Amatye amancinci e-urethra anganyangwa ngononophelo okanye i-extracorporeal shock wave lithotripsy, kodwa amatye anobubanzi obukhulu, ngakumbi amatye athintelayo, afuna ungenelelo lotyando kwangoko.
Ngenxa yendawo ekhethekileyo yamatye aphezulu e-urethra, banokungafikeleleki nge-ureteroscope eqinile, kwaye amatye anokunyuka ngokulula ukuya kwi-renal pelvis ngexesha le-lithotripsy. I-Percutaneous nephrolithotomy yonyusa umngcipheko wokuphuma kwegazi ezintso xa kusekwa umjelo.
Ukunyuka kwe-ureteroscopy eguquguqukayo kuye kwasombulula ngempumelelo ezi ngxaki zingentla. Ingena kwi-ureter kunye ne-renal pelvis ngokusebenzisa i-orifice eqhelekileyo yomzimba womntu. Ikhuselekile, iyasebenza, ayivaleli kancinci, inokopha kancinci, iintlungu zincinci kumguli, kunye nesantya esiphezulu esingenamatye. Ngoku sele ibe yindlela esetyenziswa ngokuqhelekileyo yotyando ukunyanga amatye angaphezulu kwe-urethra.
Ukuvela kweUkungena kwi-ureral sheathiye yanciphisa kakhulu ubunzima be-flexible ureteroscopic lithotripsy. Nangona kunjalo, ngokunyuka kwenani leemeko zonyango, iingxaki zayo ziye zatsala ingqalelo ngokuthe ngcembe. Iingxaki ezifana nokugqobhoza kwe-urethra kunye nokuqina kwe-ureter zixhaphakile. Oku kulandelayo zizinto ezintathu eziphambili ezikhokelela kukuqina kwe-urethra kunye nokugqobhoza.
1. Ikhosi yesifo, i-diameter yamatye, impembelelo yamatye
Izigulane ezinexesha elide lokugula zivame ukuba namatye amakhulu, kwaye amatye amakhulu ahlala kwi-ureter ixesha elide ukwenza ukuvalelwa. Amatye kwindawo yempembelelo acinezela i-mucosa ye-ureter, okubangela ukungonelanga kwegazi lendawo, i-ischemia ye-mucosal, ukudumba kunye nokwakheka komnxeba, okuhambelana ngokusondeleyo nokwakhiwa kwe-urethra.
2. Ukulimala kwe-Ureter
I-ureteroscope eguquguqukayo kulula ukugoba, kwaye i-sheath yokufikelela kwi-ureter kufuneka ifakwe phambi kwe-lithotripsy. Ukufakwa kwe-channel sheath akwenziwanga phantsi kombono othe ngqo, ngoko ke akunakuphepheka ukuba i-mucosa ye-urethra iya konakaliswa okanye ikhutshwe ngenxa yokugoba kwe-ureter okanye i-lumen encinci ngexesha lokufakwa kwe-sheath.
Ukongezelela, ukwenzela ukuxhasa i-ureter kunye nokukhupha i-perfusion fluid ukunciphisa uxinzelelo kwi-pelvis ye-renal, i-channel sheath nge-F12 / 14 idla ngokukhethwa, enokubangela ukuba i-channel sheath icinezele ngokuthe ngqo udonga lwe-ureter. Ukuba ubuchule bogqirha bukhulile kwaye ixesha lokusebenza lide, ixesha lokunyanzeliswa kwe-channel sheath eludongeni lwe-ureter liya kwandiswa kwinqanaba elithile, kwaye umngcipheko wokulimala kwe-ischemic kudonga lwe-ureter uya kuba mkhulu.
3. Umonakalo we-laser weHolmium
Ukuqhekeka kwamatye e-holmium laser ikakhulu kuxhomekeke kwimpembelelo ye-photothermal, ebangela ukuba ilitye lithathe ngokuthe ngqo amandla e-laser kwaye linyuse ubushushu bendawo ukufezekisa injongo yokuqhekeka kwamatye. Nangona ubunzulu bemitha ye-thermal ngexesha lenkqubo yokutyumza igrabile yi-0.5-1.0 mm kuphela, umphumo ogqithisayo obangelwa kukutyumzwa kwegrabile ngokuqhubekayo akunakulinganiswa.
Amanqaku aphambili okufaka iUkungena kwi-ureral sheathzezi zilandelayo:
1. Kukho ingqiqo ecacileyo yokuphumelela xa ufaka kwi-ureter, kwaye ivakalelwa xa inyuka kwi-ureter. Ukuba ukufakela kunzima, unako ukujiwuzisa ucingo lwesikhokelo ngasemva naphambili ukujonga ukuba ngaba ucingo lwesikhokelo lungena kwaye luphume ngokutyibilikayo, ukuze ufumanise ukuba i-sheath yeshaneli iqhubela phambili kwicala lentambo yesikhokelo, efana nokuba kukho ukuxhathisa okucacileyo, ulwalathiso lwe-sheathing kufuneka luhlengahlengiswe;
Isingxobo setshaneli esibekwe ngempumelelo silungisiwe kwaye asiyi kungena kwaye siphume ngokuthanda. Ukuba i-channel sheath iphuma ngokucacileyo, ithetha ukuba ihlanganiswe kwi-bladder kwaye ucingo lwesikhokelo luye lwaphuma kwi-ureter kwaye lufuna ukuphinda lubekwe;
3. Iishethi zeshaneli ye-Ureter zineenkcazo ezahlukeneyo. Izigulane zamadoda zisebenzisa imodeli ende ye-45 cm, kwaye izigulane zabasetyhini okanye ezifutshane zisebenzisa imodeli ye-35 cm ubude. Ukuba i-sheath yeshaneli ifakwe, inokudlula kuphela ekuvulekeni kwe-urethra okanye ayikwazi ukuya kwinqanaba eliphezulu. Isikhundla, izigulane zamadoda zingasebenzisa i-35 cm yokwazisa i-sheath, okanye itshintshe kwi-14F okanye i-fascial expansion sheath ukukhusela i-ureteroscope eguquguqukayo ekubeni ingakwazi ukunyuka kwi-pelvis ye-renal;
Musa ukubeka isingxobo setshaneli kwinqanaba elinye. Shiya i-10 cm ngaphandle kwe-orifice ye-urethral ukukhusela umonakalo kwi-mucosa ye-urethral okanye i-renal parenchyma kwi-UPJ. Emva kokufaka i-scope flexible, indawo ye-sheath yeshaneli inokulungiswa kwakhona phantsi kombono othe ngqo.
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Ixesha lokuposa: Sep-11-2024