Kodi pancreatic biopsy imachitika bwanji, mbali za njirayi

Pancreatic biopsy ndi kafukufuku wofunikira wofufuzira, chifukwa kapamba (kapamba) ndiye chiwalo chofunikira kwambiri cha m'mimba komanso endocrine. Zikondazo zimatulutsa mahomoni ofunikira ndi ma enzymus omwe amafunikira kagayidwe kazakudya ndi chimbudzi.

Pankhaniyi, kukokoloka kwa pancreatic ndi zinthu zomwe zimawopseza moyo zomwe zimafuna chithandizo chamanthawi.

Njira zodalirika zodziwira momwe zilili kapamba zimaphatikizanso kuwunika kwa mahomoni ndi ma pancreatic enzymes m'magazi, ma ultrasound a chiwalo komanso biopsy ya kapamba.

Kodi pancreatic biopsy ndi chiani?

A pancreatic biopsy amatanthauza njira zowononga zachilengedwe (njira zowonongeka ndi njira zamankhwala zokhudzana ndikulowerera kudzera pakhungu kapena mucous membranes), chifukwa chake njirayi iyenera kuchitidwa pokhapokha ngati akuwongolera dokotala, kuchipatala, pa oncological kapena kuchipatala.

Kuchepetsa chiwopsezo cha zovuta ndikuwonjezera kulondola kwa zitsanzo zosungidwa, pancreatic biopsy imayang'aniridwa ndikuyang'aniridwa ndi scan scanning.

Pakuwunika kwa kapamba, adotolo, pogwiritsa ntchito masingano apadera a biopsy, amatenga kachilombo ka minofu yoyeserera. Kuphatikiza apo, zitsanzo zomwe zapezedwa zimatumizidwa ku labotale, komwe zimayesedwa ndikuyang'aniridwa ndi ma microscope.

Malinga ndikuwonetsa, maphunziro a immunohistochemical okhala ndi ma reagents apadera akhoza kuphatikizidwanso.

Zotsatira za biopsy zimatanthauziridwa molumikizana ndi zizindikiritso za maphunziro ena, chifukwa chake dokotala wopezekayo amayeneranso kuthana ndi kubala.

Chizindikiro chachikulu cha pancreatic biopsy ndi kukhalapo kwa chotupa cha pancreatic mwa wodwala.

Pancreatic biopsy imakulolani kudziwa:

gawo loyambira,
kukhalapo kwa chotupa chikuwonekera m'thupi lathu (kuchuluka kwa chotupa),
chiopsezo cha metastasis.

A biopsy imakupatsaninso mwayi kuti mupange chidziwitso ndikusankha chithandizo chamankhwala chothandiza kwambiri.

Kuyang'ana kophatikizana kumapangitsa kuti:

sinthani mbiriyakale yokhudza kapangidwe ka zikondamoyo,
wunikirani mkhalidwe wamaselo am'magazi ndi kuthekera kwawo kupanga ma enzyme ndi mahomoni,
peza maselo owopsa pamizere yoyenda minofu,
onani chiopsezo chotenga ma pancreatic neoplasms,
khalani ndi matenda pakati pa matenda osiyanasiyana kapamba.

Zisonyezo za kapamba waziphuphu

Chizindikiro chachikulu cha pancreatic biopsy ndikukayikira kwa chotupa chowopsa.

Nthawi zambiri, khansa ya kapamba imatha kutengera zizindikiro za pseudotumor aakulu kapamba kwa nthawi yayitali. Kuzindikira kusiyanitsa pakati pa chifuwa chachikulu ndi chotupa nthawi zambiri kumakhala kovuta kwambiri, ndipo njira yokhayo yopezera njira yokhayo yopezera chidziwitso chodalirika.

Chizindikiro cha pancreatic biopsy ndi:

kukayikira kwa wodwala wokhala ndi zotupa zapachifuwa,
kufunika kwa kusiyanitsa pakati pa zotupa zoyipa ndi zotupa, komanso neoplasms ndi pseudotumor aakulu pancreatitis,
kufunika kudziwa zovuta za matenda a kapamba,
kusowa kwazidziwitso njira zina zomwe sizowukira (zaumoyo wa thupi, zoyesa zamankhwala, ndi zina zambiri),
kufunika kopanga zisankho zokhuza kupulumutsidwa kapena kuchotsedwa kwa gawo limodzi la kapamba (kapamba).

A biopsy yokhudza khansa ya pancreatic ndi njira yodalirika kwambiri yodalirika yodziwira matenda.

Pancreatic Biopsy - Contraindication

Pancreatic biopsy sichichita ngati wodwala ali ndi:

kutaya magazi kwambiri,
kwambiri somatic pathologies mu pachimake siteji.

Komanso, biopsy imaphatikizidwa mwa amayi apakati. Kwa ana, pancreatic biopsy imachitika pokhapokha ngati pakufunikira.

Mitundu ya pancreatic biopsy

Pakadali pano, mitundu zotsatirazi za biopsy imagwiritsidwa ntchito:

wogwira ntchito
laparoscopic
chosawoneka bwino
endoscopic.

Ndi intopoperative biopsies, pancreatic minofu sampuli imachitika mwachindunji pakanthawi kotseguka othandizira pa chiwalo. Nthawi zambiri, mtundu wamtunduwu wofufuzira umagwiritsidwa ntchito ngati pakufunika kupeza zinthu kuchokera kumchira wa kapamba.

Kugwiritsa ntchito biopsy kudzera mu intaneti kungachitike pogwiritsa ntchito njira zotsatirazi:

mwachindunji - njirayi ndiyotheka ngati wodwala ali ndi chotupa chachikulu kwambiri chomwe chili pamphepete kapena m'munsi mwa chindayo. Mtunduwu wa biopsy umachitika kudzera pakuwoneka khoma lakunja kwam'mimba. Kuti mutenge zinthu zosasiyana, gwiritsani ntchito singano kapena mfuti wapadera,
transduodenal - kafukufukuyu amachitika kudzera mu duodenum. Kuti muchotsere chotupacho, gwiritsani ntchito singano yayitali yopyapyala yolumikizidwa ndi syringe ya mamililita 10 yomwe ili ndi mpweya wa mamililita anayi.

Kafukufuku wovuta kwambiri komanso wogwiritsidwa ntchito masiku onse ndi pancreatic biopsy. Kupukutira kwa singano yoyenera nthawi zambiri kumagwiritsidwa ntchito, koma trepanobiopsy amathanso kuikidwa.

Singano imayilidwa pansi pa mankhwala oletsa ululu kudzera pakhungu loyang'ambika pakhungu. Biopsy imayang'aniridwa ndi ultrasound kapena CT.

Ndi singano yabwino kwambiri, maselo a ziwalo amatengedwa, ndipo ndi trepanobiopsy, wozungulira.

Tiyenera kudziwa kuti biopsy yotereyi ingagwiritsidwenso ntchito pochizira matenda a cysts, abscesses, etc.

Laparoscopic biopsies amachitidwa pogwiritsa ntchito endoscope ndipo amagwiritsidwa ntchito ngati wodwalayo ali ndi pseudocysts kapena zilonda zam'mimba, khansa ya kapamba, kapena matenda oopsa a biliary.

Momwe mungakonzekerere njira yopangira biopsy

Wopatsa biopsy asanaikidwe, wodwalayo amayesedwa mozama:

kusanthula kwa magazi ndi mkodzo,
kuyesa kwamwazi wamagazi,
coagulogram,
Ultrasound wa kapamba,
Kuyesedwa kwa ziwengo kwa mankhwala oletsa kupindika omwe amagwiritsidwa ntchito pa biopsy (malingana ndi mawonekedwe),
kuyesedwa kwa pakati (kwa akazi a msinkhu wobala).

Komanso, maola 12 njira isanachitike, kusuta sikuyenera kuyikidwa pambali.

Kwa masiku atatu kapena anayi, tikulimbikitsidwa kupatula zakumwa zoledzeretsa, komanso kumatira ku chakudya chopepuka (osapatula kukazinga, zokometsera, mafuta, osuta, ndi zina zambiri).

Kuphatikiza apo, masiku atatu pamaso pancreatic biopsy, zakudya zonse zomwe zingapangitse kupanga gasi komanso kuwonjezereka ziyenera kuchotsedwa muzakudya (masamba osaphika, nyemba, mafuta amkaka, ndi mkate wopanda bulauni sayenera kuperekedwa).

Ngati ndi kotheka, masiku atatu mpaka anayi, biopsy isanachitike, wodwalayo amapatsidwa mankhwala ochepetsa.

Pancreas biopsy - momwe angapangire komanso kuchuluka kwake kuchipatala

Nthawi yomweyo asanatero, adotolo amafufuza tsamba la biopsy ndi antiseptics ndipo amachititsa opaleshoni yam'deralo. Malinga ndi zomwe zikuwonetsa, njira ya pancreatic biopsy ikhoza kuchitidwa mwa opaleshoni wamba.

Ngati ndi kotheka, Dicinon amaperekedwa kwa wodwalayo kuti asataye magazi.

Kuti muwonjezere kulondola kwa njirayi ndikuchepetsa chiopsezo cha zovuta, pancreatic biopsy imagwiridwa moyang'aniridwa ndi scan scanning.

Pambuyo pokonza biopsy ndi kupumula kwawoko, dokotala, moyang'aniridwa ndi ultrasound (kapena CT), amaika singano yapadera ndipo akutulutsa minofu ya chotupa cha pancreatic. Pambuyo pake, kutsuka ndi antiseptics kapena mankhwala othandizira kumatha kuchitika kudzera mu singano ya biopsy.

Njira yonseyi imatenga pafupifupi mphindi khumi ndi zisanu.

Kukhumba kabongo koyenera kumalekerera bwino komanso sikumayambitsa mavuto. Nthawi zina, zovuta chifukwa cha kuwonongeka kwa mtima zimatha.

Malinga ndi zomwe zikuwonetsa kuti, m'malo mongolakalaka zinthu zopanda moyo, izi zitha kuchitidwa:

endoscopic retrograde cholangiopancreatography (ERCP). Mwanjira imeneyi, chubu chosinthika ndi kamera (endoscope) imayikidwa mkamwa, m'matumbo aang'ono (mpaka kapamba). Kuchita izi kumakuthandizani kuti muthe kujambula ziwalo ndipo nthawi yomweyo kuchita ziwongola dzanja,
mayeso a endoscopic ultrasound. Ndi njirayi, komanso ndi ERCP, endoscope imayikidwa mu kapamba. Pambuyo pake, pomwe mawonekedwe a chotupacho amadziwika ndi sensor ya ultrasound ndipo gawo la chotupa limatengedwa ndi singano ya biopsy.
mayeso a laparoscopic. M'maphunziro a laparoscopic, endoscope imayikidwa kudzera pakapangika kakang'ono kwambiri khoma lam'mimba. Nthawi yowerengera, dokotala amatha kuyang'ana chiwalocho ndikuwunika komwe chotupacho chili. Pambuyo pa izi, minofu imatengedwa kuti ifufuzidwe.

Zingwe zomwe zimasonkhanitsidwa nthawi yayitali ya kapamba zimatumizidwa ku labotale kuti mukaphunzitsenso za histological kapena immunohistochemical.

Pancreas biopsy - zotsatira ndi moyo pambuyo

Malinga ndi zikuwonetsa, wodwalayo amatha kusamutsidwira ku zakudya za makolo kwa maola 24-48.

M'tsogolo, wodwalayo ayenera kutsatira mosamalitsa zakudya No. 5p malinga ndi Pevzner. Zakudyazi zimawonedwa kwa pafupifupi mwezi umodzi, pomwe, povomerezedwa ndi dokotala wa gastroenterologist, pang'onopang'ono chakudya chikukula.

Kudya kumayenera kukhala kosagawika, mu mushy kapena grated mawonekedwe, kasanu mpaka kasanu ndi tsiku. Chakudya chizikhala chotentha.

Kuphatikiza apo, atatha kupanikizika kwa kapamba, Sandostatin (mankhwalawa amaletsa kupanga michere ya pancreatic, ndikupanga gawo lopuma la thupi) ndipo Cerucal akhoza kukhazikitsidwa.

Patatha masiku ochepa atatuluka, ndikulimbikitsidwa kuti muzitsatira regimen yotsika pakati. Pakatha mwezi umodzi, tikulimbikitsidwa kupewa kuchita masewera olimbitsa thupi, muyenera kukana kumwa mowa.

Kodi pancreatic biopsy ndi chiani?

Ziwalo zamkati zimakonda kukhudzidwa ndi zotupa ndi zilonda. Ngati oncology kapena benign neoplasm akuwakayikira, wodwalayo amawaboola pamatumbo kudzera pakhungu kapena mwachindunji pa opareshoni.

A pancreatic biopsy ndi njira yoyenera yomwe imachitidwa kwa odwala omwe ali ndi zotupa kapena omwe ali ndi pancreatitis yowonjezera. Ndikofunikira ngati kudzikundikira kwa madzi kapena edema ya malo obwezeretsedwako sikuloleza njira zodziwonera za ultrasound kapena MRI ya m'mimba kuti mumvetsetse bwino momwe njira zikuwonekera m'thupi. Kuphatikiza apo, ngati pakufunika kutsimikizira khansayo kapena kumvetsetsa kuti ndi gawo liti, njirayi imagwiritsidwa ntchito mwachindunji pozindikira zotupa.

Kukonzekera biopsy kumayikidwa ngati akutsimikiza, nthawi zambiri amatengedwa pakuchita opareshoni

Njira Zosonkera Zolemba

Chotupa chilichonse mu kapamba, ngakhale chitakhala chofotokozedwa ngati chisonyezo chachikulu, chimafunika kuchipeza. Kuti muchite izi, chitani kafukufuku wina. Iyi ndi njira yowunika minofu yomwe imatengedwa kuchokera kwa wodwala panthawi ya opareshoni kapena asanachitidwe opareshoni.

Ndikofunikira kwambiri kuti mutenge minofu kuchokera kumalo omwe amayimilira kupanikizana. Biopsy ndiyo njira yolondola kwambiri yodziwira zotupa zoyipa ndikuthandizira kuzindikira metastases. Amazindikira kuchuluka kwa matendawa, chikhalidwe cha oncology ndipo amawona kuti matendawa ndi ati.

Pancreatic biopsy ili ndi mitundu inayi ya maluso:

At njira yolumikizirana Tizilombo timene timasungunuka pakachitika opaleshoni yotseka m'mimba. Iyi ndi njira yodziwika, makamaka ngati pancreatic mchira biopsy ukufunika. Njirayi ndi yovuta komanso yoopsa, koma yophunzitsa momwe angathere. Zowopsa ndikuti kafukufuku wamakhalidwe osagonjetseka sangawonetse mbali zonse zamkati, ndipo pambuyo pake, chotupacho nthawi zina sichigwira ntchito, ndipo opaleshoni yachitika kale. Kuphatikiza apo, palibe chilichonse chotsimikizika kuti minofu ya neoplasm sidzayankha kukankha ndi kudina chidutswa, kuyamba kukulira mofulumira.
At laparoscopic njira Ma biopsies ali ndi mwayi osati wotenga minyewa, komanso kupenda pamimba kapena kapamba palokha. Njira iyi imagwiritsidwa ntchito nthawi zambiri ngati njira zotsalira za oncological zikufunika. Mchitidwewo umachitika pansi pa mankhwala oletsa ululu. Mu pancreatitis yovuta kapena yosatha, njira yodziwira pataroscopic imakuthandizani kuti muone malo omwe mungabwezere, kuti muwone ngati pali neoplasms kapena kuchuluka kwa madzi.
At njira yododometsa pancreatic biopsy imatengedwa pogwiritsa ntchito singano yabwino. Njira yodziwikirayi imakuthandizani kuti musiyanitse bwino pakati pa njira zapancreatic ndi neoplasms yoyipa. Komabe, njira yopangira matendawa singagwiritsidwe ntchito nthawi zonse, chifukwa ndizovuta kulowa chotupa chochepera 2 cm. Ngakhale diagnostics a ultrasound kapena pancreatic MRI amathandizira adotolo, sizotheka nthawi zonse kuwona m'maganizo momwe amapangira biopsy mothandizidwa. Dongosolo la transdermal biopsy ndi loletsedwa ngati wodwalayo wachitidwa opaleshoni yam'mimba, ndiye amene akufunika nthawi zina. Kugwirizana kwake kukufotokozedwa ndikuti kuphatikiza kwamphamvu kwambiri kwa kapamba kumapangitsa kuwonongeka kochepa kwa thanzi komanso kumachepetsa chiopsezo cha zero.
At njira endoscopic endoscope imalowetsedwa m'matumbo, minofu ya chotupacho imakhazikika kudzera mu duodenum. Njira ngati imeneyi ndi yoyenera ngati neoplasm ndi yaying'ono kukula kapena ikulimbikitsidwa kwambiri ndi kapamba.

Pancreatic biopsy kwa chotupa: machitidwe amachitika bwanji?

Wodwala akakhala kuti wapanga ma ultrasound kapena MRI ya kapamba, kuwonetsa kuti pali njira yotupa yomwe imayenera kuwunikiridwa, dokotala amapereka malangizo oti awone ngati akuwonetsa kuti ali ndi magazi. Dokotala asanadziwe momwe minofu iti idzatengedwere kuti iwunike histological, ndikofunikira kuti wodwalayo adutsenso:

kuyezetsa magazi konse
urinalysis
magazi
kusanthula kwamasamba
prothrombin index test.

Dokotala ayenera kukhala ndi chithunzi chonse cha momwe wodwalayo akumvera, momwe thupi lake limakhalira panthawi yogwira pancreatic biopsy, zovuta ndi zovuta ziti zomwe zingakhalepo. Ngati pali vuto ndi kuphatikizika kwa magazi, ndiye kuti zolengedwa ndizoletsedwa, MRI yam'mimba mosiyana ndi yomwe imayikidwa.

Kwa wodwalayo, njirayi ndi yosavuta momwe angathere, chidutswa cha minofu chimachokera kwa iye, ndipo amapatsidwa mayeso a labotale. Kugwidwa kumachitika ndi bfuti, kumapeto kwake kuli singano, nthawi zina imakhala yochepa thupi, ndipo nthawi zina imakhuthala. Njira yotengera zinthu kuchokera pancreatic neoplasm ndi njirayi ndi ofanana ndi zigawo za syringe. Chidutswa cha minofu chimayamwa mu singano ndikuchokeranso mu chubu. Chotengera chomwe chili ndi nkhaniyi chimatumizidwa ku labotale kuti ndikafufuze. Mothandizidwa ndi zida zapadera, maselo amisempha yathanzi komanso maselo odwala amapatukana, mawonekedwe a neoplasm ndi chikhalidwe chake amakhazikika.

Kukonzanso nthawi

Wodwala sayenera kudziwa momwe angachitire biopsy, komanso za njira yochira pambuyo povuta.Ziribe kanthu zomwe zimatsata, kuzindikira kumatsimikiziridwa kapena kutsimikiziridwa, pambuyo podziwonetsa, nthawi yokonzanso ikufunika.

Pambuyo pakuwerengera kachulukidwe ka zikondamoyo mwa kukhathamiritsa mosiyanasiyana, munthuyo amakhala m'chipatala. M'chipatala, ngati pakufunika kutero, amathandizidwa kuti azichita bwino, ndipo tsiku lomwelo wodwalayo amatha kuimirira. Kenako, kwa masiku angapo, madokotala amayang'ana wodwalayo, onetsetsani kuti matupi onse a thupi amapita mwanjira zawo. Tipite kwathu kwa masiku atatu, ngati zisonyezo zonse ndizabwinobwino komanso molingana ndi biopsy palibe chifukwa chofunikira chogwiritsira ntchito chotupa pa kapamba. Ndi pancreatitis, chithandizo ndi kuwongolera kumachitika isanayambe gawo lazowawa.

Posankha zofunikira pakuwunikira pogwiritsa ntchito njira yopangira singano yabwino, ndikofunikira kuti wodwalayo ayang'anire kwa maola osachepera anayi. Ngati panthawiyi palibe kusintha pa thanzi, ndiye kuti wodwala amatumizidwa kunyumba.

Mulimonse momwe madotolo amatengera phukusi la kapamba, ndikofunikira kukumbukira kuti ndikofunikira kuti wodwalayo asadikire masiku angapo:

pochita masewera olimbitsa thupi
ntchito yogwira ntchito ndi zolimbitsa thupi,
kumwa mowa
ntchito zamagalimoto kwambiri,
kuyendetsa galimoto
kusuta
kudya zonunkhira, zamchere, zokazinga.

Kuthana ndi kachilomboka kungatengedwe ndi laparoscope pakaunika matumbo

Kulowerera kulikonse kwa kapamba kumadziwika chifukwa chakuti zovuta zingayambike:

kutentha kuwonjezeka
kufooka m'thupi
magazi omwe atseguka
kudumphira m'magazi,
kuzizira
chizungulire.

Ngati mwazindikira zina mwazomwe zalembedwazo, ndiye kuti simungachoke kuchipatala, ndikofunikira kukhalabe moyang'aniridwa ndi dokotala, chifukwa thupi lirilonse limachita mosiyanasiyana pa biopsy. Nthawi zina m'malo mwa punctures kapena kuwonongeka kwa gland fistulas imatha kupanga, ndipo pamapeto pake limayimba, zotupa, ma suppurations.

Kukonzekera kwa labotale

Ndikofunika kukonzekera kutenga biopsy. Kudzimbidwa kumachitika pamimba yopanda kanthu, ndizoletsedwa ngakhale kumwa madzi, kuphatikizapo madzi. Ngati wodwala alibe pancreatitis, mavuto ndi kapamba omwe ali pachimake pachimake, ndiye kuti simuyenera kutsatira zakudya zapadera pasadakhale. Zoletsa masiku awiri okha zikhale zakumwa zoledzeretsa, mankhwala a fodya, mafuta ndi zakudya zonunkhira. Ngati wodwala akufunika kukonzekera zamaganizidwe, ndiye kuti kuchipatala amatha kuthandizidwa ndi izi, makamaka muzovuta, amalimbikitsidwa kumwa mankhwala osokoneza bongo. Kuyeretsa kwa matumbo ngati kale colonoscopy kapena anoscopy sikofunikira.

Mitundu ya Pancreatic Biopsy

Madokotala amachita njirayi pogwiritsa ntchito zida ndi njira zosiyanasiyana, nthawi zina mwachindunji pamankhwala pamimba.

singano yayikulu
kusilira bwino kwa singano kapena kozungulira,
laparoscopic
wogwira ntchito
endoscopic.

Wopanda singano ya biopsy ya chiwalochi imapangitsa kuti mupeze zitsanzo zazikuluzikulu zamaphunziro kuti muphunzire kamodzi. Phata la singano yomwe imagwiritsidwa ntchito pamenepa ndi millimeter imodzi.

Matenda a transdermal biopsy amatchedwanso kuti singano yabwino. Njira zamtunduwu zimachitika nthawi zambiri. Poterepa, adotolo amagwiritsa ntchito chida chachipatala chokhala ndi mfuti yapadera, pamapeto pake pamakhala mphuno ya mpeni. Mukakankha batani, tsamba limabalalitsa minofu. Singano yayitali, yopyapyala ndi syringe ingagwiritsidwenso ntchito. Chofunikira mu percutaneous biopsy ndi cholembera chosakanizira kapena chosakanizira cha ultrasound, momwe njirayi imayang'aniridwa.

Mayeso a Laparoscopic ndi ofunika kuti apezeke zitsanzo za tsamba linalake. Pankhaniyi, adotolo, akupanga zochepa zazing'ono, amapeza mwayi wowunika pamimba kuti apangidwe a metastases. Wodwala akapezeka kuti ali ndi pancreatitis yovuta kwambiri, laparoscopic biopsy imapangitsa kuti awone kuchuluka kwa kulowetsedwa.

Kuchita opaleshoni ya biopsy kumachitika mwachindunji pa opareshoni. Dokotala, atatha kulowa m'matumbo am'mimba chifukwa cha kulowererapo kwa opaleshoni, amasankha zitsanzo zoyeserera.

Ponena za mtundu wakudziwitsa za endoscopic, pankhaniyi, adotolo amafika ku zikondamoyo kudzera mu duodenum, pogwiritsa ntchito endoscope ndi singano yapadera mwa mawonekedwe a mphuno pa endoscope. Chifukwa chake, ndizotheka kutenga minyewa kuchokera kumutu wa ndulu kuti muyezedwe.

Nthawi zina ndi ziti zomwe zimayikidwa ngati sizingatheke

Monga mtundu wina uliwonse wazidziwitso, biopsy ili ndi mndandanda wazowonetsa. Mwachilengedwe, zitha kuchitidwa pokhapokha ngati adokotala adanenanso, ngati pakufunika kutero. Chifukwa chake, kuyesa kwina kwa kapamba kumachitika ngati:

wodwala amaganiziridwa kuti ali ndi zotupa za khansa yachiberekero,
njira zina zodziwira matenda zinawonetsa kukhalapo kwa neoplasms mu minyewa ya England, chikhalidwe chake chomwe chiyenera kukhazikitsidwa,
Njira zowunikira zomwe sizowukira sizimalola kupeza chidziwitso chokwanira chidziwitso cha matenda ndi chithandizo,
wodwalayo amapezeka ndi chifuwa chachikulu kapena chamba chachikulu,
Pakufunika kukhazikitsa zovuta za zotupa za khansa yodwalayo.

Momwemonso, biopsy ndondomeko imaperekanso zotsutsana. Gland biopsy sichichita ngati:

wodwala amapereka kukana zolembedwa kale,
wodwala ali kuphwanya magazi coagulation katundu,
mutu uli kwambiri, mwachitsanzo, wolumikizidwa ku zida zothandizira moyo,
Pali njira zina zowonetsera zosagwiritsa ntchito zomwe zingapereke chidziwitso chofanana mu buku lofanana ndi biopsy.

Kwa amayi apakati, mtundu uwu wa kuchitira opaleshoni sikuti umalembedwa, chifukwa choopsa chomwe chingachitike kwa mwana wosabadwa. M'badwo wa ana nthawi zina amathanso kukhala chopinga ku biopsy ya kapamba.

Malamulo okonzekera mayeso

Chofunikira chachikulu chomwe kupezeka ndi matendawa kumadalira ndikufunika kuchitira mosamalitsa pamimba yopanda kanthu. Maola 24 asanayambe njirayi, wodwalayo amaletsedwa kumwa mowa, chifukwa maola 12 simungathe kusuta.

Patsiku loti biopsy isanayambike, chakudya chochepa chimakhala cholimbikitsidwa, chopanda mafuta, zonunkhira komanso zowiritsa. Madzulo, chakudya chamadzulo chololedwa chimaloledwa, koma pasanathe maola 8-10 phwando lisanachitike. Nthawi yomweyo, simungamwe madzi aliwonse.

Kafukufuku pawokha, ngakhale atakhala kuti akukwaniritsidwa bwanji, akhoza kukhala opweteka kwambiri, monga momwe dokotala amachenjezera wodwalayo pasadakhale. Kuchita biopsy nthawi zambiri kumachitika pogwiritsa ntchito mankhwala oletsa ululu kapena opaleshoni wamba. Poterepa, adotolo adafotokozeratu kuti wodwalayo sayenera kuyanjana ndi mankhwala opha, ngati pakufunika, amamuwuza mayeso a ziwengo.

Amayi omwe ali ndi nthawi yoyamba kubereka ayenera kumuuza dokotala za vuto lakelo.

Kodi mitundu yosiyanasiyana ndimayendedwe bwanji?

Kukonzekera biopsy kumachitika kokha kuchipatala, moyang'aniridwa ndi ultrasound kapena computer tomography scanner. Nthawi zina, wodwala amatha kumuzindikira kuchipatala.

Wopangira maopaleshoni, anamwino komanso ochititsa dzanzi amafunika kutsatira malamulo onse aseptic pokonzekera kutengera zinthu zofufuzira.

Vuto lakuthwa laphokoso ndiye lotetezeka komanso lopweteka kwambiri pamituyi. Dokotala amatha kugwiritsa ntchito singano yopyapyala yayitali kapena mfuti yapadera. Popeza kupweteka kwa njirayi, nthawi zambiri wodwala amapatsidwa mankhwala oletsa kupweteka.

Opaleshoniyo itatha, moyang'aniridwa ndi makina a ultrasound kapena tomograph yovomerezeka, dokotala amaika singano mu chiwalo cha ziwalo kudzera pakhoma lakumbuyo lakumbuyo. Chifukwa chopopera mpweya kuchokera pa singano patsekeke, zinthu zachilengedwe zimalowa. Mfuti ya biopsy imagwiranso ntchito mofananamo. Ngati dera lomwe lakhudzidwalo likucheperachepera masentimita awiri, kapena wodwalayo atachitidwa opaleshoni kapena chifuwa cham'mimba, kuchititsa singano yoyenera ya biopsy kumakhala kopanda tanthauzo.

Kuphwanya kwa singano yayikulu imachitidwa mofananamo - mankhwala ochita kupanga amapatsidwanso kwa wodwala, ndipo adokotala, pogwiritsa ntchito singano yayikulu (1 mm), amatulutsa minofu yoyesera.

Laparoscopy imawerengedwa kuti ndiyo njira yopambana kwambiri yochitira mayeso a biopsy. Poterepa, kuwonongeka kochepa komanso zowawa zimaphatikizidwa ndi zambiri zazidziwitso. Kuphatikiza pa kapamba, pa nthawi ya laparoscopy, dokotala amatha kupima lonse m'mimba, amawunika momwe ziwalo zimakhalira, adziwe metastases ndi foci ya necrosis. Wodwalayo amamuika ngati wagona mankhwala, kenako mpweya woipa umaperekedwa pamimba. Dokotala amapanga ma piquenti awiri kapena kuposerapo pomwe zida zapadera, monga singano ya laparoscope kapena biopsy, zimalowa m'mimba.

Kukonzekera kwa endoscopic nthawi zambiri kumakhala koyenera kwa milandu pamene ma neoplasms ang'onoang'ono atagona mkati mwa zigawo zamkati mwa mutu wa chiwalo. Mutuwu, kudzera m'mkamwa ndi m'mphepete mwake, maselo am'mimba amawaikiramo. Kuchokera pamimba, kachipangizoka kamalowa mu duodenum, kuchokera komwe mphuno yapadera imatha kulanda maselo kuchokera kumutu wa ndulu. Popeza chophimba chambiri cha njirayi, sichimagwiritsidwa ntchito.

Kufufuza kwapakati pamasewera kumachitika mwachindunji pamimba yopanga m'mimba. Njirayi imawerengedwa kuti ndi yofunika kwambiri, komanso yoopsa komanso yopweteka kwambiri kwa wodwala. Zofunikira zonse zakugwirira ntchito pamimba zimapita patsogolo kwa izo. Wodwalayo amakhala akuvulala kwambiri pomwe dokotalayo ataya khoma lam'mimba mwake, motero amalowa mu ziwalozo. The intraoperative biopsy imatha kuchitika m'njira zingapo. Chifukwa chake, kuyikira mwachindunji kumatheka pokhapokha ngati pali zotupa zazikulu kwambiri zomwe zimapezeka kudera lam'mphepete kapena kumunsi kwa England. Imachitika kudzera mkutuluka, kapena kugwiritsa ntchito singano zapadera ndi mfuti. Njira ya transduodenal imachitika kudzera mu duodenum, yotsekedwa kapena yotseguka, pogwiritsa ntchito masingano ndi endoscope. Ndondomeko itha kuchitika ndi singano yopyapyala ndi syringe 10 mamilimita, yomwe ili ndi mpweya wa mamililita atatu. Chotupacho chimabedwa ndipo zinthu zimatengedwa kuchokera pamenepo.

Zambiri za kukonza zinthu zinagwidwa

Wopanga maopaleshoniyo atatenga ziwalo zomwe zakhudzidwazo, ziyenera kutumizidwa ku labotale kuti ziyezedwe. Minofu imasunthidwa mumachubu apadera osabala. Diagnostics, musanapitirize ndi kuphunzira kwa biomaterial, imayipanga ndikukonzekera kafukufuku.

Tizilombo tosankhidwa timapatsidwa chithandizo cha parafini kapena kuzizira, pambuyo pake timadulidwira timapepala tating'ono - magawo, pogwiritsa ntchito mpeni wa microtome. Zigawo zomwe zapezedwa zimayikidwa pa magalasi osalala osanjidwa, ndikuyika madontho.

Zida zomwe zimakonzedwa motere zimayesedwa ndi ma microscope. Pogwiritsa ntchito maopaleshoni okwera kwambiri, dokotala amatha kudziwa mtundu wa matenda omwe anakhudza chiwalo, kuuma kwake, komanso ngakhale mathedwe a kukula kwake.

Ngati mayeso a microscopic sikokwanira kuti adziwe ngati ali ndi chotupa cha khansa, kuwunika kwa minofu-histological kumachitika. Kwa izi, zigawo zimayatsidwa ndi antitumor sera osiyanasiyana. Maonekedwe mu umodzi wa kapangidwe ka giyala yachikaso, chosiyanitsa ndi maikulosikopu, chikuwonetsa kuti chotupacho chiri ndendende momwe seramu imayendetsedwa gawo lina.

Ma microncopy a electron amapezeka ndi kuwonjezeka kwa maselo a ziwalo mpaka nthawi zana, ndikukulolani kuti mufufuze momwe amapangira ma cell a pancreatic cell.

Mavuto ndi kukonzanso pambuyo pa njirayi

Zoopsa kwambiri pazotsatira zomwe zingakhalepo ndi gawo lochita masewera olimbitsa thupi. Pambuyo pakuchita opaleshoni yam'mimba, wodwalayo amakhala m'chipinda choperekera chithandizo chachikulu, momwe zimakhalira pang'onopang'ono. Pakapita kanthawi, adasamutsidwa kupita ku dipatimenti yopanga opaleshoni. Pakupita masiku 5-25 atachitidwa opaleshoni, nkhaniyi ili kuchipatala.

Pambuyo pa kuyesedwa ndi singano yopyapyala, wodwalayo amakhazikika moyang'aniridwa ndi madokotala kwa maola angapo. Ngati munthawi imeneyi akumva bwino, adzaloledwa kupita kwawo, makamaka kuyang'aniridwa ndi wina wapafupi naye.

Nthawi yokonzanso itatha matendawo azichitika osasuta komanso kumwa mowa. Pambuyo pa njirayi, sikulimbikitsidwa kuyendetsa kapena kugwiritsa ntchito njira zina zovuta.

Kuyambira masiku atatu mpaka 30 (kutengera mtundu wazomwe wapezeka ndi matendawa), wodwalayo amaletsedwa kuchita zolimbitsa thupi.

Mavuto pambuyo pakuchita opaleshoni ndizomwe zimachitikanso kuposa lamulo. Ngati mchitidwewo unachitika bwino, magazi, peritonitis, cysts zabodza komanso fistulas zitha kuchitika.

Pancreatic biopsy ndi njira yovuta yophunzirira mkhalidwe wa chiwalo. Ngati wodwalayo ali ndi zotupa, ndipo njira zina zonse zofufuzira sizipangitsa kuti azindikire ngati mitunduyo inali yoyipa kapena yovutikira, ndiye kuti matupi a biopsy omwe amatsatiridwa ndikuwunika kwa histological ndi ma microscopic omwe angapatse dokotala chidziwitso chofunikira. Monga njira yodziwira khansa yapancancic, ndi biopsy, mpaka pano, yomwe imapereka zotsatira zolondola kwambiri mu 85-95% ya milandu.

Mavuto pambuyo pa RV Biopsy

Nthawi zambiri, kufunsa kwamphamvu kwa kapamba kumalekeredwa bwino. Kutengera ndi malamulo onse okonzekera komanso kuchira, zovuta zimachitika kawirikawiri.

Nthawi zambiri, zovuta pambuyo pa kukomoka kwa kapamba zimachitika:

Zizindikiro zakuthwa
kufooka
kupweteka m'mimba
kusanza ndi kusanza
kuzizira
chizungulire.

Kuchepetsa chiwopsezo cha zovuta, njira ya pancreatic biopsy iyenera kuchitidwa kokha ndi akatswiri oyenerera, moyang'aniridwa ndi ultrasound, CT, etc.

Kukonzekera TIAB

Chenjezani dokotala wanu za zovuta zilizonse zamagulu osokoneza bongo, matenda ena ndi mthupi, monga kutenga pakati, matenda am'mapapo komanso matenda a mtima, komanso kutuluka magazi kwambiri. Mungafunike kuyesedwa.
Ngati mukumwa mankhwala aliwonse, dziwitsani dokotala pasadakhale. Mutha kulangizidwa kuti musakane kutenga ena a iwo.
Ndondomeko imachitidwa mosamalitsa pamimba yopanda kanthu, phunzirolo lisanathe ngakhale kumwa madzi.
Tsiku loti biopsy lisinthe, muyenera kusiya kusuta ndi kumwa mowa.
Ngati mukuopa kwambiri njira yomwe ikubwera, auzeni dokotala za izi, mutha kupatsidwa jakisoni wa tranquilizer (sedative).

Njira zochitira njirayi

Mtunduwu wa biopsy wa zikondamoyo zimagwiritsidwa ntchito pofufuza biopsy pancreatitis, oncology. Kusiyanitsa mosiyanasiyana matenda am'kati mwa ziwalo zamkati kumayikanso kutsogolera. Kutengera ndi zotsatira za maphunziro, mawu amafupikitsidwa pakufunika kuchotsa ziphuphu.

Kuchita opaleshoni yamapamba yokhala ndi chiopsezo chochepa ku thanzi, kuphunzira kuyenera kuchitika potsatira milandu:

chidziwitso chokwanira pa njira zomwe sizili zowukira,
kufunikira kofulumira kowunikira kusintha kwa maselo. Izi zimakhala zofunikira kwambiri chotupacho chikakula,
kukhazikitsidwa kwa foci ya matenda.

Zoyipa zomwe zimalepheretsa kukondera kwa kapamba zimaphatikizapo:

kukana kwathunthu wodwalayo kuchititsa maphunziro apachifwamba,
magazi akutaya
njira zophunzitsira njira zosazindikira zachilengedwe zomwe zimapereka chidziwitso chonse chokhudza kapamba,
kusakwaniritsidwa kwa kapamba wamtundu wina wazida chifukwa cha mawonekedwe ake.

Zizindikiro za biopsy ndizopweteka kwambiri pakukula kwa epigastrium, hypochondrium yoyenera, amatha kuperekera kumbuyo. Ululu wamtunduwu umalumikizidwa ndi kupindika kwa mitengo ya mitsempha, kuphimba kwa Wirsung, ducts ya bile, zochitika zoyipa zomwe zimachitika chifukwa cha kufalikira kwa kutukusira kwa kapamba.

Momwe ululu umakulirakulira, jaundice imafikiranso pa zizindikirazo, imakhala chimodzi mwazizindikiro zazikulu za oncology, koma pafupifupi nthawi zonse chizindikiro ichi chimatha kuposa kuchepa thupi komanso zochitika zina.

Kodi kapancreas biopsy amatengedwa bwanji? Kutengera luso lofufuzira, ndichikhalidwe kusiyanitsa njira zinayi zosonkhanitsira zinthu zachilengedwe: intraoperative, laparoscopic, percutaneous, endoscopic.

Zinthu zikagundidwa mukam'chita opareshoni pancreas, amalankhula za intraoperative biopsy. Njira yofufuzira iyi imasankhidwa ngati pali umboni woti utenge chitsanzo kuchokera mchira kapena thupi la chiwalo. Mchitidwewu umalingaliridwa:

zovuta
zopweteka
owopsa.

Opaleshoni amagwiritsa ntchito laparoscopic njira yopangira biomaterial kuchokera kumalo ena a kapamba ndikuyang'ana pamimba pamimba ya metastases.

Phunziroli likugwirizana ndi khansa, pozindikira ma volumetric fluid neoplasms kumbuyo kwa peritoneum mu pancreatitis ya pachimake, cholinga cha mafuta pancreatic necrosis (minofu ya pancreatic ikafa).

Kuboola kapamba chifukwa cha njira yosinthira mwanjira ina imatchedwa kuti singano yoyenerera biopsy, iyo:

ndizolondola momwe zingathere
limakupatsani kusiyanitsa kapamba ndi njira ya oncological,
kuchiritsa kwa kapamba kumachitika muulamuliro wa ultrasound.

Njira yake sigwiritsidwa ntchito ngati kukula kwa chotupa kuli ochepera masentimita awiri, popeza ndizovuta kwambiri kulowa. Komanso, njira yamkati ya khomo lachiberekero sichikulimbikitsidwa musanachitike opaleshoni yam'tsogolo (opaleshoni yam'mimba). Kusinkhasinkha moyang'aniridwa ndi CT ndi ultrasound ndikotsimikizika kuphatikiza njirayi.

Njira ya transdermal ikhoza kuwonetsa oncology pafupifupi 70-95% ya milandu, ndikuwoneka kuti pazochita zabodza:

kuphatikiza metastasis,
kuipitsidwa kwa m'mimba,
zovuta zina.

Ngati pancreatic cyst kapena neoplasm ina ili yaying'ono kapena yakuya mu kapamba, pali chizindikiro cha endoscopic biopsy; dzina lina la njirayi ndi transduodenal biopsy. Zimaphatikizapo kuyambitsa kachipangizo kapadera ndi kamera kumutu wa kapamba kudzera duodenum.

Nthawi zambiri, madotolo asankha njira yabwino yopopera, chifukwa cha kakhalidwe kake, kapamba amawombera ndi mfuti ya biopsy, ndipo mpeni waung'ono umakhala kumapeto kwa chubu.

Phunziroli nthawi zambiri limachitika pang'onopang'ono (pokhapokha ngati pakuchita opaleshoni ya biopsy komanso opaleshoni).

Pogwiritsa ntchito singano yabwino kwambiri, mankhwala ogwiritsira ntchito mankhwalawa amagwiritsidwa ntchito, pogwiritsa ntchito mankhwala oletsa kupindika ndi laparoscopic.

Kutalika kwa kafukufukuyu kuyambira pa mphindi 10 mpaka ola limodzi, kutengera njira.

Zizindikiro ndi contraindication kwa minofu kusankha

Phunziroli liyenera kuchitidwa mu milandu yotsatirayi:

zosakwanira zazidziwitso za njira zomwe sizili zowononga,
kufunika kwa kusiyanitsa kwa kusintha komwe kumachitika pang'onopang'ono, komwe ndikofunikira kwambiri pazovuta zam'mimba,
kufunika kokhazikitsa zosokoneza kapena zoyambira zam'tsogolo.

Contraindication chifukwa:

kukana kwa wodwalayo kuchititsa maphunziro apakhungu,
kutaya magazi kwambiri,
kukhalapo kwa zopinga pakuyambitsa chida (neoplasms),
ndikotheka kuchita njira zosazindikira zachilendo zomwe sizotsika ndi ma biopsies pazambiri zidziwitso.

kutha kudziwa minofu ya cytology ndikudziwa zambiri za kuchuluka kwake, kuopsa kwa matendawa,
matenda atha kuzindikirika poyambira kukula kwake ndipo zovuta zambiri zitha kupewedwa,
biopsy imakupatsani mwayi wodziwa kuchuluka kwa maopaleshoni omwe akubwera kwa odwala khansa.

Ntchito yayikulu ndikuzindikira mtundu ndi mtundu wa njira ya matenda omwe amapezeka mwa munthu. Ngati ndi kotheka, njirayi imatha kuthandizidwa ndi njira zina zodziwira, kuphatikizira x-ray, kusanthula kwa immunological, endoscopy.

Kanema kuchokera kwa katswiri:

Njira za Biopsy

Biopsy imatha kuchitidwa opareshoni kapena kuchitidwa ngati mtundu wakudziyimira pawokha. Njirayi imaphatikizapo kugwiritsa ntchito masingano apadera okhala ndi ma diameter osiyanasiyana.

Scanner ya ultrasound, CT scan (compute tomography) imagwiritsidwa ntchito pochita, kapena njira laparoscopic ingagwiritsidwe ntchito.

Njira zakufufuza:

Mbiri. Njirayi imaphatikizapo kuyesa mayeso a minofu yaying'ono. Imayikidwa phunzirolo lisanaperekedwe mwapadera, kenaka palafini ndikuyatsidwa. Chithandizo ichi chimakupatsani mwayi kusiyanitsa pakati pamagawo am'maselo ndikupanga lingaliro labwino. Wodwala amalandila zotsatira zake pakadutsa masiku 4 mpaka 14. Nthawi zina, zikafunika kusankha mtundu wa neoplasm mwachangu, kuwunikirako kumachitika mwachangu, kotero mawu omaliza amaperekedwa pambuyo mphindi 40.
Cytology. Njirayi imatengera kuphunzira kwa maselo a ma cell. Amagwiritsidwa ntchito povuta kuti apeze zidutswa za minofu. Cytology imakupatsani mwayi kuti muwoneke mawonekedwe a maphunziro komanso kusiyanitsa chotupa choopsa ndi chidindo chokhacho. Ngakhale kuphweka komanso kuthamanga ndikupeza zotsatira, njirayi ndiyotsika ku histology pakudalirika.

Mitundu yosankha minofu:

singano yabwino kwambiri,
laparoscopic njira
njira ya transduodenal
kuphatikiza kopindulitsa.

Njira zonse pamwambazi zikuphatikiza njira zingapo zoletsa kulowa kwa tizilombo tating'onoting'ono kulowa pachilonda.

Kufuna kwabwino singano

Kuboola pancreatic ndikotetezeka komanso sikowopsa chifukwa chogwiritsa ntchito pistol kapena syringe yomwe idapangidwira.

Pamapeto pake pali mpeni wapadera womwe umatha kutulutsa timinofu tina tomwe timawombera nthawi yomweyo.

Wodwalayo amapezeka kuti ali ndi opaleshoni yam'deralo musanachite biopsy kuti muchepetse ululu.

Kenako, mukuyang'aniridwa ndikuwunika kwa ultrasound kapena kugwiritsa ntchito zida za CT, singano imayikidwa kudzera pa khoma la peritoneum m'matumba a pancreatic kuti mulowetse biopsy singano.

Ngati mfuti yapadera imagwiritsidwa ntchito, ndiye kuti lumen ya singano imadzazidwa ndi mzere wama cell panthawi yoyambitsa chipangizocho.

Kugwiritsa ntchito singano kwakanthawi kokwanira sikothandiza panthawi yomwe wodwala akufuna kuchita:

laparoscopy, wophatikizika ndi kukhoma kwa khoma loyipa,
laparotomy yochitidwa ndi dissecting peritoneal zimakhala.

Njirayi siigwiritsidwa ntchito ngati kukula kwa malo omwe akukhudzidwaku sikupita masentimita 2. Ichi ndichifukwa chovuta kulowamo m'dera la minofu yomwe mwaphunzira.

Laparoscopic

Njira iyi ya biopsy imawonedwa kuti ndi yophunzitsa komanso yotetezeka. Imachepetsa chiopsezo cha kuvutika m'mavuto, komanso zimapangitsa kupenda khunyu ndi ziwalo zomwe zili mu peritoneum kuti mupeze zina zowonjezera za necrosis, zimawoneka metastases komanso njira zotupa.

Mothandizidwa ndi laparoscopy, zinthu zomwe zakonzedwa kuti zilingaliridwe zitha kutengedwa kuchokera kumalo enaake. Sali njira zonse zomwe zili ndi mwayiwu, chifukwa chake ndikofunika mu malingaliro azachipatala.

Laparoscopy ilibe chopweteka, monga momwe amachitidwira pansi pa opaleshoni yotupa. Mukukonzekera kwake, laparoscope ndi zida zofunikira pakuthandizira opaleshoni ndi biopsy zimayikidwa pamimba pamatumbo kudzera pamakina apadera a makoma.

Transduodenal

Mtundu wamtunduwu wa punction umagwiritsidwa ntchito pophunzira mawonekedwe ang'onoang'ono omwe amakhala mkati mwa gawo.

Kuchita zamatsenga kumachitika mwa njira yomwe imayikidwa kudzera mu oropharynx, yomwe imakupatsani mwayi wojambula zakuthupi kumutu kwa kutulutsa tizi. Njirayi silingagwiritsidwe ntchito pophunzira zotupa zomwe zimakhala mbali zina za thupi.

Mgwirizano

Kuboola mankhwalawa pogwiritsa ntchito njirayi kumaphatikizapo kusonkhanitsa zinthu pambuyo pa laparotomy. Nthawi zambiri, imachitika pakagwiridwe kake ntchito, koma nthawi zina imatha kukhala njira yodziyimira payokha.

Kuphatikiza kwakabodza kumawonedwa ngati kovuta, koma kopatsa chidwi kwambiri. Pa nthawi ya kukhazikitsidwa kwake, ziwalo zina zomwe zili m'mimba zam'mimba zimayesedwa. Imachitidwa pansi pa opaleshoni ndipo imayendera limodzi ndi makoma a peritoneum.

Zoyipa zazikulu za biopsy ndizowopsa zomwe zimapangitsa kuti azunzidwe, kufunikira kuchipatala kwa nthawi yayitali, nthawi yayitali yochira komanso mtengo wokwera.

Zovuta zotheka

Popewa zotsatira zosasangalatsa, wodwalayo ayenera kupewa kuchita masewera olimbitsa thupi, kusiya zizolowezi zoipa, komanso sayendetsa galimoto atachita njirayi.

magazi omwe angayambike chifukwa cha kuwonongeka kwa mtima mkati mwa njirayi.
kapangidwe ka chotupa kapena fistula mu chiwalo,
kukula kwa peritonitis.

Kukhulupirira mizimu kumawoneka kuti ndi njira yachinyengo, chifukwa zovuta zomwe zimachitika pambuyo pake ndizosowa kwambiri.

Momwe mungakonzekerere, muchira

Kodi kapamba wa kapamba amachitika bwanji? Amayamba ndikukonzekera kubera, chakudya chomwe chingapangitse kuti munthu azigwirana ntchito sayenera kuchotsedwera zakudya kwa masiku angapo.

Mkaka wonse, masamba ophika, nyemba ndi mkate wa rye amachotsedwa pamenyu.

Kafukufukuyu amachitika pokhapokha atapeza zotsatira za mayeso a labotale, kuphatikiza: kusanthula mkodzo kwathunthu, kutsekemera kwamatenda a shuga, kusanthula magazi, kutsimikiza kupatsidwa magazi m'magazi, nthawi ya kukhetsa magazi, kuwundana, chidziwitso cha prothrombin. ndi kusamutsidwa mpaka kuchira.

M'pofunikiranso kukonzekera kulowererapo mwamakhalidwe; kwa ambiri odwala, kuthandizidwa mophweka kwa ena, abale ndi abale ndikofunikira kwambiri. Zowona Zake, kwenikweni, ndiko kuchitapo opaleshoni yomweyo, sikuti aliyense adakumana ndi izi ndipo amadziwa momwe angakhalire.

Mimba ndiye gawo losatetezeka kwambiri m'thupi la munthu, wodwalayo amamva kupweteka kwambiri pakudikirira jakisoni. Pachifukwa ichi, odwala ena sangathe kuchita popanda kukonzekereratu, zomwe zimaphatikizapo kutenga:

Ndalama zotere zimachepetsa ululu, zimatha kuthana ndi nkhawa komanso kuwopa njira.

Ngati biopsy yachitika pakuchita opaleshoni yam'mimba, wodwalayo amusamutsira kumalo osamalira odwala kuti akhazikike bwino. Kenako amafunika kumuika m'dipatimenti yochita opaleshoni, pomwe amayang'aniridwa ndi madokotala mpaka atachira.

Njira yofunafuna bwino ikagwiritsidwa ntchito, munthu amayenera kuyang'aniridwa kwa pafupifupi maola awiri njirayi itatha. Malinga ngati mkhalidwe wake ukhazikika, adzamasulidwa kunyumba tsiku lomwelo, wina wochokera kwa abale ake amayenera kupita ndi wodwalayo, pomwe kuyendetsa kumaletsedwa.

Kwa kanthawi pambuyo pa kukonzekera, kuyenera kukana:

ntchito zolimbitsa thupi (kuphatikizapo kusewera masewera),
kumwa mowa
kusuta.

Nthawi zambiri, odwala onse nthawi zambiri amapilira njira yofufuzira iyi ya kapamba, komabe, kuwunika kumawonetsa kuti kuwonongeka kwa mitsempha yaying'ono ya magazi, magazi, mapangidwe abodza, fistulas, komanso kuyambika kwa peritonitis sikutsutsidwa. Kuti mupewe izi zosasangalatsa komanso zowopsa, muyenera kulumikizana ndi zipatala zokhazokha zomwe zatsimikiziridwa.

Zambiri za Biopsy zimaperekedwa mu kanema munkhaniyi.

Pambuyo biopsy wa kapamba

Wodwala akangodwala kumene, wodwalayo amakhalabe m'chipatala moyang'aniridwa ndi achipatala kwa maola awiri ndi atatu. Kenako, atakhala ndi thanzi labwino, akhoza kubwerera kwawo.
Ndi chithandizo cha opaleshoni - wodwalayo amakhalabe oyang'aniridwa ndi ogwira ntchito zamankhwala kwa tsiku limodzi kapena kupitilira. Zimatengera kuchuluka kwa maopareshoni.
Pambuyo pa opaleshoni, wodwala sangathe kuyendetsa yekha.
Masana pambuyo pa njirayi, mowa ndi kusuta ndizoletsedwa.
Pakupita masiku awiri, ndikofunikira kupatula zolimbitsa thupi.
Dokotala wanu angakulimbikitseni kuti musiye kumwa mankhwala patatha sabata limodzi pambuyo pa kukomoka.

Biopsy (puncture) pakuwonetsa khansa yapathengo

Matenda ambiri a kapamba, kuphatikiza khansa ya kapamba, ndiwopseza. Mukazindikira mozama momwe matenda awonekera, ndipamenenso mwayi wowachira. Kuzindikira mochedwa khansa ya kapamba kumalumikizidwa ndi kusapezeka kwa zizindikiro za matendawa.

Kuzindikira khansa ya pancreatic koyambirira kumatha ndi njira yolumikizira, kuphatikizapo:

chidwi pa madandaulo a wodwala (omwe akukayikira kwambiri ndi kupweteka kwa epigastric ndi kulowerera kumbuyo, kuchepetsa thupi),
radiation diagnostics (ultrasound, endo-ultrasound, CT, MRI, cholangiopancreatography, angiography),
kutsimikiza kwa zotupa zolembera - CA 19-9, CEA,
chizindikiritso cha chibadwa.
diagnostic laparoscopy,
kuboola komanso kusindikiza kwamankhwala osokoneza bongo kwa kufufuza kwa mbiriyakale ndikuwonetsetsa kuti wapezeka.

Njira yokhayo yothanirana ndi khansa ya pancreatic yomwe imapatsa chiyembekezo chakuchita bwino ndi nthawi yake, opaleshoni yoyambirira, yowonjezeredwa ndi radiation yakutali kapena chemotherapy.

Mu Chipatala cha Yachinema ku Yauza, mutha kudziwa zambiri zamatenda a kapamba.

Lowani kwa dokotala

Kukonzekera mtima

Choyamba, kulumikizana ndi dokotala ndikofunikira, pomwe wodwala amakakamizidwa kuti adziwitse zamomwe zimachitikira chifukwa cha zovuta zamankhwala, zokhudzana ndi matenda osachiritsika ndi aposachedwa.

Asanalandire biopsy, mayeso a labotale ndikofunikira:

kusanthula kwa magazi ndi mkodzo,
kuyesa magazi,
pa index ya prothrombin,
mapulateleti
Kutalika kwa magazi.

Kukonzekera kwa biopsy kumachitika motere:

patsiku muyenera kupewa kumwa mowa uliwonse,
Simungadye kapena kumwa njira isanakwane,
kusuta sikuloledwa kwa maola 12,
odwala ena amakhala ndi mantha pamaso pa njirayi, kenako amapatsidwa mankhwala olimbitsa thupi ngati jakisoni wa tranquilizer (Seduxen, Relanium).

Zizindikiro ndi contraindication kuchotsedwa kwa biopsy zakuthupi

Zisonyezero zosonyeza kukondera kwa kapamba ndi:

Zambiri zochepa za njira zowunika zosasokoneza,
Kufunika kusiyanitsa kusintha kwakapangidwe kazachilengedwe m'maselo a maselo, makamaka ndi zotupa,
Kuyeserera kukhazikitsa njira zoyambira kapena zosokoneza.

Kusagwirizana kwa wodwalayo pamanyengo awa,
Momwe magazi amakhudzira
Kupezeka pa njira ya zida zamitundu yonse (zimafunikira posankha njira yosankha mitundu),
Kupeza njira zosazindikira zachilengedwe zomwe zingakhale zothandiza.

Njira zosankhira minofu ya pancreatic

Pali njira zingapo zochotsera michere ya kapamba, imachitika ngati njira yodziyimira payokha kapena pa ntchito ya patsekeke.

Njira zilizonse zomwe zimaperekedwa kwa biopsy zimakhudzana ndi kasamalidwe ka malamulo a asepsis (magawo omwe cholinga chake ndi kupewetsa tizilombo kuti tisaloze bala.

Zabwino zabwino zotsekemera biopsy

Njira yodziwika bwino, monga yoopsa komanso yoopsa. Imapangidwa pogwiritsa ntchito syringe ndi singano yopyapyala (mainchesi osakwana 1 mm) kapena mfuti yapadera ya biopsy. Opaleshoni yakumaloko imachitika koyambirira, chifukwa njirayi imapweteka kwambiri. Kuphatikiza apo, motsogozedwa ndi CT kapena ultrasound, singano imayikidwa mu minofu ya pancreatic kudzera khoma lam'mimba komanso ndi kusilira (kupopera mpweya kapena kuchepa kwamphamvu kwambiri), zinthu zachilengedwe zimalowa mu singano. Mukamagwiritsa ntchito mfuti ya biopsy yokhala ndi mpeni kumapeto kwa chubu, pomwe chipangizocho chikuyendetsedwa, singano imabowola minofuyo kuthamanga kwambiri ndipo chinyontho cha singano chimadzaza maselo.

Njirayi ikhoza kukhala yosayenera pakuchita opaleshoni yodwala yomwe ikubwera pogwiritsa ntchito laparoscopy (kulowererapo kwa opaleshoni kudzera pamakoma pamimba) kapena laparotomy (njira ya opaleshoni yomwe imalola kufikira ziwalo zam'mimba kudzera pakatikati mwa ziwalo zapakhomo). Komanso, njirayi siigwiritsidwa ntchito pomwe kukula kwa "chandamale" (dera lomwe lakhudzidwalo) ndiochepera masentimita awiri, pomwe zovuta kulowa mmenemo zimawonjezeka kwambiri.

Laparoscopic biopsy

Njira yachitetezo yomwe imaphatikizidwa ndi zambiri zazidziwitso. Njirayi imalola, ndi zowawa zochepa, kuchita, kuwonjezera pa biopsy, kuwunika kwa kapamba ndi ziwalo zam'mimba, zomwe zimakuthandizani kuti mupeze kuyang'ana kwa necrosis, kuwunika kukula kwa kufooka, kupezeka kwa metastasis khansa, kuyang'ana zam'mimba, ziwalo zake, ndi zina. Kuphatikiza apo, biopsy yachindunji (zomwe zidasankhidwa ndi biopsy) zimatha kusankhidwa kuchokera pamalo omwe akufotokozedwa bwino, zomwe zimapangitsa laparoscopy kukhala njira yofunikira kwambiri yodziwira matenda pulani.

Laparoscopic biopsy imagwiritsidwa ntchito pansi pa opaleshoni wamba. Kenako, kaboni dayokisa umalowetsedwa pamimba yam'mimba (kuti apange malo ogwiritsira ntchito), laparoscope imayikidwa, komanso chida cha biopsy (chitha kukhala singano za biopsy kapena chida chapadera cha laparoscopic).

Transduodenal biopsy

Ntchito pophunzira zazing'onoting'ono zopezeka pansi kwambiri pancreatic minofu. Imachitika ndikuyambitsa endoscope kudzera mkamwa, esophagus ndi m'mimba mu duodenum, kuchokera komwe chitsanzo cha biopsy chimatengedwa, koma kusankha pazowerengera kumatheka pokhapokha kuchokera kumutu wa kutulutsa tizi. Choipa cha njira ya transduodenal ndikuphimba gawo lokhalo la chiwalo.

Intraoperative Biopsy

Njira yosankhira biopsy, yomwe imaphatikizapo kusankha kwa biopsy chitsanzo pambuyo pa laparotomy. Izi zitha kukhala kuchitapo kanthu kodziyimira pawokha kapena kuwonjezera pa opaleshoni ina yam'mimba. Njira zonsezi ndizovuta, zowopsa kwa wodwala, koma ndizothandiza kwambiri. Kuchita biopsy intraoperatively, pamakhala mwayi wina wowunikira mbali yam'mimba ndi ziwalo zoyandikana ndi zikondazo.

Kuchita izi kumachitika pansi pa mankhwala ochita kupanga chifukwa chakufukuta khomo lam'mimba ndikusankha zofufuzira.

Choipa chachikulu cha njirayi ndi kuchepa kwakumaso, komwe kumakhudza nthawi yomwe thupi limachira komanso kufunikira kwa wodwalayo kuchipatala.

Malangizo: kukangana motsimikiza - ndikofunikira kuvomereza pa singano yabwino kapena laparoscopic biopsy, poganizira chitetezo chawo, komanso nkhani ya laparoscopy komanso zidziwitso.

Pomaliza, ndikufuna kunena kuti madotolo amatha kuyambitsa kupweteka kwam'mimba, kapamba ndi ziwalo zina, kupereka mankhwala mutachotsa kapamba komanso kwa nthawi yayitali, ndipo koposa zonse, kufotokoza molimba zovuta zomwe zimachitika chifukwa chothandizidwa ndi kapamba, kusowa tinthu zinanso zofunika, koma ndizofunikira nthawi zonse khalani ndi malingaliro. Malingaliro awa asakhale otsogola, ndibwinonso, koma wodwalayo akatsogozedwa ndi funsolo, pamakhala mipata ingapo yolakwika yogwiritsa ntchito malingaliro ndi ziganizo, zomwe zimakhala zosavuta kwa inu.