Matenda a m'mimba/m'mimba ndi chifukwa cha zotsatira zosatha za kuthamanga kwa magazi kwa portal ndipo pafupifupi 95% amayamba chifukwa cha matenda a chiwindi a zifukwa zosiyanasiyana. Kutuluka magazi m'mitsempha ya varicose nthawi zambiri kumaphatikizapo kutuluka magazi ambiri komanso kufa kwambiri, ndipo odwala omwe akutuluka magazi salola opaleshoni.
Ndi kusintha ndi kugwiritsa ntchito ukadaulo wochizira matenda a m'mimba, chithandizo cha endoscopic chakhala njira imodzi yochizira kutuluka magazi m'mimba/m'mimba. Makamaka chimaphatikizapo endoscopic sclerotherapy (EVS), endoscopic variceal ligation (EVL) ndi endoscopic tissue glue injection therapy (EVHT).
Endoscopic Sclerotherapy (EVS)
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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: kuyambitsa kutupa kosabala m'mitsempha komwe kumayambitsa thrombosis.
2) Zizindikiro za EVS:
(1) Kuphulika kwa EV ndi kutuluka magazi mwadzidzidzi;
(2) Mbiri yakale ya kuphulika kwa EV ndi kutuluka magazi;
(3) Odwala omwe abwereranso ndi EV pambuyo pa opaleshoni;
(4) Omwe sali oyenera kuchitidwa opaleshoni.
3) Zotsutsana za EVS:
(1) Zotsutsana zomwezo monga gastroscopy;
(2) Matenda a chiwindi otchedwa hepatic encephalopathy siteji yachiwiri kapena 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 (Gwiritsani ntchitosingano ya sclerotherapy). Pa mitsempha ikuluikulu yamagazi, sankhani jakisoni wamkati mwa mitsempha. Kuchuluka kwa jakisoni nthawi zambiri kumakhala 10 mpaka 15 mL. Pa mitsempha yaying'ono yamagazi, mutha kusankha jakisoni wa paravascular. Yesetsani kupewa jakisoni pamalo osiyanasiyana pamalo amodzi (Zilonda zitha kuchitika zomwe zimapangitsa kuti m'mero mutsekeke). Ngati kupuma kwakhudzidwa panthawi ya opaleshoni, chivundikiro chowonekera chikhoza kuwonjezeredwa ku gastroscope. M'maiko akunja, baluni nthawi zambiri imayikidwa ku gastroscope. Ndikoyenera kuphunzira kuchokera pamenepo.
5) Chithandizo cha EVS pambuyo pa opaleshoni
(1) Musadye kapena kumwa kwa maola 8 mutachita opaleshoni, ndipo pang'onopang'ono pitirizani kudya zakudya zamadzimadzi;
(2) Gwiritsani ntchito mankhwala opha tizilombo oyenera kuti mupewe matenda;
(3) Gwiritsani ntchito mankhwala kuti muchepetse kuthamanga kwa magazi m'mapapo momwe mungafunikire.
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, ndipo n'zosavuta kuyambitsa magazi kutuluka kapena kutuluka magazi kuchokera m'bowo la singano pochotsa singano.
(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, chibayo cha aspiration, hypoxia, bacterial peritonitis yodzidzimutsa, portal vein thrombosis.
Kulumikiza mitsempha ya varicose ya endoscopic (EVL)
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1) Zizindikiro za EVL: Chimodzimodzi ndi EVS.
2) Zotsutsana za EVL:
(1) Zotsutsana zomwezo monga gastroscopy;
(2) EV yoyendetsedwa ndi GV yodziwikiratu;
(3) Odwala omwe ali ndi vuto lalikulu la chiwindi ndi impso, matenda ambiri a ascites, jaundice, mankhwala aposachedwa a multiple sclerotherapy kapena mitsempha yaying'ono ya varicose.
3) Momwe mungagwiritsire ntchito
Kuphatikizapo kulumikiza tsitsi limodzi, kulumikiza tsitsi lambiri, ndi kulumikiza chingwe cha nayiloni.
(1) 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.
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 ya varicose kumatuluka magazi mwamakina. EVL imatha kuthetsa mitsempha ya varicose mwachangu ndipo ili ndi zovuta zochepa, koma mitsempha ya varicose imabwereranso. Chiwerengerochi chili pamwamba;
EVL imatha kuletsa magazi ogwirizana ndi mitsempha ya m'mimba yakumanzere, mitsempha ya m'mero, ndi vena cava. Komabe, magazi a m'mero akatsekedwa, mitsempha ya m'mimba ndi mitsempha ya m'mimba imakula, magazi amawonjezeka, ndipo kuchuluka kwa magazi kumawonjezeka pakapita nthawi. Chifukwa chake, nthawi zambiri kumafunika kumangidwanso kuti kuphatikize chithandizocho. Kukula kwa mitsempha ya varicose kuyenera kukhala kochepera 1.5 cm.
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 opaleshoni ya 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 motsutsana ndi EVL
Poyerekeza ndi sclerotherapy ndi kulumikiza mafupa, palibe kusiyana kwakukulu pakati pa imfa ndi kuchuluka kwa magazi omwe amatulukanso pakati pa awiriwa. Kwa odwala omwe amafunikira chithandizo chobwerezabwereza, kulumikiza mafupa nthawi zambiri kumalimbikitsidwa. Nthawi zina kulumikiza mafupa ndi sclerotherapy kumaphatikizidwanso, zomwe zingathandize kuti chithandizo chikhale bwino. Zotsatira zake. M'mayiko akunja, ma stenti achitsulo ophimbidwa mokwanira amagwiritsidwanso ntchito kuti asiye kutuluka magazi.
Chithandizo cha jakisoni wa guluu wa minofu ya endoscopic (EVHT)
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Njira iyi ndi yoyenera pa matenda a varices a m'mimba ndi kutuluka magazi m'mitsempha ya variceal pakagwa mwadzidzidzi.
1) Mavuto a EVHT: makamaka mtsempha wa m'mapapo ndi mtsempha wa portal, koma kuchuluka kwake ndi kochepa kwambiri.
2) Ubwino wa EVHT: mitsempha yotupa imatha msanga, kuchuluka kwa magazi omwe amatulukanso m'thupi kumakhala kochepa, mavuto ndi ochepa, zizindikiro zake ndi zambiri ndipo ukadaulo wake ndi wosavuta kuudziwa.
3) Zinthu zofunika kuziganizira:
Mu chithandizo cha jakisoni wa guluu wa minofu ya endoscopic, kuchuluka kwa jakisoni kuyenera kukhala kokwanira. Endoscopic ultrasound imagwira ntchito yabwino kwambiri pochiza mitsempha ya varicose ndipo ingachepetse chiopsezo chotuluka magazi kachiwiri.
Pali malipoti m'mabuku akunja omwe amanena kuti chithandizo cha varices cha m'mimba ndi ma coil kapena cyanoacrylate motsogozedwa ndi endoscopic ultrasound ndi chothandiza pa varices za m'mimba zakomweko. Poyerekeza ndi jakisoni wa cyanoacrylate, endoscopic ultrasound-guided coiling imafuna jakisoni wochepa wa intraluminal ndipo imagwirizana ndi zochitika zochepa zoyipa.
Ife, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ndi opanga ku China omwe amagwira ntchito kwambiri pazinthu zogwiritsidwa ntchito m'ma endoscopic, mongamphamvu ya biopsy, hemoclip, msampha wa polyp, singano ya sclerotherapy, katheta wopopera, maburashi a cytology, waya wotsogolera, dengu lotengera miyala, katheta yotulutsira madzi m'mphunondi zina zotero zomwe zimagwiritsidwa ntchito kwambiri muEMR, ESD, ERCPZogulitsa zathu zili ndi satifiketi ya CE, ndipo mafakitale athu ali ndi satifiketi ya ISO. Katundu wathu watumizidwa ku Europe, North America, Middle East ndi mbali ina ya Asia, ndipo makasitomala ambiri amalandira ulemu ndi kutamandidwa!
Nthawi yotumizira: Ogasiti-15-2024