Pancreatoduodenal resection: kurapa uye zvinetso

Kusvika parizvino, kenza yepancretic inowanzove yekenza. Muzviitiko zvakawanda, izvo zvinotarisirwa zvinowanzova nemigumisiro yakaipisisa. Panguva yekuongororwa, vanachiremba vanoona kuvepo kwechipiri chemasastase, iyo inobata hutano hwakanaka hwevamwe nhengo.

Iko kusakosha kukuru kwechirwere ichi ndechekuti hapana zviratidzo zvekuratidzwa kwechirwere. Panguva imwe chete, masero ekenza anotanga kukura nesimba guru. Apo nhamba huru ye metastases inowanikwa, varwere havakwanisi kugadziriswa.

Technology ye pancreatoduodenal resection

Ndiani anogona kukurudzirwa pancreatoduodenal resection? Kupindira kwekuvhiya kunoratidzwa chete kune avo varwere vane tumaronda yekenza vane nzvimbo yakajeka mukati mepancreas. Kuvhiyiwa kwakadaro kunoshanda sechirongwa chekurapa.

Pasati yatanga kushanda, chiremba anoenda achiita chiitiko chechikamu chakagadziriswa. Nokuda kwekuongorora kwe ultrasound uye zvakasiyana-siyana zvekuongorora, chirwere chechirwere chinoratidza rudzi rwekupindira kwekupindira.

Kana kenza iri mumusoro wepascreas kana yakapoteredza kuvhura kwepancreatic duct, vanachiremba vanoita Whipple kushanda. Mukuvapo kwekuvadza kwemuitiro mumuviri kana mumuswe wepascreas, pancreatectomy inoitwa.

Kuvhima (pancreatoduodenal resection kana Whipple operation) yakatanga kuitwa pakutanga kwema1930 nachiremba Alan Whipple. Pakupera kwema1960, kufa kwekupindira kwakadaro kwakanyanya.

Kusvika iye zvino, pancreatoduodenal resection inonzi yakachengeteka zvachose. Rufu rwekufa rwakaderera kusvika 5%. Chigumisiro chekupedzisira chekupindira kunobva pane zvakaitika kune unyanzvi hwechiremba.

Ndeipi iyo nzira

Ngationgororei zvakanyanya kuti pancreatoduodenal resection iri kuitwa sei. Zvikamu zvekushanda zvakataurwa pasi apa. Panguva iyi yekuvhiyiwa, murwere wacho anobviswa kubva pamakona emusoro. Muzvirwere zvakakomba, kubviswa zvishoma kwebate duct uye duodenum kunoitwa. Kana chirwere chinouraya chinowanikwa munzvimbo yemudumbu, kusunungurwa kwayo zvishoma kunoshandiswa.

Pashure pepancreatoduodenal resection, vanachiremba vanobatanidza zvikamu zvakasara zvepancreas. Izvo bhati duct yakabatana zvakananga kumumbo. Nguva yekushanda kwakadaro inenge maawa masere. Mushure mokuvhiyiwa, murwere ari kurapwa kwenguva refu, inotora anenge masvondo matatu.

Whipple's laparoscopy

Iyi nzira yekurapa inobva pane nzvimbo yemaropant neoplasm. Whipple laparoscopy inogona kuderedza zvakanyanya nguva yekuvandudza murwere. Urwu urwu hwekuvhiya hunoitwa kune varwere vane kenza yemulullar.

Kupindira kwepaparoscopic kunoitwa kuburikidza nekufungidzirwa zviduku mudunhu remuviri. Izvo zvinoitwa nevarapi vezviitiko vane ruzivo vachishandisa rubatsiro rwemakodhi chaiwo. Mune chirongwa chinowanzoshandiswa che Whipple, cavitary incisions yemakwikidzi akaenzana anoitwa.

Pachishandiswa chirwere chinonzi laparoscopic chirwere chinoratidzira kurasikirwa kweropa kuduku munguva yekushandiswa kwebasa. Vanotarisawo ngozi yakawanda yekupinda mumhando dzakasiyana-siyana dzezvirwere.

Apo Whipple's operation inokosha

Pane huwandu hwezviratidzo umo kushanda kunokwanisa kugadzirisa zvakakwana mamiriro ezvinhu emurairo. Izvi zvinosanganisira:

• Kanzira yemusoro wepancreas (pancreatoduodenal resection ye pancreas).
• Inonyadzisa neoplasm munharaunda ye duodenum.
• Cholangiocarcinoma. Muchiitiko ichi, chirwere chinokanganisa masero ane utano hweB bile ducts echiropa.
• Ampullar kenza. Pano inonzi neoplasm inouraya iri munzvimbo yepancreatic duct, inotungamirira ku bile mu duodenum.

Kupindira kwokupindira kworudzi urwu kunoshandiswawo mukusawirirana kwezvipembenene zvinotapira. Zvinosanganisira chirwere chakadai sechirwere chinopisa.

Inenge 30% yevarwere vanotarisana nemhando iyi yekurapa. Vanorwara kuti vane tumor inowanikwa mukati mepancreas. Nemhaka yekushaikwa kwezviratidzo zvakarurama munguva dzakawanda, varwere vanowanikwa mastasis we dzimwe nhengo. Kuita kuvhiyiwa nehutano hwakadaro hwechirwere hahwupi hunoita.

Pancreatoduodenal resection inotanga nekunyatsorongororwa kwezvikamu zvakagadzikana zvechirongwa. Kubudiswa kwekuenzanisa kwakakodzera kucharatidza mararamiro aripo epachirwere ichi.

Kukura kwechirwere chinokonzera kenza kunobvumira kupindira kweparoscopic. Somugumisiro, vanachiremba vanogona kubvisa zvachose nzvimbo yakakanganiswa, asi kwete kukuvadza dzimwe nhengo dzechipfuva chemuviri.

Migumisiro yekurapa

Vazhinji varwere vanobvunza mubvunzo mumwe chete: chii chinokonzera pancreatoduodal resection? Mumakore gumi akapfuura, chiyero chekufa kwevarwere chakaderera kusvika 4%. Ichokwadi ndechokuti chiitiko chakanaka chinowanikwa kana pane ruzivo rwakakura rwechiremba chiremba achiita basa racho.

Ne adenocarcinoma, chirongwa chinonzi Whipple pancreas chinogonesa kuchengetedza vanenge 50% yevarwere. Nekusavapo kwakakwana kwemakumbo mu lymphatic system, zviyero zvakadaro zvinowedzera kuponeswa kwevarwere kakawanda.

Mushure mokuvhiyiwa, murwere anopiwa chirongwa cheredhiyo uye chemotherapy. Izvi zvakakosha kuitira kuparadza kupararira kwekenza masero kune dzimwe nhengo.

Kuwedzerwa kurapwa mushure mekuvhiyiwa kunopesana nevarwere vane tumorine inorwara, pamwe chete neurouroendocrine kuchinja.

Pancreatoduodenal resection: chirongwa chekuvhiya

Mukati yekugadziriswa kwekupindira, chikamu chikuru chechirongwa chinokonzera kuvhara insulin chinobviswa. Nekudaro, inobatsira kudzora huwandu hwehuga muhutachiona. Kusarura kunokonzera zvakanyanya kuderedza kubudisa insulini. Somugumisiro, kune varwere vakawanda, njodzi yekuva nechirwere chakadai sechirwere cheshuga chinowedzera zvinoshamisa.

Varwere vane huwandu hwehuga hwepamusoro hunowanzosvika kune chirwere ichi. Izvo zvakaenzana nehutachiona hweglucose mumurwere asina chirwere chisingaperi chisinganzwisisiki chinoshamisa chinoderedza kukura kwechirwere cheshuga.

Mushure mekupedzwa kwegadziriro yekuvandudza, chiremba anoshanda achikurudzira kunamatira kune kudya. Kubva pakudya kune zvakakosha kuti usabvisawo mafuta uye salty foods. Kakawanda mushure mokupindira kwakadaro, varwere vakawanda vakaratidza kusawirirana kwezvokudya zvinofadza. Munyaya iyi, kushandiswa kwayo kunopesana.

Matambudziko pashure pekushanda kwa Whipple

Mhando iyi yekurapa ine ngozi yakakura yezvinetso. Kuva neruzivo rwechiremba nechiremba chiremba kunoderedza kuitika kune chero dambudziko. Zvinetso zvinokonzera zvinosanganisira:

• Kuonekwa kwefistula pancreatic. Panguva yekupindira kwekupindira, chiremba anovhiya anobatanidza gland nematumbo emudumbu. Soft pancreatic organ tishu inopesana nekukurumidza kuporesa kwekubatana. Munguva iyi pane kurasikirwa kwepancreatic juice.
• Kusuruvara kwakasununguka kwemudumbu. Pakupera kwebasa racho, murwere anopiwa chirwere chekujaira kuburikidza nehotera. Izvi zvakakosha kuitira kuti vadzorere kushandiswa kwemazuva ose kushanda kwedumbu.

Chikafu mushure mokunge pancreatoduodenal resection inofanira kuva yakarurama, tsika dzose dzakaipa dzinofanira kuiswa kunze. Nezvose zvinokurudzirwa, vanhu vanononoka kudzokera kuhupenyu hwehupenyu.