Mastery ma hoʻokahi ʻatikala: Ka mālama ʻana iā Achalasia

Hoʻolauna
ʻO Achalasia o ka cardia (AC) he aka maʻi o ka esophageal motility.Ma muli o ka hoʻomaha maikaʻi ʻole o ka esophageal sphincter haʻahaʻa (LES) a me ka nele o ka esophageal peristalsis, ʻo ka mālama ʻana i ka meaʻai ka hopena.dysphagia a me ka hopena. ʻO nā hōʻailona maʻi e like me ke koko, ka ʻeha o ka umauma a me ka pohō kaumaha.ʻO ka laha ma kahi o 32.58/100,000.
ʻO kalapaʻauʻO ka achalasia ka mea nui e pili ana i ka lāʻau lapaʻau ʻole, ka dilation therapy a me ka lāʻau lapaʻau.

01Laau Laau
ʻO ka hana o ka lāʻau lapaʻau e hoʻemi i ke kaomi LES i ka wā pōkole.ʻAʻohe hōʻike maopopo e hiki i nā lāʻau lapaʻau ke hoʻomau a hoʻomaikaʻi maikaʻi i nā hōʻailona o AC.ʻO nā lāʻau lapaʻau i hoʻohana pinepine ʻia i kēia manawa, ʻo ia nā nitrates, nā mea hoʻopaʻa ala calcium, a me nā agonists β-receptor.
(1)ʻO nā nitrates, e like me ka nitroglycerin, amyl nitrate, a me ka isosorbide dinitrate
(2)ʻO nā mea hoʻopaʻa ala calcium, e like me nifedipine, verapamil, a me diltiazem
(3)β-receptor agonists, e like me ka cabuterol

02Endoscopic Botulinum Toxin Injection (BTI)
Hiki ke hoʻohana ʻia ka endoscopic botulinum toxin injection (BTl) e mālama i ka AC,akā hiki iā ia ke hāʻawi i nā hopena pōkole wale nō a hiki ke hoʻohana ʻia i nā poʻe maʻi ʻelemakule me nā pilikia kiʻekiʻe o ka ʻoki a me ka anesthesia.

1) Nā hōʻailona:nā maʻi ma waena o nā makahiki a me nā ʻelemakule (> 40 mau makahiki); ka poʻe hiki ʻole ke ʻae i ka dilation balloon endoscopic (PD) a i ʻole ka lāʻau lapaʻau; ka poʻe me ka nui o nā lāʻau lapaʻau PD a i ʻole nā ​​hopena lapaʻau kino maikaʻi ʻole; ka poʻe me ka esophageal perforation i ka wā mālama PD No ka poʻe me ka pilikia nui, hiki ke hoʻohana pū ʻia me ka PD; hiki ke hoʻohana ʻia ma ke ʻano he hoʻololi i ka ʻokiʻoki a i ʻole ka mālama PD.
(2) Kū'ē:ʻAʻole ʻōlelo ʻia no ka mālama mua ʻana o AC i nā maʻi ʻōpio (≤40 mau makahiki).

03Endoscopic Balloon Dilation (PD)
He mau hopena ko ka dilatation balloon ma ka AC, akā pono nā lāʻau lapaʻau he nui a lawe i ka pilikia o nā pilikia koʻikoʻi.
(1) Nā hōʻailona:ʻO nā mea maʻi AC me ka lawaʻole o ka cardiopulmonary, ka hanaʻole o ka coagulation, a pēlā aku; nā kāne ma luna o 50 makahiki a me nā wahine ma mua o 35 mau makahiki; nā poʻe maʻi i hāʻule ʻole ke ʻoki. Hiki ke hoʻohana ʻia e like me ke ʻano lapaʻau koho mua.
(2) Kū'ē:ʻO ka lawa ʻole o ka puʻuwai puʻuwai koʻikoʻi, ka hana ʻino o ka coagulation a me ka nui o ka pilikia o ka esophageal perforation.

04Peroral Endoscopic Myotomy (POEM)
I nā makahiki i hala iho nei, me ka hoʻokō nui ʻana o ka oral endoscopic myotomy (POEM), ua piʻi nui ka holomua o ka mālama ʻana o AC.ʻO ka mālama ʻana i ka POEM i ka AC ua kūlike loa me ka manaʻo o "super minimally invasive surgery", ʻo ia hoʻi, wehe ʻia nā ʻeha wale nō i ka wā o ka mālama ʻana, ʻaʻole wehe ʻia nā kino.Mālama ʻia ka ʻoiaʻiʻo a me ka hana o ke ʻano anatomical, a ʻaʻole pili ka maikaʻi o ke ola postoperative o ka mea maʻi. ʻO ka puka ʻana mai o ka POEM ua hana i ka mālama ʻana i ka AC super minimally invasive.