Kedu ihe bụ necrosis na pancreatic necrosis?

Ọrịa akwara nke Pancreatic bụ nnukwu nsonaazụ nke nnukwu ọrịa pancreatitis na-aga n'ihu. Ihe akparamagwa ya bu necrosis nke saịtị ma obu aru nke pancreas. Ihe ngosiputa ogwu a bu oria na-egbu mgbu, palpitations, vomiting na encephalopathy.

Nchoputa nke pancreatic necrosis gunyere ulo ogwu na uzo ihe eji eme ya. Ọgwụgwọ oria sitere na mwepu nke enzymes nke proteolytic, mkpochapu ihe mgbu, nhụchasị, mweghachi nke ihe ọ pancụ pancụ pancreatic na ntinye ịwa ahụ.

Ohere inweta lanarị ọrịa na-emebi ihe dị obere: ọgwụgwọ oge a na-azọpụta naanị 30-60% nke ndị ọrịa site na nsonaazụ na-egbu egbu. N'iburu onu ogugu onu di egwu, o gaghi ekwe omume inweta ogwugwo necrosis.

Ọrịa akwara nke Pancreatic na ụdị ya

Ọrịa a bụ ụfọdụ n'ụzọ abụghị nsogbu nke nnukwu ọrịa ogbu egbu egbu ọrịa ọrịa, kama ọ bụ otu n'ime ọkwa ya.

Na pancreatitis, enzymes nke pancreas na-emepụta anaghị erute duodenum 12. N'ihi ya, ihe ọ pancụ pancụ pancreatic na-amalite imebi akụkụ ahụ, nke a na-akpọ "mgbaze onwe". Usoro mmekpa ahụ na-eme, nke na-emesị eduga na mgbanwe ndị na-emebi ihe. Mgbe ahụ enwere mmepe nke ọtụtụ akụkụ anụ ahụ, nke bụ ihe a na-ahụ maka ọrịra nke akwara.

Taa, ọnụ ọgụgụ nke nnukwu ọrịa pancreatitis debara aha n'ụlọ ọgwụ na-arịwanye elu na Russia. Ha na-enye ohere naanị maka ikpe nke ọrịa appendicitis. Ọnụ ọgụgụ ndị ọrịa na-ata ahụhụ site na necrosis na-arị elu jiri 25% rịa elu. Ebe ọ bụ na ọnwụ n'ihi mgbanwe na-emebi ihe nke pancreas sitere na 30% ruo 80%, ụzọ kachasị belata ya bụ nchọpụta arụmọrụ, ụlọ ọgwụ na usoro ọgwụgwọ dị mma.

Ebe ọ bụ na emebi akụkụ ụfọdụ nke akụrụngwa na-apụta, ma ọ bụ isi, ahụ ma ọ bụ ọdụ, nhazi nke pathology dị mkpa.

Ihe kpatara oria a

Usoro etiology nke pancreatic necrosis ejikọtara ya na nri na-adịghị mma na ị alcoholụbiga mmanya ókè.

Nkọwa nke ezighi ezi na-egosi na 70% ndị ọrịa na-arịa ọrịa a kwa oge ma ọ bụ na-a alcoholụ mmanya. Ihe nke abuo nke pancreatic necrosis bu mbufe oria otite.

Ọ bụ ihe kwesịrị ịrịba ama na ọrịa na-etolite n'oge nwata. Ọrịa akwara dị na ọrịa pancreas na-aputa ihe ruru n'ihi:

1. Ọrịa afọ nke afọ na 12 duodenal ọnya afọ.
2. Nri edozi adighi edozi, oke nke ihe mara abuba na nri n’abali.
3. Abuse abuseụbiga mmanya ókè.
4. Surgerywa ahụ na mbụ.
5. Ọrịa mmerụ ahụ.
6. Ọrịa na nje na-efe efe.
7. Ọrịa gallstone.

Ọrịa akwara nke Pcreatic necrosis nwere ike ịdakwasị onye ọ bụla, mana n'ihe egwu gụnyere

• ndị a chronicụrụma na ndị ọgwụ ọjọọ riri ahụ;
• ndị mmadụ na-ata ahụhụ site na nsị nke akwara na pancreas;
• ndị ọrịa nwere ọrịa ọgbụgba na ọrịa eriri afọ;
• ndị mmadụ na-arịa ọrịa gallstone.

Mgbanwe Necrotic dịkwa ize ndụ maka akụkụ ahụ ndị ọzọ dị n'ime, nke a na-enyocha site n'ọmụmụ ihe ọmụmụ. N’ihi ya, ngwe nri, akụrụ na ahụ ya niile na-ata ahụhụ.

Ọnọdụ a nwere ike ịbụ nsonazụ nke ọrịa a:

1. Ọrịa purulent na-efe efe bụ otu n'ime ụdị dị oke njọ nke akụkụ oke arụ nke akụkụ ahụ na ịmepụta micro-, macroabscesses.
2. Nnukwu ihe ọreatụholicụ na-egbu egbu bụ ọrịa na-apụta ma ọ bụ n'ihi mmanya na-adịghị ala ala, ma ọ bụ otu iko mmanya na-egbu ya na nri nwere abụba.
3. Ọrịa biliary pancreatitis bụ usoro mkpali na-adịghị ala ala nke dị na akwara, nke na-apụta n'ihi mmerụ ahụ na akwara.
4. Hemorrhagic pancreatitis bụ nnukwu ọrịa nke ọrịa ahụ, nke enwere mbibi ngwa ngwa nke parenchyma na network vaskụla, nke na-enyere aka na mmepe nke gangrene, hemorrhage na peritonitis.

Ọ bụrụ na onye ọrịa ahụ achọ enyemaka ahụike n'oge, mgbe ahụ, ịmalite nke necrosis gụnyere mmepe nke etuto ahụ, emesịa ndị ọkachamara enyeghị prognosis dị mma maka nlanarị.

Ihe mgbaàmà bụ isi na ihe mgbagwoju anya

Ngosiputa ihe omumu ihe banyere oria dika ICD-10 nekezi onodu dika nke ato. Usoro nke akwara nke pancreatic necrosis nwere nsogbu na nsogbu nke ihe nchebe mpaghara.

A na-eji ọkwa mbufụt mara n’ọrịa ngwa ngwa nke nje na mmụba nke imepụta mkpụrụ mmiri. Onye ọrịa na-eme mkpesa nke ahụ ọkụ, ụkwara agbọ na afọ ọsịsa.

Ihe e ji mara ọkwa nke abụọ site na nguzobe nke oghere n’ime anụ ahụ parenchyma n’ihi enzymatic na purulent fusion.

Agba nke atọ na-eduga n’ọnwụ, ebe ọnya na-agbasa na anụ ahụ ndị ọzọ. Nke a na - ebute otutu akụkụ ahụ, ma ọnwụ na - apụta.

Ihe mgbaàmà mbụ nke ọrịa ahụ bụ nnukwu ihe mgbu na mberede enwere mpaghara ekpe na afọ na azụ ala. Enwere mmekọrịta dị n'etiti n'etiti mgbu na ogo nke ọrịa ahụ. Mgbanwe dị egwu nke anụ ahụ na-emetụta njedebe akwara niile, yabụ, iri mmadụ ahụ na mbelata mgbu mgbu.

Ka oge na-aga, a na-agbakwunye akara ndị a na sensations ihe mgbu na epigastrium:

• ọgbụgbọ na-enweghị isi, nke na-enweghị ume. N’ime ihe ọgbụgba, ọbara na ajị agba na-adọrọ adọrọ;
• akpukpo aru nke aru, n'ihi ya akpụkpọ ahụ na akpụkpọ akpọnwụwo;
• nsogbu dyspeptik, gụnyere ịba ụba nke ikuku, ike ọgwụgwụ nke peristalsis, afọ ntachi;
• ọbara ọgbụgba, dịka mmanya na egbu egbu nke ahụ na-aga n'ihu;
• yellowness, marbling ma ọ bụ ụda akpịrị na-egbu egbu;
• ọbara mgbali ala, ngwa ngwa obi na iku ume iku ume;
• ọgba aghara, enweghị ike ịnyagharịa na mbara igwe, oke iwe na ọbụna mmepe nke coma n'ihi encephalopathy.

Ọkpụkpụ akwara na-enwe ọganihu na-akpata mmụba na nha ya na nguzobe nke infiltrates na peritoneum. Ugbua n'ụbọchị nke ise mgbe mmalite nke ọrịa, infiltrate ike palpated ma hụ ya.

Mgbagha nke mgbanwe na-emebi ihe nwere ike igosipụta onwe ya dịka ndị a:

1. Guzobe onu na oke necrotic mass na pus (abscess).
2. Guzoro cysts na pseudocysts na aru.
3. Imeghari ahihia nke mechiri aru.
4. Enzymatic ụkọ.
5. Phlegmon retroperitoneal fiber.
6. Thrombosis nke mesenteric na portal vein.

Ọkpụkpụ nwekwara ike ịpụta site n’ichepụta ọnya n’ọnụ nri.

Zọ nchọpụta usoro ama ama

Ọ bụrụ na a na-enyo onye ọrịa enyo na ọ nwere necrosis pancreatic, ọtụtụ ndị ọkachamara na - enyocha ya ozugbo - dọkịta na - awa ahụ, eriri afọ na resuscitator. A na-anabata onye ọrịa n'ụlọ ọgwụ ozugbo iji zere nsonaazụ nke ọganihu nke ọrịa.

N'oge nyocha onye ọrịa, dọkịta nwere ike ịhụ ka ọ na - agbaji, ụkwara anụ ahụ na ọnya na-acha na akụkụ na azụ ala, nke na-egosi ọbara ọgbụgba.

N'ime usoro nlekọta ngalaba nyocha ahụike ahụ na-ewere. Nyocha ọbara na mmamịrị dị mkpa iji chọpụta enzymes nke anụ ahụ. Ihe nrịba ama ọjọọ bụ amylase dị elu, trypsin, elastase, glucose, sel ọbara ọcha, hematocrit, ESR, protein-Cactive, ALT, AST,

Iji dozie mbibi gangrenous nke pancreas, dọkịta na-edepụta usoro nke ụdị ngwaọrụ dị otú a:

• foto nke akụkụ ahụ;
• ultrasonography nke pancreas na eriri afọ;
• MRI na CT;
• retrograde cholangiopancreatography;
• laparoscopy

Ihe ngosi maka nyocha di iche bu nnukwu mbufụt nke ihe omimi, akpukpo ahu, ihe mgbochi nke eriri afọ, perforation nke amụ, biliary colic, infarction myocardial, ma obu nmebi nke nkpuru aortic aneurysm.

Izu oke nke oria

Ohere ịlanarị na ọrịa akwara gburu akwara sitere na etu esi eme ihe ngwa ngwa iji gwọ ọrịa ahụ. Usoro ọgwụgwọ ahụ mejupụtara usoro nchedo na ịwa ahụ, na-ahụ na iwepụ usoro nke "mgbaze onwe" nke anụ ahụ na mgbochi nke purulent-septic effects.

Ntuziaka maka ọgwụgwọ ọgwụgwọ na-agụnye ihe ndị a:

1. Amachibidoro mmega ahụ, izu ike n'akụkụ ọnọdụ anyị.
2. Parenteral nri maka ụbọchị 5-7 na nri, mmiri alkaline ịnweta mmiri.
3. Kpochapu ihe mgbu nke enwere ike ime site na ị antụ ọgwụ antispasmodics (Spazoverin, No-Shpa), ọgwụ na-abụghị ọgwụ ọjọọ (Paracetamol, Analgin) na ụmụ irighiri mmiri na ngwakọta nke glucose na Novocaine. A na-ahapụ ya ka ọ na-achịkọta ngwakọta narcotic, na mgbakwunye na morphine (Diphenhydramine + Novocaine).
4. Mbelata nke ọrụ pancreatic, duodenal, na enzymes afọ. Dịka iwu, ndị ọrịa enweghị ike ime n’enweghị iwebata ndị nnọchi anya iv (Aprocal, Gordoks, Krivriven).
5. Ojiji nke ọgwụ mgbochi iji kwụsị microflora na-emerụ ahụ yana ebumnuche mgbochi (Cefipim, Ciprofloxacin).
6. Ọgwụ infusion iji kpochapụ ihe ndị na - egbu egbu site n'ọbara ọbara (usoro ringer, ngwọta physiological, glucose + insulin).
7. Detoxification site na hemosorption, hemofiltration, ọgwụgwọ plasapheresis, peritoneal dialysis.
8. Ntughari iv somatostatin - homonụ nke na-egbochi ọrụ nzuzo nke ihe ọricụricụ gastric na nzuzo nke pancreas.

Ọtụtụ mgbe, a na-egosi ịwa ahụ maka necrosis pancreatic. Ọgwụ ịwa ahụ na-egbu oge maka ụbọchị 4-5 ruo mgbe ọnọdụ onye ọrịa ahụ ga-adị mma, mana na ngụkọta ma ọ bụ okirikiri nke pancreatic necrosis, a na-eme ya ozugbo. Ebumnuche nke ịwa ahụ nwere ike ịgụnye:

• mkpochapu nke ndi nwuru anwu nke parenchyma na hemorrhagic exudate;
• mmalite nke ihe ọ juiceụ pancụ na-egbu egbu;
• ịkwụsị ọbara ọgbụgba n'ime afọ;
• ọgbụgba nke oghere dị n’afọ na oghere ya;
• akụkụ ahụ (ihe yiri) ma ọ bụ ihe zuru oke (pancreatectomy) mwepụ akụkụ ahụ.

Ọtụtụ mgbe, ọ dị mkpa iwepu akụkụ ndị dị n'akụkụ pancreas, dịka ọmụmaatụ, gallbladder (nke nwere cholecystitis na-emebi emebi) ma ọ bụ oghere.

Amụma amụma mgbe ọ gbasasịrị ọgwụ

Nnyocha nke ịwa ahụ gasịrị bụ ihe a na-ahụkarị. Ọ dabere na ihe dị iche iche - oge ọgwụgwọ, afọ onye ọrịa, ụdị ọrịa, olu nke ịwa ahụ, ọnụnọ nke ọrịa concomitant, wdg.

Otu onye n’ime mmadụ anọ torola eto, nweela ọrịa ọria akwara na-arịa ụdị ọrịa shuga 1. Ighaghachi azụ na-egosipụtakarị, pseudocysts na pantudocist fistulas form.

O di nwute, Ohere inweta ịgwọ oria na idi ndu di obere. Ọnwụ na-egbu egbu na aseptic necrosis sitere na 15 ruo 40%, na mgbe ọ butere ọrịa, ọ bụ 60%.

Ọbụlagodi na mgbe ọ gachara usoro ọgwụgwọ nke ọma, mmadụ ga-agbasi ike. N'okwu a, ịkwesịrị ịgbaso ezigbo nri (tebụl nọmba 5 dị ka pevzner).

Iji gbochie nsonaazụ ọjọọ a, ịkwesịrị ilekọta ahụike gị. Maka nke a, mgbochi nke pancreatic necrosis dị mkpa:

• Nri ziri ezi, na -ewepu nri oriri nke abụba na eghe. Belata iji nnu, ọ smụrụ na ngwa ọhịa.
• Rejụ omume ọjọọ - ị smokingụ sịga na mmanya.

Na mgbakwunye, ịkwesịrị ịchọrọ enyemaka ahụike ozugbo ma medicationsụọ ọgwụ, na-agbaso ntuziaka dọkịta.

A kọwara ihe banyere pancreatic necrosis na vidiyo n'isiokwu a.