I. Kukonzekera kwa wodwala
1. Kumvetsetsa malo, mtundu, kukula ndi kubowoka kwa zinthu zakunja
Yesani X-ray kapena CT scans ya khosi, chifuwa, kutsogolo ndi mbali, kapena mimba ngati pakufunika kuti mumvetse komwe kuli, mtundu, mawonekedwe, kukula, ndi kupezeka kwa kubowoka kwa thupi lachilendo, koma musachite kafukufuku wa barium swallow.
2. Nthawi yosala kudya ndi nthawi yothira madzi
Kawirikawiri, odwala amasala kudya kwa maola 6 mpaka 8 kuti atulutse zonse zomwe zili m'mimba, ndipo nthawi yosala kudya ndi kumwa madzi imatha kuchepetsedwa bwino kuti ayesedwe gastroscopy yadzidzidzi.
3. Chithandizo cha mankhwala oletsa ululu
Ana, omwe ali ndi matenda amisala, omwe sagwirizana ndi dokotala, kapena omwe ali ndi matupi akunja omwe ali m'ndende, matupi akuluakulu akunja, matupi ambiri akunja, matupi akuthwa akunja, kapena opaleshoni ya endoscopic yomwe ndi yovuta kapena imatenga nthawi yayitali ayenera kuchitidwa opaleshoni pogwiritsa ntchito mankhwala oletsa ululu kapena opaleshoni ya endotracheal mothandizidwa ndi dokotala wogonetsa. Chotsani zinthu zakunja.
II. Kukonzekera zida
1. Kusankha Endoscope
Mitundu yonse ya gastroscopy yowonera kutsogolo ikupezeka. Ngati zikuoneka kuti n'zovuta kuchotsa thupi lachilendo kapena thupi lachilendo ndi lalikulu, gastroscopy yochitidwa opaleshoni yokhala ndi madoko awiri imagwiritsidwa ntchito. Ma endoscope okhala ndi mainchesi ang'onoang'ono akunja angagwiritsidwe ntchito kwa makanda ndi ana aang'ono.
2. Kusankha ma forceps
Makamaka zimadalira kukula ndi mawonekedwe a thupi lachilendo. Zida zomwe zimagwiritsidwa ntchito kwambiri ndi monga biopsy forceps, snare, three-jaw forceps, flat forceps, foreps body forceps (makoswe ndi mano, jaw-mouth forceps), stone dengu, stone removal bag, stone removing bag, etc.
Kusankha chida kungadziwike kutengera kukula, mawonekedwe, mtundu, ndi zina zotero za thupi lachilendo. Malinga ndi malipoti a mabuku, mphamvu za mano a makoswe ndi zomwe zimagwiritsidwa ntchito kwambiri. Kuchuluka kwa mphamvu za mano a makoswe ndi 24.0% ~ 46.6% ya zida zonse zomwe zimagwiritsidwa ntchito, ndipo misampha imakhala 4.0% ~ 23.6%. Kawirikawiri amakhulupirira kuti misampha ndi yabwino kwa matupi achilendo ataliatali okhala ndi mawonekedwe a ndodo. Monga ma thermometer, maburashi a mano, ndodo zophikira nsungwi, mapeni, supuni, ndi zina zotero, ndipo malo a kumapeto ophimbidwa ndi misampha sayenera kupitirira 1cm, apo ayi zidzakhala zovuta kutuluka mu cardia.
2.1 Matupi akunja okhala ngati ndodo ndi matupi akunja ozungulira
Pa zinthu zakunja zooneka ngati ndodo zomwe zili ndi malo osalala komanso opapatiza akunja monga zotsukira mano, ndi bwino kusankha zotsukira zokhala ndi milomo itatu, zotsukira mano ngati makoswe, zotsukira zathyathyathya, ndi zina zotero; pa zinthu zakunja zozungulira (monga ma cores, mipira yagalasi, mabatire a mabatani, ndi zina zotero), gwiritsani ntchito dengu lochotsera miyala kapena thumba la ukonde lochotsera miyala kuti muchotse. N'zovuta kuzichotsa.
2.2 Matupi aatali akuthwa achilendo, machubu a chakudya, ndi miyala ikuluikulu m'mimba
Pa matupi achilendo akuthwa kwambiri, mzere wautali wa thupi lachilendo uyenera kufanana ndi mzere wautali wa lumen, ndipo mbali yakuthwa kapena mbali yotseguka ikuyang'ana pansi, ndikutuluka pamene mukulowetsa mpweya. Pa matupi achilendo okhala ndi mawonekedwe ozungulira kapena matupi achilendo okhala ndi mabowo, ndibwino kugwiritsa ntchito njira yolumikizira ulusi kuti muwachotse;
Pa machubu a chakudya ndi miyala ikuluikulu m'mimba, ma forceps oluma angagwiritsidwe ntchito kuwaphwanya kenako n’kuchotsedwa ndi ma forceps a milomo itatu kapena msampha.
3. Zipangizo zodzitetezera
Gwiritsani ntchito zipangizo zodzitetezera momwe mungathere pazinthu zakunja zomwe zimakhala zovuta kuchotsa komanso zoopsa. Pakadali pano, zipangizo zodzitetezera zomwe zimagwiritsidwa ntchito kwambiri zimaphatikizapo zipewa zowonekera, machubu akunja, ndi zophimba zoteteza.
3.1 Chipewa chowonekera bwino
Pa ntchito yochotsa thupi lachilendo, chipewa chowonekera bwino chiyenera kugwiritsidwa ntchito kumapeto kwa lenzi ya endoscopic momwe mungathere kuti mucosa isakandane ndi thupi lachilendo, ndikukulitsa m'mero kuti muchepetse kukana komwe kumachitika thupi lachilendo likachotsedwa. Zingathandizenso kutseka ndikutulutsa thupi lachilendo, zomwe zimathandiza kuchotsa thupi lachilendo.
Pa matupi achilendo okhala ndi mawonekedwe a mizere omwe ali mu mucosa kumapeto onse a m'mero, chivundikiro chowonekera chingagwiritsidwe ntchito kukankhira pang'onopang'ono mucosa wa m'mero kuzungulira mbali imodzi ya thupi lachilendo kotero kuti mbali imodzi ya thupi lachilendo ituluke pakhoma la mucosal wa m'mero kuti ipewe kubowoka kwa m'mero komwe kumachitika chifukwa chochotsedwa mwachindunji.
Chipewa chowonekera bwino chingaperekenso malo okwanira ogwiritsira ntchito chidachi, chomwe ndi chosavuta kuzindikira ndi kuchotsa matupi akunja mu gawo laling'ono la khosi la m'mero.
Nthawi yomweyo, chivundikiro chowonekera bwino chingagwiritse ntchito mphamvu yoyamwa chakudya kuti chithandize kuyamwa machubu a chakudya ndikuthandizira kukonza chakudya pambuyo pake.
3.2 Chikwama chakunja
Ngakhale kuti imateteza m'mero ndi mucosa wa m'mimba, chubu chakunja chimathandiza kuchotsa matupi akutali, akuthwa, komanso ambiri akunja ndi kuchotsa machubu a chakudya, motero kuchepetsa kuchuluka kwa mavuto omwe angabwere chifukwa chochotsa matupi akunja a m'mimba. Kuonjezera chitetezo ndi mphamvu ya chithandizo.
Machubu owonjezera sagwiritsidwa ntchito kawirikawiri kwa ana chifukwa cha chiopsezo chowononga mmero poika.
3.3 Chivundikiro choteteza
Ikani chivundikiro choteteza pansi kutsogolo kwa endoscope. Mukamaliza kukanikiza chinthu chachilendo, tembenuzani chivundikirocho ndikuchikulunga ndi chinthu chachilendo mukachotsa endoscope kuti mupewe zinthu zachilendo.
Imakhudzana ndi nembanemba ya m'mimba ndipo imagwira ntchito yoteteza.
4. Njira zochiritsira mitundu yosiyanasiyana ya matupi achilendo m'mimba yapamwamba
4.1 Unyinji wa chakudya m'mimba
Malipoti akusonyeza kuti chakudya chaching'ono kwambiri m'mimba chimatha kukankhidwira pang'onopang'ono m'mimba ndikusiyidwa kuti chitulutsidwe mwachibadwa, zomwe zimakhala zosavuta, zosavuta komanso sizingayambitse mavuto. Panthawi yopititsa patsogolo gastroscopy, kutsika kwa mpweya koyenera kumatha kulowetsedwa mu lumen ya m'mero, koma odwala ena akhoza kukhala ndi zotupa zoyipa za m'mero kapena stenosis ya post-esophageal anastomotic (Chithunzi 1). Ngati pali kukana ndipo mukukankha mwamphamvu, kukanikiza kwambiri kudzawonjezera chiopsezo cha kubowoka. Ndikoyenera kugwiritsa ntchito dengu lochotsera miyala kapena thumba lochotsera miyala kuti muchotse mwachindunji thupi lachilendo. Ngati bolus ya chakudya ndi yayikulu, mutha kugwiritsa ntchito forceps ya thupi lachilendo, snares, ndi zina zotero kuti muiphwanye musanaigawe. Tulutsani.
Chithunzi 1 Pambuyo pa opaleshoni ya khansa ya m'mero, wodwalayo anatsagana ndi stenosis ya m'mero ndi kusungidwa kwa chakudya.
4.2 Zinthu zakunja zazifupi komanso zosamveka bwino
Matupi ambiri afupiafupi komanso osawoneka bwino achilendo amatha kuchotsedwa kudzera m'ma forceps a thupi lachilendo, misampha, madengu ochotsera miyala, matumba okoka ochotsera miyala, ndi zina zotero. (Chithunzi 2). Ngati thupi lachilendo lomwe lili m'mero ndi lovuta kulichotsa mwachindunji, likhoza kukankhidwira m'mimba kuti lisinthe malo ake kenako n'kuyesera kulichotsa. Matupi afupiafupi komanso osawoneka bwino achilendo okhala ndi mainchesi oposa 2.5 m'mimba ndi ovuta kwambiri kudutsa mu pylorus, ndipo endoscopic intervention iyenera kuchitidwa mwachangu momwe zingathere; ngati matupi achilendo omwe ali ndi mainchesi ang'onoang'ono m'mimba kapena duodenum sakuwonetsa kuwonongeka kwa m'mimba, amatha kudikira kutuluka kwawo kwachilengedwe. Ngati likhalabe kwa milungu yoposa 3-4 ndipo silingathe kutulutsidwabe, liyenera kuchotsedwa ndi endoscopic.
Chithunzi 2 Zinthu zakunja zapulasitiki ndi njira zochotsera
4.3 Mabungwe akunja
Zinthu zakunja zokhala ndi kutalika kwa ≥6 cm (monga ma thermometer, ma burashi a mano, ndodo za nsungwi, mapeni, masipuni, ndi zina zotero) sizophweka kuzitulutsa mwachilengedwe, choncho nthawi zambiri zimasonkhanitsidwa ndi msampha kapena mtanga wamiyala.
Msampha ungagwiritsidwe ntchito kuphimba mbali imodzi (osapitirira 1 cm kuchokera kumapeto), ndikuyikidwa mu chivundikiro chowonekera kuti chitulutsidwe. Chipangizo chakunja cha cannula chingagwiritsidwenso ntchito kugwira thupi lachilendo kenako nkubwerera bwino mu cannula yakunja kuti asawononge mucosa.
4.4 Zinthu zakuthwa zachilendo
Zinthu zakuthwa zakunja monga mafupa a nsomba, mafupa a nkhuku, mano opangidwa ndi mano, ma date hole, zotsukira mano, mapepala odulidwa, ma leza, ndi zophimba mabokosi a piritsi (Chithunzi 3) ziyenera kusamalidwa mokwanira. Zinthu zakuthwa zakunja zomwe zingawononge mosavuta nembanemba ya mucous ndi mitsempha yamagazi ndikuyambitsa mavuto monga kubowoka ziyenera kuthandizidwa mosamala. Kuyang'anira endoscopic mwadzidzidzi.
Chithunzi 3 Mitundu yosiyanasiyana ya zinthu zakuthwa zachilendo
Mukachotsa matupi akuthwa akunja pansi pa mapetoPogwiritsa ntchito scope, n'zosavuta kukanda mucosa wa m'mimba. Ndikofunikira kugwiritsa ntchito chipewa chowonekera bwino, chomwe chingawonetse bwino lumen ndikupewa kukanda khoma. Yesetsani kubweretsa mbali yosalala ya thupi lachilendo pafupi ndi mapeto a lenzi ya endoscopic kuti mbali imodzi ya thupi lachilendo iikidwe. Ikani mu chipewa chowonekera bwino, gwiritsani ntchito forceps ya thupi lachilendo kapena msampha kuti mugwire thupi lachilendo, kenako yesani kusunga mzere wautali wa thupi lachilendo likugwirizana ndi m'mero musanachoke pa scope. Matupi achilendo omwe ali mbali imodzi ya m'mero akhoza kuchotsedwa poika chipewa chowonekera kutsogolo kwa endoscope ndikulowa pang'onopang'ono mumtsempha wolowera. Kwa matupi achilendo omwe ali m'mimba mwa m'mero kumapeto onse awiri, mbali yocheperako yolumikizidwa iyenera kumasulidwa kaye, nthawi zambiri kumbali yapafupi, tulutsani mbali inayo, sinthani komwe chinthu chachilendo chikupita kuti mbali ya mutu iphatikizidwe mu chipewa chowonekera, ndikuchitulutsa. Kapena titagwiritsa ntchito mpeni wa laser kudula thupi lachilendo pakati, zomwe timakumana nazo ndi kumasula kaye mtsempha wa aorta kapena mbali ya mtima, kenako nkuchotsa pang'onopang'ono.
a. Mano obisika: Mukamadya, mukutsokomola, kapena mukulankhulag, odwala akhoza kugwa mwangozi kuchokera ku mano awo obisika, kenako n’kulowa m’mimba chapamwamba akamameza. Mano obisika akuthwa okhala ndi zingwe zachitsulo kumapeto onse awiri ndi osavuta kuwaika m’makoma a matumbo, zomwe zimapangitsa kuti kuchotsa kukhale kovuta. Kwa odwala omwe alephera chithandizo cha endoscopic, zida zingapo zomangira zingagwiritsidwe ntchito kuyesa kuchotsa pogwiritsa ntchito endoscopy ya njira ziwiri.
b. Mabowo a madeti: Mabowo a madeti omwe ali mummero nthawi zambiri amakhala akuthwa mbali zonse ziwiri, zomwe zingayambitse mavuto monga kuwonongeka kwa mucosale, kutuluka magazi, matenda am'deralo otupa ndi kubowoka kwakanthawi kochepa, ndipo ayenera kuchiritsidwa ndi chithandizo chadzidzidzi cha endoscopic (Chithunzi 4). Ngati palibe kuvulala kwa m'mimba, miyala yambiri ya date m'mimba kapena duodenum imatha kutulutsidwa mkati mwa maola 48. Omwe sangathe kutulutsidwa mwachilengedwe ayenera kuchotsedwa mwachangu momwe angathere.
Chithunzi 4 Chimake cha Jujube
Patatha masiku anayi, wodwalayo anapezeka ndi thupi lachilendo kuchipatala china. CT inasonyeza thupi lachilendo m'mero lomwe linali ndi mabowo. Mitsempha yakuthwa ya jujube kumapeto onse awiri inachotsedwa pogwiritsa ntchito endoscopy ndipo gastroscopy inachitidwanso. Zinapezeka kuti fistula inapangidwa pakhoma la mmero.
4.5 Zinthu zazikulu zakunja zokhala ndi m'mbali zazitali komanso m'mbali zakuthwa (Chithunzi 5)
a. Ikani chubu chakunja pansi pa endoscope: Ikani gastroscope kuchokera pakati pa chubu chakunja, kuti m'mphepete mwa chubu chakunja mukhale pafupi ndi m'mphepete mwa pamwamba pa gawo lopindika la gastroscope. Ikani gastroscope nthawi zonse pafupi ndi thupi lachilendo. Ikani zida zoyenera kudzera mu chubu cha biopsy, monga misampha, zida zogwiritsira ntchito thupi lachilendo, ndi zina zotero. Mukagwira chinthu chachilendo, chiyikeni mu chubu chakunja, ndipo chipangizo chonsecho chidzatuluka limodzi ndi galasi.
b. Chophimba cha mucous membrane chopangidwa kunyumba: Gwiritsani ntchito chivundikiro cha chala chachikulu cha magolovesi a rabara achipatala kuti mupange chivundikiro choteteza cha endoscope chopangidwa kunyumba. Chiduleni motsatira mzere wa chala chachikulu cha glove kukhala ngati lipenga. Dulani dzenje laling'ono pa chala, ndikudutsa mbali yakutsogolo ya thupi lagalasi kudzera mu dzenje laling'ono. Gwiritsani ntchito mphete yaying'ono ya rabara kuti muikonze pa 1.0cm kuchokera kumapeto akutsogolo kwa gastroscope, muyibwezeretse kumapeto akumtunda kwa gastroscope, ndikuitumiza pamodzi ndi gastroscope ku thupi lachilendo. Gwirani thupi lachilendo kenako muchotse pamodzi ndi gastroscope. Chovala choteteza chidzapita ku thupi lachilendo chifukwa cha kukana. Ngati njirayo yasinthidwa, idzazunguliridwa ndi zinthu zakunja kuti mutetezedwe.
Chithunzi 5: Mafupa akuthwa a nsomba adachotsedwa kudzera mu endoscopic, ndi mikwingwirima ya mucous
4.6 Zinthu zakunja zachitsulo
Kuwonjezera pa ma forceps achikhalidwe, matupi achilendo achitsulo amatha kuchotsedwa poyamwa ndi ma forceps a thupi lachilendo la magnetic. Matupi achilendo achitsulo omwe ndi oopsa kwambiri kapena ovuta kuchotsa amatha kuchiritsidwa ndi endoscopic pogwiritsa ntchito X-ray fluoroscopy. Ndikofunikira kugwiritsa ntchito dengu lochotsera miyala kapena thumba la ukonde lochotsera miyala.
Ndalama zachitsulo zimapezeka kwambiri pakati pa matupi achilendo m'mimba mwa ana (Chithunzi 6). Ngakhale kuti ndalama zambiri m'mero zimatha kuperekedwa mwachibadwa, chithandizo chosankhidwa cha endoscopic chimalimbikitsidwa. Chifukwa ana sagwirizana kwenikweni, kuchotsa matupi achilendo m'mimba mwa ana kumachitika bwino pogwiritsa ntchito mankhwala oletsa ululu. Ngati ndalamazo ndi zovuta kuzichotsa, zitha kukankhidwira m'mimba kenako nkuchotsedwa. Ngati palibe zizindikiro m'mimba, mutha kudikira kuti zitulutsidwe mwachibadwa. Ngati ndalamazo zikukhalabe kwa milungu yoposa 3-4 ndipo sizikutuluka, ziyenera kuthandizidwa ndi endoscopic.
Chithunzi 6 Ndalama yachitsulo yakunja
4.7 Zinthu zakunja zomwe zimawononga
Mabatire akunja omwe amawononga amatha kuwononga kugaya chakudya mosavuta kapena kuwononga ziwalo zina. Chithandizo chadzidzidzi cha endoscopic chimafunika mutazindikira matendawa. Mabatire ndi omwe amawononga kwambiri ziwalo zina ndipo nthawi zambiri amapezeka mwa ana osakwana zaka 5 (Chithunzi 7). Akawononga m'mero, angayambitse stenosis ya m'mero. Endoscopy iyenera kuunikidwanso mkati mwa milungu ingapo. Ngati stricture yachitika, m'mero muyenera kukulitsa msanga momwe mungathere.
Chithunzi 7 Chinthu chachilendo mu batire, muvi wofiira umasonyeza komwe chinthu chachilendo chili
4.8 Zinthu zakunja zamaginito
Pamene matupi ambiri akunja a maginito kapena matupi akunja a maginito ophatikizidwa ndi chitsulo amapezeka m'mimba, zinthuzo zimakokana ndikukanikiza makoma a matumbo, zomwe zingayambitse ischemic necrosis, kupangika kwa fistula, kubowoka, kutsekeka, peritonitis ndi kuvulala kwina kwakukulu kwa m'mimba. , zomwe zimafuna chithandizo chadzidzidzi cha endoscopic. Zinthu zakunja za maginito ziyeneranso kuchotsedwa mwachangu momwe zingathere. Kuwonjezera pa forceps yachizolowezi, matupi akunja a maginito amatha kuchotsedwa pansi pa kuyamwa ndi forceps ya thupi lakunja la maginito.
4.9 Matupi achilendo m'mimba
Ambiri mwa iwo ndi zoyatsira, mawaya achitsulo, misomali, ndi zina zotero zomwe zimamezedwa dala ndi akaidi. Matupi ambiri achilendo ndi aatali komanso akuluakulu, ovuta kudutsa mu cardia, ndipo amatha kukanda mosavuta mucous nembanemba. Ndikoyenera kugwiritsa ntchito makondomu pamodzi ndi forceps za mano a makoswe kuti muchotse matupi achilendo powayang'ana endoscopic. Choyamba, ikani forceps za mano a makoswe kutsogolo kwa endoscope kudzera mu dzenje la biopsy la endoscopic. Gwiritsani ntchito forceps za mano a makoswe kuti mutseke mphete ya rabara pansi pa kondomu. Kenako, bweretsani forceps za mano a makoswe ku dzenje la biopsy kuti kutalika kwa kondomu kuwonekere kunja kwa dzenje la biopsy. Chepetsani momwe mungathere popanda kukhudza malo owonera, kenako ikani m'mimba pamodzi ndi endoscope. Mukapeza thupi lachilendo, ikani thupi lachilendo mu kondomu. Ngati kuli kovuta kuchotsa, ikani kondomu m'mimba, ndipo gwiritsani ntchito forceps za mano a makoswe kuti mutseke thupi lachilendo ndikuliyika. Mkati mwa kondomu, gwiritsani ntchito zopukutira za mano a makoswe kuti mutseke kondomu ndikuyitulutsa pamodzi ndi galasi.
4.10 Miyala ya m'mimba
Ma gastrolith amagawidwa m'magulu awiri: ma gastrolith a masamba, ma gastrolith a nyama, ma gastrolith opangidwa ndi mankhwala ndi ma gastrolith osakaniza. Ma gastrolith a zomera ndi omwe amapezeka kwambiri, makamaka chifukwa chodya ma persimmons ambiri, hawthorns, ma date a nyengo yozizira, mapichesi, udzu winawake, kelp, ndi kokonati pamimba yopanda kanthu. Amayambitsidwa ndi zina zotero. Ma gastrolith ochokera ku zomera monga ma persimmons, ma hawthorns, ndi ma jujubes ali ndi tannic acid, pectin, ndi chingamu. Pogwiritsa ntchito asidi wa m'mimba, puloteni ya tannic acid yosasungunuka m'madzi imapangidwa, yomwe imagwirizana ndi pectin, chingamu, ulusi wa zomera, peel, ndi pakati. Miyala ya m'mimba.
Miyala ya m'mimba imakakamiza khoma la m'mimba ndipo imalimbikitsa kutulutsa asidi wambiri m'mimba, zomwe zingayambitse kuwonongeka kwa mucosal ya m'mimba, zilonda komanso kubowoka. Miyala yaying'ono, yofewa ya m'mimba imatha kusungunuka ndi sodium bicarbonate ndi mankhwala ena kenako nkuloledwa kuti itulutsidwe mwachilengedwe.
Kwa odwala omwe alephera kulandira chithandizo chamankhwala, kuchotsa miyala ya endoscopic ndiye chisankho choyamba (Chithunzi 8). Pa miyala ya m'mimba yomwe ndi yovuta kuchotsa mwachindunji pogwiritsa ntchito endoscopy chifukwa cha kukula kwake kwakukulu, zida zakunja za thupi, misampha, mabasiketi ochotsera miyala, ndi zina zotero zingagwiritsidwe ntchito kuphwanya miyalayo mwachindunji kenako n’kuichotsa; kwa iwo omwe ali ndi kapangidwe kolimba komwe sikungaphwanyidwe, kudula miyala ya endoscopic kungaganizidwe, laser lithotripsy kapena high-frequency electric lithotripsy chithandizo, pamene mwala wa m'mimba uli wochepera 2cm mutasweka, gwiritsani ntchito zida za three-claw forceps kapena zida zakunja za thupi kuti muchotse momwe mungathere. Samalani kuti miyala yoposa 2cm isatuluke m'matumbo kudzera m'mimba ndikupangitsa kuti matumbo atseke.
Chithunzi 8 Miyala m'mimba
4.11 Chikwama cha Mankhwala
Kuphulika kwa thumba la mankhwala kumabweretsa chiopsezo chachikulu ndipo ndi vuto loletsa kulandira chithandizo cha endoscopic. Odwala omwe sangathe kutulutsa madzi mwachibadwa kapena omwe akuganiziridwa kuti ali ndi thumba la mankhwala ayenera kuchitidwa opaleshoni mwachangu.
III. Mavuto ndi chithandizo
Mavuto a thupi lachilendo akugwirizana ndi mtundu, mawonekedwe, nthawi yomwe dokotala amakhala komanso kuchuluka kwa opaleshoni. Mavuto akuluakulu ndi monga kuvulala kwa mucosal ya m'mero, kutuluka magazi, ndi matenda obowoka.
Ngati thupi lachilendo ndi laling'ono ndipo palibe kuwonongeka kwa mucosal komwe kumawonekera potuluka, sikofunikira kuti munthu agoneke kuchipatala pambuyo pa opaleshoni, ndipo munthu ayenera kudya zakudya zofewa akasala kudya kwa maola 6.Kwa odwala omwe ali ndi vuto la m'mimba, glutamine granules, aluminium phosphate gel ndi zinthu zina zoteteza mucosal zitha kupatsidwa chithandizo cha zizindikiro. Ngati pakufunika kutero, kusala kudya ndi zakudya zina zopatsa thanzi zitha kuperekedwa.
Kwa odwala omwe ali ndi vuto la mucosa komanso kutuluka magaziChithandizochi chingachitike pogwiritsa ntchito njira yowunikira mwachindunji, monga kupopera mankhwala ozizira a norepinephrine ndi saline, kapena endoscopic titanium clips kuti mutseke bala.
Kwa odwala omwe CT yawo isanachitidwe opaleshoni ikusonyeza kuti thupi lachilendo lalowa mu khoma la m'mero pambuyo pochotsa endoscopicNgati thupi lachilendo likhalapo kwa maola osakwana 24 ndipo CT isapeze thumba lopangidwa kunja kwa lumen ya m'mero, chithandizo cha endoscopic chingachitike mwachindunji. Pambuyo poti thupi lachilendo lachotsedwa kudzera mu endoscope, titaniyamu imagwiritsidwa ntchito kutseka khoma lamkati la m'mero pamalo obowoka, zomwe zimatha kuletsa kutuluka magazi ndikutseka khoma lamkati la m'mero nthawi yomweyo. Chubu cha m'mimba ndi chubu chodyetsera jejunal zimayikidwa pansi pa endoscope yowona mwachindunji, ndipo wodwalayo amagonekedwa m'chipatala kuti apitirize kulandira chithandizo. Chithandizo chimaphatikizapo chithandizo cha zizindikiro monga kusala kudya, kuchepetsa m'mimba, maantibayotiki ndi zakudya. Nthawi yomweyo, zizindikiro zofunika monga kutentha kwa thupi ziyenera kuwonedwa mosamala, ndipo kuchitika kwa zovuta monga khosi subcutaneous emphysema kapena mediastinal emphysema kuyenera kuwonedwa tsiku lachitatu pambuyo pa opaleshoni. Pambuyo poti ayodini water angiography ikuwonetsa kuti palibe kutuluka kwa madzi, kudya ndi kumwa kungaloledwe.
Ngati thupi lachilendo lasungidwa kwa maola opitilira 24, ngati zizindikiro za matenda monga malungo, kuzizira, ndi kuchuluka kwakukulu kwa maselo oyera m'magazi zichitika, ngati CT ikuwonetsa kupangika kwa thumba lakunja kwa m'mero, kapena ngati pakhala mavuto akulu, odwala ayenera kusamutsidwira ku opaleshoni kuti akalandire chithandizo mwachangu.
IV. Zodzitetezera
(1) Thupi lachilendo likamakhala nthawi yayitali mu mmero, opaleshoniyo imakhala yovuta kwambiri ndipo mavuto ambiri adzachitika. Chifukwa chake, kuchitidwa opaleshoni yadzidzidzi ya endoscopic ndikofunikira kwambiri.
(2) Ngati thupi lachilendo ndi lalikulu, losakhazikika kapena lili ndi mikwingwirima, makamaka ngati thupi lachilendo lili pakati pa mmero ndipo lili pafupi ndi mtsempha wa aorta, ndipo n'kovuta kulichotsa pogwiritsa ntchito endoscopic, musalichotse mwamphamvu. Ndi bwino kufunsa upangiri wa akatswiri osiyanasiyana komanso kukonzekera opaleshoni.
(3) Kugwiritsa ntchito bwino zida zotetezera m'mero kungachepetse mavuto omwe angabwere chifukwa cha kugwiritsa ntchito molakwika zida zodzitetezera ku mkodzo.
Zathuzida zogwirira zotayidwaimagwiritsidwa ntchito limodzi ndi ma endoscope ofewa, kulowa m'mimba mwa munthu monga njira yopumira, m'mero, m'mimba, m'matumbo ndi zina zotero kudzera mu endoscope, kuti igwire minofu, miyala ndi zinthu zakunja komanso kuchotsa ma stent.
Nthawi yotumizira: Januwale-26-2024