Imithambo ye-Esophageal/gastric iwumphumela wemiphumela eqhubekayo ye-portal hypertension futhi cishe i-95% ebangelwa ukuqina kwesibindi kwezimbangela ezihlukahlukene. Ukopha kwe-varicose vein ngokuvamile kuhilela inani elikhulu lokopha nokufa okuphezulu, futhi iziguli ezophayo azikubekezeleli ukuhlinzwa.
Ngokuthuthukiswa nokusebenzisa ubuchwepheshe bokwelashwa kwe-endoscopic yokugaya, ukwelashwa kwe-endoscopic sekungenye yezindlela eziyinhloko zokwelapha ukopha kwe-variceal esophageal/gastric. Ihlanganisa ikakhulukazi i-endoscopic sclerotherapy (EVS), i-endoscopic variceal ligation (EVL) kanye ne-endoscopic tissue glue injection therapy (EVHT).
I-Endoscopic Sclerotherapy (EVS)
ingxenye 1
1) Isimiso se-endoscopic sclerotherapy (EVS):
Umjovo we-intravascular: i-sclerosing agent ibangela ukuvuvukala emithanjeni, iqinisa imithambo yegazi futhi ivimbele ukugeleza kwegazi;
Umjovo weParavascular: ukubangela ukusabela kokuvuvukala okuyinyumba emithanjeni kubangele i-thrombosis.
2) Izinkomba ze-EVS:
(1) Ukuqhuma kwe-EV okunamandla nokopha;
(2) Umlando wangaphambili wokugqashuka kwe-EV nokopha;
(3) Iziguli ezinokuphindaphinda kwe-EV ngemva kokuhlinzwa;
(4) Labo abangafaneleki ukwelashwa ngokuhlinzwa.
3) Contraindications of EVS:
(1) Ukuphikisana okufanayo ne-gastroscopy;
(2) Isigaba sesi-2 se-hepatic encephalopathy noma ngaphezulu;
(3) Iziguli ezinokukhubazeka okukhulu kwesibindi nezinso, inani elikhulu lama-ascites, ne-jaundice enzima.
4) Izinyathelo zokuphepha zokusebenza
E-China, ungakhetha i-lauromacrol (Sebenzisainaliti ye-sclerotherapy). Ngemithambo yegazi emikhulu, khetha umjovo we-intravascular. Umthamo womjovo ngokuvamile u-10 kuya ku-15 mL. Ngemithambo yegazi emincane, ungakhetha umjovo we-paravascular. Zama ukugwema ukujova ezindaweni eziningana ezihlukene endizeni eyodwa ( Izilonda zingase ziholele ekuqineni kommizo). Uma ukuphefumula kuthinteka ngesikhathi sokuhlinzwa, i-cap esobala ingafakwa ku-gastroscope. Emazweni angaphandle, ibhaluni livame ukungezwa ku-gastroscope. Kuyafaneleka ukufunda kukho.
I-5) Ukwelashwa kwangemva kokuhlinzwa 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 ukwehlisa umfutho we-portal njengoba kufanele.
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-ectopic embolism, isilonda somminzo, njll., futhi kulula ukubangela ukuphuma kwegazi noma ukugobhoza igazi embotsheni yenaliti lapho ukhipha inaliti.
(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, i-portal vein thrombosis.
I-Endoscopic varicose vein ligation (EVL)
Ingxenye 2
1) Izinkomba ze-EVL: Kuyafana ne-EVS.
2) Contraindications of EVL:
(1) Ukuphikisana okufanayo ne-gastroscopy;
(2) I-EV ehambisana ne-GV esobala;
(3) Iziguli ezinokukhubazeka okukhulu kwesibindi nezinso, inani elikhulu lama-ascites, i-jaundice, ukwelashwa kwakamuva kwe-multiple sclerotherapy noma imithambo emincane ye-varicose.
3) Isebenza kanjani
Kubandakanya ukuhlanganisa izinwele okukodwa, ukuhlanganisa izinwele eziningi, nokuhlanganisa intambo enayiloni.
(1) Isimiso: Vimba ukugeleza kwegazi emithanjeni ye-varicose futhi unikeze i-hemostasis ephuthumayo → i-venous thrombosis endaweni yokuxhuma → i-tissue necrosis → i-fibrosis → ukunyamalala kwemithambo ye-varicose.
(2) Izinyathelo zokuqapha
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.
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 liwe, futhi ukusikeka kwemithambo ye-varicose kukopha. I-EVL ingaqeda imithambo ye-varicose ngokushesha futhi ibe nezinkinga ezimbalwa, kodwa imithambo ye-varicose iyaphinda. Isilinganiso sisohlangothini oluphakeme;
I-EVL ingavimba izibopho zokopha zomthambo wesisu wesokunxele, umthambo wommizo, kanye ne-vena cava. Kodwa-ke, ngemva kokuvinjwa kwegazi le-venous yommizo, i-gastric coronary vein kanye ne-perigastric venous plexus izokhula, ukugeleza kwegazi kuzokwanda, futhi izinga lokuphindaphinda lizokhula ngokuhamba kwesikhathi. Ngakho-ke, kuvame ukuphindwaphindwa kwe-band ligation kuyadingeka ukuze kuhlanganiswe ukwelashwa. Ububanzi be-varicose vein ligation kufanele bube ngaphansi kuka-1.5 cm.
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 kokuhlinzwa 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, awukho umehluko omkhulu emazingeni okufa kanye nokopha kabusha phakathi kwalokhu kokubili. Ezigulini ezidinga ukwelashwa okuphindaphindiwe, i-ligation ivame ukunconywa. Ngezinye izikhathi i-ligation kanye ne-sclerotherapy nayo ihlangene, engathuthukisa ukwelashwa. Umphumela. Emazweni angaphandle, ama-stents ensimbi ambozwe ngokugcwele asetshenziselwa ukumisa ukopha.
I-Endoscopic tissue glue injection therapy (EVHT)
ingxenye 3
Le ndlela ilungele ukuvuvuka kwesisu kanye nokopha kwe-variceal esophageal ezimeni eziphuthumayo.
I-1) Izinkinga ze-EVHT: ikakhulukazi i-pulmonary artery kanye ne-portal vein embolism, kodwa isigameko siphansi kakhulu.
2) Izinzuzo ze-EVHT: imithambo ye-varicose iyanyamalala ngokushesha, izinga lokopha kabusha liphansi, izinkinga zimbalwa uma kuqhathaniswa, izinkomba zibanzi futhi ubuchwepheshe kulula ukubuqonda.
3) Izinto okufanele uziqaphele:
Ekwelashweni komjovo weglue wezicubu ze-endoscopic, inani lomjovo kufanele lanele. I-Endoscopic ultrasound idlala indima enhle kakhulu ekwelapheni imithambo ye-varicose futhi inganciphisa ingozi yokopha kabusha.
Kukhona imibiko ezincwadini zakwamanye amazwe ukuthi ukwelashwa kwe-gastric varices ngamakhoyili noma i-cyanoacrylate ngaphansi kokuqondisa kwe-endoscopic ultrasound kusebenza kahle kuma-varice asendaweni. Uma kuqhathaniswa nemijovo ye-cyanoacrylate, i-endoscopic ultrasound-guided coiling idinga imijovo embalwa ye-intraluminal futhi ihlotshaniswa nezenzakalo ezimbalwa ezimbi.
Thina, i-Jiangxi Zhuoruihua Medical Instrument Co., Ltd., singumkhiqizi waseChina ogxile ezintweni ezisetshenziswayo ze-endoscopic, ezifanai-biopsy forceps, i-hemoclip, polyp ugibe, inaliti ye-sclerotherapy, fafaza i-catheter, amabhulashi e-cytology, guidewire, ubhasikidi wokubuyisa amatshe, i-catheter ye-nasal biliary drainagenjll ezisetshenziswa kakhulu kuI-EMR, ESD, I-ERCP. Imikhiqizo yethu iqinisekiswe yi-CE, futhi izitshalo zethu ziqinisekiswe yi-ISO. Izimpahla zethu zithunyelwe eYurophu, eNyakatho Melika, eMpumalanga Ephakathi nasengxenyeni ye-Asia, futhi zithola kabanzi ikhasimende lokuqashelwa nokudumisa!
Isikhathi sokuthumela: Aug-15-2024