1) Mfundo yaikulu ya endoscopic sclerotherapy (EVS):
Jakisoni wa m'mitsempha yamagazi: mankhwala otupa mitsempha amayambitsa kutupa kuzungulira mitsempha, amalimbitsa mitsempha yamagazi ndikuletsa kuyenda kwa magazi;
Kubayidwa kwa mitsempha yamagazi: kumayambitsa kutupa kosabala m'mitsempha komwe kumayambitsa thrombosis.
2) Zizindikiro za EVS:
(1) Kuphulika kwa EV ndi kutuluka magazi mwadzidzidzi;
(2) Anthu omwe ali ndi mbiri ya kuphulika kwa EV ndi kutuluka magazi; (3) Anthu omwe abwereranso ndi EV atachitidwa opaleshoni; (4) Anthu omwe sali oyenera kulandira chithandizo cha opaleshoni.
3) Zotsutsana za EVS:
(1) Chimodzimodzi ndi gastroscopy;
(2) Matenda a chiwindi otchedwa hepatic encephalopathy siteji yachiwiri ndi kupitirira apo;
(3) Odwala omwe ali ndi vuto lalikulu la chiwindi ndi impso, ascites ambiri, komanso jaundice yayikulu.
4) Njira zodzitetezera ku ntchito
Ku China, mungasankhe lauromacrol. Pa mitsempha ikuluikulu yamagazi, sankhani jakisoni wamkati mwa mitsempha. Kuchuluka kwa jakisoni nthawi zambiri kumakhala 10 ~ 15mL. Pa mitsempha yaying'ono yamagazi, mutha kusankha jakisoni wa paravascular. Yesetsani kupewa jakisoni pamalo osiyanasiyana pamalo omwewo (mwina zilonda zingachitike zomwe zimapangitsa kuti m'mero mutsekeke). Ngati kupuma kwakhudzidwa panthawi ya opaleshoni, chivundikiro chowonekera chingawonjezedwe ku gastroscope. M'maiko akunja, baluni nthawi zambiri amawonjezedwa ku gastroscope. Ndikoyenera kuphunzira kuchokera pamenepo.
5) Kusamalira EVS pambuyo pa opaleshoni
(1) Musadye kapena kumwa kwa maola 8 mutachita opaleshoni ndipo pang'onopang'ono muyambenso kudya zakudya zamadzimadzi;
(2) Gwiritsani ntchito mankhwala opha tizilombo toyambitsa matenda okwanira kuti mupewe matenda; (3) Gwiritsani ntchito mankhwala omwe amachepetsa kuthamanga kwa magazi m'mapapo momwe mungafunire.
6) Njira ya chithandizo cha EVS
Kuchiza ndi sclerotherapy yambiri kumafunika mpaka mitsempha ya varicose itatha kapena kutha, ndi nthawi ya sabata imodzi pakati pa chithandizo chilichonse; gastroscopy idzawunikidwanso mwezi umodzi, miyezi itatu, miyezi isanu ndi umodzi, ndi chaka chimodzi pambuyo pa kutha kwa chithandizo.
7) Mavuto a EVS
(1) Mavuto ofala: ectopic embolism, zilonda za m'mero, ndi zina zotero, ndi
N'zosavuta kuyambitsa kutuluka kwa magazi kapena kutuluka magazi kuchokera mu dzenje la singano pamene singanoyo yatulutsidwa.
(2) Mavuto am'deralo: zilonda zam'mimba, kutuluka magazi, stenosis, kusayenda bwino kwa m'mero, odynophagia, kuvulala. Mavuto am'deralo ndi monga mediastinitis, kubowoka, pleural effusion, ndi portal hypertension gastropathy yomwe imabweretsa chiopsezo chowonjezeka cha kutuluka magazi.
(3) Mavuto a dongosolo: sepsis, aspiration pneumonia, hypoxia, bacterial peritonitis yodzidzimutsa, ndi portal vein thrombosis.
Kutsekeka kwa mitsempha ya varicose ya endoscopic (EVL)
1) Zizindikiro za EVL:Chimodzimodzi ndi EVS.
2) Zotsutsana ndi EVL:
(1) Zotsutsana zomwezo monga gastroscopy;
(2) EV yoyendetsedwa ndi GV yodziwikiratu;
(3) limodzi ndi vuto lalikulu la chiwindi ndi impso, kuchuluka kwa ascites, jaundice
Gangrene ndi mankhwala aposachedwa a multiple sclerotherapy kapena mitsempha yaying'ono ya varicose
Kutenga Ufumu wa Han ngati duofu kumatanthauza kuti anthu a ku Hua adzatha kuyenda momasuka, kapena minofu ndi kugunda kwa mtima zidzatambasulidwa kumadzulo.
Ndi.
3) Momwe mungagwiritsire ntchito
Kuphatikizapo kulumikiza tsitsi limodzi, kulumikiza tsitsi lambiri, ndi kulumikiza chingwe cha nayiloni.
Mfundo: Kuletsa kuyenda kwa magazi m'mitsempha ya varicose ndikupereka hemostasis yadzidzidzi → venous thrombosis pamalo olumikizirana → tissue necrosis → fibrosis → kutha kwa mitsempha ya varicose.
(2) Zosamala
Pa mitsempha ya varicose yapakati mpaka yoopsa ya m'mero, mitsempha iliyonse ya varicose imamangidwa mozungulira kuchokera pansi kupita pamwamba. Cholumikiziracho chiyenera kukhala pafupi momwe zingathere ndi malo olumikizira mitsempha ya varicose, kotero kuti mfundo iliyonse ikhale yolumikizidwa mokwanira komanso yolumikizidwa kwambiri. Yesetsani kuphimba mitsempha iliyonse ya varicose pa mfundo zoposa zitatu.
Masitepe a EVL
Chitsime: Speaker PPT
Zimatenga pafupifupi sabata imodzi kapena ziwiri kuti necrosis igwe pambuyo pa necrosis ya bandeji. Sabata imodzi pambuyo pa opaleshoni, zilonda zakomweko zingayambitse kutuluka magazi ambiri, gulu la khungu limagwa, ndipo kudula kwa mitsempha yotupa kumatuluka magazi, ndi zina zotero;
EVL imatha kuchotsa mitsempha ya varicose mwachangu ndipo ili ndi zovuta zochepa, koma kuchuluka kwa mitsempha ya varicose komwe kumabwereranso ndi kwakukulu;
EVL imatha kuletsa magazi ogwirizana ndi mitsempha ya kumanzere ya m'mimba, mitsempha ya m'mero, ndi vena cava, koma magazi a m'mero akatsekedwa, mitsempha ya m'mimba ndi mitsempha ya m'mimba ya perigastric zidzakula, magazi adzawonjezeka, ndipo kuchuluka kwa kubwereranso kudzawonjezeka pakapita nthawi, kotero nthawi zambiri kumafunika kumangidwanso kwa band kuti kuphatikize chithandizocho. M'mimba mwake wa mitsempha ya varicose uyenera kukhala wochepera 1.5cm.
4) Mavuto a EVL
(1) Kutuluka magazi ambiri chifukwa cha zilonda za m'deralo patatha sabata imodzi kuchokera pamene opaleshoni yachitika;
(2) Kutuluka magazi panthawi ya opaleshoni, kutayika kwa mkanda wachikopa, ndi kutuluka magazi chifukwa cha mitsempha yotupa;
(3) Matenda.
5) Kuwunikanso kwa EVL pambuyo pa opaleshoni
Chaka choyamba pambuyo pa EVL, ntchito ya chiwindi ndi impso, B-ultrasound, ndondomeko ya magazi, ntchito yotseka magazi, ndi zina zotero ziyenera kuunikidwa miyezi itatu iliyonse mpaka isanu ndi umodzi. Endoscopy iyenera kuunikidwa miyezi itatu iliyonse, kenako miyezi 0 mpaka 12 iliyonse. 6) EVS vs EVL
Poyerekeza ndi sclerotherapy ndi ligation, chiwerengero cha imfa ndi kubwereranso kwa matendawa ndi
Palibe kusiyana kwakukulu pa kuchuluka kwa magazi ndipo kwa odwala omwe amafunikira chithandizo mobwerezabwereza, kumangidwa kwa band kumalimbikitsidwa kwambiri. Kumangidwa kwa band ndi sclerotherapy nthawi zina kumaphatikizidwa kuti kuwonjezere zotsatira za chithandizo. M'maiko akunja, ma stenti achitsulo ophimbidwa mokwanira amagwiritsidwanso ntchito kuti asiye kutuluka magazi.
TheSingano ya Sclerotherapykuchokera ku ZRHmed amagwiritsidwa ntchito pa Endoscopic Sclerotherapy (EVS) ndi Endoscopic varicose vein ligation (EVL).
Nthawi yotumizira: Januwale-08-2024