I.Kukonzekera kwa odwala
1. Kumvetsetsa malo, chilengedwe, kukula ndi kuphulika kwa zinthu zakunja
Tengani ma X-ray omveka bwino kapena ma CT scans a khosi, chifuwa, anteroposterior ndi lateral mawonedwe, kapena pamimba pakufunika kuti mumvetsetse malo, chilengedwe, mawonekedwe, kukula, ndi kupezeka kwa kuphulika kwa thupi lachilendo, koma musachite kumeza kwa barium. kufufuza.
2. Nthawi yosala kudya ndi madzi
Nthawi zonse, odwala amasala kudya kwa maola 6 mpaka 8 kuti akhudze zomwe zili m'mimba, ndipo nthawi yosala kudya komanso kusala madzi imatha kumasuka moyenerera pagastroscopy yadzidzidzi.
3. Chithandizo cha anesthesia
Ana, omwe ali ndi vuto la m'maganizo, omwe sali ogwirizana, kapena omwe ali ndi matupi achilendo omangidwa, matupi akuluakulu achilendo, matupi achilendo ambiri, matupi akunja akuthwa, kapena maopaleshoni a endoscopic omwe ndi ovuta kapena otenga nthawi yaitali ayenera kuchitidwa opaleshoni kapena endotracheal. intubation mothandizidwa ndi opaleshoni ya opaleshoni.Chotsani zinthu zakunja.
II.Kukonzekera zida
1. Kusankha kwa Endoscope
Mitundu yonse ya gastroscopy yowonera kutsogolo ilipo.Ngati akuganiza kuti n'zovuta kuchotsa thupi lachilendo kapena thupi lachilendo ndi lalikulu, gastroscopy yopangira opaleshoni iwiri imagwiritsidwa ntchito.Ma endoscope okhala ndi mainchesi ochepa akunja atha kugwiritsidwa ntchito kwa makanda ndi ana aang'ono.
2. Kusankhidwa kwa forceps
Makamaka zimadalira kukula ndi mawonekedwe a thupi lachilendo.Zida zomwe zimagwiritsidwa ntchito nthawi zambiri ndi monga biopsy forceps, msampha, mphamvu za nsagwada zitatu, mphamvu zoyandama, mphamvu zakunja zakunja (mapu a makoswe, nsagwada zapakamwa), dengu lochotsa miyala, thumba lochotsa miyala, ndi zina zambiri.
Kusankhidwa kwa chida kungadziwike potengera kukula, mawonekedwe, mtundu, ndi zina za thupi lachilendo.Malinga ndi malipoti a m'mabuku, zida za makoswe ndi mano ndizo zomwe zimagwiritsidwa ntchito kwambiri.Kugwiritsa ntchito mphamvu za makoswe-dzino ndi 24.0% ~ 46.6% ya zida zonse zomwe zimagwiritsidwa ntchito, ndipo misampha imawerengera 4.0% ~ 23.6%.Anthu ambiri amakhulupirira kuti misampha ndi yabwino kwa matupi achilendo ooneka ngati ndodo.Monga ma thermometers, zitsulo zamatabwa, zopangira nsungwi, zolembera, spoons, ndi zina zotero, ndi malo otsiriza omwe amaphimbidwa ndi msampha sayenera kupitirira 1cm, mwinamwake kudzakhala kovuta kutuluka kwa cardia.
2.1 Matupi akunja okhala ngati ndodo komanso matupi akunja ozungulira
Kwa zinthu zakunja zooneka ngati ndodo zosalala komanso zowonda zakunja zakunja monga zotokosera mkamwa, ndizosavuta kusankha pliers za nsagwada zitatu, zopangira mano a makoswe, zopalasa zosalala, ndi zina zambiri;kwa zinthu zozungulira zakunja (monga pakati, mipira yamagalasi, mabatani a mabatani, ndi zina), gwiritsani ntchito dengu lochotsa miyala kapena thumba lochotsa miyala kuti muchotse.
2.2 Matupi akuthwa atalitali, minyewa ya chakudya, ndi miyala ikuluikulu m'mimba
Kwa matupi akuthwa atalitali akunja, mbali yayitali ya thupi lakunja iyenera kukhala yofanana ndi utali wa lumen, mbali yakuthwa kapena yotseguka yoyang'ana pansi, ndikutuluka pobaya mpweya.Kwa matupi akunja okhala ngati mphete kapena matupi akunja okhala ndi mabowo, ndibwino kugwiritsa ntchito njira yolumikizira kuti muwachotse;
Pazakudya ndi miyala ikuluikulu ya m'mimba, mphamvu zoluma zitha kugwiritsidwa ntchito kuphwanya ndikuchotsa ndi nsagwada zitatu kapena msampha.
3. Zida zodzitetezera
Gwiritsani ntchito zida zodzitetezera momwe mungathere pazinthu zakunja zomwe zimakhala zovuta kuchotsa komanso zowopsa.Pakadali pano, zida zodzitchinjiriza zomwe zimagwiritsidwa ntchito kwambiri zimaphatikizapo zipewa zowonekera, machubu akunja, ndi zotchingira zoteteza.
3.1 Transparent cap
Panthawi yochotsa thupi lakunja, kapu yowonekera iyenera kugwiritsidwa ntchito kumapeto kwa lens ya endoscopic momwe mungathere kuti mucosa isakandandidwe ndi thupi lakunja, komanso kukulitsa kum'mero kuti muchepetse kukana komwe kumachitika pamene thupi lachilendo. amachotsedwa.Zingathandizenso kukakamiza ndi kuchotsa thupi lachilendo, lomwe limapindulitsa kuchotsa thupi lachilendo.Chotsani.
Kwa matupi akunja ooneka ngati mizere oyikidwa mumkodzo kumapeto onse a mmero, chipewa chowonekera chingagwiritsidwe ntchito kukankhira mucosa pang'onopang'ono kuzungulira mbali imodzi ya thupi lakunja kotero kuti mbali imodzi ya thupi lakunja ituluke pakhoma la esophageal mucosal. pewani kutuluka kwa esophageal chifukwa chochotsa mwachindunji.
Chipewa chowonekera chingaperekenso malo okwanira kuti agwiritse ntchito chidacho, chomwe chimakhala chosavuta kuti chizindikire ndi kuchotsa matupi akunja mu gawo lopapatiza la khosi la esophageal.
Nthawi yomweyo, kapu yowonekera imatha kugwiritsa ntchito kukakamiza koyipa kuti ithandizire kuyamwa chakudya ndikuwongolera kukonza kotsatira.
3.2 Chikwama chakunja
Ngakhale kuteteza kummero ndi kummero-chapamimba mphambano mucosa, chubu akunja facilitates endoscopic kuchotsa yaitali, lakuthwa, ndi angapo matupi achilendo ndi kuchotsedwa kwa clumps chakudya, potero kuchepetsa zochitika za mavuto pa chapamwamba m`mimba kuchotsa thupi lachilendo.Kuonjezera chitetezo ndi mphamvu ya mankhwala.
Ma overtubes sagwiritsidwa ntchito kawirikawiri kwa ana chifukwa cha chiopsezo chowononga kummero poikapo.
3.3 Chivundikiro chachitetezo
Ikani chivundikiro chotetezera mozondoka kutsogolo kwa endoscope.Mukamaliza kukanikiza chinthu chachilendo, tembenuzirani chivundikirocho ndikukulunga chinthu chachilendocho pochotsa endoscope kuti musapewe zinthu zakunja.
Imakhudzana ndi mucous nembanemba ya m'mimba ndipo imagwira ntchito yoteteza.
4. Njira zochizira mitundu yosiyanasiyana ya matupi akunja kumtunda kwa m'mimba
4.1 Kuchuluka kwazakudya m'mimba
Malipoti akusonyeza kuti zakudya zing'onozing'ono zambiri zomwe zili m'mimba zimatha kukankhidwira m'mimba pang'onopang'ono ndikusiyidwa kuti zitulutsidwe mwachibadwa, zomwe zimakhala zosavuta, zosavuta komanso zosavuta kuyambitsa zovuta.Pakupita patsogolo kwa gastroscopy, kukwera kwamitengo koyenera kumatha kulowetsedwa mu lumen ya esophageal, koma odwala ena amatha kutsagana ndi zotupa zowopsa zapakhosi kapena post-esophageal anastomotic stenosis (Chithunzi 1).Ngati pali kukana ndikukankhira mwamphamvu, kukakamiza kwambiri kumawonjezera chiopsezo choboola.Ndibwino kuti mugwiritse ntchito dengu lochotsa miyala kapena thumba lochotsa miyala kuti muchotse mwachindunji thupi lachilendo.Ngati chakudya cha bolus ndi chachikulu, mutha kugwiritsa ntchito mphamvu zakunja, misampha, ndi zina zambiri kuti muphatikize musanagawane.Chitulutseni.
Chithunzi 1 Pambuyo opaleshoni khansa kum`mero, wodwalayo limodzi ndi esophageal stenosis ndi chakudya bolus posungira.
4.2 Zinthu zazifupi komanso zosawoneka bwino zakunja
Matupi akunja afupi komanso osawoneka bwino amatha kuchotsedwa kudzera mu mphamvu zakunja, misampha, madengu ochotsa miyala, matumba ochotsa miyala, ndi zina zambiri (Chithunzi 2).Ngati thupi lachilendo mum'memo n'zovuta kuchotsa mwachindunji, akhoza kukankhira m'mimba kusintha malo ake ndiyeno kuyesa kuchotsa izo.Matupi akunja, osawoneka bwino okhala ndi mainchesi> 2.5 cm m'mimba ndizovuta kwambiri kudutsa pylorus, ndipo kulowetsedwa kwa endoscopic kuyenera kuchitika posachedwa;ngati matupi akunja okhala ndi ma diameter ang'onoang'ono m'mimba kapena duodenum sawonetsa kuwonongeka kwa m'mimba, amatha kudikirira kutulutsa kwawo kwachilengedwe.Ngati ikhalapo kwa milungu yopitilira 3-4 ndipo sungathe kutulutsidwa, iyenera kuchotsedwa ndi endoscopically.
Chithunzi 2 Zinthu za pulasitiki zakunja ndi njira zochotsera
4.3 Mabungwe akunja
Zinthu zakunja zokhala ndi kutalika kwa ≥6 masentimita (monga ma thermometers, tsuko, zopangira nsungwi, zolembera, spoons, ndi zina zotero) sizosavuta kutulutsa mwachibadwa, choncho nthawi zambiri zimasonkhanitsidwa ndi msampha kapena dengu lamwala.
Msampha ungagwiritsidwe ntchito kuphimba mbali imodzi (osapitirira 1 cm kuchokera kumapeto), ndikuyika mu kapu yowonekera kuti utulutse.Chipangizo chakunja cha cannula chitha kugwiritsidwanso ntchito kulanda thupi lachilendo ndikubwerera bwino ku cannula kuti zisawononge mucosa.
4.4 Zinthu zakuthwa zakunja
Zinthu zakuthwa zakunja monga mafupa a nsomba, mafupa a nkhuku, mano, maenje a deti, zotokosera m'mano, timapepala tating'onoting'ono, lezala, ndi zokulunga za malata (Chithunzi 3) ziyenera kuganiziridwa mokwanira.Zinthu zakuthwa zakunja zomwe zimatha kuwononga mucous nembanemba ndi mitsempha yamagazi ndikuyambitsa zovuta monga kuphulika ziyenera kuthandizidwa mosamala.Emergency endoscopic management.
Chithunzi 3 Mitundu yosiyanasiyana ya zinthu zakuthwa zakunja
Pochotsa lakuthwa matupi achilendo pansi pa mapetooscope, ndikosavuta kukanda mucosa m'mimba.Ndikofunikira kugwiritsa ntchito kapu yowonekera, yomwe imatha kuwonetsa lumen ndikupewa kukanda khoma.Yesetsani kubweretsa kumapeto kwa thupi lachilendo pafupi ndi mapeto a mandala a endoscopic kuti malekezero amodzi a thupi lachilendo ayikidwe Ikani mu kapu yowonekera, gwiritsani ntchito mphamvu zakunja kapena msampha kuti mugwire thupi lachilendo, ndiyeno. yesetsani kusunga utali wozungulira wa thupi lachilendo kufanana ndi kummero musanachoke pakukula.Matupi akunja ophatikizidwa mbali imodzi ya mmero amatha kuchotsedwa poyika kapu yowonekera kutsogolo kwa endoscope ndikulowa pang'onopang'ono polowera kummero.Kwa matupi akunja omwe amaikidwa m'mphepete mwazitsulo kumbali zonse ziwiri, mapeto ozama kwambiri ayenera kumasulidwa poyamba, kawirikawiri Pa mbali yozungulira, tulutsani mbali inayo, sinthani njira ya chinthu chachilendo kuti mutu wamutu ukhale wowonekera. kapu, ndi kuchichotsa.Kapena titatha kugwiritsa ntchito mpeni wa laser kudula thupi lachilendo pakati, zomwe takumana nazo ndikumasula aortic arch kapena mbali ya mtima poyamba, kenako ndikuchotsa pang'onopang'ono.
a. Dentures: Podya, kutsokomola, kapena kulankhulag, odwala akhoza kugwa mwangozi mano awo, ndiyeno kulowa chapamwamba m`mimba thirakiti ndi kumeza kayendedwe.Ma mano akuthwa okhala ndi zitsulo kumbali zonse ziwiri ndizosavuta kuyika m'makoma am'mimba, zomwe zimapangitsa kuchotsa kukhala kovuta.Kwa odwala omwe amalephera chithandizo chanthawi zonse cha endoscopic, zida zingapo zomangira zitha kugwiritsidwa ntchito kuyesa kuchotsedwa pansi pa endoscopy yanjira ziwiri.
b. Maenje a deti: Maenje a deti omwe amaikidwa pakhosi nthawi zambiri amakhala akuthwa mbali zonse ziwiri, zomwe zingayambitse zovuta monga kuwonongeka kwa mucosal.e, kutuluka magazi, matenda opatsirana a m'deralo ndi kuphulika kwa nthawi yochepa, ndipo ayenera kuthandizidwa ndi chithandizo chadzidzidzi cha endoscopic (Chithunzi 4).Ngati palibe chovulala cham'mimba, miyala yambiri yam'mimba kapena duodenum imatha kutulutsidwa mkati mwa maola 48.Amene sangathe kuchotsedwa mwachibadwa ayenera kuchotsedwa mwamsanga.
Chithunzi 4 Jujube pachimake
Patapita masiku anayi, wodwalayo anapezeka ndi thupi lachilendo m'chipatala china.CT inasonyeza thupi lachilendo mum'mero ndi perforation.Mitsempha yakuthwa ya jujube kumbali zonse ziwiri idachotsedwa pansi pa endoscopy ndipo gastroscopy idachitidwanso.Zinapezeka kuti fistula inapangidwa pakhoma la mmero.
4.5 Zinthu zazikulu zakunja zokhala ndi mbali zazitali komanso zakuthwa (Chithunzi 5)
a.Ikani chubu chakunja pansi pa endoscope: Ikani gastroscope kuchokera pakati pa chubu chakunja, kuti m'munsi mwa chubu chakunja chikhale pafupi ndi kumtunda kwa gawo lopindika la gastroscope.Nthawi zonse lowetsani gastroscope pafupi ndi thupi lachilendo.Ikani zida zoyenera kudzera mu chubu cha biopsy, monga misampha, mphamvu zakunja zakunja, ndi zina zotero. Mukagwira chinthu chachilendo, chiyikeni mu chubu chakunja, ndipo chipangizo chonsecho chidzatuluka pamodzi ndi galasi.
b.Chivundikiro chodzitchinjiriza chapakhungu: Gwiritsani ntchito chivundikiro cham'manja cha magolovesi opangira mphira kuti mupange chivundikiro chakutsogolo cha endoscope.Iduleni pa bevel ya muzu wa chala chachikulu cha gulovu kukhala mawonekedwe a lipenga.Dulani dzenje laling'ono pa nsonga ya chala, ndikudutsa kutsogolo kwa galasi la galasi kupyolera mu dzenje laling'ono.Gwiritsani ntchito mphete yaying'ono ya rabara kuti muyikonze 1.0cm kutali ndi kutsogolo kwa gastroscope, ikani kumbuyo kumapeto kwa gastroscope, ndikuitumiza pamodzi ndi gastroscope ku thupi lachilendo.Gwirani thupi lachilendo ndikulichotsa pamodzi ndi gastroscope.Nkhola yoteteza mwachibadwa idzasunthira ku thupi lachilendo chifukwa cha kukana.Ngati malangizowo atembenuzidwa, adzakulungidwa ndi zinthu zakunja kuti atetezedwe.
Chithunzi 5: Mafupa akuthwa a nsomba adachotsedwa endoscopically, ndi zokopa za mucosal
4.6 Zitsulo zakunja
Kuphatikiza pa ma forceps ochiritsira, matupi akunja achitsulo amatha kuchotsedwa poyamwa ndi maginito akunja akunja.Matupi akunja achitsulo omwe ali owopsa kapena ovuta kuchotsa amatha kuthandizidwa ndi endoscopically pansi pa X-ray fluoroscopy.Ndibwino kuti mugwiritse ntchito dengu lochotsa miyala kapena thumba lochotsa miyala.
Ndalama zimakhala zofala pakati pa matupi achilendo m'mimba mwa ana (Chithunzi 6).Ngakhale ndalama zambiri zam'mimba zimatha kuperekedwa mwachilengedwe, chithandizo chosankha endoscopic ndichofunikira.Chifukwa ana ndi zochepa mgwirizano, endoscopic kuchotsa matupi achilendo ana bwino anachita pansi opaleshoni ambiri.Ngati ndalamazo ndizovuta kuchotsa, zimatha kukankhidwira m'mimba ndikutuluka.Ngati palibe zizindikiro m'mimba, mukhoza kuyembekezera kuti atulutsidwe mwachibadwa.Ngati ndalamayo ikhalabe kwa milungu yoposa 3-4 ndipo sichichotsedwa, iyenera kuthandizidwa ndi endoscopically.
Chithunzi 6 Ndalama zachitsulo zakunja
4.7 Zowononga zakunja
Matupi akunja owononga amatha kuwononga mosavuta m'mimba kapena necrosis.Emergency endoscopic chithandizo chofunika pambuyo matenda.Mabatire ndi omwe amawononga kwambiri thupi lachilendo ndipo amapezeka mwa ana osakwana zaka zisanu (Chithunzi 7).Pambuyo powononga mmero, angayambitse esophageal stenosis.Endoscopy iyenera kuwonedwa pakatha milungu ingapo.Ngati kukhwima kwapangidwa, mmerowo uyenera kuchepetsedwa posachedwa.
Chithunzi 7 Chinthu chachilendo mu batri, muvi wofiira umasonyeza malo a chinthu chachilendo
4.8 Maginito akunja
Pamene angapo maginito matupi achilendo kapena maginito matupi achilendo pamodzi ndi zitsulo alipo kumtunda m`mimba thirakiti, zinthu kukopa wina ndi mzake ndi compress makoma a m`mimba thirakiti, amene mosavuta chifukwa ischemic necrosis, fistula mapangidwe, perforation, obstruction, peritonitis ndi kuvulala kwina kwakukulu kwa m'mimba., kumafuna chithandizo chadzidzidzi cha endoscopic.Zinthu zakunja zakunja zimodzi ziyeneranso kuchotsedwa posachedwa.Kuphatikiza pa forceps wamba, maginito akunja akunja amatha kuchotsedwa poyamwa ndi maginito akunja akunja.
4.9 Matupi achilendo m'mimba
Zambiri mwa izo ndi zoyatsira, mawaya achitsulo, misomali, ndi zina zotero zomwe zimamezedwa mwadala ndi akaidi.Matupi ambiri akunja ndi aatali komanso akulu, ovuta kudutsa mu cardia, ndipo amatha kukanda mosavuta mucous nembanemba.Ndibwino kuti mugwiritse ntchito makondomu pamodzi ndi mphamvu za makoswe-dzino kuti muchotse matupi achilendo poyang'anitsitsa endoscopic.Choyamba, ikani mphamvu za dzino la makoswe kutsogolo kwa endoscope kudzera mu dzenje la endoscopic biopsy.Gwiritsani ntchito mphamvu za mano a khoswe kuti mutseke mphete ya mphira pansi pa kondomu.Kenako, bwezerani mphamvu za dzino la makoswe ku dzenje la biopsy kuti kutalika kwa kondomu kuwonekere kunja kwa dzenje la biopsy.Chepetsani momwe mungathere popanda kukhudza malo owonera, ndiyeno muyike m'mimba yapamimba pamodzi ndi endoscope.Mukazindikira thupi lachilendo, ikani thupi lachilendolo mu kondomu.Ngati kuli kovuta kuchotsa, ikani kondomu m'mimba, ndipo gwiritsani ntchito mphamvu za mano a makoswe kuti mutseke thupi lachilendo ndikuliyikamo. Mkati mwa kondomu, gwiritsani ntchito pliers za mano a makoswe kuti mutseke kondomu ndikuyichotsa pamodzi ndi kondomu. galasi.
4.10 Miyala yam'mimba
Ma gastroliths amagawidwa m'magawo a masamba, ma gastroliths a nyama, ma gastroliths opangidwa ndi mankhwala osokoneza bongo komanso ma gastroliths osakanikirana.Vegetative gastroliths ndiwofala kwambiri, makamaka chifukwa cha kudya ma persimmons ambiri, hawthorns, masiku achisanu, mapichesi, udzu winawake, kelp, ndi kokonati pamimba yopanda kanthu.Zoyambitsidwa ndi zina. Ma gastrolith opangidwa ndi zomera monga ma persimmons, hawthorns, ndi jujubes ali ndi tannic acid, pectin, ndi chingamu.Pansi pa gastric acid, mapuloteni a tannic acid osasungunuka amapangidwa, omwe amamangiriza ku pectin, chingamu, ulusi wa chomera, peel, ndi pachimake.Miyala yam'mimba.
Miyala yam'mimba imayambitsa kupanikizika kwa khoma la m'mimba ndikuwonjezera kutulutsa kwa m'mimba, komwe kungayambitse kukokoloka kwa m'mimba, zilonda zam'mimba komanso ngakhale kubowola.Miyala yaying'ono, yofewa yam'mimba imatha kusungunuka ndi sodium bicarbonate ndi mankhwala ena ndikuloledwa kuti itulutsidwe mwachilengedwe.
Kwa odwala omwe amalephera chithandizo chamankhwala, kuchotsa miyala ya endoscopic ndiyo kusankha koyamba (Chithunzi 8).Kwa miyala yam'mimba yomwe imakhala yovuta kuchotsa mwachindunji pansi pa endoscopy chifukwa cha kukula kwake kwakukulu, mphamvu zakunja za thupi, misampha, madengu ochotsa miyala, etc. angagwiritsidwe ntchito kuphwanya miyalayo mwachindunji ndikuchotsa;kwa iwo omwe ali ndi mawonekedwe olimba omwe sangathe kuphwanyidwa, kudula kwa miyala kwa endoscopic kumatha kuganiziridwa , Laser lithotripsy kapena high-frequency electric lithotripsy treatment, pamene mwala wam'mimba ndi wosakwana 2cm utathyoledwa, gwiritsani ntchito zikwatu zitatu kapena mphamvu zakunja zakunja. kuchotsa momwe ndingathere.Muyenera kusamala kuti miyala yokulirapo kuposa 2cm isatulukire m'matumbo kudzera m'mimba ndikuyambitsa kutsekeka kwa matumbo.
Chithunzi 8 Miyala m'mimba
4.11 Chikwama cha Mankhwala
Kuphulika kwa thumba la mankhwala kungayambitse chiopsezo chakupha ndipo ndizotsutsana ndi chithandizo cha endoscopic.Odwala omwe sangathe kutulutsa mwachibadwa kapena omwe akuganiziridwa kuti thumba la mankhwala linasweka ayenera kuchitidwa opaleshoni.
III.Mavuto ndi chithandizo
Zovuta za thupi lachilendo zimagwirizana ndi chikhalidwe, mawonekedwe, nthawi yokhalamo komanso mlingo wa opaleshoni wa dokotala.Zovuta zazikuluzikulu zimaphatikizapo kuvulala kwamkodzo mucosal, kutuluka magazi, ndi matenda oboola.
Ngati thupi lachilendo liri laling'ono ndipo palibe kuwonongeka kwa mucosal koonekeratu pamene kuchotsedwa, kuchipatala sikofunikira pambuyo pa opaleshoni, ndipo zakudya zofewa zimatha kutsatiridwa mutatha kusala kudya kwa maola 6.Kwa odwala omwe ali ndi vuto la esophageal mucosal, glutamine granules, aluminiyamu mankwala gel osakaniza ndi zina mucosal zoteteza mankhwala akhoza kupatsidwa symptomatic mankhwala.Ngati ndi kotheka, kusala kudya ndi zakudya zotumphukira zimatha kuperekedwa.
Kwa odwala omwe ali ndi vuto lodziwika bwino la mucosal komanso magazi, mankhwala akhoza kuchitidwa pansi pa masomphenya mwachindunji endoscopic, monga kupopera madzi oundana saline norepinephrine solution, kapena endoscopic titaniyamu tatifupi kutseka bala.
Kwa odwala omwe preoperative CT ikuwonetsa kuti thupi lakunja lalowa pakhoma la esophageal pambuyo pochotsa endoscopic., ngati thupi lachilendo likhalabe kwa maola osachepera 24 ndipo CT sichipeza mapangidwe a abscess kunja kwa lumen ya esophageal, chithandizo cha endoscopic chikhoza kuchitidwa mwachindunji.Thupi lachilendo litachotsedwa kudzera pa endoscope, titaniyamu yojambulidwa imagwiritsidwa ntchito kukakamiza khoma lamkati la mmero pamalo obowola, omwe amatha kuyimitsa magazi ndikutseka khoma lamkati la mmero nthawi yomweyo.Chubu cham'mimba ndi chubu chodyera cha jejunal chimayikidwa pansi pa masomphenya achindunji a endoscope, ndipo wodwalayo amagonekedwa m'chipatala kuti apitirize kulandira chithandizo.Kuchiza kumaphatikizapo chithandizo cha zizindikiro monga kusala kudya, kuchepa kwa m'mimba, maantibayotiki ndi zakudya.Panthawi imodzimodziyo, zizindikiro zofunika monga kutentha kwa thupi ziyenera kuyang'anitsitsa, ndipo zochitika za zovuta monga khosi la subcutaneous emphysema kapena mediastinal emphysema ziyenera kuwonedwa pa tsiku lachitatu pambuyo pa opaleshoni.Pambuyo ayodini madzi angiography amasonyeza kuti palibe kutayikira, kudya ndi kumwa akhoza kuloledwa.
Ngati thupi lachilendo lasungidwa kwa maola opitilira 24, ngati zizindikiro za matenda monga malungo, kuzizira, komanso kuchuluka kwa maselo oyera amwazi kumachitika, ngati CT ikuwonetsa kupangika kwa abscess extraluminal mum'mero, kapena ngati zovuta zazikulu zachitika. , odwala ayenera kusamutsidwa ku opaleshoni kuti akalandire chithandizo panthawi yake.
IV.Kusamalitsa
(1) Thupi lachilendo likakhala nthawi yayitali pammero, m'pamenenso opaleshoniyo imakhala yovuta kwambiri komanso zovuta zambiri.Chifukwa chake, kulowetsedwa kwadzidzidzi kwa endoscopic ndikofunikira kwambiri.
(2) Ngati thupi lachilendo ndi lalikulu, losakhazikika mu mawonekedwe kapena lili ndi spikes, makamaka ngati thupi lachilendo liri pakati pa mmero ndi pafupi ndi aortic arch, ndipo n'zovuta kulichotsa endoscopically, musachikokere mwamphamvu. kunja.Ndi bwino kufunsira kukaonana ndi magulu osiyanasiyana komanso kukonzekera opaleshoni.
(3) Kugwiritsa ntchito moyenera zida zodzitetezera ku esophageal kumatha kuchepetsa kuchitika kwa zovuta.
Zathuzogwirizira zotayidwaamagwiritsidwa ntchito molumikizana ndi ma endoscopes ofewa, kulowa m'matumbo amunthu monga kupuma, kumero, m'mimba, matumbo ndi zina zambiri kudzera munjira ya endoscope, kuti agwire minofu, miyala ndi zinthu zakunja komanso kutulutsa ma stents.
Nthawi yotumiza: Jan-26-2024