Pachimake kapamba - Ichi ndi chiwonongeko chowononga cha pancreatic parenchyma, zimakhala ndi ziwalo zozungulira zomwe zimapangitsa kuti kutupa kuyanjane.

Magawo a maphunziro a pachimake kapamba

Gawo 1 - enzymatic - masiku asanu oyamba, mapangidwe a pancreatic necrosis, kukula kwa endotoxemia. Ena amakhala ndi ziwalo zingapo komanso kulephera kwa endotoxin.

Pali mitundu iwiri yazachipatala:

a - Pancreatitis choopsa. Gawo lankhondo la morphological ndilofala pancreatic necrosis (chachikulu chachikulu komanso chonse chapamwamba).

b - Osapweteka kwambiri kapamba. Pancreatic necrosis mwina siyopanga (edema ya kapamba), kapena ndi yochepa ndipo siyofalikira kwambiri (focal pancreatic necrosis mpaka 1 cm).

Gawo lachiwiri - yogwira - amakula sabata lachiwiri, lomwe limadziwika ndi zomwe zimachitika mthupi kupita ku mawonekedwe a necrosis. Njira yachipatala yamtunduwu ndi parapancreatic infiltrate (omenobursitis). Clinic - matenda opweteka a nthawi yayitali, kutentha thupi (37,5-38), kupweteka kwamkati mwa chapakati pamimba, gastroduodenal nguvu.

Gawo lachitatu - kuphatikizika ndi kusinthana - imayambira sabata 3, imatha miyezi yambiri. Kuchulukana kwa kapamba ndi minyewa ya m'mimba kumayamba kupanga kuyambira tsiku la 14. Pali njira ziwiri zoyendera:

a - Aseptic kusungunuka ndi sequestration ndi wosabala pancreatic necrosis. Amadziwika ndi mapangidwe a post-necrotic cysts ndi fistulas.

b - Kusungunuka kwa Septic ndi kubwezeretsanso - ichi ndi kachilombo kakang'ono ka necosis komanso necrosis ya parapancreatic CHIKWANGWANI champhamvu kwambiri. Clinic - otentha thupi kutentha, kuzizira, ochepa hypotension ndi angapo ziwalo zovuta.

The matenda mawonekedwe a gawoli ndi purulent-necrotic parapancreatitis ndi zovuta zake (purulent-necrotic sagging, abscesses ya retroperitoneal space ndi m'mimba patsekeke, purent omentobursitis, purulent peritonitis, arrosion ndi m'mimba kutaya, fistulas, sepsis).

Pancreatogenic abscess (abscess of the pancreas, omental bursa, retroperitoneal fiber) - hectic fever, kuzizira, palpable zowawa zowilitsa zimawonekera zomwe sizimakonda kuchepa.

The pseudocyst imadziwika ndi kupweteka kwa nthawi yayitali kupweteka kwa epigastrium, zizindikiro za kutsekeka kwa duodenal ndi kuwoneka pamimba pamatumbo a voluminous palpable ozunguliridwa mwamphamvu kwambiri.

Zotsatira za kapamba owopsa - pseudocysts, kapamba fancula, chifuwa chachikulu, matenda a shuga ndi dyslipoproteinemia. Ndi kuthetseratu kwathunthu kwa chifukwa cha biliary kapena alimentary, ntchito za gululi zimabwezeretseka kwathunthu

29. Njira za mankhwalawa pachimake kapamba malinga ndi gawo la matendawa.

Pachimake kapamba - Ichi ndi chiwonongeko chowononga cha pancreatic parenchyma, zimakhala ndi ziwalo zozungulira zomwe zimapangitsa kuti kutupa kuyanjane.

Enzymatic gawo chithandizo:

Zochizira pancreatitis wofatsa, chithandizo chachikulu chokwanira ndi chokwanira:

1) njala (pafupifupi masiku 2-4)

2) kuwomba komanso kufunitsitsa kwa zomwe zili m'mimba

3) hypothermia yakwanthawi (kuzizira pamimba)

4) sanali a narcotic analgesics (Analgin intramuscularly kapena kudzera mu mtsempha wa 2 ml wa 50% yothetsera pambuyo pa maola 6-8, tramadol 50-100 mg kudzera mu mnofu kapena ma intramuscularly pambuyo maola 6-8)

5) narcotic analgesics yokhala ndi ululu wammbuyo (trimereperedin subcutaneously kapena mtsempha wa magazi 1 ml ya 1% kapena 2% atatha maola 6).

6) antispasmodics - papaverine hydrochloride 2 ml ya 2% yankho kudzera mu mnofu, kuchuluka kwa 40-80 mg katatu patsiku intramuscularly, kudzera m'mitsempha

7) kulowetsedwa mankhwala mu 40 ml pa 1 makilogalamu thupi ndi kukakamiza diuresis mkati 24-48 maola

Mayankho a kulowetsedwa: 0,9% sodium chloride solution, 5% kapena 10% dextrose solution, m'malo mwa plasma.

Mankhwala a antisecretory ndi antienzyme:

1) Odwala osapitirira 50, 000, masiku 5 atadwala

2) Gordoks osachepera 500 masauzande 500, masiku 5 atadwala

3) octreotide subcutaneously, 100 mcg katatu pa tsiku

4) omeprazole 20 mg 2 kawiri pa tsiku

5) femotidine kudzera m'mitsempha, 40 mg 2 kawiri pa tsiku.

Ngati palibe zovuta kwa maola 6 ndipo chimodzi mwazizindikiro za kupweteka kwambiri kwa kapamba zilipo, chifuwa chachikulu chikuyenera kuzindikirika ndipo wodwalayo asamutsidwira kumalo osamalira odwala kwambiri.

Chithandizo mu yogwira gawo (zotumphukira kulowa):

Laparotomy sabata yachiwiri imachitika kokha chifukwa cha zovuta (kuwonongeka kwa cholecystitis, kutaya magazi m'mimba, kutsekeka kwamatumbo) komwe sikungathetsedwe endoscopic.

Chithandizo chachikulu:

1) adapitilirabe mankhwala kulowetsedwa-magazi

2) zakudya zamankhwala (Zakudya No. 5) kapena thandizo la zakudya

3) mankhwala oletsa antibayotiki (cephalosporins a m'badwo wa 3-4 kapena fluoroquinolones osakanikirana ndi metronidazole, makonzedwe a carbapenema reservation)

4) immunomodulation (magawo awiri a subcutaneous kapena intravenous activation ya roncoleukin a 250,000 (okhala ndi kulemera kosakwana 70 kg) kapena mayunitsi 500,000 (okhala ndi kulemera kwa thupi opitilira 70 kg) ndikutalika kwa masiku 2-3

Chithandizo cha gawo la purulent zovuta (purulent-necrotic parapancreatitis ndi kachilombo pancreatic necrosis):

Ndi zovuta za purulent, kulowererapo kwa opaleshoni kukuwonetsedwa, cholinga chake chomwe ndikukonzanso kwa fiberoperoperoneone yomwe yakhudzidwa. Kuchitapo kanthu kumaphatikizapo kuwulura, kuchotsa mchenga ndi kukhetsa kwa mphamvu yobwezera. Njira yayikulu yoyeretsa ya purulent-necrotic foci ndi necrsecvestrectomy, yomwe imatha kukhala imodzi komanso yolingana.

Mu nthawi yogwira ntchito, chithandizo chovuta chimasonyezedwa:

1) othandizira okhudzana ndi zakudya (kudzera pa kafukufuku yemwe adayikidwa m'matumbo ang'ono kumbuyo kwa Trent ligament)

2) mankhwala oletsa antibayotiki molingana ndi mawonekedwe

- ndi sepsis yayikulu komanso kuopseza kwa septic - - mankhwala othandizira omwe ali ndi ma immunoglobulin kwa intravenous makonzedwe ophatikizana ndi kugwiritsa ntchito mahomoni

- ndi kulimbikira komanso matenda a kagayidwe kachakudya - anticytokine mankhwala (protease inhibitors, ogwira njira)

Wotsutsa nkhani yasayansi yazachipatala ndi zamankhwala, wolemba pepala lasayansi - Sanzharova Lyudmila Sergeevna

Nkhaniyi ikuwonetsa zotsatira za malamulo azachipatala ndi a morcological a kukonzanso kwa kapamba ndi kapangidwe ka parapancreatic mu pancreatitis yowopsa. Kutengera ndi zotsatira zomwe zapezedwa, zidatsimikizika kuti pamafilimu owopsa a kapamba owopsa, ndikofunikira kulingalira za machitidwe a morphofunctional a mayankho osiyanasiyana a ma cell ndi minyewa yama cell a pathological process.

CLINICAL-MORPHOLOGICAL ASPECTS OF ACUTE DESTRUCTIVE PANCREATITIS NDI PARAPANCREATITIS

M'ndemanga zotsatira za malamulo a chipatala-morphological a kukonzanso kwa kapamba ndi kapangidwe ka parapancreatic mikhalidwe ya pancreatitis yowopsa imaperekedwa. Pamaziko a zomwe zalandilidwa zimatsimikiza kuti pamafomu olemetsa a kapamba owononga kwambiri pamafunika kulingalira mozama za mayankho osiyanasiyana a ma cell ndi nsalu zomwe zimachitika.

Zolemba za ntchito yasayansi pamutu wakuti "Matenda a Clinical ndi morphological a pancreatitis pachimake owononga ndi parapancreatitis"

ZOFUNA ZA CLINICAL NDI MORPHOLOGICAL ZA ACUTE DESTRUCTIVE PANCREATITIS NDI PARAPANCREATITIS

Orenburg State Medical Academy (Orenburg)

Nkhaniyi ikuwonetsa zazotsatira zamatenda ndi maumboni a kukonzanso kwa kapamba, ndi kapangidwe ka parapancreatic mu pancreatitis yowopsa. Kutengera ndi zotsatira zomwe zapezedwa, zimatsimikiziridwa kuti. kwambiri mitundu ya pachimake owononga pancreatitis, ndikofunikira kulingalira za morphological ndi magwiridwe antchito amasiyanidwe osiyanasiyana osiyanasiyana ma cell ndi. tinthu timene timatulutsa.

Mawu ofunikira: kapamba, parapancreatitis, pathomorphogenesis, chithandizo cha opaleshoni

CLINICAL-MORPHOLOGICAL ASPECTS OF ACUTE DESTRUCTIVE PANCREATITIS NDI PARAPANCREATITIS

L.S. Sanzharova Orenburg State Medical Academy, Orenburg

M'ndemanga zotsatira za malamulo a chipatala-morphological a kukonzanso kwa kapamba ndi kapangidwe ka parapancreatic mikhalidwe ya pancreatitis yowopsa imaperekedwa. Pamaziko a zomwe zalandiridwazo, zimapangitsa kuti anthu azikhala ndi ma pancreatitis ofunika kwambiri a pancreatitis ofunika kwambiri, kuyankhidwa kwa zinthu zosiyanasiyana za cellular ndi nsalu zomwe zimapangidwa. .. Mawu ofunikira: kapamba, parapancreatitis , patomorphogenesis, opaleshoni yamankhwala

Acute pancreatitis ndi parapancreatitis m'zaka zapitazi ndi imodzi mwamavuto omwe amakambidwa kwambiri padziko lonse lapansi m'mabuku azachipatala, imodzi mwazinthu zovuta kwambiri pankhani ya opaleshoni. Zotsatira zamankhwala zimatengera mawonekedwe a pancreatitis pachimake. Ngati ndi edematous pachimake kapamba ,imfa ali wofanana

0, ndiye ndi mitundu yowonongeka - ikuyesetsa mwamphamvu 100% (ndi pancreatitis yonse).

Njira ya pancreatic necrosis imadziwika ndi gawo lotchuka, onse omasuka pamimba ndi malo am'mbuyomu. Kukondwerera kwa para-pancreatic minyewa pancreatitis yowononga kwambiri ndi chizindikiro chokhazikika komanso chokhazikika ndipo amapezeka malinga ndi olemba angapo mu 90% ya milandu 7, 8. Ngakhale ndi mawonekedwe ake ofatsa, momwe macroscopically otsimikiza pancreatic minofu necrosis sawoneka, koma okhazikika microscopically ngati "pathobiochemical bwanji". Kugonjetsedwa kwa parapancreatic fiber kumapitilira pambuyo pakupanga komaliza kwa neancosis ndipo imatenga nthawi gawo lonse la enzymatic la pancreatitis yowopsa.

Mfundo zochizira zotsatira za kapamba zomwe zakonzedwa mpaka pano ku pancreatitis ("clipping" therapy) ndi pancreatogenic peritonitis (kuchotsedwa kwa exudate, lavage, ndi kutulutsa kwa m'mimba m'mimba) zapangitsa kuti zinthu ziziwayendera bwino komanso kuchepa kwaimfa mu mitundu yayikulu. Chovuta kwambiri chinali kuchitapo kanthu

pa retoperitoneal fiber, kuyambira mbali imodzi, mankhwalawa amalowerera m'mavuto chifukwa cha kufalikira kwa kwanuko, ndipo njira zina zowonetsera pang'onopang'ono sizothandiza. Pakadali pano, 45 - 80% ya odwala omwe ali ndi pancreatitis yowononga kwambiri amwalira chifukwa chopanga zovuta za purulent ku parapancreatic fiber, zomwe ndizomwe zimapangitsa kuti ziwalo zambiri zizilephera komanso sepsis.

Pakadali pano, pafupifupi palibe amene amakayikira kuti kukhalapo kwa purulent-septic zovuta za pancreatic necrosis ndi chidziwitso chokwanira chamankhwala othandizira opaleshoni. Mwanjira yodziwika bwino, zisonyezo zakugwiritsa ntchito zidapangidwa ndi R. Visyeg ndi N.A. Reber (1999). Amakhulupirira kuti: "Matenda otsimikiziridwa a pancreatic necrosis ndi chizindikiro chokwanira cha opaleshoni, ndipo milandu ina yonse imafuna kuwunika opaleshoni yokhwima." Chilichonse chinkawoneka bwino. Ngati pali matenda - opaleshoni akuwonetsedwa, ayi - chithandizo. Nthawi yomweyo, nkhani yazowonetsa opereshoni yokhala ndi chiberekero cha necrotic pancreatitis sichinathetse. Kumayambiriro kwa matendawa (gawo lachiwiri - gawo la enzymatic toxemia), makamaka ngati kugonjetsedwa kwa parapancreatic fiber predominates, komwe kumakhala "depot" ya poizoni yemwe amalowa m'magazi nthawi zonse, komwe kumayambitsa kufa ("kufa"), koyambirira (ziwalo zingapo ) ndi mochedwa (matenda, sepsis) mavuto a pancreatic necrosis.

Cholinga cha phunziroli chinali kuwunika njira zamankhwala ochita opaleshoni ndi zotulukapo zazachipatala pachimake

kapamba, kuphatikizapo kuchokera kumbali ya kusanthula kwantchito.

ZOCHITITSA NDIPO ZOTHANDIZA

Tidasanthula mbiri 21 ya odwala omwe adafa omwe ali ndi pancreatitis yowopsa. 71.4% - osakwana zaka 60 (23,8% kuyambira 30 mpaka 40, 28.6 - kuyambira 40 mpaka 50). 18 (85.7%) anali amuna, 3 (14.3%) anali akazi.

Zomwe zimayambitsa kukula kwa matendawa zinali: mwa odwala 17 (81.9%) omwe amamwa mowa kwambiri, awiriawiri (9.5%) - cholakwika m'zakudya, chomwe chimayambitsa matendawa sichinakhazikitsidwe mwa odwala awiri (9.5%). Kuzindikiritsa kwa pancreatitis yowopsa pachimake kumatsimikiziridwa ndi zamankhwala, zamankhwala zasayansi ndi zotsatira za maphunziro othandizira (ultrasound, MRI). Odwala onse adavomerezedwa. Nthawi yomweyo, m'chipinda chothandizira kwambiri, pakulandila odwala onse, mankhwalawa, othandizira, amagwiritsidwa ntchito m'njira zonse, kutsatira zolinga zotsatirazi: kuchepetsa kukula kwa kutupa ndi kupititsa patsogolo njira zowonongeka mu kapamba, kuletsa katulutsidwe kapamba ndi michere, kukhudza njira za pathogenetic zamavuto. - analgesia, ma antacid, kubwezeretsa kwa electrolyte bwino komanso kukonza BCC, desensitizing othandizira.

Mankhwala othandizira antibacterial omwe amapha anti pancreotropic (carbopenems, fluoroquinolones III - mibadwo ya IV) adagwiritsidwa ntchito kuyambira tsiku loyamba la chithandizo.

Kafukufuku wa mbiri yakale wa kapamba ndi mawonekedwe a parapancreatic adachitika pamalo opepuka (mawonekedwe a parafini ndi Mayer hematoxylin ndi picrofuchsin malinga ndi Van Gieson).

ZOYENELA NDI KUSINTHA

Mwa odwala 19 (90,5%) omwe ali ndi pancreatitis yowopsa kwambiri, ngakhale kuti chithandizo chamankhwala chikuwonetsetsa kuti chikuchitika kwathunthu, zisonyezo zakuthandizira opaleshoni zidawonekera nthawi zosiyanasiyana zamankhwala, zomwe zimakhazikitsidwa: zosagwira ntchito mosamala, kuledzera ndikuwopseza anthu ambiri kulephera . Mu 13 odwala, laparoscopic opaleshoni (debridement, drainage of the wamental bursa and m'mimba, parapancreatic minofu) adagwiritsidwa ntchito ngati njira yoyambira kuchitira opaleshoni, yomwe mwa nthawi imodzi yokha laparotomy yotsatira sinachitike. Kusakhalapo pa nthawi ya laparoscopy ya zolembera za steatonecrosis kapena (ndi) hemorrhagic mayikidwe sikunasonyeze kusakhalapo kwa pancreatic necrosis ndi parapancreatitis.

Opaleshoniyo idachitika tsiku loyamba - odwala 7 (36.8%), kuyambira maola 24 mpaka 48. - atatu (15.8%), 5 (26.3%) - kuchokera 48 mpaka maola 72, ena onse (4

- 21.1%) patatha masiku atatu kapena kupitirira.

Opaleshoni yachikhalidwe imagwiritsidwa ntchito: laparotomy, kupweteka kwam'mimba kwa sub-

gastric gland, autopsy, debridement ndi drainage ya necrotic foci ya retoperitoneal minofu. Ngati choyambitsa cha pancreatitis pachimake chinali matenda a gallstone, ndiye kuti opaleshoniyo idathandizidwa ndi cholecystectomy ndikuwunikanso ndi kukhetsa kwa choledochus. Odwala adadutsa laparotomy yapamwamba yapakati, yomwe idapangitsa kuti athe kupeza chithunzi chonse cha mawonekedwe a zowononga kapamba, retroperitoneal fiber, mosiyana ndi mini-accesses (laparoscopic), yomwe imafunikira kulowererapo mobwerezabwereza.

Tidachotsa dala zonse kapamba ndi ziwalo za parapancreatic, ngakhale tidawopseza matenda ena, Panthawiyi, kunali kofunikira kuti athetse vuto la kuledzera.

Kukula kwakukulu (kupitirira 50%) kuwululidwa mwa odwala 12 (63.2%) omwe ali ndi laparotomy, komanso mu 7 (36.8%)

- pang'ono, zowonongeka zowononga zazing'ono zam'madzi. Tinagwiritsa ntchito gulu lotsogozedwa ndi M.I. Prutkov, malinga ndi momwe mafayilo onse a para-pancreatic amagawidwira magawo anayi: quadrant yapamwamba kumanzere [1), quadrant yapamwamba kumanzere ^ 1), quadrant yamanzere kumanja ^ 2) ndi lamanzere lamanzere qu2r ^ 2). Kugawidwa kwa njirayi m'matumbo a parapancreatic kunapezeka kumanzere (S1-S2 quadrants) mu 100% ya milandu, zomwe zimagwirizana ndi maphunziro apitawo. Kuphatikiza apo, m'magawo 6 (21.1%) adatchulidwa retropancreatocellulitis kufalikira kwa diaphragm ^ 1), mu 4 (15,9%) - chapakati retroperitoneocellulitis chofalikira kwa mesocolon, muzu wa mesentery wamatumbo ang'ono, mpaka yaying'ono pelvis, mu milandu 9 (52.6%) - S1-S2, D1-D2. Kwenikweni, izi zinali njira zodziwika zowonongeka kwa ma spiring a retoperitoneal cellular (kupatsanso trellitoneocellulitis, kulowetsedwa, phlegmon kapena abscesses ya retoperitoneal cellular space).

Kuwongolera kwa postoperative kwa odwala kunachitika muchipinda chopangira chisamaliro chogwiritsa ntchito kulowetsedwa, antibacterial, antienzyme, cytostatic therapy pogwiritsa ntchito njira zina zowonjezera.

Postmortem autopsy komanso kuwunika kwotsatira kwa mbiri yakale pamilandu yonseyo kunatsimikizira kupezeka kwa matenda a pancreatic necrosis ndi mitundu yotchuka ya necrotic parapancreatitis.

Kugonjetsedwa kwa parapancreatic fiber kudawonekera mu mawonekedwe a edema kapena hemorrhage, komanso mafuta necrosis. Serous kapena sero-hemorrhagic impregnation ya retroperitoneal minofu yokhala ndiwofatsa mankhwala a edematous kapamba pakubwera masiku atatha isanayambike amakumana ndi kusintha kosalekeza, koma nthawi zonse imapereka yachiwiri yotupa. Nthawi zina mas-

zotupa zazikulu zotumphukira m'mitsempha yotulutsa magazi ndikupanga kwa magazi a diapedezno okhetsedwa.

Timankhwala am'madzi a parapancreal anali okhudzidwa ndi njira ya pathological pafupifupi nthawi imodzi ndi chitukuko cha kusintha kowononga kwa kapamba, koma kugonjetsedwa kwake kuchipatala kumakhala kofunikira kwambiri pamene kachilombo kamanamira ndikangoyamba kumene.

Ndi chotupa chachikulu cha mchira wa pancreatic (kuposa 90%), zosintha zazikulu zimawonedwa mu minofu ya retoperitoneal kuzungulira ngodya yam'mimba, gawo lotsikira la colon ndikumanzere kwa paranephria. M'mitundu yapamwamba kwambiri yamatenda owononga pancreatitis (20 - 25%), minyewa ya retroperitoneal imakhudzidwa kuzungulira mbali zonse za kapamba, njira zowonongeka zimafalikira m'mphepete zonse, komanso chapakati, ndikugwira mizu ya mesentery yamatumbo ang'onoang'ono, nthawi zambiri imafikira minofu ya m'chiuno. Mafuta akulu kwambiri komanso osakanikirana a pancreatic necrosis nthawi zambiri amakhala limodzi ndi mapangidwe a malo akuluakulu a mafuta necrosis m'malo a lymphostasis, kuchuluka kwakukulu kwa iwo kumawonedwa muzu wa mesentery wamatumbo ang'onoang'ono, m'malo akulu komanso ang'ono. M'madera amenewa, nthawi zambiri, zilonda zam'mimba zimapangika m'magawo oyamba a matenda. Kugonjetsedwa kwa omentum yayikulu kumawonedwa nthawi zambiri mwa odwala onenepa kwambiri omwe ali ndi mitundu yayikulu ya pancreatic necrosis. Kuyambira masiku atatu mpaka chitukuko, matendawa ambiri a mafuta necrosis, omwe amaphatikizidwa nthawi zonse, amadziwika mu omentum yayikulu. Kuyambira tsiku lachitatu, polymorphic cell kulowetsedwa kwa omentum yapezeka.

Kuwunikaku kunapeza kuti chiwerengero cha anthu omwe anamwalira pambuyo pa masiku atatu chinali 54,5% (odwala 11 anamwalira), mkati mwa masiku 5 - 9.1% (1 anamwalira), otsalira a 36.3% (odwala 7) - panthawi zosiyanasiyana. Pambuyo pa opaleshoni ya endoscopic (odwala 8), kufa kwa masiku atatu ogwira ntchito kunali 50% (odwala 4 anamwalira), mkati mwa masiku 5 - 25% (2 anamwalira), ena onse - 25% (2) - panthawi zosiyanasiyana. Izi zimawonetsa kuchepa kwa ntchito ya endoscopic ntchito wamba parapancreatitis.

Ziyenera kupangidwa kuti matekinoloji ochepera ocheperako omwe amakhala ndi zochulukirapo

(zotupa zazikulu, zopitilira 50%) za kapamba wokhala ndi chotupa chachikulu cha parapancreatic fiber nthawi zambiri sizigwira ntchito monga njira yomaliza yopangira opaleshoni ndipo ingakhale gawo loyamba la njira yovuta yochizira. Ndizotheka kuti ma opaleshoni othandizira, omwe amaphatikizapo kudzipatula koyambirira kwa kapamba kuchokera ku parapancreatic fiber, drainage wide, kutseguka kwa maziko a kudzikundikira, komanso kupatsa mankhwala opatsirana mwanjira zambiri kungapangitse njira yabwino kwambiri ya parapancreatitis.

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9. Tolstoy A.D. Pancreatitis pachimake: zovuta, mwayi, chiyembekezo. - SPb., 1997 .-- 139 p.

Epidemiology ndi etiology

Maziko a chipatala ndi morphological gulu la pachimake kapamba ndi mawonekedwe a matendawa, zosakanikirana ndi zokhudza zonse zochitika, poganizira kuchuluka kwa zotupa za kapamba ndi magawo osiyanasiyana a minyewa yotupa, gawo lomwe limatulutsa njira yotupa-necrotic kuchokera kubacterial to virus.

I. edematous (interstitial) kapamba.

II. Oyipa pancreatic necrosis.

- malinga ndi kufalikira kwa chotupa: chochepa komanso chofala.

- ndi chikhalidwe cha zotupa: mafuta, hemorrhagic, osakanizidwa.

III. Wosokonekera pancreatic necrosis.

Gawo lisanafike matenda:

1. Parapancreatic infiltrate (omenobursitis, volumetric fluid formations ya retroperitoneal kutanthauzira).

2. Necrotic (aseptic) phlegmon ya retroperitoneal fiber (parapancraeal, paraclinical, perinephral, pelvic, etc.)

3. Peritonitis: enzymatic (abacterial).

4. Pseudocyst (wosabala).

5. Kutulutsa magazi owononga (kulowa mkati ndi m'mimba)

Gawo la matenda:

1. Septic cellulitis ya retroperitoneal fiber: parapancreal, paraclinical, perinephral, pelvic.

2. Pancreatogenic abscess (ma spoperoperone cell cell kapena m'mimba patsekeke)

3. Peritonitis fibrinous-purulent (wamba, wamba).

4. Pseudocyst kachilombo.

5. Mkati ndi kunja kanyumba, chifuwa ndi m'mimba fistulas.

6. Kuchepa kwa magazi (kutulutsa ziwalo ndi m'mimba)

1. Kugwedezeka kwa kapamba ndi wosabala pancreatic necrosis ndi zovuta zake zam'mimba.

2. Kugwedezeka (koopsa) kwa kachilombo ka pancreatic necrosis ndi zovuta zake zamkati pamimba.

3. Kuchulukana kachulukidwe ka ziwalo zingapo komanso kosavuta komanso kachilombo ka pancreatic necrosis ndi zovuta zawo.

Epidemiology ndi etiology edit |

Kodi parapancreatitis ndi pancreatogenic abscess ndi chiyani?

Mpaka pano, akukhulupirira kuti pancreatitis yosatha imakhala ndi zovuta zingapo, koma funso la zovuta ndi chiyani ndi zotsatira zake sizinathebe.

Nthawi zina, odwala omwe ali ndi pancreatitis yosatha yokhala ndi jaundice yovuta chifukwa cha kuponderezedwa kwa dipatimenti yovomerezeka ya choledochus kapena choledocholithiasis, zizindikiro zamankhwala monga kuchuluka kwa cholestasis ndi kutentha thupi, leukocytosis, kuledzera, ndi encephalopathy zimadziwika. Monga lamulo, chithunzi chachipatala choterocho chimakhala chifukwa cha kukula kwa cholangitis. Pankhaniyi, pali zisonyezo zakuchotsa kwa bile, komwe kumakwaniritsidwa bwino ndi cholangiostomy pogwiritsa ntchito chubu chopangidwa ndi T. Pokhapokha cholecystolithiasis, cholecystostomy ikhoza kuchitidwa.

Omentitis, ligamentitis, epiploit

Maziko a zovuta zonsezi ndi michere yama michere - omentum, ligaments ya peritoneum ndi mafuta pendants ya kolon, yomwe imabweretsa kufooka kwachiwiri.
Pali mitundu itatu yamatumbo a pancreatogenic omentitis, omwe amatha kukhala magawo a kukula kwa zovuta: enzymatic, infiltrative and purulent-necrotic. Morphologically, enzymatic omentitis amadziwika ndi kutupa kwa omentum, zotupa m'mimba yake ndi steatonecrosis. Makulidwe amakulu kwambiri komanso omentum, omwe amakhala ochulukirapo kwambiri: amakhala ndi nthawi yayitali ndipo amaphatikizana. Encapsulation wa steatonecrosis kumabweretsa kukula kwa polycystic omentitis mtsogolo ndi kuthekera kwa emental cysts. Pofika sabata la 2-3 la chitukuko cha kapamba, pindikirani kuwinduka kwa chamadzimadzi ndi mafinya amadzimadzi kapena mapangidwe amadzimadzi okhala ndi zotsekemera mu makulidwe ake. Purcin necrotic amentitis imatha kusokonezeka ndi kufalikira kwa purulent peritonitis kapena, moyandikana ndi khoma lamkati lamkati, kuwonjezereka kwa bala la opaleshoni ndikugundika ndi chilonda cha purulent.
Mwa michere yam'mimba, kupweteka kwachiwiri kwa pancreatic nthawi zambiri kumawononga chiwindi chonse cha chiwindi. Ligamentitis ndi epiploitis mwakuthupi ndizosiyana kwambiri ndi amentitis, ndipo ndizovomerezeka pokhapokha ndi laparoscopy kapena panthawi yolowerera pamimba.

Zilonda zazikuluzikulu za omentum yayikulu zimagwira monga chisonyezo cha momwe zimapezekera, makamaka odwala onenepa kwambiri. Ngati ndizosatheka kulowererapo ndikuchotsa omentum yokhala ndi ma abscesses kapena ma cystic cavities okhala ndi mafinya, zikuwonekeranso ngati zotumphukira zoterezi.

Pancreatogenic abscesses

Pancreatogenic abscesses imatha kupanikizana pachimake ndipo imatha kutulutsidwa mu kapamba palokha, m'matumbo a parapancreatic, m'malo a paranephric ndi Mediastinal oyandikana ndi kapamba (kapamba).
Zolemba za kapamba, i.e., zilonda zakuthengo pakulimba kwa gawo la parenchyma, ndizosowa kwambiri komanso zimayamba chifukwa cha matenda apakati komanso kuphatikizika kwa gawo lozama la pancreatic necrosis. Amapangidwa osapitilira masabata awiri itatha matendawa atayambika ndipo amatengedwa, monga lamulo, pamutu wa kapamba. Intrapancreatic abscesses nthawi zambiri amaphatikizidwa ndi parapancreatitis kapena omentobursitis.
Pachithunzi cha chipatala cha chifuwa cha pancreatic, limodzi ndi zizindikilo zambiri zomwe zimadziwika ndi njira iliyonse yoyeretsa yopweteka kwambiri (kufooka kwa wodwala, kutentha thupi, kuzizira, hyperleukocytosis, ndi zina zotere), pali zizindikiro zosaphatikizika ngati kupangika kwa volumetric pazinthu zapafupi. Ndikuphimba kwa mutu wa pancreatic, zizindikiritso za duodenum ndi choledoch nthawi zambiri zimapezeka ndikuphwanya kutuluka kwa zomwe zilimo.
Njira zotsogola zodziwitsira ma pancreatic abscesses ndi ultrasound ndi CT. Ngati chitupa chikapezeka, chimakhomoleredwa ndi makina a ultrasound kapena CT, ndikutsatiridwa ndi kukhazikitsidwa kwa ngalande zowirikiza kawiri ndikukhazikitsanso patment. Pankhani ya kuperewera kwa zinthu izi, zimawonekera chifukwa cha laparotomy, kutsegulidwa kwa opaleshoni ndikuchotsa gawo loyang'ana ndi purosesa yotsatira. Tiyenera kukumbukira kuti ngakhale ndi opareshoni yopambana, momwe mankhwalawo amathandizidwira pokonzekera wodwalayo panthawi yopuma, kuphatikiza othandizira, mankhwala opha maantiotic, immunocorrection, kuphatikizapo extracorporeal (ultraviolet irradiation yamagazi, ndi zina).
Zovuta zina kuzindikiritsa ndi kuchiza zilonda za kapamba ndimavuto osakanikirana a puroma ndipo makamaka, kuphatikiza ndi purulent parapancreatitis kapena omentobursitis. Muzochitika izi, kulowererako nthawi zambiri kumangokhala kutsegulira ndi kukhetsa kwa puritive foci mozungulira kapamba, ndipo chimbudzi cha intraorgan chikuwoneka ndipo chimatha kukhala maziko pazovuta zina, mpaka pakukweza kwa pancreatogenic sepsis Nthawi zina, limodzi ndi kutukusira kwakuya kwa kapamba m'matumbo ndi ma transoperitoneal minofu, michere ya polydiaphragmatic imatuluka - mbali yamanzere komanso yam'munsi. Zotsatira za kuphulika kwa zotupa za purcin-necrotic zomwe zimapezeka m'mphepete mwa m'mapapo mwa m'mimba kudzera mu mesocolon zimatha kukhala chomera cham'mimba, kupezeka kwake komwe nthawi zina kumatha kukhazikitsidwa pokhapokha ngati kukonzanso kwam'mimba.
Osachepera, koma mavuto azovuta za pancreatic abscesses amatha kukhala portal vein thrombosis ndi pylephlebitis, kusungika kwa inshuwaransi mu duodenum, m'mimba kapena bile duct, magazi a arrozionny ochokera ku ziwiya zoyandikana zomwe zimadyetsa mutu wa pancreatic, purulent pleurisy. Chifukwa chake, kusungidwa kwa zizindikiritso zamatenda oyipa pambuyo pa opaleshoni yoyeretsa pamalo ano akuwonetsa kukhalapo kwa chotupa cham'mimba, kupanga laparotomy ndikuwunikanso bwino kapamba, kapena kufufuza njira yoyeretsa m'chiwindi kapena ndulu.

Odwala ndi biliary aakulu pancreatitis ndi kukhalapo kwachidziwitso choledocholithiasis, kukula kwa cholangiogenic chiwindi abscesses n`kotheka. Amachitika ndi kuzizira, kutentha kwambiri, jaundice, hyperleukocytosis yokhala ndi ma hematological zizindikiro za kuledzera kwamankhwala ochepa. Mwathupi, ndizotheka kudziwa kuwonjezeka kwa chiwindi, chizindikiro chokhwima cha Ortner, kuyimirira kwakukulu kwa mzere wa phokoso kumanja ndi kulepheretsa kuyenda kwa m'munsi m'mphepete lamanja. Kuunika kwa X-ray pachifuwa kumavumbula maimidwe ooneka ngati ma disk makamaka m'munsi mwa mapapu olondola kapena kumanzere kwamanja. Malinga ndi ultrasound ndi CT, kutanthauzira ndi kukula kwa chiwindi cha pakhungu kuwululidwa, ndi ERCP - chifukwa cha cholangitis (mwala wa choledoch, stenosis wa BDS, ndi zina).
Chithandizo cha cholangitis abscesses a chiwindi chimaphatikizanso kuyambitsidwa kwa Mlingo wambiri wa maantibayotiki mu intraportal perfusion kudzera mu catheterized celiac thunthu kapena aorta pamwamba pake. Chizindikiro cha opaleshoni ndiyoti pakhale ma abscesses akuluakulu a chiwindi, omwe amatha kutsitsidwira mozungulira pansi pa ultrasound kapena CT kapena kapena ndi laparoscopy (kutengera malo omwe amatulutsidwayo), kutsatiridwa ndi kukhazikitsa ngalande zowirikiza kawiri.
Zilonda za ndulu zimakonda kukhala ndi ndulu. Kwambiri zodziwika ndi ululu pamimba syndrome, makamaka kutukusidwa kumanzere hypochondrium. Nthawi zina zimakhala zotheka kupukuta ndulu yokula ndi yopweteka. Kuunika kwa X-ray pachifuwa kumavumbula kuyimilira kwakumusoro kwa chifanizo cha chithunzi chocheperako komanso kuletsa kuyenda kwake, mbali yakumanzere yolumikizana. Kuzindikira kumatsimikiziridwa ndi ultrasound ndi CT ndipo pamapeto pake imakhazikitsidwa pambuyo podziwitsa kupindika kwa nduluyo kudzera m'malo amtundu woyang'aniridwa ndi ultrasound. Kugawanitsa ndi kutaya kwa chimbudzi kumachitika nthawi zambiri kudzera pabedi la nthiti yowerengedwa pamwamba pa malo ake pambuyo poti wapangiratu khomalo ndikulandila molimba mtima zomwe zalembedwazo.

Parapancreatitis

Parapancreatitis ndi pafupipafupi kuphatikizika kwa kapamba, wodziwika ndi zotupa za retroperitoneal periopancreatic minofu. Matenda onse a pancreatogenic parapancreatitis, kutengera kulumikizana ndi kuopsa kwa kapamba kapena chifuwa chachikulu cha kapamba, amagawidwa pachimake komanso matenda osachiritsika. Pachimake Parapancreatitis amagawidwa serous-hemorrhagic, necrotic ndi purulent-necrotic, ndipo aakulu - pa sclerotic kapena polycystic.
Pachimake parapancreatitis. Poyambirira pambuyo povulaza pancreatitis, kuwonongeka kwa parapancreatic fiber kumawonekera mu mawonekedwe a edema, hemorrhage kapena mafuta necrosis.Serous ndi sero-hemorrhagic impregnation ya retroperitoneal minofu yokhala ndiwofatsa mankhwala a edematous pancreatitis pakubwera masiku ake, monga lamulo, amakumana ndi kusintha ndipo samapereka yachiwiri yotupa. Pafupipafupi ndimatumbo akulu m'matumbo obwezeretsanso ndikupanga timagulu ting'onoting'ono m'malo a diapedezno okhetsedwa magazi. Poterepa, magazi omwe alowa mu CHIKWANGWANI amathandizira kuti chiwonetsero chazinthu zoyipa chitulutse mkati mwa kapamba.

Zomwe zimayambitsa kuphatikizika kwa necrotic parapancreatitis, kuphatikiza hemorrhagic imbibition ya retoperitoneal fiber, ndimphamvu yamafuta necrosis. Pansi pa aseptic, chotupa chophatikizika chamtunduwu chimadutsa pang'onopang'ono (kwa miyezi itatu kapena kupitirira) kusinthika pang'ono ndi kusintha kwacicatricial mu fiber kuzungulira kapamba, kapena kutha ndi kukula kwa parapancreatic cyst.
Mikhalidwe ya purulent-putrefactive matenda, purulent-necrotic parapancreatitis imayamba pamalo obwera, mawonekedwe omwe ndi kusungunuka kwa necrotic foci ya retoperitoneal minofu, kutulutsa komwe kungakhale kosiyana.
Sikovuta kuzindikira pachimake cha parapancreatitis pachimake, ngati mukukumbukira kuti zotupa za serous ndi hemorrhagic zotupa za retroperitoneal zimakhala mu odwala onse omwe ali ndi OH yayikulu. Kusintha kwa kutukusira mu infiltrative-necrotic kapena purulent-necrotic parapancreatitis ku mesentery yaying'ono ndi colon mwa odwala kumawonetsedwa ndi matumbo paresis. Mchitidwewo ukafalikira kwa minyewa yamkati yam'mimba, kufupika kwa tinthu tating'onoting'ono ta dera lumbar kumadziwika. Kuchuluka kwa kuwonongeka kwa minofu ya necrotic kumadziwika ndi kutupa kowawa ndipo kumadziwika ndi CT. Chofunika parapancreatitis ndi kutulutsa kwakukulu kwa kulowa mkati mwa pancreatic mutu kumayendera limodzi ndi zizindikiro za kupindika kwa duodenum kapena choledochus.
Chithandizo cha serous hemorrhagic ndi hemorrhagic parapancreatitis ambiri okhazikika, kuphatikizapo kukonza pancreatitis mankhwala, kumatheka detoxization mankhwala ndi kukhazikitsa antibacterial mankhwala a prophylactic. Njira zophatikizika za parapancreatitis zitha kuthandizidwa mosamala ndi ma Mlingo wambiri wa maantibayotiki molingana ndi mfundo zochizira matenda osakanikirana ndi maziko a heparinization makamaka mukamagwiritsa ntchito intra-aortic kapena arterial perfusion ndi endolymphatic ya antibacterial.
Ndi hemorrhagic parapancreatitis woyambira wachikatikati wa necrotic CHIKWANGWANI, komanso ndi purulent necrotic parapancreatitis, opaleshoni ikuwonetsedwa.
Matenda a parapancreatitis. Matenda a parapancreatitis atha kuonedwa kuti ndi chimodzi mwazotsatira za zovuta zoyambirira za m'matumbo a OH (omentitis kapena pachimake parapancreatitis), yomwe sinasinthe. Matenda a parapancreatitis amakhala ndi chithunzi chodziwika bwino, nthawi zina amatsata mobwerezabwereza matenda a kapamba. Kupezeka kwa matenda a parapancreatitis aakulu kumathandizidwa ndi kupezeka kwa fistulas akununkhira kwa odwala. Sclerosing parapancreatitis imatha kupangitsa kuphatikizika kwamitsempha yamagazi yoyandikana ndikuthandizira kukulitsa kwamimba ischemic syndrome ndi matenda oopsa a portal.

Conservative chithandizo cha matenda a parapancreatitis osakhazikika, komabe, ntchito zomwe zimapangidwa mwa odwala zimachitika pokhapokha ngati pakabuka zovuta: kupsinjika kwa matenda oyamba ndi ma venous mu zikondamoyo, zizindikiro za matenda oopsa a portal komanso zizindikiro zazikulu zam'mimba zamankhwala zosachepetsa zamankhwala.

Mitundu yamavuto

Mavuto oyamba a kapamba kapamba amasonyezedwa ndi:

Kugwedezeka komwe kumachitika chifukwa cha kuthira kwa poizoni ndi zinthu zonyansa za gland. Vutoli limaphatikizidwa ndi kupweteka kwambiri.
Enzymatic peritonitis, chifukwa chomwe kuchuluka kwa michere yotulutsidwa ndi gland, kumakhudza kwambiri peritoneum.
Pancreatic necrosis, kapena kutupa kwa kapamba, wodziwika ndi kufa kwakukulu.

Kodi kuledzera komwe kumachitika chifukwa cha pachimake kapamba kumakhudza bwanji thupi?

Chifukwa cha kuledzera ndi kapamba, matenda omwe amachitika chifukwa cha impso ndi kwa chiwindi. Poyerekeza ndi matenda omwe amapita patsogolo pa matenda amtundu, zilonda zam'mimba zimayamba. Pancreatitis pachimake imakwiyitsa mapapo. Ziphuphu za poizoni zimayamba chifukwa cha zovuta zoyipa za poizoni. Poizoni amayambitsa kusokoneza kwamanjenje mu mawonekedwe a kukhumudwa ndi psychosis.

Pambuyo kukhazikika kwa wachibale kwambiri ndi chifuwa chachikulu, mavuto amachedwa. Zimachitika pafupipafupi sabata yachitatu atadwala matendawa. Muzochitika zapamwamba, zovuta izi zimatha mu sepsis. Odwala omwe ali ndi matenda ofananawo ayenera kulandira chithandizo kuchipatala.

Matenda okhudzana ndi kutupa

Purulent pancreatitis, zomwe zimapangitsa kukulitsa kwa ndulu.
Parapancreatitis, kutupa kwa periopancreatic fiber.
Phlegmon ndi complication mu mawonekedwe a kutupa okolozhiruyu CHIKWANGWANI.
Kutupa kwa m'mimba, limodzi ndi zotupa za m'mimba.
Mapangidwe a Fistula.
Sepsis, wodziwika ndi kufa kwambiri.

Ma pathologies ofotokozedwa pankhani ya chithandizo chosagwira ntchito, osagwirizana ndi malingaliro a akatswiri nthawi zambiri amatsogolera ku kufa kwa maselo, njira zotupa zomwe zimathera muimfa.

Pylephlebitis

Vutoli ndi kutukusira kwa mtsempha wa portal wotengera magazi kuchokera ziwalo zosatupa. Matendawa amaphatikizidwa ndi nyengo zopweteka kumbali yamanja yam'mimba. Zizindikiro za matenda am'mimba ndi juzi, thukuta kwambiri, kutentha thupi.

Matendawa amakula mwachangu, nthawi yomwe ilipo yochizira ndiyochepa. Kuzindikira kolakwika, thandizo losayembekezereka kwa gawo lalikulu limabweretsa kuimfa.

Kodi maulosi a pancreatitis acute amakulosera chiyani?

Panthawi yamavuto apakhungu pancreatitis, kulosera zakhumudwitsa ndikotheka. Ambiri nthawi zambiri amafa. Zomwe sizingatheke ndizotupa zamkati zomwe zimayenda mu sepsis.

Chifukwa chachikulu chomwe chimakhudza njira yamatendawa ndi mowa. Odwala omwe sanakane chiwopsezo chake amadwala kapena kufa.

Wodwala pancreatic necrosis ndi zotsatira zake

The akuwonetsa mawonekedwe a zovuta amapezeka gawo limodzi mwa odwala.

Njira ya matendawa: amadziwika ndi zotupa zomwe zimakhudzana ndi kusokonezeka kwa magazi kupita ku gland. Zotsatira zake, kufa kwa minofu kumachitika, necrosis imayamba. Maselo akufa amapatsira thupi. Matenda akalowa m'magazi, ntchito ya ziwalo zina imasokonekera. Vuto lofananalo limachitika patatha milungu itatu kuchokera pamene zizindikiro zoyambirira za kapamba zimawonekera. Ndi chithandizo chosapambana, wodwalayo amamwalira.
Monga matenda ena, mtundu uwu wa zovuta umathandizidwa ndi maantibayotiki. Pofuna kuletsa matendawa, poyamba pamafunika kuchotsa gawo lakufa. Kuchotsa gawo lakufa kumachitika m'njira zingapo. Mtundu wosavuta kwambiri wochotsa ndi catheter. Ndi mitundu yovuta ya matendawa, opaleshoni ya laparoscopic imalembedwa. Opaleshoni ikuwoneka ngati iyi - gawo kumbuyo kwake limapangidwa pang'ono, pambuyo pake chubu chocheperako chimayikidwa. Zotsalira za minofu yakufa zimachotsedwa kudzera mu chubu. Njira ya laparoscopy sikugwiritsidwa ntchito nthawi zonse. Kwa anthu onenepa kwambiri, kumachitika pamimba. Matenda a kapamba amadziwika kuti ndi vuto lalikulu. Ngakhale ndi chithandizo chachipatala choyambirira, wodwala aliyense wachisanu amatchulidwa amwalira chifukwa cholephera kugwira ntchito kwa ziwalo zoyandikana.
Syndrome ya systemic kutupa poyankha (CERD) imawonetsedwanso. Uku ndikudziwonetsa kofala komwe kumachitika ndi chifuwa chachikulu cha pancreatitis, ndikutsogolera kusokonekera kwa thupi.

Kodi pseudo cyst ndi chiyani?

Izi ndizovuta zina zomwe zimagwirizanitsidwa ndi kusagwira bwino kwa pancreatitis ya pachimake.

Mitunduyi imakhala ndi "ma sacs" opangidwa pamakoma a kapamba. Mkati mwa zophukazo mumakhala madzi. Matenda ofananawo amapanga mwezi umodzi atazindikira kuti ali ndi matendawa. Ndikosatheka kudziwa ma pseudocysts popanda zida. Zizindikiro zina zimawonetsa kukhalapo kwa matenda. Kuwonetsedwa mu mawonekedwe a:

kutsekula m'mimba,
kupweteka m'mimba
matenda am'mimba thirakiti.

Ngati wodwala samva kusasangalala komwe kumakhalapo chifukwa cha kupezeka kwake, sikofunikira kuti muwachotse. Ngati kukula kwa cyst kukwera mpaka masentimita asanu ndi limodzi, magazi amatuluka. Makulidwe akulu amathandizidwa ndikutulutsa madzimadzi kuchokera kumkati.

Kodi mungapewe bwanji zovuta zomwe zimapezeka ndi pancreatitis pachimake?

Choyambitsa chachikulu ndi mowa, kugwiritsa ntchito komwe kumabweretsa zotsatirapo zomvetsa chisoni. Kutsatira zomwe amalangizidwa ndi akatswiri komanso kusintha kwa moyo wawo zithandizira kuchepetsa zinthu zoyipa. Kukhazikitsidwa kwa mowa kuchokera muzakudya kumachepetsa chiopsezo cha matenda ena, osatengera kowopsa, mwachitsanzo, khansa.

Miyala ya chikhodzodzo

Pofuna kupewa matenda a ndulu, muyenera kudya bwino. Pazakudya za wodwala yemwe ali ndi vuto lotere, mafuta ochepa ayenera kukhalapo.

Zofunikira kwambiri muzakudya zimaperekedwa kwa masamba, mbewu ndi zipatso. Zigawo zikuluzikulu za chakudyacho ndi oatmeal, phala kuchokera ku mpunga wa bulauni kapena oatmeal. Zakudya zofananazo zimapangidwa kuti muchepetse kuchuluka kwa cholesterol pakuphatikizidwa kwa bile.

Anthu onenepa nthawi zambiri amavutika ndi miyala mu chikhodzodzo, kuchuluka kwa mafuta m'thupi. Kuti mupewe izi, muyenera kukhala onenepa mokwanira, kutsatira zakudya komanso kuchita masewera olimbitsa thupi. Mitundu yotchuka yochita masewera olimbitsa thupi ndi aerobics, cycling kapena cycling. Ngati mukukayikira pa kusankha masewera olimbitsa thupi, pezani thandizo kuchipatala.

Kwa mtundu uliwonse wamavuto, kupweteka ndi kuledzera kuyenera kuthetsedwa. Zizindikiro zomwe zafotokozedwazo zimathandizidwa ndi maanti-virus. Kukhazikitsidwa kwa malingaliro omveka a madotolo, ngakhale sikutanthauza kuchiritsa kwathunthu, koma kumalonjeza thanzi labwino komanso moyo wathanzi.

Omentnt, ligamentitis, epiploit

Maziko a mavuto onsewa ndi kulephera kwa enzymatic kwamapangidwe omwe amakhala ndi minofu yamafuta (omentum, ligaments ya peritoneum ndi mafuta pendants yama koloni), zomwe zimabweretsa kutsekeka kwachiwiri.

Pali mitundu itatu ya kapamba wa pancreatogenic omentitis, yomwe imatha kukhala magawo amodzi: enzymatic, infiltrative and purulent-necrotic. Morphologically, enzymatic omentitis amadziwika ndi edema ya satana wamkulu, hemorrhage mu minofu yake ndi steatonecrosis. Makulidwe amakulu kwambiri komanso omentum, omwe amakhala ochulukirapo kwambiri: amakhala ndi nthawi yayitali ndipo amaphatikizana.

Encapsulation wa steatonecrosis kumabweretsa kukula kwa polycystic omentitis mtsogolo ndi kuthekera kwa emental cysts. Kwa masabata awiri a 2 chitukuko cha kutupa kwa kapamba, kupukusa kuyamwa kwa mankhwalawa ndi mafinya amadzimadzi ndikotheka kapena mapangidwe a zimbudzi ndi sequesters ake makulidwe. Purulent-necrotic omentitis imatha kusokonezeka ndi kufalikira kwa purulent peritonitis, kapena kuwonjezeredwa kwa bala la opaleshoni ndikuwonetsa mwadzidzidzi (popeza omentum yayikulu ili pafupi ndi khoma lakumbuyo yam'mimba).

Zinthu zaukali za pancreatic nthawi zambiri zimawononga chiwindi chonse cha chiwindi. Ligamentitis ndi epiploitis mwakuthupi ndizosiyana kwambiri ndi amentitis, ndipo ndizovomerezeka pokhapokha ndi laparoscopy kapena panthawi yolowerera pamimba.

Zilonda zazikuluzikulu za omentum - chizindikiritso cha mayendedwe ake, makamaka odwala onenepa. Ngati ndizosatheka kuchotsa omentum omwe ali ndi ma abscesses kapena cystic cavities, kutsegulidwa kwa mapangidwe awa, sequestrectomy ndi drainage akuwonetsedwa.

Pachimake Parapancreatitis

M'magawo oyambilira pambuyo povulaza pancreatitis, kuwonongeka kwa parapancreatic fiber kumawonekera mu mawonekedwe a edema, hemorrhage kapena mafuta necrosis. Sikovuta kuzindikira pachimake cha parapancreatitis pachimake, ngati tikumbukira kuti zotupa za serous ndi hemorrhagic zotupa za retroperitoneal kettica zimayamba mu odwala onse omwe ali ndi OP yayikulu. Kusintha kwa kutukusira mu infiltrative-necrotic kapena purulent-necrotic parapancreatitis ku mesentery yaying'ono ndi colon mwa odwala kumawonetsedwa ndi matumbo paresis.

Mchitidwewo ukafalikira kwa minyewa yamkati yam'mimba, edema ya minofu yolumikizira gawo lumbar imadziwika. Zowonongeka za necrotic zowonongeka kwa CHIKWANGWANI kwakukulu zimadziwika ndi kutupa kwakupweteka ndipo zimadziwika ndi CT. Chofunika parapancreatitis ndi kutulutsa kwakukulu kwa kulowa mkati mwa pancreatic mutu kumayendera limodzi ndi zizindikiro za kupindika kwa duodenum kapena choledochus.

Mankhwalawa serous-hemorrhagic ndi hemorrhagic parapancreatitis ndiwofatsa, umaphatikizapo chithandizo cha kapamba, mankhwala othandizira opatsirana pathupi komanso kukhazikitsa mankhwala a antibacterial chifukwa cha prophylactic.

Kulowetsa mitundu ya parapancreatitis imatha kuthandizidwa mosamala ndi ma Mlingo waukulu wa mankhwala molingana ndi mfundo zodziwika bwino zothandizira kupatsirana ndi heparinization, makamaka kudzera mwa intra-aortic kapena dera ochepa. Woopsa hemorrhagic parapancreatitis wayamba purifus kusakanikirana wa necrotic CHIKWANGWANI, komanso mu purulent necrotic parapancreatitis, opaleshoni ikuwonetsedwa.

Matenda a parapancreatitis

Matenda a parapancreatitis amadziwika kuti ndi chimodzi mwazotsatira za zovuta zomwe zimachitika kale ku matenda a OP (omentitis kapena pachimake parapancreatitis), omwe sanasinthe. Matenda a parapancreatitis amakhala ndi chithunzi chosadziwika bwino, nthawi zina amatsata kuukira kwa CP. Matenda a parapancreatitis osavuta kudziwa ngati odwala ali ndi fistulas yakunja.

Sclerosing parapancreatitis imatha kuponderezetsa mitsempha yoyandikana ndi magazi ndipo imathandizira kukulitsa kwamimba ischemic syndrome komanso matenda oopsa a portal. Conservative chithandizo cha matenda a parapancreatitis osakhazikika, komabe, ntchito zomwe zimakonzedwa mwa odwala zimachitika pokhapokha ngati pakabuka zovuta: kupsinjika kwa matenda osakanikirana ndi ma venous mu zikondamoyo, zizindikiro za matenda oopsa a portal komanso zizindikiro zazikulu zam'mimba zamankhwala amiseche zosagwirizana ndi chithandizo chamankhwala.