Ọrịa afọ na eriri afọ na-akpata nsogbu afọ na eriri afọ site na nsogbu ọbara mgbali elu na-adịgide adịgide, ihe dịka pasentị 95 nke ọrịa ahụ na-akpata site na cirrhosis nke ọtụtụ ihe kpatara ya. Ọbara ọbara na-abụkarị nnukwu ọbara ọgbụgba na ọnwụ dị elu, ndị ọrịa nwere ọbara ọgbụgba anaghịkwa anabata ịwa ahụ.
Site na mmụba na ojiji nke teknụzụ ọgwụgwọ endoscopic digestive, ọgwụgwọ endoscopic aghọwo otu n'ime ụzọ ndị bụ isi esi agwọ ọbara ọgbụgba nke esophagus/gastric variceal. Ọ gụnyerekarị endoscopic sclerotherapy (EVS), endoscopic variceal ligation (EVL) na endoscopic tissue glue injection therapy (EVHT).
Ọgwụ Sclerotherapy nke Endoscopic (EVS)
akụkụ nke 1
1) Ụkpụrụ nke ọgwụgwọ endoscopic sclerotherapy (EVS):
Ọgwụ mgbochi ọbara n'ime akwara: ihe na-akpata sclerosing na-akpata mbufụt gburugburu akwara, na-eme ka akwara ọbara sie ike ma na-egbochi mgbasa ọbara;
Ọgwụ nje paravaskụla: na-eme ka ihe na-akpata mbufụt dị ọcha n'ime akwara iji mee ka thrombosis pụta.
2) Ihe ngosi nke EVS:
(1) Mgbawa EV na ọbara ọgbụgba dị oke njọ;
(2) Akụkọ ihe mere eme nke mgbawa na ọbara ọgbụgba nke EV gara aga;
(3) Ndị ọrịa nwere EV ọzọ mgbe a wachara ha ahụ;
(4) Ndị na-adịghị mma maka ọgwụgwọ ịwa ahụ.
3) Ihe ndị na-egbochi EVS:
(1) Ihe ndị na-emegide ya dịka nke gastroscopy;
(2) Ọrịa imeju nke ọkwa nke abụọ ma ọ bụ karịa;
(3) Ndị ọrịa nwere nsogbu imeju na akụrụ siri ike, nnukwu ascites, na nnukwu jaundice.
4) Ịkpachara anya n'ọrụ
Na China, ị nwere ike ịhọrọ lauromacrol (Jiri ya)agịga sclerotherapyMaka nnukwu arịa ọbara, họrọ ọgwụ n'ime akwara ọbara. Oke ọgwụ n'ime akwara ọbara na-abụkarị 10 ruo 15 mL. Maka obere arịa ọbara, ị nwere ike ịhọrọ ọgwụ n'ime akwara ọbara. Gbalịa izere ịgba ọgwụ n'ọtụtụ ebe dị iche iche n'otu ebe (Ọnya nwere ike ime ka esophagus sie ike). Ọ bụrụ na iku ume emetụta n'oge ịwa ahụ, enwere ike itinye mkpuchi doro anya na gastroscope. Na mba ofesi, a na-etinyekarị balloon na gastroscope. Ọ bara uru ịmụta ihe na ya.
5) Ọgwụgwọ EVS mgbe a wachara ahụ
(1) Erila nri ma ọ bụ ṅụọ ihe ọṅụṅụ ruo awa asatọ mgbe a wachara ya ahụ, ma jiri nwayọọ nwayọọ maliteghachi nri mmiri;
(2) Jiri ọgwụ nje kwesịrị ekwesị gbochie ọrịa;
(3) Jiri ọgwụ belata nrụgide ọnụ ụzọ dịka o kwesịrị.
6) Usoro ọgwụgwọ EVS
A chọrọ ọgwụgwọ sclerotherapy ugboro ugboro ruo mgbe akwara varicose ga-apụ n'anya ma ọ bụ pụọ n'anya kpamkpam, na-enwe oge dị ihe dị ka otu izu n'etiti ọgwụgwọ ọ bụla; a ga-enyocha gastroscopy otu ọnwa, ọnwa atọ, ọnwa isii, na otu afọ mgbe ọgwụgwọ ahụ gwụchara.
7) Nsogbu nke EVS
(1) Nsogbu ndị a na-ahụkarị: ectopic embolism, ọnya esophagus, wdg, ọ dịkwa mfe ime ka ọbara gbapụta ma ọ bụ gbapụta ọbara site na oghere agịga mgbe a na-ewepụ agịga ahụ.
(2) Nsogbu mpaghara: ọnya afọ, ọbara ọgbụgba, stenosis, nsogbu mmegharị esophagus, odynophagia, lacerations. Nsogbu mpaghara gụnyere mediastinitis, oghere, pleural effusion, na portal hypertensive gastropathy nke nwere nnukwu ohere nke ọbara ọgbụgba.
(3) Nsogbu sistemụ: sepsis, pneumonia aspiration, hypoxia, nje bacteria peritonitis, thrombosis nke akwara portal.
Njikọ akwara varicose endoscopic (EVL)
Akụkụ nke Abụọ
1) Ihe ngosi maka EVL: Otu ihe ahụ dị ka EVS.
2) Ihe ndị na-egbochi EVL:
(1) Ihe ndị na-emegide ya dịka nke gastroscopy;
(2) EV tinyere GV doro anya;
(3) Ndị ọrịa nwere nsogbu imeju na akụrụ siri ike, nnukwu ascites, jaundice, ọgwụgwọ sclerotherapy ọtụtụ oge gara aga ma ọ bụ obere akwara varicose.
3) Otu esi arụ ọrụ
Gụnyere otu ntutu isi, ọtụtụ ntutu isi, na eriri naịlọn.
(1) Ụkpụrụ: Gbochie ọbara na-erugharị n'ime akwara varicose ma nye ọbara mberede → venous thrombosis na ebe njikọ → tissue necrosis → fibrosis → ọpụpụ nke varicose veins.
(2) Ihe Ndị A Ga-akpachara Anya
Maka nsogbu eriri afọ nke dị n'etiti ruo n'ókè siri ike, a na-ejikọta akwara eriri afọ nke ọ bụla n'ụzọ gbagọrọ agbagọ site n'ala ruo n'elu. Njikọta kwesịrị ịdị nso n'ebe a na-etinye eriri afọ nke varicose ahụ, ka isi ihe ọ bụla wee jikọta nke ọma ma jikọta nke ọma. Gbalịa ikpuchi akwara eriri afọ nke ọ bụla ihe karịrị isi atọ.
Ọ na-ewe ihe dị ka izu 1 ruo 2 ka necrosis ahụ daa mgbe ejiri bandeeji necrosis mechie ya. Otu izu mgbe a wachara ya ahụ, ọnya mpaghara nwere ike ibute nnukwu ọbara ọgbụgba, eriri akpụkpọ ahụ daa, ma gbutuo ọbara n'ime akwara varicose. EVL nwere ike iwepụ varicose veins ngwa ngwa ma nwee obere nsogbu, mana varicose veins na-apụtaghachi. Oke ya dị n'akụkụ dị elu;
EVL nwere ike igbochi ọbara ọgbụgba nke akwara afọ aka ekpe, akwara esophageal, na vena cava. Agbanyeghị, mgbe egbochichara ọbara ọgbụgba nke esophageal, akwara afọ na akwara perigastric ga-agbasa, ọbara ga-amụba, ọnụego nlọghachi ga-abawanye ka oge na-aga. Ya mere, ọ na-abụkarị mkpa ka e jiri eriri band mee ihe ugboro ugboro iji mee ka ọgwụgwọ ahụ sie ike. Dayameta nke eriri varicose kwesịrị ịdị ihe na-erughị 1.5 cm.
4) Nsogbu nke EVL
(1) Ọbara ọbara dị oke njọ nke sitere na ọnya mpaghara ihe dị ka otu izu mgbe a wachara ya ahụ;
(2) Ọbara ọbara n'oge a na-awa ahụ, mfu nke eriri akpụkpọ anụ, na ọbara ọgbụgba nke akwara varicose kpatara;
(3) Ọrịa.
5) Nyocha EVL mgbe ịwa ahụ gasịrị
N'afọ mbụ mgbe a wachara EVL ahụ, ọrụ imeju na akụrụ, a ga-enyocha nyocha B-ultrasound, usoro ọbara, ọrụ coagulation, wdg kwa ọnwa 3 ruo 6. A ga-enyocha nyocha Endoscopy kwa ọnwa 3, wee lelee ya kwa ọnwa 0 ruo 12.
6)EVS vs EVL
Ma e jiri ya tụnyere sclerotherapy na ligation, ọ dịghị nnukwu ọdịiche dị n'ọnwụ na ọnụego ọbara na-agbagharị n'etiti ha abụọ. Maka ndị ọrịa chọrọ ọgwụgwọ ugboro ugboro, a na-atụkarị aro ka e jiri ligation na sclerotherapy jikọta ya. Mgbe ụfọdụ, a na-ejikọkwa ligation na sclerotherapy, nke nwere ike ime ka ọgwụgwọ ka mma. Mmetụta. Na mba ndị ọzọ, a na-ejikwa stent ígwè ekpuchiri ekpuchi iji kwụsị ọbara ọgbụgba.
Ọgwụgwọ ntụtụ gluu anụ ahụ endoscopic (EVHT)
akụkụ nke atọ
Usoro a dabara adaba maka varices afọ na ọbara ọgbụgba nke esophageal variceal n'ọnọdụ mberede.
1) Nsogbu nke EVHT: ọkachasị akwara akpa ume na portal vein embolism, mana ihe na-eme dị obere.
2) Uru nke EVHT: akwara varicose na-apụ n'anya ngwa ngwa, ọnụego ọbara na-agbagharị ọzọ dị ala, nsogbu dị obere, ihe ngosi dị oke obosara na teknụzụ dị mfe ịmụta.
3) Ihe ndị dị mkpa:
N'ọgwụgwọ endoscopic anụ ahụ gluu, ọnụọgụ nke ọgwụ ahụ ga-ezu oke. Endoscopic ultrasound na-arụ ọrụ dị mma n'ịgwọ varicose veins ma nwee ike ibelata ohere nke ọbara ọgbụgba ọzọ.
E nwere akụkọ sitere n'akwụkwọ ndị mba ọzọ na-egosi na ọgwụgwọ nke varices afọ site na iji coils ma ọ bụ cyanoacrylate n'okpuru nduzi nke endoscopic ultrasound dị irè maka varices afọ mpaghara. Ma e jiri ya tụnyere cyanoacrylate injections, endoscopic ultrasound-guided coiling chọrọ obere injections intraluminal ma jikọta ya na obere ihe ọjọọ.
Anyị, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., bụ ụlọ ọrụ mmepụta ihe na China nke ọkachamara n'ihe gbasara ihe ndị a na-eji eme ihe na endoscopic, dịkaike biops, hemoklip, ọnyà polyp, agịga sclerotherapy, katetị ịgbasa, ahịhịa cytology, waya nduzi, nkata mwepụta nkume, katita drainage biliary imiwdg. nke a na-ejikarị eme ihe naEMR, ESD, ERCPNgwaahịa anyị nwere asambodo CE, ebe osisi anyị nwere asambodo ISO. Ebupụla ngwa ahịa anyị na Yuropu, North America, Middle East na akụkụ Eshia, ma na-eme ka ndị ahịa nweta otuto na otuto nke ukwuu!
Oge ozi: Ọgọst-15-2024