Hemorrhagic pancreatic necrosis (ICD code 10 K86.8.1) yog qhov ua tiav lossis tag nrho ib nrab ntawm kev tuag ntawm cov ntaub so ntswg.
Tus kabmob yog ib qho ntawm cov pathologies uas tuaj yeem ua rau tus neeg mob tuag hauv lub sijhawm luv luv.
Qhov nyuaj ntawm kev kho mob yog cuam tshuam ob qho tib si nrog kev loj hlob ntawm kev mob pancreatic necrosis (1 hnub) thiab nrog qhov tseeb tias lub cev cuam tshuam tsis txawm rov qab los thiab tsis tsim qee cov enzymes thiab cov tshuaj hormones txawm tias tom qab kho.
Tias yog vim li cas ib qho ntawm cov kev mob tshwm sim ntawm tus kab mob los ua hom 2 mob ntshav qab zib mellitus.
Kev tsim kho tshuab
Tus kab mob no yog dab tsi thiab dab tsi yog qhov ua rau nws muaj kev loj hlob? Nrog rau pancreatic necrosis, lub fistula yog tsim, los ntawm cov ntsiab lus ntawm tus txiav mus rau hauv lub plab kab noj hniav yuav luag tsis muaj kev txhim kho.
Cov ntaub so ntswg nrog rau cov mob ntshav tawm ua rau lub zog ua rau lub zog ntawm tus mob txha caj qaum, hauv 50% ntawm cov neeg mob uas ua rau kom tus neeg mob tuag tas.
Tawv nqaij necrosis tshwm vim yog lub cev tsis ua haujlwm ntawm cov kua txiav kom mob thaum lub plab zom mov. Enzymes los ntawm qhov hloov khoom nruab nrog tsis nthuav tawm thiab alkalis pib zom cov khoom sib txuas protein.
Ntawd yog, tus txiav ua ke pib zom nws tus kheej. Kev puas tsuaj tsis txwv rau qhov no. Necrosis kis mus rau cov hlab ntshav txhaws lub cev, ua rau lawv raug mob thiab ua rau ntshav.
Ua rau ntawm pathology
Hemorrhagic pancreatic necrosis tsis tsim los ntawm kos.
Cov yam zoo li no tuaj yeem ua rau muaj kev ua txhaum loj:
- lom los ntawm haus dej cawv lossis zaub mov;
- tsim txom cov tais diav uas cuam tshuam lub plab zom mov (ntse, qab ntsev, rog);
- kev tsis haum tshuaj;
- cov kab mob autoimmune;
- malignant lesions, nrog los ntawm kev ua txhaum ntawm cov ntshav coagulation;
- txhaws ntawm lub biliary huam;
- cov kab mob sib kis, uas suav nrog kev mob plab hnyuv, mob lupus thiab mob qog;
- noj tshuaj thiab tshuaj noj yam tsis muaj ntawv kho mob sau tshuaj;
- endocrine mob (hypothyroidism, mob ntshav qab zib mellitus, muaj teeb meem los ntawm cov kab mob ntawm cov hnyuv).
Ntawm cov neeg muaj kev pheej hmoo, ib qho tuaj yeem paub qhov txawv ntawm cov hauv qab no:
- cawv thiab quav yeeb quav tshuaj;
- cov laus dua nrog ib pawg ntawm cov kab mob sib kis;
- cov neeg mob nrog pathologies ntawm lub txiav, daim siab, lub plab zom mov;
- cov neeg uas niaj zaus ua phem rau qhov ntsim, qab ntsev, haus luam yeeb thiab zaub mov muaj roj;
- cov neeg muaj mob lub plab.
Cov tsos mob ntawm tus kab mob
Cov tsos mob ntawm hemorrhagic pancreatic necrosis yeej ib txwm mob. Nws yog tsis yooj yim sua kom tsis pom lawv. Nyob rau theem pib, tus neeg mob pib txhawj txog xeev siab, mob heev, feem ntau tau tawm hauv cheeb tsam sab laug hypochondrium.
Qee lub sij hawm qhov mob yog girdle-xws li, qee zaum nws zoo li cov tsos mob ntawm lub plawv nres. Tus neeg tsuas tuaj yeem txo qhov mob siab nyob hauv qhov chaw zaum, ib txwm nrog nws lub hauv caug rub tawm mus rau nws lub plab.
Kuj, pathology yog tsiag ntawv los ntawm cov cim zoo li no:
- cov kev tawm tsam thiab nquag ntuav, uas tsis nqa ib qho kev pab twg;
- qhov muaj zog hauv lub cev nce mus rau qhov siab tshaj qhov tseem ceeb;
- cov kev hloov hauv daim tawv nqaij (liab, pallor, qhov tshwm sim ntawm hematomas, nce mob rhiab heev nrog lub teeb kov);
- tawm tsam keeb kwm ntawm pancreatic necrosis, ascites, phlegmon ntawm lub plab zom plab plab;
- cov piam thaj hauv ntshav nce siab zuj zus, uas yog qhov tshwj xeeb tshaj yog nyob rau hauv cov ntshav qab zib thiab tuaj yeem ua rau hyperglycemic coma;
- muaj kev xav ntawm imposing cov lus;
- cov zis tso tawm thaum tso zis ntau zuj zus;
- txog siav ua tsis taus pa, cov mem tes cuam sai, ntshav tawm los tsis ruaj khov;
- kev cuam tshuam ntawm lub paj hlwb (inhibition lossis ntxhov siab) tau sau tseg;
- txhua tus neeg mob thib tsib paub txog lub xeev poob, txhua tus neeg mob thib peb poob rau hauv kev tsis xeev.
Kev nce qib
Muaj ob peb theem yuav tsum tau ua ntawm kev loj hlob.
Thaum thawj zaug, cov kab mob pathogenic pib hlav nyob rau hauv cov caj pas. Nws yog nyob rau theem no ntawm tus neeg mob uas ntuav pib tsim txom, cov quav ua tsis ruaj khov, lub cev kub nce siab.
Ntawm theem ob, purulent decomposition ntawm lub hlwb pib, daim ntawv tsis ua haujlwm hauv lub plab. Theem phom sij tshaj plaws yog tus thib peb. Kev mob nrawm kis mus rau thaj chaw ntawm cov nqaij mos noj qab haus huv, kev puas tsuaj ntawm tus txiav ua tiav sai sai.
Muab qhov ceev nrog qhov twg ib theem hloov chaw dhau los, koj tsis tuaj yeem ncua kev hu xov tooj rau lub tsheb thauj neeg mob hauv qee kis.
Tom qab tus neeg mob coj mus rau hauv lub tsev kho mob, nws tau ua tib zoo tshawb xyuas, hom thiab theem ntawm tus mob pancreatic necrosis tau txiav txim siab, thiab kev kho mob sai ntawm pathology tau pib.
Tus kab mob, uas tuaj yeem txhim kho raws li kev tawm tsam, yuav tsum tau pw hauv tsev kho mob thiab kho mob thaum muaj xwm txheej ceev.
Kev faib tawm thiab hom
Necrosis tshwm sim los ntawm pathology tau muab faib ua ob peb hom. Qhov no tso cai rau koj los sau tshuaj kho qhov zoo tshaj plaws thiab ua haujlwm rau tus neeg mob uas tau xa mus rau tsev kho mob thaum sijhawm.
Tus swb yuav yog:
- me focal;
- nruab nrab focal;
- loj focal;
- muaj tagnrho;
- tag nrho.
Kev kuaj mob yog tsim raws li qhov loj ntawm cov chaw pancreatic cuam tshuam los ntawm pancreatic necrosis.
Nyob rau thawj theem thib ob lossis theem ob, ciam teb yog fuzzy. Ntawm qhov thib peb - lawv tau pom meej thiab tau sau tseg. Qhov theem tag nrho txuam nrog kev tuag ntawm feem ntau ntawm cov khoom nruab nrog, tag nrho - tag nrho txoj kev tuag ntawm pancreatic ntaub so ntswg.
Hauv cov theem kawg, phais yog qhov tsis tuaj yeem. Cuam tshuam cov ntaub so ntswg yuav tsum tau muab tshem tawm tag nrho.
Tsis tas li, pancreatic necrosis yog qhov txawv txav los ntawm qhov muaj lossis tsis muaj tus txheej txheem sib kis - kis mob lossis huv.
Kev kuaj mob
Txog ntawm kev txheeb xyuas thiab kev soj ntsuam tom ntej, hemorrhagic pancreatic necrosis yog qhov sib txawv nrog lwm cov pathologies. Txhawm rau ua qhov no, tus kws kho mob xam phaj tus neeg mob, nrhiav pom tias nws tau tsim txom cawv lossis zaub mov muaj roj, muaj cov kab mob ntev li cas hauv nws anamnesis.
Tom ntej no, tus neeg mob tau kuaj mob CT scan ntawm lub plab pob txha lossis ultrasound, ntau qhov kev ntsuas tau raug kuaj, suav nrog:
- kev kuaj ntshav qhia tus kws kho mob cov ntaub ntawv ntawm cov ntsiab lus ntawm pancreatic enzymes (kev nce ntxiv hauv cov ntsuas no los ntawm 6–9 zaug qhia tias hemorrhagic pancreatic necrosis);
- kev soj ntsuam ntawm lub plab zom kua txiv, uas tso cai rau koj kom sai thiab raug txiav txim siab txog qib uas acidity;
- urinalysis rau kev tshawb nrhiav ntawm ureaplasma thiab trypsinogen;
- suab rau kev txiav txim siab ntawm bicarbonates thiab enzymes;
- kev tsom xam cov pa rau amylase thiab triglycerides;
- coproscopy tsim nyog los kawm cov roj nyob hauv cov quav.
Qhov hno ntawm thaj tsam ntawm tus mob necrosis raug txiav percutaneously, endoscopic pancreatocholangiography thiab, yog tias tsim nyog, mob plab laparoscopy tau ua, uas ua rau nws muaj peev xwm pom tag nrho daim duab ntawm kev puas tsuaj rau tus txiav thiab lwm yam tseem ceeb plab hnyuv siab raum.
Tsuas yog tom qab ua cov txheej txheem kuaj mob yooj yim lawv puas pib kho tus neeg mob.
Kho kab mob
Ntawm thawj cov tsos mob ntawm tus mob pancreatic necrosis, tus neeg mob tau pw tsev kho mob. Tom qab kuaj pom, tus neeg mob xa mus rau tsev kho mob nyhav lossis tam sim ntawd mus rau chav ua haujlwm. Nws yog ib qho tseem ceeb uas yuav tsum ua nrawm nrawm txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau tuag.
Qhov kev kho mob yog:
- relieving mob thiab spasm los ntawm cov kua tsib ducts;
- siv ceev xwmphem kev ua si enzymatic;
- kev tsim tawm ntawm lub plab ua kua txiv;
- tiv thaiv kev txuas ntawm kev kis mob theem nrab.
Tus neeg mob tau txhaj nrog cov tshuaj uas daws qhov mob, piv txwv li novocaine blockade. Tshuaj loog so kom txaus lub ducts, tso cai rau kua txiv quav yeeb kom tawm.
Lawv tuaj yeem tiv thaiv kev tsim tawm ntawm cov enzymes ntau dua los ntawm kev npaj cov tshuaj antienzyme, thiab cov tshuaj tua kab mob tiv thaiv kev tiv thaiv kev kis kab mob ntawm lwm cov kabmob thiab cov ntaub so ntswg. Qhov no tso cai rau koj kom nres qhov txheej txheem ntawm kev ua txhaum ntawm enzymatic thiab humoral ua haujlwm ntawm lub txiav.
Kev txuag txoj kev kho yog nqa tawm ntawm keeb kwm ntawm qhov ceev nrawm. Cov khoom noj uas tsim nyog tau muab tshuaj tsuas yog zwm rau kom tsis suav nrog kev zais cia ntawm pancreatic secretion.
Sij hawm dhau los, tag nrho cov ntsiab lus ntawm lub plab yog tshem tawm los ntawm kev ntxuav. Nws yog ib qho tseem ceeb kom muab tus neeg mob nrog kev thaj yeeb nyab xeeb thiab qhov chaw xis nyob. Chav yuav tsum tau cua kom zoo nrog cua txias. Qhov no yuav pab tiv thaiv kom txhob kis taug mus ntxiv cov co toxins uas ua los ntawm tus neeg mob.
Yog tias tsis muaj kev txhim kho tuaj, muaj qhov xav tau kev phais mob xwm txheej ceev. Hom kev ua haujlwm yog nyob ntawm chav kawm ntawm hemorrhagic pancreatic necrosis. Laparoscopy lossis nqig dej txhaws yog qhov cuam tshuam rau cov kis mob uas tsis tuaj.
Lub cav ua haujlwm tau ua thaum ua qhov loj ntawm exudate ntau ntxiv. Peritoneal lim ntshav yog siv dav, uas lim cov ntshav ntawm co toxins thiab enzymes thiab yog li tiv thaiv tus neeg mob los ntawm kev qaug tshuaj nrog kev lwj.
Lub neej tom qab
Lub sijhawm postoperative yog lub sijhawm ntev thiab nyuaj. Cov xwm txheej tseem ceeb tshaj plaws rau kev rov qab los yog kev ua raws nrog tsoomfwv so nrog kev siv dag zog tsawg rau tag nrho lub sijhawm rov qab (tsawg kawg 4 lub hlis).
Nws yog ib qho tsim nyog yuav tsum tau noj tshuaj insulin-cov tshuaj, tshuaj uas txhawb cov plab zom mov ntawm cov zaub mov (enzymes).
Tus neeg mob uas twb tau mob taub hau loj lawm yog kws kho lub cev ua haujlwm thiab kev tawm dag zog ua lub cev kom tsim nyog kho kom rov zoo.
Cov khoom noj kev txwv nyob mus ib txhis. Kev noj haus txhais tau tias yuav txo tau cov load ntawm lub txiav. Nws yog ib qho tseem ceeb kom noj mov tsis tu ncua thiab nquag (5-6 zaug hauv ib hnub). Cov zaub mov yuav tsum yog nruab nrab kub thiab muag muag sib xws.
Ntawm cov khoom lag luam pom zoo rau kev siv txhua hnub yog cov hauv qab no:
- cov zaub rhaub lossis ncu;
- cereals ntawm dej;
- khob cij (qhuav);
- lub teeb ci;
- khoom noj siv mis nrog cov roj tsawg kawg cov ntsiab lus;
- nqaij qaib nqaij.
Muaj ntau cov khoom lag luam uas tib neeg uas muaj tus kab mob txaus ntshai no yuav tsum hnov qab mus tas ib txhis.
Taboo overlays:
- cov kaus poom zaub mov (ntses, nqaij, zaub);
- dej cawv, txawm tias tsawg;
- dej qab zib;
- cov nqaij haus luam yeeb;
- rog rog;
- cov khoom noj qab zib tshiab;
- cov khoom noj ceev
- tag nrho cov mis;
- khoom ua si;
- pickles;
- zaub, txiv hmab txiv ntoo thiab berries (tshiab).
Nws yog ib qho tseem ceeb kom ua raws li kev noj haus zoo li no txhawm rau tiv thaiv kev txhim kho ntawm cov teeb meem cuam tshuam nrog kev ua tsis tau ntawm cov txiav kom tsim cov tshuaj hormones tsim nyog thiab cov enzymes.
Txij li thaum mob ntshav qab zib mellitus feem ntau dhau los ua ib qho kev mob tshwm sim ntawm pancreatic necrosis, nws yog ib qho tseem ceeb los soj ntsuam cov ntshav qab zib, yuav tsum tau tshuaj xyuas tas li thiab ua raws li txhua cov lus pom zoo kho mob ntawm tus kws kho mob endocrinologist.
Video los ntawm tus neeg mob uas muaj tus kab mob:
Kev tiv thaiv hemorrhagic pancreatic necrosis
Ib tus neeg uas muaj kev pheej hmoo los tsim hom kab mob no yuav tsum siv kev tiv thaiv. Txhawm rau ua qhov no, tso tseg txoj kev haus dej cawv, ua raws li cov qauv khoom noj khoom haus kom zoo.
Nws yog qhov tseem ceeb rau kev kuaj mob thiab kho kab mob hauv lub sijhawm uas tuaj yeem ua rau kev loj hlob ntawm hemorrhagic pancreatic necrosis - biliary dyskinesia, duodenal ulcer thiab mob plab, cholecystitis.
Nws yog tsim nyog kom nco ntsoov tias txawm tias kev tsim txom ib zaug los ntawm cov khoom noj muaj roj lossis dej cawv tuaj yeem ua rau pancreatic necrosis thiab, vim li ntawd, ua rau kev phais mob nyuaj thiab txawm tuag.
Cov neeg uas muaj keeb kwm muaj qee yam mob ntshav qab zib mellitus yuav tsum tau ceev faj tshwj xeeb ntawm lub rooj noj mov. Cov kev tiv thaiv yooj yim tsis tuaj yeem lav tsis tau tias kev mob pancreatic necrosis tsis txhim kho, tab sis lawv txo txoj kev pheej hmoo ntawm kev muaj pathology ntawm koj tus kheej kom tsawg kawg.
