Ọrịa pancreatitis - Nke a bụ ọnya na-emebi emebi nke paịrisy paịrisy, anụ ahụ gbara ya gburugburu na akwara nke arụ ọrụ ya, nke na-efe efe na-esonye na ya.

Usoro nke nnukwu ọrịa ọ na-eme

1st frasi - enzymatic - fivebọchị ise mbụ, ịkpụkpụ akwara nezrosis, mmepe nke endotoxemia. Somefọdụ na-etolite otutu akụkụ ọdịda na ujo endotoxin.

E nwere ụdị ọgwụgwọ abụọ:

a - Ọria pancreatitis siri ike. Mkpụrụ mkpụrụ ndụ ihe mejupụtara ya bụ necrosis na-eme ka ihe jupụta ebe niile (nnukwu ileda anya na okirikiri mgbakwunye).

b - Ọrịa pancreatitis na-adịghị ala ala. Ọrịa necrosis na-eme ọfụma anaghị etolite (edema nke pancreas), ma ọ bụ na o nwechaghị ụdị, ọ naghị agbasa ebe niile.

Oge abuo - reactive - na-etolite n'izu nke abụọ, na-eme ka mmeghachi omume nke anụ ahụ mepụta akwara nke necrosis. Thedị a na-adakarị ahụ bụ parapancreatic infiltrate (omenobursitis). Ọgwụ - ọrịa mgbu na-adịte aka, ahụ ọkụ (37.5-38), ihe mgbu na-egbu mgbu nke ukwuu na oghere dị n'ime afọ, mgbochi siri ike nke gastroduodenal.

3rd frasi - mbipụta na usoro - na-amalite site na izu nke atọ, nwere ike ịdị ọtụtụ ọnwa. Qukpa oke na pancreas na anụ ahụ retroperitoneal na-amalite n’ụbọchị nke iri na anọ. E nwere ụzọ abụọ enwere ike isi gbasaa:

a - Aseptipia na usoro na - enweghị atụ ọria akwara. Ejiri ya na nguzobe nke posta necrotic cysts na fistulas.

b - Sept gbazee na usoro - nke a bụ nje akwara na-arịa ọria akwara na necrosis nke ọrịa parapancreatic na inwekwu mmepe nke nsogbu purulent. Linlọọgwụ - oke ahụ ọkụ, akpata oyi, hypotension arterial na ọtụtụ nsogbu anụ ahụ.

Thedị nke usoro a bụ purulent-necrotic parapancreatitis na nsogbu nke ya (purulent-necrotic sagging, ọnya nke oghere azụ na oghere ime, purulent omentobursitis, purulent peritonitis, arrosion and gastrointestinal ọbara, digestive fistulas, sepsis).

Ahụhụ pancreatogenic (ọnụnọ nke pancreas, omental bursa, retroperitoneal fiber) - ọkụ ọgbụgba, akpata oyi, ọnya palpable na-egbu mgbu na-enweghị echiche ịbelata.

Ejiri pseudocyst mara site na ọrịa mgbu na-adịte aka na epigastrium, mgbaàmà nke mgbochi duodenal yana mpụta ya na elu afọ nke palpable palpable mechiri densely elastic guzobe.

Nsonaazụ nke nnukwu ọrịa ọrịa pancreatitis pseudocysts, pancreatic fistula, pancreatitis na-adịghị ala ala, ọrịa shuga mellitus na dyslipoproteinemia. Site na mkpochapu nke biliary ma obu ihe omimi, a na eweghachi oru nke aru

29. Usoro nke ọgwụgwọ nke nnukwu ọrịa pancreatitis dabere na isi nke ọrịa ahụ.

Ọrịa pancreatitis - Nke a bụ ọnya na-emebi emebi nke paịrisy paịrisy, anụ ahụ gbara ya gburugburu na akwara nke arụ ọrụ ya, nke na-efe efe na-esonye na ya.

Ọgwụ Enzymatic frasi:

Maka ọgwụgwọ nke pancreatitis dị nro, usoro ọgwụgwọ bụ isi bụ ezuru:

1) agụụ (ọbụlagodi ụbọchị 2-4)

2) ịda ụda na ọchịchọ nke ọdịnaya afọ

3) hypothermia obodo (oyi na afo)

4) analgesic na-abụghị narcotic (Analgin intramuscularly ma ọ bụ intravenously na 2 ml nke 50% ngwọta mgbe awa 6-8 gasịrị, tramadol 50-100 mg intravenously ma ọ bụ intramuscularly mgbe awa 6-8 gachara)

5) narcotic analgesics nwere nnukwu mgbu ọrịa (trimereperedin subcutaneously ma ọ bụ intravenously na 1 ml nke 1% ma ọ bụ 2% mgbe awa 6 gachara).

6) antispasmodics - papaverine hydrochloride 2 ml nke ihe ngwọta 2% intramuscularly, drotaverine 40-80 mg 1-3 ugboro n'ụbọchị intramuscularly, intravenously)

7) infusion ọgwụ na olu nke 40 ml kwa 1 n'arọ nke ahụ ike ya na-amanye diuresis n'ime awa iri anọ na anọ

Ngwọta mbufụt: 0.9% sodium chloride solution, 5% ma ọ bụ 10% ihe ndozi dextrose, nọchiri plasma.

Antisecretory na ọgwụ antienzyme:

1) Ọnọdụ ezighi erughị 50 puku nkeji, n'oge ụbọchị 5 mbụ nke ọrịa

2) Gordok anaghị erughị 500 puku nkeji intravenously, n'oge ụbọchị ise mbụ nke ọrịa

3) octreotide subcutaneously, 100 mcg ugboro atọ n'ụbọchị

4) omeprazole 20 mg ugboro abụọ n'ụbọchị

5) famotidine intravenly, 40 mg ugboro abụọ kwa ụbọchị.

Ọ bụrụ na enweghị mmetụta ọ bụla ruo awa 6 ma ọ dịkarịa ala otu ihe ịrịba ama nke ọrịa pancreatitis siri ike, ekwesịrị ịkọwapụta ọrịa pancreatitis siri ike ma a ghafere onye ọrịa ahụ na ngalaba nlekọta ahụike yana ngalaba nlekọta ahụike.

Ọgwụgwọ n'oge ana - eme ihe (peripancreatic infiltrate):

A na-eme Laparotomy n'izu nke abụọ naanị n'ihi nsogbu (cholecystitis na-emebi emebi, ọbara ọgbụgba, nnukwu eriri afọ) enweghị ike ịkwụsị ya kpamkpam.

Kachasị ọgwụgwọ:

1) gara n'ihu na ngụkọ ọgwụ ọmụmụ

2) nri nri ọgwụ (nri Nke 5) ma ọ bụ nkwado nri nri

3) ọgwụ mgbochi (cephalosporins nke ọgbọ nke 3-4 ma ọ bụ fluoroquinolones na ngwakọta na metronidazole, nkwadebe nke resba carbapenema)

4) immunomodulation (abụọ subcutaneous ma ọ bụ intravenous nchịkwa nke roncoleukin nke 250,000 nkeji (na ahu ahu erughị 70 n'arọ) ma ọ bụ 500,000 nkeji (na ahu ahu karịrị 70 n'arọ) na a nkeji nke 2-3 ụbọchị)

Ọgwụgwọ n'ọgba nke nsogbu purulent (purulent-necrotic parapancreatitis na nje pancreatic necrosis):

Site na nsogbu ndị purulent, a na-egosi ntinye aka n'ịwa ahụ, ebumnuche nke bụ nrụzigharị eriri azụ metụtara. Ntinye gụnyere mkpughe, debridement ma ọ bụ mmepu nke eriri azụ metụtara. Mainzọ kachasị ọcha nke purulent-necrotic foci bụ necrsecvestrectomy, nke nwere ike ịbụ oge abụọ na ọtụtụ nhazi.

N'ime oge ọmụmụ, a na-egosi ọgwụgwọ dị mgbagwoju anya:

1) nkwado nri nri (site na nyocha nyocha n'ime obere eriri afọ nọ n'azụ Trent ligament)

2) ọgwụ mgbochi ọgwụ dịka ihe gosiri

- ya na sepsis siri ike ya na iyi egwu nke oria septik - ogwugwo ya na immunoglobulins maka ochichi intravenous ya na iji homonu aru.

- na-arịa ọrịa na-ekweghị akwụsị akwụsị ma na-arịa ọrịa siri ike nke mmeghachi omume mkpali sistemu - ọgwụgwọ anticytokine (ihe ndị na-egbochi nchebe, usoro efferent)

Ibepu akwukwo banyere sayensi banyere ogwu na ahuike, onye dere akwukwo sayensi - Sanzharova Lyudmila Sergeevna

Edemede a gosiputara nsonaazụ nke iwu nyocha na akwara nke ịhazigharị akwara yana akụkụ paragancreatic na nnukwu pancreatitis na-emebi emebi. Dabere na nsonaazụ ndị enwetara, ekwubiri na maka ụdị ajọ ọrịa pancreatitis dị oke njọ, ọ dị mkpa iburu n'uche njirimara morphofunctional nke nzaghachi dị iche iche nke akụrụngwa na akwara dị iche iche nke usoro ahụ.

CLINICAL-MORPHOLOGICAL ASPPLESES ACUTE DESTRUCTIVE PANCREATITIS NA PARAPANCREATITIS

Na nsonaazụ ederede nke iwu ọgwụ gbasara akụrụngwa ịhazigharị nke ọrịa pancreas na akụkụ paragancreatic na ọnọdụ nke ọrịa pancreatitis dị nkọ. Dabere na nsonaazụ ndị natara kwubiri na maka ụdị dị oke nkọ nke na-emebi emebi ọ dị mkpa ịtụle atụmatụ morphofunctional nke azịza dị iche iche nke akụrụngwa na akwa akwa nke usoro pathology na-adọta.

Ederede nke ọrụ sayensị na isi okwu "akụkụ ahụike na akụkụ nke akụkụ nnukwu ọrịa pancreatitis na parapancreatitis"

CLINICAL NA MORPHOLOGICAL APLACES OF ACUTE DESTRUCTIVE PANCREATITIS NA PARAPANCREATITIS

Orenburg State Medical Academy (Orenburg)

Edemede a gosiputara nsonaazụ nke akparamaagwa na usoro akwara nke nhazi nke puru iche, yana ihe ndozi nke ihe ojoo. Dabere na nsonaazụ ndị enwetara, ekwubiri nke ahụ maka. ụdị ajọ ọrịa pancreatitis dị oke njọ, ọ dị mkpa iburu n'uche usoro morphological na arụmọrụ nke nzaghachi nzaghachi dị iche iche nke cellular na. akụkụ anụ ahụ nke usoro pathological.

Okwu gbara ọkpụrụkpụ: pancreatitis, parapancreatitis, pathomorphogenesis, ọgwụgwọ ịwa ahụ

CLINICAL-MORPHOLOGICAL ASPPLESES ACUTE DESTRUCTIVE PANCREATITIS NA PARAPANCREATITIS

L.S. Sanzharova Orenburg State Medical Academy, Orenburg

Na nsonaazụ ederede nke iwu ọgwụ gbasara akụrụngwa ịhazigharị nke ọrịa pancreas na akụkụ paragancreatic na ọnọdụ nke ọrịa pancreatitis dị nkọ. Na ndabere nke natara, rụpụta nkwubi okwu na maka ụdị dị oke njọ nke na - emebi pancreatitis ọ dị mkpa ịtụle atụmatụ morphofunctional nke ihe dị iche iche, azịza nke mkpụrụ ndụ dị iche iche na akwa nke usoro pathology na - adọta .. Okwu ndị dị mkpa: pancreatitis, parapancreatitis , patomorphogenesis, ọgwụgwọ ịwa ahụ

Ọrịa pancreatitis na parapancreatitis nke iri afọ gara aga bụ otu n'ime nsogbu ndị a tụlere na akwụkwọ ahụike ụwa, otu n'ime nsogbu ahụike kachasị sie ike nke ịwa ahụ. Nsonaazụ ọgwụgwọ dabere n'ụdị nnukwu ọrịa pancreatitis. Ọ bụrụ na ọrịa oria edematous na-akpata nnukwu ọrịa, ọnwụ na-erughị nha

0, mgbe ahụ na-eji ụdị mbibi - ọ na-agbasi mbọ ike maka 100% (yana ngụkọta nke pancreatitis).

Ihe puru iche ana –eme ka ihe akari nke akwara buru ibu, ma n’ime ogha n’onu na n’iru oghere. Exudation n'ime para-pancreatic anụ ahụ na nnukwu ajọ ọrịa pancreatitis bụ ihe mara mma na akara na-adịgide adịgide, a na-ahụkwa ya dịka ọnụọgụ ndị dere na 90% nke ikpe 7, 8. ọbụlagodi n'ụdị ya dị nro, ebe macroscopically kpebisiri akwara pancicic necrosis abụghị visualized, kama naanị kpebiri microsco dịka "pathobiochemical metụtara". Mmeri nke eriri parapancreatic na-aga n'ihu mgbe emechara nke pancreatic necrosis na-ewe oge niile enzymatic na-akpata nnukwu ọrịa pancreatitis.

Ofkpụrụ nke ọgwụgwọ ọgwụgwọ na pancreas etolitela ruo taa na nnukwu ọrịa pancreatitis (“mkpịsị”) na na pancreatogenic peritonitis (mwepu nke exudate, lavage, na mwepu nke afọ) emeela ka ụfọdụ ihe ịga nke ọma na mbelata ọnwụ na ụdị dị njọ. Ihe kachasị sie ike bụ ime ihe

na eriri retroperitoneal, kemgbe n'aka nke ọzọ, ọgwụ na-abanye na ya nke ọma n'ihi mgbasa mpaghara, yana aka nke ọzọ, ụzọ mkpughe anaghị adị. N'oge ngwụcha, 45 - 80% nke ndị ọrịa nwere ajọ ọrịa pancreatitis dị nnukwu anwụ na-anwụ n'ihi mmepe nke nnukwu nsogbu purulent mgbagwoju anya na eriri parapancreatic, nke bụ isi ihe kpatara otutu ọdịda na sepsis.

Ka ọ dị ugbu a, ihe fọrọ nke nta ka ọ bụrụ na ọ dịghị onye na-enwe obi abụọ na ọnụnọ nke purulent-septic mgbagwoju nke pancreatic necrosis bụ ihe ngosipụta zuru oke maka ọgwụgwọ ịwa ahụ. N’ụdị kachasị, R. Visyeg na N.A chepụtara ihe ndị metụtara arụmọrụ a. Reber (1999). Ha kwenyere na: "ọrịa pụtara ịgwọ ọrịa akwara bụ ihe ịrịba ama zuru oke maka ịwa ahụ, yana ọnọdụ ndị ọzọ niile chọrọ ikpe maka ịwa ahụ. Ihe niile ga - adị ka ihe doro anya. Ọ bụrụ na enwere ọrịa - a na-egosi ịwa ahụ, mba - na - akpachara anya. N'otu oge ahụ, okwu banyere ihe ngosipụta maka ịwa ahụ na-arịa ọrịa necrotic pancreatitis emebeghị ka ọ kwụsịchaa kpamkpam. N'oge mbido oria ahụ (usoro nke abụọ - usoro nke enzymatic toxemia), ọkachasị mgbe mmeri nke fipania nke parapancreatic bụ nke ga - abụ “eburu” maka toxins nke na - abanye n'ọbara mgbe niile, nke na - akpata ọnwụ (“ọnwụ”), n'oge (ọtụtụ ọdịda akụkụ ọdịda) na ngwụsị (ọrịa, sepsis) nsogbu nke pancreatic necrosis.

Ebumnuche nke ọmụmụ a bụ ịtụle ụzọ ọgwụgwọ na nsonaazụ ahụike na nnukwu

pancreatitis, gụnyere site n'echiche nke nhazi ọrụ arụmọrụ.

EGO NA EGO

Anyị nyochara akụkọ banyere mmadụ 21 metụtara ndị ọrịa nwụrụ anwụ nwere nnukwu ọrịa na-egbu egbu. 71.4% - n'okpuru afọ 60 (23.8% sitere na 30 ruo 40, 28.6 - site na 40 ruo 50). 18 (85.7%) bụ ụmụ nwoke, 3 (14.3%) bụ nwanyị.

Ihe ndị mere na-ebute mmepe nke ọrịa a: na ndị ọrịa 17 (81.9%) ị abuseụbiga mmanya ókè, na abụọ (9.5%) - njehie na nri, e guzobere ihe kpatara ọrịa ahụ na ọrịa abụọ (9.5%). Achọpụtara nchọpụta nke ọrịa pancreatitis dị oke njọ site na nyocha, nyocha ụlọ nyocha na nsonaazụ nke ọmụmụ ihe (ultrasound, MRI). A nabatara ndị ọrịa niile na ọnọdụ siri ike. Ozugbo, na ngalaba nlekọta ahụike, mgbe nnabata ndị ọrịa niile, a na-eji usoro ọgwụgwọ dị iche iche mee ihe na olu niile, na-agbaso ebumnuche ndị a: iwelata ogo mbufụt ahụ ma na-aga n’ihu usoro mbibi ahụ na pancreas, na-egbochi ihe nzuzo na enzymes, na-emetụta usoro pathogenetic nke nsogbu. - analgesia, antacids, ụgwọ nke electrolyte nguzozi na mmezi nke BCC, desensitizing elekọta mmadụ.

Ejiri ọgwụ nje antibacterial na ọgwụ nje na-akpata pancreotropic (carbopenems, fluoroquinolones III - IV) site na ụbọchị mbụ ọgwụgwọ.

Emere ihe omumu nke hrekoloji nke akwara na ulo nke purucreatic na onyonyo-light (anakpo akụkụ nke paraffin na Mayer hematoxylin na picrofuchsin dika Van Gieson si kwuo).

IHE OMUME NA EGO

N'ime ndị ọrịa 19 (90.5%) nwere ọrịa pancreatitis dị oke njọ, n'agbanyeghị ọgwụgwọ a na-eme ọgwụgwọ zuru oke, ihe ngosi maka itinye aka n'ịwa ahụ pụtara n'oge dị iche iche nke ọgwụgwọ, bụ nke dabere na: usoro nchekwa na-adịghị mma, mmụba mmụba na iyi egwu nke ọtụtụ akụkụ ọdịda. . N'ime ndị ọrịa iri na atọ, arụ ọrụ laparoscopic (debridement, mwepu nke omental bursa na eriri afọ, anụ ahụ parapancreatic) ka etinyere usoro mbido nke ịwa ahụ, nke naanị n'otu ụzọ arụpụtaghị laparotomy na-esote. Ọnụnọ na oge laparoscopy nke plaques nke steatonecrosis ma ọ bụ (na) hemorrhagic effusion egosighi enweghị ọrịị nke necrosis na ọrịa parapancreatitis.

A rụrụ ọrụ ahụ n'ụbọchị mbụ - ndị ọrịa 7 (36.8%), site na awa 24 ruo 48. - atọ (15.8%), 5 (26.3%) - site na awa 48 ruo 72, nke fọdụrụ (4

- 21.1%) mgbe ụbọchị atọ ma ọ bụ karịa gasịrị.

Ejiri ịwa ahụ ọdịnala: laparotomy, afo nke Sub-

ọnya afọ, ihe gbasara ala, mkpochapụ na mkpụkọ nke necrotic foci nke anụ ahụ retroperitoneal. Ọ bụrụ na ihe kpatara nnukwu ọrịa pancreatitis bụ ọrịa gallstone, mgbe ahụ ọrụ cholecystectomy gbakwụnyere ọrụ na ntụgharị na mmebi nke choledochus. Ndị ọrịa rọrọ ọrịa laparotomy nke dị elu, nke mere ka o kwe omume inweta nkọwa zuru oke banyere njirimara nke mmebi ahụ akwara, retroperitoneal fiva, n'ụzọ dị iche na mini-accesses (laparoscopic), nke chọrọ itinye ihe ugboro ugboro.

Anyị kpachapụrụ anya kụọ ma ọria akwara na anụ ahụ, n'agbanyeghị ihe iyi egwu nke ibute ọrịa ebe ndị a, n'ihi N'oge a, ọ dị mkpa iji kpochapụ ihe na-abawanye mmụba.

Egosiputara nnukwu (ihe karịrị 50%) na ndị ọrịa iri na abụọ (63,2%) nwere ọrịa laparotomi, na 7 (36.8%)

- ntakịrị ihe, nke kacha bụrụ ihe na - emebi akwara anụ ahụ. Anyị jiri nhazi ọkwa nke M.I. gosipụtara. Prutkov, dabere na nke a na-ekewa eriri para-pancreatic niile n'akụkụ anọ: elu quadrant ^ 1), elu quadrant ^ 1), quadrant ala ala aka nri ^ 2) na ala ala quadrant ^ 2). Achọpụtara nkesa nke usoro na anụ ahụ parapancreatic n'aka ekpe (S1-S2 quadrants) na 100% nke ikpe, nke dabara na ọmụmụ gara aga. Na mgbakwunye, na okwu 6 (21.1%) akara akpọ retropancreatocellulitis na-agbasa rue diaphragm ^ 1), na 4 (15.9%) - Central retroperitoneocellulitis na-agbasa na mesocolon, mgbọrọgwụ nke obere eriri afọ, ruo obere. pelvis, na ikpe 9 (52.6%) - S1-S2, D1-D2. N'ụzọ bụ isi, ndị a bụ ụdị mmebi nke oghere oghere nkịtị (re-traperitoneocellulitis, infiltrates, phlegmon ma ọ bụ mwepu nke oghere cellular retroperitoneal).

Ejikwa oge a na-ahụ maka ndị ọrịa site na ngalaba nlekọta ahụ ike na-eji infusion, antibacterial, antienzyme, cytostatic therapy jiri extracorporeal detoxification ụzọ.

Nnyocha izizi Postmortem na nyocha nke akụkọ na - esote n'ọnọdụ niile enwetara nchọpụta arụmọrụ nke nejiosis nke akwara na ụdị paracikotic paracikosis.

E gosipụtara mmeri nke eriri parapancreatic n'ụdị edema ma ọ bụ ọbara ọbara, yana necrosis na-egbu egbu. Ọrịa ụbụrụ nke ụbụrụ nke ọrịa azụ ma ọ bụ sero-hemorrhagic nke nwere ezigbo nchekwube nke edematous pancreatitis na ụbọchị na-abịa mgbe mmalite ya na-enwekarị mgbanwe mgbanwe, mana oge niile na-enye mmeghachi nke abụọ. Mgbe ụfọdụ

isi ọbara na anụ ahụ retroperitoneal tinyere coagulation nke diapedezno kwafuru ọbara.

Akpukpo ngwongwo nke Parapancreal tinyere aka na usoro a na - eme ihe fọrọ nke nta ka ọ bụrụ n'otu oge na mmepe nke mgbanwe na-emebi emebi na pancreas, mana mmeri ya na ụlọ ọgwụ na-abụ ihe kachasị mkpa mgbe ejiri ọrịa bute mmalite nke ọrịa.

Site na mmerụ ahụ kachasị nke ọdụdụ akwara (karịa 90%), a na-ahụ mgbanwe ndị kachasị na anụ ahụ retroperitoneal n'akụkụ akụkụ nke akụkụ ahụ, akụkụ nke eriri ala na akụkụ paranephria. N’ime usoro nke nnukwu ọrịa pancreatitis dị njọ (20 - 25%), anụ ahụ retroperitoneal na-emetụta akụkụ niile nke pancreas, usoro mbibi ahụ na-agbasa n'akụkụ abụọ, yana isi ihe, na-ejide ihe na -akpata ihe na -akpata obere eriri afọ, na-abịakarị na pelvic anụ ahụ. A na-ejikọkarị nnukwu abụba na ngwakọta nke akwara na-eme ka ọnụnọ buru ibu nke necrosis na-ebe dị na lymphostasis, ọnụ ọgụgụ kasịnụ n'ime ha na-ahụkwa na mgbọrọgwụ nke obere eriri afọ, na nnukwu nhicha. N'ime mpaghara ndị a, n'ọtụtụ oge, ọnya aseptic na-etolite n'oge mmalite nke ọrịa ahụ. A na-ahụkarị mmeri nke oke mmanye ahụ na ndị ọrịa buru ibu nwere ụdị ajọ akwara nke ọkpọ. Site na ụbọchị 1-3 nke mmalite nke ọrịa ahụ, a na-ahụkarị ọtụtụ ọdịmma nke necrosis, na-ejikọtakarịrị onwe ha na oke mmanụ ahụ. Malite n’ụbọchị nke atọ, a na-achọpụta mkpụrụ ndụ polymorphic sel nke omentum.

Nchoputa ahu choputara na onwu ubochi ato nke onwu anwu 54.5% (ndi oria 11 nwuru), n’ime ubochi ise - 9.1% (1 nwuru), ndi ozo 36.3% (ndi oria asaa) - n’oge di iche. Mgbe arụchara endoscopic (ndị ọrịa 8), ọnụ ọgụgụ ndị nwụrụ mgbe ọ dị ụbọchị atọ bụ 50% (ndị ọrịa 4 nwụrụ), n'ime ụbọchị 5 - 25% (2 nwụrụ), ndị ọzọ - 25% (2) - n'oge dị iche. Ihe omuma ndi a gosiputara adighi ike nke oru endoscopic nke nwere oria parapancreatitis.

Ekwesịrị ịhazi ya na teknụzụ ndị na-adịghị ala ala nke ukwuu

(ọnụọgụ dị ukwuu, ihe karịrị 50%) ọnya nke pancreas nwere ọnya isi nke ọrịa parapancreatic n'ọtụtụ ikpe adịghị arụ ọrụ dịka usoro ọgwụgwọ ikpeazụ nke ịwa ahụ ma nwee ike ịbụ ọkwa mbụ nke usoro ọgwụgwọ dị mgbagwoju anya. O kwere omume na usoro ịwa ahụ na-agagharị agagharị, nke gụnyere ikewapụ ngwangwa site na eriri parapancreatic, nnukwu mmiri mmiri, imeghe oke nnabata, yana oke ọgwụgwọ mmadụ ga - eso rụọ ọrụ kachasị mma maka ọrịa parapancreatitis.

1. Vashetko R.V., Tolstoy A.D., Kurygin A.A., Stoyko Yu.M. Nnukwu pancreatitis na mmerụ ahụ pancreatic: aka. maka ndị dọkịta. - St. Petersburg: Publọ Mbipụta "Peter", 2000. - 320 p.

2. Kalashov P. B. Enweghi ike nke puru iche nke oria akwara nke mgbe oria akwara: etiopathogenesis, nyocha ya na ukpuru ya bu ihe omumu nke ogwugwo. - 2003. - Nke 4. - S. 5 - 11.

3. Kostyuchenko A.L., Filin V.I. Ọrịa gbasara ihe mberede: Akwụkwọ ntuziaka maka ndị dibịa. - nkp. 2nd, rev. ma tinye. - SPb.: Publọ obibi akwụkwọ “Dean”, 2000. - 480 p.

4. Nesterenko Yu.A., Laptev VV, Mikhailu-sov S.V. Nchoputa na ọgwụgwọ nke pancreatitis na-emebi emebi. - Nke abụọ ed., Revised. ma tinye. - M.: BINOM-Press LLC, 2004. - 340 p.

5. Pugaev A.V., Achkasov E.E. Ọrịa pancreatitis. - M., 2007 .-- 336 p.

6. Prudkov M.I. Necrotizing pancreatitis, retroperitoneonecrosis na otutu akụkụ ọdịda // gerywa ahụ nke necrotizing pancreatitis: Mater. ntughari. sayensị-arụ ọrụ conf. / N'okpuru ngụkọta. ed. M.I. Prudkova. - Yekaterinburg: ụlọ akwụkwọ Ural. Mahadum, 2001. - S. 21-26.

7. Stadnikov B.A. Okpukpo ogwu na nnwale banyere iji neuropeptides na hyaluronic acid n’ogidi ogwu nke nsogbu nke anakpo anakpo pancreatitis: nkịtị. diski . Dr. med. sayensị. - Orenburg, 2005 .-- 39 p.

8. Tolstoy A.D., Panov V.P., Krasnorogov V.B. et al. Parapancreatitis. Etiology, pathogenesis, nyocha, ọgwụgwọ. - St. Petersburg: Houselọ Mbipụta “Light Ìhè”, 2003. - 256 p.

9. Tolstoy A.D. Nnukwu ọrịa akwara: nnukwu ihe isi ike, ohere, atụmanya. - SPb., 1997 .-- 139 p.

Epidemiology na etiology

Ntọala nke nhazi nke akwara na morphological nke nnukwu ọrịa ọrịa pancreatitis bụ ụdị ọrịa ahụ, intraperitoneal na nsogbu usoro, na-eburu n'uche ọnya ọnya nke akwara na akụkụ dị iche iche nke anụ ahụ na -akpọ azụ, usoro mmalite nke usoro mkpali-necrotic site na abacterial ruo na nje.

I. Edematous (ọrịa intaneti) pancreatitis.

II. Ọrịa necrosis na-egbu egbu.

- dịka nsogbu nke ọnya si dị: dị ụkọ na zuru ebe niile.

- site na okike nke ọnya: ọdụdụ, ọbara ọgbụgba, agwakọta.

III. Ọrịa necrosis na-efe efe.

Na usoro na-efe efe:

1. Parapancreatic infiltrate (omenobursitis, volumetric fluid formations nke retroperitoneal localalization).

2. Necrotic (aseptic) phlegmon nke eriri retroperitoneal (parapancraeal, paraclinical, perinephral, ​​pelvic, wdg)

3. Peritonitis: enzymatic (abacterial).

4. Pseudocyst (akpali mmasị).

5. Ọbara ọgbụgba (intraperitoneal na n'ime eriri afọ)

Na oge ọrịa:

1. Septic cellulitis nke eriri retroperitoneal: parapancreal, paraclinical, perinephral, ​​pelvic.

2. Ahụhụ pancreatogenic (oghere oghere cellular ma ọ bụ ubí nwa)

3. Peritonitis fibrinous-purulent (mpaghara, nkịtị).

4. Pseudocyst bu oria.

5. Pistulas nke dị n'ime na mpụga, eriri afọ na eriri afọ.

6. Ọbara ọgbụgba (intraperitoneal na eriri afọ)

1. Ahụhụ ụjọ akwara na-enwe ọria akwara na -akpa ekwo ekwo na nsogbu ịba n’ime ime ya.

2. Ugwu a na-egbu egbu (oria na-egbu egbu) na nje akwara na-ebute ọria ya na nsogbu afọ.

3. Ọkpụkpụ akụkụ na -eme ka nwoke ma ọ bụ olumba necrosis na-ebute ma na nsogbu ha.

Epidemiology na etiology edit |

Gini bụ ọria nnuku na enweghi oria?

Ka ọ dị ugbua, ekwenyere na ọrịa ọria ala na-arịa ọrịa nwere nsogbu dịgasị iche iche, mana azịza nke gịnị bụ nsogbu ya na ihe ga-esite na ya pụta.

N'ọnọdụ ụfọdụ, n'ime ndị ọrịa nwere ọrịa na-adịghị ala ala nke nwere ọrịa jaundice n'ihi mkpakọ nke ngalaba intrapancreatic nke choledochus ma ọ bụ choledocholithiasis, mgbaàmà nke ọrịa dịka ịba ụba cholestasis na ahụ ọkụ, ọnya dị elu leukocytosis, mmanya egbu, na encephalopathy. Dịka iwu, foto dị otú ahụ bụ n'ihi mmepe nke cholangitis. N'okwu a, enwere ihe ngosi maka iwepụ ihe bile, nke cholangiostomy na-arụ ọrụ nke ọma site na iji eriri T-tube. Na enweghị cholecystolithiasis, enwere ike ịrụ cholecystostomy.

Omentitis, ligamentitis, epiploit

Ndabere nke nsogbu ndị a niile bụ enzymatic ọnya nke anụ ahụ na- akpụ - nke ahụ bụ omentum, ligament nke peritoneum na abụba abụba nke eriri, nke ahụ na-eduga na mbufụt perifocal nke abụọ.
E nwere ụdị atọ nke ọrịa ogbu na nkwonkwo nke pancreatogenic, nke nwere ike ịbụ nkebi nke mmepe nke nsogbu: enzymatic, infiltrative na purulent-necrotic. A na - amata ọnya enzymatic nke bishọp site n'ọbara nke ọnya ahụ, ọbara ọgbụgba n'ime anụ ya na steatonecrosis. Otutu ahụ karie ma buru oke ibu, ihe ndi ozo bu aru nke necrotic leciion: foci nke steatonecrosis na - enwe otutu ma na - emekorita onwe ha. Encapsulation nke steatonecrosis na-eduga n'inwe mmepe nke polycystic omentitis n'ọdịnihu yana mkpesa cysts nke ga-ekwe omume. N’izu nke abụọ nke izu nke mmepe nke ihe otite nke panreatogenic, itesasị ya n’ite omentum ya na mmiri mmịpụta ma ọ bụ nguzo ya na ili ala n’iru ya nwere ike ime. Ọrịa purulent-necrotic amentitis nwere ike gbagwojuru anya site na purulent peritonitis ma ọ bụ, n'akụkụ akụkụ olu afọ, imerime ọnya ịwa ahụ na ịbịanye ọnya purulent.
N'ime akwara nke afọ, ihe ndị na - eme ka akwara dị imebi na-emebi akpukpo imeju. Ọrịa ligamentitis na epiploitis dị iche na nkewapụ iche karịa ọrịa omentitis, a na-atụkwasịkwara ya obi naanị site na laparoscopy ma ọ bụ n'oge ntinye nke afọ dị mkpa.

Ọrịa siri ike nke nnukwu mmanụ ahụ na-abụ ihe ngosipụta maka myirịta ya, ọ kachasị ndị ọrịa buru ibu. Ọ bụrụ na ọ gaghị ekwe omume itinye aka na iwepu omentum ahụ na ọnụnọ ma ọ bụ oghere ndị nwere ọnya ahụ, a na-egosipụta olulu ndị dị otú ahụ, usoro na ọgbụgba ahụ.

Ahụhụ akwara

Ọrịa pancreatogenic nwere ike ibute nnukwu ọrịa akwara ma nwee ike ịchọta ya na ngọngọ nke ya, na akwara paragancreatic, na paranephric na oghere oghere dị n'akụkụ pancreas (pancreas).
Ọpụpụ nke akwara, dịka, ọnya ndị dịpụrụ adịpụ na ọkpụrụkpụ nke ahụ parenchyma, na-adịkarị ụzụ ma na-etolitekwa n'ihi nsonaazụ nke abụọ na agbaze nke nnukwu ọmụmụ nke akwara. E guzobere ya karịa izu iri abụọ na asaa mgbe mmalite nke ọrịa ahụ ma a gbabeghị ya, dịka iwu, na isi nke pancreas. A na-ejikọkarị ọnya intrapancreatic na parapancreatitis ma ọ bụ omentobursitis.
Na onyonyo onyonyo nke ihe akwara nke akwara, ya na ihe mgbaàmà izugbe nke e ji mara ụdị purulent-inflammatory sistem ọ bụla (adịghị ike na-arịa ọrịa, ọkụ ọgbụgba, akpata oyi, hyperleukocytosis, wdg), e nwere ihe ịrịba ama nke etuto ahụ dị ka ihe mgbawa ugwu n'akụkụ akụkụ ahụ dị n'akụkụ. Site na mwepu nke anụ ahụ, a na-ahụkarị ihe mgbaàmà nke duodenum na choledoch na mmebi nke mkpochapụ nke ihe ahụ.
Uzo ichoputara oria a na acho acho bu ihe anakpo anakpo ultrasound na CT. Ọ bụrụ na achọpụtara etuto ahụ, a na-ejide ya na ultrasound ma ọ bụ njikwa CT, na-esote ntinye nke igbapu-lumen na ịrụzigharị ike oghere ahụ. N'ọnọdụ ezighi ezi nke usoro ndị a, ihe ngosi pụtara maka laparotomy, oghere ịwa ahụ na mwepụ nke purulent na-elekwasị anya na mmụba na-esote ya. Okwesiri iburu n’uche na oburu n’inwe oganihu n’aru, ogha aru nke ọgwụgwọ dabere na nkwado nkpa na nkwanye ugwu nke onye oria n’azu, tinyere nkwado nri, ogwu ogwu, mgbochi ogwu, tinyere extracorporeal (ultraviolet irradiation of ọbara, wdg).
Difficultiesfọdụ nsogbu na ịchọpụta na ịgwọ ọrịa ọnya bụ nkwonkwo purulent mpaghara, yana otu nchikota na purulent parapancreatitis ma ọ bụ omentobursitis. N'okwu ndị a, ntinye aka na-abụkarị naanị na mmeghe na igbapu nke purulent foci gburugburu pancreas, ọnụnọ intraorgan bụ nke a na-ahụ anya ma nwee ike bụrụ ihe ndabere maka nsogbu ọhụụ, ruo na mmepe nke nsogbu nke pancreatogenic. Mgbe ụfọdụ, yana nnukwu ọrịa purulent na pancreas na anụ ahụ retroperitoneal, ọnya polydiaphragmatic na - ebili - n'akụkụ aka ekpe na subhepatic. Nsonaazụ nke ihe na-egbochi ọnya ọgbụgba na ọnya dị na mpaghara ala pancreas n'ime oghere nke oghere site na mesocolon nwere ike bụrụ ọnya afọ, ọnụnọ nke enwere ike ịgbazigharị mgbe ụfọdụ naanị na imeghere emeghe nke oghere afọ.
Ọsọ, mana nnukwu nsogbu nke ọgịrịga akwara nwere ike ịbụ portal vein thrombosis na pylephlebitis, ọnya ezumike banye na duodenum, afo ma ọ bụ ọnya ọnya, ọnya na-agba site na arịa dị n'akụkụ nke na-enye isi ọwụwa, isi ihe na-asọ oyi. Yabụ, ichekwa ihe ịrịba ama nke ọrịa purulent na-arụ ọrụ mgbe a gbasara ịwa ahụ na mpaghara a na-egosi na ọnụnọ nke intraorgan, na-amalite laparotomy na ntụgharị nke akwara, ma ọ bụ chọọ usoro purulent na imeju ma ọ bụ splin.

N'ime ndị ọrịa nwere ọrịa biliary na-adịghị ala ala na ọnụnọ choledocholithiasis na-enweghị nchọpụta, mmepe nke ọnya cholangiogenic ga-ekwe omume. Ha na-eme ya na ọgbụgbọ, oke ọkụ, jaundice, hyperleukocytosis nwere akara hematological nke microbial mmanya. Site na anụ ahụ, enwere ike ikpebi mmụba nke imeju, mgbaàmà ọma nke Ortner, ọnụnọ dị elu nke diaphragm n'akụkụ aka nri yana mgbochi nke ngaghari nke obere onu nke ngụ aka nri. Nnyocha X-ray nke obi na-ekpughe nri nwere ụdị diski ọkachasị na mpaghara ime mmiri nke akpa ume ma ọ bụ aka nri. Dabere na ultrasound na CT, ekpughere nsonye na nha nke ọnya afọ, yana ERCP - ihe kpatara cholangitis (choledoch nkume, stenosis nke BDS, wdg).
Ofgwọ ọrịa ezumike cholangitis nke imeju na-agụnye iwebata oke ọgwụ mgbochi ọgwụ n'ime nsị na-esi ísì ụtọ site na akpati celiac catheterized ma ọ bụ aorta karịa mmpụta ya. Ihe ngosipụta maka ọgwụgwọ ịwa ahụ bụ ọnụnọ nke ọnya ọnya nke ukwuu, nke nwere ike ịre mmiri kpam kpam n'okpuru nchịkwa ultrasound ma ọ bụ njikwa CT ma ọ bụ jiri laparoscopy (dabere na ọnọdụ nke etuto ahụ), na-esote ntinye nke igbapu-lumen abụọ.
Ọrịa Spleen na-etolite site na infarction spleen. Ejiri mara mgbu afọ na -akpata ọrịa, ọkachasị mpaghara hypochondrium. Oge ụfọdụ enwere ike ịpịkọta mgbatị na-egbu mgbu ma na-egbu mgbu. Nnyocha X-ray nke akụkụ ahụ obi na-ekpughe ọkwa dị elu nke dome nke diaphragm na mmachi nke agagharị, ikike ịmịcha aka na -akpata ikike ekpe. Achọpụtara nyocha ahụ site na ultrasound na CT ma emesia guzosie ike mgbe nchọpụta ọnya nke ọnya site na oghere intercostal n'okpuru nchịkwa nke ultrasound. A na-ejikarị nsị na mwepụ nke ọgịga ọnụnọ a n'akụkụ akwa nke ọgịrịga ahụ dị n'akụkụ mpaghara ya site na mmalite nke oghere oghere ahụ na ịnata ntụkwasị obi nke ihe ndị ahụ.

Parapancreatitis

Parapancreatitis bụ nsogbu na-apụtakarị ọrịa akwara nke ọrịa akwara na-egosipụta site na ọnya mkpali nke anụ ahụ retroperitoneal periopancreatic. A na - eke ọrịa pancreatogenic parapancreatitis niile, dabere na njikọta na mwakpo nke ọrịa pancreatitis na - adịghị ala ala ma ọ bụ nke ọ na - arịa ọrịa pancreatitis. Ọrịa Parapancreatitis nke ukwu na-ekewa n'ime serous-hemorrhagic, necrotic na purulent-necrotic, na ala ala - na sclerotic ma ọ bụ polycystic.
Ọrịa parapancreatitis. Na mmalite nke mbuso agha nke pancreatitis, mbibi nke parapancreatic fiber na-egosi n'ụdị edema, ọbara ọgbụgba ma ọ bụ necrosis na-egbu egbu.Serous na sero-hemorrhagic impregnation of retroperitoneal tissue nwere ezigbo nchekwaba nke edematous pancreatitis na ụbọchị na-abịanụ mgbe ihe mechara ya, dịka iwu, na-enyocha mmepe ma ọ naghị enye mmeghachi nke abụọ oge niile. Ọbara na - adịkarị obere bụ oke ọbara ọgbụgba na akwara azụ nke na --emepụta obere mkpụchi na mpaghara diapedezno ọbara wụsara. N'okwu a, ọbara abanyela na eriri ahụ na-eso akpata mmeghachi ahụ mkparịta ụka perifocal na njikọ nke infiltrate dị gburugburu pancreas.

Ihe na - akpata ọrịa na - akpata ọbara ọgbụgba necrotic parapancreatitis, na mgbakwunye na ọbara ọgbụgba nke retroperitoneal fiber, bụ necrosis buru ibu. N'okpuru ọnọdụ bidoro, ụdị ọnya ọgbụgba ahụ na-arịa ahụ nwayọ (ọnwa 3 ma ọ bụ karịa) na mpaghara akụkụ mgbanwe na cicatricial mgbanwe na eriri gburugburu ngwo, ma ọ bụ mechie ya na mmepe nke ahụpigasị parapancreatic.
Na ọnọdụ purulent-putrefactive ọrịa, purulent-necrotic parapancreatitis na-etolite na saịtị nke infiltrate, njirimara njirimara nke bụ agbaze nke necrotic foci nke anụ ahụ retroperitoneal, nsonye nke nwere ike ịdị iche.
Ọ dịghị nhịahụ ịrịa ọrịa parapancreatitis, ma ọ bụrụ na icheta na ọnya ọnya ọgbụgba azụ retroperitoneal na-etolite na ndị ọrịa niile nwere nnukwu OH. Mgbanwe nke mbufụt ke infiltrative-necrotic ma ọ bụ purulent-necrotic parapancreatitis ka meserery nke obere na colon na ndị ọrịa dị otú ahụ na-egosipụta site na akpọ paresis akpọrọ. Mgbe usoro a ga - agbasa na akwara nke eriri afọ, akụkụ ọpụpụ nke mpaghara lumbar achọpụtara. Ejiri mmerụ ahụ necrotic anụ ahụ dị ukwuu na-egosipụta ihe ọzịza na-egbu mgbu ma CT achọpụta ya. Nnukwu parapancreatitis na ịkọwapụta ihe bụ isi na mpaghara nke isi ihe na - esochi ya na mgbaàmà nke mkpakọ nke duodenum ma ọ bụ choledochus.
Ọgwụ nke arịa ọbara ọgbụgba na ọrịa parapancreatitis na -echekarị ncheta, gụnyere mgbazi nke ọgwụgwọ ọrịa ọgwụ ọrịa pancreatitis, ọgwụgwọ detoxification dịkwuo elu na iwebata ọgwụ ọgwụ antibacterial maka ebumnuche prophylactic. Enwere ike iji ọgwụgwọ ọgwụ nje na-agwọ ọrịa parapancreatitis na usoro nke ọgwụ mgbochi mbupụ na-emegide usoro ịba ọcha n'anya na mgbe ị na-eji ọgwụ ọgbụgba ọkụ ma ọ bụ nchịkwa mpaghara na nchịkwa endolymphatic nke ọgwụ nje.
Na oké ọgbụgba parapatcreatitis nke nwere mbufụt nke necrotic, yana ọrịa purulent necrotic parapancreatitis, a na-egosipụta ọgwụgwọ ịwa ahụ.
Ọrịa na-adịghị ala ala. A pụrụ ịtụle parapancreatitis na-adịghị ala ala dị ka otu n'ime nsonaazụ nke ndagwurugwu metụtara nsogbu nke OH (omentitis ma ọ bụ nnukwu parapancreatitis), nke na-enwebeghị mgbanwe purulent. A na-ahụkarị ọrịa parapancreatitis site na onyonyo a na-ahụ anya na-adịghị ahụkebe, mgbe ụfọdụ na-e pancomi mwakpo ugboro ugboro nke ọrịa akwara na-adịghị ala ala. A na-eme ka nchọpụta nke ọrịa ppanlent na-adịghị ala ala site na ọnụnọ nke purulent fistulas nke dị n'ahụ ndị ọrịa. Sclerosing parapancreatitis nwere ike inye aka na mkpakọ nke arịa ọbara dị n'akụkụ ma jee ozi dị ka isi ihe maka mmepe nke afọ ischemic syndrome na ọbara mgbali mpaghara.

Usoro ọgwụgwọ nke ọrịa parapancreatitis na-adịghị ala ala bụ nke a na-adịghị agbanwe agbanwe, agbanyeghị, arụmọrụ a na-eme atụmatụ na ndị ọrịa dị otú ahụ ka a na-eme naanị ma ọ bụrụ na nsogbu bilitere: mkpakọ nke akwara na akwara na akụkụ ahụ, mgbaàmà nke ọbara mgbali elu na nnukwu ihe mgbaàmà nke afọ ischemic syndrome na-eguzogide ọgwụgwọ.

Compdị Mkpakọ

Egosiputa nsogbu mbu nke anakpo pancreatitis site na:

• Ujo nke na - aputa site na nmalite nke toxins na ngwaahịa nke gland. Ọnọdụ a na-esochi nnukwu mgbu.
• Enzymatic peritonitis, n'ihi nsonaazụ nke enzymes nke gland na-ezo, na-emetụta peritoneum n'ụzọ dị njọ.
• Ọrịa akwara ikpa, ma ọ bụ mbufụt nke pancreas, nke emere ka ọnwu dị elu mata.

Kedụ ka mmanya ogbugbu nke nnukwu ọrịa si emetụta ahụ?

N'ihi ị withụbiga ọria na panreatitis, ọrịa metụtara akụrụ na hepatic ezughi oke ga-ekwe omume. Na-emegide nzụlite nke ọrịa gland, ọrịa ọnya afọ. Nnukwu ọrịa akwara na-akpata mbibi nkuume. Mmiri oyi na-efe efe na-amalite n'ihi mmetụta toxins na-emetụta sistem. Xụ nsị na-akpata ọgba aghara nke ụjọ ahụ n'ụdị ịda mba na psychosis.

Mgbe ebusoro ọnọdụ nke izugbe ọnọdụ na pancreatitis, nsogbu oge na-apụta. Ọ na-aputa ihe karie n'izu nke atọ mgbe mmalite nke ụdị ọrịa ahụ. N'ọnọdụ ndị dị elu, nsogbu ndị a na-akwụsị na sepsis. A ga-agwọ ndị ọrịa nwere ụdị nchọpụta ahụ na ọnọdụ ụlọ ọgwụ.

Ọrịa mbufụt metụtara ọrịa:

1. Ọrịa preatful purulent, na-eduga n'ịba ụba nke gland.
2. Parapancreatitis, mbufụt nke eriri periopancreatic.
3. Phlegmon bụ ụdi n'ụdị mbufụt okolozhiruyu.
4. Ọnụnọ gbasara afọ, tinyere ọnya na-efe efe.
5. Guzobe Fistula.
6. Sepsis, mara nke oke onwu.

Usoro ahụ akọwapụtara n'ihe banyere ọgwụgwọ na-adịghị mma, na-agbasoghị ndụmọdụ nke ndị ọkachamara na-edugakarị ọnwụ cell, usoro mkpali na-ejedebe na ọnwụ.

Pylephlebitis

Mgbagha bụ mbufụt nke akwara ozi ọbara na - anakọta ọbara site n'ahụ ya. Ọrịa a na -eweta ọnọdụ mgbu n'akụkụ aka nri nke afọ. Ihe mgbaàmà nke ọrịa bụ jaundice, ịsụsọ oke, oke ọkụ.

Ọrịa ahụ na-amalite ngwa ngwa, oge maka ọgwụgwọ nwere oke. Nchọpụta ezighi ezi, enyemaka na-enweghị enyemaka maka akụkụ kachasị na-eduga n'ọnwụ.

Kedu ihe bụ amụma nhịahụ ọfụma?

N'ọnọdụ nsogbu nke ọrịa akwara na-akpata nsogbu, amụma ga-akụda mmụọ ga-ekwe omume. Ọtụtụ na-ebute ọnwụ. Ihe ndị a na - apụghị ịgbagha agbagha bụ mbufụt purupat nke na-abanye n'ime sepsis.

Isi ihe mere emetụta ọrịa ahụ bụ mmanya. Ndị ọrịa na-ahapụghị mmetụta ọjọọ ya nwere nkwarụ ma ọ bụ nwụọ.

Ọrịa necrosis na-emetụta ya na nsonazụ ya

Complicdị nchoputa a gosipụtara na otu ụzọ n’ụzọ atọ nke ndị ọrịa.

1. Ọrịa: e jiri ya na usoro mkpali metụtara ihe nkwụsị n'ọbara ọbara na gland. N'ihi ya, ọnwụ anụ ahụ na-ebilite, necrosis amalite. Mkpụrụ ndụ nwụrụ anwụ na-ebute ahụ. Mgbe oria batara n’ọbara, a na-agha arụ ọrụ nke akụkụ ahụ ndị ọzọ. Nsogbu ndagide a na-apụta izu atọ mgbe ihe ịrịba ama mbụ nke nnukwu pancreatitis pụtara. Site na ọgwụgwọ na-enweghị isi, onye ọrịa ahụ nwụrụ.
2. Dịka ọrịa ndị ọzọ, a na-eji ọgwụ nje maka ụdị nsogbu a. Iji kwụsị ọrịa ahụ, achọrọ ya ka iwepu akụkụ ahụ nwụrụ anwụ. Wepu akụkụ nke ndị nwụrụ anwụ na-eme ọtụtụ ụzọ. Removaldị Mwepụ kachasị mfe bụ catheter. Withnwee ụdị dị iche iche nke ọrịa ahụ, a na-atụzi ịwa ahụ ọcha. Usoro ịwa ahụ dị ka nke a - akụkụ dị n'azụ na-adị ntakịrị, mgbe nke a gasịrị, ị na-etinye tube dị mkpa. A na-ewepụ ihe ndị dị n'ime anụ ahụ nwụrụ anwụ site na nsị. A naghị eji usoro laparoscopy eme ihe mgbe niile. Maka ndị buru oke ibu, a na-eme nsị n'afọ. A na-ahụta na ọrịa ogbu egbu egbu bụ ọrịa siri ike. Ọbụna na nlekọta nlekọta ahụike nke mbụ, ndị ọrịa ọ bụla nke ise depụtara na-anwụ n'ihi ọdịda nke akụkụ ndị agbata obi na-arụ ọrụ.
3. A na-egosikwa oria nke mmeghachi omume mkpali (CERD). Nke a bụ nchọpụta a na-ahụkarị na-eme ya na nnukwu ọrịa ọrịa pancreatitis, ma na-eduga n'ọgba aghara nke anụ ahụ.

Gịnị bụ pseudo cyst

Nke a bụ nsogbu a na-ahụkarị bụ nke ejikọtara ya na ọgwụgwọ na - adịghị mma nke ọrịa pancreatitis.

Formkpụrụ ahụ na-enweta ụdị “sacs” nke etolite na mgbidi nke pancreas. N'ime mmiri ahụ na-eto. Ọrịa ndị yiri ya na-etolite otu ọnwa mgbe nchọpụta ya gasị. Ọ gaghị ekwe omume ikpebi pseudocysts na-enweghị akụrụngwa. Symptomsfọdụ mgbaàmà na-egosi ọnụnọ nke ọnya ọrịa. Egosiputa n'ụdị:

• afọ ọsịsa na bloating,
• mgbu na-egbu mgbu
• eriri afọ.

Ọ bụrụ na ọrịa adịghị enwe ahụ erughị ala metụtara ọnụnọ nke usoro, ọ dịghị mkpa iwepụ ha. Ọ bụrụ n ’ọ ga-aba n’iyi na sentimita isii, ọbara ga-apụta. A na-agwọ ụdị buru ibu site na ịmị mmiri site na oghere.

Kedu otu esi zere nsogbu ndị metụtara nnukwu ọrịa ọrịa pancreatitis?

Otu isi ihe kpatara ihe ize ndụ bụ mmanya, ojiji nke a na-eduga na nsonaazụ mwute Liancegbaso nkwenye nke ndị ọkachamara na mgbanwe obibi ndụ ga - enyere aka belata ihe ndị na - adịghị mma. Mwepụ mmanya na nri na -ebelata ihe ize ndụ nke ọrịa ndị ọzọ, enweghị ọrịa dị oke njọ, dịka ọmụmaatụ, kansa.

Nkịtị eriri afọ

Iji gbochie ọrịa gallstone, ịkwesịrị iri nri dị mma. N'ime nri onye ọrịa na-arịa ụdị nchọpụta a, obere abụba kwesịrị ịdị.

A na-ebute ihe ndị dị mkpa na nri ihe oriri, mkpụrụ osisi na mkpụrụ osisi. Isi ihe dị na nri ga-abụ oatmeal, ọka site na osikapa agba aja aja ma ọ bụ oatmeal. Erimeri yiri nke a bu iji belata ego cholesterol na ihe mejupụtara nke bile.

Ndị abụba na-enwekarị nsogbu na okwute n’ime akpa, mmụba nke cholesterol. Iji zere nke a, ị ga na-edozigharị oge niile, na-agbaso nri ma na-emega ahụ. Typesdị mmega ndị a ma ama bụ ihe omume ikuku, ịgba ígwè ma ọ bụ ịgba ígwè. Ọ bụrụ n’inwe obi abụọ ọ bụla gbasara ụdị mmega ahụ, chọọ enyemaka ahụike.

Maka ụdị mgbagwoju anya ọ bụla, a ga-ewepụrịrị ihe mgbu na mmanya. A na-eji ọgwụ nje ụdị ọhụụ akọwapụtara. Mmejuputa atumatu doro anya nke ndi dibia, n’agbanyeghi na o kweghi nkwa ogwugwo zuru oke, kama o na-ekwe nkwa ezi ahuike na ndu mara nma.

Omentnt, ligamentitis, epiploit

Ndabere nke nsogbu ndị a niile bụ mwepu enzymatic nke usoro ndị nwere anụ ahụ (mmanụ ụnụ, akwara nke peritoneum na abụba mara abụba), na-eduga na mbufụt perifocal nke abụọ.

Enwere ụdị omentitis pancreatogenic atọ, nke nwere ike ịbụ nkebi nke otu usoro: enzymatic, infiltrative and purulent-necrotic. Site na Morphologically, a na-eji enzymatic omentitis edema nke satyr ka ukwuu, ọbara ọgbụgba n'ahụ ya na steatonecrosis. Otutu ahụ karie ma buru oke ibu, ihe ndi ozo bu aru nke necrotic leciion: foci nke steatonecrosis na - enwe otutu ma na - emekorita onwe ha.

Encapsulation nke steatonecrosis na-eduga n'inwe mmepe nke polycystic omentitis n'ọdịnihu yana mkpesa cysts nke ga-ekwe omume. N'ime izu abụọ nke mmalite nke mbufụt nke pancreatogenic, ịgbasasị otite nke otite ahụ na mmiri mmiri ga-ekwe omume ma ọ bụ guzobe ọnya na sequesters na ọkpụrụkpụ ya. Ọrịa purulent-necrotic omentitis nwere ike gbagwojuru anya site na pitalent peritonitis, ma ọ bụ igbachi ọnya ọnya ahụ na ihe omume (ebe ọ bụ na nnukwu akwa ahụ dị n'akụkụ mgbidi akụkụ ihu).

Ihe ndị dị n'ime iwe na - emerụ imeju imeju. Ọrịa ligamentitis na epiploitis dị iche na nkewapụ iche karịa ọrịa omentitis, a na-atụkwasịkwara ya obi naanị site na laparoscopy ma ọ bụ n'oge ntinye nke afọ dị mkpa.

Ọrịa siri ike nke oke mmanụ akpụ - ihe ngosipụta maka myirịta ya, ọ kachasị ndị ọrịa buru ibu. Ọ bụrụ na ọ gaghị ekwe omume iwepu akwa ahụ na oghere ma ọ bụ oghere ndị nwere oghere, a na-egosipụta oghere nke usoro ndị a, usoro na ọgbụgba mmiri.

Ọrịa Parapancreatitis nke ukwu

Na mmalite nke mbuso agha nke ọgụ, ọ na-egosipụta mbibi nke eriri parapancreatic n'ụdị edema, ọbara ọgbụgba ma ọ bụ necrosis na-egbu egbu. O sighi ike ichoputa oria parapancreatitis, ma oburu n’icheta na oria obara nke retroperitoneal kettica na ebido n’azu ndi oria nile. Mgbanwe nke mbufụt ke infiltrative-necrotic ma ọ bụ purulent-necrotic parapancreatitis ka meserery nke obere na colon na ndị ọrịa dị otú ahụ na-egosipụta site na akpọ paresis akpọrọ.

Mgbe usoro a ga - agbasa na akwara nke eriri afọ, a na - achọpụta edema nke anụ ahụ dị n'okpuru mpaghara lumbar. Eji mmerụ akwara dị nebi nke akwara na-egbu akwara ozi na CT. Nnukwu parapancreatitis na ịkọwapụta ihe bụ isi na mpaghara nke isi ihe na - esochi ya na mgbaàmà nke mkpakọ nke duodenum ma ọ bụ choledochus.

Ọgwụ nke serous-hemorrhagic and hemorrhagic parapancreatitis bụ conservative, na-agụnye ọgwụgwọ nke pancreatitis, ọgwụgwọ detoxification na nkwalite na iwebata ọgwụ antibacterial maka ebumnuche prophylactic.

Candị parapancreatitis nwere ike ịgwọ ọrịa site na iji ọgwụ mgbochi buru ibu dabere na usoro ịgwọ ọrịa na-agbasa megide mmalite nke ịba ọcha n'anya, karịsịa site na ntinye akwara ma ọ bụ na -akpọ ihe mgbu na nchịkwa endolymphatic nke ọgwụ. Na oké ọbara ọgbụgba parapancreatitis na mmalite purulent iwe nke necrotic eriri, yana niile purulent necrotic parapancreatitis, ọgwụgwọ ịwa ahụ na-egosi.

Ọrịa na-adịghị ala ala

A na-ahụta ọrịa parapancreatitis na-adịghị ala ala dịka otu n'ime nsonaazụ nke nsogbu nsogbu metụtara mbu nke OP (omentitis ma ọ bụ nnukwu parapancreatitis), nke na-enwebeghị mgbanwe purulent. A na-ahụkarị ọrịa parapancreatitis site na onyonyo a na-edoghị edo anya, mgbe ụfọdụ na-eitatingomi ọgụ ugboro ugboro nke CP. Ọrịa parapancreatitis na-adịghị ala ala dị mfe ịchọpụta ma ọ bụrụ na ndị ọrịa nwere fistulas purulent mpụga.

Sclerosing parapancreatitis nwere ike mpikota arịa arịa ọbara ma bụrụ ihe dị mkpa na mmepe nke afọ ischemic syndrome na ọbara mgbali mpaghara. Usoro ọgwụgwọ nke ọrịa parapancreatitis na-adịghị ala ala bụ nke a na-adịghị agbanwe agbanwe, agbanyeghị, arụmọrụ a na-eme atụmatụ na ndị ọrịa dị otú ahụ ka a na-eme naanị ma ọ bụrụ na nsogbu bilitere: mkpakọ nke akwara na akwara na akụkụ ahụ, mgbaàmà nke ọbara mgbali elu na nnukwu ihe mgbaàmà nke afọ ischemic syndrome na-eguzogide ọgwụgwọ.