Hauv xyoo 1964, Asmeskas kws tshaj lij hluav taws xob CharlesBostone tau ua thawj qhov kev sim ntawm lub zais pa catheterization. Niaj hnub no, cov txheej txheem no yog siv nyob rau hauv ntau ceg ntawm cov tshuaj. Nws tso cai rau koj kom tsis txhob muaj kev pheej hmoo ua haujlwm nyuaj thiab txwv rau kev mus pw hauv tsev kho mob ib hnub ntawm tus neeg mob.
Balloon dilatation yog ib txoj hauv kev tshwj xeeb ntawm kev kho mob uas stenosis lossis anastomosis hauv lub cev hollow raug tshem tawm los ntawm kev ncab thaj chaw stenotic nrog lub zais pa tshwj xeeb uas ua rau hauv qhov txhaws. Cov txheej txheem yog endoscopic thiab yog siv los ntawm cov kws phais rau pathologies ntawm lub plab hnyuv ib ntsuj av, trachea thiab bronchi, kab mob ntawm lub plawv hlab ntsha, aortic valve, coronary artery kab mob, hnov kab mob, thiab lwm yam.
Daim ntawv thov ntawm txoj kev rau IHD
Kev siv txoj kev kho mob hauv plawv yog ua nrog kev nqaim ntawm cov hlab ntsha. Lub zais pa yog nyob rau ntawm qhov kawg ntawm lub catheter ntxig rau hauv lub nkoj. Tag nrho cov txheej txheem rau kev txav lub zais pa los ntawm lub nkoj yog tswjntawm X-ray screen.
Txhawm rau kom tsis txhob pom cov ntshav txhaws hauv cov hlab ntsha dilated, cov tshuaj tiv thaiv kab mob tau sau tseg. Txoj kev vam meej yog lav nyob rau hauv 80% ntawm rooj plaub.
Thaum twg nws ua tiav?
Nws tuaj yeem kho qhov nqaim ntawm cov hlab ntsha ntawm txoj kev no. Piv txwv li, nrog kev sib cuam tshuam claudication, kab mob plawv, aortic valve stenosis, thiab lwm yam.
YContraindications
Nyob rau hauv lub xub ntiag ntawm ntau qhov chaw ntawm nqaim nyob rau hauv cov neeg mob siab heev los yog nrog ib tug ntev ntawm lub stenotic cheeb tsam, dilatation tsis muab ib tug nyhuv. Tib yam siv rau thaj chaw calcified ntawm phab ntsa vascular. Tom qab ntawd ib qho kev ua haujlwm yog ua kom tshem tawm qhov cuam tshuam ntawm cov hlab ntsha thiab hloov lawv nrog ib qho prosthesis (polytetrafluoroethylene raj).
Puas dilatation ntawm cov hlab plawv puas txaus ntshai?
Lub catheter yog muab tso rau hauv cov hlab ntsha femoral. Nqa tawm balloon dilatation yog nqa tawm nrog rau ib txhij npaj rau qhib kev phais ntawm cov hlab ntsha cuam tshuam. Qhov no yog qhov tsim nyog vim tias ib txwm muaj kev pheej hmoo tias thaum lub sijhawm nthuav dav ntawm cov hlab ntsha, cov ntshav ncig ntawm lub plawv yuav tsis zoo, uas yog fraught nrog kev loj hlob ntawm lub plawv nres.
Hom kev cuam tshuam no tsis tshua muaj tab sis yuav tsum muaj kev tiv thaiv. Niaj hnub no, balloon dilatation yog ib txoj hauv kev zoo los kho cov kab mob coronary artery. Yog tias muaj ntshav los ntawm cov hlab ntsha, nws yooj yim tshem tawm.
Nyob hauv plawv li qub
Xa mus rau qhov nqaim ntawm aortic valve. Yav dhau los, nrog rau cov kab mob no, yuav tsum muaj lub plawv ua haujlwm nyuaj, tab sis hnub no lub zais pa tau muab tso rau hauv lub valve lumen thiab nyob rau hauv lub siab nws inflates, nthuav qhov nqaim ntawm lub valve. Nrog nqaim ntawm cov hlab ntsha ntawm lub plab mog thiab qis duaqhov kawg ntawm lub zais pa dilatation kuj tau siv dav.
Dilation of the esophagus
Endoscopic esophageal dilation txheej txheem yog siv rau:
- stenosis;
- scar strictures;
- tsim cov ntaub so ntswg sib txuas;
- achalasiacardia;
- nruj ntawm txoj hlab pas anastomoses tom qab esophagegoplasty.
Non-invasive balloon dilatation of the esophagus muab tau zoo heev. Tag nrho cov ntsiab lus ntawm cov txheej txheem yog pom nrog lub koob yees duab tshwj xeeb lossis fluoroscopy.
Cicatricial nruj ntawm txoj hlab pas hauv cov neeg coob coob tshwm sim feem ntau nrog kev kub hnyiab ntawm ntau yam etiologies, kev kho hluav taws xob, vim qhov tshwm sim ntawm reflux esophagitis, thiab benign neoplasms. Balloon dilatation yog siv thaum nqaim tsawg dua 9 hli. Oncology yuav tsum tau txiav tawm. Kev ua haujlwm yeej ib txwm npaj.
kab mob plab
Qhia rau tus txheej txheem:
- Kab mob plab zoo thaum tsis muaj lwm yam kev kho mob.
- Stenosis ntawm lub qhov hluav taws xob ntawm lub plab thiab duodenum vim qhov mob ulcerative.
- Kev tshem tawm ntawm cov mucous.
- Hlawv thiab cov organic nruj.
- Raws li kev ntsuas palliative los kho patency hauv cov qog.
- Pylorospasm tom qab phais plab hnyuv sab sauv.
teeb meem plab hnyuv
Dilatation tau pom zoo nyob rau hauv cov xwm txheej hauv qab no:
- Nyob zoo ib tsoom phooj ywg.
- Strictures tom qab mob (diverticulitis, UC, Crohn tus kab mob).
- plab hnyuv adhesions.
- Nyob rau hauv oncology kom rov qab plab hnyuv patency.
Pathology ntawm biliary system
Nyob rau hauv cov ntaub ntawv no, tus txheej txheem yog tsim nyog nyob rau hauv cov nram no:
- Kev nruj nruj ntawm cov ducts ntawm lub txiav thiab lub gallbladder (congenital lossis post-inflammatory in cholangitis, pancreatitis).
- Kev nruj nruj (pob qhov dilatation yog siv ua ntej muab cov yas stent los nthuav nws).
Cov kab mob ua pa
Yog hais tias muaj pathologies ntawm pulmonary system, balloon dilatation yuav tsum tau nyob rau hauv cov nram no:
- Kev tsim kho zoo ntawm lub trachea thiab bronchi, lawv nqaim tom qab mob, tom qab TB.
- Siv cua thiab intubation, kub hnyiab ntawm cov pa ib ntsuj av los yog txawv teb chaws lub cev daig nyob rau hauv lub lumen ntawm lub bronchus ntev.
- Nyob ntawm tracheobronchial anastomoses tom qab ua haujlwm.
dav dav contraindications
txwv tsis pub suav nrog cov hauv qab no:
- Tshuaj mob o thiab mob o, vim qhov no muaj kev pheej hmoo ntawm cov ntaub so ntswg raug mob.
- Tsis kho los ntshav hauv thaj tsam ntawm kev sib liam sib cais.
- Kev cuam tshuam ntawm lumen ntawm txoj hlab pas (tsis tuaj yeem nkag mus rau lub zais pa).
- Oncology rau qhov kev kho mob radical yuav raug siv.
- Post-MI lossis mob stroke.
- Hypertension nyob rau hauv lub portal hlab ntsha system.
Kev npaj rau dilatation
Yuav tsum tau yaugtxoj hlab pas thiab plab 6 teev ua ntej kev tswj hwm, thiab 5-6 teev ua ntej tsis suav cov tshuaj antiplatelet. Kev noj zaub mov tsis suav nrog 12 teev ua ntej txheej txheem, thiab haus dej 6 teev ua ntej txheej txheem. Ntshav coagulability, kam rau ua tshuaj loog thiab kuaj pom muaj kab mob hauv cov ntshav. Balloon dilatation ib txwm ua tiav ntawm lub plab khoob.
Yuav ua li cas cov txheej txheem ua haujlwm
Endoscopic balloon dilatation yuav tsum tau siv lub taub me me endoscope. Nws muaj lub catheter ntev, qhov kawg ntawm lub zais pa yog nyob rau hauv ib qho kev sib tsoo.
Rau qhov nthuav dav, cov kua yog txhaj rau hauv nws nrog lub cuab yeej tshwj xeeb nrog kev tsim ntawm qee qhov siab. Tib lub sijhawm, lub zais pa yog ncab mus rau txoj kab uas xav tau.
Kev nce nqi yog ua thaum lub zais pa nyob hauv thaj chaw nruj, uas ua rau nws cov lumen nce. Lub zais pa nyob ntev li 2-3 feeb, ces nws deflated thiab tshem tawm.
Dilatation pib nrog qhov me me ntawm balloons (10 mm) thiab maj mam hloov mus rau qhov loj - txog li 20 hli. Nrog rau txoj hlab pas, lub catheter yog ntxig rau ntawm lub qhov ntswg, txoj kab uas hla tsis tshaj 5 hli, nrog rau txoj hnyuv stenosis - 8-9 mm.
Kev kho nrog lub zais pa hauv txoj hlab pas tau ua raws li tshuaj loog hauv zos, tab sis qhov mob me tsis raug txiav tawm. Cov tshuaj loog hauv zos - 10% lidocaine tsuag. Lub nebulizer yog tsom rau ntawm phab ntsa tom qab ntawm lub pharynx, thiab cov tshuaj sedative xws li "Relanium" yog ntxiv txhaj. Thaum muab lub raj tso, tus neeg mob ua pa tsis cuam tshuam. Txhua yam yog ua tiav nyob rau hauv x-ray tswj.
Thaum lub zais pa nkag, tus neeg mob yuav hnov sab me ntsiscaj pas thiab hauv siab. Lub zais pa tuaj yeem ua rau ntau zaus nyob ntawm qhov xwm txheej.
Lub zais pa dilatation nrog fibrocolonoscopy ua li cas? Cov txheej txheem yog ua tau tsuas yog tom qab ib tug enema ntawm txoj hnyuv. Cov txheej txheem npaj ua lwm yam tsis txawv ntawm kev tswj hwm ntawm lwm lub cev.
Qhov zoo ntawm txoj kev rau kev kho mob ntawm txoj hlab pas
Kev pheej hmoo ntawm cov teeb meem tsis txaus ntseeg, raws li kev txheeb cais, muaj qhov tsawg kawg ntawm kev raug mob.
Qhov tsis zoo suav nrog qhov xav tau rov nthuav dav, ntau qhov kev rov ua dua tshiab hauv cov txheej txheem.
Balloon dilatation ntawm txoj hlab pas tshuaj xyuas feem ntau yog qhov zoo. Kev txheeb cais qhia qhov feem pua tsawg ntawm kev rov qab los. Cov neeg mob nco ntsoov tias lawv tswj tau kom tshem tau cov kab mob uas twb muaj lawm.
Baloon rau dilatation hauv pathologies ntawm biliary system yog tswj hwm endoscopically lossis percutaneously, transhepatic.
Lub sijhawm thiab kev kho ntau zaus
Tom qab lub ntsiab nthuav dav, lub zais pa dilatation yog rov ua dua ib zaug ib lub lim tiam kom txog rau thaum qhov tshwm sim ruaj khov. Qhov no txhais tau hais tias tom ntej no mus ntsib kws kho mob yuav tsum tsis txhob muaj stenosis ntau tshaj 1-2 hli.
Tom qab ntawd lub sijhawm ntawm kev kho mob yuav txuas ntxiv mus rau 10-14 hnub, tom qab ntawd txhua 3 lub lis piam. Thaum tsis muaj stenosis - 1 zaug hauv ib hlis. Kev kho mob yog li siv sijhawm 3 txog 6 lub hlis. Kev saib xyuas ntawm qhov muaj zog yog ua ib xyoos ib zaug.
Muaj Teeb Meem
Vim phau ntawv ceev tswj los ntawm lub zais pa mus rau cov ntaub so ntswgtsis yooj yim sua, muaj peev xwm ntawm kev puas tsuaj rau phab ntsa ntawm lub cev nrog nws txoj kev ntxhov siab. Yog li ntawd, qhov txuas ntxiv yog siv maj mam. Tej zaum kuj yuav los ntshav, tab sis nws nres ntawm nws tus kheej.
Qhov teeb meem loj tshaj plaws yog perforation ntawm lub cev phab ntsa, uas yuav tsum tau phais suturing.
Rehabilitation period
Nws raug nquahu kom soj ntsuam tus kws kho mob thawj 4 hnub tom qab txheej txheem kom tsis suav nrog cov teeb meem. Kev txwv:
- tsis txhob haus dab tsi rau thawj 2-3 teev tom qab dilatation;
- khoom noj khoom haus tsuas yog tso cai rau hnub tom qab.
Koj yuav tsum mus ntsib kws kho mob tam sim yog tias:
- quav dub thiab muaj cov tshuaj sib xyaw ntawm cov ntshav;
- ua pa thiab nqos nyuaj;
- kub thiab txias;
- mob plab.
Cov txiaj ntsig ntawm qhov kev tshawb fawb endoscopy ntawm Kev Tshawb Fawb Lub Tsev Haujlwm ntawm Oncology. N. N. Petrova
Kev tshuaj xyuas txog kev zais zais zais zais los ntawm cov kws kho mob tau txhawb nqa. Lawv ua tiav txoj kev kho no. Txhua hnub balloon dilatations ntawm strictures ntawm ntau yam hauv nruab nrog cev ua rau muaj kev vam meej kho ntawm tus neeg mob nyob rau hauv 95% ntawm cov neeg mob. Qhov no yog ntau tshaj qhov txiaj ntsig zoo.
Estachian tube thiab zais pa dilatation
Tus kws tshaj lij German Martin Koch los ntawm lub nroog Hannover yog suav tias yog tus sau cov thev naus laus zis tshwj xeeb. Tom qab kev ua haujlwm zoo li no, cov neeg mob tam sim ntawd pom qhov kev txhim kho hauv kev hnov lus.
Nws taw qhia tias nws cov txheej txheem Eustachian tube balloon dilatation tau ua pov thawj tau zoo. Nruab nrab pob ntseg siabyog leveled, qhov cua yog tag nrho rov qab. Hauv 85% ntawm cov neeg mob, nws muaj peev xwm tshem tawm cov tsos mob ntawm otitis (exudate hauv pob ntseg ploj, hnov tsw ntawm congestion thiab suab nrov) thiab hnov lus zoo dua.
Tsis tas yuav tsum tau rov ua dua. Kev ua haujlwm tau ua thaum muaj hnub nyoog ntawm tus neeg mob, txawm tias cov menyuam yaus.
Cov kev tshawb fawb anatomical tau pom tias tsuas yog cov cartilaginous ib feem ntawm lub auditory raj nthuav. Nws muaj kev nyab xeeb kiag li.
Cov txiaj ntsig tau ntev: tom qab 1 xyoos, 95% ntawm cov neeg mob tau hnov lus zoo dua, thiab tom qab 5 xyoos, nws tseem nyob hauv 75%.
Ntawm cov teeb meem ntawm lub zais pa dilatation ntawm lub auditory raj, purulent otitis media, subcutaneous emphysema tsis tshua muaj tshwm sim, tab sis lawv tau kho kom zoo. Tsis muaj neeg tuag.
Nyob rau xyoo 2015, balloon dilatation ntawm lub auditory raj tau ua thawj zaug nyob rau hauv Russia, nyob rau hauv lub tsev kho mob ntawm lub Department of Otorhinolaryngology ntawm lub State Medical University. I. P. Pavlova hauv St. Petersburg.
Estachian tube tswvyim
Lub auditory lossis Eustachian raj txuas rau nasopharynx thiab nruab nrab pob ntseg. Cua nkag mus rau hauv lub tympanic kab noj hniav los ntawm nws, yog li ntawd lub siab ntawm ob sab ntawm daim nyias nyias yuav zoo ib yam.
Dhau li ntawd, qhov kev coj ntawm lub suab vibrations rau cov neeg txais kev sib raug zoo yog qhov qub. Nrog rau qhov sib txawv nqaim, tag nrho cov no tau tawg. Dilation yog qhia thaum kev kho mob tsis zoo. Ib qho khoom muaj txiaj ntsig ntawm lub zais pa dilatation ntawm lub auditory raj yog qhov tseeb tias qhov kev tawm ntawm cov kab mob inflammatory secretion los ntawm nruab nrab pob ntseg tau yooj yim.
Technique
Rau dilation, lub zais pa catheter yog inflated nrog saline rau P=10 atmospheres ibcartilaginous ib feem ntawm lub auditory raj. Nyob rau hauv cov ntaub ntawv no, lub zais pa ncav ib txoj kab uas hla ntawm 3.28 hli. Txhawm rau hla lub catheter mus rau lub qhov ncauj pharyngeal ntawm lub auditory raj, ib qho khoom siv rov siv tau nrog cov lus qhia hloov pauv tau khoov ntawm lub kaum sab xis ntawm 30 °, 45 °, 70 °, 90 ° yog siv.
Lub catheter yog muab tso rau hauv intranasally ntawm lub kaum sab xis ntawm inclination ntawm tus neeg mob lub cev. Lub twj tso kua mis muaj qhov txwv uas txwv tsis pub lub catheter nkag mus rau hauv lub cev ntawm lub raj.
Lub sijhawm pom lub zais pa yog 2 feeb, thiab lub sijhawm ua haujlwm tag nrho tsis pub dhau 20 feeb. Cov tshuaj loog yog siv endotracheally. Tus neeg mob tawm tom qab 2 hnub. Kev tswj xyuas tau ua tiav tom qab 1, 6, 12 lub hlis.
Balloon dilatation ntawm lub suab raj tshuaj xyuas feem ntau yog qhov zoo. Cov neeg mob nco ntsoov tias kev siv dag zog tau yooj yim zam. Hauv 95% ntawm cov neeg mob, kev hnov lus zoo tam sim ntawd, thiab cov txiaj ntsig tau txuas ntxiv mus rau ntau dua 5 xyoos. Cov tsos mob ntawm exudative otitis tsawg zuj zus. Rov qab dilatations feem ntau tsis tas yuav tsum tau. Tsis pom muaj teeb meem.
Qhia rau tus txheej txheem:
- mob ntsws tsis ua haujlwm;
- tsis muaj qhov cua hauv lub qhov ncauj;
- nquag relapsing exudative otitis uas tsis muaj kev cuam tshuam;
- mucosal theem hauv exudative otitis.
Contraindications:
- kev xav sib txawv;
- Nkauj kab mob;
- cicatricial nqaim ntawm Eustachian raj, stenosis ntawm cov pob txha ntawm txoj kev.
Thaum xaiv cov neeg sib tw rau dilatation, pob ntseg microscopy, tympano- thiab audiometry, endoscopy ntawm nasopharynx thiab CT yuav tsum tau.
