Benign zotupa za kapamba

Pancreatitis nthawi zambiri imakhala yovuta ndi matenda owonjezera. Chimodzi mwazo ndi pancreatic cyst, chithandizo chomwe chimakhala chovuta chifukwa cha zovuta zamtundu m'thupi (ndi thupi lonse). Chiwerengero cha ozindikiritsa chinawonjezeka ndikubwera kwa njira zatsopano zodziwonera (kulingalira kwa maginito ndi kuyerekezera kwa m'maganizo, ma ultrasound).

Pancreatitis imakhala yovuta ndi makapisozi okhala ndi madzi mu 18%, milandu yotsalayo imayambitsidwa ndi kuvulala komwe kumafuna opaleshoni. Asanu mwa odwala amachiritsidwa ndi njira zina kapena modziletsa. Odwala omwe atsala samakhala omasuka ndi pancreatic cyst, opaleshoni yomwe idawonedwa kuti ndiyo yankho lokha (drainage). Opereshoni imawonedwa kuti ndi yovuta, imawopseza ndi peritonitis, zotupa zam'mimba, kuchuluka, magazi.

Pancreatic cyst kuchotsa

Milandu makumi asanu ndi atatu, madokotala amalimbikitsa kuchotsedwa kwa pancreatic cyst, kuchenjeza za zotheka. Kuvuta kwa kulowererapo kwa madokotala othandizira opaleshoni pakuthandizira kumayambitsa kufunafuna njira zatsopano. Kutulutsa anali njira zingapo zomwe sizikufuna kutsegula khungu (opareshoni):

• kukhetsa pakhungu kudzera pakhungu - makamaka kuphatikizidwa ndi zowongolera za ziwalo pogwiritsa ntchito wailesi ya ultrasound (kapena wa X-ray)
• kuboola pakhungu ndi kusilira - kochitidwa ndi singano pansi pa mayeso a ultrasound

M'magawo onse awiri, mankhwala am'nyumba, kapisozi imalowetsedwa ndi singano ya 1.7 mm, zomwe zili mkati zimachotsedwa. Njira yopumira ndi bougie, ngalande yama millimeter atatu imayikidwa. Zoyipa za njirayi ndizowopsa zovulaza ziwalo zam'malire, kulumikizana kwa kubwezeretsanso komanso malo amkati. Chotsani kuperewera posiyanitsa pomwe wodwala amwa kapu ya barium sulfate, zomwe zimapangitsa kuti azitha kusiyanitsa bwino ziwalo zoyandikana.

Chithandizo cha Pancreatic cyst

Kuchotsa bwino ma cysts pa kapamba sikuchitika nthawi zonse, chifukwa chake, gastroenterologists amalimbikitsa ma decoctions ndi kulowetsedwa kwa zitsamba. Nthawi zambiri amagwiritsa ntchito zofunda, mullein, yarrow, clover, burdock. Onsewa amadwedwa musanadye, decoction amakakamizidwa, osasefedwa. Mlingo ndi supuni. Njira yabwino imagwiritsa ntchito njira yachikhalidwe:

• celandine, calendula, yarrow m'magawo omwewo amaumirira mphindi 120 (mwezi wa mankhwala 50 g patsiku)
• mankhwala atatha, amayamba yomweyo - calendula, plantain (mivi), tansy malinga ndi zomwe adalemba kale, koma, kwa theka la chaka mzere

Amachepetsa kukula kwa makapisozi amadzimadzi ndi kulowetsedwa kwa nyemba za nyemba, manyazi a chimanga, masamba a sitiroberi, mabulosi am'madzi ndi mabulosi. Maphunziro a theka la miyezi ndi otetezeka kwa m'badwo uliwonse, yopuma imakhala yofanana ndi kutalika kwa chithandizo, chomwe chimabwerezedwa kangapo.

Opaleshoni ya pancreatic cyst

Pankhani yochotsa pancreatic cyst, chinthu choyamba chomwe muyenera kusankha ndi njira yochitira opaleshoni. Zimatengera kukula kwake, ndi malo ake. Ntchito yolimbikira kwambiri - kapangidwe kake kapamba - imachitika m'malo omwe amakhudzidwa ndi cyst. Ndizotheka kuchitira mwanjira imeneyi, bola ngati neoplasm ndi yaying'ono kukula komanso ndiowona m'chilengedwe. Poterepa, pomwe chotupa chikhale m'madipatimenti a kapamba, otchedwa distal.

Ngati neoplasm imadziwika kuti ndi pseudocyst, opaleshoni imeneyi singachitike, chifukwa gawo lakunja la mapangidwe amenewo limapangidwa ndi ziwalo zapafupi. Magwiridwe a draining chikhalidwe amatumizidwira milandu yapadera yamkati pa limba - pseudocysts. Ngati zili m'dera lachiberekero, ndiye kuti cystogastrostomy imachitika. Mu mawonekedwe a zotupa zazing'ono, chithandizo cha pancreatic cyst chimachitika ndi transduodenal cystoduodenostomy. Imachitika ndi mapangidwe a chotupa m'mutu wa chiwalo. Ngati pali kusiyana ndipo pali mwayi wa purulent peritonitis, marsupialization imachitidwa. Madziwo ndi ngalande mothandizidwa ndi matayala ake mpaka pa peritoneum. Ntchito zamtunduwu sizimangotchulidwa.

Pancreatic cyst ndi mkhalidwe wa m'magazi momwe mawonekedwe amkati amadzaza ndi pancreatic secretion ndi mawonekedwe a minofu chosokoneza mu gawo lazigawo za chiwalo. M'mitsempha yama cystic, maselo a kapamba ndi necrotic (amafa), amasinthidwa ndi zimakhala. Cysts kumaika pangozi yayikulu yathanzi chifukwa cha chiwopsezo cha kusandulika m'malo opweteka, amatha kupezeka mwa amuna ndi akazi, ana nawonso ndi osiyana.

Limagwirira ndi zoyambitsa kukula kwa matenda

Zikondazo ndizofunikira kwambiri pakuwonongeka komanso kuphatikizidwa kwa mapuloteni, zakudya, mafuta. Chiwalocho chili ndi mapangidwe am'kati mwake chomwe chikuwoneka bwino ngati cysts. Kapangidwe kazinthu zozungulira mu gland sikuchitika mwanjira iliyonse ndipo zimachitika chifukwa cha kusabereka kwa mapangidwe a ziwalo, kapena zinthu zina.

Mphamvu yamomwe imachitika imangotengera kuwonongeka kwa ziwalo zomwe. Mothandizidwa ndi zinthu zopanda pake, masango a minofu yakufa mu kachigawo kakang'ono ka kapamba, thupi limaphwanya malo am'mimba kuchokera kwa athanzi - kaphatikizidwe kamapangidwa kuchokera ku maselo olumikizika kapena ma cell. Chisipikiro chimadzazidwa pang'onopang'ono ndi zomwe zimapangidwa pang'onopang'ono ndi chinsinsi - Umu ndi momwe cyst imawonekera.

Zomwe zimayambitsa maonekedwe a matenda:

• kubadwa kwa zotumphukira za ndulu,
• kupezeka kwa miyala
• kapamba - pachimake, matenda, mowa,
• kapamba,
• ziwalo zovulala
• endocrine matenda - kunenepa, matenda a shuga,
• matenda a majeremusi.

Kutanthauzira kwa matenda a mtima

Ma Cysts amalembedwa kuti:

• Zowona (zatsopano) - mapangidwe a patsekeke m'matumbo amapezeka kuyambira pakubadwa, mapangidwe ake amayikidwa mu nthawi ya kubereka. Congenital cysts sikukula, kukula kwawo kumakhala ndi maselo owopsa. Kuwoneka kwa ma cysts owona chifukwa cha kutsekeka kwa ma pancreatic ducts kumabweretsa kutupa ndikapangidwa ndi minofu ya fibrous - matenda awa amatchedwa "cystic fibrosis", kapena polycystic.
• Zabodza (ma pseudocysts) - mawonekedwe apazitsulo omwe amawoneka motsutsana ndi maziko a zotupa m'mapapo, kuvulala ndi zina za chikhalidwe chachiwiri.

Mitsempha yachilengedwe imatha kupanga magawo osiyanasiyana a kapamba - pamutu, thupi ndi mchira. Malinga ndi ziwerengero, mutu wam'mutu suwapezeka kawirikawiri, 15% yonse, 85% imayamba chifukwa cha chotupa cha thupi ndi mchira wa chiwalo. Pafupifupi 90% ya milandu, ma cysts ndi achiwiri mwachilengedwe ndipo amakula motsutsana ndi maziko a kapamba. 10% yamilandu imakhudzana ndi zoopsa zomwe zimachitika m'thupi.

Gulu la Atlanta limagwiritsidwa ntchito pa mitundu ya cystic yomwe imawonekera pambuyo pancreatitis yovuta kwambiri:

• cysts pachimake - kuwoneka mwachangu, mulibe khoma lopangidwa bwino, milomo ya ndulu, mawonekedwe ofunikira kapena CHIKWANGWANI chingakhale cham'mbali,
• subacute (aakulu) - imapangika kuchokera pachimake monga makoma amkati amapangika kuchokera ku minyewa yamkati ndi michere,
• abscess - purifying kutupa kwa kapangidwe kake, patimayo timadzaza ndi serous nkhani.

Kuchokera pakuwona komwe zamatenda, ma cysts ndi:

• yophatikizidwa ndi fistulas, magazi, mafinya kapena mafuta oyenga,
• zosavuta.

Chithunzi cha kuchipatala

Zizindikiro za pancreatic cyst sizidziwika nthawi zonse. Mawonetsedwe azachipatala amachitika chifukwa cha kukula kwa milomo, kutengera kwawo, komwe adachokera. Pamaso pa mawonekedwe amodzi a cystic mu gland mpaka 50 mm kukula kwake, palibe umboni wowoneka bwino - chotupa sichimalimba pamizere ndi ziwalo zoyandikana, sichikuumiriza mathero a mitsempha - wodwalayo samakumana ndi vuto.

Kukhalapo kwa milomo yayikulu yambiri kumapereka mawonekedwe owoneka bwino, chizindikiro chapadera ndi kupweteka. Momwe ululu uliri umatha kudziwa kuchuluka kwa zotupa za cystic:

• pamene ma cysts abodza amapangidwa motsutsana ndi kapamba, ululu umakhala wolimba komanso wowonda, kuphimba dera lumbar ndi mbali yakumanzere,
• ululu wolekerera womwe umawoneka mwadzidzidzi ungasonyeze kutumphuka kapena kuwonjezeredwa kwamkati, makamaka ngati wodwala akutentha thupi,
• kukhalapo kwa cyst kufinya mphamvu ya dzuwa kumapangitsa kudziwikitsa kokhako ndi ululu woyaka womwe umawonekera kumbuyo.

Kuphatikiza pa zowawa, matenda a zam'mimba amadziwika ndi zina:

• kusanza ndi kusanza
• kusokonezeka kwa chopondapo, kuphatikiza mafuta am'madzi mu chopondapo),
• zovuta zam'mimba, mayamwidwe olakwika a michere ndi kuchepa thupi,
• kuchepa kwamtima
• kutentha kwa manambala ochepetsa.

Mavuto

Pancreatic cyst ndiyowopsa makamaka chifukwa chokhoza kusinthika kukhala chotupa cha khansa. Mwapangidwe, ma cystic patimatayidwe amatha kukhala ovulaza ndi owopsa. Khansa ya pancreatic ndi yovuta, pafupifupi yosasinthika, yodziwika ndi maphunziro othamanga omwe ali ndi metastasis yayikulu. Benign cysts siwowopsa chifukwa cha chiwopsezo chotumphukira komanso chitukuko cha peritonitis.

Mapangidwe a Fistula ndi vuto linanso lalikulu. Ndi mafuta opangira mawonekedwe a cystic, mafistola athunthu komanso osakwanira amawonekera - maupangiri amakulu omwe amalumikizana ndi chilengedwe chakunja kapena ziwalo zina. Kukhalapo kwa fistulas kumawonjezera chiopsezo cha matenda komanso kukula kwa mabakiteriya.

Cysts yayikulu imasunthira pamatumbo ndi zisa za m'mimba ndi ziwalo zoyandikira zam'mimba, zomwe zimayambitsa mavuto:

• chitukuko cha zopinga za jaundice ndi mutu wa cysts pamutu,
• Kutupa pamiyendo pakufinya msempha,
• matenda osokoneza bongo omwe akukakamizidwa pamitsempha yam'mimba,
• matumbo kutsekeka pamene kufinya lumen mu matumbo malupu (vuto losowa lomwe limachitika pamaso pa zikuluzikulu za kapamba).

Kuzindikira matenda

Dokotala yemwe amayesa ndi kuchitira anthu omwe akuwaganizira kuti ndi pancreatic cyst ndi dokotala wa gastroenterologist. Pa chithandizo choyambirira, anamnesis amafunikira, kumveketsa madandaulo a wodwala ndikuwunika ndi palpation. Ndikawunika pamimba pamimba, kumveka kwa malire. Kuunika kwathunthu kumaphatikiza njira zophatikiza zasayansi ndi zothandizira.

Mndandanda wa mayeso a labotore umaphatikizapo kuyezetsa magazi, kuphatikizapo biochemistry. Pamaso pa pathology, kusintha kwa ESR ndi bilirubin zikuwonetsa (kuchuluka), leukocytosis, kuchuluka kwa alkaline phosphatase kudzapezeka. Kuchita mkodzo kumatha kuwonetsa molakwika chizindikiro cha kutupa m'miyeso yovuta - mkodzo wamba ndi maselo oyera amkati amapezeka mu mkodzo.

Zambiri zodalirika mukamatsimikizira za matenda am'masiku zimachitika ndi njira zothandiza:

• Ultrasound imakupatsani mwayi kuti muwone kukula kwa michere ya cystic, kuchuluka kwawo, kukhalapo kwa zovuta,
• MRI imapangitsa kuti athe kuzindikira bwino komanso molondola, kukula kwa mgwirizano wa ma cystic ndi maukonde a gland,
• scintigraphy (radionuclide imaging) imagwiritsidwa ntchito ngati njira yowonjezerapo pofotokoza komwe kumayambira gland ya gland,
• endoscopic retrograde cholangiopancretography ngati njira yolondola kwambiri imapereka tsatanetsatane wazomwe zimayambira pamangidwe, mawonekedwe ake ndi kulumikizana ndi ma ducts, koma amakhala ndi chiopsezo chachikulu cha matenda pakubwereza,
• Rografic radiographic yam'mimba imagwiritsidwa ntchito pozindikira malire a milomo.

Ngati kapangidwe ka mkati mwa mapangidwe a cystic sikudziwika bwino, kuphatikizidwa kwa minofu ya pancreatic ndizovomerezeka kuti zitsimikizire kapena kutsutsa zilonda. Kuchita biopsy kumachitika moyang'aniridwa ndi ultrasound scan kapena pa scan scan. Kusiyanitsa mosiyanasiyana pa biopsy kumalola kudziwika kwa oncology komanso kupewa kukula kwa maselo a khansa.

Chithandizo cha pancreatic cysts imachitika kudzera mwa kuchitira opaleshoni. Mankhwala okhala ndi ma cysts angapo osatsimikizika ndi osathandiza. Opaleshoniyo sikuwonetsedwa cysts imodzi yaying'ono (mpaka 30-50 mm cysts), ngati sichikhudza ziwalo zoyandikana komanso siziyambitsa zizindikiro zoyipa. Kuchotsa cyst yoyipa, ngakhale yaying'ono yaying'ono, ndikofunikira kuti tipewe metastasis.

Mu opaleshoni ya gastroenterology, njira zitatu zimagwiritsidwa ntchito polimbana ndi cyanc:

• Kuchotsa kwa maziko a pathological - mayendedwe,
• ngalande zoyambira (zakunja ndi zamkati),
• laparoscopy

Mukasunthika, thupi la cyst ndi gawo loyandikana ndi kapamba limachotsedwa. Kuchulukitsa kwa zotengera kumadalira kukula kwa patsekeke, mkhalidwe wodabwitsa wa gland - amachitanso mbali ya mutu, distal, pancreatoduodenal.

Kukhetsa kwamkati kwa cyst kumachitika kudzera mwa anastomosis pakati pa thupi la cyst ndi m'mimba, duodenum kapena intestine yaying'ono. Kukhetsa kwamkati ndi njira yotetezeka komanso yolimbitsa thupi yomwe imawongolera mkhalidwe wa wodwalayo - kudutsa kwamkati mwazitsulo kumatsimikizika, kupweteka kumatha, mwayi womwe ungayambirenso wabwinobwino ndi wochepa.

Kutulutsa kwakunja kwa cyst kumachitika ndi njira yovuta ya matenda:

• kudzikundikira kwa purishate exudate,
• ma cystic osasinthika,
• kuchuluka kwa mtima (kupanga ziwiya zatsopano) m'makoma a cyst,
• ambiri ovuta.

Ndi drainage yakunja, zotsatira zoyipa zimatha kupezeka mwa mawonekedwe a fistula, kukulitsa kwa cysts kukula kwake, kukula kwa mawonekedwe atsopano. Nthawi zina, sepsis imayamba. Mulimonsemo, ngalande zakunja ndi zamkati zimachitika pokhapokha ndi mawonekedwe a benign.

Laparoscopy ndi njira yofatsa, phindu lake ndikusakhalapo kwa maopaleshoni ochulukirapo ndikuchira wodwala mwachangu. Laparoscopy ndi yoyenera kuchotsa nyumba zambiri, zamtambo umodzi. Chofunika cha kulowereraku kopanda tanthauzo ndikukhazikitsa singano yopumira muvuto lomwe limayambitsa kulowetsedwa.

Chithandizo cha mankhwala chothandizira kukonza matenda oyamba. Pamaso pa kapamba, kuyika kwa ma enzymes ndikofunikira kuonetsetsa kuti chimbudzi chokwanira komanso kutsitsa kwa kapamba. Kuchepetsa ululu, antispasmodics ndi analgesics amagwiritsidwa ntchito. Kuwongolera kwa shuga m'magazi ndikofunikira, ngati kusokonezedwa, mankhwala oyenera amalembedwa.

Kukhazikika kwa zotupa za cystic kumakhazikitsidwa ndi kuchuluka kwakukulu kwapancreatic. Zakudya zopangidwa moyenera zimatha kuchepetsa ngozi yobwererenso matendawa ndikuthandizira kuthekera kwa michere. Mfundo zomwe zimapatsa thanzi lokhala ndi pancreatic cyst:

• zakudya zazing'ono munthawi yomweyo (maola 3-4),
• Chakudya chonse chimapukutidwa ndi kudulidwa,
• njira zophikira - kuphika, kuphika, kutumiza,
• kukana mafuta ndi yokazinga,
• kuletsa mkate ndi confectionery,
• maziko a chakudyacho ndi chakudya chama protein (mapuloteni ofanana ndi mbewu sayenera kupitirira 30% ya tsiku ndi tsiku).

Odwala amaletsedwa kudya nyama yamafuta, bowa, nyemba. Zinthu zothandiza kwambiri ndi mkaka wokhala ndi mafuta ochepa, nkhuku ndi nyama ya nkhuku, mazira owiritsa, masamba atatha kutentha. Kuchokera kuzakumwa, timadziti tosazingira, mafuta odzola ndi zipatso zabwino. Zakudya - moyo wonse, kupuma pang'ono kungayambitse kuwonongeka.

Kukula kwa kupulumuka kumadalira zomwe zimayambitsa matenda, mapangidwe ake komanso kukwanira kwake. Matendawa amadziwika ndi zovuta zambiri - mu 10-50% ya odwala, nthawi ya matendawa imayendetsedwa ndi oncology, matenda ndi zotupa zamkati. Pambuyo posinthira, pamakhala mwayi wa cysts zatsopano zomwe zikukula.Kutengera uphungu wa zamankhwala, kuwunika pafupipafupi komanso kudya ma enzyme, pamakhala mwayi wokhala ndi moyo wabwinobwino.

Popewa kuyambiranso kukhalanso okhazikika, odwala ayenera:

• gwiritsitsani chakudya
• lekani mowa
• munthawi yake zovuta mavuto ndi m'mimba thirakiti.

Cystic lesion ya kapamba ndimatenda osowa, pakakhala chithandizo choyenera, zotsatira zake zimakhala zoipa. Kuthekera kwa mankhwala amakono kuthana ndi matendawa ndikupangitsa kuti odwala azikhala ndi moyo wonse. Chachikulu ndikuzindikira koyambirira ndi njira yosankhidwa bwino yochotsa ma cysts.

Pancreatic cyst ndi kapangidwe kodzazidwa ndi zinthu za enzymatic. Zomwe zimayambitsa kupezeka kwake ndizowonongeka chifukwa cha kuvulala kapena kutupa.

Zizindikiro zimadalira malo ndi kukula kwa mapangidwewo. Kuzindikira kumaphatikizapo ultrasound, CT, MRI. Pambuyo pake, mankhwala osokoneza bongo kapena opaleshoni amaperekedwa.

Mitundu ndi kusiyana kwa mitundu

Kugawika kwa cysts pa kapamba kumachitika malinga ndi maphunzirowo, maphunziridwe ndi mawonekedwe amkati. Maonekedwe awo amatha kuwoneka mbali zosiyanasiyana za thupi, mogwirizana ndi izi pali mitundu itatu:

• Mutu wamutu. Ndi yocheperako poyerekeza ndi ena, imapangidwa mkati mwa chikwama chodzaza. Kuphatikizika kumatha kukhala kutsina ndi duodenum.
• Ma cyst mchira amakhala kumapeto pang'ono kwa kapamba. Kukhazikika kwa kutulutsa kwake sikungawononge minyewa yoyandikana nayo.
• Chotupa pamtundu wa chiwalo ndi chimodzi mwazomwe zimapangidwa motere. Kukhalapo kwa chotupa chamtunduwu kumawonekera ndikusintha kwa m'mimba ndi m'matumbo.

Kapangidwe ka maphunziro kumalumikizana momveka bwino ndi zomwe zimayambitsa mawonekedwe ake. Kapangidwe kake kamasiyana:

• Chotupa chabodza chomwe chimawonekera pambuyo pa matenda. Alibe glandular wosanjikiza wa epithelium.
• Maseweredwe enieni omwe amapezeka pa gawo lachiberekero cha ziwalo m'mimba. Dziwani kuti simumapezeka kawirikawiri, imakhala ndi gawo la epithelial.

Ngati mapangidwewo ndi chifukwa cha kapamba, ndiye malinga ndi chikhalidwe cha maphunzirowo, malinga ndi gulu la Atlanta, amasiyanitsa:

• Zonunkhira. Chotupa pamenepa sichikhala chopanda khoma.
• Subacute, yomwe imachepetsedwa ndi makina ake owoneka bwino kapena opindika.
• Chotupa chomwe chimadziwika ndi kukhalapo kwa purulent exudate m'matumbo.

Zomwe zimayambitsa zotupa

Njira yeniyeni ya maphunziro ndi yokhudzana ndi ma intrauterine organ pathologies. Amasiyanitsidwa ndi kukula kwake kocheperako, kusadandaula, mawonekedwe a epithelial mkati mwa kapangidwe. Mutha kuwona chotupa chamtunduwu pakamtundu wa ultrasound.

Nthawi zina mawonekedwe enieni amatha kunama. Izi zimachitika pamene chotupa chachikulu chikuwonekera pamene milunda yatsekedwa m'mimba. Chinsinsi chodzilekanitsa chimakula, chimayambitsa kutupa kosatha. M'mikhalidwe yotere, mitundu ya minyewa yotupa, njirayi imatchedwa cystic fibrosis.

Zomwe zimayambitsa ma pseudocysts ndikuphwanya magwiridwe antchito a thupi.

• Njira zotupa, mwachitsanzo, kapamba, pancreatic necrosis. Zazinthu zodziwika bwino, zopitilira 80% ya milandu yabodza zimachitika pambuyo pa kuwonekera kwa kapamba.
• Pancreolithiasis, miyala ikamaletsa milawu.
• Kuvulala kwamalungu 14% ya ma cysts abodza amapangidwa pazifukwa izi. Mwa awa, 85% amavulaza thupi ndi mchira wa ndulu, ndipo 15% imagwera pamutu.
• Zakudya zopanda pake. Kugwiritsa ntchito molakwika mafuta, zakudya zonunkhira kumabweretsa kunenepa kwambiri, komwe kumayambitsa kuphwanya kwa metabolidi ya lipid.
• Makhalidwe osakhala ndi thanzi labwino, makamaka osokoneza bongo.
• Zotupa pa chiwalo.
• Kukhalapo kwa matenda a helminth, makamaka, cysticercosis ndi echinococcosis.
• Anachita opaleshoni kulowererapo pa chilichonse cham'mimba thirakiti.
• Matenda a shuga.

Zizindikiro zakuwoneka ngati chotupa

Zizindikiro zimatha kuwoneka ngati kusapeza bwino kapena kupweteka kwambiri, zimatengera kukula kwake komanso malo omwe adapangidwira. Ma cysts ang'onoang'ono samayambitsa mavuto akulu, chifukwa samapanikizika ziwalo, kusiyanasiyana ndi mawonekedwe angapo.

Ngati kukula kwa chotupa ndikofunika, wodwalayo amamva:

• Kuukira kwa kapamba mu mawonekedwe owopsa. Zowawa za paroxysmal zimachuluka pambuyo kudya kapena kumwa mowa, komanso kutenga antispasmodics ndi NSAIDs sikubweretsa mpumulo. Vomiting, flatulence, kutsegula m'mimba kumatha kulumikizana ndi izi. Pakatha mwezi umodzi, wodwalayo amakhala bwino asanayambenso.
• Kuwala kotsatira kumasiyana pakulimba komanso kutalika.
• Kuzizira, kutentha kwa thupi kumatha kuwuka.
• Zofooka zambiri, zodziwika ndi kutopa, ulesi.
• Kukula kumawonekera, makamaka mu hypochondrium yamanzere.
• Khungu la nkhope limasintha, kukhala wachikasu.
• Kusinkhasinkha kumachulukirachulukira.

Zizindikiro zimatha kukhala zowonetsera.. Pankhaniyi, mawonekedwe a khoma amawoneka pansi pa sternum. Nthawi zambiri, izi zikuwonetsa mawonekedwe akulu omwe ali pamutu pa chindayo.

Chizindikiro chake chikhoza kuwonetsa kutukula kwa maphunziro. Ngati ili pamutu pa chiwalocho ndi kufinya ma ducts a bile, ndiye kuti wodwalayo amavutitsidwa ndi kukakamira kwa mseru komanso kusanza, kusokonekera kwa chimbudzi.

Pamene kutenga nawo gawo kwa kutsekeka kwa ndulu kumachitika, kugaya chakudya, kutsegula m'mimba, kupweteka kwambiri kumayang'aniridwa. Kufooka ndi kutentha thupi kukuwonetsa kukula kwa chifuwa chifukwa cha matenda.

Zizindikiro

Kuphatikiza pakuphatikiza anamnesis ndi mayeso odutsa, kuyeserera kochitidwa kumachitika kuti mupeze matenda, omwe akuphatikizapo:

• Ultrasound yam'mimba. Njirayi imakuthandizani kuti mudziwe kupezeka kwa cyst, kukula kwake, malo ndi mawonekedwe ake. Pancreas wathanzi amayimiriridwa ndi mapangidwe akuda a tubidal echogenic. Kupezeka kwa chotupa kumatha kutsimikiziridwa ndi malo opepuka ozungulira pa thupi la chiwalo. Ngati mapangidwe ake ali ndi makhoma ake, ndiye kuti amaimiridwa ndi contour yomveka bwino yokhala ndi magawo osalala.
• MRI imathandizira kusiyanitsa chotupa kuchokera ku ma pathologies ena okhala ndi zizindikiro zokhudzana.
• CT
• ERCP imakupatsani mwayi kuti mufufuze makhoma kudzera mu endoscope yapadera ndikutenga mawonekedwe a kusanthula kwachilengedwe, a micobiological ndi cytological. Ngakhale ndichidziwitso chake, kuzindikira koteroko ndikosowa kwambiri, popeza zimakhala ndi chiopsezo chotenga kachilombo wodwala.

Kafukufuku wa Laborator samawonetsa zambiri za pathological, koma amathandizira kudziwa magazi obisika m'dera la cyst.

Njira ychithandizo chachikhalidwe

The gastroenterologist amapereka mwayi wodikirira kuwona ngati:

• Kupezeka kamodzi kwa cysts.
• Kukula kochepa kwamaphunziro (mpaka 2-3 cm).
• Chotsani malire oyenda.
• Kusakhalapo kwa zovuta ndi zovuta pa chiwalo choyandikana.

Pankhaniyi, zoyeserera za dokotala zimaphatikizapo zakudya ndi mankhwala:

1. Ma antibacterial amafunika kuteteza kumatenda omwe akukhudzidwa. Kukonzekera kwa Tetracycline ndi cephalosporin kumagwiritsidwa ntchito makamaka.
2. Proton pump zoletsa amathandizira kuchepetsa ululu ndikuchepetsa secretion. Awa ndi Omeprazole, Omez, Rabeprazole.
3. Kuwongolera chimbudzi, zopatsa mphamvu za enzymatic zimagwiritsidwa ntchito, mwachitsanzo, Creon, Pancreatin.

Pakatha mwezi umodzi amamwa mankhwalawa, amayambiranso.

Ngati maphunzirowo samakulirakulira komanso wodwalayo akumva kuwongolera, ndiye kuti gastroenterologist amayambitsa ulendo wotsatira wa ultrasound m'miyezi isanu ndi umodzi. Ngati mankhwalawa samabweretsa kufunika ndi ma cyst omwe akupitiliza kukula, opaleshoni yoikidwiratu idalembedwa.

Odwala nthawi zambiri amakhala ndi chidwi chofuna kuti maphunziro athe kudzisintha. Pali zochitika pamene, pambuyo pa miyezi 3-5, ndi zakudya zoyenera komanso kumwa mankhwala oyenera, chotupacho chinazimiririka. Koma izi zimagwira makamaka ma cysts abodza, chifukwa cha kapamba. M'matenda oyambika, matendawo amakula msanga.

Kodi opaleshoni ikufunika liti?

Ndi kusakhazikika kwa chithandizo chamankhwala, opaleshoni imasonyezedwa. Njira zingapo zochizira opaleshoni zimadziwika, kuphatikizapo njira zowukira zochepa.

Kuchotsa kwamphamvu kwa cyst kumadziwika ndi chiopsezo chotsika kwambiri cha zovuta. Njirayi imagwira ntchito popeza kapangidwe kamodzi pa thupi kapena mutu wa chiwalo.. Nthawi ya opaleshoni, malo okhudzidwawo asakugoneka, pambuyo pake phula kapena singano yokhomakhomayo imayikidwa gawo laling'ono mu epigastric zone.

Poyang'ana mkhalidwe wamachitidwe, dokotalayo amatha kuchita:

• Sclerosis ya chotupa pamene mankhwala othandizira atalowetsedwa pamatumbo oyeretsedwa. Pankhaniyi, chotupa chatsekedwa ndi minofu yolumikizana.
• Phula lamadzimadzi, lomwe limakhala likuyeretsa zamkati ndikukhazikitsa chubu cha zotumphukira. Kuchotsa drainage kumachitika pambuyo pakutha kwa kutulutsa. Cholepheretsa njirayi ndi kukula kwakukulu kwa chotupa kapena kutseka kwa duct.

Ngati opaleshoni ya percutaneous sizingatheke, dokotalayo amamuchita opaleshoni ya laparoscopic. Mwa izi, mapangidwe awiri a 2 amapangidwa kudzera omwe zida za endoscopic zimayikidwa.

Mutha kuchita izi:

• Kusangalala ndi chidziwitso chakutseguka ndi kufalikira kwa patsekeke ndi kutulutsa mimbayo kwa cyst. Imawonetsedwa pokhapokha malo omwe adapangidwira.
• Kuyambiranso kwa gawo la gland. Zimachitika pamaso pa maphunziro akulu. Tsamba lachiwalo limachotsedwa m'deralo.
• Opaleshoni Frey. Amawonetsedwa kwa odwala omwe ali ndi kukula kwa duct. Pa nthawi ya opareshoni, kukoka kwa ndulu kumakulowetsedwa m'matumbo ang'ono.

Mavuto obwera chifukwa cha laparoscopic mankhwalawa amakhala pachiwopsezo chachikulu cha zovuta. Pokhapokha ngati pali mwayi wogwiritsa ntchito njirazi, opaleshoni ya laparotomy imachitika.

Ichi ndi ntchito yokhazikika, yomwe imaphatikizapo nthawi yayitali yokonzanso.

Pankhaniyi, mutha kugwiritsa ntchito:

• Kukongola ndi kutulutsa kwakunja kwa chotupa.
• Tsegulani kwathunthu komanso pang'ono mbali
• Marsupialization. Pankhaniyi, mawonekedwe a patopsy ndikuyeretsa kwamkati amachitika, ndiye kuti m'mphepete mwa chotsekera ndi makoma a cyst amasinthidwa. Choyipa cha kunyengedwa uku ndi chiopsezo cha ndima.

Njira zina ndi kugwiritsa ntchito mankhwalawa

Zithandizo zonse zachikhalidwe zomwe wodwala amagwiritsa ntchito zimayenera kuvomerezedwa ndi gastroenterologist. Kwenikweni, chithandizo chimachitika ndi kukonzekera kwazitsamba, kuthandiza kuthetsa kutupa ndikubwezeretsa minofu:

• Calendula, celandine ndi yarrow amatengedwa chimodzimodzi. Supuni 1 ya osakaniza umathiridwa mu 250 ml ya madzi otentha ndikuumirira kwa pafupifupi maola awiri, pambuyo pake imatengedwa musanadye mu 60 ml.
• Tengani magawo awiri a tansy ndi calendula, 1 gawo la mivi yotseka, sankhani kapu yamadzi otentha ndikuwuza kuti atuluke kwa maola awiri. Atatambalala, amamwa 60 ml tsiku lililonse kwa mwezi umodzi.
• Kumwazika kumapangidwa kuchokera ku masamba ofanana ndi masamba a sitiroberi, lingonberry, buliberries, masamba a nyemba, stigmas za chimanga. Kuti 1 tbsp. 250 ml ya madzi otentha amawonjezedwa ku supuni ya osakaniza ndikuloledwa kulowetsa usiku umodzi. Mukatambasula, imwani 125 ml tsiku lililonse kwa masabata awiri. Pambuyo pakupuma kwamasiku 7, maphunzirowo amabwerezedwa.

Kufunika kwa Zakudya Zoyenera

Zakudya pamaso pa chotupa sichimakhudzana ndi kugwiritsa ntchito mafuta, zakudya zamchere komanso kuwongolera chakudya. Zakudya zimafunikira kuthira kapena kuwiritsa m'madzi. Zipatso ndi ndiwo zamasamba ziyenera kuwonjezeredwa muzakudya.

Chakudya chomwe mumadya sichiyenera kutentha kapena kuzizira.. Kwa nthawi yamankhwala, kumwa mowa kumaletsedwa. Zakudya za wodwala ziyenera kuphatikizapo zakudya zisanu ndi ziwiri pa tsiku, m'malo ochepa.

Chotupa chikamafika pamlingo waukulu ndikuwonetsa mkhalidwe wa wodwalayo, opaleshoni yoikidwiratu imalembedwa. Pokonzekera opaleshoni, wodwalayo akulimbikitsidwa kuti azisamalira zakudya zochepa, wopatsa thanzi azithandiza kupanga mndandanda woyenera, womwe uyenera kukhala ndi zambiri:

• Mapuloteni, theka la iwo liyenera kugwirizana ndi zomwe zimachokera ku nyama.
• Mavitamini, makamaka magulu a B, A ndi C.
• Lipotropic kapangidwe kazinthu.

Ndikofunikanso kupatula mafuta, chakudya komanso zakudya zamafuta ambiri.

Zotsatira zake

Matendawa amakomera pokhapokha ngati matendawa amadziwika nthawi yake. Zovuta zimawonedwa mu mawonekedwe a kuperekera, kutuluka kwamkati, ndi mawonekedwe a fistulas. Pazowopsa kwambiri, zotsatila zake zimatha kukhala zowopsa: chotumphukira kapena mapangidwe ake amakhala olakwika.

Kuopsa kobwereranso kumakhala kwakukulu ngakhale atachitidwa opaleshoni.

Njira zopewera

Kudziwa kuopsa kwa pancreatic cyst, muyenera kuyang'anira thanzi lanu ndikutsatira malamulo angapo:

• Pewani zizolowezi zoipa: Kusuta fodya, kumwa mowa.
• Khalani ndi moyo wokangalika.
• Tsatirani zakudya, ngati pali kuchuluka kwambiri, ndiye kuti muyenera kuchotsa ma kilogalamu osafunikira mothandizidwa ndi zakudya zoyenera komanso masewera olimbitsa thupi.
• Chitani panthawi yake zonse matenda am'mimba.
• Imwani mankhwala okha moyang'aniridwa ndi dokotala komanso osapitirira nthawi yolimbikitsidwa.

Pancreatic cyst ndiowopsa pakukula kwake msanga komanso kuphwanya ziwalo zoyandikana. Mankhwala osokoneza bongo sagwira ntchito, makamaka pokhalapo ambiri. Chifukwa chake, mutapezeka kuti mwazindikira, mumadya zakudya ndi ma ultrasound oyenera. A anakonza ntchito ya kukhetsa kwa patsekeke ikuchitika pamaso pa lalikulu cysts kapena purulent exudate.

Ma cystadenomas

Chochitika chodziwika bwino cha benign neoplasm chomwe chimachokera ku ductal epithelium ya kapamba. Amapezeka mu 10-15% ya zotupa zonse za kapamba komanso 1.5-5% ya zotupa zake. Nthawi zambiri zimakhala mumchira kapena m'thupi la chithokomiro. Nthawi zambiri azimayi amavutika.

Malinga ndi mbiri yapadziko lonse lapansi ya WHO (J. Kloppel et al., 1996), zotumphukira zitatu za benign pancreatic cystic chotupa zimasiyanitsidwa: serous, mucinous cystadenoma ndi intraductal papillary-mucinous chotupa.

Serous cystadenoma

Mtundu uwu wa pancreatic cystadenoma nthawi zambiri ndimapangidwe amkati, mkati mwake momwe mumakhala madzi amadzimadzi omveka. Etiology ya serous cystadenoma sizikudziwika, ngakhale akukhulupirira kuti imatha kupanga kuchokera ku maselo a epithelial a pancreatic acini chifukwa cha kusintha kwa chpososome cha Zp25.

A mawonekedwe a macroscopic kapangidwe ka cystic zotupa za kapamba ndi kupezeka kwa m'mbali mwa zida zowonjezera minofu - septa kapena misa yolimba (mkuyu. 58-11).

Mkuyu. 58-11. Serous pancreatic mchira cystadenoma: - gawo kukonzekera, b - maginidwe amatsenga.

Kufufuza kwakale kwa lakhoma la serous cystadenoma kumawulula mzere wamkati wamkati, wopangidwa ndi masentimita amtundu umodzi, ndipo panthawi ya masanjidwe, mbiri yakale yokhala ndi glycogen imapezeka mkati mwa maselo a epithelial.

Ndi serous cystadenoma, septum imagawa chotupa cha cystic m'miyeso ing'onoing'ono, ndikupangitsa kuti izioneka ngati njuchi. Kuphatikizika kwachilengedwe kumene kwa cystadenoma kumatchedwa microcystic ndipo kumangotengedwa ngati kaphokoso ka serous cystic ya kapamba. Komabe, pali chinthu china chosiyana ndi kapangidwe ka macroscopic ka serous cystic chotupa, kamawoneka ngati cysexual cyst, ndipo magawo amkati mulibemo momwemo. Kusiyanitsa uku kwa serous cystadenoma kumatchedwa macrocystic, kapena oligocystic. Ndikosavuta kusiyanitsa ndi pseudo-cysts.

Matendawa amakula pang'onopang'ono, ndipo kuyang'ana kwakanthawi sikungawonetse kukula kwa serous cystadenoma. Milandu ya kusinthika kwake koipa kukhala serous cystadenocarcinoma ndizosatheka.

Kukula kwa chotupa cha cystic nthawi zambiri sichitha kupitirira masentimita 5-7. Nthawi zambiri matendawa amapezeka pakuwunika. Zizindikiro zamankhwala sizifotokozedwa kawirikawiri, zopanda pake, nthawi zambiri zimakhala zowawa m'magawo a epigastric. Mu diagnostics, tanthauzo lalikulu ndi Makina a Ultrasound, CT ndi MRIkomanso endosonography. Pozindikira pseudocysts, mutha kugwiritsa ntchito chopindika chopangira singano chopatsa ndi kufunsa komanso kuyesa okhutira pa ntchito ya amylase makamaka cellular zikuchokera.

Kuphatikizidwa kwa zomwe zalembedwa pamitundu iyi yama cystic chotupa kumapewetsa kuchitapo kanthu ndikuwalimbikitsa kuyesedwa kwa pachaka kwa odwala. Opaleshoniyo akuwonetsedwa kuti akuwonetsa zizindikiro komanso kuchuluka kwa ma cyst kupitirira masentimita asanu ndi limodzi. Kugwiritsa ntchito ngalande yakunja kapena yamkati sikovomerezeka. Kufunika koyezetsa mbiri yadzidzidzi ya khoma la cyst, popanda zomwe nthawi zonse pamakhala chiopsezo chosankha njira yokwanira kapena kuchuluka kwa maopaleshoni, makamaka machitidwe ogwiritsa ntchito njira zachilendo.

Mucinous cystadenoma

Mucinous cystadenoma amadziwika ndi polymorphism yamapangidwe. Nthawi zambiri, imakhala ndi chipinda chachikulu cha chipinda chambiri (mkuyu. 58-12), chodzaza ndi viscous ntchofu kapena hemorrhagic zomwe zili ndi khoma lolimba.

Mkuyu. 58-12. Pancreatic mucinous cystadenoma: - kukonzekera kwina, b - yowonjezera makilogalamu osiyanitsa ena.

Nthawi zambiri, imakhala ndi mawonekedwe a unisexual cyst popanda magawo amkati (macrocystic oligocystic form). Malinga ndi imodzi mwazidziwitso zodziwika bwino, amakhulupirira kuti chotupa cham'mimba chimachokera ku minyewa yamchiberekero, zinthu zomwe zimalowa mu chizindikiritso cha zikondamoyo panthawi yomwe intrauterine imayamba. Minofu yokhala ngati khoma komanso septum ya mucinous cystadenoma imafanana kwambiri ndi minyewa yamavuto am'mimba, chifukwa chake imatchedwa stroma. Ichi ndi chimodzi mwazinthu zachilendo za kapangidwe ka chotupa cha mucinous cystic. Kapangidwe ka histoma khoma la chimbudzi cha cystic chotupa chimadziwika ndi phokoso la epithelium lopangidwa ndi epismatic epithelium yomwe ili ndi mucin. Madontho a histochemical a glycogen pankhaniyi amapereka zotsatira zoyipa.

Mucinous cystadenoma imayenda msanga, ndipo pofika pomwe yapezeka, imakhala yotalika mpaka masentimita 10-15. Chifukwa chake, vuto losadziwika bwino koma losapweteka, kumangika kwa epigastrium kumatha kukhala kwina. Kafotokozedwe kamodzi pa kukakamiza kapena kutsekereza kwa chotupa chija cha wamba duct, duodenum, ndi pancreatic duct akufotokozedwa. Chofunikira kwambiri pazotupa chotupa chotere ndi kuthekera kwakukulu pakusintha koipa.

Kafukufuku wambiri akuwonetsa kuti mu chotupa chilichonse cha mucousic cystic, pakapita nthawi, madera ena ovuta a epithelial dysplasia amawonekera, akudutsa carcinoma mu situ, kenako pancreatic cystadenocarcinoma.

Malinga ndi ultrasound ndi CT, pafupifupi 20-30% ya milandu, kuwunika kwa khoma lake lakunja kwapezeka. Nthawi zina, pakafukufuku wa kafukufuku wa CT wokhala ndi chotupa chamkati, ndimatha kuzindikira kuchuluka kwa kusiyana pakati pazigawo ndi khoma la chotupa cha cystic (onani mkuyu. 58-12). Mitsempha ya Collateral mkati mwa chotupa cha cystic imatha kupezekanso ndi ma ultrasound mumapangidwe obwereza, chifukwa cha kukhalapo kwa mitsempha yamagazi mumagulu azinthu komanso khoma la chotupa cha cystic.

Mkhalidwe wopumira wa kapamba ndizofunikira kwambiri pakuwunika chotupa cha cystic. Ndikofunikira kudziwa kuti ndi zotupa zotere sizikusintha masinthidwe. Nthawi yomweyo, ndi pseudocyst ya kapamba, sclerosis, atrophy, kuphatikiza kwa ma calcication, ndi kukulitsa kwa kutsekeka kwakukulu kwa kapamba nthawi zambiri amapezeka parenchyma yake. Mucinous cystadenoma ndi wofanana ndi pancreatic cystadenocarcinoma. Koma kutengera CT kapena Makina a Ultrasound ndi cystadenocarcinoma wokha womwe ungathe kuzindikira zotupa kulowa m'ziwalo zoyandikana, kuchuluka kwa ma lymph node, kapena metastases yakutali ziwalo zina. Kuti musiyanitse pakati pawo, ndikofunikira kuzindikira zolembera (CEA ndi CA-19-9).

Mwayi wawukulu wofufuzira za cystic chotupa cha kapamba umatseguka MRI. Zimangolandira kulandira ndi kukonza chithunzi cha ziwalo, komanso kuunikanso munthawi yomweyo zinthu zina zam'thupi pakuphunziridwa kwa zithunzi za T1- ndi T2. Izi zitha kugwiritsidwa ntchito podziwitsa ena za serous kuchokera kumtundu wa cystic chotupa. Mu serous cystadenoma, madzimadzi okhathamira amadziwika ndi mphamvu yotsika mu T1 - komanso yayitali - m'chifaniziro cha T2. Chizindikiro chochokera mkati mwa chotupa cha mucinous cystic ndichopepuka kwambiri mu chithunzi cholemera T1.

Kwa ma pseudocysts a kapamba, monga serous cystadenoma, chizindikiro chotsika kwambiri mu chithunzi cholemera T1 komanso chokulirapo mu chithunzi cholemera T2 chimadziwika. Komabe, kukhalapo kwa kuwundana kwa magazi kapena zolembera mkati mwa pseudocyst zitha kusintha mawonekedwe a chizindikiro cholandiridwa.

Magnetic Resonance Pancreaticocholangiography imakupatsani mwayi wokhazikitsa mgwirizano pakati pa cyst ndi kupendekera kwakukulu kwa kapamba. Ndi zotupa za serous ndi mucinous cystic, ubalewu mulibe. Ndipo ndi chotupa chachikulu cha papillary-mucinous-mucinous, m'malo mwake, cholowerera chachikulu cholumikizidwa ndi patsekeke la cyst ndi imodzi mwazinthu zazikulu zosiyanitsa matenda.
Komabe, kutsata kwa ultrasound ndi CT pakuwunika kwa zotupa za cystic sikupitirira 50-60%. Kuchuluka kwamaganizidwe olakwika kumachitika ndi mitundu ya oligocystic ya kapangidwe ka chotupa cha cystic.

Muzovuta zokayikitsa, momwe mawonekedwe a cystic lesion ya kapamba amakhalabe osamveka, ndikofunika kugwiritsa ntchito TAB yoyipa cysts zotsatirazi biochemical ndi cytological kusanthula. Njira imodzi yodalirika yopezera matenda am'mapazi mu kapamba ndi njira endoscopic ultrasoundchigamulo chachikulu.

Yogwira ntchito opaleshoni njira zochizira mucinous cystadenoma mosasamala kanthu za kukula kwake, zomwe zimachitika chifukwa cha chiwopsezo chachikulu cha zilonda zamtunduwu wa cyst. Pakati pa njira zamankhwala othandizira opaleshoni, kuchotsedwa kwathunthu kokha kumakhala kovomerezeka, nthawi zambiri ndi reseanc of pancreas ofanana pambuyo pakupunthwa, biopsy, cytological ndi histological kutsimikizira kuti wapezeka.

Tiyenera kukumbukira kuti khoma la chotupa cha cystic nthawi zambiri imakhala ndi malo osowa. Zidutswa zingapo khoma la cyst zimayenera kufufuza, zomwe zimapezeka makamaka malo omwe minofu yolumikizira minofu imapezeka.

Intraductal papillary-mucinous chotupa

Izi ndizosowa komanso ndizovuta kudziwa chotupa. Zimachitika pazaka zilizonse. Amayamba kuchokera ku epismatic, mucin yopanga epithelium yayikulu kapena yam'mbuyo malekezero a kapamba ndipo amapangidwira makamaka pamutu kapena pakuwoneka ngati mbedza. Zotupa zotere zimawonetsedwa ngati ma bulugulu a papillary epithelial, amatulutsa ntchofu wandiweyani ndipo amaphatikizidwa ndi kufutukuka kwakukulu kwa zofunikira zazikulu ndi zamkati za kapamba. Nthawi zina, pamakhala chotupa chachikulu cha gawo lililonse la gland. Chotupa chamtunduwu chili ndi chiwopsezo chotheratu chodwala.

Chifukwa chakuti palibe njira imodzi yofufuzira zothandizira, kupatula morphological, yomwe imatha kudziwa malire owona a kufalikira kwa chotupacho m'mphepete mwa ma ducts, njira yayikulu yothandizira ndi pancreatectomy yonse. Nthawi zina, kuchotsa chofufumitsa mkati mwa malire osintha mwakuwonekera poyesedwa mwachangu kwa zigawozo ndizovomerezeka.

Opaleshoni yamapulasitiki okonzanso kumapazi

Chimbudzi ndi chimodzi mwazinthu zazikulu kwambiri zam'mimba, imagwira ntchito ya kapangidwe ka mahomoni ndi ma enzymes ofunikira kuti tiwonetsetse njira yogaya ndi kugaya zakudya. Pochiza ziphuphu pakuchita opaleshoni, opaleshoni ina yowonjezera pulasitiki imafunikira kuti ibwezeretse ntchito m'mimba, yomwe imafunikira katswiri woyenera.

Muli ndi tinthu tating'ono tating'ono tokhala ndi ma ducts. Zilonda zopweteka ndi zotupa zimatha kupangidwa kuchokera ku maselo a glandular, ndikukula kwa njira yotupa, ma cysts ndi zotupa zimatha kuchitika gland, ndipo miyala imapangika m'mizere yake. Zochizira matenda awa, osiyanasiyana opaleshoni yam'mimba:

• pancreatic cyst - ntchito zimaphatikizapo kupatukana kwa mapangidwe athupi lathupi lathunthu ndi mtsempha wamagazi.
• miyala ya kapamba - opaleshoniyo imagwira ntchito kwambiri matendawa ndipo imaphatikizapo njira zingapo zopangira madzi otuluka a pancreatic. Kuchotsa miyala imodzi, pancreatotomy imachitika - kugawa kwa minofu pamwamba pa mwala ndi kutulutsa kwake. Ndi miyala yambiri, duct imatseguka kuchokera mchira wa gland,
• kuchotsedwa kwa kapamba - ntchito chikuwonetsedwa pakuwonongeka kwakukulu kwa ziwalo chifukwa cha kuvulala, khansa, kapamba.

Ndikupanga njira zoyipa mthupi, opaleshoni ndiyo njira yokhayo yamankhwala. Kuchiritsa kwathunthu kumatheka pokhapokha ngati metastasis ilipo ziwalo zina.

Ngati chotupa chili m'mutu wa kutulutsa, njira ya pylorus nthawi zambiri imakondedwa, yomwe, mosiyana ndi chikhalidwe cha Whipple, imakupatsani mwayi wopulumutsa m'mimba. Izi zimawongolera moyo wa wodwalayo, chifukwa samayenera kuthana ndi zovuta za mayesedwe am'mimba (mwachitsanzo, matenda otupa).

Opaleshoni Yapancreatic - CONSEQUENCES

Pancreatectomy itha kuchitidwa m'njira ziwiri. Ngati chotupa chapezeka kumtunda kwa chithokomiro, opaleshoni ya Whipple imalimbikitsidwa, yomwe imakhala ndikuchotsa mutu ndi gawo la duodenum, komanso mbali yam'mimba, chikhodzodzo cha ndulu, ducts ya bile. Pa gawo lotsatira, gawo lazakudya kudzera m'matumbo ndi pulasitiki ya duodenum ndi bile ducts limabwezeretseka.

Mu opaleshoni iyi, kuphatikiza pakuchotsa kapamba ndi minyewa yoyandikana nayo, gawo lofunikira kwambiri la opaleshoni yothandizidwa ndi gawo la kumanganso ndikupanga kutulutsa kwa pancreatic secretion ndi bile ku chitsa. Pa nthawi ya opareshoni, gawo ili la mgawo wama mgonero "limakumananso" ndikupanga ma anastomoses otsatirawa:

• gawo lam'mimba ndi jejunum,
• kukoka kwa chitsa ndi chimbale cham'mimba,
• wamba bile duct ndi matumbo.

Anastomosis ndi chida chopanga (malupu kuchokera m'matumbo, michere ya chiuno cham'matumbo ndi bile duct), chomwe chimakupatsani mwayi wambiri kuti muzidutsa timadzi timadziti.

Itha kugwiritsidwanso ntchito njira ya chimbudzi cha kapamba m'mimba, osati m'matumbo (pancreatogastroanastomosis). Njira zonsezi zimafunikira owonjezera opaleshoni yapulasitiki yowonjezera kuti abwezeretse ntchito ya m'mimba, yomwe imafunikira katswiri woyenera kwambiri.

MALANGIZO OTHANDIZA NTCHITO YA KUSONYEZA KUTSOGOLA

Zosankha zambiri ndi njira zapangidwe kuti zimangidwenso pamimba. Njira yodziwika bwino imaphatikizapo kuzunza chitsa cha ndulu ndi m'mimba ndi jejunum. Pancreatic-gastric kapena pancreatic-m'mimba anastomosis amapangidwa ndi njira ziwiri:

kugwiritsa ntchito kulowetsa kapena intussusception, komwe kumasonyezedwa kapamba wofewa wokhala ndi kapisozi kofooka komanso mawonekedwe wamba a pancreatic duct,

mucosal mucosa njira, yomwe imakhudzanso kuzungulira kwa kapamba komanso mucous membrane wam'mimba kapena jejunum. Njira iyi imagwiritsidwa ntchito pakuwonjezeka kwa kapamba wa pancreatic komanso kuwonjezeka kachulukidwe ka m'matumbo a gland chifukwa cha chifuwa chachikulu.

NTHAWI YA POSTOPERATIVE

Pancreas kuchotsa opaleshoni kumafuna michere yogaya komanso chakudya.

Kuyesedwa kwa shuga kwa shuga kumalimbikitsidwanso, chifukwa kulowerera kwa pancreatic kumawonjezera chiopsezo cha matenda a shuga. Kuyesedwa kumachitika kawiri pachaka pogwiritsa ntchito kuwunika kwa magazi. Kuphatikiza apo, kuyesedwa kokulirapo kwa glucose kungachitike. Ngati mukukumana ndi mavuto azakudya zopatsa thanzi, chakudya chimafunika.

Moyo pambuyo pakuchita opaleshoni yamapamba: zotsatirapo zake ndi ziti?

The Great Pirogov nthawi ina adati: "Ntchito ndi chamanyazi pamankhwala." Izi ziyenera kuwonjezeredwa - kwa wodwala nayenso.

Kufunitsitsa kwathu kuchiza matenda oyambira, kuyembekezera kuti zidzadutsa nthawi, komanso kunyalanyaza kwa zoyambira zamakhalidwe oyenera kumatitsogolera patebulo. Mwadzidzidzi.

Kuchita kulikonse kumapanikizika kwambiri. Opaleshoni ya pancreatic mu 25% yamilandu imatsogolera kuimfa, ndipo mu 100% kulemala. Kutalika kwa moyo wa odwala pambuyo pakuchita opaleshoni ndizochepa.

Mitundu ya kulowererapo kwa opaleshoni yaziphuphu

Masiku ano, ma pancreas amachitika pogwiritsa ntchito njira zotsatirazi:

Nthawi ya opareshoni, zovuta zambiri zimayamba chifukwa cha kapangidwe kake, malo ndi physiology.

Iron amakhala ndi glandular, minofu yofewa. Kuzisenda ndizovuta kwambiri, zitha kuwonongeka ndikugunda kosavuta ndi chala.

Ichi ndi chiwalo chosagwiritsidwa ntchito, gland ili pafupi ndi impso, mozungulira pali mitsempha, m'mimba msempha, mtsempha wamagazi, ducts ya bile, ndipo ndi duodenum imakhala ndi magazi ambiri. Nthawi zambiri mukachotsa gawo la chindayo, mumayenera kuchotsa duodenum. Kufika ku chiwalochi popanda kuwononga minofu yoyandikana nako kulinso kovuta.

Chifukwa cha kuchuluka kwa ma enzymes omwe chitsulo chimapanga, zikavuta, ma enzyme amatha kugaya chitsulo icho, m'malo mwa chakudya. Ngati pa opaleshoni enzyme italowa m'magazi, ndiye kuti nthawi yomweyo pamadzayamba kugwedezeka kwambiri.

Chifukwa cha mawonekedwe a chiwalochi, maselo otupa, ma cysts, ma absout, ndipo miyala imatha kupanga maselo ake. Zonsezi zimatha kuchiritsidwa kokha ngati akuchita opareshoni.

Opaleshoni yamatenda a pancreatic siachilendo chifukwa cha zovuta zake komanso anthu ambiri omwalira. Zifukwa zingapo ndizizindikiro zakwaniritsa:

• kapamba,
• zotupa, zoyipa ndi zoyipa,
• kuvulala ndi kuwonongeka kwa ndulu zambiri,
• chitukuko
• zoperewera
• peritonitis
• miyala m'miyenje yotsekedwa
• zotupa ndi fistulas.

Ntchito nthawi zambiri zimachitika m'magawo angapo, chifukwa ndizosatheka kugwira ntchito yonse nthawi imodzi.

Khalidwe la kapamba m'matenda ake silikudziwika, zomwe zimapangitsa kuti matenda ambiri kapamba asadziwike. Pali mkangano waukulu wokhudza matenda ambiri.

Lero, kutsegula kwa gland ndikotheka, koma wodwalayo azikhala ndi moyo zaka zitatu. Chitsulo sichimalola kusayenda kwa magazi kwa nthawi yoposa theka la ola. Mukazizira, amatha kugwiritsa ntchito, osaposa maola asanu. Ikagulitsidwa, samaikidwa m'malo mwake, koma peritoneum.

Kuthana kwa kapamba ndi njira yopanda chiyembekezo kwambiri pakuika.

Chifukwa cha zovuta zambiri zaukadaulo, kutsegula tiziwalo sikumachitika. Kufufuza kukuchitika njira zatsopano zogwirira ntchitoyo, kafukufuku akuchitika pankhani yopanga zolaula.

Zomwe zikuchitidwazo ndizosiyana, njira zothandizira ndizotengera ndizambiri, zosankha khumi ndi zisanu:

• kulimbikitsa zotupa zapanyumba,
• neurectomy
• cystoenterostomy,
• Marsunialization of the cyst
• mbali yakumanzere,
• papillotomy ndi ena.

Opaleshoni imachitidwa ndi opanga maopaleshoni odziwa bwino milandu pazofunikira kwambiri.

Kutalika kwa chithandizo cha wodwalayo pambuyo pakuchita opaleshoni zimatengera mkhalidwe waumoyo wake chisanachitike komanso njira yakuchitidwa opereshoni yosankhidwa ndi dokotala.

Matendawa omwe amafunikira kuchitira opaleshoni, atatha kukhudza wodwalayo, amasankha njira zodzitetezera ndi moyo wa wodwalayo.

Ndikosatheka kubwezeretsa ziwalo zochotsedwa; Pambuyo pakuchita opaleshoni, munthu amavutika chifukwa cha kusowa kwa mahomoni ndi ma enzyme mu gawo lochotsedwa;

Nthawi yochira pambuyo pogwira ntchito pa kapamba, wodwalayo wakhala m'dipatimenti yokhazikitsanso chipatala kwanthawi yayitali. Nthawi zambiri pamakhala zovuta zingapo za postoperative:

• peritonitis
• magazi
• kuchuluka kwa matenda ashuga
• kulephera kwa aimpso
• kulephera kwazungulira.

Kuchira kuchipatala komwe kumakhalapo mpaka miyezi iwiri kuchipatala, kugaya chakudya kuyenera kuzolowera momwe zinthu zasinthira.

Pambuyo pakuchita opaleshoni, munthu amamuthandizira kuti azidya zakudya zina. Kutalika kwa nthawi ya chakudya chamagetsi kumathandizira kuti achire. Zakudya zamkati zimachitika kuyambira masiku 5 mpaka 10. Kuchita izi kumathandiza kuchepetsa zovuta pambuyo pa opaleshoni.

Njira zothandizira odwala pakukonzanso odwala zimaphatikizaponso njira zotsatirazi:

• kudya okhwima
• masewera olimbitsa thupi nthawi zonse
• kugwiritsa ntchito insulin kuwongolera shuga,
• kugwiritsa ntchito ma enzymes pogaya chakudya.

Kuyang'anira wodwalayo nthawi zonse wodwalayo ndikofunikira kuti pakhale zovuta.

Pakupita milungu iwiri kuchokera ku chipatala, wodwalayo amalimbikitsidwa kupumula komanso kugona.

Kuyenda, kuwerenga mabuku ndi zochitika zina zolimbitsa thupi kumawonjezera dongosolo la wodwalayo malinga ndi thanzi lake, ndizosatheka kugwira ntchito mopitirira muyeso.

Njira yakuchiritsira imapangidwa ndi adotolo atatha kudziwa mbiri yachipatala, kuyerekezera kwa mayeso asanachitike kapena atachitika opereshoni.

Pazakudya, kumwa mowa, mafuta, zonunkhira komanso acidic sayenera kupatula.

Ngakhale mkhalidwe waumoyo wa anthu pambuyo pochita opaleshoni umatengera njira ya kukhazikitsidwa kwake, mtundu wa njira zakuchipatala pambuyo pake, ziwopsezo zakufa pambuyo pakuchita opaleshoni zimakhalabe zochuluka.

Opaleshoni ya pancreatic (pancreatectomy) nthawi zambiri amalembera chithandizo cha khansa. Pogwira opaleshoni, amatha kuchotsa zonse kapena gawo la gland. Amathanso kuchotsa ziwalo zoyandikana, monga:

• - ndulu ndi ndulu,
• - ma lymph malo,
• - gawo lamatumbo ang'onoang'ono kapena m'mimba.

The m'tsogolo pambuyo opaleshoni pa zikondwerero zimatengera zinthu zambiri:

• - njira ya opareshoni,
• - wodwala anali wotani,
• - mtundu wa njira zopatsirana komanso njira zochizira,
• - Zakudya zoyenera komanso chisamaliro chodwala.

Kuchotsa kwa cysts, pachimake kapamba, miyala mu kapamba ndi zina zokhudzana ndi zamankhwala zomwe zimachitidwa opaleshoni ndipo pomwe ziwalo zonse zimachotsedwa kapena gawo lokhalo silimakhudza zomwe wodwalayo amakhala nazo komanso kudwala kwakukulu.

Mwachitsanzo, opaleshoni yokhala ndi khansa ikuwopseza kubwezeretsanso. Pachifukwa ichi, kudalirika kwa kupulumuka pambuyo pa opaleshoniyo sikokwanira kwambiri. Kwa odwala khansa, atachitidwa opaleshoni, ngati pali zovuta zilizonse zosasangalatsa, mayeso ena owonjezera amalembedwa kuti azindikire kukula kwa kubwereranso kwa khansa komanso kukula kwa metastases panthawi.

M'nkhalango yamdima ya malo ophunziridwa bwino a matenda ndi opaleshoni ya pancreatic, pali kuwala kwa chiyembekezo komwe madokotala a naturopathic amatipatsa.

Katswiri wodziwika bwino pankhani yopatsa thanzi Arnold Eret adalemba kumayambiriro kwa zaka za zana la 20: "Matenda onse, kupatula, amabwera kokha kuchokera ku chakudya chosadziwika komanso kuchokera ku gramu iliyonse ya chakudya chochuluka." Ganizirani za momwe zakudya zopanda chilengedwe zidakhalira kumayambiriro kwa zaka za m'ma 2000.

Kuti muchotse matenda, simukuyenera kukhala chakudya chophika kapena chakudyacho, muyenera kungotsatira mfundo zachikhalidwe zopatsa thanzi, zomwe Eret adalatchula m'buku lomwelo.

Anthu amayang'ana zomwe zimayambitsa matenda pachilichonse - matenda, kutupa kwadzidzidzi kwa ziwalo, zoperewera, koma osati chakudya. Chifukwa chake, zomwe zimayambitsa matenda ambiri masiku ano ndizosamvetsetseka komanso zosamveka. Werengani zomwe zimayambitsa matenda mu encyclopedia yachipatala - sizidziwika nthawi zonse.

Chizolowezi ndichulukiridwe kakhumi kuposa momwe thupi limafunikira, ndipo pazakudya zopanda pake, zimasewera nthabwala zoyipa ndi anthu.

Matenda aliwonse amatanthauza kupezeka kwa zinthu zakunja, ndiye kuti, poizoni m'thupi la munthu. Kuwachotsa kumatha kukhala kosavuta komanso kovuta panthawi imodzimodzi.

Kuphweka kumakhalapo pazoyesedwa zodziwika bwino: kuchepetsa kwambiri chakudya kuti ayeretse thupi. Zakudya ziyenera kukhala zachilengedwe komanso zachilengedwe. Kuchita masewera olimbitsa thupi kumathandizira njira yoyeretsera thupi. Malo osambira dzuwa ndi othandiza kwambiri pochiritsa thupi. Malo osambira mpweya siwofunikira kwenikweni monga malo osambira madzi, chifukwa mpweya ndi wofunikira kwambiri kwa thupi kuposa chakudya.

Zakudya pambuyo opaleshoni pa zikondamoyo

Mfundo yofunikira kwambiri pambuyo poti papamba pancreas imawonedwa ngati chakudya, komanso zakudya zochizira. Pambuyo pa kulowererapo, ziwalo zogaya chakudya sizingagwire ntchito mokwanira. Kugwiritsa ntchito zakudya kumachepetsa katundu wawo. Zakudya zamagulu ake komanso nthawi yake imaperekedwa ndi dokotala.

Nthawi zambiri, ndimadwala komanso ma pathologies, odwala ayenera kusiya zinthu zilizonse zomwe zimapangitsa kuti michere ipangike. Pambuyo pakuchita opaleshoni pa kapamba, kugwira ntchito kwake kuyenera kulipidwa ndi mankhwala. Dokotala wanu angakupatseni jakisoni wa insulin kuti achulukitse shuga. Komanso, madokotala nthawi zambiri amapereka vitamini A, E, K, D, ndi B12.

Zakudya zothandizapo pambuyo pa ntchito nthawi zambiri zimakhala ndi izi:

1) Zakudya zopanga:

- pogwiritsa ntchito kafukufuku,

2) Mtundu wachilengedwe wazakudya.

Pambuyo pa opaleshoni, zakudya zamagetsi zimakhala ndi zotsatirapo zabwino.

Mankhwala othandizira pakadali pano ali ndi magawo otsatirawa:

Gawo loyamba. Zakudya za makolo okha masiku 7-12. Kutalika kwa gawoli kumatengera zovuta za ntchitoyo.

Gawo lachiwiri. Gawo ili ndikusintha kwa zakudya zachilengedwe ndipo pano amagwiritsa ntchito zakudya zochepa za makolo.

Gawo lachitatu. Wodwala amatchulidwa chakudya chachilengedwe chonse. Ndikofunikira kuwonjezera pang'onopang'ono katundu pazakudya zam'mimba za odwala:

- choyamba, sabata yoyamba, odwala adayikidwa kudya No. 0,

- atatha, sabata lachiwiri, amakupatsani zakudya No. 1a,

- ndiye, sabata lina ndikulimbikitsidwa kuti musinthe kudya No. 1b,

- gawo lotsatira mpaka miyezi iwiri limasankha mtundu woyamba wa zakudya No. 5p,

- ndiye kwa miyezi isanu ndi umodzi kufikira chaka chimodzi, chakudya chachiwiri Na. 5p ndi mankhwala.

Pambuyo podwala wodwala kuchokera kuchipatala, ndikofunikira kuchepetsa izi:

- zonunkhira ndi zokometsera,

- chakudya ndi CHIKWANGWANI chamafuta.

Chakudya cha wodwalayo chimayenera kukhala ndi mapuloteni, ndipo pang'ono ndimakhala mafuta, shuga ndi chakudya.

Nthawi yonse ya postoperative, wodwalayo ayenera kuyang'aniridwa mosamala ndi madokotala kuti ateteze mitundu yosiyanasiyana ya matenda.