Mitsempha ya m'mitsempha / m'mimba ndi zotsatira za kulimbikira kwa matenda oopsa a portal ndipo pafupifupi 95% amayamba chifukwa cha matenda enaake osiyanasiyana. Kutaya magazi m'mitsempha ya Varicose nthawi zambiri kumaphatikizapo kutaya magazi ambiri komanso kufa kwambiri, ndipo odwala omwe akutuluka magazi salola kuti achite opaleshoni.
Ndikusintha komanso kugwiritsa ntchito ukadaulo wamankhwala am'mimba, chithandizo cha endoscopic chakhala njira imodzi yochizira kutuluka kwa m'mimero/m'mimba. Zimaphatikizapo endoscopic sclerotherapy (EVS), endoscopic variceal ligation (EVL) ndi endoscopic tissue glue injection therapy (EVHT).
Endoscopic Sclerotherapy (EVS)
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1) Mfundo ya endoscopic sclerotherapy (EVS):
Intravascular jekeseni: sclerosing wothandizira amachititsa kutupa kuzungulira mitsempha, kuumitsa mitsempha ndi midadada magazi;
Jakisoni wa paravascular: kuchititsa kutupa kosabala m'mitsempha kumayambitsa thrombosis.
2) Zizindikiro za EVS:
(1) Kuphulika kwakukulu kwa EV ndi kutuluka magazi;
(2) Mbiri yakale ya EV kupasuka ndi magazi;
(3) Odwala omwe akuyambiranso EV pambuyo pa opaleshoni;
(4) Amene sali oyenerera chithandizo cha opaleshoni.
3) Zotsutsana za EVS:
(1) Zotsutsana zofanana ndi gastroscopy;
(2) Chiwindi encephalopathy siteji 2 kapena pamwamba;
(3) Odwala omwe ali ndi vuto lalikulu la chiwindi ndi impso, kuchuluka kwa ascites, ndi jaundice yoopsa.
4) Njira zodzitetezera
Ku China, mutha kusankha lauromacrol (Gwiritsani ntchitosclerotherapy singano). Pamitsempha yokulirapo, sankhani jakisoni wa intravascular. Kuchuluka kwa jakisoni nthawi zambiri kumakhala 10 mpaka 15 ml. Kwa mitsempha yaying'ono yamagazi, mutha kusankha jakisoni wa paravascular. Yesetsani kupewa kubaya jekeseni pamalo osiyanasiyana pa ndege imodzi (Zilonda zitha kuchitika zomwe zimatsogolera kukomoka). Ngati kupuma kumakhudzidwa panthawi ya opaleshoni, kapu yowonekera ikhoza kuwonjezeredwa ku gastroscope. M'mayiko akunja, buluni nthawi zambiri imawonjezeredwa ku gastroscope. Ndikoyenera kuphunzirapo.
5) Chithandizo cha postoperative cha EVS
(1) Osadya kapena kumwa kwa maola 8 mutatha opaleshoni, ndipo pang'onopang'ono muyambenso chakudya chamadzimadzi;
(2) Gwiritsani ntchito mlingo woyenera wa maantibayotiki kuti mupewe matenda;
(3) Gwiritsani ntchito mankhwala kuti muchepetse kuthamanga kwa portal ngati kuli koyenera.
6) Maphunziro a chithandizo cha EVS
Multiple sclerotherapy imafunika mpaka mitsempha ya varicose itatha kapena kutha, ndi nthawi ya sabata imodzi pakati pa chithandizo chilichonse; gastroscopy idzawunikidwa mwezi umodzi, miyezi itatu, miyezi 6, ndi chaka chimodzi pambuyo pa kutha kwa mankhwala.
7) Zovuta za EVS
(1) Zovuta zodziwika: ectopic embolism, zilonda zam'mimba, ndi zina zambiri, ndipo ndizosavuta kutulutsa magazi kapena kutuluka magazi pabowo la singano pochotsa singano.
(2) Zovuta za m'deralo: zilonda, kutuluka magazi, stenosis, kusokonekera kwa esophageal motility, odynophagia, lacerations. Zovuta zachigawo zimaphatikizapo mediastinitis, perforation, pleural effusion, ndi portal hypertensive gastropathy yokhala ndi chiopsezo chochulukira magazi.
(3) Zovuta zadongosolo: sepsis, chibayo cholakalaka, hypoxia, modzidzimutsa bakiteriya peritonitis, portal vein thrombosis.
Endoscopic varicose vein ligation (EVL)
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1) Zizindikiro za EVL: Zofanana ndi EVS.
2) Zotsutsana za EVL:
(1) Zotsutsana zofanana ndi gastroscopy;
(2) EV limodzi ndi GV zoonekeratu;
(3) Odwala omwe ali ndi vuto lalikulu la chiwindi ndi impso, kuchuluka kwa ascites, jaundice, chithandizo chaposachedwapa cha multiple sclerotherapy kapena mitsempha yaing'ono ya varicose.
3) Momwe mungagwiritsire ntchito
Kuphatikizira kulumikiza tsitsi limodzi, kulumikiza tsitsi zingapo, ndi kulumikizana kwa zingwe za nayiloni.
(1) Mfundo yofunika: Kuletsa magazi a mitsempha ya varicose ndi kupereka magazi mwadzidzidzi → venous thrombosis pamalo olumikizira → minofu necrosis → fibrosis → kutha kwa mitsempha ya varicose.
(2) Kusamala
Pamitsempha yocheperako mpaka yoopsa kwambiri, mitsempha ya varicose imalumikizidwa mozungulira mozungulira kuchokera pansi kupita pamwamba. The ligator ayenera kukhala pafupi kwambiri ndi chandamale ligation mtsempha wa varicose, kotero kuti mfundo iliyonse ligated ndi densely ligated. Yesetsani kuphimba mitsempha ya varicose pamtunda wopitilira 3 mfundo.
Zimatenga pafupifupi sabata 1 mpaka 2 kuti necrosis igwe pambuyo pa bandeji necrosis. Patangotha mlungu umodzi opareshoniyo itachitika, zilonda za m'derali zimatha kutulutsa magazi kwambiri, khungu limagwa, ndipo mitsempha ya mitsempha imatha kutuluka magazi. EVL imatha kuthetsa mitsempha ya varicose mwachangu ndipo imakhala ndi zovuta zochepa, koma mitsempha ya varicose imabwereranso. Gawoli liri pamwamba;
EVL imatha kuletsa kutuluka kwa magazi m'mitsempha yakumanzere ya m'mimba, mtsempha wa esophageal, ndi vena cava. Komabe, magazi akatsekeka m'mitsempha, mtsempha wa m'mimba ndi perigastric venous plexus zimakula, kutuluka kwa magazi kumawonjezeka, ndipo kuchuluka kwa kubwereza kumawonjezeka pakapita nthawi. Choncho, nthawi zambiri Kubwerezedwa gulu ligation chofunika kulimbikitsa mankhwala. Kuzama kwa mitsempha ya varicose kuyenera kukhala osachepera 1.5 cm.
4) Zovuta za EVL
(1) Kutaya magazi kwakukulu chifukwa cha zilonda zam’deralo pafupifupi mlungu umodzi pambuyo pa opaleshoni;
(2) Kutaya magazi m'mitsempha, kutayika kwa bandeji yachikopa, ndi kutuluka magazi chifukwa cha mitsempha ya varicose;
(3) Matenda.
5) Kubwereza pambuyo pa EVL
M'chaka choyamba pambuyo pa opaleshoni ya EVL, ntchito ya chiwindi ndi impso, B-ultrasound, chizolowezi cha magazi, coagulation ntchito, ndi zina zotero ziyenera kuwunikiridwa miyezi 3 mpaka 6 iliyonse. Endoscopy iyenera kuwunikiridwa miyezi itatu iliyonse, kenako miyezi 0 mpaka 12 iliyonse.
6) EVS vs EVL
Poyerekeza ndi sclerotherapy ndi ligation, palibe kusiyana kwakukulu pakufa ndi kutulutsanso magazi pakati pa awiriwa. Kwa odwala omwe amafunikira chithandizo chobwerezabwereza, ligation imalimbikitsidwa kwambiri. Nthawi zina ligation ndi sclerotherapy zimaphatikizidwanso, zomwe zimatha kusintha chithandizo. Zotsatira. M'mayiko akunja, zitsulo zotsekedwa mokwanira zimagwiritsidwanso ntchito poletsa kutuluka kwa magazi.
Endoscopic minofu guluu jakisoni therapy (EVHT)
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Njira imeneyi ndi yoyenera kwa chapamimba mitsempha ndi kum`mero variceal magazi pakachitika mwadzidzidzi.
1) Zovuta za EVHT: makamaka mitsempha ya m'mapapo ndi portal vein embolism, koma zochitikazo ndizochepa kwambiri.
2) Ubwino wa EVHT: mitsempha ya varicose imatha msanga, kutulutsanso magazi kumakhala kochepa, zovuta zimakhala zochepa, zisonyezo ndizokulirapo ndipo ukadaulo ndiosavuta kudziwa.
3) Zomwe muyenera kudziwa:
Mu endoscopic minofu glue jakisoni, kuchuluka kwa jakisoni kuyenera kukhala kokwanira. Endoscopic ultrasound imagwira ntchito yabwino kwambiri pochiza mitsempha ya varicose ndipo imatha kuchepetsa chiopsezo chotayanso magazi.
Pali malipoti m'mabuku akunja kuti chithandizo cham'mimba cham'mimba chokhala ndi ma coils kapena cyanoacrylate motsogozedwa ndi endoscopic ultrasound ndichothandiza pamatumbo am'mimba. Poyerekeza ndi jakisoni wa cyanoacrylate, kupopera motsogozedwa ndi endoscopic kumafuna jakisoni wocheperako wa intraluminal ndipo kumalumikizidwa ndi zovuta zochepa.
Ife, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ndi opanga ku China okhazikika pazakudya zama endoscopic, mongabiopsy forceps, hemoclip, polyp msampha, sclerotherapy singano, kupopera catheter, maburashi a cytology, guidewire, dengu lochotsa miyala, catheter ya nasal biliary drainageetc. omwe amagwiritsidwa ntchito kwambiri muEMR, ESD, ERCP. Zogulitsa zathu ndi zovomerezeka za CE, ndipo mbewu zathu ndi zovomerezeka za ISO. Katundu wathu watumizidwa ku Europe, North America, Middle East ndi gawo la Asia, ndipo amapeza makasitomala ambiri kuzindikira ndi kutamandidwa!
Nthawi yotumiza: Aug-15-2024