ʻO nā varices esophageal/gastric ka hopena o nā hopena hoʻomau o ka hypertension portal a ma kahi o 95% ma muli o ka cirrhosis o nā kumu like ʻole. Hoʻokomo pinepine ʻia ke koko varicose i ka nui o ke koko a me ka nui o ka make, a ʻo ka poʻe maʻi me ke koko ʻaʻole liʻiliʻi ka hoʻomanawanui no ka ʻoki.
Me ka hoʻomaikaʻi ʻana a me ka hoʻohana ʻana i ka ʻenehana lapaʻau endoscopic digestive, ua lilo ka lāʻau endoscopic i kekahi o nā ala nui e mālama ai i ke koko variceal esophageal/gastric. Hoʻopili nui ia i ka endoscopic sclerotherapy (EVS), endoscopic variceal ligation (EVL) a me ka endoscopic tissue glue injection therapy (EVHT).
Endoscopic Sclerotherapy (EVS)
hapa 1
1) Kumu o ka endoscopic sclerotherapy (EVS):
Intravascular injection: sclerosing agent ka mea e ho'ā a puni nā aʻa, paʻakikī i nā kīʻaha koko a poloka ke kahe koko;
ʻO ka hoʻoheheʻe ʻana o Paravascular: e hoʻoulu ai i kahi hopena inflammatory sterile i loko o nā veins e hana i ka thrombosis.
2) Nā hōʻailona o EVS:
(1) ʻAhaʻi EV nui a me ke koko;
(2) Moʻolelo mua o ka EV rupture a me ke koko;
(3) ʻO nā maʻi me ka hoʻi hou ʻana o EV ma hope o ka ʻoki ʻana;
(4) ʻO ka poʻe kūpono ʻole no ka lāʻau lapaʻau.
3) Contraindications o EVS:
(1) Hoʻohālikelike like me ka gastroscopy;
(2) Hepatic encephalopathy pae 2 a i luna;
(3) ʻO nā poʻe maʻi me ke akepaʻa koʻikoʻi a me ka hana kīkī, ka nui o ka ascites, a me ka jaundice koʻikoʻi.
4) Nā hana mālama
Ma Kina, hiki iā ʻoe ke koho i ka lauromacrol (Hoʻohananila sclerotherapy). No nā kīʻaha koko nui, koho i ka hoʻokele intravascular. ʻO ka nui o ka injection he 10 a 15 mL. No nā kīʻaha koko liʻiliʻi, hiki iā ʻoe ke koho i ka injection paravascular. E hoʻāʻo e pale i ka hoʻoinu ʻana ma nā wahi like ʻole ma ka mokulele hoʻokahi (Hiki paha nā maʻi maʻi e alakaʻi ana i ka esophageal stricture). Inā pili ka hanu ʻana i ka wā o ka hana, hiki ke hoʻohui ʻia kahi pāpale aniani i ka gastroscope. Ma nā ʻāina ʻē, hoʻohui pinepine ʻia kahi baluna i ka gastroscope. He mea pono ke aʻo mai.
5) Hoʻomaʻamaʻa postoperative o EVS
(1) Mai ʻai a inu ʻoe no 8 mau hola ma hope o ka ʻoki ʻana, a e hoʻomau mālie i ka meaʻai wai;
(2) E hoʻohana i ka nui o nā lāʻau antibiotic e pale ai i ka maʻi;
(3) E hoʻohana i nā lāʻau lapaʻau e hoʻohaʻahaʻa i ke kaomi puka puka e like me ke kūpono.
6) Papa lapaʻau EVS
Pono ka sclerotherapy lehulehu a hiki i ka nalo ʻana o nā veins varicose a i ʻole ka nalo maoli ʻana, me ka manawa o 1 pule ma waena o kēlā me kēia lapaʻau; E nānā ʻia ka gastroscopy 1 mahina, 3 mahina, 6 mahina, a me 1 makahiki ma hope o ka pau ʻana o ka papa o ka mālama ʻana.
7) Nā pilikia o EVS
(1) ʻO nā pilikia maʻamau: ectopic embolism, esophageal ulcer, etc., a he mea maʻalahi ke hoʻoheheʻe ʻana i ke koko a i ʻole ke kahe ʻana o ke koko mai ka lua o ka nila i ka wā e wehe ai i ka nila.
(2) Nā pilikia kūloko: ʻeha, kahe koko, stenosis, esophageal motility dysfunction, odynophagia, lacerations. ʻO nā pilikia kūloko e pili ana i ka mediastinitis, perforation, pleural effusion, a me portal hypertensive gastropathy me ka piʻi nui o ke koko.
(3) Nā pilikia pilikia: sepsis, pneumonia aspiration, hypoxia, bacterial peritonitis spontaneous, portal vein thrombosis.
Endoscopic varicose vein ligation (EVL)
Mahele 2
1) Nā hōʻailona no EVL: E like me EVS.
2) Contraindications o EVL:
(1) Hoʻohālikelike like me ka gastroscopy;
(2) EV i hele pū me ka GV maopopo;
(3) ʻO nā poʻe maʻi me ke akepaʻa koʻikoʻi a me ka hana kīkī, ka nui o ka ascites, jaundice, nā lāʻau sclerotherapy hou a i ʻole nā veins varicose liʻiliʻi.
3) Pehea e hana ai
Hoʻopili pū me ka ligation lauoho hoʻokahi, ka hoʻohui ʻana i ka lauoho lehulehu, a me ke kaula kaula nylon.
(1) Kumu: Kāohi i ke kahe o ke koko o nā veins varicose a hāʻawi i ka hemostasis pilikia → thrombosis venous ma ke kahua ligation → tissue necrosis → fibrosis → nalo aku nā veins varicose.
(2) Hoʻomalu
No nā ʻano ʻokoʻa o ka esophageal a i ʻole koʻikoʻi, ua hoʻopaʻa ʻia kēlā me kēia vein varicose ma ke ʻano heʻe i luna mai lalo a luna. Pono ka ligator e like me ka hiki ke hiki i ka wahi hoʻopaʻa ʻia o ka vein varicose, i hoʻopaʻa pono ʻia kēlā me kēia wahi a hoʻopaʻa ʻia. E hoʻāʻo e uhi i kēlā me kēia vein varicose ma mua o 3 mau wahi.
Ma kahi o 1 a 2 mau pule no ka hāʻule ʻana o ka necrosis ma hope o ka bandage necrosis. Hoʻokahi pule ma hope o ka hana ʻana, hiki i nā ʻeha kūloko ke hoʻoheheʻe nui ʻia, hāʻule ka ʻili o ka ʻili, a ʻoki ʻia ke koko o nā veins varicose. Hiki iā EVL ke hoʻopau koke i nā veins varicose a he liʻiliʻi nā pilikia, akā e hoʻi hou nā veins varicose. Aia ka mahele ma ka aoao kiekie;
Hiki i ka EVL ke ālai i nā mea hoʻokahe koko o ka ʻāʻī ʻāʻī hema, vein esophageal, a me vena cava. Eia nō naʻe, ma hope o ka paʻa ʻana o ke kahe o ka esophageal venous, e hoʻonui ʻia ke kahe o ka ʻōpū a me ka perigastric venous plexus, e piʻi ke kahe o ke koko, a e piʻi ka piʻi ʻana i ka manawa. No laila, ua koi pinepine Repeated band ligation e hoʻohui i ka lapaʻau. ʻO ke anawaena o ka varicose vein ligation e emi iho ma mua o 1.5 knm.
4) Nā pilikia o EVL
(1) Ke kahe nui ʻana o ke koko ma muli o nā ʻeha kūloko ma kahi o 1 pule ma hope o ke ʻoki ʻana;
(2) ʻO ke koko i loko o ka hana, ka nalowale ʻana o ke kaula ʻili, a me ke koko i hoʻokumu ʻia e nā veins varicose;
(3) Ka ma'i ma'i.
5) Ka nānā 'ana ma hope o ka hana 'ana o EVL
I ka makahiki mua ma hope o ke kaʻe ʻana o EVL, pono e nānā ʻia ka hana ate a me ke kīkī, B-ultrasound, hana maʻamau koko, hana coagulation, etc. i kēlā me kēia 3 a 6 mau mahina. Pono e nānā ʻia ka Endoscopy i kēlā me kēia 3 mahina, a laila i kēlā me kēia 0 a 12 mahina.
6)EVS vs EVL
Ke hoʻohālikelike ʻia me ka sclerotherapy a me ka ligation, ʻaʻohe ʻokoʻa koʻikoʻi o ka make a me nā helu rebleeding ma waena o nā mea ʻelua. No nā poʻe maʻi e pono ai nā lāʻau lapaʻau, ʻoi aku ka maʻamau o ka ligation. I kekahi manawa hui pū ʻia ka ligation a me ka sclerotherapy, hiki ke hoʻomaikaʻi i ka mālama ʻana. Ka hopena. Ma nā ʻāina ʻē, hoʻohana ʻia nā stents metala i uhi ʻia e hoʻōki i ke koko.
Endoscopic tissue glue injection therapy (EVHT)
hapa 3
He kūpono kēia ʻano no ka ʻōpū o ka ʻōpū a me ke koko o ka esophageal variceal i nā kūlana pilikia.
1) Nā hoʻopiʻi o EVHT: ʻo ka nui o ka pulmonary artery a me portal vein embolism, akā haʻahaʻa loa ka hopena.
2) Nā pōmaikaʻi o ka EVHT: nalo koke nā veins varicose, haʻahaʻa ke kahe koko hou, liʻiliʻi nā pilikia, ākea nā hōʻailona a maʻalahi ka ʻenehana.
3) Nā mea e nānā ai:
I ka endoscopic tissue glue injection therapy, pono e lawa ka nui o ka injection. He hana maikaʻi loa ka ultrasound endoscopic i ka mālama ʻana i nā veins varicose a hiki ke hōʻemi i ka pilikia o ke kahe hou ʻana.
Aia nā hōʻike ma nā palapala haole e ʻoi aku ka maikaʻi o ka mālama ʻana i nā varices gastric me nā coils a i ʻole cyanoacrylate ma lalo o ke alakaʻi ʻana o ka ultrasound endoscopic no nā varices gastric kūloko. Ke hoʻohālikelike ʻia me ka cyanoacrylate injections, endoscopic ultrasound-guided coiling e koi aku i ka liʻiliʻi intraluminal injections a pili pū me nā hanana ʻino.
ʻO mākou, ʻo Jiangxi Zhuoruihua Medical Instrument Co., Ltd., he mea hana ma Kina i mea kūikawā i nā mea hoʻohana endoscopic, e like mebiopsy forceps, hemoclip, pahele polyp, nila sclerotherapy, pāpaʻi pāpaʻi, cytology brushes, uea alakaʻi, hīnaʻi kiʻi pōhaku, ihu biliary drainage catheteretc. i hoohana nui ia maEMR, ESD, ERCP. ʻO kā mākou huahana i hōʻoia ʻia ʻo CE, a ua hōʻoia ʻia kā mākou mea kanu. Ua lawe ʻia kā mākou waiwai i ʻEulopa, ʻAmelika ʻAmelika, Middle East a me kahi hapa o Asia, a loaʻa nui i ka mea kūʻai aku o ka ʻike a me ka hoʻomaikaʻi!
Ka manawa hoʻouna: ʻAukake-15-2024