Ukwelashwa Pancreatoduodenectomy kanye nezinkinga

Kuze kube manje, umdlavuza pancreatic uhlobo ezivamile umdlavuza. Ezimweni eziningi, le umhlahlo nemiphumela kuhle ezimbi. Phakathi luhlolo, odokotela ukuthola ubukhona metastases yesibili, okuyinto ukuhlasela izicubu onempilo nezinye izitho.

I ethile eyinhloko lesi sifo ukuthi akukhona sebenzisa phi izimpawu izimpawu isifo. Kulokhu, amaseli umdlavuza eqala ukukhula ngamandla amakhulu. Phezu ukuthola inombolo enkulu kweziguli metastases bangenzi zokukhwabanisa kuhlinzwa.

pancreatoduodenectomy Technology

Ukuze resection pancreatoduodenal kungenziwa enconyiwe? Ukuhlinzwa kuboniswa kuphela kulezo ziguli kabani izimila abe kwasendaweni abahlukene ngaphakathi amanyikwe. Lokhu kuhlinza uba inqubo zokwelapha.

Ngaphambi ukusebenza udokotela uqhuba uphethwe esibanzi isitho abathintekayo. Ngenxa ultrasound izivivinyo kanye ihlaziya ezihlukahlukene isifo iphethini kubonisa uhlobo ukuhlinzwa.

Uma umdlavuza Itholakala ikhanda kwamanyikwe noma eduze kuvulwa imbobo pancreatic, odokotela ukuhlinza Whipple. Ephambi kwezinduna inqubo abulalayo endaweni yomzimba noma umsila we odokotela abahlinzayo amanyikwe enze pancreatectomy.

Ukusebenza (resection pancreatoduodenal noma ukuhlinzwa Whipple) siqala ukuba khona ekuqaleni kuka-1930, u-Alan udokotela Whipple. Ngasekupheleni kwawo-60-yalolucwaningo of enjalo ukuphazamiseka ngokwempilo yangenyama yayiphezulu izibalo ngokwanele.

Kuze kube manje resection pancreatoduodenal ubhekwa ephephile ngokuphelele. Lokushona kwabantwana bezalwa, walile ezingeni 5%. Umphumela wokugcina we kokungenela kwaba encike ngqo kwi isipiliyoni professional nodokotela ohlinzayo.

Iyini inqubo

Ake sicabangele indlela ukukhiqiza resection pancreatoduodenal. Izigaba ukusebenza kuchaziwe ngezansi. Ngokuhamba imisebenzi enjalo uyabekezela usebenze ukususwa pancreatic ikhanda esifundeni. Ngo ezifweni ezimbi eyenziwa ukususwa olungaphelele uvule imbobo Bile futhi duodenum. Uma umdlavuza itholakala esiswini, wenziwa a ukususwa esinqunyiwe.

Ngemva pancreatoduodenectomy odokotela xhuma asele izingxenye pancreatic. Bile imbobo ezixhunywe ngokuqondile emathunjini. Isikhathi lokhu msebenzi amahora mayelana 8. Ngemva kokuhlinzwa isiguli ukwelashwa sinenkonzo yokunakekela iziguli emakhaya, okuyinto kuthatha cishe 3 amaviki.

Laparoscopy Whipple

Le ndlela yokwelapha eyenziwa kuhlaziywa indawo umdlavuza. Laparoscopy Whipple iyehlisa isikhathi nokuvuselelwa isiguli. Lolu hlobo lokuhlinzwa wenziwa khona iziguli ampullary umdlavuza.

ukuhlinzwa Laparoscopic wenziwa ngokusebenzisa sebeziqhumbuza ezincane esiswini. Wenziwe abahlinzayo abanolwazi nge imishini ekhethekile wezokwelapha. Ngo operation evamile Whipple olwenziwa sebeziqhumbuza besisu usayizi umxhwele.

Lapho ukuhlinzwa laparoscopic, odokotela abahlinzayo ukusho okungenani ukopha phakathi nezinqubo kuhlinzwa. Baphinde futhi baphawule ingozi okungenani lokungena izinhlobo ezihlukahlukene nezifo.

Lapho ukusebenza kudingekile Whipple

Kunezindlela eziningana nemingcele ukusebenza uyakwazi ukulungisa ngokuphelele isimo lesiguli ngaphansi kwazo. Lezi zihlanganisa:

• izilonda olunomdlavuza we inhloko yomnyango kwamanyikwe (labetibambile pancreatectomy pancreatoduodenal).
• Umdlavuza endaweni ye duodenum.
• Cholangiocarcinoma. Kulokhu isimila kuthinta amaseli enempilo amavesi isibindi Bile.
• umdlavuza Ampullar. Lapha umdlavuza Itholakala imbobo pancreatic, okuyinto ethatha Bile phakathi duodenum.

Ukuhlinzwa yalolu hlobo nazo asetshenziswa ezibangela izimila ingozi. Lezi zihlanganisa izifo ezifana pancreatitis ezingamahlalakhona.

Cishe 30% eziguli ibhekane lolu hlobo ukwelashwa. Bona ukuxilonga indawo isimila ngaphakathi amanyikwe. Ngenxa yokuntuleka izimpawu eqondile iningi amacala zenzeka in iziguli Ukudlulela kwezinye izitho. Afeze ukuhlinzwa ngenkambo enjalo uthola lesi sifo akwenzi mqondo.

Pancreatoduodenectomy iqala ngokukhuphuka ukusazi ngokunembile isifo esikuphethe we abathintekayo isitho neminyango. Ukuvumela cwaningo olufanele sizobonisa isithombe lesi sifo.

Usayizi encane isimila esinomdlavuza uvumele izinqubo laparoscopic. Ngenxa yalokho, odokotela abahlinzayo Awukwazi ukususa ngokuphelele endaweni ethintekile, ngaleyo ndlela ngaphandle kokulimaza nezinye izinhlaka ngaphakathi komgodi ongaphakathi kwamathumbu.

Ezenye yokwelashwa

Iziguli eziningi bazibuza umbuzo ofanayo: namiphi imiphumela pankreatoduodnalnoy resection? Kule minyaka eyi-10, isiguli bebeletha lehla 4%. Iqiniso lokuthi umphumela omuhle kufinyelelwa ebukhoneni isipiliyoni enkulukazi udokotela ohlinzayo owenza lo msebenzi wokusebenza.

Lapho adenocarcinoma pancreatic Whipple ukusebenza evumela ukulondoloza ukuphila cishe 50% ezigulini. In the engekho ephelele izimila ohlelweni lymph, izinyathelo ezinjalo ukwandisa sokusinda iziguli izikhathi eziningana.

Ngemva kokuhlinzwa isiguli inikezwe inkambo ngemisebe nangamakhemikhali. Lokhu kuyadingeka ukuze abhubhise amangqamuzana omdlavuza basakazekela kwezinye izitho.

okunye ukwelashwa ngemva kokuhlinzwa is contraindicated in iziguli khona kuwuphawu lwesimila kungavamile ukuba ingozi, kanye neuroendocrine kwengxenye.

Pancreatoduodenectomy: amasu kuhlinzwa

Phakathi nenqubo yokuhlinzwa ususa amagatsha amaningi emzimbeni, okuyinto obangela uketshezi we-insulin. Ngakwelinye ihlangothi, kuyasiza ukulawula ezingeni ushukela ohlelweni igazi. resection kwengxenye iyehlisa ukukhiqizwa we-insulin. Ngenxa yalokho, iningi leziguli kakhulu kwandisa ingozi yokuba izifo ezinjengesifo sikashukela.

Iziguli amazinga kashukela egazini eliphezulu Lesi sifo siphatha kakhulu ukuba lolu hlobo isifo. Jwayelekile glucose amazinga e isiguli ezingamahlalakhona pancreatitis ukungabi kakhulu kunciphisa ukuthuthukiswa sikashukela.

Ekupheleni inqubo nokuvuselelwa udokotela ukuya uncoma ukudla. Kusukela Ukudla kufanele ayifakiwe kakhulu okunamafutha kanye nokudla okunosawoti. Ngokuvamile, ngemva sokungenela, iziguli eziningi kwadingeka ukungabekezelelani ukuba ukudla amnandi. Kulokhu, ukusetshenziswa kwalo contraindicated.

Izinkinga kusuka ukuhlinzwa Whipple

Lolu hlobo ukwelashwa has a ingozi ngokwanele okusezingeni eliphezulu yezinkinga. Ukutholakala isipiliyoni professional of udokotela ohlinzayo iyehlisa okuvela ababhekene nanoma iyiphi inkathazo. izinkinga ezingase zibe khona zihlanganisa:

• Ukubukeka fistula pancreatic. Phakathi ukuhlinzwa udokotela ohlinzayo uxhuma indlala emnyangweni emathunjini. Soft izicubu zomzimba umphetho pancreatic ukuvimbela ukuphulukiswa okusheshayo. Phakathi nale nkathi, kukhona ukulahleka juice pancreatic.
• ukukhubazeka olungaphelele esiswini. Ngemva kokuhlinzwa isiguli inikezwa umjovo ngokusebenzisa inkambo IV. Lokhu kuyadingeka ukuze buyisela futhi ukusebenza evamile isisu.

Ukudla ngemuva pancreatoduodenectomy kufanele kube efanele, yonke imikhuba emibi udinga ukuqeda. Ngokuhambisana zonke izincomo umuntu kancane kancane ukubuyela ekuphileni okuvamile.