esc0rp 发表于 2024-6-26 18:12:23

吴晰教授：图解痔的干涉指征


    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz/siaSz3zztouV8KhaKjyCSjQj43UTeR4GCfz2I5yskWFBdYvBHwOsuQs9C7kAXzAMTnhjVWnKiabajNE6dvyqv6Cw/640?wx_fmt=gif&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">转载<span style="color: black;">源自</span>：壹生</span></p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/siaSz3zztouXJCuNXhbr110htP5Wvhr1icAtAbPlb2j6aT5fu78YIfjRgdWdRAqjOzSL5D9Cw6ePMMbOzsyqico3g/640?wx_fmt=jpeg&amp;wx_co=1&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/siaSz3zztouUa9jlNyM9iahq5cefwSBWF7fbqQW2HwrPaO6acfqjfc37JiaI1ibmrDmzDvQN3qDlxVJqiag8Vx6A5Pg/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"><span style="color: black;">吴晰 教授</span><span style="color: black;"><strong style="color: blue;">
            <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">中国医学科学院北京协和医院</p>
      </strong></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">阅读要点提示</strong></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1. 内痔内镜下微创治疗的<strong style="color: blue;"><span style="color: black;">5个适应证</span></strong>；</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2.&nbsp;<strong style="color: blue;"><span style="color: black;">图解图说</span></strong>：<span style="color: black;">区别</span>适应证在临床<span style="color: black;">实质</span>操作中的差异。</span></p><span style="color: black;"><strong style="color: blue;">痔的<span style="color: black;">干涉</span>指征</strong></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">痔<span style="color: black;">是由于</span>血管丛<span style="color: black;">构成</span>的，<span style="color: black;">按照</span>部位，以齿状线为界，痔可分为内痔、外痔和混合痔。内痔俗<span style="color: black;">叫作</span>肛垫，是<span style="color: black;">拥有</span><span style="color: black;">要紧</span>生理功能的人体<span style="color: black;">必须</span>结构。<span style="color: black;">按照</span>内痔局部充血、是否脱垂及脱垂程度可进行Goligher<span style="color: black;">归类</span>。<span style="color: black;">没</span>症状的内痔<span style="color: black;">没</span>须治疗。内镜下微创治疗以缓解症状为目的，而非痔体<span style="color: black;">体积</span>的变化。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">日前</span>内痔内镜下微创治疗的常用<span style="color: black;">办法</span><span style="color: black;">包含</span>内镜下硬化治疗、套扎治疗和红外线疗法（IRC）等，其中在中国<span style="color: black;">重点</span>是内镜下硬化治疗和套扎治疗。<strong style="color: blue;"><span style="color: black;">二者的适应证类似，即为</span></strong>：</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">①&nbsp;</span><span style="color: black;">Ⅰ-Ⅲ度内痔伴有内痔<span style="color: black;">关联</span>症状</span><span style="color: black;">；</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">②&nbsp;</span><span style="color: black;">Ⅰ-Ⅲ度内痔经<span style="color: black;">膳食</span>及<span style="color: black;">药品</span>等保守治疗<span style="color: black;">没</span>效</span><span style="color: black;">；</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">③&nbsp;</span><span style="color: black;">内痔手术后复发，肛门反复手术后<span style="color: black;">不可</span>再次手术</span><span style="color: black;">；</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">④&nbsp;</span><span style="color: black;">高龄、高血压、糖尿病和严重的系统性<span style="color: black;">疾患</span>，<span style="color: black;">不可</span>耐受外科手术</span><span style="color: black;">；</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">⑤&nbsp;</span><span style="color: black;">不愿接受外科手术</span><span style="color: black;">。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">注：</span>Goligher<span style="color: black;">归类</span>Ⅰ-Ⅲ度分别为：有<span style="color: black;">显著</span>血管充血、但不脱垂，<span style="color: black;">或</span>用力时脱垂、但可<span style="color: black;">自动</span>还纳，或用力时脱垂、<span style="color: black;">不可</span><span style="color: black;">自动</span>还纳、需人工还纳者。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">&nbsp;为了方便学习，<span style="color: black;">以上</span>内容已整理成<span style="color: black;">照片</span>，供<span style="color: black;">大众</span>截图<span style="color: black;">保留</span>&nbsp;</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/siaSz3zztouUa9jlNyM9iahq5cefwSBWF7yeLQZ5v7ZbZl13Svbn5nBLj5yR13xicPfsd9QjAINLmM7vpS6lJqA2g/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">图1&nbsp; 内镜下硬化治疗和套扎治疗的适应证</span></p><span style="color: black;"><strong style="color: blue;"><span style="color: black;">区别</span>适应证在临床<span style="color: black;">实质</span>操作中的差异</strong></span>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">虽然Ⅰ-Ⅲ度痔内镜下硬化与套扎治疗适应证<span style="color: black;">类似</span>，但在<strong style="color: blue;"><span style="color: black;">临床<span style="color: black;">实质</span>操作中还是有<span style="color: black;">必定</span>差异的</span></strong>，下面分别列举：</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">① <span style="color: black;">通常</span><strong style="color: blue;"><span style="color: black;">以<span style="color: black;">流血</span>为主的内痔</span></strong>更适合内镜下硬化治疗（图2~图6）。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/siaSz3zztouUa9jlNyM9iahq5cefwSBWF7YpOCUwN5iadzAWcIu6OfsR4C0H52qtibDPms0cy4nB08b8L3VF8NHovQ/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">②&nbsp; 以<span style="color: black;"><strong style="color: blue;">脱出为主的内痔</strong></span>更适合套扎治疗（图7~图10）。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/siaSz3zztouUa9jlNyM9iahq5cefwSBWF7vCjicueeIdnoAI8MnefrEKLhzXZSJaI6LSdAhzqtLvvTakH0sYsg5zA/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">③&nbsp; <span style="color: black;">倘若</span><span style="color: black;">病人</span><span style="color: black;"><strong style="color: blue;">既有<span style="color: black;">流血</span>又有脱出，<span style="color: black;">能够</span><span style="color: black;">选取</span>套扎治疗，<span style="color: black;">亦</span><span style="color: black;">能够</span><span style="color: black;">选取</span>套扎联合硬化治疗</strong></span>。在临床<span style="color: black;">实质</span>操作中，可大体将以上适应证做简单的区分后采取相应治疗<span style="color: black;">办法</span>，术后并发症<span style="color: black;">显现</span>少而轻，且远期疗效<span style="color: black;">亦</span>较好（图11~图15）。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/siaSz3zztouUa9jlNyM9iahq5cefwSBWF7r62rVHQ3fQwLGaBvbicTmD8qyoe5n28FIIeZpAeyV2oR0m39lZTzNhg/640?wx_fmt=png&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">有症状的外痔、内外痔混合伴有脱垂（Ⅲ-Ⅳ度）</span></strong></span><span style="color: black;">的<span style="color: black;">病人</span>，更适合外科痔手术治疗。血栓性外痔<span style="color: black;">病人</span><span style="color: black;">初期</span>手术治疗尤其<span style="color: black;">能够</span>获益。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">作者：中国医学科学院北京协和医院&nbsp; 吴晰教授</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">照片</span>：内蒙古自治区人民医院内镜中心分中心（准格尔旗大路医院）&nbsp; 张明<span style="color: black;">专家</span></p><strong style="color: blue;">互动问答</strong>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">【说说您的看法】</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">针对既有便血又有一个痔核严重脱垂的<span style="color: black;">病人</span>，<span style="color: black;">能够</span>硬化+套扎<span style="color: black;">一块</span>做吗？<span style="color: black;">那样</span>是先做硬化还是套扎？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">请在评论区写下您的答案。<span style="color: black;">这次</span>活动<span style="color: black;">时期</span>，积极参与互动的老师，将有机会<span style="color: black;">得到</span>惊喜礼物哦~</span></p><strong style="color: blue;">上期<span style="color: black;">专题</span>反馈</strong>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">问题→&nbsp;</strong>&nbsp; 高血压、糖尿病等慢病对内痔内镜下微创治疗<span style="color: black;">是不是</span>有影响？</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">参考解析：</strong><span style="color: black;">根据</span>指南，<span style="color: black;">通常</span>没太多的影响，只是<span style="color: black;">必须</span>在围手术期<span style="color: black;">掌控</span>好血压和血糖以及由此<span style="color: black;">引起</span>的相应的并发症。</p><img src="https://mmbiz.qpic.cn/mmbiz_gif/siaSz3zztouUa9jlNyM9iahq5cefwSBWF77wvsEaS8NYicrEnCL2dQnnIS8QYWj0j68mPFtocAm0iapw8f5ia6z4wrQ/640?wx_fmt=gif&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1" style="width: 50%; margin-bottom: 20px;"><span style="color: black;">感谢内蒙古自治区人民医院内镜中心分中心（准格尔旗大路医院）张明<span style="color: black;">专家</span>为本期主题精心准备的互动内容，感谢赵贵君教授对内容把关</span><img src="https://mmbiz.qpic.cn/mmbiz_gif/siaSz3zztouUa9jlNyM9iahq5cefwSBWF77wvsEaS8NYicrEnCL2dQnnIS8QYWj0j68mPFtocAm0iapw8f5ia6z4wrQ/640?wx_fmt=gif&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1" style="width: 50%; margin-bottom: 20px;">
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">声明:本文系转载,仅<span style="color: black;">做为</span>传递知识,版权归原作者所有,硬化网不<span style="color: black;">表率</span>作者立场</span><span style="color: black;">（如有侵</span><span style="color: black;">权</span><span style="color: black;">，请联系删除）</span></p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/siaSz3zztouX24mOnGgF1qUrXIBWBbnppsW4XWfU8s5ES7ZWUvnUsUKcLDoUmGibBtJpVL9JV1a7mxv3MScJ6Afw/640?wx_fmt=jpeg&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1&amp;tp=webp" style="width: 50%; margin-bottom: 20px;">




nykek5i 发表于 2024-9-29 13:18:26

期待楼主的下一次分享！”

4zhvml8 发表于 2024-10-1 12:54:46

你的见解独到，让我受益匪浅，非常感谢。

wrjc1hod 发表于 2024-10-18 01:02:11

回顾历史，我们感慨万千；放眼未来，我们信心百倍。

wrjc1hod 发表于 2024-11-14 11:28:53

你的见解独到，让我受益匪浅，期待更多交流。
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