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 i tēnā.
(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 ingā 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