ʻO ka ʻōkuhi pancreatic he luaʻa i ka parenchyma o ke kino kūloko, kahi i kaupalena ʻia e nā paia o ka hoʻopili pili. Hoʻopiha ʻia ka lua i ka nui o ka exudate, ka etiology o nā mea i loaʻa mai ma muli o ka trauma a i ʻole nā hanana maʻi i ka pancreas.
Hoʻololi ʻokoʻa nā hōʻikeʻike maʻi i nā kiʻi like ʻole. Pili lākou i ka nui o ka hoʻokumu, kahi, nā pathogenesis o ka hoʻokumu. Hiki i nā hōʻailona ke kū mai kahi manaʻo o ke ʻano hōʻoluʻolu i ka ʻeha nui.
No ka loiloi i ka nui a me ka wahi o ka cyst, e ʻike i ka pili me nā kumu lāʻau, koho i nā mea kūpono no ka lapaʻau, kahi scan ultrasound, compact tomography, MRI o ka ʻōpū o loko, a me nā ʻano hana ʻē aʻe e hana hou ai i ke kiʻi holoʻokoʻa.
ʻO ka hapa nui, pono ke hoʻoweliweli a hoʻoiho wai ʻole paha i waho, kahi ʻāpana o ke kino me ka neoplasm pathological he palena iki ʻole ia.
Ka helu ʻana o nā cysti pancreatic
Wahi a ka ICD code, ka pancreatitis heʻā, ka maʻi, subacute, a me nā ʻano ʻē aʻe. Hoʻokomo ka hana loiloi i nā ʻano ʻelua o nā neoplasms. I ka hihia mua, i hoʻokomo ʻia ke ʻano o ka lua i ka nui.
Pono ka cyst inā aia kekahi lula epithelial. ʻO kēia ʻano kuʻikuʻi e pili ana i nā malenations congenital, ua hoʻokaʻawale ʻia nā hihia i ka lāʻau lapaʻau, ʻoiai he mea maʻamau loa ia i nā maʻi.
He fika waha ia kahi neoplasm e ulu ana ma muli o kahi maʻi. ʻAʻole ia i hoʻokaʻawale ʻia e ka helehelena o ka epithelium glandular ma nā paia, no laila ua koho ʻia he mea wahaheʻe.
Hoʻomaopopo ka papa helu lua i kahi o ka pūliki ma ka pancreas.
- ʻO Cyst o ke poʻo o ka pancreas (ma ke ʻano, ka wahi he om bur bursa). Wahi a nā helu helu, ʻike ʻia kēia hana ma 15-16% o nā kiʻi lapaʻau. ʻO ka meaʻokoʻa o ka pilina o ka duodenum.
- Ma ke kino o kahi mea maʻi - ua hōʻike ia ma kahi 46-48% o nā hihia. ʻO ia ka mau o ka laulā pinepine o nā kūloko, i kahi o ke kua o kahi kue o ka pua a me ka ʻōpū ponoʻī.
- Ma ka huelo - ʻike ʻia ma 38-39% o nā kūlana. ʻO ka meaʻokoʻa e pili ana i kēlā neoplasm, e pili koke ana i nā ʻōpala kokoke.
ʻAʻole loaʻa nā pōpō maoli i kēia hihia, ʻaʻole like ʻole nā hōʻailona like ʻole a me nā loina o ka lapaʻau o nā ʻano ʻelua, no laila e hiki mai ana i ka wā e nānā ai mākou i nā mea hoʻopunipuni wale nō.
Nā Cyst kumu a me nā hōʻailona
Hiki i nā pūlima pancreatic i nā maʻi, ʻo ka ʻokoʻa o nā ʻōpiopio, nā kāne, hiki ke ʻano like ʻole o ka nui, ʻokoʻa hoʻokahi a ʻano nui. I kekahi mau mea maʻi, ʻoi aku ma muli o ka ua congenital, ua loaʻa ka maʻi o nā polycystic ovaries, ka lolo, a me ka puʻuwai.
ʻAʻole kuhi hewa nā pōpō hewa i kahi kino ola. ʻO ke neoplasm mau ka hopena o kahi kaʻina degenerative ma ke kino. ʻO nā kumu pinepine loa e pili ana i ka pancreatitis acute, ka hōʻeha kino o ke kino
ʻO ke kumu paha ke kāʻei pōkole o ka wai excretory (no ka laʻana, i paʻi ʻia e ke kīʻaha koko a i ʻole ka pōhaku) a i ʻole ka pilikia keu o kona mau kahe. ʻO ka pinepine, hana ka cysts i nā maʻi parasit e like me ka cysticercosis, echinococcosis. Hoʻokumu ʻia ka pathogenesis e nā neoplasms tumor. I ka heleʻana o ka maʻi o ka pancreatitis, ua hoʻokumu ʻia nā cysts post-necrotic i ka hapalua o nā hihia.
Ke hōʻike nei ke kaiāulu o nā mea lapaʻau i nā mea hoʻonāukiuki nui e alakaʻi i ke kūkulu ʻia ʻana o ka cystic formation. Ua hōʻike ʻia ka hopena maikaʻi o nā kumu i nā noiʻi he nui. E pili ana kēia:
- ʻO ka make nuiʻana o nā mea inu wai.
- ʻO nā maʻi, ka mea i hui pū ʻia e ka palaki ʻana o ka hana lipid metabolism.
- ʻO ka mōʻaukala o nā hōʻiliʻili manuahi ma luna o kekahi mea o ka pūnaehana o ka kūnao ʻana.
- Diabetes mellitus (ʻoi aku ka pinepine o nā ʻano 2.
ʻO ka heleʻana o kekahi o kēia mau kūlana i ka mea maʻi me nā hōʻailona o ka maʻi pancreatic i hiki ke ʻae ʻia ka maʻi cyst.
ʻO ka hoʻomaka ʻana o ke kaʻina hana pathological kekahi mau hōʻike i ʻike ʻia ma ka 90% o nā maʻi. I ka hoʻomaka, ʻike ʻia kahi haukapila:
- ʻO ka hōʻeha ʻeha o ka herpes zoster. Ua hoʻoikaika nui ʻia ma hope o ka ʻai ʻana a i ʻole inu ʻana. ʻAʻole hoʻopau ka papa lāʻau lapaʻau i ka pilikia, ʻaʻohe hopena therapeutic.
- Hoʻomaka pinepine ʻia, ʻaʻole ia e hali i ka maʻi i ka mea maʻi.
- Nā wīwī o nā ʻōpū o ka puʻuwai - kehi ʻana, ka hoʻonaninani, ke hoʻonui ʻana i ka hoʻomohala ʻana.
Koho ua hōʻike ʻia nā haukapila a hōʻeha paha i ka 4-5 mau maʻi o nā maʻi. I ka lāʻau lapaʻau, kapa kēia manawa i kapa ʻia ʻo "ka wili māmā". Ma hope o kēlā, hōʻike hou ʻia nā hōʻailona ʻano, akā ʻoi aku ka ikaika a hoʻomau.
Hoʻomaʻo pinepine, nā mea maʻi e hoʻopiʻi i ka mahana o ke kino subfebrile, lethargy, hōʻeha ikaika i ka hypochondrium hema. I kekahi manawa (ma kahi o 5% o nā kiʻi), ka yellowness o ka ʻili, nā membrane mucous, sclera o nā kino o nā hihiʻo e loaʻa.
ʻO nā hōʻailona o ka cyra pancreatic me ka liʻiliʻi o ka hana ʻana o nā hormones e like me ka insulin, somatostatin, glucagon. ʻO ko lākou hemahema e alakaʻi i ka maloʻo ma ka waha o ka waha, kahi piʻi i loko o ke ʻano kikoʻawa o ka urine i kēlā me kēia lā, i nā hihia koʻikoʻi, nalowale ka ʻike ma muli o ka hypoglycemic a hyperglycemic coma a ʻike ʻia.
Nā hana hoʻohālikelike
Inā kānalua ʻoe i kahi lua i hoʻopiha ʻia me nā wai, pono ke kūkākūkā ʻana me ka gastroenterologist. I ka wā o ka nānā kino ʻana o ka ʻōpū, ʻike ʻia kona protrusion ma kahi o ka mea pili.
ʻO nā hoʻokolohua Laboratory, ma ke ʻano he kānāwai, ʻaʻole ia e hōʻike i kahi loli hou. He liʻiliʻi liʻiliʻi ka hoʻonui ʻana i nā leukocytes, hoʻonui ka nui o ESR. ʻO kekahi manawa i ka hoʻonuiʻana i ka kao o bilirubin.
ʻO nā mea e pili ana i nā kineneka digestive i loko o ke koko ka mea e hilinaʻi nui ʻia ma ke ala o ka mumū o nā pancreas ma mua o ka neʻe ʻana o kahi cyst. Ma kahi o 5%, ua hōʻike ka maʻi diabetes.
Ke hana ʻia nei ka noiʻi:
- Hāʻawi ka Ultrasound i kahi loiloi o ka nui o ka neoplasm, e hōʻike ana i nā hōʻailona kū ʻole o nā hoʻopiʻi mau nei. ʻO ka mea hoʻohālikelike, inā i loaʻa ka suppuration, ua ʻike ʻia ka echogenicity kūlike.
- Hiki i ka CT a me ka MRI ke hāʻawi i nā ʻike kikoʻī hou e pili ana i ka hoʻokili ʻana i ka hoʻokumu ʻana o ka cystic, ʻo kona nui, ʻaʻole a i ʻole e pili ana i ka pilina me nā kahe.
No ka hoʻokolohua ʻana, hana ʻia ʻo ERCP - kōkua ke ʻano ke kiʻi i ka ʻike kikoʻī e pili ana i ka pilina o ka cyst a me nā papa pancreatic, kahi e hoʻoholo hou ai i ka regimen lapaʻau. Eia naʻe, me kahi hoʻokolohua, aia kahi hopena nui o ka maʻi.
No laila, ke hoʻokele wale ʻia nei ʻo ERCP i nā hihia inā pono e hoʻoholo i ke ʻano o ka hōʻiliʻili o ke kaʻina, aʻo ka ʻola konservative ma ke ʻano he maʻi lapaʻau ʻole ʻia.
ʻO ka lāʻau lapaʻau
He aha ka mea weliweli o kahi honu i loko o ka pancreas? ʻO ka pōʻino he puka lōʻihi e alakaʻi nei i ka hoʻopili ʻana i nā ʻāpana kūloko, e hoʻonāukiuki i nā hoʻopiʻi like ʻole. ʻO nā hopena paha ka mea aʻe: kahaha, ka hoʻomohala ʻana o nā fistulas, suppuration a i ʻole abscess, kahe koko no ka pohihihi ʻana o kahi kīʻaha koko.
E like me nā hoʻolaha o nā kaiāulu hope loa, hiki ke ʻōlelo ʻia e mālama ʻia ka mālama conservative me nā papa ma lalo o kekahi mau kūlana. Inā aia kahi palena maopopo o ka mea pili o ka pathological, ʻo ka nui o ka hoʻolālā cystic ʻaʻole iʻoi aku ma mua o 2 mau kenimika.
Hoʻohana ʻia lākou me nā lāʻau lapaʻau inā hoʻokahi neoplasm ka hoʻokahi. ʻAʻohe ʻano hōʻike pilikino o ka jaundice obstructive, ʻeha hōʻeha.
I ka wā mua, ua kauoha ʻia ka pololi. I ka wā e hiki mai ana, ua hoʻokaʻawale ʻia nā mea momona, ka palaoa a me ka paʻakai, ʻoiai ua hoʻonāukiuki nā meaʻai i ka nui o ka hoʻoulu ʻana o nā ʻenehana digestive, kahi e hana ai i ka luku ikaika ʻana i nā kiko. Waiho i nā ulaula a me nā ʻuhane. Pono ka mea maʻi e hoʻomaha no kahi 7-10 lā.
I ka wā mālama, ua kauoha ʻia nā lāʻau lapaʻau:
- Nā antibiotics e pili ana i ka tetracyclines a cephalosporins. Hoʻonohonoho lākou e pale i ka komo ʻana o nā microbes i loko o ka lua o ka hoʻokumu, kahi e alakaʻi ai i nā hana purulent.
- No ka hōʻemi ʻana i ka ʻeha a hoʻemi ʻana i ka mea huna, hoʻohana ʻia nā inhibitors - Omez, Omeprazole a me nā mea kanu ʻē aʻe.
- Pono ʻia ka hoʻoponopono ʻana o Enzyme e hoʻomaʻamaʻa i ka hoʻowalewale ʻana o nā pakanā a me nā momona - ua ʻōlelo ʻia nā lāʻau me ka lipase a me ka amylase. Hōʻike ʻia e ka hui - Pancreatin, Creon.
Inā he hua ka hopena o ka cyst o ka pancreatitis biliary, hiki ke kuhikuhi pū ʻia nā lāʻau choleretic. I kekahi mau hihia, ma hope o ka hoʻopauʻana i ke kumu o ka pūliki, hiki i nā loina ke hoʻoholo i ko lākou iho. Eia naʻe, ʻaʻohe mea kēia mau mea. Hoʻohana ka nui o nā mea maʻi i nā ʻano ʻatikala ma ke ʻano o ka decoction o ka burdock, mummy, tincture o ka celandine, a me nā mea like o nā loiloi o nā ʻano he maikaʻi, akā ʻaʻole ia i kākoʻo ʻia e nā hōʻike hōʻike, no laila ʻaʻole maikaʻi ke hoʻopilikia a hilinaʻi ma nā kauka.
I ka wā ʻaʻole i hoʻolako ka lāʻau mālama konservative i ka hopena i makemake ʻia i loko o nā hebedoma 4, he mea hou ke kau ʻia e nā kauka.
Hana hoʻomaʻamaʻa
Wahi a nā helu helu, mālama lapaʻau ʻana ma ka 10% wale nō e pale ai i ka hōʻola. I nā hihia'ē aʻe, e lawe ʻia ana ka lāʻau lapaʻau i loko o ke keʻena hoʻokele. Aia nā hapa ʻehiku mau ʻano o ke ala o ka operative e ʻae ana i ka hoʻokuʻu ʻana iā cyst.
Hoʻāʻo nā kauka e neʻe me nā hana minimally invasive e ho'ōla i ka maʻi. E kūʻē i ke kūmole o kēlā me ka hoʻomakeke ʻia, ʻaʻole hōʻino ʻia ka ʻili o ka mea maʻi. Hōʻike ka liʻiliʻi o nā hoʻopiʻi e nā ʻenehana i lawe ʻia e ka ʻili ma lalo o ka mana o ka ultrasound.
Loaʻa ka kiʻekiʻe nui o ka hana pono ma mua o ke ʻano loiloi volumetric ma ke poʻo a i ke kino paha. He maʻalahi loa ke ʻano o nā kaʻina hana. Ma hope o ka hoʻonāukiuki ʻana o kahi pākeke a i ʻole keiki, ua hoʻokomo ʻia kahi huikaʻe a i ʻole ke aspirator ma loko o ka puncture ma ka pae epigastric. Wahi a ka nui o nā cyst, hiki i ka hana ke hele i ʻelua ala:
- Ke hoʻohana nei i ka puncture puncture percutaneous o ka neoplasm. Ma hope o ke kāpili ʻia o ka ikehu mai ka cyst, ua hoʻonoho ʻia kahi kīʻaha liʻiliʻi o nā ʻōpala e hana i kahi kahe mau mau. Aia i ke kino a hiki i ka puka ʻana o ke kahe. ʻAʻole lawe ʻia kēlā mau hoʻokolohua ʻole ʻole inā e pau ka huakaʻi cystic i nā kumu o ka lepa a he nui.
- Ma ka scutanotherapy percutaneous o kahi cyst. Hoʻokomo ka ʻenehana i ka hoʻomaka ʻana o nā kinipiko wai i loko o ka lua ma hope o ka hoʻopiʻi ʻana. A muli, loaʻa kahi hoʻomaʻemaʻe i ka ana, he piʻihue i ka nāhe.
Inā ʻaʻole hiki ke hana ʻia nā kaʻina hana i luna, a laila hoʻokō ʻia ka laparoscopy. Hana ʻia kēia hana ma o nā manawa ʻelua, kēlā me kēia ʻano i ka 1 a 2 cm. Ua hoʻokomo ʻia nā mea hōʻike ma ka ʻōpū o ka ʻōpū ma o lākou. Ma ka ʻaoʻao hoʻokahi, ʻike ʻia nā ʻano hana o kēia hoʻolālā e ka morbidity haʻahaʻa, akā, ma kekahi ʻaoʻao, hōʻike nā helu helu e kū pinepine ana nā hoʻopiʻi like ʻole.
Hiki i ke kauka ke hana i nā mea penei:
- ʻO ka hoihoi a me ka wehe ʻana o ka hoʻonaʻauao. E ʻae ʻia ke noi inā he loa loa nā cyst.
- Laparoscopy e pili ana i ka wehe ʻana o kahi mahele pancreatic. ʻO ka loiloi nui no ka pale nui i loko o nā ʻāpana.
- Hoʻopilikia ʻo Frey i ka wehe ʻana i ke poʻo a me ka hoʻokumu ʻana o ka anastomatosis pancreatojejunal. Hoʻomaopopo ʻia e hana e kūʻē i kahi kūlike o ka hoʻonui ʻia ʻana o ka papa o ke kino.
ʻO ka wānana ma muli o ka etiology o ka maʻi, ka manawa kūpono o ke ala a me ke ʻano o ka hana. ʻO kēlā maʻi ka maʻi he nui ka hopena o nā hopena maikaʻiʻole - mai 10 a 50% o nā kiʻi pena āpau. Kūʻai ʻia, perforation pinepine, fistulas, kahe koko i loko o ka ʻōpū o ka ʻōpū. ʻOiai ma hope o ka hōʻeha ʻana i ka pancreas, aia kekahi pilikia nui o ka hoʻi ʻana i ka wā e hiki mai ana.
E pili ana i ka mālama ʻana o nā cysti pankreatic i hōʻike ʻia i loko o ke wikiō ma kēia ʻatikala.
