Ka taea te rongoā i ngā kōhatu ureter iti mā te whakamahi i te rongoā ārai mate, mā te whakamahi rānei i te extracorporeal shock wave lithotripsy, engari ko ngā kōhatu nui te whānui, inā koa ko ngā kōhatu ārai, me wawe te pokanga.
Nā te tūnga motuhake o ngā kōhatu ureter o runga, kāore pea e taea te uru atu mā te ureteroscope pakari, ā, ka taea e ngā kōhatu te neke ake ki roto i te pelvis whatukuhu i te wā e lithotripsy ana. Ka whakanui ake te nephrolithotomy percutaneous i te mōrearea o te toto whatukuhu i te wā e whakatūria ana he awa.
Nā te pikinga ake o te whakamahi i te ureteroscopy ngāwari kua ea pai ngā raruraru o runga ake nei. Ka uru ki roto i te ureter me te pelvis whatukuhu mā te kōhao noa o te tinana tangata. He haumaru, he whai hua, he iti noa te whakaekenga, he iti ake te toto, he iti ake te mamae mō te tūroro, ā, he nui te auau kore kohatu. Kua waiho hei tikanga pokanga e whakamahia whānuitia ana hei rongoā i ngā kohatu ureter o runga.
Te putanga mai o tete hipoki urunga ureterkua tino whakaitihia te uauatanga o te ureteroscopic lithotripsy ngāwari. Heoi, i te pikinga ake o te maha o ngā maimoatanga, kua āta arohia ngā raruraru. He mea noa ngā raruraru pēnei i te poka o te ureter me te ureter stricture. Ko ngā mea e whai ake nei ko ngā take matua e toru e arahi ana ki te ureter stricture me te pokapoka.
1. Te ahunga o te mate, te whānui o te kōhatu, te pānga o te kōhatu
Ko ngā tūroro he roa ake te mate, he nui ake ngā kōhatu, ā, ka roa te noho o ngā kōhatu nunui ki roto i te ureter, ka noho hei whare herehere. Ka pēhia e ngā kōhatu i te wāhi i pā ai te kiriuhi o te ureter, ka hua ake he koretake te rere o te toto ā-rohe, te ischemia o te kiriuhi, te mumura me te hanganga o ngā koha, e pā tata ana ki te hanganga o te ureter stricture.
2. Te whara o te ureter
He ngāwari te piko o te ureteroscope ngāwari, ā, me whakauru he uhi urunga ureter i mua i te lithotripsy. Kāore te whakaurunga o te uhi awaawa e mahia i raro i te tirohanga tika, nō reira kāore e kore ka pakaru, ka pokaia rānei te kiriuhi ureter nā te piko o te ureter, te whaiti rānei o te pūwero i te wā e whakauruhia ana te uhi.
Hei tāpiritanga, hei tautoko i te ureter me te tango i te wai toto hei whakaiti i te pēhanga ki runga i te pelvis whatukuhu, ka tīpakohia he uhi hongere mā roto i te F12/14, ka taea ai e te uhi hongere te pēhi tika i te pakitara ureter. Mena kāore i te tino matatau te tikanga a te taote pokanga, ā, ka roa te wā pokanga, ka piki ake te wā pēhi o te uhi hongere ki runga i te pakitara ureter ki tētahi taumata, ā, ka nui ake te mōrearea o te kino ischemic ki te pakitara ureter.
3. Te kino o te taiaho holmium
Ko te pakaru o te kōhatu i te taiaho holmium e whakawhirinaki ana ki tōna pānga photothermal, e meinga ai te kōhatu kia mimiti tika i te kaha taiaho, kia piki ake ai te pāmahana o te rohe kia tutuki ai te kaupapa o te pakaru o te kōhatu. Ahakoa he 0.5-1.0 mm noa iho te hohonutanga o te hihi wera i te wā o te kuru kirikiri, he mea nui te pānga taupatupatu i puta mai i te kuru kirikiri tonu.
Ngā mea matua mō te whakauru i tete hipoki urunga ureterkoia ēnei:
1. He mārama te ahua o te pakaru ina whakaurua ki roto i te ureter, ā, he maeneene te ahua ina piki ake ki roto i te ureter. Mena he uaua te whakauru, ka taea e koe te huri i te waea arataki ki mua, ki muri hoki kia tirohia ai mena he maeneene te haere o te waea arataki ki roto, ki waho hoki, kia mōhio ai mena kei te neke haere te uhi hongere ki te ahunga o te waea arataki, pēnei i te Mena he mārama te ātete, me whakarerekē te ahunga o te uhi;
Kua mau tonu te hipoki hongere i te whakatakotoranga angitu, ā, kāore e puta mai, e puta mai rānei i te hiahia. Mēnā ka puta mārama mai te hipoki hongere, ko te tikanga kua takai ki roto i te pūkahukahu, ā, kua heke te waea ārahi mai i te ureter, me whakakapi anō;
3. He rerekē ngā whakaritenga o ngā uhi awaawa ureter. Ko te tikanga, ka whakamahia e ngā tūroro tāne te tauira 45 cm te roa, ā, ko ngā tūroro wahine, ngā tāne poto ake rānei ka whakamahia te tauira 35 cm te roa. Mena ka whakauruhia te uhi awaawa, ka taea anake te haere mā te whakatuwheratanga ureter, kāore rānei e taea te piki ki tētahi taumata teitei ake. I tōna tūranga, ka taea hoki e ngā tūroro tāne te whakamahi i tētahi uhi whakauru 35 cm, te huri rānei ki tētahi uhi whakawhānui fascial 14F, ki tētahi uhi whakawhānui fascial angiangi ake rānei hei ārai i te kore e taea e te ureteroscope ngāwari te piki ki te pelvis whatukuhu;
Kaua e whakatakotoria te uhi awa i te taahiraa kotahi. Waiho kia 10 cm te tawhiti i waho o te kōhao o te urethra hei ārai i te kino o te mucosa ureteral, te parenchyma whatukuhu rānei i te UPJ. Whai muri i te whakaurunga o te karuārai ngāwari, ka taea te whakarite anō i te tūranga o te uhi awa i raro i te tirohanga tika.
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Wā tuku: Hepetema-11-2024