Amatshe amancane e-urethra angelashwa ngokulondolozwa noma i-extracorporeal shock wave lithotripsy, kodwa amatshe anobubanzi obukhulu, ikakhulukazi amatshe avimbelayo, adinga ukungenelela kokuhlinzwa kusenesikhathi.
Ngenxa yendawo ekhethekile yamatshe aphezulu e-urethra, angase angafinyeleleki nge-ureteroscope eqinile, futhi amatshe angakhuphukela kalula ku-pelvis yezinso ngesikhathi se-lithotripsy. I-Percutaneous nephrolithotomy yandisa ingozi yokopha ezinso lapho kusungulwa umgudu.
Ukukhuphuka kwe-ureteroscopy eguquguqukayo kuye kwaxazulula ngempumelelo izinkinga ezingenhla. Ingena ku-ureter kanye ne-renal pelvis ngokusebenzisa i-orifice evamile yomzimba womuntu. Iphephile, iyasebenza, ayingeneleli kancane, inokopha okuncane, ubuhlungu obuncane esigulini, kanye nezinga eliphezulu elingenatshe. Manje isiphenduke indlela yokuhlinza esetshenziswa kakhulu ukwelapha amatshe angenhla e-urethra.
Ukuvela kwe-Ukungena emgodleni we-ureralkuye kwanciphisa kakhulu ubunzima be-flexible ureteroscopic lithotripsy. Kodwa-ke, ngokwanda kwenani lamacala okwelashwa, izinkinga zawo ziye zakhanga kancane kancane ukunakwa. Izinkinga ezifana nokubhobozwa kwe-urethra kanye ne-urethra stricture zivamile. Okulandelayo yizici ezintathu ezinkulu eziholela ekuqineni kwe-urethra kanye nokubhobozwa.
1. Inkambo yesifo, ububanzi betshe, ukuguqulwa kwamatshe
Iziguli ezinenkambo ende yesifo zivame ukuba namatshe amakhulu, futhi amatshe amakhulu ahlala e-ureter isikhathi eside ukuze enze ukuboshwa. Amatshe endaweni ye- impaction acindezela i-mucosa ye-urethra, okuholela ekungeneni kwegazi lendawo, i-ischemia ye-mucosal, ukuvuvukala nokwakheka kwezibazi, okuhlobene eduze nokwakhiwa kwe-ureterral stricture.
2. Ukulimala kwe-Ureter
I-ureteroscope eguquguqukayo kulula ukugoba, futhi igobolondo le-urethra lidinga ukufakwa ngaphambi kwe-lithotripsy. Ukufakwa kwe-channel sheath akwenziwa ngaphansi kombono oqondile, ngakho-ke akunakugwenywa ukuthi i-mucosa ye-ureter izolimala noma ibhoboze ngenxa yokugoba kwe-ureter noma i-lumen encane ngesikhathi sokufakwa kwe-sheath.
Ukwengeza, ukuze kusekelwe i-ureter futhi kukhishwe uketshezi lwe-perfusion ukuze kuncishiswe ingcindezi ku-pelvis ye-renal, ngokuvamile kuvame ukukhethwa i-sheath yesiteshi ngokusebenzisa i-F12/14, engabangela ukuthi i-sheath yesiteshi icindezele ngokuqondile udonga lwe-ureter. Uma inqubo kadokotela ohlinzayo ingavuthiwe futhi isikhathi sokusebenza sinwetshwa, isikhathi sokucindezelwa komgodla wesiteshi odongeni lwe-urethra sizokwandiswa ngezinga elithile, futhi ingozi yokulimala kwe-ischemic odongeni lwe-ureter izoba nkulu.
3. Ukulimala kwe-laser ye-Holmium
Ukuhlukaniswa kwetshe kwe-holmium laser ikakhulukazi kuncike emthelela wayo we-photothermal, okwenza itshe limunce ngokuqondile amandla e-laser futhi lenyuse izinga lokushisa lasendaweni ukuze lifinyelele inhloso yokuhlukana kwamatshe. Nakuba ukujula kwemisebe eshisayo phakathi nenqubo yokuchotshozwa kwamatshe kungu-0.5-1.0 mm kuphela, umphumela oweqayo obangelwa ukuchotshozwa kwamatshe okuqhubekayo awunakulinganiswa.
Amaphuzu abalulekile okufaka i-Ukungena emgodleni we-ureralzimi kanje:
1. Kunomqondo osobala wokuphumelela lapho ufaka ku-ureter, futhi izwakale ibushelelezi uma ikhuphukela ku-ureter. Uma ukufakwa kunzima, ungakwazi ukushwiba ucingo oluqondisayo emuva naphambili ukuze ubone ukuthi ucingo lomhlahlandlela lungena futhi luphuma kahle yini, ukuze unqume ukuthi i-sheath yesiteshi iqhubekela phambili ekuqondeni kocingo oluqondisayo, njengokuthi Uma kukhona ukumelana okusobala, isiqondiso se-sheathing sidinga ukulungiswa;
Isigqoko seshaneli esibekwe ngempumelelo silungisiwe ngokuqhathaniswa futhi ngeke singene siphume ngokuthanda kwakhe. Uma i-channel sheath iphuma ngokusobala, kusho ukuthi iboshelwe esinyeni futhi ucingo oluqondisayo lwehlile lusuka ku-ureter futhi ludinga ukubekwa kabusha;
3. Amashethi wesiteshi se-Ureter anemininingwane ehlukene. Iziguli zabesilisa ngokuvamile zisebenzisa imodeli ende engu-45 cm, kanti iziguli zesifazane noma ezifushane zisebenzisa imodeli ende engu-35 cm. Uma i-sheath yesiteshi ifakiwe, ingadlula kuphela ekuvulekeni kwe-urethra noma ayikwazi ukukhuphukela ezingeni eliphakeme. Isikhundla, iziguli zesilisa zingasebenzisa futhi i-sheath yokwethula engu-35 cm, noma zishintshele ku-14F noma ngisho ne-fascial expansion sheath ukuze kuvinjelwe i-ureteroscope eguquguqukayo ukuthi ingakwazi ukukhuphukela ku-pelvis ye-renal;
Ungabeki umgodla wesiteshi esinyathelweni esisodwa. Shiya u-10 cm ngaphandle kwembobo ye-urethral ukuze uvimbele ukulimala ku-mucosa ye-urethra noma i-renal parenchyma ku-UPJ. Ngemva kokufaka i-scope eguquguqukayo, indawo ye-sheath yesiteshi ingalungiswa futhi ngaphansi kombono oqondile.
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Isikhathi sokuthumela: Sep-11-2024