Gastroenterologist - RO

Zaka makumi atatu zapitazo, mu nthawi yoyamba ya chitukuko ziphunzitso za pancreatitis pachimake, chithandizo chake chinali chogwira ntchito kwambiri, chifukwa nthawi imeneyo mitundu yoopsa yokha ya matenda idadziwika. Izi zikufotokozera kuchuluka kwakukulu kwaimfa, mpaka 50-60%. Momwe matendawa adakulira, mitundu yocheperako ya kapamba idayamba kupezeka. Kuwona kuti chithandizo chosasamala cha mitundu yotere yamatenda imapereka zotsatira zabwino, madokotala ena adayamba kugwiritsa ntchito njirayi pakuwononga kapamba, yemwe sanachedwetse kuwonongeka kwa zotsatira za chithandizo.

Zinadziwika kuti zochizira komanso opaleshoni sangapikisane wina ndi mnzake kuti ayenera kugwiritsidwa ntchito pazisonyezo zina. Ngakhale vutoli silikukayikira, palibenso lingaliro lofanana pa chithandizo cha kapamba pakali pano. Pamodzi ndi othandizira njira yochiritsira yokhazikika, pali masukulu angapo omwe amawonetsera opaleshoni. Popeza odwala ambiri omwe ali ndi pancreatitis yovuta kwambiri amathandizidwa mosamala, tizingokhala njira yoyamba.

Monga ndi ntchito, komanso ndi njira yodziyimira yolumikizira mitundu ya mankhwala kulibe. Pali zolinga zokhazokha: 1) nkhondo yolimbana ndi nkhawa komanso kuledzera, 2) kulimbana ndi zowawa, 3) kupewa kwina kwa matenda a m'magazi, 4) kupewa matenda.

Palibe chifukwa chotsimikizira kuti kulimbana ndi mantha ndichofunika kwambiri. Mfundo zakukonzekera njira zothana ndi mankhwalawa sizosiyana ndi zomwe ambiri amavomereza. Popeza ululu ndiye chimwala cha chitukuko chake, njira zoyambirira ziyenera kukhazikitsidwa kuti zithetse izi. Tsoka ilo, sizotheka kuchita izi nthawi zonse. Nthawi zina, ndi pancreatitis yovuta, kupweteka sikumatsitsidwa ndi analgesics, ngakhale morphine. Komanso, nthawi zina pambuyo morphine amatha kulimba.

Izi ndichifukwa morphine amachititsa kuphipha kwa OddiZotsatira zake zomwe kutuluka kwa msuzi wa pancreatic kumasokonezekanso. Kuphatikiza apo, morphine imatha kuyambitsa kusanza, pomwe kukakamiza kwa dongosolo la duct la bile kumakulitsa, zomwe zimathandizira kuponyera kwa bile mu ma pancreatic ducts ndi kutsegula kwa ma enzyme. Chifukwa chake, olemba ambiri salimbikitsa morphine mu pancreatitis pachimake. Mochulukirapo, amatha kugwiritsidwa ntchito limodzi ndi atropine, yomwe imachotsa vagotropic mphamvu ya morphine. Kuphatikiza apo, atropine imalepheretsa katulutsidwe wakunja kwa kapamba ndipo imapangitsa kupumula kwa minofu yosalala. Papaverine amakhalanso ndi mankhwala a antispasmodic, omwe mwanjira izi amakonzedwa mu njira ya 1% yankho la jakisoni ndipo amalumikizidwa mosakakamiza kapena mu mnofu mu 1-3 ml.

Pofuna kuchepetsa kupweteka ikani yankho la 1-2% ya promedol, 1-2 ml pambuyo pa maola 4-6. Nthawi zina, kugwiritsa ntchito kellin, aminophylline, nitroglycerin kumapereka zotsatira zabwino. Mobwerezabwereza makonzedwe a nitroglycerin amatsutsana milandu hypotension ndikuwopseza kudandaula.

Monga ife, ndi mu pachimake kapamba yogwiritsidwa ntchito pawiri paranephral novocaine blockade malinga ndi Vishnevsky (0.25% yankho la novocaine, 100-150 ml). Olemba ambiri amati pambuyo pake, makamaka ndi mitundu ya edematous, mphamvu zowawa zimacheperachepera, kusanza kumayimitsidwa, matumbo a m'mimba amathetsedwa.

M'malo perirenal blockade olemba ena (G. G. Karavanov, 1958) agwiritsa ntchito bwino single- kapena mayiko awiri agosympathetic blockade. V. Ya. Braitsev (1962) amagwiritsa ntchito vagosympathetic blockade osati othandizira, komanso ofunika kuzindikira. Malingaliro ake, kusowa kwa njira yochiritsira kuchokera ku kugwiritsidwa ntchito kwake pamaso pa zizindikiro za kukwiya kwa peritoneal kukuwonetsa kuwonongeka kwa kapamba. Ndi madigiri osiyanasiyana opambana, madokotala ena ochita opaleshoni amagwiritsa ntchito para- ndi prevertebral blockades pa D5-D12 level.
B. A. Petrov ndi S. V. Lobachev (1956) analimbikitsa kugwiritsa ntchito yankho la 0,5% ya novocaine 20-30 ml kudzera m'mitsempha kuti muchepetse ululu pancreatitis yayikulu.

Kuchiritsa kwabwino ndi edema ya gland 3. A. Topchiashvili (1958), N. E. Burov (1962) adalandira kuchokera ku x-ray therapy.
Zatsopano njira zamankhwala kapamba pachimake adawonekera pambuyo pa Werle, Meier u. Ringelmann adapeza trypsin inactivator mu 1952. Pazifukwa zochizira, adagwiritsidwa ntchito kachipatala koyamba mu 1953 ndi Frey.

Zomwe zikugwiritsidwa minofu ya nyama, mankhwala trasilol, yomwe imayendetsedwa kudzera m'magawo a 25,000-75,000. Malinga ndi kuchuluka kwa A. A. Belyaev ndi M. N. Babichev (1964), omwe adayesa mankhwalawa pa odwala 40, ndi othandiza pakanthawi kogwiritsidwa ntchito koyambirira, njira zoyipa zisanachitike.

Pofuna kupewa kupitirira chitukuko cha zowonongeka mu chitsulo, kulengedwa kwa kupuma kwakuthupi ndikofunikira kwambiri. Pachifukwachi, madokotala ambiri opanga opaleshoni amalamula odwala mkati mwa masiku 3-4 kupewa kudya zakudya ndi zakumwa - njala yonse. Popeza kuti kudzipatula kwamankhwala kwa kapamba ndi chiwindi ndikotheka, ena amatulutsa nthawi ndi nthawi, ena amatulutsa chokwanira cha m'mimba ndi vuto.

Pa kuyenera kwa izi zochitika ndizovuta kuti tiziweruza, popeza sizigwiritsidwa ntchito kuchipatala chathu. M'malo mwake, pakusanza, timamwa zakumwa zambiri zamchere - borzh kapena koloko. Izi zimathandizira odwala ludzu lalikulu, kuthetsa madzi akusowa. Sitinawone kuwonongeka kwa chikhalidwe chonse komanso kupezeka kwa zovuta zilizonse zokhudzana ndi kukhazikitsidwa kwa zakumwa zamchere.

Woopsa, wokhala ndi zizindikiro zoopsa kusowa kwamadzi ndi kuledzera, timapereka njira yowonjezera yolowerera kapena kulowetsedwa kwa mchere wa thupi, 5% shuga wokhala ndi insulin (mayunitsi 8-10) mpaka malita atatu patsiku, ngakhale G. Majdrakov ndi ena akutsutsa kuyambitsa kwa shuga.
Ngati hypocalcemia zotchulidwa kudzera m'mitsempha 10% yankho la gluconate kapena calcium chloride (10-20 ml).

Pambuyo masiku atatu akusala kudya Odwala amalephera kupatula chakudya chamagulu (zakudya, zakudya, mkaka wopanda mkaka, mkaka wa skim) woletsa mafuta ndi mapuloteni. Zakudya zophika ndi mafuta a nyama zimalimbikitsidwa kuti zikhazikitse nthawi yayitali.

Kuphatikiza pa zochitika zambiri izi, pachimake kapamba Mankhwala opha maantibayotiki ndi mankhwala: penicillin, streptomycin, tetracycline, colimycin, ndi zina. Pogwiritsa ntchito nthawi yayitali pofuna kupewa candidiasis, ndibwino kuti mupereke nystatin (mutha kuwonetsa streptystatin).

Zochizira pancreatitis

Chithandizo cha Conservative chimaphatikizapo mfundo ya blockade mothandizidwa ndi analgesics:

Ma antispasmodics amphamvu amagwiranso ntchito:

Mankhwala oyamba ndikofunikira kwambiri pakuchotsa kupweteka kwambiri mu kapamba. Kuphatikiza apo, madokotala amakumana ndi mankhwala ochepetsa nkhawa ngati zowawa zimayamba msanga.

Njira yodzikakamira ilibe dongosolo loyenera kuchitira, ndipo njira zochizira zilizonse zimachokera pazomwe zikuwonetsa matenda a wodwala aliyense. Chithandizo chitha kusiyanasiyana mwa anthu omwe ali ndi vuto la mtima, komanso khansa ndi matenda ashuga. Zikatero, Mlingo wa mankhwalawa umasinthidwa malinga ndi mawonekedwe a kusanthula.

Kuphatikiza pakuchepetsa ululu, jakisoni amafunikira omwe amachotsa poizoni ndikukhazikitsa zovuta za metabolic. Nthawi zambiri, mankhwalawa ndi:

Kuphatikiza ndi mchere, wodwalayo amapatsidwa jakisoni wambiri masiku onse a mankhwalawa.

Kuphatikiza apo, blockade ya pancreatitis imachitika pakumwa mankhwalawa ndi njala komanso kudya madzi amchere (Borjomi). Kupuma kokwanira kwa wodwala ndikofunikira.

Kuphatikiza apo, malinga ndi momwe wodwalayo alili, mankhwala omwe amathandizira ziwiya za kapamba, chiwindi ndi impso zimayikidwa. Izi ndizofunikira, chifukwa chithandizo chilichonse chokhala ndi maantibayotiki amphamvu chimatha kusokoneza ziwalo ndikupangitsa zovuta mu mawonekedwe a kulephera kwa impso.

Njira yodziyimira imalepheretsa matenda kuyambika, omwe pambuyo pake amatha kukhala matenda a kapamba.

Njirayi ilipo kuti ikwaniritse mu chipatala chilichonse, koma imafunikira kukonzekera koyambirira.

Pancreatitis pachimake: Chithandizo cha Opaleshoni

Ngati zovuta zinabuka panthawi ya chithandizo chamankhwala, peritonitis kapena chithandizo chotere sichinabweretse zotsatira zomwe mukufuna. Zikatero, opaleshoni imagwiritsidwa ntchito. Pogwiritsa ntchito laparoscopy, mutha:

• kuwononga gwero la peritonitis,
• kukhazikitsa ntchito ya michere mu kapamba,
• sinthani mavutowo mwachangu.

Mankhwala othandizira opaleshoni ndi laparoscopy imachitika m'magawo awiri:

1. Diagnosis, yomwe imasankha mawonekedwe a kapamba, imakhala chithunzi chatsatanetsatane cha madera omwe akhudzidwa.
2. Khalidwe la intraperitoneal perfusion.

Laparoscopy ya kapamba ndiyofunikira kwambiri pakuwazindikira, chifukwa imakupatsani mwayi wodziwa pancreatic necrosis, womwe umawonetsa chidwi cha malo opaka amafuta. Amatha kukhala pamatumbo a adipose, kuwonongeka kwa m'mimba, komanso malo okhudza matumbo aang'ono. Madera onse ang'onoang'onowa amakhudza kwambiri mankhwalawa, ndipo ngati sapezeka pa nthawi yake, amatha kuchuluka msanga.

Mothandizidwa ndi dongosolo la kukoka kwa madzi, lomwe limalumikizidwa ku ngalande yamkati ndi m'chiuno chaching'ono, timachubu apadera timachotsedwa omwe amawongolera yankho lapadera pamkati mwamkati mwa m'mimba. Nthawi zambiri yankho lochokera pa trasilal ndi contractil mu chiwerengero cha 10: 1.
Kwa wodwala aliyense, nthawi ya perfusion imatsimikiziridwa payekhapayekha ndikuyimitsa pomwe mtundu wamadzimadzi wotuluka umakhala mtundu wovomerezeka ndikuwunikira kwa enzyme kusintha. Ngati kulibe mawonekedwe amtundu wa purosesa ndipo utoto ndi wonyezimira, ndiye kuti pali chizindikiritso chodziwikiratu.

Ngati pakuchitika kusefukira kwa peritonitis ndi zovuta, kupopera kumachitika pogwiritsa ntchito ngalande zakunja kudzera mu dac thoracic. Chithandizo chotere sichichitika kawirikawiri, ndipo pokhapokha pamene wodwala ali pachiwopsezo, komanso pokhapokha ngati wodwalayo ali ndi vuto.

Kuchitapo kanthu kwa opaleshoni kumafunika kwa odwala omwe ali ndi pancreatitis nthawi yayitali kuti achepetse matenda omwe angachitike komanso kupewa kupezeka kwawo.

Mukamachita opaleshoni yamankhwala othandizira pancreatitis, ndiyenera kuyang'anira kwambiri kupuma, popeza kuchuluka kwa mpweya m'magazi kumachepetsedwa, njira zina zofunika zimafunikira. Ngati palibe mpweya wokwanira wa okosijeni, wodwalayo amatha kulumikizidwa ndi makina owongolera mpweya. Izi zitha kubweretsanso mavuto ku mankhwala a kapamba.

Kutengera ndi zotsatira za mankhwalawa, odwala ena, ngakhale atachitidwa opareshoni, amatha kukhala ndi matenda osokoneza bongo, zotupa zosiyanasiyana, kapamba nthawi zambiri amapanga cyst yabodza, ndipo kufa mwa 4% ya odwala ndikotheka.

Acute pancreatitis akufotokozedwa mu kanema munkhaniyi.