I-varice yomlomo/yesisu iwumphumela wemiphumela eqhubekayo yomfutho wegazi ophakeme we-portal futhi cishe ibangelwa yi-cirrhosis yezimbangela ezahlukahlukene. Ukopha kwemithambo ye-varicose kuvame ukubandakanya ukopha okukhulu kanye nokufa okuphezulu, futhi iziguli ezinesifo sokopha azikubekezeleli ukuhlinzwa.
Ngokuthuthuka nokusetshenziswa kobuchwepheshe bokwelapha nge-endoscopic yokugaya ukudla, ukwelashwa nge-endoscopic sekuyindlela eyinhloko yokwelapha ukopha kwe-variceal emphinjeni/esiswini. Kuhlanganisa kakhulu i-endoscopic sclerotherapy (EVS), i-endoscopic variceal ligation (EVL) kanye nokwelashwa nge-endoscopic tissue glue injection (EVHT).
Ukwelashwa Nge-Endoscopic Sclerotherapy (EVS)
ingxenye 1
1) Isimiso se-endoscopic sclerotherapy (EVS):
Umjovo we-intravascular: i-sclerosing agent ibangela ukuvuvukala okuzungeze imithambo yegazi, iqinisa imithambo yegazi futhi ivimbele ukuhamba kwegazi;
Umjovo we-paravascular: okubangela ukusabela kokuvuvukala okungenamandla emithanjeni okubangela i-thrombosis.
2) Izinkomba ze-EVS:
(1) Ukuqhuma okukhulu kwe-EV kanye nokopha kwegazi;
(2) Umlando wangaphambilini wokuqhuma kwe-EV nokopha kwegazi;
(3) Iziguli eziphinde zathola i-EV ngemva kokuhlinzwa;
(4) Labo abangafaneleki ukwelashwa ngokuhlinzwa.
3) Ukuphikisana kwe-EVS:
(1) Iziphazamiso ezifanayo ne-gastroscopy;
(2) Isifo sesibindi esibizwa ngokuthi i-hepatic encephalopathy isigaba sesi-2 noma ngaphezulu;
(3) Iziguli ezinenkinga enkulu yesibindi nezinso, i-ascites eningi, kanye ne-jaundice enzima.
4) Izinyathelo zokuphepha zokusebenza
EShayina, ungakhetha i-lauromacrol (Sebenzisainaliti ye-sclerotherapy). Emithanjeni yegazi emikhulu, khetha umjovo wangaphakathi kwemithambo yegazi. Umthamo womjovo ngokuvamile u-10 kuya ku-15 mL. Emithanjeni yegazi emincane, ungakhetha umjovo we-paravascular. Zama ukugwema ukujova ezindaweni eziningana ezahlukene endaweni efanayo (Kungase kube nezilonda ezibangela ukuqina komphimbo). Uma ukuphefumula kuthinteka ngesikhathi sokuhlinzwa, isivalo esibonakalayo singafakwa ku-gastroscope. Emazweni angaphandle, ibhaluni livame ukungezwa ku-gastroscope. Kufanelekile ukufunda kukho.
5) Ukwelashwa kwe-EVS ngemva kokuhlinzwa
(1) Ungadli noma uphuze amahora angu-8 ngemva kokuhlinzwa, bese uqhubeka kancane kancane nokudla okumanzi;
(2) Sebenzisa amanani afanele ama-antibiotic ukuvimbela ukutheleleka;
(3) Sebenzisa izidakamizwa ukuze wehlise umfutho wegazi njengoba kufanele.
6) Inkambo yokwelashwa kwe-EVS
Kudingeka ukwelashwa nge-sclerotherapy eminingana kuze kube yilapho imithambo ye-varicose inyamalala noma inyamalale, kube nesikhawu esingangesonto elilodwa phakathi kokwelashwa ngakunye; i-gastoscopy izobuyekezwa inyanga eyodwa, izinyanga ezintathu, izinyanga eziyisithupha, kanye nonyaka owodwa ngemuva kokuphela kwenkambo yokwelashwa.
7) Izinkinga ze-EVS
(1) Izinkinga ezivamile: i-ectopic embolism, isilonda somqala, njll., futhi kulula ukubangela ukugeleza kwegazi noma ukugeleza kwegazi kusuka embobeni yenalithi lapho kususwa inalithi.
(2) Izinkinga zendawo: izilonda, ukopha, i-stenosis, ukungasebenzi kahle kokunyakaza komphimbo, i-odynophagia, ukuklebhuka. Izinkinga zesifunda zifaka phakathi i-mediastinitis, ukubhoboka, ukuphuma kwegazi emzimbeni, kanye ne-portal hypertension gastropathy enengozi eyengeziwe yokopha.
(3) Izinkinga zesistimu: i-sepsis, i-aspiration pneumonia, i-hypoxia, i-peritonitis yamabhaktheriya ezenzakalelayo, i-portal vein thrombosis.
Ukubopha kwemithambo ye-varicose endoscopic (EVL)
Ingxenye 2
1) Izinkomba ze-EVL: Kufana ne-EVS.
2) Izimo zokuphikisana ne-EVL:
(1) Iziphazamiso ezifanayo ne-gastroscopy;
(2) I-EV ehambisana ne-GV esobala;
(3) Iziguli ezinenkinga enkulu yesibindi nezinso, i-ascites eningi, i-jaundice, ukwelashwa kwamuva kwe-multiple sclerotherapy noma imithambo emincane ye-varicose.
3) Indlela yokusebenza
Kubandakanya ukubopha izinwele okukodwa, ukubopha izinwele eziningi, kanye nokubopha izintambo ze-nylon.
(1) Isimiso: Vimbela ukugeleza kwegazi emithanjeni evalekile futhi uhlinzeke nge-hemostasis ephuthumayo → i-venous thrombosis endaweni yokubopha → i-tissue necrosis → i-fibrosis → ukunyamalala kwemithambo evalekile.
(2) Izinyathelo Zokuqapha
Kuma-varice aphakathi nendawo kuya kwanzima omphinjeni, umthambo ngamunye we-varicose uboshelwa ngendlela ejikelezayo ukusuka phansi kuya phezulu. I-ligator kufanele isondele ngangokunokwenzeka endaweni yokubopha eqondiwe yomthambo we-varicose, ukuze iphuzu ngalinye liboshelwe ngokugcwele futhi liboshelwe kakhulu. Zama ukumboza umthambo ngamunye we-varicose ngamaphuzu angaphezu kwama-3.
Kuthatha cishe isonto eli-1 kuya kwamabili ukuthi i-necrosis iwele ngemva kwe-necrosis ye-bandage. Isonto elilodwa ngemva kokuhlinzwa, izilonda zendawo zingase zibangele ukopha okukhulu, ibhande lesikhumba liwe, futhi ukunqunywa kwemithambo ye-varicose kuphume ukopha ngomshini. I-EVL ingaqeda imithambo ye-varicose ngokushesha futhi inezinkinga ezimbalwa, kodwa imithambo ye-varicose iyabuya. Isilinganiso siphezulu;
I-EVL ingavimba ukuphuma kwegazi komthambo wesisu wesobunxele, umthambo wesisu, kanye ne-vena cava. Kodwa-ke, ngemva kokuba ukugeleza kwegazi emthanjeni wesisu kuvinjiwe, umthambo wenhliziyo wesisu kanye ne-perigastric venous plexus kuzokhula, ukugeleza kwegazi kuzokwanda, futhi izinga lokuphindeka lizokhula ngokuhamba kwesikhathi. Ngakho-ke, kuvame ukwenziwa Ukubopha ibhande okuphindaphindwayo kuyadingeka ukuze kuhlanganiswe ukwelashwa. Ububanzi bokubopha imithambo ye-varicose kufanele bube ngaphansi kuka-1.5 cm.
4) Izinkinga ze-EVL
(1) Ukopha okukhulu okubangelwa izilonda zendawo cishe isonto elilodwa ngemva kokuhlinzwa;
(2) Ukopha ngesikhathi sokuhlinzwa, ukulahlekelwa yibhande lesikhumba, kanye nokopha okubangelwa yimithambo yegazi evuvukele;
(3) Ukutheleleka.
5) Ukubuyekezwa kwe-EVL ngemva kokuhlinzwa
Ngonyaka wokuqala ngemva kokuhlinzwa kwe-EVL, ukusebenza kwesibindi nezinso, i-B-ultrasound, inqubo yegazi, ukusebenza kokuqina kwegazi, njll. kufanele kubuyekezwe njalo ezinyangeni ezi-3 kuya kwezi-6. I-Endoscopy kufanele ibukezwe njalo ezinyangeni ezi-3, bese kuba njalo ezinyangeni ezi-0 kuya kwezi-12.
6) I-EVS vs EVL
Uma kuqhathaniswa ne-sclerotherapy kanye ne-ligation, akukho mehluko obalulekile emazingeni okufa kanye nokuphinda kophe phakathi kwalokhu okubili. Ezigulini ezidinga ukwelashwa okuphindaphindiwe, i-ligation ivame ukunconywa. Ngezinye izikhathi i-ligation kanye ne-sclerotherapy nazo ziyahlanganiswa, okungathuthukisa ukwelashwa. Umphumela. Emazweni angaphandle, ama-stents ensimbi ambozwe ngokuphelele nawo asetshenziselwa ukuvimba ukopha.
Ukwelashwa ngokujova ngeglue yezicubu ze-Endoscopic (EVHT)
ingxenye 3
Le ndlela ifanelekela i-varice yesisu kanye nokopha kwe-variceal yomphimbo ezimweni eziphuthumayo.
1) Izinkinga ze-EVHT: ikakhulukazi i-pulmonary artery kanye ne-portal vein embolism, kodwa ukwenzeka kwayo kuphansi kakhulu.
2) Izinzuzo ze-EVHT: imithambo evuvukalayo iyanyamalala ngokushesha, izinga lokuphuma kwegazi liphansi, izinkinga zimbalwa kakhulu, izinkomba zibanzi futhi ubuchwepheshe kulula ukubuqonda.
3) Izinto okufanele uziqaphele:
Ekwelashweni nge-glue yezicubu ze-endoscopic, inani lomjovo kumele lanele. I-ultrasound ye-endoscopic idlala indima enhle kakhulu ekwelapheni imithambo ye-varicose futhi inganciphisa ingozi yokopha kabusha.
Kunemibiko ezincwadini zakwamanye amazwe yokuthi ukwelashwa kwama-varice esiswini ngama-coil noma i-cyanoacrylate ngaphansi kwesiqondiso se-endoscopic ultrasound kuyasebenza kuma-varice esiswini endawo. Uma kuqhathaniswa nemijovo ye-cyanoacrylate, ukugoqa okuqondiswa yi-endoscopic ultrasound kudinga imijovo embalwa yangaphakathi futhi kuhlotshaniswa nezenzakalo ezimbalwa ezimbi.
Thina, iJiangxi Zhuoruihua Medical Instrument Co.,Ltd., singumkhiqizi eShayina ogxile ezintweni ezisetshenziswayo ze-endoscopic, njengei-biopsy forceps, i-hemoclip, ugibe lwe-polyp, inaliti ye-sclerotherapy, i-catheter yokufafaza, amabhulashi e-cytology, ucingo lokuqondisa, ubhasikidi wokuthola amatshe, i-catheter yokukhipha amanzi ekhaleninjll. ezisetshenziswa kabanzi ku-I-EMR, I-ESD, I-ERCPImikhiqizo yethu inesitifiketi se-CE, kanti izitshalo zethu zinesitifiketi se-ISO. Izimpahla zethu zithunyelwe eYurophu, eNyakatho Melika, eMpumalanga Ephakathi kanye nengxenye ye-Asia, futhi zithola ukuqashelwa nokunconywa kakhulu ngamakhasimende!
Isikhathi sokuthunyelwe: Agasti-15-2024