Ọgwụgwọ endoscopic nke ọbara ọgbụgba nke esophageal/gastric venous

Ọdịiche nke esophageal/gastric bụ nsonaazụ na-adịgide adịgide nke ọbara mgbali elu portal yana ihe dịka 95% nke cirrhosis nke ihe dị iche iche kpatara. Ọbara ọgbụgba nke vein varicose na-agụnyekarị nnukwu ọbara ọgbụgba na ọnwụ dị elu, na ndị ọrịa nwere ọbara ọgbụgba anaghị enwe ntachi obi maka ịwa ahụ.

Site na nkwalite na itinye teknụzụ ọgwụgwọ endoscopic digestive, ọgwụgwọ endoscopic aghọwo otu n'ime ụzọ isi gwọọ ọbara ọgbụgba nke esophageal / gastric variceal. Ọ na-agụnye endoscopic sclerotherapy (EVS), endoscopic variceal ligation (EVL) na endoscopic tissue glue injection therapy (EVHT).

Endoscopic Sclerotherapy (EVS)

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1) Ụkpụrụ nke endoscopic sclerotherapy (EVS):
Ngwunye intravascular: onye na-ahụ maka sclerosing na-ebute mbufụt gburugburu veins, na-eme ka arịa ọbara sie ike ma na-egbochi eruba ọbara;
Ngwunye paravascular: na-eme ka mmeghachi omume mkpali na-adịghị mma na veins na-ebute thrombosis.
2) Ngosipụta nke EVS:
(1) Nnukwu mgbawa EV na ọbara ọgbụgba;
(2) Akụkọ gara aga nke mgbawa EV na ọbara ọgbụgba;
(3) Ndị ọrịa nwere nlọghachi nke EV mgbe ịwachara ahụ;
(4) Ndị na-adabaghị maka ọgwụgwọ ịwa ahụ.
3) Contraindications nke EVS:
(1) Otu contraindications dị ka gastroscopy;
(2) Hepatic encephalopathy ogbo 2 ma ọ bụ karịa;
(3) Ndị na-arịa ọrịa imeju na akụrụ na-arụ ọrụ siri ike, nnukwu ascites, na jaundice siri ike.
4) Akpachara anya ọrụ
Na China, ị nwere ike họrọ lauromacrol (Jirisclerotherapy agịga). Maka arịa ọbara buru ibu, họrọ injection intravascular. Olu injection bụ n'ozuzu 10 ruo 15 ml. Maka obere arịa ọbara, ị nwere ike ịhọrọ injection paravascular. Gbalịa ka ị ghara ịgbanye ọgwụ n'ọtụtụ ebe dị iche iche n'otu ụgbọ elu (Ulcers nwere ike ime na-eduga n'ọkpụkpụ esophageal). Ọ bụrụ na ọ na-emetụta iku ume n'oge a na-arụ ọrụ ahụ, enwere ike ịgbakwunye okpu nke ọma na gastroscope. Na mba ọzọ, a na-agbakwunye balloon na gastroscope. Ọ bara uru ịmụta na.
5) Ọgwụgwọ EVS mgbe arụchara ọrụ gasịrị
(1) erila ma ọ bụ ṅụọ ihe ọṅụṅụ ruo awa 8 mgbe ịwachara ahụ, ma jiri nwayọọ nwayọọ maliteghachi nri mmiri mmiri;
(2) Jiri ọgwụ nje mee ihe kwesịrị ekwesị iji gbochie ọrịa;
(3) Jiri ọgwụ mee ihe iji belata nrụgide portal dị ka okwesịrị.
6) Usoro ọgwụgwọ EVS
A na-achọ ọgwụgwọ ọtụtụ sclerotherapy ruo mgbe veins varicose ga-apụ n'anya ma ọ bụ na-apụ n'anya, na-ewe ihe dị ka otu izu n'etiti ọgwụgwọ ọ bụla; A ga-enyocha gastroscopy 1 ọnwa, ọnwa 3, ọnwa 6, na 1 afọ mgbe njedebe nke usoro ọgwụgwọ gasịrị.
7) Nsogbu nke EVS
(1) Nsogbu ndị a na-ahụkarị: ectopic embolism, ọnya esophageal, wdg, na ọ dị mfe ime ka ọbara na-agbapụta ma ọ bụ na-agbapụta ọbara site na oghere agịga mgbe ị na-ewepụ agịga.
(2) Nsogbu mpaghara: ọnya, ọbara ọgbụgba, stenosis, nkwụsị nke motility nke esophageal, odynophagia, lacerations. Nsogbu mpaghara gụnyere mediastinitis, perforation, pleural effusion, na portal hypertensive gastropathy nwere nnukwu ohere nke ọbara ọgbụgba.
(3) Nsogbu sistemu: sepsis, aspiration oyi baa, hypoxia, spontaneous bacterial peritonitis, portal vein thrombosis.

Endoscopic varicose vein ligation (EVL)

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1) Ngosipụta maka EVL: Otu dị ka EVS.
2) Contraindications nke EVL:
(1) Otu contraindications dị ka gastroscopy;
(2) EV tinyere GV doro anya;
(3) Ndị ọrịa nwere nnukwu imeju na akụrụ arụ ọrụ, nnukwu ascites, jaundice, ọtụtụ ọgwụgwọ sclerotherapy na-adịbeghị anya ma ọ bụ obere veins varicose.
3) Otu esi arụ ọrụ
Gụnyere otu ntutu isi, ọtụtụ ntutu isi, na eriri nylon.
(1) Ụkpụrụ: Gbochie usoro ọbara nke varicose veins ma nye hemostasis mberede → venous thrombosis na saịtị ligation → anụ ahụ necrosis → fibrosis → mwepu nke veins varicose.
(2) Akpachara anya
Maka varices esophageal dị oke ma dị njọ, vein varicose ọ bụla na-ejikọta ya n'ụzọ gbagoro elu site na ala ruo n'elu. Njikọ ahụ kwesịrị ịdị nso dị ka o kwere mee na ebe a na-achọ ligation nke vein varicose, nke mere na isi ihe ọ bụla na-ejikọta ya na nke ọma. Gbalịa ikpuchi vein varicose ọ bụla karịa isi atọ.
Ọ na-ewe ihe dị ka izu 1 ruo 2 maka necrosis ka ọ daa ma ọ bụrụ na bandeeji necrosis. Otu izu ka a wachara ya ahụ, ọnya mpaghara nwere ike ịkpata nnukwu ọbara ọgbụgba, eriri akpụkpọ ahụ dapụ, na ịkpụcha veins nke varicose na-agbapụta ọbara. EVL nwere ike ikpochapụ veins varicose ngwa ngwa ma nwee nsogbu ole na ole, mana veins varicose na-alọghachi. Ọnụ ọgụgụ dị n'akụkụ elu;
EVL nwere ike igbochi mmechi ọbara ọgbụgba nke vein gastric aka ekpe, vein esophageal, na vena cava. Otú ọ dị, mgbe a kpọchichara ọbara venous nke esophageal, eriri afọ nke eriri afọ na perigastric venous plexus ga-amụba, ọbara na-erugharị ga-abawanye, na nlọghachi ga-abawanye na oge. Ya mere, ọ na-emekarị ka a na-achọ eriri eriri ugboro ugboro iji mee ka ọgwụgwọ ahụ sie ike. Dayameta nke varicose vein ligation kwesịrị ịbụ ihe na-erughị 1.5 cm.
4) Nsogbu nke EVL
(1) Nnukwu ọbara ọgbụgba n'ihi ọnya mpaghara ihe dịka otu izu mgbe a wachara ya ahụ;
(2) Ọbara ọgbụgba n'ime ime, mfu nke eriri akpụkpọ anụ, na ọbara ọgbụgba nke varicose veins kpatara;
(3) Ọrịa.
5) Nyochaa EVL mgbe arụchara ọrụ gasịrị
N'afọ mbụ mgbe ịwa ahụ EVL gasịrị, ọrụ imeju na akụrụ, B-ultrasound, usoro ọbara, ọrụ coagulation, wdg kwesịrị nyochaa kwa ọnwa 3 ruo 6. A ga-enyocha endoscopy kwa ọnwa 3, mgbe ahụ kwa ọnwa 0 ruo 12.
6) EVS vs EVL
E jiri ya tụnyere sclerotherapy na ligation, ọ nweghị nnukwu ọdịiche dị na ọnụọgụ ọnwụ na ọnụọgụ ọbara n'etiti abụọ ahụ. Maka ndị ọrịa chọrọ ọgwụgwọ ugboro ugboro, a na-atụkarị aro ligation. Mgbe ụfọdụ, a na-ejikọta ligation na sclerotherapy, nke nwere ike imezi ọgwụgwọ. Mmetụta. Na mba ọzọ, a na-ejikwa stent metal kpuchie nke ọma iji kwụsị ọbara ọgbụgba.

Usoro ọgwụgwọ endoscopic anụ ahụ gluu (EVHT)

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Usoro a dabara adaba maka varices gastric na esophageal variceal ọbara ọgbụgba na ọnọdụ mberede.
1) Mgbagwoju anya nke EVHT: tumadi akwara pulmonary na portal vein embolism, mana ihe omume dị obere.
2) Uru nke EVHT: veins varicose na-apụ n'anya ngwa ngwa, ọnụ ọgụgụ na-agbapụta ọbara dị ala, nsogbu dị ntakịrị, ihe ngosi dị obosara na nkà na ụzụ dị mfe ịmụta.
3) Ihe ndị a ga-arịba ama:
Na endoscopic anụ ahụ gluu ọgwụgwọ injection, ọnụọgụ ntụtụ ga-ezuru. Endoscopic ultrasound na-arụ ọrụ dị mma na ọgwụgwọ nke veins varicose ma nwee ike ibelata ihe ize ndụ nke ịmaliteghachi ọbara.
Enwere akụkọ na akwụkwọ ndị mba ọzọ na ọgwụgwọ nke varices gastric na coils ma ọ bụ cyanoacrylate n'okpuru nduzi nke endoscopic ultrasound dị irè maka varices gastric mpaghara. N'iji ya na injections cyanoacrylate, endoscopic ultrasound na-eduzi coiling chọrọ obere intraluminal injections ma jikọta ya na obere ihe ọjọọ.

Anyị, Jiangxi Zhuoruihua Medical Instrument Co., Ltd., bụ emeputa na China ọkachamara na endoscopic consumables, dị kabiopsy forceps, hemoclip, polyp ọnyà, sclerotherapy agịga, ịgba catheter, cytology brushes, ndumodu, nkata eweghachite okwute, imi biliary drainage catheterwdg nke a na-ejikarị eme ihe naEMR, ESD, ERCP. Ngwaahịa anyị bụ CE asambodo, na osisi anyị bụ ISO asambodo. Ebupụla ngwongwo anyị na Europe, North America, Middle East na akụkụ nke Eshia, na-enwetakwa ndị ahịa nke nnabata na otuto!