Kūmole pancreatic

ʻO ka pūpana pancreatic (code ICD10 - K86.2) kahi lua kahi e hoʻopuni ʻia e ka pōpoki a piha i ka wai. ʻO ka puka maʻamau morphological o nā loina cystic o nā pancreas he mau pou-post-necrotic. Ma ka haukapila Yusupov, hōʻike nā kauka i nā cysts i ka pancreas ma ka hoʻohana ʻana i nā ʻano hana hoʻokolohua modern: ultrasound (ultrasound), cholangiopancreatography retrograde, magnetic resonance imaging (MRI), compute tomography (CT). Lawe ʻia nā hoʻokolohua o nā maʻi me ka hoʻohana ʻana i nā ʻoihana hou loa mai nā mea hana.

Ua hoʻonui nui ʻia ka nui o nā mea i ʻike ʻia me nā maʻi cystic o ka pancreas i nā makahiki i hala iho nei. ʻO kahi hoʻonui hiki ʻole i ka ulu ʻana o ka maʻi pancreatitis a me ke kūpaʻa, he hoʻonui i ka nui o nā mea ʻino a me ka paʻakikī o nā maʻi e kōkua ai i kēia. ʻO ka hoʻonui nui aʻe o ka heleʻana o nā cysts pancreatic post-necrotic i hoʻomaʻamaʻa ʻia e ka lanakila nui o ka hoʻokomo ʻana i nā ʻoihana maikaʻi o ka mālama ʻana i ka maʻi a me ka maʻi pancreatitis.

ʻO ke kūpaʻa ʻana i ke ʻano o ka lāʻau lapaʻau ikaika, ʻoi aku ka nui o nā lāʻau lapaʻau ma ka haukapila ʻo Yusupov e pani i ke kaʻina luku ʻana a hōʻemi i ka pinepine o nā hoʻopiʻi purulent-septic. Ke hoʻohana nei nā mea hou i nā ala kūpono no ka mālama ʻana i nā cysts pancreatic. ʻO nā hihia koʻikoʻi o ka maʻi e kamaʻilio ʻia ma ka hālāwai o ka ʻaha Manaʻo me ka komo ʻana o nā mea aʻoaʻo a me nā kauka o ka helu kiʻekiʻe. Nā hoʻoholo aʻoaʻo loea e hoʻoholo piha i nā hana hoʻomanawanui. ʻO ka nui o nā cystre pancreatic e pili i ke koho o ka mālama ʻana i ka maʻi.

ʻO nā ʻano o ka pūpū pancreatic

ʻO nā congenital (dysontogenetic) pancstatic cysts i hoʻokumu ʻia ma muli o ka malformations o ke kino kikoʻī a me kāna ʻano waiʻi. ʻO ka cysts pancreatic loaʻa:

Mālama - hoʻomohala ma muli o ka hoʻopili ʻana o nā kaomi excretory o ka momona, i ke kaohi mau ʻana o kā lākou lumen e nā neoplasms, nā pōhaku,
Degenerative - i hana ʻia ma muli o ka hoʻopōʻino ʻana i ka mea hoʻonani i ka wā o ka necrosis pancreatic, ke ʻano o ka ʻōpū, nā hemorrhages,
Proliferative - neoplasms cavitary, kahi a me nā cystadenomas a me nā cystadenocarcinomas,
Parasitic - echinococcal, cysticercic.

Aia i ke kumu o ka maʻi, ʻo ka pancreatic cysts o kahi ʻano wai ʻakaʻaka a ke ulu nei ma muli o ka hopena o ka cholelithiasis. Me ka hoʻonui o ka nui o nā hana a nā mea hana hoʻomohala pinepine, nā ʻoihana kalepa, nā pōʻino kūlohelohe a me ka ʻenekema, ke hoʻokumu ʻana i nā peka pancreatic wahaheʻe i ka hōʻeha o ka ʻehaʻeha e loaʻa nei i ka nui.

Aia i ka wahi o ke kahua o ka cystic, aia paha kahi pōā o ke poʻo, ke kino a i ʻole ka pale o ka pancreas. Hoʻokumu nā cysts i kahi 20% o nā kumu no ka cystic o ka pancreas. Aia i nā sista maoli nā:

Congenital dysontogenetic gland cysts,
ʻO ka loaʻa ʻana o nā cysts,
Nā Cystadenomas a me nā cystadenocarcinomas.

ʻO kahi hiʻohiʻona hiʻona o kahi cysti maoli ke loaʻa ʻana o ka lula epithelial ma kona ʻaoʻao o loko. ʻO nā cysts maoli, heʻokoʻa ʻole i nā hoʻopunipuni hoʻopunipuni, ka mea maʻamau ʻaʻole i hiki ke hōʻea i nā nui nui a ʻike pinepine ʻole ʻia ka wā i ke kaʻa.

Ke nānā ʻia nei ka cyst he 80% o nā cysts pancreatic āpau. Hoʻohālikelike ʻia ma hope o kahi hōʻeha maʻi o ka pancreatic a i ʻole pancreatitis lukuʻino, i ukali ʻia me ka fectrosrosis foun o ka kiko, luku ʻana i nā pā o duct, hemorrhages a me ka puka ʻana o ka wai pancreatic ma waho o ka kelepona. ʻO nā pā o nā cyst he compit peritoneum a me nā iwi fibrous, ʻaʻole i kahi līpī epithelial mai loko, akā e hōʻike ʻia ana e nā kiko granule. Hoʻopiha pinepine ʻia ka lua o ka cyst waha me nā necrotic tissue a me ke koena. ʻO kona mea i pono ai kahi exudate serous a purulent paha, kahi paʻa e pili ana i nā clots a me ke koko i hoʻololi ʻia, ka wai pancreatic spilled. Hiki ke loaʻa kahi lepa waha i ke poʻo, ke kino a me ka huʻu o ka pancreas a hiki i nā nui nui. Ua hōʻike iā 1-2 lita o nā ʻike.

Ma waena o nā ʻano cystic o ka pancreas, hoʻokaʻawale nā mea lapaʻau i nā ʻano kumuhana like ʻole, ʻokoʻa ka ʻano o nā ʻano a me nā kumu o ka hoʻokumu ʻana, nā hiʻohiʻona o ke kiʻi kauka a me ka morphology i koi ʻia i ka hoʻohana ʻana i nā hana lapaʻau:

Hoʻokumu ʻia nā cyst Extrapancreatic ma muli o ka pancreatic necrosis a i ʻole kahi hōʻeha pancreatic. Hiki iā lākou ke noho i ka ʻenemi pahu a puni, ka ʻoka a me ka ʻoka ʻākau hoʻi kekahi, i kekahi manawa ma nā wahi ʻē aʻe o ka umauma a me nā ʻōpū o ka ʻōpū, retroperitoneal kahi,
ʻO nā cysts intrapancreatic wahaheʻe maʻamau ka hoʻopiʻi ʻana o ka neʻe pancreatic fogn recurrent. ʻO lākou ka liʻiliʻi, loaʻa pinepine i ke poʻo o ka pancreas a kamaʻilio pinepine me kona ʻōnaehana ductal,
ʻO ka hoʻonui pinepine ʻana o ka puna pancreatic e ke ʻano o ka dropsy i ʻike pinepine ʻia me ka pancreatitis calculic alkohol,
Hiki i nā cysts mālama mai nā pancreas mamao, he pā ipo a ʻaʻole i hoʻopili ʻia me nā ʻili e hoʻopuni ana,
Nui nā palahalaha pālua i hoʻololi ʻia i nā koena o ka pancreas.

ʻO kahi kahua o ka cyst pancreatic formation

ʻO ke kaʻina o ka hana o kahi peka pancreatic postcrotic i hala ma 4 mau pae. I ka hoʻomaka mua o ke ʻano o kahi cyst i loko o kahi pahu pahu hāpū, hana ʻia kahi lua, hoʻopiha ʻia me ka exudate ma muli o ke kumu maʻi pancreatitis. E mau ana kēia hana ʻo 1,5-2 mahina. ʻO ka papa hana ʻelua ka hoʻomaka ʻana o ka hoʻokumu capsule. ʻIke ʻia kahi pōleke pale ʻia i ka pōʻai o ka pseudocyst unformed. Nā mālama necrotic me ka polynuclear infiltration e mālama ʻia ma ka ʻaoʻao o loko. ʻO ka lōʻihi o ka hana o ke kekona he 2-3 mau mahina mai ka manawa o ka loaʻa.

I ke kolu o ke kahua, ua hoʻokō ʻia ka hoʻokumu ʻana o ka capsule fibrous o ka pseudocyst, i hoʻopili paʻa ʻia me nā ʻili e kokoke ana. Hoʻopili ʻia ke kaʻina hana palupalu. He waiwai nui ia. Ma muli o phagocytosis, hoʻokuʻu ʻia ka cyst mai nā uaua necrotic a me nā huahana decay. ʻO ka lōʻihi lōʻihi o kēia pae mai ka 6 a 12 mau mahina.

ʻO ka ha ʻehā ke neʻawale ʻana i ka cyst. Hoʻokahi hoʻokahi makahiki ma hope aku, hoʻomaka nā hana o ka luku ʻana i nā adhesions ma waena o ka paia pseudocyst a me nā ʻiʻo a puni. Hoʻomoʻa ʻia kēia i ka neʻe mau peristaltic mau kino o nā kino i hoʻopili ʻia me ka pūnukeke ʻole, a me ka lōʻihi o ke hōʻike ʻana i nā enzyme proteolytic i nā cicatricial adhesions. E lilo ka ʻōlani a maʻalahi, kū kū mai kahi a puni.

Nā hōʻailona a me ka hoʻomohala ʻana i nā maʻi pancreatic

ʻO nā hōʻailona haukaʻi o kahi cystre pancreatic i hoʻokumu ʻia i ka maʻi ma lalo o ke ala i kū ai, ʻo ka hele ʻana o ka cyst ponoʻī a me nā mea hoʻopiʻi i kū mai. ʻO kahi cyst liʻiliʻi paha he asymptomatic. Ma ka maʻi akuhi a me ka maʻi kaumaha o ka pancreatitis i ka wā o ka hoʻomaha hou ʻana o ka maʻi, ʻike nā kauka ma ka hale hoʻomaha ʻo Yusupov i kahi hanana hōʻeha hōʻeha nui i loko o ka wahi o ka projection o nā pancreas, kahi mea e manaʻo ai i kahi manaʻo e pili ana i ka pūpū kelipi. ʻO ka pinepine mau asymptomatic ʻo nā cyst o ke ʻano o ke kino, mālama me nā cystenomas liʻiliʻi.

ʻO ka ʻeha, ma muli o ka nui o ka cyst a me kona kaomi o ke kaomi ma luna o nā ʻōpū a me nā hana hoʻoneʻe, ma ka plexus o ka lā a me nā nodes o ka lā ma nā moku nui, hiki ke paroxysmal, i ke ʻano o colic, beltle a dull paha. Me nā ʻeha koʻikoʻi, hopu ʻia ka mea maʻi i kahi kuli kaila i koʻo mau kuli, e kū ana ma ka ʻaoʻao ʻākau a hema paha, kū, e kū ana i mua. ʻO ka hōʻeha ʻia e ka cyst e helu ʻia e nā mea maʻi me ka manaʻo o ka kaumaha a i ʻole ka paʻakikī i ka wahi o ka epigastric, e hoʻonui ai ma hope o ka ʻai.

ʻO nā ʻehaʻeha koʻikoʻi me ka pehu o ke ʻano o ka cyst i ka hoʻomaka mua ʻana o kona hoʻokumu. ʻO ia nā hopena o ka pancreatitis o ka traumatic a i ʻole a me ka hoʻomaka ʻana a me ka hoʻoneʻe ʻana o ka proteolytic i ka holomua o ka lau gland. ʻO kahi kāpili e like me ke kani, kahi mea i manaʻo ʻia ma ka ʻāina epigastric, ʻo ia ka hōʻailona ʻoi loa e pili ana i kahi peka pancreatic. I kekahi manawa e ala a nalo hou. ʻO kēia pili i ka panina maʻamau o ka lua cyst i loko o ka papa pancreatic.

ʻO nā hōʻailona hou aʻe o ka pūnē pancreatic i nā hōʻailona ma lalo nei:

Kahula
ʻĀlāʻī
Nā maʻi maʻi
E piʻi ka mahana
ʻO ka momona kaumaha
Kaumo luhi
Jaundice
ʻO ka ʻili
ʻO nā ascites (ʻo ka hōʻiliʻili o ke kahe i loko o ka ʻōpū).

Hiki i kekahi manawa ke hoʻoholo i ke ʻano o kahi pale, ke kūlana e pili ai i nā palena o ka cyst, e kahi loiloi i ka ʻōpū o ka ʻōpū. Kūpono loa nā ʻalaʻehā o nā cysts i ka duodenography ma kahi kūlana o ka hypotension artial. Hoʻopiʻi pinepine ʻia nā pūpihi o ke kino a me ka lā o ka gland ma ka x-ray i ka contour o ka ʻōpū. ʻO ka poʻomanaʻo hoʻopihapiha hoʻopuni, i loaʻa i kēia hihia, hiki iā ʻoe ke kānalua i kahi pōpō. ʻIke mau ʻia nā ʻōhiʻi nui e iho ana i lalo i ke wā o irrigoscopy.

ʻO nā sela pancreatic i hoʻopaʻa ʻia ma ka angiography o nā lālā o ka celiac artery. Loaʻa i nā kauka o ka haukapila Yusupov nā ʻike koʻikoʻi no ka hoʻokumu ʻana i kahi maʻi me ka retro-pneumoperitoneum a me ka pneumoperitoneum i hui pū me ka urography. ʻO ka koho ʻana i ke pae o nā enzyme pancreatic (amylase a me lipase) i loko o ke koko a me ka ʻihi o kekahi mea nui no ka hoʻokumu ʻana i kahi maʻi kūpono. ʻO nā mānoanoa o ka hana huna mai i ka papa pancreas i kahi ʻilihune me nā cysts.

He aha ka pōʻino o kahi pūlio e kū ana ma ka pancreas? Hoʻokomo pinepine ʻia nā ʻōpiko pancreatic i nā ʻōpiopio, nā mea i hōʻike ʻia e ke kīnā ʻana o nā ʻāpana like ʻole: ka ʻōpū, ka duodenum a me nā ʻāpana ʻē aʻe o ka ʻōpū, kidney a me ureter, portal vein, a me nā kumu bile. ʻO ka hiki i kahi pōpoki pancreatic ka mea e hoʻonāukiuki i ka peritoneum (peritonitis). Ke hana nei i ka diagnostics hopena, ke kauka ʻana o nā kauka ma ka Hipa ʻo Yusupov i nā ʻōpū a me nā cysts o ka ate, nā ʻano like ʻole o splenomegaly, hydronephrosis a me nā neoplasms o nā ʻōpū, nā ʻalā a me nā cysts o ka wahi o ka wā ʻo retroperitoneal, me ka mesentery a me ka ovary, nā mākia huʻi o nā ʻōpū o ka ʻōpū a me nā aneurysm aortic.

Hoʻohana ʻia o nā cysts pancreatic

ʻO ka ʻike ʻana i nā cysti pancreatic i ka nui o nā hihia ke hoʻoholo i nā hōʻike hōʻike no ka mālama maʻi. Kuhi iki ka ʻano o ka mea hana:

ʻO nā kumu o ke kūkulu cystic,
ʻO ke ola o ka cyst
ʻO ke kaiaulu, ka nui, ke ʻano o nā mea i kau,
ʻO ka pilina o ka pilina me ka ʻōnaehana kumu o ka pancreatic,
Nā hopena
ʻO ka heleʻana o nā leona concomitant o nā kino kokoke i ka pancreas.

He aha ka pono o ka prognosis no kahi cystn pankreatic? I nā 8-15% o nā hihia, hoʻomaka ka lohi o nā cysts a hiki i ka nalo ʻana i lalo o ka mana o ka anti-inflammatory therapy. No laila, ka manaʻo e pili ana i ka hiki ke hoʻohana i nā hana hoʻomālamalama conservative-expectant i ke ʻano o ka hiki ʻana o kahi pūpū pancreatic i hoʻokumu ʻia i ka helu ʻana o "hoʻōla pilikino" i ka nui o nā hihia he hewaʻole. ʻO ka hoʻomohala ʻana i ka mea maʻi me ka pancreatitis kūpaʻa me kahi maʻi kūmole pancreatic i hoʻohua ʻia, nā kaukaʻi ma ka hale mālama ʻo Yusupov e manaʻo he mea kūkaʻa loa ia no ka hoʻomaʻamaʻi ʻana. ʻO ke koho o ka manawa kūpono, i ka nui a me nā ʻano o ka wehe ʻana i ka hōʻaia.

Loaʻa nā pono waiwai no ka cysts pancreatic i hoʻokaʻawale ʻia i nā hui 5:

Hōʻalo ka puka o ka pūpū
Hōʻalo ʻia o ka puna o ka cyst (ka hoʻokomo ʻana o nā anastomoses i waena o ka pā o ka pūima a me nā ʻāpana āpau o ka gastrointestinal tract),
Holoi waho kūka i waho.
Hoʻopili nā kāpili radical (enucleation o ka cyst a me nā ʻōkuhi pancreatic me ka cyst)
ʻO Laparoscopic, endoscopic a me nā mea minimally invasive inv punive-punheehe catheterization kahawai lulu, kahi e kuhikuhi ana i kahi wai o waho a i ʻole kūlohelohe o nā cysts ma lalo o ka mākaʻi o nā mea hana ʻona.

ʻO ka paʻa i ka paia o ka hana cystic ka mea, ʻoi aku ka nui o nā manawa kūpono e hana ai i ka wawa o ka radical. ʻO nā kūlana maikaʻi loa no ka mālama ʻana i ka maʻi e hiki mai i nā mahina 5-6 ma hope o ka hoʻomaka ʻana o ka hoʻomohala ʻana i ka cyst, i ka wā e hoʻomau ʻia ai kona pā a i nā ʻūhā hele. I kēia mea, i ke ake palela o ka maʻi, ua hoʻāʻo nā mea lapaʻau e mālama i kahi mālama conservative piha, ka mea e nānā nei i ka pale ʻana i nā hoʻopiʻi. Hoʻoweliweli ʻia nā pale hōʻiliʻili liʻiliʻi me ka neʻe ʻana o ka hoʻomohala ʻana o ka cyst.

ʻO nā hoʻopaʻapaʻa e ʻae i ka ae ʻana i ka mea hiki ke hoʻolōʻihi ʻia ka ʻikepili:

ʻO ka heleʻana o nā kānalua kūpono o ka hoʻomohala ʻana i nā hoʻopiʻi koʻikoʻi o ka hoʻokumu ʻana o ka cystic,
ʻO ka ulu holomua o ka hoʻonaʻauao, ʻoiai ke mālama ʻana i ka mālama ʻana.
ʻO ka heleʻana o nā hōʻailona hōʻoiaʻiʻo i ke ʻano o ke kinina o ke kaʻina hana cystic.

No ka nānā ʻana i ka nānā ʻana a me ka mālama ʻana no nā cysti pancreatic, hana i kahi manawa me ka mea lapaʻau o ka haukapila Yusupov ma ke kāhea ʻana i kekahi lā o ka hebedoma, ke ʻano o ka manawa o ka lā.

Hoike ʻike

ʻO ka pāpale Pancreatic kahi loulou, ke hoʻonui ʻia nei ka nui o nā makahiki i hala mau manawa, a ʻo ka hapa nui o nā kānaka ʻōpio ua pili. ʻIke ka poʻe Gastroenterologists i ke kumu o ka hoʻonui i ka mea i loaʻa i ka ulu ʻana o ka maʻi a me ka maʻi pancreatitis o nā ʻano etiologies (ʻainu, biliary, traumatic). ʻO ka cyst pancreatic ke hoʻopiʻi pinepine ʻana o ka maʻi pancreatitis (ʻoi aku a 80% o nā hihia). Nui ka manaʻo o ka hoʻopili ʻana i kēia ʻano no ka hana kumu e pono ai ke ʻano o nā pūnoho pancreatic, kahi ʻano maʻamau e hōʻike ana i ka etiology a me ka pathogenesis, a me nā kūlana kūpono o ka mālama mālama.

Kuhi kekahi poʻe kākau i nā cystre pancreatic he mau formations me nā paia palena a hoʻopiha ʻia me ka wai pancreatic, manaʻo nā poʻe ʻē aʻe ua hiki i nā mea o nā cysts ke necrotic organ parenchyma, ke koko, exudate a i ʻole pus. I kekahi hihia, ʻae nā manaʻo e pili ana i ka hoʻokumu ʻana o ka panki pancreatic, pono nā ʻano e pono ai: ka hōʻino ʻana i ka organ parenchyma, paʻakikī i ka puka ʻana o ka hana huna pancreatic, me kahi ʻikepili kūloko o ka microcirculation.

Nā kumu kumu o ke kaʻai pancreatic

ʻO ka pancreatitis ka mea maʻamau ka kumu maʻamau o ka cysts pancreatic. ʻO ka huehue o ke kumu o ka pancreas ka paʻakikī e ka hoʻomohala ʻana o nā cyst i 5-20% o nā hihia, ʻoiai ke ʻano ka puka ʻana i ka wiki ʻekolu a ʻehā paha o ka maʻi. I loko o ka maʻi pancreatitis lohi, puka i ka hope o ka pancreatic post-necrotic i loko o 40-75% o nā hihia. ʻO ka pinepine, ʻo ka kumu nui etiological o ka maʻi alakino. ʻOi ka maʻamau, ʻo ka cysts e hōʻeha ma hope o nā hōʻeha pancreatic, me ka hōʻemi ʻia hoʻi o ka cholelithiasis me ka hoʻopuka ʻana o ka wai pancreatic, ke kau nei i ka maʻi pancreatitis me nā huʻina e hele nei ma waena o ka wai ʻana o Wirsung, ʻo nā huki o ka nipple duodenal nui, cicatricial stenosis of sphincter o Oddi.

ʻO ka hoʻokumu ʻana o nā cysts pancreatic me ka pancreatitis e like me ka wā e hiki mai ana. ʻO ka poino i ka wahī o ke kino e hui pū ʻia e ka hōʻuluʻulu ʻana o nā wahi e pili ana i nā neutrophils a me nā lymphocytes, nā kaʻina hana luku a me nā mumū. Eia nō kekahi, kahi ʻāpana o ka hōʻino i wehe ʻia mai ka parenchyma a puni. I loko o ia mea, ua kū ka hoʻomaikaʻi ʻana o nā kiko i hoʻopili ʻia, hana formgrug, nā mea kiko o ke kālai i loko o ka neʻe a hoʻopau ʻia e nā mea maʻi ole, a ke waiho nei ka lua ma kēia wahi. Inā pili ka pūpū pancreatic me ka ʻōnaehana wai o ka huaʻī, hōʻiliʻili ka wai o ka pancreatic i loko, i ka hōʻuluʻulu ʻana o nā ʻāpana necrotic kiko, hiki nō hoʻi ka exudate namu, a hōʻino ʻia ke koko inā pilikia nā kīʻaha koko.

I ka hihia o ka hōʻino ʻole o ka pauku ma o ka punawai pancreatic maʻamau, hoʻokumu ʻia nā cystre pancreatic i loaʻa ka lula epithelial, i loko o kahi e hōʻiliʻili ai ka wai pancreatic. ʻO ke ʻano nui o ka hana pathogenetic o kā lākou kūkulu he intraductal hypertension. Hōʻoia ʻia ʻo ia ka paʻakikī i loko o ka lua o ka cyst i ʻekolu mau manawa e ʻoi aku i ka nui o nā kumu i loko o nā kumu.

Ka helu ʻana o nā cysti pancreatic

ʻO ka hui nui, ʻo nā pihi pancreatic e like me nā ʻano morphological i mahele ʻia i ʻelua ʻano: nā mea i hoʻokumu ʻia ma ke ʻano o ke kaʻina a me ka loaʻa ʻana o ka lula epithelial (kapa kekahi mau mea kākau i nā ʻano pseudocysts, hoʻokaʻawale ka poʻe iā lākou i kahi ʻokoʻa i hui ʻia) a hoʻokumu ʻia i ka wā o ka hana o nā kālai a me ka epithelium (mālama).

Ke hōʻailona i ka cysts pancreatic, i haku ʻia me ka hoʻopiʻi o ka maʻi pancreatitis maʻa, ʻoi aku ka hoʻohana ʻana o ka Atlanta i nā ʻano pinepine, e like me ke ʻano o ka maʻi o ka huaʻōlelo, subacute fluid a me ka unuhi o nā pancreas e hoʻokaʻawale. ʻAʻohe hana i hoʻomohala maoli i ko lākou mau pā ponoʻī; hiki i kā lākou kuleana ke hoʻokō ʻia e nā parenchyma kelima a me nā mea hoʻokele, nā kiko o ka parapancreatic, ʻo nā pā o nā kino kokoke. Hoʻohālikelike ʻia nā pūpū pancreatic maʻi e nā paia i hana ʻia ma ka kiko fibrous a me ka granulation. ʻO kahi pohō ke kūpeʻe piha piha i ka wā o ka pancreatic necrosis a i ʻole he manaʻai o kahi cyst.

Wahi ana i ka localization, hoʻokaʻawale ka poʻe cyst o ke poʻo, ke kino a me ka huʻu o ka pancreas. A'ākuhi a i paʻakikī a paʻakikī (perforation, suppuration, fistulas, blood, peritonitis, malignancy) pankreatic cysts ua hōʻike ʻia hoʻi.

Nā hōʻailona o kahi kuʻi pancreatic

ʻO ke kiʻi o ka maʻi lapaʻau ma mua o nā pankre pancreatic i hiki ke loli nui i ka nui, kahi o ke ʻano, nā kumu no kona kūkulu ʻana. ʻAno pinepine, ʻaʻole palupalu nā pancreatic cysts i nā hōʻailona: nā lua me ka lōʻihi a hiki i 5 centimeter ʻaʻole e lūlū i nā kino kokoke, nā plexuses nerve, no laila ʻaʻoleʻike ka poʻe maʻi i ka ʻehaʻeha. Me nā cysts nui, hōʻailona nui ka maʻi nui. ʻO kahi hiʻohiʻona ka ka "hakahaka ākea" (kahi hoʻolōʻihi i ka manawa i ke kiʻi lāʻau lapaʻau ma hope o ka maʻi pancreatitis a i ʻole trauma).

ʻO ka ʻeha koʻikoʻi ka ʻike ʻia i ka wā o ka hoʻokumu ʻana o pseudocysts i ka pancreatitis aʻeha paha i ka exacerbation o ke ʻano maʻi, no ka mea, he mau mea hoʻonāukiuki koʻikoʻi. ʻO ke hala ʻana o ka manawa, e emi ana ka nui o ka ʻeha o ka eha, hiki i ka ʻeha ke kaumaha, hiki ke loaʻa wale kahi manaʻo leʻaleʻa, kahi, i hui pū ʻia me ka data anamnestic (trauma a pancreatitis paha), hiki iā ʻoe ke kānalua i ka maʻi. I kekahi manawa, kū i ke ʻano o kēlā mau hōʻailona scanty, ulu ka ʻeha ʻana, ke kumu o ka hypertension intraductal. ʻO ka ʻeha i hōʻike ʻia e hiki ke hōʻike pū i ka pohō ʻana o ka pūlohi, kahi hoʻi e hoʻonui ai i ka hōʻeha ʻana i kahi hōʻeha ʻana i ke ʻano o ka hoʻonui ʻana i ke ea o ke kino a me nā mea hoʻonaninani - e pili ana i kona manaʻo.

ʻOkoʻa ʻokoʻa nā ʻōmaʻomaʻo o ka pika pancreatic i hoʻoheheʻe ʻia ʻo ia i ka plexus solar. Ma ka manawa like, ʻike ka mea maʻi i ka eha mau ʻana o ka ʻeha wela e hoʻoweliweli ana i ke kua, hiki ke hoʻonāukiuki ʻia e ʻoi aku hoʻi i nā lole. Hoʻomaha ʻia ke kūlana ma ke kūlana ʻoi-kuʻekuʻe, ʻoiai ke keʻakeʻa ma nā analcics narcotic wale nō.

ʻO nā ʻōmaʻomaʻo o ka peka pancreatic hiki ke hiki i nā hōʻailona dyspeptic: hoʻomehana, hōʻeuʻeu kekahi mau manawa (hiki iā ia ke hoʻopau i kahi hōʻeha o ka hōʻeha), hiki i ka stool. Ma muli o ka emi ʻana o ka hana exocrine o ke kumukanawai, ua hoʻemi ʻia ka hōʻemi ʻana o nā mea kanu i loko o ka ʻōpū.

ʻO ka Syndrome o ka hoʻouluulu ʻana i nā ʻāpana kūloko he ʻano o kēia pathology: inā i ka ʻōpala i nā wahi o ke poʻo o ke kīpē, hiki i ka jaundice obstructive (hiki i ka ʻili a me ka iclera ictericity, hōʻeha o ka ʻili), ke kīpī ʻia ka vena portal, ulu ka edema i ka papaha o nā poʻo haʻalulu, inā hiki i ke ʻano ke kolo ʻia ka hanana ʻana o ka urine i ka ureter, kou māmā. ʻO nā aniani, ka paʻakikī o nā pūpū pancreatic e koi i ka lumen i ka ʻōpū, ma ia mau mea e ulu ai ka pōkole o ka ʻōpū.

ʻO ka huihue o kahi kaho pancreatic

ʻO ka kūkākūkā ʻana o kahi gastroenterologist me ka mea nāna i manaʻoi i ka pancreatic cyst e hiki ai ke hoʻomaopopo i ka hoʻopiʻi ʻano o ka mea maʻi, a me ka ʻike anamnestic. Ke nānā nei i ka ʻōpū, hiki i kona asymmetry - kahi pale i ka wahi o ka hoʻokumu. Ma nā hōʻike hoʻokolohua, ʻaʻohe pinepine nā loli like ʻole, ka leukocytosis iki, kahi piʻi o ka ESR, a ma kekahi mau manawa ke hoʻonui nei ka hana o ka bilirubin a me ka hana alkatine phosphatase. ʻAʻole hilinaʻi nui ʻia ka ʻaila o ka pancreatic i ka pae ʻana o kahi pūpana e like me ke kahua o ka pancreatitis a me ka pae o ka hōʻino o ka aila. Ma kahi o 5% o nā hihia, hoʻomaka ka hana endocrine o ka pancreas a hoʻomōhala ʻia ka maʻi diabetes mellitus.

Loaʻa i nā ala kōkua o ke kuikahi o nā cyst. ʻO ka pōkole o ka pancreas e hiki iā ʻoe ke loiloi i ka nui o ka hoʻokumu, a me nā hōʻailona kūlohelohe ʻole o nā hoʻopiʻi: i ka hihia, i ka manaʻo ʻana i ka hōʻailona o ka echo e hoʻoholo i ke kūkaʻi o ka kahe, me ka hewa - ka heterogeneity o nā contours. Hoʻohui ʻia ka tomography a me ka magnetic resonance imaging (MRI o ka pancreas) ʻike i ka ʻike kikoʻī loa e pili ana i ka nui, kahi o nā cyst, ka hele ʻana o kāna pilina me nā kumu aʻoaʻo. E like me ke ʻano o nā mea kōkua, hiki ke hoʻohana ʻia ka scintigraphy, kahi e wehewehe ʻia ai kahi cyst he "zone cold" e kū'ē ana i kahi o ke ʻano o ka parenchyma kumuhana ākea.

Hāʻawi ʻia kahi wahi kūikawā i ka maʻi ʻaia o ka pancreatic cysts i ka endoscopic retrograde cholangiopancreatography (ERCP). Hāʻawi kēia ʻano i ka ʻike kikoʻī e pili ana i ka pilina o ka cyst me nā kumu kumu o ke kīpē, kahi e hoʻoholo ai i nā ʻākena o ka mālama ʻana, akā naʻe, i ka wā e nānā ana, he nui ka hopena o ka maʻi. No laila, i kēia manawa, ke hana kūʻokoʻa nei ʻo ERCP me ka pilikia hoʻonā o ka loaʻa ʻana o ka hoʻomaʻamaʻa e koho ai i ke ʻano o ka hana.

Hoʻomaʻamaʻa maikaʻi loa ʻo Cyst Pancreatic

Hoʻokomo ʻia ka hoʻomaʻamaʻa ʻana o nā cysts pancreatic. ʻAʻole kahi ʻano ikiahi hoʻokahi e hoʻokele ai i ka poʻe maʻi me kēia maʻi, a ua koho ʻia ke koho ʻana i nā kumu o ka hoʻokumu ʻana o ka cyst, ʻo kona nui, ka morphological a me ka hoʻololi ʻana i ka ʻola o ke kino, me nā kūlana kalepona.

ʻO ka poʻe loea i ka hana o ka gastroenterology hoʻokūkū hoʻokaʻawale i ʻekolu mau wahi nui o ka taktics no ka pancreatic cysts: kona wehe ʻana, ka wai o loko a me waho. Hoʻokuʻu ʻia ka hoʻokumu ʻana me ka wehe ʻana o kahi ʻāpana o ka pancreas me ka cyst, ka ʻōlaʻi e hoʻoholo ʻia ana e ka nui o nā cyst a me ka ʻāina o ka organ parenchyma (wehe ʻana i ke poʻo o ka kipi, ka wehe, ka hoʻokaʻawale ʻana o ka pancreatoduodenal).

Hiki ke hoʻoweliweli ʻia nā alahao wai i ka hoʻihoʻi ʻana ma waena o ka cyst a me ka ʻōpū (cystogastrostomy), duodenum (cystoduodenostomy), a i ʻole ka lau liʻiliʻi (cystoenterostomy). Ua noʻonoʻo ʻia kēia mau ala i ke kino loa: hāʻawi lākou i ka hana o nā mea huna huna pancreatic, hoʻohemo i ka ʻeha, ʻaʻole hiki ke alakaʻi hou.

Hoʻohana ʻia ka lua o waho o ka lua. Hōʻike ʻia kēlā ʻano kikowaena no ka suppuration o ka maʻa, cysts unformed, profuse vascularization o ka hoʻopuka, a me kahi kūlana koʻikoʻi o ka mea maʻi. ʻO kēlā mau hana, he palliative, no ka mea aia he hopena o ka suppuration a me ka hoʻi hou ʻana o ka cyst, ka hoʻomohala ʻana i nā fistulas pancreatic, ka pane maikaʻi loa ʻana i ka mālama conservative a i kekahi manawa koi i ka technologically i ʻoi aku nā mea paʻakikī loa. Kekahi ʻano hana hoʻoheheʻe ma lawe ʻia wale nō ma hope o ka hōʻoia o ka etiology o ka non-tumor o ka hoʻonaʻauao ʻana.

ʻO ka mea hou loa, ua hōʻemi ʻia ka minimally invining lawinal interventions, i hoʻohana ʻia e like me nā ʻano hana ʻē aʻe. Eia nō naʻe, ʻoiai ka invasiveness haʻahaʻa a me ka hoʻohiki i ka ʻōlelo o kēlā mau ʻano hana, hiki pinepine nā ʻōiwi i ke ʻano o ka hoʻokumu ʻana o ka fistula pancreatic waho, sepsis.

Hoʻoholo ʻia ka mālama ʻana no ka maʻi pancreatic ma nā maʻi lalo. I ka hihia o ka pancreatitis, pono kahi papa o ka ʻai ʻana, e kuhikuhi ana i ka hōʻemi nui loa i ka hana huna pancreatic. Hoʻohana ʻia nā lāʻau lapaʻau, analgesics, ke nānā ʻia ka pae glycemia, a inā pono, ʻo kona hoʻoponopono.

Ka hoʻomaikaʻi ʻana a me ka pale ʻana i nā pūpū pancreatic

ʻO ka hoʻomaʻamaʻaʻana no nā kōneka pancreatic i hilinaʻi ʻia i ke kumu o ka maʻi, ka wā i hiki ai ke nānā i ka hoʻomaʻamaʻa ʻana. Hōʻike ʻia kēia ala iā ʻoe me ka helu hoʻopiʻi kiʻekiʻe - mai 10 a 52% o nā hihia āpau i hui pū ʻia me ka suppuration, perforation, fistula form, malignancy a intra-abdominal blood. ʻOiai ma hope o ka loaʻa ʻana o ka maʻi maʻi, aia nō ka hopena o ka hana hou ʻana. Hōʻalo ka pankreatic pancstatic i ka hōʻole ʻana i ka waiʻona, ka wa kūpono e pono ai ka mālama ʻana i nā maʻi o ka gastrointestinal tract (gastrointestinal tract, pancreatitis), kaʻai kūpono.

Nā kumu a me nā kumu predisposing

Hiki i nā cysti pancreatic ke ulu i loko o nā mea maʻi o kekahi mau makahiki, nā ʻano ʻāpana like ʻole a me nā nui. I kekahi mau mea maʻi, ʻoi aku paha me ka hua mua mai o ka cyst, polycystosis systemic (polycystic ovary, kidney, brain, brain, liver cysts) e nānā.

ʻAʻole loaʻa kahi hika lapalapa i kahi kino olakino - ʻo kēia kaʻina ka hopena o kahi maʻi. Wahi a Profesor A. Kurygin, ʻo ke kumu maʻamau loa ka:

maʻiʻo pancreatitis - 84.3% o nā hihia āpau (e ʻike i nā hōʻailona o ka pancreatitis hoʻonā)
Nā hōʻeha maʻi pancreatic - 14% i loko o ke ʻano o ka maʻi, ʻo kēia ka lua o ke ʻano o ka nui o nā hanana
ka pani pōkole o ka wai excretory (me kahi pōhaku, hoʻopili ʻia e ka moku) a i ʻole ke kue ʻole ʻia i kona ʻano - hiki nō hoʻi ke hoʻonāukiuki i ka hoʻokumu ʻana o kahi cystetory.

I kēia manawa, ua ʻike ka Russian Surgical Society i ʻelima mau kumu mua predisposing. I ka wā e hoʻomaʻamaʻa ana i nā lāʻau lapaʻau, ua hōʻoia ʻia ko lākou koʻikoʻi a me ka hopena o ka hoʻoulu ʻana o kahi maʻi pancreatic i hoʻoholo ʻia ma kahi pakeneka:

ka hōʻino ʻana i ka waiʻona o ka ikaika kiʻekiʻe - 62.3%,
maʻi ʻino o ke kau - 14%,
hānō i luna - hoʻonāukiuki lipid metabolism (kahi hōʻike o ke keʻena o ka hoʻonui ʻana i nā hapa beta o nā lipids a me ka cholesterol) - 32.1%,
ka hele ʻana o nā hana i hala ma mua o nā mea i hana o ke kaomi kūwili ʻana,
maʻi mellitus maʻi maʻamau (ʻo ka hapanui o nā ʻano lua) - 15.3%.

ʻO ka heleʻana o kekahi o nā kūlana i luna ma ka mea maʻi me ka hiʻohiʻona o nā hōʻailona o ka maʻi pancreatic e hiki ai ke hana i kahi cyst e kānalua nei.

ʻO ka mālama ʻana

Hoʻohana ʻia ka mālama ʻana o nā cysts pancreatic me nā ʻano therapeutic inā:

ua maopopo maoli ka pili o ke kulekele,
he ʻāpana liʻiliʻi a me nā hiʻona (a hiki i 2 cm ke ana).
hoʻokahi kula hoʻonaʻauao
ʻaʻohe ʻano hōʻailona o ka jaundice a me kahi hōʻeha koʻikoʻi.

I nā kūlana āpau a pau, ka hopena no nā lāʻau lapaʻau o ka mālama ʻana.

No nā lā 2-3 mua, ua ʻōlelo ʻia kahi mea ʻai pōloli. Ma hope aku, pono ia e hoʻopiʻi i ka ʻai o ke momona, keʻa a me ka meaʻai paʻakai, no ka mea e hoʻoulu ai i ka mea pohihihi o ka hoʻouka ʻana o pancreatic a hoʻomaikaʻi i ka luku kino ʻana (ʻike i nā mea e ʻai ʻia me ka pancreatitis maʻi). Pono e hoʻokuʻi ʻia ka wai inu a me ka uahi. ʻO ka hoʻoponopono a ka mea maʻi e hoʻomaha ai i kahi moe (7-10 lā).

Ua kuhikuhi ʻia nā antibiotika Tetracycline a cephalosporins paha, e noʻonoʻo ana i ka pale ʻana i ke komo ʻana o ka maʻi maʻi i loko o ka pūpua a me ka hoʻopiha ʻana me ka pus. Inā ʻaʻole, hiki i ka meli ke hoʻopale i nā paia a hoʻolaha i nā kaʻina ma ka kelepaʻi a me nā pili.

Hiki ke hoʻemi i ka ʻeha a hōʻemi ʻana i ka mea huna ma o ke kau ʻana i nā "proton pump inhibitors" (OMEZ, Omeprazole, Rabeprazole, a pēlā aku). No ka hoʻokaʻawale ʻana o nā kāloti a me nā ʻōmole momona, ʻike ʻia ka lāʻau lapaʻau - nā lāʻau lapaʻau e komo pū ana ʻo Lipase a me Amylase, akā ʻaʻohe bile acid (Pancreatin, Creon).

Inā kūpono ʻole ka mālama ʻana no ka mālama ʻana no nā hebedoma he 4, hōʻike ʻia ka hana.

ʻO ka maʻi lapaʻau hou loa

ʻOi aku ma mua o ka 92% o nā maʻi āpau me nā maʻi pancreatic i mālama ʻia i loko o kahi haukapila hoʻomaʻamaʻa. I kēia manawa, aia ma kahi o 7 mau koho no ka hana e hiki ke hoʻopau i kēia ʻano. ʻO nā ʻōlelo a ka Russian Surgical Society e hāʻawi i nā makemake i ka hōʻiliʻili hōʻiliʻili minimally (i ka wā ʻaʻole i hoʻopau ʻia ka ʻili o ka mea maʻi).

ʻO ka hapa liʻiliʻi o nā hoʻopiʻi e pili ana i ka hana ʻoi ka percutaneous cyst, e hana ʻia i ka manawa like me ka ultrasound. ʻOi loa lākou e hana i ke kūleʻa ʻana i ka hana volumetric i ke poʻo a i ke kino paha. Maʻalahi loa ke kumu o ka hana ʻoki ʻana - ma hope o ka anesthesia, ua paʻi ʻia ka mea maʻi me kahi mea hana (aspirator a puncture jarumea) ma o ka puncture ma ka wahi o epigastric. Wahi a ka nui o ke kumu, hiki ke hoʻokō ʻia ka mea maʻi:

Hoʻomoe ka puncture Percutaneous o ka pehu - ma hope o ka lawe ʻana i ke kahe o ke kō mai loko mai o ka ana, hoʻoheheʻe ʻia (ke ʻōpala palupalu palupalu) i hoʻokumu ʻia e hana i kahi kahe mau mau. ʻAʻole ia e ʻae a hiki i ka huna ʻana o ka exudate i hoʻōki paʻa. Pono kēia e pani i ka kīʻaha me ke kiko hono. ʻAʻole hiki ke hoʻokō ʻia ka hana inā pani ka cyst i ke kaʻe o ka aʻi a loaʻa paha kahi nui (ʻoi aku ma mua o 50-100 ml),
ʻO ka sclerosis Percutaneous o ka cyst - ua komo kēia ʻano i ka hoʻomaka ʻana o kahi hopena hoʻonaninani i loko o ka lua o ka pū, ma hope o kona haki ʻana. ʻO ka hopena, ʻo ka hoʻomaʻemaʻe ʻana (hoʻomaʻemaʻe) o ka ana, hoʻopuni ʻana o ka hoʻopili pili a me ka pani ʻana o ka hemahema.

Inā ʻaʻole hiki i ka lawehala transdermal, hōʻike nā Standards of Surgical Care i nā hana laparoscopic. Hoʻopili lākou i ka noi o 2 mau manawa 1-2 cm lōʻihi, ma loko o kahi mea e hoʻokomo ʻia ai nā mea hana endoscopic i loko o ka ʻōpū o ka ʻōpū. ʻOi aku ka nui o nā mea hoʻopukapuka o nā mea hoʻopiʻi, ʻoiai inā loaʻa ka minimally invasiveness. E pili ana kēia:

ʻO ka hoihoi a me ka loaʻa o ka cyst - hoʻohana ʻia ma ke alo o kahi hoʻokumu superficially i loaʻa. Hoʻopili ka hana: ka wehe ʻana i ka ana o ka cyst, kona hoʻomaʻemaʻe ʻana me nā hāmeʻe antiseptic a me ka uʻi ʻana i ka pōpilikia. ʻO kahi mea hou, kūpono ia e hoʻohana i kahi electrocoagulator e pani i ka lua, eia naʻe, i kēia hihia, pono ke hana i kahi kahe hala mau (wai) no 3-7 mau lā,
ʻO ka hōʻano ʻimi laparoscopic o kahi ʻāpana o ka hana he hana traumatic i hoʻopaʻa ʻia inā aia ka nui o ka hewa i loko o ka aʻi. No ka laʻana, me ka kuahiwi o ke poʻo o ka pancreas me kahi aila o 5-7 cm, e lawe ʻia ke poʻo holoʻokoʻa.ʻO kona pono he haʻahaʻa haʻahaʻa o ka hoʻoiho hou ʻana o ka maʻi,
ʻO ka hana Frey (ka haʻalele ʻana o ke poʻo me ka hoʻokumu ʻana o ka anastomosis pancreatojejunal) kahi hoʻololi o ke kaʻina hana ma ke ʻano i ʻōlelo ʻia ma luna. Hoʻonohonoho ʻia kona hoʻohana ʻana me ka hoʻonui nui ʻana i ka dure o nā pona. Hoʻopili ʻia ke ʻano o ka hana i ka suturing i kēia papa dute i loko o ka paia o ka pūpū liʻiliʻi, kahi e hiki ai i ka hoʻokaʻawale ʻana i nā mea huna o ka huina a me ka hōʻemi ʻana i ka hopena o ka pancreatic necrosis.

ʻO ka hiki ʻole ke hana i ka hana endoskopika a percutaneous paha e hoʻokaumaha iā ʻoe i ke ana no ka lapalotomy interventions (me ka wehe ʻana o ka ʻōpū o ka ʻōpū). Pono lākou i kahi manawa hoʻoponopono hou, akā hāʻawi i ka manawa kūpono e hoʻokō i kekahi helu o ka ʻoihana. Hoʻokaʻawale ʻia nā ʻenehana kikowaena wehe e komo mai ai:

Wehe ka wehe ʻana o kahi ʻāpana o ka lepa,
ʻO ka hoʻokaʻawale a me nā kahawai o waho
Marsupilization o ka cyst - ua hana mua ʻia kēia hana ma ka 70s o ka makahiki hope a a hiki i kēia manawa ʻaʻole i nalo i kona pili. Kūpono ʻia kāna ʻano - hana ʻia ka wehe a me ka hoʻomaʻamaʻa ʻana o kahi hika, e ukali ʻia ana e ka hemming o nā paia o ka hoʻokumu i nā kihi o ka incision. Ma hope o kēlā, ua hū ʻia ka ʻeha hōʻeha i nā papena. Pēlā, e hoʻokō ʻia ana ka pani ʻana o ka ʻaoʻao pathological. ʻO ka hemahema o kēia kaʻina kumu, ka maʻamau pinepine o nā ala fistulous i ka pā o ka ʻōpū.

ʻO nā cysts pancreatic kahi ʻano lono ākea. ʻO ka pinepine o kona kū ʻana, e like me ke Kauka V.V. ʻO Vinogradova kahi 0.006% ma ka honua. Eia naʻe, nā maʻi koʻikoʻi e hōʻemi i ka maikaʻi o ke ola o ka maʻi e pono ai i ka nānā pono a me ka mālama ʻana. I kēia manawa, hiki i nā kauka ke kūleʻa i kēia maʻi. No kēia, pono wale ka mea e hoʻohana i ka kōkua olakino kūʻiʻo.

Nā kiʻi haukapila

I ka hoʻokumuʻana o pseudocysts pancreatic, 4 mauʻokoʻa i ka manawa (Karagyulyan R. G. 1974):

Kūlana 1 (a hiki i 4-6 mau pule mai ka hoʻomaka ʻana o ka pancreatitis) - ka loaʻa ʻana o kahi cyst. I ka infiltrate pancreatic, ua hoʻokumu ʻia ka lua o ka pūpana.

ʻElua hana (2-3 mau mahina mai ka hoʻomaka ʻana o ka pancreatitis) - ka hoʻomaka ʻana o ka hoʻokumu ʻana i ka pumo. Hōʻalo ka pā o cyst, maʻalahi i haehae,

Ika manawa 3 (a hiki i 6 mau mahina) - ka hoʻopau ʻana i ka hana o ka capsule. ʻO ka pā o ka pūpolo he kiko o ka aʻa o ka fibrous kiko.

ʻO ka wā 4 (6 months12 mau mahina) - kahi kaʻawale cyst. E lilo ka ʻōlama a maʻalahi i hoʻokaʻawale ʻia mai nā ʻaoʻao ʻokoʻa.

I nā hana hana 1 a me 2, ʻike ʻia ka cyst i ka hana ʻana i ka hana 3 a me 4.

Hoʻoponopono ke kiʻi haukapila |Ke mīkini a me nā kumu kumu o ka hoʻomohala ʻana o ka pathology

ʻO ka pancreas kahi hana koʻikoʻi i ka uhaʻi ʻana a me ka hoʻoliʻi ʻana o ka protein, hōʻoki i nā momona, nā momona. Loaʻa i ka okana ka hoʻolālā alveolar e wehe ana i ke ʻano o nā cysts. ʻAʻole ke ʻano o ke ʻano loina o nā cystic i loko o ka aahu.

Hoʻokumu ʻia ka mīkini o ka hanana i ka luku ʻia ʻana o nā io ponoʻī. Ma lalo o ka mana o nā hopena maikaʻiʻole, nā ʻōpala o nā ʻano make make ma ka papa parinhematous o ka papa pancreas, hoʻokaʻawale ke kino i ke wahi pathological mai nā mea olakino - he kāpili i kahi kāpili mai nā huakaʻi hoʻohui a i ʻole fibrous. Hoʻopiha iki ʻia nā kapuni i nā mea kikoo a me ka mea huna - pehea kēia e ʻike ʻia ai kahi cyst.

ʻO nā kumu maʻamau o ka helehelena o nā kulekele:

pōpilikia hanenital o nā kaupalena o ka lepa,
ka hiki ana o na pohaku
pancreatitis - akeʻeha, kūloko, ka waiʻona,
ʻOnawa papaʻaila,
ʻeha nā iwi hōʻeha
nā maʻi Endocrine - heʻano nui, ka maʻi maʻi,
maʻi maʻi parasitō.

Hoʻoikaika papa

Hoʻopiliʻia nā Cysts i:

ʻOiaʻiʻo (congenital) - loaʻa i ka hana ʻino i ka lālani ke hānau ʻia mai ka hānau ʻana mai, ua waiho ʻia ke ʻano hana hoʻomohala i ka wā prenatal. ʻAʻole hoʻonui ka nui o nā pūpale kongenital i ka nui, kūwaho ka nui o nā pūpū squamous. ʻO ke ʻano o nā cysts maoli ma muli o ke kaohi ʻana o nā kumuʻai pancreatic e alakaʻi i ka maʻi me ka hoʻokumu ʻana i nā iwi fibrous - ua kapa ʻia kēia pathology "cystic fibrosis", a i ʻole polycystic.
Luku (pseudocysts) - nā hana hoʻopili i kū i ka wā o ke kaʻina o nā keʻena i nā pancreas, nā hōʻeha a me nā mea ʻē aʻe o ke ʻano lua.

Hiki i nā lua o ke kuʻuna ke hana i nā ʻāpana like ʻole o ka pancreas - ma ke poʻo, ke kino a me ka huelo. Wahi a nā heluʻepekema, ʻike pinepine ʻia ka poʻo ke kani, ma 15% o nā hihia a pau, he 85% ka mea i hōʻā ʻia e ka cystic lesion o ke kino a me ka huelo o nā mea. Ma kahi kokoke o 90% o nā hihia, he lua ke kūlohelohe ʻana o nā cyst a kū i ke kūkaʻi o ka pancreatitis i hoʻohuli ʻia. ʻO 10% o nā hihia e pili pū ana me ka trauma organika.

Kuhi ʻia ka Atlanta i nā puka cystic i ʻike ʻia ma hope o ka maʻi pancreatitis.

ka hopena o nā ʻōpala huehue - hele koke mai, ʻaʻohe pā kūpono i nā mākeke, nā kolo o ke kelepona, nā ʻāpana o ka parinhematous a i ʻole like me ka lua.
subacute (lahilahi) - ulu mai kahi akuhiʻi e like me nā paia o nā puʻupuʻu mai nā fibrous a me ka granulation tissues.
abses - ka maʻi ʻaole purulent o ke ʻano, hoʻopiha ʻia ke ana me nā mea ʻeha.

Mai ka hoʻomakaʻana o ka papa o nā kulekele, ʻo nā cysts:

paʻakikī e nā fistulas, ke koko, pus a perforation paha,
unformawa.

Nā hopena

Pilikia nui ka maʻi pancreatic no ka hiki ʻana o ka degeneration i loko o ke kao maʻi. Ma ke hoʻonohonohoʻana, hiki i nā lua cystic ke maleign a me ka hōʻino. He maʻi hōʻeha nui ka maʻi maʻi pancreatic, kahi hoʻohālikelike o ke ʻano wikiwiki me ka metastasis ākea. ʻO nā pōpoki Benign ʻaʻole liʻiliʻi liʻiliʻi loa ma muli o ka loaʻa o ka wāwahi a me ka hoʻomohala ʻana o ka peritonitis ma hope.

ʻO ka hana fistula kekahi mea hoʻopiʻi hou. Me ka hoʻonaninani ʻana i nā hana cystic, hoʻopiha piha a me ka piha ʻole. Hoʻonui ka maikaʻi o nā fistulas i ka hopena o ka maʻi a me ka hoʻomohala ʻana i ke kaʻina o nā maʻi bacterial.

Hoʻokomo nui nā pūpū nui i nā moku a me nā kumu mua o ka hoʻopapa a me nā ʻāpana pili i loko o ka ʻōpū o ka ʻōpū, ma muli o nā hopena maikaʻi ʻole.

ka hoʻomohala ʻana o ka jaundice obstrate me ka hoʻokae ʻana o nā cyst i ke poʻo,
ka ʻaʻuhū ʻana i nā wāwae i ka wā e huki ai i ka vein portal.
disuric disorders me ka hoʻokaumaha ʻia o ka urinary tract,
ka wahī i ka wā a ka ʻū ʻana i ka lumen i loko o nā kīʻaha o ka ʻōpū (kahi kūlana i loaʻa ʻole i ka hele ʻana o nā cysts pancreatic nui).

ʻIke ʻike

ʻO kahi kauka i nānā a mālama i nā poʻe me ka maʻi pancreatic i manaʻo ʻia he gastroenterologist. I ka hoʻomaʻamaʻi mua ʻana, e koi ʻia kahi anamnesis, e hoʻomaʻemaʻe i nā hoʻopiʻi a me ka nānā ʻana me ka palpation. Me kahi hōʻike manual o ka ʻōpū o ka ʻōpū, hiki ke ʻike ʻia kahi protrusion me nā palena palena. ʻO kahi hoʻokolohua piha me ka hui pū ʻana o nā hana a me nā ʻina hana.

ʻO ka papa inoa o nā hoʻokolohua hōʻoia pili i nā hoʻokolohua o ke koko, e komo pū ana i ka biochemistry. Ma mua o ka heleʻana o ka pathology, e ʻike ʻia ka loli i loko o ka hōʻike ESR a me ka bilirubin (hoʻonui), leukocytosis, hoʻonui ʻia ka hana o ka phosphatase alkaline. Hiki i kahi urinalysis ke kūkaʻi hōʻike i nā hōʻailona o ke kuni ʻana i nā maʻi paʻakikī - nā pūpū maʻamau a me nā keʻokeʻo ke keʻokeʻo ke ʻike i ka urine.

ʻIke ʻia ka ʻike ʻike ʻoiaʻiʻo i ka wā e hōʻoia ʻia ana ka holomua ma o nā mea kōkua.

Hāʻawi ka Ultrasound iā ʻoe e hoʻoholo i ka nui o nā kahe cystic, ko lākou helu, ka hele ʻana o nā hoʻopiʻi,
ʻO ka MRI ka mea e hoʻoholo maʻalahi a kuhikuhi i ka nui, ka pilina o nā hana cystic me nā kumu o nā kuʻekuʻe,
Hoʻohana ʻia ka scintigraphy (ka hana a ka radionuclide) i mea hoʻohana hou e hoʻomālamalama ai i ka wahi o ka lua o ka pathological i loko o ka parinham o ka huila.
ʻO endogropika retrograde cholangiopancretography ma ke ʻano he kumu kiʻekiʻe ka hāʻawi ʻana i nā kikoʻī kikoʻī e pili ana i ka hoʻopili ana i ka lua, kona ʻano a me nā pilina me nā panina, akā lawe pū i ka hopena kiʻekiʻe o ka maʻi i ka wā o ka hoʻokolokolo.
Hoʻohana ʻia kahi radior panoramic o ka ʻōpū ʻōpū e hoʻomaopopo i nā palena o nā lua.

Inā maopopo ʻole ke ʻano o ke kime o ka papale o nā cystic formations, he biopsy o ka pancreatic tissue i mea e hōʻoia a hōʻoia i nā hōʻino ʻana. Hana ʻia kahi biopsy ma lalo o ka mākaʻi o kahi ʻike ultrasound a i ʻole ma ka nānā ʻana i kahi CT. ʻO ka ʻokoʻa ʻokoʻa i ka wā biopsy ka ʻimi o ka nānā ʻana i ka oncology a pale i ka ulu ʻana o nā nui o ke kanesa.

Hoʻohana ʻia ka hoʻomaʻamaʻa ʻana o nā cysts pancreatic ma o ke komo ʻana i ka holo ʻana. ʻAʻohe maikaʻi loa ka lāʻau lapaʻau me nā cysts lehulehu. ʻAʻole i kuhikuhi ʻia ka hana no nā mea liʻiliʻi (a hiki i ka 30-50 mm cysts) nā cysts, inā ʻaʻole lākou e hoʻopilikia i nā ʻāpana pili a ʻaʻole e kumu i nā hōʻailona maikaʻi ʻole. ʻO ka wehe ʻana o kahi cyst malignant, ʻoiai me nā liʻiliʻi liʻiliʻi, pono e pale i ka metastasis.

I loko o kahi gastroenterology bedah, ua hoʻohana ʻia nā 3 ala e pale aku ai i ka cysti pancreatic:

ka wehe ʻana i ke kumuhana patological - resection,
kahe uila
laparoscopy

Ke hoʻihoʻi ʻia, hoʻokaʻawale ʻia ke kino cyst a me nā ʻaoʻao pili i luna o ka pancreas. Loaʻa ka nui o ka hauʻoli i ka nui o ka lua, ka moku'āina o ka ʻāpana o ka parinhematous o ka umauma - hana lākou i kahi hana o ke poʻo, kahi mamao, pancreatoduodenal.

Hoʻomaka ka wai kūloko o ka pūpono ma o ka anastomosis ma waena o ke kino ʻoi a me ka ʻōpū, duodenum a i ʻole peʻa liʻiliʻi. ʻO ka pākuhi o loko o kahi mea palekana a me nā ala physiological e hoʻomaikaʻi ai i ke kūlana o ka mea maʻi - ke hōʻoiaʻiʻo ʻia nei ke ʻano o nā manaʻo o ke ana, hoʻopau ʻia ka ʻeha, hōʻemi ka hopena.

Ke lawe ʻia nei ka honu o waho o ka cyst me kahi papa paʻakikī o nā patology.

ka ʻohi ʻana o ka exudate purulent,
mekameka cyformic unformed,
hoʻonui vascularization (ka hoʻokumu ʻana o nā moku hou) i loko o nā paia o ka pua,
ʻano kūlana koʻikoʻi.

Me ka wai o waho, hiki i nā hopena maikaʻi ke hopena i ka hoʻopiha ʻana i ka fistula formal, hoʻonui ʻia o nā cyst i ka nui, ka ulu ʻana o nā puka hou. I kekahi manawa, ulu ka sepsis. I kēlā me kēia hihia, lawe ʻia nā ka ʻaoʻao o waho a me loko o ka pae kino wale nō.

ʻO Laparoscopy kahi ʻano maʻalahi, ʻo kona pono o ka loaʻa ʻole o nā hana hoʻokipa ākea loa a me ka wikiwiki wikiwiki o ka mea maʻi. He kūpono ʻo Laparoscopy no ka wehe ʻana i kahi nui, hoʻokahi cystic hanganga. ʻO ka manaʻo nui o kēia hana hōʻiliʻili minimally ʻo ka hoʻomaka ʻana o ka lāʻau puncture i loko o ka foci pilikia me ka suction o nā ʻike.

Hoʻokomo ʻia ka hopena me nā lāʻau lapaʻau i ka hoʻoponopono ʻana i ka maʻi lalo. Ma mua o ka pancreatitis, pono ke koho ʻana i nā huina e hōʻoia i ka hoʻowalewale 'ana a lawe mai ka pancreas. E hōʻoluʻolu i ka ʻeha, ua hoʻohana ʻia nā antispasmodics a me nā analgesics. Kahi ʻia ka paila kaulua o ke koko, inā e hoʻopilikia ʻia, e kuhikuhi ʻia nā lāʻau kūpono.

Kūkulu ʻia no nā lesi cystic i kau ʻoi loa i ka nui o ka pancreatic sparing. ʻO ka mālama kūpono e hiki ke hōʻemi i ka hoʻoneʻe ʻana i ka maʻi a kākoʻo i ka hiki ke ʻōnaehana o ka enzymatic. ʻO nā loina o ka meaʻai me ke aniani pancreatic:

hualuae pōʻaiʻai i ka manawa like (3-4 hola),
ʻai ʻia nā meaʻai a pau, a ʻuʻoki ʻia.
ʻano hana
hōʻole no ka momona a me ka palaoa,
he mea ʻoki i ka berena a me ka hūnā,
ʻO ke kumu o ka meaʻai, ʻo ka ʻai ʻai protein (ʻaʻole pono nā mea kanu i kanu ʻia i luna o 30% o ka make i kēlā me kēia lā).

ʻAi paʻa ka mea maʻi e ʻai i ka ʻiʻo momona, nā huaʻai, nā pīni. ʻO nā huahana e pono ai ka wai momona me ka haʻahaʻa haʻahaʻa haʻahaʻa, moa a me ka palaoa turki, hua manu kuke, nā lau ʻai ma hope o ka mālama wela. Mai nā mea inu, ʻai momona, kīleʻa a me ka hua stewed. Diet - kahi ola lōʻihi, ʻo ka hoʻomaha iki loa e hiki ai ke hoʻonāukiuki i kahi ʻino.

ʻO ka mākona o ke ola e pili ana i nā kumu kumu o ka pathology, papa a me ka lawa o ka ʻoihana. Hōʻike ʻia ka maʻi e ka kiʻekiʻe o nā hoʻopiʻi - i ka 10-50% o nā maʻi, ka hele ʻana o ka maʻi me ka oncology, maʻi a me nā hemorrhages i loko. Ma hope o ke kau ʻana, aia kahi manawa hou e ulu nui ana. Ma ke kumuhana e pili ana i nā kauka, ʻo ka mālama pinepine ʻana a me ka lawe ʻana i nā enzymes, aia ka manawa e mālama ai i ka kali ʻana o ke ola maʻamau.

I mea e pale ai i ka hūnā a mālama i kahi kūlana paʻa, pono nā maʻi:

kiʻi i kahi meaʻai
hāʻawi pio i nā waiʻona
pane manawa kūpono i nā pilikia me ka gastrointestinal tract.

ʻO ka lesi Cystic o ka pancreas he maʻi maʻamau, ma ke ʻano o ka mālama ʻana i nā kūpono kūpono, he mauʻu nā hopena. Hiki i ka hopena o ka lāʻau lapaʻau hou ke kūleʻa i ka maʻi a hiki i ka poʻe maʻi ke ola holoʻokoʻa. ʻO ka mea nui he ma mua o ke ʻano me ke ʻano koho maikaʻi o ka wehe ʻana i nā cysts.