I-pancreatic cyst ingumugqa osemgodleni wesitho sangaphakathi, esilinganiselwe odongeni lwezicubu ezihlangene. Umgodi ugcwala uketshezi oluphuma emzimbeni, i-etiology yokwenzeka ngenxa yokuhlukumezeka noma izinqubo zokuvuvukala kumanyikwe.
Ukubonakaliswa kwemitholampilo kwehluka kakhulu ezithombeni ezihlukile. Zincike ngosayizi wokubunjelwa, indawo, i-pathogenesis yokwakheka. Izimpawu zingasukela emqondweni wokungakhululeki kahle kuze kube buhlungu obukhulu.
Ukuhlola ubukhulu nendawo yama-cyst, bheka ukuxhumana kwamacele, khetha ubuhlakani bokwelapha, iskena se-ultrasound, i-compact tomography, i-MRI yesitho sangaphakathi, nezinye izindlela zenziwa ukuphinda isithombe sonke.
Ezimweni eziningi, ukungenelela kokuhlinzwa noma ukukhipha amanzi kwangaphandle kuyadingeka, ingxenye yesitho kanye ne-neoplasm ye-pathological icatshangelwe kancane.
Ukuhlukaniswa kwama-cysts we-pancreatic
Ngokwekhodi ye-ICD, i-pancreatitis igcwele, ihlala isikhathi eside, i-subacute nezinye izinhlobo. Ukuzilolonga kuhlukanisa izinhlobo ezimbili zama-neoplasms. Esimweni sokuqala, ukwakheka kwethambo kuyabhekwa.
I-cyst iyiqiniso uma kukhona ulayini we-epithelial. Le pathology isho ukungasebenzi kahle kokubeletha, amacala aqhelelene nawo achazwa njengomuthi, ngoba kuyivelakancane kakhulu ezigulini.
I-cyst yamanga iyi-neoplasm ekhula ngenxa yesifo. Akubonakaliswa ngokubonakala kwe-epithelium ye-glandular ezindongeni, ngakho-ke kukhethwe njengengamanga.
Ukuhlukaniswa kwesibili kucabangela indawo ye-cyst kumanyikwe:
- I-cyst yekhanda le-pancreas (ikakhulukazi, indawo iyi-bursa ye-asental). Ngokwezibalo, leli lungiselelo libonakala ku-15-16% wezithombe zemitholampilo. Isimanga ukuthi kunokucindezelwa kwe-duodenum.
- Emzimbeni wesitho - kutholakala amacala angu-46-48%. Iwuhlobo oluvame kakhulu lokusungulwa kwasendaweni, ngokubhekene nesizinda lapho kutholakala khona ukuthunyelwa kwekholoni nesisu uqobo.
- Esitsheni - kutholakala ku-38-39% yezimo. Isimanga ukuthi ngenxa yokushoda okunjalo, izitho zomzimba eziseduze azivamile ukulinyazwa.
Ama-cysts ayiqiniso awatholakali kuleli cala, ukubonakaliswa komtholampilo kanye nemigomo yokwelashwa yazo zombili lezi zinhlobo cishe akufani, ngakho-ke ngokuzayo sizobheka ama-cysts wamanga kuphela.
Izimbangela ze-cyst nezimpawu
Ama-pancreatic cysts avela ezigulini, kungakhathalekile ukuthi aneminyaka yobudala, ubulili, angaba ngosayizi abahlukahlukene, kukhona angashintshi futhi amaningi. Kwezinye iziguli, ikakhulukazi ngenxa ye-cosgenital cavity, ama-systemic polycystic ovari, ubuchopho nesibindi kungatholakala.
Ama-cysts angamanga awakheki emzimbeni ophilile. I-neoplasm ihlala ingumphumela wenqubo yokuwohloka emzimbeni. Izimbangela ezivame kakhulu zifaka i-pancreatitis eyingozi, ukulimala kwesitho
Imbangela ingaba ukwenqatshana okufushane komugqa we-excretory duct (ngokwesibonelo, kuphakanyiswe ngumthambo wegazi noma itshe) noma ukuphazamiseka okukhulu kumakhono ayo wemoto. Imvamisa, ama-cysts akha izifo ezihlaselayo ezifana ne-cysticercosis, i-echinococcosis. I-pathogenesis nayo ibangelwa yi-tumor neoplasms. Ngendlela engapheli yesifo se-pancreatitis, ama-cysts e-post-necrotic akhiwa engxenyeni yamacala.
Umphakathi odokotela abahlinzayo ukhomba izinto eziphambili eziholela ekuthuthukiseni ukwakheka kwe-cystic. Umthelela omubi wezinto uye wafakazelwa izifundo eziningi. Lokhu kufaka phakathi:
- Ukuphuza ngokweqile utshwala.
- Ukukhuluphala ngokweqile, okuhambisana nokuphulwa kwe-lipid metabolism.
- Umlando wokungenelela kokuhlinzwa kunoma yisiphi isistimu yokugaya ukudla.
- Isifo sikashukela mellitus (imvamisa yohlobo 2).
Ukuba khona kwalesinye salezi zimo esigulini esinezimpawu zezilonda ze-pancreatic kuvumela ukwakheka kwe-cyst.
Ukuqala kwenqubo ye-pathological kunokubonakaliswa okuthile kliniki okubonwa ku-90% weziguli. Ekuqaleni, umtholampilo onjalo uvela:
- Ubuhlungu obukhulu be-herpes zoster. Iyaqina ngemuva kokudla noma ukuphuza utshwala. Ithebhulethi yokubulala izinzwa ayixazululi inkinga, awukho umphumela wokwelapha.
- Ukuhlanzwa okuphindaphindwayo, okungalethi ukukhululeka esigulini.
- Izimpawu zokuphazamiseka kwamathumbu - isifo sohudo, ukuqhakaza, ukwanda kwegesi.
Ukubonakaliswa kwemitholampilo kunyamalale ngokuphelele noma ukuncipha emavikini angama-4-5 okugula. Kwezokwelapha, lesi sikhawu sibizwa ngokuthi "igebe elikhanyayo". Ngemuva kwalokho, kubuye kuvezwe izimpawu zobuntu, kepha kube kukhulu futhi kuphikelela.
Imvamisa, iziguli zikhononda ngokushisa komzimba okufushane, ubuthi, ubunzima obukhulu e-hypochondrium yangakwesobunxele. Kwesinye isikhathi (cishe i-5% yezithombe), ukuqina kwezikhumba, ulwelwesi lwama-mucous, i-sclera yezitho zombono kwenzeka.
Izimpawu ze-pancreatic cysts zifaka ukukhiqizwa okunganele kwama-hormone afana ne-insulin, somatostatin, glucagon. Ukushoda kwabo kuholela ekomeni emthanjeni womlomo, ukwanda kwamandla athile okuchama ngosuku, ezimweni ezinzima, ukulahleka kwengqondo ngenxa ye-hypoglycemic noma i-hyperglycemic coma kutholakele.
Izindlela zokuxilonga
Uma usola umgodi ogcwele uketshezi, ukubonisana nodokotela we-gastroenterologist kuyadingeka. Ngesikhathi sokuhlolwa kwesisu esisemzimbeni, ukuphuma kwaso kuyabonakala endaweni etholakala kuyo i-pathological element.
Ukuhlolwa kwelebhu, njengomthetho, akubonisi ushintsho oluthile. Kukhona ukwanda okuncane kwama-leukocytes, i-ESR iyanda. Kwesinye isikhathi kuba nokwanda kokuhlungwa kwe-bilirubin.
Okuqukethwe kwama-enzyme wokugaya egazini kuncike kakhulu esigabeni sokuvuvukala kwamanyikwe kunokubakhona kwe-cyst. Cishe i-5%, kutholakala isifo sikashukela sesibili.
Ucwaningo luyenziwa:
- I-Ultrasound inika ukuhlolwa kobukhulu be-neoplasm, kukhombisa izimpawu eziqondile zezinkinga ezikhona. Isibonelo, uma ukuvumelanisa kukhona, echogenicity engalingani iyatholakala.
- I-CT ne-MRI zinganikela ngemininingwane enemininingwane ekutholakaleni ukwakheka kwe-cystic, usayizi wayo, ukungabikho noma ukuba khona kokuxhumana kokungena.
Ngokuxilongwa, i-ERCP iyenziwa - indlela isiza ukuthola imininingwane eningiliziwe ngobudlelwano bama-cyst kanye nama-pancreatic ducts, anquma futhi irekhodi lokwelashwa. Kodwa-ke, ngokuhlolwa okunjalo, kunethuba elikhulu lokutheleleka.
Ngakho-ke, i-ERCP yenziwa kuphela ezimweni lapho kunesidingo sokuthatha isinqumo sendlela yokungenelela kokuhlinzwa, kuyilapho ukwelashwa okuvumayo njengendlela yokwelashwa kungacatshangelwa.
Ukwelashwa kwezidakamizwa
Iyini ingozi ye-cyst kumanyikwe? Ingozi ukuthi ukwakheka okukhona isikhathi eside kuholela ekucindezelweni kwezitho zangaphakathi zomakhelwane, okuvusa izingqinamba ezahlukahlukene. Imiphumela ingaba yile elandelayo: ukuqhuma, ukwakheka kwe-fistulas, supplement noma i-abscess, ukopha ngenxa yokuqhuma komkhumbi wegazi.
Ngokuhambisana nezethulo zakamuva zemiphakathi yesayensi, kungashiwo ukuthi ukwelashwa okulondolozekayo ngamathebulethi kwenziwa ngaphansi kwezimo ezithile. Uma kunokukhawulelwa okucacile kwento ye-pathological, ubukhulu bokwakhiwa kwe-cystic abukho ngaphezu kwamasentimitha ayi-2 ububanzi.
Baphathwa ngezidakamizwa uma i-neoplasm ingashadile. Akukho okubonakaliswa okuvela emtholampilo kwe-jaundice evimbayo, Ubuhlungu obulinganiselayo.
Ezinsukwini zokuqala, indlala inqunyelwe. Ukudla okunamafutha, okuthosiwe nosawoti akunakwa esikhathini esizayo, ngoba lokho kudla kuvusa umkhiqizo okhiqizayo wama-enzyme wokugaya ukudla, onomthelela ekubhujisweni okusebenzayo kwezicubu. Khipha ugwayi nemimoya. Isiguli sidinga ukuphumula kombhede izinsuku ezingama-7-10.
Ngesikhathi sokwelashwa, izidakamizwa zinqunyelwe:
- Ama-antibiotic ahlobene ne-tetracyclines noma i-cephalosporins. Zenzelwe ukuvimbela ukungena kwamagciwane emzimbeni wethoni yokwakheka, okuzoholela ezinqubweni zokuhlanza.
- Ukuze unciphise izinhlungu futhi wehlise ukukhululeka, kusetshenziswa ama-inhibitors - u-Omez, u-Omeprazole nezinye izidakamizwa.
- Ukwelashwa kwe-enzyme kuyadingeka ukuze kuqinisekiswe ukugaywa kwama-carbohydrate namafutha - kunconywa izidakamizwa ezinelipase kanye ne-amylase. Kwethulwe yiqembu - iPancreatin, eCreon.
Uma i-cyst ingumphumela we-pancreatitis ye-biliary, izidakamizwa ze-choleretic zingangezwa ngokungeziwe. Kwezinye izimo, ngemuva kokuqeda umthombo we-cyst, izilonda zingaxazulula zodwa. Kodwa-ke, lokhu akuvamile. Iziguli eziningi zisebenzisa amakhambi abantu ngendlela yesibopho se-burdock, i-mummy, i-tincture ye-celandine, njll. Ukubuyekezwa kwalezi zindlela kulungile, kepha akusekelwa ubufakazi, ngakho-ke kungcono ukungabeki engcupheni futhi wethembe odokotela.
Lapho ukwelashwa okulondoloziwe kungazange kuveze umphumela oyifunayo kungakapheli amasonto ama-4, isincomo esengeziwe odokotela abahlinzwa.
Ukwelashwa kokuhlinzwa
Ngokwezibalo, ukwelashwa okulondoloziwe ku-10% kuphela kugwema ukuhlinzwa. Kwezinye izimo, ukwelashwa kwenziwa emnyangweni wokuhlinzwa. Kunokwehluka okungaphezulu kwesikhombisa kwendlela yokusebenza evumela ukukhishwa kwe-cyst.
Odokotela bazama ukuhamba ngamasu amancane ahlaselayo okuwelapha lesi sifo. Ngokuphikisana nesizinda sokukhwabanisa okunjalo, isikhumba sesiguli asilimele. Izinkinga ezingaphansi zibonakaliswa ngamasu enzelwa esikhunjeni ngaphansi kokulawulwa kwe-ultrasound.
Izinga eliphakeme lokusebenza liyabonakala phambi kwenqubo ye-volumetric pathological ekhanda noma emzimbeni. Umgomo wenqubo ulula impela. Ngemuva kwe-anesthesia yomuntu omdala noma yengane, inaliti yokubhoboza noma umgqugquzeli ufakwa endaweni yokubhoboza endaweni ye-epigastric. Ngokuya ngosayizi we-cyst, ukusebenza kungahamba ngezindlela ezimbili:
- Kusetshenziswa ukudonswa kwamanzi okushubile kwe-neoplasm. Ngemuva kokuthi wonke uketshezi ususiwe ku-cyst, kufakwa ishubhu elincanyana nerabha ukwenza ukuphuma njalo. Kusemzimbeni kuze kuphume uketshezi. Ukuqanjwa kwenkohliso okunje akwenziwa uma isakhi se-cystic sivale izindunduma zesikhumba noma sikhulu.
- Nge-percutaneous sclerotherapy ye-cyst. Le ndlela ifaka ukungeniswa koketshezi lwamakhemikhali emgodini ngemuva kokukhishwa. Ngenxa yalokhu, kukhona ukuhlanzwa komgodi, ukugcwala kwesiphene.
Uma izinqubo ezingenhla zingenakwenziwa, lapho kwenziwa i-laparoscopy. Lo msebenzi wenziwa ngezigameko ezimbili, ngasinye sazo sihlukahluka kusuka ku-1 kuya ku-2 cm. Amathuluzi angeniswa ngaphakathi kwawo ngesisu. Ngakolunye uhlangothi, izinqubo zecebo elinjalo zibonakaliswa ukuwohloka okuphansi, kepha ngakolunye uhlangothi, izibalo zikhomba ukuthi izinkinga ezihlukahlukene zivame ukuvela.
Udokotela angenza okulandelayo:
- I-Excision kanye ne-occlusion yemfundo. Kuyamukeleka ukufaka isicelo uma i-cyst ingaphezulu.
- I-laparoscopy ebandakanya ukuhlelwa kabusha kwengxenye ye-pancreatic. Isincomo esiyinhloko senkomba enkulu ngaphakathi kwezicubu.
- Ukungenelela kukaFrey kubandakanya ukumiswa kabusha kwekhanda nokudalwa kwe-pancreatojejunal anastomatosis. Kungcono ukuthi uziphathe ngokungafani nesizinda sokunwebeka okubanzi komquba wesitho.
Ukubikezela kungenxa ye-etiology yalesi sifo, ukuxilongwa okufika ngesikhathi kanye nenkambo yokuhlinzwa. Isifo esinjalo sinemvamisa ephezulu yemiphumela emibi - sisuka ku-10 saya ku-50% wabo bonke abapende. Ukufakwa emzimbeni, i-cosmetic kuvame ukwenzeka, ama-fistulas, ukopha ngaphakathi kwethambo lesisu kwakhiwa. Ngisho nangemva kokuhlinzwa kuma-pancreas, kunobungozi obuthile bokuphinde ubuye esikhathini esizayo.
Mayelana nokwelashwa kwe-pancreatic cysts kuchazwe kule vidiyo kule ndatshana.
