Kodi necrosis ya pancreatic ndi neancosis ya pancreatic ndi chiyani?

Pancreatic necrosis ndi chotsatira chovuta cha pancreatitis yapanja. Amadziwika ndi necrosis yamasamba kapena thupi lonse la kapamba. Zowonetsera zamatenda ndizamphamvu ululu wam'mimba, palpitations, kusanza ndi encephalopathy.

Kuzindikira kwa pancreatic necrosis kumaphatikizapo njira zasayansi ndi zothandizira. Chithandizo cha matenda a matenda a mtima zimakhazikitsidwa ndi kuponderezedwa kwa michere ya proteinolytic, kuthetseratu kupweteka, kupatsanso mankhwala, kubwezeretsa kutulutsa kwa pancreatic madzi ndi kulowererapo kwa opaleshoni.

Mwayi wopulumuka matenda owonongeka ndi ochepa: chithandizo chanthawi yake chimapulumutsa 30-60% yokha ya odwala kuchokera pangozi. Poganizira ziwerengero zowopsa, ndizosatheka kuyembekezera kuchira kwa matenda apamwamba a pancreatic necrosis.

Pancreatic necrosis ndi mitundu yake

Matendawa mwanjira ina sikuti ali complication ya pachimake kapamba, koma gawo lake.

Mu kapamba, ma enzyme omwe kapamba amatulutsa sakafika pa duodenum 12. Zotsatira zake, madzi a pancreatic amayamba kuwongolera limba, lomwe limatchedwa "kudzimbidwa." Njira yotupa imachitika, yomwe pamapeto pake imabweretsa kusintha kowononga. Ndipo pali kupanga kwa ziwalo zingapo zolephera, zomwe zimachitika pancreatic necrosis.

Masiku ano, kuchuluka kwa kapamba am'mimba kwambiri olembetsedwa m'zipatala za opaleshoni kukukulira ku Russia. Amapereka njira zokhazo zomwe zimapangitsa kuti pachimake pakhale pachimake. Chiwerengero cha odwala omwe ali ndi vuto la pancreatic necrosis chinakwera ndi 25%. Popeza kufa chifukwa cha kusinthika kwakusakaza kwa kapamba kumachokera 30% mpaka 80%, njira yotsogolera yochepetsera ndiyo kuzindikira kwa opareshoni, kuchipatala komanso chithandizo chamankhwala chothandiza.

Popeza kuwonongeka kwa magawo ena a kapamba kumachitika, ngakhale mutu, thupi kapena mchira, gulu la matenda ndi lofunikira.

Zomwe zimayambitsa matendawa

Etiology ya pancreatic necrosis imalumikizidwa makamaka ndi kuperewera kwa zakudya komanso kumwa mowa kwambiri.

Ziwerengero zokhumudwitsa zimawonetsa kuti 70% ya odwala omwe ali ndi matendawa nthawi ndi nthawi kapena amamwa mowa nthawi zonse. Choyambitsa chachiwiri cha pancreatic necrosis ndikuyambitsa matenda a ndulu.

Ndikofunikira kudziwa kuti zamatsenga zimakula akadali aang'ono. Pancreatic necrosis ya kapamba imachitika chifukwa:

1. Zilonda zam'mimba ndi zilonda 12 zam'mimba.
2. Chakudya chopanda malire, kuchuluka kwa mafuta ndi nyama yokazinga m'zakudya.
3. Mowa.
4. Opaleshoni yoyambirira.
5. Kuvulala kwam'mimba.
6. Ma virus ndi matenda opatsirana.
7. Matenda a Gallstone.

Pancreatic necrosis imatha kuchitika mwa aliyense, koma pamwayi mulinso:

• oledzera osatha ndi osokoneza bongo;
• anthu omwe akuvutika ndi vuto la chiwindi ndi kapamba;
• odwala obadwa nawo malformations ndi m`mimba thirakiti;
• anthu odwala matenda amisala.

Kusintha kwa Necrotic kumakhalanso koopsa kwa ziwalo zina zamkati, zomwe zimatsimikiziridwa ndi maphunziro a pathological. Zotsatira zake, kugaya chakudya, impso ndi thupi lonse likuvutika.

Izi zitha kuchitika chifukwa cha kupita patsogolo kwa matekinoloje:

1. Purulent pancreatitis ndi amodzi mwa mitundu yoopsa kwambiri yomwe phlegmous kutupa kwa chiwalo ndikupanga ma micro-, macroabscesses.
2. Acute alcohol pancreatitis ndimatenda omwe amapezeka mwina chifukwa cha uchidakwa, kapena chakumwa chimodzi chamowa chokhala ndi zakudya zamafuta.
3. Biliary pancreatitis ndi njira yotupa yotupa yomwe imapangidwa pancreas yomwe imachitika chifukwa cha kuwonongeka kwa matumbo ndi chiwindi.
4. Hemorrhagic pancreatitis ndi mtundu waukulu wa matendawa, momwe mumakhala chiwonongeko champhamvu cha parenchyma ndi mitsempha yothandizira, yomwe imathandizira kukulitsa gangore, hemorrhage ndi peritonitis.

Ngati wodwalayo afuna chithandizo chamankhwala mochedwa kwambiri, ndiye kuti mapangidwe a necrosis amatanthauza kukhazikika kwa chotupa, pambuyo pake akatswiri samapereka chidziwitso chothandiza pakupulumuka.

Zizindikiro zazikulu ndi zovuta zake

Mawonekedwe a pathology malinga ndi ICD-10 agawika m'magawo atatu. Kupanga kwa pancreatic necrosis kumalumikizidwa ndi kusokonezeka kwa chitetezo chakudziko.

Gawo loyamba la matenda amtundu limadziwika ndi kuchulukitsa kwachangu kwa mabakiteriya ndi kutsegula kwa kapangidwe ka madzi a pancreatic. Wodwalayo amadandaula za kutentha thupi, kusanza komanso kusanza m'mimba.

Gawo lachiwiri limadziwika ndi mapangidwe a ma caverns mu organ parenchyma chifukwa cha enzymatic ndi purulent fusion.

Gawo lachitatu limatitsogolera kuimfa, pomwe kutupa kumafalikira kumankhwala ena. Izi zimapangitsa kulephera kwamankhwala angapo, kenako kufa kumachitika.

Chizindikiro choyamba cha matendawa ndi kupweteka kwadzidzidzi kwadzidzidzi kwakumaso kwakumaso pakati pamimba ndikutsikira kumbuyo. Pali ubale wosiyana pakati pa zowawa ndi kuopsa kwa matendawa. Kusintha kowopsa kwa chiwalo kumakhudzanso mathero a mitsempha, kotero, kuzolowera ndi kuchepa kwa ululu wamankhwala kumachitika.

Popita nthawi, zizindikiro zotsatirazi zimawonjezeredwa kuzinthu zopweteka za epigastrium:

• kusanza kwina, pambuyo pake kulibe mpumulo. M'masanzi mumakhala kusakanikirana kwa magazi ndi bile;
• kuchepa kwa madzi m'thupi, chifukwa cha zomwe zimapanga mucous ndi khungu zimayamba kuuma;
• dyspeptic matenda, kuphatikizapo kuchuluka kwa kupangidwa kwa mpweya, kufooka kwa peristalsis, kudzimbidwa;
• hyperthermia, ngati kuledzera ndi kuchepa kwa thupi kumapitirirabe;
• tsabola, phokoso kapena kutulutsa khunyu pakhungu;
• kuthamanga kwa magazi, kuthamanga kwa mtima komanso kupumira mosaya;
• chisokonezo, kulephera kuyenda pamtunda, kusakwiya komanso kukulitsa mtima chifukwa chokhala ndi encephalopathy.

Progressive pancreatic necrosis imapangitsa kukulira kwa kukula kwake komanso mapangidwe omwe amalowa mu peritoneum. Patsiku lachisanu atachokeratu ku matenda, kulowetsedwa kumatha kutetezedwa ndikuwoneka.

Zosintha zowonongeka zitha kuwonekera motere:

1. Mapangidwe a patsekeke ndi necrotic misa ndi mafinya (abscess).
2. Mapangidwe a cysts ndi pseudocysts mu chiwalo.
3. Kugawa minofu yolumikizana wathanzi (fibrosis).
4. Kuperewera kwa Enzymatic.
5. Phlegmon retroperitoneal fiber.
6. Thrombosis ya mesenteric ndi portal mtsempha.

Kupanikizika kumatha kuchitika ndikupangika kwa zilonda m'mimba.

Njira zodziwika zodziwikitsa

Ngati wodwala akuganiziridwa kuti ali ndi pancreatic necrosis, amawunikira nthawi yomweyo ndi akatswiri angapo - dokotala wa opaleshoni, gastroenterologist ndi resuscitator. Wodwala amagonekedwa m'chipatala nthawi yomweyo kuti apewe zotsatira za kupitirira kwa matenda.

Mukamayang'ana wodwalayo, dokotalayo amatha kuwona kutuluka, khungu la pakhungu ndi malo owala pang'ono ndi kumbuyo.

Mothandizidwa ndi mayeso othandizira odwala. Kuyesedwa kwa magazi ndi mkodzo ndikofunikira kuti mupeze michere ya chiwalo. Chizindikiro choyipa ndi mulingo wambiri wa amylase, trypsin, elastase, glucose, maselo oyera amwazi, hematocrit, ESR, mapuloteni a C-reactive, ALT, AST,

Pofuna kuwononga ziphuphu, madokotala amatiuza njira zothandiza:

• radiograph of the peritoneal membala;
• ultrasonography ya kapamba ndi m'mimba thirakiti;
• MRI ndi CT;
• kubwezeretsa cholangiopancreatography;
• laparoscopy

Zisonyezo zakusiyanitsa kosiyanasiyana ndikutupa kwakumapeto, chikhodzodzo, matumbo, kutsekeka kwa mbolo, colic biliary, infaration ya myocardial, kapena kupindika kwam'mimba kwa aneurysm.

Kwambiri mankhwala a matenda

Mwayi wopulumuka ndi pancreatic necrosis zimatengera momwe masitepe amachitidwira mwachangu kuti muchiritse matendawa. Chithandizo cha mankhwalawa chimakhala ndi njira yothandizira komanso yochitira opaleshoni, kuonetsetsa kuti kuchotsedwa kwa "kudzimbidwa" kwa thupilo ndikupewa zotsatira za purulent-septic.

Protocol yothandizira pakukhwima imaphatikizapo zinthu izi:

1. Kuletsedwa kwa zolimbitsa thupi, kugona pakama m'malo opumira.
2. Zakudya za kholo kwa masiku 5-7 ndi michere, zamchere mchere madzi.
3. Kuchotsa kupweteka komwe kumatha kupezeka ndikutenga antispasmodics (Spazoverin, No-Shpa), noncocial analgesics (Paracetamol, Analgin) ndi ma donels omwe amaphatikizidwa ndi shuga ndi Novocaine. Amaloledwa kuyendetsa zosakanikirana za narcotic, kuwonjezera pa morphine (Diphenhydramine + Novocaine).
4. Ntchito yachepetsedwa ya michere ya pancreatic, duodenal, ndi m'mimba. Monga lamulo, odwala sangathe kuchita popanda kukhazikitsa iv antiferment agents (Aprocal, Gordoks, Krivriven).
5. Kugwiritsa ntchito maantibail kupondaponda microflora yoyipa komanso pofuna kupewa (Cefipim, Ciprofloxacin).
6. Mankhwala a kulowetsedwa kuti athetse poizoni m'magazi (yankho la ringer, yankho la thupi, glucose + insulin).
7. Kutulutsa ndi hemosorption, hemofiltration, achire plasapheresis, peritoneal dialysis.
8. Kukhazikitsidwa kwa iv somatostatin - timadzi timadzi tomwe timatulutsa timadzi tating'onoting'ono ta madzi am'mimba komanso chinsinsi cha kapamba.

Nthawi zambiri, opaleshoni imasonyezedwa pancreatic pancreatic necrosis. Mankhwala othandizira opaleshoni amachedwa kwa masiku 4-5 mpaka mkhalidwe wa wodwalayo ukhale bwino, koma ndi zonse kapena zowonjezera pancreatic necrosis, zimachitika nthawi yomweyo. Zolinga za opaleshoni zingaphatikizeponso:

• Kuchotsa kwa akufa mbali ya parenchyma ndi hemorrhagic exudate;
• kuyambiranso kwa kutulutsa kwa pancreatic madzi;
• kuyimitsidwa kwamkati m'mimba;
• kukhetsa kwa m'mimba ndipo kuchokera m'malo ake;
• pang'ono kapena pang'ono pancreatectomy kuchotsa ziwalo.

Nthawi zambiri ndikofunikira kuchotsa ziwalo zomwe zimakhala pafupi ndi kapamba, mwachitsanzo, ndulu (ndi cholecystitis yowonongeka) kapena ndulu.

Zoneneratu pambuyo pa zamankhwala

Momwe matendawa atachitidwa opaleshoni amakhalabe odandaula. Zimatengera zinthu zosiyanasiyana - kutalikirana kwakanthawi, wodwalayo, mtundu wa matenda, kuchuluka kwa ma opaleshoni, kukhalapo kwa matenda olumikizana, ndi zina zambiri.

Mmodzi mwa akulu anayi omwe adadwala matenda a pancreatic necrosis ali ndi matenda amtundu 1 shuga. Kubwereranso kumawonetsedwa, ma pseudocysts ndi mawonekedwe a pancreatic fistulas.

Tsoka ilo, mwayi wochizira matendawa ndikutsalira ndiyochepa. Imfa mu aseptic necrosis imayambira pa 15 mpaka 40%, ndipo ikagwidwa, imakhala 60%.

Ngakhale atachiritsa bwino, munthu amakhalabe olumala kwa moyo wonse. Pankhaniyi, muyenera kutsatira zakudya zosasunthika (tebulo nambala 5 malinga ndi Pevzner).

Pofuna kupewa zoterezi, muyenera kusamalira thanzi lanu. Kuti muchite izi, kupewa pancreatic necrosis ndikofunikira:

• Zakudya zoyenera, kuthetsa kudya zamafuta ndi nyama yokazinga. Chepetsani kugwiritsa ntchito zinthu zamchere, zosuta komanso zosakaniza.
• Kukana kwathunthu zizolowezi zoyipa - kusuta ndi kumwa.

Kuphatikiza apo, muyenera kufunafuna chithandizo chamankhwala mwachangu ndikumwa mankhwala, kutsatira malangizo ndi malingaliro a dokotala.

About pancreatic necrosis akufotokozedwa mu kanema munkhaniyi.