Magawo a pan-European malangizo azachipatala pakuwunikira ndi kuperekera matenda a kapamba chifukwa cha gastroenterologist

* Zowonjezera mu 2017 malinga ndi RSCI

Bukuli limaphatikizidwa mu Mndandanda wamabuku omwe asayansi anzawo amawunikiranso a High Higest Attestation Commission.

Werengani mu magazini yatsopano

Pancreatology yamakono ndi nthambi yopitilira patsogolo ya gastroenterology, yomwe imakhudza mwachilengedwe kuchuluka kwamayiko (kuphatikizapo Russia) zikalata zogwirizanirana (malangizo) othandizira komanso kulandira chithandizo cha chifuwa chachikulu (CP), chodziwika ndi kukhalapo kwa malingaliro osagwirizana kapena ovuta. Kuti muchepetse kusagwirizanaku, kwanthawi yoyamba, adaganiza kuti apange protocol yoyamba yachipatala ku Europe yomwe idapangidwa motsata mfundo zamankhwala zokhala ndi umboni komanso zokhala ndi malingaliro asayansi malinga ndi mbali zazikuluzikulu zothetsera komanso kuchitira opareshoni CP. Ndemanga zowerengera zamabuku asayansi zakonzedwa pazakapangidwe kachipatala ndi magulu khumi ndi awiri a akatswiri odziwa ntchito zosiyanasiyana (ma ERG). Ma ERG osiyanasiyana adayang'anira etiology ya CP, kuwunika kothandizanso kwa CP pogwiritsa ntchito njira zoganizira, kuzindikira kwa exocrine pancreatic insuffence (kapamba), opaleshoni, mankhwala ndi endoscopic chithandizo cha CP, komanso chithandizo cha pancreatic pseudocyst, kupweteka kwa pancreatic, kuperewera kwa zakudya ndi matenda a shuga. anawunikira njira yachilengedwe matendawa ndi moyo wabwino ku CP. Kuphatikiza pazofunikira za panganoli, zomwe zimafunikira kwambiri pakati pa akatswiri am'magazi, kuwunika kwawo komanso kufunika kosinthana ndi machitidwe azachipatala aku Russia zinali zolinga zolemba nkhaniyi.

Mawu osakira: aakulu kapamba, exocrine kapamba kuchepa, matenda, mankhwala, kapamba kukonzekera.

Mwachitsanzo: Bordin D.S., Kucheryavy Yu.A. Malo ofunikira pakanema aku European akutsimikizira kuti apezeka ndi kuchiza pancreatitis yayikulu poyerekeza ndi khansa ya m'matumbo. 2017. Ayi. 10. S. 730-737

Mfundo zazikuluzikulu zamankhwala azachipatala za European pan za ku Europe zokhudzana ndi matenda komanso chithandizo cha chifuwa chachikulu pakumaso kwa gastroenterologist
Bordin D.S. 1, 2, Kucheryavy Yu.A. 3

1 Moscow Clinical Science Science And Practical Center yotchedwa A.S. Loginov
2 Tver State Medical University
3 University State Medical Stomatological University yolembedwa ndi A.I. Evdokimov

Pancreatology yamakono ndi nthambi yopanga gastroenterology, yomwe mwachilengedwe imayambitsa kuchuluka kwa malangizo amtundu (kuphatikiza ndi Russia) wofunsira matenda ndi chithandizo cha matenda apathengo a chifuwa chachikulu (CP), chodziwika ndikuyambitsa kosagwirizana kapena kosangalatsa. Kuti athe kubwezeretsa kusalinganika koteroko kunatengedwa lingaliro lopanga njira yoyamba yachipatala ku Europe, yophatikizidwa ndikuwunika mfundo zamankhwala zomwe zakhazikitsidwa ndi umboni komanso zomwe zili ndi maziko a sayansi pazoyesererazi pazinthu zazikulu pakusamalira komanso kuchitira opareshoni CP. Magulu khumi ndi awiri ogwirira ntchito zosiyanasiyana (EWG) adatsimikiza mwatsatanetsatane mabuku pamafunso omwe adakhazikitsidwa kale. Ma ERG osiyanasiyana adaganizira za UC etiology, zida zowunika za CP pogwiritsa ntchito njira zoganizira, kuzindikira kuperewera kwa pancreatic exocrine, opaleshoni, chithandizo chamankhwala ndi endoscopic, komanso nkhani zamankhwala othandizira pancreatic pseudocysts, kupweteka kwa kapamba, kuperewera kwa zakudya m'thupi ndi zakudya, matenda a shuga a pancreatogenic, mbiri yachilengedwe ya matenda ndi moyo wabwino ku CP. Zolinga zakulemba nkhaniyi zinali zomwe zikupezeka pakukhudzana kwakukulu, komwe kukufunika pakati pa akatswiri am'magazi, kuwunika kwawo komanso kufunikira kwa kuzisintha kuzolowera zamankhwala ku Russia.

Mawu ofunika: aakulu kapamba, pancreatic exocrine kuchepa, matenda, mankhwala, kapamba kukonzekera.
Mwachitsanzo: Bordin D.S., Kucheryavy Yu.A. Mfundo zazikuluzikulu zamankhwala azachipatala za European pan za ku Europe zokhudzana ndi matenda komanso kapezedwe ka matenda a kapamba chifukwa cha gastroenterologist // RMJ. 2017. Ayi 10. P. 730-737.

Mfundo zazikuluzikulu zamankhwala azakudya zamankhwala zokhala pan-European zimaperekedwa.

Malangizo zochizira pancreatitis yayitali komanso pachimake

: Novembala 1, 2014 pa 15:30

Pancreatitis imathandizidwa m'njira zambiri, koma chopambana kwambiri ndikutsatira zakudya zapadera. Ndiye amene adzathandiza kupewa kuchulukana kwa matendawa chifukwa pamakhala kufa pang'ono kwamaselo komanso kupangika kwa mabala. Kodi ndi malingaliro ati omwe akuyenera kutsatiridwa ndi wodwala yemwe ali ndi kapamba?

Ngati mukukumana ndi matenda monga kapamba, ndiye kuti muyenera kudziwa za kufunika kwa kudya pafupipafupi (osachepera 6 tsa / tsiku).

Muyenera kusiya kugwiritsa ntchito zakudya zolemera, zomwe zimayimiriridwa ndi zokometsera, zokazinga, zamchere zamchere, zinthu zamzitini, mowa, marinade, masaladi ogulitsa, masoseji, nyama ndi msuzi wopangidwa ndi nsomba, shuga, zakumwa zoziziritsa kukhosi, ndi zina zambiri.

Pancreatic pancreatitis imafuna mapuloteni ambiri.Magwero ake ndi nyama ya nkhuku, nkhuku, kalulu, ng'ombe, nyama zamwana wamchere ndi mafuta ochepa.

Zonsezi pamwambapa zikuyenera kukhala zofunikira. Onetsetsani kuti mwaphatikizanso tchizi chopanda mafuta chokoleti komanso ma casseroles, komanso zakumwa mkaka wowawasa (kefir, yogati, mkaka wowotchera) muzakudya zanu.

Idyani mazira pokhapokha ngati mumapangira mapuloteni.

Anthu omwe ali ndi kapamba amalangizidwa kuti azisiyiratu mphwayi ndi zakudya yokazinga. Musatulutsidwe amafunanso mapira, barele ndi ngale. Phatikizani ndi phala lotsika lopangidwa kuchokera ku mpunga, oatmeal kapena buckwheat muzosankha zanu. Iyenera kuphikidwa mumkaka wamafuta ochepa.

Masamba ayenera kupezeka muzakudya (zitha kuphika kapena kuwiritsa). Mutha kudya chilichonse kupatula kabichi yoyera, anyezi, sipinachi, radara, biringanya ndi sorelo.

Zoletsedwazo zimagwiranso ntchito kwa zipatso ndi zipatso, ndizoletsedwa kudya maapulo a mitundu yaiwisi, nkhuyu, mphesa, cranberries, currants, zipatso zamtundu wa zipatso.

Njira yotupa yomwe ikukhudzana ndi kapamba imatha kubweretsa kukula kwa kapamba. Pankhaniyi, simungathe kuchita popanda kuchira kwa nthawi yayitali. Kusankhidwa kwa njira zamankhwala kumadalira kwathunthu mawonekedwe a matendawo ndi mawonekedwe ake.

Kodi amalimbikitsa odwala omwe ali ndi pancreatitis yayitali? Kudya kamodzi sikungakhale kovutirapo, chifukwa matendawa amayenda limodzi ndi kutuluka kwa ululu wamphamvu. Ngati mukukumana nawo, tikulimbikitsidwa kumwa mankhwala a analgesic kwenikweni. Iyi ndi njira yokhayo yochepetsera vuto lanu.

Pambuyo popita kuchipatala mozama, odwala omwe ali ndi matenda osachiritsika amapatsidwa mankhwala osokoneza bongo komanso analgesics. Mankhwala azitsamba ndi abwino kwambiri. Iyenera kuchitika pa gawo la chikhululukiro. Nthawi yomweyo, munthu sayenera kuyiwala kumwa mankhwalawa.

Pochiza matenda a kapamba, katsabola, akufa ndi chamomile amadziwika kuti ndi othandiza. Zitsamba zonse zimatengedwa m'magawo ofanana, ndikuwotha ndikuwotha. Njira yothetsera, ndikofunika kumwa 70 ml nthawi iliyonse mukatha kudya.

Komanso, odwala amalimbikitsidwa kuti azisamalira machitidwe awo osasamala. Mfuti zam'mlengalenga zomwe zikuwoneka kuti ziyenera kuchotsedwa. Pa nthawi yakuchulukitsa kwa matendawa, amafunika kupereka nthawi yopuma komanso kudya. Kuphatikiza apo, muyenera kupita kwa dokotala munthawi yake, osayiwala kutsatira malingaliro ake.

Malangizo a pancreatitis pachimake

Malangizo kwa anthu omwe ali ndi pancreatitis yovuta kwambiri ndi kusiya kudya. Mu pachimake matenda, odwala ayenera kuyang'aniridwa ndi achipatala. Akatswiri adzaonetsetsa kuti pakudya michere yambiri mothandizidwa ndi njira zapadera zothetsera mavuto ena.

Ntchito yayikulu ndikuthandizira thupi lanu kuti lizipeza chakudya chokha mofulumira. Thupi lidzafunika kupereka kuchuluka kwa mapuloteni. Zakudya zilizonse ziyenera kuyambitsidwa muzakudya mosamala kwambiri. Chinthu chachikulu ndikuchita pang'onopang'ono.

Muyeneranso kuyang'anira momwe thupi limasunthira chakudya komanso momwe kapamba amakhudzira. Pa pancreatitis pachimake, chakudyacho chimayenera kumatenga nthawi yayitali.

Malangizo azachipatala a kapamba

Cholinga chachikulu cha mayendedwe azachipatala kwa odwala omwe ali ndi pancreatitis ndiku kuwatumiza kukayezetsa pamalo apadera. Ndi pokhapo pomwe angalandire chithandizo choyenerera cha opaleshoni. Akatswiri amatembenukira ku njira yamankhwala yothandizira pomwe wodwala akuzunzidwa ndi kupweteka kwambiri m'mapazi.

Kuthandizira opaleshoni kuyenera kuchitika ngakhale koyambirira kwa matendawa, ngati njira iyi ndiye yofunika kwambiri.

Ndondomeko ya National Pancreatitis

Nthawi zina, kuopsa kwa kapamba kumalimbikitsidwa kutsimikizika molingana ndi njira ya Atlanta. Tiyenera kukumbukira kuti kuphwanya malamulo komwe kunachitika masiku 7 oyambilira sikuyenera kukumbukiridwa ndikuyikidwa mu chizindikiritso cha kuvuta kwa pachimake kapamba.

Ngati odwala atatha masiku 8-10 atalandiridwa kupita kuchipatala, kulephera kwamankhwala kumapitirira ndipo zizindikiro za sepsis zimawonekera, ndiye kuti tikulimbikitsidwa kuchita tomography.

Ngakhale pambuyo pa maphunzirowa, maantibayotiki omwe amalepheretsa chitukuko cha matenda sikuyenera nthawi zonse.

Mpaka pano, madokotala sanapeze mgwirizano pakugwiritsa ntchito malingaliro apadziko lonse.

Matenda a kapamba a pancreatitis

Choopsa kwambiri cha ma pathological omwe amapezeka m'matumbo ndi chamba cha pancreatitis, chomwe chimakhala nthawi yayitali.

Zimakhudza kugwira ntchito kwa ziwalo zoyandikana, komanso zimayambitsa zovuta zowopsa.

Ili ndi matenda otupa kwa nthawi yayitali a kapamba, omwe amawoneka ndi kusintha kosasintha komwe kumayambitsa kupweteka kapena kuwonongeka kwakanthawi kwa ntchito.

Pali malingaliro oyenera a kapamba chifukwa cha chithandizo chamankhwala ndi zakudya, kuwunika kwa ntchito yokhudza thupi, kupuma mankhwala osokoneza bongo komanso njira zopewera.

Malangizo a matenda a kapamba

Cholinga cha malangizowa azachipatala ndikupanga malamulo othandiza kuti anthu aziyesa komanso kuthandizira pancreatitis yayitali kwa akatswiri, kutengera njira yokhwima ya mankhwala.

Matendawa omwe akufunsidwa amafunika kutsatiridwa ndi zakudya zapadera, kukhazikitsa mankhwala, komanso pazinthu zina, kuchitapo kanthu opaleshoni.

Popeza mawonekedwe osokoneza bongo a kapamba ali ndi zoyambitsa zosiyanasiyana komanso zakusiyana ndi poizoni, chithandizo cha matenda am'mimba chimaphatikizapo kuyimbira mwachangu kwa ambulansi komanso wopititsa kuchipatala kuti akamuyang'anenso.

Kuzindikira ndi Kuyesa Mayesero azachipatala

Kuzindikiritsa kumachitika chifukwa cha kupweteka kwam'mimba, kuwonetsa kusakwanira kwa ntchito ya katulutsidwe wakunja kwa kapamba mwa wodwala yemwe amakhala akumwa mowa nthawi zonse.

Mosiyana ndi pancreatitis ya pachimake, mu infrequently nthawi zambiri pamakhala kuchuluka kwa michere m'magazi kapena mkodzo, chifukwa izi zikachitika, ndizotheka kuti apange mapangidwe a pseudocysts kapena pancreatic ascites.

Kusankha kwa njira zowonera kumadalira kupezeka kwa njirayo, kupezeka kwa maluso ofunikira pakati pa akatswiri ndi kuwonongeka kwa njira yodziwitsa.

Roentgenography. Mu 1/3 mwazomwe zachitika, njirayi imathandizira kuzindikira pancreatic calcification kapena calculi mkati mwa duct. Izi zipangitsa kuti zithetse kufunika kozindikiranso matenda pofuna kutsimikizira matendawa. Mlingo wodalirika wa umboni ndi 4. Mulingo wambiri wotsimikizika pazotsimikizika ndi C.
Transabdominal ultrasound. Njira yozindikira iyi ilibe kuzindikira komanso kusakhazikika. Nthawi zambiri amapereka chidziwitso chokwanira kuzindikira matenda. Cholinga chake chachikulu ndikuchotsa zina mwa zopweteka pamimba. Mulingo wa kukhulupirika kwa malangizowo ndi A.
CT scan ndi yothandizira. Lero limaganiziridwa ngati njira yosankhira matenda oyamba ndi matendawa. Njira yothandiza kwambiri yokhazikitsa malo a pancreatic calculi. Mulingo wambiri wotsimikizika pamalangizo ndi B.
Endoscopic ultrasound. Njirayi imadziwika ndi kuwononga kochepa. Zogwiritsidwa ntchito ngati mankhwala. Imawerengedwa ngati njira yotsimikiziridwa kwambiri yopenyerera kusintha kwa ma parenchyma ndi ma pancreatic ducts koyambirira kwa matenda a kapamba.
ERCP. Kuthekera kwakukulu kwakudziwira matendawa mukufunsidwa.

Malingaliro

Malangizo a momwe angayendetsere wodwala ndi matenda oterewa amachokera pazinthu zotsatirazi:

Dziwani matenda oyamba ndi kapamba,
Kuyesa kudziwa komwe matendawo adayamba,
Kukhazikitsidwa kwa magawo
Matenda a kapamba
Kukhazikitsa njira yochizira,
Kuneneratu, kutengera zomwe zikuchitika komanso njira zamankhwala zosankhidwa.

Chithandizo cha Conservative

Conservative chithandizo cha odwala omwe ali ndi matendawa omwe akufunsidwa ndikuti ayimitse zizindikiro ndikuletsa zomwe zimachitika, zotsatirazi zimasiyanitsidwa:

kukana kumwa mowa ndi kusuta fodya,
Kuzindikiritsa zomwe zimapangitsa kupweteka pamimba ndi kuchepa kwa mphamvu yawo,
Chithandizo cha kuchepa kwa ntchito ya katulutsidwe kunja kwa kapamba,
kudziwika ndi mankhwala a endocrine osakwanira mu magawo oyamba mpaka kupanga zovuta,
chithandizo chamagulu.

Kusintha kwamakhalidwe

Kupatula zakumwa zoledzeretsa kumalimbikitsidwa kuti muchepetse pafupipafupi zowopsa ndi imfa.

Ndikosavuta kuzindikira kuti kusuta fodya kumamwa mowa kwambiri chifukwa ndi chinthu chodwalitsa chomwe chimakhudzanso chifuwa chachikulu cha chifuwa, chifukwa nthawi zambiri chimatha kumwa mowa.

Komabe, kukana kumwa mowa sikuti nthawi zonse kumachepetsa kupita patsogolo kwa njira ya matenda.

Zikakhala choncho, odwala omwe ali ndi matenda amafunsidwa kuti asiye kusuta. Mulingo wa kukhulupirika kwa malingaliro a C.

Kuchotsa kupweteka m'mimba

Nthawi zambiri, ululu amayamba chifukwa cha pseudocysts, stenosis wa duodenum 12, kutchulidwa kuti akusungidwa kwa ma ducts.

Muzochitika pamene matenda azachipatala amatsimikizira kukhalapo kwa vuto losasangalatsa ndikulungamitsa ubale ndi ululu wam'mimba, endoscopic ndi njira zamankhwala zochitira opaleshoni zimafunikira koyambira koyambira.

Nthawi zambiri, milandu ngati imeneyi imakambidwa pamodzi ndi akatswiri osiyanasiyana osiyanasiyana kuti apange dongosolo labwino kwambiri la mankhwala.

Pa ululu waukulu, episodic kapena kugwiritsa ntchito njira ya noncotic analgesics tikulimbikitsidwa: paracetamol 1000 mg katatu patsiku.

Kutalika kwa mankhwalawa mosalekeza ndi paracetamol sikuti kupitirira miyezi itatu ndikuyang'anira momwe wodwala akukhalira ndi kuchuluka kwa magazi ake. Chitsimikizo cha malingaliro - C.

Chithandizo cha exocrine pancreatic insuffence

Kuphwanya kachulukidwe ka mafuta ndi mapuloteni kumangowonetsedwa ndi kuwonongeka kwa kapamba ndioposa 90%.

Opaleshoni yolowerera pa chiwalo ichi imatha kupangitsa mapangidwe a exocrine osakwanira ndikukhazikitsa chithandizo cha enzyme.

Kuthandizira moyenera komanso panthawi yake kumakupatsani mwayi wopewa kupezeka kwa zotsatira zowopsa ndikuchepetsa kufa mu kuperewera kwa zakudya m'thupi.

Cholinga chothandizidwa ndi chithandizo ndikulimbikitsa wodwalayo kudya, kukonza komanso kuyamwa zakudya zina zofunika.

Laborator zizindikiro kukhazikitsa mankhwala:

chithuzi
matenda otsekula m'mimba,
kuperewera kwa zakudya
chifuwa chachikulu, kapangidwe ka matenda kapamba,
pancreatic opaleshoni chakudya
chikhalidwe pambuyo opaleshoni pa chiwalo ndi mawonetseredwe a exocrine kusowa.

Kukhazikitsidwa kwa pancreatic m'malo mwa enzyme chithandizo kumalimbikitsidwa kwa odwala omwe ali ndi kapamba komanso kusakwanira kwa ntchito ya exocrine, chifukwa zimathandizira kukonza ndikuyamwa kwa mafuta.

Mulingo wa kukhulupirika kwa malangizowo ndi A.

Chithandizo cha endocrine pancreatic insufficiency

Zakudya zamankhwala othandizira odwala matenda a shuga a pancreatogenic amafunika kukonza malabsorption.Chakudya chamafuta chimagwiritsidwa ntchito kupewa njira hypoglycemia.

Ngati mankhwala a insulin adayikidwa, zomwe zili mu shuga ndi zomwe zimayambitsa matenda a shuga 1.

Ndikofunikira kuzolowera wodwala kupewa kupewa kwambiri hypoglycemia, kuyang'ana pakumwa zakumwa zoledzeretsa, kuwonjezera masewera olimbitsa thupi, kusunga zakudya zabwino.

Pochiza matenda a shuga mellitus wambiri pancreatitis, tikulimbikitsidwa kuwunika zomwe zili m'magazi kuti tipewe mavuto. Chidziwitso chotsimikizika -B.

Mankhwala othandizira

Ndi zovuta zovuta za pathological process, nthawi zina osakhala ndi ululu wam'mimba, endoscopic kapena opaleshoni yotsimikizika imayikidwa.

Chisankhochi chimapangidwa ndi madokotala omwe amakhazikika pothandizira matenda a pancreatic.

Mwa njira yokhazikika yamatenda, kulowererapo kosafunikira kumayang'ana kukonza masanjidwe a chinthu chopatsidwa, kutupa kwa parenchyma.

Lingaliro lochita opareshoni liyenera kulingalira moyenera ngozi zonse zovuta.

Amafunikira kupatula zinthu zina zowawa m'matumbo am'mimba. Chithandizo choterechi chikhala chofunikira ngati palibe chisokonezo chokwanira pakatha miyezi itatu ya chithandizo chokhazikika, komanso kuwonongeka kwakukulu m'moyo wabwino.

Chithandizo cha Endoscopic

Palibe maphunziro omwe angawunikire zotsatira za endoscopic mankhwala a kapamba mwa odwala.

Chithandizo cha pseudocyst sichimatchulidwa mosasamala kukula kwake. Kuongolera nkoyenera kwambiri kuposa kulowererapo kwa maopareshoni, chifukwa ili ndi phindu labwino / chiopsezo.

Mulingo wa kukhulupirika kwa malangizowo ndi A.

Kupewa komanso kutsatira

Njira zopewera kupewera kwa kapamba zimadalira pakufalikira kwa kafukufuku, malinga ndi zotsatira zake zomwe zimapangitsa kunena kuti kupatula zakumwa zoledzeretsa komanso kusuta fodya ndi chifukwa chomwe chimachepetsa mwayi woti matendawa afotokozedwere.

Malangizo pazokhudza njira zopewera zakudya, kuvomerezeka kwa kukana khofi, mankhwala amtundu wa chokoleti, mafuta osiyanasiyana pakadali pano alibe maziko.

Zikuwoneka kuti zinthu zofunika kwambiri zomwe zimapangitsa kuchulukitsa kwa matenda a kapamba kumakhala kunenepa kwambiri, kudya kwambiri ndi hypokinesia mukatha kudya, kusowa kwa antioxidants m'zinthu zamagulu azakudya.

Komabe, tiyenera kukumbukira kuti odwala ena amatsata mosamalitsa zakudya zokhwima kuti akwaniritse matenda ena.

Chifukwa cha izi, amatha kubweretsa kudwala. Kutengera ndi zomwe tafotokozazi, kuyambira pazotsatira zamaphunziro osiyanasiyana, kusintha kwatsiku lino kumalimbikitsidwa kuti mupewe matendawa:

fotokozerani chakudya (mpaka katatu pa tsiku, m'magawo ang'onoang'ono omwe amagawa zakudya zamafuta), kupewa kudya kwambiri,
kudya zakudya zosiyanasiyana zokhala ndi mafuta ochepa komanso cholesterol (mafuta osafupika a masamba amangoperekedwa kwa odwala omwe ali onenepa kwambiri),
kupanga mndandanda wokhala ndi kuchuluka kwa mitundu yazakudya zomwe zili mumzimu, masamba ndi zipatso,
Kusamala pakati pa zakudya zomwe zadyedwa ndi zochitika zolimbitsa thupi (pofuna kukhazikika pathupi kuti muzitha kulimbitsa thupi, poganizira zomwe zikugwirizana ndi zaka).

Pofuna kupewetsa matenda oyamba a kapamba, zingakhale zoyenera kuchititsa anthu kuti azindikire matenda a bile duct omwe amafunsidwa, a hyperlipidemia.

Komabe, lero, pa dziko lapansi, lingaliroli silikhala ndi ntchito yoyenera, chifukwa likufunika ndalama zambiri.

Kutsimikizika kwa njira zotere kumatha kutsimikiziridwa ndi diagnostics a pharmacoeconomic.

Komabe, maphunziro ngati awa, chifukwa cha kuchepa kwakukulu kwa kapamba, sayenera kukhala okayikitsa.

Zotsatira zamatenda a 2017 zokhudzana ndi chithandizo cha matenda a kapamba am'mimba zimayendetsedwa ndipo akuyesera kupeza njira yodziwika yochiritsira, kusankha njira imodzi yothandizira ntchito ndi zakudya.

Izi ndi malangizo othandiza kuti matendawa afotokozedwe.

Malangizowa ndi chifukwa cha kuwunika kovuta kwa umboni womwe ulipo, poganizira zamankhwala.

Kutsetsereka ndi kukhoma malinga ndi ICD-10

Zomwe zimathandizira pancreatitis:

mowa ndi kusuta fodya,
kuwonongeka kwa kapamba chifukwa chovulala pamimba, opaleshoni, njira zodziwira matenda,
Kugwiritsidwa ntchito kosagwiritsidwa ntchito kwa nthawi yayitali kwa mankhwala omwe amawonongeka kapamba,
poyizoni wazakudya
chibadwa kapena kubadwa,
kuperewera kwa zakudya m'thupi.

Matenda a kapamba chifukwa cha uchidakwa komanso kusuta fodya.

Matenda a kapamba sangathe kuchiritsidwa kwathunthu. Pakati pa matendawa, kapamba amawonongeka pang'onopang'ono, pang'onopang'ono.

Pafupifupi pamilandu 4 iliyonse, chifukwa cha kapamba sichimadziwika.

Gulu

M'malangizo azachipatala malinga ndi ICD-10, mitundu itatu ya kapamba amadziwika:

etiology yodwala,
matenda ena apakhungu ogwirizana ndi zinthu zomwe tatchulazi, mwachitsanzo, kuchepa kwa mahomoni, cholowa, matenda a autoimmune, matenda ena am'mimba
chotupa chabodza.

Pancreatitis imasiyanitsidwa ndi chikhalidwe cha matendawa:

sikubwerera m'mbuyo
Nthawi zambiri amabwerera,
ndi zizindikiro zomwe zimakhalapo nthawi zonse.

Pancreatitis pachimake imalumikizidwa ndi njira yovuta ya matendawa. Malangizowo akuwonetsa kuti kuchulukitsa nthawi zambiri kumagwirizanitsidwa ndi:

kuphwanya kutuluka kwa ndulu,
yotupa njira
Matenda ena, mwachitsanzo, mawonekedwe owopsa kapena osakhazikika, cholecystitis, paranephritis, nthawi ya postoperative.

Chizindikiro chachikulu chomwe pancreatitis imapezeka ndi kupezeka kwa kupweteka m'dera la epigastric.

Zizindikiro

Ululu wambiri wa kapamba ndi chizindikiro chachikulu cha matendawa. Zinthu monga malo ndi mtundu wa ululuwo ndizofunikira. Dokotala adzaganiza kuti ali ndi matenda osachiritsika kapamba, ngati ululu:

perekani kumbuyo
kufooka munthu atakhala pansi kapena kutsamira patsogolo.

Nthawi zina, ululu ungathe kubwereranso, kusinthana ndi nthawi zopanda ululu, koma zimatha kukhala zosalekeza. Umu ndi momwe kutupa kumadziwonekera chifukwa cha uchidakwa. Malangizowo akuwonetsa kuti chidakwa cha pancreatitis chimatha kutsagana ndi mseru, bata. Pakapita nthawi, shuga, matenda a shuga amatha.

Kutengera ndi gawo la matenda, matendawa azikhala osiyana. Malangizowo adanena kuti kwa preclinical nyengo, ululu pafupifupi suwonekera. Mu magawo amtsogolo, munthu adzayamba kulephera kwa endocrine, komwe kumapangitsa kuti pakhale ziwonetsero.

Kuchedwa kupeza njira yoyenera yozindikira kumakhala ndi zotsatirapo zowopsa. Chifukwa chake, ngati mukukayikira muyenera kufunsa dokotala nthawi yomweyo. Kudzifufuza komweku sikungapangike.

Mukamasankha njira zodziwonera amatenga mbali:

kuphunzira,
Luso kapena chidziwitso chakutsogoza ndi achipatala,
kukula kwazovuta.

Malangizowo adakhazikitsa njira yoyeserera munthu yemwe ali ndi matenda a kapamba.

Madandaulo, mbiri yachipatala komanso mayeso

Panthawi yozindikira, dokotalayo amaganizira zodandaula za kupezeka ndi mawonekedwe a ululu pamimba.Mukakusunga anamnesis, kukhalapo kwa matenda ena (aakulu, cholowa, autoimmune), moyo womwe munthu amatsogolera, kuchuluka kwa mowa, kuchuluka kwa chitukuko cha hypoglycemia, ntchito zomwe zingatheke pamtunda wam'mimba, komanso kuvulala ndikofunikira.

Ma labotale ndi njira zofufuzira

Madokotala amatengera njira zotsatirazi zozindikiritsa zofunikira zomwe zawonetsedwa m'mayendedwe azachipatala:

radiografia ya dera la epigastric, lomwe limavumbula mawonekedwe a ziwalo,
Ultrasound - njira imatha kuwona kapamba pambuyo pake,
composed tomography, potengera momwe kungathekere kuweruza kuchuluka kwa gland atrophy,
magwiridwe amatsenga ndi njira yolondola yamakono yophunzirira ziwalo zamkati, zomwe zimakuthandizani kuti mupeze zotupa za pancreatic, necrosis.

Njira zothandizira zomwe zalembedwazo zikuthandizani kuti muphunzire za machitidwe a thupi, mwachitsanzo, kukula ndi kupindika kwa kapamba, kunenepa kwa minofu. Pa phunziroli, samalani ndi duodenum, mkhalidwe wa ma ducts (kapamba ndi bile), mitsempha ya splenic.

Ndi kapamba, kusintha kumachitika m'ziwalo zonsezi, mwachitsanzo, kapamba amakula, ma ducts amakula, ndipo splenic vein thrombosis imayamba.

Kafukufuku wopanga si njira zokhazo zodziwira matenda. Malangizowa amapereka mayeso a magazi (ambiri komanso a zamankhwala osokoneza bongo) kuti munthu azitha kutsatira zomwe zimachitika mu hypoglycemia.

Ngati glandular yotupa ikukayikira, malingaliro amalimbikitsa maphunziro a uprological. Cholinga cha mayeserowa ndikuwona mafuta omwe ali mu ndowe. Imadzuka chifukwa chosafunikira mafuta komanso mapuloteni.

Chiwindi chimagwira ntchito mwa anthu omwe amamwa mowa ndikudya molakwika, amakhala ndi vuto, motero munthu amatha kupatsidwa chiwonetsero cha ma enzymes a chiwindi.

Njira zamankhwala othandizira

Malangizo azachipatala othandizira pancreatitis amaphatikizapo mankhwala osokoneza bongo, kukonza moyo, makamaka thanzi. Nthawi zina, opaleshoni, kuyambiranso kwa kapamba angasonyezedwe, koma madokotala nthawi zambiri amayesa kupitiliza ndi chithandizo cha enzyme.

Matenda a kapamba mu ana ndi akulu amatha kuthandizidwa pokhapokha ngati matendawa ndi ofatsa. Malinga ndi mayendedwe azachipatala, chithandizo kuchipatala chimawonetsedwa pakuchulukana kwa kapamba. Cholinga ndikuyimitsa kupweteka kwam'mimba, kupewa zovuta komanso kukwaniritsa chikhululukiro chokhazikika.

Mankhwala

Malangizo a matenda a kapamba omwe amapezeka ndi mankhwala osakanikirana ndi zakudya ndikutsatira zakudya zabwino. Ngati gawo la pachimake latha, mafuta atha kuphatikizidwa menyu, koma nthawi zina zakudya zamafuta siziyenera kuphatikizidwa, kupatsa chidwi ndi mapuloteni, chakudya chamafuta.

Pankhani ya exocrine pancreatic insuffence, madokotala amatipatsa mankhwala othandizira olimbitsa thupi, kuyang'ana kusintha pamlingo wapamwamba wa patrological, enzyme yomwe ikupezeka mu ndowe.

Kuchepetsa kwa elastase kumawonetsa njira yotupa mu kapamba. Cholinga chothandizira kuchiritsa mankhwalawa ndikumachepetsa steatorrhea ndikusintha ntchito ya pancreatic.

Pancreatitis imatha kuchitika chifukwa chogwiritsa ntchito mankhwala kwa nthawi yayitali, monga potaziyamu ndi vitamini D, kotero chithandizo chimaphatikizapo kuyang'anira mankhwala omwe amaperekedwa kwa munthu chifukwa cha matenda ena.

Opaleshoni yotseguka ndi endoscopic

Malinga ndi malangizowo, magawo a matendawa ndi zizindikiro zake zitha kukhala chisonyezo choti opereshoni ayambitse kapena akana. Kuchitapo kanthu kwa opaleshoni kumachitika ngati munthu ali ndi vuto lakukulira, ngati kuchulukako sikungathe kuchiritsidwa ndi njira zamwambo.

Njira za Endoscopic zimaperekedwa ngati chithandizo cha mankhwala sichitha, ululu sutha, ndipo kutupa kumayendetsedwa limodzi ndi kuwonongeka msanga.

Mavuto ndi kudwala kwa matendawa

Kuphatikizika kwapafupipafupi kwa kapamba ndimapamba a pancreas, omwe amayamba chifukwa cha chifuwa cha pancreatic pa siteji ya minofu yakufa. Ma neoplasms amatha kufinya mitsempha yamagazi yomwe imadyetsa ziwalo zamkati, zowonetsedwa ndi zowawa pamimba. Chifukwa cha edema ndi pancreatic fibrosis, munthu amatha kudwala jaundice, chifukwa chida chokulirapo chimakanikiza bile duct.

Mavuto ena omwe akuwoneka mu malingaliro:

splenic vein thrombosis,
zilonda ndi kutsekeka kwa duodenum,
matenda oncological.

Malangizowo akuti chiopsezo chokhala ndi adenocarcinoma chikuwonjezeka chifukwa cha nthawi yayitali ya kapamba, ndipo zimadalira msinkhu wa munthu.

Kubwezeretsa ndikupewa

Njira yothandiza kwambiri yopewera kutukusira kwa pancreatic ndichakudya chopatsa thanzi. Munthu amene ali ndi kapamba ayenera kusiya mowa ndi kusuta fodya. Madokotala amalimbikitsa kusintha moyo wanu, kuthera nthawi yochulukirapo mu mpweya wabwino, kuyenda maulendo, kusewera masewera.

Panthawi yokonzanso, zakudya zolimbitsa thupi ndi zochizira zochizira zimayikidwa, zomwe zimathandizira kubwezeretsa ntchito.

Maupangiri a Dziko Lonse a Pancreatitis

Kukula kwakanthawi kochepa mu ziwonetsero za pancreatic kumabweretsa kuchitika kwa kusintha kosasintha kwa pathological mu thupi - kapamba.

Matenda amtunduwu alipo pakali pano

Izi matendawa amaphatikizidwa ndi zizindikiritso zingapo zingapo.

Zizindikiro zotere ndi izi:

kupweteka kuwoneka
kumakhala kumva kupusa ndi kusanza.
pali chisokonezo pakugwira ntchito kwa chiwalo.

Madokotala apanga malangizo apadera a kapamba wambiri, kugwiritsa ntchito komwe kumangoletsa kudziwa kukhalapo kwa matenda mwa anthu, komanso kuchita njira zopewera kupewa kuti PC isachitike

Chofunika cha matenda ndi njira yothandizira matendawo kuyambika kwa matendawa

Mukazindikira matenda, malingaliro onse a akatswiri ayenera kutsatiridwa.

Kutsatira upangiri wa adokotala kumakupatsani mwayi wogwiritsa ntchito mankhwalawa posankhidwa momwe mungapezere matenda ndi thupi la wodwalayo.

Upangiri wokhudzana ndi pancreatitis yayitali kwa ogwira ntchito kuchipatala amapangidwa ndi mabungwe apadziko lonse komanso apadziko lonse lapansi.

CP ndi njira yovuta kwambiri, pofotokoza kukhazikitsidwa kwa mankhwalawa komanso pofotokoza za matenda.

Chimodzi mwa matendawa ndi kupezeka kwa njira ya patali komanso chithunzi cha matendawo chowonetsera matendawa. Nthawi zina, zovuta zachilendo za etiological zimatha kuwonjezeredwa pazovuta zomwe zidadziwika.

Zomwe zikuchitika mkati mwa matendawa zimathandizira kuti pakhale kusagwirizana pakati pa madokotala pankhani yokhudza kupezeka kwa matenda ndi zamankhwala.

Kukula kwa kusagwirizanaku kumafunikira kuti pakhale njira yolumikizana yanjira yodziwira ndi kuchiza matendawa.

Njira iyi yodziwira matenda ndi mankhwala amawonekera mu njira zomwe mabungwe apadziko lonse lapansi ndi mayiko amapanga.

Pakadali pano, kafukufuku sanakhazikitse njira zonse zamtunduwu zomwe zimathandizira kubadwa kwa matendawa, ndipo kuzindikira kwa zomwe zimayambitsa kukulitsa kwa matenda othandizira ndi chinthu chofunikira kwambiri chomwe chikukhudza kusankha kwa njira yamankhwala.

Pakuwunika kwa CP komanso kugawa kwa matenda malinga ndi maumboni, gulu lomwe lidayesedwa ndi bungwe lapadziko lonse lapansi la gastroenterologists limagwiritsidwa ntchito.

Mitundu yotsatirayi ya pathology imasiyanitsidwa:

Zoopsa, mwachitsanzo, mawonekedwe a mowa kapena mlingo.Amapezeka mu 2/3 pama milandu onse omwe adapezeka ndi matendawa.
Fomu ya Idiopathic.
Zopatsirana.
Odalirika.
Cholowa.
Autoimmune.
Zopindulitsa.

Nthawi zambiri, CP imapitiriza kukula kwa chifuwa chachikulu cha pancreatitis, koma pamakhala zochitika zina ngati matenda atayamba kukhala ngati matenda obwera pawokha.

Kuphatikiza pa kuledzera, tikulimbikitsidwa kuganizira zina zomwe zingakhale:

cholelithiasis
poizoni ndi mankhwala oopsa,
kukhalapo kwa matenda opatsirana,
mavuto azakudya
zovuta zamagazi zam'deralo (ma spasms ndimagazi),
kulephera kwa aimpso.

Kuphatikiza apo, njira zingapo za kutupa zimatha kukhala chifukwa cha CP.

Ngati mtundu wa matenda owopsa wazindikiridwa ndi kuyimitsidwa mwa wodwala, wodwalayo amalandila kuyamwa komwe kumayendetsedwa molingana ndi kukula kwa matenda osachiritsika m'thupi.

Ku Russia, Association of Gastroenterologists yatulutsa malingaliro apadera amtunduwu pochiza matenda apamba.

Cholinga cha malangizowa ndikupanga njira yolumikizirana yodziwira matendawa ndi kulandira chithandizo cha CP.

Njira zoyesera

Kupezeka kwa CP wodwala kumatha kukayikiridwa mwa wodwala ngati ali ndi kupweteka kwapadera pamimba ndi zizindikiro zamankhwala, kupezeka kwake komwe kumadziwika kuti ndi exocrine pancreatic insuffence. Mawonekedwe awa ndi amtundu wa odwala omwe amakonda kumwa mowa ndi kusuta fodya.

Chochititsa chomwe chikuthandizira kuoneka kwa matenda, malinga ndi malingaliro omwe apangidwa, mwina kupezeka kwa matenda omwewo m'mabanja.

Kusiyana pakati pa CP ndi pachimake ndizinthu zomwe sizimawonedwa kawirikawiri, zomwe zimapangitsa kuchuluka kwa michere m'magazi ndi mkodzo.

Ngati zoterezi zimawonedwa, ndiye kuti nthawi zambiri zimakhala zodziwika pakapangidwe ka thupi la pseudo-cystic kapangidwe kapangidwe ka kapamba ka pancreatic.

Ngati kuchuluka kwa amylase kwapezeka m'thupi, wina akhoza kuganiza za zakunja kwa hyperamylasemia kunja kwa thupi.

Pozindikira, njira zotsatirazi ndizomwe zimagwiritsidwa ntchito:

Ultrasound yam'mimba.
Multispiral computed tomography.
MRPHG ndi EUSI.
Endoscopic retrograde cholangiopancreatography.
Classical njira za kutsimikiza kutsimikiza kwa kuchuluka kwa pancreatic madzi.
Kutsimikiza kwa elastase-1 mukupanga ndowe pogwiritsa ntchito enzyme immunoassay

Ultrasound yamimba yam'mimba imatha kutsimikizira kupezeka kwa mawonekedwe okhawo a CP omwe akuwonekeratu kusintha kwa ma cell mu kapangidwe ka minofu yam'mimba.

Buku lofunsa la madokotala limalimbikitsa kugwiritsa ntchito ma ultrasound poyeserera kuti awone momwe wodwalayo alili ndi matenda ake ndipo ngati munthuyo ali ndi vuto la kapamba pamatumbo.

Tiyenera kukumbukira kuti kusapezeka kwa zizindikiro zakukula kwa matendawa malinga ndi ultrasound sikumatula kupezeka kwake m'thupi la wodwalayo.

Multispiral computed tomography ndi njira yomwe imakhala yothandiza kwambiri poyerekeza ndi ultrasound yam'mimba.

Chidziwitso chodziwikiratu komanso chololera kuzindikiritsa kusintha kwa pancreatic parenchyma koyambirira koyambirira kwa matendawa ndi njira za MRPHG ndi EUSI ndikulimbikitsa panthawi yomweyo ndi secretin, koma secretin sinalembetse ku Russian Federation.

Kugwiritsa ntchito kwa MRI ndi MRCP kopanda chinsinsi sikupereka phindu pozindikira CP.

Chithandizo cha matenda

Malangizo amtundu wa National pancreatitis amalangiza njira zapakhosi zochizira kuti zichepetse zizindikiro za matendawa komanso kuti magazi asadutsidwe.

Kuthetsa mawonekedwe osakhala koopsa kumachitika potsatira kugwiritsidwa ntchito kwa mankhwalawa othandizira chithandizo, chomwe chimaphatikizapo kudya, zakudya, chubu yam'mimba, kugwiritsa ntchito kuzizira pamimba m'dera la kapamba, kuyika kwa mankhwala a ululu ndi mankhwala a antispasmodic.

Ngati njira yabwino yogwiritsira ntchito njira zoyambirira zamankhwala sizikupezeka mkati mwa maola asanu ndi limodzi, kupezeka kwa mawonekedwe owopsa a matenda kumadziwika.

Malinga ndi malingaliro omwe adazindikira ntchito zisanu ndi imodzi zamankhwala:

kusiya kumwa mowa ndi kusuta,
kudziwa zoyambitsa ululu pamimba,
Kuchotsa kwa exocrine pancreatic insuffence,
chizindikiritso ndi kuchotsa kwa endocrine kusakwanira koyambirira,
thandizo lazakudya,
pancreatic adenocarcinoma.

Njira zamankhwala zimaphatikizapo chithandizo chokhazikika. Mulingo woyenera wabwino kwambiri wamankhwala umatheka pokhapokha mutangoyamba kumene chithandizo.

Chithandizo cha Conservative ziyenera kuyamba mu maora 12 oyamba atadwala matenda oyamba. Zikakhala zotere, mwayi wopeza zotsatira zabwino ukuwonjezeka.

Malinga ndi malangizo omwe akupangidwira, kuchotsedwa kwa zovuta zomwe ndi njira zosatsimikizika za endoscopic kumachitika pogwiritsa ntchito njira ya opaleshoni - laparotomy.

Zisonyezero zothandizira opaleshoni

Pofuna kuzindikira mawonekedwe owopsa, kulowererapo kumasonyezedwa. Chowonadi ndi chakuti kukula kwa matendawa kumabweretsa kuwonongeka kwa thupi la endocrine yake ndi ntchito za exocrine. Njira ya laparoscopy imagwiritsidwa ntchito ngati njira yodziwira matenda komanso njira zochizira.

Kugwiritsa ntchito njirayi yopangira opaleshoni m'thupi la wodwalayo kumachitika ngati kupezeka kwa peritoneal syndrome kumapezeka.

Kuphatikiza apo, dokotalayo amagwiritsa ntchito laparoscopy pamene kupezeka kwa madzimadzi aulere kwapezeka m'mimba.

Ngati kuchitidwa opaleshoni ya laparoscopy sikutheka, ndiye kuti kugwiritsa ntchito laparocentesis kukuwoneka.

Opaleshoni ya Laparoscopic amatha kuthetsa ntchito zotsatirazi:

Kutsimikizira kwa wodwala matenda ake.
Zizindikiro zodalirika za matenda akulu.
Njira yakuchiritsira.

Mukukonzekera matendawa, kupezeka kwa exocrine pancreatic insuffence kumawonedwa. Pambuyo pa opaleshoni, kukonzanso komwe kumathandizira kumakonzedwa ndikuthanso chithandizo chaumoyo wa nthawi yayitali chikugwiritsidwa ntchito kulipirira. Mlingo wa mankhwala a enzymatic omwe amatengedwa zimadalira kuchuluka kwa chitukuko cha kapamba.

Pakukonzekera kugwiritsa ntchito mankhwala olowa mmalo, mankhwalawa amagwiritsidwa ntchito omwe amakhala ndi ma pancreatic enzymes.

Kuphatikiza apo, chithandizo chothandizirana chimachitika, chomwe chimatenga zovuta za mavitamini osungunuka a mafuta, omwe amaphatikiza mavitamini A, D, E, K ndi B.

Komanso, chithandizo chamankhwala chofanana chimaphatikizanso kugwiritsa ntchito kashiamu.

Mavuto a postoperative omwe angakhalepo

Pochotsa matenda, njira zopangira opaleshoni zimagwiritsidwa ntchito pochotsa madera omwe akhudzidwa.

Nthawi yotsitsimutsa ya postoperative imakhala ndi chithandizo chokwanira cha mankhwala ndikutsatira malangizo othandizira odwala matenda a matenda a mtima.

Kupezeka kwamavuto a postoperative ndizovuta zambiri zomwe zimachitika mu CP. Malinga ndi ziwerengero, zovuta zimachitika mu 40% ya milandu.

Mu nthawi ya postoperative, mapangidwe a fistula ndikotheka, kuyambiranso kwa mutu wa pancreatic kumatha kupangitsa kuti ma magazi ayambe kutuluka.

Kutha kwa mavuto a pachimake kapamba amachitika mu chipinda chosamalira odwala pogwiritsa ntchito mankhwala a antibacterial. Gulu lotchulidwa la mankhwalawa limagwiritsidwa ntchito kupatula zomwe zimachitika ndi zovuta za septic.

Nthawi yothandizira kuchira imafuna chidwi chambiri ndi zakudyazo, makamaka kutsatira boma lake.

Malangizo azachipatala a kapamba amayenera kudya zakudya zosenda zokha. Kuphika kuyenera kuchitidwa ndi nthunzi kapena kuwira. Kutentha kwa zakudya zomwe zimadyedwa sikuyenera kupitirira 50 digiri Celsius.

Chakudya chozizira kwambiri komanso chotentha chitha kuvulaza kapamba. Zakudya ziyenera kukhala zopindika, kuchuluka kwa chakudya kuyenera kukhala kosachepera sikisi patsiku.

Opaleshoni kuti muchepetse zovuta za CP zimatanthawuza ma opaleshoni ovuta, motero njira zotere ziyenera kuchitidwa ndi madokotala oyenerera omwe amagwiritsa ntchito zida zamakono.

About pancreatitis yayikulu akufotokozedwa mu kanema munkhaniyi.

Sonyezani shuga yanu kapena sankhani jenda kuti muyiyikire.

Wotsutsa nkhani yasayansi yokhudza zamankhwala ndi zaumoyo, wolemba pepala lasayansi - Kucheryavy Yury Alexandrovich, Andreev Dmitry Nikolaevich

Nkhaniyi ikuwunikiranso malangizo amayiko a Russian Gastroenterological Association kuti apezeke ngati ali ndi matenda a kapamba kuyambira 2014. Ikuwonetsa njira zamakono zodziwunikira komanso magawo olondolera a odwala omwe ali ndi pancreatitis yosatha muzochitika zamankhwala.

RUSSIAN GASTROENTEROLOGIC ASSOCIATION RECOMMENDATIONS DIAGNOSIS NDIPO KULIMBITSA KWA CHRONIC PANCREATITIS (2014): KUDZIWA ZABWINO

Pepa limapereka chidule chachidule cha zomwe Russian Gastroenterologic Association ikuyang'anira kuti apatsidwe ndi kuchiza pancreatitis yayitali ya chaka cha 2014. Njira zodziwikira za matenda omwe amapezeka ndi njira yopita kuchipatala kwa odwala omwe ali ndi pancreatitis yosatha akufotokozedwa. Zina zofunika kuzindikiridwa.

Ndime ya ntchito yasayansi pamutu wakuti "Mwachidule pofotokozera pazoyesedwa ndi Russian Gastroenterological Association kuti apezeke ngati ali ndi matenda a chifuwa chachikulu (2014)"

CHITSANZO CHA MABODZA A NATIONAL RECOMMENDATIONS A RUSSIAN GASTROENTEROLOGICAL ASSOCIATION ON DIAGNOSTICS NDIPO KULIMBITSA KWA CHRONIC PANCREATITIS

Kucheryavy Yu.A., Andreev D.N.

GBOU VPO "University State Medical-Dental University ku Moscow yotchedwa A.I. Evdokimova »Ministry of Health of Russia (MGMSU dzina lake A.I. Evdokimov), 127473, Moscow, st. Delegatskaya, 20/1, Russian Federation

Mawu ofunikira: chifuwa chachikulu, matenda, chithandizo, malangizo.

RUSSIAN GASTROENTEROLOGY ASSOCIATION RECOMMENDATIONS DIAGNOSIS NDIPO KULIMBITSA KWA CHRONIC PANCREATITIS (2014): KUDZIWA ZABWINO

Kucheryavyy Yu.A., Andreev D.N.

Moscow State University of Medicine ndi Dentistry yotchedwa A.I. Evdokimov (MSUMD), 20/1 Delegatskaya ul., Moscow, 127473, Russian Federation

Pepalali likuwunikira mwachidule zomwe zimaperekedwa ndi a Russian Gastroenterologie Association ofunikira kuti azitsimikizira ngati ali ndi matenda a kapamba kuyambira 2014. Njira zodziwikira za matenda omwe amapezeka ndi njira yopita kuchipatala kwa odwala omwe ali ndi pancreatitis akufotokozedwa. Zina zofunika kuzindikiridwa. Mawu ofunikira: chifuwa chachikulu, matenda, chithandizo, malangizo.

M'mayiko ambiri a padziko lapansi, malangizo apadziko lonse adapangidwa kuti apezeke ngati atapezeka ndi matenda osokoneza bongo a pancreatitis (CP) komanso exocrine pancreatic insufficiency (APP). Mpaka posachedwa, Russia idalibe malingaliro a mulingo uwu, ngakhale kufunikira kwakupanga kwawo kuti athandizire othandizira azaumoyo.

Mu Januwale 2013, Russian Journal of Gastroenterology, Hepatology, Coloproctology inafalitsa zoyeserera za Malangizo a Russian Gastroenterological Association (RGA) kuti adziwe ndi kuthandizira CP ndipo adalemba patsamba la RGA kuti adziwe zambiri. Mu 2013-2014 polojekitiyi idakambidwa pamiyeso yonse ya RSA, komanso zotsutsana kwambiri pamasamba omwe amafalitsidwa mwapadera 2, 3. Kuti apange chikalata chomaliza, olemba ndi akatswiri omwe adatenga nawo gawo popanga zisankho adasanthula zomwe adalandira kuchokera kwa madotolo othandizira pachaka

azaumoyo ndi asayansi. Kuti athandizire kumvetsetsa kutsimikizika kwa sayansi pazomwe zaperekedwa, malingaliro monga kuchuluka kwa umboni (UD) komanso kuchuluka kwa kudalirika kwa malingaliro (SNR) ofunsidwa ndi Oxford Center for Evidence-based Medicine amagwiritsidwa ntchito.

Cholinga cha buku lino ndikuwonetsa mwachidule malingaliro aku Russia omwe akufotokozera.

Kuzindikiritsa kwa CP kumatha kuganiziridwa pakakhala zovuta zokhudzana ndi kupweteka kwam'mimba komanso / kapena zizindikiro zamatenda zakulephera kwa exocrine pancreatic function (kapamba) wodwala yemwe amakonda kumwa mowa ndi / kapena kusuta. Mbiri yabanja yamatenda ingakhalenso chiopsezo ku CP. Mosiyana ndi pancreatitis yovuta, kuwonjezeka kwa michere sikumawonedwa kawirikawiri ndi CP

m'magazi kapena mkodzo, ngati izi zichitika, mapangidwe a pseudocysts kapena pancreatic ascites amatha kukayikiridwa. Mlingo wokhazikika wa amylase m'magazi umati macroamylasemia kapena kukhalapo kwa magwero ena a hyperamylasemia.

Transabdominal ultrasound (ultrasound) imatha kutsimikizira kuwunika kwa CP yokhwima yokha ndikusintha kwakukulu kwazinthu (UD 4 - CHP C) 1. Kugwiritsa ntchito bwino ma ultrasound modabwitsa kuti ayang'anire wodwala amene wapezeka kale kuti akudziwa za CP komanso ma pseudocysts a kapamba (UD 2b - SNR B). Tikugogomezera: kusowa kwa zizindikiro za CP malinga ndi transabdominal ultrasound sikumapatula kuzindikiritsa kwa CP (UD 1b - CHP A).

Multispiral computed tomography (MSCT) ndiyo njira yosankhira matenda a CP ku Russian Federation (UD 3 - SNR S). Mbali imodzi, MSCT imakulitsa kwambiri kuzindikira kwa transabdominal ultrasound, ndipo inayo imadziwika ndi kupezeka kwakukulu kwambiri poyerekeza ndi endoscopic ultrasound (EUS) ndi maginito a resonance pancreatocholangiography (MRCP) ndi secretin. Kusakhalako kwa kusintha kwa kapamba mu MSCT sikutanthauza kuti wodwala alibe gawo loyambirira la CP (UD 2b - CHP B), koma kuthekera kwake ndikotsika kwambiri poyerekeza ndi transabdominal ultrasound (UD 1b - CHP A). Ichi ndichifukwa chake zotsatira zoyipa za MSCT kupezeka kwa kupweteka kwapamimba ndichizindikiro cha EUS (UD 2b - CHP B).

Njira zabwino kwambiri zodziwira kusintha kwa ma parenchyma ndi ma ducts koyambirira kwa CP ndi MRPHG ndi EUS ndi kukondoweza ndi secretin (UD 2a - CHP B). Koma ku Russian Federation, secretin sinalembetsedwe, ndipo imagonance imaging (MRI) popanda kusiyanitsa ndipo MRCP popanda kukondoweza ndi secretin ilibe phindu pakudziwika kwa CP poyerekeza ndi MSCT (UD 2a - CHP B).

Endoscopic retrograde cholangiopan kulenga (ERCP) imatha kuwona kusintha mkati

1 Zopereka zonse za UD ndi CHP ziyenera kuyanjanitsidwa ndikuwonetsedwa kwa malingaliro.

ma ducts, kupezeka kwa ma pseudocysts ndikukhazikitsa chidziwitso chodalirika cha CP. Pakusowa kwa EUS kapena ngati zotsatira za MRCP ndizokayikitsa, njirayi ikhoza kukhala yopindulitsa kwambiri, ngakhale kuti chifukwa chakuwononga chadzaza ndi zovuta.

Njira zowerengera zakale zowerengera kuchuluka kwa madzi a pancreatic, kudziwa kuchuluka kwa michere ndi ma bicarbonates m'maguluwo ndizosagwiritsidwa ntchito kwenikweni podziwitsa za CP chifukwa cha kusowa, mtengo wokwera, kupezeka kochepa kwa zinthu zolimbikitsa (mpaka pano, mankhwala sanalembetsedwe kugwiritsidwa ntchito kwachipatala ku Russian Federation), ndalama zogulira antchito komanso kulekerera pang'ono ndi odwala. Malinga ndi njirazi, ndizosatheka kusiyanitsa CP kuchokera pakusakwanira kwa ntchito ya pancreatic popanda CP. Mwambiri, njira zodziwikitsa mwachindunji zitha kugwiritsidwa ntchito ngati gawo la mayesero azachipatala m'makliniki apadera kwambiri. Nthawi zina zovuta, njira zofufuzira zimatha kugwiritsidwa ntchito pakuwonetsa matenda a steatorrhea.

Kudziwitsa kwa elastase-1 mu ndowe ndi enzyme immunoassay (pogwiritsa ntchito antibodies a monoclonal) Ndipo phunziroli silowukira komanso lotsika mtengo. Mukamadutsa pamimba, m'mimba-1, mumakhala kukhazikika poyerekeza ndi michere ina ya pancreatic. Zotsatira zoyeserera sizimayimira payekha chithandizo, chifukwa njirayi imangotengera elastase yaumunthu. Komabe, njirayi imadziwika ndi chidwi chochepa chovomerezeka chokhala ndi chilolezo chochepa komanso chapakatikati (63%) komanso chotsika cha matenda am'mimba, osagwirizanitsidwa ndi kapamba b. Kuzindikira kwa kutsimikiza kwa kutsimikiza kwa elastase-1 mu ndowe kumatsika kwambiri ndikamafulumizitsa ndima, kutsegula m'mimba ndi polyfecalia. Ndipo mfundo zotsika chifukwa cha kuchepa kwa enzyme zimabweretsa zotsatira zabodza. Zofanana, zokhazokha ndi makina osiyana, zimatha kuwonedwa ndi kukula kwama bakiteriya m'matumbo ang'ono chifukwa cha bakiteriya hydrolysis ya elastase. Odalirika kwambiri akuwoneka kuti ndi digiriyo

Curly Yuri Alexandrovich - Mkati. wokondedwa mu Economics, Pulofesa Wothandizira, Department of Propaedeutics of Internal Disease and Gastroenterology, MGMSU A.I. Evdokimova. Andreev Dmitry Nikolaevich - Wothandizira, Dipatimenti ya Propaedeutics of Internal matenda ndi Gastroenterology, Moscow State Medical University yotchedwa pambuyo A.I. Evdokimova.

Kwa makalata: Dmitry Nikolaevich Andreev - 127473, Moscow, ul. Delegatskaya, 20/1, Russian Federation. Foni: +7 (905) 524 25 53. Imelo: [email protected]

Kucheryavyy Yuriy Aleksandrovich - MD, PhD, Pulofesa wothandizira, Dipatimenti ya Matenda Akati Mochulukitsa ndi Gastroenterology, MSUMD. Andreev Dmitriy Nikolaevich - MD, wothandizira kafukufuku, Department of Internal Disease Propedeutics and Gastroenterology, MSUMD. Kulemberana makalata ndi: Andreev Dmitriy Nikolaevich - 20/1 Delegatskaya ul., Moscow, 127473, Russian Federation. Tele.: +7 (905) 524 25 53. Imelo: [email protected]

Kukhazikika kwakanthawi pambuyo poyimitsa / kuchepetsa mawonekedwe ofunikira a exocrine pancreatic insufficiency (ENPI) (kutsegula m'mimba, steatorrhea) pakadali koyamba ndi mankhwala amakono a multenzyme.

Kuchepa kwa zomwe zili mu elastase-1 mu ndowe zimayimira pulayimale ya ENPI (0-100 μg / g - yayikulu, 101-200 - yapakatikati kapena yofatsa) ndipo imakhala chizindikiro kwa moyo wonse, nthawi zambiri pamakhala mankhwala a enzyme ambiri. Kuti muwone mulingo wa elastase muzosintha sizikumveka, popeza kuchuluka kwa maselo apachifwamba omwe amakhala okonzekera chinsinsi sangakulitse.

Kuzindikira kwa kusowa kwa endocrine kuyenera kukhala kwakanthawi komanso kokwanira. Zimachitika pokhazikika pozindikira kuchuluka kwa glycosylated hemoglobin (HLA1c), kuthamanga magazi komanso kuchita mayeso opsinjika ndi shuga. Kuphatikiza apo, mtundu woyang'ana bwino sichinadziwikebe. Chifukwa chake, pakuwonetsetsa kuti ali ndi matenda ashuga, International Expert Committee (IEC) ndi American Diabetes Association (American Diabetes Association NDI ADA) adalimbikitsa kugwiritsa ntchito HbA1c (kuwunika kwa matenda ashuga kumakhazikitsidwa pamlingo wa HbA1c> 6.5%, m'malo mongolimbana ndi shuga magazi. Ubwino wa kuyesedwa kwa HbA1c wagona pakusintha kocheperako kazotsatira zazotsatira zamagazi a 8, 9. Udindowu umathandizidwanso ndi malingaliro aku Russia.

Kuti muwone kuopsa kwa maphunzirowa ku CP komanso kuneneratu za zovuta ndi zotsatirapo zoyipa, odwala onse omwe ali ndi CP, onse atalowa kuchipatala komanso ngati amawatulutsa, akuyenera kuwunika pazakudya zawo. Zimakhazikitsidwa pa kuwerengera kwa misa ya body index (BMI), kuchepa kwa thupi ndi kuchuluka kwake mwamphamvu, kupezeka kwa zizindikiro zosadziwika za tropholozwi kusakwanira komwe kwapezeka pakuwunika kwa wodwala - kuchepa kwa magazi, kuchepa kwa khungu, zizindikiro za kwashiorkor, ndi zina zambiri. 10, 11.

Odwala ambiri (> 90%) omwe ali ndi CP omwe ali ndi zikwangwani zosiyanasiyana za kuchepa kwa tropholoengqondo ali ndi kuchepa kwamtundu wa 10, 12. Komanso, kuchepa kwa matulukidwe nthawi zambiri kumayamba mwa odwala omwe ali ndi CP, ngakhale ndi BMI yabwinobwino kapena yokwezeka. Chifukwa chake, kuchepa thupi ndizofunikira kwambiri pazochitika zakukula kwa tropholoengqondo.

Kuwerengera kwawogwiritsa ntchito zakudya zopezeka mthupi kumapezeka m'makiriniki ambiri aku Russia.Njira imeneyi imagwira ntchito pogwiritsa ntchito mayeso angapo osavuta - kutsimikiza kwathunthu kwamapuloteni, albumin, kuchuluka kwathunthu kwa zotumphukira zamagazi, ma hemoglobin. Kupititsa patsogolo mitundu yazosiyanasiyana ya michere ya tropholoengqondo kusakwanira kuti tidziwe kuchuluka kwa mapuloteni obwezeretsanso, vitamini B12, folic acid, transerrin, magnesium, zinc amatilola kuti tidziwe momwe wodwala alili ndi CP mwatsatanetsatane.

Kuzindikira kwakanthawi ndikuwongolera kupatuka kwakakonzedwe ka zakudya mwa odwala omwe ali ndi CP kumathandizira kwambiri matendawo, kumathandizira kuchepetsa nthawi yakuchipatala ndikuchepetsa ndalama zamankhwala mwachindunji, zomwe madokotala akuyenera kuzilingalira pochita kwawo 10, 11 (UD 3 - CHR B).

Zimatsimikiziridwa kuti chifukwa cha malabsorption a pancreatogenic, CP imakhala yovuta chifukwa cha mafupa. Pankhaniyi, tikulimbikitsidwa kuti kuwunika kamodzi kwa kuchuluka kwa minofu ya x-ray densitometry (UD 4 - SNR S). Tiyenera kukumbukira kuti sayansi ikumveka, kuphatikiza pakuwona chuma, kuwunika kwa kagayidwe ka calcium kwa odwala popanda hyperparathyroidism sikunapangidwe (UD 5 - CHP D).

Ma genetic diagnostics (masinthidwe amtundu wa CFTR, 5RSK1) a matenda obadwa nawo pancreatitis pakali pano sagwiritsidwa ntchito kwenikweni kuchipatala 15, 16.

Chifukwa chake, kuwunika kwa CP kungapangike pokhapokha pamakhalidwe odalirika kapena kuphatikiza kwa morphological ndi magwiridwe antchito. Pankhaniyi, kuzindikira kwa CP kumayambiriro, ngakhale kupezeka kwa njira zingapo zamalingaliro, kumakhalabe ntchito yovuta.

Mankhwala othandizira odwala omwe ali ndi CP cholinga chake ndikuthandizira kuchepetsa zizindikiro komanso kupewa kukula kwa zovuta. Pali zolinga zazikuluzikulu zisanu ndi chimodzi zamankhwala 1, 2, 4, 5, 8.

1. Kuthetsa kumwa kwauchidakwa ndi kusiya kusuta fodya: Ndipo mosasamala kuti amati matendawa ndi chiyani, kuchuluka kwa zakumwa tsiku lililonse ndi kuchuluka kwa ndudu zomwe zasuta, komanso kutalika kwa nthawi yomwe muledzera komanso kusuta fodya.

2. Kudziwa zoyambitsa zam'mimba ndikumachepetsa mphamvu yake.

4. Kuzindikiritsa komanso kuchiza matenda a endocrine osakwanira m'magawo oyamba (kusanachitike zovuta.)

5. Thandizo la zopatsa thanzi.

6. Kuyang'aniridwa kwa pancreatic adenocarcinoma, makamaka pamaso pa zinthu zotsatirazi zoopsa: cholowa chamtundu (banja) kapamba, mbiri yokhala ndi khansa yapakhansa, mbiri yayitali ya CP yotsimikiziridwa, zaka zopitilira 60.

Timazindikira makamaka: odwala onse omwe ali ndi CP ayenera kulangizidwa kuti asiye kusuta fodya komanso kumwa mowa (UD 2b - CHP B).

Odwala a CP ali pachiwopsezo chachikulu cha kuchepa kwa zakudya m'thupi (UD 3 - CHP C). Kuperewera kwa zakudya za "pancreatic" mwasayansi kumatsimikizira kufunikira kwa wodwala aliyense. Mankhwala othandizira pakudya, omwe akuwonetsa kukulitsa kwa chakudya, komanso njira zamakono zama enzyme, ndi njira yothandiza kupewa kuperewera kwa micro- micronutrients (UD 3 - CHP C). Panthawi yoyenera, zakudya za wodwala yemwe ali ndi CP siziyenera kusiyana pakapangidwe ndi kuchuluka kwa zakudya za munthu wathanzi (UD 4 -CHP C).

Kuti muchepetse kupweteka m'mimba, njira yotsatirayi ikulimbikitsidwa:

- khazikitsani chomwe chimayambitsa kupweteka kwakanthawi kupatula matenda omwe amafunikira endoscopic ndi / kapena chithandizo cha opaleshoni (UD 2b - CHP B),

- patsani wodwalayo chakudya chophatikiza ndi magawo onse (onjezerani kuchuluka kwa mafuta omwe amangodya kokha ndi steatorrhea osavomerezeka), ndikulimbikitsa kukana kwathunthu mowa ndi kusuta fodya (UD 4 - CHP C),

- lembetsani analgesics kwa odwala omwe ali ndi ululu waukulu: paracetamol kapena mankhwala osapweteka a antiidal (UD 4 - CHP C). Ngati sikokwanira, pitani ku tramadol. Nthawi zina, pangafunike kugwiritsidwa ntchito pafupipafupi kwa ma narcotic analgesics kapena kuwonjezeredwa kwa milungu isanu ndi iwiri yoyeserera ndi michere yambiri kapena ma pancreatin minimicrospheres osakanikirana ndi mankhwala a antisecretory (proton pump inhibitors) ndi vitamini-mineral complexes.Kapenanso, mankhwala owonjezera a antidepressants (UD 4 - CHP C) kapena pregabalin (UD 1b - CHP A) ndiwothekanso, omwe amachepetsa mawonetseredwe a kupsinjika, amachepetsa kupsinjika kwa ululu ndikupatsanso mphamvu ya ma analgesics osaphatikizidwa a narcotic,

- ndi kusagwira bwino ntchito kwa mankhwala osokoneza bongo kwa miyezi itatu kapena kuchuluka kwa mankhwala a narcotic analgesics kwa masabata awiri, kufunsa kwa opaleshoni ndikutha

Skopista kuti athe kuyesa njira zothandizira kupwetekedwa mtima pogwiritsa ntchito njira za endoscopic kapena opaleshoni.

Mfundo zoyenera kuchitira chilolezo chokhalamo ndi motere.

• Zakudya zazing'ono zam'mapulogalamu ambiri komanso zomanga thupi. Kuchuluka kwa ziletso zamafuta zimatengera kuuma kwa malabsorption komanso mphamvu ya mankhwala othandizira (UD 3 -CHP C).

• Mothandizidwa mothandizidwa ndi mankhwala othandizira ena m'chipatala posonyeza kuperewera kwa mphamvu ya pocreatic pantreatic (UD 1a - CHP A).

• Mankhwalawa malabsorption, gwiritsani ntchito microtablets kapena minimicrospheres a kapamba omwe amaphatikizidwa ndi enteric:: Ndiwothandiza kwambiri kuposa othandizira osatetezedwa komanso pancreatin woikidwa ndi pancreatin wokutira (UD 1b - CHP A).

• Mankhwala ochepetsa pancreatin osavomerezeka oyambitsidwa ndi chithandizo choyambirira ayenera kukhala ndi 25000-40000 PISCES ya lipase pachakudya chachikulu komanso 10000-25000 PIECES ya lipase pa chakudya chapakatikati (UD1b - CHP A).

Kuchita bwino kwa mankhwalawa kumatsimikizika pakukula kwa thupi ndikuchepetsa kuopsa kwa zizindikiro. Kukayikira kulikonse pakuchita bwino kuyenera kuonedwa ngati zikuwonetsa polojekiti yothandizira ma labotale ndikuthandizira kuwunika kwa enzyme m'malo mwake (UD 2a - CHP B).

• Ngati mankhwala othandizira alowa m'malo mosakwanira muyezo woyambirira, muyezo wa minimicrospheres kapena pancreatin microtablets (UD 4 - CHP C) uyenera kuchulukitsidwa.

• Ngakhale kusunga zizindikiritso zakukhazikika, ngakhale mutatenga kuchuluka kwakukulu kwa kukonzekera kwa enzyme kokutira kwa enteric, chithandizo chamankhwala chiyenera kutsimikiziridwa kuti chimapondera chapamimba (proton pump inhibitors) (UD 4 - CHP C).

• Kukhalapo kwa kuperewera kwamphamvu kwa pancreatic pambuyo povutika ndi kapamba kapenanso kufooketsa kapamba wochepetsedwa kwambiri chopondapo-1 (zosakwana 200 μg / g) kumawonetsa kufunikira kwa chithandizo chamankhwala chamoyo wonse (UD 1a - CHP A).

Pochiza matenda a shuga ndi CP, munthu ayenera kuyesetsa kukonza glycemic control kuti apewe zovuta za matenda ashuga, kupewa chitukuko cha hypoglycemia.

Njira zamomwe angayendetsere wodwala ndi CP zimaphatikizapo magawo angapo.

1. Kuzindikira kwa CP (koyambirira kwa kutsimikizika kwamatenda kapena kupatula kwa CP ndikovuta).

MSCT / EUSI ± MRI ± MRCP; Kulephera kwa RV Palibe Cholepheretsa / Biliary

ndi chithandizo cha pathogenetic

Thandizo lathanzi, mankhwala othandizira olimbitsa

Ma analgesics, antioxidants, pancreatin, antidepressants, pregabalin

Pancreatin 25000-40000 IU lipase pa chakudya

Palibe zotsatira 3 miyezi

Mkuyu. 1. Njira zoyendetsera wodwala ndi CP yodziwitsa (CP) (gwero - zowonjezera ndi zosintha)

2. Kuyesa kuzindikira etiology ya CP (izi ndizofunikira, chifukwa zotsatira za etiotropic ndizothandiza kwambiri).

3. Kudziwitsa za gawo la CP (kumawunikira kusankha kwa njira zakuchiritsira ndikuthandizira zakukula).

4. Kuzindikira kuperewera kwa kapamba (maziko osankha njira yothandizira enzyme ndi mankhwala a insulin, kudziwa Mlingo wa mankhwala kapena kuzindikira kufunika kwa chithandizo cha opaleshoni).

5. Kupanga dongosolo la chithandizo (nthawi zina, lingaliro la mgwirizano ndi kutenga nawo gawo madokotala a opaleshoni, endoscopists, endocrinologists).

6. Kudziwa za matendawa poganizira momwe zinthu zinalili komanso njira zamankhwala zosankhidwa.

Kuzindikiritsa kwa "CP yina" kumakhazikitsidwa pogwiritsa ntchito njira zophunzitsira zozama mogwirizana ndi mawonekedwe a morphological (chidziwitso chosakwanira cha ultrasound, osachepera MSCT) kuphatikiza mawonetseredwe azachipatala.Zingachitike kuti ngakhale ma ultrasound kapena MSCT sangatsimikizire za matendawo, wodwalayo amatha kuthandizidwa ndikuwathandizanso ndi matenda a CP. Chifukwa chake, ngati kuzindikira kwa CP kwatsimikiziridwa motsimikizika, gawo loyamba ndikuyesa kuonetsera etiotropic (yothandiza kwambiri). Choyamba, izi zimagwira ntchito pazinthu zamtunduwu zomwe zimafuna nthawi yake komanso zovuta zake:

autoimmune pancreatitis - glucocorticosteroids, ndi zotsekera - opaleshoni kapena endoscopic decompression. Pamaso pa ENPI, ndikofunikira kudziwa mtundu wake - woyambirira (ndi kuchepa kwa elastase-1 malinga ndi momwe mpanda) kapena sekondale (yokhala ndi mulingo wabwinobwino wa elastase), popeza nthawi yayitali ya enzyme m'malo mwake imatengera izi. Kutalika kwa nthawi ya kutenga minimicrospheres kapena ma microtablets a pancreatin ngati kwachitika kuchepa kwachiwiri kwa mapiritsi kumatsimikizika ndi nthawi yothetsera zizindikiro, kuthekera kwofunafuna ndikuchotsa zomwe zimayambitsa kuperewera (mwachitsanzo, matenda a bakiteriya okulira kwambiri m'matumbo ang'onoang'ono). Ngati mukuyambiranso kwa steatorrhea mutatha kuletsa kapena kuchepetsa mlingo wa kapamba, ngakhale mutakhala ndi tanthauzo lathanzi lachifuwa-1, kufunikira kwa mankhwala amoyo 2, 17 ndikofunikira. Mankhwalawa akuwonetsedwanso kwa wodwala wokhala ndi zotsika za 1 stool elastase-1 chifukwa chosagwirizana ndi zotsatira zoyeseza zabodza. Pofuna kupweteka kosalekeza kuphatikiza mankhwala ophatikizira mankhwala ophatikizira pancreatin, analgesics, pregabalin kwa miyezi itatu, kukambirana koyenera kumathandizika (pamodzi ndi madokotala a opaleshoni ndi endoscopists) kuti athe kudziwa kuthekera kwa endoscopic kapena chithandizo chamankhwala opaleshoni. Kukhazikitsidwa kwa

Ululu ± pancreatic insuffidence

Thandizo lathanzi, mankhwala othandizira olimbitsa

Elastase-1 ndowe Zakudya, insulin (?)

Ma analgesics, antioxidants, pancreatin, antidepressants, pregabalin

Pancreatin 25000-40000 IU lipase pa chakudya

Palibe zotsatira 3 miyezi

Kufufuza kwathunthu, kufotokoza bwino za matendawo

Mkuyu. 2. Njira zakuyang'anira wodwala yemwe ali ndi CP yodziwunika (mwina kapena CP) (gwero - zowonjezera ndi zosintha)

Cotic analgesics imalumikizidwa ndi chiwopsezo chachikulu cha kusuta, komwe kumawonetsa kufunikira kwa chisankho chotere munthawi yochepa - mkati mwa masabata awiri.

Ngati chitsimikiziro chokwanira cha morphological cha CP sichingatheke, komanso chifukwa chakuti lero njira yodziwika bwino yofufuzira ma pancreatic parenchyma ku Russian Federation ndi ultrasound, mwa odwala ena, kutengera mbiri ndi chithunzi cha kuchipatala, kuwunika kwa "pancreatitis yayitali" ndikotheka kapena kotheka ( onani mkuyu. 2). Zomwezi zimachitikanso pakakhala kusowa kwa deta ya MSCT yodziwitsa za CP, ndipo nthawi zina ngakhale EUS (yosatsimikizika, CP, kapena kukayikira kwachipatala). Chifukwa chosatsimikizika pakuzindikira, kutsimikizira kwa autoimmune pancreatitis sikungatheke. Zotsatira zake, autoimmune pancreatitis imachoka pamndandanda wazinthu zamtundu wa etiology zomwe zingathe kuwunikira.

Kudziwa mtundu wa ENPI (wokhala ndi matenda otsimikizika kapena nthendayo) - pulayimale (yocheperako-elastase-1) kapena sekondale (yodziwika bwino ndi elastase) - imakhudza kusankha kwa nthawi yayitali ya chithandizo cha enzyme ndikukulolani kuti mulankhule molimba mtima za kukhalapo kwa CP (yokhala ndi radiation yofooka muyezo wa CP ndi kupezeka kwa kapamba

zokwanira). Njira yotenga pancreatin ngati vuto lachiwiri la kapamba limapangidwanso ndi nthawi yothetsera zizindikiro, kuthekera kosaka ndikuchotsa zifukwa zachiwiri zakusakwanira (mwachitsanzo, matenda a bakiteriya okulira kwambiri m'matumbo ang'onoang'ono). Chifukwa cha kusakhulupirira mu "pancreatic" matenda a shuga mellitus, kusankha kwa wothandizira wa hypoglycemic kuyenera kuchitika pamodzi ndi endocrinologist.

Ngati palibenso njira zina zodzitchinjiriza zomwe zimayimitsidwa kuti muchepetse kupweteka kwa etiology yosakhazikika, ndiye kuti, mosiyana ndi momwe zimakhalira ndi "CP yotsimikizika", ndikofunika, musanakumane ndi dokotala, kuti mumveke bwino za kupezeka kwa CP pogwiritsa ntchito njira zodalirika zowunika pancreatic morphology (EUS, MSCT, MRCP) 2, 4.

Zomwe zili pamwambazi zikuyimira malangizo oyambira omwe amathandizirana pa CP. Ndizotsatira zakuwunika kovuta kwa umboni wodalirika pakadali pano, poganizira zomwe zachitika.

Kukonzekera kwa Creon®-enzyme No. 1 molingana ndi kuchuluka kwa osankhidwa padziko lonse lapansi

% Creon - zoposa 80% ntchito

Ma enzyme omwe amagulitsidwa mkati mwa mphindi 152

% Maluso ochepera ochepera

Pancreatin 40,000 mayunitsi 50 makapisozi

mankhwalawa enzymatic

INN: kapamba. Nambala yolembetsa: LSR-000832/08. Fomu ya Mlingo: makapisozi obwera. Mankhwala: Kukonzekera kwa enzyme komwe kumakongoletsa chimbudzi. Ma pancreatic enzymes, omwe ndi gawo la mankhwalawo, amathandizira kugaya mapuloteni, mafuta, chakudya, zomwe zimapangitsa kuti azilowetsedwa m'matumbo ang'onoang'ono. Zotsatira za ntchito: propine pancreatic insufficiency ana ndi akulu, omwe amayamba chifukwa cha matenda osiyanasiyana am'mimba ndipo amatchuka kwambiri mu cystic fibrosis, chifuwa chachikulu, atachitidwa opaleshoni yapachimbudzi, pambuyo pa matenda a m'mimba. mwachitsanzo, Billroth II), kutsekeka kwa kapamba kapena kapangidwe ka bile duct (mwachitsanzo chifukwa cha neoplasm), Schwachman-Dai syndrome Monda, vuto pambuyo kuukira kwa pachimake kapamba ndi kuyambiranso kwa zakudya. Hypersensitivity ku zilizonse za mankhwala. Gwiritsani ntchito pa nthawi yoyembekezera komanso nthawi yoyamwitsa. Mimba: Palibe zowerengeka zamankhwala pazamankhwala a amayi apakati omwe ali ndi mankhwala okhala ndi ma pancreatic Enzymes. Fotokozerani mankhwalawa kwa amayi apakati mosamala. Nthawi yoyamwitsa: mukamayamwitsa, mutha kumwa ma enzoni a pancreatic. Ngati ndi kotheka, panthawi yoyembekezera komanso poyamwitsa, mankhwalawa amayenera kumwedwa pamlingo wokwanira wathanzi. Mlingo ndi makonzedwe: mkati. Makapisozi amayenera kumwedwa nthawi iliyonse mukatha kudya (kuphatikiza chakudya chochepa), kumeza lonse, osathyoka ndipo osatafuna, kumwa madzi ambiri. Ndikofunikira kuonetsetsa kuti magazi azidutsa mosadukiza ndi wodwalayo, makamaka ndi kuwonongeka kwamadzi ambiri. Kukhazikika kwa magazi kumatha kubweretsa kapena kuonjezera kudzimbidwa. Mlingo wa akulu ndi ana omwe ali ndi cystic fibrosis: mlingo umadalira thupi ndipo uyenera kukhala koyambirira kwa mankhwalawa 10OO lipase / kg pa chakudya chilichonse cha ana osaposa zaka zinayi, ndi 500 lipase mayunitsi / kg pakudya kwa ana osaposa zaka zinayi ndi akuluakulu. Mlingo uyenera kutsimikizika molingana ndi kuopsa kwa zizindikiro za matendawa, zotsatira za kuwunika kayendedwe ka magazi ndi kukhalabe ndi thanzi labwino. Odwala ambiri, mankhwalawa amayenera kukhala ocheperako kapena osapitirira 10,000 lipase mayunitsi / kg thupi patsiku kapena 4,000 lipase unit / g anadya mafuta. Mlingo wa zinthu zina zomwe zimaphatikizidwa ndi exocrine pancreatic kuchepa kwa mphamvu: mlingo uyenera kuyikiridwa ndikuganizira za wodwalayo, zomwe zimaphatikizapo kuchuluka kwa chimbudzi chokwanira komanso mafuta okhutira ndi chakudya.Mlingo womwe wodwala amafunikira limodzi ndi chakudya chachikulu chimasiyana kuchokera pa 25,000 mpaka 80,000 IU.F. lipases, komanso kumwa zokhwasula - theka la munthu. Mu ana, mankhwalawa ayenera kugwiritsidwa ntchito molingana ndi mankhwala a dokotala. Zotsatira zoyipa: kusokonezeka kwam'mimba thirakiti: kupweteka pamimba, kusanza, kusanza, kudzimbidwa, kutulutsa, kutsegula m'mimba. Mndandanda wazotsatira zonse zoyipa umaperekedwa mu malangizo ogwiritsira ntchito mankhwala. Matenda a pakamwa kwambiri: hyperuricosuria ndi hyperuricemia. Chithandizo: kusiya mankhwala, symptomatic mankhwala. Mogwirizana ndi mankhwala ena: palibe kafukufuku wokhudzana ndi omwe adachitika. Malangizo apadera: monga kusamala poyang'ana zizindikiro zosintha kapena kusintha kwam'mimba, kuyezetsa kuchipatala ndikofunikira kupatula michere yotupa yopindika, makamaka mwa odwala omwe amamwa mankhwalawa pa mlingo wopitilira 10,000 lipase unit / kg patsiku. Zambiri pamalangizo apadera zimaperekedwa mu malangizo ogwiritsira ntchito mankhwala. Zowonongera mphamvu yakuyendetsa galimoto ndi njira zina: kugwiritsa ntchito kwa Creon® 40000 sikukhudza kapena kuyambitsa pang'ono pakuyendetsa galimoto ndi makina. Kupita kwina mankhwala: mankhwala. Chidziwitso chonse cha mankhwalawa chimaperekedwa mu malangizo ogwiritsira ntchito mankhwala. IMALIRA kuyambira pa 04/02/2013

1. IMS Health, June 2013,

2. Lohr JM et al. Katundu wamakonzedwe osiyanasiyana a pancreatin omwe amagwiritsidwa ntchito mu pancreatic exorcln Insufflcency 'European Journal of Gastroenterology & Hepatology 2009.21: 1024-1031.

LLC Abbott Laboratories

125171, Moscow, Leningradskoye Shosse, 16a, malo. 1, 6th floor Tel. +7 (495) 258 42 80, fakisi: +7 (495) 258 42 81

Lonjezo la moyo

Zambiri za ogwira ntchito azachipatala komanso azamankhwala. Iyenera kugawidwa pokhapokha pamisonkhano ndi zochitika zina zokhudzana ndikusintha kuchuluka kwa akatswiri ogwira ntchito zamankhwala ndi zamankhwala, kuphatikiza ziwonetsero zapadera, msonkhano, msonkhano, zina.

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2. Curly JA, Maev IV. Njira zakuwongolera wodwalayo chifukwa cha kupweteka kwa kapamba chifukwa cha kukonzekera kwa 2013 kwa RGA. Dr. Roo. 2014, (2): 23-32. (Kucheryavyy YuA, Maev IV. Odwala omwe ali ndi pancreatitis yosatha: njira yowongolera pogwiritsa ntchito malangizo a 2013 RGA Draft. Doktor Ru. 2014, (2): 23-32. Russian).

3. Maev IV, Kucheryavy JA, Kazyulin AN, Samsonov AA. Malangizo amakono othandiza kudziwa matenda a kapamba nthawi yayitali. Zochita Zachinsinsi. 2013, (4): 84-9. (Maev IV, Kucheryavyy YuA, Kazyulin AN, Samsonov AA. Malangizo aposachedwa pa kupezeka kwa chifuwa chachikulu cha matenda apakhungu. Terapevticheskiy arkhiv. 2013, (4): 84-9. Russian).

4. Ivashkin VT, Maev IV, Okhlobystin AV, Kucheryavy JA, Trukh-manov AS, Sheptulin AA, Shifrin OS, Lapina TL, Osipenko MF, Simanenkov VI, Hlynov IB, Alekseenko SA, Alekseeva OP, Chikunova MB. Protocol yozindikiritsa ndi kuchiza matenda a kapamba. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2014.24 (4): 70-97. (Ivashkin VT, Maev IV, Okhlobystin AV, Kucheryavyy YuA, Trukhmanov AS, Sheptulin AA, Shifrin OS, Lapina TL, Osipenko MF, Simanenkov VI, Khlynov IB, Alekseenko SA, Alekseeva OP, Chikunova MV. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii. 2014.24 (4): 70-97. Russian).

5. Maev IV, Kucheryavyy AA, Samsonov AA, Andreev DN. Zovuta ndi zolakwika pakuwongolera kwa odwala omwe ali ndi chifuwa chachikulu. Zochita Zachinsinsi. 2013, (2): 65-72. (Maev IV, Kucheryavyy YuA, Samsonov AA, Andreev DN. Zovuta ndi zolakwika pamayendedwe othandizira odwala omwe ali ndi pancreatitis yosatha. Terapevticheskiy arkhiv. 2013, (2): 65-72. Russian).

6. Gullo L, Ventrucci M, Tomassetti P, Migliori M, Pezzilli R. Fecal elastase 1 kutsimikiza mtima kwa kapamba. Dig Dis Sci. 1999.44 (l): 210-3.

7. Maev IV, Kucheryavy JA, Moskaleva AB. Matenda a kapamba: nthano ndi zenizeni. Farmateka. 2010, (12): 24-31. (Maev IV, Kucheryavyy YuA, Moskaleva AB. Pancreatitis) nthano ndi zenizeni. Farmateka. 2010, (12): 24-31. Russian).

8. PC ya Bornman, Botha JF, Ramos JM, Smith MD, Van der Merwe S, Watermeyer GA, Ziady CC. Ndondomeko yakuzindikiritsa ndi kuchiza pancreatitis yayitali. S Afr Med J. 2010,100 (12 Pt 2): 845-60.

9. Olson DE, Rhee MK, Herrick K, Ziemer DC, Twombly JG, Phillips LS. Kuwona za matenda ashuga komanso matenda ashuga omwe ali ndi njira zodziwitsira za A1C. Kusamalira Matenda a shuga. 2010.33 (10): 2184-9.

10. Cur-mutu wotsogolera SA, Maev IV, Moskaleva AB, Saydullaev MG, Tsukanov VV, Dzhavatkhanova RT, Smirnov AB, Ustinova NN. Mphamvu ya zakudya paumoyo wa kapamba. Malangizo azachipatala. 2012, (2): 100-4. . )

11. Curly-mutu SA, Moskalev AB, Sviridov AB. Zakudya zaumoyo monga chiopsezo cha zovuta za kapamba komanso kuperewera kwa kapamba. Kuyesa ndi zamankhwala gastroenterology. 2012, (7): 10-6.(Kucheryavyy YuA, Moskaleva AB, Sviridova AV. Zakudya zaumoyo monga chiopsezo cha zovuta za chifuwa chachikulu komanso kuperewera kwa kapamba. Eksperimental'naya i klinicheskaya gastroenterologiya. 2012, (7): 10-6. Russian).

12. Maev IV, Sviridova AB, Kucheryavy JA, Goncharenko AJ, Samsonov AA, Oganesyan TS, Ustinova NN, Kazyulin AN, Troshina-IV, Moskalev AB. Yaitali enzyme m'malo mankhwala osiyanasiyana pancreatin kukonzekera odwala aakulu kapamba ndi exocrine pancreatic kusowa. Farmateka. 2011, (2): 32-9. (Maev IV, Sviridova AV, Kucheryavyy YuA, Goncharenko AYu, Samsonov AA, Oganesyan TS, Ustinova NN, Kazyulin AN, Troshina IV, Moskaleva AB. Kutenga kwakanthawi kwakanthawi kwa odwala omwe ali ndi pancreatin odwala omwe ali ndi pancreatitis yayitali komanso exocrine pancreatic Kuperewera. Farmateka. 2011, (2): 32-9. Russian).

13. Lindkvist B, Domínguez-Muñoz JE, Luaces-Regueira M, Casti-ñeiras-Alvariño M, Nieto-Garcia L, ma Iglesias-Garcia J. Serum olemba zodyetsa thanzi polosera za kuperewera kwa pancreatic exocrine mu pancreatitis yayitali. Pancreatology. 2012.12 (4): 305-10.

14. Haaber AB, Rosenfalck AM, Hansen B, Hilsted J, Larsen S. Mafupa a mineral metabolism, mafupa a mineral kachulukidwe, komanso kapangidwe ka thupi mwa odwala omwe ali ndi pancreatitis yayitali komanso kuperewera kwa pancreatic exocrine. Int J Pancreatol. 2000.27 (l): 21-7.

15. Kucheryavy Yu, Tibilova 3, Andreev D, Smirnov A. Kufunika kwa masinthidwe amtundu wa N34S mu mtundu wa SPINK1 pakusintha kwa maphunziro a chipatala cha pancreatitis yosatha. Adotolo. 2013, (10): 28-32. (Kucheryavyy Yu, Tibilova Z, Andreev D, Smirnov A. Kuwala kwa masinthidwe a N34S m'tundu wa SPINK1 posintha njira yachipatala ya kapamba am'mimba. Vrach. 2013, (10): 28-32. Russian).

16. Kucheryavyi Yu, Tibilova Z, Andreev D, Smirnov A, Maev I. Udindo wa masinthidwe a mtundu wa SPINK1 mu kapangidwe ka kapamba komanso kaperekedwe ka matendawa. European Journal of Medicine (Rus). 2013, (l): 37-47.

17. Maev IV, Zaitseva EV, Dicheva DT, Andreev DN. Enzyme kukonzekera ngati maziko a matenda a kapamba ndi exocrine kuchepa: mwayi ntchito ndi kusankha gastroenterologist. Consumum Medicum. Gastroenterology. 2013, (1): 61-4. (Maev IV, Zaytse-va EV, Dicheva DT, Andreev DN. Enzyme adakonzekereratu ngati njira yofunika kwambiri yothandizira matendawa ndi chifuwa chosakwanira: kugwiritsa ntchito njira ndi kusankhidwa mu gastroenterologist. Consilium Medicum. Gastroenterologiya. 2013, (l): 61- 4. Russian).