Kodi matendawo ndi otani pambuyo pakuchita opaleshoni ya pancreatic pancreatic necrosis?

Kukhazikitsidwa kwa opaleshoni ya pancreatic necrosis (matenda oopsa a kapamba) nthawi zambiri imawerengedwa kuti ndiyo njira yokhayo yopulumutsira moyo wa wodwalayo. Zizindikiro zakuthandizira opaleshoni, njira za kukhazikitsidwa kwake, ndi zovuta za kukonzanso ziyenera kuganiziridwanso mwatsatanetsatane.

Zambiri za pancreatic necrosis

Ndi necrotic pancreatitis, gawo limodzi mwa kapamba limamwalira. Ichi ndichifukwa cha pathological momwe minofu yama michere yopanga thupi. Izi nthawi zambiri zimaphatikizidwa ndi kufalikira kwa matendawa kapena kukulira kwa kufalikira kwina kwa matendawa.

Mitundu yotsatirayi ya pancreatic necrosis ndi:

1. Pachimake edematous.
2. Hemorrhagic.
3. Zachangu.
4. Zopepuka.
5. Zowononga zowononga.

Udzu wabwino kwambiri wa edematous pancreatic necrosis. Vuto lowopsa kwambiri ndi peritonitis. Matendawa akamakula, amafunika kuchitidwa opaleshoni mwachangu. Kupanda kutero, sepris ya purulent imayamba ndipo wodwalayo amafa patangotha ​​maola ochepa.

Zomwe zimayambitsa pancreatic necrosis

Cholinga chachikulu cha khansa ya pancreatic ndi kugwiritsa ntchito mankhwala osokoneza bongo kwa nthawi yayitali. Pafupifupi 25% ya odwala ali ndi mbiri ya cholelithiasis. Pafupifupi 50% ya odwala omwe ali ndi vutoli nthawi zambiri amadya kwambiri. Zakudya zawo zimakhala ndi nyama yokazinga, yosuta, mafuta.

Zifukwa zina za chitukuko cha pancreatic necrosis zimaphatikizapo:

• kuvulala kwam'mimba
• Kupita patsogolo kwa zilonda zam'mimba,
• kulowetsa kachilombo
• kukula kwa matenda opatsirana,
• zilonda zam'mimba.

Chochititsa china chokhalitsa ndi kukhala nthawi yayitali m'mavuto opanikizika. Nthawi zina pancreatic necrosis imayamba motsutsana ndi maziko osayenera a mankhwala ena.

Magawo a chitukuko cha necrotic pancreatitis

Kukula kwa pancreatic pancreatic necrosis kumachitika m'magawo. Zonsezi zimayamba ndi toxemia. M'magazi a wodwala, ziphe zomwe zimakhala ndi mabakiteriya zimapezeka. Michere yomwe imatulutsa mabakiteriya sipezeka nthawi zonse.

Gawo lachiwiri, chikopa chimawonedwa. Nthawi zina zimakhudza ziwalo zapafupi. Maonekedwe a kusintha kwa purulent m'matumba a pancreatic ndi amtundu wa magawo atatu.

Zizindikiro zazikulu za matenda

Chizindikiro chachikulu cha matendawa ndi kupweteka. Imachitika kumanzere kwa m'mimba. Mphamvu yake imagawika m'mitundu inayi:

Nthawi zina ululu wammbuyo umafalikira kumanzere kumtunda kwa dzanja kapena lumbar. Kutentha kwa thupi kumakwera, nseru imayamba, kusanza kumatseguka, ndipo chopondapo chimasokonekera.

Poyerekeza ndi kumbuyo kwa zovuta za purancicic pancreatic necrosis, wodwalayo amatuluka thukuta kwambiri. Amanjenjemera komanso kutentha thupi. Anthu ena ali ndi zizindikiro za kulephera kwa impso. Matenda a dongosolo la mitsempha nthawi zina amapezeka. Ndi chithunzi chowawa kwambiri chodwala, wodwalayo amagwa.

Mankhwala othandizira

Ngati zilonda zam'mimba zimayambira pancreatic pancreatic necrosis, zotsatira zakupha ndizotheka. Chifukwa chake, wodwalayo amapatsidwa ntchito yofunikira mwachangu.

Dokotalayo amachotsa minofu yakufa. Gawo lotsatira ndikubwezeretsa duct conduction. Ngati chithandizo sichimabweretsa zotsatira zomwe zimafunikira, opaleshoni yachiwiri imayikidwa. Kwa odwala 48%, zimatha bwino.

Chifukwa chiyani odwala amafa

Chiwerengero cha anthu omwe amafa ndi matendawa ndiokwera kwambiri. Amasiyana 20 mpaka 50%. Choyambitsa chachikulu chaimfa ndi kuchedwa kwa septic komanso zizindikiro zoyambirira za poizoni. Zimayenda ndi ziwalo zingapo. Amapezeka mwa odwala anayi alionse omwe ali ndi vutoli.

Chinanso chomwe chimapangitsa kuti wodwalayo afe ndi vuto loopsa lomwe limabweretsa. Zimakwiya chifukwa cha zovuta za matendawa.

Matenda a pancreatic necrosis ndi osauka ndi:

• kukhalapo kwa kusintha kwodalirika mu necrotic foci,
• kusintha kwamapangidwe amisempha ndi maselo a ziwalo,
• mapangidwe a necrotic foci.

Kuthekera kwa kufa kwa wodwala kumasiyana maola 3-4 mpaka masiku awiri. Nthawi zambiri, wodwalayo amakhala ndi moyo wopitilira masiku 14.

Kuchiritsa kwa kapamba

Pambuyo pa opaleshoni, wodwalayo akuwonetsedwa zotsatirazi zochizira:

1. Physiotherapy.
2. Ochita masewera olimbitsa thupi odekha.
3. Kutikita minofu.

Kugwirira ntchito kwambiri kwa anthu kumatsutsana. Mukatha kudya, ndikofunikira kuti mupumule. Zochita poyenda zimasinthidwa ndi adokotala.

Yankho la funso ngati zikondazo zimachira pambuyo pancreatic necrosis zitha kupezeka kuchokera kwa gastroenterologist kapena endocrinologist. Kuyambiranso ntchito za thupili ndizotheka mothandizidwa ndi njira zoyeretsera. Koposa zonse, kulowetsedwa kwa chiphalaphala kumathandiza.

Kuti mukonzekere bwino, muyenera kubzala masamba 10 a mbewu 200 ml mu thermos. madzi atsopano owiritsa, tsimikizani maola 24. Tengani 50 g. theka la ola musanadye.

Pofuna kubwezeretsanso michere ya chiwalo, wodwalayo adayamwa kutenga Creon, Pancreatin, Mezim-forte. Muli proteinase, lipase, komanso amylase. Zinthu izi ndizofanana ndi ma enzyme omwe amapangidwa ndi kapamba.

Moyo pambuyo pancreatic necrosis mankhwala

Pambuyo pa opaleshoni, wodwalayo amakhala dispensary. Pakatha miyezi isanu ndi umodzi, munthu amayeserera kugaya chakudya. Amawonetsedwa gawo la ultrasound. MRI yam'mimba nthawi zina imakhazikitsidwa.

Moyo wa wodwala pambuyo pancreatic necrosis ya kapamba umasiyanasiyana. Amupatsa zakudya zoyenera kwambiri. Ndikofunikira kupatsa zakudya zazakudya zambiri. Chakudya chiyenera kutenthetsedwa. Kugwiritsa ntchito zakumwa zoledzeretsa, zakumwa zoledzeretsa sizimaphatikizidwa. Phindu lalikulu kwa thupi ndikukana maswiti.

Munthu akasiya chakudyacho, moyo wake umachepa. Machitidwe a latent akachitika, mndandanda wazinthu zololedwa zimatha kukulitsidwa.

Mwa odwala ena atachitidwa opaleshoni, kuthamanga kwa magazi kumachepa ndi 20%. 30% ya anthu ali ndi mavuto akulu ndi ziwalo zawo zamasomphenya. Ambiri amakhala akhungu. Nthawi zina ochepa hypoxia amapezeka m'mapapo. Ma syndromes owala a kupuma amayamba. Odwala ena amakhala ndi chotupa choopsa.

Kupeza chilema ndi pancreatic necrosis

Kulemala kumachitika ndi vein thrombosis komanso kukhalapo kwa zilonda zam'mimba. Ndi malire ochepera amoyo, wodwalayo amalandira gulu 3. Ngati munthu wapezeka ndi vuto logaya chakudya mozama, amapatsidwa magalamu awiri. Kulumala 1 gr. kuperekedwa pokhapokha ngati pali chiyembekezo cha kufa posachedwa.

Kodi ndizotheka kutero popanda kuchita opareshoni

Ndi pancreatic necrosis, pazifukwa zosiyanasiyana, njira ya kudzimbidwa kwa kapamba ndi michere yake yomwe imachitika. Malingaliro a madokotala okhudza njira ndi njira zochiritsira matenda amtunduwu amasiyana kwambiri. Izi zimachitika chifukwa cha kufa kwakukulu kwa odwala panthawi yochizira komanso panthawi ya opareshoni.

Ndi kuwonongeka kwa ziwalo zopitilira 50%, opaleshoni ndiyofunikira. Koma ngati matendawa sanapite patali ndipo alibe zovuta, ndiye kuti wodwalayo ayambe kulandira chithandizo chamankhwala chomwe chimaphatikizapo:

• Kukhazikitsidwa kwa anti-bacterial antibacterial mankhwala,
• kuchotsa kwa zizindikiro zazikulu,
• kusala kwakanthawi kochepa
• chakudya chapadera.

Mlingo wa ngozi yakufa ndi matenda awa munthawi ya opaleshoni kapena pambuyo pa opaleshoni ndiukweza kwambiri. Mchitidwewu ndi wovuta, wolekeredwa bwino ndi odwala, chiopsezo cha zovuta zimakhala, chifukwa chake, kumayambiriro kwa matendawa, kutsindika kumakhala pa chisamaliro chachikulu. Pambuyo masiku 5 a chithandizo chosagwira bwino, kuchitapo kanthu kwakukulu kumachitika.

Ndani akufunika opaleshoni?

Zomwe zikuwonetseratu kuti munthu wodwala opaleshoni yapadera ndi matenda a necosis ndi:

• matenda a kapamba,
• hemorrhagic mayamwidwe,
• peritonitis
• michere ya enzymatic,
• kufalikira kwa kutsekeka kwa necrosis m'mitsempha ya ziwalo zoyipa kupita ku ziwalo zoyandikana,
• chithuzi,
• phlegmon
• Kulephera kwa njira zochizira mosamala.

Kuchita opaleshoni mwadzidzidzi kwa pancreatic necrosis kumachitika ndikukula kwa mtima, aimpso kapena kulephera m'mapapo. Kuopsa kwa kupanga kwa abscess popanda malire (phlegmon) mu kapamba ndikuti mafinya amatha kufalikira thupi lonse mwachangu kudzera mumitsempha ya magazi kapena magazi. Ndi peritonitis, madzimadzi ambiri amawonekera m'malo a retroperitoneal, omwe amafunikira kutulutsidwa mwachangu.

Mothandizidwa ndi hemorrhagic mchikakamizo cha njira yomwe ikukula msanga mu kapamba ndi peritoneum, m'mitsempha yodzala ndi magazi.

Zithandizo za opaleshoni za pancreatic necrosis zimagawidwa m'magulu akulu awiri:

Pomwe zingatheke, adotolo amayesetsa kuchita zodzithandizira pogwiritsa ntchito njira zowononga zachilengedwe popanda kutsegula m'mimba. Kugwirira ntchito mwachindunji kumawonjezera ngozi yakufa.

Kutengera ndi nthawi yamachitidwe osinthika, njira zopangira opaleshoni ndizo:

• mwadzidzidzi (atangolowa kuchipatala),
• mwachangu (pasanadutse masiku atatu chichitikireni kuukira),
• mochedwa (patatha milungu iwiri).

Malinga ndi ziwerengero zamankhwala, kuwonjezereka kwaimfa kumachitika pambuyo povulala mwadzidzidzi komanso mochedwa.

Opaleshoni mwachindunji

Opaleshoni yachindunji nthawi zonse imagwirizanitsidwa ndi:

• chiopsezo chachikulu chotenga kachilombo ka ziwalo zapafupi ndi m'mimba,
• kutaya magazi ambiri,
• kuwonongeka kwa m'mimba.

Opaleshoni yotseguka imagawidwa m'magulu awiri:

• mawonekedwe okhudzana ndi kuzungulira kwa thupi kapena mchira wa kapamba,
• kuteteza-organic (organ abdominization, sequestrectomy, necrectomy).

Mukamagwira ntchito yoyeserera monga momwe zikuwonekera, komanso kuchotsa kwa mbali ya kapamba, ziwalo zowonongeka - ndulu, ndulu ya ndulu imatha.

Ndi chithandizo cha opaleshoni kuti tisunge chiwalo, minofu yakufa, madzimadzi, magazi kapena mafinya amachotsedwa. Kenako pangani kukonzanso kwina kwa thupi, ngalande zimakhazikitsidwa.

Ngati pali zovuta zosiyanasiyana mkati mwa opaleshoniyo, ntchito ikuwathetsedwa.

Zowononga zochepa

Ntchito zowononga pang'onopang'ono zimawonedwa ngati njira yofatsa yopangira opaleshoni ya pancreatic necrosis. Zida zimachitika popanda kutsegula pamimba ndi singano yapadera moyang'aniridwa ndi zida zaposachedwa. Ntchito zoterezi zimachitika pofuna kupukutira exudate (timadzi timene timatulutsa m'mitsempha yamagazi pomwe timatupa) kuchokera kuzinthu zachiwalo ndikuchotsa ma cell omwe adafa. Zinthu zomwe zimapezeka panthawi ya opareshoni zimatumizidwa kuti zikafufuzidwe zasayansi.

Zowonjezera zowononga pancreatic necrosis zimaphatikizapo:

• kuboola - kuchotsera nthawi imodzi kwamadzi kuchokera ku maziko a necrosis a chikhalidwe chosachiritsira,
• drainage - kuchotsedwa kosalekeza kwa exudate kudzera singano ndikusambitsa zotupa ndi antiseptic solution.

Mitundu yotchulidwa yochitira opaleshoni imathandizira kupewa opaleshoni yam'mimba, imawonjezera mwayi wodwalayo, komanso kuchepetsa mwayi wokhala ndi zotsatirapo zoyipa.

Koma nthawi zina njira zakulera izi zimachulukitsa matendawa komanso zimawonjezera vuto la wodwalayo. Muzochitika izi, chithandizo chamankhwala mwachindunji ndichofunikira.

Kukonzanso

Kuchira kwa wodwala yemwe adachitidwa opaleshoni ya pancreatic necrosis kumachitika moyang'aniridwa ndi adokotala am'deralo komwe akukhalamo.

Kukonzanso kwa pancreatic necrosis ikuphatikiza:

• physiotherapy
• Chitani masewera olimbitsa thupi
• achire kutikita minofu
• chakudya
• machitidwe olondola a tsiku ndi tsiku
• ntchito zakunja,
• Kuchotsa kwa zochitika zopsinja,
• kupatula zizolowezi zoipa: mowa ndi kusuta fodya,
• mayeso okhudzana ndi mankhwala azakudya zam'mimba.

Kutalika kwa nthawi yobwezeretsa kwa wodwala aliyense ndiwokhazikika ndipo zimatengera mkhalidwe wake wathanzi, zaka komanso kuuma kwa matenda. Moyo wathanzi komanso zakudya zoyenera ziyenera kutsatidwa moyo wonse.

Mbali yofunika kwambiri yochizira pancreatic necrosis ndichakudya chapadera. Thupi lofooka limayenera kulandira zonse, koma zoletsa pang'ono.

Ndi kuchulukitsa kwa matendawa, masiku angapo asanafike komanso atachitidwa opaleshoni, wodwala amalimbikitsidwa kusala kudya. Chakudya chimachitika ndikulowetsa m'magazi a mitundu yapadera ndi michere yoyenera.

Gwiritsani ntchito madzi oyera kapena kulowerera kwa m'chiuno kwa masiku 4-5 mutachitidwa opaleshoni.

Pang'onopang'ono, zakudya zovomerezeka zimayambitsidwa muzakudya za wodwalayo. Kwa anthu omwe ali ndi vuto la kapamba, m'mimba, chiwindi ndi ziwalo zina zomwe zimagwira ntchito yogaya chakudya, chakudya chapadera cha No. 5 chapangidwa.

Kugwiritsa ntchito zakudya kwa odwala oterewa kumalimbikitsidwa pokhapokha potentha komanso mofunda. Kuvutitsa sikuyenera kuloledwa. Muyenera kudya pafupipafupi, koma pang'ono. Chakudya chopendekedwera chimaloledwa ndi njira yotumiza, kuphika, kuphika. Zakudyazo sizimaphatikizapo zokometsera, zamafuta, zokazinga, zamchere.

Zakumwa zotsatirazi ndi zakudya zam'mimba zimapezeka kwa nthawi yayitali pancreatic necrosis:

• zakumwa zoledzeretsa zamphamvu zilizonse
• zakumwa zoziziritsa kukhosi
• mafuta amitundu yam'madzi ndi nyama,
• msuzi wotentha ndi zokometsera,
• ankasuta nyama
• masamba ophika
• maswiti.

Chithandizo cha mankhwala a pancreatic necrosis. Onani mndandanda wazitsanzo za sabata pano.

Ngati zakudya zotchulidwa ndi katswiri sizitsatiridwa, mkhalidwe wa kapamba angakulire mu wodwala wokhala ndi pancreatic necrosis, zomwe zimabweretsa zotsatira zowopsa.

Mavuto

Kuchita opaleshoni panthawiyi chifukwa cha pancreatic necrosis sikungatsimikizire kuti kulibe vuto la postoperative. Izi zikuphatikiza:

• zotupa zazikulu za purulent,
• fistulas, phlegmon, sepsis,
• magazi amkati
• peritonitis
• mapangidwe a benign cysts,
• matenda ashuga
• lipid kagayidwe kachakudya,
• zovuta m'mimba
• kudzimbidwa
• mtima, m'mapapo, kulephera kwaimpso,
• hypotension
• ma neuroses osiyanasiyana ndi ma psychoses,
• Zizindikiro zakulephera kwamagulu angapo, ndi zina.

Wodwala yemwe ali ndi pancreatic necrosis ayenera kupita kukayezetsa kuchipatala pafupipafupi kuti awone kusintha kosayenera mu kapamba, mkhalidwe waumoyo waumoyo nthawi ndikuchita zofunikira.

Kuzizira kwa pancreatic pancreatic necrosis ndikukhumudwitsa. Chiwopsezo cha kufa m'njira yosayenera matendawa chitha kufikira 70%. Wodwala aliyense amakhala atamwalira. Izi zimachitika chifukwa chovuta kuchitira opareshoni ndi chiwopsezo chachikulu cha mavuto obwera chifukwa cha postoperative.

Zinthu zotsatirazi zimawonjezera chiopsezo cha kufa ndi matenda awa:

• ukalamba
• kukhalapo kwa matenda amodzi,
• kuyimbira foni katswiri,
• kupitilira kwa matenda osalamulirika.

Mkhalidwe wowopsa wa wodwala ukhoza kupitirira mpaka masiku angapo pambuyo pa opareshoni.

Julia, wazaka 54, Saratov

Miyezi isanu ndi umodzi yapitayo, mwamuna wake adachitidwa opaleshoni ya pancreatic necrosis. Choyambitsa matendawa chinali uchidakwa.Anadandaula za kupweteka kwa hypochondrium kumanzere kwa nthawi yayitali, koma sanapezane ndi dokotala. Anagonekedwa m'chipatala ndi odwala kwambiri. Opaleshoni yodzidzimutsa idachitika. Papita nthawi yayitali.

Tsopano mwamunayo amangiratu ndi mowa ndi chikonga, amatsatira kwambiri zakudya, amakhala pamipala ndi sopo. Mukufunadi kukhala ndi moyo!

Egor, wazaka 35, Shatura

Posachedwa, bambo, wokonda mowa komanso zakudya zamafuta, adapezeka kuti ali ndi pancreatic necrosis ya kapamba ndipo adayikidwa opaleshoni yochotsa madera a necrosis a chiwalochi. Opaleshoniyo ikubwera posachedwa, koma madokotala samapereka chitsimikiziro chilichonse. Tsopano abale ake onse ndi bambo ake ali ndi nkhawa. Zimakhalabe ndikupemphera ndikuyembekeza zabwino.

Marina, wazaka 31, Moscow

Nthawi ina kale, madotolo adapeza mayi ali ndi vuto losakhazikika pancreatic necrosis ndipo adapanga kuboola pomwe adapopera madzimadzi kuchokera ku necrotic foci ya chiwalochi. Opaleshoni idayenda bwino, amayi akuchira pang'onopang'ono. Amatsatila zakudya zomwe amandipatsa komanso malingaliro onse a madokotala.