Isingeniso
I-Achalasia yenhliziyo (AC) yi-aI-primary esophageal motility disorder.Ngenxa yokungaphumuli kahle kwe-esophageal sphincter (LES) kanye nokuntuleka kwe-esophageal peristalsis, ukugcinwa kokudla kubangelai-dysphagia kanye nokusabela. Izimpawu zomtholampilo ezifana nokopha, ubuhlungu besifuba nokuncipha kwesisindo.Ukuvama cishe kungama-32.58/100,000.
Iukwelashwaye-achalasia ikakhulukazi ihlanganisa ukwelashwa okungahlinzeki, ukwelashwa kwe-dilation kanye nokwelashwa kokuhlinzwa.
01Ukwelashwa Kwezokwelapha
Indlela yokwelashwa kwezidakamizwa ukunciphisa ingcindezi ye-LES esikhathini esifushane.Abukho ubufakazi obusobala bokuthi izidakamizwa zingathuthukisa ngokuqhubekayo nangempumelelo izimpawu ze-AC.Izidakamizwa ezisetshenziswa njengamanje zihlanganisa ama-nitrate, izithiyo zesiteshi se-calcium, nama-β-receptor agonists.
(1)I-Nitrate, njenge-nitroglycerin, i-amyl nitrate, ne-isosorbide dinitrate
(2)Izivimbeli zesiteshi se-calcium, njenge-nifedipine, i-verapamil, ne-diltiazem
(3)ama-β-receptor agonists, njenge-cabuterol
I-02Endoscopic Botulinum Toxin Injection (BTI)
Umjovo we-endoscopic botulinum toxin(BTl) ungasetshenziswa ukwelapha i-AC,kodwa inganikeza imiphumela yesikhashana kuphela futhi ingasetshenziswa ezigulini esezikhulile ezinezingozi ezinkulu zokuhlinzwa kanye nezinzwa.
1) Izimpawu:iziguli ezineminyaka ephakathi kanye nasebekhulile (ngaphezulu kweminyaka engama-40); labo abangakwazi ukubekezelela i-endoscopic balloon dilation (PD) noma ukwelashwa kokuhlinzwa; labo abanemithi eminingi yokwelapha i-PD noma imiphumela engemihle yokwelashwa kokuhlinzwa; labo abane-esophageal perforation ngesikhathi sokwelashwa kwe-PD Kulabo abasengozini enkulu, ingasetshenziswa futhi ngokuhambisana ne-PD; ingasetshenziswa njengenguquko yokuhlinzwa noma ukwelashwa kwe-PD.
(2) I-Contraindications:Akunconyelwe ukwelashwa komugqa wokuqala kwe-AC ezigulini ezisencane (≤40 iminyaka ubudala).
03I-Endoscopic Balloon Dilation (PD)
Ukunwetshwa kwebhaluni kunemiphumela ethile ku-AC, kodwa kudinga ukwelashwa okuningi futhi kuthwala ubungozi bezinkinga ezibucayi.
(1) Izinkomba:Iziguli ze-AC ezingenakho ukungasebenzi kahle kwe-cardiopulmonary, ukungasebenzi kahle kwe-coagulation, njll.; amadoda angaphezu kweminyaka engama-50 nabesifazane abangaphezu kweminyaka engama-35; iziguli ezihlulekile ukuhlinzwa. Ingasetshenziswa njengendlela yokuqala yokwelapha yokukhetha.
(2) I-Contraindications:Ukwehluleka okukhulu kwe-cardiopulmonary, ukungasebenzi kahle kwe-coagulation kanye nengozi enkulu yokubhobozwa kwe-esophageal.
04Peroral Endoscopic Myotomy (POEM)
Eminyakeni yamuva, ngokuqaliswa okukhulu kwe-peroral endoscopic myotomy (POEM), izinga lokuphumelela lokwelashwa komtholampilo kwe-AC liye landa kakhulu.Ukwelashwa kwe-POEM kwe-AC kuhambisana kakhulu nomqondo "wokuhlinzwa okuncane kakhulu", okungukuthi, izilonda kuphela ezikhishwayo / zikhishwa phakathi nenqubo yokwelashwa, futhi izitho azisuswa.Ubuqotho nokusebenza kwesakhiwo se-anatomical kugcinwa, futhi izinga lempilo lesiguli emva kokuhlinzwa ngokuyisisekelo alithinteki. Ukuvela kwe-POEM kwenze ukwelashwa kwe-AC kuhlasele kakhulu.
Umfanekiso: Izinyathelo zokuhlinzwa ze-POEM
Ukusebenza kwe-POEM okumaphakathi nesikhathi eside ekwelapheni i-AC kuhambisana nalokho kwe-laparoscopic Heller myotomy (LHM)ingasetshenziswa njengendlela yokwelashwa yomugqa wokuqala.Ezinye iziguli zingase zibe nezimpawu ze-reflux ye-gastroesophageal ngemva kokuhlinzwa kwe-POEM
(1) Izinkomba eziphelele:I-AC ngaphandle kokunamathela okunzima kwe-submucosal, ukuphazamiseka kokusebenza kwesisu kanye ne-diverticulum enkulu.
(2) Izinkomba ezihlobene:Sabalalisa i-spasm esophageal, i-nutcracker esophagus nezinye izifo ze-esophageal motility, iziguli ezine-POEM ehlulekile noma ukuhlinzwa kwe-Heller, kanye ne-AC ene-adhesions ye-esophageal submucosal.
(3) I-Contraindications:Iziguli ezinokungasebenzi kahle kwe-coagulation, isifo senhliziyo esibi kakhulu, isimo esibi esijwayelekile, njll. ezingakwazi ukubekezelela ukuhlinzwa.
05Laparoscopic Heller Myotomy (LHM)
I-LHM isebenza kahle isikhathi eside ekwelapheni i-AC, futhi ngokuyisisekelo ithathelwe indawo INKONDLO ezindaweni lapho izimo zivuma khona.
06I-Esophagectomy Yokuhlinzwa
Uma i-AC ihlanganiswe ne-low esophageal scar stenosis, izimila, njll., ukuhlinzwa kwe-esophagectomy kungase kucatshangelwe.
Thina, i-Jiangxi Zhuoruihua Medical Instrument Co., Ltd., singumkhiqizi waseChina ogxile ezintweni ezisetshenziswayo ze-endoscopic, ezifanai-biopsy forceps, i-hemoclip, polyp ugibe, inaliti ye-sclerotherapy, fafaza i-catheter, amabhulashi e-cytology, guidewire, ubhasikidi wokubuyisa amatshe, i-catheter ye-nasal biliary drainagenjll ezisetshenziswa kakhulu kuI-EMR, ESD,I-ERCP. Imikhiqizo yethu iqinisekiswe yi-CE, futhi izitshalo zethu ziqinisekiswe yi-ISO. Izimpahla zethu zithunyelwe eYurophu, eNyakatho Melika, eMpumalanga Ephakathi nasengxenyeni ye-Asia, futhi zithola kabanzi ikhasimende lokuqashelwa nokudumisa!
Isikhathi sokuthumela: Jul-09-2024