I.Ukulungiselela isigulana
1. Qonda indawo, ubunjani, ubungakanani kunye nokugqobhozwa kwezinto zangaphandle
Thatha i-X-rays ecacileyo okanye i-CT scans zentamo, isifuba, i-anteroposterior kunye neembono zecala, okanye isisu njengoko kufuneka ukuqonda indawo, indalo, imilo, ubungakanani, kunye nobukho be-perforation yomzimba wangaphandle, kodwa musa ukwenza i-barium swallow. uviwo.
2. Ukuzila ukutya kunye nexesha lokuzila amanzi
Ngokuqhelekileyo, izigulane zizila ukutya kwii-6 ukuya kwiiyure ze-8 ukuze zikhuphe iziqulatho zesisu, kwaye ixesha lokuzila ukutya kunye namanzi linokukhululeka ngokufanelekileyo kwi-gastroscopy engxamisekileyo.
3. Uncedo lwe-anesthesia
Abantwana, abo banengxaki yengqondo, abo bangabambisani, okanye abo bavalelwe imizimba yangaphandle, imizimba emikhulu yangaphandle, imizimba yangaphandle ebukhali, imizimba yangaphandle ebukhali, okanye imisebenzi ye-endoscopic enzima okanye ethatha ixesha elide kufuneka iqhutywe phantsi kwe-anesthesia jikelele okanye i-endotracheal. Intubation ngoncedo lwe-anesthesiologist.Susa izinto zangaphandle.
II.Ukulungiswa kwezixhobo
1. Ukukhetha i-Endoscope
Zonke iintlobo ze-gastroscopy yokujonga phambili ziyafumaneka.Ukuba kuqikelelwa ukuba kunzima ukususa umzimba wangaphandle okanye umzimba wangaphandle mkhulu, i-double-port surgery gastroscopy isetyenziswa.Ii-endoscopes ezinobubanzi obuncinane bangaphandle zingasetyenziselwa iintsana kunye nabantwana abancinci.
2. Ukukhethwa kweeforceps
Ikakhulu kuxhomekeke kubukhulu kunye nokumila komzimba wangaphandle.Izixhobo ezisetyenziswa ngokuqhelekileyo ziquka i-biopsy forceps, umgibe, i-forceps yemihlathi emithathu, i-flat forceps, i-forcep yomzimba wangaphandle (i-rat-tooth forceps, i-jaw-mouth forceps), i-basket yokususa ilitye, i-bag yokususa amatye, njl.
Ukukhethwa kwesixhobo kunokumiselwa ngokusekelwe kubukhulu, imilo, uhlobo, njl njl.Ngokweengxelo zoncwadi, i-rat-tooth forceps zezona zisetyenziswa kakhulu.Izinga lokusetyenziswa kwe-rat-tooth forceps yi-24.0% ~ 46.6% yazo zonke izixhobo ezisetyenzisiweyo, kunye ne-akhawunti ye-4.0% ~ 23.6%.Ngokuqhelekileyo kukholelwa ukuba imigibe ingcono kwimizimba yasemzini emide efana nentonga.Ezifana ne-thermometers, i-toothbrush, i-bamboo chopsticks, iipeni, iipuni, njl., kunye nendawo yokuphela ehlanganiswe ngumgibe akufanele idlule i-1cm, ngaphandle koko kuya kuba nzima ukuphuma kwi-cardia.
2.1 Imizimba yasemzini emile okwentonga kunye nemizimba yangaphandle engqukuva
Kwizinto zangaphandle ezimile okwentonga ezinomgangatho ogudileyo kunye nobubanzi obungaphandle obuncinci njengama-toothpicks, kulungele ngakumbi ukukhetha iipliers ezintathu zemihlathi, i-rat-tooth pliers, i-flat pliers, njl.;izinto zangaphandle ezingqukuva (ezinje ngeecores, iibhola zeglasi, iibhetri zamaqhosha, njl.njl.), sebenzisa ibhaskithi yokususa ilitye okanye ibhegi yokususa ilitye ukuze uzisuse.
2.2 Imizimba yangaphandle ebukhali amade, amaqhina okutya, namatye amakhulu esiswini
Kwimizimba emide ebukhali yangaphandle, i-axis ende yomzimba wangaphandle kufuneka ihambelane ne-axis ye-longitudinal ye-lumen, kunye nesiphelo esibukhali okanye isiphelo esivulekileyo sijonge ezantsi, kwaye ihoxise ngelixa utofa umoya.Kwimizimba yangaphandle emile njengesangqa okanye imizimba yasemzini enemingxuma, kukhuselekile ukusebenzisa indlela yokuthunga ukuyisusa;
Kwimibhobho yokutya kunye namatye amakhulu esiswini, i-forceps yokuluma ingasetyenziselwa ukuwatyumza kwaye emva koko isuswe nge-forceps yemihlathi emithathu okanye umgibe.
3. Izixhobo ezikhuselayo
Sebenzisa izixhobo zokukhusela kangangoko kunokwenzeka kwizinto zangaphandle ekunzima ukuzisusa kwaye ziyingozi.Okwangoku, izixhobo zokukhusela ezisetyenziswa ngokuqhelekileyo ziquka iminqwazi ecacileyo, iityhubhu zangaphandle, kunye nezikhuselo ezikhuselayo.
3.1 Umnqwazi ocacileyo
Ngexesha lomsebenzi wokususwa komzimba wangaphandle, i-cap ecacileyo kufuneka isetyenziswe ekupheleni kwelensi ye-endoscopic kangangoko kunokwenzeka ukukhusela i-mucosa ukuba ingakrwelwa ngumzimba wangaphandle, kunye nokwandisa ummizo ukunciphisa ukuchasana okufunyenwe xa umzimba wangaphandle. iyasuswa.Inokunceda kwakhona ukunyanzelisa kunye nokukhupha umzimba wangaphandle, oluncedo ekususeni umzimba wangaphandle.khupha.
Kwimizimba yasemzini emile okwemilo emiliselwe kwi-mucosa kuzo zozibini iziphelo zommizo, ikepusi ecacileyo ingasetyenziselwa ukutyhala ngobunono umzobo we-esophageal ujikeleze kwelinye icala lomzimba wangaphandle ukuze isiphelo esinye somzimba wangaphandle siphume kudonga lommizo ukuya. kuphephe ukugqobhoza kommizo okubangelwa kukususwa ngokuthe ngqo.
I-cap ecacileyo inokubonelela ngesithuba esaneleyo sokusebenza kwesixhobo, esilungele ukufunyanwa kunye nokususwa kwemizimba yangaphandle kwinxalenye yentamo ye-esophageal.
Kwangaxeshanye, ikepusi ecacileyo inokusebenzisa uxinzelelo olubi lokufunxa ukufunxa ukutya kunye nokuququzelela ukusetyenzwa okulandelayo.
3.2 Isingxobo sangaphandle
Ngelixa ukhusela i-esophagus kunye ne-esophageal-gastric junction mucosa, ityhubhu yangaphandle iququzelela ukususwa kwe-endoscopic yemizimba yangaphandle emide, ebukhali, kunye nokususwa kwe-clumps yokutya, ngaloo ndlela inciphisa iziganeko zeengxaki ngexesha lokukhutshwa komzimba wangaphandle wesisu.Ukwandisa ukhuseleko kunye nokusebenza kwonyango.
Ii-Overtubes aziqhelekanga ukusetyenziswa kubantwana ngenxa yomngcipheko wokonakalisa ummizo ngexesha lokufakwa.
3.3 I-inshorensi ekhuselayo
Beka isigqubuthelo sokukhusela sijonge phantsi kwisiphelo sangaphambili se-endoscope.Emva kokucinezela into yangaphandle, flip isigqubuthelo sokukhusela kwaye usonge into yangaphandle xa urhoxisa i-endoscope ukuphepha izinto zangaphandle.
Idibana ne-mucous membrane ye-digestive tract kwaye idlala indima yokukhusela.
4. Iindlela zonyango kwiindidi ezahlukeneyo zemizimba yangaphandle kwindawo ephezulu yesisu
4.1 Ubuninzi bokutya kwi-esophagus
Iingxelo zibonisa ukuba uninzi lwezinto ezincinci zokutya kwi-esophagus zinokutyhalwa ngobunono esiswini kwaye zishiywe ukuba zikhutshwe ngokwemvelo, ezilula, ezilungele kwaye zincinci zinokubangela iingxaki.Ngethuba lenkqubo yokuqhubela phambili kwe-gastroscopy, ukunyuka kwamaxabiso okufanelekileyo kunokungeniswa kwi-lumen ye-esophageal, kodwa ezinye izigulane zinokukhatshwa ngamathumba amabi okanye i-post-esophageal anastomotic stenosis (Umfanekiso 1).Ukuba kukho ukuxhathisa kwaye utyhala ngamandla, ukufaka uxinzelelo oluninzi kuya kwandisa umngcipheko wokugqobhoza.Kunconywa ukusebenzisa ibhasikidi yokususa ilitye okanye isikhwama sokususa ilitye ukususa ngokuthe ngqo umzimba wangaphandle.Ukuba i-bolus yokutya inkulu, ungasebenzisa i-forceps yomzimba wangaphandle, imigibe, njl.njl. ukuyicola phambi kokuyahlula.Yikhuphe.
Umzobo 1 Emva kotyando lomhlaza we-esophageal, isigulane sasihamba kunye ne-esophageal stenosis kunye nokugcinwa kwe-bolus yokutya.
4.2 Izinto zangaphandle ezimfutshane nezibuthuntu
Uninzi lwemizimba yangaphandle emfutshane kunye ne-blunt inokususwa ngokusebenzisa i-forcep yangaphandle, imigibe, iibhasikithi zokususa amatye, iingxowa zokususwa kwamatye, njl njl. (Umfanekiso 2).Ukuba umzimba wangaphandle kwi-esophagus kunzima ukuwususa ngokuthe ngqo, unokutyhalela esiswini ukulungelelanisa indawo yawo kwaye uzame ukuwususa.Imizimba emifutshane, engaqhelekanga yangaphandle enobubanzi be-2.5 cm esiswini kunzima kakhulu ukudlula kwi-pylorus, kwaye ukungenelela kwe-endoscopic kufuneka kwenziwe ngokukhawuleza;ukuba imizimba yangaphandle ene-diameter encinci kwisisu okanye i-duodenum ayibonisi umonakalo wesisu, inokulinda ukukhutshwa kwayo kwendalo.Ukuba ihlala ngaphezu kweeveki ezi-3-4 kwaye ayikwazi ukukhutshwa, kufuneka isuswe endoscopically.
Umzobo 2 Izinto zeplastiki zangaphandle kunye neendlela zokususa
4.3 Amaqumrhu angaphandle
Izinto zangaphandle ezinobude be-≥6 cm (ezifana ne-thermometers, i-toothbrush, i-bamboo chopsticks, iipeni, iipuni, njl.) Akulula ukuba zikhutshwe ngokwemvelo, ngoko zihlala ziqokelelwa ngomgibe okanye ibhasikidi yamatye.
Umgibe ungasetyenziselwa ukuvala isiphelo esinye (akukho ngaphezu kwe-1 cm ukusuka ekupheleni), kwaye ubekwe kwi-cap evulekileyo ukuyikhupha.Isixhobo sangaphandle se-cannula sinokusetyenziselwa ukubamba umzimba wangaphandle kwaye emva koko uhlehle kakuhle kwi-cannula yangaphandle ukunqanda ukonakalisa i-mucosa.
4.4 Izinto ezibukhali zangaphandle
Izinto ezibukhali zangaphandle ezifana namathambo entlanzi, amathambo enkukhu, amazinyo emboleko, imingxuma yedati, ii-toothpicks, iikliphu zephepha, iincakuba, kunye neepilisi zeebhokisi zokusonga iibhokisi (Umfanekiso 3) kufuneka zinikwe ingqwalasela eyaneleyo.Izinto ezibukhali zangaphandle ezinokonakalisa ngokulula i-mucous membranes kunye nemithambo yegazi kwaye zikhokelela kwiingxaki ezinjengokugqobhoza kufuneka ziphathwe ngononophelo.Ulawulo lwe-endoscopic olungxamisekileyo.
Umzobo 3 Iintlobo ezahlukeneyo zezinto ezibukhali zangaphandle
Xa ususa imizimba ebukhali yangaphandle phantsi kwesipheloi-oscope, kulula ukukrazula i-mucosa yendlela yokugaya.Kunconywa ukusebenzisa i-cap ecacileyo, enokuthi iveze ngokupheleleyo i-lumen kwaye igweme ukukrazula udonga.Zama ukuzisa isiphelo esibuhlungu somzimba wasemzini kufutshane nesiphelo selensi ye-endoscopic ukuze isiphelo esinye somzimba wasemzini sibekwe Sibeke kwikepusi ecacileyo, sebenzisa i-forceps yangaphandle okanye umgibe wokubamba umzimba wasemzini, emva koko. zama ukugcina i-axis ye-longitudinal yomzimba wangaphandle ihambelana nommizo ngaphambi kokurhoxa kumda.Imizimba yangaphandle efakwe kwelinye icala lommizo inokususwa ngokubeka umnqwazi ocacileyo kumphambili we-endoscope kwaye ngokucothayo ungene kwi-esophageal inlet.Kwimizimba yangaphandle efakwe kwi-esophageal cavity kuzo zombini iziphelo, isiphelo esifakwe ngaphakathi esinzulu kufuneka sikhululwe kuqala, ngokuqhelekileyo Kwicala elisondeleyo, khupha elinye isiphelo, ulungelelanise isalathiso sento yangaphandle ukuze isiphelo sentloko sifakwe kwindawo ecacileyo. ikepusi, kwaye uyikhuphe.Okanye emva kokusebenzisa imela ye-laser ukusika umzimba wangaphandle phakathi, amava ethu kukukhulula i-aortic arch okanye icala lentliziyo kuqala, kwaye emva koko uyisuse ngezigaba.
a.Amazinyo emboleko: Xa usitya, ukhohlela, okanye uthethag, izigulane zinokuwa ngempazamo kumazinyo abo emboleko, kwaye emva koko zingene kumzila wesisu esiphezulu kunye neentshukumo zokuginya.Amazinyo emboleko abukhali aneentsimbi zentsimbi kwiziphelo zombini kulula ukuba afakwe kwiindonga zendlela yokwetyisa, nto leyo eyenza kube nzima ukuyisusa.Kwizigulana ezingaphumeleliyo kunyango lwe-endoscopic oluqhelekileyo, izixhobo ezininzi zokubambelela zingasetyenziselwa ukuzama ukususwa phantsi kwe-endoscopy yeetshaneli ezimbini.
b.Imingxuma yomhla: Imingxuma yomhla efakwe kummizo idla ngokubukhali kuzo zozibini iziphelo, nto leyo enokukhokelela kwiingxaki ezifana nomonakalo we-mucosal.e, ukopha, usulelo lwendawo ye-suppurative kunye nokubhoboza ngexesha elifutshane, kwaye kufuneka luphathwe ngonyango olungxamisekileyo lwe-endoscopic (Umfanekiso 4).Ukuba akukho nzakala yesisu, uninzi lwamatye omhla esiswini okanye kwi-duodenum anokukhutshwa kwiiyure ezingama-48.Abo bangenako ukukhutshwa ngokwemvelo kufuneka basuswe ngokukhawuleza.
Umzobo 4 iJujube core
Kwiintsuku ezine kamva, kwafunyaniswa ukuba isigulane sinomzimba wasemzini kwesinye isibhedlele.I-CT ibonise umzimba wangaphandle kwi-esophagus kunye ne-perforation.I-jujube cores ebukhali kwiziphelo zombini zisuswe phantsi kwe-endoscopy kwaye i-gastroscopy yenziwa kwakhona.Kwafunyaniswa ukuba i-fistula yenziwa eludongeni lommizo.
4.5 Izinto ezinkulu zangaphandle ezinamacala amade kunye neencam ezibukhali (Umfanekiso 5)
a.Faka ityhubhu yangaphandle phantsi kwe-endoscope: Faka i-gastroscope ukusuka kumbindi wetyhubhu yangaphandle, ukuze umgca ongezantsi wombhobho wangaphandle usondele kumda ongaphezulu wendawo egobileyo ye-gastroscope.Faka rhoqo i-gastroscope kufuphi nomzimba wangaphandle.Faka izixhobo ezifanelekileyo kwityhubhu ye-biopsy, njengemigibe, i-forceps yomzimba wangaphandle, njl. Emva kokubamba into yangaphandle, yibeke kumbhobho wangaphandle, kwaye isixhobo sonke siya kuphuma kunye nesipili.
b.Isigqubuthelo sokhuselo senwebu yokwenziwa ekhaya: Sebenzisa isigqubuthelo sobhontsi seeglavu zerabha yezonyango ukwenza i-endoscope yasekhaya yokhuselo olungaphambili.Yinqumle ecaleni kwebhontsi yengcambu yeglavu ibe yimo yexilongo.Sika umngxuma omncinci kwincam yeminwe, kwaye udlule isiphelo esingaphambili somzimba wesibuko ngomngxuma omncinci.Sebenzisa iringi encinci yerabha ukuyilungisa i-1.0cm ukusuka kumphambili we-gastroscope, uyibuyisele kwisiphelo esiphezulu se-gastroscope, kwaye uyithumele kunye ne-gastroscope kumzimba wangaphandle.Thatha umzimba wangaphandle uze uwukhuphe kunye ne-gastroscope.Umkhono wokukhusela uya kuhamba ngokwendalo ukuya kumzimba wangaphandle ngenxa yokuchasana.Ukuba ulwalathiso lubuyiselwe umva, luya kusongelwa kwizinto zangaphandle ukuze zikhuseleke.
Umzobo 5: Amathambo eentlanzi ezibukhali asuswe endoscopically, kunye nemikrwelo ye-mucosal
4.6 Isinyithi sangaphandle
Ukongeza kwi-forceps yesiqhelo, imizimba yangaphandle yesinyithi inokususwa ngokufunxa nge-magnetic forceps body forceps.Imizimba yangaphandle eyintsimbi eyingozi ngakumbi okanye ekunzima ukuyisusa inokunyangwa nge-endoscopically phantsi kwe-X-reyi fluoroscopy.Kunconywa ukusebenzisa ibhasikidi yokususa ilitye okanye isikhwama sokususa ilitye.
Iingqekembe zixhaphake kakhulu phakathi kwemizimba yangaphandle kwindlela yokugaya yabantwana (Umfanekiso 6).Nangona iingqekembe ezininzi kwi-esophagus zinokugqithiswa ngokwemvelo, unyango olukhethiweyo lwe-endoscopic luyacetyiswa.Ngenxa yokuba abantwana bangaphantsi kwentsebenziswano, ukususwa kwe-endoscopic yemizimba yangaphandle kubantwana kwenziwa kakuhle phantsi kwe-anesthesia jikelele.Ukuba ingqekembe kunzima ukuyisusa, inokutyhalelwa esiswini ize ikhutshwe.Ukuba akukho zimpawu esiswini, unokulinda ukuba ikhutshwe ngokwemvelo.Ukuba ingqekembe ihlala ngaphezu kweeveki ezi-3-4 kwaye ayigxothwanga, kufuneka iphathwe nge-endoscopically.
Umfanekiso 6 Ingqekembe yentsimbi yinto yangaphandle
4.7 Umba wangaphandle owonakalisayo
Imizimba yangaphandle eyonakalisayo inokubangela umonakalo kwindlela yokugaya okanye i-necrosis.Unyango olungxamisekileyo lwe-endoscopic luyafuneka emva kokuxilongwa.Iibhetri ngowona mzimba wasemzini uxhaphakileyo kwaye kaninzi ukwenzeka kubantwana abangaphantsi kweminyaka emi-5 ubudala (Umfanekiso 7).Emva kokonakalisa ummizo, zinokubangela i-esophageal stenosis.I-Endoscopy kufuneka ihlaziywe kwiiveki ezimbalwa.Ukuba i-stricture yenziwe, i-esophagus kufuneka ihlanjululwe ngokukhawuleza.
Umzobo 7 Into yangaphandle kwibhetri, utolo olubomvu lubonisa indawo yento yangaphandle
4.8 Umba wemagnethi wangaphandle
Xa imizimba yemagnethi yangaphandle okanye imizimba yemagnethi yangaphandle idityaniswe nesinyithi ikhona kwindawo ephezulu yesisu, izinto zitsala enye kwenye kwaye zicinezele iindonga zendlela yokugaya, enokubangela lula i-ischemic necrosis, ukwakheka kwefistula, ukugqobhoza, ukuvaleka, i-peritonitis kunye ezinye iingozi ezinzulu zesisu., efuna unyango olungxamisekileyo lwe-endoscopic.Izinto zemagnethi enye zangaphandle kufuneka nazo zisuswe ngokukhawuleza.Ukongeza kwi-forceps yesiqhelo, imizimba yemagnethi yangaphandle inokususwa phantsi kokufunxa nge-forceps yomzimba yangaphandle.
4.9 Imizimba yangaphandle esiswini
Uninzi lwazo zizixhobo zokulayita, iingcingo zentsimbi, izikhonkwane, njalo njalo eziginywa ngabom ngamabanjwa.Uninzi lwemizimba yangaphandle inde kwaye inkulu, kunzima ukudlula kwi-cardia, kwaye inokukrwela ngokulula i-mucous membrane.Kucetyiswa ukuba kusetyenziswe iikhondom ezidityaniswe ne-rat-tooth forceps ukususa imizimba yangaphandle phantsi kovavanyo lwe-endoscopic.Okokuqala, faka i-forcep yezinyo lempuku kumphambili ongaphambili we-endoscope ngomngxuma we-endoscopic biopsy.Sebenzisa izinyanzelo zezinyo lempuku ukucinezela iringi yerabha emazantsi ekhondom.Emva koko, rhoxisa i-forcep yezinyo lempuku ukuya kumngxuma we-biopsy ukuze ubude bekhondom buvezwe ngaphandle komngxuma we-biopsy.Nciphisa kangangoko ngaphandle kokuchaphazela intsimi yokujonga, uze uyifake kwi-gastric cavity kunye ne-endoscope.Emva kokufumanisa umzimba wasemzini, faka umzimba wasemzini kwikhondom.Ukuba kunzima ukuyisusa, faka ikhondom kumngxuma wesisu, kwaye usebenzise izinyanzelo zamazinyo empuku ukucinezela umzimba wasemzini uze uwufake. Ngaphakathi kwekhondom, sebenzisa iphini lokucinezela izinyo lempuku ukucinezela ikhondom kwaye uyirhoxise kunye nekhondom. isipili.
4.10 Amatye esisu
I-Gastroliths yahlulahlulwe kwi-gastroliths yemifuno, i-gastroliths yezilwanyana, i-gastroliths eyenziwe ngamachiza kunye ne-gastroliths edibeneyo.I-gastroliths ye-Vegetative iyona nto ixhaphakileyo, ibangelwa kukutya isixa esikhulu se-persimmons, i-hawthorns, imihla yasebusika, iipesika, i-celery, i-kelp, kunye ne-coconuts kwisisu esingenalutho.Ibangwa njalo njaloNgaphantsi kwesenzo se-asidi ye-gastric, iprotheni ye-tannic acid engenamanzi yenziwa, ebophelela kwi-pectin, i-gum, i-fiber yezityalo, i-peel kunye ne-core.Amatye esisu.
Amatye e-gastric asebenzisa uxinzelelo lomatshini kudonga lwesisu kwaye avuselele ukwanda kwe-asidi yesisu, enokubangela lula ukukhukuliseka kwe-gastric mucosal, izilonda kunye nokubhoboza.Amatye amancinci, athambileyo e-gastric anganyibilika nge-sodium bicarbonate kunye namanye amachiza kwaye emva koko avunyelwe ukuba akhutshwe ngokwemvelo.
Kwizigulane ezingaphumeleli unyango, ukususwa kwamatye e-endoscopic kukhetho lokuqala (Umfanekiso 8).Ngamatye e-gastric anzima ukususa ngokuthe ngqo phantsi kwe-endoscopy ngenxa yobukhulu bawo obukhulu, i-forceps yomzimba wangaphandle, imigibe, iibhasikithi zokususa amatye, njl.Kulabo abanobunzima obunzima obungenako ukutyunyuzwa, ukusika i-endoscopic yamatye kunokuqwalaselwa , I-Laser lithotripsy okanye unyango lwe-high-frequency electric lithotripsy, xa ilitye lesisu lingaphantsi kwe-2cm emva kokuphulwa, sebenzisa i-forceps ezintathu-claw okanye i-forceps yomzimba wangaphandle. ukuyisusa kangangoko.Kufuneka kuthathelwe ingqalelo ukuthintela amatye angaphezu kwe-2cm ukuba angakhutshelwa kumgodi wamathumbu ngesisu kwaye abangele ukuvaleka kwamathumbu.
Umzobo 8 Amatye esiswini
4.11 Ingxowa yeziyobisi
Ukuqhekeka kwengxowa yeziyobisi kuya kubangela umngcipheko obulalayo kwaye kuchasene nonyango lwe-endoscopic.Izigulane ezingakwaziyo ukukhupha ngokwemvelo okanye ezikrokrelwa ukuba zinengxowa yeziyobisi eziqhekekileyo kufuneka zisebenze ngokusebenzayo.
III.Iingxaki kunye nonyango
Iingxaki zomzimba wangaphandle zihambelana nendalo, imilo, ixesha lokuhlala kunye nenqanaba lokusebenza likagqirha.Iingxaki eziphambili ziquka ukwenzakala kwe-esophageal mucosal, ukopha, kunye nosulelo lokubhoboza.
Ukuba umzimba wangaphandle umncinci kwaye akukho monakalo ocacileyo we-mucosal xa ukhutshwa, ukulaliswa esibhedlele akufuneki emva kokusebenza, kunye nokutya okuthambileyo kunokulandelwa emva kokuzila ukutya kwiiyure ze-6.Kwizigulane ezinokulimala kwe-esophageal mucosal, i-glutamine granules, i-aluminium phosphate gel kunye nezinye ii-agent ezikhuselayo ze-mucosal zinokunikwa unyango lweempawu.Ukuba kuyimfuneko, ukuzila ukutya kunye nesondlo se-peripheral sinokunikwa.
Kwizigulane ezinomonakalo ocacileyo we-mucosal kunye nokopha, unyango lunokwenziwa phantsi kombono we-endoscopic ngokuthe ngqo, njengokutshiza i-ice-cold saline norepinephrine isisombululo, okanye i-endoscopic titanium clips ukuvala isilonda.
Izigulana ezine-CT yangaphambili ecebisa ukuba umzimba wangaphandle ungene eludongeni lwe-esophageal emva kokususwa kwe-endoscopic., ukuba umzimba wangaphandle uhlala ngaphantsi kweeyure ze-24 kwaye i-CT ayifumani ukubunjwa kwe-abscess ngaphandle kwe-lumen ye-esophageal, unyango lwe-endoscopic lunokwenziwa ngokuthe ngqo.Emva kokuba umzimba wasemzini ususiwe nge-endoscope, ikliphu ye-titanium isetyenziselwa ukucinezela udonga lwangaphakathi lommizo kwindawo yokubhoboza, enokuphelisa ukopha kwaye ivale udonga lwangaphakathi lommizo ngaxeshanye.I-tube ye-gastric kunye ne-jejunal feeding tube ibekwe phantsi kombono othe ngqo we-endoscope, kwaye isigulane sibhedlele esibhedlele ukuze siqhubeke nonyango.Unyango lubandakanya unyango lweempawu ezifana nokuzila ukudla, ukuchithwa kwesisu, i-antibiotics kunye nesondlo.Ngelo xesha, iimpawu ezibalulekileyo ezifana nokushisa komzimba kufuneka ziqwalaselwe ngokusondeleyo, kwaye ukuvela kweengxaki ezifana ne-neck subcutaneous emphysema okanye i-mediastinal emphysema kufuneka ibonwe ngosuku lwesithathu emva kokuhlinzwa.Emva kokuba i-iodine yamanzi i-angiography ibonisa ukuba akukho ukuvuza, ukutya nokusela kunokuvunyelwa.
Ukuba umzimba wasemzini ugcinwe ngaphezu kweeyure ezingama-24, ukuba iimpawu zosulelo ezifana nomkhuhlane, ukubanda, kunye nenani eliphakamileyo leeseli ezimhlophe zegazi zenzeka, ukuba i-CT ibonisa ukubunjwa kwethumba elingaphandle kummizo, okanye ukuba kukho iingxaki ezinzulu. , izigulane kufuneka zidluliselwe utyando ukuze unyango ngexesha elifanelekileyo.
IV.Ukulumkela
(1) Okukhona umzimba wasemzini uhleli kummizo, kokukhona utyando luya kuba nzima ngakumbi kwaye kokukhona kuya kubakho iingxaki.Ngoko ke, ukungenelela kwe-endoscopic engxamisekileyo kubaluleke kakhulu.
(2) Ukuba umzimba wangaphandle umkhulu, umilo ongaqhelekanga okanye unezikhonkwane, ngakumbi ukuba umzimba wangaphandle uphakathi kommizo kwaye usondele kwi-arch ye-aorta, kwaye kunzima ukuyisusa endoscopically, musa ukuyitsala ngenkani. ngaphandle.Kungcono ufune ukubonisana ngezinto ezininzi kunye nokulungiselela utyando.
(3) Ukusetyenziswa okunengqiqo kwezixhobo zokukhusela i-esophageal kunokunciphisa ukuvela kweengxaki.
Yethuukulahlwa kwezixhobo zokubambaisetyenziswa ngokudibeneyo ne-endoscopes ethambileyo, ingena kumngxuma womzimba womntu onje ngephecana lokuphefumla, ummizo, isisu, amathumbu njalo njalo ngomjelo we-endoscope, ukubamba izicubu, amatye kunye nemicimbi yangaphandle kunye nokukhupha i-stents.
Ixesha lokuposa: Jan-26-2024