Hiki ke mālama ʻia nā pōhaku ʻeha liʻiliʻi ma ke ʻano conservative a i ʻole extracorporeal shock wave lithotripsy, akā ʻo nā pōhaku nui, ʻoi aku ka nui o nā pōhaku keakea, pono ke hana mua.
Ma muli o ke kūlana kūikawā o nā pōhaku ureteral luna, ʻaʻole hiki ke loaʻa iā lākou me kahi ureteroscope paʻa, a hiki i nā pōhaku ke piʻi maʻalahi i ka pelvis renal i ka wā lithotripsy. Hoʻonui ka nephrolithotomy percutaneous i ka hopena o ke kahe ʻana o ka renal i ka wā e kūkulu ai i kahi ala.
ʻO ka piʻi ʻana o ka ureteroscopy hiki ke hoʻoponopono i nā pilikia i luna. Komo ia i ka ureter a me ka renal pelvis ma o ka puka maʻamau o ke kino kanaka. He palekana, maikaʻi, liʻiliʻi ka invasive, emi ke koko, emi ka ʻeha no ka mea maʻi, a me ka helu kiʻekiʻe o ka pōhaku. Ua lilo ia i mea hana ma'amau no ka mālama 'ana i nā pōhaku ureteral luna.
ʻO ka puka ʻana o kaureteral access sheathua hoʻemi nui i ka paʻakikī o ka lithotripsy ureteroscopic maʻalahi. Eia nō naʻe, me ka piʻi ʻana o ka nui o nā hihia lapaʻau, ua hoʻohuli mālie kona mau pilikia. ʻO nā pilikia e like me ka ureteral perforation a me ka ureteral stricture he mea maʻamau. ʻO kēia nā kumu nui ʻekolu e alakaʻi ai i ka stricture ureteral a me ka perforation.
1. Ke ala o ka maʻi, ke anawaena pōhaku, ka hopena pōhaku
ʻO ka poʻe maʻi me ka lōʻihi o ka maʻi e loaʻa i nā pōhaku nui, a noho nā pōhaku nui i loko o ka ureter no ka manawa lōʻihi e hana i ka paʻahao. ʻO nā pōhaku ma ka wahi i hoʻopaʻa ʻia e hoʻopili i ka mucosa ureteral, ka hopena i ka lawa ʻole o ke koko kūloko, ischemia mucosal, ʻulaʻula a me ka hoʻokumu ʻana i ka ʻili, pili loa i ka hoʻokumu ʻana o ka ureteral stricture.
2. ʻEha Ureteral
He mea maʻalahi ka ureteroscope hikiwawe ke pio, a pono e hoʻokomo i kahi pahu komo ma mua o ka lithotripsy. ʻAʻole i hana ʻia ka hoʻokomo ʻana i ka ʻūhā awāwa ma lalo o ka ʻike maka, no laila ʻaʻole hiki ke hōʻino ʻia ka mucosa ureteral ma muli o ke kulou ʻana o ka ureter a i ʻole ka lumen haiki i ka wā o ka hoʻokomo ʻana i ka pū.
Eia hou, i mea e kākoʻo ai i ka ureter a hoʻokahe i ka wai perfusion e hoʻemi i ke kaomi ma ka pelvis renal, koho pinepine ʻia kahi ʻauʻau ma o F12/14, e hiki ai ke hoʻopiʻi pololei i ka pā o ka ureteral. Inā ʻaʻole i oʻo ka ʻenehana a ke kauka lapaʻau a hoʻolōʻihi ʻia ka manawa hana, e hoʻonui ʻia ka manawa hoʻoemi o ka sheath channel ma ka pā ureteral i kekahi ʻano, a ʻoi aku ka nui o ka pōʻino o ka ischemic i ka pā ureteral.
3. Holmium laser poino
ʻO ka ʻāpana pōhaku o ka laser holmium e hilinaʻi nui ʻia i kāna hopena photothermal, ka mea e hoʻopili pono ai ka pōhaku i ka ikehu laser a hoʻonui i ka mahana kūloko e hoʻokō i ke kumu o ka ʻāpana pōhaku. ʻOiai ʻo 0.5-1.0 mm wale nō ka hohonu o ka radiation thermal i ka wā o ka ʻiliʻili ʻiliʻili, ʻaʻole hiki ke hoʻohālikelike ʻia ka hopena overlapping i hana ʻia e ka hoʻomau ʻana i ka ʻiliʻili.
ʻO nā mea nui no ka hoʻokomo ʻana i ka sheath access ureteral penei:
1. Aia ka mana'o o ka ho'omaka 'ana i ka wā e ho'okomo ai i loko o ka ureter, a me ka ma'alahi ke pi'i i ka ureter. Inā paʻakikī ka hoʻokomo ʻana, hiki iā ʻoe ke koli i ka uea alakaʻi i hope a i waho e nānā inā hele pololei ke uea alakaʻi i loko a i waho, no laila e hoʻoholo ai inā ke neʻe nei ka ʻauwaʻa ma ke ala o ka uea alakaʻi, e like me ʻike maopopo, pono e hoʻoponopono ʻia ke kuhikuhi o ka sheathing;
Ua paʻa paʻa ka puʻu kahawai i hoʻokomo pono ʻia a ʻaʻole e komo i waho a i waho ma ka makemake. Inā ʻike maopopo ʻia ka puʻu ʻawaʻawa, ʻo ia hoʻi, ua wili ʻia i loko o ka ʻōpū a ua hāʻule ke kaula alakaʻi mai ka ureter a pono e hoʻokomo hou ʻia;
3. He ʻokoʻa nā kikoʻī o nā sheaths channel ureteral. Hoʻohana maʻamau ka poʻe maʻi kāne i ke kumu hoʻohālike 45 knm ka lōʻihi, a hoʻohana nā mea maʻi kāne wahine a pōkole paha i ke kumu hoʻohālike 35 cm lōʻihi. Inā hoʻokomo ʻia ka puʻu kahawai, hiki iā ia ke hele wale ma ka puka ureteral a ʻaʻole hiki ke piʻi i kahi kiʻekiʻe. ʻO ke kūlana, hiki i nā maʻi kāne ke hoʻohana i kahi 35 knm hoʻokomo i ka sheath, a i ʻole e hoʻololi i kahi 14F a i ʻole ka thinner fascial expansion sheath e pale aku i ka ureteroscope hikiʻole ke piʻi i ka pelvis renal;
Mai hoʻokomo i ka puʻu auwai ma kahi ʻanuʻu. E waiho i 10 knm ma waho o ka puka urethral no ka pale ʻana i ka pōʻino i ka mucosa ureteral a i ʻole parenchyma renal ma UPJ. Ma hope o ka hoʻokomo ʻana i ka laulā maʻalahi, hiki ke hoʻoponopono hou ʻia ke kūlana sheath channel ma lalo o ka ʻike pololei.
ʻO mākou, ʻo Jiangxi Zhuoruihua Medical Instrument Co., Ltd., he mea hana ma Kina i mea kūikawā i nā mea hoʻohana endoscopic, e like mebiopsy forceps, hemoclip, pahele polyp, nila sclerotherapy, pulupulu pulupulu, cytology brushes, uea alakaʻi, hīnaʻi kiʻi pōhaku, ihu biliary drain catheteretc. i hoohana nui ia maEMR, ESD, ERCP. ʻO kā mākou huahana i hōʻoia ʻia ʻo CE, a ua hōʻoia ʻia kā mākou mea kanu. Ua lawe ʻia kā mākou waiwai i ʻEulopa, ʻAmelika ʻAmelika, Middle East a me kahi hapa o Asia, a loaʻa nui i ka mea kūʻai aku o ka ʻike a me ka hoʻomaikaʻi!
Ka manawa hoʻouna: Sep-11-2024