Kasitomala ndi amtundu wa endocrine komanso wokugaya womwe umapanga mahomoni ndi ma enzymes. Mothandizidwa ndi zinthu zingapo, ntchito ya gland imatha kusokonekera ndikutsogolera kuchiwonongeko, momwe chithandizo chogwiritsa ntchito mosasamala chimakhala chopanda mphamvu. Pankhaniyi, kuthandizira opaleshoni ndikofunikira. Zomwe zimatengera zinthu zambiri komanso momwe gland imayendera, komanso luso la opaleshoni yamakono.
Pali mitundu ingapo ya maopareshoni - suturing, necrectomy, cystoenterostomy, komanso njira yosinthira pancreatectomy. M'mbuyomu, kapamba amachotsedwa pang'ono kapena kwathunthu, ndipo ngati kuli kotheka, ziwalo zoyandikana - chikhodzodzo, ndulu, gawo limodzi la m'mimba kapena duodenum.
Pancreatectomy
Nthawi zambiri, kapamba amachotsedwa ndi zotupa zoyipa, zomwe sizikuwonetsa kuti opereshoni ndiyachangu cha kapamba. Pancreatectomy yathunthu imapangidwanso ndi kupweteka kwapweteka kosalekeza kapamba, kapamba konsekonse, kuvulala koopsa ndi kutukusira kwa ndulu, komanso kupangira mapangidwe angapo a cysts.
Kuchita koteroko pa kapamba kumachitika kawirikawiri, chifukwa kuwonongeka kwathunthu kwa chiwalo, njira yoyipa imakhala yofala kwambiri mu mawonekedwe a metastases ndipo, monga lamulo, sigwira ntchito.
Kuchotsa kwathunthu kwa chindacho mu khansa nthawi zambiri kumasinthidwa ndi distal kapena proximal resection. Izi zimachitika chifukwa chakuchepa kwa mphamvu ya chemo- ndi radiation, kusakhala bwino ndi odwala komanso kutsika kwambiri kwa mawonekedwe a oncological. Ndiye chifukwa chake opaleshoni ya zotupa zoyipa imapangidwa makamaka kuti athetse zizindikirazo ndikuwonjezera moyo wa odwala.
Kutenga kwakanthawi kumachitika chifukwa cha zotupa za thupi kapena mchira, pomwe mchirawo umakutidwa ndi ndulu
Ndi khansa ya pancreatic, pancreato-duodenal resection yachitika. Pa nthawi ya opareshoni, sikuti mutu wa kapamba yekha, komanso ziwalo zapafupi - chikhodzodzo, gawo lam'mimba ndi duodenum. Mtundu wa opaleshoni yamtunduwu ndiwowopsa kwambiri ndipo umakhala ndi zovuta zambiri komanso amafa.
Kuchita kwa Frey kumawonetsedwa kukhala kosalira zambiri, pomwe wodwala ali ndi zilonda 12 zam'mimba. Amawonetsedwa pakavulala kwambiri pamutu pa chifuwa cham'mimba ndi kufalikira kwa chifuwa chamkati ndi miyala, makomedwe, komanso kubadwa kwa stenosis.
Kugulitsa
Kuyesera koyamba kufalitsa kapamba kunachitika m'zaka za m'ma 18 ndi dokotala wa ku England yemwe anayambitsa kuyimitsidwa kwa maselo a pancreatic m'mimba yamatumbo kwa wodwala matenda a shuga 1. Ntchito yoyika zina ndi zina mwa njira yodziwitsira mbali ina ya chiwonongeko ndi chotchinga cha bandeji yomangidwa mu iliac fossa idachitidwa koyamba mu 1966
Masiku ano, kuphatikizika kwathunthu kwa kapamba kumachitika palimodzi ndi gawo la duodenum 12 kapena pang'ono, pomwe gawo lina lang'aniridwa - mwachitsanzo, thupi ndi mchira. Malingaliro a madokotala okhudzana ndi kupatutsidwa kwa madzi a pancreatic ndiotsutsana. Ngati chisa chachikulu cha mankhwalawa chasiyidwa chotseguka, ndiye kuti chimbudzi chimalowa m'mimba.
Kuchotsa kwa ziphuphu zakumaso mu khansa kumatheka pokhapokha maselo oyambira, zotupa zoyipa nthawi zambiri sizigwira ntchito
Mukamamangirira kapena kutsekereza dontho ndi ma polima, madziwo amakhala mkati mwa thupi. Chotupa chachikulu cha kapamba chimatha kulumikizidwa ndi anastomosis ndi kwamikodzo dongosolo (ureters, chikhodzodzo) kapena ndi gawo lotalika la matumbo aang'ono.
Pafupifupi anthu chikwi ambiri amachita ma pancreatic transplantant pachaka. Kusankhidwa kwa woperekayo ndi njira yochotsera ziwalo ndizofunikira kwambiri. Zikondamoyo zimachotsedwa kuchokera kwa munthu wakufa yekha, chifukwa chiwalo sichimayenda. Woperekayo amafunika kufa ndi matenda opha ziwalo kapena chifukwa cha ngozi pomwe ubongo wawonongeka (kuvulala kwamtopola).
Pancreatic oncologyKuti kupatsirana kwa kapamba kuyende bwino, ndikofunikira kupatula:
- atherosulinotic zotupa za celiac thunthu;
- matenda a kapamba ndi kuvulala;
- kapamba
- matenda ashuga.
Zaka zapamwamba kwambiri za woperekayo ndi zaka 50. Kuchotsa kwa pancreatic kumatha kuchitika padera kapena palimodzi ndi duodenum ndi chiwindi. Akangochotsa, chiwindi chimasiyanitsidwa, ndipo chindulu ndi matumbo zimasungidwa mwapadera. Zikondazo zimatha kuchotsedwa kwa munthu wakufa pasanathe ola limodzi ndi theka atamwalira - ndi momwe chitsulo chimakhalira. Moyo wa alumali pamatenthedwe otsika ndizokwanira maola 24.
Zizindikiro
Opaleshoni yamapapo ndi imodzi mwamavuto kwambiri mu transplantology. Ndikosavuta kufalitsa chiwindi kapena impso ya wodwala. Ndiye chifukwa chake opaleshoni yopanga ma pancreatic imagwira ntchito pokhapokha ngati ikuwopseza moyo wa wodwalayo komanso kusapezeka kwina.
Njira zopangira maopaleshoni zofala kwambiri pochotsa ndi kufalikira kwa kapamba ndi anthu omwe ali ndi vuto la matenda 1 a shuga, omwe amakhala ndi:
- hyperglycemia yosalamulira komanso pafupipafupi ketoacidosis;
- zotumphukira neuropathy molumikizana ndi venous kuchepa kwa m'munsi malekezero ndi chitukuko cha matenda ashuga;
- patsogolo retinopathy;
- kuvulala kwambiri kwa impso;
- kukana insulini, kuphatikiza Cushing's syndrome, acromegaly.
Kupatsirana kumachitidwanso pakagwiritsidwe ntchito ka mankhwala osokoneza bongo komanso kukula kwa shuga yachiwiri ndi kapamba, vuto loipa kapena hemochromatosis. Kufunika kothandizidwa ndi wopereka kumachitika ndi zotupa, kuwonjezeredwa pamimba pamimba yomwe wafalikira mpaka kapamba, ndi kufa kwakukulu kwa maselo a parenchyma. Imfa yam'mimba imachitika ndikulowerera pafupipafupi kapena kupunduka kwamatenda achisamba.
Contraindication
Pofuna kusiyanitsa zovuta zoyipa za opaleshoni ya pancreatic, contraindication yomwe ingachitike iyenera kukumbukiridwa. Zoletsa zopanda mayeso zimaphatikizapo zotupa zopanda pake ndi psychoses yayikulu.
Kupanikizika kwa chifuwa cha shuga kumachitika pokhapokha ngati insulini yopanda mphamvu iphatikizidwe ndi glycemia
Popeza kufalikira kwa ziwalo kumachitika makamaka kwa anthu okalamba omwe ali ndi zovuta zingapo za matenda ashuga, zotsutsana zina zimatha kuganiziridwa kuti ndi zofanana:
- zaka zopitilira 55;
- kugunda kwa mtima kapena sitiroko;
- mtima matenda - mawonekedwe ovuta a ischemic matenda, atherosulinosis apamwamba aorta ndi iliac ziwiya;
- mbiri ya kuchitapo kanthu pakuchita opaleshoni yamitsempha yama coronary;
- mitundu ina ya mtima;
- zovuta zovuta za matenda a shuga;
- chifuwa chotseguka;
- anapeza immunodeficiency syndrome;
- uchidakwa komanso uchidakwa.
Ngati wochita pancreatic transplantation ali ndi mbiri yokhudza kukhumudwa kwa mtima, ndiye kuti achire kapena opaleshoni imachitidwa opareshoni isanachitike. Izi zitha kuchepetsa kwambiri zovuta za zovuta pambuyo pake.
Pamaso pa opareshoni, kufufuza kwathunthu kumafunikira kuti athe kudziwa zoopsa zomwe zingachitike kukana wopereka
Mawonekedwe a nthawi yokonzanso
Zotsatira za opaleshoni ya pancreatic mwachindunji zimatengera mtundu ndi kuchuluka kwa kulowererapo. Ndi gawo lakusintha kwa malo osungidwa m'matumbo, kuperewera kwa michere kumachitika. Izi zimayambitsa kuphwanya chakudya, ndipo zakudya zambiri zomwe zadyedwazo sizichotsedwamo.
Zotsatira za njirayi zimatha kukhala kuchepa thupi, kufooka, zopumira pafupipafupi komanso zovuta zama metabolic. Chifukwa chake, mankhwala othandizira ndi zakudya amakhazikika. Mchira wa kapamba, momwe ma insulin imapangidwira, amachotsedwa, hyperglycemia imayamba. Pankhaniyi, kuwonjezera pa zakudya, kuwongolera shuga ndi magazi ndikofunikira.
Pambuyo kuchotsa kwathunthu kwa kapamba, thupi limataya ma enzymes onse ndi insulin, yomwe imawopseza moyo wa wodwalayo. Komabe, mchitidwewu ukuwonetsa kuti kumwa mankhwala a enzyme ophatikizika pamodzi ndi kukonza bwino magazi a shuga kumathandizira kubwezeretsa mgonero ndi ntchito ya endocrine. Zotsatira zake, moyo wa odwala umakhala wokhutiritsa.
Pambuyo pakuchita opaleshoni pamimba, chimbudzi cham'mimba chimatulutsidwa kutiichotse madzi ambiri. Kulowa pambuyo pakuchita opaleshoni kumafunikira chisamaliro chosamalitsa - imafunikira kusunthidwa tsiku ndi tsiku ndipo khungu lomwe limazungulilidwa liyenera kuchitidwa ndi ayodini kuti musatalikirane. Nthawi zambiri, ngalande zimachotsedwa pakatha sabata limodzi.
Zakudya zamagulu pambuyo pa opaleshoni ya pancreatic ndi gawo lofunikira popewa zovuta. Pambuyo kuchotsedwa kwathunthu kwa chiwalo, kusala kudya kwa masiku atatu kumalimbikitsidwa, pomwe wodwalayo amadyetsedwa makolo ake, kudzera mwa dontho lokha. Amaloledwa kumwa madzi m'magawo ang'onoang'ono, mpaka lita imodzi patsiku.
Kuyambira kuyambira pa 4th, mutha kumwa tiyi wopanda mphamvu ndikudya masamba obwera ndi mikate yoyera. Tsiku lotsatira, mbale zamadzimadzi amadzimadzi zimayambitsidwa mumenyu - zophika zophika ndi sopo. Pakatha sabata, maphunziro achiwiri amawonjezeredwa monga masamba ophika ndi masamba osenda ochokera ku nyama zopota zopindika.
Pakatha masiku 10, amasinthana ndi zakudya wamba, koma zolephera zina: chakudyacho sichikhala ndi zakudya zamafuta ndi zokazinga, zakudya zosavuta, kapena zakumwa zoledzeretsa. Mndandanda wathunthu wazakudya zololedwa komanso zoletsedwa zimafanana ndi chakudya No. 5 malinga ndi Pevzner.
Ndikofunikira kudziwa kuti pambuyo pachitetezo chilichonse cha pancreatic, chakudyacho chimayenera kutsatidwa moyo wonse. Maziko a zakudya ndi tebulo No. 5, yolimbikitsidwa kwa odwala onse omwe ali ndi matenda am'mimba.
