Ii-varice ze-Esophageal/gastric ziziphumo zeziphumo eziqhubekayo ze-portal hypertension kwaye malunga ne-95% zibangelwa yi-cirrhosis yezizathu ezahlukeneyo. Ukopha kwemithambo ye-Varicose kudla ngokubandakanya ukopha okukhulu kunye nokufa okuphezulu, kwaye izigulane ezophayo azikunyamezeli utyando.
Ngokuphucuka nokusetyenziswa kwetekhnoloji yonyango lwe-endoscopic yokugaya ukutya, unyango lwe-endoscopic luye lwaba yenye yeendlela eziphambili zokunyanga ukopha kwe-variceal esophageal/gastric. Ibandakanya ikakhulu i-endoscopic sclerotherapy (EVS), i-endoscopic variceal ligation (EVL) kunye ne-endoscopic tissue glue injection therapy (EVHT).
Unyango lwe-Endoscopic Sclerotherapy (EVS)
inxalenye 1
1) Umgaqo we-endoscopic sclerotherapy (EVS):
Inaliti yemithambo yegazi: i-sclerosing agent ibangela ukudumba okujikeleze imithambo yegazi, iqinisa imithambo yegazi kwaye ivale ukuhamba kwegazi;
Inaliti ye-paravascular: okubangela ukusabela okungengomsoco kwimithambo yegazi okubangela i-thrombosis.
2) Iimpawu ze-EVS:
(1) Ukuqhambuka kwe-EV okukhawulezileyo nokopha;
(2) Imbali yangaphambili yokuqhekeka kwe-EV nokopha;
(3) Izigulana eziphinda zibuye kwi-EV emva kotyando;
(4) Abo bangafanelekanga kunyango lotyando.
3) Izithintelo ze-EVS:
(1) Izithintelo ezifanayo nezokwenziwa kwe-gastroscopy;
(2) I-Hepatic encephalopathy inqanaba lesi-2 okanye ngaphezulu;
(3) Izigulane ezinengxaki enkulu yesibindi nezintso, ii-ascites ezininzi, kunye ne-jaundice enzima.
4) Amanyathelo okusebenza
ETshayina, ungakhetha i-lauromacrol (Sebenzisainaliti ye-sclerotherapy). Kwimithambo yegazi emikhulu, khetha inaliti efakwa ngaphakathi kwemithambo yegazi. Umthamo wenaliti ngokubanzi yi-10 ukuya kwi-15 mL. Kwimithambo yegazi emincinci, ungakhetha inaliti efakwe kwimithambo yegazi. Zama ukuphepha ukuyifaka kwiindawo ezahlukeneyo kwindawo enye (Izilonda zinokubakho ezikhokelela ekuqineni komlomo). Ukuba ukuphefumla kuyachaphazeleka ngexesha lotyando, isiciko esicacileyo sinokongezwa kwi-gastroscope. Kumazwe angaphandle, ibhaluni idla ngokufakwa kwi-gastroscope. Kubalulekile ukufunda kuyo.
5) Unyango lwe-EVS emva kotyando
(1) Musa ukutya okanye ukusela kangangeeyure ezi-8 emva kotyando, uze uqalise ukutya okumanzi kancinci kancinci;
(2) Sebenzisa izixa ezifanelekileyo zee-antibiotics ukuthintela usulelo;
(3) Sebenzisa amayeza ukuze wehlise uxinzelelo lwesango njengoko kufanelekile.
6) Ikhosi yonyango lwe-EVS
Kufuneka unyango lwe-sclerotherapy olune-multiple de imithambo ye-varicose inyamalale okanye inyamalale, kunye nesithuba seveki e-1 phakathi konyango ngalunye; i-gastoscopy iya kuhlolwa inyanga e-1, iinyanga ezi-3, iinyanga ezi-6, kunye nonyaka o-1 emva kokuphela konyango.
7) Iingxaki ze-EVS
(1) Iingxaki eziqhelekileyo: i-ectopic embolism, isilonda somqala, njl.njl., kwaye kulula ukubangela ukutshiza igazi okanye ukuphalaza igazi kumngxuma wenaliti xa kususwa inaliti.
(2) Iingxaki zasekuhlaleni: izilonda, ukopha, i-stenosis, ukungasebenzi kakuhle kokuhamba komphimbo, i-odynophagia, ukukrazuka. Iingxaki zasekuhlaleni ziquka i-mediastinitis, ukugqobhoka, i-pleural effusion, kunye ne-portal hypertension gastropathy enomngcipheko ophezulu wokopha.
(3) Iingxaki zenkqubo yomzimba: i-sepsis, i-aspiration pneumonia, i-hypoxia, i-spontaneous bacterial peritonitis, i-portal vein thrombosis.
Ukubopha imivimbo ye-varicose ye-Endoscopic (EVL)
Icandelo 2
1) Iimpawu ze-EVL: Zifana ne-EVS.
2) Izimo zokungahambelani ne-EVL:
(1) Izithintelo ezifanayo nezokwenziwa kwe-gastroscopy;
(2) I-EV ehamba ne-GV ecacileyo;
(3) Izigulane ezinengxaki enkulu yesibindi nezintso, ii-ascites ezininzi, i-jaundice, unyango lwakutshanje lwe-multiple sclerotherapy okanye imithambo emincinci ye-varicose.
3) Indlela yokusebenza
Kubandakanya ukubotshwa kweenwele ezinde, ukubotshwa kweenwele ezininzi, kunye nokubotshwa kwentambo ye-nylon.
(1) Umgaqo: Vimba ukuhamba kwegazi kwimithambo yegazi eneentlungu kwaye unikeze i-hemostasis engxamisekileyo → i-venous thrombosis kwindawo yokunamathela → i-tissue necrosis → i-fibrosis → ukunyamalala kwemithambo yegazi eneentlungu.
(2) Amanyathelo okhuseleko
Kwimithambo yegazi ephakathi ukuya kwenzima, umthambo ngamnye we-varicose ubotshelelwa ngendlela ejikelezayo ukusuka ezantsi ukuya phezulu. Umthambo kufuneka ube kufutshane kangangoko kunokwenzeka nendawo ekujoliswe kuyo yomthambo we-varicose, ukuze indawo nganye ibotshelelwe ngokupheleleyo kwaye ibotshelelwe kakhulu. Zama ukugubungela umthambo ngamnye we-varicose ngaphezulu kwamanqaku amathathu.
Kuthatha malunga neveki e-1 ukuya kwezi-2 ukuba i-necrosis iwele emva kwe-necrosis ye-bandage. Emva kweveki emva kotyando, izilonda zasekuhlaleni zinokubangela ukopha okukhulu, i-skin band iwele, kwaye ukunqunyulwa kwemithambo ye-varicose veins kuyopha ngoomatshini. I-EVL inokuphelisa imithambo ye-varicose ngokukhawuleza kwaye ayinazo iingxaki ezininzi, kodwa imithambo ye-varicose veins iyaphinda ibuye. Umlinganiselo uphezulu;
I-EVL inokuthintela ukopha kwegazi kwimithambo yesisu yasekhohlo, kwimithambo yesisu, nakwi-vena cava. Nangona kunjalo, emva kokuba ukuhamba kwegazi kwimithambo yesisu kuvaliwe, imithambo yentliziyo yesisu kunye ne-perigastric venous plexus ziya kwanda, ukuhamba kwegazi kuya kwanda, kwaye izinga lokuphinda kubuye liya kwanda ngokuhamba kwexesha. Ke ngoko, kudla ngokufuneka ukuba kudityaniswe i-band ligation ukuze kuqiniswe unyango. Ububanzi be-varicose vein ligation kufuneka bube ngaphantsi kwe-1.5 cm.
4) Iingxaki ze-EVL
(1) Ukopha okukhulu okubangelwa zizilonda zasekuhlaleni malunga neveki e-1 emva kotyando;
(2) Ukopha ngexesha lotyando, ukulahlekelwa yibhande lesikhumba, kunye nokopha okubangelwa yimithambo evuvukileyo;
(3) Usulelo.
5) Uhlolo lwe-EVL emva kotyando
Kunyaka wokuqala emva kotyando lwe-EVL, ukusebenza kwesibindi nezintso, i-B-ultrasound, inkqubo yegazi, umsebenzi wokubopha igazi, njl. kufuneka kuhlolwe rhoqo kwiinyanga ezi-3 ukuya kwezi-6. I-Endoscopy kufuneka ihlolwe rhoqo kwiinyanga ezi-3, ize emva koko ihlolwe rhoqo kwiinyanga ezi-0 ukuya kwezi-12.
6)EVS vs EVL
Xa kuthelekiswa ne-sclerotherapy kunye ne-ligation, akukho mahluko mkhulu kwizinga lokufa kunye nokopha kwakhona phakathi kwezi zimbini. Kwizigulana ezifuna unyango oluphindaphindwayo, i-ligation icetyiswa kakhulu. Ngamanye amaxesha i-ligation kunye ne-sclerotherapy nazo ziyadityaniswa, nto leyo enokuphucula unyango. Isiphumo. Kumazwe angaphandle, ii-metal stents ezigqunywe ngokupheleleyo nazo zisetyenziselwa ukunqanda ukopha.
Unyango lwe-Endoscopic tissue glue injection (EVHT)
inxalenye 3
Le ndlela ifanelekile kwi-varices yesisu kunye nokopha kwe-variceal esophageal kwiimeko ezingxamisekileyo.
1) Iingxaki ze-EVHT: ikakhulu i-pulmonary artery kunye ne-portal vein embolism, kodwa ukwenzeka kwayo kuphantsi kakhulu.
2) Iingenelo ze-EVHT: imithambo erhabaxa iyanyamalala ngokukhawuleza, izinga lokopha kwakhona liphantsi, iingxaki zimbalwa kakhulu, iimpawu zibanzi kwaye ubuchwepheshe kulula ukubuqonda.
3) Izinto ekufuneka ziqwalaselwe:
Kwi-endoscopic tissue glue injection therapy, ubungakanani be-injection kufuneka banele. I-endoscopic ultrasound idlala indima entle kakhulu kunyango lwemithambo ye-varicose kwaye inokunciphisa umngcipheko wokopha kwakhona.
Kukho iingxelo kwiincwadi zamanye amazwe zokuba unyango lwee-varice zesisu ngee-coils okanye i-cyanoacrylate phantsi kwesikhokelo se-endoscopic ultrasound luyasebenza kwii-varice zesisu zasekuhlaleni. Xa kuthelekiswa nee-injections ze-cyanoacrylate, i-endoscopic ultrasound-guided coiling ifuna ii-injections ezimbalwa zangaphakathi kwaye inxulunyaniswa neziganeko ezibi ezimbalwa.
Thina, Jiangxi Zhuoruihua Medical Instrument Co.,Ltd., singumvelisi eTshayina ogxile kwizinto ezisetyenziswayo ze-endoscopic, ezifanai-biopsy forceps, i-hemoclip, umgibe we-polyp, inaliti ye-sclerotherapy, i-catheter yokutshiza, iibhrashi ze-cytology, ucingo lwesikhokelo, ibhaskithi yokuqokelela amatye, i-catheter yokukhupha amanzi empumlweninjl. ezisetyenziswa kakhulu kwiI-EMR, I-ESD, I-ERCPIimveliso zethu ziqinisekisiwe yi-CE, kwaye izityalo zethu ziqinisekisiwe yi-ISO. Iimpahla zethu zithunyelwe eYurophu, eMntla Melika, eMbindi Mpuma nakwinxalenye yeAsia, kwaye zifumana umthengi udumo nodumo!
Ixesha leposi: Agasti-15-2024