(1). Njira zoyambira Njira zoyambira za EMR ndi izi:
Ndondomeko ya njira
① Jambulani jakisoni wapafupi ndi malo omwe pali chilondacho.
② Ikani msampha mozungulira chotupacho.
③Msampha umamangiriridwa kuti ugwire ndikutsekereza chilondacho.
④Pitirizani kulimbitsa chitseko pamene mukugwiritsa ntchito magetsi kuti mudule chotupacho.
⑤Tengani chitsanzo chochotsedwacho.
(2). Malangizo
1. Malangizo osankha malo a thupi ndi malo a endoscope
Popeza chilondacho chiyenera kuchiritsidwa pamene chithunzi chonse chikuwoneka, malo a wodwalayo ndi ofunika kwambiri. Yesetsani kupotoza chipangizocho kuti chilondacho chikhale pafupi ndi malo otsegulira biopsy forceps, kutanthauza, kuyambira 5 mpaka 7 koloko pazenera.
Musanagwiritse ntchito mankhwalawa, zotsalira ndi utoto wochulukirapo ziyenera kutsukidwa kenako nkuchotsedwa ndi kuyamwa.
Mwachitsanzo, ngati chotupa mu proximal sigmoid colon chachotsedwa pamalo a chala kapena kumanzere a lateral decubitus, chitsanzocho nthawi zambiri chimapita ku downward colon, zomwe zimapangitsa kuti zikhale zovuta kuchotsa, kotero malo a lateral decubitus akumanja ndi abwino kwambiri pochotsa.
Mofananamo, poganizira za kuchira kwa chitsanzo, malo a kumanzere a decubitus ndi omwe amakondedwa pochotsa zilonda za m'matumbo opingasa.
2. Malangizo a jakisoni wapafupi
Singano yokhuthala yapafupi ikhoza kubayidwa ndi mphamvu yotsika, koma siili yakuthwa mokwanira ndipo dzenje la singano ndi lalikulu kwambiri, kotero wolembayo akugwiritsa ntchito singano yapafupi ya 25G.
Sikokomeza kunena kuti kupambana kapena kulephera kwa EMR kumadalira kwambiri jakisoni wapafupi.
Pa zilonda zazing'ono, kuboola kumachitika kuyambira mbali ya chiberekero mpaka pansi pa chiberekero.
Pa zilonda zomwe zili m'mbali yokhota kapena m'mapiko, ngati jakisoni wapafupi wachitika kuchokera kumbali ya kumatako, nthawi zambiri zilondazo sizikudziwika bwino chifukwa zikuyang'ana mbali ya pakamwa, choncho jakisoni wapafupi uyenera kuyamba kuchokera kumbali ya pakamwa.
Zofunikira kwa Akatswiri a Endoscopy
Ngati madzi atuluka, kapena pali kukana kwakukulu panthawi yobayira, kapena palibe kukana madzi akalowa koma palibe kutupa, jakisoniyo iyenera kuyimitsidwa ndipo wogwiritsa ntchitoyo ayenera kudziwitsidwa za vutoli nthawi yomweyo kuti akambirane njira zothanirana nazo.
Kuchuluka kwa jakisoni, kumakhala bwino.
Njira yabwino ndi kupitiriza kubaya jakisoni momwe mungathere kudzera mu kubowola kamodzi mpaka chilonda chonsecho chitachotsedwa.
3. Malangizo posankha msampha
Ngati msampha uli ngati chozungulira chachitali, mucosa wamba pakamwa ndi mbali ya chotupacho ukhoza kulowetsedwa mosavuta komanso mosafunikira.
Msamphawu umakhala wozungulira kwambiri, wosavuta kutsegula mbali zonse, wosavuta kutsetsereka, ndipo uli ndi kulimba pang'ono kuti ukanikize pa chotupacho kuti ugwire chotupacho.
Kukula kwa msampha kuyenera kusinthidwa kuti kugwirizane ndi kukula kwa chotupacho.
Msampha Wochotsa Polypectomy Wotayika
Zitsanzo za EMR
a. Chithunzi cha kuwala koyera
Chilonda cha mtundu wa IIa cha 25 mm chokhala ndi gawo lapakati lofooka pang'ono.
b. Zithunzi za Narrow Band Imaging (NBI)
c. Kupopera indigo carmine kuti chithunzicho chikule
Zinapezeka kuti malo otsetsereka omwe amaoneka mwa kuwunika kwachikhalidwe kwenikweni anali mipata pakati pa masamba.
d. Chithunzi chokulitsidwa cha utoto wa kristalo violet
Kapangidwe ka dzenje la kutsegula kwa duct ya glandular m'mphepete mwa chotupacho chinali mtundu wa IV.
e. Chithunzi chokulitsidwa cha utoto wa kristalo violet
Pakati pa chilondacho panali VI, chosakhazikika pang'ono, ndipo palibe kufalikira kwa submucosal komwe kunapezeka.
f. Jakisoni wa m'deralo
Anaboola ndi kubaya jakisoni wapafupi pakati pa chotupacho, zomwe zinapangitsa kuti chiphuphu chituluke bwino.
g. Tsegulani msampha
Kanikizani nsonga ya snare pakhoma la m'matumbo kuti mutsegule snare.
h. Tsekani msampha
Tsekani msampha ndipo gwirani chotupacho.
i. Mphamvu yochotsera
Palibe chobowola, kutuluka magazi kapena chotupa chotsala chomwe chinapezeka.
j. Kukhazikitsa zitsanzo
Chitsanzo chochotsedwacho chinalumikizidwa pa pepala la rabala.
Kuzindikira matenda komaliza:khansa ya m'mimba (Tis)
4. Malangizo ogwiritsira ntchito msampha
Nsonga ya snare imayikidwa pang'onopang'ono pa mucosa wa mkamwa wa chotupacho, kenako imatsegulidwa pang'onopang'ono ndipo muzu wa snare umakanikizidwa kumbali ya ntchafu ya chotupacho. Kuti chotupacho chisawonekere bwino, muyenera kuyikamo mucosa wochepa wamba.
Dziwani kuti ngati nsonga ya msampha siikuwoneka, n'zotheka kuti mucosa yalowetsedwa bwino kuposa momwe mumayembekezera. Msampha ukamangidwa bwino, kankhirani ndikukoka dzanja lakunja la msampha kuti muwone kuyenda kwa chilondacho. Ngati chilowetsedwa mu minofu, kuyenda kwa chilondacho kudzachepa.
Malangizo a electroresection
Musakankhire chitsekocho pa khoma la matumbo, koma kwezani pang'ono chotupacho kuti muchotsedwe. Chiwopsezo cha kuboola mochedwa n'chochepa mukagwiritsa ntchito njira yochotsera opaleshoni yamagetsi, koma chingayambitse kutuluka magazi mkati mwa opaleshoni (mutangomaliza kuchotsa) magazi.
Kuchotsa mwachangu kwambiri kungayambitse kutuluka magazi, pomwe kuchotsa pang'onopang'ono kwambiri kungayambitse kubowoka mochedwa. Ngati wodwalayo akumva kupweteka, kapena wothandizira akumva kuti minofuyo ndi yotanuka ngati rabara ndipo ndi yovuta kudula, mwina minofuyo ili mu minofu, ndipo kuchotsako kuyenera kuyimitsidwa nthawi yomweyo.
Zofunikira kwa Akatswiri a Endoscopy
Ngati dokotala wa endoscopist akuona kuti minofuyo ndi yotanuka ngati rabala ndipo ndi yovuta kudula, ayenera kuuza dokotalayo nthawi yomweyo kuti akambirane njira zothanirana ndi vutoli.
Malangizo a Kudula EMR
Pa zilonda zazikulu, nthawi zina zimakhala bwino kuchotsa zilonda pang'ono m'malo mochotsa zilonda nthawi yomweyo. Komabe, zidutswa zambiri zikachuluka, mwayi woti zilonda zotsalazo zibwererenso m'malo mwake umakula. Ngakhale ndi EMR yochepa, kudula koyamba kuyenera kuchitidwa kwakukulu momwe kungathekere ndi msampha waukulu kuti muchepetse chiwerengero cha zidutswazo.
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Mphamvu za Biopsy:
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/
msampha wa polyp
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singano ya sclerotherapy
https://www.zrhendoscopy.com/gastroenterology-accessories-endoscopic-sclerotherapy-injection-needle-product/
Pukutani katheta
https://www.zrhendoscopy.com/ce-certified-disposable-endoscopic-spray-catheter-for-digestive-chromoendoscopy-product/
maburashi a cytology
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Chingwe chotsogolera
https://www.zrhendoscopy.com/gastrointestinal-endoscopic-ptfe-coated-ercp-hydrophilic-guidewire-product/
dengu lotengera miyala
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katheta yotulutsira madzi m'mphuno
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 yotumizira: Feb-13-2025