinadziwikebe. Koma zidapezeka kuti matendawa amayamba chifukwa cha kufooka kwa chitetezo chathupi. Palinso zifukwa zingapo zowopsa zomwe zimathandizira kukulitsa kwa oncology:

• Pancreatitis yayitali. Maselo a pancreatic akapupuluma nthawi zonse, amatha kuyamba kusintha.
• Matenda a shuga. Khansa imayamba chifukwa chosowa insulini.
• Kusuta. Nkhope, monga mtima, imakonda kuchita ischemia. Ndipo ziwiya zikagundidwa ndi mains, ma oncology amatha.
• Kunenepa kwambiri. Kuwonekera kwa mahomoni ogonana oyambitsidwa ndi kuwonjezeka kwa kulemera kwa thupi kumayambitsa kuphwanya ntchito za kapamba, kutupa kwake ndi kukula kwa maselo otupa.
• Zakudya zopanda pake. Khofi wambiri, soseji, msuzi ndi nyama yokazinga zimadzetsa mavuto ndi kapamba, kufikira khansa.

Komanso, zingapo zingapo zodziyimira pawokha zimakhudza chiopsezo chotenga khansa ya pancreatic. Chifukwa chake, zidapezeka kuti nthawi zambiri amuna, anthu opitilira 60 ndi omwe anali ndi khansa ya pachibale (ngakhale itakhala itcology ya ziwalo zina) amadwala izi.

Anthu onse omwe amapezeka pakhomo pazinthu zitatu kapena zingapo amalangizidwa kuti azichita prophylactic ultrasound ya malo obwezeretsanso kamodzi pachaka. Kafukufuku wina yemwe amatha kudziwa khansa ya pancreatic kumayambiriro ndi MRI yam'mimba.

Zizindikiro ndi contraindication kwa Whipple opaleshoni

Pancreatoduodenal resection sikuwonetsedwa kokha khansa ya kapamba, komanso chifukwa chamutu wa mutu wake. Opaleshoniyo idzagwiranso ntchito ngati pali duodenal oncology, cholangiocarcinoma, adenocanceroma, pseudotumarous pancreatitis ndi zovuta chotupa cha chosaopsa cha pancreatic.

Mwa njira! Kubwereranso mwa njira ya Whipple kumawerengedwa kuti ndi imodzi mwazothandiza kwambiri pamtundu woterewu, ngakhale kuti wodwalayo "apatutsanso" njira yogaya chakudya. Koma izi ndizabwinonso kuposa pancreatoduodenectomy.

Opaleshoni ya Whipple ilinso ndi zotsutsana. Sichingachitike mwa odwala okalamba, pamaso pa matenda a mtima komanso chifukwa cha kulephera kwa hepatic, chifukwa chithandizo cha opaleshoni pazinthu izi chimakhala choti chimapha pafupifupi 100%.

Momwe mungapangire kuyambitsanso kwa pancreatoduodenal

Njira yofunsira (kuchotsera pang'ono) kapamba inafunsidwa ndi dokotala waku United States Allen Whipple kumayambiriro kwa zaka za m'ma 1900. Njirayi idapangitsa kuti izitha kusunga chiwalo, koma chotsani madera onse omwe akhudzidwa ndi metastases ndikufika pa lymph node.

Mwa mtundu wakale, opaleshoni ya Whipple imaphatikizapo kuchotsedwa kwa mutu wa kapamba, chikhodzodzo ndulu ndi duodenum kwathunthu, komanso magawo awiri mwa atatu a m'mimba. Koma lero, gwiritsani ntchito kusiyanasiyana ndikusungira pang'ono ziwalo zina, ngati zingatheke.

Mwa njira! Kuchita kwa Allen Whipple sikugwirizana ndi matenda amodzi omwewo. Matenda a Whipple ndimatenda osowa kwambiri omwe amayamba chifukwa cha bakiteriya yemwe amalowa. Matendawa adatchulidwa kuti adotolo George Whipple, yemwe adapereka lingaliro la bakiteriya.

Kukonzekera opaleshoni

Chifukwa ndi khansa, ndiye kuti simungakayikire. Atazindikira chotupacho ndikuchitsimikizira ndikuyesa kwa chotupa, wodwalayo amatha kumuyika kuchipatala ndipo amayamba kukonzekera opaleshoni ya Whipple.

Ndipo uku ndikuwerengera magazi, mkodzo ndi ndowe, biopsy, ultrasound ndi zakudya zapadera.

Munthu ayenera kumvetsetsa kuti kupambana kwa kulowererapo kwa mtsogolo komanso mkhalidwe wake wopitilira zimatengera zambiri, chifukwa chake ayenera kutsatira malangizo azachipatala mosakayikira.

Kupita patsogolo kwa ntchito

Whipple pancreatoduodenal resection imatha kuchitika m'njira ziwiri: zamkati (kudzera pakuloweka pamimba pamimba) kapena laparoscopic (zida zodutsa kudzera pamatumbo pamimba).

Njira yoyamba ikhoza kukhala yaulere ndikuchitidwa pamtengo. Ndipo kwa laparoscopy, mumayenera kulipira, chifukwa iyi ndi gawo lina la opareshoni.

Opaleshoni ya Classical Whipple ndi laparoscopy amasiyana m'njira zomwe amafikira ziwalo zamkati. Kupanda kutero, zonse zili zofanana. Ndipo njira zonse ziwiri za kapangidwe ka pancreatoduodenal zimakhudza magawo awiri.

Choyamba, muyenera kuchotsa pathological gawo la kapamba ndi ziwalo zapafupi. Kuti muchite izi, m'mimba amatengedwa ndipo duodenum imatulutsa. Kenako dokotalayo amapita kukatikati ya ziwalo zonse, kukafika ku ndulu. Musanachotsere chiwalo chilichonse, zigawo zake kwambiri zimakokedwa ndi ma cell kuteteza kutulutsa magazi ndi madzi achinsinsi.

Pambuyo pochotsa ziwalo kapena ziwalo zomwe zimakhudzidwa ndi metastases, madokotala ayenera mwanjira ina kuti abwezeretse kukhulupirika kwam'mimba. Chifukwa cha izi, gawo lotsalira la kapamba limalumikizidwa ndi matumbo ochepa, ndipo duct ya bile imabweretsedwanso kwa iwo.

Gawo lachiwirili la ntchito ya Whipple limadziwikanso ndi kukhazikitsidwa kwa machubu angapo amadzimadzi, omwe kwa nthawi yoyamba amachotsa zakumwa m'malo abwino.

Kubwezeretsa nthawi pambuyo resection

Pambuyo pa opaleshoni ya Whipple, kukonza kwakanthawi kumatsata, pomwe wodwalayo amayenera kuphunzira kukhala ndi chofinya chamagulu. Koma, choyamba, nthawi yovuta yovuta ikumuyembekezera, yomwe imayamba ndi kukonzanso. Zimatenga sabata limodzi, chifukwa machubu atatu am'madzi akutuluka pamimba, ndipo ma suture angapo amafunikira chisamaliro chapadera.

Masiku oyamba atachitidwa opaleshoni ya pancreatic pogwiritsa ntchito njira ya Whipple, wodwalayo amalandila odwala omwe amapangidwa kuti azilamulira shuga m'magazi ndikupereka mankhwala ena ndi mavitamini. Pambuyo posamukira ku wadi, mutha kudzuka pang'onopang'ono. Ngati palibe zovuta monga zotupa, matenda kapena kusokonezeka kwamatumbo amkati, kutulutsa kumakonzekera pambuyo masiku ochepa.

Dokotala adzakuwuzani za mawonekedwe a regimen ya tsiku ndi tsiku komanso zakudya. Amatha kufunsanso pazovuta zomwe zingachitike, ndipo ndizambiri mwa iwo atasinthidwa ndi Whipple. Ichi ndi thrombophlebitis, ndi shuga, ndi zotupa, ndi mavuto ammimba.

Kusanza, kusanza, komanso matumbo okhumudwa kumayenda ndi wodwalayo nthawi yayitali, ndipo mwina moyo wawo wonse. Ngakhale anthu ambiri amazolowera kudya kotero kuti ziwalo zotsalira ndi matumbo ake zimayankhidwa bwino.

Titha kulankhula za zomwe zidanenedweratu pambuyo pakuchita opaleshoni kwa Whipple pokhapokha atawona wodwalayo ndikuwunika kwake. Mulingo uliwonse ndi payekhapayekha, ndipo ngati zamatsenga zidazindikira koyambirira, ndiye kuti munthu ali ndi mwayi wochira kwathunthu komanso moyo wautali.

Koma pali zinthu zina zomwe ziyenera kusinthika: ukalamba, thanzi labwino, komanso kusapezeka kwa matenda okhudzana. Tsoka ilo, nthawi zambiri, opareshoni ndi kukonza kwake ndikumva kupweteka, ndipo ambiri sakhala ndi moyo zaka 2-3 zitatha.

Pancreatoduodenal resection: chithandizo ndi zovuta

Masiku ano, khansa ya kapamba ndi mtundu wamba wa khansa. Nthawi zambiri, kudwala kumakhala ndi zotsatira zoyipa. Mukamayesedwa, madotolo amawona kukhalapo kwa metastases yachiwiri yomwe imakhudza minofu yathanzi ya ziwalo zina.

Choyipa chachikulu cha matendawa ndikuti palibe zizindikiro za matendawa. Nthawi yomweyo, maselo a khansa amayamba kukula ndi mphamvu yayikulu. Ngati metastase yambiri yapezeka, odwala samachita opaleshoni.

Pancreatoduodenal resection technology

Kodi pancreatoduodenal resection ingalimbikitsidwe kwa ndani? Kuchitapo kanthu kwa opaleshoni kumasonyezedwa kwa okhawo omwe ali ndi zotupa za khansa zomwe zimadziwika mkati mwa kapamba. Opaleshoniyo amachita ngati njira yochizira.

Pamaso pa opareshoni, dokotala yemwe amapita amakhala akuwunikiratu matenda omwe akhudzidwa. Chifukwa cha kuyesedwa kwa ultrasound ndi kusanthula kambiri, chithunzi cha matendawa chikuwonetsa mtundu wa ma opaleshoni othandizira.

Ngati khansa ili m'mutu wa zikondamoyo kapena malo otseguka pancreatic duct, ndiye kuti madotolo amamuchita opaleshoni ya Whipple. Pamaso pa vuto loyipa m'dera la thupi kapena mchira wa kapamba, madokotala ochita opaleshoni amachita pancreatectomy.

Opaleshoniyo (pancreatoduodenal resection kapena opaleshoni ya Whipple) idachitidwa koyambirira koyambirira kwa 1930 ndi dokotala Alan Whipple. Chakumapeto kwa zaka 60, anthu omwe amafa chifukwa cholowerera anali ndi ziwonetsero zambiri.

Mpaka pano, resection ya pancreatoduodenal imawonedwa ngati yotetezeka kwathunthu. Chiwerengero chaimfa chatsika mpaka 5%. Zotsatira zomaliza za kulowererapo zimangotengera luso la dotoloyo.

Kodi mchitidwe ndi chiyani?

Tiyeni tikambirane mwatsatanetsatane momwe pancreatoduodenal reseation imachitikira. Masitepe a opareshoni afotokozedwa pansipa.

Pokonzekera ntchito yamtunduwu, wodwalayo amachotsedwa pamutu wa kapamba. Woopsa matendawa, kuchotsa pang'ono kwa bile duct ndi duodenum kumachitika.

Ngati chotupa choyipa chikakhala cham'mimba, ndiye kuti amachotsa pang'ono.

Pambuyo pancreatoduodenal resection, madokotala amalumikiza zigawo zotsalira za kapamba. Duct ya bile imalumikizidwa mwachindunji ndi matumbo. Nthawi yogwira ntchito yotereyi ndi pafupifupi maola 8. Pambuyo pa opaleshoni, wodwalayo amayamba kulandira chithandizo, chomwe chimatenga pafupifupi milungu itatu.

Whipple Laparoscopy

Njira yakuchiritsira ikuchitika molingana ndi malo omwe zilonda zam'mimba zimayambira. Whipple laparoscopy imatha kuchepetsa kwambiri nthawi yobwezeretsa wodwalayo. Opaleshoni yamtunduwu imachitidwa kwa odwala omwe ali ndi khansa ya ampullar.

Opaleshoni ya Laparoscopic imachitika kudzera pakatikati kakang'ono m'mimba. Zimachitidwa ndi akatswiri odziwa ntchito zamagetsi omwe amagwiritsa ntchito zida zapadera zamankhwala. Pogwira ntchito ngati Whipple, pamimba pamapangidwe osiririka amachitika.

Pochita opaleshoni ya laparoscopic, madokotala ochita opaleshoni amazindikira kuchepa kwa magazi pang'ono pakuchita opareshoni. Amanenanso za chiwopsezo chochepa chobweretsa matenda osiyanasiyana.

Kodi opaleshoni ya Whipple ndi yofunikira liti?

Pali zisonyezo zingapo momwe opareshoniyo imatha kukonza bwino mkhalidwe wa wodwalayo. Izi zikuphatikiza:

• Khansa ya mutu wa kapamba (kapamba wam'mimba kapamba imachitika).
• Ma neoplasm oopsa m'dera la duodenum.
• Cholangiocarcinoma. Pankhaniyi, chotupa chimakhudza maselo athanzi a bile ducts a chiwindi.
• Khansa ya Ampoule. Pano, neoplasm yoyipa ikupezeka m'dera la pancreatic duct, lomwe limachotsa bile mu duodenum.

Kuchita opaleshoni yamtunduwu kumagwiritsidwanso ntchito pazovuta zam'mimba zotupa. Izi zimaphatikizira matenda monga chifuwa chachikulu cha kapamba.

Pafupifupi 30% ya odwala amathandizidwa mwanjira imeneyi. Amadziwika kuti ali ndi chotupa mkati mwa kapamba. Chifukwa cha kuchepa kwa zizindikilo zolondola, nthawi zambiri, odwala amapezeka ndi metastasis ya ziwalo zina. Kuchita opareshoni ndi njira iyi ya matenda sikumveka.

Pancreatoduodenal resection imayamba ndi kuwunika koyenera kwa ziwalo zomwe zakhudzidwa. Kugonjera koyesedwa koyenera kukuwonetsa chithunzi cha matendawa.

Kukula kochepa kwa chotupa cha khansa kumalola opaleshoni ya laparoscopic. Zotsatira zake, madokotala ochita opaleshoni amatha kuchotsa kwathunthu komwe akukhudzidwa, osavulaza ziwalo zina zam'mimba.

Chidule Chithandizo

Odwala ambiri amafunsa funso lomwelo: kodi zotsatira za pancreatoduodenal resection ndi ziti? Pazaka 10 zapitazi, chiwerengero cha odwala omwe adamwalira chatsika mpaka 4%. Chowonadi ndi chakuti zotsatira zabwino zimatheka ndi chidziwitso chachikulu cha dokotala wa opaleshoni yemwe akuchita opareshoni.

Ndi Whipple pancreatic adenocarcinoma, pafupifupi 50% ya odwala amakhalabe ndi moyo. Popeza kupezeka kwathunthu kwa zotupa mu mitsempha ya m'mimba, njira zoterezi zimawonjezera kupulumuka kwa odwala kangapo.

Kumapeto kwa opaleshoni, wodwalayo amapatsidwa maphunziro a wayilesi ndi chemotherapy. Izi ndizofunikira kuti tiwononge kufalikira kwa maselo a khansa ku ziwalo zina.

Mankhwala ena pambuyo opaleshoni amatsutsana odwala omwe ali ndi chotupa, komanso kusintha kwa neuroendocrine.

Pancreatoduodenal resection: njira ya opaleshoni

Pakupanga opaleshoni, chiwalo chochuluka chomwe chimayambitsa kutulutsa insulin chimachotsedwa. Nawonso, amathandizira kuwongolera kuchuluka kwa shuga m'madongosolo a magazi. Kusankha pang'ono pang'ono kumachepetsa kupanga insulin. Zotsatira zake, mwa odwala ambiri, chiopsezo chokhala ndi matenda monga matenda a shuga chikuwonjezeka kwambiri.

Odwala omwe ali ndi shuga yambiri yamwazi amatha kupezeka ndi matenda amtunduwu. Mlingo wabwinobwino wa shuga mwa wodwala wopanda pancreatitis yayitali amachepetsa kukula kwa shuga.

Pamapeto pa kukonzanso, dotolo yemwe akupezekapo amalimbikitsa kudya. Ndikofunikira kupatula zakudya zamafuta kwambiri komanso zamchere pazakudya. Nthawi zambiri pambuyo pa kuchitapo kanthu kwamtunduwu, odwala ambiri amalephera kudya mashuga. Pankhaniyi, kugwiritsidwa ntchito kwake kumatsutsana.

Pambuyo pancreatoduodenal resection

Pambuyo pa opaleshoni, wodwalayo amakhalabe kuchipatala masiku asanu ndi awiri mpaka khumi. Mankhwala opaka opaleshoni amayikidwa. Epidural anesthesia kapena analgesia woleza wodwala angagwiritsidwe ntchito.

Dontho lokhazikika limakhazikitsidwanso komwe kumalowa mkati mwazakudya mpaka timene wodwala amatha kulowa ndi kumwa payekha. Catheter amayikidwa kuti asokoneze mkodzo m'thupi. Masiku angapo pambuyo pake adzachotsedwa. Njira yakuchira imatenga pafupifupi mwezi.

Zimatenga pafupifupi miyezi itatu mpaka dongosolo lamagayilo litayambiranso.

Pambuyo pochotsa kapamba, zotsalazo sizingatulutse insulin yokwanira kuti iteteze shuga la magazi.

Jakisoni wa insulini amaperekedwa mpaka chiwalocho chikuchira ndipo ayambanso kupanga insulin.

Zitha kukhala zofunikira kutenga ma enzyme okugaya kuti athandize thupi kuwonongeka ndikupeza mafuta ndi mapuloteni.

Malangizo apadera a ana

Opaleshoni ya Whipple nthawi zambiri imagwiritsidwa ntchito pochiza zotupa za ana (adenocarcinomas, mwachitsanzo). Kuphunzitsa kungaphatikizepo kuchepetsa nkhawa, kulimbitsa mgwirizano, kuthandiza mwana wanu kukulitsa luso lodziletsa, komanso kutengera msinkhu wa mwana. Madokotala ndi makolo amamuthandiza kukonzekera, kumufotokozera zomwe zidzachitike.

Pangani foni yaulere

Distal pancreatectomy

Opaleshoni imeneyi imachitika pamene khansa ili mthupi ndi mchira wa gland.

Pofuna kuchitapo kanthu opaleshoni, dokotalayo amachotsa mchira wa m'mimba kapena mchira wake, gawo la thupi ndi malo apafupi a lymph.

Ngati pathological process yakhudza ndulu kapena mitsempha yamagazi ikupereka ndi magazi, nduluyo imachotsedwa. Mutu wa kapamba umalowa gawo loyambirira la matumbo aang'ono.

Pancreatectomy yonse

Pancreatectomy yathunthu simachitika. Madokotala amalingalira izi ngati maopaleshoni afalikira m'matumbo, kapena ngati sangathe kulumikizidwa bwino m'matumbo ang'ono.

Pokonzekera pancreatectomy kwathunthu, dokotalayo amachotsa kapamba konse, gawo loyambirira la matumbo ochepa, pylorous, gawo la wamba duct, ndulu ya ndulu, nthawi zina ndulu ndi pafupi.

Pambuyo pake, adotolo amalumikiza m'mimba ndi jejunum, ndikupanga gastroenteroanastomosis. Gawo lotsala la duct wamba la bile limalumikizanso ndi jejunum.

Pamene kapamba amachotsedwa, odwala amatenga matenda a shuga, ndipo pakufunika insulin. Matenda a shuga nthawi zambiri amakhala ovuta kuwongolera.

Zikondazo zimapanganso michere yomwe imathandizira kugaya chakudya. Pambuyo pakuyambiranso, pakufunika kutenga ma enzyme moyo wanu wonse.

Opaleshoni yopanga

Amatembenukiranso kuti achepetse zizindikiro za khansa yapakhungu, yozizira, kapenanso yokhazikika. Ma neoplasms m'dera la mutu wa gland nthawi zambiri amatseka wamba duct kapena gawo loyambirira la matumbo ochepa. Opaleshoni yochita kupanga imagwiritsidwa ntchito pochotsa blockage.

Kukhazikika kwa stent

Kukhazikika kwa stent ndiyo njira yomwe imagwiritsidwa ntchito kwambiri popewa kufalikira kwam'mimba chifukwa chotupa. Fungo ndi chubu chopyapyala, chopindika, chomwe nthawi zambiri chimapangidwa ndi chitsulo. Amayikidwa mu duct ya bile, amasungitsa duct lotseguka, ndikupereka mphamvu pazenera kuchokera mkati. Zitatha izi, bile limayenda m'matumbo ang'ono.

Fungo nthawi zambiri limayikidwa nthawi ya endoscopic retrograde cholangiopancreatography (ERCP). Nthawi zina madokotala amakonda njira yotchedwa percutaneous, ikafika pakhungu kutiikapo fungo la ndulu ya bile. Pambuyo pa njirayi, bile limayenda m'thumba, lomwe limakhala kunja kwa thupi.

Fungo likuyenera kusinthidwa pakatha miyezi 3-4 kapena kupitilira apo. Mitundu yatsopano ya stents ndi yotakata ndipo ili ndi kuthekera kwakukulu. Amagwiritsidwa ntchito kuyesera kuti duct isakhale yotseguka.

Opaleshoni yam'mbuyo

Kukhazikitsidwa kwa stent ya endoscopic kumatha kusintha njira yodutsa, komwe kumachepetsa kufalikira komwe kumachitika chifukwa cha pancreatic neoplasm nthawi zina. Kutengera ndi malo ogulitsira, ntchito zosiyanasiyana zodutsa apa zimagwiritsidwa ntchito.

1. Choledochoejunostomy imaphatikizira kupezeka kwa duct wamba ya jejunum. Njira yodutsa apa imatha kuchitika laparoscopically.
2. Hepaticojejunostomy ndi opaleshoni yomwe hepatic duct yolumikizidwa ndi jejunum.

Opaleshoni ya m'mimba kapena gastroenteroanastomosis ndi mtundu wa shunting, pomwe m'mimba ulumikizidwa mwachindunji ndi jejunum. Nthawi zina opaleshoni imeneyi imagwiritsidwa ntchito popewa kuchitanso opaleshoni yachiwiri ngati pali chiwopsezo chakuti duodenum imatsekedwa pamene matendawa apita.

Zotsatira zoyipa zomwe zingachitike pambuyo pancreatoduodenal resection (ndi zochitika zina za khansa ya kapamba)

Kuchita kwa Whipple kumakhala ndi ngozi zambiri. Pafupifupi 30-50% ya anthu omwe adachitidwa opaleshoni iyi amakhala ndi zotsatira zosayenera. Ndikofunika kuti muuzeko dokotala ngati zotsatirapo zilizonse zotsatirazi zimachitika.

1. Ululu nthawi zambiri umachitika pambuyo pa opaleshoni chifukwa cha kuvulala kwa minofu. Pakuwongolera kwake, ma analgesics amagwiritsidwa ntchito masiku angapo. Zimatenga kanthawi kuti ululuwo usachoke, kutengera njira yochiritsira komanso kuchuluka kwa kupweteka.
2. Chiwopsezo cha matenda. Zilonda zitha kuyikidwa mchilonda kuti muchotse madzi ochulukirapo ndikuthandizira kuchira. Madokotala amapereka mankhwala othandizira kupewa kapena kuchiza matenda. Izi ndi zosafunikira kwakanthawi zomwe zitha kuonekera pambuyo pa mtundu uliwonse wa opereshoni.
3. Kutsitsa magazi kumatha kukhala chifukwa cha zovuta ndi kuwundana kwa magazi, mwachitsanzo, kapena chifukwa chamtsempha wamagazi osagwiritsidwa ntchito pakuchita opareshoni. Mwazi wochepa ungatengedwe kukhetsa ngalande, zomwe zimadziwika kuti ndizofala.
4. Kutupa kwa anastamosis. Nthawi zina pamakhala kutaya kwa ndulu, asidi am'mimba, kapena msuzi wa pancreatic kuchokera kuzinthu zangophatikizidwa pambuyo pochotsa minofu yomwe yakhudzidwa. Dokotala atha kukulemberani okreotide (sandostatin) kuti achepetse kuchuluka kwa timadzi ta kapamba, tomwe timapereka njira yochizira mwachangu kwa anastomosis.
5. Kutha kwa m'mimba ndi vuto lomwe chakudya chimakhala m'mimba nthawi yayitali kuposa masiku onse. Izi zimachitika pamene gawo lachiberekero likuwonekera chifukwa cha kuwonongeka kwa mitsempha pakuchita opareshoni. Kuchepetsa m'mimba kumatha kuyambitsa nseru, kusanza. Pambuyo pa masabata 4-12, chizindikirocho chimazimiririka. Kudyetsa kwa Tube kungagwiritsidwe ntchito kupereka chakudya chofunikira. Nthawi zambiri, chizindikiro ichi chimachitika pambuyo pa ntchito ya Whipple yosinthidwa kuposa pambuyo povomerezeka.
6. Kutaya matenda ndi gulu la zizindikiro zomwe zimayamba chakudya chikamayenda mofulumira kuchokera m'mimba kupita m'matumbo aang'ono. Zitha kuchitikanso chifukwa chotulutsa m'mimba mwachangu. Zowonekera kwambiri pambuyo pa opaleshoni yodziwika ndi Whipple, atachitidwa opaleshoni pa pylorus ndi duodenum. Zizindikiro za kutaya matendawa zimaphatikizapo thukuta, kupukusa, kutulutsa, ndi m'mimba. Madokotala pachipatala cha ku Israeli amupatsa wodwala njira zothanirana ndi izi - kusintha kwa zakudya, mankhwala kapena opaleshoni.
7. Mavuto azakudya amatha kuchitika pambuyo pancreatoduodenal resection, pakakhala kusowa kwa michere yam'mimba mu kapamba, juwisi, kapena bile. Izi zimadzetsa kusowa kwa chakudya, kuchepetsedwa kwa mafuta (thupi samalandira mavitamini osungunuka okwanira mafuta - A, D, E ndi K), kutsekula m'mimba, kumatulutsa ndi kudzimbidwa. Madokotala ku Israeli amalangizira zamomwe angakhalire kudya moyenera pambuyo pa opaleshoni. Ndizotheka kuti wodwalayo afunika kutenga michere yokugaya. Chakudya chawekha, kugwiritsa ntchito zakudya zamafuta ochepa, mankhwala olimbana ndi mseru, komanso mavitamini othandizira. Pakabuka mavuto akulu, mungafunike chakudya ndi kafukufuku kuti thupi lilandire michere yokwanira.

M'm zipatala za ku Israeli, mapulogalamu othandizira odwala amapangidwira odwala, pomwe osati matendawo okha, komanso munthu yemwe ali patsogolo. Thandizo lachilendo limaperekedwa kwa odwala ndi mabanja awo.

Gulu la akatswiri limagwira ntchito ndi wodwalayo - gastroenterologists, oncologists, radiation Therapists, pathologists, radiologists, madokotala osamalira odwala, anamwino, etc.

Kukambirana pafupipafupi za chithandizo ndi zotsatira zake kumachitika, njira zonse zomwe zimapezekedwako zimaganiziridwa, zomwe zimapereka njira zophatikizira chithandizo chomwe chiri chofunikira kwambiri pankhaniyi.

Njira zotsogola zotsogola kwambiri zimaperekedwa, zomwe zimathandiza moyo pa nthawi ya chithandizo.