ʻO nā varices esophageal/gastric ka hopena o nā hopena mau o ka hypertension portal a ma kahi o 95% i hoʻokumu ʻia e ka cirrhosis o nā kumu like ʻole. Hoʻokomo pinepine ke kahe koko ʻana o nā aʻa Varicose i ka nui o ke kahe koko a me ka make nui, a ʻaʻole nui ka hoʻomanawanui o nā mea maʻi me ke kahe koko i ke ʻoki kino.
Me ka hoʻomaikaʻi ʻana a me ka hoʻohana ʻana i ka ʻenehana lapaʻau endoscopic digestive, ua lilo ka lapaʻau endoscopic i kekahi o nā ala nui e mālama ai i ke kahe koko ʻana o ka variceal esophageal/gastric. Hoʻokomo nui ʻia ia me ka endoscopic sclerotherapy (EVS), ka endoscopic variceal ligation (EVL) a me ka endoscopic tissue glue injection therapy (EVHT).
ʻO ka Endoscopic Sclerotherapy (EVS)
ʻāpana 1
1) Ke Kumumanaʻo o ka endoscopic sclerotherapy (EVS):
ʻO ka inikini intravascular: hoʻoulu ka mea sclerosing i ka mumū a puni nā veins, hoʻopaʻakikī i nā kīʻaha koko a ālai i ke kahe koko;
ʻIniki paravascular: ke hana nei i kahi hopena mumū sterile i loko o nā aa koko e hana ai i ka thrombosis.
2) Nā hōʻailona o EVS:
(1) Ka haki ʻana o ka EV a me ke kahe ʻana o ke koko;
(2) Ka moʻolelo mua o ka haki ʻana o ka EV a me ke kahe ʻana o ke koko;
(3) Nā maʻi me ka hoʻi hou ʻana o EV ma hope o ke ʻoki kino;
(4) ʻO ka poʻe kūpono ʻole no ke ʻoki kino.
3) Nā hōʻole o EVS:
(1) Nā contraindications like me ka gastroscopy;
(2) ʻO ka encephalopathy hepatic pae 2 a i ʻole ma luna;
(3) Nā maʻi me ka hana ʻino o ke akepaʻa a me nā puʻupaʻa, ka nui o ka ascites, a me ka jaundice koʻikoʻi.
4) Nā hana palekana
Ma Kina, hiki iā ʻoe ke koho i ka lauromacrol (Hoʻohananila sclerotherapy). No nā kīʻaha koko nui aʻe, e koho i ka inikini intravascular. ʻO ka nui o ka inikini he 10 a 15 mL. No nā kīʻaha koko liʻiliʻi, hiki iā ʻoe ke koho i ka inikini paravascular. E hoʻāʻo e pale i ka inikini ʻana ma nā wahi like ʻole ma ka mokulele hoʻokahi (hiki ke loaʻa nā ʻōpū e alakaʻi ai i ka esophageal stricture). Inā pilikia ka hanu ʻana i ka wā o ke ʻoki ʻana, hiki ke hoʻohui ʻia kahi pāpale moakaka i ka gastroscope. Ma nā ʻāina ʻē, hoʻohui pinepine ʻia kahi balloon i ka gastroscope. He mea kūpono ke aʻo ʻana mai.
5) Ka mālama ʻana ma hope o ke ʻoki ʻana o EVS
(1) Mai ʻai a inu paha no 8 mau hola ma hope o ke ʻoki ʻana, a e hoʻomaka mālie i ka ʻai wai;
(2) E hoʻohana i nā nui kūpono o nā lāʻau antibiotic e pale aku i ka maʻi;
(3) E hoʻohana i nā lāʻau lapaʻau e hoʻohaʻahaʻa i ke kaomi puka e like me ke kūpono.
6) Papa hana lapaʻau EVS
Pono ka sclerotherapy lehulehu a hiki i ka nalo ʻana o nā aʻa varicose a nalowale paha, me kahi manawa ma kahi o 1 pule ma waena o kēlā me kēia lāʻau lapaʻau; e nānā hou ʻia ka gastroscopy 1 mahina, 3 mahina, 6 mahina, a me 1 makahiki ma hope o ka pau ʻana o ka papa o ka lāʻau lapaʻau.
7) Nā pilikia o EVS
(1) Nā pilikia maʻamau: embolism ectopic, ʻeha esophageal, a pēlā aku, a he mea maʻalahi ke hoʻoulu i ke koko e pīpī ana a i ʻole ke kahe ʻana o ke koko mai ka lua o ke kui i ka wā e wehe ai i ke kui.
(2) Nā pilikia kūloko: nā ʻōpū, ke kahe koko, ka stenosis, ka hana ʻole o ka neʻe ʻana o ka esophageal, odynophagia, nā ʻokiʻoki. ʻO nā pilikia kūloko e pili ana i ka mediastinitis, perforation, pleural effusion, a me ka gastropathy hypertensive portal me ka hoʻonui ʻia o ka pilikia o ke kahe koko.
(3) Nā pilikia ʻōnaehana: sepsis, pneumonia aspiration, hypoxia, peritonitis bacterial spontaneous, thrombosis vein portal.
ʻO ka hoʻopaʻa ʻana o nā aʻa varicose endoscopic (EVL)
Māhele 2
1) Nā hōʻailona no EVL: ʻO ia hoʻi me EVS.
2) Nā hōʻole o EVL:
(1) Nā contraindications like me ka gastroscopy;
(2) EV i hele pū ʻia me GV maopopo;
(3) Nā maʻi me ka hana koʻikoʻi o ke akepaʻa a me nā puʻupaʻa, ka nui o ka ascites, ka jaundice, nā lāʻau lapaʻau sclerotherapy lehulehu hou a i ʻole nā aʻa varicose liʻiliʻi.
3) Pehea e hana ai
Me ka hoʻopaʻa ʻana o ka lauoho hoʻokahi, ka hoʻopaʻa ʻana o nā lauoho he nui, a me ka hoʻopaʻa ʻana o ke kaula nylon.
(1) Kumumanaʻo: E ālai i ke kahe koko o nā aʻa varicose a hāʻawi i ka hemostasis ulia pōpilikia → thrombosis venous ma kahi ligation → necrosis tissue → fibrosis → nalo ʻana o nā aʻa varicose.
(2) Nā Mālama
No nā varices esophageal waena a koʻikoʻi paha, ua nakinaki ʻia kēlā me kēia aa varicose ma ke ʻano wili i luna mai lalo a luna. Pono ka ligator e kokoke loa i kahi kiko hoʻopaʻa o ka aa varicose, i hiki ai i kēlā me kēia kiko ke nakinaki piha a paʻa pono. E ho'āʻo e uhi i kēlā me kēia aa varicose ma mua o 3 mau kiko.
Ma kahi o 1 a 2 mau pule e hāʻule ai ka necrosis ma hope o ka bandage necrosis. Hoʻokahi pule ma hope o ke ʻoki ʻana, hiki i nā ʻeha kūloko ke hoʻoulu i ke kahe nui ʻana o ke koko, hāʻule ke kāʻei ʻili, a kahe ke koko ma ke ʻoki ʻana o nā aʻa varicose. Hiki i ka EVL ke hoʻopau koke i nā aʻa varicose a he kakaikahi nā pilikia, akā hoʻi hou nā aʻa varicose. Aia ka hapa ma ka ʻaoʻao kiʻekiʻe;
Hiki i ka EVL ke ālai i nā mea kahe koko o ka aʻa gastric hema, ka aʻa esophageal, a me ka vena cava. Eia nō naʻe, ma hope o ke ālai ʻia ʻana o ke kahe koko venous esophageal, e hoʻonui ʻia ka aʻa coronary gastric a me ka plexus venous perigastric, e piʻi aʻe ke kahe koko, a e piʻi aʻe ka nui o ka hoʻi hou ʻana i ka hala ʻana o ka manawa. No laila, pono pinepine ʻia ka ligation band e hoʻopaʻa i ka lāʻau lapaʻau. Pono ke anawaena o ka ligation vein varicose ma lalo o 1.5 cm.
4) Nā pilikia o EVL
(1) Ke kahe koko nui ma muli o nā ʻeha kūloko ma kahi o 1 pule ma hope o ke ʻoki kino;
(2) Ke kahe ʻana o ke koko i loko o ke ʻoki ʻana, ka nalowale ʻana o ke kāʻei ʻili, a me ke kahe ʻana o ke koko i hoʻokumu ʻia e nā aʻa varicose;
(3) Ka maʻi.
5) Ka loiloi ma hope o ke ʻoki ʻana o EVL
I ka makahiki mua ma hope o ke ʻoki ʻana o EVL, pono e nānā hou ʻia ka hana o ke akepaʻa a me nā puʻupaʻa, ka B-ultrasound, ke kaʻina hana koko, ka hana coagulation, a me nā mea ʻē aʻe i kēlā me kēia 3 a 6 mahina. Pono e nānā hou 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 i ka make a me nā helu kahe hou ma waena o nā mea ʻelua. No nā poʻe maʻi e pono ai nā lāʻau lapaʻau hou, ʻoi aku ka pinepine o ka ʻōlelo ʻia ʻana o ka ligation. I kekahi manawa ua hui pū ʻia ka ligation a me ka sclerotherapy, hiki ke hoʻomaikaʻi i ka lāʻau lapaʻau. Hopena. Ma nā ʻāina ʻē, hoʻohana ʻia nā stent metala i uhi piha ʻia e hoʻōki i ke kahe ʻana o ke koko.
Ka lāʻau lapaʻau hoʻopili ʻiʻo endoscopic (EVHT)
ʻāpana 3
He kūpono kēia ʻano hana no nā varices gastric a me ke kahe koko variceal esophageal i nā kūlana pilikia.
1) Nā pilikia o ka EVHT: ʻo ka hapa nui o ka embolism o ke aʻa pulmonary a me ka vein portal, akā haʻahaʻa loa ka nui.
2) Nā Pōmaikaʻi o EVHT: nalo koke nā aʻa varicose, haʻahaʻa ka nui o ke kahe hou ʻana o ke koko, kakaikahi nā pilikia, ākea nā hōʻailona a maʻalahi ka ʻenehana e aʻo.
3) Nā mea e hoʻomaopopo ai:
I ka lāʻau lapaʻau hoʻopili ʻiʻo endoscopic, pono ka nui o ka hoʻopili ʻana. He hana maikaʻi loa ka ultrasound endoscopic i ka mālama ʻana i nā aʻa varicose a hiki ke hōʻemi i ka pilikia o ke kahe hou ʻana o ke koko.
Aia nā hōʻike ma nā palapala haole e hōʻike ana he kūpono 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 nā inikini cyanoacrylate, ʻoi aku ka liʻiliʻi o nā inikini intraluminal e pono ai ka coiling i alakaʻi ʻia e ka ultrasound endoscopic a pili pū me nā hanana ʻino liʻiliʻi.
ʻO mākou, ʻo Jiangxi Zhuoruihua Medical Instrument Co., Ltd., he mea hana ma Kina e loea ana i nā mea hoʻopau endoscopic, e like menā forceps biopsy, hemoclip, ʻūpā polyp, nila sclerotherapy, ʻaukā pīpī, nā palaki cytology, uea alakaʻi, hīnaʻi kiʻi pōhaku, catheter hoʻokahe wai biliary ihua pēlā aku i hoʻohana nui ʻia maEMR, ESD, ERCPUa hōʻoia ʻia kā mākou huahana e CE, a ua hōʻoia ʻia kā mākou mau mea kanu e ISO. Ua hoʻokuʻu ʻia aku kā mākou waiwai i ʻEulopa, ʻAmelika ʻĀkau, Hikina Waena a me kekahi ʻāpana o ʻAsia, a ua loaʻa nui ka ʻike a me ka hoʻomaikaʻi ʻia e ka mea kūʻai aku!
Ka manawa hoʻouna: Aug-15-2024