Nhanganyaya
Zviratidzo zvikuru zvehemorrhoids iropa muchituru, kurwadziwa kweanal, kudonha uye kuputika, nezvimwewo, izvo zvinonyanya kukanganisa hupenyu hwehupenyu.Muzviitiko zvakanyanya, zvinogona kukonzera kuvharirwa hemorrhoids uye kusingaperi anemia inokonzerwa neropa muchigaro.Parizvino, kurapwa kwekuchengetedza kunonyanya kuenderana nemishonga, uye kurapwa kwekuvhiya kunodiwa mumatambudziko akaoma.
Endoscopic kurapwa ichangobva kugadzirwa nzira yekurapa mumakore achangopfuura, iyo inonyanya kukodzera kuzvipatara zveuswa.Nhasi, tichapfupisa uye kugadzirisa.
1. Kuongororwa kwekliniki, anatomy uye kurapwa kwekare kwehemorrhoids
Kuongororwa kweHemorrhoids
Kuongororwa kwehemorrhoids kunonyanya kubva munhoroondo, kuongorora, digital rectal kuongorora uye colonoscopy.Maererano nenhoroondo yezvokurapa, zvinodikanwa kunzwisisa marwadzo ekumashure, ropa muchigaro, kubuda kwehemorrhoid uye kudzorerwa, etc. Kuongorora kunonyanya kunzwisisa kutaridzika kwehemorrhoids, kana pane fistula yeperianal kuzvimba, nezvimwewo, uye rectal digital. kuongororwa kunoda kunzwisisa kusimba kwe anus uye kana pane induration.Colonoscopy inoda kuziva zvimwe zvirwere zvakadai semamota, ulcerative colitis, nezvimwewo zvinokonzera kubuda ropa.Classification uye grading yehemorrhoids
Kune marudzi matatu ehemorrhoids: mahemorrhoids emukati, kunze kwehemorrhoids, uye masanganiswa ehemorrhoids.
Hemorrhoids: Internal, External, uye Mixed Hemorrhoids
Hemorrhoids inogona kuiswa mugiredhi I, II, III, uye IV.Inoiswa grade maererano nekusangana, hemorrhoid discharge uye kudzoka.
Zviratidzo zvekurapa endoscopic giredhi I, II, uye III mukati hemorrhoids, nepo giredhi IV mukati hemorrhoids, kunze hemorrhoids, uye musanganiswa hemorrhoids ari contraindications kuti endoscopic kurapwa.Mutsara unoparadzanisa pakati pe endoscopic kurapwa ndiyo dentate line.
Anatomy yeHemorrhoids
Anal line, dentate line, anal pad, uye hemorrhoids pfungwa dzinofanirwa kujairana ne endoscopists.Endoscopic identification inoda humwe ruzivo.Mutsara wemazino ndiwo musanganiswa weanal squamous epithelium uye columnar epithelium, uye nzvimbo yekuchinja pakati peanal line uye dentate line yakavharwa ne columnar epithelium asi isina kuvharwa nemuviri.Saka, endoscopic kurapwa kunobva pane dentate line.Endoscopic kurapwa inogona kuitwa mukati memutsara wemazino, uye endoscopic kurapwa haigone kuitwa kunze kweiyo dentate line.
Mufananidzo 1. Maonero epamberi emutsetse wemazino pasi pe endoscope.Museve weyero unonongedza kune serrated annular dentate mutsara, museve muchena unonongedza kune yekumashure mbiru uye yayo longitudinal vascular network, uye museve mutsvuku unonongedza kuvharuvhu yekumashure.
1A: mufananidzo chena;1B: Narrowband Light Imaging
Mufananidzo 2 Kucherechedzwa kweiyo anal flap (museve mutsvuku) uye kumucheto kwezasi kwekoramu yekumashure (museve muchena) uchitevedza maikorosikopu.
Mufananidzo 3 Kutariswa kwepapilla yekumashure pamwe nemaikorosikopu (yellow arrow)
Mufananidzo 4. Mutsara weanal uye dentate line wakaonekwa ne reverse endoscopy.Museve weyero unonongedza kumutsetse wemazino, uye museve mutema unonongedza kumutsetse wekumashure.
Pfungwa dzeanal papilla uye anal column dzinoshandiswa zvakanyanya mukuvhiya anorectal uye hazvidzokororwe pano.
Kurapa kwechinyakare kwehemorrhoids: kune kunyanya kuchengetedza kurapwa uye kurapwa kwekuvhiya.Conservative kurapa kunosanganisira zvinodhaka perianal application uye sitz bath, uye maitiro ekuvhiya anonyanya kusanganisira hemorrhoidectomy uye stapled excision (PPH).Nekuti kurapwa kwekuvhiya kwakanyanya, mhedzisiro yacho haina kugadzikana, uye njodzi idiki, murwere anoda kuiswa muchipatara kwemazuva 3-5.
2. Endoscopic kurapwa kwemukati hemorrhoids
Musiyano pakati pe endoscopic kurapwa kwemukati hemorrhoids uye EGV kurapwa:
Chinangwa che endoscopic kurapwa kwe esophagogastric varices varicose tsinga dzeropa, uye chinangwa chemukati hemorrhoid kurapwa haisi nyore tsinga dzeropa, asi hemorrhoids inoumbwa nemidziyo yeropa uye inobatana tishu.Kurapa kwehemorrhoids ndeyekubvisa zviratidzo, kusimudza pedhi yekumashure inofamba ichidzika, uye kudzivirira matambudziko akadai seanal stenosis inokonzerwa nekunyangarika kwehemorrhoids (musimboti we "kuuraya zvese kunze" unowanzoitika kune anal stenosis).
Chinangwa che endoscopic kurapwa: Kubvisa kana kubvisa zviratidzo, kwete kubvisa hemorrhoids.
Endoscopic kurapwa kunosanganisira sclerotherapy uye band ligation.
Nekuongororwa uye kurapwa kwemukati hemorrhoids, colonoscopy inoshandiswa pakuongorora, uye gastroscope inokurudzirwa kurapwa.Mukuwedzera, maererano nemamiriro ezvinhu chaiwo echipatara chega chega, unogona kusarudza kunze kana kurapwa kwechipatara.
① Sclerotherapy (inobatsirwa neyakajeka chivharo)
Iyo sclerosing agent is lauryl doro jekiseni, uye furo lauryl doro jekiseni rinogona kushandiswa zvakare.Izvo zvinodiwawo kushandisa submucosal jekiseni remethylene yebhuruu sechinhu chisipo kuti unzwisise mafambiro ekuyerera uye kuvhara kweiyo sclerosing agent.
Chinangwa chechivharo chakajeka ndechekuwedzera ndima yekuona.Iyo jekiseni tsono inogona kusarudzwa kubva kune yakajairwa mucosal jekiseni tsono.Kazhinji, kureba kwetsono ndeye 6mm.Vanachiremba vasina ruzivo rwakanyanya vanofanira kuedza kudzivisa kushandisa majekiseni etsono akareba, nokuti majekiseni etsono akareba anowanzoita ectopic injection uye jekiseni.Ngozi yakadzika uye inotungamira kune perianal abscesses uye kuzvimba.
Iyo jekiseni poindi inosarudzwa pamusoro pechikamu chemuromo chedentate mutsara, uye iyo jekiseni tsono chinzvimbo chiri pazasi pechinangwa hemorrhoid.Iyo tsono inopinzwa pa 30 ° ~ 40 ° pasi pekuona kwakananga (kumberi kana kumashure) kwe endoscope, uye tsono inopinzwa zvakanyanya mujinga rehemorrhoid.Gadzira murwi wakaoma pazasi pehemorrhoid, bvisa tsono uchibaya, ingangoita 0.5 ~ 2mL, uye misa jekiseni kusvika hemorrhoid yakura nekuchena.Mushure mekunge jekiseni rapera, tarisai kana pane kubuda ropa panzvimbo yejekiseni.
Endoscopic sclerotherapy inosanganisira jekiseni remberi regirazi uye jekiseni regirazi rakatenderedzwa.Kazhinji, inverted mirror jekiseni ndiyo nzira huru.
② kurapwa kwebhandeji
Kazhinji, multi-ring ligation device inoshandiswa, isingasviki zvindori zvinomwe zvakanyanya.Iyo ligation inoitwa pa 1 kusvika 3 cm pamusoro pemutsara wemazino, uye kusungirira kunowanzotangwa pedyo nemutsara wekumashure.Inogona kuva vascular ligation kana mucosal ligation kana kusanganiswa kwekubatanidza.Inverted mirror ligation ndiyo nzira huru, kazhinji 1-2 nguva, ine nguva yemwedzi mumwe.
Perioperative kurapwa: kutsanya hakudiwe mushure mekuvhiyiwa, chengetedza chituru chakatsetseka, uye kudzivirira kugara kwenguva refu uye basa rinorema remuviri.Kushandisa mishonga inorwisa mabhakitiriya nguva dzose haidiwi.
3. Mamiriro ezvinhu aripo uye matambudziko aripo ezvipatara zvepasi
Munguva yakapfuura, nzvimbo huru yekurapa hemorrhoids yaiva mudhipatimendi reanorectal.Kurapa kwakarongeka mudhipatimendi reanorectal kunosanganisira kuchengetedza mishonga, sclerotherapy jekiseni, uye kurapwa kwekuvhiya.
Gastrointestinal endoscopists havana ruzivo rwakanyanya mukuzivikanwa kwe perianal anatomy pasi pe endoscopy, uye zviratidzo zve endoscopic kurapwa zvishoma (chete mukati mehemorrhoids inogona kurapwa).Kuvhiya kunodiwawo kuita kupora kuzere, izvo zvave zvakaoma mukuvandudzika kweprojekiti.
Mukutaura, endoscopic kurapwa kwemukati hemorrhoids inonyanya kukodzera kuzvipatara zvekutanga, asi mukuita, hazvina kufanana nekufungidzira.
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 catheternezvimwewo izvo zvinoshandiswa 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-11-2022