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 kancane, ubuhlungu obuncane esigulini, kanye nezinga eliphezulu elingenawo amatshe. 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 ukunciphisa ukucindezela ku-pelvis ye-renal, i-sheath yesiteshi ngokusebenzisa i-F12 / 14 ngokuvamile ikhethwa, 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 uye phambili naphambili ukuze ubone ukuthi intambo yesiqondisi ingena futhi iphuma kahle yini, ukuze unqume ukuthi ingabe ishehethi yeshaneli iya phambili ibheke ocingweni 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