Pachimake othandizira pancreatic pancreatic necrosis

Necrotic pancreatitis (pancreatic necrosis) ndi amodzi mwa mitundu yoopsa kwambiri ya kapamba, chimadziwika chifukwa cha kutupa kapena kuvulala kwa kapamba, maselo ake amawonongedwa ndikutulutsidwa kwa michere yayikulu yogwira ntchito kwambiri komanso kuledzera kwambiri. Njira yamatendawa imakhala yowononga ndipo nthawi zambiri (mu 20-80% ya milandu) imatsogolera kuimfa, yomwe imalumikizidwa ndi kukhudzidwa kwa ziwalo zonse zofunika komanso machitidwe amthupi m'thupi. Matendawa nthawi zambiri amakhudza anthu azaka zogwira ntchito.

Zomwe zimayambitsa matendawa

1. Chofunikira kwambiri - matenda a ndulu ndi "blockage" yokhala ndi mwala wamba wamba duct, nthawi zambiri imakhala chifukwa cha pancreatic necrosis.
2. Zomwe zimayambitsa ndi zinthu zonse zomwe zimayambitsa kukulitsa kwa pancreatic juwisi (kuledzera kosalekeza, kugwiritsa ntchito mafuta osokoneza bongo ndi ena).
3. Okakamizidwa mitundu ya zilonda zam'mimba kapena zilonda zam'mimba.
4. Mavuto ozungulira m'matumbo a duodenum ndi kapamba (atherosulinosis, mtima stenosis, omwe ali ndi vuto lakudzidzimuka popanda kuvulala mwachindunji chifukwa chakuchepetsa mphamvu ya m'mimba m'mimba.
5. Zowopsa minofu ya England, pambuyo pake pali kuthekera kwakukulu kwa necrotic pancreatitis ndi kufa kwa wodwala.
6. Ntchito pa ziwalo zam'mimba kapena ma pancreatic ducts (opaleshoni kapena endoscopic).
7. Kuwonekera kwa poizoni kapena matenda.

Chinsinsi cha kukula kwa njira ya necrotic yafupika kuti chiwonjezeke chambiri cha madzi ndi kapamba, kuchuluka kwakuchuluka kwa njira yodutsitsa ndi njira zapakhosi, ischemia ya tiziwalo tamatumbo ndi chiwonongeko cha maselo a ziwalo ndi kutuluka kwa ma enzymes m'mimba ndi pambuyo pake kwambiri peritonitis (kutupa kwa peritoneum) ndi matenda.

Matenda ndi machitidwe monga cystic fibrosis, pakati, kusokonekera kwa electrolyte wamagazi ndi timadzimadzi tauchidakwa, matenda amchiwindi osachiritsika, njira zosagwirizana ndi kapamba, kapangidwe ka matupi athu amakonzedweratu ndi chitukuko cha pancreatic necrosis.

Njira zopukusa mu gland

Pachimake purulent pancreatitis ndi matenda oopsa, omwe amakhala limodzi ndi kupweteka kwam'mimba, komanso kuwonjezera kwa matenda. Thupi la wodwalayo siliyenera kuthana ndi vuto la poizoni, komanso tizilombo tating'onoting'ono tating'onoting'ono. Zomwe zimawoneka ndi matendawa:

• chizindikiro chachikulu cha matendawa ndi kupweteka kwa epigastric. Ikhoza kukhala ngati lamba. Ululu umayenda ndi mantha komanso kuwonongeka.
• Kuukira kumayamba ndi nseru komanso kusanza kosaletseka. Kutsanulira kwam'mimba nthawi zambiri sikubweretsa mpumulo,
• purulent pancreatitis imayendera limodzi ndi zizindikiro za kuledzera, amayamba kuonekera patatha maola 6-12 kuchokera pamene matendawa adayamba.
• wodwala akudwala malungo, manambala afika 40 ° C,
• zimachitika nthawi zambiri zimakhala pafupipafupi, zowoneka ngati ulusi,
• kupanikizika kwachepetsedwa.

Maonekedwe a wodwala akuwonetsa kuopsa kwa vutolo. Asanazindikiridwe, odwala amagonekedwa m'chipinda cha odwala osamala kwambiri.

Pancreatitis ya purulent imayamba motsutsana ndi maziko a kumwa kwambiri komanso kugwiritsa ntchito mafuta osokoneza bongo. Komabe, chizolowezi cha matendawa sichimapereka matenda tsiku loyamba. Payenera kukhala zochitika zina zoyipa izi. Pancreatitis wa purulent ukhoza kukhala kumbuyo kwa:

• Matenda a bile ducts (cholangitis),
• kuvulala, makamaka kulowa,
• mankhwalawa
• kupindika kwa Oddi kukomoka,
• matenda opatsirana.

Kodi necrosis imawoneka bwanji?

Njira yotsatira yayikulu ndi pancreatic necrosis. Uku ndikuzindikira kwa akatswiri a zamankhwala komanso ma morphologists. Madokotala sagwiritsa ntchito mawuwa kuti apeze matenda. Izi ndichifukwa choti ndizovuta kuphunzira mwatsatanetsatane kuti ndi gawo liti la kapamba amene adamwalira. Mu gawo lino la nkhaniyi, tikufotokozerani momwe matendawa amakulira, komanso zovuta zomwe zingakhalepo zitatha izi.

Zoyambitsa zakunja ndi zamkati zimayambitsa kupendekeka kwa kupindika kwa duct wamba wa bile, komwe kumapereka chinsinsi mu kuwala kwa duodenum. Madzimadzi satha kupeza njira yotuluka, ndipo sangathe kubwerera kubuluni. Njira yokhayo kwa iye ndi kapamba wa kapamba. Ikalowa kumeneko, imayendetsa ma enzyme omwe amapezeka mkati mwa maselo. Kupitilira apo, ma enzyme osweka mafuta amathandizira. Zimawononga nembanemba, zimapangitsa cytolysis. Pambuyo pakubwera kutembenukira kwa ma protein. Nthawi zambiri, ma enzymes amenewa amapukusa mapuloteni. Koma pakadwala, minyewa ya kapamba imakonzedwa. Pancreatic necrosis imachitika mpaka ntchito ya michere itachepa. Imathanso kukhudza madera ang'onoang'ono a kapamba, ndipo ikhoza kuyambitsa kufa kwa chiwalo chonse. Monga lamulo, chachikulu pancreatic necrosis imapha.

Pancreatic necrosis imatha kukhala yosabala. Pankhaniyi, kuphatikiza ma enzyme ndi chosakanizira cha minofu, palibe chomwe chimapezeka patsamba lomwe likumwaliralo. Mavuto akulu amawonekera pamene pancreatic necrosis yatenga kachilombo. Matenda a bacteria pamilandu iyi ndi ovuta kwambiri. Nthawi zambiri, mavuto ngati amenewa amafuna opaleshoni yodzidzimutsa.

Kuphatikiza apo, mafuta pancreatic necrosis amatha kusiyanitsidwa. Imayenda pang'onopang'ono ndipo imakhudza zigawo zonse za kapamba. Palinso hemorrhagic pancreatic necrosis, limodzi ndi njira yofulumira, kukoka kwa minofu ya chiwalo ndikuwonongeka kwa khoma lamitsempha.

Zizindikiro zomwe zimayambitsa pancreatic necrosis ndizofanana ndi kuukira kwa pachimake kapamba. Komabe, mkhalidwe wa odwalawo ndiwowonjezereka. Malo amtundu wa cyanotic amawonjezeredwa kuwonekera kwakanthawi kachipatala, komwe kumatha kuwonekera pamimba, pakupangika kwa kapamba, kuzungulira navel.

Komanso, pancreatic necrosis ya gland imayambitsa zovuta zotsatirazi:

• kupukusa chakudya (ma enzymus sanatulutsidwe muyezo wake, popeza kuchuluka kwa ma cell a khungu kumachepa),
• kusalingani kwa mahomoni (osangokhala exocrine komanso zigawo za endocrine zimafa, zomwe nthawi zambiri zimawonetsedwa ndi matenda a shuga),
• yachiwiri purulent zovuta (tikambirana za puranc pancreatitis ndi mitundu yake pansipa).

Kutupa kwamphamvu

Mavuto opatsirana a sekondale pambuyo kutupa kwa kapamba amapezeka mu 5-10% ya odwala. Kuwona kwawo kumawonjezeka kwa odwala omwe adachitidwa chipwirikiti. Muyeneranso kuganizira momwe thupi limakhudzidwira komanso ntchito yoyambirira, zomwe zimangokulitsa chiopsezo cha kusabala.

Gwero lalikulu la matenda a pancreatic minofu ndi matumbo. Tizilombo tomwe timakhala m'matumbo timadutsa khoma ndipo timalowamo. Pamenepo, makonzedwe abwino owapangira adawapangira: ma enzyme ali kale osagwira, detritus imatsalira m'matumba (minofu yowonongeka pang'ono), kuyankha kotsika kumachepa.

Madokotala amasiyanitsa mitundu ingapo ya puranc pancreatitis:

• kachilombo ka kapamba kachilombo (chotupa chapakhungu palokha komanso minofu yoyandikana),
• pancreatic abscess (purulent process is limited to the capsule),
• chotupa.

Mavuto apakati a bakiteriya atatha kutupa kwa kapamba kumabweretsa kufa kwakukulu kwa odwala. Odwala amafa chifukwa cha sepsis komanso mantha. Amapanganso kuperewera kwa ziwalo zofunika: chiwindi, impso, mtima. Imfa pambuyo pa purulent iliyonse yofika 30 30%.

Ndi matenda obwera ndi mabakiteriya, mafinya amapanga minyewa yozungulira tiziwalo tating'ono (omentum, pansi pa chiwindi), zomwe zimayambitsa peritonitis.

Mankhwalawa amangogwira ntchito. Dokotalayo amatsegula zotupazo ndikuwasiya madziwo. Mankhwala othandizira mwamphamvu omwe amapezeka ndi maantibayotiki, ma antienzymes, ndi mankhwala osokoneza bongo. Mankhwala amakono amalola opaleshoni yowononga pang'ono. Kutupa kocheperako kwa kapamba (abscess, cyst) kumatha kubooleredwa kudzera khoma lam'mimba motsogozedwa ndi ultrasound. Mchitidwewo umachitika pansi pa mankhwala oletsa ululu. Dokotala amayika kukhetsa mu ngalande yomwe kudzera mu mankhwalawa patuluka zotuluka. Mavuto obwera pambuyo pa nkhaniyi ndi ochepa.

Mitundu ndi magawo a matendawa

Magawo atatu a necrotic pancreatitis amadziwika:

• gawo la necrosis (chiwonongeko),
• purulent mavuto gawo,
• kuchira gawo.

Kapena malinga ndi olemba ena:

• gawo la enzymatic - masiku atatu oyamba,
• gawo lotakataka - kuyambira masiku 5 mpaka 14,
• gawo lazotsatira - mpaka masabata atatu,
• gawo la zotsatira - mpaka miyezi 6.

Pakutha kwa chiwonongeko cha gland, mitundu itatu ya pancreatic necrosis ikhoza kuzindikirika: yoyang'ana (malo ochepa owonongeka), subtotal (mpaka 70% ya tiziwalo tamadonthayo imakhudzidwa) ndikukula kwathunthu (zonse zotulutsa zimawonongeka).

Ndi mtundu wa necrosis, mafuta (mawonekedwe opepuka), hemorrhagic, osakanikirana amabisidwa. Choyamba chimadziwika ndi mapangidwe a malo a necrosis amafuta. Chachiwiri ndi kuphatikiza minofu ya chithaphwi ndi chinsinsi cha hemorrhagic. Koma nthawi zambiri mtundu wosakanikirana umayamba.

Chithunzi cha chipatala, zizindikiro za necrotic pancreatitis

Necrotic pancreatitis, monga matenda ena opweteka kwambiri am'mimba, ali ndi zizindikiro zowoneka bwino. Izi ndi:

• kupsa kosalekeza m'mimba, nthawi zambiri chakhazikitso, chikuwonekera kumbuyo, mapewa, mikono, khosi, hypochondrium wamanzere,
• kusanza kopitilira muyeso komwe sikubweretsa mpumulo,
• euphoric mkhalidwe wodwalayo, nkhawa, kuyankhula, kapena, mosasamala, adynamia, ulesi mpaka kuphwanya maziko a poizoni wa pancreatic madzi,
• kusintha kwa khungu kukhala imvi, "nthaka", nthawi zina
• Hyperthermic zimachitika thupi kuledzera - mpaka 39 madigiri,
• kuthekera kwachifuwa ndi mpweya, kusungika,
• Mukapimidwa, m'mimba mumakhala zotupa komanso zowawa kumtunda, palinso kusokonezeka kwa minofu, khungu la m'mimba, mawanga amtundu wofiirira, thupi, kufalikira kwa pafupi ndi msomali nthawi zambiri kumawonedwa,
• mbali yamtima, kugunda kwadzidzidzi kapena kosakwiya msanga, kuthamanga kwa magazi, kusintha kofanana ndi kuphwanya kwa mtima kumapezeka,
• kumva chiwindi kupweteka, kukulitsidwa,
• pancreatic necrosis imathandizira kuwonongeka kwa impso, pachimake aimpso kulephera, matumbo, kutsekeka, peritonitis, magazi, kuchuluka kwa madzimadzi m'matumbo.

Mavuto omwe angakhalepo akuphatikizapo kutuluka kwa m'mimba kuchokera kumitsempha yamagazi yowonongeka ndi ma enzymes, cysts, fistulas ndi abscesses ya kapamba, retroperitoneal phlegmon, gastric ndi 12 duodenal zilonda zam'mimba, peritonitis, ndi thrombosis yam'mimba yayikulu m'mimba. Kuchokera kwa omwe ali kutali - matenda a shuga, kuperewera kwa enzymatic, chifuwa chachikulu chokhala ndi chotupa cha fibrosis.

Kuzindikira ndi chithandizo

Zomwe zimawonetsedwa kwambiri ndi kuyesedwa kwa magazi ndi mkodzo kuti mupeze kuchuluka kwa alpha-amylase, omwe adzachulukane kuyambira maora oyamba a matendawa, koma osagwirizana ndi kuuma kwa njirayi. Kuwerengeka kwathunthu kwamwazi kumawonetsa kuchepa kwa magazi, leukocytosis, ndi kukweza ESR. Pakufufuza kwamitundu yosiyanasiyana, ma enzymes AST, ALT, ndi glucose azichulukitsa.

Ultrasound ya kapamba imakhala yothandiza kwambiri ndipo mu 97% ya milandu imathandizira kuzindikira koyenera. Mu phunziroli, dokotala wofufuzira azindikiritsa mawonekedwe, ma contour, kukula kwa tinthu timene timayang'ana ndi ma necrosis, cysts ndi abscesses, kuchuluka kwa kuphatikizira kwam'mimba ndi chifuwa, kupezeka kwa miyala mu duct ya bile ndi dancts, kupindika kwa ziwalo zapafupi, komanso kukula kwa chotupa.

FEGDS, CT ya kapamba imayikidwa, nthawi zina mayeso a MRI, X-ray ya m'mimba ndi chifuwa (kupatula matumbo kutsekeka), angiography amachitidwa.

Pazifukwa zofufuza komanso zotsatira zamankhwala, laparoscopy ikhoza kugwiritsidwa ntchito. Amakulolani kuti mudziwe mtundu wa necrosis ndi njira zamankhwala othandizira, komanso kuyeretsa kumimba kwam'mimba (chotsani madera akufa), kukhetsa matumba, malo omwe kuphatikizika kumachitika, ikani cholecystostomy ngati pakufunika kapena kuyambitsa ngalande mu choledoch, khalani okondwerera ndi chikhalidwe komanso kutsimikiza kwa mtundu wa amylase, lotseguka ndi chotsa chotupa.

Miyala ikayikidwa mu bile duct wamba, ERCP (endoscopic retro-pancreatocholangiography), PST (papillosphincterotomy) ndi lithotripsy (kuwerengetsa chiwonongeko), mwa kuyankhula kwina, kupenda kwa miyala yayikulu ya duodenal, kugawa kwake, kuphwanya ndi kuchotsa miyala yomwe imalepheretsa kutuluka kwa bile, imathandizira pakuzindikira komanso kuchiza. msuzi.

Njira zochizira:

• Mankhwala othandizira opaleshoni yokhala ndi laparoscopic kapena njira yotseguka,
• chachikulu mankhwala opha maantibayotiki ndi analgesia, antispasmodics,
• kulowetsedwa mankhwala ofuna kubwezeretsa kuchuluka kwa magazi,
• kugwiritsa ntchito mankhwala omwe amalepheretsa kupanga michere ya pancreatic,
• njira zosiyanasiyana zochotsetserekera (hemosorption, plasmapheresis).

Matenda a necrotic pancreatitis ndi akulu kwambiri. Ndi matendawa, kuyesayesa kwakukulu kwa madokotala ndi ogwira ntchito kuchipatala kuyenera kupulumutsa moyo wa wodwalayo ndikuchepetsa kulumala. Nthawi yofunsidwa kuchipatala pankhaniyi ili ndi gawo lalikulu.

Ivanova Irina Nikolaevna

Kodi tsambalo linali lothandiza? Gawani patsamba lanu lochezera!

Kodi necrotic pancreatitis ndi chiyani?

Necrotic pancreatitis imachitika pamene kapamba amwalira chifukwa cha kutupa. Ndi necrotic pancreatitis, mabakiteriya amatha kufalikira ndikuyambitsa matenda.

Chikondamoyo ndi chiwalo chomwe chimapanga ma enzymes omwe amathandizira kugaya chakudya. Zikondazo zikakhala zathanzi, ma enzyme amenewa amapyola njira kudzera m'matumbo ang'onoang'ono.

Ngati kapamba amayamba kuyatsidwa, ma enzymewa amatha kukhalabe m'mapamba ndikuwononga minofu. Izi zimatchedwa pancreatitis.

Ngati kuwonongeka kuli kwakukulu, magazi ndi mpweya sizingafike mbali zina za kapamba, zimapangitsa kufa kwa minofu.

Chikhansa ndiye chinthu chofunikira kwambiri cha munthu, chomwe sichichita. Pazifukwa izi, necrotic pancreatitis imatha kupha.

Chizindikiro chachikulu cha necrotic pancreatitis ndi kupweteka kwam'mimba. Munthu amatha kumva kupweteka m'mimba m'malo angapo, kuphatikiza:

• patsogolo pa m'mimba
• pafupi ndi m'mimba
• kupweteka kumbuyo.

Mavutowa amatha kwambiri ndipo amakhala masiku angapo. Zizindikiro zina zomwe zimatha kutsagana ndi zowawa:

• ukufalikira
• malungo
• nseru
• kusanza
• kusowa kwamadzi
• kuthamanga kwa magazi
• kukoka mwachangu.

Necrotic pancreatitis imatha kubweretsa matenda a bakiteriya ndi sepsis ngati yasiyidwa.

Sepsis ndi momwe thupi limalumikizirana kwambiri ndi mabakiteriya m'magazi, zomwe zingapangitse kuti thupi ligwedezeke.

Sepsis imatha kukhala pangozi chifukwa imachepetsa kutuluka kwa magazi kupita ziwalo zazikulu. Izi zitha kuwavulaza kwakanthawi kapena kwamuyaya. Popanda chithandizo, munthu akhoza kufa.

Necrotic pancreatitis imathanso kuponyera chifuwa.

Necrotic pancreatitis ndi zovuta za pancreatitis pachimake. Kupsinjika kotereku kumayamba pamene pancreatitis yovuta imapanda kuthandizidwa, kapena chithandizo sichitha.

Pancreatitis ndi kutupa kwa kapamba. Zomwe zimayambitsa pancreatitis ambiri ndimamwa kwambiri mowa kapena kukhala ndi ndulu. Miyala ndi miyala yaying'ono yopangidwa ndi cholesterol yomwe imapangika mu ndulu.

Mitundu iwiri yayikulu ya kapamba ndi:

• Pachimake kapamba, momwe zizindikiro zimawonekera mwadzidzidzi. 20 peresenti ya odwala omwe ali ndi pancreatitis pachimake amakumana ndi zovuta, kuphatikizapo necrotic pancreatitis.
• Matenda a kapamba - zizindikiro zimayambiranso. Nthawi zina, itha kuyambitsa necrotic pancreatitis.

Nthawi zambiri, 50 peresenti ya milandu yovuta ya kapamba imayamba chifukwa cha ma gallstones, ndipo 25% imayamba chifukwa cha mowa.

Pancreatitis amathanso chifukwa cha:

• kuwonongeka kwa kapamba
• chotupa mu kapamba,
• calcium yayikulu
• mafuta am'magazi otchedwa triglycerides
• kuwonongeka kwa kapamba,
• autoimmune ndi matenda obadwa nawo omwe amakhudza kapamba, monga cystic fibrosis.

Munthu akakhala ndi kapamba, ma enzymes am'mimba amalowa kapamba. Izi zimapangitsa kuwonongeka kwa minofu ndikulepheretsa magazi ndi mpweya kulowa nawo izi. Popanda mankhwala a kapamba, wodwalayo amatha kufa.

Bacteria imatha kupatsira minofu yakufinya. Kutenga kwa matenda kumayambitsa matenda ena akuluakulu a necrotic pancreatitis.

Chithandizo cha kapamba

Madokotala amatenga necrotic pancreatitis mu magawo awiri. Choyamba, kapamba amathandizidwa. Kachiwiri, gawo la zikondamoyo zomwe zafa zikukonzedwa.

Chithandizo cha pancreatitis chimaphatikizapo:

• jakisoni wa mankhwala
• ma pinkiller
• kupumula
• mankhwala kupewa nseru ndi kusanza,
• kudya
• zakudya kudzera nasogastric chubu.

Chakudya chopatsa thanzi kudzera chubu la nasogastric ndi pamene chakudya chamadzimadzi chimadyetsedwa kudzera chubu pamphuno. Kudyetsa munthu mwanjira imeneyi kumapatsa kapamba kapangidwe kake kapangidwe kazakudya zam'mimba.

Kuchiritsa minofu yakufa kapena yodwala

Gawo lachiwiri la mankhwala a necrotic pancreatitis limayang'ana mbali yakufa ya kapamba. Ndikotheka kuchotsa minofu yakufa. Ngati nthendayo ikakula, mankhwala opatsirana amayenera kuperekedwa.

Kuti achotse minofu yakufinya, dokotala amatha kuyika chubu chopyapyala chotchedwa catheter m'mimba. Minofu yakufa imachotsedwa kudzera mu chubu ichi. Ngati izi sizikugwira ntchito, ntchito yotseguka ingafunike.

Malinga ndi kafukufuku wa 2014, nthawi yabwino kwambiri yochita opareshoni ndi milungu itatu kapena 4 atadutsa matendawa. Komabe, ngati munthu akudwala kwambiri, opaleshoni yochotsa minofu yakufa kapena yotenga matendawa imatha kuchitika kale.

Ngati sepsis imayamba chifukwa cha matenda oyambitsidwa ndi necrotic pancreatitis, ikhoza kukhala pachiwopsezo cha moyo.

Kuchiza matenda oyambukira ndi njira yabwino kwambiri yoletsera sepsis.

Kupewa

Sizotheka nthawi zonse kupewa kapamba ndi zovuta zake. Komabe, amakhala ocheperako ngati kapambayu ali wathanzi.

Njira zotsatirazi zingathandize kukhala ndi thanzi la pancreatic:

• osamwa kwambiri mowa
• kukhala ndi thanzi labwino
• kutsatira zakudya.

Ngati munthu ali ndi vuto lililonse la kapamba, muyenera kuwona dokotala. Chithandizo choyambirira ndi njira yabwino kwambiri yochepetsera chiopsezo cha necrotizing pancreatitis kapena zovuta zina.

Ndikofunikira kuzindikira zizindikiro za necrotizing pancreatitis ndi kukaonana ndi dokotala nthawi yomweyo. Kuzindikira koyenera ndi chithandizo chamankhwala ndi njira yabwino kwambiri yopewera zovuta.

Popanda chithandizo, necrotic pancreatitis imatha kubweretsa matenda kapena sepsis. Izi zitha kubweretsa imfa.

Necrotizing kapamba amachiritsika. Ndi chithandizo choyenera cha panthawi yake, wodwala yemwe adalakwitsa pancreatitis ayenera kuchira kwathunthu.

Kusintha kwamoyo kukonza thanzi la pancreatic ndiyo njira yabwino kwambiri yopewera mavuto ena.

Nkhaniyi imagwiritsa ntchito zinthu kuchokera ku magazini ya Medical News Today.

Zambiri

Purulent pancreatitis ndi matenda oopsa omwe amayamba pamene zinthu zingapo zaubwino zimaphatikizidwa, zomwe zimayambitsa kupukusira kwa puruse yotupa m'matumbo a pancreatic. Pachimake pancreatitis ndi matenda achitatu opaleshoni omwe amafunikira kuchitidwa opaleshoni yodziwika kwambiri pambuyo pake pachimake chilonda ndi cholecystitis.

Mwa mitundu yonse ya zovuta zamatenda a pancreatic, puranc pancreatitis imapezeka mwa khumi aliyense wodwala. Mwambiri, zamatenda zimakhudza 0.02-0.08% ya anthu padziko lapansi chaka chilichonse, ambiri mwa odwala ndi amuna. Ngozi ili pachiwopsezo chachikulu chotukuka kwa ziwalo zingapo komanso kufa pambuyo pake ndi matenda osayembekezereka ndikuyamba chithandizo.

Pakupanga kwa puranc pancreatitis, sikokwanira kungofikitsa matendawa pancreatic parenchyma, ndipo kuphatikiza kwa zinthu zingapo zofunikira kumafunikira. Zina mwa zinthu zomwe zikudziwikiratu, ma gastroenterologists komanso opaleshoni yam'mimba ndizophatikizira kumwa mowa wambiri (chidakwa cha pancreatitis), kusuta, zolakwika za zakudya, komanso kugwiritsa ntchito mankhwala osokoneza bongo.

Mbiri yabwino ikhoza kukhala matenda a hepatobiliary system, zomwe zingayambitse kuphwanya kwa mapangidwe am'mimba: cholelithiasis, cholangitis, cysts, stenosis ndi zotupa za bile duct (biliary pancreatitis), kuvulala ndi pancreatic cysts. Poyerekeza ndi momwe mphamvu ya zinthuzi imapangidwira, pali kuwonjezeka kwa kupanikizika kwa ma ducts a bile, omwe amathandizira kubwezeretsanso Reflux ya madzi a pancreatic mu ma pancreatic ducts.

Pathogenesis imakhazikika pamatenda am'mimba komanso kutseguka kwam'mbuyo kwa michere ya pancreatic. Ma enzyme omwe amasungunula minyewa ya pancreatic, zomwe zimayambitsa kutupa. Chifukwa cha kukhazikika kwa khoma laling'ono la ziwalo, zotupa zingapo zimachitika parenchyma (hemorrhagic pancreatitis). Pamaso pakuyang'ana pa matenda osachiritsika (cholecystitis, cholangitis, appendicitis, bakiteriya kapena matenda ofala, ndi zina zotere), mabakiteriya amalowa m'matumbo a minyewa kudzera m'mitsempha ya bile, ndimagazi kapena kudzera m'mitsempha ya m'mimba.

Nthawi zambiri, njira yotupa imayamba ndi mawonekedwe; michere yambiri imapangika kumbuyo kwake, kuphatikizika kumiyendo ikuluikulu ya purulent patapita nthawi. Potsegula zotupa, mafinya amatha kulowa m'mimba ndi m'magazi, zomwe zimayambitsa kufalikira kwa ziwalo zina ndi machitidwe ena. P purreatitis ya purulent, Mosiyana ndi chinyezi cha kapamba, fotokozerani zotupa ndi zambiri za purulent foci ndizodziwika.

Kuyamwa kwa mafinya, zinthu zowola ndi ma pancreatic enzymes m'mitsempha ndi m'mimba zimayambitsa kukhudzana kwakukulu, kusokoneza ntchito kwa ziwalo zofunika zamkati ndipo, chifukwa chake, kufooka kwamitundu yambiri. Ngati puranc pancreatitis isanazindikiridwe tsambali lisanayambike, chithandizo chokwanira cha pathogenetic sichinayambike, kuwonongeka kwa ziwalo zamkati kumatha kusinthika, zomwe zimapangitsa kuti afe.

Zizindikiro za puranc pancreatitis

Kuyambira kumayambiriro kwa matendawa mpaka pakuwoneka chithunzi chowoneka bwino cha kapamba, masiku angapo kapena masabata angapo amatha. Nthawi zambiri chizindikiro choyambirira chachipatala chimakhala pancreatic colic - kupezeka kwa kupweteka kwakumata kwa m'chiuno. Ululu umatulukira kumbuyo, masamba akumapewa, kumbuyo kwa sternum. Kuchulukitsa kwa ululu kumatha kukhala kokulirapo kwambiri kotero kuti nthawi zina kumapangitsa kuti musamaiwale. Nthawi zambiri ululu umatsatiridwa ndi kusanza kosalekeza, komwe sikubweretsa mpumulo kwa wodwalayo, kumachitika ngakhale pakumwa madzi.

Kupumira kumadzetsa kuchuluka kwa kuponderezana kwapamimba, kupangitsa kuti timinyewa ta kapamba timaponyedwe mu kapamba, chifukwa chomwe kupweteka kwambiri pambuyo pakupuma kumawonjezeranso. Wodwala nthawi zambiri amakhala mokakamiza kumbali yake ndikugwada mawondo ake. Chifukwa chophwanya zikondamoyo, zizindikiro za dyspepsia zimayamba: nseru, belching, flatulence, kutsekula m'mimba. Chitsondicho ndi madzi, chili ndi chakudya komanso mafuta osafunikira. Kuphatikizidwa kwa kwambiri dyspeptic, ululu ndi kuledzera syndromes kumabweretsa nkhawa, kulira, ndipo nthawi zina kukulitsa kwa pancreatogenic psychosis.

Ndi kupita patsogolo kwa njirayi, pamakhala kutsekeka kwamatumbo mwamphamvu, komwe kumawonetsedwa ndi kutulutsa kwakukulu, kusanza kwa zinthu zosasunthika. Pa palpation pamimba, kupweteka kwapadera kumadziwika pakati theka; zizindikiro za kupsinjika kwa peritoneal zitha kuwoneka. Malo amtundu wa cyanotic amawonekera pakhungu la khoma lakunja kwam'mimba, kutupira kwa minofu yamafuta m'dera lumbar kumadziwika. Pa magawo oyamba amakula matendawa, kutentha kwa thupi kumakhala kochepa, koma pambuyo poti matendawa atenga nthendayi ndikutsatira, matenda oopsa amadziwika.

Mavuto

Kuwopsa kwa ma pancreatic michere pamafupa amawonetsedwa ndi thrombocytopenia, magazi m'thupi. Zotsatira za purulent fusion ya zikondamoyo ndi ziwalo zoyandikana, fistulas, enzymatic peritonitis, purulent pleurisy, chotengera chachikulu chotenga chingayambitse magazi ambiri, chifukwa cha njira yotupa, thrombosis ndi thrombophlebitis ya porto-caval system. Ndizotheka kupanga mapangidwe a septic pomwe purcin pancreatitis imakhala gawo loyang'ana.

Kuledzera kwambiri kumabweretsa kuwonongeka pamtima - pamakhala kupweteka kwa tachycardia, ochepa hypotension. Mankhwala oopsa a myocarditis amayambitsa kukula kwa kuzungulira kwamphamvu kwa magazi. Zowonongeka m'mapapu zimatha kutsagana ndi kupuma kwamatenda a matenda, kupuma. Kulephera pang'onopang'ono kwa ziwalo zambiri kumatha kubweretsa imfa.

Mayeso a biochemical Sinthani

Pazotsatira, chizindikiro (amylase, transaminases) ndi pathogenetic (lipase, trypsin) zoyesa zamankhwala amodzi zimachitika.

Ntchito ya amylase mkodzo ndi magazi mu chifuwa chachikulu cha pancreatitis imakwera kwambiri.

Kutengera ndi ntchito ya phospholipase A2 mu seramu, kuchuluka kwa matendawa, makamaka, kusokonezeka kwa m'mapapo, kumayesedwa. Mlingo wa pancreatitis yowononga pachaka imawerengeredwa ndi mulingo wa serum ribonuclease (RNAse). Kuwonjezeka kwa alkaline phosphate, transaminase ndi bilirubin ndi njira zodziwirira kuzungulira kwa mtengo wamiyala.

Chithandizo cha purcin pancreatitis

Mankhwalawa amalimbikitsidwa mu opaleshoni yam'mimba kapena dipatimenti yokhazikitsa. Mankhwala osokoneza bongo amafunikira kutsatira mfundo ya "kuzizira, njala ndi mtendere" - ndi iye yemwe amatsimikizira kutsatsa kwazotupa, kugwira ntchito mwamphamvu pochotsa matendawa. Njala yodwala imayambitsa kulepheretsa kupanga kwa ma pancreatic enzymes, kupweteka kwapweteka. Komanso, kuti muchepetse ululu wowonjezereka, tikulimbikitsidwa kuyika chikhodzodzo cha ayezi cham'mimba. Kupuma pogona kumafunikira, popeza odwala ali ndi vuto loledzera.

Mkulu mankhwala kulowetsedwa ikuchitika limodzi ndi anakakamizika diuresis kuchotsa poizoni m'magazi, kuchepetsa kuchuluka kwa michere pancreatic, ndikuchepetsa edema. Kuphatikizidwa kwa kulowetsedwa kwamankhwala kumaphatikizapo zoletsa za michere ya proteinolytic (aprotinin), ndi kuchepa kwa glucose motsutsana ndi maziko a chiwonongeko cha minofu ya pancreatic, magwiritsidwe a shuga owonjezera. Kuwongolera kusokonezeka kwa ma-electrolyte kumafuna kuyambitsa mayankho amchere, calcium, ndi magnesium.

Kupweteka kwambiri ndi puranc pancreatitis kumachitika osati kokha mwa kusungunuka kwa michere ya chiwalo, komanso ndi kukakamiza kwa kapamba wam'mimba ndi kapisozi kake. Ndi cholinga chokongoletsa, antispasmodics, narcotic analgesics ndi mankhwala. Chithandizo choyenera ndikugwiritsa ntchito maantibayotiki. Ndi kupanga ziwalo zambiri kulephera, glucocorticoids, cardiotropic mankhwala, ndi mankhwala ena okonza zofunika mu thupi zimayikidwa.

Kukhalapo kwa njira yotupa yoyipa mu kapamba kumafunika opaleshoni. Malinga ndi zomwe zikuwonetsa, laparoscopic cholecystectomy, kugawa kwa kapisozi kapamba wokhala ndi zotayira kumachitika. Woopsa milandu, ponseponse pakuchitika opaleshoni imagwiritsidwa ntchito - pancreatic necrectomy, kukhetsa kwa m'mimba.

Zotsogola ndi kupewa

Matenda a purulent pancreatitis nthawi zonse amakhala ovuta kwambiri chifukwa cha zovuta zomwe zimatsatana nawo. Ngakhale atachira, odwala oterewa amafunikira kutsatira kwa nthawi yayitali ndi gastroenterologist, chithandizo chachikulu chobwezeretsa. Kupewa kumakhala kukana kwathunthu mowa ndi kusuta fodya, kutsatira zakudya, nthawi yake chithandizo chamankhwala a hepatobiliary system (cholelithiasis, cholecystitis, ndi zina).

Zomwe zimayambitsa puranc pancreatitis

Purangan pancreatitis imatha kukhala ndi zifukwa zingapo. Itha kukhala zonse zobadwa nazo za kapamba, komanso matenda ena otupa am'mimba.

Zomwe zimayambitsa puranc pitisreatitis:

• uchidakwa (uchidakwa komanso woopsa),
• kuledzera osiyanasiyana
• kachiromboka (ma mum, hepatitis B ndi C),
• kachilombo ka bacteria
• cholelithiasis
• matenda am'mimba ndi duodenum (zilonda, gastroduodenitis),
• appendicitis
• kumwa mankhwala omwe amakhudza kapamba: maantibayotiki, ma immunosuppressants, ma estrogens, azathioprine, komanso corticosteroids ndi thiazide diuretics,
• othandizira opaleshoni ndikuvulala kosiyanasiyana kwa kapamba,
• chibadwa.

Kutupa kwachikale kwa kapamba, chifukwa cha zomwe pur puranc pitisreatitis imayambira, malinga ndi lingaliro lalikulu lazachipatala, limayamba chifukwa cha kuwonongeka kwa maselo a chiwalochi ndi ma enzyme omwe adamulowetsa asanakwane. Pogwira ntchito pancreatic yabwinobwino, michere yamagaya imapangidwa mu mawonekedwe awo osagwira. Zimayatsidwa pakudya. Komabe, motsogozedwa ndi zinthu zosiyanasiyana za m'magazi, ma enzyme amatha kutsegulidwa mwachindunji mu kapamba, zomwe zimapangitsa kudzimbidwa kwake. Zotsatira za ndondomekoyi ndi minofu edema, kutupa pachimake, kuwonongeka kwa ziwiya za pancreatic parenchyma, chitukuko cha ma abscesses, i.e. purulent kapamba.

Njira ya pathological nthawi zambiri imafikira ku peritoneum ndi fiberoperitoneal fiber, malupu amkati, ziwalo ndi zina zake. Kusokonezeka kwakukulu mu mawonekedwe a kutupa kwachiwiri mu ziwalo zina ndi kuwonongeka kwa zovuta za dystrophic zimawonedwa.

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Pachimake othandizira kapamba

Pancreatitis ya purulent ingathe kuoneka ngati pachimake - ndimtundu wowopsa kwambiri wamatendawa, womwe umawonedwa kawirikawiri, mwa 10 peresenti yokha ya odwala. Mbali yodziwika bwino ya pancreatitis yovuta kwambiri ndi kupha kwambiri.

Pachimake purulent pancreatitis nthawi zambiri amayamba chifukwa cha mavuto a mitsempha kapena poizoni wa chakudya. Nthawi zina, zomwe zimayambitsa matendawa zinali syphilis, typhoid, kapena mamps. Matendawa amapitirirabe chifukwa cha ululu wowopsa, womwe umapangitsa kuti m'mimba mwake mukhale kupindika, ndipo nthawi zambiri umayambitsa kukhumudwa ndikugwa. Mukuwawidwa kowawa, nkhope ya munthu imayamba kugwa, ndipo zimachitika kuti sizimveka. Kuphatikiza apo, kuukiridwa kumayendera limodzi ndi kutulutsa magazi, nseru komanso kusanza. Pankhaniyi, kusokonezeka kwa minofu yam'mimba kumamveka.

Akatswiri ambiri azachipatala amavomereza kuti chitukuko cha pachimake purulent pancreatitis chimakwiyitsa zinthu zingapo za pathogenic. Kulowa kwa matenda sikuti chifukwa chokhacho, ndikofunikira kukhala ndi malo oyenera: ziwiya zowonongeka, minofu ya glandular, ducts. Kutsegula kwa lipase ndi trypsin kumabweretsa zovuta zamagazi. Zina mwa zinthuzi ndi monga kupweteka m'mimba, kuperewera kwa zakudya m'thupi, ndi kuvulala kwapanyumba.

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Kuzindikira kwa puranc pitisreatitis

Purulent pancreatitis imapezeka ndikuphunzira mu labotale kuyesa magazi (kawirikawiri, mwatsatanetsatane, zamankhwala am'mimba) ndi mkodzo, x-ray, ndipo, ngati pakufunika, maphunziro ena azachipatala. Mulingo wambiri wa leukocytes (leukocytosis), kumasulidwa kwa michere ya pancreatic, makamaka, kuwonjezeka kwa amylase, kuthamanga kwa ESR, kuwonjezeka kapena kuchepa kwa shuga m'magazi, ndi chithunzi cha chitukuko cha purulent pancreatitis. Mimba ya x-ray imatha kuwonetsa zizindikiro za matumbo a m'mimba, kutuluka kwamatumbo, komanso malo apamwamba kwambiri a chifanizo.

Kuzindikira kwa puranc pancreatitis kumachitidwanso pogwiritsa ntchito kupimidwa kwa ma pancreas chifukwa chotsatira chake chomwe chikuwonjezera kukula kwa ziwalo chifukwa cha kutupa kwambiri. Kuphatikiza apo, ma cysts ndi foci a abscesses amawonedwa. Nthawi zina, pozindikira molondola, kupenda kachilombo komwe kamadwala kudzera chida chapadera - laparoscope, i.e. laparoscopy ya kapamba amachitidwa.

Mwambiri, kuwunika kwa purulent pancreatitis kumapangidwa pamaziko a zidziwitso zamankhwala. Ndi chitukuko cha purcin pancreatitis, kuchuluka kwa abscess "kusungunuka" kwa kapamba kumadziwika. Kuzindikira matendawa kumafuna kuti munthu wodwala azigonekedwa m'chipatala. Odwala omwe ali ndi vutoli amayikidwa m'chipinda chothandizira odwala kwambiri.

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Kuthamanga kwa purcin pancreatitis

Purulent pancreatitis ndikofunikira kudziwa munthawi yake kuti muchepetse chiopsezo cha kufa. Chifukwa mitundu yayikulu ya matendawa imatha kutaya munthu moyo.

Matenda a purulent pancreatitis nthawi zonse amakhala oopsa. Mavuto obwera chifukwa cha pancreatitis pachimake amaphatikizidwa makamaka ndi kutulutsidwa m'magazi a michere yambiri ya pancreatic ndi mankhwala oopsa a kuvunda kwake (pancreatic necrosis). Kulimbitsa thupi ndi kupweteka kwambiri pakukhudzidwa kumayambitsa kudwala - wodwala. Vuto lowopsa la matendawa limaphatikizanso enzymatic diffuse peritonitis, yomwe imakhala ya aseptic m'chilengedwe ndipo imayamba kutsutsana ndi maziko a kuchuluka kwa ma pancreatic enzymes omwe amakhala ndi vuto la peritoneum.

Kuledzera mwamphamvu kwa thupi, komwe kumachitika pancreatitis yovuta kwambiri, kumakhala koopsa chifukwa kungayambitse impso ndi chiwindi, kulephera kwa jaundice, zilonda zam'mimba, mapapu am'mimba chifukwa cha chibayo, komanso psychosis ya poyambira. Ziyenera kutsimikiziridwa kuti maphunzirowa komanso kupititsa patsogolo kwa puranc pitisreatitis kumakhudzidwa kwambiri ndi mowa. Ngati wodwalayo, ngakhale atazindikira kuti ali ndi matenda oopsa, akupitiliza kumwa mowa, zoopsa zakufa zimachulukanso.

Kumbukirani kuti chifukwa chachikulu cha imfa mwa odwala omwe ali ndi puranc pancreatitis ndi kuledzera kwa thupi kuphatikiza ndi zovuta za purulent-septic. Makina apamwamba kwambiri, sepsis amakula. Matenda a purulent pancreatitis amakula kwambiri chifukwa cha zovuta za matendawa. Nthawi zambiri, izi ndi zotupa zam'mimba, sepsis, retroperitoneal cellulitis ndi pylephlebitis.

Zotsatira zoyipa ndi purcin pancreatitis

Purangan pancreatitis ndiyowopsa chifukwa imatha kupha. Kuledzera kwakukulu kwa thupi la wodwala kumayambitsa kuwonongeka osati kwa kapamba kokha, komanso ziwalo zina zofunika - ubongo, impso, mtima, mapapu. Zinthu zowola ndi tinthu tating'onoting'ono timazilowetsa m'magazi, zomwe zimapangitsa kuti poizoni wambiri aziphe. Pazifukwa izi, pali chiopsezo chachikulu cha kufa.

Zotsatira zakupha ndi puranc pancreatitis zimawonedwa mu 10-15% ya milandu yonse yamatenda. Ngati poyamba zotupa zamkati chifukwa cha pachimake kapamba zimayang'ana m'chilengedwe, ndiye kuti ndi chitukuko cha matendawa, kutupa "kumayambitsa" pafupifupi thupi lonse, ndikuyambitsa kuledzera kwambiri. Kukhala bwino kwa wodwalayo kumakulirakulira ndi mphindi iliyonse, kubweretsa mavuto osapilira. Nthawi zambiri, imfa ya wodwalayo imachitika chifukwa cha matenda osayembekezereka. Zotsatira zake, chithandizo cha pathogenetic sichimabala zotsatira zomwe zimafunidwa, chifukwa zimayikidwa mochedwa.

Purangan pancreatitis ndi matenda owopsa omwe amafunika chithandizo chamankhwala mwadzidzidzi. Chifukwa chake, ndikofunikira kudziwa nthawi yomwe akudwala kuti athe kupulumutsa.

Sinthani ya Laparoscopy

Laparoscopy imakuthandizani kuti mumvetse bwino mtundu ndi mtundu wa matendawa, muzindikiritsa pancreatogenic peritonitis, parapancreatic infiltrate, cholecystitis yowonongeka (monga matenda opatsirana) ndikupeza mawonekedwe a laparotomy. Ndi laparoscopy, zodalirika komanso zosadziwika zizindikiro za kapamba kapamba zimatha kupezeka.

Zizindikiro zosadziwika za edematous pancreatitis zimaphatikizapo kutupa kwa ochepa omentum ndi hepatoduodenal ligament, kutulutsa kwam'mimba kwambiri, Hyperemia ya visceral peritoneum yam'mimba yam'mimba, ndi kuphatikizika pang'ono kwa gawo lalikulu lam'mimba. Chizindikiro chodalirika cha mafuta pancreatic necrosis ndicholinga cha mafuta necrosis pa parietal ndi visceral peritoneum, omentum yaying'ono komanso yayikulu.

Chizindikiro chachikulu cha endoscopic cha hemorrhagic pancreatic necrosis ndi hemorrhagic imbibition ya omentum ndi mesentery yamatumbo opatsirana, ndi kupezeka kwa kuphatikizika kwam'mimba ndi hemorrhagic hue.

Sinthani ya Angiography

Angiography imakupatsani mwayi wokhazikitsa zovuta kuzungulira mu kapamba ndi tiziwalo tating'ono ndi ziwalo. Izi zimakupatsirani mwayi wodziwa zakutsogolo komanso njira zamachitidwe opangira opereshoni.

Komabe, pakadali pano, chifukwa cha kutuluka ndi kusintha kwa njira zosagwiritsa ntchito monga ultrasound, CT ndi NMR, kufunikira kwa angiography pazomwe zimapezeka pancreatitis yacute ndi zotupa zina zam'mimba zimatayika kwambiri.

Gastrointestinal Endoscopy (endoscopy)

Endoscopic endoscopy imatanthawuza njira zina zowonjezera pakufufuza kwachidziwikire kwambiri kapamba.

Kuti mupeze kuopsa kwa mkhalidwe wa odwala omwe ali ndi pancreatitis yovuta kwambiri, yomwe ndi yofala kwambiri ndi kukula kwa Ranson, yomwe inafunsidwa mu 1974. Mulinso mfundo 11 zomwe zimayesedwa pakapita nthawi yayitali 48 kuchokera pomwe matenda amayambika. Chizindikiro chilichonse chomwe chilipo chimayesedwa 1 point.

Ranson Acute Pancreatitis Severity Test Searity

Pambuyo pa maola 48 ogonekedwa m'chipatala

Glucose wamagazi> 11.1 mmol / L (> 200 mg%)

Kupitilira 10% yakuchepetsa hematocrit atavomereza

Kalasi ya Plasma 4 meq / L

Kuchuluka kwa urea nayitrogeni ndi oposa 1.8 mmol / L (5 mg%) atavomereza

Odwala omwe ali ndi pancreatitis yovuta kwambiri ndi zovuta zake, zomwe kuchuluka kwake pamlingo wa Ranson ndizochepa kuposa 3, amapatsidwa gulu lokhala ndi zovuta za matendawo komanso mwayi wochepa wokhala ndi zotsatira zakupha, nthawi zambiri osapitirira 1%.

Gulu lomwe lili ndi vuto lalikulu la kapamba limaphatikizapo odwala omwe ali ndi chimodzi mwazomwezi:

1) Ranson amagwira points ma point 3 pakulandila kapena maola 48 oyamba,

2) kuchuluka kwa APACHE II kwa ≥ 8 mfundo nthawi iliyonse nthawi yamatenda.

3) Kulephera kwa chiwalo chimodzi kapena zingapo:

4) kukhalapo kwa vuto limodzi kapena zingapo zakudziko (pancreatic necrosis, pancreatic abscess, pancreatic pseudocyst).

Kuwonjezeka kwa gawo la Ranson kumawonjezera kufa. Ndi chiwopsezo chachikulu cha 3 mpaka 5, kuchuluka kwa odwala omwe ali ndi necrotic pancreatitis amafikira 10-20%, ndikuwonjezereka kwa chiwonetsero mpaka 6 kapena kuposa, chiwerengero chaimfa cha gulu ili la odwala chikukwera mpaka 60% ndi kupitilira. Zoyipa za dongosololi ndizosatheka kuwunika momwe odwala alili masiku awiri oyambilira kuchokera pachiwonetsero cha matendawa, komanso momwe zimakhudzira etiology ya kapamba ndi chithandizo.

Chithandizo cha Conservative

Mankhwalawa amayenera kusankhidwa mokhazikika, kutengera zinthu zapathupi, gawo limodzi kapena mawonekedwe ndi mawonekedwe a pancreatitis owononga.

Pa gawo loyambirira, chithandizo chimakhala mu detoxization (kuphatikizapo hemo-, lympho-, kapena plasma sorption).

Ndikofunikira kuthetsa kuphipha kwa minofu yosalala.

Mimba imawola ndikukhazikitsa chubu cha nasogastric.

Mankhwala a Antenzyme, omwe m'mbuyomu amaganiza kuti ndi njira yayikulu yothandizira pancreatitis pachimake, tsopano sangagwiritsidwe ntchito chifukwa chosagwira bwino ntchito. Chifukwa chake, ma proteinase inhibitors (kontrikal, gordok, etc.) pakali pano sawachotsa pamndandanda wazipatala zomwe zalimbikitsidwa kugwiritsidwa ntchito mu matenda awa.

Mankhwala a Cytostatic omwe amalepheretsa kuphatikizika kwa mapuloteni ndipo, makamaka, kupanga kwina kwa ma enzymes (5-fluorouracil). Pancreatic ribonuclease, yomwe imawononga m-RNA, imayambitsa kuphwanya kosintha kwa mapuloteni a biosynthesis mu kapamba ali ndi njira yofananira.

Kugwiritsidwa ntchito kwa somatostatin ndi mawonekedwe ake ndizothandiza pa matendawa pawokha komanso pazotsatira zake. Mankhwalawa amachepetsa katulutsidwe ka pancreatic, amachotsa kufunika kwa analgesic mankhwala, komanso amachepetsa zovuta ndi kufa.

Somatostatin kulowetsedwa bwino glomerular kusefera index ndi kumawonjezera aimpso magazi, ofunikira kupewa matenda a impso mu njira zowonongeka za pachimake kapamba.

Njira za Antibiotic za Acute Pancreatitis edit

1. Mu mawonekedwe osakanizira a kapamba kapamba, antibacterial prophylaxis sichinatchulidwe.

2. Kusiyanitsa cholinga chopanga mankhwala opha tizilombo ta matenda a pancreatic necrosis - prophylactic kapena achire - nthawi zambiri sizingatheke, chifukwa cha chiwopsezo chachikulu chotenga kachilombo ka pancreatic komanso kuvuta kwa matenda chifukwa cha njira zopezekera kuchipatala komanso zamankhwala.

3. Ndi chitukuko cha matenda oopsa a sepsis, makonzedwe a maantibayotiki amafunikira, omwe ali ndi zotsatira zambiri komanso zovuta zoyipa.

4. Chithandizo cha maantibayotiki chikuyenera kuwongolera mtengo.

Chithandizo cha Opaleshoni

Maluso a kulowererapo kwa opaleshoni amatsimikiziridwa makamaka ndi kuya kwa kusintha kwa masanjidwe amkati payokha.

Laparoscopy iyenera kuonedwa ngati njira yayikulu yakuthandizira opaleshoni. Kugwiritsa ntchito laparoscopy kumakuthandizani kupewa laparotomy yosaganizira, kupereka madzi okwanira komanso chithandizo chokwanira, ndikuwonetsa kwambiri laparotomy.

Mitundu yayikulu ya opereshoni

• Kukhazikitsa kwa ma drains ndi peritoneal lavage-dialysis. Izi zimakuthandizani kuti muchotse zinthu zapoizoni ndi zoyipa. Pambuyo pa opaleshoni, mkhalidwe wa wodwalayo umakhala bwino mkati mwa masiku 10 oyambirira, koma mawonekedwe a zovuta samatulutsidwa mtsogolo. Kuphatikiza apo, dialysis imatha kuchitika kokha m'maola 48 atakhazikitsa ma drains, kuyambira pamenepo amasiya kugwira ntchito.
• Kukuyang'ananso (nthawi zambiri kumakhala kwakale) kwa kapamba. Izi zimathetsa kuthekera kwa kupezeka kwa mtima komanso magazi, komanso zimalepheretsa mapangidwe a zotupa. Zoyipa za njirayi ndikuti odwala ambiri atatha kugwira ntchito amatha kukhala osakwanira komanso endocrine. Izi zimachitika chifukwa chakuchulukitsa kwakukulu ndi zotupa zochulukitsa, kapena kulephera kupeza kuchuluka kwa zotupa zisanachitike kapena panthawi ya opareshoni (ngakhale mutagwiritsa ntchito intraoperative ultrasound ya kapamba), chifukwa chake, minyewa yosasinthika imachotsedwanso.
• Opaleshoni Lawson (opaleshoni "angapo stoma"). Amakhala ndi kupakidwa kwa gastrostomy ndi cholecystostomy, kukhetsa kwa mawonekedwe akumaso ndi kapamba. Pankhaniyi, ndikofunikira kuthana ndi kutuluka kwa ma enzyme olemera kwambiri, kuti kuwonongedwa kwa ma ducts owonjezera. Wodwalayo amamuthandizira kuti azilimbitsa thupi. Opaleshoni sayenera kuchitika pancreatogenic peritonitis.

Opaleshoni sikuti nthawi zonse imathetsa mwayi wopanga zovuta za purulent. Pankhani imeneyi, nthawi zina pamakhala kufunikira kochita maulendo mobwerezabwereza, komwe kumawonjezera kufa kwa postoperative. Imfa nthawi zambiri imachitika chifukwa cha zovuta kwambiri za septic komanso kulephera kupuma.

Vuto lodziwika bwino ndi mitundu yonse ya opareshoni ndikusowa kwa relaparotomy ya pancreatic necrosis yosatha kapena kulumikizana ndi chitukuko cha zovuta zachiwiri (zotupa, magazi, ndi zina).

Kupanga mobwerezabwereza zomwe zimakonzedweratu komanso kutsekeka kwakanthawi kwa bala la laparotomy, zipper zimagwiritsidwa ntchito. Komabe, ali ndi zovuta, chifukwa zimatha kuyambitsa necrosis ya zimakhala zapakhomo, kuphatikiza, salola kuwongolera kokwanira kwa kusintha kwamkati mwa m'mimba.