Pancreatic fistulas amaimira uthenga wa pathological wa limba ductal system ndi malo akunja kapena ziwalo zamkati mwathupi.
Pali magulu awiri akuluakulu a ma pathologies awa - kunja ndi mkati fistulas.
Kunja - pakamwa pa zotupa pamatseguka pakhungu, ndipo mkati mumakhala ndi uthenga wopindika. Ziwalo zoterezi zimakhala m'mimba, yaying'ono kapena yayikulu matumbo. Kuphatikiza apo, ma fistulas amagawidwa kwathunthu komanso osakwanira.
Polepheretsa gawo loyandikira la duct, fistula yathunthu imapangidwa, yomwe imatsogolera kutulutsidwa kwa madzi onse a pancreatic kunja. Ndi uthenga wosakwanira wa pathological, kutuluka kwa gawo lalikulu la pancreatic secretion kumayang'aniridwa mwachilengedwe mu lumen ya duodenum, ndipo gawo laling'ono limalekanitsidwa ndi uthenga wa pathological.
Nthawi zambiri, pancreatic fistula ndi khungu lakunja kapena kapamba.
Njira yamkati yolankhulirana ndi patali yam'mimba ya duodenum kapena colon ndiyosowa kwenikweni.
Kulipiritsa kwa kutayika kwa madzi a pancreatic ndi zotulukapo zoterezi zimachitika ndikuthandizira zakudya za makolo masiku 7 ndi nthawi yomweyo ya Piyolfep komanso Mlingo wocheperako wa atropine. Kugwiritsa ntchito kwa Trazilol kumatha kupereka zotsatira zabwino mukamapereka mankhwala a matenda a mankhwalawa. Njira yothandiza ndikugwiritsa ntchito ma radiation pancreatic nthawi 4-8 mu gawo lonse la 300-400 R.
Kuchiza matendawa pogwiritsa ntchito chithandizo cha opaleshoni kumachitika ngati kupitirira kwa matendawa kumapha wodwalayo.
Gulu la uthenga wazam'tsogolo
M'mawu otomical, pancreatic fistula ndi njira yokhala ndi mainchesi osiyana.
Makoma a njira amapangidwa ndi minyewa ya fibrous. Pansi pa ngalande imalumikizana ndi zigawo zazikulu za kapamba. Kutalika konse kwa fistula, kukulitsa ndi kufalikira kwa lumen kumapangidwa.
Minofu ya kapamba yomwe ili pakamwa pa fistula imasinthidwa. Ndisintha zotere zomwe zimatsogolera pakupanga uthenga wazamatsenga.
Nthawi zambiri, monga kusintha kwamatenda amisempha kumakhala:
- necrosis;
- kutupa
- mapangidwe a cyst;
- mapangidwe chotupa.
Mankhwala, gulu la ma fistulas lakonzedwa ndi kuchuluka kwa zizindikiro.
Zigawo za guluzi ndi izi:
- Etiology.
- Maphunziro azachipatala.
- Kupezeka kwa kulumikizana ndi duct system
- Dera lokapeza uthenga
- Chiwerengero cha mauthenga achabechabe.
- Mlingo wa kuphatikiza ma vesi abwino.
- Kukhalapo kwa matenda.
- Kulumikizana ndi ziwalo zina zamkati.
Kutengera ndi etiology, mitundu yotsatirayi ya pathologies imasiyanitsidwa:
- pambuyo-necrotic;
- zoopsa;
- mtundu wa fistula wopangidwa pambuyo pa kukoka kwa cyst.
Malinga ndi maphunziro azachipatala, mitundu iwiri ya zovuta imasiyanitsidwa - kupitirira komanso kubwereza.
Kutengera kwa kukhalapo kwa kulumikizana ndi ductal system ya gland, njira zotsatirazi ndizosiyanitsidwa:
- Uthengawu umalumikizana ndi pancreatic duct. Pankhaniyi, njira ziwiri ndizotheka - mwayi wamkati ukadzaza ndi njira yachiwiri, pomwe patency yake siyikhala yolakwika.
- Fistula imalumikizana ndi mawonekedwe owonjezera. Momwemonso, kutengera momwe thunthu la ductyo silili bwino kapena ayi, mitundu iwiri yamatumbo ikhoza kukhazikika.
- Mauthenga a Pato samalumikizana ndimatenda a gland. Ma pathologies oterewa amaphatikiza ma parapancreatic, omwe amathera ndikupanga puritive patsekeke ndi ma fistulas omwe alibe patsekeke kumapeto.
Kutengera ndi kutengera kwa vutoli, fistula yakunja yapadera imasiyanitsidwa, yamkati komanso yosakanikirana.
Malipoti a njira akhoza kukhala amodzi-amsewu komanso njira zingapo.
Mwa kuchuluka kwa nthambi, mafistulas onse amatha kugawidwa popanda kufalikira ndi nthambi.
Mwa kukhalapo kwa matenda opatsirana, omwe ali ndi kachilomboka komanso osapatsirana amakhala okha.
Popanda kulumikizana ndi fistulas ndi ziwalo zina, amadziwika kuti ali okha. Kuphatikiza apo, pali mitundu yosiyanasiyana komanso yophatikiza.
Zizindikiro zakukula kwa matenda amisempha
Chikhalidwe cha mawonetsedwe azachipatala pakupanga mapangidwe a fanculic makamaka zimadalira pamitundu yawo, etiology, nthawi yomwe chitukuko cha matenda, magwiridwe ake ndi kuchuluka kwa chitukuko cha zovuta.
Kapangidwe ka uthengawo kumayendera limodzi ndi kupezeka kwa zowawa m'dera la epigastric komanso hypochondrium yamanzere.
Nthawi zambiri ululu umakhala ngati lamba.
Kuphatikiza apo, kukula kwa matendawa kumayendera limodzi ndi zovuta zotsatirazi:
- mavuto a dyspeptic;
- kuchuluka kwa kutentha kwa thupi;
- kusintha kwa kapangidwe ka magazi;
- maonekedwe a kulowa mkati mwa kapamba.
Mawonekedwe a zisonyezo ndi zizindikiritso zimachitika chifukwa cholowera chinsisi cha chinyezi ndikutulutsa malo a parapancreatic, kudziwonetsa kwamitsempha ya chithokomiro ndi ziwalo zozungulira komanso ziwalo zake komanso nthenda yake.
Kuphatikizika koonekeratu pakugwira ntchito kwa fistula ndikukula kwa zovuta kumawonetsedwa ndi mawonekedwe azikhalidwe pokhapokha mtundu wakunja wa mauthenga apancreatic apangidwe.
Nkhani zoterezi zimapangitsa kuti zikhale zowawa pambuyo poti kukokoloka kwakunja kwa cyst kupangike kumadutsa pancreatitis.
Kwa nthawi ya ntchito ya pancreatic fistula, mawonekedwe a kutseguka kwakunja ndi khalidwe, momwe kudzera mwa chinsinsi cha madzi a pancreatic amapezeka. Khungu lomwe limapangidwa ndi bowo limapangidwa ndikusintha. Kuchuluka kwa zomwe zimatulutsidwa zimatengera mtundu wophwanya malamulo ndipo zimatha kukhala 0,5 mpaka 1.5 malita. Tsiku lililonse. Kuwonjezeka kwa katulutsidwe kumachitika panthawi yakudya, makamaka ngati zinthuzo zili ndi mafuta. Pankhani ya kukhalapo kwa putrefactive ndi purulent mu gland, mafinya ndi magazi zimaphatikizidwa ndi chinsinsi chomwe chimasungidwa. Popanda zovuta, mawonekedwe akewa alibe mawonekedwe ndipo amadziwika ndi zambiri za amylase ndi trypsin.
Kukula kwa zovuta kumachitika chifukwa chakuchepa kwa nthawi yayitali pancreatic madzi ndikuletsa ntchito ya exocrine organ. Kuletsa kumachitika chifukwa cha atrophy ndi fibrosis ya tiziwalo tamatumbo.
Odwala omwe ali ndi kuphwanya kotere, kufooka kumawonedwa, ndipo autolysis imayendera limodzi ndi kupezeka kwa magazi.
Kuzindikira mapangidwe a fistula
Kuthekera kwakukulu kwa kukhalapo kwa mtundu wakunja wa chidziwitso cha patho kumawonetsedwa ndi data pachilonda cha pancreatic kapena kulowererapo kwa opaleshoni yam'mimba.
Kutsimikizira kwa matendawa kumachitika mwa kuchititsa maphunziro a biochemical a secretion obisika kudzera mu fistula.
Kuphatikiza apo, njira zowonjezera zothandizira kupenda thupi la wodwalayo zimagwiritsidwa ntchito.
Kuti achite kafukufuku, munthu amapatsidwa chithandizo chamankhwala kuchipatala.
Kuti mumvetse bwino za matendawa, njira zotsatirazi zikuyesa kugwiritsa ntchito:
- fistulography;
- retrograde pancreaticocholangiography;
- ultrasonography;
- Pancreatic MRI;
- zopangidwa tomography.
Kuzindikira kwa fistulas yamkati kumachitika ndikuwunika ngati pali zovuta zina. Izi ndichifukwa choti mapangidwe a ma pathologies oterewa samayendera limodzi ndi zovuta zamatenda komanso morphological.
Kuti mudziwe njira yothandizira mankhwalawa, amafunika kuyambitsa matenda osiyanasiyana apadera.
Kapangidwe ka kapamba ka kunja kamene kamasiyanitsa ndi ma fistulas omwe amachokera ku maziko a kuvunda kwa zotupa, impso, adrenal gland, retroperitoneal sarcoma, duodenal ndi gistric fistulas.
Chithandizo cha pancreatic matenda
Malinga ndi madotolo, ambiri mwa ma pathologies opangidwa amatsekedwa pamaso pa patency yabwino ya Wirsung duct ndi mankhwala.
Pakukonzekera chithandizo, mankhwala osiyanasiyana amagwiritsidwa ntchito.
Mankhwala osokoneza bongo amatsata kukwaniritsa zolinga zingapo zochizira.
Chithandizo cha mankhwalawa ndicholinga:
- Kuletsa kwa exocrine wa gland minofu.
- Kuchita pancreatic secretion enzymes (njirayi ikufanana ndi yomwe imagwiritsidwa ntchito pochiza pancreatitis pachimake).
- Kuchotsera kwa njira ya pathological.
- Konzani kuwonongeka pakhungu poyambira mbali yolimba.
- Kuwongolera kusokonezeka kwa kagayidwe kazakudya zamapuloteni, chakudya, mafuta, madzi ndi metabolism yamchere.
- Chithandizo cha matenda ophatikizika.
Kuchotsa maphunzirowa kumachitika pang'onopang'ono kapena kutsuka mosalekeza pogwiritsa ntchito mayankho okhudzana ndi antiseptic njira ndikuyambitsa antibacterial.
Kuteteza khungu ku michere ya pancreatic, mafuta apadera, mafuta apamwamba a pastes ndi ma polymer amayikidwa pamwamba pake.
Njira zochizira opaleshoni zimagwiritsidwa ntchito pokhapokha pakutha kwa mankhwalawa kwa miyezi itatu ndikuphwanya kutulutsa kwachinsinsi komanso kulumikizana kwa maphunzirowa ndi zotupa zosakoka bwino zomwe zimapezeka mu minofu ya retoperitoneal
Pa chithandizo cha opaleshoni, njira zotsatirazi zamankhwala zimagwiritsidwa ntchito:
- kufufuma kwa fistula ndi resection wa gland, kugwira ntchito kotereku ndi njira yochizira;
- kuyamwa kwa fistula ndi resection ndi mapangidwe a pancreatojejunoanastomosis, mtundu uwu wa opaleshoni othandizira amachitika pamaso pa vuto la patency ya Wirsung;
- Kapangidwe ka anastomosis koyipa kochitika ndi m'mimba kapena matumbo;
- kudzazidwa kwa maphunzirowa ndi kapamba wa pancreatic ndi zida zapadera za polima.
Kukula kwa matendawa kumakhala kwabwino kwambiri pochita chithandizo chanthawi yake komanso chokwanira.
Zambiri pazizindikiro za matenda a kapamba zimaperekedwa mu kanema munkhaniyi.
