Colonoscopy: Kuwongolera mavuto

Mu chithandizo cha colonoscopy, mavuto oyimira ndi kuboola ndi kutuluka magazi.
Kubowoka kumatanthauza mkhalidwe umene bowolo limalumikizidwa momasuka ku bowolo la thupi chifukwa cha vuto la minofu yokhuthala, ndipo kupezeka kwa mpweya womasuka pa X-ray sikukhudza tanthauzo lake.
Pamene mbali ya chilema cha minofu yokhuthala yonse yaphimbidwa ndipo palibe kulumikizana kwaufulu ndi thupi, imatchedwa kubowoka.
Tanthauzo la kutuluka magazi silinafotokozedwe bwino; malingaliro apano akuphatikizapo kuchepa kwa hemoglobin yoposa 2 g/dL kapena kufunikira kwa kuikidwa magazi.
Kutuluka magazi pambuyo pa opaleshoni nthawi zambiri kumatanthauzidwa ngati kupezeka kwa magazi ambiri m'chimbudzi pambuyo pa opaleshoni yomwe imafuna chithandizo cha hemostatic kapena kuikidwa magazi.
Kuchuluka kwa zochitika izi kumasiyana malinga ndi chithandizo:
Mlingo wa kuboola:
Kuchotsa opaleshoni ya polypectomy: 0.05%
Kuchotsa mucosal ya endoscopic (EMR): 0.58%~0.8%
Kuduladula kwa submucosal ya Endoscopic (ESD): 2%~14%
Kuchuluka kwa magazi pambuyo pa opaleshoni:
Kuchotsa opaleshoni ya polypectomy: 1.6%
EMR: 1.1%~1.7%
ESD: 0.7%~3.1

1. Momwe mungathanirane ndi kubowoka
Popeza khoma la matumbo akulu ndi lopyapyala kuposa la m'mimba, chiopsezo cha kubooka chimakhala chachikulu. Kukonzekera kokwanira kumafunika musanachite opaleshoni kuti muthane ndi kuthekera kwa kubooka.
Malangizo Othandizira Pa Opaleshoni:
Onetsetsani kuti endoscope ikugwira ntchito bwino.
Sankhani ma endoscope oyenera, zida zochizira, jakisoni wamadzimadzi ndi zida zoperekera mpweya wa carbon dioxide malinga ndi malo, mawonekedwe ake ndi kuchuluka kwa fibrosis ya chotupacho.
Kuwongolera kuboola kwa fupa mkati mwa opaleshoni:
Kutseka nthawi yomweyo: Mosasamala kanthu za malo, kutseka kwa clip ndiyo njira yabwino kwambiri (mphamvu yolangizira: Giredi 1, mulingo wa umboni: C).

In ESD, kuti tipewe kusokoneza ntchito yoduladula, minofu yozungulira iyenera kudulidwa kaye kuti pakhale malo okwanira ogwirira ntchito musanatseke.
Kuyang'anira pambuyo pa opaleshoni: Ngati kubowoka kwa diso kungatsekedwe kwathunthu, opaleshoni ingapewedwe pongolandira mankhwala opha tizilombo toyambitsa matenda komanso kusala kudya.
Chisankho cha opaleshoni: Kufunika kwa opaleshoni kumatsimikiziridwa potengera kuphatikiza kwa zizindikiro za m'mimba, zotsatira za mayeso a magazi, ndi zithunzi m'malo mongogwiritsa ntchito mpweya waulere womwe umawonetsedwa pa CT.
Chithandizo cha ziwalo zapadera:
M'munsi mwa rectum simungayambitse kubooka kwa m'mimba chifukwa cha mawonekedwe ake, koma kungayambitse kubooka kwa m'chiuno, komwe kumawonekera ngati retroperitoneal, mediastinal, kapena subcutaneous emphysema.
Kusamalitsa:
Kutseka bala pambuyo pa opaleshoni kungalepheretse mavuto enaake, koma palibe umboni wokwanira wosonyeza kuti lingalepheretse kuboola mochedwa.

2. Yankho la Kutuluka Magazi
Kusamalira kutuluka magazi mkati mwa opaleshoni:
Gwiritsani ntchito heat coagulation kapena hemostatic clips kuti musiye kutuluka magazi.
Kutuluka magazi m'mitsempha yaying'ono:
EMR, nsonga ya snare ingagwiritsidwe ntchito pophimba kutentha.
ESD, nsonga ya mpeni wamagetsi ingagwiritsidwe ntchito kukhudza kutentha kouma kapena hemostatic forceps kuti asiye kutuluka magazi.
Kutuluka magazi m'mitsempha ikuluikulu: Gwiritsani ntchito mphamvu zochotsa magazi m'mitsempha, koma samalani kuchuluka kwa magazi omwe amatsekeka kuti mupewe kubowoka mochedwa.
Kupewa kutuluka magazi pambuyo pa opaleshoni:
Kuchotsa bala pambuyo pochotsa balaEMR :
Kafukufuku wasonyeza kuti kugwiritsa ntchito mphamvu zoyezera magazi m'thupi poletsa magazi kuundana sikukhudza kwambiri kuchuluka kwa magazi omwe amatuluka pambuyo pa opaleshoni, koma pali njira yochepetsera magazi.
Kuduladula koteteza kumakhudza zilonda zazing'ono, koma kumathandiza kwambiri zilonda zazikulu kapena odwala omwe ali pachiwopsezo chachikulu chotuluka magazi pambuyo pa opaleshoni (monga omwe amalandira chithandizo cha antithrombotic).
ESD, bala limachotsedwa ndipo mitsempha yamagazi yomwe yawonekera imatsekeka. Ma hemostatic clips angagwiritsidwenso ntchito poletsa kutsekeka kwa mitsempha yayikulu yamagazi.
Zindikirani:
Pa EMR ya zilonda zazing'ono, chithandizo chodzitetezera nthawi zonse sichikulimbikitsidwa, koma kwa zilonda zazikulu kapena odwala omwe ali pachiwopsezo chachikulu, kudula koteteza pambuyo pa opaleshoni kumakhala ndi zotsatira zina (mphamvu yolangizira: Mlingo 2, mulingo wotsimikizira: C).
Kubowoka ndi kutuluka magazi ndi mavuto ofala kwambiri a endoscopy ya colorectal.
Kutenga njira zoyenera zopewera ndi kuchiza matenda osiyanasiyana kungachepetse kuchuluka kwa matenda omwe amabwera nthawi ndi nthawi komanso kupititsa patsogolo chitetezo cha odwala.

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