Hoʻokomo ʻia ka hoʻomaʻamaʻa ʻana o ka maʻi pancreatitis

Hoʻohana wale ʻia ka hana maʻi lapaʻau o ka maʻi pancreatitis no nā hōʻailona kūikawā: ka hemahema o ka hopena o ke ʻano conservative, ʻo ka hoʻonui ʻana i nā hōʻailona o ka ʻaloli a me nā peritonitis, ka ʻike ʻana i nā hōʻailona e hōʻike ana i ka hōʻemi o ka pancreatic a i ʻole hōʻiliʻili ʻana i ka pus ma ka omentum, ka hui pū ʻana o ka pancreatitis me kahi ʻano hoʻopōʻino o ka cholecystitis akiko.

ʻO nā ʻano o ka hana hou no ka maʻi pancreatitis e kū nei i ka: tamponade a me ka huki i kahi bursa omental liʻiliʻi me ka hōʻole ʻole ʻana o ka peritoneum ma luna o ka pancreas, tamponade a me ka pāhaʻi ʻana o ka bursa omental me ka ʻae ʻana i ka peritoneum e uhi ana i ka pancreas, pale ʻana i ka pancreas i hoʻololi ʻia, nā pancreas nui. ka hui pū ʻana o nā ʻano hana mua me ʻekolu ma waena o ka puhaka, extrahepatic bile ducts a me Vater nipple.

Loaʻa kahi komo intra- a me ka extraperitoneal i ke pancreas. ʻO ka mea maʻamau ka mea laparotomy median kiʻekiʻe. Hāʻawi ke ala maikaʻi i kahi hōʻeha hou o ka pā o ka ʻōpū, ʻoi aku hoʻi i nā hihia ke kahi o ka wā o ke kaʻina e pono ai ke loiloi hou i ka ʻāpana biliary.

Hiki ke hoʻokuʻi Intraperitoneal i ka pancreas ma kekahi o nā ʻano ʻehā. 1. Ma o ka ligament gastrointestinal. He kūpono loa kēia komo ʻana no ka mea e hiki ai iā ʻoe ke nānā i ka hapa o ke poʻo, ke kino a me ka huʻu o ka pancreas. Eia kekahi, hana ia i nā kūlana ʻoi aku ka maikaʻi o ka hoʻokaʻawale ʻana o ke ʻeke pahu mai nā koena o ka ʻōpū. 2. Ma o ka ligament hepatic-gastric. ʻAʻole maʻalahi kēia komo a hāʻawi ʻia ia no ka gastroptosis wale nō. 3. Ma o ka leka uila o ke kolone. ʻO nā palena iki o ka nānā ʻana i ka pancreas holoʻokoʻa, nā pilikia o ka hoʻoheheʻe ʻia ʻana o ka lua o ka omentum liʻiliʻi e hoʻoholo ai i ka hoʻohana pinepine ʻana o kēia ʻike. 4. Ma ka hoʻoneʻe ʻana i ka duodenum (T. Kocher) a pēlā i ka hoʻolaha ʻana i ke poʻo o ka pancreas. Hiki i kēia komo i ka pancreas ke hoʻohui i ka mea ʻē aʻe ma mua.

ʻO ka loaʻa i ka extraperitoneal i ka pancreas, ʻelua wale nō ka mea iʻike ai: 1) lumbotomy ʻima kūpono (ma lalo o ka maʻa XII a kūlike i ia), e ʻae ana i ke poʻo o ka pancreas, a me 2) lumbotomy hema no ka neʻe ʻana i ke kino a me ka huelo o ka pancreas. Hoʻomaopopo pinepine kēia mau ala kokoke i ke kahe o nā abscesses a me ka phlegmon o ka lumi retroperitoneal a hiki ke hoʻohana ʻia e like me ka nui o ka intraperitoneal.

ʻO ka Tamponade a me ka hoʻoheheʻe o ka omental bursa me ka hoʻokaʻa ʻole ʻana o ka peritoneum e uhi ana i ka pulipi ʻaʻole e hāʻawi i kahi kahe o nā mea ʻona a me nā ʻano hoʻonaninani hoʻōla ʻia a me ka wili pancreatic. No laila, ʻo ka hana ākea nui loa, ʻo ia ka haʻalele ʻana o ka peritoneum ma luna o ka moʻo, i ukali ʻia e ka tamponade a me ka hoʻoluku ʻana i ka omsa bursa. ʻAe aku ʻo B. A. Petrov a me S. V. Lobachev i ka hoʻokaʻawale ʻana i ka peritoneum ma luna o ka lepa me ka manawa 2–4 lōʻihi i ka ulu ʻana mai ke poʻo a i ka huʻu o ka paʻakai. ʻO V. A. Ivanov a me M. V. Molodenkov ka mea (ʻoi aku me ka pancreatitis e wāwahi ʻia) e hoʻopau i ka peritoneum a hōʻike i ka papa o ka nui, ka ʻaoʻao o luna a me nā ʻaoʻao o ka pae o ka pala, aʻo nā ʻāpana o ka nekrosis e wehe a haʻalele ʻia paha.

Hoʻopiʻi ʻia ka tamponade me nā paona maʻamau a i ʻole nā ʻāpana hoʻoneʻe. Pēlā e like me ke kānāwai, ua lawe ʻia lākou i ke kino a me ka huelo o ka pancreas a a hiki i ka ʻaoʻao kiʻekiʻe o ka ana o ka omentum liʻiliʻi. Mai ka haʻalele ʻana i ka capsule pancreatic me ka tamponade ma hope, ʻaʻole i kaohi ʻole i ka hoʻomohala ʻana o ke kaʻina hana me ka meli ʻana o ka ona gland a me ka hoʻokumu ʻana o nā abscesses retroperitoneal, kekahi mau mea kākau (A.N. Bakulev, V.V. Vinogradov, S.G. Rukosuev, etc.) e hoʻopuka ai e hana. wehe hou i ka pancreas i hoʻopilikia ʻia. Eia naʻe, ua hana ʻia ka hoʻohana ʻana o kēia hana ma ka hapa ʻole o ka laina demarcation maopopo o ka pau ʻana, hiki paha i ka hoʻomau ʻana o ka nehu ʻana aʻe. Ua noi ʻia ʻo Mikhaylants e kaupalena i ka wawa ʻana o ka pancreatic necrosis wale nō i ka tamponade koi o nā pancreas (nui omentum), i hoʻokumu ʻia i ka hana bactericidal a me ka paleke paleke o ka omentum.

I ka wā o ka hana no ka maʻi pancreatitis, hana ʻia ka novocaine blockade o ka pancreas, ua hoʻōla ʻia ka mesentery a me ka omentum liʻiliʻi. ʻO 100-200 ml o kahi hopena o 0.25% o novocaine i hoʻohui pū me nā hoʻohui o nā antibiotics (penicillin - 200,000-300,000 DB, streptomycin - 150,000-200,000 unahi).

Manaʻo kekahi helu o nā mea kākau, ma hope o ka hoʻokaʻawale ʻana i ka pepa posterior o ka peritoneum a me ka hoʻolahaʻana i ka pancreas, hoʻopiha i kona papa me ka wai maloʻo (100-150 g), kahi puʻupuʻu hemostatic, nā kīwaha koko ʻōmaʻomaʻo me ka hoʻohui o nā antibiotics. ʻO ka pahuhopu o ka noi topical o ka hoʻomākaukau ʻana i ka protein maloʻo ke hoʻoneʻe i nā enzyme pancreatic i komo i ka ʻōpū o ka ʻōpū. Ma hope aku, ua noi ʻia nā inikina o kēlā me kēia lā i kēia mauʻaina protein i loko o kahi ala mushy, a me kekahi mea paʻa i ka trasylol, ma o kahi wai ʻauʻau. Eia kekahi, e hoʻomau ʻia e ka hana drip a intravenously a hiki i ka diastase i loko o ka urine i ka nui o nā helu maʻamau.

I nā hana no ka maʻi pancreatitis maʻa, ma ke ʻano he kānāwai, pono ka hoʻokolokolo o ka ʻili biliary. Me ka gallbladder catarrhally inflamed, hōʻike ʻia ka cholecystostomy. I nā ʻike o ka nānā ʻana i kahi ʻano hoʻopōʻino kino o ka cholecystitis, cholecystectomy me ka hoʻoheheʻe ʻana o ka bile (pono a dile dile) pono. I kekahi mau hihia, i ka wā o ka hana, ua ʻike ʻia nā ʻāpana o ka hopena o ka dile bile, ua hōʻike ʻia ka choledochoduodenostomy (e ʻike i ke kūmaha ʻo Gall, ʻoi). ʻO ka hana ʻana o ka sphincterotomy i kēia mau hihia ʻaʻole i loaʻa ka noi ākea ma ka loea lapaʻau ma muli o nā hoʻopiʻi pinepine ʻana ma ka manawa postoperative.

Ma hope o ka hana, pono ia e hoʻokō i nā hana i kuhikuhi e pili ana i ka hoʻouka ʻana i ka hoʻolapalapa, nā maʻi palahalaha, nā pilikia o ka ʻōnaehana cardiovascular a me ka hanu.

Hoʻohana ʻia i ka maʻi maʻi

ʻO ka hōʻike pololei no ka hoʻouka ʻana ua hoʻopili ʻia nā ʻano o ka nekrosis pancreatic(ka maʻi maʻamau ʻo ka papa pancreatic, pancreatogenic abscess, ka maʻi o ka maʻi pehu, retroperitoneal necrotic phlegmon, peritonitis purulent, pseudocyst maʻi). I ka pāʻina septic o ka maʻi, ua koho ʻia ke koho pono ʻana me ka wehe ʻana i ke ʻano o ka maʻi lapaʻau a me ka ʻano pathomorphological o ka necrosis pancreatic a me ka paʻakikī o ke ʻano o ka mea maʻi. Me ke ʻano o ka aseptic o ka necrosis pancreatic, ʻaʻole i kuhikuhi ʻia ka hoʻohana ʻana o ka pale laparotomic ma muli o ka hiki ke kiʻekiʻe o ka maʻi ʻana o ka nui o ka necrotic me ka hoʻomohala ʻana o ke koko intraperitoneal, hōʻino iatrogen i ka ʻeha gastrointestinal. ʻO ka hana Laparotomic i hana ʻia i ka wā aseptic o ka luku pancreatitis e pono e hoʻopono pono ʻia. Ke manaʻo nei paha nā:

mālama a i ʻole ka holomua ʻana o nā ʻekekema kūwaho kūwaho i ke ʻano o ka mālama mau ʻana o ka mālama koʻikoʻi ʻana a me ka hoʻohana ʻana i nā minamina no ka pale ʻana i ka hōʻoki ʻana.

lime hala ailua,

ka hiki ʻole i ka hōʻoia ʻana e hoʻokaʻawale i ka mea i loaʻa i ke kaʻina o ka necrotic a i ʻole nā maʻi ʻē aʻe e koi ana i ka hana hōʻeha.

Ua wehe koke ʻia e ka hana maʻi no ka peritonitis enima i mua o ka manawa mua o ka pīpī o ka maʻi ma muli o nā hala i ka hopena me nā maʻi ʻē aʻe o nā ʻōpū o ka ʻōpū, me ka mālama ʻole ʻana ma mua. Nā kāpena i hoʻopihapiha-paʻa i ka hoʻopihapiha

ʻO ka hiki ke hoʻokō i ka hoʻōla kūpaʻa hopena (puncture a catheter) e hoʻoholo i ka versatility o ke kaʻina ultrasound i ka hāʻawi ʻana i ka ʻike ākea i nā pae āpau o ka mālamaʻana i nā maʻi me ka pancreatic necrosis. ʻO ka hoʻohana ʻana o nā hana hana percutaneous ua wehe i kahi mau hou i ka mālamaʻana i nā mea maʻi me nā ʻano palena o ka pankreatic pancreatic. Ke ʻike nei nā hōʻailona no ka puncture-draining interventions ma lalo o ke kaohi o ka ultrasound no ka pancreatic necrosis ʻo ka loaʻa ʻana o nā ʻano puʻupuʻu nui i loko o ka ʻōpū o ka pūhaka a me nā wahi o ka retroperitoneal. No ka hana ʻana i kahi hana kahe wai ma lalo o ke kaomi ʻana o ka ultrasound, pono kēia ʻano kumu: ʻike maikaʻi ʻana i ka lua, ka loaʻa ʻana o kahi kuhi palekana palekana no ka hoʻouka ʻana, a me ka hiki ʻana o ka hoʻokō ʻana ke hihia paha nā hihia. Koho ʻia ke ʻano o ke ala no ka hoʻokō ʻana i ka puncture percutaneous no ka hōʻuluʻulu ʻana o ka pancreatogenic fluid, i ka lima hoʻokahi, ma ke ala palekana puncture palekana, a i kekahi, e ka nui, ka ʻano a me ke ʻano o nā ʻike. ʻO ke kumu nui o ka māhuahua percutaneous kūpono e ʻike ʻia ana he “window window” - palekana acoustic i ka mea. Hāʻawi ʻia ka makemake i ka lipi e hele ana ma ka lient omryum liʻiliʻi, gastrointestinal a me gastro-splenic ligament, ma waho o nā pā o nā kolo hollow a me nā ar viva, e hilinaʻi nei i ka topology a me ka hoʻokona o ka lesion. Nā Hōʻailona mo nā puncture-draining intervent:

ka nele o ke kumuwaiwai o ka pae luku,

ka hele ʻana ma ke ala o ka puncture o nā mea o ka gastrointestinal tract, urinary system, vascular formations,

nā pilikia hōʻeha o ka ʻōnaehana hoʻonohonoho koko.

ʻO ka pae ʻana o nā hoʻolalelele ma lalo o ka mana o ka ultrasound me ka pūlima pono ʻana hoʻokahi me kona hoʻoneʻe ʻana ma hope (me ka hoʻopiha ʻia o nā ʻano wai volumetric) a i kā lākou wai (neʻe ʻia ka volumetric formations). Me ka loaʻa ʻole o ka intervez puncture, ua hele lākou i nā hana wai. Pono ka paʻu e hōʻoia i ka kahe ʻana o ka hoʻouka ʻana, nā hoʻoponopono kūpono i ka catheter i loko o ka lumen o ka ana a ma luna o nā ʻili, hoʻonohonoho maʻalahi, nā kāpae a me ka mālama ʻana i ka ʻōnaehana wai.

ʻO ka mālama ʻana

ʻO ka hoʻomaʻamaʻa conservative maʻamau o ka maʻi pancreatitis e pili ana:

pani ʻia ʻana o ka hana huna i ka ʻōpū o ka pancreas, ka ʻōpū a me ka duodenum,
ka hemo ʻana o ka hypovolemia, ka wai-electrolyte a me ka hoʻokalakupua o ka metabolic,
hoʻemi i ka hana o ka enzyme,
ka haʻalele ʻana o ka maʻi hypertension i nā ʻano biliary a me ka pancreatic,
ka hoʻomaikaʻi ʻana i ka waiwai o ka rheological o ke koko a me ka liʻiliʻi o nā maʻi microcirculatory,
ka pale a me ka mālama ʻana i ka hana hana pono o ka gastrointestinal tract,
ka pale a me ka mālama ʻana i nā koi septic,
ka mālama ʻana i ka hoʻokele oxygen hāmeʻe i ke kino o ka mea maʻi me ka cardiotonizing a me ka hanu ʻana,
hōʻoluʻolu o ka ʻeha.

Hoʻomaka ka hana maʻi me ka hoʻoponopono ʻana i ka kaulike wai-electrolyte, me ka hoʻokaʻawale ʻana o nā hopena isotonic a me ka hoʻomākaukau ʻana o ka potassium chloride me ka hypokalemia. I mea e detoxify e hana ai i ka therapy infusion ma ke aupuni o nā diuresis ikaika. No ka mea ka hihia o ka necrosis pancreatic aia ka hapa o ka bcc ma muli o ka nalowale ʻana o ka hapa o ka plasma o ke koko, pono ia e hoʻopuka i nā ʻōmua kūlohelohe (hou plasma i hoʻomākaukau ʻia, hoʻomākaukau ʻana o ka albumin kanaka). ʻO ka ʻikepili no ka nui o ka nui o ka media infusion ua hoʻonui hou i ka pae maʻamau o ka BCC, hematocrit, normalization o CVP. ʻO ka hoʻihoʻi ʻana o ka microcirculation a me ka waiwai o ka rheological o ke koko i loaʻa i ka koho ʻo dextran me ka pentoxifylline.

Ma ka hoʻohālike, lawe ʻia ka mālama ʻia e kuhikuhi ana i ke kāohi ʻana i ka hana o ka pancreas, ka mea i loaʻa mua i ka hoʻokumu ʻana i kahi "hoʻomaha physiological" ma o ke kāohi paʻa ʻana i ka ʻai o ka meaʻai no 5 mau lā. Hoʻomaʻamaʻa maikaʻi ka hōʻemi ʻana i ka mea huna pancreatic ma o ka minamina o nā ʻili o ka ʻōpū ma o ke kahawai nasogastric a me ka nui o ka gastric me ka wai anuanu (hypothermia kūloko). No ka hoʻēmiʻana i ka acidity o ka ʻeneki kikowaena, ka mea inu alkaline, ua koho ʻia nā pale ākea proton (omeprazole). No ka hoʻopau ʻana i ka hana huna o ka ʻaha gastropancreatoduodenal, ua hana ʻia kahi analog synthetic o somatostatin - octreotide i kahi pānaʻi ʻana o 300-600 mcg / lā me ʻekolu hoʻomalu a subutaneus a intravenous. ʻO kēia lāʻau lapaʻau he mea pale i ka basal a hoʻoikaika i ka mea huna o ka pancreas, ka ʻōpū a me ka ʻili liʻiliʻi. ʻO ka lōʻihi o ke kauʻana he 5-7 mau lā, e pili ana i ka lōʻihi o ka hyperenzymemia ikaika.

Me nā nekrosis pancreatic, no ke kumu o ka detoxification o ka ʻōnaehana, ua kuhikuhi ʻia e hoʻohana i nā hana extracorporeal: ultrafiltration, plasmapheresis.

Ke hana nei i nā prophylaxis rational kūpono a me ka hoʻopaʻa ʻana i ka maʻi pancreatogenic ke alakaʻi nui i ka hōʻailona pathogenetic. Me ka interstitial (form edematous) pancreatitis, ʻaʻole i hōʻike ʻia ka antibacterial prophylaxis. ʻO ka hōʻike ʻana o ka necrosis pancreatic e koi i ka koho ʻana i nā lāʻau antibacterial e hana ai i ka hoʻoulu ʻana o ka bactericidal koʻikoʻi ma ka wahi i hoʻopili ʻia me kahi kiko o nā hana e pili ana i nā pathogens etiologically nui. ʻO nā lāʻau lapaʻau i koho no ka hoʻohana ʻana i prophylactic a me ka therapeutic, he mau kapapena, 3 a me ka 4 mau hanauna cephalosporins i hui pū me metronidazole, fluoroquinolones i hui pū me ka metronidazole.

Me ka hoʻomohala ʻana o ka maʻi ʻeha o ka metabolic, ka pā ʻana i ka hypermetabolic, kahi ʻano kīpika piha piha i ʻōlelo ʻia (nā kūmole o ka glucose, nā waikawa amino). Ke hoʻihoʻi nei i ka hana o ka papa gastrointestinal i loko o nā poʻe maʻi me ka necrosis pancreatic, pono e kuhikuhi i ke kōkomo i loko o ka palalapala (a me nā mea kanu ʻai), i mālama ʻia e ka huina nasojunal i hoʻonohonoho pololei ʻia i ka Treitz ligament endoscopically, a i ka wā o ka ʻoihana.

Nā hōʻailona no ka ʻoihana

ʻO ka hōʻike pololei no ka hoʻouka ʻana ua hoʻopili ʻia nā ʻano o ka nekrosis pancreatic (ka maʻi maʻamau ʻo ka papa pancreatic, pancreatogenic abscess, ka maʻi o ka maʻi pehu, retroperitoneal necrotic phlegmon, peritonitis purulent, pseudocyst maʻi). I ka pāʻina septic o ka maʻi, ua koho ʻia ke koho pono ʻana me ka wehe ʻana i ke ʻano o ka maʻi lapaʻau a me ka ʻano pathomorphological o ka necrosis pancreatic a me ka paʻakikī o ke ʻano o ka mea maʻi. Me ke ʻano o ka aseptic o ka necrosis pancreatic, ʻaʻole i kuhikuhi ʻia ka hoʻohana ʻana o ka pale laparotomic ma muli o ka hiki ke kiʻekiʻe o ka maʻi ʻana o ka nui o ka necrotic me ka hoʻomohala ʻana o ke koko intraperitoneal, hōʻino iatrogen i ka ʻeha gastrointestinal.

Nā pihi scterile o ka necrosis pancreatic - Hōʻike no ka hoʻohana pono ʻana i nā loea minimally invasive o ka hoʻomaʻamaʻi ʻana: ka ʻōpala laparoscopic a me ka hoʻoheheʻe ʻana o ka ʻōpū o ka ʻōpū ma ke ʻano o ka peritonitis enzymatic a me / a me ke kau ʻana (percutaneous) i ka wā o ka hoʻokumu ʻana o nā kumuikika akene ma ka lumi retroperitoneal. Hoʻokomo ʻia ka hana hoʻomalu e ka laparotomic hele, i mālama ʻia i ka mea maʻi me ka sterrosre pancreatic sterile, e lilo ia i mea kūpono a e pili ana i ka "hana hoʻoluhi".

ʻO ka hana Laparotomic i hana ʻia i ka wā aseptic o ka luku pancreatitis e pono e hoʻopono pono ʻia.
Ke manaʻo nei paha nā:

mālama a i ʻole ka holomua ʻana o nā ʻekekema kūwaho kūwaho i ke ʻano o ka mālama mau ʻana o ka mālama koʻikoʻi ʻana a me ka hoʻohana ʻana i nā minamina no ka pale ʻana i ka hōʻoki ʻana.
lime hala ailua,
ka hiki ʻole i ka hōʻoia ʻana e hoʻokaʻawale i ka mea i loaʻa i ke kaʻina o ka necrotic a i ʻole nā maʻi ʻē aʻe e koi ana i ka hana hōʻeha.

Ua wehe koke ʻia e ka hana maʻi no ka peritonitis enima i mua o ka manawa mua o ka pīpī o ka maʻi ma muli o nā hala i ka hopena me nā maʻi ʻē aʻe o nā ʻōpū o ka ʻōpū, me ka mālama ʻole ʻana ma mua.

Nā kāpena i hoʻopihapiha-paʻa i ka hoʻopihapiha

Hoʻopilikia i nā wawa a kau i lalo o ka mana o ka ultrasound e hoʻoponopono ai i nā hana diagnostic a me therapeutic. Hoʻololi ʻo ka hana, ʻo ia ka loaʻa o nā mea pono no nā bacteriological, cytological a me biochemical Studies, ka mea e ʻae ʻia ai ka hoʻokaʻawale ʻana o ka ʻano aseptic a i ʻole ka maʻi pawa o ka pancreatic necrosis. Kauka ʻo ka hana ka haʻalele ʻana i nā mea o loko o ka hana pathological a me kāna hana hou ʻana inā inā ʻike ʻia nā hōʻailona o ka maʻi.

Ke ʻike nei nā hōʻailona no ka puncture-draining interventions ma lalo o ke kaohi o ka ultrasound no ka pancreatic necrosis ʻo ka loaʻa ʻana o nā ʻano puʻupuʻu nui i loko o ka ʻōpū o ka pūhaka a me nā wahi o ka retroperitoneal.

No ka hana ʻana i kahi hana kahe wai ma lalo o ke kaomi ʻana o ka ultrasound, pono kēia ʻano kumu: ʻike maikaʻi ʻana i ka lua, ka loaʻa ʻana o kahi kuhi palekana palekana no ka hoʻouka ʻana, a me ka hiki ʻana o ka hoʻokō ʻana ke hihia paha nā hihia. Koho ʻia ke ʻano o ke ala no ka hoʻokō ʻana i ka puncture percutaneous no ka hōʻuluʻulu ʻana o ka pancreatogenic fluid, i ka lima hoʻokahi, ma ke ala palekana puncture palekana, a i kekahi, e ka nui, ka ʻano a me ke ʻano o nā ʻike. ʻO ke kumu nui o ka māhuahua percutaneous kūpono e ʻike ʻia ana he “window window” - palekana acoustic i ka mea. Hāʻawi ʻia ka makemake i ka lipi e hele ana ma ka lient omryum liʻiliʻi, gastrointestinal a me gastro-splenic ligament, ma waho o nā pā o nā kolo hollow a me nā ar viva, e hilinaʻi nei i ka topology a me ka hoʻokona o ka lesion.

Nā Hōʻailona mo nā puncture-draining intervent:

ka nele o ke kumuwaiwai o ka pae luku,
ka hele ʻana ma ke ala o ka puncture o nā mea o ka gastrointestinal tract, urinary system, vascular formations,
nā pilikia hōʻeha o ka ʻōnaehana hoʻonohonoho koko.

ʻO ke kumu nui o ka kahe e kau ana i ka wai o ka pakanika o ka purulent-necrotic foci me ka pancreatic necrosis he nui ʻōnaehana nui e kū'ē ana i ke kāʻei o ka hoʻohana ʻana o nā papaha waikini liʻiliʻi liʻiliʻi, e koi ai i ka hoʻouka ʻana o nā waikā hou a i ʻole ke hoʻololi ʻana me ka nui o ka pulu lapalapa. Ma kēlā kūlana, ʻo ka mea mua, pono e alakaʻi ʻia e nā hopena o ka CT, e ʻae i kahi loiloi kumuhana o ka pae ʻana o nā kiko a me nā mea hoʻonaninani o ka luku retroperitoneal, a me ka mea hoʻohui puʻuwai o ke ʻano o ka mea maʻi a me ka nui o ka hopena ʻōnaehana. Ke waiho ʻole ʻana o nā hana he nui i ka mea maʻi ma ka mea maʻi me ka pancreatic necrosis, hoʻomaikaʻi i ke ʻano o ka mea maʻi, ka hoʻoponopono ʻana o nā maʻi a me nā ʻōnaehana maʻi o ke ʻano maʻi i loko o 3 mau lā ma hope o ke ʻano maʻi sanina o ka luku i ke kūmole o ka palena o ka necrosis pancreatic, ma ke komo ʻana i ka nui o nā kahe ma nā limu i ʻike ʻia a me nā leʻaleʻa me ka echogenesis ho'ēmi. I ka wā postoperative, pono ia e hōʻoia pono i ka holo ʻana (a i ʻole ka fractional) ka holoi ʻana i nā mea luku me nā hopena antiseptic.

ʻO ka hana hema ʻole o ka waihue o ka hoʻokumu ʻana o ka pancreatogenic fluid, i hana ʻia ma lalo o ka mana o ka ultrasound i ka mea maʻi me ka pancreatic necrosis, hōʻailona ʻia e nā syndromes o kahi ʻōkuhi a me ka maʻi o ka maʻi, ka hoʻomau a hoʻomohala ʻana i nā hemahema o ka nui o ka okana, ka hiki ʻana o ka hyperechoic, echo-inhomogeneous inclusions ma ka wahi luku.

I loko o nā kūlana o ka nīnūnū pancreatic i hele aku ai, a ma muli o nā hopena o ka ultrasound a me ka CT ua ʻike ʻia ka hapa nui o ka necrotic o ka lesion ma mua o kāna ʻōhua wai (a i ʻole ua panee i ka pae manawa o ka kahawai percutaneous), a me ka paʻakikī o ka noho ʻana o ke ʻano o ka mea maʻi ʻaʻole i hoʻomaikaʻi, hoʻomaikaʻi ʻia. hoʻomaʻemaʻe pono nā ʻano hana.

Loaʻa ʻia nā hōʻuluʻulu hōʻemi minimally i ka hoʻopili ʻana o ka hoʻopiha ʻana o ka volumetric formations ma nā manawa like ʻole ma hope o nā hana laparotomic, ʻoi aku hoʻi ma hope o ke kaʻina hana hoʻohena ʻana. ʻAʻole hiki ke hoʻohana ʻia nā ʻauwaena kaulua Percutaneous i ke ala nui no ka mālama ʻana i kēlā me kēia ʻano o ka necrosis pancreatic i ka wā lōʻihi a me ka nui o ka sequestration i manaʻo ʻia. I kēlā mau kūlana, e hoʻokō i ka hopena therapeutic, pono e hilinaʻi kekahi i ka makemake i ka hoʻopili laparotomy.