Ib qho ntawm cov kab mob hnyav tshaj plaws ntawm kev mob plab hnyuv yog pancreatic necrosis. Nws kuj tseem hu ua pancreatic necrosis lossis necrotic pancreatitis. Txawm hais tias txoj kev kho mob zoo, ib nrab ntawm cov neeg mob uas kuaj mob no tuag. Tom qab tag nrho, tus kab mob yog tus cwj pwm los ntawm kev tuag ntawm cov cell, uas ua rau kev puas tsuaj ntawm cov qog ua pa. Vim tias cov txheej txheem no, nws cov haujlwm tau ua txhaum, uas cuam tshuam tsis zoo rau lub cev ntawm lub cev.
Kev tsim kho tshuab
Necrosis yog txheej txheem ntawm kev tuag ntawm tes ua rau necrosis thiab rhuav tshem cov ntaub so ntswg. Hauv cov txiav, cov mob no tuaj yeem tsim los ntawm cov txheej txheem ua mob lossis lwm yam mob tsis zoo. Cov txheej txheem pathological tuaj yeem ua rau qhov tseeb tias kua txiv pancreatic stagnates hauv ducts lossis raug pov rov qab rau lawv los ntawm duodenum. Kev siv tshuaj tua kab mob rau lub cev pancreatic yog txhoj puab heev, yog li lawv pib zom cov ntaub so ntswg ntawm lub qog nws tus kheej. Qhov no yog feem ntau elastase, uas txhawm tawm cov protein ntawm cov nqaij mos sib txuas.
Ua ntej, mob nrawm lossis mob nraub qaum yog tshwm sim vim qhov no. Yog tsis muaj kev kho mob kom raws sijhawm lossis yog tias tus neeg mob ua txhaum kev noj haus uas kws kho mob tau sau tseg, mob tshwm sim zuj zus. Maj mam, cov txheej txheem ntawm cov ntaub so ntswg kis, cov phab ntsa ntawm cov hlab ntsha pib vau. Daim ntawv qhaj ntawv yuav yog. Yog tias cov txheej txheem no cuam tshuam rau lub qog ntawm lub caj pas thiab pus tawm los, kab mob peritonitis thiab sepsis tuaj yeem txhim kho.
Vim li cas
Cov ua rau tseem ceeb ntawm pancreatic necrosis yog pathologies ntawm biliary huam. Dyskinesia, mob hlwb cholecystitis, lossis mob tus kab mob gallstone tuaj yeem ua rau txhaws ntawm Wirsung duct. Ntau zaus, necrosis muaj kev quav dej caw thiab haus cawv ntau dhau. Raws li kev txheeb cais, qhov no ntau dua ib nrab ntawm cov neeg mob uas tau kuaj pom qhov no. Cov dej cawv thiab cov zaub mov uas nyuaj rau kev zom ua rau lub caj pas o tuaj thiab cov kua qog ua kua hauv cov kua txiv pancreatic. Vim tias qhov no, kab mob pancreatitis. Feem ntau, nws yog nws leej twg ua ntej ntawm kev txhim kho necrosis.
Ib qho ntxiv, tus kabmob no muaj lwm qhov laj thawj:
- cov khoom noj tsis tsim nyog - ua kom yoo mov ntev ntev, yoo mov, muaj ntau yam ntawm cov rog, nqaij kib thiab ntsim, khoom qab zib thiab cov khoom noj ua tiav;
- mob plab los yog phais plab;
- duodenal mob rwj;
- inflammatory kab mob ntawm lub plab;
- ua txhaum ntawm cov ntshav mus rau cov hnyuv;
- cov khoom noj rau mob siab, haus dej cawv lossis tshuaj lom;
- nquag kis mob los sis cab.
Ntau tshaj li ib nrab ntawm cov neeg mob, kev haus cawv ntau dhau thiab haus dej haus cawv ua rau tus mob necrosis.
Tag nrho cov xwm txheej no tuaj yeem ua rau kev loj hlob ntawm kev mob ua paug (pancreatitis), uas, tsis muaj kev kho mob, ua rau cov nqaij mos necrosis. Tab sis kev mob hlab ntsha leeg mob necrosis tuaj yeem tshwm sim vim kev siv qee yam tshuaj tsis raug, kev ntxhov siab, lub cev lossis lub siab ntau dhau.
Kev faib tawm
Txhawm rau tshuaj kho qhov tseeb, ntxiv rau kev txiav txim siab qhov ua rau tus txheej txheem necrotic, nws yog qhov tsim nyog los txiav txim siab nws ntau yam. Nta ntawm tus kab mob cuam tshuam tsis tsuas yog cov tsos mob uas tau ua pov thawj, tab sis kuj xaiv cov kev kho kom zoo. Feem ntau, ib tus kab mob raug cais raws qhov xwm txheej ntawm nws txoj kev loj hlob. Qhia qhov txawv ntawm cov mob necrosis, dhau zuj zus, thiab mob ntev, qeeb qeeb. Cov mob hnyav tshwm sim sai thiab tsis muaj kev kho mob tuaj yeem ua rau tuag taus hauv ob peb hnub. Cov mob necrosis yuav mob ntev, tab sis nrog kev kho kom zoo nws tsis ua rau muaj kev tsis xis nyob.
Raws li kev ua kom tiav hauv cheeb tsam ntawm cov txheej txheem necrotic, focal pancreatic necrosis yog qhov txawv txav, uas cuam tshuam tsuas yog qee qhov ntawm lub qog, thiab tag nrho, thaum tag nrho cov kab mob hauv cov nqaij mos raug rhuav tshem. Tus mob no ua rau kev ua tiav ntawm kev ua haujlwm ntawm lub qog uas tsis muaj kev cia siab ntawm nws txoj kev rov qab los. Qee zaum ib qho kev sib kis tau koom nrog cov txheej txheem necrotic, thaum pus tawm, uas nrog cov ntshav ntws tuaj yeem sib kis rau lwm yam kabmob. Ntau hom kabmob muaj qhov sib txawv raws li cov txheej txheem ntawm cov txheej txheem necrotic.
Muaj xws li ib tug necrosis:
Puas tuaj yeem tshem tawm cov txiav tawm?- hemorrhagic - hom txaus ntshai tshaj plaws ntawm pathology, nyob rau hauv kev rhuav tshem cov phab ntsa ntawm cov hlab ntsha tshwm sim, feem ntau ua rau tus neeg mob tuag;
- hemostatic - tus txheej txheem necrotic yog nrog los ntawm kev ua txhaum ntawm cov ntshav mus rau lub caj pas;
- edematous qhov tau nrog cov kev txuam ntawm cov kua intercellular nyob rau hauv cov ntaub so ntswg;
- ua haujlwm - ua txhaum tag nrho cov haujlwm ntawm cov txiav;
- kev puas tsuaj tsim nrog cov nqaij ua kev puas tsuaj loj, thiab, tom qab ntawd, lawv tsis raug hloov dua tshiab lawm.
Cov tsos mob
Ib qhov tshwj xeeb ntawm cov kab mob pathology no yog nyob rau theem pib nws yuav tsis tshwm sim nyob rau hauv txhua txoj kev, tshwj xeeb nrog daim ntawv qeeb ntawm cov txheej txheem necrotic. Thawj yam tshwm sim yog tib yam li nrog lwm yam kab mob ntawm txoj hnyuv:
- xeev siab tom qab noj mov;
- ntuav heev nrog impurities ntawm bile lossis ntshav;
- hnyav hauv lub plab, ua qab;
- mob plab siab;
- plab hnyuv colic;
- tsis qab los noj mov;
- chim quav.
Tab sis nrog necrosis, muaj cov tsos mob tshwj xeeb uas tuaj yeem qhia rau tus kws kho mob tshwj xeeb peculiarity ntawm pathology. Ua ntej ntawm tag nrho cov, nws yog ib qhov mob nyob hauv sab laug hypochondrium. Nws tuaj yeem tseem txuas ntxiv mus rau tag nrho lub plab hauv plab, mus rau hauv qab plab, nraub qaum, xub pwg. Qhov mob yog feem ntau thab los ntawm thaj chaw noj mov, nrog kev txav, nrog rau thaj chaw supine. Nws tuaj yeem tingling, hlawv lossis hauv daim ntawv ntawm spasms. Thiab nyob rau hauv ib nrab ntawm cov neeg mob lub mob yog tsis tau.
Cov tsos mob tseem ceeb ntawm pancreatic necrosis yog mob hnyav thiab xeev siab.
Tsis tas li ntawd, ib qho kev nce hauv qhov kub yog qhov ua tau, uas qhia tau tias muaj cov txheej txheem mob. Thaum nias rau ntawm lub txiav, mob tshwm sim. Thiab ntawm daim tawv nqaij ntawm plab plab, cyanotic me ntsis tuaj yeem pom. Tus neeg mob sai sai poob phaus, poob nws lub siab, nws muaj intolerance mus rau muaj zog tsw.
Kev kuaj mob
Pancreatic necrosis yog qhov nyuaj heev kom pom tseeb thaum pib. Yog hais tias cov txheej txheem necrotic tau qeeb qeeb, hauv ib cheeb tsam hauv cov chaw sib cais, qhov no tsis pom nrog ntau txoj kev kuaj. Yog li no, ntau zaus, kev kuaj mob zoo sib xws txawm hais tias nyob hauv cov neeg mob siab, thaum kho tsis tuaj yeem tsis pom.
Tab sis nrog lub sijhawm mus ntsib tus kws kho mob, cov kws tshaj lij muaj peev xwm xav tias necrosis twb nyob ntawm thawj qhov kev kuaj mob ntawm tus neeg mob. Txhawm rau kom paub tseeb tias kev kuaj mob, tus neeg mob xa mus rau tso zis thiab kuaj ntshav, nrog rau ultrasound ntawm lub txiav. Qee lub sijhawm nws yuav tsim nyog los ua kev soj ntsuam ntxiv: MRI lossis CT, angiography, laparoscopy. Qhov no yuav pab tau qhov sib txawv pathology los ntawm biliary colic, plab hnyuv txhaws, plab pob txha aortic aneurysm, myocardial infarction.
Lub ntsiab kev kuaj mob rau tag nrho cov pathologies ntawm lub txiav yog ultrasound
Kev Kho Mob
Feem ntau cov feem ntau, kev kho mob ntawm pancreatic necrosis yog nqa tawm hauv tsev kho mob. Qhov tseeb tiag, txawm tias muaj mob me, yuav tsum muaj kev saib xyuas tas li los ntawm kws kho mob yog qhov tsim nyog, vim nws yog ib qho tseem ceeb los saib xyuas kev nce qib ntawm cov txheej txheem rov qab. Qhov no yuav pab tau nyob rau hauv lub sijhawm kom paub txog qhov kev vam meej ntawm pathology.
Hauv cov theem pib ntawm necrosis, kev kho kom zoo yog feem ntau txaus. Nws muaj kev noj cov tshuaj tshwj xeeb thiab kev hloov khoom noj zoo. Tsuas yog kev siv ua ke ntawm cov qauv no tuaj yeem nres cov txheej txheem necrotic. Tsis tas li ntawd, nyob rau thawj ob peb hnub tus neeg mob pom tias so kom txaus thiab tsis muaj zaub mov.
Ntawm cov tshuaj, analgesics lossis antispasmodics feem ntau siv, uas pab txo kev mob. Nws yog qhov zoo tshaj plaws los tswj lawv rau cov tshuaj intramuscularly lossis intravenously, zoo li ntuav tuaj yeem cuam tshuam nrog lawv qhov nqus. Qee zaum novocaine blockade ntawm lub caj pas kuj tseem siv. Nrog rau o, NSAIDs yuav tsum muaj, thiab muaj qhov kis tau tus mob yuav tsum siv tshuaj tua kab mob. Yog hais tias tus neeg mob nws lub cev qhuav dej, saline yog txhaj tshuaj ntxig rau. Cov tshuaj tshwj xeeb rau kev mob tua kab mob necrosis yog cov uas thaiv qhov kev txiav txim ntawm cov enzymes, piv txwv li, Contrical lossis Gordox. Qee zaum antihistamines kuj tau sau tseg.
Tom qab qhov mob hnyav ntawm tus kab mob mus lawm thiab cov txheej txheem necrotic nres, txoj kev noj haus nruj me ntsis rau cov neeg mob kom txo lub nra ntawm cov mob ntawm tus txiav. Nws yog ib qho tsim nyog yuav tsum tso tseg cov dej cawv, cov rog thiab kib zaub mov, cov txuj lom, khoom qab zib, dej haus.
Hauv cov xwm txheej siab, nrog rau kev faib nrog cov txheej txheem necrotic, kev phais yog tsim nyog. Txheeb nws tsis pub dhau 5-6 hnub tom qab kuaj pom. Muaj qhov zam tau tsuas yog cov xwm txheej kub ntxhov uas yog hem rau tus neeg mob lub neej. Thaum lub sijhawm ua haujlwm, cov ntaub so ntswg tuag, mob exudate thiab pus tau raug tshem tawm, qhov cuam tshuam ntawm los ntshav yog tshem tawm, thiab qhov ua haujlwm tawm ntawm cov kua txiv pancreatic rov qab los.
Kev phais mob yuav tsum muaj nyob rau hauv Feem ntau ntawm pancreatic necrosis, tab sis txawm tias nws tsis tas yuav pab.
Huab Cua
Nws yog ib qho tsim nyog yuav tsum sab laj tus kws kho mob kom raws sijhawm kom muaj qhov tsis xis nyob hauv plab hauv plab. Tom qab tag nrho, cov txheej txheem ntawm cov nqaij mos necrosis tuaj yeem tsim kho sai, ntau thiab ntau lub hlwb raug rhuav tshem, uas ua rau muaj kev ua txhaum ntawm cov zom zaub mov. Yog tias koj pom cov txheej txheem no thaum theem pib, koj tuaj yeem nres nws. Thiab edematous necrosis yog kho nrog cov tshuaj tiv thaiv. Yog li, koj tsis tuaj yeem ua lub cev tsis muaj zog lossis noj tshuaj rau nws tus kheej, tsuas yog kev mus ntsib kws kho mob raws sijhawm kom tuaj yeem txuag koj ntawm cov teeb meem.
Tab sis kev kwv yees rau pancreatic necrosis nyob tsis yog ntawm qhov no. Raws li kev txheeb cais, txawm tias txoj hauv kev xaiv txoj kev kho mob, kev tuag ntawm cov kab mob no ncav cuag li 70%. Kev rov qab yog nyob ntawm cov yam ntxwv ntawm chav kawm ntawm tus txheej txheem necrotic, nws qhov chaw nyob, qhov mob hnyav, muaj cov teeb meem tshwm sim, nrog rau lub hnub nyoog ntawm tus neeg mob. Kev muaj mob ntshav siab feem ntau pom nyob rau cov neeg laus dua 50 xyoo, thiab cov neeg mob uas tsis muaj cov kab mob acid los yog cov ntshav qab zib, ntshav siab lossis o nrawm heev. Tsis tas li ntawd, nyob rau hauv kev mob siab rau necrosis, tsawg dua 10% ntawm cov neeg mob ciaj sia txawm tias muaj txoj kev kho mob zoo.
Txawm tias muaj kev rov qab ua tiav, ib tug neeg raug yuam ua raws li kev noj haus tshwj xeeb thoob plaws nws lub neej thiab soj qab nws txoj kev ua neej. Coob leej tau txais kev tsis taus, vim lawv tau sib txuas tsis yog tsuas yog ua txhaum kev noj haus, tabsis tseem ua haujlwm lub cev, nrog rau kev ntxhov siab. Tab sis raug rau lub neej zoo thiab kev noj haus, koj tuaj yeem tswj kev noj qab haus huv ntawm pancreatic thiab tiv thaiv kom tsis txhob muaj teeb meem ntxiv.
