Pancreatic cyst ndichotsekezera cham'mimba cha ziwalo zamkati, zomwe zimakhazikitsidwa ndi makoma a minofu yolumikizana. Mimbayo imadzaza ndimadzi zotuluka, etiology ya zomwe zimachitikazo imachitika chifukwa chazovuta kapena njira yotupa m'matumbo.
Mawonetsedwe azachipatala amasiyana kwambiri pazithunzi zosiyanasiyana. Zimatengera kukula kwa mapangidwe, malo, pathogenesis ya mapangidwe. Zizindikiro zake zimatha kukhala zopanda chidwi komanso kupweteka kwambiri.
Kuti muwone kukula ndi kutulutsa kwa cyst, onani kulumikizana ndi ma ducts, kusankha njira zamankhwala othandizira, kusunthika kwa ultrasound, computer tomography, MRI yamkati ndi njira zina zimachitidwa kuti iwonenso chithunzi chonse.
Nthawi zambiri, kuchitapo kanthu opaleshoni kapena kukhetsa kwina kumafunikira, gawo la chiwalo limodzi ndi pathological neoplasm silikhala lofanana.
Gulu la pancreatic cysts
Malinga ndi code ya ICD, kapamba ndimapapo, nthawi yayitali, subacute, ndi mitundu ina. Kuchita opaleshoni kumasiyanitsa mitundu iwiri ya neoplasms. Poyambirira, kapangidwe ka patimayo kamakhudzidwa.
Cyst imakhala yoona ngati pali chingwe cha epithelial. Izi matendawa amatanthauza kubadwa kwatsopano, milandu yodziwika yokha imafotokozeredwa mu mankhwala, chifukwa ndizosowa kwambiri kwa odwala.
Masewera abodza ndi vuto lomwe limayamba chifukwa cha matenda. Sichizindikirika ndi mawonekedwe a glandular epithelium pamakoma, chifukwa chake amasankhidwa kuti abodza.
Gulu lachiwiri limaganizira malo a cyst omwe amapezeka m'mimba:
- Cyst ya mutu wa kapamba (makamaka, malowa ndi amamu bursa). Malinga ndi ziwerengero, makonzedwe awa amawonekera mu 15-16% a zithunzi zamankhwala. Chodabwitsa ndichakuti pali kuphatikizika kwa duodenum.
- Pa thupi la chiwalo - imapezeka mu 46-48% ya milandu. Ndizosintha pafupipafupi kwambiri, pomwe amakumana ndi khanda ndi m'mimba mwake.
- Pa mchira - wopezeka 38-39% ya zochitika. Chodabwitsachi ndikuti chifukwa cha chotupa chotere, ziwalo zapafupi sizowonongeka.
Cysts owona ali osowa pankhaniyi, mawonetsedwe azachipatala ndi mfundo zamankhwala amitundu yonseyi sizosiyana, chifukwa mtsogolomo tikambirana ma cysts abodza okha.
Zomwe zimayambitsa ndi ma cyst
Cancreatic cysts amapezeka mwa odwala, mosaganizira zaka, gululi, amatha kukhala osiyana siyana, amakhala amodzi komanso angapo. Mwa odwala ena, makamaka chifukwa cha kubadwa kwa m'mimba, ma ovicular systemic, ubongo, ndi chiwindi zimatha kupezeka.
Cyss zabodza sizimapanga gawo lathanzi. Mitsempha nthawi zonse imakhala chifukwa chazinthu zoyipa mthupi. Zomwe zimayambitsa kwambiri zimaphatikizapo pachimake kapamba, kuvulala kwa ziwalo
Choyambitsa chimatha kukhala chochulukirapo kwa duct ya excretory (mwachitsanzo, chopindika ndi chotengera chamagazi kapena mwala) kapena vuto lalikulu mu luso lake la mota. Nthawi zambiri, ma cysts amapezeka ndi matenda a parasitic monga cysticercosis, echinococcosis. Pathogenesis imayambikanso ndi chotupa neoplasms. Mu chifuwa chachikulu cha kapamba, ma post-necrotic cysts amapangidwa theka la milandu.
Gulu la madokotala othandizira opaleshoni limazindikira zinthu zazikulu zomwe zimatsogolera pakupanga mapangidwe a cystic. Zovuta zoyipa zatsimikiziridwa ndi kafukufuku wambiri. Izi zikuphatikiza:
- Mowa wambiri.
- Kunenepa kwambiri, komwe kumayendetsedwa ndi kuphwanya kwa lipid metabolism.
- Mbiri yokhudza kuchitapo kanthu pakuchita opaleshoni pachinthu chilichonse cha m'mimba.
- Matenda a shuga (nthawi zambiri a 2).
Kukhalapo kwa imodzi mwazinthu izi wodwala wokhala ndi zizindikiro za zotupa zam'mimba zimathandizira kupanga mapangidwe a cyst.
Kukhazikika kwa njira ya pathological kumakhala ndi mawonetsedwe ena azachipatala omwe amawonedwa mu 90% ya odwala. Poyamba, chipatala choterocho chimawonekera:
- Zowawa za herpes zoster. Amalimbikira ndikatha kudya kapena kumwa mowa. Piritsi loletsa mankhwala silithetsa vutoli, palibe njira zochizira.
- Kusanza mobwerezabwereza, komwe sikubweretsa mpumulo kwa wodwala.
- Zizindikiro za vuto la m'matumbo - kutsekula m'mimba, kumatulutsa, kuchuluka kwa mpweya.
Mawonetseredwe azachipatala amatheratu kapena atachepa pakadutsa milungu 4-5. Mankhwala, nthawi imeneyi imatchedwa "kusiyana kowala". Pambuyo pake, zizindikiritso zimawululidwanso, koma zowonjezereka komanso kulimbikira.
Nthawi zambiri, odwala amadandaula za kuchepa thupi kutentha, ulesi, kuvuta kwambiri kumanzere kwa hypochondrium. Nthawi zina (pafupifupi 5% ya zithunzi), khungu la pakhungu, mucous membrane, sclera ya ziwalo zam'maso.
Zizindikiro za pancreatic cysts zimaphatikizapo kuperewera kwa mahomoni monga insulin, somatostatin, glucagon. Kuperewera kwawo kumayambitsa kuwuma pamkamwa wamkamwa, kuwonjezeka kwamikodzo mwachindunji patsiku, m'malo ovuta kwambiri, kutaya chikumbumtima chifukwa cha hypoglycemic kapena hyperglycemic coma yapezeka.
Njira zoyesera
Ngati mukukayikira kuti patsekeke patsekeke ndi madzi, muyenera kufunsa ndi gastroenterologist. Pakuwunika pamimba, kutuluka kwake kumayang'aniridwa pamalo omwe amapezeka matenda.
Mayeso a labotale, monga lamulo, samawonetsa kusintha kwina. Pali kuwonjezeka pang'ono kwa leukocytes, ESR ikuwonjezeka. Nthawi zina pamakhala kuwonjezeka kwa kuchuluka kwa bilirubin.
Zomwe zimapanga michere yogaya m'magazi zimatengera kwambiri gawo la kutupa kwa kapamba kuposa kukhalapo kwa cyst. Pafupifupi 5%, odwala matenda am'mimba amapezeka.
Kafukufuku akuchitika:
- Ultrasound imapereka kuyesa kukula kwa neoplasm, imawonetsa zizindikiro zosakhudzana ndi zovuta zomwe zilipo. Mwachitsanzo, ngati kupendekera kulipo, kupezeka kosagwirizana kumapezeka.
- CT ndi MRI imatha kupereka zambiri mwatsatanetsatane pazomwe zimapangidwira mawonekedwe a cystic, kukula kwake, kusakhalapo kapena kupezeka kwake polumikizana ndi kuzungulira.
Pozindikira, ERCP imachitidwa - njirayi imathandizira kupeza tsatanetsatane watsatanetsatane pa ubale wa cyst ndi pancreatic ducts, yomwe imatsimikiziranso njira yamankhwala. Komabe, mwa kufufuza koteroko, pali kuthekera kwakukulu kwa matenda.
Chifukwa chake, ERCP imachitika pokhapokha ngati pakufunika kusankha njira ya opaleshoni, pomwe chithandizo chamankhwala chosasamala sichingaganiziridwe nkomwe.
Mankhwala
Kodi chiwopsezo cha chotupa cha m'mimba chimakhala chiani? Choopsa ndichakuti kupanga kwa nthawi yayitali kumayambitsa ziwalo zamkati zoyandikana, zomwe zimayambitsa mavuto osiyanasiyana. Zotsatira zake zitha kukhala zotsatirazi: kupasuka, mapangidwe a fistulas, supplement kapena vaccess, magazi chifukwa chotumphukira mtsempha wamagazi.
Malinga ndi zomwe aposachedwa omwe asayansi akuwonetsa, zitha kunenedwa kuti chithandizo chokhala ndi mapiritsi chimachitika pazochitika zina. Ngati pali choletsa chomveka bwino cha pathological element, kukula kwa mapangidwe a cystic kulibe kupitirira masentimita awiri.
Amathandizidwa ndi mankhwala osokoneza bongo ngati neoplasm ndi imodzi. Palibe mawonetseredwe azachipatala a jaundice ovuta, kupweteka kwapakati.
M'masiku oyambilira, njala imayikidwa. Mtsogolomo, zakudya zamafuta, zosaphika komanso zamchere sizimayikidwa kunja, chifukwa zakudya zotere zimayambitsa kuchuluka kwa michere ya m'mimba, yomwe imathandizira kuwonongeka kwa minofu. Pewani ndudu ndi mizimu. Wodwala amafunikira kupumula pa kama kwa masiku 7-10.
Mankhwala, mankhwala amakonzekera:
- Maantibayotiki okhudzana ndi ma tetracyclines kapena cephalosporins. Cholinga chake ndikulepheretsa kulowetsedwa kwa ma virus m'mitsempha ya mapangidwe, zomwe zimatsogolera njira zoyipa.
- Pofuna kuchepetsa kupweteka komanso kuchepetsa kubisala, ma inhibitors amagwiritsidwa ntchito - Omez, Omeprazole ndi mankhwala ena.
- Mankhwala a enzyme amafunika kuti achulukitse chimbudzi cha mafuta ndi mafuta - Mankhwala okhala ndi lipase ndi amylase amalimbikitsidwa. Zowonetsedwa ndi gululi - Pancreatin, Creon.
Ngati cyst ndi chifukwa cha biliary pancreatitis, mankhwala a choleretic mwina akhoza kupatsidwa. Nthawi zina, mutatha kuchotsa komwe kumayambira cyst, zotupa zimatha kusintha pazokha. Komabe, izi ndizosowa. Odwala ambiri amagwiritsa ntchito wowerengeka azitsamba mwanjira ya decoction ya burdock, mummy, tincture wa celandine, ndi zina. Kuunikira kwa njirazi ndi kwabwino, koma sikugwirizana ndi umboni, choncho ndibwino kuti usaike pachiwopsezo ndikudalira madokotala.
Ngati chithandizo chakuchulukitsa sichinapereke zotsatira zomwe zingafunikire pakadutsa milungu 4, kulimbikitsidwa kwina ndi madokotala ndikuchita opareshoni.
Mankhwala othandizira
Malinga ndi ziwerengero, chithandizo chamankhwala pokhapokha 10% chimapewe opaleshoni. Nthawi zina, mankhwalawa amachitika mu dipatimenti yochita opareshoni. Pali zosiyana zopitilira zisanu ndi ziwiri za njira yothandizira zomwe zimalola kuchotsedwa kwa cyst.
Madotolo amayesa kudutsamo ndi njira zochepa zowononga zochizira matendawa. Poyerekeza ndi zomwe mabodzawo amachita, khungu la wodwalayo silikuwonongeka. Mavuto ocheperako amadziwika ndi maluso omwe amachitika kudzera pakhungu poyang'aniridwa ndi ultrasound.
Mulingo woyenera kwambiri wamankhwala umadziwika pamaso pa dongosolo la volumetric pathological pamutu kapena pa thupi. Mfundo za machitidwe ndizosavuta. Pambuyo pa mankhwala okhudzana ndi munthu wamkulu kapena mwana, singano yopopera kapena yoyesa imayikidwa mwa kupyoza m'gawo la epigastric. Kutengera ndi kukula kwa cyst, opareshoniyo amatha kupita m'njira ziwiri:
- Kugwiritsa ntchito njira yokhotakhota yopopera. Madzi onse atachotsedwa mu cyst, chubu chopyapyala cha mphira chimayikidwa kuti chikhale chotuluka nthawi zonse. Muli m'thupi mpaka madzi atuluka. Kudzinyenga kotereku sikuchitika ngati cystic element yatseka zisa za ndulu kapena yayikulu.
- Mwa percutaneous sclerotherapy ya chotupa. Njirayi imaphatikizira kuyambitsidwa kwa madzimadzi am'magazi atatha kutsitsidwa. Zotsatira zake, ndikuyeretsa kwamkati, kuthana ndi chilema.
Ngati njira zomwe zili pamwambazi sizingatheke, ndiye kuti laparoscopy imachitika. Izi zimachitika pogwiritsa ntchito zigawo ziwiri, chilichonse chomwe chimasiyana kuchokera 1 mpaka 2 cm. Zida zimayambitsidwa pamimba kudzera mwa iwo. Kumbali ina, njira za dongosolo lotere limadziwika ndi kuchepa kwakuthupi, komabe, ziwonetsero zimawonetsa kuti zovuta zambiri zimachitika nthawi zambiri.
Dokotala angachite izi:
- Kusangalatsa ndi mapangidwe a maphunziro. Ndizovomerezeka kugwiritsa ntchito ngati cyst ndiwowonjezera.
- Laparoscopy yokhudza kuphatikizanso gawo la kapamba. Malangizo apamwamba a chilema chachikulu mkati mwa zimakhala.
- Kulowera kwa Frey kumakhudzanso kuphatikizanso kwa mutu ndi kulengedwa kwa pancreatojejunal anastomatosis. Ndikofunika kuchitira motsutsana ndi maziko amakulidwe a thupilo.
Kuneneratu kumachitika chifukwa cha ukadaulo wa matendawa, kuzindikira kwa nthawi yake komanso njira ya opareshoni. Matendawa amakhala ndi pafupipafupi pazotsatira zoyipa - kuyambira 10 mpaka 50% ya zojambula zonse. Kukula, kukonzanso kumachitika nthawi zambiri, fistulas, magazi mkati mwa m'mimba amapangidwa. Ngakhale atachitidwa opaleshoni ku kapamba, pamakhala chiwopsezo chobwereranso mtsogolo.
Pazithandizo za pancreatic cysts akufotokozedwa mu kanema munkhaniyi.
