Izifo ze-pancreas zivame ukuphakamisa umbuzo kudokotela nakwisiguli - yiziphi izindlela zokwelapha okufanele zikhethe - ukuhlinzwa noma ukwelashwa okulondoloziwe.
Ukuhlinzwa kuyindlela yokwelashwa esetshenziswa ezimweni lapho ukwelashwa kwezidakamizwa akunanjongo futhi kunganikeli imiphumela emihle.
Izinkomba eziphambili zokwelashwa okuhlinzwa yilezi:
- umdlavuza we-pancreatic;
- i-pancreatitis engapheli, uma nje kunesifo sezinhlungu esingaqedwa ukusetshenziswa kwama-analgesics;
- ama-cysts amaningi ekhanda lama-pancreas;
- izilonda zalengxenye yesitho ngokuhlanganiswa ne-stenosis ye-duodenum noma i-duct okuphuma kuyo i-bile;
- izinkinga noma i-stenosis ngemuva kokuhlinzwa kwe-pancreatojejunostomy.
Ukulimala okungapheli kwekhanda kubhekwa njengophawu oluphambili lokuhlinzwa. Njengoba ngaphezu kobukhona bezinhlungu nezinkinga ezahlukahlukene, ukuvuvukala kungahambisana nenqubo ye-oncological noma ukufihla isimila. Lesi yisifo ku-etiology lapho indima eyinhloko idlalwa khona lokungeniswa kotshwala.
Ngenxa yemiphumela ye-ethanol ye-pathological, kukhona ukuthuthukiswa kokugxila okungapheli kokuvuvukala kwezicubu ze-gland, ukwephulwa kwemisebenzi yayo ye-endocrine ne-exocrine. Amasu wamangqamuzana kanye nokuqanjwa kobunzima obuholela ekulimazekeni okugxile ekujuleni kolwelwesi nokuqina kwe-pancreatic fibrosis akaziwa kakhulu
Isici esijwayelekile sesithombe se-histological ukufakwa kwe-leukocyte, izinguquko emgodini we-pancreatic kanye namagatsha we-lateral, i-necrosis egxile kanye ne-organ fibrosis eqhubekayo.
Ukuqalwa kabusha kwe-gastropancreatoduodenal ezigulini ezine-pancreatitis engadakwa engapheli, lapho inqubo yokuvuvukala ithuthukiswe ekhanda le-pancreatic, kuholela ekuguqukeni kwenkambo yemvelo yesifo:
- Izinguquko ekujuleni kobuhlungu.
- Yehlisa imvamisa yeziqephu eziyingozi
- Ukuqedwa kwesidingo sokuqhubeka esibhedlela.
- Yehla ekufeni.
- Ukwenza ngcono impilo.
Ubuhlungu esiswini esingenhla kuwuphawu oluhamba phambili lomtholampilo oluhambisana nokwanda kwengcindezi kuma-ducts nezicubu zamanyikwe. Izinguquko ze-pathomorphological in the sensory nerves, and the di bophara of the nerve, kanye nokufakwa kwe-perineural ukungena kwamaseli okuvuvukala kubhekwa njengezimbangela eziphambili zesifo sezinhlungu.
Izici zokusebenza kukaWhipple
Iqembu elincane leziguli ezine-pancreatitis engapheli liqukethe ikakhulukazi amadoda angaphansi kweminyaka engu-40. Lezi ziguli zivame ukuba nezinhlungu ezinzima zesisu, ezingamelana nokwelashwa kwe-analgesic futhi zivame ukuhambisana nezinkinga zasendaweni.
Leli qembu leziguli lifuna ukwelashwa okuhlinzwa, ngoba ngaphezu kokushintsha okungapheli kwamanyikwe, kwesinye isikhathi liba nezinye izilonda zalesi sitho kanye neziseduze, isibonelo, isimila se-duodenal, isisu, noma i-biliary tract tumor.
Ukuhlinzwa kwe-Whipple noma i-pacreatoduodenal reseation ukuhlinzwa okukhulu okuvame ukwenziwa ukuze kususwe ama-tumor ayingozi noma acashile ekhanda le-pancreatic noma kwesinye sezinhlaka ezizungezile.
Le ndlela isetshenziselwa futhi ukwelapha ukulimala kwama-pancreas noma i-duodenum, noma njengendlela yokubonisa ukwelashwa ngobuhlungu be-pancreatitis engapheli.
Indlela ejwayelekile kakhulu ye-pancreatoduodenectomy iqukethe ukususa lezo zinhlaka:
- i-distal segment (antrum) yesisu;
- izingxenye zokuqala nezesibili ze-duodenum;
- amakhanda we-pancreatic;
- i-bile duct ejwayelekile;
- isigaxa senyongo;
- ama-lymph node nemithambo yegazi.
Ukuphinda kwakhiwe kufaka ukunamathisela amanye ama-pancreas e-jejunum, okunamathisela i-duct ejwayelekile yejee (i-choledochojejunostomy) ukuze ujusi wokugaya kanye ne-bile kungenelele emgodini wesisu ngokufanele. Futhi silungisa isisu ku-jejunum (gastrojejunostomy) ukubuyisa ukuhamba kokudla.
Ubulukhuni bokungenelela kokuhlinzwa kuma-pancreas ubukhona bomsebenzi we-enzymatic walesi sitho. Ngakho-ke, imisebenzi enjalo idinga indlela yokusebenza eyinkimbinkimbi ukuze uvikele lapho ama-pancreas eqala ukuzigaya uqobo. Kuyaqapheleka futhi ukuthi izicubu ze-gland zintekenteke kakhulu futhi zidinga ukwelashwa ngokucophelela, kunzima ukuzinyonga. Ngakho-ke, kaningi imisebenzi enjalo ihambisana nokuvela kwama-fistulas kanye nokopha. Izithiyo ezingeziwe yilezi:
Izakhiwo ezakhiwe zitholakala kulesisigaba se-patity esiswini:
- eliphakeme futhi eliphansi i-vena cava.
- i-aorta yesisu.
- imithambo ye-mesenteric ephezulu.
- imithambo.
Ngaphezu kwalokho, i-bile duct evamile nezinso zitholakala lapha.
Qhathanisa ne-pancreatectomy ejwayelekile
Umqondo oyisisekelo we-pancreatoduodenectomy ukuthi ikhanda le-pancreas ne-duodenum inegazi elifanayo le-arterial (i-gastroduodenal artery).
Lo mthambo udlula ekhanda lamanyikwe, ukuze izitho zombili kufanele zisuswe lapho ukugeleza kwegazi konke kuvinjiwe. Ukube nje kususwe ikhanda lamakhanda, lokhu kungafaka ukungena kwegazi engozini, okuzoholela ekutheni i-necrosis yezicubu zayo ivele.
Izivivinyo zemitholampilo azikwazanga ukukhombisa ukusinda okukhulu nge-pancreatectomy ejwayelekile, ikakhulukazi ngoba iziguli ezenziwa lo msebenzi wokuhlinzwa zivame ukuba nefomu lesifo sikashukela esinamandla kakhulu.
Kwesinye isikhathi, ngenxa yobuthakathaka bomzimba noma ukuphathwa okungafanele kwesiguli esikhathini sokuhlinzwa, kungenzeka ukwanda nokwanda kokutheleleka esiswini sesisu, okungahle kudinge ukungenelela kwesibili, ngenxa yokuthi ingxenye esele yamakhankethi, kanye nobubanzi obuseduze, kuyasuswa.
Lokhu kwenziwa ukuvikela ukusakazeka kokutheleleka, kepha, ngeshwa, kuholela ekulimaleni okwengeziwe esigulini.
I-pylorus-sparing pancreatoduodenectomy
Eminyakeni yamuva, i-pyloropreservation pancreatoduodenal resection (eyaziwa nangokuthi inqubo yeTraverse-Longmire) idumile, ikakhulukazi phakathi kodokotela abahlinzayo baseYurophu. Inzuzo enkulu yale ndlela ukuthi i-pylorus futhi, ngenxa yalokho, ukungagcwaliseki okujwayelekile kwegastric kuyagcinwa. Kodwa-ke, okunye ukungabaza kuhlala kungukuthi lokhu kungukusebenza okwanele kombono we-oncological.
Elinye iphuzu eliphikisayo ukuthi iziguli kufanele zenze i-lymphadenectomy.
Uma kuqhathaniswa nenqubo ejwayelekile yeWhipple, i-pylorus, indlela yokulondolozwa kwe-pancreatoduodenectomy, ihlotshaniswa nesikhathi sokuhlinzwa esifushane, izigaba ezimbalwa zokuhlinzwa, kanye nokwehliswa kwe-intraoperative kwegazi, okudinga ukumpontshelwa kwegazi okuncane. Ngokufanelekile, kunezingozi ezimbalwa zokuthola ukusabela ekumpontshelweni kwegazi. Izinkinga zangemva kokusebenza, ukushona kwesibhedlela, kanye nokusinda kwehlukile kulezi zindlela ezimbili.
I-Pancreatoduodenectomy ngokuya nganoma iyiphi indinganiso kubhekwa njengenqubo eyinhloko yokuhlinzwa.
Izifundo eziningi zikhombisile ukuthi izibhedlela lapho lo msebenzi wenziwa khona zivame ukuba nemiphumela engcono. Kepha ungakhohlwa ngezinkinga nemiphumela yokuhlinzwa okunjalo, okungabukwa yizo zonke izitho ezenziwa ukuhlinzwa.
Lapho wenza ukuhlinzwa ekhanda le-pancreatic:
- isifo sikashukela mellitus;
- isifutho sokusebenza ngemuva.
Ukusuka ohlangothini lwesisu, kunamathuba aphezulu wezinkinga ezinjengokushoda kwevithamini B12 nokukhula kwe-megaloblastic anemia.
Ukusuka ku-duodenum, izinkinga ezilandelayo zingavela:
- Dysbacteriosis
- Ukuvinjwa komzimba ngenxa ye-stenosis ye-anastomotic.
- Ukudangala (i-cachexia).
Ukusuka kwipheshana le-biliary, ukuvela kwezinkinga ezinjalo kungenzeka:
- cholangitis;
- i-pancreatitis ye-biliary;
- i-biliary cirrhosis.
Ngaphezu kwalokho, kungaqhamuka amathumba esibindi.
I-Prognosis yeziguli ngemuva kokuhlinzwa
Ngokuhambisana nayo yonke imiyalo kadokotela ngesikhathi sokuvuselelwa kwayo, isiguli singanciphisa ubungozi bezinkinga bube buncane.
Kuphoqelekile ukuthatha amalungiselelo e-enzyme, ama-antibacterials, kubalulekile futhi ukulandela isidlo ukuze ulondoloze ubunikazi besigaba se-gastrointestinal.
Iziguli ezinomdlavuza, uma kunesidingo, kumele futhi zithole i-chemotherapy noma i-radiation.
Esikhathini sokuqala somsebenzi, kubalulekile ukukhumbula ngezimo ezisongela impilo:
- Ukuthuthukiswa kokushaqeka kwehla kwengcindezi yegazi.
- Ukutheleleka - umkhuhlane kanye nomkhuhlane, i-leukocytosis;
- Ukwehluleka kwe-anastomosis - ukuthuthukiswa kwezimpawu ze-peritonitis;
- Ukulimazeka emithanjeni yama-pancreas, ukwehluleka kwama-ligature - ukukhuphuka kwamazinga e-amylase egazini nomchamo.
- Ukuthuthukiswa kwe-pancreatitis ye-postoperative, uma ukuhlinzwa kungazange kwenziwe maqondana nokuvuvukala kwepancreatic, ukuvinjwa komgodi we-pancreatic kuba ngenxa yokuvuvukala kwesitho.
Iziguli ezinomdlavuza we-pancreatic zinikezwa ithuba lokukhulisa impilo yazo. Uma ukuhlinzwa kwenziwa ekuqaleni kwesigaba, khona-ke odokotela balindele ukuxolelwa okuphelele, ezigabeni zakamuva, ukubonakaliswa kwama-metastases kungenzeka, kodwa lokhu akuvame futhi kubangele umphumela obulalayo. Ezigulini ezine-pancreatitis engalapheki, umphumela wokuhlinzwa ungahle uhluka - ube nomphumela omuhle, lezi ziguli zilahlekelwa umuzwa wazo wokulwa nezinkinga ngokusebenza kohlelo lokugaya ukudla, ngokusebenza okungaphumeleli kwezimo, umtholampilo we-pancreatitis ungahlala, yize umsebenzi onxeshezelwe wezitho.
Zonke iziguli ngemuva kokuhlinzwa kwe-pancreatic zibhalisiwe futhi ziyahlolwa njalo ezinyangeni eziyisithupha. Kubalulekile ukuqapha isimo sazo zonke izakhiwo, ngoba izinkinga ezifika sekwephuzile njenge-stenosis ye-anastomoses, ukuthuthukiswa kwesifo sikashukela ngenxa ye-pancreatic fibrosis, futhi nezinqubo ze-oncological kungenzeka.
Mayelana nokululama okusheshayo ngemuva kokuchazwa kabusha kwe-pancreatoduodenal kuchazwe kuvidiyo kule ndatshana.
