Zambiri za opaleshoni ya kapamba

Zikondazo ndizoyandikana ndi cholumikizira msana ndi ziwiya zazikulu za malo a retroperitoneal, kutupa ndi chotupa chofala. Kuchita kwadzidzidzi kwa pancreatitis pachimake kumachitika m'maola kapena masiku oyamba a matendawa, kuchepetsedwa kuchitapo kanthu pochita opaleshoni kukuwonetsedwa masabata awiri pambuyo pakupanga kwa matenda. Ntchito zoyeserera zimachitidwa kuti muchepetse kubwererenso kwa kapamba kapenanso pakakhala kuti palibe gawo la necrotic.

Zizindikiro zothandizira

Zisonyezo za opaleshoni ndi:

• pachimake kutupa ndi pancreatic necrosis ndi peritonitis,
• kusagwira ntchito kwa mankhwalawa kwa masiku awiri,
• kupweteka kwambiri ndi kupitirira kwa matenda,
• magazi ovulala
• ma neoplasms osiyanasiyana,
• chotupa choteteza
• abscesses (kudzaza mafinya),
• calculi mu ndulu ndi ma ducts,
• cysts pamodzi ndi zowawa,
• chifuwa chachikulu chokhala ndi ululu waukulu.

Chithandizo cha opaleshoni chimapangitsa kuti njira ya pathological ikhale yokhazikika, ululu umachepa pakatha masiku 2-3 atachitidwa opaleshoni. Chowonetsera chachikulu cha matenda opatsirana ndi kuperewera kwa michere.

Musanagwiritse ntchito opaleshoni, onetsetsani kuchuluka kwa zowononga kapamba. Izi ndizofunikira kusankha njira yochitira opareshoni. Kuchita opaleshoni kuchipatala kumaphatikizapo:

1. Njira yotseguka. Uku ndi laparotomy, kutsegula chikopa ndi kutulutsa timadzi timatumbo tosambira mpaka kuyeretsa kwathunthu.
2. Laparoscopic ngalande. Moyang'aniridwa ndi laparoscope, chotupa chimatsegulidwa, zimakhala zowoneka bwino za necrotic zimachotsedwa, ndipo ngalande zamkati zimakonzedwa.
3. Kukhetsa kwamkati. Chotupa chimatsegulidwa kumbuyo kwam'mimba. Kuchita kotereku kumatha kuchitika ndi laparotomy kapena laparoscopic. Zotsatira za opareshoni ndikumasulidwa kwa zomwe zimapezeka pamimba kudzera mu fistula yokumba yopangidwa m'mimba. Mitsempha imasungunuka pang'onopang'ono (kukulira), kutseguka mwachangu pambuyo pa opaleshoni kumalimbitsidwa mwachangu.

Chithandizo cha mankhwalawa chimathandizira magazi, kuchepa kwa zovuta zam'magazi kumawonedwa.

Zakudya pambuyo opaleshoni chifukwa cha pancreatitis pachimake

Mu nthawi ya ntchito, wodwalayo ayenera kutsatira malamulo apadera azakudya. Pambuyo pa opaleshoni, masiku awiri, kusala kwathunthu ndikofunikira. Kenako, mutha kulowa muzakudya:

• anakanda mazira
• phala yophika kwambiri,
• msuzi wamasamba
• tchizi tchizi
• obera.

Masiku oyamba asanu ndi awiri pambuyo pa opaleshoni, zakudya ziyenera kukhala zazing'ono. Zakudya ziyenera kumwedwa mpaka nthawi 7-8 masana. Kukula kotumikirako sikuyenera kupitirira 300. Zakudya ziyenera kuwiritsa kapena kuwiritsa. Porridge imawiritsa pamadzi pokhapokha, opanga amafunika kuti azinyowa mu tiyi. Zothandiza masamba purees, puddings ndi zakudya.

Kuyambira masabata awiri atachitidwa opaleshoni, wodwalayo ayenera kutsatira zakudya zomwe zimaperekedwa kwa matenda a m'mimba. Amalimbikitsidwa miyezi itatu. Mutha kugwiritsa ntchito:

• Mitundu yochepa yamafuta ndi nsomba, nkhuku,
• mazira a nkhuku (osaposa ma PC 2 patsiku),
• tchizi tchizi
• wowawasa zonona
• msuzi wa rosehip,
• zakumwa za zipatso
• masamba
• mafuta kapena masamba monga chowonjezera m'mbale.

Kumwa mowa pambuyo pakuchita opaleshoni kumapangidwa.

Kubwezeretsa kuchipatala kumatha mpaka miyezi iwiri, munthawi yomwe kugaya chakudya kumayenera kuyenderana ndi zochitika zina, zomwe zimachokera ku enzymatic process.

Zotheka ndi zovuta

Pambuyo pakuchita opaleshoni mankhwala a kapamba, zotsatira zina siziyikidwa pambali:

• kutuluka magazi mwadzidzidzi m'mimba
• Mitsempha yachilendo yotuluka mthupi,
• kuwonongeka kwa odwala matenda a shuga,
• purulent peritonitis,
• vuto la magazi
• kachilombo ka pseudocyst
• kusakwanira kwa kwamikodzo dongosolo ndi chiwindi.

Vuto lodziwika bwino pambuyo pa opaleshoni ndi purcin pancreatitis. Zizindikiro zake:

• malungo
• kuwoneka kwa ululu waukulu m'mimba ndi chiwindi,
• kuwonongeka kuti mugwedezeke,
• leukocytosis
• kuchuluka kwa amylase m'magazi ndi mkodzo.

Chizindikiro cha puritis peritonitis ndi malungo.

Chithandizo cha opaleshoni yamatenda a kapamba nthawi zambiri satha kuthetsa kusintha komwe kumayamba chifukwa cha kapamba. Pankhaniyi, njira zambiri zothandizira opaleshoni zimatha kuthandizidwa pokhapokha pothana ndi zovuta za kapamba ndi kupweteka. Pokonzekera njira yogwirira ntchito, ntchito yayitali kwambiri yoteteza chinsinsi cha England ndi zida zake zapamwamba ziyenera kuperekedwa.

Zisonyezero zochizira matenda a kapamba:

• tuben stenosis a terminal gawo wamba wamba duct,
• duodenal stenosis,
• stenosis yofunikira pancreatic duct,
• pancreatic ascites (pleurisy),
• gawo lamatenda a portal,
• magazi amkati,
• non-Conservative pain syndrome
• amaganiza kuti ali ndi khansa ya kapamba.

M'malo ochita opaleshoni yochitira opaleshoni yodwalayo, pamakhala ntchito zambiri zosiyanasiyana pa kapamba palokha komanso ziwalo zina moyandikana nazo. Kuchulukitsa kwa opaleshoni kumatsimikiziridwa ndi chikhalidwe, kutengera kwachilendo ndi kusinthasintha kwa morphological mu kapamba ndi ziwalo zozungulira, ndipo nthawi zambiri pamakhala kufunikira kwa njira zingapo zopangira opaleshoni.

Ntchito zokhazokha pa ndulu ndi ma ducts, komanso pamimba, zimachitika pancreatitis yayitali, yomwe imachitika motsutsana ndi maziko a cholelithiasis kapena zilonda zam'mimba kapena duodenum pakalibe kusintha kwakukuru kwa morphological. Amachitika molingana ndi mfundo zamankhwala othandizira matenda oyamba ndipo amaphatikizanso cholecystectomy, kulowererapo pa ma ducts a bile (endoscopic kapena opaleshoni), resection yam'mimba, kapena amodzi mwa mitundu ya vagotomy.

Pankhani ya pancreatogenic stenosis ya wamba bile duct kapena duodenum, zikuwonetsa zomwe zimapangitsa kuti shunting azichitika: poyambirira, zokonda zimaperekedwa pakugwiritsa ntchito hepaticoyunoanastomosis pamalopo limodzi ndi Ru kuphatikiza ndi cholecystectomy, chachiwiri, mapangidwe a gastroenteroanastomosis sangathe.

Splenectomy (nthawi zambiri imaphatikizidwa ndi mitsempha ya varicose yam'mimba yam'mimba) imachitika chifukwa cha chifuwa chachikulu, chomwe chidayambitsa matenda a spinic vein thrombosis ndipo, chifukwa chake, chitukuko cha matenda oopsa a portal portal, omwe nthawi zambiri amawonekeranso ndi magazi obweranso m'matumbo.

Ndi kukulira kwa ductal system ya kapamba ndipo, choyambirira, kupendekera kwake kwakukulu malinga ndi mtundu wa unyolo wamadzi, mwayi umaperekedwa pakugwiritsa ntchito kotenga nthawi yayitali pancreatoeunoanastomosis. Chofunika cha opareshoni ndi gawo lalikulu kwambiri la kapamba kudzera munsi mwa kapamba, kuyambira kumutu mpaka kumchira, kenako ndikulowetsa chidacho ndi lobo ya jejunum yoyikidwa pambali pa Ru.

Mkuyu. 1. Longitudinal pancreatojejunostomy (chiwembu chogwiritsa ntchito). Pambuyo pakugawanika kwa gawo lalikulu la pancreatic duct, limasungidwa ndi chiuno cha jejunum chayikidwa pambali pa Ru.

Nthawi zina chifuwa chachikulu cha kapamba wokhala ndi padera kapena chodontha chachikulu cha thupi ndi mchira wa thupilo, zotengera za kapamba ka buku loyenera - hemipancreatectomy, subtotal organ resection - itha kukhala ntchito. Funso lakusankhidwa kwa njira yogwirira ntchito yotchedwa "caprate" pancreatitis, yomwe siyimayikidwa limodzi ndi kufalikira kwamkati mwakachetechete. Pankhaniyi, pancreatoduodenal resection ndiyotheka, makamaka ngati khansa yam'mimba ya pancreatic siyipatula.M'zaka zaposachedwa, ndi "caplect" pancreatitis, adayamba kugwiritsa ntchito mawonekedwe apadera a mutu wa kapamba posungira osati m'mimba yokha, komanso duodenum. Ngakhale ndizovuta zamakina, mwayi wogwira ntchito ndi kuteteza kwathunthu kwa chakudya, zomwe mosakayikira zimasintha moyo wa odwala.

Kuchulukitsa kwa chithandizo chamkati cha fancula yamkati, yoyenda ndi ascites kapena pleurisy, zimatengera mkhalidwe wa pancreatic ductal system komanso malo omwe ali ndi chilema. Ndi fistulas m'chigawo cha mchira wa gland, gawo lachigawo lachigawo limachitika ndi dera la pathological anastomosis. Fistulas yochokera kumutu kapena thupi la kapamba ndipo nthawi zambiri imayendera limodzi ndi kufutukula kwa ductal system yake imafunikira madzi okwanira mkati mwa maliseche pogwiritsa ntchito kotenga nthawi yayitali pancreatojejunoanastomosis, ndipo sikofunikira kufunafuna ndikuwunikanso kutseguka koyimba, kumangotseka pakokha pakatha kuchotsedwa kwina.

Kukhazikika kwa njira zakuchiritsira za endoscopic kwapangitsa kuti zizitha kugwiritsa ntchito mitundu ina ya matenda kapamba. Chifukwa chake ndi okhazikika stenosis mkamwa mwa chachikulu pancreatic duct, endoscopic papillosphincterotomy ndi virzungotomy angathe kuchitidwa. Ndi masitepe angapo munkhumbi, njira yodalirika yochepetsera matenda oopsa ndi kutsika kwa mapangidwe a pulasitiki wa papilla papillae m'magawo a distzort diz, i.e. pancreatoduodenal prosthetics, pamaso pa virzungolithiasis, kulowererako kungaperekedwe ndi extracorporeal ultrasound lithotripsy.

Kukhalapo kwa fancula yamkati wamkati, yowonetsedwa ndi ascites kapena pleurisy, imakhalanso chisonyezo chogwiritsa ntchito virzung duct endoprosthetics, pambuyo pake fistulas imatseka mwachangu. Mbali yabwino yolowera ku endoscopic ndikuwonongeka kwawo kochepa. Komabe, chifukwa cha kuyimirira kwa nthawi yayitali, matenthedwe ake amachitika, zomwe zimayambitsanso matendawa, motero palibe chifukwa chodalira kukhululukidwa kwakanthawi pambuyo pa ma prosthetics. Komabe, kulowererapo kotereku kumawoneka ngati kothandiza kwambiri ngati njira yongoyembekezera kukonzekeretsa odwala ovuta kwambiri.

Mkuyu. 2. Chiwembu cha kupatula kwa mutu wa pancreatic mu chifuwa chachikulu.

Zochizira ululu wosalekeza kwa odwala omwe ali ndi pancreatitis yachilendo komanso njira yachilendo ya kapamba, osagwirizana ndi ziwalo zozungulira, njira zochitira opaleshoni zamagetsi zam'magazi nthawi zina zimagwiritsidwa ntchito posokoneza ma ululu okhudzana ndi pathological. Mwa iwo, splanchnicectomy (osakwatiwa komanso aŵiri) komanso kuyang'ana kwa mwezi wa celiac plexus node zinali zofala kwambiri. Kuchita bwino kwa ntchito izi ndikotsika chifukwa chosakwanira kwambiri kwa analgesic kwenikweni komanso kwanthawi yochepa. M'zaka zaposachedwa, endoscopic splannicectomy yomwe idachitika kudzera mu thoracoscopic kulowa ndi zomwe zimadziwika kuti "chemical splanchnectectomy", zomwe zimapangidwa poyambitsa mowa kapena phenol mu celiac trunk zone mwina transdermally pansi pa kayendetsedwe ka CT kapena kuchokera ku lumen pamimba yoyang'aniridwa ndi echo endoscope, akhala akugwiritsa ntchito ngati njira zothandiza posachedwa.

Pancreatitis ndi kutupa kwa kapamba amene amapezeka mwamtundu kapena pachimake. Munthu akakumana ndi matenda, minofu yake imakwiya ndikuyamba kugwa. Kuletsa njirayi, ndikofunikira kukwaniritsa kupumitsa kokwanira kwam'mimba, kenako ndikuthandizira. Nthawi zina madokotala amayenera kugwiritsa ntchito mankhwalawa pancreatitis.Tidziwa zomwe zikuwonetsa opareshoni, momwe opaleshoni imachitikira, zomwe zimayembekezera wodwalayo pambuyo pake.

Ngati pancreatitis yayitali idalumphira mwadzidzidzi mawonekedwe, sizitanthauza kuti opaleshoni ifunika. Kuukira kungachiritsidwe ndi zomwe zimachitika mwanjira iliyonse: kufooketsa chimbudzi mwa kusala, kenako ndikutsatira zakudya zochizira. Kenako ululu umachoka.

Nthawi zambiri akapezeka ndi matenda othandizira pancreatic, wodwalayo amagonekedwa kuchipatala ndi njira yochizira. Madokotala amalabadira kwambiri:

• machitidwe a wodwala,
• mbiri yazachipatala
• kukhalapo kwa zovuta m'mbuyomu.

Chithandizo chimagwira mosamala - poyamba amakhala oyenera kuti athetse matendawa kudzera m'mankhwala komanso zakudya zochizira. Zimachitika kuti njira zowononga zoyera zimadziwonekera - ndipo opareshoni sangapatsidwe. Kuyambiranso kofananako kumakumana ndi 20% ya odwala.

Mankhwala othandizira kapamba nthawi zonse amakhala njira yomaliza. Madokotala amadziwa bwino momwe opaleshoniyo imakhudzira ziwalo zamkati. Njira zoterezi zimakhudzidwa kwambiri.

Kutupa koyamba nthawi ndi nthawi kumadutsa gawo la kuvunda kwa kutulutsa. Ndikosatheka kuthandizidwa pogwiritsa ntchito njira zopangika ndi njira zopopera, mapangidwe a mafinya pamimba sangathenso kuyimitsidwa, komanso sizotheka kuichotsa m'thupi.

Zizindikiro zina zothandizira opaleshoni ndikuphatikizapo:

• kupweteka kwambiri, mankhwala okongoletsa sathandiza,
• kufala kwamatenda
• makina oyendetsa,
• mawonekedwe a ndulu, ndulu za calculi kapena miyala.

Opaleshoni ya kapamba imachitidwa ngakhale koyambirira, yankho lina liyenera kukwaniritsa zizindikiro. Kuchita opaleshoni ndikuthandizira kupewa zovuta komanso kuletsa kupweteka kwapathengo pachiwopsezo cha matendawa.

Mavuto omwe amafuna opaleshoni

Matenda a kapamba amatha kuchitika mwakachetechete thupi lake mpaka kumenyedwa mwamphamvu. Izi zimachitika kuti wodwala yemwe wapezeka kuti ali ndi vutoli amakupimidwa kuchipatala chifukwa chotsatira:

• fistulas
• mawonekedwe a pseudocysts,
• mawonekedwe a zotuluka za purulent,
• kapamba wambiri,
• zikondamoyo.

Mulimonsemo pazomwe tafotokozazi, opaleshoni imakhala yovomerezeka. Kupita patsogolo kwamavuto sikungapindulitse thupi, ndikofunikira kuthana ndi mavuto mosavuta.

Zizindikiro za purulent abscesses

Zina mwazovuta zomwe zimafunikira pakuchitapo kanthu pakuchitidwa opaleshoni ndikuwoneka ngati zotupa za purulent - mawonekedwe omwe amafala kwambiri. Kuzindikira zomwe zikuchitika pasadakhale mwina ndi izi:

• kutentha kosatha
• kudera lamapazi (pakudzitupa kwachilengedwe), palpation imawulula mawonekedwe,
• khungu loyera limapita kumanzere,
• hyperglycemia imawonedwa,
• Ma X-ray amazindikira mizere yokhala ndi mpweya,
• Ultrasound imazindikira mizere yodzaza ndi madzimadzi.

Posakhalitsa vuto likazindikirika, ndiye kuti mungathe kukhalanso ndi minofu yathanzi.

Contraindication opaleshoni

Kuphatikiza pazizindikiro zakuthandizira opaleshoni, pali zotsutsana:

• kulumpha mu magazi,
• kugwedezeka kosalekeza komwe sikungathetsedwe,
• kusowa kwa mkodzo
• kuchuluka kwa michere mthupi,
• shuga wokwera mumkodzo,
• kuchuluka kwa magazi m'thupi, osayesa kubwezeretsa akale.

Kwa chizindikiro chilichonse chomwe chatchulidwa, opaleshoni yoletsedwa. Poyamba, ndikofunikira kuti wodwalayo akonzedwe, kuti athetse mavuto osautsa, kenako ndikuthandizira opaleshoni.

Chifukwa cha zochitika zotere, madokotala amayang'anitsitsa wodwalayo, amayesa mayeso osiyanasiyana ndipo, atatha kufufuza, asankha ngati dokotala akufunika chithandizo kapena ngati palibe chifukwa.

Ntchito ikuyenda bwanji?

Mankhwala ochizira pancreatitis pachimake amachitika masiku awiri. Poyamba, wodwalayo amakonzekera kwambiri, chachiwiri, opaleshoni imachitidwa mwachindunji.

Ntchito madokotala kuchitira opaleshoni mankhwala a pachimake kapamba:

• kuthetsa ululu
• kupewa zotheka
• kusamalira / kukonza ntchito
• Chotsa mafinya ndi zinthu zina zowola.

Chithandizo cha opaleshoni yayikulu pancreatitis imayimitsa kupititsa patsogolo kwa matendawa, ndikupangitsa mawonekedwe okhazikika. Matenda a kapamba sangathe kwathunthu, zimachitika kawirikawiri. Odwala omwe adapezeka kuti ali ndi kutupa kwa pancreatic ayenera kutsatira zakudya zapadera ndikumwa mapiritsi amoyo wonse.

Pali njira zambiri panthawi ya opareshoni: kudukiza kumadalira mbiri ya wodwala. Muli zitsamba zotulutsa. Ngati dokotalayo ataona kutuluka kwa bile mu duodenum, cholecystostomy imachitika.

Choyambirira kwa dotoloyo ndi momwe wodwalayo alili. Ngati magazi amatuluka kwambiri, dokotalayo akuganiza zongoyimira pomwepo osafuna kuchiritsa matenda angapo nthawi imodzi. Ngati ndi kotheka, madokotala amagwira ntchito 8 mpaka 10, kumaliza ntchito mpaka kumapeto.

Kodi mawonekedwe ndi chiyani?

Nthawi zina dokotalayo amayenera kuchita kufufuzanso - kuchotsera pang'ono kapamba. Imachitika pachitukuko cha kutukusidwa mu gawo linalake la England. Ngati cholinga chokhala ndi kutupa ndikochepa, zolinga za necrosis zimachotsedwa. Nthawi zambiri ndikofunikira kuti tichotse minyewa yomwe kuwonongeka kwake kuli kokulirapo - kupewa mkhalidwe wapoizoni wa thupi ndi zinthu zowola ndikufalikira kwa kutupa kuzinthu zina. Malinga ndi zomwe zikuwonetsa, nduluyo imachotsedwa.

Kodi chithandizo cha opaleshoni chikufunika liti?

Thupi ili limapereka zovuta zambiri kwa akatswiri onse pakuchita opareshoni komanso pambuyo. Pochotsa kapamba, opaleshoni iyenera kuchitidwa kokha ndi madokotala oyenera ndipo pokhapokha ngati pakufunikira kutero.

Matenda otsatirawa akhoza kukhala deta ya chithandizo cha opaleshoni:

• kuvulala chiwalo
• pafupipafupi kuchuluka kwa kapamba,
• kupweteka kwapweteka,
• kapamba,
• pachimake owononga pancreatitis,
• pseudocysts ndi cyst.

Kodi zovuta zomwe zingachitike ndi opaleshoni ndi ziti?

Ntchito yochotsa kapamba imayambitsa zovuta zina zomwe zimalumikizidwa ndi thupi lake komanso malo ndi kapangidwe ka chiwalo. Ili mu "malo osavutikira." Kuphatikiza apo, imakhala ndi magazi oyenda limodzi ndi duodenum.

Mphepoyi imakhala pafupi ndi ziwalo monga impso ndi m'mimba msempha, wamba duct, m'munsi komanso kumtunda kwa vena cava.

Zovuta za opaleshoni mu pancreatitis pachimake zimagwirizanitsidwa ndi enzymatic ntchito ya gland. Izi zikufotokozedwa chifukwa chakuti chomaliza chimatha kugaya minyewa ya chiwalocho.

Nkhani yothandiza? Gawani ulalo

Kuphatikiza apo, kuchitapo kanthu opaleshoni kumakhala kodzaza ndi zotsatira monga kupanga fistula ndi magazi. Izi zitha kuchitika chifukwa minofu ya parenchymal yomwe chiwalocho chimapangidwa ndichopanda mphamvu kwambiri. Chifukwa chake, nkovuta kwambiri kuzimeza.

Kodi opaleshoni ya kapamba imachitika liti?

Kufunika kwa mankhwalawa 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, mankhwalawa opaleshoni pamaso pa kapamba amachitika motere:

• Mkhalidwe wodwala, wodziwika ndi gawo lowopsa la matenda owononga. Ndi chithunzithunzi chofananira, kuwonongeka kwa tiziwalo tomwe tili ndi matenda amtundu wa necrotic kumayang'aniridwa, pomwe njira zoyeretsa zimatha kuwonjezeredwa, 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.

Kodi opaleshoni imachitika bwanji?

Kwa khansa ya kapamba, opaleshoni imafunikanso. Milandu yotsala yomwe chithandizo cha opaleshoni ndiyofunikira idalembedwa pamwambapa. Komanso, ndi pancreatic cyst, opaleshoni ndiyofunikira kuvomerezedwa. Mankhwala opangira opaleshoni amachitidwa mothandizidwa ndi opaleshoni yofinya thupi ndi minofu yopumula.

Ngati pali zizindikiro za kutuluka kwamkati, ndiye kuti pakufunika kuchitidwa kanthu mwadzidzidzi pa chiwalochi. Nthawi zina, kuchitapo kanthu opaleshoni yochitidwa.

Chifukwa chake, opaleshoni yamapamba amachitidwa motere:

• Choyamba, chiwalo chimatsegulidwa,
• chikwama chakudulira chimasulidwa ku magazi,
• kupindika kwapaderako kumakhala kovutikira,
• hematomas amatsegulidwa ndikutseka malaya,
• Pakachitika nthiti, zikunguzika, zimayikidwamo, ndipo chimbudzi chimayatsidwa panthawiyi.
• Ngati zolakwika zazikulu zili mchira wa kapamba, ndiye kuti gawo ili limachotsedwa limodzi ndi ndulu,
• Ngati mutu wa chiwalo chawonongeka, umachotsedwanso, koma ndi gawo la duodenum.
• Kuchita opaleshoni kumatha ndikutulutsira thumba la zinthu.

Mitundu ina yamankhwala opaleshoni

Pamaso pancreatic cyst, opaleshoni imaphatikizapo kuchotsa koyambirira ndi gawo la chiwalo. Monga lamulo, pamenepa, opaleshoni siziwoneka ngati yovuta kwambiri.

Ndi miyala mu kapamba, opaleshoni imayamba ndi kugwirana kwa ziwalo. Komanso makoma a duct amawonekera pachithunzi ichi. Pambuyo pake, miyala imachotsedwa. Ngati pali chiwerengero chachikulu cha chotsirizachi, ndiye kuti kukanika kwa gawo lalitali kumachitika, ndikutsatira calculi.

Zimachitikanso kuti amazindikira khansa ya kapamba. Opaleshoniyo ndiye yovuta kwambiri. Ndi chotupa mchira ndi thupi, chindayo ndi ndulu zimachotsedwa. Ndi kupweteka koyipa mchira ndi mutu, chiwalo chimachotsedwa limodzi ndi duodenum ndi ndulu.

Pancreatic resection - ndi chiyani?

Chiwalochi chimachotsedwa pang'ono, koma osati kwathunthu, chifukwa munthu sangakhale popanda icho. Njira iyi ya chithandizo imatchedwa resection. Monga lamulo, iwo amapangira icho ndi chotupa choyipa.

Pofuna kuchotsa mutu wa chiwalo, ntchito ya Frey imachitidwa. Ndi wowopsa komanso wovuta.

Kuchita opaleshoni ndikuchita ndi njirayi kumachitidwa pancreatic necrosis, kuvulala komwe kumapangitsa kwambiri zikondwerero zambiri, komanso chotupa.

Zomwe zimachitika pambuyo pa opaleshoni zimasakanikirana. Zachidziwikire, ziwalo zomwe zikusowa sizimabwezeretsedwa.

Mukachotsa mchira wa kapamba, zotsatira zabwino zimatheka popanda zovuta m'mimba komanso kukula kwa matenda ashuga. Koma ndi ntchito yowonjezereka kwa ndulu, pamakhala chiopsezo chakuchepa kwa chitetezo chokwanira komanso mapangidwe a thrombosis.

Pambuyo pa kuchitidwa opaleshoni kwa Frey, zotheka zimaphatikizapo zovuta zamagazi, magazi, ndi kuwonongeka kwa mitsempha yapafupi komanso mitsempha yamagazi.

Pambuyo pa opaleshoni, munthu amakhala ndi kusowa kwa mahomoni ndi ma enzyme. Kupatula apo, ndi iwo omwe amapangidwa ndi chiwalo chakutali. Pankhaniyi, wodwalayo adapangidwira chithandizo chamankhwala, chomwe chimakupatsani mwayi wothandizira gland.

Kupandukira kwa kapamba

Opaleshoni iyi ndi yovuta kwambiri. Sichichita, ngakhale wodwalayo atapezeka kuti ali ndi chotupa cha m'mimba. Zotsirizirazi sizichoka kawirikawiri. Choyamba, opaleshoni imawonedwa kuti ndi yokwera mtengo kwambiri, ndipo chachiwiri, kuchuluka kochepa kwa kupulumuka kwa odwala. Popeza kapamba ndi chiwalo chosatupa, chimangotengedwa kuchokera kwa munthu wopanda moyo.

Pambuyo pa kuzizira, chiwalo chimatha kusungidwa kwa pafupifupi maola anayi. Uku ndikovutikira kochita ma pancreatic transplant opaleshoni.

Kukhazikitsidwa kwa wopereka mothandizidwa m'malo ake olimbitsa thupi ndikovuta. Kupatsika kwake kumachitika ndikusunthira kumtunda ndikumalumikiza ndi ziac, splenic, ndi hepatic.

Kuchita izi ndizovuta kwambiri, ndipo pali kuthekera kwakukulu kwa kufa kwa wodwalayo chifukwa chadzidzidzi komanso kutaya magazi kwambiri. Chifukwa chake, njira iyi yothandizira opaleshoni sichichitika.

Matupi a kapamba amadziwika ndi antigenicity yayikulu. Ndipo ngati palibe chithandizo choyenera, gland ya woperekayo imangokhala masiku ochepa atatha opaleshoni. Kenako padzakhala kukanidwa.

Kodi zingakhale zovuta zovuta kuchita chiyani?

Monga lamulo, chimodzi mwazotsatira zoyipa pambuyo pakuchita opaleshoni ndi postoperative pancreatitis. Zizindikiro zakukula kwa matenda awa:

• leukocytosis
• malungo
• kuwonongeka msanga kwa momwe munthu aliri,
• kupweteka kwambiri m'dera la epigastric,
• kuchuluka kwa amylase m'magazi ndi mkodzo.

Pachimake kapamba nthawi zambiri amapezeka odwala amene, pambuyo opaleshoni pa kapamba, amapanga pachimake kutsekeka kwa waukulu. Izi zimachitika chifukwa cha edema ya organ.

Mavuto ena atachitidwa opaleshoni imaphatikizira kuchuluka kwa matenda a shuga, matenda a peritonitis ndi magazi, kulephera kwa magazi, chifuwa cha leancosis komanso kuperewera kwa impso.

Kodi tanthauzo la chithandizo cha postoperative ndi lotani?

Chithandizo choyenera chimasankhidwa ndi katswiri ataphunzira mbiri yachipatala ya wodwalayo.

Monga lamulo, atachitidwa opaleshoni, madokotala amakulangizani kuti muzitsatira zakudya, khalani ndi njira ina yapadera, idyani zakudya zapadera za enzyme zomwe zimathandizira kugaya chakudya.

Chofunikanso ndicholimbitsa thupi ndi physiotherapy.

Popeza kuchotsedwa kwa kapamba ambiri amayamba kudwala matenda a shuga, amapatsidwa insulin.

Zakudya pambuyo opaleshoni

Zakudya zamankhwala ndizimodzi mwazinthu zazikulu zomwe zimapangitsa kuti wodwala athe kukonzanso.

Zakudya zimayambira pakatha masiku awiri kusala kudya. Patsiku lachitatu, wodwalayo amaloledwa kudya sopo wophika, tiyi wopanda shuga, mankhwala obiriwira, mpunga ndi phala la mkaka wamkaka, tchizi tchizi, batala pang'ono ndi omele mapuloteni.

Asanagone, wodwalayo amatha kumwa kapu yamadzi ndi uchi kapena yogurt.

Masiku asanu ndi awiri oyamba kwa wodwalayo, zakudya zonse ziyenera kuwotchedwa. Pambuyo pa nthawi imeneyi, mutha kudya zakudya zophika.

Kuzindikira pambuyo opaleshoni

Nthawi zambiri, tsogolo la munthu limakhala lotani malinga ndi momwe wodwalayo alili, njira yochitira opaleshoni, kuchuluka kwa zochitika komanso chakudya choyenera.

Mkhalidwe wa pathological, chifukwa chomwe gawo limodzi la kapamba amachotsedwa, likupitilizabe kukhudzanso wodwala.

Ndi rese resection khansa, pali kuthekera kwakukulu kobwereranso. Ngati zizindikiro zina zovuta zikuwonekera mwa odwala otere, muyenera kufunsa katswiri kuti musatenge njira ya metastasis.

Kupsinjika kwakuthupi ndi kwamaganizidwe, kuphwanya njira zochiritsira komanso zakudya zoyenera sizingakhudze thupi la wodwalayo m'njira zabwino. Zimatithandizanso kukulitsa kuchulukana kwa matenda a kapamba. Kuchokera pazolondola, kulangizidwa ndikuwonetsetsa ndendende nthawi zonse zomwe dokotala amapanga adokotala zimatengera kuchuluka komanso momwe munthu angakhalire.

Opaleshoni ya pancreatic: kuwunika kwa wodwala

Popeza taphunzira za maopaleshoni, titha kunena kuti mayankho ake ndiabwino. Kwenikweni tikukamba za neoplasms yoyipitsitsa mu kapamba. Achibale komanso odwala omwewo akuti adatha kuthana ndi matendawa, ngakhale anali ndi mantha.

Chifukwa chake, kuchitapo kanthu opaleshoni, chifukwa cha thandizo la akatswiri oyenerera, ndi mtundu wa moyo wa odwala.

Palinso ndemanga za anthu pancreatic necrosis. Monga mukudziwa, matendawa ndiwanyalanyaza chifukwa cha pachimake kapamba. Chiwerengero chachikulu chothokoza madokotala ochita opaleshoni kuchokera kwa anthu omwe adawathandiza kupulumuka amatha kuwoneka pa intaneti.

Zikuchokera pamenepa kuti, ngakhale kuti opaleshoni ya pancreatic imawonedwa ngati njira imodzi yovuta kwambiri yochitira opaleshoni, zimathandiza kutulutsa odwala ndikupitilizabe kugwira ntchito mu mzimu womwewo. Ingoyiyi musayiwale kuchuluka kwa malingaliro ndi upangiri womwe umaperekedwa ndi dokotala. Ndipo mudzamva ngati munthu wathanzi komanso wamphumphu.

Pancreatitis ya kapamba ndimatenda oopsa omwe matendawa amawonongeka, ndipo mtsogolomo izi zimabweretsa kusintha kwa metabolic. Lero tilingalira zomwe zimayambitsa matenda, momwe mungathane nawo, njira zogwiritsira ntchito.

Zomwe zimayambitsa matendawa

Kuzindikiritsidwa kwa kapamba kapamba munthawi yathu yathu. Koma kodi chifukwa chiyani anthu akuvutikirabe? Mudzamvetsetsa chilichonse mukazindikira zifukwa zomwe zimakulimbikitsani maonekedwe anu.

1. Kumangika ndi zakumwa zoledzeretsa.
2. Zakudya zoperewera, zomwe ndimakonda kugwiritsa ntchito zakudya zamchere, zonunkhira komanso mafuta.
3. Kulemera kwambiri.
4. Matenda onga, monga: cholecystitis, hepatitis, cholelithiasis, zilonda zam'mimba, gastritis, kutupa.
5. Opaleshoni yam'mimba kapena kuvulaza kwake.
6. Kusuta
7. Zakudya.
8. Khalidweli.
9. Kumwa mankhwala, pambuyo pake matendawa amawoneka (tetracyclines, cytostatics, sulfonamides).

Zizindikiro za pancreatitis pachimake

Ndi matenda amtunduwu, kutulutsa kwaulere kwa pancreatic madzi kumasokonekera, kumatha kugayidwa ndi michere yake. Pa matenda a pancreatic pancreatic pachimake, zotsatirazi ndi zikhalidwe:

1. Zowawa. Imachitika kumanzere kwam'mimba, ndipo patapita kanthawi imafalikira kumimba yonse.
2. Kuchepetsa mseru komanso kusanza.
3. Kuthamanga kwa magazi sikunapangidwe.
4. Kumvetsetsa kwenikweni kumaphwanyidwa.
5. Vuto ladzidzidzi lingachitike.

Zizindikiro zake ndizazikulu kwambiri pochiza matendawa kunyumba. Chifukwa chake, mu pancreatitis yovuta kwambiri, ambulansi imayenera kuyitanidwa mwachangu.Dokotala wodziwa bwino adokotala ayenera kumuyesa wodwalayo, ndipo alephera, amuzindikiritse kuchipatala kuti apitirize chithandizo. Sizokayikitsa kuti opaleshoni ya pancreatic ikhoza kupewedwa m'njira yamatenda.

Matenda a kapamba: zizindikiro ndi chithandizo koyamba

Zizindikiro za matenda amtunduwu sizowopsa ndipo sizikufunika chisamaliro chofunikira. Tsopano tikambirana za pancreatitis yayitali, zizindikiro ndi chithandizo cha matenda amtunduwu.

Poyamba, ndikofunikira kusiyanitsa magawo awiri mu kutupa kosapumira:

1. Woyambira.
2. Nthawi yowonongeka kwanyumba.

Nthawi yoyamba imatha kukhala nthawi yayitali - mpaka zaka 10. Zizindikiro zanyengo iyi:

1. Ululu wammbuyo Zowawa zimatha kutulutsidwa kumtunda ndi pakati pamimba, m'chigawo chakumanzere cha lumbar ngakhale pagawo la mtima. Nthawi zambiri, zosasangalatsa zoterezi zimachitika pakadutsa mphindi 15 mpaka 20 mutatha kudya.
2. Kusanza, kusanza ndikotheka.
3. Kufalikira.
4. Kutsegula m'mimba.

Choyambirira chimawonedwa mwa odwala nthawi zambiri, koma zina sizingachitike. Ngakhale chizindikiro chikawoneka, ndiye kuti mothandizidwa ndi mankhwala mutha kuthetsa vutoli mwachangu.

Nthawi Yawonongeka Pancreatic

Izi ndi izi:

1. Zowawa sizodziwikiratu ngati poyamba.
2. Pankhaniyi, dyspeptic syndrome predominates: kutentha pa chifuwa, kupindika, nseru, kutulutsa.
3. Pali matenda a maldigestion. Apa ndipomwe pali kuphwanya kwa chimbudzi cha chakudya kuzinthu zomwe zimayamwa.
4. Pali matenda a malabsorption. Poterepa, kachipangizo kamene kamayamwa matumbo ang'onoang'ono sikasokonezeka konse.

Pa maldigestion ndi malabsorption, zizindikiro zotsatirazi ndizodziwika:

• fetid, zopondera zambiri,
• kuwonda
• Kuchepa kwamadzulo usiku,
• kutulutsa magazi kumachitika
• conjunctivitis, stomatitis, ndi kuyabwa kwa khungu kumachitika
• kuchepa kwa magazi kumayamba
• chifukwa chakuti pali kuphwanya mayamwidwe kashiamu, pamakhala kukokana ndi mafupa,
• neuropsychic arousal,
• mawonekedwe a thukuta lozizira
• kunjenjemera m'thupi
• khungu lowuma
• pali kumverera kwa ludzu losalekeza.

Ndikofunikira kuchiza pancreatitis yayitali kuti mupewe opaleshoni ya pancreatic. Mankhwalawa ayenera kukhala okwanira komanso ovomerezeka. Pambuyo poti mwadutsa mayeso onse ofunikira, komanso kufunsa dokotala, chithandizo chitha kutumikiridwa. Tsopano tikambirana za matenda omwe wodwala amayenera kupeza kuti chithunzi chake chikhale bwino.

Kuzindikira matenda

Mitundu yotsatirayi yazidziwitso ipereka chithunzi chonse cha matendawa:

1. Kuyesa kwa Ultrasound Pancreatic ultrasound ya kapamba ndi njira yofunika kwambiri yowunikira. Matenda amtunduwu akuwonetsa kuchuluka kwa kuchuluka kwake, kukuwonetsa kupendekeka kwa kapangidwe, kupezeka kwa cysts ndi kukula kwa ma ducts. Kulondola kwa phunziroli ndi 80-85%. Izi sizotsatira zapamwamba kwambiri, kotero kuyesa kwa labotale kuyeneranso kutengedwa.
2. Kuyerekezera ndi maginito okonzanso. Mitundu yodziwitsa, monga ija, imawonetsa kuchuluka kwa kapamba amakulitsidwa. Kuphatikiza apo, mothandizidwa ndi kafukufuku wotere, mitundu yoipa, mapangidwe apadera, ndi zotupa za ziwalo zapafupi zitha kupezeka.
3. Endoscopic retrograde cholangiopancreatography. Iyi ndiye njira yolondola kwambiri, yomwe ikuwonetsa pafupifupi 100% zotsatira. Komanso, mtundu wodziwonetsa ndi wotsika mtengo kwambiri pamwambapa. Zowona, pali opanda: njira imeneyi si yosangalatsa kwambiri, ndipo nthawi zina imakhala yopweteka.

Ndi mayeso ati omwe akuyenera kuchitika kuti adziwe matenda?

Kuphatikiza pa njira zomwe zatchulidwazi pakuzindikira matenda, dokotala amapereka malangizo operekera maphunziro awa:

1. Kuyesedwa kwa magazi konse. Zotsatira zake zikuwonetsa zizindikiro za kutupa ndi kuchepa kwa magazi m'thupi.
2. Kupereka magazi kuti mupeze shuga.Kusanthula koteroko ndikofunikira kuti mudziwe ngati wodwala ali ndi shuga.
3. Urinalysis Ikuwonetsa matenda a impso.
4. Electrocardiogram ndi echocardiography zimapatula matenda a mtima.

Pambuyo pakupereka mayeso omwe ali pamwambapa, chithunzicho chidzaonekera bwino, komanso kuwunika kwa kapamba kapangidwe kapangidwe kapena ayi.

Udindo wa akatswiri pochiza matendawa

Matenda a kapamba amafunika chithandizo choyenera. Chifukwa chake, wodwalayo sayenera kukafunsidwa ndi dokotala m'modzi, koma ndi angapo, kuti chithunzi cha momwe akuwonera chikuchitika, ndipo madotolo adamupatsa chithandizo choyenera.

Wodwalayo ayenera kukumana ndi akatswiri ngati awa:

1. Gastroenterologist. Amapereka chithandizo.
2. Kwa dotolo. Kuthandiza kwa katswiriyu ndikofunikira ngati zowawa sizisiya kapena pali zovuta zina.
3. Endocrinologist. Ndikofunikira ngati wodwala ali ndi matenda a shuga.
4. Kwa wa mtima. Kulumikizana ndi katswiriyu ndikofunikira kupatula zotheka za mtima ndi mtima.

Zotsatira za chithandizo zimadalira ziyeneretso za madokotala. Chifukwa chake, muyenera kusankha zabwino kwambiri pazigawo zawo. Mutha kufunsa za zomwe adotolo adakumana nazo, kuchuluka kwa maopa omwe adachita, ngakhale pali ziwerengero. Thanzi lanu lili m'manja mwanu. Ndipo chifukwa cha luso waluso, kuthamanga ndi chithandizo chamankhwala anu ndikuchira mwachangu zimadalira 80%.

Mfundo za zakudya zoyenera za kapamba. Zakudya

Ndi matendawa, ndikofunikira kutsatira malamulo ena okhudzana ndi zakudya. Popeza kukhala wodwala kumadalira mtundu ndi chakudya chomwe chimatengedwa. Mfundo zotsatirazi zomwe muyenera kudziwa:

1. Muyenera kudya zakudya zosachepera 5-6 patsiku. Muyenera kudya pang'ono, pang'ono.
2. Ndikofunika kudya zakudya zosenda bwino. Chowonadi ndi chakuti, monga kuphatikiza kwa mbale, kupukusira kwa m'mimba sikungakwiyitsidwe.
3. Mapuloteni (magalamu 150 patsiku) ayenera kuchuluka m'zakudya. Kuchuluka kwa mafuta sikuyenera kupitirira 80 magalamu patsiku. Zakudya zomanga thupi zimafunikiranso kusamala.
4. Taboo ndi yotentha kwambiri kapena, m'malo mwake, mbale yozizira.
5. Munthawi yakuchulukirachulukira kwa vutolo, ndikofunika kusiya chilichonse chokwanira chakudya tsiku limodzi.

Tsopano taonani zakudya zomwe zili ndi phindu pa boma pa kapamba.

Mndandanda Wazogulitsa

Mkhalidwe waukulu wamatenda monga pancreatic pancreatitis ndi zakudya. Ili ndiye mfundo yayikulu yothandizira. Kodi tanthauzo la chakudya ndi chiyani? Gwiritsani ntchito zakudya zokha ndi mbale zomwe sizimakwiyitsa mucous membrane wa kapamba. Zotsatirazi zingathe ndipo ziyenera kudyedwa ndi anthu omwe akudwala matendawa.

1. Dzulo ndi mkate wakale wa tirigu.
2. Yachiwiri nkhuku kapena msuzi wa ng'ombe.
3. Nyama: nkhuku, nyama yamphongo, nkhuku. Njira kukonzekera: wiritsani, kuphika mu uvuni. Nyama siyenera kukhala ndi zokometsera zilizonse.
4. Nsomba zaphika, zophika kapena kuphika mu uvuni.
5. Zinthu zamkaka zokhala ndi mafuta ochepa.
6. Yophika masamba. Ngati mukufuna yaiwisi, ndiye pokhapokha mu grated mawonekedwe.
7. Mitundu yosiyanasiyana ya pasitala.
8. Groats (buckwheat, mpunga, oatmeal).
9. Zipatso zophika (maapulo ndi mapeyala m'maganizo).
10. Jelly.
11. Chipatso chofewa, zakudya, tiyi wopanda mphamvu.

Mndandanda wazakudya zomwe zimapangidwa ndi kapamba

1. Nyama yoyamba kapena msuzi wa nsomba. Ndiye kuti, mafuta oopsa, opatsa mphamvu.
2. Mapira sayenera kudyedwa kuchokera ku chimanga.
3. Nyama zamafuta, nsomba, nkhuku.
4. Kuyambira masamba, masamba a radish, radish, kabichi, sorelo ndi sipinachi.
5. Mkate watsopano kapena makeke aliwonse.
6. Mitundu yosiyanasiyana ya soseji, zakudya zamzitini.
7. Zakumwa zoledzeretsa.
8. Ayisikilimu.
9. Tiyi yamphamvu, khofi.

Kugwiritsa ntchito zinthu zomwe zatchulidwazi kumabweretsa zotsatira zoyipa, zomwe zimatchedwa "kutupa kwa kapamba" (kapamba, pongoyika). Pofuna kuti musasewere roulette ndi thanzi lanu, kumbukirani zakudya zomwe zaletsedwa kudya ndi matendawa. Kupatula apo, kudya kale 60% yazotsatira zabwino zamatenda.

Chithandizo cha matenda kapamba

Chithandizo cha matendawa ndikufuna kuchepetsa kuchuluka kwa bile.Pancreatitis ya kapamba, mankhwalawa omwe amachepetsa kokha kugwiritsa ntchito mapiritsi apadera, apereka zotsatira kwakanthawi. Ndipo, kuphatikiza pa izi, wodwalayo azidya molondola, kutsatira zakudya, ndiye kuti izi zikhala pafupifupi chitsimikizo cha kuchira kochita bwino.

Koma tsopano tiyeni tiganizire za mankhwala omwe amathandiza kulimbana ndi matenda.

Chifukwa chake, mankhwala omwe amathandizira kuchotsa kuphipha kwa minofu:

1. Awa ndimapiritsi a kapamba. Pancreatitis imachiritsidwa ndi antispasmodics otsatirawa: No-Shpa, Spazmoverin, Spazmol.
2. Dongosolo lokonzekera milingo "Papaverine".

Mankhwala otsatirawa amachepetsa kubisala kwa madzi a m'mimba:

1. Makapisozi Omeprazole.
2. Mapale "Ranitidine", "Famotidine".

Mankhwalawa otsatirawa amateteza kugaya chakudya ndikuwongolera ntchito ya pancreatic. "Allohol", "Pancreatin", "Phenipentol" - awa ndi magome ochokera ku kapamba. Pancreatitis si sentensi.

Komanso, mankhwala omwe amalepheretsa kupanga ma pancreatic enzymes amapatsidwa mankhwala ochizira kapamba. Pakati pa mankhwalawa, yankho la Aprotinin limagwiritsidwa ntchito nthawi zambiri.

Ngati ululu wowopsa ulipo kapena munthu akuonda, ndiye kuti kulandira kuchipatala ndi chithandizo chowonjezereka ndizotheka mosamalitsa ndi akatswiri. Kuchitapo kanthu kwa opaleshoni kumayikidwa ngati zikondamoyo sizikuliranso. Kuchiza, kudya ndi kugonjetsedwa kwambiri sikungathandize. Kuchotsa kokha gawo limodzi lomwe kudzapulumutse ku chiwonongeko chowonjezereka.

Izi sizikutanthauza kuti mukalandira chithandizo cha mankhwala, kuchira kwathunthu kumachitika. Zachisoni kuti, koma kapamba sangathe kuchiritsidwa kwathunthu. Koma kuti zikondamoyo zisawonongeke, ndikofunikira kulandira chithandizo, ndikutsatira zakudya zosasunthika, zomwe tafotokozazi.

Chithandizo cha pachimake kapamba

Matenda amtunduwu amafunikira kuchipatala. M'chipatala, wodwala amayankhidwa kuti azitsatira:

1. Kulowetsedwa kwamitsempha komwe kumathandiza kuyeretsa magazi a poizoni ndi michere ya pancreatic.
2. Mankhwala opweteka.
3. Mapiritsi omwe amawononga ma enzymes a gland. Mwachitsanzo, mapiritsi a Cordox.
4. Mankhwala oletsa kusanza.
5. Maantibayotiki.
6. Antispasmodics.

Kuphatikiza apo, chithandizo chamankhwala chimaphatikizapo:

1. Kusokonezeka kwathunthu kwa zakudya kudzera pakamwa mpaka masiku 6. Izi ndizofunikira kuti ntchito ya kapamba iyimitsidwe kwakanthawi.
2. Mitseko yamkati.
3. Kupanga kwa kukodza kuti mkodzo ukhale wambiri kuti uchoke m'thupi ndi mkodzo.
4. Bowel lavage.

Kupewa kwa Pancreatitis

Pofuna kuti musayambenso, ndipo matendawa sangakugwetseninso, ndikofunika kutsatira malamulo otsatirawa:

1. Idyani pomwe. Kutsatira zakudya ndizofunikira kwambiri kuti mukhale ndi thanzi la pancreatic.
2. Kuletsa kwamtundu uliwonse zakumwa zoledzeretsa zilizonse.
3. Siyani kusuta.
4. Chepetsani zolimbitsa thupi. Kuthamanga, kudumpha, kuchezera malo osambira ndi saunas kuli koyipa kwa kapamba. Njira yabwino ndiyo kupumira masewera olimbitsa thupi komanso kutikita minofu.

Kuchokera munkhaniyi, mudaphunzira zomwe zimatengera matenda otchedwa pancreatic pancreatitis. Adasankha njira zochizira matendawa komanso momwe angadziwire matendawa. Tidazindikira kuti kudya mosamalitsa ndiye njira yofunika kuti wodwalayo achotse mwachangu.

Kuthandizira kwa opaleshoni yamapapo pancreatitis mwina mwachangu kapena mwachangu, njirayi imachitidwa m'maola oyambukira, komanso m'masiku oyamba omwe wodwalayo akuwonetsa matendawo. Chizindikiro mu nkhaniyi ndi peritonitis ya enzymatic kapena pachimake mtundu, yomwe imayamba chifukwa cha kufalikira kwa papilla wa duodenum. Wachedwa mtundu wa kulowererapo kwa opaleshoni kumachitika mu gawo la kukanidwa ndikusungunuka kwa madera a necrotic ndi fiberfroitoneal fiber. Monga lamulo, izi zimachitika patsiku lakhumi pambuyo pa kuyamba kwa kuopsa kwa wodwala.

Ntchito yokhazikika ya kapamba imachitika pakumachotsa kwathunthu njira yotupa mu thupi lathu. Cholinga pamenepa ndikuletsa matendawa. Njira zilizonse zimatengedwa pokhapokha atazindikira mozama, komanso, kuwunika kokwanira kwa wodwalayo. Tidzazindikira momwe machitidwe opangira opaleshoni amafunikira, ndikupezanso zovuta komanso zotsatirazi zomwe zingachitike panthawi yobwezeretsa.

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 kuyambitsa zovuta mu thupi 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.

Mavuto atandichita opareshoni

Pambuyo opaleshoni ya kapamba, zotsatirazi zovuta zimachitika:

• M`kati mwa m'mimba, ma necrotic kapena purulent zomwe zili mkati zimayamba kudziunjikira, zomwe zimafotokozedwa mchilankhulo cha sayansi, wodwalayo amapezeka ndi peritonitis.
• Izi zimachitika kuti pali zochulukitsa za matenda obwera chifukwa cha kapamba komanso kupanga michere.
• Pali njira yotsekera njira zikuluzikulu, zomwe zingayambitse kufooka kwa kapamba.
• Tizilombo zofewa za matenda odwala sitingathe kuchiritsa, ndipo kusintha kwamphamvu kwa kapamba sikungawoneke.
• Mavuto owopsa kwambiri akuphatikizapo kulephera kwamphamvu kwa ziwalo limodzi ndi kukokoloka kwa pancreatic ndi septic.
• Zotsatira zoyipa pambuyo pake za opaleshoni ya kapamba zimaphatikizira mawonekedwe a pseudocysts limodzi ndi fanculas ya pancreatic, kukula kwa matenda osokoneza bongo a shuga ndi exocrine.

Kukonzekera kwa opareshoni

Mosasamala mtundu wa kapamba, kaya ndi parenchymal, biliary, chidakwa, kuwerengera, ndi zina zambiri, chochitika chachikulu pokonzekera ndi kufa kwathunthu ndi njala, yomwe, mwatsoka, imagwira ntchito ngati yowonjezera matenda. Zomwe zimachitidwa ndi kapamba, tikambirananso.

Kuperewera kwa chakudya m'magawo am'mimba kumachepetsa kwambiri zovuta za postoperative. Pomwepo patsiku la opareshoni, wodwalayo sangadye, amapatsidwa enema yotsuka, kenako kukonzekereratu kumachitika. Njira yotsirizayi imaphatikizapo kuperekera mankhwala othandizira kuti athandize wodwala kuyambitsa kulowetsedwa.Mankhwalawa amathetseratu mantha obera mankhwalawa, amathandizira kuchepetsa kutulutsa kwa gland komanso kupewa kutulutsa ziwopsezo zosiyanasiyana. Pachifukwa ichi, mitundu yosiyanasiyana ya mankhwala imagwiritsidwa ntchito, kuyambira pamtendere ndi ma antihistamines mpaka cholinolytics ndi antipsychotic.

Njira zotsatirazi ndi njira zochitira opaleshoni ya pancreatitis pachimake.

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 la chithandizo, madontho akulu amakhazikika m'malo ang'onoang'ono, zomwe zimathandiza kuti pang'onopang'ono machiritso am'mimba atithandizire kutuluka 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.
• Hyperglycemia ndi kusintha kosangalatsa kwa leukocyte chida kumanzere.
• Chidzalo cha malo omwe akhudzidwa ndi mafinya pa nthawi ya ultrasound.

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 zamankhwala 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 pakama, 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 panja, akuyenda mwachidule ndi njira yosavutikira. Iyenera kutsimikiziridwa kuti pakuchira, odwala saloledwa kugwira ntchito mopitirira muyeso. Zotsatira za opaleshoni ya kapamba zimaperekedwa pansipa.

Kodi opaleshoni ndiyofunikira liti?

Kutupa kwa kapamba kumayambitsa zowonongeka zambiri pa thanzi la munthu. Nthawi zina chithandizo chosasamala sichimabweretsa mpumulo, ndipo matendawa amayenera kuthandizidwa. Nthawi zambiri, opaleshoni ya kapamba amachitika kuti apulumutse moyo wa wodwalayo.

Kodi kupewa matenda oopsa a pancreatitis ndi chiyani?

Kodi ndiyenera kuchita chiyani?

Kodi muyenera kupewa chiyani?

Zakudya zoyenera. Kutsatira zakudya. Muzikhala ndi thanzi labwino. Kuchita masewera olimbitsa thupi mokwanira. Munthawi yake chithandizo cha matenda am'mimba (m'mimba ndi duodenum, chiwindi ndi ndulu), wowona ndi gastroenterologist, kutsatira malingaliro onse a dokotala. Kupewa kuyambiranso kwa kapamba : Kuzindikira koyambirira ndi chithandizo choyenera cha pancreatitis chachikulu pachimake. Chithandizo chokwanira kuchipatala cha pulayimale yachilendo pachaka, mpaka zizindikiro zonse zitadutsa ndipo zizindikilo zonse zibwerere mwakale. Kuwona ndi gastroenterologist pambuyo pachiwopsezo chachikulu cha kapamba.

Zakudya zamafuta, zokazinga, zonunkhira, kuchuluka kwa zonunkhira. Chakudya chofulumira. Kudya kwambiri mwadongosolo. Osakhazikika, kuperewera kwa zakudya m'thupi. Kunenepa kwambiri. Kuchita masewera olimbitsa thupi ochepa, kumangokhala. Mowa Mochedwa kuonekera kwa dokotala, mwadzidzidzi chithandizo cha matenda am'mimba.

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 zotsatira zomaliza za kulowererapo, kuchuluka kwa kubwezeretsa kwachimbudzi, zotsatira za mayeso a labotale ndi zida zothandizira kudziwa zamankhwala.

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 chinanso chomwe chimaphatikizapo chithandizo chamankhwala othandizira kapamba?

Kuphatikiza apo, odwala amalimbikitsidwanso zochitika machitidwe a zakudya, achire olimbitsa 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 ochepa.

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 pa 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 kapamba amachitidwa? Tidazindikira kuti inde.

Kodi ndizotheka kupereka chithandizo choyamba cha pancreatitis pachimake dokotala asanafike?

Kodi ndiyenera kuchita chiyani?

Kodi sizingachitike bwanji?

Mugoneke wodwala pambali pake. Ngati wagona kumsana kwake ndipo kusanza kuyambika, ndiye kuti masanzi akhoza kulowa m'mapazi. Ikani ozizira pamimba yapamwamba: ayezi wokutidwa ndi thaulo, chopukutira ndi madzi ozizira, chopukutira chosungunuka ndi madzi ozizira. Imbani ambulansi nthawi yomweyo. Zoneneratu zimadalira mwamphamvu momwe wodwala amaperekedwera kuchipatala ndikuthandizidwa ndi dokotala.

Patsani chakudya, chakumwa. Mu kapamba pachimake, njala ndiyofunikira. Sansani m'mimba. Izi sizingabweretse phindu, koma zimangowonjezera kusanza. Apatseni ma pinkiller. Amatha kununkhira chithunzicho, ndipo zimakhala zovuta kwa dokotala kuti azindikire zoyenera.

Kodi pali chithandizo chamankhwala chothandiza wowerengeka cha kapamba?

Palibe mankhwala wowerengeka omwe angalowe m'malo mwa chithandizo chamankhwala kuchipatala. Komanso, kugwiritsa ntchito mankhwala azomera ndi njira zina, mutha kuvulaza wodwala, kukulitsa kukula kwa vuto lakelo. Kudzilimbitsa nokha ndikuyika kuyitanira ambulansi, mutha kutaya nthawi.

Ndi matenda ati omwe angafanane ndi pancreatitis pachimake?

Matenda omwe amafanana ndi pancreatitis pachimake :

• Pachimake cholecystitis - kutupa kwa ndulu. Zimayamba pang'onopang'ono. Imadziwoneka ngati ululu wopondaponda pansi pa nthiti yakumanja, yomwe imaperekedwa kumapewa, pansi pa phewa, khungu lozizira, nseru, ndi kusanza.
• Kukwaniritsa chilonda cham'mimba kapena zilonda zam'mimba - mawonekedwe omwe bowo limapezeka mu khoma lachiberekero. Pali kupweteka kwambiri pamimba pamimba (nthawi zina imayerekezeredwa ndi "kugunda kwakuthwa"), nseru, kusanza kamodzi. Minofu yam'mimba imakhala yovuta kwambiri. Monga lamulo, izi zisanachitike, wodwalayo wapezeka kale ndi chilonda.
• Kulepheretsa kwamkati . Izi zitha kukhala chifukwa cha zifukwa zosiyanasiyana. Imadziwawoneka ngati kuwonjezeka pang'onopang'ono kwa colic, kupindika m'mimba, kusowa tulo, kusanza ndi fungo losasangalatsa.
• Mtsempha wamkati . Zimachitika pamene magazi amasokonekera zotengera za mesenteric kudyetsa m'matumbo. Pali kupweteka kwam'mimba kwambiri, nseru, kusanza, ndipo palibe chopondapo. Nthawi zambiri, anthu oterewa kale ankadwala matenda amtima.
• Pachimake appendicitis - kutupa kwa zowonjezera (zowonjezera )Ululu wam'mimba ukupita patsogolo pang'onopang'ono, pomwe umasunthira kumunsi kwake, kumakhala mseru, nkhawa yam'mimba. Kutentha kwa thupi kumatha kukwera pang'ono.
• Myocardial infaration . Nthawi zambiri amadziwika ndi kupweteka kumbuyo kwa sternum, koma amatha kuchitika mwachitsanzo, mwa kupweteka kwambiri pamimba. Wodwalayo amakhala wotumbululuka, kupuma movutikira kumawonekera, kuzizira, thukuta lotata. Kuzindikira komaliza kumachitika pambuyo pa ECG.
• Mimbulu yopanga . Diaphragmatic hernia ndi gawo lomwe gawo lachiberekero ndi / kapena matumbo limatuluka kudzera m'munsi kudzera pachifuwa. Nthawi zambiri, kutsina kumachitika pakulimbitsa thupi, kumakhala kupweteka pachifuwa ndi m'mimba, komwe kumafikira nkono, pansi pa scapula. Wodwalayo agona pambali pake ndikugwedeza mawondo ake pachifuwa chake, kuthamanga kwa magazi ake kumatsika, amakhala wotuwa, thukuta lozizira limayamba. Mimba ikapanikizika, kusanza kumachitika.
• Chakudya Choopsa cha Chakudya . Matenda omwe matenda opatsirana ndi poizoni amapezeka, nthawi zambiri kudzera mu chakudya. Pali ululu wam'mimba, kutsegula m'mimba, kuwonongeka kwapafupipafupi.
• Ziphuphu zotsika - kutupa m'munsi m'mapapu. Kutentha kwa thupi kumakwera, kupweteka kumachitika pachifuwa, nthawi zina pamimba. Kukhosakhota kouma kumatulukira, komwe pakatha masiku awiri kumanyowa. Kupuma pang'ono kumachitika, zomwe zimachitika kuti wodwalayo akuwonjezereka.

Kodi gulu la Atlanta limagawana chiyani ndi pancreatitis pachimake?

Atlanta International Classization of Acute Pancreatitis:

Njira zachikhalidwe mu kapamba	1. Pancreatitis pachimake : digiri yofatsa madigiri akulu. 2.Pachimake zapakati pancreatitis (kuchuluka kwa madzimadzi mu kapamba): 3.Pancreatic necrosis (kufa kwa minofu ya pancreatic): kachilombo osadziwika (wosabala). 4.Fake pancreatic cyst . 5.Pancreatic abscess (zilonda) .
Matende a Pancreatic	mafuta pancreatic necrosis, edematous kapamba, hemorrhagic pancreatic necrosis.
Kufalikira kwa necrosis mu minofu ya pancreatic	zotupa zakomweko - necrosis ya malo ochepa, chotupa chapakatikati - necrosis ya gawo lalikulu la kapamba, kugonja kwathunthu - necrosis ya kapamba wonse.
Njira ya matendawa	Achabe . Imafanana ndi edematous pachimake kapamba. Zimadutsa zokha kapena chifukwa cha mankhwala owononga. Kupita patsogolo . Imafanana ndi mafuta ndi hemorrhagic pancreatic necrosis. Ma fomu owopsa, nthawi zambiri amafunikira opaleshoni.
Nthawi yamatenda	1. Kusokonezeka kwazungulira, mantha. 2. Kuphwanya kachitidwe ka ziwalo zamkati. 3. Mavuto.

Kodi postoperative pancreatitis ndi chiyani?

Zizindikiro, kuzindikira ndi kuchiza kwa postoperative pancreatitis ndizofanana ndi mitundu ina. Nthawi zambiri zimakhala zovuta kuti dokotala akhazikitse matenda ake chifukwa cha zinthu zotsatirazi :

• sizikudziwika ngati kupweteka kumachitika chifukwa cha opaleshoni palokha, kapena kuwonongeka kwa kapamba,
• chifukwa chogwiritsa ntchito ma pinkiller ndi sedative, zizindikiro sizitchulidwa
• pambuyo pa opaleshoni, zovuta zambiri zimatha kuchitika, ndipo ndizosatheka nthawi zonse kuzindikira kuti zizindikirazi zimagwirizanitsidwa ndi kapamba.

Zisonyezero zamitundu mitundu ya kutupa kwapancreatic

Kuchita opaleshoni yapachimbudzi kumachitika:

• kuvulala kapena kuvulala kwam'mimba,
• chotupa choteteza ku matenda oyambitsidwa ndi matenda opatsirana panjira,
• matenda osadziwika,
• kapamba kapena hemorrhagic kapamba,
• magazi, chifuwa, kukonzanso m'mimba.

Zisonyezero za opaleshoni yamtundu wa matenda:

• virsungolithiasis (miyala m'makola a ndulu),
• kuchuluka kwa zonyansa zam'mimbayo,
• aakulu kapamba ndi matenda a chiwindi, m'mimba, duodenum,
• chifuwa chachikulu chokhala ndi ululu wokhazikika.
• khansa ya kapamba,
• fistulas ndi cysts,
• duodenostasis.

Opaleshoni mankhwala a pancreatitis aakulu mawonekedwe ali mu magawo

• opaleshoni yam'mimba,
• opaleshoni yam'mimba ndi duodenum,
• kuchotsera ndulu,
• kulowerera mu dongosolo laumiseche.

Ntchito malinga ndi mawu ophedwa ndi:

• Oyambirira. Amachitika patatha sabata limodzi kuchokera pachiwonetsero cha matendawa pokhudzana ndi peritonitis, pancreatitis pachimake ndi chiwonongeko cha cholecystitis, chosagwira bwino.
• Mochedwa. Patatha pafupifupi mwezi kuchokera pa chiyambi cha kutupa, ndi kuphatikizika kwa minyewa ya cell ya kapamba, ma abscesses.
• Wosemedwa. Amakhala ndi cholinga chopewa kuyambiranso, atha mwezi umodzi kapena kupitilira apo atadwala chifuwa chachikulu.

Ndi mitundu iti yomwe imachitika?

Mwa mitundu ingapo yomwe ikugwiritsidwa ntchito kwa chifuwa chachikulu, zotsatirazi zimagwiritsidwa ntchito pochita:

1. Longitudinal anastomosis ya pancreatic duct (pancreatojejunal anastomosis). Mtundu wa opaleshoni yamtunduwu umasankhidwa ndi pancreatic duct mdawo wa 8 mm, womwe umachitika ndi kuwonongeka kwakukulu kwa chimbudzi cha gland.
2. Kaphatikizidwe kapamba:

• Caudal Kumanzere. Ngati kuwonongeka kwa distal kapamba kumakhalabe patency, mtundu uwu wa opaleshoni imachitidwa, kuphatikiza ndi splenectomy (kuchotsa ndulu). Ngati mawonekedwe a Wirsung duct ali ndi vuto, ntchitoyo imathandizidwa ndi kukhetsa kwamkati kwa duct system.
• Chachikulu. Wochititsidwa ndi chifuwa chachikulu chovulaza mchira, thupi ndi gawo la mutu. Pafupifupi tinthu tonse timene timagwira limodzi ndi ndulu zimachotsedwa, gawo laling'ono limatsalira mu duodenum.
• Pancreatoduodenal. Ntchito yamtunduwu imachitika ndi kuwonongeka kwa mutu wa gland ndi duct wamba wa bile. Ubwino wa mtundu wamtunduwu ndikuwonetsetsa kuti insulini ingapangidwe. Kapangidwe kokhala ngati V kamapangidwa kutsogolo kwa thupi la gland mpaka kumapeto kwa chimbudzi. Amapanga chiuno kuchokera m'matumbo ang'onoang'ono, pomwe ma encyen amaperekedwa ku duodenum. Opaleshoniyo imatha kupewetsa ululu m'magulu ambiri opareshoni.
• Onse duodenopancreatectomy. Opaleshoni akuwonetsedwa kwa anthu omwe ali ndi vuto lalitali la parenchyma ndipo adalumikizana necrosis khoma la duodenum. Nthawi zambiri uku ndikochita kwachiwiri kwa odwala omwe ali ndi vuto la kapamba. Opaleshoni ya pancreatic necrosis ili ndi nthawi yovuta kwambiri ya postoperative, yomwe imapangitsa kuti anthu ambiri azifa.

Pancreatojejunostomy poyerekeza ndi resection ndizosavuta kuchita, sichimalepheretsa kugwira ntchito kwa chiwalo, chimayambitsa zovuta zochepa za postoperative, imakhala ndi chiwerengero chochepa cha kufa.

Yang'anani! Kuchitapo kanthu kwa opaleshoni yamankhwala osokoneza bongo sikubwezeretsa kutulutsa ndi kugwira ntchito. Cholinga chachikulu cha opaleshoni pano ndikuchotsa ululu.

Mankhwala othandizira pachimake kapamba

Pachimake pancreatic pancreatitis amachiza opaleshoni milandu zotsatirazi zovuta pancreatic necrosis:

• peritonitis
• kunyowa
• cholangitis, blockage of the duodenal papilla with calculus,
• magazi m'malo a necrosis,
• matumbo ochepa

Mitundu yotsatirayi ikuchitidwa:

• Diagnostic laparoscopy. Pa khoma lamkati lakumbuyo, ma tinthu ting'onoting'ono timapangidwa kuti tiike zida ndi kafukufuku. M'mimba mumadzaza mpweya woipa. Amagwira ndikuchotsa malo okufa a parenchyma, pamimba. Mlingo waukulu wa mankhwalawa umaperekedwa kuti muchepetse chiopsezo cha matenda opatsirana pambuyo pake. Zilonda zimasungidwa, kuthandizidwa ndi antiseptic. Ngati sizotheka kugwira ntchito yoyenera munthawi ya ndondomekoyi, laparotomy imachitika nthawi yomweyo.
• Laparocentesis Kuchitika ndi ascites kuchotsa zomwe zikuyang'aniridwa ndi makina a ultrasound. Kuchekeka kumapangika m'mimba masentimita atatu kuchokera ku msomali, khungu, mafuta osunthika ndi minofu yam'mimba imatayidwa. Kuboola komaliza kumachitika ndi thunthu, kumayilowetsa kumimba ndi kayendedwe kazungulira. Madzi amatuluka pang'onopang'ono, pafupifupi lita imodzi mu mphindi 5. Ngati bandeji yolimba imagwiritsidwa ntchito kuchotseredwa, m'mimba imangirizika ndi bandeji yachigoba kuti ikhalebe yolimba.
• Laparotomy Kuchita m'mimba kumachitika ndi transverse incision, kapena kuwonekera kumachitika mu hypochondrium yoyenera. Chikwama chodzikongoletsera chatsegulidwa, mwayi wopezeka ku zikondamoyo umaperekedwa. Gastrocolic ligament ndi yopanda pake, ziboko zimakhazikitsidwa kuti ziunikire kunja kwa gland. Madera akufa amachotsedwa ndi excision kapena kuchotsedwa ndi zala zanu. Masana, kutulutsa thukuta mosalekeza kumachitika, komwe amatsogoza ndi kutsitsa ziwiya ziwiri. Chikwama chodzikirira chimatsekeka ndi ma suture osiyana ndipo m'matumbo am'mimba chimabwezeretsedwa kuti chikhale chotseka chotseka chotseka.
• Lumbotomy. Chitani ndi phlegmon parapancreatic fiber pansi pa opaleshoni wamba. Zofanana ndi nthiti kumbuyo kwa mzere wotsatira wa axillary, mawonekedwe okoka amapangidwa mpaka kutikita minofu kutalika kwa 5. cm. Minofu imafalikira, phlegmon imatsegulidwa ndipo masilayidi amadzimadzi a silicone 1.5 cm ndikuyiyika ndipo zofunikira zamakonzedwe zimachotsedwa. Manda ndi okhazikika. Kuyeretsa kwamtambo kumachitika tsiku limodzi.

Kutengera ndi zomwe ntchito zimachitika ndi kapamba (pang'onopang'ono kapena m'mimba) kutalika kwa nthawi yochira komanso kudalirika kwa nthawi ya postoperative kumadalira. Kuchita opaleshoni yocheperako nthawi zambiri sikuti kumayambitsa zovuta pambuyo pakuchita opareshoni ndipo ndikosavuta kulekerera ndi odwala poyerekeza ndi msempha.

Zovuta pakugwiritsa ntchito kapamba

Opaleshoni yamatenda a kapambangati chitetezo cha wodwalayo chimadalira. Lumikizanani ndi opaleshoni ya kapamba kuyambira 6 mpaka 12% ya odwala.

Mapamba ndi chiwalo chosasinthika chomwe chimafuna kusamalidwa mosamala komanso modekha. Ndizosatheka kunena molondola momwe adzachitire opareshoni, komanso, malo osavomerezeka amaphatikizira ntchitoyo.

Zikondwererozi zimapezeka pafupi nthawi imodzi kukhala "maudindo" angapo ofunikira:

• Mimba.
• Wamba bile duct.
• Kwa impso.
• Mitsempha yokwera komanso yotsika.
• Mitsempha yapamwamba ya mesenteric ndi mitsempha.

Zofunika! Zikondazo zimalumikizana ndi duodenum ndi magazi ena, omwe amasokoneza ma opaleshoni. Tizilombo ta pancreatic sakhazikika kuti tiwononge, pambuyo poti opaleshoni ya gland fistulas imapangidwe, magazi amatuluka.

Opaleshoni yamankhwala ovuta kwambiri ndi ovuta ndipo kufa kwawo ndikwambiri. Prostosis yokhumudwitsa kwambiri pambuyo pochita opaleshoni ya pancreatic necrosis. Zachidziwikire, zambiri zimatengera nthawi ya opareshoni, thanzi la wodwalayo, zaka zake.

Matenda abwinobwino atatha opaleshoni chifukwa cha zilonda. Odwala oterewa amatha kuyambiranso. Ndi malingaliro oyenera paumoyo, kutsatira malangizo a dokotala, kutsatira zakudya, zakutsogolo zimatipatsa chiyembekezo.

Postoperative pancreatitis

Kasitomala ndi chiwalo chomwe chimakonda kwambiri kuwonongeka kwa makina. Tsoka ilo, kulowererapo kwa opaleshoni pa kapamba, m'mimba, Vater papilla ikhoza kuyambitsa postoperative pancreatitis. Nthawi zambiri kupanikizika kumachitika pakavuta ntchito pamimba ndi duodenum.

Zofunika! Pancreatitis pambuyo pa opaleshoni nthawi zambiri imachitika ndi nthawi yayitali ya cholecystitis, cholangitis ndi choledocholithiasis. Matendawa amapezeka kuti ndi edematous kapena wowononga kapamba.Imfa yayikulu kwambiri - pafupifupi theka la milandu ya pancreatitis ya postoperative imatha muimfa ya wodwalayo.

Ndemanga za odwala omwe adachitidwa opaleshoni yamapamba akuwonetsa kufunikira kwa kutsatira zakudya ndi mankhwala.

Mitundu ndi zoyambitsa za pancreatitis pachimake

Acute pancreatitis ndimatenda omwe amakhudza kapamba. Nthawi zambiri, matendawa amakula chifukwa chomwa zakumwa zoledzeretsa, nthawi zambiri zimakhala zamphamvu komanso zopanda pake. Njira yotupa imayamba msanga chifukwa cha kuchuluka kwa ntchito zachinsinsi. Kuchuluka kwa ma enzyme obisalira thupi kumapangitsa kuti thupi lake lizimbidwa.

Nthawi zambiri, ma enzymes amathandizira pokhapokha atalowa matumbo. Ndi matenda, kutsegukira kumachitika mu chiwalo chokha. Gawo lowopsa la matendawa amagawidwa m'magulu:

• aseptic, pamene zoyang'ana zikuwoneka bwino, koma osayambukiridwa,
• purulent (ndi mapangidwe a purulent foci).

Kuphatikiza pa kumwa mowa mwauchidakwa, kapamba amayamba chifukwa:

• matenda am'mimba thirakiti
• matenda opatsirana, endocrine,
• mankhwala oopsa
• kuperewera kwa zakudya m'thupi
• kuvulala kwam'mimba, pamimba, kuphatikizapo omwe amapezeka pa endoscopy.

Kukonzekera wodwala opaleshoni ya pancreatic

Zochita za opaleshoni pa kapamba ndizovuta komanso zowopsa, motero, amafunika kukonzekera wodwala:

1. Mu chifuwa chachikulu, kukonzekera kumadalira chithandizo. Zimachitika kuti munthu amachiritsidwa, ndipo amamuthandizira pochita opaleshoni.
2. Ndi kuvulala kapena puranc pancreatitis, nthawi yochepa yokonzekera.

Pamaso pa opareshoni, ndikofunikira kubwezeretsa ntchito za ziwalo zomwe zakhudzidwa ndikuchepetsa kuchuluka kwa kuledzera.

Ogwira ntchito zamankhwala ayenera kukukonzekererani opareshoni.

Kafukufuku wama michere ya pancreatic amathandiza kusankha njira yabwino yochizira. Munthawi yogwira ntchito, odwala amawonetsedwa:

• Njala ikamenyedwa (patsiku la opareshoni).
• Kumwa mankhwala omwe amalimbikitsa mtima ndi kupuma kwa thupi kumathandizira kupewa hypoxia komanso kusokoneza kayendedwe kazinthu zamagetsi.
• Kupangira mapiritsi ogona, ma antihistamines.
• Kuchita antihypertensive mankhwala ngati munthu ali ndi matenda oopsa.

Mitundu ya maopareshoni ndi momwe zimayendera

Opaleshoni ya pancreatitis pachimake imagawidwa m'magulu, kutengera:

1. Voliyumu yomwe imakhudza opareshoni. Pa ntchito yosunga chiwalo, minofu imasungidwa. Ikapangidwa, gawo la chiwalo limachotsedwa. Ngati kuchotsa pang'ono sikungathandize, pancreatectomy imachitika, chiwalo chonse chimachotsedwa.
2. Njira yolowerera. Ma opaleshoni amatha kutseguka, osazungulira, pogwiritsa ntchito laparoscopy kapena popanda magazi.

Pa opaleshoni yoteteza ziwalo:

• tsegulani, katani zotupa, zilonda, hematomas, thumba loyika zinthu,
• Patula kapisozi ndi edema yayikulu,
• minofu yowonongeka.

Kuyambiranso kumachitika mu dipatimenti ya zigawo pomwe pali chotupa, cyst kapena necrotic. Mwachitsanzo, mutu wofananirana umapangidwa pofuna kutsekeka ndulu ya bile. Kuchotsa zopinga kumayambira pansi ndikudulira matayala amatumbo.

Ngati chiwalocho chifewa, kukhudzidwa ndi chotupa chachikulu kapena zimbira, chimachotsedwa kwathunthu.

Ntchito zotseguka zimayimiranso vuto la peritonitis, lomwe limayambitsa kukomoka kwa duodenum chifukwa cha kutupa kwa kapamba ndi matumbo.

Njira zopangira ma opaleshoni zotseguka zimaphatikizapo kuchotsedwa kwa ziwalo zakufa, kuchapa, kutulutsa kwam'mimba ndi malo a kubwezeretsanso. Kuchita koteroko kumakhala kovuta komanso koopsa, ngati mbali yakufa ya nduluyo ndiying'ono, ndipo chiwalo chokha chikugwira ntchito, madokotala ochita opaleshoni amasankha njira yowononga kapena yopanda magazi:

1. Ndi necrosis yosadziwika ya gland, kupuma kumachitika: madzi amachotsedwa pachinthu chokhudzidwa.
2. Kuongolera thupi kumathandizira kutuluka kwamadzi. Zikondazo zimatsukidwa ndikuthira mankhwala.
3. Laparoscopy, pomwe dokotala amachita opaleshoni yaying'ono pamimba, ndikuyambitsa kafukufuku wapakanema ndi zida zapadera kudzera mwa iwo, amakupatsani mwayi kuwona momwe ntchito ikuyendera kudzera pazenera lapadera. Cholinga cha laparoscopy ndikumasulidwa kwa duct ya bile, kuchotsedwa kwa zopinga ku gawo laulere la kapamba wamatumbo.

Ngati kapamba amakhudzidwa ndi chotupa, madokotala amatembenukira ku magazi osafunikira:

• mpeni wa cyber kapena radiosurgery,
• kulira
• opaleshoni ya laser
• ultrasound.

Zambiri mwazipangizo zimachitika pogwiritsa ntchito probe yomwe imayikidwa mu duodenum.

Zovuta za opaleshoni yamankhwala

Pakati pa madokotala, kapambayu adadziwika kuti ndi gawo lofatsa, losasinthika. Opaleshoni ya kapamba nthawi zambiri imapha, ngakhale njira zamakono zamankhwala.

Ndikosavuta kusesa kapamba wowonongeka. Chifukwa chake, m'nthawi ya ntchito, ma fistulas amatha kupezeka pamalo omwe amapangidwapo, ndipo magazi amatuluka mkati.

Kuopsa kochita opaleshoni kumachitika chifukwa cha mawonekedwe a chiwalo:

Iron ali pafupi kwambiri ndi ziwalo zofunika:

• bile duct
• The duodenum (ziwalo pakazungulira magazi),
• pamimba komanso apamwamba mesenteric aorta,
• chotupa chachikulu cha mesenteric, vena cava,
• impso.

Pambuyo pa opaleshoni

Ngati opaleshoni ya kanyumba idayenda bwino, chisamaliro cha wodwala kumayambiriro kwa nthawi yautumiki ndichofunikira kwambiri. Momwe zimathandizira, zimatengera kuti munthuyo achira.

Pasanathe tsiku limodzi atachitidwa opareshoni, mkhalidwe wa wodwalayo umawongoleredwa mosamalitsa m'chipinda chothandizira kwambiri. Madokotala:

1. Zizindikiro za kuthamanga kwa magazi zimayezedwa.
2. Onani acidity, magazi.
3. Yesani mkodzo.
4. Hmatocrit (kuchuluka kwa maselo ofiira a m'magazi) amawongoleredwa.
5. Chitani zamagetsi yamagalasi ndi chifuwa x-ray.

Ngati wodwalayo akhazikika, patsiku lachiwiri atachitidwa opaleshoni, amusamutsa ku dipatimenti yopanga opaleshoni, komwe amakayang'anira chisamaliro chokwanira - chithandizo chonse komanso zakudya.

Ngakhale kupita patsogolo kwa zamankhwala komwe kumalola kuti odwala azichita opaleshoni yopanda magazi, zotsatira za opaleshoni zimakhalabe imodzi yamankhwala oopsa kwambiri.

Kutulutsa kumachitika osati kale kuposa momwe dongosolo logaya chakudya limayambira kugwira ntchito moyenera, ndipo wodwalayo amatha kukhala ndi moyo wabwinobwino, akuwonetsetsa pazachipatala.

Mankhwala ndi machitidwe

Kuphatikiza pa chithandizo chamankhwala, chithandizo chokwanira chimaphatikizapo:

1. Kumwa mankhwala osokoneza bongo pafupipafupi, insulin, zowonjezera za enzyme.
2. Physiotherapy, achire olimbitsa thupi. Njira zilizonse komanso zolimbitsa thupi ziyenera kuvomerezedwa ndi dokotala.

Zolinga za masewera olimbitsa thupi ndi njira zochiritsira nthawi yakukonzanso:

• Matenda a matenda a thupi, kupuma, mtima.
• Kubwezeretsa ntchito zamagalimoto.

Mavuto a opaleshoni chithandizo cha pachimake kapamba

Chiwopsezo cha opaleshoni yothandizira pancreatitis yachilendo imayenderana ndi zovuta zomwe zimachitika nthawi ya postoperative. Zizindikiro za zovuta:

1. Kupweteka kwambiri.
2. Kuwonongeka msanga kwa chikhalidwe cha munthu mpaka kukhumudwa.
3. Mankhwala okwera m'magazi ndi mkodzo.
4. Kutentha ndi kuzizira ndi chizindikiro cha kutupira.
5. Kuwonjezeka kwa maselo oyera amwazi.

Vutoli limatchedwa postoperative pancreatitis, yomwe imayambitsa matenda a zilonda zam'mimba kapena kufalikira kwa njira yotupa mu gland.

Zovuta pachimake postoperative limayamba chifukwa cha kutsekeka kwa duct, zomwe zimakwiyitsa ziwalo edema. Njira zina zopangira opaleshoni zimayambitsa zovuta.

Kuphatikiza pa zomwe zili pamwambapa, wodwalayo nthawi zambiri:

• magazi amatseguka
• peritonitis iyamba,
• kulephera kwazungulira, aimpso,
• matenda a shuga akuchulukirachulukira,
• minofu necrosis kumachitika.

Mphamvu ya opaleshoni chithandizo ndi matendawo

Kuchita bwino kwa maopaleshoni kutha kuthandizika ndikuwonetsetsa momwe wodwala akuwathandizira ndikuwathandizira panthawi yothandizira. Zikafika pancreatitis yosatha, nthawi zambiri chithandizo chamankhwala chisanachitike chimakhala chothandiza kwambiri kotero chimakulolani kuchedwetsa opaleshoni.

Zina zomwe zimatsimikizira kuyendetsa bwino kwa opareshoni ndikukulolani kuneneratu za matendawo mtsogolo:

1. General chikhalidwe cha munthu musanachite opareshoni.
2. Njira, kuchuluka kwa opaleshoni.
3. Ubwino wa chithandizo cha postoperative, chithandizo chokwanira chamankhwala.
4. Kutsatira zakudya.
5. Zochita Zoleza Mtima

Ngati munthu sadzaza thupi, kuwunika zakudya, kumakhala ndi moyo wabwino, ndiye kuti mwayi wokuchotsedwako umachulukira.

Kodi matupi a pancreatitis owopsa ndi otani?

Chidziwitso chapamwamba kwambiri chimawonedwa ndi mawonekedwe a edematous. Nthawi zambiri, pancreatitis yovuta kwambiri imatsimikiza yokha, kapena mothandizidwa ndi mankhwala. Osakwana 1% ya odwala amafa.

Kulosera za pancreatic necrosis ndizowopsa. Amatsogolera kuimfa ya 20% -40% ya odwala. Mavuto a purulent amawonjezeranso zoopsa zake.

Kubwera kwaukadaulo wamakono, kudalirika kwa odwala omwe ali ndi pancreatitis yovuta kwambiri kwasintha. Chifukwa chake, mukamagwiritsa ntchito matekinoloje ochepera, kufa ndi 10% kapena kuchepera.

Kodi pali kusiyana pakati pancreatitis yayikulu ndi pachimake?

Makina a chitukuko cha matenda a kapamba, komanso pachimake, sanamveke bwino. Ngati ali pachimake mawonekedwe, kuwonongeka kwa tiziwalo tamatumbo kumachitika makamaka ndi ma enzymes ake, ndiye mu mawonekedwe osakhwima, minyewa ya m'mimba yake imalowedwa ndi minofu yaing'ono.

Pancreatitis yachilendo imakonda kupezeka mafunde: mukachulukitsa, zizindikiro zimatchulidwa kwambiri, kenako zimachitika chikhululukiro kusintha kwa zinthu.

Monga lamulo, chikhansa chachikulu ndimachira. Pamaso pa zisonyezo zina muyenera kuchita opaleshoni.

Kodi kuyeretsa magazi kumagwiritsidwa ntchito mu pancreatitis pachimake?

Zisonyezero za plasmapheresis mu kapamba kapamba :

• Nthawi yomweyo atangolowa kuchipatala. Pankhaniyi, mutha "kugwira" kapamba kachuma pachimake ndikuthana ndi kuphwanya kwakukulu.
• Ndi chitukuko cha pancreatic necrosis.
• Ndi kwambiri kutupa, peritonitis, kuphwanya ntchito kwamkati ziwalo.
• Pamaso pa opareshoni - kuchepetsa kuledzera ndi kupewa zovuta.

Contraindication kwa plasmapheresis mu pachimake kapamba :

• Zowonongeka zazikulu ziwalo zofunika.
• Kukhetsa magazi komwe sangathe kuyimitsidwa.

Nthawi zambiri, panthawi ya plasmapheresis mu pancreatitis pachimake, 25-30% ya madzi am'madzi am'magazi amachotsedwa kwa wodwala ndikusinthidwa ndi njira zapadera. Pamaso pa njirayi, sodium hypochlorite solution imayendetsedwa kudzera m'mitsempha. Panthawi ya plasmapheresis, magazi amayatsidwa ndi laser. M'mavuto akuchulukirapo, 50-70% ya kuchuluka kwa madzi am'madzi amatha kuchotsedwa kwa wodwala, m'malo mwake omwe plasma yatsopano yozizira imalowetsedwa.

Kodi chithandizo chowonongera chazovuta chitha kupweteka pancreatitis?

Zowonjezera zazowonongera zomwe zimakhala ndi maubwino pazowonjezera opaleshoni yachilendo. Zimathandizanso, koma kuvulala kwamtundu kumachepetsedwa. Ndi kuyambitsidwa kwa njira zowononga zachilengedwe zowonongeka, zotsatira za mankhwalawa a pancreatitis pachimake zimayenda bwino, odwala anayamba kufa pafupipafupi.

Kodi kukonzanso pambuyo pancreatitis pachimake?

Ngati palibe zovuta, ndiye kuti wodwala ali kuchipatala milungu iwiri. Pambuyo pakuchotsa, ndikofunikira kuchepetsa kuchita masewera olimbitsa thupi kwa miyezi iwiri.

Ngati pambuyo opaleshoni wodwala zovuta, chithandizo inpatient chikhala nthawi yayitali. Nthawi zina pancreatitis pachimake imatha kubweretsa kulumala, wodwala amatha kupatsidwa I, II kapena gulu la III.

Ma Sanatorium ndi malo odyera omwe ali abwino kwa odwala otere :

Mitundu ya magwiridwe

Njira za Etiopathogenetic zimathandizira adokotala kupanga algorithm yothandiza ngati pali kufalikira kwa kapamba.

2010 03 12 Opaleshoni ya kapamba

Opaleshoni Yapancreatic

Opaleshoni yachipatala amasiyanitsa njira zingapo zopangira opaleshoni. Njira zomwe zimagwiritsidwa ntchito:

• Kutalikirana kwakuthupi. Imatembenuza kuchotsedwa pang'ono. Potere, thupi ndi mchira wa chiwalo chokha ndiomwe umatuluka. Kuthandizira kwamtunduwu ndikofunikira panthawi yomwe matenda akhudza gawo limodzi lokha la minyewa ya pancreatitis.
• Kuchotsa kwakukulu. Ndi ma opaleshoni othandizira opaleshoni iyi, resection imagwira ntchito osati thupi ndi mchira wake, komanso mbali ina ya mutu. Malo ochepa chabe ndi omwe amasungidwa, omwe amakhala pafupi kwambiri ndi duodenum.
• Khalidkhaldi. Ntchito yamtunduwu mu pancreatitis yovuta imachitika pokhapokha kuyang'aniridwa ndi ultrasound. The pancreatic fluid formations amaboola ndipo zomwe zili mkati zimatsitsidwa pogwiritsa ntchito ngalande.

Kufikira kwa chotupa ndikotheka pogwiritsa ntchito laparotomic ndi endoscopic. Njira yachiwiri siyowonongera kuposa yoyamba.

Mavuto obwera pambuyo pake

Ambiri mavuto pambuyo opaleshoni kwa pachimake kapamba:

• Purulent peritonitis. Zimachitika pamene CHIKWANGWANI chikadwala. Kufalikira kwa masamu a purulent-necrotic m'malo a retroperitoneal kumatha kubweretsa imfa. Zotsatirazi ndizothekanso ndi njira yolakwika ya laparotomy.
• Kuchulukitsa kwa matenda a Hirschsprung. Ndi yayitali yotsika ya pathologies a m'matumbo akulu, kuyang'ana kwa zidutswa zina za kapamba kumabweretsa kudzimbidwa kosalekeza.
• Pancreatic shock. Njira yovuta ya pathological, yophatikizidwa ndi kukhudzana ndi endotoxins, yomwe imayambitsa necrosis yotsala ya chiwalo. Zimakwiyitsa kuchepa kwa magazi a magazi. Poterepa, kuthamanga kwa magazi kumatsika. Ndi aseptic chikhalidwe cha pancreatic necrosis, ma endotoxins amakhala ngati ma enzymes enieni, omwe amakhudza kwambiri chiwalo, ndikupangitsa kupangika kwa kutsekemera.

Chithandizo cha opaleshoni yamatenda a kapamba amasonyezedwa ndi kuperewera kwa mphamvu yawofatsa ndi a gastroenterologist. Malinga ndi ziwerengero, 40% ya odwala omwe ali ndi pancreatitis yayitali (CP) amakhala odwala m'dipatimenti yopanga opaleshoni pachipatalachi chifukwa chosiya kulandira chithandizo chamankhwala ndikupanga zovuta. Njira zopangira opaleshoni zimakhazikitsa njira yothandizira - kuchepetsa kuchepa kwa kapamba.

Kodi opaleshoni amachitidwa liti chifukwa cha chifuwa chachikulu?

Kukula kwa kapamba ndi kusintha kwa nthendayo kukhala yovuta kumayendera limodzi ndi kuphwanya kwa matupi athu. Nthawi zambiri, ma cysts, miyala, stenosis ya chimbulu chachikulu cha kapamba kapena ma ducts a bile amapangika, kuwonjezeka kwakukulu kwa kukula kwa mutu wa chiwalo chifukwa cha kutupa (kapena "caplect", pancreatitis) pamene kutsutsana kwa ziwalo zapafupi:

• duodenum
• antrum
• bile ducts
• mitsempha yapa portal ndi mabungwe ake.

Zikatero, wodwalayo amagonekedwa m'chipatala m'dipatimenti yochita opaleshoni, ngati sizinathandize mu magawo am'mbuyomu, ndipo mkhalidwe wa wodwalayo umakulirakulira, kapena mavuto obwera chifukwa cha moyo adayamba. Kuzindikira kumawonekera:

• kuchuluka kwa zowawa
• kuwoneka kwa zizindikiro zakukwiyimbira kwachiphamaso,
• kuledzera
• kuchuluka kwa mkodzo.

Mankhwala othandizira opaleshoni amachitika molingana ndi mawonekedwe okhwimitsa, chifukwa chilichonse chokhudzana ndi kapamba chingakulitse vutoli.

Njira yayitali ya kapamba amawonekera ndi zizindikiro zomwe zimakhalapo pafupipafupi chifukwa cha kutupa ndi mafupa a minofu ya chiwalo.

Kuchitapo kanthu kwa opaleshoni nthawi zambiri kumagwiritsidwa ntchito poyambira matenda (1-5 masiku) potsatira:

• ngati alipo
• Ndi zowawa zazikulu,
• ndi choteteza
• Pamaso pake ndikuwoneka.

Nthawi zina, ntchito zadzidzidzi zimachitika pomwe CP ipezeka:

1. kutulutsa magazi kwambiri mu patseudocyst patsekeke kapena m'mimba thirakiti,
2. chotupa cha chotupa.

Nthawi zambiri, chithandizo cha opaleshoni kwa CP chimachitika monga momwe anakonzera atazindikira mozama.

Pali zotsutsana pa kukhazikitsidwa kwa njira zamankhwala zochiritsira pa kapamba:

• kutsika kwa magazi pang'onopang'ono,
• anuria (kusowa kwathunthu kwamkodzo),
• mkulu hyperglycemia,
• kulephera kubwezeretsa kuchuluka kwa magazi.

Zizindikiro zakuchita opareshoni

Kuchita opaleshoni yokhala ndi kapamba kumawonekera pazochitika zotsatirazi:

• Refractoriness (kukana) kwa chizindikiro cha ululu m'mimba mpaka zotsatira zamankhwala,
• Kupanikizika kwa kapamba (pamene, chifukwa cha kupindika kwa nthawi yayitali, minofu yolumikizana yolumikizana ndikuwonekera, kuchuluka ndi kukula kwa kapamba kumawonjezeka kwambiri, koma ntchito zake zimachepera kwambiri),
• masentimita angapo (oyimitsa) a pancreatic duct,
• stenosis ya intrapancreatic biliary thirakiti,
• kukakamira kwa zotengera zikuluzikulu (chotengera kapena chapamwamba cha mesenteric),
• pseudo-cysts
• Kusintha kwa ma pancreatic minofu, kuchititsa kukayikirana kwa vuto loipitsa (chiwopsezo cha khansa pamaso pa CP chikuwonjezeka ka 5),
• kwambiri duodenal stenosis.

Kuchita bwino kwa maopareshoni othandizira

Zotsatira za opaleshoni ndikuchotsa ululu, kumasulidwa kwa thupi ku kuledzera ndi zinthu zotupa ndi kuvunda, kubwezeretsa kwachilendo kwa ntchito yapamba. Mankhwala othandizira opaleshoni ndikothandiza kupewa: fistulas, cysts, ascites, pleurisy, zotupa zosiyanasiyana za purulent.

Kuchita bwino kwa chithandizo cha opaleshoni ya CP kumalumikizidwa ndi gawo la pancreatic pathology ndi zovuta ziwiri zazikulu, zimatengera mwachindunji momwe mungakwaniritsire kuthana nazo:

1. Kusintha kwadzeru m'matumba a pancreatic ndizowopsa, zofalikira komanso zosasinthika. Kuchita bwino kuyenera kutsatiridwa mtsogolomo ndi chithandizo chamankhwala chotenga nthawi yayitali komanso nthawi zina. Malangizowa ndi gawo lofunika kuti chithandizo chithandizike, popanda omwe opaleshoni yamankhwala amachepetsa.
2. Mwambiri, HP watero. Ngati njira zopangira opaleshoni zovuta kwambiri zotsika mtengo, zakumwa zoledzeretsa sizisiya, kuthandizira kwa opaleshoniyo kudzakhala kwakanthawi.

Kukonzekera kwa opaleshoni ndi mitundu ya njira zochizira

Mitundu yonse yamatenda a kapamba, mosasamala kanthu za mtundu wake ndi kapangidwe kake (mowa, biliary, pseudotumor, pseudocystic, indental) kapena maphunziro (pachimake kapena operewera), mfundo yayikulu yokonzekera opaleshoni ndiyo kufa ndi njala. Izi zimachepetsa chiopsezo cha zovuta za postoperative. Chifukwa chake, tsiku loti lisanachitike opareshoni, ndikofunikira kukana chakudya chilichonse, chamadzulo ndi m'mawa machiritso apamwamba amachitika. Patsiku la opaleshoni, kukonzekera thupi kumachitika, zomwe zimathandizira kukhazikitsa kwa wodwalayo. Cholinga chake:

• tsimikizani wodwalayo ndikuchotsa mantha pakuchita opareshoni,
• letsa kukula kwa thupi lawo siligwirizana,
• sinthani katulutsidwe ka kapamba ndi m'mimba.

Kukonzekera Mankhwala

Pofuna kukonzekera, mankhwala a magulu osiyanasiyana amagwiritsidwa ntchito (tranquilizer, antipsychotic, antihistamines, anticholinergics).

Kuphatikiza apo, wodwala yemwe ali ndi CP kwa zaka zambiri amachepa kwambiri chifukwa cha zovuta m'mimba.Chifukwa chake, opaleshoni isanachitike, odwala ambiri amadziwitsidwa kukhazikitsa plasma, mayankho a mapuloteni, madzi amtundu wa saline kapena 5% shuga. Nthawi zina, malinga ndi zomwe zikuwonetsa, magazi kapena magazi ofiira amathandizira kuwonjezera hemoglobin, prothrombin index, ndi protein.

Ndi jaundice wa nthawi yayitali chifukwa chakutha kwa kutaya kwa ndulu kudzera mu lumen ya duodenum, Hypo- kapena vitamini akusowa. Ichi ndichifukwa chosowa kuthekera kosintha makanema osavomerezeka a mavitamini kukhala osungunuka - njirayi imachitika ndi kutenga kwa ndulu. Zikatero, mavitamini amathandizidwa ndi makolo komanso pakamwa.

Udindo wofunikira pokonzekera ntchito yomwe wakonzekera umachitika ndi:

• Methionine, Lipocaine (zotchulidwa piritsi 0,5 x katatu pa tsiku kwa masiku 10).
• Sirepar - amaperekedwa kudzera mu mtsempha wa 5 ml kamodzi patsiku kwa sabata.

Njira zopangira opaleshoni

Thandizo la opaleshoni ya kapamba zimatengera zovuta zomwe zadziwika ndipo zitha kukhala:

• mankhwala a endoscopic apakati,
• laparotomy kulowererapo.

Njira ya opaleshoni yapamwamba ya laparotomy imagwiritsidwa ntchito kwa zaka zana. Imachitika milandu:

• kukula kwakukulu kwa minofu yapancreatic,
• kusungidwa - poyang'ana gawo la chiwalo,
• (Chimodzi mwazosintha ndikuchotsa gawo la mutu wa pancreatic ndi njira ya Frey).

Mtundu womaliza wa chithandizo cha opaleshoni pogwiritsa ntchito laparotomy ndiwowopsa. Chiwopsezo cha kukhala ndi matenda ashuga pambuyo pantchito chimakhala chochepa, ndipo kufa kumakhala kochepa kuposa 2%. Koma mchaka choyamba pambuyo pa opaleshoni, kubwereranso kwa ululu kumawonedwa mu 85%, kwa zaka 5 ululu umapitilira mu 50% ya odwala omwe adachitidwa opaleshoni.

Ntchito yosungirako (pamene gawo laling'ono lakhudzidwa ndi chiwalo likachotsedwa, mwachitsanzo, duodenum - yosungirako mutu wapa pencreatic malinga ndi Berger, chiwongola dzanja chokhala ndi ndulu, kuchotsa pang'ono pathupi ndikusungidwa ndulu) kumawonetsa zotsatira zabwino zazitali - chizindikiro cha ululu chimasowa mu 91% ya odwala, 69% ya odwala amabwerera kuntchito yokhazikika.

Kuchita opaleshoni yayikulu kwambiri ndi mtundu wowopsa kwambiri wopangira opaleshoni (pyloroplasty resection of the pancreatic head, whole pancreatectomy). Mankhwalawa sagwiritsidwa ntchito kawirikawiri, mwapadera, chifukwa cha kufooka kwambiri, kufa kwa anthu komanso kuchuluka kwa zovuta. Zochititsidwa:

• ndi kukayikira kwa matenda okhala ndi vuto lalitali la CP, pakakhala kupukusira kwa zotupa za pancreatic,
• Ndi portal matenda oopsa chifukwa cha kukakamiza kwa splenic mtsempha wokulirapo ndi zikondamoyo.
• ndi kuwonongeka kwathunthu komanso kuwonongeka kwamphamvu kwa minofu ya kapamba.

Pancreatectomy, malinga ndi madokotala ochita opaleshoni, amangolondola pokhapokha ngati muli ndi khansa ya mutu komanso thupi la kapamba. Kuphatikiza pa chiwopsezo chachikulu cha zovuta zomwe zikuopseza moyo, wodwalayo amakakamizidwa kuti atenge enzyme m'malo ndi insulin yothandizira moyo, zomwe zimapangitsa kuti ntchitozi zizikhala zopanda tanthauzo kwa CP.

Kupulumuka kwa zaka zisanu ndi 2%.

Endoscopic okhazikika chithandizo

Njira ya endoscopic imagwiritsidwa ntchito pazovuta za CP:

• pseudocyst
• kuchepa (kukakamiza) kwa kudzimbidwa kwakukulu,
• kukhalapo kwa miyala mumiyendo ya kapamba kapena chikhodzodzo.

Amabweretsa kukhazikika kwa matenda oopsa a pancreatic ndipo amafunikira njira zamkati zolowera.

Sphincterotomy ndiye njira yopemphedwa kwambiri. Nthawi zambiri, zimakhala ndi:

• endoprosthesis cholowa chachikulu chakhansa,
• pamaso pa mwala - ndi kuchotsa kwake (lipoextraction) kapena lithotripsy,
• kukhetsa kwa chotupa.

Ngati endoprosthesis yaikidwa, imasinthidwa miyezi itatu iliyonse. Zikatero, mankhwala odana ndi kutupa amachitika miyezi 12-18.

Zovuta za njirayi: magazi, kukula kwa kapamba, cholangitis. Mukafuna kupusitsa bwino, amaloledwa kudya tsiku lotsatira.Pambuyo pa tsiku, wodwala amatha kuchotsedwa.

Ndondomeko ya laparoscopic

Zomwe zimagwiritsidwa ntchito pokhapokha pofuna kuzindikira. M'zaka khumi zapitazi, njirayi ndi yothandiza. Zowonetsera pakukonzekera kwake:

• (machitidwe)
• chotupa (ngalande),
• kunyowa
• zotupa zakomweko.

Monga njira yodziwitsa, imagwiritsidwa ntchito ngati jaundice (kukhazikitsa etiology), kukulitsa kwakukulu kwa chiwindi, ascites - ngati sizingatheke kukhazikitsa zifukwa zenizeni za izi mwa njira zina zofufuzira, kulephera kwamphamvu kwa ziwalo zambiri, osagwirizana ndi zovuta masiku atatu. Ndi pancreatitis, njirayi imapangitsa kudziwa gawo la matendawa komanso kuwonongeka kwa chindacho pachokha komanso ziwalo zapafupi.

Ili ndi zopindulitsa zingapo pakuthandizira opaleshoni yakale. Izi zikuphatikiza:

• kusapweteka kwapachibale
• kuchepa kwa magazi ndi chiwopsezo cha zovuta,
• kutsika kwakukulu pakukonzanso nthawi,
• kusowa kwa bala pakhoma lamkati lakumbuyo,
• Kuchepetsa kwamatumbo paresis pambuyo pa njirayi ndi kusakhalapo kwa chitukuko cha matenda omatira.

Laparoscopy pazozindikira komanso zochizira zimachitika ndi njira yoyambira sedation ndi analgesia. Pofuna kudziwa kuti muli ndi vuto lotani, limagwiritsidwa ntchito pokhapokha ngati njira zowunikira zomwe sizowukira (ultrasound OBP ndi ZP, CT) sizinapange kanthu. Njirayi imakhala yopanga chaching'ono (0.5-1 cm) pakhoma lamkati lakumbuyo kuti ikayikemo projekiti ya laparoscope ndi chimodzi kapena zingapo zogwiritsa ntchito zida zothandizira opaleshoni (zothandizira). Pangani pneumoperitonium - dzazani pamimba ndi kaboni dayokosi kuti mupange malo ogwirira ntchito. Moyang'aniridwa ndi laparoscope, ogwiritsa ntchito amachotsa madera a necrotic, ngati kuli kotheka, (kuchotsa zikondwererozo pamalo omwe amapangidwira - malo a retroperitoneal - kulowa m'mimba.

Mothandizidwa ndi laparoscope, kutulutsa tiziwalo tokha, ziwalo zoyandikana zimayesedwa, mkhalidwe wa phokoso lofufuzira umayesedwa.

Ngati mkati mwa laparoscopy zitapezeka kuti sizingatheke kuthetsa vuto lomwe lapezeka ndi njirayi, opaleshoni ya patsekeke imachitika pa tebulo logwiritsira ntchito.

Kusamalira odwala komanso kukonza odwala atamuchita opaleshoni

Pambuyo pa opaleshoni, wodwalayo amasamutsidwa kumalo osamalira odwala kwambiri. Izi ndizofunikira kusamalira wodwala ndikuwunikira zizindikiro zofunika, kupereka njira zofunikira zokulitsa zovuta. Ngati vutoli likugwirizana (pakakhala zovuta), patsiku lachiwiri wodwalayo alowa mu dipatimenti yochita opaleshoni, komwe chithandizo chokwanira, chisamaliro, ndi zakudya zimapitilirabe.

Pambuyo pakuchita opaleshoni, wodwalayo amafunika kuyang'aniridwa kuchipatala kwa miyezi 1.5-2. Nthawi iyi ndiyofunikira kubwezeretsa mgonero ndi chiyambi cha kugwira ntchito kwa kapamba, ngati gawo lake lapulumutsidwa.

Pambuyo pochoka kuchipatala, malingaliro onse akuyenera kutsatiridwa ndikulembetsedwa kwamankhwala. Lili ndi:

• mumtendere wathunthu
• m'maloto masana
• mu zakudya okhwima.

Zakudya zamagulu azakudya ziyenera kukhala zofatsa komanso zowonjezereka, zotchulidwa ndi kusinthidwa ndi dokotala. Panthawi zosiyanasiyana zakukonzanso, zakudya ndizosiyana, koma zili m'malire a tebulo No. 5 malinga ndi Pevzner. Ili ndi mfundo zapakati pazakudya: kugwiritsa ntchito zinthu zololedwa zokha, kupatula (nthawi zambiri kumakhala kambiri: 6-8 patsiku, koma m'magawo ang'onoang'ono), kugwiritsa ntchito zakudya zotentha ndi zosankhika, madzi okwanira. Nthawi zambiri, amadya zakudya zomwe zimapatsa moyo.

Masabata awiri atachoka kuchipatala, boma limakulitsa: kuyenda kumaloledwa ndi phokoso lokhazikika.

Chithandizo cha postoperative ndi zakudya za odwala

Kuwongolera kwina kwa wodwala mu postoperative nthawi kumachitika ndi gastroenterologist kapena akatswiri othandizira odwala.Chithandizo chowongolera chimalamulidwa pambuyo pofufuza bwino mbiri yachipatala, kulowererapo kwa opaleshoni, zotulukapo zake, thanzi lonse, zambiri zofufuza. Mlingo wofunikira, insulin ndi mankhwala obwezeretsera omwe amagwiritsidwa ntchito ngati mankhwalawa amagwiritsidwa ntchito moyang'aniridwa ndi ma laboratori, njira zamankhwala zodziwikiratu (analgesia, mankhwala omwe amachepetsa kubwezeretsa, kuchepetsa matenda, kuchepetsa matenda obisika.

The zovuta mankhwala zikuphatikiza:

• chakudya -
• olimbitsa thupi
• njira zina zochizira thupi.

Kuzindikira kuchira pambuyo pa opaleshoni

Zomwe zimachitika pambuyo pa opaleshoni zimatengera zinthu zambiri, monga:

• chifukwa chomwe chinapangitsa kuti athandizidwe opaleshoni (cyst kapena khansa ya pancreatic ndi kusiyana kwakukulu pakuvuta kwa matenda oyamba),
• kukula kwa ziwalo komanso kuchuluka kwa opareshoni
• momwe wodwala alili asanalandire chithandizo champhamvu (kupezeka kwa matenda ena),
• kupezeka kwa concomitant matenda mu postoperative nthawi (zilonda zam'mimba kapena zilonda zam'mimba zam'mimba, zomwe zimayambitsa magwiridwe antchito a kapamba, owonetsedwa ndi kudzipatula kwa enzyme - kuwonjezeka kwa zochitika za amylase motsutsana ndi maziko a kuchepa kwa trypsin ndi milingo ya lipase),
• mtundu wa zochitika zapa postoperative komanso zopumira.
• kutsatira boma la moyo ndi zakudya.

Kuphwanya kulikonse komwe dokotala akutsimikizira pankhani ya kadyedwe, kupsinjika (m'thupi ndi m'maganizo) kumatha kukulitsa vutolo ndikupangitsa kuchulukana. Ndi chidakwa cha pancreatitis, kumwa mowa kopitilira kumabweretsa kuchepa kwamphamvu m'moyo chifukwa chobwerezabwereza. Chifukwa chake, moyo wabwino pambuyo pakuchita opaleshoni zimadalira wodwalayo, kutsatira kwake malangizo ndi malangizo onse a dokotala.

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