Opaleshoni ya pancreatic - Zizindikiro ndi njira, chithandizo ndi zakudya mu nthawi ya postoperative

Ndi pancreatitis, kuvulala kwachikondwerero cham'mimba komanso zinthu zina zowopsa zomwe zimachitika ndi thupi, opaleshoni imachitidwa. Kukula kwa chithandizo choterocho kumatsimikiziridwa ndi gawo la matendawa komanso momwe thupi liliri. Opaleshoni yamatenda a m'mimba imawonedwa ngati imodzi yovuta kwambiri. Cholinga chake ndikuti sizikudziwika kuti chiwalochi chizichita bwanji nthawi ya opaleshoni iyi. Opaleshoni ya pancreatic imadziwika ndi chiwerengero chachikulu chaimfa, chifukwa chake, panthawi yakukonzanso, malamulo apadera angapo ayenera kuyang'aniridwa.

Zisonyezo za opaleshoni ya pancreatic

Kuthandizira kwa opaleshoni ya kapamba (kapamba) kumachitika mosamalitsa monga momwe zikuwonekera, pomwe palibe njira zina zochiritsira zomwe zingathandize kuchepetsa wodwalayo kapena kumupulumutsa kuimfa. Milandu yotereyi imaphatikizapo matenda ndi matenda:

kukokoloka kwa chifuwa chachikulu, limodzi ndi ululu waukulu.
kuvulala kwachikopa ndi magazi,
zotupa
neoplasms yoyipa,
necrotic pancreatitis ndi kukula,
pseudocysts ndi cysts, limodzi ndi kuphwanya kwa thupi ndi zowawa,
pachimake kutupa kwa kapamba ndi peritonitis ndi kapamba necrosis.

Zovuta za Pancreatic

Ntchito ya kapamba ndikupanga ma enzymes apadera omwe amafunikira kugaya, komanso mahomoni a insulin ndi glucagon omwe amawongolera kagayidwe kazachilengedwe. Gland imakhala ndi zovuta kupanga: imapangidwa ndi minyewa komanso yolumikizana, imakhala ndi network yolumikizana ndi zombo komanso ma ducts. Pancreas amatanthauza ziwalo za parenchymal, i.e. imakhala ndi stroma yopanga chimango, ndi parenchyma (chinthu chachikulu).

Kutikako kumakhala kumtunda kwam'mimba - mkati mwamkati mwa peritoneum, kumbuyo kwa m'mimba. Magawo atatu a gland awa amadziwika: mchira, thupi ndi mutu. Kuphatikizika sikungokhala kapangidwe kake ndi kagwiritsidwe kake, komanso malo kapamba. Mpandawo umakhazikika pamutu pake, ndipo kumbuyo kwake kuli chiwalo cholumikizana kwambiri ndi msempha, kutulutsa kwa adrenal, komanso impso yolondola. Madokotala samvera odwala omwe ali ndi matenda kapamba chifukwa cha zifukwa zotsatirazi:

njira yama pathologies omwe amagwirizanitsidwa ndi chiwalochi ndizovuta kulosera chifukwa chakuti sizimamveka pang'ono pokhudzana ndi pathogeneis ndi etiology.
malo osokoneza bongo komanso mawonekedwe osokoneza bongo a chimbudzi chimayambitsa zovuta pa opaleshoni,
ndi kulowererapo kwa kapamba, zovuta zimatha kupezeka, kuphatikizapo magazi ndi kuwonjezereka.

Kodi opaleshoni yamapamba imachitika bwanji?

Ndi chithandizo chofunikira mwadzidzidzi kwa wodwala, kuchitapo kanthu opangira opaleshoni kumachitika pa kapamba. Pakupanga opaleshoni, munthu amakhala ndi opaleshoni ya minofu ndi minyewa yopuma. Opaleshoni imaphatikizapo izi:

kutsegula kwa kapamba
Kuthetsa chikwama magazi
kusintha misozi,
kutsegula ndi kuvala ndi hematomas,
pamene chiwalo chikugundika, suture imagwiritsidwa ntchito kwa iye ndipo chimbudzi cha pancreatic chimakodzedwa nthawi yomweyo,
pamene kuphwanya kwakukulu kumayikiridwa mu mchira wa ndulu, imachotsedwa limodzi ndi mbali ya ndulu,
pakuwonongeka kwa mutu wa chiwalo, ntchito yake imagwiranso ntchito, koma ndikagwira gawo la duodenum,
kukhetsa kwa thumba lodzikongoletsera kuchotsera pambuyo pake pazomwe zili pachilonda.

Opaleshoni yokhala ndi pancreatitis pachimake

Pankhani ya pancreatitis pachimake, madokotala samapereka ziwonetsero zomveka bwino zothandizira opaleshoni. Zimafunikira kuti pakhale zovuta zowopsa za matendawa, zomwe zimatsogolera pakuphedwa kwa wodwala. Zizindikiro zotere ndizophatikizira izi:

zotupa zapachifuwa,
purulent peritonitis,
kusowa kwa mphamvu yochizira masiku awiri,
purulent kuphatikizidwa kwa minyewa minofu - kachilombo pancreatic necrosis.

Vutoli lotsiriza limapezeka mu 70% ya milandu ya kapamba ndipo ndiyowopsa kwambiri, chifukwa popanda chithandizo champhamvu, kufa ndi 100%. Mitundu yotsatirayi ikuthandizira kupewa imfa:

Tsegulani laparotomy. Ndi njirayi, khoma lakunja lam'mimba limatulutsa. Pafupifupi 40% ya milandu, wodwalayo amafunikira laparotomy kuti achotse madera a necrosis omwe amapangidwanso pakubwezeretsanso. Pazifukwa izi, pamimba pamimba nthawi zambiri simakodzedwa, koma kumatseguka.
Khalid Opaleshoni yamapazi iyi chifukwa cha kapamba ndi kuchotsedwa kwa necrosis - minofu yakufa. Necrectomy imaphatikizidwa ndi kupukutira kwakukulu kwa postoperative: pambuyo pochotsa minofu yakufa, machubu amadzi amadzala amasiyidwa m'malo opangira opaleshoni. Zofunikira pakutsuka kwamkati ndi njira yothana ndi maantibayotiki ndi antiseptics. Pa nthawi yomweyo, kusangalala kumachitika - kuyamwa kwa mafinya.
Cholecystectomy Imachitika pamene kapamba adakwiya chifukwa cha matenda a gallstone. Kuti athetse vutoli, ndulu imachotsedwa.

Ndi ma pseudocysts

Mawu akuti "pseudocyst" ndi mawonekedwe opangidwa ndi madzi a pancreatic osakhala ndi nembanemba. Kupanga koteroko kumawonekera kumapeto kwa njira yovuta yotupa. Dongosolo la pseudocyst limatha kufika masentimita 5. Mapangidwe ake ndiwowopsa:

ikhoza kukhala yopambana ndipo imabweretsa matumbo,
Finyani zitsitsi ndi tinthu tating'ono,
khalani ndi ululu wambiri
imatha kulowa m'mimba,
chifukwa cha kupukusa kwam'mimba michere yawo kuyamwa kumayambitsa kukokoloka kwa mtima komanso magazi.

Ngati ma pseudocysts akuphatikizidwa ndi kupweteka kwambiri, kupondereza ma ducts ndipo ndi akulu, ndiye kuti ayenera kuchotsedwa. Kuwunikanso kwamapangidweko kumachitika ndi njira zotsatirazi:

Kukhetsa kwamkati. Amakhala ndikuchita pancreatogastroanastomosis, pamene cyst yolumikizidwa ndi m'mimba kudzera kumbuyo kwake khoma. Chifukwa chake zomwe zili m'ma neoplasms zimatulutsidwa m'matumbo kudzera mu fistula wopangidwa mwaluso. Ngati chotupa sichiri pafupi ndi m'mimba, ndiye kuti anastomosis (kulumikizana kwa zinthu zomwe zimachitika) zimachitika ndi matumbo ang'onoang'ono - ntchito ya cystejunostomy.
Kusangalatsa kwa chotupa. Amakhala ndikutsegula kwa cyst, mankhwalawa ndi antiseptics ndi suturing yotsatira.
Percutaneous kunja kukhetsa kwa cyst. Pogwiritsa ntchito mabowo angapo khoma lam'mimba, machubu amalumikizidwa pamapangidwe omwe nkhani zawo zimatuluka.

Kasitomala kapenanso

Nthawi zina, kuchotsedwa kwa kapamba kumafunika, koma osati kwathunthu, koma magawo okha, chifukwa popanda chiwalo ichi munthu sangakhale ndi moyo. Mankhwalawa amatchedwa resection. Zisonyezo za opaleshoni yolowerera ndi njira zotsatirazi:

Khansa ya kapamba
kuvulala kwa gland
aakulu kapamba.

Panthawi ya reseation, dokotala wa opaleshoni amaganizira zomwe zimapezeka m'magazi kupita kwa kapamba. Poganiza izi, mutha kungochotsa ziwalo zina za thupi:

mutu wokhala ndi gawo la duodenum - Opaleshoni ya Whipple,
thupi ndi mchira, i.e. gawo la distal - distal resection.

Pancreatoduodenal

Opaleshoni yamtunduwu amatchedwanso opaleshoni ya Whipple. Nthawi imeneyi, mutu wa pancreatic umachotsedwa limodzi ndi envelopu ya duodenum, gawo la m'mimba, chikhodzodzo cha ndulu ndi malo oyandikira a m'mimba. Zisonyezero zotere:

zotupa zomwe zili m'mutu wa kapamba,
Khansa ya papar Vat
aakulu kapamba.

Opaleshoniyo imachitika m'magawo awiri: kuyang'ana kwa chidutswa cha kapamba ndi ziwalo zoyandikana, kumanganso ma ndulu Zotsirizira zake, titero, zimapangidwanso pamodzi ndikupanga ma anastomoses angapo:

wamba ndi matumbo a bile duct,
kutulutsa kwam'mimba ndi jejunum,
chitsa chitsa kukamwa ndi kupindika kwamatumbo.

Kuchita kwa Whipple ndi nthano ya kapamba, pomwe dokotala wa opaleshoni amaika laparoscope kudzera munjira zazifupi ndikuwunikira komwe akugwira ntchito. Mchitidwewo umachitika pansi pa mankhwala oletsa ululu. Pambuyo pa opaleshoni yotere, odwala ambiri amakhala ndi kuperewera kwa zakudya m'thupi. Izi zimachitika chifukwa cha kuzimiririka kwa thupi komwe kumapanga michere yokugaya.

Chachikulu

Pakuwonongeka kwa gawo la caudal kapena thupi la kapamba, distal pancreotomy imachitika. Ndizofunikira kudziwa kuti opaleshoni yotere imagwira ntchito ndi zotupa, chifukwa zopweteka zomwe zimakhala m'malo oterewa sizigwira ntchito nthawi zonse. Gawo la kapamba amachotsedwa limodzi ndi ndulu ngati ikhudzidwanso ndi neoplasm. Pambuyo pa opaleshoni, odwala amatha kudwala matenda a shuga chifukwa kuchotsedwa kwa tiziwalo timene timatulutsa timene timatulutsidwa. Pachifukwa ichi, kugwiritsidwa ntchito kwa distal resection ndikochepa. Imachitika malinga ndi zomwe zikuwonetsa:

pseudocysts of body and mchira wa gland,
kwambiri kapamba ndi kutsekeka kwa duct wamkulu pa gawo lachiwopsezo cha kapamba,
fistulas pambuyo povutitsa kwambiri mu mzere.

Kupandukira kwa kapamba

Uwu ndi opaleshoni yamatenda a shuga, omwe adachitidwa koyamba mu 1967. Wolandila adakwanitsa kukwaniritsa Normoglycemia komanso kudziyimira pawokha kuchokera ku insulin, koma mayiyo adamwalira patatha miyezi iwiri chifukwa chokana thupi. M'mbiri yonse, moyo wautali kwambiri atatha kupatsidwa kwa opaleshoni ya pancreatic anali zaka 3.5. Pachifukwa ichi, opaleshoni yotereyi sichichitika ngakhale pakubuka chotupa cha gland, ngakhale chaposachedwa, mankhwala apita patsogolo kwambiri m'derali.

Chifukwa chogwiritsa ntchito cyclosporin ndi ma steroid atachitidwa opaleshoni, ndizotheka kuwonjezera kupulumuka kwa odwala. Mokulira, kuphatikizika kwa kapamba mwa odwala matenda a shuga m'magazi a matenda oopsa aimpso kumakhalabe nkhani yakusankha. Zovuta pakugwera ntchito zimayenderana ndi izi:

kapamba si chiwalo chophatikizika, chifukwa chitha kuchotsedwa kwa munthu wakufa,
ziwalo zimalephera kutaya kwa magazi komwe kumangokhala ndi theka la ora, ndipo ndikusungika, osaposa maola asanu.
kutikita minofu ndikosavuta - ndikosavuta kuwononga ngakhale kukhudza chala,
poika mbewu, ndikofunikira kusoka ziwiya zambiri,
Kapamba ali ndi antigenicity yayitali, chifukwa, pakalibe chithandizo pambuyo pakuthana, gawo lopereka lidzakanidwa m'masiku angapo.

Zovuta pambuyo pancreatic opaleshoni

Popeza opaleshoni yam'mapapo ndizovuta, zimatha kubweretsa zovuta zazikulu. Chofala kwambiri ndi postoperative pancreatitis. Amawonetsedwa ndi kuwonjezeka kwa kutentha kwa thupi, kupweteka kwa epigastric, leukocytosis, kuchuluka kwa amylase mkodzo ndi magazi. Kupsinjika koteroko kumadziwika kwambiri ndi pancreatic edema ndi chitukuko cha pachimake cha kutsekeka kwakukulu kwa chiwalo. Zina mwazowopsa zomwe zimachitika chifukwa cha opaleshoni yamapazi ndi izi:

peritonitis ndi magazi,
kulephera kwazungulira
kuchuluka kwa matenda ashuga
kapamba,
kulephera kwaimpso,
kulephera kwa anastomoses,
zotupa, sepsis,
malabsorption syndrome - kuphwanya kwa chimbudzi cha chakudya ndi mayamwidwe a michere.

Chithandizo cha postoperative

M'miyezi yoyamba atachitidwa opaleshoni, thupi limasinthasintha. Chifukwa cha izi, munthu amachepetsa thupi, amamva kusasangalala komanso kulemera m'mimba atatha kudya, chimbudzi chonyansa komanso malaise. Ndikukonzanso koyenera, zizindikirazi zimatha pang'onopang'ono. Popanda zikondamoyo, ndimalandira chithandizo chokwanira, munthu amatha kukhala ndi moyo zaka zambiri. Kuti tichite izi, atachitidwa opaleshoni kapamba, wodwalayo ayenera kuchita izi:

kutsatira zakudya mpaka kumapeto kwa moyo,
kuthetseratu mowa
lawani shuga, chifukwa theka la milandu pambuyo pancreatic opaleshoni ya shuga imayamba,
khalani ndi zokonzekera za adokotala kuti muthe kukonza chimbudzi,
kutsatira njira ya insulin yotsimikiziridwa ndi endocrinologist - ngati matenda a shuga atapezeka atachitidwa opaleshoni.

Zopatsa thanzi pambuyo pa opaleshoni yamapazi

Chimodzi mwazinthu zazikulu zothandizira kukonzanso pambuyo pachitetezo cha pancreatic ndi zakudya zamankhwala. Malamulo a zakudya amasiyana malinga ndi nthawi yomwe atatha opareshoni:

Masiku 2 oyamba. Kusala kwachithandizo kukuwonetsedwa.
Tsiku lachitatu. Amaloledwa kugwiritsa ntchito soups yosenda, tiyi wopanda shuga, mpunga ndi buckwheat mkaka phala, crackers, tchizi chofufumitsa, omeledte mapuloteni omwera, batala pang'ono. Musanagone, mungamwe kapu ya yogati kapena madzi ndi uchi.
Masiku 5-7 otsatira - zakudya zamankhwala No. 0. Zimaphatikizapo kugwiritsa ntchito mafuta osakanikirana mosavuta ndi zakudya zamagetsi zomwe zimakhala ndi mavitamini. Wodwalayo amaloledwa msuzi wofowoka, zakudya, zipatso ndi mabulosi, mazira owiritsa. Malita osachepera 2 a madzi azimwa. Zophatikiza tsiku ndi tsiku za calorie ndi 1000 kcal. Nthawi zina, m'malo mwa chakudya, zakudya za makolo kudzera pa kafukufuku zimagwiritsidwa ntchito, i.e. kudutsa chimbudzi.
Masiku asanu ndi awiri otsatira - chakudya 1a. Malonda amafunika kuwiritsa kapena kuwotcha. Zakudya zopukutira ndi zosenda. Amayesedwa zakudya zopatsa thanzi, momwe mumayenera kudya osachepera 6 pa tsiku m'magawo ang'onoang'ono. Zolemba tsiku ndi tsiku za calorie ndi 1800-1900 kcal. Ndikulimbikitsidwa kugwiritsa ntchito soups kuchokera ku semolina, oat kapena mpunga, batala, mkaka, maelekela amaproteni am'madzi, nyama yotsika ndi nsomba ngati mawonekedwe a soufflé kapena mbatata yosenda. Kutsekemera kolola zakudya zamafuta komanso zachilengedwe.

Mitundu ya magwiridwe

Sutting kuvulala kwachikopa kumapangidwa ndi zotupa zazing'ono zam'madera zomwe sizimaphwanya umphumphu wa GLP. Pangani ma nodal kapena ma -U-mawonekedwe osokonekera kuchokera ku mphaka. Drainage imabweretsedwa patsamba lakusokerera kapamba.

Khalid Pancreatic necrectomy imapangidwira pancreatic necrosis, puranc pancreatitis pokhapokha pamakhala kutupa kwapakhungu kogwiritsa ntchito pamimba, kusinthana bwino OK, komanso pamene wodwalayo salola opaleshoni yayikulu (pancreatectomy). Ndi cancreatic necrosis yatsopano, malo a necrotic a gland oyeserera osasinthika amakhala opanda khungu, zotengera sizituluka magazi. Pambuyo pake, minofu komanso yosasinthika (yathanzi) imapangidwa bwino.

Pancreatic necrectomy imafuna njira yapamwamba yogwirira ntchito, kuwongolera kowonekera bwino pakusintha kwa topographic ndi anatomical. Kulephera kutsatira izi kumatha kupweteketsa ziwiya zikuluzikulu za pancreatoduodenal zone ndikutulutsa magazi kwambiri, ndikusiya madera amakono omwe amapezeka pambuyo pake, mtima wamitsempha, necrosis yam'mimba khoma ndi matumbo AL. Shalimov, 1988, M.M. Mamakeev et al., 1999.

Cystenterostomy (chithunzi 4). Amawonetsedwa pseudocysts a pancreatic okhala ndi makoma opangidwa bwino komanso kusakhalapo kwa kupitilizira zomwe zidalipo. Ngati pali matumba m'matumbo a cyst, magawo amawachotsa, kuwasandutsa gawo limodzi. Minofu ya Necrotic kuchokera pamkono wa cyst imachotsedwa. Kwa anastomosis yokhala ndi chotupa, chiuno cha jejunum chomwe chimatembenuzika motsatira Ru ndi 20-25 cm kapena Brownian anastomosis A.A. Kurygin et al., 1998.

Marsunialization wa kapamba. Imawonetsedwa makoma owonda, osasinthika, komanso ngati nthawi yakuthandizira pazomwe zili. Mzere umatsegulidwa, zomwe zili mkati mwake zimasamutsidwa, matumba onse ndi zigawo zomwe zili mkati mwa cyst zimachotsedwa, ndikupanga mzere umodzi. Makoma a cyst amawokeredwa kupita ku parietal peritoneum ndipo machubu amadzimadzi amaikidwa mu cyst patsekeke.

Kudzera mu ngalande mu postoperative nyengo, cyst patsekini imatsukidwa. Pambuyo pa opaleshoni iyi, fistula yakunja yolimbikira imapangidwa.

Transduodenal sphincterovirusungoplasty (chithunzi 5). Imachitidwa ndi stenosis ya BDS ndi stenosis mkamwa mwa pancreatic duct. Choyamba, papillosphincterotomy imachitidwa. Pakamlomo pa dambo la Wirsung limapezeka pakhoma la medial la BDS yomwe yasiyidwa. Khoma lakumapeto kwa nyumbayi limasulidwa kumayendedwe a pancreatic mpaka kutalika kwa 3 mm. Makoma osiyidwa a Wirsung duct ndi BDS amawokedwa ndi magawo osiyana ndi singano ya atraumatic. Mu duodenum, pansi pa Vater papilla, proanasal probe imachitika, yomwe imachitika mpaka kugwira matumbo kuchitika.

Wirsungoduodenostomy (chithunzi 6). Chitani zomwe zingachitike ngati mukulephera kwa GLP m'dera la mutu wa kapamba chifukwa cha 1.5-3 cm. Kusagwirizana kwa khoma la pancreatic ndi duodenum kumakhala ndi suture yokhala ndi mizere iwiri.

Papillotomy. Chitani ndi zotupa za BDS komanso zotupa zazing'ono zolakwika kwa odwala omwe, ambiri, sangathe kulekerera pancreatoduodenal resection. KDP ndi mutu wapa pancreatic amalimbikitsidwa malinga ndi Kocher. Duodenotomy yautali imachitika pamlingo wa papilla wa Vater. Kuzindikira kosangalatsa mkati mwa thupi labwino kumapangitsa chotupa. OSHP ndi GLP zimasokonekera kukhoma la KDP ndizosokonekera. Chowonongeka chotsalira khoma lanyumba ya duodenum chimadzikongoletsa ndi suture yayitali-iwiri. Kutsegulira kwa duodenotomy kumawongoleredwa ndi suture ya mizere iwiri mu njira yopingasa.

Longitudinal pancreatojejunostomy. Opaleshoni iyi imachitika pokhapokha matenda enducopic pancreatitis ndi kuphwanya patency wa GLP. Pambuyo pakugawika kwa GLP kutalika konse kwa gawo lake lopapatiza, anastomosis yokhala ndi mizere iwiri imapangidwa pakati pa khoma lopanda duct ndi loleza ya TC. Kutupa kwamatumbo komwe cholinga cha pancreatojejunoanastomosis (20-25 cm kutalika) chimachoka pakadutsa chakudya limodzi ndi Ru kapena Brownian anastomosis (Chithunzi 7).

a) kapamba amayenera kudutsa pakati pa minyewa yomwe imaperekedwa bwino ndi magazi - malo omwe nthambi zakunja zimatuluka kuchokera kumzere wam'mimba, molunjika kumanja kapena kumanzere kwa zomwe zimaphulika,
b) onetsetsani kutuluka kwaulere kwa PS kudzera pa BDS,
c) CHIVULE chimayenera kupakidwa mafuta okhala ndi gawo limodzi, ndipo chitsa cha ndulu chimapangidwa mokwanira chifukwa cha minyewa yoyandikana nayo, makamaka kuchokera ku zida zapamwamba za OC.

Pancreatoduodenal resection (chithunzi 8). Amapangidwa ndi zotupa komanso kusintha kwakuwonongeka kwakukulu m'mutu wa pancreatic, osafikira ku lingaliro ndi thupi la chithokomiro.

Magawo otsatirawa opaleshoni ndi amodzi:
1. Kulimbikitsa mutu wa duodenum ndi pancreatic malinga ndi Kocher, kulekanitsidwa kooneka bwino komanso kosakanikirana kwa kachigawo ka gland kuchokera pakuphulika. Njira imeneyi ikagwiritsidwa ntchito, kusowa kwa chotupa mu malo ochepetsetsa a venva cava ndi mitsempha ya portal kumayang'aniridwa ndikuwona mwayi wakuchita opaleshoni yayikulu kwa khansa yapancancion imakhazikitsidwa.
2. Kulimbikitsa kwa pancreatoduodenal tata: m'mimba umadutsa pamlingo wa 1/2 choleledoch - pamlingo wakubowoleza PP, duodenum - pamalo omwe amasinthika kulowa pakhungu kupita kumanzere kwa BB, gastro-duodenal artery idadutsa pakati pa ma clamp ndi ligated. Njira yolimbirana ndi mbedza komanso zombo zolumikizira mutu wamapangidwe ndi zotengera zapamwamba za mesenteric zimadutsidwa pambuyo pakuziwunikira ndi zida za UKL kapena zida zina. Pokhapokha ngati tili ndi chithokomiro ndipo thupi lake limatulutsa timadzi timene timayamwa.
3. Gawo lachirengedwe la opareshoni: kutsatira kwa kapamba, choledochoe, ndi gastroenteroanastomosis pachiuno chimodzi cha TC ndi mtunda wa 25-30 masentimita pakati pa anastomoses.

Mu zotupa za mutu wa pancreatic, kufalikira ku gawo la thupi ndi thupi, chomaliziracho chimawoloka mchira wa gland - subtotal pancreatoduodenal resection. Pambuyo pake, AA imawonedwa ngati yovomerezeka. Shalimov, 1988, musagwiritsidwe ntchito pancreatojejunoanastomosis ngati pakuchitika kusintha kwakukulu kwa chitsa mu chitsa cha glandular ndi choletsa lakuthwa kwa ntchito ya exocrine.

Zikatero, catheter wochepa thupi amamuyika mu chamba cha chifuchi kuti ayang'anire kutuluka kwa PS m'nthawi ya postoperative nyengo, chilonda cha chitsa cha chofufumira chimakola. Masiku 7-10 atachitidwa opaleshoni, catheter imachotsedwa, fancula ya pancreatic imadzitsekera yokha. Ndikothekanso kuyambitsa 1-1.5 ml ya neoprene mu GLP ya chitsa cha pancreatic, pomwe ma dancts onse a pancreatic amakhala oletsedwa ndipo palibe fistula yomwe imachitika.

Onse duodenopancreatectomy. Amachitidwa povulala pancreatic ndikuphwanya gawo lalikulu la iko komanso kupindika kosaneneka kwa duodenum, pancreatonecrosis yathunthu ndi necrosis ya khoma la duodenal: zotupa zomwe zimakhudza kapamba wonse, pakalibe metastases.

Kuphatikizika kwa pancreatoduodenal kumapangidwanso chimodzimodzi monga pancreatoduodenal resection, ndikusiyana kokhako kuti kapamba samawoloka, koma amaphatikizidwa pamodzi ndi ndulu. Pachigawo chochita opareshoni, choledochojejuno-ndi gastroenteroanastomosis imagwiritsidwa ntchito mosiyanasiyana m'chiuno chimodzi cha TC. Mu nthawi ya postoperative, kukonza moyenera kagayidwe kazinthu kumawoneka koyenera.

Mbali yamanzere splanchnectectomy (Chithunzi 9) ndi kufanana kwa mbali yakumanzere kwa dzuwa. Amagwiritsidwa ntchito ku CP yokhala ndi glandular fibrosis komanso ululu. Nthawi yomweyo, gastrointestinal ligament kapena omentum yaying'ono imatayidwa ndipo m'mphepete mwenimweni mwa kapamba amawonekera poyera. Mwa pulsation, thunthu la celiac limapezeka ndikubisidwa, mawonekedwe akumanzere a solar plexus ili kumanzere molunjika pafupi ndi thunthu la celiac ndi aorta. Imasungidwa ndikukweza, ndikukoka ndi kukweza mawonekedwe, imasunga mitsempha yayikulu komanso yaying'ono yomwe ili pakati pa miyendo yamdima ndi yapakati pa diaphragm. Potuluka kuchokera ku diaphragm, misempha yayikulu ndi yaying'ono imadulidwa ndikuchotsedwa limodzi ndi solar plexus node. Mothandizidwa ndi opaleshoni iyi, njira yayikulu yofalitsa matenda yakupweteka kuchokera mthupi ndi mchira wa kapamba imasokonekera.

Kumanja kwa splanchnectectomy (chithunzi 10). Cholinga cha opaleshoni iyi ndikusokoneza kufalitsa kwa kupweteka kwapakhosi kuchokera pamimba komanso pancreatic mutu. Mitsempha ya Celiac ndi mtengo wamtengo wozungulira umasungidwa pakati pa OA, thunthu la celiac ndi aorta ndikuchotsedwa.

Postganglionic neurotomy (Opaleshoni Yoshioka-Wakabayashi). Pogwira ntchito imeneyi, ulusi wamitsempha ya postganglionic yomwe imataya kakhansa m'mphepete mwa mediyo yomwe ili yolowerera nduluyo imatulutsidwa.

Marginal pancreatic neurotomy malinga ndi Napalkov - Trunin. Nthawi yomweyo, mitengo ya mitsempha imadutsa m'mbali mwa ziphuphu.
Pitani pa mndandanda wazidule

Zizindikiro zakuchita opareshoni

Opaleshoni ya kansa imachitika molingana ndi zofunikira, zomwe zimatsimikiziridwa payekhapayekha kwa wodwala aliyense:

kapamba, ndikusandulika kukhala kapamba wa necosis,
chifuwa kapena phlegmon,
Kupangidwa kwa miyala yomwe imatchinga mabowo,
purulent kapamba ndi kukula kwa peritonitis,
kuvulala kwakukulu ndi magazi osaletseka,
chotupa chowopsa
ma cyst angapo omwe amachititsa kupweteka kosalekeza.

Izi zimawerengedwa kuti ndi zofunikira kwambiri pakuwathandiza opaleshoni - yokonzekera kapena yodzidzimutsa. Chitani zochizira matenda ena kapamba, zimatengera momwe matendawa aliri, thanzi la wodwalayo.

Mu pachimake kapamba

Pancreatitis kokha sichizindikiro cha opaleshoni ya pancreatic. Amayesa kuchiza matenda mosamala, ngakhale ndi mawonekedwe owopsa. Opaleshoni ya kapamba ndiyofunikira pakachitika zovuta:

kuphatikiza minofu
kusakaniza
kutupa pamimba, kutengera kuwonongeka kwa kapamba,
mapangidwe a abscess.

Choopsa kwambiri m'mawu a Prosticic ndi purulent-necrotic pancreatitis. Opaleshoni yamapazi imachitidwa ngati necondolaomy. Mulinso zotsatirazi:

yapakati pa laparotomy - kugawanika kwa khomo lamkati,
kuchotsa minofu yakufa,
kuchapa kwamkati ndi ma antiseptics,
kukhazikitsa ngalande,
kukoletsa chilonda.

Zilonda ndizofunikira kutulutsa kwamadzi otupa, kudzera mwa iwo malowo amatsukidwa ndi njira yothana ndi maantiotic.

Moyo pambuyo resection kapena kuchotsedwa kwa England

Kuchita kwa chiwalo chokhudzidwa ndi chimbudzi kumapangitsa zotsatirapo zake m'moyo wamunthu wakale. Zikondwerero zimakonda kwambiri kuwonongeka kwa makina. Chifukwa chake, opaleshoni yamapazi imayambitsa zovuta zingapo komanso zovuta, Zizindikiro zomwe zimagwirizanitsidwa ndi zovuta zam'mimba.

Kuti amve bwino pambuyo pochita opaleshoni yapachibale, munthu ayenera kusintha moyo wake. Kutalika kwa kutsatira zoletsa kumatengera mtundu wa opaleshoni yomwe wachita. Ndikofunika kutsatira zakudya. Ndikulimbikitsidwa kudya pang'onopang'ono - muziwayeza ndi kuchuluka kwa odwala. Pafupipafupi kayendetsedwe ka kayendetsedwe ka nthawi ndi nthawi 5-6 patsiku, mosataya nthawi. Zakudya zotsatirazi sizimachotsedwa muzakudya:

nyama zamafuta ndi nsomba,
mkaka, kirimu wowawasa, zonona,
chakudya chamzitini
nyama zosuta, zakudya zabwino,
bowa
zonunkhira.

Mowa suwapatula. Zakudya ziyenera kugayidwa mosavuta, zimakhala ndi mavitamini okwanira. Zakudya zamafuta ochepa zimachepa.

Kusunga chinsinsi cha ntchito ya thupi, kukonzekera kwa enzyme kumayikidwa: Pancreatin, Mezim. Zovomerezedwa kwa nthawi yayitali, ndikuchotsa zofunikira - mosalekeza. Odwala omwe ali pachiwopsezo chachikulu chotenga matenda a shuga amawonetsedwa pafupipafupi ndi endocrinologist. Ngati ndi kotheka, mankhwala a hypoglycemic.

Mukangotaya kwa masabata awiri, kupumula kwakukulu kumawonedwa - kupuma pabedi, kudya kwambiri, komanso kumwa mankhwala omwe dokotala amakupatsani. Kuchira kwathunthu kumawonedwa pambuyo pa miyezi 3-5. Kuchita masewera olimbitsa thupi kwambiri. Wodwalayo amayang'aniridwa ndi katswiri wazachipatala komanso gastroenterologist. Kuunikira kwa m'mimba kumachitika chaka chilichonse; kuyezetsa magazi ndi mkodzo pafupipafupi kumayang'aniridwa.

Zambiri za pancreatic anatomy

Kasitomala ndi chiwalo chotalika pafupifupi 15 cm, kunja kwake chimafanana ndi peyala. Imasiyanitsa magawo atatu: mutu, thupi ndi mchira. Zikondwererozo zimapezeka m'mimba kumbuyo kwa m'mimba. Alipo kubwerera, ndiye kuti, yokutidwa ndi peritoneum kumbali imodzi yokha. Mutu wa chiwalo chimakwirira duodenum.

Pancreas imakhala ndi mitundu iwiri ya minofu, iliyonse imachita ntchito zake:

Minofu ya Procrine Amatulutsa madzi okhala ndi ma enzymes, omwe amalowa mu duodenum kudzera mumkamwa ndipo amathandizira kugaya.
Minofu ya Endocrine ili m'makutu amtundu wa zilumba zazing'ono, imatulutsa insulin ndi mahomoni ena.

Gastropancreatoduodenal resection for cancer ya pancreatic: kuchita kapena kusachita?

Kodi ndiyenera kuchitidwa opaleshoni? Kodi zingawonjezere moyo? Kapena kuwunika khansa yapathengo ndi sentensi, ndipo palibe chomwe chikuyenera kuchitika. Ndi zovuta ziti zomwe zimachitika pambuyo pakuchita opaleshoni? Kodi kuchuluka kwa moyo kudzachuluka motani pambuyo pakuchita opaleshoni yapancreatic?

Kuchita kapena kusachita DA / DAG? Chifukwa chiyani funso lotere limapezeka m'mutu mwa odwala khansa ya kapamba? Tsoka ilo, mdziko lathu lapansi chithandizo chochepa kwambiri cha opaleshoni iyi. Kuwonongeka kwa masukulu opanga opaleshoni m'masukulu ambiri ophunzitsa zamalonda m'dziko lathu kumabweretsa imfa zapamwamba komanso zotsala, komanso zotsatira zosagwiranso ntchito kwa nthawi yayitali. Izi nthawi zambiri zimakhala maziko a kukana kwa oncologists kuchokera kuzowonjezera zam'mbuyo zokhudzana ndi khansa ya pancreatic. Malingaliro ofananawa amasungidwa ndi madokotala othandizira - endocrinologists, endoscopists, madokotala okha. Kusagwirizana mu nyuzipepala yakunja ndi kwanyumba yasayansi yokhudza zakukula kwa kupulumuka kwa odwala omwe ali ndi khansa ya pancreatic atachitidwa opaleshoni yayikulu kwambiri pamenepa.

Chifukwa chiyani? Njira yodziwitsa, magawo a zotupa, kapangidwe kake kosiyanasiyana ku Japan, USA ndi Western Europe.

Zovuta kwambiri zomwe odwala ndi achibale awo amatha kudziwa ndizotsatira za kupulumuka kwa odwala omwe ali ndi khansa ya pancreatic atachitidwa opaleshoni yayikulu. Pafupifupi, malinga ndi magwero osiyanasiyana, kuyambira 30 mpaka 70% odwala amakhala ndi moyo chaka chatha atachitidwa opaleshoni, nthawi yayitali yokhala ndi moyo pambuyo pa GPD, malinga ndi kuchuluka kwa nyumba, miyezi 12 mpaka 15,5, kupulumuka kwa zaka zisanu ngakhale pambuyo pogwira ntchito m'malo opambana padziko lonse lapansi mankhwala sapitirira 3.5-15.7%. Chifukwa chake, kuchita opareshoni kapena ayi - kusankha ndi kwanu!

Kodi chinsinsi chake ndi chiyani?

Chifukwa chake, popeza muyenera kukhala ndi pancreatoduodenal resection yokhudza khansa ya kapamba, muyenera kuchita motani ndi pati?

Choyamba. Miyezo ya NCCN imazindikira kuti kufufuma kwamatenda a gastropancreatoduodenal kumafunika nthawi yomweyo atazindikira kuti khansa yapanimbayi yapangidwa, ngakhale popanda kutsimikizira kwa mbiriyakale kapena cytological, komanso kutengera PET-CT ndi kulingalira kwa maginito. Izi ndizofunikira chifukwa chakuti ngakhale pa laparoscopic intraoperative biopsy ya kapamba, pafupipafupi mayankho onyenga osaposa 10%. Tsoka ilo, izi zikuwululidwa kale mochedwa, matenda atasinthika kukhala gawo losagwira. Chifukwa chake, timawona kuti ndizoyenera, pambuyo poyendetsa PET-CT ndi MRI, kuchita opareshoni ya PDE.

Kachiwiri. Khansa ya kapamba, chifukwa cha kapangidwe ka gawo lakhudzidwa, pafupifupi imakhudzana ndi micrometastases minofu yonse yolumikizana ndi kapamba, maselo a chotupa amapanga micrometastases pamipanda yolumikizana ndi m'mitsempha yam'mimba, m'mitsempha yapafupi, mumitsempha yam'mimba komanso m'mimba. Micrometastases mawonekedwe ngakhale ang'onoang'ono - kuchokera 0,4 mpaka 3.5 masentimita a chachikulu chachikulu chotupa chokhazikika cha khansa ya Prostate.

Nthawi yomweyo, lingaliro lomaliza la kuchuluka kwa PD limapangidwa modabwitsa, pakaunikidwe koyesedwa kwam'mimba kupatulapo metastases yakutali komanso kuchuluka kwa njira zam'deralo. Nthawi zina, zinthu zimawonedwa ngati zosagwira (zosasinthika), chifukwa amakhulupirira kuti chotupa chimalowa m'matumbo obwezeretsanso, kuphatikiza mitsempha ya mitsempha komanso metastases ya lymph node, zimapangitsa opaleshoniyo kukhala yosatheka. Chifukwa chake, pakuchita opaleshoni, timayesetsa nthawi zina kuchita kuchuluka kwakukulu kwa zotumphukira zam'madera, komanso nthawi zina ndi resection ya mtima, yomwe imakulitsa kupulumuka kwa odwala athu.

Pazomwe takumana nazo, kupulumuka kwapabwino kwambiri kwa zaka 5 pambuyo pa DHD yowonjezereka kumawonedwa m'matumbo ang'onoang'ono a mutu wa pancreatic (ductal adenocarcinoma), popanda kuwonekera mwatsatanetsatane wa mesenteric chotengera, ma lymph node a juxtaregional sonkhanitsa ndi metastases yakutali.

Chachitatu. Odwala ambiri omwe ali ndi khansa yam'mutu ya pancreatic, metastases mpaka zotsekemera zomwe zimazungulira mchira wa zikondamoyo sizinapezeke, komanso metastase pazipata za ndulu, minofu yapakati.Ndizosangalatsa kuti, monga lamulo, palibe chotupa chotupa chomwe chimapezeka mu mbali ya distal motsatira pancreatic duct.

Chifukwa chake, ndikofunikira kuganizira mtundu wa zotupa pamlingo wa opereshoni. Zoyenera, mbiri yakale yotupa, chifukwa imapangitsa kupulumuka kwa odwala. Chifukwa chake, PDR yovomerezeka ya ductal adenocarcinoma ya mutu wapa pancreatic imapereka zotsatira zoyenera (zamkati mwa intra- ndi postoperative infa ya 0-5%), zotsatira zosakhutira za nthawi yayitali (chiyembekezo cha moyo wapakati pambuyo pa opaleshoni miyezi 10-18, palibe kupulumuka kwa zaka 5). Nthawi yomweyo, opaleshoni ya cystadenocarcinoma ya mutu wapa pancreatic imapereka kupulumuka kwa zaka 5 mpaka 60-78%. Chifukwa chake, sitigwiritsa ntchito ntchito ya Whipple yoyambilira, yomwe ikufunsidwa koyambirira kwa zaka za zana la 20, koma zosiyana siyana ndi kusungidwa pang'ono pang'ono kwa ziwalo zina, ngati zingatheke.

Chachinayi. Popeza chipatala "Medicine 24/7" chimagwira DPR yowonjezereka, timakonda kufanana mutu ndi thupi la kapamba, m'mimba mwa pyloric palimodzi ndi omentum yaying'ono ndi theka lamanja la omentum, 12 duodenum, ndulu, blal ngati zovuta imodzi. gawo la hepatic duct komanso wamba bile duct. Zingwe zochotsedwa ndi limodzi zimaphatikizira minyewa yolumikizana, ziwiya zamitsempha ndi ma node, kuchuluka kwa mitsempha, milandu ya ma cell apakati pazitima zonse zazikulu zomwe zimagwiritsidwa ntchito. Kuphatikiza apo, ngati pali kukayikira kwa chotupa cholowa chamkati wa mesenteric wapamwamba, mitsempha yapa portal, yotsirizira imapangidwanso. Kuphatikiza apo, mafupa a m'mitsempha yonse yayikulu komanso mitsempha imachitika.

Lachisanu. Zambiri zathu, komanso kuchuluka kwa zomwe anzathu ku Japan ndi America akuwona, zikuwonetsa kuti kupulumuka kwa zaka zisanu zokha kwaoposa 15%, ndipo kumapeto, ndi zotupa za neuroendocrine - 85% imatheka ndi DDR yowonjezereka, ndikuwunikira koyeserera kwa mbiriyakale yonse, metastases imodzi yamtundu wamtundu wa juxtaregional wotolera idapezeka, kapena kuwululidwa. Komabe, kuchuluka kwakukulu kwa opaleshoni kumayang'anizidwanso ndi vuto lina - kusinthika kwa DPR yapamwamba. Kuchuluka kwa HDR, kumakhala kovuta pafupipafupi - kutsegula m'mimba, kulephera kwa pancreaticoeunoanastomosis. Modabwitsa, kutsegula m'mimba komwe kumatha miyezi ingapo atachitidwa opareshoni kumawonetsa kuchuluka kwa opaleshoniyo ndikulosera zotsatira zabwino zazitali za DDR.

Wachisanu ndi chimodzi. Ku Russia, popeza khansa ya Prostine ya prostate imakonda kuchitidwa HDR yodziwika bwino, odwala ambiri amafa chaka choyamba atachitidwa opaleshoni, mosasamala kanthu za kuchuluka kwa zotupa, odwala osakwatiwa amakhalabe ndi moyo zaka zitatu. Ndikofunikira kudziwa kuti zambiri zomwe zimawonetsedwa m'mapepala asayansi ndizokhazikitsidwa ndi zomwe akuti mapiritsi opulumuka, pafupifupi nthawi zinayi kupitilira zaka zisanu poyerekeza ndi data yachindunji, pomwe ife, tikudziwa zowunika mazana ambiri kuyambira 1996, timangogwiritsa ntchito zowongolera zokha zowonera. Odwala ambiri amafa chifukwa cha kupititsa patsogolo kwa khansa ya kapamba chifukwa cha chitukuko cha kubwereranso kwina popanda metastases kwa chiwindi pambuyo pa HDR yokhazikika.

Mitundu yayikulu yogwirapo khansa ya kapamba

Muzochita zamankhwala, zochitika zazikulu kwambiri za khansa ya Prostate zimasiyanitsidwa, kuphatikiza muyezo wa PDR (Whipple opaleshoni), gastropancreatoduodenal resection, HDR yowonjezera, pancreatectomy, distal pamodzi pancreatic resection, yowonjezera pancreatoduodenectomy. Ntchito zonsezi ndizovuta kwambiri, chifukwa zofunikira zomwe dokotala amafunika pakuchita opaleshoni zimaphatikizapo luso osati kungodziwa kuchuluka kwa kuchuluka kwa ntchitoyo panthawi ya opareshoniyo, kuichita, komanso kuchita machitidwe angapo omanganso munthawi ina - pancreatojejunostomy, biliary digestive anastomosis, gastrojejunostomy and inter-intestine anastomosis. Ichi ndichifukwa chake gululi nthawi zambiri limakhala ndi madokotala a 4-5 opanga opaleshoni, ndipo nthawi yayitali yogwira ntchito ili pafupifupi maola 6-8.

Ntchito ya Whipple (pancreatoduodenal resection)

Pancreatoduodenal resection ndimagwira ntchito kwambiri kwa khansa ya kapamba yomwe imachokera ku ma cell a exocrine. Dokotalayo amachotsa mutu wa kapamba (nthawi zina ndi thupi), gawo lamatumbo ang'ono, bile duct, chikhodzodzo, mabatani am'mimba, nthawi zina amakhala mbali yam'mimba. Kuchulukitsa kwakukulu kotero kumathandiza kuchotsa minofu yonse ya chotupa ndi kuthekera kwakukulu ndikuchepetsa ngozi yobwereranso.

Magawo otsala a m'matumbo ndi m'mimba amalumikizika, kapamba ndi gawo lotsala la ndulu ya bile limagwirizika kumtumbo yaying'ono. Chifukwa chake, atachitidwa opaleshoni, bile ndi mgonero zimapitilira kulowa m'matumbo.

Pakalepo, opaleshoni ya Whipple imachitika kudzera pachiwopsezo chachikulu chomwe chimayenda pakati pamimba. Koma m'makliniki ena, zida ndi maluso a madokotala amaloleza kulowererapo kwa laparoscopic.

Pancreas anatomical mbali

Zikondwererozo zimakhala kumbuyo kwa m'mimba, pang'ono kumanzere kwake. Ili ndi gawo lopendekeka ngati momwe thupi lake, mutu wa gland ndi mchira wake zimagawika. Pogwiritsa ntchito mutu wachitsulo, limalumikizana ndi duodenum, ndipo malire pakati pawo amafotokozedwa ndi recess yomwe mitsempha ya portal ikuyenda pamenepo.

Thupi la chithokomiro tingafanizidwe ndi mawonekedwe am'munsi, pomwe kutsogolo kwake kumayendetsedwa chakumwamba khoma lakumaso kwa m'mimba.
Kumbuyo kwa chiwalo kumalunjikitsidwa kumsana ndipo kumalumikizana mwachindunji ndi celiac plexus, komanso ndi infa cava yam'mimba ndi m'mimba aorta yomwe ilipo.
Gawo lam'munsi la prism yodabwitsayi imayendetsedwa pang'ono kupita pansi, yomwe ili pansi pa mesentery a kolon.

Mchira wa gland umakhala ndi mawonekedwe a peyala, yomwe imayandikana ndi ndulu.

Kupyola pancreas yonse kumadutsa mzere wotchedwa Virsungova, womwe umalowa mkatikati mwa duodenum.

Chizindikiro cha kapamba ndi kuchuluka kwa magazi ake, chifukwa chakudya chake chimachitika nthawi imodzi ndi mitsempha ingapo: mutu ndi nthambi za pancreatoduodenal, ndi mchira ndi thupi lokhala ndi nthambi zamankhwala.

Kutuluka kwa magazi kumachitika pogwiritsa ntchito mitsempha ya pancreatoduodenal, yomwe ndi amodzi mwa magawo a mitsempha ya portal.

Pancreas ili ndi mawonekedwe ovuta, okhala ndi lobules yaying'ono, yomwe imadutsa maukonde ang'onoang'ono, misempha, komanso zingwe zazing'ono zomwe zimatulutsa chinsinsi kuti zichotseke kuchotsere chachikulu.

Pancreas yonse ikhoza kugawidwa m'magawo awiri, iliyonse yomwe imayang'anira ntchito zina, monga:

Exocrine - yopangidwa ndi acini yomwe ili mu lobules, pomwe imachokapo, kudutsa motsatizana kuchoka pamkati kupita kumagulidwe am'mimba, kenako kupita ku chimbudzi chachikulu cha pancreatic ndi duodenum,
Endocrine - mu mawonekedwe amachitidwe am'midzi ya Langerhans, yopanga ma insulocytes omwe amagawidwa ma β-cell, α-cell, Δ-cell, D-cell, PP-cell.

Kufunika ndi contraindication opaleshoni mankhwala

Panthawi yochita opaleshoni, zimachitika zovuta zina zomwe zingatsate wodwalayo, chifukwa chake, chithandizo chamtunduwu chimasonyezedwa pokhapokha ngati chikufunikira mwachangu ndipo chikuyenera kuchitidwa ndi akatswiri odziwa bwino ntchito yake.

Kufunika kochita opaleshoni kungayambike chifukwa cha zotsatirazi:

Kuvulala kwa gland
Nthawi zambiri kukokoloka kwa matenda a kapamba,
Matenda opweteka,
Pancreatic necrosis ndi mawonekedwe owopsa a kapamba,
Matenda a cyst ndi pseudocysts.

Opaleshoniyo imayikidwa ndipo sikuti imakhala yovuta pakapangidwa chotupa mu kapamba, pamene chotupa chimachotsedwa limodzi ndi gawo lina la chiwalo. Ndi miyala, minyewa ya ndulu imatulutsidwa ndipo ngati kuli kotheka, makhoma a duct. Ntchito yovuta kwambiri ndiyomwe imachitika pakumanga kwa zotupa, popeza ndi neoplasm mchira wa chiwalo ndi thupi lake, nduluyo imachotsedwa limodzi ndi chindindayo. Chotupa choyipa chikachotsedwa, kuchotsa kwa duodenum kumawonjezeredwa pazinthu zomwe zalembedwa.

Ndi angati omwe amakhala atachitidwa opaleshoni ya kanyumba?

Kutalika kwa nthawi ya wodwala atachitidwa opaleshoni zimatengera zifukwa zambiri, zazikulu zomwe ndi:

Mkhalidwe wa wodwala musanachite opareshoni
Njira yomwe imagwiritsidwa ntchito pochita opaleshoni,
Mtundu wa njira zoperekera,
Kutsatira zakudya zoyenera.

Chifukwa chake matenda omwe adakhala ngati chifukwa choperekera opaleshoni ndikuchotsa gawo la kapamba amapitilizabe kukhudza mkhalidwe wa wodwalayo panthawi yothandizira. Ngati choyambitsa cha khansa chinali khansa, ndiye kuti pali kuyambiranso. Pankhaniyi, pamaso pa mawonekedwe aliwonse ovuta, muyenera kufunsa dokotala kuti asatenge mapangidwe a metastasis. Kuchita masewera olimbitsa thupi panthawiyi, kusowa kwa njira yochiritsira komanso kuperewera kwa chakudya kungakhudze mkhalidwe wa wodwalayo atamuchita opaleshoni. Kutengera momwe kuthandizira kwa dotolo kumatsatiridwa komanso panthawi yomwe opaleshoniyo idachitikira, kuchuluka kwa wodwala komanso momwe angamverere kumadalira m'njira zambiri.

Opaleshoni yamatenda a shuga

Opaleshoni yamatenda a shuga imachitika pokhapokha ngati pakufunikira mwachangu komanso monga momwe zikuwonekera, ndiwo njira yokhayo yothandizira. Monga lamulo, njirayi ndi zovomerezeka musanafike kuwonongeka kwa kapamba kumayendera limodzi ndi zovuta zazikulu, monga:

Nephropathy,
Pang'onopang'ono retinopathy,
Mavuto akulu m'boma la zombo zazikulu komanso zazing'ono.

Panthawi imeneyi, pamene gland ya wodwala matenda ashuga ikhudzidwa kwambiri kotero kuti sangathe kukwaniritsa ntchito zomwe apatsidwa, kupatsirana kwa chiwalo kungalimbikitsidwe. Komanso, gawo lotere limagwiritsidwa ntchito popanga zovuta zomwe zimayamba kuwopseza moyo wa odwala matenda ashuga. Kuika ziwalo kumachitika potsatira zotsatirazi za wodwalayo:

Zosintha mwachangu zamomwe zimachitika pang'onopang'ono ndi matenda a shuga a mitundu yonse iwiri,
Organ oncology,
Cushing's Syndrome
Kuphwanya kwadzidzidzi kwa kuchuluka kwa mahomoni.

Kuphatikiza pa izi, chithandizo chamankhwala opangira opaleshoni chikulimbikitsidwa ngati chiwopsezo chimbudzi cha enzyme chitha kwa wodwala matenda ashuga, omwe amachititsa chiwonongeko cha pancreatic.

Odwala omwe ali ndi matenda ashuga nthawi zambiri amalimbikitsidwa njira zingapo zosinthira gawo lomwe lakhudzidwa, motere:

Pancreas munthawi yomweyo kumuika ndi impso. Izi zimachitika ndi chitukuko cha matenda ashuga nephropathy, kukhalapo kwa aimpso kulephera, kapena kuwonongeka kwa impso ndi kusowa kwawo.
Ikani mu njira yokhayokha. Amagwiritsidwa ntchito kwa odwala omwe ali ndi matenda amtundu wa 1 komanso pakakhala zovuta zambiri.
Kuyika kwachinyengo chimodzi cha impso, kuperekera kutulutsa kwina kwa gland. Imachitika ndikuwopseza nephropathy komanso zovuta zina zoyambitsidwa ndi matenda ashuga.

Zovuta zakukula ndizosakira munthu wopereka, popeza zikondamoyo ndizopanda zinthu, sizingatengedwe kuti zitha kuchokera kwa wachibale kapenanso kwa munthu wamoyo, kotero muyenera kuyembekezera mlandu woyenera ndi zochitika zonse zotsatirazi. Vuto lachiwiri ndi moyo wa alumali wa chinthu chomwe chatengedwa, chitsulo chosinthika chimatha kukhalapo osaposa theka la ola kuchokera nthawi yomwe oxygen idasiya kuyipeza. Kusungidwa kozizira kumatha kuwonjezera nthawi imeneyi, koma osapitilira maola atatu mpaka asanu ndi limodzi kuchokera tsiku lomwe wachoka.

Mavuto ndi boma la kapamba ndi matenda ashuga ndizogwirizana kwambiri, koma ngakhale pali zovuta, kukhalabe ndi thupi ili bwino komanso kukhala ndi mwayi wogwira ntchito zonse ndizotheka. Ndikofunika kufunsa dokotala munthawi yake, kutsatira malingaliro awo onse, kuwunika zakudya zanu ndikukhala ndi moyo wathanzi.

Mitundu ya kulowererapo kwa opaleshoni yaziphuphu

Njira zopangira opaleshoni zimatha kuchitidwa m'njira yotseguka, pamene cholowa chogwirira ntchito chikuchitika pogwiritsa ntchito khoma la m'mimba kapena m'chigawo cholumikizira. Kutengera komwe kuli chotupa, njira zochizira zochepa zitha kugwiritsidwa ntchito pogwiritsa ntchito opaleshoni ya laparoscopic kapena njira yopopera ndi zochita zonse zochitidwa pogwiritsa ntchito ma punctures mu peritoneum.

Pankhani ya kukhazikika kwa cholelithiasis pakuwonjezereka, opaleshoni imatha kuchitika ndikuchotsa ndulu, popeza mu nkhani iyi bile limatha kulowa m'matumba a pancreatic ndikukhazikika mkati mwake, ndikupangitsa kutupa komwe kumawopseza moyo.

Kutengera mtundu wa matenda omwe amachititsa opaleshoniyo, pali njira zingapo:

Kuchotsa minofu yakufa pogwiritsa ntchito necrectomy.
Kubwezeretsanso, komwe kumaphatikizapo kuchotsedwa kwa gawo lina la chithokomiro. Ngati ndi kotheka, chotsani mutu wa chiwalo, gwiritsani ntchito pancreatoduodenal resection, ndi chotupa chomwe chimafikira m'thupi kapena mchira - distal.
Mtundu wonse wa kapamba.
Kutenga kukhetsa kwa ma cysts kapena zilonda.

Kaya ndi njira iti yomwe imagwiritsidwa ntchito pakuthandizira opaleshoni, chiopsezo chowonjezereka cha zovuta zina chimatsalirabe. Kuchepetsa lumen mu ndulu za zuluzika kumatha kuchitika chifukwa chakukula kwakanthawi. Pali mwayi wokhala ndi chotupa pambuyo pochitidwa opaleshoni yamtundu wa kapamba, kuti mupewe kutulutsa madzi kokwanira komwe kumachitika.

Njira zochepa zowukira

Chimodzi mwazinthu zomwe zakwaniritsidwa masiku ano ndi njira zapamwamba kwambiri zochizira opaleshoni mu kapamba pogwiritsa ntchito maopaleshoni ena osagwiritsa ntchito magazi:

Njira yama radiosurgery ndimagwiritsa ntchito ma radiation yamphamvu munjira ya mpeni wa cyber,
Njira yolira ndi kuzizira kwa mapangidwe a chotupa,
Kugwiritsa ntchito opaleshoni ya laser,
Kugwiritsa ntchito kwa ultrasound yokhazikika.

Tekinoloje zonse zomwe zalembedweratu, kupatula ma radiosurgery, zimachitika pogwiritsa ntchito kafukufuku yemwe adayikidwiratu tiziwopsezo tamadutsamo. Pambuyo pa kuchitapo kanthu kotereku, komwe kumachitika mwa kuchekekera pang'ono pakhungu pamimba, nthawi yochira imakhala yochepa kwambiri, ndipo kukhalamo kwa chipatala nthawi zambiri kumakhala kochepa kwa masiku angapo.

Ukadaulo waposachedwa

Mankhwala samayima chilili ndikuyesetsa kuthetsa mkhalidwe wa odwala omwe ali ndi ma pancreatic pathologies omwe amafunikira chithandizo cha opaleshoni. Chifukwa chake, akatswiri a Shalimov National Institute of Surgery and Transplantology akupanga zochitika zowononga zachilengedwezi pazinthu izi komanso kuzungulira kwa ndulu. Mwa izi, akufuna kuti agwiritse ntchito njira ya X-ray endoscopic, yomwe imatenga nthawi yochepa, kuyambira mphindi khumi ndi zisanu mpaka ola limodzi ndi theka. Kuchita opareshoni sikopanda magazi, chifukwa kumachitika pogwiritsa ntchito zida zapamwamba kwambiri mwa mawonekedwe a duodenfibroscope ndi kukhalapo kwa ofananira nawo patsekeke amene amaikidwa pakamwa.Kutheka kwa magazi kumachotsa mpeni wamagetsi, womwe podula minofu yomweyo umatulutsa cauterization. Pankhani yochepetsetsa duct, fungo lokhala ndi nitenol limalowetsedwamo, zomwe zimathandizanso kukhala ndi moyo wodwala wokhala ndi chotupa kwa zaka zitatu.

Zochita zochitidwa opaleshoni zomwe zimapangidwa pakukula kwa ma ducts ang'onoang'ono omwe amagwiritsa ntchito echoendoscopes amatha kudziwa ndikuchotsa zotupa zoyipa koyambirira, ndipo njirayi imalekeredwa mosavuta osati ndi odwala achikulire, komanso ndi ana.

Njira ya ukadaulo AMBUYE imatha kuchotsa ma cysts ndi zotupa mu gland mwa kuzifikitsa kudzera mu mawonekedwe a chilengedwe. Pankhaniyi, palibe zosagwirizana zomwe zimachitika, komabe, vuto lalikulu la njirayo ndi kukwera mtengo kwa zida zofunika, zomwe zipatala zazikulu zokha ndizomwe zingakwanitse kufikira pano.

Opaleshoni yokhala ndi chifuwa chachikulu

Ngati wodwala ali ndi pancreatitis yovuta kwambiri, amapititsidwa kuchipatala chachipatala chopangira opaleshoni, kumene, ngati kuli koyenera, kuchitapo kanthu opaleshoni yoyambirira kuchitidwa. Komanso, kuopsa kwa kuukiridwa sikumakhala umboni kwa opaleshoni, zotsatirazi ndizoyenera kuchitira ziwalo:

Magwero a necrosis a zimakhala,
Kuchiza sikubweretsa zotsatira zomwe zikuyembekezeredwa, ndipo patatha masiku awiri njira zakuchiritsira zolimba, wodwalayo akupitilirabe kuipiraipira.
Pamodzi ndi pancreatitis pachimake, edema inayamba kuwonjezeka ndi kuthekera kwa kupanga kwa enzymatic peritonitis, pakachitika njira yoyeretsa, mwadzidzidzi kapena ntchito yofunikira imachitidwa.

Mutha kuchedwetsa opaleshoniyo kwa masiku 10 mpaka milungu iwiri kuti pakhale kusungunuka ndi kukana kwa minofu yokhala ndi necrosis. Ndi pancreatic necrosis yomwe ikupita patsogolo, kuzengereza ndi thandizo la opaleshoni kumapha.

Kupulumutsa moyo wa wodwala ndi pancreatic pathology, izi:

Distal pancreatectomy
Corpuscaudal resection wochotsa mankhwalawa pooplasm,
Mgwirizano wophatikizira kuchotsa minofu yakufa,
Kukhazikitsa madambo omwe kumachitika madera ambiri,
Pancreatectomy - ndikuchotsa kwathunthu chiwalo chonse,
Kuyambiranso mutu umodzi wa England.

Osangokhala mkhalidwe wotsatira wa thupi, komanso kutalika kwa kukhalanso ndi moyo kumatengera nthawi yake yopanga opereshoni.

Opaleshoni ya pancreatic pseudocyst

Kapangidwe ka cyst yabodza ndi imodzi mwazovuta za kupweteka kwa kapamba, komwe kumafunikira opareshoni. Ndi kupangika kwa patsekeke podzaza ndi madzi a pancreatic, ma misa omwe amapangidwa chifukwa cha njira za necrotic, ndipo nthawi zina ndimagazi. Makoma ake amapangidwa ndi minofu yowongoka yolumikizana, ndipo mkati mwake mulibe gawo la epithelium, lomwe limatsimikizira chikhalidwe chake ngati pseudocyst. Mapangidwe amtunduwu amatha kufikira kukula kwa masentimita 40, amatha kukula kukhala chotengera chachikulu ndi mwayi wotaya magazi kutha. Makulidwe ang'onoang'ono a ma pseudocysts - ochepera masentimita 5, samawonetsa zizindikiro zamankhwala ndipo amangopezeka mwamwayi panthawi yamayeso pazifukwa zina.

Pamene pseudocysts amawoneka, akuphatikizidwa ndi ululu, kupweteka mseru kapena kuwonda m'mimba, amachotsedwa limodzi ndi gawo la kapamba. Kutengera ndi kukula ndi komwe cystyo imatha, imatha kuchotsedwa ndi enucleation kapena husking.

Pancreatic resection kapena kuchotsedwa kwathunthu

Kuchita opaleshoni ya pathologies ya chimbudzi chazimbudzi kungachitike pogwiritsa ntchito gawo limodzi kapena kuchotsa ziwalo zonse, i.e. Pancreatectomy. Chovuta chachikulu pochita ndi mtundu wa pancreatoduodenal reseation, womwe umagwira ntchito zowopsa kwambiri komanso umatha kuwopsa chifukwa cha zovuta zakumaso ndi kufa. Nthawi zambiri, njirayi imagwiranso ntchito ngati khansa ya m'mutu, yomwe ziwalo zoyandikana nayo imachotsedwa ngati mbali yam'mimba, chikhodzodzo cha ndulu kapena duodenum. Umboni wa kapamba wodziwika ndi kuchotsa kwathunthu kwa kapamba ndi:

Kufalikira kwa pancreatic necrosis,
Kupangidwe kwa ma cysts angapo,
Njira zoyipa zomwe zimakhala m'dera lalikulu,
Kuvulala kwambiri m'matumbo ndi kuvulala kofikako.

Kuchita ndi njira zofatsa kwambiri ndi Frey resection, yomwe imalola kubwezeretsa kutsekeka kwa pancreatic duct mu minofu ya mutu. Mothandizidwa ndi opaleshoni yothandizira, mutu umachotsedwa ndikusweka kwa duct yayikulu ndikulowera kwinaku mukutuluka kwa duodenal. Izi zimathandizira kuti madzi amasamba a pancreatic aulere m'matumbo ang'onoang'ono.

Opaleshoni yokhansa yapathengo

Njira zingapo zopangira opaleshoni zimagwiritsidwa ntchito kwa odwala omwe ali ndi pancreatitis yayikulu, chikhalidwe ndi machitidwe omwe amadalira ziwalo zomwe zimagwira opaleshoni komanso kukula kwa ntchitoyo. Kuti muchite izi, gwiritsani ntchito:

Njira zachindunji kuti muchepetse chifukwa chomwe chikuchedwa kulowa pancreatic secretion mu duodenal lumen. Mwakutero, sphincterotomy kapena miyala yotulutsa kuchokera m'thupi kapena kuchokera pakanunkhira gland imagwiritsidwa ntchito.
Kutsegula kwa ma dancts a pancreatic mu mawonekedwe a gastrostomy, virsungoduodenostomy, kuyikiridwa kwa stent.
Njira zachindunji za opaleshoni ndi resection la m'mimba ndi kuphatikiza kosankha kwa vagotomy, cholecystectomy pamitsempha yothandizira, komanso vagotomy yomwe ili ndi gawo la mitsempha ina.

Mu mawonekedwe a pancreatitis, pancreatectomy nthawi zambiri imachitidwa ngati mbali yamanja, mbali yakumanzere, kapena duodenopancreatectomy.

Mavuto opaleshoni

Zikondazo zimapatsidwa ntchito yothandizira thupi. Mavuto omwe amachitika pakuchita opaleshoni mu chiwalochi ndi chifukwa cha kupangika kwa mankhwalawa, komanso malo omwe amagwirizana ndi ziwalo zina. Mutu wake umawerama kuzungulira duodenum, ndipo kumbuyo kumalumikizana kwambiri ndi mbali zofunika kwambiri za thupi monga msempha, impso kumanja ndi adrenal gland. Chifukwa cha ubalewu wapafupi, ndizovuta kuneneratu zamtundu ndi mtundu wa kakulidwe ka pathologies mu kapamba. Kuchita chilichonse kwa opaleshoni mwa njira ngati izi kungayambitse kusokonezeka osati minyewa yokha, komanso ziwalo zoyandikana nayo, kuphatikiza osaphatikizira mwayi wowonjezereka komanso kupanga magazi.

Nthawi yogwira ntchito

M'miyezi yoyamba ya kuchira kwa postoperative, thupi limasinthana ndi zatsopano zakhalapo. Pankhaniyi, wodwalayo amachepetsa thupi pambuyo pakuchita opaleshoni, amakhala ndi nkhawa komanso nkhawa m'mimba atatha kudya chakudya chilichonse, kusokonezeka kwa mawonekedwe amkati m'matumbo ndi kufooka wamba. Kukonzanso moyenera kumachotsa zizindikiro zosasangalatsa izi, ndipo wodwala wopanda kapamba mothandizidwa ndi mankhwala othandizira amatha kukhalanso ndi moyo zaka zambiri.

Kuwonetsetsa kuti pakhale opaleshoni yonse pambuyo pa opaleshoni, wodwalayo ayenera kutsatira malamulo otsatirawa kwa moyo wake wonse.

Idyani mosamalitsa ndi zakudya,
Siyani kumwa mowa kwathunthu
Sungani shuga m'magazi anu, monga 50% ya milandu itachotsedwa England, matenda a shuga amapezeka,
Imwani mankhwala omwe adokotala adakupatsani omwe ali ndi ma enzymes kuti muthandize kugaya,
Ndi kuchuluka kwa shuga, tsatirani dongosolo la insulin.

Mkhalidwe waumoyo wopitilira muyeso waumoyo wa wodwalayo panthawi yothandizidwa zimadalira kuchuluka kwazovuta zovuta, kukonzanso bwino komanso kuuma kwazovuta zomwe zidabuka. Izi zikuphatikiza:

Kutulutsa magazi kwambiri
Abscesses kapena peritonitis chifukwa cha kufalikira kwa matenda,
Mapangidwe a Fistula,
Maonekedwe a thrombosis kapena thromboembolism,
Ndi momwe mchira wa tinthu timene timayendera - kukula kwa matenda ashuga,
Kuthekera kwa Fermentopathy.

Pankhani ya kupangika kwa enzyme akusowa kapena kupezeka kwa matenda ashuga, kwanthawi yayitali mankhwala omwe ali ndi michere kapena mankhwala a insulin.

Kusamalira ana

Kutalika kwa nthawi yochira ndikukhazikika kuchipatala zimatengera njira yogwiritsira ntchito yomwe imagwiritsidwa ntchito. Pankhani ya opaleshoni yam'mimba yovuta, odwala samangokhala kuchipatala kwa nthawi yayitali, koma atachotsedwa, amakhalabe oyang'aniridwa ndi dokotala ndikupitiliza chithandizo. Ngati kulowererapo kosafunikira kunachitika, ndiye kuti wodwalayo wachotsedwa kale kunyumba tsiku lachiwiri kapena lachitatu, ndipo pakatha masiku angapo amakhala wamphamvu ndipo amatha kuyamba ntchito zina.

Pambuyo pa opaleshoni, wodwalayo amakhalabe m'chipinda chothandizira kwambiri kwa maola 24 moyang'aniridwa ndi madokotala komanso ndi njira zoyenera, chifukwa masiku atatu oyamba samapatsidwa chakudya, amangokhala ndi madzi. Mafuta pakadali pano amaperekedwa pogwiritsa ntchito njira zapadera mwanjira yaubwino. Ngati wodwalayo alidi okhazikika, chithandizo chinanso chimachitika m'dipatimenti ya opaleshoni.

Wodwalayo amasamutsidwa kukalandira chithandizo chakunyumba pokhapokha masiku 45-60, kupeza kumeneku kuyenera kuperekedwa ndi kupumula kwa kama, kupuma, kusowa nkhawa komanso kulimbitsa thupi, kudya mokhazikika komanso kulandira mankhwala osokoneza bongo. Kuyenda maulendo kumayambira milungu iwiri kuchokera nthawi imeneyi. Nthawi zina, wodwalayo amayenera kuchita chithandizo chamankhwala pamoyo ndikutsatira malamulo oletsa kudya.

Mavuto omwe angakhalepo komanso zotsatirapo zake

Kuchita opaleshoni yam'mimba ndikovuta kwambiri, kotero, zovuta zazikulu zimatha kupanga pambuyo pochita. Nthawi zambiri, zoterezi ndi postoperative pancreatitis, ndi zizindikiro zonse zomwe zimafanana ndi mankhwalawa, kupweteka kwapadera pamalo a epigastia, kuchuluka kwama cell oyera m'magazi ndi amylase mkodzo. Mawonetseredwe omwewo amatsagana ndi edema ya gland ndi kutsekeka kwotsatira kwa kukoka kwake kwakukulu.

Zinthu zotsatirazi zimathanso kuchitika ngati zowopsa pambuyo pa opaleshoni:

Kuthekera kwa magazi kwambiri,
Kulephera kwazungulira
Kuchulukitsa kwa matenda ashuga,
Kukula kwa kapamba ka neancosis,
Mapangidwe aimpso hepatic kulephera,
Maonekedwe a abscesses kapena sepsis.

Nthawi zambiri, chifukwa cha kulowererapo kwa opaleshoni, kukula kwa malabsorption syndrome mu mawonekedwe a zosokoneza pakugaya chakudya ndi kugwidwa ndi michere kuchokera komwe kumapezeka.

Kutsatira zakudya ndikofunikira kwambiri osati pakukonzanso pambuyo pakuchita opaleshoni, komanso kuonetsetsa kuti thanzi labwino ndi kuthekanso kuchita ntchito zawo ndi zikondamoyo kwa moyo wawo wonse. Masiku atatu oyamba atachitidwa opaleshoni, zikondamoyo sizimadzaza ndipo zimapereka kusala kudya kwathunthu, kuyambira tsiku lachitatu mungathe kusintha pang'ono pang'onopang'ono kuzakudya zomwe sizisamalidwa.

Poyamba, mumangofunika kudya zakudya zowotcha, ndiye kuti pali zakudya zophika zokha. Kusiyidwa kwambiri kuyenera kukhala zonunkhira, zakudya zokazinga, komanso malonda okhala ndi mafuta ambiri.

Mankhwala

Pambuyo pakuchita opaleshoni pa kapamba, ndikofunikira kumwa mankhwala okhala ndi ma enzymes kapena mankhwala omwe amathandizira kupanga kwawo. Mothandizidwa ndi mankhwalawa, ndikotheka kutulutsa mphamvu ya ziwalo zomwe zimakhudzidwa ndi chimbudzi ndikuchepetsa zovuta.

Ngati mukukana kumwa mankhwala amtunduwu, zovuta zotsatirazi zingachitike:

Kuchuluka kwa kupanga kwa mpweya
Pali maluwa,
Kusokoneza chopondapo ndi zosokoneza pamtima.

Pambuyo pakuchita opaleshoni ndikufalitsa gland, wodwalayo adzafunikira kumwa mankhwala othandizira kuponderezana chitetezo chokwanira, kuti athe kupewa kukakamizidwa.

Zochita zolimbitsa thupi

Zochita zolimbitsa thupi zochokera ku akatswiri othandizira olimbitsa thupi ndi zina mwazomwe zimapanganso kukonzanso. Apatseni gawo atakwaniritsa chikhululukiro chomaliza. Maphunziro amayamba ndikuyenda kwakanthawi kochepa, masewera olimbitsa thupi m'mawa, omwe amaphatikizapo kutembenuza thupi, masewera olimbitsa thupi poyambitsa kupumira kwamphamvu komanso kupumira. Kutikita mwapadera ndi kutenga nawo mbali yam'mimba ndikwabwino pamthupi. Zochitika zomwe zikuyendetsedwa zimathandizira magazi kulowa mu gland, kuthetsa edema yake, komanso kusintha chimbudzi.

Izi ndi njira zamagetsi sizifunikira kulimba, zinthu zonse zimapangidwa kuti zikonzedwe bwino. Khalidwe lokhazikika la makalasi amenewa limathandizira kuti chikhululukiro chikhale nthawi yayitali.

Moyo pambuyo kuchotsa chiwalo kapena mbali yake

Pambuyo pa opaleshoni yochotsa gawo la gland, komanso ngati pali mayikidwe athunthu, mothandizidwa ndi mankhwalawa molondola pogwiritsa ntchito mankhwala osankhidwa ndi adokotala komanso zakudya zoyenera, wodwalayo amatha kukhala moyo kwanthawi yayitali.

Kuchulukitsa kwa michere yamagetsi ndi mahomoni omwe amapangidwa ndi kapamba akhoza kupanga kuti agwiritse ntchito mankhwalawa. Muyenera kudziwongolera nokha mopanda shuga komanso kuchitapo kanthu panthawi yake. Malinga ndi malingaliro onse azachipatala, thupi la wodwalayo limasinthika pakapita nthawi ndikuzolowera momwe zinthu ziliri, ndipo wodwalayo atha kubwereranso m'moyo wake momwe amasintha pang'ono.

Mtengo wogwira

Mtengo wa opaleshoni ya kapamba zimatengera njira yomwe imagwiritsidwa ntchito kuti athetse matenda, komanso pazomwe ayenera kuchitapo pakuchita opaleshoni. Chifukwa chake, opaleshoni yokhala ndi zotulutsira zotupa imatha kuwerengeka kuchoka pa 7.5,000 mpaka 45,000 rubles.

Kuchotsa ma cysts osiyanasiyana kudzawononga ndalama kuchokera 23, 1 mpaka 134,000 ma ruble, opaleshoni ya pancreatic necrosis pogwiritsa ntchito njira zosiyanasiyana - kuchokera 12,000 mpaka 176,000 rubles.

Resection pancreatic, kutengera gawo lomwe lakhudzidwalo, lidzagula ruble 19,000 mpaka 130,000, ndi pancreatectomy yathunthu - kuchokera pa 45,000 mpaka 270,000 rubles.

Mitengo iyi imatha kusiyanasiyana kutengera kuyenerera kwa dokotala wa opaleshoniyo ndi zina, chifukwa chake mtengo wodziwika bwino wa chithandizo chachipatala chomwe chikubwerachi chitha kulengezedwa mukapita ku chipatala.

Okondedwa owerenga, lingaliro lanu ndilofunika kwambiri kwa ife - chifukwa chake, tidzakhala okondwa kuwunikira ntchito ya kapamba mu ndemanga, ithandizanso kwa ogwiritsa ntchito ena a tsambali.

Alena:

Nditachita opaleshoni yapanyumba, ndinatsatira kudya kwamphamvu miyezi itatu. Inde, ndipo tsopano ndimachepetsa zakudya zonunkhira ndipo ndimayesetsa kuti ndisadye mafuta. Zotsatira zake, momwe zinthu zinakhalira zabwinobwino, sindimakumana ndi vuto lililonse.

Denis:

Ndibwino kuti kuphwanya kwa kapamba kunapezeka munthawi yake ndipo opareshoni anachitidwa kuti akweze chimbudzi pogwiritsa ntchito stenting, njira za kudzipatula kwa enzyme zidabwezeretseka.

Opaleshoni ya pancreatic pseudocyst

Pseudocysts mu kapamba amapangidwa pambuyo pa kuthetsa kwa pachimake njira yotupa. Pseudocyst ndi patchi yopanda nembanemba yopangidwa ndi madzi a pancreatic.

Ma pseudocysts akhoza kukhala akulu kwambiri (kupitilira masentimita 5), owopsa chifukwa:

Amatha kupondereza zimakhala, ma ducts.
Pweteketsani kupweteka kwambiri.
Supplement ndi mapangidwe a abscess ndikotheka.
Cysts yokhala ndi michere yamphamvu yogaya chakudya ingayambitse kukokoloka kwa mtima komanso magazi.
Pomaliza, chotupa chimatha kulowa m'mimba.

Cysts zazikulu zoterezi, zomwe zimaphatikizidwa ndi zowawa kapena kukakamiza kwa ma ducts, zimathandizidwa ndikuchotsedwa kapena kukhetsa.Mitundu yayikulu yogwiritsira ntchito ndi pseudocysts:

Percutaneous kunja kukhetsa kwa cyst.
Kusangalatsa kwa chotupa.
Kukhetsa kwamkati. Mfundo yake ndi kulenga kwa anastomosis ya cyst yokhala ndi m'mimba kapena kuzungulira kwamatumbo.

Nthawi yogwira ntchito ndi yaposachedwa

Kukonzekera kwa opaleshoni yamapapo sikuti ndizosiyana kwambiri ndikukonzekera zochitika zina. Chachilendo ndikuti ntchito pa zikondamoyo zimachitika makamaka pazifukwa zaumoyo, ndiko kuti, pokhapokha ngati chiopsezo chosasokoneza chikhale chambiri kwambiri kuposa chiwopsezo cha ntchito nokha. Chifukwa chake, kutsutsana kwa zinthu ngati izi kumangokhala vuto lalikulu kwambiri la wodwalayo. Opaleshoni yamatenda ochita opaleshoni amachitika kokha pansi pa opaleshoni wamba.

Pambuyo pakuchita opaleshoni pa kapamba, zakudya za makolo zimapangidwa kwa masiku angapo oyambira (zothetsera michere zimayikidwa m'magazi kudzera ndi dontho) kapena chubu chamatumbo chimayikidwa pakuchita opaleshoni ndipo kusakaniza kwapadera kwamankhwala kumayikidwa mwachindunji m'matumbo kudzera mwa iye.

Patatha masiku atatu, ndikotheka kumwa kaye, kenako ndikusenda chakudya chambiri chamafuta popanda mchere ndi shuga.

Moyo pambuyo pakuyambiranso kapena kuchotsedwa kwa kapamba

Mapamba, monga tanena kale, ndi gawo lofunikira kwambiri komanso lapadera la thupi lathu. Amapanga ma enzyme angapo am'mimba, komanso okhawo kapamba amatulutsa mahomoni omwe amawongolera kagayidwe kazakudya - insulin ndi glucagon.

Komabe, ziyenera kudziwika kuti magawo onse a chiwalochi akhoza kulipira bwino ndi chithandizo cholowa m'malo. Munthu sangathe kupulumuka, mwachitsanzo, popanda chiwindi, koma popanda kapamba wokhala ndi njira yoyenera komanso chithandizo choyenera, akhoza kukhala ndi moyo zaka zambiri.

Kodi malamulo a moyo ndi chiyani pambuyo pa ntchito pa kapamba (makamaka popanga gawo kapena chiwalo chonse)?

Kutsatira kwambiri zakudya mpaka kumapeto kwa moyo. Muyenera kudya m'magawo ang'onoang'ono 5-6 patsiku. Zakudya ziyenera kugayidwa mosavuta ndi mafuta ochepa.
Kupatula kwathunthu kwa mowa.
Makonzedwe a enzyme mu chovala chovomerezeka chotchulidwa ndi dokotala.
Kudziyang'anira nokha shuga. Kukula kwa matenda ashuga okhala ndi gawo limodzi la kapamba sikuti kumangokakamiza konse. Malinga ndi magwero osiyanasiyana, zimachitika mu 50% ya milandu.
Mukazindikira matenda a shuga - mankhwalawa a insulin malinga ndi mapulani omwe adapangidwa ndi endocrinologist.

Nthawi zambiri m'miyezi yoyamba atachitidwa opaleshoni, thupi limasinthana:

Wodwala, monga lamulo, amachepetsa thupi.
Kusasangalala, kulemera ndi kupweteka pamimba mukatha kudya kumamveka.
Nthawi zambiri zimbudzi zotayidwa zimawonedwa (nthawi zambiri itatha chakudya chilichonse).
Kufooka, malaise, ndi zizindikiro za kuchepa kwa vitamini chifukwa cha kupweteka kwa malabsorption ndi zoletsa zakudya zimadziwika.
Mukamapatsa mankhwala a insulin, nthawi zambiri zinthu zofunikira kwambiri za hypoglycemic ndizotheka (chifukwa chake, tikulimbikitsidwa kuti pasakhale kuchuluka kwa shuga).

Koma, pang'onopang'ono, thupi limazolowera zatsopano, wodwalayo amaphunziranso kudziwongolera, ndipo pambuyo pake moyo umayamba kuchita bwino.