I-pancreatitis, noma ukuvuvukala kwamanyikwe, kubhekwa njengesifo esiyingozi ngenxa yezinkinga ezivame ukwakheka ezisongela impilo yesiguli. Ukufa kwezicubu zomzimba ngenxa yemiphumela enolaka yama-enzymes abo kuholela ekubhujisweni kwesakhiwo kwamanyikwe, ukukhishwa kobuthi emgudwini wegazi ojwayelekile, nokwakheka kwama-systemic pathologies. Le nqubo ibizwa nge-pancreatic necrosis futhi iyinkimbinkimbi edala ukufa cishe kwengxenye yamacala (ngokusho kweminye imibiko - 80%).
Ukulimala emithanjeni yegazi ye-pancreas, eyenzeka ngokumelene nesizinda senqubo yokuvuvukala, kuvame ukuholela ekwakhekeni kwezinsimbi eziphuma emgodini we-parenchyma. Ama-hematomas anjalo enza ukuthi inqubo ye-pathological ikhule futhi, anciphise izindunduma futhi enze nzima ukudonsa isitho. I-hemorrhagic pancreatic necrosis yakheka, lapho ukuphazamiseka kwemithambo kuhamba kuqala ekubhujisweni kwe-gland.
Izizathu kanye nendlela yokuthuthuka
Ezimweni eziningi, isifo sangemuva (nesisekelo) siba yisicanucanu se-hemorrhagic pancreatitis, okuwukuthi, isigaba sokuqala sokubhujiswa kwezicubu ze-pancreatic ngama-enzyme nenqubo yokuvuvukala. Kubonakaliswa ukubhujiswa kwezindonga ze-vascular, ukukhishwa kwegazi ezikhaleni ze-interstitial, ukwakheka kwemithambo yegazi. Lezi zinhlobo ziqala ukuncipha izindawo ezisebenzayo zesitho, esenza impilo yezindlala nokuvuselelwa kwayo kabusha.
Kwezinye izimo, ukuqhekeka kwemithambo yegazi noma ukuncipha kwezindonga zazo akwenzeki, kepha amafomu egazi, ahambisana nezinqubo ezilandelwayo. Bafihla imithambo, ngenxa yokuthi yiziphi izingxenye ezithile ze-gland ezihlala ngaphandle kwe-oksijini bese ziqala ukufa. I-pancreatitis enjalo ye-hemorrhagic, ephenduka i-necrosis, ibizwa ngokuthi ischemic ngokwedlulele, okungukuthi, ekuqaleni isuselwa ekufeni kwamaseli, kepha inqubo yokuvuvukala ijoyina ngokuhamba kwesikhathi.
Ukugxila kwe-hemorrhage kube yizindawo ze-necrosis
Kungakhathalekile ukuthi yini ebangele ukulimala kwezindawo zama-pancreas noma isitho sonke, imiphumela yama-enzymes, ama-hemorrhages noma ama-tisk ischemia, aqala ukuwa ngokushesha okukhulu. Endaweni yazo, kwakhiwa ama-foci okubola, lapho kuphuma khona igazi, uketshezi olungena ngaphakathi, inani elikhulu lobuthi buthelela. Zonke lezi zinto ziqala ukungena egazini, "zinoshevu" umzimba. Nge-hemorrhagic pancreatitis, ephenduka i-necrosis, izinso, inhliziyo, isibindi kanye nobuchopho kuyahlupheka.
Kunezizathu eziningana ezingadala i-pancreatitis eyingozi, eyinkimbinkimbi yi-necrosis. Zingamelelwa ngale ndlela elandelayo:
- ukuphuza ngokweqile utshwala;
- ukusetshenziswa ngokweqile kwamafutha, isipayisi, ukudla okubhemayo;
- Izifo zangemuva zesibindi kanye nenyanga (i-cholecystitis, cholelithiasis, i-biliary dyskinesia);
- ukuphazamiseka kwegazi;
- i-autoimmune pathologies (i-systemic vasculitis);
- ukulimala kwama-pancreas ngesikhathi sokulimala noma ukungenelela kokuhlinzwa.
Njengoba ukusebenza komtholampilo kukhombisa, i-acute hemorrhagic pancreatic necrosis ihlala ikhula isencane futhi iphakathi, futhi amaphutha otshwala nawondawo wokudla abe yizinto ezivusayo. Ngaso leso sikhathi, iziguli ezimweni eziningi akubona “abathandi besiphuzo,” kepha umthamo owodwa we-ethanol owedlulele ungaholela emiphumeleni eyethusayo emshubeni. Ezidakamizweni zotshwala, ukungena kotshwala njalo emzimbeni akuvamile ukubangela i-pancreatic necrosis, kuvame ukwenzeka i-pancreatitis engapheli, kulandelwa yi-pancreatic sclerosis.
Izimpawu
Izimpawu ze-acanc pancreatic necrosis zikhula ngokushesha okukhulu, emahoreni ambalwa futhi zifike osukwini olulodwa. Ekuqaleni kwenqubo ye-pathological, lapho ukwaziwa kusabonakala, isiguli singakwazi ukuhlobanisa ukuqala kwesifo nokuselwa, ngokwesibonelo, sotshwala (lezi ziguli zidakiwe). Lapho-ke kusungulwa lapho kusungulwa umdwebo obizwa ngokuthi ukudakwa kanye nokulimala kobuchopho.
Ngakho-ke, ukunakekelwa kwezokwelashwa kufanele kunikezwe isiguli esimweni esiphuthumayo. Iziguli ezinjalo zilaliswa esibhedlela ngokuphuthumayo endaweni yokunakekelwa okukhulu, ngoba ngokoqobo yonke iminithi inganquma kumuntu.
Ngokuvamile, izibonakaliso zemitholampilo ze-hemorrhagic pancreatic necrosis zifana kakhulu ne-pancreatitis eyingozi, kepha ukubukeka kwabo nokukhula kwenzeka ngokushesha okukhulu. Ngaphezu kwalokho, phakathi nezinsuku zokuqala kusukela ekuqaleni kwe-necrosis, ukulimala kwezinso kuqala ukubonakala, kwakheka ukuphazamiseka kwengqondo nokomqondo.
Izimpawu ezejwayelekile kakhulu ze-pancreatic necrosis yilezi ezilandelayo:
Ingabe umuntu angaphila ngaphandle kwama-pancreas- Ubuhlungu obukhali, obukhulayo esiswini esingaphezulu futhi buyekwe yi-hypochondrium, busakazekela ohlangothini lwesobunxele. Emahoreni okuqala we-necrosis, ubukhulu bezinhlungu buhambelana nobunzima be-pathology kanye nezinga lokubhujiswa kwama-pancreas. Kepha-ke, lapho ukufa kokuphela kwezinzwa sekuqala emzimbeni, ukutholwa kwezihibe zobuhlungu kuyaphela. Ukuba khona kokudakwa kakhulu nokuthambekela kokwehlisa izinhlungu kubhekwa njengophawu olungelutho.
- Ukuhlanza okuphindaphindekile, okuvela ngemuva nje kokuqala kobuhlungu futhi kuholele ekuphelisweni komzimba komuntu (ekuhlanzeni - mucus, bile nasegazini).
- Isikhumba esomile nolwelwesi lwe-mucous ngenxa yokuphelelwa ngamanzi emzimbeni, okune-tint ephaphathekile.
- Ulimi olomile oluphekwe ngombala omhlophe.
- I-Intoxication syndrome (umkhuhlane, ukubanda, ubuthakathaka obedlulele, ukuntuleka kwesifiso sokudla).
- Ukuphazamiseka kwemithambo yegazi, okuvezwa izinguquko ekucindezelweni kwegazi. Imvamisa, iyawa, iholele ekuweni (ekushayweni).
- Ukuthuthukiswa kwe-flatulence ngenxa yokuhamba kancane kwamathumbu emathunjini kanye nokuntuleka kwesitulo.
- Kwehlisiwe ukuphuma komchamo noma ukuntuleka kokuchama.
- Ukwakheka kwe-encephalopathy, noma ukulimala kobuchopho (ukwazi ukungadideki, ukudideka, ukuyaluza, bese lezi zimpawu ziphenduka i-coma).
Ngaphezu kwalokho, ama-hemorrhages amaningi akhiwa nge-hemorrhagic pancreatic necrosis angabonakala ngokubonakalayo esikhunjeni sesisu ngaphambili nasezinhlangothini. Babukeka njengamabala e-cyanotic (cyanotic) ngokumelene nesizinda sesikhumba esiphaphathekile nesibandayo.
Ukulimazeka kwesilo esikhunjeni kwenza ukuthi sikwazi ukuthola ukuxilongwa okuqondile.
Ukufa okusheshayo kwezicubu zesitho kanye ne-capsule, eyenzeka ngesikhathi sokubhujiswa, ikakhulukazi ukubhujiswa okuphelele, ngemuva kwamahora ambalwa kuholela ekwakhekeni kwemiphumela eyingozi kakhulu. Okuqukethwe ama-pancreas, izingcezwana zezicubu ze-necrotic, i-hemorrhagic exudate, ubuthi buhamba ngaphezu komzimba, okungukuthi, bungena esiswini sesisu. I-Peritonitis iyaqala, ukwakheka kwamathumbu we-purulent ku-peritoneum nezinye izitho zangaphakathi, i-sepsis iyakhula (ukutheleleka okujwayelekile kwegazi). Zonke lezi zinqubo zishiya isiguli sicishe sibe nethuba lokusinda.
Izindlela Zokuxilonga
Ijubane lezinyathelo zokuxilonga kanye nokuxilongwa okuyiyo ngokuqondile inquma impumelelo yokwelapha kanye ne-diagnostic. Emnyangweni wokungeniswa esibhedlela sesiguli, ovame ukuba sesimweni esibi kakhulu, odokotela abaningana bayahlola (udokotela wezokwelapha, udokotela ohlinzayo ngokuhlinzwa, udokotela ohlinzayo, ohlinzayo). Imininingwane ye-anamnesis ichazwe kubantu abahambisana nesiguli, izikhalazo, uma kungenzeka, esigulini uqobo. Isimo sesikhumba, ubukhona bamaphoyinti wezinhlungu, izinga lokukhishwa komchamo, ukucaca kokuqwashisa kuyahlolwa.
Ukuhlolwa okudingekayo kuthathwa ngokuphuthumayo:
- igazi lokunquma okuqukethwe ama-enzyme (amylase, lipase, trypsin, elastase);
- umchamo we-amylase;
- kusetshenziswa ukuzwakala, ijusi lesisu kanye nokuqunjelwa kwe-pancreatic, lapho kuthathwa khona ama-enzymes kanye ne-acidity degree;
- I-programme yokuqukethwe kwamafutha.
Ngaphezu kokuhlolwa kwelebhu, kusetshenziswa izindlela ezinamandla. Lezi yi-ultrasound, i-radiography, i-CT, i-Mri Uma kunesidingo, kusetshenziswa i-laparoscopy noma i-endoscopy, evumela ukuthi wena ngqo, ngokubheka ngamehlo, uhlole isimo samanyikwe kanye nesisu sesisu sisonke.
Zonke izivivinyo ze-pancreatic necrosis zenziwa ngokushesha.
Zonke izindlela zokuxilonga, ngasikhathi sinye nokucacisa ukutholakala kwe-pancreatitis noma i-pancreatic necrosis eyingozi, kungabeka ezinye izindlela ezenzeka ngezimpawu ezifanayo. Lokhu kungukuvinjwa kwamathumbu kwamathumbu, i-acute appendicitis, i-cholecystitis eyingozi, isilonda esiswini eyenziwe kahle, ukuqhekeka kwe-aorta yesisu, ukuhanjiswa kwemithambo yethambo lesisu.
Izindlela zokwelapha
Ukwelashwa kwe-necrosis kuyinkimbinkimbi futhi kuyinhlanganisela yezindlela zokulondolozwa nokuqina. Ezinsukwini ezimbalwa zokuqala kusukela ekuqaleni kwe-pancreatic necrosis, ukungenelela kokuhlinzwa akunconywa, ngoba ukutheleleka kwesibili kungenzeka ngokumelene nesizinda "sokuncibilika" okusheshayo kwezicubu ze-pancreatic kungasenza kabi isimo sesiguli. Ngalesi sikhathi, preference inikezwa ekwelashweni Conservative.
Kuhloswe uku:
- ukwehla kobunzima bezinhlungu;
- ukukhishwa kwama-pancreas kusuka ekusithekeni;
- ukuncipha kwengcindezi ye-intraorgan;
- ukususwa kobuthi emzimbeni.
Ukunciphisa amandla nokususa ama-enzyme aphuma kumanyikwe, kusetshenziswe i-Trasilol, Contrical, iRibonuclease. Kubalulekile futhi ukunciphisa i-acidity yejusi yesisu ne-Atropine, Ephedrine. Ukusetshenziswa kwe-diuretics kuholela ekunciphiseni kwe-edema esitholeni kanye nokwehla kwengcindezi ye-capsule ku-parenchyma. "Ukuhlanzwa" kwegazi kusuka kubuthi, okuwukuthi, ukukhipha izidumbu, kwenziwa ngokwethulwa kwezigaba zegazi kanye nokuphoqelelwa okulandelayo kokulwa kwezimpawu usebenzisa ama-diuretics.
I-hemorrhagic pancreatic necrosis ivame ukudinga ukuhlinzwa
Ngemuva kwezinsuku ezimbalwa, uma impumelelo yezindlela zokulondolozela incane, kwenziwa umsebenzi. Ngesikhathi sokuhlinzwa, isisipha se-hemorrhagic kanye necrotic sisuswa, imithamo yethambo lendlala iyabuyiselwa, ukuphuma kwegazi kuyalungiswa. I-hemorrhagic pancreatic necrosis ephelele idinga ukuhlelwa kabusha kwesitho noma ukususwa kwayo ngokuphelele.
I-prognosis yazo zonke izinhlobo ze-hemorrhagic pancreatic necrosis is ambiguous. Izinga lokufa liphezulu kakhulu, ikakhulukazi ngenxa yezilonda ezihambisana nohlelo, kepha kuhlala kunethuba lokululama.
