I-Esophageal / gastric varices ziziphumo zeziphumo eziqhubekayo ze-portal hypertension kwaye malunga ne-95% ebangelwa yi-cirrhosis yezizathu ezahlukeneyo. Ukopha kwe-varicose vein kaninzi kubandakanya ukopha okukhulu kunye nokufa okuphezulu, kwaye izigulane ezophayo azikwazi ukunyamezela utyando.
Ngokuphuculwa kunye nokusetyenziswa kwetekhnoloji yonyango lwe-endoscopic yokugaya, unyango lwe-endoscopic luye lwaba yenye yeendlela eziphambili zokunyanga ukopha kwe-esophageal / gastric variceal. Ikakhulu ibandakanya i-endoscopic sclerotherapy (EVS), i-endoscopic variceal ligation (EVL) kunye ne-endoscopic tissue glue injection therapy (EVHT).
I-Endoscopic Sclerotherapy (EVS)
icandelo 1
1) Umgaqo we-endoscopic sclerotherapy (EVS):
Isitofu se-Intravascular: i-agent ye-sclerosing ibangela ukuvuvukala kwi-veins, iqinisa imithwalo yegazi kunye nokuthintela ukuhamba kwegazi;
Inaliti yeParavascular: ukubangela ukudumba okungenantsholongwane emithanjeni ukuze kubangele i-thrombosis.
2) Iimpawu ze-EVS:
(1) Ukuqhambuka kwe-EV ngokukhawuleza kunye nokopha;
(2) Imbali yangaphambili yokugqabhuka kwe-EV kunye nokuphuma kwegazi;
(3) Izigulane ngokuphindaphindiweyo kwe-EV emva kokuhlinzwa;
(4) Abo bangafanelekanga unyango lotyando.
3)Ukunyangwa kwe-EVS:
(1) Ukuchasana okufanayo njenge-gastroscopy;
(2) I-Hepatic encephalopathy isigaba 2 okanye ngaphezulu;
(3) Izigulane ezinesibindi esinzima kunye nokungasebenzi kakuhle kwezintso, ubuninzi be-ascites, kunye ne-jaundice enzima.
4) Izilumkiso zokusebenza
E-China, ungakhetha i-lauromacrol (Sebenzisainaliti ye-sclerotherapy). Kwimithambo yegazi emikhulu, khetha inaliti ye-intravascular. Umthamo wesitofu udla ngokuba yi-10 ukuya kwi-15 ml. Kwimithambo yegazi emincinci, ungakhetha inaliti ye-paravascular. Zama ukunqanda ukutofa kwiindawo ezininzi ezahlukeneyo kwinqwelomoya enye (Izilonda zisenokwenzeka zikhokelela kukuqina kommizo). Ukuba ukuphefumla kuchaphazeleka ngexesha lokusebenza, i-cap ecacileyo inokongezwa kwi-gastroscope. Kwamazwe angaphandle, ibhaluni idla ngokufakwa kwi-gastroscope. Kufanelekile ukufunda kuyo.
I-5) Unyango lwasemva kwe-EVS
(1) Ungatyi okanye usele iiyure ezisi-8 emva kotyando, kwaye ngokuthe ngcembe uqalise ukutya okungamanzi;
(2) Sebenzisa umlinganiselo ofanelekileyo wamayeza okubulala iintsholongwane ukuze uthintele usulelo;
(3) Sebenzisa iziyobisi ukunciphisa uxinzelelo lwe-portal njengoko kufanelekile.
6) Ikhosi yonyango ye-EVS
I-Multiple sclerotherapy iyadingeka de i-varicose veins inyamalale okanye iphele ngokusisiseko, kunye nekhefu malunga neveki ye-1 phakathi kwonyango ngalunye; I-gastroscopy iya kuhlaziywa inyanga eyi-1, iinyanga ezi-3, iinyanga ezi-6, kunye no-1 unyaka emva kokuphela kwekhosi yonyango.
7) Iingxaki ze-EVS
(1) Iingxaki eziqhelekileyo: i-ectopic embolism, i-ectopic embolism, i-esophageal ulcer, njl., kwaye kulula ukubangela ukukhupha igazi okanye ukukhupha igazi kumngxuma yenaliti xa ususa inaliti.
(2) Iingxaki zasekuhlaleni: izilonda, ukopha, i-stenosis, ukungasebenzi kakuhle kommizo, i-odynophagia, i-lacerations. Iingxaki zengingqi ziquka i-mediastinitis, i-perforation, i-pleural effusion, kunye ne-portal hypertension gastropathy kunye nomngcipheko wokopha.
(3) Iingxaki zenkqubo: i-sepsis, i-aspiration pneumonia, i-hypoxia, i-peritonitis yebhaktiriya ezenzekelayo, i-portal vein thrombosis.
I-Endoscopic varicose vein ligation (EVL)
Icandelo lesi-2
1) Iimpawu ze-EVL: Ifana ne-EVS.
2)Ukunyangwa kwe-EVL:
(1) Ukuchasana okufanayo njenge-gastroscopy;
(2) I-EV ihamba ne-GV ecacileyo;
(3) Izigulane ezinesibindi esinzima kunye nokungasebenzi kakuhle kwezintso, ubuninzi be-ascites, i-jaundice, unyango lwakutshanje lwe-multiple sclerotherapy okanye i-varicose veins encinci.
3)Isebenza njani
Kubandakanya ukudibanisa iinwele enye, ukudibanisa iinwele ezininzi, kunye nentambo yenylon.
(1) Umgaqo: Vimba ukuhamba kwegazi kwimithambo ye-varicose kwaye unikeze i-hemostasis engxamisekileyo → i-venous thrombosis kwindawo yokuxhuma → i-tissue necrosis → i-fibrosis → ukunyamalala kwe-varicose veins.
(2) Izilumkiso
Kwimibhobho yommizo ephakathi ukuya kobukhali, umthambo ngamnye we-varicose ubotshelelwe ngendlela ejikelezayo ukuya phezulu ukusuka ezantsi ukuya phezulu. I-ligator kufuneka isondele ngokusemandleni kwindawo ekujoliswe kuyo kwi-varicose vein, ukwenzela ukuba inqaku ngalinye lihlanganiswe ngokupheleleyo kwaye lidibene. Zama ukugubungela umthambo we-varicose ngamanqaku angaphezu kwama-3.
Kuthatha malunga ne-1 ukuya kwiiveki ezi-2 ukuba i-necrosis iwele emva kwe-bandage necrosis. Kwiveki enye emva kotyando, izilonda zasekuhlaleni zisenokubangela ukopha kakhulu, ulusu luyawa, kuze kuphume igazi. I-EVL inokuphelisa i-varicose veins ngokukhawuleza kwaye ineengxaki ezimbalwa, kodwa i-varicose veins iphinda ibuyele. Umlinganiso ukwindawo ephakamileyo;
I-EVL inokuthintela izibambiso zokopha kwi-vein ye-gastric yesobunxele, i-esophageal vein, kunye ne-vena cava. Nangona kunjalo, emva kokuba ukuhamba kwegazi kwe-esophageal kuvaliwe, i-gastric coronary vein kunye ne-perigastric venous plexus iya kwanda, ukuhamba kwegazi kuya kwanda, kwaye izinga lokuphindaphinda liya kunyuka ngokuhamba kwexesha. Ngoko ke, kudla ngokuphindaphindiweyo i-band ligation iyafuneka ukudibanisa unyango. Ububanzi be-varicose vein ligation kufuneka bube ngaphantsi kwe-1.5 cm.
4) Iingxaki ze-EVL
(1) Ukopha okukhulu ngenxa yezilonda zendawo malunga neveki ye-1 emva kotyando;
(2) Ukopha kwi-intraoperative, ukulahleka kwebhanti yesikhumba, kunye nokopha okubangelwa yi-varicose veins;
(3) Usulelo.
5) Uphononongo lwasemva kokusebenza kwe-EVL
Ngomnyaka wokuqala emva kokuhlinzwa kwe-EVL, isibindi kunye nomsebenzi wezintso, i-B-ultrasound, i-blood routine, i-coagulation function, njl. Kufuneka ihlaziywe rhoqo kwii-3 kwiinyanga ze-6. I-Endoscopy kufuneka ihlaziywe rhoqo kwiinyanga ezi-3, kwaye emva kwe-0 ukuya kwiinyanga ezili-12.
6)EVS vs EVL
Xa kuthelekiswa ne-sclerotherapy kunye ne-ligation, akukho mahluko ubalulekileyo wokufa kunye namazinga okuphinda okopha phakathi kwezi zibini. Kwizigulane ezifuna unyango oluphindaphindiweyo, i-ligation iyacetyiswa ngokuqhelekileyo. Ngamanye amaxesha i-ligation kunye ne-sclerotherapy nayo idibene, enokuphucula unyango. Isiphumo. Kumazwe angaphandle, izinti zentsimbi ezigqunywe ngokupheleleyo zikwasetyenziswa ukunqanda ukopha.
I-Endoscopic tissue glue injection treatment (EVHT)
inxalenye yesi-3
Le ndlela ifanelekile kwi-varice yesisu kunye ne-esophageal variceal ukopha kwiimeko ezingxamisekileyo.
I-1) Iingxaki ze-EVHT: ubukhulu becala umthambo we-pulmonary kunye ne-portal vein embolism, kodwa iziganeko ziphantsi kakhulu.
2) Izinto eziluncedo ze-EVHT: imithambo ye-varicose iyanyamalala ngokukhawuleza, isantya sokuphinda ukopha siphantsi, iingxaki zimbalwa, izibonakaliso zibanzi kwaye iteknoloji kulula ukuyiqonda.
3) Izinto ekufuneka uziqwalasele:
Kunyango lwenaliti yeglue ye-endoscopic, inani lenaliti kufuneka lanele. I-Endoscopic ultrasound idlala indima entle kakhulu kunyango lwemithambo ye-varicose kwaye inokunciphisa umngcipheko wokuphinda ukopha.
Kukho iingxelo kwiincwadi zamazwe angaphandle ukuba unyango lwe-gastric varices kunye neekhoyili okanye i-cyanoacrylate phantsi kolwalathiso lwe-endoscopic ultrasound lusebenza kakuhle kwii-varice zesisu zesisu. Xa kuthelekiswa ne-cyanoacrylate injections, i-endoscopic ultrasound-guided coiling idinga ii-injection ze-intraluminal ezimbalwa kwaye ihambelana neziganeko ezimbalwa ezimbi.
Thina, i-Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ngumvelisi e-China ogxile kwizinto ezityiwayo ze-endoscopic, ezifanai-biopsy forceps, i-hemoclip, polyp umgibe, inaliti ye-sclerotherapy, fafaza i-catheter, iibrashi zecytology, guidewire, ibhasikithi yokubuyiswa kwamatye, i-catheter ye-biliary drainage yeempumlonjl ezisetyenziswa ngokubanzi kwiI-EMR, ESD, I-ERCP. Iimveliso zethu ziqinisekisiwe nge-CE, kwaye izityalo zethu ziqinisekisiwe nge-ISO. Impahla yethu ithunyelwe eYurophu, kuMntla Melika, kuMbindi Mpuma kunye nenxalenye yeAsia, kwaye ifumana ngokubanzi umthengi wokuqatshelwa kunye nendumiso!
Ixesha lokuposa: Aug-15-2024