Hemorrhagic pancreatic necrosis - matenda oopsa okhala ndi zotsatira zoyipa

Matenda oopsa kwambiri a kapamba ndi hemorrhagic pancreatic necrosis. Umu ndi momwe amafa posinthira maselo ake, omwe amachitika mofulumira kwambiri. Matendawa ndi kupitilira kwa pachimake kapamba. Pancreatitis yotere imachitika chifukwa cha kuledzera, kuwonongeka kwa makina, zovuta pambuyo pa opaleshoni. Pancreatic necrosis imawonekanso kuchokera pakukulitsa kwa matenda opatsirana a kapamba.

Mwa munthu wathanzi, madzi a pancreatic amapangidwa ndi gland, omwe amapanga mapuloteni am'mimba. Enzymes mu madzi amachotsedwa kapamba kulowa duodenum. Poyang'aniridwa ndikupanga zinsinsi za michere iyi, kudziunjikira kwawo kosalamulika kumachitika, zomwe zimapangitsa kuti adziwonongere kapamba. Zingwe ndi mitsempha yamagazi zawonongeka. Mitsempha yam'mimba imawoneka. Posakhalitsa, maselo akufa amakhala m'malo ochulukirapo (necrosis). Kuthamanga kwa njirayi kumatengera kuchuluka kwa kupanga kwa michere yambiri.

Kuchepetsa kotereku kumakhudza magwiridwe antchito a thupi lonse. Njira yogaya chakudya imakwiya, chitetezo chokwanira chimachepa kwambiri. Ziwerengero zamankhwala zimawonetsa kukhumudwitsa. Hemorrhagic pancreatic necrosis ndiyo imayambitsa imfa 7 mpaka 15 peresenti akapezeka.

Zomwe zimayambitsa matendawa

Malingaliro azachipatala a matenda oopsawa sanafike pakugwirizana pazomwe zimayambitsa. Koma chithandizo chachipatala chimatilola kunena kuti zinthu zotsatirazi zimayambitsa kuwoneka kwa hemorrhagic pancreatic necrosis:

ngati m'mbuyomu panali zotupa, zomwe zimapangitsa kuti ntchito zake ziziwonongeka pang'ono.
ngati kutulutsa kwa pancreatic madzi kumasokoneza,
ngati pakhala poyizoni padziko lonse lapansi chifukwa cha mowa kapena mankhwala,
ngati panali matenda opatsirana a bile duct: cholangitis, cholecystitis, etc.,
Ngati magazi akuchulukana chifukwa cha matenda akale am'mbuyomu, mankhwala othandizira omwe amagwiritsa ntchito mankhwala,
ngati autoimmune pathologies a hemorrhagic mitundu ilipo m'thupi,
ngati gilasi yofunsira itavulala chifukwa cha zochitika zamakina, mwachitsanzo, malowedwe opangira opaleshoni,
ngati oncology adathandizidwa ndi chemotherapy kapena radiation, komanso motsutsana ndi maziko awa, DIC.

Izi zimapangitsa kusokoneza magwiridwe antchito, omwe amachititsa kuti michere ipangidwe. Gastroenterologists awulula kuchokera pazotsatira za kafukufuku kuti imodzi mwamagawo ofunika kwambiri pancreatic necrosis ndikuphwanya malamulo amanyazi. Ntchitoyi imawongolera moyo wa munthu kudzera m'magazi, ma lymph, ndi ma media ena amadzimadzi ogwiritsa ntchito mahomoni.

Zizindikiro zamatsenga

Kuopsa kwa matenda a m'magazi kumachitika chifukwa chakuti ndi matendawa pali zizindikiro zake zodziwikiratu zomwe zingapezeke kuti ali ndi kuthekera kwakukulu. Vutoli ndikuti hemorrhagic pancreatic necrosis imakula mofulumira, ndipo odwala amafika kuchipatala mochedwa. Ndipo mu izi, ngakhale njira zamakono zamankhwala sizingathandize. Mwa amodzi mwa milandu isanu, kugwa kumachitika, ndipo gawo limodzi mwa magawo atatuwo limayamba kugwa. Pancreas minofu nthawi zambiri imang'ambika. Madzi a pancreatic ali m'mimba, ndikupangitsa puritonitis ya purulent. Kuti mupewe zoyipitsitsa, muyenera kudziwa zomwe zimapezeka mu pancreatic necrosis:

kupweteka kwambiri mu hypochondrium yamanzere, yomwe imatha kupereka zonse pachifuwa ndi mapewa komanso kutsika kumbuyo,
mawonekedwe ofika pachilankhulo cholochedwa choyera kapena chachikaso,
kamwa youma yosagwedezeka, yosatheka ndikuchotsa.
kusanza kosalekeza, nseru,
chisangalalo
kutsegula m'mimba
kutentha chifukwa chakupha poyizoni,
kutentha kuwonjezeka
kutupa kwa khungu kumaso,
m'mimba yabuluu
kuthamanga kwa magazi
kuchepa kwakukulu kwa ntchito ya msana wamafinya (mkodzo, ndowe),
magawo a psychoemotional state (kukhumudwa, kuchita ukali).

Ululu kumanzere hypochondrium

Kuzindikira matendawa

Madokotala okha ndi omwe angadziwike mozama atapima mayeso athunthu: kufufuzidwa pamakompyuta, mayeso a labotale. Ngati mukukayikira hemorrhagic pancreatic necrosis, zotsatirazi zotchulidwa:

Ultrasound wa kapamba,
CT yofufuza yonse yam'mimba,
MRI
kuyezetsa magazi wamba, kuyesa kwamikodzo,
kutsimikiza kwa zikuchokera pancreatic ndi chapamimba timadziti.

Magazi amawunika kuti apeze ma enzymes omwe amapangidwa ndi gland. Mumkodzo, chidwi chimakhudzidwa ndi kuchuluka kwa trypsinogen, amylase. Acidity ya chapamimba madzi, kuchuluka kwa michere mu pancreatic madzi, mafuta mu ndowe, triglycerides m'mapapu ndikofunikira. Zingakhale zofunikira kutenga chithunzithunzi cha minofu yakufa.

Kuchuluka kwa zotsatira zomwe zapezedwa zikuthandizira kusiyanitsa matendawa ndi matenda ena am'mimba komanso matumbo. Nthawi zina, odwala amaloledwa kupita kuchipatala kuti atha kuphunzitsidwa asanaphunzire koyambirira.

Gulu ndi mitundu

Pambuyo pa kufufuza kwathunthu kwa pachimake hemorrhagic pancreatic necrosis, matendawa amawagawa m'magulu angapo kutengera:

kuchokera kukula kwa madera omwe akhudzidwa,
pamaso pa matenda,
kuchokera ku matenda.

Potengera madera ang'onoang'ono omwe akhudzidwa, matendawa amawerengedwa ngati necrosis yochepa. Kupanda kutero, okwanira hemorrhagic pancreatic necrosis (kufalikira kwa necrosis).

Pali mitundu ingapo ya pachimake pancreatic necrosis: wosabala komanso yopatsirana. Ngati pali matenda amafuta amtunduwo, ndiye kuti matulukidwe ake ndi abwino, chitukuko chimachedwa. Ndi necrosis yosakanikirana, njira yogwira ntchito imachitika yomwe imayambitsa magazi.

Matendawa amatha kuimitsa (mawonekedwe amwano) ndikukula mofulumira (mawonekedwe opita patsogolo).

Kuchiza matenda

Ngati munthu wadwala kwambiri gawo la hemorrhagic pancreatic necrosis, kuchipatala ndikofunikira. Kugwiritsa ntchito mankhwala akudzisamalira nokha kuli koopsa kwambiri. Choyambitsa imfa ndi chithandizo chamankhwala osayembekezereka. Ndi matenda awa, pali njira ziwiri: wodwalayo amathera m'chipinda chothandizira kwambiri kapena patebulo la opaleshoni. Chithandizo chokwanira chimagwira ntchito zotsatirazi:

kupweteka kwakumayima,
kupanga kwambiri ma pancreatic Enzymes amayima
spasms amamasuka
secretion wa madzi a m'mimba amachepetsa,
Matendawa amapewedwa.

Njira zopulumutsira ziyenera kugwiritsidwa ntchito mosazengereza. Antispasmodics amagwiritsidwa ntchito. Kuchita mwachangu kumaperekedwa ndi Novocain. Ma ducts amakula, ndipo msuzi wa pancreatic umachotsedwapo popanda kulowerera. Kuyambira maolaola a antienzyme ndi antibacterial amagwiritsidwa ntchito, ntchito yachinsinsi imachepa ndipo minofu necrosis imaletsedwa.

Patatha maola angapo atalandira chithandizo chotere, madotolo amayang'ana momwe zimagwirira ntchito, amayeza zabwino ndi zoopsa zake. Sankhani za kufunika koperekera opaleshoni. Ngati mawonekedwe a matendawa si opatsirana, ndiye kuti laparoscopy akuwonetsedwa. Ndikotheka kugwiritsa ntchito ngalande zamkati kudzera pakhungu. Ngati zochulukirapo zapezeka, kuchitidwa opaleshoniyo kuyenera kuchitidwa. Zotsatira zabwino zimatsata njira ya peritoneal dialysis.Chifukwa cha iye, ma enzyme ndi zinthu zapoizoni amachotsedwa m'mwazi, chiopsezo cha kufa chimachepa kwambiri.

Ndi wamba pancreatic necrosis, kuchotsa pang'ono kapamba (kamodzikamodzi kwathunthu) kungakhale kofunikira. Atangochita opaleshoni, chithandizo chamankhwala chimakhazikitsidwa. Pankhaniyi, mankhwala omwe amathandizira pakugwira ntchito kwa gland amakhala ovomerezeka.

Kuteteza matenda

Kuti muchepetse pambuyo pochita opaleshoni, muyenera miyezi inayi. Nthawi yomweyo, zakudya zapadera, kupumula ndi kupsinjika pang'ono ndikuchiritsidwanso. Njira ya kumwa mapiritsi ndi insulin, mankhwala a enzyme, physiotherapy ndi mankhwala.

Zakudya zopatsa thanzi ziyenera kutsatiridwa moyo wonse. Chakudya chimatengedwa nthawi 5-6 patsiku m'magawo ang'onoang'ono. Nthawi yolandila ndi yomweyo. Amawonetsedwa kuphika kapena masamba a nthunzi. Porridge kokha pamadzi, mafuta ochepa mkaka. Mwa nyama, nkhuku zimalimbikitsidwa. Sizoletsedwa kudya zipatso ndi ndiwo zamasamba zatsopano, zakudya zopangidwa mwachangu, mowa, mkaka, kusungidwa.

Popewa kupezeka kwa hemorrhagic pancreatic necrosis, muyenera kutsatira malamulo osavuta a moyo wathanzi. Idyani zamasamba ndi zipatso zatsopano, tirigu wathunthu, mtedza, mafuta a masamba, nsomba zam'madzi. Pewani zakudya zamafuta, zakudya zakonzedwa, shuga ndi mchere wambiri. Imwani madzi oyera ambiri. Lekani kusuta, osamamwa mowa kwambiri, kusuntha komanso nthawi zambiri mumlengalenga. Pewani zochitika zovuta komanso pezani mayeso azachipatala nthawi zonse.

Pomaliza

Muyenera kudziwa kuti ziwerengero zimayang'ana magulu owonjezereka a pancreatic necrosis: okalamba, oledzera osagwiritsa ntchito mankhwala osokoneza bongo, omwe ali onenepa kwambiri chifukwa cha kudya zakudya zamafuta ambiri, matenda oyamba m'mimba, matumbo, chiwindi, kapamba, komanso kuwonongeka kwamakina pamimba. mafupa.

Kumvetsetsa njira za necrosis (zomwe zimayambitsa, zizindikiro ndi chithandizo) zimateteza ku zovuta komanso kuyamba kwa njira zosasinthika. Matenda akulu samachitika kuyambira poyambira. Zimatenga zaka ndalama zochepa ndikukhala wopatsa chidwi. Njira yoyenera yathanzi lanu imakutetezani ku hemorrhagic necrosis ndi matenda ena ambiri.

Lingaliro lalikulu la njira ya pathological

Hemorrhagic pancreatic necrosis imayamba mu kapamba motsutsana ndi kumbuyo kwa kapamba kapamba kapena kufalikira kwamkati mwa kapamba. Pathology imadziwika ndi kufa mwachangu kwa maselo a ziwalo, ndipo kusintha kumeneku sikungasinthe. Izi, zimayambitsa kuphwanyidwa kwa ntchito zochititsa manyazi ndi michere ya thupi.

Matendawa ndi owopsa, ndipo ngati sapezeka m'nthawi yake, ndiye kuti amapha. Njira ya pathological imatha kuwononga maselo ndi ziwalo zina zomwe zimakhala pafupi ndi kapamba, zomwe zimawonetsanso ngozi ina.

Kodi matendawa amakula bwanji?

Yodziwika ngati matenda achiwiri, hemorrhagic pancreatic necrosis imayamba chifukwa cha zinthu zotsatirazi:

kutupa mu kapamba, limodzi ndi kukomoka kwa ziwalo ndi kusagwira ntchito pakumasulidwa kwa michere,
poyizoni wa chakudya, kuledzera kwa ethanol chifukwa chodalira mowa, kumwa mankhwala ambiri osokoneza bongo,
chifuwa chachikulu, pokhapokha ngati zakudya zapadera sizitsatiridwa,
autoimmune pathologies,
kuchitapo kanthu kwa opaleshoni osagwiritsa ntchito chakudya pamimba, pambuyo pake zovuta zinabuka.
zikondamoyo
ma gallstones pamene madzi a pancreatic aponyedwa mumizere,
biliary thirakiti matenda
DIC-syndrome, yomwe imawoneka motsutsana ndi maziko a matenda oyamba ndi bakiteriya, zotsatira zoyipa za ions, chemotherapy.

Mosasamala kanthu zomwe zimayambitsa kukula kwa matenda a m'matumbo, hemorrhagic pancreatic necrosis imakhudza acinus, yomwe imayang'anira kupanga ma enzymes okumba. Zotsatira zake, kuchuluka kwa ma enzymes kumawonjezeka kwambiri, komwe kumakhudza minyewa yapanja chifukwa cha kuwonongeka kwa mapuloteni ake. Izi zimayambitsa matendawa. Imodzi mwa michereyi imatchedwa elastase, yomwe imawonongeka, kuphatikiza mitsempha yamagazi, yomwe imayambitsa kutaya magazi.

Mitundu ndi magawo a hemorrhagic pancreatic necrosis

Kutengera ndi dera lomwe lakhudzidwalo, mitundu yotsatirayi ya pathology imasiyanitsidwa: yochepa (yokhazikika, yokhala ndi mawonekedwe ena osiyana) ndikufalikira (kwathunthu) hemorrhagic pancreatic necrosis, yomwe imakhudza gawo limodzi lokhala ndi gland kapena chiwalo chonse.

Magawo angapo a matendawo amatithandizanso:

Gawo I, lokhala pafupifupi sabata limodzi, pomwe kupangidwanso kwa mabakiteriya (kuwonjezereka kwa iwo kumathandizira poizoni wa thupi ndi zinthu zofunika, zomwe zimafooketsa England),
Gawo lachiwiri: lodziwika ndi kuwonongeka kwa maselo a ndulu, zomwe zimaphatikizira mawonekedwe a purulent foci ndi zolephera za chikhalidwe chimodzi,
Gawo lachitatu, m'mene kutupa kumafalikira osati kudera lalikulu la chinyezi, komanso ziwalo zoyandikana.

Kodi matendawa amapezeka bwanji?

Poyamba, katswiri amatenga anamnesis, pomwepo amamuwunikira (pakhungu, pakamwa pakamwa) ndi palpation ya peritoneum. Kenako urinalysis imachitika kuti muwone zomwe zili trypsinogen ndi uroamylase mmenemo, magazi pamlingo wa michere. Kuphatikiza apo, njirayi imapangidwira kuti itsimikizire gastric acidity, maphunziro amadzimadzi a pancreatic kuti azindikire kuchuluka kwa ma bicarbonates, komanso kuwunika ndowe kuti pakhale zotsalira zamafuta osagwiritsidwa ntchito. Njira zina zodziwitsira matenda zimafunikira:

MRI ndi CT, zomwe zimatsimikizira madera owonongeka,
endoscopic pancreatocholangiography.

Pomwe akuwonetsa, laparoscopy ya peritoneum imalengezedwanso, yomwe imawonetsa kuwonongeka kwa ziwalo zamkati ndi pathological process.

Ndi njira ziti zochizira zomwe zimagwiritsidwa ntchito?

Popeza nthawi zambiri pachimake hemorrhagic pancreatic necrosis imafuna chithandizo chamankhwala mwadzidzidzi, amawagwiritsa ntchito kuchipatala, ndipo milandu yayikulu imafuna kuti wodwalayo aikidwe m'chipinda chothandizira kwambiri. Poyamba, chithandizo chamankhwala chokhazikika chimayikidwa (kupatula milandu ngati pakufunika opaleshoni mwachangu komanso mwachangu). Njira zake zazikulu, kuphatikiza masiku atatu mpaka anayi osala kudya, ndi izi:

mpumulo wa zowawa, zomwe nthawi zambiri mankhwalawa amagwiritsidwa ntchito mpaka novocaine blockade, chifukwa ululu, monga lamulo, uli ndi dzina lotchulidwa,
normalization wa acidity ndi antisecretolytics,
kuchepa kwa chiwerengero cha ma enzymes opangidwa,
cramping
kupewa kupewa kupewa kukula kwa ntchito ndi antibacterial othandizira.

Nthawi zambiri, njira zotere sizimalimbitsa thupi konse. Kenako amathandizira kuchitapo kanthu pochita opaleshoni, yomwe imasonyezedwanso pamavuto oyamba a wodwala, mwachitsanzo, kufalikira kwa matenda a ziwalo zapafupi.

Nthawi zambiri, laparoscopy imagwiritsidwa ntchito pochotsa madera a necrosis, ndipo pakakhala njira yopatsirana, kapamba amaphatikizidwanso. Milandu yoopsa kwambiri, yophatikizidwa ndi kufa kwa magawo ofunikira, imafunikira opareshoni yotchedwa pancreatectomy.

Ndiyenera kunena kuti ngakhale kuchitidwa opaleshoni yayikulu sikuti kumachotsa matendawa mpaka kalekale ndi matenda a pancreatic necrosis a hemorrhagic. Nthawi zina, ndikofunikira kuti mudzachitenso kachiwiri.

Matenda a pancreatic amadziwika ndi maphunziro othamanga komanso chiwopsezo chachikulu cha zovuta. Matendawa monga hemorrhagic pancreatic necrosis ndi owopsa kwambiri. Ndi matendawa, kusala kudya, koma koposa zonse, njira yosasinthika ya kufa kwa cell imawonedwa. Kuphwanya kofala kwambiri kumayamba chifukwa cha pancreatitis pachimake kapena pakubwezanso. Choyipa ndichakuti ngakhale chithandizo chomwe chidayamba pa nthawi sichimatsimikizira kuti necrosis sidzayambitsa kufa.

Hemorrhagic pancreatic necrosis - mkhalidwe womwe umafunikira chisamaliro chodzidzimutsa

Zizindikiro ndi magawo

Zizindikiro zimatengera njira yamatendawa komanso kukula kwa zotupa. Malinga ndi chizindikiro chomaliza, ndichoperewera (madera a necrosis akhazikika m'dera limodzi) ndipo ambiri (matendawa amakhudza dipatimenti yonse kapena chiwalo chonse).

Gulu la hemorrhagic necrosis ndi mawonekedwe:

Lakuthwa. Matendawa amakula chifukwa cha pachimake kapena. Acute hemorrhagic pancreatic necrosis imawonetsedwa ndi zizindikiro zotchulidwa ndipo imabweretsa zotsatira zoyipa.
Matenda Fomu yolemekezeka imangokhala chifukwa cha kukhathamiritsa.

Malinga ndi kukula kwa chotupa:

Pafupi Kufa kwakanthawi kochepa kokhala ndi mbali yake.
Onse hemorrhagic pancreatic necrosis. Zimawonetsedwa ndi kufa kwa maselo onse.

Mwa kukhalapo kwa matenda:

Ndi mtundu wa maphunzirowa:

Mosasamala mtundu wake, matendawa ayenera kuthandizidwa.

Chizindikiro chachikulu cha hemorrhagic pancreatic necrosis ndi kupweteka mbali yakumanzere. Zomverera zowawa zimakhala zolimba, nthawi zina zimapatsa dera lam'munsi kumbuyo, mapewa kapena pachifuwa.

kusanza kwambiri kusakanikirana ndi magazi ndi bile,
chikwangwani chachikaso pa lilime,
kamwa yowuma
kutulutsa, chisangalalo,
kutsegula m'mimba
Kutulutsa kwamkodzo, zizindikiro za kuchepa kwamadzi,
Amayang'ana buluu pamimba yomwe imawonetsa kutuluka kwa magazi,
kuthamanga kwa magazi
malungo, malungo,
kulephera kupuma
kugunda kwa mtima ndi kugunda kwa mtima
khungu, kufinya kapena khungu pakhungu,
kudumpha mu shuga
mgwirizano wolakwika, kukhumudwa, kapena ulesi.

Mavuto akayamba, Zizindikiro zimayamba kukula. Mwina kukula kwa ziwalo zingapo kulephera, magazi amkati, zotupa ndi peritonitis.

Mu 20% ya odwala, mawonekedwe owopsa a matendawa amabweretsa vuto, 35% imayambitsa kusokonezeka kwa malingaliro.

Hemorrhagic pancreatic necrosis imayamba pang'onopang'ono. Pali magawo atatu:

Choyamba ndi kubereka mwachangu kwa tizilombo tating'onoting'ono tomwe timafooketsa thupi, kuyambitsa kuledzera ndi zinyalala. Kutalika kwa gawo loyamba ndi sabata.
Lachiwiri limadziwika ndi kuwonongeka kwa purulent maselo a ziwalo ndikupanga mabowo m'makoma ake.
Gawo lachitatu, ziphuphu zambiri zimakhudzidwa, kutupa kumafalikira kwa ziwalo zoyandikana.

Imfa ndi matenda

Kufa kwa hemorrhagic pancreatic necrosis ndi 7-15%, ndi koopsa - 40-70%. Matendawa amatitsogolera osati kuthandizira kwa kapamba, komanso thupi lonse. Kusadwala kwa wodwala kumachepa, kugaya chakudya kumasokonekera.

Hemorrhagic pancreatic necrosis imatha kuyambitsa necrosis yama cell a ziwalo zina zomwe zimakhala pafupi ndi kapamba.

Choyambitsa matenda ambiri chifukwa cha matendawa ndi kuledzera kwa thupi chifukwa cha puritis peritonitis.

Momwe matendawo amachiritsidwira ndi abwino pokhapokha kukafika kuchipatala ndikulandira chithandizo choyenera. Pambuyo pa chithandizo, muyenera kutsatira zakudya ndikusiya zizolowezi zoipa.

Kanema wothandiza wokhudza pancreatic necrosis

Pancreatic necrosis ya kapamba amatanthauza kufa kwa maselo a chiwalochi chifukwa cha kapamba. Katswiri wa zam'mawere amapanga matendawa, chifukwa kufutukuka kwa njirayi nthawi zambiri kumabweretsa imfa.

Pancreatic necrosis imachitika chifukwa cha kapamba, ngati sichinachitike kwa nthawi yayitali, kapena wodwalayo adachita mankhwala osathandiza popanda kuyang'anira akatswiri.

Pancreatitis imapangidwa chifukwa cha:

kumwa mowa mwauchidakwa,
kuperewera kwa zakudya m'thupi, komwe kumapangidwa ndi zakudya zamafuta ambiri,
Matenda a bile
matenda a ziwalo zilizonse zam'mimba.

Chifukwa chotchuka kwambiri chofika anthu kuti azikafika patebulo ndi madokotala a opaleshoni ndiyo kugwiritsa ntchito mankhwala osokoneza bongo nthawi yomweyo komanso kudya zakudya zamafuta kwambiri. Monga lamulo, pambuyo pamisonkhano yaphwando yokhala ndi chakudya chokwanira, madipatimenti opanga opaleshoni ndi gastroenterology amadzaza ndi odwala.

Pancreatic mutu necrosis imatanthawuza kuyimbira mwachangu kwa ambulansi kapena kutumiza wodwala ku dipatimenti yopanga opaleshoni. Tsoka ilo, ambiri mwa ozunzidwayo amalandila matenda a pancreatic necrosis, popeza asanalowe kuchipatala panali zofunikira za kapamba.

Ndikofunikanso kudziwa zomwe zimayambitsa izi:

Ngati milandu ili pamwambapa ilipo, munthuyo ayenera kuyang'aniridwa ndi dokotala kuti apewe zovuta.

Pamaso pa zovuta za kapamba, kupanikizika kwa chifuwa chachikulu ndi chifuwa chachikulu chomwe chimapangitsa imfa. Kuthekera kwa kufa kumadalira mtundu wamatenda. Kugawika kumachitika malinga ndi magawo angapo, omwe aliwonse ofunika kuwerengera payokha.

Gulu la anthu wamba

Poyamba, adokotala amasankha mtundu wa kukhazikika kwa necrosis:

laling'ono loyang'ana
chapakati
chachikulu chachikulu
chapamwamba
chonse.

Zosiyanasiyana zimatsimikizidwa ndi kukula kwa zotupa za England ndi pancreatic necrosis. Gawo loyamba ndi lachiwiri lilibe malire, gawo lachitatu ndi lalikulu. Mu gawo lachinayi, akatswiri amawona imfa ya woposa theka la chiwalo.

Hemorrhagic okwana necrosis - ndi chiyani? Uku ndi kufa mwachangu ndi kwathunthu kwa chiwalo, komwe kumatsogolera kuimfa.

Magawo omwe ali pamwambawa m'mbuyomu anali ndi magulu awiri okha - ochepa (magawo atatu oyambayo) ndipo ambiri (awiriwo omaliza, opita ku imfa). Kugawidwa kosavuta kumeneku kumawonedwa ngati njira ina.

Gulu la kupezeka kwa matenda opatsirana

Palinso mitundu ina iwiri yamatenda a pancreatic necrosis - osabala ndi kachilombo. Kugawikaku kumakhudza kwambiri zosankha zamankhwala, chifukwa zimawonetsa kukhalapo kapena kusakhalapo kwa vuto la matenda m'thupi. Tiyeni tiwalingalire mwatsatanetsatane.

Fomu la hemorrhagic

Hemorrhagic pancreatic necrosis (pancreatitis) kapena pancreatic necrosis ndi matenda omwe amapezeka mwadzidzidzi omwe amabweretsa imfa yaumunthu mkati mwa maola 24. Matendawa amatchedwanso "gangrene" - necrosis yamatupi amthupi pogunda.

Hemorrhagic pancreatic necrosis imayamba chifukwa cha zinthu izi:

poyizoni woopsa
kuperewera kwa zakudya m'thupi ndi kugwiritsa ntchito molakwika zakudya zomwe zimasokoneza makina am'mimba (zonunkhira, mafuta, wowawasa ndi amchere),
chifuwa
ndi matenda a shuga limodzi ndi matenda am'mimba,
lupus kusamutsa
kumwa mankhwala ambiri pamankhwala osalankhulidwa ndi adokotala,
Mitundu ina yamatenda opatsirana (ma mumps, matenda am'mimba),
hypothyroidism ndi zina.

Chifukwa chachikulu chomwe chimathandizira kuoneka kwa necrosis ndiko kugwiritsa ntchito molakwika zakumwa zoledzeretsa komanso zamafuta.Chomwe chimayambitsa imfa mu hemorrhagic pancreatic necrosis ndikuwola kwa thupi, kumagwira ziwalo zonse ndi machitidwe omwe ali ndi poizoni kuchokera mkati.

Chizindikiro chodziwika bwino cha kukhala ndi necrosis ndikuwonetsa kuti wodwalayo sakudziwa. Popeza poizoni amatulutsa pakamenyera mkati mwa tinthu tamoyo, izi zimayambitsa mantha m'thupi:

Khungu la wodwalayo limasandulika,
zimachitika kuti zatha
matumbo kutsekeka.

Zizindikiro zina zamatenda pakuchulukana, monga cholecystitis, imakhalanso ndi zizindikilo zotere. Pancreatic necrosis imadziwika kuti mawonekedwe onsewa amawonetsedwa atangodya.

Pachimake hemorrhagic pancreatic necrosis amapanga sabata limodzi mpaka awiri, kutha. Nthawi zina, zonse zimachitika patsiku.

Njirayi imakhala ndikusokoneza magwiridwe anthawi zonse a michere omwe amatulutsidwa ndi kapamba. Mwa njira yofananira, amamasulidwa kuchokera ku chiwalo ndikuyenda m'matumbo. Imalandiranso bile yotulutsa chiwindi. Mukakumana, zinthu ziwiri izi zimayambitsa ndikuyamba kugaya chakudya.

Ngati mndandanda utasweka, ma enzymewo amathandizira kuzungulira, osafikira komwe akupita. Chifukwa cha izi, samasinthanso chakudya, koma chitsulo chomwe, chomwe chimatulutsa.

Pancreatitis amatenga mawonekedwe owopsa chifukwa kuledzera kwambiri. Pankhaniyi, kusintha koteroko kumawonedwa:

sphincter yomwe imayang'anira kutuluka kwa ndulu ndi kapamba wamkati kulowa mkati mwa duodenum imakulitsa kamvekedwe,
chimbudzi chimakulitsidwa
kwambiri kumawonjezera kukakamiza kwa bile duct ndi ma pancreatic ndima.

Kusintha konseku kumayambitsa kayendedwe ka bile mu ma pancreatic ducts, popeza alibe kwina kotuluka. The sphincter siziwupatsira matumbo, kusakaniza ndi madzi a pancreatic kumachitika ndikuyenda mu ma pancreatic enzyme. Chifukwa chake pali kuyambitsa kwa zinthu izi. Choyamba, nembanemba yama cell athanzi amawonongeka, ndipo ngati njirayo ikupitiliza, mapuloteniwo amawonongeka pansi pa zochita za ma enzymes, omwe amadziwika kuti kupindika kwa kapamba.

Umu ndi momwe kudzimbidwa kwa ndulu kumachitika. M'malo mwake, amadziwononga.

Tcherani khutu! Vuto lalikulu lomwe limapangitsa kuti khungu likhale ndi pancreatic necrosis - limapezeka mkati mwa ziwalo zam'mimba.

Pachimake hemorrhagic pancreatic necrosis

Hemorrhagic (parenchymal) pancreatic necrosis ndi chifukwa cha proteinol wa minofu ya pancreatic, ndi ya collicational chikhalidwe. Zinadziwika mu 37.2% ya mitundu yonse ya pacuteitis yayikulu, imakhala chidakwa (52.7%), biliary (31.3%), nthawi zambiri - munthu wina. Kuopsa kwa masinthidwe a pathomorphological ndi chifukwa cha gawo la matendawa. Zikondamoyo ndizofanana, zowala, zofiirira, zofiirira, zofiirira kapena zakimaso ndi magawo ake a mawonekedwe osasinthika.

Matenda a hemorrhagic omwe ali ndi malo a hemorrhage, hemorrhagic imbibition amadziwika. Kuunika kwa microscopic kumayang'aniridwa ndi parenchymal necrosis, hemorrhage, edema, thrombosis ya arterioles ndi venological omwe amadziwika kuti amachititsa kutupa. Pali zofunika kudziwa za necrosis. Pang'onopang'ono, njira yotupa imachepa, kukonza ndikukonzanso kumachulukirachulukira.

Hemorrhagic pachimake pancreatic necrosis ndi yayikulu kapena yayikulu-yokhazikika mwachilengedwe, imagwira chidutswa chimodzi kapena zingapo za chiwopsezo, kuwonongeka kwathunthu ndikosowa kwambiri.

Kuyambira sabata la 2-3, madera ozizira amawonda ndipo amawoneka ngati osakhazikika, ofewa, osiyanitsidwa ndi bulauni kapena amtundu wakuda, kapena okhazikika.

Pachimake mafuta pancreatic necrosis

Mafuta necrosis amakula ndi predominant of activated lipolytic enzymes, amayamba mu chilengedwe. Zikondwererozo zimachulukitsidwa katatu, kubiriwira, kachulukidwe kokhala ndi mitundu yoyera kapena yachikasu kapena imaso yachikuda yokhala ndi necrosis yamafuta osiyanasiyana, nthawi zina kuphatikiza. Kutalikirana kwa hemorrhages ndi foci ya parenchymal necrosis amathanso kuwonedwa.

Ma cellular omwe amayang'ana mbali ya necrosis ali mu dystrophy kapena necrosis mu mawonekedwe a misa yopanda dongosolo, osasiyanitsa.Nuclei kulibe, mu parenchyma yosungidwa kwa England, edema ya intralobular stroma, fibrinoid necrosis ya makoma a zombo zazing'ono. Khalidwe ndi kupezeka kwa m'mimba m'mimba mwa kuwala kwa chikasu champhamvu mosiyanasiyana.

Pang'onopang'ono, pamene edema ndi kulowetsedwa kumalowa kuchepa, mchere wa calcium umayikidwa mu gawo la pancreatic necrosis, cholumikizira minyewa yolumikizana imapangidwa, ndipo foci amatenga mawonekedwe a "milandu" yayikulu. Zoyimira zazikulu za necrosis yamafuta zimakonzedwanso ndikupanga "imvi" kapena "oyera" sequestration.

Ndi munthawi yomweyo kukulira kwa proteinolysis ndi lipolysis ya kapamba, zosakanikirana za kapamba zimachitika. Poopsa, imatenga malo achiwiri pambuyo pa hemorrhagic pancreatic necrosis, yowerengera 19.2% ya mitundu ina. Amadziwika ndi kuchuluka ndi kupezeka kwa kapamba a malo akulu am'mimba, parenchymal ndi mafuta pancreatic necrosis, kukhalapo kwa hemorrhagic activation pamimba. Zikondazo ndi zokulitsidwa, malo a necrosis omwe amasinthana ndi madera omwe sanasinthe. Pakatha sabata, chifukwa cha kuwonongeka kwa magazi, zoyang'ana m'matumbo zimatulutsa tint ya bulauni, yofewetsa zimawoneka pamtunda wa gawo la necrosis. Kusungunula komanso kutsatizika kwa cholinga cha necrosis kumayendera limodzi ndi kusinthika kwa njira, fibrosis. Thrombosis ya ziwiya zazikulu komanso kufotokozedwanso kwa zidutswa zikuluzikulu za kapamba, mosiyana ndi hemorrhagic pancreatic necrosis, sichinawonedwe.

Microscopically wapezeka koyambirira kwamatenda edema, parenchymal, mafuta pancreatic necrosis, hemorrhage, capillary thrombosis ndi venges. Kuzungulira mozungulira necrosis, kugwedeza kumasonyezedwa. Pang'onopang'ono, minyewa yotsekemera imalowetsedwa ndi ma macrophages, pafupi ndi cholinga cha mafuta a necrosis lipophages omwe amadziunjikira ndi kuchuluka kwa michere ya fibroblasts ndikupanga minyewa yongolumikizana tating'ono, collagenization ya tinthu tosakanikirana mbali zonse za kapamba. Tinthu tating'onoting'ono timene timamera mkati mwa lobules ndi atrophy ya acini. Kuzungulira mitsuko, ziwiya, ndi mitengo ikuluikulu ya mitsempha, "zophatikizira" zimapangidwa kuchokera kuzinthu zowoneka bwino.

Mu pachimake pancreatic necrosis, kutchulidwa ofanana matupi kusintha kumachitika osati mu kapamba, komanso mu retoperitoneal minofu, omental bursa, peritoneum (enzymatic peritonitis), omentum (omentitis), chikhodzodzo (enzymatic cholecystitis), komanso matumbo mesentery, hepatoduodenal , njira zoyipa.

Pankhani yakuchulukirachulukira, pancreatic necrosis yocheperako komanso yofalikira.

1. limited acute pancreatic necrosis imadziwika ndi kukhalapo kwa necrosis mkati mwa gawo limodzi la anatomical la kapamba ndi gawo lolingana la parapancreatic fiber.
2. wamba pachimake pancreatic necrosis imadziwika ndi kukhalapo kwa kusintha kwa necrotic m'magawo angapo a kapamba omwe samangokhala parapancreal, komanso magawo ena a fiberoperitoneal fiber.

Zosintha mu kapamba, minyewa ya retroperitoneal siyofanana panthawi zosiyana za pachimake kapamba, chifukwa cha kusintha kwa minofu ya necrotic kukhala nthawi ya aseptic kapena matenda opatsirana.

Mu aseptic nthawi, pachimake pancreatic necrosis ndi parapancreatic retroperitoneal minofu mawonekedwe a pancreatic kulowa mkati kuchokera pafupi ziwalo: m'mimba, duodenum, kupindika koloni, omentum, chiwindi.

Zotsatira za kulowetsedwa kwa zotumphukira za retroperitoneal fiber kuzungulira mbali zake za necrotic ndikupangika kwa necrotic phlegmon ya danga la retroperitoneal.

Zakonzedwa ndikuwongoleredwa ndi: dokotala wa opaleshoni

Zimayambitsa pancreatic necrosis

Zomwe zimayambitsa pancreatic pancreatic necrosis ndizambiri, koma nthawi zambiri zimayamba kumamwa mowa wambiri kuphatikizapo zakudya zama protein.Zimachitika kuti matendawa amatuluka nthawi yomweyo ndipo kuukira kumatha kuchitika motsutsana ndi maziko amoyo wathunthu. Milandu yanenedwa pomwe pancreatic pancreatic necrosis, zotsatira zakupha zomwe zidachitika patangodutsa maola ochepa chiyambireni zizindikiro zamatendawa, pakapita masiku angapo pambuyo pa phwando lochuluka.

Zomwe zimachitika ndi pancreatic necrosis

Wathanzi amatulutsa michere yomwe imafunika kuti chakudya chisalowe m'mimba. Ndili othokoza kuti chakudya chimagawika muzinthu zomwe zingalowe m'magazi kudzera mucous membrane wam'mimba, omwe amawapereka kwa zimakhala ndi ziwalo. Izi zimapangitsa kapamba kukhala chimodzi mwazinthu zofunika mthupi. Kumwa mowa ndi zakudya zamafuta ambiri kumalimbikitsa kwambiri kapamba kuti apange madzi, ndipo popeza ma ducts sangathe kuwachotsa kwathunthu, amayamba kudziunjikira mkati mwa gland. Izi zimabweretsa kukulira kwa edema, kuphatikizidwa kwina kwa ma ducts komanso kutsika kwawo kwotsatira. Ma enzymes olimbirana a kapamba, omwe ntchito yake inali kuwonongedwa kwa mapuloteni, amatuluka thukuta m'makumba ndikuyamba kuyisungunula, mothandizidwa ndi ma enzyme, "ake" a gland "amadzimbidwa". Ma enzymes othandizira ndi zinthu zowola zomwe zimapangidwa munjira imeneyi amalowa m'magazi ndikuthandizira kuti ziwalo zina ndi minyewa itha, ndikupangitsa kuledzera kwambiri. Chifukwa chake, matenda a pancreatic pancreatic necrosis, zomwe mtsogolo mwake zimakhala zovuta kudziwa, ndi matenda oopsa.

Gulu la pancreatic necrosis

Kutengera ndi kuchuluka kwa zotupa za England, tating'onoting'ono tating'ono, tating'onoting'ono, tating'ono, totsogola komanso tokwanira ta pancreatic necrosis. Zachidziwikire, kusiyanasiyana pakati pa mitundu iwiri yoyamba kumakhala kotsutsana. Madokotala amagwiritsa ntchito malingaliro awa kuti adziwe kuchuluka kwa kuwonongeka kwa ziwalo. Ndi subtotal pancreatic necrosis, kusintha kwa necrotic kumakhudza kwambiri England. Ngati chiwalocho chikukhudzidwa kwathunthu, ndiye kuti pancreatic pancreatic necrosis yonse yapezeka. Potere, zotsatira zakupha zimawonedwa nthawi zonse.

Palinso mtundu wina wosankha. Amagawa necrosis ya pancreatic m'mitundu iwiri:

Zochepa. Izi zimaphatikizira njira yomwe cholinga cha zigawo zazikulu zimapangidwa.
Zofala. Poterepa, zambiri mwa tiziwalo kapena chiwalo chonse chimakhudzidwa.

Mitundu ya pancreatic necrosis

Kutengera kwa kukhalapo kwa matenda omwe akukhudzidwa ndi madera omwe akhudzidwa, wosabala kapena kachilombo ka pancreatic necrosis imasiyanitsidwa. Kuphatikiza apo, matenda akakhala kuti ali ndi kachilombo, matendawa amakhala osavomerezeka, popeza pali kuthekera kwakukulu kodzetsa nkhawa, ndipo zimakhala zovuta kwambiri kuti wodwala atuluke.

Sterile pancreatic necrosis imagawidwa m'mitundu iyi:

mafuta - amadziwika ndi kusuntha kwapang'onopang'ono mkati mwa masiku 4-5 komanso njira yofatsa,
hemorrhagic - yodziwika ndi njira yofulumira komanso magazi pafupipafupi,
osakanikirana - amapezeka nthawi zambiri, chifukwa ndi pancreatic necrosis, minofu ya adipose ndi pancreatic parenchyma zimakhudzanso chimodzimodzi.

Ngati pancreatic pancreatic necrosis ikapezeka, opaleshoni ndiyosapeweka. Koma nthawi zambiri sizimapereka zotsatira zomwe zikufunidwa, ndipo mwina kukonzanso kwa necrotic foci.

Zizindikiro ndi kuzindikira kwa pancreatic necrosis

Clanical pachimake kapamba amasonyezedwa ndi kupweteka kwambiri mu hypochondrium wamanzere kapena kupweteka komwe kumakhala ndi shingles. Pali kusanza kwam'matumbo, komwe sikubweretsa mpumulo, kutsegula m'mimba. Poyerekeza ndi maziko awa, kusowa kwamadzi kumachitika mwachangu, kuledzera kumakulirakulira. Popanga matenda, kuphatikiza kwa anamnesis ndikofunikira kwambiri.Ngati ili ndi chidziwitso chokhudza kuledzera, zakudya zamafuta kapena chidziwitso cha matenda amchiwindi ndi ndulu. Zomwe zimachitika mu vutoli zimadalira kwambiri matenda omwe wodwala amafunafuna chithandizo, komanso kuchuluka kwa zotupa.

Ponena za diagnostics a labotale, apa amalipira kusanthula kwamkodzo ndi magazi, momwe mumakhala kuchuluka kwakukulu kwa amylase. Kutulutsa kwamimba m'mimba, CT kapena MRI kumachitidwanso, komwe mumatha kuwona mawonekedwe a necrotic m'misempha ya kapamba.

Nthawi zambiri, pancreatic necrosis imafunika opaleshoni yothandizira. Nthawi yomweyo, ngakhale kuti chiwerengero cha anthu omwalira chimakhala chambiri, kugwira ntchito kwakanthawi kumapereka mwayi wowombolera. Chithandizo cha Conservative chikuphatikiza zotsatirazi:

Pakupita masiku ochepa kuukiraku - kufa kwathunthu ndi njala, komanso kutengera kuwuma kwa matendawa, kuyambitsidwa kwa michere kudzera mu kulowetsedwa kwa magazi kumatha kukhala kwa milungu ingapo,
kuyeretsa magazi (hemosorption) - kumachitika ndi kuledzera kwambiri,
somatostatin ndi timadzi timene timatha kuchepetsa mavuto obwera chifukwa cha impso, nthawi zambiri timayendera limodzi ndi pancreatic necrosis,
ndi matenda opatsirana - maantibayotiki.

Mowa

Nthawi zambiri, matendawa amapezeka mwa anthu omwe ali ndi chidakwa.

Ziwopsezo zopangidwa chifukwa chakuwonongeka kwa mowa wa ethyl zimadziunjikira m'matumba a kapamba, zimapangitsa kuwonongeka kwawo. Zizindikiro zoyambirira za mawonekedwe owopsa zimawonekera motsutsana ndi maziko a kuledzera, kuphatikizapo kuphatikiza zakudya zamafuta.

Onse hemorrhagic pancreatic necrosis amadziwika kuti ndi matenda oopsa, momwe 90% ya zikondamoyo zimakhudzidwa. Matenda a wodwalayo akuipiraipira patatha masiku atatu ngakhale atasamalidwa kwambiri, zizindikilo za kulephera kwamankhwala ambiri zimawonjezeredwa ndi zomwe zilipo.

Chachikulu

Ndi matenda amtunduwu, necrosis ya 50-70% ya zikondamoyo. Izi zimathandizidwa ndi thrombosis yomwe imachitika motsutsana ndi maziko a zovuta zamagazi.

Kuchepa kwa zakudya za ziwalo zam'mimba kumayambitsa kufa pang'ono kwamaselo ake.

Odwala omwe ali ndi subtotal pancreatic necrosis amasonyezedwa pakuthandizira opaleshoni yotsatiridwa ndi chithandizo chamankhwala.

Chifukwa cha hemorrhagic pancreatic necrosis imachitika

Zinthu zotsatirazi zimathandizira kukulitsa kwa pancreatic necrosis:

kutupa kwa kapamba ndi kuphwanya ntchito zake ndi kusiya kutulutsa kwa pancreatic madzi,
kuledzera kwamthupi ndi zakumwa zoledzeretsa mwatsatanetsatane.
pafupipafupi Reflux wa kapamba wa pancreatic mu ma pancreatic ducts omwe amapezeka ndimatenda a ndulu,
Matenda opatsirana a ndulu ndi ndulu za ndulu,
thrombohemorrhagic syndrome, limodzi ndi kuchuluka kwa magazi mkati mwa ziwiya,
matenda a bakiteriya komanso ma virus,
kugwiritsa ntchito nthawi yayitali ma cytostatics,
kuyang'anira ma radiation
autoimmune pathologies (hemorrhagic vasculitis),
matenda a mtima, kupangitsa matenda kuzungulira ziwalo zonse ndi minyewa.
chovala cha kapamba, kuphatikiza zovuta za njira zopangira opaleshoni.

Mosasamala kanthu zomwe zimayambitsa pancreatic necrosis, magwiritsidwe ake a chitukuko amatengera:

pakugonjetsedwa kwa malo osungirako ziphuphu osokoneza bongo omwe ali ndi vuto lopanga ma enzoni a pancreatic,
kukweza mulingo wa enzyme kukhala yofunikira. Pankhaniyi, zinthuzo zimayamba kuwononga minofu ya pancreatic - kupangira mapuloteni a hydrolyze,
pakuwonongeka kwa makoma amitsempha yamagazi. Kudzikundikira kwa puloteni ya elastase m'matimu kumabweretsa hemorrheges. Akatswiri a gastroenterologists amatcha izi pancreatic autoaggression,
pa zovuta za trypsin ndi pancreatopeptidase - michere ya proteinolytic yofunikira pakuchepa kwa zakudya za protein,
pa kulephera mu humidity njira kuwongolera kaphatikizidwe am'mimba michere.

Chithunzi cha chipatala cha pancreatic necrosis chimaphatikizapo:

kupweteka kwapakati, kupweteka kwamtundu wa kumanzere kwa dera la epigastric, mpaka kufikira phewa ndi phewa,
kamwa yowuma
Kuonekera kwa kuyala kwamilime yolankhula palilime,
nseru ndi kusanza zomwe sizibweretsa mpumulo,
chisangalalo, maluwa,
zimbudzi zotayirira
khungu kapena nkhope yamaso
kuchepetsedwa kwa peritoneum, limodzi ndi mawonekedwe a mawonekedwe ofiirira pakhungu pamimba,
kusintha kwadzidzidzi kwa kuthamanga kwa magazi,
tachycardia, kupuma movutikira,
kuphwanya diuresis,
matenda amisala (mota kukwiya kapena ulesi).

Chithandizo cha hemorrhagic pancreatic necrosis

Ndi pancreatic necrosis, kuchipatala kwadzidzidzi komwe kuli m'chipinda chothandizira kwambiri kukuwonetsedwa. Chithandizo cha mankhwala:

kuthetsa ululu
kuyimitsa kapangidwe kazakudya zam'mimba,
kuthetsa spasms,
kubwezeretsa patency ya ma pancreatic ducts,
Kuchepetsa katulutsidwe ka madzi am'mimba ndi acidity yake,
popewa kukula kwam'madzi ndi kuledzera kwa thupi,
popewa zovuta zobwera chifukwa cha matenda am'mimba.

Pazifukwa izi, njira zopangira opaleshoni, mankhwala, zakudya zapadera, ndi kupuma pabedi kumagwiritsidwa ntchito.

Mankhwala othandizira

Njira yothandizira mankhwalawa pancreatic necrosis imaphatikizapo kugwiritsa ntchito mankhwala otsatirawa:

Analgesics ndi antispasmodics. Tsitsimutsani wodwalayo kuchokera kupweteka kwambiri. Mankhwala othandiza kwambiri ndi Papaverine, Platifillin, Ketanov. Kukhazikitsidwa kwa yankho la novocaine osakanikirana ndi shuga m'magawo a peritoneum-lumbar amathetsa kupweteka. Chomwe chimagwiritsidwa ntchito kwambiri ndi Promedol ndi diphenhydramine.
Inhibitors a proteinolytic enzymes (Gordox, Ribonuclease, Contrical). Mitsempha ya mtsempha wamagazi imathandizira kuwonongeka kwa pancreatic madzi.
Maantacidine (Atropine, Kvamatel, Ephedrine). Kuchepetsa acidity ya chapamimba madzi, ntchito limodzi ndi achire kusala.
Maantibiotic (Cephalexin, Kanamycin). Mlingo wokwanira wa mankhwala amalepheretsa kukula kwa peritonitis ndi abscess.

Opaleshoni

Lingaliro pazakufunika kwa opaleshoni limapangidwa ndi kufunsa kwa madokotala potengera zotsatira za chithandizo chamankhwala chokhwima komanso momwe wodwalayo alili. Ngati pancreatic necrosis siyiperekezedwa ndi kukula kwa zovuta, laparoscopic drainage is okwanira. Ndi kudzikundikira kwa hemorrhagic exudate, peritoneal dialysis akusonyezedwa - kulowetsedwa mwa magazi. Chiwonetsero chonse cha pancreatic necrosis ndikuwona pancreatectomy (kuchotsedwa kwathunthu kwa kapamba).

Zakudya zapadera sizoyenera kuchitika osati pakanthawi kothandizira, komanso moyo wonse.

Idyani m'magawo ang'onoang'ono, nthawi 5-6 patsiku. Chakudya chimasenda popanda kuwonjezera mafuta ndi zonunkhira, chimadyedwa mofunda. Zakumwa zoledzeretsa, zamafuta, zokazinga ndi zokometsera, zipatso zowawasa, zakumwa za sopo sizikupezeka muzakudya.

Mavuto

Mu 20% ya milandu, pachimake pancreatic necrosis imayendera limodzi ndi chikhalidwe cha kugwa kapena chikomokere, matenda amisala ambiri amapezeka mwa odwala anayi alionse. Kapangidwe ka fancula ya pancreatic retroperitoneal imathandizira kulowa kwa kapamba, minofu yakufa ndi hemorrhagic exudate m'mimba. Izi zimayamba chifukwa cha kupititsa patsogolo kwa peritoneum komanso kukula kwa peritonitis.

Kulemala

Gulu loyamba lopuwala limaperekedwa kwa odwala omwe akuchotsedwa pancreatic, omwe akuvutika ndi magazi amkati komanso kupukusa kwambiri m'mimba. Palibe zovuta, pali mwayi wopeza gulu lachitatu.Mapangidwe a fistulas akunja, kupukusira kwam'mimba pang'ono - zikuwonetsa kugwiritsidwa ntchito kwa gulu lachiwiri la olumala.

Zizindikiro zake

Kukula ndi mawonekedwe owonetsera amadalira makamaka kukula kwa zotupa. Dera lomwe lingakhudzidwe ndi:

zocheperako (pang'onopang'ono, pakatikati kapena pakuchitika kwakukulu),
kufalikira (kumakhudza gawo limodzi lokhazikika, zofunikira zonse kapena chabalira mosiyanasiyana mkati mwa minofu).

Komanso, njira ya pancreatic necrosis imasiyana pamaso pa opaleshoni yothandizira:

Kukula kwa matendawa kumachitika m'magawo angapo:

Pa gawo loyamba, tizilombo tating'onoting'ono timayamba kukula ndikuchulukana mkati mwa gland. Kuwonjezeka kowopsa kwa chiwerengero chawo kumadzetsa poyizoni owonjezereka ndi zinthu zotayidwa, zomwe zimapangitsa kuwonetsa kwa poizoni ndikufooketsa thupi lisanachitike autoxgression. Gawoli limatenga pafupifupi pafupifupi sabata.
Pa gawo lachiwiri, chifukwa cha kuwonongeka kwa maselo a parenchyma, kutsekemera kwa purosesa kumachitika komanso mawonekedwe am'deralo polephera.
Pomaliza, kutupa kumakhudza dera lalikulu ndikufalikira kwa ziwalo zamagulu oyandikana, zomwe zimayambitsa kupweteka kwamphamvu konse kwamatupi athupi.

Chizindikiro chopanda pake chomwe matendawa sapezeka konse ndi ululu. Ululu umapezeka kudera lakumanzere kapena hypochondrium kumanzere. Kukula kwa zomverera zopweteka kumafotokozedwa mwamphamvu ndipo akufotokozedwa ndikuphatikizidwa kwa minyewa yamitsempha yamafuta m'mitsempha yotupa. Ndi kuwonjezeka kwa zizindikiro, ululu umatha kukhala lamba ndikupereka kwa lumbar dera kumbuyo, lamba wamapewa kapena sternum.

Zizindikiro zina:

kusanza mobwerezabwereza (m'masanzi, kupezeka kwa magazi ndi bile kumadziwika),
Lilime limakutidwa ndi mitundu yayikulu yachikasu,
Hypohydrosis ya pamlomo
kutsika kwa kuchuluka kwa mkodzo potengera kuchepa kwa madzi m'thupi,
chisangalalo ndi m'mimba,
malungo
kusintha kwadzidzidzi kwa kuthamanga kwa magazi,
kupuma movutikira
kulumikizana m'magulu a glucose kumatha kusokoneza, kuletsa kapena kusangalala kwambiri, chisokonezo.

Mawonekedwe ena amatha kuwonekera pakuwoneka koyang'ana. Zizindikiro izi za hemorrhagic pancreatic necrosis ndi:

kutulutsa m'mimba
adawoneka malo owoneka ofiira okhala ndimtambo wabuluu pamimba, m'mbali. Malo omwewo amatha kuzungulira msomali kapena kuwonekera pamabowo, zomwe ndi zotsatira za kukhetsa magazi m'magazi am'mimba,
kupuma kumakhala kosazama komanso pafupipafupi.
chifukwa kuchepa kwa lumen m'mitsempha yamagazi, nkhope yake imasanduka yofiira, koma ndi kusiyana kwakukulu pamlingo wama glucose, khungu limayamba,
kuthamanga kwa phokoso la mtima komanso kuthamanga kwa mtima,
khungu la chikasu kapena imvi pakhungu.

Zizindikiro zimakulirakulira chifukwa cha zovuta. Ndi mawonekedwe a thupi kukhala opsinjika, kulephera kwamankhwala angapo kumachitika. Chifukwa cha kutuluka kwamkati, kuchuluka kwa magazi omwe amayenderera m'thupi lonse kumachepa. Zilonda zimakhudza chiwindi, zimapatsa zovuta m'mapapo, zimayambitsa mawonekedwe a purulent mu minofu ya pancreatic komanso dera la recoperitoneal.

Pambuyo pa izi, chitukuko cha zilonda zam'mimba ndi mawonekedwe a purulent peritonitis atha. Kuthekera kwa chikhalidwe cha kugwa kapena chikomokere ndikwapamwamba.

Zindikirika bwanji?

Zizindikiro zomwe hemorrhagic pancreatic necrosis ali munjira zambiri zofanana ndi kuwonetsa kwa matenda ena am'mimba otupa, motero, kungowunika wodwalayo kuti athe kupeza matenda sikokwanira.

Choyamba, adokotala amatenga deta ya anamnesis, yomwe imaphatikizapo mayankho a mafunso awa:

Kodi wodwalayo amamwa mowa mopitirira muyeso?
ngati munthu waledzera panthawi yopanga zizindikiro zamankhwala,
kaya wodwala kapena biliary thirakiti.

Pofuna kumveketsa matenda ake oyambirirawo, dokotalayo apereka nthawi yokumana ndi mayeso ofufuza:

kuyezetsa magazi, komwe kumatsimikizira kuchuluka kwa kukhalapo kwa michere ya pancreatic secretion. Ndi hemorrhagic pancreatic necrosis, ntchito ya enzymatic imatha kupitilira nthawi 6-9,
urinalysis ndi kutsimikiza kwa uroamylase ndi trypsinogen,
kutsimikiza kwa acidity zam'mimba,
Ultrasound yamimba yam'mimba kuti ithandizire kupeza,
kufunafuna katulutsidwe ka pancreatic kuti mupeze ma bicarbonate komanso ma enzyme akhama
Coproscopy, yomwe imathandizira kukhazikitsa kuchuluka kwa mafuta osakwanitsidwa mu ndowe,
pancreatic radiology,
kutsimikiza kwa amylase ndi triglycerides mu mpweya wotuluka,
endoscopic pancreatocholangiography,
kuchotsera potenga zitsanzo za minofu ya necrotic,
magonedwe amatsenga ndi CT kuti adziwe mawonekedwe a necrotic formations.

Ndi hemorrhagic pancreatic necrosis, wodwalayo, monga lamulo, amathera kuchipatala atayimba ambulansi, chifukwa chomwe amamuika kuchipatala ndikuwunikira kwakukulu.

Wodwalayo ali ndi vuto lalikulu.

Kuchiza ndi wowerengeka azitsamba amangoikidwa padera chifukwa cha kusakwanira. Chithandizo cha mankhwalawa chimachitika pokhapokha kuwunika kwa ola lathunthu ndi anthu odziwa ntchito zachipatala.

Njira zogwirira ntchito

Ngati njira yopanda matenda ya hemorrhagic pancreatic necrosis ikakhazikitsidwa, ngalande za laparoscopic zimagwiritsidwa ntchito. Ndi ma voliyumu akuluakulu a exudate, kuyeretsa magazi kwa peritone kumachitika motsatana - intraperitoneal dialysis.

Matenda akasankhidwa, mtundu wina wa opaleshoni amasankhidwa: pancreatic resection yochotsa madera omwe akhudzidwa ndi necrosis.

Pankhani ya malo akulu omwe adafa, opaleshoni yayikulu imachitidwa - pancreatectomy, yomwe imaphatikizapo kuchotsa kwathunthu kwa kapamba. Panthawi imeneyi.

Njira ina yodzithandizira yochiritsira ndikutsatizanatsatizanatsatizanenso ndi magawo akufa.

Opaleshoni sikuti nthawi zonse imathetsa vutoli, nthawi zina kumwalira kumachitika pambuyo pa opaleshoni ndipo kumafunika kuchitanso mgwirizano.

Nthawi yochira imatha pafupifupi miyezi isanu ndi umodzi, pambuyo pake wodwala amalembetsedwa ndi dispensary. Munthu amayenera kukayesedwa kachiwiri miyezi isanu ndi umodzi.

Munthawi zonsezi, zotsatira za matendawa zitha kukhala zabwino komanso zoyipa. Zimatengera zinthu izi:

kufalikira kwa matenda
Gawo lomwe munthu amalandila chithandizo,
kukula kwa njira zochizira
zaka odwala
mulingo wa kuchira kwa wodwalayo.

Chiwopsezo cha kufa kwa hemorrhagic mtundu pancreatic necrosis ndi 40-70%. Chovuta chofala kwambiri ndikubwera kuchipatala. Chotsatira ndi kukula kwa njirayi: kukulira dera la zotupa zokhazokha, ndizochedwa kufa.

Nthawi zina zotsatira za matendawa ndi kulumala. Izi zimatha kuchitika mwamphamvu ndi matendawa kapena chifukwa cha zovuta pambuyo pakuchita opareshoni.

Mwayi wopulumuka umachulukitsidwa ngati pakufunika thandizo ndi chithandizo choyenera. Pambuyo kuchira, munthu ayenera kutsatira zakudya zapadera za moyo wonse, kupatula mowa ndipo onetsetsani kuti akusiya kusuta ngati anali wosuta fodya asanadwale.

Mu kanemayo, mtsikanayo amakamba za mbiri yake yazaumoyo ndi moyo atamuchita opareshoni.

Mu gulu la pachimake pancreatic necrosis (Atlanta), mitundu yake iwiri imasiyanitsidwa ndi matenda: wosabala kapena kachilombo popanda kupatukana ndi mitundu ya patomorphological: hemorrhagic (parenchymal), mafuta komanso yosakanikirana. Kugawikaku pamitundu yotere "malinga ndi malingaliro amakono kulibe tanthauzo lokhazikika komanso chidziwitso chozama."

Kufotokozera kwa pancreatic necrosis ya pachimake sikutheka popanda kudzipatula mwa mitundu iyi. Kuphatikiza apo, mitundu yosiyanasiyana yamatenda a pancreatic necrosis imayendera limodzi ndi kusiyanasiyana kwa zovuta zamankhwala, pafupipafupi zovuta ndi kufa. Ndi chitukuko cha mankhwala ndi pharmacology, chithandizo cha pathogenetic cha mitundu ya proteinolytic kapena lipolytic cha necrosis ndizothekanso.

Kodi hemorrhagic pancreatitis ndi chiyani

Hemorrhagic pancreatitis limodzi ndi pachimake maphunziro sichinthu chongokhala mawonekedwe ovuta a chiwalo ichi, chomwe chizindikirocho chimathandizira kuti chiwonongeko cha ziwongo ndi pancreatic. Izi zimayambitsa necrosis, limodzi ndi zotupa ndipo zimachitika chifukwa cha michere yake. Zimatha ndikukula kwa hemorrhagic peritonitis.

Zizindikiro zazikulu za matendawa zimadziwika ndi mawonekedwe:

Kupezeka kwa zowawa, kupeza mawonekedwe a matendawa.
Kukula kwa toxemia.

Mkhalidwe wamba wa wodwala amawonedwa ngati wovuta. Kuti mukhale ndi lingaliro la momwe hemorrhagic pancreatitis imakhalira, chifukwa chake mawonekedwe ake, momwe angadziwire ndi kuchiza matendawa, ndikofunikira kuti mudziwe zambiri pazokhudza nkhaniyi.

Zimayambitsa hemorrhagic pancreatitis

Izi ndi zifukwa zofunika kukhazikitsa pachimake hemorrhagic pancreatitis:

kuledzera kwa thupi chifukwa cha poyizoni wa chakudya,
Zakudya zopanda pake: Kugwiritsa ntchito mankhwala osokoneza bongo, zonona ndi mafuta okazinga, ma marinade ndi nyama yofuka
kukula kwa sayanjana pazifukwa zina,
chimfine
kuphwanya magwiridwe antchito a kapamba,
bongo wa mankhwala osokoneza bongo
kuvulala kumbuyo ndi m'mimba.

Matendawa amatha kuonekera kwa anthu azaka zilizonse, ngakhale atakhala kuti ndi amuna kapena akazi. Malinga ndi ziwerengero zamankhwala, nthawi zambiri hemorrhagic pancreatitis imayamba mwa amuna adakali aang'ono, makamaka iwo omwe amakonda kulemera ndi kumwa mowa kwambiri. Njira ya chitukuko cha matendawa imayendera limodzi ndi kutsegula kwa trypsin mu kapamba, pomwe zikuchitika mwanjira yokhazikika izi zimayenera kuchitika mkati mwa matumbo.

Nthawi zambiri, chitukuko cha pachimake hemorrhagic pancreatitis chimachitika pompopompo ndipo chimayendera limodzi ndi kupezeka kwa ululu wopweteka kwambiri womwe umafalikira ku dera lumbar. Ndipo malo a kuthekera kwake kwakukulu ndi kapamba.

Zizindikiro za hemorrhagic pancreatitis

Monga matenda ena aliwonse, hemorrhagic pancreatitis ili ndi zizindikiro zake. Kukula kwake kumachitika chifukwa chakuwonekera pazinthu zina za causative zomwe zimapangitsa kuti ma enzymatic ayambe kugwira ntchito.

Hemorrhagic pancreatitis imayamba chifukwa chogwira ntchito yotupa, yomwe imayambitsa kuphwanya kwa kutuluka kwa madzi omwe amapangidwa ndi kapamba. Zomwe zimapangitsa kuti pachimake hemorrhagic pancreatitis imakhala matenda omwe amaphatikizidwa ndi njira yodziyimira payokha, yomwe zotsatirazi ndizodziwika:

mapangidwe a gallstones
chitukuko cha DIC
vuto la autoimmune.

Mwa zina mwazomwe zimachitika, kukula kwa matenda amtunduwu kumatha kuyambitsa kuchuluka kwa ma radiation a ionizing, komanso kuvulala kapena kuwonongeka kwa makina.

Kuwonongeka kwa chiwalo kumatha chifukwa cha kuchuluka kwakukulu kwa enzymatic mu kapamba, komwe kumayambitsa kudzipukusa kwa parenchyma, chifukwa chomwe makoma amitsempha yamagazi amawonongeka. Ndondomeko yonseyi imatsogolera kuti minofu imalowetsedwa ndimagazi ndipo tinthu tovuta timalo timalowa m'mimba, zomwe zimatha kutsogola kwa peritonitis.

Ntchito yofunikira pakukula kwa hemorrhagic pancreatitis imaseweredwa ndi zochitika zoyipa zomwe zimakhudza kuchuluka kwa mapangidwe a pulancic ya pancreatic.

Chizindikiro chimodzi cha matendawa ndi kusokonezeka. Ponena za zizindikilo zakunja, zitha kuphatikizanso kusintha kwa mawonekedwe, komwe kumakhala kotuwa. Chizindikiro ichi chimatsatiridwa ndi kugunda kwamanyazi. Zowona kuti thupi likupanga njira yotupa ikhoza kuweruzidwa molingana ndi zotsatira zoyesedwa m'magazi.

Chifukwa cha kugwedezeka komwe kumadziwika kuti ndi hemorrhagic pancreatitis ndi kuledzera kwa thupi, komwe nthawi zambiri kumayendera limodzi ndi kuwonongeka kwa chiwalo. Vutoli limapweteka, chifukwa kapamba kali ndi mathero ambiri amitsempha.

Mtundu wowopsa wa matendawa ndi owopsa pamoyo wamunthu, pomwe imfa imatha kuchitika patatha masiku ochepa.

Kuzindikira ndi kuchiza matenda a hemorrhagic pancreatitis

Monga matenda ena aliwonse, hemorrhagic pancreatitis imafunikira kudziwitsidwa ndi chithandizo chachikulu. Pankhaniyi, njira zadzidzidzi zasayansi, monga:

Ultrasound yam'mimba
laparoscopy

Mwa zina, kufunikira kwakudziwitsa matenda angapo, monga:

zilonda zam'mimba
matumbo kulowetsedwa
chopinga chimadziwika ndi pachimake maphunziro.

Hemorrhagic pancreatitis ndi chifukwa chomveka chogulitsira odwala mwachangu, chomwe chimachitika ndi cholinga chotsitsimutsanso chipinda chopangira chisamaliro chokwanira ndikuthandizanso chithandizo kudzera mwa opaleshoni.

Pancreatic necrosis imachitika chifukwa cha kapamba, ngati sichinachitike kwa nthawi yayitali, kapena wodwalayo adachita mankhwala osathandiza popanda kuyang'anira akatswiri.

Pancreatitis imapangidwa chifukwa cha:

kumwa mowa mwauchidakwa,
kuperewera kwa zakudya m'thupi, komwe kumapangidwa ndi zakudya zamafuta ambiri,
Matenda a bile
matenda a ziwalo zilizonse zam'mimba.

Chifukwa chotchuka kwambiri chofika anthu kuti azikafika patebulo ndi madokotala a opaleshoni ndiyo kugwiritsa ntchito mankhwala osokoneza bongo nthawi yomweyo komanso kudya zakudya zamafuta kwambiri. Monga lamulo, pambuyo pamisonkhano yaphwando yokhala ndi chakudya chokwanira, madipatimenti opanga opaleshoni ndi gastroenterology amadzaza ndi odwala.

Ndikofunikanso kudziwa zomwe zimayambitsa izi:

Ngati milandu ili pamwambapa ilipo, munthuyo ayenera kuyang'aniridwa ndi dokotala kuti apewe zovuta.

Pamaso pa zovuta za kapamba, kupanikizika kwa chifuwa chachikulu ndi chifuwa chachikulu chomwe chimapangitsa imfa. Kuthekera kwa kufa kumadalira mtundu wamatenda.Kugawika kumachitika malinga ndi magawo angapo, omwe aliwonse ofunika kuwerengera payokha.

Pancreatitis pachimake - Zakudya

Popeza ndizofunikira zakudya zomwe nthawi zambiri zimayamba kukhala chifukwa cha pancreatitis pachimake, ndikofunikira kwambiri pakuthandizira. Monga tafotokozera pamwambapa, m'masiku oyamba atapezeka kuti khansa yapakhungu idayambika, zakudya ndizofunikira kwambiri - kufa kwathunthu kumawonedwa. Woopsa milandu, makonzedwe a makolo pazakudya amatha milungu ingapo.

Mtsogolomo, kapamba amatanthauza njira yotsalira, yomwe imatsimikiziridwa ndi kupatula kwamafuta ndi chakudya chamagulu kuchokera m'zakudya, komanso zinthu zomwe zimapangitsa kupangidwa kwa gasi. Chakudyacho chimawotchera ndi kuwaza. Imatengedwa m'magawo ang'onoang'ono kasanu ndi kamodzi patsiku. Kugwiritsa ntchito mankhwala ochokera kunja ndi mchere kumatha. Zakudya zoterezi, kutengera kuwuma kwa matendawa, ziyenera kukhala miyezi ingapo mpaka chaka.

Zachidziwikire, ndi matenda oopsa monga pancreatic pancreatic necrosis, zotsatira zakupha ndizotheka, ndipo, ndithudi, ndibwino kuti musabweretse thupi lanu, kuti muchepetse ziwopsezo momwe mungathere. Koma ngati matendawa adakulirakonso, kutsatira kwambiri mosamala zakudyazo kumathandiza kupewa kubwereranso mtsogolo.

Cancreas amafotokozedwa ngati imodzi mwazomwe zimapangidwa kwambiri komanso zovuta kwambiri. Kutengera ndi dzina lenilenilo, lomwe lili ndi "necrosis", munthu amatha kumvetsetsa kukula kwa matendawa. Inde, "necrosis" imamasuliridwa kuti "kufa, kufa" ndipo imafotokozedwa ngati kuwonongeka kwa maselo kapena minofu motsogozedwa ndi mabakiteriya, ndiko kuti, kuwonongeka.

Ziwerengero zonse za pancreatic necrosis zakwaniritsidwa, zachisoni, pafupifupi 80% ya milandu imatha muimfa ya odwala.

Ndi matendawa, kuwonongeka pang'onopang'ono kwa chiwalo kumachitika, komwe kumachitika chifukwa cha kuwonongeka kwa maselo ndi minyewa mothandizidwa ndi michere. Kuchuluka kwa zowonongeka kumatengera kuchuluka kwa ma enzymes a proteinolytic omwe amalowa kapamba kudzera mumitsempha ndi magazi.

Imfa ya wodwala imatha kuchitika chifukwa cha kuwonongeka kwakukulu kwa chiwalo chomwe minofu yake ndi maselo ake sangabwezeretse. Aliyense amadziwa kuti kapambayu ndiye amachititsa kuti pakhale ma enzymes enaake omwe amathandiza kusintha chakudya. Kalanga ine, munthu sangakhale ndi moyo popanda izi.

Matendawa ali ndi mulu wonse wazizindikiro zomwe zimawonetsa kukhalapo kwake:

, kupweteka kwamphamvu, komwe wodwalayo amayamba kumva kumanzere kwamkati pamimba, kenako amapezedwa m'dera lumbar, molumikizana mafupa.
Kusanza, kusanza komwe sikubweretsa mpumulo,
Magazi olimba atuluka kumaso, kupangitsa kuti kusandulike ofiira.
Kuwonjezeka kwa m'mimba, komwe kumayendetsedwa ndi kusefukira,
Kuthamanga kwa magazi, komwe kumatsika, kenako kudumpha,
Zomwe zimachitika zimachitika mwachangu
Kutsitsa mkodzo kudzera mu mkodzo
Plaque pa lilime, ndikumva kuwuma pamkamwa,
Kufupika, kupumira mofulumira.

Kuphatikiza pazizindikiro zomwe tafotokozazi, mwa odwala omwe ali ndi vuto lachipatalachi, zizindikiro zina zitha kukhalapo. Pafupifupi 2/5 odwala omwe ali ndi pachimake pancreatic necrosis amachoka, akukumana ndi omwe amadziwika kuti "kugwa", pomwe odwala otsala amatha kupeza chitukuko cha matenda amisala motsutsana ndi pancreatic necrosis. Mwachitsanzo, vuto losakhala losalamulirika limatha.

Kodi chimayambitsa maonekedwe ndi chiyani?

Zomwe zimadziwika kwambiri za hemorrhagic pancreatic pancreatic necrosis lero ndi izi:

Zakudya zopanda pake, zomwe zimatsatiridwa ndikugwiritsa ntchito zakumwa zoledzeretsa zambiri pamodzi ndi zakudya zamafuta.
Kukhalapo kwa pachimake () kapamba.
Chidwi cha zakudya zopanda mafuta komanso zamafuta.
Matenda a gallbladder.
Congenital kapena opaleshoni matenda a kapamba.

Palinso ena oyambitsa chitukuko, omwe pazifukwa zotsatirazi titha kusiyanasiyana:

Chithunzi cha chipatala chomwe wodwalayo amafotokozera kwa gastroenterologist sichilola kutsimikizira kwathunthu matendawo. Zizindikiro zonse zomwe zimayenda ndi wodwalayo ndizofanana ndi matenda ena am'mimba otupa, chithandizo cha omwe pakati pawo, ndizosiyana.

Kuti mudziwe zomwe zimayambitsa, dokotalayo akhoza kukulemberani kalata yotumizira ma ultrasound, yogwirizana ya tomography ndi. Mayeso am'mbali omwe angathandize dokotala kuthana ndi kukayikira akuphatikizapo kuyezetsa magazi, kuyesa kwamatumbo, kusanthula madzi am'mimba, kusanthula madzi am'mimba, ndi mapere.

Zoneneratu zamatenda.

Njira zingapo zodzitetezera pakupezeka kwa matendawa ndi monga: kuyezetsa kuchipatala kamodzi miyezi isanu ndi umodzi, kudya bwino, kusiya zizolowezi zoipa.

Kutengera kwazovuta za milanduyo, kuthamanga kwa chitukuko, njira zamankhwala komanso nthawi yake, pakhoza kukhala zabwino komanso zosauka.

Kukula kwakumaso kumawonekera ngati munthu sanapatsidwe uchi mu pancreatic necrosis yovuta. thandizo ndipo adayamba peritonitis. Zomwe zimayamba chifukwa cholowa m'mimba, momwemonso zimakhazikika m'matumbo athu onse am'mimba, monga lamulo, pazinthu izi, kuchuluka kwa kuledzera kumapezeka m'magazi.

Nthawi zambiri, chithandizo cha matendawa chimachokera ku mankhwala.

Hemorrhagic pancreatic necrosis (code malinga ndi ICD 10 K86.8.1) ndiyo imfa yathunthu kapena pang'ono yamatenda.

Matendawa ndi amodzi mwa matenda omwe angayambitse kudwala kwa nthawi yochepa.

Kuvuta kwa mankhwalawa kumagwirizanitsidwa onse ndi kuchuluka kwa chitukuko cha pancreatic necrosis (tsiku 1), komanso chifukwa chakuti gawo lomwe lakhudzidwalo silikuchira komanso silitulutsa ma enzymes ndi mahomoni ena ngakhale atalandira chithandizo.

Ichi ndi chifukwa chake chimodzi mwazovuta za matendawa chimakhala mtundu 2 wa shuga.

Njira yopititsira patsogolo

Kodi nthendayi ndi chiani ndipo ndiyani yomwe imayambitsa kukula? Ndi pancreatic necrosis, fistula imapangidwa, yomwe mkati mwake mumakhala zikondamoyo zomwe zimalowa mkatikati mwa m'mimba pafupifupi osazungulira.

Minofu yakufa limodzi ndi hemorrhagic exudate imakhala chothandizira kukulitsa kwa puritive peritonitis, mu 50% ya milandu yomwe imatsogolera kuphedwa kwa wodwala.

Tissue necrosis imawoneka chifukwa cha kulephera kwa kapamba kupirira madzi amwano a m'mimba. Ma Enzymes ochokera ku chiwalo chomwe chakhudzidwacho sakutulutsidwa ndipo alkalis amayamba kugwetsa mapuloteni.

Ndiye kuti, kapamba amayamba kudzipenda yekha. Chiwonongeko sichingokhala ndi izi. Necrosis amafalikira kumitsempha yamagazi yolasa chiwalo, chovulaza ndikupangitsa magazi.

Zoyambitsa matenda

Hemorrhagic pancreatic necrosis sikukula kuyambira.

Zinthu ngati izi zimayambitsa kuphwanya kwakukulu:

zakumwa zoledzeretsa kapena zakudya,
kuvutitsidwa ndi mbale zomwe zimasokoneza m'matumbo am'mimba (lakuthwa, amchere, mafuta),
thupi lawo siligwirizana
matenda a autoimmune
zotupa zoyipa limodzi ndi vuto la magazi,
bile duct chotchinga,
matenda opatsirana, omwe akuphatikizira matumbo owopsa, lupus ndi mumps,
kumwa mankhwala osokoneza bongo komanso mankhwala popanda dokotala
endocrine matenda (hypothyroidism, matenda ashuga, kuphatikizika ndi matenda am'mimba).

Mwa anthu omwe ali pachiwopsezo, wina amatha kusiyanitsa magulu otsatirawa:

zidakwa ndi mankhwala osokoneza bongo,
anthu okalamba omwe ali ndi gulu la matenda ophatikizika,
odwala ndi pathologies a kapamba, chiwindi, m'mimba,
anthu omwe amagwiritsa ntchito mankhwala osokoneza bongo nthawi zambiri, amchere, osuta komanso mafuta,
anthu ovulala pamimba.

Zizindikiro za matendawa

Zizindikiro za hemorrhagic pancreatic necrosis nthawi zonse zimakhala zowawa. Ndizosatheka kuzizindikira. Pa gawo loyambirira, wodwalayo amayamba kuda nkhawa ndi nseru, kupweteka kwambiri, komwe nthawi zambiri kumakhala kutulutsidwa mu hypochondrium yamanzere.

Nthawi zina ululu umakhala ngati lamba, nthawi zina umafanana ndi zizindikiro za kugunda kwa mtima. Munthu amangoletsa zomverera zowawa kukhala pansi, nthawi zonse mawondo ake amakhala akukoka m'mimba.

Komanso, matenda am'mimba amadziwika ndi zizindikiro zotere:

kusanza komanso kusanza pafupipafupi komwe sikubweretsa mpumulo,
kuchuluka kwamphamvu kwa kutentha kwa thupi mpaka pamitengo yayitali,
kusintha pakhungu (redness, pallor, mawonekedwe a hematomas, kuwonjezereka kumva kwa kupweteka ndi kukhudza kowala),
motsutsana ndi pancreatic necrosis, ascites, m'mimba phlegmon akufotokozera,
shuga wamagazi amakwera kwambiri, yomwe imakhala yowopsa kwambiri mu shuga ndipo imatha
kumakhala chilankhulo chopatsa chidwi,
kuchuluka kwa mkodzo wotulutsidwa pokodza kumachepa kwambiri,
kupuma movutikira kumawonekera, kugunda kumafulumira, kuthamanga kwa magazi kumakhala kusakhazikika,
zosokoneza mbali yamanjenje (zotchinga kapena zamkati) zimadziwika,
Wodwala wachisanu aliyense amakhala ndi vuto la kugwa, m'modzi mwa atatu amatsika.

Magawo opita patsogolo

Pali magawo angapo omwe ayenera kuvomerezeka.

Poyamba, tizilombo tating'onoting'ono toyambitsa matenda timayamba kuchuluka ochulukitsa. Ndi nthawi iyi yomwe wodwalayo amasanza kuyamba kuzunza, chopondacho chimakhala chosakhazikika, kutentha kwa thupi kumakwera kwambiri.

Pa gawo lachiwiri, kuwola kwa maselo kumayamba, ndipo mafomu amalephera. Gawo lowopsa kwambiri ndi lachitatu. Kutupa kumafalikira mwachangu kumadera a minofu yathanzi, chiwonongeko cha kapamba chimathandizira.

Popeza liwiro lomwe gawo limodzi limasinthira lina lakale, sikungachedwe kuyimbira ambulansi mulimonsemo.

Wodwala akamapita kuchipatala, amawunika mosamala, mtundu ndi gawo la pancreatic necrosis zimatsimikiziridwa, ndipo chithandizo chamankhwala cham'mimba chikuyambika.

Matendawa, omwe amayamba chifukwa cha chinthu chilichonse chofunikira, amafunika kuchipatala mokakamizidwa komanso chithandizo chamankhwala mwadzidzidzi.

Kuzindikira

Pakufufuza ndi kuyesedwa pambuyo pake, hemorrhagic pancreatic necrosis imasiyanitsidwa ndi ma pathologies ena. Kuti muchite izi, dokotala amafufuza wodwalayo, kuti adziwe ngati amamwa mowa kapena zakudya zamafuta, kodi ali ndi matenda otani m'manenis ake.

kuyezetsa magazi komwe kumawonetsa dokotala pazomwe zimapangidwira ma pancreatic enzymes (kuchuluka kwa izi mwa kuchuluka kwa nthawi za 6-9 kukuwonetsa hemorrhagic pancreatic necrosis),
kusanthula kwa madzi am'mimba, omwe amakupatsani mwayi kuti muzindikire kuchuluka kwa acidity,
urinalysis kuti mufufuze za ureaplasma ndi trypsinogen,
kuwomba kwa bicarbonate ndi ma enzyme,
kusanthula kwa mpweya wotuluka wa amylase ndi triglycerides,
Coproscopy zofunika kuphunzira zotsalira mafuta mu ndowe.

Kujambula kwa dera la necrosis kumatengedwa modabwitsa, endoscopic pancreatocholangiography ndipo ngati kuli kotheka, laparoscopy yam'mimba imachitidwa, zomwe zimapangitsa kuwona chithunzi chonse cha kuwonongeka kwa kapamba ndi ziwalo zina zofunika.

Pambuyo pokhazikitsa njira zovuta zodziwirira matenda zimayamba kuthandiza wodwalayo.

Moyo pambuyo

Nthawi yogwira ntchito ndi yayitali komanso yovuta. Chofunikira kwambiri pakuchira ndikutsata boma lonse ndikupatsa mphamvu yayitali nthawi yonse yobwezeretsa (osachepera miyezi 4).

Ndikofunikira kumwa mankhwala okhala ndi insulin, mankhwala omwe amalimbikitsa chimbudzi cha chakudya (ma enzymes).

Wodwala yemwe adakhala ndi pancreatic necrosis yodziwika bwino amapatsidwa njira zolimbitsa thupi ndi masewera olimbitsa thupi ofunikira kuti akonzenso mwachangu.

Kuletsa zakudya kumakhala moyo wonse. Zakudya zimatanthawuza kuchepetsa katundu pa kapamba. Ndikofunikira kudya pafupipafupi komanso nthawi zambiri (nthawi 5-6 patsiku). Chakudya chizikhala chosalowerera ndale komanso chofewa.

masamba ophika kapena otentha,
phala pamadzi
buledi (wouma)
msuzi wowala
zopangidwa mkaka zopanda mafuta ambiri,
nyama yankhuku.

Pali zinthu zingapo zomwe anthu omwe adadwala matendawa ayenera kuyiwalika kwamuyaya.

Kugundika kwa Taboo:

Zakudya zamzitini (nsomba, nyama, masamba),
Zakumwa zoledzeretsa, ngakhale zochuluka kwambiri,
koloko
ankasuta nyama
nyama zamafuta
makeke atsopano
chakudya chofulumira
mkaka wonse
zokometsera
maapulo
masamba, zipatso ndi zipatso (zatsopano).

Ndikofunika kutsatira chakudya choterocho kuti muchepetse zovuta zomwe zimakhudzana ndi kulephera kwa kapamba kupanga mahomoni ndi ma enzymes ofunikira.

Popeza shuga mellitus imakhala yovuta ya pancreatic necrosis, ndikofunikira kuyang'anira, kumayesedwa pafupipafupi ndikutsatira malangizo onse azachipatala a endocrinologist.

Kanema kuchokera kwa wodwala yemwe anali ndi matendawa:

Kupewa hemorrhagic pancreatic necrosis

Munthu amene ali pachiwopsezo chotenga matendawa ayenera kutenga njira zopewera. Kuti muchite izi, siyani kugwiritsa ntchito zakumwa zoledzeretsa, kutsatira mfundo za zakudya zoyenera.

Ndikofunikira kuzindikira ndi kuchiza matenda munthawi yomwe ingayambitse kukula kwa hemorrhagic pancreatic necrosis - dyskinesia wa biliary, duodenal chilonda ndi zilonda zam'mimba, cholecystitis.

Ndikofunika kukumbukira kuti ngakhale kuvutikira kamodzi kwa zakudya zamafuta kapena mowa kumatha kubweretsa pancreatic necrosis ndipo, chotsatira chake, kuchitidwa opareshoni yayikulu komanso ngakhale kufa.

Anthu omwe ali ndi mbiri yamtundu uliwonse wa matenda ashuga ayenera kusamala kwambiri patebulo la tchuthi. Njira zodzitetezera zosavuta sizitsimikizira kuti pancreatic necrosis sikukula, koma amachepetsa mwayi wokhala ndi matenda ochepa.

Hemorrhagic pancreatic necrosis - mkhalidwe womwe umafunikira chisamaliro chodzidzimutsa

Zokhudza chitukuko cha matenda

Zomwe zimathandizira kukulitsa matenda omwe akuwonetsedwa, madokotala amati:

Kulowetsedwa mu ndulu ducts ndi njira yomwe bile amuchotseredwa.
Kugwiritsa ntchito moledzera mowa, komwe nthawi zambiri kumadziwika kuti ndi akatswiri othandizira kuti matendawa akhazikike.
Kuponyera madzi a pancreatic kubwerera mu ducts ya chiwalo.
Kutseka kwa magazi ndi thrombosis, yomwe nthawi zambiri imawonedwa mwa odwala omwe akupanga chemotherapy, komanso matenda a bacteria kapena virus.
Kukula kwa autoimmune pathologies ndipo makamaka hemorrhagic vasculitis.
Wovulaza ziwalo, zomwe zimachitika ndi kupweteka kwamphamvu kapena pakuchita opaleshoni ziwalo zomwe zili m'mimba.

Wodwala akayamba kuchuluka kapena hemorrhagic pancreatic necrosis mulimonsemo, acinus, yemwe ali ndi udindo wopanga ma enzymes omwe amathandizira kuti akhale amodzi mwa magawo a madzi a kapamba, amaphatikizidwanso motere. Ngati kuchuluka kwa ma enzymes amenewa kumafika pamtengo wokwera kwambiri, ndiye kuti amayamba kukhala ndi vuto pa tiziwalo tating'onoting'ono tokha komanso mitsempha yamagazi. Zotsatira zake, makoma azotengera amawumbidwa ndipo zotupa kapena zotupa zimatulutsa, zomwe zimapatsa dzinalo matendawa.

Matenda a Pathology

Muzochita zamankhwala, pakhala pali zochitika pamene chifukwa cha kufa kwa odwala chinali ndendende mu hemorrhagic pancreatic necrosis. Pofuna kupewa zoterezi, pamafunika kukhala osamala kwambiri ndi chisonyezo chilichonse cha matenda m'thupi, popeza nthendayi ili ndi zizindikilo zingapo, zomwe zimapangitsa kuzindikiritsa popanda zovuta zapadera.

Pofuna kutsimikizira kapena kukana za matendawa, wodwalayo adzatumizidwa kukakumana ndi maphunziro angapo a labotale ndi a Hardware. Izi zimalola ndikulondola kwambiri kuzindikira zomwe zimayambitsa matenda a wodwalayo amene wapempha thandizo.

Ndikofunika kuti aliyense akumbukire kuti kuzindikira kwadzidzidzi kungapangitse kuti tizingogwira ntchito, tisamveke zowawa, komanso kufa.

Akatswiri amasiyanitsa zizindikiro zotsatirazi za hemorrhagic pancreatic necrosis:

kupweteka kosasunthika m'dera la hypochondrium yamanzere, yomwe imatha kumveka kumbuyo, phewa, m'munsi,
chikhazikitso champhamvu mu chilankhulo choyera kapena chachikaso,
Pakamwa pouma, pomwe pamatha kupindika nthawi zonse.
Mkhalidwe wopitilira mseru komanso kusanza, komwe kumakupatsani mwayi wopuma.
kutulutsa m'mimba
phokoso mokhumudwa
kuchuluka kwa thupi ndi kutentha thupi, komwe kumachitika chifukwa cha kuledzera kwambiri kwa thupi,
redness pakhungu, makamaka pankhope,
buluu kapena hematomas m'mimba,
kuthamanga kapena kutsika kwa magazi, tachycardia,
kuchepa ndowe ndi mkodzo, zomwe zimatuluka m'thupi,
mkhalidwe wopanda chidwi kapena, mmalo mwake, ukali wosaganizira ndi zizindikiro zina zamavuto amanjenje.

Kuzindikira kumatsimikiziridwa ndi kupimidwa kwa ultrasound ya kapamba kapena kawerengedwe kazonse ka m'mimba.

Ponena za mayeso a labotale omwe angapangitse kuti athe kupeza chidziwitso cholondola, wodwalayo amayesedwa magazi ndi mkodzo pafupipafupi, ndikuphunziranso zamadzimadzi am'mimba ndi kapamba kuti adziwe zambiri za ma enzymes ena okhala mwa iwo.

Chithandizo cha matenda a mtima

Monga momwe masewera akusonyezera, odwala ambiri omwe ali ndi vutoli ofanana ndi omwe amapezeka kuchipatala ku ambulansi. Chithandizo cha matenda amtunduwu, odwala amayikidwa kuchipatala, monga lamulo, m'chipinda chothandizira kwambiri. Kuyesa konse kwa ogwira ntchito zachipatala pankhaniyi kumayambitsa kupweteka, kuletsa ntchito ya thupi kwakanthawi, kuchulukitsa kuti muchepetse kusokonezeka kwa magazi, kuchepetsa kupanga kwa juwisi ndikuchepetsa kuchuluka kwake kwa asidi, kupewa kukula kwa matenda opatsirana ndikuchotsa poizoni m'thupi.

Kutengera ndi zotsatira za kafukufukuyu kapena pakakhala kuti palibe kugwiritsa ntchito mankhwala moyenera, komanso potengera momwe wodwalayo alili, dokotala amasankha ngati opaleshoni ndiyoyenera.Ngati, motsutsana ndi maziko a pachimake mawonekedwe a matenda omwe akufotokozedwawo, palibe matenda omwe angayambike nawo, ndiye kuti wodwalayo amapezeka pamatumbo a pataroscopy kapena ngalande yam'mimba. Komabe, ngati matenda atapezeka, ndiye kuti kuchotsedwa kwathunthu kapena kuchotsedwa kwathunthu kwa chinthucho kukachitika.

Ponena za odwala omwe adwala, mu 50% ya milandu yomwe matendawo amawonetsa amwalira, chomwe chimapangitsa kuledzera kwa thupi chifukwa cha puritis peritonitis.

Ngati tikunena za kupewa matendawa, ndiye kuti kuphatikiza mowa kumachotsedwa m'zakudya komanso moyenera. Kupatula apo, monga zotsatira za kafukufukuyu zikusonyeza, kumwa zakumwa zoledzeretsa za 80 ml kwa zaka zingapo, mwayi wokhala ndi matendawa umakhala wokwanira.

Ndi nthawi yake kuthana ndi mankhwalawa a cholecystitis pamaso pa, matenda a ndulu, zilonda zam'mimba kapena zilonda zam'mimba. Ngati mutsatira malangizowa, ndiye kuti aliyense atha kupewa matenda amenewa ndikukhala ndi moyo komanso chisangalalo.

Hemorrhagic pancreatic necrosis (code malinga ndi ICD 10 K86.8.1) ndiyo imfa yathunthu kapena pang'ono yamatenda.

Matendawa ndi amodzi mwa matenda omwe angayambitse kudwala kwa nthawi yochepa.

Ichi ndi chifukwa chake chimodzi mwazovuta za matendawa chimakhala mtundu 2 wa shuga.

Amayambitsa hemorrhagic pancreatic necrosis

Kupezeka kwa hemorrhagic pancreatic necrosis amadziwika ndi kutseguka kwa michere ina yomwe imalowa kuchokera mumimba. Ndipo kuchokera pamenepo kupita kumagazi ambiri. Imfa ya maselo ambiri chifukwa chodzimbidwa ndi kapamba zimayambitsa matendawa.

Zomwe zimayambitsa hemorrhagic pancreatic necrosis ndi:

zotupa pa kapamba,
kuledzera kwa thupi chifukwa cha kuphatikizika kwa Mowa ndi zinthu zina zoyipa mkati mwake.
biliary thirakiti matenda
thrombophlebitis kapena vasculitis ya zikondamoyo, kuphatikizapo chifukwa cha pachimake mtima kulephera,
kuwonongeka kwa minofu chifukwa cha chiwonetsero chazinthu chamakina,
chitetezo chamthupi. Pamene chitetezo cha mthupi sichitha kuzindikira maselo amthupi. Amatengedwera ngati ma cell tizilombo achilendo ndipo, chifukwa chake, amakana,
mavuto pambuyo opaleshoni pamimba,
kusokonezeka kwakukulu kapena kuwonongeka kwa minofu ya kapamba chifukwa cha kukhalapo kwa chotupa neoplasms m'thupi,
kumwa kwauchidakwa zakumwa zoledzeretsa, zomwe mwachindunji zimawononga kwambiri kapamba, kuyambitsa ntchito yake yachinsinsi.

Kudziimira pawokha kwa hemorrhagic pancreatic necrosis kumatheka pokhapokha kuwonongeka mwachindunji kwa minofu ya kapamba. Nthawi zina, amapangika chifukwa cha kupweteka kwa kapamba kaphatikizidwe ndi kutupa kwa kapamba.

Zizindikiro za hemorrhagic pancreatic necrosis

Kupweteka paroxysmal pachimake hypochondrium.
Pakamwa pakamwa, nseru, komanso kusanza mobwerezabwereza.
Kutulutsa magazi, kusilira komanso kutsegula m'mimba.
Kuzizira komanso kuwonjezeka kwakukulu kwa kutentha kwa thupi. Nthawi zina amakhala okwera kwambiri kotero kuti wodwalayo amayamba kutentha thupi, motero.
Khungu lowoneka bwino la nkhope, komanso mawonekedwe amtambo wakhungu pakhungu pamimba.
Amalumphira mwadzidzidzi magazi.Kuchera kwambiri.
Kuluma kwa mtima ndi kupuma movutikira kumapuma.
Dera lokondwa, nkhawa.
Mawonekedwe ofanana ndi zizindikiro za kulephera kwa impso.
Nthawi zina, kusokonezeka kwa malingaliro kumawonedwa.

Zizindikiro za hemorrhagic pancreatic necrosis zimawonetsedwa ndikukula msanga. Nthawi zambiri izi zimachitika pakapita nthawi yochepa chifukwa chodya zakudya zoletsa matendawa. Hemorrhagic pancreatic necrosis ndi yovuta kwambiri, koma magawo awiri motsatizana amadziwika bwino, omwe ndi:

gawo loyamba. Nthawi zambiri zimakhala sabata limodzi, nthawi zina motalika. Munthawi imeneyi, michere ya proteinolytic imayamba kuyendayenda m'magazi, mwakutero imapereka poizoni m'ziwalo zosiyanasiyana. Sizotheka kuyimitsa mawonekedwe owoneka pogwiritsa ntchito mankhwala oyenera,
gawo lachiwiri. Amadziwika ndi purulent ndi postnecrotic zovuta. Nthawi zambiri muzivala. Kuperewera kwa foci ya hemorrhagic pancreatic necrosis ndi amkati. Zotsatira zakumwa zoledzeretsa za thupi zimawonekera bwino. Kufika kwa mtima kumachulukanso, ululu umakulirakulira. Chifukwa cha masiku ambiri otentha kwambiri, ziwopsezo zamkati mwa ziwalo zamkati zimadziwika. Kupuma chifukwa cha kutsekeka kwa khoma la mtima kungayambenso.

Hemorrhagic pacreonecrosis - chifukwa cha imfa

M'masiku oyamba a matenda kupititsa patsogolo, odwala ena amakhala ndi ululu wamphamvu kwambiri, komanso kuvomerezeka kosavomerezeka kwa anthu oopsa m'magazi.

Chifukwa cha zifukwa zomwe tatchulazi, kuphatikiza kulephera kusintha thupi la wodwala, hemorrhagic pancreatic necrosis imatha kupha.

Mpaka pano, pali magulu angapo a pancreatic necrosis, pakati omwe amatchuka kwambiri ndi gulu lomwe latengedwa kuyambira 1992.

Pancreatic necrosis ndi zovuta za matenda monga pachimake kapamba (kutupa kwa kapamba). Imfa mu matenda ovutawa.

Ndi pancreatitis, ginger wodula bwino amaonedwa ngati wogwira ntchito, yemwe amadziwika ndi mankhwala ambiri. Choyamba, izi.

Zomwe zimayambitsa kupezeka kwa hemorrhagic pancreatic necrosis

Njira yochizira

Pachimake pancreatic necrosis nthawi zonse chimayambitsa kuchipatala. Odwala amatumizidwa ku chipinda cha odwala kwambiri, kapena mwachindunji opareshoni. Mankhwalawa ali ndi zolinga zotsatirazi:

ululu wammbuyo umatha,
enzymatic ntchito iyima
kuphipha kumachotsedwa,
kupanga madzi am'mimba amachepetsa,
matenda opatsirana amaletsa.

Chifukwa chakuti pancreatic necrosis ndiyomwe imayambitsa kufa m'madipatimenti a gastroenterology, njira zochizira ziyenera kuyamba nthawi yomweyo. Chifukwa cha izi, choyambirira, antispasmodics amayamba. Novocain blockade imakhala ndi zotsatira zabwino. Chifukwa cha izi, ndizotheka kupumula ma ducts ndikupereka malo otulutsa madzi a pancreatic.

Kupitilira apo, chifukwa chachikulu chimachotsedwa - kuchuluka kwa michere. Chifukwa chake, kukonzekera kwa antienzyme, othandizira kuti achepetse kubisala, histamine receptor blockers imayambitsidwa.Kuyambira m'masiku oyamba a kutupa, minofu necrosis imayamba, kotero chithandizo chake chimayenera kukhala ndi antibacterial chithandizo.

Kuchiza kumapitilira kwa maola angapo, pambuyo pake kuyesedwa ndikufunika kwa opaleshoni. Izi zimawonjezera mwayi wopewa imfa ya wodwala.

Kuthandizira opaleshoni kumatha kuchitika kamodzi mukalandira chithandizo. Njirayi mwachindunji imatengera mawonekedwe a mapangidwe a pancreatic necrosis. Popanda matenda, laparoscopy imalimbikitsa. Kutulutsa kwamkati mwa patali kumakhalanso koyenera. Ngati, chifukwa cha kuyesedwa, kudziwitsidwa kwakukulu kwawululidwa, ndikofunikira kuchitidwa opaleshoni yam'mimba. Kuphatikiza apo, njira monga peritoneal dialysis imakhudzanso mkhalidwe wa wodwalayo. Tikuthokoza, adakwanitsa kuyeretsa magazi a ma enzyme ndi poizoni, kuchepetsa mwayi wa imfa ya wodwala ku kuledzera.

Madera akuluakulu a gland akakhudzidwa, chofunikira chofunikira chimafunika. Nthawi zina, kuchotsera chiwalo kwathunthu kumachitika. Mosasamala kuti ndi njira yanji yomwe imagwiritsidwa ntchito, atangopanga opaleshoni, chithandizo chamankhwala omwe ali pamwambapa ndi mankhwala. Mtsogolomo, kukonzekera kwa enzyme komwe kumathandizira kugwira ntchito kwa gland kumakhala kovomerezeka.

Chifukwa chiyani matendawa amawonekera?

Monga lamulo, hemorrhagic pancreatic necrosis ndi njira yonse. Imagwira magawo onse a gland ndikupita ndi liwiro la mphezi. Chifukwa chake, zinthu zamphamvu ziyenera kuyambitsa.

Hemorrhagic pancreatitis imatha kupezeka ndi poizoni wa chakudya (nthawi zambiri ndimamwa mowa mwauchidakwa).
Matendawa amawoneka motsutsana ndi maziko a chifuwa chachikulu, pomwe minofu idasinthidwa kale, ndipo wodwalayo samatsata zakudya ndikudya mafuta ambiri, zonunkhira komanso acidic.
Pachimake hemorrhagic pancreatic necrosis nthawi zambiri kumachitika pambuyo povulala. Ma Enzito amatuluka ndipo amayambitsa zochitika zoyipa.
Nthawi zina vutoli limakwiyitsidwa ndi madokotala. Zomwe zimayambitsa matendawa ndizosinthanitsa ndi ma pancreatic ducts (ERCP).
Hemorrhagic pancreatitis imachitika ndi ma virus ndi autoimmune pathologies. Mwachitsanzo, maphunziro owopsa a mumps kapena chimfine angayambitse zovuta ku England. Systemic lupus erythematosus nthawi zina imawononga ziwiya za kapamba.
Mu ana, pachimake hemorrhagic pancreatitis amatha kuchitika chifukwa cha majini. Mitundu ya cystic fibrosis ndi zonyansa pakapangidwe ka gland ndizomwe zimayambitsa matenda komanso kufa mwadzidzidzi.
Matenda a chiwindi ndi ndulu.

Zomwe zimayambitsa matendawa ndizambiri, koma monga momwe zimasonyezera, nthawi zambiri, necrosis ya gland imayamba motsutsana ndi zakumbuyo kwa mowa. Odwala amalowetsedwa kuchipatala ndikuwopseza mkati mwa maola 6 kuchokera pomwe matendawa atayamba. Zizindikiro zotsatirazi ndizodziwika ndi pancreatic necrosis:

vuto lalikulu la wodwala,
khungu ndi mawonekedwe a nthaka,
kuthamanga kwa magazi komanso kugunda kwamanyazi,
ukufalikira
kusokonezeka kwa minofu khoma lamkati,
kusanza komwe sikubweretsa mpumulo,
mawanga a cyanotic, zotupa zimatuluka pamimba, kumbuyo ndi m'mbali.

Monga lamulo, odwala oterewa amapita kuchipatala chamankhwala osamala kwambiri. Ndikofunikira kupatula magwero ena a pachimake a peritonitis, omwe chithandizo cha opaleshoni chofunikira chimafunikira (kuwerengetsa cholecystitis, chilonda chopaka).

Kugwedezeka kwa kapamba kumatha kupha. Inde, pakadwala, zinthu zingapo zowonongeka zimachita: kupweteka, kuledzera kwa thupi, kukula kwa zovuta m'magazi oyambitsidwa. Imfa imachitika chifukwa cha kufooka kwa ziwalo zingapo kapena zovuta zina. Muzochitika izi, pali zochitika pamene tsiku 1 lidadutsa kuchokera ku kuwukira kwa imfa.Chifukwa chake, mtundu wokulirapo wa kapambayu amafunika chithandizo chamankhwala.

Chinthu choyamba chomwe wodwala amafunikira ndi kupuma kokwanira komanso kuthana ndi mantha. Pazifukwa izi, wodwalayo amaphatikizidwa ndi mayankho a electrolyte ndi mapuloteni amakonzekera magazi (Polyglyukin, Reopoliglyukin, Hemodez, plasma ndi albumin). Kwa analgesia, narcotic analgesics (Promedol, Diazepam) amagwiritsidwa ntchito. Nthawi zina, amathandizidwa ndi ma antihistamines am'badwo woyamba, omwe samangokhala ndi anti-allergen, komanso komanso osokoneza.

Mfundo yofunikira ya chithandizo ndikuchotsedwa kwa sphincter spasm. Mwa izi, antispasmodics amagwiritsidwa ntchito (Plifillin, Papaverin, Eufillin). Kusanza kwambiri kumatha kuyambitsa kusowa kwa ma elekitirodi. Chifukwa chake, wodwalayo mu chisamaliro chovuta nthawi zambiri amaphatikizidwa ndi mayankho a potaziyamu, calcium, magnesium. Amathandizira kuti minofu ikhale yachilengedwe.

Kuti muchepetse zowonongeka za ma enzymes, mankhwala omwe amachepetsa zochitika zama proteinase (Trasilol, Contrical) amaperekedwa. Komanso, ntchito ya gland imalepheretsedwa ndi mankhwala a mahomoni (Octreocide, Sandostatin). Amachepetsa gawo la necrosis. Ndi kayendetsedwe ka prophylactic pa nthawi yazipangizo zachitsulo, kupsa mtima kwa michere kumachepa.

Ndi pancreatic necrosis, njirayi imafalikira kupitirira thupi, ndikupanga foci yowonongeka m'zinthu zozungulira. Chifukwa chake, chithandizo cha opaleshoni ndi mtundu uwu wa kapamba ndichofunikira kwambiri. Ntchito zam'mimba zambiri zimakhala zopanda chiyembekezo. Madokotala amakonda kulowererapo kwa laparoscopic. Pankhaniyi, foci ya necrosis imachotsedwa, machubu amadzimadzi amaikidwa mu kulowetsedwa.

Mu njira pamene njira zonse sizipereka zomwe mukufuna, zotsatira zowopsa zimachitika. Ndi matenda amtunduwu, amatha kuchitika tsiku loyamba la matendawa. Ndi chithandizo chokwanira, koma chitetezo chofooka chathupi, odwala amafa masabata awiri pambuyo pa kuukira. Zomwe zimayambitsa kufa ndi purulent-septic complication, chibayo, kufooka kwa ziwalo zingapo, kugwedezeka kwa matenda oopsa. Mwa odwala omwe atsala, pancreatic necrosis imabweretsa kulumala.

Kupewa matenda

Chiwonetsero chonse cha gland ndi chakufa. Chifukwa chake, ngati mukukhala ndi vuto la kapamba, muyenera kusamala kwambiri.

Tsatirani zakudya zomwe adokotala adatipatsa (musamadye zonunkhira, zamafuta, zowawasa, zosuta fodya).
Lekani kumwa ndi kusuta (mankhwala nawonso aletsedwa).
Chitani matenda a chiwindi ndi ndulu mu nthawi.
Khalani ndi moyo wathanzi.

Onse hemorrhagic pancreatic pancreatic necrosis: 80% ya imfa ya wodwala

Hemorrhagic pancreatic pancreatic necrosis imafotokozedwa kuti ndi imodzi mwazomwe zimapangidwa kwambiri komanso zovuta kwambiri. Kutengera ndi dzina lenilenilo, lomwe lili ndi "necrosis", munthu amatha kumvetsetsa kukula kwa matendawa. Inde, "necrosis" imamasuliridwa kuti "kufa, kufa" ndipo imafotokozedwa ngati kuwonongeka kwa maselo kapena minofu motsogozedwa ndi mabakiteriya, ndiko kuti, kuwonongeka.

Ziwerengero zonse za pancreatic necrosis zakwaniritsidwa, zachisoni, pafupifupi 80% ya milandu imatha muimfa ya odwala.

Momwe mungazindikire zizindikilo za thupi zokhudzana ndi pancreatic necrosis?

Matendawa ali ndi mulu wonse wazizindikiro zomwe zimawonetsa kukhalapo kwake:

Ululu wamphamvu, wowopsa womwe wodwalayo amakhala nawo kumanzere kumimba, kenako umawonekera kudera lumbar, molumikizana mafupa,
Kusanza, kusanza komwe sikubweretsa mpumulo,
Magazi olimba atuluka kumaso, kupangitsa kuti kusandulike ofiira.
Kuwonjezeka kwa m'mimba, komwe kumayendetsedwa ndi kusefukira,
Kuthamanga kwa magazi, komwe kumatsika, kenako kudumpha,
Zomwe zimachitika zimachitika mwachangu
Kutsitsa mkodzo kudzera mu mkodzo
Plaque pa lilime, ndikumva kuwuma pamkamwa,
Kufupika, kupumira mofulumira.