Achalasia
Pfupiso
Achalasia chirwere chekurova chinokanganisa chubhu inobatanidza muromo nemudumbu, inonzi esophagus. Matsimba akakuvara anoita kuti zviomere tsandanyama dzeesophagus kumanikidza chikafu nechinwiwa mudumbu. Chikafu chinobva chaunganidzwa mu esophagus, dzimwe nguva chichivirisika uye chichiuya kumusoro mumuromo. Ichi chikafu chakawirisika chinogona kunaka kwazvo. Achalasia chirwere chisingawanzoitika. Vamwe vanhu vanochiita sechirwere chegastroesophageal reflux (GERD). Zvisinei, mu achalasia, chikafu chinobva mu esophagus. Mu GERD, zvinhu zvinobva mudumbu. Hapana mushonga we achalasia. Kana esophagus yakakuvara, tsandanyama hadzikwanisi kushanda zvakare. Asi zviratidzo zvinowanzochengetwa ne endoscopy, kurapwa kusina kukanganisa kana kuvhiya.
Zviratidzo
Zviratidzo zveAchalasia kazhinji zvinoonekwa zvishoma nezvishoma uye zvinoita kuti zviwedzere nekufamba kwenguva. Zviratidzo zvinogona kusanganisira:
- Kusava nehanya pakuruma, kunonzi dysphagia, izvo zvinogona kunzwa sekunge chikafu kana chinwiwa chakamira muhuro.
- Chikafu chakamirwa kana mate achibuda muhuro.
- Heartburn.
- Belching.
- Kurwadziwa kwepfupa kunouya nekufamba.
- Kukosora usiku.
- Pneumonia kubva pakupinda kwechikafu mumapapu.
- Kurasikirwa nehuremu.
- Kuita manyoka.
Zvinokonzera
Chikonzero chaicho cheachalasia hachizivikanwi zvakanaka. Vatsvakurudzi vanofungidzira kuti chingave chiri kubva pakushomeka kwemasero ane nerve mu esophagus. Kune dzidziso pamusoro pezvinokonzera izvi, asi hutachiona hwehutachiona kana mhinduro dze autoimmune ndezvimwe zvingangoitika. Zvisingawanzoitiki, achalasia inogona kukonzerwa nechirwere chinogara chiri mumagene kana hutachiona.
Zvinhu zvinokonzera njodzi
Zvinokonzera achalasia zvinosanganisira:
- Age. Kunyange zvazvo achalasia inogona kukanganisa vanhu vemazera ese, inowanzowanikwa muvanhu vane makore ari pakati pemakore 25 ne60.
- Zvimwe zvirwere. Njodzi ye achalasia yakakwira muvanhu vane zvirwere zvemanyoka, kushomeka kwe adrenal kana Allgrove syndrome, chirwere chinonakidza chinonakidza chinonakidza.
Kuongorora
Achalasia inogona kuregererwa kana kukanganiswa nekuti ine zviratidzo zvakafanana nezvemamwe matambudziko ekugaya. Kuongorora achalasia, nyanzvi yehutano inogona kukurudzira: Manometry yeEsophagus. Uyu bvunzo inoyeresa kuita kwemisungo yemhasuru mu esophagus panguva yekumeza. Inoyeresawo kuti lower esophageal sphincter inovhurwa zvakanaka sei panguva yekumeza. Uyu bvunzo ndiwo unobatsira zvikuru pakusarudza rudzi rwemamiriro ekumeza aunogona kuva nawo. X-rays yesystem yekugaya yepamusoro. X-rays inotorwa mushure mekunwa mvura ine chalk inonzi barium. Barium inopfeka mukati memukati we digestive tract uye inozadza nhengo dzekugaya. Iyi kupfeka inobvumira nyanzvi yehutano kuona chimiro che esophagus, dumbu neura hwakakwirira. Kuwedzera pakunwa mvura, kumeza piritsi re barium kunogona kubatsira kuratidza chinhambwe mu esophagus. Upper endoscopy. Upper endoscopy inoshandisa kamera duku pamugumo we tube refu kuti iongorore ziso system yekugaya yepamusoro. Endoscopy inogona kushandiswa kuwana chinhambwe chiduku che esophagus. Endoscopy inogona kushandiswawo kuunganidza sampuli yetsinga, inonzi biopsy, kuti iongororwe nezvinetso zve reflux senge Barrett esophagus. Functional luminal imaging probe (FLIP) technology. FLIP ndiyo nzira itsva inogona kubatsira kusimbisa chirwere che achalasia kana bvunzo dzakawanda dzisina kukwana. Kutarisirwa paMayo Clinic Timu yedu inokutarisira ye Mayo Clinic nyanzvi inogona kukubatsira nezvinetso zvako zvehutano zvine chekuita ne achalasia Tanga pano
Kurapa
Kurapa achalasia kunonyanya kukoshesa kuzorodza kana kuwedzera kuvhura esophageal sphincter yepasi kuitira kuti chikafu nechinwiwa zvikwanise kufamba nyore nyore kuburikidza neura hwemudumbu. Kurapa kunoitwa kunoenderana nezera rako, mamiriro ezveutano uye huipi hwe achalasia. Sarudzo dzisingaiti opresheni dzinosanganisira:
- Kuwedzera kwepneumatic. Panguva ino yekurapa isingadi kupindira kwakakura, bharuni inoiswa pakati pe esophageal sphincter uye inofukurwa kuwedzera kuvhura. Kuwedzera kwepneumatic kunogona kudikanwa kudzokororwa kana esophageal sphincter isingavhuriki. Anenge wechitatu vevanhu vanorapwa nekuwedzera kwe bharuni vanoda kurapwa kudzokororwa mukati memakore mashanu. Iyi nzira inoda kuzorodzwa.
- OnabotulinumtoxinA (Botox). Iyi mushonga unoramba kuoma kwemhasuru inogona kuiswa zvakananga mu esophageal sphincter ne tsono panguva ye endoscopy. Kuisa mishonga kunogona kudikanwa kudzokororwa, uye kuisa mishonga kudzokororwa kunogona kuita kuti zviome kuita opresheni gare gare kana zvichidikanwa.
Botox kazhinji inokurudzirwa chete kune vanhu vasina kuwedzera pneumatic kana opresheni nekuda kwezera kana hutano hwese. Kuisa Botox kazhinji hakusi kwenguva refu kupfuura mwedzi mitanhatu. Kuvandudzika kwakasimba kubva pakuiswa kweBotox kunogona kubatsira kusimbisa chirwere che achalasia.
- Mishonga. Chiremba wako angakurudzira mushonga unoramba kuoma kwemhasuru senge nitroglycerin (Nitrostat) kana nifedipine (Procardia) usati wadya. Aya mishonga ine mhedzisiro shoma yekurapa uye mhedzisiro yakaipa yakakura. Mishonga kazhinji inofungwa chete kana iwe usiri munhu anokodzera kuwedzera pneumatic kana opresheni uye Botox haina kubatsira. Rudzi urwu rwekurapa rwunonyanya kushayikwa.
OnabotulinumtoxinA (Botox). Iyi mushonga unoramba kuoma kwemhasuru inogona kuiswa zvakananga mu esophageal sphincter ne tsono panguva ye endoscopy. Kuisa mishonga kunogona kudikanwa kudzokororwa, uye kuisa mishonga kudzokororwa kunogona kuita kuti zviome kuita opresheni gare gare kana zvichidikanwa.
Botox kazhinji inokurudzirwa chete kune vanhu vasina kuwedzera pneumatic kana opresheni nekuda kwezera kana hutano hwese. Kuisa Botox kazhinji hakusi kwenguva refu kupfuura mwedzi mitanhatu. Kuvandudzika kwakasimba kubva pakuiswa kweBotox kunogona kubatsira kusimbisa chirwere che achalasia.
Sarudzo dzekuvhiya dzekurapa achalasia dzinosanganisira:
- Heller myotomy. Heller myotomy inosanganisira kukamura mhasuru kumucheto wepasi pe esophageal sphincter. Izvi zvinoita kuti chikafu chifambire nyore nyore mudumbu. Nzira iyi inogona kuitwa uchishandisa nzira isingapindiri yakakura inonzi laparoscopic Heller myotomy. Vamwe vanhu vane Heller myotomy vanogona gare gare kuwana chirwere che gastroesophageal reflux (GERD).
Kuti udzivise matambudziko ekumberi ne GERD, chiremba angaita nzira inozivikanwa se fundoplication panguva imwe chete ne Heller myotomy. Mu fundoplication, chiremba anofukidza pamusoro pemudumbu kumativi e esophageal yepasi kuitira kuti ave ne valve inodzivirira kudzoka kweacid, kudzivirira asidhi kubva kudzoka mu esophagus. Fundoplication kazhinji inoitirwa ne nzira isingapindiri yakakura, inonziwo laparoscopic procedure.
- Peroral endoscopic myotomy (POEM). Mu nzira ye POEM, chiremba anoshandisa endoscope inoiswa kuburikidza nemuromo uye pasi pehuro kuita incision mukati me esophagus. Zvadaro, sezvakaita mu Heller myotomy, chiremba anokamura mhasuru kumucheto wepasi pe esophageal sphincter.
POEM inogona zvakare kusanganiswa kana kuteverwa gare gare ne fundoplication kubatsira kudzivirira GERD. Vamwe varwere vane POEM uye vanowana GERD mushure mekurapwa vanorapwa nemishonga yemazuva ese inotorwa nemuromo.
Heller myotomy. Heller myotomy inosanganisira kukamura mhasuru kumucheto wepasi pe esophageal sphincter. Izvi zvinoita kuti chikafu chifambire nyore nyore mudumbu. Nzira iyi inogona kuitwa uchishandisa nzira isingapindiri yakakura inonzi laparoscopic Heller myotomy. Vamwe vanhu vane Heller myotomy vanogona gare gare kuwana chirwere che gastroesophageal reflux (GERD).
Kuti udzivise matambudziko ekumberi ne GERD, chiremba angaita nzira inozivikanwa se fundoplication panguva imwe chete ne Heller myotomy. Mu fundoplication, chiremba anofukidza pamusoro pemudumbu kumativi e esophageal yepasi kuitira kuti ave ne valve inodzivirira kudzoka kweacid, kudzivirira asidhi kubva kudzoka mu esophagus. Fundoplication kazhinji inoitirwa ne nzira isingapindiri yakakura, inonziwo laparoscopic procedure.
Peroral endoscopic myotomy (POEM). Mu nzira ye POEM, chiremba anoshandisa endoscope inoiswa kuburikidza nemuromo uye pasi pehuro kuita incision mukati me esophagus. Zvadaro, sezvakaita mu Heller myotomy, chiremba anokamura mhasuru kumucheto wepasi pe esophageal sphincter.
POEM inogona zvakare kusanganiswa kana kuteverwa gare gare ne fundoplication kubatsira kudzivirira GERD. Vamwe varwere vane POEM uye vanowana GERD mushure mekurapwa vanorapwa nemishonga yemazuva ese inotorwa nemuromo.
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