Endoscopic Sclerotherapy (EVS) chikamu chekutanga

1) Nheyo ye endoscopic sclerotherapy (EVS):

Intravascular jekiseni: sclerosing agent inokonzera kuzvimba kwakatenderedza tsinga, inoomesa tsinga dzeropa uye inovhara kubuda kweropa;

Paravascular jekiseni: inokonzeresa kusabereka kuzvimba kuita mutsinga kukonzeresa thrombosis.2) Zviratidzo zveEVS:

(1) Acute EV kuputika uye kubuda ropa;

(2) Vanhu vane nhoroondo yeEV kuputika uye kubuda ropa;(3) Vanhu vane kudzokorora kweEV mushure mekuvhiyiwa;(4) Vanhu vasina kukodzera kurapwa kuvhiyiwa.

3) Contraindications yeEVS:

(1) Zvakafanana negastroscopy;

(2) Hepatic encephalopathy danho rechipiri uye pamusoro;

(3) Varwere vane chiropa chakakomba uye kusagadzikana kwetsvo, kuwanda kweascites, uye jaundice yakaoma.

4) Maitiro ekuchengetedza

MuChina, unogona kusarudza lauromacrol.Kune tsinga dzakakura dzeropa, sarudza jekiseni re intravascular.Huwandu hwejekiseni hunowanzo 10 ~ 15mL.Kune mitsipa midiki yeropa, unogona kusarudza paravascular jekiseni.Edza kudzivisa kubaya jekiseni panzvimbo dzakati wandei pandege imwe chete (pamwe Maronda anogona kuitika achitungamira esophageal stricture).Kana kufema kuchikanganiswa panguva yekushanda, chivharo chakajeka chinogona kuwedzerwa kune gastroscope.Munyika dzekunze, bharumu inowanzowedzerwa kune gastroscope.Zvakakodzera kudzidza kubva.

5) Postoperative management yeEVS

(1) Usadya kana kunwa kwemaawa masere mushure mekuvhiyiwa uye zvishoma nezvishoma tangazve chikafu chemvura;

(2) Shandisa mwero wakafanira wemishonga inorwisa mabhakitiriya kudzivirira utachiona;(3) Shandisa zvinodhaka zvinoderedza portal pressure sezvakakodzera.

6) EVS kurapwa kosi

Multiple sclerotherapy inodiwa kusvikira varicose tsinga dzanyangarika kana kuti dzakanyangarika, pamwe nepakati pevhiki imwe pakati pekurapa kwega kwega;gastroscopy ichaongororwa 1 mwedzi, 3 mwedzi, 6 mwedzi, uye 1 gore mushure mekupera kwekosi yekurapa.

7) Matambudziko eEVS

(1) Matambudziko akajairika: ectopic embolism, esophageal ulcer, nezvimwewo, uye

Zviri nyore kukonzera kubuda ropa kana kubuda ropa kubva paburi retsono kana tsono yadhonzwa.

(2) Matambudziko emunharaunda: maronda, kubuda ropa, stenosis, esophageal motility dysfunction, odynophagia, lacerations.Matambudziko emudunhu anosanganisira mediastinitis, perforation, pleural effusion, uye portal hypertensive gastropathy ine njodzi yekubuda ropa.

(3) Systemic complications: sepsis, aspiration pneumonia, hypoxia, spontaneous bacterial peritonitis, uye portal vein thrombosis.

Endoscopic varicose vein ligation (EVL)

(1) Zviratidzo zveEVL: Zvakafanana neEVS.

(2) Contraindications yeEVL:

(1) Zvimwe zvinopesana negastroscopy;

(2) EV inoperekedzwa neGV iri pachena;

(3) ichiperekedzwa nechiropa chakakomba uye kusagadzikana kwetsvo, yakawanda yeascites, jaundice

Gangrene uye ichangoburwa multiple sclerotherapy kurapwa kana diki varicose tsinga

Kutora Dynasty yeHan sepedyo-duofu zvinoreva kuti vanhu veHua vachakwanisa kufamba vakasununguka, kana kuti tendon nemapulses zvichatambanudzirwa kumadokero.

By.

3)Kushanda sei

Kusanganisira single hair ligation, multiple hair ligation, uye nylon rope ligation.

Nheyo: Vhara kubuda kweropa kwevaricose veins uye upe emergency hemostasis → venous thrombosis panzvimbo yekubatanidza → tissue necrosis → fibrosis → kunyangarika kwevaricose veins.

(2) Kungwarira

Kune mitsipa iri pakati nepakati kusvika yakaoma yesophageal, tsinga yega yega yevaricose inosungirirwa nenzira inotenderera ichikwira kubva pasi kusvika kumusoro.Iyo ligator inofanirwa kunge iri padyo sezvinobvira kune inotarirwa ligation point yevaricose vein, kuitira kuti imwe neimwe pfungwa yakanyatso kusungirirwa uye densely ligated.Edza kuvhara yega yega varicose tsinga pane anopfuura matatu mapoinzi.