Chiyambi
Achalasia ya Cardia (AC) ndi matenda a mtimamatenda oyamba a m'mero.Chifukwa cha kusapumula bwino kwa sphincter ya m'munsi mwa esophageal (LES) komanso kusowa kwa peristalsis ya esophageal, kusunga chakudya kumabweretsaZizindikiro monga kutuluka magazi, kupweteka pachifuwa komanso kuchepa thupi.Kuchuluka kwa matendawa kuli pafupifupi 32.58/100,000.
ThechithandizoChithandizo cha achalasia chimaphatikizapo chithandizo chosagwiritsa ntchito opaleshoni, chithandizo chokulitsa mafupa ndi chithandizo cha opaleshoni.
01 Chithandizo cha Zamankhwala
Njira yogwiritsira ntchito mankhwala ndi kuchepetsa kuthamanga kwa magazi (LES) pakapita nthawi.Palibe umboni woonekeratu wosonyeza kuti mankhwala amatha kusintha zizindikiro za AC mosalekeza komanso moyenera.Mankhwala omwe amagwiritsidwa ntchito kwambiri masiku ano ndi monga nitrates, calcium channel blockers, ndi β-receptor agonists.
(1)Nitratesmonga nitroglycerin, amyl nitrate, ndi isosorbide dinitrate
(2)Zoletsa njira za calciummankhwala monga nifedipine, verapamil, ndi diltiazem
(3)β-receptor agonistsmonga cabuterol
02 Endoscopic Botulinum Toxin Injection (BTI)
Jakisoni wa poizoni wa botulinum (BTl) wopangidwa ndi endoscopic ungagwiritsidwe ntchito pochiza matenda a AC,koma imangopereka zotsatira za kanthawi kochepa ndipo ingagwiritsidwe ntchito kwa odwala okalamba omwe ali ndi chiopsezo chachikulu cha opaleshoni ndi mankhwala oletsa ululu.
1) Zizindikiro:odwala azaka zapakati ndi okalamba (opitirira zaka 40); omwe sangathe kulekerera endoscopic balloon dilation (PD) kapena chithandizo cha opaleshoni; omwe ali ndi chithandizo cha PD chambiri kapena zotsatira zoyipa za opaleshoni; omwe ali ndi kubowoka kwa m'mero panthawi ya chithandizo cha PD Kwa iwo omwe ali pachiwopsezo chachikulu, ingagwiritsidwenso ntchito limodzi ndi PD; ingagwiritsidwe ntchito ngati njira yosinthira ku opaleshoni kapena chithandizo cha PD.
(2) Zoletsa:Sikovomerezeka pochiza AC koyamba mwa odwala achichepere (azaka ≤40).
03 Kutambasula kwa Baluni ya Endoscopic (PD)
Kutambasuka kwa mabaluni kumakhudza AC, koma kumafuna chithandizo chambiri ndipo kumabweretsa mavuto aakulu.
(1) Zizindikiro:Odwala a AC omwe alibe vuto la mtima ndi mapapo, matenda otsekeka kwa magazi, ndi zina zotero; amuna azaka zopitilira 50 ndi akazi azaka zopitilira 35; odwala omwe alephera opaleshoni. Itha kugwiritsidwa ntchito ngati njira yoyamba yochizira.
(2) Zoletsa:Kulephera kugwira ntchito bwino kwa mtima ndi mapapo, kulephera kugwira bwino ntchito kwa magazi komanso chiopsezo chachikulu cha kuboola kwa m'mero.
04 Kutsegula M'mimba kwa M'kamwa (NDANDANDA)
M'zaka zaposachedwapa, chifukwa cha kugwiritsa ntchito kwambiri njira yochotsera AC myotomy (POEM), kuchuluka kwa chithandizo chamankhwala cha AC kwawonjezeka kwambiri.Chithandizo cha ndakatulo cha AC chikugwirizana kwambiri ndi lingaliro la "opaleshoni yocheperako kwambiri", kutanthauza kuti, zilonda zokha ndi zomwe zimachotsedwa/kuchotsedwa panthawi ya chithandizo, ndipo ziwalo sizichotsedwa.Kugwira ntchito bwino kwa kapangidwe ka thupi kumasungidwa, ndipo moyo wa wodwalayo pambuyo pa opaleshoni sumakhudzidwa kwenikweni. Kubwera kwa POEM kwapangitsa kuti chithandizo cha AC chisakhale chovuta kwambiri.
Chithunzi: Njira zochitira opaleshoni ya POEM
Kugwira ntchito kwapakati komanso kwa nthawi yayitali kwa POEM pochiza AC kumagwirizana ndi kwa laparoscopic Heller myotomy (LHM)ingagwiritsidwe ntchito ngati njira yoyamba yothandizira.Odwala ena akhoza kukhala ndi zizindikiro za reflux ya gastroesophageal pambuyo pa opaleshoni ya POEM
(1) Zizindikiro zenizeni:AC yopanda kumatirira kwambiri kwa submucosal, vuto la m'mimba lotulutsa madzi m'mimba komanso diverticulum yayikulu.
(2) Zizindikiro zofananira:Kutsekeka kwa m'mero, matenda a nutcracker esophagus ndi matenda ena oyenda m'mero, odwala omwe alephera opaleshoni ya POEM kapena Heller, komanso AC omwe ali ndi ma adhesion ena a submucosal esophageal.
(3) Zoletsa:Odwala omwe ali ndi vuto lalikulu la magazi otsekeka, matenda oopsa a mtima ndi mapapo, matenda osakhazikika, ndi zina zotero omwe sangathe kulekerera opaleshoni.
05Laparoscopic Heller Myotomy (LHM)
LHM ili ndi mphamvu yabwino kwa nthawi yayitali pochiza AC, ndipo kwenikweni yasinthidwa ndi POEM m'malo omwe zinthu zimalola.
06 Kuchotsa Misozi ya M'mimba mwa Opaleshoni
Ngati AC ikuphatikizidwa ndi stenosis ya m'munsi mwa mmero, zotupa, ndi zina zotero, opaleshoni ya esophagectomy ingaganizidwe.
Ife, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ndi opanga ku China omwe amagwira ntchito kwambiri pazinthu zogwiritsidwa ntchito m'ma endoscopic, mongamphamvu ya biopsy, hemoclip, msampha wa polyp, singano ya sclerotherapy, katheta wopopera, maburashi a cytology, waya wotsogolera, dengu lotengera miyala, katheta yotulutsira madzi m'mphunondi zina zotero zomwe zimagwiritsidwa ntchito kwambiri muEMR, ESD,ERCPZogulitsa zathu zili ndi satifiketi ya CE, ndipo mafakitale athu ali ndi satifiketi ya ISO. Katundu wathu watumizidwa ku Europe, North America, Middle East ndi mbali ina ya Asia, ndipo makasitomala ambiri amalandira ulemu ndi kutamandidwa!
Nthawi yotumizira: Julayi-09-2024