Ubuhanga mu ngingo imwe: Kuvura Achalasia

Intangiriro
Achalasia yumutima (AC) ni aprimaire esophageal motility disorder.Bitewe no kuruhuka nabi kwa sphincter yo hepfo (LES) no kubura peristalisike esofageal, kubika ibiryo bivamodysphagia na reaction. Ibimenyetso byamavuriro nko kuva amaraso, kubabara mu gatuza no kugabanya ibiro.Ikwirakwizwa ni 32.58 / 100.000.
Uwitekakwivuzaya achalasia ikubiyemo cyane cyane kuvura kutabaga, kuvura dilation no kuvura.

01Ubuvuzi
Uburyo bwo kuvura ibiyobyabwenge ni ukugabanya umuvuduko wa LES mugihe gito.Nta kimenyetso kigaragara cyerekana ko ibiyobyabwenge bishobora gukomeza kandi neza kunoza ibimenyetso bya AC.Kugeza ubu ibiyobyabwenge bikunze gukoreshwa birimo nitrate, imiyoboro ya calcium, hamwe na β-reseptor agonist.
(1)Nitrate, nka nitroglycerine, nitrat ya amyl, na dinitrate ya isosorbide
(2)Inzitizi ya Kalisiyumu, nka nifedipine, verapamil, na diltiazem
(3)β-reseptor agonist, nka cabuterol

02Endoscopique Botuline Yatewe Uburozi (BTI)
Endoscopic botulinum toxin inshinge (BTl) irashobora gukoreshwa mukuvura AC,ariko irashobora gutanga ingaruka zigihe gito kandi irashobora gukoreshwa mubarwayi bageze mu zabukuru bafite ibyago byinshi byo kubagwa na anesteya.

1) Ibyerekana:abarwayi bo hagati n'abasaza (> imyaka 40); abadashobora kwihanganira kwaguka kwa ballon ya endoskopi (PD) cyangwa kuvura kubaga; abafite imiti myinshi ya PD cyangwa ibisubizo bibi byo kubaga; abafite perfora esofageal mugihe cyo kuvura PD Kubafite ibyago byinshi, irashobora kandi gukoreshwa ifatanije na PD; irashobora gukoreshwa nkinzibacyuho yo kubaga cyangwa kuvura PD.
(2) Kwivuguruza:Ntabwo byemewe kuvurwa kumurongo wambere wa AC kubarwayi bakiri bato (≤40 ans).

03Endoscopic Ballon Yagutse (PD)
Kwiyongera kwa Ballon bigira ingaruka zimwe kuri AC, ariko bisaba kuvurwa inshuro nyinshi kandi bitwara ibyago byingutu zikomeye.
(1) Ibyerekana:Abarwayi ba AC badafite umutima udahagije, imikorere mibi ya coagulation, nibindi.; abagabo barengeje imyaka 50 n'abagore barengeje imyaka 35; abarwayi bananiwe kubagwa. Irashobora gukoreshwa nkuburyo bwambere bwo kuvura.
(2) Kwivuguruza:Kubura umutima bikabije, kubura imikorere ya coagulation hamwe nimpanuka nyinshi zo gutobora esofage.

04Peroral Endoscopic Myotomy (POEM)
Mu myaka yashize, hamwe n’ishyirwa mu bikorwa ryinshi rya perot endoskopique myotomy (POEM), igipimo cyo gutsinda kwa AC cyo kuvura cyiyongereye cyane.POEM ivura AC irahuza cyane nigitekerezo cya "super minimally invasive surgery", ni ukuvuga gusa ibikomere bivanwaho / bivanwaho mugihe cyo kuvura, kandi ingingo ntizikurwaho.Ubunyangamugayo n'imikorere yimiterere ya anatomique birakomeza, kandi ubuzima bwumurwayi nyuma yubuzima bwa operasiyo ntabwo bugira ingaruka. Kugaragara kwa POEM byatumye kuvura AC super byibuze byibasirwa.