Pancreatic necrosis (pancreatic necrosis)

Pancreatic necrosis (pancreatic necrosis) ndi matenda owopsa a kapamba omwe amavuta kwambiri chifukwa cha pachimake kapena chovuta kapamba. Khodi ya pancreatic necrosis malinga ndi ICD-10 ndi K86.8.1. Chizindikiro cha matenda oopsa ndi kupindika kwapang'onopang'ono kwa minofu yapakhosi. Ichi ndi matenda owopsa omwe amabweretsa chiopsezo pamoyo wamunthu.

Imfa ya chiwalo ichi imachitika chifukwa chakuti minofu ya kapamba imasungunuka micherezomwe amapanga yekha. Monga lamulo, njirayi imaphatikizidwa ndi zochitika zina za pathological - njira zotupa, matenda, zina.

Matendawa ndiye vuto lalikulu kwambiri la kapamba. Monga lamulo, zimakhudza anthu achinyamata azaka zogwira ntchito. Malinga ndi ziwerengero zamankhwala, matendawa ndi pafupifupi 1% ya milandu yonse yam'mimba yam'mimba. Komabe, kuchuluka kwa matendawa kwachulukanso posachedwapa. Kufa kwakukulu pamilandu ya pancreatic necrosis kumakhala kowopsa - ndi 30-80%. Chifukwa chake, ndikofunikira kwambiri kuzindikira matendawa munthawi yake ndikuyamba chithandizo chokwanira nthawi yomweyo.

Maziko a pathogenesis a pancreatic necrosis ndi kulephera mumapangidwe achitetezo chamkati kuchokera ku chisonkhezero cha ma pancreatic michere omwe amachiwononga. Ngati munthu amamwa kwambiri komanso mopitirira muyeso, kutulutsa kwina kumathandizika kwambiri, milomo ya ndulu imatambasuka, ndipo kutuluka kwa timadzi ta pancreatic kumadzaza.

Pancreatic necrosis imayamba kumbuyo kapamba - kutupa komwe kumachitika chifukwa cha kapamba, pomwe zimachitika kuti kufa kwa gawo kapena ziwalo zonse.

Chikhansa ndi gawo lofunikira pakugwira bwino ntchito kwa thupi. Ntchito zake zikuluzikulu ndikupanga ma enzymes akuluakulu omwe akukhudzidwa ndi chimbudzi, komanso kuwongolera shuga wamagazi chifukwa chopanga mahomoni insulinndi glucagon. Chifukwa chake, kusakhala bwino kwa chiwalochi kumabweretsa kuphwanya kwakukulu kwamunthu.

Munthu akakhala ndi njala, timadziti ndi ma enzyme amatengedwa kudzera mumalowedwe olowetsa matumbo ochepa, omwe amathandizira kukonza kwa enzymatic. Pancreatic madzimadzi amachita acidic chilengedwe cha chapamimba madzi, kosasokoneza. M'matumbo, michere ya m'mimba imaphwanya ndikupanga zinthu.

Zikondazo zimatulutsa michere yayikulu yokumba:

lipase - amawononga mafuta,
amylase - amapanga shuga.
chymotrypsin, trypsin- kutenga nawo mbali pakuwonongeka kwa mapuloteni,
glucagon, insulin, polypeptidendi ena

Ngati mwa anthu athanzi michere yomwe kapamba amatulutsa imagwira mwachindunji m'mimba, ndiye kuti mwa odwala omwe awonongeka ndi zonyansa m'mimbayo, ma enzymes amakhudza mwachindunji kapamba. Poyerekeza ndi kuwonjezeka kwa kupanikizika mkati mwa ma ducts, edema ya parenchyma imayamba, pancreatic acini imawonongeka, ndipo ma enzymes a proteinolytic adayambitsidwa msanga. Zotsatira zake, nduluyo 'imadzipeza.' Chifukwa cha kutsegula kwa lipase, necrosis yama cell am'mimba imachitika, mitsempha yamagazi imawonongeka mothandizidwa ndi elastase, ndipo ma enzymes ophatikizidwa, komanso zinthu zowola, amalowa m'magazi. Poterepa, poizoni m'thupi lonse amadziwika. Choyamba, pamakhala kuwonongeka kwa chiwindi, impso, mtima, ubongo.

Ndi pancreatic necrosis, magawo atatu a minofu ya kufa atsimikiza:

Zoopsa- awonekere m'magazi poizoniwokhala ndi chiyambi cha bakiteriya, chitsulo chimatulutsa ma enzyme mwachangu.
Kukula kwa Abscess - amakonza njira yochotsa zotupa m'matumbo ndi ziwalo zomwe zimazungulira kapamba.
Kusintha kwa minyewa ya purulent- ngati purse sepsis ikakula, kuyenera kuchitidwa opaleshoni mwachangu ndikofunikira, popeza mkhalidwewu ndiwopseza moyo.

Gulu

Kutengera kuchuluka kwa njira zowonongeka, mitundu itatu yamatendawa idatsimikiza:

Mafuta- ndi kuchuluka kwa ntchito ya lipase, minofu ya pancreatic adipose imawonongeka. Lipase itakhala kunja kwa kapukusi ya kapamba, imagwira, ikulimbikitsa kupezeka kwa necrosis m'masamba a peritoneum, omentum lalikulu ndi ochepa, mesentery, ziwalo zamkati. Monga lamulo, ndi mawonekedwe a mafuta, mankhwala olemera pambuyo pake amakula. asepticperitonitis, kulephera kwa ziwalo zingapo.
Hemorrhagic- ndi kuchuluka kwa ntchito ya elastase, vuto lama microcirculatory limayamba, chifukwa cha kupanikizika kwa zotulutsa zam'mimba zimayamba. Kwa kanthawi kochepa - masiku angapo, ndipo nthawi zina - toxemia amakhumudwitsa khoma lamitsempha, vasodilation, ndi magazi amatuluka m'mitsempha ya minofu yake. Izi zimapangitsa kuti chiwopsezo cha magazi chiwonjezeke, ndipo pambuyo pake - ischemic necrosis. Poyamba, khoma lamitsempha limawonongeka lokwanira kuposa kapamba, ndipo pambuyo pake - ziwalo zina. Zotsatira za njirazi zonse ndikutuluka kwa mitsempha ya m'mimba ndi ziwalo zamkati. Chizindikiro chachikulu chomwe chimadziwika ndi hemorrhagic pancreatic necrosis ndi kuphatikiza pamimba ndi kukhalapo kwa magazi. Matendawa amakula msanga, chifukwa chomaliza cha madotolo mumatha kuwona kuti: "Choyambitsa imfa - hemorrhagic pancreatic necrosis».
Zosakanizidwa- Pafupifupi zochitika zofanana za elastase ndi lipase, zizindikiro za mafuta necrosis ndi hemorrhagic imbibition zimanenedwanso chimodzimodzi.

Mitundu iwiri imatsimikiziridwa kutengera kuchuluka kwa mawonetseredwe a pathological:

kwanuko(gawo limodzi lakhudzidwa)
sokoneza(madera awiri kapena kupitirirapo akhudzidwa).

Kutengera ndi kuchuluka kwa momwe amapitira patsogolo:

pang'onopang'ono,
waulesi.

Kutengera ndi kuya kwa chotupa:

zapamwamba,
zakuya,
chonse.

Kutengera ndi matendawa:

zinthawi zonse,
pang'onopang'ono,
zachisoni,
mphezi mwachangu,
kuchotsa.

Kutengera kuwonongeka kwa matendawa, madigiri angapo amatsimikiza:

Ofatsa - monga lamulo, ndi edematous kapena kuphatikiza necrosis yopanda kukulitsa.
Giredi yapakatikati- kusokoneza kapena wamba kwanthawi yotchulika.
Madigiri akulu - sokoneza kapena wathunthu ndi waukulu.
Gawo lovuta kwambiri - necosis ya pancreatic imayendera limodzi ndi zovuta zomwe zimabweretsa zotsatira zosasinthika ndi imfa.

Zambiri zomwe zimapangitsa ncrotic njira mu pancreatic zimakhala zimatsimikiza:

kumwa kwambiri mowa,
kudya mopitirira muyeso, kuvuta, kusuta, zakudya zamafuta,
zilonda zam'mimba,
ma gallstones
kupezeka kwa kuvulala kwam'mimba komanso njira zothandizira za opaleshoni zam'mbuyomu.
matenda opatsirana opatsirana.

Mothandizidwa ndi zinthu izi, kukanika kwa pancreatic kumatha kupezeka, komwe kumayambitsa kapamba wa kapamba ndi kapamba. Koma, monga lamulo, pancreatic necrosis imawonetsedwa motsutsana ndi maziko azakumwa za episodic. Kafukufuku watsimikizira kuti nthawi zambiri, pancreatic necrosis imachitika pambuyo poti idya mowa kwambiri.

Zizindikiro za pancreatic necrosis

Zizindikiro za matendawa zimatha kuonekera patadutsa maola angapo kapena masiku angapo kuchokera pamene zinthu zomwe zimapangitsa matendawa zidadziwika.

Chizindikiro chachikulu ndi kupweteka, kuwonetsedwa mu hypochondrium yamanzere. Komanso, kupweteka kumatha kuperekedwa kumbali, kumbuyo, kumverera m'mimba. Ululu umakhalapo nthawi zonse, mwamphamvu kwambiri kapena mosapumira. Ikhoza kukhala lamba, kupereka kwa phewa, phewa, kuti munthu angaganize kuti akuvutika ndi mtima. Ululu umalimba pambuyo poti wadwala. Izi zimatha kuyambitsa nseru komanso kusanza mobwerezabwereza. Pancreatic necrosis siyotheka popanda kupweteka.

Chizindikiro chotsatira cha pancreatic necrosis mwina:

Kucha kwa khungu, chifukwa cha kuwonongeka kwa kapamba, zinthu zomwe zimapangitsa kuti mitsempha ya magazi ilowe m'magazi,
chisangalalo - chifukwa chovunda komanso kupsa m'matumbo,
mabala kapena kapezi pamimba, matako pambali - otchedwa chizindikiro chakumutu,
kutulutsa magazi m'mimba - chotsatira cha kuwonongeka kwa ma enzyme pazitseko zamitsempha yamagazi,
kutentha kuwonjezeka
kusokonezeka kwa khoma lakunja kwamkati, kupweteka palpation,
youma mucous nembanemba, khungu, ludzu - zotsatira za kuchepa kwamadzi,
kutsitsa kuthamanga kwa magazi,
chisokonezo, delirium.

Matendawa, monga lamulo, amayamba kwambiri, ndipo nthawi zambiri odwala ake amati ndi zizindikilo zake zoyambirira za kumwa kwambiri komanso kuphwanya kwambiri zakudya. Madokotala akuwonetsa kuti ambiri mwa odwalawa amalowetsedwa m'zipatala pomwe adamwa, zomwe zimatsimikizira kukula kwachidziwikire cha kusintha kwa matenda m'thupi. Pali kulumikizana mwachindunji pakati pa kupweteka kwapweteka ndi kuopsa kwa necrosis. Ngati kusintha kowononga kukufika kumapeto kwa mitsempha, izi zimabweretsa kuchepa kwapang'onopang'ono mu kupweteka kwapweteka. Koma chizindikiro ichi kuphatikiza kuledzera ndichowopsa pamalingaliro am'tsogolo.

Pambuyo pakupweteka kuwonekera, patapita kanthawi wodwalayo ayamba kuda nkhawa za kusanza. Zimakhala zovuta kusinza, ndipo sizibweretsa mpumulo. M'masanzi mumakhala magazi, bile. Chifukwa cha kusanza kosalekeza, madzi am'madzi amayamba, omwe amachititsa kuti khungu liume komanso khungu lolimba. Diuresis ikupita patsogolo. Flatulence, kuchepa kwa chopondapo ndi gasi kumadziwika. Zizindikiro zimayendera limodzi malungo.

Chifukwa cha kusinthasintha kwa glucose, toxemia ndi hyperenzymemia, ubongo umakhudzidwa ndikukula encephalopathy. Ngati kutupa kumapita patsogolo, kapamba amakula kwambiri kukula kwake. Amalowa m'mitundu yam'mimba. Mkhalidwe uwu ndiwopseza wodwala.

Kuyesa ndi kufufuza matenda

Ngati mukukayikira kuti chitukuko cha necrosis chikuyenera, muyenera kufunsa katswiri wamba. Katswiriyo amamuunika, amawunika momwe matendawa amakulira. Amachita palpation ndikuwona kukhalapo, chilengedwe ndi malo owonetsera kuwawa. Ngati mukukayikira matenda a wodwala, endocrinologist amayesa. Ngati zotupa zikupezeka m'matumbo, oncologist imaphatikizidwanso pakuthandizira.

Kuti mupeze matenda, muyenera kuwunika ndi kuwunika ma labotale.

Kafukufuku wa Laborator akuphatikiza kuyezetsanso kwa magazi, popeza ndi necrosis, zosintha zotsatirazi zazomwe zimadziwika:

Kuchulukitsa shuga, grit yowonjezereka maselo oyeraneutrophils.
Kuchulukitsa ESR.
Zokwera milingo ya elastase, trypsin, hematocrit chifukwa cha kusowa kwamadzi.
Kuchulukitsa michere ya chiwindi chifukwa cha njira yotupa.
Kukula kwa necrosis kumasonyezedwanso ndi kuchuluka kwa amylase mkodzo.
Pakukonzekera kafukufuku wa labotale, mkhalidwe wamahomoni ndi michere yokugaya atsimikiza.

Komanso, pofufuza matenda, maphunziro oterewa akhoza kulembedwa:

Kuyesa kwa Ultrasound - pofuna kudziwa mawonekedwe osagwirizana a minyewa ya ndulu, kudziwa ma cysts, zilonda zamadzimadzi, madzi am'mimba, miyala yomwe ili munthaka. Ultrasound imathandizanso kupenda mawonekedwe a ma ducts.
Magnetic resonance imaging, yowerengera tomography - amakulolani kuti muwonetsetse komwe kumayambira matendawa, kukula kwa chiwalo, komanso kudziwa ngati kutupa kumayamba, ngati pali kutupa, zilonda, neoplasms, kufooka.
Glandular angiography.
Diagnostic laparoscopy.
Kuchotsera.

Katswiriyu adzatha kudziwikitsa komaliza atalandira deta ya maphunziro onse.

Ngati necrosis ikukayikira, wodwalayo ayenera kuchipatala mwachangu. Inde, kudalirika kwa m'tsogolo kumadalira mosakhalitsa kwa chithandizo. Kuchiza kumachitika kokha kuchipatala. Chiwembu chake zimatengera kuchuluka kwa gawo lomwe lakhudzidwa. Ngati ndi gawo loyambirira, ndiye kuti opaleshoni nthawi zambiri imapetsedwa. Kupatula apo, kulowererapo kotereku sikuli kotetezeka, chifukwa ndizovuta kudziwa kuti ndi chiwalo chiti chomwe chidawonongeka.

M'masiku oyambirira a chithandizo, kusala kudya kumachitika, kenako ndikutsatira kwambiri zakudya.

Zapolskikh Sergey Viktorovich

Mankhwala osamala a matendawa amakhudzana ndi kuperekedwa kwa mankhwala angapo a magulu osiyanasiyana. Pogwiritsa ntchito mankhwalawa, okodzetsa amagwiritsidwa ntchito, blockade yakwanuko amachitidwa. Ngati wodwala akuvutika kwambiri ndi ululu, amapatsidwa antispasmodics. Ma antibacterial amathandizidwanso.

Ngati ndi kotheka, wodwalayo amapatsidwa insulin, proteinase inhibitors. Ngati ma gallstones sanapezeka, wodwalayo amapatsidwa mankhwala a choleretic. Mankhwala amchere a alkaline ndi kuzizira kwa pancreatic kumachitidwanso. Ndi matenda anthawi yake, ndipo, moyenera, chithandizo chokwanira, ndizotheka kuchotsa zizindikilo za necrosis patatha milungu ingapo.

Ndi pancreatic necrosis, mankhwala otsatirawa amagwiritsidwa ntchito:

Mankhwala opaka - cholinga cha kudya kwawo sichithandizo, koma kupumula kwa ululu waukulu. Pachifukwa ichi Ketanov, Ketanol, Analgin, Mebeverin, Acetamifen, Baralgin, Indomethacin, Papaverine, Movalis, Voltaren. Ngati ndi kotheka, opamadid analgesic Tramadol imagwiritsidwanso ntchito. Chifukwa cha mankhwala oletsa kupweteka, msanganizo wa glucose-novocaine ukhoza kuperekedwa, perirenal novocaine blockade, blockural blockade imachitidwanso.
Kuti mukwaniritse kwambiri mankhwalawa pancreatic necrosis mu gawo la toxemia, antifermental mankhwala amachitidwa. Cholinga chake ndikuletsa kuphatikiza kwa michere ndi ma enzymes omwe akuzungulira m'magazi. Panthawi imeneyi, chakudya sichokwanira. Mankhwala othandiza ndi somatostatin analogues (Octreotide, Sandostatin).
Ndikotheka kutsekereza katulutsidwe ka m'mimba mothandizidwa ndi H2-histamine blockers. Pachifukwa ichi Famotidine, Ranitidine. Proton pump blockers ndi othandiza: Omeprazole, Rabeprazole.
Pofuna kukhazikitsa ma enzymes oyendayenda, kukonzekera kwothandizira kumathandizira kumathandizira. Pachifukwa ichi, mankhwala ozikidwa pa aprotinin amagwiritsidwa ntchito - Ingitrile, Proudox, Trasilol.
Ma Enzymes omwe amayenda mozungulira m'magazi amathandizidwa ndi othandizira okakamiza, ndipo m'malo ovuta, mothandizidwa ndi hemosorption, plasmosorption, plasmapheresis, peritoneal dialysis.
Komanso, othandizira omwe amawongolera kuthekera kwa kugaya chakudya amagwiritsidwanso ntchito. Pachifukwa ichi, dopamine receptor antagonists adalembedwa: Domperidone, Metoclopramide, Drotaverinum.
Wodwala akayamba kusanza kosatha, akhoza kupatsidwa mankhwala okhala ndi antipsychotic ChlorpromazineMlingo wocheperako.
Mukakhala pancreatic necrosis, ndikofunikira kwambiri kuti muchepetse mawonetseredwe a purulent zovuta pogwiritsa ntchito mankhwala a antibacterial. Ndikofunikira kutsatira izi maantibayotikizomwe zimakhudza gram-negative ndi gram-aerobic ndi anaerobic zolengedwa. Kutengera ndi komwe dokotala amupatsa, mankhwalawa a pancreatic necrosis, aminopenicillins, aminoglycosides, cephalosporins, tazobactam + clavulanate, III m'badwo wa cephalosporins amagwiritsidwa ntchito, ciprofloxacin, ofloxacin, pefloxacinetc. Ma antibacterial amathandizira wodwalayo, koma ndikofunikira kusamalira kubwezeretsa microflora yamatumbo, mutatenga ma probiotic.

Njira ndi magwiridwe antchito

Ngati palibe zotsatira pambuyo pa chithandizo chamankhwala, ndibwino kuti muchite opareshoni. Pa nthawi ya opareshoni, gawo lakumalilo limatulutsidwa. Komabe, njirayi imawonedwa mopitirira muyeso, chifukwa opaleshoni iyi ndiyowopsa ndipo ndizovuta kulekerera.

Monga lamulo, pa siteji ya purulent mavuto, zosokoneza zina zomwe zimachitika, zomwe zimachitika ndikuwongolera kwa CT ndi ultrasound. Njira imeneyi imalola kupuma-kukhetsa kwa mankhwala a zilonda zam'mimba, kutsekeka kwa endoscopic, ndi zina zambiri.

Kuchiza ndi wowerengeka azitsamba

Wodwala akachulukirachulukira pancreatic necrosis, amayamba kumva kupweteka kwambiri. Zithandizo za anthu zomwe zimagwiritsidwa ntchito limodzi ndi chithandizo chachikulu zingathandize pang'ono kukonza mkhalidwe. Koma, musanachite izi, ndikofunikira kukaonana ndi dokotala, kukhazikitsa matenda, ndikuyamba kuchita machitidwe olondola.

Zipatso za Sophora Japanese - amapanga decoction. Supuni ya zopangira ayenera kutsanulira 1 tbsp. madzi otentha ndi kunena 5 maola. Imwani ofunda musanadye chilichonse. Njira yovomerezeka ndi masiku 10.
Blueberries ndi masamba - msuzi wakonzedwa kwa iwo, kuthira zouma kapena zatsopano zopangira ndi madzi otentha ndi kuwira kwa mphindi 5. (2 tbsp. L. Raw zida pa 250 ml ya madzi). Imwani m'malo mwa tiyi.
Udzu wa Immortelle - Chizindikiro chimathandiza kuthetsa ululu ndi kutupa. Kukonzekera msuzi kutenga 1 tbsp. l zitsamba zowuma ndi kapu yamadzi, wiritsani kwa mphindi 5. Sakani ndi kumwa chifukwa cha msuzi masana.
Msuzi wa oat- Imathandizira kuchepetsa kukwiya komanso kubwezeretsa maselo a ziwalo. Kuti mukonzekere bwino, muyenera kuthilira mbewuzo ndikudikirira masiku angapo mpaka kuti zimere. Mbewu zokhala ndi tirigu zimafunika kuti ziume ndi nthaka. Thirani osakaniza ndi madzi ozizira (1 tbsp. L oats pa 1 galasi lamadzi) ndikuumirira kwa theka la ola. Tsiku lomwe muyenera kumwa magalasi awiri a chida chotere.
Ndimu- amathandiza kuchepetsa ululu. Kuti muchite izi, wiritsani mandimu kwa mphindi 5, kenako pofinyani msuziwo ndikusakaniza ndi yolk. Kumwa mankhwalawa pamimba yopanda kanthu ndipo pambuyo pake osadya kwa maola atatu. Imwani kangapo patsiku, kamodzi masiku atatu aliwonse. Njira ya mankhwala kumatenga miyezi ingapo.
Muzu wa licorice - pakukonzekera kwake muyenera kutenga 1 tbsp. l Muzu wophwanyika wa licorice wowuma, masamba ofanana a dandelion ndi masamba a burdock. Thirani osakaniza ndi magalasi awiri a madzi otentha, imwani kulowetsedwa kwa theka kapu 3-4 patsiku.

Palinso mankhwala apadera azitsamba omwe amagwiritsidwa ntchito pochotsa ziphuphu. Koma ndikofunikira kulingalira kuti zimapindulitsa thupi ngati mumalandira ndalama zambiri pafupipafupi komanso malinga ndi chiwembu chovomerezedwa ndi adokotala. N`zosatheka kuyeseza nokha mankhwala omwe ali ndi wowerengeka azitsamba lotere lodziwika bwino ngati pancreatic necrosis mulimonse.

Kupewa

Popewa pancreatic necrosis, muyenera kutsatira malangizo osavuta:

Chepetsa kuchuluka ndi kuchuluka kwa zakumwa zoledzera.
Pewani zakudya zopanda pake - chakudya chofulumira, chakudya chosavuta, koloko, muchepetsani kudya kwamafuta ndi zakudya yokazinga.
Osamamwa mankhwala popanda mankhwala a dokotala, makamaka kuti musawagwiritse ntchito molakwika.
Yesani kupanga zakudya zochokera kuzinthu zachilengedwe, yesani kudya zakudya zamagulu pang'ono.
Muyenera kuchiza matenda a ndulu.
Pazizindikiro zoyambirira zomwe zikuwonetsa zovuta ndi kapamba, pitani kuchipatala msanga.
Onani mfundo za moyo wathanzi.

Mankhwala

M'magawo oyamba a matendawa, mankhwala angagwiritsidwe ntchito kuchepetsa ululu. Dokotala amasankha mankhwala mwanjira yochepetsera kupweteka m'mapapo ndipo ngati zingatheke, amachotsa zomwe zimayambitsa matendawa.

Chizindikiro chachikulu cha pancreatic necrosis ndikusanza kwambiri. Zotsatira zake, kuchepa kwamphamvu kwamthupi ndi kuphwanya kwamchere wamchere kumachitika. Kuti mubwezeretse, wodwalayo amapaka jekeseni wa potaziyamu wambiri ndi njira ya kulowetsedwa.

Matenda a kapamba amaphatikizidwa ndi kuledzera kwambiri kwa thupi komanso kusokoneza magazi m'thupi lathu. Kuti muthane ndi zizindikiro izi, mankhwala otsatirawa amatha kuperekedwa kwa wodwala:

Kukhazikika kwa ma albumin kapena magazi a m'magazi omwe atapanga mazira.
Kupititsa patsogolo kukwera kwa magazi, dextran ndi pentoxifylline ndi mankhwala.
Kuchepetsa kuchuluka kwa kusintha kwa thupi, wodwalayo amalimbikitsidwa kumwa zamadzi zambiri ndi kutenga ma diuretics, mwachitsanzo, furosemide.

Ndi pancreatic necrosis, kapamba payokha amawononga maselo ake, mwakutero ntchito yake imasokonekera ndipo imakhudza njira zonse mthupi momwe zimachitikira. Pankhaniyi, wodwalayo amapatsidwa mankhwala omwe amachepetsa kugwira ntchito kwa kapamba. Cholinga cha mankhwalawa ndikuyesa kuchepetsa njira yodziwonongera yokha.

Pachifukwa ichi, zinthu zapadera zimayambitsidwa m'thupi la wodwalayo zomwe zimachepetsa kupanga pancreatic enzyme. Komabe, posachedwapa, madokotala asiya njira iyi yochizira matendawa, popeza sizinathandize.

M'mankhwala amakono, njira zotsatirazi zimagwiritsidwa ntchito pochulukitsa thupi la wodwalayo, monga plasmapheresis kapena ultrafiltration. Komabe, ndikofunikira kugwiritsa ntchito njirazi kuti muchotse poizoni m'thupi mosamala kwambiri.

Akatswiri ena adanenanso kuti njira zomwe zimagwiritsidwa ntchito sizibweretsa zotsatira zomwe zikuyembekezeredwa ndipo sizikhudza kubwezeretsanso kwa odwala.

Pancreatic necrosis ndi matenda omwe amakula msanga mokwanira. Zimatha kutenga kachilombo ka bakiteriya, komwe kanthawi kochepa komwe kungayambitse kudwala. Chifukwa chake, adotolo ayenera kufotokozera maantibayotiki nthawi yomweyo kuti aletse kufalikira kwa matenda.

Chithandizo cha opaleshoni ya pancreatic necrosis

Nthawi zambiri, popanda kuchitidwa opaleshoni, mwayi wochira wodwala wokhala ndi pancreatic necrosis amakhala kuti ulibe. Opaleshoniyo imayikidwa popanda vuto pamene matenda alowa mthupi.

Ngati opareshoniyo singachitike munthawi yake, wodwalayo amatha kufa.

Ngati matendawa sanalowe m'thupi la munthu, ndiye kuti kuthekera kwa opaleshoni kumawunikiridwa malinga ndi njira zina zingapo. Ndi matenda osabala a matendawa, opaleshoni imalembedwa motere:

mankhwalawa sanathandize ndipo matendawa akupitilizabe,
pali mwayi wotupa ndi kachilombo ka kapamba,
pancreatic necrosis imafikira kwa ziwalo zapafupi zam'mimba.

Ngati madokotala akutsimikiza kuti palibe matenda opatsirana, ndiye kuti wodwalayo amapatsidwa njira ina yothandizira, mwachitsanzo, opaleshoni yovulala yochepa. Amachitidwa popanda kutsegula m'mimba, komwe kumawonjezera mwayi wodwalayo ndikuchepetsa chiopsezo chotaya magazi ndi matenda am'mimbamo pakuchita opaleshoni.

Opaleshoni yocheperako

Kwenikweni, njira iyi yopangira opaleshoni imagwiritsidwa ntchito ngati zikondamoyo zimangoyambika ndi matendawa, ndipo pancreatic necrosis sinayambike. Potsogola matendawa, madzi am'madzi ndi maselo akufa amadzisonkhanitsa. Ntchito ya dokotala wa opaleshoniyo pakuchita maopaleshoni ocheperako ndikuchotsa madzimadzi ndi maselo.

Maselo a pancreatic amatumizidwa pambuyo pake pamayeso angapo othandizira omwe amathandizira kudziwa zomwe zimayambitsa matendawa komanso njira yake yachitukuko.

Kafukufuku wa bacteria amathandizira kudziwa kupezeka kwa tizilombo mu kapamba.
Kuunika kwa mbiri yakale ndikufuna kuzindikira maselo osowa m'thupi, monga ma cell a khansa.
Kupenda kwamomwe kumachitika zamadzimadzi.

Ubwino wa mtundu wamtunduwu ndikuti umachitidwa ndikuwunikira mosalekeza kwa ultrasound. Izi zimathandiza kudziwa ndi kulondola kwambiri pancreatic necrosis, monga gawo loyang'ana matendawa komanso kudziwa njira yobweretsera singano m'thupi pokoka madzimadzi, pomwe simumenya ziwalo zina ndi mitsempha yamagazi.

Cholinga chachikulu cha ntchitoyi ndikuchotsa chidwi cha pancreatic necrosis ndipo potero mupewe opaleshoni yotseguka.

Komanso, maopaleshoni ocheperako amakupatsirani mwayi wowopsa wa matendawa, kupezeka kwa matenda ndi kuchuluka kwa zotupa. Kutengera ndi zomwe zapezedwa ndikufufuza, chisankho chimapangidwa pakuchita opaleshoni yotseguka.

Zosiyanasiyana zochitika zowononga - - kupuma ndi kukhetsa

Mukapopera madzimadzi kuchokera ku foci ya necrosis, dokotala amayika singano yapadera mu kapamba. Ngati madziwo ataphwa ndipo singano yachotsedwa, ndiye kuti ntchito yotereyi imatchedwa punction.

Ntchito yamtunduwu imagwiritsidwa ntchito pokhapokha ngati wodwala ali ndi pancreatic necrosis ya mawonekedwe osabala ndipo palibe matenda. Komanso, singano itachotsedwa pamkono, madzimadzi sadziunjikira.

Kupanda kutero, zida zapadera zimayikidwa mu kapamba - ngalande, momwe zimamenyera madzi ndi zowola. Zitha kukhazikitsidwa zingapo. Kudzera pamadzi, njira zapadera zimayambitsidwa ndi kapamba kuti azitsuka mkati mwake ndikuchotsa exudate.

Nthawi zina njira zochiritsira zomwe zimagwiritsidwa ntchito sizimabweretsa zotsatira zomwe zimafunikira ndipo kufalikira kwamatenda kumatheka. Zikatero, opaleshoni yachindunji ndiyofunikira. Mulimonsemo, vuto monga pancreatic necrosis prognosis silingakhale lokwanira 100%.

Tsegulani pancreatic opaleshoni

Pakadali pano, njira zingapo zoyendetsera kapamba zimagwiritsidwa ntchito. Komabe, cholinga chawo chachikulu chimatsala kuti aletse matendawa ndipo ngati kuli kotheka achotse chomwe chimayambitsa.

Pa opaleshoni, madokotala samayesetsa kuchotsa kapamba konse, koma nthawi zambiri amakhala ndi necrosis. Poletsa kukula kwa matendawa komanso kutupa kwa ziwalo zina pogwira ntchito, chikhodzodzo kapena ndulu zimatha kuchotsedwa.

Kuchiza nthawi zonse kumadalira kuchuluka kwa kuwonongeka kwa ziwalo; munthawi ya opaleshoni, ngalowa zitha kukhazikitsidwa kudzera pomwe madzi ndi madzi ochuluka. Wodwala wokhala ndi madzi okhazikika ayenera kukhala moyang'aniridwa ndi madokotala nthawi zonse. Kuchita mobwerezabwereza kumatha kudwalitsa wodwalayo matenda ndikuwadzetsa zovuta.

Moyo pambuyo opaleshoni

Malinga ndi ziwerengero zamankhwala, pafupifupi 50% ya odwala amapulumuka atachitidwa opaleshoni ya pancreatic, matendawo sakhala otonthoza kwambiri, koma ziwonetserozo sizinama ndipo kufa kuchokera ku chancreatic necrosis kumachitika kawirikawiri. Popewa kugwiranso ntchito, wodwalayo ayenera kuyang'aniridwa ndi achipatala mosalekeza.

Odwala omwe adachitapo opaleshoni yovuta chotere ayenera kupitiliza chithandizo, komanso kupewa kupewa kuyambiranso matendawa kwa moyo wawo wonse. Mankhwala ena amatengera kuuma kwa matendawa komanso momwe thupilo limagwirira ntchito.

Pambuyo pa opaleshoni, wodwala wotero amayenera kupita pafupipafupi kwa dokotala wake, kupita kukayezetsa koyenera ndikukumaliza pamimba. Komanso, chakudya chimayenera kukhala chofunikira kwa wodwalayo, chifukwa chake kudalirika kumakhala koyenera nthawi zonse.

Chifukwa chakuti akatha opareshoni, kapamba amapitiliza kupanga mahomoni, komabe, kupanga ma enzymes okhudzana ndi kugaya chakudya kumachepetsedwa kwambiri, zotsatirazi ndizotheka:

kudzimbidwa,
mapangidwe a cyst
kuphwanya lipid kagayidwe,
matenda ashuga
kapamba wa kapamba.

Pambuyo pa opareshoni, wodwalayo amaletsedwa kudya zakudya zamafuta, mowa ndi zakudya zokhala ndi shuga. Mosakayikira, mankhwala atayamba, wodwalayo ayenera kusiya kusuta. Pofuna kupweteka m'matumbo, wodwala amatha kupatsidwa mankhwala osokoneza bongo komanso antispasmodic.

Pancreatic necrosis ndi mitundu yake

Pancreatic necrosis ndimatenda a kapamba, momwe maselo ake amafa chifukwa chotukuka kwa chotupa mu chiwalo. Zotsatira zake, chitsulo chimagwa njira zowonongeka (zowonongeka) ndikulephera kwamagulu angapo. Pancreatic necrosis sindiye kuti imakhala yovuta ya kapamba, koma gawo lake, ndipo imadziwika ndi njira yayikulu komanso kupita patsogolo mwachangu.

Matendawa amatchulidwa potsatira magawo otsatirawa:

Kutengera kuchuluka kwa zowonongeka:
- ochepa necrosis (yaying'ono, yapakati komanso yayikulu),
- kufalikira kwazonse (subtotal - pafupifupi ma gland onse amakhudzidwa, ndipo kwathunthu - gland imawonongeka pang'onopang'ono).
Kodi pali matenda a kapamba kapena ayi:
- kachilombo
- wosabala.
Kutengera ndi matendawa:
- kuchotsa
- pang'onopang'ono.

Nawonso wosabala pancreatic necrosis agawidwa m'magulu atatu azachipatala ndi a anatomical:

mafuta (amakula pang'onopang'ono, pakadutsa masiku 4 - 5 ndipo ali ndi chidziwitso chabwino),
hemorrhagic pancreatic necrosis (imayenda mwachangu, limodzi ndi magazi amkati),
zosakanikirana za pancreatic necrosis (zofala kwambiri kuposa mitundu ina).

Kukula kwa matendawa kumayambitsa zinthu zitatu:

Reflux

Zotsatira zake, bile limaponyedwa kuchokera m'matumbo a 12 mu kapamba, komwe limayambitsa proenzymes ndikuyambitsa enzymatic reaction. Pankhaniyi, ndi pancreatic necrosis, zomwe zimayambitsa ndi zovuta pambuyo pamimba, ziwopsezo zam'mimba, kupweteka kwam'mimba, vasculitis / thrombophlebitis yamatumbo a pancreatic, kusokonezeka kwa sphincter ya Oddi yomwe ili m'matumbo a 12, zonyansa zam'mimba.

Gulu la chiwopsezo cha pancreatic necrosis

Matendawa amatha kuchitika mwa munthu aliyense, koma pali gulu lowopsa lomwe limakulitsa mwayi wa pancreatic necrotization:

zidakwa zopitirira,
anthu omwe ali ndi cholelithiasis
odwala hepatic matenda ndi matenda a kapamba,
matenda am'mimba thirakiti
osokoneza bongo
odwala ndi obadwa nako malformations.

Limagwirira a chitukuko cha matenda

Maziko a chitukuko cha nthendayi ndi kusokonezeka kwa mphamvu yoteteza ku gland. Kukula kwa pancreatic necrosis kumachitika mu magawo atatu:

Pancreatic necrosis ya kapamba

Zotsatira zamachitidwe a etiological factor, kutulutsa kwakunja kwa kapamba kumapangitsika kwambiri, ma ducts ake amathambalala, ndipo kutuluka kwa timadzi ta pancreatic kumadzaza. Kuchulukana kwachulukidwe kumayambitsa kutupa kwa ziwalo parenchyma, kuwonongedwa kwa malo ochepa a chisa (acini) komanso kuchuluka kwa michere ya proteinolytic, yomwe imayambitsa kuwonongeka kwakukulu (necrosis) ya gland. Ndiye kuti, chiwalocho chimayamba kudzizimbitsa. Ngati lipase imayatsidwa, maselo amafuta ndi necrotic, ndipo pakakhazikitsidwa kwa elastase, khoma lamitsempha limawonongedwa. Ma poizoni (zida zakuphwanya minofu) ndi ma enzymes ophatikizidwa amalowa m'magazi chifukwa cha kuwonongeka kwa makoma amitsempha yamagazi ndipo amathandizira ziwalo zonse. Chiwindi ndi impso, mtima ndi ubongo ndizoyambira kukhudzidwa (kufooka kwa ziwalo zingapo).

Kukula kwa mtundu wina wamatenda ndi mawonekedwe a matendawa kumatengera kuchuluka kwa ntchito ya lipase ndi elastase. Ngati ntchito ya lipase ichulukira pamlingo wokulirapo, minofu ya adipose imawonongeka, ndiye kuti madera a omentum okulirapo komanso ocheperako, a peritoneum, mesentery ndi ziwalo zamkati ndi necrotic. Matendawa amatchedwa mafuta.

Ngati vuto la microcirculatory lakhazikika, kuphipha kwamatumbo a ziwalo kumachitika, komwe kumayambitsa edema yake yofulumira. Kwa maola angapo, toxemia imayambitsa ma presis a makoma amitsempha yamagazi, kukula kwawo ndi kuchepa kwa magazi m'mitsempha yake. Njira izi zimakulitsa thrombosis, kenako zimatsogolera pakukula kwa ischemic necrosis. Kulimbitsa machitidwe a elastase kumathandizira kuwonongeka kwa makoma amitsempha yamagazi m'makulidwe a England, ndipo pambuyo pake ziwalo zina. Zotsatira zake, chitsulo chimalembedwa m'magazi, zotupa zimatulutsa ziwalo zamkati ndikukutulutsa kwa fiber, ndipo kukomoka ndi magazi kumawonekera m'mimba. Matendawa amatchedwa hemorrhagic necrosis ya England.

Ndi mulingo wofanana wa zochitika, lipases ndi elastases zimawonetsa mawonekedwe osakanikirana a necrosis.

Ma fomu a abscess mu kapamba ndi ziwalo zamkati.

Kusintha kwa purulent kumayamba mu kapamba ndi matupi obwezeretsa.

Zizindikiro za pancreatic necrosis

Pancreatic necrosis ya kapamba ali ndi chithunzi chodziwikiratu chachipatala kotero kuti ndizovuta kusokoneza chizindikiro cha matendawa ndi matenda ena aliwonse.

Chizindikiro chachikulu cha pancreatic necrosis ndi ululu. Kumva kupweteka kumachitika mu theka lamanzere lam'mimba, kukugwedezeka mpaka phewa, kumbuyo, poyambira kapena pachifuwa. Nthawi zambiri wodwala sangathe kufotokozera momwe ululu wamalondawo ndikuwutcha ululu wa herpes zoster. Kukula kwa kupweteka kwamawu kungakhale kosiyana ndipo zimatengera kuopsa kwa necrosis ya gland. Popitilira njira yowonongeka mu chiwalocho ikupita patsogolo, ululuwo umachepera, womwe umalumikizidwa ndi kufa kwa mitsempha yotsalira m'matumbo. Kupuma pang'ono ndi zovuta za kuledzera ndi chizindikiro "cholakwika" chakukula.

Kumva kupweteka kumafooka m'malo mwa miyendo ndi miyendo ndikugwada m'matumbo, kotero wodwalayo amatenga gawo lomwe lakakamizidwa ndi matendawa.

Zizindikiro za kuledzera

Poizoni wa mabakiteriya (mabakiteriya enieni m'magazi sangakhalepo), ozungulira m'magazi, amachititsa kuledzera kwa thupi. Kutentha kumakwera (mpaka 38 ndi pamwambapa), kufooka kwathunthu kumalumikizana, kugunda kwa mtima ndikupuma kumafulumira, kupuma pang'ono kumawonekera, kuthamanga kwa magazi kumachepa. Mphamvu ya poizoni ku bongo imabweretsa encephalopathy. Chidziwitso cha wodwalayo chimasokonezeka, wodwalayo asokonezeka kapena kufooka, kusokonezeka. Povulala kwambiri, amatha kupuma.

Kukutira kapena kutsekemera kwa khungu

Mchigawo cha toxemia, kapamba amatulutsa zinthu zoyipa m'magazi (kuchepetsa mitsempha ya magazi), yomwe imawonetsedwa ndi khungu red. Pambuyo pake, pakukula kwa kuledzera, khungu limasandulika, limasanduka lamadzi, loyenda kapena loyenda ndipo limazizira mpaka kukhudza. Malo amtundu wa buluu-violet amawoneka mbali zam'mimba, kumbuyo, matako komanso m'malo a navel chifukwa cha hematomas wamkati komanso zotupa zokhala ndi zotupa. Kutuluka kwam'mimba kwa m'mimba sikumawonedwa pazochitika zonse za pancreatic necrosis.

Zizindikiro za peritoneal mkwiyo

Gawo la toxemia limatenga masiku 5 mpaka 9 ndipo limadziwika ndi kuwonjezeka kwa zizindikiro mosasamala za chithandizo chamankhwala. Gawo lotsatira ndikupanga zovuta za purulent ndi postnecrotic. Zikondazo chifukwa cha kutupa zimakulanso kukula kwake, ndipo kulowetsedwa kwa purulent kumayamba kupanga m'mimba. M'dera la kapamba, khungu limakhala lochepa kwambiri (hyperparesthesia). Kulephera kwamankhwala angapo kumayamba (hepatitis ya poizoni ndi nephritis, carditis ndi kupuma).

Mavuto

Mavuto a pancreatic necrosis ndi awa:

kugwedeza (kachilombo koyambitsa matenda kapena kowawa),
peritonitis
pamimba
m'mimba,
kuchuluka kwa kapamba, kapamba,
kuchepa kwa puloteni
chotupa cham'mbuyo,
zilonda zam'mimba ndi matumbo,
thrombosis ya portal, splenic, mesenteric mitsempha,
fistulas.

Zizindikiro

Kuzindikira kwa pancreatic pancreatic necrosis yokhazikika kumakhazikitsidwa pamaziko a anamnesis ndi mawonekedwe akudandaula, kuyang'ana wodwalayo ndikuwunikira kowonjezera.

kuyezetsa magazi kwapafupipafupi (leukocytosis, granularity of neutrophils, kuchuluka kwa ESR, kuchuluka kwa hematocrit chifukwa cha kusowa kwamadzi),
amylase, elastase, trypsin mu mkodzo ndi magazi (kuchuluka kwambiri),
shuga wamagazi (akukwera)
calcitonin m'magazi (mulingo wake umachulukana ndi kutupa kwambiri ndi matenda, makamaka ndi matenda a gland necrosis),
Kukula kwa mapuloteni othandizira (mawonekedwe a kutupa),
kukula kwa michere ya chiwindi (AST, ALT).

Ultrasound ya kapamba ndi biliary thirakiti (kukhalapo kwa calculi mu biliary thirakiti, kukulitsidwa kwa tiziwalo tating'onoting'ono, kupangika kwa mapangidwe ndi kusokonekera kwa matupi a thupi, kutulutsa kwamkati pamimba ndi kubwezeretsa malo, maziko a necrosis, cysts ndi abscesses ndi kutulutsa kwawo)
complication tomography (kukulitsa gland, kukulitsa kapamba wamkati, chinangwa cha necrosis, kutupa kwa utsi kuzungulira kapamba, kulowetsedwa kwam'mimba),
radiology yam'mimba,
maginidwe amatsenga,
kapangidwe ka madzimadzi kapangidwe kake kapamba kotsatira tank. kufesa zinthu, kuzindikira kwa tizilombo komanso kudziwa kwake maantibayotiki),
makonda amiseche ya gland,
bweretsani cholangiopancreatography (mkhalidwe wa kapamba),
diagnostic laparoscopy.

Mukazindikira pancreatic necrosis, chithandizo chiyenera kuyambika nthawi yomweyo. Wodwalayo amayikidwa m'chipatala mu dipatimenti yochita opaleshoni. Ku chipatala, chithandizo chovuta chikuchitika chimaponderezedwa kupondaponda njira za kapamba ndi chimbudzi chake, kuchotsa zizindikiritso za toxemia, kuletsa kukula kwa zovuta za purulent-septic. Njira zoyambira zamankhwala zimayambira mochulukirapo komanso mochuluka. Kuchiza kumachitika ndi njira zosasamala komanso za opareshoni.

Mankhwala othandizira

Conservative chithandizo chimaphatikizapo:

Kuonetsetsa kuti kupumula kwathunthu (kupuma pabedi) komanso kusala kudya

Wodwalayo amaletsedwa kuchita masewera olimbitsa thupi, kudya. Chakudya chimachitika motere, ndi michere masiku 5 mpaka 7. Kumwa kumaloledwa popanda choletsa, makamaka zamchere zamchere zamchere.

Kupweteka kupweteka

Kuperekera ululu ndi kupumula kwa sphincter ya Oddi kumatheka ndi parenteral makonzedwe a antispasmodic mankhwala (opanda-spa, platifillin), sanali-narcotic analgesics (paracetamol, baralgin, analgin), dera novocaine blockade, kulowetsedwa kwa 1000 - 2000 ml ya glucose-novocaine. Kukhazikitsidwa kwa mankhwala a narcotic amaloledwa (promedol ndi atropine, diphenhydramine ndi novocaine), kupatula morphine, womwe sphincter wa Oddi kukokana. Onani Mankhwala a kapamba.

Kuletsa katulutsidwe wa kapamba, m'mimba ndi duodenum

Kuti muchepetse ntchito zachinsinsi za kapamba komanso kugwiritsa ntchito mapuloteni, ma antienzyme (Gordox, Contrical, Trasilolum) amathandizidwa mwachinsinsi. Kupsinjika kwa katulutsidwe ka m'mimba kamaperekedwa ndi kuyambitsa kwa anticholinergics (atropine) ndi chiphalaphala cha m'mimba ndi mayankho ozizira. Amachepetsa chapamimba katulutsidwe omeprazole, pantoprazole - proton pump zoletsa. Ngati palibe cholelithiasis yolumikizana, mankhwala a choleretic amalembedwa kuti atulutse zimbudzi ndi ma ducts a bile. Hypothermia ya m'deralo (yozizira pamimba) imaperekedwanso, yomwe siyimangobweza zinsinsi za kapamba ndi ziwalo zina, komanso zimachepetsa ululu.

Mankhwala a antibacterial a chiwonongeko cha pancreatic amalembedwa chifukwa cha prophylactic ngati aseptic pancreatic necrosis komanso kuponderezedwa kwa microflora ya pathogenic ngati akudwala neancosis ya pancreatic. Cephalosporins (cefipim) yokhala ndi fluoroquinolones (ciprofloxacin) wophatikiza ndi metronidazole amagwiritsidwa ntchito ngati mankhwala opha tizilombo.

Kuti ayeretse magazi a poizoni ndi michere yamphamvu ya pancreatic, kulowetsedwa kwakukulu (shuga ndi insulin, yankho la Ringer, saline yanyama). Kubwezeretsanso voliyumu ndikuwongolera zinthu zamagazi, ma colloids (reopoliglukin, albin) ndi jakisoni wothokoka. Kuponderezedwa kusanza kumachitika ndi makonzedwe a cerucal. Kulowetsedwa mankhwala adayikidwa limodzi ndi okodzetsa (furosemide), amene amapereka okakamiza diuresis ndi kuchepetsa pancreatic edema.

Njira zochizira zowonjezera zam'mimba zimagwiritsidwa ntchito: achire plasmapheresis, hemosorption, peritoneal dialysis, hemofiltration.

Homoni ya hypothalamic, somatostatin, imayendetsedwa kudzera m'mitsempha, yomwe imalepheretsa chinsinsi cha madzi a m'mimba ndi exocrine ndi endocrine ntchito ya kapamba. Komanso, mankhwalawa amachepetsa kuyenda kwamkati mwa ziwalo zamkati komanso kupewa kutulutsa magazi mkati.

Mankhwala othandizira

Ndi chitukuko cha pancreatic necrosis, nthawi zambiri, opaleshoni imasonyezedwa. Cholinga cha opaleshoniyo ndikobwezeretsa kutulutsa kwa pancreatic madzi, kuchotsa necrotic foci ndi hemorrhagic exudate, kukhetsa kwam'mimba ndi malo opatsirana, kusiya magazi osagwirizana. Chithandizo cha opaleshoni chimayimitsidwa kwa masiku angapo (masiku 4 - 5), mpaka njira yovuta kwambiri imatha, hemodynamics imabwezeretseka ndipo mkhalidwe wa wodwalayo umakhazikika. Kuchita opaleshoni mwansanga kumasonyezedwa pokhapokha pancreatic necrosis, purcin peritonitis, chifuwa cha pancreatogenic. Ngati chithokomiro chowononga cha matenda amtunduwu, mumakonda kupatsidwa ntchito ya laparotomy, yomwe imapereka kufalikira kwam'mimba. Kuphatikiza apo, pakuchita opaleshoni, nthawi zambiri ndikofunikira kuchotsa ziwalo zoyandikana (chikhodzodzo ndi chowopsa cha cholecystitis, ndulu). Nthawi zambiri, kuchitidwa opaleshoni mobwerezabwereza kumafunikira chifukwa chodziwonongera kosatha cha kapamba. Mankhwala othandizira opaleshoni yayikulu imaphatikizira sequestrectomy (kuchotsedwa kwa ma necrotic misa), kuchotsanso kapamba (kuchotsa gawo la chiwalo) ndi kapamba (kuchotsa chiwalo kwathunthu).

Ngati wosabala pancreatic necrosis, njira zowonjezera opaleshoni njira (laparoscopic debridement ndi m'mimba drainage, puncutaneous punctuation) ndikofunikira.

Kusamalira komanso kukonza

Kulephera kwakanthawi kwa wodwala pambuyo pakuchita opaleshoni kumangokhala kwa nthawi yayitali (mpaka 3 - miyezi 4 kapena kupitilira). Mu nthawi ya ntchito, kuchira koyambirira kwa wodwala kumadalira njira zosamalira komanso kukonza. Kwa masiku awiri oyamba, wodwalayo amakhala m'chipinda cha odwala osamala kwambiri, pomwe amayang'aniridwa ndi kuthamanga kwa magazi, ma electrolyte ndi shuga m'magazi, hematocrit, ndi kuwerengera mkodzo. Ndi magulu okhazikika komanso hemodynamic magawo, wodwalayo amasamutsidwa kupita ku opaleshoni wamba. Masiku 2 oyamba atachitidwa opaleshoni, kusala kudya kwawongo kumasonyezedwa. Kuyambira tsiku lachitatu chakudya chololedwa:

osati tiyi wokoma ndi achifwamba,
mafuta osenda msuzi pamsuzi wa masamba,
phala ndi burwheat phala (mkaka / madzi ndi 1/1),
omele mapuloteni (theka la dzira patsiku),
buledi wouma umaphatikizidwa muzakudya 6,
tchizi tchizi
batala (15 gr.).

Usiku, kapu ya yogati kapena madzi ofunda okhala ndi uchi amaloledwa.

Zakudya zonse zofunikira sabata yoyamba atachitidwa opaleshoni, pakatha masiku 7 - 10 nyama yochepa yophika ndi nsomba zimayambitsidwa muzakudya.

Kutulutsa kuchokera kuchipatala kumapangidwa pambuyo pa miyezi 1.5 - 2.

Chithandizo cha kunyumba

M'masiku oyambira kutaya, wodwalayo amalimbikitsidwa kuti apumule mokwanira. Mosalephera, chakudya ndi masana pang'ono zimawonetsedwa. Pambuyo masiku 10-14, kuyenda kwakanthawi mlengalenga kumaloledwa, kutalika kwake kumawonjezeka ndi nthawi. Panthawi yokonzanso, pewani kugwira ntchito mopitirira muyeso. Kuwerenga, kuonera TV, kuyenda ndi nyumba zopepuka sikuyenera kukhala nthawi yayitali ndikumaima ngati wodwalayo akumva kuti sanasangalale.

Ntchito zakukonzanso zikuphatikiza:

chakudya
kumwa mapiritsi okhala ndi insulin (malamulo a shuga)
kukonzekera kwa polyenzyme (kupititsa patsogolo kukondweretsa chakudya),
olimbitsa thupi
physiotherapy.

Zimayambitsa pancreatic necrosis

Pachimake kapamba, complication ya pancreatic necrosis, ali lachitatu malo pafupipafupi, kungolola patsogolo pachimake appendicitis ndi cholecystitis. Monga lamulo, limayamba chifukwa cha kuwonongeka kwa ma cell achinsinsi a kapamba, kupanga kwambiri madzi a kapamba komanso kuphwanya kutuluka kwake. Njira izi zitha kupangitsa kuti:

kuvulala kwam'mimba
opaleshoni yam'mimba
kuledzera kwa thupi (kuphatikizapo mowa),
thupi lawo siligwirizana
matenda a ndulu
matenda opatsirana kapena parasitic,
kudya kwambiri nyama yokazinga, zinthu zina zowonjezera, mafuta a nyama.

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

Chikondamoyo chathanzi chimatulutsa ma enzyme omwe amafunikira 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.

Mitundu ya pancreatic necrosis

Nkhani yothandiza? Gawani ulalo

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 kukula kwapang'onopang'ono kwa 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 imakhudzanso 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.

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.

M'tsogolomu, zakudya mu pancreatic pancreatic necrosis zimatanthawuza boma losasamala, lomwe limatsimikiziridwa ndi kupatula kwakukulu kwa mafuta ndi chakudya kuchokera kuzakudya, komanso zinthu zomwe zimayambitsa kupangika kwa mpweya. 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.

Pancreatitis pachimake ndi kutukusira kwamphamvu kwa kapamba, ndipo pancreatic pancreatic necrosis ndi zovuta zake. Awa ndi matenda oopsa, pomwepo amafa ma cell a chamba kuchokera pakudziyimbira kwake. Zotsatira zamatenda monga pancreatic necrosis ya kapamba ndizowonjezeranso matenda ena, chifukwa chomwe peritonitis ndi zovuta zina zazikulu zimayamba.

Mankhwala amakono sangatsimikizire kuchira kwa 100%, ndipo ngati kufa kwa pancreatitis kuli pafupifupi 15%, ndiye kuti pancreatic pancreatic necrosis imayambitsa kufa mu 50-70% ya milandu yonse. Zowona, m'zipatala zotsogola zadziko lapansi, chiwerengerochi chimatsitsidwa mpaka 20%, koma sangathenso kutsimikizira kuti matendawa achira.

Malinga ndi ziwerengero zomwe zilipo, pafupifupi 70% ya anthu onse omwe ali ndi pancreatic pancreatic necrosis amamwa mowa. Komanso, 30% ya odwala onse kwanthawi yayitali asadakhale ndi nthenda ya ndulu.

Mitundu ya kapamba ndi zomwe zimayambitsa

Mitundu itatu ya kapamba wamapapo amadziwika: hemorrhagic pancreatic necrosis, mafuta pancreatic necrosis ndi edematous pancreatitis.

Zomwe zimayambitsa matendawa ndi kumwa mowa kwambiri, komanso kudya kwambiri, makamaka yokazinga ndi mafuta, kupezeka kwa matenda a ndulu. Zomwe zimapangidwanso zimatha kukhala zilonda zam'mimba kapena m'mimba, poyizoni wakupha, matenda opatsirana komanso ma virus.

Chimodzi mwa madandaulo akuluakulu a wodwalayo ndi kupezeka kwa ululu pamimba, zomwe zimachitika mu hypochondrium yamanzere. Komanso, ululu umatha kuperekera kumbuyo, tsamba lamanzere ndi mkono, nthawi zambiri ululu umachitika. Odwala amayamba kusanza ndi mseru, kutsegula m'mimba komanso kumatulutsa. Kutentha kwa thupi kumakwera, ndipo nthawi zina kumatha kukhala kokulirapo, chifukwa chomwe kutentha ndi kusokonezeka kwa thupi kumayambira.

Pancreatic necrosis - zotsatira ndi zovuta

Zovuta zazikulu za matendawa ndi:

- kuledzera kwambiri kwa thupi lonse, kusagwira ntchito machitidwe ake onse,

- mawonekedwe a pancreatic cyst. Potere, madzi amadzisonkhanitsa ndi mawonekedwe amkati ndipo amatha kukhala onse kunja kwa gland ndipo mkati mwake momwe,

- Maonekedwe a chifuwa chachikulu, pomwe minofu yathanzi imasinthidwa ndi ma connective,

- mawonekedwe a pancreatic fistulas, ndi kulumikizana kwa chimbudzi cha ziwalo ndi ziwalo zamkati kapena chilengedwe chakunja,

- peritonitis ndi kuledzera kwambiri kwa thupi lonse kumatha kuyamba,

- kutuluka kwamkati pamimba kumatha kuchitika, komwe kumapangidwa chifukwa chakuti msuzi wa pancreatic umawononga mitsempha ya magazi,

- mawonekedwe a shuga wodwala, popeza pali kuphwanya kwa endocrine.

Kukayikira koyamba kwa kukhalapo kwa matendawa kungapezeke mwa kufufuza mwatsatanetsatane wodwala za thanzi lake. Ngati pali nkhawa, mutha kuyendetsa ma ultrasound scan, makina ojambula pamakina kapena maginito amatsenga, komanso njira zina zodziwonera zambiri. Ndikothekanso kudziwa kukhalapo kwa matendawa pochita kuyezetsa magazi a labotale.

Kuchiza matendawa kumatheka pokhapokha pachipatala chopangira opaleshoni, chifukwa zovuta zambiri zimatha kuchitika, zomwe zimatha kuyendetsedwa ndi opaleshoni yodzidzimutsa.

Ngati matendawa amayamba popanda zovuta, ndiye kuti wodwalayo amatha kudya zakudya zochepa. Amamulembera shuga ndi mchere wambiri, womwe umaperekedwa kudzera m'mitsempha, motero amachepetsa kuledzera kwa thupi. Lembani mankhwala omwe amachepetsa katulutsidwe wa pancreatic a madzi ndi ntchito ya enzyme.

Tini ya nasogastric imayikidwanso kuti muchepetse kuthamanga m'mimba thirakiti. Fotokozerani maantibayotiki ndipo ngati kuli kotheka, opweteka. Ngati zonse zachitika pa nthawi yake, ndiye kuti mwayi wochira wodwalayo ndiwokwera kwambiri.

Panconecrosis amadziwika ndi akatswiri ngati amodzi mwa matenda oyipa kwambiri omwe angakhudze kapamba. Monga lamulo, ndi zovuta za kapangidwe kake ka kapamba, ndipo nthawi zina zimachitika ngati imodzi mwanjira zake. Ngozi yake yayikulu imakhala chifukwa chofuna kuthamanga kwambiri. Zochita zamankhwala zimadziwa zochitika pamene wodwala wamwalira patangotha maola ochepa pambuyo zizindikiritso zoyambirira zikuwonekera chifukwa cha matendawo athunthu. Lero tiwona bwino za matendawa ndikuwona zomwe zimayambitsa chitukuko, momwe zimadziwonekera ndikusamaliridwa.

Mawu ochepa pazomwe zimayambitsa vutoli
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Chithandizo cha Pancreatonecrosis

Mawu ochepa pazomwe zimayambitsa vutoli

Pancreatic necrosis ya kapamba, mosiyana ndi matenda ena ambiri am'mimba, nthawi zambiri imakhudza osati okalamba, koma anthu azaka zapakati komanso ngakhale achinyamata. Nthawi zambiri, ziwerengero zimawonetsa kuti choyambitsa chitukuko ndi kuphwanya zakudya, makamaka kugwiritsa ntchito zakudya zochuluka yokazinga, mafuta ndi zina zopanda pake, komanso mowa. Komabe, mfundo imodzi yofunika iyenera kudziwidwa apa: odwala omwe amamwa mowa nthawi zonse amakhala pachiwopsezo chotenga matenda a kapamba. Ponena za pancreatic necrosis, nthawi zambiri imakhudza anthu omwe amamwa kwambiri pambuyo pakumwa zakumwa zoledzeretsa zochuluka.

Ganizirani izi pamlingo wamapangidwe ochitapo kanthu pa kapamba. Kugwiritsa ntchito mowa, kuphatikiza ndi zakudya zamafuta, makamaka, zomwe zimakhala ndi mapuloteni ambiri, kumayambitsa kutulutsidwa kwakanthawi kwa kuchuluka kwa enzyme ndi kapamba. Zitsamba zobiriwira sizimakwanitsa kuthana ndi vuto lotere, chifukwa choti msuzi umayamba kudzikundana. Pamapeto pake, zikondazo zimatupa, zomwe zimakhumudwitsa kufinya ndi kuzungulira kwawo. Pamapeto pake, njira yoopsa kwambiri ya "chimbudzi" imayambitsidwa, ndiye kuti, kupanikizana kumatulutsa ziwalo zake zomwe. Ma enzyme omwe amagwira ntchito limodzi ndi zinthu zowola, amalowa m'magazi ambiri, ndikupangitsa kuledzera kwambiri.

China, koma chosawonekera kwambiri pakukula kwa vutoli ndi kuvulala kwapachibale. Kwa gulu lomweli lomwe lingakhale pachiwopsezo, akatswiri amalingalira zovuta za mankhwala, komanso matenda opatsirana ambiri.

Zakudya zamagulu

Malangizo pazakudya za pancreatic necrosis:

zakudya zopindulitsa mpaka 6 pa tsiku, m'magawo ang'onoang'ono,
kudya nthawi yomweyo
kuthetsa mowa ndi kusuta,
Kutentha kwa chakudya kuyenera kukhala pamawonekedwe otentha (otentha kwambiri ndi ozizira saloledwa),
chakudya chimayenera kudulidwa (chosenda kapena chosemedwa),
mbale zimawotchera, kuwiritsa ndi kuwotcha.

buledi watsopano ndi makeke,
chimanga, mapira, barele,
nyemba, nandolo, nyemba, mphodza,
nyama zamafuta, nkhuku ndi nsomba,
chokoleti, koko, tiyi komanso khofi,
zamzitini ndi soseji, nyama zosuta,
ma pickles ndi ma pickles,
chakudya chofulumira
bowa ndi msuzi wa bowa,
nyama ndi msuzi wa nsomba,
zonunkhira
kabichi yoyera (mwanjira iliyonse),
masamba azonunkhira komanso wowawasa (sorelo, anyezi wa masika, radish, sipinachi, radish, adyo),
mafuta am'madzi ndi nyama, mafuta anyama,
mkaka wonse ndi mafuta mkaka,
mazira amtundu uliwonse ndi yolk,
mphesa, nkhuyu, masiku.

buledi wowuma
tchizi chamafuta pang'ono,
supu zamasamba
chimanga mu msuzi wamadzi osakaniza (1/1),
nyama yophika,
kefir, yogurt yamafuta ochepa,
dzira loyera la dzira
nsomba zowonda, nyama ndi nkhuku (ng'ombe, nkhuku, mungu, flounder),
masamba ophika (beets, kolifulawa, zukini, dzungu),
timadziti tothira madzi,
batala (zosaposa 15 gr pa tsiku),
mafuta masamba (osaposa 30 gr.),
ma cookie owuma osawerengeka.

Ndi pancreatic necrosis, matendawa amakhala okayikira ndipo zimatengera zinthu zambiri (momwe mankhwalawa amayambira mwachangu komanso mokwanira, zaka za wodwalayo, mtundu wa matendawa, kupezeka kwa matenda othandizira, kutsatira malangizo azachipatala ndi zakudya, kuchuluka kwa kulowererapo kwa opaleshoni).

25% ya odwala omwe amadwala matenda oopsa a kapamba amadwala matenda a shuga. Ma pseudocysts amapangidwanso nthawi zambiri, amapezekanso pancreatitis, ndi mawonekedwe a fanculas a pancreatic. Kufa kwa matendawa ndikokwera kwambiri. Ndi aseptic pancreatic necrosis, ndi 15 - 40%, ndipo wokhala ndi kachilomboka amafika 60%.

Funso - yankho

Choyamba, muyenera kuyika wodwalayo pabedi, ozizira pamimba (pafupifupi pakati) (thovu lamadzi oundana kapena chilichonse chomwe chayandikira). Kudya ndi kumwa ndizoletsedwa. Kuwongolera kwa analgesics ndi enzyme kukonzekera mkati sikuwonetsedwanso (kumafoola chithunzi cha matenda). Kuchepetsa ululu (ndi maluso) intramuscularly yambitsa papaverine kapena ayi-shpu. Imbani ambulansi nthawi yomweyo.

Sizomvetsa chisoni, koma muyenera kukhala "pachakudya chambiri pamoyo wanu wonse." Koma musataye chiyembekezo, m'moyo, kuwonjezera pa chakudya chokoma ndi chopanda pake, mowa ndi ndudu, pali zambiri zomwe ndizokongola. Pitani kumalo osungirako zinthu zakale ndi malo oonera zisudzo, pitani panja, pezani zosangalatsa, werengani, lembani ndakatulo, lankhulanani ndi anzanu.

Palibe njira. Munthu akadwala kwambiri mwakuti akufuna kufa ndi kukumba, kutenga msuzi wosiyanasiyana ndi kulowetsedwa kumachedwetsa nthawi yosamalidwa mwapadera, chifukwa chake, kumakulitsa kudalirika kwa matendawa ndipo amatha kupha munthu.

Choyamba, zolakwika mu chakudya. Kachiwiri ndi kudziletsa. Kuphatikiza apo, kuyambiranso kumayambitsa matenda am'mimba thirakiti (zilonda zam'mimba ndi zilonda zam'mimba, kuchuluka kwa cholecystitis) ndi kukula kwa zovuta za pancreatic necrosis.

Kugwirizana kwa vutoli ndi matenda

Mavuto ofunikira kwambiri opaleshoni amakhalabe: kudziwitsidwa koyambirira kwa pancreatic necrosis, kupewa matenda opatsirana pancreatic, njira zingapo zamankhwala othandizira (zovuta pakuzindikira), kusankha kwa ma opaleshoni amisala poyambira pancreatic necrosis.

Vuto lina ndilokhudzana ndi chikhalidwe cha anthu - kuzindikira kwa odwala zomwe zimayambitsa ngozi komanso kukula kwa matendawa. Ndiye kuti, kupatuka panjira yodutsira kwa dokotala ndi chimodzi mwazomwe zimayambitsa kukula kwa pancreatitis yacanc komanso pancreatic necrosis.

Chithunzi cha kuchipatala

Dongosolo Lopweteka: kupweteka ndi pancreatic necrosis kumawonedwa mu 100% ya milandu ndipo amatha kusiyanasiyana mwamphamvu. Mu 4 - 5% ya odwala, kupweteka kumakhala pang'ono, ambiri amamva kupweteka kwambiri, ndipo mu 8 - 10%, ululu wosalephera, womwe ungayambitse kudandaula. Nthawi zambiri, dera lopweteka limakhala kumanzere kwa hypochondrium, epigastrium. Nthawi zina ululu umamvekera kumbuyo, phewa, mtima, tsamba lamapewa, etc. Mankhwala osapatsirana omwe samapatsa chitetezo samapereka kufunika kwa pancreatic necrosis.

Dyspeptic syndrome: kusanza mobwerezabwereza, komwe sikubweretsa mpumulo, nseru, kutulutsa.

Matenda a Metabolic ndi mtima: redness of the nkhope, pallor of the limb, tachycardia (kuchuluka kwa kuchuluka kwa mtima), tachypnea (kuchuluka kwa kupuma), pakamwa kowuma, kunjenjemera, kutuluka thukuta, kusokonezeka kwa mitsempha (hyperesthesia, kupsinjika, kupsinjika kwa chikumbumtima, zina).

Pagulu: mu kapamba, kulowetsedwa (kachulukidwe kakupangika) kumatha kugonedwa. Amalowetsedwa zimapangidwa kutengera mtundu wa pancreatic necrosis (yokhala ndi mafuta - mwachangu kwambiri, ndi hemorrhagic - m'magawo aposachedwa, ndi kuchuluka kwa zizindikiro zambiri).

Zizindikiro Grey-Turner - mawonekedwe a kapezi (wofiirira) m'mphepete mwa m'mimba.

Zizindikiro Zoyipa - mawanga ofiirira pakhoma lanyumba yam'mimba.

Chizindikiro cha Grunwold - amawoneka ngati kapezi kuzungulira navel.

Zizindikiro za davis - mawanga ofiirira pamabowo, m'munsi kumbuyo.

Pomaliza

Pancreatic necrosis ndi zovuta kwambiri zovuta za pancreatitis pachimake. Mpaka pano ,imfa mu izi zimachokera ku 70% mpaka 90%. Zovuta zakuzindikira koyambirira komanso kupewa matenda oika moyo pachiwopsezo (mantha, magazi, sepsis) ndizothandiza.

Choyambitsa chachikulu cha pancreatic necrosis ndimamwa mowa wambiri ndi zakudya zamafuta.

Pozindikira pancreatic necrosis, machitidwe "oyembekezera" amagwiritsidwa ntchito nthawi zambiri, popeza vuto lalikulu la wodwalayo sililola njira zambiri zodziwira matenda.

Chithandizo cha pancreatic necrosis iyenera kuchitika m'chipinda chothandizira kwambiri ndi chisamaliro chachikulu chowunikira poyang'anira zizindikiro zofunika. Chithandizo cha opaleshoni chimakhazikitsidwa mpaka wodwala akhazikika.

Tidayesetsa kwambiri kuti muwerengenso nkhaniyi, ndipo tidzakondwera kuyankha kwanu mwanjira yoyeserera. Wolemba angasangalale kuwona kuti mumakondwera ndi izi. Zikomo!

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Matendawa amadzimva amitundu iwiri yazisonyezo:

mawonetseredwe ofala okhala ndi matenda ambiri am'mimbamo, makamaka, kudumpha koopsa, chizungulire, kusintha kwa kuthamanga kwa magazi, kumayambitsa milandu yayikulu ngakhale kusazindikira, m'mawu, kuphwanya kwambiri chizolowezi cha thupi.
Zizindikiro zina, zomwe chachikulu ndi ululu wolimba kwambiri wamkamwa, womwe umapezeka kumanzere kwa hypochondrium ndikutsagana ndi mseru komanso kusanza kwadzaoneni.

Kuti mupange kuzindikira koyenera, maphunziro angapo azachipatala amafunikira, makamaka, mkodzo wa diastasis, kusanthula kwa leukocyte wamagazi, larroscopy ndi ultrasound yachikhalidwe.

Chithandizo cha Pancreatonecrosis

Tanena kale mobwerezabwereza za matendawa omwe atulukiratu, omwe amachititsa kuti azindikire nthawi yake. Pazifukwa zomwezo, ndizovutanso kuchiza matenda a pancreatic necrosis: ngakhale mutalandira chithandizo chokwanira komanso chokwanira, milandu ina imakhala yosagwirizana ndi wodwalayo.

Mwambiri, ndi pancreatic necrosis, zovuta zochizira zimachitika, zomwe zimaphatikizapo:

njira zochotsa poizoni m'thupi,
kupangika kwa michere yambiri ya proteinolytic,
kubwezeretsa kutulutsa ndi kusintha kwa ma ducts,
opaleshoni yamphamvu, yomwe idzapulumutse wodwalayo ku zowawa zazowawa, zomwe zidzayenderana ndi matendawa.

Chinanso chofunikira chachipatala, chomwe chimagwiritsidwa ntchito kuthetsa matenda, sizachilengedwe. Zake zimapumira popereka kupuma kwathunthu, njala ndi kuzizira kwa kapamba wowonongeka. Poyamba, chakudya sichimasiyidwa kwathunthu, ndipo mayendedwe a wodwalayo amakhala ochepa momwe angathere ngakhale mkati mwa mpumulo wokhazikika wa kama. Kuphatikiza apo, m'mimba mumatsukidwa nthawi zonse kudzera mu chubu ndikutsuka madzi ozizira.

Ngati mankhwalawa amagwiritsidwa ntchito mosiyanasiyana, akatswiri amalimbikitsa kuti pakhale opaleshoni yofunika kuchitapo kanthu.

Zoyambitsa matenda

Choyambitsa chachikulu komanso chokhacho cha pancreatic necrosis ndikuwukira kwachimbudzi, komwe kumadzipukusa kwa chida cha pancreatic ndi kufa kwa minyewa ndi ma ducts. Acute pancreatitis sikuti nthawi zonse amangokhala ndi necrosis ya minofu, koma mu 15% ya kuchuluka kwa ozunzidwa, amapeza matendawa m'njira zomwe zingachitike chifukwa cha matendawa.

Kupezeka kwa matenda kwa munthu kumakhala ndi zifukwa zake:

kuchuluka kwa kupsinjika kwa m'mimba,
kuchuluka katulutsidwe wa michere ndi kapamba wa pancreatic mu pancreatic organ system,
kutseguka kwa chakudya cham'mimba mu makonzedwe a zotulutsa,
uchidakwa
zilonda zam'mimba zotseguka, zilonda 12 zam'mimba,
kudya zakudya zamafuta, zomwe zimakwiyitsa kwambiri kapamba,
mavuto a ndulu
matenda
matenda a virus
kuvulala kwamitsempha
anasamutsa ntchito pamimba.

Zotsatira zomwe zimachitika kuchokera pachimake kapamba - minofu necrosis (pancreatic necrosis) imayesedwa matenda oyipa, omwe nthawi zambiri amabweretsa imfa kwa wozunzidwayo.

Mukamapanga, pancreatitis pachimake imapanga edema ya England, ndipo izi zimayimitsa kutulutsa kwa pancreatic madzi ndi michere. Kupanga chithaphwi m'mizere, amayamba kugwira ntchito ndikuwongolera makoma ndi ziwalo za ziwalo. Kuperewera kwa chithandizo chamwadzidzidzi kumayambitsa kuwoneka kwa minofu necrosis komanso abscess, zomwe zimapangitsa kuti matendawa azikhala osathandiza m'tsogolo.

Mokulira, necrosis imawonedwa pamene izi zimayamba kuyenda nthawi yomweyo, izi zimabweretsa chiwonetsero champhamvu cha pancreatitis pachimake ndikudya ziwalo za ziwalo zozungulira gland, zomwe zimakwiyitsa peritonitis ya peritoneum. Mukakhala m'mimba, m'mimba ndi michere imayambitsa kwambiri kuwonongeka kwamakanidwe am'mimba, omwe amatsogolera kumatira komanso gawo lachiwiri la necrosis. Opaleshoni, yomwe ndi njira yokhayo yopulumutsira moyo waumunthu ndi pancreatic necrosis komanso mpumulo wokhazikika wa peritonitis ya ziwalo zam'mimba.

Magawo a chitukuko cha necrotic pancreatitis

Pancreatic necrosis imakhala ndi magawo atatu a chitukuko, momwe kupezeka kwadzidzidzi kwa matenda kungayambitse kuvulaza thupi ndikuyambitsa imfa:

Gawo loyamba la pancreatic necrosis. Poizoni ndi mabakiteriya owopsa amadziunjikira m'magazi a wozunzidwayo. Pali vuto lofufuza ma virus m'magazi, chifukwa chake matenda omwe ali pakadali pano ndi ovuta kudziwa.
Gawo lachiwiri la pancreatic necrosis. Popeza chifukwa chomwe gawo loyamba silinadziwike, ichi chimakhala chifukwa chochedwetsa kulandira chithandizo komanso kupezeka kwa abscess, komwe kumakhudza kapamba ndi ziwalo zapafupi zam'mimba.
Gawo lachitatu la pancreatic necrosis. Njira zotupa za purulent zimayamba kupindika komanso ma peritoneum, ndipo izi zimabweretsa imfa.

Ndi pancreatic necrosis, kutsimikiza kwakanthawi kokhako komanso kolondola komwe kumayambitsa kupezeka kwa mankhwalawa kumapangitsa kuti pakhale opareshoni yofulumira ndipo ipereka mwayi wopewa kufa.

Zizindikiro zamatsenga

Belu loyamba komanso lalikulu mu pancreatic necrosis ndi kupweteka kwapweteka kumanzere kwa hypochondrium. Chifukwa chake, ndikofunikira kumvetsetsa mtundu wamawu omwe kupweteka kwa munthu amapatsa:

ululu uli kumbuyo
kupweteka konyenga mu minofu ya mtima kumalengedwa,
kupweteka kwa phewa.

Zizindikiro zonsezi zimawonetsa vuto mu gland, ndipo kupweteka kumayatsidwa ngati mwana ali pang'ono, ndikumakankhira mawondo ake pachifuwa, zomwe zimangotsimikizira kuzindikira. Kuphatikiza pazizindikiro zomwe zatchulidwa, kusanza pafupipafupi kumatha kuchitika, pambuyo pake palibe mpumulo, womwe umatsogolera kutha kwa thupi.

Mafuta ambiri a zigawo zikuluzikulu amapezeka m'magazi a munthu yemwe akhudzidwa, kapena m'malo mwake, omwe amachititsa kuti khungu liziphimba komanso khungu. Zotsatira zoyipa kwambiri, m'malo mwake, pakhale khungu lowoneka bwino.

Panthawi ya pancreatic necrosis, mu thupi lomwe lakhudzidwa, ndende ya elastase imachulukitsidwa kwambiri. Ndi kuchuluka kwambiri, mitsempha yamagazi yamunthu imawonongeka, yomwe imatsogolera kukhetsa magazi m'mimba. Nthawi imeneyi, magazi amawundana ndi ndowe zosanza. Ndipo mutha kuwonanso kusintha kwakuthupi - mawonedwe ofiirira pazibowo ndi matako a munthu wakhudzidwa ndi matendawa.

Pancreatic necrosis imanyamula zizindikiro ndi zovuta, komanso zotsatira zomwe zimafuna opaleshoni yofulumira, yomwe imapatsa wodwala mwayi wopulumuka.

Chifukwa chiyani odwala amafa

Acute pancreatic pancreatic necrosis imakhala ndi zokhumudwitsa, ngakhale asanapangidwe opareshoni. Chifukwa chiyani izi zikuchitika?

Zotsatira zakupha zimatheka muzochitika zotere:

mu pancreatitis pachimake, maselo a gland amafa, necrosis ya minofu yaumunthu ndi ziwalo zimachitika,
khoma lamatumbo ndi peritonitis amawonongeka, zomwe zimatsogolera kumatenda kwambiri a peritoneum,
zimakhudza chiwindi, impso, mtima, mitsempha yamagazi, yomwe imayamba kusweka chifukwa cha michere ya pancreatic ndi madzi,
mtima sugwira katundu wolemera ndikuima,
kuthamanga kwa magazi kumagwa
pali kuchuluka kwa kukakamira mu ma choleretic ducts, komwe kumabweretsa kuledzera kwambiri kwa thupi,
sphincter ya Oddi, imasiya kudutsa yokha michere ndi chakudya cham'mimba, zomwe zimapangitsa kuwonongeka kwa ziwalo komanso mawonekedwe a peritonitis.

Izi zonse zimabweretsa imfa, kotero muyenera kusamala zaumoyo wanu, ndipo chizindikiro choyamba, mupeze zoyenera zonse za thupi.

Moyo pambuyo mankhwala

Pambuyo pakuchita opaleshoni ya pancreatic necrosis, wodwalayo amaikidwa ku akaunti ya dispensary pamalo omwe amakhala. Miyezi isanu ndi umodzi iliyonse amakakamizidwa kupimidwa matenda ndikutsatira kudya koyenera No. 5P. Mukamapangira ultrasound, kapamba, chiwindi, impso, matumbo ndikofunikira kwambiri. Kusanthula mkodzo, magazi, afotokozere za momwe wodwalayo alili komanso zovuta zomwe zingachitike pambuyo pake.

Panthawi yokonzanso izi, wodwala ayenera:

physiotherapy
Therapyutic kuwala olimbitsa thupi,
amayenda mumweya watsopano,
kusintha kwam'mimba
mutatha kudya, kupumula kumayikidwa,
ndizoletsedwa kupukusa wodwala, chifukwa izi zimapangitsa chidwi cha kapamba.

Pambuyo pa opaleshoni ya pancreatic necrosis, ndi angati akukhala? Palibe lingaliro lomveka bwino komanso kudalirika kwa matendawa, koma kwenikweni zonse zimatengera kukhazikitsidwa koyenera kwa machitidwe azakudya omwe adokotala adawunikira komanso kuyang'aniridwa kolondola kwa njira zachipatala.

Ndipo pali zifukwa zina zomwe zikuyambitsa izi:

kuchuluka kwa zowonongeka
zaka
chithandizo choyenera
kukula kwa necrosis,
matenda ophatikizana ndi pancreatic necrosis.

Kulemala

Ndi kapamba, pali magulu atatu olumala:

1. Gulu loyamba la olumala.

Ngati wodwalayo atha kudwala matenda am'mimba osalephera,
dystrophic mkhalidwe wa wozunzidwa,
palibe njira yosamalirira thupi lanu,
Kuletsa ntchito zamagalimoto.

2. Gulu lachiwiri la olumala.

3. Gulu lachitatu la olumala.

ngati pambuyo pa opaleshoniyo palibe mavuto,
chimbudzi cha pancreas chimagwira ntchito bwino, koma chimadziwulula kamodzi pakatha miyezi isanu ndi umodzi komanso kusapeza bwino.

Gulu lachitatu limakupatsani mwayi wokhala ndi moyo wogwira ntchito popanda kuchita masewera olimbitsa thupi.