Chikhansa ndi chimodzi mwazinthu zofunika kwambiri za m'mimba. Amayang'anira kuphatikiza kwa insulini ndikupanga ma enzyme ambiri okhudzana ndi metabolism. Milandu ikayamba kufinya, ndichizolowezi kumanena za matenda omwe amachitika ngati kapamba. Itha kukhala yopanda magawo kapena pachimake.
The pachimake gawo la kapamba limayamba chifukwa ma cell enanso ma enzymes, omwe nthawi zambiri amakhala osachita kanthu, amathandizidwa motsogozedwa ndi zinthu zosiyanasiyana. Izi zimayambitsa kugaya kwachitsulo. Potere, munthu amatha kuwona bwino kukula kwa ziwalo zamkati, cell necrosis ndikupanga malo owonongeka.
Zizindikiro zomwe odwala amafotokoza zimatengera zinthu zambiri - mawonekedwe a kapamba, nthawi yomwe amakula. Nthawi zambiri, matendawa amawonekera kupweteka kwambiri pamimba, yomwe imabweza. Zikatero, mseru wambiri komanso mobwerezabwereza ungachitike. Ngati matendawa amayamba chifukwa chomwa mowa kwambiri, kupweteka kumatha kuonekera patapita nthawi atatha kuledzera. Ndi cholecystopancreatitis, kupweteka kumatha kuwonekera mutatha kudya. Pancreatitis pachimake imatha kuchitika popanda kupweteka, koma pali kutchulidwa kwamomwe kumachitika.
Mkhalidwe wa wodwala wa kapamba amatha kufalikira chifukwa cha zovuta zake:
- Retroperitoneal phlegmon;
- Diffuse peritonitis;
- Cysts, pseudocysts a kapamba;
- Chotupa;
- Matenda a shuga;
- Thrombosis ya ziwiya zam'mimbamo;
- Kuwerengetsa cholecystitis.
Monga lamulo, chithandizo cha pancreatitis pachimake chimachitika movomerezeka hospitalization. Popeza matendawa ndi owopsa, simungakayike kukaonana ndi dokotala.
Chithandizo cha odwala omwe ali ndi pancreatitis yovuta kwambiri iyenera kusankhidwa ndi dokotala pozindikira za matenda ndi matenda a pathomorphological, gawo lachitukuko cha njirayi, kuopsa kwa mkhalidwe wa wodwalayo.
Pancreatitis imatha kuthandizidwa pang'onopang'ono komanso mokakamiza.
Ndi mankhwala osokoneza bongo, omwe nthawi zambiri amayamba njira zingapo zochizira, choyambirira, kukonza kwa mawonekedwe amagetsi-amadzimadzi kumachitika.
Izi zimaphatikizira kuthana ndi mayankho a isotonic ndikukonzekera kwa potaziyamu mankhwala enaake ochepetsedwa okhala ndi magazi a wodwalayo.
Kuphatikiza apo, zofunikira zochizira pancreatitis zimaphatikizapo:
- Tactical kukakamiza kwa katulutsidwe ka timadziti a ziwalo zina zam'mimba dongosolo;
- Anachepetsa ntchito ya enzyme;
- Kuthetsa kuthamanga kwa magazi munjira zapanja komanso pancreatic;
- Kupititsa patsogolo magazi m'thupi ndi kuthana ndimatenda;
- Kupewa ndi kuchiza kwa magwiridwe osakwanira am'mimba, komanso mavuto omwe amayamba chifukwa cha sepsis;
- Kusunga mulingo woyenera wa okosijeni m'thupi la wodwalayo pogwiritsa ntchito mtima ndi kupuma;
- Kuthandiza wodwala pomuchotsera ululu.
Ngati zotupa za hypermetabolism zikukula, amayamba kugwiritsa ntchito mtundu wina wa zakudya zomwe michere imayambitsa thupi la wodwalayo pogwiritsa ntchito jakisoni wambiri.
Mukabwezeretsa ntchito yam'mimba, kukhazikitsidwa kwa zakudya zamagulu ndizofunikira, momwe wodwalayo amalandirira chakudya kudzera pa kafukufuku wapadera.
Chithandizo cha opaleshoni yamapapo pancreatitis imagwiritsidwa ntchito pokhapokha pali zifukwa zapadera:
- Kugwiritsa ntchito njira zachipatala mosasamala sikunabweretse zotsatira zabwino;
- Kuzindikira kwa wodwala chifukwa chakuwonjezeka kwa zizindikiro za kuledzera kwa thupi
- Maonekedwe a zisonyezo zomwe zimawonetsa kukhalapo kwa kapamba;
- Kuphatikiza kwa kapamba ndi mawonekedwe owononga a pachimake cholecystitis.
Pafupifupi 15% ya odwala omwe ali ndi vuto lalikulu la pancreatitis adutsa gawo la puritive zovuta amafunikira opaleshoni. Ndondomeko amachitidwa pansi pa opaleshoni yambirimbiri ya mapapo, magawo a necrosis (minofu yakufa) amachotsedwa kapamba.
Kuchita opaleshoni yapachimbudzi kumachitika m'njira ziwiri:
- Laparotomy, pomwe adotolo amalowerera zokhudzana ndi kapamba chifukwa cha kukomoka pakhoma pamimba komanso m'chigawo chokhala ndi lumbar. Madokotala ambiri amavomereza kuti opaleshoni yotereyi yomwe imagwiritsidwa ntchito mu gawo la aseptic la pancreatitis yowonongeka iyenera kukhala yovomerezeka ndikugwiritsa ntchito pokhapokha zikuwonetsa, zomwe zingakhale:
- Kusungidwa ndi kuwonjezeka kwa zovuta zomwe zikupitabe patsogolo motsutsana ndi kutsika kwa chisamaliro chokwanira champhamvu chogwiritsidwa ntchito komanso kugwiritsa ntchito njira zowonjezera za opaleshoni;
- Kutalika kofalikira ndi kofalikira kwa danga lobwezeretsa;
- Kuperewera kwa kuthekera kwodalirika komanso kupatula kwathunthu kwa kachilombo ka necrotic kapena matenda ena othandizira opaleshoni yodzidzimutsa.
Madokotala ambiri amavomereza kuti kuchitidwa opaleshoni yotseguka, yomwe imatengedwa mwachangu kwa enzymatic peritonitis mu gawo loyambirira la matenda chifukwa chazidziwitso zolakwika ndi matenda ena a ziwalo zoyipa, popanda chisamaliro cholimbikira sichinthu chosagwirizana komanso cholakwika.
- Njira zowononga zachilengedwe (laparoscopy ya kapamba, kulowerera), zomwe zimachitika kudzera m'makoma a m'mimba khoma la wodwala. Njirayi imathetsa osati zovuta zamankhwala zokha, komanso mavuto azidziwitso, chifukwa chake ndizotheka kupeza zothandizira kuphunzira, bacteriological, cytological and biochemical maphunziro, zomwe zimapangitsa kuti zithe kusiyanitsa bwino kwambiri aseptic kapena kachilombo ka pancreatic necrosis.
Zizindikiro za kupuma-pang'onopang'ono pokoka mozungulira pansi pa kuwongolera kwa pancreatic necrosis ndikuwoneka kwamadzimadzi pamimba ndi kubwezeretsa malo.
Kutsutsana kwa kulowererapo-kukhetsa kulumikizidwa kumadziwika kuti kulibe gawo lamadzi, kupezeka kwa m'mimba thirakiti, kwamikodzo dongosolo, mawonekedwe a mtima panjira yopumira, ndikuwonetsa kusokonezeka kwa dongosolo la magazi.
Moyang'aniridwa ndi ultrasound, kubowoleza singano imodzi kumachitika ndikuchotsa kwina (ndi wosabala volumetric fluid form) kapena ngalande zawo (form voletetric fluid fluid). Izi zikuyenera kutsimikizira kutuluka kwa zomwe zili mkati, kukhazikika kokwanira kwa catheter mu lumen ya patsekeke ndi pakhungu.
Nthawi zina, madzi akumwa samapereka zomwe mukufuna. Mutha kuyankhula izi pamaso pa zovuta zazotupa, kulephera kwa ziwalo zingapo, mitundu yonse ya zinthu zomwe zikufuna kuwonongedwa.
Ngati zotsatira za kafukufuku zakhazikitsa kuti gawo la necrotic la zotupa limapambaniratu pazinthu zake zamadzimadzi ndipo mkhalidwe wa wodwalayo sukusintha, kugwiritsa ntchito njira zoterezi sikokwanira.
- Distal pancreatectomy. Imachitika nthawi yomwe chiwalo chiwonongeka pang'ono. Pankhaniyi, kuchotsedwa kwa mchira ndi thupi la kapamba osiyanasiyana.
- Resetotal resection imakhala yovomerezeka pokhapokha gland ikakhudzidwa kwathunthu. Amakhala ndikuchotsa mchira, thupi komanso mutu waukulu wa kapamba. Nthawi yomweyo, zigawo zake zochepa zomwe zimayandikana ndi duodenum zimasungidwa. Kubwezeretsa kwathunthu kwa ziwalo zogwira ntchito pambuyo pa opaleshoni sikuchitika. Izi zitha kuchitika pokhapokha pancreas.
- Necrosecvestrectomy imagwiritsidwa ntchito moyang'aniridwa ndi ultrasound ndi fluoroscopy. Amadziwika mapangidwe amadzi am'madzi pancreatic pogwiritsa ntchito machubu amadzaza amachotsedwa. Kenako, zikuluzikulu zowonjezera zamkati zimalowetsedwa pamkati ndipo kutsuka kumachitika. Pa gawo lomaliza la mankhwalawa, ma dragine akuluakulu amadzalidwa ndi ena ochepa, omwe amathandizira pang'onopang'ono machiritso am'mimba ndi bala la postoperative ndikusunga kutulutsa kwamadzi kuchokera pamenepo.
Mfundo yofunika kwambiri yomwe imayang'ana kukonzekera ntchitoyi ndi njala. Nthawi yomweyo, chiopsezo cha zovuta chimachepetsedwa kwambiri, chifukwa zomwe zili m'matumbo zimatha kupweteka m'mimba.
Patsiku la opareshoni, wodwalayo amaletsedwa kudya. Chofunikira kwambiri ndi mtundu wa kuyeretsa. Kuphatikiza apo, kudziwitsira kukonzekera kumachitika kwa wodwala, komwe kumayambitsidwa ndi mankhwala omwe amathandizira kulowa kwa wodwalayo mosavuta, kupondera mantha opaleshoni, kuchepetsa kubisalira kwa tiziwalo timene timatulutsa.
Mavuto owopsa kwambiri atatha kugwira ntchito ndi:
- Kulephera kwamitundu yambiri;
- Pancreatogenic mantha;
- Kugwedezeka.
Pambuyo pake, odwala omwe adachitidwa opaleshoni ya pancreatic amatha kukhala ndi mitundu yonse yamatenda a pseudocysts, fistulas, shuga mellitus ndi exocrine pancreatic insuffidence.
Nthawi yoyamba, yomwe nthawi zambiri imakhala masiku awiri, wodwalayo satenga chakudya chilichonse ndipo ali pachakudya chokwanira. Patsiku la 3, pang'onopang'ono, pamiyeso yaying'ono, tiyi, supu zosaphika zophika popanda nyama, zotsekemera zomanga mapuloteni, zotsekemera, tchizi cha kanyumba zimayambitsidwa muzakudya. Madokotala amalimbikitsa kutsatira zakudya zotere kwa pafupifupi sabata limodzi. Pang'onopang'ono, zinthu zonse zomwe zimaloledwa kwa odwala omwe ali ndi matenda am'mimba zimayambitsidwa muzakudya. Kuthekera kochita masewera olimbitsa thupi kumatsimikiziridwa ndi kuchuluka kwa opareshoni ndi machitidwe a thupi.
Ndikofunikira kudziwa kuti opaleshoni ya pancreatitis yovuta nthawi zonse sikutha kuyika pambali chiopsezo cha zovuta zamkati. Nthawi zina, kuchitapo opaleshoni mobwerezabwereza kumafunika, komwe kumatha kukhala ndi zotsatirapo zoipa ndikuwopseza moyo wa wodwalayo.
Momwe opaleshoni yamapamba amachitikira ikuwonetsedwa mu kanema munkhaniyi.
