Cov pob zeb me me hauv ureteral tuaj yeem kho tau nrog kev ceev faj lossis siv tshuaj lithotripsy sab nraud lub cev, tab sis cov pob zeb loj, tshwj xeeb tshaj yog cov pob zeb thaiv kev, yuav tsum tau phais thaum ntxov.
Vim yog qhov chaw tshwj xeeb ntawm cov pob zeb hauv ureteral sab saud, lawv yuav tsis tuaj yeem nkag mus nrog lub ureteroscope khov kho, thiab cov pob zeb tuaj yeem yooj yim txav mus rau hauv lub raum thaum lub sijhawm lithotripsy. Percutaneous nephrolithotomy ua rau muaj kev pheej hmoo ntawm kev los ntshav hauv lub raum thaum tsim ib txoj kab.
Kev nce qib ntawm kev siv ureteroscopy uas yoog tau tau daws cov teeb meem saum toj no tau zoo. Nws nkag mus rau hauv ureter thiab lub raum pelvis los ntawm qhov orifice ib txwm ntawm lub cev tib neeg. Nws muaj kev nyab xeeb, ua haujlwm tau zoo, tsis tshua muaj kev cuam tshuam, muaj tsawg dua los ntshav, mob tsawg dua rau tus neeg mob, thiab tus nqi siab tsis muaj pob zeb. Tam sim no nws tau dhau los ua txoj kev phais mob uas siv ntau los kho cov pob zeb ureteral sab saud.
Qhov tshwm sim ntawmlub ureteral nkag mus rau hauv lub sheathtau txo qhov nyuaj ntawm kev siv tshuaj ureteroscopic lithotripsy uas yooj ywm heev. Txawm li cas los xij, nrog rau kev nce ntxiv ntawm cov neeg mob kho mob, nws cov teeb meem tau maj mam nyiam mloog. Cov teeb meem xws li ureteral perforation thiab ureteral stricture yog qhov tshwm sim. Cov hauv qab no yog peb yam tseem ceeb ua rau ureteral stricture thiab perforation.
1. Kev mob nkeeg, txoj kab uas hla ntawm pob zeb, qhov pob zeb raug mob
Cov neeg mob uas muaj mob ntev dua feem ntau muaj cov pob zeb loj dua, thiab cov pob zeb loj nyob hauv txoj hlab zis ntev heev ua rau muaj kev sib cais. Cov pob zeb ntawm qhov chaw raug mob yuav nias lub ureter mucosa, ua rau cov ntshav tsis txaus, cov hlab zis tsis ua haujlwm, o thiab ua rau muaj qhov caws pliav, uas muaj feem cuam tshuam nrog kev tsim cov ureteral stricture.
2. Kev raug mob ntawm cov hlab ntsha
Lub ureteroscope uas yooj ywm yooj yim khoov, thiab yuav tsum tau ntxig lub ureteral access sheath ua ntej lithotripsy. Kev ntxig lub channel sheath tsis ua tiav thaum pom ncaj qha, yog li nws tsis zam tsis tau tias cov ureteral mucosa yuav raug puas tsuaj lossis perforated vim yog qhov khoov ntawm lub ureter lossis lub lumen nqaim thaum lub sijhawm ntxig lub sheath.
Ntxiv rau, txhawm rau txhawb nqa lub ureter thiab ntws cov kua dej kom txo qhov siab ntawm lub raum pelvis, feem ntau xaiv ib lub channel sheath los ntawm F12 / 14, uas yuav ua rau lub channel sheath ncaj qha nias phab ntsa ureteral. Yog tias tus kws phais mob txoj kev siv tshuab tsis paub tab thiab lub sijhawm phais mob ntev, lub sijhawm nias ntawm lub channel sheath ntawm phab ntsa ureteral yuav nce ntxiv mus rau qee qhov, thiab qhov kev pheej hmoo ntawm kev puas tsuaj rau phab ntsa ureteral yuav ntau dua.
3. Kev puas tsuaj ntawm Holmium laser
Qhov kev tawg pob zeb ntawm holmium laser feem ntau vam khom nws cov nyhuv photothermal, uas ua rau lub pob zeb nqus tau lub zog laser ncaj qha thiab ua rau qhov kub hauv zos nce ntxiv kom ua tiav lub hom phiaj ntawm kev tawg pob zeb. Txawm hais tias qhov tob ntawm lub zog thermal thaum lub sijhawm zom pob zeb tsuas yog 0.5-1.0 hli xwb, qhov cuam tshuam sib tshooj los ntawm kev zom pob zeb tas mus li tsis muaj qhov kwv yees tau.
Cov ntsiab lus tseem ceeb rau kev ntxig cov ntawvlub ureteral nkag mus rau hauv lub sheathyog raws li nram no:
1. Thaum ntxig rau hauv lub qhov zis, nws yuav pom tseeb tias nws nkag mus rau hauv lub qhov zis, thiab nws yuav zoo li du thaum nws nkag mus rau hauv lub qhov zis. Yog tias qhov ntxig nyuaj, koj tuaj yeem tig lub hlau qhia rov qab los saib seb lub hlau qhia puas nkag mus thiab tawm zoo, yog li txiav txim siab seb lub plhaub channel puas mus rau hauv qhov kev taw qhia ntawm lub hlau qhia, xws li Yog tias muaj kev tiv thaiv pom tseeb, qhov kev taw qhia ntawm lub plhaub yuav tsum tau hloov kho;
Lub plhaub channel uas tau muab tso rau hauv qhov chaw zoo lawm yeej ruaj khov heev thiab yuav tsis nkag thiab tawm thaum twg xav tau. Yog tias lub plhaub channel tawm los pom tseeb, nws txhais tau tias nws tau dov rau hauv lub zais zis thiab cov hlau qhia tau tawm ntawm lub ureter thiab yuav tsum tau hloov dua tshiab;
3. Cov ntaub thaiv qhov zis ntawm cov zis muaj cov lus qhia sib txawv. Cov neeg mob txiv neej feem ntau siv cov qauv ntev 45 cm, thiab cov poj niam lossis cov txiv neej luv dua siv cov qauv ntev 35 cm. Yog tias cov ntaub thaiv qhov zis raug ntxig, nws tsuas yog hla dhau qhov qhib ntawm cov zis lossis tsis tuaj yeem nce mus rau qib siab dua. Txoj hauj lwm, cov neeg mob txiv neej kuj tuaj yeem siv cov ntaub thaiv qhov zis 35 cm, lossis hloov mus rau 14F lossis txawm tias cov ntaub thaiv qhov zis nyias dua kom tiv thaiv cov ureteroscope uas yoog tau los ntawm kev tsis tuaj yeem nce mus rau lub raum.
Tsis txhob muab lub plhaub channel tso rau hauv ib kauj ruam. Cia 10 cm sab nraum lub qhov urethral kom tiv thaiv kev puas tsuaj rau cov ureteral mucosa lossis lub raum parenchyma ntawm UPJ. Tom qab ntxig lub scope uas yoog tau, qhov chaw ntawm lub plhaub channel tuaj yeem hloov kho dua hauv qab kev pom ncaj qha.
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Lub sijhawm tshaj tawm: Cuaj hlis-11-2024