Kodi ndizotheka kufa ndi kapamba (pancreatic necrosis)

Necrosis yamatumba a pancreatic popanda chisamaliro chodzidzimutsa imapangitsa kuti ma enzyme ambiri atulutsidwe. Chifukwa cha kuchuluka kwa mpweya mkati mwa makoma, ma enzyme amalowa m'malo otchingidwira. Kutukusira kwa zotupa, zotupa zimatuluka m'matupi ake ndi mawonekedwe a retroperitoneal, zomwe zimayambitsa njira zosasinthika, pakati pomwe zoyambirira komanso zofala kwambiri:

• lowetsani
• hemorrhagic mayamwidwe,
• peritonitis
• retoperitoneal abscess kapena phlegmon.

Lowani

Kukula kwa parapancreatic kulowetsedwa kumachitika osati mu ndulu, komanso m'ziwalo zoyandikana. Zikhudzidwa:

• duodenum
• m'mimba
• ndulu.

Mchitidwewo umatha kupita ku chikhodzodzo, chiwindi, zimapangitsa kusintha m'matumbo apansi. Amagulitsidwira wina ndi mzake ndi gawo la exudate, ndikudzaza kumtunda kwa m'mimba kapena malo ake onse. Kapangidwe kamene kamalowerera kumachitika chifukwa cha chitetezo chamthupi m'thupi lathu. Mchitidwe wokha ndiwotseka panthawiyi, palibe matenda. Chifukwa chake, ndizotheka:

• kusintha kosintha - kusinthanitsa,
• mapangidwe a cyst
• purulent njira.

Ngati wolowerera samasowa pakatha miyezi itatu, ma cysts amawoneka. Ili ndi chenjezo lokhudza vuto lalikulu.

Kulowa ndi matenda kumabweretsa:

• kuwonongeka kwa purancle kapamba,
• peritonitis
• kunyowa
• phlegmon.

Izi zimawonjezera kwambiri mkhalidwe ndi kudwala kwa matendawa.

Ndikosavuta kusiyanitsa parapancreatic kulowa mkati ndikupanga matenda popanda njira zowonjezera. Izi ndichifukwa chosawoneka bwino kuchipatala chifukwa cha aseptic process:

• zambiri sizikuphwanyidwa, wodwala alibe zodandaula,
• Kutentha kumakhala kwabwinobwino, nthawi zina kumachitika pang'onopang'ono - kuwonjezeka mpaka 37-37.9 digiri Celsius,
• pamafotokozedwe ambiri a magazi, kupatula kusintha kosagwirizana ndi zakumanzere (osati nthawi zonse), palibe kusintha.

Kupanikizika kungayikiridwe panthawi yopanga mawonekedwe a retroperitoneal space, magazi ndi mkodzo mayeso okhutira a pancreatic enzymes: mu biochemical kusanthula, kuchuluka kwakukulu kwa amylase kutsimikizika, ndikuwunika kwa ultrasound, kusintha kwa mawonekedwe.

Peritonitis ndi kutukusira kwa pepala lamatumbo lam'mimba, zomwe zimatsogolera kudzikundikira kwa madzimadzi okhala ndi michere yambiri. Pafupipafupi pamenepa ndi 60-70%. Imadziwonetsa ngati chithunzi chowoneka bwino cham'mimba. Kuwonekera:

• kupweteka kwa paroxysmal kwambiri, popanda kutanthauzira momveka bwino, nthawi zina kumatsimikiziridwa kumanzere kwa hypochondrium ndi epigastrium,
• Zizindikiro zam'mimba kwambiri: kusokonezeka kwa khoma lakunja kwam'mimba komanso zonse zofunikira za kutupa,
• kuledzera kwambiri: kufooketsa mpaka 40 ndi kupitilira, tachycardia, kutsika magazi, nseru, kusanza, kusanza,
• psychosis
• kugwa - kuchepa kwambiri kwa kuthamanga kwa magazi komanso kutsika kwa ntchito zamtima.

• kuyezetsa magazi kwapakati - leukocytosis ndi ESR yayikulu,
• biochemical - diastasis ya mkodzo ndi magazi zimaposa zonse.

Hemorrhagic mayamwidwe

Peritoneal hemorrhagic effusion ndi chimodzi mwazomwe zimayambitsa kufa kuchokera ku pancreatic necrosis. Ndili zovuta kwambiri. Ma enzymes omwe amagwira ntchito kwambiri amatsogolera pakukula kwa necrosis ndi kufa kwa maselo ambiri. Kutuluka kwamphamvu kwambiri kumachitika, ziwalo zathupi zimaphatikizidwa ndi magazi. Ziwalo zoyandikana nawo zimagwira nawo ndewu, kachilomboka kamajowina, kuledzera kwa purulent kumayamba. Matendawa amapita patsogolo mwachangu, mwachangu, kuyambiranso kumafunika.

Mwachikhalidwe, chimafanana ndi chifuwa cham'mimba, koma zizindikiro zake zonse zimafotokozedwa momwe zingathere. Mwadzidzidzi:

• Hyperthermia - kutentha kumafika madigiri 41-25, Celsius,
• kuzizira kwambiri komanso kusokonezeka kwa chikumbumtima,
• ulesi kapena kukwiya,
• kukomoka kwa mtima, kusakhazikika kwa magazi,
• kupuma movutikira
• kupweteka kwammbuyo - kuvuta kwamkati kwam'mimba kwambiri, makamaka kumanzere kwa hypochondrium,
• kusanza, kusanza mobwerezabwereza,
• kutsegula m'mimba komanso kusilira.

Retroperitoneal phlegmon ndikutupa kwa minofu yamafuta popanda malire omveka bwino omwe amapezeka kwathunthu. Pathogenic microflora yokhala ndi magazi kapena magazi a m'mimba amalowa mu fiber kuchokera pakulunjika kwa matenda kapena nthawi ya opareshoni. Zizindikiro zamankhwala zimapereka chitukuko cha zovuta:

• kutentha kwa thupi (38 388,5 madigiri Celsius ndi pamwambapa),
• kupweteka m'dera lumbar - mawonekedwe a pulsating kapena kukoka ndi radiation kupita kumimba pamene ziwalo zina zimagwira nawo gawo la pathological process.
• kuwonjezeka kwa ululu posuntha kapena kusintha mawonekedwe a thupi.

Kuphatikiza pa zomwe zidatchulidwa zotupa za pancreatic necrosis, nthawi zambiri zimakhala:

• fistulas
• vein thrombosis yokhala ndi ziwalo zamkati zamkati,
• madera akumalo a hepatobiliary,
• m'mimba,
• zilonda zam'mimba ndi matumbo,
• kuchepa kwa puloteni.

Kodi pali mwayi uliwonse wopulumuka ndi matendawa?

Kuti mukhale ndi moyo ndi pancreatic necrosis, kuchipatala kwadzidzidzi ndikofunikira. Njira zopweteka za kufa kwa maselo zimapitirira mwachangu, zimatha kukhala mphezi mwachangu komanso mwathunthu mkati mwa ola limodzi kapena awiri. Ngati necrosis yakhala yathunthu - kufa kumachitika mwa 100% milandu. Kuti tisokoneze gulu loyipa lazinthu zam'magazi, kupulumutsanso mwachangu ndikofunikira. Pankhaniyi, kupulumutsa moyo ndikotheka.

Poyamba, wodwalayo amalowa m'chipinda choperekera chithandizo chachikulu, kumene njira zonse zochiritsira mwadzidzidzi zimachitika kuti wodwalayo asadabwe. Kutulutsa, kupweteka kwa mankhwalawa kumachitika, kupuma kokwanira kwa kapamba kumapangidwa. Pafupifupi patsiku la 5, pomwe malire ndi kuwonongeka kwa ziwalo zikuwonekeratu, necrectomy imachitika.

Koma sizichitika nthawi ngati izi. Ngati zotupa zakhala zokwanira ndipo kuwerengera kumapitilira koloko, opaleshoniyo imachitika nthawi yomweyo, nthawi zina kapamba amachotsedwa kwathunthu - kapamba. Wodwalayo ayenera kukhazikitsidwa kuti athandizire zina kuti azitha kuyendetsa ma drainage drainage, ndipo m'malo mwake atha kukhala nthawi yayitali.

Kutalika kwa chithandizo pambuyo pakuchita opaleshoni ndikutalika, kumatenga kuposa miyezi isanu ndi umodzi kapena chaka. Zakudya zotchulidwa ndizovomerezeka - tebulo No. 5 malinga ndi Pevzner. Pambuyo pake, kuyang'aniridwa ndi dokotala wa gastroenterologist, imatha kusintha ku tebulo No. 1 ndi kusintha kwake. Katswiri yekha ndi amene angadziwe kuti muyenera kukhala ndi zakudya zazingati motani.

Kuphatikiza pa chakudyacho, kukonzekera kwa enzyme kumayendetsedwa, komwe kumakhala ndi malingaliro abwino okhudza mankhwalawa kapamba, komanso mankhwala angapo omwe amafunikira kuti akhale ndi thanzi labwino. Mankhwala onse ayenera kutsatiridwa mosamalitsa - njira yokhayo yosinthira moyo wabwino atachitidwa opaleshoni.

Chiwerengero chaimfa cha pancreatic necrosis

Ziwerengero zimawonetsa kuti kufa ndi isanayambike necrosis kumachitika mu 40-70% ya milandu. Zifukwa:

• tachedwa kukaonana ndi adotolo,
• malo owonongeka ambiri
• kuphatikiza matenda
• kuchuluka kwa zovuta (zopitilira zitatu).

Kuzindikira komaliza pamilandu yotere kumapangidwa kale ndi pathomorphologist, ndipo osati ndi dokotala wazachipatala kapena dokotala wa opaleshoni.

Mu pancreatic necrosis (PN), chiwerengero cha anthu omwalira chimakhala chambiri (pazochita zonse - mpaka 100%), ndipo palibe chizolowezi chotsika. Mu 97% ya PN yoopsa, kufa kwa odwala kumachitika chifukwa cha zovuta, kuphatikiza zomwe zimagwira ntchito pambuyo pake. Mchitidwe wa necrotic pawokha umatha kubwerezabwereza, koma mavuto amakula mwachangu ndikupangitsa zotsatira zowonongeka.

Ziwerengero zakufa kwa PN ndizakhumudwitsa: mwa odwala 10, kuyambira 2 mpaka 9 amafa kuchipatala kapena chifukwa cha zovuta zazikulu kapena matenda atsopano atatha. Ziwerengerozi ndizowopsa kwambiri, chifukwa choti anthu azaka zapakati pa zaka 30 mpaka 50 - amadwala PN.

Pambuyo akuvutika ndi pancreatic necrosis, mphamvu ya wodwalayo yogwira ntchito imachepa kapena kutayika kwathunthu. M'tsogolomu, kuthandizira opaleshoni kungafunikenso chifukwa cha zovuta za PN kapena kuwuka pakuchitika kwakukulu.

Zimayambitsa kufa mu matenda

Kufa kwa odwala omwe ali ndi ST kumafika 70%; matchulidwe ake siabwino kwenikweni. Malinga ndi ziwerengero, opitilira theka la odwala amafa patebulo logwiritsira ntchito panthawi yochizira opaleshoni. Chiwopsezo cha kufa chimatengera nthawi yakufunafuna chithandizo chamankhwala chapadera. Tengani gawo:

• ukalamba (pambuyo pa zaka 50),
• hypotension
• matenda ashuga
• magazi owonjezera,
• metabolic acidosis
• leukocytosis.

Malinga ndi kafukufuku wambiri, zomwe zimayambitsa kuphedwa zimaphatikizapo:

• kuwonetsa koyambirira kwa toxemia,
• kutali septic zosiyanasiyana zovuta.

Chifukwa cha chitukuko chawo, wodwala aliyense wachinayi amakhala ndi zolephera zingapo. Choyambitsa kufa pambuyo pake ndi chodwala choopsa.

Zofunikira ndizofunikanso:

• kuchuluka kwakumwa kwa zakumwa zoledzeretsa - monga odwala amuna,
• kuphwanya zakudya ndi kudya kwambiri mafuta, zonunkhira komanso zakudya zokazinga,
• matenda a gallstone - nthawi zambiri amakupezeka mwa akazi, ngati wodwalayo samatsatira malangizo othandizira odwala,
• zochitika zopsinja nthawi zonse.

Kukonzanso nthawi pambuyo pa opaleshoni

Pambuyo pa chithandizo cha opaleshoni, odwala amakumana ndi mavuto omwe amabwera ndi zovuta za postoperative, osati ndi zizindikiro zosatha za pancreatic necrosis. Munthawi imeneyi, kuwunika kwa dokotala wa opaleshoni, endocrinologist, ndi kukonzanso ndikofunikira.

Pambuyo pa pancreatic necrosis yayikulu, mu 70% ya milandu, odwala amakhalabe kumalo osungirako okalamba kapena kosamalidwa kwambiri ndi oyang'aniridwa ndi madokotala kwa nthawi yayitali - mpaka chaka chimodzi. Popeza njira yodekha komanso kupumula kwathunthu kumayikidwa, wodwalayo amakhala pakama. Popita nthawi, izi zimabweretsa kuwongolera kwa minofu ndikukula kwa miyendo yosinthika. Komanso, minofu yofooka siyilimbana ndi thupi la munthu mwiniyo. Kuti mupewe izi, tikulimbikitsidwa kutikita minofu, kuchita masewera olimbitsa thupi omwe amathandizira kulimbitsa minofu.

Chifukwa cha Autolysis (kudzimbidwa kwa ndulu nthawi yayitali), chimbudzi chimasokonekera kwambiri. Wodwala amachepetsa mpaka 50% yakulemera kwa thupi. Munthawi yakukonzanso kwa ntchito, ndikofunikira kutsatira zakudya zochizira kuti musangowonjezera vutoli ndikuwonjezera mafuta. Ndikulimbikitsidwa kuti muzidya zakudya zosenda mobwerezabwereza katatu patsiku m'magawo ang'onoang'ono.

Kutsatira kwambiri zakudya kumatanthauza kupatulidwa kwa zokometsera, mafuta, yokazinga, mbale zowuma, mowa, zakumwa zozizilitsa kukhosi, tiyi wamphamvu komanso khofi, chokoleti kuchokera kuzakudya. Mndandanda wa zoletsa ndi wawukulu, koma wodwala aliyense ayenera kudziwa kuti asasokoneze zakudya.

Powona zakudya zopatsa thanzi, wodwalayo amabwerera ku moyo wake wakale ndipo samamva kupweteka kapena kusasangalala. Kuphwanya zakudya kumabweretsa imfa.

Kodi mungapewe bwanji zotsatira zoyipa za kapamba?

Pancreatic necrosis atachitidwa opaleshoni ndikuwongolera, ngati munthu wapulumuka, amatanthauza matenda omwe amatha kuwongoleredwa. Ngati pali chikhumbo chokhala ndi moyo, ndiye kuti munthu amakhala ndi matenda otere, kutsatira malangizowo, ndipo kufa sikuwopsezedwa. Ndikofunikanso kuwunikira momwe akumvera, kupewa kupsinjika, kutsatira malamulo a chakudya chopatsa thanzi, kupita kukayezetsa mayeso ndi kukaonana ndi dokotala osadziletsa. Kupewa mavuto kumatanthauza kukana zizolowezi zoyipa: kukana kugwiritsa ntchito zakumwa zoledzeretsa zam'kati komanso moperewera. Kutengera ndi malamulowa, thanzi limakhalabe labwino.

Etiology ya matenda

Pali zifukwa ziwiri zazikuluzikulu za kapamba: kumwa mowa kwambiri (pafupifupi 60%) ndi matenda a gallstone (pafupifupi 30%).

Zowonjezera zomwe zikuthandizira kukulitsa kutupa:

• matenda a duodenum
• kuvulala kwam'mimba
• mbiri yam'mimba kapena njira yothandizira
• matenda - chiwindi B ndi C mwachilengedwe, ma mumps ("mamps"),
• helminthic infestation - ascariasis, enterobiasis,
• kusintha kwa mahomoni,
• cholowa
• zotupa, kufinya kwa mapindikidwe a kapamba mu anamnesis.

Pali mitundu iwiri ya kapamba: pachimake komanso chovuta.

Zizindikiro za Pancreatitis

Fomu

Kufotokozera Mwachidule

Pachimake maphunziro - owopsa moyoUlulu wamphamvu kumtunda kwa m'mimba, womwe umaduka.Zowawa zimakhudza dera la kumanja kapena kumanzere kwa hypochondrium, gawo la epigastric, kumbuyo, lamba lonyowa limapweteka. Ma antispasmodics alibe mphamvu ndipo osasiya kupweteka. Nthawi zambiri pamakhala kusanza.Samabweretsa mpumulo. Zocheperako, kutsegula m'mimba, kufooka wamba, chizungulire.Wodwalayo amakhala ndi nkhawa komanso amayamba kuda nkhawa. Kunja - kuchuluka kwachilengedwe pamimba, zizindikiro za matumbo ndi m'mimba.Zizindikirozi zikuwonetsa kutukuka kwapang'onopang'ono. Kutentha kwamphamvu, kugunda kwa mtima ndi kugunda kwa mtima ndizapamwamba, kuthamanga kwa magazi kumachepa, khungu la utoto, kuchepa mphamvu kwa thupi, mapangidwe ofunika amawonekera palilime, mawonekedwe amtundu amakhala owala.Izi ndi zizindikiro zoyipa kale zomwe zimatha kuonetsa kuti munthu akhoza kufa chifukwa cha kupweteka kwa kapamba. Matenda a kapambaZizindikiro sizinatchulidwe motero, zizindikiro zazikulu ndiz: kumverera kolemetsa mutatha kudya, makamaka ndi phwando lochulukirapo. Mimba zokulitsa, nseru, kupindika m'mimba, kutsegula m'mimba modzidzimutsa, kupweteka kwakuthwa, komanso mofulumira.Njira yodwala siyikhala pachiwopsezo cha moyo wa wodwalayo, koma amafunika kudya komanso kuwunika pafupipafupi ndi katswiri. Khansa ya kapamba imalembedwa mwa odwala omwe kale anali ndi vuto losatha. Chifukwa chake, ndikofunikira kwambiri kumvetsetsa kuwopsa kwa matendawa komanso mwayi wakufa chifukwa chake.

Zifukwa zakuzindikira

Kuzindikira kumachitika pambuyo pa maphunziro angapo ndikuwunika kwathunthu pazotsatira. Chitani izi:

• kuyezetsa magazi koyamba, choyamba, amayang'ana kuchuluka kwa leukocytes, kudziwa ESR - izi ndizomwe zikuwonetsa kukhalapo kapena kusapezeka kwa njira yotupa,
• magazi zamankhwala amuzolengedwa - kuyang'ana mulingo wa michere ya kapamba,
• kuzindikira kwa magawo a amylase pakuwunika mkodzo ndiye chisonyezo chachikulu chotsimikizira kuchuluka kwa kuwonongeka kwa kapamba,
• kutsimikiza kwa undigested CHIKWANGWANI cha wodwalayo - momwe ma enzyme amalowa mu duodenum,
• Ultrasound ndi radiology yam'mimba ziwalo - kuyesa kuchuluka kwa zotupa komanso ngati ziwalo zina zimakhudzidwa ndi njira yothandizira.
• gastroscopy
• bweretsani cholangiopancreatography ndi endoscopic njira,
• kuyeseza zoyeserera zothandiza.

Zofunika! Musataye nthawi ngati mukukayikira kuti pancreatitis yayikulu, kuletsa kufa kwa maselo a kapamba ndi kufa kwina kuchokera ku chifuwa cha pancreatic.

Kodi ndizotheka kufa ndi kapamba - zoona kapena zabodza

Imfa ya kapamba, kapena makamaka kuchokera ku chancreatic necrosis ndiyotheka. Mutha kuziyerekeza m'magawo angapo, omwe amatsatizana:

1. The pachimake mawonekedwe a kapamba mkati mwa masiku ochepa amatha kukula ndipo maselo a pancreatic amayamba kufa.
2. Pali zolinga za necrosis.Imfa yam'mimba imachitika chifukwa chakuti michere ya gland imayamba kugaya maselo awo - izi zimatchedwa pancreatic necrosis.
3. Magawo a gland omwe adawukiridwa ndi ma enzymes awo ndi necrotic.
4. Makoma a matumbo amayaka ndikuwonongeka chifukwa cha ma enzyme, mabakiteriya komanso zomwe sizimapezeka m'matumbo zimayambitsa chilichonse chozungulira.
5. Kutulutsa magazi kumachitika, ndipo m'malo ena magazi, m'malo mwake, amawundana ndikutseka magazi.
6. Kuwonongeka kwa ziwalo zingapo zofunika (chiwindi, impso, matumbo, mapapu) zimawonedwa.
7. Mtima kumangidwa ndi kupuma kumachitika, makamaka mwachangu mwa okalamba odwala, mtima sungathe kuthana ndi katundu.
8. Khungu limakhala lotuwa, milomo imasanduka buluu, ana amasiya kuyankha, kuwala, kutentha kwa thupi ndi kukakamizidwa kumachepera.
9. Pali zomverera pafupi-kufa.
10. Imfa yamatenda ochokera ku kapamba amalembedwa.

Imfa ya pancreatic necrosis ndi pamene michere ya thupi lanu imakumba chilichonse mu njira yawo, ikukhudza chiwalo pambuyo pa chiwalo.

Imfa ya kapamba amatha chifukwa cha izi:

1. Kapangidwe ka minyewa ndi maselo a nduluzo zimasintha modabwitsa.
2. Ndi mapangidwe a foci a necrosis mu kapamba.
3. Ndi yotupa yotakataka ku kapamba ndi kufalikira kwamchiberekero cha maselo.
4. Code imawonjezera kukakamizidwa mu bile ducts ndi ducts ya kapamba.
5. Pamene sphincter ya Oddi imatsekedwa, minofu yomwe imalepheretsa kulowa kwa timadziti ta bile ndi kapamba, ma enzymes ambiri amaponyedwa mu kapamba ndipo maselo ake amafa.

Zindikirani! Choyimira chachikulu chomwe chimatsogolera ku imfa ndi chophimba cha zikondamoyo, komanso kuphatikiza koopsa kwa mowa ndi zakudya zamafuta kamodzi.

Kodi nditha kufa ndi matenda a pancreatic necrosis - ziwerengero

Pafupipafupi imfa kuchokera ku kapamba mu mawonekedwe ake owopsa imapezeka mu gawo limodzi mwa magawo atatu a odwala - ziwerengerozi ndizowopsa. Zotsatira zakupha ndi kachilombo ka pancreatic pancreatic necrosis zimachitika mu 100% ya milandu. Chiwerengero cha anthu omwe amafa ndi matendawa amadzithandiza okha.

Chiwerengero chachikulu cha odwala omwe akukayikira kuti ndi pancreatic pancreatic necrosis amafunikira kuchitapo kanthu mwachangu. Kuthandiza panthawi yake komanso mwaluso kumawonjezera mwayi wowachira. Dokotalayo amachotsa kapena kusokoneza madera a necrosis, koma nthawi zambiri necrosis imafalikira. Pambuyo pakuchita opaleshoni, wodwalayo amaikidwa m'chipinda chothandizira kwambiri ndipo akupitilizidwa kuthandizira, kuti achedwetse kapena kupewa kufa.

Ndi mankhwala osokoneza bongo, maantibayotiki amagwiritsidwa ntchito, kusala kudya kwa masiku angapo kumayikidwa, pochita izi kholo, michere, hemodez, polyglucin. Amayeretsa magazi a poizoni ndi zinthu zowola mwa kuikidwa magazi. Somatostatin adalembedwa - iyi ndi mahomoni omwe amayimitsa kuwonongeka kwa maselo a pancreatic.

Chifukwa chake, kapamba amapha - amatha kutsata wina ndi mnzake ndipo izi ziyenera kukumbukiridwa, makamaka kwa odwala okalamba, muyenera kutsatira zakudya osamwa mowa, ndiye kuti mutha kukulitsa moyo wanu kwazaka zambiri.

Zotupa za Necrotic ndi zizindikiro

Monga mukudziwa, necrosis ya chiwalo ichi imawonekera mchikakamizo cha kapamba. Gawo loyambirira la matendawa limadziwika ndi umphawi wazizindikiro. Mwa zina mwazizindikiro kwambiri m'chipatalachi titha kudziwa kuchepa kwa khungu, kufinya mtima ndi khungu.

Kugundika kumatha kukhala kwabwinobwino kapena kuthamanga pang'ono, kutentha kwa thupi, monga lamulo, sikusintha. Ngati matenda amachitika m'magawo a necrotic, kutentha kumakwera.

Palpation nthawi zambiri imawonetsa kupweteka mu epigastrium ndikufalikira. Poyerekeza ndi maziko a mafuta necrosis, wolowerera amayamba kupanga mwachangu. Itha kumveka m'mimba pamtunda wamkaka, zotulukapo zake zingakhale zosavomerezeka, ndiye kuti, imfa, ndizosiyana.

Matendawa amakula ndikuwonjezereka kwa paresis ndikutulutsa magazi ndi manong'onong'ono ofooka, zonse zomwe zingasonyeze zizindikiro za khansa ya kapamba, zizindikiro pano nthawi zambiri zimakhala zofanana.

Pancreatic necrosis imakwiyitsa mawonekedwe akuwonekera kwa kayendedwe ka kayendedwe ka kutupa, ntchito zamagulu ofunikira zimawonongeka, zomwe zimatsogolera kuwoneka ngati osakwanira, zotsatira zake sizabwino kwambiri. Ndi matenda, zitha kuchitika:

• Mtima
• Kupumira
• Renal
• Hepatic
• Matenda osakwanira m'mimba.

Ziwalo zamkati mwa kupuma zimakhudzidwa, zomwe zimafotokozedwa momwe amaphatikizidwira mu pleural patsekeke ya transudate ndi interstitial pulmonary edema.

Ndi mtima kulephera, hypotension, pafupipafupi zimachitika zamkati, myocardial ischemia, cyanosis pakhungu ndi mucous nembanemba, kuchepa kwa kuchuluka kwa mtima, zizindikilo zonsezi zimasonyeza pancreatic necrosis.

Kuphatikiza apo, odwala omwe ali ndi vuto la m'maganizo pafupipafupi, lomwe limadziwonetsa ngati chisokonezo komanso (kapena) kusangalala kopitilira muyeso. Mosachedwa, magwiridwe antchito a chiwindi amatayika, mwakudzilimbitsa amadziwoneka ngati jaundice.

Zovuta zazikulu za pancreatic necrosis ndizodziwika:

• Hypovolemic mantha,
• Kulephera kwamitundu yambiri
• Pleuropulmonary zovuta,
• Makina a retoperitoneal fiber ndi kapamba,
• Fistula yakunja ndi yamkati,

Peritonitis ndi magazi amkati okhala ndi zizindikiro zosiyanasiyana. Peritonitis imachitika chifukwa cha kufalikira kwa chotupa cha parapancreatic pamimba.

Nthawi zambiri, madera a necrosis amayamba kuzunguliridwa, ndiye kuti, atsekedwa ndi kapukusi ka minofu yolumikizana ndi minofu yathanzi. Masewera amatha kukhala ndi zotsukira komanso zotsalira.

Chithandizo cha Pancreatic Necrosis

Chithandizo chophatikiza chimagwiritsidwa ntchito, chomwe chimakhala ndi ntchito zotsatirazi:

• Kupumula
• Kupsinjika kwa procrine pancreatic function,
• Kubwezeretsa kuchuluka kwa magazi,
• Zakudya za makolo
• Chithandizo chowonjezera.

Kuchepetsa ululu, ma analgesics omwe si a narcotic amagwiritsidwa ntchito. Ngati mlandu wayambika, amagwiritsa ntchito mankhwalawa a narcotic, chinthu chachikulu ndikuti zotsatira zake sizikhala mankhwala osokoneza bongo.

Pofuna kupewetsa tinthu timene timatulutsa kunja, kudya kudzera pakamwa sikuphatikizidwa. Maantacid ndi anticholinergics (atropine) amagwiritsidwa ntchito.

Kubwezeretsanso kuchuluka kwa magazi, ndikofunikira kuperekera mayankho a crystalloid ndi colloidal. Ma electrolyte angapo ofunikira amapezeka mu mayankho a crystalloid; awa ndi mankhwala a chlorine, calcium, potaziyamu, ndi sodium.

Mkhalidwe wofunikira pakulandila kwa makolo ndikutsatira zofunika za thupi la munthu. Amagwiritsa ntchito mayankho a amino acid, glucose ndi mapuloteni hydrolysates.

Pancreatic necrosis imangothandizidwa mwachangu ndi kuchotsedwa kwa kapamba. Opaleshoni ikufuna kuchotsa madera a minofu ya necrotic mpaka kuti iwonjezeke. Ngati pali peritonitis, kukhetsa kwa peritoneum kumachitika.

Kuchulukitsa kwa distal gland kumawonetsedwa kuti kwasintha kwambiri. Zikondazo zimachotsedwa kwathunthu pazochitika zonse za necrosis. Kuchita koteroko ndikowopsa, mwina zitha kukhala zowopsa, motero sizichitika ndipo kusokonekera kwa pancreatic kutha kuthandizidwa ndi njira zotetezeka.

Posachedwa, madokotala amakonda kugwiritsa ntchito njira zowonetsetsa kuti akugwira ntchito ndi necrosis komanso zovuta zake, kotero kuti zotsatira zoyipa ndizochitika zakale.

Monga lamulo, ngalande zimayikidwa mu purity patsekeke. Izi zimapangitsa kuthekera kwa kufunitsitsa kwa zomwe zili m'matumbo ndi kuyambitsa kwa antibacterial. Mankhwalawa amalekeredwa bwino, amakhala ndi vuto lochepa ndipo akuwonetsa zovuta zochepa.

Zomwe zimayambitsa matendawa

Kodi necrosis ya pancreatic ndi chiyani? Masiku ano, mapangidwe a pancreatic necrotic amapezeka nthawi zambiri ngati pancreatitis yovuta kwambiri, yomwe imawerengedwa ngati matenda oyipa kwambiri komanso owopsa pamimba.

Nthawi zambiri, kapamba amawononga mphamvu ya kapamba ndipo amayambitsa ziwalo zomwe zapezeka pafupi, zomwe zimakhudzana ndi gawo logaya chakudya. Nthawi zambiri azimayi achichepere amakhudzidwa ndi matendawa.
Kufunika kwa kapamba ndi ntchito yopanga ma enzyme, omwe adamulowetsa mu duodenum 12, amathandizira kutsekeka kwachakudya. Kuphatikiza apo, chifukwa cha zifukwa zingapo, milomo ya chiwalo imatha kuboweka, ndichifukwa chake zofunikira zake zimaphwanyika. Chodabwitsachi chimatchedwa pancreatic necrosis.

Pamene madera a gland awonongeka, necrosis imasungidwa:

Nthawi zambiri, izi zimapangidwa ndipo zimachitika m'magawo atatu.

1. Kupezeka kwa poizoni wa etiology yodziwika bwino, sangathe kupezeka m'magazi a wozunzidwayo.
2. M'matumba a kapamba kapena ziwalo zoyandikana, mafinya amapangika.
3. Pali matenda a purulent otuluka mu minofu, peritoneal minofu ya chiwalo.

Mtundu wonse wamatenda a pancreatic necrosis amawonedwa ngati owopsa kwa wodwala, pamene zotupa zathunthu za England zimachitika ndipo nthawi zonse zimabweretsa imfa.

Gulu la matenda

Mawonekedwe a Necrotic amawerengedwa chifukwa cha zifukwa izi:

• mapangidwe a kutupa ndi mawonekedwe ochulukirapo komanso owoneka bwino,
• chikhalidwe cha matendawa chikukula ndikuopsa,
• mwa mtundu wa zotupa - edema, hemorrhagic, yowononga, yothandiza, yotakasika.

Ndi mtundu wa edematous wamatenda a matendawa, mwayi wochira ukuwonjezeka. Mtunduwu ndiwokongola kwambiri, zotupa za m'matumbo zimatupa, chifukwa chomwe ma microcirculation amasokonezeka ndikuwonjezereka kwa zovuta. Ngati mumasankha ndikuyamba kulandira chithandizo munthawi yake, wodwalayo ali ndi mwayi wokonza.

Matenda a pancreatic necrotic amatha kuchitika mwa aliyense, koma pali gulu lowopsa lomwe limakulitsa mwayi wodwala.

1. Oledzera osatha.
2. Anthu omwe akudwala cholelithiasis.
3. Achidwi.
4. Odwala ndi matenda a chiwindi, kapamba,
5. Odwala omwe ali ndi vuto lobadwa nawo la m'mimba.

Ngati matenda a pancreatic sanalandiridwe, ma enzymes a chiwalo samapeza ntchito yabwinobwino, amadziunjikira mkati ndikuyamba kuchita zinthu mwankhanza. Kenako peritonitis imayamba yomwe imatha kupha.

Zovuta zamatenda

Kuti mukwaniritse bwino kwambiri pochotsa matendawa, zomwe zimayambitsa matenda oyamba ndi matenda. Malinga ndi ziwerengero, pafupifupi 70% ya omwe ali ndi vutoli amamwa mowa kwambiri. 30% yotsala ya odwala omwe ali ndi cholelithiasis ndi zifukwa zingapo.

1. Kuwerengera cholecystitis.
2. Matenda a matenda opatsirana.
3. Zilonda.
4. Kuzunza.
5. Kudya pafupipafupi zakudya zamafuta.
6. Chithandizo cha opaleshoni ya peritoneum ndi zowawa zake.

Zomwe zimayambitsa ndi zizindikiro za necrosis mwa odwala onse ndizosiyana. Kukula kwa mawonekedwe abwinobwino kungayambitsidwe ndikupanga mankhwala osankhidwa molakwika, omwe amagwiritsidwa ntchito kwa nthawi yayitali.

Matendawa amatha kupitirira pang'onopang'ono, popanda zizindikilo kapena kupita patsogolo mwachangu. Zimatengera mtundu wa kufalikira kwa matenda a pancreatic ndi mtundu wa matenda.

Zofunikira

Zizindikiro za necrosis zimadziwika ndi zizindikiritso kutengera mtundu wamatenda omwe ukupita patsogolo, komanso machitidwe a thupi.

Kuwonetsedwa kwakukulu kwa kapamba ndizovuta zakumwa, zowongolera mosiyanasiyana. Matendawa amakhala ofooka kapena osapilira pomwe ululu sutha.

Pafupifupi 6% ya odwala amamva kupweteka pang'ono, kupweteka kwambiri kumawonekera mu 40%, ndipo kupweteka kosalephera kumachitika mu 50% - mu 1/10% ya odwala omwe anali ndi vuto linalake lomwe limatsatiridwa ndi kuwonongeka.

Komabe, ululu wammbuyo nthawi zambiri umafanana ndi womwe umachitika ndi zowawa mu mtima, chifukwa odwala amasokonezeka ndi matenda amtima.

Kuti muwone pancreatic necrosis, khalani pansi, kokerani miyendo yanu pamimba. Ngati ululu umachepa, izi zikuwonetsa kupezeka kwa mawonekedwe a necrotic.

Kuphatikiza apo, pamene matenda awoneka ululu, necrosis ya kapamba imayendera limodzi ndi zizindikiro:

• nseru
• kusanza kwambiri
• ukufalikira,
• mapangidwe a mpweya
• khungu ndi redness,
• mapangidwe a mawonekedwe abuluu, ofiira mbali zam'mimba,
• kuvulala kwam'mimba pamimba,
• kuchuluka kwa kutentha.

Ndi chifuwa chachikulu, poyizoni amakula, wodziwika ndi kusokonezeka kwa chikumbumtima komanso chikomokere.

Mavuto a necrosis amayimiridwa ndi mawonekedwe awa:

• jaundice
• kuchepa kwa ziwalo zingapo
• gilovolemic mantha,
• fancula kapamba mkati ndi kunja,
• zovuta zamagulu a maphunziro aururopulmonary,
• steatosis
• zilonda
• kutupa kwa peritoneum,
• magazi a mkati mwenimweni.

Zizindikiro

Kodi kutupa kwapancreatic necrotic kungachiritsidwe, ndipo ndikuyembekeza kupulumuka? Musanayambe chithandizo cha gland ndi necrosis, ndikofunikira kukayezetsa, zimatsimikizira kapena kukana kukhalapo kwa matenda amkati mwazinsinsi, kudziwa zomwe zimayambitsa matendawa.

Njira zodziwira matenda

• kuyezetsa magazi komwe, ndi necrosis, ikuwonetsa kuwonjezeka kwa ESR, kuchuluka kwa hematocrit, kusintha kwa kapangidwe ka magazi, tirigu wowuma, chifukwa chakusowa kwa thupi,
• pali kuwonjezeka kwa hydrolytic, puloteni ya puloteni, trypsin m'magazi ndi mkodzo,
• kuchuluka kwa magazi
• kuchuluka kwa calcitonin m'magazi owonongeka kwambiri ndi matenda,
• ndi chotupa, index ya C-reactive yogwira,
• kuchuluka kwa chiwindi michere.

Pancreatic necrosis imapezeka pogwiritsa ntchito luso.

1. Ultrasound
2. Zolemba pamakompyuta
3. X-ray ya ziwalo zoyipa.
4. MRI
5. Kudzudzula kwamadzi pancreas.
6. Zolemba zazingwe za ziwalo.
7. Laparoscopy
8. Kubwezeretsa cholangiopancreatography.

Kuunika kofunikira ndikudziwikanso kwa mitundu ina yotupa ya peritoneum, kuvulala kwamatumbo, kuthamanga kwa magawo aorta mu peritoneum, hepatic colic, kugunda kwamtima.
Mayeso onse kwa wodwala amadziwika malinga ndi chithunzi cha matenda, kuchuluka kwa necrosis, momwe wodwalayo alili.

Ponena za chiyembekezo chodzudzulidwa, ndi necrosis, kuchuluka kwa odwala kumatsika ndi 40-70%, ngakhale chithandizo chikuyambira pa nthawi. Kuphatikiza apo, mwayi wochira umadalira zinthu zingapo.

1. M'badwo.
2. Gawo losasamala la matendawa.
3. Kukhalapo kwa zovuta.
4. Kukula kwa dera lomwe lakhudzidwalo.
5. Kutalika kwa kuyambitsidwa kwa chithandizo, komanso momwe mankhwalawo alili.

Odwala omwe amatha kuthana ndi matenda a zamitsempha, masiku onse otsala a moyo, amatsatira malangizo okhwima a dokotala.

Kuchiza matenda ndi matenda obwera chifukwa cha matenda

Chithandizo cha necrosis chimachitika mu njira ziwiri - mwamphamvu komanso mwamphamvu.

Chithandizo cha Conservative chimagwiritsidwa ntchito pokonzekera opareshoni kapena pamaso penipeni la pancreatic necrosis, yomwe imachitika:

• pakuwonongeka kwa michere
• kuyeretsa thupi la mafuta oopsa omwe amaphatikizidwamo,
• kuthetsa kupweteka
• kupewa mavuto.

Chezani zinthu zingapo:

• ku kulowetsedwa - njira zamchere zimatsanulira m'mitsempha,
• kugwiritsa ntchito ma analgesics, novocaine blockades, mankhwala omwe amachepetsa spasms,
• kumwa mankhwala a antibacterial,
• antihistamines
• symptomatic mankhwala.

Kuphatikiza apo, wogwiridwayo amafunikira mtendere wathunthu wa mumtima. Zakudya zam'mimba zimaperekedwa kwa wodwala ndi dontho ndipo akamagwiritsa ntchito regimen inayake, yomwe imakhala ndi kugunda kwa masiku angapo komanso kusakhalapo kwa nkhawa pamlingo wakuthupi.

Mankhwala othandizira opaleshoni amachitika pafupifupi nthawi zonse kubwezeretsa kutuluka kwa chimbudzi cham'mimba ndi bile, kuchotsa minofu yakufa ndi zomwe zili mkati.

Njira zopangira opaleshoni zimakhala ndi izi:

• laparotomy
• laparoscopy
• punction ya peritoneum.

Chithandizo cha necrosis chimachitika pokhapokha povomerezeka, wodwalayo amafunikira chisamaliro cha madokotala osiyanasiyana, ndipo nthawi zina amasintha.

Mkhalidwe waukulu pakasinthidwe ndikutsatira kudya mosamalitsa. Zakudya zopatsa thanzi zimatanthauzira izi:

• idyani kangapo kakang'ono m'magawo ang'onoang'ono,
• osamadya kwambiri,
• Idyani zakudya zophika ndi zotentha,
• zogulitsa sizitentha, osati kuzizira,
• pogaya chakudya, pera,
• lekani mowa.

Zakudya ndizofunikira mpaka kuchotsedwa kwakukhazikika. Mutha kuyambitsa mbale zatsopano mutatha kufunsa dokotala.
Chithandizo cha matendawa chitha kuchitika ndi njira zina, ngati sizinakwaniritse kuti zitheke m'njira zazikulu. Izi zikhale maphikidwe a mankhwala a infusions, decoctions. Mungathenso kudya mtedza ndi uchi, nyama yophika, maapulo ophika, zakudya, mafuta amphaka, chimanga, maimamu.

Zimakhala zovuta kunena za pang'onopang'ono kwa pancreatic necrosis atalandira chithandizo cha opaleshoni, chifukwa zotsatira za matenda zimadalira zifukwa zingapo. Zotsatira zowopsa m'mayendedwe osakhala akulu komanso owonda ndi 50%.

Kuthekera kwaimfa kumawonjezeka ngati:

• wodwala wopitilira 50,
• mgonero wa insulin ndi wokwera kuposa wabwinobwino,
• kuchuluka kwa calcium
• kusokoneza acid alkaline bwino,
• kuthamanga kwa magazi
• pali kutupa kwakukulu ndi kutuluka kwa magazi mkati.

Zizindikiro zonsezi pamodzi zimapereka malingaliro osasangalatsa a 100%.

Kudzipatsa nokha mankhwala, akapezeka ndi pancreatic necrosis, sikoyenera. Ngati zizindikilo zikuwoneka, muyenera kufunsa chithandizo kuchipatala, izi zitha kupewa kupititsa patsogolo kwa vutoli.