I. Hoʻomākaukau ʻana o ka mea maʻi
1. E hoʻomaopopo i kahi, ke ʻano, ka nui a me ka puka ʻana o nā mea haole
E lawe i nā kiʻi X-ray maʻemaʻe a i ʻole CT scan o ka ʻāʻī, ka umauma, nā hiʻohiʻona anteroposterior a me ka ʻaoʻao, a i ʻole ka ʻōpū e like me ka mea e pono ai e hoʻomaopopo i kahi, ke ʻano, ke ʻano, ka nui, a me ke alo o ka perforation o ke kino ʻē, akā, mai hana i ka hoʻokolokolo barium ale.
2. Ka hoʻokē ʻai a me ka manawa hoʻokē ʻai wai
ʻO ka maʻamau, hoʻokē ʻai nā mea maʻi no 6 a 8 mau hola e hoʻokahe i nā mea o loko o ka ʻōpū, a hiki ke hoʻomaha kūpono i ka manawa hoʻokē ʻai a me ka manawa hoʻokē ʻai wai no ka gastroscopy ulia pōpilikia.
3. Kōkua Anesthesia
ʻO nā keiki, ka poʻe me nā maʻi noʻonoʻo, ka poʻe i hana ʻole, a i ʻole ka poʻe me nā kino haole i hoʻopaʻa ʻia, nā kino haole nui, nā kino haole he nui, nā kino haole ʻoi, a i ʻole nā hana endoscopic paʻakikī a lōʻihi paha e hana ʻia ma lalo o ka anesthesia laulā a i ʻole ka intubation endotracheal me ke kōkua o kahi anesthesiologist. Wehe i nā mea haole.
II. Hoʻomākaukau lako
1. Koho ʻana o ka Endoscope
Loaʻa nā ʻano gastroscopy nānā mua a pau. Inā manaʻo ʻia he paʻakikī ke wehe i ke kino haole a i ʻole he nui ke kino haole, hoʻohana ʻia ka gastroscopy ʻoki kino pālua. Hiki ke hoʻohana ʻia nā Endoscopes me ke anawaena waho liʻiliʻi no nā pēpē a me nā keiki ʻōpio.
2. Ke koho ʻana o nā forceps
ʻO ka nui a me ke ʻano o ke kino haole e hilinaʻi nui ʻia. ʻO nā mea hana i hoʻohana pinepine ʻia e komo pū me nā forceps biopsy, snare, forceps ʻekolu-ʻauwae, forceps pālahalaha, forceps kino haole (forceps niho ʻiole, forceps waha-ʻauwae), hīnaʻi wehe pōhaku, ʻeke ʻupena wehe pōhaku, a pēlā aku.
Hiki ke hoʻoholo ʻia ke koho ʻana o ka mea hana ma muli o ka nui, ke ʻano, ke ʻano, a me nā mea ʻē aʻe o ke kino haole. Wahi a nā hōʻike palapala, ʻo nā forceps niho-ʻiole ka mea i hoʻohana nui ʻia. ʻO ka nui o ka hoʻohana ʻana i nā forceps niho-ʻiole he 24.0% ~ 46.6% o nā mea hana a pau i hoʻohana ʻia, a ʻo nā pahele he 4.0% ~ 23.6%. Manaʻo nui ʻia he ʻoi aku ka maikaʻi o nā pahele no nā kino haole lōʻihi. E like me nā ana wela, nā pulupulu niho, nā chopsticks ʻohe, nā peni, nā puna, a me nā mea ʻē aʻe, a ʻo ke kūlana o ka hopena i uhi ʻia e ka pahele ʻaʻole e ʻoi aku ma mua o 1cm, inā ʻaʻole e paʻakikī ke puka i waho o ke cardia.
2.1 Nā kino ʻē i ke ʻano o ke koʻokoʻo a me nā kino ʻē poepoe
No nā mea ʻē me ke ʻano koʻokoʻo me kahi ʻili laumania a me ke anawaena waho lahilahi e like me nā niho niho, ʻoi aku ka maʻalahi o ke koho ʻana i nā pliers ʻekolu ʻauwae, nā pliers niho ʻiole, nā pliers pālahalaha, a pēlā aku; no nā mea ʻē poepoe (e like me nā ʻiʻo, nā pōpō aniani, nā pila pihi, a pēlā aku), e hoʻohana i kahi hīnaʻi wehe pōhaku a i ʻole kahi ʻeke ʻupena wehe pōhaku e wehe iā lākou. He paʻakikī ke hemo.
2.2 Nā kino ʻē lōʻihi a ʻoi, nā puʻupuʻu meaʻai, a me nā pōhaku nui i loko o ka ʻōpū
No nā kino ʻē lōʻihi a ʻoi, pono ke ʻano lōʻihi o ke kino ʻē e kūlike me ke ʻano lōʻihi o ka lumen, me ka ʻaoʻao ʻoi a i ʻole ka ʻaoʻao hāmama e kū pono ana i lalo, a e huki ana i ka wā e hoʻokomo ana i ka ea. No nā kino ʻē ʻano apo a i ʻole nā kino ʻē me nā lua, ʻoi aku ka palekana o ka hoʻohana ʻana i ke ʻano wili e wehe ai iā lākou;
No nā puʻu meaʻai a me nā pōhaku nui i loko o ka ʻōpū, hiki ke hoʻohana ʻia nā forceps nahu e wāwahi iā lākou a laila e wehe ʻia me nā forceps ʻekolu ʻauwae a i ʻole kahi pahele.
3. Nā lako palekana
E hoʻohana i nā mea pale e like me ka hiki no nā mea ʻē aʻe i paʻakikī ke wehe a he mea weliweli hoʻi. I kēia manawa, ʻo nā mea pale e hoʻohana pinepine ʻia e komo pū me nā pāpale moakaka, nā paipu waho, a me nā uhi pale.
3.1 Pāpale moakaka
I ka wā o ke kaʻina hana wehe kino haole, pono e hoʻohana ʻia kahi pāpale moakaka ma ka hopena o ka lens endoscopic i ka hiki ke pale aku i ka mucosa mai ka ʻōpala ʻia e ke kino haole, a e hoʻonui i ka esophagus e hōʻemi i ke kū'ē i loaʻa i ka wā e wehe ʻia ai ke kino haole. Hiki iā ia ke kōkua i ka hoʻopaʻa ʻana a me ka wehe ʻana i ke kino haole, kahi mea maikaʻi no ka wehe ʻana i ke kino haole.
No nā kino ʻē i ʻano ʻokiʻoki i hoʻokomo ʻia i loko o ka mucosa ma nā wēlau ʻelua o ka esophagus, hiki ke hoʻohana ʻia kahi pāpale moakaka e pahu mālie i ka mucosa esophageal a puni kekahi wēlau o ke kino ʻē i puka aku ai kekahi wēlau o ke kino ʻē mai ka paia mucosal esophageal e pale aku i ka perforation esophageal i hoʻokumu ʻia e ka wehe pololei ʻana.
Hiki i ka pāpale moakaka ke hāʻawi i kahi lawa no ka hana o ka mea kani, kahi kūpono no ka ʻike ʻana a me ka wehe ʻana i nā kino ʻē ma ka ʻāpana ʻāʻī esophageal haiki.
I ka manawa like, hiki i ka pāpale moakaka ke hoʻohana i ka omo kaomi maikaʻi ʻole e kōkua i ka hoʻopili ʻana i nā puʻupuʻu meaʻai a hoʻomaʻalahi i ka hana ʻana ma hope.
3.2 ʻĀpana waho
ʻOiai e pale ana i ka esophagus a me ka mucosa esophageal-gastric junction, hoʻomaʻamaʻa ka paipu waho i ka wehe ʻana o nā kino haole lōʻihi, ʻoi, a he nui a me ka wehe ʻana i nā puʻupuʻu meaʻai, a laila e hōʻemi ana i ka nui o nā pilikia i ka wā o ka wehe ʻana i nā kino haole o ka ʻōpū o luna. Hoʻonui i ka palekana a me ka pono o ka lāʻau lapaʻau.
ʻAʻole hoʻohana pinepine ʻia nā overtubes i nā keiki ma muli o ka pilikia o ka hōʻino ʻana i ka esophagus i ka wā e hoʻokomo ʻia ai.
3.3 Uhi pale
E kau i ka uhi pale i lalo ma ka ʻaoʻao mua o ka endoscope. Ma hope o ke kāohi ʻana i ka mea haole, e hoʻohuli i ka uhi pale a kāʻei i ka mea haole i ka wā e huki ai i ka endoscope e pale aku i nā mea haole.
Hoʻopili ia me ka membrane mucous o ke ala ʻai a he kuleana pale kāna.
4. Nā ʻano lapaʻau no nā ʻano kino haole like ʻole ma ke ala ʻōpū o luna
4.1 Nā puʻu meaʻai i loko o ka esophagus
Hōʻike nā hōʻike e hiki ke hoʻokuʻu mālie ʻia ka hapa nui o nā meaʻai liʻiliʻi i loko o ka esophagus i loko o ka ʻōpū a waiho ʻia e hoʻokuʻu maoli ʻia, he mea maʻalahi, kūpono a emi iki ka pilikia. I ka wā o ke kaʻina hana hoʻolaha gastroscopy, hiki ke hoʻokomo ʻia ka hoʻonui kūpono i loko o ka lumen esophageal, akā hiki i kekahi mau maʻi ke hele pū me nā ʻōpū malignant esophageal a i ʻole ka stenosis anastomotic post-esophageal (Kiʻi 1). Inā he kūʻē a paʻi ikaika ʻoe, ʻo ka hoʻopili ʻana i ke kaomi nui e hoʻonui i ka pilikia o ka perforation. Manaʻo ʻia e hoʻohana i kahi hīnaʻi ʻupena wehe pōhaku a i ʻole kahi ʻeke ʻupena wehe pōhaku e wehe pololei i ke kino haole. Inā nui ka bolus meaʻai, hiki iā ʻoe ke hoʻohana i nā forceps kino haole, nā pahele, a pēlā aku e kuʻi iā ia ma mua o ka māhele ʻana. E lawe i waho.
Kiʻi 1 Ma hope o ke ʻoki ʻana no ke kanesa esophageal, ua hele pū ka mea maʻi me ka stenosis esophageal a me ka paʻa ʻana o ka bolus meaʻai.
4.2 Nā mea haole pōkole a ʻōkole
Hiki ke wehe ʻia ka hapa nui o nā kino haole pōkole a ʻōkole ma o nā forceps kino haole, nā pahele, nā hīnaʻi wehe pōhaku, nā ʻeke ʻupena wehe pōhaku, a pēlā aku (Kiʻi 2). Inā paʻakikī ke wehe pololei ʻana i ke kino haole i loko o ka esophagus, hiki ke hoʻokomo ʻia i loko o ka ʻōpū e hoʻoponopono i kona kūlana a laila e hoʻāʻo e wehe. ʻOi aku ka paʻakikī o nā kino haole pōkole a ʻōkole me ke anawaena o >2.5 cm i loko o ka ʻōpū ke hele ma waena o ka pylorus, a pono e hana ʻia ke komo ʻana o ka endoscopic i ka hikiwawe loa; inā ʻaʻole hōʻike nā kino haole me nā anawaena liʻiliʻi i loko o ka ʻōpū a i ʻole duodenum i ka hōʻino ʻana o ka gastrointestinal, hiki iā lākou ke kali no ko lākou hoʻokuʻu kūlohelohe. Inā noho ia no nā pule he 3-4 a ʻaʻole hiki ke hoʻokuʻu ʻia, pono e wehe ʻia ma o ka endoscopically.
Kiʻi 2 Nā mea haole plastik a me nā ʻano wehe
4.3 Nā kino haole
ʻAʻole maʻalahi ka hoʻokuʻu ʻia ʻana o nā mea ʻē me ka lōʻihi o ≥6 cm (e like me nā ana wela, nā pulumu niho, nā ʻōpae ʻohe, nā peni, nā puna, a me nā mea ʻē aʻe) ma ke ʻano kūlohelohe, no laila e hōʻiliʻili pinepine ʻia lākou me kahi pahele a i ʻole ka hīnaʻi pōhaku.
Hiki ke hoʻohana ʻia kahi pahele e uhi i kekahi wēlau (ʻaʻole iʻoi aku ma mua o 1 kenimika ka mamao mai ka wēlau), a kau ʻia i loko o kahi pāpale moakaka e lawe i waho. Hiki ke hoʻohana ʻia kahi mea cannula waho e hopu i ke kino haole a laila e hoʻi mālie i loko o ka cannula waho e pale aku i ka hōʻino ʻana i ka mucosa.
4.4 Nā mea ʻē ʻoi
Pono e mālama pono ʻia nā mea ʻoiʻoi e like me nā iwi iʻa, nā iwi moa, nā niho kuʻi, nā lua lā, nā niho ʻūpā, nā ʻūpā pepa, nā pahi ʻumiʻumi, a me nā ʻōwili pahu pila (Kiʻi 3). Pono e mālama pono ʻia nā mea ʻoiʻoi e hiki ke hōʻino maʻalahi i nā membrane mucous a me nā kīʻaha koko a alakaʻi i nā pilikia e like me ka perforation. Hoʻokele endoscopic ulia pōpilikia.
Kiʻi 3 Nā ʻano mea ʻē ʻoi like ʻole
I ka wehe ʻana i nā kino ʻē ʻoi ma lalo o kahi hopenaʻO ka oscope, he mea maʻalahi ke kahakaha i ka mucosa o ke ala ʻai. Manaʻo ʻia e hoʻohana i kahi pāpale moakaka, hiki ke hōʻike piha i ka lumen a pale i ke kahakaha ʻana i ka paia. E hoʻāʻo e lawe mai i ka hopena blunt o ke kino haole kokoke i ka hopena o ka lens endoscopic i kau ʻia kekahi hopena o ke kino haole E hoʻokomo i loko o ka pāpale moakaka, e hoʻohana i nā forceps kino haole a i ʻole kahi pahele e hopu i ke kino haole, a laila e hoʻāʻo e mālama i ke axis longitudinal o ke kino haole e like me ka esophagus ma mua o ka haʻalele ʻana mai ka scope. Hiki ke wehe ʻia nā kino haole i hoʻokomo ʻia ma kekahi ʻaoʻao o ka esophagus ma ke kau ʻana i kahi pāpale moakaka ma ka ʻaoʻao mua o ka endoscope a komo mālie i loko o ka esophageal inlet. No nā kino haole i hoʻokomo ʻia i loko o ka lua esophageal ma nā wēlau ʻelua, pono e wehe mua ʻia ka wēlau pāpaʻu i hoʻokomo ʻia, maʻamau Ma ka ʻaoʻao proximal, e huki i waho i kekahi wēlau, e hoʻoponopono i ke kuhikuhi o ka mea haole i hoʻokomo ʻia ke poʻo i loko o ka pāpale moakaka, a lawe i waho. A i ʻole ma hope o ka hoʻohana ʻana i ka pahi laser e ʻoki i ke kino haole ma waena, ʻo kā mākou ʻike ka wehe mua ʻana i ke arc aortic a i ʻole ka ʻaoʻao puʻuwai, a laila wehe iā ia i nā pae.
a.Nā niho kuʻi: I ka wā e ʻai ai, e ʻū ana, a e kamaʻilio ana pahag, hiki i nā mea maʻi ke hāʻule hewa mai ko lākou mau niho kuʻi, a laila komo i loko o ke ala ʻōpū o luna me nā neʻe moni. ʻO nā niho kuʻi ʻoi me nā mea hoʻopaʻa hao ma nā wēlau ʻelua he mea maʻalahi ke hoʻokomo ʻia i loko o nā paia o ke ala ʻōpū, e paʻakikī ai ka wehe ʻana. No nā mea maʻi i hāʻule ʻole i ka mālama endoscopic maʻamau, hiki ke hoʻohana ʻia nā mea hana hoʻopaʻa he nui e hoʻāʻo ai e wehe ma lalo o ka endoscopy dual-channel.
b. Nā lua o ka lā: ʻO nā lua o ka lā i hoʻokomo ʻia i loko o ka esophagus he ʻoi pinepine ma nā wēlau ʻelua, hiki ke alakaʻi i nā pilikia e like me ka hōʻino ʻana o ka mucosale, ke kahe koko, ka maʻi suppurative kūloko a me ka perforation i loko o kahi manawa pōkole, a pono e mālama ʻia me ka mālama endoscopic ulia pōpilikia (Kiʻi 4). Inā ʻaʻohe ʻeha gastrointestinal, hiki ke hoʻokuʻu ʻia ka hapa nui o nā pōhaku lā i loko o ka ʻōpū a i ʻole duodenum i loko o 48 mau hola. ʻO ka poʻe hiki ʻole ke hoʻokuʻu maoli ʻia e pono e wehe koke ʻia.
Kiʻi 4 ʻO ke kikowaena o ka jujube
ʻEhā lā ma hope mai, ua ʻike ʻia ka maʻi me kahi kino ʻē ma kahi haukapila ʻē aʻe. Ua hōʻike ʻo CT i kahi kino ʻē i loko o ka esophagus me ka perforation. Ua wehe ʻia nā ʻiʻo jujube ʻoi ma nā wēlau ʻelua ma lalo o ka endoscopy a ua hana hou ʻia ka gastroscopy. Ua ʻike ʻia ua hana ʻia kahi fistula ma ka paia o ka esophagus.
4.5 Nā mea ʻē nui aʻe me nā lihi lōʻihi a me nā lihi ʻoi (Kiʻi 5)
a. E hoʻokomo i ka ʻōmole waho ma lalo o ka endoscope: E hoʻokomo i ka gastroscope mai ke kikowaena o ka ʻōmole waho, i kokoke ai ka lihi haʻahaʻa o ka ʻōmole waho i ka lihi luna o ka ʻāpana piʻo o ka gastroscope. E hoʻokomo mau i ka gastroscope kokoke i ke kino haole. E hoʻokomo i nā mea hana kūpono ma o ka ʻōmole biopsy, e like me nā pahele, nā forceps kino haole, a pēlā aku. Ma hope o ka hopu ʻana i ka mea haole, e hoʻokomo i loko o ka ʻōmole waho, a e puka pū ka mea holoʻokoʻa me ke aniani.
b. Uhi pale membrane mucous i hana ʻia ma ka home: E hoʻohana i ka uhi manamana nui o nā mīkina lima laholio lapaʻau e hana i kahi uhi pale mua endoscope hana ʻia ma ka home. E ʻoki iā ia ma ke kihi o ke aʻa manamana nui o ka mīkina lima i loko o ke ʻano pū. E ʻoki i kahi puka liʻiliʻi ma ka piko o ka manamana lima, a e hoʻokomo i ka ʻaoʻao mua o ke kino aniani ma o ka puka liʻiliʻi. E hoʻohana i kahi apo laholio liʻiliʻi e hoʻopaʻa iā ia he 1.0cm ka mamao mai ka ʻaoʻao mua o ka gastroscope, e hoʻihoʻi i loko o ka ʻaoʻao luna o ka gastroscope, a hoʻouna pū me ka gastroscope i ke kino ʻē. E hopu i ke kino ʻē a laila e huki pū me ka gastroscope. E neʻe maoli ka ʻūlū pale i ke kino ʻē ma muli o ke kūʻē. Inā hoʻohuli ʻia ke kuhikuhi, e ʻōwili ʻia a puni nā mea ʻē no ka pale ʻana.
Kiʻi 5: Ua wehe ʻia nā iwi iʻa ʻoi ma o ka endoscopically, me nā ʻōpala mucosal
4.6 Mea hao haole
Ma waho aʻe o nā forceps maʻamau, hiki ke wehe ʻia nā kino hao ʻē ma o ka omo ʻana me nā forceps kino hao magnetic. Hiki ke mālama ʻia nā kino hao ʻē i ʻoi aku ka weliweli a paʻakikī paha e wehe ma o ka endoscopically ma lalo o ka X-ray fluoroscopy. Manaʻo ʻia e hoʻohana i kahi hīnaʻi wehe pōhaku a i ʻole kahi ʻeke ʻupena wehe pōhaku.
ʻOi aku ka maʻamau o nā ʻāpana kālā i waena o nā kino haole i loko o ke ala ʻai o nā keiki (Kiʻi 6). ʻOiai hiki ke hoʻokuʻu maoli ʻia ka hapa nui o nā ʻāpana kālā i loko o ka esophagus, ua ʻōlelo ʻia ka mālama ʻana i ka endoscopic koho. No ka mea, ʻaʻole i launa pū nā keiki, ʻoi aku ka maikaʻi o ka wehe ʻana i nā kino haole ma lalo o ka anesthesia laulā ma o ka endoscopic. Inā paʻakikī ke wehe ʻana i ke ʻāpana kālā, hiki ke hoʻokomo ʻia i loko o ka ʻōpū a laila lawe ʻia i waho. Inā ʻaʻohe hōʻailona i loko o ka ʻōpū, hiki iā ʻoe ke kali a hiki i ka hoʻokuʻu maoli ʻia. Inā noho ke ʻāpana kālā no nā pule he 3-4 a ʻaʻole i hoʻokuʻu ʻia, pono e mālama ʻia ma ke ʻano endoscopic.
Kiʻi 6 Mea ʻē o ke kālā hao
4.7 Mea ʻino haole
Hiki i nā kino ʻino ke hōʻino maʻalahi i ke ala ʻai a i ʻole ka necrosis. Pono ka mālama endoscopic ulia pōpilikia ma hope o ka ʻike ʻana. ʻO nā pila ka kino ʻino maʻamau a loaʻa pinepine i nā keiki ma lalo o 5 mau makahiki (Kiʻi 7). Ma hope o ka hōʻino ʻana i ka esophagus, hiki iā lākou ke hana i ka stenosis esophageal. Pono e nānā hou ʻia ka Endoscopy i loko o kekahi mau pule. Inā hana ʻia ka stricture, pono e hoʻonui ʻia ka esophagus i ka hikiwawe loa.
Kiʻi 7 Mea haole i loko o ka pila, hōʻike ka pua ʻulaʻula i kahi o ka mea haole
4.8 Mea haole makeneka
Ke loaʻa nā kino haole magnetic he nui a i ʻole nā kino haole magnetic i hui pū ʻia me ka metala ma ke ala gastrointestinal kiʻekiʻe, huki nā mea kekahi i kekahi a hoʻopaʻa i nā paia o ke ala ʻai, hiki ke maʻalahi i ka necrosis ischemic, ka hoʻokumu ʻana o ka fistula, ka perforation, ke ālai ʻana, ka peritonitis a me nā ʻeha gastrointestinal koʻikoʻi ʻē aʻe. , e koi ana i ka mālama endoscopic ulia pōpilikia. Pono e wehe koke ʻia nā mea haole magnetic hoʻokahi. Ma waho aʻe o nā forceps maʻamau, hiki ke wehe ʻia nā kino haole magnetic ma lalo o ka omo ʻana me nā forceps kino haole magnetic.
4.9 Nā kino ʻē i loko o ka ʻōpū
ʻO ka hapa nui o lākou he mau mea hoʻomāmā, nā uea hao, nā kui, a me nā mea ʻē aʻe i moni ʻia e nā pio. ʻO ka hapa nui o nā kino ʻē he lōʻihi a nui, paʻakikī ke hele ma waena o ke cardia, a hiki ke kahakaha maʻalahi i ka membrane mucous. Manaʻo ʻia e hoʻohana i nā condom i hui pū ʻia me nā forceps niho-ʻiole e wehe i nā kino ʻē ma lalo o ka nānā ʻana endoscopic. ʻO ka mea mua, e hoʻokomo i nā forceps niho-ʻiole i loko o ka ʻaoʻao mua o ka endoscope ma o ka lua biopsy endoscopic. E hoʻohana i nā forceps niho-ʻiole e hoʻopaʻa i ke apo laholio ma lalo o ka condom. A laila, e hoʻihoʻi i nā forceps niho-ʻiole i ka lua biopsy i ʻike ʻia ka lōʻihi o ka condom ma waho o ka lua biopsy. E hoʻēmi iā ia i ka hiki me ka ʻole o ka hoʻopilikia ʻana i ke kahua o ka ʻike, a laila e hoʻokomo i loko o ka lua ʻōpū me ka endoscope. Ma hope o ka ʻike ʻana i ke kino ʻē, e hoʻokomo i ke kino ʻē i loko o ka condom. Inā paʻakikī ke wehe, e kau i ka condom i loko o ka lua ʻōpū, a e hoʻohana i nā forceps niho-ʻiole e hoʻopaʻa i ke kino ʻē a hoʻokomo i loko. I loko o ka condom, e hoʻohana i nā pliers niho-ʻiole e hoʻopaʻa i ka condom a huki pū me ke aniani.
4.10 Nā pōhaku ʻōpū
Ua māhele ʻia nā Gastroliths i nā gastroliths mea kanu, nā gastroliths holoholona, nā gastroliths i hoʻoulu ʻia e ka lāʻau lapaʻau a me nā gastroliths hui pū ʻia. ʻO nā gastroliths mea kanu ka mea maʻamau, ʻo ka hapa nui i hana ʻia e ka ʻai ʻana i ka nui o nā persimmons, hawthorns, nā lā hoʻoilo, nā peaches, celery, kelp, a me nā niu ma ka ʻōpū ʻole. Hana ʻia e etc. ʻO nā gastroliths mea kanu e like me nā persimmons, hawthorns, a me nā jujubes he tannic acid, pectin, a me ka gum. Ma lalo o ka hana a ka gastric acid, ua hoʻokumu ʻia ka protein tannic acid hiki ʻole ke hoʻoheheʻe ʻia i ka wai, kahi e hoʻopaʻa ai i ka pectin, gum, fiber mea kanu, ʻili, a me ke kumu. Nā pōhaku ʻōpū.
Hoʻokomo nā pōhaku ʻōpū i ke kaomi mechanical ma ka paia o ka ʻōpū a hoʻoulu i ka hoʻonui ʻia o ka waikawa gastric, hiki ke maʻalahi ke hana i ka ʻino ʻana o ka mucosal gastric, nā ʻeha a me nā perforation. Hiki ke hoʻoheheʻe ʻia nā pōhaku ʻōpū liʻiliʻi a palupalu me ka sodium bicarbonate a me nā lāʻau ʻē aʻe a laila ʻae ʻia e hoʻokuʻu maoli ʻia.
No nā poʻe maʻi i hāʻule i ka mālama ʻana i ke olakino, ʻo ka wehe ʻana i ka pōhaku endoscopic ke koho mua (Kiʻi 8). No nā pōhaku ʻōpū paʻakikī ke wehe pololei ma lalo o ka endoscopy ma muli o ko lākou nui, hiki ke hoʻohana ʻia nā forceps kino haole, nā pahele, nā hīnaʻi wehe pōhaku, a me nā mea ʻē aʻe e wāwahi pololei i nā pōhaku a laila wehe iā lākou; no ka poʻe me ke ʻano paʻakikī ʻaʻole hiki ke wāwahi ʻia, hiki ke noʻonoʻo ʻia ka ʻoki ʻana o nā pōhaku endoscopic, Laser lithotripsy a i ʻole ka mālama ʻana i ka lithotripsy uila kiʻekiʻe, i ka wā e emi ai ka pōhaku ʻōpū ma mua o 2cm ma hope o ka haki ʻana, e hoʻohana i nā forceps ʻekolu-maiʻuʻu a i ʻole nā forceps kino haole e wehe iā ia i ka hiki. Pono e mālama pono e pale i nā pōhaku ʻoi aku ka nui ma mua o 2cm mai ka hoʻokuʻu ʻia ʻana i loko o ka lua ʻōpū ma o ka ʻōpū a me ke kumu o ka pale ʻana o ka ʻōpū.
Kiʻi 8 Nā pōhaku i loko o ka ʻōpū
4.11 ʻEke Lāʻau Lapaʻau
ʻO ka haki ʻana o ka ʻeke lāʻau lapaʻau e hoʻoweliweli i ka make a he contraindication ia no ka mālama ʻana endoscopic. Pono e hana ʻoki kino i nā mea maʻi i hiki ʻole ke hoʻokuʻu maoli ʻia a i ʻole i manaʻo ʻia he haki ka ʻeke lāʻau lapaʻau.
III. Nā pilikia a me ka mālama ʻana
Pili nā pilikia o ke kino haole i ke ʻano, ke ʻano, ka manawa noho a me ke kiʻekiʻe o ke kauka. ʻO nā pilikia nui e pili ana i ka ʻeha mucosal esophageal, ke kahe ʻana o ke koko, a me ka maʻi perforation.
Inā he liʻiliʻi ke kino haole a ʻaʻohe hōʻino mucosal maopopo i ka wā e lawe ʻia ai i waho, ʻaʻole pono ka hoʻokipa ʻana ma ka haukapila ma hope o ke ʻoki ʻana, a hiki ke hahai ʻia kahi papaʻai palupalu ma hope o ka hoʻokē ʻai ʻana no 6 mau hola.No nā poʻe maʻi me nā ʻeha mucosal esophageal, hiki ke hāʻawi ʻia i nā granules glutamine, ka alumini phosphate gel a me nā mea pale mucosal ʻē aʻe i ka lāʻau lapaʻau hōʻailona. Inā pono, hiki ke hāʻawi ʻia ka hoʻokē ʻai a me ka meaʻai peripheral.
No nā poʻe maʻi me ka hōʻino mucosal maopopo a me ke kahe koko, hiki ke hana ʻia ka lāʻau lapaʻau ma lalo o ka ʻike endoscopic pololei, e like me ka pīpī ʻana i ka hopena saline norepinephrine anuanu, a i ʻole nā kīpī titanium endoscopic e pani i ka ʻeha.
No nā poʻe maʻi nona ka CT preoperative e hōʻike ana ua komo ke kino haole i loko o ka paia esophageal ma hope o ka wehe ʻana o ka endoscopic, inā noho ke kino haole no ka liʻiliʻi ma mua o 24 mau hola a ʻaʻole ʻike ʻo CT i ka hoʻokumu ʻana o ka abscess ma waho o ka lumen esophageal, hiki ke hana pololei ʻia ka mālama ʻana endoscopic. Ma hope o ka wehe ʻia ʻana o ke kino haole ma o ka endoscope, hoʻohana ʻia kahi clip titanium e hoʻopaʻa i ka paia o loko o ka esophagus ma kahi perforation, hiki ke hoʻōki i ke kahe koko a pani i ka paia o loko o ka esophagus i ka manawa like. Hoʻokomo ʻia kahi paipu gastric a me kahi paipu hānai jejunal ma lalo o ka ʻike pololei o ka endoscope, a hoʻopaʻa ʻia ka mea maʻi i ka haukapila no ka hoʻomau ʻana i ka mālama ʻana. Hoʻokomo pū ka mālama ʻana i ka mālama ʻana i nā hōʻailona e like me ka hoʻokē ʻai, ka decompression gastrointestinal, nā antibiotics a me ka meaʻai. I ka manawa like, pono e nānā pono ʻia nā hōʻailona koʻikoʻi e like me ka mahana o ke kino, a pono e nānā ʻia ka hanana o nā pilikia e like me ka emphysema subcutaneous ʻāʻī a i ʻole ka emphysema mediastinal i ke kolu o ka lā ma hope o ke ʻoki ʻana. Ma hope o ka hōʻike ʻana o ka angiography wai iodine ʻaʻohe leakage, hiki ke ʻae ʻia ka ʻai a me ka inu ʻana.
Inā ua mālama ʻia ke kino haole no nā hola he 24 a ʻoi, inā ʻike ʻia nā hōʻailona o ka maʻi e like me ke kuni, ke anu, a me ka nui o nā helu koko keʻokeʻo i hoʻonui ʻia, inā hōʻike ka CT i ke kūkulu ʻia ʻana o kahi abscess extraluminal i loko o ka esophagus, a inā paha ua loaʻa nā pilikia koʻikoʻi, pono e hoʻoneʻe ʻia nā maʻi i ke ʻoki kino no ka mālama ʻana i ka manawa kūpono.
IV. Nā Mālama
(1) ʻO ka lōʻihi o ka noho ʻana o ke kino haole i loko o ka esophagus, ʻoi aku ka paʻakikī o ka hana a me ka nui o nā pilikia e hiki mai ana. No laila, he mea pono loa ke komo ʻana o ka endoscopic ulia pōpilikia.
(2) Inā nui ke kino ʻē, ʻano ʻē aʻe ke ʻano a i ʻole he mau kui, ʻoiai inā aia ke kino ʻē ma waenakonu o ka esophagus a kokoke i ke aortic arch, a he paʻakikī ke wehe iā ia ma o ka endoscopically, mai huki ikaika iā ia i waho. ʻOi aku ka maikaʻi o ka ʻimi ʻana i ka kūkākūkā multidisciplinary a me ka hoʻomākaukau no ke ʻoki ʻana.
(3) ʻO ka hoʻohana pono ʻana i nā mea pale esophageal hiki ke hōʻemi i ka hanana o nā pilikia.
ʻO kā mākounā forceps hopu hoʻoleiHoʻohana ʻia me nā endoscopes palupalu, e komo ana i loko o ke kino o ke kanaka e like me ke ala hanu, esophagus, ʻōpū, naʻau a pēlā aku ma o ke kahawai endoscope, e hopu i nā ʻiʻo, nā pōhaku a me nā mea ʻē a me ka lawe ʻana i nā stents.
Ka manawa hoʻouna: Ian-26-2024