Nhanganyaya
Achalasia yecardia (AC) ndeyeprimary esophageal motility disorder.Nekuda kwekutadza kuzorora kweyepasi esophageal sphincter (LES) uye kushomeka kwesophageal peristalsis, kuchengetwa kwechikafu kunogumadysphagia uye reaction. Zviratidzo zvekiriniki zvakadai sekubuda ropa, kurwadziwa kwechipfuva uye kuora muviri.Huwandu hunosvika 32.58/100,000.
Thekurapwayeachalasia inonyanya kusanganisira kurapwa kusiri kwekuvhiya, dilation therapy uye kurapwa kwekuvhiya.
01Kurapwa Kwekurapa
Iyo nzira yekurapa zvinodhaka ndeyekudzikisa LES kudzvanywa munguva pfupi.Hapana humbowo huri pachena hwekuti zvinodhaka zvinogona kuenderera uye zvinobudirira kuvandudza zviratidzo zve AC.Parizvino mishonga inowanzoshandiswa inosanganisira nitrate, calcium channel blockers, uye β-receptor agonists.
(1)Nitrates, zvakadai se nitroglycerin, amyl nitrate, uye isosorbide dinitrate
(2)Calcium channel blockers, zvakadai senifedipine, verapamil, uye diltiazem
(3)β-receptor agonist, zvakadai se cabuterol
02Endoscopic Botulinum Toxin Injection (BTI)
Endoscopic botulinum toxin jekiseni (BTl) inogona kushandiswa kurapa AC,asi inogona kupa chete migumisiro yenguva pfupi uye inogona kushandiswa kune vakwegura varwere vane njodzi dzakakwirira dzekuvhiyiwa uye anesthesia.
1) Zviratidzo:varwere vepakati uye vakwegura (> makore makumi mana); avo vasingakwanisi kushivirira endoscopic balloon dilation (PD) kana kurapwa kwekuvhiya; avo vane mishonga yakawanda yePD kana migumisiro yakaipa yekuvhiya; avo vane esophageal perforation panguva yePD kurapwa Kune avo vane njodzi huru, inogonawo kushandiswa pamwe chete nePD; inogona kushandiswa seshanduko yekuvhiyiwa kana PD kurapwa.
(2) Contraindications:Hazvikurudzirwi kurapwa kwekutanga kweAC muvarwere vechidiki (≤40 makore).
03Endoscopic Balloon Dilation (PD)
Balloon dilatation ine zvimwe zvinokonzeresa paAC, asi inoda marapirwo akawanda uye inotakura njodzi yematambudziko akakomba.
(1) Zvinoratidza:AC varwere vasina cardiopulmonary insufficiency, coagulation dysfunction, nezvimwewo; varume vanopfuura makore makumi mashanu uye vakadzi vanopfuura makore makumi matatu nemashanu; varwere vakakundikana kuvhiyiwa. Inogona kushandiswa seyokutanga sarudzo yekurapa nzira.
(2) Contraindications:Yakanyanya cardiopulmonary insufficiency, coagulation dysfunction uye njodzi yakakura yekubuda esophageal perforation.
04Peroral Endoscopic Myotomy (Nhetembo)
Mumakore achangopfuura, nekuitwa kukuru kweperoral endoscopic myotomy (POEM), chiyero chekubudirira kwekiriniki kurapwa kweAC kwakawedzera zvakanyanya.POEM kurapwa kwe AC kunopindirana zvakanyanya nepfungwa ye "super minimally invasive kuvhiyiwa", kureva, maronda chete anobviswa / anobviswa panguva yekurapwa, uye nhengo hadzibviswi.Kutendeseka uye kushanda kwechimiro cheanatomical chinochengetedzwa, uye hupenyu hwepashure hwekuvhiyiwa kwemurwere hahuna kukanganiswa. Kubuda kwePOEM kwaita kuti kurapwa kwe AC kunyanye kupindira.
Mufananidzo: Matanho ekuvhiya POEM
Kushanda kwepakati uye kwenguva refu kwePOEM mukurapa kwe AC kunopindirana neye laparoscopic Heller myotomy (LHM)inogona kushandiswa senzira yekutanga yekurapa.Vamwe varwere vanogona kugadzira gastroesophageal reflux zviratidzo mushure mekuvhiyiwa kwePOEM
(1) Mhedziso zviratidzo:AC isina yakanyanya submucosal adhesion, gastric inoshanda yekubvisa kusagadzikana uye hombe diverticulum.
(2) Hukama zviratidzo:Diffuse esophageal spasm, nutcracker esophagus uye zvimwe esophageal motility zvirwere, varwere vakakundikana POEM kana Heller kuvhiyiwa, uye AC ine mamwe esophageal submucosal adhesions.
(3) Contraindications:Varwere vane chirwere chakanyanya coagulation dysfunction, yakaoma cardiopulmonary chirwere, urombo huzhinji hwehutano, nezvimwewo vasingagoni kushivirira kuvhiyiwa.
05Laparoscopic Heller Myotomy (LHM)
LHM ine kushanda kwakanaka kwenguva refu mukurapa AC, uye yakatsiviwa nePOEM munzvimbo dzinobvumidza.
06Kuvhiya Esophagectomy
Kana AC yakasanganiswa nechepazasi esophageal scar stenosis, mapundu, nezvimwewo, kuvhiya esophagectomy kunogona kutariswa.
Isu, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., inogadzira muChina inyanzvi mune endoscopic consumables, senge.biopsy forceps, hemoclip, polyp musungo, sclerotherapy tsono, pfapfaidza catheter, cytology brushes, guidewire, dombo rekudzosa tswanda, nasal biliary drainage catheteretc. ayo anoshandiswa zvakanyanya muEMR, ESD,ERCP. Zvigadzirwa zvedu ndezveEC Certified, uye zvidyarwa zvedu ISO certified. Zvinhu zvedu zvakatumirwa kuEurope, North America, Middle East uye chikamu cheAsia, uye zvakanyanya kuwana mutengi wekuzivikanwa nekurumbidzwa!
Nguva yekutumira: Jul-09-2024