Chirwere chemudumbu chinonzi gastric esophageal reflux disease (GerD) chirwere chinowanzoitika muchikamu chekugaya. Kuwanda kwacho uye zviratidzo zvakaoma zvekiriniki zvine chekuita zvakanyanya nehupenyu hwevarwere. Uye kuzvimba kwenguva refu kwegurokuro kune njodzi yekukonzera kenza yegurokuro. Maitiro ekuongorora nemazvo uye kugadzirisa marapirwo ndiwo musimboti webasa rekiriniki.
02 Zviratidzo zveGERD muchipatara
GERD inogona kukamurwa kuita non-eroded reflux (NERD), reflux esophagitis (RE) uye Barreta esophageal (BE) zvichienderana ne endoscopy.
NERD: Barrett esophagus ne clear esophageal mucosa zvakakuvara mutsanangudzo yeGerd asi endoscopy yakakuvara.
Re: Endoscopy inogona kuona mucosa yemudumbu nepagurokuro yakabatana negurokuro kana pamusoro payo. Mucosa yacho inokuvara nguva nenguva.
BE: Chikamu che epithelial chemudumbu-esophageal che epithelium yakaita seesophagus chekubatana kwe esophagus pa endoscopy chinotsiviwa ne cylindrical epithelium.
02 Zviratidzo zveGERD muchipatara
Kuwedzera pakupisa kwemoyo uye kufema, zviratidzo zvakaita sekurwadziwa muchipfuva, kurwadziwa kwemudumbu, uye gumbo rinoshamisa, kukosora, asima nezvimwe zviratidzo zvegurokuro zvinogona kuitika.
Zvinofanira kucherechedzwa kuti varwere vane varwere vakwegura veGerD vane chirwere chemwoyo uye reflux shoma. Kuwanda kwezviratidzo mu extractive tube kwakakwira. Zviratidzo hazvisi zvemazuva ose, kana kutoti hazvina zviratidzo. Kukura kwezviratidzo hakuenderane nekuoma kwechirwere. Factory Guiyu aive asina kusimba, uye paaiva chiremba, akakurira muGuangli.
03 Kuongororwa kweGERD
Mufananidzo. Zviratidzo zveGerD zvakajairika uye zviratidzo zvemudumbu wepamusoro zvisingawanzoitiki zvinosangana nechati yekuyerera kweGERD. Chitubu: Chinese Medical Association
Kuongororwa kwemushonga wekudzvinyirira acid
Kune varwere vane chirwere chegomarara (inowanzo shandiswa PPI), mushonga wakajairika unogara kwemavhiki maviri (avo vane zviratidzo zviri kunze kwechubhu vanofanira kugara kwemavhiki anopfuura mana). Kana zviratidzo zvikapera zvachose kana kuti chiratidzo chimwe chete chisina kunyanya kuoma chikaonekwa kuti chinoshanda.
2) Endoscopic
-Re -Los Angeles yakakamurwa kuita mamakisi (ona mufananidzo uri pazasi):
Kirasi A: 1 kana kupfuura kukuvara kwemucosal yegurokuro, kureba kwekukuvara ≤5 mm;
Giredhi B: kukuvara kwemucosal yegurokuro rimwe kana kupfuura, kureba kwekukuvara kwacho kuri pasi pe5 mm, kukuvara kwemucosal uye kusabatana;
Kirasi C: Kanenge kaviri mucous membrane yegurokuro kakakuvara, uye mucous membrane yakakuvara yakasanganiswa.
Kirasi D: Inoreva kukuvara kwemucosa uye kubatana kweumwe neumwe, uye huwandu hwekubatana kwemudumbu hunosvika 75% yegurokuro.
-B biopsy strategy: Zvinokurudzirwa kuti pave ne biopsy yakawanda uye pfupi, uye biopsy inowanikwa ne 1cm yakatenderedza chitofu. Saizi yehuwandu hwacho ine chekuita nenjodzi yekenza, uye njodzi yekenza iri kuwedzera uye ichiwedzera 3cm.
3) Kuyera kwehuro zvine resolution yepamusoro
Varwere vane GerD vanowanzo ratidza simba risingashande regurokuro: chikamu che70% kana chiyero chekukundikana kweperistalsis che70% kana peristalsis chiri ≥50%.
Kutarisa kweAnti-current
Ndiyo nzira yekuongorora chirwere cheCEDD. Ndiyo nzira yekuongorora chirwere cheGERD, kusanganisira kuongorora huwandu hweNH yemudumbu uye kuongorora huwandu hweNH yemudumbu uye kuongorora huwandu hweNH yemudumbu. Kuongororwa kwehuwandu hwepH <4 (nguva yekuonekwa kweacid, AET)> 4% mu24H, zvinofungidzirwa kuti pane pathological acid reflux.
04 Kurapwa kweGERD
Mufananidzo .Chati yekufamba kwekurapwa kwaGerd
Kwakabva: Sangano reVarapi vekuChina
Zvekungwaririra:
-PPI neP-CAB ndiwo masarudzo ekutanga ekurapa nekuchengetedza varwere vane Gard. Kurapa kwekutanga kwePPI kunotora mavhiki masere uye kurapwa kweP-CAB kunotora mavhiki anopfuura mana.
-Kune varwere vane mhedzisiro yakaipa usiku (paunenge uchitora PPI, pH <4 time> 1H husiku hweusiku), unogona kushandisa H2 receptor blockers usati warara zvichibva pakurapwa kwePPI, kana kushandisa P-CAB uye kwenguva refu. Kurapwa kwePPI kwehafu yehupenyu.
-Mushonga unorwisa asidhi uye mishonga inoshanda mudumbu inogona kushandiswa kwenguva pfupi kuderedza zviratidzo zvekusagadzikana zvakaita sekupisa kwemoyo uye kudzoka kweropa.
-Chiratidzo chekurapa ne endoscopic: Kuongororwa kweGERD kwakajeka, kurapwa neacid hakushande, kusada kutora mushonga kwenguva yakareba, kana kusawirirana nemishonga, uye haagoni kutsungirira.
-Chiratidzo chekuvhiyiwa kwekuvhiyiwa: pane zviratidzo zveGerD zvakajairika, kurapwa kwePPI hakushande; endoscopy inoona esophageal hernia, BE, RE, Los Angeles mamakisi kana kupfuura; Kuongororwa kweX-ray kwakawana kuti pane esophageal hole hernia.
Nguva yekutumira: Kurume-21-2024