Ka ʻike loea ma kahi ʻatikala hoʻokahi: Ka mālama ʻana iā Achalasia

Hoʻolauna
ʻO ka Achalasia o ka cardia (AC)ka maʻi neʻe mua o ka esophageal.Ma muli o ka hoʻomaha maikaʻi ʻole o ka sphincter esophageal haʻahaʻa (LES) a me ka nele o ka peristalsis esophageal, ʻo ka paʻa ʻana o ka meaʻai ka hopenadysphagia a me ka hopena. Nā hōʻailona lapaʻau e like me ke kahe ʻana o ke koko, ka ʻeha o ka umauma a me ka pohō kaumaha.ʻO ka laha ma kahi o 32.58/100,000.
ʻO kalāʻau lapaʻauʻO ka maʻi achalasia e komo pū ana me ka mālama ʻoki ʻole ʻana, ka dilation therapy a me ka mālama ʻoki kino.

01Lapaʻau Lapaʻau
ʻO ke ʻano o ka mālama ʻana i ka lāʻau lapaʻau, ʻo ia ka hoʻemi ʻana i ke kaomi LES i ka wā pōkole.ʻAʻohe hōʻike maopopo e hiki i nā lāʻau lapaʻau ke hoʻomaikaʻi mau a hoʻomaikaʻi maikaʻi i nā hōʻailona o AC.ʻO nā lāʻau lapaʻau i hoʻohana pinepine ʻia i kēia manawa e komo pū ana me nā nitrates, nā blockers kahawai calcium, a me nā β-receptor agonists.
(1)Nā nitratesnā mea hoʻohuihui e like me ka nitroglycerin, amyl nitrate, a me ka isosorbide dinitrate.
(2)Nā mea pale i ke kahawai calciumnā lāʻau lapaʻau e like me nifedipine, verapamil, a me diltiazem
(3)nā agonists β-receptor, e like me ka cabuterol

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

1) Nā Hōʻailona:nā poʻe maʻi waena a me ka poʻe ʻelemakule (>40 mau makahiki); ka poʻe i hiki ʻole ke ʻae i ka endoscopic balloon dilation (PD) a i ʻole ka mālama ʻoki kino; ka poʻe me nā lāʻau PD he nui a i ʻole nā ​​​​hopena lapaʻau ʻoki kino maikaʻi ʻole; ka poʻe me ka perforation esophageal i ka wā o ka mālama ʻana iā PD No ka poʻe me ka pilikia kiʻekiʻe, hiki ke hoʻohana ʻia me ka PD; hiki ke hoʻohana ʻia ma ke ʻano he hoʻololi i ke ʻoki kino a i ʻole ka mālama ʻana iā PD.
(2) Nā mea e pale aku ai:ʻAʻole ia e ʻōlelo ʻia no ka mālama mua ʻana o AC i nā poʻe maʻi ʻōpio (≤40 mau makahiki).

03Hoʻonui ʻana o ka Balloon Endoscopic (PD)
Loaʻa i ka hoʻolaha ʻana o ka balloon kekahi mau hopena ma ka AC, akā koi ʻia nā lāʻau lapaʻau he nui a lawe i ka pilikia o nā pilikia koʻikoʻi.
(1) Nā Hōʻailona:Nā poʻe maʻi AC me ka ʻole o ka lawa ʻole o ka cardiopulmonary, ka hana coagulation, a pēlā aku; nā kāne ma luna o 50 mau makahiki a me nā wahine ma luna o 35 mau makahiki; nā poʻe maʻi i hāʻule i ke ʻoki ʻana. Hiki ke hoʻohana ʻia ma ke ʻano he koho mua o ka mālama ʻana.
(2) Nā mea e pale aku ai:ʻO ka lawa ʻole o ka cardiopulmonary, ka hana coagulation a me ke kiʻekiʻe o ka pilikia o ka perforation esophageal.

04ʻO ka Myotomy Endoscopic Peroral (POEM)
I nā makahiki i hala iho nei, me ka hoʻokō nui ʻana o ka peroral endoscopic myotomy (POEM), ua piʻi nui ka nui o ka holomua o ka mālama ʻana i ka AC.He kūlike loa ka mālama ʻana o POEM no ka AC me ka manaʻo o "super minimally invasive surgery", ʻo ia hoʻi, ʻo nā ʻeha wale nō e wehe ʻia/wehe ʻia i ka wā o ke kaʻina hana lapaʻau, a ʻaʻole e wehe ʻia nā ʻōpū.Mālama ʻia ka pono a me ka hana o ke ʻano anatomical, a ʻaʻole i hoʻopilikia ʻia ke ʻano o ke ola postoperative o ka mea maʻi. ʻO ka puka ʻana mai o POEM ua hoʻolilo i ka mālama ʻana o AC i mea invasive loa.