Kukonzekera Kwa I.Petiece
1. Mumvetsetse malowo, chilengedwe, kukula ndi kapangidwe ka zinthu zakunja
Chitani za X-ray kapena ct scan ya khosi, pachifuwa, anteropterokonga komanso ofanana ndi kumvetsetsa komwe kuli thupi lachilendo, koma osayesedwa ndi barium sment.
2. Kusala kudya ndi nthawi yofulumira
Mosakhalitsa, odwala amasala kudya kwa maola 6 mpaka 8 kuti achotse zam'mimba, ndipo nthawi yosatha komanso nthawi yosatha imatha kupumula moyenerera chifukwa cha matenda a gastrascopy.
3. Thandizo la Alernesua
Ana, omwe ali ndi matenda amisala, omwe sakhala osagwirizana, kapena omwe ali ndi matupi akuluakulu akunja, matupi akuluakulu, matupi owopsa ayenera kugwira ntchito mothandizidwa ndi dokotala wa mankhwala osokoneza bongo. Chotsani zinthu zakunja.
Ii. Kukonzekela kwa Chida
1. Kusankha kwa Indoscope
Mitundu yonse ya gastroscops yoyang'ana. Ngati zikuyerekezeredwa kuti ndizovuta kuchotsa thupi lachilendo kapena thupi lakunja ndi lalikulu, dokotala wopaleshoni gastroscopy amagwiritsidwa ntchito. Ma endoscopes okhala ndi mainchesi ocheperako omwe angagwiritsidwe ntchito kwa makanda ndi ana aang'ono.
2. Kusankhidwa kwa mphamvu
Makamaka zimatengera kukula ndi mawonekedwe a thupi lachilendo. Zida zomwe anthu ambiri amagwiritsa ntchito zimaphatikizapo mphamvu za biopsy, misasa, mapangidwe a nsagwada zitatu, thupi lakunja, mano am'mimba, kuchotsa miyala, kuchotsa miyala, kuchotsa miyala yamiyala, etc.
Kusankha kwa chida kumatha kutsimikizika molingana ndi kukula kwake, mawonekedwe, mtundu, etc. wa thupi lakunja. Malinga ndi malipoti, mapangidwe a mano a khomo ndi omwe amagwiritsidwa ntchito kwambiri. Kuchuluka kwa ma cell-mano am'madzi ndi 24.0% ~ 46.6% ya zida zonse zogwiritsidwa ntchito, komanso akaunti ya Snores ya 4.0% ~ 23.6%. Nthawi zambiri amakhulupirira kuti misampha ndiyabwino kwa matupi ooneka ngati achilendo. Monga ma thermometers, nsidze, zodula za bamboo, zolembera, ma spoons, ndi malekezero okutidwa ndi msampha sayenera kupitirira 1cm, sizingakhale zovuta kutuluka mwaluso.
2.1 matupi owoneka ngati achilendo komanso matupi owoneka bwino
Chifukwa cha zinthu zakunja zowoneka bwino ndi mawonekedwe osalala ndi mainchesi yopyapyala monga mano onga mano, ma place-mano, ndi zina.; Kwa zinthu zakunja (monga ma cores, mipira yamagalasi, mabatire atchera, etc.), gwiritsani ntchito mtanga wochotsa miyala kuti awachotsere zovuta.
2.2 Matupi Achilendo Achinyamata Achinyamata Achinyamata, Zowonongeka Zakudya, ndi miyala yayikulu m'mimba
Kwa matupi ang'ono akulu achilendo, a nkhwangwa yayitali ya thupi lachilendo liyenera kukhala lofanana ndi ma axi atatalika, omwe ali ndi mathero akuthwa kapena mathero otseguka pofikira pansi, ndikuchotsa jekeseni. Kwa matupi owoneka ngati mphete kapena matupi achilendo okhala ndi mabowo, ndizotetezeka kugwiritsa ntchito njira yopindika kuti ichotse;
Pazakudya ndi miyala yayikulu m'mimba, kuluma mphamvu kumatha kuwaphwanya kenako nkuchotsedwa ndi ma forteps atatu kapena msampha.
3. Zida zoteteza
Gwiritsani ntchito zida zoteteza moyenera kwambiri kwa zinthu zakunja zomwe ndizovuta kuchotsa ndipo ndizowopsa. Pakadali pano, zida zoteteza zomwe zimagwiritsidwa ntchito nthawi zambiri zimaphatikizapo zipewa zowonekera, machubu akunja, ndi zophimba.
3.1 Transparent kapu
Kupita kwa thupi lakunja, kapu yowonekera iyenera kugwiritsidwa ntchito kumapeto kwa mandala a endoscopic momwe mungathere kuti mucosa kuti usawononge matenda akunja, ndikuwonjezera esophagus kuti achepetse thupi lachilendo pomwe thupi lakunja lichotsedwa. Itha kuthandizanso kuwongolera ndikuchotsa thupi lakunja, lomwe limapindulitsa pakuchotsa thupi lakunja. Chotsani.
Kuti matupi owoneka bwino ophatikizidwa mu mucosa kumapeto kwa esophagus, chipewa chowonekera chikhoza kugwiritsidwa ntchito modekha mucosa wa esophageal mucosal mucosal mucosal chowonjezera.
Chipewa chowonekera chimathanso kupereka malo okwanira kugwira ntchito ya chida, chomwe chimakhala chosavuta kuzindikirika ndikuchotsa matupi akunja mu gawo lopapatiza la Esophageal.
Nthawi yomweyo, chipewa chowonekera chimatha kugwiritsa ntchito kutembenuka movutikira kuthandizira kuyamwa chakudya ndikuwongolera njira yotsatirira.
3.2
Ndikuteteza esophogus ndi esophageal-gestric inniction mucosa, chubu chakunja chakuthwa chimathandizira kuchotsedwa kwa endoscopic. Onjezerani chitetezo komanso mphamvu ya chithandizo.
Zovuta sizimagwiritsidwa ntchito kwambiri mwa ana chifukwa chowopsa kuwononga esophagus poyiyika.
3.3 chivundikiro choteteza
Ikani chivundikiro chotchinjiriza kumapeto kwa chiwonetsero cha endoscope. Pambuyo potseka chinthu chakunja, chotsani chivundikiro choteteza ndikukulunga chinthu chakunja pochotsa matooscoscope kuti apewe zinthu zakunja.
Zimalumikizana ndi nembanemba mucous wa m'mimba thirakiti ndikuchita ntchito yoteteza.
4. Njira zothandizira mitundu yosiyanasiyana ya matupi akunja m'mimba thirakiti
4.1 Zakudya Zakudya ku ESOPHAGUS
Malipoti akusonyeza kuti zakudya zazing'ono kwambiri mu esophagus zimatha kudulidwa pang'ono m'mimba ndikusiyidwa kuti zitulutsidwe mwachilengedwe, zomwe ndizosavuta, zosavuta komanso zosavuta komanso zosavuta. Pakapita patsogolo kwa gastroscopy, yoyenera kutsegulidwa mu esophageal lumen, koma odwala ena amatha kutsagana ndi zotupa zoyipa kapena positi-esophagetic asnoastolisis (Chithunzi 1). Ngati pali kukana ndipo mukukankha mwachiwawa, kugwiritsa ntchito zovuta zambiri kudzakulitsa chiopsezo cha zonunkhira. Ndikulimbikitsidwa kugwiritsa ntchito mwala wamwala kuti muchotse thumba la mwala kuti chotsani mwachindunji thupi lakunja. Ngati chakudya bolus ndichachikulu, mutha kugwiritsa ntchito mphamvu zakunja, misampha, etc. kutsatsa musanagawire. Chotsani.
Chithunzi 1 Pambuyo pa opaleshoni ya khansa ya Esophogel, wodwalayo adatsagana ndi esophageal stenosis ndi chakudya bolus.
4.2 Zinthu zazifupi komanso zachilendo
Matupi achilendo kwambiri komanso osaneneka amatha kuchotsedwa kudzera mwa mphamvu zakunja, misampha, kuchotsa miyala, kuchotsa miyala, kuchotsa miyala 2). Ngati thupi lachilendo ku esophagus ndizovuta kuchotsa mwachindunji, itha kusunthidwa m'mimba kuti musinthe mawonekedwe ndikuyesera kuti athetse. Matupi achichepere, osaneneka ndi mainchesi a> 2,5 cm m'mimba mwake mumakhala zovuta kudutsa pylorus, ndi endoscopic kuyenera kuchitidwa mwachangu; Ngati matupi achilendo okhala ndi diameter yaying'ono m'mimba kapena duodenum sakuwonetsa kuwonongeka kwa m'mimba, amayembekeza zotulutsa zawo zachilengedwe. Ngati zingakhalebe kwa milungu yoposa 3-4 zokha koma osachotsedwa, iyenera kuchotsedwa endoscopically.
Chithunzi 2 zinthu zakunja za pulasitiki ndi njira zochotsera
4.3 Thupi Lakunja
Zinthu zakunja ndi kutalika kwa ≥6 cm (monga ma thermometers, nsidze, nsikidzi, zophweka, zotupa nthawi zambiri.
Msampha ukhoza kugwiritsidwa ntchito kuphimba mathero amodzi (osapitirira 1 cm kuchokera kumapeto), ndikuyika kapu yowonekera kuti ichotse. Chipangizo cha cannula chachanga chitha kugwiritsidwanso ntchito kulanda thupi lakunja kenako ndikuli kunyadira bwino kuthengo wakunja kuti asawononge mucosa.
4.4 Zinthu zakunja
Zinthu zakuthwa monga mafupa a nsomba, mafupa a nkhuku, mano, ma pizira, mapepala, mapepala a TV, ndi mapiri 3) ayenera kupatsidwa chidwi chokwanira. Zinthu zakuthwa zomwe zimatha kuwononga mucous mosavuta mucous membranes ndi mitsempha yamagazi ndikubweretsa zovuta monga momwe kuchitidwira kuchitiridwa zinthu mosamala. Kayendetsedwe kadzidzidzi.
Chithunzi 3 Mitundu Yosiyanasiyana ya Zinthu Zakuthwa
Mukachotsa matupi akunja othaOscope, ndikosavuta kukwapula mucosa wa m'mimba. Ndikulimbikitsidwa kugwiritsa ntchito chipewa chowonekera, chomwe chingatulutse lume ndikupewa kukanda khoma. Yesani kubweretsa kutha kwa thupi lachilendo kumapeto kwa mandala a endoscopic kotero kuti malekezero a thupi lachilendo kuti agwiritse ntchito thupi lachilendo, kenako yesani kumvetsetsa bwino thupi lakunja. Matupi akunja ophatikizidwa mbali imodzi ya esophagus imatha kuchotsedwa ndikuyika chipewa chakumaso chakumaso kwa matooscope ndikulowa pang'onopang'ono. Kwa matupi akunja ophatikizidwa pamiyeso yonseyo, kumapeto kwamiyendo iyenera kumasulidwa koyamba, kutulutsa mbali inayo, sinthani chipewa chamutu kuti mutuwo uziphatikizidwa. Kapena mutatha kugwiritsa ntchito mpeni wa laser kudula thupi lachilendo pakati, zomwe tasankha ndikumasula artic chitsatsa kapena mbali yoyamba, kenako ndikuchichotsa mu magawo.
A.dener: Mukamadya, kutsokomola, kapena kuyankhulaG, odwala amatha kugwa mwangozi maloweredwe awo, kenako amalowa m'mimba mwake m'mimba yokhala ndi miyala yomeza. Mano a mano ndi zitsulo pamapeto onse ndiosavuta kuphatikizidwa m'makoma a m'mimba thirakiti, ndikuchotsa kovuta. Kwa odwala omwe amalephera chithandizo cha endoscopic, zida zingapo zophatikizira zitha kugwiritsidwa ntchito kuyesa kuchotsa pansi pa dilesil-channel endoscopy.
B.Date Maenje: MaedE, kutulutsa magazi, kulowetsedwa kwaumoyo wamba ndi zotupa munthawi yochepa, ndipo ziyenera kuthandizidwa ndi chithandizo chadzidzidzi cha endoscopic (Chithunzi 4). Ngati palibe kuvulala kwam'mimba, miyala yambiri yazomwe ili m'mimba kapena duodenum imatha kuchotsera mkati mwa maola 48. Iwo omwe sangathe kudzipereka mwachilengedwe amayenera kuchotsedwa posachedwa.
Chithunzi 4 Jujuber Core
Patatha masiku anayi, wodwalayo adapezeka ndi thupi lachilendo kuchipatala china. CT adawonetsa thupi lakunja ku esophagus ndi zotupa. Makina akuthwa a jujube pamapeto onse adachotsedwa pansi pa endoscopy ndipo gastroscopy adachitidwanso. Zinapezeka kuti fistula idapangidwa pakhoma la esophagus.
4.5 zinthu zakunja zakunja zakunja ndi m'mbali zazitali komanso m'mbali mwa nyanja (Chithunzi 5)
a. Ikani chubu lakunja pansi pa endoscope: ikani gastroscope kuchokera pakatikati pa chubu chakunja, kotero kuti m'mphepete mwa chubu chakunja ili pafupi ndi m'mphepete mwa gastroscope yamage. Kuyikanso gastrosocks pafupi ndi thupi lakunja. Ikani zida zoyenera kudzera mu chubu cha biops, monga misampha, mphamvu yakunja thupi, ndi zina mwawiri mutagwira chinthu chakunja, ndipo chipangizo chonsecho chidzatuluka palimodzi ndi galasi.
b. Homemade mucous membrane chotchinga: gwiritsani ntchito chala chophimba cha magolovesi a rabaning kuti apange chivundikiro chanyumba. Dulani pansi pa chikithunzi cha muzu wabululu wa magolovesi mu mawonekedwe a lipenga. Dulani bowo laling'ono pazala, ndikudutsa kumapeto kwa mpweya wagalasi kudzera mu dzenje laling'ono. Gwiritsani ntchito mphete yaying'ono kuti ikonze 1.0cm kutali ndi kumapeto kwa gastrospope ya gastroscope, ndikutumiza limodzi ndi gastrosmopu kwa thupi lachilendo. Gwirani thupi lachilendo kenako ndikuchotsa limodzi ndi gastroscope. Khadi loteteza mwachilengedwe lidzasamukira kudziko lina chifukwa chokana kukana. Ngati malangizowo abwezeretsedwa, adzakulungidwa ndi zinthu zakunja kuti atetezedwe.
Chithunzi 5: Mafupa a nsomba akuthwa anachotsedwa endoscopically, ndi zikwangwani za mucosal
4.6 Chitsulo Chakunja
Kuphatikiza pa mphamvu zachilendo, matupi achilendo amatha kuchotsedwa chifukwa choyamwa ndi mphamvu zakunja zakunja. Matupi achilendo omwe ali owopsa kapena ovuta kuchotsa amatha kuthandizidwa ndi ext fluoroscopy. Ndikulimbikitsidwa kugwiritsa ntchito basiketi yamwala kapena mwalawo.
Ndalama ndizofala kwambiri pakati pa matupi akunja mu thirakiti la m'mimba (Chithunzi 6). Ngakhale ndalama zambiri ku Esophagus zitha kudutsa mwachilengedwe, chithandizo chamankhwala cha endoscopic tikulimbikitsidwa. Chifukwa ana sagwirizana kwambiri, kuchotsa matupi achilendo mwa ana kumachitika m'malo mwa mankhwala osokoneza bongo. Ngati ndalamayo ndi yovuta kuchotsa, imatha kusunthidwa m'mimba kenako kutuluka. Ngati palibe zizindikiro m'mimba, mutha kudikirira kuti ichotsedwe mwachilengedwe. Ngati ndalamazo zimakhalapo kwa masabata opitilira 3-4 ndipo sathamangitsidwa, ziyenera kuthandizidwa.
Chithunzi 6 Chitsulo Coin Chikhalidwe Chachilendo
4.7 Choyipa Chachilendo
Matupi achilendo amatha kuwononga terakiti kapena necrosis. Chithandizo cha endoscopic chadzidzidzi chimafunikira mutazindikira. Mabatire ndi thupi lachilendo kwambiri ndipo nthawi zambiri limachitika mwa ana osakwana zaka 5 (Chithunzi 7). Pambuyo powononga esophagus, atha kubweretsa esophageal stenosis. Endoscopy iyenera kuwunikiridwa pasanathe milungu ingapo. Ngati zonga zokhazikitsidwa zimapangidwa, esophagus iyenera kukhazikitsidwa posachedwa.
Chithunzi 7 Chinthu Chachikulu mu Battery, Mivi Yofiyira ikuwonetsa komwe kuli chinthu chakunja
4.8 Nkhani yakunja
Ngati matupi angapo azamagnetic kapena matupi achilendo ophatikizidwa ndi zitsulo zilipo m'mphepete mwa m'mimba, zomwe zimapangitsa wina ndi mnzake ndikupanga zitsulo zam'madzi, peritonitis zazikulu kwambiri zam'mimba. , Kufuna chithandizo cha endoscopic. Zinthu zakunja zokha zimayeneranso kuchotsedwa posachedwa. Kuphatikiza pa mphamvu wamba, matupi akunja amatha kuchotsedwa kuyamwa ndi mphamvu zakunja zakunja.
4.9 matupi achilendo m'mimba
Ambiri aiwo ndi oyatsira, mawaya achitsulo, misomali, etc. yomwe imamezedwa mwadala ndi akaidi. Thupi lalikulu kwambiri ndi lalitali komanso lalikulu, lovuta kudutsa kanyumba, ndipo imatha kukwapula mucous membrane. Ndikulimbikitsidwa kugwiritsa ntchito makondomu ophatikizidwa ndi mano a khomo kuti muchotse matupi achilendo pansi pa mayeso a endoscopic. Choyamba, ikani dzino la cur-cur-kutsogolo kwa endoscope kudzera pa endoscopic biopsy bowo. Gwiritsani ntchito dzino la cut-con-cent kuti muchepetse mphete ya mphira pansi pa kondomu. Kenako, bweretsani dzino la rat-racks ku dzenje la biopsy kotero kuti kutalika kwa kondomu kumawululidwa kunja kwa dzenje la biopsy. Muchepetsenso momwe mungathere popanda kukhudza gawo la malingaliro, kenako ndikuyika mu chapamimba pachimake ndi endoscoscospe. Pambuyo popeza thupi lachilendo, kuyika thupi lachilendo kukhala kondomu. Ngati nkovuta kuchotsa, ikani kondomu mu chapamimba, ndikugwiritsa ntchito dzino la khomo kuti lizimitsa thupi lachilendo ndikuyikamo makondo akondo.
4.10 miyala yamkumba
Magasriths amagawidwa m'masamba am'masamba, gostalrorith ya nyama, kuphatikizika kwa mankhwala osokoneza bongo ndi m'mimba osakanikirana. Masamba a masamba obiriwira ndiofala kwambiri chifukwa cha kudya kuchuluka kwa mapiri, ma khwyerns, masiku ozizira, mapichesi, udzu winawake, ndi ma coconuts pamimba yopanda m'mimba. Oyambitsidwa ndi zina zobzala zomera. Mothandizidwa ndi gastric acid, okonda ma anin acid a anin amapangidwa, omwe amaphatikizidwa ndi Pectin, chingamu, fiberni, fiberni, peel. Miyala ya m'mimba.
Miyala yam'mimba imapangitsa kupanikizika pamakina pakhoma la m'mimba ndikulimbikitsa kuchuluka kwa chapamimba asidi, omwe angayambitse kukokoloka kwamimba, zilonda komanso ngakhale zopereka. Miyala yaying'ono, yofewa imasungunuka ndi sodium bicarbonate ndi mankhwala ena kenako ndikuloleza mwachilengedwe.
Kwa odwala omwe amalephera chithandizo chamankhwala, mwala wa endoscopic kuchotsa ndiye chisankho choyamba (Chithunzi 8). Kwa miyala yam'mimba yomwe ndi yovuta kuchotsa mwachindunji pansi pa endoscopy chifukwa cha kukula kwawo, mphamvu zakunja, misonkho yochotsa miyala, etc. itha kuphwanya mwachindunji; Kwa iwo omwe ali ndi mawonekedwe olimba omwe sangathe kuphwanyidwa, kudula miyala ya Lithotripsy kapena Racency-Frequency Frant Actipsy, pomwe mwalawo utasweka, gwiritsani ntchito mphamvu zakunja zomwe zingathe. Chisamaliro chiyenera kutengedwa kuti zilepheretse miyala yayikulu kuposa 2cm kuchokera kuzolowera matumbo kudutsa m'mimba ndikuyambitsa matumbo kutsekeka.
Chithunzi 8 miyala m'mimba
4.11 Chikwama cha mankhwala
Kulefuka kwa thumba la mankhwalawa kudzayambitsa chiopsezo chachikulu ndipo ndi contraication ku chithandizo cha endoscopic. Odwala omwe sangathe kuzimitsa mwachilengedwe kapena omwe amakaikika chifukwa chokhala ndi kuchitidwa opaleshoni mwachangu.
Iii. Mavuto ndi Chithandizo
Zovuta za thupi lachilendo zimakhudzana ndi chikhalidwe, mawonekedwe, nthawi yokhazikika komanso katswiri wa dokotala. Zida zazikulu zimakhala ngati ESophageal Mucoassas kuvulala, magazi, ndi matenda opatsirana.
Ngati thupi lakunja ndilochepa ndipo palibe kuwonongeka kwa mucols yodziwikiratu mukadzachotsedwa, kuchipatala sikufunikira opareshoni, ndipo zakudya zofewa zitha kutsatiridwa mutasala kudya kwa maola 6.Kwa odwala omwe ali ndi esophageal mucosal kuvulala, Glutamine glunules, aluminiyamu phosphate gel ndi mankhwala ena oteteza mucosas amatha kupereka chithandizo. Ngati ndi kotheka, kusala komanso zakudya zotumphukira zitha kuperekedwa.
Kwa odwala omwe ali ndi vuto la mucols yodziwikiratu komanso magazi, chithandizo chitha kuchitidwa motsogozedwa ndi chivomerezo cha Endoscopic, monga kupopera mbewu mankhwala ozizira a ayezi
Kwa odwala omwe gawo lawo likufuna kuti thupi lachilendo lalowa khoma la esophogeal pambuyo pochotsa endoscopic, ngati thupi lakunja limakhalabe kwa ochepera maola 24 ndipo CT sapeza mapangidwe opanda pake kunja kwa iSophageal Limen, chithandizo cha endoscopic chitha kuchitidwa mwachindunji. Thupi lakunja litachotsedwa pamapeto, clip ya Titanium imagwiritsidwa ntchito pomupangitsa kuti azithamangitsa khoma lamkati pa malo opaka, omwe amatha kusiya magazi ndikutseka khoma lamkati la esophagus nthawi yomweyo. Chipinda cham'mimba ndi jejunment yodyetsa chubu chimayikidwa pansi pa chinsinsi cha endoscope, ndipo wodwalayo adagonekedwa m'chipatala kuti apitilizidwa. Chithandizo chimaphatikizapo chithandizo chachikulu monga kusala, kulowerera kwa m'mimba, maantibayotiki ndi zakudya. Nthawi yomweyo, zizindikilo zofunika monga kutentha kwa thupi kuyenera kuonedwa mosamala, ndipo kupezeka kwa zovuta monga makhosi ang'onoang'ono monga mabungwe a pakompyuta ayenera kuwonedwa tsiku lachitatu atachitidwa opaleshoni. Pambuyo pa aodine madzi ang'ono akuwonetsa kuti palibe kutaya, kudya ndi kumwa zitha kuloledwa.
Ngati thupi lachilendo lasungidwa kwa maola oposa 24, ngati matenda obwera chifukwa cha malungo, kuzizira, ndipo ngati zovuta zidayamba kuchitika, kapena ngati zovuta ziyenera kusamutsidwa ku opaleshoni ya chithandizo munthawi yake.
Iv. Kusamalitsa
. Chifukwa chake, kulowerera kwadzidzidzi kwa endoscopic ndikofunikira makamaka.
. Ndikwabwino kufunafuna kufunsana komanso kukonzekera opaleshoni.
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ZathuZoyimitsa Zoyipaimagwiritsidwa ntchito molumikizana ndi endoscopes yofewa, kulowa mu thupi laumunthu monga kupuma thirakiti, ESOPHAGUS, m'mimba, matumbo ndi zinthu zakunja komanso zinthu zakunja.
Post Nthawi: Jan-26-2024