Wirsung duct amachita ngati gawo lalikulu (lalikulu) la kapamba, kakang'ono kakang'ono kamene kamalowa mkati mwake. Kukula kwake kapena stenosis (kutsika mosalekeza) sikuti ndi matenda odziyimira pawokha, koma ndi chizindikiro cha ma pathologies ena, omwe nthawi zambiri amatupa kapena kupweteka kwamatumbo.
Ngati pakuchepa kwa ma pancreatic ducts, mankhwalawa amapezeka palimodzi ndi mankhwalawa oyambira. Kubwezeretsa kumafuna kuchotsa komwe kumayambira chizindikirocho. Nthawi zambiri, vutoli limafunikira opareshoni.
Wowongolera wamkulu umalowa mu bile duct, kenako mu duodenum. Ntchitoyi ndikupereka madzi a pancreatic kumimba yamagaya. Kapangidwe kake ndi kapamba. Kanemayo amachokera mchira wa chiwalo, amadutsa thupi lonse kupita kumutu. Kutalika kwake kumakhala kosiyanasiyana masentimita 15 mpaka 20 ndi mainchesi 4 mm.
Kutuluka kwa pancreatic secretion kumayendetsedwa pogwiritsa ntchito minofu yapadera yosalala. Matenda a ziwalo zamkati amatsogolera pakuchepa kwa kupanga kwa juisi kapena kukwiya kwake pazinthu zawo. Zotsatira zake, kutupa kwa duct kumadziwika, zomwe zimayambitsa kusokonezeka kwa njira zam'mimba.
Chophimba chachikulu cha kapamba
Kukwapula komwe kubisalira kwa duodenum 12 kumawerengedwa kuti ndi kofunikira kwambiri mu kapamba. Pulogalamuyo, yomwe timayamwa tating'onoting'ono tambiri timalowa, timene timayambira. Mapeto ake ndi sphincter yomwe imayang'anira kayendedwe kazinthu zachilengedwe.
Mawonekedwewo amangidwa, akubwereza kubowo kwa kapamba. Komabe, kusintha kwina m'thupi kumatha kudzetsa mawonekedwe a bondo kapena mawonekedwe a S. Munthu aliyense ali ndi mitundu yosiyanasiyana ya zothandizira.
Ngati ngalande ya Wirsung imadziwika ndi mtundu waukulu, ndiye kuti munthu ali ndi tubules pafupi 30. Mukamayankhula za mawonekedwe osasinthika kapena otayirira, ndiye oposa 50.
Momwe zimakhalira pakapangidwe kazinthu zazikulu, njira zothandizira zapamtunda zimapezeka pamtunda wa 2 cm kuchokera wina ndi mnzake. Wodwala akakhala ndi mtundu wotayirira, mipata imafupikitsidwa kwambiri.
Mtsuko waukulu wa kapamba umaphatikizika ndi wamba bile duct ndipo kenako umalowa mu duodenum. Koma muzochita zamankhwala pamakhala zochitika pamene mawonekedwe a anatomical amasinthidwa. Mwachitsanzo, dambo la Wirsung limayenda mu dongosolo la m'mimba, lomwe limatalikirana ndi wamba duct. Izi zoterezi ndizofanana kwa anthu 15-20%, sizimaganiziridwa kuti ndi matenda.
Pali zosiyana pakamangidwe ka ziwalo zamkati, zomwe, mothandizidwa ndi zina, nthambi zazikulu zomwe zimayikidwa mu nthambi ziwiri, zimagwira ntchito mosiyana, chifukwa chomwe njira ziwiri zimapangidwira.
Kapangidwe kameneka ndi kamachilengedwe mwachilengedwe, kamakhala kocheperako, kumabweretsa kutsekeka kwakukulu kapena kutseka kwathunthu kwa ma ducts.
Kapangidwe ka duct kovuta
Kusintha kwa kapamba, kutsegulidwa kwa njira zowonjezera, kukulitsa kwa dongosolowedwe kapamba, kupendekera kwache, ndi njirazi njira zowonongeka - zonsezi zimayambitsa kusokonezeka kwa dongosolo logaya chakudya.
Zofooka za chibadwa zimatha kubowoleza ngalande yayikulu, chifukwa chomwe nthambi zingapo zimapangidwa. Ngalande zikagwera, amalankhula za stenosis - kupendekera kokhazikika kwa ngalande.
Chifukwa cha kusayenda kapena kubisalira tubules tating'onoting'ono, mavuto a m'mimba amachitika. Kusunthika ndi kusintha kwa madzimadzi kumabweretsa kukula kwa cystic fibrosis, komwe kumayambitsa kusinthika osati mu gland, komanso machitidwe ena a thupi.
Kukula kwabwinobwino, makamaka, m'mimba mwake mwa duct wamkulu ndi 2 mm. Ngati kuchulukitsa kapena kuchepa kwake kumawonedwa, ndiye kuti ntchito ya kapamba imasokonezeka zokha. Wirsung duct wa kapamba akakulitsidwa, amatsogolera pakupanga miyala, chotupa neoplasms.
Ngati katumba wamkati wamkati watsekedwa, kapangidwe kake ka kapamba kamayamba. Zovuta za pachimake, mobwerezabwereza ndimawonekedwe osavuta, nthawi zambiri zimafunikira kuchitapo kanthu pakuchita opaleshoni ndi thunthu lathunthu la mkati.
Zomwe zimayambitsa ndi zizindikiro za kukulitsa kwa mzere waukulu
Kukula kwa Wirsung duct kwa kapamba mwa akulu ndi 80% kumagwirizana ndi etiology ya zotupa zina zamkati. Pafupifupi 30% ya zithunzi zamankhwala, sizotheka kukhazikitsa zifukwa zowonjezerazi, chifukwa chomwe pathogenesis imakhala chinsinsi.
Zomwe zimapangitsa kuti pakhale kuchuluka kapena kuchuluka kwakukwaniritsa zimaphatikizapo: opaleshoni pamimba kapena m'mimba, matenda a duodenum 12, kuvulala kwamtundu wa peritoneum.
Zomwe zimayambitsa kupsa kwamphamvu mu kapamba zimachitika chifukwa chomwa mowa mwauchidakwa, zomwe zimachitika chifukwa cha mankhwala ena (antibacterial and hormonal drug). Komanso kusowa kwa mahomoni, matenda opatsirana.
Pamene pancreatic duct imatha, nthawi zina pathogenesis imakhazikitsidwa kuchokera kubadwa kwamtsogolo. Pankhaniyi, "genetic" pancreatitis imawonekera, zomwe zimabweretsa kusintha kwa ziwalo zapafupi komanso minofu yofewa.
Chowonekera chachikulu cha chipatala chimaphatikizapo kuphwanya kwam'mimba. Pancreatitis imatha kupangitsa kuchepa komanso kuwonjezeka mumkamwa waukulu. Muzochita zamankhwala, matendawa amatchedwa "unyolo wamadzi."
Ma contours a pancreatic ngalande amakhala osagwirizana, mu lumen mumakhala ma inclusions olimba - miyala. Mawonetseredwe azachipatala:
- Chowawa champhamvu kwambiri mu hypochondrium. Mankhwala samathandiza kuthetsa ululu.
- Kudzimbidwa, komwe kumawonetsedwa ndi kutsegula m'mimba kwa nthawi yayitali ndi kuchuluka kwa chakudya chosaphikidwa.
- Kusanza, kusanza kosaletseka.
- Kuchepetsa chilakolako cha chakudya, ndi zina zambiri.
Zizindikiro zapadera, zomwe zikuwonetsa kupitiliza kwa kupendekera kwakukulu kwa kapamba, kulibe.
Zizindikiro
Njira zodziwonera zamakono zimathandizira kuzindikira kusintha kosavuta kwa duct, kumapereka kuyesa kwa kapamba. Endoscopic retrograde pancreatocholangiography imawoneka kuti ndi njira yophunzitsira kwambiri yoyesa kupindika kwa msewu.
Njira yodziwika yodziwitsira zamankhwala imapatsa katswiri wa zamankhwala lingaliro osati chongokhudza chimbudzi, komanso za momwe magwiridwe am'mimba ndi zimbudzi. Pakusintha kwachipatala, adotolo amadzaza ngalande mothandizidwa ndi othandizira, ndiye kuti makina a X-ray amagwiritsidwa ntchito.
Zoyesa zasayansi ikuchitika. M'pofunika kufufuza mwatsatanetsatane magazi am'magazi, kuwerenga mapikidwe a lipid, mawonekedwe a magazi, kudziwa kuchuluka kwa michere m'mimba, komanso kusanthula kwamkodzo mwamkati.
Njira zina zodziwitsira matenda:
- Sonography (ultrasound) yam'mimba ziwalo. Zimakupatsani mwayi kuwona m'mphepete mwa msewu waukulu, kuyeza mulifupi mwake. Njirayi imagwira ntchito bwino m'mafanizo amenewo pamene wodwala sananenepa kwambiri. Njira ya Wirsung ndiyosavuta kuwona m'matupi a kapamba kuposa mchira kapena mutu, zomwe zimachitika chifukwa chazinthu zokhudzana ndi kutengera kwina komwe kukuphatikizidwa ndi mawonekedwe a mafunde akupanga.
- MRI imathandizira kuwona mawonekedwe oyamba komanso mapindikidwe a kapamba, imakupatsani mwayi kuti mupeze tsatanetsatane wa parenchyma yozungulira.
Endoscopic retrograde pancreatocholangiography ndi njira yolowerera, chifukwa chake imafotokozedwa pazochitika pomwe MRI ndi ultrasound si njira zophunzitsira.
Njira zochizira
Matendawa akatsimikizira kukula kwa duct yayikulu, adotolo, makamaka dokotalayo, amasankha njira zamankhwala ochita opaleshoni. Ndi chifukwa cha mawonekedwe azachipatala, msambo wa wodwalayo, kuchuluka kwake, ndi zina.
Dokotalayo amatha kuyambiranso dera la stenotic kudzera mwa perthaneous arthroplasty. Njira ina, kukonzanso kotseguka kwa Wirsung duct ndi bile ducts kapena kuyambiranso kwa kapamba wam'mimba chifukwa cha opaleshoni yapulasitiki yomwe idachitika pambuyo pake. Njira yotsatirayi ndiyosowa kwambiri.
Chithandizo cha kukulitsa kwa duct chikugwirizana ndi algorithm zochizira chachikulu matenda - kapamba. Ntchito yamkati yamkati itasintha, kutupa kumayendetsedwa, ndipo milomo imabwezanso.
Mankhwala a pachimake kapamba:
- Kukana chakudya. Kusala kudya ndi kapamba kuyenera kuchitika nthawi yonse ya kukokomeza.
- Kugwiritsa ntchito antispasmodics.
- Intravenous makonzedwe a colloidal ndi saline.
- Kupereka mankhwala omwe amalepheretsa kugwira ntchito kwa michere ya m'mimba.
Nthawi zina opaleshoni imafunika. Mwachitsanzo, kufufutidwa kwina kwa gawo la kapamba, kapena kuchotsa miyala m'miyala.
Sluggish pancreatitis, yomwe imayambitsa kupitiliza kwa duct yayikulu, imathandizidwa mothandizidwa ndi chakudya chamagulu, mavitamini ndi ma mineral complexes. Mankhwala opweteka amathandizidwanso, mankhwala othandizira amathandizanso.
Katsitsimutsidwe koyambira kumbuyo kwa chithandizo chamankhwala chapanthawi yake komanso chokwanira. Njira zopewera kukula kwa duct zikuphatikiza chakudya 5, kukana zakumwa zoledzeretsa, chithandizo chakanthawi ya bile ducts ndi pancreatic pathologies.
Momwe mungapewere zovuta komanso momwe mungathandizire pancreatitis yamatenda akufotokozedwa mu kanema munkhaniyi.
