Ihe na-akpata ọdịdị na ọgwụgwọ nke necrosis

Arụ na ahụ mmadụ na-arụ ọtụtụ ọrụ (nhazi, ịkwado, nchebe, wdg), yabụ, mmebi ọ bụla nke metabolism nke mkpụrụ ndụ nwere ike ịkpalite mmeghachi omume na-emebi ihe. Ọ bụrụ na achọpụtara ajọ ọrịa akwara, o nwere ike ịbụ na a na-enyo enyo necrosis pancreatic. Ọrịa a metụtara ihe dịka 10−20% nke ndị bi n'ụwa.

Ihe na-akpata ya na iche

A na-akpọ Necrosis ọnwụ nke ọrịa anụ ahụ na-akpata, nke sitere na mbufụt ya. Ime ihe ngwa ngwa nke enzymes emee, na - ebute mmebi nke iguzosi ike n’ezi ihe nke uru ahụ na akwara vaskụla.

Iji hụ na ọgwụgwọ kachasị, ọ dị mkpa iji gosipụta ihe kpatara ọrịa ahụ. Dabere na ọnụ ọgụgụ, na 70% nke ikpe, a na-achọpụta ọrịa pancreatic necrosis n'ime ndị na-a abuseụ mmanya. N'ime 30% nke ndị ọrịa, pathology na-etolite megide oria akwara.

Ọzọkwa, ihe ndị na-akpata necrosis nwere ike ịbụ ihe ndị a:

ị .ụbiga mmanya ókè
na ngụgụ nke cholecystitis,
ọnya ọnya
pathologies nke ọrịa na-efe efe,
oriri na-egbu egbu,
mmerụ ime na ịba n’afọ.

Ojiji nke ọgwụ na-adịghị mma, yana ojiji ha ogologo oge, nwere ike ịkpasu mmepe nke ọrịa ahụ. Ọnụego ọnya ọrịa na mgbaàmà ya nwekwara ike ịdị iche. Somefọdụ, ọrịa ahụ ekwupụtala ihe ịrịba ama ma tobe ngwa ngwa, ebe ndị ọzọ fọrọ nke nta ka ọ bụrụ na ha anaghị achọpụta ọnụnọ nke ọrịa.

A na - ahụ ụdị dị iche iche nke necrosis pancreatic:

na-emebi ihe
edematous
ọbara ọgbụgba
hemostatic.

Demdị ụdị ọrịa ecdematous nwere prognosis kachasị mma, ebe ọ na-aga n'ihu n'ụdị dị nro. Site na nyocha nke oge na ọgwụgwọ n'oge, ohere nke ịgbake zuru oke dị oke.

Ihe nrịbama

Ihe akwara nke akwara nke Pancreatic necrosis bu ihe ngosi nke ihe mgbu na mpaghara hypochondrium aka ekpe, ebe enwere ike inye ihe mgbu na mpaghara obi ma obu ubu.

You nwere ike ịmata ọdịiche dị n’etiti nkụchi akwara nkụwa sitere na nkụchi obi n’ime ụzọ ndị a:

N ’oche, dọrọ ikpere gị n’afọ,
Ọ bụrụ na ọrịa mgbu na-ebelata nke ukwuu ma ọ bụ na-apụ n'anya kpamkpam, mgbe ahụ, nke a bụ necrosis.

Otu n'ime ihe ịrịba ama nke ọrịa ahụ bụ mgbu na hypochondrium ekpe, nke nwere ike inyefe mpaghara ubu ma ọ bụ obi. Mgbe ụfọdụ ọ na-esiri onye ọrịa ike ikpebi ọnọdụ ihe mgbu a, nke bụ herpes zoster.

Isi ihe akwara nke pancreatic necrosis bu ndi a:

Ire. Usoro ịgba ụka na-apụta na eriri afọ na-eme ka ịkpụbe gas abawanye. N'ihi nke a, a na-ejigide gas, nke na-eduga ná mgbochi na afọ ntachi.
Ogbugbu ma ọ bụ ọgbụgbọ na-ebelataghị ọnọdụ ahụ na ejikọghị ya na iri nri. Vomit nwere ike ịnwe ọbara na ọbara. Nke a bụ n'ihi eziokwu ahụ bụ na ya na necrosis nke anụ ahụ, mbibi nke arịa ọbara. Vom siri ike na - eme ka akpịrị kọọ, mbelata nke mmamịrị na - emepụta, yana n'ihi nke a, enweghị urination.
Mgbu, ike ya na-ekpebi ụdị ihe ọrịa ahụ na ogo ya. Ya mere, anaghị ekwupụta ihe mgbu oge niile. N'ụfọdụ ndị ọrịa, ihe mgbu ahụ adịghị ala, ebe ndị ọzọ (ihe dị ka 90%) na-ata ahụhụ site na mgbu na-egbu mgbu, nke enwere ike ibute ọrịa obi na ọnya ruo ọnwụ.
Mmanya Ka usoro ogwu ahụ na-eto, ọnụọgụ nke ọrịa na-abawanye nke ukwuu, ngwaahịa metabolic ha na-ebutekwa egbu egbu. Mmadụ na-enwe adịghị ike nke ukwuu, ọbara mgbali ya na-ada, tachycardia na-apụta ma iku ume dị obere. Ihe mmetụta na-egbu egbu nke microorganisms pathogenic nwere ike ime ka mmepe nke encephalopathy na-akpasu ọbụna coma.
Hyperemia. N'iji udiri oria a di elu, n'ihi oke ịxụ ahụ nke anụ ahụ, akpụkpọ ahụ na-acha nke ọma. N'ihi ọbara ọgbụgba n'ime, ntụpọ na-acha anụnụ anụnụ na-apụta n'akụkụ abụọ nke azụ na afọ, mgbe ụfọdụ na otube.
Ọria ọnya. Nke a bụ ọkwa dị oke elu n'ọrịa ahụ. N'ihi oke mmanya na mmepe nke usoro mkpali, ogo nke pancreas na-abawanye nke ukwuu, nke na-enyere aka n'ịmepụta ọrịre na mmepe nke ịba ọcha n'anya. Nnyocha nke ụdị ahụ bụ ihe na-akụda mmụọ.

Nsogbu na nsonaazụ ya

Site na mmepe ngwa ngwa nke pancreatic necrosis nwere ike ime ka ọnwụ nke onye ọrịa n'ime otu ụbọchị mmalite nke ọrịa ahụ. Nnọpụta nke ndụ nwere anụ ahụ necrosis na-adabere ọ bụghị naanị na nbibi nke mbibi yana mpaghara nkesa, kamakwa na mpaghara nke ọrịa azụ. Ọrịa ụkwara akwara nwekwara ike ibute nsonaazụ ndị a:

edere n'ụbụrụ,
mgbapu nke trakili biliary
nnukwu mbibi anụ ahụ
mmebi nke pancreas na afọ n'onwe ya n'ihi ọbara mepere emepe,
mmenaanya nke eriri afọ.

Mkpakọ nwere ike ịdị ka ndị a:

na-agba ọbara na eriri afọ,
nkuchi pancreiki, ngbanye ume na pancreas (pancreas),
akuko nke oma
ọnyá afọ
peritonitis
ụkọ enzyme
thrombosis venous,
akwara anụ ahụ na akụkụ afọ,
ala ujo (mgbu ma ọ bụ toxicological).

Ọrịa aria Pancreatic nwere ike ịkpalite mmepe nke ọrịa shuga mellitus, kansa kansa ma ọ bụ akwara na-eduga n'ọnwụ. Iji wepu ihe kpatara ya na ihe mgbaàmà nke nnukwu ọrịa ọrịa pancreatitis, yana igbochi nsogbu ndị ọzọ, a na-egosi ndị ọrịa ịwa ahụ.

Pleurisy nwere ike iji aka ekpe na uezie ya. Formszọ abụọ a na-enye nsogbu nke akpa ume. Onye ọrịa ahụ na-akụda iku ume iku ume, yana ihe mgbaàmà ndị dịka mgbu n'azụ azụ azụ, akpụkpọ anụ anụnụ anụnụ, na iku ume iku ume.

Ọkpụkpụ akwara ọbara-ọbara nwere mgbaama ndị a:

obi palpitations
acha odo odo,
ntụgharị uche
imeju imeju
akpụkpọ anụ mucous na akpụkpọ,
mmụba ọbara mgbali elu na 200 mmHg na elu,
enweghị mmamịrị ma ọ bụ mmụba ya.

10-15% nke ndị ọrịa nwere nnukwu ọrịa pancreatitis nwere nsogbu ndị purulent. N'okwu a, ọnọdụ onye ọrịa dị njọ, ọnwu nke ọnwụ na-amụba ọtụtụ oge. Ọrịa ụbụrụ na-etolite dịka mmeghachi omume fermentopathic ozugbo maka ọdịdị nke ihe dị iche iche (ọgba aghara nke sistem akwara, nsị nri, wdg).

Ọrịa na ọgwụgwọ

N'ime usoro mmalite nke mmepe nke ọrịa ahụ, a na-eji ọgwụ ọgwụ eme ihe n'ụzọ gara nke ọma, na-enweghị mkpa ịwa ahụ. Ya mere, ọ dị ezigbo mkpa ịchọpụta ọrịa ahụ na oge wee gaa na ọgwụgwọ ya. Nchọpụta ahụ gụnyere ọmụmụ gbasara anamnesis, mkpesa nke onye ọrịa, yana usoro ndị dị mkpa. Maka nke a, usoro nyocha abụọ ka edepụtara: usoro na laabu.

Nnyocha ụlọ nyocha na-egosi nnwale ọbara dị ogologo, ebe ọ bụ akwara necrossial bu ọnọdụ ndi a:

ubara shuga, yana ogo nke leukocytes na neutrophils,
mmụba n'ọnụ ọgụgụ nke ESR,
n'ihi akpịrị ịkpọ nkụ, a na-achọpụta mmụba nke trypsin, elastase na hematocrit,
uto nke enzymes imeju bụkwa ihe ịrịba ama nke mmepe nke usoro mkpali.

Nchọpụta nyocha ihe omume gụnyere ọrụ ndị a:

ntụgharị nke arịa nke pancreas,
Ultrasound, nke na-enye ohere ikpebi usoro ezighi ezi nke gland, ọnụnọ / enweghị ọnya, ọnya, okwute na ọnya biliary na mmiri dị n'ime oghere afọ.
ndọta ndọta
nyocha laparoscopy,
mgbapu
agbakọrọ tomography, nke na - enyere aka ịchọpụta ọdịiche nke ọrịa ahụ, yana ikpebi oke anụ ahụ n'onwe ya na ọnụnọ nke usoro mkpali nke eriri.

Ọ bụrụ na ị na-enyo nzụlite mmepe nke ọrịa akwara pensụl, onye ọrịa kwesịrị ịga ụlọ ọgwụ ozugbo. Prognosis nke ọrịa ahụ ga-adị mma naanị ma ọ bụrụ na amalitere ọgwụgwọ n'oge. Enyemaka mbụ na ọnụnọ nke purulent-septisis nsogbu gụnyere iji usoro ọgwụgwọ ma ọ bụ nke ịwa ahụ, yana idebe iwu nke nri pụrụ iche.

Nri nri

A na-achịkwa nri nke onye ọrịa ahụ na ịka dọkịta ahụ. Maka akwa akwa, ọ bụ ihe amamihe dị na ya iji mmanụ olive ma ọ bụ sunflower ma ọ bụ naanị na obere obere. Ndị ọkachamara na-enye ndụmọdụ iri nri ndị a:

achịcha stale
mmiri ara ehi skim na obere kalori ụlọ,
ndị na-eme mkpọtụ
Mkpụrụ osisi na-adịghị acidic
akwa omelet.

Nke ihe ọ drinksụ ,ụ, ihe ọ juụicesụ na-enweghị shuga, compotes, efere nke ọhịa ọhịa, na tii na-adịghị ike zuru oke.

Onye ọrịa ahụ kwesịrị ịchọpụta ngọngọ maka ụdị ngwaahịa ndị a:

soseji na anụ m smụrụ
kabeji ọcha, ose, yabasị
mẹ ndu ọwhu
nri shuga dị elu
mmanya na-egbu egbu
ọka na agwa
ihe ọ juiceụpeụ mkpụrụ osisi vaịn.

Na mgbakwunye, ịkwesighi iri muffins, nri mkpọ, nri mara abụba (mmiri ara ehi, azụ, anụ), ofe ero.

Ọgwụ ọgwụ

Ọrịa nje nke akwara na-ebute ọrịa megide nje na-efe efe. Ọgwụgwọ kwesịrị ịdị ngwa ma n’oge, n’ihi na oge ọ bụla nwere ike igbu mmadụ. Onweghi oge ichoputa udiri oria nkiti, ya mere dokita tiri ogwu mgbochi. Ma ọ bụghị ya, mmepe nke sepsis na ọnwụ ozugbo enwere ike.

Ọgwụ ọgwụ na-emetụta iji ọgwụ ndị na-esonụ n'ọtụtụ ọgwụ mgbochi:

Gatifloxacin na levofloxacin,
Cefepim
Meropenem na Imipenem.

Ọgwụ ọhụrụ bụ nke ndị na-edebe ihe, a na-ejikwa ya naanị n'ọnọdụ ndị dị oke njọ.

A na-eme ịwa ahụ site na laparotomy ma ọ bụ laparoscopy. Ihe ọghọm ndị dị na ọgwụgwọ a bụ enweghị nkwa na nsogbu ndị nwere ike ịdapụta na nzụlite anụ ahụ necrosis mgbe a wasịrị ya ahụ. Ya mere, a na-emezigharị ndị ọrịa oge ụfọdụ n'ụlọ ọgwụ n'okpuru nlekọta nke ndị ọkachamara elekere.

Oge weghachite ya na akwara nke akwara na-ewe ogologo oge - ihe dị ka otu afọ. N'ime onye ọrịa a manyere idebe izu ike ogologo oge, enwere ike ịhụ mgbatị nkwonkwo ụkwụ yana mgbatị. N'ihi nke a, mmadụ na - atụfu ikike nke iguzoro onwe ya. Ọkachamara na-adụ ndị ọrịa niile oge ezumike ume iji mee ihe omume pụrụ iche iji mee ka ụda olu dịkwuo elu. Nke nta nke nta, ha na-agbakwunye ije ije nwayọ. Na njedebe ngwụsị usoro ọgwụgwọ, ị nwere ike ịmalite ọzụzụ ike.

Site n'ọrịa dị otú ahụ, ọ na-esiri ike ịme amụma ọ bụla. Nke bu eziokwu bu na udiri oria a na - eme ka onodu onwu di elu (ihe dika 70%), agbanyeghi iji uzo ogwu di elu nke ndi ogwu ogbara ohuru na - enye. Agbanyeghị, enwere ike ịnwe ọgwụgwọ zuru oke ka dị mma.

A na-ekpebi ịkọ nkọ dị mma site na ịrịọ dọkịta ọsọ, afọ onye ọrịa, yana ụdị oria na ogo mmebi ahụ. Ndị ọrịa a chọpụtara n'ọrịa micronecrosis nwere ohere gbakere. Ọ bụrụ na akụkụ akwara nke n’akwara na-emetụta akụkụ akwara ahụ, ihe ga-egbu ya, ọ dị mwute ikwu, enweghị atụ.

Ofdị nke necrosis pancreatic

Dabere na nkesa na ntinye nke usoro mbibi, enwere:

necrosis na-egbu egbu,
juputara na ya (n'ihi ihe akwara nke pancreatic pancreatic necrosis, ihe buru ibu na - emetụta ihe niile di n’ime ya),
ngụkọta (mmeri zuru oke nke akụkụ ngwa ngwa).

Dabere ma usoro ọrịa ahụ na-esonyere usoro na-efe efe:

onye nwere oria, ya bu, oria onye oria,
akpali mmasị - enweghị ọrịa.

Iledị enweghị atụ nke pancreatic necrosis nwere ike ime na otu n'ime ụzọ atọ a na-ahụ maka akwara ọrịa:

Abụba Ọkpụkpụ nke usoro necrotic na-apụta nwayọ, karịa ụbọchị 4-5, prognosis na nke a bụ ihe kachasị mma.
Ọbara. Mmepe nke ọrịa ahụ na-eme ngwa ngwa, na-enwekarị ọbara ọgbụgba n'ime.
Gwakọta. Enwere akara nke ụdị abụba na ọbara ọgbụgba, ụdị a bụkarị.

Isi ihe kpatara ya

Ihe na - ebutekarị ọrịa akwara na-egbu egbu bụ ị drinkingụ ihe ọ alcoholụ andụ na-aba n'anya na iri nri na-adịghị mma. Ọzọkwa, n'ọtụtụ ọnọdụ, a na-achọpụta necrosis na-egbu ọfụma mgbe ejiri mmanya na nri mara abụba were otu. Ọtụtụ mgbe, nke a na-eme n'ememe, mgbe ọ gachara oriri oriri nke oke abụba na ihe ọholicụholicụ na-aba n'anya. A ga-ahụrịrị mgbaama nke mmepe nke ọrịa ahụ n’ụbọchị mbụ mgbe ekpughere ihe kpatara ya.

Ihe ọzọ ga - eme ka pancreatic necrosis nwere ike ịmalite bụ ọnụnọ nke cholelithiasis n'ime onye ọrịa. N'okwu a, akwara ndị a na-emechi emechi ka akwara dị, n'ihi nke mgbali intracleal na-ebili, anụ ahụ na-agbazekwa.

Ihe ndị na-akpata ọria akwara na-esite n’azụ nwekwara ike ịbụ nsogbu ndị bilitere mgbe a wasịrị ya ahụ, mmerụ ahụ n’ime afọ, na eriri afọ na-ewe iwe. N'ihi otu n'ime ihe ndị a dị n'elu, reflux na - apụta - a na - atụba ihe na - eme ka a na - eme ka a na - emeghachi omume na enzymatic.

Usoro ogwu nke pancreatic pancreatitis sitere na mmebi nke usoro nchebe mpaghara nke akụkụ ahụ. Nwebata nri na mmanya na-abawanye ụba na-eme ka emeputa mmiri mpụta dị nke ukwuu, n'ihi nke ọ na-agbasa ihe ọ juiceụ pancụ nke pancreatic ma bute akwara ndị ahụ. N'ihi nrụgide dị ukwuu n'ime akwara ndị ahụ, a na-emepụta parenchyma edema, a na-ebibi akụkụ acini. Ihe niile a na - eme ka akwara dị ukwuu nke akwara anụ ahụ (mgbaze nke mkpụrụ ndụ abụba na mgbidi vaskụla). Site na ntinye ọzọ nke enzymes na ngwaahịa mebiri emebi na sistem, a na-emetụta ihe niile na-egbu egbu. Ahụhụ na-eme na imeju, akụrụ, obi, ụbụrụ.

Ma n’agbanyeghi na onweghi onye dị nchebe pụọ na mmepe nke ọrịa akwara dị n’ọkpụkpụ, ị nwere ike ikpebi otu ihe egwu ga-esi mee ka ọrịa a. Nke a kwesiri ị includeụbiga mmanya na-egbu egbu, yana ndị ọrịa na-arịa ọrịa gallstone, ọrịa hepatic, na nsogbu nke eriri afọ. Ndị mmadụ na-arịa ọrịa afọ ma ọ bụ akụkụ akwara akụkụ nọkwa ebe a.

Usoro mmepe

Nwere ike ikwu maka mmalite nke oria ọrịa ọbụlagodi tupu a achọpụta ihe mgbaàmà mbụ. Ihe ndabere maka mmepe nke ọrịa akwara na-akụrisị bụ ọdịda nke usoro nchebe obodo nke pancreas.

Ọga n'ihu ọrịa a na - ewere ọnọdụ na usoro atọ:

Ogbe toxemia.Mgbe ihe kpatara nke ahụ gbasoro akwara, enwere ihe mmụba na mpụta nke mpụga nke akụkụ ahụ yana oke mgbanye nke gland, n'ihi nke a na-enwe mmụba na mmalite nke usoro anụ ahụ necrosis. Nke ahụ bụ, ahụ ahụ dig dig onwe ya. N'ihe banyere Lipase activation, abụba sel necrosis na-eme; a na - akpọ abụba a na usoro akwara nke akwara na -akpọ abụba. Ma ọ bụrụ na ịgbalite elastase emee, mbibi akwara bidoro, n'ọnọdụ nke ọ bụ omenala ikwu banyere ụdị ọbara ọgbụgba. N'okwu abụọ ahụ, a gaghị ezere ọdịda ọtụtụ akụkụ ahụ, ya bụ, ọnya nke akụkụ ahụ niile dị mkpa - obi, umeji, akụrụ na ụbụrụ.
Mgbe oria bidoro itolite, ọnwu amalite. Na ọkwa a, a na-eme usoro mkpali na gland, nke na - esochizi akụkụ ahụ ndị ọzọ na - esote oghere purulent na-esote.
Iji bulie ohere nke nsonaazụ dị mma, ọ dị mkpa iji zere mmepe nke agba nke atọ nke mmepe nke akwara purulent. Ọ bụrụ na ọrịa ahụ erutela n'ọkwa a, ọbụlagodi ọgwụgwọ kachasị ọhụụ na nke ọkachamara anaghị enye nkwa ọ bụla.

Ihe njiri mara

Ihe onyonyo a na-acho onyonyo nke akwara nke puru iche di nkpa, odi mfe ichoputa ya na oria ndi ozo. Ihe mgbaàmà nke mmepe nke ọrịa ahụ bụ isi ihe mgbu dị na mpaghara aka ekpe ma na-efegharị na azụ, ubu, ma ọ bụ ukwu. Ọtụtụ mgbe, ọ na-esiri onye ọrịa ike ịchọpụta kpọmkwem ọnọdụ ihe mgbu ahụ, ọ na-ekwu na ọ bụ herpes zoster. Dabere na ogo mmepe usoro necrotic, ihe mgbu ahụ nwere ike ịdị oke iche: ọnụọgụ anụ ahụ mebiri emebi karị, ihe mgbu ahụ na-enwe ntakịrị, n'ihi necrosis nke anụ ahụ na njedebe akwara.

Ọ bụ ya mere imezi ọdịmma onye ọrịa ya na necrosis nke ekpughere ekpughe bụ ihe mgbaàmà dị oke njọ, nke kwesịrị ka agbatị usoro ọgwụgwọ ahụ ga-agbaso. Agbanyeghị, mwepụ ihe mgbu na mmalite nke mmalite nke ọrịa ahụ enwere ike mgbe onye ọrịa ahụ nwetagoro aka na dina n'akụkụ ya na ikpere.

Ihe mgbaàmà ọzọ mgbe mmalite nke mgbu bụ ọgbụgbọ na ọgbụgbọ. N'agbanyeghị nri a na-eri na ihe ndị ọzọ, onye ọrịa na-eme mkpesa nke ọgbụgbọ na-enweghị atụ. Mgbe ị na-enyocha ọgbụgbọ na ọgbụgba, enwere ike ịchọpụta adịghị adị nke ọbara na ọbara. Ọbụlagodi na nri enweghị na afọ, ọgbụgbọ ga na-aga n’ihu, mana ugbua n’ụdị mkpụkọ ọbara na bile. Nke a na - egosi na enwere usoro ibibi arịa ọbara site na elastase. Mgbe ogologo oge nke ọgbụgbọ gasịrị, akpịrị kpọrọ nkụ na - apụta. Ahụ onye ọrịa wee kpọọ nkụ, ọnya na-egosi na ire, a na-enwe nkụ n'ime oghere mucous, a na -ebelata mmamịrị ahụ na ọnụnọ ya zuru oke, akpịrị na-akpọ nkụ mgbe niile, nke na-enweghị ike ịkwụsị ya n'ihi ọgbụgbọ na-adịgide.

Ndakpọ nke eriri afọ bụ ihe ọzọ na-egosi mmalite nke mmepe nke ọrịa. N'ihi "mmechi" nke pancreas site na usoro mgbari nri, ihe na-adịghị mma dị na sistemụ a, ọgbụgba na isi na-apụta, yana njigide afọ na gas. Furtherzọ ọzọ ọrịa ahụ na-eduga n'ịxụbiga ahụ anụ ahụ, ihe ịrịba ama nke ndị bụ:

na-abawanye na ahụ ọkụ ruo ogo 38 na karịa,
okpukpu obi, iku ume
iku ume ya dị mkpụmkpụ,
na-ebelata ọbara mgbali elu
adighi ike na aru.

Site na mgbasa nke toxins na-emebi ihe na ụbụrụ, encephalopathy na-etolite, nke na-egosipụta onwe ya n'ọgba aghara, na-abawanye ike ma ọ bụ, na mkparịta ụka, inhibition, disorientation na mbara. Ihe kachasị njọ nsonaazụ nke egbu egbu bụ coma.

A na-egosipụta nrịba ama nke ọrịa ọrịa na mgbanwe na anụahụ. Nke mbu, site na mwepu nke pancreas nke vasoactive ihe na - eme ka akwara obara ghara imeghari, o mere ka amalitegharia ahu ya, site na mmalite mmenaanya akpukpo ahu ghichazi, mgbe e mechara agba nke akpukpo aru nwere ike ibu icteric, earthy, marble. N'ọnọdụ ụfọdụ, ọbara ọgbụgba nwere ike ibilite, na-apụta n'ụdị ọnya-acha uhie uhie na-acha odo odo, nke mbụ n’elu afọ, emesia n’akụkụ ndị ọzọ nke ahụ. Na agbanyeghị ike dị iche iche ndị na - eme ọgwụgwọ, usoro toxemia dị ihe dịka mkpụrụ ụbọchị 4-5 na mmụba kwa ụbọchị na ngosipụta nke mgbaàmà.

Agba nke ozo banyere onyonyo nke oria bu oria nke purulent infiltrates - nsogbu diri usoro necrotic n’ime akwara. Ọdịdị nke ọtụtụ akụkụ na - amalite ime - arụ ọrụ nke arụ niile dị oke mkpa. Na mgbakwunye na mgbaàmà izugbe, n'ọtụtụ ebe enwere ụdị nsogbu dị iche iche. Ndị kasị dị ize ndụ bụ:

peritonitis
ọbara ọgbụgba n'ime
nnukwu oghere afọ,
ụkọ enzyme
ọbara egbochi,
mgbu ma ọ bụ ujo na-efe efe.

Ọ bụrụ na ọ dịkarịa ala otu n’ime nsogbu ndị ahụ mere, ihe ga-esite na ya bụ ọrịa ga-abụ ihe nwute.

Ọgwụgwọ etinyere

Dika a gha eme nyocha nke ikpe azu, odi nkpa ka eji emegharia ahu ogwu. A na-ebugharị onye ọrịa ozugbo n'ụlọ ọrụ nlekọta kpụ ọkụ n'ọnụ nke ngalaba ịwa ahụ. Ekwesịrị imepụta usoro ọgwụgwọ ọgwụgwọ naanị n'ụlọ ọgwụ. Nke mbu, ogwu bu n’obi igbochi usoro ibibi aru n’agha: igbochi igbari onwe nke pancreas, wepu ihe mmetuta ahu, ma oburu na achoputala ihe iriba ama, wepu ya ozugbo. Prognosis kachasị dị mma nwere ike ịbụ ma ọ bụrụ na achọtara ọrịa ahụ n'oge mmalite ma malite ọgwụgwọ n'oge kwesịrị ekwesị.

Maka ọgwụgwọ nke necrosis, a na-eji ụzọ nchekwa na ịwa ahụ. Uzo nke ncheghari gunyere ihe ndia:

na-ahụkwa izu ike nke onye ọrịa, ya bụ, izu oke n'ọrụ ahụ ya,
mwepu nke nri a na - eri (a na - enye ahu ahu iji ihe nlebara anya puru iche site na ndi eji etinye ya),
iwebata ọgwụ na-ebelata ihe mgbu (a ga-emerịrị nke a iji zere mmepe nke nsogbu ndị dịka ụfụ mgbu),
igbochi nzuzo nke afọ, pancreas na duodenum (site na nchịkwa intravenous nke ndị ọrụ antienzyme na gastric lavage na mmiri oyi),
na enweghị ọrịa cholelithiasis na-esote, iwebata ọgwụ choleretic ga-ekwe omume,
na-enye hypothermia nke obodo (itinye oyi na afọ),
iwebata ọgwụ mgbochi iji gbochie ma kwụsị usoro mkpali na gland (enwere ike iji ọgwụ nje ndị dị ka cefepim, ciprofloxacin na metronidazole),
nchịkwa intramuscular nke cerucal iji belata ọgbụgbọ,
ya na ihe ngosi di uku nke xicationụbiga mmanya ókè, ọbara di ọcha site na iji plasmapheresis, hemosorption, peritoneal dialysis, hemofiltration,
Iji gbochie ntopute nke ọbara ọgbụgba n'ime, a na-ahazi somatostatin.

Ọ bụrụ na anyị na-atụle ụzọ ọgwụgwọ ịwa ahụ, mgbe ahụ na nchọpụta nke necrosis nke pancreatic necrosis n'ọtụtụ oge, onye ọrịa ahụ kwesịrị ịwa ahụ, ebe ọnụọgụ nke ịgbanahụ ya bụ nke ileghara anya. Ihe ntanetị dị mkpa iji weghachi ihe ọ restoreụ ofụ gland, wepu mpaghara post-necrotic na usoro purulent, kwụsị ọbara ọgbụgba n'ime. Ekwesịrị ịwa ahụ na ọrịa pancreatic necrosis mgbe usoro ọgwụgwọ nke nnukwu gasịrị, nke nwere ike ịdị ihe dị ka ụbọchị 4-5. Enwere ike ịme ịwa ahụ ngwa ngwa ma ọ bụrụ na enwere ọnya anụ ahụ na necrosis, purulent peritonitis na purulent n’akwara na ọnya. N'ọtụtụ oge, ndị ọrịa na-egosigharịgharị maka iwepu nsị na ọrịa na necrotic foci.

Mgbake mgbe ọgwụgwọ

Surgerywa ahụ na usoro ọgwụgwọ ndị ọzọ, ndị dọkịta nwere ike ịkọpụta amụma ga-eme ka onye ọrịa na ndị ikwu ya nwee atụ ọzọ. Site na ọrịa akwara na-eme ka a na-enwe ọria mmadụ, enwere ike ibute nsonaazụ ọbụlagodi ịnye nlekọta ahụike zuru oke. Ọbụna mgbe usoro ọgwụgwọ gara nke ọma, onye ọrịa ahụ ga-achọ ọtụtụ usoro nhazigharị dị mgbagwoju anya. N'ime ọnwa 3-4 ma ọ bụ karịa, a ga-ele mmadụ anya nwere nkwarụ.

Iji gbochie mmepe nke necrosis pancreatic, ọ dị mkpa iji zere ihe ndị na-akpasu iwe a maara maka mmetụta ọjọọ ha na ahụ. Nke a bụ nri na-adịghị mma, ụzọ ndụ ịnọ nkịtị na ị alcoholụbiga mmanya ókè.

Ozi izugbe

Ọrịa akwara bụ ọrịa na-akachasị agbasa bụ ọrịa akwara na-emetụta ihe na-eto eto nke mmadụ. Ọ bụ pathogenesis nke necrosis na-akpata ọdịda nke usoro nke nchedo ihe dị n’ime ahụ na-emebi ihe enzymes na-emebi ihe.

N'oge na-adịbeghị anya, ọnụ ọgụgụ nnukwu ọrịa pancreatitis na-abawanye na Russia - ọrịa a na-abịa n'ọkwa nke abụọ mgbe ọrịa juputara na ọrịa ọgwụ n'ụlọ ọgwụ. Onu ogugu ndi puru iche nke pancreatitis, karie ihe akwara puru iche, na-etolite - rue 20-25%. N'ime ụlọọgwụ dị iche iche, ọnwụ na mbibi nke pancreas ruru 30-80%. Leadingzọ mbu iji belata onwu na necrosis bụ ọrịa nyocha oge, ụlọ ọgwụ yana mbido ọgwụgwọ pathogenetic.

Ihe na-akpata pancreatic necrosis

Ihe kpatara mmepe nke pancreatitis na pancreatic necrosis bụ nsogbu nri na ị alcoholụ mmanya mgbe ụfọdụ. Nchoputa omumu ihe banyere akwara akwara gosiputara na necrosis na-emetari ndi n’enweghi nsogbu ị alcoholu mmanya. Agbanyeghị, n'ọtụtụ oge, mmalite nke pancreatic necrosis na-ebute tupu ị drinkingụ mmanya buru ibu. Ndị ọrịa nwere mmanya na-adịghị ala ala ihe fọrọ nke nta ka ọ bụrụ mgbe niile ịzụlite pancreatitis na-adịghị ala ala, na-adịghị ahụkebe site na necrosis pancreatic. Ihe ịrịba ama mbụ nke ọrịa ahụ nwere ike ịpụta ọtụtụ awa ma ọ bụ ụbọchị mgbe emechara ihe ndị na-akpata ya.

Usoro ogwu nke pancreatic necrosis sitere na mmebi nke mpaghara nchebe nke pancreas. Iri nri na mmanya bara ụba na-eduga na mmụba dị ukwuu na nzuzo nke mpụga, ịrstụbiga mmiri ókè nke oke ahụ. Mmụba intraductal na-akpalite parenchyma edema, mbibi nke pancreatic acini, mmeghari akaghi aka nke enzymes proteolytic, nke na-eduga na nnukwu necrosis nke anụ ahụ gland (mgbaze onwe).

Lipase na-eme ka akwara necrosis nke sel akwara, na - emebi mgbidi ahu. Enzymes na-arụ ọrụ na ngwaahịa mebiri emebi, n'ihi ọrụ nke elastase, banye n'ọbara ọbara, nwee mmetụta na-egbu egbu n'ahụ akụkụ ahụ na anụ ahụ niile. Nke mbu, imeju, akụrụ, obi, ụbụrụ na-ata ahụhụ.

Nkewa

Dabere na usoro ndị na-emebi ihe na-eduga na pathogenesis, abụba, ọbara ọgbụgba na n'ụdị usoro nke pancreatic necrosis na-ezoro ezo.

Dị abụba. Ọ bụrụ na mmụba nke ọrụ lipase adịkarịsịrị, a na-ebibi ihe anụ ahụ na-emebi emebi. Lipase na-adabaghị na mpe mpe mpe akwa, na-eme ka ọdịdị nke necrosis buru ibu, peritoneum, mesia, na akwara dị n’ime. Thedị abụba nke pancreatic necrosis na-ejedebe na mmepe nke ọgwụ kemikal siri ike na akwara, ọtụtụ akụkụ ahụ na-emejọ.
Ọkpụkpụ Hemorrhagic. N'ihe banyere nsogbu nke microcirculatory, spasm nke arịa ahụ na-amalite, na-ebute mmụba ngwa ngwa na edema parenchyma. N'ime ọtụtụ awa ma ọ bụ ụbọchị, toxemia ji nwayọọ nwayọọ na-eduga na paresis nke akwara vaskụla, vasodilation, na-ebelata ọbara ọgbụgba na akwara gland. Ihe a niile na - enye aka na ụba thrombosis, na ọdịnihu - mmepe nke ischemic necrosis. Ntughari nke Elastase na-ebute mbibi nke akwara vaskụla, nke mbụ na ọkpụrụkpụ nke pancreas, ma akụkụ ahụ ndị ọzọ. Na ngwụcha, nke a na - eduga n'ọbara ọgbụgba na pania, hemorrhages n'ime anụ ahụ na akwara retroperitoneal. Ihe ịrịba ama nke ọbara ọgbụgba na-adị n'ọbara bụ mkpochapụ oghere dị n'ime oghere nke ọbara.
Dị agwakọta. Ọ bụrụ na ọrụ nke elastase na lipase dị ihe n’otu ọkwa, ụdị ngwakọta nke pancreatic necrosis na-amalite. N'okwu a, a na-egosipụta ihe ịtụnanya nke necrosis na hyriaha nke imbi ọbara. Site na necrosis pancreatic, ọkwa nke alfa-amylase na-abawanye nke ukwuu, mana eziokwu a adịghị arụ ọrụ na pathogenesis. Amylase bụ naanị ihe dị mkpa banyere ọgwụ.

Ihe mgbaàmà nke necrosis

Mmepe nke pancreatic necrosis ụlọ na-ewere ọnọdụ na atọ. Enwere ike ibute ọnọdụ a site na ọrịa puselent pancreatitis, nnukwu pancreatitis na-egbu egbu, biliary pancreatitis, hemorrhagic pancreatitis. N’agba nke mbụ, uto na-arụ ọrụ n’ime nje na akwara na-akpata toxinemia dị ukwuu ma na-eme ka ọrụ ahụike nke enzymatic na-aba ụba. Ọrịa ahụ na-echegbu onwe ya maka ahụ ọkụ, ọgbụgbọ, na enweghị ike oche. Na ọkwa nke abụọ nke ọrịa ahụ, ngwakọta ụfụ na enzymatic nke gland anụ ahụ na-amalite mgbe etolite otu oghere ma ọ bụ karịa. Na usoro ikpeazụ, usoro mkpali na-agbasa na anụ ahụ gbara ya gburugburu, na-eduga n'ọtụtụ akụkụ anụ ahụ na ọnwụ nke onye ọrịa ahụ.

Ọrịa ahụ nwere mmalite siri ike, ọ na-abụkarị ndị ọrịa na-akpakọrịta nke ọma na njirimara nke akara mbụ na njehie nri na ị dietụ mmanya. Ihe dị ka 70% ndị ọrịa na-anabata n'ụlọ ọgwụ na oke mmanya, nke na-egosi mmepe ngwa ngwa nke mgbanwe mgbanwe akparamagwa na pancreas.

Mgbaàmà nke mbụ na-abụkarị nnukwu ihe mgbu na-egbu mgbu na ọkara n'akụkụ nke afọ na azụ ala, ubu aka ekpe. Enweghị ụdị ọrịa akwara na-adịghị egbu mgbu. Enwere njikọ dị n'etiti ogo ihe mgbu yana ịdị njọ nke ọrịa akwara na-arịa. Mgbasa nke mgbanwe mbibi na njedebe akwara na-eduga ná mgbu nwayọ nwayọ, yana mgbakwunye mmụkọ na-adịgide, nke a bụ ihe mgbaaka prognostic na-adịghị mma.

Oge ụfọdụ mgbe mmalite nke mgbu, ọgbụgbọ na-enweghị nchịkwa na-esiteghị na iri nri ma ọ dịghị eweta ahụ efe. Vomit nwere bile, mkpụkọ ọbara. N'ihi ọgbụgbọ, akpịrị na-emebi emebi, nke anụ ahụ na-egosipụta site na akpụkpọ akọrọ na mucous membranes, na-ekpuchi ire, a na-eji nwayọọ nwayọọ belata ọnụego nke diuresis. Ọkpụkpụ nke eriri afọ na-amalite, ike gwụrụ peristalsis, enwere oge na gas na oche. .Ụ mmiri na akpịrị ịkpọ nkụ na-eji fever.

Toxemia, mgbanwe na glucose ọbara, hyperfermentemia na-eduga mbibi ụbụrụ na mmepe nke encephalopathy, nke na-egosipụta ọgba aghara, oke iwe, ọgba aghara, ruo na mmepe nke coma (ihe dị ka otu ụzọ n'ụzọ atọ nke ndị ọrịa).

Ọkpụkpụ nke usoro mkpali na-eduga na mmụba dị ukwuu na pancreas na nha, nguzobe nke ọgbụgba n'ime oghere apịtị.Ugbua site n'ụbọchị nke ise site na mmalite nke ọrịa, infiltrate ike ọ bụghị naanị palpated, kamakwa anya gba ọtọ. Hyperesthesia nke anụ ahụ na-apụta na nyocha nke pancreas.

Usoro ọgwụgwọ

Ọgwụgwọ nke akwara na-amalite site n'ịhụ na ezumike ezumike zuru ezu. A na-agụpụ mmega ahụ, nri nri enteral, a ga-edenye akwa nke gastric na ngwọta dị jụụ. Akụkụ ndị bụ isi nke ọgwụgwọ bụ ngbanye ọkụ, mgbochi nke enzymes proteolytic, ọgwụgwọ detoxification.

Analgesia. Nnyocha zuru ezu gụnyere ntinye nke analgesics (ọ bụrụ na ọ dị mkpa, narcotic), antispasmodics, dissection of the capsule of pancreas, novocaine mgbochi. Mbelata edema nke gland n'okpuru mmetụta nke diuretics na-eduga na mkpochapu nke ihe mgbu (dịka ọ na-eduga na-eme ka ike gwụ njigide nke capsule pancreatic).
Inye ogwu ogwu. Etodọrọ ọnya na-ebu site na ọnụọgụ nke ọgwụ infusion n'okpuru nchịkwa nke diuresis. Aprotinin agbakwunye na infusion ngwọta. Achọrọ antihistamines.
Ọgwụ nje. Iji gbochie nsogbu purulent, a na -eme ọgwụ mgbochi nje yana ọgwụ mgbochi oke. Usoro ọgwụgwọ Symptomatic gụnyere mgbochi ụjọ ujo, iweghachi ọrụ nke akụkụ ahụ na sistem ndị ọzọ.

Ọgwụ ịwa ahụ

N'ihe fọrọ nke nta ka ọ bụrụ ọrịa pancreatic necrosis, a chọrọ ọgwụgwọ ịwa ahụ iji weghachi ihe ọ juụ ofụ nke pancreatic ma wepụ akwara necrotic (pancreatic necrectomy). N'ime ụbọchị ise mbụ site na mmalite nke usoro ọnya ọgbụgba, a naghị atụ aro ịwa ahụ, ebe ọ bụ na ọ ka agaghị ekwe omume ịchọpụta ọkwa nke necrosis n'ime oge ndị a, mana ihe egwu nke ọrịa ọrịa na nsogbu ọrịa na-abawanye oke.

Na nrịanrịa ọnya afọ, a nwere ike iji usoro dị iche iche (pịppa, laparoscopic, laparotomy) weghachite osisa ahụ site na akwara, wepu oke necrotic, mkpali na exudate ọbara, wee kwụsị ọbara afọ. Enwere ike ịchọpụta imebi imebi iji meziwanye akụkụ ahụ.

Amụma na Mgbochi Ya

Gme prognosis maka ndị ọrịa nwere ọrịa akwara gburu akwara bụ ọrụ siri ike, ebe ọ dabere na ọtụtụ ọnọdụ. Nnọọ ahụ na-akawanye njọ ma ọ bụrụ na otu n'ime ihe ndị a dị ugbu a: afọ karịrị afọ iri ise, leukocytosis karịa 16x10 9 / L, hyperglycemia, agamere, metabolic acidosis, hypotension, urea, LDH na AST, nnukwu ọnwụ nke mmiri si n'ọbara. anụ ahụ. Ọnụnọ nke asaa n'ime njirisi ndị a na-eme ka 100% nwụọ ọnwụ nke onye ọrịa. Mgbochi nke akwara na-egbu egbu bụ oge nnweta nlekọta ahụike, ọgwụgwọ n'oge, gụnyere ịwa ahụ.