Post-necrotic pancreatic cyst: madzi akumwa amatheka bwanji?

Mayina ena: opaleshoni yam'madzi yopopera.

Pancreatic cyst ndimapangidwe am'mimba a pancreatic. Mitsempha ya cyst imadzaza ndi zotulutsa cham'mimba komanso minyewa ya khungu (minofu yowonongeka).

Cysts zowona kapena zatsopano komanso zokhala ndi cysts (pseudocysts) zimasiyanitsidwa. Choyambitsa chachikulu cha pseudocysts ndi pancreatitis yovuta komanso yovuta, kuvulala kwa kapamba. Mwachitsanzo, pancreatitis yovuta kwambiri imapangidwa ndi cyst mu 5-19% ya milandu, yayikulu - mu 20-40% ya milandu, kuvulala kwa chotupa kumawonekera mu 20-30% ya odwala.

Njira imodzi yochizira ma cysts ndi kutulutsira m'madzi, ndiye kuti, kukhazikitsidwa kwa zinthu zomwe zimatuluka mu cyst, zomwe zimayenera kutsogolera kwake komanso mtsogolo - kukonzanso. Drainage ndi njira ya opaleshoni yochizira pancreatic cysts; imagwiritsidwa ntchito molingana ndi zofunikira, chifukwa ndi njira yovomerezeka yolandirira.

Zomwe muyenera kudziwa ponena za matendawa?

Ndi mapangidwe a cyst, minofu necrosis imayamba, zomwe zimapangitsa kuti pakhale kuwonekera kwa granular misa ndikudziunjikira kwa katulutsidwe ka kapamba.

Pali mitundu iwiri ya ma cystic omwe amapanga - obadwa nawo komanso otengedwa.

A cyst ikhoza kukhudza magawo onse a kapamba - gawo la mutu, thupi la gland ndi gawo lake la mchira. Neoplasm imatha kukhala yosavuta kapena yovuta.

M'mayiko azachipatala, ma pathological patiski amagawika m'magulu awiri molingana ndi chikhalidwe chawo:

• Mitsempha yam'mimba yotupa chifukwa cha kutupa komanso
• neoplasms, pambuyo pake amapanga kutsekeka kwa ma ducts.

Nawonso zotupa zomwe zimachitika chifukwa cha zovuta za pachimake kapamba zimagawika:

1. Pachimake, omwe alibe makoma awo ndipo amagwiritsa ntchito pazinthu zotsekemera za England kapena ma ducts, pancreatic fiber. Nthawi zina m'malo mwa makhoma mumakhala zokutira za ziwalo zoyandikana.
2. Mapangidwe amadzimadzi am'madzi omwe ali ndi makoma a minofu ya fibrous.
3. Zotsatira za pancreatic necrosis zimatha kukhala mawonekedwe a patsekeke lodzala ndi mafinya - ichi ndi chopopera.

Pancreatitis ndiyomwe imayambitsa cysts, imati:

• mu kutupa kwambiri kwa kapamba - kuyambira 5% mpaka 20 peresenti ya milandu ya cysts yomwe imachitika pakatha masabata 3-4 akudwala,
• matenda a kapamba ndi chifukwa chachikulu cha mawonekedwe a post-necrotic cysts mu 75% ya milandu.

Nthawi zina, mawonekedwe a cystic amawonekera chifukwa cha mawonekedwe amiyala mu chikhodzodzo, pomwe kutulutsa kwa pancreatic madzi kumasokoneza.

Kuphatikiza apo, mapangidwe a cysts amatha kuchitika chifukwa cha kuvulala kwamakina, kapangidwe kake ka pancreatitis komanso stenosis ya sphincter ya Oddi.

Pathologies mu kapamba amapangidwa motere:

1. Kuwonongeka kwa zokutira kwa minofu kumachitika, komwe kumayendetsedwa ndi kudziunjikira kwa neutrophils ndi ma lymphocyte, njira zowonongeka komanso zotupa.
2. Dera lomwe lakhudzidwalo limakhala lopanda malire kuchokera ku ma cell a epithelial omwe amagwira ntchito, chifukwa chomwe kuchuluka kwa minofu yolumikizana kumayambira ndikuyamba kupindika.
3. Thupi, kuyesera kudziteteza ku njira zowonongeka, kugunda kutupa, maselo a chitetezo cha mthupi amawononga tinthu tating'onoting'ono poyang'ana njira yotupa yomwe imayambitsa khosilo.
4. Kutengera komwe kuli khomalo, madzi a kapamba, zokutira, zotupa, kapenanso magazi atha kudzikundikira. Mapeto ake amatha ndi kuwonongeka kwa mtima.

Kuphatikizika kwa magazi mkati mwazinthu zazikulu ndizomwe zimawoneka ngati zotupa, chifukwa ndi izo, kupanikizika mkati mwamkati kumatha kuwonjezeka katatu, komwe kumayambitsa ziwopsezo zazing'ono.

Zomwe zimayambitsa komanso zizindikiritso za pancreatic cysts

Posachedwa, pancreatic cyst ndi matenda ofala kwambiri. Kuopsa kopezeka, kukula ndi kuchuluka kwa mitundu yotereyi m'matumbo sizitengera zaka kapena mtundu wa munthu. Magawo onse aanthu ali ogonjera, ngakhale gawo lawo kapena zochitika zawo. Komanso, chotupa chingakhudze ziwalo zathanzi.

Ndikofunikira kudziwa kuti m'thupi lathanzi, mitundu yonyenga ya ma cysts sikhala. Komanso, imapangidwa chifukwa cha kusokonezeka kulikonse m'thupi.

Matenda ofala kwambiri ndi kapamba komanso kuvulala, mwachitsanzo, kuperewera kapena kugwira ntchito kwa dongosolo la duct. Izi zitha kuchitika ndi thrombosis, pomwe zolembera zitatseka chotengera.

Kuphatikiza apo, chotupa chimatha kupangidwa chifukwa chakuwukira kwa parasitic m'thupi. Koma gawo la mkango pamilandu ndi kapamba, mawonekedwe osakhalitsa omwe angayambitse kuwoneka kwa post-necrotic cyst.

Zotsatira zamaphunziro angapo azachipatala, zifukwa zotsatirazi zoyipa zomwe zimawoneka komanso kukulitsa mawonekedwe a cystic zatsimikiziridwa:

• kukonda mowa
• kunenepa kwambiri, komwe kumatha kuyambitsa vuto la lipid metabolism,
• mavuto obwera pambuyo opaleshoni ya ziwalo zomwe zimagwira chimbudzi,
• mtundu II matenda a shuga.

Kukhalapo kwa cyst mwa munthu ndikotheka, ngakhale kungafanane ndi chimodzi mwazinthu izi pamwambapa, zomwe zimakhudza magwiridwe antchito a kapamba.

Zizindikiro zomwe zimawonekera kwambiri nthawi zambiri cha cystosis:

1. Mukatha kudya kapena kumwa mowa, kupweteka kwambiri kwa herpes zoster kumawonekera, komwe sikopita pakumwa mankhwala. Kupweteka kwapafupipafupi kumatheka, kukulitsidwa ndi kudya, mapiritsi nawonso samathandizira kuchepetsa ululu. Kusanza pafupipafupi kumathandiza kuthetsa ululu.
2. Kulephera m'matumbo - kutsekula m'mimba, kupangika kwa mpweya m'thupi, kuphuka nthawi zonse.
3. Nthawi zambiri kutentha kwa thupi kumakwera, kuwonda kumawonekera, pamakhala kupweteka kwamphamvu kwakanthawi mbali yakumanzere.

Ndizodziwika kuti chizindikiro ichi chimatha pambuyo pa milungu ingapo, koma chizolowezi chosakhalitsa chodwalitsa wodwalayo ndi chifukwa chodandaula kwambiri, chifukwa ndiye kuti ululu umabweranso ndikulimba.

Ndizothekanso kuwoneka pakamwa pouma, kugwiritsa ntchito chimbudzi pafupipafupi osafunikira, komanso m'malo ovuta kwambiri - kutaya chikumbumtima komanso kugona.

Njira zodziwitsira ndi njira zamankhwala

Ngati dokotala wakupeza wavumbulutsa mwa wodwalayo zam'tsogolo mthupi kuti pakhale kupangika kwa kapamba, kuyezetsa kwa endocrinological kumachitika.

Ngati kukayikiraku kuli koyenera, ndiye kuti mndandanda wowonjezera umachitika.

Kuti muwone chithunzi chonse cha matendawa, kuti mudziwe kuchuluka ndi kuchuluka kwa ma neoplasms, ma radiation a ultrasound amalo omwe akhudzidwa amachitidwa.

Ngati pali purulent cystic neoplasms, kusinthasintha kwa zachilengedwe kudzakhalapo. Pofuna kuphunzira mosamalitsa ma neoplasms ndi momwe zimakhalira, kuti mudziwe ubale ndi othandizira komanso kulumikizana ndi ziwalo zina, MRI ya kapamba ndi CT zimachitika.

Kuti mupeze mankhwala molondola, ndikofunikira kudziwa ubale wa mawonekedwe a cystic ndi ma pancreatic ducts. Izi zimakuthandizani kuti muchite endoscopic retrograde cholangiopancreatography (ERCP).

Kwenikweni, ERCP imalembedwa ngati chithandizo cha mankhwala sichingatheke ndipo pakufunika kuthana ndi vuto la opaleshoni, pakati pawo pali njira monga kukhetsa kwa pancreatic cyst ndi marsupialization ya pancreatic cyst.

Njira yoyamba yoperekera opaleshoni ndiyo kukhetsa madzi kunja, komwe kumapangidwira kuchiritsa wodwala kuchokera ku mawonekedwe a cystic. Kuti mugwire bwino ntchito, ndikofunikira kuti ma cyst apangidwe ndi okulirapo (kupitirira masentimita 5).

Mtundu wachiwiri wa opaleshoni ndi womwe umapangidwira ngati ma dragege amatsutsana ndikusiyana kuti ma cyst samachotsedwa, koma amatsanulidwa, ndipo m'mphepete mwake amakankhidwa kumphepete mwa opaleshoni kuti opaleshoni isachitike.

Chithandizo chachipatala cha ma cystic formations ndikotheka ngati cyst ndi yokhayo, ili ndi malire omveka ndipo m'mimba mwake simapitirira 2 cm.

Njira yothandizira mankhwalawa kapamba ndi motere:

1. Pachigawo choyamba, wodwalayo ayenera kutsatira zakudya zowonjezera, kukana chakudya kwathunthu.
2. Kenako mutha kudya, kupatula zakudya zamchere, zokazinga ndi zamafuta kuchokera kuzakudya.
3. Kuletsedwa mwamphamvu zakumwa zoledzeretsa ndi malonda a fodya.
4. Kupuma pogona kuyenera kuonedwa mosamalitsa kwa sabata limodzi ndi theka.

Pambuyo pokwaniritsa zofunikira za gawo loyamba la chithandizo, mankhwala amalembedwa:

• kupewa ma virus atalowa mu cyst patsekeke yomwe imayambitsa kuwola, ma tetracyclines kapena cephalosporins ndi mankhwala,
• ma inhibitors adapangidwa kuti athetse ululu ndikuchepetsa kubisalira. Omez ndi omeprazole amadziwika kwambiri,
• kukonzekera okhala ndi lipase ndi amylase, kumathandizira kuti pakhale chimbudzi. Nthawi zambiri, Pancreatin ndi Creon amatchulidwa kuti azisintha njira zokumba.

Mapangidwe a cystic oyambitsidwa ndi biliary pancreatitis amafunikira chithandizo chowonjezera ndi mankhwala okodzetsa.

Nthawi zina mapangidwe a cystic amatha pambuyo pakutha kwa chinthu chomwe chimapangitsa mapangidwe awo. Ngati chithandizo cha mankhwala sichinayende bwino mkati mwa mwezi umodzi wa kalendala, opaleshoni imayikidwa.

Mutha kupeza ndemanga zambiri zothandiza pa njira zina zamankhwala, kuphatikiza mankhwala ophatikizira a burdock, celandine, mummy, ndi zina zambiri, koma palibe umboni wina wodwala. Chifukwa chake, ndikoyenera kufunsa funso, kodi ndikofunikira kuyika thanzi ndi kuyesa?

Zakudya za mitundu yama cystic zimafanana ndi chakudya cha kapamba. Zakudya ndizofunikira kuti muchiritse bwino mankhwala, ngakhale ndi mankhwala kapena opareshoni. Chofunikira kuti munthu abwezeretsedwe pambuyo pake, ndikutsatira kwambiri zakudya zopatsa thanzi.

Zotsatirazi ndizoletsedwa:

• zakudya zamafuta
• chakudya chokazinga
• Zakudya zamchere (ndipo nthawi zina kukana mchere kwathunthu ndikofunikira).

Ndiosafunika kudya zakudya zozizira kapena zotentha ndi zakumwa. Muyenera kudya zakudya zotentha zokha. Chakudya chophatikiza chimayenera kukhala pansi mu blender kuti chithandizire kugaya. M'pofunika kuganizira za zakudya zosiyana. Ndikulimbikitsidwa kudya pang'ono, koma nthawi zambiri.

Chithandizo cha post-necrotic cysts chikufotokozedwa mu kanema munkhaniyi.

LAPAROSCOPIC INNER TOTHER Pseudocyst wa kapamba

Ma pancreatic pseudocysts osagwiritsidwa ntchito popereka chithandizo nthawi zambiri amathandizidwa ndi kukhetsa kwamkati m'mimba, duodenum kapena jejunum, kutengera ndi malo a cyst. Nthawi zambiri, ngalande zamkati zam'mimba zimachitika pansi pa kayendetsedwe ka ultrasound kapena x-ray. Mabukuwa amapereka zotsatira zabwino pogwiritsa ntchito njirayi pafupipafupi 60 mpaka 80% ya milandu, komabe, mpaka ma pseudocysts atathetsedwa kwathunthu ndi mankhwalawa, amatenga sabata 4 mpaka 12.

Ubwino wa laparoscopic wamkati wamkati wamatumbo wa pancreas umagona kuthekera kwa atraumatic kugwiritsa ntchito anastomoses kwathunthu komanso pakalibe kufunikira kwa kukhetsa kwina. Cystogastrostomy yoyambirira ya laparoscopic idachitika mu 1991.

Njira yomwe amagwiritsidwa ntchito kwambiri ndi cystogastrostomy njira yomwe akufuna ndi L. Way. Malingana ndi njirayi, kaboni dayokisai imadzilowetsa m'mimba kudzera mu chubu la nasogastric, ndipo kenako amayambitsa. Mimba yopanda magazi imagwiritsidwa ntchito ngati malo opangira opaleshoni.

Laparoscopic ascastric cystogastrostomy

Pali njira ziwiri zogwirira ntchito zotere. Yoyamba imayamba ndi kuzindikira lapaproscopy kudzera mwa umbilical. Magawo awiri owonjezerapo amayambitsidwa kuti awonekere m'malo amtunduwu. Mogwirizana ochita endoscopy. Ngati khoma lakumbuyo kwa m'mimba silikuwoneka bwino, ngalande ikhoza kuyikika. Kuwongolera kwa laparoscopic kumapangitsa kupangika kwa anastomosis pakati pa khoma lakumaso kwa khomo lakhomalo ndi khoma lakunja la cyst moyang'aniridwa ndikuwoneka ndipo, ngati kuli kotheka, muziyendetsa pseudocyst.

Njira yachiwiri yotsutsa ya cystogastrostomy imagwira intraluminally (kuchokera m'mimba) pogwiritsa ntchito trocar yapadera yomwe ikukulira cuff. Ma trogar awa ali ndi baluni yotsika kumapeto kuti ikonzekere m'mimba kuti opaleshoni yamkati yamitsempha ingachitike ndi ma tracars awiri owonjezera. Ma trogars ogwiritsidwa ntchito amakhala ndi mainchesi a 5 ndi 7 mm motero musalole kugwiritsa ntchito clip clip kapena ELSA. Komabe, chifukwa cha kangagawo kakang'ono kotere, zotseguka khoma la m'mimba ndizochepa, ndipo zimatha kuthekera ndi seams imodzi 2-0 (silika kapena zinthu zotengeka).

Wodwala yemwe ali patebulo logwiritsira ntchito wagona kumbuyo kwake. Pneumoperitoneum imayikidwa. Malikulu atatu amabwezedwa: mdilical dera (11 mm), kumanzere kwa midline (11 mm) ndi kumanzere (5 mm). Procar yoyamba ya intraluminal imalowetsedwa m'dera la epigastric pamwamba pa pseudocyst kudzera khoma lam'mimba komanso khoma lakunja kwa m'mimba. Pambuyo pochotsa matayala, kuwuma kwa trocar kumakwera, motero kumakonza chida chija kukhoma lam'mimba ndikupanga cholimba mu kuwala kwake. Intraoperative makonzedwe a gastroscope amakupatsani kukhazikitsa nasogastric chubu ndi insufflate mpweya m'mimba pa ntchito yonse. Kuti muwone ngati khoma lakumbuyo kwam'mimba, pakhale pataroscope 5mm molunjika. Gawo lachiwiri la intraductal lakhazikitsidwa pafupifupi 8 cm kumanzere kapena kumanzere kwa ulimi wothirira.

A cyst amadziwika mothandizidwa ndi singano zazitali zomwe zimayikidwa transdermally kudzera khoma lakutsogolo kwa m'mimba, ndipo motsogozedwa ndi laparoscopic intraluminal visual control, khoma lachiberekero cha m'mimba limakhazikika m'dera lachitukuko cha cyst. Kukweza zomwe zili mu cyst kumatsimikizira malo oyenerera a ziwiyazo ndikuwonetsa kusowa kwa zowononga ziwiyazo. Gastrostomy yokhala ndi kutalika kwa 4-5 masentimita imagwira ntchito limodzi ndi khoma lakumbuyo mothandizidwa ndi "ogwiritsawo". Zomwe zili mu cyst zimachotsedwera, patsekelo limatsukidwa ndikuwunika. Kupatula chotupa cha cystadenomatous, biopsy ya cyst wall imachitika.

Tini ya nasogastric imakhalabe m'mimba, trocar balloon desufflates ndipo zida zimachotsedwa. Ma punctur m'mimba amatsekedwa ndi ma intracorporeal sutures osiyana ndi silika 2-0. Kwa maola 24-48, ngalande ya Jackson-Pratt imabweretsedwa m'dera la anastomosis. Madzi am'mimba amatha kuperekedwa kuyambira tsiku lachiwiri pambuyo pakukoka kwa laparoscopic kwa pancreatic cyst. Kenako onetsetsani kukula kwa anastomosis - gastrography yokhala ndi madzi mosiyanitsa. Odwala pambuyo pa laparoscopic drainage wa pancreatic cyst akhoza kutulutsa tsiku lachisanu.

Mawonekedwe a kukhetsa kwa pancreatic cyst

Njira yofunika yowerengera komanso kuchiza matenda a pancreatic cysts ndi kudzera mu madzi. Izi zimachitika motsogozedwa ndi ultrasound pogwiritsa ntchito ma drains apadera. Pogwiritsa ntchito njirayi, mutha kuchotsa mapangidwewo popanda kugwiritsa ntchito opaleshoni. Ndondomeko ikuchitika mothandizidwa ndi mankhwala ochititsa dzanzi.Ndondomeko imachitidwanso pambuyo opaleshoni. Kukhetsa kwamakono kumapeto kwake kumathandiza kupewa zovuta, chifukwa cholinga chotseguka ndi purulent kumatseguka moyenerera.

Kodi kuboola pancreatic cyst kumachitika bwanji?

Pancreatic punuction imachitika pamimba yopanda kanthu. Asanazindikire matendawo, wodwalayo ayenera kuchita zambiri. Duodenum ndi malo abwino kupeza kubooleza, chifukwa amayenda pang'ono ndi kapamba. Kukonzekera biopsy kumapangitsa kuti athe kupeza madzi owunikira pamaso pa maselo a khansa kapena mitundu ina. Njira yodziwikirayi idapangidwa kuti iphunzire ma cell a gland osapangidwa. Njira yotchingira malembedwe otetezedwa imasankhidwa motsogozedwa ndi kupanga kwa ultrasound. Njira yowombera imachitika pogwiritsa ntchito masingano omwe ali ndi zilembo, zomwe zimachotsa chiopsezo chakuboola mwangozi munthawi imodzimodziyo. Njira yodziwikirayi imakuthandizani kuti mupeze madzi kuti mufufuze bwino za momwe mapangidwewo adapangidwira. Pambuyo pa njirayi, wodwalayo amayang'aniridwa kwa maola awiri, pambuyo pake amapita kwawo.

Laparoscopy ya pancreatic cyst

Pamaso pa opaleshoni, kupezeka kapena kusowa kwa metastases mu kapamba kumatsimikiziridwa pogwiritsa ntchito njira yamakono ya laparoscopy. Pogwiritsa ntchito njira yodziwitsira matenda, mutha kusankha njira yabwino yochiritsira matenda, ndikujambulanso njira yomwe mukufuna. Laparoscopy ndi njira yosavuta komanso yotetezeka yochizira ma pancreatic cysts; samayendetsedwa ndi kuchuluka kwakukulu kwavulala poyerekeza ndi ena. Pogwiritsa ntchito mtundu wamtunduwu wazodziwitsa, mtundu wa maphunziro ukhoza kufotokozedwa. Kugwiritsa ntchito njirayi kumachepetsa kwambiri kupweteka kwa postoperative, kuchepetsa nthawi yakuchipatala komanso nthawi yobwezeretsa. Kuchira msanga kwa thupi kumafotokozedwera chifukwa chakusowa kufunika kopanga laparotomy yayikulu kuti ikwaniritse zolimba ndi ziwalo zamkati kuti athe kuyandikira. Chifukwa cha njira iyi yochizira, chithunzi chabwino kwambiri chautomiki chitha kupezeka, chomwe ndichofunikira pochita ndi kapamba, yemwe amakhala ndi ziwiya zazikulu m'dera lomwe lingagwiriridwe ntchito.

Kuwongolera kwapamwamba kwa tsamba la Leading Medical Hyde kumachitika kudzera m'njira zotsatirazi.

• Malangizo oyang'anira malo azachipatala
• Zosachepera zaka 10 mu utsogoleri
• Kutenga nawo gawo pazitupa ndi kasamalidwe kaumoyo wabwino
• Chiwerengero chopitilira pachaka cha kuchuluka kwa ntchito zomwe zachitika kapena njira zina zamankhwala
• Kugunda kwa njira zamakono zodziwitsira za matenda ndi opaleshoni
• Kukhala mu kutsogola mayiko akatswiri

Kodi mufunika thandizo lathu kuti mupeze dokotala?

Pancreas anatomy

Chikondamoyo (kapamba) chimakhala kumtunda kwam'mimba pakati pa matumbo ang'ono ndi ndulu. Amatulutsa madzi ofunika a pancreatic (pancreatic), omwe amakhala ndi ma enzymes omwe amayambitsa kuwonongeka kwa mafuta, mapuloteni komanso chakudya chamafuta pakudya.

Madzi a m'mimba (m'mimba) amalowa mu duodenum kudzera pakabowole (pancreatic), gawo lomaliza lomwe limagwirizana ndi gawo lomaliza la bile duct, momwe madzi a bile amalowanso mu duodenum. Ntchito yotsatira yofunikira ya kapamba ndikupanga mahomoni a insulin ndi glucagon, omwe amawongolera shuga la magazi ndipo amakhala ndi zotsutsana nazo. Ma mahomoni amapangidwa m'maselo apadera a kapamba. Matenda a kapamba (kapamba) amatha chifukwa cha zinthu zambiri.

Pachimake kapamba

Ngati nkovuta kuthira madzi am'mimba, mwachitsanzo. chifukwa cha cholelithiasis (gawo lomaliza la mapindikidwe az kapamba ndi ma ducts a bile) kapena chifukwa cholimbikitsidwa kwambiri ndi maselo (kumwa mowa kwambiri), pakhoza kulephera pakuyenda kwa ma enzymes m'matumbo - kapena chifukwa chopanga kwambiri, gawo limodzi laiwo lidzatsalira kapamba, kuwononga maselo a kapamba kapenanso kuwawononga. Zotsatira zake, kutupa kumachitika, komwe kumayambitsa pancreatic edema, ndikupangitsanso kutulutsa kwa kutulutsa madzi.

Ngati simutenga kufinya kwa kapamba amene amayang'aniridwa, imafalikira ndipo msuzi “wamkali” ukhoza kuyamba kusokoneza kapangidwe kake kapenanso zida zomwe zimayandikana nawo, ndikuziwononga. Mtundu wowopsa wa kutupa kwa kapamba (wotchedwa necrotizing pancreatitis) nthawi zina umatha kupha.

Chithandizo cha pachimake kapamba

Choyamba, chithandizo chamankhwala chikuchitika, i.e., chosachitidwa opaleshoni. Nthawi yomweyo, kupewa kudya ndikofunikira kuti usalimbikitse kapangidwe ka madzi am'mimba, komanso kuthamanga kwamadzimadzi okwanira kuti mukhale ndi njira yogaya chakudya. Pofuna kupewa matenda chifukwa cha minofu yakufa, mankhwalawa amaperekedwa nthawi zina. Pokhapokha ngati matendawa atha kutsimikizika kapena kupezeka kwa cyst yabodza (monga tafotokozera pansipa), kuchitira opaleshoni kumafunika. Ndikofunikanso kudziwa zomwe zimayambitsa kutupa, kuti zithetsedwe. Ngati choyambitsa, mwachitsanzo, ndi matenda a ndulu, miyala iyenera kuchotsedwa - nthawi zina, kuchotsedwa kwa chikhodzodzo chonse kungafunike.

Matenda a kapamba

Nthawi zina, kutupa kwanyani kwa kapamba kumathandizidwa popanda kusiya zotsatira zake, koma kungayambitsenso kufa kwa cell ndikupanga minyewa yosagwira ntchito. Ngati minyewa yansonga imayambitsa kuchekera kwa zikondamoyo, izi zimayambitsa kutupa kwa ziphuphu zakumaso. Akatswiri amalankhula za chifuwa chachikulu chomwe chimatenga nthawi yayitali.

Kukula kulikonse kwa kutupa kumakhala koopsa ndi kufa kwa maselo ndipo, monga chotulukapo chake, kuletsa ntchito kwa kapamba, komwe sikungathenso kupanga michere yokwanira yogaya chakudya. Mwanjira imeneyi, michere yambiri imalowa m'matumbo, zomwe zimapangitsa kubereka kwambiri, komwe kumayambitsa kutsekula m'mimba (m'mimba). Amawonanso "zopondchera mafuta" chifukwa chosowa ma enzymes omwe amagwira ntchito pakugawa mafuta ndi ululu pamimba pamimba, kutuluka kumbuyo.

Panthawi yomwe ikupita patsogolo, matenda a shuga amatha chifukwa cha kuchuluka kwamahomoni (insulin ndi glucagon) omwe amawongolera shuga. Chochulukitsa chomwe chimayambitsa matenda am'mimbazi kumayiko a Azungu ndi mowa, pomwe sichimakhala chokhudza kumwa mowa kwambiri, chifukwa mwa anthu ena ngakhale pang'ono mlingo wa mowa umatha kukhala chothandizira kukulitsa matendawa. Zina zofunika kwambiri za chifuwa chachikulu: kuperewera kwa cholelithiasis, kusauka kwa majini, kubadwa kwa pancreatic duct ndi matenda a metabolic. Nthawi zina, sizomwe zimayambitsa.

Pancreatic cyst

Ngakhale patadutsa zaka zochepa pambuyo pathupi wamatenda otulutsa kapamba, chotupa chabodza (chotupa cha cellular) cha kapamba chimatha kuchitika. Cyst iyi imatchedwa yabodza chifukwa khoma lake lamkati silikhala ndi ma mucous membrane. Cyst yabodza ilibe tanthauzo lachipatala ndipo pamaso pa madandaulo (kumva kutopetsa m'mimba, nseru, kupweteka, ndi zina), imangoyenera kuchitidwa opareshoni.

Khansa ya Pancreatic - Khansa ya Chamba

Otchedwa ductal pancreatic adenocarcinoma ndi mtundu wofala kwambiri wamatumbo. Khansa ya pancreatic ndiyowopsa makamaka, chifukwa ndi chotupa chomwe chikukula msanga chomwe chimatha kukula kukhala minofu yoyandikana. Kuphatikiza pa cholowa chamtundu wa chibadwa, pali zinthu zingapo zomwe zimayambitsa khansa ya kapamba. Zina mwa zinthuzi ndi monga nikotini, mowa, zakudya zambiri za cholesterol ndi nitrosamine, komanso pancreatitis yosatha.

Nthawi zambiri, matendawa amadzipangitsa kumverera pang'onopang'ono ndipo zizindikiro zake zimatengera komwe kuli chotupa. Ngati chotupa chili m'mutu wa kapamba, ndiye kuti chotupacho chikamakula, bile limazungulira. Izi zimabweretsa kukokomeza kwa bile ndi chikaso cha khungu la nkhope ndi maso sclera (lat. Icterus).

Ngati chotupa chili pakatikati kapena mchira wa kapamba, ndiye kuti izi zimabweretsa ululu pamimba pamimba ndi kumbuyo, chifukwa malo am'mimba omwe amapezeka kumbuyo kwa kapamba amakwiya. Maonekedwe a shuga amathanso kuwonetsa khansa ya pancreatic. Chithandizo cha opaleshoni ya kapamba ndi njira yokhayo yomwe imapatsa wodwala mwayi wochizira matendawa.

Ndi mayeso ati omwe amayenera kuchitidwa asanafike opaleshoni ya pancreatic?

Komwe kakhansa m'thupi kumapangira kufikira. Pafupi pake pali m'mimba, matumbo ang'ono ndi ndulu ya ndulu ndi ma ducts a bile, omwe nthawi zambiri amapangitsa mayeso. Chifukwa chake, malingaliro omwe amayang'anira kupezeka kwa khansa nthawi yayitali kwa odwala popanda madandaulo sikumveka. Pankhani ya khansa ya kapamba, kuzindikira kumalephereka ndi kuchedwa kwa chizindikiritso. Chifukwa chakuti kapamba amapezeka kutsogolo kwa msana ndipo mitsempha ya m'mitsempha yake imayambitsa kupweteka, chifukwa chake kuyambitsa kuzindikirika kwa matendawa.

Nthawi zambiri zimachitika kuyezetsa magazi. kudziwa kuchuluka kwa michere ya pancreatic m'magazi, ndipo ngati khansa ikukayikiridwa, kuyesa kwa oncomarker (CEA, carbohydrate antigen-19-9) kumachitika. Mulimonsemo, zikuchitika Ultrasound ya kapamba ndipo monga lamulo, kutengera funso, zopangidwa tomography ndi MRCP (magnetic resonance cholangiopancreatography). Momwe ma bile ndi ducts za kapamba zimatha kuwonekera. Ngati pakufunika chithandizo chamankhwala (mwachitsanzo kuchotsedwa kwa miyala ndi ducts ya bile), choyambirira ndicho ERCP (endoscopic retrograde cholangiopancreatography). popeza mukamayesedwa mutha kulandira chithandizo nthawi yomweyo.

Endoscopic retrograde cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography (ERCP) imagwiritsidwa ntchito kuwona mawonekedwe a ndulu ndi ma ndulu a bile, komanso chimbudzi cha ma pancreas kudzera mwa wothandizira wosiyana ndi x-ray. Chifukwa cha kuyandikana kwa kapamba ndi ziwalo zoyandikana, amafunikiranso kuyesedwa. Izi zimaphatikizapo m'mimba, matumbo, ndi m'mimba.

Kubwezera chitsimikizo cha matenda a oncological sikofunikira

Kutsimikizira kwa matenda a oncological asanafike pochita opaleshoni ya pancreatic pogwiritsa ntchito punct kapena biopsy (sampuli ya minofu) sikulimbikitsidwa ndipo nthawi zina kumakhala kosatheka chifukwa chakumaso kwa kapamba (kumbuyo kwa patsekeke pamimba). Kuphatikiza apo, magazi kapena fistula zimatha kupangika pakapumira. Poganizira zinthu zonsezi, akatswiri amafunafuna kuti apange opaleshoni kupita ku kapamba ndikuchotsa zotumphukira zonse monga gawo la opaleshoni yam'mimba.

Zomangidwanso pambuyo pakuchita opaleshoni pa kapamba

Chifukwa chakupezeka kwapadera kwa zotupa m'dera la kapamba wam'mimba, nthawi zina kuchotsedwa kwa gawo la duodenum ndi m'mimba, chikhodzodzo, komanso gawo la kapamba amafunikanso. Opaleshoni amapanga mafupa ochita kupanga (anastomoses) - matumbo a matumbo, komanso kulumikizana kwa matumbo a matumbo ndi bile duct ndi kapamba, kuti abwezeretse kayendedwe kudzera m'mimba.

Opaleshoni Yamapazi: Postoperative

Pambuyo pochotsa kapamba, ndikofunikira kutenga michere yokugaya ndi chakudya. Mlingo umakhazikitsidwa payekhapayekha, kutengera kuchuluka kwa ndulu ndi gawo lake, komanso momwe wodwalayo aliri. Ngati ndulu zachotsedwa, ndiye kuti kuwunika kwa mankhwalawo ndikofunikira. Ngati akwezedwa m'magazi, njira za thrombosis prophylaxis zingafunike.

Ngakhale pa nthawi ya opaleshoni ya kapamba ndipo pambuyo pake, wodwalayo alibe matenda a shuga, ndikofunikira kuchita mayeso a shuga wamagazi, chifukwa chifukwa cha opaleshoni yamapapo pali kuthekera kwa matendawa. Kuyesaku kutha kuchitika kawiri pachaka pogwiritsa ntchito kuwunika kwamagazi wamagazi kapena kuyesedwa kwa shuga m'mlomo.

Ngati, ngakhale mutasintha njira zopangira opaleshoni, pomwe m'mimba simachotsedwa, mavuto azakudya akupezekanso, mutha kuyang'ana kwa alangizi othandizira zakudya. Pambuyo pa opaleshoni yochotsa khansa yapakhungu, kutsatiridwa pafupipafupi ndi dokotala ndikofunikira. Kuphatikiza pa kuyezetsa thupi, kupukusa kwam'mimba kwam'mimba kumachitika, komanso kuwunikira zolembera za CEA ndi antigen 19-9 m'magazi.

Kufufuza kwamtsogolo kwa odwala omwe akuchitidwa opaleshoni kuti athetse khansa ya pancreatic koyambira kumachitika miyezi itatu iliyonse. Kupitilira apo, malinga ndi malangizo azachipatala komanso malingaliro a adotolo, kupita patali kwa mayeso kumatha kuchuluka. Mankhwala ena omwe angapangidwenso ndi chemotherapy amachitidwa monga momwe adalembera wa oncologist.

Kuopsa ndi zovuta za opaleshoni yamankhwala opaleshoni

Pylorus-pancreatoduodenal resection ndi njira yoopsa kwambiri yoyendetsera opaleshoni, koma zovuta ndizosowa. Vuto lalikulu kwambiri ndi kupindika kwakanthawi kwam'mimba, chifukwa cha edema ya anastomosis ya m'mimba. Vutoli limakhala lakanthawi ndipo limachoka ukangotupa tiziwoneka. Mavuto omwe amapangidwa ndi mankhwala opangidwa mwaluso amapezeka mu 10% ya odwala. Kutulutsa kwachiwiri kumatseguka mu 5-10% ya odwala onse.

Zisonyezero zamkati wamadzi

Popeza ngalande, monga njira zonse zowukira, sizotetezeka kwathunthu, pali zisonyezo zina za njirayi. Zotsatira zakuthandizira opaleshoni mwachindunji kwa kapamba ndizomwe zimayambitsa zovuta za postoperative, zomwe mu milandu yoposa 50% imayambitsa imfa.

Ngati ngalandeyo singathe kukhazikitsidwa munthawi yake, fistulas for the m'mimba, komanso chifukwa chosakwanira kutuluka kwamadzi ambiri okhala ndi ma enzymes, magazi amatuluka m'malo pambuyo pa ntchito.

Zisonyezero zamadzi:

• bala la postoperative
• Zotupa za kutulutsa kosiyanasiyana: mu thumba lodzikongoletsera ndi pansi pa chifanizo, nthawi zina m'malo ena am'mimba,
• cysts.

Izi pathological zikhalidwe zimatha kutulutsidwa pazotsatirazi:

• ndi kusagwira bwino ntchito kwa mankhwala othandizira, makamaka maantibayotiki,
• Ndi zowawa zazikulu,
• ndi chiwopsezo chachikulu cha zovuta,
• ndi zilonda.

Kukhetsa koyenera panthawi yake ndiko kupewa zovuta zakupha: zimathandizira kuwulula kwa pathological foci ndi mitsinje ya purulent ndi kuyeretsa kwawo.

Kodi ngalawa ndi iti?

Ntchito yayikulu ndikuchotsa mafinya ndi kuchotsa pachilonda.

Pogwira opaleshoni, kuwonongeka kwa minofu kumachitika, ndipo kenako kutuluka kwawo kwa aseptic (njira ya chitukuko chake imagwirizanitsidwa ndi kuwonongeka kwa maselo). Njira yotupa yomweyi imayendera limodzi ndi kukwiya - gawo lamagazi lamadzimadzi limayenda kulowa m'malo ammbuyo wammbuyo. Ndi pancreatic necrosis, kuwonjezereka kwa chilondacho kumayamba. Izi zimayambitsa kuchuluka kwakukulu kwa madzimadzi ndi mapangidwe a mafinya - chifukwa cha kupezeka kwawo, matendawa amatha kufalikira mthupi.

Cholinga chachiwiri chadzakumwa ndikuwongolera momwe machitidwe akuvulala:

• ndi kuchuluka kwa mankhwala akumatumbo a purified, kuchuluka kwa kutukusira kapena kusakanikirana kwa matenda kumatsimikiziridwa, pamaziko omwe adokotala amasintha mankhwalawa.
• mulingo wa amylase pazomwe zimatsimikizira gawo la machiritso,
• Ngati magazi akutuluka mu ngalande, amachitanso opareshoni yachiwiri.

Kukhetsa kwa positi

Kutengera zolinga zomwe ngalandeyo idayikirako, malo omwe masanjidwe ake akhoza kukhala osiyana. Madzi akhungu amagwiritsidwa ntchito kwambiri kutulutsa kuchokera ku bokosi lodzikongoletsera. Pazifukwa izi, machubu amaikidwa kudzera kumadula kumanzere kumanja ndi kumanzere kwa hypochondria. Nthawi zina mitundu ina imagwiritsidwa ntchito: ngalande zimachitika kudzera m'dera lumbar.

Popewa kuphonya zovuta, kutaya kumayang'aniridwa pogwiritsa ntchito ngalande yomwe idayikidwayo. Ndi kuchuluka kwa chinsinsi cha mafinya, mlingo kapena maantibayotiki pawokha amasintha. Mitsempha yomwe mumayikiramo madzi amalumikizidwa ndimakina ndikuchotsa zithandizo zamaanti kapena ma anesthetics.

Contraindication for drainage

Drainage simachitika ngati:

• zotupa zopezeka pancreatic cyst,
• kusinthika kwakatikati mkati mwa chotupa,
• kusintha kosonyeza khansa ya England.

Kukonzekera njirayi

Kukonzekera drainage ndi kufufuza kwathunthu kwa wodwalayo:

• labotale, kuphatikiza kuyesedwa kwa magazi (ambiri kuchipatala, zamankhwala am'mimba, coagulogram, hepatitis ndi HIV),
• njira zantchito - ultrasound OBP ndi ZP, CT kapena MRI.

Maola 8 asanafike pamchitidwewu, kukana kwathunthu chakudya kumafunikira.

Pancreatic Drainage Technique

Njira yokhazikitsira ngalande imachitika m'magawo.

Mitsempha yamkati ya laparoscopic - mkati mwa kulowerera kwa laparoscopic, cystogastrostomy imapangidwadi.

Zovuta zomwe zingayambike panthawi ya kukhetsa kwa ndowe

Kukhetsa kwa gland nthawi zambiri kumakhala kovuta. Mavuto owopsa a njirayi ndi monga: