Nhanganyaya
Achalasia yecardia (AC) chirwere chemwoyochirwere chekutanga chekufamba kwegurokuro.Nekuda kwekusagadzikana kwe sphincter yepasi pesophageal (LES) uye kushaikwa kwe peristalsis yesophageal, kuchengetedza chikafu kunogumaKushaya simba uye maitiro emuviri. Zviratidzo zvekurapwa zvakaita sekubuda ropa, kurwadziwa muchipfuva uye kudzikira kwehuremu.Kuwanda kwevanhu vane chirwere ichi kunosvika 32.58/100,000.
Iyokurapwayeachalasia inonyanya kusanganisira kurapwa kusingashandisi kuvhiyiwa, kurapwa kwekuwedzerwa kweropa uye kurapwa kwekuvhiyiwa.
01Kurapwa Kwezvekurapa
Maitiro ekurapa nemishonga ndeyekuderedza kumanikidzwa kweLES munguva pfupi.Hapana humbowo huri pachena hunoratidza kuti mishonga inogona kuramba ichivandudza zviratidzo zveAC.Mishonga inoshandiswa zvakanyanya pari zvino inosanganisira nitrates, calcium channel blockers, uye β-receptor agonists.
(1)Nitrates, zvakaita se nitroglycerin, amyl nitrate, uye isosorbide dinitrate
(2)Zvinodzivirira calcium channelmishonga yakadai se nifedipine, verapamil, uye diltiazem
(3)β-receptor agonists, zvakaita se cabuterol
02 Endoscopic Botulinum Toxin Jekiseni (BTI)
Injection ye botulinum toxin (BTl) inogona kushandiswa kurapa AC,asi inogona kungopa mhedzisiro yenguva pfupi chete uye inogona kushandiswa kuvarwere vakwegura vane njodzi huru dzekuvhiyiwa uye kunetsa.
1) Zviratidzo:varwere vezera repakati nepakati nevakwegura (vanopfuura makore makumi mana); avo vasingakwanise kushivirira endoscopic balloon dilation (PD) kana kurapwa kwekuvhiyiwa; avo vane PD dzakawanda kana mhedzisiro isina kunaka yekuvhiyiwa; avo vane gumbo rakaboorwa panguva yekurapwa kwePD Kune avo vane njodzi huru, inogona zvakare kushandiswa pamwe chete nePD; inogona kushandiswa senzira yekuchinja kuenda kuvhiyiwa kana kurapwa kwePD.
(2) Zvinorambidzwa:Hazvikurudzirwi kurapa AC nenzira yekutanga muvarwere vadiki (vane makore anopfuura makumi mana).
03 Kukura kweBharuni reEndoscopic (PD)
Kukura kwemabharumu kune zvimwe zvakunokanganisa paAC, asi kunoda kurapwa kwakawanda uye kune njodzi yematambudziko akakomba.
(1) Zviratidzo:Varwere vane AC vasina chirwere chemwoyo nemapapu, vasina kutadza kushanda zvakanaka kweropa, nezvimwewo; varume vane makore anopfuura makumi mashanu nevakadzi vane makore anopfuura makumi matatu nemashanu; varwere vakakundikana kuvhiyiwa. Inogona kushandiswa senzira yekutanga yekurapa.
(2) Zvinorambidzwa:Kusashanda zvakanaka kwemwoyo nemapapu, kusashanda zvakanaka kweropa uye njodzi huru yekuboorwa kwegurokuro.
04Peroscopic Endoscopic Myotomy (Nhetembo)
Mumakore achangopfuura, nekushandiswa kukuru kwe peroral endoscopic myotomy (POEM), mwero wekubudirira kwekurapwa kweAC mukiriniki wakawedzera zvakanyanya.Kurapa AC nenhetembo kunoenderana zvikuru nepfungwa yekuti "kuvhiyiwa kushoma kwazvo", kureva kuti, maronda chete ndiwo anobviswa panguva yekurapwa, uye nhengo dzemuviri hadzibviswi.Kushanda zvakanaka kwemuviri wemurwere kunochengetwa, uye hupenyu hwake mushure mekuvhiyiwa hahuna kukanganiswa. Kubuda kwePOEM kwakaita kuti kurapwa kweAC kusanyanye kukuvadza.
Mufananidzo: Matanho ekuvhiya kwePOEM
Kushanda kwePOEM pakati nepanguva refu mukurapa AC kunoenderana nekushanda kwe laparoscopic Heller myotomy (LHM)inogona kushandiswa senzira yekutanga yekurapa.Vamwe varwere vanogona kuva nezviratidzo zve gastroesophageal reflux mushure mekuvhiyiwa kwePOEM
(1) Zviratidzo zvachose:AC isina kunamira kwakanyanya kwemudumbu, chirwere chemudumbu chekubuda kwechinhu mudumbu uye diverticulum yakakura.
(2) Zviratidzo zvine hukama:Kupararira kweropa remudumbu, nutcracker esophagus nezvimwe zvirwere zvekufamba kwemudumbu, varwere vane POEM kana Heller surgery yakakundikana, uye AC ine mamwe ma adhesions emudumbu.
(3) Zvinorambidzwa:Varwere vane dambudziko guru rekugwinya kweropa, chirwere chemwoyo nemapapu, mamiriro asina kunaka, nezvimwewo vasingakwanise kushivirira kuvhiyiwa.
05Laparoscopic Heller Myotomy (LHM)
LHM inoshanda zvakanaka kwenguva refu mukurapa AC, uye yakatsiviwa nePOEM munzvimbo dzinenge dzichibvumira.
06 Kuvhiyiwa kweEsophagectomy
Kana AC ikabatanidzwa ne stenosis yemavanga epaurophage, bundu, nezvimwewo, kuvhiyiwa kwe esophagectomy kunogona kufungwa nezvako.
Isu, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., tinogadzira zvinhu muChina zvine chekuita ne endoscopic consumables, zvakaita sesimba re biopsy, hemoclip, musungo wepolyp, tsono yekurapa sclerotherapy, katheta yekupfapfaidza, mabhurashi e cytology, waya yekufambisa, tswanda yekutorwa kwematombo, katheta yekubuditsa mvura yemumhinonezvimwewo zvinoshandiswa zvakanyanya muEMR, ESD,ERCPZvigadzirwa zvedu zvakanyoreswa neCE, uye mafekitori edu akanyoreswa neISO. Zvinhu zvedu zvakatumirwa kuEurope, North America, Middle East nedzimwe nzvimbo dzeAsia, uye zviri kuita kuti mutengi azivikanwe uye arumbidzwe zvikuru!
Nguva yekutumira: Chikunguru-09-2024