I. Ukulungiselela isiguli
1. Qonda indawo, uhlobo, usayizi kanye nokubhoboka kwezinto zakwamanye amazwe
Thatha ama-X-ray noma ama-CT scan ajwayelekile entanyeni, esifubeni, ekubukeni kwe-anteroposterior kanye ne-lateral, noma esiswini njengoba kudingeka ukuze uqonde indawo, uhlobo, ukuma, usayizi, kanye nokuba khona kokubhoboka komzimba wangaphandle, kodwa ungenzi ukuhlolwa kwe-barium swallow.
2. Isikhathi sokuzila ukudla kanye nesikhathi sokuzila ukudla emanzini
Ngokuvamile, iziguli zizila ukudla amahora angu-6 kuya kwangu-8 ukuze zikhiphe konke okusesiswini, futhi isikhathi sokuzila ukudla kanye nesikhathi sokuzila ukudla emanzini singakhululeka ngokufanele ukuze kwenziwe i-gastoscopy ephuthumayo.
3. Usizo lwe-anesthesia
Izingane, labo abanezinkinga zengqondo, labo abangasebenzisani kahle, noma labo abanemizimba yangaphandle eboshiwe, imizimba emikhulu yangaphandle, imizimba eminingi yangaphandle, imizimba yangaphandle ebukhali, noma ukuhlinzwa kwe-endoscopic okunzima noma okuthatha isikhathi eside kufanele kuhlinzwe ngaphansi kwe-anesthesia ejwayelekile noma i-endotracheal intubation ngosizo lodokotela we-anesthesiologist. Susa izinto zangaphandle.
II. Ukulungiselela imishini
1. Ukukhetha i-Endoscope
Zonke izinhlobo ze-gastroscopy yokubuka phambili ziyatholakala. Uma kulinganiselwa ukuthi kunzima ukususa umzimba wangaphandle noma umzimba wangaphandle mkhulu, kusetshenziswa i-gastroscopy yokuhlinzwa enamachweba amabili. Ama-Endoscope anobubanzi obuncane bangaphandle angasetshenziswa ezinsaneni nasezinganeni ezincane.
2. Ukukhethwa kwama-forceps
Ngokuyinhloko kuncike ngobukhulu kanye nesimo somzimba wangaphandle. Izinsimbi ezisetshenziswa kakhulu zifaka phakathi i-biopsy forceps, i-snare, i-three-jaw forceps, i-flat forceps, i-foreign body forceps (i-rat-tooth forceps, i-jaw-mouth forceps), ubhasikidi wokususa itshe, isikhwama senethi sokususa itshe, njll.
Ukukhetha ithuluzi kunganqunywa ngokusekelwe kusayizi, ukuma, uhlobo, njll. komzimba wangaphandle. Ngokusho kwemibiko yezincwadi, ama-forcep amazinyo egundane yiwona asetshenziswa kakhulu. Izinga lokusetshenziswa kwama-forcep amazinyo egundane lingu-24.0% ~ 46.6% wazo zonke izinsimbi ezisetshenziswayo, kanti ama-snare abiza u-4.0% ~ 23.6%. Ngokuvamile kukholelwa ukuthi ama-snare angcono emizimbeni emide yangaphandle efana nenduku. Njenge-thermometer, ama-brushbrush, izinti zomqalo, amapeni, izipuni, njll., kanye nendawo yokugcina embozwe yi-snare akufanele idlule u-1cm, ngaphandle kwalokho kuzoba nzima ukuphuma e-cardia.
2.1 Imizimba yangaphandle efana nenduku kanye nemizimba yangaphandle eyindilinga
Ezintweni zangaphandle ezimise okwenduku ezinobuso obubushelelezi kanye nobubanzi obuncane bangaphandle njengezinti zokuxubha, kulula kakhulu ukukhetha izinti ezinemihlathi emithathu, izinti zamazinyo ezithambile, izinti ezisicaba, njll.; ezintweni zangaphandle eziyindilinga (njengezinsika, amabhola engilazi, amabhethri ezinkinobho, njll.), sebenzisa ibhasikidi lokususa itshe noma isikhwama senethi sokususa itshe ukuze uzisuse Kunzima kakhulu ukuzisusa.
2.2 Imizimba emide ebukhali yangaphandle, amaqoqo okudla, namatshe amakhulu esiswini
Kuma-extrabody abukhali angaphandle, i-axis ende yomzimba wangaphandle kufanele ihambisane ne-axis ende ye-lumen, lapho i-edge ebukhali noma i-edge evulekile ibheke phansi, bese ihoxa ngenkathi ifaka umoya. Kuma-extrabody abukeka njengendandatho noma ama-extrabody anezimbobo, kuphephile ukusebenzisa indlela yokufaka intambo ukuze uwasuse;
Uma kutholakala amaqoqo okudla namatshe amakhulu esiswini, ama-bite forceps angasetshenziswa ukuwachoboza bese esuswa nge-forceps enemihlathi emithathu noma i-snare.
3. Imishini yokuvikela
Sebenzisa amadivayisi okuvikela ngangokunokwenzeka ezintweni zangaphandle okunzima ukuzisusa futhi eziyingozi. Njengamanje, amadivayisi okuvikela asetshenziswa kakhulu afaka izivalo ezibonakalayo, amashubhu angaphandle, kanye nezembozo zokuvikela.
3.1 Isivalo esibonakalayo
Ngesikhathi sokususwa komzimba wangaphandle, kufanele kusetshenziswe isivalo esibonakalayo ekugcineni kwelensi ye-endoscopic ngangokunokwenzeka ukuvimbela i-mucosa ukuthi ingaklwebhiswa umzimba wangaphandle, nokwandisa umphimbo ukunciphisa ukumelana okutholakala lapho umzimba wangaphandle ukhishwa. Kungasiza futhi ekubambeni nasekukhipheni umzimba wangaphandle, okuwusizo ekususweni komzimba wangaphandle.
Kubantu abangaphandle abanesimo semicu abafakwe ku-mucosa kuzo zombili izinhlangothi zomhubhe, isivalo esibonakalayo singasetshenziswa ukusunduza ngobumnene i-mucosa yomphimbo nxazonke komunye umkhawulo womzimba wangaphandle ukuze omunye umkhawulo womzimba wangaphandle uphume odongeni lomphimbo ukuze kugwenywe ukubhoboka komphimbo okubangelwa ukususwa okuqondile.
Isivalo esibonakalayo singanikeza isikhala esanele sokusebenza kwethuluzi, okulula ukutholakala nokususwa kwezidumbu zangaphandle engxenyeni encane yentamo yomphimbo.
Ngesikhathi esifanayo, isivalo esibonakalayo singasebenzisa ukumunca umfutho ongemuhle ukusiza ukumunca amaqoqo okudla futhi kube lula ukucutshungulwa okulandelayo.
3.2 Ibhokisi langaphandle
Ngenkathi ivikela umphimbo kanye ne-mucosa yokuhlangana komphimbo nesisu, ithubhu yangaphandle yenza kube lula ukususwa kwemizimba emide, ebukhali, neyangaphandle nge-endoscopic kanye nokususwa kwamaqoqo okudla, ngaleyo ndlela kuncishiswe ukwanda kwezinkinga ngesikhathi sokususwa komzimba wangaphandle wesisu. Yandisa ukuphepha nokusebenza kahle kokwelashwa.
Ama-overtubes awavamile ukusetshenziswa ezinganeni ngenxa yengozi yokulimaza umphimbo ngesikhathi sokufakwa.
3.3 Isembozo esivikelayo
Beka isembozo sokuvikela sibheke phansi engxenyeni engaphambili ye-endoscope. Ngemva kokubopha into yangaphandle, phendula isembozo sokuvikela bese usonga into yangaphandle uma ukhipha i-endoscope ukuze ugweme izinto zangaphandle.
Ihlangana nolwelwesi lwamafinyila lomgudu wokugaya ukudla futhi idlala indima yokuvikela.
4. Izindlela zokwelapha izinhlobo ezahlukene zezidumbu zangaphandle endaweni engenhla yokugaya ukudla
4.1 Ukudla okunesisindo esiphansi emphinjeni
Imibiko iphakamisa ukuthi iningi lokudla okuncane ku-esophagus lingacindezelwa kancane esiswini bese lishiywa ukuze likhishwe ngokwemvelo, okulula, okulula futhi okungenakwenzeka ukuthi kubangele izinkinga. Ngesikhathi senqubo yokuthuthuka kwe-gastroscopy, i-inflation efanele ingafakwa ku-lumen ye-esophagus, kodwa ezinye iziguli zingase zihambisane nezimila ezimbi zomsipha noma i-post-esophagus anastomotic stenosis (Isithombe 1). Uma kukhona ukumelana futhi ucindezela ngamandla, ukusebenzisa ingcindezi enkulu kuzokwandisa ingozi yokubhoboka. Kunconywa ukusebenzisa ubhasikidi wenethi wokususa itshe noma isikhwama senethi sokususa itshe ukuze ususe ngqo umzimba wangaphandle. Uma i-bolus yokudla inkulu, ungasebenzisa ama-forceps omzimba wangaphandle, izithiyo, njll. ukuze uyihlanganise ngaphambi kokuyihlukanisa. Yikhiphe.
Isithombe 1 Ngemva kokuhlinzwa komdlavuza womphimbo, isiguli sasihambisana nokuqina komphimbo kanye nokugcinwa kwe-food bolus.
4.2 Izinto zangaphandle ezimfushane nezibuthuntu
Iningi lemizimba yangaphandle emifushane nebuthuntu ingasuswa ngezindlamzimba zangaphandle, izingibe, obhasikidi bokususa amatshe, izikhwama zamanethi zokususa amatshe, njll. (Isithombe 2). Uma umzimba wangaphandle emhubheni kunzima ukuwususa ngqo, ungacindezelwa esiswini ukuze ulungise indawo yawo bese uzama ukuwususa. Imizimba yangaphandle emifushane, ebuthuntu enobubanzi obungu->2.5 cm esiswini kunzima kakhulu ukuyidlula nge-pylorus, futhi ukungenelela kwe-endoscopic kufanele kwenziwe ngokushesha okukhulu; uma imizimba yangaphandle enobubanzi obuncane esiswini noma e-duodenum ingakhombisi umonakalo wesisu, ingalinda ukukhishwa kwayo kwemvelo. Uma ihlala isikhathi esingaphezu kwamasonto angu-3-4 futhi ingakakhishwa, kumele isuswe nge-endoscopic.
Umfanekiso 2 Izinto zangaphandle zepulasitiki nezindlela zokususa
4.3 Izinhlangano zakwamanye amazwe
Izinto zangaphandle ezinobude obungu-≥6 cm (njenge-thermometer, amabhulashi amazinyo, izinti zomqalo, amapeni, izipuni, njll.) akulula ukuzikhipha ngokwemvelo, ngakho-ke zivame ukuqoqwa ngebhasikidi elinogibe noma lamatshe.
Ugibe lungasetshenziswa ukumboza uhlangothi olulodwa (kungabi ngaphezu kwe-1 cm ukusuka ekugcineni), bese lufakwa esivalweni esibonakalayo ukuze lukhishwe. Idivayisi yangaphandle ye-cannula ingasetshenziswa futhi ukubamba umzimba wangaphandle bese ibuyela emuva kahle ku-cannula yangaphandle ukuze kugwenywe ukulimaza i-mucosa.
4.4 Izinto ezibukhali zakwamanye amazwe
Izinto ezibukhali zangaphandle ezifana namathambo enhlanzi, amathambo enkukhu, amazinyo okufakelwa, ama-date pit, amazinyo okuxubha, iziqeshana zamaphepha, ama-razor blades, kanye nezimbozo zebhokisi lamaphilisi (Isithombe 3) kufanele zinikezwe ukunakwa okwanele. Izinto ezibukhali zangaphandle ezingalimaza kalula ulwelwesi lwamafinyila kanye nemithambo yegazi futhi ziholele ezinkingeni ezifana nokubhoboka kufanele ziphathwe ngokucophelela. Ukuphathwa kwe-endoscopic okuphuthumayo.
Umfanekiso 3 Izinhlobo ezahlukene zezinto ezibukhali zakwamanye amazwe
Uma kususwa izidumbu zangaphandle ezibukhali ngaphansi komkhawuloI-scope, kulula ukuklwebha ulwelwesi lomgudu wokugaya ukudla. Kunconywa ukusebenzisa isivalo esibonakalayo, esingaveza ngokuphelele i-lumen futhi sigweme ukuklwebha udonga. Zama ukuletha ingxenye engabonakali yomzimba wangaphandle eduze nengxenye yelensi ye-endoscopic ukuze kubekwe ingxenye eyodwa yomzimba wangaphandle. Yifake esivaloni esibonakalayo, sebenzisa ama-forceps omzimba wangaphandle noma i-snare ukuze ubambe umzimba wangaphandle, bese uzama ukugcina i-axis ende yomzimba wangaphandle ihambisana ne-esophagus ngaphambi kokuhoxa esibukweni. Imizimba yangaphandle efakwe ohlangothini olulodwa lwe-esophagus ingasuswa ngokubeka isivalo esibonakalayo engxenyeni engaphambili ye-endoscope bese ungena kancane kancane endaweni yokungena ye-esophagus. Emizimbeni yangaphandle efakwe emgodini we-esophagus kuzo zombili izinhlangothi, ingxenye engezansi efakwe kufanele ikhululwe kuqala, ngokuvamile ohlangothini oluseduze, khipha enye ingxenye, lungisa indlela yento yangaphandle ukuze ingxenye eyinhloko ifakwe esivaloni esibonakalayo, bese uyikhipha. Noma ngemva kokusebenzisa ummese we-laser ukusika umzimba wangaphandle phakathi, okuhlangenwe nakho kwethu ukukhulula i-aorta arch noma uhlangothi lwenhliziyo kuqala, bese silususa ngezigaba.
a. Amazinyo okufakelwa: Uma udla, ukhwehlela, noma ukhulumag, iziguli zingase ziwe ngengozi emazinyweni azo okufakelwa, bese zingena emgudwini ongaphezulu wokugaya ukudla ngokugwinya. Amazinyo okufakelwa abukhali anezikhonkwane zensimbi kuzo zombili izinhlangothi kulula ukuwafaka ezindongeni zomgudwini wokugaya ukudla, okwenza ukususwa kube nzima. Ezigulini ezihluleka ukwelashwa okuvamile kwe-endoscopic, amathuluzi amaningi okubopha angasetshenziswa ukuzama ukususa ngaphansi kwe-endoscopy yeziteshi ezimbili.
b.Imigodi yedethi: Imigodi yedethi efakwe emhubheni ivame ukuba bukhali kuzo zombili izinhlangothi, okungaholela ezinkingeni ezifana nokulimala kwe-mucosale, ukopha, ukutheleleka kwendawo okubangela ukushaqeka kanye nokubhoboka esikhathini esifushane, futhi kufanele kwelashwe ngokwelashwa okuphuthumayo kwe-endoscopic (Isithombe 4). Uma kungekho ukulimala kwesisu, iningi lamatshe e-date esiswini noma e-duodenum lingakhishwa zingakapheli amahora angu-48. Labo abangakwazi ukukhishwa ngokwemvelo kufanele basuswe ngokushesha okukhulu.
Umfanekiso 4 Ingqikithi yeJujube
Ngemva kwezinsuku ezine, isiguli satholakala sinomzimba wangaphandle kwesinye isibhedlela. I-CT yabonisa umzimba wangaphandle emhubheni onezimbobo. Ama-jujube cores abukhali kuzo zombili izinhlangothi asuswa nge-endoscopy futhi kwenziwa i-gastoscopy futhi. Kwatholakala ukuthi i-fistula yakheka odongeni lomhubhe.
4.5 Izinto ezinkulu zakwamanye amazwe ezinemiphetho emide kanye nemiphetho ebukhali (Isithombe 5)
a. Faka ithubhu langaphandle ngaphansi kwe-endoscope: Faka i-gastroscope kusukela maphakathi nethubhu langaphandle, ukuze umkhawulo ongezansi wethubhu langaphandle usondele onqenqemeni olungaphezulu lwengxenye egobile ye-gastroscope. Faka i-gastroscope njalo eduze komzimba wangaphandle. Faka amathuluzi afanele ngethubhu ye-biopsy, njenge-snares, i-forceps yomzimba wangaphandle, njll. Ngemva kokubamba into yangaphandle, yifake ethubhu langaphandle, bese yonke idivayisi izophuma kanye nesibuko.
b. Isembozo sokuvikela ulwelwesi lwamafinyila esenziwe ekhaya: Sebenzisa isembozo sesithupha samagilavu enjoloba yezokwelapha ukwenza isembozo sokuvikela esingaphambili se-endoscope esenziwe ekhaya. Sika eceleni kwempande yesithupha segilavu sibe yisimo secilongo. Sika imbobo encane esihlokweni somunwe, bese udlulisa ingxenye engaphambili yomzimba wesibuko ngembobo encane. Sebenzisa indandatho encane yerabha ukuyilungisa ibanga elingamasentimitha ayi-1.0 ukusuka engxenyeni engaphambili ye-gastroscope, uyibuyisele engxenyeni engenhla ye-gastroscope, bese uyithumela kanye ne-gastroscope emzimbeni wangaphandle. Bamba umzimba wangaphandle bese uwukhipha kanye ne-gastroscope. Isikhwama sokuvikela sizohamba ngokwemvelo siye emzimbeni wangaphandle ngenxa yokumelana. Uma indlela iqondiswa emuva, izogoqwa ngezinto zangaphandle ukuze ivikelwe.
Umfanekiso 5: Amathambo enhlanzi abukhali asusiwe nge-endoscopically, anemihuzuko ye-mucosal
4.6 Izinto zangaphandle zensimbi
Ngaphezu kwama-forcep avamile, imizimba yangaphandle yensimbi ingasuswa ngokumunca nge-magnetic body forceps. Imizimba yangaphandle yensimbi eyingozi kakhulu noma enzima ukuyisusa ingelashwa nge-endoscopically ngaphansi kwe-X-ray fluoroscopy. Kunconywa ukusebenzisa ubhasikidi wokususa itshe noma isikhwama senethi sokususa itshe.
Izinhlamvu zemali zivame kakhulu phakathi kwemizimba yangaphandle emgudwini wokugaya ukudla kwezingane (Isithombe 6). Nakuba izinhlamvu zemali eziningi emgudwini wokugaya ukudla zingadluliswa ngokwemvelo, ukwelashwa nge-endoscopic okukhethwayo kuyanconywa. Ngenxa yokuthi izingane azibambisani kangako, ukususwa kwemizimba yangaphandle e-endoscopic ezinganeni kwenziwa kangcono ngaphansi kwe-anesthesia ejwayelekile. Uma uhlamvu lwemali kunzima ukulususa, lungafakwa esiswini bese lukhishwa. Uma kungekho zimpawu esiswini, ungalinda ukuthi lukhishwe ngokwemvelo. Uma uhlamvu lwemali luhlala isikhathi esingaphezu kwamasonto ama-3-4 futhi lungakhishwa, kumele luphathwe nge-endoscopic.
Umfanekiso 6 Uhlamvu lwensimbi olungaphandle kwezinto zangaphandle
4.7 Izinto zangaphandle ezonakalisayo
Imizimba yangaphandle egqwalisayo ingabangela kalula umonakalo endleleni yokugaya ukudla noma ngisho ne-necrosis. Ukwelashwa okuphuthumayo kwe-endoscopic kuyadingeka ngemva kokuxilongwa. Amabhethri ayimizimba yangaphandle egqwalisayo evame kakhulu futhi avame ukuvela ezinganeni ezingaphansi kweminyaka emi-5 ubudala (Isithombe 7). Ngemva kokulimaza i-esophagus, angabangela i-stenosis ye-esophagus. I-Endoscopy kumele ihlolwe zingakapheli amasonto ambalwa. Uma kwakheka i-stricture, i-esophagus kufanele ivulwe ngokushesha okukhulu.
Umfanekiso 7 Into yangaphandle ebhethrini, umcibisholo obomvu ubonisa indawo yento yangaphandle
4.8 Izinto zangaphandle ezisebenzisa ugesi
Uma kunemizimba eminingi yakwamanye amazwe enezibuthe noma imizimba yakwamanye amazwe enezibuthe ehlanganiswe nensimbi endaweni ephezulu yokugaya ukudla, izinto ziyadonselana futhi zicindezele izindonga zomgudu wokugaya ukudla, okungabangela kalula i-ischemic necrosis, ukwakheka kwe-fistula, ukubhoboka, ukuvaleka, i-peritonitis kanye nokunye ukulimala okukhulu kwesisu. , okudinga ukwelashwa okuphuthumayo kwe-endoscopic. Izinto zakwamanye amazwe ezinezibuthe kufanele zisuswe ngokushesha okukhulu. Ngaphezu kwe-forceps evamile, imizimba yakwamanye amazwe enezibuthe ingasuswa ngaphansi kokumuncwa nge-forceps yakwamanye amazwe enezibuthe.
4.9 Izidumbu zangaphandle esiswini
Iningi lazo yizibani zokukhanyisa, izintambo zensimbi, izipikili, njll. ezigwinywa ngamabomu yiziboshwa. Iningi lezidumbu zangaphandle zinde futhi zinkulu, kunzima ukudlula e-cardia, futhi zingaklwebha kalula ulwelwesi lwamafinyila. Kunconywa ukusebenzisa amakhondomu ahlanganiswe ne-forceps yamazinyo egundane ukususa izidumbu zangaphandle ngaphansi kokuhlolwa kwe-endoscopic. Okokuqala, faka i-forceps yamazinyo egundane engxenyeni engaphambili ye-endoscope ngembobo ye-biopsy ye-endoscopic. Sebenzisa i-forceps yamazinyo egundane ukubopha indandatho yerabha engezansi kwekhondomu. Bese, buyisela i-forceps yamazinyo egundane ngasembobeni ye-biopsy ukuze ubude bekhondomu buvezwe ngaphandle kwembobo ye-biopsy. Yehlisa ngangokunokwenzeka ngaphandle kokuthinta insimu yokubuka, bese uyifaka emgodini wesisu kanye ne-endoscope. Ngemva kokuthola umzimba wangaphandle, faka umzimba wangaphandle kwikhondomu. Uma kunzima ukuwususa, faka ikhondomu emgodini wesisu, bese usebenzisa i-forceps yamazinyo egundane ukubopha umzimba wangaphandle bese uwufaka. Ngaphakathi kwekhondomu, sebenzisa izinti zezinyo zegundane ukubopha ikhondomu bese uyikhipha kanye nesibuko.
4.10 Amatshe esiswini
Ama-gastrolith ahlukaniswe ngama-gastrolith emifino, ama-gastrolith ezilwane, ama-gastrolith abangelwa izidakamizwa kanye nama-gastrolith axubile. Ama-gastrolith ezitshalo yiwona avame kakhulu, abangelwa kakhulu ukudla inani elikhulu lama-persimmon, ama-hawthorn, ama-winter date, ama-peaches, i-celery, i-kelp, nama-coconut esiswini esingenalutho. Kubangelwa njll. Ama-gastrolith asekelwe ezitshalweni njenge-persimmon, ama-hawthorn, nama-jujube aqukethe i-tannic acid, i-pectin, kanye ne-gum. Ngaphansi kwesenzo se-asidi yesisu, kwakheka iphrotheni ye-tannic acid enganyibiliki emanzini, ebopha i-pectin, i-gum, i-plant fiber, i-peel, kanye ne-core. Amatshe esiswini.
Amatshe esisu acindezela udonga lwesisu futhi akhuthaza ukwanda kokukhiqizwa kwe-asidi yesisu, okungabangela kalula ukuguguleka kwe-mucosal yesisu, izilonda ngisho nokubhoboka. Amatshe amancane, athambile esisu angancibilikiswa nge-sodium bicarbonate kanye neminye imithi bese evunyelwa ukuba akhishwe ngokwemvelo.
Ezigulini ezingaphumeleli ukwelashwa, ukususwa kwamatshe e-endoscopic kuyindlela yokuqala yokukhetha (Isithombe 8). Kumatshe esiswini okunzima ukuwasusa ngqo ngaphansi kwe-endoscopy ngenxa yobukhulu bawo obukhulu, ama-forceps omzimba wangaphandle, izingibe, amabhasikidi okususa amatshe, njll. angasetshenziswa ukuchoboza ngqo amatshe bese ewasusa; kulabo abanobuthuntu obuqinile obungenakuchobozwa, ukusika amatshe e-endoscopic kungacatshangelwa, ukwelashwa nge-laser lithotripsy noma i-high-frequency electric lithotripsy, lapho itshe lesisu lingaphansi kuka-2cm ngemva kokuphuka, sebenzisa ama-forceps amathathu noma ama-forceps omzimba wangaphandle ukuze ulisuse ngangokunokwenzeka. Kufanele kuthathwe ukunakekelwa ukuvimbela amatshe amakhulu kuno-2cm ukuthi angakhishwa angene emgodini wamathumbu ngesisu futhi abangele ukuvinjelwa kwamathumbu.
Isithombe 8 Amatshe esiswini
4.11 Isikhwama Sezidakamizwa
Ukuqhekeka kwesikhwama semithi kuzoba yingozi ebulalayo futhi kuyisinqumo esingalungile sokwelashwa nge-endoscopic. Iziguli ezingakwazi ukuphuma ngokwemvelo noma okusolwa ukuthi ziqhekeke isikhwama semithi kufanele zihlinzwe ngenkuthalo.
III. Izinkinga kanye nokwelashwa
Izinkinga zomzimba wangaphandle zihlobene nohlobo, ukuma, isikhathi sokuhlala kanye nezinga lokuhlinzwa likadokotela. Izinkinga eziyinhloko zifaka phakathi ukulimala kolwelwesi lomphimbo, ukopha, kanye nokutheleleka okubhobokile.
Uma umzimba wangaphandle umncane futhi kungekho umonakalo obonakalayo we-mucosal lapho ukhishwa, akudingeki ukuthi ulaliswe esibhedlela ngemva kokuhlinzwa, futhi ukudla okuthambile kungalandelwa ngemva kokuzila ukudla amahora ayisithupha.Iziguli ezinezinhlungu zomqala, ama-granule e-glutamine, ijeli ye-aluminium phosphate kanye nezinye izinto zokuvikela i-mucosal zinganikezwa ukwelashwa okunezimpawu. Uma kudingeka, ukudla okunempilo kanye nokudla okunomsoco kunganikezwa.
Ezigulini ezinomonakalo osobala we-mucosal kanye nokopha kwegazi, ukwelashwa kungenziwa ngaphansi kokubona okuqondile kwe-endoscopic, njengokufutha isixazululo se-norepinephrine esibandayo se-saline, noma ama-titanium clips e-endoscopic ukuvala inxeba.
Ezigulini ezine-CT yangaphambi kokuhlinzwa ezibonisa ukuthi umzimba wangaphandle ungene odongeni lomphimbo ngemva kokususwa kwe-endoscopic, uma umzimba wangaphandle uhlala isikhathi esingaphansi kwamahora angama-24 futhi i-CT ingatholi ukwakheka kwethumba ngaphandle kwe-lumen yomphimbo, ukwelashwa nge-endoscopic kungenziwa ngqo. Ngemva kokuba umzimba wangaphandle ususiwe nge-endoscope, kusetshenziswa i-titanium clip ukubopha udonga lwangaphakathi lomphimbo endaweni yokubhoboza, okungamisa ukopha futhi kuvalwe udonga lwangaphakathi lomphimbo ngesikhathi esifanayo. Ithubhu yesisu kanye nethubhu yokudla ye-jejunal kubekwa ngaphansi kombono oqondile we-endoscope, futhi isiguli silaliswa esibhedlela ukuze siqhubeke nokwelashwa. Ukwelashwa kufaka phakathi ukwelashwa okunezimpawu njengokuzila ukudla, ukudambisa ukucindezeleka kwamathumbu, ama-antibiotic kanye nokudla okunempilo. Ngesikhathi esifanayo, izimpawu ezibalulekile ezifana nokushisa komzimba kumele zibhekwe eduze, futhi ukuvela kwezinkinga ezifana ne-empysema yentamo noma i-mediastinal emphysema kumele kubhekwe ngosuku lwesithathu ngemuva kokuhlinzwa. Ngemuva kokuthi i-iodine water angiography ikhombisa ukuthi akukho ukuvuza, ukudla nokuphuza kungavunyelwa.
Uma umzimba wangaphandle ugcinwe isikhathi esingaphezu kwamahora angama-24, uma kuvela izimpawu zokutheleleka njengomkhuhlane, ukubanda, kanye nenani eliphezulu kakhulu lamaseli amhlophe egazi, uma i-CT ibonisa ukwakheka kwethumba elingaphandle komphimbo, noma uma kube nezinkinga ezinkulu, iziguli kufanele zidluliselwe ekuhlinzweni ukuze zelashwe ngesikhathi esifanele.
IV. Izinyathelo Zokuqapha
(1) Uma umzimba wangaphandle uhlala isikhathi eside emphinjeni, ukuhlinzwa kuzoba nzima kakhulu futhi kuzoba nezinkinga eziningi. Ngakho-ke, ukungenelela okuphuthumayo kwe-endoscopic kuyadingeka kakhulu.
(2) Uma umzimba wangaphandle mkhulu, ungajwayelekile ngesimo noma unezipikili, ikakhulukazi uma umzimba wangaphandle uphakathi komphimbo futhi useduze ne-aorta arch, futhi kunzima ukuwususa nge-endoscopic, ungawukhiphi ngenkani. Kungcono ukufuna ukubonisana kwemikhakha eminingi kanye nokulungiselela ukuhlinzwa.
(3) Ukusetshenziswa okunengqondo kwamadivayisi okuvikela umphimbo kunganciphisa ukwenzeka kwezinkinga.
Okwethuama-forceps okubamba alahlwayoisetshenziswa kanye nama-endoscope athambile, angena emzimbeni womuntu njengomgudu wokuphefumula, umphimbo, isisu, amathumbu njalo njalo ngomzila we-endoscope, ukuze abambe izicubu, amatshe nezinto zangaphandle kanye nokukhipha ama-stents.
Isikhathi sokuthunyelwe: Jan-26-2024