Khokahano e ka sehloohong ho pathogeneis ea pancreatitis e hlobaetsang

Ho latela V.S. Gcinalieva et al., 2001

Khothatso ea secretion + e holofetse ea ho tsoa

Phetolelong ea trypsinogen ho trypsin:

Motheo oa pathogenesis ea pancreatitis e matla ke lits'ebetso tsa litlamorao tsa lehae le tsa tsamaiso ea li-enzymes tsa pancreatic le li-cytokines tsa tlhaho e fapaneng. Khopolo ea enzyme e nang le karolo e ka sehloohong ea trypsin ho pathogeneis ea lefu lena e nkoa e le eona e etellang pele. Ho kopana ha lintlha tse 'maloa tse bakang khatello ea kelello ka har'a polyetiology ea pancreatitis e matla ke ntlha ea mantlha ea ts'ebetso e kenang ea li-enzyme tsa protheine le ho hlohlona kahare ho manyeme. Boemong ba cytoplasm ba sele ea acinar, ho kenngoa karoloana ea li-agmogenic granules le lysosomal hydrolase (ka "khopolo ea" colocalization "), ka lebaka leo liprotheine li hlahisoang ka tokollo e latelang ea liprotheine ho" pancreatic interstitium ". Ho kenngwa tshebetsong ha trypsinogen le phetoho ea eona ho trypsin ke sesebelisoa se matla sa li-proenzymes tsohle tse ling ka ho thehoa ha papali ea karabelo e matla ea pathobiochemical. Bohlokoa bo boholo ho pathogenesis ea lefu lena ke ts'ebetso ea peleho ea lisebelisoa tsa enzyme, mme ts'ebetso ea ts'ebetso ea pele e amanang le tšenyo ea likarolo tsa lisele le ho sitisoa ha litšebelisano tsa transmembrane.

E 'ngoe ea mekhoa ea' nete ea pathogenesis ea pancreatic necrosis ha ho senyeha sele ea acinar ke phetoho ea phallo ea calcium ions ka seleng le hole, e lebisang ts'ebetsong ea trypsin. Ka keketseho e ntseng e eketseha ea calcium ions ka seleng, ho kenella ka hare ho methapo ea methapo (activator ea mantlha e kenellang).

Mekhoa e meng ea autoactivation ea enzyme system ka har'a makhopho: ho leka-lekana tsamaisong ea enzyme kapa ho haella ha li-trypsin inhibitors (alpha-1-antitrypsin kapa alpha-2-macroglobulin), ho nts'etsapele 'mele oa phetoho ea mofuta o lumellanang.

Trypsin ke ts'ebetso ea mantlha ea moferefere oa ts'ebetso e matla ea pathobiochemical, empa ho teba ha methapo ea methapo ea methapo ho bakoa ke ketso ea motsoako o kopanetsoeng oa lits'ebetso tsohle tsa pancreatic enzyme (trypsin, chymotrypsin, lipase, phospholipase A2, elastase, carboxypeptidase, collagenase, jj.).

Li-enzymes tsa "pancreatic activated" li sebetsa e le lintho tsa mantlha tsa mabifi, li na le phello ea lehae, kena sebakeng se khutlisang, mokokotlo oa mpa, ka mothapo o kenang ka har'a sebete le kahare ho methapo ea methapo ho potoloha tsamaiso ea methapo. Phospholipase A2 e senya li-membrane tsa sele, lipase hydrolyzes intracellular triglycerides ho mafura acid, tseo, ha li kopantsoe le calcium, li etsa likarolo tsa sebopeho sa mafura (lipolytic) necrosis ka har'a manyeme, fiber ea sebaka se khutlang le peritoneum. Trypsin le chymotrypsin li baka protheine ea protheine ea lisele, elastase e senya lebota la sejana le likarolo tsa methapo tse sebetsanang le methapo, e isang kholisong ea hemorrhagic (proteinolytic) necrosis. Tsepamiso e hlahang ea necrobiosis, necrosis e nang le potoloho ea phello ea phello ea ho ruruha makhophong le litonong tsa morao-rao ke aseptic.

Khokahano ea bohlokoa ho pathogenesis ea pancreatitis e matla ke ts'ebetso ea trypsin ea ts'ebetso ea kallikrein-kinin ka sebopeho sa lintlha tsa bobeli tsa mabifi: bradykinin, histamine, serotonin. Sena se tsamaisana le ho eketseha ha tumello ea methapo ea methapo, ho holofala ha microcirculation, sebopeho sa edema ka har'a manyeme le sebaka sa ho khutlisa, ho eketseha ha exudation ho ea ka mpeng ea mpa.

Lintho tsa mabifi tse laeloang karolo ea boraro tse amehang ho ts'oaetso ea ts'oaetso ea ts'oaetso ea lehae, le ts'oaetso ea methapo ea methapo, ho se sebetse hantle ha pelo le ho hema, ho kenyelletsa lisele tsa mononuclear, macrophages le neutrophils tsa bahanyetsi ba fapaneng ba ts'oaetso (cytokines): li-interleukins 1, 6 le 8, necrosis factor tumors, platelet activation factor, mofuta o sa pancreatic oa phospholipase A2, prostaglandins, thromboxane, leukotrienes, nitric oxide.

Li-cytokine tsa Proinflammatory li kenyelletsa: li-tumor necrosis factor, li-interleukins 1-beta le 6, le tse thibelang mafu - li-interleukins 1 le 10. Qalong ea lefu lena, khatello ea methapo ea methapo ea methapo mokhoeng oa mokokotlo, sebete, matšoafo, ho pharalla le tsamaiso ea mali e eketseha, e hlalosang lits'ebetso tsa nts'etsopele. tsa lehae, setho le tsamaiso ea methapo ea ts'oaetso.

Li-Enzymes, li-cytokine le metabolites ea tlhaho e fapaneng, e thehiloeng nakong ea pancreatitis e hlobaetsang manyeme, sebaka sa ho khutla, mokokotlo oa mokokotlo le leseli la phepelo ea ka mpeng, e kenella ka potlako maling le ka methapo ea thoracic lymphatic tsamaisong ea potoloho le pancreatogenic toxin. Litho tsa pele tse lebisitsoeng ha li le tseleng e tlohang sebakeng sa ho khutla li ea litho tsa tšebetso ea mpa e eketsehileng ke sebete le matšoafo, pelo, boko le liphio. Sephetho sa phello e matla ea cytotoxic ea metsoako ena ea biochemical qalong ea lefu ke nts'etsopele ea manyeme a pancreatogenic le mathata a mangata a setho a khethollang ho teba ha boemo ba mokuli ka pancreatitis e matla.

Ho pathogenesis ea mathata a systemic, le pele ho nts'etsopele ea mathata a septic, toxinemia ea baktheria 'me ka holim'a tsohle, lipopolysaccharide ea leseli la lisele tsa libaktheria tsa gram-negative (endotoxin), e hlahisitsoeng ka lumen ea pampitšana ea gastrointestinal ka microflora ea mala. A pancreatitis e hlobaetsang, motsamao oa "microslora" ea endo native le "endotoxin" ea "gram-negative" e etsahala ka tlas'a maemo a tšoanang a ts'ebetso (e fokolang morphological) ea ts'ebetso ea metabolic le thibelo ea "gastrointestinal", system ea reticuloendothelial ea sebete le matšoafo.

Ho sisinyeha ha "microflora ea" "mesifa" ho tsoa mpeng ea mpa ea ka mpeng ho kenella liseleng tsa manyeme le sebaka sa ho rarolla ke sona sehokela sa pathogenesis ea pancreatitis e senya. Ts'ebetso ena ke khokahano e hokahanyang pakeng tsa "pele" (pele ho ts'oaetso), le e latelang, "morao" (septic), methapo ea pancreatitis e mpe.

Ho pathogenesis ea pancreatitis e hlobaetsang, likarolo tse peli tse ka sehloohong li khetholloa. Karolo ea pele e hlahisoa ke ho fetoha ha methapo ea methapo ka nako ea matsatsi a pele ho tloha ho qala ha lefu lena, ha ho ruruha, ho phunyelletsa ha motho ka boeona, necrobiosis le necrosis ea manyeme, lithane tse khutlisang mahlo. Tlas'a maemo ana, bekeng ea pele ea lefu lena, ho latela botebo ba mathata a pathomorphological, ho bopa mefuta e latelang ea pancreatitis e mpe e ka etsahala:

ka necrobiosis, ho ruruha le ho tsitsipanya ha tšebetso, pancreatitis e bohloko ea "li" ("adematous form"),

ka mafura kapa hemorrhagic necrosis - e sa sebetseng ea pancreatic necrosis (necrotic pancreatitis).

Botebo ba boemo ba mokuli bo nang le pancreatitis e matla ke ka lebaka la pathomorphology ea lefu lena le pancreatogenic toxinemia, ho makala ha pancreatogenic le ho hloleha ha litho tse ngata. Ka mehato ea kalafo e tlang ka nako, ts'ebetso ea methapo e ka emisoa sethaleng sa "pancreatitis" ea methapo, athe maemong a fapaneng, e fetoha pancreatic necrosis.

Ka tsoelo-pele ea lefu lena le phello ea pancreatic necrosis, ts'ebetso ea phetoho ea methapo ea methapo ho ea karolong ea bobeli (septic) ea pancreatitis e mpe, e amanang le ts'oaetso ea libaka tsa necrosis tsa lehae tse fapaneng ka beke ea 2-3 ea lefu lena. Tlas'a maemo ana, ts'ebetso e nchafatsang le ho hlahisa bobuelli ba boemeli bo tšoanang le mohato oa pele hoa etsahala, ntho e mpang e le chefo ea likokoana-hloko tse ikopanye le libaka tsa necrosis. Karolong ea tšoaetso ea lefu lena, karolo e mpe ea methapo ea methapo ea methapo ke boemo bo bocha ba ho qaptjoa ha mefuta e fapaneng ea tšoaetso ea pancreatic necrosis le sepsis ea mpa ka ho sisinyeha ha septic le ho senyeha ha litho tse ngata. Khafetsa khafetsa ea ts'oaetso e nang le pancreatic necrosis ke 30-80%, e ikemiselitsoeng ke ho ata ha pancreatic necrosis, nako ea ho qala ha lefu lena, mofuta oa kalafo e thibelang le mekhoa ea phekolo ea ho buuoa. Nts'etsopele ea tšoaetso e nang le pancreatic necrosis e lokela ho nkoa e le mohato oa bohlokoa phetohong ea ts'ebetso ea pathomorphological.

Ho na le khokahano e tobileng pakeng tsa tekanyo ea ho ruruha ha lisele tsa necrotic le monyetla oa ts'oaetso. Mefuta e tšoaelitsoeng ea necrosis e bonoa ho mokuli e mong le e mong oa beke bekeng ea pele ea lefu lena, hoo e batlang e le halofo ea bakuli ba nang le pancreatic necrosis bekeng ea bobeli, ho mokuli e mong le e mong oa boraro ea nang le pancreatitis e timetsang nakong ea libeke tsa boraro le tsa bone ho tloha ha lefu le qala.

Lisosa tse tloaelehileng tsa ts'oaetso ea ts'oaetso ea pancreatogenic: E. coli (26%), Pseudomonas aeruginosa (16%), Staphylococcus (15%), Klebsiella (10%), Streptococcus (4%), Enterobacter (3%) le Anaerobes. Ts'oaetso ea fungal e hlaha kamora libeke tse peli kapa ho feta ho tloha qalong ea pancreatic necrosis, e bakiloeng ke nako ea kalafo ea kalafo ea lithibela-mafu.

Ts'oaetso ea libaka tse sa sebetseng tsa pancreatic necrosis e bakoa ke tšilafalo ea microflora ea menyetla ea "endo native" (colonic) le kantle ho naha (ka har'a mokuli ea sebetsitsoeng ka drainage le tampons tse tsoang tikolohong ea lefapha la tlhokomelo e batsi).

Litlaleho tsa pele tsa pancreatitis e matla

1641 - Ngaka ea Madache ea bitsoang van Tulp N. (Tulpius) ke oa pele ea ileng a hlokomela ho itlotsa ka pancreatic abscess.

1578 - Alberti S. - Tlhaloso ea pele ea tlhahlobo ea karoloana ea ts'oaetso ea pancreatic e matla.

1673 - Greisel e bile eena oa pele oa ho hlalosa nyeoe ea bongaka ea pancreatic necrosis e bakang lefu ka lihora tse 18 kamora ho qala ha lefu lena mme le netefalitsoe ke autopsy.

1694 - Diemenbroek I. e hlokometse pathoanatomical semiotic ea pancreatic necrosis ho mohoebi ea tsoang Leiden ea neng a tšoeroe ke purcin pancreatitis.

1762 - Stoerk o hlalositse setšoantšo sa kliniki sa "hemorrhage manyepeng.

1804 - Portal o hlalositse ho bonoa ha pancreatic necrosis le abscess.

1813 - Perival o hlokometse nyeoe ea makhopho a maholo a makhopho.

1830 - Rekur o bontšitse sechabeng sa bongaka tokisetso ea pancreatic e nang le li-abscesses tse ngata.

1831 - Lawrence o phatlalalitse tlhahlobo ea pancreatitis ea hemorrhagic.

1842 - Claessen ea pele ea bongaka o ile a lemoha ka matla manyeme pancreatitis

1842 - Karl Rokytansky o ithutile setšoantšo sa methapo ea mafu a tšoaetso ea manyeme

1864 - Ancelet e phatlalalitse tataiso ea pele ea lefu la pancreatic Paris.

1865 - Karl Rokytansky o ithutile ka ho qaqileng patologia ea hemorrhagic pancreatitis.

1866 - Spiess o hlalositse nyeoe ea lefu ho tsoa ho "hemorrhage e ngata" makhophong.

1867 - Luke le Klebs e bile bona ba pele ba ho etsa pina ea pele ea pancreatic ea bohata, empa kapele mokuli o ile a hlokahala.

1870 - Klebs - setsebi sa thuto ea methapo sa Amerika se qalileng sehlopha sa pele sa pancreatitis e mpe, e ileng ea atleha hoo mesebetsing ea balateli ba eona ba bangata ba ileng ba ntlafatsa litlolo tse fapaneng feela.

1874 - Zenker o hlalositse "apoplexy" ea manyeme.

1881 - Tirsh le Kulenkampf ba buelletse draina ea ka ntle ea li-cysts tsa post-necrotic.

1882 - Ngaka e buoang ea Amerika Bozeman e atlehile ho tlosa cyst ea pancreatic e sebelisang cyst e kholo ea ovari.

1882 - Balser e ile ea etsa lithuto tsa morphological tsa mafura a necrosis ho pancreatitis e hlobaetsang.

1882 - Gussenbauer o tšoaea cystost pancreatic cyst mme a etsa cystostomy e tšoanang (marsupialization) ka lebaka la ho se khonehe ha phello ea eona ka lebaka la ho ba haufi le likepe tse kholo.

1886 - Miculicz e khothalelitsoe ho etsa marsupialization ho pancreatic necrosis le pancreatic abscess.

1886 - Ngaka e buoang ea Amerika Senn e khothalelitse kalafo ea kalafo, joalo ka Ke ne ke kholoa hore ts'ebetso ea ho buuoa e tla ama hantle sephetho sa lefu lena ka pancreatic necrosis kapa abscess.

1889 - Reginald Fitz, ngaka ea mafu a sepetlele sa Massachusetts, United States, o buile ka sehlopha sa pele, se neng se kenyelletsa mefuta e mehlano ea pancreatitis e mpe. O buelletse ts'ebetso ea bongaka ea tšohanyetso, eo a bileng a soetsehile ha a re "ho buuoa kapele ha ho na thuso ebile ho kotsi."

1890 - Tataiso ea pele ea kalafo ea kalafo ea mafu a pancreatic (Braun) e phatlalalitsoe.

1894 - Bothata ba pancreatitis e hlobaetsang bo ile ba qala ho tšohloa kopanong ea lingaka tse buoang Jeremane, moo Kerte a ileng a etsa tlhahiso ea maano a ts'ebetso ea bongaka ea tšohanyetso.

1895 - Monographic ea pele e mabapi le pathological anatomy ea maloetse a pancreatic (Diekhoff) e phatlalalitsoe.

1896 - Setsebi sa mafu a kelello sa Austria Chiari H. beha khopolo-taba mabapi le bohlokoa ba "ho itšeha" ho nts'etsopele ea "pancreatic necrosis" le "paripancreatic adipose" tiske.

1897 - Ngaka e buoang ea Russia, Martynov A.V. e sirelelitse dissertation ea pele ea Russia ka mafu a pancreatic. Ha a hlalosa bothata ba ho fumana pancreatitis e hlobaetsang, o ngotse: "Ha a lemoha pancreatitis e matla," phoso ke molao, ha tlhahlobo e nepahetseng ea lefutso e le eona e khethollang. " A. Martynov o bitsitse sethala sa ho ithuta mafu a pancreatic ho eena "ke nako ea ho tloaelana le methapo ea mafu".

1897 - Hale-White N.N. e phatlalalitse tlaleho e mabapi le prosecture ea sepetlele sa Guy's London, e kenyellelitseng tlhokomeliso ea mafu a fapaneng a manyeme le hoo e batlang e le mefuta eohle ea liphetoho tsa methapo ea methapo ea methapo le methapo ea setho sena.

1899 - Razumovsky o bontšitse hore, leha e le sephetho se bolaeang se emela pheletso e tloaelehileng ea pancreatic hemorrhage, "maemong a tsebahalang, ho fola hoa khoneha."

1900 - Bessel-Hagen tlhahiso ea metsi ea "canc" ea "pancreatic" ke "cystogastrostomy"

1901 - Opie E. L. le Halsted W. S. e bontšitse kamano ea etiopathogenetic lipakeng tsa cholelithiasis le hemorrhagic pancreatitis, e theha "the tloaelehileng Channel theory."

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Lisosa tsa pancreatitis

Maemong a 80%, mabaka a ho qala ha lefu lena a ka ts'ebeliso e mpe ea joala, lits'oaetso tsa gallbladder le ducts. Ho 45% ea linyeoe, ho hlokomeloa hore sebopeho sa ts'oaetso ea pancreatic se khothalletsoa ke choledocholithiasis, cholelithiasis, compression ea liteishene ka li-cysts le tumors, pathologies ea mala.

Lefu le leng le le leng le kopaneng le na le lisosa tsa kholo. Leha ho le joalo, kaofela li lebisa ho hlaha ha pancreatitis e hlobaetsang.

Lintho tse etellang pele ho pathogenesis ea pancreatitis ke: bothata ba ho tsoa ha enzyme ea pancreatic ka methapong. Ka hona, kalafo ea lefu lena le tlase e qala ka kalafo ea li-pathologies tsohle tse kopaneng.

Etiology ea pancreatitis e hlobaetsang e amana haholo le joala bo sa foleng. Maemong ana, mokhoa oa nts'etsopele ea lefu lena ke ho se sebetse hantle ha likhahla tsa sebete le boteng.

Lihlahisoa tsa joala li eketsa secretion, li etsa hore setloholo se bonahale se bonahala.Sena se eketsa khatello seteisheneng, se lebisang ho taheng makhophong, se sitisa mokhoa oa ho enzyme o ho lona mme se nyopisa tšebetso ea metabolic ka har'a sebete.

Lebaka le leng le tloaelehileng la pancreatitis le nkoa e le ntho e nang le phepo. Tabeng ena, ho ruruha ho hlaha ha motho a hlekefetsa lijo tsa nama, mafura le tse halikiloeng.

Hangata, pathophysiology ea pancreatitis e baka mabaka a mang a mangata:

1. tšoaetso ea vaerase (mumps, vaerase ea coxsackie, hepatitis),
2. genetic predisposition (cystic fibrosis),
3. baktheria (mycoplasma, campylobacter),
4. liso tsa ka mpeng,
5. ho lemala ha pancreatic
6. Litho tsa tlhaho tsa kholo ea kholo ea litho,
7. ho sebelisa meriana (li-estrogens, corticosteroids, diuretics, azathioprine),
8. khaello ea metabolic e bakiloeng ke ho ba teng hoa mafu a 'maloa (vasculitis, lefu la tsoekere, AIDS).

Pancreatitis e boetse e ba teng ka lebaka la ts'ebetso ea ts'ebetso ea ts'ebetso e sebelisitsoeng ho pathology ea manyeme le li-ducts tsa bile. Ho lemala ha setho ho ka etsahala nakong ea ho ruruha ho matla, endoscopy, prosthetics, papillotomy, le mefuta e meng ea ts'ebetso.

Postoperative pancreatitis ke motsoako oa kalafo ea ho buoa. E etsahala ka tšenyo e bakoang ke litšoelesa le botenya ba tsona.

Lisosa tse sa tloaelehang tsa ho ruruha ha pancreatic li kenyelletsa tlhaselo ea helminthic (ts'oaetso ea ascaris), hyperparathyroidism (parathyroid pathology) le chefo ea organophosphate.

Lintho tse ling tse sa bonahaleng bakeng sa ponahalo ea lefu lena li kenyelletsa ho longoa ke scorpion le ischemia ea letamo la mesenteric, le etsahalang nakong ea ho etsoa ha mesenteric artery thrombi.

Pathomorphogenesis

The patomorphogenesis ea pancreatitis e hlobaetsang e lula e thehiloe ho latela tatellano le / kapa phetoho e lumellanang lits'ebetsong tsa ho ruruha, necrobiosis, necrosis le ts'oaetso libakeng tse fapaneng tsa anatomical. Mefuta e fapaneng e kopantsoeng ea ho senya likarolo tsa motho ka mong tsa makhopho le / kapa li-tiske tse khutšoane li lula li bonoa: ho tloha ka li-interstitial edema kapa microscopically tse tsejoang tsa steatonecrosis ka manyeme (ka mokhoa o bobebe oa lefu lena) ho libaka tse tlalehiloeng tsa mafura le / kapa hemorrhagic pancreatic necrosis e nang le karolo ea ho khutlisetsa morao. , perinephral, ​​pelvic) sebaka le litho tsa ka mpeng.

Tlhaloso e nepahetseng ea liphetoho ho pancreatic necrosis e bohlokoa. Ho ipapisitse le boholo ba ts'ebetso ea necrotic ka har'a manyeme le sebaka sa ho khutlisa. tloaelehileng le limited mefuta ea pancreatic necrosis.

Ho ho ata ha pancreatic necrosis ho na le necrosis ea lefapha le fetang la e le 'ngoe la manyeme ka ho kenya letsoho ho tlatselletsang ts'ebetsong ea pathological ea parapancreatic fiber le libakeng tse ling tsa sebaka sa retroperitoneal (parietal, paranephral, ​​pelvis tse nyane).
Ho limited pancreatic necrosis ka har'a manyeme, tse nyane (ho fihla ho 1 cm) le / kapa tse kholo (> 1 cm) tsa necrosis li bonoa ka tšenyo kahare ho karolo e le ngoe ea manyeme le karolo e tsamaellanang ea fiber ea parapancreatic. Ho fapana le mofuta o tloaelehileng oa pancreatic necrosis, timetso ea necrotic le ho ruruha ha perifocal hangata e lekanyetsoa meeli ea sebaka sa parapancreatic.

Ho latela sebopeho se atileng sa li-enzyme tsa secretion tsa makhopho, pancreatic necrosis e hlahisa protheine (hemorrhagic necrosis) le lipolysis (mafura a necrosis) ea manyeme le mafura a khutlang. Ho ntlafatsoa ka nako e le 'ngoe ea mefuta ena ea necrotic process (motsoako oa pancreatic necrosis) ke tšobotsi.

Hemorrhagic Karolo ea pancreatic necrosis e na le lipontšo tse makatsang ka ho fetisisa. Ka manyeme le linama tse haufi le ona, ho fumanoa libaka tse ngata tsa hemorrhage, hemorrhagic impregnation, sebaka sa batho ba batsho le / kapa grey necrosis. Lesapo la ka mpeng le na le motsoako o mongata oa hemorrhagic o nang le ts'ebetso e phahameng ea li-enzyme le lintho tse nang le chefo.

Bakeng sa mafura Karolo ea pancreatic necrosis e tšoauoa ka keketseho ea boholo ba manyeme khahlanong le bokantle ba edema ea eona e bohale, ho nyamela ha sebopeho sa lobular la setho, libaka tse ngata tsa steatonecrosis le hemorrhage ka har'a li-pancreas le li-retentitoneal tishu, mesentery, ho e kholo le e nyane ho omentum, le tiskeng ea subcutaneous. Ka mpeng ea mpa, serous e tsoang pepeneneng e ka bonoa.

Bakeng sa pancreatitis ea necrotic, phetoho ea likarolo tsa necrobiosis le necrosis ea manyeme le fiber ea morao-rao e atolositsoeng ka nako le mefuta e fapaneng ea pathomorphology, e na le tšobotsi le tloaelo khafetsa.

Karolong ea pele ho ts'oaetso ea lefu lena, nts'etsopele ea mathata a ka morao ho necrotic ea etsahala. Ho potoloha le libaka tse sa sebetseng hantle tsa necrosis e fumanehang ka har'a manyeme le / kapa karolong efe kapa efe ea lithane tse khutlisetsang methapo, ho kenella kahare, sebopeho sa sona se kenyelletsa litho tse haufi (mpa, duodenum, omentum, spleen, sebete), mesentery ea mala a maholo le a manyane. Sebakeng sa makhopho a hlaha parapancreatic infiltratele libakeng tsa parietal le paranephral le lisele tsa pelvis, ho kenella ka hare ho litho tsa botšehali ho ntšetsa pele mohopolo oa necrosis le necrobiosis, e tsamaellanang le setšoantšo. necrotic (aseptic) phlegmon libaka tse tsamaellanang tsa cellular.

Karolo ea mafura ea necrosis tlasa maemo a aseptic ha e qhibilihe ebile ha se mohloli oa tahi e matla, empa hamorao (kamora ho kula ha libeke tse 3-4) e latelloa habonolo, e lebisang ho bopeng pseudocysts. Ho qala ho tloha bekeng ea bobeli ea lefu lena, phetoho e eketsehileng ea mafura a necrosis e tsamaisana le ho etsoa ha li-abscesses tse nyane tse nang le boima ba "detritus".

Ho fapana le karolo ea mafura ea necrosis, ntho e hemorrhagic e tsoelapele ka hemorrhagic impregnation ea retroperitoneal fiber e tšoauoa ka liketsahalo tsa ho qhibiliha ka potlako le nts'etsopele ea seo ho thoeng ke degenerative phlegmon, e lateloe ke tatellano e kholo (e kholo) le ho etsoa ha li-pseudocysts.

Mekhoa ea ntlafatso ea mefuta e meng ea pancreatitis

Karolelano ea pancreatitis e kenyelletsa mefuta e fapaneng ea maloetse. Li-pathogenesis tsa bona li ka fapana hanyane. Kahoo, mofuta oa mofuta o sa tloaelehang oa ho ruruha ha tšoelesa o hlaha ha mofuta oa calculi o le teng ka leqeleng le amehang la "inficory" (carbonic le phosphoric lime).

Ka ponahalo, ena ea morao e tšoana le majoe a manyane kapa lehlabathe le lesoeu. Mme liphetoho tsa pathological ka makhophong, moo likholumo li bokellanang, li bakoa ke ho ruruha le ho atoloha ha "duct" e pepileng.

Pathogenesis ea mofuta o tahang oa pancreatitis ke hore joala bo eketsa molumo oa sphincter oa Oddi. Sena se thibela ho phatlalla ha secocrine secretion mme se baka khatello ea mali maemong a manyane. Joala bo na le litlamorao tse ling tse 'maloa:

1. E khothaletsa ho kenella ha li-enzyme ka har'a gland, e tsosang li-enzymes tsa protheine le ho baka ho hlaka ha lisele tsa litho.
2. E eketsa secretion ea lero la gastric le hydrochloric acid, e eketsang secretion, e tsosetsang hypersecretion ea 'mele' meleng.

Pathogenesis ea biliary pancreatitis e amahanngoa le engress ea bile le lero la pancreatic. Tsamaiso e joalo e bakoa ke ha khatello e phahama kahara pampiri ea duodenum le biliary. Ho ipapisitsoe le sena, tlhaloso ea lefu lena e thehiloe e le ts'ebetso ea ho ruruha e sa foleng e bakiloeng ke tšenyo ea sebete le tsamaiso ea methapo.

Biliary pancreatitis e ka bakoa ke liphetoho tsa morphological tse hlahang ka har'a sphincter ea Oddi kapa duodenal papilla. Ts'ebetso ea Trypsin e phahamisa tlhahlobo ea 'mala oa parenchyma le ho icheketsa eona.

Ka mofuta oa biliary oa lefu lena, libaka tsohle tse amehang tsa boteng li na le lithane tse ngata. Ha ho se na kalafo e tlang ka nako, setho se khaotsa ho sebetsa.

Mofuta oa liphatsa tsa lefutso o hlaha ha liphatsa tsa lefutso li fetoloa, e leng se futsitsoeng. Ho hloleha ho etsahala ha ho nkela leino la amino acid sebaka.

Hape, pancreatitis ea lefutso e tsamaea le ho se sebetse hantle ha lisele ka har'a lisele. Ka lebaka leo, manyeme a qala ho monya metsoako ea hae.

Mokhoa o kulang oa ho ruruha ha letlalo oa pancreatic o bonahala haholo ho bakuli ba nang le lefu la sethoathoa sa Rhinitis, urticaria, kapa asthma ea bronchial. Mokhoa oa nts'etsopele ea mofuta ona oa lefu o ipapisitse le ho hlaha hoa karohano e tsoang ho mekhahlelo e meraro:

• Tsebiso ea 'mele,
• sebopeho sa li-antibodies ho pathogen,
• ho senyeha ha lisele tsa parenchymal gland.

Ntshetsopele ea mekhoa ea autoimmune e kenya letsoho linthong tse ngata le liphetoho. Ka hona, allergic pancreatitis e na le mokhoa o rarahaneng oa pathogeneis.

Matšoao le kalafo ea pancreatitis

Pancreatitis e bonolo ho tseba hore na e etsahala neng ka karolo ea methapo. Maemong ana, setšoantšo sa lefu lena le tsebahala haholo ka lefu lena.

Matšoao a etellang pele a ho ruruha ha pancreatic ke bohloko bo sa feleng bo amanang le epigastrium, hangata e chatsi ho hypochondrium e ka letsohong, eo ka eona mokuli a ka bang a akheha. Ho nyahama ho eketseha ha mokuli a robala kapa a ja lijo.

Ntle le bohloko, pancreatitis e tsamaisana le ho hlatsa, mocheso oa febrile, ho nyekeloa le pelo le 'mala o mosehla oa letlalo. Bakuli ba bang ba na le likhohola mokokotlong. Le ha ho le joalo bakuli ba tletleba ka letsoalo le otlang pelo.

Ho haella ha kalafo bakeng sa ho ruruha ho matla ha pancreatic ho tla lebisa ho nts'etsopele ea mathata a mangata a kotsi - lefu la tsoekere, syphilis ea ka mpeng, cystic fibrosis le vascular thrombosis. Ka hona, kalafo e lokela ho etsoa sepetlele tlas'a tlhokomelo ea lingaka.

Lipheo tsa mantlha tsa kalafo:

1. Ho felisoa ha matšoao a bohloko,
2. Ho tlosoa ha enzyme ea "pancreatic" e tsoang molapong oa mali,
3. Morero oa lijo tse khethehileng.

Motho oa sejoale-joale o hlokomoloha melao ea lijo tse phetseng hantle le tse leka-lekaneng, tse lebisang mathateng a ho ja. Ka hona, karolo ea bohlokoa ea kalafo ea pancreatitis ke ho netefatsa hore khutso ho setho se kulang ka ho itima lijo le lijo. Letsatsing la pele la ho kena sepetlele, mokuli a ke ke a ja letho, joale ba mo kenya ka lerotholi la tsoekere mme ke feela ka mor'a moo a fetohelang lijo tse bobebe.

Kaha ho ruruha ho matla ho tsamaisana le bohloko, hangata ho fanoa ka litlhare tse matla tsa analgesic. Hape, tharollo e khethehileng (Contrical, Trasilol) e fanoa ka methapo ho mokuli ho tlosa tahi ea 'mele ka enzyme ea pancreatic. Haeba ho hlokahala, ho lokisetsoa lithibela-mafu le litlhare.

Haeba ho se na ntlafatso ka mor'a beke ea kalafo ea lithethefatsi, laparotomy e etsoa. Nakong ea ts'ebetso, ngaka e buoang e tlosa likarolo tse shoeleng tsa setho sa parenchymal. Maemong a tšohanyetso, ka sebopeho sa li-pseudocysts (ho bokelloa ha lisele tse shoeleng, li-enzyme) ka manyeme, drainage e etsoa.

Tlhahisoleseling ka pancreatitis e matla e fanoa videong ena.