1) Isimiso se-endoscopic sclerotherapy (EVS):
Umjovo we-intravascular: i-sclerosing agent ibangela ukuvuvukala emithanjeni, iqinisa imithambo yegazi futhi ivimbele ukugeleza kwegazi;
Umjovo we-Paravascular: udala ukusabela kokuvuvukala okubulalayo emithanjeni kubangele i-thrombosis.
2) Izinkomba ze-EVS:
(1) Ukuqhuma kwe-EV okunamandla nokopha;
(2) Abantu abanomlando wokuqhuma kwe-EV nokopha;(3) Abantu abanokuphindaphinda kwe-EV ngemva kokuhlinzwa;(4) Abantu abangafanele ukwelashwa ngokuhlinzwa.
3) I-Contraindication ye-EVS:
(1) Ngokufanayo ne-gastroscopy;
(2) I-Hepatic encephalopathy isigaba 2 nangaphezulu;
(3) Iziguli ezinokukhubazeka okukhulu kwesibindi nezinso, inani elikhulu lama-ascites, ne-jaundice enzima.
4) Izinyathelo zokuphepha zokusebenza
E-China, ungakhetha i-lauromacrol.Ngemithambo yegazi emikhulu, khetha umjovo we-intravascular.Ivolumu yomjovo ngokuvamile i-10 ~ 15mL.Ngemithambo yegazi emincane, ungakhetha umjovo we-paravascular.Zama ukugwema ukujova ezindaweni eziningana ezihlukene endizeni eyodwa (mhlawumbe Izilonda zingase zenzeke okuholela ekuqineni kommizo).Uma ukuphefumula kuthinteka ngesikhathi sokuhlinzwa, i-cap esobala ingafakwa ku-gastroscope.Emazweni angaphandle, ibhaluni livame ukungezwa ku-gastroscope.Kuyafaneleka ukufunda kukho.
5) Ukuphathwa kwangemva kokusebenza kwe-EVS
(1) Ungadli noma uphuze amahora angu-8 ngemva kokuhlinzwa futhi kancane kancane uqale kabusha ukudla okuwuketshezi;
(2) Sebenzisa inani elifanele lemithi elwa namagciwane ukuze uvimbele ukutheleleka;(3) Sebenzisa izidakamizwa ezehlisa umfutho wephothali ngendlela efanele.
6) Inkambo yokwelashwa kwe-EVS
I-Multiple sclerotherapy iyadingeka kuze kube yilapho imithambo ye-varicose inyamalala noma ngokuyisisekelo inyamalala, ngesikhawu esingangesonto eli-1 phakathi kokwelashwa ngakunye;I-gastroscopy izobuyekezwa inyanga engu-1, izinyanga ezingu-3, izinyanga ezingu-6, kanye nonyaka ongu-1 ngemva kokuphela kwenkambo yokwelashwa.
7) Izinkinga ze-EVS
(1) Izinkinga ezivamile: i-ectopic embolism, i-esophageal ulcer, njll., kanye
Kulula ukubangela ukuphuma kwegazi noma ukugobhoza igazi embotsheni yenaliti lapho inaliti ikhishwa.
(2) Izinkinga zendawo: izilonda, ukopha, i-stenosis, ukungasebenzi kahle kommizo, i-odynophagia, izilonda.Izinkinga zesifunda zifaka i-mediastinitis, ukubhobozwa, ukuphuma kwe-pleural, kanye ne-portal hypertensive gastropathy enengozi enkulu yokopha.
(3) Izinkinga zesistimu: i-sepsis, inyumoniya ye-aspiration, i-hypoxia, i-peritonitis yebhaktheriya ezenzakalelayo, kanye ne-portal vein thrombosis.
I-Endoscopic varicose vein ligation (EVL)
1) Izinkomba ze-EVL:Ngokufanayo ne-EVS.
2) I-EVL Contraindications:
(1) Ukuphikisana okufanayo ne-gastroscopy;
(2) I-EV ehambisana ne-GV esobala;
(3) ehambisana nokukhubazeka okukhulu kwesibindi nezinso, inani elikhulu lama-ascites, i-jaundice
I-Gangrene kanye nokwelashwa kwakamuva kwe-multiple sclerotherapy noma imithambo ye-varicose emincane
Ukuthatha ubukhosi bakwa-Han njenge-duofu eseduze kusho ukuthi abantu base-Hua bazokwazi ukunyakaza ngokukhululeka, noma imisipha nama-pulses kuzokwelulelwa ngasentshonalanga.
Ngu.
3) Isebenza kanjani
Kubandakanya ukuhlanganisa izinwele okukodwa, ukuhlanganisa izinwele eziningi, nokuhlanganisa intambo enayiloni.
Isimiso: Vimba ukugeleza kwegazi emithanjeni ye-varicose futhi unikeze i-hemostasis ephuthumayo → i-venous thrombosis endaweni yokuxhuma → i-tissue necrosis → i-fibrosis → ukunyamalala kwe-varicose veins.
(2) Izinyathelo zokuphepha
Ukuze uthole i-varicose ephakathi nendawo ukuya kokuqina, umthambo we-varicose ngamunye uboshwe ngendlela ezungeza phezulu ukusuka phansi kuye phezulu.I-ligator kufanele ibe eduze ngangokunokwenzeka endaweni ehlosiwe ye-ligation ye-varicose vein, ukuze iphuzu ngalinye lihlanganiswe ngokugcwele futhi lihlanganiswe.Zama ukumboza umthambo we-varicose ngamaphuzu angaphezu kwama-3.
Izinyathelo ze-EVL
Umthombo: Isipikha se-PPT
Kuthatha cishe iviki elingu-1 ukuya kwangu-2 ukuze i-necrosis iwe ngemuva kwe-bandage necrosis.Isonto elilodwa ngemva kokuhlinzwa, izilonda zendawo zingase zidale ukopha okukhulu, ibhande lesikhumba liyawa, futhi ukusikwa kwemithambo ye-varicose kukopha, njll.;
I-EVL ingaqeda imithambo ye-varicose ngokushesha futhi inezinkinga ezimbalwa, kodwa izinga lokuphindaphinda kwemithambo ye-varicose liphezulu;
I-EVL ingavimba izibopho zokopha zomthambo wesisu wesokunxele, umthambo wommizo, kanye ne-vena cava, kodwa ngemva kokuvinjelwa ukugeleza kwegazi kwe-venous esophageal, i-gastric coronary vein kanye ne-perigastric venous plexus izokhula, ukugeleza kwegazi kuzokwanda, futhi izinga lokuphindaphinda. izokwanda ngokuhamba kwesikhathi, ngakho-ke kuvame Ukuphindwaphindwa kwebhande ukubopha kuyadingeka ukuze kuhlanganiswe ukwelashwa.Ububanzi be-varicose vein ligation kufanele bube ngaphansi kuka-1.5cm.
4) Izinkinga ze-EVL
(1) Ukopha okukhulu ngenxa yezilonda zendawo cishe isonto elilodwa ngemva kokuhlinzwa;
(2) Ukopha ngokuhlinza, ukulahlekelwa ibhande lesikhumba, nokopha okubangelwa imithambo ye-varicose;
(3) Ukutheleleka.
5) Ukubuyekezwa kwangemva kokuhlinzwa kwe-EVL
Ngonyaka wokuqala ngemva kwe-EVL, ukusebenza kwesibindi nezinso, i-B-ultrasound, isimiso segazi, ukusebenza kwe-coagulation, njll. kufanele kubuyekezwe njalo ezinyangeni ezi-3 kuya kwezingu-6.I-Endoscopy kufanele ibuyekezwe njalo ezinyangeni ezi-3, bese kuba njalo ezinyangeni ezi-0 kuye kweziyi-12.6) EVS vs EVL
Uma kuqhathaniswa ne-sclerotherapy kanye ne-ligation, amazinga okufa kanye nokuphinda abuyele emuva kokubili
Awukho umehluko obalulekile esilinganisweni segazi futhi ezigulini ezidinga ukwelashwa okuphindaphindiwe, i-band ligation ivame ukutuswa.I-band ligation kanye ne-sclerotherapy ngezinye izikhathi kuhlanganiswe ukuze kuthuthukiswe umphumela wokwelapha.Emazweni angaphandle, ama-stents ensimbi ambozwe ngokugcwele asetshenziselwa ukumisa ukopha.
IInaliti ye-Sclerotherapykusuka ku-ZRHmed asetshenziselwa i-Endoscopic Sclerotherapy (EVS) kanye ne-Endoscopic varicose vein ligation(EVL).
Isikhathi sokuthumela: Jan-08-2024