Medical Marijuana, The Truth!
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Gastroscope operates a result (2009-2-21)
Zhong Dejin
(one) the method that take looking glass
1, hold mirror: Before bosom of left hand park, left hand is held inside the operation ministry of lens, carry operation department erect condition, with tiger‘s mouth-jaws of death
The force of the ministry that reach wrist is propped up inside lens, hold with left hand ring finger and little finger only grasp inside lens operates a department, do not catch hold
Too close, stress the flexibility that has held urgent meeting to affect an operation; Adjust with left-hand big toe and middle finger and ring finger big
Small knob, two point to the stability that cooperates to maintain knob, with preventing picture jitter influence observes (adjust small
The rock range of the eye shot when knob is very big, can use rotate lens body is replaced) ; Left hand middle finger uses control water supply,
Give energy of life, control of left hand forefinger attracts pushbutton, at the same time control is frozen image and remove freeze; To prevent
Excessive aspirated, can control two pushbutton with forefinger merely, put index finger in attract pushbutton to go up.
The right hand runs tube department, the advance and retreat of the lens inside control, can assist at the same time rotate lens body, rotate when left hand
When operating a department, the right hand cannot be grasped had held close, otherwise lens body front cannot rotate; When the left hand when dextral lens body
When can no more rotating right, can push lens body with right hand towards the left the tube ministry outside body is dextral perhaps of lens body
Tube ministry, dextrorotation can be assisted on certain level; Same handle is put make the same score or cannot when Zun Xuan, can
Go up right with the right hand the body that pull lens the tube department outside body is wrong perhaps the tube ministry of body of lens coming back, can be in certain level
Go up in order to assist Zun Xuan; If want to rotate to or so direction, also can rotate with the right hand temporarily.
The right hand catchs the body that hold mirror to should not be less than 15cm, with 20 ～ 30cm advisable; Its advantage has 2, above all,
Before gastroscope inserts esophagus, grasp the right hand that holds gastroscope tube ministry to need not change the position; Catch had held brief meeting to bring about inside
When lens just enters esophagus, the right hand has touched shut up mat, must change hands changes lens, such meetings make just be entered
The emergence of gastroscope tip ministry that enters esophagus comes; Grasping another good point that runs longer tube department is, although be in mouth
What antrum or pharynx ministry existence fail to expect is counteractive, because inside lens oneself has flexibility and flexibility, also can prevent
Give by check person the happening that brings anguish and risk.
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Before we are moving knob, must understand the position of oneself lens body: Whether had happened to rotate with
Reach rotated how many degrees, the fluctuation left and right sides of knob is to show lens body is in whack to did not produce any whirl
The athletic way when perhaps retroflexioning. The circumstance after happening to rotate to perhaps retroflexion is about specific issue is specific cent
Analyse. Of course, to image character Up when move downward by upper part, lens body bends on tip ministry;
Left moment image by left move right. Towards the left of ministry of lens body tip bends.
Abide antrum has 2 skill into lens: A, advance along small curved side as far as possible, anguish is small, arrive at pylorus lens body
Short; Body of right handgrip lens is light when B, advancement push to glossal extent direction pressure, the epiglottis that reduces lens body and pharynx rear wall and
The contact of uvula, the patient is unwell reaction is little.
2, the operation that pharynx ministry enters the mouth to esophagus: Epiglottis cartilage can see after gastroscope passes glossal root, visible now and then vocal cords,
Esophagus entrance is in normally close position (esophagus mouth is located in bail condition epiglottis to folds in a garment of cartilage of two medium small part
Between rear, refer to next graphs) , because the patient is taken commonly left lie, inside majority of lens tip ministry is natural from below
Pharynx ministry is left enter, should drive for the target with recess of left pear shape inside lens is ongoing, from tubercle of left wedge shape
Clearance back side begins to in the center of (clockwise) Bian Xuan turns the edge is inserted gently, enter esophagus entrance very easily.
In the process that inserts esophagus entrance, at hand can feel slight resistance, when entering the mouth through esophagus, but
In order to see the blood capillary of straight travel, these take a way hemally is our direction that take looking glass, inside lens first
The person that carry the art after the ministry enters the mouth through esophagus can have " come to nothing feeling " .
4 pictures are under inside the sketch map that lens sees to pharynx ministry place from oral cavity, c graph arrowhead indicates for
Epiglottis, d graph line indicates by on to below ordinal for: Vocal cords, sound foldses in a garment, pear shape nest, wedge is nodal.
Attention: We are the direction that take looking glass with recess of left pear shape, but not be true enter pear shape pit,
Just inside the left predestined relationship that lens foldses in a garment to bail condition epiglottis a bit tilts can (the small part cartilage in pointing to bail condition epiglottis to folds in a garment
With the wedge tubercle) between wedge shape cartilage, inside the position that lens tip ministry supports finally is wedge tubercle, next in a way
Dextral while advance inside lens is OK very easy enter esophagus; If inside lens enters pear shape pit really
Can do not have eye shot, and have particular risk, below pear shape nest and esophagus paragraph perforative (see more at side-glance
Lens is operated) 50% what occupy entire bore a hole; When carrying pharynx department because of the lens inside this cannot excessive forcibly, direct and forward
Advance inside lens also is danger, and succeed not easily, should advancing inside lens while gently rotate right
(suitable hour hand of handle of left hand operation rotates) , before dextrorotation can gently Down. Some handlers habits are connected
When crossing pharynx ministry drive up left hand, actually such operation and dextral result are same, it is to make
Inside the tip ministry of lens is slight and dextral. Summary rises even if: Left hand first slowly Up, after seeing pear shape nest (much
Take left) , light Down of left handle gently, lens body front touchs wedge tubercle, the action that has appreciably dextrorotation (in
When looking glass is being taken on the right side of a bit Zun Xuan can be entered) , at the same time jog of right handle gently sends a mirror. Inference -- to passing by
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The narrow esophagus that causes at pathological changes when, also can use this method, point to ministry of lens body tip tubal antrum,
Encounter in the process that advances ahead lens body can rotate to be advanced ahead at the same time at the same time when having resistance inside lens,
Often can carry narrow department smoothly, and safer. Because of the process that advances simply ahead in,
Place getting power is one is nodded merely, and rotate when advancing can the force cent that will be centered so
Come dispersedly, because this compares safety, and rotate driving power also compares the power that boosts simply big, and
Can make tip him ministry of lens body seeks the way taking looking glass of the easiest dilate.
Cartilage of esophagus mouth small part
3, when to let patient deglutition; Need not use usually let a patient make deglutition motion, next orthoptic insertion can;
Esophagus mouth is located in bail condition epiglottis to folds in a garment cartilaginous of two small part is rear, be in normally close position, insert difficulty
When, want when inside when lens front carries the wedge tubercle in pharynx ministry on the head, right hand push sends inside lens makes inside lens front has
The patient lets make deglutition motion again after certain resistance, the take advantage of an opportunity when the ministry that wait for pharynx is stretched sends inside lens enters esophagus; Because
Deglutition movement causes systole of muscle of ministry issueing pharynx, lens is met inside by natural oriented and right way, at the same time deglutition
Esophagus enters the mouth when ministry instant open, feeling of pharynx ministry resistance disappears, inside mirror by inspiratory and same enter cervical esophagus.
Attention: From inside the tip ministry of lens touchs esophagus to enter the mouth through esophagus (esophagus the first stricture) before
When, classics regular meeting has flashy the antrum that we cannot see those who make clear is clear, how to judge me at that time
People the way that take looking glass is right it is very important, at this moment, we are OK with us in eye shot straight
The little blood vessel of travel serves as our direction that take looking glass, should seeing straight travel blood-vessel can decide lens body only is to be in feed
The canal is medium; If see is ruleless in eye shot meshy blood capillary, so lens body is to be touched in certainly
Inside pear shape nest, inside the resting room that still one kind may take esophagus upside namely, had better remove looking glass
Enter afresh; If one sees in eye shot cadaverous ashen perhaps cricoid structure, that is entered namely tracheal in
Face, must remove looking glass immediately.
4, pass esophagus: After lens inserts esophagus inside (after be apart from fore-tooth 15cm) , can the edge pours vital energy, observe esophagus antrum has
After having stricture and other pathological changes, the edge passes gastroscope, be in commonly be apart from fore-tooth 40cm to control (38cm ～ 42cm)
See the dentate line of cardia and upper part, in cardia open position falls to insert gastroscope gastric body, attention: Be in still
Esophagus can be not attracted absolutely before doing not have esophagus varicosity certainly inside mucous, second liver is electropositive patient blame
Its should notice.
About a few numerical value of esophagus: Average length makes an appointment with adult esophagus 20 ～ 25 centimeters, make an appointment with a diameter on average 2
Centimeter, esophagus has area of stricture of 3 physiology sex: Area of stricture of sex of the first physiology is esophagus entrance to be in (be equivalent to
C6 level) , distance of the tine that be apart from the door makes an appointment with 16-17 centimeter; The 2nd stricture gives priority to A bend to reach left advocate bronchus over or across
The wall before esophagus is in, be apart from fore-tooth to make an appointment with 26-27 centimeter; The 3rd stricture crosses midriff flesh to crack aperture to be in for esophagus (quite
At T11 level) , be apart from fore-tooth to make an appointment with 40-45 centimeter; The heart causes esophagus to oppress be apart from fore-tooth commonly 35 li
Rice, be equivalent to right atrium place, esophagus moves wrestle to also insert electrode to here. Additional, upside bosom esophagus
Be oppressed by rear vertebra, the superiority that shows the pattern rises and fall, can help rear wall of fixed position esophagus.
5, after entering a stomach, continue to pour vital energy, after opening gastric system, one arc mark is seen in gastric body upside, (when inverting relatively easily
Observation) its are right upper part is ministry of Long of the dome end the stomach, wrong lower part is gastric body ministry. Should not be beyond the mark right now aerate, otherwise
Enter pylorus to be able to compare difficulty.
6, through bottom of cardia, stomach, enter gastric system: When gastroscope passes cardia, antrum wanting abide takes looking glass, right now antrum is in
Pear shape nest
Vocal cords
Pear shape nest
Shape nest
Tracheal
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The wrong lower part of eye shot (before be like two pictures) , adjust towards the left of curved horn button (body of Zun Xuan lens) , downward (Down)
Can make inside lens enters gastric system; Can the vertical travel that abide bends side greatly is knitted folds in a garment for guide, but knit with big turn folds in a garment for
When guide, want to pass mucous lake commonly, cut the space that wants to go further also, should as far as possible along small turn
Side is ongoing, odds of such wall of stomach of lens body contact are small, patient anguish is small, and body of the lens when arriving at pylorus is short.
Specific operation method is -- big button is pushed ahead (Down) , subsequently Xiaoniu is hit downward (Left) , dozen come back
The opportunity with specific button and degree want with seeing well antrum is a standard. Of course such operation movement scope is less,
The pose is more beautiful, but the difficulty in be being operated actually is greater.
Simpler and commonly used practice is commonly -- handle of left operation coming back adds Up big button at the same time, such
the operation is simpler, master easily, at the same time drive up holds the right hand of ministry of tube of the body that hold mirror, in order to make up for Zun Xuan
Insufficient.
The viewpoint of Mr. Liu: Sinistral makes operate handle to put at the same time smooth, can make size two knob at the same time
The direction to him handlers is hit, two knob are pressed below thumb namely, compare save effort so. My understanding:
When we just enter gastric system, antrum is the wrong lower part in eye shot commonly, our purpose is to should make
Lower part of towards the left of lens body front is moved, want body of left lens coming back to be down so (Down) , this affirmation does not have a problem, liu is old
The practice of division is: Left hand is put smooth (be equivalent to lens body Zun Xuan 90 degrees) , at that time Up became towards the left, below
Press small knob (L) became downward, final result or lens body front get lost wrong lower part. I feel
Zun Xuan operates a department or Down, it is easy to perhaps put body of flat looking glass as Up.
We still look at a graph to tell a few more convenient, structure of cardia seeing Qing Dynasty (go up graph 1) , in a way is pushed
Into inside we can see looking glass on graph 2, can see gastric antrum is in at that time wrong lower part, abide antrum takes looking glass, zun Xuan is addedThe purpose of Up is to pass cardia (otherwise the tip ministry of lens body is in with respect to meeting top cardia small turn, pursue on 3, 4) , through
After cardia immediately dextral (pursue as follows 1) , can see gastric antrum is in at that time right upper part, gastroscope has been entered
Entered gastric system (next graphs 2, 3, 4) . If do not have seasonable dextral restoration,pass cardia hind, can turn
The stomach went inside bottom antrum, best in that way in a way is regressive, take looking glass anew again next.
7, adopt gastric system: After entering gastric system, abide antrum takes looking glass, the right upper part that right now antrum is located in eye shot (after as above pursues 2
) , the vertical travel that best abide bends side greatly is knitted folds in a garment for guide, rotate right lens body, make inside lens restores normality, hand
The handle turns into erect perpendicular grow an axis at the patient, to gastric body bottom hind moves big Niu Xiang to go up (Up) , gastroscope is in mucous
Small curved side adopts system of stomach of edge of lake upper part, do not want immerge as far as possible mucous lake, make gastroscope enters gastric antrum ministry. Notice 1:
If black lens body sees in taking looking glass, state gastroscope has inverted in gastric bottom, can retreat lens to fall to cardia right now
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Square, adjust directional hind to be inserted again, cannot invert too much in gastric bottom, cause a patient unwell; Notice 2: Avoid
Dismiss occurrence view aglow, the tip ministry of the lens inside aglow specification supports occurrence view gastric mucous membrane, at this moment of the patient
Disgusting, unwell feeling will be aggravating, the method of processing removes looking glass only or aspirated, after seeing well, undertaking below
operation, cannot operate blindly. Notice 3: When seeing there is deeper ulcer inside gastric body, be about
Measure little aspirated, when passing, avoid to come up against the hematic scab above ulcer. Notice 4: Suspect the patient of haemorrhage,
Enter a stomach inside hind the picture that must take a piece of mucous lake first.
8, of gastric antrum ministry through: The gastric antrum of ox horn stomach and gastric body are linear almost, it is very easy to take looking glass; Of falcate stomach
Gastric antrum and gastric system are almost parallel, must puissant adjustment on big Niu Xiang, push send gastroscope to just can enter gastric hole (into
Lens may see pylorus is far from eye shot gradually from time to tome, but continue to be able to enter pylorus into lens) ; Enter
Should make pylorus mouth maintains from beginning to end after gastric antrum in the center of in eye shot, so that advance inside lens enters ball ministry.
10, of pylorus and duodenum through: Essentials: Follow pylorus -- use adjust knob and rotate lens body, make
Pylorus maintains from beginning to end in the center of in eye shot. The affection with open condition and normal peristalsis of gastric antrum ministry is in in pylorus mouth
Besides below, want to aim pylorus mouth to take looking glass only, can pass pylorus; Be like pylorus lock, gastric antrum wriggles relatively
Acuteness when it is more difficult to enter ball ministry, right now enjoin patient breathes calmly, adjust horny button to make gastroscope carries ministry front
Aim pylorus mouth, stand by to pylorus as far as possible, want pylorus not to have pathological changes only, in clingy pylorus mouth at the same time pylorus
Can natural open. In pylorus open circumstance falls, when passing pylorus, art person can have " come to nothing feeling " .
Mr. Liu ana: 1, enter pyloric little skill: When entering pylorus difficulty, can first a little
After removing looking glass first as far as possible inspiratory (because the gas inside the stomach is more, jump over difficulty through pylorus) , next, alignment
Pylorus is advanced inside lens, if pylorus is in the process that advances ahead,produced deflection, we must remember deep and remote
The direction of door deflection, back down again next lens body, when pushing lens body ahead again, want to be being advanced
Lens coming back perhaps makes the proper to pylorus deflection way in the process small knob, the purpose follows pylorus namely, this
The successful rate that appearance makes can rise greatly. 2, knock law: The person that enter pylorus difficulty is usable knock law -- in
Gastroscope of advance and retreat relapses a few times before pylorus, stimulate its plant god has food to come via making its think and diastole pylorus,
Can seize the opportunity to advance gastroscope to pass pylorus.
If do not have eye shot,pass pylorus hind, clew gastroscope is clingy the wall before ball ministry, but in a way recedes lens pours vital energy
Or affusion, (body of right hand handholding lens, maintain the distance between the right hand and buccal mat changeless, lens body is perpendicular at the patient
X-axis prevents lens body front slippery antrum giving a ball) can see duodenum ball antrum 4 walls. Eye shot before ahead is
Wall, it is the place that duodenum ball ministry observes the most easily, also be good hair place of ulcer; The upper part of eye shot
It is small turn (inside the ball if the liquid is put,stay to be able to be put take Yu Xiaowan side) , the lower part of eye shot is big turn, show not
Clear when OK and slight adjustment knob (Down/up) , big button of general upward adjustment (Up) can observe
Small curved side, move big knob downward (Down) can observe big curved side; What rear wall is located in eye shot is right, show
Show not clear when be retreated later and rear wall of dextral and considerable examine, perhaps can observe rear wall when exit, hind
The wall also is good hair place of ulcer, observation must careful, but, when the observation that remove looking glass, have a bit inadvertent
Meeting emergence, still must take looking glass 2 times.
As above pursues the first pair of place is shown, aim pylorus, the picture that we see is the 2nd graph, at this moment
If place of the 3rd picture is shown,await; Push ahead send gastroscope, if enter just good word, we can be entered
Of goal ministry before wall, namely the 4th picture. If you are advanced overmuch word, pursue as follows
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A pair of place is shown, the tip ministry of gastroscope is in with respect to meeting top of duodenum before wall, 2 what you can see next pictures
Picture -- eye shot a red (similar just, this picture is to be taken an examination of nearlier merely, still do not have
The wall before the top arrives) ; At that time we want in a way to recede only lens, following graphs are shown 3 times, OK clearly
The wall before seeing what the graph shows 4 times.
Following it is the picture that is ball ministry, arrowhead indicates to go up for duodenum horn.
11, enter duodenum to fall through the horn on duodenum paragraph: After gastroscope enters ball ministry, see the role on clear duodenum
Hind, right now antrum is in commonly the right upper part of eye shot, rotate right lens body (suitable hour hand changes direction, must sufficient
But not beyond the mark) , adjust horny button right (left hand is sufficient and dextral replaceable horn Niu Youxuan, and dextral
It is easy to should compare dozen of small knob) reach up (slow Up keeps changeless after all) , here the process is pleasant to the eye
Had succeeded with respect to the specification to brightness -- through the horn on duodenum, enter duodenum to fall paragraph. Rotate
opportunity: Go ahead lens is in to the horn on duodenum of eye shot on the right side of when will disappearing, can fill
Cent dextrorotation adds Up, see shining place arrives namely.
Enter fall the method with paragraph of succeed ongoing add: Mr. Liu ana: After carrying the part on duodenum, maintain
Knob position, aerate while carry backward pull, take straight lens body, gastroscope is pulled inside the stomach straight when meet from
Move enter fall a far end. The observation of the tit: To see clear duodenum tit, can be in through ministry hind
Push lens body ahead at the same time a little Zun Xuan, can see duodenum tit, the moment that remove looking glass also can be watched
Examine arrives tit, but cannot observe carefully commonly and take a picture; Suspect a tit pathological changes, and before the observation that inspect looking glass not
Clear when can change duodenum lens observation. Attention: If be in,enter fall Duan Qianfa has duodenum ball
The wall has ulcer before, do not enter constrainedly fall paragraph, because the operation is undeserved, violent operation moment is caused extremely easily
Perforative, want to complete an inspection quickly, aerate not overly also, lest cause perforation, can check after cure
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Observe again when fall ministry.
We look at a picture to explain, after gastroscope enters ball ministry, pursue on 1 is shown, look clear 12 point to
After the horn on bowel, right now antrum is in commonly the right upper part of eye shot (on graph 2) , in a way pushs lens body ahead (on graph
3) , be in to the horn on duodenum of eye shot on the right side of when will disappearing (on graph 4) , rotate right lens body
(next graphs 1) , see in this process brightness carries the part on duodenum with respect to the specification, enter duodenum to fall
Paragraph (next graphs 2) . After carrying the part on duodenum, hold knob position, aerate while pull backward straight
Lens body, gastroscope is pulled inside the stomach straight when can enter automatically fall a far end (next graphs 3, go up quite graph 3
More be clear at a glance) . If be pushed ahead,send lens the body right now, body top is in lens to bend side greatly, operate not only not square
, and the patient can be borne hard (next graphs 4) .
(2) observation method
1, duodenum falls paragraph: Duodenum mucous membrane is annular knit folds in a garment, the small intestine that shows a pattern manages antrum construction, but than
Of jejunum knit folds in a garment want bounty a few (finish the output of operation of collect II type paragraph and input paragraph of jejunum that is a model to written guarantee
Compose) , the attention makes full use of adjust the Niu Ji that bend horn to note the method such as gas, avoid lens face to stick a wall to make view not clear. In
Below groovy circumstance, the terminus that the lens inside enteron checks on falls for duodenum paragraph, if doubt has duodenum breed
Head pathological changes, lens is inspected to also can observe the flank of the tit resembles before, but if observation is dissatisfactory, can change with 12 point to
Alvine lens is checked. Gastroscope falls by duodenum paragraph when exiting, want as far as possible edge adjustment knob at the same time measurable
Rotate lens body, one by one is knitted folds in a garment have careful observation, avoid as far as possible at a draught from fall face emergence comes to Duan Li.
2, fall of Duan Sibi name: It is position level with the tit, duodenum tit and vertical travel knit a side of place foldsing in a garment
For inside measure a wall, its are right the sidewall outside side, the wall before be between both and rear wall, the clockwise is ordinal for: Inside
Measure a wall, before wall, outside sidewall, rear wall. Horizontal fixed position also is with duodenum the tit is a standard, make the same score a tit,
Below the tit (go up) ××cm level. The duodenum below falls paragraph the vertical travel of the picture knits a wall to all be in on the right side of.
But the whirl as lens body, its each wall also can be changed subsequently in the position in eye shot.
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3, duodenum ball ministry: Lens can observe ball ministry through pylorus inside (refer to the part that take looking glass) , when removing looking glass, become inside lens
Retreat to pylorus predestined relationship, the wall before ministry of the ball after in a way pours vital energy is namely in eye shot, the upper part of eye shot is small turn (be like inside the ball
The liquid is put stay to be able to be put take Yu Xiaowan side) , the lower part of eye shot is big turn observation can have in pylorus mouth, show
Show not clear when OK and slight adjustment knob (Down/up) , big button of general upward adjustment (Up) can
Observe small curved side, move big knob downward (Down) can observe big curved side; What rear wall is located in eye shot is right,
Show not clear when be retreated later and rear wall of dextral and considerable examine. Clew: Prevent lens body automatic " slippery piece "
The method of ball antrum is: 1, the right hand holds lens body to secure, maintain the distance between the right hand and buccal mat changeless. 2,
Lens body is perpendicular patient body x-axis goes out with making lens body cannot slip. Following graph blue arrowhead indicate the wall before be, black
Lubricious arrowhead indicates for rear wall, the wall before be respectively between both reachs rear wall.
4, ball ministry of 4 walls name: Similar stomach ministry, namely before wall (eye shot is left) , rear wall (on the right side of eye shot) , small turn
(eye shot upper part) reach big turn (eye shot lower part) .
5, the observation of gastric antrum: It is a center with pylorus, adjust curved horn button observes gastric Dou Sibi respectively (of eye shot on, below,
Left, right the small turn that is gastric antrum respectively, big turn, before wall and rear wall) , namely before wall (eye shot is left) , rear wall
(on the right side of eye shot) , small turn (eye shot upper part) reach big turn (eye shot lower part) ; Be like small turn cannot all peek
(pursue as follows 3) , can bend gastroscope edge side to make greatly invert observation. Method: On the Niu Xiang that bend horn (Up) , advance
Gastroscope (undertake at the same time into lens and Up) , the side of small turn of observation stomach antrum that can understand (pursue as follows 4) . Observation
Should observe whether each wall is normal not only when gastric antrum and pylorus, observe pylorus is opened even shut motion to reach whether to have 10
The functional sex such as countercurrent of 2 fluid pointing to bowel is changed. Pylorus position change is little, observe more easily, horn of Dan Xiaowan close stomach
Place should invert sometimes observation, the observation of around wall can adjust little button towards the left or observe right, also can lean
Rotate lens body will come true.
6, the observation of gastric horn: Gastric horn is become by small curved fold, it is more difficult that lens is inspected to observe before. Can use in gastric antrum ministry low
Turn over facing (making bend horny Niu Xiang to go up as far as possible to pylorus to have a common boundary of gastric antrum body into lens, advance gastroscope can,
Undertake at the same time into lens and Up) , see two antrum, upper part is gastric body cavity (visible lens body) , lower part is gastric antrum
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Antrum (visible pylorus) , of have a common boundary cut mark to cut mark for gastric horn namely (institute of before be like two plans is shown) , of eye shot left for
Before wall, rear wall is on the right side of, gastric part part is small turn, gastric horn is big turn to side, around wall span becomes factitious 5cm
Or so; Retreat when gastroscope to the bottom in gastric body when, can make openly observation to gastric horn, visible one vaulted cut mark namely
The horn that it is a stomach (hind two graphs orchid color arrowhead indicates) .
The skill that retroflexion: When ministry of lens body tip is located in boundary of gastric antrum body (even if big curved side knits disappear foldsing in a garment all right
The place that lose) , left hand big toe hits big button downward at the same time (Up) , at the same time the right hand slowly push ahead send inside lens,
Lens body can retroflexion naturally come over, can see gastric role clearly, in retroflexion can see black
lens body and gastric antrum and gastric body two antrum. Notice 1: Up and must undertake at the same time into lens, otherwise cannot
Implementation retroflexions. Notice 2: Before retroflexioning, should aerate make gastric antrum plentiful, aerate undesirable gastric antrum also is very difficult
Invert, diffuse infiltration cancer of the stomach (leather stomach) the patient often aerates outspread and undesirable, very difficult implementation breaks up
Turn.
7, the observation of ministry of gastric bottom, cardia: Should observe gastric bottom (arched roof ministry) need to invert observation, have two kinds of methods:
1) , low turn over facing: Invert in gastric antrum namely after watching gastric part (refer to the operation in front) , continue to push
Change a stomach to body cavity namely into gastroscope lens face, cardia is seen far after spending dextrorotation gently (before dextrorotation first Zun Xuan bypasses
After gastric horn again dextral) , carry backward pull gastroscope, body of stomach of the most good-looking Qing Dynasty is carried again after small curved side pull gastroscope, before gastroscope
Small curved side raises put oneself in another‘s position of the stomach that carry an edge pull to gastric bottom, small curved side is in the upper part of eye shot, big curved mucous lake is in of eye shot
Lower part, such gastroscope front won‘t invade mucous lake in, compare safety so, 2 will won‘t be come up against
Gastric wall, the patient‘s reaction will be less -- can say to do not have disgusting reaction even, answer the body that pull lens to make lens face
Approach cardia point, can observe gastric bottom and cardia; The left and right sides rotates observation, do not omit lens back cardia small
Bend side.
Observe gastric antrum, add of gastric horn succeed pushs gastroscope looking glass ahead, at the same time the tip ministry of body of lens of big knob Up
Change a stomach to body cavity namely, cardia and gastric bottom structure are seen far after spending dextrorotation gently, following plan institute notify particular procedure.
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Dextral opportunity: Horn of the stomach in eye shot is shown at 1 o‘clock - positional moment is OK and dextral at 7 o‘clock, before dextrorotation
First after Zun Xuan confuses role crossing a stomach again dextral, right now, right now lens body rotates inside gastric body, space of gastric body cavity is large,
Won‘t encounter gastric wall, the patient‘s reaction is less, when rotating, eye shot shows anticlockwise direction to rotate, stomach
Side of body small turn turns to the upper part of eye shot; Still can be in of course gastric antrum ministry retroflexions behind lens, zun Xuan sees clear cardia
The body that pull lens is carried backward after, the ministry still can operate left hand put when Zun Xuan is insufficient smooth, can look clear likewise
Hunan stomach bottom and cardia, but often should pass mucous lake.
Notice 1: Invert when observation, when the left and right sides rotates, should make ministry of lens body tube assumes unbend position (alleged " straight "
Not be true linear, it is lens body maintains unbend as far as possible, important is the part outside the body of lens body
Should go up in same plane) , when lens body is in inflectional condition, rotate otherwise, torque is used up the Pan music outside body
On, the whirl that can affect lens body front and influence observation;
Notice 2: Invert when observation, eye shot lower part is small turn, upper part is big turn, left for rear wall, right
The wall before side is, but, invert often can accompany in the process have inside the whirl of lens, accordingly all around direction is met somewhat
Change. Below 4 graphs pursue 4 times Long of dome of the bottom that it is a stomach, the arc of lower part knits a wall to be base system dividing line its upper part is
Dome Long ministry, its play the big curved side of upside of the body that it is a stomach, lens body part and small turn are linked together, the left and right sides parts with gastric body
Around wall photograph is successive.
Notice 3: Carry backward in helping gastroscope process, cardia of bottom of stomach of OK and sufficient observation can, cannot beyond the mark
Carry backward pull, lest the patient is acuteness and disgusting when gastroscope takes off esophagus. Be like the knot on the X mating plate below
Fruit is same, occasion is bad to clear away.
Notice 4: When rotating, be like the feeling does not rotate to reach the designated position and left hand can no more rotate further, can change
The opposite height of two tactics (drive up right hand, lower left hand to be able to assist Zun Xuan, drive up left hand, lower the right hand but
Auxiliary dextrorotation) , or the right hand rotates lens body, so that OK also and rotational body rotates at left hand; Additional, to
The part outside the body of the left body that push looking glass is equivalent to dextral lens body, the part outside the system that turns lens body right is equivalent to left lens coming back
Personally.
2) , perch turns over facing: Retreat gastroscope to gastric body upside when (real operation is in the picture the position of 1
The position of upgrade of in a way retroflexions) , rotational lens body moves the Niu Xiang that bend horn to go up at the same time right, continue to push send gastroscope, this
Clingy cardia mouth is in gastroscope when invert, adjust horny button to be able to observe cardia carefully, this law is multi-purpose at work check or
Person the operation when cure.
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9, the observation of gastric body: After observing gastric bottom and cardia, can control rotate lens body sends lens observation stomach form ahead,
Look at gastric body small turn to send lens ahead, it is the best opportunity of side of small turn of observation stomach body at that time, can come back at the same time
Turn the big turn that watchs gastric system and around wall, when sending lens to arrive at antrum body have a common boundary -- see gastric role namely
Hind, left hand is loose knob, lens body relies on stretch and natural restoration, the reply arrives unbend condition, eye shot is antrum body
Have a common boundary, we are OK the edge retreats lens edge to watch gastric system.
Retreat lens to enrage body of stomach of OK and sufficient observation to bend the rear wall before reaching greatly amply at the same time at the same time, such gastric body are without
Omission observation is complete. Gastric body cavity is similar channel, mucous membrane of big curved side knits lower part folds in a garment to show a head to return written complaint all right, knit
Folds in a garment it is clear that the mucous membrane between cannot observe, must it is clear that enough gas makes its spread out ability adequately to be able to observe, fill
The standard of enough gas is mucous membrane is knitted folds in a garment it is OK to show departure pointing to shape, if knit,folds in a garment disappear, big curved mucous membrane
Spreading out completely is to aerate exceeding is behaved (excessive the patient after aerating is abdominal distension bear hard, disgusting reaction is aggravating) ,
The continuance ministry that small turn of gastric body upper part is gastric horn (but small curved observation is bad at that time, but in front we already
Passed via observation) , the wall before controlling what be gastric body respectively reachs rear wall, can adjust the rear wall before Xiaoniu observes, also
Can rely on rotate the rear wall before lens body will observe. Following plan institute are shown, big turn, rear wall, before wall, small turn is not had
Omit.
Gastric body can be divided relatively to go up, medium, bottom, mid call perpendicular department again, as a result of its rear wall and gastroscope
The face shows tangent concern, consequently Yi Wei leaks pathological changes, can adjust curved horn button to observe right, but some moment this
The effect of appearance is not very good, our practice is at the same time dextral lens body, at the same time Up big button, make lens body first
Upright ministry slightly below inflectional condition, rotate in bottom of base system have a common boundary half weeks, can watch gastric system carefully so
Rear wall and antrum body have a common boundary, after observation ends at the same time left restoration coming back, make at the same time big button restoration, rotate process
The range that we make knob in wants with seeing well antrum is a purpose, must look at antrum to hold clear view
The circumstance falls to rotate and observe, OK also of course left observation coming back, but compare and character is not very convenient, and
The pose also is not very beautiful.
Rotate opportunity: Retreat lens to come when base system have a common boundary, should see big turn is knitted when foldsing in a garment to be far from eye shot gradually (or
Person the right rear wall that sees view appears rightward take a sudden turn when) can rotate -- right now before lens body
Carry the plane that almost perpendicular Yu Dawan is in unbend. Lens rotates by the side of gently at that time beside Up, OK
The rear wall before the gastric body that bends have a common boundary of gastric base system boundary of the body that reach an end greatly sees well. It is normal that the first pair of picture is
Observe the image when, rear wall shows not beautiful; In order of 8 pairs of pictures showed the image of different process coming back to change below
Change a course, right now rear wall can show the wrong lower part that rear wall of have a common boundary of system of base of the 8th attached drawing is located in eye shot adequately,
Moment pouring looking glass observes not clear bottom put oneself in another‘s position hands in a big Yi Ke that bend side to observe with what be clear about. Attention: The eye shot when dextrorotation
Anticlockwise direction rotates, clockwise of the eye shot when Zun Xuan rotates, with inside the direction of rotation of lens is contrary. Be like
If really we not such words, what omit a stomach very easily to bend the base system have a common boundary of the rear wall before base system have a common boundary still has greatly is ill
Change, because, pure lens observes or pouring lens to observe what think without legal principle to indicate this position.
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9, the observation of esophagus, cardia: After end stomach ministry observes, should absorb the gas inside clean stomach, in order to decrease abdominal distension (gastroscope
In be in gastric body inspiratory) , retreat gastroscope to esophagus lower part, the front observes cardia mouth, notice to observe cardia
Open close a case. Esophagus makes an appointment with 20 ～ 25cm endlong, divide into equal parts is 3 paragraphs fall in going up, esophagus lower end is esophagitis is reached
The good hair place of esophagus cancer, answer to observe carefully, white is dentate line, into interlocking shape, it is gastric ministry gland go up
Skin and esophagus scale shape are epithelial join position (SCJ) . About the mark of gastric esophagus have a common boundary: Mucous membrane of A, stomach knits a wall
Disappear several millimeter are ministry of gastric esophagus have a common boundary to 1 centimeter over place (the mark of GEJ) ; B, in water of gastric His horn
Make the same score the mucous membrane that has one infestation to knit folds in a garment to be in for gastric esophagus have a common boundary the expression inside antrum, also express gastric esophagus have a common boundary. Below
The face issues Duan Tu 4 times for esophagus, blood-vessel of its mucous membrane is before two graphic representation to even if go,be arranged more thick and fast, hind two graphs but
See dentate line. Attention: Dentate line and both of ministry of gastric esophagus have a common boundary are not same a concept, both place is compared
Relatively close, but not be same structure, former the have a common boundary that is used at describing mucous membrane, for shape of scale of esophagus mucous membrane
Epithelial columnar and as epithelial as gastric mucous membrane boundary, the position is alterable, can wait for a reason because of the disease (be like
Barrett esophagus) and produce a change; Latter uses the flesh sex connection that defines stomach and esophagus, the position is compared
Constant.
About esophagus of each wall decide: Because esophagus is,go all the time conduit, its fixed position and stomach reach duodenum
Different, the upper part of eye shot is right sidewall, lower part is left wall, left the wall before be, rear wall is on the right side of, but
It is lens body the change can produce when rotating, when be being judged hard the liquid that can remain inside basis esophagus
Will judge -- liquid retention side is left wall; Esophagus middle has left atrium to approach mark (left wall) , visible
Beating moves; Yi Ke sees bronchus approachs mark (before wall: Be apart from fore-tooth to make an appointment with 26-27 centimeter) ; Upside bosom esophagus
Be oppressed by rear vertebra, the superiority that shows the pattern rises and fall, can help rear wall of fixed position esophagus.
Mid the good hair place that is esophagus resting room should grant to notice. 4 pieces of pictures of this group are middle esophagus, blood
Form of Guan Chengshu branch is visible left advocate tracheal approach mark (before wall) , in esophagus before the wall moves toward next left going by right upper part
All right.
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10, the law with the unchangeable image inside the stomach: lens Shi Xiaowan, rear wall, big turn, before wall, small turn is to press suitable hour hand to discharge
Cloth, rotate anyhow; Invert order is arranged to be small turn when observation, before wall, big turn, rear wall, small turn
Show suitable hour hand to arrange, for instance small turn is in the upper part moment of eye shot, left for rear wall, the wall before be on the right side of; Small
Bend the lower part moment in eye shot, eye shot is left the wall before be, rear wall is on the right side of eye shot, what bend greatly is right side is
Small turn; The wall before after deciding one of big turn, small turn, can deciding and rear wall (gastric body cavity foldses in a garment with even if go,be being knitted
Fixed position is bent greatly; Gastric antrum antrum locates with gastric horn small turn; Back of gastric bottom lens and small curved photograph are successive, long of the dome end the stomach
The ministry is far from lens body part and gastric body to bend side to be linked together greatly) . Can remember so: See looking glass trade of body criterion around.
12, the attention when mucus lake attracts problem: In left lie when, gastric bottom and boundary of gastric body upside are located in inside the stomach
Lowermost place, right now gastric juice lay aside stays, call mucus lake. Want to see the gastric mucous membrane below mucus lake,
Be about to suck clean mucus lake, when attracting mucus lake, can lens is attracted also can pour lens to attract, should prevent
Stop gastric mucous membrane is sucked to cause deputy loss by accident when attracting, when be being attracted normally, attract implement sound is successive,
Can see water is in in eye shot of rock video.
Have a few problems that need an attention here:
Problem 1: Attract moment to had better make lens body parallel at fluid face, namely the half in eye shot is mucus lake half
It is gastric antrum (can see fluid enrages plane namely) ;
Problem 2: When attracting, attract implement sound should be successive, if hear,appear desultory sound
Phonic criterion is to suck gastric mucous membrane likely very;
Problem 3: The eye shot when attracting turns into gules moment, perhaps hear " attack " attract after sound implement
Sound is interrupted, be to suck gastric mucous membrane certainly, answer to stop instantly;
Problem 4: When lens is attracted, must see well attract again after gastric bottom, if gastric bottom has vein music
Zhang Ze is unfavorable attract, lest suck Qu Zhangjing arteries and veins by accident, cause on enteron massive haemorrhage (the patient of second liver positive
Should notice especially) .
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Problem 5: When attracting mucous lake: After observing gastric bottom, left-hand operates a department a little the stomach when excessive dextrorotation
Lens front namely immerge is mucous lake, can attract mucous lake; Also need not touch operation handle, right hand towards the left is pushed
The part outside the body of lens body, can have the effect of dextral lens body likewise, be helpful for attracting mucous lake, and appearance
Situation is more beautiful.
Problem 6: When to mucus the lake cannot be attracted quite, can lake of mucus of dilute of infuse clear water is rear
Observe and attract, the position that perhaps changes a patient (turn into smooth lie perhaps lie on his back, very convenient also very
Effective) , so that observe the mucous membrane below original mucus lake.
Notice 1: Low when retroflexioning the body that pull lens is carried again after spending dextrorotation gently to see side of gastric body small turn, gastric horn is in inspect
Wild in be in at 1 o‘clock at 7 o‘clock the dextrorotation when the position, side of gastric body small turn turns to the upper part of eye shot, gastroscope front along
By stomach of go back of side of gastric body small turn, gastroscope is in from beginning to end mucous lake upper part, OK and sufficient observation reachs cardia by the stomach;
Notice 2: Invert when observing gastric bottom, zun Xuan also can reach gastric end, but gastroscope front can be in mucous lake
Cross, can have when having eye shot, relatively insecure.
13, the attention about aspirated problem: Notice 1: In just enter gastric body cavity to observe not clear case falls, cannot
Blind and excessive aspirated, not only the influence passes pylorus into lens, and should have inside the stomach deeper ulcer or 12 point to
When ulcer of the wall before alvine ball very incidental perforation; When taking looking glass, in principle sees antrum does not need aspirated
, increase into the difficulty of lens not only otherwise, and the unwell touch that can add a patient; Notice 2: Spend too
The unwell move that early aspirated also meets aggravating patient; When should retreating lens to watch gastric system to send when body of sufficient and outspread stomach
Angry, have in order to observe big turn is knitted between the wall deny pathological change, when gastric antrum heaves already adequately, do not want again aspirated,
It is OK to can see well apart between drape, not was necessary to be exhibited completely smooth, otherwise the patient is met special not
Comfortable, after sufficient observation the gas inside clean stomach should be absorbed before rolling out gastric body cavity, lest cause a patient unwell;
Ambiguous moment may have view mucous add at camera lens, can water supply is rinsed, maintain eye shot clarity.
14, a few about observation special place,
About " 3 3 " problem -- the place that 3 observation are less than, place of examine of 3 easy leakage,
3 place that are held off easily, it is respectively --
3 place that observe not easily: Esophagus entrance, cardia, ball falls have a common boundary;
3 place that are held off easily: Big turn is knitted folds in a garment, below mucous lake, behind lens of gastric bottom small turn;
The place of examine of 3 easy leakage: Duodenum falls rear wall of have a common boundary of system of paragraph of inside wall, base, gastric body rear wall.
About the problem of mucous membrane have a common boundary: The place of have a common boundary of two kinds of different mucous membrane is the good hair place of early carcinoma,
Need special attention, these place are ordinal have:
Dentate line -- the place of gland of gastric bottom cardia and esophagus have a common boundary, also be gastric mucous membrane is columnar and epithelial and feed
The place of have a common boundary with scale epithelial shape of the canal;
Gastric body small turn stands by gastric horn to be in -- the place of gastric antrum gland and have a common boundary of gland of door of gastric De Ben, here also is
Good hair place of ulcer, as the accretion of the age this boundary is met go up gradually move;
Pylorus -- gastric antrum gland and place of duodenum gland have a common boundary.
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