I. Kwitegura umurwayi
1. Sobanukirwa aho ibintu by'amahanga biherereye, imiterere yabyo, ingano yabyo n'aho bibomoka
Fata X-ray cyangwa CT scans zisanzwe mu ijosi, mu gituza, imbere n'inyuma, cyangwa mu nda uko bikenewe kugira ngo usobanukirwe aho umubiri w'amahanga uherereye, imiterere yawo, imiterere yawo, ingano yawo, n'uko umubiri w'amahanga urimo ubomoka, ariko ntukore isuzuma rya barium swallow.
2. Igihe cyo kwiyiriza ubusa no kunywa amazi
Mu buryo busanzwe, abarwayi biyiriza ubusa amasaha 6 kugeza kuri 8 kugira ngo bakuremo ibinure mu nda, kandi igihe cyo kwiyiriza ubusa no kwiyiriza ubusa mu mazi gishobora koroshywa neza kugira ngo habeho gupimwa indwara yihutirwa.
3. Ubufasha bwo gusinziriza
Abana, abafite ibibazo byo mu mutwe, abadakorana, cyangwa abafite imibiri y’abanyamahanga bafunze, imirambo minini y’amahanga, imirambo myinshi y’abanyamahanga, imirambo y’amahanga ikaze, cyangwa kubagwa mu buryo bwa endoscopique bigoranye cyangwa bifata igihe kirekire bagomba kubagwa hakoreshejwe ikinya rusange cyangwa intubation y’imiyoboro y’amaraso hifashishijwe umuhanga mu by’imiti. Kuramo ibintu by’amahanga.
II. Gutegura ibikoresho
1. Guhitamo endoscope
Ubwoko bwose bwa gastroscopy yo kureba imbere burahari. Iyo bigaragaye ko bigoye gukuramo umubiri w’amahanga cyangwa umubiri w’amahanga ari munini, hakoreshwa gastroscopy yo kubaga ifite imiyoboro ibiri. Endoscope ifite umurambararo muto wo hanze irashobora gukoreshwa ku bana bato n’impinja.
2. Guhitamo forceps
Biterwa ahanini n'ingano n'imiterere y'umubiri w'umunyamahanga. Ibikoresho bikunze gukoreshwa birimo forceps za biopsy, snare, forceps z'iminwa itatu, forceps zigororotse, forceps z'umubiri w'umunyamahanga (forceps-tooth tooth, forceps-mouth forceps), igikapu cyo gukuramo amabuye, umufuka wo gukuramo amabuye, nibindi.
Amahitamo y'igikoresho ashobora kugenwa hashingiwe ku bunini, imiterere, ubwoko, n'ibindi by'umubiri w'umunyamahanga. Nk'uko raporo zibigaragaza, imbaraga zo gupfuka amenyo y'imbeba ni zo zikoreshwa cyane. Igipimo cy'ikoreshwa ry'imbaraga zo gupfuka amenyo y'imbeba ni 24.0% ~ 46.6% by'ibikoresho byose bikoreshwa, naho imbaraga zo gupfuka amenyo zigizwe na 4.0% ~ 23.6%. Muri rusange abantu bemera ko imbaraga zo gupfuka amenyo ari nziza ku nyoni ndende zifite ishusho y'inkoni. Nk'ibipimo bya thermometer, uburoso bw'amenyo, uduti two gupfuka amenyo twa bamboo, amakaramu, ibiyiko, n'ibindi, kandi aho impera y'umutego ipfutse ntihagomba kurenza cm 1, bitabaye ibyo bizagorana gusohoka mu mutima.
2.1 Imibiri y'amahanga ifite ishusho y'inkoni n'imibiri y'amahanga ifite ishusho y'uruziga
Ku bintu by’amahanga bifite ishusho y’inkoni bifite ubuso bworoshye n’umurambararo muto wo hanze nk’udupira two guteka amenyo, biroroshye guhitamo udupira dufite iminwa itatu, udupira tw’amenyo y’imbeba, udupira duto, nibindi; ku bintu by’amahanga bifite uruziga (nk’imitwe, udupira tw’ibirahure, bateri z’amabuto, nibindi), koresha agasanduku ko gukuraho amabuye cyangwa ishashi yo gukuraho amabuye kugira ngo ubikureho. Kubikuramo biragoye cyane.
2.2 Imibiri miremire y'amahanga ityaye, ibiryo bivanze, n'amabuye manini mu nda
Ku mibiri miremire y’amahanga ifite ubukana, umurongo muremure w’umubiri w’amahanga ugomba kuba ujyanye n’umurongo muremure w’ubwonko, aho impera ikarishye cyangwa impera ifunguye ireba hasi, kandi ikagenda ivamo mu gihe cyo gutera umwuka. Ku mibiri y’amahanga ifite ishusho y’uruziga cyangwa imibiri y’amahanga ifite imyobo, ni byiza gukoresha uburyo bwo kuyikuramo;
Ku macupa y'ibiryo n'amabuye manini mu nda, uduce duto two gutema dushobora gukoreshwa mu kubisya hanyuma tukavanwaho hakoreshejwe uduce duto tw'iminwa itatu cyangwa umutego.
3. Ibikoresho byo kurinda
Koresha ibikoresho byo kwirinda ibintu bidasanzwe ku bintu bigoye kubikuraho kandi bishobora guteza akaga. Muri iki gihe, ibikoresho byo kwirinda bikunze gukoreshwa birimo imipfundikizo ibonerana, imiyoboro yo hanze, n'ibipfundikizo byo kwirinda.
3.1 Umugozi ubonerana
Mu gihe cyo gukuraho umubiri w’umunyamahanga, umupfundikizo ubonerana ugomba gukoreshwa ku mpera y’indorerwamo ya endoscopic uko bishoboka kose kugira ngo hirindwe ko umwobo w’umura udakubitwa n’umubiri w’umunyamahanga, no kwagura umwobo kugira ngo ugabanye ubudahangarwa buboneka iyo umubiri w’umunyamahanga ukuweho. Bishobora kandi gufasha gufata no gukuramo umubiri w’umunyamahanga, ibyo bikaba ingirakamaro mu gukuraho umubiri w’umunyamahanga.
Ku mibiri y’amahanga ifite ishusho y’imirongo iri mu mucosa ku mpera zombi z’umuyoboro w’amaraso, umupfundikizo ubonerana ushobora gukoreshwa mu gusunika buhoro buhoro umuyoboro w’amaraso mu muyoboro w’amaraso hirya no hino ku mpera imwe y’umubiri w’amahanga kugira ngo impera imwe y’umubiri w’amahanga isohoke mu rukuta rw’umuyoboro w’amaraso kugira ngo hirindwe ko umuyoboro w’amaraso wangirika bitewe no gukurwaho mu buryo butaziguye.
Umupfundikizo ubonerana ushobora kandi gutanga umwanya uhagije wo gukoresha igikoresho, ibyo bikaba byoroshye mu kubona no gukuramo imibiri y’abanyamahanga mu gice gito cy’ijosi ry’umuhogo.
Muri icyo gihe, umupfundikizo ubonerana ushobora gukoresha uburyo bwo gukurura umuvuduko mubi kugira ngo ufashe mu kwinjiza ibiryo no koroshya gutunganya nyuma.
3.2 Agasanduku ko hanze
Mu gihe kirinda umwobo n'uruti rw'umuyoboro w'amaraso hagati y'umuyoboro n'igifu, umuyoboro wo hanze worohereza gukuraho imibiri miremire, ikarishye, kandi myinshi y'amahanga no gukuraho ibiryo, bityo bigabanye ingaruka mbi mu gihe cyo gukuraho umubiri w'amahanga wo hejuru y'igifu. Kongera umutekano n'ubushobozi bwo kuvura.
Imiyoboro ya overtubes ntikunze gukoreshwa ku bana kubera ibyago byo kwangiza umwobo mu gihe cyo kuyishyiramo.
3.3 Ubwishingizi bw'uburinzi
Shyira igipfundikizo cy'uburinzi ku mpera y'imbere ya endoscope. Nyuma yo gufata ikintu cy'amahanga, zunguza igipfundikizo cy'uburinzi hanyuma ugipfundikishe mu gihe ukuramo endoscope kugira ngo wirinde ibintu by'amahanga.
Igera ku ruhererekane rw'ibinure byo mu nzira y'igogora kandi ikagira uruhare mu kurinda.
4. Uburyo bwo kuvura ubwoko butandukanye bw'ibinyabuzima by'amahanga mu gice cyo hejuru cy'igifu
4.1 Ibiryo byinshi mu muhogo
Raporo zigaragaza ko ibiryo byinshi bito mu muhogo bishobora gusunikwa buhoro buhoro mu gifu bigasigwa mu buryo busanzwe, ibyo bikaba byoroshye, byoroshye kandi bidakunze guteza ibibazo. Mu gihe cyo gutera gastroscopy, inflation ikwiye ishobora gushyirwa mu muhogo, ariko bamwe mu barwayi bashobora kuba baherekejwe n'ibibyimba bibi byo mu muhogo cyangwa stenosis ya anastomotic nyuma yo gukamura umuhogo (Ishusho ya 1). Niba hari ubudahangarwa kandi ukabyirukana cyane, gushyiramo igitutu kinini byongera ibyago byo gutobora. Ni byiza gukoresha agasanduku k'urushundura rwo gukuramo amabuye cyangwa agasakoshi ko gukuramo amabuye kugira ngo ukuremo umubiri w'amahanga. Niba umuhogo w'ibiryo ari munini, ushobora gukoresha forceps z'umubiri w'amahanga, imitego, nibindi kugira ngo ubicemo mbere yo kugabanyamo ibice. Kuramo.
Ishusho ya 1 Nyuma yo kubagwa kanseri yo mu muhogo, umurwayi yaherekejwe no gucika intege k'umuhogo no kugumana ibiryo mu mubiri.
4.2 Ibintu bigufi kandi bitoroshye byo mu mahanga
Imibiri myinshi migufi kandi yoroheje ishobora gukurwaho binyuze mu mitego y’umubiri w’amahanga, imitego, uduseke two gukuraho amabuye, imifuka yo gukuraho amabuye, nibindi. (Ishusho ya 2). Niba umubiri w’amahanga uri mu muhogo bigoye kuwukuramo neza, ushobora gusunikwa mu gifu kugira ngo uhindure aho uherereye hanyuma ugerageze kuwukuramo. Imibiri migufi kandi yoroheje ifite umurambararo wa cm 2.5 mu gifu iragoye kunyura muri pylorus, kandi hagomba gukorwa uburyo bwo gusuzuma mu mara vuba bishoboka; niba imibiri y’amahanga ifite umurambararo muto mu gifu cyangwa mu nda idagaragaje kwangirika mu gifu, ishobora gutegereza ko isohoka mu mara. Iyo igumyeho ibyumweru birenga 3-4 kandi idashobora gusohoka, igomba gukurwaho mu mara.
Igishushanyo cya 2 Ibintu by'inyuma bya pulasitiki n'uburyo bwo kubikuraho
4.3 Imiryango y'amahanga
Ibintu by’inyamahanga bifite uburebure bwa ≥6 cm (nk'ibipimo bya thermometer, uburoso bw'amenyo, uduti twa bamboo, amakaramu, ibiyiko, nibindi) ntabwo byoroshye kubisohora mu buryo busanzwe, bityo akenshi bikusanyirizwa hamwe n'agaseke k'amabuye cyangwa umutego.
Umutego ushobora gukoreshwa mu gupfuka impera imwe (nta kure ya cm 1 uvuye ku mpera), ugashyirwa mu mupfundikizo ubonerana kugira ngo uwukuremo. Agakoresho ko hanze ka cannula gashobora kandi gukoreshwa mu gufata umubiri w’amahanga hanyuma kagasubira inyuma neza mu gice cyo hanze kugira ngo wirinde kwangiza umwotsi.
4.4 Ibintu by'amahanga bityaye
Ibintu by’amahanga bityaye nk’amagufwa y’amafi, amagufwa y’inkoko, amenyo y’amenyo, utubuto tw’amenyo, impapuro zifunga, ibyuma byo kwisiga, n’udupfunyika tw’amabati (Ishusho ya 3) bigomba kwitabwaho bihagije. Ibintu by’amahanga bityaye bishobora kwangiza ururenda rw’amaraso n’imitsi y’amaraso byoroshye bigatera ingorane nko gutobora bigomba kuvurwa neza. Gucunga byihutirwa hakoreshejwe endoscope.
Ishusho ya 3 Ubwoko butandukanye bw'ibintu bityaye by'amahanga
Mu gihe cyo gukuraho imibiri y'abanyamahanga ikaze munsi y'umusozoIshusho y'umuyoboro w'igogora, biroroshye gukurura umwobo w'igogora. Ni byiza gukoresha agapfundikizo kabonerana, gashobora kwerekana neza urumuri rw'umubiri kandi wirinde gukurura urukuta. Gerageza kuzana impera y'umubiri w'amahanga hafi y'inyuma y'indorerwamo y'ijisho kugira ngo impera imwe y'umubiri w'amahanga ishyirwemo. Shyira mu gapfundikizo kabonerana, koresha imbaraga z'umubiri w'amahanga cyangwa umutego kugira ngo ufate umubiri w'amahanga, hanyuma ugerageze kugumana umurongo muremure w'umubiri w'amahanga ujyanye n'umuyoboro mbere yo kuva kuri scope. Inyama z'amahanga zishyizwe ku ruhande rumwe rw'umuyoboro zishobora gukurwaho ushyize agapfundikizo kabonerana ku mpera y'imbere ya endoscope hanyuma ukinjira buhoro buhoro mu mwobo w'igogora. Ku nyama z'amahanga zishyizwe mu mwobo w'igogora ku mpera zombi, impera y'igogora igomba kubanza kurekurwa, akenshi ku ruhande rwo hafi, kura indi mpera, hindura icyerekezo cy'ikintu cy'amahanga kugira ngo impera y'umutwe ishyirwe mu mwobo w'igogora, hanyuma uyikuremo. Cyangwa nyuma yo gukoresha icyuma cya laser mu gukata umubiri w’amahanga hagati, ubunararibonye bwacu ni ukubanza gukurura umuyoboro w’amaraso cyangwa uruhande rw’umutima, hanyuma tukawukuraho buhoro buhoro.
a. Inyo z'amenyo: Iyo urya, ukorora, cyangwa uvugag, abarwayi bashobora kugwa ku bw'impanuka bakava ku menyo yabo y'amenyo, hanyuma bakinjira mu gice cyo hejuru cy'igifu bamira. Menyo y'amenyo atyaye afite imigozi y'icyuma ku mpera zombi biroroshye kuyashyira mu nkuta z'igifu, bigatuma kuyikura bigorana. Ku barwayi bananiwe kuvurwa hakoreshejwe uburyo busanzwe bwo gupima, ibikoresho byinshi byo gufunga bishobora gukoreshwa mu kugerageza kuyikuramo hakoreshejwe endoskopiya y'imiyoboro ibiri.
b.Ibinogo by'amatariki: Ibinogo by'amatariki biri mu muhogo akenshi biba bityaye ku mpande zombi, bishobora gutera ingorane nko kwangirika kw'imitsie, kuva amaraso, kwandura indwara zo mu gace k’umubiri no gutobora mu gihe gito, kandi bigomba kuvurwa byihutirwa hifashishijwe ubuvuzi bwa endoscopic (Ishusho ya 4). Iyo nta cyago cy’igifu cyabaye, amabuye menshi y’amata mu gifu cyangwa mu duodenum ashobora gusohoka mu masaha 48. Ayo adashobora gusohoka mu buryo busanzwe agomba gukurwaho vuba bishoboka.
Ishusho ya 4: Ishingiro rya Jujube
Nyuma y'iminsi ine, umurwayi yasuzumwe mu bitaro by'ahandi. CT yagaragaje umubiri w'amahanga mu mwobo ufite icyuho. Imisokoro y'ijisho ityaye ku mpande zombi yakuweho hakoreshejwe endoskopiya hanyuma yongera gukorwa gastroscopy. Byagaragaye ko fistula yakozwe ku rukuta rw'uwo mwobo.
4.5 Ibintu binini by'amahanga bifite impande ndende n'impande zityaye (Ishusho ya 5)
a. Shyira umuyoboro w'inyuma munsi ya endoscope: Shyira gastroscope hagati mu muyoboro w'inyuma, ku buryo impande zo hasi z'umuyoboro w'inyuma zegereye impande zo hejuru z'igice cy'agapira gakonje cya gastroscope. Shyira gastroscope buri gihe hafi y'umubiri w'inyuma. Shyira ibikoresho bikwiye unyuze mu muyoboro wa biopsy, nka snares, forceps z'umubiri w'inyuma, nibindi. Umaze gufata ikintu cy'inyuma, gishyire mu muyoboro w'inyuma, maze igikoresho cyose kizasohoka hamwe n'indorerwamo.
b. Igipfundikizo cy'urumuri cyakorewe mu rugo: Koresha igipfundikizo cy'urutoki rw'uturindantoki twa muganga kugira ngo ukore igipfundikizo cy'imbere cya endoscope cyakorewe mu rugo. Gikate ku ruhande rw'umuzi w'urutoki rw'agapfundikizo mu buryo bw'impanda. Kata umwobo muto ku mutwe w'urutoki, hanyuma unyuze impera y'imbere y'umubiri w'indorerwamo mu mwobo muto. Koresha impeta ntoya ya rubber kugira ngo uyishyire kuri cm 1.0 uvuye ku mpera y'imbere ya gastroscope, uyisubize mu mpera yo hejuru ya gastroscope, hanyuma wohereze hamwe na gastroscope ku mubiri w'amahanga. Fata umubiri w'amahanga hanyuma uwukuremo hamwe na gastroscope. Agakoresho k'uburinzi kazerekeza ku mubiri w'amahanga bitewe n'ubudahangarwa. Niba icyerekezo gihindukiye, kizazungurutswa ku bintu by'amahanga kugira ngo birindwe.
Ishusho ya 5: Amagufwa y'ifi atyaye yakuweho hakoreshejwe endoscope, hamwe n'imitsi yo mu mucosa
4.6 Ibintu by'ubukorikori by'icyuma
Uretse forceps zisanzwe, ibyuma bishobora gukurwaho hakoreshejwe forceps z'umubiri w'amahanga ufite magnetic. Ibyuma bishobora guterwa n'icyuma biteje akaga cyangwa bigoye gukuraho bishobora kuvurwa hakoreshejwe endoscope hakoreshejwe X-ray fluoroscopy. Ni byiza gukoresha agasanduku ko gukuraho amabuye cyangwa agasanduku ko gukuraho amabuye.
Ibiceri bikunze kugaragara mu mibiri y’abanyamahanga mu nzira y’igogora ry’abana (Ishusho ya 6). Nubwo ibiceri byinshi mu muhogo bishobora kwanduzwa mu buryo busanzwe, ni byiza kuvura hifashishijwe endoscope. Kubera ko abana badakorana neza, gukuramo imibiri y’abanyamahanga mu bana ni byiza gukorwa hifashishijwe anesthesia rusange. Iyo igiceri kigoye gukuramo, gishobora gusunikwa mu nda hanyuma kikavanwamo. Niba nta bimenyetso bigaragara mu nda, ushobora gutegereza ko gisohoka mu buryo busanzwe. Niba igiceri kigumyeho ibyumweru birenga 3-4 kandi ntigisohoke, kigomba kuvurwa hifashishijwe endoscope.
Ishusho ya 6 Igiceri cy'icyuma cy'imigabane yo mu mahanga
4.7 Ibintu byo mu mahanga byangiza
Imibiri y’amahanga yangiritse ishobora kwangiza inzira y’igogora cyangwa ndetse no kwangirika. Ubuvuzi bwihutirwa bwo mu ikoranabuhanga rya endoscopic burakenewe nyuma yo gusuzuma. Bateri ni zo zikunze kwangiza cyane kandi zikunze kugaragara ku bana bari munsi y’imyaka 5 (Ishusho ya 7). Nyuma yo kwangiza umwobo, zishobora gutera stenosis y’umwobo. Endoscope igomba gusuzumwa mu byumweru bike. Iyo habayeho stricture, umwobo ugomba kwaguka vuba bishoboka.
Ishusho ya 7 Ikintu cy'amahanga kiri muri batiri, akambi gatukura kerekana aho ikintu cy'amahanga kiri
4.8 Ibintu by'amahanga bya rukuruzi
Iyo hari ibintu byinshi by’amahanga bifite imbaraga zidasanzwe cyangwa ibintu by’amahanga bifite imbaraga zidasanzwe bivanze n’icyuma mu gice cyo hejuru cy’igifu, ibintu bikururana kandi bigakanda inkuta z’igifu, ibyo bikaba byatera indwara ya ischemic necrosis, fistula, gutobora, kuziba, peritonitis n’ibindi bikomere bikomeye by’igifu. , bisaba ubuvuzi bwihutirwa bwo mu gifu. Ibintu by’amahanga bifite imbaraga zidasanzwe nabyo bigomba gukurwaho vuba bishoboka. Uretse imbaraga zisanzwe, ibintu by’amahanga bifite imbaraga zidasanzwe bishobora gukurwaho mu gihe cyo gukururwa hakoreshejwe imbaraga zidasanzwe z’umubiri.
4.9 Imibiri y'amahanga mu nda
Inyinshi muri zo ni ibyuma bishyushya, insinga z'icyuma, imisumari, nibindi bimirwa n'imfungwa nkana. Inyama nyinshi z'abanyamahanga ni ndende kandi nini, zigoye kunyura muri cardia, kandi zishobora gukurura ururenda rw'amenyo byoroshye. Ni byiza gukoresha udukingirizo hamwe n'udukingirizo tw'amenyo y'imbeba kugira ngo ukureho imibiri y'abanyamahanga ukoresheje endoscope. Ubwa mbere, shyira udukingirizo tw'amenyo y'imbeba mu mpera y'imbere ya endoscope unyuze mu mwobo wa biopsy ya endoscope. Koresha udukingirizo tw'amenyo y'imbeba kugira ngo uhambire impeta y'umukara iri hepfo ya agakingirizo. Hanyuma, subiza udukingirizo tw'amenyo y'imbeba mu mwobo wa biopsy kugira ngo uburebure bw'agakingirizo bugaragare hanze y'umwobo wa biopsy. Gabanya uko bishoboka kose nta kibazo, hanyuma ushyire mu mwobo w'igifu hamwe na endoscope. Nyuma yo kuvumbura umubiri w'amahanga, shyira umubiri w'amahanga mu gakingirizo. Niba bigoye gukuramo, shyira agakingirizo mu mwobo w'igifu, hanyuma ukoreshe udukingirizo tw'amenyo y'imbeba kugira ngo uhambire umubiri w'amahanga hanyuma ushyiremo. Imbere mu gakingirizo, koresha udukingirizo tw'amenyo y'imbeba kugira ngo uhambire agakingirizo hanyuma ukabikuramo hamwe n'indorerwamo.
4.10 Amabuye yo mu nda
Gastrolith zigabanyijemo ibimera, ibimera by’amatungo, ibimera bikomoka ku biyobyabwenge n’ibimera bivanze. Ibimera by’ibimera ni byo bikunze kugaragara cyane, ahanini biterwa no kurya persimmon nyinshi, hawthorns, date z’itumba, peaches, seleri, kelp, na coconuts mu nda idafite icyo imaze. Biterwa n’ibindi. Ibimera by’ibimera nka persimmons, hawthorns, na jujubes birimo aside tannic, pectin, na shim. Bitewe n’aside yo mu gifu, poroteyine ya aside tannic idashonga mu mazi irakorwa, ifatana na pectin, shim, fibre y’ibimera, igishishwa, n’inyama zo mu nda. Amabuye yo mu gifu.
Amabuye yo mu gifu ashyira igitutu ku rukuta rw'igifu kandi agatuma aside yo mu gifu yiyongera, ibyo bikaba byatera kwangirika kw'imitsi yo mu gifu, ibisebe ndetse no gutobora. Amabuye mato yoroshye yo mu gifu ashobora gushonga hamwe na sodium bicarbonate n'indi miti hanyuma akarekurwa agasohoka mu buryo busanzwe.
Ku barwayi bananiwe kuvurwa, gukuraho amabuye yo mu nda ni amahitamo ya mbere (Ishusho ya 8). Ku mabuye yo mu nda agoye kuyakuraho hakoreshejwe endoskopiya bitewe n'ingano yayo nini, forceps z'umubiri w'amahanga, imitego, uduseke two gukuraho amabuye, nibindi bishobora gukoreshwa mu gusya amabuye hanyuma bakayakuraho; ku bafite imiterere ikomeye idashobora gusya, gukata amabuye yo mu nda bishobora kwitabwaho, laser lithotripsy cyangwa high-frequency electric lithotripsy, iyo ibuye ryo mu nda riri munsi ya 2cm nyuma yo kuvunika, koresha forceps z'inzara eshatu cyangwa forceps z'umubiri w'amahanga kugira ngo uyakureho uko bishoboka kose. Hakwiye kwitonderwa kugira ngo hirindwe ko amabuye arengeje 2cm atajya mu mara anyuze mu gifu bigatuma amara aziba.
Ishusho ya 8 Amabuye mu nda
4.11 Isakoshi y'imiti
Gucika kw'agapfunyika k'umuti bizatera ibyago byinshi kandi ni itegeko kuvura hakoreshejwe endoscope. Abarwayi badashobora kuva mu mubiri mu buryo busanzwe cyangwa bakekwaho gucika kw'agapfunyika k'umuti bagomba kubagwa cyane.
III. Ingorane n'uburyo bwo kuvura
Ingorane z'umubiri w'umunyamahanga zifitanye isano n'imiterere, imiterere, igihe umuganga aba atuyemo ndetse n'urwego rw'ubuvuzi. Ingorane nyamukuru zirimo gukomereka mu muhogo, kuva amaraso, no kwandura indwara zitoboye.
Iyo umubiri w’umunyamahanga ari muto kandi nta kintu kigaragara cyangiritse mu maraso iyo uvuye mu mubiri, ntabwo ari ngombwa kujya mu bitaro nyuma yo kubagwa, kandi ushobora gukurikiza indyo yoroheje nyuma yo kwiyiriza ubusa amasaha 6.Ku barwayi bafite imvune zo mu muhogo, glutamine granules, aluminiyumu fosfeti gel n'ibindi bintu birinda mucosal bishobora guhabwa ubuvuzi bw'ibimenyetso. Iyo bibaye ngombwa, kwiyiriza ubusa no kurya indyo yuzuye bishobora gutangwa.
Ku barwayi bafite ikibazo cy’ibyangiritse mu mucosa no kuva amaraso bigaragara, kuvura bishobora gukorwa hifashishijwe uburyo bwo kureba mu buryo butaziguye, nko gutera umuti wa norepinephrine wo mu bwoko bwa barafu, cyangwa gufata titanium clips kugira ngo bifunge igikomere.
Ku barwayi bafite CT mbere yo kubagwa igaragaza ko umubiri w’amahanga winjiye mu rukuta rw’umuyoboro w’amaraso nyuma yo gukurwamo endoscope, iyo umubiri w’umunyamahanga ugumye mu masaha ari munsi ya 24 kandi CT isanze nta gisebe cyavutse hanze y’umuyoboro w’amaraso, ubuvuzi bwa endoscope bushobora gukorwa mu buryo butaziguye. Nyuma yuko umubiri w’umunyamahanga ukuwemo unyuze muri endoscope, hakoreshwa titanium clip kugira ngo ifatanye urukuta rw’imbere rw’umuyoboro w’amaraso aho watobotse, bishobora guhagarika kuva amaraso no gufunga urukuta rw’imbere rw’umuyoboro w’amaraso icyarimwe. Umuyoboro w’igifu n’umuyoboro w’amafunguro wa jejunal bishyirwa munsi y’amaso ya endoscope, maze umurwayi agakomeza kuvurwa. Ubuvuzi burimo ubuvuzi bugaragaza ibimenyetso nko kwiyiriza ubusa, gukuraho igifu, imiti yica udukoko n’imirire. Muri icyo gihe, ibimenyetso by’ingenzi nk’ubushyuhe bw’umubiri bigomba kwitabwaho cyane, kandi hagomba kubaho ingorane nko kuvura ijosi cyangwa kuvura impyiko y’amaraso cyangwa kuvura impyiko y’amaraso ku munsi wa gatatu nyuma yo kubagwa. Nyuma yuko isuzuma ry’amazi rya iyode rigaragaza ko nta gusohoka kw’amaraso kwabayeho, kurya no kunywa bishobora kwemererwa.
Iyo umubiri w’umunyamahanga wamaze amasaha arenga 24 uguma mu mubiri, iyo hagaragaye ibimenyetso by’ubwandu nk’umuriro, ubukonje, n’umubare munini w’uturemangingo tw’amaraso twera, iyo CT igaragaza ko hari ikibyimba cyo hanze y’umuyoboro w’amaraso, cyangwa niba habayeho ibibazo bikomeye, abarwayi bagomba kwimurirwa mu bitaro kugira ngo bavurwe vuba.
IV. Amabwiriza yo kwirinda
(1) Uko umubiri w’amahanga umara igihe kirekire mu muhogo, ni ko kubagwa bizarushaho kugorana kandi ni ko ibibazo bizarushaho kwiyongera. Kubwibyo, gukorerwa isuzuma ryihutirwa rya endoscopic ni ngombwa cyane.
(2) Niba umubiri w’amahanga ari munini, ufite imiterere idahwitse cyangwa ufite imitsi, cyane cyane niba umubiri w’amahanga uri hagati mu muhogo kandi hafi y’umuyoboro w’amaraso, kandi bikaba bigoye kuwukuraho hakoreshejwe endoscope, ntuwukuremo ku ngufu. Ni byiza gusaba inama ku nzego zitandukanye no kwitegura kubagwa.
(3) Gukoresha ibikoresho birinda umuhogo mu buryo bwumvikana bishobora kugabanya ibibazo bishobora kubaho.
Ibyacuforceps zo gufata zikoreshwa mu buryo butunguranyeIkoreshwa hamwe na endoscope zoroshye, zinjira mu bwobo bw'umubiri w'umuntu nko mu nzira z'ubuhumekero, mu muhogo, mu gifu, mu mara n'ibindi binyuze mu muyoboro wa endoscope, kugira ngo ifate ingirabuzima fatizo, amabuye n'ibintu byo hanze ndetse no gukuramo stent.
Igihe cyo kohereza: Mutarama-26-2024