Intangiriro
Ibimenyetso nyamukuru bya hemorroide ni amaraso muntebe, kubabara anal, kugwa no kwishongora, nibindi, bigira ingaruka zikomeye mubuzima.Mu bihe bikomeye, irashobora gutera indwara ya hemorroide ifunzwe hamwe na anemia idakira iterwa n'amaraso mu ntebe.Kugeza ubu, ubuvuzi bwa conservateur bushingiye ahanini ku biyobyabwenge, kandi hakenewe ubuvuzi bwo kubaga mu bihe bikomeye.
Ubuvuzi bwa Endoscopique nuburyo bushya bwo kuvura mumyaka yashize, bukwiranye nibitaro byatsi.Uyu munsi, tuzavuga muri make kandi tuyitondere.
1. Kwipimisha kwa Clinical, anatomy no kuvura mbere ya hemorroide
Gupima indwara ya Hemorroide
Gupima indwara ya hemorroide ishingiye cyane cyane ku mateka, kugenzura, gusuzuma ibizamini bya digitale na colonoskopi.Ku bijyanye n'amateka y'ubuvuzi, birakenewe gusobanukirwa ububabare bwa anal, amaraso mu ntebe, gusohoka kwa hemorroide no gusubirana, n'ibindi. Ubugenzuzi bwumva cyane cyane isura ya hemorroide, niba hari fistula ya anal yo gutwika perianal, nibindi, hamwe na rectal digitale. ikizamini gikeneye kumva ubukana bwa anus kandi niba hari induration.Colonoscopy igomba kumenya izindi ndwara nk'ibibyimba, colitis ulcerative, nibindi bitera kuva amaraso.Gutondekanya no gutondekanya amaraso
Hariho ubwoko butatu bwa hemorroide: hemorroide y'imbere, hemorroide yo hanze, hamwe na hemorroide ivanze.
Indwara ya Hemorroide: Imbere, Hanze, na Imvange
Hemorroide irashobora gushyirwa mubyiciro I, II, III, na IV.Itondekanya hakurikijwe ubukana, gusohoka kwa hemorroide no kugaruka.
Ibimenyetso byo kuvura endoskopique ni icyiciro cya I, II, na III imbere ya hemorroide, naho icyiciro cya IV imbere ya hemorroide y'imbere, hemorroide yo hanze, hamwe na hemorroide ivanze ni ibintu bibuza kuvura endoskopi.Umurongo ugabanya ubuvuzi bwa endoskopi ni umurongo wa dentate.
Anatomy ya Hemorroide
Umurongo wa Anal, umurongo wa dentate, anal padi, na hemorroide ni imyumvire endoscopiste igomba kuba imenyereye.Kumenyekanisha Endoskopi bisaba uburambe.Umurongo wa dentate ni ihuriro rya anal squamous epithelium na epitelium yinkingi, hamwe na zone yinzibacyuho hagati yumurongo wa anal n'umurongo wa dentate itwikiriwe na epitelium yinkingi ariko ntizinjizwe numubiri.Kubwibyo, kuvura endoskopique bishingiye kumurongo wa dentate.Kuvura endoskopique birashobora gukorwa mumurongo w amenyo, kandi kuvura endoskopique ntibishobora gukorerwa hanze yumurongo w amenyo.
Igishushanyo 1.Imbere yimbere yumurongo wa dentate munsi ya endoscope.Umwambi w'umuhondo werekana umurongo wa dentate ya seriveri, umwambi wera werekana inkingi ya anal hamwe numuyoboro wacyo wa longitudinal, naho umwambi utukura werekeza kuri valve ya anal
1A:ishusho yera;1B:Umuyoboro mugari
Igishushanyo 2Kwitegereza flap ya anal (umwambi utukura) nu mpera yo hepfo yinkingi ya anal (umwambi wera) hafi ya microscope
Igishushanyo 3Kwitegereza papilla anal kuri microscope (umwambi w'umuhondo)
Igicapo 4.Umurongo wa anal n'umurongo wa dentate byagaragaye na revers endoscopi.Umwambi wumuhondo werekeza kumurongo wa dentate, naho umwambi wumukara werekeza kumurongo wa anal.
Ibisobanuro bya anal papilla hamwe ninkingi ya anal bikoreshwa cyane mububiko bwa anorectal kandi ntibizasubirwamo hano.
Ubuvuzi bwa kera bwo kuvura indwara ya hemorroide:hariho cyane cyane kuvura no kuvura no kubaga.Ubuvuzi bwa conservateur burimo gukoresha ibiyobyabwenge bya perianal hamwe na sitz yo kwiyuhagira, kandi uburyo bwo kubaga burimo cyane cyane indwara ya hemorroidectomie hamwe na stapled excision (PPH).Kuberako ubuvuzi bwo kubaga aribwo busanzwe, ingaruka zirahagaze neza, kandi ibyago ni bito, umurwayi agomba kuba mubitaro iminsi 3-5.
2. Kuvura endoskopi yo kuvura indwara ya hemorroide y'imbere
Itandukaniro riri hagati yo kuvura endoskopi yo kuvura indwara ya hemorroide imbere no kuvura EGV:
Intego yo kuvura endoskopique ivura esophagogastric varices ni imiyoboro y'amaraso ya varicose, kandi intego yo kuvura indwara ya hemorroide y'imbere ntabwo ari imiyoboro y'amaraso yoroshye, ahubwo ni hemorroide igizwe n'imiyoboro y'amaraso hamwe nuduce duhuza.Kuvura indwara ya hemorroide ni ukugabanya ibimenyetso, kuzamura pisine igabanuka, no kwirinda ingorane nka anal stenosis iterwa no kubura kwa hemorroide (ihame ryo "kwica byose hanze" rikunda kwibasirwa na stenosis).
Intego yo kuvura endoskopi: Kugabanya cyangwa gukuraho ibimenyetso, ntabwo ari ugukuraho hemorroide.
Kuvura endoskopi birimosclerotherapynabande.
Mu gusuzuma no kuvura indwara ya hemorroide y'imbere, colonoskopi ikoreshwa mu gusuzuma, kandi gastroscope irasabwa kuvurwa.Byongeye kandi, ukurikije uko ibintu bimeze kuri buri bitaro, urashobora guhitamo kwivuza cyangwa kuvura indwara.
①Scoterapi (ifashwa na capa ibonerana)
Sclerose agent ni inshinge ya lauryl, kandi inshinge ya lauryl ya alcool nayo irashobora gukoreshwa.Birakenewe kandi gukoresha inshinge ya subucosal ya methylene yubururu nkumukozi wabuze kugirango wumve icyerekezo cyogukwirakwiza hamwe na agent ya sclerose.
Intego ya capa ibonerana nukwagura umurima wicyerekezo.Urushinge rwo gutera inshinge rushobora gutoranywa mu nshinge zisanzwe zo gutera inshinge.Mubisanzwe, uburebure bwurushinge ni 6mm.Abaganga badafite uburambe cyane bagomba kugerageza kwirinda gukoresha inshinge ndende, kubera ko inshinge ndende zikunda guterwa no gutera inshinge.Ibyago byinshi kandi biganisha ku bisebe bya perianal no gutwika.
Ingingo yo gutera inshinge yatoranijwe hejuru yumunwa wumurongo wa dentate, kandi inshinge zinshinge ziherereye munsi yumutwe wa hemorroide.Urushinge rwinjijwe kuri 30 ° ~ 40 ° munsi yerekwa neza (imbere cyangwa inyuma) ya endoscope, kandi urushinge rwinjizwa cyane mumutwe wa hemorroide.Kora ikirundo gikomye munsi ya hemorroide, gukuramo urushinge mugihe utera, hafi 0.5 ~ 2mL, hanyuma uhagarike inshinge kugeza igihe hemorroide izaba nini kandi yera.Nyuma yo gutera inshinge zirangiye, reba niba hari amaraso aho batewe.
Endoscopic sclerotherapy ikubiyemo inshinge zindorerwamo imbere hamwe no guterwa indorerwamo.Mubisanzwe, inshinge zindorerwamo ninzira nyamukuru.
Treatment kuvura bande
Mubisanzwe, ibikoresho byinshi bifata amajwi bikoreshwa, bitarenze impeta ndwi cyane.Ihuriro rikorwa kuri cm 1 kugeza kuri 3 hejuru yumurongo wa dentate, kandi mubisanzwe bitangirwa hafi yumurongo wa anal.Irashobora kuba imitsi y'amaraso cyangwa mucosal ligation cyangwa guhuza hamwe.Indorerwamo ihindagurika nuburyo bukuru, mubisanzwe inshuro 1-2, hamwe nintera yukwezi 1.
Kuvura igihe cyose: kwiyiriza ubusa ntibisabwa nyuma yo kubagwa, gukomeza intebe nziza, kandi wirinde kwicara igihe kinini nakazi gakomeye.Gukoresha buri gihe antibiyotike ntabwo bisabwa.
3. Ibihe byubu nibibazo bihari byibitaro byibanze
Kera, umwanya wingenzi wo kuvura indwara ya hemorroide yari mu ishami rya anorectal.Ubuvuzi bwa sisitemu mu ishami rya anorectal burimo imiti igabanya ubukana, inshinge za sclerotherapie, hamwe no kubaga.
Indwara ya Gastrointestinal ntabwo iba inararibonye cyane mu kumenya anatomiya ya perianal munsi ya endoskopi, kandi ibimenyetso byo kuvura endoskopique ni bike (hashobora kuvurwa gusa indwara ya hemorroide y'imbere).Kubaga nabyo birasabwa kugirango ukire byuzuye, byabaye ingingo igoye mugutezimbere umushinga.
Mubyigisho, kuvura endoskopi yo kuvura indwara ya hemorroide y'imbere irakwiriye cyane cyane kubitaro byibanze, ariko mubikorwa, ntabwo ari nkuko byatekerejwe.
Twebwe, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., Ni uruganda mu Bushinwa ruzobereye mu gukoresha endoskopi, nkabiopsy imbaraga, hemoclip, umutego, inshinge, spray catheter, cytology, kuyobora, igitebo cyo kugarura amabuye, izuru rya biliary drainage catheternibindi bikoreshwa cyane muriEMR, ESD, ERCP.Ibicuruzwa byacu byemewe na CE, kandi ibihingwa byacu byemewe na ISO.Ibicuruzwa byacu byoherejwe mu Burayi, Amerika y'Amajyaruguru, Uburasirazuba bwo hagati ndetse no muri Aziya, kandi bigera ku bakiriya bamenyekana kandi bashimwe!
Igihe cyo kohereza: Nyakanga-11-2022