Pancreas abdominization: opareshoni imachitika bwanji?

Opaleshoni ya pancreatic ndi njira yopangira opaleshoni yowonjezereka, chifukwa chiwalochi chimakhala chokhudza mtima kwambiri ndipo sichikudziwika kuti chitha bwanji kugwira ntchito pambuyo pochotsa kapena kuchotsa chotupacho. Ntchito zimadziwika ndi chiopsezo chowonjezeka chaimfa ndi chitukuko cha zovuta zaumoyo.

Ndimagwira ntchito yanji pa kapamba ndipo ndizowopsa?

Mitundu yotsatirayi yochita opaleshoni:

1. Chiwerengero chonse. Nthawi zina dokotalayo amayenera kupanga zisankho zofunika pochita. Kuchitapo kanthu kumatenga pafupifupi maola 7.
2. Subtotal pancreatectomy ndikuchotsa pang'ono kapamba. Kachigawo kakang'ono ka chiwalo kamatsala, kamene kali pafupi ndi duodenum.
3. Pancreato-duodenal resection ndiye ntchito yovuta kwambiri. Zikopa, duodenum, chikhodzodzo ndi gawo la m'mimba zimachotsedwa. Amalembera pamaso pa zotupa zoyipa. Ndizowopsa ndi chiwopsezo chachikulu chovulaza minofu yoyandikana, kupezeka kwa zovuta za postoperative ndi kufa.

Laparoscopy

Opaleshoni ya Laparoscopic, yomwe idagwiritsidwa ntchito pokhapokha pozindikira, tsopano imatha kukonza mkhalidwe wa wodwalayo ndi pancreatic necrosis ndi chotupa cham'mimba cha kapamba. Opaleshoni imadziwika ndi nthawi yochepa yochira, chiopsezo chochepa cha zovuta. Pogwiritsa ntchito njira yotsiriza ya endoscopic, chiwalocho chimafikiridwa kudzera mu kuyang'ambika pang'ono, ndikuwunika mavidiyo kumapangitsa kuti njirayi ikhale yotetezeka komanso yogwira mtima.

Kuchotsa kwa tumor

Kuthana kwa chosaopsa pancreatic chotupa amachitika m'njira ziwiri:

1. Kuchita kwa beger. Kulowa kwa chiwalo kumadutsa gawo la gastrocolic ligament, pambuyo pake mitsempha yapamwamba ya mesenteric imalekanitsidwa. M'madera apamwamba komanso apansi a kapamba, zosunga pakhungu zimayikidwa. Pambuyo posinthira mosavutikira, mutu wa chiwalo cha mgonero umakwezedwa ndikulekanitsidwa ndi mitsempha yapamwamba kwambiri.
2. Opaleshoni Frey - kuchotsedwa kwina kwa gawo lamkati la kapamba wokhala ndi ma pancreatojejunostomiasis.

Opaleshoni yofananira imaperekedwa kwa odwala matenda ashuga. Contraindication ndi ofanana kuphatikiza ziwalo zina. Zikondamoyo zonyamula zimapezeka kwa wopereka wachinyamata yemwe wamwalira ndi ubongo. Kuchita koteroko kumalumikizidwa ndi chiopsezo chokana chiwalo chofalitsidwacho, motero, chimachitika motsutsana ndi maziko a mankhwala a immunosuppression. Pakakhala zovuta, kagayidwe kamafanana, kufunikira kwamphamvu kwa insulin kumatha.

Kuchotsa ziwalo kwathunthu

Kukwaniritsidwa kwathunthu kumasonyezedwa pamatenda omwe amayenda ndi necrosis ya zimakhala. Opaleshoniyo amamutsatira pokhapokha mutayang'anitsitsa thupi, pamaso pazowonetsa mwamtheradi. Pambuyo kuchotsa kwathunthu kwa kapamba, wodwalayo adzafunika kudya kwa ma enzymes, insulin, zakudya zapadera, kuyendera pafupipafupi kwa endocrinologist.

Kuthetsa mimba

Njirayi imaphatikizira kuchotsedwa kwa kapamba kulowa m'mimba. Amagwiritsidwa ntchito pa matenda omwe amaphatikizidwa ndi pancreatic necrosis popanda kusungunuka minofu ndikupanga ma voids.

Pa opaleshoni, peritoneum imasulidwa, chiwalo chimasiyanitsidwa ndi zimakhala ndipo zimasunthidwa kumbuyo kwa omentum. Pambuyo pamimba, mapangidwe a zotupa exudate, zopangidwa ndi poizoni ndi madzi a pancreatic m'malo obwezeretsanso.

Kununkha

Opaleshoni ndi njira yothandiza yochotsera zovuta zowongolera. Ili ndi chiopsezo chochepa kwambiri cha zovuta komanso kuphweka pochita. Pancreatic duct stenting imagwira ntchito molowera. Pa nthawi ya opareshoni, phata la chitsulo limayikidwa, yokutidwa ndi kupopera mankhwala kwa antibacterial. Izi zimachepetsa chiopsezo cha kufinya kwamphamvu ndi matenda.

Manda

Njira yofananayi imachitidwa pakukula kwa zotsatira zowopsa pambuyo polowerera mwachindunji. Kugwiritsidwa ntchito kochuluka kwa ngalande kumachitika chifukwa cha chiwopsezo chachikulu cha zovuta zapadera kumayambiriro kwa ntchito. Ntchito zikuluzikulu za opareshoni ndikuwachotsa kwachangu komanso kotheratu kwa zotupa zotuluka, kuchotsedwa kwa purulent foci.

Zizindikiro za

Zomwe zimayikidwa pochita opaleshoni yapancreatic:

• pachimake kapamba, limodzi ndi kuwonongeka kwa minofu,
• kukula kwa peritonitis,
• kagayidwe kachakudya komwe kamayendetsedwa ndi kupindika,
• zotupa
• chotupa, kukula komwe kumabweretsa kupweteka kwambiri,
• zotupa zoyipa ndi zoyipa,
• kufalikira kwa bile ducts wa chiwalo,
• kapamba.

Kukonzekera

Kukonzekera ntchitoyo kumaphatikizapo zochitika monga:

1. Kuyang'ana wodwala. Masiku angapo opaleshoni isanachitike, ECG, x-ray ya chifuwa, kuyezetsa magazi konsekonse, ma ultrasound am'mimba, CT ndi MRI amachitidwa.
2. Kuthana kwa mankhwala ena, mwachitsanzo, anticoagulants.
3. Kutsatira ndi zakudya zapadera. Chakudya chimatayika kwathunthu maola 24-48 musanachite opareshoni. Izi zimachepetsa mwayi wamavuto omwe amabwera ndi kulowa kwa matumbo m'mimba.
4. Kukhazikitsa enema yotsuka.
5. Kukonzekera. Wodwalayo amapaka jekeseni ndi mankhwala omwe amathandizira kuti alowetse magazi othandizira, amachotsa mantha komanso kuchepetsa zomwe zimachitika m'magazi.

Opaleshoni yamapazi

Njira yoyenera kuchitapo kanthu pochita opaleshoni imaphatikizapo zinthu izi:

• mawu a opaleshoni, kuyambitsa kwa opuma minofu,
• kulowa kwa kapamba,
• kuyang'anira ziwalo
• kuchotsa kwamadzimadzi m'thumba lolekanitsa kapamba ndi m'mimba,
• kuchotsedwa kwa mipata,
• kukongola ndi kubudula kwa hematomas,
• kusoka kwa minofu yowonongeka ndi zonyowa za chiwalo,
• Kuchotsa gawo la mchira kapena mutu wokhala ndi gawo la duodenum pamaso pa zotupa
• kukhazikitsa ngalande
• wosanjikiza
• kutsatira kuvala kovutira.

Kutalika kwa ntchitoyo kumatengera chifukwa chake, chomwe chakhala chidziwitso pakukwaniritsidwa kwake, ndipo ndi maola 4-10.

Mitengo yotsimikizika yochitapo kanthu pochita opaleshoni mu kapamba:

• resection ya mutu - ma ruble 30-130,000.,
• chonse pancreatectomy - ma ruble 45-270,000,
• duodenopancreatectomy - ma ruble 50,5-230 masauzande,
• stenting wa pancreatic duct - 3-44000 rubles.,
• Kuchotsa kwa chosaopsa pancreatic chotupa ndi endoscopic njira - 17-407 zikwi rubles.

Nthawi yogwira ntchito

Kuchira kwa wodwala pambuyo pake kumaphatikizanso izi:

1. Khalani m'chipinda cholandirira odwala. Gawo limatenga maola 24 ndipo limaphatikizanso kuwunikira zofunikira za thupi: kuthamanga kwa magazi, shuga m'magazi, kutentha kwa thupi.
2. Tumizani ku dipatimenti yochita opareshoni. Kutalika kwa mankhwala a inpatient ndi masiku 30-60. Panthawi imeneyi, thupi limasinthasintha ndikuyamba kugwira ntchito bwino.
3. Theroper Postoperative Zimaphatikizaponso njira yochizira yovomerezeka, kuchuluka kwa shuga m'magazi, kudya makonzedwe a enzyme, njira zolimbitsa thupi.
4. Kugwirizana ndi kupumula pabedi, bungwe la mabungwe olamulira tsiku lonse atatuluka m'chipatala.

Mfundo zofunika kudya pambuyo pancreatic organ opaleshoni:

1. Kutsatira ndi pafupipafupi chakudya. Idyani zosachepera 5-6 patsiku.
2. Muchepetse kuchuluka kwa chakudya chomwe mumadya. Kutumikira sikuyenera kupitirira 300 g, makamaka m'miyezi yoyamba atachitidwa opaleshoni.
3. Kutenga madzi okwanira. Ndikofunikira kuchotsa poizoni ndikukhalanso ndi magazi abwinobwino.
4. Kutsatira ndi mndandanda wazinthu zololedwa ndi zoletsedwa. Pewani zakumwa zoledzeretsa, zakumwa zoziziritsa kukhosi, kaboni, chokoleti, khofi, zinthu zamzitini, masoseji.

Mavuto atandichita opareshoni

Zotsatira zofala kwambiri za opaleshoni yamapamba ndi:

• magazi akulu amkati
• thrombosis
• malungo
• matenda ammimba (mseru ndi kusanza, kudzimbidwa, kutsatiridwa ndi matenda am'mimba),
• kuchuluka kwa mabakiteriya,
• kapangidwe ka fistulas ndi abscesses,
• peritonitis
• pachimake ululu syndrome
• kukula kwa zadzidzidzi,
• kuchuluka kwa matenda ashuga
• ziwalo minofu necrosis pambuyo resection,
• kusokonezeka kwa magazi.

Mbiri ya moyo

Kutalika kwa moyo wa wodwala zimadalira momwe thupi limagwirira, mtundu wa opereshoniwo, kutsatira malangizo a dokotala panthawi yobwezeretsa.

Pancreato-duodenal resection ili ndi chiwopsezo chachikulu cha kufa.

Kuyambiranso kwa chithokomiro ndi khansa kumalumikizidwa ndi chiopsezo chowonjezereka. Chiwonetsero chazaka 5 zapulumuka pambuyo pa opareshoni sichidutsa 10%. Wodwalayo ali ndi mwayi uliwonse wobwerera mwakale pambuyo poti mutu kapena mchira wa chiwalo chikukula kwambiri kapeneka kapena zotupa.

Ndemanga za Opaleshoni ya Pancreatic

Polina, wazaka 30, ku Kiev: “Zaka 2 zapitazo adamuchita opareshoni kuti achotse thupi ndi mchira wa kapamba. Madokotala adavotera mwayi wokhala ndi moyo wochepa kwambiri. Kukula kwa gawo lomwe latsala sikupita masentimita 4. Kuchipatala, zidatenga miyezi iwiri kupereka antibacterial ndi painkiller, ma enzyme. Pakupita miyezi yocheperako, zinthu zinayamba kuyenda bwino, koma sizinali zotheka kunenepa. Ndimayesetsa kudya mosamala, kumwa mankhwala. ”

A Alexander, azaka 38, Chita: “Kwa zaka zitatu, zowawa za m'chigawo cha epigastric zimazunza, madotolo adzipanga matenda osiyanasiyana. Mu 2014, adalowa mu dipatimenti yopanga opaleshoni ali pamavuto akulu, pomwe mutu wapa pancreatic adapangidwanso. Nthawi yochira inali yovuta, m'miyezi iwiri idataya 30 kg. Ndakhala ndikutsatira zakudya mwamphamvu kwa zaka zitatu tsopano, kulemera kukukula pang'onopang'ono. ”

8.4.2. Omentopancreatopexy

Zowonetsa: pancreatic necrosis wapezeka pa matenda laparotomy.

Pofikira: chapamwamba chapakati pa laparotomy.

Pakuwunika ndi kuwunikanso kwa m'mimba, gastrocolic ligament imatsegulidwa kwambiri, kapamba amayesedwa. Blockchavo ya novocaine imapangidwa kuchokera ku mfundo zitatu: muzu wa mesentery wamtundu wopatsirana, ulusi m'dera la duodenum ndi mchira wa gland. Mzere wawukulu kwambiri umachitika kudzera pakatseguka m'matumbo am'mimba ndikukhazikika ndi magawo osiyanasiyana a pepala la peritoneum kumtunda ndi m'munsi kumapeto kwa kapamba. Iwindo lomwe lili pamtanda limakulungidwa ndi suture osiyana.

Mkuyu. 34. Omentopancreatopexy

Microirrigator imayambitsidwa kudzera mu kutsegulira kochepa omentum. Kuphatikiza apo, ngalande za peritoneal dialysis zimatha kuyikiridwa.

Cholinga cha kulowererapo ndikulekanitsa kapamba kumbuyo kwa minofu ya peritoneal.

Khoma lam'mimba limawongoleredwa m'magawo.

Njira zazikulu zochizira matendawa

Njira zochizira matendawa zimatsimikiziridwa ndi akatswiri oyenerera, kutengera zifukwa zosiyanasiyana. Mlingo wazowonongeka, momwe wodwalayo angakhudzire njira zamankhwala zochizira. Choyamba, kugwiritsa ntchito mankhwala osokoneza bongo kumagwiritsidwa ntchito.

Chithandizo cha mankhwala osokoneza bongo chikuchitika moyang'aniridwa ndi dokotala kuchipatala. Zimaphatikizanso kubwezeretsa ntchito za chiwalo, kupondereza njira yotupa ndikubwezeretsa bwino.

Pa mankhwala, wodwalayo amakulimbikitsidwa kugwiritsa ntchito njira yochepetsera zakudya panthawi yonse ya chithandizo kuti mukwaniritse zabwino zambiri, ndipo kusala kudya kwa masiku angapo kumalimbikitsidwa munthawi yamankhwala olimbitsa thupi kuti muthe kuchira. Kwa wodwala, kuti muchepetse madzi a m'mimba pancreatic minofu, m'mimba timatsukidwa ndi kafukufuku wapadera.

Kuchepetsa acidity, zakumwa zamchere tikulimbikitsidwa.

Kuphatikiza pa kuchiritsa kwa zamzitini, ndizotheka kuchitapo kanthu opaleshoni.

Kuthandizira opaleshoni kuyenera kuchitidwa pamene wodwala ali ndi kachilombo ka pancreatic necrosis, ndikuwonetsetsa momwe wodwalayo akumvera. Ngati wodwala ali ndi pancreatic necrosis, yomwe ndi aseptic m'chilengedwe, njira zochitikira opaleshoni zimapangidwa mosamalitsa, chifukwa pamakhala chiopsezo kwambiri chotaya magazi mkatikati, matenda a malo osakhudzidwa, komanso kuwonongeka kwakukulu pamtunda wamatumbo.

Kodi opaleshoni ikufunika liti?

Opaleshoni ya laparotomy imayikidwa pokhapokha ngati aseptic gawo la matendawa. Sichosankhidwa, payenera kukhala zifukwa zomveka.

Ndondomeko ikuchitika ngati, motsutsana ndi maziko a zovuta chithandizo chamankhwala, kupita patsogolo kwa matendawa kumaululidwa ndikufalikira kwa matenda opatsirana kumadera ena am'mimbamo.

Njirayi ndi yovuta kwambiri motero imapatsidwa komaliza, ndiye kuti, nthawi zonse imakhala yofunikira.

Zingakhale zolakwika ngati atchulidwa popanda njira zoyambirira za zovuta kutsata. Njira yakugwirira ntchito ndiyosowa kwambiri, popeza pali zoopsa zazikulu.

Opaleshoni imatheka kokha mwa 6-12 peresenti ya odwala.

Zizindikiro za izi zitha kukhala motere:

• peritonitis
• Chithandizo cha Conservative sichikuyenda bwino kwa masiku angapo,
• ngati peritonitis imayendera limodzi ndi cholecystitis kapena purulent.

Nthawi yakulowererapo ndi yosiyana:

1. Oyambirira amatchedwa kulowererapo komwe kumachitika sabata yoyamba yamatenda.
2. Chakumapeto ndizomwe zimachitika mkati mwa sabata lachiwiri ndi lachitatu matendawa atadwala, popanda chithandizo.
3. Zochedwetsedwa zimachitika kale munthawi ya kukokomeza, kapena matendawa atatsala pang'ono kufika. Kuchitapo kanthu kotereku kumachitika pambuyo poti kudutsa kovutirako kutha.

Kuchita opaleshoni iliyonse kumathandizira kupewa kuti matenda asadzayambenso.

Mlingo wa kulowerera umatsimikiziridwa ndi zovuta za njira ya matendawa. Zimatanthauzanso kupezeka kwa purulent foci ndi zotupa za biliary system.

Kuti muwone izi, laparoscopy, kuyezetsa zam'mimba ndi zotupa zimachitika.

Kodi pamimba ndi chiyani?

Mtundu umodzi wothandizirana opaleshoni ndiyo kukhetsa ziphuphu. Kuchita koteroko pa kapamba kumaphatikizapo kuchotsedwa kwa kapamba pamimba m'matumbo kuchokera ku chifinya. Choyamba, amapatsidwa mankhwala ngati wodwala ali ndi peritonitis, pancreatic necrosis.

Panthawi imeneyi, kapamba amatsukidwa minofu yomwe ili pafupi kuti tisatenge matenda ena. Izi zimapangidwanso pofuna kupewa kufalitsa kwa poizoni kuti achepetse mphamvu yake pamatenda a gland. Kuthinjidwa kwam'mimba kumachitika kuti minofu ya chiwalo ikhale pang'onopang'ono ndi madzi a pancreatic.

Pofuna kuchitidwa opareshoni, kukonzekera mwatsatanetsatane kumachitika koyamba. Kukonzekeraku kumaphatikizapo kusonkhanitsa deta ndikuwunika mwatsatanetsatane ndi dotolo, mayeso onse ofunikira kuti atsimikizire kuti matendawa amatumizidwa.

Zolinga zazikulu za chithandizo cha opereshoni ndi:

• kupweteka
• zimathandizira kuti magwiridwe antchito a chinsinsi cha chiwalo,
• kuchotsedwa kwa poizoni ndi zoopsa zosiyanasiyana.

Opaleshoni iyi imalepheretsa kuwoneka kwa zovuta zochuluka zomwe zimakhudzana ndi kupitilira kwa kutupa mkati mwa ziwalo za thupilo.

Kuthandizira opaleshoni kumakhala ndi magawo otsatirawa:

1. Mawu oyamba ndi opaleshoni yodwala.
2. Kuchititsa laparotomy a chapamwamba pakati.
3. Gastrocolic ligament imasulidwa, ndiye kuti kapamba amayesedwa, pambuyo pake fiber imayesedwa.
4. Pansi pa kutulutsa, kupendekera kumapangidwa, kuwongoleredwa motsatira.
5. Zikondazo zimakokedwa kotero kuti mutu ndi mchira wokha ndi womwe umakhazikika.
6. Mapeto aulere a omentum amakokedwa kudzera m'munsi m'munsi mwa gland. Pambuyo pake, imabweretsedwa pamphepete ndipo imayikidwa patsogolo.
7. Thumba lamadzimadzi limayikidwa kudzera kumanzere kumanzere kumbuyo.
8. Khoma lam'mimba limadzisenda pang'onopang'ono, m'magawo.

Njira yolowererapo ndi yovuta, koma ndizotheka ngati dokotala wothandizira akudziwa bwino ntchito zovuta.

Kukonzanso pambuyo pamimba

Makoma akamakongoletsedwa, baluni yotseka imayikidwa pazitsulo, imafunikira kuti kuziziritsa chiwalocho.

Izi zimachitika motere: mkhungu umapangika pansi pa nthiti yakumanzere, yomwe chubu chake chimatuluka cholumikizana ndi silinda. Thupi limaziziritsa katatu patsiku, m'masiku atatu atatha kulowererapo. Wodwala akakhala bwino, baluni imachotsedwa. Gastroenterologists ndi lingaliro kuti kuziziritsa kukhazikika kwachilengedwe kumachitika mthupi ndipo kumathandizira kubwezeretsa.

Ngakhale ikuyenda bwino, njirayi ili ndi zotsutsana zina.

Opaleshoni sangachitike ngati:

• wodwala amadwala matenda oopsa,
• shuga wamagazi ambiri
• wodwalayo amakhala ndi mantha omwe samatenga nthawi yayitali,
• ngati kuchuluka kwa magazi komwe kwatayika chifukwa cha opareshoni sikungabwezeretsedwe.

Kuchotsa mimba ndichinthu chovuta kwambiri, motero zovuta zina siziperekedwa. Zitha kuchitika pokhapokha ngati opareshoniyo sachitidwa ndi dokotala wodziwa zambiri.

Kupatsirana ndikotheka, komwe mtsogolomo kumakhala ndi zotsatira zosayembekezereka.

Pali kuthekera kwakukulu kwa magazi. Zotsatira za Lethal ndizochepa, komabe siziyenera kupatula.

Zotsatira zabwino za opaleshoni sizimangotengera zofunikira za dokotala wothandizayo, komanso mkhalidwe wa wodwalayo, kukula kwakeko kwa kulowererapo.

Chofunika kwambiri, kupewa koyambirira kumachitika ngakhale matendawa asanadziwike okha. Choyamba, muyenera kuyambitsa zakudya zoyenera m'moyo wanu, osasiya kumwa pang'ono. Kukhala wakhama ndi kukana kwathunthu zinthu za fodya kumachepetsa chiopsezo chotenga matendawa.

Chithandizo cha opaleshoni ya pancreatic chafotokozedwa mu kanema m'nkhaniyi.