Intshayelelo
Iimpawu eziphambili ze-hemorrhoids zigazi kwi-stool, intlungu ye-anal, ukuwa kunye nokubetha, njl., echaphazela kakhulu umgangatho wobomi.Kwiimeko ezinzima, kunokubangela i-hemorrhoids evalelwe kunye ne-anemia engapheliyo ebangelwa igazi kwi-stool.Okwangoku, unyango olulondolozayo lusekelwe ikakhulu kumachiza, kwaye unyango lotyando luyafuneka kwiimeko ezinzima.
Unyango lwe-Endoscopic yindlela yonyango esanda kuphuhliswa kwiminyaka yamuva, efanelekileyo kakhulu kwizibhedlele zengca.Namhlanje, siza kushwankathela kwaye silungise.
1. Ukuxilongwa kweklinikhi, i-anatomy kunye nonyango lwangaphambili lwe-hemorrhoids
Ukuxilongwa kweHemorrhoids
Ukuxilongwa kwe-hemorrhoids kusekelwe ikakhulu kwimbali, ukuhlolwa, ukuhlolwa kwe-digital rectal kunye ne-colonoscopy.Ngokubhekiselele kwimbali yonyango, kuyimfuneko ukuqonda intlungu ye-anal, igazi kwi-stool, ukukhutshwa kwe-hemorrhoid kunye nokubuyiselwa, njl. Ukuhlolwa ngokuyinhloko kukuqonda ukubonakala kwe-hemorrhoids, nokuba kukho i-fistula ye-anal ye-perianal inflammation, njl., kunye ne-digital rectal Uviwo ludinga ukuqonda ukuqina kwe-anus kunye nokuba kukho induration.I-Colonoscopy kufuneka iqaphele ezinye izifo ezinjengamathumba, i-ulcerative colitis, njl njl. ebangela ukopha.Ukuhlelwa kunye nokuhlelwa kwee-hemorrhoids
Zintathu iindidi zehemorrhoids: ihemorrhoids yangaphakathi, ihemorrhoids yangaphandle, kunye nehemorrhoids edibeneyo.
IHemorrhoids: Ngaphakathi, Ngaphandle, kunye neMixed Hemorrhoids
I-Hemorrhoids ingahlelwa ngokwamabakala I, II, III, kunye ne-IV.Ihlelwa ngokokuxinana, ukukhutshwa kwehemorrhoid kunye nokubuya.
Izibonakaliso zonyango lwe-endoscopic zibakala I, II, kunye ne-III i-hemorrhoids yangaphakathi, ngelixa i-grade IV yangaphakathi ye-hemorrhoids, i-hemorrhoids yangaphandle, kunye ne-mixed hemorrhoids ziyi-contraindications kunyango lwe-endoscopic.Umgca wokwahlula phakathi konyango lwe-endoscopic ngumgca wamazinyo.
I-Anatomy ye-Hemorrhoids
Umgca we-Anal, umgca wamazinyo, i-anal pad, kunye ne-hemorrhoids yimibono ekufuneka i-endoscopists iqhelane nayo.Ukuchongwa kwe-Endoscopic kufuna amava athile.Umgca we-dentate yi-junction ye-anal squamous epithelium kunye ne-columnar epithelium, kwaye ummandla wenguqu phakathi komgca we-anal kunye nomgca we-dentate uhlanganiswe yi-columnar epithelium kodwa ingagcinwanga ngumzimba.Ngoko ke, unyango lwe-endoscopic lusekelwe kumgca wamazinyo.Unyango lwe-Endoscopic lunokwenziwa ngaphakathi komgca wamazinyo, kwaye unyango lwe-endoscopic alunakwenziwa ngaphandle komgca wamazinyo.
Umzobo 1. Umbono wangaphambili womgca wamazinyo phantsi kwe-endoscope.Utolo olutyheli lukhomba kumgca ojikijelweyo wamazinyo, utolo olumhlophe lukhomba kwikholamu yomquku kunye nothungelwano lwemithambo emide, kunye notolo olubomvu lukhomba kwivalve yokuphuma ezinzulwini zomva.
1A: umfanekiso omhlophe wokukhanya;1B: I-Narrowband Light Imaging
Umzobo 2 Ukujongwa kwelaphu lempundu (utolo olubomvu) kunye nesiphelo esisezantsi sekholamu yangemuva (utolo olumhlophe) ecaleni kwemakroskopu.
Umzobo 3 Ukujongwa kwepapilla yangasese ecaleni kwemakroskopu (utolo olumthubi)
Umzobo 4. Umgca we-anal kunye nomgca we-dentate wabonwa nge-endoscopy ye-reverse.Utolo olutyheli lwalatha kumgca wamazinyo, kwaye utolo olumnyama lukhomba kumgca womva.
Iingcamango ze-papilla ye-anal kunye nekholamu yangasese zisetyenziswa ngokubanzi kwi-anorectal operation kwaye aziyi kuphinda ziphindwe apha.
Unyango oluqhelekileyo lwe-hemorrhoids: kukho unyango olugcinayo kunye nonyango lotyando.Unyango olulondolozayo lubandakanya ukusetyenziswa kwechiza perianal kunye nebhafu ye-sitz, kunye neenkqubo zotyando ikakhulu zibandakanya ukususwa kwe-hemorrhoid kunye ne-stapled excision (PPH).Ngenxa yokuba unyango lotyando luyiklasiki, umphumo uzinzile, kwaye umngcipheko uncinci, isigulane kufuneka silaliswe esibhedlele iintsuku ezi-3-5.
2. Unyango lwe-Endoscopic ye-hemorrhoids yangaphakathi
Umahluko phakathi konyango lwe-endoscopic lwe-hemorrhoids yangaphakathi kunye nonyango lwe-EGV:
Ithagethi yonyango lwe-endoscopic ye-esophagogastric varices yimithambo yegazi ye-varicose, kwaye injongo yonyango lwe-hemorrhoid yangaphakathi ayikho imithwalo yegazi elula, kodwa i-hemorrhoids eyenziwe yimithambo yegazi kunye nezicubu ezidibeneyo.Unyango lwe-hemorrhoids kukunciphisa iimpawu, ukuphakamisa i-pad yangasese ehamba ezantsi, kwaye uphephe iingxaki ezifana ne-anal stenosis ebangelwa ukunyamalala kwe-hemorrhoids (umgaqo "wokubulala yonke into ngaphandle" uqhelene ne-anal stenosis).
Injongo yonyango lwe-endoscopic: Ukukhulula okanye ukuphelisa iimpawu, kungekhona ukuphelisa i-hemorrhoids.
Unyango lwe-Endoscopic lubandakanya i-sclerotherapy kunye ne-band ligation.
Ukuxilongwa kunye nokunyangwa kwe-hemorrhoids yangaphakathi, i-colonoscopy isetyenziselwa uviwo, kwaye i-gastroscope iyacetyiswa ukuba unyango.Ukongezelela, ngokwemeko yangempela yesibhedlele ngasinye, unokukhetha i-outpatient okanye unyango lwe-inpatient.
①Sclerotherapy (incediswa ngumnqwazi ocacileyo)
I-agent ye-sclerosing yinaliti yotywala ye-lauryl, kunye ne-foam lauryl alcohol injection nayo ingasetyenziswa.Kukwayimfuneko ukusebenzisa inaliti ye-submucosal ye-methylene blue njenge-arhente engekhoyo ukuze uqonde indlela yokuhamba kunye nokhuseleko lwe-agent sclerosing.
Injongo ye-cap ecacileyo kukwandisa intsimi yombono.Inaliti yokutofa inokukhethwa kwiinaliti eziqhelekileyo zesitofu se-mucosal.Ngokuqhelekileyo, ubude benaliti yi-6mm.Oogqirha abanamava kakhulu kufuneka bazame ukuphepha ukusebenzisa inaliti yenaliti ende, kuba iinaliti zenaliti ezinde zixhomekeke kwi-ectopic injection kunye nenaliti.Umngcipheko onzulu kwaye ukhokelela kumathumba e-perianal kunye nokudumba.
Indawo yokutofa ikhethwe ngaphezu kwecala lomlomo lomgca we-dentate, kwaye indawo yenaliti yenaliti ifumaneka kwisiseko se-hemorrhoid ekujoliswe kuyo.Inaliti ifakwe kwi-30 ° ~ 40 ° phantsi kombono othe ngqo (ngaphambili okanye umva) we-endoscope, kwaye inaliti ifakwe ngokunzulu kwisiseko se-hemorrhoid.Yenza imfumba eqinile kwisiseko sehemorrhoid, yirhoxise inaliti ngelixa utofa, malunga ne-0.5 ~ 2mL, kwaye uyeke inaliti de ihemorrhoid ibe nkulu kwaye ibe mhlophe.Emva kokuba inaliti iphelile, jonga ukuba kukho ukopha kwindawo yokutofa.
I-Endoscopic sclerotherapy ibandakanya inaliti yesibuko sangaphambili kunye nenaliti yesipili esiguqulweyo.Ngokubanzi, inaliti yesipili esijijelweyo yeyona ndlela iphambili.
② unyango ngebhandeji
Ngokuqhelekileyo, isixhobo sokudibanisa i-multi-ring sisetyenziswa, akukho ngaphezu kweringi ezisixhenxe kakhulu.I-ligation yenziwa kwi-1 ukuya kwi-3 cm ngaphezu komgca wamazinyo, kwaye ukudibanisa ngokuqhelekileyo kuqalwa kufuphi nomgca we-anal.Ingaba yi-vascular ligation okanye i-mucosal ligation okanye i-ligation edibeneyo.I-Mirror ligation yeyona ndlela iphambili, ngokuqhelekileyo amaxesha angama-1-2, kunye nekhefu elingangenyanga enye.
Unyango lwePerioperative: ukuzila ukutya akufuneki emva kokuhlinzwa, gcina isitulo esigudileyo, kwaye ugweme ukuhlala ixesha elide kunye nomsebenzi onzima womzimba.Ukusetyenziswa rhoqo kwee-antibiotics akuyomfuneko.
3. Imeko ekhoyo ngoku kunye neengxaki ezikhoyo zezibhedlele ezisezantsi
Ngaphambili, indawo ephambili yonyango lwe-hemorrhoids yayikwisebe le-anorectal.Unyango olucwangcisiweyo kwisebe le-anorectal lubandakanya amayeza olondolozo, inaliti ye-sclerotherapy, kunye nonyango lotyando.
Iingcali ze-endoscopist zesisu azinamava kakhulu ekuchongeni i-perianal anatomy phantsi kwe-endoscopy, kwaye izibonakaliso zonyango lwe-endoscopic zilinganiselwe (kuphela kwe-hemorrhoids yangaphakathi inokunyangwa).Utyando luyafuneka kwakhona ukuze kubuyiselwe ngokupheleleyo, okuye kwaba yinto enzima ekuphuhlisweni kweprojekthi.
Kwithiyori, unyango lwe-endoscopic lwe-hemorrhoids yangaphakathi lufanelekile ngokukodwa kwizibhedlele eziziiprayimari, kodwa ekusebenzeni, akukhona njengoko kucingelwa.
Thina, i-Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ngumvelisi e-China ogxile kwizinto ezityiwayo ze-endoscopic, ezifanai-biopsy forceps, i-hemoclip, polyp umgibe, inaliti ye-sclerotherapy, fafaza i-catheter, iibrashi zecytology, guidewire, ibhasikithi yokubuyiswa kwamatye, i-catheter ye-biliary drainage yeempumlonjl ezisetyenziswa ngokubanzi kwi-EMR, ESD, ERCP.Iimveliso zethu ziqinisekisiwe nge-CE, kwaye izityalo zethu ziqinisekisiwe nge-ISO.Impahla yethu ithunyelwe eYurophu, kuMntla Melika, kuMbindi Mpuma kunye nenxalenye yeAsia, kwaye ifumana ngokubanzi umthengi wokuqatshelwa kunye nendumiso!
Ixesha lokuposa: Jul-11-2022