I-pancreatic necrosis ingumphumela onzima we-pancreatitis e-acute eqhubekayo. Kubonakaliswa yi-necrosis yeziza noma umzimba wonke we-pancreas. Izimpawu zomtholampilo zalesi sifo zinobuhlungu besisu obukhulu, ama-palpitations, ukugabha kanye ne-encephalopathy.
Ukuxilongwa kwe-pancreatic necrosis kufaka izindlela zaselebhu nezokusebenzisa izinsimbi. Ukwelashwa kwe-pathology kususelwa ekucindezelweni kwama-enzyme e-proteinolytic, ukuqedwa kobuhlungu, ukukhipha izidumbu, ukubuyiselwa ukuphuma kwejusi le-pancreatic nokungenelela kokuhlinzwa.
Amathuba okusinda kwesifo esonakalisayo mancane: ukwelashwa okufika ngesikhathi kusindisa ama-30-60% eziguli kuphela kumphumela obulalayo. Njengoba unikezwe izibalo ezesabekayo, akunakwenzeka ukuba nethemba lokuthola ikhambi le-necosis epancreatic ye-pancreatic.
I-pancreatic necrosis nezinhlobo zayo
Lesi sifo ngandlela thile asiyona inkinga yokuqina kwesikhumba, kodwa kungesinye sezigaba zaso.
Kwi-pancreatitis, ama-enzymes akhiqizwa ngamanyikwe awafinyeleli ku-duodenum 12. Ngenxa yalokhu, ujusi we-pancreatic uqala ukhipha isitho, esibizwa ngokuthi "ukuzicwilisa." Inqubo yokuvuvukala iyenzeka, okugcina kuholele ezinguquko ezonakalisayo. Bese kuba nokukhula kokuhluleka kwezitho eziningi, okujwayelekile i-pancreatic necrosis.
Namuhla, isibalo se-pancreatitis esibuhlungu esibhalisiwe ezibhedlela zokuhlinza siyakhula eRussia. Banika kuphela amacala okuthi aphethwe yi-appendicitis acute. Inani leziguli ezihlushwa i-pancreatic necrosis lenyuke ngamaphesenti angama-25. Njengoba ukushona kwabantu ngenxa yezinguquko ezibhubhisayo kumanyikwe kusuka ku-30% kuya ku-80%, indlela eholayo yokunciphisa lokho kungukuxilonga okusebenzayo, ukulaliswa esibhedlela nokwelashwa okusebenzayo.
Njengoba kulimala izingxenye ezithile zepancreas, noma ngabe kuyikhanda, umzimba noma umsila, ukuhlukaniswa kwe-pathology kuyafaneleka.
| Isici sokuhlukaniswa | Izinhlobo zeNecrosis | Ukulandela okulandelayo |
| Ukwanda kwenqubo yokubhubhisa | kunqunyelwe | ezinkulu, eziphakathi nezincane ezigxile |
| ejwayelekile | i-subtotal (cishe i-lesion ephelele) nenani eliphelele (i-lesion ephelele yomzimba we-pancreas) | |
| Ukuba khona kokutheleleka | oyinyumba | amanoni (akhula ngezinsuku ezingama-4-5), i-hemorrhagic (ithuthuka ngokushesha, ukulahleka kwegazi kwangaphakathi kuyabonakala), kuxutshwe (kuvamile) |
| onegciwane | - | |
| I-Pathology | abahlukumezayo | - |
| ethuthukayo | - |
Izimbangela zesifo
I-etiology ye-pancreatic necrosis ikakhulu ihlotshaniswa nokungondleki kahle nokusebenzisa kabi utshwala.
Izibalo ezedumazayo zikhombisa ukuthi ama-70% eziguli ezinalesi sifo ngezikhathi ezithile noma ezihlala ziphuza utshwala. Imbangela yesibili ye-pancreatic necrosis ukudluliselwa kwesifo se-gallstone.
Kuyaphawuleka ukuthi i-pathology ikhula isencane kakhulu. I-pancreatic necrosis ye-pancreas ivela ngenxa:
- I-Peptic ulcer yesisu kanye ne-12 duodenal ulcer.
- Ukudla okungenakulinganiselwa, ukubaluleka kokudla okunamafutha nokuthosiwe ekudleni.
- Ukusebenzisa kabi utshwala.
- Phambilini ukuhlinzwa.
- Ukulimala kwesisu.
- Ama-pathologies we-viral kanye nezifo.
- Isifo se-Gallstone.
I-pancreatic necrosis ingenzeka kunoma ngubani, kepha engozini ifaka:
- izidakwa ezingalapheki nezidakamizwa;
- abantu abanenkinga yokuntuleka kwesibindi namanyikwe;
- iziguli ezinokungazalwa kahle kanye ne-pathologies yesisu;
- abantu abaphethwe yisifo se-gallstone.
Izinguquko ze-Necrotic ziyingozi nakwezinye izitho zangaphakathi, eziqinisekiswa izifundo ze-pathological. Ngenxa yalokhu, ipheshana lokugaya ukudla, izinso nomzimba wonke kuhlupheka.
Lesi simo singaba umphumela wokuqhubekela phambili kwama-pathologies anjalo:
- I-Purulent pancreatitis ingenye yezindlela ezinzima kakhulu lapho ukuvuvukala okukuhle kwesitho nokwakheka kwama-mic-, macroabscesses kwenzeka.
- I-pancreatitis ephuza kakhulu i-pancreatitis yisifo esenzeka noma ngenxa yotshwala obungamahlalakhona, noma isiphuzo esisodwa sesiphuzo esinokudla okunamafutha.
- I-biliary pancreatitis inqubo engapheli yokuvuvukala eyenziwe lapho kumanyikwe okwenzeka ngenxa yomonakalo emgodini wamathumbu nesibindi.
- I-hemorrhagic pancreatitis iyindlela enzima yalesi sifo, lapho kubhujiswa khona ngokushesha i-parenchyma nenethiwekhi ye-vascular, okufaka isandla ekuthuthukiseni i-gangrene, hemorrhage kanye ne-peritonitis.
Uma isiguli sithola usizo lodokotela sekwephuze kakhulu, khona-ke ukwakheka kwe-necrosis kufaka ukuthuthukiswa kwe-abscess, ngemuva kwalokho ochwepheshe abangayinikezeli i-prognosis enhle yokusinda.
Izimpawu eziphambili nezinkinga
Ukubonakaliswa kwe-pathology ngokusho kwe-ICD-10 kuhlukaniswe ngombandela ngezigaba ezintathu. Umshini we-pancreatic necrosis uhlotshaniswa nokuphazamiseka kokuvikelwa kwendawo yomzimba.
Isigaba sokuqala se-pathology sibonakaliswa ukuphindaphindwa okusheshayo kwamagciwane kanye nokwenza kusebenze ukwenziwa kwejusi le-pancreatic. Isiguli sikhononda ngomkhuhlane, ukuphefumula nokuhlanza.
Isigaba sesibili sibonisa ukwakheka kwemihume emgodini we-organ parenchyma ngenxa ye-enzymatic ne-purulent fusion.
Isigaba sesithathu siholela ekufeni, njengoba ukuvuvukala kusakazekela kwamanye izicubu. Lokhu kubangela ukwehluleka kwezitho eziningi, bese kufa.
Isibonakaliso sokuqala salesi sifo kubuhlungu obunzima obungavele buqhamuke bebhodwe engxenyeni yesobunxele yesisu bese ubuyela emuva emuva. Kunobudlelwano obuhlukile phakathi kobuhlungu nobunzima besifo. Izinguquko ezinkulu ezibhubhisayo esithowini zihlala zithinta ukuphela kwezinzwa, ngakho-ke umlutha kanye nokwehla kwezimpawu zobuhlungu.
Ngokuhamba kwesikhathi, izimpawu ezilandelayo zengezwa emizweni yobuhlungu epigastrium:
- ukuhlanza okungenakugwenywa, emva kwalokho akukho ukukhululeka. Ehlanzweni kukhona ukuhlangana kwegazi ne-bile;
- ukuncipha komzimba, njengomphumela lapho ulwelwesi lwama-mucous nolusu lube loma;
- isifo se-dyspeptic, kufaka phakathi ukwanda kwegesi, ukwenza buthaka kwe-peristalsis, ukuqunjelwa;
- i-hyperthermia, njengoba ukudakwa nokuphelelwa ngumzimba kuqhubeka;
- ukuthakazela, ukumangalisa noma iphimbo lesikhumba lomhlaba olunamabala;
- umfutho wegazi ophansi, ukushaya kwenhliziyo okusheshayo nokuphefumula okujulile;
- ukudideka, ukungakwazi ukuzulazula esikhaleni, ukungabinakho ukuthuthukiswa noma ukuthuthukiswa komqondo ngenxa ye-encephalopathy.
I-pancreatic necrosis ethuthukayo ibangela ukwanda kosayizi wayo kanye nokwakheka kokungena kwe-peritoneum. Kakade ngosuku lwesihlanu ngemuva kokuqala kokugula, i-infiltrate ingagxotshwa ngokuphepha futhi ibonwe.
Ukuhlangana kwezinguquko ezibhubhisayo kungabonakala ngokulandelayo:
- Ukwakheka kwe-cavity enama-necrotic massus kanye ne-pus (abscess).
- Ukwakheka kwama-cysts nama-pseudocysts esitho.
- Ukufakwa esikhundleni kwezicubu ezihlangene (i-fibrosis) enempilo.
- Ukuntuleka kwe-Enzymatic.
- I-fiber ye-Phlegmon retroperitoneal fiber.
- I-Thrombosis ye-mesenteric ne-portal vein.
Ukuxazulula kungenzeka futhi nokwenziwa kwezilonda emgodini wokugaya ukudla.
Izindlela zokuxilonga ezidumile
Uma isiguli sisolwa ukuthi sine-pancreatic necrosis, sihlolwe ngaso leso sikhathi ngongcweti abaningana - udokotela ohlinzayo, udokotela obambele ubuchopho kanye ne-resuscitator. Isiguli silaliswa esibhedlela ngokushesha ukugwema imiphumela yokudlondlobala kwe-pathology.
Ngesikhathi sokuhlolwa kwesiguli, udokotela angabona ukuqhakaza, ukukhala kwesikhumba kanye namabala aluhlaza ezinhlangothini naphansi emuva, okukhombisa ukuthi kukhona ukuqaqamba kwamalunga.
E-unit ukunakekelwa kwendawo yokuhlolwa kuyathathwa. Ukutadisha igazi nomchamo kuyadingeka ukuthola ama-enzyme omzimba. Isibonakaliso esibi yindawo ephezulu ye-amylase, trypsin, elastase, glucose, amaseli amhlophe egazi, i-hematocrit, i-ESR, iprotheni esebenza ngokusebenza kwe-C-ALT, AST,
Ukulungisa ukucekelwa phansi komoya wamanyikwe, udokotela unikeza indlela yezindlela ezinjengalezi:
- i-radiography yezitho zangasese;
- i-ultrasonography yamanyikwe kanye nepheshana esiswini;
- I-MRI ne-CT;
- buyisa kabusha i-cholangiopancreatography;
- i-laparoscopy
Izinkomba zokuhlaziywa ngokwahlukana ukuvuvukala okunamandla kwesithasiselo, amabele enyongo, ukuvinjwa kwamathumbu, ukugcwala kobumba, i-biliary colic, infarction ye-myocardial, noma ukuqhuma kwe-aneurysm yesisu.
Ukwelashwa okuphelele kwe-pathology
Ithuba lokusinda nge-pancreatic necrosis lincike ekutheni izinyathelo zithathwa ngokushesha kanjani ukwelapha lesi sifo. I-Therapy iqukethe indlela yokulondolozela nokuhlinzwa, eqinisekisa ukuqedwa kwenqubo "yokuzigaya" yesitho kanye nokuvimbela imiphumela ye-purulent-septic.
Isivumelwano sokwelashwa okulondoloziwe kubandakanya izinto ezilandelayo:
- Ukuvinjwa kokusebenza komzimba, ukuphumula kombhede ezimeni zokuma.
- Ukudla komzali kwezinsuku ezingama-5-7 ngezakhi zomzimba, ukuphuza amanzi amaminerali we-alkaline.
- Ukuqedwa kobuhlungu obungatholakala ngokuthatha i-antispasmodics (Spazoverin, No-Shpa), i-non-narcotic analgesics (Paracetamol, Analgin) nama-droppers anengxube ye-glucose neNovocaine. Kuvunyelwe ukuphatha izingxube ze-narcotic, ngaphezu kwe-morphine (diphenhydramine + Novocaine).
- Umsebenzi wehlisiwe we-pancreatic, duodenal, kanye nesisu enzymes. Njengomthetho, iziguli azikwazi ukwenza ngaphandle kokufakwa kwama-iv antiferment agents (Aprocal, Gordoks, Krivriven).
- Ukusetshenziswa kwemithi elwa namagciwane ukuvimbela ama-microflora ayingozi nezinjongo zokuvimbela (Cefipim, Ciprofloxacin).
- Ukwelashwa kokumunca ukuqeda izinto ezinobuthi egazini (isisombululo sika-ringer, isixazululo somzimba, i-glucose + insulin).
- Ukukhishwa yi-hemosorption, hemofiltration, plasapheresis yokwelapha, i-peritoneal dialysis.
- Ukwethulwa kwe-iv somatostatin - i-hormone ecindezela umsebenzi wokukhipha ujusi we-gastric kanye nemfihlo yamanyikwe.
Imvamisa, ukuhlinzwa kukhonjiswa nge-pancreatic pancreatic necrosis. Ukwelashwa kokuhlinzwa kuyabambezeleka izinsuku ezingama-4-5 kuze kube yilapho isimo sesiguli sithuthuka, kepha nge-necrosis ephelele noma esezingeni eliphansi, yenziwa ngokushesha. Izinhloso zokuhlinzwa zingafaka:
- ukuqedwa kwezingxenye ezifile ze-parenchyma ne-hemorrhagic exudate;
- ukuqalwa kabusha kokuphuma kwejusi le-pancreatic;
- ukuvimba ukuphuma kwe-intra-isisu;
- ukukhipha umgoqo wesisu futhi kuphume endaweni yawo;
- ukususwa kwengxenye
Imvamisa kuyadingeka ukususa izitho eziseduzane nama-pancreas, ngokwesibonelo, i-gallbladder (ene-cholecystitis ebhubhisayo) noma umhluzi.
Izibikezeli ngemuva kokwelashwa
Isifo sokuhlinzwa ngemuva kokuhlinzwa sihlala simangele. Kuya ngezici ezahlukahlukene - isikhathi sokwelashwa, iminyaka yesiguli, uhlobo lwe-pathology, umthamo wokungenelela kokuhlinzwa, ukuba khona kwezifo ezikhona, njll.
Umuntu oyedwa kwabane abadala oye waba ne-pancreatic necrosis unesifo sikashukela sohlobo lokuqala. Ukubuyela emuva kuvame ukubonakaliswa, ama-pseudocysts kanye nefomu le-pancreatic fistulas.
Ngeshwa, amathuba okwelapha lesi sifo nokusinda mancane. Ukufa ku-aseptic necrosis kusuka ku-15 kuye ku-40%, kuthi uma kunegciwane lelo, kube ngama-60%.
Ngisho nangemva kokulashwa okuphumelelayo, umuntu uhlala ekhubazekile impilo yonke. Kulokhu, kufanele ulandele ukudla okuqinile (inombolo yetafula 5 ngokusho kwe-Pevzner).
Ukuvimbela umphumela onjalo odabukisayo, udinga ukunakekela impilo yakho. Kulokhu, ukuvimbela i-pancreatic necrosis kuyadingeka:
- Ukudla okulinganiselayo, ukuqeda ukudla kwamafutha nokudla okuthosiwe. Khawulela ukusetshenziswa kwemikhiqizo enosawoti, obhemayo kanye nothile.
- Ukwenqaba ngokuphelele imikhuba emibi - ukubhema nokuphuza.
Ngaphezu kwalokho, kufanele ufune usizo lwezokwelashwa ngokushesha futhi uthathe imishanguzo, ulandele imiyalo nezincomo zikadokotela.
Mayelana ne-pancreatic necrosis ichazwe kuvidiyo kule ndatshana.
