I.Ukulungiselela isiguli
1. Qonda indawo, imvelo, ubukhulu kanye nokubhobozwa kwezinto zangaphandle
Thatha ama-X-ray noma ama-CT scans wentamo, isifuba, ukubukwa kwe-anteroposterior kanye ne-lateral, noma isisu njengoba kudingeka ukuze uqonde indawo, imvelo, ukwakheka, usayizi, kanye nokuba khona kwe-perforation yomzimba wangaphandle, kodwa ungenzi ukugwinya kwe-barium. ukuhlolwa.
2. Isikhathi sokuzila ukudla namanzi
Ngokuvamile, iziguli zizila ukudla amahora angu-6 kuye kwayi-8 ukuze zikhiphe okusesiswini, futhi isikhathi sokuzila ukudla nokudla kwamanzi singakhululeka ngokufanele ukuze kutholakale i-gastroscopy ephuthumayo.
3. Usizo lokubulala izinzwa
Izingane, labo abanokuphazamiseka kwengqondo, labo abangabambisene nabo, noma labo abanemizimba yangaphandle eboshiwe, imizimba emikhulu yangaphandle, imizimba yangaphandle eminingi, imizimba yangaphandle ebukhali, noma ukuhlinzwa kwe-endoscopic okunzima noma okuthatha isikhathi eside kufanele kuhlinzwe ngaphansi kwe-anesthesia jikelele noma i-endotracheal. intubation ngosizo lwe-anesthesiologist.Susa izinto zangaphandle.
II.Ukulungiswa kwemishini
1. Ukukhetha i-Endoscope
Zonke izinhlobo ze-gastroscopy yokubuka phambili ziyatholakala.Uma kulinganiselwa ukuthi kunzima ukususa umzimba wangaphandle noma umzimba wangaphandle mkhulu, i-double-port surgical gastroscopy isetshenziswa.Ama-endoscopes anobubanzi obuncane obungaphandle angasetshenziselwa izinsana nezingane ezincane.
2. Ukukhethwa kwama-forceps
Ikakhulukazi kuncike kusayizi kanye nokuma komzimba wangaphandle.Amathuluzi asetshenziswa kakhulu ahlanganisa i-biopsy forceps, ugibe, i-forceps yemihlathi emithathu, izindlawu eziyisicaba, amandla omzimba wangaphandle (i-rat-tooth forceps, i-forceps yomlomo womhlathi), ubhasikidi wokukhipha itshe, isikhwama senethi sokususa itshe, njll.
Ukukhethwa kwensimbi kunganqunywa ngokusekelwe kusayizi, ukuma, uhlobo, njll.Ngokwemibiko yezincwadi, ama-rat-tooth forceps yiwona asetshenziswa kakhulu.Izinga lokusetshenziswa kwe-forcep yezinyo legundane lingu-24.0%~46.6% wazo zonke izinsimbi ezisetshenzisiwe, futhi izingibe zenza u-4.0%~23.6%.Ngokuvamile kunenkolelo yokuthi izingibe zingcono emizimbeni yangaphandle emise okwenduku ende.Okufana nama-thermometers, izixubho, izinti ze-bamboo, amapeni, izinkezo, njll., kanye nesimo sokuphela esimbozwe yisicupho akufanele sidlule u-1cm, ngaphandle kwalokho kuyoba nzima ukuphuma ku-cardia.
2.1 Imizimba yangaphandle emise okwenduku kanye nemizimba yangaphandle eyindilinga
Ezintweni zangaphandle ezimise okwenduku ezinobuso obushelelezi kanye nobubanzi obuncane obungaphandle njengezipikili zamazinyo, kulula kakhulu ukukhetha udlawu lwemihlathi emithathu, izidladla zezinyo legundane, iziphaleni eziyisicaba, njll.;ezintweni zangaphandle eziyindilinga (njengama-cores, amabhola engilazi, amabhethri ezinkinobho, njll.), sebenzisa ubhasikidi wokukhipha itshe noma isikhwama senethi sokususa itshe ukuze uzisuse Kunzima ngokuqhathaniswa ukushelela.
2.2 Imizimba yangaphandle ebukhali amade, izigaxa zokudla, namatshe amakhulu esiswini
Emizimbeni yangaphandle ebukhali ende, i-eksisi ende yomzimba wangaphandle kufanele ihambisane ne-axis longitudinal ye-lumen, isiphetho esicijile noma isiphetho esivulekile sibheke phansi, futhi ihoxise ngenkathi ijova umoya.Emizimbeni yangaphandle emise okwendandatho noma imizimba yangaphandle enezimbobo, kuphephe kakhudlwana ukusebenzisa indlela yokulutha ukuyisusa;
Ukuze uthole izigaxa zokudla namatshe amakhulu esiswini, i-forcep yokuluma ingasetshenziswa ukuwachoboza bese ikhishwa ngama-forceps emihlathi emithathu noma ngogibe.
3. Izinto zokuzivikela
Sebenzisa izinto zokuvikela ngangokunokwenzeka ezintweni zangaphandle okunzima ukuzisusa futhi eziyingozi.Njengamanje, izinto zokuvikela ezivame ukusetshenziswa zihlanganisa amakepisi abonisa ngale, amashubhu angaphandle, namakhava okuvikela.
3.1 I-cap esobala
Ngesikhathi sokuhlinzwa kokukhipha umzimba wangaphandle, ikepisi elibonisa ngale kufanele lisetshenziswe ekugcineni kwelensi ye-endoscopic ukuze kuvinjelwe ulwelwesi lwamafinyila ukuthi lungaklwebheki wumzimba wangaphandle, futhi kwandiswe umminzo ukuze kuncishiswe ukumelana okuhlangatshezwana nawo lapho umzimba wangaphandle. iyasuswa.Kungasiza futhi ukubopha nokukhipha umzimba wangaphandle, okuzuzisa ukukhishwa komzimba wangaphandle.khipha.
Emizimbeni yangaphandle emise okwe-strip eshumekwe ku-mucosa emaphethelweni womabili womminzo, ikepisi elikhanyelayo lingasetshenziswa ukusunduza ngobumnene umuco womminzo uzungeze umkhawulo owodwa womzimba wangaphandle ukuze umkhawulo owodwa womzimba wangaphandle uphume odongeni lomminzo ukuze gwema ukubhobozwa kommizo okubangelwa ukususwa okuqondile.
Ikepisi elibonisa ngale linganikeza isikhala esanele sokusebenza kwethuluzi, elilungele ukutholwa nokususwa kwemizimba yangaphandle engxenyeni encane yentamo yommizo.
Ngesikhathi esifanayo, ikepisi elibonisa ngale lingasebenzisa ukumunca ingcindezi engalungile ukusiza ukumunca izigaxa zokudla kanye nokwenza lula ukucutshungulwa okulandelayo.
3.2 Ibhokisi langaphandle
Nakuba ivikela umphimbo kanye ne-esophageal-gastric junction mucosa, ithubhu elingaphandle lisiza ukukhishwa kwe-endoscopic yemizimba yangaphandle emide, ebukhali, neningi kanye nokukhishwa kwezigaxa zokudla, ngaleyo ndlela kuncishiswe izigameko zezinkinga ngesikhathi sokukhishwa komzimba wangaphandle wesisu.Khulisa ukuphepha nokusebenza ngempumelelo kokwelashwa.
Ama-overtubes awavamisile ukusetshenziswa ezinganeni ngenxa yengozi yokulimaza umminzo ngesikhathi sokufakwa.
3.3 Ikhava yokuzivikela
Beka isembozo sokuzivikela sibheke phansi ekugcineni kwe-endoscope.Ngemva kokubopha into yangaphandle, phenya ikhava yokuvikela bese ugoqa into yangaphandle lapho ukhipha i-endoscope ukugwema izinto zangaphandle.
Ihlangana nolwelwesi lwamafinyila lomgudu wokugaya ukudla futhi idlala indima yokuvikela.
4. Izindlela zokwelashwa zezinhlobo ezahlukene zemizimba yangaphandle endaweni engenhla yamathumbu
4.1 Izixuku zokudla kumphimbo
Imibiko iphakamisa ukuthi izixuku eziningi zokudla ezincane ku-esophagus zingaphushwa ngesineke esiswini futhi zishiywe ukuze zikhishwe ngokwemvelo, okuyinto elula, elula futhi engase ibangele izinkinga.Phakathi nenqubo yokuthuthuka kwe-gastroscopy, ukwehla kwamandla emali okufanelekile kungangeniswa emthonjeni womminzo, kodwa ezinye iziguli zingase zihambisane nezimila eziyingozi ze-esophageal noma i-post-esophageal anastomotic stenosis (Umfanekiso 1).Uma kukhona ukumelana futhi uphusha ngamandla, ukufaka ukucindezela okukhulu kuzokwandisa ingozi yokubhobozwa.Kunconywa ukusebenzisa ubhasikidi wenetha wokukhipha itshe noma isikhwama senetha sokukhipha itshe ukuze ususe ngokuqondile umzimba wangaphandle.Uma i-bolus yokudla inkulu, ungasebenzisa izindlawu zomzimba wangaphandle, izingibe, njll. ukuze uyihlanganise ngaphambi kokuyihlukanisa.Ikhiphe.
Umfanekiso we-1 Ngemva kokuhlinzwa umdlavuza we-esophageal, isiguli sasihambisana ne-esophageal stenosis kanye nokugcinwa kokudla.
4.2 Izinto zangaphandle ezimfishane nezingacacile
Imizimba eminingi yangaphandle emfishane futhi eshubile ingasuswa ngokusebenzisa izindlawu zangaphandle, izingibe, obhasikidi abakhipha amatshe, izikhwama zenethi zokususa amatshe, njll. (Umfanekiso 2).Uma umzimba wangaphandle ku-esophagus kunzima ukuwukhipha ngokuqondile, ungaphushelwa esiswini ukuze ulungise indawo yawo bese uzama ukuwususa.Imizimba yangaphandle emifushane, engacacile enobubanzi obungaphezu kuka-2.5 cm esiswini kunzima kakhulu ukudlula ku-pylorus, futhi ukungenelela kwe-endoscopic kufanele kwenziwe ngokushesha ngangokunokwenzeka;uma imizimba yangaphandle enobubanzi obuncane esiswini noma i-duodenum ingabonisi ukulimala kwamathumbu, ingalinda ukukhishwa kwayo kwemvelo.Uma lihlala isikhathi esingaphezu kwamaviki angu-3-4 futhi lingasakwazi ukukhishwa, kufanele likhishwe nge-endoscopically.
Umfanekiso 2 Izinto zangaphandle zePlastiki nezindlela zokususa
4.3 Imizimba yangaphandle
Izinto zakwamanye amazwe ezinobude obungu-≥6 cm (njengama-thermometers, izixubho, izinti zoqalo, amapeni, izinkezo, njll.) akulula ukuthi zikhishwe ngokwemvelo, ngakho-ke zivame ukuqoqwa ngogibe noma ubhasikidi wamatshe.
Ugibe lungasetshenziswa ukuvala uhlangothi olulodwa (olungekho ngaphezu kuka-1 cm ukusuka ekugcineni), bese lufakwa kukepisi olusobala ukuze lukhishwe.Umshini wangaphandle we-cannula ungasetshenziswa futhi ukubamba umzimba wangaphandle bese uhlehla ngokushelela ku-cannula yangaphandle ukugwema ukulimaza ulwelwesi lwamafinyila.
4.4 Izinto zangaphandle ezibukhali
Izinto zangaphandle ezibukhali njengamathambo ezinhlanzi, amathambo enkukhu, amazinyo okufakelwa, imigodi yedethi, izigxobo zamazinyo, iziqeshana zamaphepha, ama-razor blades namabhokisi okugoqa amaphilisi (Umfanekiso 3) kufanele kunakwe ngokwanele.Izinto zangaphandle ezibukhali ezingalimaza kalula ulwelwesi lwamafinyila kanye nemithambo yegazi futhi ziholele ezinkingeni ezinjengokubhoboza kufanele ziphathwe ngokucophelela.Ukuphathwa kwe-endoscopic ephuthumayo.
Umfanekiso 3 Izinhlobo ezahlukene zezinto zangaphandle ezibukhali
Lapho ususa imizimba yangaphandle ebukhali ngaphansi kokuphelai-oscope, kulula ukunwaya i-mucosa yomgudu wokugaya ukudla.Kunconywa ukusebenzisa i-cap esobala, engadalula ngokugcwele i-lumen futhi igweme ukunwaya udonga.Zama ukuletha isiphetho esibuthuntu somzimba wangaphandle eduze nesiphetho selensi ye-endoscopic ukuze kubekwe umkhawulo owodwa womzimba wangaphandle Uwufake ekepisini elibonisa ngale, sebenzisa izindlawu zomzimba wangaphandle noma ugibe ukuze ubambe umzimba wangaphandle, bese emva kwalokho. zama ukugcina i-axis ye-longitudinal yomzimba wangaphandle ihambisana nomminzo ngaphambi kokuhoxa kububanzi.Imizimba yangaphandle eshumekwe ohlangothini olulodwa lomminzo ingasuswa ngokubeka ikepisi esobala engxenyeni engaphambili ye-endoscope futhi ingene kancane kancane endaweni yokungena emmizweni.Emizimbeni yangaphandle eshumekwe emgodini womminzo emikhawulweni yomibili, isiphetho esishumekiwe esingashoni kufanele sikhululwe kuqala, ngokuvamile Ehlangothini oluseduze, khipha omunye umkhawulo, lungisa isiqondiso sento yangaphandle ukuze isiphetho sekhanda sifakwe endaweni esobala. ikepisi, futhi uyikhiphe.Noma ngemva kokusebenzisa ummese we-laser ukusika umzimba wangaphandle phakathi nendawo, okuhlangenwe nakho kwethu ukukhulula i-aorta arch noma uhlangothi lwenhliziyo kuqala, bese siyisusa ngezigaba.
a.Amazinyo Okufakelwa: Lapho udla, ukhwehlela, noma ukhulumag, iziguli zingase ziwe amazinyo okufakelwa ngephutha, bese zingena egunjini eliphezulu lesisu ngokunyakazisa ukugwinya.Amazinyo okufakelwa acijile anensimbi emikhawulweni yomibili kulula ukushumeka ezindongeni zomgudu wokugaya ukudla, okwenza kube nzima ukususa.Ezigulini ezehluleka ukwelashwa kwe-endoscopic okujwayelekile, amathuluzi okubamba amaningi angasetshenziswa ukuzama ukususwa ngaphansi kwe-endoscopy yamashaneli amabili.
b.Imigodi yosuku: Imigodi yedethi eshumekwe kumphimbo ngokuvamile ibukhali kuzo zombili iziphetho, okungaholela ezinkingeni ezifana ne-mucosal damag.e, ukopha, ukutheleleka kwe-suppurative yendawo kanye nokubhoboza ngesikhathi esifushane, futhi kufanele zelashwe ngokwelashwa okuphuthumayo kwe-endoscopic (Umfanekiso 4).Uma kungenakulimala emathunjini, iningi lamatshe edethi esiswini noma e-duodenum lingakhishwa phakathi kwamahora angu-48.Labo abangakwazi ukukhishwa ngokwemvelo kufanele basuswe ngokushesha ngangokunokwenzeka.
Umfanekiso 4 Umongo weJujube
Ngemva kwezinsuku ezine, isiguli kwatholakala ukuthi sinomzimba wangaphandle kwesinye isibhedlela.I-CT ibonise umzimba wangaphandle ku-esophagus ngokubhoboza.Ama-jujube cores abukhali emikhawulweni yomibili akhishwe ngaphansi kwe-endoscopy futhi i-gastroscopy yenziwa futhi.Kwatholakala ukuthi kwakheka i-fistula odongeni lomminzo.
4.5 Izinto ezinkulu zangaphandle ezinemiphetho emide nezicijile (Umfanekiso 5)
a.Faka ithubhu elingaphandle ngaphansi kwe-endoscope: Faka i-gastroscope ukusuka maphakathi neshubhu elingaphandle, ukuze unqenqema olungezansi lweshubhu langaphandle lusondele ekugcineni kwengxenye egobile ye-gastroscope.Faka njalo i-gastroscope eduze nomzimba wangaphandle.Faka amathuluzi afanelekile ngeshubhu le-biopsy, njengezingibe, izindlawu zomzimba zangaphandle, njll. Ngemva kokubamba into yangaphandle, yifake eshubhuni elingaphandle, futhi lonke idivayisi izophuma kanye nesibuko.
b.Isembozo sokuzivikela solwelwesi lwamafinyila esenziwe ekhaya: Sebenzisa isembozo sesithupha samagilavu enjoloba yezokwelapha ukuze wenze ikhava yokuzivikela ye-endoscope yasekhaya.Sika ngokuhambisana ne-bevel yempande yesithupha yegilavu ibe yisimo secilongo.Sika imbobo encane ekugcineni komunwe, bese udlula ingxenye engaphambili yesibuko ngembobo encane.Sebenzisa indandatho yerabha encane ukuyilungisa ngo-1.0cm ukusuka ekugcineni kwe-gastroscope, uyibuyisele engxenyeni engenhla ye-gastroscope, bese uyithumela kanye ne-gastroscope emzimbeni wangaphandle.Bamba umzimba wangaphandle bese uwukhipha kanye ne-gastroscope.Umkhono ovikelayo uzohamba ngokwemvelo ubheke emzimbeni wangaphandle ngenxa yokumelana.Uma isiqondiso sibuyiselwa emuva, sizosongwa ezintweni zangaphandle ukuze sivikeleke.
Umfanekiso wesi-5: Amathambo ezinhlanzi abukhali akhishwe ekugcineni, anemihuzuko ye-mucosal
4.6 Insimbi yangaphandle
Ngokungeziwe kuma-forceps avamile, imizimba yangaphandle yensimbi ingasuswa ngokumuncwa ngama-forceps omzimba wangaphandle azibuthe.Imizimba yangaphandle eyinsimbi eyingozi kakhulu noma okunzima ukuyikhipha ingelashwa nge-endoscopically ngaphansi kwe-X-ray fluoroscopy.Kunconywa ukusebenzisa ubhasikidi wokukhipha itshe noma isikhwama senetha sokukhipha itshe.
Izinhlamvu zemali zivame kakhulu phakathi kwemizimba yangaphandle emgudwini wokugaya wezingane (Umfanekiso 6).Nakuba izinhlamvu zemali eziningi ku-esophagus zingadluliselwa ngokwemvelo, ukwelashwa kwe-endoscopic okukhethiwe kuyanconywa.Ngenxa yokuthi izingane azibambisani kakhulu, ukukhishwa kwe-endoscopic kwemizimba yangaphandle ezinganeni kwenziwa kangcono ngaphansi kwe-anesthesia ejwayelekile.Uma uhlamvu lwemali lunzima ukususa, lungaphonswa esiswini bese lukhishwa.Uma zingekho izimpawu esiswini, ungalinda ukuthi ikhishwe ngokwemvelo.Uma uhlamvu lwemali luhlala isikhathi esingaphezu kwamaviki angu-3-4 futhi lungaxoshwa, kufanele luphathwe nge-endoscopically.
Umfanekiso 6 Uhlamvu lwensimbi lwangaphandle
4.7 Udaba lwangaphandle olulimazayo
Imizimba yangaphandle ebolayo ingabangela kalula ukulimala emgudwini wokugaya ukudla noma ngisho ne-necrosis.Ukwelashwa kwe-endoscopic okuphuthumayo kuyadingeka ngemuva kokuxilongwa.Amabhethri awumzimba wangaphandle odla kakhulu futhi avame ukuvela ezinganeni ezingaphansi kweminyaka engu-5 ubudala (Umfanekiso 7).Ngemva kokulimaza i-esophagus, bangase babangele i-stenosis ye-esophageal.I-Endoscopy kufanele ibuyekezwe phakathi namasonto ambalwa.Uma kwakheka ukuqina, i-esophagus kufanele ivuleke ngokushesha ngangokunokwenzeka.
Umfanekiso 7 Into engaziwa ebhethrini, umcibisholo obomvu ukhombisa indawo yento yangaphandle
4.8 Izinto zangaphandle zikazibuthe
Lapho imizimba eminingi yangaphandle kazibuthe noma imizimba yangaphandle kazibuthe ehlanganiswe nensimbi ikhona endaweni engenhla ye-gastrointestinal tract, izinto zidonselana futhi zicindezele izindonga ze-digestive tract, ezingabangela kalula i-ischemic necrosis, ukwakheka kwe-fistula, ukubhoboza, ukuvinjelwa, i-peritonitis kanye okunye ukulimala okukhulu kwamathumbu., edinga ukwelashwa okuphuthumayo kwe-endoscopic.Izinto zangaphandle kazibuthe eyodwa kufanele nazo zisuswe ngokushesha ngangokunokwenzeka.Ngokungeziwe kuma-forceps avamile, imizimba yangaphandle kazibuthe ingasuswa ngaphansi kokumuncwa nge-forceps yomzimba wangaphandle kazibuthe.
4.9 Imizimba yangaphandle esiswini
Iningi lazo ngamalambu, izintambo zensimbi, izinzipho nokunye okugwinywa iziboshwa ngamabomu.Imizimba eminingi yangaphandle mide futhi mikhulu, kunzima ukudlula ku-cardia, futhi inganwaya kalula ulwelwesi lwamafinyila.Kunconywa ukusebenzisa amakhondomu ahlanganiswe ne-rat-tooth forceps ukususa imizimba yangaphandle ngaphansi kokuhlolwa kwe-endoscopic.Okokuqala, faka izindlawu zezinyo legundane engxenyeni engaphambili ye-endoscope ngembobo ye-endoscopic biopsy.Sebenzisa izindlawu zezinyo legundane ukuze ubambe indandatho yerabha ngezansi kwekhondomu.Bese, uhoxise ama-forceps wezinyo legundane uye embotsheni ye-biopsy ukuze ubude bekhondomu buvezwe ngaphandle kwembobo ye-biopsy.Yinciphise ngangokunokwenzeka ngaphandle kokuthinta indawo yokubuka, bese uyifaka emgodini wesisu kanye ne-endoscope.Ngemva kokuthola isidumbu sangaphandle, faka isidumbu sangaphandle kukhondomu.Uma kunzima ukuyikhipha, faka ikhondomu esiswini, bese usebenzisa izindlawu zezinyo legundane ukuze ubambe umzimba wangaphandle bese uwufaka. Ngaphakathi kwekhondomu, sebenzisa izinti zezinyo legundane ukuze ubambe ikhondomu bese uyikhipha kanye isibuko.
4.10 Amatshe esisu
Ama-gastroliths ahlukaniswe ama-gastroliths emifino, ama-gastroliths ezilwane, ama-gastroliths abangelwa izidakamizwa kanye nama-gastroliths axubile.I-Vegetative gastrolith yizona ezivame kakhulu, ikakhulukazi ezibangelwa ukudla inani elikhulu lama-persimmons, ama-hawthorns, izinsuku zasebusika, amapentshisi, isilimo esidliwayo esinamagatsha anamanzi, i-kelp, nokhukhunathi esiswini esingenalutho.Ibangelwa njll. Ama-gastrolith asekelwe ezitshalweni afana nama-persimmons, ama-hawthorn, nama-jujube aqukethe i-tannic acid, i-pectin, ne-gum.Ngaphansi kwesenzo se-gastric acid, kwakheka iphrotheni ye-tannic acid engancibiliki emanzini, ebophezela ku-pectin, inhlaka, i-plant fiber, ikhasi kanye nomgogodla.Amatshe esisu.
Amatshe e-gastric acindezela udonga lwesisu futhi akhuthaze ukwanda kwe-asidi yesisu, engabangela kalula ukuguguleka kwe-gastric mucosal, izilonda kanye nokubhobozwa.Amatshe amancane, athambile esiswini angancibilika nge-sodium bicarbonate nezinye izidakamizwa bese evunyelwa ukuba akhishwe ngokwemvelo.
Ezigulini ezihluleka ukwelashwa, ukususwa kwamatshe e-endoscopic kuyisinqumo sokuqala (Umfanekiso 8).Ngamatshe e-gastric okunzima ukuwakhipha ngokuqondile ngaphansi kwe-endoscopy ngenxa yobukhulu bawo obukhulu, ama-forceps angaphandle, izicupho, amabhasikidi okukhipha amatshe, njll. angasetshenziswa ukuchoboza amatshe ngokuqondile bese uwasusa;kulabo abanokwakheka okuqinile okungenakuchotshozwa, ukusikwa kwe-endoscopic kwamatshe kungabhekwa , I-Laser lithotripsy noma ukwelashwa kwe-high-frequency electric lithotripsy, lapho itshe lesisu lingaphansi kuka-2cm ngemva kokuphulwa, sebenzisa i-forceps ye-claw emithathu noma i-forceps yomzimba wangaphandle. ukuyisusa ngangokunokwenzeka.Kufanele kuqashelwe ukuvikela amatshe amakhulu kuno-2cm ukuthi angakhishelwa emgodini wamathumbu ngokusebenzisa isisu futhi abangele ukuvinjelwa kwamathumbu.
Umfanekiso 8 Amatshe esiswini
4.11 Isikhwama Sezidakamizwa
Ukuqhekeka kwesikhwama sezidakamizwa kuzobeka ingozi ebulalayo futhi kuyi-contraindication yokwelashwa kwe-endoscopic.Iziguli ezingakwazi ukuzikhulula ngokwemvelo noma okusolwa ukuthi ziqhume isikhwama sezidakamizwa kufanele zihlinzwe.
III.Izinkinga nokwelashwa
Izinkinga zomzimba wangaphandle zihlobene nemvelo, ukuma, isikhathi sokuhlala kanye nezinga lokusebenza kukadokotela.Izinkinga eziyinhloko zihlanganisa ukulimala kwe-mucosal esophageal, ukopha, kanye nokutheleleka nge-perforation.
Uma umzimba wangaphandle umncane futhi kungekho monakalo ocacile we-mucosal lapho ukhishwa, ukulaliswa esibhedlela akudingeki ngemva kokuhlinzwa, futhi ukudla okuthambile kungalandelwa ngemva kokuzila ukudla amahora angu-6.Ezigulini ezinokulimala kwe-mucosal esophageal, ama-glutamine granules, ijeli ye-aluminium phosphate namanye ama-ejenti okuvikela ama-mucosal anganikezwa ukwelashwa okuyizimpawu.Uma kunesidingo, ukuzila ukudla kanye nokudla okunomsoco kunganikezwa.
Kuziguli ezinomonakalo osobala we-mucosal kanye nokopha, ukwelashwa kungenziwa ngaphansi kombono oqondile we-endoscopic, njengokufafaza isixazululo se-ice-cold saline norepinephrine, noma iziqeshana ze-endoscopic titanium zokuvala isilonda.
Ezigulini i-CT yazo yangaphambi kokuhlinzwa iphakamisa ukuthi umzimba wangaphandle ungene odongeni lomgudu ngemuva kokususwa kwe-endoscopic., uma umzimba wangaphandle uhlala isikhathi esingaphansi kwamahora angu-24 futhi i-CT ingatholi ukwakheka kwethumba ngaphandle kwe-lumen ye-esophageal, ukwelashwa kwe-endoscopic kungenziwa ngokuqondile.Ngemva kokukhishwa komzimba wangaphandle nge-endoscope, isiqeshana se-titanium sisetshenziswa ukubopha udonga lwangaphakathi lomminzo endaweni yokubhoboza, olungamisa ukopha futhi luvale udonga lwangaphakathi lomminzo ngesikhathi esifanayo.Ishubhu yesisu kanye neshubhu yokudla ijejunal ibekwe ngaphansi kombono oqondile we-endoscope, futhi isiguli silaliswa esibhedlela ukuze siqhubeke nokwelashwa.Ukwelashwa kuhlanganisa ukwelashwa okunezimpawu ezifana nokuzila ukudla, ukuwohloka kwamathumbu emathunjini, ama-antibiotic kanye nokudla okunomsoco.Ngesikhathi esifanayo, izimpawu ezibalulekile ezifana nokushisa komzimba kufanele zibhekwe eduze, futhi ukuvela kwezinkinga ezifana ne-neck subcutaneous emphysema noma i-mediastinal emphysema kufanele kubonwe ngosuku lwesithathu ngemva kokuhlinzwa.Ngemuva kokuthi i-iodine yamanzi i-angiography ibonisa ukuthi akukho ukuvuza, ukudla nokuphuza kungavunyelwa.
Uma umzimba wangaphandle ugcinwe isikhathi esingaphezu kwamahora angu-24, uma izimpawu zokutheleleka ezifana nemfiva, ukugodola, kanye nokubalwa kwamangqamuzana amhlophe egazi aphakeme kakhulu kwenzeka, uma i-CT ibonisa ukwakheka kwethumba elingaphandle kommizo, noma uma sekwenzekile izinkinga ezinkulu. , iziguli kufanele zidluliselwe ekuhlinzweni ukuze zelashwe ngesikhathi esifanele.
IV.Izinyathelo zokuzivikela
(1) Uma umzimba wangaphandle uhlala isikhathi eside kumphimbo, ukuhlinzwa kuzoba nzima kakhulu futhi kuzoba nezinkinga ezengeziwe.Ngakho-ke, ukungenelela okuphuthumayo kwe-endoscopic kuyadingeka ikakhulukazi.
(2) Uma umzimba wangaphandle umkhulu, umumo ongajwayelekile noma unezikhonkwane, ikakhulukazi uma umzimba wangaphandle uphakathi kommizo futhi useduze ne-aorta arch, futhi kunzima ukuwukhipha nge-endoscopically, ungawudonsi ngamandla. ngaphandle.Kungcono ukufuna ukubonisana kwemikhakha eminingi kanye nokulungiselela ukuhlinzwa.
(3) Ukusetshenziswa okunengqondo kwemishini yokuvikela umminzo kunganciphisa ukuvela kwezinkinga.
Eyethualahlwayo ukubamba forcepsisetshenziswa kanye ne-endoscopes ethambile, ingena emgodini womzimba womuntu njengepheshana lokuphefumula, umminzo, isisu, amathumbu nokunye ngokusebenzisa i-endoscope channel, ukubamba izicubu, amatshe kanye nezindaba zangaphandle kanye nokukhipha ama-stents.
Isikhathi sokuthumela: Jan-26-2024