Nge-pancreatitis nezinye izifo zepancreas, kukhona ushintsho ngosayizi, ukwakheka nendawo okutholwe kuyo isitho ngaphakathi kwethambo lesisu. Kepha uma imingcele emibili yokuqala ibonakala kahle ngesikhathi sokuhlolwa kwe-Ultra, khona-ke ukuzimisela okuyikho kwendawo yesitho kungumsebenzi onzima futhi kudinga ulwazi olukhethekile.
Isikhundla esinembile kunazo zonke se-pancreas singasungulwa ngokuhlobene nesithambo somuntu, ikakhulukazi ikholomu yomgogodla nezimbambo. Le ndlela ibizwa nge-skeletotopy futhi ikuvumela ukuthi ubone ukuthambekela okuncane kakhulu kokujwayelekile, kuze kufike kumamilimitha ambalwa.
I-Topography
Akunakwenzeka ukucacisa kahle ukuthi yilapho ama-pancreas ngaphandle kokwazi i-anatomy yayo. Lesi sitho sitholakala esiswini sesisu futhi, ngaphandle kwegama, asitholakali ngaphansi kwesisu, kodwa ngemuva kwaso. Ngaphansi kwesisu, i-iron iwela kuphela endaweni ephakeme, futhi ngokuhlelwa komzimba okuqondile, ibuyela ezingeni elifanayo nesisu.
Ubude besitho kubantu abahlukile abufani futhi bungasukela ku-16 kuye ku-23 cm, bese isisindo singama-80-100g. Ukuhlukanisa ama-pancreas kwezinye izitho nezicubu zomgogodla wesisu, kubekwa ohlotsheni lwe-capsule kusuka ezicutshini ezixhunyiwe.
Kule capulethi kunezigaba ezintathu ezihlukanisa ama-pancreas izingxenye ezintathu ezingalingani. Banesakhiwo esihlukile futhi benza imisebenzi ehlukene emzimbeni. Ngayinye yazo ibaluleke kakhulu empilweni yabantu futhi noma ukungasebenzi kahle okuncane kungaholela emiphumeleni emibi.
Amanyikwe aqukethe izingxenye ezilandelayo:
- Ikhanda;
- Umzimba;
- Umsila.
Ikhanda liyingxenye ebanzi kakhulu futhi lapho ligotshwa lingafinyelela ku-7 cm. Lihlangana ngqo ne-duodenum, egoqa ngakuyo njengehhashi. Imithambo yegazi ebaluleke kakhulu, efana ne-vena cava ephansi, i-portal vein, ne-renal artery ne-vein efanele, isondela ekhanda.
Futhi ekhanda kudlula i-bile duct ejwayelekile kwi-duodenum namanyikwe. Endaweni lapho ikhanda lingena emzimbeni, kuneminye imithambo yegazi emikhulu, okungukuthi i-mesenteric artery ne-vein ephakeme.
Umzimba wamanyikwe ekwakhekeni ufana ne-prism yodumo enentaba yangaphambili ngaphambili nendiza ephansi. Umthambo ovamile we-hepatic ugijimisa yonke ubude bomzimba, futhi ngakwesobunxele komthambo we-splenic. Izimpande zemilando yekolon enqamukayo nazo zitholakala emzimbeni, okuvame ukubangela i-paresis yayo ngesikhathi se-pancreatitis esibuhlungu.
Umsila yingxenye emincane kunazo zonke. Inesimo sethanga futhi isiphelo saso sixhakene namasango wokhaxulu. Ngasohlangothini lwangemuva, umsila uthintana nezinso kwesokunxele, izindlala ze-adrenal, i-renal artery ne-vein. Iziteshi zeLangerhans zitholakala emsileni - amaseli akhiqiza i-insulin.
Ngakho-ke, ukwehlulwa kwale ngxenye kuvame ukukhuthaza ukukhula kwesifo sikashukela.
I-Skeletonotopy
I-pancreas itholakala engxenyeni engenhla ye-peritoneum futhi iwela umgogodla womuntu ezingeni lesifunda se-lumbar, noma kunalokho, maqondana ne-vertebrae 2. Umsila wayo ungakwesobunxele somzimba futhi ugoba kancane phezulu, kuze kube yilapho ifinyelela ku-1 lumbar vertebra. Ikhanda lilele ngakwesokunene somzimba futhi lisesezingeni elifanayo nomzimba ophambene ne-vertebrae engu-2.
Ebuntwaneni, i-pancreas iphakeme kancane kunasemdala, ngakho-ke, ezinganeni lesi sitho sitholakala ezingeni le-10-11 vertebrae yomgogodla we-thoracic. Lokhu kubalulekile ukucubungula lapho uthola izifo zesifo se-pancreatic ezigulini ezisencane.
I-pancreatic skeletotopy ibaluleke kakhulu kulokhu kuxilongwa. Kunganqunywa kusetshenziswa i-ultrasound, ama-x-ray nama-pancreatogram, okuyindlela yesimanje yokuhlola isitho esineguli.
I-Holotopia
Amanyikwe atholakala esifundeni se-epigastric, iningi lawo lisendaweni eyi-hypochondrium yangakwesobunxele. Lesi sitho sifihlwe yisisu, ngakho-ke, ngesikhathi sokuhlinzwa kuma-pancreas, udokotela ohlinzayo udinga ukufeza izinto eziningi ezidingekayo.
Okokuqala, hlikihla i-omentum, uhlukanise isisu nezinye izitho zesisu, futhi okwesibili, hambisa isisu eceleni. Kungemva kwalokhu kuphela, udokotela ohlinzayo azokwazi ukwenza ukungenelela kokuhlinzwa okudingakalayo kumanyikwe, ngokwesibonelo, ukususa i-cyst, isimila noma izicubu ezifile nge-pancreatic necrosis.
Ikhanda le-pancreas lisesandleni sokudla sekholomu yomgogodla futhi lifihlwe yi-peritoneum. Okulandelayo ngumzimba nomsila, okutholakala kwi-hypochondrium yangakwesobunxele. Umsila uphakanyiswa kancane futhi uhlangana namasango endle.
Ngokusho kodokotela, cishe akunakwenzeka ukuzwa ama-pancreas kumuntu ophilile. Kuzwakala ngenkathi i-palpation kuphela kuma-4% abesifazane no-1% wamadoda.
Uma isitho sikhala kalula ngesikhathi sokuhlolwa, lokhu kukhombisa ukwanda okukhulu ngosayizi wayo, okungenzeka kuphela ngenqubo yokuvuvukala enamandla noma ukwakheka kwezimila ezinkulu.
I-Syntopy
I-Syntopia yecanada ikuvumela ukuthi unqume isikhundla sayo maqondana nezinye izitho nezicubu zomgogodla wesisu. Ngakho ikhanda nomzimba kuvaliwe phambi komzimba nesisu se-pyloric, kuthi umsila ufihlwe phansi kwesisu.
Ukusondelana okunjalo kwama-pancreas ngesisu kunomphumela obalulekile ekwakhekeni kwawo futhi kwakha amabheji enhlamvu kanye nama concavities ebusweni besitho. Akunamphumela emisebenzini yikhona okujwayelekile.
Ingaphambili le-pancreas licishe lifihlwe ngokuphelele yi-peritoneum, kuphela umucu omncane wesitho uhlala uvulekile. Ihamba lonke ubude be-gland futhi icishe ihlangane ne-axis yayo. Okokuqala, lo mzila unqamula ikhanda enkabeni, bese ugijimisana nomphetho ongezansi womzimba nomsila.
Umsila, otholakala kwi-hypochondrium yangakwesobunxele, umboza izinso zesokunxele kanye ne-adrenal gland, bese uphumula ubheke emasangweni enqolobane. Umsila nobubanzi kuxhumene kusetshenziswa i-pancreas-splenic ligament, okuwukuqhubeka kwe-omentum.
Yonke ingxenye yamapancreas, etholakala ngakwesokunene somgogodla, futhi ikakhulukazi ikhanda lawo, ivalwa yi-gastro-colon ligament, ikoloni eguqukayo kanye nokuxhuma kwamathumbu amancane.
Kulesi simo, ikhanda linokuhlangana eduze ne-duodenum isebenzisa i-duct ejwayelekile, lapho kungena ujusi we-pancreatic.
Ukuhlolwa kwe-Ultrasound
Ukuhlolwa kwe-Ultrasound kwama-pancreas ngamaphesenti angama-85 wamacala kwenza ukuthi kutholakale isithombe esiphelele sesitho, ku-15% osele kuphela. Kubaluleke kakhulu ngalesi sikhathi sokuhlolwa ukuthola uhlelo oluqondile lwamacele alo, ngoba kukuwo lapho izinqubo ze-pathological zivame ukwenzeka.
Kumuntu ophile kahle, ikhanda le-pancreas lihlala litholakala ngqo ngaphansi kwe-hepatic lobe efanelekile, futhi umzimba nomsila zingaphansi kwesisu nasesinxele se-hepatic lobe. Umsila wokuskena we-ultrasound ubonakala ikakhulukazi ngaphezulu kwesinso sobunxele nasendaweni eseduze yesango le-spleen.
Ikhanda lesigaxa esikeni lihlala libonakala ngesimo esikhulu sokwakheka kwe-echo-negative, esisendaweni engakwesokunene yomgogodla. I-vena cava ephansi kakhulu idlula ngemuva kwekhanda, bese i-mesenteric vein ephakeme isuka ezingxenyeni ezingaphambili nezesobunxele. Kukuyo lapho umuntu kufanele aqondiswe khona lapho efuna ingxenye yengxenye yesitho ngesikhathi sokuhlolwa kwe-Ultra.
Ngaphezu kwalokho, ukuthola indawo yekhanda, ungasebenzisa i-mesenteric artery kanye ne-splenic vein ne-aorta njengesiqondiso. Imithambo yegazi iyizinkomba ezithembekile zokuthi indawo yesitho ikhona, ngoba ihlala idlula eduze kwayo.
Lapho uhlola i-pancreatic scan, kubalulekile ukukhumbula ukuthi ikhanda kuphela elitholakala ngakwesokunene somgogodla, wonke amanye, okungukuthi umzimba nomsila, abekwe ngakwesokunxele sethambo lesisu. Kulokhu, ukuphela komsila kuhlala kuphakanyiswa kancane.
Ngesikhathi sokuhlolwa kwe-ultrasound, ikhanda lamanyikwe ngokuvamile linomumo oyindilinga noma o-oval, futhi umzimba nomsila zingama-cylindrical aphakeme mayelana nobubanzi obufanayo. Into enzima kakhulu ngale ndlela yokucwaninga ukubona i-pancreatic duct, engafundwa kuphela ezimweni ezingama-30 kwezingu-100. Ububanzi bayo abuvamile ukwedlula i-1 mm.
Uma ama-pancreas evikelwe ngokwengxenye, khona-ke ngokunokwenzeka lokhu kubangelwa ukuqunjelwa kwamagesi emgodini wesisu. Ngakho-ke isithunzi esivela kugesi esinqwabelene ku-lumen ye-duodenum singakwazi ngokwengxenye noma ukuvala ngokuphelele ikhanda lesitho bese ngokwenza lokho kuhlolisisa ukuhlolwa kwalo.
Futhi, igesi inganqwabelana esiswini noma kwikholoni, ngenxa yokuthi umsila we-pancreas uvame ukubonwa ngenkathi kuskena i-ultrasound. Kulokhu, ukuhlolwa kufanele kuhlehliselwe olunye usuku futhi ukulungele ngokucophelela.
Ngakho-ke ngaphambi kwe-ultrasound, akunconywa ukusebenzisa imikhiqizo enikela ekwakhiweni kwegesi eyengeziwe, okungukuthi:
- I-legumes (ubhontshisi, uphizi, ubhontshisi, soya, udali);
- Zonke izinhlobo iklabishi;
- Imifino ecebile ngefibre: isithombo, itheniphu, isithombo, ulethisi wamaqabunga;
- I-rye nesinkwa esiphelele sokusanhlamvu;
- Iphalishi elivela kuzo zonke izinhlobo zamabele, ngaphezu kwelayisi;
- Izithelo: amapharele, ama-apula, amagilebhisi, amaplamu, amapentshisi;
- Amanzi acwebezelayo neziphuzo;
- Imikhiqizo yobisi: ubisi, i-kefir, ukhokho ushizi, iyogathi, ubisi olubilisiwe olubilisiwe, ukhilimu omuncu, u-ayisikhilimu.
Isakhiwo nemisebenzi yamanyikwe kuchazwe kule vidiyo kule ndatshana.
