Inqubo yesikhathi eside yokuvuvukala izicubu zepancreas iholela ekuqubukeni kwezinguquko ze-pathological ezingenakulungiswa esitho - pancreatitis.
Lolu hlobo lwesifo njengamanje
Le pathology ihambisana nezimpawu nezimpawu ezithile ezithile.
Izimpawu ezinje yilezi ezilandelayo:
- kubuhlungu;
- kukhona umuzwa wokucanuzelelwa kwenhliziyo kanye nezikhathi zokuhlanza;
- kukhona isitho sokuhlukumezeka esisebenzayo.
Odokotela bahlakulele izincomo ezikhethekile ze-pancreatitis engapheli, ukusetshenziswa kwayo okuvumela hhayi ukuthola kuphela ubukhona be-pathology kubantu, kodwa futhi nokwenza izinyathelo zokuvimbela ukwenzeka kwe-CP
Umnyombo we-pathology kanye ne-etiological mechanism yokuqalwa kwesifo
Lapho ukhomba isifo, zonke izincomo zochwepheshe kufanele zilandelwe.
Ukulandela izeluleko zikadokotela ozokuvumela kuzokuvumela ukuthi usebenzise kahle irejimeni yokwelashwa ekhethiwe, unikezwe ubukhona bezinto ezitholakala ngesikhathi sokugula nomzimba wesiguli.
Iziphakamiso ze-pancreatitis engalapheki zabasebenzi bezokwelapha zakhiwa izinhlangano zezwe nezomhlaba jikelele.
I-CP iyindlela eyinkimbinkimbi kakhulu, zombili maqondana nokuqaliswa kokulashwa kanye nangokokuxilongwa.
Isici salesi sifo i-heterogeneity yenqubo ye-pathological kanye nesithombe somtholampilo sokubonakaliswa kwalesi sifo. Kwezinye izimo, ama-nuance nuances angaziwa angangezwa ebunzimeni obukhonjwayo.
Ama-inhomogeneities ngesikhathi lesi sifo sinomthelela ekuqubukeni kokungaboni ngaso linye phakathi kodokotela ngezinkinga zokuxilongwa kwe-pathology nokwelashwa kwayo.
Ukuvela kokungaboni ngaso linye okunjalo kudinga ukuthuthukiswa kwendlela enobunye yezindlela zokutholwa nokwelashwa kwalesi sifo.
Le ndlela yokuxilongwa nokwelashwa ibonakala kumasu athuthukiswa izinhlangano zomhlaba nezazwelonke ze-gastroenterologists.
Okwamanje, ucwaningo aluzange lusungule zonke izinqubo zemvelo ezibangela isizukulwane salesi sifo, futhi ukuhlonza izimbangela zokuthuthuka kwe-pathology kuyinto ebaluleke kakhulu enomthelela ekukhetheni kwendlela yokwelashwa.
Ekuhlaziyweni kwe-CP kanye nokuhlukaniswa kwe-pathology ngokusho kwezimpawu zokutholwa kwemvelo, kuhlukaniswa isigaba esihlongozwe yinhlangano yamazwe aphesheya kwe-gastroenterologists.
Izinhlobo ezilandelayo ze-pathology ziyahlukaniswa:
- Ubuthi, ngokwesibonelo, ifomu lotshwala noma lomthamo. Kutholakala ku-2/3 kuwo wonke amacala okutholwa kwalesi sifo.
- Ifomu le-Idiopathic.
- Ukutheleleka.
- Ukuncika kweBiliary.
- Ifa.
- I-Autoimmune.
- Kuyasiza.
Imvamisa, i-CP ngukuthuthuka okwengeziwe kwe-pancreatitis eyingozi, kepha kunezimo lapho ifomu lesifo elingamahlalakhona liqala ukuvela njengesifo esizimele.
Ngaphezu kokudakwa kakhulu, kunconywa ukuthi unake izizathu ezengeziwe ezingaba:
- cholelithiasis;
- ubuthi obunamakhompiyutha anobuthi;
- ukuba khona kwezifo ezithathelwanayo;
- izinkinga zokudla;
- ukuphazamiseka kokujikeleza kwesimo sendawo (ama-spasms kanye nokwakheka kwezihibe zegazi);
- ukwehluleka kwezinso.
Ngaphezu kwalokho, izinqubo ezahlukahlukene zokuvuvukala zingaba imbangela ye-CP.
Uma kutholakala uhlobo olubi lwe-pathology bese kumiswa esigulini, isiguli sithola izincomo lapho sikhululwa esiqondiswa ekuqhakambisweni kwesifo esingamahlalakhona emzimbeni.
E-Russia, i-Association of Gastroenterologists iye yathuthukisa izincomo ezikhethekile zikazwelonke zokwelapha i-pancreatitis.
Inhloso yezincomo ezinjalo ukuthuthukisa indlela enobunye ekuhlolweni nasekuphatheni i-CP.
Izindlela zokuxilonga
Ukuba khona kwe-CP esigulini kungasolwa esigulini uma enamakhambi athile obuhlungu esifundeni sesisu kanye nezimpawu zomtholampilo, okuvela ukuthi kuyisici sokungapheleli kweproocrine pancreatic. Ukuvela kwalezi zimpawu kubalwa ezigulini ezihlala ziphuza utshwala nokubhema ugwayi.
Isici esinomthelela ekubonakala kwe-pathology, ngokuya ngezincomo zendlela esetshenzisiwe, kungaba khona kwezifo ezifanayo emalungwini omndeni.
Umehluko phakathi kwe-CP kanye ne-acute yinto engabonwa kangako, equkethe ukwanda kwezinga lama-enzyme egazini nomchamo.
Uma isimo esinjengalesi sibhekwa, khona-ke kaningi kuyimpawu yezinqubo zokwenziwa emzimbeni wokubumba kwe-pseudo-cystic noma ukuthuthukiswa kwe-pancreatic ascites.
Uma kutholakala inani elithile le-amylase emzimbeni, umuntu angacabanga ngethonya lemithombo yangaphandle ye-hyperamylasemia emzimbeni.
Izindlela ezilandelayo zokuxilonga zisetshenziselwa ukuxilonga:
- I-Ultrasound yesibeletho sesisu.
- I-Multispiral computed tomography.
- I-MRPHG ne-EUSI.
- I-Endoscopic retrograde cholangiopancreatography.
- Izindlela ze-Classical zokuhlaziya kwe-pancreatic juice yevolumu.
- Ukunqunywa kwe-elastase-1 ekwakhiweni kwezindunduma kusetshenziswa i-enzyme immunoassay
I-Ultrasound yezitho zesisu ingakuqinisekisa ukuba khona kwefomu elinzima kuphela le-CP ngezinguquko ezisobala ze-pathological ekwakhekeni kwezicubu ze-pancreatic.
Imanyuwali yokuxilonga yodokotela incoma ukusetshenziswa kwe-ultrasound ku-dynamics ukuqapha isimo sesiguli lapho kutholwa isifo futhi uma umuntu ene-pseudocyst kumanyikwe.
Kumele kukhunjulwe ukuthi ukungabi bikho kwezimpawu zokuthuthuka kwalesi sifo ngokwe-ultrasound akubukeli ubukhona bayo emzimbeni wesiguli.
I-Mography ye-Multispiral computed tomography iyindlela esetshenziswayo enikeza ulwazi kakhulu ngokuqhathaniswa ne-ultrasound esiswini.
Okufundisayo kakhulu nokuvumela ukuxilongwa okubonakalayo kokushintshwa kwe-pancreatic parenchyma ekuqaleni kwezigaba zokuqhubeka kwesifo kuyizindlela ze-MRPHG ne-EUSI ngokukhuthaza okwenziwe ngasikhathi sinye ngasikhathi sinye, kodwa i-secretin ayibhalisiwe kwiRussian Federation.
Ukusetshenziswa kwe-MRI ne-MRCP ngaphandle kwe-siriin akunikeli zinzuzo ekuhlolweni kwe-CP.
Ukwelashwa kwalesi sifo
Izincomo zikazwelonke zokwelashwa kwe-pancreatitis zeluleka izindlela zokulondolozela ukwelashwa kabusha kwezimpawu zesifo futhi zivikele ukuqhubeka kwalesi sifo, izinkinga.
Ukuqedwa kwefomu elingelona elibi kwenziwa ngesisekelo sokusetshenziswa kwenkimbinkimbi yokwelapha, okubandakanya ukuzila okwelashwa, ukudla, 
ukuqaliswa kokuzwakala kwesisu, ukusetshenziswa kwamakhaza esiswini endaweni yamaphaphu, ukuqashwa kwemithi yezinhlungu nemithi ye-antispasmodic.
Esimweni lapho umphumela omuhle wokusetshenziswa kwezindlela eziyisisekelo zokwelashwa ungatholakali kungakapheli amahora ayisithupha, ukuba khona kwesimo esibi sesifo kuyabonakala esigulini.
Ngokuhambisana nezincomo ezikhonjwe imisebenzi eyisithupha yokwelapha:
- ukuyeka ukuphuza utshwala nokuyeka ukubhema;
- ukuzimisela kwezimbangela zobuhlungu esiswini;
- ukuqothulwa kokungapheleli kwe-pocrreatic pancreatic;
- ukukhonjwa kanye nokuqedwa kokungapheleli kwe-endocrine ezigabeni zokuqala;
- ukwesekwa kokudla okunempilo;
- ukuhlolwa kwe-pancreatic adenocarcinoma.
Inqubo yokwelashwa ifaka ukwelashwa okuqinisa umzimba. Umphumela omuhle kakhulu ophathelene nokwelashwa utholakala kuphela esimweni sokuqala kokulashwa ekuqaleni kakhulu kwezigaba zokuqala zokukhula kwesifo.
Ukwelashwa kokugada kufanele kuqalwe emahoreni angama-12 okuqala ngemuva kwezimpawu zokuqala zalesi sifo. Esimweni esinjalo, amathuba okuthola umphumela omuhle akhuphuka kakhulu.
Ngokuhambisana nemihlahlandlela yezincomo ezithuthukisiwe, ukuqedwa kwezinkinga okuyizindlela ezingenakuqhathaniswa ze-endoscopic kwenziwa ngokusebenzisa indlela yokuhlinzwa - i-laparotomy.
Izinkomba zokungenelela kokuhlinzwa
Uma kutholwa ifomu elinzima, ukungenelela kokuhlinzwa kuyakhonjiswa. Iqiniso ngukuthi ukuthuthukiswa kwalesi sifo kuholela ekulahlekelweni ngumzimba wemisebenzi yayo ye-endocrine kanye ne-exocrine. Indlela ye-laparoscopy isetshenziswa njengendlela yokuxilonga nangezinhloso zokwelapha.
Ukusetshenziswa kwale ndlela yokungenelela kokuhlinzwa emzimbeni wesiguli kwenziwa uma kutholakala ukuba khona kwe-peritoneal syndrome.
Ngaphezu kwalokho, udokotela ohlinzayo usebenzisa i-laparoscopy lapho kutholakala khona ukuthi kukhona uketshezi lwamahhala esibelethweni sesisu.
Uma kwenzeka ukuthi ukungenelela okuhlinza nge-laparoscopy kungenzeki, khona-ke ukusetshenziswa kwe-laparocentesis kubonisiwe.
Ukuhlinzwa kweLaparoscopic uyakwazi ukuxazulula imisebenzi elandelayo:
- Ukuqinisekiswa kwe-pathology yesiguli.
- Ukukhonjwa okuthembekile kwezimpawu zefomu lesifo esinzima.
- Inqubo yokwelashwa.
Ngenqubo yokuthuthukiswa kwalesi sifo, kuvela ukuthi i-exocrine pancreatic insuffence iyabonakala. Ngemuva kokuhlinzwa, ukuthikamezeka kokusebenza okukhethiwe kuyathuthukiswa futhi esikhundleni salokho isikhathi eside sisetshenziselwa ukunxephezela. Umthamo wezidakamizwa ze-enzymatic ezithathiwe ngokuya ngezinga lokuthuthuka kokuntuleka kwe-pancreatic.
Ngenqubo yokuqalisa ukusebenzisa okunye ukwelashwa, kusetshenziswa izidakamizwa eziqukethe ama-enzyme e-pancreatic.
Ngaphezu kwalokho, i-concomitant therapy iyenziwa, equkethe ngokuthatha izakhi eziyinkimbinkimbi zama-vitamin soluble, kufaka phakathi amavithamini A, D, E, K no-B ekwakhiweni kwawo.
Ukwelashwa kwezidakamizwa okuhambisanayo kuhlanganisa nokusetshenziswa kokulungiswa kwe-calcium.
Izinkinga ezinokwenzeka ngemuva kokusebenza
Lapho uqeda i-pathology, izindlela zokuhlinzwa zisetshenziselwa ukususa izindawo ezithintekile.
Isikhathi sokubuyisela emuva siqukethe ukwelashwa okuphelele kwezidakamizwa nokuhambisana nezincomo zomtholampilo zokwelashwa kwe-pathology.
Ukuvela kwezinkinga zangemva kokusebenza kwesikhashana yinto eyejwayelekile eCP. Ngokwezibalo, izinkinga zenzeka ngamaphesenti angama-40 wamacala.
Esikhathini se-postoperative, ukwakheka kwe-fistula kungenzeka, ukuvela kabusha kwekhanda le-pancreatic kuyakwazi ukukhipha ukubukeka kokuphuma kwegazi kwangaphambili.
Ukuqedwa kwezinkinga ze-pancreatitis ebukhali kwenziwa ophikweni lokunakekela olunzulu lusebenzisa izidakamizwa ze-antibacterial. Iqembu elichaziwe lezidakamizwa lisetshenziselwa ukukhipha okwenzeka ezinkingeni ze-septic.
Isikhathi sokubuyisela emuva sokusebenza sidinga ukunakwa okukhulu ekudleni, ikakhulukazi ukunamathela embusweni wayo.
Izincomo zemitholampilo ze-pancreatitis zivimbela ukuthi kudliwe kuphela izidlo ezicijile. Ukupheka kufanele kwenziwe kuphela ngumbusi noma ngokubilisa. Amazinga okudla okudliwayo kufanele angabi ngaphezu kwama-50 degrees Celsius.
Ukudla okubandayo kakhulu nokushisayo kungalimaza i-pancreas. Ukudla kufanele kube ngokuxutshanayo, inani lokudla kufanele okungenani libe kathathu ngosuku.
Ukuhlinzwa ukuze kususwe izinkinga ze-CP kusho inqubo yokuhlinzwa eyinkimbinkimbi, ngakho-ke izinqubo ezinjalo kufanele zenziwe ngodokotela abaqeqeshiwe kakhulu abasebenzisa imishini yesimanje.
Mayelana ne-pancreatitis engapheli ichazwa kuvidiyo kule ndatshana.
