Zotupa - Zotupa - Zotupa

Zotupa ndi matenda ambiri, koma palibe amene amalankhula za izo.

Kodi sind Hämorrhoiden? 

Zotupa - zotupa - ndi nodular dilations wa mitsempha mu rectum, amene amaperekedwa ndi chapakati mtsempha wamagazi ndi kuthamanga kwa magazi. Zotupa za m'mimba si ziwiya zabwinobwino zamatako, zomwe zimapereka njira yoyendetsera chimbudzi. Zotupa za m'mimba ndi ziwiya zam'mimba zomwe zatha kale, zomwe zingayambitse kuphulika kwa matumbo ndikuyambitsa kutulutsa ndi kutuluka kwa ntchofu. Zotsatira zake, zotupa zimabweretsa zizindikiro monga kutulutsa, kuyabwa pakhungu, kuyaka, kuyabwa komanso nthawi zina kutuluka magazi. M'chilankhulo chaukadaulo, zotupa zakunja zimatchedwa "mitsempha ya perianal". Perianal thrombosis kapena anal vein thrombosis ndi chotupa chadzidzidzi, chowawa mu rectum chomwe chimafuna chithandizo chamankhwala mwamsanga.

Zomwe zimayambitsa zotupa

Zomwe zimayambitsa zotupa sizimamveka bwino. Choyambitsa chachikulu chikuwoneka kukhala moyo wongokhala komanso kusadya bwino kwa fiber. Zakudya zokhala ndi fiber zambiri monga chimanga, saladi, oatmeal ndi chinangwa cha tirigu ndi gawo lazakudya zopatsa thanzi, koma si anthu onse omwe amatsatira. Kuonjezera apo, chibadwa cha chibadwa chingathandizenso pakukula kwa zotupa.

Zotupa zotupa - zithunzi zisanachitike komanso pambuyo pake

Phunzirani zambiri kudzera pazithunzi komanso zithunzi zakale komanso pambuyo pake zotupa m'mimba,  mitsempha ya perianal, zithunzi zisanachitike ndi pambuyo pa opaleshoni ya laser ya hemorrhoid (LHPC)  ndi chithandizo cha laser chotupa, komanso Perianal mtsempha laser chithandizo ndi Perianal thrombosis laser chithandizo ku HeumarktClinic Cologne ndi Dr. Haffner.  

Zizindikiro za zotupa?

Zotupa zamtundu uliwonse zimatha kuyambitsa magazi komanso kuyabwa m'dera lakuthako. Nthawi zambiri pamakhala mavuto ndi matumbo. Odwala zotupa nthawi zambiri amapita kuchimbudzi kangapo motsatizana ndipo sangathe kutulutsa zonse nthawi imodzi. Kudzimbidwa, kupanikizika ndi ululu ndi zizindikiro zofala. Kupaka chimbudzi kumathanso kuchitika, koma izi ndizosiyana ndi kusadziletsa kwa ndowe. Ndi zotupa, woona ndowe incontinence si zimachitika chifukwa reflexively anakakamizika kwambiri sphincter osati kuteteza chotupa kuti prolapse, komanso kuteteza ku chimbudzi incontinence. Komabe, chitetezo cha minyewachi choperekedwa ndi minyewa yakuya ya m'chiuno sichingalepheretse vuto la continence yabwino m'mphepete mwa kumatako. Kusakwanira kumatako polowera kumatako ndiye kumayambitsa zizindikiro za hemorrhoid monga kutulutsa, kuyabwa, kuyaka, kuyabwa. "Mitsempha ya perianal" yodzaza, yomwe imadziwika kuti "mitsempha ya varicose ya rectum" kapena zotupa zakunja, zimakhala ndi vuto chifukwa zimatha kuyambitsa matenda amtundu wa perianal kapena thrombosis kapena kuyambitsa misozi yaying'ono yomwe imatuluka magazi ndipo imakhala yopweteka komanso chifukwa cha matenda oyambitsa matenda a Hemorrhoid. ndizovuta kuchiza.

Kutuluka magazi kuchokera ku rectum

Malinga ndi malangizo a S3, chiwonetsero chodziwika bwino cha zotupa ndikutuluka magazi kuchokera ku rectum. Malinga ndi malangizo, mafupipafupi ndi kuopsa kwa magazi satsatira ndondomeko ya zotupa zomwe tazitchula pamwambapa. Kutuluka magazi kuchokera ku rectum kumatha kuchitika ngakhale ndi zotupa zazing'ono ndipo zimachenjeza odwala omwe atangoyamba kumene matenda a hemorrhoid. Popeza palibe amene akufuna kukhala ndi magazi kuchokera ku rectum, chithandizo, mwachitsanzo. B. ndi opaleshoni yotengera laser, amasonyezedwa kale zotupa zazing'ono ngati zimayambitsa magazi kapena zizindikiro zina. Kutuluka kwa magazi kuchokera m'mitsempha ya mitsempha yomwe imapanga zotupa nthawi zambiri imakhala yofiira kwambiri. Kutaya magazi kumakhala kochepa, koma kumakhala kolemera kwambiri ndipo kumayambitsa kugwa. Popeza thupi la munthu nthawi zonse limatha kutseka rectum chifukwa cha minofu yolimba ya sphincter, magazi amayamba kusonkhanitsa mu ampulla ya rectum. Kenako imatha kuperekedwa mokulirapo ngati chimbudzi chofiyira chakuda. Mitsempha ya perianal yomwe imatuluka kuchokera kumatako imathanso kutuluka magazi ofiira kwambiri. Ndikofunika kudziwa kuti zizindikiro zoyamba za zotupa zam'mimba ndi zam'mimba nthawi zambiri zimatuluka magazi. Chifukwa chake, ngati mukutuluka magazi kuchokera ku rectum, ndikofunikira kukaonana ndi proctologist ku Cologne ndikudziwitsani mwachangu popanda kukonzekera zovuta. Zomwe zimafunikira ndikutuluka kwamatumbo kunyumba musanayesedwe ndikuyeretsa mwaukhondo.

Perianal eczema - kutupa kwa perianal

Kutupa kosatha, kokwiyitsa komanso kowopsa kwa khungu pa anus kumatchedwa perianal eczema. Proctologist watcheru amazindikira khungu loyera-lofiira lomwe lili ndi mabala ang'onoang'ono mpaka akulu ndi ming'alu. Khungu la perianal ndi lotupa, limawonetsa makwinya komanso ma tag apakhungu omwe amatchedwa ma skin tag. Matendawa amathanso kupangidwa ndi dokotala wabanja kudzera mukuyang'ana maso popanda kuyezetsanso: Dokotala amawona khungu loyera-lofiira komanso lokutidwa, zilonda komanso makwinya pamalo ozungulira 2-6 cm kuzungulira rectum. Pamene ngalande yakuthako yafalikira, ntchofu, chinyezi, kapena nthawi zina zopaka chimbudzi zimatha kudziwika. Odwala ena amagwiritsa ntchito zonona nthawi zonse. Ngati wodwala ndi zononatem Pamene rectum imabwera kwa proctologist, izi zimasonyeza kale matenda a hemorrhoid.

Kuyabwa kumatako, kuyabwa ndi moto mu rectum

Zizindikiro za zotupa, monga kuyabwa, kuyaka, kupweteka ndi mbola mu rectum, zimayamba chifukwa cholephera kumatako kumene rectum sangathe kutseka kwathunthu ndi youma. Izi zimayambitsa kupsa mtima kwa khungu, mofanana ndi chimfine choopsa, kumene mphuno yothamanga imakwiyitsa kwambiri khungu lathanzi komanso louma. Ngakhale kuti rectum sinatsekedwe kwathunthu chifukwa cha zotupa, ndizokwanira kuti ntchofu pang'ono kuchokera ku ngalande ya kumatako, yomwe imakutidwa ndi mucous nembanemba, imalowa pakhungu lowuma ndikupakapaka. Khungu louma, lathanzi lolowera kumatako limawukiridwa, limawonongeka, limapsa ndi kutupa, zomwe zimapangitsa kuyabwa ndi kuyaka. Chifukwa chake sikofunikira kuti "kusayenda kwa chimbudzi" kuchitike kuti mumve kuyabwa ndi kuyaka mu rectum. Ngakhale kuti rectum imatha kugwira chopondapo cholimba, centimita yomaliza pakhomo la kumatako ikhoza kutseka mosayenera ngati kutsekedwa kwathunthu sikutheka chifukwa cha zotupa zotupa. Izi zimapangitsa kuti ntchofu ndi chinyontho zituluke kuchokera ku mucous nembanemba, zomwe zimapangitsa kuyabwa kwa khungu lakunja, lomwe silingathe kulekerera ntchofu kwa nthawi yayitali.

Kutuluka kwa zotupa

Mapangidwe a Goligher a zotupa molakwika akuwonetsa kuti zotupa zimayambitsa vuto limodzi lokha, kuphulika. Kupanga kwachikale kumeneku kumapereka chithunzi chakuti kuopsa kwa matenda a chotupa ndi zizindikiro zake zimangokhudzana ndi kuchuluka kwa zotupa zamkati. Prolapses kunja zotupa, thrombosis wa kunja zotupa, kumatako insufficiency, zabwino continence matenda, magazi, dampness ndi kuyabwa komanso khungu chikanga si kuganiziridwa. Ngakhale chitsogozo cha S3 ku Germany chatengera kachitidwe kachikale kameneka ndikuwonetsa zisonyezo za opaleshoni potengera momwe zimakhalira zotupa. Zotupa za Goligher zimangoganizira za prolapse ya zotupa zamkati. Komabe, m'zipatala za proctology, odwala nthawi zambiri amakhala ndi kufalikira kwa zotupa zamkati ndi zakunja komanso ma tag a pakhungu, omwe amamveka ngati chotupa chowoneka bwino pa anus ndikusokoneza ukhondo ndikutulutsa. Pamene thrombosis wa kunja zotupa kapena nthawi zonse mkwiyo wa khungu pa nsonga ya prolapse kumachitika, odwala zambiri amafuna wodekha ndi wopanda ululu kuchotsa, kaya zotupa mkati siteji II kapena III. Pafupifupi 90-95% ya odwala amafunafuna thandizo chifukwa cha chotupa chowoneka bwino chapa rectum, chomwe chimawoneka ngati mtsempha wa thrombosed perianal. Pafupifupi 10 peresenti ya odwala amafunafuna chithandizo cha zotupa zotupa, zomwe nthawi zina zimayenera kukankhidwira kumbuyo ndi chala. Zizindikiro zapakhungu monga zotupa pa anus ndi chifukwa chofala choyendera proctologist, ndipo odwala ambiri amafuna chithandizo popanda opaleshoni, mwachitsanzo. B. kudzera mu chithandizo cha laser.

Kuphulika kumatako

Misozi yamatako imatha kuchitika chifukwa cha kutambasula kwambiri kapena popanda kuvulala kwakunja chifukwa cha kufewetsa komanso kutukusira kwa khungu la perianal ndi mucous nembanemba. Ming'alu imatha kuchitika polowera kumatako ngati ming'alu yachikale kapena ngati ming'alu yaying'ono ndi mabala ozungulira khosi. Khungu lotupa, ming'alu ndi mabala zimapweteka kwambiri modzidzimutsa komanso ndi kukhudza pang'ono. Chifukwa cha kuchulukana kwa magazi m'mitsempha yamagazi ndi mitsempha ya perianal, nembanemba ya mucous imatuluka ngati baluni. Kenako nembanemba yotupayo imang'ambika ngati chibaluni pamene chopondapo chikukanda. Khungu lotupa ndi eczematous perianal sililimba kuposa khungu lathanzi. Choncho, zotupa kungayambitse ming'alu kumatako chifukwa kuwonongeka khungu ndi distended woonda kumatako khungu ndi mucous nembanemba. Ku HeumarktClinic Proctology ku Cologne, palibe njira zopweteketsa mtima zomwe zimafooketsa sphincter ndipo, malinga ndi mapepala a chidziwitso cha proctology omwe akulimbikitsidwa ku Germany, atha kukhala gawo la pulogalamu ya opaleshoni ya akatswiri abwino kwambiri a proctologists ku Cologne. Popeza misozi yamatako si matenda odziyimira pawokha m'lingaliro lenileni, koma chotsatira cha zotupa, ziyenera kuchitidwa ngati gawo la matenda otupa. Ndipo popanda mabala, mipeni kapena lumo, koma ndi laser irradiation mu HeumarktClinic Proctology ku Cologne. Makamaka, kudula kapena kudula sphincter komanso kudula misozi monga momwe tafotokozera papepala lachidziwitso sikuvomerezeka.

Kupweteka kwa anus ndi rectum

Zotupa zokha sizimayambitsa ululu! Odwala nthawi zambiri amabwera kukaonana ndi proctology yathu yachinsinsi ku Cologne omwe amadabwa pamene proctologist amawauza kuti ali ndi zotupa zotupa, zomwe zimayambitsa chinyezi, kutupa, kuyabwa ndi kuyaka ndipo zimafunikira chithandizo chamankhwala mwachangu. Chifukwa chakuti zotupa sizimayambitsa kupweteka, nthawi zambiri zimalekerera, ngakhale zitatuluka m'mimba ndipo nthawi zina zimafunika kukankhidwira kumbuyo. Odwala amazoloŵera mkhalidwe wa rectum yawo, chifukwa mkhalidwewo umangosintha pang'onopang'ono kwa zaka zambiri ndipo ukhoza kulipidwa makamaka ndi minofu yomwe imakhala yolimba kwambiri. Ndizodabwitsa kwa proctologist kuti odwala ambiri samazindikira chikanga ndi kutupa kwa khungu la perianal. Anthu ambiri samawoneka kuti amasamala kuti kuyabwa nthawi zina koma amachoka ndi "mafuta abwino a hemorrhoid". Ena sadziwa n’komwe pamene kutupa kumafalikira ku tailbone kapena kutsogolo kwa chikoko mwa amuna kapena potsegula nyini mwa akazi. Anthu ambiri samawona kudalira kwawo mafuta odzola m'mimba ngati matenda ndipo amaganiza kuti ndi khungu lokha lomwe limakanda pang'ono.

Marisques

Zolemba zapakhungu kapena zotchinga ndi zilembo zapakhungu pakhomo lakunja lakuthako, m'dera la anus. Mosiyana ndi ma mucosal appendages kapena polyps m'matumbo kapena kumatako, zizindikiro zapakhungu ndi minofu yapakhungu. Mapangidwe a ma tag a pakhungu amatha chifukwa cha zinthu zingapo, kuphatikiza kuchuluka kwa mucous nembanemba, micro thrombosis ya mitsempha ya perianal, kapena kuphatikiza zonse ziwiri. Kupsa mtima kwa khungu chifukwa cha chinyezi ndi kusokonezeka kwa continence yabwino kumathandizanso kupanga zizindikiro za khungu. Ma tag a pakhungu amatha kuvutitsa anthu ambiri, makamaka pazifukwa zokongoletsa, ngakhale samayambitsa kupweteka. Wodwala akafika ku proctology ku Cologne chifukwa cha ululu waukulu, 90% ya omwe akhudzidwa kale amakhala ndi zopweteka kwambiri kumatako. Monga tanenera kale, ming'alu sizichitika popanda chifukwa, koma chifukwa chong'ambika mitsempha perianal chifukwa cha kupsyinjika mkulu kapena kuonongeka, chotupa kumatako khungu pa milandu kulephera kumatako ndi zotupa. Kupweteka kwadzidzidzi ndi kupezeka kwa palpable hemorrhoidal nodule pa rectum zimasonyeza thrombosis wa zotupa kapena perianal mitsempha.

Kusokonezeka kwa anal ndi continence disorder

Lord's anal spasm ndi chizindikiro chodziwika bwino cha zotupa zomwe zidathandizidwa ndi dilator munthawi ya woyambitsa. Ngakhale lero, ma anal dilators amagwiritsidwabe ntchito pamene rectum imakhala yovuta kwambiri kotero kuti mbali imodzi imayambitsa ululu waukulu, womwe nthawi zina umatchedwa "proctalgia fugax", ndipo kumbali inayo kumabweretsa kusokonezeka kwa kutaya kwa rectal. Mwachidule, rectum silingatseguke bwino motero silingathe kutulutsa kwathunthu. Wina angafunse chifukwa chomwe onse amatako kuphipha ndi kutayikira kumatako amaonedwa mbali ya zotupa. Kodi minofu yam'mimba ndi yofooka komanso yosakwanira kapena yolimba kwambiri? Kufotokozera kwa izi ndi motere: Mu proctology ku Cologne sitilankhula za sphincter, koma za sphincters. Ma sphincters amatha kugawidwa m'magulu awiri akuluakulu a minofu omwe ali ndi ntchito zosiyanasiyana ndi ntchito zokhudzana ndi continence:

A/ Fine continence: Udindo = minyewa ya sphincter yakunja (sphincter yakunja, sphincter yamkati)

Pankhani ya zotupa, kufooka kwa minofu ya kumatako kumatha kuzindikirika ndi kumatako manometry. Chifukwa cha izi ndikuti zotupa zimatuluka mu ngalande ya kumatako, zomwe zimasiya ngalande yakuthako yotseguka pang'ono ndipo minofu simatha kupitilira kukakamiza kwa zotupa. Izi zimabweretsa kusokonezeka kwa continence yabwino, yodziwika ndi chinyontho, kupaka utoto ndi kuyabwa. Ngati zotupa zimachotsedwa pogwiritsa ntchito laser, HAL, RAR, etc. popanda kudulidwa, m'mphepete mwa kumatako ukhoza kutsekanso bwino ndipo chinyontho ndi kuyabwa kumatha. Nthawi zina maphunziro a endo-anal biofeedback amafunikiranso, omwe amachitidwa kudzera muzochita zapansi pa chiuno kapena mothandizidwa ndi chipangizo chamakono chokondoweza.

B/ Gross continence: Responsible = deep sphincters (M. Puborectalis, Levator ani)

Ma sphincters akuzama amaonetsetsa kuti kumtunda kwa rectum kumatsekedwa momveka bwino pamene zotupa zimatuluka. Malinga ndi Ambuye, chotupa okhazikika ndi kuphipha kwakuya sphincters ndi vuto la defecation chifukwa cha kutsekeka kwa kumatako kutsegula ndi zina mwa zizindikiro tingachipeze powerenga zotupa zapamwamba, mosasamala kanthu kuti zotupa akhoza kukankhidwira mmbuyo ndi chala kapena ayi. Pankhani ya matenda otupa kwambiri otupa kumatako, chithandizo chimaphatikizapo kutambasula minofu yakuya (levator ndi puborectalis) ndikuchotsa zotupa monga gawo la njira yotupa. Ngati izi sizikubweretsa kusintha kulikonse pakapita nthawi, HeumarktClinic Proctology ku Cologne imapereka jakisoni wapadera, woyendetsedwa ndi ultrasound, wolunjika pamitsempha yakuya ya chiuno cham'chiuno yokhala ndi minofu yopumula kuti muchepetse kukokana kwa miyezi yosachepera 6 ndikupangitsa kutulutsa kwanthawi zonse. .

kumatako kusakwanira

Kusakwanira kumatako kumatanthauza kusakhazikika bwino. Malinga ndi chitsogozo cha S3 chamagulu aku Germany akatswiri a proctology ndi colon-proctology, zotupa zomwe zimachulukirachulukira zimapangitsa kutulutsa konyowa komanso nthawi zina ngakhale kutulutsa ndowe, komwe kumangowoneka ngati kutulutsa, koma pambuyo pake ngati kupaka chimbudzi ndipo pamapeto pake kumatha kubweretsa zovala zamkati zodetsedwa. Chinyezi chokhazikika chimakwiyitsa khungu la perianal kosatha. Ndizosamvetsetseka kuti ukhondo wouma komanso wosapaka mafuta samaperekedwa ndipo anthu ambiri samawona chimbudzi pa zovala zawo zamkati monga chizindikiro chakuti chinachake chalakwika ndi rectum. Mawu akuti "anal insufficiency" - chabwino continence disorder - ndi mawu achilendo kwa anthu onse, kutanthauza "sindikhudza ine" chifukwa "Ine ndikhozabe kulamulira chopondapo changa".

Perianal thrombosis - kumatako thrombosis

Perianal thrombosis kapena kumatako mtsempha thrombosis kumachitika pamene anasonkhana magazi mu dilated mitsempha pa m'mphepete mwa kumatako clumps pamodzi. Chotupa chowawa chimapangika m'mphepete mwa anus. Kukhala ndi kuchita chimbudzi kumapweteka. Ma perianal thromboses nthawi zambiri amaphulika ndipo magazi amatha kuchitika. Ululu, zotupa zomveka komanso kutuluka magazi kumapangitsa odwala kupita kuchipatala mwachangu. Ndikofunikira kudziwa kuti thromboses m'mphepete mwa kumatako ndi zizindikiro zakunja zowonekera za zotupa zamkati. M'mayiko olankhula Chingerezi, kusiyana kumapangidwa pakati pa zotupa zakunja ndi zamkati, zomwe zimayimira zigawo ziwiri za matenda a hemorrhoidal. Popanda zotupa zamkati, zotupa zakunja sizipanga ndipo thrombosis ya mitsempha ya perianal m'dera la anal sizichitika. Nthawi zina thrombosis wa mkati ndi kunja zotupa zotupa kumachitika, zomwe zingakhale zopweteka kwambiri ndipo amafuna mwamsanga proctological chithandizo.

Zoyenera kuchita ngati muli ndi zotupa? 

Ngati muli ndi zizindikiro monga kuyabwa, kuyaka, kupaka kapena kutulutsa magazi kumatako, muyenera kupita kwa katswiri wa proctology ku Cologne kuti akamuyezetse matumbo anu ndikuwunikanso matenda ndi kuyezetsa khansa. Pambuyo pakuwunika, mutha kupeza upangiri panjira zosiyanasiyana zochizira, kuphatikiza njira zodzitetezera monga rubber band ligation, sclerotherapy, kuzizira, komanso njira zopangira opaleshoni monga njira ya HAL, THD, RAR, submucosal ligation ndi ligature excision. Muzochita zathu za proctology ku Cologne, timayamba kufotokoza za njira zochiritsira zomwe zingatheke ndi laser therapy chifukwa tili otsimikiza kuti laser ndiye njira yabwino kwambiri. Mothandizidwa ndi ukadaulo wa laser, chithandizo chotseka mosavutikira cha zotupa chimatha kuchitidwa popanda kudulidwa kwakukulu kwa opaleshoni.

LHPC - Opaleshoni ya Plastiki ya Laser Hemorrhoid

Pafupifupi zaka zitatu zapitazo tinayamba laser hemorrhoid pulasitiki opaleshoni pambuyo Dr. (H) Haffner anali atamaliza maphunziro a opaleshoni ya laser ku Bio-Litec. Poyamba, tidachita njirayi molingana ndi malingaliro omwe ali patsamba la Bio-Litec LHP. Komabe, m'kupita kwamankhwala zidawonekeratu kuti mtengo wa laser ukhoza ndipo uyenera kugwiritsidwa ntchito m'njira zosiyanasiyana kuti upeze zotsatira zabwinoko. Tasintha njira ndi zida moyenerera. Njira yatsopanoyi idapangidwa pansi pa dzina la Laser Hemorrhoid Plastic Surgery (LHPC). Maziko a LHPC adapangidwa mwasayansi kudzera mu kafukufuku woyesera nyama mogwirizana ndi Experimental Surgical Institute ku yunivesite ya Semmelweis. Umu ndi momwe njira yatsopano ya laser yopangira opaleshoni yotupa idapangidwa monga LHPC, opaleshoni ya pulasitiki ya laser hemorrhoid ku Cologne, yomwe yakhala njira yochizira mitundu yonse ndi magawo a zotupa m'machitidwe athu.

Ubwino wa LHPC:

- Palibe mabala - palibe vuto lakuchiritsa mabala - ngakhale kupweteka kulikonse
- Kulimbitsa osati kufooketsa sphincter
-Kuyenda bwino m'matumbo poyerekeza ndi kale
- Kudziletsa bwino poyerekeza ndi kale
- Kutenga nawo mbali mwachangu

Pamaso pa kusankhidwa kwa LHPC, kuyezetsa koyambirira kwa ultrasound kumachitika, pomwe maukonde onse a mitsempha ndi mitsempha amawonetsedwa ndipo madandaulo anu enieni amamveka bwino. Opaleshoni ya pulasitiki ya Laser hemorrhoid imachitidwa pachipatala chakunja pansi pa anesthesia wamba kapena kugona kwamadzulo. Mankhwala ogonetsa am'deralo pogwiritsa ntchito njira ya tumescent amangokwanira zotupa zazing'ono.

LHP laser hemorrhoidoplasty

The original LHP Laser Hemorrhoidoplasty****, imachokera ku kutseka kwa mitsempha yomwe imapereka zotupa poyembekezera kuti izi zipangitsa kuti zotupa zibwerere. Mmodzi mayesero azachipatala ku LHP ku USA ClinicalTrials.gov  ku nambala NCT03322527 EN PARADES Vincent, MD mu 2018 zachitika, koma palibe zotsatira zomwe zilipo. Komabe, zofalitsa zina za LHP zasindikizidwa ndi zotsatira zabwino. Malangizo aku Germany S3, monga tafotokozera mu Ärzteblatt, akadali akuonetsa ntchito ochiritsira ndi mipeni ndi lumo zochizira zotupa zapamwamba, monga akadali mabuku ochepa ndi maphunziro ankalamulira laser ndi wailesi yoweyula njira, ngakhale mabuku munthu ndi olemba lipoti zotsatira zabwino . 

Njira za HAL, THD ndi RAR

HAL, THD ndi RAR ndi njira zochiritsira za proctological potengera njira zapadera za suturing. Lingaliro loyambirira la njira zonse ndikuchepetsa zotupa podula magazi. Mu njira ya HAL, mtsempha umodzi umakhala ndi kafukufuku wa Doppler ultrasound ndipo umamangidwa ndi ligature. Mu njira ya THD, misempha yayikulu yonse ya zotupa imamangiriridwa mumsewu wozungulira womwe uli m'mphepete mwa rectum. Cholinga cha njira ya THD, monga momwe dzinalo likusonyezera, ndikuchotsa zotupa poyimitsa mitsempha yonse yofunika kwambiri yamagazi. Ndi njira ya RAR, zotupa zimatetezedwa koyamba, monga ndi njira ya HAL. Komabe, pambuyo pa kulumikiza kwa mtsempha waukulu, njirayi imapitilira ndikumangirira misa ya hemorrhoid ndi ma ligatures owonjezera ndikumangitsa mucous nembanemba. RAR ligation ndi kumangitsa nthawi zambiri kumakhala ndi zingwe zinayi zazikulu za zotupa. Ku HeumarktClinic Proctology ku Cologne, njira zonsezi zopangira suturing zimagwiritsidwa ntchito ndi zaka zambiri komanso kuchita bwino. Zomwe takumana nazo zasonyeza kuti kuphatikiza njirazi ndi laser irradiation ya hemorrhoid mass ndi yothandiza kwambiri. Mwachidule, tinganene kuti HAL-RAR-THD kuphatikiza laser ndiye njira yothandiza kwambiri komanso yofatsa mu proctology. Palibe kudulidwa komwe kumapangidwa, zomwe zimachepetsa chiopsezo cha zovuta.

Kuwonongeka, kumangiriza ndi mphira ndi icing

Ndi njira zomwe zimagwiritsidwa ntchito mobwerezabwereza kwa odwala omwe ali kunja kwa zotupa mu proctology, ndi proctologists ndi proctologists ku Cologne. Mankhwalawa ndi osavuta ndipo nthawi zambiri sakhala opweteka. Sclerotherapy imaphatikizapo jekeseni wa sclerotherapy mu minofu ya hemorrhoid, yomwe imapangitsa kuti ikhale yochepa. Komabe, chifukwa cha zotupa zowopsa kwambiri, njirayi ndi yosasangalatsa ndipo kuyambiranso kumatha kuchitika. Rubber band ligation imaphatikizapo kumanga mfundo imodzi yokha ya chotupa, koma izi nthawi zambiri zimakhala zogwira mtima. Mu proctology ku HeumarktClinic ku Cologne, kuphatikiza kwa njirazi kumagwiritsidwa ntchito kukhathamiritsa bwino ndikuchepetsa zotsatira zoyipa. Mphuno imodzi yokha imamangiriridwa panthawi imodzi ndipo sclerotherapy imalowetsedwa mu gawo lomangirizidwa kuti apewe zotsatira zoyipa monga zilonda kapena kuuma kwa khoma lamatumbo athanzi. Kenako mfundo yothirapo amayizidwa ndi pensulo yozizira kwambiri. Ndi kuphatikiza uku, odwala ku HeumarktClinic Proctology ku Cologne samamva ululu panthawi ya chithandizo komanso pambuyo pake komanso zotsatirapo zazing'ono monga kuchepa kwa magazi achiwiri komanso osowa kwambiri. Zovuta monga abscesses kapena fistulas, zomwe zanenedwa ndi proctologists ena, sizinachitikepo ndi ife pambuyo pa mankhwalawa.

Ndi mafuta ati abwino kwambiri a zotupa

Mafuta abwino kwambiri a zotupa amasiyanasiyana malinga ndi zizindikiro za munthu payekha komanso mkhalidwe wa chigawo cha kumatako. Mafuta abwino a hemorrhoid ayenera kukhala ochepetsa ululu, oziziritsa komanso odekha. Zitha kukhala ndi zinthu zachilengedwe zomwe zimapangitsa kuti khungu la kumatako likhale losalala komanso kulimbikitsa machiritso. Mafuta abwino amayeneranso kugwira ntchito ngati mafuta panthawi yoyenda matumbo osamamatira ku zovala zamkati. Ndikofunika kuti mafutawo asapangitse ziwengo komanso salowerera ndale.

Wopanga nthawi zambiri amapereka chogwiritsira ntchito chomwe chingagwiritsidwe ntchito kuyika mafutawo pang'onopang'ono mu ngalande ya anal. Kusankha pakati pa gel osakaniza, suppositories kapena mafuta odzola kumadalira zizindikiro za munthu, monga kupweteka, kutuluka magazi, kuyabwa kapena kuyaka, komanso momwe malo amako amachitira. Palibe mafuta abwino kwambiri amtundu uliwonse komanso gawo lililonse la zotupa. Ndikofunikira kufunsa upangiri ndi kuyezetsa kwa proctologist. Mafuta odzola amangothandiza kuthetsa zizindikiro ndipo sangathe kuchiza zotupa. Ichi ndichifukwa chake mawu otsatsira akuti "Laser ndiye mafuta abwino kwambiri a hemorrhoid" adapangidwa, popeza chithandizo cha laser chimatha kuchepetsa zotupa ndikuchepetsa zizindikiro.

Mwachidule: Mafuta amathandizira, koma chithandizo cha laser chimachiritsa.

Kodi opaleshoni ya hemorrhoid imawonetsedwa liti? 

The staging of hemorrhoids malinga ndi Goligher kuyambira 1980, yomwe idagwiritsidwa ntchito kale kuti adziwe chomwe chikuwonetsa opaleshoni, yachikale. Gulu ili silimaganizira zizindikiro zonse ndi madigiri a kuopsa kwa matenda a hemorrhoidal. Zimalimbikitsidwabe kuchita opaleshoni pokhapokha pazochitika zapamwamba za III kapena IV zomwe zotupa zimatuluka ndipo zimafunika kukankhira kumbuyo ndi chala. Gulu lolimba ili linali loyenera m'mbuyomu pamene maopaleshoni akuluakulu ankachitidwa ndi mipeni ndipo opaleshoni inali yoopsa kwambiri.

Komabe, masiku ano, njira zofatsa komanso zogwira mtima kwambiri monga chithandizo cha laser zilipo. Ku HeumarktClinic Proctology ku Cologne, cholinga chake ndikuvutika ndi zizindikiro za wodwalayo. Therapy ikufuna kuthetsa zizindikiro, mosasamala kanthu za siteji ya zotupa. Magawo akale a Goligher samalumikizana ndi zizindikiro ndi kuzunzika kwa odwala. Magulu atsopano ndi njira zochiritsira zimatengera zizindikiro zosiyanasiyana monga magazi, prolapse, thrombosis ndi zovuta zapakhungu (kuyabwa, kuyaka, kutuluka, chikanga) komanso thrombosis ya mitsempha yakunja ya perianal. 

Chifukwa malangizo akale komanso kuchuluka kwa kuuma kwa hemorrhoid sikubisa zizindikiro zomwe anthu amakumana nazo, kupangika kwatsopano kwa kuuma kwa hemorrhoid kuyenera kupangidwa (4,5,6,7). Magulu atsopano owopsa a hemorrhoid sagwiritsidwa ntchito pochiza zotupa zamkati, komanso kuchiza zotupa "zakunja" komanso zizindikiro zodziwika bwino. Mwachitsanzo, mbiri ya magazi imaganiziridwa mu gulu la "PNR-Bleed" polemba zovuta (7). Ndi BRST staging malinga ndi Sobrado (4), njira zochiritsira zatsopano komanso zizindikiro zofunika za zotupa zapamwamba zimaganiziridwa pozindikira zizindikiro za opaleshoni, motere: magazi (B), prolapse (P), ngozi (S) mavuto ndi zotsatira za thrombosis (T) zotupa zakunja.

Chithandizo cha laser chimatha kuchiza zotupa zamkati ndi zakunja ndikupewa zovuta. Yakwana nthawi yoti proctology iyang'ane pamagulu atsopano ndi njira zochepetsera zofatsa monga kugwiritsa ntchito ma laser.

Chizindikiro cha ntchito pa moyo watsiku ndi tsiku

akutuluka magazi, ma prolapses akuluakulu kapena kutsekeka kwa rectum. Kusakwanira kumatako, kupaka chopondapo, kulira, kuyaka, chikanga cha perianal, kupweteka, ming'alu yamatako kapena thrombosis ndi zotsatira za matenda a hemorrhoid. Zotsatira zazikuluzikuluzi zimafotokozedwa mwachidule monga "matenda otupa kwambiri a hemorrhoid" ndipo ndi chisonyezo chokwanira cha opaleshoni. Komabe, cholinga cha opaleshoniyi masiku ano chikuyenera kukhala chosasokoneza. Ngati zotupa zotupa zimatha kuchotsedwa pang'onopang'ono komanso popanda zoopsa zazikulu pogwiritsa ntchito laser kapena njira ina, ndiye kuti njira zina zam'mbuyomu sizikufunikanso.

Kapenanso, muyenera kutero

Sclerotherapy kapena rubber band ligatures of hemorrhoids

ziyenera kuganiziridwa, koma zotsatira zawo sizimafika pakuchita bwino kwa opaleshoni ya hemorrhoid ndipo motero sizikwanira kuchiritsa komaliza kwa matenda otupa kwambiri, otsogola. Malinga ndi mabukuwa, njira zopanda opaleshoni zimakhalanso ndi zotsatira zoopsa.

Zotupa ndi thrombosis pa nthawi ya mimba

Chifukwa ndi alipo zotupa mkati, amene ali pansi pa kukangana kwakukulu pa mimba. Zotsatira zake ndi prolapse ndi thrombosis. Chithandizo cha thrombosis ya mimba nthawi zonse chimakhala payekha ndipo zimadalira yemwe akuchiza mayi wapakati, zomwe proctologist ali nazo komanso masiku angati mpaka tsiku loyenera. Mankhwala opha ululu nthawi zambiri saloledwa ndipo palibe mankhwala opha ululu omwe angapatsidwe. Kodi thrombosis yopweteka kwambiri iyenera kuchotsedwa bwanji? Kuti tiyankhe funso lovutali, titha kungogawana nawo zachipatala komanso zomwe takumana nazo: Ma thrombosis nthawi zambiri amayambitsa kuzunzika kwakukulu panthawi yomwe ali ndi pakati ndipo zimakhala zosokoneza komanso zowawa panthawi yobereka. Choncho timayesetsa kuthandiza mayi woyembekezerayo pochita maopaleshoni odekha, osasokoneza kwambiri. Izi zimafuna luso lopereka mankhwala oletsa ululu wamba popanda kupweteka. Kachiwiri, pasakhale kukhetsa magazi, kukhetsa magazi kwachiwiri komanso kupweteka pang'ono pambuyo pa opaleshoni. Pachifukwa ichi, timapereka chithandizo cha laser chochotsa mimba ya thrombosis kuchokera ku mini-incision, yomwe imayambitsa ululu wochepa kwambiri wapambuyo pa opaleshoni, zomwe zakhala zikuwonetsa kukhala zopirira. Zovuta sizingayembekezeredwe. Komabe, timalangiza motsutsana ndi njira zazikulu za hemorrhoid; izi ziyenera kuchitidwa pambuyo pa kubadwa.

Zoyenera kuchita ngati muli ndi zotupa zakunja?

Zotupa zakunja ndi zotupa Mitsempha kunja kwa anus zimakhudza, nchifukwa chake zotupa kunja amatchedwa pianal mitsempha. Zotupa izi zimatha Kutuluka magazi, ming'alu ndi kuyabwa ndipo koposa zonse nthawi zambiri perianal thrombosis / kumatako mitsempha thrombosis chifukwa. Zotupa zakunja sizingathe kuthetsedwa kapena kumangidwa chifukwa zimadzetsa vuto lalikulu - thrombosis. Zotupa zakunja zimatha kuchotsedwa pang'ono, zomwe zimakhudza cheza ting'onoting'ono ta zotupa zakunja / mitsempha ya perianal. Komabe, izi ndi zopweteka kwambiri. Kuchotsa bwino, kwathunthu komanso kosatha kwa mitsempha ya perianal - zotupa zakunja - zimachitika ndi laser ku HeumarktClinic. HeumarktClinic imagwira ntchito pochotsa laser zotupa zakunja ndi zamkati popanda mabala kapena kupweteka kwakukulu. Pankhani ya thrombosis ya zotupa zakunja / mitsempha ya perianal, njira ya laser ndiyonso yabwino ngati mukufuna kuchotsa mitsempha ya perianal. Komabe, ma thromboses ang'onoang'ono amathanso kutha zokha koma amathanso kubwereranso ngati mitsempha ya perianal / zotupa zakunja sizichotsedwa. Anthu okhudzidwa ndiye amatsagana nawo m'miyoyo yawo yonse ndi kubwerezabwereza kwa perianal thrombosis kuchokera ku mitsempha ya perianal yomwe siinachotsedwe.

Mtengo wa Chithandizo cha Zotupa

Mayeso onse ndi njira zochiritsira zimachitika mu dipatimenti ya proctology ya HeumarktClinic ku Cologne malinga ndi ndondomeko yolipira. Tsoka ilo, palibe nambala yofotokozera ya opaleshoni ya laser ya hemorrhoid patebulo lolipira. Chifukwa chake, mchitidwewu umagwiritsa ntchito nambala 2886 ndi zowonjezera zake, zomwe zili mundalama zolipirira mautumiki ofanana a laser therapy ya zotupa zofananira m'mitsempha yamagazi ndipo, malinga ndi zomwe bungwe la Germany Medical Association linanena, ndizolondola pakuwunikira kwa mitsempha yamagazi laser. Zochuluka bwanji za izi zomwe kampani ya inshuwaransi yaumoyo imaphimba zimasiyanasiyana pazochitika zilizonse. Tikupatsirani mtengo wa opaleshoni ya laser hemorrhoid, yomwe mungakambirane ndi kampani yanu ya inshuwaransi ndikupeza chitsimikiziro cha mtengo. Bili ya GOÄ imalipidwa ndi odzilipira okha kapena kufuna anthu omwe ali ndi inshuwaransi yovomerezeka; Kwa iwo omwe ali ndi inshuwaransi yachinsinsi, zambiri mwa izi zimabwezeredwa ndi inshuwaransi yazaumoyo.

Dziwani zambiri ndikukonzekera nthawi yokambirana pafoni pa: 0221 257 2976 kapena mwa Kusungitsa malo pa intaneti - ngakhale kunja kwa ntchito. Lumikizanani ndi imelo apa.

Zolemba:

1. Goligher JC. Zotupa kapena milu. Mu: Goligher JC, Duthie HL, Nixon HH, akonzi. Kuchita opaleshoni ya anus, rectum ndi colon.4th ed. London: Baillière Tindall; 1980. p. 96. [Google Scholar]

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3. Gerjy R, Lindhoff-Larson A, Nystrom PO. Magulu a prolapse ndi zizindikiro za zotupa sizimalumikizana bwino: zotsatira za gulu la odwala 270. Mtundu wa Colorectal Dis. 2008; 10:694-700. [Adasankhidwa] [Google Scholar]

4. Sobrado Júnior CW, Obregon CA, E Sousa Júnior AHDS, Sobrado LF, Nahas SC, Cecconello I. Gulu Latsopano la Matenda a Hemorrhoidal: Kulengedwa kwa Masitepe a "BPRST" ndi Kugwiritsa Ntchito Kwake mu Kuchita Zachipatala. Ann Coloproctol. 2020 Aug; 36 (4): 249-255. doi: 10.3393/ac.2020.02.06. Epub 2020 Jun 1. PMID: 32674550; PMCID: PMC7508483.

5. Rubbini M, Ascanelli S, Fabbian F. Matenda a Hemorrhoidal: ndi nthawi yoti mukhale ndi gulu latsopano? Int J Colorectal Dis. 2018; 33:831-3. [Adasankhidwa] [Google Scholar]

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8. Murie JA, Sim AJ, Mackenzie I: Kufunika kwa ululu, pruritus ndi dothi monga zizindikiro za zotupa ndi kuyankha kwawo kwa hemorrhoidectomy kapena rubber band ligation. Br J Surg 1981; 68(4): 247–9.

 

 

Mgwirizano:

* Njira ya HAL= Hemorrhoidal artery ligation malinga ndi Morinaga 

** Njira ya THD= Transanal hemorrhoidal arteries ligation - Njira yowonjezera ya Morinaga

*** Njira ya RAR =Clinical.Trials.gov Clinical Trial No  NCT01301209, 

****LHP  = Laser Hemorrhoidoplasty: https://clinicaltrials.gov/ct2/show/NCT03322527 Kafukufuku wa DE PARADES Vincent, MD wa Gawo 2 ndi 3 Zotupa 

*****LHPC = Opaleshoni ya Plastiki ya Laser Hemorrhoids - Dr. (H) Haffner (Cologne) adagwiritsa ntchito njira zosinthika za chigoba cha laser zotupa m'magawo onse. Kuyesera kwa zinyama ndi deta yachipatala zilipo. Amagwiritsidwa ntchito motsatira maopaleshoni opitilira 500 a hemorrhoid omwe amakhala ndi vuto lochepa, pongopita kunja komanso osamva kupweteka kulikonse.