Kunengqondo ukukhuluma nge-pseudocyst (ngokoqobo "i-cyst yamanga") yamanyikwe (i-pancreas) kuphela uma sekucacile ngokuphelele ukuthi iyini i-cyst yangempela.
Okungukuthi, kuyisiko ukubiza i-patity eyakhelwe emathunjini esitho esiminyene (ubuchopho, izinso, amaphaphu), okumele kugcwaliswe nganoma yiluphi uketshezi - i-serous, i-mucous, igazi, elinqabela ukuwa kwalo, ukuwa - ngaphandle kwalokho alikwazi ukubizwa ngokuthi yi-cyst (elihunyushwe kusuka esiLatinini ngokuthi "bubble").
Kepha uma i-cyst eyiqiniso iyisakhiwo esiyimpumputhe (ayinakho ukuxhumana nanoma iyiphi enye i-cavity), khona-ke i-cyst yamanga ibhamu ebunjiwe evela emgodini omncane we-gland ngenxa "yokuxhuma" ukuphuma kuyo.
Ngenxa yalokhu, kwakhiwa “ibhodlela”, elixhunywe ngokungemthetho kumugqa osondelene “ngentamo” emincane - kodwa ngenxa yobukhona besithiyo kulo, ijusi le-pancreatic alikwazi ukungena ngokukhululeka esiqwini esijwayelekile (liqongelela ngaphakathi ngenxa yokukhiqizwa kwensimbi okuqhubekayo), umgodi ulula futhi unwebeke ngokulinganayo kuzo zonke izinkomba, kwakheka "umhume" oyindilinga nokuqukethwe koketshezi (pseudocyst).
Izigaba zesifo nezimpawu
Ukuqonda ukuthi yikuphi okuvumela lokhu, indlela ye-ultrasound, njenge-X-ray, ingangena kunoma yisiphi isitho esiminyene (kufaka phakathi i-pancreatic gland) ngokufunda ngemisebe, inikeze isithombe esandisiwe sesakhiwo sayo sangaphakathi.
Akukwazi ukuthola ukuthi i-pseudocyst encanyana kangakanani noma iyiphi enye indlela - ayizenzi izwakale kuze kube yilapho ukwanda kwayo kubangela izimpawu ezibonisa i-pathology enzima yesitho esiqukethe.
Uma ucabanga ukuthi cishe noma yimuphi umonakalo kumanyikwe yi-pancreas ubangelwa utshwala, ukudla ngokweqile (ukudla ngokushesha, ukudla okwomile, ngamanani amakhulu, ngaphandle kokuhlafunisisa nokuqonda), ukucindezela (kufaka phakathi isimo sokudla esisondele empini encane nayo), kuboniswa ngokugaya ebusweni:
- Ubuhlungu besimo esivela ngezikhathi ezithile kubandakanya indawo ye-epigastric (ingxenye yesithathu ephezulu yesisu);
- isifo sohudo;
- ukuqothuka;
- isicanucanu
- ukuphakama kwesisu (kuze kufike ezingeni lokusekelwa kwidayaphragm kusuka ngezansi, okubangela ukuphefumula nokushaya kwenhliziyo).
Ngokusobala, yonke into etholwa yisiguli ibalwa njengokudla okungenampilo, noma isiqephu sotshwala, noma esiphuthumayo enkonzweni.
Uma ucabanga ukuthi bambalwa abantu abeza kudokotela "namaqhinga" anjalo, konke kukhawulelwe ekuthatheni i-No-shpa. Noma, ngemuva kokuzwa ngchwepheshe ukuthola ukuthi yi- "pancreatitis engamahlalakhona", isiguli siqhubeka nendlela yaso yokuphila yangaphambili (sikhumbula ukuthatha imithi ebekiwe ngezikhathi ezithile kuphela).
Ngenxa yokushiswa ngokweqile kotshwala (lapho kuphonswa kwinethiwekhi enkulu ye-ductal of the gland), kuvela izizathu eziningana eziholela ekuvinjelweni kwemithambo ngayinye (lapho i-pseudocyst ingaqala ukwakheka kancane):
- ukucekelwa phansi kwesendlalelo sangaphakathi samaseli - i-epithelium ngokwakhiwa kwamapulangwe-plugs e-cell-protein
- ukwakheka kwesilonda se-fibrous (ngemuva kokuvuvukala okuphindaphindiwe), kunciphisa ishubhu ekhipha ujusi;
- ukwakheka kwesimila esidlala indima efanayo.
Njengoba kunikezwe indawo eseduze yokuvulwa kwendawo okuphuma kuyo isibindi nepancreas efanayo, kungasaphindeki ukuthi kube nokujikijelwa emiseleni yesihlabathi senyongo yokugcina ngisho namatshe amatshe amatshe amancane aqukethe ukwakheka kwe-bile.
Ekugcineni, ukuphuma kwezicubu emgudwini we-gland kungahle kube nomphumela wokucindezelwa (ngenxa yokuhlukumezeka esiswini noma ngesinye isizathu).
Izimpawu ezisetshenziswa kamuva zihlanganisa:
- ukugabha ngenxa yokuphazamiseka ekuhambeni kokudla ngokusebenzisa izitho eziyize ngenxa yokuncipha kwendima kusuka esiswini kuya kwi-duodenum;
- i-jaundice ngenxa yokucindezela kwe-bile duct ejwayelekile;
- ukuzindla kwe-palpation ngobukhulu obukhulu kanye nobunzima be-gland;
- ukunciphisa umzimba.
Lapho kwakheka ukwakheka ngaphakathi kwesitho esincane se-peritoneal (peritoneal), bakhuluma nge-pseudocyst ye-peritoneal (ngokwasendaweni yayo ngaphansi kweshidi le-peritoneum elimboza ngaphambili nangephezulu kwamanyikwe), imiphumela yalokho ayihlukile ekwakhiweni okufanayo okukhona ngaphakathi kwesitho.
Ngaphezu kokuba khona kwezimpawu ezijwayelekile nezingaxutshiwe ze-pancreatitis engapheli, ukubonakaliswa kwama-pseudocysts, afinyelele kububanzi obukhulu, kunganikeza isithombe sesisu esibi nge:
- ikhefu lakhe;
- ukwakheka kwama-fistulas axhumanisa indlala nesisu, i-pericardium (pericardial sac), amathumbu;
- ukwengezelwa kwezicubu zomthambo - ukwakheka kwesilonda, kuyingozi ngokwako futhi kugcwele ukopha kwangaphakathi kwesisu ngenxa yomonakalo esitsheni esikhulu - kaningi ukwedlula esiswini, emithanjeni yemithambo yegazi noma imithambo ye-duodenum.
Ngaphezu kwalokho, ukuvela kwe-pleural (imvamisa engxenyeni yesobunxele ye-pleural patity) kungenzeka.
Ngenxa yokuthi okuqukethwe yi-pathological patity echaziwe kungukuphuza kwe-pancreatic okunezinto eziphezulu zokugaya kanye nezakhiwo ezonakalisayo, ukungena kwawo noma kuphi ngaphakathi emzimbeni kuyinhlekelele engathi sína kunokuhlaselwa yinhliziyo noma unhlangothi (lapho kuthululelwa umgodi we-pericardial, i-cardiogenic shock eba, nge ukutheleleka kwe-peritoneum - peritonitis).
Inkulumo yevidiyo kuma-cysts e-pancreatic:
Izindlela Zokuxilonga
Hlukanisa phakathi kokuxilongwa ngokusebenzisa izindlela:
- imitholampilo ejwayelekile;
- ilabhorethri;
- okokusebenza.
Esikhathini sokuqala kwesifo, okubaluleke kakhulu yindlela ye-ultrasound yokuthola isimo sesitho esingenampilo, siveza ukuphambuka okuncane ekwakhekeni kwamanyikwe. Izindlela zemitholampilo ezijwayelekile (ukuphenywa, ukuhlolwa, i-palpation, i-percussion) zingaphakamisa kuphela ukuvela kwe-pancreatitis engapheli.
Ngokuxhamazela kwenqubo, kuphambuka ekuhlolweni kwegazi kwenzeka:
- jikelele (ngesimo se-neutrophilic leukocytosis);
- biochemical (izinga ngokweqile lama-enzyme, ikakhulukazi, ama-amylase).
Ushintsho olufanayo ekuhlolweni kwegazi olujwayelekile lubonwa ngesikhathi sokudluliselwa - ukuphambuka kwezinto eziphilayo kukhombisa ukuqhuma kwama-enzyme egazini (lapho i-cyst igqekeza ngokuphuma kwejusi le-pancreatic liye esiswini noma esifubeni sesibeletho).
Ngaphezu kwalokho, kanye nezinkinga zesifo, kuvela izimpawu ezijwayelekile zomtholampilo:
- ngokuqhekeka kwama-pseudocysts - ukwehla komsebenzi wezinhliziyo kuze kufike esimweni sokushaqeka;
- lapho ihlukana nokufakwa kwama-enzyme emgodini wesisu - ukucasuka okukhulu kwe-peritoneum ngobuhlungu obukhulu esiswini, ukugabha nokusabela kwezicubu zesisu (ukuvikelwa kwemisipha);
- nge-supplement - izimpawu ze-peritonitis (izinga lokushisa likhuphuka ngaphezu kuka-37.9 noma u-39 ° C, umkhuhlane, ukubanda, nezinye izimpawu zokudakwa);
- ukopha - ukwehla kwamapharamitha wezinhliziyo nemithambo yegazi, kanye nezimpawu zokuqongelelwa kwegazi emgodini wesisu noma esifubeni.
Ukusetshenziswa kwezindlela zaselebhu (ukunquma izinga le-creatinine, ama-electrolyte, ushukela, i-urea kanye ne-nitrogen yegazi) kwandisa amathuba okuxilongwa okunembile. Isibonelo, i-hypokalemia ne-hypocalcemia kubonisa ukomisa, kanti i-hematocrit ephansi ikhombisa ukopha.
Ngaphezu kwe-ultrasound, ukusetshenziswa kwe:
- I-CT (MRI) yama-pancreas;
- i-angiography yemikhumbi ye-pancreas (njengendlela yokuxilongwa okuhlukile ngokuphuka kwe-aneurysm ye-aorta yesisu - ukusetshenziswa kuphela esimweni esigulisayo sesiguli).
Isilonda i-cystic lesion
Ukwelashwa nokwelashwa
Amasu wokulawula icala ngalinye ngalinye kuncike ngosayizi wokwakheka kwe-pathological (futhi ngenxa yalokho ingozi yokuqhekeka kwayo), ubudala besiguli, amandla omzimba wakhe (okunqunywa ukuba khona noma ukungabi bikho kwezifo ezikhona, imikhuba emibi, isimo sengqondo kanye nezinye izinto).
Esikhathini esiyizinyanga ezicishe zibe ngu-1.5, kufundwa izici zesakhiwo kanye nokufakwa kwegazi kwe-gland (ukuze kudale ukungabikhona komkhumbi ngendlela yemvelo - ngokubuyisela ubuciko bendlela "ebiyelwe ngodonga").
Uma kungekho ukubuyiselwa okuzimele komsebenzi wokudonswa kwengxenye yesitho, i-pseudocyst cavity ikhishwa ngokusebenzisa enye yezindlela zokusebenza:
- i-endoscopic;
- ukusetshenziswa kokungenelela okugcwele (ngaphansi kokulawulwa kwe-CT noma i-ultrasound)
Kuya ngokuthi
"ibukeka kuphi" imfundo ye-pathological, tindlela ezisetshenziswayo:
- isasasa elikhulu le-cyst;
- ukudonswa kwamanzi ngokususwa kokuqukethwe ngaphandle (cishe ama-20% amacala);
- Ukudalwa kokudonswa kwamanzi ngaphakathi (inketho evamile yokuxazulula izingxabano).
Lapho usebenzisa indlela ye-marsupialization, okuqukethwe okufakwe emgodini ovulekile kuyakhutshwa, khona-ke imiphetho yakhona ifakwa kwisibeletho sobabili se-parietal (parietal) kanye nasesikhumbeni - ukukhipha kwenziwa ngaphandle ngaphandle kusetshenziswa abaphothula iziqu nangezisulu zokucwilisa.
Ukwehlukahlukana kokudonswa kwamanzi ngaphakathi kungukudalwa komyalezo-anastomosis (stoma) wethambo lomzimba elinokukhanya kwesitho esiseduze somgodi:
- isisu (cystogastrostomy);
- duodenum (cystoduodenostomy);
- jejunum (cystoejunostomy).
Ngosayizi abancane bama-pseudocysts angavumeli ukwenziwa kobuqili ngokukhohlisa nabo, bangena ekucasheni okucashile (ukuvela kabusha) kanye nengxenye yomdwebo oqukethe.
Ngesikhathi sokuhlinzwa, izinyathelo ezinjengokuthi:
- ukugcina isimo esanele sokugeleza kwegazi lesiguli ngokufakwa kwe-saline (uma kunesidingo, izingxenye zegazi);
- isifiso sokuhlanza nge-nasogastric tube kanye nokuphathwa kwezidakamizwa ze-antiemetic (Prochlorperazine);
- ukukhululeka kobuhlungu ngokusebenzisa i-meperidine;
- Ukwelashwa komoya-mpilo.
I-Hypokalemia imiswa ukuphathwa kwe-potasium chloride ngesixazululo, i-hypocalcemia - ngesisombululo seCalcium gluconate, ukusilela kwe-magnesium - ngokwethulwa kwekhambi le-Magnesium sulfate.
Izinkinga kanye ne-diagnostic
Ukuqalwa kwempilo kosindile kokuhlinzwa kuncike ekutheni ngabe isimo sakhe sokuphila kanye naye uqobo kuyo siyoshintsha yini.
Ukuphuza okuqhubekayo (ngisho nakuma- “doses amaholide”) kungadala ukuphindeka kwesimo. Ama-pseudocysts abuye abe yi-prognosis ebucayi ene-tumor genesis - nakhu ukwakheka kwamaselula kwesimila, izinga lokukhula kwalo nomsebenzi, isikhathi sokufuna usizo lodokotela, amakhono enkambiso yokusebenza nezinye izinto kubalulekile.
Kufanele iphinde ikhunjuzwe ukuthi kungenzeka ukuthi kube nezinkinga ngendlela
- imfundo yegebe - ngosayizi omkhulu singakhuluma ngokuqhuma kwendlala;
- ukopha ngenxa yokuguguleka komthambo;
- ukuthuthukiswa kwe-serous (noma purulent) peritonitis, ukumiswa kwe-pleura, i-pericarditis (ngenxa yokuvela kwe-fistulas noma ukuvela kokuphuma kokuqukethwe kwe-pseudocyst emgodini wesisu).
Ukuvela kwanoma yimuphi wabo kungayiphazamisa kakhulu impilo yesiguli, kubangele ukufa noma ukukhubazeka okukhulu.
