(1). Njira zoyambira Njira zoyambira za EMR ndi izi:
Kutsatizana kwa njira
①Bayikeni jekeseni wapafupi ndi zilonda.
②Ikani msampha mozungulira chotupacho.
③Msampha umalimbitsidwa kuti ugwire ndi kukokera chotupacho.
④Pitirizani kukhwimitsa msampha mukuyika magetsi kuti mudule chotupacho.
⑤Fukulani chitsanzo chochotsedwa.
(2). Malangizo
1.Malangizo osankha malo a thupi ndi malo a endoscope
Chifukwa chotupacho chiyenera kuthandizidwa pamene chithunzi chonse chikuwoneka, malo a wodwalayo ndi ofunika kwambiri. Yesetsani kupotoza kukula kotero kuti chotupacho chili pafupi ndi kutsegula kwa biopsy, ndiko kuti, kuyambira 5 mpaka 7 koloko pazenera.
Pamaso mankhwala, zotsalira ndi owonjezera pigment ayenera kutsukidwa ndiyeno kuchotsedwa ndi kuyamwa.
Mwachitsanzo, ngati chotupa cha m'matumbo a proximal sigmoid chachotsedwa pamalo a supine kapena kumanzere chakumbuyo kwa decubitus, chitsanzocho nthawi zambiri chimasunthira kumatumbo otsika, zomwe zimapangitsa kuti zikhale zovuta kuzichotsa, kotero kuti kumanja kwa lateral decubitus ndikobwino kuti muchotse.
Momwemonso, potengera kuchira kwachitsanzo, malo akumanzere akumanzere amasankhidwa kuti achotse zotupa zam'matumbo.
2.Malangizo a jakisoni wamba
Singano ya jakisoni yam'deralo imatha kubayidwa mocheperako, koma siili yakuthwa mokwanira ndipo bowo la singano ndi lalikulu kwambiri, chifukwa chake wolemba amagwiritsa ntchito singano ya 25G yakumaloko.
Sikokokomeza kunena kuti kupambana kapena kulephera kwa EMR kumadalira kwambiri jakisoni wamba.
Paziphuphu zing'onozing'ono, kubowola kumachitika kuchokera kumbali yakuthako mpaka pansi pa chotupacho.
Pa zotupa pa mbali yopindika kapena m'mapindikidwe, ngati jekeseni wamba wapangidwa kuchokera kumbali ya kumatako, nthawi zambiri zotupazo zimakhala zosamveka bwino chifukwa zayang'ana m'kamwa, choncho jekeseni wa m'deralo ayenera kuyambika kuchokera kukamwa.
Zofunikira kwa Akatswiri a Endoscopy
Ngati madzi akutuluka, kapena pali kukana kwakukulu panthawi ya jekeseni, kapena palibe kukana pamene madzi amalowa koma palibe chotupa chomwe chimapangidwa, jekeseni iyenera kuyimitsidwa ndipo wogwiritsa ntchitoyo ayenera kudziwitsidwa za momwe zinthu zilili panthawi yake kuti akambirane zotsutsana.
Kuchuluka kwa jekeseni kumakhala bwinoko.
Chinyengo ndi kupitiriza kubaya jekeseni momwe mungathere kupyolera mu puncture imodzi mpaka chotupa chonsecho chichotsedwa.
3.Malangizo osankha msampha
Ngati msamphawo uli ngati mawonekedwe a oval elongated, mucosa wabwinobwino pakamwa ndi kuthako mbali zake zitha kuphatikizidwa mosavuta komanso mosayenera.
Msamphawo makamaka umakhala wozungulira, wosavuta kutseguka mozungulira, wosavuta kutsetsereka, ndipo uli ndi kulimba kwina kwake kukanikizira pachilonda kuti ugwire chotupacho.
Kukula kwa msampha kumayenera kusinthidwa ndi kukula kwa chotupacho.
Msampha Wotayika wa Polypectomy
Zitsanzo za EMR
a. Chithunzi chowala choyera
Chotupa chamtundu wa 25 mm IIa chokhala ndi gawo lapakati lokhumudwa pang'ono.
b. Zithunzi za Narrow band imaging (NBI).
c. Kupopera kwa indigo carmine kuti mukulitse chithunzicho
Zinapezeka kuti kupsinjika komwe kumawonedwa mwa kuwonera kwanthawi zonse kunalidi mitsinje pakati pa masamba.
d. Chithunzi chokulirapo cha madontho a crystal violet
Dongosolo la dzenje lotsegulira kwa glandular m'mphepete mwa chotupacho linali mtundu wa IV.
e. Chithunzi chokulirapo cha madontho a crystal violet
mkatikati mwa chotupacho panali VI, wosakhazikika pang'ono, ndipo palibe kulowetsedwa koonekera kwa submucosal komwe kunapezeka.
f. Jekeseni wamba
Kubowola ndi jekeseni wamba kunkachitika pakati pa chotupacho, zomwe zimapangitsa kuti pakhale phokoso labwino.
g. Tsegulani msampha
Dinani nsonga ya msampha pakhoma la m'matumbo kuti mutsegule msamphawo.
h. Tsekani msampha
Tsekani msampha ndikugwira chotupacho.
i.Mphamvu pakuchotsa
Palibe kuphulika, kutuluka magazi kapena chotupa chotsalira chomwe chinapezeka.
j. Kukonzekera kwachitsanzo
Chitsanzo chodulidwacho chinayikidwa pa pepala la rabara.
Kuzindikira komaliza kwa pathological:intramucosal carcinoma (Tis)
4.Malangizo ogwiritsira ntchito msampha
Nsonga ya msampha imayikidwa pang'onopang'ono pamphuno yapakamwa ya zilondazo, kenako imatsegulidwa pang'onopang'ono ndipo muzu wa msampha umakanikizidwa ku mbali ya anal ya chotupacho. Pofuna kupewa kuti lateral incision ikhale yabwino, pang'onopang'ono mucosa wamba ayenera kuikidwa.
Tiyenera kuzindikira kuti pamene msampha wa msampha sungakhoze kuwonedwa, ndizotheka kuti mucosa yowonjezera yowonjezera yalowetsedwa kuposa momwe amayembekezera. Msamphawo ukalimba kwambiri, kanikizani ndi kukokera mkono wakunja wa msamphawo kuti muwone kuyenda kwa chotupacho. Ngati alowetsedwa mu minofu wosanjikiza, kuyenda kwa chotupacho kudzachepetsedwa.
Malangizo a electroresection
Osakanikiza msampha pakhoma la matumbo, koma kwezani pang'ono chotupacho kuti chichotsedwe. Chiwopsezo cha kuchedwa kung'ambika ndi chochepa mukamagwiritsa ntchito electrosurgical resection, koma sachedwa kutulutsa magazi (oyambirira pambuyo pochotsa) magazi.
Kudula kothamanga kwambiri kungayambitse magazi, pamene kuchotsa pang'onopang'ono kungayambitse kuchedwa kung'ambika. Ngati wodwalayo akumva ululu, kapena wothandizira akumva kuti minofuyo ndi yotanuka ngati mphira ndipo imakhala yovuta kudula, n'kutheka kuti minofuyo imakhudzidwa ndi minofu, ndipo kuchotsako kuyenera kuyimitsidwa nthawi yomweyo.
Zofunikira kwa Akatswiri a Endoscopy
Ngati katswiri wa endoscopist akuwona kuti minofuyo ndi yotanuka ngati labala ndipo ndi yovuta kudula, ayenera kudziwitsa wogwiritsa ntchito nthawi yomweyo kuti akambirane njira zotsutsana nazo.
Malangizo a Sharding EMR
Kwa zotupa zazikulu, nthawi zina zimakhala zotetezeka kupanga piecemeal resection m'malo mokakamiza mokakamiza konsekonse. Komabe, zidutswa zikakhala zochulukira, m'pamenenso mwayi woti zotsalira za m'deralo zibwerenso. Ngakhale ndi EMR ya piecemeal, kuchotsa koyambirira kuyenera kuchitidwa kwakukulu momwe kungathekere ndi msampha waukulu kuti kuchepetsa chiwerengero cha zidutswa.
Ife, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ndi Mlengi ku China okhazikika mu consumables endoscopic, monga biopsy forceps, hemoclip, polyp msampha, sclerotherapy singano, utsi catheter, cytology maburashi, guidewire, mwala kubweza dengu, ngalande ndi EM biliter, ndi zina zotero. ERCP. Zogulitsa zathu ndi zovomerezeka za CE, ndipo mbewu zathu ndi zovomerezeka za ISO. Katundu wathu watumizidwa ku Europe, North America, Middle East ndi gawo la Asia, ndipo amapeza makasitomala ambiri kuzindikira ndi kutamandidwa!
Biopsy forceps:
https://www.zrhendoscopy.com/single-use-endoscopic-tissue-biopsy-forceps-with-graduation-product/
Hemoclip
https://www.zrhendoscopy.com/disposable-rotatable-endoscopic-hemoclip-for-gastroscopy-use-product/
polyp msampha
https://www.zrhendoscopy.com/disposable-endoscopic-resection-polypectomy-snare-for-gastroenterology-product/
sclerotherapy singano
https://www.zrhendoscopy.com/gastroenterology-accessories-endoscopic-sclerotherapy-injection-needle-product/
Kupopera catheter
https://www.zrhendoscopy.com/ce-certified-disposable-endoscopic-spray-catheter-for-digestive-chromoendoscopy-product/
maburashi a cytology
https://www.zrhendoscopy.com/endoscopy-accessories-disposable-endoscopic-cytology-brush-for-gastrointestinal-tract-product/
dengu lochotsa miyala
https://www.zrhendoscopy.com/ercp-instrument-gallstone-stone-retrieval-basket-for-endoscopy-product/
catheter ya nasal biliary drainage
https://www.zrhendoscopy.com/medical-instrument-disposable-nasal-biliary-drainage-catheter-for-ercp-operation-product/
EMR
https://www.zrhendoscopy.com/emresd/
ESD
https://www.zrhendoscopy.com/emresd/
ERCP
https://www.zrhendoscopy.com/ercp/
Nthawi yotumiza: Feb-13-2025