Opaleshoni ya Pancreatitis

Zizindikiro chifukwa opaleshoni yamapazi

pancreatic duct okhwima ndipo

matenda oopsa mu distal (posonyeza kukakamiza) m'madipatimenti ake,

mitundu yayikulu yopweteka yamatenda a kapamba omwe sangagwiritsidwe ntchito popanga mankhwala osokoneza bongo.

Zizindikiro zakuchita opareshoni ndi chifuwa chachikulu ndi:

kugonjetsedwa ndiwofatsa

Kununkha kwa ndulu,

aakulu kapamba, kuphatikiza matenda ophatikizika a ziwalo zam'mimba (m'mimba, duodenum, thirakiti ya biliary),

chifuwa chachikulu chokhala ndi jaundice wovuta kapena duodenostasis, fistulas ndi cysts,

aakulu kapamba ndi khansa ya kapamba.

63. Kutseka kwa gawo lachiberekero cha m'mimba ndi duodenum mu chifuwa chachikulu (matenda, mankhwala)

Pyloric stenosis. Kuzindikira matendawa kumatengera maphunziro otsatirawa:

· X-ray mayeso. Potere, kuwonjezeka kwa kukula kwam'mimba, kuchepa kwa zochitika za pistaltic, kupendekera kwa ngalande, kuwonjezeka mu nthawi yotulutsa zomwe zili m'mimba,

Esophagogastroduodenoscopy. Ikuwonetsa kupendekera ndi kusinthika kwa m'mimba pamalo opumira, kukula kwamimba,

- Kuphunzira ntchito yamagalimoto (pogwiritsa ntchito njira yamagetsi yamagetsi). Njirayi imathandizira kuti aphunzire za mamvekedwe, ntchito zamagetsi, pafupipafupi komanso kukwera kwa mphamvu yamimba m'mimba mutatha kudya komanso pamimba yopanda kanthu,

Ultrasound Pakapita nthawi, m'mimba mwake mumakhala chowoneka bwino.

Chithandizo cha pyloric stenosis (pyloric stenosis) amangokhala opareshoni. Mankhwala osokoneza bongo akuphatikizira chithandizo cha matenda oyambitsidwa, kukonzekera kwa preoperative. Mankhwala a antiulcer amalembedwa, kukonza zosokoneza mu protein, madzi-electrolyte metabolism, ndikubwezeretsa kulemera kwa thupi kumachitika.

Chithandizo cha pyloric stenosis ndi maopareshoni okha. Kuchiritsa mosiyanasiyana kumapereka mawonekedwe am'mimba. Woopsa milandu, amakhala ndi malire okhazikitsidwa ndi posterior gastroenteroanastomosis, yomwe imawonetsetsa kuti zinthu zitha kutuluka.

64. Mitundu yogwirapo ntchito kapamba wambiri wa kapamba.

Njira zonse za opaleshoni zomwe zimagwiritsidwa ntchito pochiza odwala omwe ali ndi vuto la pancreatitis amagawidwa pawiri:

1) kulowererapo mwachindunji kwa kapamba, 2) opaleshoni pamitsempha yamagazi, 3) opaleshoni yam'mimba, 4) opaleshoni pamimba ndi duodenum.

1) Zowongolera mwachindunji pancreatic anachita vuto la occlusion ndi kuchepera kwa malo ogulitsira, virzungolithiasis, amaganiziridwa khansa yachifungo, zotupa zam'mimba kwambiri za kapamba, kapamba, kaphatikizidwe ndi pseudocysts, calcification. Ntchito za gululi zimaphatikizapo opaleshoni ya resection, magwiridwe amkati amkati mwa pancreatic duct system ndi iye kupenda.

Opaleshoni othandizira Zochita pacancreas zimaphatikizapo: reseac caudal resection, resetotal resection, resection pancreatoduodenal, ndi duodenopanreatectomy yonse.

Kuchuluka kwa pancreatic resection kwa odwala omwe ali ndi pancreatitis yayitali kumadalira kuchuluka kwa njira ya occlusal-stenotic.

Ntchito zamkati zamkati pancreatic duct system kubwezeretsa kutulutsa kwa pancreatic secretion m'mimba yaying'ono. Mwa njira zopangira opaleshoni za gululi, zochitika zofala kwambiri Pestov-1 Pestov-2, Duval, magawo ndi mapulasitiki a pakamwa pa danc kuu.

Ntchito Pestov-1 ndi Mpumulo zokhudzana ndi machitidwe a caudal pancreatojejunostomy. Amagwiritsidwa ntchito pochiza odwala omwe sangasinthe mu gland, kuphatikiza ndi kufalikira kwa chimbudzi cha Wirsung m'malo otsala a gland pambuyo poti papezeke magawo ambiri.

Mukamachita opareshoni Pestov-1 mchira wa zikondwerero zoyambirira umapangidwanso. Nthawi yomweyo, ndulu zimachotsedwa. Kenako, khoma lakunja kwa Wirsung duct limodzi ndi minofu ya pancreatic yomwe ili pamwamba pake imatulutsidwa kwakanthawi mpaka gawo losasinthika la duct. Chovala cha jejunum chokhazikitsidwa ndi Ru chimachitika kunja. Anastomosis imapangidwa ndimizere yowirikiza pakati pa matumbo ndi chitsa, yomwe imalowa mu lumen ya m'matumbo ang'ono mpaka gawo la gawo losavulaza. Monga zosankha za anastomoses, anastomoses amtundu "kumapeto kwa kapamba" ndikutha matumbo aang'ono "ndikulemba" kumapeto kwa zikondwerero kumbali yamatumbo ang'ono "amagwiritsidwa ntchito.

Nthawi ya opareshoni Mpumulo reseation ya distal kapamba ndi splenectomy amachitidwa. Chitsa cha zikondamoyo ndi chopondapo ndi chigamba cha matumbo ang'onoang'ono, chitazimitsidwa molingana ndi Ru, pogwiritsa ntchito termolateral pancreatojejunoanast oz a.

Longitudinal pancreatojejunostomy malinga Pestov-2 imagwiritsidwa ntchito pochiza odwala omwe ali ndi pancreatitis yayikulu ndikuwonongeka kwathunthu kwa kapamba wambiri (kupatula kachulukidwe kamkati kamkati ndi kukula kwake) ngati simungathe kuchita ntchito yatsopano. Chinsinsi cha opareshoniyo ndi kupangika kwa anastomosis pakati pa kachilomboka komwe kamayesedwa kwautali wautali (pafupifupi 30 cm) ka jejunum, komwe kamakhala ngati anastomosis Y malinga.

Kukhazikika (kudzaza, kulepheretsa) kwa danc pancreatic duct system imatheka pobweretsa zida zodzaza (pancreasil, glue wa acrylic, guluu la KL-3, ndi zina zambiri) mwa icho limodzi ndi maantibayotiki. Kukhazikitsidwa kwa zinthu zopanga ma occlusive kumayambitsa atrophy ndi sclerosis ya procrine parenchyma ya gland, ndikuthandizira kupweteka kwapang'onopang'ono.

2) Ntchito pa autonomic mantha system anachita ndi ululu waukulu. Amayang'aniridwa ndikulunjika kwa njira zopweteketsa ululu. Ntchito zazikuluzikulu za gululi ndizolowera kumanzere kwa splanchnectectomy kuphatikiza ndi kufanana kwa mwezi wamanzere (mwezi wamanzere)Ntchito ku Malle-Guy), bilateral thoracic splanchnectomy and audiatectomy, postganglionic neurotomy (Operation Yoshioka - Wakabayashi), minyewa yam'mimba (ntchito P.N. Napalkov - M A. Trunina - I.F Krutikova)..

Opaleshoni Malle-Gee (1966) limasokoneza ulusi wamanjenje womwe umachokera mchira komanso pang'ono kuchokera kumutu wa kapamba. Opaleshoni imachitidwa kuchokera ku extraperitoneal ndi laparotomic accesses. Mu Choyamba mlandu umabweretsa kuyaka ndi mawonekedwe a nthiti za XII. Mtengo wapamwamba ukasamutsidwa, impso zimayamba kuwonetsedwa ndi misempha yayikulu ndi yaying'ono yamkati, yomwe imadutsana molunjika ndi miyendo ya phokoso. Kukokometsedwa ndi mitsempha, kuwulula mawonekedwe a mwezi womwe wagona pa aorta. Pankhani ya opareshoni Malle-Gee kuchokera laparatnogo wa mwayi poyera mbali yakumanzere kwa thunthu la celiac ndipo mu ngodya pakati pake ndi aorta apeze gawo lamanzere lamanzere la celiac plexus, komanso misempha yayikulu ndi yaying'ono yamkati.

Bilateral thoracic splanchnectomy ndi sympathectomy afotokozedwa kuti athandizire odwala omwe ali ndi pancreatitis yokhala ndi ululu wokhazikika. Zipolopolo zam'mbuyo za postganglionic zimachokera ku mitsempha ya mitsempha ya mkono wamanzere wamanzere, komanso kuwala kwa msempha. Zimagwira mkati mwa mutu ndipo mbali ina ya thupi kapamba, kulowa mkati mwake mwa malekezero a mbezo. Nthawi ya opareshoni Yogiioka - Wakabayagi Choyamba, gawo loyamba la plexus iyi, kudutsa kuchokera kumanjawo oyenera, kumadutsana. Imayamba kupezeka pambuyo poti ikulowetsa duodenum malingana ndi Kocher komanso kupezeka kwa mpanda pakona pakati pa dzenje lakumanzere ndi kumanzere kwa impso. Kenako tulutsani gawo lachiwiri la ulusi womwe ukupita ku kapamba kuchokera ku chotupa chachikulu cha mesenteric.

Chachikulu matenda zotsatira za ntchito Yogiioka - Wakabayashi Amawona odwala matenda kapamba ndi kutanthauzira kwa pathological njira mu mutu wa kapamba. Komabe, postganglionic neurotomy imatha kupanikizika ndi matumbo paresis, kutsegula m'mimba.

Marginal pancreatic neurotomy amalephera zolakwitsa izi. (opaleshoni P. K Napalkov - M. A. Trunina - Ndi F. Krutikova). Kukhazikitsa kwa opaleshoni imeneyi kumayendera limodzi ndi kulowererapo kwa mitundu iwiri yolumikizana komanso yothandiza komanso yolimbikitsa mtima komanso yolimba. Kuti muchite izi, dulani parietal peritoneum m'mphepete mwenimweni mwa kapamba ndikuwonetsa thunthu la celiac ndi nthambi zake. I% yothetsera wa novocaine ndi mowa imayambitsidwa mu masitilamu amisala. Kenako yambanitsani mitengo ikuluikulu ya m'mitsempha kuchokera kumatanthwe a m'mimba ndi m'mimba kupita m'mphepete mwenimweni mwa nduyo. A peritoneum imadulidwa pamwamba pa zotengera za mesenteric ndi mitengo ikuluikulu ya mitsempha yomwe imathamangira ku zikondwerero zomwe zimagwirizana ndi chotupa chachikulu cha mesenteric zimatayika.

Kubwezeretsanso kwakukulu kwa ma opaleshoni yam'mimbayo yapachifuwa. Periarterial neurotomy ya orifice ya hepatic ndi splenic artery, monga lamulo, imachitika pokhapokha ngati sizingatheke kugwira ntchito kwa minyewa. Njira zonse ziwiri za opaleshoni ndizofanana pakuchita bwino kwa chipatala.

3) Ntchito pa biliary thirakiti odwala matenda a kapamba, amagwiritsidwa ntchito ngati matenda amtundu wamatsenga, stenosis ya duodenal papilla yayikulu, komanso kukula kwa zovuta za jaundice. Ndi matenda amtunduwu, cholecystectomy yokhala ndi zotupa za wamba bile duct, biliodigestive anastomoses, papillosphincterotomy ndi papillosphincteroplasty amagwiritsidwa ntchito kwambiri.

4) Kuchokerantchito pamimba mu chifuwa chachikulu, kuperekera kumachitika kawirikawiri kuchitira zilonda zamkati ndipo kumapangidwa ndi chanconitis yachiwiri, komanso pa duodenum - vagotmia (SPV) kuphatikiza pamimba kapena kutulutsa kwam'mimba.

Mitundu Yothandiza

Kusankha kwa opaleshoni kumatengera umboni. Ntchito ndi:

mwadzidzidzi (i.e. ndi peritonitis),
kuchedwa
anakonza (atatha ntchito yovuta kwambiri).

Opaleshoni ya pancreatic imachitika pogwiritsa ntchito njira zotsatirazi:

Sutting. Amagwiritsidwa ntchito ngati pali kuwonongeka pang'ono m'mphepete komwe sikuphwanya umphumphu wa chiwalo.
Pachawan. Amawonetsedwa popereka ma pseudocysts.
Khalidkhaldi. Amagwiritsidwa ntchito pakuwonjezera kutukusira kwa puritive okhudza ziwalo zapafupi.
Marsunialization. Amagwiritsidwa ntchito pochotsa ma pseudocysts okhala ndi makoma owonda komanso zamkati za purulent.
Transduodenal sphincterovirusungoplasty imagwiritsidwa ntchito pochiza stenosis.
Virsungoduodenostomy. Wosankhidwa kuti athetse kusokonezeka kwa ma ducts.
Longitudinal pancreatojejunostomy. Iwo ikuchitika ngati matenda endoscopic kapamba ndi kuphwanya patency a militi.
Papillotomy. Imachitidwa pochotsa ma benign neoplasms kapena ma neoplasms ang'onoang'ono.
Mbali yakumanzere. Imachitika ndi zotupa za thupi (mchira) wa gland ndikuphwanya umphumphu.
Onse duodenopancreatectomy. Amalembera zolumikizira zingapo komanso zotupa zomwe zimakhudza chithokomiro chonse popanda metastases.
Pancreatoduodenal resection. Zimachitika ndi ma pathologies owonongeka omwe amakhudza gawo la mutu, komanso mawonekedwe a zotupa.
Kumanzere splanchnectectomy ndi resection mbali yakumanzere ya solar plexus. Amagwiritsidwa ntchito mu mawonekedwe a pancreatitis omwe ali ndi fibrosis yayikulu komanso kupweteka kwambiri.
Splanchnectectomy yamanja. Mumakulolani kuti musiye kufalitsa kwa zopweteka kuchokera kumutu ndi ma ducts a bile.

Zizindikiro ndi contraindication

Kuthandizira opaleshoni ndiyowonjezera, chifukwa opaleshoniyo imakhudza ziwalo zamkati. Zisonyezo za opaleshoni ndi:

pachimake mawonekedwe owononga kapamba,
matenda a kapamba a necosis
aakulu mawonekedwe a kapamba ndi kukokoloka pafupipafupi komanso nthawi yayitali chikhululukiro,
kachilombo ka kapamba kachilombo,
matenda oopsa
kusabadwa kobadwa nako,
minofu yofewa ya gland yomwe imayambitsidwa ndi kupsinjika kwamakina,
pseudocyst
peritonitis
neoplasms yoyipa.

Chifukwa cha kusungunuka kwa kapamba, m'mimba, zilonda 12 zam'mimba, komanso chikhodzodzo.

Pali ma contraindication opangira opaleshoni:

kusintha kwadzidzidzi kwa kuthamanga kwa magazi,
kuchuluka kwa michere
mantha akuti sangathe kuthana nawo,
anuria (kusowa kwa mkodzo),
shuga wambiri wa mkodzo
zovuta zophatikizika.

Mwa zilizonse mwazizindikirozi, opaleshoni yoletsedwa. Choyamba muyenera kusintha zizindikiro.

Pali ma contraindication opangira opaleshoni.

Kukonzekera

Poletsa kukula kwa zovuta komanso kukonzekera opaleshoni, zamankhwala zojambula zamanja ndi zothandizira zimachitika:

Kuyesedwa kwa magazi kumachitika (kawirikawiri komanso mwatsatanetsatane). Ngati chotupa m'mutu wa gland chikayikiridwa, kuyezetsa chotupa kumachitika.
Kufufuza kwazitsulo kumaphatikizapo ma ultrasound a kapamba ndi ziwalo zapafupi.
Kutengera ndi matendawa, makina owerengera angafunike. Nthawi zambiri maginito achitetezo cholangiopancreatography amafunikira.
Ngati mukuyenera kuchotsa miyala ku ducts, endoscopic retrograde cholangiopancreatography imachitika. Pogwiritsa ntchito njirayi, zambiri zimapezeka zokhudzana ndi zonyansa za England.
Ngati kupweteka kwakhungu kumayikiridwa, kukonzekera kwachitsanzo kumachitika pogwiritsa ntchito punication (kudziwa mtundu wa chotupacho).

Mukamamwa ma biopsy, zovuta zimatha kukhalapo: munthawi ya kukonzekera, magazi amatha kumachitika, ndipo kumapeto kwa zitsanzozo, mapangidwe a fistula.

Chochitika chofunikira pokonzekera ndi kufa ndi njala (mosasamala mawonekedwe a kapamba). Kuperewera kwa chakudya m'mimba kumachepetsa chiopsezo cha zovuta panthawi ya opareshoni.

Patsiku la opareshoni, wodwalayo amapatsidwa enema yotsuka, ndiye kuti mankhwala osokoneza bongo (mankhwala amaperekedwa kuti akonzekeze wodwalayo chifukwa cha opaleshoni ndi opaleshoni).

Zimayenda bwanji?

Opaleshoni mankhwala a pancreatitis pachimake ikuchitika kwa masiku 2: woyamba - ntchito preoperative, wachiwiri - ntchito.

Pali njira ziwiri zochitira opaleshoni:

Kutseguka (kukhazikika kumapangidwa m'mimba patsekeke ndi dera lumbar kuti mulowetse chiwalo).
Zowonongera zochepa (kupumira pang'onopang'ono) - kuwongolera kumachitika kudzera m'makina am'mimba. Chizindikiro cha kulowetsedwa-kukhetsa kulamulidwa motsogozedwa ndi ultrasound ndiko kukhalapo kwa mapangidwe amadzimadzi am'mimbamu m'mimba.

Njira yolowera imagwiritsidwa ntchito ngati chotupa cha retroperitoneal chachitika kapena ngalande ikufunika kuti muchotse madzimadzi omwe ali ndi matendawa.

Ntchito zimachitidwa molingana ndi algorithm yokonzedweratu: mutatsegula mapangidwe (zotupa kapena zotulutsa), gawo la chiwalo (mutu kapena mchira) limachotsedwa. Woopsa milandu, thunthu wathunthu chimachitika.

Pali njira ziwiri zochitira opaleshoni: zotseguka komanso zowononga pang'onopang'ono.

Mavuto

Zotsatira zoyipa zimatha kuyambitsa opaleshoni iliyonse. Mphamvu yamakina pa chiwalo ingayambitse zovuta pakukonzanso:

magazi
zotupa zotupa,
kudzimbidwa,
matenda ashuga
kuwonongeka kwa mitsempha yamagazi ndi mitsempha yoyandikana ndi chogwirira ntchito,
postoperative pancreatitis,
peritonitis
Kuchulukitsa kwa mitundu ya matenda.

Chifukwa cha mtima wamtima, zovuta za coagulation zimayamba.

Kukonzanso odwala

Pambuyo pa opaleshoniyo, wodwalayo amasamutsidwa kumalo osamalira odwala kwambiri, komwe amawunika. Ndikosavuta kuzindikira zovuta zomwe zimachitika tsiku loyamba.

Kuwunikira kuthamanga kwa magazi, hematocrit ndi shuga wamagazi, magawo amthupi a mkodzo, magawo ena ofunika amachitika, kafukufuku wa x-ray amachitika.

Mu nthawi ya postoperative, kutsuka (kutuluka kapena kupindika) kwa magawo owononga omwe ali ndi antiseptic solution amachitika. Sabata yoyamba, kupumula kwa kama kumachitika.

Wodwalayo amakhala m'chipatala osachepera milungu 4. Pambuyo panthawiyi, wodwalayo amatha kusamutsidwa kupita kuchipatala cham'tsogolo.

Ngati wodwalayo akupitilizabe kukhazikika, tsiku lachiwiri amusamutsa ku dipatimenti yopanga opaleshoni. Wodwalayo amalandira chithandizo chodalirika ndi dokotala. Kusamalira ikuchitika kuganizira mawonekedwe a opaleshoni kulowererapo, kuopsa kwa vuto, kukhalapo kwa zovuta.

Wodwalayo amakhala m'chipatala osachepera milungu 4. Pambuyo panthawiyi, wodwalayo amatha kusamutsidwa kupita kuchipatala cham'tsogolo. Kutsatira kupuma, kudya, kumwa mankhwala ofunikira ndikofunikira.

Maulendo afupiafupi amaloledwa, zolimbitsa thupi zilizonse zimatsutsana.

Zakudya zamankhwala

Pakukonzanso kwa postoperative, gawo lofunikira limaperekedwa kuzipatsa thanzi komanso zakudya. Masiku awiri oyambilira akuonetsa njala, kuyambira tsiku lachitatu - kuteteza zakudya (zopaka, phala la mkaka, tchizi cha kanyumba, chakudya chosowa madzi popanda mchere, shuga ndi zonunkhira).

Sabata yoyamba pambuyo pa opareshoni, amaloledwa kudya mbale zowotcha, mtsogolo zimalimbikitsidwa kuphatikiza zakudya zowiritsa muzakudya.

Kuyambira sabata lachiwiri, ngati wodwalayo alola, amaloledwa kudya nsomba zochepa ndi nyama yotsamira. Ndikofunikira kukana mafuta, zokometsera, zokazinga, ndi fodya. Maswiti, zopangidwa ndi ufa, zophika sizimaphatikizidwa.

Zochita zolimbitsa thupi

Malo omwe amakakamizidwira pulogalamu yakukonzanso ndi LFK. Mu nthawi yogwira ntchito, mumaphatikizanso masewera olimbitsa thupi komanso masewera olimbitsa thupi a Cardio. Masewera olimbitsa thupi amachitidwa motsogozedwa ndi dokotala.

Malinga ndi ziwerengero, kukana kwa odwala kuchokera ku masewera olimbitsa thupi kumathandizanso kuti ayambenso kuwonjezeka komanso kumawonjezera mwayi woti ayambenso pambuyo pochita opaleshoni chifukwa cha zilonda zam'mimba.

Malo omwe amakakamizidwira pulogalamu yakukonzanso ndi LFK.

Mbiri ya moyo

Pambuyo pakuyambiranso kwathunthu kapena kuchotsedwa kwa gawo limodzi la kapamba, wodwalayo amatha kukhala ndi moyo nthawi yayitali, malinga ndi zomwe akuchita chithandizo chamankhwala, kenako, mpaka kumapeto kwa moyo wake, amadya ndikumwa mankhwala omwe adokotala adanenera.

Udindo wa zotupa m'miyoyo ya thupi ndizabwino: amapanga mahomoni ndipo amatulutsa michere yokugaya. Enzyme ndi mahomoni ntchito akhoza kulipidwa ndi thandizo m'malo.

Mankhwala okhala ndi enzyme amalembedwa kwa odwala, odwala ayenera kuwongolera kuchuluka kwa shuga m'magazi (chifukwa chowonjezera chiopsezo chokhala ndi matenda osokoneza bongo).

Kodi opaleshoni ya kapamba imachitika liti?

Kufunika kwa chithandizo cha opaleshoni kumachitika chifukwa cha zovuta za kapamba powona zilonda zam'mimba. Monga lamulo, opareshoni imachitika panjira pomwe zosankha zina zimangoyambitsa kulephera, kapena pomwe wodwalayo ali woopsa kwambiri.

Tiyenera kukumbukira kuti kulowererapo kwina kulikonse m'thupi la munthu kumakhala ndi zotsatirapo zosiyanasiyana zoyipa. Njira yamakina silipereka chitsimikizo cha kuchira kwa wodwala, koma, m'malo mwake, pamakhala chiopsezo chowonjezeka cha chithunzi chonse chaumoyo. Zizindikiro ndi mankhwala a pancreatitis mwa akulu nthawi zambiri amaphatikizidwa.

Kuphatikiza apo, ndi dokotala yekha wodziwa bwino kwambiri za akatswiri ochepa kwambiri omwe amatha kuchita opareshoni, ndipo si onse mabungwe azachipatala omwe angadzitamande ndi akatswiri otere. Chifukwa chake, opaleshoni ya pancreatic pamaso pa kapamba amachitika motere:

Mkhalidwe wodwala, wodziwika ndi gawo lowopsa la matenda owononga. Ndi chithunzithunzi chofananira, kuwonongeka kwa tiziwalo ta matenda amtundu wa necrotic kumayang'aniridwa, pomwe njira zopukutira zimatha kuphatikizika, zomwe zimawopseza moyo wa wodwalayo.
Kukhalapo kwa pancreatitis mu pachimake kapena mawonekedwe osakhazikika, omwe wadutsa mpaka gawo la pancreatic necrosis, ndiko kuti, necrotic stratization yamoyo minofu.
Matenda a kapamba, omwe amadziwika ndi kupweteka kwapafupipafupi komanso kwakanthawi kochepa.

Zonsezi ma pathologies posowa opaleshoni zimatha kubweretsa zotsatira zoyipa. Kuphatikiza apo, njira zilizonse zamankhwala othandizira sizingapereke zotsatira zoyenera, chomwe ndichizindikiro chogwira ntchito.

Zovuta zazikulu pakuchita opareshoni

Kuchita opaleshoni kumbuyo kwa pancreatitis nthawi zonse kumakhala kovuta, komanso kovuta kulosera, komwe kumachokera pazinthu zingapo zomwe zimagwirizanitsidwa ndi anatomy a mkati mwa ziwalo zophatikizika.

Tizilombo ta ziwalo zamkati timakhala osalimba, chifukwa kutulutsa magazi kwambiri kumayamba chifukwa cha chinyengo chochepa kwambiri. Vuto lofananalo pakumuchiritsa wodwala silimachotsedwa.

Kuphatikiza apo, kufupi kwenikweni kwa nduluyo ndi ziwalo zofunika, ndipo kuwonongeka kwawo pang'ono kumatha kubweretsa zovuta zina mthupi la munthu, komanso zotsatira zosasintha. Chinsinsi, limodzi ndi ma enzyme omwe amapangidwa mwachindunji m'gululi, zimakhudza mkati, zomwe zimapangitsa kuti minofu ikhale yovuta, zomwe zimapangitsa kuti ntchitoyo igwirike bwino kwambiri.

Zizindikiro ndi mankhwala a kapamba mwa akulu

Pancreatitis pachimake imadziwika ndi zizindikiro zotsatirazi:

Zowawa zam'mimba ndi kutulutsidwa kwa hypochondrium kumanja komanso kumanzere.
General malaise.
Kukweza kutentha kwa thupi.
Kusanza ndi kusanza, koma utatulutsa m'mimba, kupuma sikumachitika.
Kudzimbidwa kapena kutsegula m'mimba.
Dyspnea wolimbitsa.
Hiccups.
Kuphulika ndi kusapeza bwino m'mimba.
Kusintha kwa khungu - mawonekedwe a khungu loyera, chikaso kapena kufiyira nkhope.

Wodwalayo amamuika m'chipinda chomwe odwala amawongolera kwambiri. Woopsa, opaleshoni imafunika.

Fotokozani mankhwala:

maantibayotiki
anti-yotupa mankhwala
michere
mahomoni
calcium
mankhwala a choleretic
Zovala zazitsamba.

Mitundu ya njira zochitira opaleshoni ya kapamba

Mitundu yotsatirapo ya opaleshoni ya pancreatitis ilipo:

Distal organ resection process. Panthawi ya chithandizo, dokotalayo amachotsa mchira, komanso thupi la kapamba. Ma voliyumu amawonekera ndi kuchuluka kwa zowonongeka. Kudzinyenga kotereku kumaonedwa kuti ndi koyenera panthawi yomwe chindoko sichikhudza thupi lonse. Zakudya za pancreatitis pambuyo pa opaleshoni ndizofunikira kwambiri.
Kudzera kwamtunda kumatanthawuza kuti kuchotsedwa kwa mchira, kwambiri mutu wa kapamba ndi thupi lake. Komabe, magawo ena oyandikira duodenum ndi omwe amasungidwa. Izi zimachitika pokhapokha ndi mtundu wonse wa zotupa.
Necrosecvest sahihiomy imagwira ntchito ngati gawo la kuwongolera kwa ultrasound, komanso fluoroscopy. Nthawi yomweyo, madzimadzi amapezeka m'goli, amayendetsa ngalande kudzera m'matumba apadera. Pambuyo pake, zimayambira zikuluzikulu zowerengeka kuti zitsuke mzerewo ndikutsata utupu. Monga gawo lomaliza lamankhwala, ma draini akuluakulu amasinthidwa ndi ang'onoang'ono, omwe amathandizira pang'onopang'ono kuchira kwa bala la postoperative ndikusunga kutulutsa kwamadzi. Zizindikiro za opaleshoni ya kapamba ziyenera kuyang'aniridwa mosamalitsa.

Pakati pazovuta zambiri, zotupa za purulent zimapezeka. Amatha kuzindikiridwa ndi zizindikiro izi:

Kukhalapo kwa mavuto.

Kukonzanso komanso kusamalira odwala kuchipatala

Pambuyo pakuchita opaleshoni ya kapamba, wodwalayo amapita kuchipatala chopatsa chidwi. Poyamba, amasungidwa kwambiri, komwe amathandizidwa, ndikuwunikira.

Kukhala bwino kwa wodwala mu maola makumi awiri ndi anayi oyamba kumapangitsa kuti pakhale zovuta za postoperative. Kuyang'anira kwamikodzo, kuthamanga kwa magazi, komanso hematocrit ndi shuga m'thupi. Njira zofunika zowunikira zimaphatikizapo x-ray ndi electrocardiogram ya mtima.

Patsiku lachiwiri, pokhapokha ngati ali ndi vuto lokwanira, wodwalayo amapititsidwa ku dipatimenti yopanga opaleshoni, komwe amapatsidwa chisamaliro chofunikira limodzi ndi zakudya zoyenera komanso zovuta kuchita. Zakudya pambuyo pancreatitis opaleshoni amasankhidwa mosamala. Njira ya chithandizo chotsatira zimatengera kuuma, komanso, kupezeka kapena kusakhalapo kwa zotsatira zoyipa.

Opaleshoni amadziwa kuti wodwalayo amayenera kuyang'aniridwa ndi ogwira ntchito kuchipatala kwa mwezi umodzi ndi theka mpaka awiri atachitidwa opaleshoni. Nthawi ino nthawi zambiri imakhala yokwanira kulola kuti dongosolo la m'mimba ligwirizane ndi zosintha, komanso kubwerera ku ntchito yake yokhazikika.

Monga malingaliro a kukonzanso, odwala atatha kuyamwa amalangizidwa kuti azitsatira mosamalitsa, komanso kupumula pabedi, kuwonjezera apo, odwala otere amafunika kupuma masana komanso kudya. Chofunikanso chimodzimodzi ndi mnyumba ndi banja. Madokotala amadziwa kuti achibale komanso abale amafunika kuthandizira wodwalayo. Njira zoterezi zithandizira wodwala kuti azikhala ndi chitsimikizo chifukwa chotsatira bwino pambuyo pake.

Pakatha milungu iwiri atatuluka m'chipatala, wodwalayo amaloledwa kupita kunja, ndikuyenda mwachidule ndi njira yosavutikira. Iyenera kutsimikiziridwa kuti pakuchira, odwala saloledwa kugwira ntchito mopitirira muyeso. Zotsatira za opaleshoni ya kapamba zimaperekedwa pansipa.

Mankhwala othandizira pambuyo pake

Mwakutero, chithandizo cha algorithm pambuyo pa opaleshoni yolimbana ndi pancreatitis imatsimikiziridwa ndi zinthu zina. Pofuna kupereka chithandizo, dokotala amayang'anitsitsa mbiri yachipatala ya wodwalayo limodzi ndi mathedwe omwe amathandizira, kuchuluka kwa kutulutsa kwatsitsa, zotsatira za mayeso a labotale ndi zida zothandizira.

Ngati pakhale insulin yokwanira ya insulin, chithandizo cha insulin chitha kuphatikizidwanso. Mahomoni opanga amathandizira kubwezeretsa ndikupangitsa shuga kukhala m'thupi la munthu.

Ndikulimbikitsidwa kumwa mankhwala kuti muthandizire kukulitsa michere yokwanira, kapena muli nayo kale. Mankhwalawa amathandizira kuti magawo azigwira ntchito. Ngati mankhwalawa sakuphatikizidwa mu mankhwalawa, wodwalayo amatha kukhala ndi mawonekedwe monga kuwonjezereka kwa kapangidwe ka gasi limodzi ndi kutulutsa, kutsegula m'mimba ndi kutentha kwa mtima.

Ndi chiani china chomwe chimaphatikizapo chithandizo cha opaleshoni ya kapamba?

Kuphatikiza apo, odwala amathandizidwanso kuti azichita zinthu monga zakudya, njira zochiritsira zolimbitsa thupi ndi physiotherapy. Zakudya zoyenera ndi njira yabwino kwambiri pakachira. Kuthana ndi zakudya mutatha kuyambiranso chiwalo chimaphatikizanso kusala kwa masiku awiri, ndipo tsiku lachitatu kusungirako zakudya kumaloledwa. Pankhaniyi, ndizovomerezeka kudya zotsatirazi:

Tiyi yopanda shuga yokhala ndi zophera komanso msuzi wosenda.
Porridge mkaka ndi mpunga kapena buckwheat. Pakuphika, mkaka uyenera kuchepetsedwa ndi madzi.
Omeled yolimba, yokhala ndi mapuloteni okha.
Mkate wouma dzulo.
Mpaka magalamu khumi ndi asanu a batala patsiku.
Tchizi chamafuta pang'ono.

Asanagone, odwala amalimbikitsidwa kumwa kapu imodzi ya kefir yamafuta ochepa, yomwe nthawi zina imatha m'malo mwake ndi kapu yamadzi ofunda ndikuphatikizira uchi. Ndipo pokhapokha masiku khumi wodwala amaloledwa kuphatikiza nsomba kapena nyama zina menyu.

Kupita patsogolo kwa zamankhwala kwa opaleshoni ya kapamba chifukwa cha kapamba

Tsoka la munthu pambuyo pakuchita opaleshoni yamapenchi limatsimikiziridwa ndi zinthu zambiri, zomwe zimaphatikizapo opareshoni, njira za kukhazikitsidwa kwake komanso mtundu wa njira zochiritsira komanso zotsatsira, komanso, thandizo la wodwalayo payekha komanso zina.

Matenda kapena mkhalidwe wam'magazi, ngakhale uli mtundu wovuta kwambiri wa kutupa kwa kapamba kapena cyst, chifukwa chomwe mankhwalawa azachipatala adagwiritsidwa ntchito, monga lamulo, akupitilizabe kukhudzana ndi thanzi la munthu, komanso kutha kwa matendawa.

Mwachitsanzo, ngati kuyambiranso kumachitika chifukwa cha khansa, ndiye kuti pamakhala chiopsezo chobwereranso. Zomwe zikudziwikiratu zomwe zidzachitike pakadutsa zaka zisanu zomwe odwalawa ali nazo ndizokhumudwitsa ndipo zimafika mpaka peresenti khumi.

Ngakhale osagwirizana pang'ono ndi zomwe adotolo adachita, mwachitsanzo, kutopa kwakuthupi kapena m'maganizo, komanso nkhawa ya zakudyazo, zingakhudze mkhalidwe wa wodwalayo, kupangitsa kufalikira, zomwe zingayambitse kufa.

Chifukwa chake, moyo wa wodwalayo, komanso nthawi yake atachitidwa opareshoni kapamba, zimatengera mwachindunji kulangizidwa kwa wodwalayo ndikutsatira malangizo onse azachipatala.

Kodi mumachitapo opaleshoni ya kapamba? Tidazindikira kuti inde.

Kodi opareshoni imachitika liti?

Kufunika kochita opaleshoni kumachitika chifukwa cha matenda a kapamba, pakaonongeka kwambiri ziwalo za chiwalo. Nthawi zambiri opareshoni imachitika panjira zomwe zosankha zina zitha kuchititsa kuti zilephere, kapena wodwala amakhala mu vuto lalikulu kwambiri.

Izi ndichifukwa choti kulowererapo kwa gawo la "mtima wachifundo" kuli ndi zovuta zingapo zoyipa. Njira yamakina sikutsimikizira kuchira kwa wodwalayo, mmalo mwake, pamakhala chiwopsezo chowonjezeka cha chithunzicho.

Kuphatikiza apo, ndi dokotala wodziwa bwino kwambiri yemwe ali ndi akatswiri ochepa omwe amatha kuchita opaleshoniyo, ndipo akatswiri oterewa sapezeka m'mabungwe onse azachipatala.

Pancreatic opaleshoni ya kapamba imachitika mu milandu yotsatirayi:

Gawo la pachimake cha matenda owononga. Mu chithunzichi, kuwonongeka kwa minyewa yamtundu wa chinthu cha necrotic kumawonedwa, kuwonjezeredwa kwa purulent njira sikumasiyidwa, komwe kumawopseza moyo wa wodwalayo.
Pancreatitis mu pachimake kapena mawonekedwe osakhazikika, omwe adasinthidwa kukhala pancreatic necrosis - necrotic stratization yamoyo minofu.
Matenda a kapamba, omwe amadziwika ndi kupweteka kwapafupipafupi komanso nthawi yochepa yotikhululuka.

Zonsezi ma pathologies posowa opaleshoni zimatha kubweretsa zotsatira zoyipa.

Njira zilizonse zosagwiritsidwa ntchito poperekera chithandizo sizipereka zotsatira zoyenera, chomwe ndi chisonyezo chachindunji pantchitoyo.

Zovuta za opaleshoni yamankhwala

Opaleshoni ya pancreatitis imawoneka kuti ndi yovuta komanso yovuta kulosera, yomwe idakhazikitsidwa pazinthu zambiri zokhudzana ndi anatomy of the mkati mwa secretion osakanikirana.

Minofu ya mkati mwa thupi imadziwika ndi kusokonekera kwambiri, komwe pa nthawi yopusitsa kungayambitse magazi kwambiri. Vutoli silimachotsedwa pakubwezerera kwakachira kwa wodwalayo.

Ziwalo zoyenera zimakhala pafupi ndi thumbo; kuwonongeka kwawo pang'ono kumatha kubweretsa zovuta zina mthupi komanso zotsatira zosasinthika. Chinsinsi ndi ma enzyme omwe amapangidwa mwachindunji mu chiwalocho, amakhudzidwa kuchokera mkati, zomwe zimapangitsa kuti minofu ikhale, imasokoneza kwambiri ntchitoyo.

M'matumbo am'mimba, zomwe zili mu necrotic kapena purulent zimayamba kudziunjikira, ngati ndi chilankhulo cha sayansi, ndiye kuti wodwalayo amapezeka ndi peritonitis.
Kuchulukitsa kwa matenda ophatikizika omwe amalumikizidwa ndi ntchito ya kapamba komanso kupanga michere.
Kudukiza matumba akuluakulu kumayambitsa kukokoloka kwa kapamba.
Minofu yofewa ya limba sichichiritsa, mphamvu zoyipa za pancreatic sizinawonedwe.

Mavuto owopsa kwambiri akuphatikizapo kulephera kwamphamvu kwa ziwalo, kapamba ndi septic.

Zotsatira zoyipa pambuyo pake zimaphatikizira mawonekedwe a pseudocysts, fancula ya pancreatic, chitukuko cha matenda a shuga komanso kuperewera kwa exocrine.

Kusamalira odwala komanso kukonza odwala

Pambuyo pa opaleshoniyo, wodwala amatumizidwa kumalo osamalira odwala kwambiri. Poyamba, amakhala ndi chisamaliro chachikulu, komwe amasamalidwa moyenera ndikuyang'anira mawonetseredwe ofunikira.

Vuto lalikulu la wodwalayo m'maola 24 oyambirira limapangitsa kuti kuzindikirika kwa zovuta za postoperative. Onetsetsani kuwunika kwa magazi, mkodzo, hematocrit, shuga m'thupi. Njira zoyendetsera zolimbikitsidwa zikuphatikiza chifuwa x-ray, ECG.

Pa tsiku lachiwiri, ndimikhalidwe yokhutiritsa, wamkuluyo amapititsidwa ku dipatimenti yochita opaleshoni. Kumene amapatsidwa chisamaliro chofunikira, zakudya, zovuta. Njira yowonjezerapo chithandizo chimadalira kuuma, kupezeka / kusakhalapo kwa zotsatirapo zoyipa za opereshoni.

Kuunikiridwa kwa madokotala ndikuwona kuti wodwalayo ayenera kuyang'aniridwa ndi akatswiri azachipatala kwa miyezi 1.5-2 atatha kulowererapo. Ino ndi yokwanira kuti dongosolo la m'mimba ligwirizane ndi zosintha ndikubwerera kuntchito wamba.

Malangizo okonzanso mukachotsa:

Kupuma kwathunthu ndi kugona pa bedi.
Masana tulo.
Zakudya

Chofunikanso chimodzimodzi monga mkhalidwe wabanja. Madokotala amati achibale ayenera kuthandiza wodwalayo, izi zimamupatsa mwayi wotsimikiza za tsogolo labwino la mankhwala ena.

Masabata awiri mutachotsedwa, mutha kupita panja ndikuyenda mwachidule ndi njira yosasangalatsa.

Panthawi yochira, ndizoletsedwa kugwira ntchito mopitirira muyeso.

Ichi ndi chiyani

Opaleshoni yamatenda a kapamba, kutengera mtundu womwewo, ikhoza kukhala yovuta.

Opaleshoniyo ikuchitika pambuyo pa kufotokozera zinthu zina, makamaka kupezeka kwa kusiyanasiyana kwa minofu yowonongeka kuchokera kwa athanzi, kuchuluka kwa purulent necrotic njira mu kapamba, kuchuluka kwa kutupa ndi kupezeka kwa matenda am'mimba. Njira yogwirira ntchito ikuchitika pogwiritsa ntchito laparoscopy, njira yotanthauzira yopenda ziphuphu ndi m'mimba.

Mukukonzekera kwa laparoscopy wa pancreatitis enzymatic peritonitis, laporoscopic drainage wamatumbo am'mimba amadziwika, ndipo atatha - peritoneal dialysis ndi kulowetsedwa kwa mankhwala. Opaleshoniyo ikuchitika motsogozedwa ndi laparoscope. Ma Microirrigator amabweretsedwa ku gland kutseguka ndi malo amanzere a subphrenic, ndipo ngalande yayikulu yotsegulira imayambitsidwa kudzera pakatundu kakang'ono ka khoma lachiberekero kumanzere kwa iliac m'dambo laling'ono.

Mayankho othandizira amakhala ndi maantibayotiki, ma antiproteases, cytostatics, antiseptics, glucose solution. Njira yake imagwira ntchito mwa masiku atatu atangoyamba kukonza kwa pachimake peritonitis. Njirayi sikuchitika ndi mafuta pancreatic necrosis, komanso biliary pancreatitis. Kukhumudwa kwa biliary thirakiti pancreatogenic peritonitis amachitidwa ndi laparoscopic drainage wamatumbo am'mimbamo, amathandizidwa ndi kugwiritsa ntchito cholecystoma.

Mlanduwu ukamapangika pancreatitis wam'mimba pakhungu la patanotomy, minofu yolumikizana ndi kapamba imalowetsedwa ndikupanga novocaine ndi antiotic, cytostatics, ndi proteinase inhibitors. Mwa infusions wowonjezereka wa mankhwala, microirrigator imayambitsidwa muzu wa mesentery wa transverse colon. Pambuyo pochita kukhetsa kwa chotsekeramo bokosi lotseguka ndi kugwiritsa ntchito cholecystoma. Pofuna kupewa kupindika kwa ma enzyme komanso kufalitsa kwa zinthu zomwe zimapangitsa kuti zinthu ziwonongeke paziwongola dzanja, thupi ndi mchira wa kapamba zimachotsedwa mu parapancreatic fiber. Ngati necrosis ikuyenda bwino pambuyo pakuchita opaleshoni, kuyambiranso kumachitika, kusayenera kwake komwe kumalumikizidwa ndi katundu wambiri m'thupi lofooka.

Imodzi mwa mitundu ya matenda omwe amafunikira chithandizo cha opaleshoni ndi pancreatitis yowerengera, yomwe imakhala mawonekedwe a calculi mu kapamba. Mwalawo ukapezeka kumtundu, mumangochotsa khoma lokakamiza. Ngati pali miyala ingapo, ndiye kuti kusakanikirana kumachitika pamodzi ndi chithaphwi chonse. Nthawi zina, chiwonetsero chathunthu cha chiwalo chowonongeka ndi calculi chimasonyezedwa.

Maseze akapezeka ndi kapamba, amachotsedwa limodzi ndi gawo la chindayo. Nthawi zina kuchotsedwa kwathunthu kwa chiwalo kumafunika. Pozindikira khansa, njira zochizira zamtunduwu zimagwiritsidwa ntchito.

Kulowerera kwambiri kwa pancreatitis pachimake ndi kapamba. Opaleshoniyo imachitidwa ndi necrosis yathunthu ya kapamba; munthawi ya opaleshoni, mbali ina ya chiberekero ndi 12 ya mphete yamatumbo imatsala.

Opaleshoni sikuti limatsimikizira kuti ayambiranso kukhala ndi moyo wabwino, ndizosautsa, zimamwalira. Sinthani njirayi kukhala cyrodistribution, yomwe imachitika ndi hemorrhagic pancreatic necrosis. Pogwira opaleshoni, minofu imawululidwa ndi kutentha kotsika kwambiri. Patsamba lowonetserako, minofu yolumikizana bwino imapangidwa. Pofuna kuzindikira ma concomitant pathologies omwe amagwirizana ndi biliary thirakiti, kugwiritsa ntchito njirayi sikuloledwa, popeza pali chiopsezo chowonongeka cha ndulu, 12 - matumbo ndi m'mimba.

Njira ya endoscopic imagwiritsidwa ntchito pazovuta zamatenda a kapamba, pakakhala ma pseudocysts, kutsekeka kwa ndulu yayikulu, kupezeka kwa miyala pamiyendo ya kapamba kapena ndulu. Amatha kutsogolera matenda oopsa a pancreatic ndipo amafunikira njira zotsalira za endoscopic.

Njira yotchuka kwambiri ndi sphincterotomy, yomwe imatsatiridwa ndi endoprosthesis m'malo mwa duct wamkulu wa kapamba, pamaso pa mwala - mawonekedwe ake kapena ma lithotripsy, ngalulu yam'mimbayo. Endoprosthesis iyenera m'malo mwa miyezi itatu iliyonse, mwanjira zotere, anti-yotupa imalimbikitsidwa kwa chaka chimodzi.

Matenda a patsogolo pa chithandizo cha mitundu yowononga ya kapamba ndi osauka, popeza pali chiwerengero chachikulu cha imfa.

Zizindikiro za

Ndi chitukuko cha kapamba ndi kusinthika kwake kukhala mawonekedwe osakhazikika, kuphwanya kwa morphological kwa gland minofu kumawonekera, makamaka, cysts, miyala, stenosis ya duct yayikulu ya kapamba chifukwa cha kuwoneka kwa kukula kwa mutu wa ndulu chifukwa cha kuwoneka kwa kufinya kapena kupindika pancreatitis. Zosintha zimawonedwanso pamaso pa kuphwanya ziwalo zapafupi, monga 12 - duodenum, m'mimba ochepa, ducts za bile, mitsempha ya portal ndi ma ducts ake.

Ngati ma pathologies omwe ali pamwambawa apezeka, kuchipatala kwa wodwala kumachitika. Kuzindikira kumawonekera ndi kuwonjezeka kwa ululu, zizindikiro za kuyimitsidwa kwamkati, kuledzera, kuchuluka kwa amylase m'magazi ndi mkodzo.

Njira yodwalayo imadziwika ndi kupezeka kwakanthawi kwa chizindikiro cha matendawa chifukwa cha kutupa ndi mafupa a minyewa. Njira ya opaleshoni imagwiritsidwa ntchito pazigawo zoyambirira za matendawa ngati pali zizindikiro za peritonitis, kupweteka kwambiri ndi jaundice yokhazikika imakonzedwa, komanso pamaso pa miyala pamiyendo ndi ndulu. Nthawi zambiri, opareshoni imachitika ngati chifuwa chachikulu cha m'mimba chimatuluka ndimatenda owopsa am'mapapo kapena m'matumbo am'mimba, kapena pakatuluka chotupa.

Zizindikiro zantchitoyo ndi:

Reflex ululu pamimba pakuchitika kwa mankhwala,
Induction pancreatitis, chifukwa cha kupindika kwakutali kotsutsana ndi maziko a ntchito yochepetsedwa, pali kuchuluka kwa minofu yolumikizana ndikupanga zipsera, komanso kuwonjezeka kwa kuchuluka ndi kukula kwa kapamba. Vutoli limafanana ndi zizindikiro za khansa,
Kutalikirana kwa ngalande yayikulu ya kapamba,
Stenosis wamtundu wambiri wa biliary,
Kuphonya kwamtundu kapena portent mesenteric yapamwamba,
Ma pseudo-cysts okhalitsa,
Stenosis yayikulu ya 12 - mphete yamatumbo.

Zomwe zimachotsedwa

Kuchita opareshoni kumachitika ndikupereka mwayi kwa kapamba, kupangitsa kuti izi zitheke. Kuwala komwe kumagwiritsidwa ntchito potsegula pamimba. Pambuyo kutseguka, kapamba amabisala ndikuchotsa ma cell ndi ma mesentery a m'matumbo, ndikugwiritsanso ntchito ma lig ligital ziwiya zapafupi. Kenako kapamba amachotsedwa. Nthawi zina, osadzaza, koma kuchotsa pang'ono kwa kapamba kumayikidwa.

Ndi matenda osiyanasiyana, mbali ina ya chiwalo imachotsedwa. Nthawi zambiri, mutu kapena mchira wa chiwalo umachotsedwa. Mukachotsa mutu, njira ya Whipple imachitika. Ndondomeko ikuchitika m'magawo awiri:

Kuchotsa gawo lomwe matenda amapezekamo,
Kugwiritsa ntchito pochita kubwezeretsa ngalande yokumba, ntchito ya ndulu ndi mitsuko yake.

Kubera kumachitika pansi pa mankhwala oletsa ululu. Pofuna kupezeka ndi kapamba, tating'onoting'ono tingapo timapangidwa momwe timuyo timayeserera pogwiritsa ntchito laparoscope.

Zitatha izi, ziwiya zomwe zimalimbikitsidwa zimatulutsidwa ndikuchotsedwa. Nthawi zina, ziwalo zoyandikana nazo zimathandizidwanso.

Kubwezeretsa chakudya cham'mimba, thupi la chimbudzi limalumikizana ndi m'mimba komanso mkati mwa matumbo aang'ono.

Pankhani chotupa mumchira wa kapamba, amachitidwa opareshoni, komwe kumatchedwa mbali ya paral pancreotomy. Mchira wa ndulu umachotsedwa, kenako chiwalocho chimakokedwa pamodzi ndi mzere wodula. Mutu wa pancreatic umachotsedwa pokhapokha pakuwonetsa mwamphamvu, popeza opaleshoniyo imakhala yovuta komanso yodzala ndi zovuta komanso ngakhale kufa panthawi ya opareshoni kapena pambuyo pake.

Kodi machitidwe awa amatchedwa chiyani

Njira zosiyanasiyana zimagwiritsidwa ntchito pobwezeretsa kutulutsa kwa pancreatic secretion ndikuchotsa minofu ya necrotic, kutupa kwachangu ndikumayimitsa magazi mkati:

Laparotomy ndi necrectomy. Izi ndi ntchito zam'mimba. Malo obwezeretsedwawo amatsegulidwa, mafinya amasakanikirana ndipo minyewa ya necrotic imachotsedwa, ndipo matupi othandizira othandizira amasungidwa ngati nkotheka.
Malo otsekeka otsekeka ophatikizidwa ndi Cardinal necrectomy.
Kukhetsa kwa Endoscopic. Pali njira zambiri zotulutsira madzi ndikuchotsa minofu ya necrotic, imodzi mwazomwe zimaphatikizira kukulira kwa ngalande ya ngalande yozungulira, yochitidwa muulamuliro wa CT.
Punctic - jekeseni imodzi yothetsera yankho mu necrotic organ. Njira imeneyi imatheka pokhapokha ngati pali chosabala, popanda chotupa.
Kubwezeretsanso ndi kupatsirana. Kubwezeretsanso ndikuchotsa pang'ono mbali yomwe yakhudzidwa. Iron imakhala ndi antigenicity yapamwamba, yomwe imasokoneza kupulumuka kwake panthawi yopatsirana. Nthawi zambiri chiwalo chovekeracho chimakanidwa pa tsiku la 5-6 pambuyo pa opareshoni.

Kutengera ndi zovuta zomwe zadziwika, izi zitha kuchitidwa:

Chithandizo cha mankhwala a endoscopic,
Kulowerera kwa laparotomy.

Zotsatira ndi zovuta

Opaleshoni ingasokoneze thanzi la wodwalayo. Kuchita opaleshoni kumatha kudzetsa kukula kwa peritonitis, kuchulukitsa kwa matenda omwe amaphatikizidwa ndi kupanga ma enzyme, kutaya magazi kwambiri komanso kuchiritsa pang'onopang'ono minofu itatha opaleshoni, zovuta zomwe zimagwiritsidwa ntchito pazomwe ziwalo zapafupi ndizotheka.

Wodwala pambuyo pakuchita opaleshoni ayenera kukhala kuchipatala pafupifupi mwezi umodzi. Izi zikuthandizira kukonza zovuta mu nthawi. Pambuyo pa opaleshoni, tikulimbikitsidwa kuti mutenge mankhwala a insulin komanso kugaya chakudya, mankhwala olimbitsa thupi ndi zakudya zochizira zimayikidwa.

Mu nthawi yogwira ntchito, pamakhala chiopsezo chobisalira mitsuko yayikulu yomwe imachotsa michere. Kutulutsa magazi kwambiri pambuyo pakuchita opaleshoni komanso kusowa kwa mphamvu ya kuchiritsa kwa ma pancreatic ndizovuta zina.

Pambuyo pa opaleshoni, wodwalayo amapatsidwa zakudya zapadera, zakudya patebulo lambala 5. zimafikiridwa nthawi zonse.

Zakudya zoperewera ndizothandiza nthawi yofananira masana kupanga matenda ophatikizidwa ndi chimbudzi. Chakudya chizimitsidwa chophika, chophika kapena chopatsidwa, m'magawo ang'onoang'ono. Mlingo wa mafuta omwe amagwiritsidwa ntchito tsiku lililonse sayenera kupitirira 0,25 g Mafuta ophikira, odzola, msuzi wosenda, mucous porridge, jelly wachilengedwe, msuzi wa rosehip ndiwothandiza.

Ndikofunikira kutsatira zakudya m'moyo wonse; kuphwanya zakudya zopangidwa mwapadera kumadzetsa zovuta zazikulu.

Zomwe zimachitika pambuyo pa opaleshoni zimatengera zinthu zambiri.Matenda a matendawa amakhudzidwa ndi chifukwa chosankha opaleshoni ngati njira yothandizira, kuchuluka kwa kuwonongeka kwa ziwalo ndi kuchuluka kwa kulowererapo kwa opaleshoni, mkhalidwe wofikira wodwalayo, kupezeka kwa matenda othandizirana mu nthawi ya postoperative, mtundu wa zochitika za postoperative ndi dispensary, kutsatira malangizo a dokotala, kuphatikizapo zakudya.

Kuphwanya kulikonse kwa malingaliro a madokotala, kuchita masewera olimbitsa thupi mopitirira muyeso, kutengeka mtima kwambiri kungayambitse matenda. Ndi pancreatitis yoledzera, ndi kumwa kosalekeza, chiyembekezo cha moyo chimatsika kwambiri.

Ubwino wamoyo pambuyo pakuchita opaleshoni yamapamba zimadalira wodwalayo. Kutengera malangizo a dokotala komanso opaleshoni yoyenera kuchitidwa opaleshoni, kuwonjezereka kwa moyo kumalembedwa mwa odwala ambiri.

Okondedwa owerenga, malingaliro anu ndiofunika kwambiri kwa ife - chifukwa chake, tidzakhala okondwa kukumbukira kugwiriridwa kwa kapamba mu ndemanga, ndizothandizanso kwa ogwiritsa ntchito ena a tsambali.

Nikolay

Pambuyo povulala pancreatic, atazindikira kuti akutuluka magazi, madotolo anaganiza zochita opaleshoni. Opaleshoniyo idachitidwa pansi pa opaleshoni yayikulu. Gawo lomwe lidawonongeka (mchira) lidachotsedwa, pambuyo pa opaleshoniyo, njira yayitali yobwezeretsa idatengedwa. Ndimakonda kudya pafupipafupi, mkhalidwe wanga uli bwino, kunalibe zovuta za postoperative.

Alexey

Chipatalacho adachisinthira moyipa. Opangawo adachitidwa popanda kufufuza kambiri, popeza kunalibe nthawi. Kuzindikira kunali necrotic pancreatitis yokhala ndi mafinya. Opaleshoniyo inatenga maola 6. Adakhala kuchipatala miyezi iwiri. Pambuyo pakuchotsa, physiotherapy ndi zakudya zapadera adalembedwa. Ndimangodya mbale zokhazokha, zopanda mchere komanso shuga. Ndikumva bwino.

Chithandizo cha postoperative

The algorithm ya mankhwala atatha kulowerera kumbuyo kwa kapamba chifukwa cha zinthu zina. Kuti apereke mankhwala, adotolo amawerengera mbiri yachipatala ya wodwalayo, zotsatira zomaliza za kulowererapo, kuchuluka kwa kukonzekera kwa gland, zotsatira za mayeso a labotale ndi zida zothandizira.

Ndi osakwanira kupanga insulin ndi kapamba, insulin mankhwala ndi mankhwala. Mahomoni opanga amathandizira kubwezeretsa komanso kusintha mtundu wa glucose m'thupi.

Ndikulimbikitsidwa kuti mumwe mankhwala omwe amathandizira kupanga ma enzymes okwanira, kapena omwe ali nawo kale. Amathandizira kukhazikitsa magwiridwe antchito am'mimba. Mankhwalawa akaphatikizidwa mu regimen yothandizira, ndiye kuti wodwalayo amakula monga kupangika kwa mpweya, kutulutsa m'mimba, kutsegula m'mimba, kutentha kwa mtima.

Kuphatikiza apo, ntchito zotsatirazi zikulimbikitsidwa:

Zakudya zopatsa thanzi.
Zochita zolimbitsa thupi.
Physiotherapy.

Kudya moyenerera kumawoneka ngati gawo lalikulu nthawi yodwalayo. Chakudya pambuyo pothandizanso ndi chiwalo chimakhala ndi kudya kwa masiku awiri. Pa tsiku lachitatu, kudya zakudya ndizovomerezeka. Mutha kudya zotsatirazi:

Tulutsani tiyi wopanda shuga ndi osokoneza.
Msuzi wosenda.
Porridge mu mkaka (mpunga kapena buckwheat). Pakukonzekera, mkaka umasungunuka ndi madzi.
Steeled omelet (agologolo okha).
Mkate wouma, dzulo lokha.
Kufikira 15 g batala patsiku.
Tchizi chamafuta ochepa.

Asanagone, ndikulimbikitsidwa kumwa kapu ya kefir yamafuta ochepa. Nthawi zina amasinthidwa ndi kapu yamadzi ofunda ndikuphatikiza ndi uchi wochepa. T

Pambuyo masiku 10 okha wodwala amaloledwa kuphatikiza nsomba ndi nyama zina menyu.

Kuzindikira pambuyo opaleshoni pa gland

Tsoka la munthu pambuyo pakuchita opaleshoni yam'mimba limatsimikiziridwa ndi zinthu zambiri. Izi zimaphatikizapo zomwe zimachitika opareshoni isanachitike, njira yolowererapo, mtundu wa njira zochiritsira komanso zotsatsira, thandizo la wodwalayo, ndi zina zambiri.

Matenda kapena matenda am'matumbo, ngakhale ali gawo lovuta kwambiri la kutupa kwa kapamba kapena cyst, chifukwa cha zomwe mankhwalawa amachitidwa, monga lamulo, apitilizabe kukhudza thanzi la wodwalayo komanso kuchuluka kwa matendawo.

Mwachitsanzo, ngati mayambidwewo ali chifukwa cha khansa, ndiye kuti pali chiopsezo chobwereranso. Zomwe zimachitika pakadutsa zaka 5 za odwala oterewa ndizokhumudwitsa, mpaka 10%.

Ngakhale kuphwanya kochepa komwe madokotala akufotokozera - kuchuluka kwa thupi kapena malingaliro, kuchuluka kwa zakudya, ndi zina zambiri, kungasinthe wodwalayo. Zimayambitsa kukokomeza komwe kumatha zotsatira zoyipa.

Zotsatira zake: mtundu wa moyo ndi nthawi yake atachitidwa opaleshoni yamkaka zimatengera kulangizidwa kwa wodwalayo, potsatira zonse zofunika ndi nthawi yoika dokotala.

Pazithandizo za kapamba zimafotokozedwa muvidiyoyi.

Kodi ma opaleshoni amawonetsedwa pancreatitis yayikulu?

Opaleshoni yokhala ndi chifuwa chachikulu kuchitika m'njira ziwiri:

laparotomy, pomwe adotolo amalowerera zokhudzana ndi chikhodzodzo kudzera pachiwopsezo cha khoma lam'mimba komanso m'chigawo chodzaza ndi lumbar,
njira zowononga zachilengedwe (laparoscopy, kulowerera-kukoka), zomwe zimachitika poboola m'mimba khoma la wodwala.

Laparotomy imachitika ngati mawonekedwe a purulent a pancreatonecrosis awululidwa: ma abscesses, kachilombo ka cysts ndi pseudocysts, pancreatonecrosis yodziwika bwino, retoperitoneal cellulitis, peritonitis.

Laparoscopy ndi puncture zotsatiridwa ndi ngalandezi zimagwiritsidwa ntchito pochotsa kulowetsedwa mu aseptic mitundu yamatenda ndi zomwe zili m'magazi ophatikizidwa ndi madzi. Njira zochepa zowonongera zingagwiritsidwenso ntchito ngati gawo lokonzekera laparotomy.

Ambiri opaleshoni njira kwa pachimake kapamba

Kutalikirana kwakuthupi kapamba. Amatembenuza kuchotsedwa kwa mchira ndi thupi la kapamba amakulu akulu osiyanasiyana. Imachitika ngati zowonongeka kwa kapamba ndizochepa ndipo sizigwira gawo lonse.
Kuyang'ana Kwapansi umakhala ndikuchotsa mchira, thupi komanso mutu waukulu wa kapamba. Magawo omwe ali pafupi ndi duodenum amasungidwa. Opaleshoniyo ndi yovomerezeka pokhapokha kuwonongeka kwathunthu kwa England. Popeza chiwalochi sichikhala chopanda mphamvu, chokhoma cha kapamba chokha chimatha kubwezeretsanso ntchito yake pambuyo pa opareshoni.
KhalidAkhaldi ikuchitika moyang'aniridwa ndi ultrasound ndi fluoroscopy. Momwe amapezeka amadzimadzi amtundu wa kapamba amaponyedwa ndipo zomwe zili mkati mwake zimachotsedwa pogwiritsa ntchito machubu omiza. Kenako, zikuluzikulu zowonjezera zamkati zimayambitsidwa mu patsekeke ndikuwotcherera ndipo kupakidwa kwa vacuum kumachitika. Pa gawo lomaliza la mankhwalawa, ma dragine akuluakulu amadzalidwa ndi ena ochepa, omwe amathandizira pang'onopang'ono machiritso am'mimba ndi bala la postoperative ndikusunga kutulutsa kwamadzi kuchokera pamenepo.

Zakudya zopatsa thanzi komanso wodwala pambuyo opaleshoni ya pancreatic

M'masiku 2 oyamba atachitidwa opaleshoni, wodwala amakhala ndi njala. Kenako, tiyi, msuzi wosenda wamasamba, chimanga chophika, mafuta omiza, mapuloteni, tchizi cha kanyumba pang'onopang'ono zimayambitsidwa m'zakudya, zomwe ndi zomwe zimatha kudyedwa pambuyo pakuchita opaleshoni yapanchipatala sabata yoyamba.

Mtsogolomo, odwala amatsatira zakudya zomwe zimagwiritsidwa ntchito pakulimbira. Zochita zolimbitsa thupi za wodwala zimatsimikiziridwa ndi kuchuluka kwa opareshoni.