Kuchita opaleshoni ya kanyumba ndi njira yofunika kwambiri komanso yovuta.

Mankhwala, pancreatectomy imawonedwa ngati imodzi mwamagawo othandizira opangira opaleshoni yomwe amachotsa zonse kapena gawo limodzi la kapamba.

Njira yodalirika yothandizirayi imagwiritsidwa ntchito poti chithandizo cha mankhwala sichinaperekenso zotsatira zabwino.

Pali mitundu ingapo ya pancreatectomy, kuphatikizapo:

• pancreatoduodenectomy (njira ya Whipple),
• distal pancreatectomy,
• gawo pancreatometry,
• pancreatometry ambiri.

Njira izi zimagwiritsidwa ntchito kutengera kuzindikira komwe kumachitika kwa wodwala. Koma mwanjira iliyonse, amagwirizanitsidwa ndi kapamba. Tiyerekeze, mutazindikira chotupa cha kapamba, kapena khansa mu chiwalo ichi.

Kuti mupeze yankho lolondola la funso kuti pancreatectomy ndi chiyani, ndi njira yanji komanso momwe mungakonzekere bwino, muyenera kumvetsetsa zomwe zikuwonetsa.

Mndandandawu ukuphatikizapo:

1. Kutupa kwa chiwalo.
2. Necrotizing kapamba.
3. Pancreatitis yayitali ndi ululu.
4. Kuvulala
5. Tumors
6. Adenocarcinoma (85%).
7. Cystadenoma (mucinous / serous).
8. Cystadenocarcinoma.
9. Tumors of islet cell (neuroendocrine zotupa).
10. Papillary cystic neoplasms.
11. Lymphoma
12. Acinar cell chotupa.
13. Mkulu hyperinsulinemic hypoglycemia.

Monga momwe ziliri nthawi zina zonse, kupezeka kwa mankhwala othandizira njirazi kumatsimikiziridwa ndi dokotala wodziwa ntchito. Kuti muchite izi, muyenera kukayesedwa kwathunthu ndi kuzindikira kufunika kochita opareshoni.

Zojambula zamitundu yosiyanasiyana

Opaleshoni yofala kwambiri yomwe imagwiritsidwa ntchito pochotsa gawo la kapamba limatchedwa pancreatoduodenectomy. Amakhala ndikuchotsa gawo la distal gawo lam'mimba, magawo oyambilira ndi achiwiri a duodenum, mutu wa kapamba, chimbudzi wamba cha bile ndi ndulu.

Pancreatectomy yonse itha kugwiritsidwanso ntchito. Mwa zina mwazotsatira za pancreatectomy yathunthu kapena pafupifupi yathunthu, pali zosowa mu endocrine kapena exocrine pancreatic function yomwe imafuna kulowetsedwa kwa insulin kapena michere.

Pambuyo pa opaleshoni yotere, wodwalayo amatenga matenda a shuga a mtundu woyamba, chifukwa chakuti chifukwa cha kulowererapo kwa opaleshoni, kapamba kapenanso kuti palibe. Matenda a shuga amtundu wa 1 amatha kuthandizidwa ndikuwonetsetsa kuti shuga ndi magazi apezeka motani.

Popeza kapambayu ndi amene amapangitsa kuti pakhale michere yambiri yokumba m'mimba, kapamba ayenera kuchitidwa ngati gawo lomaliza. Chizindikiro chake chimakhala matenda oopsa a kapamba omwe amaopseza moyo, monga chotupa cha khansa. Ndikofunika kwambiri kuzindikira kuti ngakhale pambuyo pancreatectomy, ululu umapitilirabe kwa odwala ambiri.

Distal pancreatectomy ndikuchotsa thupi ndi mchira wa kapamba.

Kodi madokotala odziwa ntchito amalosera chiyani?

Pambuyo pancreatectomy yodziwika bwino, thupi silipanganso michere yake pansi pa kapamba kapena insulin, chifukwa chake, odwala amawonetsedwa ndi insulin ndipo amatenga zakudya zama enzyme. Zomwezi zimachitikanso pakakhala matenda a pancreatic necrosis.

Matendawa akusonyeza kuti mothandizidwa ndi michere yakeyake, gawo limodzi la kapamba limataya ntchito ndikufa. Choyipa koposa, pamene chiwalo chonse chimwalira. Chizindikiro ichi chikuwonetsa kuti thupi la munthu silidzatulutsanso kuchuluka kwa mahomoni, ndipo makonzedwe apakhungu a insulin ndi ma enzyme ena amafunikira.

Iwo omwe sanadwalebe matenda ashuga, atazindikira matendawa, mwatsoka, amakhala otero. Chifukwa chake, amakakamizidwa kuti asinthe moyo wawo ndikutsatira malingaliro atsopano a adokotala. Choyamba, muyenera kuphunzira momwe mungayezere index ya glycemic m'magazi ndikuwunika nthawi zonse.

Kuwongolera kotereku ndikovuta ngakhale kwa achinyamata komanso athanzi labwino. Koma popanda izi, thanzi lingawonongeke kwambiri. Komanso, chifukwa cha zovuta za m'mimba, kusowa kwa ma insulin komanso inshuwaransi ya pancreatic, wodwalayo amafunika jakisoni wambiri wa insulin analogue. Izi zitha kukhala zovuta kuzimvetsa kutengera zaka komanso matenda omwe akukhudzana nawo. Pazonse, moyo wa odwala pambuyo pancreatectomy yofananira imafanana ndi moyo wa odwala omwe amakhala ndi mbali yina ya thupilo.

Pali njira ya adjunct yotchedwa islet cell transplantation, yomwe imathandizira kuchepetsa zotsatira za kuchepa kwa endocrine pambuyo pancreas wamba.

Zachidziwikire, nthawi zonse, njira za matendawo komanso njira zamankhwala zimasiyana. Ndiye chifukwa chake, adotolo akhoza kulimbikitsa njira zosiyanasiyana zochiritsira kwa wodwala aliyense.

Kukula kwa opaleshoni ndi nthawi yothandizira

Ponena za momwe zochitika zikuyembekezerera wodwala yemwe adachita izi, ziyenera kudziwidwa kuti zimayambitsa zovuta zazikulu za metabolic ndi exocrine insuffence. Zotsatira zake, kuwongolera odwala matenda ashuga komanso kusamalira thupi kuyenera kuonedwa, ndipo nthawi zambiri zimakhala zovuta kuchita.

Kupulumuka kwa anthu omwe ali ndi matenda owopsa kumakhalabe kosakhutiritsa. Komabe ,imfa ikuwoneka ikuchepa. Izi zimachitika chifukwa chakuti zamankhwala zamakono zikukonzedwa mosalekeza, ndipo chifukwa chake, ukadaulo wa kuchitira opaleshoni ukupitikanso bwino.

Ponena za mtengo wa opareshoni iyi, ziyenera kudziwidwa kuti zimasiyanasiyana kutengera kutengera komwe wodwala wapeza. Koma nthawi zambiri mtengo umayambira ku ma ruble 3,000.

Ndondomeko ya odwala omwe ali ndi zilonda zam'mimbazi komanso zowonda zimafunikirabe pochizira matenda a pancreatic. Komabe, TA imabweretsa zovuta zazikulu za metabolic zomwe zimafuna kuwongolera kosiyanasiyana. Kuwongolera odwala matenda ashuga komanso kusamalira thupi kumakhalabe vuto.

Upangiri wokhudza anthu odwala matenda ashuga komanso opatsa thanzi kuphatikiza ndi insulin, pancreas exocrine, ndi mavitamini othandizira ndizofunikira kwambiri pakuthandizira. Kuwerengera komanso kuchepa kwa thupi ndizofunikira ndipo zimawonetsa kuti odwalawa amafunikira kutsatira mosamalitsa komanso zakudya zopatsa thanzi kwakanthawi.

Kufa komanso kusakhalitsa kwa nthawi yayitali komwe kumalumikizidwa ndi TA kwakhala kukuchepa kwakadutsa makumi angapo zapitazo, zomwe zikuwonetsa kuti zoopsa zimawoneka zovomerezeka poyerekeza ndi mapindu a resection, makamaka kwa odwala omwe ali ndi matenda oopsa. Mwambiri, kupulumuka kumachitika chifukwa cha matendawo, osati pazotsatira zake.

Titha kunena kuti opaleshoni iyi ingakhale yovomerezeka kwa wodwala komanso wophunzira yemwe ali ndi matenda osokoneza bongo a chamba chonse chokhala ndi zilonda zapambuyo kapena khansa yapachibale.

Momwe opaleshoni yamapamba amachitidwira akufotokozedwera kanema munkhaniyi.

Kodi pancreatectomy ndi chiyani?

Mawu akuti pancreatectomy ndikuchotsa minofu ya pancreatic (pang'ono kapena kwathunthu) pakukhumudwa pachimake ndi minyewa ya necrosis kapena khansa ya ziwalo. Ngati khansa yapanga mitundu yoyandikana nayo, ndiye kuti zotupa zimachotsedwa.

Pancreatectomy imawonedwa ngati chothandiza kwambiri pa khansa ya kapamba. Gawo lalikulu kwambiri la limba limatchedwa mutu ndipo limakhala pafupi ndi duodenum 12.

Gawo lapakati la kapamba limatchedwa thupi, ndipo dera loonda kwambiri lomwe limalumikiza nduluyo limatchedwa mchira.

• Nthawi zambiri, zomwe zikuwonetsa kulowererapo ndi zotupa zoyipa mu minofu ya England.
• Nthawi zina kufunika kwa ntchito yotere kumachitika chifukwa cha kupweteka kwa m'mimba mu kapamba.
• Kuchotsa pang'ono kumachitika ngati pseudocysts, fistulas, kapena zoopsa za limba zimachitika, komanso nthawi yowonjezera ya kapamba ndi kusintha kwamapangidwe amisempha.

Kwa zotupa mu kapamba, opaleshoni imatengedwa ngati njira yomwe amathandizira pochizira, koma zimatheka pokhapokha mwa 15% odwala omwe ali ndi vuto lofananalo, pokhapokha ngati njira yotupa imapezeka msanga.

Nthawi zambiri, opareshoniyo akuwonetsedwa ngati zotupa zazing'ono mu mutu wam'mutu popanda zizindikiro za metastasis.

Pancreatic kuchotsa mutu

Malinga ndi mawerengero, zotupa m'mimba ya kapamba zimakonda kutulutsidwa m'mutu. Ngati chotupa chitha kugwira ntchito, ndiye kuti kuchotsedwa kwina kwa ziwalo ndi ziwalo zapafupi kumachitidwa.

Kenako, bile, m'mimba ngalande ndi duct zomangira zimabwezeretseka. Kulowerera kotereku kumatchedwa pancreatoduodenectomy.

1. Wodwalayo amalumidwa ndi jekeseni wothandizila, kudzera mu kuyang'anitsitsa, kulowa kwa chiwalo chomwe chikugwiriridwa kumachitika, mothandizidwa ndi zida zapamadzi, kafukufuku wofunikira wa dera lomwe kulowererapo kuyenera kuchitidwa.
2. Dokotalayo amatseka ndikuchotsa njira zofunika zomwe minofu yake imadyetsa.
3. Nthawi zina ndikofunikira kuchotsa nyumba zapafupi monga gawo la duodenum, malo apafupi a lymph node kapena gallbladder organ.
4. Kuti abwezeretse chakudya cham'mimba, dokotalayo amalowa m'mimba ndi m'mimba mwake komanso m'chigawo chapakati cha matumbo ang'ono.

Kuchita kwa beger

Kuchita kwa Beger kumatchedwa opaleshoni, momwe gawo lachiberekero limachotsedwa, pomwe duodenum ya m'matumbo imasungidwa ndipo pancreatojejunoanastomosis imayikidwa.

Kulowerera koteroko nthawi zambiri kumagwiritsidwa ntchito pochiza matenda a kapamba, omwe amapezeka kwambiri ndipo amakhala ovuta kuwononga matenda oopsa, kupezeka kwa calculi, kuwerengera ndi ma pysts a parenchyma.

Malinga ndi zomwe zachitika mmbuyomu, ntchito ya Beger imakhudza kulowerera kwa zikondamoyo zomwe zili m'chigawocho ndi gawo lalikulu kwambiri lachigawo komanso kupangika kwa anastomosis kwa zigawo zotsogola komanso zodutsa.

Mwaukadaulo, opaleshoni iyi ili ndi mawonekedwe osokonekera ndipo nthawi zambiri imayambitsa magazi ochuluka.

Chilinganizo cham Mchira

Kuchotsa kwa mchira wa pancreatic kungakhale kofunikira pakuvulala kwamakina kapena cyst, zovuta za pancreatitis yayitali, kapena kwa pancreatic necrosis, kuwonjezeranso gawo la mchira, monga zina.

• Chitetezo chimachitika pogwiritsa ntchito mankhwala opaleshoni.
• Wopangirayo amachita opaleshoni ya peritoneum, ndikutchingira kapamba ndikuchotsa ziwalo zonse zogwirizana ndi gawo la mchira, ndipo ngati kuli kotheka, ndulu ndi zina.
• Ngati mapangidwe a metastases mu minofu ya ndulu, ndiye kuti ayenera kuchotsedwa.

Kuchitapo kanthu kumadziwika ndi kusakhalapo kwa chitukuko cha kagayidwe kachakudya ka zakudya ndi matenda ashuga, ngakhale kusokonezeka pang'ono m'mimba komwe kumachitika nthawi zina.

Kodi kapamba amachotsedwa bwanji (kapamba)

Pancreatectomy ndikuchotsa opaleshoni. Pancreatectomy ikhoza kukhala yathunthu, ndipo pamenepa thunthu lonse limachotsedwa, nthawi zambiri limodzi ndi ndulu, chikhodzodzo, ndulu yodziwika bwino komanso mbali zamatumbo ndi m'mimba.

Ndondomeko imathanso kukhala ya distal, zomwe zikutanthauza kuti kapamba amachotsedwa pang'ono.

Kuchotsa duodenum palimodzi ndi zonse kapena gawo limodzi la kapamba amatchedwa pancreatoduodenectomy ndipo amagwiritsidwa ntchito kawirikawiri pochiza matenda oyipa ndi chosaopsa cha kapamba. Njira imeneyi nthawi zambiri imaphatikizanso kusinthidwa kwa ma lymph node.

Kodi kuchotsedwa kwa kapamba kumachitika chifukwa chiyani?

Pancreatectomy ndiye chithandizo chothandiza kwambiri cha khansa ya kapamba.

Chotsirizachi ndi chiwalo cham'mimba chomwe chimapangitsa kuti ma enzymes agayike, insulin ndi mahomoni ena.

Gawo lalikulu kwambiri la kapamba limakhala pafupi ndi duodenum ndipo limatchedwa mutu, gawo lapakati limatchedwa thupi, ndipo gawo loonda kwambiri moyandikana ndi nduluyo ndi mchira.

Ngakhale kuchotsedwa kwa zotupa mu kapamba ndiye chithandizo chomwe amakonda, ndizotheka mwa anthu 10%% omwe amapezeka ndi matendawa.

Kuchita opaleshoni nthawi zambiri kumachitika kwa odwala omwe ali ndi zotupa zazing'ono m'mutu wa kapamba (pafupi ndi duodenum kapena gawo loyambirira la matumbo ochepa), ndi jaundice ngati chizindikiro choyambirira komanso popanda zizindikiro za matenda a metastatic (kufalikira kwa khansa kwa ziwalo zina ndi minyewa).

Gawo la khansa ndilofunikira pancreatomy, yomwe imatha kukhala yonse komanso yopanda malire.

Pancreatectomy pang'ono

Pancreatectomy yocheperako imatha kuwonetsedwa ngati kapamba akuwonongeka kwambiri, makamaka mthupi ndi mchira. Ngakhale opaleshoni yotere imaphatikizidwa ndikuchotsa minofu yachilengedwe, zotsatira zake zotsatira zake ndizochepa, ndipo sizikhudza kapangidwe ka insulin, michere yama michere ndi mahomoni ena.

Matenda a kapamba ndi mkhalidwe wina womwe kapamba nthawi zina amachotsedwa.

Matenda a kapamba (kupindika kosalekeza kwa kapamba), komwe kumayambitsa chiwonongeko chotheratu cha chiwalochi, kumatha kuchitika kuyambira nthawi yayitali pancreatitis ya pachimake.

Vutoli limapweteka nthawi zambiri chifukwa chomwa mowa kwambiri kapena kupezeka kwa ma gallstones. Mwa odwala ambiri omwe ali ndi matendawa, kukonza maopaleshoni sikungatheke chifukwa chokhala ndi mowa.

Ndani amagwira ntchito yamatumba

Kuyambitsanso kwachi pancreatic kumachitidwa ndi dokotala wa opaleshoni ya gastroenterologist, opaleshoniyo imayambitsa opaleshoni, ndipo opaleshoni imachitika kuchipatala, pomwe oncologist pankhani ya khansa ya pancreatic imalimbikitsa njirayi.

Kuchotsa kwa pancreatic kutha kuchitika pogwiritsa ntchito opaleshoni yotseguka, pomwe vuto limodzi lalikulu limapangidwa, kapena limatha kuchitidwa laparoscopically, mu mawonekedwe awa, adotolo amapanga zazing'ono zazinayi kuti azidziwitse zida zopangira opaleshoni yofunika.

Mimba imadzaza ndi mpweya, nthawi zambiri kaboni dayokisaidi, kuti dokotalayo awone m'mimba. Kamera imayikidwa kudzera mu umodzi wa machubu ndikuwonetsa zithunzi pazowunika mu chipinda chogwiririra. Zida zina zimayikidwa kudzera pamachubu owonjezera.

Njira ya laparoscopic imalola dokotalayo kugwira ntchito mkati mwa m'mimba mwa wodwalayo popanda mawonekedwe akulu.

Ngati pancreatectomy ndiyosankha, dokotala wochita opaleshoniyo amachepetsa ndimitsempha yamagazi, ndipo zikondazo zimachotsa pang'ono pokha. Ngati nthendayo ikukhudza mtsempha wamagazi kapena mtsempha, nduluyo imachotsedwa. Ngati pancreatectomy imakhala yofala, dokotalayo amachotsa kapamba ndi ziwalo zonse zomwe zimalumikizidwa nazo.

Panthawi yogwiritsira ntchito kapamba, machubu angapo a chisamaliro cha postoperative amaikidwa. Popewa kudzikundikira kwa timadzi tanthete pantchito, kukhetsa kwakanthawi kumayikidwa, komanso chubu chopangidwa ndi g kuti muchepetse mseru komanso kusanza. Chubu amathanso kuyikidwira m'matumbo ang'ono ngati njira yowonjezera zakudya.

Kukonzekera opaleshoni

Odwala omwe ali ndi zizindikiro za matenda a pancreatic amayesedwa angapo asanalingalire opaleshoni.

Kafukufuku akhoza kuphatikizira ndi ultrasonography, x-ray, angiography, tomography komanso endoscopic retrograde cholangiopancreatography, kulingalira kwapadera.

Kuyesedwa ndikofunikira kuti kukhazikitse koyenera kuzindikirika kwa matenda a pancreatic ndikukonzekera ntchito.

Popeza odwala ambiri omwe ali ndi khansa ya pancreatic amadya pang'ono, thandizo loyenera lazakudya lingafunike musanachite opareshoni, nthawi zina mwa kudyetsa chubu.

Odwala ena omwe ali ndi khansa ya pancreatic amapatsidwa mankhwala a chemotherapy ndi radiation. Mankhwalawa cholinga chake ndi kuchepetsa chotupacho, chomwe chithandiza mwayi wopanga bwino opaleshoni.

Radiation therapy imatha kugwiritsidwanso ntchito pakuchita opaleshoni (pa intaneti) kukonza mwayi wopulumuka.

Kafukufuku wina wawonetsa kuti intraoperative radiation therapy imawonjezera kupulumuka ndi miyezi ingapo.

Odwala omwe akukhudzidwa ndi distal pancreatic resection, yomwe imaphatikizapo kuchotsa ndulu, amalandila chithandizo chothandizira kuti achepetse matenda.

Njira zogwirira ntchito

Pancreatectomy ndi ntchito yayikulu. Chifukwa chake, kugonekedwa kuchipatala ndi odwala kuchipatala kwa milungu iwiri kapena itatu ndikofunikira.

Odwala ena omwe ali ndi khansa ya pancreatic amathanso kulandila radiation ndi chemotherapy atachitidwa opaleshoni. Chithandizo chowonjezera nthawi zambiri chimathandizira kupulumuka.

Pambuyo pa opaleshoni, odwala amamva kupweteka kwam'mimba ndipo amapatsidwa mankhwala opweteka. Kuwunikanso kwambiri kubwezeretsa ndikuchotsa machubu obwezeretsedwa ndikofunikira.

General pancreatectomy imatsogolera ku vuto lotchedwa pancreatic insufficiency, chifukwa chakudya sichingakonzedwenso ndi michere yomwe imapangidwa ndi kapamba. Katemera wa insulin ndiosatheka.

Izi zimafuna pancreatic enzyme m'malo mankhwala ndi insulin jakisoni.

Nthawi zina, distal pancreatic resection ingayambitse kufooka kwa ziwalo, kutengera thanzi la wodwalayo asanachitidwe opaleshoni komanso kuchuluka kwa kuchotsedwa kwa pancreatic.

Kuwopsa ndi Mavuto

Pali chiopsezo chachikulu cha zovuta zomwe zimakhudzana ndi ndondomeko iliyonse ya kapamba. Mavuto osiyanasiyana amachitika mu 41% ya milandu. Choopsa kwambiri mwa izi ndi kutuluka kwa magazi kwa postoperative, komwe kumawonjezera chiopsezo cha kufa mpaka 20-50%. Zikachitika magazi a postoperative, wodwalayo amathanso kuthandizidwa kapena kutumizidwa njira zina.

Chimodzi mwazinthu zovuta kwambiri za pancreatoduodenectomy chachedwa kuchotsedwa, komwe mumakhala chakudya ndi zakumwa pang'ono pang'onopang'ono. Vutoli limapezeka 19% ya odwala.

Kuti muthane ndi vutoli, madokotala ambiri opanga opaleshoni amagwiritsa ntchito chakudya kuti adyetse malo omwe amagwirako ntchito, momwe michere imatha kuperekera mwachindunji matumbo a wodwala.

Njirayi, yomwe imatchedwa kuti zakudya zowonjezera, imathandizira zakudya ngati m'mimba zimabwezeretsa ntchito yake pang'onopang'ono. Mankhwala ena atha kuthandiza mu chakudya cham'mimba chija.

Pambuyo kuchotsa kwathunthu kwa kapamba, thupi limataya mphamvu yake yopanga insulin, ma enzyme ndi zinthu zina.

Odwala nthawi zambiri amayambiranso yachilendo pakatha mwezi umodzi. Afunsidwa kuti apewe kuchita masewera olimbitsa thupi kwa milungu isanu ndi umodzi mpaka isanu ndi itatu atachitidwa opaleshoni komanso kuti asayendetse galimoto mpaka atamwa mankhwala.

Chiwopsezo cha kufa kwa pancreatic resection m'zaka zaposachedwa chatsika mpaka 5-10%, kutengera kuchuluka kwaukali wa opaleshoniyo komanso luso la opereshoni. Tsoka ilo, khansa ya kapamba ndimtundu wakufa wa khansa yam'mimba. Komabe, pancreatectomy imapereka mwayi wamankhwala, makamaka ngati opareshoniyo ikuchitidwa ndi dokotala wodziwa ntchito.

Chodzikanira: Chidziwitso chomwe chatchulidwa m'nkhaniyi chokhudza pancreatectomy ndicholinga chongowerengera owerenga. Singakhale cholowa m'malo mwa kufunsidwa ndi katswiri wazachipatala.

Opaleshoni Frey

Kuchita opareshoni molingana ndi njira ya Frey kumaphatikizapo gawo lachigawo cha pancreatic mutu ndikugwiritsa ntchito pancreatojejunoanastomosis.

Kuchita kofananako kumasonyezedwera kwa chifuwa chachikulu, chotupa chachikulu chomwe chimapweteka kwambiri komanso kupindika kwa pancreatic duct, komanso pamaso pa calculi osakanikirana ndi kusintha kwa cystic m'mutu wotsekemera.

Choyamba, adotolo amataya chimbudzi ndipo amachotsa miyala, amatsutsana ndi mapangidwe ake. Kenako dokotalayo amachotsa pang'ono mutu wa pancreatic. Kenako, chidutswa cha Ru chimapangidwa pa jejunum, pancreatojejunoanastomosis imayikidwa, yolumikizitsa duct ya pancreatic, gland yokhazikikanso ndipo chiuno cha Ru chinazimitsidwa.

Kuchotsa kwathunthu kapamba kumakhala kochepa kwambiri komanso kumakhalapo pazinthu zina. Ngakhale pamavuto ovuta kwambiri, madokotala ochita opaleshoni amakonda kusunga chiwalo.

Kuchotsa kwa pancreatic ndikosapeweka ngati pali necrosis ya organ, pamene kuli kofunikira kupulumutsa moyo wa wodwalayo. Kuchulukitsa kwathunthu kumawerengedwa ngati njira zovuta zowonjezera zomwe zimafunikira kudziwa.

Chifukwa cha kuyandikira kwa ngalande ya aortic, opaleshoni imafunika kusamala kwambiri, komanso kuyandikira kwa ziwalo zina monga m'mimba ndi duodenum, ndulu ndi bile, chiwindi, zimapangitsa kuti zikhale zovuta kupeza kapamba. Kuchitapo kanthu kumatenga pafupifupi maola 6.

nkhani yokhudza kuchotsa kwathunthu kwa kapamba:

Zotsatira zake

Mwa zina zomwe zimachitika pafupipafupi, akatswiri adziwa zambiri:

• Matenda kapena magazi akulu,
• Kulowa kwa zinthu za pancreatic enzyme mu peritoneum,
• Zowonongeka zam'mimba kapena kusachita bwino kwa mankhwala osokoneza bongo.

Zakudya pambuyo opaleshoni

Kukhala ndi pancreatectomy m'miyezi yoyambirira ndikovuta. Atangochita opaleshoni, wodwalayo amazunzidwa ndi ululu waukulu m'malo a suture ,anjala silipumulanso, chifukwa amaletsedwa kudya masiku angapo pambuyo poti athandize. Pambuyo pake, wodwalayo amayenera kutsatira malamulo okhwima a zakudya zofunika pamoyo.

Mfundo zazikuluzakudya zamagulu azakudya mutachotsa kapamba ndizochulukitsa komanso kugawikana. Mutha kudya zokhazo zomwe pulogalamu yamachakudya chimalola.

• Mu chakudya chochulukirapo chikuyenera kukhalapo mapuloteni omwe akukhudzidwa pakubwezeretsa ziwalo zam'mimba ndikuthandizira kuchira.
• Zakudya zopatsa thanzi ziyenera kukhala zochepa, chifukwa motsutsana ndi mapangidwe a insulin, endocrine pancreatic ntchito imakhala yovuta.
• Mafuta amaletsedwa kotheratu; ndiwo masamba ochepa kapena batala wokha amene amaloledwa.
• Zonunkhira, zamchere, zokazinga ndi kuzifutsa ndizoletsedwa.

Zoyembekeza Za Moyo

Kukhala wopanda chamba cha pancreatic glandular ndizotheka. Ngakhale palibe chiwalo chomwe chingalowe m'malo mwake, potero, thanzi la wodwalayo liziwonongeka kwambiri ngati satsata zakudya zolimbitsa thupi, kutsatira malangizo ndi malangizo a dokotala wa gastroenterologist.

Ndikachotsa pang'ono, zofunikira zake ndizabwino, chifukwa zimakhala kuti ziwalo zotsalazo zimagwira ntchito zonse za kapamba. Ngati chithandizo chachotsedwa kwathunthu, ndiye kuti chithandizo chamankhwala chadzakhala moyo wonse (kumwa insulini, ma enzymes, kukonza zakudya, ndi zina).

Pancreatectomy

Zonse zaLive zimawunikiridwa ndi akatswiri azachipatala kuti atsimikizire kulondola kwakukulu ndi kusasinthika ndi zowona zake.

Tili ndi malamulo okhwima osankha magwero azidziwitso ndipo timangotengera masamba otchuka, mabungwe ofufuza zamaphunziro, ndipo ngati zingatheke, kafukufuku wazachipatala wotsimikiziridwa. Chonde dziwani kuti manambala omwe ali m'mabakaki (, ndi zina zambiri), amalumikizano olumikizana ndi maphunziro awa.

Ngati mukuganiza kuti chilichonse mwazida zathu sizolondola, zachikale kapena zosafunikira, sankhani ndikusindikiza Ctrl Enter Enter.

Pancreatectomy - kuchotsedwa kwa kapamba (wathunthu kapena mbali ya chiwalo) wokhala ndi chotupa cha khansa kapena chifuwa chachikulu (chokhala ndi minofu necrosis). Ngati chotupa chikukhudza ziwalo zoyandikana ndi khosi (ndulu, chikhodzodzo, gawo la matumbo aang'ono kapena m'mimba, ma lymph node), kuchotsa kwa madera okhudzidwawo kumafunikiranso.

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Zizindikiro ndi njira pancreatectomy

Nthawi zambiri, opaleshoni imalembedwa chifukwa cha zotupa zoyipa pakhungu, nthawi zina kuchotsedwa kwa chiwalo kumachitika chifukwa cha kupweteka kwa kapamba (kutupa kwa kapamba).

Ngati pakachitika m'mimba, dokotalayo amachotsa chiwalocho kwathunthu kapena pang'ono, kuphatikiza zikondamoyo, ngati chotupa chakhudza ziwalo zapafupi, amathanso kuchotsedwa. Kenako tsambalo limasokedwa kapena kukhazikitsidwa ndi mabatani apadera.

Ngati ndi kotheka, machubu am'madzi amayikidwa m'matumbo am'mimba, pomwe madzi amayenda, amadzisonkhanitsa ndi malo a dokotala wa opaleshoni. Nthawi zina akatswiri amachotsa chubu china kuchokera m'matumbo kuti adyetse chubu.

Ngati mukufuna kuchotsa gawo limodzi lokha la kapamba, dokotalayo amatha kugwiritsa ntchito njira ya laparoscopy - kudzera m'mabowo ang'onoang'ono omwe dokotalayo amaika chida chapadera ndi kamera komanso zida zazing'onoting'ono zomwe zimapangidwiranso ntchito.

Kuzindikira kwa pancreatectomy

Kuchotsa kwina kwa chiwalo, nyamazo ndizabwino koposa ndikuchotsa kwathunthu kapamba, popeza gawo lotsala la ndulu limagwira ntchito yonse. Pochotsa kapamba wonse m'matumbo am'mimba, vuto lalikulu limachitika ndipo nthawi zonse limabwezeretsa (zakudya, michere, insulin).

Pancreatectomy nthawi zambiri imachitidwa kuti ipulumutse moyo wa munthu. Ndi zotupa za khansa, ngakhale ndi zotupa zazikulu, opaleshoni ndiyo njira yokhayo yosinthira thanzi la wodwalayo.

Mavuto a Pancreatectomy

Pambuyo kuchotsedwa kwa kapamba, zovuta zina zimatha kutuluka - magazi, matenda, kusintha kwa mankhwala oletsa kupweteka (kuthamanga kwa magazi, chizungulire, ndi zina); mbali ya chiwalo ikachotsedwa, michere yapachifungo imatha kulowa m'mimba, kuwonongeka kwa ziwalo zapafupi.

Chiwopsezo cha zovuta zimachuluka ndi kunenepa kwambiri, ukalamba, kuperewera kwa zakudya, matenda a mtima ndi ziwalo.

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Kusamalira Pancreatectomy ndi Kubwezeretsa

Pambuyo pa opaleshoni kuchipatala kwa masiku angapo, dokotala amayang'anira momwe wodwalayo alili, opaleshoni ndi mankhwala a nseru nawonso adzalembedwera. Ngati machubu am'madzi akhazikitsidwa, adotolo amawachotsa thupi litayamba kuchira.

Pambuyo pazimasamba, wodwalayo ayenera kutsatira zakudya zapadera, chifukwa ma enzyme a pancreatic sangakhale okwanira kugaya chakudya. Komanso, kutengera kuchuluka kwa chiwalo chomwe chachotsedwa, kukonzekera kwa enzyme, insulini (kukhazikitsa shuga) ingathe kutumikiridwa.

Pambuyo pa opaleshoni, ndikofunikira kusunga regimen yofatsa, osakweza zolemera, osagwiritsa ntchito mopitilira muyeso (pafupifupi 1.5 - miyezi iwiri).

Nthawi yochira pambuyo pochita opaleshoni imatha miyezi yambiri. Odwala ambiri amawona zovuta akamatsata zakudya zatsopano kapena akamamwa mankhwala atsopano.

Odwala ena amalimbikitsidwa kutenga nawo mbali m'magulu othandizira omwe amathandizira kukonza malingaliro awo.

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Mitundu ya ma pancreatic opaleshoni

Opaleshoni ya pancreatic ndi njira yopangira opaleshoni yowonjezereka, chifukwa chiwalochi chimakhala chokhudza mtima kwambiri ndipo sichikudziwika kuti chitha bwanji kugwira ntchito pambuyo pochotsa kapena kuchotsa chotupacho. Ntchito zimadziwika ndi chiopsezo chowonjezeka chaimfa ndi chitukuko cha zovuta zaumoyo.

Opaleshoni ya pancreatic ndi njira yopangira opaleshoni yowonjezereka, chifukwa chiwalochi chimakhala chokhudza mtima kwambiri ndipo sichikudziwika kuti chitha bwanji kugwira ntchito pambuyo pochotsa kapena kuchotsa chotupacho.

Zisonyezo za distal pancreatectomy

Opaleshoni imeneyi imagwiritsidwa ntchito ngati njira yochizira khansa yofufuma ya gland, ndiye kuti ndi chotupa cha khansa chomwe chimatha kuchotsedwa.

Komanso, distal pancreatectomy ikhoza kuchitidwa chifukwa cha chifuwa chachikulu, chokhazikika cha pakhungu, kuvulala koopsa kwa gland, chifuwa cha thupi ndi mchira wa kapamba, ngati chithandizo chaumunthu sichingapereke zotsatira zabwino.

Ngati chotupa cha khansa chikufalikira ku ndulu, m'mimba, tiziwalo tamadontho, diaphragm kapena colon, ziwalo zomwe zimakhudzidwa ndi khansa zimapangidwanso kapena kuchotsedwa kwathunthu.

Makonzedwe athunthu

Kuchotsa kwathunthu kapamba kumakhala kochepa kwambiri komanso kumakhalapo pazinthu zina. Ngakhale pamavuto ovuta kwambiri, madokotala ochita opaleshoni amakonda kusunga chiwalo.

Kuchotsa kwa kapamba ndikosapeweka ngati pali necrosis ya chiwalo, pakafunika kupulumutsa moyo wa wodwalayo. Kuchulukitsa kwathunthu kumawerengedwa ngati njira zovuta zowonjezera zomwe zimafunikira kudziwa.

Chifukwa cha kuyandikira kwa ngalande ya aortic, opaleshoni imafunika kusamala kwambiri, komanso kuyandikira kwa ziwalo zina monga m'mimba ndi duodenum, ndulu ndi bile, chiwindi, zimapangitsa kuti zikhale zovuta kupeza kapamba. Kuchitapo kanthu kumatenga pafupifupi maola 6.

Nkhani yavidiyo yakuchotsa kwathunthu kapamba:

Asanachitike kapena atachitidwa opareshoni

Ku Elite Medical Clinic, odwala omwe ali ndi khansa ya pancreatic amathandizidwa ndi chemotherapy ndi radiation chithandizo pamaso pa distal pancreatectomy, kuti muchepetse chotupa cha khansa.

Pambuyo pa opaleshoni, odwala amathandizidwanso mankhwala a chemotherapy ndi radiation kuti muchepetse kubwereza khansa.

Zizindikiro za Cancer Pancreatic

Mawonekedwe a khansa ya pancreatic nthawi zambiri amachedwa kwambiri ndipo sizivuta kuzindikira. Zizindikiro zotsatirazi zimatha kukhala tcheru:

• kupweteka pachifuwa chapamwamba cha lamba kapena kufikira kumbuyo,
• kutaya chakudya komanso kuwonda kwambiri,
• chikasu pakhungu ndi mucous nembanemba
• kudzimbidwa mu mawonekedwe a kudzimbidwa kapena kutsegula m'mimba,
• Zizindikiro za dyspeptic mu mawonekedwe a mseru ndi kusanza, zomwe sizibweretsa mpumulo.

KULIMBITSA NDI ZINSINSI

Zowopsa za Cancer wa Cancreatic

Kuunikira mwachindunji kwa khansa ya kapamba yomwe ingapereke kuzindikira koyambirira kulibe.

Zowopsa ndi:

• mowa ndi kusuta ndudu,
• kunenepa
• nyama yambiri ndi chakudya chamagulu ndi zipatso ndi ndiwo zamasamba,
• kunenepa
• chifuwa chachikulu komanso matenda ashuga

Kudziwikiratu kudziwiratu khansa ya kapamba

Kwa zaka zambiri, madotolo aku Italy akhala akuwunika mitu yankhani yokhudza khansa ya kapamba. Nthawi zina, "cancer of pancreatic cancer" (PCA) imawonedwa (pafupifupi 3% ya milandu) ngati mabanja ali ndi achibale osachepera awiri omwe ali ndi khansa ya pancreatic. Ma syndromes awa ndi monga: cholowa cha matenda obadwa nawo ambiri omwe amachitika ndi melanoma (FAMMM), Peitz-Jägers syndrome (PJS), chibadwa cha chibadwa (HP), chiberekero cha chiberekero cha polypous colorectal (HNPCC), chifuwa cha chiberekero ndi khansa yamchiberekero (HBOC). cystic fibrosis (CF), adenomatous polyposis (FAP), Fanconi anemia

Zakudya zam'mimba za khansa ya kapamba *

Kutengera kuwunika kokwanira kwa zotsatira zomwe zapezeka munthawi ya kafukufuku wasayansi, zidatha kuzindikira zofunikira zakudya komanso zoteteza ku mitundu inayake ya khansa. Akatswiri adagawa zotsatirazi m'magulu anayi: "umboni wotsimikizika", "umboni wopezeka", "umboni woperewera" komanso gawo lomaliza lomwe limagwirizanitsa zomwe ubale wawo ndi chotupacho uli "wovuta kwambiri". Malangizowa amachokera pa umboni wotsimikizika komanso wodalirika.

Zomwe zimayambitsa kupezeka ndi khansa yapancreatic:

• kunenepa kwambiri komanso kunenepa kwambiri (umboni wamphamvu),
• minofu yamafuta am'mimba (umboni wotheka).

Zakudya zoteteza ku khansa ya kapamba:

Zakudya zokhala ndi mchere wambiri wa folic acid: masamba obiriwira (sipinachi, chicory, endive, chard), broccoli, tirigu wamera (umboni wotheka). axial telangiectasia (AT) ndi Fanconi anemia (FA).

Pancreatic chotupa chithandizo ndi maphunziro azachipatala

Pancreatic khansa ntchito

Mu 2015, kupezedwa kunapangidwa ku Italy komwe kumalimbikitsa kuchira kwathunthu komanso koyenera kwa khansa ya kapamba. Madokotala aku Italy adazindikira mitundu inayi ya zilonda zapancreatic zomwe zimayankha mosiyana ndi mankhwala ena ndi zina. Pakadali pano, kusankha kwa mankhwala ndi njira zochizira khansa yapakansa ikuchitika. Uku ndiko kupambana kopanda kukayikira kwa madotolo aku Italy, polankhula za luso lazambiri pochiritsa matenda a mtundu uwu ndiukadaulo waluso.

Pachikhalidwe, njira yayikulu pakuthandizira khansa ya pancreatic ndi opaleshoni. Panthawi yodziwitsa, mwatsoka, ndi 520% ​​yokha ya zotupa za kapamba zomwe zimagwira ntchito kwambiri. Kusankha kwa opaleshoni kumadalira kukula ndi malo a chotupacho. Ntchito zopulumutsa - distal pancreatectomy yokhala ndi splenectomy, duodenectomy yokhala ndi resection ya mutu wa pancreatic. Woopsa milandu, pancreatectomy okwanira amafunika. Ngati mungathe kuyambiranso, ndikofunikira kulumikizana ndi malo omwe khansa imakhala yodetsa komanso kufa kwake. Izi zimatengera, choyamba, pazochitikazo komanso kuchuluka kwazomwe zimayendetsedwa ndipo, chachiwiri, pazomwe zinasakanikirana zomwe akatswiri osiyanasiyana (opaleshoni ya oncologist, chemotherapist, radiologist, endoscopist-gastroenterologist, radiologist, pathologist, wathanzi, endocrinologist). Malo onsewa ali ku Italy, ndipo ali ndi akatswiri omwe amathandizana wina ndi mnzake kuti athe kutsegulira bwino komanso kudziwitsa za mankhwalawa.

Pochepetsa njira yochizira khansa ya kapamba

Chifukwa cha kusintha kwa matekinoloje, zida ndi njira zopangira opaleshoni yosafunikira, zitha kugwiritsa ntchito njira yolumikizana mosavomerezeka pancreatic malignancies. Mothandizidwa ndi laparoscopy, gawo ndi kufalikira kwa chotupa chatsimikizika, ndipo distal pancreatectomy ikhoza kuchitidwanso. Njira iyi ndi yofatsa komanso yotetezeka ndipo imapereka mwayi waukulu pakuchita opaleshoni yayikulu yochitidwa ndi laparotomy.

Mu nthawi ya postoperative, kusintha komwe kumachitika mu kagayidwe ka matenda a shuga kumakhazikitsidwa ndikuwongoleredwa ndi endocrinologists ndi akatswiri azakudya.

Pancreatic Cancer Chemotherapy

Pofuna kupewa kuyambiranso kwa chotupa ndi metastasis, mankhwala othandizira a chemotherapy amagwiritsidwa ntchito. Adjuvant chemotherapy yolepheretsa kutulukanso kwa chotupacho ikuyimira njira yoyenera yothandizira odwala omwe ali pachiwopsezo chotenga thupi ngakhale atakhala kale. Pankhani ya chotupa chosagwira ntchito kapena ma metastasis ofunikira, ndiye mankhwala okhawo omwe ndi chithandizo chamankhwala. Chifukwa cha kuphatikiza kwatsopano kwa mankhwala a chemotherapy m'zaka zaposachedwa, ndizotheka kukulitsa chithandizo cha khansa pambuyo pake. Chemotherapy gemcitabine yakhala ikuwoneka ngati njira yokhayo yothandizira kwa zaka makumi ambiri; pakadali pano, mndandanda wa othandizira a chemotherapeutic wabwezeredwa kwambiri ndi mankhwala monga irinotecan, oxaliplatin ndi nab-paclitaxel.

Biliary endoprosthetics kapena ngalande

Njira ina yothandizira pakuchita opaleshoni yothandiza pakhungu la jaundice ndikuyika kwa biliary endoprosthesis ndi endoscopy (endoscopic retrograde cholangiopancreatography, ERCP). zotsatira zopambana ndizoposa 80%, nthawi yayitali yolowera kuchipatala komanso chiwopsezo chaimfa chimachepa. Odwala omwe ali ndi contraindication ku endoprosthetics, komanso omwe apita kukakhala m'mimba, kutulutsa kwina kwa biliary ndikotheka.

Maphunziro azachipatala a khansa ya pancreatic

Zoyesa zamankhwala pakadali pano zikuchitika ku Italy kuti aphunzire kukonzekera kwa neoadjuvant chemotherapy yothandizira khansa yomwe ingagwiritsidwe ntchito, komanso mankhwala atsopano achilengedwe ochizira chotupa cha metastases. Madera atsopano a ntchito za akatswiri ndi kufufuza kwa maselo amomwe amtunduwu obadwa nawo komanso omwe amapezeka pang'onopang'ono matendawa.

Ngati mukuganizira kwambiri chithandizo ku Europe, ndiye kuti Italy ndi chisankho chabwino. Ku Milan, mtunda wa mphindi 15 pagalimoto kuchokera pakati pa mzindawo, pali malo akuluakulu asanu ndi limodzi a khansa, omwe ali ndiukadaulo wapamwamba kwambiri, wokhala ndi madokotala oyenerera. Tikukulangizani komwe kuli bwino kuthana ndi vuto linalake ndikuthandizira kukonza zonse.

ZOFUNIKITSA ZABWINO KWAMBIRI:

• Chithandizo cha Khansa ya Pancreatic ku Italy - Cure Chatsopano
• Anthu aku Italiya akupanga mankhwala ochizira khansa ya kapamba
• Chithandizo cha chotupa cha pancreatic Europe
• Miyezo yatsopano yothandizira khansa ya kapamba

Kodi khansa ya kapamba ndi chiyani?

Mu magawo oyambilira, khansa ya kapamba nthawi zambiri imakhala yacymptomatic. Zizindikiro ndi zotsatirazi ndizodziwika osati khansa ya kapamba, komanso matenda ena. Pangana ndi dokotala ngati muli:

jaundice (chikasu cha pakhungu ndi mapuloteni amaso),

kupweteka pamimba kapena pakati pamimba,

kuwonda popanda chifukwa

Pancreatic oncology sichidziwika bwino m'mayambiriro oyambirira.

Khansa ya pancreatic ndi yovuta kudziwa pazifukwa zotsatirazi:

M'mayambiriro oyamba a matendawa, odwala alibe zizindikiro kapena zizindikiro za matenda.

Zizindikiro zake zodziwika bwino za khansa ya kapamba ndizofanana ndi matenda ena ambiri.

Zikondazo zimabisala kumbuyo kwa ziwalo zina zamkati, kuphatikiza m'mimba, matumbo ochepa, chiwindi, ndulu ya ndulu, ndulu, ndulu ya bile.

Kuti mupeze khansa ya kapamba, madokotala aku Israeli amapereka mankhwala ndi mayeso kwa odwala kuti awone momwe matendawa amapezeka.

Khansa ya Pancreatic: Kulosera

Kukula ndi kusankha kwa njira zamankhwala zochizira pancreatic oncology zimadalira izi:

kuthekera kochotsa chotupa, gawo la matendawa (kukula kwa chotupa ndi kupezeka kapena kusakhalapo kwa maselo a khansa kunja kwa kapamba, ndiko kuti, pafupi ndi ziphuphu, zotupa zam'mimba kapena ziwalo zamkati ndi ziwalo zakunja),

thanzi labwino la wodwala,

matenda oyamba kapena kubwerezanso khansa (kukonzanso matenda pambuyo pamankhwala).

Khansa yapakansa imatha kuthandizidwa pokhapokha ngati yapezeka isanafalikire. Ngati chotupa apanga metastases, wodwalayo mankhwala. Palliative tiba imathandizira wodwalayo kukhala ndi moyo, kuthandiza kuthana ndi zizindikiro ndi zovuta za matendawa.

Matenda a Kansa ya Pancreatic ku Israel

Dokotala waluso wa dipatimenti ya oncology ya Ichilov MC

Nthawi zambiri, kukula kwa khansa ya kapamba kumalumikizidwa ndi mbiri yabanja yamatendawa. Chifukwa chake, anthu omwe abale awo apamtima adadwala khansa ya pancreatic adayezetsa majini ku Israeli. Pambuyo pazindikira vuto la majini, wodwalayo amasankhidwa payekha payokha kuti adziwe ngati ali ndi khansa.

Njira zazikulu zodziwitsira khansa ya kapamba:

endosonografia - ultrasound, momwe sensa imayikidwa kumapeto kwa endoscope ndikuyiyika mu mgodi wammimba kudzera kummero.

Njirazi zimangoleketsa chotupacho komanso kuwunika momwe imagwirira ntchito. Kuti muwone kufalikira kwa njirayi, PET-CT ikhoza kulembedwa.

Kuzindikira khansa yamtunduwu, kuyezetsa magazi kwa chotupa chothandizira CA 19-9 kungagwiritsidwe ntchito. Komabe, ziyenera kukumbukiridwa kuti ndi mitundu ina ya khansa ya kapamba, zotsatira za kuwunikaku zimakhalabe zabwinobwino.

Kodi khansa ya kapamba imachiritsidwa bwanji ku Israeli?

Mutu wa Komiti Yapadziko Lonse ya American Association of Surgeon Oncologists.

Njira yokhayo yokwaniritsira mankhwala athunthu a khansa ya pancreatic ndi opaleshoni:

pancratectomy kwathunthu, kapena kuchotsedwa kwathunthu kwa kapamba.

Njira yovomerezeka yomwe ingagwiritsidwe ntchito popanga opaleshoni pamenepa ndi opaleshoni yotseguka. Njira zopangira ma opaleshoni a Laparoscopic nthawi zina zimachitika, koma sizoyenera kwa odwala onse. Kuphatikiza apo, opaleshoni ya laparoscopic imafuna zambiri kuchokera kwa dokotala wochita opaleshoni.

Mkulu wa Oncology department of MC Ihilov-Surasky.

Khansa ya kapamba imakonda kugwiritsa ntchito chemotherapy protocol yotchedwa FOLFIRINOX. Zimaphatikizapo

Research Kafukufuku waposachedwa akuwonetsa kuti protocol iyi imakupatsani mwayi wowongolera matendawa (kuphatikiza pamlingo wapamwamba) kuposa protocol yachikhalidwe ndi gemcitabine.

wodwala akhoza kutchulidwa

chithandizo chilichonse chosatha

Mtengo wochizira khansa yapakhungu ku Israeli?

Israel Doctors Association nthawi zambiri imalandira mafunso okhudzana ndi mtengo wofufuza komanso kuchiza khansa ya kapamba. Chifukwa chake, ipereka mitengo yapakati pamitundu ina ya chithandizo.

Chithandizo cha khansa ya pancreatic ndizovuta kwambiri. Katswiri wodziwa ntchito kwambiri yekha ndiamene amatha kuchita bwino pakuchotsa zodutsazo kapena kusankha njira yoyenera ya chemotherapy kwa wodwala wina. Ngati sizovuta kwa inu kusankha dokotala ndipo mukufuna upangiri - alumikizanani nafe.

Israeli Doctors Association imapatsa odwala maupangiri mahhala. Lembani fomu yolumikizirana ndipo mudzalandira yankho mkati mwa tsiku lotsatira.

Ndimagwira ntchito yanji pa kapamba ndipo ndizowopsa?

Mitundu yotsatirayi yochita opaleshoni:

1. Chiwerengero chonse. Nthawi zina dokotalayo amayenera kupanga zisankho zofunika pochita. Kuchitapo kanthu kumatenga pafupifupi maola 7.
2. Subtotal pancreatectomy ndikuchotsa pang'ono kapamba. Kachigawo kakang'ono ka chiwalo kamatsala, kamene kali pafupi ndi duodenum.
3. Pancreato-duodenal resection ndiye ntchito yovuta kwambiri. Zikopa, duodenum, chikhodzodzo ndi gawo la m'mimba zimachotsedwa. Amalembera pamaso pa zotupa zoyipa. Ndizowopsa ndi chiwopsezo chachikulu chovulaza minofu yoyandikana, kupezeka kwa zovuta za postoperative ndi kufa.

Laparoscopy

Opaleshoni ya Laparoscopic, yomwe idagwiritsidwa ntchito pokhapokha pozindikira, tsopano imatha kukonza mkhalidwe wa wodwalayo ndi pancreatic necrosis ndi chotupa cham'mimba cha kapamba.

Opaleshoni imadziwika ndi nthawi yochepa yochira, chiopsezo chochepa cha zovuta.

Pogwiritsa ntchito njira yotsiriza ya endoscopic, chiwalocho chimafikiridwa kudzera mu kuyang'ambika pang'ono, ndikuwunika mavidiyo kumapangitsa kuti njirayi ikhale yotetezeka komanso yogwira mtima.

Kuchotsa kwa tumor

Kuthana kwa chosaopsa pancreatic chotupa amachitika m'njira ziwiri:

1. Kuchita kwa beger. Kulowa kwa chiwalo kumadutsa gawo la gastrocolic ligament, pambuyo pake mitsempha yapamwamba ya mesenteric imalekanitsidwa. M'madera apamwamba komanso apansi a kapamba, zosunga pakhungu zimayikidwa. Pambuyo posinthira mosavutikira, mutu wa chiwalo cha mgonero umakwezedwa ndikulekanitsidwa ndi mitsempha yapamwamba kwambiri.
2. Opaleshoni Frey - kuchotsedwa kwina kwa gawo lamkati la kapamba wokhala ndi ma pancreatojejunostomiasis.

Kuthamanga kwa kapamba kumapangidwira odwala matenda ashuga.

Opaleshoni yofananira imaperekedwa kwa odwala matenda ashuga. Contraindication ndi ofanana kuphatikiza ziwalo zina.

Zikondamoyo zonyamula zimapezeka kwa wopereka wachinyamata yemwe wamwalira ndi ubongo. Kuchita koteroko kumalumikizidwa ndi chiopsezo chokana chiwalo chofalitsidwacho, motero, chimachitidwa motsutsana ndi maziko a mankhwala a immunosuppression.

Pakakhala zovuta, kagayidwe kamafanana, kufunikira kwamphamvu kwa insulin kumatha.

Kuchotsa ziwalo kwathunthu

Kukwaniritsidwa kwathunthu kumasonyezedwa pamatenda omwe amayenda ndi necrosis ya zimakhala. Opaleshoniyo amamutsatira pokhapokha mutayang'anitsitsa thupi, pamaso pazowonetsa mwamtheradi. Pambuyo kuchotsa kwathunthu kwa kapamba, wodwalayo adzafunika kudya kwa ma enzymes, insulin, zakudya zapadera, kuyendera pafupipafupi kwa endocrinologist.

Kuthetsa mimba

Njirayi imaphatikizira kuchotsedwa kwa kapamba kulowa m'mimba. Amagwiritsidwa ntchito pa matenda omwe amaphatikizidwa ndi pancreatic necrosis popanda kusungunuka minofu ndikupanga ma voids.

Pa opaleshoni, peritoneum imasulidwa, chiwalo chimasiyanitsidwa ndi zimakhala ndipo zimasunthidwa kumbuyo kwa omentum. Pambuyo pamimba.

Kununkha

Opaleshoni ndi njira yothandiza yochotsera zovuta zowongolera. Ili ndi chiopsezo chochepa kwambiri cha zovuta komanso kuphweka pochita.Pancreatic duct stenting imagwira ntchito molowera. Pa nthawi ya opareshoni, phata la chitsulo limayikidwa, yokutidwa ndi kupopera mankhwala kwa antibacterial. Izi zimachepetsa chiopsezo cha kufinya kwamphamvu ndi matenda.

Manda

Njira yofananayi imachitidwa pakukula kwa zotsatira zowopsa pambuyo polowerera mwachindunji. Kugwiritsidwa ntchito kochuluka kwa ngalande kumachitika chifukwa cha chiwopsezo chachikulu cha zovuta zapadera kumayambiriro kwa ntchito. Ntchito zikuluzikulu za opareshoni ndikuwachotsa kwachangu komanso kotheratu kwa zotupa zotuluka, kuchotsedwa kwa purulent foci.

Opaleshoni yamapazi

Anesthesia ndiye chinthu choyamba pakuchita opareshoni.

Njira yoyeserera yokwaniritsira ili ndi zinthu zotsatirazi:

• mawu a opaleshoni, kuyambitsa kwa opuma minofu,
• kulowa kwa kapamba,
• kuyang'anira ziwalo
• kuchotsa kwamadzimadzi m'thumba lolekanitsa kapamba ndi m'mimba,
• kuchotsedwa kwa mipata,
• kukongola ndi kubudula kwa hematomas,
• kusoka kwa minofu yowonongeka ndi zonyowa za chiwalo,
• Kuchotsa gawo la mchira kapena mutu wokhala ndi gawo la duodenum pamaso pa zotupa
• kukhazikitsa ngalande
• kusoka kwa nsalu,
• kutsatira kuvala kovutira.

Kutalika kwa ntchitoyo kumatengera chifukwa chake, chomwe chakhala chidziwitso pakukwaniritsidwa kwake, ndipo ndi maola 4-10.

Mitengo yotsimikizika yochitapo kanthu pochita opaleshoni mu kapamba:

• resection ya mutu - ma ruble 30-130,000.,
• chonse pancreatectomy - ma ruble 45-270,000,
• duodenopancreatectomy - ma ruble 50,5-230 masauzande,
• stenting wa pancreatic duct - 3-44000 rubles.,
• Kuchotsa kwa chosaopsa pancreatic chotupa ndi endoscopic njira - 17-407 zikwi rubles.

Nthawi yogwira ntchito

Kuchira kwa wodwala pambuyo pake kumaphatikizanso izi:

1. Khalani m'chipinda cholandirira odwala. Gawo limatenga maola 24 ndipo limaphatikizanso kuwunikira zofunikira za thupi: kuthamanga kwa magazi, shuga m'magazi, kutentha kwa thupi.
2. Tumizani ku dipatimenti yochita opareshoni. Kutalika kwa mankhwala a inpatient ndi masiku 30-60. Panthawi imeneyi, thupi limasinthasintha ndikuyamba kugwira ntchito bwino.
3. Theroper Postoperative Zimaphatikizaponso njira yochizira yovomerezeka, kuchuluka kwa shuga m'magazi, kudya makonzedwe a enzyme, njira zolimbitsa thupi.
4. Kugwirizana ndi kupumula pabedi, bungwe la mabungwe olamulira tsiku lonse atatuluka m'chipatala.

Pambuyo pa opareshoni, muyenera kudya madzi okwanira.

Mfundo zofunika kudya pambuyo pancreatic organ opaleshoni:

1. Kugwirizana ndi kuchuluka kwa chakudya. Idyani zosachepera 5-6 patsiku.
2. Muchepetse kuchuluka kwa chakudya chomwe mumadya. Kutumikira sikuyenera kupitirira 300 g, makamaka m'miyezi yoyamba atachitidwa opaleshoni.
3. Kutenga madzi okwanira. Ndikofunikira kuchotsa poizoni ndikukhalanso ndi magazi abwinobwino.
4. Kutsatira ndi mndandanda wazinthu zololedwa ndi zoletsedwa. Pewani zakumwa zoledzeretsa, zakumwa zoziziritsa kukhosi, kaboni, chokoleti, khofi, zinthu zamzitini, masoseji.

Mavuto atandichita opareshoni

Zotsatira zofala kwambiri za opaleshoni ya pancreatic ndizowonjezera kutentha kwa thupi.

Zotsatira zofala kwambiri za opaleshoni yamapamba ndi:

• magazi akulu amkati
• thrombosis
• malungo
• matenda ammimba (mseru ndi kusanza, kudzimbidwa, kutsatiridwa ndi matenda am'mimba),
• kuchuluka kwa mabakiteriya,
• kapangidwe ka fistulas ndi abscesses,
• peritonitis
• pachimake ululu syndrome
• kukula kwa zadzidzidzi,
• kuchuluka kwa matenda ashuga
• ziwalo minofu necrosis pambuyo resection,
• kusokonezeka kwa magazi.

Mbiri ya moyo

Kutalika kwa moyo wa wodwala zimadalira momwe thupi limagwirira, mtundu wa opereshoniwo, kutsatira malangizo a dokotala panthawi yobwezeretsa.

Pancreato-duodenal resection ili ndi chiwopsezo chachikulu cha kufa.

Kuyambiranso kwa chithokomiro ndi khansa kumalumikizidwa ndi chiopsezo chowonjezereka. Chiwonetsero chazaka 5 zapulumuka pambuyo pa opareshoni sichidutsa 10%. Wodwalayo ali ndi mwayi uliwonse wobwerera mwakale pambuyo poti mutu kapena mchira wa chiwalo chikukula kwambiri kapeneka kapena zotupa.

Ndemanga za Opaleshoni ya Pancreatic

Polina, wazaka 30, ku Kiev: “Zaka 2 zapitazo adamuchita opareshoni kuti achotse thupi ndi mchira wa kapamba. Madokotala adavotera mwayi wokhala ndi moyo wochepa kwambiri. Kukula kwa gawo lomwe latsala sikupitirira 4 cm.

Ndinakhala miyezi iwiri kuchipatala, ma antibacterial ndi ma painkiller, ma enzymes adayendetsedwa. Pakupita miyezi yocheperako, zinthu zinayamba kuyenda bwino, koma sizinali zotheka kunenepa.

Ndimayesetsa kudya mosamala, kumwa mankhwala. ”

A Alexander, azaka 38, Chita: “Kwa zaka zitatu, zowawa za m'chigawo cha epigastric zimazunza, madotolo adzipanga matenda osiyanasiyana. Mu 2014, adalowa mu dipatimenti yopanga opaleshoni ali pamavuto akulu, pomwe mutu wapa pancreatic adapangidwanso. Nthawi yochira inali yovuta, m'miyezi iwiri idataya 30 kg. Ndakhala ndikutsatira zakudya mwamphamvu kwa zaka zitatu tsopano, kulemera kukukula pang'onopang'ono. ”

Opaleshoni ya pancreatic: Zizindikiro, mitundu, udzu

Mphepoyi ndi gawo lapadera m'njira yoti imakhala chimbudzi cha chinsinsi chakunja ndi chamkati. Amapanga ma enzyme ofunikira kuti chimbudzi chikulowe m'matumbo kudzera m'mitsempha, komanso mahomoni omwe amalowa m'magazi mwachindunji.

Zikondwererozo zimapezeka m'chipinda chapamwamba cha m'mimba, kumbuyo kwenikweni kwa m'mimba, zimayambiranso, makamaka. Amagawika m'magawo atatu: mutu, thupi ndi mchira.

Amalumikizidwa ndi ziwalo zambiri zofunika: mutu umaphimbidwa ndi duodenum, kumbuyo kwake kumayandikana kwambiri ndi impso yoyenera, adrenal gland, aorta, apamwamba komanso otsika a vena cava, zotengera zina zambiri zofunika, komanso ndulu.

kapamba

Kasitomala ndi gawo lapadera osati mwa mtundu wa magwiridwe ake, komanso mwa kapangidwe ndi malo. Ichi ndi chiwalo cha parenchymal, chokhala ndi minyewa yolumikizana ndi minyewa, yolumikizana ndi ma ducts ndi mitsempha yamagazi.

Kuphatikiza apo, titha kunena kuti chiwalochi sichimamvetsetsa pang'ono pokhudzana ndi etiology, pathogenesis, ndipo, motero, chithandizo cha matenda omwe akhudzana nacho (makamaka pachimake ndi chikhansa chachikulu). Madokotala nthawi zonse amakhala osamala ndi odwala otere, chifukwa nthawi yamatenda a kapamba sanganenedweratu.

Kapangidwe ka chiwalo ichi, komanso malo ake osasangalatsa kumapangitsa kuti zisakhale zovuta kwambiri kwa opaleshoni.

Kulowererapo kulikonse m'derali kukuwonekera ndikukula kwamavuto ambiri - magazi, kuchuluka, kubwereranso, kumasulidwa kwa michere yankhanza kunja kwa thupi komanso kusungunuka kwa timinofu tating'ono.

Chifukwa chake, titha kunena kuti zikondamoyozi zimangogwiritsidwa ntchito pazifukwa zaumoyo - pomwe zikuwonekeratu kuti palibe njira zina zomwe zingachepetse mkhalidwe wa wodwalayo kapena kuletsa imfa yake.

Zizindikiro zakuchita opareshoni

• Pachimake kutupa ndi pancreatic necrosis ndi peritonitis.
• Necrotic pancreatitis yokhala ndi supplement (chizindikiro chokwanira cha opaleshoni yodzidzimutsa).
• Zofoka.
• Kuvulala kwam magazi.
• Tumors
• Cysts ndi pseudocysts, omwe amaphatikizidwa ndi zowawa komanso zovuta kutuluka.
• Pancreatitis yayitali yokhala ndi ululu waukulu.