Gabatarwa
Achalasia na zuciya (AC) wani nau'in ciwon zuciya nematsalar motsi na farko a cikin esophagus.Saboda rashin sassautawar ƙashin ƙashin ƙashin ƙashin ƙashin ƙashin ƙashin (LES) da kuma rashin ƙarfin tsokar hanji, riƙe abinci yana haifar darashin isasshen jini da kuma amsawar jiki. Alamomin asibiti kamar zubar jini, ciwon ƙirji da rage kiba.Yaɗuwar cutar ta kai kimanin 32.58/100,000.
ThemaganiNau'in achalasia ya ƙunshi maganin da ba na tiyata ba, maganin faɗaɗawa da kuma maganin tiyata.
01 Maganin Lafiya
Hanyar maganin miyagun ƙwayoyi ita ce rage matsin lamba na LES a cikin ɗan gajeren lokaci.Babu wata shaida da ke nuna cewa magunguna na iya inganta alamun cutar AC akai-akai da kuma yadda ya kamata.Magungunan da ake amfani da su a yanzu sun haɗa da nitrates, masu toshe hanyoyin calcium, da kuma β-receptor agonists.
(1)Nitrateskamar nitroglycerin, amyl nitrate, da isosorbide dinitrate
(2)Masu toshe hanyoyin calciumkamar nifedipine, verapamil, da diltiazem
(3)masu maganin β-receptorkamar cabuterol
02 Allurar Gubar Botulinum ta Endoscopic (BTI)
Ana iya amfani da allurar toxin botulinum ta endoscopic (BTl) don magance AC,amma yana iya samar da sakamako na ɗan gajeren lokaci ne kawai kuma ana iya amfani da shi ga tsofaffi marasa lafiya waɗanda ke da haɗarin tiyata da maganin sa barci.
1) Alamomi:Marasa lafiya masu matsakaicin shekaru da tsofaffi (> shekaru 40); waɗanda ba za su iya jure wa faɗaɗa balan-balan na endoscopic (PD) ko maganin tiyata ba; waɗanda ke da magungunan PD da yawa ko sakamakon tiyata mara kyau; waɗanda ke da huda a cikin esophagus yayin maganin PD Ga waɗanda ke da babban haɗari, ana iya amfani da shi tare da PD; ana iya amfani da shi azaman sauyawa zuwa tiyata ko maganin PD.
(2) Abubuwan da ba su dace ba:Ba a ba da shawarar yin amfani da maganin AC a matakin farko ga ƙananan marasa lafiya (masu shekaru sama da 40).
03 Faɗaɗa Balloon na Endoscopic (PD)
Faɗaɗa balan-balan yana da wasu tasirin akan AC, amma yana buƙatar magani da yawa kuma yana ɗauke da haɗarin matsaloli masu tsanani.
(1) Alamomi:Marasa lafiya masu fama da matsalar jijiyoyi ba tare da isasshen bugun zuciya ba, matsalar toshewar jini, da sauransu; maza sama da shekaru 50 da mata sama da shekaru 35; marasa lafiya da suka kasa yin tiyata. Ana iya amfani da shi azaman hanyar magani ta farko.
(2) Abubuwan da ba su dace ba:Matsanancin rashin isasshen iskar huhu, matsalar toshewar jijiyoyin jini da kuma babban haɗarin toshewar makogwaro.
04 Myotomy na Endoscopic na Peroral (POEM)
A cikin 'yan shekarun nan, tare da babban aiwatar da myotomy na peroral endoscopic (POEM), nasarar maganin AC ya ƙaru sosai.Maganin POEM na AC ya yi daidai da manufar "tiyatar da ba ta da tasiri sosai", wato, raunuka ne kawai ake cirewa/cire su yayin aikin jiyya, kuma ba a cire gaɓoɓi ba.Ana kiyaye mutunci da aikin tsarin jiki, kuma ingancin rayuwar majiyyaci bayan tiyata ba shi da wani tasiri. Bayyanar POEM ya sa maganin AC ya zama mafi ƙarancin tasiri.
Hoto: Matakan tiyatar POEM
Ingancin POEM na matsakaici da na dogon lokaci a cikin maganin AC yayi daidai da na laparoscopic Heller myotomy (LHM)ana iya amfani da shi azaman zaɓin magani na farko.Wasu marasa lafiya na iya samun alamun cutar gastroesophageal reflux bayan tiyatar POEM
(1) Alamomi cikakke:AC ba tare da mannewa mai tsanani a cikin mucosa ba, matsalar rashin aikin narkewar abinci a cikin ciki da kuma babban diverticulum.
(2) Alamomin da suka shafi dangantaka:Ciwon farfadiya na esophagus, ciwon farfadiya na nutcracker da sauran cututtukan motsin hanji, marasa lafiya da suka kasa yin aikin tiyata na POEM ko Heller, da kuma AC da wasu mannewar submucosal na esophageal suka shafa.
(3) Abubuwan da ba su dace ba:Marasa lafiya masu fama da matsalar toshewar jini, cututtukan zuciya da huhu masu tsanani, rashin lafiyar gabaɗaya, da sauransu waɗanda ba za su iya jure wa tiyata ba.
05 Laparoscopic Heller Myotomy (LHM)
LHM yana da kyakkyawan tasiri na dogon lokaci wajen magance AC, kuma an maye gurbinsa da POEM a wuraren da yanayi ya ba da dama.
06 Gyaran esophagus na Tiyata
Idan aka haɗa AC da tabon esophageal da ke toshewa, ciwace-ciwacen ciki, da sauransu, za a iya yin la'akari da tiyatar cire esophageal.
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Lokacin Saƙo: Yuli-09-2024