Mawu Oyamba
Zizindikiro zazikulu zotupa ndi magazi mu chopondapo, kupweteka kumatako, kugwa ndi kuyabwa, etc., zomwe zimakhudza kwambiri moyo.Woopsa milandu, zingachititse m'ndende zotupa ndi aakulu magazi m'thupi chifukwa cha magazi mu chopondapo.Pakalipano, chithandizo chamankhwala chokhazikika chimachokera ku mankhwala osokoneza bongo, ndipo chithandizo cha opaleshoni chimafunika pazovuta kwambiri.
Chithandizo cha Endoscopic ndi njira yochiritsira yomwe yangopangidwa kumene m'zaka zaposachedwa, yomwe ili yoyenera kwambiri zipatala zoyambira udzu.Lero, tifotokoza mwachidule ndikukonza.
1. Clinical matenda, thunthu ndi yapita mankhwala zotupa
Kuzindikira kwa Zotupa
Kuzindikira za zotupa makamaka zochokera mbiri, kuyendera, digito rectal kufufuza ndi colonoscopy.Pankhani ya mbiri yachipatala, m`pofunika kumvetsa ululu kumatako, magazi mu chopondapo, zotupa kumaliseche ndi kubwezeretsedwa, etc. The anayendera makamaka amamvetsa maonekedwe a zotupa, kaya pali kumatako fistula wa perianal kutupa, etc., ndi digito thumbo Kufufuza kumafunika kumvetsetsa kulimba kwa anus komanso ngati pali kutsekemera.Colonoscopy ayenera kudziwa matenda ena monga zotupa, ulcerative colitis, etc. kuti kumayambitsa magazi.Gulu ndi masanjidwe a zotupa
Pali mitundu itatu ya zotupa: zotupa zamkati, zotupa zakunja, ndi zotupa zosakanikirana.
Zotupa: Zotupa Zamkati, Zakunja, ndi Zosakanizika
Ma hemorrhoids amatha kugawidwa m'makalasi I, II, III, ndi IV.Imayikidwa molingana ndi kuchulukana, kutuluka kwa hemorrhoid ndikubwerera.
The zizindikiro endoscopic mankhwala ndi kalasi I, II, ndi III zotupa mkati, pamene kalasi IV zotupa mkati, zotupa kunja, ndi zotupa wosakanikirana ndi contraindications kwa endoscopic mankhwala.Mzere wogawa pakati pa chithandizo cha endoscopic ndi mzere wa mano.
Anatomy ya Zotupa
Mzere wa anal, dentate line, anal pad, ndi zotupa zotupa ndi mfundo zomwe akatswiri a endoscopists ayenera kuzidziwa.Chizindikiritso cha Endoscopic chimafuna chidziwitso.Mzere wa dentate ndi mphambano ya epithelium ya anal squamous epithelium ndi columnar epithelium, ndipo malo osinthira pakati pa mzere wa anal ndi mzere wa dentate amaphimbidwa ndi columnar epithelium koma osasungidwa ndi thupi.Chifukwa chake, chithandizo cha endoscopic chimakhazikitsidwa pamzere wamano.Chithandizo cha endoscopic chikhoza kuchitidwa mkati mwa mzere wa dentate, ndipo chithandizo cha endoscopic sichingachitike kunja kwa mzere wa mano.
Chithunzi 1.Kuwonekera kutsogolo kwa mzere wa dentate pansi pa endoscope.Muvi wachikasu umaloza pamzere wa serrated annular dentate, muvi woyera umaloza kugawo la kumatako ndi netiweki yake yautali wamtima, ndipo muvi wofiyira umaloza ku valavu yamatako.
1A:chithunzi chowala choyera;1B:Narrowband Light Imaging
Chithunzi 2Kuyang'ana nthiti ya kumatako (muvi wofiyira) ndi kumapeto kwa mzati wakuthako (muvi woyera) motsatira maikulosikopu.
Chithunzi 3Kuyang'ana papilla yakuthako pamodzi ndi maikulosikopu (muvi wachikasu)
Chithunzi 4.Mzere wa anal ndi dentate mzere unkawonedwa ndi reverse endoscopy.Muvi wachikasu umaloza pamzere wa dentate, ndipo muvi wakuda umaloza pamzere wakuthako.
Mfundo za papilla yamatako ndi nyundo zimagwiritsidwa ntchito kwambiri popanga opaleshoni ya anorectal ndipo sizidzabwerezedwa pano.
Chithandizo cha classic cha zotupa:pali makamaka ndiwofatsa chithandizo ndi mankhwala opaleshoni.Chithandizo chodziletsa chimaphatikizapo kugwiritsa ntchito mankhwala osokoneza bongo komanso kusamba kwa sitz, ndipo maopaleshoni makamaka amaphatikizapo hemorrhoidectomy ndi stapled excision (PPH).Chifukwa chithandizo cha opaleshoni ndi chapamwamba kwambiri, zotsatira zake zimakhala zokhazikika, ndipo chiopsezo ndi chochepa, wodwalayo ayenera kugonekedwa m'chipatala kwa masiku 3-5.
2. Endoscopic chithandizo cha zotupa mkati
Kusiyana pakati pa chithandizo cha endoscopic cha zotupa zamkati ndi chithandizo cha EGV:
Cholinga cha endoscopic chithandizo cha mitsempha ya esophagogastric ndi mitsempha ya varicose, ndipo chandamale cha mankhwala otupa mkati si mitsempha yamagazi, koma zotupa zomwe zimapangidwa ndi mitsempha yamagazi ndi minofu yolumikizana.Chithandizo cha zotupa ndikuchepetsa zizindikiro, kukweza thako lakuthako lomwe limasunthira pansi, ndikupewa zovuta monga stenosis ya kumatako chifukwa cha kutha kwa zotupa (mfundo yoti "kupha chilichonse" imakonda kudwala stenosis).
Cholinga cha endoscopic chithandizo: Kuchepetsa kapena kuthetsa zizindikiro, osati kuchotsa zotupa.
Endoscopic chithandizo chimaphatikizaposclerotherapyndibanda ligation.
Pozindikira ndi kuchiza zotupa zamkati, colonoscopy imagwiritsidwa ntchito pofufuza, ndipo gastroscope ikulimbikitsidwa kuti ichiritsidwe.Kuphatikiza apo, malinga ndi momwe chipatala chilichonse chilili, mutha kusankha chithandizo chakunja kapena chachipatala.
① Sclerotherapy (mothandizidwa ndi kapu yowonekera)
The sclerosing jekeseni ndi lauryl mowa jakisoni, ndipo thovu lauryl mowa jakisoni angagwiritsidwenso ntchito.Ndikofunikiranso kugwiritsa ntchito jekeseni wa submucosal wa methylene buluu ngati wothandizira wosowa kuti amvetsetse komwe kumayenda komanso kufalikira kwa sclerosing agent.
Cholinga cha kapu yowonekera ndikukulitsa gawo la masomphenya.Singano ya jakisoni imatha kusankhidwa kuchokera ku singano wamba wa mucosal.Nthawi zambiri, kutalika kwa singano ndi 6mm.Madokotala omwe sadziwa zambiri ayesetse kupewa kubayidwa kwa singano zazitali, chifukwa jakisoni wa singano wautali nthawi zambiri amakhala ndi jakisoni wa ectopic ndi jakisoni.Chiwopsezo chozama ndikuyambitsa matumbo a perianal ndi kutupa.
Malo a jakisoni amasankhidwa pamwamba pa mbali yapakamwa ya mzere wa dentate, ndipo malo a singano a jakisoni ali pamunsi pa chandamale cha hemorrhoid.Singano imalowetsedwa pa 30 ° ~ 40 ° pansi pa masomphenya achindunji (kutsogolo kapena kumbuyo) kwa endoscope, ndipo singanoyo imalowetsedwa mozama m'munsi mwa chotupa.Pangani mulu wowuma m'munsi mwa chotupacho, chotsani singanoyo pobaya, pafupifupi 0.5 ~ 2mL, ndipo siyani jekeseniyo mpaka chotupacho chikhale chachikulu ndi choyera.Jekeseni akatha, onani ngati pali magazi pamalo obaya jekeseni.
Endoscopic sclerotherapy imaphatikizapo jakisoni wagalasi wakutsogolo ndi jekeseni wopindika wagalasi.Nthawi zambiri, inverted galasi jakisoni ndiyo njira yayikulu.
② mankhwala bandeji
Nthawi zambiri, chipangizo cholumikizira ma mphete ambiri chimagwiritsidwa ntchito, osapitilira mphete zisanu ndi ziwiri.Kulumikizana kumachitidwa pa 1 mpaka 3 masentimita pamwamba pa mzere wa dentate, ndipo kugwirizanitsa kumayambira pafupi ndi mzere wa anal.Kungakhale vascular ligation kapena mucosal ligation kapena kuphatikiza ligation.Inverted mirror ligation ndiyo njira yayikulu, nthawi zambiri 1-2, ndi nthawi ya mwezi umodzi.
Perioperative chithandizo: kusala kudya sikufunika pambuyo opaleshoni, kukhala yosalala chopondapo, ndi kupewa kukhala nthawi yaitali ndi ntchito zolemetsa thupi.Kugwiritsa ntchito maantibayotiki pafupipafupi sikofunikira.
3. Zomwe zikuchitika komanso mavuto omwe alipo a zipatala zapansi panthaka
M'mbuyomu, udindo waukulu zochizira zotupa anali mu anorectal dipatimenti.Chithandizo chamankhwala mu dipatimenti ya anorectal chimaphatikizapo mankhwala ochiritsira, jekeseni wa sclerotherapy, ndi chithandizo cha opaleshoni.
Madokotala a m'mimba sakhala odziwa zambiri pakuzindikiritsa anatomy ya perianal pansi pa endoscopy, ndipo zisonyezo za chithandizo cha endoscopic ndizochepa (zotupa zamkati zokha zimatha kuthandizidwa).Kuchita opaleshoni kumafunikanso kuti munthu ayambe kuchira, zomwe zakhala zovuta kwambiri pakukula kwa polojekitiyi.
M'maganizo, endoscopic mankhwala a zotupa mkati makamaka oyenera zipatala pulayimale, koma kuchita, si monga momwe ankaganizira.
Ife, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ndi opanga ku China okhazikika pazakudya zama endoscopic, mongabiopsy forceps, hemoclip, polyp msampha, sclerotherapy singano, kupopera catheter, maburashi a cytology, guidewire, dengu lochotsa miyala, catheter ya nasal biliary drainageetc. omwe amagwiritsidwa ntchito kwambiri muEMR, ESD, 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!
Nthawi yotumiza: Jul-11-2022