Esophageal / gastric varices mhedzisiro yekuenderera mberi kweiyo portal hypertension uye ingangoita 95% inokonzerwa ne cirrhosis yezvikonzero zvakasiyana. Varicose vein kubuda ropa kunowanzobatanidza kuwanda kwekubuda ropa uye kufa kwakanyanya, uye varwere vanobuda ropa havana kushivirira pakuvhiyiwa.
Nekuvandudzwa uye kushandiswa kwekugayiwa endoscopic kurapwa tekinoroji, endoscopic kurapwa kwave imwe yenzira huru dzekurapa esophageal/gastric variceal kubuda ropa. Inonyanya kusanganisira endoscopic sclerotherapy (EVS), endoscopic variceal ligation (EVL) uye endoscopic tissue glue injection therapy (EVHT).
Endoscopic Sclerotherapy (EVS)
chikamu 1
1) Nheyo ye endoscopic sclerotherapy (EVS):
Intravascular jekiseni: sclerosing agent inokonzera kuzvimba kwakatenderedza tsinga, inoomesa tsinga dzeropa uye inovhara kubuda kweropa;
Paravascular jekiseni: kukonzera kusabereka kuzvimba kuita mutsinga kukonzeresa thrombosis.
2) Zviratidzo zveEVS:
(1) Acute EV kuputika uye kubuda ropa;
(2) Nhoroondo yekare yeEV kuputika uye kubuda ropa;
(3) Varwere vane kudzoka kweEV mushure mekuvhiyiwa;
(4) Vaya vasina kukodzera kurapwa.
3) Contraindications yeEVS:
(1) Zvimwe zvinopesana negastroscopy;
(2) Hepatic encephalopathy danho rechipiri kana pamusoro;
(3) Varwere vane chiropa chakanyanya uye kusagadzikana kweitsvo, kuwanda kweascites, uye jaundice yakaoma.
4) Maitiro ekuchengetedza
MuChina, unogona kusarudza lauromacrol (Shandisasclerotherapy tsono) Kune tsinga dzakakura dzeropa, sarudza jekiseni re intravascular. Huwandu hwejekiseni kazhinji 10 kusvika 15 mL. Kune mitsipa midiki yeropa, unogona kusarudza paravascular jekiseni. Edza kudzivirira kubaya jekiseni panzvimbo dzakati wandei pandege imwechete ( Maronda anogona kuitika achitungamira esophageal kuomarara). Kana kufema kuchikanganiswa panguva yekushanda, chivharo chakajeka chinogona kuwedzerwa kune gastroscope. Munyika dzekunze, bharumu inowanzowedzerwa kune gastroscope. Zvakakodzera kudzidza kubva.
5) Postoperative kurapwa kweEVS
(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 kuderedza 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 anowanzo: ectopic embolism, esophageal ulcer, nezvimwewo, uye zviri nyore kukonzera kubuda kweropa kana kubuda ropa kubva paburi retsono pakubvisa tsono.
(2) Matambudziko emunharaunda: maronda, kubuda ropa, stenosis, esophageal motility dysfunction, odynophagia, lacerations. Matambudziko edunhu anosanganisira mediastinitis, perforation, pleural effusion, uye portal hypertensive gastropathy ine njodzi yekubuda ropa.
(3) Systemic complications: sepsis, aspiration pneumonia, hypoxia, spontaneous bacterial peritonitis, portal vein thrombosis.
Endoscopic varicose vein ligation (EVL)
Chikamu 2
1) Zviratidzo zveEVL: Zvakafanana neEVS.
2) Contraindications yeEVL:
(1) Zvimwe zvinopesana negastroscopy;
(2) EV inoperekedzwa neGV iri pachena;
(3) Varwere vane chiropa chakanyanya uye kusagadzikana kwetsvo, yakawanda yeascites, jaundice, ichangopfuura multiple sclerotherapy mishonga kana zviduku varicose veins.
3)Kushanda sei
Kusanganisira single hair ligation, multiple hair ligation, uye nylon rope ligation.
(1) Nheyo: Vhara kubuda kweropa kwevaricose veins uye kupa chimbichimbi 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.
Zvinotora vhiki imwe kusvika ku2 kuti necrosis idonhe mushure mebhanji necrosis. Vhiki imwe pashure pokuvhiyiwa, maronda omunzvimbomo anogona kukonzera kubuda ropa kukuru, bhande reganda rinodonha, uye kucheka kwevaricose veins kunobuda ropa. EVL inogona kubvisa varicose tsinga nekukurumidza uye ine mashoma matambudziko, asi varicose tsinga dzinodzoka. Mugove uri kurutivi rwakakwirira;
EVL inogona kuvharidzira kuvharika kwekubuda ropa kwekuruboshwe gastric vein, esophageal vein, uye vena cava. Nekudaro, mushure me esophageal venous kubuda kweropa kuvharika, gastric coronary vein uye perigastric venous plexus ichawedzera, kuyerera kweropa kuchawedzera, uye chiyero chekudzokorora chichawedzera nekufamba kwenguva. Naizvozvo, kazhinji Inodzokororwa bhendi ligation inodiwa kuti isimbise kurapwa. Kureba kwevaricose vein ligation kunofanirwa kunge kuri pasi pe1.5 cm.
4) Matambudziko eEVL
(1) Kubuda ropa kukuru nemhaka yemaronda emunzvimbo inenge vhiki imwe pashure pokuvhiyiwa;
(2) Kubuda ropa muropa, kurasikirwa nebhande redehwe, uye kubuda ropa kunokonzerwa nevaricose veins;
(3) Utachiona.
5) Postoperative wongororo yeEVL
Mugore rekutanga mushure mekuvhiyiwa kweEVL, kushanda kwechiropa neitsvo, B-ultrasound, maitiro eropa, coagulation function, nezvimwewo zvinofanira kuongororwa mwedzi mitatu kusvika ku6. Endoscopy inofanira kuongororwa mwedzi mitatu yega yega, uyezve mwedzi 0 kusvika ku12.
6)EVS vs EVL
Kuenzaniswa ne sclerotherapy uye ligation, hapana mutsauko wakakura mukufa uye kuburitsazve ropa pakati pezviviri. Kune varwere vanoda kurapwa kakawanda, ligation inonyanya kukurudzirwa. Dzimwe nguva ligation uye sclerotherapy inosanganiswawo, iyo inogona kuvandudza kurapwa. Mhedzisiro. Munyika dzekunze, simbi dzakafukidzwa zvakakwana dzinoshandiswawo kumisa kubuda ropa.
Endoscopic tissue glue injection therapy (EVHT)
chikamu 3
Iyi nzira inokodzera gastric varices uye esophageal variceal kubuda ropa mumamiriro ekukurumidzira.
1) Matambudziko eEVHT: kunyanya pulmonary artery uye portal vein embolism, asi chiitiko chakanyanya kuderera.
2) Zvakanakira EVHT: varicose veins inonyangarika nekukurumidza, chiyero chekubudazve ropa chakaderera, matambudziko mashoma, zviratidzo zvakakura uye tekinoroji iri nyore kugona.
3) Zvinhu zvekucherechedza:
Mune endoscopic tishu glue jekiseni kurapwa, huwandu hwejekiseni hunofanirwa kukwana. Endoscopic ultrasound inoita basa rakanaka kwazvo mukurapa varicose tsinga uye inogona kuderedza njodzi yekubudazve ropa.
Kune mishumo mumabhuku ekunze ekuti kurapwa kwegastric varices nemakoiri kana cyanoacrylate pasi pekutungamirwa kwe endoscopic ultrasound kunoshanda kune yemuno gastric varices. Kuenzaniswa nemajekiseni ecyanoacrylate, endoscopic ultrasound-inotungamirirwa coiling inoda majekiseni mashoma emukati uye inosanganiswa nezviitiko zvishoma zvakashata.
Isu, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., inogadzira muChina inyanzvi mune endoscopic consumables, senge.biopsy forceps, hemoclip, polyp musungo, sclerotherapy tsono, pfapfaidza catheter, cytology brushes, guidewire, dombo rekudzosa tswanda, nasal biliary drainage catheteretc. ayo anoshandiswa zvakanyanya muEMR, ESD, ERCP. Zvigadzirwa zvedu ndezveEC Certified, uye zvidyarwa zvedu ISO certified. Zvinhu zvedu zvakatumirwa kuEurope, North America, Middle East uye chikamu cheAsia, uye zvakanyanya kuwana mutengi wekuzivikanwa nekurumbidzwa!
Nguva yekutumira: Aug-15-2024