I. Ukulungiselela isigulana
1. Ukuqonda indawo, uhlobo, ubungakanani kunye nokugqobhoka kwezinto zasemzini
Thatha ii-X-rays okanye ii-CT scans zentamo, isifuba, umbono we-anteroposterior kunye nowecala, okanye isisu njengoko kufuneka ukuze uqonde indawo, uhlobo, imilo, ubungakanani, kunye nokuba khona kokugqobhoka komzimba wangaphandle, kodwa ungenzi uvavanyo lwe-barium swallow.
2. Ixesha lokuzila ukutya kunye nexesha lokuzila amanzi
Ngokwesiqhelo, izigulana zizila ukutya iiyure ezi-6 ukuya kwezi-8 ukuze zikhuphe konke okungaphakathi esiswini, kwaye ixesha lokuzila ukutya nelokusela amanzi linokukhululeka ngokufanelekileyo ukuze kwenziwe i-gastroscopy engxamisekileyo.
3. Uncedo lwe-Anesthesia
Abantwana, abo baneengxaki zengqondo, abo bangasebenzisaniyo, okanye abo banemizimba yangaphandle evalelweyo, imizimba emikhulu yangaphandle, imizimba yangaphandle emininzi, imizimba yangaphandle ebukhali, okanye utyando lwe-endoscopic olunzima okanye oluthatha ixesha elide kufuneka batyandwe phantsi kwe-anesthesia jikelele okanye i-endotracheal intubation ngoncedo lwe-anesthesiologist. Susa izinto zangaphandle.
II. Ukulungiswa kwezixhobo
1. Ukukhetha i-Endoskopu
Zonke iintlobo ze-gastroscopy yokujonga phambili ziyafumaneka. Ukuba kuqikelelwa ukuba kunzima ukususa umzimba wangaphandle okanye umzimba wangaphandle mkhulu, kusetyenziswa i-gastroscopy yotyando olunezibuko ezimbini. Ii-Endoscopes ezinobubanzi obuncinci bangaphandle zinokusetyenziswa kwiintsana nabantwana abancinci.
2. Ukukhethwa kwee-forceps
Ngokuyintloko kuxhomekeke kubukhulu kunye nokuma komzimba wangaphandle. Izixhobo ezisetyenziswa rhoqo ziquka i-biopsy forceps, i-snare, i-three-jaw forceps, i-flat forceps, i-foreign body forceps (i-rat-tooth forceps, i-jaw-mouth forceps), i-jaw-mouth removal bag, i-net removal bag, njl.njl.
Ukukhethwa kwesixhobo kunokumiselwa ngokusekwe kubukhulu, imo, uhlobo, njl.njl. yomzimba wangaphandle. Ngokweengxelo zoncwadi, i-forceps yamazinyo eempuku zezona zisetyenziswa kakhulu. Izinga lokusetyenziswa kwe-forceps yamazinyo eempuku yi-24.0% ~ 46.6% yazo zonke izixhobo ezisetyenzisiweyo, kwaye i-snares ibalelwa kwi-4.0% ~ 23.6%. Ngokuqhelekileyo kukholelwa ukuba i-snares zingcono kwimizimba yangaphandle emide efana nenduku. Ezifana nee-thermometers, iibrashi zamazinyo, izinti ze-bamboo, iipeni, amacephe, njl.njl., kwaye indawo yesiphelo esigqunywe yi-snare akufuneki idlule kwi-1cm, kungenjalo kuya kuba nzima ukuphuma kwi-cardia.
2.1 Imizimba yangaphandle efana nentonga kunye nemizimba yangaphandle engqukuva
Kwizinto zangaphandle ezimile okwentonga ezinomphezulu ogudileyo kunye nobubanzi obuncinci bangaphandle njengee-toothpicks, kulula ngakumbi ukukhetha ii-pliers ezinemihlathi emithathu, ii-pliers ezinamazinyo empuku, ii-pliers ezisicaba, njl.njl.; kwizinto zangaphandle ezingqukuva (ezifana nee-cores, iibhola zeglasi, iibhetri zamaqhosha, njl.njl.), sebenzisa ibhaskithi yokususa amatye okanye ibhegi yokususa amatye ukuze uzisuse. Kunzima kakhulu ukuzisusa.
2.2 Imizimba emide ebukhali yangaphandle, iziqwenga zokutya, kunye namatye amakhulu esiswini
Kwimizimba emide ebukhali yangaphandle, i-axis ende yomzimba wangaphandle kufuneka ihambelane ne-axis ende ye-lumen, apho isiphelo esibukhali okanye isiphelo esivulekileyo sijonge ezantsi, kwaye sirhoxe ngelixa ufaka umoya. Kwimizimba yangaphandle enemilo esangqa okanye imizimba yangaphandle enemingxunya, kukhuselekile ukusebenzisa indlela yokufaka imisonto ukuyisusa;
Kwiziqwenga zokutya kunye namatye amakhulu esiswini, ii-bite forceps zingasetyenziselwa ukuzityumza zize zisuswe nge-three-jaw forceps okanye i-snare.
3. Izixhobo zokukhusela
Sebenzisa izixhobo zokukhusela kangangoko unako kwizinto zangaphandle ezinzima ukuzisusa kwaye ziyingozi. Okwangoku, izixhobo zokukhusela ezisetyenziswa rhoqo ziquka izigqubuthelo ezibonakalayo, iityhubhu zangaphandle, kunye nezigqubuthelo zokukhusela.
3.1 Isivalo esibonakalayo
Ngexesha lokususa umzimba wangaphandle, kufuneka kusetyenziswe isiciko esibonakalayo ekupheleni kwelensi ye-endoscopic kangangoko kunokwenzeka ukuthintela i-mucosa ukuba ingakrwelwa ngumzimba wangaphandle, nokwandisa umphimbo ukunciphisa ukumelana okufumanekayo xa umzimba wangaphandle ususwa. Inokunceda nokubamba nokukhupha umzimba wangaphandle, nto leyo eluncedo ekususeni umzimba wangaphandle.
Kwimizimba yangaphandle enemicu efakwe kwi-mucosa kuzo zombini iziphelo ze-esophagus, isiciko esibonakalayo singasetyenziselwa ukutyhala i-esophagus mucosa kancinci ijikeleze elinye icala lomzimba wangaphandle ukuze elinye icala lomzimba wangaphandle liphume eludongeni lwe-esophagus mucosal ukuze kuthintelwe ukugqobhoka kwe-esophagus okubangelwa kukususwa ngokuthe ngqo.
Isigqubuthelo esibonakalayo sinokubonelela ngendawo eyaneleyo yokusebenza kwesi sixhobo, esilungele ukufunyanwa nokususwa kwezinto zangaphandle kwicandelo elincinci lentamo yomqala.
Kwangaxeshanye, isigqubuthelo esibonakalayo singasebenzisa ukufunxa uxinzelelo olungalunganga ukunceda ukufunxa iziqwenga zokutya kunye nokwenza kube lula ukucutshungulwa kwazo okulandelayo.
3.2 Ibhokisi yangaphandle
Ngelixa ikhusela umphimbo kunye ne-mucosa ye-esophageal-gastric junction, ityhubhu yangaphandle inceda ekususweni kwe-endoscopic kwezinto ezinde, ezibukhali, nezininzi zangaphandle kunye nokususwa kwamaqoqo okutya, ngaloo ndlela kunciphisa ukwanda kweengxaki ngexesha lokususwa komzimba wangaphandle wesisu. Yandisa ukhuseleko kunye nokusebenza kakuhle konyango.
Ii-Overtubes azisetyenziswa rhoqo ebantwaneni ngenxa yomngcipheko wokonakalisa umphimbo ngexesha lokufakwa.
3.3 Isigqubuthelo sokukhusela
Beka isigqubuthelo sokukhusela sijonge phantsi kwicala elingaphambili le-endoscope. Emva kokuyibamba into yangaphandle, jika isigqubuthelo sokukhusela uze uyisonge loo nto ingaphandle xa ukhupha i-endoscope ukuze uphephe izinto ezingaphandle.
Idibana ne-mucous membrane yendlela yokugaya ukutya kwaye idlala indima yokukhusela.
4. Iindlela zonyango lweentlobo ezahlukeneyo zemizimba yangaphandle kwindlela ephezulu yesisu
4.1 Ukutya okuninzi kwi-esophagus
Iingxelo zibonisa ukuba uninzi lokutya okuncinci kwi-esophagus kunokutyhalelwa kancinci esiswini kwaye kushiywe ukuba kukhutshwe ngokwendalo, nto leyo elula, elula kwaye engenakubangela iingxaki. Ngexesha lenkqubo yokuqhubela phambili i-gastroscopy, ukunyuka okufanelekileyo kunokungeniswa kwi-esophageal lumen, kodwa ezinye izigulana zinokuhamba neethumba ezinobungozi ze-esophageal okanye i-post-esophageal anastomotic stenosis (Umfanekiso 1). Ukuba kukho ukumelana kwaye utyhala ngamandla, ukufaka uxinzelelo oluninzi kuya kwandisa umngcipheko wokugqobhoka. Kucetyiswa ukusebenzisa ibhaskithi yokususa ilitye okanye ibhegi yokususa ilitye ukususa ngokuthe ngqo umzimba wangaphandle. Ukuba i-bolus yokutya inkulu, ungasebenzisa i-forceps yomzimba wangaphandle, imigibe, njl.njl. ukuyityumza ngaphambi kokuba uyahlule. Yikhuphe.
Umfanekiso 1 Emva kotyando lomhlaza womqala, isigulana sasihamba kunye ne-esophageal stenosis kunye nokugcinwa kwe-food bolus.
4.2 Izinto ezingaqhelekanga ezimfutshane nezibuthuntu
Uninzi lwemizimba yangaphandle emifutshane nebuthuntu ingasuswa ngee-forceps zomzimba wangaphandle, izibatha, iingobozi zokususa amatye, iingxowa zenethi zokususa amatye, njl. (Umfanekiso 2). Ukuba umzimba wangaphandle kwi-esophagus kunzima ukuwususa ngokuthe ngqo, ungatyhalelwa esiswini ukuze ulungise indawo yawo uze uzame ukuwususa. Imizimba yangaphandle emifutshane, ebuthuntu enobubanzi obungaphezulu kwe-2.5 cm esiswini kunzima ukuyidlula kwi-pylorus, kwaye kufuneka kwenziwe utyando lwe-endoscopic ngokukhawuleza; ukuba imizimba yangaphandle ene-diameter encinci esiswini okanye kwi-duodenum ayibonisi monakalo wesisu, inokulinda ukukhutshwa kwayo kwendalo. Ukuba ihlala ngaphezu kweeveki ezi-3-4 kwaye isenokungakhutshwa, kufuneka isuswe nge-endoscopically.
Umfanekiso 2 Izinto zeplastiki zangaphandle kunye neendlela zokususa
4.3 Imibutho yangaphandle
Izinto zangaphandle ezinobude obuyi-≥6 cm (ezifana nee-thermometers, iibrashi zamazinyo, izinti ze-bamboo, iipeni, amacephe, njl.njl.) azilula ukuzikhupha ngokwendalo, ngoko ke zihlala ziqokelelwa ngebhasikithi ye-snare okanye yamatye.
I-snare ingasetyenziselwa ukugquma isiphelo esinye (kungabi ngaphezu kwe-1 cm ukusuka esiphelweni), ize ibekwe kwisigqubuthelo esibonakalayo ukuze ikhutshwe. Isixhobo se-cannula sangaphandle singasetyenziselwa nokubamba umzimba wangaphandle size sibuyele kwi-cannula yangaphandle ngokutyibilikayo ukuze kuthintelwe ukonakala kwe-mucosa.
4.4 Izinto ezibukhali zangaphandle
Izinto ezibukhali zangaphandle ezifana namathambo eentlanzi, amathambo enkukhu, amazinyo okufakelwa, imingxunya yedate pits, amazinyo okuxuba, iikliphu zamaphepha, iirazor blades, kunye neziqwenga zebhokisi yepilisi (Umfanekiso 3) kufuneka zinikwe ingqwalasela eyaneleyo. Izinto ezibukhali zangaphandle ezinokonakalisa ngokulula ii-mucous membranes kunye nemithambo yegazi kwaye zikhokelele kwiingxaki ezifana nokugqobhoka kufuneka ziphathwe ngononophelo. Ulawulo olungxamisekileyo lwe-endoscopic.
Umfanekiso 3 Iintlobo ezahlukeneyo zezinto ezibukhali zasemzini
Xa kususwa izidumbu ezibukhali zangaphandle phantsi komphethoI-scope, kulula ukukrwela i-mucosa yendlela yokugaya ukutya. Kucetyiswa ukuba usebenzise isiciko esicacileyo, esinokutyhila ngokupheleleyo i-lumen kwaye siphephe ukukrwela udonga. Zama ukusondeza isiphelo esicacileyo somzimba wangaphandle kufutshane nesiphelo selensi ye-endoscopic ukuze kubekwe isiphelo esinye somzimba wangaphandle. Yifake kwisiciko esicacileyo, sebenzisa i-forceps yomzimba wangaphandle okanye i-snare ukuze ubambe umzimba wangaphandle, uze uzame ukugcina i-axis ende yomzimba wangaphandle ihambelana ne-esophagus ngaphambi kokuba uphume kwi-scope. Imizimba yangaphandle efakwe kwelinye icala le-esophagus inokususwa ngokubeka isiciko esicacileyo kwisiphelo esingaphambili se-endoscope kwaye ungene kancinci kwi-esophageal inlet. Kwimizimba yangaphandle efakwe kwi-esophageal cavity kuzo zombini iziphelo, isiphelo esingaphantsi esifakwe kufuneka sikhululwe kuqala, ngesiqhelo Kwicala elikufutshane, khupha elinye icala, lungisa indlela yento yangaphandle ukuze isiphelo sentloko sifakwe kwisiciko esicacileyo, uze usikhuphe. Okanye emva kokusebenzisa imela yelaser ukusika umzimba wangaphandle embindini, amava ethu kukukhulula i-aortic arch okanye icala lentliziyo kuqala, size siyisuse ngokwamanqanaba.
a. Amazinyo okufakelwa: Xa usitya, ukhohlela, okanye uthethag, izigulana zinokuwa ngengozi kwiimazinyo azo okufakelwa, zize zingene kwindlela ephezulu yokugaya ukutya ngokuginya. Iimazinyo okufakelwa abukhali anezikhonkwane zesinyithi kuzo zombini iziphelo kulula ukuzifaka eludongeni lomgudu wokugaya ukutya, nto leyo eyenza kube nzima ukuzisusa. Kwizigulana ezingaphumeleliyo kunyango lwe-endoscopic oluqhelekileyo, izixhobo ezininzi zokuzibamba zingasetyenziselwa ukuzama ukuzisusa phantsi kwe-endoscopy yeendlela ezimbini.
b. Imingxunya yemihla: Imingxunya yemihla engaphakathi kwi-esophagus idla ngokuba bukhali kuzo zombini iziphelo, nto leyo enokubangela iingxaki ezifana nokonakala kwe-mucosale, ukopha, usulelo lwendawo olukhupha igazi kunye nokugqobhoka ngexesha elifutshane, kwaye kufuneka kunyangwe ngonyango olungxamisekileyo lwe-endoscopic (Umfanekiso 4). Ukuba akukho monakalo wesisu, uninzi lwamatye eedate esiswini okanye kwi-duodenum anokukhutshwa kwiiyure ezingama-48. Abo bangenakukhutshwa ngokwendalo kufuneka basuswe ngokukhawuleza.
Umfanekiso 4 Isiseko seJujube
Emva kweentsuku ezine, isigulana safunyaniswa ukuba sinomzimba wangaphandle kwesinye isibhedlele. I-CT yabonisa umzimba wangaphandle kwi-esophagus enemingxuma. Ii-jujube cores ezibukhali kuzo zombini iziphelo zasuswa nge-endoscopy kwaye kwenziwa i-gastroscopy kwakhona. Kwafunyaniswa ukuba i-fistula yenziwe eludongeni lwe-esophagus.
4.5 Izinto ezinkulu zangaphandle ezinemiphetho emide kunye nemiphetho ebukhali (Umfanekiso 5)
a. Faka ityhubhu yangaphandle phantsi kwe-endoscope: Faka i-gastroscope embindini wetyhubhu yangaphandle, ukuze umda ongezantsi wetyhubhu yangaphandle usondele kumda ongaphezulu wenxalenye egobileyo ye-gastroscope. Faka i-gastroscope rhoqo kufutshane nomzimba wangaphandle. Faka izixhobo ezifanelekileyo ngetyhubhu ye-biopsy, ezinje ngee-snares, ii-forceps zomzimba wangaphandle, njl. Emva kokubamba into yangaphandle, yifake kwityhubhu yangaphandle, kwaye lonke isixhobo siya kuphuma kunye nesibuko.
b. Isiciko sokukhusela ulwelwesi lwe-mucous esenziwe ekhaya: Sebenzisa isigqubuthelo sesithupha seeglavu zerabha zonyango ukwenza isigqubuthelo sokukhusela esingaphambili se-endoscope esenziwe ekhaya. Sika ecaleni kwe-bevel yengcambu yesithupha seglavu ibe yimo yexilongo. Sika umngxuma omncinci kwincam yomunwe, uze udlulise isiphelo esingaphambili somzimba wesibuko ngomngxuma omncinci. Sebenzisa iringi encinci yerabha ukuyilungisa i-1.0cm ukusuka kwisiphelo esingaphambili se-gastroscope, uyibuyisele kwisiphelo esiphezulu se-gastroscope, uze uyithumele kunye ne-gastroscope kumzimba wangaphandle. Bamba umzimba wangaphandle uze uwukhuphe kunye ne-gastroscope. Isiciko sokukhusela siya kuhamba ngokwemvelo siye kumzimba wangaphandle ngenxa yokuxhathisa. Ukuba icala liyajikwa, liya kusongelwa kwizinto zangaphandle ukuze likhuseleke.
Umfanekiso 5: Amathambo eentlanzi abukhali asuswe nge-endoscopically, kunye nemikrwelo ye-mucosal
4.6 Izinto zangaphandle zesinyithi
Ukongeza kwii-forceps eziqhelekileyo, imizimba yangaphandle yesinyithi inokususwa ngokufunxwa nge-magnetic body forceps. Imizimba yangaphandle yesinyithi eyingozi ngakumbi okanye enzima ukuyisusa inokunyangelwa nge-endoscopically phantsi kwe-X-ray fluoroscopy. Kucetyiswa ukusebenzisa ibhaskithi yokususa ilitye okanye ibhegi yokususa ilitye.
Iingqekembe zixhaphake kakhulu phakathi kwemizimba yangaphandle kwindlela yokugaya ukutya yabantwana (Umfanekiso 6). Nangona uninzi lweengqekembe kwi-esophagus zinokudluliswa ngokwendalo, unyango olukhethiweyo lwe-endoscopic luyacetyiswa. Ngenxa yokuba abantwana abasebenzisani kangako, ukususwa kweemizimba yangaphandle kwi-endoscopic kwenziwa ngcono phantsi kwe-anesthesia eqhelekileyo. Ukuba ingqekembe kunzima ukuyisusa, inokutyhalelwa esiswini ize ikhutshwe. Ukuba akukho zimpawu esiswini, ungalinda ukuba ikhutshwe ngokwendalo. Ukuba ingqekembe ihlala ngaphezulu kweeveki ezi-3-4 kwaye ayikhutshwa, kufuneka inyangwe nge-endoscopic.
Umfanekiso 6 Ingqekembe yesinyithi izinto zangaphandle
4.7 Izinto zangaphandle ezonakalisayo
Imizimba yangaphandle egqwalisayo inokubangela umonakalo kwindlela yokugaya ukutya okanye i-necrosis. Unyango olungxamisekileyo lwe-endoscopic luyafuneka emva kokuxilongwa. Iibhetri zezona mizimba yangaphandle egqwalisayo kwaye zihlala zenzeka kubantwana abangaphantsi kweminyaka emi-5 ubudala (Umfanekiso 7). Emva kokonakalisa i-esophagus, zinokubangela i-esophageal stenosis. I-Endoscopy kufuneka ihlolwe kwiiveki ezimbalwa. Ukuba kuye kwenziwa i-stricture, i-esophagus kufuneka ikhuliswe ngokukhawuleza.
Umfanekiso 7 Into yangaphandle kwibhetri, utolo olubomvu lubonisa indawo yento yangaphandle
4.8 Izinto zangaphandle zemagnethi
Xa kukho imizimba emininzi yasemzini enemagnethi okanye imizimba yasemzini enemagnethi edityaniswe nesinyithi kwindlela ephezulu yesisu, izinto ziyatsalana kwaye zicinezele iindonga zendlela yokugaya ukutya, nto leyo enokubangela i-ischemic necrosis, ukwakheka kwe-fistula, ukugqobhoka, ukuvaleka, i-peritonitis kunye nezinye iingozi ezinkulu zesisu. , ezifuna unyango olungxamisekileyo lwe-endoscopic. Izinto zasemzini ezinemagnethi enye nazo kufuneka zisuswe ngokukhawuleza. Ukongeza kwi-forceps eqhelekileyo, imizimba yasemzini enemagnethi ingasuswa phantsi kokufunxwa nge-forceps yomzimba wangaphandle enemagnethi.
4.9 Imizimba yangaphandle esiswini
Uninzi lwazo zizikhanyisi, iingcingo zentsimbi, izikhonkwane, njl.njl. eziginywa ngabom ngamabanjwa. Uninzi lwezidumbu zasemzini zinde kwaye zikhulu, kunzima ukudlula kwi-cardia, kwaye zinokukrwela lula ulwelwesi lwamafinyila. Kucetyiswa ukusebenzisa iikhondom ezidityaniswe nee-forceps zamazinyo empuku ukususa izidumbu zasemzini phantsi kovavanyo lwe-endoscopic. Okokuqala, faka ii-forceps zamazinyo empuku kwisiphelo esingaphambili se-endoscope ngomngxuma we-biopsy we-endoscopic. Sebenzisa ii-forceps zamazinyo empuku ukubopha iringi yerabha ezantsi kwekhondom. Emva koko, buyisela ii-forceps zamazinyo empuku kumngxuma we-biopsy ukuze ubude bekhondom buvele ngaphandle komngxuma we-biopsy. Yinciphise kangangoko kunokwenzeka ngaphandle kokuchaphazela intsimi yokujonga, uze uyifake kumngxuma wesisu kunye ne-endoscope. Emva kokufumanisa umzimba wasemzini, faka umzimba wasemzini kwikhondom. Ukuba kunzima ukuyisusa, beka ikhondom kumngxuma wesisu, kwaye usebenzise ii-forceps zamazinyo empuku ukubopha umzimba wasemzini uze uwufake. Ngaphakathi kwikhondom, sebenzisa iipliers zamazinyo empuku ukubopha ikhondom uze uyikhuphe kunye nesipili.
4.10 Amatye esisu
IiGastroliths zahlulwe zibe zii-gastroliths zemifuno, ii-gastroliths zezilwanyana, ii-gastroliths ezibangelwa ngamayeza kunye nee-gastroliths ezixutyiweyo. Ii-gastroliths zezityalo zezona zixhaphakileyo, ikakhulu zibangelwa kukutya inani elikhulu lee-persimmons, ii-hawthorns, ii-winter dates, iipesika, i-celery, i-kelp, kunye neekhokhonathi esiswini esingenanto. Zibangelwa njalo njalo. Ii-gastroliths ezisekelwe kwizityalo ezifana nee-persimmons, ii-hawthorns, kunye nee-jujubes ziqulethe i-tannic acid, i-pectin, kunye ne-gum. Phantsi kwesenzo se-asidi yesisu, kwakheka iproteni ye-tannic acid enganyibilikiyo emanzini, ebopha kwi-pectin, i-gum, i-plant fiber, i-peel, kunye ne-core. Amatye esisu.
Amatye esisu acinezela udonga lwesisu kwaye akhuthaza ukwanda kokukhutshwa kwe-asidi yesisu, nto leyo enokubangela ukukhukuliseka kwe-mucosal yesisu, izilonda kwanokugqobhoka. Amatye amancinci, athambileyo esisu anokunyibilikiswa nge-sodium bicarbonate kunye nezinye iziyobisi aze emva koko avunyelwe ukuba akhutshwe ngokwendalo.
Kwizigulane ezingaphumeleliyo kunyango, ukususwa kwamatye e-endoscopic lukhetho lokuqala (Umfanekiso 8). Kumatye esisu akunzima ukuwasusa ngqo phantsi kwe-endoscopy ngenxa yobukhulu bawo obukhulu, ii-forceps zomzimba wangaphandle, imigibe, iingobozi zokususa amatye, njl.njl. zinokusetyenziselwa ukutyumza ngqo amatye uze uwasuse; kwabo baneempawu eziqinileyo ezingenako ukutyumzwa, ukunqunyulwa kwamatye e-endoscopic kunokuqwalaselwa, unyango lwe-laser lithotripsy okanye i-high-frequency electric lithotripsy, xa ilitye lesisu lingaphantsi kwe-2cm emva kokuqhekeka, sebenzisa ii-forceps ezintathu okanye ii-forceps zomzimba wangaphandle ukuze ulisuse kangangoko kunokwenzeka. Kufuneka kuthathwe unonophelo ukuthintela amatye amakhulu kune-2cm ukuba angaphumi aye emgodini wamathumbu ngesisu aze abangele ukuvaleka kwamathumbu.
Umfanekiso 8 Amatye esiswini
4.11 Ingxowa yamayeza
Ukuqhekeka kwengxowa yeziyobisi kuya kuba yingozi kwaye yinto engafanelekanga kunyango lwe-endoscopic. Izigulane ezingakwaziyo ukuphuma ngaphandle ngokwendalo okanye ezirhanelwa ukuba ziqhekeke kwingxowa yeziyobisi kufuneka zenze utyando olusebenzayo.
III. Iingxaki kunye nonyango
Iingxaki zomzimba wangaphandle zinxulumene nohlobo, imo, ixesha lokuhlala kunye nenqanaba lotyando lukagqirha. Iingxaki eziphambili ziquka ukwenzakala komlomo womqala, ukopha, kunye nosulelo olugqobhokileyo.
Ukuba umzimba wangaphandle umncinci kwaye akukho monakalo ubonakalayo kwi-mucosal xa ukhutshwa, akufuneki ukuba ulaliswe esibhedlele emva kotyando, kwaye ukutya okuthambileyo kunokulandelwa emva kokuzila ukutya iiyure ezi-6.Kwizigulane ezineengozi zomqala, ii-glutamine granules, ijeli ye-aluminium phosphate kunye nezinye izinto ezikhusela i-mucosal zinokunikwa unyango oluneempawu. Ukuba kuyimfuneko, ukutya okuzila ukutya kunye nesondlo esingaphandle kunokunikwa.
Kwizigulane ezinomonakalo ocacileyo we-mucosal kunye nokopha kwegazi, unyango lunokwenziwa phantsi kombono othe ngqo we-endoscopic, njengokutshiza isisombululo se-ice-cold saline norepinephrine, okanye ii-endoscopic titanium clips ukuvala inxeba.
Kwizigulane ezine-CT yangaphambi kotyando ezibonisa ukuba umzimba wangaphandle ungene eludongeni lwe-esophageal emva kokususwa kwe-endoscopic, ukuba umzimba wangaphandle uhlala ngaphantsi kweeyure ezingama-24 kwaye i-CT ayifumani kwakheka kwethumba ngaphandle kwe-lumen ye-esophageal, unyango lwe-endoscopic lunokwenziwa ngokuthe ngqo. Emva kokuba umzimba wangaphandle ususiwe nge-endoscope, i-titanium clip isetyenziselwa ukubamba udonga lwangaphakathi lwe-esophagus kwindawo yokubhoboza, enokuyeka ukopha kwaye ivale udonga lwangaphakathi lwe-esophagus ngaxeshanye. Ityhubhu yesisu kunye netyhubhu yokutya ye-jejunal zifakwa phantsi kombono othe ngqo we-endoscope, kwaye isigulane silaliswa esibhedlele ukuze siqhubeke nonyango. Unyango luquka unyango oluneempawu ezifana nokuzila ukutya, ukuthomalalisa amathumbu, ii-antibiotics kunye nesondlo. Kwangaxeshanye, iimpawu ezibalulekileyo ezifana nobushushu bomzimba kufuneka zijongwe ngokusondeleyo, kwaye ukuvela kweengxaki ezifana ne-empysema yentamo okanye i-mediastinal emphysema kufuneka kujongwe ngosuku lwesithathu emva kotyando. Emva kokuba i-iodine water angiography ibonisa ukuba akukho kuvuza, ukutya nokusela kunokuvunyelwa.
Ukuba umzimba wangaphandle ugcinwe ixesha elingaphezulu kweeyure ezingama-24, ukuba iimpawu zosulelo ezifana nomkhuhlane, ukugodola, kunye nokwanda okukhulu kwenani leeseli ezimhlophe zegazi, ukuba i-CT ibonisa ukwakheka kwethumba elingaphandle kolusu emqaleni, okanye ukuba kubekho iingxaki ezinkulu, izigulana kufuneka zidluliselwe kutyando ukuze zifumane unyango ngexesha elifanelekileyo.
IV. Amanyathelo okuzikhusela
(1) Okukhona umzimba wangaphandle uhlala ixesha elide kwi-esophagus, kokukhona utyando luya kuba nzima kwaye kokukhona kuza kubakho iingxaki ezininzi. Ke ngoko, ukungenelela okungxamisekileyo kwe-endoscopic kubaluleke kakhulu.
(2) Ukuba umzimba wangaphandle mkhulu, umi ngendlela engaqhelekanga okanye unezipikili, ingakumbi ukuba umzimba wangaphandle uphakathi kwe-esophagus kwaye ukufutshane ne-aortic arch, kwaye kunzima ukuwususa nge-endoscopically, musa ukuwukhupha ngenkani. Kungcono ukufuna iingcebiso ezininzi kunye nokulungiselela utyando.
(3) Ukusetyenziswa ngengqiqo kwezixhobo zokukhusela umqala kunokunciphisa ukwenzeka kweengxaki.
Zethuii-forceps zokubamba ezilahlwayoIsetyenziswa kunye nee-endoscopes ezithambileyo, zingena emzimbeni womntu njengeendlela zokuphefumla, umphimbo, isisu, amathumbu njalo njalo nge-endoscope channel, ukuze zibambe izicubu, amatye kunye nezinto zangaphandle kunye nokukhupha ii-stents.
Ixesha leposi: Jan-26-2024