I-Prognosis ngemuva kokuhlinzwa kwe-pancreatic pancreatic necrosis

Abantu bathi: labo abanenhlanhla balayishwa kulokho, okusebenza ngokuphelele kumanyikwe. Lesi sakhi esibalulekile sethu sisebenza ngomthwalo ophindwe kabili, uhlobo lwemigodi eminingi eyenza imisebenzi emibili eyimfihlo ngokufana: ingaphakathi (i-endocrine) nengaphandle (i-exocrine).

Uyasebenza, uyasebenza, akuvamile ukuba azikhumbuze yena. Kuyiqiniso, konke lokhu okwamanje. Futhi konke akufunayo kithina, futhi akudingi, kepha kuyabuza, kuphela isimo sengqondo sokucophelela nenhlonipho kumuntu wakhe onesizotha.

Ngakho-ke, cha, sithandwa, thola - lapha unokudla okunezipayisi, okunamafutha, nokubhemayo. Akwanele? Thola "ku-appendage" isabelo esilinganayo sotshwala obuvame ukusetshenziswa. Futhi kuye okuthile okumpofu, ngaphandle kwalokhu, kunezinye izilonda ezanele.

Hhayi-ke, ubani ozosinda emva kwalokho? Futhi siyahamba, lina. Kuze kube yizifo ezibucayi kakhulu, okuyi-pancreatic necrosis.

I-pancreatic necrosis nezinhlobo zayo

Ekhuluma nge-pancreatic necrosis, kuyadingeka ukugcizelela ukuthi lesi sifo esibucayi sibangelwa ukulimala okujulile kwamaseli e-pancreas, i-necrosis yabo kanye nokulahleka okungaphatheki kahle. Kuholela ekunyamalaleni ngokuphelele kwemisebenzi yesitho esibalulekile.

I-Pathology iba ngokuvela kwezinto eziningi ezidale lokhu kugula. Ngeshwa, ukufa kwe-pancreatic necrosis kwenzeka ngamaphesenti angama-70 ezifo, ikakhulukazi ngokufakwa kwezimo ezingezinhle ezidlulise lesi sifo esigabeni esingenakuphikwa futhi esingalapheki.

Lapho behlukanisa futhi bechaza i-pancreatic necrosis, odokotela banaka izici ezahlukahlukene:

• izigaba zokukhula kwe-necrosis;
• izindawo ezithintekile;
• Izinkinga ezivelayo.

Ngokunikwa konke lokhu, izinhlobo zayo eziningi ziyaqokonyiswa:

• okugxile okuncane noma kwasendaweni, lapho enye yezingxenye zesitho yathinteka khona;
• ukugxila okuphakathi;
• okugxilwe kakhulu
• faka noma okuphelele, lapho kuthinteka zonke izakhiwo ze-pancreatic, kufaka phakathi izindunduma ezinkulu zemfihlo, imithambo yegazi nezicubu.

Ngaphezu kwalokho, uma unikezwe isimo nesikhathi sokuqhubeka kwenkambo yesifo, lesi sifo siyabonakala:

• ukuxhaphaza kakhulu okulimazayo;
• i-hemorrhagic pancreatic necrosis, lapho kunokufa okusheshayo nokungaphenduki kwamaseli we-gland;
• i-fat pancreatic necrosis;
• ezejwayelekile futhi ezigxile;
• ethuthukayo futhi ovilaphayo;
• heestatic, osebenzayo, purulent okubhubhisayo.

Ngokwesibonakaliso senqubo yokutheleleka, i-necrosis ihlukaniswe ngamaqembu amabili:

• onegciwane
• aseptic futhi oyinyumba.

Ithuba elihle kakhulu lokusinda linikezwa yi-edematous pancreatic necrosis. Kulesi sigaba, yonke i-pathology eguqukayo yenzeka ngenxa ye-edema ye-parenchyma (amaseli asebenzayo) kanye nengcindezi ekhuphukayo kuma-pancreatocytes.

Izimbangela zesifo

Ngokuphathelene nezimbangela zalesi sifo, kufanelekile futhi ukubuyela ekuqaleni kwendatshana, lapho sakhuluma khona ngesimo esibi samanyikwe, esihlala sikhombisa.

Yebo, yebo - kungukudla okulimazayo, "okufafazwe" ngesabelo esingapheli sotshwala, futhi futhi okubuye kwenziwe i-surrogate, kuyimbangela yangempela ye-pancreatic necrosis.

Kodwa-ke, akuyona yonke into elula kakhulu - hhayi kuphela abayimilutha yezidakwa nabaphuza utshwala abahola iqembu eliyingozi.

Ngeshwa, kufaka phakathi abantu abahloniphekayo abathi, ngenxa yezimo zempilo nentando yesiphetho, bathola lokhu kugula okubulalayo.

Izimbangela ze-pathology:

• isilonda se-duodenal kanye nesilonda esiswini;
• ukuhlukumezeka esiswini;
• izinkinga ngemuva kokuhlinzwa;
• isifo se-gallstone;
• ukuhlasela okuhlukahlukene okutheleleka futhi okuhambisana negciwane;
• i-pathology yokuzalwa kanye namaphutha esiswini.

Ividiyo mayelana ne-pancreatic necrosis evela kusazi:

Izimpawu eziphambili nezinkinga

Umkhuba wesikhathi eside wokutadisha nokulwa ne-pancreatic necrosis usivumela ukuthi siphethe ngokuthi ukuhlaselwa kwaso okulimazayo emzimbeni kwenzeka, njengomthetho, ngokushesha okukhulu.

Ngaphandle kwesizathu esibonakalayo, isiguli siqala ukuzizwa sisinda esiswini nasezinkingeni zokucanuzelelwa kwenhliziyo, okuguqula kube ukuhlanza okuqhubeka isikhathi eside, nokuwohloka.

Ngokuthuthuka okuqhubekayo kwalesi sifo, ubuhlungu obukhulu buvela ku-hypochondrium yangakwesobunxele. Ezinye izinkomba zingafani nokuhlaselwa yinhliziyo, noma kunjalo, udokotela uthola ukuthi lezo zimpawu zithunyelwa ngamanyikwe endaweni engemuva kwe-pancreatic necrosis.

I-Irradiation (ukusabalala kobuhlungu) ngaphansi kwe-scapula kanye nehlombe lakwesobunxele nakho kuwuphawu olujwayelekile lwalesi sifo.

Ezinye izinkomba eziphawula i-pancreatic necrosis:

1. Ukuhlanza isikhathi eside, ngaphandle kokuqala kokukhululeka okubonakalayo.
2. Umkhuhlane, ukubanda, umkhuhlane.
3. Ukuvela kombala wesikhumba esibuhlungu: ukukhumsha nokubomvu kwesikhumba.
4. I-Paresis noma ukukhubazeka kwamathumbu yisifo sezinzwa esivezwa ukungabikho kwemoto yamathumbu emathunjini (i-peristalsis), ngenxa yalokho okuthi ukumbiwa kwendle kungakhishwa emzimbeni.
5. Izinga lokushaya kwenhliziyo elisheshayo, ukushesha komoya.
6. Ngenxa yokuhlanza, ukopha umzimba, ukomisa ulwelwesi lwe-mucous emlonyeni.
7. Isisu siyavuvukala, izicubu engxenyeni yayo engenhla iyaqina.
8. Ukuchama kuyancipha noma kuyeke ngokuphelele.
9. Cishe inkaba, ezinqeni, kubukeka okukhulu okuvela emuva emuva, kuvela amabala we-cyanotic.
10. Kufika ubuthakathaka obujwayelekile, noma, njengoba abantu besho, - ukukhathala komzimba.
11. Ukubonakaliswa kwesimo sengqondo sengqondo sesiguli kuyabonakala: ukukhathazeka okungagudluki, ukukhathazeka, ukudideka kwemicabango, ukukhuluma, ukwazi, ukulahleka kokuma kwendawo-okwesikhashana, ukuthintela jikelele.
12. Njengomphumela wesilonda esijulile se-vascular, i-gastric kanye nokuphuma kwamathumbu kuyavuleka.

Izinguquko ezonakalisayo ezihambisana nomonakalo wamanyikwe zingadala izinkinga ezilandelayo:

1. Ukwakheka kwama-voids agcwaliswe ngamaphisi nokuxinana kwe-necrotic, okusongela ukusabalala kwe-abscess.
2. Ukuthuthukiswa kwama-pseudocysts kanye nama-cysts emzimbeni.
3. Ukuvela kwe-fibrosis, ngenxa yalokho amaseli okusebenza asebenza esikhundleni sawo athathelwa indawo izicubu ezilula ezithintekayo, kuyilapho umthwalo olahlekile wokusebenza ungabuyiswanga.
4. Ukuvinjelwa kokuqunjelwa kwe-pancreatic - ukuntuleka kwe-enzymatic.
5. Ukuvuvukala okukhulu kwe-purulent yi-phlegmon ye-retroperitoneal fiber.
6. Ukuvela kwe-thrombosis emikhunjini ye-mesenteric ne-portal vein.

Ukuthuthuka okuqhubekayo kwe-pancreatic necrosis akubangeli kuphela ukwanda ngosayizi wamanyikwe, kodwa futhi kuholela ekwakhekeni kokufakwa - izindikimba ze-atypical eziqukethe ama-lymph, igazi namaseli afile. Ngosuku lwesihlanu, umuntu ocwengekile utholwa ngokuthula yi-palpation.

Izindlela Zokuxilonga

I-Symbomatology ye-pancreatic necrosis ayikhulunywa, ikhombisa ngokusobala lesi sifo. Ezinye izibonakaliso zinokubonakaliswa okufanayo. Ngakho-ke, ukuthola ukuxilongwa okuyikho, izifundo ezihlukanisiwe zelebhu esetshenziswa amathuluzi ahlukahlukene ziyadingeka.

Lokhu kufaka phakathi:

1. IHemogram. Ukuhlaziywa kwemitholampilo okunquma okuqukethwe okwengeziwe kwama-leukocytes egazini, ukubukeka kobunzima be-neutrophils, ukukhuphuka kwezinga lokudalwa kwe-erythrocyte (ESR).
2. Ukuhlolwa kwegazi kwe-amylase yi-enzyme yejusi ye-pancreatic. I-pancreatic necrosis ikhulisa kakhulu okuqukethwe kwayo.
3. Ukuhlolwa kwegazi kweCalcitonin Ukuqonda okungcono, kufanelekile ukuchaza ukuthi i-calcitonin yi-hormone ebandakanyeka ekushintshisaneni kwe-calcium egazini. Okuqukethwe kwayo okwandisiwe kubonisa ukuqhubeka kwesifo.
4. Ukuhlolwa kwe-Ultrasound I-ultrasound evumela ukuthi wena ukwazi ukubona ngokungafani ukwakheka kwe-gland ne-edema yayo, nokubona ukwanda kwesikhala phakathi kwama-pancreas nama-pancreas wangemuva.
5. I-Magnetic resonance ne-compact tomography (MRI ne-CT). Amathuluzi amaningi anamuhla asuselwa ekusetshenzisweni kwama-x-ray, enza ukuthi ukwazi ukutadisha isitho emithanjeni enezici ezintathu. Lo mkhuba wezokwelapha ukuvumela ukuthi ukhombe izilonda ezithile, kufaka phakathi ezincane, kanye nemiphumela (ukunqwabelana koketshezi lwezinto eziphilayo) emgodini wesisu.
6. Ukubhoboza (ukubhoboza) kwezindlela zemvelo ze-necrotic, ngenhloso yokuqhubeka nokufunda (ukuhlwanyela).
7. I-Angiography. Enye yezindlela ezahlukaniswe, evumela ukusebenzisa ukuhlolwa kwe-X-ray ukutadisha isimo semikhumbi.
8. I-Laparoscopy Lokhu kungukuhlinzwa kwesimanje okuvumela udokotela ukuthi "abheke" ngaphakathi ngaphandle kokuhlola futhi ahlole izindawo ezithintekile zamanyikwe nokuthola izinhlobo ezithile ze-pancreatic necrosis.

Ukwelashwa okuphelele kwe-pathology

Ngaphandle kokungabaza, i-pancreatic necrosis iyisifo ngqo esingakubekezeleli ukubambezeleka, isiguli sidinga ukulashwa esibhedlela ngokushesha.

Imvamisa, odokotela abanamandla ngaphambi kwe-nectosis ephelele ye-pancreatic, ukuthuthukiswa kwayo kwenzeka emahoreni ambalwa. Inqubo ephelele ye-pathological ayilawulwa futhi ayilawulwa. Ithemba elinjalo lempilo kanye nemiphumela ebulalayo ilindele izidakwa ezingalapheki nemilutha yezidakamizwa.

Ngakho-ke, siyaphinda ukuthi ukulaliswa esibhedlela nokwelashwa kuphela esibhedlela okuqondiswa abasebenzi abanolwazi kungasindisa isiguli. Yilapho kuphela udokotela ekwazi khona ukukhetha isu namasu okwelapha isiguli esebenzisa izindlela zokubamba noma zokuhlinzwa.

Inqubo yokuvimbela nokwelapha i-pancreatogenic toxemia kanye nokuphazamiseka kwe-toxemic kuthatha isikhathi esiningi namandla kusuka kuzo zombili iziguli nodokotela oya khona.

Siqukethe izindlela nezindlela eziningi:

1. Ukwelashwa kwe-Antenzyme.
2. I-Detoxification (plasmapheresis kanye ne-diuresis ephoqelelwe). Lezi zindlela zokwelashwa zenziwa ngenhloso yokuqeda nokunciphisa ubuthi.
3. Ukwelashwa kwe-syndromic kokwethuka kobuhlungu ne-hypovolemia (ukwehla kokujikeleza kwevolumu yegazi).
4. Ukuqedwa kwe-DIC - lokhu kwephulwa kufaka ukonakala kokuqina kwegazi.
5. Ukwelashwa kokumiliswa kokuqedwa - ukuqedwa kokungalingani kwamanzi-elektrolte okubangelwa ukukhipha amanzi emzimbeni kanye nokulahleka kwegazi.
6. Ukuvimbela izinkinga ze-purulent-septic.
7. Ukulungiswa kwemithi yezinso, amaphaphu, isibindi, isimiso sezinzwa esiphakathi nokudakwa komzimba okujwayelekile.

Ukungenelela kokuhlinzwa kusenesikhathi kukuvumela ukuthi wenze indawo futhi uvimbele ukusakazeka kwezinkinga ze-purulent-septic nezine necrosis ephelele.

Izinhlobo zokuhlinzwa:

1. Ukulandelana kwezimpawu - ukususwa kuma-pancreas ezinxenye ezahlukahlukene zezicubu ezifile.
2. Ukudalwa kabusha kwe-gland - ukususwa kwesigaba sengxenye yesitho esithintekile.
3. I-Pancreatectomy ingukungenelela kokuhlinzwa okuqine kakhulu. Uyini, uyini umongo wawo, kungani uzwakala ethusa kangaka? I-Radicalism ilele eqinisweni lokuthi ngesikhathi sokuhlinzwa, ama-pancreas nengxenye ye-duodenum asuswe ngokuphelele (bheka isithombe).

Izibikezeli ngemuva kokwelashwa

Ngemuva kwenkambo yezindlela zokwelapha, isiguli siphila ngethemba lokululama, okuyindlela, engenye yezinto ezinqumayo zokuqala kwamandla amahle.

Kodwa-ke, ezifweni ezinzima, ukunikeza i-prognosis ngemuva kokuhlinzwa kungumsebenzi ongabongi, ikakhulukazi uma kuziwa kwi-pancreatic necrosis. Futhi kuleli cala, okuqondakala impela, odokotela baziphatha ngokucophelela okweqile ukuze bangagxilisi ithemba eliningi esigulini nasemndenini wakhe.

Ithemba lokululama liba likhulu lapho isiguli sinenye yalezi zinto ezilandelayo, futhi okubi kakhulu - lapho zifingqa:

1. Iminyaka yesiguli ingaphezu kweminyaka engamashumi amahlanu.
2. Okuqukethwe ama-leukocytes esegazini kungaphezu kwe-10 * 109 / l, okubandakanya i-leukocytosis.
3. I-Hyperglycemia - ushukela wegazi ophezulu.
4. I-Metabolic acidosis ukwephula ukulinganisela kwe-acid-base ngenxa yokukhishwa okwengeziwe kwe-hydrochloric acid.
5. I-Hypocalcemia Lesi yisimo lapho inani le-calcium ku-plasma yegazi lehla ngaphansi kwe-1.87 mmol / L.
6. I-Arterial hypotension - ukwehla komfutho wegazi ngama-20% okuhlobene nenani elijwayelekile lansuku zonke.
7. Amanani andayo we-urea, LDH ne-AST enzymes.
8. Ukomisa okuphambili.

Indaba yevidiyo evela esigulini esigulayo:

Izindaba zeziguli ezisindayo ezihlushwa i-pancreatic necrosis azizwakali njengezinkumbulo, kepha zifana nesikhumbuzi nokuhlanganiswa kulabo abangayithokozeli injabulo yansuku zonke, eqondiswa yisimiso esiyingozi - siphila kanye, kudingeka sizame konke futhi sonke sizoba lapho, sibhubhisa ngokungananazi impilo enikelwe uNkulunkulu .