Kupu Whakataki
Ko te Achalasia o te ngakau (AC) he matete mate tuatahi o te nekehanga o te esophagus.Nā te ngoikore o te whakangā o te sphincter esophageal o raro (LES) me te korenga o te peristalsis esophageal, ka hua ake te pupuri kaite kore e taea te horomi me te tauhohenga. Ngā tohu haumanu pēnei i te toto, te mamae o te uma me te whakaheke taumaha.Ko te auau tata ki te 32.58/100,000.
TemaimoatangaKo ngā wāhanga matua o te achalasia ko te maimoatanga kore-pokanga, te whakaora whakawhānui me te maimoatanga pokanga.
01Maimoatanga Hauora
Ko te tikanga o te rongoā he whakaiti i te pehanga LES i te wā poto.Kāore he taunakitanga mārama e whakaatu ana ka taea e ngā rongoā te whakapai tonu, me te whai hua hoki i ngā tohu o te mate AC.Ko ngā rongoā e whakamahia whānuitia ana i tēnei wā ko ngā nitrates, ngā aukati hongere konupūmā, me ngā β-receptor agonists.
(1)Ngā Nitrate, pērā i te nitroglycerin, te amyl nitrate, me te isosorbide dinitrate
(2)Ngā aukati hongere konupūmāngā rongoā pēnei i te nifedipine, verapamil, me te diltiazem
(3)ngā kaiwhakaoho β-receptor, pērā i te cabuterol
02 Werohanga Paitini Botulinum Endoscopic (BTI)
Ka taea te whakamahi i te werohanga paitini botulinum endoscopic (BTl) hei rongoā i te AC,engari he poto noa ngā pānga ka puta, ā, ka taea te whakamahi ki ngā tūroro kaumātua he nui ngā mōrearea o te pokanga me te rongoā whakamoe.
1) Ngā tohu:ngā tūroro pakeke me ngā kaumātua (>40 tau te pakeke); te hunga kāore e taea te aro ki te whakawhanuitanga poihau endoscopic (PD) me te maimoatanga pokanga rānei; te hunga he maha ngā maimoatanga PD, he kino rānei ngā hua o te maimoatanga pokanga; te hunga he pokanga te esophageal i te wā e maimoatanga ana i te PD Mō te hunga he nui te mōrearea, ka taea hoki te whakamahi tahi me te PD; ka taea te whakamahi hei whakawhiti ki te pokanga, ki te maimoatanga PD rānei.
(2) Ngā Ārai:Kāore i te tūtohutia mō te maimoatanga tuatahi o te AC i ngā tūroro taitamariki (≤40 tau te pakeke).
03 Te Whakawhanuitanga o te Poihau Endoskopiko (PD)
He pānga ētahi o te whakawhānui o te poihau ki te AC, engari me maha ngā maimoatanga, ā, he mōrearea hoki kei roto ko ngā raruraru nui.
(1) Ngā Tohu:Ngā tūroro AC kāore he ngoikore o te manawa, he ngoikore te toto toto, me ētahi atu; ngā tāne neke atu i te 50 tau te pakeke me ngā wāhine neke atu i te 35 tau te pakeke; ngā tūroro kāore i angitu te pokanga. Ka taea te whakamahi hei tikanga maimoatanga tuatahi.
(2) Ngā Ārai:Te ngoikore nui o te ngākau me te manawa, te ngoikore o te toto toto, me te mōrearea nui o te poka o te korokoro.
04 Te Myotomy Endoscopic Peros-waha (POEM)
I ngā tau tata nei, nā te whakatinanatanga whānui o te peroral endoscopic myotomy (POEM), kua tino piki ake te angitu o te maimoatanga haumanu o te AC.He tino rite te maimoatanga POEM mō te AC ki te ariā o te "pokanga tino iti te whakaekenga", arā, ko ngā whara anake ka tangohia/tangohia i te wā o te tukanga maimoatanga, ā, kāore ngā whekau e tangohia.Ka mau tonu te āhua me te mahi a te hanganga tinana, ā, kāore te kounga o te oranga o te tūroro i muri i te pokanga i pāngia. Nā te putanga mai o te POEM kua iti rawa te whakaekenga o te maimoatanga o te AC.
Pikitia: Ngā taahiraa pokanga POEM
Ko te whai huatanga o te POEM i te wā waenga me te wā roa i roto i te maimoatanga o te AC he rite ki te whai huatanga o te laparoscopic Heller myotomy (LHM)ka taea te whakamahi hei whiringa maimoatanga raina tuatahi.Tērā pea ka pāngia ētahi tūroro e ngā tohumate reflux gastroesophageal i muri i te pokanga POEM.
(1) Ngā tohu tino tika:AC kāore he piri kino ki raro i te mucosa, he mate whakawātea mahi puku, me te diverticulum nui.
(2) Ngā tohu whanaunga:Te pupuhi o te esophagus horapa, te nati-cracker esophagus me ētahi atu mate nekehanga esophageal, ngā tūroro kāore i angitu te pokanga POEM, Heller rānei, me te AC me ētahi piri o te mucosal esophageal.
(3) Ngā Ārai:Ngā tūroro e pāngia ana e te ngoikore nui o te toto toto, te mate manawa nui, te āhua kino o te tinana, me ētahi atu, kāore e taea te aro ki te pokanga.
05Te Myotomy Heller Laparoscopic (LHM)
He pai te whai huatanga roa o te LHM ki te rongoā i te AC, ā, kua whakakapia kētia e te POEM i ngā wāhi e taea ai e ngā āhuatanga te puta.
06 Te Pokanga o te Esophagus
Mena ka honoa te AC me te stenosis o te koha o te korokoro o raro, ngā pukupuku, me ētahi atu, ka whakaarohia pea te pokanga esophagectomy.
Ko mātou, ko Jiangxi Zhuoruihua Medical Instrument Co.,Ltd., he kaihanga i Haina e tohunga ana ki ngā taonga endoscopic, pērā i tengā kukupa koiora, hemoclip, mahanga poripi, ngira whakaora kiriuhi, pūwero rehu, paraihe cytology, waea ārahi, kete tiki kohatu, te katitere whakaheke wai ihume ētahi atu e whakamahia whānuitia ana i roto iEMR, ESD,ERCPKua whai tiwhikete CE ā mātou hua, ā, kua whai tiwhikete ISO ā mātou whare hanga. Kua kaweakehia ā mātou taonga ki Ūropi, Amerika Te Raki, Te Rawhiti o Waenganui me tētahi wāhanga o Āhia, ā, kua whānuitia te mihi me te whakamoemiti a te kiritaki!
Wā tuku: Hōngongoi-09-2024