He aha nā pancrosatic pancreatic a me ka pancreatic necrosis?

ʻO ka nepe ʻana o ka pancreatic he hopena koʻikoʻi o ka maʻi pancreatitis koʻikoʻi. Hoʻohālikelike ia e nā nekrosis o nā pūnaewele a me ke kino holoʻokoʻa o ka pancreas. ʻO nā hōʻike kulana o nā maʻi he ikaika nui ʻo ka ʻeha o ka ʻōpū, palpitations, ka luaʻi a me ka encephalopathy.

Hoʻomaʻamaʻa ʻo ka helehelena o ka necrosis pancreatic me nā ʻenehana a me nā hana instrumental. Hoʻokumu ʻia ka hana o ka pathology me ka hoʻomakeʻa ʻana o nā enzymes proteolytic, ka hoʻopau ʻana o ka hōʻeha ʻana, detoxification, hoʻihoʻi hou ʻana i ka wai o pancreatic wai a me ka hoʻoweliweli o ka hōʻemi.

ʻO ka liʻiliʻi o ke ola ʻana i kahi maʻi luku he mea liʻiliʻi loa: ʻo ka manawa kūpono ka mālama ʻana i ka maʻi 30-60% wale nō o nā mea maʻi mai kahi hopena hōʻeha. Kuhi i nā helu weliweli, ʻaʻole hiki ke hopohopo no ka ho'ōla no ka holomua pancreatic necrosis.

ʻO ka nekrewa pancreatic a me kāna ʻano

ʻO kekahi maʻi i kekahi ala ʻaʻole ia he hoʻopiʻi o ka pancreatitisʻeha, akā ʻo kekahi o kāna mau papa.

I loko o ka pancreatitis, nā enzymes i hoʻopuka ai ka pancreas i ʻole e hōʻea i ka duodenum 12. ʻO ka hopena, hoʻomaka ka wai pancreatic e hoʻoponopono i ke kino, i kapa ʻia ʻo "ka hoʻowalewale ʻana iā ʻoe iho." Ke hele nei kekahi hanana maʻi, kahi e alakaʻi ai i nā loli luku. A laila aia ka hoʻomohala ʻana o ka hana pinepine ʻana o nā mea maʻi, kahi maʻamau no ka necrosis pancreatic.

I kēia mau lā, ke ulu nei ka nui o ka maʻi pancreatitis i hoʻopaʻa ʻia i nā haukapila i loko o Rūsia. Hāʻawi lākou i nā hihia wale nō o ka appendicitis maʻa. ʻO ka nui o nā mea maʻi e loaʻa nei i ka necrosis pancreatic i hoʻonui ʻia ma 25%. Mai ka make ma muli o nā hoʻololi luhi i ka pancreas ma waena o 30% a 80%, ke ala nui e hōʻemi ai i ka maʻi operative, hospitalization a me ka hoʻoikaika pono ʻana.

ʻO ka hōʻeha ʻana i kekahi mau ʻāpana o ka pancreas e hele ana, ʻoiai ke poʻo, ka kino a me ka ʻili paha, kūpono ka papa inoa o nā pathology.

Nā kumu kumu o ka maʻi

Hoʻopili loa ka etiology o ka pancreatic necrosis me nā meaʻai maikaʻi a me ka hōʻino.

Ke hōʻike nei ka helu helu hōʻole ʻana i ka 70% o nā mea maʻi e loaʻa nei i kēia maʻi i kēlā me kēia manawa aʻai mau i ka waiʻona. ʻO ke kumu ʻelua o ka necrosis pancreatic ka hoʻololi ʻana i nā maʻi gallstone.

He mea nui ia e ulu ana ke kālaʻai i ka wā ʻōpio. ʻO ka neʻe ʻana o ka pancreatic o ka pancreas ma muli o:

1. Waha ulaula o ka ʻōpū a me nā ʻōpio duodenal 12.
2. ʻO kahi meaʻai paʻa ʻole, ka nui o ka momona a me nā meaʻai i loko o ka meaʻai.
3. Ka inu maikaʻi ʻana i ka waiʻona.
4. Ua hana ʻia ma mua.
5. Nā hōʻeha ʻino.
6. Nā ʻōwili a me nā maʻi.
7. ʻO ka maʻi Gallstone.

Hiki i ka necrosis pancreatic ke hele mai i kekahi, akā ke kau ʻia

• uliaola a me nā mea inu wai lāʻau;
• nā kānaka e hōʻeha nei i ka holo ʻana o ka ate a me ka pancreas;
• nā mea maʻi me nā malenations congenital a me nā ala maʻi gastrointestinal;
• poʻe e ʻeha ana iā ʻoe i ka maʻi ʻōpala.

Hoʻololi loa nā hoʻololi Necrotic i nā kino pilikino ʻē aʻe, i hōʻoiaʻiʻo ʻia e nā hoʻokele pathological. Ma muli o ka hopena, hana kaʻi ʻana, nā pēpē a me ke kino o ke kino holoʻokoʻa.

Hiki i kēia ʻano ke hopena i ka holomua o kēlā mau ʻōla:

1. ʻO ka pancreatitis Purulent kekahi o nā pāpā koʻikoʻi loa e hoʻokō ʻia ai nā maʻi phlegmous o ke kino a me ka hoʻokumu ʻana i ka micro-, macroabscesses.
2. ʻO ka pancreatitis acute ka mea maʻi nō ia e hele mai ma muli o ka waiʻona maʻi, a ʻo ka inu hoʻokahi o ka mea inu me nā mea momona.
3. ʻO ka pancreatitis Biliary kahi kahi hana kumu a me nā maʻi i hoʻoliʻiliʻi ʻia i loko o ka pancreas e hele mai ma muli o ka hoʻopōʻino ʻana i ka ʻōpala a me nā puʻuwai.
4. ʻO ka pancreatitis hemorrhagic kahi kūlana koʻikoʻi o ka maʻi, kahi e luku koke ai i ka parenchyma a me ka vascular network, kahi i hāʻawi ʻia i ka hoʻomohala ʻana i ka gangrene, hemorrhage a me peritonitis.

Inā ʻimi pinepine ka mea maʻi i ka kōkua olakino, a laila pili ka hoʻokumu ʻana i ka necrosis i ka hoʻomohala ʻana o kahi hemo, a ma hope o ka mea e hāʻawi ʻole ai ka poʻe loea i kahi kuhi kūpono e ola ai.

ʻO nā hōʻailona nui a me nā hoʻopiʻi

ʻO ka hōʻikeʻana o nā patology e like me ICD-10 ua hoʻokaʻawale ʻia i loko o ʻekolu mau ʻāpana. Hoʻopili ʻia nā hana o ka necrosis pancreatic i kahi pilikia o nā pale kūloko o ke kino.

Hōʻike ʻia ka hana mua o ka pathology me ka hoʻonui wikiwiki o ka baki a me ka hoʻōla ʻana o ka hana wai pancreatic. E hoʻopiʻi ka mea maʻi i ka maʻi o ka maʻi, nā pale o ka luaʻi a me nā maʻi maʻi.

Hōʻike ʻia ka hōʻike hana mua e ka hoʻokumu ʻana i nā ana i loko o ka organ parenchyma ma ke ʻano o ka enzymatic and purulent fusion.

ʻEkolu ke kolu o ka make i ka make, ʻoiai ke kīholo ʻia ana nā māla i nā ʻili kino. Hoʻopilikia kēia i nā hana huelo he nui, a laila pili ka make.

ʻO ka hōʻailona ʻeha o ka maʻi nui ka maʻi ākea o ke kāʻei ʻili i kūloko i ka hapa hema o ka ʻōpū a me ka kua i hope. Aia kahi pilina kūpono ma waena o ka hōʻeha a me ka paʻakikī o ka maʻi. ʻO nā loli hōʻino koʻikoʻi i ka ʻōpala e hoʻopilikia mau i ka hopena o nā nerve, no laila hele i ka addiction a me ka hoʻohaʻahaʻa i ka ʻeha ʻeha.

I ka hala ʻana i ka manawa, hoʻohui ʻia nā hōʻailona e ʻike ai i ka ʻeha o ke kaumaha ma ka epigastrium:

• hoʻoheheʻe ulu ʻole ʻia, ma hope iki ʻaʻohe hoʻomaha. I ka luaʻi aʻe nā loaʻa o ke koko a me ka bile;
• hana ka momona o ke kino, ma muli o kahi nā membrane a me ka hōʻili ʻia o ka ʻili;
• nā huina dyspeptic, me ka hoʻonui ʻana i ka hoʻomohala ʻenehana, nāwaliwali o peristalsis, constipation;
• ke ʻano o ka hyperthermia, ma ke ʻano o ka lilo a me ke ʻano o ka hōʻino o ke kino;
• yellowness, marbling a i ʻole ʻano honua-pale melemele;
• puʻuwai haʻahaʻa, hoʻohaʻahaʻa wikiwiki a me ka pūpū papa;
• hilahila, ka hiki ʻole ke hoʻokele i ka lewa, irritability a me ka hoʻomohala ʻana o ka coma ma muli o ka encephalopathy.

ʻO ka neʻeʻana o ka pancreatic necrosis e hoʻonui i kona nui a me ke kūkulu ʻana o ka infiltrates i ka peritoneum. Aia ma ka lā ʻelima ma hope o ka hoʻomaka ʻana o ka palaualelo, hiki ke palekana palaka ʻia a ʻike ʻia ka infiltrate.

ʻO kahi hoʻopiʻi o nā loli hōʻino e hiki ke hōʻike iā ia iho penei:

1. ʻO ke hoʻokumu ʻana o kahi lua i nā masa me ka nodrotic a me ka ihu (abscess).
2. ʻO ka hoʻokumuʻana o nā cysts a me pseudocysts i ke kino.
3. Ka hoʻēmi ʻana o ke kino hoʻopili maikaʻi (fibrosis).
4. ʻO nā hemahema Enzymatic.
5. He halepule retroperitoneal fiber.
6. Hoʻopuka lākou i nā mesenteric a me nā veins portal.

Hiki nō ke hoʻopiʻi pū kekahi me ka hoʻokumu ʻana o nā ʻōpala i ka kūwili ʻana.

ʻO nā ala diagnostic kaulana

Inā kānalua ka mea maʻi i ka necrosis pancreatic, ua ʻike koke ʻia lākou e kekahi mau mea loea - kahi maʻi maʻi, gastroenterologist a me resuscitator. Hoʻomaopopo koke ka mea maʻi i ka hopena o ka holomua o ka patolo.

I ka wā ʻike loiloi o ka mea maʻi, hiki i ke kauka ke ʻike i ka hū o ka ʻūhā, ka ʻūhā ʻana o ka ʻili a me nā ʻula o ka ʻula ma nā ʻaoʻao a me ke kua i lalo, e hōʻike ana i nā ʻōpū.

Ke lawe ʻia nei nā hōʻike ʻoihana ʻĀina e mālama ai. Pono ke aʻo ʻana i ke koko a me ka urine e hoʻoholo ai i nā enzyme o ke kino. ʻO kahi hōʻailona maikaʻi aʻe ka kiʻekiʻe o ka amylase, trypsin, elastase, glucose, nā kaila keʻokeʻo keʻokeʻo, hematocrit, ESR, C-reactive protein, ALT, AST,

No ka hoʻoponopono ʻana i ka luku piha ʻana o ka pancreas, ua kuhikuhi ke kauka i ka pau ʻana o ia ʻano hana.

• nā kikoʻī o nā kino peritoneal;
• ka ultrasonography o ka pancreas a me ka gastrointestinal tract;
• MRI a me CT;
• retrograde cholangiopancreatography;
• laparoscopy

Hōʻike ʻia nā ʻike no ka hoʻoliʻina ʻana o ka ʻōpū o ke kikoʻī, ke ʻōpala, ka hāpū ʻana o ka ʻōpū, perforation of the penis, biliary colic, myocardial infarction, a i ʻole ka hakahaka o ka ʻōpū aortic aneurysm o ka ʻōpū.

ʻO ka hoʻomaikaʻi ākea o nā kulekele

ʻO ka manawa e ola me ka pancreatic necrosis hilinaʻi ʻia i ka wikiwiki o ke kaʻina hana e mālama ai i ka maʻi. ʻO ka Therapy ka hana me ke kākā ʻana a me ka hoʻokele ʻana, e hōʻoia ana i ka hoʻopau ʻana o ke kaʻina hana o "ka pale ʻana o" a me ka pale ʻana o nā hopena purulent-septic.

Hoʻokomo ʻia ka poloka no ka mālama conservative i kēia mau mea aʻe:

1. Ke papa ʻana i ka hana pilikino, hoʻomaha moe ma nā kūlana noho.
2. ʻO ka papaʻai hānai no nā lā 5-7 me nā mea kanu, ka wai hoʻokomo wai o ka wai.
3. ʻO ke kāpae ʻana o ka ʻeha hiki ke hoʻokau ʻia ma o ka lawe ʻana i nā antispasmodics (Spazoverin, No-Shpa), non-narcotic analgesics (Paracetamol, Analgin) a me nā droppers me ka hoʻoneʻe ʻana o ka glucose a me Novocaine. Hāʻawi ia e hoʻokele i nā hui miʻo narcotic, i mea pū i ka morphine (Diphenhydramine + Novocaine).
4. Hoʻopau i nā hana o ka pancreatic, duodenal, a me nā ʻōpū o ka ʻōpū. Ma ke ʻano he kānāwai, ʻaʻole hiki i nā mea maʻi ke hana me ka ʻole o ka hoʻopuka ʻana i nā mākaʻi iv antiferment (Aprocal, Gordoks, Krivriven).
5. Ka hoʻohana ʻana i nā antibiotics e hōʻoki ai i ka microflora kino a no nā kumu pale (Cefipim, Ciprofloxacin).
6. Hoʻopili i nā maʻi infusion e hoʻopau i nā mea'ōlohelohe mai ke kahawai (vahaolana o ka mea hoʻokele, ka hopena fula, glucose + insulin).
7. Hoʻopuka ʻia e ka hemosorption, hemofiltration, plasapheresis therapeutic, peritoneal dialysis.
8. ʻO ka hoʻomakaʻana o iv somatostatin - he hormone e kāohi ai i ka hana o ka huna ʻana i ka wai o loko o ka pakanui a me ka hūnā ʻia o ka pancreas

Hoʻomaʻo pinepine, hōʻike ʻia nā hana maʻi no ka pudrosis pancreatic pancreatic. Hoʻololi ʻia ka lāʻau lapaʻau no 4-5 mau lā a hiki i ka hoʻomaikaʻi ʻana o ke ʻano o ka mea maʻi, akā me ka heluna a me ka subrosot pancreatic necrosis, lawe koke ia. Loaʻa nā pahuhopu o ka ʻoihana:

• ka hemo ʻana o nā wahi make o ka parenchyma a me ka hemudhagic exudate;
• ke ala o ka kahe ʻana o ka wai pancreatic;
• ka hooki ʻana i ka hoʻāla ʻana i loko o ka ʻōpū;
• ka lua o ka ʻōpū o ka ʻōpū a i waho o kona wahi;
• kahi ʻāpana (pale) a hoʻopau paha (pancreatectomy) ʻoki wehe ʻana.

Hoʻohana pinepine ʻia e hoʻoneʻe i nā ʻōpala e kokoke ana i ka pancreas, no ka laʻana, ka maʻi gallbladder (me ka cholecystitis luku ʻia) a i ʻole ka spleen paha.

ʻO nā wānana ma hope o ka pena

ʻO ka hoʻomohala ma hope o ka hana ʻana e hoʻomau ka lūlū. Aia ia i nā ʻano mea like ʻole - ka wā o ka mālama ʻana, ka makahiki o ka mea maʻi, ke ʻano o ka palaka nui, ka nui o ka hoʻokalakupua, ka nui o nā maʻi concomitant, a pēlā aku.

Hoʻokahi i loko o ka pākaha ʻehā i loaʻa ka pancreatic necrosis i loaʻa ka maʻi type o ka maʻi type 1. Hōʻike pinepine ʻia ka resaps, pseudocysts a me ka formist fistulas pancreatic.

Kino, ʻo ka wā o ka ho'ōla i ka maʻi a ola i ka liʻiliʻi. ʻO ka makehewa ma ka necrosis aseptic e pili ana i 15 a 40%, a i ka wā e nānā ai, ʻo 60% ia.

ʻOiai ma hope o ka hoʻōla kūpono ʻana, e kīleʻa ʻia kahi kanaka no ke ola. I kēia hihia, pono ʻoe e hahai i kahi ʻai ikaika (helu papa 5 e like me Pevzner).

I mea e pale ai i kēlā hopena kaumaha, pono ʻoe e mālama i kou olakino. No kēia, pono ke paleʻana i ka necrosis pancreatic:

• ʻO kahi meaʻai uku, hoʻoneʻe i ka kaila o ka momona a me nā meaʻai i kālai ʻia. Hoʻopili i ka hoʻohana ʻana o nā huahana paʻakai, ʻūmi a ʻili i nā huahana.
• ʻO ke hōʻole kūʻokoʻa i ka hana maikaʻi - ka ulaula a me ka inu.

Eia kekahi, pono e ʻimi koke i ke kōkua olakino a lawe i nā lāʻau lapaʻau, ma hope o nā ʻōlelo a me nā ʻōlelo a ke kauka.

E pili ana i ka mikrosis pancreatic i wehewehe ʻia i ke wikiō ma kēia atikala.