Intshayelelo
Iimpawu eziphambili ze-hemorrhoids ligazi elikwisitulo, iintlungu zempundu, ukuwa nokurhawuzelelwa, njl.njl., nto leyo echaphazela kakhulu umgangatho wobomi. Kwiimeko ezinzima, zinokubangela ii-hemorrhoids ezivalelweyo kunye ne-anemia engapheliyo ebangelwa ligazi elikwisitulo. Okwangoku, unyango olugcina ixesha lusekelwe kakhulu kumayeza, kwaye unyango lotyando luyafuneka kwiimeko ezinzima.
Unyango lwe-Endoscopic yindlela entsha yonyango ephuhliswe kwiminyaka yakutshanje, efanelekileyo ngakumbi kwizibhedlele ezisemgangathweni. Namhlanje, siza kushwankathela size silungise.
1. Ukuxilongwa kwezonyango, ukwakheka komzimba kunye nonyango lwangaphambili lwe-hemorrhoids
Ukuxilongwa kweHemorrhoids
Ukuxilongwa kwee-hemorrhoids kusekelwe kakhulu kwimbali, ekuhlolweni, ekuhlolweni kwe-digital rectal kunye ne-colonoscopy. Ngokwembali yezonyango, kubalulekile ukuqonda iintlungu ze-anal, igazi elisesitulweni, ukuphuma kwe-hemorrhoid kunye nokubuyiselwa kwayo, njl. Ukuhlolwa kuqonda kakhulu ukubonakala kwee-hemorrhoids, nokuba kukho i-anal fistula yokudumba kwe-perianal, njl., kwaye uvavanyo lwe-digital rectal kufuneka luqonde ukuqina kwe-anus kunye nokuba kukho i-induration. I-Colonoscopy kufuneka iqaphele ezinye izifo ezifana neethumba, i-ulcerative colitis, njl.njl. ezibangela ukopha. Ukwahlulahlula kunye nokubeka amanqaku kwii-hemorrhoids.
Kukho iintlobo ezintathu ze-hemorrhoids: i-internal hemorrhoids, i-external hemorrhoids, kunye ne-mixed hemorrhoids.
IiHemorrhoids: IiHemorrhoids zangaphakathi, zangaphandle, kunye nezixutyiweyo
IiHemorrhoids zingahlulwahlulwa zibe ngamanqanaba okuQala, okweSibini, okweSithathu, kunye nokweSine. Zihlelwa ngokwezinga lokuxinana, ukuphuma kweehemorrhoids kunye nokubuya kwazo.
Iimpawu zonyango lwe-endoscopic zii-hemorrhoids zangaphakathi zebanga loku-1, lesi-2, nelesi-3, ngelixa ii-hemorrhoids zangaphakathi zebanga lesi-4, ii-hemorrhoids zangaphandle, kunye nee-hemorrhoids ezixutyiweyo ziyi-contraindications zonyango lwe-endoscopic. Umgca owahlula phakathi konyango lwe-endoscopic ngumgca wamazinyo.
I-Anatomy yeHemorrhoids
Umgca wempundu, umgca wamazinyo, i-anal pad, kunye ne-hemorrhoids ziingcamango ekufuneka iingcali ze-endoscopies zizazi. Ukuchonga i-endoscopic kufuna amava athile. Umgca wamazinyo yindawo edibana kuyo i-anal squamous epithelium kunye ne-columnar epithelium, kwaye indawo yokutshintsha phakathi komgca wempundu kunye nomgca wamazinyo igutyungelwe yi-columnar epithelium kodwa ayigcinwanga ngumzimba. Ke ngoko, unyango lwe-endoscopic lusekelwe kumgca wamazinyo. Unyango lwe-endoscopic lunokwenziwa ngaphakathi komgca wamazinyo, kwaye unyango lwe-endoscopic alunakwenziwa ngaphandle komgca wamazinyo.
Umfanekiso 1.Umbono ongaphambili womgca wamazinyo phantsi kwe-endoscope. Utolo olumthubi lukhomba kumgca wamazinyo ajikelezileyo ajikelezileyo, utolo olumhlophe lukhomba kwikholamu yempundu kunye nenethiwekhi yayo yemithambo yegazi ende, kwaye utolo olubomvu lukhomba kwivalvu yempundu.
1A:umfanekiso omhlophe okhanyayo;1B:Umfanekiso wokukhanya kweNarrowband
Umfanekiso 2Ukujongwa kwe-anal flap (utolo olubomvu) kunye nesiphelo esisezantsi se-anal column (utolo olumhlophe) kwi-microscope
Umfanekiso 3Ukujongwa kwe-anal papilla ecaleni kwe-microscope (utolo olutyheli)
Umfanekiso 4.Umgca wempundu kunye nomgca wamazinyo agutyungelweyo zibonwe nge-reverse endoscopy. Utolo olumthubi lukhomba kumgca wamazinyo agutyungelweyo, kwaye utolo olumnyama lukhomba kumgca wempundu.
Iingcamango ze-anal papilla kunye ne-anal column zisetyenziswa kakhulu kutyando lwe-anorectal kwaye aziyi kuphinda ziphindwe apha.
Unyango oluqhelekileyo lwe-hemorrhoids:Kukho unyango oluhlala luhleli kunye nonyango lotyando. Unyango oluhlala luhleli luquka ukusetyenziswa kwamayeza e-perianal kunye nokuhlamba i-sitz, kwaye iinkqubo zotyando ziquka ikakhulu i-hemorrhoidectomy kunye ne-stapled excision (PPH). Ngenxa yokuba unyango lotyando luqhelekile, isiphumo sizinzile, kwaye umngcipheko mncinane, isigulana kufuneka silaliswe esibhedlele iintsuku ezi-3-5.
2. Unyango lwe-endoscopic lwe-hemorrhoids yangaphakathi
Umahluko phakathi konyango lwe-endoscopic lwe-hemorrhoids yangaphakathi kunye nonyango lwe-EGV:
Injongo yonyango lwe-endoscopic lwe-esophagogastric varices yimithambo yegazi eneentsholongwane, kwaye injongo yonyango lwe-internal hemorrhoid ayisiyomithambo yegazi elula, kodwa zii-hemorrhoids ezenziwe ngemithambo yegazi kunye nezicubu ezinxibelelanayo. Unyango lwe-hemorrhoids kukunciphisa iimpawu, ukuphakamisa i-anal pad ehamba phantsi, kunye nokuphepha iingxaki ezifana ne-anal stenosis ebangelwa kukuphela kwe-hemorrhoids (umgaqo "wokubulala yonke into" uthambekele kwi-anal stenosis).
Injongo yonyango lwe-endoskopu: Ukunciphisa okanye ukuphelisa iimpawu, kungekhona ukuphelisa ii-hemorrhoids.
Unyango lwe-Endoscopic luqukaunyango lwe-sclerotherapykwayeukubotshwa kwebhendi.
Ukuxilongwa nokunyangwa kwe-hemorrhoids yangaphakathi, i-colonoscopy isetyenziselwa ukuvavanywa, kwaye i-gastroscope iyacetyiswa kunyango. Ukongeza, ngokwemeko yokwenyani yesibhedlele ngasinye, ungakhetha unyango lwe-outpatient okanye lwe-inpatient.
①Unyango lweSclerotherapy (oluncediswa sisigqubuthelo esibonakalayo)
I-arhente ye-sclerosing yi-lauryl alcohol injection, kwaye i-foam lauryl alcohol injection nayo ingasetyenziswa. Kukwafuneka ukusebenzisa i-submucosal injection ye-methylene blue njenge-arhente engekhoyo ukuze kuqondwe indlela ehamba ngayo kunye nokugutyungelwa kwe-arhente ye-sclerosing.
Injongo yesigqubuthelo esicacileyo kukwandisa intsimi yokubona. Inaliti yokujova ingakhethwa kwiinaliti eziqhelekileyo zokujova i-mucosal. Ngokubanzi, ubude benaliti yi-6mm. Oogqirha abangenamava kakhulu kufuneka bazame ukuphepha ukusebenzisa iinaliti ezinde, kuba iinaliti ezinde zinomngcipheko wokufumana inaliti ephuma embundwini kunye nenaliti. Umngcipheko omkhulu kwaye ukhokelela kwi-perianal abscesses kunye nokudumba.
Indawo yokufaka inaliti ikhethwa ngaphezulu kwecala lomlomo lomgca we-dentate, kwaye indawo yenaliti yokufaka inaliti ikwisiseko se-hemorrhoid ekujoliswe kuyo. Inaliti ifakwe kwi-30°~40° phantsi kombono othe ngqo (ngaphambili okanye ngasemva) we-endoscope, kwaye inaliti ifakwe nzulu kwisiseko se-hemorrhoid. Yenza inqwaba eqinileyo kwisiseko se-hemorrhoid, khupha inaliti ngelixa uyifaka, malunga ne-0.5~2mL, kwaye uyeke ukufaka inaliti ide i-hemorrhoid ibe nkulu kwaye ibe mhlophe. Emva kokuba inaliti iphelile, jonga ukuba kukho ukopha kwindawo yokufaka inaliti.
I-Endoscopic sclerotherapy ibandakanya inaliti yesipili esingaphambili kunye nenaliti yesipili esijikelezileyo. Ngokuqhelekileyo, inaliti yesipili esijikelezileyo yeyona ndlela iphambili.
② unyango lwebhandishi
Ngokubanzi, kusetyenziswa isixhobo sokubopha esineendandatho ezininzi, kungabikho ngaphezulu kweendandatho ezisixhenxe ubuninzi. Ukubopha kwenziwa kwi-1 ukuya kwi-3 cm ngaphezulu komgca wamazinyo, kwaye ukubopha kudla ngokuqaliswa kufutshane nomgca wempundu. Kungaba kukubopha kwemithambo yegazi okanye ukubopha kwe-mucosal okanye ukubopha okudibeneyo. Ukubopha kwesipili okuguqulweyo yindlela ephambili, ngokuqhelekileyo amaxesha ali-1-2, kunye nesithuba senyanga e-1.
Unyango oluhamba notyando: akufuneki ukuzila ukutya emva kotyando, gcina isitulo sicocekile, kwaye uphephe ukuhlala ixesha elide kunye nokusebenza nzima komzimba. Ukusetyenziswa rhoqo kwee-antibiotics akufuneki.
3. Imeko yangoku kunye neengxaki ezikhoyo zezibhedlele ezisemgangathweni
Ngaphambili, indawo ephambili yokunyanga ii-hemorrhoids yayikwicandelo le-anorectal. Unyango olucwangcisiweyo kwicandelo le-anorectal luquka amayeza alondolozayo, inaliti ye-sclerotherapy, kunye nonyango lotyando.
Iingcali ze-endoscopist zesisu azinamava kangako ekuchongeni i-perianal anatomy phantsi kwe-endoscopy, kwaye imiqondiso yonyango lwe-endoscopic inqongophele (kuphela ii-hemorrhoids zangaphakathi ezinokunyangwa). Utyando lukwafuneka ukuze kuphinde kulunge ngokupheleleyo, nto leyo eye yaba yingongoma enzima kuphuhliso lweprojekthi.
Ngokwethiyori, unyango lwe-endoscopic lwe-hemorrhoids yangaphakathi lufanelekile ngakumbi kwizibhedlele zokuqala, kodwa ngokwesiqhelo, alukho kangako njengoko bekucingelwa.
Thina, Jiangxi Zhuoruihua Medical Instrument Co.,Ltd., singumvelisi eTshayina ogxile kwizinto ezisetyenziswayo ze-endoscopic, ezifanai-biopsy forceps, i-hemoclip, umgibe we-polyp, inaliti ye-sclerotherapy, i-catheter yokutshiza, iibhrashi ze-cytology, ucingo lwesikhokelo, ibhaskithi yokuqokelela amatye, i-catheter yokukhupha amanzi empumlweninjl. ezisetyenziswa kakhulu kwiI-EMR, i-ESD, i-ERCPIimveliso zethu ziqinisekisiwe yi-CE, kwaye izityalo zethu ziqinisekisiwe yi-ISO. Iimpahla zethu zithunyelwe eYurophu, eMntla Melika, eMbindi Mpuma nakwinxalenye yeAsia, kwaye zifumana umthengi udumo nodumo!
Ixesha lokuthumela: Julayi-11-2022