Isingeniso
Izimpawu eziyinhloko zama-hemorrhoids yigazi esitulweni, ubuhlungu bendunu, ukuwa nokuluma, njll., okuthinta kakhulu izinga lokuphila.Ezimweni ezimbi kakhulu, kungabangela ama-hemorrhoids avalelwe kanye ne-anemia engapheli ebangelwa igazi esitokisini.Njengamanje, ukwelashwa okulondolozayo kusekelwe ikakhulukazi emithini, futhi ukwelashwa kokuhlinzwa kuyadingeka ezimweni ezinzima.
Ukwelashwa kwe-Endoscopic kuyindlela yokwelapha esanda kuthuthukiswa eminyakeni yamuva, efaneleka kakhulu ezibhedlela ezisemazingeni aphansi.Namuhla, sizofingqa futhi silungise.
1. Ukuxilongwa komtholampilo, i-anatomy kanye nokwelashwa kwangaphambilini kwama-hemorrhoids
Ukuxilongwa Kwe-Hemorrhoids
Ukuxilongwa kwama-hemorrhoids kusekelwe ikakhulukazi emlandweni, ukuhlolwa, ukuhlolwa kwe-digital rectal kanye ne-colonoscopy.Ngokomlando wezokwelapha, kuyadingeka ukuqonda ubuhlungu be-anal, igazi esitokisini, ukukhishwa kwe-hemorrhoid nokubuyiselwa, njll. Ukuhlola ngokuyinhloko kuqonda ukubukeka kwama-hemorrhoids, kungakhathaliseki ukuthi kukhona i-anal fistula yokuvuvukala kwe-perianal, njll., kanye ne-digital rectal ukuhlolwa kudinga ukuqonda ukucinana kwe-anus nokuthi ingabe kukhona ukucwiliswa.I-Colonoscopy idinga ukuqaphela ezinye izifo ezifana nezimila, i-ulcerative colitis, njll. ezibangela ukopha.Ukuhlukaniswa nokuhlelwa kwama-hemorrhoids
Kunezinhlobo ezintathu zama-hemorrhoids: ama-hemorrhoids angaphakathi, ama-hemorrhoids angaphandle, nama-hemorrhoids axubile.
Ama-Hemorrhoids: Ama-Hemorrhoids Angaphakathi, Angaphandle, Nahlanganisiwe
Ama-hemorrhoids angahlukaniswa ngezigaba I, II, III, kanye ne-IV.Ihlelwa ngokuhambisana nokuminyana, ukuphuma kwe-hemorrhoid nokubuya.
Izinkomba zokwelashwa kwe-endoscopic ama-hemorrhoids angaphakathi ebangeni I, II, kanye ne-III, kuyilapho ama-hemorrhoids angaphakathi ebangeni lesi-IV, ama-hemorrhoids angaphandle, nama-hemorrhoids axubile kuyizingqinamba zokwelashwa kwe-endoscopic.Umugqa ohlukanisayo phakathi kokwelashwa kwe-endoscopic umugqa wamazinyo.
I-Anatomy ye-Hemorrhoids
Ulayini we-anal, umugqa wamazinyo, i-anal pad, nama-hemorrhoids yimibono okufanele izazi ze-endoscopists zizazi.Ukuhlonza i-Endoscopic kudinga ulwazi oluthile.Umugqa wamazinyo ukuhlangana kwe-epithelium ye-anal squamous kanye ne-columnar epithelium, futhi indawo yoshintsho phakathi komugqa wamazinyo nomugqa wamazinyo imbozwe yi-columnar epithelium kodwa ayivalwanga umzimba.Ngakho-ke, ukwelashwa kwe-endoscopic kusekelwe emgqeni wamazinyo.Ukwelashwa kwe-endoscopic kungenziwa ngaphakathi komugqa wamazinyo, futhi ukwelashwa kwe-endoscopic akukwazi ukwenziwa ngaphandle komugqa wamazinyo.
Umfanekiso 1. Ukubuka okungaphambili komugqa wamazinyo ngaphansi kwe-endoscope.Umcibisholo ophuzi ukhomba kulayini wamazinyo onyaka ohlukanisiwe, umcibisholo omhlophe ukhomba ikholomu yangemuva nenethiwekhi yayo yemithambo emide, kanye nomcibisholo obomvu ukhomba ku-valve yangemuva.
1A: isithombe sokukhanya okumhlophe;1B: I-Narrowband Light Imaging
Umfanekiso 2 Ukubhekwa kwe-flap ye-anal (umcibisholo obomvu) kanye nesiphetho esingezansi sekholomu yangemuva (umcibisholo omhlophe) eduze kwesibonakhulu.
Umfanekiso 3 Ukubhekwa kwe-papilla yangemuva eduze kwesibonakhulu (umcibisholo ophuzi)
Umfanekiso 4. Umugqa we-anal kanye nomugqa wamazinyo wabonwa nge-endoscopy ehlanekezelwe.Umcibisholo ophuzi ukhomba kulayini wamazinyo, futhi umcibisholo omnyama ukhomba kulayini wangemuva.
Imiqondo ye-papilla yangemuva kanye nekholomu yangemuva isetshenziswa kakhulu ekuhlinzeni i-anorectal futhi ngeke iphindwe lapha.
Ukwelashwa kwakudala kwama-hemorrhoids: kukhona ikakhulukazi ukwelashwa okugodlayo kanye nokwelashwa kokuhlinzwa.Ukwelashwa okulondolozayo kuhlanganisa ukusetshenziswa kwezidakamizwa kanye nokugeza kwe-sitz, futhi izinqubo zokuhlinzwa ikakhulukazi zihlanganisa i-hemorrhoidectomy kanye ne-stapled excision (PPH).Ngenxa yokuthi ukwelashwa kokuhlinzwa kuyinkimbinkimbi kakhulu, umphumela uzinzile, futhi ubungozi buncane, isiguli sidinga ukulaliswa esibhedlela izinsuku ezingu-3-5.
2. Ukwelashwa kwe-Endoscopic yama-hemorrhoids angaphakathi
Umehluko phakathi kokwelashwa kwe-endoscopic yama-hemorrhoids yangaphakathi kanye nokwelashwa kwe-EGV:
Inhloso yokwelashwa kwe-endoscopic yemithambo ye-esophagogastric imithambo yegazi ye-varicose, futhi okuhlosiwe kokwelashwa kwe-hemorrhoid yangaphakathi akuyona imithambo yegazi elula, kodwa ama-hemorrhoids akhiwa imithambo yegazi nezicubu ezixhumeneyo.Ukwelashwa kwama-hemorrhoids ukukhulula izimpawu, ukuphakamisa i-pad ye-anal eyehlela phansi, futhi ugweme izinkinga ezifana ne-anal stenosis ebangelwa ukunyamalala kwama-hemorrhoids (isimiso "sokubulala yonke into ngaphandle" sivame ukuba ne-anal stenosis).
Inhloso yokwelashwa kwe-endoscopic: Ukukhulula noma ukuqeda izimpawu, hhayi ukuqeda ama-hemorrhoids.
Ukwelashwa kwe-endoscopic kuhlanganisa i-sclerotherapy kanye ne-band ligation.
Ukuxilongwa nokwelashwa kwama-hemorrhoids angaphakathi, i-colonoscopy isetshenziselwa ukuhlolwa, futhi i-gastroscope inconywa ukwelashwa.Ngaphezu kwalokho, ngokusho kwesimo sangempela sesibhedlela ngasinye, ungakhetha ukwelashwa kwesiguli noma isiguli.
①Sclerotherapy (isizwa ikepisi esobala)
I-sclerosing ejenti umjovo we-lauryl alcohol, kanye nomjovo we-foam lauryl alcohol nawo ungasetshenziswa.Kuyadingeka futhi ukusebenzisa umjovo we-submucosal we-methylene eluhlaza okwesibhakabhaka njenge-ejenti engekho ukuze uqonde isiqondiso sokugeleza kanye nokufakwa kwe-sclerosing agent.
Inhloso yekepisi esobala ukukhulisa umkhakha wokubona.Inaliti yomjovo ingakhethwa ezinalitini ezijwayelekile zomjovo we-mucosal.Ngokuvamile, ubude benaliti buyi-6mm.Odokotela abangenalo ulwazi oluningi kufanele bazame ukugwema ukusebenzisa imijovo yenaliti ende, ngoba imijovo enaliti emide ijwayele ukujova i-ectopic kanye nomjovo.Ingozi ejulile futhi iholela kumathumba e-perianal nokuvuvukala.
Iphuzu lomjovo likhethwa ngaphezu kohlangothi lomlomo lomugqa wamazinyo, futhi indawo yenaliti yomjovo itholakala phansi kwe-hemorrhoid eqondiwe.Inaliti ifakwe ku-30 ° ~ 40 ° ngaphansi kombono oqondile (ngaphambili noma emuva) we-endoscope, futhi inaliti ifakwe ngokujulile esisekelweni se-hemorrhoid.Yakha inqwaba eqinile phansi kwe-hemorrhoid, khipha inaliti ngenkathi ujova, cishe u-0.5 ~ 2mL, futhi umise umjovo kuze kube yilapho i-hemorrhoid iba nkulu futhi ibe mhlophe.Ngemuva kokuthi umjovo usuphelile, bheka ukuthi akukho yini ukopha endaweni yomjovo.
I-Endoscopic sclerotherapy ihlanganisa umjovo wesibuko sangaphambili nomjovo wesibuko ohlanekezelwe.Ngokuvamile, umjovo wesibuko ohlanekezelwe uyindlela eyinhloko.
② ukwelashwa ngebhandeshi
Ngokuvamile, kusetshenziswa idivayisi yokuhlanganisa izindandatho eziningi, hhayi amaringi amaningi kakhulu.Ukuxhunyaniswa kwenziwa ku-1 kuya ku-3 cm ngaphezu komugqa wamazinyo, futhi ukubopha kuvame ukuqaliswa eduze komugqa wangemuva.Kungaba i-vascular ligation noma i-mucosal ligation noma i-ligation ehlangene.I-Mirror ligation iyindlela eyinhloko, ngokuvamile izikhathi ezingu-1-2, nesikhawu esingangenyanga eyodwa.
Ukwelashwa kwe-Perioperative: ukuzila ukudla akudingekile ngemva kokuhlinzwa, gcina isihlalo esibushelelezi, futhi ugweme ukuhlala isikhathi eside nokusebenza kanzima ngokomzimba.Ukusetshenziswa njalo kwama-antibiotic akudingekile.
3. Isimo samanje nezinkinga ezikhona zezibhedlela ezisezingeni eliphansi
Esikhathini esidlule, isikhundla esiyinhloko sokwelashwa kwama-hemorrhoids sasisemnyangweni we-anorectal.Ukwelashwa okuhlelekile emnyangweni we-anorectal kuhlanganisa imithi elondolozayo, umjovo we-sclerotherapy, nokwelashwa kokuhlinzwa.
Ama-endoscopists asemathunjini awanolwazi oluningi ekuhlonzweni kwe-perianal anatomy ngaphansi kwe-endoscopy, futhi izinkomba zokwelashwa kwe-endoscopic zilinganiselwe (ama-hemorrhoids angaphakathi kuphela angelashwa).Ukuhlinzwa kuyadingeka futhi ukuze ululame ngokugcwele, osekuyiphuzu elinzima ekuthuthukisweni kwephrojekthi.
Ngokombono, ukwelashwa kwe-endoscopic kwama-hemorrhoids angaphakathi kufanelekile ikakhulukazi ezibhedlela eziyinhloko, kodwa ekusebenzeni, akuyona into ecatshangwayo.
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 ku-EMR, ESD, 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-11-2022