Mawu Oyamba
Achalasia of cardia (AC) ndimatenda oyamba a esophageal motility.Chifukwa chosapumula bwino kwa m'munsi esophageal sphincter (LES) komanso kusowa kwa esophageal peristalsis, kusunga chakudya kumabweretsadysphagia ndi zochita. Zizindikiro zachipatala monga magazi, kupweteka pachifuwa ndi kuwonda.Kufalikira kuli pafupifupi 32.58/100,000.
Thechithandizocha achalasia makamaka chimaphatikizapo chithandizo chosapanga opaleshoni, chithandizo cha dilation ndi chithandizo cha opaleshoni.
01Chithandizo cha Zamankhwala
Njira yothandizira mankhwala ndikuchepetsa kupanikizika kwa LES pakanthawi kochepa.Palibe umboni wodziwikiratu kuti mankhwala amatha kuwongolera mosalekeza komanso moyenera zizindikiro za AC.Masiku ano mankhwala omwe amagwiritsidwa ntchito kwambiri ndi ma nitrates, calcium channel blockers, ndi β-receptor agonists.
(1)Nitrates, monga nitroglycerin, amyl nitrate, ndi isosorbide dinitrate
(2)Calcium channel blockers, monga nifedipine, verapamil, ndi diltiazem
(3)β-receptor agonists, monga cabuterol
02Endoscopic Botulinum Toxin Injection (BTI)
Endoscopic botulinum jekeseni wa poizoni (BTl) angagwiritsidwe ntchito pochiza AC,koma ikhoza kupereka zotsatira za nthawi yochepa ndipo ingagwiritsidwe ntchito kwa odwala okalamba omwe ali ndi chiopsezo chachikulu cha opaleshoni ndi anesthesia.
1) Zizindikiro:odwala azaka zapakati ndi okalamba (> zaka 40); omwe sangathe kulekerera endoscopic balloon dilation (PD) kapena chithandizo cha opaleshoni; omwe ali ndi chithandizo chambiri cha PD kapena zotsatira zoyipa za opaleshoni; omwe ali ndi zotupa zam'mimba panthawi ya chithandizo cha PD Kwa omwe ali pachiwopsezo chachikulu, itha kugwiritsidwanso ntchito kuphatikiza ndi PD; itha kugwiritsidwa ntchito ngati kusintha kwa opaleshoni kapena chithandizo cha PD.
(2) Contraindications:Ndizosavomerezeka chithandizo choyambirira cha AC mwa odwala achichepere (≤40 wazaka).
03 Endoscopic Balloon Dilation (PD)
Kutanuka kwa baluni kumakhala ndi zotsatira zina pa AC, koma kumafuna chithandizo chambiri ndipo kumabweretsa zovuta zazikulu.
(1) Zizindikiro:Odwala AC opanda cardiopulmonary insufficiency, coagulation kukanika, etc.; amuna opitirira zaka 50 ndi akazi opitirira zaka 35; odwala amene alephera opaleshoni. Itha kugwiritsidwa ntchito ngati njira yoyamba yochizira.
(2) Contraindications:Kulephera kwakukulu kwa cardiopulmonary, coagulation dysfunction komanso chiopsezo chachikulu cha kuphulika kwa esophageal.
04Peroral Endoscopic Myotomy (POEM)
M'zaka zaposachedwa, ndi kukhazikitsidwa kwakukulu kwa peroral endoscopic myotomy (POEM), kupambana kwa chithandizo chamankhwala cha AC chawonjezeka kwambiri.Thandizo la POEM la AC limagwirizana kwambiri ndi lingaliro la "opaleshoni yapamwamba yochepetsetsa", ndiko kuti, zotupa zokha zimachotsedwa / kuchotsedwa panthawi ya chithandizo, ndipo ziwalo sizimachotsedwa.Umphumphu ndi magwiridwe antchito a mawonekedwe a anatomical amasungidwa, ndipo moyo wapambuyo wa wodwalayo sukhudzidwa kwenikweni. Kutuluka kwa POEM kwapangitsa kuti chithandizo cha AC chikhale chovuta kwambiri.
Chithunzi: Masitepe opangira POEM
Kuchita bwino kwapakati ndi nthawi yayitali kwa POEM pochiza AC kumagwirizana ndi laparoscopic Heller myotomy (LHM)angagwiritsidwe ntchito ngati njira yoyamba yothandizira.Odwala ena amatha kukhala ndi zizindikiro za gastroesophageal reflux pambuyo pa opaleshoni ya POEM
(1) Zizindikiro zenizeni:AC yopanda kumatira kwambiri kwa submucosal, vuto lotulutsa m'mimba komanso diverticulum yayikulu.
(2) Zizindikiro zofananira:Kufalikira kwa esophageal spasm, nutcracker esophagus ndi matenda ena a esophageal motility, odwala omwe adalephera POEM kapena Opaleshoni ya Heller, ndi AC yokhala ndi zomatira za esophageal submucosal.
(3) Contraindications:Odwala kwambiri coagulation kukanika, kwambiri cardiopulmonary matenda, osauka ambiri chikhalidwe, etc. amene sangathe kulekerera opaleshoni.
05Laparoscopic Heller Myotomy (LHM)
LHM ili ndi nthawi yabwino yochizira AC, ndipo m'malo mwake yasinthidwa ndi POEM m'malo omwe zinthu zimaloleza.
06 Opaleshoni Esophagectomy
Ngati AC ikuphatikizidwa ndi kutsika kwa esophageal scar stenosis, zotupa, ndi zina zotero, opaleshoni ya esophagectomy ingaganizidwe.
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Nthawi yotumiza: Jul-09-2024