Amatshe amancane e-ureteral angelashwa ngendlela egcinayo noma i-extracorporeal shock wave lithotripsy, kodwa amatshe amakhulu, ikakhulukazi amatshe avimbayo, adinga ukuhlinzwa kusenesikhathi.
Ngenxa yendawo ekhethekile yamatshe angaphezulu e-ureteral, angase angafinyeleleki nge-ureteroscope eqinile, futhi amatshe angangena kalula e-renal pelvis ngesikhathi se-lithotripsy. I-Percutaneous nephrolithotomy yandisa ingozi yokopha kwezinso lapho kusungulwa umsele.
Ukwanda kwe-ureteroscopy eguquguqukayo kuxazulule ngempumelelo lezi zinkinga ezingenhla. Ingena ku-ureter kanye ne-renal pelvis ngokusebenzisa umgodi ojwayelekile womzimba womuntu. Iphephile, iyasebenza, ayihlaseli kakhulu, inokopha okuncane, ubuhlungu obuncane esigulini, kanye nesilinganiso esiphakeme sokungabi namatshe. Manje isiyindlela yokuhlinzwa esetshenziswa kakhulu ukwelapha amatshe aphezulu e-ureteral.
Ukuvela kweisivikelo sokufinyelela urethrakuye kunciphisa kakhulu ubunzima be-ureteroscopic lithotripsy eguquguqukayo. Kodwa-ke, ngokwanda kwenani lamacala okwelashwa, izinkinga zayo ziye zadonsela ukunaka kancane kancane. Izinkinga ezifana nokubhoboka kwe-ureteral kanye nokuqina kwe-ureteral zivame kakhulu. Lokhu okulandelayo yizici ezintathu ezinkulu eziholela ekuqineni kwe-ureteral kanye nokubhoboka.
1. Inkambo yesifo, ububanzi bamatshe, umthelela wamatshe
Iziguli ezinesikhathi eside sesifo zivame ukuba namatshe amakhulu, kanti amatshe amakhulu ahlala ku-ureter isikhathi eside ukuze akhe ukuboshwa. Amatshe endaweni yokulimala acindezela i-mucosa ye-ureteral, okuholela ekungatholakali kwegazi eliningi endaweni, ischemia ye-mucosal, ukuvuvukala kanye nokwakheka kwezibazi, okuhlobene kakhulu nokwakheka kwe-ureteral stricture.
2. Ukulimala komchamo
I-ureteroscope eguquguqukayo kulula ukuyigoba, futhi i-ureteral access sheath idinga ukufakwa ngaphambi kwe-lithotripsy. Ukufakwa kwe-channel sheath akwenziwa ngaphansi kombono oqondile, ngakho-ke akunakugwenywa ukuthi i-ureteral mucosa yonakale noma ibhoboke ngenxa yokugoba kwe-ureter noma i-lumen encane ngesikhathi sokufakwa kwe-sheath.
Ngaphezu kwalokho, ukuze kusekelwe i-ureter futhi kukhishwe uketshezi lokugeleza kwegazi ukuze kuncishiswe ingcindezi e-pelvis yezinso, kuvame ukukhethwa i-channel sheath edlula ku-F12/14, okungabangela ukuthi i-channel sheath icindezele ngqo udonga lwe-ureteral. Uma inqubo kadokotela ohlinzayo ingakavuthwa futhi isikhathi sokuhlinzwa sinwetshwa, isikhathi sokucindezela se-channel sheath odongeni lwe-ureteral sizokhushulwa ngezinga elithile, futhi ingozi yokulimala kwe-ischemic odongeni lwe-ureteral izoba nkulu.
3. Umonakalo we-laser we-Holmium
Ukuqhekeka kwamatshe kwe-laser ye-holmium kuncike kakhulu emphumeleni wayo we-photothermal, obangela ukuthi itshe limunce ngqo amandla e-laser futhi linyuse izinga lokushisa lendawo ukuze kufezwe injongo yokuqhekeka kwamatshe. Nakuba ukujula kwemisebe yokushisa ngesikhathi senqubo yokuchoboza amatshe kuyi-0.5-1.0 mm kuphela, umphumela ohambisanayo obangelwa ukuchoboza amatshe okuqhubekayo awunakulinganiswa.
Amaphuzu abalulekile okufakaisivikelo sokufinyelela urethrayilezi ezilandelayo:
1. Kunomuzwa osobala wokuphuka lapho ufaka ku-ureter, futhi uzwakala ubushelelezi uma ukhuphuka ku-ureter. Uma ukufakwa kunzima, ungashwiba ucingo lokuqondisa emuva naphambili ukuze ubone ukuthi ucingo lokuqondisa lungena futhi luphuma kahle yini, ukuze kutholakale ukuthi i-channel sheath iya phambili yini ohlangothini lwentambo yokuqondisa, njengokuthi Uma kukhona ukumelana okusobala, indlela yokubopha idinga ukulungiswa;
I-channel sheath ebekwe ngempumelelo iqinile futhi ngeke iphume futhi ingene ngokuthanda kwayo. Uma i-channel sheath iphuma ngokusobala, kusho ukuthi igoqekile esinyeni futhi ucingo oluqondisayo luphumile lusuka ku-ureter futhi ludinga ukufakwa kabusha;
3. Ama-sheath emisele ye-Ureteral anemininingwane ehlukile. Iziguli zesilisa ngokuvamile zisebenzisa imodeli engu-45 cm ubude, kanti iziguli zesilisa zesifazane noma ezimfushane zisebenzisa imodeli engu-35 cm ubude. Uma i-sheath yemisele ifakiwe, ingadlula kuphela ekuvulekeni kwe-ureteral noma ayikwazi ukukhuphukela ezingeni eliphakeme. Indawo, iziguli zesilisa zingasebenzisa ne-sheath engenisa engu-35 cm, noma zishintshele ku-sheath yokukhulisa i-fascial engu-14F noma ngisho ne-thinner ukuze kuvinjelwe i-ureteroscope eguquguqukayo ukuthi ingakwazi ukukhuphukela e-renal pelvis;
Ungabeki i-channel sheath ngesinyathelo esisodwa. Shiya u-10 cm ngaphandle kwe-urethral orifice ukuvimbela umonakalo ku-ureteral mucosa noma ku-renal parenchyma ku-UPJ. Ngemva kokufaka i-flexible scope, indawo ye-channel sheath ingalungiswa futhi ngaphansi kokubona okuqondile.
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Isikhathi sokuthunyelwe: Septhemba 11-2024