Hoʻolauna
ʻO nā hōʻailona nui o ka hemorrhoids ʻo ke koko i loko o ka waihona, ka ʻeha anal, ka hāʻule ʻana a me ka ʻāʻī, a me nā mea ʻē aʻe, e hoʻopilikia nui i ka maikaʻi o ke ola.I nā hihia koʻikoʻi, hiki ke hoʻoulu i ka hemorrhoids i hoʻopaʻa ʻia a me ka anemia maʻi i hoʻokumu ʻia e ke koko i loko o ka waihona.I kēia manawa, hoʻokumu ʻia ka mālama conservative ma luna o nā lāʻau lapaʻau, a koi ʻia ka lāʻau lapaʻau i nā hihia koʻikoʻi.
ʻO ka lāʻau endoscopic kahi ʻano hana lapaʻau hou i kūkulu ʻia i nā makahiki i hala iho nei, ʻoi aku ka maikaʻi no nā halemai o ka mauʻu.I kēia lā, e hōʻuluʻulu mākou a hoʻokaʻawale.
1. ʻO ka maʻi maʻi, anatomy a me ka mālama mua ʻana i nā hemorrhoids
ʻO ka ʻike ʻana o ka hemorrhoids
Hoʻokumu ʻia ka ʻike o ka hemorrhoids ma ka mōʻaukala, ka nānā ʻana, ka hoʻokolokolo rectal digital a me ka colonoscopy.Ma nā ʻōlelo o ka mōʻaukala olakino, pono ia e hoʻomaopopo i ka ʻeha anal, ke koko i loko o ka waihona, ka hemorrhoid discharge a me ka hoʻihoʻi hou ʻana, a me nā mea ʻē aʻe. Pono ka hoʻokolokolo e hoʻomaopopo i ka paʻa o ka anus a inā he induration.Pono e makaʻala ka colonoscopy i nā maʻi ʻē aʻe e like me ke koko, ulcerative colitis, etc.Ka hoʻokaʻawale ʻana a me ka helu ʻana i nā hemorrhoids
ʻEkolu ʻano o ka hemorrhoids: ʻo ka hemorrhoids kūloko, ka hemorrhoids waho, a me ka hemorrhoids hui ʻia.
Hemorrhoids: Hemoroid Kuloko, Kuwaho, a Huihui
Hiki ke hoʻokaʻawale ʻia nā hemorrhoids i nā papa I, II, III, a me IV.Hoʻopili ʻia e like me ka congestion, hemorrhoid discharge a me ka hoʻi.
ʻO nā hōʻailona no ka mālama ʻana i ka endoscopic, ʻo ia ka pae I, II, a me III i loko o ka hemorrhoids, aʻo ka grade IV i loko, nā hemorrhoids waho, a me nā hemorrhoids hui ʻia nā contraindications no ka mālama endoscopic.ʻO ka laina hoʻokaʻawale ma waena o ka lāʻau endoscopic ka laina dentate.
Anatomy of Hemorrhoids
ʻO ka laina anal, ka laina niho, ka pā anal, a me nā hemorrhoids, he mau manaʻo ia e pono ai ka poʻe endoskopi e kamaʻāina.Pono ka ʻike endoscopic i kahi ʻike.ʻO ka laina dentate ka hui o ka epithelium squamous anal a me ka epithelium columnar, a ʻo ka wahi hoʻololi ma waena o ka laina anal a me ka laina dentate i uhi ʻia e ka epithelium columnar akā ʻaʻole i hoʻokomo ʻia e ke kino.No laila, hoʻokumu ʻia ka lāʻau endoscopic ma ka laina dentate.Hiki ke hana ʻia ka lāʻau endoscopic ma loko o ka laina dentate, a ʻaʻole hiki ke hana ʻia ka lāʻau endoscopic ma waho o ka laina dentate.
Kiʻi 1. ʻO ka nānā mua o ka laina dentate ma lalo o ka endoscope.Kuhi ka pua melemele i ka laina dentate annular serrated, kuhikuhi ka pua keʻokeʻo i ke kolamu anal a me kona ʻupena vascular longitudinal, a kuhikuhi ka pua ʻulaʻula i ka valve anal.
1A: kiʻi māmā keʻokeʻo;1B: Narrowband Light Kiʻi
Kiʻi 2 Ka nānā ʻana i ka ʻāpala anal (pua ʻulaʻula) a me ka hope haʻahaʻa o ke kolamu anal (pua keʻokeʻo) ma ka microscope
Kiʻi 3 Ka nānā ʻana i ka papilla anal ma ka microscope (pua melemele)
Kiʻi 4. Ua ʻike ʻia ka laina anal a me ka laina dentate e ka hope endoscopy.Kuhi ka pua melemele i ka laina niho, a kuhikuhi ka pua ʻeleʻele i ka laina anal.
Hoʻohana nui ʻia nā manaʻo o ka papilla anal a me ke kolamu anal i ke ʻoki anorectal a ʻaʻole e hana hou ʻia ma aneʻi.
ʻO ka mālama maʻamau o nā hemorrhoids: aia ka nui o ka mālama conservative a me ka mālama ʻokiʻoki.Hoʻokomo ʻia ka mālama ʻana i ka lāʻau lapaʻau perianal a me ka ʻauʻau sitz, a ʻo nā kaʻina hana kaʻina hana he hemorrhoidectomy a me ka stapled excision (PPH).No ka mea ʻoi aku ka maʻamau o ka hoʻomaʻamaʻa ʻana, ʻoi aku ka paʻa o ka hopena, a he liʻiliʻi ka pilikia, pono ka mea maʻi e hoʻokipa ʻia no nā lā 3-5.
2. Hoʻomaʻamaʻa endoscopic o nā hemorrhoids kūloko
ʻO ka ʻokoʻa ma waena o ka mālama endoscopic o nā hemorrhoids kūloko a me ka mālama ʻana i ka EGV:
ʻO ka pahuhopu o ka mālama endoscopic o nā varices esophagogastric he mau kīʻaha koko varicose, a ʻo ka pahuhopu o ka mālama ʻana i ka hemorrhoid kūloko ʻaʻole nā kīʻaha koko maʻalahi, akā ʻo nā hemorrhoids i haku ʻia me nā kīʻaha koko a me nā mea pili.ʻO ka mālama ʻana i nā maʻi hemorrhoids e hoʻomaha i nā hōʻailona, e hoʻokiʻekiʻe i ka anal pad e neʻe i lalo, a pale i nā pilikia e like me ka anal stenosis ma muli o ka nalowale ʻana o nā hemorrhoids (ʻo ke kumu o ka "pepehi ʻana i nā mea āpau" hiki i ka anal stenosis).
Pahuhopu o ka lapaʻau endoscopic: E hoʻomaha a hoʻopau i nā hōʻailona, ʻaʻole e hoʻopau i ka hemorrhoids.
ʻO ka mālama ʻana i ka endoscopic e pili ana i ka sclerotherapy a me ka band ligation.
No ka hōʻoia ʻana a me ka mālama ʻana i nā hemorrhoids kūloko, hoʻohana ʻia ka colonoscopy no ka nānā ʻana, a ua ʻōlelo ʻia ka gastroscope no ka mālama ʻana.Eia kekahi, e like me ke kūlana maoli o kēlā me kēia haukapila, hiki iā ʻoe ke koho i ka maʻi outpatient a i ʻole ka maʻi maʻi maʻi.
①Sclerotherapy (kōkua ʻia e ka pāpale aniani)
ʻO ka sclerosing agent ka lauryl alcohol injection, a hiki ke hoʻohana pū ʻia hoʻi ka pahu lauryl alcohol injection.Pono nō hoʻi e hoʻohana i ka submucosal injection o ka methylene blue ma ke ʻano he mea nalo e hoʻomaopopo i ke ala kahe a me ka uhi ʻana o ka mea sclerosing agent.
ʻO ke kumu o ka pāpale aniani e hoʻonui i ke kahua o ka ʻike.Hiki ke koho ʻia ka nila mai loko mai o nā nila maʻamau.ʻO ka maʻamau, ʻo 6mm ka lōʻihi o ka nila.Pono nā kauka ʻike ʻole e hoʻāʻo e pale i ka hoʻohana ʻana i ka nila lōʻihi, no ka mea, ʻoi aku ka maʻalahi o ka hoʻopaʻa ʻana i ka ectopic a me ka injection.ʻO ka pilikia hohonu a alakaʻi i nā abscesses perianal a me ka mumū.
Koho ʻia ka ʻaoʻao o ka ʻaoʻao waha o ka laina dentate, a aia ke kūlana o ka nila i ke kumu o ka hemorrhoid.Hoʻokomo ʻia ka nila ma 30 ° ~ 40 ° ma lalo o ka ʻike maka (mua a i ʻole hope) o ka endoscope, a ua hoʻokomo hohonu ka nila i ke kumu o ka hemorrhoid.E hoʻokumu i kahi puʻu paʻakikī ma ke kumu o ka hemorrhoid, e hoʻihoʻi i ka nila i ka wā e hoʻopiʻi ai, ma kahi o 0.5 ~ 2mL, a hoʻōki i ka hoʻokele a hiki i ka nui a keʻokeʻo ka hemorrhoid.Ma hope o ka pau ʻana o ka injection, e nānā inā he koko ma ka wahi i hoʻopaʻa ʻia.
Hoʻokomo ʻia ka sclerotherapy endoscopic i ke aniani aniani mua a me ke aniani hoʻohuli ʻia.ʻO ka maʻamau, ʻo ke ʻano o ke aniani inverted injection ke ʻano nui.
② lāʻau lapaʻau
ʻO ka mea maʻamau, hoʻohana ʻia kahi hāmeʻa ligation multi-ring, ʻaʻole i ʻoi aku ma mua o ʻehiku apo i ka nui.Hana ʻia ka ligation ma 1 a 3 cm ma luna o ka laina dentate, a hoʻomaka pinepine ʻia ka ligation kokoke i ka laina anal.Hiki iā ia ke vascular ligation a i ʻole mucosal ligation a i hui pū ʻia.ʻO ka ligation mirror inverted ke ʻano nui, maʻamau 1-2 mau manawa, me kahi manawa o 1 mahina.
ʻO ka lāʻau perioperative: ʻaʻole koi ʻia ka hoʻokē ʻai ma hope o ka hana ʻana, mālama i ka noho maʻemaʻe, a pale i ka noho lōʻihi a me ka hana kino.ʻAʻole pono ka hoʻohana mau ʻana i nā lāʻau antibiotic.
3. ʻO ke kūlana o kēia manawa a me nā pilikia e kū nei o nā halemai
I ka wā ma mua, ʻo ke kūlana koʻikoʻi no ka mālama ʻana i nā hemorrhoids ma ka ʻoihana anorectal.ʻO ka mālama ʻana i ka ʻōnaehana ma ka ʻoihana anorectal e pili ana i ka lāʻau lapaʻau conservative, sclerotherapy injection, a me ka lāʻau lapaʻau.
ʻAʻole ʻike nui nā endoscopists gastrointestinal i ka ʻike ʻana i ke anatomy perianal ma lalo o ka endoscopy, a ua kaupalena ʻia nā hōʻailona no ka mālama ʻana i ka endoscopic (hiki ke mālama ʻia nā hemorrhoids kūloko wale nō).Pono ka ʻokiʻoki e hana i ka hoʻōla piha, i lilo i wahi paʻakikī i ka hoʻomohala ʻana o ka papahana.
Ma ke kumumanaʻo, kūpono loa ka mālama ʻana i ka endoscopic o nā hemorrhoids i loko no nā halemai mua, akā i ka hoʻomaʻamaʻa, ʻaʻole ia e like me ka mea i manaʻo ʻia.
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 hoʻohana nui ʻia ma EMR, 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: Jul-11-2022