Kubuda ropa mumitsipa yeropa/yemudumbu kunokonzerwa nemigumisiro inogara iripo yeBP uye inenge 95% inokonzerwa nechirwere chemwoyo chinokonzerwa nezvikonzero zvakasiyana-siyana. Kubuda ropa mumitsipa yeropa kunowanzo sanganisira kubuda ropa kwakawanda uye kufa kwakawanda, uye varwere vanobuda ropa havadi kuvhiyiwa.
Nekuvandudzika nekushandiswa kwetekinoroji yekurapa endoscopic yekugaya chikafu, kurapwa kwe endoscopic kwave imwe yenzira huru dzekurapa kubuda ropa mudumbu/mudumbu. Kunosanganisira zvikuru endoscopic sclerotherapy (EVS), endoscopic variceal ligation (EVL) uye endoscopic tissue glue injection therapy (EVHT).
Kurapa Nekuvhiya Kweganda (EVS)
chikamu 1
1) Nheyo ye endoscopic sclerotherapy (EVS):
Jekiseni remutsinga: mushonga we sclerosing unokonzera kuzvimba kwakatenderedza tsinga, unoomesa tsinga dzeropa uye unovhara kufamba kweropa;
Kubaiwa jekiseni reropa mutsinga: kukonzera kuzvimba mutsinga kunokonzera thrombosis.
2) Zviratidzo zveEVS:
(1) Kuputika kweEV kwakanyanya uye kubuda ropa;
(2) Nhoroondo yekare yekuputika kweEV nekubuda ropa;
(3) Varwere vane EV inodzoka mushure mekuvhiyiwa;
(4) Avo vasina kukodzera kurapwa nekuvhiyiwa.
3) Zvipingamupinyi zveEVS:
(1) Zvimwe zvinopesana nekushandiswa kwegastroscopy;
(2) Hepatic encephalopathy danho rechipiri kana kupfuura;
(3) Varwere vane chirwere chakakomba chechiropa neitsvo, vane ascites yakawanda, uye jaundice yakanyanya.
4) Matanho ekudzivirira mashandiro
MuChina, unogona kusarudza lauromacrol (Kushandisatsono yekurapa sclerotherapy). Kumidziyo mikuru yeropa, sarudza jekiseni remutsinga. Huwandu hwejekiseni hunowanzova 10 kusvika 15 mL. Kumidziyo midiki yeropa, unogona kusarudza jekiseni reparavascular. Edza kudzivirira kubaya jekiseni panzvimbo dzakasiyana-siyana panzvimbo imwe chete (Maronda anogona kuitika zvichikonzera kuvharika kwegurokuro). Kana kufema kukakanganiswa panguva yekuvhiyiwa, chivharo chakajeka chinogona kuwedzerwa kugastroscope. Munyika dzekunze, bharumu rinowanzoiswa kugastroscope. Zvakakosha kudzidza kubva.
5) Kurapwa kweEVS mushure mekuvhiyiwa
(1) Usadye kana kunwa kwemaawa masere mushure mekuvhiyiwa, uye zvishoma nezvishoma tangazve kudya zvine mvura;
(2) Shandisa huwandu hwakakodzera hwemishonga inorwisa mabhakitiriya kudzivirira hutachiona;
(3) Shandisa mishonga kuderedza kumanikidzwa kwepazasi penzira yekupinda kweropa kana zvakakodzera.
6) Kosi yekurapa yeEVS
Kurapwa kwe sclerotherapy kakawanda kunodiwa kusvika tsinga dzakakuvara dzanyangarika kana kuti dzanyangarika, nechikamu chevhiki imwe chete pakati pekurapwa kwega kwega; gastroscopy ichaongororwa mwedzi mumwe, mwedzi mitatu, mwedzi mitanhatu, uye gore rimwe chete mushure mekupera kwekurapwa.
7) Matambudziko eEVS
(1) Matambudziko anowanzoitika: ectopic embolism, ulcer yegurokuro, nezvimwewo, uye zviri nyore kukonzera ropa kubuda kana kubuda ropa kubva muburi retsono kana uchibvisa tsono.
(2) Matambudziko emunharaunda: maronda, kubuda ropa, stenosis, kutadza kufamba zvakanaka kwegurokuro, odynophagia, maronda. Matambudziko emunharaunda anosanganisira mediastinitis, kubooka, pleural effusion, uye portal hypertension gastropathy ine njodzi yakawedzera yekubuda ropa.
(3) Matambudziko emuviri: sepsis, aspiration pneumonia, hypoxia, bacterial peritonitis inongoerekana yaitika, portal vein thrombosis.
Kusunga mitsipa yeropa iri muropa (EVL)
Chikamu 2
1) Zviratidzo zveEVL: Zvakafanana neEVS.
2) Zvipingamupinyi zveEVL:
(1) Zvimwe zvinopesana nekushandiswa kwegastroscopy;
(2) EV inoperekedzwa neGV iri pachena;
(3) Varwere vane chirwere chakakomba chechiropa neitsvo, vane ascites yakawanda, jaundice, kurapwa kwakaitwa munguva pfupi yapfuura nemultiple sclerotherapy kana mitsipa midiki iri kutenderera.
3) Maitiro ekushanda
Kusanganisira kusungirirwa kwebvudzi rimwe chete, kusungirirwa kwebvudzi rakawanda, uye kusungirirwa kwetambo yenylon.
(1) Musimboti: Kuvhara kufamba kweropa mutsinga dzakakuvara uye kupa emergency hemostasis → venous thrombosis panzvimbo yakasungirirwa → tissue necrosis → fibrosis → kunyangarika kwetsinga dzakakuvara.
(2) Kuchenjerera
Kune varices dzepagurokuro dzine mwero kusvika dzakakomba, tsinga yega yega yevaricose inosungirirwa mudenga kubva pasi kuenda kumusoro. Chinosungirirwa chinofanira kunge chiri pedyo nepanosungirirwa tsinga yevaricose, kuitira kuti tsinga yega yega ive yakasungirirwa zvakakwana uye yakasungirirwa zvakanyanya. Edza kufukidza tsinga yega yega yevaricose pane anopfuura mapoinzi matatu.
Zvinotora vhiki imwe kusvika mbiri kuti necrosis ipere mushure mekubatwa nebhandeji. Vhiki imwe mushure mekuvhiyiwa, maronda emunharaunda anogona kukonzera kubuda ropa kwakanyanya, bhandi reganda rinodonha, uye kuchekwa kweropa remitsipa yevaricose kunobuda ropa. EVL inogona kubvisa mitsipa yevaricose nekukurumidza uye haina matambudziko akawanda, asi mitsipa yevaricose inodzoka zvakare. Chikamu chacho chiri pamusoro;
EVL inogona kuvharira kubuda ropa kwetsinga yekuruboshwe yedumbu, tsinga yesophageal, uye vena cava. Zvisinei, mushure mekunge kuyerera kweropa mutsinga yesophageal kwavharwa, tsinga yemoyo yemudumbu ne perigastric venous plexus zvinokura, kuyerera kweropa kuchawedzera, uye mwero wekudzoka kweropa uchawedzera nekufamba kwenguva. Nokudaro, kazhinji kunobatanidzwa ne band ligation kuti kurapwa kusimbiswe. Dhayamita yekubatanidza mitsinga yesophageal inofanira kunge iri pasi pe 1.5 cm.
4) Matambudziko eEVL
(1) Kubuda ropa rakawanda nekuda kwemaronda emunzvimbo inenge vhiki imwe chete mushure mekuvhiyiwa;
(2) Kubuda ropa panguva yekuvhiyiwa, kurasikirwa nebhande reganda, uye kubuda ropa kunokonzerwa netsinga dzakakuvara;
(3) Kutapukirwa.
5) Ongororo yeEVL mushure mekuvhiyiwa
Mugore rekutanga mushure mekuvhiyiwa kweEVL, kushanda kwechiropa neitsvo, B-ultrasound, maitiro eropa, kushanda kweropa rakagwamba, nezvimwewo zvinofanira kuongororwa mwedzi mitatu kusvika mitanhatu yega yega. Endoscopy inofanira kuongororwa mwedzi mitatu yega yega, uyezve mwedzi 0 kusvika gumi nemiviri yega yega.
6)EVS vs EVL
Zvichienzaniswa nekurapa nesclerotherapy nekubatanidza, hapana musiyano wakakura mukufa uye mwero wekubuda ropa zvakare pakati pezviviri izvi. Kune varwere vanoda kurapwa kakawanda, kusungirirwa kunokurudzirwa zvikuru. Dzimwe nguva kusungirirwa nesclerotherapy zvinosanganiswawo, izvo zvinogona kuvandudza kurapwa. Mhedzisiro. Munyika dzekunze, simbi dzakavharirwa zvizere dzinoshandiswawo kumisa kubuda ropa.
Kurapa ne endoscopic tissue glue injection (EVHT)
chikamu 3
Nzira iyi yakakodzera pakurapa varices dzemudumbu uye kubuda ropa mugumbo kana paine emergency.
1) Matambudziko eEVHT: kunyanya pulmonary artery uye portal vein embolism, asi kuwanda kwacho kwakaderera zvikuru.
2) Mabhenefiti eEVHT: mitsipa yeropa inonyangarika nekukurumidza, kubuda ropa zvakare kwakaderera, matambudziko mashoma, zviratidzo zvakawanda uye tekinoroji iri nyore kunzwisisa.
3) Zvinhu zvekucherechedza:
Mukurapa ne endoscopic tissue glue injection, huwandu hwejekiseni hunofanira kukwana. Endoscopic ultrasound inobatsira zvikuru mukurapa varicose veins uye inogona kuderedza njodzi yekubuda ropa zvakare.
Kune mishumo mumabhuku ekune dzimwe nyika inoti kurapa varices dzemudumbu ne coils kana cyanoacrylate pasi pekutungamirirwa ne endoscopic ultrasound kunoshanda kune varices dzemudumbu dzemuno. Kana tichienzanisa ne majekiseni e cyanoacrylate, endoscopic ultrasound-guided coiling inoda majekiseni mashoma emukati memuviri uye inobatanidzwa nezviitiko zvishoma zvakaipa.
Isu, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., tinogadzira zvinhu muChina zvine chekuita ne endoscopic consumables, zvakaita sesimba re biopsy, hemoclip, musungo wepolyp, tsono yekurapa sclerotherapy, katheta yekupfapfaidza, mabhurashi e cytology, waya yekufambisa, tswanda yekutorwa kwematombo, katheta yekubuditsa mvura yemumhinonezvimwewo zvinoshandiswa zvakanyanya muEMR, ESD, ERCPZvigadzirwa zvedu zvakanyoreswa neCE, uye mafekitori edu akanyoreswa neISO. Zvinhu zvedu zvakatumirwa kuEurope, North America, Middle East nedzimwe nzvimbo dzeAsia, uye zviri kuita kuti mutengi azivikanwe uye arumbidzwe zvikuru!
Nguva yekutumira: Nyamavhuvhu-15-2024